For the mario lemieux center for blood cancers, call 4128646600. How do i request an exception to the upmc for life formulary. Search for providers who cover medicare part beligible durable. You can check our prescription drug list to make sure your medications are covered.
Medications on the formulary drug list that are prescribed by a doctor are paid for by upmc for you. Basic formulary the following is a list of the most commonly prescribed drugs. Providence formulary j searcu wue formularx there are two ways to search the formulary. Youll find links to formularies, program benefit guides, announcements, and more.
To schedule a video visit with your primary care provider, or find a new pcp, visit our online directory to schedule an appointment with a specialist, call your providers office or 18005338762. If you believe you have been exposed to the coronavirus or have symptoms, visit our how to find covid19 care webpage on upmc. To search for drug pricing information, you must sign in to your optumrx account. Learn more about how the myupmc online portal and new myupmc mobile app provide convenient and secure access to your health information. There are also separate formularies for upmc for kids childrens. Express scripts medicare pdp 2018 formulary list of covered aug 14, 2017 generally, if you are taking a drug covered by your plan in 2018, express scripts. Below is the formulary, or drug list, for upmc for life hmo rx hmo from upmc health plan, inc a formulary is a list of prescription medications that are covered under upmc health plan, inc.
Benefits, formulary, pharmacy network, andor copaymentscoinsurance may change on january 1, 2018, and from time to time during the year. You will pay the most if you use an outofnetwork provider, and you might receive a bill from a provider for the difference between the providers. If you are unable to locate a specific drug on our formulary, you can also select non formulary medications, then complete and submit that prior authorization form. Information in this summary will help you compare the value and scope of formulary benefits. Upmc community healthchoices nonpdl formulary drug list. Find care with upmc health plans provider directory. For appointments, contact your preferred doctor or location directly. Covered formulary drugs are listed in the first column under the drug heading. Cvs caremark value formulary effective as of 04012020. Connect with a upmc online health care professional conveniently and securely using your smart phone, tablet, or computer. Fep 5 tier managed rx drug formulary 807 basic option.
If you arent clear about any of the underlined terms used in this form, see the glossary. Summary of formulary benefits community health choice, inc. You can also get more information about the restrictions applied to specific covered drugs by visiting our website. The list does not include every medication a doctor might. The summary of benefits and coverage sbc document will help you choose a health plan. In addition to using this list, you are encouraged to ask your doctor to prescribe generic. Prothrombin complex concentrate human kcentra, csl behring llc requested by.
If you learn that independent health does not cover your drug, you have two options. Medicare plans with prescription drug coverage upmc for life. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you. This list was developed by upmc for you doctors and pharmacists and includes the most commonly used drugs. We will generally cover the drugs listed in our formulary as long as the drug is. Please use the following link to return to the upmc health plan home pageupmc health plan home page. We have posted on line documents that explain our prior authorization restriction and step therapy restriction. On this page you can read or download chg formulary in pdf format. The upmc for you pharmacy formulary is a list of food and drug administration fda approved medications. When this drug list formulary refers to we, us, or our, it means upmc health plan. You pay the least if you use a provider in the upmc inside advantage network benefit level 1 network. It represents an abbreviated version of the drug list formulary that is at the core of your prescription plan. Your 2019 formulary for the most current list of covered medications or if you have questions.
Pharmacy prior authorization providers upmc health plan. You can ask our plan to make an exception and cover your drug. As a upmc health plan member, you have access to much more than topranked care. Your plan includes online health tools, awardwinning customer service, health and wellness programs, travel coverage, and many more benefits and services. Fep 5 tier managed rx drug formulary 807 basic option effective april 7, 2020 v2. Tier 5 preferred pharmacy costsharing during initial coverage phase. Dec 10, 2015 on this page you can read or download chg medical formulary in pdf format. Services preferred drug list pdl upmc for you nonpdl formulary drug list. A health maintenance organization high and standard option and a high deductible health plan important rates.
On this page you can read or download chg medical formulary in pdf format. Aug 14, 20 20 formulary list of covered drugs upmc health plan a formulary is a list of covered drugs selected by upmc for life in upmc for life will generally cover the drugs listed on our formulary as long as the drug is value choice upmc health plan 2. Gunn md ccm recommendations it is recommended that fourfactor prothrombin complex concentrate pcc kcentra be added to formulary. Your session has ended, thank you for using upmc health plan online. Call 18888762756 or visit us at if you arent clear about any of the underlined terms used in this form, see the glossary. Chemotherapy drug sheets upmc hillman cancer center. You can ask us to make an exception to our coverage rules. If this is an urgent request, please call upmc health plan pharmacy. Morphine sulfate oral soln 100mg5ml quantity limit. The information in this document will help you understand the prescription drug benefits offered under this plan and to compare these benefits to those offered by other plans. St step therapy even if a drug is on the formulary, we may require you to try one or more alternative drugs on the formulary before this drug will be covered.
Upmc health plan is waiving member costsharing for upmc anywherecare visits through june 15, including deductibles or copayments for most members. Non formulary medications prior authorization form if this is an urgent request, please call upmc health plan pharmacy services. Upmc health plan university of pittsburgh panther gold plan enhanced access hmo the enhanced access hmo encourages you to use a primary care physician pcp for medical care. Start the process of becoming a upmc health plan producer or log in to your existing producer online account. You must generally use network pharmacies to use your prescription drug benefit. The formulary can help you and your physician choose effective, quality medications that minimize your outof pocket expense. Generic equivalent drugs will be substituted for brand name drugs unless you. Medicaid pharmacy coverage upmc for you upmc health plan. Upmc health plan recommends that you contact the providers listed in this directory to confirm that the. A health maintenance organization high and standard.
Chemotherapy drug sheets education upmc hillman cancer center. Individual questions regarding the amendment or if you did not recieve an amendment to your existing contract or if you are not current particpating with upmchp but are interested. Formulary product alternative list april 2020 ql quantity limitations st step therapy indicates medication is covered generically non. The health care provider will conduct a facetoface video visit with you to determine a diagnosis. Dec 10, 2015 on this page you can read or download chg formulary in pdf format. Medicaid and medical assistance plans upmc for you. Ummc online formulary version 2 ummc pharmacy portal v2.
The formulary states which drugs need approval or authorization. Medstar medicare choice dual advantage hmo snp 2017. If you dont see any interesting for you, use our search form on bottom v. When you need those investment dollars for health care expenses, you can return them to your original hsa account without penalty.
You can get more information about medicare prescription drug plans and the coverage offered in your area from these places. It tells you which prescription drugs and overthecounter otc drugs are covered by unitedhealthcare connected for mycare ohio. You can find out if your drug has any additional requirements or limits by looking in the formulary that begins on page 3. For more recent information or other questions, please. A health maintenance organization high and standard option. For general information or questions, call 4126472811. Pharmacy resources for health care providers upmc health plan. You can search the formulary alphabetically by selecting the first letter of the drug you are looking for, or by either the brand or generic name of a drug by entering the name of the drug or the first few letters if the full name or correct spelling is not known. However, if you choose to enroll in medicare part d, you can keep your fehb coverage and your fehb plan will coordinate benefits with medicare. The notes column in the formulary will tell you which drugs may have any additional. The prescription drug plan you receive is based upon your medical plan selection. This is a live document and shall be updated from time to time as needed.
If you do not get approval, we may not cover the drug. Some of the medications on the formulary require prior authorization, have a quantity limit, must be dispensed by a specialty pharmacy or require step therapy. Visit your plans member website listed on your id card to. Upmc health plan university of pittsburgh panther gold plan. Prescription drug plan for cigna oap and upmc epo plans cvs. See below for information about how to request an exception. Get the most from your pharmacy benefits upmc health plan. Locate a participating retail pharmacy by zip code.
Upmc health plan offers affordable health care coverage options for people from all walks of life. You pay more if you use a provider in the other participating upmc facilities level 2 network. Our health care concierge team is available to assist you monday, tuesday, thursday, friday from 7 a. If your drug is not included in this formulary list of covered drugs, you should first contact member services and ask if your drug is covered. To search information on medication, press buttons ctrl and f together.
If you require a prior authorization for a medication not listed here, please contact upmc health plan pharmacy services at 1800979 upmc 8762. You can ask member services for a list of similar drugs that are covered by independent health. If you are taking a drug on our 2020 formulary that is covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 2020 coverage year except when a new, lessexpensive generic drug becomes available, or when new adverse information about the. If you decide to enroll in medicare part d later, you will not have to pay a penalty for late enrollment as long as you keep your fehb coverage. The list is not allinclusive and does not guarantee coverage. Aug 14, 20 for days 1100, upmc complementary plan pays 100%.
Manage your hsa online or via mobile app its easy to access your upmc consumer advantage hsa 247 through a secure online account. You can also search the formulary by therapeutic class of the drug if the exact drug name is not known. If you choose then high deductible health plan coverage, subject to deductibles, is provided using your cigna hdhp or upmc hdhp medical plan card. Below is the formulary, or drug list, for upmc for life dual hmo snp from upmc for you, inc this formulary is a list of prescription medications that are covered under upmc for you, incs 2017 medicare advantage plan.
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