Find pharmacy information related to prescription drugs including prescription drug lists, step therapy, quantity limits and prior authorization requirements for Community Plan care providers.
Expand All add_circle_outline Clinical Pharmacy Guidelines and Policies expand_moreEffective July 1, 2021, the North Carolina Department for Medicaid Services requires UnitedHealthcare Community Plan to follow the North Carolina Fee-For-Service PDL and Clinical Criteria. Additional pharmacy benefit and medication information can be found below in this section to assist our providers.
North Carolina Pharmacy Services Clinical Coverage Policies can be found in the Clinical Pharmacy Guidelines
For submission of a prior authorization for a UnitedHealthcare Community Plan of North Carolina Member:
Prior Authorization Requests - Prescribers may submit prior authorizations for Community Plan Members:
In response to the U.S. opioid epidemic, UnitedHealthcare has developed programs to help our members receive the care and treatment they need safely and effectively.
We’ve also established measures based on the Centers for Disease Control and Prevention’s (CDC) opioid treatment guidelines to help prevent overuse of short-acting and long-acting opioid medications.