MedicaidCoverageMedium impact
MSA 18-02
Michigan Medicaid - MDHHS·MI·Provider Bulletin
Effective date
Jul 1, 2017
We identified it
Jun 20, 2026
Summary
Michigan Medicaid has updated coverage for physician-administered drugs and biologicals, creating a carved-out list of specific drugs that will be reimbursed as Fee-for-Service even for managed care enrollees. Some drugs require prior authorization, and providers must use specific National Drug Codes when billing.
Action Required
Immediately: Review the carved-out drug list on the MDHHS website at michigan.gov/medicaidproviders under Billing & Reimbursement. For Medicaid Health Plan enrollees receiving carved-out drugs, submit drug claims to Fee-for-Service Medicaid and bill other services to the health plan. Include National Drug Codes on all carved-out drug claims. For drugs requiring prior authorization, complete form MSA-6544-B and contact PRD at 1-800-622-0276 for documentation checklists. Monitor the online list regularly as no direct notices will be sent for updates.