275-3835 tx f300 digi_

2007 Three-Tier Prescription Drug List Reference Guide The UnitedHealthcare pharmacy benefit offers you flexibility and choice in the prescriptionmedications available to you. Understanding your Prescription Drug List will help you make moreinformed decisions about prescription medications.
This guide will help you understand these choices. It will also enable you to ask your doctor orpharmacist the right questions regarding your medication needs. Our goal is to provide informationthat will help you make informed decisions regarding medications for you and your family.
Below you will find some common questions people have asked regarding UnitedHealthcare’spharmacy benefit. If you have pharmacy benefit coverage with UnitedHealthcare, please visit us atwww.myuhc.com or call the Customer Care number on your ID card for additional information. Ifyou are not currently enrolled with UnitedHealthcare for pharmacy benefit coverage, you mayaccess www.myuhc.com for additional information during your open enrollment period or you maycontact your employer or health plan for additional information.
A Prescription Drug List (PDL) is a list of Food and Drug Administration (FDA)-approved brand-name and generic medications. The UnitedHealthcare pharmacy benefit is designed to provide you with coverage for acomprehensive selection of prescription medications. This guide lists the most commonlyprescribed medications for certain conditions. If you have pharmacy benefit coverage withUnitedHealthcare, you can find our complete PDL at www.myuhc.com. If you are not currentlyenrolled with UnitedHealthcare for pharmacy benefit coverage, you may access the complete PDLat www.myuhc.com during your open enrollment period. You and your doctor may refer to this listto consider prescription medication choices and select the appropriate medication to meet yourneeds. Keep in mind that the benefit plan documents provided by your employer or health plan mayinclude a Summary Plan Description or a Certificate of Coverage, and a Pharmacy Rider. Thesedocuments define your pharmacy coverage and may exclude coverage for certain medicationslisted in the PDL found in this guide. If you do not have the benefit plan documents, please contactyour employer or health plan for this information. What are tier designations and how do they affect what I actually pay at the pharmacy? Prescription medications are categorized within three tiers. Each tier is assigned a copayment,which is an amount you pay when you fill a prescription at a participating retail pharmacy or refillyour ongoing prescription through the network mail-order pharmacy service. Your employer orhealth plan sets the actual copayment amounts for the medications covered under your pharmacybenefit. Consult the benefit plan documents provided by your employer or health plan for morespecific information about the copayments, coinsurance, and deductibles that may apply to yourpharmacy benefit coverage. If you have pharmacy benefit coverage with UnitedHealthcare, you may learn more about your benefit by visiting www.myuhc.com orby calling the Customer Care telephone number printed on your ID card. If you are not currently enrolled with UnitedHealthcare forpharmacy benefit coverage, you may access www.myuhc.com for additional information during your open enrollment period or youmay contact your employer or health plan for additional information.
Tier 1 is your lowest copayment option. For the lowest out-of-pocket expense, you should alwaysconsider Tier 1 medications if you and your doctor decide they are appropriate for your treatment.
Midrange-Cost Option Tier 2 is your middle copayment option. Consider Tier 2 medications if you and your doctordecide that a Tier 2 medication is the most appropriate to treat your condition. Tier 3 is your highest copayment option. Sometimes there are alternatives available in Tier 1 orTier 2. If you are currently taking a medication in Tier 3, ask your doctor whether there are Tier 1 orTier 2 alternatives that may be appropriate for your treatment. Compounded medications, thosemedications containing one or more ingredients that are prepared “on-site” by a pharmacist, areclassified at the Tier 3 level, provided that the individual ingredients used in compounding arecovered under the pharmacy benefit.
Please note: Some plans have a two-tier pharmacy benefit rather than a three-tier pharmacybenefit. Generally, a two-tier closed pharmacy benefit plan does not cover medications classified inTier 3 of this PDL. A two-tier open pharmacy benefit plan covers one tier at the lower copaymentand covers a second tier at a higher copayment. In addition, some plans have a four-tier prescription plan. Refer to your enrollment materials, checkthe Drug Pricing / Coverage information on www.myuhc.com, or call the Customer Care number onyour ID card for more information about your benefit plan.
Who decides which medications get placed in which tier? The UnitedHealthcare PDL Management Committee makes tier placement decisions to help ensureaccess to a wide range of medications and control health care costs for you and your employer orhealth plan. You and your doctor decide which medication is appropriate for you.
How often will prescription medications change tiers? While medications change tiers infrequently, such changes may occur up to six times per calendaryear, depending on your benefit. Additionally, when a brand-name medication becomes availableas a generic, the tier status of the brand name medication and its corresponding generic will beevaluated. When a medication changes tiers, you may be required to pay more or less for thatmedication. These changes may occur without prior notice to you. However, if you have pharmacybenefit coverage with UnitedHealthcare, you may visit our Web site, www.myuhc.com, or call theCustomer Care number on your ID card for copayment information about a particular medication. If you are not currently enrolled with UnitedHealthcare for pharmacy benefit coverage, you mayaccess www.myuhc.com during your open enrollment period for additional information about aparticular medication.
If you have pharmacy benefit coverage with UnitedHealthcare, you may learn more about your benefit by visiting www.myuhc.com orby calling the Customer Care telephone number printed on your ID card. If you are not currently enrolled with UnitedHealthcare forpharmacy benefit coverage, you may access www.myuhc.com for additional information during your open enrollment period or youmay contact your employer or health plan for additional information.
What is the difference between brand-name and generic medications? Generic medications contain the same active ingredients as brand-name medications, but theyoften cost less. Generic medications become available after the patent on the brand-namemedication expires. At that time, other companies are permitted to manufacture a chemicallyequivalent medication.
Before a generic medication can be sold, the FDA must be satisfied that the medication containsthe same active ingredients in the same strength as the brand-name equivalent. It must also meetthe same quality standards. Many companies that make brand-name medications also produce andmarket generic medications that are equivalent to the branded products.
The next time your doctor gives you a prescription for a brand-name medication, ask if a genericequivalent is available and if it might be appropriate for you. While there are exceptions, genericmedications are usually your lowest cost option. You and your employer or health plan may savemoney if you and your doctor decide the generic medication is right for you.
Why is the medication that I am currently taking no longer covered? Medications may be excluded from coverage under your pharmacy benefit. For example, aprescription medication may be excluded from coverage when it is therapeutically equivalent to anover-the-counter medication.
Your doctor can recommend either an over-the-counter medication or a prescription medication foryour treatment. You can purchase an over-the-counter medication at your local pharmacy without aprescription.
When should I consider discussing “over-the-counter” or non-prescription medications with mydoctor? An over-the-counter medication can be an appropriate treatment for many conditions. Consult yourdoctor about over-the-counter alternatives to treat your condition. These medications are notcovered under your pharmacy benefit, but they may cost less than your out-of-pocket expense forprescription medications.
Why are there “notations” next to certain medications in the PDL, and what do they mean? Certain medications in this guide have a notation, such as N (for “notification”), QL (for “quantitylimitations”), QD (for “quantity duration”), and DS (for “diabetic supplies”). The specific definitionsfor these notations are listed at the bottom of each page of the PDL. Please call Customer Care ifyou need additional information about these notations.
What should I do if I use a self-administered injectable medication? You may have coverage for self-administered injectable medications through your pharmacy benefitplan. You will find these medications included in the body of this document within the list ofmedications. UnitedHealthcare has developed an enhanced specialty pharmacy network that is partof our Specialty Pharmacy Program. The specialty pharmacy network includes specialty pharmacies,each selected based on their clinical expertise for the targeted therapeutic classes, quality ofservices and cost. Their pharmacists are trained to help educate members and create personalizedplans, if needed, for these specialty medications, which may help improve treatment. Please call our toll-free Specialty Pharmacy Referral Line at 1-866-429-8177 where a representativewill answer questions about our program and then transfer you to a specialty pharmacy based onyour particular specialty medication prescription.
If you have pharmacy benefit coverage with UnitedHealthcare, you may learn more about your benefit by visiting www.myuhc.com orby calling the Customer Care telephone number printed on your ID card. If you are not currently enrolled with UnitedHealthcare forpharmacy benefit coverage, you may access www.myuhc.com for additional information during your open enrollment period or youmay contact your employer or health plan for additional information.
How do I access updated information about my pharmacy benefit? Since the PDL may change periodically, we encourage you to visit www.myuhc.com or call theCustomer Care number on your ID card for the most current information. If you are not currentlyenrolled with UnitedHealthcare for pharmacy benefit coverage, you may access www.myuhc.comduring your open enrollment period for the most current information. In addition to informationabout your pharmacy benefit, www.myuhc.com is your online resource for a variety of health andwellness topics. The site is designed to help you make informed health care decisions for you andyour family.
With www.myuhc.com, you can view your prescription claims history, compare costs of medicationsto identify cost-saving opportunities, and contact a registered pharmacist seven days a week.
How do I find information about my pharmacy benefit on www.myuhc.com? If you have pharmacy benefit coverage with UnitedHealthcare, you may learn more about yourcoverage by visiting www.myuhc.com. Follow the instructions for initial registration. Once registered,you can log in and click on the Prescriptions tab, then on Drug Pricing / Coverage, and you will haveaccess to copayment, pricing, and coverage information on most prescription medications. You willalso have access to the following information. • Pharmacy benefit and coverage information• Specific copayment amounts for prescription medications • Possible lower-cost medication alternatives • A list of medications based on a specific medical condition • Medication interactions, side effects, etc. At www.myuhc.com, you will also be able to:• Locate a participating retail pharmacy by zip code• Review your prescription historyIf mail order is included in your pharmacy benefit, you can also:• Access www.myuhc.com to refill prescriptions• Check the status of your order• Set up e-mail reminders for refills• Manage your accountIf you are not currently enrolled with UnitedHealthcare for pharmacy benefit coverage, you mayaccess www.myuhc.com during your open enrollment period to learn more about theUnitedHealthcare pharmacy benefit or you may contact your employer or health plan for additionalinformation.
If you have pharmacy benefit coverage with UnitedHealthcare and you have additional questionsabout your pharmacy benefit, please call the Customer Care number on your ID card.
Representatives are available to assist you 24 hours a day, except Thanksgiving and Christmas. If youare not currently enrolled with UnitedHealthcare for pharmacy benefit coverage, please contact youremployer or health plan for additional information about the UnitedHealthcare pharmacy benefit.
If you have pharmacy benefit coverage with UnitedHealthcare, you may learn more about your benefit by visiting www.myuhc.com orby calling the Customer Care telephone number printed on your ID card. If you are not currently enrolled with UnitedHealthcare forpharmacy benefit coverage, you may access www.myuhc.com for additional information during your open enrollment period or youmay contact your employer or health plan for additional information.
Your doctor may be able to help you save money by prescribing medications in Tier 1 and Tier 2 ofthe PDL. You and your doctor always make the decisions regarding your treatment. Here are somepractical suggestions for getting the most out of your pharmacy benefit:• Bring this PDL guide to your doctor appointments and ask your doctor to refer to the PDL when prescribing medications. It is a tool that helps guide you and your doctor in choosing medicationsthat allow the most effective and affordable use of your pharmacy benefit.
• If you would like to view a more complete version of the PDL and information about your specific benefit plan, please visit www.myuhc.com. Once you have logged in, click on “Prescriptions.” • If you have pharmacy benefit coverage with UnitedHealthcare and you have additional questions about your pharmacy benefit, please call the Customer Care number on your ID card.
Representatives are available to assist you 24 hours a day, except Thanksgiving and Christmas. Ifyou are not currently enrolled with UnitedHealthcare for pharmacy benefit coverage, pleasecontact your employer or health plan for additional information about the UnitedHealthcarepharmacy benefit.
In certain documents, the Prescription Drug List (PDL) was referred to as the “Preferred Drug List (PDL).” This change in descriptiveterms does not affect your benefit coverage.
Where differences are noted between this PDL reference guide and your benefit plan documents, the benefit plan documents willgovern.
In certain documents, Tier 1 was referred to as “generics;” Tier 2 was referred to as “preferred brands” or “brand name on the PDL;”and Tier 3 was referred to as “non-preferred brands,” “not on the PDL,” or “brand name not on the PDL.” These changes indescriptive terms do not affect your benefit coverage.
If you have pharmacy benefit coverage with UnitedHealthcare, you may learn more about your benefit by visiting www.myuhc.com orby calling the Customer Care telephone number printed on your ID card. If you are not currently enrolled with UnitedHealthcare forpharmacy benefit coverage, you may access www.myuhc.com for additional information during your open enrollment period or youmay contact your employer or health plan for additional information.
2007 Three-Tier Prescription Drug List Reference Guide Some medications are noted with N, QD, QL, or DS. The definitions for these symbols are listed QD = Quantity Duration. Some medications have a limited amount that can be covered for a below. Your benefit plan determines how these medications may be covered for you.
N = Notification. There are a few medications that your doctor must notify us of to make sure their QL = Quantity Level. Some medications have a limited amount that can be covered at one time.
DS = Diabetic Supplies. Diabetic supplies may be covered by your benefit plan.
2007 Three-Tier Prescription Drug List Reference Guide Some medications are noted with N, QD, QL, or DS. The definitions for these symbols are listed QD = Quantity Duration. Some medications have a limited amount that can be covered for a below. Your benefit plan determines how these medications may be covered for you.
N = Notification. There are a few medications that your doctor must notify us of to make sure their QL = Quantity Level. Some medications have a limited amount that can be covered at one time.
DS = Diabetic Supplies. Diabetic supplies may be covered by your benefit plan.
2007 Three-Tier Prescription Drug List Reference Guide Paroxetine QLPremarinPremphasePremproPrevacid Solutab QL/QDPrometriumProtonix QL/QDProtopic NPulmicort QLQuinaprilQuinapril with QVAR QLRelpax QL/QDRisperdal (M-Tab = Tier 3)Serevent QLSeroquelSertraline QLSingulair QLSpiriva QLSularSymbyaxSynthroidTegretolTegretol XRTilade QLTolmetinToprol XLTravatan QLTricor TabletTriglideTrileptalTriphasilTwinject QLValtrex QLVesicare QLVivelle QLVivelle Dot QLVytorin QLYasmin Some medications are noted with N, QD, QL, or DS. The definitions for these symbols are listed QD = Quantity Duration. Some medications have a limited amount that can be covered for a below. Your benefit plan determines how these medications may be covered for you.
N = Notification. There are a few medications that your doctor must notify us of to make sure their QL = Quantity Level. Some medications have a limited amount that can be covered at one time.
DS = Diabetic Supplies. Diabetic supplies may be covered by your benefit plan.
2007 Three-Tier Prescription Drug List Reference Guide • Compounded prescriptions are Tier Three • Pens & cartridges are Tier Three except for Some medications are noted with N, QD, QL, or DS. The definitions for these symbols are listed QD = Quantity Duration. Some medications have a limited amount that can be covered for a below. Your benefit plan determines how these medications may be covered for you.
N = Notification. There are a few medications that your doctor must notify us of to make sure their QL = Quantity Level. Some medications have a limited amount that can be covered at one time.
DS = Diabetic Supplies. Diabetic supplies may be covered by your benefit plan.
2007 Three-Tier Prescription Drug List Reference Guide Some medications are noted with N, QD, QL, or DS. The definitions for these symbols are listed QD = Quantity Duration. Some medications have a limited amount that can be covered for a below. Your benefit plan determines how these medications may be covered for you.
N = Notification. There are a few medications that your doctor must notify us of to make sure their QL = Quantity Level. Some medications have a limited amount that can be covered at one time.
DS = Diabetic Supplies. Diabetic supplies may be covered by your benefit plan.

Source: http://www.moroch.com/internal/HR/HRPDFs/RX_List_UHC_Inspire.pdf