Back to Insights and Updates for ProvidersMarch 2024

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 May 6, 2024. The table below outlines these changes. Tufts Health Together-MassHealth MCO Plan and ACPPs utilize 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) Agamree (PA); Anzemet tablet (PA); FreeStyle Libre 3 reader (PA, QL); Fruzaqla (PA, QL); Jesduvroq (PA); Likmez (PA); Motpoly XR (PA); Penbraya (QL); Rozlytrek pellet (PA, QL); Sohonos (PA); Suflave (PA); Takhzyro 150 mg/mL (PA); Vanflyta (PA, QL); Xalkori pellet (PA); Vevye (PA, QL); Voquezna (PA, QL); Xdemvy (PA, QL)
Adding or updating quantity limit Marinol; Testosterone 1% gel 2.5 gram packet; testosterone 1.62% gel 1.25 gram packet
Adding or updating prior authorization restrictions Alendronate solution (PA); coenzyme Q10 (PA for 21 years of age and older); Namzaric (PA); tolnaftate liquid (PA)
Updating therapeutic class tables Acromegaly, Carcinoid Syndrome, and Cushing’s Syndrome Agents; Agents Not Otherwise Classified; Alzheimer’s Agents; Androgens; Anti-Allergy and Anti-Inflammatory Agents – Ophthalmic; Antibiotics and Anti-Infectives – Oral and Inhaled; Anticonvulsants; Antidepressants; Antiemetics, Appetite Stimulants, and Anabolics; Antidiabetic Agents; Antifungal Agents – Topical; Antiglaucoma Agents – Ophthalmic; Anti-Hemophilia Agents; Anti-Obesity Agents; Antiparkinsonian Agents; Antipsychotics; Cardiovascular Agents; Antiretroviral/HIV Therapy; Diabetes Medical Supplies and Emergency Treatments; Gastrointestinal Drugs – Antidiarrheals, Constipation, and Miscellaneous Gastrointestinal Agents; Hematologic Agents – Hematopoietic and Miscellaneous Hematologic Agents; Hereditary Angioedema Agents; Immunological Agents; Lipid-Lowering Agents; Nonsteroidal Anti-Inflammatory Drugs; Oncology Agents; Osteoporosis and Bone Metabolism Agents; Pediatric Behavioral Health; Serums, Toxoids, and Vaccines; T-Cell Immunotherapies; Thrombocytopenic Agents
Drugs being added to the MassHealth brand name preferred over generic list Emflaza; Farxiga; Isentress; Marinol; Restasis; Sprycel; Toujeo; Xigduo XR
Drugs being removed from the MassHealth brand name preferred over generic list Fortesta; Kazano; Luzu; Nesina; Oseni; Oxistat cream; Pennsaid; Pristiq; Rapamune solution; Welchol
Drugs being locked to the medical benefit (utilization management restrictions may apply) Elrexfio; Izervay; Mylotarg; Portrazza; Rybrevant; Talvey; Veopoz; Zepzelca; Zilretta
Drugs being removed from the medical benefit lock (utilization management restrictions may apply) Vyvujek
Drugs being added to the mandatory 90-day supply (M90) program Farxiga; Xigduo XR
Drugs being added to the allowable 90-day supply (A90) program Bromsite; Korlym
Removing from MHDL due to product discontinuation Adlyxin; Aloxi; Bydureon; etidronate; Loprox 1% shampoo; Natpara; ondansetron 24 mg; Varubi injection

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