Medicare Advantage Plan Formularies (Drug Lists) | UnitedHealthcare®

Medicare Advantage Plans

Formularies (Drug Lists)

A formulary, or drug list, is a list of prescription medications that are covered under a health care plan that provides prescription drug coverage.

 

Full plan prescription drug formulary (drug list)

To view your plan's entire prescription drug list, go to View plans and pricing, enter your ZIP code and select a specific plan with prescription drug benefits. Because coverage varies by plan, and plans vary by state, you may want to see if your medications are covered. You can also look up your drugs. This formulary (PDF) may change during the plan year. If you view the formulary (PDF), also review formulary additions, formulary deletions, step therapy, and prior authorization criteria (PDFs).

Once you know if a prescription drug is covered by a UnitedHealthcare® Medicare Advantage plan in your area, you can find drug cost information in View plans and pricing. If a drug you currently take is not covered, learn more about the prescription drug transition process.

Please note: The following documents are in PDF format and may take some time to download, depending on your connection speed. You will need the free Adobe® Reader® software to view these files.

Prior authorization criteria
Step therapy criteria
60-day formulary change notice
Formulary changes

Coverage limitations: To be covered, drugs must be prescribed for a use that is approved by the FDA or documented in at least one of the specific peer-review compendia identified by the Centers for Medicare and Medicaid Services (CMS). You can find out if any additional prescription drug coverage limitations apply to your drugs by looking at the Prior Authorization. Prior authorization requires you or your doctor to get approval from the plan before your drug is covered. View the prior authorization criteria PDF below that applies to your plan to determine if the drug is covered. You will need the free Adobe® Reader® software to view this document.

 

Prior authorization criteria

The plan requires you or your doctor to get prior authorization for certain drugs. This means the plan needs more information from your doctor to make sure the drug is being used correctly for a medical condition covered by Medicare. If you don't get approval, the plan may not cover the drug. To view your plan's prior authorization criteria to determine if your drugs qualify for coverage, go to View plans and pricing, enter your ZIP code and select a specific plan with prescription drug benefits. You can find the Prior Authorization Criteria (PDF) in the Helpful Resources section of the Plan Details page.

Coverage determination and exceptions: A coverage determination is a decision made by your plan regarding payment for a drug or the types of drugs covered as part of your benefit. If you wish to have the plan review its coverage decision based on your individual circumstances, you may request an exception to a coverage determination. Learn more about Prescription grievances, coverage determinations and appeals.

Step therapy criteria

There are effective, lower-cost drugs that treat the same medical condition as this drug. You may be required to try one or more of these other drugs before the plan will cover your drug. If you have already tried other drugs or your doctor thinks they are not right for you, you and your doctor can ask the plan to cover this drug.

To view your plan's step therapy criteria to determine if your drugs qualify for coverage, go to View plans and pricing, enter your ZIP code and select a specific plan with prescription drug benefits. You can find the Step Therapy Criteria (PDF) in the Helpful Resources section of the Plan Details page.

60-day formulary change notice

Notice of Formulary Changes will be posted 60 days prior to the removal or change in the preferred or tiered cost-sharing status of a Medicare Part D drug. The posting will include:

  • The name of the affected covered Medicare Part D drug.
  • Information on whether the covered Medicare Part D drug is being removed from the formulary, or changing its preferred or tiered cost-sharing status.
  • The reason the covered Medicare Part D drug is being removed from the formulary, or changing its preferred or tiered cost-sharing status.
  • Alternative drugs in the same therapeutic category, class or cost-sharing tier, and the expected cost sharing for that drug.
  • The means by which members may obtain an updated coverage determination or an exception to a coverage determination.

Formulary changes

Formulary additions update

2015

  • 2015 Formulary Additions (PDF) (59.8 KB) - For members of the UnitedHealthcare® MedicareComplete Choice® (PPO) plan in Madison County, New York; and members of the AARP® MedicareComplete® Choice Plan 2 (PPO) in Boone, Hamilton, Hancock, Hendricks, Johnson, Madison, Marion Counties, Indiana.
  • 2015 Formulary Additions (PDF) (70.9 KB) - For members of the UnitedHealthcare® The Villages® MedicareComplete® (HMO) plan.
  • 2015 Formulary Additions (PDF) (65.1 KB) - For members of all other UnitedHealthcare Medicare Advantage plans and AARP® Medicare Advantage plans with prescription drug coverage in all other locations.

 

Formulary deletions and changes update

2015

  • 2015 Formulary Deletions (PDF) (63.3 KB) - For members of the UnitedHealthcare® MedicareComplete Choice® (PPO) plan in Madison County, New York; and members of the AARP® MedicareComplete® Choice Plan 2 (PPO) in Boone, Hamilton, Hancock, Hendricks, Johnson, Madison, Marion Counties, Indiana.
  • 2015 Formulary Deletions (PDF) (63.3 KB) - For members of the UnitedHealthcare® The Villages® MedicareComplete® (HMO) plan.
  • 2015 Formulary Deletions (PDF) (63.3 KB) - For members of all other UnitedHealthcare Medicare Advantage plans and AARP® Medicare Advantage plans with prescription drug coverage in all other locations.

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