Update: Effective February 1, 2013
Important Update to February 1, 2013 NDC Coding Requirement
NHP will reject claims that do not meet the following requirements for NHP Mass Health members only. Providers will need to submit claims for HCPCS on this list with both HCPCS and NDC codes to NHP with the exact NDC that appears on the medication packaging in the 5-4-2 digit format (i.e. xxxxx-xxxx-xx). NHP will continue to accept NDC for all lines of business. As a reminder, if you have a bundled rate or global fee arrangement for outpatient claims with NHP then your claims will be accepted without NDC codes.
Neighborhood Health Plan will require the 11-digit National Drug Code (NDC), NDC units and unit descriptors on outpatient claims for drugs administered during a patient's visit in addition to the HCPCS code in order to be compliant with the State regulations.
For services provided as of February 1, 2013, outpatient claims that include physician-administered drugs will need to be submitted with the appropriate NDC information. Mass Health claims submitted without the applicable NDC information will be rejected and subject to re-filing and timely filing limits.
At this time, MassHealth is requiring NDC information on all Single-Source Drugs as defined by CMS, with the exceptions listed below:
- Inpatient Claims
- Outpatient claims that are part of a bundled rate or global fee
- Contrast media
- 340B program drugs
340B Program Information
Please note that the MassHealth requirement to include NDC information for drugs purchased through the 340B program does not apply to MCO drugs at this time. To indicate that the drug was purchased through the 340B program, providers must add "Modifier UD" with the HCPCS code.
If you have additional questions about filing claims using the NDC number, please read MassHealth's NDC and HCPCS Frequently Asked Questions at http://www.mass.gov/eohhs/gov/newsroom/masshealth/providers/national-drug-code-ndc-requirements-for-html.
NHP has several recent updates regarding pharmacy coverage for our members.
- Use this Pharmacy Change Reference Guide to help you remember key dates outlined below.
Maintenance 90 Program
Effective July 16, 2012, NHP members will be enrolled automatically in a new Maintenance 90-day supply program for ongoing prescription refills. Members who have filled a maintenance prescription at least twice in the past four months will need to fill a 90-day supply on their next fill. As a result, members or their pharmacy will contact you for a new prescription.
Please provide your patients with a 90-day script as soon as possible. All maintenance medications (such as those for high blood pressure or diabetes) will require a 90-day prescription. For the most up-to-date list of maintenance medications, use the Drug Lookup Tool.
Medfusion/Ascend specialty pharmacy will be replacing CuraScript, Walgreens, and Accredo Specialty pharmacies in providing specialty medication to members. The transition will be gradual starting in August 2012 with a scheduled completion date of December 31, 2012.
New Mail Order Pharmacy: informedMail™
Effective July 16, 2012, informedMail™ Prescription by Mail Service will become the mail order pharmacy for NHP members. InformedMail offers a convenient and cost-effective way for members to receive maintenance medications.
- All eligible members will need to enroll with informedMail in order to receive prescriptions through the mail.
- Members not already enrolled with our current mail-order vendor will need to enroll with informedMail in order to receive prescriptions through the mail.
- Members who already use mail-order services and have refills remaining on their prescriptions will have their prescriptions transferred automatically to informedMail.
- Members who already use mail-order services but have no remaining refills will need a new prescription.
- MassHealth members are not eligible for this mail-order benefit.
Enhanced Fax Process for Pharmacy Prior Authorization Requests
NHP offers a single point of contact for faxing pharmacy authorization requests.
Coverage requests for medications subject to prior authorization requirements should be submitted directly to MedMetrics Health Partners at 1-800-918-7542. Most requests can be processed within 24 hours. For urgent requests, providers should call the 24 Hour MedMetrics Prior Authorization Line at 1-800-918-7550.
Pharmacy authorization requests can also be submitted online.
Pharmacy information, including the Preferred Drug List, is updated on an ongoing basis. Check this page often for the most current information.
- Drug Lookup
NHP's Preferred Drug List is now searchable!
- MAC List
- Excluded Drug List
- Massaschusetts Medical Society Formulary Guide
- Pharmacy Forms and Prior Authorization Information
- Drug Alerts
NHP's Prescription Drug Benefit
Please visit the Member Pharmacy section of this web site for information about NHP's Drug Benefit.
Please check the member's ID card for details about pharmacy coverage.
The Over-the-Counter Drug Benefit
A complete description of this benefit and list of covered over-the-counter drugs is available for download below.
- Business Choice and Non-Group (Commercial Plans) OTC Benefit
- MassHealth (Basic, Family Assistance, and Standard) OTC Benefit
Pharmacy inquiries should be directed to MedMetrics, NHP's Pharmacy benefit manager.
- 1-800-918-7545 (Pharmacist Help Desk)