Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
www.mass.gov/masshealth

MassHealth
Transmittal Letter PHM-59 
July 2011


TO:	Pharmacy Providers Participating in MassHealth

FROM:	Terence G. Dougherty, Medicaid Director 

RE:	Pharmacy Manual (Revised Appendix D)


MassHealth is updating Appendix D of the Pharmacy Manual. Appendix D lists those drugs that 
are subject to the unit-dose-dispensing and return requirement for pharmacies and nursing 
facilities. (See 130 CMR 406.420 and 406.446 for applicable requirements.) 

The revised Appendix D is effective August 1, 2011.

MassHealth Web Site

This transmittal letter and attached pages are available on the MassHealth Web site at 
www.mass.gov/masshealth.

Questions

Pharmacies may contact ACS at 1-866-246-8503 if they have questions related to the unit-dose 
dispensing or return requirements. If you have any questions about the information in this 
transmittal letter, please contact MassHealth Customer Service at 1-800-841-2900, e-mail your 
inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974.  

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(The pages listed here are no longer in effect.)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-49


Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Pharmacy Manual	

Subchapter Number and Title
Appendix D.  Unit-Dose Drugs	

Page
D-1

Transmittal Letter
PHM-59	

Date
08/01/11

Unit-Dose Drugs

This appendix lists the unit-dose-packaged drugs that the dispensing pharmacy must credit to 
MassHealth 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. The minimum 
quantity of unused doses applicable to each drug on this list that the MassHealth agency will 
accept for return is one.

Abilify
Advair
Aricept
Arixtra
Atripla
Avonex
Copaxone
Epzicom
Flovent
Fragmin
Geodon
Humalog
Invega
Invega Sustenna
Isentress
Lantus
Levaquin
Lovenox
Novolog
Pegasys
ProAir HFA
Pulmicort
Rebif
Reyataz
Spiriva
Truvada
Vancocin
Zyprexa



Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Pharmacy Manual	

Subchapter Number and Title
Appendix D.  Unit-Dose Drugs	

Page
 D-2

Transmittal Letter
PHM-59	

Date
08/01/11


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