How Can I Find Out if My Prescription Drugs Are Covered by My UnitedHealthcare Plan?

Last Updated : 05/28/20193 min read

UnitedHealthcare (UHC) is a private insurance company contracted with Medicare to provide prescription drug coverage in certain UnitedHealthcare Medicare Advantage plans and UnitedHealthcare Medicare Part D Prescription Drug Plans. If you are enrolled in a United Healthcare Medicare plan that has prescription drug coverage, or are considering a UHC Medicare plan, here’s how to find out if your medications are covered.

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What is a UnitedHealthcare Medicare Part D Prescription Drug Plan formulary?

All Medicare Advantage Prescription Drug plans and stand-alone Medicare Part D Prescription Drug Plans produce and maintain formularies to determine benefits for their plan members. A formulary is simply a list of prescription drugs covered by the plan. Your plan may change its formulary from time to time, but you will be notified when necessary.

Medicare Advantage plans and Medicare Prescription Drug Plans are available from private, Medicare-approved insurance companies like UnitedHealthcare. The Medicare program requires that all Medicare plans with prescription drug coverage provide benefits for a wide range of prescription medications to treat a variety of diseases and conditions.

Most UnitedHealthcare Medicare plans with prescription drug coverage use one or more of the following protocols to help keep plan costs low for enrollees:

  • Tiered formularies. A tiered formulary categorizes prescription drugs into different tiers and offers different benefits for each tier. For example, medications in the lower tiers may have lower copayments and/or deductible requirements, while those at the top have higher out-of-pocket costs.
  • Prior authorization. In some cases, your plan may need more information from your doctor before your plan will cover a certain medication. If your doctor doesn’t get prior approval, your plan might not pay for that prescription drug.
  • Step therapy. If your doctor prescribes a more expensive medication to treat a particular condition when there are other, less expensive prescription drugs that are also effective, your plan may require your doctor to start you on the lower priced medication to see how you respond before approving treatment with the more expensive one.

How can I find out if my medication is included in my UnitedHealthcare Medicare plan formulary?

There are several ways to find the prescription drugs included in your plan’s formulary.

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  • You can enter your zip code, select a plan, and click “View plan details.”
  • You can use this drug cost estimator to create a list of up to 25 medications and see estimated costs for your prescription drugs. You will also be asked to choose a pharmacy when you use this tool.
  • If you’re already enrolled in a UHC Medicare Advantage plan or a UHC Medicare Prescription Drug Plan, you can register for an online account and use the member tools to find coverage for specific medications.
  • If a medication you currently take is not on your plan’s formulary, you can read about UnitedHealthcare’s transition process .

UnitedHealthcare’s profile page can tell you more about the company and its products. To check out the UHC Medicare plans available in your vicinity, use the Find Plans button on this page.

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