Medicaid Health Plan Pharmacy Benefit

This webpage is designed to provide easy access for members and providers looking for information on the drugs and supplies covered by Michigan Medicaid Health Plans.

All plans must at a minimum cover the drugs listed on the Medicaid Health Plan Common Formulary.

General Formulary Information

FOR PROVIDERS AND PRESCRIBERS ONLY
Prior Authorization (PA) Step Therapy

The Prior Authorization criteria for drugs indicated on the Medicaid Health Plan Common Formulary as requiring PA is below:

Drug PA Criteria

A standard prior authorization form, FIS 2288, was created by the Michigan Department of Insurance and Financial Services (DIFS) to simplify the process of requesting prior authorization for prescription drugs. This form or a prior authorization used by a health plan may be used.

The Step Therapy criteria for drugs indicated on the Medicaid Health Plan Common Formulary as requiring ST is below:

Step Therapy Criteria

 

Medicaid Common Formulary Workgroup Members

Scroll down for health plan specific information.

 

MEDICAID HEALTH PLANS

Plans may choose to include additional drugs that are not on the Medicaid Health Plan Common Formulary in their own drug formularies. In addition, plans may enforce drug utilization management policies such as quantity limits, age and gender edits, prior authorization criteria and step therapies that are less restrictive than the coverage parameters of the Medicaid Health Plan Common Formulary. Click on the health plans below for more information about their formularies and pharmacy related contact information.

 

Aetna logo

 

Blue Cross Complete of Michigan Logo

 

HAP Midwest Health Plan Logo

 

 

Harbor Health Plan

 

McLaren Health Plan

 

Meridian Health Plan

 

 

Molina Healthcare

 

Priority Health

 

Total Health Care

 

UnitedHealthcare Community Plan

 

Upper Peninsula Health Plan

 

 

 

RESOURCE INFORMATION

     BENEFICIARIES
Current beneficiaries can find out which health plan they are enrolled in by calling the Beneficiairy Help Line at 800-642-3195 (TTY 866-501-5656) or by logging in to their myHealth Portal account online at www.michigan.gov/myhealthportal.

   

     PROVIDERS
For more information on the drug benefit for people not enrolled in a health plan (Fee-for-Service Medicaid) visit http://michigan.fhsc.com.

For more general information on Michigan Medicaid Health Plans, visit www.michigan.gov/managedcare.

   

    STAKEHOLDER MEETINGS AND COMMENT PERIOD

October 24,2016 Stakeholder Meeting Presentation

Stakeholder Meeting Questions and Answers

Frequently Asked Questions for Drug Manufacturers   

Public Comment on MDHHS Medicaid Health Plan Common Formulary

The Michigan Department of Health and Human Services (MDHHS) is soliciting comments from the public on the Michigan Medicaid Health Plan Common Formulary.  The Common Formulary applies to pharmacy claims paid by Medicaid Managed Care Organizations – it will not apply to claims paid through Fee-for-Service.  The public may submit comments on the drugs included or not included on the Common Formulary, new drug products, prior authorization criteria, step therapy criteria and other topics related to drug coverage under the Common Formulary.  The comments will be reviewed by MDHHS and the Michigan Medicaid Health Plan Common Formulary Workgroup.  The next drug classes to be reviewed by the Workgroup include Anti-Infective, Respiratory and Contraceptives.  Changes may be made to the Common Formulary based on comments received.  Comments will be solicited once per calendar quarter. 

The Michigan Medicaid Health Plan Common Formulary can be found above.

Please send your comments by June 23, 2017 to:

Linda VanCamp, Formulary Analyst 
Bureau of Medicaid Care Management & Quality Assurance 
Medical Services Administration 
P.O. Box 30479 
Lansing, Michigan 48909-7979 
 
Telephone Number: 517-373-9252 
Fax Number: 517-763-0142 
E-mail Address: VanCampL@michigan.gov