UPMC for You is expanding across Pennsylvania in September!
Jun. 2022Important Notices
"We are excited to announce that the Pennsylvania Department of Human Services (PA-DHS) has awarded UPMC for You a Medicaid Managed Care Contract for all five Physical HealthChoices zones across the Commonwealth of Pennsylvania. UPMC for You currently serves the Northwest, Southwest, and Lehigh/Capital HealthChoices zones and will expand into the Northeast and Southeast zones, effective Sept. 1, 2022.*
After June 22, 2022*, your Medicaid patients will receive a letter from PA-DHS to let them know about the Medicaid Managed Care Organizations (MCOs) selected to service their HealthChoices zones. Please look for a provider toolkit arriving in the mail in the coming weeks, explaining various value-added benefits for your patients and a variety of materials to display in your office. You can also review a list of frequently asked questions at upmchp.us/ProviderFAQ.
*Go-live implementation dates and communication timelines are subject to change at discretion of the Pennsylvania Department of Human Services."
After June 22, 2022*, your Medicaid patients will receive a letter from PA-DHS to let them know about the Medicaid Managed Care Organizations (MCOs) selected to service their HealthChoices zones. Please look for a provider toolkit arriving in the mail in the coming weeks, explaining various value-added benefits for your patients and a variety of materials to display in your office. You can also review a list of frequently asked questions at upmchp.us/ProviderFAQ.
*Go-live implementation dates and communication timelines are subject to change at discretion of the Pennsylvania Department of Human Services."
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