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individuals & families Pharmacy Services

On this page you can:


Are your medications covered? Use our drug search tool

Step 1:

Find your type of health insurance in this column

Step 2:

Select your specific pharmacy benefit program from this column
Employer-sponsored:
(for non-retirees)
Your Choice
Your Choice (PDF)
Advantage Choice
Advantage Choice (PDF)
Value Choice (PDF)
Open Choice (PDF)
First Choice (PDF)
Direct Purchase:
(individuals and families)
Value Choice (PDF)
Medicare Advantage: UPMC for Life HMO and PPO (PDF)
Medicare Special Needs Plans: UPMC for You Advantage (PDF)
UPMC for Life Options (PDF)
UPMC Community Care (PDF)
Medical Assistance: UPMC for You
UPMC for You, Southwest Region (PDF)
UPMC for You, Lehigh Capital Region (PDF)
UPMC for You, New West Region (PDF)
Children's Health Insurance Program: UPMC for Kids
UPMC for Kids (PDF)
Individual and Family -
Government Health Insurance Marketplace Plans:
Advantage Choice
Advantage Choice (PDF)
Individual and Family -
Direct Purchase Plans:
Advantage Choice
Advantage Choice (PDF)

Find a pharmacy

Our broad pharmacy network of more than 30,000 retail chain and independent pharmacies includes CVS/pharmacy, Giant Eagle, Kmart, Rite Aid, Sam’s Club, Target, Walmart, and Wegmans (Erie locations).

Attention: Our pharmacy network has recently expanded to include CVS/pharmacy.

Step 1:

Find your type of health insurance in this column

Step 2:

Select your specific pharmacy benefit program from this column
Employer-sponsored:
(for non-retirees)
Your Choice
Value Choice
First Choice
Open Choice
Direct Purchase:
(individuals and families)
Your Choice
Value Choice
Medicare Advantage: UPMC for Life HMO and PPO
Medicare Special Needs Plans: UPMC for You Advantage
UPMC for Life Options
UPMC Community Care
Medical Assistance: UPMC for You
Children's Health Insurance Program: UPMC for Kids
Individual and Family -
Government Health Insurance Marketplace Plans:
Advantage Choice
Individual and Family -
Direct Purchase Plans:
Advantage Choice

Mail-order pharmacy

You can order refills of prescriptions that are already on file with Express Scripts Inc. (ESI) by calling the ESI 24/7 customer service center at 1-877-787-6279 (TTY: 1-800-899-2114) or by logging in to MyHealth OnLine to request refills online.


Reimbursement for a pharmacy claim

When you receive your prescription, some pharmacies may ask you to pay the full price of the medication rather than your normal copayment. If this should happen, you can submit a Direct Reimbursement Claim to UPMC Health Plan and ask to be reimbursed. If your claim is approved, you will be reimbursed the amount that you paid for the medication, less the appropriate copayment.

Pharmacy Program Direct Reimbursement Claim Form
Note: This form is for prescription reimbursements only. Click here for the flu shot reimbursement form.


Generic drugs — balancing cost and quality

Every year, generic drugs save consumers billions of dollars. By choosing a generic medication, you:

  • Often save on your prescription copayment.
  • Get the same quality and effectiveness as that of a brand-name drug.
  • Help keep medical care more affordable for everyone.

Consumers are looking for ways to reduce health care costs. Selecting generic drugs is one of the most effective ways to save money.

What are generic drugs?

Generic drugs are cost-effective alternatives that offer the same level of safety and quality as their brand-name equivalents. Generic drugs have the same active ingredients, but they cost significantly less.

The Food and Drug Administration (FDA) regulates generic drug manufacturers just as it regulates the makers of brand-name medications.

Find out if the drugs you are taking have a generic equivalent. Log in to MyHealth OnLine, our 24/7 online member resource, and start saving money today.


Specialty Medications

UPMC Health Plan utilizes CuraScript, a division of Express Scripts Inc., and Chartwell for our specialty pharmacy administration. Specialty medications generally are used for complex and chronic diseases. These medications may require close management due to potential side effects and frequent dose adjustments.

Both CuraScript and Chartwell have the ability to dispense medications to your physician’s office as well as your home, depending on where your medication will be administered. Due to the unique characteristics of specialty medications, they are limited to a 30-day supply.

Specialty drugs may require:

  • Close management by a physician
  • Frequent dosing adjustments
  • Intensive clinical monitoring
  • In-depth patient training
  • Special handling or administration

For these reasons, it is recommended that specialty medications be filled through Accredo or Chartwell pharmacies.

Personalized Care

Traditional retail and mail-order pharmacies are not able to offer you the higher level of care that our specialty medication support services can provide, including therapy-specific programs, patient financial assistance, and compliance monitoring. UPMC Health Plan’s specialty medication program provides you with personalized, highly technical care to help you get the most from your treatments.

If you are a Health Plan member and would like to find out if your plan offers specialty pharmacy service, including any copayments that may apply, log in to MyHealth OnLine to review your pharmacy plan documents.

Your doctor can order new prescriptions, and you can order refills for specialty or injectable medications by contacting one of the following specialty pharmacies:

CuraScript 1-888-853-5525
TTY: 1-800-955-8770
Monday through Friday 8 a.m. to 9 p.m.
and Saturday 9 a.m. to 1 p.m.
Chartwell 1-800-366-6020 Monday through Friday 8 a.m. to 5:30 p.m.