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Pharmacy

Information by UCare Plan

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UCare Individual & Family Plans

Commercial products for individual and family (IFP) coverage available through MNsure, including UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview.

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Medicare Programs

UCare Medicare Plans, UCare Medicare Plans with M Health Fairview and North Memorial, UCare Medicare Group Plans, UCare Advocate Plans, EssentiaCare and UCare Your Choice Plans.

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Medicare + Medical Assistance

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

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State Medical Assistance Programs

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

Resources & Information

2024

ePA is the preferred method to submit Prior Authorization requests to Navitus for pharmacy benefit drugs. Providers may use ePA through SurescriptsCoverMyMeds  or the Electronic Health Record.

For info on Medical Injectable Drug Prior Authorization requests, see "Medical Injectable Drug Prior Authorization Resources" on the Pharmacy page.

2023

Authorization requests for pharmacy benefit drugs will not be accepted by ExpressScripts after Dec. 31, 2023.

See the Medical Injectable Drugs requiring prior authorization.

Review Medical Drug Policies.

Participating providers can submit prior authorization, authorization adjustment and pre-determination requests to Care Continuum 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 request form to Care Continuum at 1-877-266-1871.
  • Call Care Continuum at 1-800-818-6747.

Non-participating and MultiPlan providers can submit prior authorization, authorization adjustment and pre-determination requests to UCare one of the following ways:

  • Fax an authorization request form to UCare Clinical Pharmacy Intake at 612-617-3948.
  • By mail to UCare, Attn: Pharmacy at P.O. Box 52, Minneapolis, MN 55440-0052.

Providers that receive a claim denial will continue to work through the provider claims appeal process using the Provider Claim Reconsideration Request Form.

Our Medication Therapy Management (MTM) Program is a free service for eligible UCare members to optimize their medication therapy, experience and outcomes. Members receive a one-on-one consultation with a pharmacist to review their entire medication regimen (including prescription, over-the-counter medications and herbal supplements) to help resolve any potential medication-related problems regarding indication, effectiveness, safety and convenience.

UCare partners with many pharmacists across the state of Minnesota and provides reimbursement for MTM services for in-network pharmacist practitioners.

Please refer to the MTM section of the provider manual for full program information including detailed topics such as eligibility, expectations, audits, billing and more.

Eligibility

  • Most UCare plans with prescription drug coverage are eligible for MTM services and can receive these services with contracted local pharmacists.
  • Internal UCare telephonic MTM services are only available to Medicare, Connect + Medicare, MSHO and select Medicaid members.

Billing

UCare’s expectation is that MTM services will be billed using MTM CPT codes 99605, 99606 and 99607. Billing is based on complexity, not time, for all lines of business.

Program Information

Important Time Sensitive Requirement Reminders

  • All Medicare members must be provided with CMS standardized format materials (including medication action plan and personalized medication list). These should be provided within 14 days of the encounter.
  • UCare's Continuity of Care Document (CCD) must be submitted within 45 days of the original visit for Medicare members.
  • Member opt-outs from the MTM program must be received within 30 days of member’s decision to opt-out.

Continuity of Care Document (CCD)

MTM providers are required to maintain and submit a CCD for all Medicare visits. It is acceptable to send information for non-Medicare members as well.

Questions

For any questions or inquiries regarding the MTM program at UCare, please contact us via email at pharmacyliaison@ucare.org.

Additional Helpful Resources

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. 

View the following Pharmacy and Therapeutics Committee Decisions:

January 2024
November 2023
September 2023
June 2023
April 2023
March 2023
January 2023
November 2022 

 

Pharmacy Benefit Prior Authorization - Navitus Health Solutions *New PBM for 2024*

State Medical Assistance Programs

  • Phone: 1-833-837-4300
  • Fax: 1-855-668-8553

UCare Individual & Family Plans

  • Phone: 1-833-837-4300
  • Fax: 1-833-210-5963

Medicare and Medicare + Medical Assistance (dual eligibles)

  • Phone: 1-833-837-4300
  • Fax: 1-855-668-8552

Medical Injectable Drug Prior Authorization
Participating Providers Contact
Care Continuum, a subsidiary of Express Scripts:

Non-Participating Providers Contact
UCare Clinical Pharmacy Intake:

  • Phone: 612-676-6504
  • Fax: 612-617-3948

Fairview Specialty Pharmacy (exclusive network provider of specialty drugs for UCare Individual & Family Plans and State Medical Assistance Programs)

Lumicera Specialty Pharmacy *New for 2024*

Costco Mail Order Pharmacy *New for 2024*

  • Phone: 1-800-607-6861
  • Fax: 1-877-258-9584
  • ePrescribing: Costco Mail Order Pharmacy #1348

Questions? Contact the Provider Assistance Center 

Phone (local): 612-676-3300
Phone (toll free): 1-888-531-1493 
Hours: 8 am - 5 pm, Monday through Friday

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