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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.

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.



Here are two easy ways to make sure your medications are covered:

  • Search covered drugs (search our drug list by the name of the drug you are taking).
  • Download a formulary (download the formulary for your plan using the drop down above).

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.

UPMC for Life drug tiers

  1. Preferred Generic
  2. Generic
  3. Preferred Brand
  4. Nonpreferred
  5. Specialty

$0 preferred generic medications

We’ve added even more medications to our $0 preferred generic list. These prescriptions have a $0 copay when filled at preferred pharmacies. Preferred generic (Tier 1) $0 copays apply only during the initial coverage stage unless you are enrolled in the HMO Rx (HMO) plan.

Save money on covered diabetes medications and insulin

Many UPMC for Life plans offer copays as low as $10 for covered brand-name, non-insulin diabetes medications. Lower copays for non-insulin brand-name diabetic medications (Tier 2) apply only to the initial coverage stage and do not apply to the HMO No Rx (HMO) and HMO Salute (HMO) plans and plans that use Formulary 1. Members who receive Low Income Subsidy (Extra Help paying for Part D prescriptions) will not have reduced copays or reduced insulin costs. These benefits do not apply to all plans. See your plan formulary for more information.

Plus, UPMC for Life members have coverage through the “donut hole” for covered insulins! Your copay for covered insulin is the same during the initial coverage and coverage gap donut hole stages. This means you will not pay more in the donut hole, which can save you hundreds! This coverage applies only to the initial coverage and coverage gap stages. 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 and some employer group plans. See your plan formulary for more information.

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

Save money on generic medications in the donut hole (Tier 1 and 2)

UPMC for Life HMO Rx (HMO) plan members have additional coverage through the Medicare Part D coverage gap, otherwise known as the “donut hole.” Members in this plan pay the same copays for generic medications on Tiers 1 and 2 in the Part D initial coverage and coverage gap donut hole stages. That means members will not pay more in the donut hole.

Learn more about Tier 1 and 2 coverage through the donut hole.

Ask a pharmacist program

Need help sorting through your medications, or just have a few questions you’d like to ask an expert? UPMC for Life members can schedule a free video appointment with one of our licensed pharmacists through UPMC AnywhereCare. All you need is access to a smartphone, tablet, or computer with a camera and microphone!

Learn more and schedule your appointment.

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

Take advantage of preferred pharmacies

Members can fill prescriptions at any participating pharmacy of their choice and can get low copays when filling at one of our preferred retail or mail-order pharmacies. Some preferred retail pharmacy locations include Giant Eagle, Rite Aid, Sam’s Club, Walgreens, Walmart, and Weis. Search for a preferred pharmacy near you.

With Express Scripts, our preferred mail-order pharmacy, you can have your prescriptions delivered right to your door! Simply ask your doctor to send your prescription to Express Scripts or call 1-877-787-6279 (TTY: 1-800-899-2114) 24 hours a day, 7 days a week.

Make sure to use your UPMC for Life member ID card when filling medications to be sure you get the lowest copays available.

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. Choose your county in the dropdown below to get details about low-income subsidies in your area. Then click the purple button below to view the 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

Low Income Subsidy Premium Summary Table (Español)
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

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 7 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.
 

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 Information Kit

Request a free information 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.

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.

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UPMC for Life Members
Call us toll-free: 1-877-539-3080
TTY: 711

Oct. 1 – March 31:
Seven days a week from 8 a.m. to 8 p.m.

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

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

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Last Updated: 10/01/2021