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Pharmacy Program

 

UnitedHealthcare Community Plan
QUEST Integration Program

Pharmacy Program

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by UnitedHealthcare Community Plan QUEST Integration Program.

Click on the link below to view the Preferred Drug List.

Preferred Drug List (PDL) Search

UnitedHealthcare Community Plan - QUEST Program Preferred Drug List (PDF 1.26 MB)

1/1/2017 PDL Update (PDF 165.72 KB) 
10/1/2017 PDL Update (PDF 61.28 KB)
7/1/2017 PDL Update (PDF 122.73 KB)
4/1/2017 PDL Update (PDF 63.34 KB)
1/1/2017 PDL Update (PDF 173.07 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 225.02 KB) 
Synagis Program (PDF 59.42 KB)
Synagis Program 5 Doses (PDF 51.26 KB)

 

Pharmacy Prior Authorization Forms 

Prior authorization is required for some services and medications. A current list of prior authorization services, medications and forms can be found below.


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


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

Pharmacy Program 

 

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by UnitedHealthcare Dual Complete RP (Regional PPO SNP) R3175-003.

Click on the link below to view the Preferred Drug List.

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.

Medicare Prescription Drug Determination Request Form