Important Changes to Meridian Medicaid Pharmacy Formulary Effective on 11/1/2026: Humira, Cosentyx, and others
The State of Michigan (MI) Medicaid Program and Michigan Department of Health and Human Services (MDHHS) pharmacy department are mandating several high impact formulary changes that will affect many Michigan Meridian Medicaid members, prescribers, and pharmacies, effective on 11/01/2026.
These are mandated changes and updates to the Common Formulary and Single Preferred Drug List (SPDL) according to the state’s Pharmacy & Therapeutics Committee meeting from September 2026.
These changes include moving several highly utilized biologic medicines, including brand name Humira and Cosentyx, from preferred without prior authorization status, to non-preferred with prior authorization status.
These changes also include other highly utilized prescription medicines such as Nexium packets for oral suspension, Janumet XR tablets, and Farxiga, moving from preferred without prior authorization, to non-preferred with prior authorization status.
Meridian wants to communicate these changes and corresponding preferred formulary alternatives that will be effective on and after 11/01/2026. Please use the table below to identify drugs moving to non-preferred status on 11/01/2026, and their corresponding preferred alternatives, and if prior authorization is required for the new preferred alternative.
Grandfathering for certain members impacted by the negative formulary changes as allowed by MDHHS is outlined below. The following situations are where members will be automatically grandfathered and allowed to bypass new prior authorization requirements that are effective on 11/01/2026:
- Cosentyx: 1-year grandfathering to bypass new prior authorization, only for members who are already established on Cosentyx and using to treat a diagnosis Hidradenitis suppurativa (ICD-10 code: L73.2).
- Nexium Packets for oral suspension, brand name: 1-year grandfathering to bypass new prior authorization, for all current utilizers
- Janumet XR tablets, brand name: 90-day grandfathering to bypass new prior authorization, for all current utilizers
You can also find more information on our website:
Current preferred drug moving to non-preferred | New Utilization Management restrictions on the current preferred drug (eff 11.1.26) | New corresponding preferred alternative drug (eff 11.1.26) | New corresponding preferred alternative drug restrictions |
|---|---|---|---|
Humira (brand name) | Non-Preferred Prior Authorization required Quantity Limits (variable depending upon drug strength & formulation) | Adalimumab-adbm (*unbranded Cyltezo from Boehringer Ingelheim – only NDCs beginning with 00597-) Hadlima (adalimumab-bwwd) | Preferred No Prior Auth required Quantity Limits (variable depending upon drug strength & formulation) |
Cosentyx | Non-Preferred Prior Authorization required Quantity Limits (variable depending upon drug strength & formulation) | Adalimumab-adbm (*unbranded Cyltezo from Boehringer Ingelheim – only NDCs beginning with 00597-) Hadlima (adalimumab-bwwd) Taltz | Preferred No Prior Auth required (*except for Taltz – requires Prior Auth*) Quantity Limits (variable depending upon drug strength & formulation) |
Steqeyma (ustekinumab-stba, biosimilar to Stelara) | Non-Preferred Prior Authorization required Quantity Limits (variable depending upon drug strength & formulation) | Pyzchiva (ustekinumab-ttwe) Starjemza (ustekinumab-hmny) | Preferred Prior Auth required Quantity Limits (variable depending upon drug strength & formulation) |
Nexium packets for oral suspension (brand name) | Non-Preferred Prior Authorization required Quantity Limits (2 packets per day) | Protonix packets for oral suspension (*brand name preferred) Omeprazole capsules Pantoprazole tablets | Preferred No Prior Auth required Quantity Limits (2 packets, capsules, or tablets per day) |
Janumet XR oral tablets (brand name) | Non-Preferred Prior Authorization required | Janumet immediate release tablets (*brand name preferred) Jentadueto tablets Jentadueto XR tablets | Preferred No Prior Auth required Quantity Limits (*2 tablets per day -only for Janumet immediate release) |
Farxiga oral tablets (brand name) | Non-Preferred Prior Authorization required | Dapagliflozin tablets (generic for Farxiga) Jardiance tablets | Preferred No Prior Auth required |
Fylnetra prefilled syringe (pegfilgrastim-pbbk, biosimilar to Neulasta) | Non-Preferred Prior Authorization required Quantity limits (1 syringe per 14 days) | Fulphila prefilled syringe Nyvepria prefilled syringe | Preferred No Prior Auth required Quantity Limits (1 prefilled syringe per 14 days) |
Tracleer oral tablets (brand name) | Non-Preferred Prior Authorization required | Bosentan tablets (generic for Tracleer) Ambrisentan tablets Opsumit tablets (*brand name preferred) | Preferred Prior Auth required |