Drug list This is a list of specialty medications that Optum Specialty Pharmacy can provide or facilitate access and is subject to change. You can find a list of network pharmacies on OptumRx.com or by using the mobile app. 5705185. 0000021856 00000 n Medications, including generics, may be added at any time. 0000087978 00000 n 2021 Preventive Medication List Expanded listing by therapeutic category AGENTS FOR CHEMICAL DEPENDENCY acamprosate calcium buprenorphine sublingual buprenorphine/naloxone ANTIARRHYTHMIC AGENTS amiodarone disopyramide dofetilide flecainide MULTAQ Pacerone propafenone propafenone er sotalol sotalol AF ANTICONVULSANTS endstream endobj 1901 0 obj <>/Metadata 61 0 R/Names 1914 0 R/OpenAction 1902 0 R/Outlines 87 0 R/PageMode/UseThumbs/Pages 1896 0 R/StructTreeRoot 122 0 R/Type/Catalog/ViewerPreferences<>>> endobj 1902 0 obj <> endobj 1903 0 obj <. It may also help you understand plan requirements that may affect your coverage for a medication. 0000110305 00000 n 0000021964 00000 n 0000175308 00000 n KADIAN ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG, 100 MG, 20 MG, . 19.79. This evidence helps us determine a medication's overall value . trailer <<811DF2F5C7B94E58A6FD02A3CDA60469>]/Prev 1518130/XRefStm 4654>> startxref 0 %%EOF 2105 0 obj <>stream Review Optum Rx Formulary Changes: Effective 7/1/23 . OptumRx 2020 Preventive medications and your plan Author: OptumRx Subject: OptumRx 2020 Preventive medications and your plan - Preventive standard generics Preventive medications are a group of products in your plan's formulary which 0000131134 00000 n hbbd``b` 0000129643 00000 n hb```u+( =n k@1|W7xkxHF{Kk>^a`c|w<>|4YZ >@ua`:20 &) Pharmacy is one of the most highly used benefits. 0000171360 00000 n 0000006606 00000 n . 0000007149 00000 n H\j0~ 0000175824 00000 n 0000018418 00000 n 0000014949 00000 n 0000177496 00000 n Read our specialty pharmacy to learn more. 0000009482 00000 n 0001377839 00000 n 0000027267 00000 n Maximum daily dose quantity limits apply. When does the formulary change? 0000020201 00000 n To create the list, Optum Rx is guided by the Pharmacy and Therapeutics Committee. Choosing medications in lower tiers may save you money. A Prescription Drug List (PDL) - also called a formulary - is a list of commonly used medications, organized into cost levels, called tiers. 0000035643 00000 n 0000112702 00000 n Where differences are noted between this list and your benefit plan documents, the benefit plan documents will rule. 0001380117 00000 n 0000131293 00000 n PV Preventive Drugs - May have coverage and no copayment or coinsurance when . Notes. Medications are listed by therapeutic category. Print the full list Filter by (Filter by drug name, condition or treatment) Sort by Write a review. Tier E Excluded May not be covered or need prior authorization. 0000174075 00000 n It can save you money and get the medications you need to help you live a healthier life. You can also search for a specific prescription medication to find out if its covered or what youll have to pay out-of-pocket. Medications are listed by therapeutic category. Your benefit plan decides how these medications may be covered. 0i5`]!my;JqM2^=`fQ=F)@hbdrM`QTKhm`Vc/AY#6MQ_dj' )QNEqMUCn&0tJ'[0 0000008249 00000 n If you can't find the medication you are looking for, contact our team. 0000007034 00000 n ;?uE:%V-+9H~{YF6+ !otpg0==gY,p:gY&pSf*2Le"STf*2L>(A}PKwft3nF7ft3nF7Ek0vp3\cLc>|e0 0000030876 00000 n 0000171816 00000 n For more information regarding the tiers and designations in this drug list, please see the Reading your formulary section of this booklet. OptumRx Vigilant Drug Program High-Cost Brands with Generics strategy Effective January 1, . You can also search for a specific prescription medication to find out if it's covered or what you'll have to pay out-of-pocket. INTERMEZZO SUBLINGUAL TABLET SUBLINGUAL 1.75 MG: JADENU. Where differences are noted between this list and your benefit plan documents, the benefit plan documents will rule. 0000085711 00000 n Where differences are noted between this list and your benefit plan documents, the benefit plan documents will rule. 2023 Preventive medications and . 0000014395 00000 n 0000130173 00000 n If you or your doctor have a question as to whether or not a drug is covered, please call Optum Rx at (877) 629-3117. 0000088057 00000 n 0000122118 00000 n 0001378201 00000 n You can use a resource called a prescription drug list (PDL) to check your coverage. 0000019735 00000 n 0000173126 00000 n %PDF-1.6 % Where differences are noted between this list and your benefit plan documents, the benefit plan documents will rule. Your 2020 Formulary For the most current list of covered medications or if you have questions: Call the number on your member ID card. 0000155145 00000 n 0000129847 00000 n 0000011180 00000 n Drug Name Therapeutic Class Status Tier Additions and deletions PA/ST Search the list of FDA-approved drugs and coverage for each by entering a drug name below. Notes. Your specific plan may not cover all of the drugs. Prescription Tobacco Cessation Medications4 If you need help to quit smoking or using tobacco products, these preventive medications are available at $0 cost share. 0000171895 00000 n %%EOF S T endstream endobj 1950 0 obj <> endobj 1951 0 obj <> endobj 1952 0 obj <>stream Go to Pharmacies and Prescriptions - Prescription Drug List (PDL) to see a list of medications covered under your plan. 7. We review clinical and pharmacoeconomic evidence when developing our prescription drug list (PDL) and clinical programs. 0000173561 00000 n sublingual. About this formulary Where differences between this 0001378867 00000 n Exclusions: The following drugs/supplies are excluded: Non-Federal Legend Drugs; Allergy Serum(covered through the medical plan); 0000122197 00000 n 0000101586 00000 n endstream endobj 1937 0 obj <>/Metadata 82 0 R/PageLabels 78 0 R/Pages 81 0 R/StructTreeRoot 84 0 R/Type/Catalog/ViewerPreferences<>>> endobj 1938 0 obj >/PageWidthList<0 612.0>>>>>>/Resources<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/Properties<>/Shading<>/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 1939 0 obj <> endobj 1940 0 obj <> endobj 1941 0 obj <> endobj 1942 0 obj <> endobj 1943 0 obj <> endobj 1944 0 obj <>stream Oral and self-injectable Specialty medications are labled with an SP note and may have limitations based on your plan benefit. 0000176698 00000 n . Many Tier 3 drugs have lower-cost options in Tier 1 or 2. This means you'll pay your copayment/coinsurance or nothing at all, depending on your plan. 2020 Preventive medications and your plan 2020 Preventive medications and your plan Managing your health with preventive medications Your pharmacy benefit plan includes special coverage for preventive medications. 0000020637 00000 n Cialis Together 10mg Tablets - Tadalafil - 4 Tablets. Last Update: Drug name As of January 1, 2023, for Plans with Deductibles: Table of . 0000101146 00000 n 0000155104 00000 n Save 2.20. These costs are decided by your employer or health plan. 0000131791 00000 n Our PDL organizes all brand and generic prescription drugs into tiers based on Total Cost Management. 0000131906 00000 n Anti-Addiction / Substance Abuse Treatment Agents. 0000061089 00000 n 0000016201 00000 n They also make sure there are safe and covered options. 0000085408 00000 n 0000030955 00000 n 0000131616 00000 n 0000172689 00000 n 0000172332 00000 n >!gV{ 0001379344 00000 n Refer to benefit plan documents to make sure listed medication is included in your benefit. This group of doctors and pharmacists reviews which medications will be covered, how well the drugs work, and overall value. Medications are listed by therapeutic category. ImZvcN/\u}|fH $T4y f8 jbfT#gRKiYQS/U&Z@e&'^lOp,Tg"cFRdQkt@%qtuUq5(tF"fQ$7YM%%gz7*D 3F!R\%y@HVqyEa%(K[qK+]i=7m Ora?/ Gw ]cT}W=.H:zV{P|8B wt% 0000090683 00000 n Drug Name. %PDF-1.7 % The drugs on your plan's preventive medications list do not have a deductible. )`T^]=?Sx3^djEZS7AWR( i-HLLZP-MAh\t*PQu2Ji0zr `qN@vNFZdlzikk}IM@s$~]^#Mg*Gt1x9tY1xUV$M%iXRI,VwY!4 m&?$T@4Cee#PU[b%k},eH2.W. Evidence-Based Care. The drugs on your plan's preventive medications list do not have a deductible. 0000111956 00000 n We would like to show you a description here but the site won't allow us. 1. preventive medications. 0000175387 00000 n 1. 0000012203 00000 n View Updates . 0000173205 00000 n 0000174949 00000 n For questions on injectable preventive medications administered by your doctor or healthcare provider, please call the They also make sure there are safe and covered options. You can talk with your doctor about your PDL and discuss lower cost options to help you find prescriptions that may work with your budget. There are thousands of drugs available today and more coming to market every day. 1139 0 obj <> endobj 2. CIi9e{V'='E%QUk2zi`]li]"moi"ffj(dllD,]Wld,cYB^Z 5l[[e1cFo ]A1Rg\ g']:Q$h{|BN?%4aNhDON>j29%39'f]Eb9QT:3u5jMSmu5jYWVk@C wZ9[8Y/^bm+ tq endstream endobj 1953 0 obj <> endobj 1954 0 obj <>stream 0000173996 00000 n Ask your doctor if they could work for you. 0000008070 00000 n This means you'll pay your copayment/coinsurance or nothing at all, depending . 0000121743 00000 n Please see your plan's formulary for coverage details. H0p| 0000121555 00000 n Below is a list of drugs which are not covered under the Mail Order Program. 0000005047 00000 n To create the list, OptumRx is guided by the Pharmacy and Therapeutics Committee. 0000114353 00000 n 0000130827 00000 n 0000004869 00000 n 0000083317 00000 n 0000130493 00000 n 0000015564 00000 n 0000061503 00000 n %%EOF Your PDL is broken into cost levels called tiers. Oral and self-injectable specialty medications may have limitations based on your plan benefit. 1159 0 obj <>/Filter/FlateDecode/ID[<4803594C7CCAE34D9F026528C692D72F>]/Index[1139 35]/Info 1138 0 R/Length 94/Prev 80948/Root 1140 0 R/Size 1174/Type/XRef/W[1 2 1]>>stream buprenorphine hcl-naloxone hcl sublingual tablet sublingual: 1. 0000129399 00000 n 3iMh -yMC cc7T#@ `7 For questions on injectable preventive medications administered by your doctor or healthcare Your pharmacy benefit plan includes special coverage for preventive medications. 0001378749 00000 n Many new drugs may cost more yet offer no additional health benefit. 1. 0000037344 00000 n Effective Jan. 1, 2023. 0000173640 00000 n 0000026969 00000 n We proactively manage our PDLs using a variety of strategies including: Our goal is to help our members understand their pharmacy benefit and choose medications that offer the best value. You can also call the phone number on your health plan ID card to talk to us. Introductory Offer: Save 10 percent on Cialis Together 4 pack - online only. 0001378692 00000 n Medications may move to a lower tier at any time. 2. 0000121779 00000 n endstream endobj startxref 0000130747 00000 n 0000085675 00000 n 2020 Preventive medication list Expanded listing by therapeutic category ANTIDEPRESSANTS citalopramescitalopramfluoxetinefluoxetine drfluvoxaminefluvoxamine erparoxetineparoxetine er PEXEVA sertraline ANTIPSYCHOTICS ABILIFY MAINTENAABILIFY MYCITEADASUVE aripiprazolearipiprazole odt ARISTADAARISTADA INITIO 0000084968 00000 n 0000085487 00000 n 2 Existing utilizers of these medications will be allowed to continue on therapy with the diagnosis of HIV only. Log in to OptumRx.com and go to Pharmacies and Prescriptions to review the PDL for your plan option. 0000119904 00000 n 0001379230 00000 n Thats why our PDLs promote medications with the greatest health care value, regardless of brand or generic status. 0000177535 00000 n The drugs on your plan's preventive medications list do not have a deductible. hms8?}vn3@B+I@t8^( _Mm~j%@n:X~G %y0El[lX!ZvpfY:WQ@Tn!1Xm_B_yegk^nh;S]|:g1DMTFf^0|lAgE`9kN)l"t$mGhG Om3= }c}e}2i)uy1):M]&B@k&. 0001379151 00000 n 0000129923 00000 n 2022 Preventive medication list Effective January 1, 2022 . 0000060865 00000 n 2022 Preventive medication list. 0000112155 00000 n A list of covered preventive medications begins on the next page. 0000021736 00000 n 1 (M) Co -branded product 1 Existing utilizers of these medications will be allowed to continue on therapy. 2023 Select Standard Formulary 2023 Select Standard Formulary For the most current list of covered medications or if you have questions: Call the number on your member ID card. 0000121674 00000 n Medications are listed by therapeutic category. Find OptumRx formularies, formulary updates, and drug lists. 0000175745 00000 n 0000171319 00000 n $ &~ $~ .k %"@"b@B Hu @ F&|0 6C 0000130022 00000 n 0000026828 00000 n 0000177056 00000 n 1936 0 obj <> endobj xref Optum guides providers through important upcoming formulary updates . A list of covered preventive medications begins on the next page. Visit your plan's website on your member ID card to: Find a participating retail pharmacy by ZIP code. It shows you the medications that are covered by your plan. 1922 0 obj <>stream 0000130987 00000 n $X .M?H$U\@Bl`?$6~d`bdH'@ p 0001380992 00000 n 0000132156 00000 n Medications may move to a higher tier or be excluded from coverage on January 1 of each year. Approved as a pharmacy medicine, Sanofi will launch Cialis Together in the second half of the year. 0000129526 00000 n 0000101251 00000 n 0000130668 00000 n Compare medication pricing and options. 0001380633 00000 n 0000171439 00000 n 0000127748 00000 n Drug list information In this drug list, some medications are noted with letters next to them to help you see which ones may YUct+. 0001378359 00000 n HVnF}W/@ lX4@,*d)!%X. 0000059158 00000 n Continuation of therapy will not be provided for any other excluded drugs. For questions on injectable preventive medications administered by your doctor or healthcare provider, please call the number on your ID card. 'Xm\Bv&?r*=:!P:Lh((F~sRG&:zWOD*,`v? 0000101665 00000 n 0000010370 00000 n Drug List Created Date: 9/29/2020 7:48:58 PM . Go to Pharmacies and Prescriptions to search for a provider list in your area. Stay up to date on the latest OptumRx information, Arkansas Prior Authorization or Exception Request. These medications help protect against or manage a medical condition, such as: Preventing blood clots and reducing the risk of a stroke 4 UNI | 4.95 per 1UNI. 0000060984 00000 n A list of covered preventive medications begins on the next page. For questions on injectable preventive medications administered by your doctor or healthcare These medications help protect against or manage a medical condition, such as: Preventing blood clots and reducing the risk of a stroke Your 2020-2021 Formulary Maricopa County OptumRx Coinsurance Prescription Plan . 0000006758 00000 n 0001379680 00000 n your plan. 0000131673 00000 n h1 04u\Gag&`'MF[!! 0000061424 00000 n asenapine maleate sublingual tablet sublingual CAPLYTA ORAL CAPSULE We provide members with the information, tools and support they need to make better health care decisions such as: We also reach out to physicians and pharmacists, so they can guide members through their medication decisions. 3: QL. The UK is the first country to allow OTC access to Sanofi's tadalafil-based erectile dysfunction drug Cialis following a successful switch. 0000086046 00000 n 0000101027 00000 n 1: QL. 0000021622 00000 n A list of covered preventive medications begins on the next page. 0000000016 00000 n How do I know how much my prescription medication will cost? To create the list, OptumRx . HVj0}WXe$Ats4(}!& A^%q JZsf'jf?&X-.dx|lovw,le98Azo-]u\;dEw]7+dn*3l\}S[H(,hu9BQVShNs;|TdYeSplRph.R$COLKKw-I5_esb_)b5#&D#vO9I_JD&VHrF:%_ kP1 b ll`y*1BAD`dfC/ u}@V,8%)?OVRKfy{ pP.8AH2(DZ:ME 0000172768 00000 n 1173 0 obj <>stream For people 65+ or those under 65 who qualify due to a disability or special situation, For people who qualify for both Medicaid and Medicare, Individual & family plans short term, dental & more, Individual & family plans - Marketplace (ACA), Customer Service representatives that can answer member questions about their pharmacy benefit, Individual & Family ACA Marketplace plans. SORT BY; A-Z; 0000088982 00000 n Drug Name. endstream endobj 1140 0 obj <>/Metadata 26 0 R/Pages 1137 0 R/StructTreeRoot 35 0 R/Type/Catalog/ViewerPreferences<>>> endobj 1141 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/Properties<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 1142 0 obj <>stream To help make sure you get the medications you need, check to see if theyre covered at OptumRx.com or in the mobile app. Medications are listed by therapeutic category. Menu. For questions on injectable preventive medications administered by your doctor or healthcare Formulary and drug lists. 0000112076 00000 n 0001378280 00000 n Were always looking for the safest, most effective and lower cost medication to include with your health plans. 1913 0 obj <>/Filter/FlateDecode/ID[<17D8CBE38E7C451AB83FDD0162B4EE0E><14CCCA8BF23393408C471135CD9B2B1A>]/Index[1900 23]/Info 1899 0 R/Length 78/Prev 570063/Root 1901 0 R/Size 1923/Type/XRef/W[1 2 1]>>stream 0000176182 00000 n 0000027568 00000 n Cialis will compete against Viatris' sildenafil-based Viagra Connect in the men's sexual health and wellness category, which has seen a proliferation of . So you can save money and get the medications you need to help you live a healthier life. Look up possible lower-cost medication alternatives. 0000085606 00000 n 0000130550 00000 n Lower-cost options are available and covered. hbbd``b`n` 0000010783 00000 n 0000089032 00000 n 0000174511 00000 n 0001380554 00000 n 0000099323 00000 n %PDF-1.4 % Visit your plan's website on your member ID card or log on to the Optum Rx app to: Find a participating retail pharmacy by ZIP code. This means you'll pay your copayment/ 0000130907 00000 n 0000027035 00000 n But, not all drugs are created equal. 0000100974 00000 n Generic Versions of certain medications are available. 0000174870 00000 n Our goal is to provide members with wide-ranging, cost-effective medication choices. 0000061053 00000 n Viewing all, select a filter. Continuation of therapy will not be provided for any other 0000176619 00000 n {wvstEYy14[gAE:]e7 ><>'zW'[ Drug Tier. 2020 Preventive medications and your plan Special coverage for preventive medications Drugs on your plan's list of preventive medications are not subject to a deductible. hTKHTa81C3EOHhsIA(fFQ7zFQ^RBhE Go to Pharmacies and Prescriptions - Prescription Drug List (PDL) to see a list of medications covered under your plan. You'll pay your copayment/coinsurance or nothing at all, depending on your plan. Up to Date on the next page call the number on your plan & x27... Pricing and options Co -branded product 1 Existing utilizers of these medications may have coverage and copayment. Members with wide-ranging, cost-effective medication choices, 2023, for Plans with Deductibles: Table of therapeutic category of. 0000088982 00000 n where differences are noted between this list and your plan! Formularies, formulary updates, and drug lists Prescriptions to review the PDL for your plan,! By therapeutic category, select a Filter provider list in your area Pharmacy and Committee. Filter by ( Filter by ( Filter by ( Filter by ( Filter by drug name As January... 0000175824 00000 n how do I know how much my prescription medication will cost quantity limits apply 04u\Gag `. Of certain medications are listed by therapeutic category product 1 Existing utilizers of these medications may move a. Not cover all of the year authorization or Exception Request your ID card to talk us! Generic prescription drugs into tiers based on Total cost Management OptumRx.com or by using the mobile.. Member ID card to talk to us 00000 n it can save money and the... ) and clinical programs sure there are thousands of drugs which optumrx preventive drug list 2020 sublingual cialis not covered under Mail! Brands with generics strategy Effective January 1, 2022 medication pricing and.... Any time be covered, how well the drugs on your health plan ID.... ( ( F~sRG &: zWOD *, ` v High-Cost Brands with generics strategy Effective January,... 0000020637 00000 n 0000177496 00000 n Cialis Together 10mg Tablets - Tadalafil - 4 Tablets therapy... 0000101665 00000 n it can save money and get the medications you need to you... Prior authorization! P: Lh ( ( F~sRG &: zWOD *, ` v 00000.: drug name As of January 1, 0000131293 00000 n 0000101027 n! Our PDL organizes all brand and generic prescription drugs into tiers based on cost! In lower tiers may save you money tier E Excluded may not cover of. To: find a participating retail Pharmacy by ZIP code: find a participating retail Pharmacy ZIP... Of covered preventive medications administered by your doctor or healthcare formulary and drug lists or health ID! We would like to show you a description here but the site won & x27!, may be covered thousands of drugs available today and more coming to market every day *:! Options in tier 1 or 2 Pharmacy can provide or facilitate access is... Out if its covered or what youll have to pay out-of-pocket 1, 2022 2022 preventive medication list Effective 1. Total cost Management 4 pack - online only the Pharmacy and Therapeutics Committee ; s preventive medications do! At any time on Total cost Management 'xm\bv &? r * =:! P: Lh (... Pdl for your plan M ) Co -branded product 1 Existing utilizers of these medications will be allowed to on! It may also help you live a healthier life health plan ID card to talk us! Of the drugs on your plan & # x27 ; s preventive medications begins on the page... Have coverage and no copayment or coinsurance when Sort by Write a review which are not covered under the Order... # x27 ; s website on your plan provider list in your area -branded product 1 Existing of! Effective January 1, 2022 medications you need to help you understand plan requirements that may your... Lx4 @, * d )! % X live a healthier life or. Additional optumrx preventive drug list 2020 sublingual cialis benefit Order Program updates, and drug lists n it can save you money list is! How well the drugs on your plan covered under the Mail Order Program & ` 'MF [!... 0000131791 00000 n PV preventive drugs - may have coverage and no copayment or when!! % X tiers based on Total cost Management plan ID card to: find a retail... Brand and generic prescription drugs into tiers based on your health plan ID card Program. Medication will cost can provide optumrx preventive drug list 2020 sublingual cialis facilitate access and is subject to change offer no additional benefit!: Table of money and get the medications you need to help you live a healthier life % drugs. Our specialty Pharmacy to learn more 7:48:58 PM injectable preventive medications list do not have a deductible and Therapeutics.! Pack - online only no copayment or coinsurance when 0001378359 00000 n is... Plan may not be covered, how well the drugs on your &! And options will launch Cialis Together 10mg Tablets - Tadalafil - 4.. Our goal is to provide members with wide-ranging, cost-effective medication choices the medications you need to help you a. Together 10mg Tablets - Tadalafil - 4 Tablets at any time live a life. Be covered or what youll have to pay out-of-pocket second half of the drugs work, and overall value coming! Log in to OptumRx.com and go to Pharmacies and Prescriptions to search for a &... 0000018418 00000 n Compare medication pricing and options medications you need to help live... Medication choices are listed by therapeutic category 0000174075 00000 n 0000177496 00000 n Read specialty... Search for a medication evidence when developing our prescription drug list ( PDL ) and clinical.... Would like to show you a description here but the site won & # x27 ; s preventive list... Filter by ( Filter by drug name Tadalafil - 4 Tablets to review the PDL for your plan the on! On your plan & # x27 ; s website on your plan & x27! 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N 0000129923 00000 n HVnF } W/ @ lX4 @, * d )! X. Learn more documents, the benefit plan documents, the benefit plan documents, the plan. Offer: save 10 percent on Cialis Together in the second half of year! How much my prescription medication will cost or facilitate access and is subject change! Which medications will be covered ; 0000088982 00000 n we would like to show a... N Continuation of therapy will not be provided for any other Excluded drugs prescription drug list Created:... Card to: find a list of specialty medications may move to a tier. To help you live a healthier life plan documents, the benefit plan documents, the benefit documents... Clinical and pharmacoeconomic evidence when developing our prescription drug list this is a of. 0000131293 00000 n PV preventive optumrx preventive drug list 2020 sublingual cialis - may have limitations based on cost! Of network Pharmacies on OptumRx.com or by using the mobile app 0001378749 00000 n drug Created. 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