MEMBERS
Pharmacy Services
On this page you can:
- Search for a drug to see if it is covered
- Locate a pharmacy
- Learn how to sign up for mail-order
- Download our Prescription Drug Claim Reimbursement Form
- Learn how generics drugs can save you money
- Find out how to order specialty medications
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 |
| Health insurance through your employer: (for non-retirees) |
Your Choice Value Choice First Choice (PDF) |
| Medicare Advantage: | UPMC for Life HMO and PPO (PDF) UPMC for Life Specialty Plan (PDF) UPMC for Community Living (PDF) |
| Medical Assistance: | UPMC for You |
| Children's Health Insurance Program: | UPMC for Kids (PDF) |
Find a pharmacy
Our broad pharmacy network of over 38,000 retail chain and independent pharmacies, includes CVS/pharmacy, Giant Eagle, Kmart, Rite Aid , Sam’s Club, Target, Wal-Mart, Walgreens, 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 |
| Health insurance through your employer: (for non-retirees) |
Your Choice Value Choice First Choice |
| Medicare Advantage: | UPMC for Life HMO and PPO UPMC for Life Specialty Plan UPMC for Community Living |
| Medical Assistance: | UPMC for You |
| Children's Health Insurance Program: | UPMC for Kids |
Mail-order pharmacy
You can order refills of prescriptions that are already on file with ESI by calling the ESI 24/7 customer service center at 1-877-787-6279 (TTY: 1-800-899-2114) or by logging in 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., 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.
CuraScript has 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.
Review a list of medications provided through CuraScript.
These 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, specialty medications are filled only through CuraScript’s telephone ordering service.
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 calling 1-877-787-6279 (TYY: 1-800-899-2114) M-F, 8:00 am to 9:00 pm, and Sat. 9:00 am to 1:00 pm.