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Medicare Prescription Coverage

Prescription Drug Coverage

UPMC for Life Complete Care Part D Prescription Drug Coverage

Make sure your prescription drugs are covered. UPMC for Life covers thousands of brand-name and generic medications. These drugs are reviewed and approved by UPMC physicians, community pharmacists, and Medicare.

All UPMC Medicare Special Needs Plans combine medical and Part D prescription drug coverage. 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 Formularies

UPMC for Life has two Part D prescription drug formularies. A formulary is a list of covered drugs for your plan. The name of the formulary and the plans that use it are important for you to know when reviewing your prescription drug coverage. Drug coverage is different between these formularies, so it's good to make sure you review the formulary for your plan in detail.





Here are two easy ways to make sure your medications are covered:

  • Search covered drugs (search our drug list by the name of the drug you are taking).
  • Download a formulary (download the formulary for your plan using the drop down above).

Each formulary has five levels of drug benefits. These levels are referred to as drug tiers. Learn about our drug tiers below, along with benefits that can help you save money on covered prescription drugs.

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.



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).

UPMC for Life drug tiers

  1. Preferred Generic
  2. Generic
  3. Preferred Brand
  4. Non-Preferred Drug
  5. Specialty

$0 preferred generic medications

We’ve added even more medications to our $0 preferred generic list. These prescriptions have a $0 copay when filled at preferred pharmacies. Preferred generic (Tier 1) $0 copays apply only during the initial coverage stage unless you are enrolled in the HMO Rx (HMO) plan.

Save money on generic medications in the donut hole (Tier 1 and 2)

UPMC for Life HMO Rx (HMO) plan members have additional coverage through the Medicare Part D coverage gap, otherwise known as the “donut hole.” Members in this plan pay the same copays for generic medications on Tiers 1 and 2 in the Part D initial coverage and coverage gap donut hole stages. That means members will not pay more in the donut hole.

Learn more about Tier 1 and 2 coverage through the donut hole.

Save money on diabetes medications

Many UPMC for Life plans offer copays as low as $10 for covered brand-name, non-insulin diabetes medications during the initial coverage stage. Plus, many UPMC for Life members have coverage through the “donut hole” for covered insulins! Your copay for covered insulin is the same during the initial coverage and coverage gap donut hole stages. This means you will not pay more in the donut hole for your insulin, which can save you hundreds!

Learn more about cost savings for members with diabetes.

Members who receive Low Income Subsidy (Extra Help paying for Part D prescriptions) do not have reduced copays or insulin costs. These benefits do not apply to all plans. See your plan formulary for more information.

Take advantage of preferred pharmacies

Members can fill prescriptions at any in-network pharmacy of their choice and can have low copays when filling at one of our preferred retail or mail-order pharmacies. Some preferred retail pharmacy locations include Giant Eagle, Rite Aid, Sam’s Club, Walgreens, Walmart, and Weis. Search for a preferred pharmacy near you.

With Express Scripts, our preferred mail-order pharmacy, you can have your prescriptions delivered right to your door! Simply ask your doctor to send your prescription to Express Scripts or call 1-877-787-6279 (TTY: 1-800-899-2114) 24 hours a day, 7 days a week.

Make sure to use your UPMC for Life member ID card when filling medications to be sure you get the lowest copays available.

Prior Authorization Requirements

Some of the drugs that UPMC for Life covers may require you and your doctor to get prior approval. Select your plan to see a list of which drugs require prior authorization.



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.



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. Select your plan below to see which drugs require step therapy.



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.



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

The document below contains a list of drugs that require Part B Step Therapy.
2023 Drugs requiring Part B Step Therapy
2022 Drugs requiring Part B Step Therapy

Get help with medication costs

If you have limited income, you may qualify for extra help to pay for your prescription drugs. Many people are eligible for these savings and don't even know it. Choose your county in the dropdown below to get details about low-income subsidies in your area. Then click the purple button below to view the Low-Income Subsidy Premium Summary Table.

2023 Low Income Subsidy Premium Summary Table
2022 Low Income Subsidy Premium Summary Table

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.

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.

Next Steps

Shop for Medicare Plans

Find a UPMC for Life Medicare plan that best fits your needs. You can compare and sort plans here.

Request a Free Information Kit

Request a free information kit to learn about UPMC for Life plans and coverage options.

Contact Us

We can answer your questions and help you choose a Medicare plan that's right for you.

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. © 2021 Tivity Health Inc. All rights reserved.
UPMC for Life Complete Care (HMO SNP) Members
Call us toll-free: 1-800-606-8648
TTY: 711

24 hours a day, 7 days a week

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: 10/01/2022
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