2022 Lycoming Tioga MA Kit

2022 UPMC for Life Top 200 Drug List This is a list of the most used prescription drugs for our UPMC for Life plans. This is not a complete list of the drugs we cover. For a complete drug list: CALL 1-877-381-3765 (TTY: 711) Oct. 1 – Dec. 7 seven days a week from 7 a.m. to 9 p.m. Dec. 8 – Dec. 31 seven days a week from 8 a.m. to 8 p.m. Jan. 1 – Sept. 30 Monday through Friday from 8 a.m. to 8 p.m. Saturday from 9 a.m. to 3 p.m. CLICK Search for your medications using our prescription drug tool at upmchp.us/prescription-coverage. Here are some things you should know about this drug list: • BRAND NAME drugs are CAPITALIZED. • Generic drugs are in lowercase italics. Some generic drugs are in a preferred brand or nonpreferred drug tier. Be sure to check the drug tier listed next to the drug. • Drug tier descriptions: – T1: Tier 1 Preferred generic – T2: Tier 2 Generic – T3: Tier 3 Preferred brand – T4: Tier 4 Nonpreferred – T5: Tier 5 Specialty • Some UPMC for Life plans have a di erent formulary. See the descriptions below to understand which plans are included in each formulary. Formulary 1: The gray-shaded column lists the tier for these UPMC for Life plans: – UPMC for Life HMO Premier Rx (HMO) – UPMC for Life PPO Flex Rx (PPO) Formulary 2: The nonshaded column lists the tier for these UPMC for Life plans: – UPMC for Life HMO Deductible Rx (HMO) – UPMC for Life HMO Rx Choice (HMO) – UPMC for Life HMO Rx (HMO) – UPMC for Life HMO Rx Enhanced (HMO) Drug List 11