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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
PrecosedrugId:143 (acarbose)drugId:143 DIABETIC AGENTS #
Proair HFA (albuterol inhaler-Proair HFA)drugId:1 BRONCHODILATORS BP
Prolastin (alpha-1-proteinase inhibitor, human-Prolastin) ENZYMES
Paser (aminosalicylic acid)drugId:2500 TB PREPARATIONS
Pylera (bismuth subcitrate / metronidazole / tetracycline)drugId:367 H. PYLORI AGENTS
Prolensa (bromfenac 0.07%)drugId:2788 OPHTHALMIC PREPARATIONS
ParlodeldrugId:377 (bromocriptine 2.5 mg, 5 mg)drugId:377 ANTIPARKINSON #
Pulmicort (budesonide inhalation powder)drugId:380 BRONCHODILATORS
Phoslyra (calcium acetate) ELECTROLYTES AND NUTRIENTS
PrevalitedrugId:228 (cholestyramine / aspartame-Prevalite)drugId:228 LIPID LOWERING AGENTS #
PlavixdrugId:277 (clopidogrel)drugId:277 ANTIPLATELET AGENT #
Paragard (copper IUD) CONTRACEPTIVES
Pradaxa (dabigatran etexilate mesylate)drugId:5286 ANTICOAGULANTS BP
Prezista (darunavir)drugId:330 ANTIVIRALS BP PD
Prezcobix (darunavir / cobicistat)drugId:4792 ANTIVIRALS PD
Proglycem (diazoxide) DIABETIC AGENTS BP
Pennsaid (diclofenac topical solution)drugId:1944 NONSTEROIDAL ANTI-INFLAMMATORY
Pentacel (diphtheria / tetanus / acellular pertussis / poliovirus inactivated / haemophilus B conjugate vaccine)drugId:581 BIOLOGICAL 1
Pediarix (diphtheria / tetanus toxoids / acellular pertussis / hepatitis B, recombinant / poliovirus, inactivated vaccine)drugId:700 BIOLOGICAL 1
Pifeltro (doravirine)drugId:6986 ANTIVIRALS PD
Pulmozyme (dornase alfa)drugId:562 ENZYMES
Phospholine Iodide (echothiophate)drugId:587 OPHTHALMIC PREPARATIONS
PCE (erythromycin delayed-release tablet-PCE)drugId:5132 ANTIBIOTICS
Prefest (estradiol / norgestimate) HORMONE REPLACEMENT THERAPY
Premarin (estrogens, conjugated) HORMONE REPLACEMENT THERAPY
Parsabiv (etelcalcetide) CALCIMIMETIC ^
Peganone (ethotoin); See Table 20drugId:669; See Table 71drugId:3420 ANTICONVULSANTS
Profilnine SD (factor IX complex human-Profilnine SD) ANTI-HEMOPHILIA AGENTS
PepciddrugId:461 (famotidine tablet)drugId:461 H2 ANTAGONISTS * #
Pred-G (gentamicin / prednisolone ophthalmic suspension)drugId:929 OPHTHALMIC PREPARATIONS
Pedvaxhib (haemophilus B conjugate vaccine-Pedvaxhib)drugId:694 BIOLOGICAL 1
Pandel (hydrocortisone probutate cream)drugId:732 GLUCOCORTICOIDS
PrimaxindrugId:781 (imipenem / cilastatin)drugId:781 ANTIBIOTICS #
Phexxi (lactic acid / citric acid / potassium bitartrate vaginal gel) CONTRACEPTIVES
PrinivildrugId:1087 (lisinopril)drugId:1087 CARDIOVASCULAR #
Proquad (measles / mumps / rubella / varicella virus vaccine)drugId:1122 BIOLOGICAL 1
Premphase (medroxyprogesterone / estrogens, conjugated-Premphase) HORMONE REPLACEMENT THERAPY
Prempro (medroxyprogesterone / estrogens, conjugated-Prempro) HORMONE REPLACEMENT THERAPY
Provera (medroxyprogesterone tablet) HORMONE REPLACEMENT THERAPY #
Pentasa (mesalamine controlled-release)drugId:1154 GI ANTI-INFLAMMATORY
Pamine (methscopolamine) ANTISPASMODICS,ANTICHOLINERGIC #
ProcardiadrugId:2064 (nifedipine capsule)drugId:2064 CARDIOVASCULAR #
Procardia XLdrugId:1215 (nifedipine extended-release)drugId:1215 CARDIOVASCULAR #
paclitaxel injectable suspensiondrugId:1468 CHEMOTHERAPY
paclitaxel injectiondrugId:1467 CHEMOTHERAPY
palifermin ANTIDOTES
pamidronatedrugId:1474 ELECTROLYTES AND NUTRIENTS #
pancrelipase-Creon DRdrugId:1082 ENZYMES
pancrelipase-Pancreaze DRdrugId:2565 ENZYMES
Pancreaze DR (pancrelipase-Pancreaze DR)drugId:2565 ENZYMES
pancrelipase-Pertzye DRdrugId:2730 ENZYMES
Pertzye DR (pancrelipase-Pertzye DR)drugId:2730 ENZYMES
pancrelipase-ViokacedrugId:2597 ENZYMES
pancrelipase-Zenpep DRdrugId:1084 ENZYMES
panitumumabdrugId:1475 CHEMOTHERAPY
pantoprazole IVdrugId:1477 PROTON PUMP INHIBITORS #
Protonix IVdrugId:1477 (pantoprazole IV)drugId:1477 PROTON PUMP INHIBITORS #
paricalcitol injectiondrugId:5781 ELECTROLYTES AND NUTRIENTS ^
paromomycindrugId:1482 ANTIPARASITICS
pediatric multivitaminsdrugId:1487 ELECTROLYTES AND NUTRIENTS *
pegaptanib OPHTHALMIC PREPARATIONS ^
pegaspargasedrugId:2430 CHEMOTHERAPY ^
pegfilgrastimdrugId:1489 HEMATINIC AGENT
pegfilgrastim-apgfdrugId:7617 HEMATINIC AGENT
pegfilgrastim-bmezdrugId:7337 HEMATINIC AGENT
pegfilgrastim-cbqvdrugId:7012 HEMATINIC AGENT
pegfilgrastim-jmdbdrugId:6903 HEMATINIC AGENT
peginterferon alfa-2b-Sylatron ANTIVIRALS
pemetrexeddrugId:1492 CHEMOTHERAPY
penicillamine capsule CHELATING AGENT BP
penicillamine tablet CHELATING AGENT #
penicillin G 0.6 million, 1.2 million, 2.4 million unitsdrugId:2625 ANTIBIOTICS
penicillin G 5 million, 20 million unitsdrugId:1499 ANTIBIOTICS #
PfizerpendrugId:1499 (penicillin G 5 million, 20 million units)drugId:1499 ANTIBIOTICS #
penicillin G benzathine / penicillin G procainedrugId:2624 ANTIBIOTICS
penicillin VdrugId:1500 ANTIBIOTICS
pentamidine ANTIPARASITICS #
pentazocinedrugId:1502 OPIOID ANALGESICS
pentosan ANALGESICS
pentostatindrugId:2692 CHEMOTHERAPY
pentoxifylline CARDIOVASCULAR
perindoprildrugId:1509 CARDIOVASCULAR
permethrindrugId:1510 ANTIPARASITICS *
permethrin creamdrugId:4700 ANTIPARASITICS #
petrolatum DERMATOLOGICAL *
Pfizer COVID-19 vaccine ≥ 16 years of age COVID - 19 related Treatments and Vaccines COVID
Pfizer COVID-19 vaccine COVID EUA – May 10, 2021 for members 12 to 15 years of age COVID - 19 related Treatments and Vaccines COVID
Pfizer COVID-19 vaccine COVID EUA – October 29, 2021 for members 5 to 11 years of age COVID - 19 related Treatments and Vaccines COVID
phenazopyridine ANALGESICS
phenobarbitaldrugId:1516 BARBITURATES
phenylephrine ADRENERGICS
phenylephrine / ketorolac OPHTHALMIC PREPARATIONS ^
phenylephrine / promethazine DECONGESTANT
phenytoin chewable tablet; See Table 20drugId:1523; See Table 71drugId:4520 ANTICONVULSANTS #
phenytoin extended 200 mg and 300 mg capsule; See Table 20drugId:1526; See Table 71drugId:4524 ANTICONVULSANTS
phenytoin extended 30 mg and 100 mg capsule; See Table 20drugId:1525; See Table 71drugId:4523 ANTICONVULSANTS #
phenytoin injectiondrugId:2661 ANTICONVULSANTS ^
phenytoin suspension; See Table 20drugId:2938; See Table 71drugId:4522 ANTICONVULSANTS #
phytonadione ELECTROLYTES AND NUTRIENTS BP
pilocarpine PARASYMPATHETIC AGENTS #
pilocarpine eye dropsdrugId:2635 OPHTHALMIC PREPARATIONS #
pimecrolimusdrugId:1531 DERMATOLOGICAL BP
pindololdrugId:1533 CARDIOVASCULAR
pioglitazonedrugId:1534 DIABETIC AGENTS #
pioglitazone / metformindrugId:1536 DIABETIC AGENTS #
piperacillin / tazobactamdrugId:1537 ANTIBIOTICS #
piperonyl butoxide / pyrethrinsdrugId:1538 ANTIPARASITICS *
piroxicamdrugId:1540 NONSTEROIDAL ANTI-INFLAMMATORY #
plerixafor HEMATINIC AGENT
pneumococcal 13-valent conjugate vaccinedrugId:1542 BIOLOGICAL 1
Prevnar 13 (pneumococcal 13-valent conjugate vaccine)drugId:1542 BIOLOGICAL 1
pneumococcal 15-valent conjugate vaccinedrugId:7983 BIOLOGICAL
pneumococcal 20-valent conjugate vaccinedrugId:7924 BIOLOGICALS
Prevnar 20 (pneumococcal 20-valent conjugate vaccine)drugId:7924 BIOLOGICALS
pneumococcal 23-valent polysaccharide vaccinedrugId:1544 BIOLOGICAL 1
Pneumovax (pneumococcal 23-valent polysaccharide vaccine)drugId:1544 BIOLOGICAL 1
podofiloxdrugId:2261 DERMATOLOGICAL #
poliovirus vaccine, inactivateddrugId:1546 BIOLOGICAL 1
polyethylene glycol 3350drugId:1547 LAXATIVES *
polyethylene glycol-electrolyte solution-GolytelydrugId:1549 LAXATIVES #
polyethylene glycol-electrolyte solution-MoviprepdrugId:1551 LAXATIVES BP
polyethylene glycol-electrolyte solution-NulytelydrugId:1552 LAXATIVES #
polyethylene glycol-electrolyte solution-PlenvudrugId:7137 LAXATIVES
Plenvu (polyethylene glycol-electrolyte solution-Plenvu)drugId:7137 LAXATIVES
potassium bicarbonate ELECTROLYTES AND NUTRIENTS
potassium chloride injection ELECTROLYTES AND NUTRIENTS
potassium chloride-K-Tab ELECTROLYTES AND NUTRIENTS
potassium chloride-Kaochlor ELECTROLYTES AND NUTRIENTS
potassium chloride-Kaon-CL ELECTROLYTES AND NUTRIENTS
potassium chloride-Klor-Con ELECTROLYTES AND NUTRIENTS #
potassium chloride-Micro-K ELECTROLYTES AND NUTRIENTS #
potassium citrate ELECTROLYTES AND NUTRIENTS #
potassium citrate / citric acid ELECTROLYTES AND NUTRIENTS
potassium citrate / sodium citrate / citric acid ELECTROLYTES AND NUTRIENTS
potassium phosphate ELECTROLYTES AND NUTRIENTS *
potassium phosphate / dibasic sodium phosphate / monobasic sodium phosphate ELECTROLYTES AND NUTRIENTS
potassium phosphate / sodium phosphate ELECTROLYTES AND NUTRIENTS
potassium phosphate / sodium phosphate / phosphorus ELECTROLYTES AND NUTRIENTS
povidonedrugId:1567 ANTISEPTICS *
pralatrexatedrugId:1568 CHEMOTHERAPY
pramipexoledrugId:1569 ANTIPARKINSON #
pramlintidedrugId:1570 DIABETIC AGENTS
prasugreldrugId:1571 ANTIPLATELET AGENT #
praziquanteldrugId:2358 ANTIPARASITICS BP
prazosin; See Table 18drugId:1573; See Table 19drugId:5164 CARDIOVASCULAR #
prednicarbate cream, ointmentdrugId:1574 GLUCOCORTICOIDS
prednisolone 15 mg/5 mL, 25 mg/5 mL oral solutiondrugId:1576 GLUCOCORTICOIDS
prednisolone 5 mg/5 mL oral solutiondrugId:1578 GLUCOCORTICOIDS #
PediapreddrugId:1578 (prednisolone 5 mg/5 mL oral solution)drugId:1578 GLUCOCORTICOIDS #
prednisolone acetate 0.12% ophthalmic suspensiondrugId:5001 OPHTHALMIC PREPARATIONS
Pred Mild (prednisolone acetate 0.12% ophthalmic suspension)drugId:5001 OPHTHALMIC PREPARATIONS
prednisolone acetate 1% ophthalmic suspensiondrugId:1580 OPHTHALMIC PREPARATIONS #
Pred FortedrugId:1580 (prednisolone acetate 1% ophthalmic suspension)drugId:1580 OPHTHALMIC PREPARATIONS #
prednisolone sodium phosphate ophthalmic solutiondrugId:2618 OPHTHALMIC PREPARATIONS
prednisolone tabletdrugId:2199 GLUCOCORTICOIDS
prednisonedrugId:1581 GLUCOCORTICOIDS
prenatal vitaminsdrugId:1583 ELECTROLYTES AND NUTRIENTS *
primaquine ANTIMALARIALS
primidone; See Table 20drugId:1586; See Table 71drugId:4461 ANTICONVULSANTS #
probeneciddrugId:1587 GOUT AGENTS
probenecid / colchicinedrugId:287 GOUT AGENTS
procarbazinedrugId:1589 CHEMOTHERAPY
prochlorperazine ANTIEMETICS
progesterone capsule HORMONE REPLACEMENT THERAPY BP
Prometrium (progesterone capsule) HORMONE REPLACEMENT THERAPY BP
progesterone injection PROGESTERONE
promethazinedrugId:1593 ANTIHISTAMINES #
PhenergandrugId:1593 (promethazine)drugId:1593 ANTIHISTAMINES #
propafenone extended-releasedrugId:7637 CARDIOVASCULAR #
propafenone immediate-releasedrugId:1594 CARDIOVASCULAR
propantheline URINARY ANTISPASMODICS
proparacaine OPHTHALMIC PREPARATIONS
propranolol / hydrochlorothiazidedrugId:1603 CARDIOVASCULAR
propranolol extended-releasedrugId:1601 CARDIOVASCULAR #
propranolol immediate-releasedrugId:1600 CARDIOVASCULAR
propylthiouracil THYROID PREPARATIONS
prothrombin complex concentrate, human HEMOSTATICS
psylliumdrugId:1610 CONSTIPATION AGENTS *
pyrantel pamoatedrugId:6215 ANTIPARASITICS
Pin-X (pyrantel pamoate)drugId:6215 ANTIPARASITICS
pyrazinamidedrugId:1611 ANTIBIOTICS
pyridostigmine bromidedrugId:1612 PARASYMPATHETIC AGENTS #
pyridoxinedrugId:1613 ELECTROLYTES AND NUTRIENTS *
Priftin (rifapentine)drugId:2501 TB PREPARATIONS
Pulmosal (sodium chloride 7% for inhalation) - Non-Drug Product NON-DRUG PRODUCT
Phos-Flur (sodium fluoride oral rinse) ELECTROLYTES AND NUTRIENTS
PrografdrugId:1918 (tacrolimus immediate-release capsule)drugId:1918 IMMUNOMODULATOR #
Prograf (tacrolimus injection)drugId:2741 IMMUNOMODULATOR ^
Protopic (tacrolimus topical)drugId:1919 DERMATOLOGICAL BP
PolytrimdrugId:2060 (trimethoprim / polymyxin B ophthalmic solution)drugId:2060 OPHTHALMIC PREPARATIONS #
perampanel; See Table 20drugId:7566; See Table 71drugId:7567 PA ANTICONVULSANTS
pregabalin; See Table 20drugId:1582; See Table 71drugId:4460 PA ANTICONVULSANTS
Praluent (alirocumab)drugId:5119 PA LIPID LOWERING AGENTS
pitavastatin calciumdrugId:1962 PA LIPID LOWERING AGENTS
pitavastatin magnesiumdrugId:7109 PA LIPID LOWERING AGENTS
pravastatin 10 mg, 20 mg, 40 mgdrugId:2736 PA > 1.5 units/day LIPID LOWERING AGENTS #
PravacholdrugId:2736 (pravastatin 10 mg, 20 mg, 40 mg)drugId:2736 PA > 1.5 units/day LIPID LOWERING AGENTS #
PercocetdrugId:1323 (oxycodone / acetaminophen-Percocet)drugId:1323 PA > 80 mg/day OPIOID ANALGESICS #
palonosetron 0.25 mg/2 mL injectiondrugId:6614 PA > 2 units/28 days ANTIEMETICS
palonosetron 0.25 mg/5 mL injectiondrugId:1473 PA > 2 units/28 days ANTIEMETICS #
Picato (ingenol gel)drugId:2521 PA DERMATOLOGICAL
pyrimethaminedrugId:1614 PA ANTIMALARIALS BP
peginterferon alfa-2adrugId:2059 PA ANTIVIRALS
Pegasys (peginterferon alfa-2a)drugId:2059 PA ANTIVIRALS
peginterferon alfa-2bdrugId:1490 PA ANTIVIRALS
Pegintron (peginterferon alfa-2b)drugId:1490 PA ANTIVIRALS
Prilosec (omeprazole suspension)drugId:2054 PA PROTON PUMP INHIBITORS
pantoprazole 40 mg suspensiondrugId:2702 PA PROTON PUMP INHIBITORS BP
Protonix (pantoprazole 40 mg suspension)drugId:2702 PA PROTON PUMP INHIBITORS BP
Prevacid Solutab (lansoprazole orally disintegrating tablet)drugId:1022 PA ≥ 2 years PROTON PUMP INHIBITORS BP
PrevaciddrugId:1021 (lansoprazole capsule)drugId:1021 PA > 1 unit/day PROTON PUMP INHIBITORS #
pantoprazole tabletdrugId:1476 PA > 4 units/day PROTON PUMP INHIBITORS #
ProtonixdrugId:1476 (pantoprazole tablet)drugId:1476 PA > 4 units/day PROTON PUMP INHIBITORS #
Proscar (finasteride)drugId:857 PA BENIGN PROSTATIC HYPERPLASIA AGENTS
Probuphine (buprenorphine implant)drugId:5591 PA ALCOHOL AND DRUG CESSATION AGENT
penciclovirdrugId:1495 PA ANTIVIRALS
Prozac Weekly (fluoxetine 90 mg delayed-release capsule); See Table 17drugId:880; See Table 71drugId:3720 PA ANTIDEPRESSANTS
paroxetine controlled-release; See Table 17drugId:1485; See Table 71drugId:3800 PA ANTIDEPRESSANTS
Paxil CR (paroxetine controlled-release); See Table 17drugId:1485; See Table 71drugId:3800 PA ANTIDEPRESSANTS
paroxetine mesylate; See Table 17drugId:1483; See Table 71drugId:3802 PA ANTIDEPRESSANTS
Pexeva (paroxetine mesylate); See Table 17drugId:1483; See Table 71drugId:3802 PA ANTIDEPRESSANTS
Prozac (fluoxetine 10 mg, 20 mg, 40 mg capsule, solution); See Table 17drugId:879; See Table 71drugId:3721 PA < 6 years ANTIDEPRESSANTS #
paroxetine hydrochloride; See Table 17drugId:1484; See Table 71drugId:3801 PA < 6 years ANTIDEPRESSANTS #
Paxil (paroxetine hydrochloride); See Table 17drugId:1484; See Table 71drugId:3801 PA < 6 years ANTIDEPRESSANTS #
Pristiq (desvenlafaxine succinate extended-release); See Table 17drugId:490; See Table 71drugId:3940 PA < 6 years and PA > 1 unit/day ANTIDEPRESSANTS #
peginterferon beta-1adrugId:4631 PA MULTIPLE SCLEROSIS AGENTS
Plegridy (peginterferon beta-1a)drugId:4631 PA MULTIPLE SCLEROSIS AGENTS
ponesimoddrugId:7794 PA SPHINGOSINE 1-PHOSPHATE RECEPTOR MODULATOR
Ponvory (ponesimod)drugId:7794 PA SPHINGOSINE 1-PHOSPHATE RECEPTOR MODULATOR
posaconazoledrugId:2928 PA FUNGICIDES BP
Procysbi (cysteamine delayed-release capsule)drugId:2861 PA ENZYMES
Procysbi (cysteamine delayed-release granule)drugId:7374 PA ENZYMES
Prudoxin (doxepin cream-Prudoxin)drugId:568 PA DERMATOLOGICAL
Pred-G (gentamicin / prednisolone ophthalmic ointment)drugId:7963 PA OPHTHALMIC PREPARATIONS
Prevymis (letermovir)drugId:6615 PA ANTIVIRALS
palivizumabdrugId:1472 PA ANTIVIRALS
paricalcitol capsuledrugId:1481 PA ELECTROLYTES AND NUTRIENTS
paroxetine 7.5 mg capsuledrugId:2839 PA UNCLASSIFIED DRUG PRODUCTS
pasireotidedrugId:2791 PA ENDOCRINE/METABOLIC AGENTS
pasireotide injectable suspensiondrugId:4912 PA ENDOCRINE/METABOLIC AGENTS
patisirandrugId:6985 PA SMALL INTERFERING RNA AGENTS PD
peanut allergen powder-dnfpdrugId:7373 PA ALLERGENS
Palforzia (peanut allergen powder-dnfp)drugId:7373 PA ALLERGENS
pegcetacoplandrugId:7919 PA BIOLOGICAL
pegvaliase-pqpzdrugId:6923 PA ENZYMES
Palynziq (pegvaliase-pqpz)drugId:6923 PA ENZYMES
pegvisomantdrugId:1491 PA HORMONE AGENTS
pentazocine / naloxonedrugId:1504 PA OPIOID ANALGESICS
phenoxybenzaminedrugId:5123 PA CARDIOVASCULAR
pimavanserindrugId:5588 PA ANTIPSYCHOTIC
polidocanoldrugId:2934 PA CARDIOVASCULAR ^
pramipexole extended-releasedrugId:1943 PA ANTIPARKINSON
prednisolone 10 mg/5 mL oral solutiondrugId:1575 PA GLUCOCORTICOIDS
prednisolone 20 mg/5 mL oral solutiondrugId:1579 PA GLUCOCORTICOIDS
prednisolone orally disintegrating tabletdrugId:1577 PA GLUCOCORTICOIDS
prednisone delayed-releasedrugId:2645 PA GLUCOCORTICOIDS
pretomaniddrugId:7568 PA TB PREPARATIONS
propranolol long-acting capsuledrugId:6562 PA CARDIOVASCULAR
propranolol solutiondrugId:2959 PA CARDIOVASCULAR
protein C concentratedrugId:1605 PA HEMATINIC AGENT
pyridostigmine bromide 30 mg tabletdrugId:7226 PA PARASYMPATHETIC AGENTS
pyridoxine crystalsdrugId:7341 PA ELECTROLYTES AND NUTRIENTS
Prograf (tacrolimus granules)drugId:7264 PA IMMUNOMODULATOR
Prialt (ziconotide)drugId:1819 PA ANALGESICS
pravastatin 80 mgdrugId:1572 PA > 1 unit/day LIPID LOWERING AGENTS #
PravacholdrugId:1572 (pravastatin 80 mg)drugId:1572 PA > 1 unit/day LIPID LOWERING AGENTS #
pseudoephedrinedrugId:1607 PA > 240 mg/day DECONGESTANT *
patiromerdrugId:5320 PA > 30 units/month CHELATING AGENT
pregabalin extended-release; See Table 71drugId:6609; See Table 72drugId:6608 PA GABA ANALOGS BP
plecanatidedrugId:6043 PA CONSTIPATION AGENTS
prucalopridedrugId:7136 PA CONSTIPATION AGENTS
pitolisantdrugId:7356 PA NARCOLEPSY AGENTS
Provigil (modafinil 100 mg); See Table 50drugId:1373; See Table 71drugId:7451 PA < 6 years and PA > 1.5 units/day NARCOLEPSY AGENTS #
Provigil (modafinil 200 mg); See Table 50drugId:7450; See Table 71drugId:7452 PA < 6 years and PA > 2 units/day NARCOLEPSY AGENTS #
Pamelor (nortriptyline); See Table 17drugId:1262; See Table 71drugId:4120 PA < 6 years ANTIDEPRESSANTS #
phenelzine; See Table 17drugId:1515; See Table 71drugId:3580 PA < 6 years ANTIDEPRESSANTS #
protriptyline; See Table 17drugId:1606; See Table 71drugId:4140 PA < 6 years ANTIDEPRESSANTS
progesterone geldrugId:2587 PA HORMONE REPLACEMENT THERAPY
paliperidone tablet; See Table 24drugId:1471; See Table 71drugId:4280 PA ANTIPSYCHOTIC BP
Perseris (risperidone extended-release subcutaneous injection); See Table 24drugId:7007; See Table 71drugId:7009 PA ANTIPSYCHOTIC
paliperidone extended-release 1-month injection; See Table 24drugId:1470; See Table 71drugId:4281 PA < 6 years, PA > 2 injections/month within the first 30 days of therapy and PA > 1 injection/month after 30 days of therapy ANTIPSYCHOTIC PD
perphenazine; See Table 24drugId:6326; See Table 71drugId:1511 PA < 6 years ANTIPSYCHOTIC
pimozide; See Table 24drugId:6327; See Table 71drugId:1532 PA < 6 years ANTIPSYCHOTIC #
paliperidone extended-release 3-month injection; See Table 24drugId:5121; See Table 71drugId:5122 PA < 6 years and PA > 1 injection/3 months ANTIPSYCHOTIC PD
Procrit (epoetin alfa-Procrit)drugId:611 PA HEMATINIC AGENT
Promacta (eltrombopag)drugId:594 PA HEMATINIC AGENT
Piqray (alpelisib)drugId:7225 PA CHEMOTHERAPY
Padcev (enfortumab vedotin-ejfv)drugId:7351 PA CHEMOTHERAPY
Pepaxto (melphalan flufenamide)drugId:7884 PA CHEMOTHERAPY
Purixan (mercaptopurine oral suspension)drugId:4632 PA CHEMOTHERAPY
Poteligeo (mogamulizumab-kpkc)drugId:6924 PA CHEMOTHERAPY
Portrazza (necitumumab)drugId:5420 PA CHEMOTHERAPY
palbociclibdrugId:4940 PA CHEMOTHERAPY PD
panobinostatdrugId:5105 PA CHEMOTHERAPY
pazopanibdrugId:1486 PA CHEMOTHERAPY
pembrolizumabdrugId:4780 PA CHEMOTHERAPY
pemigatinibdrugId:7455 PA CHEMOTHERAPY
Pemazyre (pemigatinib)drugId:7455 PA CHEMOTHERAPY
pertuzumabdrugId:2583 PA CHEMOTHERAPY
Perjeta (pertuzumab)drugId:2583 PA CHEMOTHERAPY
pertuzumab / trastuzumab / hyaluronidase-zzxfdrugId:7618 PA CHEMOTHERAPY
Phesgo (pertuzumab / trastuzumab / hyaluronidase-zzxf)drugId:7618 PA CHEMOTHERAPY
pexidartinibdrugId:7279 PA CHEMOTHERAPY
polatuzumab vedotin-piiqdrugId:7263 PA CHEMOTHERAPY
Polivy (polatuzumab vedotin-piiq)drugId:7263 PA CHEMOTHERAPY
pomalidomidedrugId:2787 PA CHEMOTHERAPY
Pomalyst (pomalidomide)drugId:2787 PA CHEMOTHERAPY
ponatinibdrugId:2724 PA CHEMOTHERAPY
pralsetinibdrugId:7660 PA CHEMOTHERAPY
Prolia (denosumab-Prolia)drugId:1967 PA BIOLOGICAL
parathyroid hormonedrugId:5107 PA HORMONE AGENTS
pegloticasedrugId:6294 PA GOUT AGENTS
plazomicindrugId:7014 PA ANTIBIOTICS
Proair Digihaler (albuterol inhalation powder-Proair Digihaler)drugId:7352 PA BRONCHODILATORS
Proair Respiclick (albuterol inhalation powder-Proair Respiclick)drugId:5109 PA BRONCHODILATORS
Proventil (albuterol inhaler-Proventil)drugId:2 PA BRONCHODILATORS
Perforomist (formoterol)drugId:906 PA BRONCHODILATORS BP
PulmicortdrugId:381 (budesonide inhalation suspension)drugId:381 PA ≥ 13 years BRONCHODILATORS #
Patanase (olopatadine nasal spray)drugId:1283 PA NASAL PREPARATIONS
pirfenidonedrugId:4767 PA PULMONARY FIBROSIS AGENTS
Provenge (sipuleucel-T)drugId:2288 PA CHEMOTHERAPY ^
Panzyga (immune globulin IV, human-ifas)drugId:7104 PA BIOLOGICAL
Privigen (immune globulin IV, human-Privigen)drugId:2197 PA BIOLOGICAL

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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