UnitedHealthcare Medication List Maintenance ... - myuhc

Maintenance Medication List.

Effective January 1, 2018

UnitedHealthcare Medication List

Below is a list of all the therapeutic classes of medications included in home delivery programs. The most commonly prescribed medications are included under each therapeutic class. It is not inclusive of all maintenance medications that may be included in home delivery programs.

The maintenance medication list was determined by taking into consideration chronic, long-term use of a medication, frequency of dose changes and other clinical factors.

If you have questions or are not sure if your medication needs to be filled with OptumRx? home delivery, call Customer Service at the phone number listed on your plan ID card.

Drug Name ADHD GUANFACINE ER INTUNIV+ Agents used for Dry Mouth CAPHOSOL CEVIMELINE EVOXAC GELCLAIR NEUTRASAL NUMOISYN ORAFATE PILOCARPINE SALAGEN Alzheimer's Disease ARICEPT ARICEPT 23 MG* ARICEPT ODT DONEPEZIL HCL EXELON+ GALANTAMINE HBR MEMANTINE NAMENDA NAMENDA XR* NAMZARIC* RAZADYNE RAZADYNE ER RIVASTIGMINE Asthma/Chronic Obstructive Pulmonary Disease (COPD) ACCOLATE ADVAIR DISKUS ADVAIR HFA AIRDUO RESPICLICK* ALVESCO ANORO ELLIPTA

Drug Name ARCAPTA NEOHALER ARNUITY ELLIPTA ASMANEX TWISTHALER ASMANEX HFA ATROVENT HFA BEVESPI AEROSPHERE BREO ELLIPTA BROVANA BUDESONIDE NEB COMBIVENT RESPIMAT DALIRESP DULERA* DUONEB DYLIX ELIXOPHYLLIN FLOVENT DISKUS FLOVENT HFA FLUTICASONE/SALMETEROL (GENERIC AIRDUO RESPICLICK) INCRUSE ELLIPTA IPRATROPIUM BROMIDE IPRATROPIUM-ALBUTEROL LUFYLLIN MONTELUKAST SODIUM PERFOROMIST PULMICORT PULMICORT FLEXHALER QVAR SEEBRI NEOHALER* SEREVENT DISKUS SINGULAIR+ SPIRIVA HANDIHALER SPIRIVA RESPIMAT STIOLTO RESPIMAT* STRIVERDI RESPIMAT

Drug Name SYMBICORT THEO-24 THEOCHRON THEOPHYLLINE ANHYDROUS TUDORZA PRESSAIR UTIBRON NEOHALER* ZILEUTON ER ZAFIRLUKAST ZYFLO ZYFLO CR Blood Clots/Prevention ELIQUIS PRADAXA SAVAYSA XARELTO Benign Prostatic Hyperplasia (BPH) ALFUZOSIN HCL AVODART+ CARDURA XL DOXAZOSIN DUTASTERIDE DUTASTERIDE/TAMSULOSIN* FINASTERIDE FLOMAX+ JALYN* PROSCAR RAPAFLO TAMSULOSIN HCL TERAZOSIN UROXATRAL Breast Cancer Prevention ANASTROZOLE ARIMIDEX+ AROMASIN

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Drug Name Breast Cancer Prevention continued... FARESTON FEMARA+ LETROZOLE SOLTAMOX* TAMOXIFEN CITRATE Chest Pain IMDUR ISORDIL ISOSORBIDE DINITRATE ISOSORBIDE MONONITRATE MINITRAN NITROGLYCERIN NITROGLYCERIN PATCH NITRO-DUR RANEXA Cholesterol/Lipid Lowering ALTOPREV* ANTARA* ATORVASTATIN CALCIUM CHOLESTYRAMINE CHOLESTYRAMINE LIGHT COLESTID COLESTIPOL HCL CRESTOR+ EZETIMIBE EZETIMIBE/SIMVASTATIN FENOFIBRATE 43, 50, 67, 130, 134, 150, 200 MG CAPSULE* FENOFIBRATE 40 MG, 45 MG, 120MG, 145 MG TABLET* FENOFIBRATE 54, 160 MG TABLET FENOFIBRIC ACID* FENOGLIDE FLOLIPID FLUVASTATIN ER FLUVASTATIN SODIUM GEMFIBROZIL LESCOL LESCOL XL+ LIPITOR+ LIPOFEN* LIVALO LOPID LOVASTATIN LOVAZA+ MEVACOR NIACOR NIASPAN OMEGA-3-ACID ETHYL ESTERS PRAVACHOL PRAVASTATIN SODIUM PREVALITE

Drug Name ROSUVASTAIN QUESTRAN QUESTRAN LIGHT ROSUVASTATIN SIMVASTATIN TRICOR* TRIGLIDE* TRILIPIX* VASCEPA VYTORIN* WELCHOL ZETIA+ ZOCOR Constipation AMITIZA LINZESS MOVANTIK RELISTOR TABLET* TRULANCE Contraceptive ALTAVERA ALYACEN AMETHIA AMETHIA LO APRI ARANELLE AVIANE AZURETTE BALZIVA BEKYREE BEYAZ* BLISOVI 24 FE BLISOVI FE BREVICON BRIELLYN CAMILA CAMRESE CAMRESE LO CAZIANT CHATEAL CRYSELLE CYCLAFEM CYCLESSA CYRED DASETTA DAYSEE DESOGEN DROSPIRENONE-ETHINYL ESTRADIOL-FOLIC ACID* DROSPIRENONE-ETHINYL ESTRADIOL ELINEST EMOQUETTE ENPRESSE

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Drug Name ENSKYCE ERRIN ESTARYLLA ESTRADIOL-FOLIC ACID* ESTROSTEP FE FALESSA KIT* FALMINA FAYOSIM* FEMYNOR GENERESS FE* GIANVI GILDAGIA HEATHER INTROVALE ISIBLOOM JENCYCLA JOLESSA JOLIVETTE JULEBER JUNEL 24 FE JUNEL JUNEL FE KARIVA KELNOR 1-35 KIMIDESS KURVELO LARISSIA LEENA LESSINA LEVONEST LEVONORGESTREL-ETHINYL ESTRADIOL LEVONORGESTREL-ETHINYL ESTRADIOL 150-30 (84) LEVORA-28 LILLOW LO LOESTRIN FE LO MEDIA 24 FE LOESTRIN LOESTRIN FE LORYNA LOSEASONIQUE LOW-OGESTREL LUTERA MARLISSA MIBELAS 24 FE* MICROGESTIN MICROGESTIN FE MICRONOR MIRCETTE MONO-LINYAH MONONESSA MYZILRA NATAZIA

Drug Name Contraceptive continued... NECON NORA-BE NORETHINDRONE NORETHINDRONE-ETHINYL ESTRADIOLFERROUS FUMARATE NORGESTIMATE-ETHINYL ESTADIOL NORGESTIMATE ETHINYL ESTRADIOL LO NORGESTREL-ETHINY ESTRADIOL NORINYL NORLYDA NORTREL NUVARING OCELLA OGESTREL ORSYTHIA ORTHO TRI-CYCLEN ORTHO TRI-CYCLEN LO+ ORTHO-CEPT ORTHO-CYCLEN ORTHO-NOVUM OVCON-35 PHILITH PORTIA PREVIFEM QUARTETTE* QUASENSE RANJANI* RECLIPSEN RIVELSA* SAFYRAL* SEASONIQUE SETLAKIN SPRINTEC SRONYX SYEDA TAYTULLA* TILIA FE TRI-ESTARYLLA TRI-FEMYNOR TRI-LEGEST FE TRI-LINYAH TRINESSA TRI-LO-ESTARYLLA TRI-LO-MARZIA TRI-LO SPRINTEC TRI-NORINYL TRI-PREVIFEM TRI-SPRINTEC TRINESSA LO TRIVORA-28 VELIVET VESTURA

Drug Name VIENVA VIORELE WERA WYMZYA FE XULANE YASMIN YAZ ZARAH ZENCHENT ZENCHENT FE ZEOSA ZOVIA 1-35E ZOVIA 1-50E Depression APLENZIN* BUDEPRION BUDEPRION XL BUPROPION CELEXA+ CITALOPRAM CYMBALTA+ DESVENLAFAXINE (GENERIC PRISTIQ) DULOXETINE EFFEXOR EFFEXOR XR+ ESCITALOPRAM FETZIMA FLUVOXAMINE FORFIVO XL* KHEDEZLA* LEXAPRO+ LUVOX CR MAPROTILINE MIRTAZAPINE NEFAZODONE OLEPTRO* PAROXETINE PAROXETINE ER PAXIL PAXIL CR PEXEVA PRISTIQ PROZAC+ REMERON REMERON SOLUTAB SERTRALINE TRAZODONE TRINTELLIX* VENLAFAXINE VENLAFAXINE ER CAPSULE VIIBRYD WELLBUTRIN+

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Drug Name WELLBUTRIN SR+ WELLBUTRIN XL+ ZOLOFT+ Diabetes ACARBOSE ACTOPLUS MET XR ACTOS+ ADLYXIN AFREZZA* ALOGLIPTIN* ALOGLIPTIN-METFORMIN* ALOGLIPTIN-PIOGLITAZONE* AMARYL APIDRA APIDRA SOLOSTAR BASAGLAR BYDUREON BYETTA CYCLOSET DIABETA DUETACT FARXIGA FORTAMET* GLIMEPIRIDE GLIPIZIDE GLIPIZIDE ER GLIPIZIDE-METFORMIN GLUCOPHAGE GLUCOPHAGE XR GLUCOTROL GLUCOTROL XL GLUCOVANCE GLUMETZA* GLYBURIDE GLYBURIDE MICRONIZED GLYBURIDE-METFORMIN GLYNASE GLYSET GLYXAMBI* HUMALOG HUMALOG MIX 50-50 HUMALOG MIX 75-25 HUMULIN 70-30 HUMULIN N HUMULIN R INVOKAMET INVOKAMET XR INVOKANA JANUMET JANUMET XR JANUVIA JARDIANCE

Drug Name Diabetes continued... JENTADUETO JENTADUETO XR* KAZANO KOMBIGLYZE XR LANTUS* LANTUS SOLOSTAR* LEVEMIR LEVEMIR FLEXPEN METFORMIN HCL METFORMIN HCL ER METFORMIN SR MODIFIED-RELEASE* MIGLITOL NATEGLINIDE NESINA NOVOLOG NOVOLOG FLEXPEN NOVOLOG MIX 70-30 NOVOLOG MIX 70-30 FLEXPEN ONGLYZA OSENI PIOGLITAZONE HCL PIOGLITAZONE-GLIMEPIRIDE PIOGLITAZONE-METFORMIN PRANDIMET PRANDIN PRECOSE REPAGLINIDE-METFORMIN RIOMET SOLIQUA STARLIX SYNJARDY SYNJARDY XR TANZEUM TOUJEO* TRADJENTA TRESIBA* TRULICITY VICTOZA XIGDUO XR* XULTOPHY* Diabetic Supplies INSULIN SYRINGE LANCETS PEN NEEDLE TEST STRIPS Diarrhea ALOSETRON LOTRONEX VIBERZI Elevated Thyroid Hormone METHIMAZOLE PROPYLTHIOURACIL

Drug Name TAPAZOLE Fibromyalgia SAVELLA Glaucoma ALPHAGAN P APRACLONIDINE HCL AZOPT BETAGAN BETAXOLOL HCL 0.5% BETIMOL BETOPTIC S 0.25 % BIMATOPROST 0.03%* BRIMONIDINE TARTRATE OPHTHALMIC SOLUTION CARTEOLOL HCL 1% COMBIGAN 0.2%-0.5% COSOPT 2%-0.5% COSOPT PF 2%-0.5%* DORZOLAMIDE HCL 2 % DORZOLAMIDE-TIMOLOL 2%-0.5% IOPIDINE ISOPTO CARBACHOL OPHTHALMIC ISOPTO CARPINE LATANOPROST LEVOBUNOLOL HCL OPHTHALMIC SOLUTION LUMIGAN 0.01% METIPRANOLOL 0.3% MIOSTAT 0.01% PHOSPHOLINE IODIDE PILOCARPINE HCL PILOPINE HS SIMBRINZA* TIMOLOL MALEATE OPHTHALMIC SOLUTION TIMOPTIC TIMOPTIC OCUDOSE TIMOPTIC-XE TRAVATAN Z TRAVOPROST TRUSOPT 2% XALATAN ZIOPTAN Gout ALLOPURINOL COLCHICINE CAPSULE* COLCHICINE TABLET* COLCRYS* DUZALLO* MITIGARE PROBENECID PROBENECID-COLCHICINE ULORIC ZURAMPIC ZYLOPRIM

Drug Name Heart Failure CORLANOR ENTRESTO Heart Rhythm AMIODARONE HCL BETAPACE+ BETAPACE AF CORDARONE DIGOXIN DISOPYRAMIDE PHOSPHATE DOFETILIDE FLECAINIDE ACETATE LANOXIN MEXILETINE HCL MULTAQ NORPACE NORPACE CR PACERONE PROPAFENONE HCL QUINIDINE GLUCONATE QUINIDINE SULFATE RYTHMOL RYTHMOL SR SOTALOL AF TAMBOCOR TIKOSYN High Blood Pressure ACCUPRIL ACCURETIC ACEBUTOLOL HCL ACEON ADALAT CC ALDACTAZIDE ALDACTONE ALTACE AMILORIDE HCL AMILORIDE-HYDROCHLOROTHIAZIDE AMLODIPINE BESYLATE AMLODIPINE BESYLATE-BENAZAPRIL AMLODIPINE BESYLATE-VALARTAN AMLODIPINE BESYLATE-VALARTANHYDROCHLOROTHIAZIDE* AMLODIPINE-OLMESARTAN* AMLODIPINE-OLMESARTANHYDROCHLOROHTHIZIE* AMTURNIDE* ATACAND ATACAND HCT ATENOLOL ATENOLOL-CHLORTHALIDONE AVALIDE AVAPRO AZOR*

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Drug Name High Blood Pressure continued... BENAZEPRIL HCL BENAZEPRIL-HYDROCHLOROTHIAZIDE BENICAR+ BENICAR HCT+ BETAXOLOL HCL BISOPROLOL FUMARATE BISOPROLOL-HYDROCHLOROTHIAZIDE BUMETANIDE BYVALSON* CALAN CALAN SR CANDESARTAN CILEXETIL CANDESARTAN-HYDROCHLOROTHIZIDE CAPTOPRIL CAPTOPRIL-HYDROCHLOROTHIAZIDE CARDENE SR CARDIZEM+ CARDIZEM CD+ CARDIZEM LA+ CARDURA CARTIA XT CARVEDILOL CATAPRES CATAPRES-TTS CHLOROTHIAZIDE CHLORTHALIDONE CLONIDINE PATCH CLONIDINE HCL CLORPRES COREG COREG CR* CORGARD CORZIDE COZAAR DEMADEX DIAMOX SEQUELS DIBENZYLINE DILACOR XR DILT-CD DILTIA XT DILTIAZEM 24HR CD DILTIAZEM 24HR ER DILTIAZEM HCL DILT-XR DILTZAC ER DIOVAN+ DIOVAN HCT+ DOXAZOSIN MESYLATE DUTOPROL* DYAZIDE DYRENIUM

Drug Name EDARBI EDARBYCLOR EDECRIN ENALAPRIL MALEATE ENALAPRIL-HYDROCHLOROTHIAZIDE EPLERENONE EPROSARTAN ETHACRYNIC ACID EXFORGE+ EXFORGE HCT* FELODIPINE ER FOSINOPRIL SODIUM FOSINOPRIL-HYDROCHLOROTHIAZIDE FUROSEMIDE GUANFACINE HCL HYDRALAZINE HCL HYDROCHLOROTHIAZIDE HYZAAR INDAPAMIDE INDERAL LA* INNOPRAN XL INSPRA IRBESARTAN IRBESARTAN-HYDROCHLOROTHIAZIDE ISRADIPINE KERLONE LABETALOL HCL LASIX LEVATOL LISINOPRIL LISINOPRIL-HYDROCHLOROTHIAZIDE LOPRESSOR LOPRESSOR HCT LOSARTAN POTASSIUM LOSARTAN-HYDROCHLOROTHIAZIDE LOTENSIN LOTENSIN HCT LOTREL MATZIM LA MAVIK MAXZIDE METHYCLOTHIAZIDE METHYLDOPA METHYLDOPA-HYDROCHLOROTHIAZIDE METOLAZONE METOPROLOL EXTENDED-RELEASE/ HYDROCHLOROTHIAZIDE* METOPROLOL SUCCINATE METOPROLOL TARTRATE METOPROLOL-HYDROCHLOROTIAZIDE MICARDIS+ MICARDIS HCT+ MICROZIDE

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Drug Name MINIPRESS MINOXIDIL MOEXIPRIL HCL MOEXIPRIL-HYDROCHLOROTHIAZIDE NADOLOL NADOLOL-BENDROFLUMETHIAZIDE NEPTAZANE NICARDIPINE HCL NIFEDIPINE NIFEDIPINE ER NIMODIPINE NISOLDIPINE NORVASC OLMESARTAN OLMESARTAN-HYDROCHLOROTHIAZIDE PERINDOPRIL ERBUMINE PINDOLOL PRAZOSIN HCL PRINIVIL PROCARDIA PROCARDIA XL PROPRANOLOL HCL PROPRANOLOL-HYDROCHLOROTHIAZIDE QBRELIS* QUINAPRIL HCL QUINAPRIL-HYDROCHLOROTHIAZIDE RAMIPRIL RESERPINE SECTRAL SOTALOL SPIRONOLACTONE SPIRONOLACTONE-HCTZ SULAR TARKA TAZTIA XT TEKTURNA TEKTURNA HCT TENEX TENORETIC+ TENORMIN+ TERAZOSIN HCL TEVETEN TEVETEN HCT TIAZAC TIMOLOL MALEATE TOPROL XL TORSEMIDE TRANDATE TRANDOLAPRIL TRANDOLAPRIL-VERAPAMIL TRIAMTERENE TRIAMTERENE-HCTZ

Drug Name High Blood Pressure continued... TRIBENZOR* TWYNSTA* UNIRETIC UNIVASC VALSARTAN VALSARTAN-HYDROCHLOROTHIAZIDE VASERETIC+ VASOTEC+ VERAPAMIL ER VERAPAMIL ER PM VERAPAMIL HCL VERELAN VERELAN PM ZAROXOLYN ZEBETA ZESTORETIC+ ZESTRIL+ ZIAC Hormone Replacement ACTIVELLA ALORA ANGELIQ CLIMARA CLIMARA PRO COMBIPATCH COVARYX H.S. DIVIGEL EEMT H.S. ESTRACE ESTRACE CREAM ESTRADIOL ESTRADIOL TRANSDERMAL PATCH* ESTRADIOL-NORETHINDRONE PATCH ESTRASORB ESTRING ESTROGEL ESTROGEN METHYLTESTOSTERONE ESTROPIPATE EVAMIST FEMHRT FEMRING JINTELI MEDROXYPROGESTERONE MENEST MENOSTAR MIMVEY MINIVELLE NORETHINDRONE ACETATE OGEN PREFEST PREMARIN PREMPHASE

Drug Name PREMPRO PROGESTERONE PROMETRIUM PROVERA VAGIFEM+ VIVELLE-DOT YUVAFEM Inflammatory Bowel Disease APRISO ASACOL HD* AZULFIDINE BALSALAZIDE DISODIUM CANASA COLAZAL DELZICOL* DIPENTUM GIAZO* LIALDA MESALAMINE ENEMA MESALAMINE TABLET* PENTASA* ROWASA SF ROWASA SULFASALAZINE Irritable Bowel Disease HYOSCYAMINE SR Myasthenia Gravis MESTINON MYTELASE PROSTIGMIN PYRIDOSTIGMINE BROMIDE Neuropathic Pain GABAPENTIN GRALISE* HORIZANT* LYRICA Osteoporosis ACTONEL ALENDRONATE SODIUM ATELVIA* BINOSTO* BONIVA ETIDRONATE DISODIUM EVISTA+ IBANDRONATE SODIUM RISEDRONATE Overactive Bladder DARIFENACIN ER* DETROL* DETROL LA* DITROPAN XL ENABLEX* GELNIQUE*

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Drug Name MYRBETRIQ* OXYBUTYNIN OXYBUTYNIN CHLORIDE ER OXYTROL* SANCTURA* TOLTERODINE TARTRATE* TOLTERODINE TARTRATE ER* TOVIAZ TROSPIUM CHLORIDE* VESICARE* Pancreatic Enzyme Replacement CREON PANCREAZE PERTZYE ULTRESA VIOKACE ZENPEP Parkinson's Disease AZILECT BENZTROPINE MESYLATE BROMOCRIPTINE MESYLATE CARBIDOPA CARBIDOPA-LEVODOPA CARBIDOPA-LEVODOPA-ENTACAPONE COMTAN ELDEPRYL ENTACAPONE GABAPENTIN LODOSYN LYRICA MIRAPEX MIRAPEX ER* NEUPRO PARCOPA PARLODEL* PRAMIPEXOLE DIHYDROCHLORIDE ER* PRAMIPEXOLE DIHYDROCHLORIDE RASAGILINE REQUIP REQUIP XL* ROPINIROLE HCL ROPINIROLE HCL ER* RYTARY* SELEGILINE HCL SINEMET SINEMET CR STALEVO TASMAR TRIHEXYPHENIDYL HCL XADAGO* ZELAPAR Phosphate Binding Agents AURYXIA

Drug Name Phosphate Binding Agents continued... CALCIUM ACETATE ELIPHOS FOSRENOL LANTHANUM PHOSLO PHOSLYRA RENAGEL RENVELA SEVELAMER VELPHORO Potassium Replacement KLOR-CON K-TAB POTASSIUM CHLORIDE Rheumatoid Arthritis ARAVA HYDROXYCHLOROQUINE LEFLUNOMIDE PLAQUENIL RIDAURA Seizures APTIOM BANZEL BRIVACT CARBAMAZEPINE CARBAMAZEPINE ER CARBATROL CELONTIN DEPAKENE DEPAKOTE DEPAKOTE ER DEPAKOTE SPRINKLE DILANTIN DIVALPROEX SODIUM DIVALPROEX SODIUM ER ETHOSUXIMIDE FELBAMATE FELBATOL GABAPENTIN GABITRIL KEPPRA KEPPRA XR LAMICTAL LAMICTAL ODT

Drug Name LAMICTAL XR LAMOTRIGINE LAMOTRIGINE ER LAMOTRIGINE ODT LEVETIRACETAM LEVETIRACETAM ER LYRICA MYSOLINE NEURONTIN OXCARBAZEPINE OXTELLAR XR* PEGANONE PHENYTOIN POTIGA PRIMIDONE SPRITAM* STAVZOR TEGRETOL TEGRETOL XR TIAGABINE HCL TOPAMAX TOPIRAMATE TOPIRAMATE ER SPRINKLE* TROKENDI XR* TRILEPTAL VALPROIC ACID VIMPAT ZARONTIN ZONEGRAN ZONISAMIDE Stroke and Heart Attack Prevention AGGRENOX ASPIRIN-DIPYRIDAMOLE BRILINTA CILOSTAZOL CLOPIDOGREL DIPYRIDAMOLE EFFIENT PENTOXIFYLLINE PERSANTINE PLAVIX+ PLETAL PRASUGREL TICLOPIDINE HCL TRENTAL

Drug Name YOSPRALA* ZONTIVITY Testosterone Replacement ANDRODERM ANDROID METHYLTESTOSTERONE CAPSULE TESTRED Thyroid Hormone Replacement ARMOUR THYROID CYTOMEL LEVOTHROID LEVOTHYROXINE SODIUM LEVOXYL LIOTHYRONINE SODIUM SYNTHROID THYROLAR TIROSINT* Ulcers, Heartburn and Reflux ACIPHEX+ ACIPHEX SPRINKLE* DEXILANT LANSOPRAZOLE* ESOMEPRAZOLE* NEXIUM* OMEPRAZOLE OMEPRAZOLE/SODIUM BICARBONATE* PANTOPRAZOLE PREVACID* PREVACID SOLUTAB PRILOSEC+ RABEPRAZOLE ZEGERID* Vitamins DECARA DRISDOL FOLIC ACID NASCOBAL Women's Health BRISDELLE* DUAVEE INTRAROSA OSPHENA SARAFEM

*Brand and/or generic may be excluded from coverage. Lower-cost options are available and covered. + Brand may be excluded from coverage. Lower-cost options are available and covered.

This is not a complete list of medications, and not all medications listed may be covered under your plan. Medications subject to change without notice. Not all medications listed may be covered under your benefit plan. Review your benefit plan documents to see what medications are covered under your plan. Where differences are noted between this list and your benefit plan documents, the benefit plan documents will govern. UnitedHealthcare and the dimensional U logo are registered trademarks owned by UnitedHealth Group Incorporated. All branded medications are trademarks or registered trademarks of their respective owners. This list is subject to change. Please refer to for information on specific drugs included in these programs or call the member phone number listed on your member ID card.

UnitedHealthcare UHC M52574-E 10/17 ?2017 United HealthCare Services, Inc.

UnitedHealthcare

UnitedHealthcare

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