Commercial and Medicare formulary updates coming Jan. 1, 2024

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

Commercial changes effective Jan. 1, 2024

Starting Jan. 1, 2024, 53 commercial drug changes impacting 14,166 members will go into effect. These changes will either remove a drug from the formulary, increase the tier the drug is in or add prior authorization to a drug.

Medicare changes effective January 1, 2024

Starting Jan. 1, 2024, 50 Medicare drug changes impacting 5,738 members will go into effect. We’ve made the following enhancements to the Medicare formulary, positively impacting thousands of our members:

Formulary changes

The following drug changes take effect Jan. 1, 2024, and will either add a prior authorization requirement if a diagnosis is not on file, remove the drug from formulary or increase the tier the drug is in.

Pharmacy network update

• Commercial/individual pharmacy updates
  Meijer Specialty Pharmacy will no longer be a participating network specialty pharmacy for commercial and individual members beginning Jan. 1, 2024. Find more information here

Medicare pharmacy updates

• Kroger pharmacy will no longer be a participating network pharmacy for Medicare members effective Jan. 1, 2024.
• Orsini Specialty Pharmacy will no longer be a participating network specialty pharmacy for Medicare members effective Jan. 1, 2024. Providers are encouraged to submit new prescriptions to our in-network specialty pharmacies, Accredo or Corewell Health Specialty Pharmacy 

Learn more

If you’d like to learn about our 2024 formulary changes, join us Dec. 14 at our Virtual Office Advisory.