MassHealth recently announced updates to the MassHealth Unified Formulary, which will take effect on Oct. 1, 2025. Tufts Health Together-MassHealth MCO Plan and Accountable Care Partnership Plans (ACPPs) utilize MassHealth’s Unified Formulary for pharmacy medications and select medical benefit drugs, and providers should be aware that updated coverage and criteria will be available on the MassHealth Drug List on or after the effective date.
Back to Insights and Updates for ProvidersAugust 2025
MassHealth updates to Unified Formulary
Tufts Health Together
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In this issue:
August 2025- Elevidys moved to non-covered due to FDA concerns
- Telehealth flexibilities for Medicare members
- Expansion of vendor program for spine and interventional pain management services
- Upcoming coverage changes for diabetic testing supplies
- Updates to CBHI-FIT program Medical Necessity Guidelines
- Preventive screenings at-home for select members
- New open access product offerings
- Updates to Targeted Case Management Services’ ICC Medical Necessity Guidelines
- 2025 Home Care Seasonal Flu Vaccine Fee Schedule
- Behavioral Health and substance use disorder tools and resources
- Reminder: One Care training requirement
- New Point32Health Hospice Payment Policy
- Coordinating care for medical and behavioral health
- Reducing 30-day readmissions
- Initiation and engagement of substance use disorder treatment (IET)
- Point32Health Medical Necessity Guideline updates
- Point32Health medical drug program updates
- Pharmacy coverage changes