Drug List - U

U
Drug Name Tier Restrictions
ULESFIA LOT 5% 3 Prior authorization
ULORIC 3 Prior authorization
ULTRA NATALCARE 3
ULTRACET 3 Prior authorizaton
ULTRAM 3 Prior authorization
ULTRAVATE 3 Quantity limit
UMECTA EMU 3 Prior authorization, Quantity limit, Step therapy
UMECTA MOUSSE AER 3 Prior authorization, Quantity limit
UMECTA NAIL FILM 3 Prior authorization, Quantity limit, Step therapy
UNIRETIC 3 Prior authorization
UNIVASC 3 Prior authorization
UREA 1 Quantity limit
UREA NAIL STK 50% 2 Prior authorization, Quantity limit
UREALAC LOTION 1 Quantity limit
UREALAC NAIL GEL 3 Prior authorization, Quantity limit
URIBEL CAP 118MG 3
URIMAX 3
URISED 1
UROQID 1
URSO 2
URSO FORTE 2
URSODIL 1
USEPT 1