Formulary

The Upper Peninsula Health Plan (UPHP) has a list of covered drugs (Formulary).  We call it the “Drug List” for short.  It tells which Part D prescription drugs are covered by our plan.  The drugs on this list are selected by the plan with the help of a team of doctors and pharmacists.  The list must meet requirements set by Medicare.  Medicare has approved the UPHP Drug List.

UPHP covers both brand-name drugs and generic drugs.  Generic drugs have the same active-ingredient formula as a brand-name drug.  Generic drugs usually cost less than brand-name drugs and are rated by the U.S. Food and Drug Administration to be as safe and effective as the brand-name drugs.

The UPHP Drug List may change throughout the year.  Please see the “Formulary Change History” for your health plan below for further information or contact the plan for the most recent list of drugs.

For Calendar Year 2018:

UPHP Advantage, UPHP Choice, and UPHP MI Health Link each have a specific Drug List. You can view the complete list of drugs, or search for a specific drug for your health plan below. You can also get information on prior authorization, step therapy, quantity limits, formulary change histories, quantity limits, out-of-network coverage, formulary exceptions and coverage determinations, and formulary appeals and grievances below. (Please note: clicking some of these links will take you away from UPHP’s website).

Prescription Drug Transition Policy for Calendar Year 2018:

UPHP has a transition policy for members to help them get their medications when they first become a member of our plan.  We will cover a temporary supply of their drug one time only during the first 90 days of their membership in the plan.  This temporary supply will be for a maximum of a 30-day supply, or less if the prescription is written for fewer days.  The prescription must be filled at a network pharmacy.  For more information regarding the transition policy, see the appropriate Evidence of Coverage.

For the most recent list of drugs, Call Magellan Rx Customer Service at 855-380-0275 (TTY: 711), 24 hours a day, seven days a week.

Centers for Medicare and Medicaid Services (CMS) Best Available Evidence Policy

For information on the CMS Best Available Evidence policy, click here.
(Clicking on this link will take you away from the Upper Peninsula Health Plan’s website.)UPHP


Page Last Updated: 08/2/2018