Current information for pharmacists about the MassHealth Pharmacy program

Number 25

January 5, 2007

Pharmacy Facts

MassHealth Pharmacy Program
www.mass.gov/masshealth/pharmacy
 
• Editor: Vic Vangel • Contributors: Chris Burke, Gary Gilmore, Paul Jeffrey, 
James Monahan, Chuck Young • 

Medicare Part D Prescription Drug Coverage Update 

1. Expiration of one-time 30-day supplies 
Due to the expiration date included in the state legislation governing 
assistance available to MassHealth members with Medicare (dual eligibles), 
effective January 5, 2007, at 12:01 A.M., MassHealth will no longer pay for one-
time 30-day supplies for dually eligible members. 

If a dually eligible member is not yet in a Medicare prescription drug plan, 
bill the point-of-sale facilitator (Wellpoint/Anthem), which provides temporary 
coverage for dual eligible members not yet enrolled in a Medicare prescription 
drug plan. Call 1-800-662-0210 and choose option “7” if you need help processing 
a Wellpoint/Anthem point-of-sale claim. 

2. One-time 72-hour supplies continue 
If you are unable to bill a Medicare prescription drug plan and unable to bill 
the point-of-sale facilitator (Wellpoint/Anthem), you may bill MassHealth for a 
one-time 72-hour supply by using level-of-service code 03 (emergency fill). This 
assistance does not have an expiration date. 

3. Copayment assistance continues 
MassHealth assistance with Medicare prescription drug plan copayments will also 
continue. In 2007, the maximum copayment that a Medicare prescription drug plan 
is permitted to charge a dually eligible member is $5.35. If a Medicare 
prescription drug plan charges a dually eligible member a copayment (up to 
$5.35) that is higher than what the individual would have paid under MassHealth, 
charge the individual what she or he would have paid under MassHealth and submit 
a claim to MassHealth for the difference. 

In the event that the drug plan assesses a copayment in excess of $5.35 for a 
dual eligible member, contact the plan. If the plan refuses to correct the 
copayment, MassHealth will supplement the copayment to standard MassHealth 
levels. 

Please direct any questions or comments (or to be taken off of this fax 
distribution) to 
Victor Moquin of ACS at 617-423-9830.