November 17, 2022

2023 MAPD core formulary and C-SNP formulary improvements

For 2023, UnitedHealthcare® Medicare Advantage Prescription Drug (MAPD) formularies remain stable with very few negative changes for members. We have taken what is already a leading formulary among national competitors and made improvements to further enhance our competitive position in 2023. 

For 2023, there will be 26 down-tiered drugs and 4 formulary additions:

  • Of the 26 drugs, 23 will move to Tier 1 – half of which are highly utilized cardiovascular medications. Additional down-tiered drugs will target multiple disease states such as depression, osteoarthritis, glaucoma, overactive bladder (OAB) and more. The remaining drugs improve dental formulary coverage, aligning with the broader Medicare Advantage strategy.
  • Chronic Special Needs Plan (C-SNP) members have a distinct formulary that includes the MAPD Core changes above, plus an additional 8 drugs down-tiered that specifically target cardiovascular disease (C-SNP-qualifying), while differentiating UnitedHealthcare chronic plans and preserving the formulary’s market-leading position.

Note: UnitedHealthcare’s MAPD formularies meet all Centers for Medicare & Medicaid Services formulary requirements and include at least 2 drugs from each therapeutic category (i.e., cholesterol-lowering medications) except for those categories that don’t include 2 or more drugs. As new generics are made available and added to the formulary, some brands may be removed – standard industry practice to allow access to similar drugs at a lower cost to members.

Core formulary and C-SNP formulary down-tiering and additions

Please note the following drug down-tiering and additions for 2023:

Drug name Common use 2023 Tier UM edit*
Cardiovascular down-tiers
Clopidogrel Antiplatelet 1 QL
Doxazosin Hypertension/Prostate health (BPH) 1 -
Ezetimibe Cholesterol 1 QL
Hydralazine Heart failure/Hypertension 1 -
Isosorbide mononitrate Angina 1 -
Isosorbide mononitrate ER Angina 1 -
Labetalol Heart rate/Hypertension 1 -
Nifedipine ER Hypertension 1 QL
Potassium chloride ER & CR Cardiovascular/Potassium supplement 2 -
Propranolol Hypertension/Migraines 1 -
Spironolactone Heart failure/Hypertension 1 -
Multiple disease state down-tiers
Brimonidine ophthalmic Glaucoma 1 -
Dorzolamide/Timolol ophthalmic Glaucoma 1 -
Fluoxetine capsules Depression 1 -
Methotrexate Rheumatoid arthritis 1 -
Oxybutynin ER Overactive bladder 1 QL
Terazosin Prostate health (BPH) 1 -
Topiramate Seizures/Migraines 1 -
Celecoxib Osteoarthritis 2 QL
Dutasteride Prostate health (BPH) 2 QL
Raloxifene Osteoporosis 2 QL
Dental down-tiers
Chlorhexidine gluconate Antibiotic, oral rinse 1 -
Lidocaine viscous Pain, oral topical 1 -
Sodium fluoride (Various formulations) Fluoride 1 -
Periogard Antibiotic, oral rinse 1 -
Formulary additions
Desloratadine Respiratory 3 -
Levalbuterol HFA inhaler Respiratory 3 -
Tolterodine Overactive bladder 3 -
Trospium Overactive bladder 3 -

Additional Improvements specific for C-SNP members

Please note the following improvements specific to C-SNP members for 2023:

Drug name Common use 2023 Tier UM edit*
C-SNP only down-tiers
Chlorthalidone Hypertension/Edema 1 -
Eplerenone Heart Failure/Hypertension 2 -
Fenofibrate High cholesterol 1 -
Fenofibrate micronized High cholesterol 1 -
Fenofibric acid DR High cholesterol 1 -
Gemfibrozil High cholesterol 1 -
Prasugrel Antiplatelet 1 1 QL
Sotalol Antiarrhythmic 1 1 -

* QL = Quantity Limit


If you have questions, please contact your provider advocate, provider relations or network management representative.

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