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Microsoft word - 070113_advmemberflyer_030413

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

Source: http://ktbenefits.com/uploads/2013-04-12%20070113_AdvFlyer_030413_000.pdf

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