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Click on the arrow above to view information about medical injectables.
Specialty pharmacy medications covered under the member’s medical benefit may be provided through a various sources ‒ home infusion provider, outpatient facility, physician, or specialty pharmacy.
If you don’t want to buy-and-bill a specialty pharmacy medication that is covered under the member’s medical benefit, you may order it through one of the following network specialty pharmacies:
Network Specialty Pharmacy
The following specialty pharmacies also provide certain types of specialty medications:
Network Specialty Pharmacy
Accredo (offers nursing services)
Option Care (offers nursing services)
CVS Caremark Specialty Pharmacy
Coverage of a requested medication depends on the member’s benefits. and availability of a specific drug from a network specialty pharmacy.
Upon request, a specialty pharmacy can deliver the medication to your office or another site such as the member’s home.
Medications obtained through a Specialty Pharmacy will be directly billed to the patient’s health plan.
Healthy Michigan Plan
UnitedHealthcare Community Plan
The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by UnitedHealthcare Community Plan of Michigan.
Click on the link below to view the Preferred Drug List.
Michigan Prior Authorization Request Form for Prescription Drugs (PDF 179.55 KB)
Pharmacy Prior Authorization Forms
Prior authorization is required for some services and medications. Click the arrow above to view a current list of services and information on how to request an authorization.
Click on the arrow below to view the pharmacy prior authorization forms. All forms updated on 6.1.2016 unless otherwise noted.
- Ampyra (PDF 164.14 KB)
- Aranesp / Epogen / Procrit - Initial Review (PDF 184.26 KB)
- Aranesp / Epogen / Procrit - Re-Authorization Review (PDF 179.45 KB)
- Arixtra (PDF 269.1 KB)
- Avonex (PDF 145.84 KB)
- Cayston (PDF 203.05 KB)
- Celebrex (PDF 123.37 KB)
- Claravis (PDF 158.66 KB) - 1.4.2018
- Clobetasol (Temovate) (PDF 129.66 KB)
- Compound Medications (PDF 73.82 KB)
- Copaxone (PDF 70.84 KB) - 1.10.2018
- Daraprim (Pyrimethamine) (PDF 117.23 KB)
- Desmopressin / Stimate / DDAVP (PDF 230.93 KB)
- Dovonex (Calcipotriene) (PDF 124.79 KB)
- DPP 4 Inhibitors (PDF 120.63 KB)
- Dronabinol - Marinol (PDF 121.54 KB)
- Elidel (PDF 192.11 KB)
- Elmiron (PDF 126.76 KB)
- Enoxaparin (PDF 187.87 KB)
- Fentanyl Transdermal (PDF 150.4 KB)
- Forteo (PDF 140.95 KB)
- General Non-Preferred Medication (PDF 117.37 KB)
- Gilenya (PDF 162.87 KB)
- Global Quantity Limits (PDF 49.95 KB)
- GLP-1 Agonists (PDF 71.05 KB) - 11.16.2017
- Growth Hormones - Initial Review (PDF 168.52 KB)
- Growth Hormones - Re-Authorization Review (PDF 158.83 KB)
- Hepatitis C Medications (PDF 195.29 KB)
- Humulin R U-500 (PDF 84.39 KB)
- Imiquimod Cream (PDF 154.6 KB)
- Increlex (PDF 166.39 KB)
- Lidocaine Patch / Lidoderm (PDF 106.99 KB)
- Lovaza (PDF 45.51 KB)
- Mefloquine / Lariam (PDF 103.75 KB)
- Memantin / Namenda (PDF 69.59 KB)
- Mepron / Atovaquone (PDF 124.45 KB)
- Neupogen (PDF 172.89 KB)
- Octreotide / Sandostatin (PDF 128.96 KB)
- Oncology Agents (PDF 130.87 KB)
- Oral Contraceptives (PDF 91.4 KB)
- Protopic (PDF 68.8 KB)
- Pulmonary Arterial Hypertension (PAH) (PDF 163.76 KB) - 2.6.2018
- Pulmozyme (PDF 116.49 KB)
- Rectiv (PDF 148.35 KB) 1.4.2018
- Renvela (PDF 84.21 KB)
- Re-Review Reconsideration Request Form (PDF 89.03 KB)
- Sensipar (PDF 91.19 KB)
- SGLT-2 Inhibitors (PDF 71.95 KB) - 1.10.2018
- Solaraze - Diclofenac (PDF 85.9 KB)
- Soriatane (PDF 97.75 KB)
- Sumatriptan - Imitrex Injection (PDF 232.03 KB)
- Synagis (PDF 210.31 KB)
- Tanzeum (PDF 87.35 KB)
- Tecfidera (PDF 172.18 KB)
- Tekturna (PDF 75.51 KB)
- Tobramycin Inhalation Solution (Tobi / Tobi Podhaler) (PDF 72.18 KB) - 1.10.2018
- Uloric (PDF 70.3 KB)
- Valcyte (PDF 108.43 KB)
- Victoza (PDF 87.21 KB)
- Xarelto (PDF 103.39 KB)
- Xolair (PDF 121.99 KB) - 3.24.2017
- Zyvox (PDF 143.5 KB)
Preferred Diabetic Testing Supplies
Diabetic Supply Changes Effective Jan. 1, 2016
To help provide our members with clinically appropriate, cost-effective diabetic supplies, UnitedHealthcare Community Plan has selected LifeScan (OneTouch®) as the preferred manufacturer for diabetic blood glucose meters and test strips.
As of Jan. 1, 2016, only LifeScan (OneTouch) meters and test strips are included on the Preferred Drug List. The LifeScan meters are offered at no cost for members. Other tests strip manufacturers, including Roche (Accu-Chek®), are no longer preferred and have been removed from the Preferred Drug List.
|NON-PREFERRED TESTING SUPPLIES||PREFERRED TESTING SUPPLIES|
Accu-Chek Test Strips:
One-Touch Test Strips:
What We’re Asking You to Do
Please encourage your patients to use products on the Preferred Drug List, and provide them with a new prescription for these products.
If the preferred alternative testing supplies are not appropriate for your patients, they may still obtain the non-preferred brand through a Durable Medical Equipment (DME) care provider and you won’t need to do anything different to keep your patient on the non-preferred product.
We’re Here to Help
If you have questions, please call Provider Services at 800-903-5253, Monday through Friday, 8:30 a.m. to 5:30 p.m. Eastern Time.
View the preferred testing supply notice (PDF 42.89 KB).