Massachusetts General Laws
Chapter 118e - Division of Medical Assistance
Section 17 - Reimbursements for Non-Generic Drugs

Section 17. Multiple source drugs listed in the Massachusetts list of interchangeable drug products established pursuant to the provisions of section thirteen of chapter seventeen of the General Laws and regulations adopted thereunder shall not be reimbursable except for the ''Massachusetts maximum allowable cost'', as defined by regulations of the department, unless the division grants prior authorization based upon the provision of written documentation by the practitioner to the division that satisfactorily demonstrates that a recipient's medical condition requires the use of a nongeneric drug and unless the practitioner writes on the face of the prescription in his or her own handwriting the words ''brand name medically necessary'' under the words ''no substitution'' in a manner consistent with applicable state law; provided that a pharmacist dispensing in accordance with this section shall be exempt from the provisions of the fourth paragraph of section twelve D of chapter one hundred and twelve.

Structure Massachusetts General Laws

Massachusetts General Laws

Part I - Administration of the Government

Title XVII - Public Welfare

Chapter 118e - Division of Medical Assistance

Section 1 - Duties of Office

Section 2 - Established Authority

Section 2a - Director of Dental Services

Section 6 - Medical Care Advisory Committee; Member; Staff; Report From Office of Medicaid

Section 7 - Powers

Section 8 - Definitions

Section 8a - Definitions for Secs. 13c to 13k and Secs. 64 to 70

Section 9 - Eligibility

Section 9a - Masshealth; Beneficiaries; Eligibility; Payment; Information Applications

Section 9c - Medical Insurance Reimbursement Programs; Definitions; Eligibility; Expenditures; Submission of Plans

Section 9d - Senior Care Options Initiative; Senior Care Organizations; Enrollment Choices; Advisory Committee; Report

Section 9e - Application for Authority; Implementation of Measures; Waiver of Measures Due to Hardship

Section 9f - Duals Demonstration; Review of Request for Financial Solvency

Section 10 - Medical Care Assistance Program for Pregnant Women and Infants

Section 10a - Required Coverage for Prenatal Care, Childbirth and Postpartum Care

Section 10b - Required Coverage for Newborn Hearing Screening Tests

Section 10c - Required Coverage for Items Medically Necessary for the Diagnosis or Treatment of Diabetes

Section 10d - Required Coverage for Treatment of Breast and Cervical Cancer

Section 10e - Healthy Start Program; Medical Assistance for Pregnant Women and Infants; Eligibility; Types of Assistance; Protection From Billing and Collection Practices

Section 10f - Health Care Services for Dependent and Adopted Youths; Funding; Types of Services; Eligibility; Program Reports; No Entitlement

Section 10g - Coverage for Children Under Age 18 for Cleft Lip and Cleft Palate

Section 10h - Coverage for Medically Necessary Treatments for Persons Younger Than 21 Years Old Diagnosed With an Autism Spectrum Disorder by a Licensed Physician or a Licensed Psychologist

Section 10i - Coverage for Administration of All Federal Food and Drug Administration Approved Drugs for Opioid or Alcohol Dependence Treatment

Section 10j - Coverage for Medical or Drug Treatments to Correct or Repair Disturbances of Body Composition Caused by HIV Associated Lipodystrophy Syndrome

Section 10k - Coverage for Certain Services and Contraceptive Methods

Section 10l - Filling of Remaining Portion of Prescription for Covered Drug That Is a Narcotic Substance Earlier Filled in Lesser Quantity

Section 10m - Coverage for Tobacco Use Cessation Counseling and Products

Section 10n - Urgent Care Facilities; Referrals; Primary Care Providers

Section 11 - Cooperation With Federal Authorities

Section 12 - Policies; Procedures; Rules and Regulations; Contracts

Section 12a - Pharmaceutical Drugs; Negotiation of Supplemental Rebate Agreements

Section 13 - Rate Changes; Review

Section 13a - Non-Acute Hospitals; Rates and Terms of Payment

Section 13b - Hospital Rate Increases; Quality Standards and Benchmarks

Section 13c - Establishment of Rates of Payment for Health Care Services

Section 13d - Duties of Ratemaking Authority; Criteria for Establishing Rates

Section 13e - Appeals of Interim or Final Rates

Section 13e1/2 - Contractual Arrangements With Acute and Non-Acute Hospitals

Section 13f - Contracts Between Acute and Non-Acute Hospital Service Providers and Office of Medicaid

Section 13g - Hospital Assets Not to Be Considered as Resources for Purpose of Establishing Rates

Section 13h - Recipients of Benefits Under Chapter 117a

Section 13i - Patients With Foreign Residency

Section 13j - Health Maintenance Organizations; Contracting Rights

Section 13k - Adjustment of Facility's Rate

Section 13l - Restriction of Hospital Access to Discounted Purchase of Prescription Drugs

Section 14 - Nursing Home Negotiated Rate Contracts

Section 14a - Reimbursement to Nursing Homes for Admissions to Acute Care and Chronic Disease or Rehabilitation Hospitals

Section 15 - Medicaid Benefits; Rules and Regulations; Managed Care; Personal Expenses

Section 16 - Primary and Supplemental Medical Care and Assistance Program for Disabled Residents; Assistance Program for Chronically Ill or Disabled Persons Forced to Leave Employment or Substantially Reduce Work Hours

Section 16a - Medical Care and Assistance Program for Disabled Children

Section 16a1/2 - Costs Incurred for Medical Programs Projected to Exceed Available Appropriations; Notice

Section 16c - Child Health Insurance Program; Medical Benefits; Costs; Eligibility

Section 16d - Aliens or Persons Residing in United States Under Color of Law; Benefits

Section 17 - Reimbursements for Non-Generic Drugs

Section 17a - Emergency Services Provided to Beneficiaries for Emergency Medical Conditions

Section 18 - Medical Insurance Purchases for Persons Eligible for Assistance

Section 19 - Prior Approval of Medical Services; Methods; Rules and Regulations; Posttreatment Examinations

Section 20 - Application; Forms; Application by Institution

Section 21 - Inquiry by Department; Notification of Applicant; Agreement

Section 21a - Medical Assistance Eligibility of an Institutionalized Spouse

Section 22 - Third Party Payments; Repayment; Assignment; Subrogation

Section 23 - Subrogation Rights; Health Insurance Benefits; Garnishment of Wages

Section 23a - Financial Institutions; Request for Deposit and Withdrawal Records; Penalty

Section 25 - Exempt Income and Resources

Section 25a - Determination of Eligibility for Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary and Qualified Individual Programs; Consideration of Certain Income or Assets

Section 26 - Identification Card

Section 27 - Redetermination of Eligibility

Section 28 - Disposal of Resources at Less Than Fair Market Value; Period of Ineligibility

Section 29 - Transfer of Interest in Real Property; Notice

Section 30 - Time of Payment

Section 31 - Adjustment or Recovery of Payments

Section 32 - Provision of Death Certificate and Probate Petition to Division; Liability of Estate Beneficiaries; Claims Against Estate; Sale or Transfer of Property Subject to Lien or Claim

Section 33 - Long Term Care Insurance Purchasers; Liability for Medical Assistance Paid

Section 34 - Liens and Encumbrances

Section 35 - Reimbursement for Covered Claims; Submission of Information

Section 36 - Eligible Providers; Responsibility for Overpayments

Section 37 - Distribution of Rules, Regulations to Providers; Administrative Sanctions

Section 38 - Submission of Bills by Providers; Appeals for Erroneous Denials; Overpayments; Civil Collection Actions

Section 38a - Retroactive Claims Denials for Behavioral Health Services

Section 39 - False Representations, Failure to Disclose; Penalty

Section 40 - False Statements or Representations by Providers; Penalty

Section 41 - Bribery or Rebates; Penalty

Section 42 - Excess Charges; Penalty

Section 43 - Health Care Facilities; Additional Charges as Precondition for Admission or Continuance; Penalty

Section 44 - Civil Remedies; Limitations

Section 45 - Venue; Actions Relating to False Claims

Section 46 - Availability of Other Remedies

Section 46a - Providers; Submission of Claims for Payment Not in Compliance With Policies and Procedures of Medical Assistance Program; Proof of Clerical or Administrative Error

Section 47 - Persons Aggrieved; Right to Hearing; Investigation; Decision; Rehearing; Notice

Section 47a - Benefits Available Only to Otherwise Eligible Individuals Showing Lawful Presence in the United States or Meeting Applicable Federal Requirements Necessary to Qualify for Benefits for Which the Commonwealth Receives Federal Reimbursemen...

Section 48 - Board of Hearings

Section 49 - Use and Disclosure of Information

Section 50 - Contract for Administrative Functions; Underwriting of Program

Section 51 - Utilization Review of Care and Services; Data Processing and Collection Procedures; Liability in Civil Actions

Section 52 - Maintenance of Standards for Providers; Development of New Programs

Section 53 - Covered Services

Section 54 - Wellness Program for Masshealth Enrollees

Section 56 - Controlled Substance Management Program for Masshealth Enrollees

Section 61 - Availability of Benefits to Persons Recognized as a Spouse Under Laws of the Commonwealth

Section 62 - Acceptance and Recognition of Information Submitted Pursuant to Coding Standards and Guidelines Required; Use of Standardized Claim Formats

Section 63 - Assessment per Non-Medicare Reimbursed Patient Day

Section 64 - Definitions for Secs. 64 Through 69

Section 65 - Health Safety Net Office

Section 66 - Health Safety Net Trust Fund

Section 67 - Liability of Acute Hospital to Fund

Section 67a - Nonpublic Ambulance Services; Liability; Uniform Assessment; Enforcement

Section 68 - Surcharge Assessed by Acute Hospitals and Ambulatory Surgical Centers

Section 69 - Reimbursements to Hospitals and Community Health Centers for Health Services Provided to Uninsured and Underinsured Individuals

Section 70 - Definitions for Secs. 70 Through 75

Section 71 - Pca Quality Home Care Workforce Council

Section 72 - Duties of Workforce Council; Pca Recruitment, Training and Referral Resources; Lists of Pcas

Section 73 - Rights of Consumers Regarding Pcas; Public Employee Status for Limited Purposes; Collective Bargaining

Section 74 - Pca Quality Home Care Workforce Council; Scope of Power and Authority

Section 75 - Performance Reviews

Section 76 - Designation of Another Governmental Unit to Perform Functions Set Forth in Secs. 13c Through 13k and 64 Through 75

Section 77 - Office of Medicaid to Attribute Members to Primary Care Providers

Section 78 - Employer Healthcare Coverage Form

Section 79 - Coverage for Health Care Services Delivered via Telehealth by a Contracted Health Care Provider; Right in In-Person Services; Copayment or Coinsurance; Rate of Payment; Standards of Care