UnitedHealthcare Community Plan
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Pharmacy Program

 

UnitedHealthcare Community Plan

Pharmacy Program

 

Preferred Drug List and Updates

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by UnitedHealthcare Community Plan.

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

Preferred Drug List (PDL) Search

Preferred Drug List  (PDF 1.33 MB)

7/1/2017 PDL Update (PDF 121.86 KB)
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)


Step Therapy Program 

Step Therapy Policy (PDF 16.75 KB)


Drug Quantity Limits 

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 Frequently Asked Questions (PDF 57.78 KB)
Vivitrol Provider Frequently Asked Questions
(PDF 65.19 KB)

Touchpoints Enrollment Form (PDF 238.87 KB)

 

Pharmacy Prior Authorization and Medical Exception Forms

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


Prior Authorization List (PDF 325.38 KB)

Prior Authorization and Medical Exception Forms

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

 

Clinical Guidelines

Our Clinical Pharmacy Program Guidelines are updated on an ongoing basis by our Pharmacy and Therapeutics Committee. Our changes reflect recent developments in pharmaceutical health care so we’re aligned with national treatment standards.

Clinical Guidelines and Policies

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

Clinical Phramacy Program Guideline Changes – Effective 9/1/2017

Clinical Pharmacy Program Guideline Changes - Effective 8/1/2017 


UnitedHealthcare Connected® for MyCare Ohio
H2531-001

Pharmacy Program 

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by UnitedHealthcare Connected for MyCare Ohio
H2531-001.

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

Preferred Drug List (PDL) Search

Download (PDF 965.78 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