MassHealth
Controlled Substance Management Program
The Massachusetts Division of Medical Assistance (DMA) recently announced details of a plan to enroll certain MassHealth members into a new program to "enhance coordination among caregivers and pharmacies to deter members from obtaining controlled substances at a frequency or amount that is not medically necessary." The Controlled Substances Management program will begin enrolling over the next few months. When the DMA determines that the member has obtained 11 or more prescriptions, including refills, for controlled substances from four or more prescribers and/or from four or more pharmacies within a three month period, the member (and the primary physician) will be informed that the member will be enrolled in the program.
Enrollment in the program means that the member will be restricted to one designated primary pharmacy for all except emergency prescriptions. Other pharmacies that try to enter the prescription into the Pharmacy On-line Processing System will receive an error message stating that the member is restricted to another pharmacy. If the pharmacist determines that the member's health or safety would be jeopardized without immediate access to the drug, she/he may request specific approval to fill the prescription.
If the member and his/her primary physician wish to appeal enrollment into the program the physician can request an exemption. A letter must be written on letterhead, contain an original signature and be received within three weeks of the date of the member's notification letter. The letter can be mailed or faxed to:
MassHealth Drug Utilization Re-view Program
P.O. Box 2586
Worcester, MA 01613-2586
1-877-208-7428 (fax)
- Adapted from MassHealth Outpatient Hospital Bulletin 45, June 2003.
06/03