Commonwealth of Massachusetts 
Executive Office of Health and Human Services 
Division of Medical Assistance 
600 Washington Street
Boston, MA 02111


MassHealth 
Substance Abuse Treatment Bulletin 6 
April 2000 

TO: Substance Abuse Treatment Providers 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 Requiring Prior Authorization 

Brand-name analgesics, benzodiazepines, and muscle relaxants 
require prior authorization if they are an AB-rated multi-source product 
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 Procedures 

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