Commercial formulary changes

So far in 2019, Priority Health has added 72 new drugs to the commercial formulary. They’ve also reduced the tier or removed step therapy or prior authorization on 28 drugs.

On January 1, 2020, they’ll have 128 changes that will either remove a drug from the formulary, increase the tier the drug is in, or add step therapy or prior authorization. These changes impact 4,225 members. Approximately 70% of members impacted are from the following 10 drug changes.

Medicare formulary changes

Effective January 1, 2020, 96 drugs will be removed from the Medicare formulary, impacting 3,620 members. Many drugs are being removed because they are brands that now have generics on the market. Approximately 56% of members are impacted from the following five drug changes:

Here’s how Priority Health is communicating to their members

Members impacted by changes to either the commercial or Medicare formulary will receive a letter advising them of how their drug coverage will be changing and what steps they can take prior to January 1, 2020. The letters also include a list of alternative medications that may be options for them.

Learn more

Priority Health’s November 6^th Virtual Office Advisory (VOA) webinar will cover these changes.