Coming soon: Formulary updates effective Jan. 1, 2025
Please review updated information for the prescription drugs covered under each plan.
UPMC Health Plan Commercial plans
- View Advantage Choice formulary updates: upmchp.us/acformularychanges
- View Your Choice formulary updates: upmchp.us/ycformularychanges
- Policies can be found here: upmchealthplan.com/providers/medical/resources/manuals/policies-procedures.aspx
UPMC for Life Medicare and SNP plans
View UPMC for Life formulary updates:
- UPMC for Life Complete Care (HMO D-SNP): upmchp.us/MCcompletecareRxformulary
- UPMC for Life Advantage Rx (HMO, PPO): upmchp.us/MCadvantageRxRXformulary
- UPMC for Life Premier Rx (HMO, PPO): upmchp.us/MCpremierRxformulary
- Medicare Part D policies can be found here: upmchealthplan.com/medicare/learn/basics/medicare-prescription-coverage
- Medicare Part B policies can be found here: upmchealthplan.com/providers/medical/resources/manuals/policies-procedures.aspx
IVIG/SCIG preferred products
Effective Jan. 1, 2025, certain intravenous immune globulin (IVIG) and subcutaneous immune globulin (SCIG) products that are preferred in 2024 will move to nonpreferred for all UPMC lines of business. All products currently require prior authorization in 2024, which will continue in 2025 regardless of status. However, members currently on nonpreferred products will not need updated authorizations when switching to preferred products in 2025. Please reference upmchp.us/PreferredImmuneGlobulins for preferred and nonpreferred products.
IV oncology prior authorization
Effective Jan. 1, 2025, select medically administered oncology products will require a prior authorization for all UPMC lines of business and drug formularies. The prior authorization applies only to new starts to therapy. The criteria for approval include that the requested drug is used for a medically accepted indication, prescribed by or in consultation with a specialist, and used for a dose and duration consistent with FDA-approved labeling or clinical literature. Please refer to products that will newly require prior authorization as of Jan. 1, 2025: upmchp.us/IVoncologyPA
Exception request options
Requests for exceptions can be submitted to Pharmacy Services by one of the following methods:
- Online: Through SureScripts ePA or through the portal at upmchp.us/ProviderPharmacyPAForms