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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
timothy grass pollen allergen extractdrugId:8501 PA ALLERGENS
Tiglutik (riluzole suspension)drugId:7010 PA AMYOTROPHIC LATERAL SCLEROSIS AGENTS
tramadol / acetaminophendrugId:1737 PA ANALGESICS
tramadol 100 mgdrugId:7359 PA ANALGESICS
tramadol 50 mgdrugId:1735 PA < 12 years and PA > 400 mg/day ANALGESICS #
tramadol extended-release capsuledrugId:2362 PA ANALGESICS
tramadol extended-release tabletdrugId:1736 PA ANALGESICS
tramadol solutiondrugId:8401 PA ANALGESICS
tedizolid injectiondrugId:4636 PA ANTIBIOTICS
tedizolid tabletdrugId:4635 PA ANTIBIOTICS
Teflaro (ceftaroline)drugId:2179 ANTIBIOTICS BP
telavancindrugId:1949 PA ANTIBIOTICS
Terazol (terconazole) ANTIBIOTICS A90, #
terconazole ANTIBIOTICS A90, #
tetracyclinedrugId:1689 ANTIBIOTICS A90
tigecyclinedrugId:1701 PA ANTIBIOTICS
TobidrugId:1713 (tobramycin inhalation solution-Tobi)drugId:1713 ANTIBIOTICS A90, #
Tobi Podhaler (tobramycin inhalation powder)drugId:2794 PA ANTIBIOTICS
tobramycin inhalation powderdrugId:2794 PA ANTIBIOTICS
tobramycin inhalation solution-BethkisdrugId:2884 PA ANTIBIOTICS BP, A90
tobramycin inhalation solution-Kitabis PakdrugId:4781 ANTIBIOTICS BP, A90
tobramycin inhalation solution-TobidrugId:1713 ANTIBIOTICS A90, #
tobramycin injectiondrugId:2630 ANTIBIOTICS
trimethoprim tabletdrugId:4886 ANTIBIOTICS A90
triple antibiotic ointment (neomycin / bacitracin / polymyxin B topical ointment)drugId:1994 ANTIBIOTICS *, A90
Tygacil (tigecycline)drugId:1701 PA ANTIBIOTICS
Tegretol (carbamazepine-Tegretol); See Table 20drugId:170; See Table 71drugId:3280 PA < 6 years ANTICONVULSANTS A90, #
Tegretol XR (carbamazepine extended-release); See Table 20drugId:2192; See Table 71drugId:3220 PA < 6 years ANTICONVULSANTS BP, A90
tiagabinedrugId:2617 PA ANTICONVULSANTS A90
Topamax (topiramate sprinkle capsule); See Table 20drugId:2316; See Table 71drugId:4504 PA < 6 years ANTICONVULSANTS A90, #
Topamax (topiramate tablet); See Table 20drugId:1729; See Table 71drugId:4503 PA < 6 years ANTICONVULSANTS A90, #
topiramate extended-release capsule-Qudexy XR; See Table 20drugId:2943; See Table 71drugId:4502 PA < 6 years ANTICONVULSANTS A90, #
topiramate extended-release capsule-Trokendi XR; See Table 20drugId:2859; See Table 71drugId:4505 PA ANTICONVULSANTS BP, A90
topiramate solution; See Table 20drugId:8189; See Table 71drugId:8190 PA ANTICONVULSANTS
topiramate sprinkle capsule; See Table 20drugId:2316; See Table 71drugId:4504 PA < 6 years ANTICONVULSANTS A90, #
topiramate tablet; See Table 20drugId:1729; See Table 71drugId:4503 PA < 6 years ANTICONVULSANTS A90, #
Trileptal (oxcarbazepine suspension); See Table 20drugId:8201; See Table 71drugId:8202 PA < 6 years ANTICONVULSANTS BP, A90
Trileptal (oxcarbazepine tablet); See Table 20drugId:1311; See Table 71drugId:4442 PA < 6 years ANTICONVULSANTS A90, #
Trokendi XR (topiramate extended-release capsule-Trokendi XR); See Table 20drugId:2859; See Table 71drugId:4505 PA ANTICONVULSANTS BP, A90
tranylcypromine; See Table 17drugId:1741; See Table 71drugId:3540 PA < 6 years ANTIDEPRESSANTS A90
trazodone 300 mg tablet; See Table 17drugId:2062; See Table 71drugId:3862 PA ANTIDEPRESSANTS A90
trazodone 50 mg, 100 mg, 150 mg; See Table 17drugId:1744; See Table 71drugId:3861 PA < 6 years ANTIDEPRESSANTS A90
trimipramine; See Table 17drugId:1765; See Table 71drugId:4160 PA ANTIDEPRESSANTS A90
Trintellix (vortioxetine); See Table 17drugId:2885; See Table 71drugId:3881 PA ANTIDEPRESSANTS
telotristat ethyldrugId:6108 PA ANTIDIARRHEALS
Totect (dexrazoxane) ANTIDOTES
Tigan (trimethobenzamide) ANTIEMETICS A90, #
Transderm-Scop (scopolamine transdermal patch)drugId:1835 ANTIEMETICS BP, A90
trimethobenzamide ANTIEMETICS A90, #
Tretten (factor XIII A-subunit recombinant)drugId:2921 ANTI-HEMOPHILIA AGENTS
tafenoquinedrugId:7261 PA > 2 units/365 days ANTIMALARIALS
talquetamab-tgvsdrugId:8787 PA ANTINEOPLASTICS MB
Talvey (talquetamab-tgvs)drugId:8787 PA ANTINEOPLASTICS MB
teclistamab-cqyvdrugId:8543 PA ANTINEOPLASTICS MB
Tecvayli (teclistamab-cqyv)drugId:8543 PA ANTINEOPLASTICS MB
tremelimumab-actldrugId:8529 PA ANTINEOPLASTICS MB
tinidazoledrugId:1706 ANTIPARASITICS A90
triclabendazoledrugId:7283 PA ANTIPARASITICS
Tasmar (tolcapone)drugId:1722 PA ANTIPARKINSON A90
tolcaponedrugId:1722 PA ANTIPARKINSON A90
trihexyphenidyldrugId:1762 ANTIPARKINSON A90
ticagrelordrugId:2359 ANTIPLATELET AGENT
thioridazine; See Table 24drugId:6328; See Table 71drugId:1694 PA < 6 years ANTIPSYCHOTIC A90
thiothixene; See Table 24drugId:6329; See Table 71drugId:1696 PA < 6 years ANTIPSYCHOTIC A90, #
trifluoperazine; See Table 24drugId:6330; See Table 71drugId:1760 PA < 6 years ANTIPSYCHOTIC A90
TamifludrugId:1303 (oseltamivir 30mg)drugId:1303 PA > 20 units/ claim and PA > 40 units/ 365 days ANTIVIRALS #
TamifludrugId:1305 (oseltamivir 45 mg and 75 mg)drugId:1305 PA > 10 units/ claim and PA > 20 units/ 365 days ANTIVIRALS #
TamifludrugId:2314 (oseltamivir suspension)drugId:2314 PA > 180 mL/ claim and PA > 360 mL/ 365 days ANTIVIRALS #
Temixys (lamivudine / tenofovir disoproxil fumarate)drugId:7277 PA ANTIVIRALS
tenofovir alafenamidedrugId:5768 ANTIVIRALS PD
tenofovir disoproxil fumarate powder; See Table 38drugId:2489; See Table 44drugId:5821 PA ≥ 13 years ANTIVIRALS A90
tenofovir disoproxil fumarate tablet; See Table 38drugId:1669; See Table 44drugId:5820 PA > 1 unit/day ANTIVIRALS A90, #
tipranavirdrugId:1709 ANTIVIRALS
Tivicay (dolutegravir tablet)drugId:2852 PA > 1 unit/day ANTIVIRALS
Tivicay PD (dolutegravir tablet for oral suspension)drugId:7459 ANTIVIRALS
Triumeq (abacavir / dolutegravir / lamivudine)drugId:4642 ANTIVIRALS PD
TrizivirdrugId:139 (abacavir / lamivudine / zidovudine)drugId:139 ANTIVIRALS A90, #
Trogarzo (ibalizumab-uiyk)drugId:6687 PA ANTIVIRALS
TruvadadrugId:597 (emtricitabine / tenofovir disoproxil fumarate)drugId:597 ANTIVIRALS A90, #
Tybost (cobicistat)drugId:4816 ANTIVIRALS
tadalafil tablet-CialisdrugId:2373 PA BENIGN PROSTATIC HYPERPLASIA AGENTS
temazepam 22.5 mg; See Table 69drugId:1666; See Table 71drugId:4351 PA BENZODIAZEPINES
temazepam 7.5 mg, 15 mg, 30 mg; See Table 69drugId:1665; See Table 71drugId:4352 PA < 6 years and PA > 1 unit/day BENZODIAZEPINES #
triazolam; See Table 69drugId:1757; See Table 71drugId:4353 PA < 6 years and PA > 1 unit/day BENZODIAZEPINES #
tetanus toxoids / diphtheria / acellular pertussis / inactivated poliovirus vaccinedrugId:8195 BIOLOGICALS
tick-borne encephalitis vaccinedrugId:8025 BIOLOGICALS
Ticovac (tick-borne encephalitis vaccine)drugId:8025 BIOLOGICALS
Takhzyro (lanadelumab-flyo)drugId:7008 PA BIOLOGICAL
Tenivac (tetanus toxoid / diphtheria vaccine)drugId:1686 BIOLOGICAL 1
Tepezza (teprotumumab-trbw)drugId:7461 PA BIOLOGICAL MB
teprotumumab-trbwdrugId:7461 PA BIOLOGICAL MB
tetanus immune globulin IM, humandrugId:1687 BIOLOGICAL
tetanus toxoid / diphtheria vaccinedrugId:1686 BIOLOGICAL 1
tetanus toxoids / diphtheria / acellular pertussis vaccinedrugId:539 BIOLOGICAL 1
tezepelumab-ekkodrugId:8197 PA BIOLOGICAL
Tezspire (tezepelumab-ekko)drugId:8197 PA BIOLOGICAL
Thymoglobulin (antithymocyte globulin, rabbit)drugId:1111 BIOLOGICAL
Trumenba (meningococcal group B vaccine-Trumenba)drugId:4815 BIOLOGICAL 1
Twinrix (hepatitis A, inactivated / hepatitis B recombinant)drugId:2627 BIOLOGICAL 1
Typhim VI (typhoid vaccine injection)drugId:1771 BIOLOGICAL
typhoid vaccine capsuledrugId:2628 BIOLOGICAL
typhoid vaccine injectiondrugId:1771 BIOLOGICAL
theophyllinedrugId:1691 BRONCHODILATORS M90
tiotropium / olodateroldrugId:5112 PA BRONCHODILATORS
tiotropium inhalation powderdrugId:1708 BRONCHODILATORS BP, A90
tiotropium inhalation solutiondrugId:8057 BRONCHODILATORS
Trelegy (fluticasone furoate / umeclidinium / vilanterol)drugId:6408 PA BRONCHODILATORS
Tudorza (aclidinium)drugId:2649 BRONCHODILATORS
tadalafil tablet-AdcircadrugId:1920 PA CARDIOVASCULAR A90
Tekturna (aliskiren)drugId:13 PA CARDIOVASCULAR BP, M90
Tekturna HCT (aliskiren / hydrochlorothiazide)drugId:14 CARDIOVASCULAR
telmisartan / hydrochlorothiazidedrugId:1663 CARDIOVASCULAR M90, #
telmisartandrugId:1660 CARDIOVASCULAR M90, #
TenoreticdrugId:103 (atenolol / chlorthalidone)drugId:103 CARDIOVASCULAR M90, #
TenormindrugId:102 (atenolol)drugId:102 CARDIOVASCULAR M90, #
terazosin; See Table 18drugId:1670; See Table 19drugId:5165 CARDIOVASCULAR M90
tetradecyl sulfate injectiondrugId:2495 PA CARDIOVASCULAR MB
Thalitone (chlorthalidone)drugId:8168 CARDIOVASCULAR
Tiazac ERdrugId:533 (diltiazem-Tiazac ER)drugId:533 CARDIOVASCULAR M90, #
TikosyndrugId:556 (dofetilide)drugId:556 CARDIOVASCULAR M90, #
timolol tabletdrugId:5020 CARDIOVASCULAR M90
Toprol XLdrugId:1337 (metoprolol extended-release tablet)drugId:1337 CARDIOVASCULAR M90, #
torsemidedrugId:1732 CARDIOVASCULAR M90
Tracleer (bosentan)drugId:372 PA CARDIOVASCULAR BP, A90
trandolapril / verapamildrugId:4812 PA CARDIOVASCULAR M90
trandolaprildrugId:1738 CARDIOVASCULAR M90
treprostinil inhalation powderdrugId:8304 PA CARDIOVASCULAR
treprostinil inhalation solutiondrugId:1746 PA CARDIOVASCULAR
treprostinil injectiondrugId:1745 PA CARDIOVASCULAR BP
treprostinil tabletdrugId:2940 PA CARDIOVASCULAR
triamterenedrugId:5247 PA CARDIOVASCULAR M90
Tribenzor (amlodipine / olmesartan / hydrochlorothiazide)drugId:1969 PA CARDIOVASCULAR M90
Twynsta (amlodipine / telmisartan)drugId:1661 PA CARDIOVASCULAR M90
Tyvaso (treprostinil inhalation solution)drugId:1746 PA CARDIOVASCULAR
Tyvaso DPI (treprostinil inhalation powder)drugId:8304 PA CARDIOVASCULAR
Thiola (tiopronin) CHELATING AGENT BP, A90
trientine capsuledrugId:1759 CHELATING AGENT BP, A90
trientine tabletdrugId:8604 PA CHELATING AGENT
Tabloid (thioguanine)drugId:1693 CHEMOTHERAPY
Tabrecta (capmatinib)drugId:7458 PA CHEMOTHERAPY
tafasitamab-cxixdrugId:7492 PA CHEMOTHERAPY
Tafinlar (dabrafenib)drugId:2823 PA CHEMOTHERAPY
tagraxofusp-erzsdrugId:7182 PA CHEMOTHERAPY MB
Tagrisso (osimertinib)drugId:5301 PA CHEMOTHERAPY
talazoparibdrugId:7045 PA CHEMOTHERAPY
talimogene laherparepvecdrugId:5440 PA CHEMOTHERAPY MB
Talzenna (talazoparib)drugId:7045 PA CHEMOTHERAPY
tamoxifen solutiondrugId:4980 CHEMOTHERAPY
tamoxifen tabletdrugId:1921 CHEMOTHERAPY M90
Tarceva (erlotinib)drugId:619 PA CHEMOTHERAPY A90
Targretin (bexarotene)drugId:361 CHEMOTHERAPY BP, A90
Tasigna (nilotinib)drugId:1216 CHEMOTHERAPY
tazemetostatdrugId:7381 PA CHEMOTHERAPY
Tazverik (tazemetostat)drugId:7381 PA CHEMOTHERAPY
tebentafusp-tebndrugId:8209 PA CHEMOTHERAPY MB
Tecartus (brexucabtagene autoleucel)drugId:7495 PA CHEMOTHERAPY CO, MB
Tecentriq (atezolizumab)drugId:5593 PA CHEMOTHERAPY MB
TemodardrugId:1667 (temozolomide)drugId:1667 CHEMOTHERAPY A90, #
temozolomidedrugId:1667 CHEMOTHERAPY A90, #
temsirolimusdrugId:1668 CHEMOTHERAPY #
teniposidedrugId:2699 CHEMOTHERAPY
Tepmetko (tepotinib)drugId:7797 PA CHEMOTHERAPY
tepotinibdrugId:7797 PA CHEMOTHERAPY
thioguaninedrugId:1693 CHEMOTHERAPY
Tibsovo (ivosidenib)drugId:6925 PA CHEMOTHERAPY
tisagenlecleuceldrugId:6404 PA CHEMOTHERAPY CO, MB
tisotumab vedotin-tftvdrugId:8161 PA CHEMOTHERAPY MB
Tivdak (tisotumab vedotin-tftv)drugId:8161 PA CHEMOTHERAPY MB
tivozanibdrugId:7882 PA CHEMOTHERAPY
topotecan capsuledrugId:1730 CHEMOTHERAPY
topotecan injectiondrugId:8366 CHEMOTHERAPY MB
toremifenedrugId:1731 CHEMOTHERAPY A90, #
ToriseldrugId:1668 (temsirolimus)drugId:1668 CHEMOTHERAPY #
trametinibdrugId:2845 PA CHEMOTHERAPY
trastuzumab / hyaluronidase-oyskdrugId:7782 PA CHEMOTHERAPY MB
trastuzumab-annsdrugId:7784 PA CHEMOTHERAPY MB
trastuzumab-dkstdrugId:7789 PA CHEMOTHERAPY MB
trastuzumab-dttbdrugId:7791 PA CHEMOTHERAPY MB
trastuzumabdrugId:1742 PA CHEMOTHERAPY MB
trastuzumab-pkrbdrugId:7783 PA CHEMOTHERAPY MB
trastuzumab-qyypdrugId:7799 PA CHEMOTHERAPY MB
Trazimera (trastuzumab-qyyp)drugId:7799 PA CHEMOTHERAPY MB
Treanda (bendamustine)drugId:134 CHEMOTHERAPY MB
Trelstar (triptorelin-Trelstar)drugId:1766 PA CHEMOTHERAPY MB
tretinoin capsuledrugId:5135 CHEMOTHERAPY A90
trifluridine / tipiracildrugId:5261 PA CHEMOTHERAPY
trilaciclibdrugId:7897 PA CHEMOTHERAPY MB
triptorelin-TrelstardrugId:1766 PA CHEMOTHERAPY MB
TrisenoxdrugId:2697 (arsenic trioxide)drugId:2697 CHEMOTHERAPY #
Trodelvy (sacituzumab govitecan-hziy)drugId:7397 PA CHEMOTHERAPY MB
Truseltiq (infigratinib)drugId:8026 PA CHEMOTHERAPY
Truxima (rituximab-abbs)drugId:7382 PA CHEMOTHERAPY MB
tucatinibdrugId:7398 PA CHEMOTHERAPY
Tukysa (tucatinib)drugId:7398 PA CHEMOTHERAPY
Turalio (pexidartinib)drugId:7279 PA CHEMOTHERAPY
Tykerb (lapatinib)drugId:1025 CHEMOTHERAPY BP, A90
Tyrvaya (varenicline nasal spray)drugId:8198 PA CHOLINERGIC AGONIST
tenapanordrugId:8208 PA CONSTIPATION AGENTS
Trulance (plecanatide)drugId:6043 PA CONSTIPATION AGENTS
Taytulla (ethinyl estradiol / norethindrone / ferrous fumarate) CONTRACEPTIVES M90, #
Twirla (levonorgestrel / ethinyl estradiol patch) CONTRACEPTIVES
Tyblume (levonorgestrel / ethinyl estradiol) CONTRACEPTIVES
tocilizumab vial COVIDdrugId:7837 COVID - 19 related Treatments and Vaccines MB
tezacaftor / ivacaftordrugId:6540 PA CYSTIC FIBROSIS AGENTS PD
Trikafta (elexacaftor / tezacaftor / ivacaftor)drugId:7278 PA CYSTIC FIBROSIS AGENTS PD
tacrolimus topicaldrugId:1919 DERMATOLOGICAL A90, #
tapinarofdrugId:8309 PA DERMATOLOGICAL
tazarotene 0.1% cream, geldrugId:1657 PA DERMATOLOGICAL A90
tazarotene foamdrugId:2841 PA DERMATOLOGICAL
tazarotene lotiondrugId:7365 PA DERMATOLOGICAL
tretinoin 0.05% geldrugId:2432 PA DERMATOLOGICAL A90
tretinoin 0.05% lotiondrugId:6900 PA ≥ 22 years DERMATOLOGICAL
tretinoin-AvitadrugId:1747 PA ≥ 22 years DERMATOLOGICAL A90, #
tretinoin microspheresdrugId:1749 PA DERMATOLOGICAL A90
tretinoin-Retin-AdrugId:1748 PA ≥ 22 years DERMATOLOGICAL BP, A90
tirzepatide; See Table 26drugId:8254; See Table 81drugId:8792 PA DIABETIC AGENTS
Toujeo (insulin glargine-Toujeo)drugId:4914 DIABETIC AGENTS BP
Tradjenta (linagliptin)drugId:2293 DIABETIC AGENTS
Tresiba (insulin degludec)drugId:5302 DIABETIC AGENTS BP
Trijardy XR (empagliflozin / linagliptin / metformin extended-release)drugId:7396 PA DIABETIC AGENTS
Trulicity (dulaglutide)drugId:4814 PA > 2 mL/28 days DIABETIC AGENTS PD
teplizumab-mzwvdrugId:8544 PA DIABETIC THERAPY
Tzield (teplizumab-mzwv)drugId:8544 PA DIABETIC THERAPY
thiaminedrugId:1692 ELECTROLYTES AND NUTRIENTS *, M90
Travasol (amino acid and electrolyte IV infusion) ELECTROLYTES AND NUTRIENTS
taliglucerase alfadrugId:2558 PA ENZYMES MB
tavaboroledrugId:4629 PA FUNGICIDES A90
terbinafine tabletdrugId:1672 FUNGICIDES A90
tolnaftate cream, powderdrugId:1724 FUNGICIDES *, A90
Tolsura (itraconazole 65 mg capsule)drugId:7011 PA FUNGICIDES
teduglutide injectiondrugId:2722 PA GASTROINTESTINAL AGENT BP
Taclonex (betamethasone / calcipotriene ointment)drugId:7889 PA GLUCOCORTICOIDS A90
Taclonex (betamethasone / calcipotriene scalp suspension)drugId:421 PA GLUCOCORTICOIDS BP, A90
Tarpeyo (budesonide 4 mg delayed-release capsule)drugId:8262 PA GLUCOCORTICOIDS
TemovatedrugId:269 (clobetasol propionate cream, ointment)drugId:269 GLUCOCORTICOIDS A90, #
Topicort (desoximetasone 0.05% cream, ointment)drugId:5021 PA GLUCOCORTICOIDS A90
Topicort (desoximetasone 0.25% ointment, spray, 0.05% gel)drugId:488 PA GLUCOCORTICOIDS A90
triamcinolone, oral GLUCOCORTICOIDS A90
triamcinolone 0.025% cream, lotiondrugId:1753 GLUCOCORTICOIDS A90
triamcinolone 0.05% ointmentdrugId:2527 PA GLUCOCORTICOIDS A90
triamcinolone 0.1% creamdrugId:5029 GLUCOCORTICOIDS A90
triamcinolone 0.1% lotion, 0.025% ointmentdrugId:5028 GLUCOCORTICOIDS A90
triamcinolone 0.1% ointment, 0.5% creamdrugId:5030 GLUCOCORTICOIDS A90
triamcinolone 0.5% ointmentdrugId:5032 GLUCOCORTICOIDS A90
triamcinolone extended-release injectable suspensiondrugId:6415 PA GLUCOCORTICOIDS MB
triamcinolone injectiondrugId:6460 GLUCOCORTICOIDS #
triamcinolone pastedrugId:1754 GLUCOCORTICOIDS A90
triamcinolone spraydrugId:2526 PA GLUCOCORTICOIDS A90
Talicia (omeprazole / amoxicillin / rifabutin)drugId:7380 PA H. PYLORI AGENTS
TBO-filgrastimdrugId:2889 HEMATINIC AGENT
Triferic (ferric pyrophosphate citrate)drugId:6021 HEMATINIC AGENT MB
Tavalisse (fostamatinib)drugId:6823 PA HEMATOLOGIC
tranexamic acid tablet HEMOSTATICS #
teriparatide 600 mcg/2.4 mLdrugId:1678 PA HORMONE AGENTS BP
teriparatide 620 mcg/0.48 mLdrugId:7471 PA HORMONE AGENTS
Triptodur (triptorelin-Triptodur)drugId:6486 PA HORMONE AGENTS
triptorelin-TriptodurdrugId:6486 PA HORMONE AGENTS
Tymlos (abaloparatide)drugId:6362 PA HORMONE AGENTS
Testim (testosterone 1% gel tube)drugId:1684 PA HORMONE REPLACEMENT THERAPY BP
Testopel (testosterone intramuscular pellet)drugId:1685 PA HORMONE REPLACEMENT THERAPY
testosterone 1.62% gel packetdrugId:2280 PA HORMONE REPLACEMENT THERAPY
testosterone 1.62% gel pumpdrugId:7573 PA HORMONE REPLACEMENT THERAPY
testosterone 1% gel packetdrugId:2248 PA HORMONE REPLACEMENT THERAPY
testosterone 1% gel tube, packet, pumpdrugId:2948 PA HORMONE REPLACEMENT THERAPY
testosterone 1% gel tubedrugId:1684 PA HORMONE REPLACEMENT THERAPY BP
testosterone 2% gel pumpdrugId:2241 PA HORMONE REPLACEMENT THERAPY
testosterone 2% solutiondrugId:2237 PA HORMONE REPLACEMENT THERAPY
testosterone cypionatedrugId:1680 PA HORMONE REPLACEMENT THERAPY
testosterone enanthatedrugId:7050 PA HORMONE REPLACEMENT THERAPY
testosterone intramuscular pelletdrugId:1685 PA HORMONE REPLACEMENT THERAPY
testosterone nasal geldrugId:7661 PA HORMONE REPLACEMENT THERAPY
testosterone patchdrugId:1682 PA HORMONE REPLACEMENT THERAPY
testosterone undecanoate capsuledrugId:7371 PA HORMONE REPLACEMENT THERAPY
testosterone undecanoate injectiondrugId:2954 PA HORMONE REPLACEMENT THERAPY MB
Tlando (testosterone undecanoate capsule)drugId:8302 PA HORMONE REPLACEMENT THERAPY
Triluron (hyaluronate-Triluron)drugId:7268 PA HYALURONAN MB
Trivisc (hyaluronate-Trivisc)drugId:6926 PA HYALURONAN MB
tacrolimus extended-release capsuledrugId:2838 IMMUNOMODULATOR
tacrolimus extended-release tabletdrugId:5249 PA IMMUNOMODULATOR
tacrolimus granulesdrugId:7264 PA IMMUNOMODULATOR
tacrolimus immediate-release capsuledrugId:1918 IMMUNOMODULATOR A90, #
tacrolimus injectiondrugId:2741 IMMUNOMODULATOR MB
Taltz (ixekizumab)drugId:5399 PA IMMUNOMODULATOR PD
Tavneos (avacopan)drugId:8159 PA IMMUNOMODULATOR
thalidomidedrugId:1690 IMMUNOMODULATOR BP
Thalomid (thalidomide)drugId:1690 IMMUNOMODULATOR BP
tildrakizumab-asmndrugId:7004 PA IMMUNOMODULATOR
tocilizumab auto-injection, prefilled syringedrugId:8381 PA IMMUNOMODULATOR
tocilizumab vialdrugId:1719 PA IMMUNOMODULATOR MB
tofacitinib extended-releasedrugId:5407 PA IMMUNOMODULATOR
tofacitinibdrugId:2660 PA IMMUNOMODULATOR
tralokinumab-ldrmdrugId:8203 PA IMMUNOMODULATOR
Tremfya (guselkumab)drugId:6289 PA IMMUNOMODULATOR
TricordrugId:467 (fenofibrate 48 mg, 145 mg tablet)drugId:467 LIPID LOWERING AGENTS M90, #
TrilipixdrugId:837 (fenofibric acid)drugId:837 LIPID LOWERING AGENTS M90, #
TecfideradrugId:2793 (dimethyl fumarate)drugId:2793 PA > 2 units/day MULTIPLE SCLEROSIS AGENTS A90, #
teriflunomidedrugId:2657 PA > 1 unit/day MULTIPLE SCLEROSIS AGENTS A90, #
Tysabri (natalizumab)drugId:1177 MULTIPLE SCLEROSIS AGENTS
tizanidine capsuledrugId:1711 PA MUSCLE RELAXANT A90
tizanidine tabletdrugId:1712 MUSCLE RELAXANT A90, #
triamcinolone OTC nasal spraydrugId:6241 PA > 1 inhaler/30 days NASAL PREPARATIONS M90
tetrabenazinedrugId:1688 PA NEUROLOGIC AGENT M90
test strips, blood glucose, all other non-preferreddrugId:8778 - Non-Drug Product PA NON-DRUG PRODUCT
test strips, blood glucose, preferreddrugId:8754 - Non-Drug Product PA NON-DRUG PRODUCT PND
test strips, blood glucose, preferreddrugId:8765 - Non-Drug Product PA > 100 units/30 days NON-DRUG PRODUCT PND
Tegsedi (inotersen)drugId:6988 PA OLIGONUCLEOTIDE AGENTS
tafluprostdrugId:2524 PA OPHTHALMIC PREPARATIONS BP, M90
tetracainedrugId:6367 OPHTHALMIC PREPARATIONS A90
timolol-BetimoldrugId:8180 PA OPHTHALMIC PREPARATIONS
timolol-IstaloldrugId:1703 OPHTHALMIC PREPARATIONS BP, M90
timolol ophthalmic gel forming solutiondrugId:2211 PA OPHTHALMIC PREPARATIONS M90
timolol ophthalmic unit dose solutiondrugId:2210 PA OPHTHALMIC PREPARATIONS BP, M90
timolol-TimopticdrugId:1704 OPHTHALMIC PREPARATIONS M90, #
TimopticdrugId:1704 (timolol-Timoptic)drugId:1704 OPHTHALMIC PREPARATIONS M90, #
Timoptic Ocudose (timolol ophthalmic unit dose solution)drugId:2210 PA OPHTHALMIC PREPARATIONS BP, M90
Timoptic-XE (timolol ophthalmic gel forming solution)drugId:2211 PA OPHTHALMIC PREPARATIONS M90
TobradexdrugId:1717 (tobramycin 0.3% / dexamethasone 0.1%, ophthalmic ointment, suspension)drugId:1717 OPHTHALMIC PREPARATIONS A90, #
Tobradex ST (tobramycin 0.3% / dexamethasone 0.05%, ophthalmic suspension)drugId:2088 OPHTHALMIC PREPARATIONS
tobramycin / loteprednol ophthalmic suspensiondrugId:1718 OPHTHALMIC PREPARATIONS
tobramycin 0.3% / dexamethasone 0.05%, ophthalmic suspensiondrugId:2088 OPHTHALMIC PREPARATIONS
tobramycin 0.3% / dexamethasone 0.1%, ophthalmic ointment, suspensiondrugId:1717 OPHTHALMIC PREPARATIONS A90, #
tobramycin ophthalmic ointment, solutiondrugId:1715 OPHTHALMIC PREPARATIONS A90, #
TobrexdrugId:1715 (tobramycin ophthalmic ointment, solution)drugId:1715 OPHTHALMIC PREPARATIONS A90, #
Travatan Z (travoprost 0.004% eye drop)drugId:1743 OPHTHALMIC PREPARATIONS BP, M90
travoprost 0.004% eye dropdrugId:1743 OPHTHALMIC PREPARATIONS BP, M90
triamcinolone ophthalmic suspension-Triesence OPHTHALMIC PREPARATIONS MB
triamcinolone ophthalmic suspension-Xipere OPHTHALMIC PREPARATIONS MB
Triesence (triamcinolone ophthalmic suspension-Triesence) OPHTHALMIC PREPARATIONS MB
trimethoprim / polymyxin B ophthalmic solutiondrugId:2060 OPHTHALMIC PREPARATIONS A90, #
TrusoptdrugId:563 (dorzolamide)drugId:563 OPHTHALMIC PREPARATIONS M90, #
tapentadol extended-releasedrugId:2369 PA OPIOID ANALGESICS
tapentadoldrugId:1923 PA OPIOID ANALGESICS
tadalafil suspensiondrugId:8542 PA OTHER ANTIHYPERTENSIVES
Tadliq (tadalafil suspension)drugId:8542 PA OTHER ANTIHYPERTENSIVES
tesamorelindrugId:5626 PA OTHER HORMONES
tasimelteondrugId:2960 PA SEDATIVE, NON-BARBITURATE BP, A90
Tascenso ODT (fingolimod orally disintegrating tablet)drugId:8335 PA SPHINGOSINE 1-PHOSPHATE RECEPTOR MODULATOR
Trecator (ethionamide)drugId:2499 TB PREPARATIONS
Tapazole (methimazole) THYROID PREPARATIONS M90, #
Thyquidity (levothyroxine-Thyquidity) THYROID PREPARATIONS
Tirosint (levothyroxine-Tirosint) THYROID PREPARATIONS BP, M90
Tosymra (sumatriptan 10 mg nasal spray)drugId:7335 PA TRIPTAN
tolterodine extended-releasedrugId:1725 URINARY ANTISPASMODICS A90, #
tolterodine immediate-releasedrugId:1726 URINARY ANTISPASMODICS A90, #
Toviaz (fesoterodine)drugId:850 URINARY ANTISPASMODICS BP, A90
trospium extended-releasedrugId:1769 PA URINARY ANTISPASMODICS A90
trospium immediate-releasedrugId:1770 URINARY ANTISPASMODICS A90
tolvaptan-JynarquedrugId:6801 PA VASOPRESSIN ANTAGONISTS
tolvaptan-SamscadrugId:1728 PA VASOPRESSIN ANTAGONISTS BP, A90

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

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Last updated 05/16/24