Does MassHealth cover over-the-counter drugs?

Non-brand- name (generic) OTC medications will be dispensed unless otherwise approved by the Plan. As a member, you pay $0 for your covered over-the-counter (OTC) medications. 1Branded OTC nonoxynol-9 products are covered by MassHealth without prior authorization.

Who is the PBM for MassHealth?

MassHealth PBM BIN
Primary Care Clinician (PCC) Plan Conduent 009555

Does MassHealth need prior authorization?

MassHealth determines the medical necessity of a service or product to be provided to its members through the use of prior authorization (PA) See 130 CMR 450.303.

What is covered by MassHealth?

MassHealth pays for many important health-care services including doctor visits, hospital stays, rehabilitation and therapeutic services, and behavioral health and substance use disorder services. To get more specific information, call the MassHealth Customer Service Center.

Does MassHealth cover gym memberships?

Eligible Tufts Health Together (MassHealth) members can receive a reimbursement of up to $30 once every calendar year for a gym membership or fitness-related activity.

Is MassHealth Medicare?

Medicaid and MassHealth actually refer to the same program. Unlike Medicare, it’s income and/or asset based (depending on the particular program) rather than age based. It is a joint federal and state program designed for low to moderate income residents. Coverage options vary based on age and medical conditions.

How long does a MassHealth prior authorization take?

Send PA requests via the Provider Online Service Center (POSC). We respond to complete submitted PA requests within 14-21 calendar days.

What is prior authorization when does the MA need to obtain it?

Prior authorization is a requirement that a health care provider obtain approval from Medicare to provide a given service. Prior Authorization is about cost-savings, not care. Under Prior Authorization, benefits are only paid if the medical care has been pre-approved by Medicare.