MassHealth Pharmacy Program
-
The MassHealth Drug List is an alphabetical list of commonly prescribed drugs and therapeutic class tables. The List specifies which drugs need prior authorization (PA) when prescribed for MassHealth members and also specifies the generic over-the-counter drugs that are payable under MassHealth.
-
This link provides a list of drugs that Medicare Part D excludes from prescription coverage, but may be covered by MassHealth.
-
These are regulations related to the MassHealth Pharmacy Program. See also Division of Health Care Finance and Policy regulations and policies on prescribed drugs at 114.3 CMR 31.00
-
-
-
-
Additional communications (see also Pharmacy Facts above), including guidance on payment, intended for pharmacists.
-
Communications, including educational notices, intended for physicians, nurse practitioners, community health centers, and other medical providers involved in prescribing drugs.
-
This link provides information about the DUR Program and the DUR Board, including links to the Board meeting schedule, minutes, and agendas.
-
The first page of the MassHealth remittance advice (RA) is used to send important messages to providers. These messages may contain billing, regulation, and reimbursement information, as well as other topics. These updates should be communicated to all applicable staff.
-
For providers who would prefer to receive their remittance advice as an ANSI X12 835 transaction, this link supports the setup and operation for receiving this electronic file transfer process.
-
This is a link to an ACS State Healthcare site that offers providers with industry information about HIPAA compliance and the NCPDP 5.1 standard. It provides answers to frequently asked questions, links to reference sites, and other information to help providers with HIPAA-compliance issues.
-
(U.S. Food and Drug Administration Orange Book)
-