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.


2017 Commercial Summary

Highmark offers a variety of commercial products to meet our members' needs. In 2017, we are introducing a new individual plan, my Connect Blue WV PPO, in the West Virginia market. my Connect Blue WV PPO will be available in 2017, along with Highmark West Virginia's other commercial products.

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

  • my Connect Blue WV PPO Information
  • Locating Your Participation Status via NaviNet
  • Find a Doctor: When you refer a Highmark member to another provider for care, please remember that in-network providers offer lower member cost sharing. Use our Find a Doctor tool, also available via the Provider Directory link on the left menu, to locate in-network providers. You can view those who are participating at the Preferred Value, Enhanced Value or Standard Value Benefit Levels, when applicable.

2017 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 5/10/2017

 

To Top