MedicaidCoverageMedium impact
Managed Care Entity Bulletin 132: Changes in Exclusion of Designated 340B Drugs from MassHealth Coverage
MassHealth·MA·Pharmacy
Effective date
Aug 18, 2025
We identified it
Jun 18, 2026
Summary
Effective August 18, 2025, MassHealth Accountable Care Partnership Plans (ACPPs) and Managed Care Organizations (MCOs) are required to exclude certain high-cost drugs purchased through the 340B Drug Pricing Program from coverage. This mirrors existing MassHealth payment policies that deny reimbursement for specific 340B drugs listed in Provider Bulletins 390 and 407.
Action Required
By August 18, 2025: Billing teams working with MassHealth ACPPs and MCOs must review All Provider Bulletins 390 and 407 to identify the specific high-cost 340B drugs that will no longer be covered. Update pharmacy billing systems and prior authorization workflows to reflect these exclusions. Verify drug acquisition source before submitting claims, as 340B-purchased drugs on the exclusion list will be denied payment.