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||
|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||
|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|
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