MCO Common Formulary Stakeholder Meeting

Updates


In order to streamline drug coverage policies for Medicaid and Healthy Michigan Plan beneficiaries and providers, the Michigan Department of Health and Human Services has decided to pursue a formulary that is common across all contracted health plans for the next Comprehensive Health Plan contract.  A Common Formulary will better align coverage across health plans.  The intent is to reduce interruptions in a beneficiary’s drug therapy due to a change in health plan.

The Common Formulary also includes certain drug utilization management tools, such as prior authorization criteria and step therapies.  Health plans may be less restrictive, but not more restrictive, than the coverage parameters of the Common Formulary.

The list of drugs that are currently covered under the Fee-for-Service benefit will remain unchanged.

To promote safe medication transitions and minimize the burden on prescribers and patients, all contracted health plans will be required to follow one set of policies and procedures on transition of care and grandfathering of drug therapy.

Timeline:

  • January 1, 2016: After the draft Common Formulary is reviewed and approved by the Department it will be finalized and posted on the Department’s website
  • January 1, 2016-March 31, 2016: Contracted health plans code and test Common Formulary in their claims systems
  • April 1, 2016: Health plans start to transition members to the Common Formulary
  • September 30, 2016: All members are transitioned to the Common Formulary

Once the Common Formulary is finalized it will be reviewed on a quarterly basis.  During these reviews new medications that are FDA-approved will be evaluated after they have been available in the marketplace for at least six months.

The Department’s Preferred Drug List Supplemental rebates will continue to apply to the Fee-for-Service program, and will not be part of this project.  Available Federal Medicaid rebates will continue to be invoiced for both the Fee-for-Service and MCO lines of business.

The purpose of the stakeholder meetings is to provide a forum for the public to comment on the Common Formulary.  Please note that drug rebates, the Fee-for-Service formulary, and drugs that are covered under the Fee-for-Service benefit are not being reviewed as part of this project.  In addition, the stakeholder meetings are not intended to be a venue for pharmaceutical drug product-specific presentations.