WellFirst Health provider communications

Provider information

We release communications to in-network providers about changes to health plan procedures, policies and benefits, as well as information about larger initiatives. This page lists some of our issued notifications for reference.




Growing with a new partner - What to expect in 2023

Upcoming changes as we partner with Medica to align best practices and share technology.
Issued: January 2023
Audience: All in-network providers

What to expect in 2023

Plan and benefits changes for 2023

2023 member plan and benefit highlights for provider awareness.
Issued: November 2022
Audience: All in-network providers
Effective date: 1/1/23

See 2023 changes

New Claim Appeals Portal Application

WellFirst Health is transitioning the Claim Appeals application in the Provider Portal.
Issued: August 2022
Audience: All in-network providers
Effective date: 8/24/22

View new claim appeals portal application

Plan and benefit changes for 2022

Annual notification with member-centered plan and benefit topics for provider awareness for 2022.
Issued: November 2021
Audience: All in-network providers
Effective date: 1/1/22

See 2022 changes

New drugs are not covered until reviewed and approved by P&T Committee

FDA approved drugs that are new to the market will not be covered until they are reviewed and approved by P&T Committee.
Issued: September 2021
Audience: All in-network providers
Effective date: 12/1/21

See P&T Committee change

Other information


Medical and drug policy updates

Audience: all in-network providers

Pharmacy material change notices

For pharmacy updates issued on and after April 1, 2022, see the medical and drug policy updates listed on this page.

Audience: All in-network providers 

ALDURAZYME-laronidase, ARANESP-darbepoetin alpha, ELAPRASE-idursulfase, ELELYSO-taliglucerase alfa, Epoetin Alfa Products, NAGLAZYME-galsulfase, VIMIZIM-elosulfase, and retired policy
Issued: February 2022
Effective date: 6/1/2022

Xeljanz (tofacitinib), Rinvoq (upadacitinib, Benlysta (belimumab, GAZYVA-obinutuzumab, SPINRAZA-nusinersen and retired policies
Issued: February 2022
Effective date: 5/1/2022

INFUGEM-gemcitabine, Parenteral Iron products and retired policy 
Issued: December 2021
Effective date: 4/1/2022

CRYSVITA (burosumab)
Also includes changes to fax and phone numbers on Medical Benefit Drug Prior Authorization Forms and the new Pharmacy and Therapeutics Committee review process.
Issued: December 2021
Effective date: 3/1/2022

Medicare Part B Step Therapy, ORENCIA (abatacept-IV) SIMPONI ARIA (golimumab), FLOLAN-epoprostenol-REMODULIN-treprostinil and New Drug Policies for Medicare Advantage
Issued: October 2021
Audience: All in-network providers
Effective date: 2/1/2022 & 4/1/2022

Medically Administered Oncology Products, Pegfilgrastim Products, PROLIA, XGEVA and Retired Policies
Issued: October 2021
Audience: All in-network providers
Effective date: 1/1/2022