MASSHEALTH EMERGENCY DRUG COVERAGE UPDATE

1. Expiration of one time 30-day supply

As you may recall, MassHealth used their emergency powers last year to provide a 30-day supply of drugs to dual eligibles that were unable to fill their prescriptions due to some systematic issues during their transition to Part D. This law originally set to expire on June 30, 2006 was extended until December 31, 2006. Unfortunately, this emergency drug coverage expired on January 05, 2007 meaning that MassHealth will no longer pay for a 30-day supply of drugs for dual eligibles.

If a dual eligible is not yet enrolled in a Part D plan, pharmacies should bill WellPoint for temporary coverage. Pharmacists may also call 1-800-662-0210 and choose option “7” to help process WellPoint point of sale claim.

2. One time 72-hour supply continues

If a pharmacist is unable to bill the Part D plan and unable to bill WellPoint, they may bill MassHealth for a one-time 72 hour supply by using service code 03 (emergency fill). This assistance does not have an expiration date.

3. Co-payment assistance continues

Massachusetts dual eligibles should never pay more than $1 for a generic drug or $3 for a brand-name drug. In 2007, the maximum co-payment a Part D Plan can charge a dual eligible is $5.35 up from $5 last year, but the pharmacy would bill MassHealth as a secondary payor for the difference. Since other MassHealth members (i.e., not eligible for Medicare) would just pay $1 and $3 for drugs, it was made sure that dual eligibles were not responsible for higher copays under Part D. Also, since MassHealth is a wraparound for drugs not covered by Part D (like benzodiazepines etc), a member would never have to pay more than $3 for any MassHealth covered drug.

-Adapted from e-mail from Pragy Rizal, Partners Community Benefit Programs, January 10, 2007

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