Starting in February 2018, OptumRx, the pharmacy benefit manager for UnitedHealthcare Employer and Individual, will now allow an approved diagnosis code (ICD10) to be entered at the Point of Sale for select medications that require Prior Authorization.

If a claim for a medication requiring Prior Authorization is submitted, pharmacists and or technicians may be prompted to enter a diagnosis code or submit for Prior Authorization. If the submitted diagnosis code is aligned with coverage criteria, the claim will pay. If the claims continues to reject, a Prior Authorization may be initiated for additional review. Not all medications will have this prompt. The following message may display to the pharmacy at the point of sale:

*Please see attached for more information.