UPMC Health Plan:Provider Pharmacy Resources

All UPMC Health Plan's pharmacy-related information is located in this section. Here you will find links to the pharmacy directory, program benefit guides, pharmacy announcements, prior authorization forms, and pharmacy formularies.

For the latest pharmacy announcements, Click Here.

Rx Prior Authorization Forms

If you require a prior authorization for a medication not listed here, please contact UPMC Health Plan Pharmacy Services at 1-800-396-4139. UPMC Health Plan makes all decisions on prior authorization requests within 24 hours from the time of initial review.

Our Prior Authorization process has been enhanced to better serve you. To see several common questions and answers that arise around the Prior Authorization process, click on the icon to the right.

Prior Authorization Process:
UPMC Health Plan makes all decisions on prior authorization requests within 24 hours from the time of initial review. The Health Plan occasionally requires additional information when completing a clinical review. If additional information is required, we will fax a letter to your office that details what additional information is needed.

The requested information must be received within 24 hours of the original prior authorization request, or the request will be denied due to lack of sufficient information for review. The Health Plan will notify you of its prior authorization decision via fax on the date the actual decision is made. If your office is unable to receive faxes, you will be notified via U.S. mail.

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

These forms serve all UPMC Health Plan products unless specified otherwise.

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Sarafem
Selzentry
Seroquel (Low Dose)
Singulair
Soliris
Sporanox
Sprycel
Long Acting Stimulants (For use over age 18)
Suboxone
Subutex
Supartz
Sutent
Symbyax
Symlin
Synagis
Synvisc

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Zorbtive

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Ordering Specialty Medications

The CuraScript Specialty pharmacy patient enrollment form can be found below. Please fax this form, the patient's prescription, and a completed prior authorization form (if applicable) to the number located on the enrollment form.
CuraScript Enrollment Form
If you are a UPMC owned physician practice and wish to use Falk Clinic instead of CuraScript to provide your patient's specialty drug, the necessary enrollment form can be found below. Please note the enrollment form and prior authorization form (if applicable) must be faxed to Falk Clinic, not the CuraScript pharmacy.
Falk Clinic Enrollment Form

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