Number 67 September 21, 2011
www.mass.gov/masshealth/pharmacy Editor: Vic Vangel • Contributors: Chris Burke, Gary Gilmore, Paul Jeffrey, James Monahan, Nancy Schiff
National Council for Prescription Drug Sylatron (peginterferon alpha-2b) Programs (NCPDP) Version D.0 Tamiflu (oseltamivir 6 mg/mL suspension) - PA all quantities (June 1st to September 30th); This is a reminder that, effective January 1, 2012, the PA > 180 mL/month; and National Council for Prescription Drug Programs PA > 360 mL/season (October 1st to May 31st) (NCPDP) Version D.0 transaction standards will Topicort LP ointment (desoximetasone low potency become mandatory for all MassHealth pharmacy ointment) – PA claims. D.0 is an updated version of the HIPAA Tradjenta (linagliptin) – PA standard for pharmacy claims transactions. All Viibryd (vilazodone) – PA pharmacy software vendors should be upgrading their Viramune XR (nevirapine ER) – PA products in order to support D.0. YERVOY (ipilimumab) Zytiga (abiraterone) – PA MassHealth has posted a draft of the D.0 version of 1 Product may be obtained through the Massachusetts Department of the POPS Billing Guide on the MassHealth Pharmacy Public Health (DPH); please check for availability. MassHealth does not Program Web site. Please ensure your software pay for immunizing biologicals (i.e., vaccines) and tubercular (TB) drugs that are available free of charge through local boards of public health or vendor has been notified. To view the draft Billing through DPH without prior authorization (130 CMR 406.413(C)). Guide go to www.mass.gov/masshealth/pharmacy and MassHealth will pay pharmacies for seasonal flu vaccine serum without prior authorization if the vaccine is not available free of cost. click on the link for MassHealth Pharmacy Publications ^ This drug is available through the health-care professional who and Notices for Pharmacy Providers, then Draft POPS administers this drug. MassHealth does not pay for this drug to be Billing Guide Standard D.0. dispensed through a retail pharmacy.
Member Identification Number 2. Change in Prior-Authorization Status Also effective January 1, 2012, all MassHealth a. The following drug will require prior authorization for pharmacy claims must contain the 12-digit member those under 50 years of age. identification number that was introduced in May 2009. Zostavax (herpes zoster vaccine) – PA < 50 years The older 10-digit member identification numbers will b. The following drugs will require prior authorization to no longer be accepted (i.e., claims will be denied). We exceed quantity limits effective October 11, 2011. are still seeing many claims being submitted with the Revlimid (lenalidomide) 5 mg, 10 mg – PA > 30 older identification numbers. units/month Revlimid (lenalidomide) 15 mg, 25 mg – PA > 21 MHDL Updates units/28 days Below are certain updates to the MassHealth Drug List c. The following drugs will require prior authorization (MHDL). See the MHDL for a complete listing of effective October 11, 2011. updates. Cardizem CD (diltiazem 360 mg) – PA Jevtana (cabazitaxel) – PA 1. Additions a. The following newly marketed drugs have been d. The following antidepressants will require prior added to the MassHealth Drug List, effective authorization effective October 11, 2011. Tofranil-PM (imipramine pamoate) – PA September 26, 2011. venlafaxine ER tablets – PA Amethyst (ethinyl estradiol/levonorgestrel) e. The following oral antibiotics will require prior Androgel (testosterone 1.62% pump) – PA authorization effective October 11, 2011. CAPRELSA (vandetanib) – PA Avelox (moxifloxacin) – PA Daliresp (roflumilast) – PA doxycycline monohydrate – PA Dificid (fidaxomicin) – PA Dynacin (minocycline tablets) – PA Edurant (rilpivirine) – PA > 30 units/month Factive (gemifloxacin) – PA Fluzone Intradermal (influenza virus vaccine)1 Noroxin (norfloxacin) – PA Horizant (gabapentin enacarbil) – PA Nulojix (belatacept) – PA f. The following androgens will require prior Orsythia (ethinyl estradiol/levonorgestrel) authorization effective October 11, 2011. Provenge (sipuleucel-T) ^ – PA Delatestryl (testosterone enanthate) – PA Sprix (ketorolac nasal spray) – PA Depo-Testosterone (testosterone cypionate) – PA Syeda (ethinyl estradiol/drospirenone) testosterone powder – PA
Please direct any questions or comments (or to be taken off this fax distribution) to Victor Moquin of ACS at 617-423-9830