Back to Insights and Updates for ProvidersFebruary 2023

MassHealth unified formulary eff. 4/1

Tufts Health Together

Effective April 1, 2023, Tufts Health Together–MassHealth MCO Plan and ACPPs, in conjunction with the other Medicaid managed care organizations (MCOs) in the Commonwealth, will be utilizing MassHealth’s Unified Formulary for pharmacy medications and for select medical benefit drugs.

As of that date, pharmacy coverage and criteria for Tufts Health Together consequently will mirror that of MassHealth. Tufts Health Together will maintain its own coverage policies for select scenarios as granted by MassHealth when appropriate, including but not limited to, quantity limit exceptions. Please note that MassHealth will be updating its opioid management strategy in April to require prior authorization of opioids exceeding 180 milligram of morphine equivalents (MME) per day when two or more opioids are being prescribed.

For medical drug benefit coverage, in some cases we will utilize the Unified Formulary coverage and criteria, while in others Point32Health criteria will apply. Our website will specify when MassHealth coverage will be followed. If MassHealth coverage is not followed, Point32Health criteria applies and can also be accessed on our provider website.

Members and providers are encouraged to review the MassHealth Drug List for pharmacy drug coverage and criteria, as well as the medical necessity guidelines found in the Resource Center on the Tufts Health Plan provider website.

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