UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) Lookup Tools

Prior Authorizations

Download the list of services that require prior authorizations. 

Prior Authorization Process

Prior authorization is an okay for services that must be approved by UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan).

Your doctor must call Utilization Management (UM) at 1-800-366-7304 before you obtain a service or procedure that is listed as requiring an okay on pages 19-22. Our UM team is available Monday through Friday, 8 AM to 5 PM On-call staff is available 24 hours a day, 7 days a week for emergency okays.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) also reviews some of your services and care as they are happening. This is called concurrent review. Examples are when you are:

• A patient in the hospital
• Receiving home care by nurses
• Certain outpatient services such as speech therapy and physical therapy

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) reviews your progress with your doctor to be sure you still need those services or if other services would be better for you.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) has policies and procedures to follow when the UM team makes decisions regarding medical services. The UM doctors and nurses make their decision based on your coverage and what you need for your medical condition. The goal is to make sure that services are medically necessary, that they are provided in an appropriate setting, and that quality care is provided.

We want to help you stay well. If you are sick we want you to get better.

• UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) does not pay employees extra for limiting your care.
• Our network doctors do not receive extra money or rewards if they limit your care.

If you have questions about UM decisions or processes, call Member Services at 1-877-542-9236 (TTY 711).

Appeal or Grievance

To file an Appeal or Grievance, please visit or FAQ section.

Prior Authorizations

Pharmacy Prior Authorization Request to OptumRx

ဆှၢထီၣ်တၢ်ဃ့ထီၣ်ဆိကသံၣ်ကသီအတၢ်ဟ့ၣ်ခွဲးစိကမီၤလၢညါဆူ OptumRx အအိၣ်တက့ၢ်.

ကသံၣ်လၢကသံၣ်သရၣ်ကွဲးနဲၣ်လီၤ - တအုၣ်ကီၤလုၢ်ဘၢသးခီဖျိ Medicare အကူာ် D

While most of your prescription drugs will be covered by Medicare Part D, there are a few drugs that are not covered by Medicare Part D but are covered by UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan).  You can view our plan’s List of Covered Drugs on our website at https://member.uhc.com/communityplan. 

Drugs with an asterisk are not covered by Medicare Part D but are covered by UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan). You do not have any co-pays for non-Part D drugs covered by our plan.

Please note that our list of medications that require prior authorization can change so it is important for you and/or your provider to check this information when you need to fill/refill a medication.

ကွၢ်ဃုပှၤရဲၣ်ကျဲၤမၤစၢၤဘၣ်ဃးမဲဂ့ၢ်ဝီ

ကွၢ်ဃုမဲကသံၣ်သရၣ်တဂၤဖဲနလီၢ်ကဝီၤပူၤတက့ၢ်. စံၢ်လီၤဖဲ "Search for a Dentist" (“တၢ်ဃုကွၢ်ကသံၣ်သရၣ်တဂၤ”) ဖဲလာ်အံၤလၢနကစးထီၣ်နတၢ်ဃုကွၢ်အဂီၢ်တက့ၢ်.

ကွၢ်ဃုမဲကသံၣ်သရၣ်န့ၣ်တက့ၢ်.

Prior Authorization Process

Prior authorization is an okay for services that must be approved by UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan).

Your doctor must call Utilization Management (UM) at 1-800-366-7304 before you obtain a service or procedure that is listed as requiring an okay. Our UM team is available Monday through Friday, 8 AM to 5 PM On-call staff is available 24 hours a day, 7 days a week for emergency okays.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) also reviews some of your services and care as they are happening. This is called concurrent review. Examples are when you are:

• A patient in the hospital
• Receiving home care by nurses
• Certain outpatient services such as speech therapy and physical therapy

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) reviews your progress with your doctor to be sure you still need those services or if other services would be better for you.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) has policies and procedures to follow when the UM team makes decisions regarding medical services. The UM doctors and nurses make their decision based on your coverage and what you need for your medical condition. The goal is to make sure that services are medically necessary, that they are provided in an appropriate setting, and that quality care is provided.

We want to help you stay well. If you are sick we want you to get better.

• UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) does not pay employees extra for limiting your care.
• Our network doctors do not receive extra money or rewards if they limit your care.

If you have questions about UM decisions or processes, call Member Services at 1-877-542-9236 (TTY 711).

Appeal or Grievance

To file an Appeal or Grievance, please visit or FAQ section.

တၢ်ကွၢ်ဃုကသံၣ်ကျးတဖျၢၣ်

Search for a UnitedHealthcare network pharmacy below.

Pharmacies

This part of the directory provides a list of pharmacies in UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) network. These network pharmacies are pharmacies that have agreed to provide prescription drugs to you as a member of the plan.

• UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) Members must use network pharmacies to get prescription drugs.
  • You must use network pharmacies except in emergency or urgent care situations. If you go to an out-of-network pharmacy for prescriptions when it is not an emergency or urgent care situation, including when you are out of the service area, call UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) toll-free Member Services or 24-hour nurse advice line for assistance in getting your prescription filled.
  • If you go to an out-of-network pharmacy for prescriptions when it is not an emergency, you will have to pay out of pocket for the service. Read the UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) Member Handbook for more information.
• Some network pharmacies may not be listed in this Directory.
  • Some network pharmacies may have been added or removed from our plan after this Directory was published.

For up to date information about UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) network pharmacies in your area, please visit our web site at www.UHCCommunityPlan.com or call Member Services at 1-877-542-9236, TTY users should call 711, 8 AM - 8 PM, local time, Monday - Friday. တၢ်ကိးလီတဲစိန့ၣ်မ့ၢ်အပှ့ၤကလီလီၤ.

To get a complete description of your prescription coverage, including how to fill your prescriptions, please read the Member Handbook and UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) List of Covered Drugs. You received the List of Covered Drugs in the mail when you became a member of this plan. You may also visit our web site at www.UHCCommunityPlan.com for the drug list.

Identifying Pharmacies in Our Network
Along with retail pharmacies, your plan’s network of pharmacies includes:

• Mail-Order Pharmacies
• Home infusion pharmacies
• Long-term care (LTC) pharmacies

You are not required to continue going to the same pharmacy to fill your prescriptions. You can go to any of the pharmacies in our network.

Mail Order Pharmacy(ies)
You can get prescription drugs shipped to your home through our network mail order delivery program which is called OptumRx® home delivery pharmacy. Prescription orders sent directly from your doctor must have your approval before we can send your medications. This includes new prescriptions and prescriptions refills. We will contact you, by phone, to get your approval. If we are unable to reach you for approval, your prescription will not be sent to you.

You also have the choice to sign up for automated mail order delivery through our OptumRx® home delivery pharmacy. Typically, you should expect to get your prescription drugs from 4 to 6 days from the time that the mail order pharmacy gets the order.

If you do not get your prescription drug(s) within this time, if you would like to cancel an automatic order, or if you need to ask for a refund for prescriptions you got that you did not want or need, please contact us at 1-877-542-9236, TTY 711, 8 AM - 8 PM, local time, Monday - Friday.

Home Infusion Pharmacies
You can get home infusion therapy if UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) has approved your prescription for home infusion therapy and if you get your prescription from an authorized prescriber.

For more information, please see your Member Handbook, or call Member Services at 1-877-542-9236, TTY 711, 8 AM - 8 PM, local time, Monday - Friday.

Long-Term Care Pharmacies
Residents of a long-term care facility, such as a nursing home, may access their prescription drugs covered under UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) through the facility’s pharmacy or another network pharmacy.

For more information, you can call Member Services at 1-877-542-9236, TTY 711, 8 AM - 8 PM, local time, Monday - Friday.

Prior Authorizations

Prior authorization is an okay for services that must be approved by UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan). Your doctor must call Utilization Management (UM) at 1-800-366-7304 before you obtain a service or procedure that is listed as requiring an okay. Our UM team is available Monday through Friday, 8 AM to 5 PM On-call staff is available 24 hours a day, 7 days a week for emergency okays.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) also reviews some of your services and care as they are happening. This is called concurrent review. Examples are when you are:

• A patient in the hospital
• Receiving home care by nurses
• Certain outpatient services such as speech therapy and physical therapy

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) reviews your progress with your doctor to be sure you still need those services or if other services would be better for you.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) has policies and procedures to follow when the UM team makes decisions regarding medical services. The UM doctors and nurses make their decision based on your coverage and what you need for your medical condition. The goal is to make sure that services are medically necessary, that they are provided in an appropriate setting, and that quality care is provided.

We want to help you stay well. If you are sick we want you to get better.

• UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) does not pay employees extra for limiting your care.
• Our network doctors do not receive extra money or rewards if they limit your care.

If you have questions about UM decisions or processes, call Member Services at 1-877-542-9236 (TTY 711).

တၢ်ဆီတလဲကသံၣ်လၢကသံၣ်သရၣ်နဲၣ်လီၤဝဲအတၢ်မၤကျိၤကျဲတဖၣ်

What to do if your current prescription drugs are not on the formulary or are limited on the formulary.

ကရၢဖိအသီတဖၣ်
As a new member of UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan), insured through UnitedHealthcare, you may currently be taking drugs that are not on the UnitedHealthcare® formulary (drug list), or they are on the formulary but your ability to get them is limited.

ဖဲတၢ်အိၣ်သးဒ်သိးအံၤအခါ, စးထီၣ်ကတိၤသကိးဒီးနကသံၣ်သရၣ်ဘၣ်ဃးဒီးတၢ်ဃုထၢကသံၣ်ကသီကြၢးဝဲဘၣ်ဝဲလၢအအိၣ်ဖဲကသံၣ်တၢ်မၤကျိၤကျဲအပူၤအဂ့ၢ်တက့ၢ်. ဖဲတၢ်ဃုထံၣ်န့ၢ်တၢ်ဃုထၢကသံၣ်ကသီကြၢးဝဲဘၣ်ဝဲမ့ၢ်တသ့အခါ, နၤ မ့တမ့ၢ် နကသံၣ်သရၣ်ဃ့ထီၣ်ဝဲဒၣ်တၢ်ပာ်ကပၤကွံာ်ကသံၣ်တၢ်မၤကျိၤကျဲသ့ဝဲန့ၣ်လီၤ. If the exception is approved, you will be able to obtain the drug for a specified period of time. While you and your doctor are determining your course of action, you may be eligible to receive an initial 31-day transition supply (unless your prescription is written for fewer days) of the drug anytime during the first 90 days you are a plan member.

For each of your drugs that is not on the formulary or if your ability to get your drugs is limited, UnitedHealthcare will cover a 31-day supply (unless your prescription is for fewer days) when you go to a network pharmacy. If the prescription is written for less than 31 days, multiple fills are allowed to provide up to a total of 31 days of drugs. After your first 31-day transition supply, these drugs may not continue to be covered. Talk with your doctor about appropriate alternative medications. If there are none on the formulary, you or your doctor can request a formulary exception.

If you live in a long-term care facility, UnitedHealthcare will cover a temporary 31-day transition supply (unless your prescription is for fewer days). UnitedHealthcare will cover more than one refill of these drugs for the first 90 days for plan members, up to a 93-day supply. If you need a drug that is not on the formulary or your ability to get your drugs is limited, but you are past the first 90 days of plan membership, the transition program will cover a 31-day emergency supply of that drug (unless your prescription is for fewer days) while you pursue a formulary exception.

You may face unplanned transitions after the first 90 days of plan enrollment, such as hospital discharges or level of care changes (i.e., in the week before a long-term care discharge), If you are prescribed a drug that is not on the formulary or your ability to get your drugs is limited, you are required to use the plan's exception process. You can request a one-time emergency supply of up to 31 days to allow you time to discuss alternative treatment with your doctor or to pursue a formulary exception.

တၢ်ဆဲးကဲကရၢဖိဆူညါကွ့ၢ်ကွ့ၢ်
ဒ်တၢ်ဆဲးကဲကရၢဖိဖဲတၢ်တိာ်ကျဲၤပူၤအသိး, နဒိးန့ၢ်ဝဲဒၣ် Annual Notice of Changes (ANOC) (တၢ်ဘိးသ့ၣ်ညါတၢ်ဆီတလဲတနံၣ်တဘျီ) အဂ့ၢ်န့ၣ်လီၤ. You may notice that a formulary medication you are currently taking is either not on the upcoming year's formulary or its cost sharing or coverage is limited in the upcoming year.

For coverage requests received each year by December 15, and approved, the plan will cover the drug as of January 1. For coverage requests initiated on or after December 16, normal time frames for resolution apply: you will receive an answer within 24 hours for urgent requests and within 72 hours for all other requests. If your request is still in process on January 1, you may receive a temporary supply of the drug for your current plan cost-sharing until your request is answered.

If you have any questions about this transition policy or need help asking for a formulary exception, a UnitedHealthcare representative can help.

တၢ်ဂ့ၢ်တၢ်ကျိၤလၢအဘၣ်ထွဲတဖၣ်
The Coverage Determination Request Form may be found under Appeal a Coverage Decision section on this page.