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COVID-19 Information For Providers

Pharmacy and Formularies

All information contained on this page is applicable only during the declared pandemic time period or other time frames specified below. In the event of any conflict or inconsistency between the information contained on this page and the contents of the UCare Provider Manual, the information on this page shall control during the identified time frame.

PAGE LAST UPDATED JANUARY 22, 2021

 

Early Refills

UCare continues to ease “refill too soon” requirements on medications for members in all UCare products. We have worked closely with our pharmacy benefit manager, Express Scripts, to allow pharmacies to override refill too soon rejections if the pharmacist identifies the need to fill the prescription early due to the Coronavirus pandemic. This change went into place the week of March 16, 2020.

Early refills for controlled substances will be subject to a pharmacy’s internal policy and direction from the member’s provider.

 

90-Day Prescription Refills & Mail Order Services

Medicare and Individual & Family plan members may ask their health care provider for a 90-day supply of maintenance medications and are encouraged to use mail order services to minimize exposure. Members may contact Express Scripts Mail Order by phone at 1-877-567-6320 or login to the ESI member portal at express-scripts.com.

As of April 9, 2020, Medicaid members are allowed 90-day fills for maintenance medications. This 90-day fill benefit applies to non-controlled substances and non-specialty drugs. Members with a copay responsibility will be charged a one-month copay for up to a 90-day supply of medication. Services from Express Scripts mail order pharmacy are not available for Medicaid members. The 90-day fill benefit for Medicaid members will last the duration of the public health emergency or until other regulatory guidance mandates a change.

 

Delivery Options

Express Scripts has reached a temporary agreement with some pharmacies to mail prescriptions to UCare members. This temporary agreement is solely due to the COVID-19 pandemic and will be revisited periodically to determine if it is still necessary.

Due to COVID-19, many retail pharmacies are offering delivery services or special pickup services. Members should contact their pharmacy for details about services they offer. Delivery services may not be available at all locations and not all medications are included. Delivery services may be stopped at any time as determined by each pharmacy. Members can still use transportation services that are covered/available through UCare if part of their benefit.

 

COVID-19 Vaccine Coverage Through the Pharmacy Benefit

UCare will be following State and Federal guidelines regarding the coverage, availability and distribution of vaccines. When pharmacies receive COVID-19 vaccines free of charge, UCare members are to receive the vaccine free of charge. UCare will reimburse the pharmacies for the administration fee of the vaccine per the terms of the pharmacy agreement with our pharmacy benefit manager, Express Scripts, Inc.

For Medicare members, pharmacy claims for COVID-19 vaccines and vaccine administration should not be billed to UCare or our pharmacy benefit manager, Express Scripts, Inc. Claims should be submitted directly to the Centers for Medicare & Medicaid Services (CMS) Medicare Administrative Contractor (MAC). The MAC will reimburse vaccine administration claims with no cost share (copayment, coinsurance or deductible) through 2021.

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