UnitedHealthcare Community Plan
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Child Health Plus

Preferred Drug List (PDL) Search

Preferred Drug List (PDF 925.97 KB)

10/1/2016 PDL Update (PDF 53.13 KB)
8/1/2016 PDL Update (PDF 62.53 KB)
5/1/2016 PDL Update (PDF 55.68 KB)
1/1/2016 PDL Update (PDF 45.11 KB)
Step Therapy (PDF 21.03 KB)


Pharmacy Bulletins

Synagis Enrollment Form (PDF 511.58 KB)  
Synagis Program  (PDF 58.92 KB)
(PDF 42.79 KB)Synagis Program 5 Doses (PDF 51.26 KB)


Pharmacy Prior Authorization Forms

Standard Prior Authorization Request Form (PDF 129.66 KB)

Re-Review Reconsideration Request Form (PDF 158.04 KB)

Essential Plan

United Healthcare Community Plan Essential Plan 1 Preferred Drug List (PDL) Search
United Healthcare Community Plan Essential Plan 2 Preferred Drug List (PDL) Search
United Healthcare Community Plan Essential Plan 3 Preferred Drug List (PDL) Search
United Healthcare Community Plan Essential Plan 4 Preferred Drug List (PDL) Search

NY Essential Plan Preferred Drug List (PDF 990.5 KB)

Quantity Limits  (PDF 20.11 KB)
Step Therapy (PDF 21.03 KB)


Pharmacy Bulletins

 


Pharmacy Prior Authorization Forms

Standard Prior Authorization Request Form (PDF 129.66 KB)

Re-Review Reconsideration Request Form (PDF 158.04 KB)

NY Community Plan MLTSS

Preferred Drug List (PDL) Search

Preferred Drug List  (PDF 897.21 KB)
PDL Updates  (PDF 61.89 KB)
Quantity Limits  (PDF 20.11 KB)
Step Therapy (PDF 21.03 KB)


Pharmacy Bulletins

Synagis Enrollment Form (PDF 245.92 KB)  
Synagis Program 
(PDF 245.92 KB)
Synagis Program 5 Doses (PDF 51.26 KB)


Pharmacy Prior Authorization Forms

UnitedHealthcare Community Plan

Preferred Drug List (PDL) Search

 

Preferred Drug List (PDF 925.47 KB)
PDL Updates (PDF 61.89 KB)
Quantity Limits (PDF 20.11 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

Standard Prior Authorization Request Form (PDF 129.66 KB)

Re-Review Reconsideration Request Form (PDF 158.04 KB)

UnitedHealthcare Community Plan Personal Assist
UnitedHealthcare Dual Advantage
UnitedHealthcare Dual Complete® (HMO SNP)

Preferred Drug List (PDL) Search

Download (PDF 1.52 MB) the Acrobat version of the Preferred Drug List (PDL)

Submit a Pharmacy Prior Authorization Request to Prescription Solutions.

Request for Medicare Prescription Drug Determination Request form

UnitedHealthcare Personal Assist™
UnitedHealthcare Wellness4Me

Pharmacy benefit summary BH /HARP implementation (PDF 267.71 KB)

Wellness4ME Preferred Drug List Search
Preferred Drug List (PDF 926.3 KB)

Quantity Limits  (PDF 20.11 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)