Biosimilar Medication Formulary Updates

Sep. 2025Pharmacy Updates

Updates to formulary biosimilar medications for denosumab, eculizumab, and ustekinumab products

In ongoing efforts to improve the value and affordability of health care benefits for our members, UPMC Health Plan has implemented biosimilar medication formulary updates for denosumab, eculizumab, and ustekinumab products. Effective dates for these changes are as follows.

  • UPMC for Life (Medicare/Special Needs Plan):
    • Part D formularies effective Sept. 1, 2025
    • Part B policies effective Sept. 10, 2025
  • UPMC Health Plan (Commercial/Exchange) and UPMC for Kids (CHIP): Formularies effective Oct. 1, 2025
  • UPMC for You and UPMC CHC: Effective Oct. 1, 2025

For full details on these changes, please refer to pages 18-19 in the September 2025 edition of Provider Partner Update.

Recent Announcements

Community Care Behavioral Health is excited to announce this free upcoming web-based training opportunity:

A growing body of U.S. and international research demonstrates that the rapid legalization and commercialization of gambling—including online casinos and mobile sports betting platforms—are associated with significant and escalating gambling related harm. Although Pennsylvania specific prevalence data remain limited, available evidence is increasingly concerning, with gambling disorder linked to alarmingly high rates of suicide, psychiatric comorbidity, and social and financial harm. Drawing on lessons from the tobacco and opioid crises, this presentation will examine how delayed recognition and regulation can amplify population level harm, underscoring the need for earlier screening, prevention, and policy engagement. Participants will gain practical guidance on identifying patients at elevated risk, implementing evidence informed screening and diagnostic strategies, and applying current treatment approaches across the lifespan.
May 2026Education/Webinars

Bridging Smiles and Systems: Collaborative Care for Children with Chronic Conditions

Please join us for a live, CME-accredited and CEU-accredited webinar on May 13 from noon to 1p.m., that will explore the critical connection between oral health and pediatric chronic conditions such as diabetes, asthma, congenital heart disease, and ADHD.
Apr. 2026Education/Webinars

Certified Community Health Worker (CCHW) Provider Billing Notification

UPMC for You will now reimburse for up to three certified community health worker (CCHW) visits per member per calendar year for Medicaid recipients, per the Pennsylvania Department of Human Services (PA DHS).
Apr. 2026Important Notices