• Welcome to Chapter 5 – Pharmacy• Please remember:

• All Chapters provided in the 2016 Employee Presentation are intended to be part of a module series

• There are 6 chapters• Follow along with and compile these into your own

presentation (see below) in the order they are presented• Text items in red are variable. Please modify them as

necessary in order to fit your customers’ needs• Please pick and choose from the slides provided to

create a custom presentation that is right for you and your customers. If UHC is not your client’s pharmacy provider, do not include any of the slides in this chapter.

1Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Delete this slide before distribution

Delete this slide before distribution

Filling your prescriptions has never been easier.

PRESCRIPTIONS

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

PRESCRIPTIONS

You’ll be covered for a wide variety of medications from UnitedHealthcare. Best of all, we’ve made it easy for you to get your prescriptions filled and save money.

Access thousands of retail pharmacies

Save when you use a network pharmacy

[Take advantage of special programs for complex conditions.]

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Easily fill and save on your medications.

PRESCRIPTIONS

With Mail Service Member SelectSM from OptumRx, you can get your long-term medications delivered to your door at no charge, often for less than they cost at retail. You can cancel home delivery service at any time and fill prescriptions at a retail pharmacy for your standard co-pay or cost. However, canceling this service may increase your medication costs.

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Get more at myuhc.com

Refill prescriptions.

Find network pharmacies.

Estimate and compare costs.

Take advantage of no-cost home delivery.

Clinical ProgramsPromoting Safety and Appropriate Use

PRESCRIPTIONS

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Notification or Prior

Authorization

• Requires your doctor to tell us why you are taking your medication in order to determine if you will receive benefit coverage

• To start the process talk to your doctor. Once we review the information, we will send you and your doctor a letter to let you know if the medication is covered

SupplyLimits

StepTherapy

• A supply limit is the largest quantity of medication covered per copayment or in a time period

• Based on FDA guidelines for medication dosage, clinical guidelines or usage patterns

• With this program you need to try a lower-cost medication first, before a higher-cost medication may be covered.

PRESCRIPTIONS

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Tier 1Lower-costMedications

Tier 2 Midrange-costMedications

Tier 3Higher-costMedications

How we cover prescriptions.

[Organized by cost tiers]

[Choosing medications in lower tiers may save you money.]

The UnitedHealthcare Prescription Drug List (PDL) is the list of prescriptions that are covered by the plan

PRESCRIPTIONS

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

TIER 1 TIER 2 TIER 3 TIER 4

Plan 1 <$XX> <$XX> <$XX> <$XX>

How we cover prescriptions.

[Organized by cost tiers]

[Choosing medications in lower tiers may save you money.]

The UnitedHealthcare Prescription Drug List (PDL) is the list of prescriptions that are covered by the plan

PRESCRIPTIONS

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

TIER 1 TIER 2 TIER 3 TIER 4

Plan 1 <$XX> <$XX> <$XX> <$XX>

Plan 2 <$XX> <$XX> <$XX> <$XX>

How we cover prescriptions.

[Organized by cost tiers]

[Choosing medications in lower tiers may save you money.]

The UnitedHealthcare Prescription Drug List (PDL) is the list of prescriptions that are covered by the plan

PRESCRIPTIONS

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

TIER 1 TIER 2 TIER 3 TIER 4

Plan 1 <$XX> <$XX> <$XX> <$XX>

Plan 2 <$XX> <$XX> <$XX> <$XX>

Plan 3 <$XX> <$XX> <$XX> <$XX>

How we cover prescriptions.

[Organized by cost tiers]

[Choosing medications in lower tiers may save you money.]

The UnitedHealthcare Prescription Drug List (PDL) is the list of prescriptions that are covered by the plan

PRESCRIPTIONS

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

TIER 1 TIER 2 TIER 3 TIER 4

Plan 1 <$XX> <$XX> <$XX> <$XX>

Plan 2 <$XX> <$XX> <$XX> <$XX>

Plan 3 <$XX> <$XX> <$XX> <$XX>

Plan 4 <$XX> <$XX> <$XX> <$XX>

How we cover prescriptions.

[Organized by cost tiers]

[Choosing medications in lower tiers may save you money.]

The UnitedHealthcare Prescription Drug List (PDL) is the list of prescriptions that are covered by the plan

PRESCRIPTIONS

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

TIER 1 TIER 2 TIER 3 TIER 4

Plan 1 <$XX> <$XX> <$XX> <$XX>

Plan 2 <$XX> <$XX> <$XX> <$XX>

Plan 3 <$XX> <$XX> <$XX> <$XX>

Plan 4 <$XX> <$XX> <$XX> <$XX>

Plan 5 <$XX> <$XX> <$XX> <$XX>

How we cover prescriptions.

[Organized by cost tiers]

[Choosing medications in lower tiers may save you money.]

The UnitedHealthcare Prescription Drug List (PDL) is the list of prescriptions that are covered by the plan

Pharmacy Payment Process

PRESCRIPTIONS

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Pharmacy verifies eligibility and any amount you owe at the point of sale.

You pay your member cost responsibility for medications covered under your pharmacy benefit.

Present health plan ID card to pharmacy.

Specialty Pharmacy

PRESCRIPTIONS

We focus on you and the total condition, not just drug utilization.

Conditions Include: Cancer, Hemophilia, Hepatitis C, Multiple Sclerosis, Rheumatoid Arthritis, HIV and more

Our Specialty Pharmacy Program provides the resources and the condition-specific support you need to help you manage your complex condition and achieve your best help.

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Access to pharmacies, providing support focused on you

Adherence and clinical programs to help you better manage your condition

Online support and medication information

•This ends Chapter 5- Pharmacy•Please open Chapter 6- Other Benefits and Resources•Copy and paste slides from Chapter 6 to your Master

1. Click on the first slide and then press shift while you click on the last slide

2. Right click on the first slide and select copy3. Go to your Master (Chapter 1)4. Click below the thumbnail of the last slide in that

section5. Right click there and select Copy—Use Source

Formatting

•Delete any slides from Chapter 6 that do not apply to your customer’s needs

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.14

Delete this slide before distribution

Delete this slide before distribution