MedicaidCoverageMedium impact
MassHealth updates to Unified Formulary
Harvard Pilgrim Health Care·MA · Pharmacy·Pharmacy
Effective date
Oct 1, 2026
We identified it
Aug 3, 2026
Summary
MassHealth is updating its Unified Formulary effective October 1, 2026. MassHealth Tufts Health Together-MassHealth ACPPs will use the updated formulary for pharmacy medications and select medical benefit drugs. Billing teams must monitor the MassHealth Drug List and Point32Health Provider website for specific coverage and prior authorization criteria changes that will apply to this plan.
Action Required
By September 15, 2026: Billing team must review the updated MassHealth Drug List and Unified Medical Policies (MNG) available on Point32Health Provider website to identify which pharmacy and medical benefit drugs have new coverage criteria or prior authorization requirements. Update billing software and EMR templates to reflect any new prior authorization workflows, coverage restrictions, or documentation requirements for affected medications. Communicate changes to providers and clinical staff. Failure to implement updates may result in claim denials for medications that require new prior authorizations or no longer meet coverage criteria.