Unitedhealthcare community plan formulary drug list 2022

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Benefit

Preferred Drug List

Brand Name Drug Preferred List [79KB PDF] Updated November 3, 2022

Prior Authorization Requirements and Forms

Electronic Prior Authorizations [21KB PDF]

Drug Criteria

Summary of Drug Limitations, [930KB PDF] Updated October 31, 2022

Hernandez Settlement Agreement/Ombudsman Information/Pamphlet Reorder Form

Provider Synergies - Supplemental Rebate Process

List of Manufacturers with Federal Rebates [230KB PDF] Updated August 10, 2022

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4. Prescription Drug Lists

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Prescription Drug Lists

Check your PDL to stay updated on your pharmacy coverage

A Prescription Drug List (PDL) – also called a formulary – is a list of commonly used medications, organized into cost levels, called tiers. These costs are decided by your employer or health plan. View your PDL to learn what’s covered by your plan.

Health Insurance Marketplace and Small and Large Group plans

Learn about PDLs for health plans available through the Health Insurance Marketplace (also called State Exchange plans), Small Business Health Options Program (SHOP) and Small Group and Large Group plans. 

Sign in to view the PDL for your plan

Individual and SHOP Marketplace Drug Lists (On-Exchange)

• Individual Health Insurance Marketplace (if selecting a plan on your own)
• SHOP Marketplace (If selecting a plan through your job)

Small Group and Large Group Drug Lists (Off-Exchange)

Looking for information about Health Care Reform?

Find information about Affordable Care Act (ACA) plans.

View General Prescription Drug Lists (PDLs)

View the lists below to find general pharmacy benefits information for UnitedHealthcare plans, including certain PDLs. Remember, this is only general information. Sign in on myuhc.com or call the number on your health plan ID card to see your PDL and get specific information about your pharmacy benefits.

These PDLs are for general plans that include a pharmacy benefit.

• Specialty medications not eligible for coupons (1/1/2021)
• Split Fill Program Drug List 2019

Advantage

• Advantage Tier 3 Prescription Drug List for UnitedHealthcare, Neighborhood Health Plan, River Valley, All Savers, and Oxford medical plans (1/1/2023)
• Advantage Tier 3 Prescription Drug List for UnitedHealthcare, Neighborhood Health Plan, River Valley, All Savers, and Oxford medical plans (9/1/2022)
• Advantage Tier 4 Prescription Drug List for UnitedHealthcare, Golden Rule, UnitedHealthOne, Oxford, All Savers, Neighborhood Health Plan and River Valley medical plans (1/1/2023)
• Advantage Tier 4 Prescription Drug List for UnitedHealthcare, Golden Rule, UnitedHealthOne, Oxford, All Savers, Neighborhood Health Plan and River Valley medical plans (9/1/2022)

Access

• Access Tier 3 Prescription Drug List for UnitedHealthcare, Neighborhood Health Plan, River Valley and Oxford medical plans (1/1/2023)
• Access Tier 3 Prescription Drug List for UnitedHealthcare, Neighborhood Health Plan, River Valley and Oxford medical plans (9/1/2022)
• Access Tier 4 Prescription Drug List for UnitedHealthcare, Neighborhood Health Plan, River Valley and Oxford medical plans (1/1/2023)
• Access Tier 4 Prescription Drug List for UnitedHealthcare, Neighborhood Health Plan, River Valley and Oxford medical plans (9/1/2022)

Traditional

• Traditional Tier 3 Prescription Drug List for UnitedHealthcare, River Valley, Oxford and Student Resources medical plans (1/1/2023)
• Traditional Tier 3 Prescription Drug List for UnitedHealthcare, River Valley, Oxford and Student Resources medical plans (9/1/2022)
• Traditional Tier 4 Prescription Drug List for UnitedHealthcare and Student Resources medical plans (1/1/2023)
• Traditional Tier 4 Prescription Drug List for UnitedHealthcare and Student Resources medical plans (9/1/2022)

Essential

• Essential Tier 4 Prescription Drug List for UnitedHealthcare, All Savers, Golden Rule, Neighborhood Health Plan and River Valley medical plans (1/1/2023)
• Essential Tier 4 Prescription Drug List for UnitedHealthcare, All Savers, Golden Rule, Neighborhood Health Plan and River Valley medical plans (9/1/2022)

SignatureValue HMO (Non-California only. For California, view "California Plans" below.)

• SignatureValue HMO Formulary (5/1/2022)
• SignatureValue HMO Formulary (1/1/2022)

This drug list shows which drugs can be dispensed in quantities up to a 90-day or 100-day supply.

UnitedHealthcare Services Company of the River Valley, Inc.

• River Valley Pharmacy program 90/100 day list (1/1/2022)

Prescription Drug Lists for River Valley are found under "Standard drug lists" above.

Zero-cost preventive care medications

As part of Health Care Reform, health plans must cover certain Preventive Care Medications at no cost to you. Stay up to date on any changes in the law and get updates about Health Care Reform at healthcare.gov.

These lists are for general information only. Lists may change over time and some medications listed may not be covered by your specific plan.

To find the most updated information:

• Review your benefit documents.
• View current lists on myuhc.com.
• Call the phone number on your health plan ID card.

The health reform law (Affordable Care Act) requires most health plans to pay for birth control (contraceptives and sterilization) for women at no cost to you. Some organizations can choose not to cover birth control (contraceptives) as part of their group health plan for religious reasons. If you are a member of one of these groups (Eligible Organizations), UnitedHealthcare is required to cover certain birth control products and services at no cost to you.

You can use your Contraceptive Services Only ID card to get the birth control services, products and drugs on the Contraceptive Services Only drug list for $0 cost-share if they are:

• Prescribed by a health care professional such as your doctor
• For services performed by a network health care professional
• For products and drugs filled at a network pharmacy

Most Commonly Used Contraceptive Services Only drug lists:

• Contraceptive Services Only drug list (all states other than those below), effective July 1, 2019
• Emergency Contraceptive Services Only drug list (all states), effective July 1, 2019

If your benefit plan is based in California and fully insured:

• CA Contraceptive Services Only drug list, effective July 1, 2019

If your benefit plan is based in Connecticut, District of Columbia, Delaware, Illinois, Massachusetts, Maryland, Oregon, or Washington, and fully insured:

• CT/DC/DE/IL/MA/MD/OR/WA Contraceptive Services Only drug list, effective July 1, 2019

Preventive Medication List (optional add-on)

The below lists contain preventive medications that may be covered under your plan. If your plan has one of these lists, your insurance benefit may be applied before you meet your deductible for the listed preventive medications. Some medications may have other requirements or limits depending on your benefit plan.

These lists are for general information only. Lists may change over time and some medications listed may not be covered by your specific plan.

To find the most updated information:

• Review your benefit documents
• View current lists on myuhc.com
• Call the phone number on your health plan ID card

Vital Medication Program

This list includes certain classes of preferred drugs offered at no out-of-pocket cost to you. They include certain vital use drugs such as preferred insulins.

This list is for general information only. The drug list may change over time and may not be covered by your specific plan.

To find the most up-to-date information:

• Review your benefit documents
• View current lists on myuhc.com
• Call the phone number on your member ID card.

What type of medications are not covered on a formulary?

What drugs are in each tier?

What are Tier 5 medications?

Does UnitedHealthcare cover generic Adderall?