October 2025 UPMC for You and UPMC Community HealthChoices Formulary Update

Sep. 2025Pharmacy Updates

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.

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.

Recent Announcements

Voluntary nationwide recall: Ocaliva (Intercept – September)

Intercept Pharmaceuticals, Inc. is voluntarily withdrawing Ocaliva® (obeticholic acid) from the market. Ocaliva is used to treat a rare liver disease called primary biliary cholangitis (PBC).
Oct. 2025Pharmacy Updates

HelpScript service helps patients enroll in manufacturer copay assistance programs

End-to-end provider support helps ensure a smooth submission process
Oct. 2025Important Notices

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