UnitedHealthcare Community Plan
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Pharmacy Program

 

AHCCCS/Medicaid

Pharmacy Program 

Preferred Drug List (PDL) Search
AHCCCS/Medicaid Preferred Drug List  (PDF 1,022.64 KB)

4/1/2017 PDL Update (PDF 186.03 KB)
1/1/2017 PDL Update  (PDF 126.35 KB)
10/1/2016 PDL update (PDF 77.24 KB)
8/1/2016 PDL update (PDF 77.19 KB)

Step Therapy (PDF 21.02 KB)

 

Pharmacy Bulletins

UnitedHealthcare Community Plan AZ Specialty Pharmacy Program Changes (PDF 246.6 KB)
Synagis Enrollment Form  (PDF 511.58 KB)
Synagis Program
(PDF 58.92 KB)
Synagis Program 5 Doses (PDF 51.26 KB)


Pharmacy Prior Authorization Forms


Children's Rehabilitative Services (CRS) Program

Pharmacy Program 

Search for Drugs Covered by CRS 
Search for Drugs Covered by CRS Partially Integrated Acute 
Search for Drugs Covered by CRS Fully Integrated Acute 
Search for Drugs Covered by CRS Partially Integrated Behavioral Health

Children's Rehabilitative Services Preferred Drug List (PDF 1.02 MB)
Preferred Drug List Updates (PDF 36.79 KB)

Step Therapy (PDF 21.02 KB)

Pharmacy Bulletins

UnitedHealthcare Community Plan AZ Specialty Pharmacy Program Changes (PDF 246.6 KB) 
Synagis Enrollment Form (PDF 511.58 KB) 
Synagis Program (PDF 58.92 KB)
Synagis Benefit Coverage (PDF 42.77 KB)
Synagis Program 5 Doses (PDF 51.26 KB)


Pharmacy Prior Authorization Guidelines

Olysio (PDF 94.56 KB)
Sovaldi (PDF 149.44 KB)


Pharmacy Prior Authorization Forms


Developmentally Disabled Program

Pharmacy Program 

Preferred Drug List (PDL) Search
Developmentally Disabled Preferred Drug List (PDF 1,022.64 KB)
Step Therapy (PDF 21.02 KB) 

Pharmacy Bulletins

UnitedHealthcare Community Plan AZ Specialty Pharmacy Program Changes (PDF 246.6 KB) Synagis Enrollment Form (PDF 511.58 KB) 
Synagis Program (PDF 58.92 KB)
Synagis Program 5 Doses (PDF 51.26 KB)

Pharmacy Prior Authorization Guidelines

Olysio (PDF 94.56 KB)
Sovaldi (PDF 149.44 KB)


Pharmacy Prior Authorization Forms


KidsCare


Long Term Care

Pharmacy Program

Preferred Drug List (PDL) Search
Preferred Drug List (PDF 1.07 MB)

1/1/2017 PDL Update  (PDF 126.35 KB)
10/1/2016 PDL Update (PDF 77.24 KB)
8/1/2016 PDL Update (PDF 77.19 KB)
5/1/2016 PDL Update (PDF 81.2 KB)
Dual Eligible Drug Coverage (Wrap List) (PDF 3.42 MB)

Important Step Therapy Information

Step Therapy Policy (PDF 21.02 KB)

Quantity Limit Initiatives

Quantity Limit Policy (PDF 20.11 KB)

 

Pharmacy Bulletins

UnitedHealthcare Community Plan AZ Specialty Pharmacy Program Changes (PDF 246.6 KB)

Pharmacy Prior Authorization Guidelines

Olysio (PDF 94.56 KB)
Sovaldi (PDF 149.44 KB)


Pharmacy Prior Authorization Forms


UnitedHealthcare Dual Complete® (HMO SNP)
H0321-002

Pharmacy Program 

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 Dual Complete™ ONE (HMO SNP)
H0321-004