Please select the state where you practice.

Pharmacy Program

 

NJ FamilyCare

Pharmacy Program

 

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by NJ FamilyCare.

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

Search Preferred Drug List (PDL)
Preferred Drug List (PDL) (PDF 1.09 MB)

10/1/2017 PDL Update (PDF 60.14 KB)
7/1/2017 PDL Update (PDF 121.74 KB)
4/1/2017 PDL Update (PDF 63.3 KB)
1/1/2017 PDL Update (PDF 172.62 KB)

 

Step Therapy Program 

Step Therapy (PDF 21.03 KB)


Pharmacy Bulletins

Synagis Enrollment Form (PDF 225.02 KB)  
Synagis Program  (PDF 58.92 KB)
Synagis Program 5 Doses (PDF 51.26 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.


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



Managed Long Term Services and Supports (MLTSS)
Pharmacy Program

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by Managed Long Term Services and Supports. Click on the link below to view the Preferred Drug List.

Preferred Drug List (PDL) Search
Preferred Drug List (PDF 1.08 MB)

 

Step Therapy Program 

Step Therapy (PDF 21.03 KB)


Pharmacy Bulletins

Synagis Enrollment Form (PDF 225.02 KB)  
Synagis Program (PDF 58.92 KB) 
Synagis Program 5 Doses (PDF 51.26 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.