MassHealth recently announced the following updates to the MassHealth Unified Formulary, effective Dec. 4, 2023. The table below outlines these changes, which include pharmacy products and medical drugs being added to the MassHealth Drug List, as well as new and updated prior authorization programs.
Tufts Health Together-MassHealth MCO Plan and ACPPs, in conjunction with the other managed care organizations (MCOs) in the Commonwealth, now utilize MassHealth’s Unified Formulary for pharmacy medications and select medical benefit drugs. 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 (MHDL) on or after the effective date.
|Adding to MHDL||Balfaxor, Brixadi (PA), Rezvoglar (PA), Sogroya (PA), zolpidem 7.5 mg capsule (PA)|
|Therapeutic class tables being updated||Agents not Otherwise Classified; Antibiotics and Anti-Infectives – Oral and Inhaled; Anticoagulants and Antiplatelet Agents; Anticonvulsants; Antidepressants; Anti-Hemophilia Agents; Cardiovascular Agents; Cerebral Stimulants and Miscellaneous Agents; Dermatologic Agents – Topical Chemotherapy, Genital Wart Treatment, and Miscellaneous Dermatologic Agents; Drug and Alcohol Cessation Agents; Enzyme Replacement and Substrate Reduction Therapies; Gastrointestinal Drugs – Antidiarrheals, Constipation, and Miscellaneous Gastrointestinal Agents; Growth Hormones and Increlex; Hypnotics; Immunological Agents; Inflammatory Bowel Disease Agents; Opioids and Analgesics; Pediatric Behavioral Health; Pulmonary Hypertension Agents; Respiratory Agents – Inhaled|
|Drugs being removed from the MassHealth brand name preferred over generic list||Asacol HD, Canasa, Coreg CR, Veletri, Viibryd, Zytiga 500 mg tablet|
|Drugs being locked to the medical benefit (utilization management restrictions may apply)||Astiladrin, Nexviazyme, Roctavian, Skysonsa, Zynyz|
|Removing from MassHealth Drug list due to product discontinuation||Bunavail, Probuphine|
|Drugs being added to the Mandatory 90 day (M90) program||Kombiglyze XR, metformin immediate-release 625 mg tablet, Onglyza|
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