MassHealth Drug List

Introduction to MassHealth Drug List

Information about the MassHealth Drug List and updates to the list. Sign up to receive e-mail notification of when updates to the MassHealth drug list are posted on the Web.

Upcoming and Recent Updates

Link to the most recent updates to the MassHealth Drug List. May be subject to change.

Prior Authorization Forms for Pharmacy Services

Link to all Prior Authorization forms for MassHealth Pharmacy Services.

Link to the list of drugs preferred by MassHealth based on supplemental rebate agreements between MassHealth and drug manufacturers. In general, MassHealth requires a trial of the preferred drug or clinical rationale for prescribing a non-preferred drug within a therapeutic class.

Link to the list of brand name drugs that MassHealth prefers over their generic equivalents because the net cost of the brand name drug adjusted for rebates is lower than the net cost of the generic equivalent. In general, MassHealth requires a trial of the preferred drug or clinical rationale for prescribing the non-preferred drug generic equivalent.

Link to a list of the drugs that are the only nonlegend drugs, with the exception of insulins, that are covered by MassHealth without prior authorization.

Link to the list of naloxone products that are covered by MassHealth without prior authorization.

Link to the list of non-drug products preferred by MassHealth based on rebate agreements between MassHealth and product manufacturers.

Link to a list of non-drug products that MassHealth pays for through the Pharmacy Online Processing System (POPS).

Link to the list of the professional services that MassHealth pays for through the Pharmacy Online Processing System (POPS).

Link to the current list of “APAD Carve-Out Drugs” and “APEC Carve-Out Drugs” for which a Hospital must obtain prior authorization (PA) from MassHealth. Please note that these treatments will be subject to monitoring. Other requirements also apply.

Link to the list of the "Certain MassHealth Outpatient Physician Administered Drugs to be Paid by Fee Schedule" which identifies the current list of “Fee Schedule Drugs” and reimbursement for outpatient administration of certain physician administered drugs

Link to the list of the "Long-Acting Injectable Antipsychotic Medications Administered in Inpatient Psychiatry Units" which identifies the current list of long-acting injectable antipsychotic medications that, when administered in an inpatient psychiatry unit, are reimbursable outside of the applicable per diem rates for Acute and Psychiatric Hospitals.

Link to a list that describes the types of drugs that are allowed or required to be dispensed in a 90-day supply.

Medicare Part D Exclusion Drug List

Link to a list of drugs that Medicare Part D excludes from prescription coverage, but may be covered by MassHealth.

This document describes the MassHealth Medication Therapy Management (MTM) program, which is a clinical outreach initiative for members with targeted disease states.

MassHealth Pharmacy Initiatives and Clinical Information

Link to the Concomitant Opioid Benzodiazepine, Pediatric Behavioral Health Medication, Hospital Outpatient Prior Authorization, Opioid and Pain, and Second-Generation (Atypical) Antipsychotic Initiatives.

MassHealth Accountable Care Partnership Plans and Managed Care Organizations Pharmacy Information

Link to additional information regarding obligations of MassHealth Accountable Care Partnership Plans (ACPPs) and Managed Care Organizations (MCOs) with respect to the MHDL, including Certain MassHealth Outpatient Physician Administered Drugs to be Paid by Fee Schedule, Medical Benefit, Non-Rebate Drugs and Biologics, One-Time Cell and Gene Therapies, Opioids and Analgesics, Specialty Drugs and Specialty Pharmacy Networks, and Under Review Medications.

This page lists operational information related to new-to-market, non-FDA approved, and non-rebate drugs and biologics.

Please note that this document does not represent the complete MassHealth Drug List.

The MassHealth Drug List Downloads

Download the current MassHealth Drug List and the previous 5 updates to the MassHealth Drug List in PDF or DOC format. Download the current MassHealth Formulary and Benefit file and the previous 5 updates to the MassHealth Formulary and Benefit file in TXT format.