2027 Medicare Formulary Updates

Highmark will update its Medicare Part D formularies effective Jan. 1, 2027. These changes are designed to ensure your patients have continued access to affordable and effective prescription medications.

What Is Changing

Some medications may be removed from the formularies or become subject to new restrictions. To identify if a drug's status or restriction has been updated, you will be able to review the 2027 formularies when they are made available on the Provider Resource Center’s (PRC's) Medicare Formularies page.

Member and Provider Outreach – Starting Next Month

Beginning in mid-November 2026, Highmark will send notification letters to both prescribing providers and affected members outlining specific changes to the Medicare Part D formularies.

If your patients are taking medications affected by these updates, you may consider the following options:

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

How to Submit Coverage Determination Requests

Coverage determination requests for the 2027 plan year can be submitted beginning Nov. 16. Highmark will review all requests and notify both you and the member of the decision. You may submit a coverage determination request via:

• CoverMyMeds: Initiate a coverage determination through CoverMyMeds, which is accessible from Availity Essentials^®. (Once logged into Availity, select your state, click Payer Spaces, choose your Highmark plan, and locate CoverMyMeds under Applications.)