COVID-19 vaccines; No cost share for members
Jan. 2022Important Notices
"UPMC Health Plan believes that vaccination is important, helps protect our communities, and saves lives. We advocate that all who can be vaccinated should be vaccinated. Since the first Emergency Use Authorizations were granted, the COVID-19 vaccine has been covered as a preventive service at no cost for UPMC Health Plan members. This applies to all of our comprehensive medical coverage products, including UPMC for Life, UPMC for Life Complete Care, UPMC for You, UPMC for Kids, UPMC Community HealthChoices, and all UPMC commercial group and individual (Pennie/Marketplace) products.
CMS has provided billing guidance and vaccine toolkits that can be found at cms.gov/COVIDvax. As of Jan. 1, 2022, vaccination claims for members with UPMC for Life (Medicare Advantage) should go to UPMC Health Plan, not Medicare Fee-For-Service. To learn more, visit our provider FAQ and Appendix A for more information."
CMS has provided billing guidance and vaccine toolkits that can be found at cms.gov/COVIDvax. As of Jan. 1, 2022, vaccination claims for members with UPMC for Life (Medicare Advantage) should go to UPMC Health Plan, not Medicare Fee-For-Service. To learn more, visit our provider FAQ and Appendix A for more information."
Recent Announcements
Important announcement – Telehealth submissions
As of October 1, 2025, UPMC Health Plan continues to accept the submission of telehealth claims. Providers may conduct telehealth visits for UPMC Health Plan members in all UPMC Insurance products. UPMC Insurance products include UPMC Advantage group and individual products, UPMC for Life Medicare Advantage plans, UPMC for Kids CHIP plans, UPMC Community HealthChoices, and UPMC for You Medical Assistance plans.Sep. 2025Important Notices
October 2025 UPMC for You and UPMC Community HealthChoices Formulary Update
Effective October 1st, 2025, Xifaxan and Retin-A (cream, gel) will no longer be covered by UPMC for You and UPMC Community HealthChoices due to non-participation in the Medicaid Drug Rebate Program.Sep. 2025Pharmacy Updates
Biosimilar Medication Formulary Updates
Updates to formulary biosimilar medications for denosumab, eculizumab, and ustekinumab productsSep. 2025Pharmacy Updates