Payer Updates | November 2025

For a curated summary of the latest payer updates* impacting Northern Michigan provider offices, grouped by payer then category, please see below:

BCBSM and BCN

All Providers: Beginning Jan. 1, Blue Cross commercial self-funded groups will move to Exclusive Specialty Network. SOURCE

All Providers: BCBSM and BCNA 2026 Medicare Advantage retired and new plans. SOURCE

Primary Care and Endocrinology: BCBSM and BCN Commercial changing coverage for continuous glucose monitors. SOURCE

Priority Health

All Providers: Priority Health has updated their resource for drug coverage review. Feedback back is requested on Priority Health’s new drug list format by emailing ph-pharmacybusinessopswebsite@priorityhealth.com.

*News items from the following payers were reviewed for this month’s highlighted articles: Aetna, BCBSM, Blue Care Complete, Blue Care Network (BCN), Health Alliance, McLaren, Molina, and Priority Health.