Medicare AdvantagePrior AuthHigh impact
August 2026 UPMC for You and UPMC Community HealthChoices Formulary Updates
UPMC Health Plan·PA · Endocrinology, Gastroenterology, Ophthalmology +4 more·Pharmacy
Effective date
Aug 15, 2026
We identified it
Aug 7, 2026
Summary
Effective August 15, 2026, UPMC for You and UPMC Community HealthChoices are moving multiple drugs and medical supplies to nonpreferred status, including common medications (dicyclomine, cevimeline, potassium formulations, bowel prep solutions) and most pen needles and lancets except for specific preferred brands. All nonpreferred items now require prior authorization before dispensing.
Action Required
By August 15, 2026: (1) Billing team must update pharmacy billing system to flag all nonpreferred drugs and supplies listed in this policy as requiring prior authorization in UPMC for You and UPMC Community HealthChoices plans. (2) Clinical staff must verify preferred alternatives are available for patients on affected medications (Belladonna Opium Suppository, Cevimeline Capsule, Cyclomydril Eye Drops, Dicyclomine Oral Solution, Klor-con M15 Tablet, Potassium CL ER 15 MEQ Tablet, Generic Suprep). (3) Pharmacy and billing teams must update ordering systems to prioritize preferred pen needles (Techlite, Techlite Plus, Assure ID series, Trueplus) and lancets (Trueplus Safety 28G, Accu-Chek Softclix, Trueplus Ultra Thin 30G, Trueplus Super Thin 28G, Trueplus 33G, Trividia Thin/Ultra Thin brands). (4) Before August 15: Train all staff submitting prescriptions/supplies for these plans on new prior authorization requirements. Failure to obtain prior authorization will result in claim denials and patient access delays.