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
	Pharmacy Bulletin 71
	November 2002

	TO:	Pharmacies Participating in MassHealth

	FROM:	Wendy E. Warring, Commissioner

	RE:	Changes to Pharmacy Copayments

Background	The Massachusetts Legislature increased pharmacy copayments for MassHealth members from 50 cents per prescription to $2 per prescription.  The revised regulations for this change will be effective January 1, 2003.  You will receive these revised regulations sometime in early January 2003.

	The Division will send MassHealth members a notice beginning in November 2002, informing them of this copayment increase.  An advance copy of the member notice is attached to this bulletin.  We are sending you this bulletin before MassHealth members are notified of the change.

Scope of Copayment	This copayment increase applies to drugs covered by MassHealth (whether legend or nonlegend), including the original prescriptions and all refills, with certain exceptions listed below.

Copayment Exceptions	The following continue to be excluded from the copayment requirement:
•	MassHealth members who have not reached their 19th birthday;
•	MassHealth members who are pregnant;
•	MassHealth members who are in the postpartum period that extends through the last day of the second calendar month following the month in which their pregnancy ends;
•	MassHealth Limited (emergency MassHealth) members;
•	MassHealth Senior Buy-In (MassHealth and Medicare) members or MassHealth Standard members for Medicare-covered drugs only, when furnished by a Medicare-certified provider;
•	MassHealth members who are inpatients in hospitals, nursing facilities, chronic-disease or rehabilitation hospitals, or intermediate-care facilities for the mentally retarded;
		family-planning services and supplies;
	
	(continued on reverse side)

Copayment Exceptions		emergency services; 
(cont.)		hospice-care services; and
		persons getting medical services through the Emergency Aid to the
		Elderly, Disabled and Children (EAEDC) Program, if they do not 
		receive MassHealth Basic or MassHealth Standard.

MassHealth MCOs	Members of one of these MassHealth managed-care organizations (MCOs)—Fallon Community Health Plan, Neighborhood Health Plan, Network Health, or Boston Medical Center HealthNet Plan—must follow the MassHealth copayment policy of their MCO.

Restrictions	The pharmacy may not refuse to fill or refill a prescription for a MassHealth member who is financially unable to pay the copayment.

Collection of 	The pharmacy may use any legal means to collect unpaid copayments 
Copayments 	from the member.

Claims Processing	Pharmacy claims with dates of service on or after January 1, 2003, will reflect the increased copayment amount of $2.

Questions	If you have any questions about claims processing, contact the
		ACS Help Desk
		1-866-246-8503
		24 hours a day, seven days a week.

	If MassHealth members have a question, advise them to call the
		MassHealth Customer Service Center
		1-800-841-2900 (TTY:  1-800-497-4648 for the deaf and hard of 	hearing) between 8 A.M. – 5 P.M., Monday through Friday.