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

August 2026 UPMC for You and UPMC Community HealthChoices Formulary Updates

Effective Aug. 15, 2026, UPMC for You and UPMC Community HealthChoices are updating their formularies.
Jul. 2026Pharmacy Updates

Give feedback on your experience with UPMC Health Plan

 You may be invited to participate in a 2026 Press Ganey provider satisfaction survey, which will begin next month. This survey will be given to a random sampling of in-network primary care providers.
Jul. 2026Important Notices

Prescription for Wellness - Leveraging Insurance Carrier Resources to Optimize Patient Engagement Outcomes!

Prescription for Wellness is a nationally recognized, Six Sigma-developed best practice system that provides a convenient and effective way for providers to prescribe resources and support offered by UPMC Health Plan to their patients who are UPMC Health Plan members.
Jul. 2026Education/Webinars