UnitedHealthcare Community Plan
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Pharmacy Program

 

Children with Special Health Care Needs

Pharmacy Program 

 

Preferred Drug List (PDL) Search
Preferred Drug List
(PDF 1.11 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 (PDF 21.03 KB)
Specialty Pharmacy Information

 

Pharmacy Bulletins

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

Direct Acting Antiviral (DAA) Policy (PDF 111.03 KB)


Pharmacy Prior Authorization Forms 


UnitedHealthcare Dual Complete® (HMO SNP)
H3113-010


UnitedHealthcare RIte Care

Pharmacy Program  (PDF 113.34 KB)

Preferred Drug List (PDL) Search
Preferred Drug List
(PDF 1.11 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 (PDF 21.03 KB)
Specialty Pharmacy Information

 

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 Rhody Health Partners

Pharmacy Program 

Preferred Drug List (PDL) Search
Preferred Drug List (PDF 1.11 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 (PDF 21.03 KB)
Specialty Pharmacy Information


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 Rhody Health Partners ACA Adult Expansion

Pharmacy Program 

Preferred Drug List (PDL) Search
Preferred Drug List  (PDF 1.11 MB)
(PDF 48.99 KB)

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 (PDF 21.03 KB)
Specialty Pharmacy Information

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