Important information about your prescription benefits Effective July 1, 2013
Within the Prescription Drug List (PDL), medications
are grouped by tier. The tier indicates the amount you pay when
you fill a prescription. Your lower-cost options are found in Tier 1.
Medications moving to a lower tier Medications may move from a higher tier to a lower tier, which can occur at any time throughout the year to provide members with immediate cost savings.
Condition Medication Name Tier Placement Effective Date Nasal Allergies New benefit coverage The following medications, previously not covered under most of our benefit plans, will now be eligible for coverage under many plans. Tier placement for these medications is shown below. Condition Medication Name Tier Placement Effective Date Cancer Pain Nasal Allergies Medications moving to a higher tier We evaluate medications based on their total value, including how a medication works. When two or more medications work the same way, other factors, including cost, may play a role in their tier placement on the PDL. Medications may move to a higher tier because they offer less health care value than similar medications in their therapeutic classes. If your medication is listed below, you may continue taking it, but you may pay a higher cost. We encourage you to talk with your doctor about the lower-cost option(s) listed below that also may treat your condition.
Condition Medication Name Tier Placement Lower-Cost Options Excess Growth
methylphenidate (generic Ritalin), methylphenidate
Excess Sleepiness
extended-release (generic Ritalin LA), Adderall XR,
HIV-related Complication Low Platelet Levels
naratriptan (generic Amerge), sumatriptan succinate
Migraine Nasal Allergies
fluticasone (generic Flonase), Omnaris, Zetonna
trospium extended-release (generic Sanctura
oxybutynin (generic Ditropan), oxybutynin extended-
Overactive Bladder
release (generic Ditropan XL), trospium (Sanctura)
Medications moving to a higher tier (continued) Condition Medication Name Tier Placement Lower-Cost Options Pulmonary Arterial Hypertension Transplant Medications being added to the Select Designated Pharmacy (SDP) Program Through this program, members must either fill their prescription by mail or switch to a lower-cost option or do both in order to continue to receive network benefits. Call the number on the back of your health plan ID card to determine if this program applies to your benefit plan and for additional details about the program. Condition Medication Name Tier Placement Lower-Cost Options
fluoxetine (generic Prozac), paroxetine (generic Paxil),
Depression
sertraline (generic Zoloft), citalopram (generic Celexa),
oxybutynin (generic Ditropan), oxybutynin extended-
Overactive Bladder
release (generic Ditropan XL), trospium (Sanctura)
Medications no longer covered under most of our benefit plans When several medications work in the same way, we may choose to not cover the higher-cost option. The medications listed below will no longer be covered under many of our pharmacy benefit plans. Condition Medication Name Lower-Cost Options
montelukast chewable tablet (generic Singulair)
Allergies/Asthma Breast Cancer Cancer Pain
venlafaxine extended-release capsule (generic Effexor XR)
Depression
bupropion sustained-release (generic Wellbutrin SR)
bupropion extended-release (generic Wellbutrin XL)
Dermatitis
2013 United HealthCare Services, Inc. UnitedHealthcare® and the dimensional U
All branded medications are trademarks or registered trademarks of their respective
logo are registered marks owned by Unitedhealth Group, Inc. Applies to Advantage
owners. Please note not all PDL updates apply to all groups depending on state
Medications no longer covered under most of our benefit plans (continued)
Condition Medication Name Lower-Cost Options Glaucoma
eprosartan (generic Teveten), losartan (generic Cozaar),
Benicar or Micardis + amlodipine (generic Norvasc)
High Blood Pressure
valsartan/hydrochlorothiazide (generic Diovan HCT)
doxycycline hyclate (generic Vibramycin), doxycycline
Infections Inflammatory Bowel
malathion (generic Ovide), permethrin (generic Elimite),
Nasal Allergies
fluticasone (generic Flonase), azelastine (generic Astelin)
Osteoporosis
acetaminophen/oxycodone (generic Percocet)
zolpidem (generic Ambien), zolpidem extended-release
zaleplon (generic Sonata), zolpidem (generic Ambien)
Stroke and Heart Attack Prevention Topical Fungal Infections
omeprazole (Prilosec) + clarithromycin (Biaxin) +
Ulcers, Heartburn & Relux Wart Removal
Over-the-counter (OTC) salicylic acid products
For more information
Visit myuhc.com or call the toll-free number on the back of your health plan ID card.
2013 United HealthCare Services, Inc. UnitedHealthcare® and the dimensional U
All branded medications are trademarks or registered trademarks of their respective
logo are registered marks owned by Unitedhealth Group, Inc. Applies to Advantage
owners. Please note not all PDL updates apply to all groups depending on state
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Important information about your 
Medications moving to a higher tier (continued) 
Medications no longer covered under most of our benefit plans (continued)