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

UPMC Dental Advantage celebrates 15-years of growth

From pilot program to now serving all product lines
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Provider Directory Updates and Required Attestation

As you know, UPMC Health Plan requires all providers to verify their provider directory information at least every 90 days (quarterly).
Jan. 2026Important Notices

Important: Expedited appeals fax requirement

Please remember that you must adhere to the designated process for submitting expedited appeals to have them processed in a timely manner. Follow these guidelines to help you successfully submit expedited appeals:
Jan. 2026Important Notices