Most medications covered on the medical benefit require prior authorization through Specialty Fusion. Click here for a list of the medications authorized by Specialty Fusion*
*Please note: This list is not inclusive of all medications that require prior authorization by Mass General Brigham Health Plan. This list is specific to medical specialty medications that require authorization through Specialty Fusion only.
For non-specialty medications covered on the pharmacy benefit and non-formulary medications, please submit prior authorizations to Optum Rx using the information below.
For specialty medications, please submit prior authorizations to Specialty Fusion using the information below.
To find out if a medication requires prior authorization or if it is listed on the MassHealth formulary please search the MassHealth Drug List.
Please note, the following policies are pharmacy benefit drugs that are not aligned with MassHealth. If a policy is not listed below search the MassHealth Drug List for criteria.
Massachusetts Step Therapy Protocol Exception
Off-Label/Non-FDA Approved Indications
Call provider services at 855-444-4647.