MassHealth has created this list of frequently asked questions to help you understand the Controlled Substances Management Program and to help you answer questions from MassHealth members about the Program. The questions are asked from the member's perspective.
Questions and Answers about CSMP
Why have I been chosen for this Program?
You have met the rules for enrollment in the Program. MassHealth reviewed claims it has paid for your pharmacy services. MassHealth found that you received 11 or more prescriptions and/or refills for controlled drugs. These prescriptions were filled over a three-month period. In addition, these prescriptions were written by four or more prescribers or filled by four or more pharmacies.
I believe that my pattern of use of controlled drugs was justified. What do I need to do so that I am not put into the Program?
If it is three weeks or less from the date that MassHealth first contacted you about this Program, you may ask your primary care clinician (PCC) to write a letter to MassHealth. The letter must explain why your use of controlled drugs is medically necessary. The letter must be written on your PCC's stationery and include an original signature. Your PCC may mail or fax the letter to the MassHealth Drug Utilization Review Program. The address and fax number are listed at the bottom of this page.
If you have received an enrollment letter that identifies your primary pharmacy, you may file an appeal within 30 days from the date you received the letter. More information about filing a request for an appeal is described in the letter.
What does it mean to be enrolled in the Program?
MassHealth will pay for your prescriptions only if they are filled at your primary pharmacy. Your primary pharmacy will have the name of your PCC. If the pharmacist has any questions or concerns about your prescriptions, he or she may call your PCC. In addition, the MassHealth computer systems will show all of your MassHealth providers that you are enrolled in this Program. Our computer systems also give out your PCC's name and phone number.
How was my primary pharmacy picked?
MassHealth picked the last pharmacy that you used, based on claims information. You have 30 days from the date that you received your letter to pick a different primary pharmacy if you do not want to use the one that you have been assigned to. You may also request a new pharmacy only once a year, unless your primary pharmacy can no longer address your pharmacy needs because of a change in your residence, medical condition, or primary pharmacy's business practices. To request a new pharmacy, send a request in writing to the MassHealth Drug Utilization Review Program. Make sure to include the name of your requested pharmacy.
How long will I be enrolled in the CSMP?
You will be enrolled in the program for one year from the date that you were originally enrolled. After a year you can request that you become disenrolled. The request must be made in writing and sent to the MassHealth Drug Utilization Review Program.
How do I find out who my PCC is?
Call MassHealth Customer Service at 1-800-841-2900 (TTY: 1-800-497-4648 for people who are deaf, hard of hearing, or speech disabled).
Send correspondence about the Controlled Substances Management Program to:
MassHealth Drug Utilization Review Program
P.O. Box 2586
Worcester, MA 01613-2586