Medicare Behavioral Health Benefits and Resources

Affordable prescriptions

Part of behavioral health treatment may include managing depression, anxiety, or other conditions with certain medications. That’s why we cover more than 20 medications used for behavioral health conditions on Tier 1 and 2 of our formularies.

Below are some of the antidepressant medications included on Tier 1 of our UPMC for Life Medicare formularies. You pay $0 when you fill these prescriptions at a preferred pharmacy during the initial coverage phase:

• Citalopram tablet (10 mg, 20 mg, and 40 mg)
• Fluoxetine capsule (10 mg, 20 mg, and 40 mg)
• Sertraline tablet (25 mg, 50 mg, and 100 mg)

Many other commonly used medications for depression and anxiety are on Tier 2 of our Medicare formularies. You pay $10 when you fill a 30-day supply and $20 when you fill a 90-day supply of these medications at a preferred pharmacy during the initial coverage phase. Some examples include:

• Escitalopram tablet (5 mg, 10 mg, and 20 mg)
• Buspirone tablet (5 mg, 10 mg, and 15 mg)

See our complete UPMC for Life formulary based on your plan.

Need help sorting through your medications, or just have a few questions you’d like to ask an expert?

You can schedule a video visit through UPMC AnywhereCare with one of our licensed pharmacists. Our pharmacists can help you understand each of your medications, suggest ways to save money, and answer your questions. They can even talk with your doctor if you are experiencing side effects.

Log in to the app or go to UPMC AnywhereCare to schedule a time that’s convenient for you.

Reduced copays for mental health visits

Members who have a mental health condition and are eligible for Low-Income Subsidy (LIS) have a reduced copay of $15 for each in-network outpatient mental health therapy visit.

This benefit is part of the Special Supplemental Benefits for the Chronically Ill (SSBCI) program. You must meet certain eligibility requirements to qualify for this program.

Access to behavioral health treatment

Our behavioral health coverage includes treatment for the following:

• Emotional difficulties
• Bereavement issues
• Marital or family problems
• Mental health disorders
• Substance abuse or dependence

Get connected with our large network of inpatient and outpatient treatment centers. To find participating providers, visit our find care page, then click Behavioral Health. You can also call 1-888-251-0083 (TTY: 711).

Behavioral health coaching

Members can get one-on-one support from a behavioral health coach for free! Our team of health coaches can help with a variety of concerns such as depression, stress, anxiety, attention-deficit/hyperactivity disorder, substance use, and more. We can help you:

• Better understand your symptoms and know when it’s time to get help.
• Set goals and overcome barriers that may prevent you from reaching those goals.
• Find behavioral health treatment and community resources in your area.

Talk with a licensed behavioral health coach over the phone today. Call UPMC Health Plan Behavioral Health Services toll-free at 1-888-777-8754 (TTY: 711).

Personal care management

Our dedicated personal care managers can help you:

• Connect with the best doctors for your needs and coordinate your care.
• Understand your doctor’s instructions after a visit.
• Contact your doctor’s office if a prescription is not filled or a service is not covered, and let you know ways to save money on your medications.
• Find services you may need in your community.

Members can call us toll-free at 1-855-395-8762 Monday through Friday from 8 a.m. to 4:30 p.m. to get started.

UPMC Resources for Life

Resources for Life is your connection to personal resources for your everyday needs. We can connect you with community resources, legal and financial advice, caregiving, pet sitting, transportation, and more. Plus, take advantage of personal counseling or counseling for your family members or caregivers. Our counselors can help you cope with family and relationship concerns, stress, grief, and other emotional issues. You get six personal sessions per concern per year at no cost*. Your family member or caregiver can also receive six counseling sessions per year.

Call 1-866-441-4395 (TTY: 711) Monday through Friday from 8 a.m. to 5 p.m. to get started. You can also connect with a counselor face-to-face through UPMC AnywhereCare. Just select UPMC Virtual Counseling after you sign up or log in.

RxWell

With the RxWell app, you can get personal support from a live health coach for things like stress, anxiety, depression, weight management, nutrition, physical activity, and tobacco cessation. Your health coach will create a customized plan for you and help you use doctor-recommended activities to reach your health and wellness goals. RxWell is free and easy to use anytime, right from your smartphone.

Get easy-to-use health support from the comfort and safety of home. Download RxWell from your device's app store.

See additional free benefits and resources for members.

*This benefit is administered through UPMC Resources for Life and is a separate benefit from the outpatient mental health benefits provided under your plan, which may require a copay or other cost sharing. Please see your Evidence of Coverage for details.

UPMC for Life members who are in Pennsylvania at the time of a virtual visit may select a UPMC-employed provider, subject to availability and discretion of the provider. Members located outside of Pennsylvania at the time of service will receive care from a provider employed or contracted by Online Care Network II PC (OCN), also known as Amwell Medical Group. OCN is not an affiliate of UPMC. Providers are not available to treat members who are in Puerto Rico.