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

View Advantage Choice formulary updates: upmchp.us/acformularychanges
View Your Choice formulary updates: upmchp.us/ycformularychanges
Policies can be found here: upmchealthplan.com/providers/medical/resources/manuals/policies-procedures.aspx

UPMC for Life Medicare and SNP plans

View UPMC for Life formulary updates:

UPMC for Life Complete Care (HMO D-SNP): upmchp.us/MCcompletecareRxformulary
UPMC for Life Advantage Rx (HMO, PPO): upmchp.us/MCadvantageRxRXformulary
UPMC for Life Premier Rx (HMO, PPO): upmchp.us/MCpremierRxformulary
Medicare Part D policies can be found here: upmchealthplan.com/medicare/learn/basics/medicare-prescription-coverage
Medicare Part B policies can be found here: upmchealthplan.com/providers/medical/resources/manuals/policies-procedures.aspx

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:

Online: Through SureScripts ePA or through the portal at upmchp.us/ProviderPharmacyPAForms

Recent Announcements

Fostering Trust in Vaccinations Through Shared Decision Making

Please join us for a live, CME-accredited webinar on Thursday, September 11, from noon to 1 p.m. that will provide an overview of fostering trust in vaccinations through shared decision making.

May 2025Education/Webinars

Pause in Prior Authorization Policies

On April 1, 2025, we announced that UPMC Health Plan would start requiring prior authorization for certain services. Please note that we are delaying or changing the implementation of prior authorization for some of these services, as described below.

May 2025Important Notices

May is Mental Health Awareness Month

“Turn Awareness into Action”Mental Health America founded Mental Health Month in 1949, and since that time, every May has been a time to unite millions of people to promote awareness, provide vital resources, and advocate for everyones mental well-being. 1 in 5 people will experience a mental health condition in any given year¹. Mental health affects us all, and its critical that we move beyond awareness to take meaningful steps for our well-being and that of our community.

May 2025Important Notices