For 2023, UnitedHealthcare® Medicare Advantage Prescription Drug (MAPD) formularies remain stable with very few negative changes for members. We have taken what is already a leading formulary among national competitors and made improvements to further enhance our competitive position in 2023.
For 2023, there will be 26 down-tiered drugs and 4 formulary additions:
Note: UnitedHealthcare’s MAPD formularies meet all Centers for Medicare & Medicaid Services formulary requirements and include at least 2 drugs from each therapeutic category (i.e., cholesterol-lowering medications) except for those categories that don’t include 2 or more drugs. As new generics are made available and added to the formulary, some brands may be removed – standard industry practice to allow access to similar drugs at a lower cost to members.
Please note the following drug down-tiering and additions for 2023:
Drug name | Common use | 2023 Tier | UM edit* |
---|---|---|---|
Cardiovascular down-tiers | |||
Clopidogrel | Antiplatelet | 1 | QL |
Doxazosin | Hypertension/Prostate health (BPH) | 1 | - |
Ezetimibe | Cholesterol | 1 | QL |
Hydralazine | Heart failure/Hypertension | 1 | - |
Isosorbide mononitrate | Angina | 1 | - |
Isosorbide mononitrate ER | Angina | 1 | - |
Labetalol | Heart rate/Hypertension | 1 | - |
Nifedipine ER | Hypertension | 1 | QL |
Potassium chloride ER & CR | Cardiovascular/Potassium supplement | 2 | - |
Propranolol | Hypertension/Migraines | 1 | - |
Spironolactone | Heart failure/Hypertension | 1 | - |
Multiple disease state down-tiers | |||
Brimonidine ophthalmic | Glaucoma | 1 | - |
Dorzolamide/Timolol ophthalmic | Glaucoma | 1 | - |
Fluoxetine capsules | Depression | 1 | - |
Methotrexate | Rheumatoid arthritis | 1 | - |
Oxybutynin ER | Overactive bladder | 1 | QL |
Terazosin | Prostate health (BPH) | 1 | - |
Topiramate | Seizures/Migraines | 1 | - |
Celecoxib | Osteoarthritis | 2 | QL |
Dutasteride | Prostate health (BPH) | 2 | QL |
Raloxifene | Osteoporosis | 2 | QL |
Dental down-tiers | |||
Chlorhexidine gluconate | Antibiotic, oral rinse | 1 | - |
Lidocaine viscous | Pain, oral topical | 1 | - |
Sodium fluoride (Various formulations) | Fluoride | 1 | - |
Periogard | Antibiotic, oral rinse | 1 | - |
Formulary additions | |||
Desloratadine | Respiratory | 3 | - |
Levalbuterol HFA inhaler | Respiratory | 3 | - |
Tolterodine | Overactive bladder | 3 | - |
Trospium | Overactive bladder | 3 | - |
Please note the following improvements specific to C-SNP members for 2023:
Drug name | Common use | 2023 Tier | UM edit* |
---|---|---|---|
C-SNP only down-tiers | |||
Chlorthalidone | Hypertension/Edema | 1 | - |
Eplerenone | Heart Failure/Hypertension | 2 | - |
Fenofibrate | High cholesterol | 1 | - |
Fenofibrate micronized | High cholesterol | 1 | - |
Fenofibric acid DR | High cholesterol | 1 | - |
Gemfibrozil | High cholesterol | 1 | - |
Prasugrel | Antiplatelet 1 | 1 | QL |
Sotalol | Antiarrhythmic 1 | 1 | - |
* QL = Quantity Limit
If you have questions, please contact your provider advocate, provider relations or network management representative.