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Drug Lists and Pharmacy

Real Savings, Real Results

PreCheck MyScript integrated directly within your EMR allows you to easily run a pharmacy trial claim and get real-time prescription coverage detail for your UnitedHealthcare patients.

Read the transcript to the PreCheck MyScript introduction video

UnitedHealthcare now offers the option to enroll in emailing clinical information for prior authorization and appeal requests for Medicare pharmacy claims. This process will allow you to send and receive clinical documents in a secure, HIPAA-compliant, electronic environment, allowing you more time with your patients and less time on paperwork.

Video: Learn how to save time by sending and receiving documents electronically

These UnitedHealthcare reference documents provide prior authorization, notification and medical necessity coverage criteria for medications with utilization management programs in place.

UnitedHealthcare’s Step Therapy program helps encourage use of less expensive, but similarly effective medications. Members must try a lower-cost medication (known as step 1) before progressing to a higher-cost alternative (known as step 2).

Find Commercial Pharmacy Specific Step Therapy Programs.

Supply limits are based on several factors including Food and Drug Administration (FDA) approved dosing, medical literature and other supportive and analytic data.

Quantity Duration (QD) limits define the maximum quantity of medications that may be covered in a specified time period. For example, 30 units or 1,000 mg per month.

Quantity Level Limits (QLLs) define the maximum quantity of medications that may be covered per prescription or copayment. For example, 30 units per prescription.

Specialty pharmacies focus primarily on specialty medications that need special handling and storage. They can also provide extra services such as clinical support and education for members.

Learn more about the Specialty Pharmacy Program.

Members who have questions about their specialty drug coverage should call the Customer Service number listed on the back of their Medical ID Card.

UnitedHealthcare is confronting the opioid epidemic from all angles. We’re joining with care providers and communities to prevent opioid misuse and addiction. Through touch points, we help support safe and appropriate opioid use right from the start.

To help with this effort, we developed the following UnitedHealthcare pharmacy-based programs to align with The Centers for Medicare and Medicaid Services (CMS) Medicare Part D Opioid Overutilization Policy.

These programs are specific to UnitedHealthcare Medicare Advantage and Prescription Drug Plans.

Resources from UnitedHealthcare

Resources from The Centers for Medicare & Medicaid Services (CMS)

The following formularies are unique to individuals covered under The New York State Empire Plan.

UnitedHealthcare Oxford offers these pharmacy resources to help care providers manage prescription drug coverage and ensure appropriate use of medications for members.

In addition to other applicable clinical programs as noted in the Prior Authorization, Step Therapy, and Specialty Pharmacy sections, the programs below are uniquely for Oxford lines of business.

For additional information visit, UnitedHealthcare Oxford Health

Total Health Care Approach

UnitedHealthcare makes pharmacy coverage decisions based on an understanding of how our coverage affects total health care. We do this by integrating pharmacy coverage with medical management, accessing information in a database including pharmacy, medical and laboratory data.

Evidence-Based Care

Pharmacy is one of the most highly used benefits. Our goal is to provide members with wide-ranging, cost-effective medication choices. We review clinical and pharmacoeconomic evidence when developing our prescription drug list (PDL) and clinical programs. This evidence helps us determine a medication's overall value relative to other medications in its class so we can effectively manage overall cost and care.

Member Engagement

Our personalized member engagement strategies aim to make health care work better for members. When provided with the right resources, a member can be empowered to discuss their options with their care providers and help make more educated decisions.

NOTE: The information on this website is intended to provide general pharmacy information for care providers. The information on this site is NOT specific to a member’s benefit plan.