UPMC Health Plan medical drug coverage updates

Jan. 2025Important Notices

UPMC Health Plan initiated changes to certain medical drug coverage policies for all lines of business on Jan. 1, 2025. Please visit upmchp.us/pharm-services-medical for more information. If you have questions about the changes, call Provider Services at 1-866-918-1595. Thank you for your continued support and for the great care you provide our members.


Recent Announcements

The importance of PRD forms for complex patients and staying updated on changes

Personal representative designation (PRD) forms are critical to the care process for patients and providers alike. Not only do PRDs support accurate, efficient, and compliant patient care—they also streamline administrative processes.
Aug. 2025Important Notices

Important announcement: UPMC Health Plan retires MP.PA.147

This communication is in regards to UPMC Health Plan Policy MP.PA.147 – Diagnostic and Surveillance Colonoscopy, 18 Years Old and Older. UPMC Health Plan previously communicated that the prior authorization requirement under this policy would be paused until Sept. 1, 2025. However, policy MP.PA.147 has been retired, and this policy will no longer be implemented or active.
Aug. 2025Important Notices

CMS expands Medicare Advantage RADV audits to all eligible plans

On May 21, 2025, the Centers for Medicare & Medicaid Services (CMS) announced a substantial expansion of its Risk Adjustment Data Validation (RADV) audit program for Medicare Advantage plans.
Aug. 2025What's New