UnitedHealthcare Community Plan
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UnitedHealthcare Community Plan

Pharmacy Program


Preferred Drugs

Preferred Drug List (PDL) Search
Preferred Drug List (PDF 1.14 MB)

7/1/2017 PDL Update (PDF 134.94 KB)
4/1/2017 PDL Update (PDF 62.28 KB)
1/1/2017 PDL Update
(PDF 61.94 KB)
10/1/2016 PDL Update
(PDF 52.51 KB)

Step Therapy Information

Step Therapy Policy (PDF 21.02 KB)

Quantity Limit Initiatives

Quantity Limit Policy (PDF 20.11 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 and Medical Exception Forms

UnitedHealthcare Dual Complete® (HMO SNP)

Preferred Drug List (PDL) Search

Download the Acrobat version of the Preferred Drug List (PDL)

Submit a Pharmacy Prior Authorization Request to Prescription Solutions.


Request for Medicare Prescription Drug Determination Request form