Effective November 1, 2026: Pharmacy and Biopharmacy Policies

Date: 08/04/26

Magnolia Health Plan has added, updated or retired certain pharmacy and biopharmacy policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result, the following policies are effective on November 1, 2026, at 12:00AM.

All pharmacy and biopharmacy clinical policies are reviewed and approved by the Pharmacy and Therapeutics (P&T) Committee before implementation.

The criteria summary table provides a summary of the policy changes.

HIM Criteria Summary Table (PDF)

To review all policies, please visit Ambetter from Magnolia Health’s Clinical and Payment Policies webpage

For questions or additional information, please contact Magnolia’s Pharmacy Department at 1-866-912-6285, ext. 66409.