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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
Lithostat (acetohydroxamic acid) ANTIBIOTICS
Levulan (aminolevulinic acid) CHEMOTHERAPY MB
LotreldrugId:44 (amlodipine / benazepril)drugId:44 CARDIOVASCULAR M90, #
Lioresal (baclofen intrathecal injection)drugId:125 MUSCLE RELAXANT
LotensindrugId:132 (benazepril)drugId:132 CARDIOVASCULAR M90, #
Lotensin HCTdrugId:133 (benazepril / hydrochlorothiazide)drugId:133 CARDIOVASCULAR M90, #
LuxiqdrugId:355 (betamethasone valerate foam)drugId:355 GLUCOCORTICOIDS A90, #
Lumigan (bimatoprost 0.01% ophthalmic solution)drugId:363 OPHTHALMIC PREPARATIONS
LodosyndrugId:173 (carbidopa)drugId:173 ANTIPARKINSON A90, #
LoproxdrugId:5625 (ciclopirox 0.77% cream)drugId:5625 FUNGICIDES A90, #
LanoxindrugId:524 (digoxin)drugId:524 CARDIOVASCULAR M90, #
LomotildrugId:542 (diphenoxylate / atropine)drugId:542 ANTIDIARRHEALS #
LovenoxdrugId:601 (enoxaparin)drugId:601 ANTICOAGULANTS #
Liposyn (fat emulsions, intravenous-liposyn) ELECTROLYTES AND NUTRIENTS #
Lipofen (fenofibrate 50 mg, 150 mg capsule)drugId:5480 LIPID LOWERING AGENTS M90
Lexiva (fosamprenavir)drugId:908 ANTIVIRALS BP, A90
LasixdrugId:916 (furosemide tablet, solution, injection)drugId:916 CARDIOVASCULAR M90, #
LopiddrugId:927 (gemfibrozil)drugId:927 LIPID LOWERING AGENTS M90, #
Lacrisert (hydroxypropyl cellulose ophthalmic insert)drugId:2172 OPHTHALMIC PREPARATIONS
Levemir (insulin detemir)drugId:805 DIABETIC AGENTS
Lantus (insulin glargine-Lantus)drugId:807 DIABETIC AGENTS BP, PD
labetaloldrugId:1001 CARDIOVASCULAR M90
lacosamide tablet, solution, vialdrugId:1972 ANTICONVULSANTS A90, #
lactase GASTROINTESTINAL AGENT *, A90
lactic acid / citric acid / potassium bitartrate vaginal gel CONTRACEPTIVES
lactulose solutiondrugId:1008 GASTROINTESTINAL AGENT A90
lamivudine / zidovudinedrugId:1012 ANTIVIRALS A90, #
lamivudine 10 mg/mL solutiondrugId:2541 ANTIVIRALS A90, #
lamivudine 150 mg, 300 mg tabletdrugId:1009 ANTIVIRALS A90, #
lanolindrugId:1019 COMPOUNDING AGENT *
lanreotidedrugId:1020 ENDOCRINE/METABOLIC AGENTS
lanthanum ELECTROLYTES AND NUTRIENTS A90, #
lapatinibdrugId:1025 CHEMOTHERAPY BP, A90
latanoprost solution - XalatandrugId:1027 OPHTHALMIC PREPARATIONS M90, #
leflunomide IMMUNOMODULATOR A90, #
letrozoledrugId:1031 CHEMOTHERAPY A90, #
leucovorindrugId:1032 ANTIDOTES A90
levalbuterol inhalerdrugId:1035 BRONCHODILATORS A90, #
levetiracetam extended-release-Keppra XRdrugId:1038 ANTICONVULSANTS A90, #
levetiracetam injection, solution, tabletdrugId:1037 ANTICONVULSANTS A90, #
levobunololdrugId:1040 OPHTHALMIC PREPARATIONS M90
levocarnitine ELECTROLYTES AND NUTRIENTS
L-Carnitine (levocarnitine) ELECTROLYTES AND NUTRIENTS
levocarnitine injection ELECTROLYTES AND NUTRIENTS MB
levocarnitine tablet, solution ELECTROLYTES AND NUTRIENTS A90, #
levocetirizine tabletdrugId:1043 ANTIHISTAMINES M90, #
levofloxacin; See Table 35drugId:1044; See Table 66drugId:4720 ANTIBIOTICS A90
levonorgestrel / ethinyl estradiol CONTRACEPTIVES
levonorgestrel / ethinyl estradiol / ferrous bisglycinate CONTRACEPTIVES M90
levonorgestrel / ethinyl estradiol 0.10/0.02 mg CONTRACEPTIVES M90
levonorgestrel / ethinyl estradiol 0.15/0.03 mg CONTRACEPTIVES M90
levonorgestrel / ethinyl estradiol 90/20 mcg CONTRACEPTIVES M90
levonorgestrel / ethinyl estradiol patch CONTRACEPTIVES
levonorgestrel / ethinyl estradiol triphasic CONTRACEPTIVES M90
levonorgestrel / ethinyl estradiol-Loseasonique CONTRACEPTIVES M90, #
Loseasonique (levonorgestrel / ethinyl estradiol-Loseasonique) CONTRACEPTIVES M90, #
levonorgestrel / ethinyl estradiol-Quartette CONTRACEPTIVES M90, #
levonorgestrel / ethinyl estradiol-Seasonique CONTRACEPTIVES M90, #
levonorgestrel 1.5 mg tablet CONTRACEPTIVES *
levonorgestrel-releasing intrauterine system 13.5 mg CONTRACEPTIVES
levonorgestrel-releasing intrauterine system 19.5 mg CONTRACEPTIVES
levonorgestrel-releasing intrauterine system 52 mg-Liletta CONTRACEPTIVES
Liletta (levonorgestrel-releasing intrauterine system 52 mg-Liletta) CONTRACEPTIVES
levonorgestrel-releasing intrauterine system 52 mg-Mirena CONTRACEPTIVES
levothyroxine THYROID PREPARATIONS M90
levothyroxine-Ermeza THYROID PREPARATIONS
levothyroxine-Euthyrox THYROID PREPARATIONS M90, #
levothyroxine-Levo-T THYROID PREPARATIONS M90, #
Levo-T (levothyroxine-Levo-T) THYROID PREPARATIONS M90, #
levothyroxine-Levoxyl THYROID PREPARATIONS M90, #
Levoxyl (levothyroxine-Levoxyl) THYROID PREPARATIONS M90, #
levothyroxine-Synthroid THYROID PREPARATIONS M90, #
levothyroxine-Thyquidity THYROID PREPARATIONS
levothyroxine-Tirosint THYROID PREPARATIONS BP, M90
levothyroxine-Unithroid THYROID PREPARATIONS M90, #
lidocaine / prilocainedrugId:1074 ANESTHETICS A90
lidocaine ointmentdrugId:5604 ANESTHETICS A90
lidocaine ophthalmic geldrugId:1072 OPHTHALMIC PREPARATIONS
lidocaine topical jelly, solutiondrugId:7957 ANESTHETICS
lidocaine vial ANESTHETICS #
lidocaine vial, preservative free ANESTHETICS #
lidocaine viscous solutiondrugId:5605 ANESTHETICS
linaclotide 145 mcg, 290 mcgdrugId:2658 CONSTIPATION AGENTS
Linzess (linaclotide 145 mcg, 290 mcg)drugId:2658 CONSTIPATION AGENTS
linagliptindrugId:2293 DIABETIC AGENTS
linagliptin / metformindrugId:2486 DIABETIC AGENTS
linagliptin / metformin extended-releasedrugId:5724 DIABETIC AGENTS
lincomycindrugId:2634 ANTIBIOTICS #
LincocindrugId:2634 (lincomycin)drugId:2634 ANTIBIOTICS #
linezolid tabletdrugId:8038 ANTIBIOTICS A90, #
liothyronine THYROID PREPARATIONS M90, #
lisinoprildrugId:1088 CARDIOVASCULAR M90, #
lisinopril / hydrochlorothiazidedrugId:1090 CARDIOVASCULAR M90, #
lodoxamidedrugId:1095 OPHTHALMIC PREPARATIONS
loperamidedrugId:1097 ANTIDIARRHEALS *
lopinavir / ritonavirdrugId:1098 ANTIVIRALS A90, #
loratadine / pseudoephedrinedrugId:2264 ANTIHISTAMINES *, A90
loratadine tablet, solutiondrugId:1099 ANTIHISTAMINES *, M90
lorazepam injectiondrugId:7662 BENZODIAZEPINES #
losartandrugId:1103 CARDIOVASCULAR M90, #
losartan / hydrochlorothiazidedrugId:1104 CARDIOVASCULAR M90, #
loteprednol 0.2%drugId:1105 OPHTHALMIC PREPARATIONS A90, #
loteprednol 0.5%drugId:7304 OPHTHALMIC PREPARATIONS BP, A90
Lotemax (loteprednol 0.5%)drugId:7304 OPHTHALMIC PREPARATIONS BP, A90
low molecular weight iron dextrandrugId:972 HEMATINIC AGENT
Lialda (mesalamine delayed-release)drugId:1153 GI ANTI-INFLAMMATORY BP, A90
LopressordrugId:1338 (metoprolol)drugId:1338 CARDIOVASCULAR M90, #
Lysodren (mitotane)drugId:4881 CHEMOTHERAPY
Lagevrio (molnupiravir COVID EUA – December 23, 2021)drugId:8128 COVID - 19 related Treatments and Vaccines
Lo Loestrin Fe (norethindrone / ethinyl estradiol / ferrous fumarate) CONTRACEPTIVES
LovazadrugId:1288 (omega-3 acid ethyl esters)drugId:1288 LIPID LOWERING AGENTS M90, #
Lucentis (ranibizumab) OPHTHALMIC PREPARATIONS MB
Leukine (sargramostim)drugId:1833 HEMATINIC AGENT
Lysteda (tranexamic acid tablet) HEMOSTATICS #
lacosamide extended-release capsuledrugId:8784 PA ANTICONVULSANTS
levetiracetam extended-release-Elepsia XRdrugId:8187 PA ANTICONVULSANTS
levetiracetam tablet for oral suspensiondrugId:5397 PA ANTICONVULSANTS
lamotrigine extended-release tablet; See Table 20drugId:1017; See Table 71drugId:4297 PA ANTICONVULSANTS A90
Lamictal XR (lamotrigine extended-release tablet); See Table 20drugId:1017; See Table 71drugId:4297 PA ANTICONVULSANTS A90
lamotrigine extended-release tablet starter kit; See Table 20drugId:1018; See Table 71drugId:4300 PA ANTICONVULSANTS
Lamictal XR (lamotrigine extended-release tablet starter kit); See Table 20drugId:1018; See Table 71drugId:4300 PA ANTICONVULSANTS
lamotrigine orally disintegrating tablet; See Table 20drugId:1014; See Table 71drugId:4291 PA ANTICONVULSANTS A90
Lamictal ODT (lamotrigine orally disintegrating tablet); See Table 20drugId:1014; See Table 71drugId:4291 PA ANTICONVULSANTS A90
lamotrigine orally disintegrating tablet starter kit; See Table 20drugId:1015; See Table 71drugId:4292 PA ANTICONVULSANTS
Lamictal ODT (lamotrigine orally disintegrating tablet starter kit); See Table 20drugId:1015; See Table 71drugId:4292 PA ANTICONVULSANTS
lamotrigine tablet starter kit; See Table 20drugId:1016; See Table 71drugId:4284 PA ANTICONVULSANTS
Lamictal (lamotrigine tablet starter kit); See Table 20drugId:1016; See Table 71drugId:4284 PA ANTICONVULSANTS
Lyrica (pregabalin); See Table 20drugId:1582; See Table 71drugId:4460 PA ANTICONVULSANTS
Lescol XL (fluvastatin extended-release)drugId:898 PA LIPID LOWERING AGENTS M90
Leqvio (inclisiran)drugId:8192 PA LIPID LOWERING AGENTS
lomitapidedrugId:2727 PA LIPID LOWERING AGENTS
lovastatin extended-releasedrugId:1107 PA LIPID LOWERING AGENTS
Livalo (pitavastatin calcium)drugId:1962 PA LIPID LOWERING AGENTS M90
LipitordrugId:105 (atorvastatin 10 mg, 20 mg, 40 mg tablet)drugId:105 PA > 1.5 units/day LIPID LOWERING AGENTS M90, #
lovastatin 10 mg, 20 mgdrugId:1108 PA > 1.5 units/day LIPID LOWERING AGENTS M90
LipitordrugId:2933 (atorvastatin 80 mg tablet)drugId:2933 PA > 1 unit/day LIPID LOWERING AGENTS M90, #
lovastatin 40 mgdrugId:2735 PA > 2 units/day LIPID LOWERING AGENTS M90
lidocaine 1.8% patchdrugId:7015 PA ANESTHETICS
lidocaine 5% patchdrugId:1071 PA > 3 patches/day ANESTHETICS A90, #
LidodermdrugId:1071 (lidocaine 5% patch)drugId:1071 PA > 3 patches/day ANESTHETICS A90, #
lidocaine / tetracainedrugId:1075 PA > 4 patches/30 days ANESTHETICS
lanadelumab-flyodrugId:7008 PA BIOLOGICAL
levorphanol tabletdrugId:1064 PA OPIOID ANALGESICS
Licart (diclofenac topical patch-Licart)drugId:7454 PA NONSTEROIDAL ANTI-INFLAMMATORY
lindane shampoodrugId:1076 PA ANTIPARASITICS A90
Lymepak (doxycycline hyclate 100 mg tablet pack)drugId:8616 PA TETRACYCLINES
linezolid suspensiondrugId:1078 PA ANTIBIOTICS A90
Likmez (metronidazole suspension)drugId:8783 PA ANTIPARASITICS
Lampit (nifurtimox)drugId:7598 PA ANTIBIOTICS
ledipasvir / sofosbuvirdrugId:4600 PA ANTIVIRALS PD
lansoprazole orally disintegrating tabletdrugId:1022 PA ≥ 2 years PROTON PUMP INHIBITORS BP, M90
lansoprazole capsuledrugId:1021 PA > 1 unit/day PROTON PUMP INHIBITORS M90, #
lisdexamfetamine chewable tablet; See Table 31drugId:8178; See Table 71drugId:8179 PA CEREBRAL STIMULANTS BP
lisdexamfetamine capsule; See Table 31drugId:1086; See Table 71drugId:3021 PA < 3 years or ≥ 21 years and PA > 2 units/day CEREBRAL STIMULANTS BP
lofexidinedrugId:6906 PA ALPHA-2 ADRENERGIC AGONIST
Lucemyra (lofexidine)drugId:6906 PA ALPHA-2 ADRENERGIC AGONIST
Lifems Naloxone (naloxone syringe kit)drugId:8615 PA ANTIDOTES
lasmiditandrugId:7377 PA SEROTONIN RECEPTOR AGENTS
lamivudine / tenofovir disoproxil fumaratedrugId:6780 PA ANTIVIRALS
lenacapavirdrugId:8580 PA ANTIVIRALS
Letairis (ambrisentan)drugId:30 PA CARDIOVASCULAR A90
Liqrev (sildenafil oral suspension-Liqrev)drugId:8713 PA CARDIOVASCULAR
Litfulo (ritlecitinib)drugId:8712 PA IMMUNOMODULATOR
levomilnacipran; See Table 17drugId:2886; See Table 71drugId:3980 PA ANTIDEPRESSANTS
Lexapro (escitalopram); See Table 17drugId:630; See Table 71drugId:3701 PA < 6 years ANTIDEPRESSANTS A90, #
Lotronex (alosetron)drugId:19 PA GASTROINTESTINAL AGENT A90
Lemtrada (alemtuzumab 12 mg)drugId:4782 PA MULTIPLE SCLEROSIS AGENTS MB
Lumizyme (alglucosidase alfa)drugId:11 PA ENZYMES MB
Lyvispah (baclofen granules)drugId:8315 PA MUSCLE RELAXANT
Librax (chlordiazepoxide / clidinium)drugId:6843 PA ANTISPASMODICS,ANTICHOLINERGIC
Loprox (ciclopirox 0.77% suspension)drugId:232 PA FUNGICIDES A90
lansoprazole / amoxicillin / clarithromycindrugId:1023 PA H. PYLORI AGENTS A90
laronidasedrugId:1026 PA ENZYMES MB
leniolisibdrugId:8658 PA CHEMOTHERAPY
letermovirdrugId:6615 PA ANTIVIRALS
levamlodipinedrugId:8200 PA CARDIOVASCULAR M90
levodopadrugId:7237 PA ANTIPARKINSON
levofloxacin ophthalmic solutiondrugId:1046 PA OPHTHALMIC PREPARATIONS A90
levoketoconazoledrugId:8261 PA OTHER HORMONES
lisinopril solutiondrugId:5592 PA CARDIOVASCULAR
lonafarnibdrugId:7723 PA UNCLASSIFIED DRUG PRODUCTS
luliconazoledrugId:2925 PA FUNGICIDES A90
Luzu (luliconazole)drugId:2925 PA FUNGICIDES A90
lumasirandrugId:7793 PA SMALL INTERFERING RNA AGENTS PD, MB
Livmarli (maralixibat)drugId:8193 PA BILE THERAPY
Livtencity (maribavir)drugId:8194 PA ANTIVIRALS
Lamzede (velmanase alfa-tycv)drugId:8571 PA ENZYMES MB
Lupkynis (voclosporin)drugId:7785 PA IMMUNOMODULATOR
lactobacillus rhamnosus GGdrugId:6204 PA ≥ 22 years GASTROINTESTINAL AGENT
lamivudine 100 mg tabletdrugId:1010 PA > 1 unit/day ANTIVIRALS A90, #
Lokelma (sodium zirconium cyclosilicate)drugId:6905 PA > 1 unit/day CHELATING AGENT
lamivudine 5 mg/mL solutiondrugId:1011 PA > 20 mL/day ANTIVIRALS A90
Lyrica CR (pregabalin extended-release); See Table 71drugId:6609; See Table 72drugId:6608 PA GABA ANALOGS BP
Lyumjev (insulin lispro-aabc)drugId:7491 PA DIABETIC AGENTS
Lyumjev Tempo (insulin lispro-aabc)drugId:8532 PA DIABETIC THERAPY
liraglutide-VictozadrugId:1085 PA >9 mL/30 days DIABETIC AGENTS BP
latanoprost emulsiondrugId:7013 PA OPHTHALMIC PREPARATIONS
latanoprost solution - IyuzehdrugId:8724 PA OPHTHALMIC PREPARATIONS
latanoprostenedrugId:6487 PA OPHTHALMIC PREPARATIONS
lactulose packetdrugId:1007 PA CONSTIPATION AGENTS
linaclotide 72 mcgdrugId:8218 PA CONSTIPATION AGENTS
Linzess (linaclotide 72 mcg)drugId:8218 PA CONSTIPATION AGENTS
lubiprostonedrugId:1110 PA CONSTIPATION AGENTS BP, M90
lamotrigine dispersible tablet; See Table 20drugId:2216; See Table 71drugId:4288 PA < 6 years ANTICONVULSANTS A90, #
Lamictal (lamotrigine dispersible tablet); See Table 20drugId:2216; See Table 71drugId:4288 PA < 6 years ANTICONVULSANTS A90, #
lamotrigine tablet; See Table 20drugId:1013; See Table 71drugId:4289 PA < 6 years ANTICONVULSANTS A90, #
Lamictal (lamotrigine tablet); See Table 20drugId:1013; See Table 71drugId:4289 PA < 6 years ANTICONVULSANTS A90, #
lithiumdrugId:1092 PA < 6 years ANTIPSYCHOTIC A90, #
LithobiddrugId:1092 (lithium)drugId:1092 PA < 6 years ANTIPSYCHOTIC A90, #
lorazepam extended-release; See Table 69drugId:8118; See Table 71drugId:8119 PA BENZODIAZEPINES
Loreev XR (lorazepam extended-release); See Table 69drugId:8118; See Table 71drugId:8119 PA BENZODIAZEPINES
lorazepam solution, tablet; See Table 69drugId:1100; See Table 71drugId:4400 PA < 6 years BENZODIAZEPINES #
Lexette (halobetasol foam)drugId:6983 PA GLUCOCORTICOIDS A90
Locoid Lipocream (hydrocortisone butyrate / emollient)drugId:5031 PA GLUCOCORTICOIDS A90
Locoid (hydrocortisone butyrate lotion)drugId:6561 PA GLUCOCORTICOIDS A90
lumateperone; See Table 24drugId:7361; See Table 71drugId:7362 PA ANTIPSYCHOTIC
lurasidone; See Table 24drugId:2174; See Table 71drugId:4266 PA ANTIPSYCHOTIC A90
Latuda (lurasidone); See Table 24drugId:2174; See Table 71drugId:4266 PA ANTIPSYCHOTIC A90
Lybalvi (olanzapine / samidorphan); See Table 24drugId:8120; See Table 71drugId:8121 PA ANTIPSYCHOTIC
loxapine capsule; See Table 24drugId:6324; See Table 71drugId:1109 PA < 6 years ANTIPSYCHOTIC A90, #
Loxitane (loxapine capsule); See Table 24drugId:6324; See Table 71drugId:1109 PA < 6 years ANTIPSYCHOTIC A90, #
lumacaftor / ivacaftordrugId:5126 PA CYSTIC FIBROSIS AGENTS PD
lifitegrastdrugId:5681 PA OPHTHALMIC PREPARATIONS
loteprednol 0.25% suspensiondrugId:7779 PA OPHTHALMIC PREPARATIONS
loteprednol 0.38% geldrugId:7287 PA OPHTHALMIC PREPARATIONS
Lotemax SM (loteprednol 0.38% gel)drugId:7287 PA OPHTHALMIC PREPARATIONS
loteprednol 1% suspensiondrugId:7285 PA OPHTHALMIC PREPARATIONS
lotilanerdrugId:8791 PA OPHTHALMIC PREPARATIONS
lusutrombopagdrugId:6991 PA HEMATOLOGIC
lisocabtagene maraleuceldrugId:7778 PA CHEMOTHERAPY CO, MB
Lunsumio (mosunetuzumab-axgb)drugId:8572 PA CHEMOTHERAPY MB
Libtayo (cemiplimab-rwlc)drugId:7005 PA CHEMOTHERAPY MB
Leukeran (chlorambucil)drugId:216 PA CHEMOTHERAPY
Lytgobi (futibatinib)drugId:8531 PA ANTINEOPLASTICS
larotrectinibdrugId:7047 PA CHEMOTHERAPY
lenalidomidedrugId:2298 PA CHEMOTHERAPY BP, A90
lenvatinibdrugId:4943 PA CHEMOTHERAPY
Lenvima (lenvatinib)drugId:4943 PA CHEMOTHERAPY
levoleucovorin injectiondrugId:4944 PA ANTIDOTES
levoleucovorin powder for injectiondrugId:1047 PA ANTIDOTES
lomustinedrugId:8405 PA ONCOLOGY AGENTS
loncastuximab tesirine-lpyldrugId:8027 PA CHEMOTHERAPY
Lumoxiti (moxetumomab pasudotox-tdfk)drugId:7043 PA CHEMOTHERAPY MB
Lynparza (olaparib)drugId:4783 PA CHEMOTHERAPY
Lonsurf (trifluridine / tipiracil)drugId:5261 PA CHEMOTHERAPY
l-glutaminedrugId:6503 PA ELECTROLYTES AND NUTRIENTS
luspatercept-aamtdrugId:7334 PA HEMATOLOGIC MB
Luxturna (voretigene neparvovec)drugId:7497 PA OPHTHALMIC PREPARATIONS CO, MB
lecanemab-irmbdrugId:8605 PA BIOLOGICAL
Leqembi (lecanemab-irmb)drugId:8605 PA BIOLOGICAL
lorlatinibdrugId:7042 PA CHEMOTHERAPY
Lorbrena (lorlatinib)drugId:7042 PA CHEMOTHERAPY
lurbinectedindrugId:7604 PA CHEMOTHERAPY MB
Lumakras (sotorasib)drugId:7980 PA CHEMOTHERAPY
liraglutide-SaxendadrugId:8670 PA ANTI-OBESITY AGENTS PD
Lomaira (phentermine 8 mg tablet)drugId:8666 PA ANTI-OBESITY AGENTS
lonapegsomatropin-tcgddrugId:8158 PA HORMONE AGENTS PD
lemborexant; See Table 15drugId:7388; See Table 71drugId:7389 PA SEDATIVE, NON-BARBITURATE
Lunesta (eszopiclone); See Table 15drugId:662; See Table 71drugId:4348 PA < 6 years and PA > 1 unit/day SEDATIVES #
leuprolidedrugId:8332 PA HORMONE AGENTS
Lupron (leuprolide)drugId:1033 PA HORMONE AGENTS
leuprolide / norethindronedrugId:2964 PA OTHER HORMONES
Lupaneta Pack (leuprolide / norethindrone)drugId:2964 PA OTHER HORMONES
linezolid injectiondrugId:1079 PA ANTIBIOTICS
Lonhala (glycopyrrolate inhalation solution)drugId:6742 PA BRONCHODILATORS
levalbuterol inhalation solutiondrugId:1036 PA BRONCHODILATORS A90
levocetirizine solutiondrugId:5960 PA ANTIHISTAMINES M90

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


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Last updated 05/16/24

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