Pharmacy Coverage

Our members can count on us for prescription drug coverage. UPMC for Kids covers many medications, plus some over-the-counter drugs and vitamins with a prescription. UPMC for Kids members must fill prescriptions at a participating pharmacy.

The UPMC for Kids Pharmacy Benefits Guide is a list of Food and Drug Administration (FDA) approved medications. This list was developed by UPMC for Kids doctors and pharmacists and includes the most commonly used drugs. Medications on the formulary (drug list) that are prescribed by a doctor are paid for by UPMC for Kids. The list does not include every medication a doctor might prescribe. The drugs on the formulary have been selected because they are safe, work well, and cost less than other drugs that have the same level of effectiveness.

Based on your family’s income, your child may be enrolled in free, low-cost, or full-cost CHIP. Depending on your child’s CHIP coverage, there may be copayments for some drugs. A copayment is the amount of money a UPMC for Kids member is responsible to pay. The chart below provides a summary of these copayments.

	Free CHIP	Low-Cost CHIP	Full-Cost CHIP
30-day supply: Generic drug	$0	$6	$10
30-day supply: Brand-name drug	$0	$9	$18
90-day supply: Generic drug	$0	$12	$20
90-day supply: Brand-name drug	$0	$18	$36

Find a participating pharmacy

View the UPMC for Kids Pharmacy Benefits Guide

Your managed care plan may not cover all your health care expenses. Read your member handbook carefully to determine which health care services are covered.