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NON-FORMULARY MEDICATIONS Prior Authorization Form IF THIS IS AN URGENT REQUEST, please call UPMC Health Plan Pharmacy Services. Otherwise please return completed form to: UPMC HEALTH PLAN PHARMACY.

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A formulary is a list of generic and brand name prescription drugs covered by your health plan. Your health plan may only help you pay for the drugs listed on its formulary. It's their way of providing a wide range of effective medications at the lowest possible cost.

Formularies can differ form plan to plan, but Medicare dictates some medications that all Medicare Part D formularies must cover.

A drug formulary is a list of generic and brand-name prescription drugs covered by a health plan. The health plan generally creates this list by forming a pharmacy and therapeutics committee consisting of pharmacists and physicians from various medical specialties.

If a medication is non-formulary, it means it is not included on the insurance company's formulary or list of covered medications. A medication may not be on the formulary because there is an alternative proven to be just as effective and safe, but is less costly.

A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list.

UPMC Health Plan provides a broad retail pharmacy network that includes: National chain pharmacies, including CVS, Giant Eagle, Kmart, Rite Aid, Sam's Club, Target, and Walmart. An extensive network of independent pharmacies and several regional chain pharmacies.

Formulary prescriptions are medications that are on a preferred drug list. ... Drugs that are usually considered non-formulary are ones that are not as cost effective and that usually have generic equivalents available. 3. How can I find out if my brand name prescription is formulary or non-formulary?

Non-formulary drugs and most specialty drugs are covered only when prior authorization is approved. An incentive formulary plan provides coverage for generic drugs, formulary brand-name drugs, and specialty drugs. Non-formulary drugs are also covered for a higher copayment.

Most Medicare drug plans have their own list of covered drugs, called a formulary. Plans cover both generic and brand-name prescription drugs. The formulary includes at least 2 drugs in the most commonly prescribed categories and classes.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232