Formulary updates

Page last updated on: 8/20/25

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. 

Medicaid Common Formulary Updates

Pharmacy benefit drug coverage for Priority Health Choice Inc. Medicaid plans is determined by the Common Formulary. The Medicaid Common formulary workgroup meets once quarterly to review drugs and criteria. Coverage decisions are posted by MDHHS. Find out more.

Use the Medicaid Approved Drug List to understand what is currently covered and how.