MassHealth recently announced the following updates to the MassHealth Unified Formulary, effective March 4, 2024. The table below outlines these changes. Tufts Health Together-MassHealth MCO Plan and ACPPs utilizes MassHealth’s Unified Formulary for pharmacy medications and select medical benefit drugs. Please keep in mind that updated coverage and criteria will be available on the MassHealth Drug List on or after the effective date.
| Adding to MassHealth Drug List (MHDL) | Abrilada (PA); adalimumab-aacf,unbranded (PA); adalimumab-fkip, unbranded (PA); adalimumab-adaz, unbranded (PA); adalimumab-adbm, unbranded (PA); ADEK Gummies (PA); Airsupra (PA); Akeega (PA, QL); Amjevita (PA); Austedo XR (PA, QL); Cyltezo (PA); Filspari (PA, QL); Hadlima (PA); Hulio (PA); Hyrimoz (PA); Idacio (PA); Iheezo (PA); Inpefa (PA, QL); Iyuzeh (PA); Liqrev (PA); Litfulo (PA, QL); Mekinist oral solution (PA, QL); Miebo (PA, QL); Ngenla (PA); Opvee (PA, QL); Rezzayo (PA, QL); Rykindo (PA, QL, PBHMI); Tafinlar oral solution (PA, QL); Veozah (PA, QL); Yuflyma (PA); Yusimry (PA); Zavzpret (PA, QL), Zurzuvae (PA, QL, PBHMI) |
| Adding or updating quantity limit | Dyanavel, Opium tincture, Quillivant, Zejula |
| Updating therapeutic class tables | Agents not Otherwise Classified; Anesthetics – Topical; Anti-Allergy and Anti-Inflammatory Agents – Ophthalmic; Antibiotics and Anti-Infectives – Oral and Inhaled; Antibiotics – Topical; Antidepressants; Antidiabetic Agents; Antifungal Agents – Oral and Injectable; Antiglaucoma Agents – Ophthalmic; Anti-Obesity Agents; Antipsychotics; Asthma/Allergy Monoclonal Antibodies; Barbituates, Benzodiazepines, and Miscellaneous Antianxiety Agents; Beta Thalassemia, Myelodysplastic Syndrome, and Sickle Cell Disease Agents; Cardiovascular Agents; Cerebral Stimulants and Miscellaneous Agents; Dermatological Agents – Topical Chemotherapy, Genital Wart Treatment, and Miscellaneous Dermatologic Agents; Diabetes Medical Supplies and Emergency Treatments; Drug and Alcohol Cessation Agents; Gastrointestinal Drugs – Antidiarrheals, Constipation, and Miscellaneous Gastrointestinal Agents; Growth Hormones and Increlex; Headache Therapy; Hematologic Agents – Hematopoietic and Miscellaneous Hematologic Agents; Hepatitis Antiviral Agents; Immunological Agents; Lipid-Lowering Agents; Neuromuscular Agents – Duchenne Muscular Dystrophy and Spinal Muscular Atrophy; Nutrients, Vitamins, and Vitamin Analogs; Oncology Agents; Opioids and Analgesics; Osteoporosis and Bone Metabolism Agents; Pediatric Behavioral Health; Pharmaceutical Compounds; Pulmonary Hypertension Agents; Respiratory Agents – Inhaled; T-Cell Immunotherapies; Vesicular Monoamine Transporter 2 (VMAT2) Inhibitors |
| Drugs being removed from the MassHealth brand name preferred over generic list | Lotronex |
| Drugs being locked to the medical benefit (utilization management restrictions may apply) | Columvi, Elevidys, Enhertu, Epkinly, Ketalar, Kimmtrak, Qalsody, Rystiggo, Sandimmune injection, Sezaby, Simulect, Vyvgart Hytrulo, Vyvujek, Ycanth |
| Drugs being added to the mandatory 90-day supply (M90) program | Carospir, Livalo |
| Removing from MHDL due to product discontinuation | Adalat, Adhansia XR, Adzenys ER, Albenza, Aldactazide, Aldara, Brisdelle, Intron A, metoprolol/hydrochlorothiazide, Navelbine, Ranexa, Seconal, Tranxene, Vecamyl, Verelan |
| Updates to compounding program | Compounded transdermal products will require PA. |
| Updates to Concomitant Opioid and Benzodiazepine Initiative (COBI) | COBI will be updated such that either the benzodiazepine or opioid could reject at the pharmacy for PA if used concomitantly. Concomitant use will be defined as 15 or more days of an opioid and a benzodiazepine within the past 45 days. |