Medicaid & Healthy Michigan Plan Common Formulary Finalized
Wednesday, January 6, 2016
To streamline drug coverage policies for Medicaid and Healthy Michigan Plan beneficiaries and providers, the Michigan Department of Health and Human Services (MDHHS) has finalized a Common Formulary for all contracted health plans.
The Common Formulary is part of the recent comprehensive health plan contract and streamlines coverage for beneficiaries and providers. Prior to this, each health plan had their own different formulary by which drugs were covered for beneficiaries. By aligning coverage across the state, MDHHS aims to reduce interruptions in a beneficiary’s drug therapy should they have a change in health plan.
Included in the Common Formulary are certain drug management tools such as prior authorization criteria and step therapies. Contracted Health plans may be less restrictive, but not more restrictive, than the coverage parameters of the Common Formulary.
The list of drugs covered under the Fee-for-Service benefit remain unchanged. To promote safe medication transitions and minimize the burden on prescribers and patients, all contracted health plans are required to follow the common set of policies and procedures on transition of care and grandfathering of drug therapy.
On Jan. 1, 2016, the Common Formulary was finalized and is currently available on the MDHHS website. Through March 31, the contracted health plans will code and test the Common Formulary in their claims systems. Beginning April 1, health plans will transition members to the Common Formulary with all members being moved to the new policy by September 30, 2016.
The final Common Formulary is the result of an MDHHS Workgroup review. The workgroup, led by MDHHS and comprised of representatives from Medicaid health plans, began its review last year and streamlined previous formularies into one for better aligned drug coverage policies and procedures across the state.
The Common Formulary will be reviewed by MDHHS on a quarterly basis. During these reviews, new medications that are FDA-approved will be evaluated after they have been available in the marketplace for at least six months.
The Department’s Preferred Drug List Supplemental rebates will continue to apply to the Fee-for-Service program, and will not be part of this. Available Federal Medicaid rebates will continue to be invoiced for both the Fee-for-Service and MCO lines of business.
For more information about the common formulary, visit http://www.michigan.gov/documents/mdhhs/Managed_Care_Common_Formulary_Listing_506275_7.pdf.
Source: Michigan Department of Health & Human Services