Prescription Drug Coverage
All UPMC for Life Complete Care members have a $0 copay for covered Part D prescription drugs filled at a participating pharmacy. UPMC for Life covers thousands of brand-name and generic medications. These drugs are reviewed and approved by UPMC physicians, community pharmacists, and Medicare.
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Prescription drug formulary
The link below will allow you to see the UPMC for Life Complete Care (HMO D-SNP) prescription drug formulary. A formulary is a list of prescription drugs covered by your plan.
2024 UPMC for Life Complete Care prescription drug formulary
Last updated 10/1/2024
2025 UPMC for Life Complete Care prescription drug formulary
Last updated 11/13/2024
Language Assistance (PDF)
Last updated 1/19/2023
Two easy ways to make sure your medications are covered:
- Download the formulary using the link above.
- Search covered drugs (search our drug list by the name of the drug you are taking).
Top 200 drug list
Our top 200 drug list includes the most commonly used prescription drugs for members in our UPMC for Life plans along with their drug tiers.
UPMC for Life 2024 top 200 drug list
UPMC for Life 2025 top 200 drug list
This is not a complete list of the drugs we cover. See your plan formulary for a complete list.
Prior authorization requirements
Some of the drugs that UPMC for Life covers may require you and your doctor to get prior approval from UPMC for Life. The document below will advise you of which drugs require prior authorization.
2024 Prior Authorization Requirements
Last updated 11/1/2024
2025 Prior Authorization Requirements
Last updated 10/15/2024
Step therapy requirements
In some cases you may need to first try certain drugs to treat a medical problem before we will cover another drug. The document below will advise you of which drugs require step therapy.
2024 Step Therapy Requirements
Last updated 11/1/2024
2025 Step Therapy Requirements
Last updated 11/14/2024
Quantity Limits
For certain prescription drugs, our plan limits the amount of the drug that we will cover. Prescription drugs with quantity limits are listed in your plan’s comprehensive formulary (list of covered drugs). To see if any of your prescription drugs have a quantity limit, select your plan’s comprehensive formulary above and check for "QL" next to the drug name under Requirements/Limits.
Part B Drugs and Supplies
The document below contains a list of select Part B drugs that UPMC for Life covers.
Covered Select Part B Drugs and Supplies
Last updated 12/22/2020
The document below contains a list of drugs that require Part B Step Therapy.
2024 Drugs and Products Requiring Part B Step Therapy or Prior Authorization
Last updated 8/7/2024
2025 Drugs and Products Requiring Part B Step Therapy or Prior Authorization
Last updated 11/13/2024
Get help with medication costs
All UPMC for Life Complete Care members have a $0 copay for covered prescription drugs filled at a participating pharmacy. You can save money on medications no matter the level of Extra Help (Low Income Subsidy) you receive. This benefit applies to all phases of prescription drug coverage.
2024 Low Income Subsidy Premium Summary Table
Last updated 10/1/2023
2025 Low-Income Subsidy Premium Summary Table
Last updated 10/1/2024
Apply for Extra Help with your medications at socialsecurity.gov
How do I ask about my LIS status or level?
To find out about your LIS status or level, call:
- 1-800-MEDICARE(1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048
- Social Security at 1-800-772-1213 Monday through Friday from 8 a.m. to 7 p.m. TTY users should call 1-877-486-2048.
- Your state Medical Assistance (Medicaid) office. In Pennsylvania the Medicaid program is managed by the Department of Human Services (DHS). In Ohio the Medicaid program is managed by the Department of Medicaid.
- Medicare may not have the correct income information to give UPMC for Life at the time a person is applying for help. The Best Available Evidence policy helps plans review costs for those members.
Medication Therapy Management (MTM) program
UPMC Health Plan has developed a unique medication therapy management program for members who take many medications and meet certain criteria.
Use the links below to learn more:
This information is available for free in other languages. Please call our customer service number at 1-800-606-8648 (TTY: 711).
UPMC for Life has a contract with Medicare to provide HMO, HMO D-SNP, and PPO plans. The HMO D-SNP plans have a contract with the PA State Medical Assistance program. Enrollment in UPMC for Life depends on contract renewal. UPMC for Life is a product of and operated by UPMC Health Plan Inc., UPMC Health Network Inc., UPMC Health Benefits Inc., UPMC for You Inc., and UPMC Health Coverage Inc.
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UPMC for Life Complete Care (HMO D-SNP) members
Call us toll-free: 1-800-606-8648
TTY: 711
Oct. 1 – March 31:
Seven days a week from 8 a.m. to 8 p.m.
April 1 – Sept. 30:
Monday through Friday from 8 a.m. to 8 p.m.
UPMC for Life Complete Care prospective members
Call us toll-free: 1-844-575-8241
TTY: 711
Oct. 1 – Mar. 31:
Seven days a week from 8 a.m. to 8 p.m.
April. 1 – Sept. 30:
Monday through Friday from 8 a.m. to 8 p.m. Saturday from 9 a.m. to 3 p.m.
Last Updated: 10/1/2024