Back to Insights and Updates for ProvidersMay 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 July 1, 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) Augtyro (PA, QL); Bimzelx (PA); Jylvamo (PA); Ojjaara (PA, QL); Truqap (PA, QL); Valcyte powder for oral solution (PA, QL, BP); Velphoro (PA, QL); Velsipity (PA, QL); Wainu (PA); Xolair 300 mg/mL syringe, auto-injector (PA); Zituvio (PA, QL); Zoryve foam (PA, QL)
Adding prior authorization restrictions Amoxapine; Aplenzin; Butalbital/aspirin/caffeine tablet; Calcitriol solution; Ciprofloxacin/dexamethasone otic suspension; Indomethacin suppository; Mesalamine 400 mg delayed-release capsule; Mesalamine 800 mg delayed-release tablet
Adding or updating quantity limit Bupropion extended-release 450 mg; Prevymis tablet; Vyndamax; Vyndaqel
Updating therapeutic class tables Agents not Otherwise Classified; Antibiotics and Anti-Infectives – Injectables; Antidepressants; Antidiabetic Agents; Antifungal Agents – Oral and Injectable; Anti-Obesity Agents; Antiviral Agents; Asthma/Allergy Monoclonal Antibodies; Beta Thalassemia, Myelodysplastic Syndrome, and Sickle Cell Disease Agents; Enzyme and Metabolic Disorder Therapies; Growth Hormones and Increlex; Headache Agents; Immune Suppressants – Topical; Immunological Agents; Inflammatory Bowel Disease Agents; Neuromuscular Agents – Duchenne Muscular  Dystrophy and Spinal Muscular Atrophy; Nonsteroidal Anti-Inflammatory Drugs; Nutrients, Vitamins, and Vitamin Analogs; Oncology Agents; Otic Agents
Drugs being added to MassHealth brand name preferred over generic list Denavir; Valcyte powder for oral solution
Drugs being removed from the MassHealth brand name preferred over generic list Delzicol DR; Lexiva; Noxafil suspension; Prezista; Proair HFA; Proventil; Sorilux
Drugs being locked to the medical benefit (utilization management restrictions may apply) Aphexda; Eylea HD; Loqtorzi; Lyfgenia; Mozobil; Pombiliti
Updates to pharmaceutical compounding program Adding prior authorization restrictions for all intradermal compounds
Drugs being removed from the 90-day supply program Denavir; Zovirax cream

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