Skip left navigation

Drug Lists and Pharmacy

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.

PreCheck MyScript Tool: Check Pharmacy Eligibility & Prior Authorization

Check current prescription coverage and price, including out-of-pocket prescription costs for UnitedHealthcare members at their selected pharmacy with the PreCheck MyScript tool on Link.

  • Get information on lower-cost prescription alternatives, if available, to help save members money.
  • See which prescriptions currently require prior authorization, or are non-covered or non-preferred.
  • Request prior authorization and receive status and results.

Learn more about the PreCheck MyScript tool.

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

Commercial 

The Prescription Drug List (PDL) is a list of prescription medications commonly chosen by doctors and pharmacies. Prescription drug coverage varies by member benefit plan.

Prescription Drug List Updates

We combine clinical and pharmacoeconomic data to define a medication's overall value in its class so we can effectively manage overall cost and care.

Community Plan / Medicaid 

For UnitedHealthcare Community Plan PDLs, visit our Health Plans by State section and select your state to view.

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.

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

Other 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

Other Resources

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.

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 Speciality Pharmacy sections, the programs below are uniquely for Oxford lines of business.

For additional information visit, UnitedHealthcare Oxford Health