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.





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: 8/24/2022

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: 1/1/2022

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: 12/1/2021

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