MassHealth recently announced the following updates to the MassHealth Unified formulary, effective June 5, 2023. The table below outlines these changes, which include pharmacy products being added to the MassHealth Drug List, as well as new and updated prior authorization programs.
As we noted previously, Tufts Health Together-MassHealth MCO Plan and ACPPs, in conjunction with the other managed care organizations (MCOs) in the Commonwealth, will begin utilizing MassHealth’s Unified Formulary for pharmacy medications and select medical benefit drugs as of April 1, 2023. Consequently, the pharmacy coverage and criteria for Tufts Health Together consequently will mirror that of MassHealth.
Please keep in mind that updated coverage and criteria will be available on the MassHealth Drug List on or after the effective date.
Pharmacy coverage changes: New and updated prior authorization programs (Effective 6/5/2023)
| Type of update | Drug |
| Criteria update | Abilify Maintena, Abilify MyCite, Adempas, Adhansia XR, Adlyxin, Admelog, Afrezza, Alavert, Allegra ODT/suspension, Antipsychotic polypharmacy in adults, Antipsychotic quantity limits, Aranesp, Aripiprazole ODT/solution, Asenapine SL tablet, Auvi-Q, Azasite, Azelastine 0.15% nasal spray, Azstarys, Bacitracin ophthalmic ointment, Basaglar KwikPen, Bijuva, Brexafemme, Bydureon BCise, Caplyta, Carbinoxamine 6 mg tablet, Karbinal ER, Cimduo, Clarinex-D, Claritin Chewtabs/Liqui-gel capsule/Reditabs/ODT, Clonidine ER, Clozapine ODT, Concomitant Opioids and Benzodiazepines (COBI), Corticotropin (Acthar, Cortrophin), Cosentyx, Cotempla XR-ODT, Daurismo, Desipramine, Desloratadine tablet/ODT, Dexamethasone tablet pack, Dexchlorpheniramine solution, Dexcom G6, Dexcom G7, Duetact, Dupixent, Efavirenz/lamivudine/ tenofovir disoproxil fumarate (generic Symfi, Symfi Lo), Emflaza, Epogen, Evekeo ODT, Exkivity, Fanapt, Fiasp, FreeStyle Libre 14 Day, FreeStyle Libre 2, FreeStyle Libre 3, Gilotrif, Glyxambi, Grastek, Growth hormones (Genotropin, Humatrope, Norditropin, Nutropin AQ, Omnitrope, Saizen, Serostim, Sytrofa, Zomacton), Hemady, Ibrance, Immune globulin (Asceniv, Bivigam, Cutaquig, Cuvitru, Flebogamma, Gamastan S/D, Gammagard, Gammagard S/D, Gammaked, Gammaplex, Gamunex-C, Hizentra, Hyqvia, Octagam, Panzyga, Privigen, Xembify), Invega tablet, Isturisa, Jornay PM, Jynarque, Kazano, Korlym, Levocetirizine solution, Levofloxacin ophthalmic solution, Lumakras, Lurasidone, Lybalvi, Lynparza, Lyumjev, Marplan, Megestrol 625 mg/5 mL suspension, Metformin ER osmotic tablet, Metformin immediate-release solution, Methylphenidate extended-release (generic Aptensio XR, Ritalin LA), Methylphenidate extended-release CD, Miglitol, Mounjaro, Neomycin/polymyxin B/hydrocortisone ophthalmic solution, Nesina, Noxafil injection, Nucala, Nuplazid, Odactra, Ofev, Omnipod Classic, Omnipod Dash, Omnipod 5, Oseni, Ozempic, Padcev, Patanase, Perphenazine/amitriptyline, Perseris, Pirfenidone 267 mg, 801 mg, Pred-G, Prednisolone 10 mg/5 mL oral solution, Prednisolone 20 mg/5mL oral solution, Prednisolone ODT, Prednisolone tablet, Procrit, Protriptyline, Qbrexza, Quillichew ER, Quillivant XR, Qtern, Ragwitek, Rayos, Retacrit, Revatio suspension, Rexulti, Riomet ER, Risperidone ODT 3 mg, 4 mg, Rozlytrek, Rubraca, Rybelsus, Rybrevant, Secuado, Segluromet, Semglee, Sirturo, Soliqua, Steglatro, Steglujan, Sotyktu,Tagrisso, Taperdex, Tarpeyo, Temixys, Trijardy XR, Trimipramine, Trogarzo, Ursodiol (Reltone), V-Go, Versacloz, Vitrakvi, Vivjoa, Vraylar, Xolair, Xultophy, Zejula, Zokinvy, Zyrtec chewable tablet/Liquid Gels/ODT |
| Removing from MassHealth Drug List due to product discontinuation | Avandia, Bleph-10, Blephamide, Entocort EC, Fortamet, Maptroline, Moxeza, Phenergan, Starlix, Viramune, Viramune XR, Zorbtive |
| Adding prior authorization restrictions | Fetzima |
| Criteria update, quantity limit added | Erivedge, Hyftor, Odomzo, Rinvoq |
| Will be locked to medical benefit | Daunorubicin, Gemcitabine, Jemperli, Opdualag, Tivdak, Vyxeos |
| New strength being added to MassHealth Drug List, criteria update | Tascenso ODT |
| New Drugs Being Added to MassHealth Drug List – Effective 6/5/2023 (utilization management restrictions may apply) | Auvelity, Basaglar Tempo, Dyanavel XR chewable tablet, Drysol, Humalog Tempo, Fylnetra, Imjudo (will be locked to medical benefit), Krazati, Lytgobi, Lyumjev Tempo, Noxafil powder for oral suspension, Oravig, Orserdu, Pirfenidone 534 mg tablet, Quetiapine 150 mg tablet, Rebyota, Relexxi, Rolvedon (will be locked to medical benefit), Ryplazim, Stimufend, Tadliq,Tecvayli (will be locked to medical benefit) Tzield, Vegezelma (will be locked to medical benefit), Xelstrym, Xenpozyme (will be locked to medical benefit), Zynteglo (will be locked to medical benefit), Zonisade, Ztalmy |
| Drugs Being Added to the MassHealth Brand Name Preferred Over Generic List | Advair HFA, Denavir, Hetlioz, Mycobutin, Vyvanse capsule, Vyvanse chewable tablet, Zioptan |
| Drugs Being Removed from the MassHealth Brand Name Preferred Over Generic Drug List | Evamist, Jublia, Sandostatin LAR, Strattera |
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