Updates to your prescription benefits
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- Edward Banks
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1 Updates to your prescription benefits Effective Jan. 1, 2018 Update Summary Within the Prescription Drug List (PDL), are grouped by tier. The tier indicates the amount you pay when you fill a prescription. Please reference this chart as you review the following updates. $ $$ $$$ Tier 1 Tier 2 Tier Your lowest-cost Your mid-range cost Your highest-cost Medications with new benefit coverage. The following were previously not covered under most benefit plans and are now eligible for coverage. Therapeutic Use Medication Name Tier Placement Allergies RyVent Asthma/COPD AirDuo Respiclick (Brand Only) Chest Pain GoNitro Constipation Trulance Diabetes* Xultophy Dry Eye Disease Restasis MultiDose Duchenne Muscular Dystrophy Emflaza Elevated Parathyroid Hormone Rayaldee Eye Pain/Inflammation BromSite Hepatitis C High Blood Pressure Mavyret Vosevi metoprolol extended-release/hydrochlorothiazide (Dutoprol Authorized Generic) 2 * For Oxford plans, diabetic supplies and prescription may be subject to different cost-share arrangements. Please see your Summary of Benefits and Coverage (SBC) for specifics. Enhanced Traditional Three-Tier PDL Update Summary
2 Therapeutic Use Medication Name Tier Placement Infections Daxbia Otovel Migraines Ergomar Opioid Induced Constipation Relistor tablet Oral Steroid LoCort ZonaCort Osteoporosis Tymlos Pain Arymo ER Skin Conditions Micort-HC 2.5% cream Rhofade Medications moving to a lower tier. The following are moving to a lower tier, making them more affordable. Therapeutic Use Medication Name Tier Placement Inflammatory Conditions Otezla u 2 Pain Xtampza ER u 2 Medications moving to a higher tier. Medications may move from a lower tier to a higher tier when they are more costly and have available lower-cost options. Therapeutic Use Allergic Reactions Cancer Medication Name EpiPen (Brand Only) EpiPen Jr (Brand Only) Mekinist Tafinlar Tier Placement 2 u Lower-Cost Options epinephrine auto-injector (generic EpiPen) epinephrine auto-injector (generic EpiPen Jr) 2 u Discuss with your doctor Contraceptive Natazia $0 u 2 Discuss with your doctor Hepatitis C High Blood Pressure Infections Daklinza Sovaldi Dutoprol 2 u Albenza Ciprodex 2 u Discuss with your doctor 2 u metoprolol (generic Toprol-XL) plus hydrochlorothiazide OTC pyrantel pamoate ofloxacin 0.% solution (generic Floxin Otic, Ocuflox) Osteoporosis Forteo 2 u Discuss with your doctor Pain Opana ER 2 u morphine sulfate extended-release tablet (generic MS Contin), Nucynta ER, Xtampza ER
3 Prescription with over-the-counter equivalents.** Prescription containing the same active ingredient available in an over-the-counter product may be excluded from coverage. Therapeutic Use Medication Name Lower-Cost Options Stroke & Heart Attack Prevention Yosprala OTC aspirin plus omeprazole (Prilosec), pantoprazole (Protonix) ** This is not applicable for plans written in New Jersey. For New York plans, a prescription drug product that is therapeutically equivalent to an over-the counter drug may be covered if it is determined to be medically necessary. Visit the member website listed on your health plan ID card to look up the price of drugs covered by your plan, find lower-cost options and more. For more information, call the toll-free phone number on the back of your health plan ID card to speak with a Customer Service respresentive. This document applies to commercial group members of UnitedHealthcare and Oxford New York and New Jersey plans. UnitedHealthcare is a registered trademark owned by UnitedHealth Group, Inc. All branded are trademarks or registered trademarks of their respective owners. Please note not all PDL updates apply to all groups depending on state regulation, riders and SPDs. Insurance coverage provided by or through UnitedHealthcare Insurance Company, UnitedHealthcare Insurance Company of New York, or Oxford Health Insurance, Inc. Oxford HMO products are underwritten by Oxford Health Plans (NJ), Inc. Administrative services provided by United HealthCare Services, Inc., UnitedHealthcare Service LLC, Oxford Health Plans LLC, or their affiliates. MT / United HealthCare Services, Inc. MS Enhanced Traditional Three-Tier PDL Update Summary
4 Nondiscrimination notice and access to communication services UnitedHealthcare and Oxford do not discriminate on the basis of race, color, national origin, age, disability or sex in its health programs or activities. If you think you were treated unfairly because of your sex, age, race, color, disability or national origin, you can send a complaint to the Civil Rights Coordinator. Online: UHC_Civil_Rights@uhc.com Mail: Civil Rights Coordinator UnitedHealthcare Civil Rights Grievance P.O. Box 0608 Salt Lake City, UT 8410 You must send the complaint within 60 days of your experience. A decision will be sent to you within 0 days. If you disagree with the decision, you have 15 days to ask us to look at it again. If you need help with your complaint, please call the toll-free phone number listed on your ID card, TTY 711, Monday through Friday, 8 a.m. to 8 p.m. if you are a UnitedHealthcare member, or Monday through Friday, 8 a.m. to 6 p.m. if you are a member of an Oxford plan. You can also file a complaint with the U.S. Dept. of Health and Human Services. Online: Complaint forms are available at Phone: Toll free , (TDD) Mail: U.S. Dept. of Health and Human Services 200 Independence Avenue SW Room 509F, HHH Building Washington, D.C We provide free services to help you communicate with us, including letters in other languages or large print. Or, you can ask for an interpreter. To ask for help, please call the toll-free phone number listed on your ID card, TTY 711, Monday through Friday, 8 a.m. to 8 p.m. if you are a UnitedHealthcare member, or Monday through Friday, 8 a.m. to 6 p.m. if you are a member of an Oxford plan.
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Updates to your prescription benefits
Updates to your prescription benefits Effective Jan. 1, 2018 Update Summary Within the Prescription Drug List (PDL), medications are grouped by tier. The tier indicates the amount you pay when you fill
Updates to your prescription benefits
Updates to your prescription benefits Effective Jan. 1, 2018 Update Summary Within the Prescription Drug List (PDL), are grouped by tier. The tier indicates the amount you pay when you fill a prescription.
Updates to your prescription benefits
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Updates to your prescription benefits
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Updates to your prescription benefits
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Updates to your prescription benefits
Updates to your prescription benefits Effective July 1, 2018 Update Summary Within the Prescription Drug List (PDL), medications are grouped by tier. The tier indicates the amount you pay when you fill
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