New Mexico $0 behavioral health coverage
Describes a New Mexico state mandate requiring certain behavioral health medications to be covered with $0 cost-share under the member's pharmacy benefit; applies when medications (including some not FDA-approved for the treated condition) may qualify and require review/notification by UnitedHealthcare/OptumRx.
No material clinical or coverage changes in this revision.
Eligibility for $0 Cost-Share Coverage
Eligibility for $0 cost-share coverage
A medication may be covered at $0 cost-share when ALL of the following conditions are met:
ALL of the following
- Medication is used to treat a behavioral health condition for a New Mexico member
- Medication is a drug included in the select list determined eligible under the state mandate (may include medications not FDA‑approved for that condition)
Inclusion on the select list is determined by UnitedHealthcare/OptumRx review
- Notification and review have been completed as required by UnitedHealthcare/OptumRx
Member's pharmacy benefit must be reviewed to confirm $0 coverage
What Providers Must Do
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.