The information on this website is intended to provide general pharmacy information for UnitedHealthcare members. The information on this site is NOT specific to your benefit plan. If you are a UnitedHealthcare member, please register or log on to myuhc.com® to find pharmacy information specific to your benefit plan. Whether you are a UnitedHealthcare member or pre-enrollee, your pharmacy benefit could differ greatly from the information provided here. This website should only be used for estimating purposes. If you are a pre-enrollee, and you would like to learn more about your specific pharmacy benefit, please contact your employer.
Our Goal We want to assist you in maximizing your pharmacy benefit and lowering your overall pharmacy costs.
We provide access to a wide variety of U.S. Food and Drug Administration (FDA) approved prescription medications.
Our pharmacy network includes more than 66,000 retail pharmacies and OptumRx® Mail Service Pharmacy. Just log in to myuhc.com and use our "Pharmacy Locator" tool to find a network pharmacy.
Our programs and tools are designed to empower you to make better decisions, live healthier lives and save money on prescription medications.
Prescription Medication Costs Prescription medication prices are among the fastest growing costs in health care. Our programs and tools are designed to help you make informed decisions about your prescription medication choices and pharmacy product options. At UnitedHealthcare, we want to help you manage your prescription medication costs and get the most out of your pharmacy benefit. One tool you should be familiar with that can help you save money is the Prescription Drug List (PDL).*
Your Prescription Drug List (PDL)* The PDL* includes the most commonly used medications and groups them on tiers, representing the cost you pay. This cost is decided by your employer or health plan. Tiering medications makes it easy for you to find other options that will help you save money if the drug you are taking is on a higher tier. It's more than a list of drugs, and can help you manage your costs and find other medication options.
*The UnitedHealthcare SignatureValue HMO has a formulary, rather than a PDL.
Prescription Drug Lists
Health Insurance Marketplaces, State Exchanges, Small Group and Large Group
2019 Advantage Tier 3 Prescription Drug List effective January 1, 2019. This PDL applies to members of our UnitedHealthcare, Neighborhood Health Plan, River Valley, All Savers, and Oxford medical plans with a pharmacy benefit.
2019 Access Tier 3 Prescription Drug List effective January 1, 2019. This PDL applies to members of our UnitedHealthcare, Neighborhood Health Plan, River Valley and Oxford medical plans with a pharmacy benefit.
2019 Access Tier 4 Prescription Drug List effective January 1, 2019. This PDL applies to members of our UnitedHealthcare, Neighborhood Health Plan, River Valley and Oxford medical plans with a pharmacy benefit.
2019 Advantage Tier 4 Prescription Drug Listeffective January 1, 2019. This PDL applies to members of our UnitedHealthcare, Golden Rule, UnitedHealthOne, Oxford, All Savers, Neighborhood Health Plan and River Valley medical plans with a pharmacy benefit.
2018 Advantage Tier 4 Prescription Drug Listeffective July 1, 2018. This PDL applies to members of our UnitedHealthcare, Golden Rule, UnitedHealthOne, Oxford, All Savers, Neighborhood Health Plan and River Valley medical plans with a pharmacy benefit.
California Prescription Drug Lists (PDL) and Formulary (For Pre-Members/Members)
These PDLs and formulary are available if your benefit plan is based in California. These listings may be refreshed on a monthly basis. If you need an exclusion exception, view our process as described in Your Right to Request an Exclusion Exception.
IMPORTANT - The above UnitedHealthcare standard PDLs and SignatureValue HMO Formulary do not apply to all plans. If you are a member, log in to myuhc.com to learn about your specific benefit coverage.
Health Care Reform - Preventive Care Medications
As part of Health Care Reform, health plans must cover certain Preventive Care Medications at no cost to you when:
Prescribed by a health care professional
Age-, gender- and condition-appropriate
Filled at a network pharmacy
To comply with the health reform law, UnitedHealthcare is offering:
A list of prescription contraceptives available to you on Tier 1, or the lowest tier on your Prescription Drug List (PDL) or formulary, for no cost. These contraceptives are available now for most benefit plans.
The U.S. Preventive Services Task Force A&B Recommendation medications for no cost at point of sale at network pharmacies starting November 1, 2013. These drugs include aspirin, folic acid supplements for women, iron supplements and prescription fluoride for children.
OTC contraceptives for women at no cost at point of sale at network pharmacies starting November 1, 2013. OTC contraceptives include female condoms, emergency contraceptives, and contraceptive film, foam and gel.
Effective September 24, 2014, risk-reducing breast cancer medications as a preventive benefit for women:
Age 35 and older
At increased risk for the first occurrence of breast cancer - after risk assessment and counseling
Who obtain a Notification/Prior Authorization
For these women, UnitedHealthcare will cover raloxifene or tamoxifen without cost-share for up to five years for eligible women, minus any time members have already been taking these drugs for prevention.
Effective January 1, 2015, tobacco cessation products will be available at no cost starting on your health plan's next renewal date on or after January 1, 2015 for those who are:
Age 18 or older
Get Notification/Prior Authorization from their doctor, to let us know they are getting counseling to help them stop using tobacco products
Get a prescription for these products from their doctor, even if the products are sold over-the-counter (OTC)
Fill the prescriptions at a network pharmacy
Up to two 90-day treatment courses are covered at no cost each year. Notification/Prior Authorization is required for each 90-day drug supply.
Please see the most commonly used Preventive Care Medication Lists:
If your benefit plan is based in Connecticut, District of Columbia, Delaware, Illinois, Massachusetts, Maryland, Maine, Oregon, and Washington, and fully insured, these are the most commonly used Preventive Care Medication Lists:
Although these lists may change over time or be different due to your specific plan design, you can always learn the cost of Preventive Care Medications for your plan by logging in to myuhc.com, or calling the number on your health plan ID card.
Always refer to your benefit plan materials to determine your coverage for medications and cost-share. Some medications listed on the PDL or formulary may not be covered under your specific benefit. Where differences are noted, the benefit plan documents will govern.
What if the federal health reform law requirements for Preventive Care Medications coverage change?If the law requiring plans to provide Preventive Care Medications at no cost changes, information on how your costs may be impacted will be available to you by:
*Calling the member phone number on your health plan ID card
Health Care Reform - Contraceptive Services Only
The health reform law (Affordable Care Act) requires most health plans to pay for birth control (contraceptives and sterilization) for women at no cost to you. Some nonprofit organizations can choose not to cover birth control (contraceptives) as part of their group health plan for religious reasons. If you are a member of one of these groups (Eligible Organizations), UnitedHealthcare is required to cover certain birth control products and services at no cost to you.
You can use your Contraceptive Services Only ID card to get the birth control services, products and drugs on this list for $0 cost-share if they are:
Prescribed by a health care professional such as your doctor
For services performed by a network health care professional
For products and drugs filled at a network pharmacy
Special Programs (not available on the SignatureValue HMO Formulary)
Automated Transition of Care (ATOC) Provides members of new UHC groups moving from a non-UHC plan with extra time to make any needed medication changes during the first 120 days of the plan year. Members may automatically obtain up to two 31-day grace fills on medications that are not typically covered under their new pharmacy plan so they have time to speak with their provider about switching to a covered alternative and/or satisfying the drug?s clinical program requirements. This only applies to specific drugs and does not include specialty pharmacy.
Refill and Save The Refill and Save Program is designed to help you with prescription medication adherence and can help save you money. If you are covered under an eligible benefit plan, you will receive a $20 savings off your copayment or coinsurance when you refill your prescription for a qualifying medication as prescribed (usually about once per month). The savings is $50 off your copayment or coinsurance for refills of qualifying medications at mail for a 90 day supply.
The savings will automatically be applied to your copayment or coinsurance at the time you pick up your medication. To find out which medications are currently included in the program, and if you are covered under an eligible benefit plan, please call the toll-free member phone number on the back of your health plan ID card. Qualifying medications: Asthma: Advair®, Breo ®, Ellipta®, Symbicort®
Coupon Adjustment: Benefit Plan Protection Depending on your benefit design, your plan may participate in the Coupon Adjustment: Benefit Plan Protection. Click the member flyer below to learn more about this program. You can call the number on the back of your health plan ID card to find out if your plan participates in this program.
Specialty Pharmacy Program
Specialty prescriptions medications are high-cost medications used to treat complex conditions such as cancer, Hepatitis C, and multiple sclerosis. If you are taking a specialty medication, use one of our designated specialty pharmacies to fill your prescription. Specialty pharmacies provide educational and clinical support not found in a retail pharmacy. Call the phone number on the back of your health plan ID card or visit BriovaRx.com to locate a designated specialty pharmacy for your medication.
My ScriptRewards provides added benefits to members who use certain medications. My ScriptRewards offers $0 cost-share for some HIV medications. If you switch to a $0 cost-share drug, you may be able to get up to $500 annually in prepaid debit cards to offset other medical expenses. To find out if the My ScriptRewards program is available to you, call 1-877-636-9712. Click here to learn more about how the program works
Pharmacy Locations for Oxford Members
OptumRx® is your plan's pharmacy services manager and is committed to helping our Oxford1 members find cost-effective ways to get your medications. Be sure to fill your prescriptions at a network (participating) pharmacy, otherwise they may not be covered or you may pay more2. To search for network pharmacies, please click the link below. If you have questions or need help locating a network pharmacy, call the toll-free phone number on your health plan ID card. TTY users can dial 711.
Special note for members of certain Oxford benefit plans
- Metro Network
- Connecticut Liberty Network - New Jersey Garden State Network
If you are enrolled in a New York Metro Network, Connecticut Liberty Network or New Jersey Garden State Network please note that you will use the OptumRx Value Pharmacy Network. The Value Pharmacy Network is specific to these plans and intended to offer members access to select pharmacies, in an effort to help further manage costs. This network of participating retail pharmacies includes major chains, mass merchants and supermarkets. Prescriptions cannot be filled at out-of-network (nonparticipating) pharmacies. To search for a Value Pharmacy Network pharmacy, please click the link below. If you have questions or need help locating a Value Pharmacy Network pharmacy, call the toll-free phone number on your health plan ID card. TTY users can dial 711.
1Oxford insurance products are underwritten by Oxford Health Insurance, Inc. Oxford HMO products are underwritten by Oxford Health Plans (CT), Inc. and Oxford Health Plans (NJ), Inc. Administrative services provided by Oxford Health Plans LLC.
2In New York, prescriptions filled at an out-of-network pharmacy may not be covered. In New Jersey, you may need to pay more for prescriptions filled at an out-of-network pharmacy.