MedicaidCoverageHigh impact
All Provider Bulletin 414: Changes in Exclusion of Designated 340B Drugs for MassHealth Fee-for-Service Coverage
MassHealth·MA·Pharmacy
Effective date
Jul 1, 2026
We identified it
Jun 18, 2026
Summary
Effective July 1, 2026, MassHealth will no longer pay for 340B drugs dispensed through pharmacy point-of-sale systems in fee-for-service plans. Providers must use non-340B drug stock for MassHealth FFS, PCC Plan, and Primary Care ACO members to receive reimbursement.
Action Required
By July 1, 2026: Billing team must coordinate with pharmacy staff to ensure all MassHealth FFS, PCC Plan, and Primary Care ACO members receive non-340B drug stock only. Update pharmacy systems to flag these plan types and prevent 340B drug dispensing through point-of-sale adjudication. Verify MassHealth Drug List for any drugs completely excluded when purchased through 340B program. Claims for 340B drugs billed through pharmacy point-of-sale will be denied.