Pharmacy Program
Care Improvement Plus Dual Advantage (Local PPO SNP)
UnitedHealthcare Dual Complete™ (HMOPOS SNP)
Preferred Drug List (PDL) Search
Download the Acrobat version of the Preferred Drug List (PDL)
Submit a Pharmacy Prior Authorization Request to Prescription Solutions.
Request for Medicare Prescription Drug Determination Request form
UnitedHealthcare hawk-i
Preferred Drug List (PDL) Search
UnitedHealthcare hawk-i Pharmacy InformationPreferred Drug List (PDF 854.93 KB)
PDL Updates (PDF 740.99 KB)
Step Therapy (PDF 23.14 KB)
Pharmacy Bulletins
Synagis Program (PDF 37.63 KB)
Synagis Program 5 Doses (PDF 42.77 KB)
Pharmacy Prior Authorization Forms
Acthar Gel (PDF 56.9 KB)
Ampyra (PDF 57.82 KB)
Aranesp Epogen Procrit (PDF 105.19 KB)
Celebrex (PDF 63.28 KB)
Effient (PDF 46.2 KB)
Elidel Protopic (PDF 54.09 KB)
Factor Prescription Request Form (PDF 85.68 KB)
Fenofibrate (PDF 55.7 KB)
Forteo (PDF 106.46 KB)
Growth Hormone (PDF 105.38 KB)
Hepatitis C (PDF 142.4 KB)
Increlex (PDF 69.23 KB)
Itraconazole (PDF 82.75 KB)
Kuvan (PDF 56.37 KB)
Long-Acting Opiates (PDF 63.04 KB)
Lovaza (PDF 56.24 KB)
Lovenox (PDF 85.29 KB)
Lupron (PDF 111.2 KB)
Multaq (PDF 75.78 KB)
Oral Chemo (PDF 72.85 KB)
Prior Authorization Request Form (PDF 56.68 KB)
Promacta (PDF 65.36 KB)
Proton Pump Inhibitors (PDF 61.58 KB)
Renvela (PDF 53.33 KB)
Sensipar (PDF 45.17 KB)
Singulair (PDF 61.87 KB)
Soriatane (PDF 64.33 KB)
Specialty Medication Prior Authorization Cover Sheet (PDF 24.4 KB)
Suboxone (PDF 62.26 KB)
Symlin (PDF 54.29 KB)
Synagis (PDF 97.6 KB)
Testosterone (PDF 97.34 KB)
Topical NSAIDs (PDF 55.45 KB)
TZDs and DPP-4 (PDF 62.6 KB)
Uloric (PDF 55.33 KB)
VFend (PDF 53.31 KB)
Xenazine (PDF 67.28 KB)
Xifaxin (PDF 51.05 KB)
Xolair (PDF 57.61 KB)
Zetia (PDF 57.92 KB)
Zyvox (PDF 47.87 KB)