Covered Drugs and Medical Supplies

(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 those at 105 CMR 700.000: Implementation of M.G.L. c. 94C and 247 CMR 16.00: Collaborative Drug Therapy Management. 4. Program Regulations