Prescription Drug Formularies

UPMC for Life has two Part D prescription drug formularies. A formulary is a list of covered drugs for your plan. The name of the formulary and the plans that use it are important for you to know when reviewing your prescription drug coverage. Drug coverage is different between these formularies, so it's good to make sure you review the formulary for your plan in detail.

Select One HMO Deductible Rx (HMO) HMO Premier Rx (HMO) HMO Rx (HMO) HMO Rx Choice (HMO) HMO Rx Enhanced (HMO) PPO High Deductible Rx (PPO) PPO Premier Rx (PPO) PPO Rx Choice (PPO) PPO Rx Enhanced (PPO)

Each formulary has five levels of drug benefits. These levels are referred to as drug tiers. Learn about our drug tiers below, along with benefits that can help you save money on covered prescription drugs.

UPMC for Life drug tiers

1. Preferred Generic
2. Generic
3. Preferred Brand
4. Non-Preferred Drug
5. Specialty

$0 preferred generic medications

We’ve added even more medications to our $0 preferred generic list. These prescriptions have a $0 copay when filled at preferred pharmacies. Preferred generic (Tier 1) $0 copays apply only during the initial coverage stage unless you are enrolled in the HMO Rx (HMO) plan.

• See a complete list of preferred generic drugs for our Premier Rx Formulary plans:
  
• See a complete list of preferred generic drugs for our Advantage Rx Formulary plans:
  

Save money on generic medications in the donut hole (Tier 1 and 2)

UPMC for Life HMO Rx (HMO) plan members have additional coverage through the Medicare Part D coverage gap, otherwise known as the “donut hole.” Members in this plan pay the same copays for generic medications on Tiers 1 and 2 in the Part D initial coverage and coverage gap donut hole stages. That means members will not pay more in the donut hole.

Learn more about Tier 1 and 2 coverage through the donut hole.

Save money on diabetes medications

Many UPMC for Life plans offer copays as low as $10 for covered brand-name, non-insulin diabetes medications during the initial coverage stage. Plus, UPMC for Life members have coverage through the “donut hole” for covered insulins! Your copay for covered insulin is the same during the initial coverage and coverage gap donut hole stages. This means you will not pay more in the donut hole for your insulin, which can save you hundreds!

Learn more about cost savings for members with diabetes.

Covered insulins have a $35 copay for each one-month supply. This means you will not pay more than $35 for a one-month supply or more than $105 for a three-month supply. These copays apply through all Part D coverage stages in 2023. See your plan Evidence of Coverage for more information.

Take advantage of preferred pharmacies

Members can fill prescriptions at any in-network pharmacy of their choice and can have low copays when filling at one of our preferred retail or mail-order pharmacies. Some preferred retail pharmacy locations include Giant Eagle, Rite Aid, Sam’s Club, Walgreens, Walmart, and Weis. Search for a preferred pharmacy near you.

With Express Scripts, our preferred mail-order pharmacy, you can have your prescriptions delivered right to your door! Simply ask your doctor to send your prescription to Express Scripts or call 1-877-787-6279 (TTY: 1-800-899-2114) 24 hours a day, 7 days a week.

Make sure to use your UPMC for Life member ID card when filling medications to be sure you get the lowest copays available.