Medicare AdvantageAdministrativeHigh impact
Provider News - June 2025
Security Health Plan·Provider News
Effective date
May 1, 2025
We identified it
Jun 20, 2026
Summary
Security Health Plan has made several key changes including reducing Medicare Advantage appeal timeframes from 365 to 65 days (effective May 1, 2025), removing Humira® and Stelara® from formulary requiring biosimilar switches (effective July 1, 2025), and confirming GLP-1 medications are excluded for weight loss coverage.
Action Required
Immediately: Update billing team on new 65-day appeal deadline for Medicare Advantage claims processed after May 1, 2025 (vs. previous 365 days). By July 1, 2025: Notify providers that Humira® and Stelara® will be removed from formulary for Commercial and Marketplace plans - patients must switch to preferred biosimilars. Update prior authorization workflows to reflect GLP-1 medications are excluded for weight loss indications. Train staff on Security Health Plan's provider portal requirements for claim verification and prior authorization submissions.