What is the OptumRx Prescription Drug List (PDL)? A PDL is a list of Food and Drug Administration (FDA)-approved brand name and generic medications. Your UnitedHealthcare pharmacy benefit provides coverage for a comprehensive selection of prescription medications. Below you will find some commonly prescribed medications. You and your doctor may refer to this list to select the right medication to meet your needs. The benefit plan documents provided by your employer or health plan include a Summary Plan Description. Please refer to these documents to determine which medications are covered under your individual plan. Who decides which medications get placed in which tier? The OptumRx Business Implementation Committee makes tier placement decisions to help ensure access to a wide range of medications and to control health care costs for you and your employer or health plan. You and your doctor decide which medication is appropriate for you. What factors does the Business Implementation Committee look at to make tier placement decisions? The Business Implementation Committee decides the tier placement of a particular prescription medication based upon clinical information from the OptumRx Pharmacy and Therapeutic (P&T) Committee and economic and financial considerations. This committee, comprised of practicing general and specialist physicians and pharmacists, looks at the overall health care value of a particular medication in order to balance the need for flexibility and choice for our members and an affordable pharmacy benefit for employer groups and health plans. Understanding Tiers Prescription medications are categorized within three tiers. Each tier is assigned a copayment, the amount you pay when you fill a prescription. The copayment is determined by your employer or health plan. Consult your benefit plan documents to find out the specific copayments, coinsurance and deductibles that are part of your plan. Some plans may require you to pay the entire cost of the medication until the plan deductible has been met, or may require you to meet a deductible before copayments or coinsurance applies. Tier 1 – Your lowest-cost option This is your lowest copayment option. For the lowest out-of-pocket expense, you should always consider Tier 1 medications if you and your doctor decide they are right for your treatment. Tier 2 – Your midrange-cost option This is your middle copayment option. Consider Tier 2 medications if you and your doctor decide that a Tier 2 medication is right for your treatment. Tier 3 – Your highest-cost option This is your highest copayment option. Sometimes there are alternatives available in Tier 1 or Tier 2 that may be appropriate to treat your condition. If you are currently taking a medication in Tier 3, ask your doctor whether there are Tier 1 or Tier 2 alternatives that may be right for your treatment. Compounded medications: medications with one or more ingredients that are prepared “on-site” by a pharmacist, are classified at the Tier 3 level. 3 Please note: Some plans have a four-tier prescription plan. Refer to your enrollment materials, check the drug pricing/coverage information on myuhc.com , click Pharmacies and Prescriptions or call the Customer Care number on your health plan ID card for more information about your benefit plan.