Formulary

The Upper Peninsula Health Plan has a List of Cover 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 Upper Peninsula Health Plan Drug List.

Upper Peninsula Health Plan 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 Upper Peninsula Health Plan formulary may change throughout the year.  Please see “Formulary Updates and Changes” below for further information or contact the plan for the most recent list of drugs.

 

For calendar year 2017:

To view the comprehensive formulary, which is a complete list of covered drugs, click on the link below.

2017 UPHP Advantage Formulary (List of Covered Drugs)
(Clicking on this link will take you away from the Upper Peninsula Health Plan’s website.)
(Last Updated 05/23/17.)

2017 UPHP MI Health Link Formulary (List of Covered Drugs)
(clicking on this link will take you away from the Upper Peninsula Health Plan’s website.)
(Last Updated 05/23/17.)

Looking for a specific drug? Click on the link below and key in the first few letters of the drug name:

Search the 2017 UPHP Advantage Formulary
(Clicking on this link will take you away from the Upper Peninsula Health Plan’s website.)
(Last Updated 05/23/17.)

Search the 2017 UPHP MI Health Link Formulary
(clicking on this link will take you away from the Upper Peninsula Health Plan’s website.)
(Last Updated 05/23/17.)

The Upper Peninsula Health Plan has a transition policy for members to help them get your 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: Phone: 855-380-0275 (TTY: 711) 24 hours a day, 7 days a week.

 

Prior Authorization

For the Upper Peninsula Health Plan Advantage’s prior-authorization information, criteria, and quantity-limit information, click here.

For the Upper Peninsula Health Plan MI Health Link’s prior-authorization information, criteria, and quantity-limit information, click here.

Step Therapy

For  the Upper Peninsula Health Plan Advantage’s step-therapy information and criteria, click here.

For  the Upper Peninsula Health Plan MI Health Link’s step-therapy information and criteria, click here.

Prescription Drug Transition Policy 

For calendar year 2017:

For the Upper Peninsula Health Plan Advantage’s Prescription Drug Transition Process, click here.

Formulary Change History

For calendar year 2017:

To find the latest updates and changes to the Upper Peninsula Health Plan Advantage’s formulary, click here.

To find the latest updates and changes to the Upper Peninsula Health Plan MI Health Link’s formulary, click here.

Quantity Limits

Upper Peninsula Health Plan Advantage has Quantity Limits. This is when there is a limit on the amount that a drug is covered per prescription, or within a specific time frame.

For calendar year 2017:

For quantity limits, click here, to search the 2017 Formulary.
(clicking on this link will take you away from the Upper Peninsula Health Plan’s website.).


Upper Peninsula Health Plan MI Health Link has Quantity Limits. This is when there is a limit on the amount that a drug is covered per prescription, or within a specific time frame.

For calendar year 2017:

For quantity limits, click here, to search the 2017 Formulary.
(clicking on this link will take you away from the Upper Peninsula Health Plan’s website.)

Out-of-Network Coverage

For information on using pharmacies that are out of the Upper Peninsula Health Plan Advantage’s network, click here.

For information on using pharmacies that are out of the Upper Peninsula Health Plan MI Health Link’s network, click here.

Formulary Exceptions and Coverage Determinations 

To find out how to ask the Upper Peninsula Health Plan Advantage to cover a drug that is not listed on the formulary, click here.

To find out how to ask the Upper Peninsula Health Plan MI Health Link to cover a drug that is not listed on the formulary, click here.

Formulary Grievances and Appeals

For information about the Upper Peninsula Health Plan Advantage’s formulary grievances and appeals, click here.

For information about the Upper Peninsula Health Plan MI Health Link’s formulary grievances and appeals, click here.

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.)

 


Page Last Updated: 06/16/2017