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2025 UHC Dual Complete MI-V001 (HMO-POS D-SNP) Lookup tools
Search our directory of network doctors and more including: specialists, hospitals, laboratories and X-ray centers.
Enter a 5-digit ZIP code.
Provider Directories
*Remember, your primary doctor makes all referrals to other health
care providers for you.
We're dedicated to improving your health and well-being. Members have access to specialized behavioral health services, which includes mental health and may include substance use treatment. Coverage services may vary based on eligibility.
This search option is only available for desktop users. Note that you
can download a list of covered drugs below.
Formularies
Pharmacy Prior Authorization Request
Appeal a Coverage Decision
If we make a coverage decision and you are not satisfied with this decision, you can "appeal" the decision. An appeal is a formal way of asking us to review and change a coverage decision we have made.
Click here to send an email with your appeal request.
Download the evidence of coverage for this plan and review the grievance and appeals section
Or you may download our drug coverage determination request form fill it out and mail it to us
Pharmacy Direct Member Reimbursement Form
Prescription Drug Transition Process
What to do if your current prescription drugs are not on the drug list (formulary) or are restricted in some way
Drugs aren’t on list section
Sometimes, you may take a prescription drug that isn’t on your
plan’s Drug List or it’s restricted in some way. Whether you’re a new
member or a continuing member, there’s a way to get help.
Start by talking to your doctor. Your doctor can help decide if there’s another drug on the Drug List you can switch to. If there isn’t a good alternative drug, you, your representative or your doctor can ask for a formulary exception. If the exception is approved, you can keep getting your current drug for a certain period of time.
Review your Evidence of Coverage (EOC) to find out exactly what your plan covers. If you’re a continuing member, you’ll get an Annual Notice of Changes (ANOC). Review the ANOC carefully to find out if your current drugs will be covered the same way in the upcoming year.
Whether you’re switching drugs or waiting for an exception approval, you may be eligible for a transition supply of your current drug.
- You must get your 1-month supply, as described in EOC, during the first 90 days of membership with the plan as a new member OR within the first 90 days of the calendar year if you are a continuing member and your drug has encountered a negative formulary change.
- You may also be eligible for a one-time, temporary 1-month supply if you qualify for an emergency fill while residing in a long-term care (LTC) facility after the first 90 days as a new member or you have encountered a level of care change.
- If your doctor writes your prescription for
fewer days and the prescription has refills, you may refill the drug
until you’ve received at least a 1-month supply, as described in
your EOC.
New members
As a new plan member, you may currently be taking drugs that are not on the plan’s formulary (drug list), or they are on the formulary but are restricted in some way.
In instances like these, start by talking with your doctor about appropriate alternative medications available on the formulary. If no appropriate alternatives can be found, you or your doctor can request a formulary exception. If the exception is approved, you may be able to obtain the drug for a specified period of time.
During the first 90 days of your membership in the plan if you are a new member, you can request at least a 1-month supply, as described in your plan’s evidence of coverage.
During the first 90 days of the calendar year if you were in the plan last year and your drug encountered a negative formulary change, you can request at least a 1-month supply, as described in your plan’s evidence of coverage.
Members who have unplanned transitions such as hospital discharges (including psychiatric hospitals) or level of care changes (i.e., changing long-term care facilities, exiting and entering a long-term care facility, ending Part A coverage within a skilled nursing facility, or ending hospice coverage and reverting to Medicare coverage) at any time during the plan year. You can request at least a 1-month supply, as described in your plan’s evidence of coverage.
Continuing members
As a continuing member in the plan, you receive an Annual Notice of Changes (ANOC). You may notice that a drug you are currently taking is either not on the upcoming year’s formulary or is on the formulary but restricted in some way in the upcoming year.
Starting October 15, 2024, you may request a 2025 coverage
review. If your request is approved, the plan will cover the drug as
of January 1, 2025.
If your drug is subject to new formulary restrictions on January 1,
2025 and you have not discussed switching to an alternative formulary
medication or pursued a formulary exception with your doctor, you may
receive a temporary supply within the first 90 days of the new
calendar year when you go to a network pharmacy. This would be at
least a 1-month supply, as described in your plan’s evidence of
coverage, to allow you time to discuss alternative treatment with your
doctor or to pursue a formulary exception.
If you live in a long-term care facility, you can obtain multiple refills until you’ve reached at least a 31-day supply, including when prescriptions are dispensed for less than the written amount due to drug utilization edits that are based on approved product labeling.
There may be unplanned transitions such as hospital discharges or level of care changes (i.e., changing long-term care facility or in the week before or after a long-term care discharge, end of skilled nursing facility stay and reverting to Part D coverage or when taken off hospice care) that can occur anytime. If you are prescribed a drug that is not on our formulary or your ability to get your drugs is restricted in some way, you are required to use the plan's exception process. For most drugs, you may request a one-time temporary supply of at least one month, as described in your plan’s evidence of Coverage, to allow you time to discuss alternative treatment with your doctor or to pursue a formulary exception.
For members who have been in the plan for more than 90 days and reside in a long-term care (LTC) facility and need a supply right away, we will cover at least a 31-day temporary supply, as described in your plan’s evidence of Coverage.
If you have any questions about this transition policy or need help asking for a formulary exception, contact a member services representative.
For prescription drug transition process information in Spanish, go to Forms and Resources and view section 5.2 of your evidence of coverage (Spanish) for more information.
If you’re out of medication after receiving a temporary transition supply and you’re working with your prescriber to switch to an alternative drug or request an exception, call the number on your member ID card or contact UnitedHealthcare Customer Service.
Related information
The Coverage Determination Request Form may be found under Appeal a Coverage Decision section on this page.
Medication Therapy Management Program
UnitedHealthcare’s Medication Therapy Management (MTM) program was
developed by a team of pharmacists and doctors. This program helps
eligible members use their coverage and understand their medications
and how to use those medications, by providing members with a
comprehensive medication review (CMR) with a pharmacist or other
qualified health care provider. It can also help protect members from
the possible risks of drug side effects and potentially harmful drug
combinations.
How to qualify
What you
need to do
What's next
How to qualify
This program is available at no cost. You’ll be automatically
enrolled in the Medication Therapy Management Program if you:
- take eight (8) or more chronic Part D medications, and
- have three (3) or more long-term health conditions, and
- are likely to spend more than $1,623 a year on covered Part D medications
OR
- are in a Drug Management Program to help better manage and safely use medications such as opioids and benzodiazepines
You need to have three or more of these health conditions to qualify for the Medication Therapy Management program.
- Alzheimer’s disease
- Bone disease-arthritis (including osteoporosis, osteoarthritis, and rheumatoid arthritis)
- Chronic congestive heart failure (CHF)
- Diabetes
- Dyslipidemia
- End-stage renal disease (ESRD)
- Human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS)
- Hypertension
- Mental health (including depression, schizophrenia, bipolar disorder, and other chronic/disabling mental health conditions) and
- Respiratory disease (including asthma, chronic obstructive pulmonary disease (COPD), and other chronic lung disorders)
What you need to do
Within 60 days of becoming eligible for the MTM program, you’ll
receive an offer by mail to complete a Comprehensive Medication Review
(CMR). You may also receive this offer by phone, email or text.
You can complete the CMR by phone. It takes about 30 minutes. A pharmacist, or qualified CMR provider, will review your medication history, including prescription and over-the-counter medications, and look for any issues.
What's next
After completing a CMR, you’ll receive a packet containing a
summary of the review including action items discussed and a list of
the medications you are taking and why you take them. This can be
helpful when meeting with your doctor or pharmacist. The results may
be sent to your doctor. In addition, you will receive information on
the safe disposal of prescription medications including controlled
substances.
You can also download a blank Medication List (PDF) for your own personal use.
In addition to the CMR, Targeted Medication Reviews are done at least quarterly. This is done to find possible drug interactions or other medication concerns. Those reviews may be sent to your doctor for review.
MTM is not a benefit of your prescription drug plan, but a Medicare designed program offered at no cost by UnitedHealthcare. For more information on UnitedHealthcare’s Medication Therapy Management program, please call Customer Service (the phone number is on the back of your plan member ID card) or you may call the Optum Rx MTM clinical call center team at 1-866-216-0198, TTY 711, Monday – Friday 9 a.m. – 9 p.m. EST.
To search for a dental provider, click on the link below, then click on "Dentist Locator," and then choose the name of your health plan.
You may also go to OptumRx to order and manage your
prescription drugs online.
Learn more about dual special needs plans
Learn more
UHC Dual Complete MI-V001 (HMO-POS D-SNP)