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Are you a first time user? You can create your own personalized OnLine account by registering here.
If you require a prior authorization for a medication not listed here, please contact UPMC Health Plan Pharmacy Services at 1-800-979-UPMC (8762)*.
We occasionally require 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.
If the requested information is not received back in a timely manner 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.
These forms serve all UPMC Health Plan products unless specified otherwise.
*If you are unable to locate a specific drug on our formulary, you can also select Non-Formulary Medications, then complete and submit that prior authorization form.
Prescribing physicians can fill out the following form to request a prescription drug exception for UPMC for Life members. There are two ways you can submit this form to us:
UPMC Health Plan, Inc.