MedicaidCoverageMedium impact
MassHealth Updates to Unified Formulary
Harvard Pilgrim Health Care·MA·Pharmacy
Effective date
Aug 10, 2026
We identified it
Jun 20, 2026
Summary
MassHealth is updating their Unified Formulary effective August 10, 2026, which will change coverage criteria for both pharmacy medications and select medical benefit drugs for MassHealth Tufts Health Together-MassHealth ACPPs. Providers need to check the updated MassHealth Drug List and Medical Benefit Drug guidelines after the effective date.
Action Required
By August 10, 2026: Billing team must review the updated MassHealth Drug List on the Point32Health Provider website to identify changes in coverage criteria for pharmacy medications and medical benefit drugs. Update prior authorization requirements and coverage verification processes based on the new Unified Formulary guidelines. Reference the Medical Benefit Drug Medical Necessity Guideline titled 'Unified Medical Policies' for affected medical benefit drugs.