Coming soon: Formulary updates effective Jan. 1, 2025

Jan. 2025Important Notices

Please review updated information for the prescription drugs covered under each plan.

UPMC Health Plan Commercial plans

UPMC for Life Medicare and SNP plans

View UPMC for Life formulary updates:

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:

Recent Announcements

Virtual Institute: Bridging the Gap: Foundations of Integrated Care CME Courses Available

Bridging the Gap: Foundations of Integrated Healthcare is a free educational series designed to support behavioral health and physical health providers in integrating physical health and wellness strategies into their practices and programs to support recovery of individuals living with serious mental illnesses. The series emphasizes tools, education, and resources that empower healthcare providers and individuals to become informed and effective managers of their health and health care.
Jun. 2026Education/Webinars

Important information regarding Medicare GLP-1 Bridge through CMS

The Centers for Medicare & Medicaid Services (CMS) is expanding access to certain GLP-1 medications through the Medicare GLP-1 Bridge short-term demonstration starting July 1, 2026.
Jun. 2026Important Notices

CME/CEU Webinar: Bright Beginnings: The Role of Medical and Dental Providers in Early Oral Health

Please join us for a live, CME-accredited and CEU-accredited webinar on Monday, Aug. 24 from noon to 1 p.m., that will educate providers on the importance of early childhood oral health.
Jun. 2026Education/Webinars