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.
Pharmacy Facts
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Pharmacy Facts 212: Reminds pharmacy providers that the Massachusetts Department of Public Health has issued a statewide standing order that allows licensed pharmacists to dispense at-home antigen self-test kits to any individual, and to treat that standing order as a prescription for any such test kit. In addition, to address a shortage of medically necessary formula and thickening agents, effective September 22, 2023, MassHealth pays pharmacies to process and dispense medically necessary enteral nutrition liquid products also through POPS. Finally, pharmacies will be paid for medically necessary enteral nutrition liquid products at the lowest of the Wholesale Acquisition Cost, the usual fee for patients other than publicly aided individuals, or the actual charges submitted. PDF | Word
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Pharmacy Facts 183: Details that, effective September 19, 2022, MassHealth will no longer allow 90-day supplies for most brand name drugs. Only drugs designated by the MassHealth Drug List will be allowed to be dispensed in a 90-day supply.) PDF | Word
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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
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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, 2021. PDF | 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 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
- For additional guidance related to COVID-19 and MassHealth’s pharmacy program, visit https://masshealthdruglist.ehs.state.ma.us/MHDL/
| Last updated: | October 3, 2023 |
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