Upper Peninsula Health Plan
 
 
 
 
FREE electronic prescribing…
for every physician in America.
 

UPPER PENINSULA HEALTH PLAN
   
 

PHARMACY
 
 

Welcome to E-Prescribing

   







   
  • UPHP Restricted Drug Classes  
         (Effective January 2009.)
    		•
  • UPHP Drug Formulary
         (Revised April 2009.)
    		•
  • Advair-to-Symbicort Therapeutic Interchange
    		•
  • Contraceptive Coverage  
             (Revised August 2009.)
    		•
  • Epocrates®
         (Effective October 2006.  Revised September 2008.)
    		•
  • Narcotic Pain Medications on the UPHP Formulary
    		•
  • PPI Formulary Protocol
         (Effective March 2009.)
    		•
  • Request for Prescription Restriction
    		•
  • Statin Cost Comparisons (Chart)
    		•

     

     

    4D Pharmacy Management Systems
  • Request for Prior Authorization (Form)
         (Print Only)
    		•
  • Request for Prior Authorization (Form)
         (Download or save the form; then complete and print.)
    		•
  • 4D Ascensia® Glucose Meter Fax Order Form  
             (Effective March 2007.)
    		•
  • 4D Ascensia® Glucose Meter Characteristics (Chart)
         (Effective March 2007.)
    		•
  • Synagis: 4D Request for Prior Authorization
         (Effective October 2009.)

    •  

    Policies
  • Pharmacy Management
    		•
  • Pharmacy Prior-Authorization Process
    		•
  • Pharmaceutical Safety
    		•
  • Prescription Restrictions
    		•

    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
    Wins National Pharmacy-Benefit Award

     

     


    The Upper Peninsula Health Plan won a national
    2008 Rx Benefit Innovation Award
    for its role in implementing a regional, cooperative,
    drug-management system.

     

    For more information, click here:   

     

    Please contact our Webmaster with questions or comments about this site.
     
    © Copyright 2010 Upper Peninsula Health Plan.
    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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