2026 Medicare Advantage Formulary Updates

Highmark will be updating its Medicare Part D formularies on Jan. 1, 2026. These changes are designed to ensure our members have access to affordable and effective prescription medications.

Key Updates

Some medications may be removed from the formulary or have new restrictions. To identify if a drug status or restriction has been updated, review the 2026 formulary.

Accessing the Medicare Formularies

On the Provider Resource Center (PRC):

• Select your region from the dropdown menu in the upper right corner.
• Navigate to Policies & Programs > Formulary > Medicare Formulary.

Member and Provider Communication

Starting in mid-November, Highmark will send letters to both prescribing providers and members outlining the specific changes to the Medicare Part D formularies.

If your patients are taking medications affected by these changes, please consider the following options:

• Prescribe a covered formulary alternative.
• Submit a coverage determination request.

Submitting Coverage Determination Requests

Coverage determination requests for the 2026 plan year can be submitted beginning Nov. 17, 2025. Highmark will review all requests and notify both you and the member of the decision.

CoverMyMeds

You can initiate a coverage determination through CoverMyMeds, which is available via Availity Essentials, Highmark’s provider portal. Once you log in, select your state, click Payer Spaces, choose your Highmark plan, and then find CoverMyMeds under Applications.