Frequently Asked Questions

1. What is a Prescription Drug List (PDL)?
2. Understanding Tiers
3. Who decides which medications get placed in which tier?
4. What factors does the PDL Management Committee look at to make tier placement decisions?
5. How often will prescription medications change tiers?
6. What is the difference between brand name and generic medications?
7. Why is the medication that I am currently taking no longer covered?
8. When should I consider discussing over-the-counter or non-prescription medications with my doctor?
9. Why are there notations next to certain medications in the PDL, and what do they mean?
10. What should I do if I use a self-administered injectable medication?
11. How do I access updated information about my pharmacy benefit?
12. What if I still have questions?

1. What is a Prescription Drug List (PDL)?
A PDL is a list that categorizes medications, products or devices that have been approved by the U.S. Food and Drug Administration into Tiers.
Your UnitedHealthcare pharmacy benefit provides coverage for a comprehensive selection of prescription medications. On this site you will find some commonly prescribed medications for certain conditions. You and your doctor can refer to this list to select the right medication to meet your needs.
The benefit plan documents provided by your employer or health plan include a Summary Plan Description (SPD) or a Certificate of Coverage (COC). Please refer to these documents to determine which medications are covered under your individual plan.
If you have pharmacy benefit coverage with UnitedHealthcare, you may learn more about your benefit by visiting myuhc.com or by calling the toll-free member phone number on the back of your ID card. If you are not currently enrolled with UnitedHealthcare for pharmacy benefit coverage, you may access myuhc.com for additional information during your open enrollment period or you may contact your employer or health plan for additional information.
In certain documents, the Prescription Drug List (PDL) was referred to as the "Preferred Drug List (PDL)." This change in descriptive terms does not affect your benefit coverage. Where differences are noted between this PDL reference guide and your benefit plan documents, the benefit plan documents will govern.
2. Understanding Tiers
Prescription medications are placed into tiers. Each tier has different levels of cost sharing, which is determined by your employer or health plan. Consult your benefit plan documents to find out the specific costs associated with your plan. Some plans may require you to pay the entire cost of the medication until the plan deductible has been met.

Tier 1 is your lowest cost option.  
3. Who decides which medications get placed in which tier?
The UnitedHealthcare PDL Management Committee makes tier placement decisions. The Committee’s goal is to help ensure access to a wide range of medications, while controlling health care costs for you and your employer or health plan. The PDL Management Committee is comprised of senior level UnitedHealth Group physicians and business leaders. You and your doctor decide which medication is appropriate for you.
4. What factors does the PDL Management Committee look at to make tier placement decisions?
The PDL Management Committee decides the tier placement of a particular prescription medication based on clinical information from the UnitedHealthcare Pharmacy and Therapeutics (P&T) Committee and economic considerations. The Committee looks at the overall health care value of a particular medication, balancing the need for flexibility and choice for you and an affordable pharmacy benefit for employer groups and health plans.
5. How often will prescription medications change tiers?
Medications may change tiers up to six times per calendar year, depending on your benefit. Most changes will occur on January 1 and July 1. Additionally, when a brand-name medication becomes available as a generic, the tier status of the brand-name medication and its corresponding generic will be evaluated. When a medication changes tiers, you may be required to pay more or less for that medication. These changes may occur without prior notice to you. For the most current information on your pharmacy coverage, please call the toll-free member phone number on the back of your ID card or visit your member Web site.
6. What is the difference between brand name and generic medications?
Generic medications contain the same active ingredients as brand name medications, but they often cost less. Generic medications become available after the patent on the brand name medication expires. At that time, other companies are permitted to manufacture an FDA-approved, chemically equivalent medication. Many companies that make brand name medications also produce and market generic medications.
The next time your doctor gives you a prescription for a brand name medication, ask if a generic equivalent or lower tier alternative is available and if it might be appropriate for you. While there are exceptions, generic medications are usually your lowest-cost option. Please note that some generic medications may be in Tier 2 or Tier 3 and will not have the lowest copayment available under your pharmacy benefit plan. Go to myuhc.com to determine the copayment for your generic medication.
7. Why is the medication that I am currently taking no longer covered?
Medications may be excluded from coverage under your pharmacy benefit. For example, a prescription medication may be excluded from coverage when it is therapeutically equivalent to another prescription medication or an over-the-counter medication. There may be alternatives on the PDL or over-the-counter medications that are appropriate for your treatment.
8. When should I consider discussing over-the-counter or non-prescription medications with my doctor?
An over-the-counter medication can be an appropriate treatment for some conditions. Consult your doctor about over-the-counter alternatives to treat your condition. These medications are not covered under your pharmacy benefit, but they may cost less than your out-of-pocket expense for prescription medications.
9. Why are there notations next to certain medications in the PDL, and what do they mean?
The specific definitions for these notations (SL, N, etc.) are listed at the bottom of each page of the PDL and refer to our pharmacy programs. These programs as well as our drug utilization review processes can help confirm coverage based on your benefit plan.
Please call the toll-free member phone number on the back of your ID card if you need additional information about these notations.
10. What should I do if I use a self-administered injectable medication?
You may have coverage for self-administered injectable medications through your pharmacy benefit plan. UnitedHealthcare has developed a specialty pharmacy network for these medications. Please call our toll-free Specialty Pharmacy Referral Line at 1-866-429-8177. A representative will answer questions about our program and then transfer you to a specialty pharmacy based on your particular specialty medication prescription. To learn more about the Specialty Pharmacy Program, specialty medications and conditions, visit uhcspecialtyrx.com.
11. How do I access updated information about my pharmacy benefit?
Since the PDL may change, we encourage you to visit your member Web site or call the toll-free member phone number on the back of your ID card for more current information.
12. What if I still have questions?
Please call the toll-free member phone number on the back of your ID card. Representatives are available to assist you 24 hours a day (except Thanksgiving and Christmas).