Highmark 2017: Important Product News

For your convenience, the following links summarize what our network providers need to know about our 2017 product changes, enhancements and innovations, for both commercial and Medicare Advantage.


Commercial Summary

Highmark offers a variety of commercial products to meet our members' needs. For 2017, we will be introducing Lehigh Valley Flex Blue in central Pennsylvania , as well as my Lehigh Valley Flex Blue HMO and my Priority Blue Flex HMO in northeastern Pennsylvania. These new products will be available beginning Jan. 1, 2017, along with Highmark's other commercial products

We've gathered the following resources to answer some common questions from our network providers.


Medicare Advantage Summary

Access the following important updates and information regarding our Medicare Advantage products for 2017.


Formularies

Essential Formulary

MA Closed Formulary

The complete list of drugs included in the MA Closed Formulary is available online at 2017 Medicare-Approved Closed Formulary.

  • Four drugs added; one drug deleted
  • Prior Authorization added to 11 drugs
  • Quantity Level Limits added to 71 drugs; modified for nine drugs
  • Drugs moved to a higher tier (continue to have a mixed-tier structure)
    • Tier 3 = five drugs
    • Tier 4 = 17 drugs

MA Incentive Formulary

The complete list of drugs included in the MA Incentive Formulary is available online at 2017 Medicare-Approved Incentive Formulary.

  • Added two drugs (Tier 5/Specialty with Prior Authorization)
  • Prior Authorization added to 19 drugs
  • Quantity Level Limits added to 107 drugs; modified for four drugs
  • Drugs moved to a higher tier
    • Tier 3 = six drugs
    • Tier 4 = 18 drugs

Preventive Schedules

Last updated on 10/5/2017

 

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