UPMC for Life Online Prescription Drug Formulary

You can use the UPMC for Life formulary to see if the medication(s) you are taking are covered by our plan. In order to find your drug, select the first letter of the drug from the alphabet below. Once selected, brand-name drugs will be displayed in ALL CAPS and generics will be in lower case.

Updates are made to our formulary on a monthly basis. For more recent information, or if you do not see your drug listed below, please call us at 1-866-400-5077 from 8 a.m. to 8 p.m., seven days a week.* TTY users should call 1-800-361-2629.

If a brand-name drug that you are taking is not covered by our plan, you may be able to switch to a generic drug equivalent. A generic drug has exactly the same active ingredient(s), drug strength, and dosage form as its brand-name equivalent. Contact us at the phone number above for more information.

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Formulary updated 09/2014

Some covered drugs may have additional requirements or limits on coverage. These drugs will have abbreviations next to them in the formulary document. Use the definitions below to help you understand what these abbreviations mean:

  • B/D: This prescription drug may be covered under Medicare Part B or D depending upon the circumstance. Information may need to be submitted describing the use and setting of the drug to make the determination.
  • LA: Limited Availability. This prescription may be available only at certain pharmacies. For more information, please call us at the phone number above.
  • MO: Mail-Order Drug. This prescription drug is available through our mail-order services, as well as through our retail network pharmacies. Consider using mail order for your long-term (maintenance) medications (such as high blood pressure medications). Retail network pharmacies may be more appropriate for short-term prescriptions (such as antibiotics).
  • PA: Prior Authorization. UPMC for Life requires you or your physician to get prior authorization for certain drugs. This means that you will need to get approval before you fill your prescriptions. If you donít get approval, UPMC for Life may not cover the drug.
  • QL: Quantity Limits. For certain drugs, UPMC for Life limits the amount of the drug that we will cover.
  • ST: Step Therapy. In some cases, UPMC for Life requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, we may not cover Drug B unless you try Drug A first. If Drug A does not work for you, we will then cover Drug B.

During the first 90 days that you are a member of UPMC for Life, we may cover a limited amount of your current non-formulary drug therapy in certain cases while you talk to your doctor to determine the right course of action for you. Click here for more information.

UPMC for Life members may ask for a coverage determination, redetermination, or appeal for a Part D prescription drug. Click here to make a coverage request.

Some drugs may be covered under Medicare Part B or D depending upon the circumstances. Information may need to be submitted describing the use and setting of the drug to make the determination.

To find out more about mail-order availability and limited access drugs, please call us at the number above.

Click here for a list of additional plan documents and forms.

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