January 01, 2022

UnitedHealthcare Community Plan preferred drug list update

Beginning Jan. 1, 2022, the following preferred drug list changes will be effective in Colorado, Florida, Hawaii, Indiana, Maryland, Minnesota, Nevada, New Jersey, New York CHIP, New York EPP, New York Medicaid, Pennsylvania CHIP, Rhode Island and Virginia.

These changes do not apply to UnitedHealthcare Community Plans in Kansas, Kentucky, Louisiana, Michigan, Mississippi, Nebraska, North Carolina, Ohio, Pennsylvania-Medicaid, Texas and Washington.

Drugs added to the preferred drug list

Drug/product name Comments
Anoro® Ellipta Indicated for the maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema.
Dexmethylphenidate tablet (generic Focalin®)

Indicated for the treatment of attention-deficit hyperactivity disorder (ADHD). Diagnosis required.

Dexmethylphenidate ER capsule (generic Focalin® XR)  Indicated for the treatment of attention-deficit hyperactivity disorder (ADHD). Diagnosis required.
Modafinil tablet (generic Provigil® Indicated to improve wakefulness in patients with excessive sleepiness associated with narcolepsy, obstructive sleep apnea or shift work disorder. Diagnosis required.
Budesonide-Formoterol Inhalation*(generic Symbicort®)

Indicated for the treatment of asthma or maintenance treatment in patients with chronic obstructive pulmonary disease (COPD). Prior authorization is required.

Changes to coverage within preferred drug list

Drug/product name Comments
Dexcom® CGM These continuous glucose monitors and supplies will now be available to process under the pharmacy benefit. Prior authorization is required.
Freestyle Libre® CGM These continuous glucose monitors and supplies will now be available to process under the pharmacy benefit. Prior authorization is required.
Prenatal vitamins We’re removing and adding various prenatal vitamins.  For a specific list, prescribers should check the state prescription drug list for their state-specific list of preferred drugs.  

Drugs removed from the preferred drug list

Drug/product name Comments
Adderall® XR Amphetamine/dextroamphetamine extended-release capsule (generic Adderall® XR) is a covered drug. Current utilizers will be required to transition to the generic Adderall® XR. 
Trulance® tablet

Lubiprostone and Motegrity® are alternate options.

*Only the authorized generic is preferred

For medications that have been removed from the prescription drug list, we have provided potential alternatives for UnitedHealthcare Community Plan members. If the drug alternative is medically appropriate, please provide members with a new prescription for a preferred alternative using one of the following methods:

  • Call or fax the pharmacy
  • Use e-Script
  • Write a new prescription and give it directly to the member (where permitted by state regulations)

If a preferred alternative is not medically appropriate for the patient’s individual situation, please call 800-310-6826 to request a prescription drug list exception (prior authorization). If criteria is met, the UnitedHealthcare Community Plan member may be granted coverage to remain on their current medication.

You may also view the changes at UHCprovider.com/plans > Choose your state > Medicaid (Community Plan) > Pharmacy Resources and Physician-Administered Drugs.

Questions?

Call the UnitedHealthcare Community Plan Pharmacy department at 800-310-6826. Thank you.

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