UPMC Health Plan uses Interqual® criteria sets for prior authorizations
May 2024Education/Webinars
UPMC for Life Medicare Advantage credentialed providers may use the UPMC Health Plan Self-Registration Transparency Tool for additional information.
Recent Announcements
October 2025 UPMC for You and UPMC Community HealthChoices formulary update
Effective Oct. 1, 2025, Xifaxan and Retin-A (cream, gel) will no longer be covered by UPMC for You and UPMC Community HealthChoices due to nonparticipation in the Medicaid Drug Rebate Program.Oct. 2025Pharmacy Updates
Voluntary nationwide recall: Ocaliva (Intercept – September)
Intercept Pharmaceuticals, Inc. is voluntarily withdrawing Ocaliva® (obeticholic acid) from the market. Ocaliva is used to treat a rare liver disease called primary biliary cholangitis (PBC).Oct. 2025Pharmacy Updates
HelpScript service helps patients enroll in manufacturer copay assistance programs
End-to-end provider support helps ensure a smooth submission processOct. 2025Important Notices