Prior authorization for certain brand-name multi-source drugs
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MassHealth requires prior authorization for certain brand-name multi-source analgesics, benzodiazepines, and muscle relaxants that are AB-rated multi-source products; this bulletin informs participating pharmacies and prescribers about the requirement and submission procedures.
No material clinical or coverage changes in this revision.
Coverage Criteria
Coverage contingent on prior authorization
Covered when the following condition is met
Submission may be faxed or mailed to the Drug Utilization Review Program at the University of Massachusetts Medical School (address and fax in bulletin).
This bulletin applies specifically to brand-name multi-source analgesics, benzodiazepines, and muscle relaxants that are listed as AB-rated multi-source products in the FDA’s Approved Drug Products with Therapeutic Equivalence Evaluations (the Orange Book). Only those brand-name products meeting the AB-rated multi-source designation in the most recent edition or supplement of the Orange Book are subject to the requirements described in this policy.
Provider Actions and Requirements
Prior authorization required for specified brand-name multi-source products
Prior authorization is required for brand-name analgesics, benzodiazepines, and muscle relaxants that are AB-rated multi-source products as listed in the FDA Approved Drug Products with Therapeutic Equivalence Evaluations (Orange Book).
Confirm AB-rated multi-source brand-name status
Ensure the prescription is for a brand-name analgesic, benzodiazepine, or muscle relaxant that is AB-rated and listed in the FDA Orange Book; other products are not covered by this specific PA requirement.
Required documentation and submission methods for PA
The prescriber must submit a completed Request for Prior Authorization form or provide the required information on office letterhead as specified in Subchapter 5 of the provider manual; submissions may be faxed or mailed to the Drug Utilization Review Program at the University of Massachusetts Medical School.
- Mailing address: Drug Utilization Review Program, University of Massachusetts Medical School, 11 Midstate Drive, Auburn, MA 01501
- Fax: (508) 721-7138
Denial risk if PA not obtained for AB-rated multi-source brand-name products
Dispensing a brand-name analgesic, benzodiazepine, or muscle relaxant that is an AB-rated multi-source product without an approved prior authorization may result in claim denial.
Definitions
Background
The Division implemented prior authorization for certain brand-name multi-source products to promote selection of the most appropriate, efficacious, and cost-effective therapy. Specifically, prior authorization is required when a brand-name analgesic, benzodiazepine, or muscle relaxant is identified as an AB-rated multi-source product in the FDA Orange Book; this ensures that dispensing of these brand-name products is reviewed and authorized before coverage is provided.
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