Current information for pharmacists about the MassHealth Pharmacy program

PHARMACY PROGRAM

Number 6

Page 1

January 5, 2005

Pharmacy Facts

MassHealth Pharmacy Program

 • Editor: Vic Vangel  Contributors: Chris Burke, Gary Gilmore, Paul Jeffrey • 

Pharmacy Program Regulations
Pharmacies have been mailed a transmittal letter that contains an update to the Pharmacy Manual. This document can also be found at: www.mass.gov/masshealthpubs. Click on “Provider Library,” then on “Transmittal Letters,” then on “2004 Transmittal Letters,” then on “PHM-51.”
One change that will be of particular interest to pharmacists is that effective 1/1/05 MassHealth will pay for prescription refills for up to one year from the written date of the prescription. MassHealth will now pay for a maximum of 11 monthly refills.
 
MassHealth Drug List
On 1/18/05 there will be a change in coverage for ranitidine. Ranitidine 150 and 300mg capsules will require PA.

Please remember that the MHDL and its updates can be found at: www.mass.gov/druglist.

Patient Locations
There seems to be some confusion among pharmacists concerning the transmittal of patient location codes on a pharmacy claim submitted through the Pharmacy Online Processing System (POPS). Members that reside in assisted living facilities, rest homes, or “group homes” are considered to have patient location 1 -home. A member cannot be considered a long-term care or nursing home resident unless the place of residence has around-the-clock nursing care.

Prescriber DEA Numbers
Please remember that MassHealth will only pay for claims that contain a valid prescriber DEA number. The Pharmacy Online Processing System (POPS) will only allow a claim to pay if the DEA # submitted matches a DEA # in the POPS prescriber file. This DEA # has to have a name and address associated with that prescriber in the prescriber file.

Claims Issue
The Center for Medicare and Medicaid Services (CMS) has informed Medicaid programs that effective 1/1/05 over 300 NDC #s will be excluded from the federal rebate program. In accordance with federal law and MassHealth regulations, MassHealth will no longer pay for claims that are submitted with these NDCs. See 130 CMR 406.412(A)(1). The affected NDCs can be found at www.cms.hhs.gov/medicaid/drugs/drug1.asp. (Select 2004, then select R135.)

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