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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 Common Formulary public comment period will be announced here.