Changes to UnitedHealthcare plans effective July 1

To contain the costs of WUSTL’s UnitedHealthcare HMO and POS plans, two program changes will take effect July 1.

These changes are an enforcement of 1) the use of participating network providers for lab testing; and 2) the maximum quantity of a medication for one prescription or co-payment and for a specified time period.

Employees participating in UnitedHealthcare’s HMO and POS plans are encouraged to familiarize themselves with the new requirements to avoid paying more out-of-pocket costs for lab testing and prescription drugs.

Employees also are encouraged to share this information with their and their family’s doctors so that the doctors can determine the best course of action for employees and family members and employees can avoid additional out-of-pocket costs.

Network provider for lab testing

Effective July 1, if a physician prescribes lab testing for blood, urine, tissue (Pap smear) or other samples for employees or family members outside of a WUSTL School of Medicine lab, a BJC lab or physician-based office lab, the physician must send the order to Lab Corp, the preferred in-network provider.

If lab-testing orders are processed by Quest Diagnostics or Lab One, these services will not be paid by the WUSTL UnitedHealthcare HMO plan and will be paid as an out-of-network expense by the WUSTL UnitedHealthcare POS plan.

To find the nearest participating lab, visit If not registered, click on “Find Physician or Facility,” and search for “Hospital or Other Facility.” Search for a “Laboratory,” and under “Select Plan,” choose “Choice (HMO)/Choice Plus (HMO).” Enter a city, state and ZIP code.

If already registered, log in and click on “Physicians & Facilities.” Click on “Find a Laboratory,” and search for a “Laboratory.” Enter a city, state and ZIP code.

Quantity limits

Effective July 1, some medications will be limited to a certain quantity and for a certain period of time for each co-pay under the UnitedHealthcare HMO and POS plans.

Here are some examples of how the program works: An employee receives a prescription for Cozaar 25mg, which is limited to a quantity of 31 pills for a 31-day supply; and another employee receives a prescription for Ambien, which is limited to a quantity of 60 pills within a 90-day period.

If the physician wrote the prescription for Cozaar 25mg for a quantity of 42 or for Ambien for a period of 60 days, the employee can: 1) accept the allowed quantity of 31 pills or allowed period of 90 days; 2) pay out-of-pocket for the additional quantity; 3) discuss alternatives with their physician; or 4) request a coverage review for those prescription drugs that do have override criteria.

The quantity and period limits for both of these programs are based on Food and Drug Administration guidelines, manufacturer guidelines and medical literature.

To determine if a specific medication has a quantity limit, visit Click on “Prescription Drug Information,” and then “Prescription Drug List.” Medications with supply limits are marked with an “SL.” Employees also may call the customer service number on the back of their UnitedHealthcare ID cards: 800-382-3210.

Contact the benefits department with any questions.