Commonwealth of Massachusetts 
Executive Office of Health and Human Services 
Division of Medical Assistance 

600 Washington Street 
Boston, MA 02111


 MassHealth 
Pharmacy Bulletin 62 
March 2000

 TO: Pharmacies Participating in MassHealth 

FROM: Mark E. Reynolds, Acting Commissioner 

RE: Prior Authorization for Certain Brand-Name Products 

Background 
The bulletin is being sent to all MassHealth pharmacies and prescribers. 
Effective March 15, 2000, the Division requires prior authorization for 
certain brand-name multi-source products to ensure that the most 
appropriate, efficacious, and cost-effective drugs are prescribed and 
dispensed to MassHealth members. 

Brand-Name Drugs Brand-name analgesics, benzodiazepines, and muscle relaxants 
Requiring Prior require prior authorization if they are an AB-rated multi-source product 
Authorization listed in the most recent edition of or supplement to the Approved Drug 

Products with Therapeutic Equivalence Evaluations, also known as the 
Orange Book, published by the U.S. Food and Drug Administration. 

Prior Authorization 
The prescriber must submit to the Division a completed Request for Prior 

Procedures 
Authorization form or submit on office letterhead the information required 
in Subchapter 5 of the provider manual. The form or letterhead may be 
faxed or mailed to: 

Drug Utilization Review Program 
University of Massachusetts Medical School 
11 Midstate Drive 
Auburn, MA 01501 
Fax: (508) 721-7138 

Questions 
If you have any questions about the information in this bulletin, please 
contact the Unisys Provider Services Department at (617) 628-4141 or 
1-800-325-5231.