MedicaidCoverageMedium impact
All Provider Bulletin 407: Changes in Exclusion of Designated 340B Drugs from MassHealth Coverage
MassHealth·MA · Oncology, Hematology·Pharmacy
Effective date
Sep 2, 2025
We identified it
Jun 18, 2026
Summary
MassHealth will no longer cover seven high-cost specialty drugs (including gene therapies like Casgevy, Elevidys, and Lenmeldy) when purchased through the 340B Drug Pricing Program. Providers must use non-340B stock for these drugs to receive MassHealth reimbursement, though they will be paid the higher actual acquisition cost.
Action Required
By September 2, 2025: Pharmacy and billing teams must ensure the seven specified drugs (Casgevy, Elevidys, Lenmeldy, Lyfgenia, Omisirge, Roctavian, Tecelra) are purchased from non-340B stock when dispensing to MassHealth Fee-for-Service, PCC Plan, and Primary Care ACO members. Update inventory management systems to flag these drugs for MassHealth patients. Claims will be denied if drugs are purchased through 340B program.