2010 UPMC for Life Part D Prescription Drug Coverage
UPMC for Life offers Part D prescription drug coverage as part of our HMO and PPO plans and as a stand-alone plan option. Use the documents and links below to help you gather important information about the types of prescription drug coverage that UPMC for Life offers, what drugs are covered under our prescription drug formulary, and what pharmacies are participating in our network.
Click here to learn more about the prescription drug plans that UPMC for Life offers.
Prescription Drug Formulary Information
Participating Pharmacies
Reimbursement for a Pharmacy Claim
Prescription Drug Authorizations, Exceptions, Redeterminations, and Grievances (to UPMC for Life Formulary)
- What should I do before talking to my doctor about changing my prescription drugs or requesting an exception to the UPMC for Life formulary?
- Prescription Drug Coverage Determination Form/Exception Request Form
- Prescription Drug Coverage Redetermination Form
- Transition policy — Information for members currently residing in a non long-term care facility
- Transition policy — Information for members currently residing in a long-term care facility
- Transition policy — Information for members moving from home to a long-term care facility or from a long-term care facility to home
- How to obtain an aggregate number of grievances and appeals:
Please call our Member Services Department seven days a week from 8 a.m. to 8 p.m. at 1-877-539-3080 if you need more information about the number of appeals and grievances filed by our members. TTY/TDD users should call 1-800-361-2629. - Appointment of Representative
- Part D Appeals and Grievances
- Disenrollment Rights and Responsibilities information
- Contract Termination Information
- Out-of-Network Coverage
To ask for a coverage determination, redetermination, or appeal about a Part D drug, a signed, written appeal request should be faxed to UPMC for Life or sent to the address below. Please click on the Prescription Drug Coverage Determination Form/Exception Request and Prescription Drug Coverage Redetermination Forms above.
FAX: 412-454-7920
WRITE:
UPMC Health Plan
Attn: Appeals and Grievances
P.O. Box 2939
Pittsburgh, PA 15230-2939
You may also ask for a coverage determination, redetermination, or appeal by calling our Member Services Department at 1-877-539-3080, from 8 a.m. to 8 p.m.,* seven days a week. TTY/TDD users should call 1-800-361-2629. You may also contact the number above to get information about this process or to check on the status of your request.
In order to appoint a person to act on your behalf concerning your health care benefits, print the form above, complete the required fields, and fax or mail it to us. Once you return this completed, signed, and dated for to us, we can verify your request, adjust our records accordingly, and speak to your appointed representative. Please return this completed form either by fax or mail:
FAX: 412-454-7829
MAIL TO:
UPMC for Life
P.O. Box 2965
Pittsburgh, Pennsylvania 15230-2965
If you have any questions about this form, please call our Member Services Department at 1-877-539-3080, from 8 a.m. to 8 p.m.,* seven days a week. TTY/TTD users should call 1-800-361-2629.
Information for People Who Need Extra Help to Pay for Their Prescription Drugs
- Sign-up for extra help for paying for your prescription drugs
- How do I inquire about my LIS status or level?
- Low Income Subsidy Website Premium Summary Table for Pennsylvania
- Low Income Subsidy Website Premium Summary Table for Ohio
- Low Income Subsidy Website Premium Summary Table for West Virginia
- Link to CMS Website — Best Available Evidence (BAE)
UPMC for Life Medication Management Program
For Additional Plan Documents, please click here.
To see our Frequently Asked Questions page for more information and common questions asked by Medicare beneficiaries, please click here.
If you have any questions or would like to receive this information by mail, please call us toll-free at 1-866-400-5077 from 8 a.m. to 8 p.m.,* seven days a week or click on one of the links below. TTY/TDD users should call 1-800-361-2629.
- Join us for a seminar on Medicare and UPMC for Life
- Schedule a one-on-one meeting with an authorized UPMC for Life representative
- Speak with a sales representative over the phone
*From March 2 through November 14, you may receive a messaging service on weekends and holidays. Please leave a message and your call will be returned the next business day.