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Medicare Prescription Coverage

UPMC for Life Part D Prescription Drug Coverage

UPMC for Life offers many plan options that combine medical and Part D prescription drug coverage. All plans that include Part D prescription drug coverage have five levels of drug benefits. These levels are referred to in our prescription drug list (formulary) as Drug Tier Numbers. Learn about our Drug Tier Numbers below, along with benefits that can help our members save money on covered prescription drugs.

UPMC for Life Drug Tiers

  1. Preferred Generic
  2. Generic
  3. Preferred Brand
  4. Non-Preferred (generic and brand drugs)
  5. Specialty

$0 preferred generic prescriptions

We’ve added even more medications to our $0 preferred generic list. These prescriptions have a $0 copay when filled at a preferred pharmacy or through mail order.*

See a complete list of preferred generic drugs for HMO and PPO Rx plans:
2021 HMO and PPO Rx Preferred Generics

See a complete list of preferred generic drugs for our HMO Premier Rx (HMO) plans.
2021 HMO Premier Rx (HMO) Preferred Generics

Save money on covered diabetes medications and insulin

Members can save money on covered brand-name diabetes medications that help to lower blood sugar. Copays are as low as $10!** Plus, starting Jan. 1, 2021, members can save hundreds of dollars when filling diabetic insulin medications in the Part D Coverage Gap, otherwise known as the “donut hole.”

Learn more about benefits and cost-saving opportunities for members with diabetes.

Additional “donut hole” coverage for generic Tier 1 and 2 drugs

New! Starting Jan. 1, 2021, members enrolled in the UPMC for Life HMO Rx (HMO) plan will have additional coverage for generic Tier 1 and 2 drugs through the Medicare Part D Coverage Gap, otherwise known as the “donut hole.” You pay the same copays in the Part D Initial Coverage and Coverage Gap donut hole stages. That means you will not pay more in the donut hole.

Learn more about HMO Rx prescription drug coverage through the donut hole.

New! Ask a Pharmacist

Need help sorting through your medications, or just have a few questions you’d like to ask an expert? You can schedule a free video visit with one of our licensed pharmacists through UPMC AnywhereCare.

Learn more and schedule your appointment now

Make sure your prescription drugs are covered

The UPMC for Life Part D prescription drug list includes thousands of brand-name and generic medications. These drugs have been approved for coverage by UPMC Health Plan. They are also reviewed and approved by UPMC physicians, community pharmacists, and Medicare.

You can check our prescription drug list to make sure your medications are covered:

Compare and view details about our medical and prescription drug coverage plans.

Brand-name drugs are capitalized. Generic drugs are listed in lowercase italics. Some generic drugs may be categorized in a preferred brand or non-preferred drug tier. Make sure to check the Drug Tier Number listed next to the drug to understand the drug’s copays and costs.

Learn about how our Part D prescription drug coverage is important to UPMC for Life member Ruth:

Pharmacies in all the right places

You can fill prescriptions at your local pharmacy or through our mail-order program, making it easier to take your medications on time. Take advantage of thousands of national and regional pharmacies. You’ll pay less for prescriptions filled at one of our preferred pharmacies or through mail order. A preferred pharmacy is a pharmacy that has agreed to offer preferred cost sharing (our lowest copays) for covered prescription drugs. Here are just some of our preferred pharmacy locations: Giant Eagle, Rite Aid, Sam’s Club, Walgreens, and Walmart. Search for a preferred pharmacy near you.

Drugs can be filled for 30-day or 90-day supplies. If you’re filling a 90-day maintenance prescription, you can save money at our mail-order pharmacy. Your out-of-pocket cost for preferred generic, generic, and preferred brand drugs will be lower than purchasing three 30-day supplies at a standard pharmacy. Our mail-order pharmacy will even mail medications directly to you.

Help for prescription drug costs

People with limited incomes may qualify for extra help to pay for their prescription drugs. Many people are eligible for these savings and don't even know it. Please select the area where you live to get information about low-income subsidies.



Low Income Subsidy Premium Summary Table
Low Income Subsidy Premium Summary Table
Low Income Subsidy Premium Summary Table
Low Income Subsidy Premium Summary Table
Low Income Subsidy Premium Summary Table
Low Income Subsidy Premium Summary Table
Low Income Subsidy Premium Summary Table
Low Income Subsidy Premium Summary Table
Low Income Subsidy Premium Summary Table
Low Income Subsidy Premium Summary Table
Low Income Subsidy Premium Summary Table
Low Income Subsidy Premium Summary Table

Sign up for extra help at socialsecurity.gov for paying for your prescription drugs.
How do I ask about my LIS status or level?


 

Next Steps

Shop for Medicare Plans

Find a UPMC for Life Medicare plan that best fits your needs. You can compare and sort plans here.

Request a Free Enrollment Kit

Request a free enrollment kit to learn about UPMC for Life plans and coverage options.

Contact Us

We can answer your questions and help you choose a Medicare plan that's right for you.

*The preferred generic (Tier 1) $0 copay applies only during the Initial Coverage Stage unless you are enrolled in the HMO Rx (HMO) plan.

**These copays apply only to the Initial Coverage Stage. Members who receive Low Income Subsidy (Extra Help paying for Part D prescriptions) will not have reduced copays. This benefit does not apply to the HMO No Rx (HMO) plan, the HMO Premier Rx (HMO) plan, and some employer group plans. See your plan formulary for more information.

This information is not a complete description of benefits. Call 1-866-400-5077 (TTY: 711) for more information. Out-of-network/noncontracted providers are under no obligation to treat UPMC for Life members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services. Other physicians/providers are available in the UPMC for Life network.

This information is available for free in other languages. Please call our customer service number at 1-877-539-3080 (TTY: 711).

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.

SilverSneakers is a registered trademark of Tivity Health Inc. SilverSneakers GO is a trademark of Tivity Health Inc. © 2021 Tivity Health Inc. All rights reserved.
UPMC for Life Members
Call us toll-free: 1-877-539-3080
TTY: 711

Oct. 1 through March 31:
seven days a week from 8 a.m. to 8 p.m.

April 1 through Sept. 30:
Monday through Friday: 8 a.m. to 8 p.m.
Saturday: 8 a.m. to 3 p.m.

UPMC for Life Prospective Members
Call us toll-free: 1-866-400-5077
TTY: 711

Oct. 1 through Dec. 31:
seven days a week from 8 a.m. to 8 p.m.

Jan. 1 through Sept. 30:
Monday through Friday: 8 a.m. to 8 p.m.
Saturday: 9 a.m. to 3 p.m.

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Last Updated: 10/01/2020
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