UnitedHealthcare Community Plan
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UnitedHealthcare Community Plan for Families


Preferred Drug List (PDL) Search

PDL and Updates
Preferred Drug List (PDF 925.27 KB)

10/1/2016 PDL Update (PDF 52.88 KB)
8/1/2016 PDL Update (PDF 63.87 KB)
5/1/2016 PDL Update (PDF 55.71 KB)
1/1/2016 PDL Update (PDF 54.54 KB)


Important Step Therapy Information
Step Therapy Policy (PDF 21.02 KB) 

Quantity Limit Initiatives 
Monthly Prescription Limits (PDF 57.53 KB) 
Quantity Limit Policy (PDF 20.11 KB) 
Monthly Benefit Limits (PDF 48.85 KB) 

Pharmacy and Therapeutics (P&T) Committee Meeting Minutes 

Third Quarter 2016 (PDF 56.45 KB)
Second Quarter 2016 (PDF 36.32 KB) 
First Quater 2016 (PDF 44.62 KB)
Fourth Quater 2015 (PDF 38.88 KB)
Third Quater 2015 (PDF 66.85 KB)


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

Hepatitis C Medication Guidelines

Hepatitis C Harvoni - PENNSYLVANIA ONLY (PDF 113.95 KB)
Hepatitis C Olysio - PENNSYLVANIA ONLY (PDF 111.7 KB)

 

Pharmacy Prior Authorization Forms  

Re-Review Reconsideration Request Form (PDF 158.04 KB)


UnitedHealthcare Community Plan for Kids

Preferred Drug List (PDL) Search 

PDL and Updates 
Preferred Drug List (PDF 931.24 KB)
PDL Updates (PDF 57 KB) 

Important Step Therapy Information 
Step Therapy Policy (PDF 21.02 KB) 

Quantity Limit Initiatives 
Quantity Limit Policy (PDF 20.11 KB) 
Monthly Benefit Limit (PDF 48.85 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)


UnitedHealthcare Dual Complete® (HMO SNP)