UnitedHealthcare Community Plan
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Pharmacy Program

 

UnitedHealthcare Community Plan for Families

Pharmacy Program


PDL and Updates

Preferred Drug List (PDL) Search
Preferred Drug List
(PDF 915.44 KB)

4/1/2017 PDL Update (PDF 163.76 KB)
1/1/2017 PDL Update (PDF 136.59 KB)
10/1/2016 PDL Update (PDF 52.88 KB)
8/1/2016 PDL Update (PDF 63.87 KB)


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 

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) 
First Quarter 2016 (PDF 44.62 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   


UnitedHealthcare Community Plan for Kids

Pharmacy Program 

Preferred Drug List (PDL) Search 

PDL and Updates 
Preferred Drug List (PDF 915.11 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


UnitedHealthcare Dual Complete® (HMO SNP)
H3113-009


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