Infusion Access Foundation (@infusionaccessfoundation.org)

Patient Experience Survey: UPMC Health Plan Changes – Infusion Therapies Effective January 1, 2026, UPMC Health Plan implemented significant policy changes impacting patients in Pennsylvania. These changes materially affect patients receiving infusion and injectable therapies for chronic inflammatory conditions and create new administrative and financial barriers to care. If you are enrolled in UPMC Health Plan and have been affected by the below changes, we would like to hear from you. Changes to Your Prescription Coverage UPMC Health Plan is changing which medications it covers starting in 2026. These changes affect some treatments for Crohn’s disease and ulcerative colitis. Some medications may no longer be covered or may be harder to get approved, including Tremfya and Omvhoh. To get certain medications approved, UPMC may now require: - Trying other covered medications first - Extra approval steps from your doctor - Limits on how much medication you can receive For medications that are not covered, UPMC may require you to pay entirely out of pocket or impose additional step therapy requirements by requiring proof that you have tried many other treatments (sometimes up to nine). Each treatment may need to be used for about three months before moving on to the next one. Copay Assistance Program Changes UPMC also uses a copay maximizer that enrolls patients in drug manufacturer copay assistance. Here’s what that means for you: - The copay assistance does not count toward your deductible or out-of-pocket maximum. - The plan is able to maximize the value paid by assistance programs while delaying when UPMC Health Plan begins paying its share of drug costs. - You may experience high out-of-pocket costs later in the year, once copay assistance is exhausted. What This Means for You These changes may: - Limit which medications you can access - Delay starting or continuing certain treatments - Increase your out-of-pocket costs later in the year We value your feedback. Completing this survey will help patient advocacy organizations understand the real-world impact of these changes and advocate for improvements. Your responses will remain confidential. https://docs.google.com/forms/d/e/1FAIpQLScqWvfx_SeqG-Izj5xbxIq9R5XjVbR9f3A4Vqp1ZR8bC8vFmg/viewform?usp=header