2010 Part D Prescription Drug Coverage
UPMC for Life Specialty Plan (HMO) and UPMC for Community Living (HMO) offers Part D prescription drug coverage as part of our plan. Use the documents and links below to help you gather important information about the types of prescription drug coverage that UPMC for Life Specialty Plan and UPMC for Community Living offers, what drugs are covered under our prescription drug formulary, and what pharmacies are participating in our network.
UPMC for Life Specialty Plan and UPMC for Community Living members utilize the UPMC for Life Formulary, Pharmacy, and Prescription Drug Forms.
Prescription Drug Formulary Information
Prescription Drug Authorizations, Exceptions, Redeterminations, and Grievances (to UPMC for Life Formulary)
- What should I do before talking to my doctor about changing my prescription drugs or requesting an exception to the UPMC for Life formulary?
- Prescription Drug Coverage Determination Form/Exception Request Form*
- 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 Specialty Plan/UPMC for Community Living 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 1-800-606-8648.* TTY users should call 1-866-407-8762.
Transition Process
New members in our Plan may be taking drugs that are not on our formulary or that are subject to certain restrictions, such as prior authorization or step therapy. Current members may also be affected by changes in our formulary from one year to the next. Members should talk to their doctors to decide if they should switch to a different drug that we cover or request a formulary exception in order to get coverage for the drug. Please contact Member Services if your drug is not on our formulary, is subject to certain restrictions, such as prior authorization or step therapy, or will no longer be on our formulary next year and you need help switching to a different drug that we cover or requesting a formulary exception.
- Transition policy — Information for members currently residing in a non long-term care facility
- Transition policy — Information for members currently residing in a long-term care facility
- Transition policy — Information for members moving from home to a long-term care facility or from a long-term care facility to home
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 1-800-606-8648 if you need more information about the number of appeals and grievances filed by our members. TTY users should call 1-866-407-8762. 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.
Out-of-Network Coverage*Participating Pharmacies
- UPMC for Life Pharmacy Directory
- The number of participating pharmacies in the UPMC for Life network*
- UPMC for Life meets CMS requirements for pharmacy access*
We have network pharmacies outside of the service area where you can get your drugs covered as a member of our Plan. Generally, we only cover drugs filled at an out-of-network pharmacy in limited, non-routine circumstances when a network pharmacy is not available. Below are some circumstances when we would cover prescriptions filled at an out-of-network pharmacy. Before you fill your prescription in these situations, call Member Services to see if there is a network pharmacy in your area where you can fill your prescription. If you do go to an out-of-network pharmacy for the reasons listed below, you may have to pay the full cost when you fill your prescription.
Information for People Who Need Extra Help to Pay for Their Prescription Drugs
UPMC for Life Medication Management Program
For Important Plan Information, please click here.
To see our Frequently Asked Questions page for more information and common questions asked by Medicare Specialty Program beneficiaries, please click here.
If you have any questions or would like to receive this information by mail, please call us toll-free at 1-866-405-8762 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 1-866-407-8762.