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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