Your Michigan Medicaid Drug List Changed on November 1. What to Ask If You Are Mid-Treatment

Did Michigan Medicaid change its preferred drug list on November 1, 2026?

Yes. Effective November 1, 2026, Michigan's Single Preferred Drug List moved several widely used biologic products from preferred status to non-preferred status, with prior authorization now required. A medicine you have been filling as preferred may now need new paperwork before the next fill (Michigan Department of Health and Human Services PDL change notice). The Michigan Department of Health and Human Services' PDL change notice lists preferred/non-preferred flips for adalimumab, ustekinumab, and interleukin-17 (IL-17) inhibitors across conditions that include plaque psoriasis, hidradenitis suppurativa, ankylosing spondylitis, non-radiographic axial spondyloarthritis, Crohn's disease, ulcerative colitis, rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis, and uveitis. For adalimumab, the notice moves coverage toward Hadlima, a biosimilar of the same medicine. For ustekinumab, it moves coverage toward Starjemza, also a biosimilar of the same medicine. For IL-17 inhibitors, it moves coverage toward Taltz, a different preferred drug in that class. Naming a preferred alternative does not mean EllenRx® recommends a switch or promises coverage. For how managed care formulary rules show up as denials, see Medicaid managed care denials. Biosimilar preference changes can also raise biosimilar switch questions; mid-year list changes differ from the January framing in formulary changes in January.

What should you ask if you are already on one of these medicines?

Call your plan about the November 1 preferred-drug-list change while you still have supply left, so a new prior authorization can start before your next fill date. If a refill is already rejected, keep the notice and use the steps below right away (how to read a denial letter).

Am I grandfathered? The change notice describes limited continuation rules for some products and diagnoses. One path is a one-year continuation for people already established on an IL-17 inhibitor for hidradenitis suppurativa. Other products on the change list do not get the same automatic pass. Ask your plan, in writing, whether you are covered under any grandfathering rule and through what date (MDHHS PDL change notice).

What is the exception or prior authorization path to stay on my current medicine? Non- preferred status usually means your prescriber must show medical need. For the IL-17 hidradenitis path, the notice also allows the prescriber to attest that trying a preferred agent is not clinically appropriate for the patient's hidradenitis suppurativa. Ask what clinical criteria and forms the plan wants. For how plans define that showing, see medical necessity explained.

What are the preferred alternatives, and do they also need prior authorization? The notice lists Hadlima for adalimumab, Starjemza for ustekinumab, and Taltz for IL-17 inhibitors. Some preferred alternatives still require prior authorization. Confirm that before anyone switches you.

What is the appeal deadline if the first request is denied? Get the date in writing. Then see how to appeal.

Do not stop or change a prescribed medication without talking to your doctor. Keep taking your prescribed medication as directed unless your doctor tells you otherwise. The November 1 preferred-drug-list update changes how the plan covers the drug; it does not itself change your prescription.

What if your Michigan Medicaid refill needs a new prior authorization?

If the refill is rejected or you receive a prior authorization denial, read the reason on the notice, ask your prescriber to submit the exception or prior authorization with the clinical criteria the plan listed, and calendar the appeal deadline printed on the letter. Start the exception path before your current supply runs out.

How can Ellen® help after a Michigan Medicaid drug-list change?

If your refill is rejected or you receive a prior authorization denial, upload the letter or notice to EllenRx®'s Denial Decoder to see what it says. Then use Ellen's Appeal wizard to organize the clinical points and documents your prescriber may need for an exception or appeal. You can also begin from I Was Denied or Medicaid denial help. Your next step: if your November refill hit a new prior authorization wall, open the Appeal wizard and work through the exception or appeal path with your prescriber before your current supply runs out.

Sources

Michigan Department of Health and Human Services, Preferred Drug List / Single PDL change notice (changes effective November 1, 2026)

Michigan Preferred Drug List / Single PDL (effective November 1, 2026)