MedicaidCoverageMedium impact
MassHealth Updates to Unified Formulary
Harvard Pilgrim Health Care·MA·Pharmacy
Effective date
Jul 1, 2026
We identified it
Jun 20, 2026
Summary
MassHealth is updating their Unified Formulary effective July 1, 2026, which will change coverage and criteria for pharmacy medications and select medical benefit drugs. Providers using MassHealth Tufts Health Together-MassHealth ACPPs will need to reference the updated MassHealth Drug List and Medical Necessity Guidelines after the effective date.
Action Required
By July 1, 2026: Billing team must review updated MassHealth Drug List on Point32Health Provider website to identify coverage changes for pharmacy and medical benefit drugs. Update prior authorization requirements and coverage verification procedures based on new formulary criteria. Check Medical Benefit Drug Medical Necessity Guideline titled 'Unified Medical Policies' for affected medical benefit drugs.