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Managed Care Pharmacy Benefit

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:

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. 

Aetna Health Plan logo

Aetna

Blue Cross Complete of Michigan
HAP Empowered Logo

HAP Empowered
McLaren Health Plan logo

McLaren Health Plan
Meridian Health Logo

Meridian
Molina Logo

Molina Healthcare
Priority Health Plan logo

Priority Health
United Heathcare Health Plan logo

United Healthcare
Upper Peninsula Health Plan logo

Upper Peninsula Health Plan

RESOURCE INFORMATION

BENEFICIARIES

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