Back to Insights and Updates for ProvidersJune 2023

MassHealth Unified Formulary: pharmacy drug updates

Tufts Health Together - MassHealth MCO Plan and ACPPs

MassHealth recently announced the following updates to the MassHealth Unified Formulary, effective July 31, 2023. The table below outlines these changes, which include pharmacy products being added to the MassHealth Drug List, as well as new and updated prior authorization programs.

As we noted previously, Tufts Health Together-MassHealth MCO Plan and ACPPs, in conjunction with the other managed care organizations (MCOs) in the Commonwealth, began utilizing MassHealth’s Unified Formulary for pharmacy medications and select medical benefit drugs as of April 1, 2023. Consequently, the pharmacy coverage and criteria for Tufts Health Together mirror that of MassHealth.

Please keep in mind that updated coverage and criteria will be available on the MassHealth Drug List on or after the effective date.

Therapeutic Class Tables Being Updated
  • Agents Not Otherwise Classified 
  • Antibiotics and Anti-Infectives – Oral and Inhaled 
  • Anticoagulants and Antiplatelet Agents
  • Anticonvulsants
  • Antidepressants 
  • Antidiabetic Agents 
  • Antipsychotics 
  • Antiretroviral/HIV Therapy
  • Barbituates, Benzodiazepines, and Miscellaneous Anti-Anxiety Agents
  • Cardiovascular Agents
  • Cystic Fibrosis Agents 
  • Diabetes Medical Supplies and Emergency Treatments 
  • Gastrointestinal Drugs – Antidiarrheals, Constipation, and Miscellaneous Gastrointestinal Agents
  • Gastrointestinal Drugs – Histamine H2 Antagonists, Proton Pump Inhibitors, and Miscellaneous Gastroesophageal Reflux Agents
  • Headache Therapy
  • Immunological Agents
  • Lipid-Lowering Agents
  • Multiple Myeloma Agents
  • Multiple Sclerosis Agents
  • Neuromuscular Blocker Agents
  • Oncology Agents
  • Pediatric Behavioral Health  
  • Respiratory Agents – Oral
  • Urinary Dysfunction Agents
Drugs Moving to Prior Authorized Required Neulasta Onpro, Oxybutynin solution
Drugs Being Added to the Brand-Over-Generic List (BOGL) Pylera, Zegerid capsule, Zegerid suspension
Drugs Being Removed from the BOGL Gilenya
Quantity Limit Updates
  • Covered COVID-19 antigen self-tests (BinaxNow, CareStart, CVS COVID-19 At—Home Test, FlowFlex, Genabio, IHealth,Inteliswab, On-Go, QuickVue) will have a quantity limit of 2 kits per 28 days
  • Ozempic quantity limit updated to 1 pen per 28 days 
  • Ezallor quantity limit updated to 1 capsule per day 
Drugs Being Locked to the Medical Benefit (Utilization Management Restrictions May Apply) And Are Not Depicted Here)  Aponvie, Darzalex Faspro, Durysta, Elahere, Lamzede, Lunsumio, Miostat, Mitochol-E, Nexobrid, Pedmark, Sarclisa, Trodelvy, Veklury, Vivimusta 
Drugs Being Removed from Medical Benefit Lock Crysvita (PA), Spravato (PA, PBHMI) 
Drugs Being Added to the MassHealth Drug List (Utilization Management Restrictions May Apply) Aspruzyo (PA, QL), Atorvaliq (PA), Briumvi (PA), Furoscix (PA), Konvomep (PA), Oxybutynin 2.5 mg tablet (PA, QL), Phospholine iodide, Pradaxa pellets (PA), Rezlidhia (PA, QL), Skyclarys (PA, QL), Sunlenca (PA), Trikafta granules (PA, QL)
Drugs Being Removed from MHDL Due to Product Discontinuation  Bydureon, Brand Glucotrol IR tablet, Cafergot, DHE 45, Helidac, nizatidine solution, metoclopramide ODT, Zantac injection 

Audrey Kleinberg,
Director, Provider Relations & Communications

Annmarie Dadoly,
Senior Manager, Provider Communications

Joseph O’Riordan, Jesse Salvato, Stephen Wong,

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Graphic Designer