UnitedHealthcare Community Plan
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Pharmacy Program

 

Healthy Michigan Plan

Pharmacy Program 

Preferred Drug List (PDL) Search

Managed Care Common Formulary

Michigan Prior Authorization Request Form for Prescription Drugs  (PDF 179.55 KB)

 

Pharmacy Bulletins

Synagis Enrollment Form (PDF 511.58 KB) 
Synagis Program (PDF 58.92 KB) 


Pharmacy Prior Authorization Forms

Re-Review Reconsideration Request Form (PDF 158.04 KB)


UnitedHealthcare Community Plan

Pharmacy Program 

Preferred Drug List (PDL) Search

Managed Care Common Formulary


Pharmacy Bulletins

Synagis Enrollment Form (PDF 511.58 KB) 
Synagis Program (PDF 58.92 KB)

 

Pharmacy Prior Authorization Forms

Re-Review Reconsideration Request Form (PDF 158.04 KB)