Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street Boston, MA 02111 www.state.ma.us/dma
MassHealth
Pharmacy Bulletin 68 July 2001
TO:       Pharmacies Participating in MassHealth FROM:       Wendy E. Warring, Commissioner
RE:       Reference Chart re: Medication Utilization in Nursing Facilities

Background

Medication waste is a significant problem for nursing facilities. The Division of Medical Assistance is collaborating with the Department of Public Health to help nursing facilities better handle and reduce the waste of medications.

Reference Chart

The accompanying chart reviews relevant Division of Medical Assistance and Department of Public Health policies and procedures pharmacies should follow to ensure the appropriate handling of medications for residents of nursing facilities.

Questions

If you have any questions about the information on this chart, contact the MassHealth Provider Relations Department at (617) 628-4141 or 1-800-325-5231 or the DPH Division of Health Care Quality at (617) 753-8106 or access the DPH Web site at www.state.ma.us/dph.

Pharmacy Responsibilities
In Handling Schedule VI Medications for Nursing-Facility Residents

Multiple Dispensing Fees	The Division allows multiple dispensing fees where applicable; for instance, monitoring small quantities of antibiotics or psychotropics where dosages may vary over time.	
Medication Label	Department of Public Health regulations require that only a pharmacist can affix a prescription label to a medication container whenever there is a change in dose but no change in the medication. It is permissible for a nurse to affix an auxiliary label that states, “Directions have changed; refer to the resident’s medication record for proper dose.” The pharmacy should supply these labels to the nursing facility.	
Early Refills	Refilling prescriptions sooner than seven days before the end of the current supply is not allowed for residents of nursing facilities.	
Amount of Medication to Be Ordered by the Nursing Facility	The nursing facility must order only the amount of medication prescribed: for example, a quantity sufficient for 10 days or less for medications new to the resident, for medications that require monitoring (for example, psychotropic or cardiac medications), or for medications that require frequent dosage adjustments (for example, anticoagulants or antibiotics).
Order prescribed maintenance medications in 30-to-60 day quantities.	
Change of Pharmacy	The Division will not pay for new prescriptions solely because of a change in the pharmacy provider. The nursing facility should re-order medication only when the current supply is about to be exhausted.	
PHM-NF/Meds (07/01)