Clinical Pharmacy Policies

Healthy Blue adopted UniCare’s nationally recognized, evidence-based medical policies and clinical utilization management guidelines effective May 1, 2013. These policies are publicly available at on the UniCare website.

The drug coverage policies are based on medical necessity considerations subject to applicable benefits. The documents assist with medical necessity coverage decisions, may include state-specific guidance regarding coverage and do not constitute medical advice. Benefit determination is based on the applicable contract language and/or state requirements. Our clinical policies can be found within our searchable formulary located here

These policies are not a guarantee of coverage. Contract language or state requirements will prevail when there are conflicts with any medication coverage policy. In all cases, Medicaid contracts or Centers for Medicare & Medicaid Services requirements supersede UniCare policy criteria.

If Healthy Blue does not manage the pharmacy benefit for your state, please reference the applicable pharmacy benefit manager’s website and/or manual.

These policies are effective June 1, 2014 for Louisiana.