Formulary Information

Pharmacy Formulary
The Upper Peninsula Health Plan’s (UPHP) formularies are lists of medications
that are recommended for use.

Note: Effective 6/1/2016, Upper Peninsula Health Plan’s formulary is aligned with the MCO Common Formulary. For further information, click here.


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

Search the 2017 Medicaid/CSHCS/Healthy Michigan Formulary 
(clicking on this link will take you away from the Upper Peninsula Health Plan’s website)

(Effective June 2016.)


Common Formulary Ophthalmic Agent Summary
(Effective July 2017.)

Coverage Quick Guide:
Diabetes Medication, Smoking Cessation and Vaccines

(Effective April 2017.)

Blood Glucose Meter Coverage

(Effective March 2017.)

Epocrates®

MDHHS Updated Carve-Out List — Medicaid
(Revised August 2017.)

Specialty Pharmacy

Partial Fill Specialty Drug List


Synagis Notice to Providers
(Effective November 2017.)

RSV Criteria Summary

Pharmacy Network Claims Processing Webinar. February 2017 (Video)

Pharmacy Network Claims Processing Webinar. February 2017 (PDF)


Page Last Updated: 10/12/2017