Pharmacy-benefit drugs for WellSense MassHealth members; ePA via Surescripts, CoverMyMeds or ExpressPath also accepted. Gene therapy drugs for MassHealth members go directly to MassHealth (fax 877-208-7428).
Wait time: not establishedBest time from caller reports: not established. Published hours are not a wait forecast.
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Call preparation · editorial guide
Make the call count.
Separate pharmacy-benefit requests from drugs billed under the medical benefit. The PBM and the insurer may use different contacts.
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PBM name and the pharmacy identifiers on the card
Drug, formulation and prescription information
Prescriber details and previous review reference
Questions to resolve
Is this processed under the medical or pharmacy benefit?
What is the correct review and submission channel?
Is there a separate specialty pharmacy or appeal team?
This is a general administrative checklist, not payer policy or advice about a particular patient. Confirm the current plan instructions.
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For the people making the calls
Put payer follow-up on your office’s worklist.
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A request does not create an account or start a call. Use business contact information only. No patient information.
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