OSP News

Priority Health Medicaid Notifies Members About Out of Network Pharmacies

Posted: 10/18/2021

As a partner in your health, Priority Health wants to make sure your patients receive the care and information they need to stay healthy. They sent out communication to make members aware of an upcoming change to their drug coverage so they can plan ahead.

The Michigan Department of Health and Human Services (MDHHS) has worked with its health plan partners to create a list of drugs that all Medicaid health plans must cover. This list is called the Michigan Medicaid Managed Care Common Formulary.  Some former Total Health Care Medicaid now Priority Health Choice Medicaid members received letters stating (click here to view), “their medication was covered by your Total Health Care Medicaid plan but is not covered on the Common Formulary or by Priority Health Choice”. These members will need to switch to an alternative drug that is included in the Common Formulary by October 1, 2021.

Priority Health also sent letter (click here to view) to members notifying them that certain pharmacies are not in network with Priority Health Medicaid. These letters contained the names and locations of the pharmacies along with in network pharmacies located near the members.

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