Abstract
MassHealth, the Massachusetts state Medicaid program, serves 1.19 million low-income state residents, with an annual budget of 8.2 billion.3 The MassHealth Pharmacy program is
responsible for providing and managing prescription and selected over-the-counter (OTC) medications for all non-Medicare beneficiaries, with the exception of those in managed
care. In addition, MassHealth fills in coverage gaps for uncovered drug classes for the 220,000 dual eligible beneficiaries who were transferred to private prescription drug coverage in 2006 as a result of the Medicare Modernization Act of 2003. The MassHealth Pharmacy program has as its foundation several components: the MassHealth Drug List (MHDL), which designates which drugs require prior authorization for dispensing; drug
management strategies stressing appropriate drug use and generics when indicated; drug
price management; monitoring of quality; provider, pharmacist, and patient education; and
the setting of benefit design and other policies. In state fiscal year (FY) 2009, MassHealth
Pharmacy services are expected to account for approximately 6.2 percent of the
MassHealth budget.