Pharmacy

Our Prescription Drug List is a list of prescription medications, including brand name and generic medications, that have been approved by the United States Food and Drug Administration (FDA) as safe and effective. It is a tool that helps guide you and your patient in choosing medications that allow the most effective and affordable use of their pharmacy benefit. The Prescription Drug List is subject to review and modification.

Remember, your patients' pharmacy benefit plan determines their out-of-pocket costs. Here are some general guidelines for a standard three-tier pharmacy plan:

  • Tier 1 (formerly generic drugs) is the lowest copayment option.
  • Tier 2 (formerly formulary brand name drugs) is the middle copayment option.
  • Tier 3 (formerly non-formulary brand name drugs) is the highest copayment option.

To view the Physician Prescription Drug List follow these instructions:

  1. Go to www.unitedhealthcareonline.com
  2. Click the link in the upper navigation "Clinical Programs"
  3. Click the link in the left hand navigation "Pharmacy Programs"
  4. Click the link under Pharmacy Programs called "Prescription Drug List"

Specialty Pharmacy Program

Specialty medications are critical to improving the health and lives of individuals and are also some of the most expensive medications being used today. Specialty medications are typically more than $250 per prescription, in an injectable or oral form, treat chronic and complex diseases and typically require additional clinical support for better health outcomes.

We want to make these medications accessible and affordable for our members and employers. That’s why we offer the Specialty Pharmacy Program. For more information please visit UnitedHealthcare’s Specialty Pharmacy website:
www.uhcspecialty.com

Prior Authorization Requests

To promote the most appropriate utilization, selected high-risk or high-cost medications require prior authorization by the health plan to be eligible for coverage. Prior authorization criteria are established by the P&T committee with input from plan physicians and consideration of the current medical literature. In order for a customer to receive coverage for a medication requiring prior authorization, the physician must submit a Prior Authorization request online.

Click here to submit a Prior Authorization Request with OptumRx.