Pharmacy Coverage

UPMC Community HealthChoices offers prescription drug coverage for participants.

The UPMC Community HealthChoices Pharmacy Formulary (Non-PDL) is a list of Food and Drug Administration (FDA) approved medications. Medications on the formulary (drug list) that are prescribed by a doctor are paid for by UPMC Community HealthChoices. The list does not include every medication a doctor might prescribe. The drugs on the formulary have been selected because they are safe, work well, and cost less than other drugs that have the same level of effectiveness. You can find the formulary and search for covered drugs with our online searchable formulary.

UPMC Community HealthChoices also covers medications found on the Pennsylvania Medical Assistance Statewide Preferred Drug List.

Some medications, on the UPMC Community Health Choices non-PDL formulary and the Statewide Preferred Drug List, require prior authorization. Brand name medications require a $3 copay. You may not have to pay a copayment for brand medications in certain classes. Generic medications are a $0 copay.

For individuals who are dual eligible for Medicare and Medicaid, most medications are covered by Medicare. Individuals must enroll in a Medicare plan that provides Part D medication coverage. Doctors should prescribe medications from an individual’s Medicare plan’s formulary. Medicare copays apply. For more information about Medicare medication coverage and assistance to find a Medicare plan, call Pennsylvania Medicare Education and Decision Insight (PA MEDI) at 1-800-783-7067.

Find participating UPMC Community HealthChoices pharmacies.

Participants who need help finding a pharmacy, or have questions about their prescription coverage, can call the UPMC Community HealthChoices HealthCare Concierge team at 1-844-833-0523 (TTY: 711).