Health Safety Net (HSN) Formulary

---

Health Safety Net Prior Authorization Request

Effective January 12, 2026, the Health Safety Net Formulary will no longer match the MassHealth Drug List. The Health Safety Net Prior Authorization Request form can be found linked below.

Health Safety Net Prior Authorization Request  | 

 

 

Health Safety Net Reimbursable Pharmacy Services - Formulary Changes

General overview of recent changes to the Health Safety Net Formulary.

Health Safety Net Reimbursable Pharmacy Services - Formulary Changes  | 

 

 

Patient Assistance Program Resource

List of patient assistance program websites for multiple drug manufacturers.

Patient Assistance Program Resource  | 

 

 

Health Safety Net Reimbursable Pharmacy Services - Highly Utilized Therapeutic Classes

List of generic and branded products that will be available without prior authorization effective January 12, 2026 for commonly utilized therapeutic classes.

Health Safety Net Reimbursable Pharmacy Services - Highly Utilized Therapeutic Classes  |