Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street Boston, MA 02111 www.mass.gov/dma

MASSHEALTH
TRANSMITTAL LETTER NF-48 November 2003
TO:      Nursing Facilities Participating in MassHealth
FROM:      Beth Waldman, Acting Commissioner
RE:      Nursing Facility Manual (Unit-Dose Return for Certain Drugs)
In an effort to reduce pharmaceutical waste in nursing facilities, the Division implemented in July 2002 a unit-dose return requirement of certain drugs for nursing facilities and pharmacies. (See 130 CMR 456.621.) Under these regulations, the nursing facility must return to the dispensing pharmacy certain unused unit-dose-packaged drugs that were dispensed to MassHealth members. The Division is expanding the number of drugs that are to be a part of the program from eight to 29.
Department of Public Health Guidelines
The Department of Public Health has issued two documents about unit-dose dispensing and return:
 •	Policy on Return for Redispensing of Medications from Long Term Care Facilities
 •	Guidelines for Use of Unit-Dose Packaging for the Management and Administration of Pharmaceuticals in Long Term Care Facilities.
Nursing facilities must adhere to these guidelines when returning drugs in unit-dose packaging. Please refer to Department of Public Health guidelines and “Best Practices” guidelines that were issued within Transmittal Letter NF-43, dated June 2002.
Best Practices
The Division, in concert with nursing facility and pharmacy stakeholders, has also prepared “Best Practices” guidelines. These guidelines advise nursing facilities and pharmacies on how to best manage the unit-dose return policy described in the attached regulations. Please refer to Department of Public Health guidelines and “Best Practices” guidelines that were issued with Transmittal Letter NF-43, dated June 2002.
These changes are effective January 1, 2004.

MASSHEALTH
TRANSMITTAL LETTER NF-48 November 2003 Page 2
NEW MATERIAL
(The pages listed here contain new or revised language.)
Nursing Facilities Manual
Pages F-1 and F-2
OBSOLETE MATERIAL
(The pages listed here are no longer in effect.)
Nursing Facilities Manual
Pages F-1 and F-2 — transmitted by Transmittal Letter NF-43

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
NURSING FACILITY MANUAL	SUBCHAPTER NUMBER AND TITLE
APPENDIX F: UNIT-DOSE DRUGS	PAGE
F-1	

	TRANSMITTAL LETTER
NF-48	DATE
01/01/04	
Unit-Dose Drugs
This appendix lists the unit-dose-packaged drugs that a nursing facility must return to the dispensing pharmacy in accordance with 130 CMR 456.621, when the use of the drug for the member is discontinued. Beside each drug is the minimum quantity of the doses of the drug acceptable for return.

Drug
Actonel
Aricept
Avandia
Celebrex
Celexa
Depakote
Detrol LA
DuoNeb
Effexor
Fosamax
Fragmin
Lamictal
Levaquin
Lipitor
Lovenox
Neurontin
Norvasc
Paxil
Prevacid
Plavix
Protonix
Remeron
Reminyl
Risperdal
Rocephin
Seroquel
Wellbutrin SR
Zoloft
Zyprexa

Minimum Quantity
3 3 3 3 3 3 3 3 3 3 1 3 3 3 1 3 3 3 3 3 3 3 3 3 1 3 3 3 3

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
NURSING FACILITY MANUAL	SUBCHAPTER NUMBER AND TITLE
APPENDIX F: UNIT-DOSE DRUGS	PAGE
F-2	

	TRANSMITTAL LETTER
NF-48	DATE
01/01/04	
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