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Managed Care Pharmacy Benefit

MDHHS MEETING ANNOUNCEMENT

Michigan Medicaid Health Plan Common Formulary Stakeholder Meeting

When:       October 3, 2022, from 9:30 a.m. to noon (Eastern Time)

Where:      Pursuant to the Michigan Open Meetings Act, as amended, this will be a virtual meeting to mitigate the spread of COVID-19 and protect the health of the public and members of the panel. To attend the Common Formulary Stakeholder Meeting at 9:30 am connect via Zoom.

The Zoom can be accessed here and the password is: s1GJxM. Participants may also access by phone by dialing 636-651-3128 and entering access code 287658.

(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 29, 2022.

The Michigan Department of Health and Human Services (MDHHS) invites the public to attend a stakeholder meeting regarding the Michigan Medicaid Health Plan Common Formulary on October 3, 2022.

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.

Section 1806 of Public Act 84 of 2015 first 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 were required to follow the Fee-For-Service Michigan Preferred Drug List (PDL) coverage including any prior authorization and step therapy requirements. This significant savings initiative, the Single PDL further streamlined and maintains more consistent coverage between Managed and Fee-For-Service Medicaid. Drug products not listed on the Single PDL continue to be covered by the health plans in accordance with the established Common Formulary and no more restrictive than those coverage parameters.

For those unable to attend, you may submit your questions to the Common Formulary mailbox at MDHHSCommonFormulary@michigan.gov by September 29, 2022.

Special Services to Join Meeting

If you need the services below to join, please contact the MDHHS Section 1557 Coordinator 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

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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. 

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 18, 2021 Stakeholder Meeting Presentation

Stakeholder Meeting Questions and Answers

Frequently Asked Questions for Drug Manufacturers   

Drug Class & Workgroup Review Schedule for 2022

 

The next Michigan Medicaid Health Plan Common Formulary public comment period will be announced here.