Western PA/Susquehanna Member Guide

18 Covered prescription drugs UPMC for Life covered drug list Taking your prescriptions as directed by your doctor is important. UPMC for Life wants to make it as easy and affordable as possible for you to get the medications you need and to follow your doctor’s plan of care. That’s why UPMC for Life works with community doctors and pharmacists to maintain a list of drugs that are covered by our plan. This list is called a formulary. Each drug on our formulary is selected by the plan based on the drug’s safety, effectiveness, and cost. We also review and update the formulary regularly during the year. For the most current list of drugs our plan covers, visit upmchp.us/prescription-coverage. The HMO Premier Rx plan has a different drug list from our other plans. Check the correct formulary to make sure your medications are covered. Restrictions on coverage for some drugs Special rules limit how and when the plan covers certain prescription drugs. A team of doctors and pharmacists developed these rules to help our members access drugs in the most effective way. These rules are approved by the Centers for Medicare & Medicaid Services (CMS). They also help control drug costs, which keeps your coverage more affordable. If there is a restriction for a drug that you are taking, such as a quantity limit, step therapy, or prior authorization, you or your providers must take additional steps for us to cover the drug. If a drug you are taking is not on our formulary, you can ask us to decide whether to add it. This decision takes the form of a coverage determination, redetermination, or appeal for a Part D prescription drug. You can fill out a request form on our website at upmchealthplan.com/medicare. Click on the Additional Documents & Forms link at the top of the page. You can also call your Health Care Concierge team to receive a copy of the request form in the mail. We can help you keep your medications organized Request a pillbox. We have FREE pillboxes available for our UPMC for Life members. Call your Health Care Concierge team to request yours today! Automatic refills. Ask your pharmacist to sign you up for automatic refills. This free program (at participating pharmacies) allows the pharmacy to fill your medications when they are due. You will get a call or text message when it’s time to pick them up. Medication packaging. If you take many prescriptions, you may be able to get your medications organized, packaged, and mailed to you. Medication packaging can help you make sure you’re taking your prescriptions the right way. We have preferred pharmacies in our network that offer this service at no cost to you. To find out if you are eligible for medication packaging, call your Health Care Concierge team. Review your prescriptions with a pharmacist from the safety of home Need help sorting through your medications? Or just have a few questions you’d like to ask an expert? We can help. Starting Jan. 1, you can schedule an online video appointment with a licensed pharmacist through the UPMC AnywhereCare app. Your pharmacist will go over each of your medications and answer any questions you may have face-to- face with you. To use UPMC AnywhereCare, you just need access to a smartphone, tablet, or computer that can show video and has a microphone. Ready to schedule your appointment? Download the UPMC AnywhereCare app from Google Play or the Apple App Store. If your computer has a camera and microphone, you can use your desktop or laptop by going to UPMCAnywhereCare.com. Log in or sign up for an account and schedule your appointment today! For questions or help using UPMC AnywhereCare, you can call our support line 24/7 at 1-833-716-8447 (TTY: 711).