MedicaidCoverageMedium impact
MassHealth updates to Unified Formulary
Harvard Pilgrim Health Care·MA·Pharmacy
Effective date
Nov 17, 2025
We identified it
Jun 20, 2026
Summary
MassHealth is updating its Unified Formulary effective November 17, 2025, which will affect medication coverage and criteria for Tufts Health Together-MassHealth MCO Plan and ACPPs. Providers will need to check the updated MassHealth Drug List after the effective date for new coverage requirements.
Action Required
By November 17, 2025: Billing and clinical teams must review the updated MassHealth Drug List for new medication coverage criteria. Update prior authorization workflows and medication ordering protocols based on formulary changes. Verify coverage for commonly prescribed medications to avoid claim denials.