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Managed Care Pharmacy Benefit
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.
History of Formulary Changes:
|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:
Medicaid Common Formulary Workgroup Members
Scroll down for health plan specific information.
Current beneficiaries can find out which health plan they are enrolled in by calling the Beneficiary 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.
This link contains a list of Medicaid Health Plan BIN, PCN and Group Information. Please contact individual health plans to verify their most current BIN, PCN and Group Information.
STAKEHOLDER MEETINGS AND COMMENT PERIOD
October 3, 2022 Stakeholder Meeting Presentation
Stakeholder Meeting Questions and Answers
Frequently Asked Questions for Drug Manufacturers
Drug Class & Workgroup Review Schedule for 2023
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 Diabetes, GI, P & T Miscellaneous, Non-Drug Products and Endocrine & Metabolic. 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 at Michigan.gov/MCOpharmacy.
Please send your comments by June 16, 2023, to:
Linda VanCamp, CPhT Formulary Analyst
Bureau of Medicaid Care Management & Customer Service
Behavioral and Physical Health and Aging 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