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Pharmacy Program

 

Children with Special Health Care Needs

Pharmacy Program

 

Preferred Drug List and Updates

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by Children with Special Health Care Needs.

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

Preferred Drug List (PDL) Search
Preferred Drug List
(PDF 1.09 MB)

7/1/2017 PDL Update (PDF 131.46 KB)
4/1/2017 PDL Update (PDF 60.71 KB)
1/1/2017 PDL Update (PDF 227.42 KB) 
10/1/2016 PDL Update (PDF 51.69 KB)

 

Step Therapy Program 

Step Therapy (PDF 21.03 KB)

 

Specialty Pharmacy 

BriovaRx, the OptumRx specialty pharmacy, is a leading specialty pharmacy services company dedicated to helping administer and deliver high-quality, cost-effective specialty pharmacy care.

Specialty Pharmacy Information

 

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)
H3113-010


UnitedHealthcare RIte Care

Pharmacy Program 

 

Preferred Drug List and Updates

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by RIte Care.

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

Preferred Drug List (PDL) Search
Preferred Drug List
(PDF 1.09 MB)

7/1/2017 PDL Update (PDF 131.46 KB)
4/1/2017 PDL Update (PDF 60.71 KB)
1/1/2017 PDL Update (PDF 227.42 KB) 
10/1/2016 PDL Update (PDF 51.69 KB)

 

Step Therapy Program 

Step Therapy (PDF 21.03 KB)

 

Specialty Pharmacy

BriovaRx, the OptumRx specialty pharmacy, is a leading specialty pharmacy services company dedicated to helping administer and deliver high-quality, cost-effective specialty pharmacy care.

Specialty Pharmacy Information

 

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 Rhody Health Partners

Pharmacy Program 

 

Preferred Drug List and Updates

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by Rhody Health Partners.

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

Preferred Drug List (PDL) Search
Preferred Drug List (PDF 1.09 MB)

7/1/2017 PDL Update (PDF 131.46 KB)
4/1/2017 PDL Update (PDF 60.71 KB)
1/1/2017 PDL Update (PDF 227.42 KB)
10/1/2016 PDL Update (PDF 51.69 KB)

 

Step Therapy Program 

Step Therapy (PDF 21.03 KB)

 

Specialty Pharmacy

BriovaRx, the OptumRx specialty pharmacy, is a leading specialty pharmacy services company dedicated to helping administer and deliver high-quality, cost-effective specialty pharmacy care.

Specialty Pharmacy Information

 

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 Rhody Health Partners ACA Adult Expansion

Pharmacy Program 

 

Preferred Drug List and Updates

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by Rhody Health Partners ACA Adult Expansion.

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

Preferred Drug List (PDL) Search
Preferred Drug List  (PDF 1.09 MB)

7/1/2017 PDL Update (PDF 131.46 KB)
4/1/2017 PDL Update (PDF 60.71 KB)
1/1/2017 PDL Update (PDF 227.42 KB)
10/1/2016 PDL Update (PDF 51.69 KB)

 

Step Therapy Program 

Step Therapy (PDF 21.03 KB)

 

Specialty Pharmacy

BriovaRx, the OptumRx specialty pharmacy, is a leading specialty pharmacy services company dedicated to helping administer and deliver high-quality, cost-effective specialty pharmacy care.

Specialty Pharmacy Information

 

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.