Medicaid formulary changes coming Feb. 1, 2025

As decided by the Michigan Department of Health and Human Services (MDHHS), beginning Feb. 1, 2025, combination use of medications in the following Preferred Drug List (PDL) drug classes won’t be covered under the Medicaid Health Plan Common Formulary:

• Oral Hypoglycemic DPP4 (e.g., Januvia, Tradjenta), Oral Hypoglycemic-Combinations (e.g., Janumet, Jentadueto,)
• Incretin Mimetics (e.g., Byetta, Ozempic, Trulicity, Victoza)
• Anti-Obesity GLP-1s (Saxenda, Wegovy, Zepbound)

What do you need to do?

If you have impacted Medicaid patients, you’ll need to limit their therapy to a single drug from any of the above drug classes. If your patient continues treatment with two or more drugs from any of the above drug classes after February 1, their medication won’t be covered.

How are we communicating this change?

Impacted members and their prescribing providers will receive a letter in the mail detailing these changes and what steps they can take. Members are encouraged to contact their prescribing provider to discuss their treatment plan.

Why the change?

MDHHS works with health plans to create the Medicaid Health Plan Common Formulary - a list of drugs that all Medicaid health plans must cover. This formulary is reviewed quarterly by the Common Formulary Workgroup and the MDHHS fee-for-service (FFS) and Pharmacy and Therapeutics (P&T) Committee.

Questions?

Please review the coverage and criteria information found on our Medicaid formulary page. Pharmacy changes are posted quarterly in the Provider Manual, on our formulary updates page. You can also call us at 800.466.6642. We’re available 8 a.m. to 7 p.m., Monday – Friday and from 8:30 a.m. to 12 p.m. on Saturday.