Michigan Medicaid Prescription Coverage List


Medicaid Health Plan Common Formulary

Biogen’s Alzheimer’s Drug Coverage Limited by U.S.

Your physician is the person best suited to help you make decisions about prescription drugs, and the prescription drug information is intended for your guidance only. This information relates to the Medicaid Prescription Drug Formulary , generally, and may not describe your specific health concern.

While every effort has been made to ensure accuracy, some information may be out of date. The Formulary is subject to change based on decisions made by MDHHS and Medicaid coverages. New drugs and medications are not covered until reviewed and approved by the Michigan Department of Health and Human Services . Medications with an over-the-counter equivalent are not a covered benefit.

The information contained in the Medicaid Formulary is provided by MDHHS. OCHN does not warrant or assure the accuracy of such information nor is it intended to be comprehensive in nature. The Medicaid Formulary is not intended to be a substitute for the knowledge, expertise, skill, and judgment of the medical practitioner in his/her choice of prescription drugs. The document is subject to state-specific regulations and rules, including, but not limited to, those regarding generic substitution, controlled substance schedules, preference for brands, and mandatory generics whenever applicable.

Understandng The Qualifications For Medicaid In Michigan

What are the requirements for Medicaid in MI? is a question you must ask before applying for healthcare coverage during the open enrollment period. Medicaid eligibility requirements in Michigan may differ from those of other states. Low-income families and individuals who lack health insurance can safeguard their future by enrolling in the Michigan Medicaid Health Care Program.

Get Help Managing Your Medications

If youre taking a number of medications prescribed by more than 1 doctor, you may be eligible to take advantage of Medication Therapy Management . Through this program, you can meet 1-on-1 with a doctor or pharmacist to learn more about your medicines and how they work, ask questions about side effects or interactions with other medications and look for opportunities to lower your costs.

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B Drug Pricing Program

The 340B Program requires drug manufacturers participating in Medicaid to provide outpatient drugs to covered entities at significantly reduced prices. To participate in the 340B Program, covered entities must register and be enrolled with the 340B program and comply with all 340B Program requirements administered by HRSA. State Medicaid agencies are prohibited from billing manufacturers for Medicaid rebates for drugs dispensed to Medicaid patients that have already been discounted under the 340B Program. Additional information on the 340B Program.

Find Out How To Apply For Medicaid In Michigan

MiHealth.org: Your link to Michigan Health Resources

Where do you sign up for Medicaid in Michigan, exactly? Michigan Medicaid, also known as the Healthy Michigan Plan, currently covers more than 600,000 patients statewide. Understanding where and how to apply for Medicaid in Michigan are your first steps toward enrollment. And, thanks to technological advances, there are several ways to apply for Medicaid for your convenience.

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Medicine Disposal Bags Available For Members

Do you have old or unused medicine lying around? Its important to get rid of it safely. Blue Cross Complete can help you do that. We provide free medicine disposal bags to members. You can use these bags to get rid of your old medicine. Its good for the environment and protects your household from any misuse.

Michigan Medicaid Health Plans

Most people with Michigan Medicaid will have to select a health plan. Plans are different in every county. The benefit of choosing a plan is that your care will likely be much more coordinated and run more smoothly. Your doctors and specialists are more likely to work well together. Aside from the county health plans, Michigan has four eligibility group plans:

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List Of Drugs Change Notice

Drugs may be added or removed from our list of drugs during the year. We will tell you 60 days before the following changes are made to the list of drugs:

  • Remove a drug from the list
  • Change drug requirements
  • Move a drug to a higher cost sharing tier

If the Food and Drug Administration or the drugs maker says a drug is not safe, it will be removed from our list of drugs right away. To view the changes, open the PDF list below.

If you have questions about our list of drugs, or want the most recent version, . We are here to help.

Our list of drugs shows the drugs we cover. The list includes:

  • Medicare Part D drugs
  • Some Medicaid covered prescription and over-the-counter drugs and items

In general, we cover drugs if they are medically necessary. Drugs on the list of drugs are covered when you use our network pharmacies or mail order program for maintenance drugs. Maintenance drugs are drugs you take for a chronic or long-term condition. Some drugs we cover have limits or other rules.

The Pharmacy and Therapeutics Committee, our team of independent healthcare experts, reviews and approves the list of drugs. We dont include all drugs. Some drugs may not be covered or are excluded. Other drugs are not on the list because of clinical and cost reasons.

How do I search for a drug in the List of Drugs?

You can search for a drug by using the search tool, alphabetical index or by medical condition.

State Supplemental Drug Rebate Agreements

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Many states have received CMS approval on their State Plan Amendments to enter into single-state and multi-state supplemental drug rebate pools that generate rebates that are at least as large as the rebates set forth in the Health and Human Services Secretary’s national rebate agreement with drug manufacturers. For your information, we have compiled a chart that depicts the States with Medicaid Pharmacy Supplemental Rebate Agreements with their effective dates.

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Human Resources University Of Michigan

View the University of Michigan Prescription Drug Plan Formulary.

The formulary is a list of generic, brand and specialty drugs that are covered by the plan. Inclusions of drugs on the formulary are determined by the clinical judgment of a committee of U-M physicians and pharmacists as well as published medical evidence in the diagnosis and treatment of disease.

Find complete medication coverage and member cost information through the Magellan Rx member website.

How To Complete The Michigan Medicaid Application

The easiest way to apply for Michigan Medicaid is to complete the online application through MI Bridges. If you prefer, you can also enroll through Healthcare.gov. If you dont want to apply online, you can and either fax or hand it into your local office, or mail it to:

Health Insurance Affordability Program

Michigan Department of Community Health

P.O. Box 30273

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Standard And Fast Decisions

If you or your doctor believe that waiting 72 hours for a standard decision could seriously harm your health, you can ask for a fast decision. This is only for Part D drugs that you have not already received. We must make expedited decisions within 24 hours after we get your doctors information.

If we approve your drugs exception, the approval will be until the end of the plan year. To keep the exception in place, you must be enrolled in our plan, your doctor must continue to prescribe your drug, and your drug must be safe to treat your condition.

After we make a decision, we send you a letter telling you our decision. The letter has information on how to appeal.

Reasons To Choose Priority Health

Michigan Rx Assistance Programs
  • We are one of the top-rated Medicaid plans in Michigan, with a rating of 4 out of 5 in NCQA’s Medicaid Health Insurance Plan Ratings 2019-2020.*
  • We offer more opportunities to get the right care with added benefits like care management and virtual care when and where you need it.
  • Priority Health Choice Medicaid plans meet all of the criteria in all six care categories from the Michigan Medicaid Consumer Product Guide, which include: overall rating of health plan, doctor communication and service, getting care, keeping kids healthy, living with illness and taking care of women.

*Due to COVID-19, NCQA has canceled the release of 2020-2021 Health Plan ratings. The most recent ratings are 2019-2020

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Which Medicaid Plan Would Be Best In Michigan

Michigan has 11 total health plan providers that you can choose from and each one will have varying packages that you may wish to look before you decide just which plan you want to choose for you and your family.

The plans are:

2. Blue Cross Complete of Michigan

3. Hap- Midwest Health Plan

4. Harbor Health Plan

10. United Health Care community plan

11. UPHP- Upper Peninsula Health Plan

All of the links to each of these providers sites and what they have to offer can be found on Michigans government webpage for you to view, so that you can get a better understanding of what they all have to offer and compare them so that you can find what is right for you and your family.

Learn About Medicaid Costs And Coverage In Michigan

Medicaid coverage in Michigan has the intention of providing affordable health care options to low-income families and eligible applicants. The different types of Medicaid insurance available include more than one option to approved applicants seeking medical benefits. Most new applicants have concerns about what services are covered by Medicaid and how much does Medicaid cost Michigan enrollees. MI Medicaid coverages extend through a variety of health care services and treatments considered medically necessary. The program will not cover elective procedures and services from non-Medicaid providers. Knowing what does Medicaid not cover is important to avoid financial surprises after applying to the Medicaid program. With just a bit of understanding and knowledge involving Medicaid coverages, applicants can avoid unnecessary burdens on a financial or medical level. Medicaid benefit coverages include not only the medical services and treatments required by law on a federal level, but also the services that Michigan elects to cover as well. Since federal and state provisions fund Medicaid in Michigan, state officials can choose to cover certain Medicaid benefits at their discretion. To learn more about Medicaid cost estimates as well as the services Medicaid will cover in Michigan, continue reading the following sections.

What services are covered by Medicaid in Michigan?

Learn more about the basic requirements of Medicaid by downloading our free guide.

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Michild And Healthy Kids

MiChild is for uninsured kids who belong to households with low income. Your kids may qualify for MiChild even if you do not qualify yourself for Michigan Medicaid. No matter how many kids are in your household, Michigan MiChild only costs $10 per month for your family. The Healthy Kids program is free. Both MiChild and Healthy Kids offer comprehensive medical benefits. The best way to find out which program you qualify for is to go ahead and apply for all Michigan health benefits through MI Bridges. You will receive notice of which program your family is qualified for.

Here’s What Else Is Included In Our Medicaid Plans:

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We make it easy to find a doctor near you who accepts your insurance plan. Our online Find a Doctor tool makes it easy to search for available doctors near you.

When it comes to preventive care, we’ve got you covered. We have a whole list of free services that are designed to help you get and stay healthy. With a Priority Health Medicaid plan, your preventive health care is covered. You never have to worry about getting the services you need to stay your healthiest.

Virtual care is a convenient way to see a doctor for non-emergency care using your smartphone, laptop or tablet for a variety of common illnesseswithout having to go to the emergency room or urgent care center. Best of all, it’s free for Priority Health Medicaid members.

We’ve partnered with FeelSafe Wireless to connect Priority Health Medicaid members with free cell phones and free monthly service. This initiative was created to help you stay on top of your health care needs.

With a Priority Health Medicaid plan, you won’t have to worry about being covered during pregnancy and after your baby arrives. We offer a variety of programs and benefits to our expecting members, including pregnancy dental benefits and the Maternal Infant Health Program .

If you’re ready to quit, we have programs for no-cost smoking cessation coaching and nicotine replacement therapy through the Michigan Tobacco Quitline.

*Available for Healthy Michigan Plan members only.

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D Explanation Of Benefits

When you use your Part D benefit, we send you an Explanation of Benefits to help you understand and keep track of your drug payments. The EOB is available for free in another format or language upon request.

If you have questions about your pharmacy benefits, . We are here to help.

With our plan, your Part D prescription drugs are covered at no cost. We select the generic and brand name drugs in our list of drugs as part of a quality treatment program. To find out if your drug is covered, select the tab on the left, or for help.

We also can assist you with:

Coverage For People Impacted By Flint Water

The Flint water Medicaid program covers kids up to age 21 and pregnant women who were affected by the Flint water crisis and have incomes at or below 400% of the FPL. If you qualify, you can get coverage for lead screenings, doctor visits, dental, vision, nutrition counseling, behavioral health, and more. You can also get coordination services like appointment scheduling, transportation assistance, and access to educational resources and social services, all without fees. To access these services, you will have to see a doctor who accepts Medicaid. You CAN get Flint water Medicaid coverage while still having other insurance, but your other insurance will always come first.

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State Medicaid Reimbursement Information

The Medicaid reimbursement chart outlines the methodologies and professional dispensing fee amounts utilized by states. Pharmacy payment requirements are outlined in Federal regulations at 42 CFR 447 Subpart F. The Code of Federal Regulations specifically covers payment requirements for estimated acquisition cost and reasonable dispensing fees. Co-payment amounts are addressed at 42 CFR 447.54. Information will be updated and posted on the web quarterly with the data provided for in the CMS approved state plans. We update the chart quarterly and archive the previous four quarters.

Understanding Michigan Medicaid Eligibility

Public invited to Oct. 6 Medicaid health plans prescription drug ...

The first step to determining whether or not you qualify for Michigan Medicaid or other healthcare assistance is determining your total household income. The chart below can help you determine whether or not you might be eligible for Michigan Medicaid in 2019. The income limits are subject to change each year.

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Medicaid Health Plans Prescription Drug Coverage Topic Of Oct 9 Meeting


CONTACT: Bob Wheaton, 517-241-2112

LANSING, Mich. The public can attend an Oct. 9 meeting regarding the list of prescription drugs covered under Michigans Medicaid Health Plans.

The Michigan Medicaid Health Plan common formulary stakeholder meeting is from 9:30 a.m. to noon in the Lansing Community College West Campus Auditorium, 5708 Cornerstone Drive in Delta Township near Lansing.

The Michigan Department of Health and Human Services has developed the list of prescription drugs known as a common formulary to streamline drug coverage policies for Medicaid and Healthy Michigan Plan beneficiaries and providers. The prescription drugs are common across all contracted health plans for the departments current Comprehensive Health Plan contract.

The common formulary is important to the approximately 1.8 million Michigan residents who are Medicaid managed care beneficiaries, said MDHHS Director Nick Lyon. It reduces any interruptions in a beneficiarys drug therapy due to a change in health plans.

Health plans may be less restrictive, but not more restrictive, than the coverage parameters of the common formulary.

The purpose of the stakeholder meeting is to provide an in-person forum for the public to comment on the common formulary. Drug rebates, the Fee-for-Service formulary, and drugs that are covered under the Fee-for-Service benefit will not be reviewed at this meeting.

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Learn About Michigan Medicaid

Michigan Medicaid is a medical assistance program that currently covers more than 2 million residents of Michigan. MI Medicaid enrollment has increased by 19 percent since 2013. If you are new to Michigan, you might be wondering, What is Medicaid in MI? The United States federal government developed Medicaid to help low-income individuals and families get the medical coverage they need. Each state is free to adapt its own Medicaid system to meet the needs of its citizens, within federal guidelines.

Every states Medicaid program is run at the state level the federal government does not control them. Each program must conform to federal regulations to qualify for federal funding. Medicaid coverage can vary from one state to another but certain information about Medicaid is true in every state. Medicaid in Michigan for instance, covers some services that other states do not cover, while other states may cover services that Michigan does not. In addition, not every beneficiary in Michigan will pay the same monthly premium. Certain low-income Medicaid insurance beneficiaries will qualify for no-cost coverage and pay no premiums at all.

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Facts About Your Approved Drugs

When a generic drug is listed for a brand copay or coinsurance, there will be little cost difference between the brand and its generic equivalent.

Important: Even if a drug is on the Approved Drug List for employer-sponsored plans, it may not be included in your employer’s prescription drug program. Check your Priority Health coverage documents and riders to find out if any approved drugs are not included.

Additional Medicaid benefit: Medicaid members are eligible for some non-prescription items sold a pharmacies. For details on this benefit, ask your pharmacist or primary care physician, or call our Customer Service department at .


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