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HAP CareSource Medicaid

Documents and Links

  • HAP CareSource Formulary
  • HAP CareSource Formulary Change Notice
  • Machine Readable Formulary File (JSON)
    ** Machine-readable format in accordance with CMS/MDHHS requirements**
  • HAP CareSource Medicaid Medical Drug Review Guidelines
  • MDHHS Practitioner and Medical Clinic Fee Schedule
  • Michigan Common Formulary
  • Michigan Medicaid Common Formulary Prior Authorization Criteria
  • Michigan Preferred Drug List (PDL) / Single PDL

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  • Antiseptics And Disinfectants
  • Biological Agents
  • Drugs For Addiction
  • Drugs For Cancer
  • Drugs For Eating Disorders
  • Drugs For Infections
  • Drugs For Metabolic Disease
  • Drugs For Muscles, Ligaments, Tendons, And Bones
  • Drugs For Nerves And Muscles
  • Drugs For Nutrition
  • Drugs For Organ Transplants
  • Drugs For Overdose Or Poisoning
  • Drugs For Pain And Fever
  • Drugs For The Blood
  • Drugs For The Ear
  • Drugs For The Eye
  • Drugs For The Heart
  • Drugs For The Liver
  • Drugs For The Lungs
  • Drugs For The Mouth And Throat
  • Drugs For The Nervous System
  • Drugs For The Nose
  • Drugs For The Skin
  • Drugs For The Stomach
  • Drugs For The Urinary System
  • Drugs For Women
  • Drugs That Alter Metabolism
  • Hormones
  • Medical Supplies And Durable Medical Equipment
  • Miscellaneous
  • Rectal Preparations
  • Vitamins And Minerals
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Formulary Id: HAP CareSource SPDL
Formulary Effective Date: 02/01/2025
Updated:
03/2025
CMS Approval Date:
11/01/2023
CMS Version:
4

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