URL Insurance Group

This email is intended for producers with business in Delaware, New York, Pennsylvania, and West Virginia.

Highmark April 2026 Formulary Overview: Prescription Drug Management Updates

Highmark wants to ensure our members get safe and cost-effective treatment options. We regularly review the most current research and make necessary adjustments to formularies for member safety and cost effectiveness.

Highmark Pharmacy Services is implementing changes on April 1, 2026, for Commercial and Healthcare Reform members. Changes include:

Step Therapy (requiring trials of preferred drugs first)
Quantity Limits (restricting the amount of certain medications)

An overview of the formulary updates is attached for your reference.

Highmark April 2026 Formulary Overview: Prescription Drug Management Updates (Blue Cross Blue Shield branded)
Highmark April 2026 Formulary Overview: Prescription Drug Management Updates (Blue Shield branded)

Affected members will receive letters and should contact Member Service with benefit-related questions or to discuss alternative treatment options.

Where do I go with questions?

Please contact your Sales Executive or Client Manager with any additional questions.

Benefits and/or benefit administration may be provided by or through the following entities, which are independent licensees of the Blue Cross Blue Shield Association:
Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc., Highmark Benefits Group Inc., First Priority Health, First Priority Life or Highmark Senior Health Company.
Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company.
PA: Your plan may not cover all your health care expenses. Read your plan materials carefully to determine which health care services are covered. For more information, call the number on the back of your member ID card or, if not a member, call 866-459-4418.
Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield.
West Virginia: Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Health Insurance Company or Highmark Senior Solutions Company. Visit https://www.highmarkbcbswv.com/networkaccessplan to view the Access Plan required by the Health Benefit Plan Network Access and Adequacy Act. You may also request a copy by contacting us at the number on the back of your ID card.
Western NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield.
Northeastern NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Shield.
Highmark Blue Cross Blue Shield and Highmark Blue Shield are Medicare Advantage HMO, PPO, and/or Part D plans with a Medicare contract. Enrollment in these plans depends on contract renewal.
All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration and/or to one or more of its affiliated Blue companies.

This email was sent by: Highmark, Inc.-
Fifth Avenue Place 120 5th Ave., HARRISBURG, PA, 17089 US

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