Pharmacy

Information by UCare Plan

 

UCare Individual & Family Plans

 

Commercial products for individual and family coverage available through MNsure, including UCare Choices and UCare Choices with Fairview

Medicare Programs

 

 

UCare for Seniors (UFS), Group UCare for Seniors, UCare Medicare Plans, UCare Medicare Plans with Fairview and North Memorial, EssentiaCare.

Medicare + Medical Assistance

 

UCare Connect + Medicare and Minnesota Senior Health Options (MSHO)

State Medical Assistance Programs

 

UCare Connect (Special Needs BasicCare), Minnesota Senior Care Plus (MSC Plus), MinnesotaCare (MnCare), Prepaid Medical Assistance Program (PMAP)

 

Resources & Information

 

Electronic Prior Authorization (ePA): 

ePA is the preferred method to submit Prior Authorization requests to Express Scripts. Providers may use ePA through Express Scripts, Surescripts, CoverMyMeds or through the Electronic Health Record.

The Pharmacy and Therapeutics Committee, a group of practicing physicians and pharmacists, meets up to six times per year to recommend medication inclusion or exclusion to our formularies. The Pharmacy and Therapeutics Committee evaluates drugs based on clinical evidence and efficacy (drug monographs, peer reviewed literature, compendia resources), therapeutic guidelines, medication safety and comparable data to other therapeutic alternatives. This committee reviews all new drugs approved by the FDA, new generics, new dosage forms, new indications as well as regular therapeutic class reviews and annual review of all utilization management criteria.

January 2019 Decisions
November 2018 Decisions
September 2018 Decisions
June 2018 Decisions
March 2018 Decisions
January 2018 Decisions


 

Pharmacy Benefit Prior Authorization

Express Scripts - State Medical Assistance Programs, 2018 UCare Choices, and 2019 UCare Individual & Family Plans
Phone: 1-877-558-7523
Fax: 1-877-251-5896  
 
Express Scripts - Medicare, Medicare + Medical Assistance (dual eligibles)
Phone: 1-877-558-7521
Fax: 1-877-251-5896 

Medical Injectable Drug Prior Authorization

UCare Clinical Services Intake - State Medical Assistance Programs
Fax: 612-884-2300
 
UCare Clinical Services - Medicare, Medicare & Medical Assistance (dual eligibles), 2018 UCare Choices, and 2019 UCare Individual & Family Plans
Fax: 612-884-2094 or 1-866-610-7215 toll free
 

Specialty Pharmacy Contact Information

Fairview Specialty Pharmacy
Phone: 612-672-5260 or 1-800-595-7140 toll free
Fax: 1-866-347-4939
* exclusive network provider of specialty drugs for 2018 UCare Choices, 2019 UCare Individual & Family Plans, and State Medical Assistance Programs
 
Accredo
 

Mail Order Contact Information

Express Scripts Mail Order Pharmacy
Phone: 1-866-544-7950  
Fax: 1-800-837-0959  
ePrescribing: Express Scripts Home Delivery Pharmacy   
If you have other questions, contact the Provider Assistance Center:

612-676-3300 or 1-888-531-1493
Hours:  8 a.m. to 5 p.m.,  Monday through Friday

Newsletters & Alerts

 

See Full Provider News Library

Inhaler Preferred Drug List Status Changes 

Coverage for Advair Diskus and Ventolin HFA inhaler products on the UCare Minnesota State Health Care Programs formulary will change on Oct. 1, 2019. Proactive review of preferred alternative products, if appropriate, can be made prior to the effective date.  
 
Read the Sept. 6 bulletin for the inhalers and health plans impacted.
 
 
 

September 2019 Health Lines

Read about  HCBS billing requirement reminder, Ineligible Provider List update, PANDAS and PANS pediatric autoimmune coverage requirements, SNF CMS Methodology Change and Documentation for Bipolar Disorder.

 

Read the September Health Lines.

 

 

 

Minnesota Health Care Programs Drug List Changes Coming Effective July 1, 2019

Starting July 1, 2019, UCare will adopt the Department of Human Services’ (DHS) Preferred Drug List (PDL) for members in Prepaid Medical Assistance Program, MinnesotaCare, Minnesota Senior Care Plus and UCare Connect. 

 

Please see the June 4 Provider Bulletin

 

 

Medicaid Nutritional Supplement Benefit Change

Starting April 1, 2019, nutritional supplements such as Boost and Ensure will no longer be covered under the pharmacy benefit for UCare Medicaid members; however, they may be covered under the medical benefit through a Durable Medical Equipment (DME) provider.

 

Read the full bulletin.

 

 

 

2019 Pharmacy Formulary update

This bulletin provides a summary of the UCare pharmacy formulary changes taking effect Jan. 1, 2019. Plan names have changed for 2019 for Medicare plans and Individual & Family plans.

 

See the full Provider Bulletin.

 


 

UCare to Suspend Authorizations in 2019 For UCare Individual & Family Plans

During 2019, UCare will temporarily suspend the requirement for prior authorizations for services delivered to members with UCare  Individual & Family Plans and UCare Individual & Family Plans with Fairview.
 

See the full Provider Bulletin.

 

 

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