MedicaidPrior AuthHigh impact
Mental Health Formulary, Managed Care Carve-Out
Maryland Medicaid·MD · Psychiatry, Family Medicine, Internal Medicine +2 more·Managed Care Organizations
Effective date
Apr 1, 2004
We identified it
Jun 20, 2026
Summary
Maryland Medicaid has implemented a Preferred Drug List that carves out certain mental health medications from Managed Care Organization (MCO) pharmacy benefits, requiring prior authorization for non-preferred mental health drugs. Refills for current mental health regimens dispensed within the last 90 days will be processed without prior authorization.
Action Required
Immediately: Billing team must verify that mental health medication claims for Maryland Medicaid MCO patients are being processed as fee-for-service through Maryland Medical Assistance rather than through the MCO pharmacy benefit. Update billing system to flag mental health drugs requiring prior authorization per the attached formulary. Notify network physicians that prior authorization is now required for non-preferred mental health medications. Monitor the updated formulary at http://mdmedicaidrx.fhsc.com/ or www.mdmahealthchoicerx.com for changes.