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Pharmacy Program

 

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Looking for Paper Pharmacy Prior Authorization Fax Forms? They are now available at UHCprovider.com 

 

Opioid Program and Resources

In response to the U.S. opioid epidemic, UnitedHealthcare has developed programs to help our members receive the care and treatment they need safely and effectively.

We’ve also established measures based on the Centers for Disease Control and Prevention’s (CDC) opioid treatment guidelines to help prevent overuse of short-acting and long-acting opioid medications.

Resources from UnitedHealthcare and Optum

Naloxone Coverage for UnitedHealthcare Members (PDF 323.61 KB)
Naloxone: What You Need to Know
(PDF 62.67 KB)
Opioid Tapering Recommendations
(PDF 102.65 KB)
The Role of Dentists in Managing Opioids
(PDF 448.16 KB)
Treatment Alternatives for Common Pain Conditions 
(PDF 96.61 KB)


Other Resources

Agency for Healthcare Research and Quality (AHRQ)
Interagency Guideline on Prescribing Opioids for Pain

Centers for Disease Control and Prevention (CDC)
CDC Guideline for Prescribing Opioids for Chronic Pain (2016)
CDC Opioid Overdose Guideline Resources

Substance Abuse and Mental Health Services Administration (SAMHSA)
The Role of Prevention in Addressing Neonatal Abstinence Syndrome

 

Clinical Pharmacy Guidelines and Policies

UnitedHealthcare Community Plan’s Clinical Pharmacy Program Guidelines are updated on an ongoing basis by our Pharmacy and Therapeutics Committee. Our changes reflect recent developments in pharmaceutical health care so we’re aligned with national treatment standards.

These guidelines apply to the following plans:

  • Arizona AHCCCS/Medicaid
  • Arizona Children's Rehabilitative Services (CRS) Program
  • Arizona Developmentally Disabled Program
  • Arizona Long Term Care 

View Clinical Pharmacy Guidelines and Policies 

AHCCCS Complete Care


AHCCCS/Medicaid

Pharmacy Program 

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by AHCCCS/Medicaid.

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

Preferred Drug List (PDL) Search
AHCCCS/Medicaid Preferred Drug List  (PDF 1.1 MB)

7/1/2018 PDL Update (PDF 62.6 KB) 
4/1/2018 PDL Update (PDF 216.22 KB)
1/1/2018 PDL Update (PDF 157.01 KB)
10/1/2017 PDL Update (PDF 58.09 KB)

Step Therapy Information 

Step Therapy (PDF 21.02 KB)

 

Pharmacy Bulletins

UnitedHealthcare Community Plan Specialty Pharmacy Program Changes (PDF 246.6 KB)
Synagis Enrollment Form  (PDF 112.99 KB)
Synagis Program
(PDF 58.92 KB)
Synagis Program 5 Doses  (PDF 51.26 KB)


Children's Rehabilitative Services (CRS) Program

Pharmacy Program 

 

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by Children's Rehabilitative Services (CRS) Program. Click on the link below to view the Preferred Drug List.

Search for Drugs Covered by CRS 
Search for Drugs Covered by CRS - Partially Integrated Acute 
Search for Drugs Covered by CRS - Fully Integrated Acute 
Search for Drugs Covered by CRS - Partially Integrated Behavioral Health

Children's Rehabilitative Services Preferred Drug List (PDF 1.12 MB)
Preferred Drug List Updates (PDF 36.79 KB)

 

Step Therapy Information 

Step Therapy (PDF 21.02 KB)


Pharmacy Bulletins

UnitedHealthcare Community Plan Specialty Pharmacy Program Changes (PDF 246.6 KB) 
Synagis Enrollment Form (PDF 112.99 KB) 
Synagis Program (PDF 58.92 KB)
Synagis Program 5 Doses (PDF 51.26 KB)

 


Developmentally Disabled Program

Pharmacy Program 

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by Developmentally Disabled Program. Click on the link below to view the Preferred Drug List.

Preferred Drug List (PDL) Search
Developmentally Disabled Preferred Drug List (PDF 1.1 MB)

 

Step Therapy Information 

Step Therapy (PDF 21.02 KB)


Pharmacy Bulletins

UnitedHealthcare Community Plan Specialty Pharmacy Program Changes (PDF 246.6 KB) Synagis Enrollment Form (PDF 112.99 KB) 
Synagis Program (PDF 58.92 KB)
Synagis Program 5 Doses (PDF 51.26 KB)

 


KidsCare


Long Term Care

Pharmacy Program

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by Long Term Care. Click on the link below to view the Preferred Drug List.

Preferred Drug List (PDL) Search
Preferred Drug List  (PDF 1.25 MB)

7/1/2018 PDL Update (PDF 62.6 KB) 
4/1/2018 PDL Update (PDF 216.22 KB)
1/1/2018 PDL Update (PDF 157.01 KB)
10/1/2017 PDL Update (PDF 58.09 KB)


Step Therapy Program Information

Step Therapy Policy (PDF 21.02 KB)


Quantity Limit Initiatives

Quantity Limit Policy  (PDF 20.11 KB)


UnitedHealthcare Dual Complete® (HMO SNP)
H0321-002

Pharmacy Program 

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by UnitedHealthcare Dual Complete (HMO SNP) H0321-002. 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)

Submit a Pharmacy Prior Authorization Request to Prescription Solutions.

Request for Medicare Prescription Drug Determination Request form


UnitedHealthcare Dual Complete® (HMO SNP)
H5008-012


UnitedHealthcare Dual Complete® ONE (HMO SNP)
H0321-004

Pharmacy Program

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by UnitedHealthcare Dual Complete (HMO SNP) H0321-004. Click on the link below to view the Preferred Drug List.

Preferred Drug List (PDL) Search