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Xtampza ER
UPMC Health Plan
UPMC Health Plan Coverage for Xtampza ER
All
9
Commercial
4
Health Exchange
2
Managed Medicaid
1
Medicare
2
Commercial
Commercial - HMO
PA Required
No Step Therapy
Quantity Limit
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Commercial - PPO
PA Required
No Step Therapy
Quantity Limit
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Commercial - Other Insurer
PA Required
No Step Therapy
Quantity Limit
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Commercial - Employer
PA Required
No Step Therapy
Quantity Limit
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Health Exchange
Health Exchange - PPO - Health Insurance Exchange
PA Required
No Step Therapy
Quantity Limit
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Health Exchange - HMO - Health Insurance Exchange
PA Required
No Step Therapy
Quantity Limit
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Managed Medicaid
Managed Medicaid - HMO - Medicaid
PA Required
No Step Therapy
Quantity Limit
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Medicare
Medicare - Medicare Advantage Part D
PA Required
Step Therapy
Quantity Limit
See Details
Medicare - Prescription Drug Plan
PA Required
Step Therapy
Quantity Limit
See Details
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