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Medicare Pharmacy

Across
Second stage of prescription coverage for UPMC Health Plan
Tier 5 Medications
First stage of prescription coverage for UPMC Health Plan
Includes member copays and coinsurance in initial coverage stage.
Must be submitted to C&G within 60 days of the original denial.
B/D stands for....
PA stands for.....
Quantity Limit stands for....
Formulary medication to be covered at a lower cost share for the member. Requires clinical review.
Third stage of prescription coverage for UPMC Health Plan
Type of coverage determination that must be done in 72 hours
Down
A percentage designated for the member to pay
Tier 3 Medications
Tier 4 Medications
Tier 1 Medications
A set amount of money designated for the member to pay
List of medications that are covered, restrictions and tier information
Type of coverage determination that must be done in 24 hours.
Step Therapy stands for....
Tier 2 Medications
Mail Order stands for....