DRUG - UnitedHealthcare MedicareRx for Groups

More documents

Recommendations

Info

2 About this complete drug list. UnitedHealth Rx for Groups helps members like you lower prescription drug costs. This complete formulary is a list of drugs covered by UnitedHealth Rx for Groups. UnitedHealth Rx for Groups selected the drugs in consultation with a team of health care providers with expertise in the prescription drug needs of people on Medicare. For more information, go to www.UnitedHealthRxforGroups.com or call Customer Care using the number on the bottom of the next page. The UnitedHealth Rx for Groups drug list includes 100% of the drugs covered by Medicare Part D. For your prescription drugs to be covered by this plan, the drugs must be included in the drug list and in most cases the prescriptions must be filled at one of our network pharmacies. UnitedHealth Rx for Groups includes over 60,000 network pharmacies for your convenience. Some of our network retail pharmacies include: Brooks Costco CVS HEB Pharmacy Kmart Kroger Longs Medicine Shoppe Publix Rite Aid Safeway Shopko/Pamida Target Walgreens Wal-Mart Winn Dixie and more ... Plus thousands of independent neighborhood pharmacies! To find a pharmacy location within our network, call Customer Care or visit us online at www.UnitedHealthRxforGroups.com. This is a complete drug formulary as of January 1, 2008. For more information, call 1-888-556-6648, 24 hours a day, 7 days a week. TTY users should call 1-877-730-4203. or visit us online at www.UnitedHealthRxforGroups.com.
HOW TO FIND OUT IF YOUR DRUG IS COVERED. There are two ways to find your prescription drugs within the drug list. 1. Look for a drug by name in the Drug Index, which begins on page 54. 2. Look for a drug by the health condition in the category section. For example, if you want to find drugs used to treat chest pain, turn to the category listing and look for “Chest Pain Drugs”. Brand-name drugs are in bold type (e.g., Lipitor) while generic drugs are not (e.g., Furosemide). If you cannot find your drug in this complete drug list, contact Customer Care for assistance in finding your drug. If your drug is not in the complete drug list, you should talk with your doctor to see if the drug list includes an alternative drug choice that is right for you. Note: If your plan has an open formulary, many additional drugs not usually covered by a Medicare Part D plan are covered. With open formulary plans, all Food and Drug Administration (FDA) approved prescription drugs will be covered except those listed on the Limitations and Exclusions document. Only drugs covered under the Medicare Part D program are eligible when calculating true out-of-pocket (TrOOP) costs, will help you move into or out of the coverage gap, and qualify for catastrophic coverage. In addition, only drugs covered under the Medicare Part D program are eligible for the Medicare Appeals process. All other drugs are eligible for the UnitedHealth Rx for Groups grievance process. Please refer to your Summary of Benefits or contact Customer Care if you have specific questions about your prescription drugs. Your copay. During the initial coverage period, UnitedHealth Rx for Groups pays part of the costs for your covered drugs and you pay part. Your copayment (copay) depends on the tier (or coverage level) assigned to your prescription drug. This complete drug list includes four tiers. Each tier has a different copay amount. The Summary of Benefits lists the copays that apply to each tier. If you qualify for extra help in paying for your prescription drugs, your copays may be different than those described in the Summary of Benefits. Please contact Customer Care to find out what your costs are in this situation. This is a complete drug formulary as of January 1, 2008. For more information, call 1-888-556-6648, 24 hours a day, 7 days a week. TTY users should call 1-877-730-4203. or visit us online at www.UnitedHealthRxforGroups.com. 3
Page 1: 2008 formulary (COMPLETE LIST OF CO
Page 5 and 6: These requirements and limits apply
Page 7 and 8: Drug list changes. UnitedHealth Rx
Page 9 and 10: DRUG Gentamicin Sulfate 1 Kanamycin
Page 11 and 12: DRUG UnitedHealth Rx for Groups TIE
Page 13 and 14: DRUG Mepron 4 Metro IV 3 Metronidaz
Page 15 and 16: DRUG Bactrim 3 Bactrim DS 3 Gantris
Page 17 and 18: DRUG Ifosfamide/Mesna 4 UnitedHealt
Page 19 and 20: DRUG Salagen 3 Urecholine 3 UnitedH
Page 21 and 22: DRUG Minipress 3 Prazosin HCl 1 Ter
Page 23 and 24: DRUG Trandate 3 Trandate IV 3 Zebet
Page 27 and 28: DRUG Moban 2 navane 3 orap 2 Perphe
Page 29 and 30: DRUG Stalevo 150 2 Stalevo 200 2 Un
Page 31 and 32: DRUG Morphine Sulfate/D5W 1 UnitedH
Page 33 and 34: DRUG Chlorothiazide 1 Chlorthalidon
Page 35 and 36: DRUG Romycin 1 Sulf-10 1 Sulfacetam
Page 37 and 38: DRUG Mydral 1 Mydriacyl 3 Propine 3
Page 39 and 40: DRUG Pangestyme UL 12 3 Pangestyme
Page 43 and 44: DRUG Alora 2 Angeliq 3 cenestin 2 c
Page 47 and 48: DRUG Sandostatin 4 Sandostatin LAR
Page 49 and 50: DRUG Erygel 3 UnitedHealth Rx for G
Page 51 and 52: DRUG Procto-Pak 1 Proctosol HC 1 Pr
Page 53 and 54:
DRUG Uniphyl 2 VITAMInS UnitedHealt
Page 55 and 56:
Amoclan............................
Page 57 and 58:
Cefotaxime Sodium .................
Page 59 and 60:
Dilor .............................
Page 61 and 62:
Gemzar ............................
Page 63 and 64:
Levo-Dromoran......................
Page 65 and 66:
Nalfon.............................
Page 67 and 68:
Pediarix ..........................
Page 69 and 70:
Robinul Forte .....................
Page 71 and 72:
TriHiBit ..........................
Page 73 and 74:
LOWER-COST OPTION(S) Tier 3 Drug Lo
Page 75:
This document includes: UnitedHealt
show all

DRUG - UnitedHealthcare MedicareRx for Groups

Create successful ePaper yourself

Delete template?

Save as template?