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Pharmacy Program 

 

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

Medicated Assisted Treatment: Locate a Provider (PDF 84.58 KB)
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

 

UnitedHealthcare Community Plan - IA Health Link


UnitedHealthcare Community Plan hawk-i

Pharmacy Program

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by Hawk-i.

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

Preferred Drug List (PDL) Search

Preferred Drug List

 

Pharmacy Prior Authorization Forms

Prior authorization is required for some services and medications. A current list of prior authorization services, medications and forms can be found below.

 

 

  • Acne and Rosacea Products - Topical (PDF 798.76 KB)
  • Alpha1-Proteinase Inhibitor Enzymes (PDF 37.29 KB)
  • Alpha 2 Agonist, Extended Release (PDF 74.41 KB)
  • Amprya (dlfampridine) (PDF 27.64 KB)
  • Amylino Mimetic (PDF 56.81 KB)
  • Antidepressant (PDF 29.33 KB)
  • Anti-Diabetic, Non-Insulin Agentsl (PDF 32.42 KB)
  • Antiemetic-5HT3 Receptor Antogonists / Substance P Neurokinin Agents (PDF 49.73 KB)
  • Antifungals (PDF 55.1 KB)
  • Antifungals for Onychomycosis - Topical (PDF 25.67 KB)
  • Antihistamines (PDF 46.68 KB)
  • Angiotension Receptor Blocker before ACE Inhibitor (PDF 44.92 KB)
  • Binge Eating Disorder Agents (PDF 35.87 KB)
  • Benzodiazepines (PDF 59.53 KB)
  • Biologicals for Ankylosing Spondylitis (PDF 62.81 KB)
  • Biologicals for Arthritis (PDF 40.93 KB)
  • Biologicals for Inflammatory Bowel Disease (PDF 63.02 KB)
  • Biologicals for Plaque Psoriasis (PDF 61.3 KB)
  • Buprenophine / Naloxone (PDF 81.43 KB)
  • Bystolic (nebivolol) (PDF 48.08 KB)
  • Cholbam (cholic acid) (PDF 69.93 KB)
  • Chronic Pain Syndromes (PDF 64.27 KB)
  • CNS Stimulants (PDF 640.91 KB)
  • Concurrent IM/PO Antipsychotic (PDF 743.27 KB)
  • Constipation Agents - Oral (PDF 86.99 KB)
  • Corticosteroids - Topical (PDF 24.45 KB)
  • Daliresp (roflumilast) (PDF 42.17 KB)
  • Duplicate Therapy Edit Override (PDF 744.47 KB)
  • Eliquis (apixaban) (PDF 49.4 KB)
  • Emflaza (deflazacort) (PDF 621 KB)
  • Entresto (valsartan/sacubitril) (PDF 626.36 KB)
  • Erythropoesis Stimulating Agents (PDF 30.53 KB)
  • Eucrisa (crisaborole) (PDF 630.19 KB)
  • Exjade (deferasirox) (PDF 36.5 KB)
  • Extended Release Formulation (PDF 26.55 KB)
  • Fentanyl, Short Acting Oral Products (PDF 57.82 KB)
  • Fifteen Day Initial Prescription Supply Override (PDF 25.62 KB)
  • GLP-1 Agonist / Basal Insulin Combinations (PDF 622.04 KB)
  • Granulocyte Colony Stimulating Factor (PDF 26.74 KB)
  • Growth Hormones (PDF 36.11 KB)
  • Hetlioz (tasimelteon) (PDF 30.85 KB)
  • Hepatitis C Treatments (PDF 777.73 KB)
  • Hepatitis C Post Treatment Information Sustained Virologic Response (SVR) Reporting (PDF 825.4 KB)
  • Idiopathic Pulmonary Fibrosis (PDF 53.14 KB)
  • Insulin, Pre-Filled Pens (PDF 55.69 KB)
  • Immunomodulators - Topical (PDF 29.34 KB)
  • Immunotherapy - Oral (PDF 79.81 KB)
  • Isotretinoin - Oral (PDF 57.64 KB)
  • Janus Kinase Inhibitors (PDF 34.91 KB)
  • Kalydeco (ivacaftor) (PDF 31.91 KB)
  • Ketorolac (PDF 35.45 KB)
  • Korlym (mifepristone) (PDF 26.12 KB)
  • Kuvan (sapropterin dihydrochloride) (PDF 644.97 KB)
  • Lidocaine Patch (lidoderm) (PDF 27.49 KB)
  • Long-Acting Opioids (PDF 843.44 KB)
  • Methotrexate Injection (PDF 60.44 KB)
  • Miscellaneous (PDF 44.25 KB)
  • Modified Formulations (PDF 27.65 KB)
  • Multiple Sclerosis Agents - Oral (PDF 50.14 KB)
  • Muscle Relaxants (PDF 33.2 KB)
  • Narcan (naloxone) Nasal Spray (PDF 778.78 KB)
  • Narcotic Agonist Antagonist Nasal Spray (PDF 57.32 KB)
  • New-to-Market Drugs (PDF 615.78 KB)
  • Nicotine Replacement Therapy (PDF 605.86 KB)
  • Non-Parenteral Vasopressin Derivatives (PDF 57.92 KB)
  • Non-Preferred Drug (PDF 25.33 KB)
  • Non-Steroidal Anti-Inflammatory Drugs (NSAID) (PDF 58.65 KB)
  • Nudexta (dextromethorphan / quinidine) (PDF 67.53 KB)
  • Orkambi (lumacaftor / ivacaftor) (PDF 40.82 KB)
  • Otezla (apremilast) (PDF 39.59 KB)
  • PCSK9 Inhibitors (PDF 836.96 KB)
  • Pradaxa (dabigatran) (PDF 59.3 KB)
  • Proton Pump Inhibitors (PPI) (PDF 36.33 KB)
  • Pulmonary Arterial Hypertension (PAH) Agents (PDF 49.93 KB)
  • Quantity Limit Override (PDF 48.08 KB)
  • Rayaldee (calcifediol) (PDF 655.35 KB)
  • Regranex (becaplermin) (PDF 55.48 KB)
  • Repository Corticotropin Injection (PDF 25.1 KB)
  • Re-Review Reconsideration Request Form (PDF 65.94 KB)
  • Savaysa (edoxaban) (PDF 51.85 KB)
  • Sedative / Hypnotic-Non-Benzodiazepine (PDF 61.47 KB)
  • Selected Brand Name Drug (PDF 62.26 KB)
  • Select Oncology Agents (PDF 29.58 KB)
  • Serotonin 5-HT1-Receptor Agonists (PDF 619.42 KB)
  • Short Acting Opiods (PDF 809.52 KB)
  • Smoking Cessation Therapy - Oral (PDF 529.51 KB)
  • Synagis (pavilizumab) (PDF 34.23 KB)
  • Testosterone Products (PDF 70.42 KB)
  • Thrombopoietin Receptor Agonists (PDF 76.41 KB)
  • Uloric (febuxostat) (PDF 34.38 KB)
  • Viberzi (eluxadoline) (PDF 649.99 KB)
  • Vitamins Minerals and Multiple Vitamins (PDF 22.28 KB)
  • Vusion Ointment (PDF 51.96 KB)
  • Xarelto (rivaroxaban) (PDF 93.58 KB)
  • Xyrem (sodium oxybate) (PDF 58.95 KB)
  • Zontivity (vorapaxar) (PDF 641.96 KB)
  • Zurampic (lesinurad) (PDF 641.96 KB)
  • Zyvox (linezolid) (PDF 57.79 KB)
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    UnitedHealthcare Dual Complete® (HMO SNP)
    H0169-001



    NCQA Accredited HealthPlan