Medicare AdvantageCoverageMedium impact
Biosimilar Medication Formulary Updates
UPMC Health Plan·PA · Rheumatology, Oncology, Nephrology +2 more·Pharmacy
Effective date
Sep 1, 2025
We identified it
Jun 20, 2026
Summary
UPMC Health Plan is updating their formulary to prefer biosimilar medications for denosumab, eculizumab, and ustekinumab products. This affects prescribing and billing for these specialty medications with different effective dates by plan type starting September 1, 2025.
Action Required
By August 15, 2025: Review pages 18-19 of the September 2025 Provider Partner Update for complete formulary details. Providers must update prescribing preferences to biosimilar versions of denosumab, eculizumab, and ustekinumab for UPMC Health Plan members. Billing team should verify formulary status before dispensing and update prior authorization processes if required for brand name versions.