UnitedHealthcare Community Plan
You appear to be browsing this site using Internet Explorer 6. This browser is now out of date. For safer, more reliable browsing it is recommended that you upgrade your browser to Firefox, Safari or Internet Explorer 7 or 8.
Shortcut Navigation:
Please select the state where you practice.

Pharmacy Program

 

Centennial Care - UnitedHealthcare Community Plan

Pharmacy Program

 

Preferred Drug List and Updates 

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

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

Preferred Drug List (PDL) Search  
Preferred Drug List  (PDF 1.71 MB)

10/1/2017 PDL Update (PDF 60.38 KB)
7/1/2017 PDL Update (PDF 122.49 KB)
4/1/2017 PDL Update (PDF 63.45 KB)
1/1/2017 PDL Update (PDF 173.18 KB)

 

Pharmacy Bulletins

New Mexico Synagis Form (PDF 102.29 KB)
Synagis Enrollment Form (PDF 225.02 KB)  
Synagis Program  (PDF 58.92 KB) 
Synagis Program 5 Doses (PDF 51.26 KB)

 

Quantity Limit Initiatives and Policy

Quantity Limit Policy (PDF 20.11 KB)

 

Step Therapy Information

Step Therapy Policy (PDF 21.02 KB)

 

Pharmacy Prior Authorization Forms

Prior authorization is required for some services and medications. A current list of prior authorization services, medications and forms can be found below.

Pharmacy Prior Authorization Forms

Click on the arrow above to view the pharmacy prior authorization forms. 

 


UnitedHealthcare Dual Complete® (HMO-POS SNP)
H5008-009


UnitedHealthcare Dual Complete® (Local PPO SNP)
H2228-042


UnitedHealthcare Dual Complete® (Local PPO SNP)
H2228-046