Medicare AdvantageDocumentationHigh impact
Medicare: New non-formulary medication request process
UnitedHealthcare·Network News
Effective date
Jan 1, 2026
We identified it
Jun 13, 2026
Summary
Starting January 1, 2026, all Medicare non-formulary medication requests for patients who cannot be switched to formulary alternatives must include progress notes and supporting documentation. UnitedHealthcare strongly encourages prescribing formulary alternatives to avoid delays and denials.
Action Required
By January 1, 2026: Providers must include progress notes and comprehensive documentation (medical records showing prior failed medications, clinical rationale, labs, treatment history) for all non-formulary medication requests when formulary alternatives cannot be used. Billing team should update workflow to verify documentation completeness before submission. Use PreCheckMyScript or UnitedHealthcare Provider Portal to check formulary alternatives first. Incomplete documentation will result in delays and potential denials.