Pharmacy Policies

These pharmacy policies apply to our HAP CareSource™ Medicaid plan.

HAP CareSource aligns with the Michigan Preferred Drug List (PDL)/Single PDL and the Michigan Medicaid Health Plan (MHP) Common Formulary. The Single PDL and Common Formulary, and related prior authorization and step therapy criteria, can be found on the Michigan Medicaid Health Plan Pharmacy Benefit Page.

These pharmacy policies below apply to products in categories outside of the Single PDL and Common Formulary for our Michigan Medicaid plan.

Pharmacy policies offer guidance on determination of medical necessity coverage of pharmaceutical products. The coverage criteria are consistent with FDA-approved prescribing information, treatment guidelines and literature. The policies listed on this page are not inclusive of all pharmaceutical products. New policies will be added as new pharmaceutical products become available or as needed. Existing policies are regularly reviewed and updated to reflect current treatment guidelines and prescribing information.

The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here.

Current Pharmacy Policies