Commercial and Medicaid formulary changes taking effect

Commercial formulary changes take effect July 1

Each July, the Priority Health Pharmacy and Therapeutics committee makes changes to the commercial group and individual formulary to align with industry and regulatory changes and to ensure our members have access to safe and effective drugs. Beginning Jul. 1, 2025, changes will be implemented that will either add or remove a drug from the formulary, change the tier a drug is in or change the prior authorization or step therapy requirements of a drug. Site of Service changes and changes to the SaveOnSP drug list are also included.

View a full list of the July formulary changes for commercial group and individual members.

As a reminder: Stelara will be removed from coverage under the pharmacy benefit for commercial group and individual members beginning Jun. 1, 2025.

Medicaid formulary changes take effect May 1

The Michigan Department of Health and Human Services (MDHHS) works with its health plan partners to create the Medicaid Health Plan Common Formulary — a list of drugs that all Medicaid health plans must cover. The formulary is reviewed each quarter by MDHHS’s Common Formulary Workgroup. The MDHHS Common Formulary Workgroup has implemented changes that take effect on May 1, 2025. 

View a full list of Medicaid formulary changes.

How are we communicating changes to members?

Impacted members will receive a letter advising them of their drug coverage changes and what steps they can take prior to their formulary change effective date.

Want to know more?

These changes will be reviewed at our July 1 Formulary Updates Provider Webinar. Can’t make it? All webinars are recorded and posted to our website within a week of the event, so you can watch at your convenience.