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Guide Pharmacy (PHM) Manual

The Pharmacy Manual contains the regulations and administrative and billing instructions for pharmacies. The Executive Office of Health and Human Services (EOHHS) establishes rates for MassHealth services. See 101 CMR 331.00. MassHealth issues transmittal letters to update any part of the provider manual. MassHealth issues provider bulletins to communicate information that is not contained in the provider manual. Each part of the Pharmacy Manual is listed below from beginning to end. You can print each part separately (or any individual pages) or print all parts for a complete manual.

Table of Contents

Table of Contents

  • Table of contents pages i, ii, ii-a, and iii appear at the beginning of Subchapter 1 below.
  • Table of contents page iv appears at the beginning of Subchapter 4 below.
  • Table of contents page v (see below)
  • Table of contents page vi (see below)

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Preface

See below for the Pharmacy (PHM) Manual Preface.

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Subchapters 1 through 3

Administrative and Billing Regulations (apply to all providers).

Additional Resources for Subchapters 1 through 3

Subchapter 4

See below for the Pharmacy (PHM) regulations (130 CMR 406.000).

Additional Resources for Subchapter 4

Subchapter 5

The Administrative and Billing Instructions (Subchapter 5) are divided into seven parts. For instructions for electronic billing, refer to the MassHealth Companion Guides. To request a copy of any of the MassHealth Companion Guides please contact MassHealth Customer Service Center at 1-800-841-2900. For instructions for billing MassHealth using paper claim forms refer to MassHealth Billing Guides for Paper Claim Submitters.

Please see below for Subchapter 5: Administrative and Billing Instructions.

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MassHealth All Provider Manual Appendices

The MassHealth generic appendices contained in all provider manuals (Appendices A, C, T, U, V, W, X, Y, and Z).

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Pharmacy Manual Appendices

Appendix D: Unit-Dose DrugsĀ 

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.

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