Welcome

Welcome to your Pharmacy Benefits for UnitedHealthcare Individual & Family Affordable Care Act (ACA) Marketplace plans in Texas. 

UnitedHealthcare works with Optum Rx, a focused, collaborative, and innovative leader in the pharmacy benefit management (PBM) industry. Every day, Optum Rx serves millions of people through a state-of-the-art home delivery pharmacy, specialty pharmacy, and a national network of community pharmacies.  We are here to guide you through the open enrollment process and to help you understand your plan options, so that you can save time and money when your benefits plan starts. 

Price a Drug
You can price a drug to determine if it is covered and estimate your cost-sharing. Search by health plan categories: Gold, Silver or Bronze.

Your Formulary by Health Benefit Plan

A Prescription Drug List (PDL) or a formulary is a list of covered prescribed medications or supplies. The PDL includes information you need, like: 

  • If your medication is covered
  • What tier your medication is considered under your plan
  • If your medication has coverage requirements or limits, like prior authorization, step therapy or quantity limits 

Choose a medication in Tier 1 or Tier 2 for your lowest cost options. If your medication is in a higher tier, you may pay more. Ask your health care provider if a lower cost medication can work to treat your condition.

If your medication is not covered or has a coverage requirement or limit, talk to your health care provider. They may be able to ask about a prior authorization or exception to get your medication covered or may switch you to a covered medication that can treat your condition.

When to use the Medication Search or PDF formats of the Prescription Drug list:

  • For up-to-date coverage information, search for medications us ing the Medication Search.
  • Use the PDF to learn about the drug list, tier information, and coverage requirements or limits such as prior authorization, step therapy, and quantity limits. The PDF also explains how to request a prior authorization or exception.

Prescription Drug Lists

  • If your plan name does NOT include "Standard", use the Essential Plus Prescription Drug List (6-tier): Medication Search | English (pdf)
  • If your plan name is one of the following, use the Essential Plus Prescription Drug List (6-tier): Medication Search | English (pdf) 
    • UHC Gold Standard $0 Indiv Ded ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, $0 Insulin)
    • UHC Gold-A Standard ($0 Virtual Urgent Care + $0 PCP Visits, $0 Tier 2 Rx, $0 Insulin)
    • UHC Gold-B Standard $0 Indiv Ded ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, $0 Insulin)
    • UHC Gold-X Standard $0 Indiv Ded ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, $0 Insulin)
  • For all other plans that include “Standard” in the plan name, use the QHP Standard Prescription Drug List (5-tier): Medication Search | English (pdf)