UnitedHealthcare Community Plan
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Pharmacy Program

 

UnitedHealthcare Community Plan

Pharmacy Program 

Preferred Drug List (PDL) Search

Preferred Drug List  (PDF 1.56 MB)

1/1/2017 PDL Update (PDF 178.04 KB) 
10/1/2016 PDL Update (PDF 66.17 KB)
8/1/2016 PDL Update (PDF 63.08 KB)

 


Prior Authorization List (PDF 374.22 KB)
Step Therapy Policy  (PDF 16.75 KB)
Quantity Limit Policy (PDF 24.38 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 Bulletins


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

Pharmacy Bulletins

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

Makena FAQ (PDF 57.78 KB)
Vivitrol Provider FAQ
(PDF 65.19 KB)

Touchpoints Enrollment Form (PDF 238.87 KB)

 

Clinical Guidelines

Click on the arrow above to view clinical pharmacy program policies and guidelines. 

Clinical Pharmacy Program Guideline Changes - Effective 5/1/2017

Clinical Pharmacy Program Guideline Changes - Effective 6/1/2017

Prior Authorization and Medical Exception Forms

Click on the arrow above to view prior authorization and medical exception forms. 

Prior Authorization and Medical Exception Forms


UnitedHealthcare Connected® for MyCare Ohio
H2531-001

Pharmacy Program 

Preferred Drug List (PDL) Search

Download (PDF 772.39 KB) the Acrobat version of the Preferred Drug List (PDL)


UnitedHealthcare Dual Complete® (HMO SNP)
H5253-059


UnitedHealthcare Dual Complete® (HMO-POS SNP)
H5322-028