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04/2019: UnitedHealthcare Community Plan 2nd Quarter 2019 Preferred Drug List

UnitedHealthcare Community Plan’s Preferred Drug List (PDL) is updated quarterly by our Pharmacy and Therapeutics Committee. Please review the changes and update your references as necessary.

Not all medications will be added, modified or deleted in each state, so please check the state’s PDL for a state-specific list of preferred drugs. You may also view the changes at UHCprovider.com/plans > [select your state].

We provided a list of available alternatives to UnitedHealthcare Community Plan members whose current treatment includes a medication removed from the PDL. Please provide affected members a prescription for a preferred alternative in one of the following ways:

  • Call or fax the pharmacy.
  • Use e-Script.
  • Write a new prescription and give it directly to the member.

If a preferred alternative is not appropriate, call 800-310-6826 for prior authorization for the UnitedHealthcare Community Plan member to remain on their current medication.

Changes will be effective April 1, 2019 for: Arizona, California, Florida — Healthy Kids, Hawaii, Maryland, Michigan, Mississippi, Nebraska, Nevada, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, and Virginia.

These changes don’t apply to UnitedHealthcare Community Plans in Florida Managed Medicaid, Iowa, Kansas, Louisiana, Texas, and Washington.

PDL Additions

  • Aimovig™/Erenumab-aooe injection: Indicated for the preventive treatment of migraines. Prior authorization required.
  • Butrans®*/Buprenorphine patch: Indicated for the treatment of moderate to severe pain. Prior authorization required.
  • Emgality™/Galcanezumab-gnlm injection: Indicated for the preventive treatment of migraines. Prior authorization required.
  • Idhifa®/Enasidenib tablet: Indicated for the treatment of relapsed or refractory acute myeloid leukemia (AML). Prior authorization required. Available through specialty pharmacy.
  • Lokelma®/Sodium zirconium cy-closilicate suspension packet: Indicated for the treatment of chronic hyperkalemia. Prior au-thorization required.
  • Mulpleta®/Lusutrombopag tablet: Indicated for the treatment of thrombocytopenia in patients with chronic liver disease (CLD) who are scheduled to undergo a procedure. Prior authorization required. Available through specialty pharmacy.
  • Olumiant®/Baricitinib tablet: Indicated for the treatment of moderately to severely active rheumatoid arthritis. Prior authorization required. Available through specialty pharmacy.
  • Orilissa™/Elagolix tablet: Indicated for the management of moderate to severe pain as-sociated with endometriosis. Prior authorization required.
  • Repatha®/Evolocumab injection: Indicated for the treatment of heterozygous and homozygous familial hypercholesterolemia. Prior authorization required. Available through specialty pharmacy.
  • Tibsovo®/Ivosidenib tablet: Indicated for the treatment of relapsed or refractory AML. Prior authorization required. Available through specialty pharmacy.
  • Udenyca™/Pegfilgrastim-cbqv sy-ringe: Indicated to decrease the incidence of infection in patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs. Prior authorization required. Available through specialty pharmacy.
  • Zepatier®/Elbasvir-grazoprevir tablet: Indicated for the treatment of hepatitis C. Prior authorization required. Available through specialty pharmacy.
*Only generics are preferred.

Removed from PDL

  • Diabinese®/Chlorpropamide tablet: Glimepiride and glipizide are alternate options. Current utilizers will be grandfathered.
  • Orinase®/Tolbutamide tablet: Glimepiride and glipizide are alternate options. Current utilizers will be grandfathered.
  • Tolinase®/Tolazamide tablet: Glimepiride and glipizide are alternate options. Current utilizers will be grandfathered.
  • Zytiga® 500mg/Abiraterone tablet: Abiraterone 250mg tablets are an alternate option. Current utilizers will not be grandfathered.
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PDL update training on UHC On Air - be sure to go to UHC On Air to check out an on-demand video highlighting this quarter’s more impactful PDL changes.

Go to UHC on Air

UnitedHealthcare Link users can access UHC On Air by selecting the UHC On Air tile on their Link dashboard. From there, go to your state, and click on UnitedHealthcare Community Plan. You’ll find the Preferred Drug List Q2 Update in the video listings.

Neonatal Resource Services Clinical Guideline: Inhaled Nitric Oxide (iNO)

A new Neonatal Resource Services (NRS) medical necessity clinical guideline on Inhaled Nitric Oxide (iNO) will take effect April 1, 2019. This guideline provides an evidence-based approach to inhaled nitric oxide therapy and describes the limitations of and recommendations for this treatment. Effective May 1, 2019, the guideline will apply to UnitedHealthcare Community Plan members in Arizona, California, Florida, Iowa, Louisiana, Mississippi, Kansas, Nevada, New Jersey and Pennsylvania. Effective June 1, 2019, the guideline will apply to UnitedHealthcare Community Plan members in Massachusetts, Missouri, Nebraska, New York and Washington. Effective July 1, 2019, this guideline will apply to UnitedHealthcare Community Plan members in Ohio and Texas.

Questions?

If you have any questions, please call UnitedHealthcare Community Plan’s Pharmacy Department at 800-310-6826.