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Medications new to the market will not be covered for a minimum of six months
until they can be evaluated for effectiveness, safety, and overall value. Certain drugs
require prior authorizations and/or have dispensing limits. For specific drug or
dose inquiries, please call the Pharmacy Services Department at (413) 787-4000 or
refer to the website www.hne.com.
Neighborhood Health Plan of Massachusetts (NHP)
The drugs listed in this document represent agents that were on NHP’s Preferred
Drug List (PDL) at the time of printing. Non-preferred brand name drugs are not
listed in this edition of the Massachusetts Outpatient Formulary Guide. The list is
applicable to all NHP members who have pharmacy coverage, including Medicaid,
Commonwealth Care Plan, Commonwealth Choice, and Commercial.
The standard drug benefits for most Commercial, Commonwealth Choice, and
Commonwealth Care Plan Types 2 and 3 have three tiers.
Tier 1 — Generic drugs, lowest copayment
Tier 2 — Preferred brand drugs, higher copayment
Tier 3 — Non-preferred brand drugs, highest copayment
The standard drug benefits for Medicaid and Commonwealth Care Plan Type 1
are as follows:
Tier 1 ($1) — Generic antihyperglycemics
Generic antihypertensives
Generic antihyperlipidemics
Tier 3 ($3) — For each prescription and refill for other generic drugs, OTC,
and brand-name drugs covered by NHP
A prescription is required for all prescription and OTC medications. When
available, FDA-approved generic drugs are to be used in all instances, regardless of
“Dispense as Written” indicated. Certain drugs may require prior authorization (PA),
step therapy (ST) or may have a dispensing limitation (DL). NHP’s Pharmacy
and Therapeutics (P&T) Committee reviews all pharmacy programs annually and
new drugs for safety, efficacy, side effects and post-marketing reports. While a drug
is being reviewed, it is not covered. Please refer to the NHP pharmacy benefit, visit
the website at www.nhp.org, or call (617) 772-5500 for more detailed information.
Our website also contains the forms required to request prior approval for specific
medications. These forms specify the information elements needed to evaluate and
process prior approval (PA) requests, and can be downloaded as needed.
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