Prescription Drug List (PDL)

There are thousands of drugs available today and more coming to market every day. But, not all drugs are created equal. Many new drugs may cost more yet offer no additional health benefit. That’s why our PDLs promote medications with the greatest health care value, regardless of brand or generic status.

Our PDL organizes all brand and generic prescription drugs into tiers based on Total Cost Management. Every drug is evaluated to determine how well it works, how it compares to others in its class, the total cost, and a number of other significant considerations to make sure that the medications with the highest health care value are affordable for your employees. We proactively manage our PDLs using a variety of strategies including:

• Exclusions – In situations where medications offer no additional clinical and/or financial value over other options in their class, exclusions may make sense. However, we understand exclusions can be disruptive for members – so we only make the decision to exclude a drug when it meets specific clinical and savings criteria.
• High Cost Generics – While increasing use of generic drugs is one way to lower pharmacy costs, not all generics represent the best value. In fact, there are instances where a generic can be more expensive than the brand and its other alternatives. We continually monitor generic prices and market dynamics, and place medications –brand or generic – with the best overall health care value at the lowest possible tier.

Our goal is to help our members understand their pharmacy benefit and choose medications that offer the best value. We provide members with the information, tools and support they need to make better health care decisions such as:

• Personalized letters
• Online tools at myuhc.com
• Customer Service representatives that can answer member questions about their pharmacy benefit

We also reach out to physicians and pharmacists, so they can guide members through their medication decisions.