UnitedHealthcare Community Plan
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Pharmacy Program

 

NJ FamilyCare

Pharmacy Program

 

Preferred Drug List (PDL)
Search
Preferred Drug List (PDF 1.19 MB)

4/1/2017 PDL Update (PDF 63.3 KB)
1/1/2017 PDL Update
10/1/2016 PDL Update
8/1/2016 PDL Update 

Step Therapy (PDF 21.03 KB)


Pharmacy Bulletins

Synagis Enrollment Form (PDF 511.58 KB)  
Synagis Program  (PDF 58.92 KB)
Synagis Program 5 Doses (PDF 51.26 KB)


Pharmacy Prior Authorization Forms

Re-Review Reconsideration Request Form (PDF 158.04 KB)

 


UnitedHealthcare Dual Complete® ONE (HMO SNP)
H3113-005



Managed Long Term Services and Supports (MLTSS)
Pharmacy Program

 

Preferred Drug List (PDL) Search
Preferred Drug List ( 1.12 MB)
Step Therapy (PDF 21.03 KB)


Pharmacy Bulletins

Synagis Enrollment Form (PDF 511.58 KB)  
Synagis Program (PDF 58.92 KB) 
Synagis Program 5 Doses (PDF 51.26 KB)


Pharmacy Prior Authorization Forms

Re-Review Reconsideration Request Form (PDF 158.04 KB)