USP Drug Classification Updates Could Shape Medicaid Formulary Decisions and Federal Pricing Models

The U.S. Pharmacopeia's 2026 Drug Classification update revises how drugs are grouped for non-Part D health plan formularies, including Medicaid managed care plans. While primarily focused on Medicare Part D guidance, these classifications influence how all health plans structure formularies and could affect drug eligibility for upcoming Medicare international reference pricing demonstrations. The annual update cycle for non-Part D classifications offers Medicaid plans more frequent opportunities to engage on drug categorization than the three-year Medicare cycle.

Pharmacy · Managed Care

This is outside commentary from Avalere, not part of Medicaid Monitor's independently scored news coverage.

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