Update to pharmacy benefits and prescription drug lists
- All States
- Fully Insured and Self-Funded
The following updates will take effect for the UnitedHealthcare Prescription Drug Lists (PDLs) Jan. 1, 2018. These updates apply to all UnitedHealthcare integrated commercial business. They do not apply to direct commercial business (OptumRx direct business without UnitedHealthcare medical coverage).
UnitedHealthcare Pharmacy Benefits
You and your customers are invited to view our online, pre-recorded presentation of the pharmacy benefit strategies for Jan. 1, 2018 You can watch these presentations at any time that is convenient for you, with the opportunity to submit questions and feedback following the webcast.
Presentation for Clients
Pharmacy Coupon Adjustment Changes for Members (Updated Oct. 11, 2017)
As part of the Jan. 1, 2018 pharmacy benefit updates the Coupon Adjustment: Benefit Plan Protection program will be rolling out to customers. Currently, copay card dollars count towards the member’s deductible and out-of-pocket (OOP) maximum, which doesn’t accurately reflect what the member is paying.
The Coupon Adjustment: Benefit Plan Protection program is designed to provide a real-time solution that only includes the amount a member has paid (i.e., does not include amounts that are paid by the pharmaceutical manufacturer’s copay card program) towards a member’s deductible and out-of-pocket maximum when filled at BriovaRx, the OptumRx specialty pharmacy BriovaRx specialty pharmacy, UnitedHealthcare’s primary designated specialty pharmacy.
As a reminder, impacted members will be receiving letters November 1 and December 1, informing them of this program and how it will impact their pharmacy benefit. In addition, UnitedHealthcare has made updates to ensure the copay card amount and an explanation will be reflected on myuhc.com and on member’s Explanation of Benefits.
For self-funded clients, this program is available to add to your benefit. Work with your UnitedHealthcare representative to learn more and how to adopt this program.
Louisiana and Texas Customers
For fully-insured customers in Louisiana and Texas, these changes will take place upon the group renewal date.
For more information about the Jan. 1, 2018, pharmacy benefit, or if you are unsure of your plan or which PDL applies to you, contact your UnitedHealthcare representative. For more general PDL information, visit uhc.com/pharmacy.
Note not all PDL updates apply to all groups depending on state regulations, riders, and Summary Plan Descriptions (SPDs).