Current information for pharmacists about the MassHealth Pharmacy program
MassHealth Pharmacy Program
Number 70
March 19, 2012
Pharmacy Facts
MassHealth Pharmacy Program
www.mass.gov/masshealth/pharmacy
Editor: Vic Vangel
Contributors: Chris Burke, Gary Gilmore, Paul Jeffrey, James Monahan, Nancy Schiff

MHDL Updates
Below are certain updates to the MassHealth Drug List (MHDL). See the MHDL for a complete 
listing of updates.

1. Additions
The following newly marketed drugs have been added to the MassHealth Drug List as of 
March 12, 2012.
       Erwinaze (asparaginase Erwinia chrysanthemi) ^
           – PA
       fluoxetine 60 mg tablet – PA 
       Jakafi (ruxolitinib) – PA
       ONFI  (clobazam) – PA

2. New FDA “A”–Rated Generics
The following FDA “A”-rated generic drugs have been added to the MassHealth Drug List as 
of March 12, 2012. The brand name is listed with a # symbol, to indicate that prior 
authorization is required for the brand.

New FDA “A”-Rated 
Generic Drug                          Generic Equivalent
methylphenidate 20, 30 or 
40 mg – PA > 60 units/month    	      Ritalin LA # 
fluocinolone oil, otic drops          DermOtic # 
piperacillin/tazobactam               Zosyn #

3. Change in Prior-Authorization Status
a. The following drug requires prior authorization when exceeding quantity limits effective 
March 12, 2012.
	Aricept # (donepezil 10 mg tablet) – PA > 60 units/month

b. The following drug is covered without prior authorization effective March 12, 2012.
	Vivitrol (naltrexone injection)

c. The following drugs will require prior authorization when exceeding quantity limits effective 
March 26, 2012.
	Spiriva (tiotropium) – PA > 30 units/month

d. The following antidiarrheal agents will require prior authorization effective March 26, 2012.
	opium tincture – PA
	Motofen (atropine/difenoxin) – PA

e. The following drugs will require prior authorization effective March 26, 2012.
	Avastin (bevacizumab) – PA
	Berinert (c1 esterase inhibitor, human) – PA
	Cinryze (c1 esterase inhibitor, human) – PA
	naltrexone powder – PA
          
4. Corrections
a. The following drugs have been added to the MassHealth Drug List. They were omitted in error. 
These changes do not reflect any change in MassHealth policy.
        Atralin (tretinoin) – PA
        chloral hydrate solution
        Elspar (asparaginase) ^
        erythromycin, topical – PA > 22 years
        fenofibric acid tablet 35 mg and 105 mg
        Ifex (ifosfamide)
        Oncaspar (pegasparaginase) ^
        Questran Light # (cholestyramine/aspartame)

b. The prior-authorization status of the following drug has been clarified. These changes do not 
reflect any change in MassHealth policy.
        Evoclin (clindamycin foam) – PA > 22 years

^ This drug is available through the health care professional who administers the drug. Medicaid does
not pay for this drug to be dispensed through a retail pharmacy

#   This is a brand-name drug with FDA “A”-rated generic equivalents. Prior authorization is required 
for the brand, unless a particular form of that drug (i.e., tablet, capsule, or liquid) does not have 
an FDA “A”-rated generic equivalent.

Reminder about Claims Processing When MassHealth is a Secondary Insurer
When a pharmacy is not a participating provider for a MassHealth member’s primary insurance, 
or the pharmacy receives a message from the primary insurer that a product is covered only at 
certain network pharmacies, the pharmacy cannot appropriately bill MassHealth as the primary 
payer using Other Coverage Code 3.

In these instances, the pharmacy must instruct the member that they need to use a participating 
pharmacy of the primary insurer.


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