OSP News

Priority Health Formulary Changes Coming July

Posted: 05/04/2023

In January and July of each year, the Priority Health Pharmacy and Therapeutics committee make changes to the commercial and individual formularies to ensure members have access to safe, effective and affordable drugs.

Commercial formulary changes effective July 1, 2023

This year Priority Health has made more than 100 enhancements to the commercial formulary, including 51 new drugs along with changes to 53 current drugs. Effective July 1, 2023, nine drug changes will go into effect that will either increase the drug tier, increase cost share or add prior authorization requirements.

Continuous glucose monitor (CGM) changes

Priority Health is also making changes to continuous glucose monitor (CGM) devices and supplies that will impact members. Freestyle Libre and Dexcom G6 continuous glucose monitor (CGM) devices and supplies will require a confirmed pharmacy claim for insulin within the last six months prior to coverage, which will affect optimized and traditional formularies.

Pharmacy claims for other drugs, such as GLP-1, DPP-4, and SGLT2 medications, will not qualify in place of insulin. These changes will have an impact on a total of 1,302 members. Coverage for the Dexcom G7 CGM devices and supplies (previously non-formulary) will be added to the traditional and optimized formularies with the same restrictions.

Click here to learn more about the changes coming July 1st from Priority Health.

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