CurrentColorado Rocky Mountain Health PlansPolicy N/A

Exemption requests for zero-cost preventive care medications

Governs how health care professionals request exemptions from cost-sharing for zero-cost preventive medications under UnitedHealthcare commercial plans; affects prescribing providers and plan members seeking contraceptive and non-contraceptive exemptions.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyExemption requests for zero-cost preventive care medications

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionSubmit the completed health care reform copay waiver request form via the specified fax or mail options (or call Optum Rx for contraceptive requests).

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3submission methods listed (phone, fax, mail)

2distinct pathways for contraceptive vs non-contraceptive requests

1expedited request option described

PDLsreference to Prescription Drug Lists for zero-cost meds

Key Definitions

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Preventive care medications covered without cost sharing per ACA and payer lists

AuthorityPatient Protection and Affordable Care Act allows clinicians to request exemptions from cost‑sharing for certain preventive care medications for UnitedHealthcare commercial plans.

Where to check covered drugsConsult the payer's Prescription Drug Lists (PDLs) on myuhc.com for current lists of zero‑cost preventive care medications.

ScopeApplies to preventive care medications identified as zero‑cost on ACA/payer lists; exemptions requested when medication is not on those lists.

Affected partiesPrescribing health care professionals and UnitedHealthcare commercial plan members seeking cost‑sharing exemptions.

Expedited exemption (when delay could significantly increase health risk or impair function)

DefinitionAn expedited exemption is a medication exemption request processed faster when standard processing time could significantly increase the member's health risk or impair ability to regain maximum function.

How to requestComplete the expedited form (page 2 of the packet) and fax to 801-994-1058.

When to useWhen time needed for a standard exemption could significantly increase risk to the member's health or their ability to regain maximum function.

Exemption Request Coverage Criteria

Exemption request criteria

Exemption requests must include a clinician attestation of medical necessity plus the specific supporting information described below; requirements differ for contraceptive versus non-contraceptive medications.

ALL of the following

What the patient will use the medication for.
Attestation that the medication is medically necessary for the patient.
Supporting information (include if applicable)
- Supporting labs or test results.
- Additional comments or information including diagnoses, symptoms, or medications attempted or failed.

Contraceptive-specific

Provider attestation: Do you attest that the medication is medically necessary for contraceptive purposes? (Yes/No).

Non-contraceptive-specific

Provide the patient’s diagnosis: ICD-10 code(s).
Document prior medication trials: specify all medication(s)/strengths tried, length of trial, and reason for discontinuation for each.
If applicable
- List medications to which the patient has a contraindication, with the associated contraindication for each medication.
- List medications the patient is intolerant to, and describe the specific issues resulting in intolerance for each medication.

Expedited review condition: If standard processing time could significantly increase the member’s health risk or impair ability to regain maximum function, request an expedited exemption via the specified fax number.

Diagnosis Coding and Documentation

Diagnosis coding for non-contraceptivesICD-10

ICD-10

Provider must provide ICD-10 diagnosis code(s) for non-contraceptive medication requests as applicable.

Documentation required for prior medication trials (non‑contraceptives)

Required detailsSpecify all medication(s) and strengths tried, the length of each trial, and the reason for discontinuation for each medication.

Diagnosis codingProvide applicable ICD‑10 diagnosis code(s) for the medication request.

Contraindications/intolerancesList any medication(s) the patient has a contraindication or intolerance to, with the associated contraindication or specific intolerance issues.

Supporting informationInclude supporting labs or test results if applicable and any additional comments (diagnoses, symptoms, medications attempted or failed).

How to Submit an Exemption Request

Documentation Required

Contraceptive exemption submission

To request a cost share exemption for contraceptive medications, contact Optum Rx Prior Authorization by phone or complete and fax the health care reform copay waiver request form.

Phone: 800-711-4555
Fax completed form to: 844-403-1027

Documentation Required

Non-contraceptive exemption submission

To request a cost share exemption for non-contraceptive medications, complete the health care reform copay waiver request form and submit by fax or mail to UnitedHealthcare.

Fax: 801-994-1345
Mail: UnitedHealthcare P.O. Box 30573, Salt Lake City, UT 84130-0573

Documentation Required

Expedited exemption request

If standard processing could significantly increase risk to the member's health or ability to regain maximum function, request an expedited exemption by completing the form and faxing it to the expedited number.

Fax completed form to: 801-994-1058 for expedited review

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyExemption requests for zero-cost preventive care medications

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionSubmit the completed health care reform copay waiver request form via the specified fax or mail options (or call Optum Rx for contraceptive requests).

SourceLink

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