UnitedHealthcare Community Plan
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NJ FamilyCare

Pharmacy Program 

Preferred Drug List (PDL) Search
Preferred Drug List
(PDF 983.65 KB)

1/1/2017 PDL Update (PDF 172.62 KB)
10/1/2016 PDL Update (PDF 69.78 KB)
8/1/2016 PDL Update  (PDF 66.77 KB)
5/1/2016 PDL Update (PDF 61.36 KB)

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  (PDF 951.38 KB)
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)