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. In 2017, we are introducing Conemaugh Region Connect Blue EPO in western Pennsylvania. Connect Blue EPO will be available in 2017, along with Highmark's other commercial products.

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

• Conemaugh Region Connect Blue EPO 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.
• Pennsylvania Employees Benefit Trust Find (PEBTF): Benefit Changes For 2017

Medicare Advantage Summary

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

• Key Information for Providers
• VBID Pilot: Key Information for Providers
• VBID: 2017 Blue Care Advantage Provider Directory

Formularies

Essential Formulary

• Special Bulletin announcing Commercial: Highmark Essential Formulary for ACA
• 2017 Highmark 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

• 2017 Preventive Schedule