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MassHealth Controlled Substances Management Program

MassHealth has established a Controlled Substances Management Program for MassHealth members who overutilize or improperly utilize prescribed drugs.

Criteria for enrollment can be found on the MassHealth Drug List by going to https://masshealthdruglist.ehs.state.ma.us/MHDL/ under the section called “Controlled Substances Management Program (CSMP): Criteria for Member Enrollment.”

Before enrollment, members are notified that they have met the criteria, and are advised that they may request a letter of exemption from their primary care provider (PCP) if they and their prescriber feel that their selection for the program is an error. Members will also have the opportunity to appeal MassHealth's decision before the member is actually enrolled. MassHealth strongly urges PCPs to review the member's controlled-drug prescription history in the Prescription Monitoring Program (PMP) before requesting an exemption.

Enrolled members are restricted to obtaining prescribed drugs only from the provider that MassHealth designates as the member's primary pharmacy. The one exception to this is when the member cannot access the medication from their primary pharmacy (due to emergency, etc.) and a pharmacist at a different pharmacy determines that the member's health or safety would be jeopardized without immediate access to the drug. Members who are enrolled in the program will be identified by the Eligibility Verification System (EVS) as participants. All practices should ensure that the member's participation in the program is conveyed to all providers who issue prescriptions.

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