Medicaid Formulary Benefit Changes

Medicaid Pharmacy Benefit Changes as of 7/15/2020

  • Humira will require a Prior Authorization and will be subject to Quantity Limits
    • Members who have obtained Humira in the past 6 months will be able to receive the medication until 12/31/2022 without a Prior Authorization.
  • However, members who have obtained Humira in the past 6 months and are currently dosed higher than the FDA-approved recommended dosing will be able to receive the medication until 9/1/2020 without an Authorization.
  • Enbrel will require a Prior Authorization and will be subject to Quantity Limits
    • Members who have obtained Enbrel in the past 6 months will be able to receive the medication until 3/31/2021 without a Prior Authorization.
  • However, members who have obtained Enbrel in the past 6 months and are currently dosed higher than the FDA-approved recommended dosing will be able to receive the medication until 9/1/2020 without an Authorization.

Medicaid Pharmacy Benefit Changes as of 8/15/2020

  • Esomeprazole OTC will be added to the Medicaid Pharmacy Benefit Formulary.
  • Generic Rx ONLY Esomeprazole will be removed from the Medicaid Pharmacy Benefit Formulary.

Medicaid Pharmacy Benefit Changes as of 9/1/2020

  • Voltaren Gel OTC 1% will be added to the Medicaid Formulary with a Quantity Limit of 100 grams per 30 days.
  • Generic Rx ONLY Diclofenac Gel 1% will require that a member try and fail Voltaren Gel OTC 1% before obtaining the Rx ONLY product.
    • Members who have obtained the Rx ONLY product in the last 6 months will continue to have access to the Rx ONLY product without an Authorization.
  • Descovy will require a trial and failure, documented intolerance or contraindication to Truvada.
    • All members currently on Descovy will continue to have access to the medication.