• Editor: Vic Vangel • Contributors: Chris Burke, Gary Gilmore, Paul Jeffrey, James Monahan, Chuck Young • 

Pharmacy Program Regulations 

MassHealth has updated the Pharmacy Manual with 
changes detailed in Transmittal Letter PHM-58. It was 
mailed last month and can be found at 
www.mass.gov/masshealthpubs. Click on “Provider 
Library,” then “Transmittal Letters,” then “2008 
Transmittal Letters,” then “PHM-58.” 

Changes to regulations transmitted by Transmittal 
Letter PHM-58 will become effective September 15, 
2008. The following changes may be of particular 
interest to pharmacists. 

• MassHealth will allow the following additional 
exceptions to the 30-day quantity limit to allow 90-
day supplies: 


o for all family-planning drugs; and 


o when MassHealth is the secondary payer and 
the primary payer allows a 90-day supply. 




• The MassHealth Drug List (MHDL) will be used to: 


o specify refill limitations; and 


o specify all medical supplies and devices that 
are paid through POPS, in a section called the 
MassHealth Non-Drug Product List. 




• MassHealth is revising the definition of “usual and 
customary charge” to require pharmacies to include 
cash-paying customers and advertised prices for 
OTC drugs when determining the lowest price. 




MHDL Reminders 

In some instances MassHealth requires prior 
authorization (PA) for specific formulations or 
strengths of certain prescribed drugs. This does not 
mean that all formulations and strengths of that drug 
will require PA. MassHealth encourages the 
pharmacy, when clinically appropriate, to obtain a new 
prescription for a formulation or strength of that drug 
that does not require PA. 

Examples of drugs that require PA for certain 
formulations or strengths (indicated in italics) include 
the following: 

ranitidine capsules 

fluoxetine 20 mg. tablets and fluoxetine 40mg. 

trazodone 300 mg. 

clindamycin 300 mg. 

metronidazole 375 mg and Flagyl ER 750 mg. 

Keflex 750 mg. 

Additionally, the MHDL therapeutic tables are 
undergoing revisions. The tables provide a view of 
drugs within their respective therapeutic classes along 
with PA requirements, clinical information about the 
drug, and evaluation criteria for PA for select 
therapeutic classes. The tables may not include all 
medications, dosage forms, and combination products 
within that therapeutic class. The criteria for PA 
identify the clinical information MassHealth considers 
when determining medical necessity for selected 
medications. These criteria are based upon generally 
accepted standards of practice, review of the medical 
literature, federal and state policies, as well as laws 
applicable to the Massachusetts Medicaid Program 
(MassHealth). The clinical information included in the 
criteria is not intended to serve as a source of 
comprehensive prescribing information. 

NewMMIS Update 

The NewMMIS implementation date has been 
changed from September 29, 2008 to January 5, 
2009. The additional time will enable MassHealth to 
continue internal testing and ensure that the new 
system functions as intended. It will also give 
MassHealth providers some additional time to prepare 
for the transition to NewMMIS. 

All MassHealth providers will receive a bulletin 
explaining the delayed implementation date of 
NewMMIS in more detail. 



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

www.mass.gov/masshealth/pharmacy 

Number 43 

September 9, 2008