UPMC Diabetes Medications and Insulin Coverage Update

UPMC for Life’s 2023 plans include many exciting benefits that can improve the overall health of members. One of the ways to help members live their best lives is by providing affordable prescription drug coverage, including those living with diabetes. With so many improvements, UPMC wanted to provide you with a recap of the positive changes to their diabetic drug coverage.
 
Low copays for covered diabetes medications
Members can save money on brand-name, non-insulin diabetic medications (Tier 2)that help lower blood sugar. These copays are available only in the Initial Coverage Stage and do not apply to members of the HMO No Rx (HMO), HMO Premier Rx (HMO), PPO Premier Rx (PPO), PPO Salute (PPO), Complete Care (HMO SNP), and employer group plans. Copays for these covered medications are:

• $10 for a 30-day supply filled at a preferred retail pharmacy.
• $20 for a 90-day supply filled at a preferred pharmacy.

Save money with donut hole coverage for insulin medications
The copay for covered insulins is the same during the initial coverage and coverage gap “donut hole” stages. This means members will not pay more in the donut hole, which can save them hundreds! Copays for insulins included on plan formulary are:

• $35 for a 30-day supply filled at a retail pharmacy.
• $87.50 for a 90-day supply filled at a preferred mail-order pharmacy.
• $96.25 for a 90-day supply filled at a preferred retail pharmacy.
• $105 for a 90-day supply filled at a standard pharmacy.

‍Please note: Covered insulins have a maximum $35 copay for each one-month supply. This means members will not pay more than $35 for a one-month supply or more than $105 for a three-month supply. These copays also apply to LIS members and are through all Part D coverage stages in 2023. LIS members will pay the lesser of their LIS copay or the copays above. This is an update from what is included in the 2023 enrollment kits. Members can review their plan Evidence of Coverage for more information. ‍For more information about diabetes medications, click here.