Current information for pharmacists about the MassHealth Pharmacy program
MassHealth Pharmacy Program
Number 75
December 28, 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

Update on Medicare Part-D Prescription 

Drug Coverage 

1. Copayments 

MassHealth continues to provide assistance with 
Medicare Part-D prescription drug plan 
copayments for dually eligible members to ensure 
that the member does not pay a copayment that is 
greater than the standard MassHealth copayment 
for that drug. Currently, the maximum amount that 
a Part-D plan is permitted to charge a dually 
eligible member is $6.50. Effective January 1, 
2013, this maximum amount will increase to $6.60. 
If a Part-D plan returns a copayment amount in 
excess of $6.60, pharmacies are reminded to 
follow the instructions published in Pharmacy 
Facts #47 to correct this issue (see 
www.mass.gov/eohhs/docs/masshealth/pharmacy/ 
pharmacy-fact-47.pdf). 

2. Benzodiazepines 

Effective January 1, 2013, benzodiazepines will no 
longer be an excluded drug under Medicare 
Part-D. MassHealth will no longer cover this class 
of drugs for dually eligible members for dates of 
service beginning January 1, 2013, because 
Medicare Part-D prescription drug plans will now 
provide coverage of benzodiazepines. 

3. Barbiturates 

Effective January 1, 2013, Medicare Part-D 
prescription drug plans will provide coverage of 
barbiturates when used to treat epilepsy, cancer, 
or a chronic mental health disorder. Therefore, 
MassHealth will no longer cover barbiturates for 
dually eligible members when used to treat those 
conditions for dates of service on or after 
January 1, 2013. 

3. Barbiturates (cont.)
 
However, MassHealth will continue to provide 
coverage of barbiturates for dually eligible 
members being treated for other conditions, when 
medically necessary. The pharmacy may use the 
standard NCPDP Other Coverage Code (NCPDP 
field 308-C8) and Reject Code (NCPDP field 4726E) 
to override a denied claim from the Medicare 
Part-D plan for a barbiturate if the barbiturate is 
not being used to treat epilepsy, cancer, or chronic 
mental health disorder. 

Buprenorphine/Naloxone 

MassHealth is aware of Reckitt Benckiser’s 
planned withdrawal of Suboxone tablets. 
MassHealth will continue to pay for available 
formulations of buprenorphine/naloxone for 
members, when used only if medically necessary. 
MassHealth will issue additional advisories on this 
matter as necessary. MassHealth has also 
adjusted prior authorization criteria to allow for 
coverage of the unit-dosed film formulation, upon 
request, for those members who were prescribed 
Suboxone and reside in households with children 
under six years of age. 

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