THE HEALTH SAFETY NET PHARMACY COVERAGE
Health care facilities, such as MGH, that have an outpatient pharmacy have historically been able to write off prescriptions drugs to the Uncompensated Care Pool/Free Care for eligible patients. The Health Safety Net Trust Fund (HSN) that replaced Free Care in October has revamped pharmacy coverage.
- HSN patients now have to follow the MassHealth drug formulary, including Prior Authorization requirements and 30 day supply limitations.
- Originally as of December 1, 2007 HSN patients would be responsible for $1 and $3 pharmacy co-pays. This has been delayed until February or March 2008.
- There is no more HSN co-pay "wrap around" to cover private insurance or Commonwealth Care pharmacy co-pays. These patients must pay their co-pays at the pharmacy.
- Those with Medicare and HSN can still use HSN to cover their pharmacy costs.
On October 1st, the pharmacies that serve Free Care/HSN patients went live with a new eligibility and claims system. This means that our pharmacies at BWH, MGH, and MGH Revere must submit pharmacy claims to a state system that will determine eligibility and accept or deny a claim on the spot. The pharmacies must follow the state's new eligibility rules, since all of their claims for MassHealth and HSN must run through this system.
See attached grid. Also available on our website: www.mghsocialwork.org staff access > basic needs > health care coverage > health safety net.
--Adapted from “Health Safety Net and Pharmacy Coverage” November 13, 2007 and “Operational Updates: MassHealth, Commonwealth Care, Commonwealth Choice, and HSN”, Sunday, December 02, 2007 e-mails from Kim Simonian, MPH, Partners Healthcare Community Benefits Programs.
11/07