Coming soon: Formulary updates effective Jan. 1, 2025

Jan. 2025Important Notices

Please review updated information for the prescription drugs covered under each plan.

UPMC Health Plan Commercial plans

UPMC for Life Medicare and SNP plans

View UPMC for Life formulary updates:

IVIG/SCIG preferred products
Effective Jan. 1, 2025, certain intravenous immune globulin (IVIG) and subcutaneous immune globulin (SCIG) products that are preferred in 2024 will move to nonpreferred for all UPMC lines of business. All products currently require prior authorization in 2024, which will continue in 2025 regardless of status. However, members currently on nonpreferred products will not need updated authorizations when switching to preferred products in 2025. Please reference upmchp.us/PreferredImmuneGlobulins for preferred and nonpreferred products.

IV oncology prior authorization
Effective Jan. 1, 2025, select medically administered oncology products will require a prior authorization for all UPMC lines of business and drug formularies. The prior authorization applies only to new starts to therapy. The criteria for approval include that the requested drug is used for a medically accepted indication, prescribed by or in consultation with a specialist, and used for a dose and duration consistent with FDA-approved labeling or clinical literature. Please refer to products that will newly require prior authorization as of Jan. 1, 2025: upmchp.us/IVoncologyPA

Exception request options
Requests for exceptions can be submitted to Pharmacy Services by one of the following methods:

Recent Announcements

February 2026 UPMC for You and UPMC Community HealthChoices formulary update

Pulmicort Flexhaler has a new distributor, Rubicon Holding. National Drug Codes (NDCs) for Pulmicort Flexhaler from Rubicon Holding are not included in the Medicaid Drug Rebate program and are not covered under the Medicaid Prescription Drug Program. Pulmicort Flexhaler NDCs from the previous manufacturer, H2 Pharma, have been discontinued but may be billed/dispensed until supplies are exhausted.
Feb. 2026Pharmacy Updates

CME Webinar: American Foundation for Suicide Prevention’s ‘Talk Saves Lives’ Program

Please join us on Tuesday, April 28, from noon to 1 p.m. for “Talk Saves Lives: An Introduction to Suicide Prevention.” This live, CME-accredited webinar is the American Foundation for Suicide Prevention’s flagship suicide prevention education program. It covers the scope of this leading cause of death, warning signs and risk factors for suicide, and strategies to prevent it.
Feb. 2026Education/Webinars

Training Webinar: Conversio Health COPD Management Program

Please join us for a live training webinar by UPMC Health Plan that will provide an overview of a comprehensive COPD management program from Conversio Health.
Jan. 2026Education/Webinars