MedicaidCoverageMedium impact
MassHealth updates to Unified Formulary
Harvard Pilgrim Health Care·MA · Pharmacy·Pharmacy
Effective date
Apr 1, 2026
We identified it
Jun 20, 2026
Summary
MassHealth is updating their Unified Formulary effective April 1, 2026, which will affect pharmacy medications and select medical benefit drugs covered under MassHealth Tufts Health Together plans. Providers need to check the updated MassHealth Drug List and Medical Benefit Drug guidelines for new coverage criteria and requirements.
Action Required
Before April 1, 2026: Billing team must review the updated MassHealth Drug List on the MassHealth website for new coverage criteria. Check the Medical Benefit Drug Medical Necessity Guideline (MNG) titled 'Unified Medical Policies' on the Point32Health Provider website for affected medical benefit drugs. Update prior authorization workflows and coverage verification processes for MassHealth Tufts Health Together patients to reflect new formulary requirements.