Upper Peninsula Health Plan

UPPER PENINSULA HEALTH PLAN

PHARMACY INFORMATION
  • UPHP Restricted Drug Classes List  
         (Effective January 1, 2008.)
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  • UPHP Drug Formulary
         (Revised January 2008.)
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  • Advair-to-Symbicort Therapeutic Interchange
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  • Oral Contraceptive Coverage  
             (Revised October 2007.)
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  • Statin Cost Comparisons (Chart)
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  • Synagis: 4D Request for Prior Authorization  
         (Effective September 2006.)
  • Synagis Criteria
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  • Epocrates® References  
         (Effective October 4, 2006.)
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    4D Pharmacy Management Systems
  • 4D Prior Authorization Form
         (Print Only)
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  • 4D Prior Authorization Form
         (Download or save the document first; then complete and print.)
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  • 4D Ascensia® Glucose Meter Fax Order Form  
             (Effective March 2007.)
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  • 4D Ascensia® Glucose Meter Characteristics Chart
         (Effective March 2007.)
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    Policies
  • Pharmacy Management
    		•
  • Pharmacy Prior-Authorization Process
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  • Pharmaceutical Safety
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  • Prescription Restrictions
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    Providers and Prescribers

    For information about UPHP pharmacy services not specified on the forms listed above, call 4D Pharmacy Management Systems at 1-888-274-2031.

    Pharmacist Claim System

    For inquiries and support, please call 1-888-378-4743.

    UPHP Members

    For information about UPHP pharmacy services, call UPHP Customer Service at 1-800-835-2556.
    Upper Peninsula Health Plan

    Please contact our Webmaster with questions or comments about this site.
    © Copyright 1999 Upper Peninsula Health Plan, Inc. All rights reserved.

    Upper Peninsula Health Plan - 228 W. Washington Street - Marquette, MI 49855

    1-800-835-2556 or  906-225-7500

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