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Updated PPACA/HCR Preventive Care Medication Lists Available

May 22, 2017

Statins Added to Standard Advantage and Traditional Prescription Drug List (PDL) Editions for New York Fully Insured and Non-ERISA Self-funded Business

The latest versions of the standard UnitedHealthcare Patient Protection and Affordable Care Act/Health Care Reform (PPACA/HCR) Preventive Care Medication Lists are now available.

Updates to these lists include:

  • Addition of statins to the standard PPACA/HCR Preventive Care Medication Lists to accommodate early implementation for New York fully insured and Non-ERISA self-funded business on May 15.
    • Certain statins will be available at $0 cost-share to members who qualify.
    • To qualify, members will be required to meet all of the following criteria and not have a history of cardiovascular disease:
      • Must be aged 40-75, and
      • Have one or more cardiovascular risk factors, such as dyslipidemia, diabetes, hypertension or smoking, and
      • Have a calculated 10-year risk of a cardiovascular event of 10 percent or greater.
    • Not all statins will be covered at zero cost-share.
    • Lovastatin will be available for zero cost-share.
    • Atorvastatin and simvastatin will be available for zero cost-share after prior authorization criteria are met.
    • For members who do not go through prior authorization, statins will continue to be covered at their current tier.
    • This policy will apply to most self-funded and fully insured plans as of Dec. 1, 2017. 

 

Statins To Be Covered At $0 Cost-Share
No Prior Authorization Required Lovastatin (generic Mevacor®) All Strengths
Prior Authorization Required to Confirm Risk for Cardiovascular Disease (CVD)

Atorvastatin (generic Lipitor®) 10 & 20 mg*

Simvastatin (generic Zocor®) 5, 10, 20 & 40 mg*

*Only these strengths will be available for $0 cost-share.

 We have added improved member friendly language in the Frequently Asked Questions (FAQs) included with the drug lists.

  • Contraceptive updates for the July 1, 2017 PDL cycle are accessible by clicking on the links in the grid. 

 

UnitedHealthcare Member Preventive Care Medication Lists
Standard California Illinois
 Advantage Traditional Advantage Traditional  Advantage Traditional  
 SignatureValue Formulary SignatureValue Formulary 

 

  • New Illinois versions of these lists have been created to accommodate Illinois-specific contraceptive coverage requirements. UnitedHealthcare fully insured clients sitused in Illinois should use these lists. 
  • The current PPACA/HCR SignatureValue Preventive Medication lists include contraceptive updates for July 1, 2017. Statins will not be added to these SignatureValue lists until fall 2017, since there are no New York fully insured or Non-ERISA self-funded clients using the SignatureValue Formulary.
  • Oxford Advantage and Traditional PDL versions of these lists are also available now.
  • These updated lists are also posted to the myuhc.com  pharmacy pre-login page.

For more information, contact your UnitedHealthcare representative.

January 1, 2017 PDL Updates


The following updates will take effect for the OptumRx direct Prescription Drug Lists (PDLs) on January 1, 2017. Learn more

New Sales Automation Management Tool


Check out our new Sales Automation Management (SAM). Learn more

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