Additional drug classes added to Medicaid carve-out as of April 1
Effective for service dates on or after April 1, 2010, medications within the listed drug classes are billed at the pharmacy directly to the MDCH-contracted Pharmacy Benefit Manager (PBM) — First Health Services Corporation. The drug classes below are no longer part of the Priority Health Medicaid formulary. You may have already received information on this change from MDCH. However, we wanted to be sure you knew:
- The member's copay will remain the same with MDCH — $1.00 for generic medications and $3.00 for brand name medications.
- These medications will continue to be subject to current MDCH pharmacy policies and coverage limitations, including prior authorization requirements, when applicable.
- Prior authorizations that have been approved by Priority Health within 90 days prior to April 1, 2010, will be grandfathered with First Health Services Corporation for 180 days.
- Affected members have been notified of this change.
Coverage questions and prior authorization requests for drugs in these classes should be directed to First Health Services Corporation at 877 864-9014.
For a list of covered medications within the drug classes below, please refer to the Michigan Pharmaceutical Product List (MPPL) on the First Health Services Corporation
website.
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