Specialty Drugs and Exceptional Cases For members requiring specialized medications, often used to treat chronic conditions like multiple sclerosis or rheumatoid arthritis, the formulary may have a distinct specialty tier. This collaborative approach ensures that your medical treatment is never compromised by financial barriers.
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When a medication is prescribed, asking if it is on your formulary and what the associated cost will be is a simple yet critical step. A medication that was covered last year at a low copay might be moved to a higher tier or require prior authorization the next year.
While these medications represent a significant portion of plan costs, United Healthcare often works closely with members and providers to manage these therapies effectively and ensure adherence. A proactive approach to reviewing this list annually can result in significant savings and ensure that your necessary treatments remain accessible and affordable.
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Reviewing this structure annually during the Open Enrollment period is crucial, as a drug’s placement can change year to year based on new negotiations and plan adjustments. Understanding this structure helps you and your healthcare provider make choices that align with both clinical needs and financial goals.
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