Prescription Drug Lists (PDLs) for Exchange Plans: Small Business Health Options Program (SHOP)
Learn more about PDLs for health plans available through the Health Insurance Marketplace. The PDL includes brand and generic medications separated into cost levels called tiers. When selecting a medication, review the PDL to see if there is a Tier 1 option (lowest cost) to treat your condition. If your medication is in Tier 2, 3 or 4 (highest cost), you may pay more.
2022 PDLs
- 4 Tier Essential PDL with Specialty Medication Cost Share Drugs
Use for all plans except for those listed below
- 4 Tier Essential PDL without Specialty Medication Cost Share Drugs
Use for: - Optimum Choice, Inc.
- UHC OCI Platinum 500
- UHC OCI Gold 500
- UHC OCI Silver 5000-1
- UHC OCI Silver 2000
- UHC OCI HSA Bronze 7000
- UnitedHealthcare Insurance Company
- UHC Choice Platinum 500
- UHC Choice Plus Gold 0-1
- UHC Choice Gold 500
- UHC Choice HSA Bronze 7000
- UHC Core Essential HSA Bronze 7000
- UnitedHealthcare of the Mid-Atlantic, Inc.
- UHC Navigate HSA Bronze 7000
- 4 Tier Essential PDL with Specialty Medication Cost Share Drugs
Use for all plans except for those listed below
- 4 Tier Essential PDL without Specialty Medication Cost Share Drugs
Use for: - MAMSI Life and Health Insurance Company
- UHC Choice HSA Bronze 7000-2
- Optimum Choice, Inc.
- UHC OCI Silver 2000-2
- UHC OCI HSA Bronze 7000-2
- UnitedHealthcare Insurance Company
- UHC Choice Plus HSA Bronze 7000-2
- UnitedHealthcare of the Mid-Atlantic, Inc.
- UHC Core Essential HSA Bronze 7000-2
- UHC Navigate HSA Bronze 7000-2
- Visit www.uhceservices.com/nyshop to learn more
2021 PDLs
- 3 Tier Advantage PDL with Specialty Medication Cost Share Drugs
Use for all plans except for those listed below
- 3 Tier Advantage PDL without Specialty Medication Cost Share Drugs
Use for:- Choice plans: Platinum 500 and Gold 500
- Choice Plus Platinum 0-1
- OCI plans: Platinum 500, Gold 500 and Silver 5000-3
- 4 Tier Advantage PDL without Specialty Medication Cost Share Drugs
Use for:- Choice EPO Gold 0
- Choice Plus POS Gold 0-1
- OCI HMO Gold 0
- Choice EPO Gold 0
- 4 Tier Essential PDL
Use for:- Choice plans: HSA Gold 1600-1, HSA Silver 2500-1 and HSA Bronze 7000
- Choice Plus plans: HSA Gold 1600-1 and HSA Silver 2500-1
- Core Essential plans: Gold 750, HSA Silver 2500 and HSA Bronze 7000
- Navigate plans: Gold 750, HSA Silver 2500 and HSA Bronze 7000
- OCI plans: HSA Gold 1600-1, HSA Silver 2500-1, Silver 2000 and HSA Bronze 7000
- 3 Tier Advantage PDL with Specialty Medication Cost Share Drugs
Use for:- Choice plans: Platinum 0-2 and 0-4, Gold 1500-2 and 1500-4, HSA Gold 1600-4, Silver 3500-2 and 5000-3, HSA Silver 2500-4
- Choice Plus plans: Platinum 0-2, Gold 750-2 and 1500-4. HSA Gold 1600-4, Silver 3500-2 and 5000-3, HSA Silver 2500-4
- OCI plans: Platinum 0-2 and 0-4, Gold 750-2, 1500-5 and 3500-2, Silver 5000-2, HSA Silver 2500-6
- 4 Tier Essential PDL
Use for:- Choice plans: HSA Gold 1600-2, HSA Gold 2250-2, HSA Silver 2500-2, HSA Bronze 7000-2
- Choice Plus plans: HSA Gold 1600-2, HSA Silver 2500-2, HSA Bronze 7000-2
- All Core Essential plans
- All Navigate plans
- OCI plans: HSA Bronze 7000-4, HSA Gold 2250-2, HSA Silver 2500-4, Silver 2000-2, HSA Bronze 7000-4
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