UnitedHealthcare will update its prescription drug list (PDL) for small group plans 2-99, effective July 1, 2017.
Changes will affect Tier 3 and Tier 4 prescription plans including medications with new benefit coverage, medications moving to a higher tier, and medications excluded from benefit coverage.
Tier 3 changes
Medications with new benefit coverage
The following medications were previously not covered under most benefit plans and are now eligible for coverage.
| Therapeutic Use | Medication Name | Tier Placement |
| ADHD | methylphenidate extended-release (generic Metadate CD) | 2 |
| methylphenidate extended-release (generic Ritalin LA) | 2 | |
| Cholesterol/Lipid Lowering | ezetimibe tablet (generic Zetia) | 3 |
| COPD | Bevespi | 2 |
| Diabetes | Adlyxin | 3 |
| Soliqua | 2 | |
| Gout | Zurampic | 3 |
| Hemophilia | Afstyla | 3 |
| High Blood Pressure | olmesartan (generic Benicar) | 2 |
| olmesartan HCT (generic Benicar HCT) | 2 | |
| Hormone Replacement Therapy | estradiol vaginal tablet (Yuvafem (generic Vagifem)) | 2 |
| Narcotic Overdose | Narcan nasal spray | 2 |
| Skin Conditions | Ultravate 0.05% lotion | 3 |
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 | Medication Name | Tier change | Lower-Cost Options |
| Acne | tretinoin (generic Retin-A) cream |
1 > 3 | OTC Differin gel |
| ADHD | Metadate ER | 1 > 3 | methylphenidate extended-release capsules (generic Metadate CD, Ritalin LA), Adderall XR, Concerta, Vyvanse |
| methylphenidate extendedrelease tablet (generic Metadate ER) |
|||
| Contraceptive | Natazia | $0 > 2 | Various contraceptives available for $0 cost share |
| Yasmin | |||
| Hepatitis C | Daklinza | 2 > 3 | Epclusa |
| Infections | Albenza | 2 > 3 | OTC pyrantel pamoate |
| Ciprodex | 2 > 3 | ofloxacin 0.3 % solution (generic Floxin Otic, Ocuflox) |
|
| ofloxacin otic (generic Floxin Otic) |
1 > 2 | ofloxacin 0.3 % solution (generic Ocuflox) | |
| Irritable Bowel Disease | chlordiazepoxide/clidinium (generic Librax) |
1 > 3 | dicyclomine (generic Bentyl), hyoscyamine (generic Levsin) |
| Neuropathic Pain | lidocaine 5% patch (generic Lidoderm) |
2 > 3 | Discuss with your doctor |
| Pain | lidocaine 5% ointment | 1 > 2 | Discuss with your doctor |
To see the full list of Tier 3 drugs affected by the change, click here.
To see the list of Tier 4 drugs affected by the change, click here.
For a full list of covered drugs: Tier 3 and Tier 4.
If you have any questions, please contact your Bukaty Companies benefits consultant at 913.345.0440.
