08/18/2025

United Healthcare

Molina Managed Care Committee Member

Whitney Williams, CPB - Newland Medical Associates

Medical Policy Update

• UnitedHealthcare Commercial 
• UnitedHealthcare Individual Exchange 
• UnitedHealthcare Community Plan 
• UnitedHealthcare Medicare Advantage 

Reimbursement Policy Updates

• UnitedHealthcare Commercial Plan 
• UnitedHealthcare Individual Exchange 
• UnitedHealthcare Community Plan 
• UnitedHealthcare Medicare Advantage 

Pharmacy and Clinical Updates

• Commercial Business Pharmacy Update: Effective August 1
  • Notice of Changes to Prior Authorization Requirements and Coverage Criteria 
• Commercial Prescription Drug List: Effective September 1, 2025 
• Advantage 3-Tier PDL Update: Effective September 1, 2025  
• Advantage 4-Tier PDL Update: Effective September 1, 2025  

Other

• Medical Benefit Specialty Medication Update 
• 2025 Summary of Changes to Advance Notification and Prior Authorization Requirements  
• National Gold Card Program Enters Second Year  
  • Check your Gold Card eligibility status starting Sept. 1