Ongoing Reminders

RSV Season 2025-2026: Our pharmacy team has created a summary of RSV-related immunization updates and information on coverage under medical and pharmacy benefits for RSV vaccines and RSV monoclonal antibodies used for immunization.
The Michigan Medicaid SPDL Formulary has been updated as of 8/1/2025. These changes include drugs that have been added, removed, or had utilization management restrictions adjusted for preferred and non-preferred medications
- August 2025 Michigan Medicaid SPDL Formulary Changes
The coverage of certain insulin syringes and pen needle products is changing on 08/01/2025 for all members. Effective on 08/01/2025, insulin syringes and pen needles other than Embecta (formerly known as B.D.) branded products will be removed from the formulary.
- Insulin Syringe & Pen Needles Changes Effective 8/1/2025
- Diabetic Supply Reference Guide Update for July 2025
Coverage of OneTouch Diabetic Test Strips has changed as of 10/01/2025 for all members. Effective 10/01/2025, OneTouch Diabetic Test Strips have been removed from the formulary (list of covered medications). Starting on 10/01/2025, the preferred diabetic test strips and glucometers is Accu-Chek Guide Test Strips, along with Accu-Chek Guide and Guide Me branded glucometers. This applies under the pharmacy benefit for Michigan Meridian Medicaid members.
Recent Authorization, Billing, and Policy Updates:
- Prior Authorization required for certain skin substitute codes (Effective 10/16/2025)
- New Clinical Policies effective 8/22/2025
- Prior Authorization Requirement for Unlisted CPT Codes (Effective 7/21/2025)
- Prior Authorization required for 01966 – Anesthesia for Induced Abortion (Effective 7/21/2025)
Get reimbursement for pediatric oral health screenings and fluoride varnish services for patients aged zero to three
- www.SmilesforLifeOralHealth.org
Hepatitis C Virus Program: The recommended treatment for HCV is Mavyret, which can be dispensed in eight- week supply. Providers who have prescriptive authority can prescribe Mavyret to their patients with a positive Hepatitis C diagnosis. Prior authorization is not required for Medicaid.
Medicare-Medicaid Plan (MMP) Dedicated Care Management: All MMP members have a dedicated care manager who is a registered nurse or licensed social worker assigned to support them with their health care needs, navigating the health care system, and assisting with resources for SDoH needs. For more information call 1-855-323-4578 or contact provider relations via our Provider Relations Inquiry Form.

Last Updated: 10/16/2025