Back to Insights and Updates for ProvidersNovember 2023

MassHealth updates to Unified Formulary

Tufts Health Together - MassHealth MCO Plan and ACPPs

MassHealth recently announced the following updates to the MassHealth Unified Formulary, effective Jan. 2, 2024. 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, 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  Daybue (PA), Elfabrio (PA), Jaypirca (PA), Joenja (PA),
Adding prior authorization Brimonidine/timolol ophthalmic solution, Lumigan, omeprazole/sodium bicarbonate suspension, penciclovir
Therapeutic class tables being updated  Anti-Allergy and Anti-Inflammatory Agents – Ophthalmic, Antibiotics and Anti-Infectives, Antidiabetic Agents, Antiglaucoma Agents – Ophthalmic, Antiviral Agents, Gastrointestinal Drugs – Histamine H2 Antagonists, Osteoporosis and Bone Metabolism Agents, Proton Pump Inhibitors, and Miscellaneous Gastroesophageal Reflux Agents, Headache Therapy, Immunological Agents, Respiratory Agents – Inhaled
Adding Quantity Limit  Byetta, Trulicity, Victoza
Drugs being locked to the medical benefit (utilization management restrictions may apply)  Hemgenix, Omisirge
Drugs being removed from MassHealth brand over generic list (utilization management restrictions for generic noted in parentheses) Combigan (PA), Denavir (PA), Glumetza (PA), Imitrex nasal spray (QL), Miacalcin injection (PA), Restasis, Zegerid suspension (PA), Zyvox suspension (PA)

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Senior Manager, Provider Communications

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