Prescription Drug Coverage

UPMC for Life Complete Care Part D Prescription Drug Coverage

All UPMC for Life Complete Care members have a $0 copay for covered Part D prescription drugs filled at a participating pharmacy. UPMC for Life covers thousands of brand-name and generic medications. These drugs are reviewed and approved by UPMC physicians, community pharmacists, and Medicare.

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Prescription drug formulary

The link below will allow you to see the UPMC for Life Complete Care (HMO SNP) prescription drug formulary. A formulary is a list of prescription drugs covered by your plan.

2024 UPMC for Life Complete Care prescription drug formulary
Last updated 6/3/2024

Language Assistance (PDF)
Last updated 1/19/2023 

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 2024 top 200 drug list

This is not a complete list of the drugs we cover. See your plan formulary for a complete list.

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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.

2024 Prior Authorization Requirements
Last updated 6/3/2024

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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.

2024 Step Therapy Requirements
Last updated 6/3/2024

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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.

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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 12/22/2020


The document below contains a list of drugs that require Part B Step Therapy.
2024 Drugs and Products Requiring Part B Step Therapy or Prior Authorization, Last updated 6/3/2024

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Get help with medication costs

All UPMC for Life Complete Care members have a $0 copay for covered prescription drugs filled at a participating pharmacy. 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.

2024 Low Income Subsidy Premium Summary Table, Last updated 10/1/2023

Language assistance
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.

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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:

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This information is not a complete description of benefits. Call 1-844-575-8241 (TTY: 711) for more information.

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 SNP, and PPO plans. The HMO 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., and UPMC Health Coverage Inc.

SilverSneakers is a registered trademark of Tivity Health Inc. SilverSneakers GO is a trademark of Tivity Health Inc. © 2023 Tivity Health Inc. All rights reserved.
UPMC for Life Complete Care (HMO D-SNP) members
Call us toll-free: 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., Saturday from 8 a.m. to 3 p.m.

UPMC for Life Complete Care prospective members
Call us toll-free: 1-844-575-8241
TTY: 711

Jan. 1 – Sept. 30:
Seven days a week from 8 a.m. to 8 p.m.

Oct. 1 – Dec. 31:
Seven days a week from 7 a.m. to 9 p.m.
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Last Updated: 1/02/2024