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Make sure your prescription drugs are covered. UPMC for Life covers thousands of brand-name and generic medications. These drugs are reviewed and approved by UPMC physicians, community pharmacists, and Medicare.
All UPMC Medicare Special Needs Plans combine medical and Part D prescription drug coverage. 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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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.
Here are two easy ways to make sure your medications are covered:
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.
The link below will allow you to see the UPMC for Life Complete Care (HMO SNP) prescription drug formulary. A formulary is a list of prescription drugs covered by your plan.
Two easy ways to make sure your medications are covered:
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.
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.
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!
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.
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.
Some of the drugs that UPMC for Life covers may require you and your doctor to get prior approval. Select your plan to see a list of which drugs require prior authorization.
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.
In some cases you may need to first try certain drugs to treat a medical problem before we will cover another drug. Select your plan below to see which drugs require step therapy.
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.
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.
The document below contains a list of select Part B drugs that UPMC for Life covers.
Covered Select Part B Drugs and Supplies
The document below contains a list of drugs that require Part B Step Therapy.
2023 Drugs requiring Part B Step Therapy
All UPMC for Life Complete Care members have a $0 copay for covered prescription drugs. 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.
If you have limited income, you may qualify for extra help to pay for your prescription drugs. Many people are eligible for these savings and don't even know it. Choose your county in the dropdown below to get details about low-income subsidies in your area. Then click the purple button below to view the Low-Income Subsidy Premium Summary Table.
2023 Low Income Subsidy Premium Summary Table
Apply for extra help with your medications at socialsecurity.gov
To find out about your LIS status or level, call:
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.
Find a UPMC for Life Medicare plan that best fits your needs. You can compare and sort plans here.
Request a free information kit to learn about UPMC for Life plans and coverage options.
We can answer your questions and help you choose a Medicare plan that's right for you.