October 2025 UPMC for You and UPMC Community HealthChoices formulary update

Oct. 2025Pharmacy Updates

Effective Oct. 1, 2025, Xifaxan and Retin-A (cream, gel) will no longer be covered by UPMC for You and UPMC Community HealthChoices due to nonparticipation in the Medicaid Drug Rebate Program.

There are covered alternatives that may be an option for your patients, depending on their health needs.

Tretinoin cream is a covered alternative for Retin-A (cream, gel).

Covered alternatives for Xifaxan include loperamide capsule, dicyclomine (10 mg capsule, 20 mg tablet), lactulose solution, and azithromycin. Coverage is available for Xifaxan 200 mg tablet for a diagnosis of hepatic encephalopathy only and a prior authorization is required. The dose and duration of therapy for Xifaxan 200 mg tablet must be consistent with nationally recognized compendia or peer-reviewed literature.

Xifaxan coverage update

Coverage of Xifaxan tablet, including both the 200 mg and 550 mg strengths, is no longer available under UPMC for You and UPMC Community HealthChoices.

The manufacturer of Xifaxan may provide the drug to Medicaid patients at no cost through its patient assistance program. The program application is available by phone at 1-833-862-8727 or online at bauschhealthpap.com.

Recent Announcements

Voluntary nationwide recall: Famotidine (Fresenius – November)

Fresenius Kabi USA, LLC is recalling three lots (6133156, 6133194, and 6133388) of Famotidine Injection, USP, 20 mg per 2 mL. Famotidine is used to treat excessive secretion of stomach acid or stomach ulcers.
Nov. 2025Pharmacy Updates

Medicaid provider update: High-cost Medicaid drug billing

Billing requirements for Medicaid-covered drugs
Nov. 2025Important Notices

Training Webinar: Conversio Health COPD Management Program

Please join us for a live training webinar for primary care providers and pulmonologists by UPMC Health Plan that will provide an overview of a comprehensive COPD management program from Conversio Health.
Nov. 2025Education/Webinars