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

Michigan Meridian Medicaid would like to share changes to our formulary. Changes are effective 8/1/2025. 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 8/1/2025. 

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

New Drugs Added to the PDL:

  1. Biosimilars to ustekinumab (Stelara): 
    • Steqeyma (ustekinumab-stba) injection 
    •  Yesintek (ustekinumab-kfce) injection 
    • Both added to the PDL classes: Biologics:  Agents to Treat Plaque Psoriasis; Agents to treat Psoriatic Arthritis; Agents to Treat Crohn’s Disease; Agents to Treat Ulcerative Colitis 
    • Both added with the additional medication-specific criteria: 
      • Diagnosis of plaque psoriasis or psoriatic arthritis; AND Quantity limit:  90 mg every 12 weeks with initial dose Week 0 and 4; OR 
      • Diagnosis of Crohn’s disease or ulcerative colitis; AND Quantity limit:  520 mg for initial dose 90 mg every 8 weeks 
      • Length of approval:  1 year

PDL Class Category:  Anti-Infectives Classes:

  1. Antifungals – Topical
    • Move econazole cream to preferred 
  2. Antivirals – COVID-19  - new class 
    • Add Paxlovid (nirmatrelvir tablets/ritonavir tablets) as preferred 
  3. Antivirals – Influenza
    •  Move Xofluza (baloxavir) tablets to non-preferred  
  4. Gastrointestinal Antibiotics  
    • Move Dificid (fidaxomicin) suspension only to non-preferred • Dificid (fidaxomicin) tablets will remain preferred 
  5. Anti-Infective Class Criteria Review 
    • Antifungals – Oral: 
      • Cresemba (isavauconazonium) – add diagnosis of mucormycosis and expanded age indication of ≥6 years of age and patient weight >16 kg.
      • Diflucan (fluconazole) 150mg tablets – increase quantity limit to 4 per fill to allow for treatment of complicated vulvovaginal candidiasis. 
    •  Macrolides: 
      •  Zithromax (azithromycin) 500mg tablets – increase quantity limit from 3 per fill to 5 per fill to allow for treatment duration of 5 days for community-acquired pneumonia.  Allow up to a quantity of 10 per fill for Lyme disease.
    • Quinolones: 
      • moxifloxacin 400 mg tablets – increase quantity limit from 14 per fill to 21 per fill to match the FDA approved treatment duration of complicated infection of skin and/or subcutaneous tissues for 7 to 21 days 
      • levofloxacin 250 mg & 500 mg tablets - increase quantity limit from 14 per fill to 28 per fill matching FDA approved treatment duration of Chronic Bacterial Prostatitis for 28 days 
      • levofloxacin 750 mg tablets – decrease quantity limit from 28 per fill to 14 per fill matching FDA approved treatment duration of infection of skin and/or subcutaneous tissue 
      • Cipro (ciprofloxacin) 250 mg, 500 mg, and 750 mg tablets – increase quantity limit from 42 per fill (typically 21 days) to 56 per fill to match the FDA approved treatment duration of Chronic Bacterial Prostatitis for 28 days, Infection of Bone (joint) 4-8 weeks, osteomyelitis 4-8 weeks 
    • Gastrointestinal Antibiotics: 
      • Aemcolo (rifamycin) tablets – clarify quantity limit as 12 tablets per claim in the criteria   
      • Xifaxan (rifaximin) 200 mg tablets – quantity limit missing from criteria. Add quantity limit of 9 tablets per claim to the criteria.  
      • Xifaxan (rifaximin) 550 mg tablets - add a quantity limit of 3 tablets per day to allow TID dosing for IBS without constipation  

PDL Class Category: Asthma/COPD/Allergy Classes:

  1. Beta Adrenergics – Short Acting  
    • Move albuterol HFA to preferred except for the Prasco authorized generic product. Add a specific supplemental message to the Prasco generic product to indicate all other generic albuterol HFA products are preferred. 
    •  Move Airsupra from Beta Adrenergic/Corticosteroid Inhaler Combinations to Beta-Adrenergics – Short Acting as non-preferred.
  2.   Beta Adrenergic/ Corticosteroid Inhaler Combinations  
    • Move Airsupra to Beta Adrenergics – Short acting as non-preferred 
  3.  Inhaled Glucocorticoids 
    • Move Asmanex HFA (mometasone) to preferred 
  4. Asthma/COPD/Allergy Class Criteria Review  
    •  Inhaled Glucocorticoids: 
      • Asmanex HFA (mometasone) – remove PA criteria

 

 Brand Preferred Products (Brand over Generic) Changes: 

  1. Remove Pradaxa capsules (dabigatran) 
  2. Remove Humalog Mix pen (insulin lispro) 3
  3. Remove Novolog cartridge (insulin aspart)

 

Last Updated: 07/14/2025