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On June 20, 2024, UnitedHealth Group issued a press release offering an update on the Change Healthcare cybersecurity incident that occurred on Feb. 21, 2024. While the investigation to determine whose data is impacted is not yet complete, UnitedHealth Group has started the process to notify impacted customers and shared a website that provides additional information. UnitedHealth Group continues to offer credit monitoring and identity protection services, as well as a dedicated contact center to address questions. You can learn more about the support resources by visiting Change Healthcare Cyberattack Support and/or by reaching out to the contact center at 1-866-262-5342 with any questions.  

Pharmacy

NH Healthy Families is committed to providing appropriate, high-quality, and cost-effective drug therapy to all NH Healthy Families members. NH Healthy Families covers prescription and certain over-the-counter medications with a written order from a NH Healthy Families provider. Not all medications are covered by the pharmacy program. Some medications may require prior authorization or may have age, dosage or quantity limitations. Please use the below Preferred Drug List to find more information on the drugs that are covered.

NH Healthy Families Preferred Drug List (PDF)

Machine-Readable File (JSON)

Members have the option to receive a 90-day supply of their maintenance medications at in-network pharmacies.

NH Healthy Families also has in network mail-order pharmacies available to our membership to ensure timely delivery of medications. For additional information please reach out to NH Healthy Families at 1-866-769-3085, Monday through Friday 8 a.m. to 5 p.m.

Prior Authorization Criteria

NH Healthy Families Medical and Pharmacy Policies.

NH Healthy Families Prescription Prior Authorization FAQ’s (PDF).

Medication Requests

Submit a secure electronic Prior Authorization request for any of the below forms through Cover My Meds.

Pharmacy Services processes pharmacy claims for self-administered (i.e. oral, self-injectable, topical, ophthalmic) drugs. For self-administered medications, submit a secure electronic Prior Authorization request through Cover My Meds or use the medication request form(s) below:

Provider Help Desk:

1-877-250-5227

Pharmacy Value Handout (PDF)

Comprehensive Medication Review

As a pharmacy serving NH Healthy Families members for New Hampshire Medicaid plans, you can earn revenue for providing Medication Therapy Management (MTM) services, such as a Comprehensive Medication Review (CMR) that empower your patients to effectively manage their medications and health.

How it works:

  • Outcomes® shares CMR-eligible patients for your review and action.
  • You document the results of your intervention in the free OutcomesOne online platform.
  • Your pharmacy earns revenue for helping an eligible patient improve adherence to their medication regimen by completing a comprehensive medication review.

To take advantage of this opportunity:

  1. Go to Outcomes Contracting.
    • Complete the contracting form for your pharmacy.
  2. Outcomes will contact you to help you complete setup for your pharmacy and access your CMR-eligible patients. 
  3. Document the results of your MTM services in the OutcomesOne platform.

There is no cost to participate with Outcomes. For help getting started, call the Outcomes help desk at 1-877-237-0050, Monday through Friday, 8 a.m. to 8 p.m. EST. We look forward to working with you to improve medication outcomes for your patients. For additional information please reach out to NH Healthy Families at 1-866-769-3085, Monday through Friday 8 a.m. to 5 p.m. EST.

NH Healthy Families Oncology Management Program

NH Healthy Families is pleased to collaborate with Evolent Specialty Services (ESS), an oncology quality management company, to implement a new oncology pre-approval program, NH Healthy Families Oncology Pathway Solutions. The program simplifies the administrative process for providers to support the effective delivery of quality patient care.

As of May 1, 2020, all oncology-related chemotherapeutic drugs and supportive agents require clinical review by ESS before being administered in a physician’s office, outpatient hospital or ambulatory setting. This prior authorization requirement applies to both pharmacy dispensed and office administered medication requests for all NH Healthy Families Medicaid members.

NH Healthy Families Oncology Pathway Solutions program benefits include:

  • The use of clinical criteria, based on nationally-recognized guidelines, to promote evidence-based cancer care.
  • Increased collaboration with physician offices to foster a team approach.
  • Peer-to-peer discussions with medical oncologists who can understand and better discuss treatment plans.
  • A provider web portal to:
    • Obtain real-time approvals when selecting evidence-based ESS treatment care pathways.
    • Determine which clinical documentation is necessary for medical necessity review.
    • View all submitted requests for authorization in one location.
    • Check member eligibility.

Pre-approval Process

  • The requesting physician must complete an authorization request using one of the following methods:

Pharmacy Policy and Formulary Changes