Important Notice Regarding Prior Authorizations for MP.PA.147

Jul. 2025Important Notices

UPMC Health Plan previously communicated that prior authorizations would be required under policy Diagnostic and Surveillance Colonoscopy, 18 Years Old and Older – MP.PA.147 effective June 1, 2025. However, the prior authorization requirement will be paused until Sept. 1, 2025.

Authorizations that have already been submitted will be entered without a review. Patient care should not be delayed or interrupted.

The provider is responsible for clinical decisions and billing. An authorization is not a guarantee of payment for services rendered. 


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 products
Sep. 2025Pharmacy Updates