OSP News

Priority Health Has Formulary Changes for Medicaid Members

Posted: 01/19/2024

Beginning February 1, 2024, The Michigan Department of Health and Human Services (MDHHS) will implement Medicaid formulary changes for the following drugs:

Movantik® - used to treat constipation caused by prescription pain medication

  • Movantik will become a non-preferred drug on the state’s Preferred Drug List (PDL). Amitiza® and Linzess® are PDL preferred formulary alternatives for Movantik that treat the same condition and don’t require prior authorization.

Byetta®, Trulicity®, Victoza® - used to manage blood sugar in adults and children with type 2 diabetes

  • Byetta, Trulicity and Victoza will require prior authorization to confirm diagnosis and the discontinuation of other GLP-1 agonists. If a patient has a qualifying ICD-10 code on file (E11-E11.9) and is not using more than one GLP-1, the prior authorization requirement for Byetta, Trulicity and Victoza will be automatically satisfied.

How to request a coverage determination or prior authorization
Providers may submit authorization requests by electronic prior authorization via electronic health records (EHR) or the Surescripts portal. They can also fax a request to 877.974.4411.

Prior authorization forms can be found at priorityhealth.com/formulary/medicaid. To determine whether your patient will require prior authorization for Byetta, Trulicity or Victoza, please call 800.466.6642. Priority Health is available 8 a.m. to 7 p.m., Monday – Friday and from 8:30 a.m. to 12 p.m. on Saturday.

How will this impact you?
You’ll need to write impacted members a new prescription for a formulary alternative or obtain prior authorization for their current medication by February 1, 2024.

Why is Priority Health making this change?
The Michigan Department of Health and Human Services works with its health plan partners to create the Medicaid Health Plan Common Formulary, a list of drugs that all Medicaid health plans must cover. The formulary is reviewed each quarter and changes made during this review period go into effect on February 1, 2024.

How Priority Health is communicating this to members?
Impacted members will receive a letter advising them of their drug coverage changes and what steps they can take.

Priority Health is here to help.
Click here for more information on covered drugs, criteria and authorizations.

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