Recent and upcoming formulary changes 

Medicaid formulary changes effective Oct. 1

Each Medicaid health plan in Michigan follows and adopts the same common formulary, which is updated each October. Although there are multiple formulary changes, there are two we anticipate to be high disruptors.

On Oct. 1, there were two major changes with drugs moving off-formulary:

Apidra®, Humalog® and Novolog®

  • Admelog is the formulary alternative
  • Patients taking Apidra®, Humalog® and Novolog® continue to receive these medications until 12/31/2018

Symbicort® and Dulera®

  • Fluticasone-salmeterol is the formulary alternative
  • Patients taking Symbicort® and Dulera® can continue to receive these medications until 12/31/2018. They'll need to a covered medication or work through their provider to request additional coverage

Communication: Letters were sent to both impacted members and providers in late September. Presentations on Medicaid common formulary changes were presented at both the Virtual Office Advisory webinar and Provider Network Leadership Forum in October.

Medicare formulary changes effective Jan. 1

Effective Jan. 1, 2019, 186 changes, most of which are tier or prior authorization changes, are coming.  Also, 28 drugs have been removed from the formulary entirely, none of which impact more than 70 members. A list of all formulary changes effective Jan. 1 will be posted to our formulary updates page.

Communication: Members impacted by any changes to the formulary will receive a letter in the coming weeks. Due to the low volume of members impacted by changes, no provider letters are planned to be sent. Presentations on Medicare formulary changes were presented at both the Virtual Office Advisory webinar and Provider Network Leadership Forum in October.

Commercial formulary changes effective Jan. 1

There are 81 drug changes, 6 of which impact more than 100 members.

  • Clindamycin/benzoyl peroxide will have a tier increase
  • Timolol maleate 0.5% (generic Istalol®) daily drop will have a tier increase
  • Tolterodine tartrate ER will have a tier increase
  • Ursodiol will have a tier increase
  • Xifaxan® will have a prior authorization requirement added
  • Lidocaine 5% patches will be removed from formulary (available OTC)

Communication: Members impacted by any changes to the formulary will receive a letter in the coming weeks. Letters were not mailed to providers for any of these changes because pharmacists can automatically substitute a covered alternative without the provider having to write a new prescription. Presentations on Medicare formulary changes were presented at both the Virtual Office Advisory and Provider Network Leadership Forum in October.