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.
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.