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Physicians Health Choice Total (HMO) and Select (HMO SNP) plans
FORMULARY ADDITIONS UPDATE – Physicians Health Choice Total (HMO) and Select (HMO SNP) plans:
The following summary describes recent changes to the formulary effective March 1, 2013.

FORMULARY ADDITIONS, REDUCTIONS IN PREFERRED OR TIERED COST-SHARING STATUS,
OR REMOVAL OF UTILIZATION MANAGEMENT TO AN EXISTING FORMULARY DRUG
Effective Date
Drug Name
Description of Change
Utilization Management Notes
of Change
Physicians Health Choice Total (HMO) and Select (HMO SNP) plans
FORMULARY ADDITIONS UPDATE – Physicians Health Choice Total (HMO) and Select (HMO SNP) plans:
The following summary describes recent changes to the formulary effective March 1, 2013.

FORMULARY ADDITIONS, REDUCTIONS IN PREFERRED OR TIERED COST-SHARING STATUS,
OR REMOVAL OF UTILIZATION MANAGEMENT TO AN EXISTING FORMULARY DRUG
Effective Date
Drug Name
Description of Change
Utilization Management Notes
of Change
Physicians Health Choice Total (HMO) and Select (HMO SNP) plans
FORMULARY ADDITIONS UPDATE – Physicians Health Choice Total (HMO) and Select (HMO SNP) plans:
The following summary describes recent changes to the formulary effective March 1, 2013.

FORMULARY ADDITIONS, REDUCTIONS IN PREFERRED OR TIERED COST-SHARING STATUS,
OR REMOVAL OF UTILIZATION MANAGEMENT TO AN EXISTING FORMULARY DRUG
Effective Date
Drug Name
Description of Change
Utilization Management Notes
of Change
Physicians Health Choice Total (HMO) and Select (HMO SNP) plans
FORMULARY ADDITIONS UPDATE – Physicians Health Choice Total (HMO) and Select (HMO SNP) plans:
The following summary describes recent changes to the formulary effective March 1, 2013.

FORMULARY ADDITIONS, REDUCTIONS IN PREFERRED OR TIERED COST-SHARING STATUS,
OR REMOVAL OF UTILIZATION MANAGEMENT TO AN EXISTING FORMULARY DRUG
Effective Date
Drug Name
Description of Change
Utilization Management Notes
of Change
Physicians Health Choice Total (HMO) and Select (HMO SNP) plans
FORMULARY ADDITIONS UPDATE – Physicians Health Choice Total (HMO) and Select (HMO SNP) plans:
The following summary describes recent changes to the formulary effective March 1, 2013.

FORMULARY ADDITIONS, REDUCTIONS IN PREFERRED OR TIERED COST-SHARING STATUS,
OR REMOVAL OF UTILIZATION MANAGEMENT TO AN EXISTING FORMULARY DRUG
Effective Date
Drug Name
Description of Change
Utilization Management Notes
of Change
Physicians Health Choice Total (HMO) and Select (HMO SNP) plans
FORMULARY ADDITIONS UPDATE – Physicians Health Choice Total (HMO) and Select (HMO SNP) plans:
The following summary describes recent changes to the formulary effective March 1, 2013.

FORMULARY ADDITIONS, REDUCTIONS IN PREFERRED OR TIERED COST-SHARING STATUS,
OR REMOVAL OF UTILIZATION MANAGEMENT TO AN EXISTING FORMULARY DRUG
Effective Date
Drug Name
Description of Change
Utilization Management Notes
of Change
Physicians Health Choice Total (HMO) and Select (HMO SNP) plans
FORMULARY ADDITIONS UPDATE – Physicians Health Choice Total (HMO) and Select (HMO SNP) plans:
The following summary describes recent changes to the formulary effective March 1, 2013.

FORMULARY ADDITIONS, REDUCTIONS IN PREFERRED OR TIERED COST-SHARING STATUS,
OR REMOVAL OF UTILIZATION MANAGEMENT TO AN EXISTING FORMULARY DRUG
Effective Date
Drug Name
Description of Change
Utilization Management Notes
of Change
Physicians Health Choice Total (HMO) and Select (HMO SNP) plans
FORMULARY ADDITIONS UPDATE – Physicians Health Choice Total (HMO) and Select (HMO SNP) plans:
The following summary describes recent changes to the formulary effective March 1, 2013.

FORMULARY ADDITIONS, REDUCTIONS IN PREFERRED OR TIERED COST-SHARING STATUS,
OR REMOVAL OF UTILIZATION MANAGEMENT TO AN EXISTING FORMULARY DRUG
Effective Date
Drug Name
Description of Change
Utilization Management Notes
of Change
Physicians Health Choice Total (HMO) and Select (HMO SNP) plans
FORMULARY ADDITIONS UPDATE – Physicians Health Choice Total (HMO) and Select (HMO SNP) plans:
The following summary describes recent changes to the formulary effective March 1, 2013.

FORMULARY ADDITIONS, REDUCTIONS IN PREFERRED OR TIERED COST-SHARING STATUS,
OR REMOVAL OF UTILIZATION MANAGEMENT TO AN EXISTING FORMULARY DRUG
Effective Date
Drug Name
Description of Change
Utilization Management Notes
of Change
Physicians Health Choice Total (HMO) and Select (HMO SNP) plans
FORMULARY ADDITIONS UPDATE – Physicians Health Choice Total (HMO) and Select (HMO SNP) plans:
The following summary describes recent changes to the formulary effective March 1, 2013.

FORMULARY ADDITIONS, REDUCTIONS IN PREFERRED OR TIERED COST-SHARING STATUS,
OR REMOVAL OF UTILIZATION MANAGEMENT TO AN EXISTING FORMULARY DRUG
Effective Date
Drug Name
Description of Change
Utilization Management Notes
of Change
Physicians Health Choice Total (HMO) and Select (HMO SNP) plans
FORMULARY ADDITIONS UPDATE – Physicians Health Choice Total (HMO) and Select (HMO SNP) plans:
The following summary describes recent changes to the formulary effective March 1, 2013.

FORMULARY ADDITIONS, REDUCTIONS IN PREFERRED OR TIERED COST-SHARING STATUS,
OR REMOVAL OF UTILIZATION MANAGEMENT TO AN EXISTING FORMULARY DRUG
Effective Date
Drug Name
Description of Change
Utilization Management Notes
of Change
Physicians Health Choice Total (HMO) and Select (HMO SNP) plans
FORMULARY ADDITIONS UPDATE – Physicians Health Choice Total (HMO) and Select (HMO SNP) plans:
The following summary describes recent changes to the formulary effective March 1, 2013.

FORMULARY ADDITIONS, REDUCTIONS IN PREFERRED OR TIERED COST-SHARING STATUS,
OR REMOVAL OF UTILIZATION MANAGEMENT TO AN EXISTING FORMULARY DRUG
Effective Date
Drug Name
Description of Change
Utilization Management Notes
of Change
Physicians Health Choice Total (HMO) and Select (HMO SNP) plans
FORMULARY ADDITIONS UPDATE – Physicians Health Choice Total (HMO) and Select (HMO SNP) plans:
The following summary describes recent changes to the formulary effective March 1, 2013.

FORMULARY ADDITIONS, REDUCTIONS IN PREFERRED OR TIERED COST-SHARING STATUS,
OR REMOVAL OF UTILIZATION MANAGEMENT TO AN EXISTING FORMULARY DRUG
Effective Date
Drug Name
Description of Change
Utilization Management Notes
of Change
Physicians Health Choice Total (HMO) and Select (HMO SNP) plans
FORMULARY ADDITIONS UPDATE – Physicians Health Choice Total (HMO) and Select (HMO SNP) plans:
The following summary describes recent changes to the formulary effective March 1, 2013.

FORMULARY ADDITIONS, REDUCTIONS IN PREFERRED OR TIERED COST-SHARING STATUS,
OR REMOVAL OF UTILIZATION MANAGEMENT TO AN EXISTING FORMULARY DRUG
Effective Date
Drug Name
Description of Change
Utilization Management Notes
of Change
Physicians Health Choice Total (HMO) and Select (HMO SNP) plans
FORMULARY ADDITIONS UPDATE – Physicians Health Choice Total (HMO) and Select (HMO SNP) plans:
The following summary describes recent changes to the formulary effective March 1, 2013.

FORMULARY ADDITIONS, REDUCTIONS IN PREFERRED OR TIERED COST-SHARING STATUS,
OR REMOVAL OF UTILIZATION MANAGEMENT TO AN EXISTING FORMULARY DRUG
Effective Date
Drug Name
Description of Change
Utilization Management Notes
of Change
Physicians Health Choice Total (HMO) and Select (HMO SNP) plans
FORMULARY ADDITIONS UPDATE – Physicians Health Choice Total (HMO) and Select (HMO SNP) plans:
The following summary describes recent changes to the formulary effective March 1, 2013.

FORMULARY ADDITIONS, REDUCTIONS IN PREFERRED OR TIERED COST-SHARING STATUS,
OR REMOVAL OF UTILIZATION MANAGEMENT TO AN EXISTING FORMULARY DRUG
Effective Date
Drug Name
Description of Change
Utilization Management Notes
of Change
Physicians Health Choice Total (HMO) and Select (HMO SNP) plans
FORMULARY ADDITIONS UPDATE – Physicians Health Choice Total (HMO) and Select (HMO SNP) plans:
The following summary describes recent changes to the formulary effective March 1, 2013.

FORMULARY ADDITIONS, REDUCTIONS IN PREFERRED OR TIERED COST-SHARING STATUS,
OR REMOVAL OF UTILIZATION MANAGEMENT TO AN EXISTING FORMULARY DRUG
Effective Date
Drug Name
Description of Change
Utilization Management Notes
of Change
Physicians Health Choice Total (HMO) and Select (HMO SNP) plans
FORMULARY ADDITIONS UPDATE – Physicians Health Choice Total (HMO) and Select (HMO SNP) plans:
The following summary describes recent changes to the formulary effective March 1, 2013.

FORMULARY ADDITIONS, REDUCTIONS IN PREFERRED OR TIERED COST-SHARING STATUS,
OR REMOVAL OF UTILIZATION MANAGEMENT TO AN EXISTING FORMULARY DRUG
Effective Date
Drug Name
Description of Change
Utilization Management Notes
of Change
Plans are insured or covered by UnitedHealthcare Insurance Company or one of its affiliates, a Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor.
Physicians Health Choice Total (HMO) and Select (HMO SNP) plans
FORMULARY ADDITIONS UPDATE – Physicians Health Choice Total (HMO) and Select (HMO SNP) plans:
The following summary describes recent changes to the formulary effective March 1, 2013.

FORMULARY ADDITIONS, REDUCTIONS IN PREFERRED OR TIERED COST-SHARING STATUS,
OR REMOVAL OF UTILIZATION MANAGEMENT TO AN EXISTING FORMULARY DRUG
Effective Date
Drug Name
Description of Change
Utilization Management Notes
of Change
QL = Quantity Limit, PA = Prior Authorization, ST = Step Therapy, B/D = Medicare Part B/D determination
AER = Aerosol, CAP = Capsule, CON = Concentrate, CRE = Cream, DRO = Drops, ER = Extended Release, ENE = Enema, GRA = Granules,
INH = Inhalation, INJ = Injection, LOT = Lotion, NEB = Nebulizer, ODT = Orally Disintegrating, OIN = Ointment, OP = Ophthalmic, POW =
Powder, SHA = Shampoo, SOL = Solution, SPR = Spray, SUB = Sublingual, SUP = Suppository, SUS = Suspension, TAB = Tablet
[<OVEX3385284_000>] Formulary ID# 00013520 Y0066_111223_140152 File & Use 12282011

Source: http://smtp.phcares.net/pdf/PHC_Formulary_Additions_3-1-2013.pdf

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