MedicaidCoverageMedium impact
MassHealth updates to Unified Formulary
Harvard Pilgrim Health Care·MA·Pharmacy
Effective date
May 11, 2026
We identified it
Jun 20, 2026
Summary
MassHealth is updating their Unified Formulary for pharmacy medications and select medical benefit drugs, effective May 11, 2026. Providers will need to check the updated MassHealth Drug List for new coverage criteria and refer to the Unified Medical Policies guideline for medical benefit drugs.
Action Required
By May 11, 2026: Billing team and providers must review the updated MassHealth Drug List on the MassHealth website for new coverage and prior authorization criteria. Check the Medical Benefit Drug Medical Necessity Guideline titled 'Unified Medical Policies' on the Point32Health Provider website for medical benefit drugs that are unified with MassHealth formulary. Update internal drug coverage references and prior authorization workflows accordingly.