UnitedHealthcare Community Plan
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Commonwealth Coordinated Care Plus
(CCC Plus)

Pharmacy Program

 



Preferred Drug List 

Preferred Drug List (PDL) Search
Preferred Drug List
(PDF 2.38 MB) 

 

Pharmacy Prior Authorization Forms       

 

 

  • Anti-Allergens (PDF 73.1 KB)
  • Antipsychotics in Children (PDF 72.12 KB)
  • Carisoprodol Products (PDF 71.36 KB)
  • Celebrex (PDF 71.46 KB)
  • Cephalosporins (PDF 68.07 KB)
  • Cialis (PDF 66.62 KB)
  • Colcrys (PDF 67.75 KB)
  • Daliresp (PDF 113.17 KB)
  • Dermatologic Acne Agents (PDF 67.27 KB)
  • Diabetes Hypoglycemics – Symlin (PDF 67.27 KB)
  • Dronabinol (PDF 72.49 KB)
  • Emflaza (PDF 65.98 KB)
  • Enstilar (PDF 67.47 KB)
  • Entresto (PDF 66.67 KB)
  • Forteo / Tymlos (PDF 74.88 KB)
  • General Non-Preferred Medications (PDF 66.4 KB)
  • GI Antibiotics (PDF 74.53 KB)
  • GI Motility (PDF 80.98 KB)
  • Hemangeol (PDF 66.32 KB)
  • Hereditary Angioedema Agents (PDF 74.54 KB)
  • Hetlioz (PDF 66.92 KB)
  • Inhaled Antibiotics-Tobi Podhaler (PDF 66.83 KB)
  • Lyrica (PDF 66.36 KB)
  • Macrolides and Ketolides (PDF 72.75 KB)
  • Methadone (PDF 97.51 KB)
  • Nuplazid (PDF 66.57 KB)
  • Omega-3 Fatty Acid Agents (PDF 67.78 KB)
  • Onfi (PDF 67.19 KB)
  • Opiod Dependency (PDF 73.89 KB)
  • Opioid Medications (PDF 154.28 KB)
  • Ortrexup (PDF 71.95 KB)
  • Oxybutynin ER / Ditropan XL (PDF 66.6 KB)
  • Pancreatic Enzymes (PDF 72.27 KB)
  • Phosphodiesterase 5 Inhibitors (Adcirca, Sildenafil, Revatio) (PDF 72.09 KB)
  • Platelet Inhibitors (Durlaza, Yosprala, Zontivity) (PDF 73.14 KB)
  • Proton Pump Inhibitors (PDF 71.78 KB)
  • Provigil and Nuvigil (PDF 71.53 KB)
  • Quinolones (PDF 68.18 KB)
  • Savaysa (PDF 67.95 KB)
  • Sernivo (PDF 67.52 KB)
  • SGLT-2 Inhibitors (PDF 71.95 KB)
  • Stimulants / ADHD Medications (PDF 72.93 KB)
  • Topical NSAIDs (PDF 71.44 KB)
  • Xeljanz (PDF 119.07 KB)
  • Zurampic (PDF 71.73 KB)
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