Pharmacy benefits for members with UnitedHealthcare Individual & Family ACA Marketplace plans

As you’re getting started with using your pharmacy benefits, it may help to get guidance on how it all works. Explore the tips below to learn how to use your pharmacy benefit if you’re a member with a UnitedHealthcare Individual & Family Affordable Care Act (ACA) Marketplace plan in one of these following states:

  • Arizona
  • Alabama
  • Colorado
  • Florida
  • Georgia
  • Iowa
  • Illinois
  • Indiana
  • Kansas
  • Louisiana
  • Maryland
  • Michigan
  • Missouri
  • Mississippi
  • Nebraska
  • North Carolina
  • New Jersey
  • New Mexico
  • Ohio
  • Oklahoma
  • South Carolina
  • Tennessee
  • Texas
  • Virginia
  • Washington
  • Wisconsin
  • Wyoming
  • Arizona
  • Alabama
  • Colorado
  • Florida
  • Georgia
  • Illinois
  • Kansas
  • Louisiana
  • Maryland
  • Michigan
  • Missouri
  • Mississippi
  • North Carolina
  • New Jersey
  • New Mexico
  • Ohio
  • Oklahoma
  • South Carolina
  • Tennessee
  • Texas
  • Virginia
  • Washington
  • Wisconsin

Check if your medication is covered

For each plan, there’s a Prescription Drug List (PDL). This is a list of covered prescription medications and supplies. The PDL includes information you need, like:

If your medication is not covered or has a coverage rule or limit, talk to your health care provider. They may be able to ask about a prior authorization or exception to get your medication covered or may switch you to a covered medication that can work for your condition.

Sign in to your health plan account to find your plan specific PDL.

View PDL without signing in to your account.

Find a network pharmacy

There are a couple of ways to fill your prescription medications using your pharmacy benefit. You can choose the option that works best for your situation.

1. Choose a network retail pharmacy

With locations available across the country, it’s likely you can find a network retail pharmacy near where you live. If you’re traveling or live out of state for school, you can also find a network pharmacy near where you are. To switch pharmacies, call your new pharmacy and ask them to transfer your prescription.

2. Get prescriptions delivered by Optum Home Delivery Pharmacy

You can also choose Optum Home Delivery Pharmacy. With this option, your prescriptions can be delivered directly to you. Ask your health care provider to send a prescription to Optum Home Delivery Pharmacy. Then, you can sign in to check status and set up payment.

Check the price for a drug

When your plan becomes effective, you can check the price of a drug to see if it’s covered and estimate your costs. You can also look for lower cost alternatives if they’re available. Your health care provider can find drug prices and alternatives as well, by using PreCheck MyScript.

Sign in to your health plan account to find the price of a drug.

Frequently asked questions (FAQs) about pharmacy benefits for Individual and Family ACA Marketplace plans

Common pharmacy terms

When you’re using your pharmacy benefits, you may hear terms that are unfamiliar, like prior authorization, step therapy or quantity limits. You can find some quick definitions to help you know what these may mean for your benefits and payments.

Looking for more resources?

Sign in to your health plan account to find more plan-specific information about your pharmacy benefits.