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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
midodrine ADRENERGICS
mirabegron extended-releasedrugId:2642 ADRENERGICS
Myrbetriq (mirabegron extended-release)drugId:2642 ADRENERGICS
memantine / donepezil extended-release; See Table 56drugId:5127; See Table 71drugId:7448 PA < 6 years and PA > 1 unit/day ALZHEIMER'S THERAPY
memantine extended-release; See Table 56drugId:2821; See Table 71drugId:7447 PA < 6 years and PA > 1 unit/day ALZHEIMER'S THERAPY BP
memantine solution; See Table 56drugId:2252; See Table 71drugId:7405 PA ALZHEIMER'S THERAPY
memantine tablet; See Table 56drugId:1139; See Table 71drugId:7446 PA < 6 years and PA > 2 units/day ALZHEIMER'S THERAPY #
memantine titration pack; See Table 56drugId:2253; See Table 71drugId:7404 PA < 6 years and PA > 49 units/28 days ALZHEIMER'S THERAPY
Migranal (dihydroergotamine nasal spray)drugId:527 PA ANALGESICS
milnacipran ANALGESICS
Marcaine (bupivacaine) ANESTHETICS #
mepivacaine ANESTHETICS ^
misoprostol ANTACIDS #
meprobamate; See Table 69drugId:5727; See Table 71drugId:1146 PA ANTI-ANXIETY AGENT
meloxicam capsuledrugId:5404 PA ANTIARTHRITICS
methenaminedrugId:938 ANTIBACTERIAL #
MacrobiddrugId:1225 (nitrofurantoin monohydrate / macrocrystals)drugId:1225 ANTIBIOTICS #
MacrodantindrugId:1224 (nitrofurantoin macrocrystals)drugId:1224 ANTIBIOTICS #
mafenidedrugId:1113 ANTIBIOTICS #
meropenemdrugId:1148 ANTIBIOTICS #
MerremdrugId:1148 (meropenem)drugId:1148 ANTIBIOTICS #
MetrodrugId:5640 (metronidazole injection)drugId:5640 ANTIBIOTICS #
Metrogel-VaginaldrugId:4882 (metronidazole 0.75% vaginal gel-Metrogel-Vaginal)drugId:4882 ANTIBIOTICS #
metronidazole 0.75% vaginal gel-Metrogel-VaginaldrugId:4882 ANTIBIOTICS #
metronidazole 0.75% vaginal gel-VandazoledrugId:4887 ANTIBIOTICS
metronidazole 1.3% vaginal geldrugId:4948 ANTIBIOTICS
metronidazole 250 mg, 500 mg tabletdrugId:1341 ANTIBIOTICS #
metronidazole 375 mg capsuledrugId:1988 PA ANTIBIOTICS
metronidazole injectiondrugId:5640 ANTIBIOTICS #
micafungin ANTIBIOTICS #
Minocin (minocycline injection)drugId:5660 ANTIBIOTICS
minocycline 1.5% foamdrugId:7605 PA ANTIBIOTICS
minocycline 4% foamdrugId:7344 PA ANTIBIOTICS
minocycline capsuledrugId:2303 ANTIBIOTICS
minocycline extended-release 105 mg, 135 mg tabletdrugId:7262 PA ANTIBIOTICS
minocycline extended-release 45 mg, 90 mg, 135 mg tabletdrugId:7165 PA ANTIBIOTICS
minocycline extended-release 55 mg, 65 mg, 115 mg tabletdrugId:1364 ANTIBIOTICS BP
minocycline extended-release 80 mg, 105 mg tabletdrugId:1363 ANTIBIOTICS #
minocycline extended-release capsuledrugId:6413 PA ANTIBIOTICS
minocycline injectiondrugId:5660 ANTIBIOTICS
minocycline tabletdrugId:1361 PA ANTIBIOTICS
Minolira (minocycline extended-release 105 mg, 135 mg tablet)drugId:7262 PA ANTIBIOTICS
Monurol (fosfomycin)drugId:911 ANTIBIOTICS BP
moxifloxacin injectiondrugId:2748 ANTIBIOTICS
moxifloxacin tabletdrugId:1398 PA ANTIBIOTICS
mupirocin creamdrugId:1406 PA ANTIBIOTICS
mupirocin ointmentdrugId:2564 ANTIBIOTICS
mupirocin powderdrugId:7054 PA ANTIBIOTICS
MyambutoldrugId:665 (ethambutol)drugId:665 ANTIBIOTICS #
Mycamine (micafungin) ANTIBIOTICS #
Mycobutin (rifabutin)drugId:1429 ANTIBIOTICS
methsuximide; See Table 20drugId:948; See Table 71drugId:4441 ANTICONVULSANTS
Mysoline (primidone); See Table 20drugId:1586; See Table 71drugId:4461 ANTICONVULSANTS #
maprotiline; See Table 17drugId:1118; See Table 71drugId:4100 PA < 6 years ANTIDEPRESSANTS
Marplan (isocarboxazid); See Table 17drugId:2619; See Table 71drugId:3600 PA ANTIDEPRESSANTS
mirtazapine orally disintegrating tablet; See Table 17drugId:1367; See Table 71drugId:3620 PA ANTIDEPRESSANTS
mirtazapine; See Table 17drugId:1366; See Table 71drugId:3621 PA < 6 years ANTIDEPRESSANTS #
Motofen (difenoxin / atropine)drugId:6111 PA ANTIDIARRHEALS
Mytesi (crofelemer)drugId:5684 PA ANTIDIARRHEALS
mesna injection ANTIDOTES #
mesna tablet ANTIDOTES
Mesnex (mesna tablet) ANTIDOTES
Mesnex (mesna injection) ANTIDOTES #
Marinol (dronabinol capsule)drugId:582 PA ANTIEMETICS
meclizine ANTIEMETICS *
metoclopramide ANTIEMETICS #
Monoclate-P (antihemophilic factor, human-Monoclate-P) ANTI-HEMOPHILIA AGENTS
Mononine (factor IX) ANTI-HEMOPHILIA AGENTS
Malarone (atovaquone / proguanil) ANTIMALARIALS #
mefloquine ANTIMALARIALS
malathiondrugId:1117 PA ANTIPARASITICS
mebendazoledrugId:5394 PA ANTIPARASITICS
MeprondrugId:106 (atovaquone)drugId:106 ANTIPARASITICS #
MirapexdrugId:1569 (pramipexole)drugId:1569 ANTIPARKINSON #
Mirapex ER (pramipexole extended-release)drugId:1943 PA ANTIPARKINSON
molindone; See Table 24drugId:6325; See Table 71drugId:1378 PA < 6 years ANTIPSYCHOTIC
mepenzolate ANTISPASMODICS,ANTICHOLINERGIC
methscopolamine ANTISPASMODICS,ANTICHOLINERGIC #
maraviroc solutiondrugId:7577 PA ANTIVIRALS
maraviroc tabletdrugId:1119 PA ANTIVIRALS BP
Mavyret (glecaprevir / pibrentasvir)drugId:6360 PA ANTIVIRALS PD
megestrol 40 mg/mL suspensiondrugId:1135 APPETITE STIMULANTS
megestrol 625 mg/5 mL suspensiondrugId:1136 PA APPETITE STIMULANTS
megestrol tablet APPETITE STIMULANTS
midazolam injectiondrugId:1354 BENZODIAZEPINES
midazolam nasal spraydrugId:7288 PA > 10 units/month BENZODIAZEPINES
midazolam powder; See Table 69drugId:2507; See Table 71drugId:4422 PA BENZODIAZEPINES
midazolam syrup; See Table 69drugId:4421; See Table 71drugId:4420 PA < 6 years BENZODIAZEPINES
measles / mumps / rubella / varicella virus vaccinedrugId:1122 BIOLOGICAL 1
measles / mumps / rubella vaccinedrugId:1121 BIOLOGICAL 1
Menactra (quadrivalent meningococcal conjugate vaccine-Menactra)drugId:1140 BIOLOGICAL 1
meningococcal group B vaccine-BexserodrugId:4905 BIOLOGICAL 1
meningococcal group B vaccine-TrumenbadrugId:4815 BIOLOGICAL 1
Menquadfi (quadrivalent meningococcal conjugate vaccine-Menquadfi)drugId:7468 BIOLOGICAL 1
Menveo (quadrivalent meningococcal quadrivalent vaccine-Menveo)drugId:1141 BIOLOGICAL 1
mepolizumabdrugId:5282 PA BIOLOGICAL
Micrhogam (rho(d) immune globulin IM, human-Micrhogam)drugId:2746 BIOLOGICAL
M-M-R II Vaccine (measles / mumps / rubella vaccine)drugId:1121 BIOLOGICAL 1
Myobloc (rimabotulinumtoxinB)drugId:1436 PA BIOLOGICAL
metaproterenol tablet, syrupdrugId:2196 BRONCHODILATORS
mometasone / formoteroldrugId:1958 BRONCHODILATORS BP
mometasone 110 mcg inhalation powderdrugId:2663 PA ≥ 12 years BRONCHODILATORS
mometasone 220 mcg inhalation powderdrugId:1379 PA < 12 years BRONCHODILATORS
mometasone inhalation aerosoldrugId:5102 BRONCHODILATORS
montelukast granulesdrugId:5129 PA BRONCHODILATORS
montelukast tablet, chewable tabletdrugId:1383 BRONCHODILATORS #
macitentandrugId:2892 PA CARDIOVASCULAR
MaxzidedrugId:1756 (hydrochlorothiazide / triamterene)drugId:1756 CARDIOVASCULAR #
mecamylaminedrugId:2824 PA CARDIOVASCULAR
methazolamide CARDIOVASCULAR #
methyldopadrugId:950 CARDIOVASCULAR
methyldopa / hydrochlorothiazidedrugId:951 CARDIOVASCULAR
metolazonedrugId:1335 CARDIOVASCULAR
metoprololdrugId:1338 CARDIOVASCULAR #
metoprolol / hydrochlorothiazidedrugId:1339 CARDIOVASCULAR #
metoprolol extended-release capsuledrugId:7135 PA CARDIOVASCULAR
metoprolol extended-release tabletdrugId:1337 CARDIOVASCULAR #
metyrosine CARDIOVASCULAR BP
mexiletinedrugId:1350 CARDIOVASCULAR
MicardisdrugId:1660 (telmisartan)drugId:1660 CARDIOVASCULAR #
Micardis HCTdrugId:1663 (telmisartan / hydrochlorothiazide)drugId:1663 CARDIOVASCULAR #
milrinone CARDIOVASCULAR
Minipress (prazosin); See Table 18drugId:1573; See Table 19drugId:5164 CARDIOVASCULAR #
minoxidildrugId:1365 CARDIOVASCULAR
moexiprildrugId:1375 CARDIOVASCULAR
Multaq (dronedarone) CARDIOVASCULAR
methamphetamine; See Table 31drugId:1165; See Table 71drugId:3142 PA CEREBRAL STIMULANTS
Methylin oral solution (methylphenidate oral solution); See Table 31drugId:960; See Table 71drugId:3161 PA < 3 years and PA > 30 mL/day CEREBRAL STIMULANTS #
methylphenidate chewable tablet; See Table 31drugId:959; See Table 71drugId:3181 PA < 3 years and PA > 3 units/day CEREBRAL STIMULANTS
methylphenidate extended-release, CD; See Table 31drugId:957; See Table 71drugId:3043 PA CEREBRAL STIMULANTS
methylphenidate extended-release 72 mg tablet; See Table 31drugId:6610; See Table 71drugId:6611 PA CEREBRAL STIMULANTS
methylphenidate extended-release-Adhansia XR; See Table 31drugId:7232; See Table 71drugId:7233 PA CEREBRAL STIMULANTS
methylphenidate extended-release-Aptensio XR; See Table 31drugId:5100; See Table 71drugId:5101 PA CEREBRAL STIMULANTS
methylphenidate extended-release chewable tablet; See Table 31drugId:5391; See Table 71drugId:5392 PA CEREBRAL STIMULANTS
methylphenidate extended-release-Concerta; See Table 31drugId:2662; See Table 71drugId:3041 PA < 3 years and PA > 2 units/day CEREBRAL STIMULANTS BP
methylphenidate extended-release-Jornay PM; See Table 31drugId:7238; See Table 71drugId:7239 PA CEREBRAL STIMULANTS
methylphenidate extended-release orally disintegrating tablet; See Table 31drugId:6281; See Table 71drugId:6282 PA CEREBRAL STIMULANTS
methylphenidate extended-release oral suspension; See Table 31drugId:2731; See Table 71drugId:3042 PA CEREBRAL STIMULANTS
methylphenidate oral solution; See Table 31drugId:960; See Table 71drugId:3161 PA < 3 years and PA > 30 mL/day CEREBRAL STIMULANTS #
methylphenidate powder; See Table 31drugId:954; See Table 71drugId:3180 PA CEREBRAL STIMULANTS
methylphenidate-Ritalin LA; See Table 31drugId:2421; See Table 71drugId:3040 PA CEREBRAL STIMULANTS
methylphenidate-Ritalin; See Table 31drugId:961; See Table 71drugId:3201 PA < 3 years and PA > 3 units/day CEREBRAL STIMULANTS #
methylphenidate sustained-release tablet; See Table 31drugId:963; See Table 71drugId:3200 PA < 3 years and PA > 3 units/day CEREBRAL STIMULANTS
methylphenidate transdermal; See Table 31drugId:955; See Table 71drugId:3060 PA < 3 years and PA > 1 unit/day CEREBRAL STIMULANTS
Mydayis (amphetamine salts extended-release-Mydayis); See Table 31drugId:6285; See Table 71drugId:6286 PA CEREBRAL STIMULANTS
Margenza (margetuximab-cmkb)drugId:7786 PA CHEMOTHERAPY
margetuximab-cmkbdrugId:7786 PA CHEMOTHERAPY
Marqibo (vincristine liposome)drugId:2890 PA CHEMOTHERAPY
Matulane (procarbazine)drugId:1589 CHEMOTHERAPY
mechlorethamine geldrugId:2893 CHEMOTHERAPY
mechlorethamine injectiondrugId:1125 CHEMOTHERAPY
Mekinist (trametinib)drugId:2845 PA CHEMOTHERAPY
Mektovi (binimetinib)drugId:6802 PA CHEMOTHERAPY
melphalan flufenamidedrugId:7884 PA CHEMOTHERAPY
melphalan hydrochloride injectiondrugId:1138 CHEMOTHERAPY #
melphalan injectiondrugId:5385 CHEMOTHERAPY
melphalan tabletdrugId:5504 CHEMOTHERAPY #
mercaptopurine oral suspensiondrugId:4632 PA CHEMOTHERAPY
mercaptopurine tabletdrugId:1147 CHEMOTHERAPY
methotrexate injectiondrugId:2935 CHEMOTHERAPY
methotrexate tablet; See Table 5drugId:5140; See Table 57drugId:943 CHEMOTHERAPY
midostaurindrugId:6184 PA CHEMOTHERAPY
mitomycin injectiondrugId:1370 CHEMOTHERAPY
mitomycin pyelocalyceal solutiondrugId:7453 PA CHEMOTHERAPY ^
mitotanedrugId:4881 CHEMOTHERAPY
mitoxantronedrugId:1372 CHEMOTHERAPY #
mogamulizumab-kpkcdrugId:6924 PA CHEMOTHERAPY
Monjuvi (tafasitamab-cxix)drugId:7492 PA CHEMOTHERAPY
moxetumomab pasudotox-tdfkdrugId:7043 PA CHEMOTHERAPY
Mustargen (mechlorethamine injection)drugId:1125 CHEMOTHERAPY
Mvasi (bevacizumab-awwb)drugId:7787 PA CHEMOTHERAPY
Myleran (busulfan tablet)drugId:2536 CHEMOTHERAPY
Mylotarg (gemtuzumab ozogamicin)drugId:6342 PA CHEMOTHERAPY
magnesium saltsdrugId:1114 CONSTIPATION AGENTS *
methylcellulosedrugId:5920 CONSTIPATION AGENTS *
methylnaltrexonedrugId:953 PA CONSTIPATION AGENTS
mineral oildrugId:1360 CONSTIPATION AGENTS *
Motegrity (prucalopride)drugId:7136 PA CONSTIPATION AGENTS
medroxyprogesterone injection CONTRACEPTIVES #
Minastrin 24 Fe (ethinyl estradiol / norethindrone / ferrous fumarate chewable-Minastrin 24 Fe) CONTRACEPTIVES #
Mirena (levonorgestrel-releasing intrauterine system 52 mg-Mirena) CONTRACEPTIVES
Moderna COVID-19 Vaccine (COVID EUA – December 18, 2020) COVID - 19 related Treatments and Vaccines COVID
methoxsalen capsules DERMATOLOGICAL #
methoxsalen topical DERMATOLOGICAL
MetrocreamdrugId:1344 (metronidazole 0.75% cream)drugId:1344 DERMATOLOGICAL #
Metrogel (metronidazole 1% gel)drugId:1345 PA DERMATOLOGICAL
Metrolotion (metronidazole lotion)drugId:1346 PA DERMATOLOGICAL
metronidazole 0.75% creamdrugId:1344 DERMATOLOGICAL #
metronidazole 0.75% geldrugId:4883 DERMATOLOGICAL
metronidazole 1% creamdrugId:1348 DERMATOLOGICAL
metronidazole 1% geldrugId:1345 PA DERMATOLOGICAL
metronidazole lotiondrugId:1346 PA DERMATOLOGICAL
Mirvaso (brimonidine topical gel, 0.33%)drugId:2891 PA DERMATOLOGICAL
metformin extended-release, gastric tabletdrugId:2987 PA DIABETIC AGENTS BP
metformin extended-release, osmotic tabletdrugId:1157 PA DIABETIC AGENTS
metformin extended-release, XR tabletdrugId:1159 DIABETIC AGENTS
metformin extended-release suspensiondrugId:7457 PA DIABETIC AGENTS
metformin immediate-release solutiondrugId:1161 PA ≥ 13 years DIABETIC AGENTS #
metformin immediate-release tabletdrugId:1158 DIABETIC AGENTS
mifepristone 300 mgdrugId:2519 PA DIABETIC AGENTS
miglitoldrugId:1356 PA DIABETIC AGENTS
melatonin / pyridoxine tabletdrugId:6211 ELECTROLYTES AND NUTRIENTS *
melatonin powderdrugId:7111 PA ELECTROLYTES AND NUTRIENTS
melatonin tablet, solutiondrugId:6210 ELECTROLYTES AND NUTRIENTS *
Mephyton (phytonadione) ELECTROLYTES AND NUTRIENTS BP
Micro-K (potassium chloride-Micro-K) ELECTROLYTES AND NUTRIENTS #
Monoferric (ferric derisomaltose)drugId:7599 PA ELECTROLYTES AND NUTRIENTS
multivitamins / minerals / folic acid / coenzyme Q10-Dekas BariatricdrugId:6605 PA ELECTROLYTES AND NUTRIENTS
multivitaminsdrugId:1399 ELECTROLYTES AND NUTRIENTS *
Mycapssa (octreotide capsule)drugId:7788 PA ENDOCRINE/METABOLIC AGENTS
Mepsevii (vestronidase alfa-vjbk)drugId:6521 PA ENZYMES
migalastatdrugId:6982 PA ENZYMES
miglustatdrugId:1357 PA ENZYMES BP
Mentax (butenafine)drugId:412 FUNGICIDES
miconazole / zinc oxide ointmentdrugId:1353 PA FUNGICIDES
miconazoledrugId:1352 FUNGICIDES *
miconazole buccal tabletdrugId:1966 PA FUNGICIDES
miconazole nitrate powderdrugId:7163 PA FUNGICIDES
magaldrate GASTROINTESTINAL AGENT *
metoclopramide orally disintegrating tabletdrugId:1334 PA GASTROINTESTINAL AGENT
mesalamine capsuledrugId:2720 GI ANTI-INFLAMMATORY #
mesalamine controlled-releasedrugId:1154 GI ANTI-INFLAMMATORY
mesalamine delayed-releasedrugId:1153 GI ANTI-INFLAMMATORY BP
mesalamine enemadrugId:2937 GI ANTI-INFLAMMATORY #
mesalamine extended-releasedrugId:1150 GI ANTI-INFLAMMATORY BP
mesalamine high dose delayed-releasedrugId:1152 GI ANTI-INFLAMMATORY BP
mesalamine kitdrugId:1149 PA GI ANTI-INFLAMMATORY
mesalamine suppositorydrugId:2095 GI ANTI-INFLAMMATORY #
MedroldrugId:967 (methylprednisolone)drugId:967 GLUCOCORTICOIDS #
methylprednisolonedrugId:967 GLUCOCORTICOIDS #
methylprednisolone acetatedrugId:966 GLUCOCORTICOIDS #
methylprednisolone sodium succinatedrugId:964 GLUCOCORTICOIDS #
mometasone cream, solutiondrugId:1382 GLUCOCORTICOIDS
mometasone ointmentdrugId:5024 GLUCOCORTICOIDS
Mitigare (colchicine capsule)drugId:4765 PA GOUT AGENTS BP
methoxy polyethylene glycol / epoetin betadrugId:4784 HEMATINIC AGENT ^
Mircera (methoxy polyethylene glycol / epoetin beta)drugId:4784 HEMATINIC AGENT ^
Mozobil (plerixafor) HEMATINIC AGENT
multivitamin-Dekas EssentialdrugId:5623 PA HEMATINIC AGENT
multivitamins / minerals / coenzyme Q10-AquadeksdrugId:2380 PA HEMATINIC AGENT
multivitamins / minerals / coenzyme Q10-Dekas PlusdrugId:5621 PA HEMATINIC AGENT
multivitamins / minerals / folic acid / coenzyme Q10-AquadeksdrugId:2385 PA HEMATINIC AGENT
multivitamins / minerals / folic acid / coenzyme Q10-Dekas PlusdrugId:5622 PA HEMATINIC AGENT
Mulpleta (lusutrombopag)drugId:6991 PA HEMATOLOGIC
mecasermindrugId:1124 PA HORMONE AGENTS
Miacalcin (calcitonin salmon injection)drugId:4960 PA HORMONE AGENTS
MiacalcindrugId:423 (calcitonin salmon nasal spray-Miacalcin)drugId:423 HORMONE AGENTS #
Makena (hydroxyprogesterone caproate injection-Makena)drugId:2243 PA HORMONE REPLACEMENT THERAPY
medroxyprogesterone / estrogens, conjugated-Premphase HORMONE REPLACEMENT THERAPY
medroxyprogesterone / estrogens, conjugated-Prempro HORMONE REPLACEMENT THERAPY
medroxyprogesterone tablet HORMONE REPLACEMENT THERAPY #
Menest (estrogens,esterified) HORMONE REPLACEMENT THERAPY
Menostar (estradiol-menostar) HORMONE REPLACEMENT THERAPY
methyltestosterone HORMONE REPLACEMENT THERAPY #
Minivelle (estradiol-Minivelle) HORMONE REPLACEMENT THERAPY #
methotrexate oral solutiondrugId:6125 PA IMMUNOMODULATOR
methotrexate subcutaneous injection-OtrexupdrugId:2929 PA IMMUNOMODULATOR
methotrexate subcutaneous injection-RasuvodrugId:4633 PA IMMUNOMODULATOR
methotrexate subcutaneous injection-ReditrexdrugId:7885 PA IMMUNOMODULATOR
mycophenolate mofetildrugId:1410 IMMUNOMODULATOR #
mycophenolic aciddrugId:1409 PA IMMUNOMODULATOR
Myfortic (mycophenolic acid)drugId:1409 PA IMMUNOMODULATOR
magnesium sulfate LAXATIVES
Movantik (naloxegol)drugId:4946 PA LAXATIVES
Moviprep (polyethylene glycol-electrolyte solution-Moviprep)drugId:1551 LAXATIVES BP
mannitol inhalation powderdrugId:7879 PA MUCOLYTICS
Mavenclad (cladribine tablet)drugId:7224 PA MULTIPLE SCLEROSIS AGENTS
monomethyl fumaratedrugId:7717 PA MULTIPLE SCLEROSIS AGENTS
metaxalonedrugId:1156 PA MUSCLE RELAXANT
methocarbamoldrugId:942 PA < 16 years MUSCLE RELAXANT #
modafinil 100 mg; See Table 50drugId:1373; See Table 71drugId:7451 PA < 6 years and PA > 1.5 units/day NARCOLEPSY AGENTS #
modafinil 200 mg; See Table 50drugId:7450; See Table 71drugId:7452 PA < 6 years and PA > 2 units/day NARCOLEPSY AGENTS #
mometasone nasal spraydrugId:1381 PA NASAL PREPARATIONS
mometasone sinus implantdrugId:6684 PA NASAL PREPARATIONS
Monovisc (hyaluronate-Monovisc)drugId:4805 - Non-Drug Product PA NON-DRUG PRODUCT
meclofenamatedrugId:1127 PA NONSTEROIDAL ANTI-INFLAMMATORY
mefenamic aciddrugId:1133 NONSTEROIDAL ANTI-INFLAMMATORY
meloxicam orally disintegrating tabletdrugId:7265 PA NONSTEROIDAL ANTI-INFLAMMATORY
meloxicam suspensiondrugId:2052 PA NONSTEROIDAL ANTI-INFLAMMATORY
meloxicam tabletdrugId:1137 NONSTEROIDAL ANTI-INFLAMMATORY #
MobicdrugId:1137 (meloxicam tablet)drugId:1137 NONSTEROIDAL ANTI-INFLAMMATORY #
Macugen (pegaptanib) OPHTHALMIC PREPARATIONS ^
Maxidex (dexamethasone ophthalmic suspension)drugId:493 OPHTHALMIC PREPARATIONS
MaxitroldrugId:1191 (neomycin / polymyxin B / dexamethasone ophthalmic ointment, suspension)drugId:1191 OPHTHALMIC PREPARATIONS #
metipranololdrugId:1331 OPHTHALMIC PREPARATIONS
Miochol-E (acetylcholine chloride)drugId:1982 OPHTHALMIC PREPARATIONS
Miostat (carbachol 0.01%)drugId:1984 OPHTHALMIC PREPARATIONS
Moxeza (moxifloxacin ophthalmic solution-Moxeza)drugId:2175 PA OPHTHALMIC PREPARATIONS
moxifloxacin ophthalmic solution-MoxezadrugId:2175 PA OPHTHALMIC PREPARATIONS
moxifloxacin ophthalmic solution-VigamoxdrugId:1397 OPHTHALMIC PREPARATIONS #
Mydriacyl (tropicamide) OPHTHALMIC PREPARATIONS #
meperidinedrugId:1144 PA OPIOID ANALGESICS
methadone injectiondrugId:2738 PA OPIOID ANALGESICS
methadone oral-DolophinedrugId:1163 PA OPIOID ANALGESICS
methadone oral-MethadosedrugId:1164 PA OPIOID ANALGESICS
methadone powderdrugId:1162 PA OPIOID ANALGESICS
Methadose (methadone oral-Methadose)drugId:1164 PA OPIOID ANALGESICS
Morphabond ER (morphine extended-release tablet-Morphabond ER)drugId:6124 PA OPIOID ANALGESICS
morphine, injection-Astramorph-PFdrugId:1391 PA > 120 mg/day OPIOID ANALGESICS
morphine, injection-DuramorphdrugId:1392 PA > 120 mg/day OPIOID ANALGESICS
morphine controlled-release tabletdrugId:1389 PA > 120 mg/day OPIOID ANALGESICS #
morphine extended-release capsuledrugId:1385 PA OPIOID ANALGESICS
morphine extended-release tablet-Morphabond ERdrugId:6124 PA OPIOID ANALGESICS
morphine immediate-releasedrugId:1386 PA > 120 mg/day OPIOID ANALGESICS
morphine infusiondrugId:1393 OPIOID ANALGESICS
morphine powderdrugId:1395 PA OPIOID ANALGESICS
morphine suppositoriesdrugId:1387 OPIOID ANALGESICS
MS ContindrugId:1389 (morphine controlled-release tablet)drugId:1389 PA > 120 mg/day OPIOID ANALGESICS #
meropenem / vaborbactamdrugId:6363 PA OTHER ANTIBIOTICS
macimorelindrugId:6920 OTHER HORMONES ^
Macrilen (macimorelin)drugId:6920 OTHER HORMONES ^
metreleptindrugId:2965 PA OTHER HORMONES
Myalept (metreleptin)drugId:2965 PA OTHER HORMONES
Myfembree (relugolix / estradiol / norethindrone)drugId:7922 PA OTHER HORMONES
methylergonovine OXYTOCICS
MestinondrugId:1612 (pyridostigmine bromide)drugId:1612 PARASYMPATHETIC AGENTS #
Mayzent (siponimod)drugId:7184 PA SPHINGOSINE 1-PHOSPHATE RECEPTOR MODULATOR
methimazole THYROID PREPARATIONS #
MaxaltdrugId:1451 (rizatriptan tablet)drugId:1451 PA > 18 units/month TRIPTAN #
Maxalt MLTdrugId:1450 (rizatriptan orally disintegrating tablet)drugId:1450 PA > 18 units/month TRIPTAN #

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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