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 PHM-49
November 2003
TO:      Pharmacies Participating in MassHealth
FROM:      Beth Waldman, Acting Commissioner
RE:      Pharmacy 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-dispensing and return requirement of certain drugs for pharmacies and nursing facilities. (See 130 CMR 406.446.) Under these regulations, the pharmacy must fill prescriptions for certain drugs in unit-dose packaging when they are dispensed to MassHealth members residing in a skilled nursing facility.    The pharmacy must also credit to the Division amounts paid by the Division for certain unused unit-dose-packaged drugs that have been returned by the nursing facility.   The Division is expanding the drugs that will be a part of this program from eight to 29.
The Division will continue to pay the pharmacy a unit-dose return fee in accordance with the rate established by the Massachusetts Division of Health Care Finance and Policy (DHCFP), for each returned prescription credited to the Division. The amount of the return fee is $5 per prescription.
Updated Billing Guides
Pharmacies have received updated billing guides from ACS, the Division’s Pharmacy On-line Processing vendor, that describes how to credit the amount of the returned drugs to the Division and receive the return fee. Once the returned drugs are credited to the Division, the pharmacy may redispense the drugs in accordance with guidelines established by the Department of Public Health.
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.
•	
MASSHEALTH
TRANSMITTAL LETTER PHM-49 November 2003 Page 2
Pharmacies must adhere to these guidelines when dispensing drugs in unit-dose packaging, and when redispensing returned unit-dose-packaged drugs. Please refer to Department of Public Health guidelines and “Best Practices” guidelines that were issued with Transmittal Letter PHM-45, dated June 2002.
Best Practices
The Division, in concert with nursing facility and pharmacy stakeholders, has also prepared “Best Practices” guidelines. These guidelines advise pharmacies and nursing facilities on how to best manage the unit-dose return and redispense policy described in the attached regulations. Please refer to Department of Public Health guidelines and “Best Practices” guidelines that were issued with Transmittal Letter PHM-45, dated June 2002.
Questions or Comments
Pharmacies may contact ACS at 1-866-246-8505 if they have questions related to the unit-dose dispensing or return requirements.
These changes are effective January 1, 2004.
NEW MATERIAL
(The pages listed here contain new or revised language.)
Pharmacy Manual
Pages D-1 and D-2
OBSOLETE MATERIAL
(The pages listed here are no longer in effect.)
Pharmacy Manual
Pages D-1 and D-2 — transmitted by Transmittal Letter PHM-45

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

	TRANSMITTAL LETTER
PHM-49	DATE
01/01/04	
Unit-Dose Drugs
This appendix lists the unit-dose-packaged drugs that the dispensing pharmacy must credit to the Division when they have been dispensed to a MassHealth member in a nursing facility and have been returned by the nursing facility in accordance with 130 CMR 406.446. Beside each drug is the minimum quantity of the doses of the drug that the Division will accept 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
33333333331333133333333313333

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

	TRANSMITTAL LETTER
PHM-49	DATE
01/01/04	
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