Updates to Individual Exchange plans PDLs on Jan. 1, 2025

Beginning Jan. 1, 2025, we’re making prescription drug list (PDL) updates for UnitedHealthcare Individual Exchange plans, also referred to as UnitedHealthcare Individual & Family ACA Marketplace plans. This will include addition of drugs to the formulary, removal of drugs from the formulary, changes to medication tiers, and changes to prior authorization coverage and quantity limits.

How to access the updates

To see the PDL updates for each state, please visit the Prescription Drug Lists (PDLs) for UnitedHealthcare Individual & Family ACA Marketplace plans page.

How we’ll notify members

If an Individual Exchange plan member is taking a drug that will no longer be covered or is affected by a tier increase, we’ll communicate with them in advance to allow time for prescription adjustments before the effective date. These members who are your patients may need your help switching to a covered medication. To continue coverage of their current medication, you can request a prior authorization or exception beginning Jan. 1.

Questions?

If you have questions, please visit our Individual Exchange plans page. You can also connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.

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