UnitedHealthcare Community Plan
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UnitedHealthcare Community Plan

Preferred Drug List (PDL) Search

 

Preferred Drug List  (PDF 966.29 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)
5/1/2016 PDL Update (PDF 54.93 KB)
Prior Authorization List  (PDF 417.51 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)


Prior Authorization and Medical Exception Forms

Re-Review Reconsideration Request Form (PDF 158.04 KB)

 


UnitedHealthcare Connected® for MyCare Ohio
H2531-001

Preferred Drug List (PDL) Search

Download the Acrobat version of the Preferred Drug List (PDL)


UnitedHealthcare Dual Complete® (HMO SNP)
H5253-059