UPMC for Life members may ask for a coverage determination or redetermination (appeal) for a Part D prescription drug. Use the links below to learn more.

Determination/Exception Request

Members can request a coverage determination/exception by completing and signing the form below. It can be mailed or faxed to UPMC Health Plan. You may also call our Member Services Department to file an appeal, get information about this process, check on the status of a request, or obtain an aggregate number of appeals, grievances, and exceptions for our plan. Please contact us by:

Phone: UPMC for Life HMO/PPO members can call our Member Services Department at 1-877-539-3080 (TTY: 711). UPMC for Life Complete Care (HMO D-SNP) members can call 1-800-606-8648 (TTY: 711). From Oct. 1 – March 31, we are available seven days a week from 8 a.m. to 8 p.m. From April 1 – Sept. 30, we are available Monday through Friday from 8 a.m. to 8 p.m.
Fax: 412-454-7722
Mail: UPMC Health Plan Pharmacy Department
U.S. Steel Tower, 12th Floor
600 Grant Street
Pittsburgh, PA 15219

UPMC for Life Prescription Drug Coverage Determination/Exception Request Form, last updated 4/17/2025

Language Assistance

If you would like to appoint a person to act on behalf of the member, please visit our Appointment of Representative page for more information.

Redetermination (Appeal) Request

Members can request a redetermination (appeal) by completing and signing one of the forms below. It can be mailed or faxed to UPMC Health Plan. You may also call our Member Services Department to file an appeal, get information about this process, check on the status of a request, or obtain an aggregate number of appeals, grievances, and exceptions for our plan. Please contact us by:

Phone: UPMC for Life HMO/PPO members can call our Member Services Department at 1-877-539-3080 (TTY: 711). UPMC for Life Complete Care (HMO D-SNP) members can call 1-800-606-8648. From Oct. 1 – March 31, we are available seven days a week from 8 a.m. to 8 p.m. From April 1 – Sept. 30, we are available Monday through Friday from 8 a.m. to 8 p.m.
Fax: 412-454-7920
Mail: UPMC Health Plan
ATTN: Appeals and Grievances
PO Box 2939
Pittsburgh, PA 15230-2939

UPMC for Life Medicare Prescription Drug Coverage Redetermination Request Form, last updated 4/25/2025

Language Assistance

If you would like to appoint a person to act on behalf of the member, please visit our Appointment of Representative page for more information.

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