Unite Healthcare Formulary Changes for 2017: What to Expect

As part of its ongoing efforts to manage healthcare costs, UnitedHealth has announced changes to its formulary, which will take effect on January 1, 2017. The company's decision is a significant step towards controlling costs and ensuring that patients receive the best possible care.

Some health plans are only available in certain counties and/or ZIP codes, but members can log in to m圜alPERS to use the Search Health Plans tool to research coverage and benefits that meet their needs. By visiting your health plan's website, you can learn more about how benefits, claims, and payment of claims are covered, as well as any service limitations or exclusions that may apply.

In recent months, commercial payors have been taking aggressive steps to control formulary costs, a trend that is expected to continue in the coming year. In its latest move, UnitedHealth has excluded several pain drugs from its preferred drug list (PDL), citing concerns over 'aggressive drug marketing of opioids.' The company has also modified its prior-authorization criteria to comply with changes announced by the Centers for Disease Control and Prevention (CDC) in March 2016.

The exclusion of certain drugs, including Ox圜ontin and Butrans, is expected to have a significant impact on the healthcare industry. According to Ronny Gal, an analyst at Bernstein, these exclusions could lead to similar changes for other biologics, such as Enbrel and Humira, when biosimilars arrive on the market.

UnitedHealth's formulary changes will also affect specialty medications, which represent a significant portion of the company's costs. Despite accounting for only 1% to 2% of utilization, these high-cost prescription medications can account for more than 36% of UnitedHealth's pharmacy expenses.

In its presentation on pharmacy benefits and prescription drug lists, UnitedHealth provides an update on its PDL decision-making process, which includes financial, clinical, market impact, and pharmacoeconomic evaluations. The company has also posted information on its website about the various aspects of its PDL decision-making process.

The changes to UnitedHealth's formulary are in line with similar exclusions announced by other major pharmacy benefit managers, such as Express Scripts and CVS Health. These moves are expected to have a significant impact on the healthcare industry, particularly for patients who rely on certain medications to manage their conditions.

Overall, the changes to UnitedHealth's formulary are an important step towards controlling costs and ensuring that patients receive the best possible care. By making these changes, the company is demonstrating its commitment to managing healthcare costs while still providing access to necessary treatments and medications.

Unite health care formulary