UPMC Health Plan prior authorization criteria
Submission criteria, documentation packets, and P2P prep by drug — for prescribers and PA staff. 30-day standard PA decision.
UPMC Health Plan reviews prior-authorization requests against its published medical policies — diagnosis with ICD-10 code, documented step-therapy history, and prescriber attestation of medical necessity. Standard PA decisions return in 30 days; if denied, prescribers and members have 180 days to appeal. Criteria by drug below.
Prior authorization criteria by drug
Each page covers UPMC Health Plan's submission criteria, the documentation packet, and peer-to-peer prep for that drug.
- Adalimumab at UPMC Health Plan →
- Aflibercept at UPMC Health Plan →
- Apixaban at UPMC Health Plan →
- Atezolizumab at UPMC Health Plan →
- Atogepant at UPMC Health Plan →
- Benralizumab at UPMC Health Plan →
- Bevacizumab at UPMC Health Plan →
- Bictegravir at UPMC Health Plan →
- Buprenorphine at UPMC Health Plan →
- Dapagliflozin at UPMC Health Plan →
- Dulaglutide at UPMC Health Plan →
- Dupilumab at UPMC Health Plan →
- Eculizumab at UPMC Health Plan →
- Elexacaftor Tezacaftor Ivacaftor at UPMC Health Plan →
- Empagliflozin at UPMC Health Plan →
- Erenumab at UPMC Health Plan →
- Evolocumab at UPMC Health Plan →
- Faricimab at UPMC Health Plan →
- Fingolimod at UPMC Health Plan →
- Fremanezumab at UPMC Health Plan →
- Galcanezumab at UPMC Health Plan →
- Glecaprevir Pibrentasvir at UPMC Health Plan →
- Guselkumab at UPMC Health Plan →
- Ibrutinib at UPMC Health Plan →
- Imatinib at UPMC Health Plan →
- Inclisiran at UPMC Health Plan →
- Infliximab at UPMC Health Plan →
- Ixekizumab at UPMC Health Plan →
- Lenalidomide at UPMC Health Plan →
- Liraglutide at UPMC Health Plan →
- Lisdexamfetamine at UPMC Health Plan →
- Mepolizumab at UPMC Health Plan →
- Methylphenidate at UPMC Health Plan →
- Naltrexone at UPMC Health Plan →
- Natalizumab at UPMC Health Plan →
- Nintedanib at UPMC Health Plan →
- Nivolumab at UPMC Health Plan →
- Nusinersen at UPMC Health Plan →
- Ocrelizumab at UPMC Health Plan →
- Ofatumumab at UPMC Health Plan →
- Omalizumab at UPMC Health Plan →
- Ozanimod at UPMC Health Plan →
- Palbociclib at UPMC Health Plan →
- Pembrolizumab at UPMC Health Plan →
- Pirfenidone at UPMC Health Plan →
- Ribociclib at UPMC Health Plan →
- Rimegepant at UPMC Health Plan →
- Risankizumab at UPMC Health Plan →
- Rituximab at UPMC Health Plan →
- Rivaroxaban at UPMC Health Plan →
- Sacubitril Valsartan at UPMC Health Plan →
- Secukinumab at UPMC Health Plan →
- Semaglutide at UPMC Health Plan →
- Sofosbuvir at UPMC Health Plan →
- Tafamidis at UPMC Health Plan →
- Tenofovir Alafenamide at UPMC Health Plan →
- Tezepelumab at UPMC Health Plan →
- Tirzepatide at UPMC Health Plan →
- Tofacitinib at UPMC Health Plan →
- Trastuzumab at UPMC Health Plan →
- Upadacitinib at UPMC Health Plan →
- Ustekinumab at UPMC Health Plan →
Generate a UPMC Health Plan PA packet
Open ApprovalHelp — generate a prior-auth packet tailored to UPMC Health Plan's criteria, with prescriber attestation and step-therapy documentation pre-filled.
Get started →Contact: hello@approvalhelp.com