UnitedHealthcare Community Plan
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Pharmacy Program

 

UnitedHealthcare Community Plan
QUEST Integration Program

Pharmacy Program

Preferred Drug List (PDL) Search

UnitedHealthcare Community Plan - QUEST Program Preferred Drug List (PDF 1.45 MB)

4/1/2017 PDL Update (PDF 63.34 KB)
1/1/2017 PDL Update (PDF 173.07 KB)
10/1/2016 PDL Update (PDF 66.23 KB)
5/1/2016 PDL Update (PDF 55.4 KB)

Step Therapy Information

Step Therapy Policy (PDF 21.02 KB)


Quantity Limit Initiatives

Quantity Limit Policy (PDF 20.1 KB)


Direct Member Reimbursement

Direct Member Reimbursement Form (PDF 194.84 KB)

 

Pharmacy Bulletins

Synagis Enrollment Form (PDF 511.58 KB) 
Synagis Program (PDF 59.42 KB)
Synagis Program 5 Doses (PDF 51.26 KB)


Pharmacy Prior Authorization Forms


UnitedHealthcare Dual Complete® (Local PPO SNP)
H2228-043


UnitedHealthcare Dual Complete®RP (Regional PPO SNP)
R3175-003

Pharmacy Program 

 

Preferred Drug List (PDL) Search

Download the Acrobat PDF version of the Preferred Drug List (PDL)

Submit a Pharmacy Prior Authorization Request to Prescription Solutions.

 

Request for Medicare Prescription Drug Determination Request form