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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

 

Pharmacy Prior Authorization Forms for UnitedHealthcare Community Plan for Families and UnitedHealthcare Community Plan for Kids

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

UnitedHealthcare Community Plan for Families

Pharmacy Program

Preferred Drug List and Updates

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

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

Preferred Drug List (PDL) Search
Preferred Drug List (PDL)
(PDF 1.24 MB) 

1/1/2018 PDL Update (PDF 57.23 KB)
10/1/2017 PDL Update (PDF 60.09 KB)
7/1/2017 PDL Update (PDF 122.16 KB)
4/1/2017 PDL Update (PDF 163.76 KB)


Step Therapy Information

Step Therapy Policy (PDF 21.02 KB) 

 

Medication Quantity Limits Initiative

Opioid Changes (PDF 55.44 KB) - Updated 12.20.2017
Monthly Prescription Limits (PDF 57.53 KB) 
Quantity Limit Policy (PDF 20.11 KB) 
Monthly Benefit Limits (PDF 48.85 KB)

 

Pharmacy Bulletins

Synagis Enrollment Form (PDF 225.02 KB)  
Synagis Program  (PDF 58.92 KB)
Synagis Program 5 Doses (PDF 51.26 KB)

 

 

Pharmacy and Therapeutics (P&T) Committee Meeting Minutes

Fourth Quarter 2017 (PDF 44.2 KB) 
Third Quarter 2017 (PDF 56.74 KB)
Second Quarter 2017 (PDF 57.57 KB) 
First Quarter 2017 (PDF 57.96 KB)

 


UnitedHealthcare Community Plan for Kids

Pharmacy Program 


Preferred Drug List and Updates

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

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

Preferred Drug List (PDL) Search 

Preferred Drug List (PDL) (PDF 1.24 MB)

Preferred Drug List Updates (PDF 57 KB)

 

Step Therapy Program

Step Therapy Policy (PDF 21.02 KB) 


Drug Quantity Limits Initiative

Quantity Limit Policy (PDF 20.11 KB) 
Monthly Benefit Limit (PDF 48.85 KB)

 

Pharmacy Bulletins 

Synagis Enrollment Form (PDF 225.02 KB)  
Synagis Program (PDF 58.92 KB) 
Synagis Program 5 Doses (PDF 51.26 KB)

 


UnitedHealthcare Dual Complete® (HMO SNP)
H3113-009


UnitedHealthcare Dual Complete® ONE (HMO SNP)
H3113-012