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UPMC for Life Specialty Plan

2009 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

Searchable drug formulary UPMC for Life’s Searchable Prescription Drug Formulary
Prescription drug formulary UPMC for Life Prescription Drug Formulary
60-day formulary change information 60-day Formulary Change Information
Prior Authorization information for prescription drugs UPMC for Life Prior Authorization Information for Prescription Drugs

Prescription Drug Authorizations, Exceptions, Redeterminations, and Grievances (to UPMC for Life Formulary)

Talking to your doctor What should I do before talking to my doctor about changing my prescription drugs or requesting an exception to the UPMC for Life formulary?
pdf Prescription Drug Coverage Determination Form/Exception Request Form
pdf

Prescription Drug Coverage Redetermination Form

To ask for an appeal about a Part D drug and/or Part C medical care or service, a signed, written appeal request must be faxed to UPMC for Life or sent to the address listed below.

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 an appeal by calling our Member Services Department seven days a week from 8 a.m. to 8 p.m. at 1-877-539-3080. TTY users should call 1-800-361-2629. 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.

Transition policy Transition policy — Information for members currently residing in a non long-term care facility
Transition policy Transition policy — Information for members currently residing in a long-term care facility
Transition policy Transition policy — Information for members moving from home to a long-term care facility or from a long-term care facility to home

prior authorization form

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 users should call 1-800-361-2629. 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.
Low income subsidy website - PA Appointment of Representative
Low income subsidy website - PA Part D Appeals and Grievances
Low income subsidy website - PA Appeals & Grievances
Transition policy Disenrollment Rights and Responsibilities information
Low income subsidy website - PA Contract Termination Information
pdf Out-of-Network Coverage

Participating Pharmacies

Pharmacy directory - PA and WV UPMC for Life Pharmacy Directory Pennsylvania and West Virginia
Pharmacy Directory - Ohio UPMC for Life Pharmacy Directory Ohio
Number of pharmacies The number of participating pharmacies in the UPMC for Life network
CMS pharmacy access requirements UPMC for Life meets CMS requirements for pharmacy access

Information for People Who Need Extra Help to Pay for Their Prescription Drugs

Help for paying for drugs and other insurance Help for paying for drugs and other insurance
Low income subsidy website - PA Low Income Subsidy Website Premium Summary Table for Pennsylvania
Low income subsidy - OH Low Income Subsidy Website Premium Summary Table for Ohio
Low income subsidy - WV Low Income Subsidy Website Premium Summary Table for West Virginia
CMS website Link to CMS Website – Best Available Evidence (BAE)

UPMC for Life Medication Management Program

Drug utilization How does UPMC for Life manage drug utilization?
Drug utilization Help for members who take many medications
Help for members who take many medications Eligibility criteria for UPMC for Life’s 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.

Ways to Learn More

  • 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

Contact Us

  • Find important phone numbers and the address of UPMC Health Plan

 

 


*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.