Getting to know your Prescription Drug List (PDL)The PDL includes the most commonly used medications covered under your pharmacy benefit plan and groups them on tiers, representing the cost you pay. This makes it easy for you to find other options that will help you save money if the drug you are taking is on a higher tier.

It is more than a list of drugs and can help you: } Manage your drug costs } Find other medication options } Answer your pharmacy benefit questions

What’s a tier?Tiers are the different cost levels you pay for a medication. The lower the tier number, the lower the cost. Tier 1 is your lowest cost option.

How do I save money?Changing from a higher tier medication to a lower tier medication may save you money. Check your PDL and work with your doctor to see if there are medication options in Tier 1 that would treat your condition. Consider switching your prescriptions to mail order. Simply visit myuhc.com and download the mail order form.

Where can I find my PDL?

Online – visit the pharmacy information section before you login on myuhc.com.

Call – use the phone number on the back of your health plan ID card and have one shipped to you at no cost.

1 Introduction

Prescription Drug List - 2012

Anti-Infectives6 Antibiotics6 Antifungals7 Antivirals

Cardiovascular/ Heart Disease7 Coagulation Therapy7 High Blood Pressure8 High Cholesterol9 Other

Central Nervous System9 Attention Deficit Disorder9 Depression10 Migraine10 Multiple Sclerosis10 Sedatives/Hypnotics11 Seizure Disorders11 Other

12 Dermatology

Diabetes/Endocrine13 Blood Glucose Monitoring13 Insulin13 Non-Insulin

Endocrine14 Growth Hormone14 Other

Eye Conditions14 Allergies15 Antibiotics 15 Glaucoma

Gastrointestinal15 Acid Suppression16 Nausea/Vomiting16 Other

Men’s Health16 Erectile Dysfunction16 Prostate

Miscellaneous17 Miscellaneous17 Overactive Bladder

Musculoskeletal17 Osteoporosis18 Pain Relief18 Rheumatoid Arthritis19 Other

Respiratory19 Asthma/COPD19 Nasal Allergies20 Oral Allergies

Women’s Health20 Contraceptives21 Estrogen/Progesterone21 Prenatal Vitamins

22 Additional Tier 3 Drugs with a generic equivalent in Tier 1

24 Index

Table of Contents

24 Visit www.myuhc.com for updates

AAbilify 11Abstral 18Acanya 12Acarbose 13, 22Accolate 22Accu-Chek Active Test Strips 13Accu-Chek Aviva Plus Care Kit 13Accu-Chek Aviva Plus Test Strips 13Accu-Chek Comfort Curve Test Strips 13Accu-Chek Compact Care Kit 13Accu-Chek Compact Test Strips 13Accupril 22Aceon 8Acetaminophen/Butalbital/Caffeine 10, 18, 22Acetaminophen/Butalbital/Caffeine/Codeine 18Acetaminophen/Codeine 18, 23Acetaminophen/Dichloralphenazone/Isometheptene Mucate 10Acetaminophen/Hydrocodone 18, 23Acetaminophen/Hydrocodone Bit 18Acetaminophen/Hydrocodone Bit 7.5 -325 mg/15 ml Oral Solution 18Acetaminophen/Oxycodone 18, 22Acetazolamide 15Aciphex 15Activella 21Actonel 17Actoplus Met 13Actoplus Met XR 13Actos 13Acular 22Acuvail 17Acyclovir 7, 23Acyclovir Capsule, Suspension, Tablet 23Aczone 12Adapalene 12Adderall 9, 22Adderall XR 9Adoxa 6Advair Diskus 19Advair HFA 19Advanced Care Plus 21Advicor 8Aggrenox 7

Akineton 11Albuterol Sulfate 19Albuterol Sulfate/Ipratropium Non-Oral Solution 19Alclometasone Dipropionate 12Aldactazide 50-50 mg 8Aldactone 22Alendronate 17, 22Alfuzosin 16, 23Allopurinol 19Alora 21Alphagan P 0.1% 15Alprazolam 11, 23Alsuma 10Altabax 12Altace 22Altavera 20Altoprev 8Alvesco 19Amantadine 7Amaryl 22Ambien 10, 22Ambien CR 10Amerge 22Amethia 20Amethia Lo 20Amethyst 20Amiodarone 9Amitiza 16Amitriptyline 9Amitriptyline/Perphenazine 9Amlodipine 7-8, 22Amlodipine/Atorvastatin 8Amlodipine/Benazepril 8Amoxicillin 6, 22Amoxicillin-Clavulanate ER 6Amoxicillin/Potassium Clavulanate 6, 22Amphetamine/Dextroamphetamine Salt Combination 22Amphetamine Aspartate/Amphetamine Sulfate/Dextroamphetamine Sustained-Release 24 Hour Capsule 9Amphetamine Salt Combo 9Ampicillin 6Ampyra 10Amrix 19Amturnide 8Anaprox 22Anastrozole 17, 22Androderm 14Androgel 14Android 14Antara 8Antipyrine/Benzocaine 17Anzemet 16

Apidra Solostar 13Apidra Vial 13Aplenzin 9Apokyn 11Apraclonidine 15Apri 20Apriso 16Aranelle 20Aricept 11, 22Aricept 23 mg 11Arimidex 22Armour Thyroid 14Aromasin 17Arthrotec 18Asacol 16Asacol HD 16Ascensia Autodisc Test Strips 13Ascensia Breeze 2 Test Strips 13Asmanex 19Aspirin/Butalbital/Caffeine 10, 18Aspirin/Butalbital/Caffeine/Codeine 18Aspirin/Oxycodone 18Astelin 19Astepro 19Atacand 8Atacand HCT 8Atelvia 17Atenolol 7, 22Atenolol/Chlorthalidone 7, 22Ativan 22Atorvastatin 8Atralin 12Atrovent HFA 19Augmentin 6, 22Augmentin ES 22Augmentin XR 6Avalide 8Avandamet 13Avandaryl 13Avandia 13Avapro 8Avelox 6Aviane 20Avinza 18Avita Gel 12Avodart 16Avonex 10Axert 10Axiron 14Azasite 15Azathioprine 17-18Azelastine HCl 14, 19Azelex 12Azithromycin 6, 23Azopt 15Azor 8

Index

How do I find my medication?

1. Use the table of contents to find your condition. or2. Search for your medication by name in the index.

6Visit www.myuhc.com for updates 2012 Prescription Drug List – Advantage Three-Tier

Please refer to page 3 for a definition of notations/symbols.

Cardiovascular/Heart Disease High Blood Pressure

AmlodipineAtenolol Atenolol/ChlorthalidoneBenazepril Benazepril/HydrochlorothiazideBisoprolol Bisoprolol/Hydrochlorothiazide Bumetanide Captopril Captopril/Hydrochlorothiazide Carvedilol Chlorthalidone ClonidineDiltiazem Diltiazem Controlled-Release Capsule Diltiazem Sustained-Release 12 Hour CapsuleDoxazosin EnalaprilEnalapril/Hydrochlorothiazide Eprosartan SL

Felodipine Fosinopril Fosinopril/Hydrochlorothiazide FurosemideGuanfacine Hydralazine Hydrochlorothiazide Indapamide IsradipineLabetalol Lisinopril Lisinopril/HydrochlorothiazideLosartan 1/2TLosartan/HydrochlorothiazideMethyldopaMethyldopa/Hydrochlorothiazide MetolazoneMetoprolol Succinate Sustained-Release

Tablet 25 mgMetoprolol Tartrate

Metoprolol/Hydrochlorothiazide Minoxidil Moexipril 1/2TNadolol Nifedipine Propranolol Tablet Propranolol/HydrochlorothiazideQuinapril Ramipril Spironolactone Spironolactone/HydrochlorothiazideTerazosin Timolol Maleate TorsemideTrandolapril 1/2TTriamterene/Hydrochlorothiazide Verapamil

Tier 1

Aldactazide 50-50 mg Benicar 1/2T SLBenicar HCT SLBiDilBystolic Cardizem CD 360 mg Cardizem LA 120 mgClorpres

Dibenzyline Diltiazem Sustained-Action CapsuleDiltiazem Sustained-Release 24 Hour CapsuleDiltiazem Sustained-Release 24 Hour TabletDiuril Suspension 250 mg/5 mlEplerenone Metoprolol Succinate Sustained-Release Tablet

50, 100, 200 mg

Micardis SLMicardis HCT SLNisoldipine Perindopril Erbumine 1/2TPropranolol Sustained-Action CapsuleQuinapril/Hydrochlorothiazide Thalitone

Tier 2

Aceon 1/2TAmlodipine/Benazepril SLAmturnide E SLAtacand 1/2T SDP SLAtacand HCT SDP SLAvalide SDP SLAvapro 1/2T SDP SLAzor SLCardizem LA 180, 240, 300, 360, 420 mgClonidine Transdermal Weekly Patch SL

Coreg CR E SLDiovan 1/2T SLDiovan HCT SLEdarbi SLEdarbyclor SLExforge SLExforge HCT SLNexiclon XR ESularTekamlo E SL

Tekturna SDP SLTekturna HCT SDP SLTeveten HCT SLTrandolapril/VerapamilTribenzor E SLTwynsta E SLValturna E SLVerapamil Sustained-Release 24 Hour Pellets

Tier 3

Cardiovascular/Heart Disease High Cholesterol

Atorvastatin 1/2T SLCholestyramineColestipol

Fenofibric AcidGemfibrozil Lovastatin

Pravastatin 1/2TSimvastatin 1/2T

Tier 1

Altoprev SLAntara

Crestor 1/2T SLFenofibrate

Lipofen Welchol

Tier 2

Advicor SLAmlodipine/Atorvastatin E SLCaduet E SLFenoglideLescol SLLescol XL SL

Lipitor 1/2T SLLivalo SLLovaza NNiaspanSimcor SLTricor E

Triglide Trilipix EVytorin SLZetia SL

Tier 3

How do I read the Prescription Drug List?

Medications are grouped by the conditions they treat.

How much will my medication cost?Within the PDL, medications are grouped by tier. The tier indicates the amount you pay to fill a prescription, which is decided by your employer or health plan. Consult your benefit plan documents or visit myuhc.com to find your specific costs.

2 Visit www.myuhc.com for updates

How do I use my PDL? When choosing a medication, you and your doctor should consult the PDL. This guide is organized by common medical conditions. Then, within each medical condition section, medications are listed by tier.If your medication is not located in the PDL please log on to myuhc.com or call the toll-free member phone number on the back of your health plan ID card.

What are Tiers? Tiers are the different cost levels you pay for a medication. Each tier is assigned a cost, which is determined by your employer or health plan. This is how much you will pay when you fill a prescription. Tier 1 medications are your lowest-cost options. If your medication is placed in Tier 2 or 3 look to see if there is a Tier 1 alternative. Discuss your options with your doctor.Check your benefit plan documents to find out your pharmacy plan costs.

Tier 1 Tier 2 Tier 3 Your lowest-cost Your midrange-cost Your highest-cost medications medications medications

Are there plans that don’t have three tiers?Some plans have a two-tier pharmacy benefit rather than a three-tier pharmacy benefit. Generally, a two-tier pharmacy benefit plan does not cover medications listed in Tier 3 of this PDL. A two-tier pharmacy benefit plan covers one tier at the lower-cost and covers a second tier at a higher-cost. In addition, some plans have a four-tier prescription plan or additional medication lists that should be referenced. Check your benefit plan documents or log on to myuhc.com for information about your benefits.

Who determines medication tier placements? The UnitedHealthcare PDL Management Committee makes tier placement decisions. The PDL Management Committee is comprised of senior level UnitedHealth Group physicians and business leaders. The Committee’s goal is to help ensure access to a wide range of medications, while helping to control health care costs for you and your employer or health plan.

2 Visit www.myuhc.com for updates

How do I use my PDL? When choosing a medication, you and your doctor should consult the PDL. This guide is organized by common medical conditions. Then, within each medical condition section, medications are listed by tier.If your medication is not located in the PDL please log on to myuhc.com or call the toll-free member phone number on the back of your health plan ID card.

What are Tiers? Tiers are the different cost levels you pay for a medication. Each tier is assigned a cost, which is determined by your employer or health plan. This is how much you will pay when you fill a prescription. Tier 1 medications are your lowest-cost options. If your medication is placed in Tier 2 or 3 look to see if there is a Tier 1 alternative. Discuss your options with your doctor.Check your benefit plan documents to find out your pharmacy plan costs.

Tier 1 Tier 2 Tier 3 Your lowest-cost Your midrange-cost Your highest-cost medications medications medications

Are there plans that don’t have three tiers?Some plans have a two-tier pharmacy benefit rather than a three-tier pharmacy benefit. Generally, a two-tier pharmacy benefit plan does not cover medications listed in Tier 3 of this PDL. A two-tier pharmacy benefit plan covers one tier at the lower-cost and covers a second tier at a higher-cost. In addition, some plans have a four-tier prescription plan or additional medication lists that should be referenced. Check your benefit plan documents or log on to myuhc.com for information about your benefits.

Who determines medication tier placements? The UnitedHealthcare PDL Management Committee makes tier placement decisions. The PDL Management Committee is comprised of senior level UnitedHealth Group physicians and business leaders. The Committee’s goal is to help ensure access to a wide range of medications, while helping to control health care costs for you and your employer or health plan.

2 Visit www.myuhc.com for updates

How do I use my PDL? When choosing a medication, you and your doctor should consult the PDL. This guide is organized by common medical conditions. Then, within each medical condition section, medications are listed by tier.If your medication is not located in the PDL please log on to myuhc.com or call the toll-free member phone number on the back of your health plan ID card.

What are Tiers? Tiers are the different cost levels you pay for a medication. Each tier is assigned a cost, which is determined by your employer or health plan. This is how much you will pay when you fill a prescription. Tier 1 medications are your lowest-cost options. If your medication is placed in Tier 2 or 3 look to see if there is a Tier 1 alternative. Discuss your options with your doctor.Check your benefit plan documents to find out your pharmacy plan costs.

Tier 1 Tier 2 Tier 3 Your lowest-cost Your midrange-cost Your highest-cost medications medications medications

Are there plans that don’t have three tiers?Some plans have a two-tier pharmacy benefit rather than a three-tier pharmacy benefit. Generally, a two-tier pharmacy benefit plan does not cover medications listed in Tier 3 of this PDL. A two-tier pharmacy benefit plan covers one tier at the lower-cost and covers a second tier at a higher-cost. In addition, some plans have a four-tier prescription plan or additional medication lists that should be referenced. Check your benefit plan documents or log on to myuhc.com for information about your benefits.

Who determines medication tier placements? The UnitedHealthcare PDL Management Committee makes tier placement decisions. The PDL Management Committee is comprised of senior level UnitedHealth Group physicians and business leaders. The Committee’s goal is to help ensure access to a wide range of medications, while helping to control health care costs for you and your employer or health plan.

Generic medications: are they always the best value?Usually, yes. However, although most generics cost less than brand name medications, there are times that the generic actually costs more than the brand. Visit myuhc.com to compare prices. We also work with pharmacists to make sure they dispense the lowest cost version of the drug, whether generic or brand name.

Symbols after medications refer to pharmacy programs

1/2 T Half Tablet ProgramDSN Designated Specialty

NetworkE Excluded from coverageMC Multiple copayN Notification or Prior

Authorization required

P Step TherapyRS Refill and Save

programSDP Select Designated

Pharmacy ProgramSL Supply limit

Not all programs will apply to you. Check your benefit documents to find out what programs are available on your plan.

Note: you may only have two tiers or have a high-deductible plan, in which tiers don’t apply until you reach your deductible.

1

1 This example is for illustrative purposes only and may not reflect actual tiers or coverage for the listed medications.

Log on to myuhc.com for the following pharmacy information and tools:

} Pharmacy benefit and coverage information

} Possible lower-cost medication alternatives

} A list of medications based on a specific medical condition

} Medication interactions and side effects

} Participating retail pharmacy by zip code

} Prescription history

Bring your PDL to your doctor appointment to discuss medication options to treat your condition.

How do I access updated information about my pharmacy benefit?Since the PDL is updated throughout the year, please visit myuhc.com or call the toll-free member phone number on the back of your health plan ID card for the most current information.

UnitedHealthcare® and the dimensional U logo are registered marks owned by UnitedHealth Group Incorporated.

100-8109 C-1499-01 7/12 © 2012 United HealthCare Services, Inc.