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

PA DOH Antibiotic Stewardship Resources

Order antibiotic stewardship resources at no cost
Jun. 2026Important Notices

Medical device correction: Omnipod (Insulet – May 2026)

Insulet Corporation Inc. has announced a medical device correction for certain Omnipod Pods. These pods are wearable devices that are used to deliver insulin.
Jun. 2026Pharmacy Updates

Clinical documentation required for medical policy prior authorizations

As you know, UPMC Health Plan requires certain clinical documentation/notes in support of a request for prior authorization for the listed procedures below in accordance with its established policies and procedures, in addition to CMS requirements that medical record documentation must support the medical necessity of the services requested.
Jun. 2026Important Notices