MedicaidCoverageMedium impact
MassHealth Updates to Unified Formulary
Harvard Pilgrim Health Care·MA · Pharmacy·Pharmacy
Effective date
Nov 16, 2026
We identified it
Sep 2, 2026
Summary
MassHealth is updating its Unified Formulary effective November 16, 2026. MassHealth Tufts Health Together-MassHealth ACPPs will use the updated formulary for pharmacy medications and select medical benefit drugs, with new coverage criteria and medical necessity guidelines available on the MassHealth Drug List and Point32Health Provider website.
Action Required
By November 16, 2026: Billing and clinical teams must review the updated MassHealth Drug List and Unified Medical Policies (MNG) on the Point32Health Provider website to identify formulary changes affecting your patient population. Update pharmacy verification systems, prior authorization workflows, and billing software to reflect new coverage criteria and medical benefit drug policies. Ensure providers are aware of updated medical necessity requirements for affected medications and medical benefit drugs. Failure to comply with updated formulary requirements may result in claim denials or patient access issues.