Medicaid formulary changes coming Nov. 1, 2024

The Michigan Department of Health and Human Services (MDHHS) works with its health plan partners to create a list of drugs that all Medicaid health plans must cover. This list is called the Medicaid Health Plan Common Formulary. The formulary is reviewed each quarter by MDHHS’s Common Formulary Workgroup. The following changes will take effect on Nov. 1, 2024 for your Priority Health Medicaid patients.

Drug name	Common use	What's changing	Formulary alternatives
Invokana®	Improves blood sugar in people with type 2 diabetes.	Moving to Preferred Drug List (PDL) Non-preferred and will require prior authorization.	Jardiance and Farxiga®
Invokamet®	Improves blood sugar in people with type 2 diabetes.	Moving to Preferred Drug List (PDL) Non-preferred and will require prior authorization.	Xigduo XR and Synjardy
hydrocortisone 1% cream made by either Ani or BRP pharmaceuticals	Treats redness, swelling, itching and discomfort of various skin conditions.	Will no longer be a covered drug.	hydrocortisone 1% cream made by either Fougera, Sandoz or Sola pharmaceuticals
Arnuity® 50 mcg	Treats asthma in children and adults.	Adding age limitations in alignment with the drug label. New max age will be 11 years.	Arnuity® 100 and 200 mcg, Qvar® and fluticasone propionate HFA
budesonide nebulizer suspension	Treats asthma in children and adults.	Adding age limitations in alignment with the drug label. The new max age will be 11 years.	Arnuity® 100 and 200 mcg, Qvar® and fluticasone propionate HFA
Dulera® 50 mcg	Treats asthma in children and adults.	Adding age limitations in alignment with the drug label. The new max age will be 11 years.	Dulera® 100 and 200mcg, Symbicort®, Advair HFA® and Advair Diskus®
lubiprostone capsules	Treats irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC).	Adding age limitations in alignment with the drug label. The new minimum age will be 18 years.	Linzess®
metformin 625mg tablets	Treats type 2 and gestational diabetes.	Moving to Preferred Drug List (PDL) Non-Preferred and will require prior authorization.	metformin 500mg, metformin 850mg, and metformin 1000mg tablets

How are we communicating this to our members?

Impacted members will receive a letter advising them of their drug coverage changes and what steps they can take. We’ve also asked them to reach out to their provider to discuss alternative treatment options.

What do you need to do?

You must switch your impacted patients to a formulary alternative or obtain a prior authorization for their current medication before Nov. 1, 2024. We encourage you to reach out to them to discuss treatment options.

Questions?

Contact our Pharmacy Provider Helpline at 800.466.6642.