Skip to Content

MassHealth Drug List A - Z


A    B    C    D    E    F    G    H    I    J    K    L    M    N    O    P    Q    R    S    T    U    V    W    X    Y    Z


This is a listing of all of the drugs covered by MassHealth. Please select a letter to see drugs listed by that letter, or enter the name of the drug you wish to search for.



MassHealth Drug List table
Drug - Brand Name (Generic Name) PA Status Class Drug Notes
c1 esterase inhibitor, human-BerinertdrugId:1938 PA ENZYMES
c1 esterase inhibitor, human-CinryzedrugId:416 PA ENZYMES
c1 esterase inhibitor, human-HaegardadrugId:6283 PA ENZYMES
c1 esterase inhibitor, recombinant-RuconestdrugId:4794 PA ENZYMES
cabazitaxeldrugId:1961 PA CHEMOTHERAPY MB
Cabenuva (cabotegravir / rilpivirine)drugId:7719 ANTIVIRALS PD
cabergoline HORMONE AGENTS A90
Cablivi (caplacizumab-yhdp)drugId:7180 PA BIOLOGICAL
Cabometyx (cabozantinib tablet)drugId:5585 PA CHEMOTHERAPY
cabotegravir / rilpivirinedrugId:7719 ANTIVIRALS PD
cabotegravir injectiondrugId:8250 ANTIVIRALS PD
cabotegravir tabletdrugId:7722 ANTIVIRALS
cabozantinib capsuledrugId:2719 PA CHEMOTHERAPY
cabozantinib tabletdrugId:5585 PA CHEMOTHERAPY
Caduet (amlodipine / atorvastatin); See Table 13drugId:42; See Table 18drugId:43 PA CARDIOVASCULAR/STATIN M90
cafcit (caffeine citrate injection) BRONCHODILATORS MB
caffeine citrate injection BRONCHODILATORS MB
caffeine citrate solution BRONCHODILATORS
calamine lotion DERMATOLOGICAL *
Calan SRdrugId:2742 (verapamil sustained-release)drugId:2742 CARDIOVASCULAR M90, #
calaspargase pegol-mknldrugId:7328 PA CHEMOTHERAPY MB
calcifedioldrugId:5765 PA ELECTROLYTES AND NUTRIENTS
calcipotriene creamdrugId:420 PA > 60 grams/month DERMATOLOGICAL A90, #
calcipotriene foamdrugId:2560 PA DERMATOLOGICAL BP, A90
calcipotriene ointmentdrugId:2563 PA > 60 grams/month DERMATOLOGICAL A90
calcipotriene scalp solutiondrugId:2562 DERMATOLOGICAL A90
calcitonin salmon injectiondrugId:4960 PA HORMONE AGENTS
calcitonin salmon nasal spraydrugId:423 HORMONE AGENTS M90
calcitriol capsule, solutiondrugId:426 ELECTROLYTES AND NUTRIENTS M90, #
calcitriol injectiondrugId:425 ELECTROLYTES AND NUTRIENTS MB
calcitriol ointmentdrugId:424 PA DERMATOLOGICAL A90
calcium acetate ELECTROLYTES AND NUTRIENTS
calcium acetate ELECTROLYTES AND NUTRIENTS M90
calcium oxybate / magnesium oxybate / potassium oxybate / sodium oxybatedrugId:7603 PA SEDATIVES
calcium polycarbophildrugId:8607 LAXATIVES *, M90
calcium replacementdrugId:428 ELECTROLYTES AND NUTRIENTS *, M90
Calquence (acalabrutinib)drugId:6483 PA CHEMOTHERAPY
Camcevi (leuprolide)drugId:8332 PA HORMONE AGENTS
Campath (alemtuzumab 30 mg)drugId:6110 CHEMOTHERAPY
Camptosar (irinotecan)drugId:970 CHEMOTHERAPY MB
Camzyos (mavacamten)drugId:8252 PA CARDIOVASCULAR
canagliflozindrugId:2780 DIABETIC AGENTS
canagliflozin / metformindrugId:4775 DIABETIC AGENTS
canagliflozin / metformin extended-releasedrugId:5723 DIABETIC AGENTS
canakinumabdrugId:432 PA IMMUNOMODULATOR
CanasadrugId:2095 (mesalamine suppository)drugId:2095 GI ANTI-INFLAMMATORY A90, #
Cancidas (caspofungin) ANTIBIOTICS #
candesartan / hydrochlorothiazidedrugId:434 PA CARDIOVASCULAR M90
candesartandrugId:433 PA CARDIOVASCULAR M90
cannabidioldrugId:6901 PA ANTICONVULSANTS
cantharidindrugId:8729 PA DERMATOLOGICAL MB
Capastat (capreomycin)drugId:2490 TB PREPARATIONS
capecitabinedrugId:435 CHEMOTHERAPY A90, #
caplacizumab-yhdpdrugId:7180 PA BIOLOGICAL
Caplyta (lumateperone); See Table 24drugId:7361; See Table 71drugId:7362 PA ANTIPSYCHOTIC
capmatinibdrugId:7458 PA CHEMOTHERAPY
Caprelsa (vandetanib)drugId:2281 PA CHEMOTHERAPY
capreomycindrugId:2490 TB PREPARATIONS
capsaicin DERMATOLOGICAL *, A90
capsaicin high dose patchdrugId:1946 PA ANALGESICS MB
captopril / hydrochlorothiazidedrugId:438 PA CARDIOVASCULAR M90
captoprildrugId:437 PA CARDIOVASCULAR M90
Carac (fluorouracil 0.5% cream)drugId:876 CHEMOTHERAPY BP, A90
Carafate (sucralfate suspension) ANTACIDS BP, A90
Carafate (sucralfate tablet) ANTACIDS A90, #
carbachol 0.01%drugId:1984 OPHTHALMIC PREPARATIONS MB
Carbaglu (carglumic acid)drugId:2161 PA ENZYMES BP, PD, A90
carbamazepine extended-release; See Table 20drugId:439; See Table 71drugId:3240 PA < 6 years ANTICONVULSANTS A90, #
carbamazepine extended-release; See Table 20drugId:2192; See Table 71drugId:3220 PA < 6 years ANTICONVULSANTS BP, A90
carbamazepine extended-release; See Table 20drugId:171; See Table 71drugId:3260 PA < 6 years ANTICONVULSANTS
carbamazepine-Tegretol; See Table 20drugId:170; See Table 71drugId:3280 PA < 6 years ANTICONVULSANTS A90, #
carbamide peroxide OTIC PREPARATIONS *, A90
Carbatrol (carbamazepine extended-release); See Table 20drugId:439; See Table 71drugId:3240 PA < 6 years ANTICONVULSANTS A90, #
carbidopa / levodopa / entacaponedrugId:176 ANTIPARKINSON A90, #
carbidopa / levodopa enteral suspensiondrugId:5104 PA ANTIPARKINSON
carbidopa / levodopa extended-release capsuledrugId:4950 PA ANTIPARKINSON
carbidopa / levodopa extended-release tabletdrugId:1997 ANTIPARKINSON A90
carbidopa / levodopa orally disintegrating tabletdrugId:174 PA ANTIPARKINSON A90
carbidopa / levodopa tabletdrugId:175 ANTIPARKINSON A90, #
carbidopadrugId:173 ANTIPARKINSON A90, #
carbinoxamine 4 mg/5 mL solution, 4 mg tabletdrugId:2267 ANTIHISTAMINES A90
carbinoxamine 6 mg tabletdrugId:7229 PA ANTIHISTAMINES A90
carbinoxamine extended-releasedrugId:2962 PA ANTIHISTAMINES
Carbocaine (mepivacaine) ANESTHETICS MB
carboplatindrugId:179 CHEMOTHERAPY MB
CardizemdrugId:528 (diltiazem-Cardizem)drugId:528 CARDIOVASCULAR M90, #
Cardizem CDdrugId:531 (diltiazem extended-release capsule)drugId:531 CARDIOVASCULAR M90, #
Cardizem LAdrugId:529 (diltiazem extended-release tablet)drugId:529 CARDIOVASCULAR M90, #
Cardura (doxazosin immediate-release); See Table 18drugId:565; See Table 19drugId:5163 CARDIOVASCULAR M90, #
Cardura XL (doxazosin extended-release)drugId:566 BENIGN PROSTATIC HYPERPLASIA AGENTS
Carestart (COVID-19 antigen self-test)drugId:8174 - Non-Drug Product PA > 2 tests/28 days DIAGNOSTICS
carfilzomibdrugId:2581 PA CHEMOTHERAPY MB
carglumic aciddrugId:2161 PA ENZYMES BP, PD, A90
cariprazine; See Table 24drugId:5405; See Table 71drugId:5406 PA ANTIPSYCHOTIC PD
carisoprodol / aspirin / codeinedrugId:182 PA OPIOID ANALGESICS/MUSCLE RELAXANTS
carisoprodol / aspirindrugId:181 PA MUSCLE RELAXANT
carisoprodoldrugId:180 PA MUSCLE RELAXANT
carmustinedrugId:183 CHEMOTHERAPY MB
Carnitor (levocarnitine injection) ELECTROLYTES AND NUTRIENTS MB
Carnitor (levocarnitine tablet, solution) ELECTROLYTES AND NUTRIENTS A90, #
Carospir (spironolactone suspension)drugId:6280 PA ALDOSTERONE ANTAGONISTS M90
carteololdrugId:184 OPHTHALMIC PREPARATIONS M90
carvedilol extended-releasedrugId:186 PA CARDIOVASCULAR M90
carvediloldrugId:185 CARDIOVASCULAR M90, #
Carvykti (ciltacabtagene autoleucel)drugId:8204 PA CHEMOTHERAPY CO, MB
Casgevy (exagamglogene autotemcel for sickle cell disease)drugId:834 PA HEMATINICS & BLOOD CELL STIMULATORS CO, PD, MB
casimersendrugId:7878 PA BIOLOGICAL
CasodexdrugId:362 (bicalutamide)drugId:362 CHEMOTHERAPY A90, #
caspofungin ANTIBIOTICS #
Cayston (aztreonam) ANTIBIOTICS
cefaclor capsuledrugId:189 ANTIBIOTICS A90
cefaclor extended-releasedrugId:190 PA ANTIBIOTICS A90
cefaclor suspensiondrugId:8338 PA CEPHALOSPORINS A90
cefadroxil capsule, suspensiondrugId:191 ANTIBIOTICS A90
cefadroxil tabletdrugId:1986 PA ANTIBIOTICS A90
cefazolindrugId:192 ANTIBIOTICS
cefdinirdrugId:193 ANTIBIOTICS A90
cefepimedrugId:195 ANTIBIOTICS
cefiderocoldrugId:7392 PA ANTIBIOTICS
cefiximedrugId:196 PA ANTIBIOTICS A90
cefotaximedrugId:197 ANTIBIOTICS #
cefotetandrugId:5200 ANTIBIOTICS
cefoxitindrugId:198 ANTIBIOTICS
cefpodoxime suspensiondrugId:8039 PA ANTIBIOTICS A90
cefpodoxime tabletdrugId:199 ANTIBIOTICS A90
cefprozildrugId:200 ANTIBIOTICS A90
ceftarolinedrugId:2179 ANTIBIOTICS BP
ceftazidimedrugId:202 ANTIBIOTICS
ceftazidime / avibactamdrugId:4902 PA ANTIBIOTICS
ceftolozane / tazobactamdrugId:4842 PA ANTIBIOTICS
ceftriaxonedrugId:204 ANTIBIOTICS
cefuroxime axetildrugId:205 ANTIBIOTICS A90
cefuroxime sodiumdrugId:206 ANTIBIOTICS
CelebrexdrugId:207 (celecoxib)drugId:207 NONSTEROIDAL ANTI-INFLAMMATORY A90, #
celecoxib / tramadoldrugId:8211 PA ANALGESICS
celecoxibdrugId:207 NONSTEROIDAL ANTI-INFLAMMATORY A90, #
celecoxib oral solutiondrugId:8188 PA NONSTEROIDAL ANTI-INFLAMMATORY
CelestonedrugId:357 (betamethasone injection)drugId:357 GLUCOCORTICOIDS #
Celexa (citalopram solution, tablet); See Table 17drugId:248; See Table 71drugId:3700 PA < 6 years ANTIDEPRESSANTS A90, #
CellceptdrugId:1410 (mycophenolate mofetil)drugId:1410 IMMUNOMODULATOR A90, #
CelontindrugId:948 (methsuximide)drugId:948 ANTICONVULSANTS A90, #
cemiplimab-rwlcdrugId:7005 PA CHEMOTHERAPY MB
cenegermin-bkbjdrugId:7103 PA OPHTHALMIC PREPARATIONS
cenobamatedrugId:7406 PA ANTICONVULSANTS
Centany (mupirocin ointment)drugId:2564 ANTIBIOTICS A90
centruroides immune F(ab’)2, equine ANTIDOTES MB
cephalexin 250 mg, 500 mg capsule, suspensiondrugId:208 ANTIBIOTICS A90
cephalexin 750 mg capsuledrugId:209 PA ANTIBIOTICS A90
Ceprotin (protein C concentrate)drugId:1605 PA HEMATINIC AGENT MB
Cequa (cyclosporine 0.09% ophthalmic solution)drugId:7282 PA OPHTHALMIC PREPARATIONS
Cequr Simplicity (insulin bolus delivery patch)drugId:8761 - Non-Drug Product PA NON-DRUG PRODUCT PND
Cerdelga (eliglustat)drugId:4764 PA ENZYMES
CerebyxdrugId:2681 (fosphenytoin)drugId:2681 ANTICONVULSANTS #
Cerezyme (imiglucerase)drugId:780 PA ENZYMES MB
ceritinibdrugId:2951 PA CHEMOTHERAPY
certolizumabdrugId:210 PA IMMUNOMODULATOR
cetirizine / pseudoephedrinedrugId:2265 ANTIHISTAMINES *, A90
cetirizine ophthalmic solutiondrugId:7472 PA ANTIHISTAMINES
cetirizine syrup, tabletdrugId:211 ANTIHISTAMINES *, M90
cetuximabdrugId:212 CHEMOTHERAPY MB
cevimeline PARASYMPATHETIC AGENTS A90, #
Chantix (varenicline tablet) SMOKING CESSATION A90, #
Chemet (succimer) CHELATING AGENT
chenodioldrugId:1956 PA BILE THERAPY A90
cherry syrupdrugId:214 COMPOUNDING AGENT *
chikungunya virus vaccine, livedrugId:8735 BIOLOGICALS
chlorambucildrugId:216 PA CHEMOTHERAPY
chloramphenicoldrugId:217 ANTIBIOTICS MB
chlordiazepoxide / clidiniumdrugId:6843 PA ANTISPASMODICS,ANTICHOLINERGIC
chlordiazepoxide; See Table 69drugId:218; See Table 71drugId:4361 PA < 6 years BENZODIAZEPINES
chlorhexidine gluconatedrugId:1990 ANTISEPTICS *, A90
chloroprocaine injectiondrugId:8441 ANESTHETICS MB
chloroprocaine ophthalmic geldrugId:8719 PA ANESTHETICS
chloroprocaine vialdrugId:2667 ANESTHETICS MB
chloroquine phosphate ANTIMALARIALS A90
chlorothiazidedrugId:221 CARDIOVASCULAR M90, #
chlorpheniraminedrugId:222 ANTIHISTAMINES *, A90
chlorpromazine; See Table 24drugId:6321; See Table 71drugId:223 PA < 6 years ANTIPSYCHOTIC A90
chlorthalidonedrugId:8168 CARDIOVASCULAR
chlorthalidonedrugId:225 CARDIOVASCULAR M90
chlorzoxazone 250 mg, 375 mg, 750 mgdrugId:2360 PA MUSCLE RELAXANT A90
chlorzoxazone 500 mgdrugId:226 PA < 18 years MUSCLE RELAXANT A90, #
Cholbam (cholic acid)drugId:4907 PA BILE THERAPY
cholera vaccine, live, oraldrugId:5594 BIOLOGICAL
cholestyramine / aspartamedrugId:228 LIPID LOWERING AGENTS M90
cholestyramine / sucrosedrugId:229 LIPID LOWERING AGENTS M90
cholic aciddrugId:4907 PA BILE THERAPY
Cialis (tadalafil tablet-Cialis)drugId:2373 PA BENIGN PROSTATIC HYPERPLASIA AGENTS
Cibinqo (abrocitinib)drugId:8205 PA IMMUNOMODULATOR
ciclesonide 37 mcg nasal aerosoldrugId:2561 PA NASAL PREPARATIONS
ciclesonide 50 mcg nasal spraydrugId:231 PA > 1 inhaler/30 days NASAL PREPARATIONS
ciclesonide inhalerdrugId:230 PA BRONCHODILATORS
ciclopirox 0.77% creamdrugId:5625 FUNGICIDES A90, #
ciclopirox 0.77% suspensiondrugId:232 PA FUNGICIDES A90
ciclopirox 1% shampoo, 0.77% geldrugId:5128 PA FUNGICIDES A90
ciclopirox 8% nail lacquerdrugId:233 FUNGICIDES A90
cidofovirdrugId:234 ANTIVIRALS
cilostazoldrugId:235 ANTIPLATELET AGENT A90
CiloxandrugId:244 (ciprofloxacin ophthalmic ointment, solution)drugId:244 OPHTHALMIC PREPARATIONS A90, #
ciltacabtagene autoleuceldrugId:8204 PA CHEMOTHERAPY CO, MB
Cimduo (lamivudine / tenofovir disoproxil fumarate)drugId:6780 PA ANTIVIRALS
Cimerli (ranibizumab-eqrn) OPHTHALMIC PREPARATIONS MB
cimetidinedrugId:236 H2 ANTAGONISTS *, M90
Cimzia (certolizumab)drugId:210 PA IMMUNOMODULATOR
cinacalcet CALCIMIMETIC A90, #
Cinqair (reslizumab)drugId:5586 PA BIOLOGICAL MB
Cinryze (c1 esterase inhibitor, human-Cinryze)drugId:416 PA ENZYMES
Cinvanti (aprepitant injectable emulsion)drugId:6604 PA ANTIEMETICS
Cipro (ciprofloxacin injection, suspension, 250 mg, 500 mg, 750 mg tablet); See Table 35drugId:241; See Table 66drugId:5663 ANTIBIOTICS A90, #
CiprodexdrugId:245 (ciprofloxacin / dexamethasone)drugId:245 OTIC PREPARATIONS A90, #
ciprofloxacin / dexamethasonedrugId:245 OTIC PREPARATIONS A90, #
ciprofloxacin / fluocinolonedrugId:5683 PA OTIC PREPARATIONS A90
ciprofloxacin / hydrocortisonedrugId:246 OTIC PREPARATIONS
ciprofloxacin 0.2% otic solutiondrugId:2895 PA OTIC PREPARATIONS A90
ciprofloxacin 100 mg tabletdrugId:8040 PA ANTIBIOTICS A90
ciprofloxacin injection, suspension, 250 mg, 500 mg, 750 mg tablet; See Table 35drugId:241; See Table 66drugId:5663 ANTIBIOTICS A90, #
ciprofloxacin ophthalmic ointment, solutiondrugId:244 OPHTHALMIC PREPARATIONS A90, #
Cipro HC (ciprofloxacin / hydrocortisone)drugId:246 OTIC PREPARATIONS
cisplatindrugId:247 CHEMOTHERAPY MB
citalopram capsule; See Table 17drugId:8183; See Table 71drugId:8184 PA ANTIDEPRESSANTS A90
citalopram solution, tablet; See Table 17drugId:248; See Table 71drugId:3700 PA < 6 years ANTIDEPRESSANTS A90, #
citric acid / potassium citrate ELECTROLYTES AND NUTRIENTS A90
citric acid / sodium citrate / potassium citrate ELECTROLYTES AND NUTRIENTS A90
cladribine injectiondrugId:2673 CHEMOTHERAPY MB
cladribine tabletdrugId:7224 PA MULTIPLE SCLEROSIS AGENTS
ClaforandrugId:197 (cefotaxime)drugId:197 ANTIBIOTICS #
Clarinex (desloratadine tablet)drugId:339 PA ANTIHISTAMINES M90
Clarinex-D (desloratadine / pseudoephedrine)drugId:474 PA ANTIHISTAMINES
clarithromycindrugId:252 ANTIBIOTICS A90
clarithromycin extended-releasedrugId:253 PA ANTIBIOTICS A90
clascoteronedrugId:8044 PA DERMATOLOGICAL
clemastine tabletdrugId:254 ANTIHISTAMINES A90
Clenpiq (sodium picosulfate / magnesium oxide / anhydrous citric acid-Clenpiq)drugId:6380 PA LAXATIVES
Cleocin (clindamycin capsule, injection, oral solution); See Table 35drugId:255; See Table 66drugId:2626 ANTIBIOTICS A90, #
CleocindrugId:5000 (clindamycin vaginal cream-Cleocin)drugId:5000 ANTIBIOTICS A90, #
Cleocin TdrugId:257 (clindamycin gel, lotion, solution)drugId:257 ANTIBIOTICS A90, #
Cleocin Vaginal Ovule (clindamycin vaginal suppository)drugId:4915 ANTIBIOTICS
Climara (estradiol-Climara) HORMONE REPLACEMENT THERAPY M90, #
Clindagel (clindamycin gel-Clindagel)drugId:258 PA ANTIBIOTICS
clindamycin / benzoyl peroxide-AcanyadrugId:262 PA DERMATOLOGICAL A90
clindamycin / benzoyl peroxide-BenzaclindrugId:263 PA DERMATOLOGICAL A90
clindamycin / benzoyl peroxide-OnextondrugId:4788 PA DERMATOLOGICAL A90
clindamycin / tretinoin-VeltindrugId:1970 PA DERMATOLOGICAL A90
clindamycin / tretinoin-ZianadrugId:265 PA DERMATOLOGICAL A90
clindamycin 1.2% / benzoyl peroxide 5%drugId:264 PA DERMATOLOGICAL A90
clindamycin capsule, injection, oral solution; See Table 35drugId:255; See Table 66drugId:2626 ANTIBIOTICS A90, #
clindamycin foamdrugId:261 PA ANTIBIOTICS A90
clindamycin gel, lotion, solutiondrugId:257 ANTIBIOTICS A90, #
clindamycin gel-ClindageldrugId:258 PA ANTIBIOTICS
clindamycin pledgetsdrugId:256 ANTIBIOTICS A90
clindamycin vaginal cream-CleocindrugId:5000 ANTIBIOTICS A90, #
clindamycin vaginal cream-ClindessedrugId:260 PA ANTIBIOTICS
clindamycin vaginal geldrugId:8372 PA ANTIBIOTICS
clindamycin vaginal suppositorydrugId:4915 ANTIBIOTICS
Clindesse (clindamycin vaginal cream-Clindesse)drugId:260 PA ANTIBIOTICS
clobazam filmdrugId:7106 PA ANTICONVULSANTS
clobazam suspension, tabletdrugId:2419 ANTICONVULSANTS #
clobetasol propionate cream, ointmentdrugId:269 GLUCOCORTICOIDS A90, #
clobetasol propionate cream / emollientdrugId:5035 GLUCOCORTICOIDS A90
clobetasol propionate foam / emollientdrugId:2532 PA GLUCOCORTICOIDS A90
clobetasol propionate foamdrugId:268 GLUCOCORTICOIDS A90, #
clobetasol propionate gel, solutiondrugId:5080 GLUCOCORTICOIDS A90
clobetasol propionate lotion, shampoo, spraydrugId:7858 GLUCOCORTICOIDS A90
clobetasol propionate lotion pumpdrugId:7920 PA GLUCOCORTICOIDS
clobetasol propionate shampoo kitdrugId:5033 PA GLUCOCORTICOIDS A90
clocortolone creamdrugId:270 PA GLUCOCORTICOIDS A90
Cloderm (clocortolone cream)drugId:270 PA GLUCOCORTICOIDS A90
clofarabinedrugId:271 CHEMOTHERAPY MB
Clolar (clofarabine)drugId:271 CHEMOTHERAPY MB
clomipramine; See Table 17drugId:272; See Table 71drugId:4002 PA ANTIDEPRESSANTS A90
clonazepam 0.125 mg, 0.25 mg, 0.5 mg, 1 mg orally disintegrating tablet; See Table 69drugId:273; See Table 71drugId:4362 PA < 6 years and PA > 3 units/day BENZODIAZEPINES
clonazepam 2 mg orally disintegrating tablet; See Table 69drugId:2909; See Table 71drugId:4364 PA < 6 years and PA > 2 units/day BENZODIAZEPINES
clonazepam tablet; See Table 69drugId:274; See Table 71drugId:4363 PA < 6 years BENZODIAZEPINES #
clonidine extended-release 0.17 mg tablet; See Table 18drugId:8340; See Table 71drugId:8341 PA CARDIOVASCULAR A90
clonidine extended-release 0.1 mg tablet; See Table 31drugId:2170; See Table 71drugId:3081 PA < 3 years and PA > 4 units/day NONSTIMULANT ADHD AGENTS A90
clonidine injectiondrugId:2750 ANALGESICS #
clonidine patch; See Table 18drugId:5160; See Table 71drugId:2194 PA CARDIOVASCULAR A90
clonidine tablet; See Table 18drugId:5161; See Table 71drugId:2105 PA < 3 years CARDIOVASCULAR A90
clopidogreldrugId:277 ANTIPLATELET AGENT A90, #
clorazepate; See Table 69drugId:278; See Table 71drugId:4380 PA BENZODIAZEPINES
Clorotekal (chloroprocaine injection)drugId:8441 ANESTHETICS MB
clotrimazole / betamethasone creamdrugId:280 FUNGICIDES A90
clotrimazole / betamethasone lotiondrugId:2856 PA FUNGICIDES A90
clotrimazoledrugId:279 FUNGICIDES *, A90
clotrimazole trochedrugId:1995 FUNGICIDES A90
clozapine orally disintegrating tablet; See Table 24drugId:282; See Table 71drugId:4262 PA ANTIPSYCHOTIC A90
clozapine suspension; See Table 24drugId:2930; See Table 71drugId:4263 PA ANTIPSYCHOTIC A90
clozapine tablet; See Table 24drugId:281; See Table 71drugId:4261 PA < 6 years ANTIPSYCHOTIC A90, #
Clozaril (clozapine tablet); See Table 24drugId:281; See Table 71drugId:4261 PA < 6 years ANTIPSYCHOTIC A90, #
Coagadex (coagulation factor X, human)drugId:5242 ANTI-HEMOPHILIA AGENTS
coagulation factor IX, recombinantdrugId:2848 ANTI-HEMOPHILIA AGENTS
coagulation factor IX recombinant, glycopegylated-RebinyndrugId:6960 ANTI-HEMOPHILIA AGENTS
coagulation factor VIIa, recombinantdrugId:459 ANTI-HEMOPHILIA AGENTS
coagulation factor X, humandrugId:5242 ANTI-HEMOPHILIA AGENTS
Coartem (artemether / lumefantrine)drugId:95 PA > 24 units/365 days ANTIMALARIALS
cobicistatdrugId:4816 ANTIVIRALS
cobimetinibdrugId:5243 PA CHEMOTHERAPY
codeinedrugId:285 PA < 12 years and PA > 360 mg/day OPIOID ANALGESICS
cod liver oil ELECTROLYTES AND NUTRIENTS *, M90
coenzyme Q10drugId:6202 PA ≥ 21 years ELECTROLYTES AND NUTRIENTS
ColazaldrugId:126 (balsalazide)drugId:126 GI ANTI-INFLAMMATORY A90, #
colchicine capsuledrugId:4765 PA GOUT AGENTS BP, A90
colchicine solutiondrugId:7331 PA GOUT AGENTS
colchicine tabletdrugId:2162 GOUT AGENTS A90, #
ColcrysdrugId:2162 (colchicine tablet)drugId:2162 GOUT AGENTS A90, #
colesevelam; See Table 13drugId:288; See Table 26drugId:289 LIPID LOWERING AGENTS M90, #
ColestiddrugId:290 (colestipol)drugId:290 LIPID LOWERING AGENTS M90, #
colestipoldrugId:290 LIPID LOWERING AGENTS M90, #
colistimethate sodium injectiondrugId:291 ANTIBIOTICS #
colistin / neomycin / thonzonium / hydrocortisonedrugId:2108 OTIC PREPARATIONS A90
collagenase clostridium histolyticumdrugId:1951 PA ENZYMES
collagenasedrugId:8414 PA DERMATOLOGICAL
colloidal oatmeal DERMATOLOGICAL *
Columvi (glofitamab-gxbm)drugId:8702 PA ANTINEOPLASTICS MB
Coly-Mycin MdrugId:291 (colistimethate sodium injection)drugId:291 ANTIBIOTICS #
Combigan (brimonidine / timolol, ophthalmic)drugId:374 PA OPHTHALMIC PREPARATIONS M90
Combipatch (estradiol / norethindrone-Combipatch) HORMONE REPLACEMENT THERAPY
Combivent (albuterol / ipratropium inhalation spray)drugId:2557 BRONCHODILATORS
CombivirdrugId:1012 (lamivudine / zidovudine)drugId:1012 ANTIVIRALS A90, #
Cometriq (cabozantinib capsule)drugId:2719 PA CHEMOTHERAPY
Comirnaty (COVID-19 Pfizer vaccine, COVID EUA – September 11, 2023 for members ≥ 6 months of age)drugId:8310 COVID - 19 related Treatments and Vaccines
Complera (emtricitabine / rilpivirine / tenofovir disoproxil fumarate)drugId:2361 ANTIVIRALS
compounded pharmaceutical product with a total allowed ingredient cost ≥ $100drugId:8613 PA MISCELLANEOUS CP
compounded pharmaceutical product with a total allowed ingredient cost < $100 and non-topical / non-transdermal ROAdrugId:8612 MISCELLANEOUS CP
compounded pharmaceutical product with topical or transdermal ROAdrugId:8614 PA MISCELLANEOUS CP
ComtandrugId:602 (entacapone)drugId:602 ANTIPARKINSON A90, #
Concerta (methylphenidate extended-release-Concerta); See Table 31drugId:2662; See Table 71drugId:3041 PA < 3 years or ≥ 21 years and PA > 2 units/day CEREBRAL STIMULANTS BP
CondyloxdrugId:2261 (podofilox)drugId:2261 DERMATOLOGICAL A90, #
continuous glucose monitoring systemdrugId:8763 - Non-Drug Product PA NON-DRUG PRODUCT PND
Conzip (tramadol extended-release capsule)drugId:2362 PA ANALGESICS
copanlisibdrugId:6500 PA CHEMOTHERAPY MB
Copaxone (glatiramer)drugId:930 MULTIPLE SCLEROSIS AGENTS BP
Copiktra (duvelisib)drugId:7002 PA CHEMOTHERAPY
copper IUD CONTRACEPTIVES
CoregdrugId:185 (carvedilol)drugId:185 CARDIOVASCULAR M90, #
Coreg CR (carvedilol extended-release)drugId:186 PA CARDIOVASCULAR M90
CorgarddrugId:1416 (nadolol)drugId:1416 CARDIOVASCULAR M90, #
Corifact (factor XIII concentrate, human)drugId:2675 ANTI-HEMOPHILIA AGENTS
Corlanor (ivabradine)drugId:5124 PA CARDIOVASCULAR
CortefdrugId:736 (hydrocortisone tablet)drugId:736 GLUCOCORTICOIDS A90, #
CortenemadrugId:2983 (hydrocortisone enema)drugId:2983 GLUCOCORTICOIDS A90, #
corticotropindrugId:294 PA HORMONE AGENTS
Cortifoam (hydrocortisone foam)drugId:731 GLUCOCORTICOIDS
Cortisporin-TC (colistin / neomycin / thonzonium / hydrocortisone)drugId:2108 OTIC PREPARATIONS A90
Cortrophin (corticotropin)drugId:8185 PA HORMONE AGENTS
Cortrosyn (cosyntropin) DIAGNOSTICS #
Cosela (trilaciclib)drugId:7897 PA CHEMOTHERAPY MB
Cosentyx (secukinumab)drugId:4908 PA IMMUNOMODULATOR
Cosmegen (dactinomycin)drugId:2674 CHEMOTHERAPY MB
CosoptdrugId:564 (dorzolamide / timolol)drugId:564 OPHTHALMIC PREPARATIONS M90, #
Cosopt PF (dorzolamide / timolol, preservative free)drugId:2517 PA OPHTHALMIC PREPARATIONS BP, M90
cosyntropin DIAGNOSTICS #
Cotellic (cobimetinib)drugId:5243 PA CHEMOTHERAPY
Cotempla XR-ODT (methylphenidate extended-release orally disintegrating tablet); See Table 31drugId:6281; See Table 71drugId:6282 PA CEREBRAL STIMULANTS
COVID-19 antigen self-testdrugId:8169 - Non-Drug Product PA > 2 tests/28 days DIAGNOSTICS
COVID-19 antigen self-testdrugId:8174 - Non-Drug Product PA > 2 tests/28 days DIAGNOSTICS
COVID-19 Moderna vaccine, COVID EUA – September 11, 2023 for members ≥ 6 months of agedrugId:8312 COVID - 19 related Treatments and Vaccines
COVID-19 Pfizer vaccine, COVID EUA – September 11, 2023 for members ≥ 6 months of agedrugId:8310 COVID - 19 related Treatments and Vaccines
COVID EUA – October 3, 2023 for members ≥ 12 years of agedrugId:8270 COVID - 19 related Treatments and Vaccines
CozaardrugId:1103 (losartan)drugId:1103 CARDIOVASCULAR M90, #
Creon DR (pancrelipase-Creon DR)drugId:1082 ENZYMES
Cresemba (isavuconazonium)drugId:4909 PA FUNGICIDES
CrestordrugId:5601 (rosuvastatin 40 mg)drugId:5601 PA > 1 unit/day LIPID LOWERING AGENTS M90, #
CrestordrugId:1459 (rosuvastatin 5 mg, 10 mg, 20 mg)drugId:1459 PA > 1.5 units/day LIPID LOWERING AGENTS M90, #
Crinone (progesterone gel)drugId:2587 PA HORMONE REPLACEMENT THERAPY
crisaboroledrugId:6041 PA DERMATOLOGICAL PD
crizanlizumab-tmcadrugId:7326 PA HEMATOLOGIC MB
crizotinibdrugId:2376 PA CHEMOTHERAPY
crofelemerdrugId:5684 PA ANTIDIARRHEALS
cromolyn inhalationdrugId:298 BRONCHODILATORS A90
cromolyn ophthalmicdrugId:299 OPHTHALMIC PREPARATIONS A90
cromolyn oral BRONCHODILATORS A90, #
crotamiton creamdrugId:7338 ANTIPARASITICS
crotamiton lotiondrugId:300 PA ANTIPARASITICS BP
Crysvita (burosumab-twza)drugId:6740 PA BIOLOGICAL
CubicindrugId:326 (daptomycin)drugId:326 ANTIBIOTICS #
Culturelle (lactobacillus rhamnosus GG)drugId:6204 PA ≥ 22 years GASTROINTESTINAL AGENT
Cuprimine (penicillamine capsule)drugId:1496 CHELATING AGENT BP, A90
Cutaquig (immune globulin subcutaneous injection, human-hipp)drugId:7131 PA BIOLOGICAL
Cuvitru (immune globulin subcutaneous injection, human-Cuvitru)drugId:5720 PA BIOLOGICAL
Cuvposa (glycopyrrolate oral solution)drugId:2163 PA ANTISPASMODICS,ANTICHOLINERGIC A90
Cuvrior (trientine tablet)drugId:8604 PA CHELATING AGENT
CVS COVID-19 At-Home Test (COVID-19 antigen self-test)drugId:8330 - Non-Drug Product PA > 2 tests/28 days DIAGNOSTICS
cyanocobalamin / folic aciddrugId:303 PA ELECTROLYTES AND NUTRIENTS
cyanocobalamin-NascobaldrugId:301 PA ELECTROLYTES AND NUTRIENTS
cyanocobalamindrugId:302 ELECTROLYTES AND NUTRIENTS o, M90
Cyanokit (hydroxocobalamin) ANTIDOTES
cyclobenzaprine 5 mg, 10 mgdrugId:305 PA < 15 years MUSCLE RELAXANT A90
cyclobenzaprine 7.5 mgdrugId:306 PA MUSCLE RELAXANT A90
cyclobenzaprine extended-releasedrugId:304 PA MUSCLE RELAXANT A90
cyclopentolate / phenylephrine OPHTHALMIC PREPARATIONS
cyclopentolate OPHTHALMIC PREPARATIONS A90
cyclophosphamide capsule, tabletdrugId:310 CHEMOTHERAPY A90
cyclophosphamide injectiondrugId:8364 CHEMOTHERAPY MB
cycloserinedrugId:2498 TB PREPARATIONS A90
Cycloset (bromocriptine 0.8 mg tablet)drugId:2984 DIABETIC AGENTS
cyclosporine 0.05% ophthalmic emulsiondrugId:311 OPHTHALMIC PREPARATIONS BP, A90
cyclosporine 0.09% ophthalmic solutiondrugId:7282 PA OPHTHALMIC PREPARATIONS
cyclosporine 0.1% ophthalmic emulsiondrugId:8336 PA OPHTHALMIC PREPARATIONS
cyclosporine 0.1% ophthalmic solutiondrugId:8789 PA OPHTHALMIC PREPARATIONS
cyclosporine capsuledrugId:2092 IMMUNOMODULATOR A90, #
cyclosporine injectiondrugId:8711 IMMUNOMODULATOR MB
cyclosporine modifieddrugId:314 IMMUNOMODULATOR A90, #
cyclosporine multidose 0.05% ophthalmic emulsiondrugId:7305 PA OPHTHALMIC PREPARATIONS
cyclosporine solutiondrugId:8049 PA IMMUNOMODULATOR
Cyltezo (adalimumab-adbm)drugId:8703 PA IMMUNOMODULATOR
Cymbalta (duloxetine 20 mg, 30 mg, 60 mg capsule); See Table 17drugId:585; See Table 71drugId:3960 PA < 6 years ANTIDEPRESSANTS A90, #
cyproheptadinedrugId:315 ANTIHISTAMINES A90
Cyramza (ramucirumab)drugId:2955 PA CHEMOTHERAPY MB
Cystadane (betaine) ELECTROLYTES AND NUTRIENTS BP
Cystadrops (cysteamine 0.37% ophthalmic solution)drugId:7659 PA OPHTHALMIC PREPARATIONS
Cystagon (cysteamine immediate-release capsule)drugId:316 ENZYMES
Cystaran (cysteamine 0.44% ophthalmic solution)drugId:2818 PA OPHTHALMIC PREPARATIONS
cysteamine 0.37% ophthalmic solutiondrugId:7659 PA OPHTHALMIC PREPARATIONS
cysteamine 0.44% ophthalmic solutiondrugId:2818 PA OPHTHALMIC PREPARATIONS
cysteamine delayed-release capsuledrugId:2861 PA ENZYMES
cysteamine delayed-release granuledrugId:7374 PA ENZYMES
cysteamine immediate-release capsuledrugId:316 ENZYMES
cytarabinedrugId:317 CHEMOTHERAPY MB
Cytogam (cytomegalovirus immune globulin IV, human)drugId:318 BIOLOGICAL MB
cytomegalovirus immune globulin IV, humandrugId:318 BIOLOGICAL MB
Cytomel (liothyronine) THYROID PREPARATIONS M90, #
Cytotec (misoprostol) ANTACIDS A90, #
Cytra-2 (sodium citrate / citric acid) ELECTROLYTES AND NUTRIENTS A90
Cytra-3 (potassium citrate / sodium citrate / citric acid) ELECTROLYTES AND NUTRIENTS A90
Cytra-K (potassium citrate / citric acid) ELECTROLYTES AND NUTRIENTS A90

Note: Any drug that does not appear on the List requires prior authorization.


Back to Top | Previous | Next
Last updated 06/24/24

Feedback