UnitedHealthcare Community Plan
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Pharmacy Program

 

UnitedHealthcare Community Plan for Families

Pharmacy Program


Preferred Drug List and Updates

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

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

Preferred Drug List (PDL) Search
Preferred Drug List (PDL)
(PDF 1.19 MB) 

10/1/2017 PDL Update (PDF 60.09 KB)
7/1/2017 PDL Update (PDF 122.16 KB)
4/1/2017 PDL Update (PDF 163.76 KB)
1/1/2017 PDL Update (PDF 136.59 KB)


Step Therapy Information

Step Therapy Policy (PDF 21.02 KB) 

 

Medication Quantity Limits Initiative

New Opioid Quantity Limits (PDF 56.81 KB)
Monthly Prescription Limits (PDF 57.53 KB) 
Quantity Limit Policy (PDF 20.11 KB) 
Monthly Benefit Limits (PDF 48.85 KB)

 

Pharmacy Bulletins

Synagis Enrollment Form (PDF 225.02 KB)  
Synagis Program  (PDF 58.92 KB)
Synagis Program 5 Doses (PDF 51.26 KB)

 

Pharmacy Prior Authorization Forms

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

Pharmacy Prior Authorization Forms

Click on the arrow above to view the pharmacy prior authorization forms.

 

Pharmacy and Therapeutics (P&T) Committee Meeting Minutes 
(PDF 68.92 KB)

Second Quarter 2017 (PDF 68.92 KB) 
First Quarter 2017 (PDF 65.36 KB)
Fourth Quarter 2016  (PDF 63.05 KB)
Third Quarter 2016 (PDF 56.45 KB)
Second Quarter 2016 (PDF 36.32 KB) 

 


UnitedHealthcare Community Plan for Kids

Pharmacy Program 


Preferred Drug List and Updates

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

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

Preferred Drug List (PDL) Search 

Preferred Drug List (PDL) (PDF 1.19 MB)

Preferred Drug List Updates (PDF 57 KB)

 

Step Therapy Program

Step Therapy Policy (PDF 21.02 KB) 


Drug Quantity Limits Initiative

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

 

Pharmacy Bulletins 

Synagis Enrollment Form (PDF 225.02 KB)  
Synagis Program (PDF 58.92 KB) 
Synagis Program 5 Doses (PDF 51.26 KB)

 

Pharmacy Prior Authorization Forms

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

Pharmacy Prior Authorization Forms

Click on the arrow above to view the pharmacy prior authorization forms.


UnitedHealthcare Dual Complete® (HMO SNP)
H3113-009


UnitedHealthcare Dual Complete™ ONE (HMO SNP)
H3113-012