What are Prescription Drugs Lists (PDLs)?

When your doctor prescribes a medication, it’s important to know if it is covered. To do that, you’ll want to know how to access your plan’s Prescription Drug List (PDL), sometimes called a formulary. The PDL is a list of the most commonly prescribed medications. It includes both brand-name and generic prescription medications approved by the U.S. Food and Drug Administration (FDA). Medications are listed by common categories or classes and placed in tiers that represent the cost you pay out-of-pocket.

What is a drug tier? How does it work?

Prescription Drug Lists often have tiers, or groups of drugs categorized by cost. Your cost-share or copayment is based on which tier your drug is in. There are typically three or four tiers:

  • Tier 1: Least expensive drug options, often generic drugs
  • Tier 2: Higher-price generic and lower-price brand-name drugs
  • Tier 3: Mainly higher-price brand-name drugs
  • Tier 4: Highest-cost prescription drugs

What’s the difference between brand and generic drugs?

Does health insurance cover all prescription drugs?

Medications under different names may provide similar clinical benefits yet look different and have different price points. Sometimes only certain types or brands of prescriptions are covered under your plan. Know your pharmacy benefits and if your prescription is covered before you head to the pharmacy counter.

How do I know if a plan covers my prescriptions?

Sign in to your account to view your Prescription Drug List (PDL) or call the number on your member ID card.

Prescription drugs are evaluated on the following:

  • How well they work
  • How they compare to others in the same class
  • Total cost

Medicare

Medicare Part B covers some outpatient prescription drugs. If a drug is not covered under Part B, it may be covered under Part D. See examples of Part B drugs commonly covered. Most Medicare Part D drug plans have their own Prescription Drug List, also known as a formulary, with drugs placed into tiers.

Medicaid

Most Medicaid plans cover some prescription drugs, but the Prescription Drug List and plan benefits can vary from state to state.

If you are enrolled in a UnitedHealthcare Community Plan, sign in to your account to confirm your pharmacy benefits. 

Frequently asked questions