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May 2025 Michigan Medicaid Single Preferred Drug List (SPDL) Formulary Changes

Michigan Meridian Medicaid would like to share changes to our formulary. Changes are effective 5/1/2025. As a reminder, these changes have been previously communicated by Michigan Department of Health & Human Services (MDHHS) and are effective for all Michigan Medicaid managed care plans. 

These changes include drugs that have been added, removed, or had utilization management restrictions adjusted for preferred and non-preferred medications on the Single Preferred Drug List (SPDL). Please see below for a complete description of formulary changes effective 5/1/2025. 

Changes being made to the Michigan Preferred Drug List (PDL)/Single PDL effective May 1, 2025

New Drugs Added to the PDL

  1. Crexont (carbidopa/levodopa) extended-release capsules - added to the PDL class: Anti-Parkinson’s Agents- Other as nonpreferred with the additional medication-specific criteria:
    • Patient is 18 years or older; AND
    • Prescribed by or in consultation with a neurologist
    • Length of approval: Up to 1 year
  2. Ebglyss (lebrikizumab-lbkz) pen/syringe – added to the PDL class: Oral Hypoglycemics - Combinations as non-preferred with additional medication-specific criteria:
    • Diagnosis of moderate to severe atopic dermatitis; AND
    • Patient is 12 years of age or older; AND
    • Patient weighs at least 40 kg (88 lbs)
    • Quantity Limit: 1 pen (2mL) per 28-day days (special allowance for initial and subsequent induction fills)
    • Length of approval: 6 months
  3. Neffy (epinephrine) nasal spray - added to the PDL class: Epinephrine Self-Administered as non-preferred with additional medication-specific criteria:
    • Therapeutic failure or contraindication to the use of a preferred medication; AND
    • Patient weighs at least 30kg
    • Quantity limit: 4 sprays (2 pkgs) per fill
    • Length of approval: 1 year
  4. Nemluvio (nemolizumab-ilto) pen - added to the PDL class: Immunomodulators – Agents for Atopic Dermatitis and new PDL class: Immunomodulators – Agents to Treat Prurigo Nodularis as non-preferred with additional medication-specific criteria:
    • Atopic Dermatitis:
      • Initial
        • Diagnosis of moderate to severe atopic dermatitis; AND
        • Patient is 12 years of age or older
        • Quantity Limit: 1 pen (30mg) per 28 days (special allowance of 2 pens for loading dose)
        • Length of approval: 6 months
      • Renewal
        • Documentation submitted demonstrating a positive response to therapy.
          • Prescriber attests the patient has achieved clear or almost clear skin, and in accordance with the product label, the patient will be transitioned to a dosage of 1 pen (30 mg) every 8 weeks. NOTE: renewal PA will limit dosage accordingly; OR
          • Prescriber attests the patient has not achieved clear or almost clear skin yet but has had a positive response to therapy. Prescriber is requesting continuation of dosage of 1 pen (30 mg) every 4 weeks.
        • Length of renewal: 6 months
    • Prurigo Nodularis:
      •  Diagnosis for prurigo nodularis; AND
      • Patient is 18 years of age or older; AND
      • Prescribed by or in consultation with a dermatologist, allergist or immunologist
      • Quantity Limit: 1 pen (30mg) per 28 days (special allowance of 2 pens for loading dose and patients weighing ≥90 kg)
      • Length of approval: 1 year
  5. Vyalev (foslevodopa and foscarbidopa) vials - added to the PDL class: Anti-Parkinson’s Agents- Other as non-preferred with the additional medication-specific criteria:
    • Patient is 18 years of age or older; AND
    • Diagnosis of Parkinson’s disease that is levodopa-responsive; AND
    • Prescribed by or in consultation with a neurologist; AND
    • Prescriber attests that the patient is experiencing persistent motor fluctuations with a minimum of 2.5 hours of “off” time per day despite optimized carbidopa/levodopa therapy
    • Length of approval: Up to 1 year

PDL Class Category: Cardiovascular Classes

  1. Angiotensin-II Receptor Neprilysin Inhibitors (ARNIs)
    • Move only the Entresto (sacubitril/valsartan) Sprinkles to non-preferred with medication-specific criteria to allow PDL bypass if patient is unable to swallow tablets.
    • Entresto (tablets) would remain PDL preferred.
  2. Beta Blockers
    • Move bisoprolol tablets to preferred
    • Move Bystolic (nebivolol) tablets to non-preferred
    • Move carvedilol ER tablets to non-preferred – grandfather existing members for 90 days to allow transition
    • Move nadolol tablets to preferred
    • Move Hemangeol (propranolol) oral solution to preferred with max age edit of 1 year
  3. Calcium Channel Blockers-Dihydropyridine
    • Move Norliqva (amlodipine) oral solution to preferred with existing clinical PA
  4. Lipotropics: Statins
    • Move ezetimibe/simvastatin tablets (generic for Vytorin) to preferred
  5. Cardiovascular Class Criteria Review
    • ARNIs: Entresto Sprinkles (sacubitril/valsartan) – add medication-specific criteria to allow PDL bypass if patient is unable to swallow.
    • Beta Blockers: Hemangeol (propranolol) oral solution – add Patient age < 1 year

PDL Class Category: Ophthalmic Classes

  1. Glaucoma: Carbonic Anhydrase Inhibitors
    • Move Azopt (brinzolamide) eye drops to non-preferred
    • Move brinzolamide eye drops (generic for Azopt) to preferred
  2. Ophthalmic Anti-Inflammatory/Immunomodulator
    • Move only Restasis Multidose drops (cyclosporine) to non-preferred.
    • Restasis Single-Use to remain preferred.

Brand Preferred Products (Brand over Generic) Changes:

  1. Remove Azopt (brinzolamide)
Last Updated: 05/20/2025