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MassHealth COVID-19 Guidance for Pharmacy Providers

This page provides MassHealth Coronavirus Disease (COVID-19) guidance and information from MassHealth specific to pharmacy providers.

In response to COVID-19, MassHealth is allowing certain flexibilities in its pharmacy benefit. Pharmacies should review all editions of Pharmacy Facts for the latest guidance on how to implement these policies.

For MassHealth COVID-19 guidance and information covering all MassHealth providers, please see MassHealth COVID-19 Guidance for All Providers. You may also find it helpful to review DPH’s COVID-19 guidance for health care professionals.

Table of Contents

Pharmacy Facts

  • Pharmacy Facts 178: This Pharmacy Facts describes revisions to the pharmacy regulations at 130 CMR 406.000. These revisions implement new polices to exclude certain drugs from being purchased through the 340B Drug Pricing Program for MassHealth members; requiring or allowing 90-day supplies of particular drugs; and adding some exceptions to day-supply limits. Amendments were made to clarify or update some already-existing policies, including the 365-day supply for drugs used for family planning; payment for vaccines and non-drug products provided to pharmacies; cash payments; and required notifications when a drug was not dispensed because the prescriber had not sought prior authorization (PA). PDF | Word

  • Pharmacy Facts 177: Announces and details MassHealth’s coverage of OTC COVID-19 at-home antigen self-test kits through the MassHealth pharmacy benefit, effective January 14, 2021PDF | Word

  • Pharmacy Facts 172: Amid the COVID-19 pandemic, the prescribing of ivermectin for the prevention or treatment of COVID-19 has increased. MassHealth has adopted immediate new policies for the prescribing and dispensing of ivermectin. There are also various updates to the MassHealth Drug List. PDF | Word
  • Pharmacy Facts 170: MassHealth is providing updates on claim submission for members receiving a third Pfizer-BioNTech and Moderna COVID-19 vaccine dose, coverage for Apo-Varenicline, and a 10% rate add-on for durable medical equipment and oxygen and respiratory therapy (DME/OXY) providers. MassHealth has also included links to previously issued guidance about billing for COVID-19 vaccination. PDF | Word
  • Pharmacy Facts 167: Updates Related to Coronavirus Disease 2019 (COVID-19) Effective June 15, 2021 describes how MassHealth will continue to pay for prescription delivery and allow for additional exceptions to 30-day supply limitations following the end of the state of emergency in Massachusetts. PDF | Word
  • Pharmacy Facts 165: Coronavirus Disease 2019 (COVID-19) Vaccine Billing Information, Including Vaccine Coverage Policy for MassHealth Limited Members provides a summary of MassHealth guidance related to billing for COVID-19 vaccines. PDF | Word
  • Pharmacy Facts 163: Removal of Prior Authorization (PA) Requirements for Chloroquine and Hydroxychloroquine removes the requirement that members must go through a PA process before chloroquine and hydroxychloroquine can be dispensed. PDF | Word
  • Pharmacy Facts 162: COVID Vaccine Billing Information outlines the MassHealth rates of payment for COVID-19 vaccines and provides guidance on submitting claims for the vaccines. PDF | Word
  • Pharmacy Facts 160: The first COVID-19 vaccine product received Emergency Use Authorization (EUA) by the U.S. Food and Drug Administration (FDA) on December 11, 2020, and a second product received EUA on December 18, 2020. MassHealth will cover the vaccines for members in MassHealth Standard, CommonHealth, Family Assistance, CarePlus, Children’s Medical Security Plan, and Health Safety Net. PDF | Word
  • Pharmacy Facts 157: Additional Updates Related to Coronavirus Disease 2019 (COVID-19) allows pharmacists to dispense up to a 365-day supply of drugs used for family planning if requested by a MassHealth member or that member’s prescriber. PDF | Word
  • Pharmacy Facts 155 provides guidance on additional flexibilities for pharmacy coverage and billing for individuals who are Health Safety Net patients. PDFWord
  • Pharmacy Facts 154: Additional Update Related to Coronavirus Disease 2019 (COVID-19) ends a policy change made during the COVID-19 pandemic regarding albuterol inhaler prescribing requirements. PDF | Word
  • Pharmacy Facts 150: Additional Updates Related to Coronavirus Disease 2019 (COVID-19) ends several temporary policy changes made in response to COVID-19, including early refills and some prior authorization flexibilities PDF | Word
  • Pharmacy Facts 147: Additional Updates for Pharmacies Serving Health Safety Net Patients provides guidance for how pharmacies should submit claims for Health Safety Net (HSN) patients in light of new flexibilities that temporarily allow patients who are unable to receive their medications from their regular (HSN) provider to have those prescriptions filled by any pharmacy in the MassHealth network. PDF | Word
  • Pharmacy Facts 145: Additional Updates Related to Coronavirus Disease 2019 (COVID-19) provides guidance on how pharmacies should bill for home delivery, and updated information for pharmacies that provide durable medical equipment (DME) including DME prior authorization flexibilities. PDF | Word
  • Pharmacy Facts 143: Coronavirus Disease 2019 (COVID-19) and New Policies on Chloroquine and Hydroxychloroquine—Effective for Dates of Service on or after March 26, 2020 PDF | Word
  • Pharmacy Facts 142: Additional Updates Related to Coronavirus Disease 2019 (COVID-19 Effective Immediately PDF | Word
  • For additional guidance related to COVID-19 and MassHealth’s pharmacy program, visit: https://masshealthdruglist.ehs.state.ma.us/MHDL/
Last updated: January 14, 2022
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