Prior Authorization

Certain drugs may need to get approval from the Upper Peninsula Health Plan (UPHP) before we will agree to cover the drug for a member.  This is called “prior authorization.”  Sometimes plan approval is required so that we can be sure the drug is covered by Medicare rules.  Sometimes the requirement for getting approval in advance helps guide appropriate use of certain drugs.  If the prior authorization does not get approved, the drug might not be covered by the health plan.  Refer to the UPHP Evidence of Coverage for further information on prior authorizations, or call UPHP Customer Service at 1-877-349-9324 (TTY 711), Monday through Friday from 8 a.m. to 9 p.m. Eastern time, with weekend hours Oct. 1 through March 31.  The call is free.

2018 Prior Authorization Criteria

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2019 Prior Authorization Criteria

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Page Last Updated: 12/17/2018