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
















































  • UPHP Restricted Drug Classes  
        (Effective July 2011.)
    		•
     
  • UPHP Drug Formulary
        (Effective January 2012.)
    		•
     
  • Summary of Changes
        (Effective December 2011.)
    		•
     
  • Advair-to-Symbicort Therapeutic Interchange
    		•
     
  • Acetaminophen Questions and Answers
        (Posted January 2012.)
    		•
     
  • Beneficiary Carve-Out Letter
        (Effective April 2010.)
    		•
  • Contraceptive Coverage  
            (Revised December 2010.)
    		•
  • Electronic Prescribing
    		•
  • Epocrates®
        (Effective October 2006.  Revised September 2008.)
    		•
  • Glucose-Meter Characteristics
         (Effective July 2010.)
    		•
  • Narcotic Pain Medications on the UPHP Formulary
    		•
  • RSV Prophylaxis: Notice to Providers
    		•
  • Statin Cost Comparisons (Chart)
    		•
  • Synagis Notice to Providers
        (Effective October 2011.)
    		•
  • Synagis Prior-Authorization Form
    		•
     
     
    PHARMACY BENEFIT MANAGER
    CATALYST Rx
  • Request for Prior Authorization (Form)
         (Print Only)
    		•
  • Request for Prior Authorization (Form)
         (Download or save the form; then complete and print.)
    		•
  • Prior-Authorization Form—Synagis
        (Print Only)
    		•
  • Prior-Authorization Form—Synagis (Form)
        (Download or save the form; then complete and print.)
    		•

     

     

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

    Providers and Prescribers

    For information about Upper Peninsula Health Plan pharmacy services not specified on the forms listed above, call Catalyst Rx at 1-877-464-0084.
     

    Pharmacist Claim System

    For claim inquiries and support, call Catalyst Rx at 1-877-464-0084.
     

    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.
    Upper Peninsula Health Plan ● 228 West Washington Street ● Marquette, Michigan 49855
    906-225-7500 or 800-835-2556
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