UnitedHealthcare Community Plan in Texas will begin requiring review for all ingredients in a compound
medication, if the total combined cost for the ingredients exceeds the $200 claim limit, effective March 15, 2018.
If the pharmacy is processing a prescription for the member that has a total cost that exceeds the $200
limit, you’ll see rejection code “78” at the point of sale. The pharmacy will also see “PA Required, MD
Call 800-310-6826.”
* All other edits still apply.
* The pharmacy will be reimbursed only for compensable ingredients.
If ingredients require review, please ask the prescribing care provider to call 800-310-6826 before filling
the prescription from 7 AM – 7 PM CST, Monday through Friday.
*Please see attached for more information.