Medicare Prescription Coverage

UPMC for Life Part D Prescription Drug Coverage

Make sure your prescription drugs are covered. UPMC for Life covers thousands of brand-name and generic medications. These drugs are reviewed and approved by UPMC physicians, community pharmacists, and Medicare.

Jump to a section:

• Prescription Drug Formularies
• Drug tiers
• Top 200 drug list
• Annual limit of $2,000 for prescription drug costs
• $0 copay for Tier 1 and 2 medications at preferred pharmacies
• Insulin medications
• Preferred pharmacies
• Prior authorization requirements
• Step therapy
• Quantity limits
• Part B drugs and supplies
• Medicare Prescription Payment Plan
• Help with medication costs
• Medication Therapy Management (MTM) program

Prescription Drug Formularies

UPMC for Life has two Part D prescription drug formularies. A formulary is a list of covered drugs for your plan. The name of the formulary and the plans that use it are important for you to know when reviewing your prescription drug coverage. Drug coverage is different between these formularies, so it's good to make sure you review the formulary for your plan in detail.

Each formulary has five levels of drug benefits. These levels are referred to as drug tiers. Learn about our drug tiers below, along with benefits that can help you save money on covered prescription drugs.

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UPMC for Life drug tiers

1. Preferred Generic
2. Generic
3. Preferred Brand
4. Non-Preferred Drug
5. Specialty

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Top 200 drug list

Our top 200 drug list includes the most commonly used prescription drugs for members in our UPMC for Life plans along with their drug tiers.
UPMC for Life 2024 top 200 drug list

UPMC for Life 2025 top 200 drug list

This is not a complete list of the drugs we cover. See your plan formulary for a complete list.

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Annual limit of $2,000 for Part D prescription drug costs

As part of the Inflation Reduction Act, there will no longer be a Medicare Part D Coverage Gap (donut hole). Starting Jan. 1, 2025, all Medicare beneficiaries will have a maximum out-of-pocket of $2,000 on Part D prescription drug costs. This means once you meet the $2,000 limit, you will no longer be responsible for paying any out-of-pocket costs for your prescriptions throughout the rest of the year!

Learn more about the 2025 Medicare Part D stages of prescription drug coverage.

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$0 copay for Tier 1 AND 2 medications at preferred pharmacies

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Insulin medications

Covered insulins have a maximum $35 copay for each one-month supply. This means you will not pay more than $35 for a 30-day supply or more than $105 for a 100-day supply during deductible (if applicable) and the initial coverage stages. Once you reach the catastrophic stage, you will no longer pay for your prescriptions. Your Medicare Advantage plan will be responsible for paying your share of the cost for your prescriptions. See your plan Evidence of Coverage for more information.

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Take advantage of preferred pharmacies

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Prior authorization requirements

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Step therapy requirements

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Quantity Limits

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Part B Drugs and Supplies

The document below contains a list of select Part B drugs that UPMC for Life covers.
Covered Select Part B Drugs and Supplies, Last updated 12/22/2020


The document below contains a list of drugs that require Part B Step Therapy.
2024 Drugs and Products Requiring Part B Step Therapy or Prior Authorization, Last updated 8/7/2024

2025 Drugs and Products Requiring Part B Step Therapy or Prior Authorization, Last updated 11/13/2024

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Medicare Prescription Payment Plan

Starting Jan. 1, 2025, Medicare members with high prescription drug costs can get help with their payments through the Medicare Prescription Payment Plan. This new payment option allows you to spread your prescription drug costs across monthly payments throughout the year instead of paying them up front at the pharmacy.

Learn more about the Medicare Prescription Payment Plan.

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Get help with medication costs

If you have limited income, you may qualify for Extra Help to pay for your prescription drugs. Many people are eligible for these savings and don't even know it. See the Low-Income Subsidy Premium Summary Table below to get details about low-income subsidies in your area.

2024 Low Income Subsidy Premium Summary Table, Last updated 10/1/2023
2025 Low Income Subsidy Premium Summary Table, Last updated 10/1/2024

Language assistance

Apply for Extra Help with your medications at socialsecurity.gov

How do I ask about my LIS status or level?

To find out about your LIS status or level, call:

• 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.
• Social Security at 1-800-772-1213 Monday through Friday from 8 a.m. to 7 p.m. TTY users should call 1-877-486-2048.
• Your state Medical Assistance (Medicaid) office. In Pennsylvania the Medicaid program is managed by the Department of Human Services (DHS). In Ohio the Medicaid program is managed by the Department of Medicaid.
• Medicare may not have the correct income information to give UPMC for Life at the time a person is applying for help. The Best Available Evidence policy helps plans review costs for those members.

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Medication Therapy Management (MTM) program

UPMC Health Plan has developed a unique medication therapy management program for members who take many medications and meet certain criteria.

Use the links below to learn more:

• About the program
• Who is eligible for UPMC for Life's medication therapy management program?
• How can I safely dispose of my medications?

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