MedicaidCoverageMedium impact
October 2025 UPMC for You and UPMC Community HealthChoices formulary update
UPMC Health Plan·Gastroenterology, Dermatology, Family Medicine +1 more·Pharmacy
Effective date
Oct 1, 2025
We identified it
Jun 20, 2026
Summary
Effective October 1, 2025, UPMC for You and UPMC Community HealthChoices will no longer cover Xifaxan (all strengths) and Retin-A (cream, gel) due to manufacturer non-participation in Medicaid Drug Rebate Program. Covered alternatives are available including tretinoin cream for Retin-A and several options for Xifaxan, with limited coverage for Xifaxan 200mg requiring prior authorization only for hepatic encephalopathy diagnosis.
Action Required
By October 1, 2025: Billing team must update formulary system to remove coverage for Xifaxan (all strengths) and Retin-A cream/gel for UPMC for You and UPMC Community HealthChoices patients. Add prior authorization requirement for Xifaxan 200mg tablets with hepatic encephalopathy diagnosis only. Update provider alerts to recommend covered alternatives: tretinoin cream for Retin-A, and loperamide, dicyclomine, lactulose, or azithromycin for Xifaxan. Inform providers of manufacturer patient assistance program at 1-833-862-8727 or bauschhealthpap.com.