Clinical Pharmacy Clinical Guidelines & Policies - UnitedHealthcare Community Plan of Arizona

UnitedHealthcare Community Plan’s Clinical Pharmacy Program Guidelines are updated on an ongoing basis by our Pharmacy and Therapeutics Committee. Our changes reflect recent developments in pharmaceutical health care so we’re aligned with national treatment standards.

These guidelines apply to the following plans:

Arizona AHCCCS Complete Care / Medicaid
Arizona Developmentally Disabled (DD) Program
Arizona Long Term Care

Azelastine Ophthalmic Solution - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 02.21.2020

Azelastine Ophthalmic Solution,
Actemra - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Acthar Gel - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.01.2020
Actimmune - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
ADHD Products - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Aemcolo - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.01.2020
Afinitor - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Afrezza - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Alecensa - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Alfa Interferons - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Alinia - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Alinia (nitazoxanide)
Alunbrig - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Alzheimer's Agents - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Ampyra - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Anthelmintics - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Anticonvulsants - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Antidepressants - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Antiemetics - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Antiglaucoma Agents - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Antipsoriatic Agents - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Calcipotriene cream, calcipotriene ointment, calcitriol ointment
Antipsychotics - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.01.2020
Apokyn - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Aquadeks - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 04.24.2019
Aralast NP - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Arcalyst - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.01.2020
Arikayce - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.01.2020
Austedo - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Ayvakit - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Azole Antifungals - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.30.2019

Sporanox (itraconazole) capsules, Sporanox (itraconazole) oral solution, Onmel (itraconazole) tablets, Vfend (voriconazole) tablets, Vfend (voriconazole) powder for oral suspension, Noxafil (posaconazole) tablets, Noxafil (posaconazole) oral suspension, Cresemba (isavuconazonium) capsules, Tolsura (itraconazole) capsule
Balversa - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.30.2019

Balversa (erdafitinib)
Belbuca / Butrans - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.27.2019

Belbuca (buprenorphine hydrochloride film), Butrans (buprenorphine patch, extended-release)
Benlysta - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Benznidazole - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.31.2020
Berinert - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 09.29.2019

Berinert® (C1 esterase inhibitor, human)
Berinert - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Biltricide - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 02.21.2020

Biltricide (praziquantel),
Bonjesta and Diclegis - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.28.2019

Diclegis (doxylamine/pyridoxine), Bonjesta (doxylamine/pyridoxine extended-release)
Bosulif - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.01.2020
Braftovi - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Breast Cancer - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Brilinta / Effient - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Brilinta (ticagrelor), Effient (prasugrel)
Buphenyl - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Cablivi - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.01.2020
Cabometyx - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.31.2020
Calquence - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.01.2020
Caprelsa - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Carbaglu - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Cayston - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.01.2020
Celebrex - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.31.2020
Cesamet, Marinol, Syndros - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.27.2019

Cesamet (nabilone), Marinol (dronabinol), Syndros (dronabinol) oral solution
CGRP - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Cholbam - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.31.2020
Cialis - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.01.2020
Cimzia - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Cinryze - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Ciprodex - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.31.2020
CMV and Herpes Virus Agents - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Colcrys - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Colony Stimulating Factors - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 03.31.2020
Combination Basal Insulin/GLP-1 Receptor Agonist - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.01.2020
Combination DPP4-SGLT2 - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Cometriq - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Complement Inhibitors - Soliris - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 03.04.2020

Complement Inhibitors (Soliris),
Compounds and Bulk Powders - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Constipation Agents - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 03.31.2020
Copiktra - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Copiktra® (duvelisib)
Copper Chelating Agents - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Corlanor - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Corlanor® (ivabradine) tablets and oral solution
Cosentyx - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Cotellic - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Cotellic® (cobimetinib)
Cystaran - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Daliresp - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.27.2019

Daliresp (roflumilast)
Daraprim - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Daurismo - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 03.31.2020
DDAVP - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Declomycin - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Dificid - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.01.2020
Dofetilide - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Doptelet - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.01.2020
DPP-4 Inhibitors - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 02.21.2020

Preferred Products: Tradjenta (linagliptin), Januvia (sitagliptin), Onglyza (saxagliptin), Kombiglyze XR (saxagliptin/metformin extended release), Janumet (sitagliptin/metformin), Janumet XR (sitagliptin/metformin extended-release), Jentadueto (linagliptin/metformin). Non-Preferred Products: alogliptin, alogliptin/metformin, alogliptin/pioglitazone, Jentadueto XR (linagliptin/metformin extended-release).,
Dry Eye Disease - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.01.2020
Duexis and Vimovo - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Duopa - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Dupixent (dupilumab) - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Egrifta - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.01.2020
Elidel and Protopic - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Elmiron - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.27.2019

Elmiron (pentosan polysuflate sodium)
Emflaza - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.27.2019

Emflaza (deflazacort)
Emsam - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Enbrel - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Endari - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.01.2020
Entocort - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 02.21.2020

Entocort EC (budesonide),
Entresto - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Entresto (valsartan-sacubitril)
Epaned - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Eplerenone - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Erivedge - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Erleada (apalutmide) - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Erleada (apalutamide)
Erythropoietic Agents - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Esbriet, Ofev - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.01.2020
Estrogens - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Etoposide - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Eucrisa - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Evrysdi - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Exondys - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.01.2020
Farydak - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.31.2020
Fasenra - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 02.21.2020

Fasenra Pen™ (benralizumab),
Fenofibrate - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.01.2020
Fentanyl IR - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.27.2019

Abstral (fentanyl sublingual tablets), Actiq (fentanyl transmucosal lozenge), Fentora (fentanyl buccal tablet), Lazanda (fentanyl nasal spray), Subsys (fentanyl sublingual spray), and fentanyl citrate
Fexmid (cyclobenzaprine 7.5mg) - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.01.2020
Firazyr - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Firdapse - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.27.2019

Firdapse (amifampridine)
Flucytosine - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Forteo - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Galafold - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.27.2019

Galafold (migalastat)
Gattex - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Gaucher’s Disease Agents - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Gilotrif (afatinib) - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Gleevec - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.27.2019

Gleevec (imatinib mesylate)
GLP-1-Agonists - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Glumetza-Fortamet-Glucophage XR - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.28.2019

Fortamet (metformin extended-release, brand and generic), Glucophage XR (metformin extended-release, brand only) and Glumetza (metformin extended-release, brand and generic)
Gonadotropin-Releasing Hormone Agonists - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Gralise, Horizant - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Haegarda - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
HCG - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.01.2020
Hemangeol - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Hemangeol (propranolol hydrochloride oral solution)
Hemlibra - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Hemophilia Products - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 02.25.2019
Hepatitis B - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Hepatitis-C-Agents - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.21.2020

Preferred Agents: Mavyret™(glecaprevir/pibrentasvir) Sofosbuvir/Velpatasvir (Authorized generic of Epclusa). Non-Preferred Agents: Daklinza® (daclatasvir), Epclusa (sofosbuvir/velpatasvir), Harvoni™ (ledipasvir/sofosbuvir), ledipasvir/sofosbuvir (authorized generic of Harvoni), Olysio® (simeprevir), Sovaldi® (sofosbuvir), Technivie™ (ombitasvir, paritaprevir, and ritonavir tablets), Viekira Pak™ (ombitasvir, paritaprevir, and ritonavir tablets; dasabuvir tablets), Viekira XR™ (dasabuvir, ombitasvir, paritaprevir, and ritonavir extended-release tablets), Vosevi™ (sofosbuvir/velpatasvir/voxilaprevir), Zepatier™ (elbasvir/grazoprevir)
Hetlioz - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Humira - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Hycamtin - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Hycamtin® (topotecan hydrochloride)
Ibrance - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Iclusig - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Iclusig® (ponatinib)
ICS Single Agents - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
ICS-LABA Combination Products - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Idhifa - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Idiopathic Pulmonary Fibrosis - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.28.2019

Esbriet (pirfenidone), Ofev (nintedanib)
Ilaris - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Ilaris (canakinumab)
Ilumya - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Imbruvica - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Immune Globulin (IVIG and SCIG) - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.27.2019

Immune Globulin (IVIG and SCIG)
Inbrija - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Ingrezza - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.28.2019

Ingrezza (valbenazine)
Inlyta - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Inrebic - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 03.31.2020
Insulin Pen Needles and Syringes - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Iressa - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Iron Chelators - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Irritable Bowel Syndrome - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.31.2020
Isotretinoin - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 02.21.2020

Myorisan (isotretinoin), Claravis (isotretinoin), Amnesteem (isotretinoin), Zenatane (isotretinoin),
Isturisa - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Jakafi - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.31.2020
Juxtapid - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Jynarque - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.01.2020
Kalydeco - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.01.2020
Keveyis - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.01.2020
Kevzara - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Kineret - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.31.2020
Kisqali - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.01.2020
Kisqali Femara Co-Pack - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Korlym - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.31.2020
Koselugo - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.01.2020
Kuvan - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
LAMA / LABA - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Lenvima - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Lenvima™ (lenvatinib)
Leucovorin - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Lidocaine - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.01.2020
Lokelma, Veltassa - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 03.31.2020
Long-Acting Opioid Products - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.28.2020

Morphine sulfate controlled-release tablets, fentanyl transdermal*, Embeda (morphine sulfate and naltrexone), Xtampza ER (oxycodone extended-release), tramadol extended release tablets (non-biphasic release tablets) Avinza (morphine sulfate extended-release capsules), Exalgo (hydromorphone extended-release), Kadian (morphine sulfate sustained-release capsules), MS Contin [brand name], Opana ERcrush resistant (oxymorphone extended-release), fentanyl transdermal 37.5mcg/hr, 62.5mcg/hr, and 87.5mcg/hr, Zohydro ER (hydrocodone extended-release), oxymorphone ER (generic non-crush resistant), methadone, Arymo (morphine sulfate extended-release tablet) ER, Morphabond ER (morphine sulfate extended-release), Troxyca ER (oxycodone and naltrexone extended-release), Vantrela ER (hydrocodone bitartrate extendedrelease), Hysingla ER (hydrocodone extended release), OxyContin (oxycodone controlled release), Nucynta ER (tapentadol extended release), tramadol extended release capsules, tramadol extended release biphasic release tablets,
Lonhala Magnair, Yupelri - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.01.2020
Lonsurf - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.01.2020
Lorbrena - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 02.21.2020

Lorbrena (lorlatinib),
Lucemyra - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Lucemyra (lofexidine)
Lynparza - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Lyrica - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.27.2019

Lyrica capsules, Lyrica Solution, Lyrica CR tablets (pregabalin)
Lysteda - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.27.2019

Lysteda (tranexamic acid)
Makena - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.21.2020

17-ALPHA-HYDROXYPROGESTERONE CAPROATE (MAKENA AND 17P)
Mavenclad - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.27.2019

Mavenclad (cladribine)
Mayzent - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.28.2019

Mayzent (siponimod)
Mekinist - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.31.2020
Mektovi (binimetinib) - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Mepron - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Migranal - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.01.2020
Mirvaso - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Mozobil - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Mozobil® (plerixafor) injection
Mulpleta - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.27.2019

Mulpleta (lusutrombopag)
Multaq (dronedarone) - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Multiple Sclerosis (MS) Agents - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.27.2019

Multiple Sclerosis - Aubagio (teriflunomide), Copaxone (glatiramer acetate), Gilenya (fingolimod), glatiramer acetate, Glatopa (glatiramer acetate), Plegridy (peginterferon β-1a), Tecfidera (dimethyl fumarate), Avonex (interferon β-1a), Rebif (interferon β-1a), Betaseron/Extavia (interferon β-1b), Mayzent (siponimod)
Multiple Sclerosis Agents - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.01.2020
Myalept - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Mytesi - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.01.2020
Namzaric - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Natpara - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Nayzilam and Valtoco - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.01.2020
Nerlynx - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.01.2020
Nexavar - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Nexletol and Nexlizet - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Ninlaro - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.31.2020
Nityr - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.01.2020
Noctiva and Nocdurna - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.01.2020
Noctiva and Nocdurna - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.28.2018
Non-Preferred Drugs - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.01.2020
Northera - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.01.2020
Nourianz - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 02.21.2020

Nourianz (istradefylline),
Nubeqa - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Nucala - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.01.2020
Nuedexta - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Nuplazid - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.28.2019

Nuplazid (pimavanserin tartrate)
Nurtec ODT, Ubrelvy - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.31.2020
Nuzyra - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 03.31.2020
Ocaliva - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Odomzo - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Olumiant - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Omega-3 Acid Derivatives - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.01.2020
Orencia - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Orfadin - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.01.2020
Oriahnn - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Orilissa - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Orkambi - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.28.2019

Orkambi (lumacaftor/ivacaftor)
Osphena - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.31.2020
Otezla - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Overactive Bladder (OAB) Agents - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 02.21.2020

Preferred: oxybutynin syrup, oxybutynin tablet, oxybutynin extended-release tablet, Oxytrol for Women (oxybutynin OTC) patch. Preferred with Step Therapy: tolterodine tablet, trospium tablet, Detrol LA (tolterodine) extended-release capsule. Non-Preferred: Oxytrol (oxybutynin Rx) patch, flavoxate tablet, trospium extended-release capsule, Enablex (darifenacin) extended-release tablet, Toviaz (fesoterodine) extended release tablet, Vesicare (solifenacin) tablet, Myrbetriq (mirabegron) extended-release tablet, Gelnique (oxybutynin) topical gel, Ditropan XL (oxybutynin) extended-release tablet, Detrol (tolterodine) tablet,
Oxervate - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.01.2020
PAH Agents - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.01.2020
Palforzia - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.31.2020
Palynziq - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Panretin - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Panretin® (alitretinoin)
Pediculicides - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Pemazyre - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Piqray - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.01.2020
Pomalyst - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Praluent - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.01.2020
Preferred Non-Solid Dosage Forms - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 06.01.2020

Preferred Non-Solid Dosage Forms,
Pretomanid - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.01.2020
Prevymis - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Procysbi - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Progesterone - Non-Oral - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.31.2020
Promacta - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Promacta® (eltrombopag)
Prometrium - Oral - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Proton Pump Inhibitors - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Provigil, Nuvigil - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 03.31.2020
Pulmozyme - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.01.2020
Qinlock - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Quantity Limits - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.01.2020
Ranexa - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.01.2020
Ravicti - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.01.2020
Rayos - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Rectiv - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Rectiv (nitroglycerin) ointment 0.4%
Regranex - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Relistor - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Renvela - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.28.2019

Renvela (sevelamer carbonate) tablets
Repatha - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.01.2020
Retevmo - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Revcovi - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Revlimid - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Reyvow - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.31.2020
Rhofade - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Rinvoq - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Rozlytrek - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.28.2019

Rozlytrek (entrectinib)
Rubraca - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Ruconest - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Ruzurgi - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Rydapt - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Samsca - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Sandostatin - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Sedative Hypnotics - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Sensipar - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.01.2020
Serevent Diskus - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
SGLT-2 Inhibitors - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Short-Acting Opioid Products - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.31.2020
Signifor - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Siliq (brodalumab) - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Simponi - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Sivextro - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Skyrizi - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Somavert - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Soriatane - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.01.2020
Spinraza - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.17.2019
Spravato - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Sprycel - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.27.2019

Sprycel (dasatinib)
Stelara - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Stivarga - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Strensiq - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.19.2019
Sublingual Immunitherapy (SLIT) - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.31.2020
Sublocade - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.31.2020
Suboxone - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.28.2019

Suboxone (buprenorphine/naloxone), Zubsolv (buprenorphine/naloxone), Bunavail, (buprenorphine/naloxone), buprenorphine/naloxone tablet
Subutex - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.28.2019

Subutex (buprenorphine sublingual tablet)
Sucraid (sacrosidase) oral solution - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 03.31.2020
Sunosi - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Sutent - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.31.2020
Symdeko - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.01.2020
Symlin - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Synagis® (Palivizumab) - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 02.21.2020

Synagis (Palivizumab) ,
Synribo - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Synribo (omacetaxine) injection
Tabrecta - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Tafinlar - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.31.2020
Tagrisso - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Tagrisso™ (osimertinib)
Takhzyro - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Taltz - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Talzenna - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 02.21.2020

Talzenna (talazoparib),
Tarceva - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Tarceva® (erlotinib)
Targretin - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Targretin® (bexarotene)
Tasigna - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Tasigna® (nilotinib)
Tavalisse - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Tazverik - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.31.2020
Tegsedi - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Tegsedi (inotersen)
Temodar - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Test Strips - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Testosterone - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Thalomid - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Tibsovo (ivosidenib) - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Tobramycin Inhalation - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.01.2020
Topical Androgens - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Topical NSAIDs - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan
Last Published 02.21.2020

Flector Patch (diclofenac epolamine topical patch 1.3%), diclofenac sodium topical gel 1%, Pennsaid (diclofenac sodium topical solution 1.5%, 2%),
Topical Retinoid Products - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 02.25.2019
Trelegy Ellipta - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Tremfya - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Tretinoin Capsules - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Tretinoin Topical - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.27.2019

Tretinoin cream (Retin- A), tretinoin gel (Retin-A)
Triptans - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.28.2019

Triptans
Tukysa - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Turalio - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.28.2019

Turalio (pexidartinib)
Tykerb - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Tymlos (abaloparatide) - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 03.31.2020
Uloric - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 10.01.2020
Valchlor - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Vancomycin - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.01.2020
Vecamyl - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Vemlidy - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.27.2019

Vemlidy (tenofovir alafenamide)
Venclexta - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.01.2020
Verzenio - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Vitrakvi (larotrectinib) - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 03.31.2020
Vizimpro - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Vizimpro® (dacomitinib)
Votrient - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Votrient (pazopanib)
Vyndaqel and Vyndamax - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.01.2020
Wakix - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Xalkori (crizotinib) - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 03.31.2020
Xeljanz / Xeljanz XR - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Xeljanz and Xeljanz XR (tofacitinib) - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Xenazine - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.27.2019

Xenazine (tetrabenazine)
Xermelo - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Xifaxan - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 07.01.2020
Xolair - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Xopenex - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 03.31.2020
Xospata - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.01.2020
Xpovio - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.28.2019

Xpovio (selinexor)
Xtandi - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.31.2020
Xuriden - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Xyrem - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 03.31.2020
Yonsa - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 03.31.2020
Zejula - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Zelboraf - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 05.31.2020
Zetia - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 02.21.2020

Zetia (ezetimibe),
Zolgensma (Onasemnogene Abeparvovec-Xioi) - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.28.2019

Onasemnogene Abeparvovec-Xioi
Zolinza - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 01.24.2020

Zolinza® (vorinostat)
Zontivity - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Zortress - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 11.05.2020
Zydelig - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 12.01.2020
Zykadia - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.31.2020
Zytiga - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 08.01.2020
Zyvox - Clinical Pharmacy Program Guidelines - UnitedHealthcare Community Plan of Arizona
Last Published 03.31.2020

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