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AmeriHealth Caritas Members Transitioning to Community Plan

Starting Dec. 1, 2017, UnitedHealthcare Community Plan will begin servicing IA Health Link members who were previously managed by AmeriHealth Caritas. If a member doesn’t present their new UnitedHealthcare Community Plan member ID card, please verify eligibility using their Medicaid State ID number. You may verify by calling the Eligibility and Verification Information System (ELVS) at 800-338-7752 or by signing in to their web portal here. You may also call UnitedHealthcare’s Provider Services at 888-650-3462. More information about the transition can be viewed on our Bulletins page. You can also use our tool for looking up in-network providers.

Please select the state where you practice.

UnitedHealthcare Community Plan - IA Health Link


UnitedHealthcare Community Plan hawk-i

Pharmacy Program

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by Hawk-i.

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

Preferred Drug List (PDL) Search

Preferred Drug List

 

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.

 

  • Alpha1-Proteinase Inhibitor Enzymes (PDF 37.29 KB)
  • Alpha 2 Agonist, Extended Release (PDF 74.41 KB)
  • Dalfampridine (Ampyra) (PDF 27.64 KB)
  • Amylino Mimetic (PDF 56.81 KB)
  • Antidepressant (PDF 29.33 KB)
  • Anti-Diabetic, Non-Insulin Agents (PDF 32.42 KB)
  • Antiemetic-5HT3 receptor Antogonists / Substance P Neurokinin Agents (PDF 49.73 KB)
  • Anti-Fungal (PDF 55.1 KB)
  • Antihistamines (PDF 45.04 KB)
  • Apixaban (Eliquis) (PDF 49.4 KB)
  • Apremilast (Otezla) (PDF 39.59 KB)
  • Angiotension Receptor Blocker Before ACE Inhibitor (PDF 44.92 KB)
  • Binge Eating Disorder Agents (PDF 35.87 KB)
  • Benzodiazepines (PDF 59.53 KB)
  • Biologicals for Ankylosing Spondylitis (PDF 62.81 KB)
  • Biologicals for Arthritis (PDF 40.93 KB)
  • Biologicals for Inflammatory Bowel Disease (PDF 63.02 KB)
  • Biologicals for Plaque Psoriasis (PDF 61.3 KB)
  • Buprenophine / Naloxone (PDF 747.51 KB)
  • Nebivolol (Bystolic) (PDF 48.08 KB)
  • Cholic Acid (Cholbam) (PDF 69.93 KB)
  • Chronic Pain Syndromes (PDF 64.27 KB)
  • CNS Stimulants (PDF 73.72 KB)
  • Concurrent IM / PO Antipsychotic (PDF 743.27 KB)
  • Dabigatran (Pradaxa) (PDF 59.3 KB)
  • Deferasirox (Exjade) (PDF 36.5 KB)
  • Deflazacort (Emflaza) (PDF 621 KB)
  • Duplicate Therapy Edit Override (PDF 744.47 KB)
  • Edoxaban (Savaysa) (PDF 51.85 KB)
  • Erythropoesis Stimulating Agents (PDF 30.53 KB)
  • Extended Release Formulation (PDF 26.55 KB)
  • Febuxostat (Uloric) (PDF 34.38 KB)
  • Fentanyl, Short Acting Oral Products (PDF 57.82 KB)
  • Fifteen Day Initial Prescription Supply Override (PDF 25.62 KB)
  • Granulocyte Colony Stimulating Factor PA (PDF 26.74 KB)
  • Growth Hormone (PDF 36.11 KB)
  • Hepatitis C Treatments (PDF 184.01 KB)
  • Hepatitis C Post Treatment Information Sustained Virologic Response (SVR) Reporting (PDF 825.4 KB) - 7.11.2017
  • Idiopathic Pulmonary Fibrosis (PDF 53.14 KB)
  • Insulin, Pre-Filled Pens (PDF 55.69 KB)
  • Isotretinoin (Oral) (PDF 57.64 KB)
  • Janus Kinase Inhibitors (PDF 34.91 KB)
  • Kalydeco (Ivacaftor) (PDF 31.91 KB)
  • Ketorolac (PDF 35.45 KB)
  • Korlym (Mifepristone) (PDF 26.12 KB)
  • Lidocaine Patch (Lidoderm) (PDF 27.49 KB)
  • Methotrexate Injection (PDF 60.44 KB)
  • Miscellaneous (PDF 44.25 KB)
  • Modified Formulations (PDF 27.65 KB)
  • Muscle Relaxants (PDF 33.2 KB)
  • Narcan (Naloxone) Nasal Spray (PDF 778.78 KB)
  • Narcotic Agonist Antagonist Nasal Spray (PDF 57.32 KB)
  • Nicotine Replacement Therapy (PDF 876.4 KB) - 8.8.2017
  • Non-Parenteral Vasopressin Derivatives (PDF 57.92 KB)
  • Non-Preferred Drug (PDF 25.33 KB)
  • Non-Steroidal Anti-Inflammatory Drugs (PDF 58.65 KB)
  • Dextromethorphan and Quinidine (Nuedexta) (PDF 67.53 KB)
  • Omalizumab (Xolair) (PDF 848.99 KB)
  • Oral Constipating Agents (PDF 67.03 KB)
  • Oral Immunotherapy (PDF 79.81 KB)
  • Multiple Sclerosis Agents - Oral (PDF 50.14 KB)
  • Long-Acting Opioids (PDF 843.44 KB)
  • Lumacaftor / Ivacaftor (Orkambi) (PDF 40.82 KB)
  • Pavilizumab (Synagis) (PDF 34.23 KB)
  • Proton Pump Inhibitors (PDF 36.33 KB)
  • Pulmonary Arterial Hypertension (PDF 49.93 KB)
  • Quantity Limit Override (PDF 48.08 KB)
  • Becaplermin (Regranex) (PDF 55.48 KB)
  • Repository Corticotropin Injection (PDF 25.1 KB)
  • Roflumilast (Daliresp) (PDF 42.17 KB)
  • Sedative / Hypnotic-Non-Benzodiazepine (PDF 61.47 KB)
  • Selected Brand Name Drug (PDF 62.26 KB)
  • Select Oncology Agents (PDF 29.58 KB)
  • Serotonin 5-HT1-Receptor Agonists (PDF 49.4 KB)
  • Short Acting Opiods (PDF 809.52 KB)
  • Smoking Cessation Therapy - Oral (PDF 31.04 KB)
  • Tasimelteon (Hetlioz) (PDF 30.85 KB)
  • Testosterone Products (PDF 70.42 KB)
  • Thrombopoietin Receptor Agonists (PDF 76.41 KB)
  • Topical Acne and Rosacea Products (PDF 798.76 KB)
  • Topical Antifungals for Onychomycosis (PDF 25.67 KB)
  • Topical Corticosteroids (PDF 24.45 KB)
  • Immunomodulators - Topical (PDF 29.34 KB)
  • Vitamins Minerals and Multiple Vitamins (PDF 22.28 KB)
  • Vorapaxar (Zontivity) (PDF 26.41 KB)
  • Vusion Ointment (PDF 51.96 KB)
  • Rivaroxaban (Xarelto) (PDF 93.58 KB)
  • Omalizumab (Xolair) (PDF 35.73 KB)
  • Sodium Oxybate (Xyrem) (PDF 58.95 KB)
  • Linezolid (Zyvox) (PDF 57.79 KB)
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