Erickson Advantage Formulary
You will find the Erickson Advantage formulary and drug utilization management when you click on the link below.
When you click this link—2017 Drug Formulary—you will be taken to the OptumRx formulary (the list of drugs covered under Erickson Advantage). The Erickson Advantage formulary and OptumRx formulary are the same. You will also find the Step Therapy Criteria and Prior Authorization Criteria on OptumRx.
Download and print the Erickson Advantage 2017 Comprehensive Formulary | Spanish Language Version
Or view the pdf below.
Erickson Advantage Drug Management
Click the links below to download your necessary documents.
- 2017 Pharmacy Directory, English | Spanish
- Prescription Drug Transition Process
- Medication Therapy Management
- Personal medication Form
- Coverage Determinations, Appeals and Grievances
- Redetermination Request Form
- CMS Prescription Drug Determination Request Form
- Medication Prior Authorization Request Criteria
- Step Therapy Criteria
- Appointment of Authorized Representative Form
- Privacy Notice under the HIPAA Privacy Rule
*The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments, and restrictions may apply. Benefits, premium and/or co-payments/co-insurance may change on January 1 of each year.
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan's contract renewal with Medicare.
You must continue to pay your Medicare Part B premium.
This information is available for free in other languages. Please call our customer service number at 1-866-314-8188, TTY 711, 8 a.m. - 8 p.m. local time, 7 days a week.
Esta información está disponible sin costo en otros idiomas. Comuníquese con nuestro Servicio al Cliente al número 1-866-314-8188, TTY 711, de 8 a.m. – 8 p.m. hora local, los 7 días de la semana.
For more information on Erickson Advantage, just stop by the office Monday through Friday 8:30 a.m.-5:00 p.m. or call 1-866-774-9671, TTY: 711. 8 a.m. - 8 p.m. local time, 7 days a week.
Please read the UnitedHealthcare Non-Discrimination Notice.
Language Assistance/Non-Discrimination Notice