UnitedHealthcare Community Plan
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MS CHIP


Preferred Drug List (PDL) Search

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by the Mississippi Department of Medicaid. Click on the link below to see the PDL.
Preferred Drug List

Transitional Care Override Process (PDF 35.45 KB)

90 Day Maintenance List

Mississippi Prior Authorization Form (PDF 431.45 KB)

Pharmacy Bulletins

Synagis Program (PDF 52.6 KB)

Pharmacy Prior Authorization and Medical Exception Forms

Compound Medications - 24 Hour Urgent (PDF 76.86 KB)
Mississippi 6 RX Limit (PDF 113.17 KB)
Prior Authorization Request Form (PDF 85.31 KB)
Prior Authorization Request Form - Urgent (PDF 85.46 KB)



MississippiCAN

Preferred Drug List (PDL) Search

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by the Mississippi Department of Medicaid. Click on the link below to see the PDL.
Preferred Drug List

Transitional Care Override Process (PDF 35.45 KB)

90 Day Maintenance List

Mississippi Prior Authorization Form (PDF 431.45 KB)

Pharmacy Bulletins

Synagis Program (PDF 52.6 KB)

Pharmacy Prior Authorization and Medical Exception Forms

Compound Medications - 24 Hour Urgent (PDF 76.86 KB)
Mississippi 6 RX Limit (PDF 113.17 KB)
Prior Authorization Request Form - Urgent (PDF 85.46 KB)