UPMC for Life covers thousands of brand-name and generic medications. These drugs are reviewed and approved by UPMC physicians, community pharmacists, and Medicare.
For 2026, the UPMC for Life Complete Care formulary will have five levels of drug benefits, also referred to as drug tiers. See more information about drug tiers below. .
Jump to a section:
UPMC for Life drug tiers
The UPMC for Life Complete Care formulary has five levels of drug benefits for 2026. These levels are referred to as drug tiers. Tier 1 and Tier 2 drugs have a $0 copay, while drugs on Tiers 3, 4, and 5 may have a copay, depending on the level of Extra Help you receive.
- Preferred Generic
- Generic
- Preferred Brand
- Non-Preferred Drug
- Specialty
Tier | UPMC for Life Complete Care Copay |
---|---|
Tier 1: Preferred Generic |
$0 |
Tier 3: Preferred Brand |
Depending on the level of Extra Help you receive: |
Prescription drug formulary
The link below will allow you to see the UPMC for Life Complete Care (HMO D-SNP) prescription drug formulary. A formulary is a list of prescription drugs covered by your plan.
2025 UPMC for Life Complete Care prescription drug formulary
Last updated 8/29/2025
2026 UPMC for Life Complete Care prescription drug formulary
Last updated 10/1/2025
Language Assistance (PDF)
Last updated 10/1/2025
Two easy ways to make sure your medications are covered:
- Download the formulary using the link above.
- Search covered drugs (search our drug list by the name of the drug you are taking).
Top 200 drug list
Our top 200 drug list includes the most commonly used prescription drugs for members in our UPMC for Life plans along with their drug tiers.
UPMC for Life 2025 top 200 drug list
UPMC for Life 2026 top 200 drug list
This is not a complete list of the drugs we cover. See your plan formulary for a complete list.
Prior authorization requirements
Some of the drugs that UPMC for Life covers may require you and your doctor to get prior approval from UPMC for Life. The document below will advise you of which drugs require prior authorization.
2025 Prior Authorization Requirements
Last updated 8/29/2025
2026 Prior Authorization Requirements
Last updated 10/1/2025
Step therapy requirements
In some cases you may need to first try certain drugs to treat a medical problem before we will cover another drug. The document below will advise you of which drugs require step therapy.
2025 Step Therapy Requirements
Last updated 8/29/2025
2026 Step Therapy Requirements
Last updated 10/1/2025
Quantity limits
For certain prescription drugs, our plan limits the amount of the drug that we will cover. Prescription drugs with quantity limits are listed in your plan’s comprehensive formulary (list of covered drugs). To see if any of your prescription drugs have a quantity limit, select your plan’s comprehensive formulary above and check for "QL" next to the drug name under Requirements/Limits.
Part B drugs and supplies
The document below contains a list of select Part B drugs that UPMC for Life covers.
Covered Select Part B Drugs and Supplies
Last updated 9/2/2025
The document below contains a list of drugs that require Part B step therapy.
2025 Drugs and Products Requiring Part B Step Therapy or Prior Authorization
Last updated 9/12/2025
2026 Drugs and Products Requiring Part B Step Therapy or Prior Authorization
Last updated 10/1/2025
Get help with medication costs
All UPMC for Life Complete Care members have a $0 copay for covered Tier 1 and Tier 2 prescription drugs filled at a participating pharmacy. Drugs on Tiers 3, 4, and 5 may have a copay, depending on the level of Extra Help you receive. You can save money on medications no matter the level of Extra Help (Low-Income Subsidy) you receive. This benefit applies to all phases of prescription drug coverage.
2025 Low-Income Subsidy Premium Summary Table
Last updated 10/1/2024
Tabla Resumen de Primas de Subsidios para Personas de Bajos Ingresos de 2025
Last updated 12/10/2024
2026 Low-Income Subsidy Premium Summary Table
Last updated 10/1/2025
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 8 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.
- Medicare may not have the correct income information to give UPMC for Life at the time a person is applying for help. The Best Available Evidence policy helps plans review costs for those members.
Medication therapy management (MTM) program
UPMC Health Plan has developed a unique medication therapy management program for members who take many medications and meet certain criteria.
Use the links below to learn more:
This information is available for free in other languages. Please call our customer service number at 1-800-606-8648 (TTY: 711).
UPMC for Life has a contract with Medicare to provide HMO, HMO D-SNP, and PPO plans. The HMO D-SNP plans have a contract with the PA State Medical Assistance program. Enrollment in UPMC for Life depends on contract renewal. UPMC for Life is a product of and operated by UPMC Health Plan Inc., UPMC Health Network Inc., UPMC Health Benefits Inc., UPMC for You Inc., and UPMC Health Coverage Inc.
SilverSneakers is a registered trademark of Tivity Health Inc. SilverSneakers GO is a trademark of Tivity Health Inc. © 2025 Tivity Health Inc. All rights reserved.
UPMC for Life Complete Care (HMO D-SNP) members
Call us: 1-800-606-8648
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.
UPMC for Life Complete Care prospective members
Call us: 1-844-575-8241
TTY: 711
Oct. 1 – March 31:
Seven days a week from 8 a.m. to 8 p.m.
April. 1 – July 31:
Monday through Friday from 8 a.m. to 8 p.m.
Aug. 1 – Sept. 30:
Monday through Friday from 8 a.m. to 8 p.m. Saturday from 9 a.m. to 3 p.m.
Y0069_260015
Last Updated: 10/1/2025