HAP CareSource Medicaid
Please use the search box below to look for the drug being requested. You can search by drug name or NDC. Formulary status and any applicable restrictions or notes will display when you select the drug from the search results.
Review all “More Info” links to see drug criteria, limits, and administrative notes.
NOTE: If a medication is included on the SPDL/ HAP CareSource PDL or Common Formulary (Tiers 1, 2, and 3), review should follow the drug or drug class-specific criteria as listed on the Common Formulary PA Criteria – see link below.
If a medication is not listed on the SPDL/ HAP CareSource PDL or Common Formulary, refer to the Michigan Pharmaceutical Product List (MPPL) – see link below. If listed on the MPPL, these requests should be reviewed per MMIT drug or drug-class specific criteria or policy, if available, or Medical Necessity for Administrative Policy, if not available. All requests must be set up and sent to the RPH for review.
If a medication is not listed on the SPDL/ HAP CareSource PDL, Common Formulary, or MPPL, please reach out via IM Consult for next steps.
Documents and Links
Formulary Files and References
State Carve Out Drugs
Medical Benefit Review
- Review PA Status in the Procedure Code Lookup Tool
- If Prior Authorization Required? = Y
- If the medication is listed on the Michigan Preferred Drug List (PDL) / Single PDL and/or Michigan Common Formulary, review per Michigan Medicaid Clinical and PDL Criteria.
- If the medication is NOT listed on the SPDL or Common Formulary, review per posted drug-specific Michigan Medicaid Pharmacy Policy.
- If drug-specific policy is NOT available, review per Medical Benefit Medications policy posted for Michigan Medicaid.
- If Prior Authorization Required? = N, send fax back and dismiss, in alignment with established process for dismissal.
Pharmacy Benefit Review