MassHealth recently announced updates being made to the Unified Formulary effective Jan. 5, 2026, as well as additional updates which will take effect on Feb. 17, 2026. Tufts Health Together - MassHealth ACPPs utilize MassHealth’s Unified Formulary for pharmacy medications and select medical benefit drugs, and providers should be aware that updated coverage and criteria will be available on the MassHealth Drug List, on or after the respective effective dates. To view a list of the medical benefit drugs that are unified with MassHealth, refer to Point32Health’s Unified Medical Policies in the Medical Benefit Drug Medical Necessity Guidelines section of our provider website. 

Also effective Jan. 1, 2026, prior authorization requirements for the following therapeutic drug classes, unless otherwise specified by Executive Office of Health and Human Services (EOHHS), will be aligned with MassHealth for medical billing in the hospital outpatient setting:

  • Complement inhibitors
  • Multiple myeloma
  • Multiple sclerosis
  • Oncology immunotherapies
  • Targeted immunotherapies

As a result of this change, prior authorization will be required for the following medical benefit drugs:

  • Arcalyst
  • Bavencio
  • Bizengri
  • Cimzia
  • Darzalex
  • Darzalex Faspro
  • Empliciti
  • Imfinzi
  • Imjudo
  • Jemperli
  • Keytruda
  • Kyprolis
  • Libtayo
  • Loqtorzi
  • Opdivo
  • Opdivo Qvantig
  • Sarclisa
  • Tecentriq
  • Tecentriq Hybreza
  • Tevimbra
  • Tremfya
  • Yervoy
  • Zynyz

Providers can find detailed information on the Mass.gov Hospital Outpatient PA MHDL Unified Class Drugs list. Please note that drugs that are only available in a self-administered formulation will be limited to the pharmacy benefit.