Medicaid Health Plan Pharmacy Benefit

 

**************************************************************************************************************************
MDHHS MEETING ANNOUNCEMENT

Michigan Medicaid Health Plan Common Formulary Stakeholder Meeting

When:       October 1, 2020, from 9:30 a.m. to 12 noon

Where:      The Common Formulary Stakeholder meeting on October 1, 2020, will not be held at the LCC Campus. A virtual web type meeting will be held instead. The Governor’s Executive Order 2020-154 provides authority for remote participation in public meetings. To attend the Common Formulary Stakeholder Meeting at 9:30 a.m. connect via:

Join Microsoft Teams Meeting
+1 248-509-0316   United States, Pontiac (Toll)
Conference ID: 620 190 146#
(If you need special services to join this meeting, please see bottom of this announcement)
 

RSVP:       Attendees are asked to RSVP for this meeting. If you plan to attend, please notify Donna Kreps, at KrepsD@Michigan.gov no later than September 21, 2020. 
 

The Michigan Department of Health and Human Services (MDHHS) invites the public to attend a stakeholder meeting on October 1, 2020, regarding the Michigan Medicaid Health Plan Common Formulary.

Section 1806 of Public Act 84 of 2015 required the MDHHS to develop a formulary that is common across all contracted health plans to streamline drug coverage policies for Medicaid and Healthy Michigan Plan beneficiaries and providers. The intent was to reduce interruptions in a beneficiary’s drug therapy due to a change in health plan. All Health Plan member’s drug therapies were then transitioned to the Common Formulary by September 30, 2016. 

Effective October 1, 2020, the Medicaid Health plans will be required to follow the Fee-For-Service Michigan Preferred Drug List coverage including any prior authorization and step therapy requirements. This new initiative is called the Single PDL and is expected to result in significant savings to the State of Michigan while further streamlining and resulting in more consistent coverage between Managed and Fee-For-Service Medicaid. Drug products not listed on the Single PDL will continue to be covered by the health plans in accordance with the established Common Formulary and no more restrictive than those coverage parameters.

The purpose of the stakeholder meeting is to provide a forum for the public to comment on the Common Formulary. This annual forum supplements the quarterly written public comment periods. Please note that drug rebates and Fee-for-Service pharmacy benefit coverage will not be reviewed at this meeting. In addition, the stakeholder meeting is not intended to be a venue for pharmaceutical drug product-specific presentations.

For those unable to attend the in-person meeting, you may submit your questions to the Common Formulary mailbox at MDHHSCommonFormulary@michigan.gov by September 21, 2020.

Special Services to Join Meeting
If you need the services below to join, please contact the MDHHS Section 1557 Coordinator at 517-284-1018 (Main), TTY users call 711, 517-335-6146 (Fax), MDHHS-ComplianceOffice@michigan.gov.

  • Provide free aids and services to people with disabilities with communicate with us, such as:
    • Qualified sign language interpreters
    • Written information in other formats (large print, audio, accessible electronic formats, other formats); and
  • Provide free language services to people whose primary language is not English; such as:
    • Qualified interpreters
    • Information written in other languages


QUESTIONS FROM THE PUBLIC

  • Questions can be submitted in advance via email to KrepsD@michigan.gov with Stakeholder Question in the subject line. If the answer to a question is not included in the stakeholder meeting presentation, the question/answer will be presented during the Q&A portion of the meeting.
  • Individuals joining the stakeholder meeting via Microsoft Teams web application can ask a question in one of the following ways:
  1. Raise their hand using the toolbar icon and unmute themselves to ask a question when prompted by the meeting facilitator.
  2. Submit a question using the chat feature and the meeting facilitator will read the question.
  3. Unmute themselves to ask a question during the Q&A period when prompted by the meeting facilitator.
  • Individuals joining the stakeholder meeting via telephone can unmute themselves to ask their question during the Q&A period when prompted by the meeting facilitator.
**************************************************************************************************************************

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.

History of Formulary Changes

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

 

 

 

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 https://michigan.magellanrx.com .

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

   

    STAKEHOLDER MEETINGS AND COMMENT PERIOD

October 7, 2019 Stakeholder Meeting Presentation

Stakeholder Meeting Questions and Answers

Frequently Asked Questions for Drug Manufacturers   

Drug Class & Workgroup Review Schedule for 2020

 

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 Analgesics, CNS, Dermatological and Anti-Neoplastic. Changes may be made to the Common Formulary based on comments received. Comments will be solicited once per calendar quarter. 

Please send your comments by September 25, 2020 to:

Linda VanCamp, Formulary Analyst
Bureau of Medicaid Care Management & Customer Service
Medical Services Administration
P.O. Box 30479
Lansing, Michigan 48909-7979

Telephone Number: 517-245-2758
Fax Number: 517-763-0142
E-mail Address: MDHHSCommonFormulary@michigan.gov