MedicaidCoverageHigh impact
February 2026 UPMC for You and UPMC Community HealthChoices formulary update
UPMC Health Plan·PA · Pulmonology, Family Medicine, Pediatrics +2 more·Pharmacy
Effective date
Feb 1, 2026
We identified it
Aug 7, 2026
Summary
UPMC for You and UPMC Community HealthChoices has discontinued coverage for Pulmicort Flexhaler NDCs from the new distributor (Rubicon Holding) under the Medicaid Drug Rebate program effective immediately. Existing H2 Pharma NDCs may be dispensed until supplies are exhausted, but prescribers must transition patients to covered alternatives (Arnuity Ellipta, Asmanex HFA, Asmanex Twisthaler, Budesonide Respules, Qvar Redihaler, or Fluticasone Propionate HFA) to avoid pharmacy claim denials.
Action Required
Immediately: Billing and clinical teams must identify all patients currently prescribed Pulmicort Flexhaler (Rubicon Holding NDCs) in the practice EMR. Notify prescribers to transition affected UPMC Medicaid patients to one of the covered alternatives: Arnuity Ellipta, Asmanex HFA, Asmanex Twisthaler, Budesonide 0.25 mg/2 mL and 0.5 mg/2 mL Respules, Qvar Redihaler, or Fluticasone Propionate HFA (for patients < 19 years). Update pharmacy benefit verification workflows to flag Pulmicort Flexhaler as non-covered for UPMC Medicaid plans. Educate front-desk and authorization staff that claims for Rubicon Holding NDCs will be denied. Continue processing existing H2 Pharma NDC supplies through depletion, but monitor for claim rejections and coordinate with patients and pharmacies on transition timing.