Medicare + Medical Assistance - Pharmacy

 

The Pharmacy Benefit Manager (PBM) for all UCare members is Express Scripts, Inc. (ESI). 

UCare Connect + Medicare | UCare's Minnesota Senior Health Options (MSHO)

 

2020 Prescription Drug coverage page

UCare Connect + Medicare

Minnesota Senior Health Options

2021 Prescription Drug coverage page

UCare Connect + Medicare

Minnesota Senior Health Options

 

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

Prior authorization requests for medical drugs administered in a doctor's office will be reviewed by Care Continuum, a subsidiary of Express Scripts. See information in Medical Injectable Drug Prior Authorization Resources. 

2020
See the  2020 Medical Injectable Drugs requiring prior authorization .

 

2021

Care Continuum reviews Medical Drug Prior Authorization requests for all UCare plans. See the 2021 Drug PA bulletin. 

To submit an authorization request, use one of the following ways:

  • Online (ePA) via the ExpressPAth Portal at www.express-path.com/.  Providers can submit requests, check on the status of submitted requests, and submit an authorization renewal on the ExpressPAth Portal. The site also provides 24/7 access, potential for real-time approvals, and email notifications once a decision is reached. 
  • Fax an authorization form to Care Continuum at 1-877-266-1871.
  • Call Care Continuum at 1-800-818-6747. 

To request an adjustment to an existing prior authorization:

  • Providers should contact CareContinuum – for 2020 prior authorization changes.
  • The authorization must be active.
  • End date extensions can be completed due to scheduling issues or health reasons (ex: chemo delayed due to blood count) that may prevent the administration of the previously approved drug. 
  • Required information for these requests:
    • Reason for extension.
    • Revised end date.
  • Adjustments are not approved for the reasons listed below. A new review/renewal is required.  
    • Additional drug is requested.
    • The patient is due for a renewal.

Non-participating providers should send requests using this form :

  • by fax to UCare Clinical Services at 612-884-2300.
  • or by mail to UCare, Attn: Clinical Services at P.O. Box 52, Minneapolis, MN 55440-0052.

Providers that received a claim denial due to no authorization in place will continue to work through the provider claims appeal process using the Provider Claim Reconsideration Request Form.

Pharmacy Benefit Prior Authorization

Express Scripts, Inc. - Medicare + Medical Assistance (dual eligibles)
Phone: 1-877-558-7521
Fax: 1-877-251-5896     
 

Medical Injectable Drug Prior Authorization

Care Continuum, a subsidiary of Express Scripts
Online (ePA): ExpressPAth Portal at www.express-path.com/.
Phone: 1-800-818-6747 
Fax: 1-877-266-1871

UCare Clinical Services Intake
Fax: 612-884-2300

Specialty Pharmacy Contact Information

Fairview Specialty Pharmacy
Phone: 612-672-5260 or 1-800-595-7140 toll free
Fax: 1-866-347-4939
www.fairviewspecialtyrx.org/

Accredo
www.accredo.com
 

Mail Order Contact Informtation

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