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MassHealth Drug List A - Z


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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
Carospir (spironolactone suspension)drugId:6280 PA ALDOSTERONE ANTAGONISTS
capsaicin high dose patchdrugId:1946 PA ANALGESICS ^
clonidine injectiondrugId:2750 ANALGESICS #
Conzip (tramadol extended-release capsule)drugId:2362 PA ANALGESICS
Carbocaine (mepivacaine) ANESTHETICS ^
chloroprocaine ANESTHETICS ^
Carafate (sucralfate suspension) ANTACIDS BP
Carafate (sucralfate tablet) ANTACIDS #
Cytotec (misoprostol) ANTACIDS #
Cancidas (caspofungin) ANTIBIOTICS #
caspofungin ANTIBIOTICS #
Cayston (aztreonam) ANTIBIOTICS BP
cefaclordrugId:189 ANTIBIOTICS
cefaclor extended-releasedrugId:190 PA ANTIBIOTICS
cefadroxil capsule, suspensiondrugId:191 ANTIBIOTICS
cefadroxil tabletdrugId:1986 PA ANTIBIOTICS
cefazolindrugId:192 ANTIBIOTICS
cefdinirdrugId:193 ANTIBIOTICS
cefepimedrugId:195 ANTIBIOTICS
cefiderocoldrugId:7392 PA ANTIBIOTICS
cefiximedrugId:196 PA ANTIBIOTICS
CefotandrugId:5200 (cefotetan)drugId:5200 ANTIBIOTICS #
cefotaximedrugId:197 ANTIBIOTICS #
cefotetandrugId:5200 ANTIBIOTICS #
cefoxitindrugId:198 ANTIBIOTICS
cefpodoximedrugId:199 ANTIBIOTICS
cefprozildrugId:200 ANTIBIOTICS
ceftarolinedrugId:2179 PA ANTIBIOTICS BP
ceftazidimedrugId:202 ANTIBIOTICS #
ceftazidime / avibactamdrugId:4902 PA ANTIBIOTICS
ceftolozane / tazobactamdrugId:4842 PA ANTIBIOTICS
ceftriaxonedrugId:204 ANTIBIOTICS
cefuroxime axetildrugId:205 ANTIBIOTICS
cefuroxime sodiumdrugId:206 ANTIBIOTICS
Centany (mupirocin ointment)drugId:2564 ANTIBIOTICS
cephalexin 250 mg, 500 mg capsule, suspensiondrugId:208 ANTIBIOTICS #
cephalexin 333 mg capsuledrugId:6484 PA ANTIBIOTICS
cephalexin 750 mg capsuledrugId:209 PA ANTIBIOTICS
chloramphenicoldrugId:217 ANTIBIOTICS
Cipro (ciprofloxacin); See Table 35drugId:241; See Table 66drugId:5663 ANTIBIOTICS #
ciprofloxacin; See Table 35drugId:241; See Table 66drugId:5663 ANTIBIOTICS #
ciprofloxacin extended-releasedrugId:238 PA ANTIBIOTICS
Cipro XR (ciprofloxacin extended-release)drugId:238 PA ANTIBIOTICS
ClaforandrugId:197 (cefotaxime)drugId:197 ANTIBIOTICS #
clarithromycindrugId:252 ANTIBIOTICS #
clarithromycin extended-releasedrugId:253 PA ANTIBIOTICS
Cleocin (clindamycin capsule, injection, oral solution); See Table 35drugId:255; See Table 66drugId:2626 ANTIBIOTICS #
CleocindrugId:5000 (clindamycin vaginal cream-Cleocin)drugId:5000 ANTIBIOTICS #
Cleocin T (clindamycin pledgets)drugId:256 PA ANTIBIOTICS
Cleocin TdrugId:257 (clindamycin gel, lotion, solution)drugId:257 PA ≥ 22 years ANTIBIOTICS #
Cleocin Vaginal Ovule (clindamycin vaginal suppository)drugId:4915 ANTIBIOTICS
Clindagel (clindamycin gel-Clindagel)drugId:258 PA ANTIBIOTICS
clindamycin capsule, injection, oral solution; See Table 35drugId:255; See Table 66drugId:2626 ANTIBIOTICS #
clindamycin foamdrugId:261 PA ANTIBIOTICS
clindamycin gel, lotion, solutiondrugId:257 PA ≥ 22 years ANTIBIOTICS #
clindamycin gel-ClindageldrugId:258 PA ANTIBIOTICS
clindamycin pledgetsdrugId:256 PA ANTIBIOTICS
clindamycin powderdrugId:7738 PA ANTIBIOTICS
clindamycin vaginal cream-CleocindrugId:5000 ANTIBIOTICS #
clindamycin vaginal cream-ClindessedrugId:260 PA ANTIBIOTICS
clindamycin vaginal suppositorydrugId:4915 ANTIBIOTICS
Clindesse (clindamycin vaginal cream-Clindesse)drugId:260 PA ANTIBIOTICS
colistimethate sodium injectiondrugId:291 ANTIBIOTICS #
Coly-Mycin MdrugId:291 (colistimethate sodium injection)drugId:291 ANTIBIOTICS #
Cortisporin (neomycin / bacitracin / polymyxin B / hydrocortisone topical ointment)drugId:5502 ANTIBIOTICS
Cortisporin (neomycin / polymyxin B / hydrocortisone cream)drugId:1184 ANTIBIOTICS
CubicindrugId:326 (daptomycin)drugId:326 ANTIBIOTICS #
cannabidiol; See Table 20drugId:6901; See Table 71drugId:6902 PA ANTICONVULSANTS
carbamazepine extended-release; See Table 20drugId:439; See Table 71drugId:3240 PA < 6 years ANTICONVULSANTS #
carbamazepine-Tegretol; See Table 20drugId:170; See Table 71drugId:3280 PA < 6 years ANTICONVULSANTS #
Carbatrol (carbamazepine extended-release); See Table 20drugId:439; See Table 71drugId:3240 PA < 6 years ANTICONVULSANTS #
Celontin (methsuximide); See Table 20drugId:948; See Table 71drugId:4441 ANTICONVULSANTS
cenobamate; See Table 20drugId:7406; See Table 71drugId:7407 PA ANTICONVULSANTS
CerebyxdrugId:2681 (fosphenytoin)drugId:2681 ANTICONVULSANTS #
clobazam film; See Table 20drugId:7106; See Table 71drugId:7107 PA ANTICONVULSANTS
clobazam suspension, tablet; See Table 20drugId:2419; See Table 71drugId:3300 ANTICONVULSANTS #
Celexa (citalopram); See Table 17drugId:248; See Table 71drugId:3700 PA < 6 years ANTIDEPRESSANTS #
citalopram; See Table 17drugId:248; See Table 71drugId:3700 PA < 6 years ANTIDEPRESSANTS #
clomipramine; See Table 17drugId:272; See Table 71drugId:4002 PA ANTIDEPRESSANTS
Cymbalta (duloxetine 20 mg, 30 mg, 60 mg capsule); See Table 17drugId:585; See Table 71drugId:3960 PA < 6 years ANTIDEPRESSANTS #
crofelemerdrugId:5684 PA ANTIDIARRHEALS
centruroides immune F(ab’)2, equine ANTIDOTES ^
Cyanokit (hydroxocobalamin) ANTIDOTES
Cesamet (nabilone)drugId:1414 PA ANTIEMETICS
Cinvanti (aprepitant injectable emulsion)drugId:6604 PA ANTIEMETICS
Coagadex (coagulation factor X, human) ANTI-HEMOPHILIA AGENTS
coagulation factor IX, recombinant ANTI-HEMOPHILIA AGENTS
coagulation factor IX recombinant, glycopegylated-Rebinyn ANTI-HEMOPHILIA AGENTS
coagulation factor VIIa, recombinant ANTI-HEMOPHILIA AGENTS
coagulation factor X, human ANTI-HEMOPHILIA AGENTS
Corifact (factor XIII concentrate, human) ANTI-HEMOPHILIA AGENTS
carbinoxamine 4 mg/5 mL solution, 4 mg tabletdrugId:2267 ANTIHISTAMINES
carbinoxamine 6 mg tabletdrugId:7229 PA ANTIHISTAMINES
carbinoxamine extended-releasedrugId:2962 PA ANTIHISTAMINES
cetirizine / pseudoephedrinedrugId:2265 ANTIHISTAMINES *
cetirizine injectiondrugId:7375 PA ANTIHISTAMINES ^
cetirizine ophthalmic solutiondrugId:7472 PA ANTIHISTAMINES
cetirizine syrup, tabletdrugId:211 ANTIHISTAMINES *
chlorpheniraminedrugId:222 ANTIHISTAMINES *
ClarinexdrugId:339 (desloratadine syrup, tablet)drugId:339 ANTIHISTAMINES #
Clarinex-D (desloratadine / pseudoephedrine)drugId:474 PA ANTIHISTAMINES
clemastinedrugId:254 ANTIHISTAMINES
cyproheptadinedrugId:315 ANTIHISTAMINES
chloroquine phosphate ANTIMALARIALS
Coartem (artemether / lumefantrine)drugId:95 PA > 24 units/365 days ANTIMALARIALS
crotamiton creamdrugId:7338 ANTIPARASITICS
crotamiton lotiondrugId:300 PA ANTIPARASITICS
carbidopadrugId:173 ANTIPARKINSON #
carbidopa / levodopa / entacaponedrugId:176 PA ANTIPARKINSON
carbidopa / levodopa enteral suspensiondrugId:5104 PA ANTIPARKINSON
carbidopa / levodopa extended-release capsuledrugId:4950 PA ANTIPARKINSON
carbidopa / levodopa extended-release tabletdrugId:1997 ANTIPARKINSON
carbidopa / levodopa orally disintegrating tabletdrugId:174 PA ANTIPARKINSON
carbidopa / levodopa tabletdrugId:175 ANTIPARKINSON #
Comtan (entacapone)drugId:602 PA ANTIPARKINSON
cilostazoldrugId:235 ANTIPLATELET AGENT
clopidogreldrugId:277 ANTIPLATELET AGENT #
Caplyta (lumateperone); See Table 24drugId:7361; See Table 71drugId:7362 PA ANTIPSYCHOTIC
cariprazine; See Table 24drugId:5405; See Table 71drugId:5406 PA ANTIPSYCHOTIC
chlorpromazine; See Table 24drugId:6321; See Table 71drugId:223 PA < 6 years ANTIPSYCHOTIC
clozapine orally disintegrating tablet; See Table 24drugId:282; See Table 71drugId:4262 PA ANTIPSYCHOTIC
clozapine suspension; See Table 24drugId:2930; See Table 71drugId:4263 PA ANTIPSYCHOTIC
clozapine tablet; See Table 24drugId:281; See Table 71drugId:4261 PA < 6 years ANTIPSYCHOTIC #
Clozaril (clozapine tablet); See Table 24drugId:281; See Table 71drugId:4261 PA < 6 years ANTIPSYCHOTIC #
chlorhexidine gluconatedrugId:1990 ANTISEPTICS *
Cantil (mepenzolate) ANTISPASMODICS,ANTICHOLINERGIC
chlordiazepoxide / clidiniumdrugId:6843 PA ANTISPASMODICS,ANTICHOLINERGIC
Cuvposa (glycopyrrolate oral solution)drugId:2163 PA ANTISPASMODICS,ANTICHOLINERGIC
Cabenuva (cabotegravir / rilpivirine)drugId:7719 ANTIVIRALS PD
cabotegravirdrugId:7722 ANTIVIRALS
cabotegravir / rilpivirinedrugId:7719 ANTIVIRALS PD
cidofovir ANTIVIRALS #
Cimduo (lamivudine / tenofovir disoproxil fumarate)drugId:6780 PA ANTIVIRALS
cobicistatdrugId:4816 ANTIVIRALS
CombivirdrugId:1012 (lamivudine / zidovudine)drugId:1012 ANTIVIRALS #
Complera (emtricitabine / rilpivirine / tenofovir disoproxil fumarate)drugId:2361 ANTIVIRALS
Crixivan (indinavir)drugId:791 ANTIVIRALS
CytovenedrugId:922 (ganciclovir injection)drugId:922 ANTIVIRALS #
Cardura XL (doxazosin extended-release)drugId:566 PA BENIGN PROSTATIC HYPERPLASIA AGENTS
Cialis (tadalafil-Cialis)drugId:2373 PA BENIGN PROSTATIC HYPERPLASIA AGENTS
chlordiazepoxide; See Table 69drugId:218; See Table 71drugId:4361 PA < 6 years BENZODIAZEPINES
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 powder; See Table 69drugId:7022; See Table 71drugId:7023 PA BENZODIAZEPINES
clonazepam tablet; See Table 69drugId:274; See Table 71drugId:4363 PA < 6 years BENZODIAZEPINES #
clorazepate; See Table 69drugId:278; See Table 71drugId:4380 PA < 6 years BENZODIAZEPINES #
chenodioldrugId:1956 PA BILE THERAPY
Cholbam (cholic acid)drugId:4907 PA BILE THERAPY
cholic aciddrugId:4907 PA BILE THERAPY
Cablivi (caplacizumab-yhdp)drugId:7180 PA BIOLOGICAL
caplacizumab-yhdpdrugId:7180 PA BIOLOGICAL
casimersendrugId:7878 PA BIOLOGICAL
cholera vaccine, live, oraldrugId:5594 BIOLOGICAL
Cinqair (reslizumab)drugId:5586 PA BIOLOGICAL
Crysvita (burosumab-twza)drugId:6740 PA BIOLOGICAL
Cutaquig (immune globulin subcutaneous injection, human-hipp)drugId:7131 PA BIOLOGICAL
Cuvitru (immune globulin subcutaneous injection, human-Cuvitru)drugId:5720 PA BIOLOGICAL
Cytogam (cytomegalovirus immune globulin IV, human)drugId:318 BIOLOGICAL
cytomegalovirus immune globulin IV, humandrugId:318 BIOLOGICAL
Cafcit (caffeine) BRONCHODILATORS #
caffeine BRONCHODILATORS #
ciclesonide inhalerdrugId:230 PA BRONCHODILATORS
Combivent (albuterol / ipratropium inhalation spray)drugId:2557 BRONCHODILATORS
cromolyn inhalationdrugId:298 BRONCHODILATORS
cromolyn oral BRONCHODILATORS #
cinacalcet CALCIMIMETIC #
Caduet (amlodipine / atorvastatin); See Table 13drugId:42; See Table 18drugId:43 PA CARDIOVASCULAR/STATIN
CalandrugId:1800 (verapamil tablet)drugId:1800 CARDIOVASCULAR #
Calan SRdrugId:2742 (verapamil sustained-release)drugId:2742 CARDIOVASCULAR #
candesartan / hydrochlorothiazidedrugId:434 PA CARDIOVASCULAR
candesartandrugId:433 PA CARDIOVASCULAR
captopril / hydrochlorothiazidedrugId:438 PA CARDIOVASCULAR
captoprildrugId:437 PA CARDIOVASCULAR
CardizemdrugId:528 (diltiazem-Cardizem)drugId:528 CARDIOVASCULAR #
Cardizem CD (diltiazem 360 mg-Cardizem CD)drugId:2299 PA CARDIOVASCULAR
Cardizem CDdrugId:531 (diltiazem 120 mg, 180 mg, 240 mg, 300 mg-Cardizem CD)drugId:531 CARDIOVASCULAR #
Cardizem LAdrugId:529 (diltiazem extended-release tablet)drugId:529 CARDIOVASCULAR #
Cardura (doxazosin immediate-release); See Table 18drugId:565; See Table 19drugId:5163 CARDIOVASCULAR #
carvediloldrugId:185 CARDIOVASCULAR #
carvedilol extended-releasedrugId:186 PA CARDIOVASCULAR
Catapres (clonidine tablet); See Table 18drugId:5161; See Table 71drugId:2105 PA < 3 years CARDIOVASCULAR #
Catapres-TTS (clonidine patch); See Table 18drugId:5160; See Table 71drugId:2194 PA CARDIOVASCULAR BP
chlorothiazidedrugId:221 CARDIOVASCULAR #
chlorthalidonedrugId:225 CARDIOVASCULAR
clevidipinedrugId:2896 CARDIOVASCULAR
Cleviprex (clevidipine)drugId:2896 CARDIOVASCULAR
clonidine patch; See Table 18drugId:5160; See Table 71drugId:2194 PA CARDIOVASCULAR BP
clonidine powder; See Table 18drugId:6370; See Table 71drugId:6371 PA CARDIOVASCULAR
clonidine tablet; See Table 18drugId:5161; See Table 71drugId:2105 PA < 3 years CARDIOVASCULAR #
CoregdrugId:185 (carvedilol)drugId:185 CARDIOVASCULAR #
Coreg CR (carvedilol extended-release)drugId:186 PA CARDIOVASCULAR
CorgarddrugId:1416 (nadolol)drugId:1416 CARDIOVASCULAR #
Corlanor (ivabradine)drugId:5124 PA CARDIOVASCULAR
CozaardrugId:1103 (losartan)drugId:1103 CARDIOVASCULAR #
Concerta (methylphenidate extended-release-Concerta); See Table 31drugId:2662; See Table 71drugId:3041 PA < 3 years and PA > 2 units/day CEREBRAL STIMULANTS BP
Cotempla XR-ODT (methylphenidate extended-release orally disintegrating tablet); See Table 31drugId:6281; See Table 71drugId:6282 PA CEREBRAL STIMULANTS
Chemet (succimer) CHELATING AGENT
Cuprimine (penicillamine capsule) CHELATING AGENT BP
cabazitaxeldrugId:1961 PA CHEMOTHERAPY BP
Cabometyx (cabozantinib tablet)drugId:5585 PA CHEMOTHERAPY
cabozantinib capsuledrugId:2719 PA CHEMOTHERAPY
cabozantinib tabletdrugId:5585 PA CHEMOTHERAPY
calaspargase pegol-mknldrugId:7328 PA CHEMOTHERAPY ^
Calquence (acalabrutinib)drugId:6483 PA CHEMOTHERAPY
Campath (alemtuzumab 30 mg)drugId:6110 CHEMOTHERAPY
CamptosardrugId:970 (irinotecan)drugId:970 CHEMOTHERAPY #
capecitabinedrugId:435 CHEMOTHERAPY #
capmatinibdrugId:7458 PA CHEMOTHERAPY
Caprelsa (vandetanib)drugId:2281 PA CHEMOTHERAPY
Carac (fluorouracil 0.5% cream)drugId:876 PA CHEMOTHERAPY BP
carboplatindrugId:179 CHEMOTHERAPY
carfilzomibdrugId:2581 PA CHEMOTHERAPY
carmustinedrugId:183 CHEMOTHERAPY #
CasodexdrugId:362 (bicalutamide)drugId:362 CHEMOTHERAPY #
cemiplimab-rwlcdrugId:7005 PA CHEMOTHERAPY
ceritinibdrugId:2951 PA CHEMOTHERAPY
cetuximabdrugId:212 CHEMOTHERAPY
chlorambucildrugId:216 CHEMOTHERAPY
cisplatindrugId:247 CHEMOTHERAPY
cladribine injectiondrugId:2673 CHEMOTHERAPY
clofarabinedrugId:271 CHEMOTHERAPY #
ClolardrugId:271 (clofarabine)drugId:271 CHEMOTHERAPY #
cobimetinibdrugId:5243 PA CHEMOTHERAPY
Cometriq (cabozantinib capsule)drugId:2719 PA CHEMOTHERAPY
copanlisibdrugId:6500 PA CHEMOTHERAPY
Copiktra (duvelisib)drugId:7002 PA CHEMOTHERAPY
Cosela (trilaciclib)drugId:7897 PA CHEMOTHERAPY
CosmegendrugId:2674 (dactinomycin)drugId:2674 CHEMOTHERAPY #
Cotellic (cobimetinib)drugId:5243 PA CHEMOTHERAPY
crizotinibdrugId:2376 PA CHEMOTHERAPY
cyclophosphamidedrugId:310 CHEMOTHERAPY
Cyramza (ramucirumab)drugId:2955 PA CHEMOTHERAPY
cytarabinedrugId:317 CHEMOTHERAPY
cherry syrup COMPOUNDING AGENT *
copper IUD CONTRACEPTIVES
casirivimab, administered with imdevimab (COVID EUA - November 21, 2020) COVID - 19 related Treatments and Vaccines COVID
Comirnaty (COVID-19 Pfizer vaccine ≥ 16 years of age) COVID - 19 related Treatments and Vaccines COVID
Comirnaty (COVID-19 Pfizer vaccine COVID EUA – May 10, 2021 for members 12 to 15 years of age) COVID - 19 related Treatments and Vaccines COVID
Comirnaty (COVID-19 Pfizer vaccine COVID EUA – October 29, 2021 for members 5 to 11 years of age) COVID - 19 related Treatments and Vaccines COVID
Comirnaty (Pfizer COVID-19 vaccine ≥ 16 years of age) COVID - 19 related Treatments and Vaccines COVID
Comirnaty (Pfizer COVID-19 vaccine COVID EUA – May 10, 2021 for members 12 to 15 years of age) COVID - 19 related Treatments and Vaccines COVID
Comirnaty (Pfizer COVID-19 vaccine COVID EUA – October 29, 2021 for members 5 to 11 years of age) COVID - 19 related Treatments and Vaccines COVID
COVID-19 Pfizer vaccine ≥ 16 years of age COVID - 19 related Treatments and Vaccines COVID
COVID-19 Pfizer vaccine COVID EUA – May 10, 2021 for members 12 to 15 years of age COVID - 19 related Treatments and Vaccines COVID
COVID-19 Pfizer vaccine COVID EUA – October 29, 2021 for members 5 to 11 years of age COVID - 19 related Treatments and Vaccines COVID
COVID EUA – December 18, 2020 COVID - 19 related Treatments and Vaccines COVID
COVID EUA – February 27, 2021 COVID - 19 related Treatments and Vaccines COVID
COVID EUA – February 9, 2021 COVID - 19 related Treatments and Vaccines COVID
COVID EUA - May 26, 2021 COVID - 19 related Treatments and Vaccines COVID
COVID EUA - November 21, 2020 COVID - 19 related Treatments and Vaccines COVID
calamine lotion DERMATOLOGICAL *
calcipotriene creamdrugId:420 PA > 60 grams/month DERMATOLOGICAL #
calcipotriene foamdrugId:2560 PA DERMATOLOGICAL BP
calcipotriene ointmentdrugId:2563 PA > 60 grams/month DERMATOLOGICAL
calcipotriene scalp solutiondrugId:2562 DERMATOLOGICAL
calcitriol ointmentdrugId:424 PA DERMATOLOGICAL
capsaicin DERMATOLOGICAL *
clindamycin / benzoyl peroxide-AcanyadrugId:262 PA DERMATOLOGICAL
clindamycin / benzoyl peroxide-BenzaclindrugId:263 PA DERMATOLOGICAL
clindamycin / benzoyl peroxide-DuacdrugId:264 PA DERMATOLOGICAL
clindamycin / benzoyl peroxide-OnextondrugId:4788 PA DERMATOLOGICAL
clindamycin / tretinoin-VeltindrugId:1970 PA DERMATOLOGICAL
clindamycin / tretinoin-ZianadrugId:265 PA DERMATOLOGICAL
colloidal oatmeal DERMATOLOGICAL *
CondyloxdrugId:2261 (podofilox)drugId:2261 DERMATOLOGICAL #
crisaboroledrugId:6041 PA DERMATOLOGICAL PD
canagliflozindrugId:2780 DIABETIC AGENTS
canagliflozin / metformindrugId:4775 DIABETIC AGENTS
canagliflozin / metformin extended-releasedrugId:5723 DIABETIC AGENTS
Cycloset (bromocriptine 0.8 mg tablet)drugId:2984 DIABETIC AGENTS
Cortrosyn (cosyntropin) DIAGNOSTICS #
cosyntropin DIAGNOSTICS #
calcifedioldrugId:5765 PA ELECTROLYTES AND NUTRIENTS
calcitrioldrugId:426 ELECTROLYTES AND NUTRIENTS #
calcitriol injectiondrugId:425 ELECTROLYTES AND NUTRIENTS
calcium acetate ELECTROLYTES AND NUTRIENTS
calcium replacementdrugId:428 ELECTROLYTES AND NUTRIENTS *
Carnitor (levocarnitine) ELECTROLYTES AND NUTRIENTS #
citric acid / potassium citrate ELECTROLYTES AND NUTRIENTS
citric acid / sodium citrate / potassium citrate ELECTROLYTES AND NUTRIENTS
cod liver oil ELECTROLYTES AND NUTRIENTS *
coenzyme Q10drugId:6202 PA ≥ 19 years ELECTROLYTES AND NUTRIENTS
cyanocobalamin / folic aciddrugId:303 PA ELECTROLYTES AND NUTRIENTS
cyanocobalamin-NascobaldrugId:301 PA ELECTROLYTES AND NUTRIENTS
cyanocobalamindrugId:302 ELECTROLYTES AND NUTRIENTS o
Cystadane (betaine) ELECTROLYTES AND NUTRIENTS
Cytra-2 (sodium citrate / citric acid) ELECTROLYTES AND NUTRIENTS
Cytra-3 (potassium citrate / sodium citrate / citric acid) ELECTROLYTES AND NUTRIENTS
Cytra-K (potassium citrate / citric acid) ELECTROLYTES AND NUTRIENTS
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
Carbaglu (carglumic acid)drugId:2161 PA ENZYMES
carglumic aciddrugId:2161 PA ENZYMES
Cerdelga (eliglustat)drugId:4764 PA ENZYMES
Cerezyme (imiglucerase)drugId:780 PA ENZYMES
Cinryze (c1 esterase inhibitor, human-Cinryze)drugId:416 PA ENZYMES
collagenase clostridium histolyticumdrugId:1951 PA ENZYMES
Creon DR (pancrelipase-Creon DR)drugId:1082 ENZYMES
Cystagon (cysteamine immediate-release capsule)drugId:316 ENZYMES
cysteamine delayed-release capsuledrugId:2861 PA ENZYMES
cysteamine delayed-release granuledrugId:7374 PA ENZYMES
cysteamine immediate-release capsuledrugId:316 ENZYMES
ciclopirox 0.77% cream, suspensiondrugId:5625 FUNGICIDES #
ciclopirox 0.77% geldrugId:232 PA FUNGICIDES
ciclopirox 1% shampoodrugId:5128 PA FUNGICIDES
ciclopirox 8% nail lacquerdrugId:233 FUNGICIDES
ciclopirox powderdrugId:7737 PA FUNGICIDES
clotrimazole / betamethasone creamdrugId:280 FUNGICIDES
clotrimazole / betamethasone lotiondrugId:2856 PA FUNGICIDES
clotrimazoledrugId:279 FUNGICIDES *
clotrimazole trochedrugId:1995 FUNGICIDES
Cresemba (isavuconazonium)drugId:4909 PA FUNGICIDES
Culturelle (lactobacillus rhamnosus GG)drugId:6204 PA ≥ 19 years GASTROINTESTINAL AGENT
CanasadrugId:2095 (mesalamine suppository)drugId:2095 GI ANTI-INFLAMMATORY #
ColazaldrugId:126 (balsalazide)drugId:126 GI ANTI-INFLAMMATORY #
Capex (fluocinolone shampoo)drugId:868 GLUCOCORTICOIDS
CelestonedrugId:357 (betamethasone injection)drugId:357 GLUCOCORTICOIDS #
clobetasol propionate cream, ointmentdrugId:269 GLUCOCORTICOIDS #
clobetasol propionate cream / emollientdrugId:5035 GLUCOCORTICOIDS
clobetasol propionate foamdrugId:268 GLUCOCORTICOIDS #
clobetasol propionate foam / emollientdrugId:2532 PA GLUCOCORTICOIDS
clobetasol propionate gel, shampoo kitdrugId:5033 PA GLUCOCORTICOIDS
clobetasol propionate lotion, spray-ClobexdrugId:266 GLUCOCORTICOIDS #
clobetasol propionate lotion-ImpeklodrugId:7920 PA GLUCOCORTICOIDS
clobetasol propionate powderdrugId:7160 PA GLUCOCORTICOIDS
clobetasol propionate shampoodrugId:7858 PA GLUCOCORTICOIDS
clobetasol propionate solutiondrugId:5080 GLUCOCORTICOIDS
Clobex (clobetasol propionate shampoo)drugId:7858 PA GLUCOCORTICOIDS
ClobexdrugId:266 (clobetasol propionate lotion, spray-Clobex)drugId:266 GLUCOCORTICOIDS #
clocortolone creamdrugId:270 PA GLUCOCORTICOIDS
Cloderm (clocortolone cream)drugId:270 PA GLUCOCORTICOIDS
CortefdrugId:736 (hydrocortisone tablet)drugId:736 GLUCOCORTICOIDS #
CortenemadrugId:2983 (hydrocortisone enema)drugId:2983 GLUCOCORTICOIDS #
Cortifoam (hydrocortisone foam)drugId:731 GLUCOCORTICOIDS
cortisonedrugId:295 GLUCOCORTICOIDS
Cutivate (fluticasone lotion)drugId:892 PA GLUCOCORTICOIDS
CutivatedrugId:5065 (fluticasone cream)drugId:5065 GLUCOCORTICOIDS #
colchicine capsuledrugId:4765 PA GOUT AGENTS BP
colchicine solutiondrugId:7331 PA GOUT AGENTS
colchicine tabletdrugId:2162 GOUT AGENTS BP
Colcrys (colchicine tablet)drugId:2162 GOUT AGENTS BP
cimetidinedrugId:236 H2 ANTAGONISTS *
cimetidine powderdrugId:7271 PA H2 ANTAGONISTS
Ceprotin (protein C concentrate)drugId:1605 PA HEMATINIC AGENT
crizanlizumab-tmcadrugId:7326 PA HEMATOLOGIC
cabergoline HORMONE AGENTS
calcitonin salmon injectiondrugId:4960 PA HORMONE AGENTS
calcitonin salmon nasal spray-ForticaldrugId:422 HORMONE AGENTS
calcitonin salmon nasal spray-MiacalcindrugId:423 HORMONE AGENTS #
corticotropindrugId:294 PA HORMONE AGENTS
Climara (estradiol-Climara) HORMONE REPLACEMENT THERAPY #
Combipatch (estradiol / norethindrone-Combipatch) HORMONE REPLACEMENT THERAPY
Crinone (progesterone gel)drugId:2587 PA HORMONE REPLACEMENT THERAPY
canakinumabdrugId:432 PA IMMUNOMODULATOR
CellceptdrugId:1410 (mycophenolate mofetil)drugId:1410 IMMUNOMODULATOR #
certolizumabdrugId:210 PA IMMUNOMODULATOR
Cimzia (certolizumab)drugId:210 PA IMMUNOMODULATOR
Cosentyx (secukinumab)drugId:4908 PA IMMUNOMODULATOR
cyclosporinedrugId:2092 IMMUNOMODULATOR #
cyclosporine modifieddrugId:314 IMMUNOMODULATOR #
Clenpiq (sodium picosulfate / magnesium oxide / anhydrous citric acid-Clenpiq)drugId:6380 PA LAXATIVES
cholestyramine / aspartame-PrevalitedrugId:228 LIPID LOWERING AGENTS #
cholestyramine / aspartame-Questran LightdrugId:2431 LIPID LOWERING AGENTS #
cholestyramine / sucrosedrugId:229 LIPID LOWERING AGENTS #
cholestyramine resin powderdrugId:7110 PA LIPID LOWERING AGENTS
colesevelam; See Table 13drugId:288; See Table 26drugId:289 LIPID LOWERING AGENTS BP
ColestiddrugId:290 (colestipol)drugId:290 LIPID LOWERING AGENTS #
colestipoldrugId:290 LIPID LOWERING AGENTS #
CrestordrugId:5601 (rosuvastatin 40 mg)drugId:5601 PA > 1 unit/day LIPID LOWERING AGENTS #
CrestordrugId:1459 (rosuvastatin 5 mg, 10 mg, 20 mg)drugId:1459 PA > 1.5 units/day LIPID LOWERING AGENTS #
cladribine tabletdrugId:7224 PA MULTIPLE SCLEROSIS AGENTS
Copaxone (glatiramer)drugId:930 MULTIPLE SCLEROSIS AGENTS BP
carisoprodol / aspirindrugId:181 PA MUSCLE RELAXANT
carisoprodoldrugId:180 PA MUSCLE RELAXANT
chlorzoxazone 250 mg, 375 mg, 750 mgdrugId:2360 PA MUSCLE RELAXANT
chlorzoxazone 500 mgdrugId:226 PA < 18 years MUSCLE RELAXANT #
cyclobenzaprine 5 mg, 10 mgdrugId:305 PA < 15 years MUSCLE RELAXANT
cyclobenzaprine 7.5 mgdrugId:306 PA MUSCLE RELAXANT
cyclobenzaprine extended-releasedrugId:304 PA MUSCLE RELAXANT
ciclesonide nasal aerosol, 37 mcgdrugId:2561 PA > 1 inhaler/month NASAL PREPARATIONS
ciclesonide nasal spray, 50 mcgdrugId:231 PA NASAL PREPARATIONS
crossed-linked hyaluronatedrugId:4802 - Non-Drug Product PA NON-DRUG PRODUCT
Cambia (diclofenac powder for solution)drugId:1953 PA NONSTEROIDAL ANTI-INFLAMMATORY
CelebrexdrugId:207 (celecoxib)drugId:207 NONSTEROIDAL ANTI-INFLAMMATORY #
celecoxibdrugId:207 NONSTEROIDAL ANTI-INFLAMMATORY #
clonidine extended-release tablet; See Table 31drugId:2170; See Table 71drugId:3081 PA NONSTIMULANT ADHD AGENTS
carbachol 0.01%drugId:1984 OPHTHALMIC PREPARATIONS
carteololdrugId:184 OPHTHALMIC PREPARATIONS
cenegermin-bkbjdrugId:7103 PA OPHTHALMIC PREPARATIONS
Cequa (cyclosporine 0.09% ophthalmic solution)drugId:7282 PA OPHTHALMIC PREPARATIONS
CiloxandrugId:244 (ciprofloxacin ophthalmic ointment, solution)drugId:244 OPHTHALMIC PREPARATIONS #
ciprofloxacin ophthalmic ointment, solutiondrugId:244 OPHTHALMIC PREPARATIONS #
Combigan (brimonidine / timolol, ophthalmic)drugId:374 OPHTHALMIC PREPARATIONS BP
CosoptdrugId:564 (dorzolamide / timolol)drugId:564 OPHTHALMIC PREPARATIONS #
Cosopt PF (dorzolamide / timolol, preservative free)drugId:2517 PA OPHTHALMIC PREPARATIONS
cromolyn ophthalmicdrugId:299 OPHTHALMIC PREPARATIONS
cyclopentolate OPHTHALMIC PREPARATIONS
cyclopentolate / phenylephrine OPHTHALMIC PREPARATIONS
cyclosporine 0.05% ophthalmic emulsiondrugId:311 OPHTHALMIC PREPARATIONS BP
cyclosporine 0.09% ophthalmic solutiondrugId:7282 PA OPHTHALMIC PREPARATIONS
cyclosporine multidose 0.05% ophthalmic emulsiondrugId:7305 PA OPHTHALMIC PREPARATIONS
Cystadrops (cysteamine 0.37% ophthalmic solution)drugId:7659 PA OPHTHALMIC PREPARATIONS
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
carisoprodol / aspirin / codeinedrugId:182 PA OPIOID ANALGESICS/MUSCLE RELAXANTS
codeinedrugId:285 PA < 12 years and PA > 360 mg/day OPIOID ANALGESICS
codeine powderdrugId:286 PA OPIOID ANALGESICS
carbamide peroxide OTIC PREPARATIONS *
Ciprodex (ciprofloxacin / dexamethasone)drugId:245 OTIC PREPARATIONS BP
ciprofloxacin / dexamethasonedrugId:245 OTIC PREPARATIONS BP
ciprofloxacin / fluocinolonedrugId:5683 PA OTIC PREPARATIONS
ciprofloxacin / hydrocortisonedrugId:246 OTIC PREPARATIONS
ciprofloxacin 0.2% otic solutiondrugId:2895 PA OTIC PREPARATIONS
ciprofloxacin otic suspensiondrugId:5390 OTIC PREPARATIONS ^
Cipro HC (ciprofloxacin / hydrocortisone)drugId:246 OTIC PREPARATIONS
colistin / neomycin / thonzonium / hydrocortisonedrugId:2108 OTIC PREPARATIONS
Cortisporin-TC (colistin / neomycin / thonzonium / hydrocortisone)drugId:2108 OTIC PREPARATIONS
cevimeline PARASYMPATHETIC AGENTS #
calcium oxybate / magnesium oxybate / potassium oxybate / sodium oxybatedrugId:7603 PA SEDATIVES
Chantix (varenicline) SMOKING CESSATION #
Capastat (capreomycin)drugId:2490 TB PREPARATIONS
capreomycindrugId:2490 TB PREPARATIONS
cycloserinedrugId:2498 TB PREPARATIONS
Cytomel (liothyronine) THYROID PREPARATIONS #

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


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Last updated 11/19/21

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