2022 Lycoming Tioga MA Kit

Some drugs have special rules for coverage. To see if your drug has special rules for coverage, use our searchable prescription drug tool at upmchp.us/prescription-coverage or call us at the phone number on the first page of this drug list. Talk to your doctor to decide if you should switch to another drug that we cover or make a coverage request. UPMC for Life has a contract with Medicare to provide HMO, HMO SNP, and PPO plans. The HMO SNP plans have a contract with the PA State Medical Assistance program. Enrollment in UPMC for Life depends on contract renewal. V valacyclovir oral tablet T3 T3 valsartan oral tablet T1 T1 valsartan- hydrochlorothiazide oral tablet T1 T1 venlafaxine oral capsule, extended release 24hr T2 T2 VENTOLIN HFA AEROSOL INHALER T3 T3 verapamil oral tablet extended release T2 T1 W warfarin oral tablet T2 T1 X XARELTO ORAL TABLET T3 T3 XIIDRA OPHTHALMIC (EYE) DROPPERETTE T3 T3 Z zolpidem oral tablet T2 T2 Y0069_221003_C Copyright 2021 UPMC Health Plan Inc.All rights reserved. 2022_SUSQPRMDRUGLIST_21MCID1921 (RT) 9/7/21 Drug List 19