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Prescription Drug Plan2008 - 2009 Plan Year This Prescription Drug Coverage applies to all four medical plans Under this program services are subject to medical necessity and appropriateness. Certain types of medications require your physician to obtain an authorization before prescribing. The program follows drug-specific guidelines (FDA) for once daily dosing and maximum quantity limits.
For a listing of UPMC’s Health Plan’s Your Choice Pharmacy Drug Program, click here. Prescription Drug Program Generic first provision When a generic equivalent is available, a pharmacist will dispense that version. If you choose not to accept the generic equivalent and elect a brand name drug, you will be responsible for the middle-tier copayment plus the cost difference between the generic equivalent and brand drug. If there is a medical reason why you cannot take a generic version of a drug, your physician can request a medical exception from UPMC Health Plan. Prescriptions for non-sedating antihistamines (i.e. Allegra, Zyrtec, Clarinex) will require your doctor to consult in advance with UPMC Health Plan’s Pharmacy Services department to obtain prior authorization. The prescribing physician will be responsible for providing the appropriate information to UPMC Health Plan Pharmacy Services. Coverage for these medications will not be available if a prior authorization is not obtained.
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