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MassHealth Drug List


Introduction to MassHealth Drug List 

Information about the MassHealth Drug List and updates to the list. Sign up to receive e-mail notification of when updates to the MassHealth drug list are posted on the Web.

Upcoming and Recent Updates 

Link to the most recent updates to the MassHealth Drug List. May be subject to change.

Prior Authorization Forms for Pharmacy Services 

Link to all Prior Authorization forms for MassHealth Pharmacy Services.

MassHealth Supplemental Rebate/Preferred Drug List

Link to the list of drugs preferred by MassHealth based on supplemental rebate agreements between MassHealth and drug manufacturers. In general, MassHealth requires a trial of the preferred drug or clinical rationale for prescribing a non-preferred drug within a therapeutic class.

MassHealth Brand Name Preferred Over Generic Drug List

Link to the list of brand name drugs that MassHealth prefers over their generic equivalents because the net cost of the brand name drug adjusted for rebates is lower than the net cost of the generic equivalent. In general, MassHealth requires a trial of the preferred drug or clinical rationale for prescribing the non-preferred drug generic equivalent.

MassHealth Over-the-Counter Drug List

Link to a list of the drugs that are the only nonlegend drugs, with the exception of insulins, that are covered by MassHealth without prior authorization.

MassHealth Pharmacy Naloxone Availability and Coverage

Link to the list of naloxone products that are covered by MassHealth without prior authorization.

MassHealth Preferred Non-Drug Product List

Link to the list of non-drug products preferred by MassHealth based on rebate agreements between MassHealth and product manufacturers.

MassHealth Non-Drug Product List

Link to a list of non-drug products that MassHealth pays for through the Pharmacy Online Processing System (POPS).

MassHealth Pharmacy Covered Professional Services List

Link to the list of the professional services that MassHealth pays for through the Pharmacy Online Processing System (POPS).

MassHealth Acute Hospital Carve-Out Drugs List

Link to the current list of “APAD Carve-Out Drugs” and “APEC Carve-Out Drugs” for which a Hospital must obtain prior authorization (PA) from MassHealth. Please note that these treatments will be subject to monitoring. Other requirements also apply.

Certain MassHealth Outpatient Physician Administered Drugs to be Paid by Fee Schedule

Link to the list of the "Certain MassHealth Outpatient Physician Administered Drugs to be Paid by Fee Schedule" which identifies the current list of “Fee Schedule Drugs” and reimbursement for outpatient administration of certain physician administered drugs

Long-Acting Injectable Antipsychotic Medications Administered in Inpatient Psychiatry Units

Link to the list of the "Long-Acting Injectable Antipsychotic Medications Administered in Inpatient Psychiatry Units" which identifies the current list of long-acting injectable antipsychotic medications that, when administered in an inpatient psychiatry unit, are reimbursable outside of the applicable per diem rates for Acute and Psychiatric Hospitals.

MassHealth Drug List 90-day Supply Page

Link to a list that describes the types of drugs that are allowed or required to be dispensed in a 90-day supply.

Medicare Part D Exclusion Drug List 

Link to a list of drugs that Medicare Part D excludes from prescription coverage, but may be covered by MassHealth.

MassHealth Medication Therapy Management Program

This document describes the MassHealth Medication Therapy Management (MTM) program, which is a clinical outreach initiative for members with targeted disease states.

MassHealth Pharmacy Initiatives and Clinical Information 

Link to the Concomitant Opioid Benzodiazepine, Pediatric Behavioral Health Medication, Hospital Outpatient Prior Authorization, Opioid and Pain, and Second-Generation (Atypical) Antipsychotic Initiatives.

MassHealth Accountable Care Partnership Plans and Managed Care Organizations Pharmacy Information 

Link to additional information regarding obligations of MassHealth Accountable Care Partnership Plans (ACPPs) and Managed Care Organizations (MCOs) with respect to the MHDL, including Certain MassHealth Outpatient Physician Administered Drugs to be Paid by Fee Schedule, Medical Benefit, Non-Rebate Drugs and Biologics, Opioids and Analgesics, Pharmaceutical Compounds, and Specialty Pharmacy.

MassHealth Pharmacy Operational Page

This page lists operational information related to new-to-market, non-FDA approved, and non-rebate drugs and biologics.

Controlled Substances Management Program (CSMP): Criteria for Member Enrollment

Controlled Substance Management Program (CSMP): Pharmacy Selection Form

Quick Reference Guide

Please note that this document does not represent the complete MassHealth Drug List.

The MassHealth Drug List Downloads 

Download the current MassHealth Drug List and the previous 5 updates to the MassHealth Drug List in PDF or DOC format. Download the current MassHealth Formulary and Benefit file and the previous 5 updates to the MassHealth Formulary and Benefit file in TXT format.

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