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PRIORITY: NEED TO KNOW

REMINDER: Medicaid Pharmacy Changes
Effective January 2026

Effective January 1, 2026, Utah Medicaid is requiring that we align certain drug classes on our Medicaid managed care formulary with the Utah Medicaid Preferred Drug List (PDL). An initial 90-day transition period applied prior to January 1, 2026, for impacted members. We previously mailed you a patient list identifying members who may be affected, along with an email that includes the list of drug classes on the Medicaid Hybrid PDL.

On the formulary, impacted medications will now display either “Hybrid PDL Preferred” or “Hybrid PDL Non-Preferred” to indicate their status under the Medicaid Hybrid PDL. 

Members who are new to the plan after January 1, 2026, and are taking non-preferred medications will follow the standard transition policy, which allows a single 30-day supply within the first 90 days of enrollment while the medication is transitioned to a preferred product or receives prior authorization.

The impacted preferred medication drug classes can be found here for Healthy U and here for Health Choice Utah.  

 

EXAMPLE OF FORMULARY INDICATORS:

  • HYB in green = Hybrid PDL Preferred
  • HYB in red = Hybrid PDL Non-Preferred
 

EXAMPLE OF HOW HYBRID PDL INDICATORS
WILL DISPLAY ON THE FORMULARY:

 

KEY REMINDERS:

  • Review your patient list and consider transitions to preferred products when appropriate.
  • GLP-1 prescriptions will require a diabetes ICD-10 code of E11#### to process under the Medicaid benefit starting January 1, 2026.
  • After January 1, 2026, requests for non-preferred products will be evaluated on a case-by-case basis for medical necessity.
  • The formularies have been updated to reflect these changes. Access them here:
    • Healthy U
    • Health Choice Utah

If you have questions or would like to confirm which of your patients are impacted, please contact Pharmacy Customer Service for Healthy U at 855-856-5694 or Pharmacy Customer Service for Health Choice Utah at 855-864-1404.

Thank you for your cooperation during this transition.

 

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