Current through Register 1531, September 27, 2024
(A)
Drugs. The MassHealth Drug List specifies the drugs
that are payable under MassHealth. In addition, the following rules apply.
(1)
Prescription
Drugs. The MassHealth agency pays only for prescription drugs that
are approved by the U.S. Food and Drug Administration and manufactured by
companies that have signed rebate agreements with the U.S. Secretary of Health
and Human Services pursuant to
42 U.S.C.
1396r-8. Payment is calculated in accordance
with 101 CMR 331.00: Prescribed Drugs.
(2)
Over-the-counter
Drugs. Payment by the MassHealth agency for over-the-counter drugs
is calculated in accordance with 101 CMR 331.00: Prescribed
Drugs.
(3)
Compounded Drugs. MassHealth pays for compounded drugs
specified in the MassHealth Drug List. Payment for compounded drugs is
calculated in accordance with 101 CMR 331.00: Prescribed
Drugs.
(B)
Non-drug Products Paid through POPS.
(1) The MassHealth agency pays through POPS
for products not classified as drugs only if such products are listed in the
Non-drug Product List section of the MassHealth Drug List.
(2)
Non-drug Product
List. Except as designated by Pharmacy Facts, provider bulletin,
or other written issuance from the MassHealth agency, payment for items listed
in the Non-drug Product List is in accordance with rates published in the EOHHS
regulations at 101 CMR 322.00: Rates for Durable Medical Equipment,
Oxygen, and Respiratory Therapy Equipment and 101 CMR 317.00:
Rates for Medicine Services. The MassHealth Non-drug Product
List also specifies which of the included products require prior
authorization.
(C)
Non-drug Products That Require Certification by Other MassHealth
Programs.
(1)
Durable Medical Equipment. Pharmacy providers who
intend to provide durable medical equipment and medical supplies that are not
listed in the Non-drug Product List section of the MassHealth Drug List to
MassHealth members must meet the applicable requirements of 130 CMR 409.000:
Durable Medical Equipment Services, and must obtain a durable
medical equipment specialty designation from the MassHealth agency.
(2)
Oxygen and Respiratory
Therapy Equipment. Pharmacy providers who intend to provide oxygen
and respiratory therapy equipment and supplies that are not listed in the
Non-drug Product List to MassHealth members must meet the applicable
requirements of 130 CMR 427.000: Oxygen and Respiratory Therapy
Equipment and must obtain an oxygen and respiratory therapy equipment
specialty designation from the MassHealth agency.
(D)
Covered Professional Services
Paid through POPS. The MassHealth Pharmacy Covered Professional
Services List specifies certain services that may be provided by a pharmacy
provider and payable through POPS (e.g., the administration of
a particular vaccine). The service must be provided by a properly trained and
certified pharmacist or other appropriately certified health care professional
in accordance with Massachusetts Department of Public Health regulations and
employed or contracted by a MassHealth pharmacy provider. Services must be
provided in accordance with applicable Department of Public Health regulations,
including 105 CMR 700.000: Implementation of M.G.L. c. 94C,
and 247 CMR 16.00: Collaborative Drug Therapy
Management.
