Transcript Pharmacy - UnitedHealthcare

• Welcome to Chapter 5 – Pharmacy
• Please remember:
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• All Chapters provided in the 2016 Employee
Presentation are intended to be part of a module series
• There are 6 chapters
• Follow along with and compile these into your own
presentation (see below) in the order they are presented
• Text items in red are variable. Please modify them as
necessary in order to fit your customers’ needs
• Please pick and choose from the slides provided to
create a custom presentation that is right for you and
your customers. If UHC is not your client’s pharmacy
provider, do not include any of the slides in this chapter.
1
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
PRESCRIPTIONS
Filling your prescriptions
has never been easier.
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
PRESCRIPTIONS
Easily fill and save
on your medications.
You’ll be covered for a wide variety of medications from
UnitedHealthcare. Best of all, we’ve made it easy for you
to get your prescriptions filled and save money.
Access thousands of retail pharmacies
Save when you use a network pharmacy
[Take advantage of special programs for
complex conditions.]
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
PRESCRIPTIONS
Take advantage of
no-cost home delivery.
With Mail Service Member SelectSM
from OptumRx, you can get your longterm medications delivered to your
door at no charge, often for less than
they cost at retail. You can cancel
home delivery service at any time and
fill prescriptions at a retail pharmacy for
your standard co-pay or cost. However,
canceling this service may increase
your medication costs.
Get more at
myuhc.com
Refill prescriptions.
Find network pharmacies.
Estimate and
compare costs.
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth
Group.
PRESCRIPTIONS
Clinical Programs
Promoting Safety and Appropriate Use
Notification or
Prior
Authorization
• Requires your doctor to tell us why you are taking your medication in
order to determine if you will receive benefit coverage
• To start the process talk to your doctor. Once we review the
information, we will send you and your doctor a letter to let you know
if the medication is covered
Supply
Limits
• A supply limit is the largest quantity of medication covered per
copayment or in a time period
• Based on FDA guidelines for medication dosage, clinical guidelines
or usage patterns
Step
Therapy
• With this program you
need to try a lowercost medication first,
before a higher-cost
medication may be
covered.
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
PRESCRIPTIONS
How we cover prescriptions.
The UnitedHealthcare Prescription Drug List (PDL) is the list of
prescriptions that are covered by the plan
[Organized by cost tiers]
[Choosing medications in lower tiers may save you money.]
Tier 1
Tier 2
Tier 3
Lower-cost
Medications
Midrange-cost
Medications
Higher-cost
Medications
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
PRESCRIPTIONS
How we cover prescriptions.
The UnitedHealthcare Prescription Drug List (PDL) is the list of
prescriptions that are covered by the plan
[Organized by cost tiers]
[Choosing medications in lower tiers may save you money.]
Plan 1
TIER 1
TIER 2
TIER 3
TIER 4
<$XX>
<$XX>
<$XX>
<$XX>
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth
Group.
PRESCRIPTIONS
How we cover prescriptions.
The UnitedHealthcare Prescription Drug List (PDL) is the list of
prescriptions that are covered by the plan
[Organized by cost tiers]
[Choosing medications in lower tiers may save you money.]
TIER 1
TIER 2
TIER 3
TIER 4
Plan 1
<$XX>
<$XX>
<$XX>
<$XX>
Plan 2
<$XX>
<$XX>
<$XX>
<$XX>
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
PRESCRIPTIONS
How we cover prescriptions.
The UnitedHealthcare Prescription Drug List (PDL) is the list of
prescriptions that are covered by the plan
[Organized by cost tiers]
[Choosing medications in lower tiers may save you money.]
TIER 1
TIER 2
TIER 3
TIER 4
Plan 1
<$XX>
<$XX>
<$XX>
<$XX>
Plan 2
<$XX>
<$XX>
<$XX>
<$XX>
Plan 3
<$XX>
<$XX>
<$XX>
<$XX>
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
PRESCRIPTIONS
How we cover prescriptions.
The UnitedHealthcare Prescription Drug List (PDL) is the list of
prescriptions that are covered by the plan
[Organized by cost tiers]
[Choosing medications in lower tiers may save you money.]
TIER 1
TIER 2
TIER 3
TIER 4
Plan 1
<$XX>
<$XX>
<$XX>
<$XX>
Plan 2
<$XX>
<$XX>
<$XX>
<$XX>
Plan 3
<$XX>
<$XX>
<$XX>
<$XX>
Plan 4
<$XX>
<$XX>
<$XX>
<$XX>
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth
Group.
PRESCRIPTIONS
How we cover prescriptions.
The UnitedHealthcare Prescription Drug List (PDL) is the list of
prescriptions that are covered by the plan
[Organized by cost tiers]
[Choosing medications in lower tiers may save you money.]
TIER 1
TIER 2
TIER 3
TIER 4
Plan 1
<$XX>
<$XX>
<$XX>
<$XX>
Plan 2
<$XX>
<$XX>
<$XX>
<$XX>
Plan 3
<$XX>
<$XX>
<$XX>
<$XX>
Plan 4
<$XX>
<$XX>
<$XX>
<$XX>
Plan 5
<$XX>
<$XX>
<$XX>
<$XX>
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth
Group.
PRESCRIPTIONS
Pharmacy Payment Process
1
2
3
Present health
plan ID card to
pharmacy.
Pharmacy
verifies
eligibility and
any amount
you owe at
the point of
sale.
You pay your
member cost
responsibility
for medications
covered under
your pharmacy
benefit.
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
PRESCRIPTIONS
Specialty Pharmacy
We focus on you and the total condition, not just
drug utilization.
Conditions Include: Cancer,
Hemophilia, Hepatitis C, Multiple Sclerosis,
Rheumatoid Arthritis, HIV and more
Access to pharmacies, providing support focused
on you
Adherence and clinical programs to help you
better manage your condition
Online support and medication information
Our Specialty Pharmacy Program provides the resources
and the condition-specific support you need to help you
manage your complex condition and achieve your best
help.
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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14
•This ends Chapter 5- Pharmacy
•Please open Chapter 6- Other Benefits and
Resources
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Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.