UnitedHealthcare Community Plan
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Pharmacy Program

 

UnitedHealthcare Community Plan

Pharmacy Program

 

Preferred Drug List and Updates

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by UnitedHealthcare Community Plan.

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

Preferred Drug List (PDL) Search
Preferred Drug List (PDF 1.65 MB)

10/1/2017 PDL Update  (PDF 60.16 KB)
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)

 

Step Therapy Program

Step Therapy Policy (PDF 21.02 KB)
 

Drug Quantity Limits Initiative

Quantity Limit Policy (PDF 20.11 KB)
 

Pharmacy Bulletins

Synagis Enrollment Form (PDF 205.63 KB)  
Synagis Program (PDF 58.92 KB)    
Synagis Program 5 Doses (PDF 51.26 KB)

 

Pharmacy Prior Authorization and Medical Exception 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 and Medical Exception Forms

Click on the arrow above to view the pharmacy prior authorization forms.


UnitedHealthcare Dual Complete® (HMO SNP)
H5008-002

Pharmacy Program

 

Preferred Drug List

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by Dual Complete (HMO SNP) H5008-002.

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

Preferred Drug List (PDL) Search

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

 

Pharmacy Forms 

Submit a Pharmacy Prior Authorization Request to Prescription Solutions.

Medicare Prescription Drug Determination Request Form