Drug - Brand Name (Generic Name) PA Status Class Drug Notes midodrine A90 ADRENERGICS A90 mirabegron extended-release BP ADRENERGICS BP Myrbetriq (mirabegron extended-release) BP ADRENERGICS BP memantine / donepezil extended-release - PA 1 unit/day; See Table 56; See Table 71 PA 1 unit/day ALZHEIMER'S THERAPY memantine extended-release A90 - PA 1 unit/day; See Table 56; See Table 71 PA 1 unit/day ALZHEIMER'S THERAPY "A90, #" memantine solution A90 - PA; See Table 56; See Table 71 PA ALZHEIMER'S THERAPY A90 memantine tablet A90 - PA 2 units/day; See Table 56; See Table 71 PA 2 units/day ALZHEIMER'S THERAPY "A90, #" memantine titration pack A90 - PA 49 units/28 days; See Table 56; See Table 71 PA 49 units/28 days ALZHEIMER'S THERAPY A90 Migranal (dihydroergotamine nasal spray) A90 - PA PA ANALGESICS A90 milnacipran ANALGESICS Marcaine (bupivacaine) MB ANESTHETICS MB mepivacaine MB ANESTHETICS MB misoprostol A90 ANTACIDS "A90, #" meprobamate - PA; See Table 69; See Table 71 PA ANTI-ANXIETY AGENT meloxicam capsule A90 - PA PA ANTIARTHRITICS A90 methenamine A90 ANTIBACTERIAL "A90, #" Macrobid # (nitrofurantoin monohydrate / macrocrystals) A90 ANTIBIOTICS "A90, #" Macrodantin # (nitrofurantoin macrocrystals) A90 ANTIBIOTICS "A90, #" mafenide A90 ANTIBIOTICS "A90, #" meropenem ANTIBIOTICS Metro # (metronidazole injection) ANTIBIOTICS # metronidazole 0.75% vaginal gel A90 ANTIBIOTICS A90 metronidazole 1.3% vaginal gel - PA PA ANTIBIOTICS "metronidazole 250 mg, 500 mg tablet A90" ANTIBIOTICS A90 metronidazole 375 mg capsule A90 - PA PA ANTIBIOTICS A90 metronidazole injection ANTIBIOTICS # micafungin ANTIBIOTICS # Minocin (minocycline injection) ANTIBIOTICS minocycline capsule A90 ANTIBIOTICS A90 "minocycline extended-release 105 mg, 135 mg tablet A90 - PA" PA ANTIBIOTICS A90 "minocycline extended-release 45 mg, 90 mg, 135 mg tablet A90 - PA" PA ANTIBIOTICS A90 "minocycline extended-release 55 mg, 65 mg, 80 mg, 105 mg, 115 mg tablet BP, A90" ANTIBIOTICS "BP, A90" minocycline injection ANTIBIOTICS minocycline tablet A90 - PA PA ANTIBIOTICS A90 "Minolira (minocycline extended-release 105 mg, 135 mg tablet) A90 - PA" PA ANTIBIOTICS A90 Monurol # (fosfomycin) A90 ANTIBIOTICS "A90, #" moxifloxacin injection ANTIBIOTICS moxifloxacin tablet A90 ANTIBIOTICS A90 mupirocin cream A90 - PA PA ANTIBIOTICS A90 mupirocin ointment A90 ANTIBIOTICS A90 Myambutol # (ethambutol) A90 ANTIBIOTICS "A90, #" Mycamine # (micafungin) ANTIBIOTICS # "Mycobutin (rifabutin) BP, A90" ANTIBIOTICS "BP, A90" methsuximide A90 ANTICONVULSANTS "A90, #" Mysoline # (primidone) A90 ANTICONVULSANTS "A90, #" Marplan (isocarboxazid) - PA; See Table 17; See Table 71 PA ANTIDEPRESSANTS mirtazapine A90 - PA < 6 years; See Table 17; See Table 71 PA ANTIDEPRESSANTS "A90, #" mirtazapine orally disintegrating tablet A90 - PA; See Table 17; See Table 71 PA ANTIDEPRESSANTS A90 Motofen (difenoxin / atropine) - PA PA ANTIDIARRHEALS Mytesi (crofelemer) - PA PA ANTIDIARRHEALS mesna injection MB ANTIDOTES MB mesna tablet ANTIDOTES Mesnex (mesna injection) MB ANTIDOTES MB Mesnex (mesna tablet) ANTIDOTES Marinol (dronabinol capsule) - PA PA ANTIEMETICS "meclizine *, A90" ANTIEMETICS "*, A90, #" metoclopramide A90 ANTIEMETICS "A90, #" Mononine (factor IX) ANTI-HEMOPHILIA AGENTS Malarone # (atovaquone / proguanil) A90 ANTIMALARIALS "A90, #" mefloquine A90 ANTIMALARIALS A90 malathion A90 - PA PA ANTIPARASITICS A90 mebendazole A90 - PA PA ANTIPARASITICS A90 Mepron # (atovaquone) A90 ANTIPARASITICS "A90, #" Mirapex # (pramipexole) A90 ANTIPARKINSON "A90, #" Mirapex ER (pramipexole extended-release) A90 - PA PA ANTIPARKINSON A90 Mifeprex # (mifepristone 200 mg) ANTIPROGESTIN # mifepristone 200 mg ANTIPROGESTIN # molindone A90 - PA < 6 years; See Table 24; See Table 71 PA ANTIPSYCHOTIC A90 maraviroc solution - PA PA ANTIVIRALS "maraviroc tablet BP, A90 - PA" PA ANTIVIRALS "BP, A90" maribavir - PA PA ANTIVIRALS Mavyret (glecaprevir / pibrentasvir) PD - PA PA ANTIVIRALS PD megestrol 40 mg/mL suspension A90 APPETITE STIMULANTS A90 megestrol 625 mg/5 mL suspension A90 - PA PA APPETITE STIMULANTS A90 megestrol tablet A90 APPETITE STIMULANTS A90 midazolam injection MB BENZODIAZEPINES MB midazolam nasal spray - PA > 10 units/30 days PA > 10 units/30 days BENZODIAZEPINES midazolam syrup - PA < 6 years; See Table 69; See Table 71 PA BENZODIAZEPINES maralixibat - PA PA BILE THERAPY measles / mumps / rubella / varicella virus vaccine 1 BIOLOGICAL 1 measles / mumps / rubella vaccine BIOLOGICAL measles / mumps / rubella vaccine 1 BIOLOGICAL 1 Menactra (quadrivalent meningococcal conjugate vaccine-Menactra) 1 BIOLOGICAL 1 meningococcal group B vaccine-Bexsero 1 BIOLOGICAL 1 meningococcal group B vaccine-Trumenba 1 BIOLOGICAL 1 Menquadfi (quadrivalent meningococcal conjugate vaccine-Menquadfi) 1 BIOLOGICAL 1 Menveo (quadrivalent meningococcal conjugate vaccine-Menveo) 1 BIOLOGICAL 1 mepolizumab - PA PA BIOLOGICAL "Micrhogam (rho(d) immune globulin IM, human-Micrhogam)" BIOLOGICAL M-M-R II Vaccine (measles / mumps / rubella vaccine) 1 BIOLOGICAL 1 Myobloc (rimabotulinumtoxinB) - PA PA BIOLOGICAL "metaproterenol tablet, syrup A90" BRONCHODILATORS A90 mometasone / formoterol BP BRONCHODILATORS BP mometasone 110 mcg inhalation powder - PA ≥ 12 years PA ≥ 12 years BRONCHODILATORS mometasone 220 mcg inhalation powder - PA < 12 years PA BRONCHODILATORS mometasone inhalation aerosol BRONCHODILATORS montelukast granules M90 - PA PA BRONCHODILATORS M90 "montelukast tablet, chewable tablet M90" BRONCHODILATORS "M90, #" macitentan - PA PA CARDIOVASCULAR mavacamten - PA PA CARDIOVASCULAR Maxzide # (hydrochlorothiazide / triamterene) M90 CARDIOVASCULAR "M90, #" methazolamide A90 CARDIOVASCULAR "A90, #" methyldopa / hydrochlorothiazide M90 CARDIOVASCULAR M90 methyldopa M90 CARDIOVASCULAR M90 metolazone M90 CARDIOVASCULAR M90 metoprolol extended-release capsule - PA PA CARDIOVASCULAR metoprolol extended-release tablet M90 CARDIOVASCULAR "M90, #" metoprolol M90 CARDIOVASCULAR "M90, #" metyrosine BP CARDIOVASCULAR BP mexiletine M90 CARDIOVASCULAR M90 Micardis # (telmisartan) M90 CARDIOVASCULAR "M90, #" Micardis HCT # (telmisartan / hydrochlorothiazide) M90 CARDIOVASCULAR "M90, #" milrinone CARDIOVASCULAR Minipress # (prazosin) M90; See Table 18; See Table 19 CARDIOVASCULAR "M90, #" minoxidil M90 CARDIOVASCULAR M90 moexipril M90 CARDIOVASCULAR M90 Multaq (dronedarone) A90 CARDIOVASCULAR A90 methamphetamine - PA; See Table 31; See Table 71 PA CEREBRAL STIMULANTS Methylin oral solution # (methylphenidate oral solution) - PA 30 mL/day; See Table 31; See Table 71 PA 30 mL/day CEREBRAL STIMULANTS # methylphenidate chewable tablet - PA 3 units/day; See Table 31; See Table 71 PA 3 units/day CEREBRAL STIMULANTS "methylphenidate extended-release, CD - PA; See Table 31; See Table 71" PA CEREBRAL STIMULANTS methylphenidate extended-release 72 mg tablet - PA; See Table 31; See Table 71 PA CEREBRAL STIMULANTS methylphenidate extended-release-Aptensio XR - PA; See Table 31; See Table 71 PA CEREBRAL STIMULANTS methylphenidate extended-release chewable tablet - PA; See Table 31; See Table 71 PA CEREBRAL STIMULANTS methylphenidate extended-release-Concerta BP - PA 2 units/day; See Table 31; See Table 71 PA 2 units/day CEREBRAL STIMULANTS BP methylphenidate extended-release-Jornay PM - PA; See Table 31; See Table 71 PA CEREBRAL STIMULANTS methylphenidate extended-release orally disintegrating tablet - PA; See Table 31; See Table 71 PA CEREBRAL STIMULANTS methylphenidate extended-release oral suspension - PA; See Table 31; See Table 71 PA CEREBRAL STIMULANTS methylphenidate oral solution - PA 30 mL/day; See Table 31; See Table 71 PA 30 mL/day CEREBRAL STIMULANTS # methylphenidate-Ritalin LA - PA; See Table 31; See Table 71 PA CEREBRAL STIMULANTS methylphenidate-Ritalin - PA 3 units/day; See Table 31; See Table 71 PA 3 units/day CEREBRAL STIMULANTS # methylphenidate sustained-release tablet - PA 3 units/day; See Table 31; See Table 71 PA 3 units/day CEREBRAL STIMULANTS methylphenidate transdermal BP - PA 1 unit/day; See Table 31; See Table 71 PA 1 unit/day CEREBRAL STIMULANTS BP Mydayis (amphetamine salts extended-release-Mydayis) - PA; See Table 31; See Table 71 PA CEREBRAL STIMULANTS Margenza (margetuximab-cmkb) MB - PA PA CHEMOTHERAPY MB margetuximab-cmkb MB - PA PA CHEMOTHERAPY MB Marqibo (vincristine liposome) MB - PA PA CHEMOTHERAPY MB Matulane (procarbazine) CHEMOTHERAPY mechlorethamine gel CHEMOTHERAPY Mekinist (trametinib) - PA PA CHEMOTHERAPY Mektovi (binimetinib) - PA PA CHEMOTHERAPY melphalan hydrochloride injection MB CHEMOTHERAPY MB melphalan injection MB CHEMOTHERAPY MB melphalan tablet A90 CHEMOTHERAPY "A90, #" mercaptopurine oral suspension - PA PA CHEMOTHERAPY mercaptopurine tablet A90 CHEMOTHERAPY A90 methotrexate injection CHEMOTHERAPY methotrexate tablet A90; See Table 5; See Table 57 CHEMOTHERAPY A90 midostaurin - PA PA CHEMOTHERAPY mirvetuximab soravtansine-gynx MB - PA PA CHEMOTHERAPY MB mitomycin injection MB CHEMOTHERAPY MB mitomycin pyelocalyceal solution MB - PA PA CHEMOTHERAPY MB mitotane CHEMOTHERAPY mitoxantrone MB CHEMOTHERAPY MB mobocertinib - PA PA CHEMOTHERAPY mogamulizumab-kpkc MB - PA PA CHEMOTHERAPY MB Monjuvi (tafasitamab-cxix) - PA PA CHEMOTHERAPY mosunetuzumab-axgb MB - PA PA CHEMOTHERAPY MB moxetumomab pasudotox-tdfk MB - PA PA CHEMOTHERAPY MB Mvasi (bevacizumab-awwb) MB - PA PA CHEMOTHERAPY MB Myleran (busulfan tablet) CHEMOTHERAPY Mylotarg (gemtuzumab ozogamicin) - PA PA CHEMOTHERAPY methylphenidate extended-release-Relexxii - PA; See Table 31; See Table 71 PA CNS STIMULANTS "methylcellulose *, A90" CONSTIPATION AGENTS "*, A90" methylnaltrexone - PA PA CONSTIPATION AGENTS "mineral oil *, A90" CONSTIPATION AGENTS "*, A90" Motegrity (prucalopride) - PA PA CONSTIPATION AGENTS medroxyprogesterone injection CONTRACEPTIVES # Minastrin 24 Fe # (ethinyl estradiol / norethindrone / ferrous fumarate chewable-Minastrin 24 Fe) M90 CONTRACEPTIVES "M90, #" Mirena (levonorgestrel-releasing intrauterine system 52 mg-Mirena) CONTRACEPTIVES "molnupiravir COVID EUA – December 23, 2021" COVID - 19 related Treatments and Vaccines methoxsalen capsules A90 DERMATOLOGICAL "A90, #" methoxsalen topical A90 DERMATOLOGICAL A90 metronidazole 0.75% cream A90 DERMATOLOGICAL A90 metronidazole 0.75% gel A90 DERMATOLOGICAL A90 metronidazole 1% cream DERMATOLOGICAL metronidazole 1% gel A90 - PA PA DERMATOLOGICAL A90 metronidazole lotion A90 - PA PA DERMATOLOGICAL A90 "metformin extended-release, gastric tablet M90 - PA" PA DIABETIC AGENTS M90 "metformin extended-release, osmotic tablet M90 - PA" PA DIABETIC AGENTS M90 "metformin extended-release, XR tablet M90" DIABETIC AGENTS M90 metformin extended-release suspension - PA PA DIABETIC AGENTS "metformin immediate-release 500 mg, 850 mg, 1,000 mg tablet M90" DIABETIC AGENTS M90 metformin immediate-release solution M90 - PA ≥ 13 years PA ≥ 13 years DIABETIC AGENTS "M90, #" mifepristone 300 mg - PA PA DIABETIC AGENTS miglitol M90 - PA PA DIABETIC AGENTS M90 Mounjaro (tirzepatide) - PA PA DIABETIC AGENTS metformin immediate-release 625 mg tablet M90 - PA PA DIABETIC THERAPY M90 magnesium injection MB ELECTROLYTES & MISCELLANEOUS NUTRIENTS MB "magnesium salts *, A90; See Table 6; See Table 61" "ELECTROLYTES AND NUTRIENTS, GI AGENTS" "*, A90" melatonin / pyridoxine tablet A90 ELECTROLYTES AND NUTRIENTS A90 "melatonin gummy, solution, tablet *, A90" ELECTROLYTES AND NUTRIENTS "*, A90" Mephyton # (phytonadione) A90 ELECTROLYTES AND NUTRIENTS "A90, #" Micro-K # (potassium chloride-Micro-K) A90 ELECTROLYTES AND NUTRIENTS "A90, #" multivitamins / minerals / folic acid / coenzyme Q10-Dekas Bariatric M90 - PA PA ELECTROLYTES AND NUTRIENTS M90 multivitamins / zinc gummy M90 - PA PA ELECTROLYTES AND NUTRIENTS M90 "multivitamins *, M90" ELECTROLYTES AND NUTRIENTS "*, M90" Mycapssa (octreotide capsule) - PA PA ENDOCRINE/METABOLIC AGENTS Mepsevii (vestronidase alfa-vjbk) MB - PA PA ENZYMES MB migalastat - PA PA ENZYMES miglustat BP - PA PA ENZYMES BP Mentax (butenafine) FUNGICIDES "miconazole / zinc oxide ointment BP, A90" FUNGICIDES "BP, A90" "miconazole *, A90" FUNGICIDES "*, A90" miconazole buccal tablet - PA PA FUNGICIDES "magaldrate *, A90" GASTROINTESTINAL AGENT "*, A90" metoclopramide nasal spray - PA PA GASTROINTESTINAL AGENT "mesalamine capsule BP, A90" GI ANTI-INFLAMMATORY "BP, A90" "mesalamine controlled-release BP, A90" GI ANTI-INFLAMMATORY "BP, A90" "mesalamine delayed-release BP, A90" GI ANTI-INFLAMMATORY "BP, A90" mesalamine enema A90 GI ANTI-INFLAMMATORY "A90, #" "mesalamine extended-release BP, A90" GI ANTI-INFLAMMATORY "BP, A90" mesalamine high dose delayed-release A90 GI ANTI-INFLAMMATORY "A90, #" mesalamine kit A90 - PA PA GI ANTI-INFLAMMATORY A90 mesalamine suppository A90 GI ANTI-INFLAMMATORY "A90, #" Medrol # (methylprednisolone) A90 GLUCOCORTICOIDS "A90, #" methylprednisolone A90 GLUCOCORTICOIDS "A90, #" methylprednisolone acetate GLUCOCORTICOIDS # methylprednisolone sodium succinate GLUCOCORTICOIDS # "mometasone cream, solution A90" GLUCOCORTICOIDS A90 mometasone ointment A90 GLUCOCORTICOIDS A90 "Mitigare (colchicine capsule) BP, A90 - PA" PA GOUT AGENTS "BP, A90" methoxy polyethylene glycol / epoetin beta MB HEMATINIC AGENT MB Mircera (methoxy polyethylene glycol / epoetin beta) MB HEMATINIC AGENT MB Monoferric (ferric derisomaltose) - PA PA HEMATINIC AGENT Mozobil # (plerixafor) HEMATINIC AGENT # multivitamin-Dekas Essential M90 - PA PA HEMATINIC AGENT M90 multivitamins / minerals / coenzyme Q10-Aquadeks - PA PA HEMATINIC AGENT multivitamins / minerals / coenzyme Q10-Dekas Plus M90 - PA PA HEMATINIC AGENT M90 multivitamins / minerals / folic acid / coenzyme Q10-Aquadeks - PA PA HEMATINIC AGENT multivitamins / minerals / folic acid / coenzyme Q10-Dekas Plus M90 - PA PA HEMATINIC AGENT M90 Mulpleta (lusutrombopag) - PA PA HEMATOLOGIC mecasermin - PA PA HORMONE AGENTS Miacalcin (calcitonin salmon injection) - PA PA HORMONE AGENTS "medroxyprogesterone / estrogens, conjugated-Premphase" HORMONE REPLACEMENT THERAPY "medroxyprogesterone / estrogens, conjugated-Prempro" HORMONE REPLACEMENT THERAPY medroxyprogesterone tablet A90 HORMONE REPLACEMENT THERAPY "A90, #" "Menest (estrogens,esterified) A90" HORMONE REPLACEMENT THERAPY A90 Menostar (estradiol-menostar) HORMONE REPLACEMENT THERAPY methyltestosterone - PA PA HORMONE REPLACEMENT THERAPY Minivelle # (estradiol-Minivelle) M90 HORMONE REPLACEMENT THERAPY "M90, #" Monovisc (hyaluronate-Monovisc) MB - PA PA HYALURONAN MB methotrexate oral solution - PA PA IMMUNOMODULATOR methotrexate subcutaneous injection-Otrexup - PA PA IMMUNOMODULATOR methotrexate subcutaneous injection-Rasuvo - PA PA IMMUNOMODULATOR methotrexate subcutaneous injection-Reditrex - PA PA IMMUNOMODULATOR mycophenolate mofetil A90 IMMUNOMODULATOR "A90, #" mycophenolic acid A90 IMMUNOMODULATOR "A90, #" Myfortic # (mycophenolic acid) A90 IMMUNOMODULATOR "A90, #" Movantik (naloxegol) - PA PA LAXATIVES "Moviprep (polyethylene glycol-electrolyte solution-Moviprep) BP, A90" LAXATIVES "BP, A90" mannitol inhalation powder - PA PA MUCOLYTICS Mavenclad (cladribine tablet) - PA PA MULTIPLE SCLEROSIS AGENTS monomethyl fumarate - PA PA MULTIPLE SCLEROSIS AGENTS metaxalone A90 - PA PA MUSCLE RELAXANT A90 methocarbamol A90 - PA < 16 years PA MUSCLE RELAXANT "A90, #" modafinil 100 mg - PA 1.5 units/day; See Table 50; See Table 71 PA 1.5 units/day NARCOLEPSY AGENTS # modafinil 200 mg - PA 2 units/day; See Table 50; See Table 71 PA 2 units/day NARCOLEPSY AGENTS # mometasone nasal spray M90 - PA PA NASAL PREPARATIONS M90 mometasone sinus implant - PA PA NASAL PREPARATIONS meclofenamate A90 - PA PA NONSTEROIDAL ANTI-INFLAMMATORY A90 mefenamic acid A90 NONSTEROIDAL ANTI-INFLAMMATORY A90 meloxicam tablet A90 NONSTEROIDAL ANTI-INFLAMMATORY "A90, #" Mobic # (meloxicam tablet) A90 NONSTEROIDAL ANTI-INFLAMMATORY "A90, #" Macugen (pegaptanib) MB OPHTHALMIC PREPARATIONS MB Maxidex (dexamethasone ophthalmic suspension) OPHTHALMIC PREPARATIONS "Maxitrol # (neomycin / polymyxin B / dexamethasone ophthalmic ointment, suspension) A90" OPHTHALMIC PREPARATIONS "A90, #" Miebo (perfluorohexyloctane) - PA PA OPHTHALMIC PREPARATIONS Miochol-E (acetylcholine chloride) MB OPHTHALMIC PREPARATIONS MB Miostat (carbachol 0.01%) MB OPHTHALMIC PREPARATIONS MB "moxifloxacin ophthalmic solution, twice daily A90 - PA" PA OPHTHALMIC PREPARATIONS A90 moxifloxacin ophthalmic solution-Vigamox A90 OPHTHALMIC PREPARATIONS "A90, #" Mydriacyl # (tropicamide) A90 OPHTHALMIC PREPARATIONS "A90, #" meperidine - PA PA OPIOID ANALGESICS methadone injection - PA PA OPIOID ANALGESICS methadone oral-Dolophine - PA PA OPIOID ANALGESICS methadone oral-Methadose - PA PA OPIOID ANALGESICS Methadose (methadone oral-Methadose) - PA PA OPIOID ANALGESICS "morphine, injection-Astramorph-PF - PA > 120 mg/day" PA > 120 mg/day OPIOID ANALGESICS "morphine, injection-Duramorph - PA > 120 mg/day" PA > 120 mg/day OPIOID ANALGESICS morphine controlled-release tablet - PA > 120 mg/day PA > 120 mg/day OPIOID ANALGESICS # morphine extended-release capsule - PA PA OPIOID ANALGESICS morphine immediate-release - PA > 120 mg/day PA > 120 mg/day OPIOID ANALGESICS morphine infusion OPIOID ANALGESICS morphine suppositories OPIOID ANALGESICS MS Contin # (morphine controlled-release tablet) - PA > 120 mg/day PA > 120 mg/day OPIOID ANALGESICS # meropenem / vaborbactam - PA PA OTHER ANTIBIOTICS macimorelin MB OTHER HORMONES MB Macrilen (macimorelin) MB OTHER HORMONES MB metreleptin - PA PA OTHER HORMONES Myalept (metreleptin) - PA PA OTHER HORMONES Myfembree (relugolix / estradiol / norethindrone) - PA PA OTHER HORMONES methylergonovine OXYTOCICS "Mestinon (pyridostigmine bromide solution) BP, A90" PARASYMPATHETIC AGENTS "BP, A90" "Mestinon # (pyridostigmine bromide 60 mg tablet, 180 mg extended-release tablet) A90" PARASYMPATHETIC AGENTS "A90, #" Mayzent (siponimod) - PA PA SPHINGOSINE 1-PHOSPHATE RECEPTOR MODULATOR methimazole M90 THYROID PREPARATIONS "M90, #" Maxalt # (rizatriptan tablet) A90 - PA > 18 units/30 days PA > 18 units/30 days TRIPTAN "A90, #" Maxalt MLT # (rizatriptan orally disintegrating tablet) A90 - PA > 18 units/30 days PA > 18 units/30 days TRIPTAN "A90, #" mitapivat - PA PA UNCLASSIFIED DRUG PRODUCTS