All PlansCoverageHigh impact
Formulary updates effective Jan. 1, 2026
UPMC Health Plan·Endocrinology, Rheumatology, Orthopedics +2 more·Pharmacy
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Effective January 2026, UPMC Health Plan is implementing comprehensive formulary changes affecting all lines of business, including coverage updates for adalimumab products, continuous glucose monitors (CGM), and billing processes for hyaluronate joint injections and select IV/subcutaneous products. Medical billing teams must review the full policy details to understand specific coverage and billing requirement changes.
Action Required
Before January 1, 2026: Billing team must access the full policy details at the source URL to review specific changes to adalimumab product coverage, CGM billing requirements, and hyaluronate intra-articular injection processes. Update billing software rules and prior authorization workflows based on the detailed formulary changes. Update encounter forms and provider documentation requirements for affected IV and subcutaneous products.