The Priority Health Pharmacy & Therapeutics (P&T) Committee meets six times a year to review drugs, policies and prior authorization criteria, updating our formulary to reflect any changes in drug coverage.
P&T Committee formulary updates
July 2023 - July 2025 formulary updates
Our process for formulary updates
Our Pharmacy and Therapeutics (P&T) Committee meets 6 times a year to assess our commercial group, individual and Medicare formularies to ensure our members have access to safe and affordable therapies. Formulary changes made by our P&T committee take effect on the following dates:
- For our Medicare Part D formulary: Changes that may impact providers will take effect on January 1 of the following year, with 60 days’ notice provided.
- For our commercial group and individual formulary: Changes that may impact provider reimbursement or workflow will take effect on January 1 or July 1 of each year, with 60 days’ notice provided.
Positive formulary changes are made throughout the year, like adding new drugs to coverage or removing prior authorization requirements. Those with a large impact will be communicated to providers for awareness. We recommend reviewing our P&T Committee formulary updates (above) to determine coverage options for your patients before prescribing them a new drug.
Changes resulting from regulatory or market shifts
Occasionally, market, regulatory or drug manufacturer changes require us to make changes to our formularies outside of the regular January/July cycle. When this occurs, we’ll communicate changes as soon as possible.
Medicaid formulary information is below.