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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

 

Commonwealth Coordinated Care Plus
(CCC Plus)

Pharmacy Program

 

Preferred Drug List 

Preferred Drug List (PDL) Search

Preferred Drug List (PDF 1.99 MB)

1/1/2018 PDL Update  (PDF 159.71 KB)

 

Medical Injectables 

Specialty pharmacy medications covered under the member’s medical benefit may be obtained through various sources ‒ home infusion providers, outpatient facilities, physicians or specialty pharmacy.

Specialty pharmacy medications covered under the member’s medical benefit may be obtained through various sources ‒ home infusion providers, outpatient facilities, physicians or specialty pharmacy.

If you don’t want to buy and bill a specialty pharmacy medication covered under the member’s medical benefit, you may order it through the following network specialty pharmacy:

Network Specialty Pharmacy

Phone Number

BriovaRx

855-427-4682

The following specialty pharmacies also provide certain types of specialty medications:

Network Specialty Pharmacy

Medication Category

Phone Number

Accredo (nursing services)

Enzyme Deficiency

Gaucher's Disease

Immune Globulin

Pulmonary Hypertension

800-803-2523

 

Option Care (nursing services)

Enzyme Deficiency

Gaucher's Disease

Hemophilia

Immune Globulin

Makena

866-827-8203

CVS Caremark Specialty Pharmacy

Pulmonary Hypertension

800-237-2767


Coverage of a requested medication depends on the member’s benefit, and availability of a specific drug from a network specialty pharmacy may vary.

Upon request, a specialty pharmacy can deliver the medication to your office or another site such as a member’s home.

Medications obtained through a specialty pharmacy will be directly billed to the patient’s health plan.

Pharmacy Prior Authorization Forms

View the current pharmacy prior authorization forms below.   

 

 

  • Actimmune (PDF 75.34 KB)
  • ADHD Medications, Non-Stimulant (PDF 74.01 KB)
  • ADHD Medications, Stimulant (PDF 158.07 KB)
  • Alecensa (PDF 66.61 KB)
  • Alfa Interferons (PDF 156.8 KB)
  • Anthelmintics (PDF 67.33 KB)
  • Anti-Allergens (PDF 73.1 KB)
  • Antipsychotic Medications for Children (PDF 153.93 KB)
  • Apokyn (PDF 155.17 KB)
  • Arcalyst (PDF 156.76 KB)
  • Biltricide (PDF 66.57 KB)
  • Bosulif (PDF 71.9 KB)
  • Buphenyl (PDF 66.16 KB)
  • Cabometyx (PDF 67.28 KB)
  • Calquence (PDF 67.55 KB)
  • Caprelsa (PDF 72.07 KB)
  • Carbaglu (PDF 66.51 KB)
  • Carisoprodol Products (PDF 75.58 KB)
  • Celebrex (PDF 71.46 KB)
  • Cephalosporins (PDF 68.07 KB)
  • Cialis (PDF 66.62 KB)
  • Colcrys (PDF 67.75 KB)
  • Colony Stimulating Factors (PDF 190.49 KB)
  • Complera (PDF 71.44 KB)
  • Compound Medications (PDF 149.08 KB)
  • Copper Chelating Agents (PDF 71.14 KB)
  • Corlanor (PDF 156.26 KB)
  • Cotellic (PDF 73.85 KB)
  • Cystaran (PDF 67.06 KB)
  • Daliresp (PDF 113.17 KB)
  • Daraprim (PDF 72.87 KB)
  • Deferasirox Products (Exjade / Jadenu) (PDF 74.65 KB)
  • Dermatologic Acne Agents (PDF 67.27 KB)
  • Diabetes Hypoglycemics (Symlin) (PDF 67.27 KB)
  • Dronabinol (PDF 72.49 KB)
  • Dry Eye Disease (PDF 73.23 KB)
  • Duopa (PDF 156.29 KB)
  • Egrifta (PDF 150.64 KB)
  • Elmiron (PDF 150.58 KB)
  • Emflaza (PDF 65.98 KB)
  • Endari (PDF 161.19 KB)
  • Enstilar (PDF 67.47 KB)
  • Entresto (PDF 66.67 KB)
  • Erivedge (PDF 71.48 KB)
  • Farydak (PDF 71.37 KB)
  • Forteo / Tymlos (PDF 74.88 KB)
  • Gattex (PDF 67.21 KB)
  • General Non-Preferred Medications (PDF 66.4 KB)
  • Genvoya (PDF 71.55 KB)
  • GI Antibiotics (PDF 74.53 KB)
  • GI Motility (PDF 171.2 KB)
  • Gilotrif (PDF 72.96 KB)
  • Gleevec (PDF 167.11 KB)
  • Gonadotropin-Releasing Hormone Agonists (PDF 80.34 KB)
  • Growth Hormone (PDF 494.13 KB)
  • HCG (PDF 150.95 KB)
  • Hemangeol (PDF 66.32 KB)
  • Hereditary Angioedema Agents (PDF 166.01 KB)
  • Hepatitis C Medications (PDF 276.15 KB)
  • Hetlioz (PDF 66.92 KB)
  • Hycamtin (PDF 70.68 KB)
  • Ibrance (PDF 71.48 KB)
  • Iclusig (PDF 71.86 KB)
  • Idiopathic Pulmonary Fibrosis (IPF) Agents (PDF 72 KB)
  • Ilaris (PDF 252.31 KB)
  • Imbruvica (PDF 160.23 KB)
  • Impavido (PDF 152.8 KB)
  • Increlex (PDF 78.21 KB)
  • Inhaled Antibiotics (Tobi Podhaler) (PDF 66.74 KB)
  • Inlyta (PDF 71.98 KB)
  • Iressa (PDF 159.38 KB)
  • Isotrentinoin (PDF 79.84 KB)
  • Jakafi (PDF 71.33 KB)
  • Juxtapid / Kynamro (PDF 67.88 KB)
  • Kalydeco (PDF 72.04 KB)
  • Keveyis (PDF 156.02 KB)
  • Korlym (PDF 71.1 KB)
  • Kuvan (PDF 66.9 KB)
  • Lenvima (PDF 74.13 KB)
  • Long-Acting Beta Adrenergics (PDF 67.58 KB)
  • Lonsurf (PDF 72.1 KB)
  • Lynparza (PDF 167.76 KB)
  • Lyrica (PDF 151.63 KB)
  • Lysteda (PDF 66.88 KB)
  • Macrolides / Ketolides (PDF 72.75 KB)
  • Mekinist (PDF 71.33 KB)
  • Mepron (PDF 71.67 KB)
  • Methadone (PDF 200.9 KB)
  • Migranal (PDF 166.08 KB)
  • Mozobil (PDF 70.99 KB)
  • Multaq (PDF 155.65 KB)
  • Multiple Scelorsis (MS) Agents (PDF 74.92 KB)
  • Myalept (PDF 157.67 KB)
  • Mytesi (PDF 150.76 KB)
  • Natpara (PDF 155.16 KB)
  • Nerlynx (PDF 152.33 KB)
  • Nexavar (PDF 77.05 KB)
  • Ninlaro (PDF 71.14 KB)
  • Northera (PDF 162.18 KB)
  • Nuedexta (PDF 71.05 KB)
  • Nuplazid (PDF 66.57 KB)
  • Odomzo (PDF 70.92 KB)
  • Omega-3 Fatty Acid Agents (PDF 67.78 KB)
  • Onfi (PDF 67.19 KB)
  • Opioid Dependency (PDF 73.89 KB)
  • Opioid Products (PDF 476.18 KB)
  • Orfadin (PDF 71.06 KB)
  • Orkambi (PDF 72.24 KB)
  • Ortrexup (PDF 71.95 KB)
  • Oxybutynin ER / Ditropan XL (PDF 66.6 KB)
  • Pancreatic Enzymes (PDF 72.27 KB)
  • Panretin (PDF 67.14 KB)
  • PCSK9 Inhibitors (PDF 90.91 KB)
  • Phosphodiesterase 5 Inhibitors (Adcirca / Sildenafil / Revatio) (PDF 72.09 KB)
  • Platelet Inhibitors (Durlaza / Yosprala / Zontivity) (PDF 73.14 KB)
  • Pomalyst (PDF 71.68 KB)
  • Procysbi (PDF 153.8 KB)
  • Promacta (PDF 157.13 KB)
  • Proton Pump Inhibitors (PDF 71.78 KB)
  • Provigil / Nuvigil (PDF 71.53 KB)
  • Pulmozyme (PDF 71.14 KB)
  • Quinolones (PDF 68.18 KB)
  • Ranexa (PDF 155.38 KB)
  • Ravicti (PDF 72.23 KB)
  • Rectiv (PDF 66.76 KB)
  • Regranex (PDF 151.67 KB)
  • Revlimid (PDF 75.08 KB)
  • Rubraca (PDF 71.28 KB)
  • Samsca (PDF 153.03 KB)
  • Sandostatin (PDF 162.1 KB)
  • Savaysa (PDF 67.95 KB)
  • Sensipar (PDF 72.16 KB)
  • Sernivo (PDF 67.52 KB)
  • SGLT-2 Inhibitors (PDF 71.95 KB)
  • Siliq (PDF 159.04 KB)
  • Signifor (PDF 71.47 KB)
  • Somavert (PDF 72.7 KB)
  • Soriatane (PDF 80.75 KB)
  • Specialty Medication Cover Sheet (PDF 72.32 KB)
  • Sprycel (PDF 157.32 KB)
  • Stivarga (PDF 73.32 KB)
  • Strensiq (PDF 161.32 KB)
  • Stribild (PDF 71.5 KB)
  • Sutent (PDF 80.61 KB)
  • Synagis (PDF 225.02 KB)
  • Tagrisso (PDF 161.03 KB)
  • Tafinlar (PDF 71.16 KB)
  • Tarceva (PDF 170.64 KB)
  • Targretin (PDF 154.82 KB)
  • Tasigna (PDF 161.44 KB)
  • Temodar (PDF 76.43 KB)
  • Thalomid (PDF 74.07 KB)
  • Topical Androgens (PDF 161.18 KB)
  • Topical NSAIDs (PDF 71.44 KB)
  • Tykerb (PDF 73.4 KB)
  • Vecamyl (PDF 153.38 KB)
  • Veltassa (PDF 77.46 KB)
  • Vemlidy (PDF 157.84 KB)
  • Venclexta (PDF 71.07 KB)
  • Verzenio (PDF 156.51 KB)
  • Votrient (PDF 180.65 KB)
  • Xalkori (PDF 163.82 KB)
  • Xeljanz (PDF 119.07 KB)
  • Xenazine (PDF 71.8 KB)
  • Xermelo (PDF 155.17 KB)
  • Xtandi (PDF 156.08 KB)
  • Xolair (PDF 81.06 KB)
  • Xuriden (PDF 152.07 KB)
  • Xyrem (PDF 167.24 KB)
  • Zelboraf (PDF 71.71 KB)
  • Zolinza (PDF 154.26 KB)
  • Zurampic (PDF 71.73 KB)
  • Zydelig (PDF 72.07 KB)
  • Zykadia (PDF 71.18 KB)
  • Zytiga (PDF 66.86 KB)
  • Zyvox (PDF 182.67 KB)
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    UnitedHealthcare Dual Complete® (HMO SNP)
    H7464-001


    UnitedHealthcare Dual Complete® RP (Regional PPO SNP)
    R1548-001