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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
abacavir / dolutegravir / lamivudinedrugId:4642 ANTIVIRALS PD
abacavir / lamivudine / zidovudinedrugId:139 ANTIVIRALS A90, #
abacavir / lamivudinedrugId:138 ANTIVIRALS A90, #
abacavirdrugId:137 ANTIVIRALS A90, #
abaloparatidedrugId:6362 PA HORMONE AGENTS
abatacept auto-injection, prefilled syringedrugId:8383 PA IMMUNOMODULATOR
abatacept vialdrugId:140 PA IMMUNOMODULATOR MB
Abecma (idecabtagene vicleucel)drugId:7877 PA CHEMOTHERAPY CO, MB
Abelcet (amphotericin B lipid complex) ANTIBIOTICS
abemaciclibdrugId:6410 PA CHEMOTHERAPY
Abilify (aripiprazole tablet); See Table 24drugId:90; See Table 71drugId:4180 PA < 6 years and PA > 2 units/day ANTIPSYCHOTIC A90, #
Abilify Asimtufii (aripiprazole extended-release injection); See Table 24drugId:8601; See Table 71drugId:8602 PA ANTIPSYCHOTIC
Abilify Maintena (aripiprazole extended-release injection); See Table 24drugId:2717; See Table 71drugId:4200 PA ANTIPSYCHOTIC
Abilify Mycite (aripiprazole tablet with sensor); See Table 24drugId:7230; See Table 71drugId:7231 PA ANTIPSYCHOTIC
abiraterone 125 mgdrugId:6824 PA CHEMOTHERAPY
abiraterone 250 mg, 500 mgdrugId:8292 PA CHEMOTHERAPY A90
abobotulinumtoxinAdrugId:141 PA BIOLOGICAL
Abraxane (paclitaxel injectable suspension)drugId:1468 CHEMOTHERAPY MB
Abrilada (adalimumab-afzb)drugId:8694 PA IMMUNOMODULATOR
abrocitinibdrugId:8205 PA IMMUNOMODULATOR
Abrysvo (respiratory syncytial virus vaccine)drugId:8619 PA < 60 years BIOLOGICAL
Absorica (isotretinoin-Absorica)drugId:2881 PA DERMATOLOGICAL BP, A90
Absorica LD (isotretinoin micronized)drugId:7368 PA DERMATOLOGICAL A90
acalabrutinibdrugId:6483 PA CHEMOTHERAPY
Acanya (clindamycin / benzoyl peroxide-Acanya)drugId:262 PA DERMATOLOGICAL A90
acarbosedrugId:143 DIABETIC AGENTS M90, #
Accolate (zafirlukast)drugId:1816 PA BRONCHODILATORS M90
Accrufer (ferric maltol)drugId:7918 PA HEMATINIC AGENT
AccunebdrugId:168 (albuterol inhalation solution)drugId:168 BRONCHODILATORS A90, #
AccuprildrugId:1620 (quinapril)drugId:1620 CARDIOVASCULAR M90, #
AccureticdrugId:1621 (quinapril / hydrochlorothiazide)drugId:1621 CARDIOVASCULAR M90, #
acebutololdrugId:144 CARDIOVASCULAR M90
Acetadote (acetylcysteine injection) ANTIDOTES MB
acetaminophen / codeinedrugId:146 PA < 12 years and PA > 4 g/day acetaminophen and PA > 360 mg/day codeine OPIOID ANALGESICS
acetaminophendrugId:145 PA > 4 g/day ANALGESICS *, A90
acetazolamidedrugId:147 CARDIOVASCULAR A90
acetic acid / hydrocortisonedrugId:149 OTIC PREPARATIONS A90
acetic aciddrugId:148 OTIC PREPARATIONS A90
acetohydroxamic acid ANTIBIOTICS
acetylcholine chloridedrugId:1982 OPHTHALMIC PREPARATIONS MB
acetylcysteine MUCOLYTICS
acetylcysteine injection ANTIDOTES MB
AciphexdrugId:1624 (rabeprazole delayed-release tablet)drugId:1624 PA > 1 unit/day PROTON PUMP INHIBITORS M90, #
Aciphex Sprinkle (rabeprazole delayed-release capsule)drugId:2882 PA PROTON PUMP INHIBITORS
acitretindrugId:153 DERMATOLOGICAL A90
aclidiniumdrugId:2649 BRONCHODILATORS
aclidinium / formoteroldrugId:7330 PA BRONCHODILATORS
Actemra (tocilizumab auto-injection, prefilled syringe)drugId:8381 PA IMMUNOMODULATOR
Actemra (tocilizumab vial)drugId:1719 PA IMMUNOMODULATOR MB
Actemra (tocilizumab vial COVID)drugId:7837 COVID - 19 related Treatments and Vaccines MB
Acthar (corticotropin)drugId:294 PA HORMONE AGENTS
Acthib (haemophilus B conjugate vaccine-Acthib)drugId:693 BIOLOGICAL 1
Actimmune (interferon gamma-1b)drugId:829 CHEMOTHERAPY
Actiq (fentanyl transmucosal system)drugId:844 PA OPIOID ANALGESICS
Activella (estradiol / norethindrone-Activella) HORMONE REPLACEMENT THERAPY M90, #
Actonel (risedronate)drugId:1439 PA ELECTROLYTES AND NUTRIENTS M90
Actoplus MetdrugId:1536 (pioglitazone / metformin)drugId:1536 DIABETIC AGENTS M90, #
ActosdrugId:1534 (pioglitazone)drugId:1534 DIABETIC AGENTS M90, #
AculardrugId:2270 (ketorolac 0.5% ophthalmic solution)drugId:2270 OPHTHALMIC PREPARATIONS A90, #
Acular LSdrugId:2271 (ketorolac 0.4% ophthalmic solution)drugId:2271 OPHTHALMIC PREPARATIONS A90, #
Acuvail (ketorolac 0.45% ophthalmic solution)drugId:999 OPHTHALMIC PREPARATIONS
acyclovir / hydrocortisonedrugId:1973 DERMATOLOGICAL BP
acyclovir buccal tabletdrugId:2945 PA ANTIVIRALS
acyclovir capsule, tabletdrugId:155 ANTIVIRALS A90
acyclovir creamdrugId:157 ANTIVIRALS BP, A90
acyclovir injectiondrugId:2744 ANTIVIRALS
acyclovir ointmentdrugId:156 ANTIVIRALS #
acyclovir suspensiondrugId:7997 ANTIVIRALS A90, #
Aczone (dapsone gel)drugId:325 PA DERMATOLOGICAL A90
Adacel (tetanus toxoids / diphtheria / acellular pertussis vaccine)drugId:539 BIOLOGICAL 1
adagrasibdrugId:8530 PA ANTINEOPLASTICS
Adakveo (crizanlizumab-tmca)drugId:7326 PA HEMATOLOGIC MB
adalimumab-aacf, unbrandeddrugId:8695 PA IMMUNOMODULATOR
adalimumab-aacfdrugId:8710 PA IMMUNOMODULATOR
adalimumab-aatydrugId:8730 PA IMMUNOMODULATOR
adalimumab-adaz, unbrandeddrugId:8696 PA IMMUNOMODULATOR
adalimumab-adazdrugId:8709 PA IMMUNOMODULATOR
adalimumab-adbm, unbrandeddrugId:8697 PA IMMUNOMODULATOR
adalimumab-adbmdrugId:8703 PA IMMUNOMODULATOR
adalimumab-afzbdrugId:8694 PA IMMUNOMODULATOR
adalimumab-aqvhdrugId:8731 PA IMMUNOMODULATOR
adalimumab-attodrugId:8700 PA IMMUNOMODULATOR
adalimumabdrugId:158 PA IMMUNOMODULATOR BP, PD
adalimumab-bwwddrugId:8707 PA IMMUNOMODULATOR
adalimumab-fkjp, unbrandeddrugId:8698 PA IMMUNOMODULATOR
adalimumab-fkjpdrugId:8708 PA IMMUNOMODULATOR
adapalene 0.1% / benzoyl peroxide 2.5%drugId:160 PA DERMATOLOGICAL A90
adapalene 0.3% / benzoyl peroxide 2.5%drugId:8077 PA DERMATOLOGICAL A90
adapalenedrugId:7678 PA DERMATOLOGICAL A90
Adbry (tralokinumab-ldrm)drugId:8203 PA IMMUNOMODULATOR
Adcetris (brentuximab)drugId:2374 PA CHEMOTHERAPY MB
Adcirca (tadalafil tablet-Adcirca)drugId:1920 PA CARDIOVASCULAR A90
Adderall (amphetamine salts); See Table 31drugId:60; See Table 71drugId:3100 PA < 3 years or ≥ 21 years and PA > 3 units/day CEREBRAL STIMULANTS #
Adderall XR (amphetamine salts extended-release-Adderall XR); See Table 31drugId:59; See Table 71drugId:3000 PA < 3 years or ≥ 21 years and PA > 2 units/day CEREBRAL STIMULANTS BP
adefovirdrugId:161 PA > 1 unit/day ANTIVIRALS A90, #
Adek Gummies (multivitamins / zinc gummy)drugId:8674 PA ELECTROLYTES AND NUTRIENTS M90
Adempas (riociguat)drugId:2883 PA CARDIOVASCULAR
adenovirus live vaccine delayed-release oral tabletsdrugId:2837 BIOLOGICAL
Adipex-P (phentermine 37.5 mg capsule, tablet)drugId:8662 PA ANTI-OBESITY AGENTS
Adlarity (donepezil patch); See Table 56drugId:8293; See Table 71drugId:8294 PA ALZHEIMER'S THERAPY
Adlyxin (lixisenatide)drugId:5760 PA DIABETIC AGENTS
Admelog (insulin lispro-Admelog)drugId:6660 PA DIABETIC AGENTS
ado-trastuzumabdrugId:2781 PA CHEMOTHERAPY MB
Adrenalin (epinephrine injection)drugId:606 ADRENERGICS
Adriamycin (doxorubicin)drugId:571 CHEMOTHERAPY MB
Adstiladrin (nadofaragene firadenovec-vncg)drugId:8644 PA ANTINEOPLASTICS MB
aducanumab-avwadrugId:8110 PA BIOLOGICAL
Aduhelm (aducanumab-avwa)drugId:8110 PA BIOLOGICAL
Advair (fluticasone / salmeterol inhalation-Advair)drugId:896 BRONCHODILATORS BP, A90
Advate (antihemophilic factor, recombinant-Advate)drugId:71 ANTI-HEMOPHILIA AGENTS
Adynovate (antihemophilic factor, recombinant pegylated-Adynovate)drugId:5220 ANTI-HEMOPHILIA AGENTS
Adzenys XR-ODT (amphetamine extended-release orally disintegrating tablet); See Table 31drugId:5360; See Table 71drugId:5361 PA CEREBRAL STIMULANTS
Aemcolo (rifamycin)drugId:8339 PA ANTIBIOTICS
afamelanotidedrugId:8115 PA DERMATOLOGICAL MB
afatinibdrugId:2843 PA CHEMOTHERAPY
Afinitor (everolimus 2.5 mg, 5 mg, 7.5 mg, 10 mg); See Table 20drugId:448; See Table 57drugId:1954 PA CHEMOTHERAPY BP, A90
Afinitor Disperz (everolimus tablets for oral suspension); See Table 20drugId:6880; See Table 57drugId:2795 PA CHEMOTHERAPY BP, A90
Afluria (influenza virus vaccine-Afluria)drugId:2046 BIOLOGICAL 1
Afrezza (insulin human inhalation powder)drugId:4900 PA DIABETIC AGENTS
Afstyla (antihemophilic factor, recombinant, single chain-Afstyla)drugId:5580 ANTI-HEMOPHILIA AGENTS
agalsidase betadrugId:162 PA ENZYMES
AgrylindrugId:65 (anagrelide)drugId:65 ANTIPLATELET AGENT A90, #
Airduo Digihaler (fluticasone / salmeterol inhalation powder-Airduo Digihaler)drugId:7485 PA BRONCHODILATORS
Airduo Respiclick (fluticasone / salmeterol inhalation powder-Airduo Respiclick)drugId:6120 PA BRONCHODILATORS BP, A90
Airsupra (albuterol/budesonide)drugId:8699 PA BRONCHODILATORS
Ajovy (fremanezumab-vfrm for migraine prophylaxis)drugId:7000 PA CALCITONIN GENE-RELATED PEPTIDE INHIBITOR PD
Akeega (niraparib/abiraterone)drugId:8737 PA ANTINEOPLASTICS
Akten (lidocaine ophthalmic gel)drugId:1072 OPHTHALMIC PREPARATIONS
Akynzeo (fosnetupitant / palonosetron injection)drugId:6620 PA > 2 vials/28 days ANTIEMETICS
Akynzeo (netupitant / palonosetron capsule)drugId:4761 PA > 2 capsules/28 days ANTIEMETICS
albendazoledrugId:166 ANTIPARASITICS A90
albumin, human solutions PLASMA PROTEINS MB
albuterol/budesonidedrugId:8699 PA BRONCHODILATORS
albuterol / ipratropium inhalation solutiondrugId:835 BRONCHODILATORS A90
albuterol / ipratropium inhalation spraydrugId:2557 BRONCHODILATORS
albuterol inhalation powder-Proair DigihalerdrugId:7352 PA BRONCHODILATORS
albuterol inhalation powder-Proair RespiclickdrugId:5109 BRONCHODILATORS
albuterol inhalation solutiondrugId:168 BRONCHODILATORS A90, #
albuterol inhalerdrugId:8291 PA BRONCHODILATORS
albuterol inhaler-Proair HFAdrugId:1 BRONCHODILATORS BP, A90
albuterol inhaler-ProventildrugId:2 BRONCHODILATORS BP, A90
albuterol inhaler-VentolindrugId:3 BRONCHODILATORS BP, A90
albuterol syrup, tabletdrugId:2193 BRONCHODILATORS A90
alclometasone cream, ointmentdrugId:4 GLUCOCORTICOIDS A90
AldactonedrugId:1892 (spironolactone tablet)drugId:1892 ALDOSTERONE ANTAGONISTS M90, #
aldesleukindrugId:8406 PA ANTINEOPLASTICS
Aldurazyme (laronidase)drugId:1026 PA ENZYMES MB
Alecensa (alectinib)drugId:5221 PA CHEMOTHERAPY
alectinibdrugId:5221 PA CHEMOTHERAPY
alemtuzumab 12 mgdrugId:4782 PA MULTIPLE SCLEROSIS AGENTS MB
alemtuzumab 30 mgdrugId:6110 CHEMOTHERAPY
alendronate / cholecalciferoldrugId:9 PA ELECTROLYTES AND NUTRIENTS
alendronate solutiondrugId:2796 ELECTROLYTES AND NUTRIENTS M90
alendronate tabletdrugId:7 ELECTROLYTES AND NUTRIENTS M90, #
alfuzosin extended-releasedrugId:10 URINARY ANTISPASMODICS M90
alglucosidase alfadrugId:11 PA ENZYMES MB
Align (bifidobacterium infantis)drugId:6200 PA ≥ 22 years GASTROINTESTINAL AGENT
Alimta (pemetrexed disodium)drugId:1492 CHEMOTHERAPY MB
Alinia (nitazoxanide)drugId:7576 PA ANTIPARASITICS
Aliqopa (copanlisib)drugId:6500 PA CHEMOTHERAPY MB
alirocumabdrugId:5119 PA LIPID LOWERING AGENTS
aliskiren / hydrochlorothiazidedrugId:14 CARDIOVASCULAR
aliskirendrugId:13 PA CARDIOVASCULAR BP, M90
alitretinoindrugId:8411 PA ANTINEOPLASTICS
Alkeran (melphalan hydrochloride injection)drugId:1138 CHEMOTHERAPY MB
AlkerandrugId:5504 (melphalan tablet)drugId:5504 CHEMOTHERAPY A90, #
Alkindi (hydrocortisone sprinkle capsule)drugId:7639 PA GLUCOCORTICOIDS
allopurinol 100 mg, 300 mg tabletdrugId:17 GOUT AGENTS M90, #
allopurinol 200 mg tabletdrugId:8603 PA GOUT AGENTS M90
allopurinol sodiumdrugId:7545 CHEMOTHERAPY #
almotriptandrugId:18 PA TRIPTAN A90
Alocril (nedocromil)drugId:1180 OPHTHALMIC PREPARATIONS
alogliptin / metformindrugId:2782 PA DIABETIC AGENTS BP, M90
alogliptin / pioglitazonedrugId:2783 PA DIABETIC AGENTS BP, M90
alogliptindrugId:2784 PA DIABETIC AGENTS BP, M90
Alomide (lodoxamide)drugId:1095 OPHTHALMIC PREPARATIONS
AloprimdrugId:7545 (allopurinol sodium)drugId:7545 CHEMOTHERAPY #
AloxidrugId:1473 (palonosetron 0.25 mg/5 mL injection)drugId:1473 PA > 2 units/28 days ANTIEMETICS #
alpelisib-PiqraydrugId:7225 PA CHEMOTHERAPY
alpelisib-VijoicedrugId:8264 PA UNCLASSIFIED DRUG PRODUCTS
alpha-1-proteinase inhibitor, human-Aralast NP ENZYMES MB
alpha-1-proteinase inhibitor, human-Glassia ENZYMES MB
alpha-1-proteinase inhibitor, human-Prolastin-C ENZYMES MB
alpha-1-proteinase inhibitor, human-Zemaira ENZYMES MB
Alphagan P (brimonidine 0.1%, 0.15% eye drops)drugId:2505 OPHTHALMIC PREPARATIONS BP, M90
Alphanate (antihemophilic factor / von willebrand factor complex, human)drugId:163 ANTI-HEMOPHILIA AGENTS
Alphanine SD (factor IX, human)drugId:454 ANTI-HEMOPHILIA AGENTS
alprazolam extended-release; See Table 69drugId:26; See Table 71drugId:4359 PA < 6 years and PA > 2 units/day BENZODIAZEPINES #
alprazolam orally disintegrating tablet; See Table 69drugId:24; See Table 71drugId:4357 PA BENZODIAZEPINES
alprazolam; See Table 69drugId:25; See Table 71drugId:4358 PA < 6 years BENZODIAZEPINES #
Alprolix (factor IX recombinant, Fc fusion protein)drugId:2922 ANTI-HEMOPHILIA AGENTS
AlrexdrugId:1105 (loteprednol 0.2%)drugId:1105 OPHTHALMIC PREPARATIONS A90, #
AltacedrugId:2588 (ramipril)drugId:2588 CARDIOVASCULAR M90, #
Altoprev (lovastatin extended-release)drugId:1107 PA LIPID LOWERING AGENTS
Altreno (tretinoin 0.05% lotion)drugId:6900 PA ≥ 22 years DERMATOLOGICAL
Altuviiio (antihemophilic factor, recombinant, fc-vwf-xten fusion protein-ehtl)drugId:8562 ANTI-HEMOPHILIA AGENTS
aluminum carbonate GASTROINTESTINAL AGENT *, A90
aluminum chloridedrugId:8408 PA DERMATOLOGICAL
aluminum hydroxidedrugId:28 ANTACIDS *, A90
Alunbrig (brigatinib)drugId:6180 PA CHEMOTHERAPY
Alvesco (ciclesonide inhaler)drugId:230 PA BRONCHODILATORS
Alymsys (bevacizumab-maly)drugId:8331 PA CHEMOTHERAPY MB
amantadine extended-release capsuledrugId:6402 PA ANTIPARKINSON
amantadine extended-release tabletdrugId:7006 PA ANTIPARKINSON
amantadine immediate-release capsule, solution, tabletdrugId:29 ANTIPARKINSON A90
AmaryldrugId:931 (glimepiride)drugId:931 DIABETIC AGENTS M90, #
Ambien (zolpidem 10 mg tablet); See Table 15drugId:1932; See Table 71drugId:4342 PA < 6 years and PA > 1 unit/day SEDATIVES #
Ambien (zolpidem 5 mg tablet); See Table 15drugId:1933; See Table 71drugId:4344 PA < 6 years and PA > 1.5 units/day SEDATIVES #
Ambien CR (zolpidem extended-release tablet); See Table 15drugId:1934; See Table 71drugId:4345 PA < 6 years and PA > 1 unit/day SEDATIVES #
Ambisome (amphotericin B liposome) ANTIBIOTICS
ambrisentandrugId:30 PA CARDIOVASCULAR A90
amcinonide creamdrugId:31 PA GLUCOCORTICOIDS A90
Ameluz (aminolevulinic acid)drugId:6841 CHEMOTHERAPY MB
amifampridinedrugId:7041 PA POTASSIUM CHANNEL BLOCKER
amikacindrugId:32 ANTIBIOTICS
amikacin liposome inhalationdrugId:7040 PA ANTIBIOTICS
amiloride / hydrochlorothiazidedrugId:34 CARDIOVASCULAR M90
amiloridedrugId:33 CARDIOVASCULAR M90
amino acid and electrolyte IV infusion ELECTROLYTES AND NUTRIENTS
aminocaproic acid HEMATINIC AGENT A90
aminolevulinic aciddrugId:6841 CHEMOTHERAPY MB
aminosalicylic aciddrugId:2500 TB PREPARATIONS
amiodarone injectiondrugId:37 CARDIOVASCULAR MB
amiodarone tabletdrugId:38 CARDIOVASCULAR M90
Amitiza (lubiprostone)drugId:1110 PA CONSTIPATION AGENTS BP, M90
amitriptyline / chlordiazepoxide; See Table 17drugId:8047; See Table 69drugId:7366; See Table 71drugId:40 PA ANTIDEPRESSANTS
amitriptyline / perphenazine; See Table 17drugId:8048; See Table 24drugId:6320; See Table 71drugId:1512 PA ANTIPSYCHOTIC A90
amitriptyline tablet; See Table 17drugId:39; See Table 71drugId:4000 PA < 6 years ANTIDEPRESSANTS A90
amivantamab-vmjwdrugId:7982 PA CHEMOTHERAPY
Amjevita (adalimumab-atto)drugId:8700 PA IMMUNOMODULATOR
amlodipine / atorvastatin; See Table 13drugId:42; See Table 18drugId:43 PA CARDIOVASCULAR/STATIN M90
amlodipine / benazeprildrugId:44 CARDIOVASCULAR M90, #
amlodipine / olmesartan / hydrochlorothiazidedrugId:1969 PA CARDIOVASCULAR M90
amlodipine / olmesartandrugId:46 CARDIOVASCULAR M90, #
amlodipine / telmisartandrugId:1661 PA CARDIOVASCULAR M90
amlodipine / valsartan / hydrochlorothiazidedrugId:50 CARDIOVASCULAR M90, #
amlodipine / valsartandrugId:48 CARDIOVASCULAR M90, #
amlodipinedrugId:41 CARDIOVASCULAR M90, #
amlodipine solutiondrugId:8255 PA CARDIOVASCULAR
amlodipine suspensiondrugId:7260 PA CARDIOVASCULAR
ammonium lactate DERMATOLOGICAL
Ammonul (sodium phenylacetate / sodium benzoate) ELECTROLYTES AND NUTRIENTS #
Amondys 45 (casimersen)drugId:7878 PA BIOLOGICAL
amoxapine; See Table 17drugId:56; See Table 71drugId:4001 PA < 6 years ANTIDEPRESSANTS A90
amoxicillin / clavulanate 125/31.25 mg/5 mL suspensiondrugId:54 PA ANTIBIOTICS
amoxicillin / clavulanate chewable tablet, 200/28.5, 250/62.5, 400/57, 600/42.9 mg/5 mL suspension, tabletdrugId:6420 ANTIBIOTICS A90, #
amoxicillin / clavulanate extended-releasedrugId:55 PA ANTIBIOTICS A90
amoxicillindrugId:57 ANTIBIOTICS A90
Amphadase (hyaluronidase) ENZYMES MB
amphetamine extended-release 1.25 mg/mL oral suspension; See Table 31drugId:6600; See Table 71drugId:6601 PA CEREBRAL STIMULANTS
amphetamine extended-release 2.5 mg/mL oral suspension; See Table 31drugId:5383; See Table 71drugId:5384 PA CEREBRAL STIMULANTS
amphetamine extended-release chewable tablet; See Table 31drugId:8525; See Table 71drugId:8526 PA AMPHETAMINE PREPARATIONS
amphetamine extended-release orally disintegrating tablet; See Table 31drugId:5360; See Table 71drugId:5361 PA CEREBRAL STIMULANTS
amphetamine salts extended-release-Adderall XR; See Table 31drugId:59; See Table 71drugId:3000 PA < 3 years or ≥ 21 years and PA > 2 units/day CEREBRAL STIMULANTS BP
amphetamine salts extended-release-Mydayis; See Table 31drugId:6285; See Table 71drugId:6286 PA CEREBRAL STIMULANTS
amphetamine salts; See Table 31drugId:60; See Table 71drugId:3100 PA < 3 years or ≥ 21 years and PA > 3 units/day CEREBRAL STIMULANTS #
amphetamine sulfate orally disintegrating tablet; See Table 31drugId:7235; See Table 71drugId:7236 PA CEREBRAL STIMULANTS
amphetamine sulfate; See Table 31drugId:4901; See Table 71drugId:4920 PA CEREBRAL STIMULANTS
amphotericin B ANTIBIOTICS
amphotericin B lipid complex ANTIBIOTICS
amphotericin B liposome ANTIBIOTICS
ampicillin / sulbactamdrugId:64 ANTIBIOTICS #
ampicillin; See Table 35drugId:63; See Table 66drugId:2623 ANTIBIOTICS A90
AmpyradrugId:320 (dalfampridine)drugId:320 PA > 2 units/day MULTIPLE SCLEROSIS AGENTS A90, #
Amrix (cyclobenzaprine extended-release)drugId:304 PA MUSCLE RELAXANT A90
Amvuttra (vutrisiran)drugId:8295 PA SMALL INTERFERING RNA AGENTS PD, MB
anacaulase-bcdbdrugId:8573 PA ENZYMES MB
Anafranil (clomipramine); See Table 17drugId:272; See Table 71drugId:4002 PA ANTIDEPRESSANTS A90
anagrelidedrugId:65 ANTIPLATELET AGENT A90, #
anakinradrugId:66 PA IMMUNOMODULATOR
Anascorp (centruroides immune F(ab’)2, equine) ANTIDOTES MB
anastrozoledrugId:69 CHEMOTHERAPY A90, #
Ancobon (flucytosine)drugId:861 ANTIBIOTICS BP, A90
Androderm (testosterone patch)drugId:1682 PA HORMONE REPLACEMENT THERAPY
Androgel (testosterone 1.62% gel packet)drugId:2280 PA HORMONE REPLACEMENT THERAPY
Androgel (testosterone 1.62% gel pump)drugId:7573 PA HORMONE REPLACEMENT THERAPY
Androgel (testosterone 1% gel packet)drugId:2248 PA HORMONE REPLACEMENT THERAPY
Angeliq (estradiol / drospirenone) HORMONE REPLACEMENT THERAPY
anidulafungin ANTIBIOTICS
anifrolumab-fniadrugId:8124 PA BIOLOGICAL MB
Annovera (segesterone / ethinyl estradiol) CONTRACEPTIVES
Anoro (umeclidinium / vilanterol)drugId:2952 BRONCHODILATORS
antihemophilic factor, human-Humate-PdrugId:164 ANTI-HEMOPHILIA AGENTS
antihemophilic factor, human-Koate-DVIdrugId:78 ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant, fc-vwf-xten fusion protein-ehtldrugId:8562 ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant, porcine sequence-ObizurdrugId:4786 ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant, single chain-AfstyladrugId:5580 ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant-AdvatedrugId:71 ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant-HelixatedrugId:73 ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant-Hemofil-MdrugId:77 ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant-KogenatedrugId:74 ANTI-HEMOPHILIA AGENTS PD
antihemophilic factor, recombinant-KovaltrydrugId:5395 ANTI-HEMOPHILIA AGENTS PD
antihemophilic factor, recombinant-NovoeightdrugId:4785 ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant-NuwiqdrugId:5283 ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant pegylated-AdynovatedrugId:5220 ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant pegylated-aucl-JividrugId:6904 ANTI-HEMOPHILIA AGENTS PD
antihemophilic factor, recombinant-RecombinatedrugId:75 ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant-XynthadrugId:72 ANTI-HEMOPHILIA AGENTS PD
antihemophilic factor / von willebrand factor complex, humandrugId:163 ANTI-HEMOPHILIA AGENTS
anti-inhibitor coagulant complex-Feiba NFdrugId:80 ANTI-HEMOPHILIA AGENTS
antithymocyte globulin, equinedrugId:1112 BIOLOGICAL
antithymocyte globulin, rabbitdrugId:1111 BIOLOGICAL
Antivert (meclizine) ANTIEMETICS *, A90, #
Anusol-HCdrugId:740 (hydrocortisone hemorrhoidal cream)drugId:740 GLUCOCORTICOIDS A90, #
Apadaz (benzhydrocodone / acetaminophen)drugId:7234 PA OPIOID ANALGESICS
apalutamidedrugId:6682 PA CHEMOTHERAPY
Apexicon-E (diflorasone cream / emollient)drugId:520 PA GLUCOCORTICOIDS A90
Apidra (insulin glulisine)drugId:810 DIABETIC AGENTS
apixabandrugId:2721 ANTICOAGULANTS
Aplenzin (bupropion hydrobromide extended-release); See Table 17drugId:395; See Table 71drugId:3640 PA < 6 years and PA > 1 unit/day ANTIDEPRESSANTS
ApokyndrugId:83 (apomorphine injection)drugId:83 ANTIPARKINSON #
apomorphine filmdrugId:7490 PA ANTIPARKINSON
apomorphine injectiondrugId:83 ANTIPARKINSON #
apraclonidinedrugId:84 OPHTHALMIC PREPARATIONS M90, #
apremilastdrugId:2941 PA IMMUNOMODULATOR
aprepitant 125 mg powder for oral suspensiondrugId:5726 PA > 6 units/28 days ANTIEMETICS A90
aprepitant 40 mg, 125 mg capsuledrugId:7498 PA > 2 capsules/28 days ANTIEMETICS A90
aprepitant 80 mgdrugId:85 PA > 4 capsules/28 days ANTIEMETICS A90, #
aprepitant injectable emulsiondrugId:6604 PA ANTIEMETICS
aprepitant trifold packdrugId:87 PA > 2 packs/28 days ANTIEMETICS BP, A90
Apretude (cabotegravir injection)drugId:8250 ANTIVIRALS PD
Apriso (mesalamine extended-release)drugId:1150 GI ANTI-INFLAMMATORY BP, A90
Aptensio XR (methylphenidate extended-release-Aptensio XR); See Table 31drugId:5100; See Table 71drugId:5101 PA CEREBRAL STIMULANTS
Aptiom (eslicarbazepine); See Table 20drugId:2953; See Table 71drugId:3380 PA ANTICONVULSANTS
Aptivus (tipranavir)drugId:1709 ANTIVIRALS
Aquadeks (multivitamins / minerals / coenzyme Q10-Aquadeks)drugId:2380 PA HEMATINIC AGENT
Aquadeks (multivitamins / minerals / folic acid / coenzyme Q10-Aquadeks)drugId:2385 PA HEMATINIC AGENT
Aralast NP (alpha-1-proteinase inhibitor, human-Aralast NP) ENZYMES MB
Aranesp (darbepoetin alfa)drugId:327 PA HEMATINIC AGENT
Arava (leflunomide) IMMUNOMODULATOR A90, #
Arazlo (tazarotene lotion)drugId:7365 PA DERMATOLOGICAL
Arcalyst (rilonacept)drugId:1434 PA BIOLOGICAL
Arexvy (respiratory syncytial virus vaccine, adjuvanted)drugId:8620 PA < 60 years BIOLOGICAL
arformoteroldrugId:88 PA BRONCHODILATORS A90
Aricept (donepezil 10 mg tablet); See Table 56drugId:2422; See Table 71drugId:7399 PA < 6 years and PA > 2 units/day ALZHEIMER'S THERAPY A90, #
Aricept (donepezil 5 mg, 23 mg tablet); See Table 56drugId:559; See Table 71drugId:7401 PA < 6 years and PA > 1 unit/day ALZHEIMER'S THERAPY A90, #
Arikayce (amikacin liposome inhalation)drugId:7040 PA ANTIBIOTICS
ArimidexdrugId:69 (anastrozole)drugId:69 CHEMOTHERAPY A90, #
aripiprazole extended-release injection; See Table 24drugId:8601; See Table 71drugId:8602 PA ANTIPSYCHOTIC
aripiprazole lauroxil 1,064 mg; See Table 24drugId:6300; See Table 71drugId:6301 PA < 6 years and PA > 1 injection/56 days ANTIPSYCHOTIC PD
aripiprazole lauroxil 441 mg, 662 mg, 882 mg; See Table 24drugId:5240; See Table 71drugId:5241 PA < 6 years and PA > 1 injection/28 days ANTIPSYCHOTIC PD
aripiprazole lauroxil 675 mg; See Table 24drugId:6861; See Table 71drugId:6860 PA < 6 years and PA > 1 injection/28 days ANTIPSYCHOTIC PD
aripiprazole orally disintegrating tablet; See Table 24drugId:92; See Table 71drugId:4220 PA ANTIPSYCHOTIC A90
aripiprazole solution; See Table 24drugId:91; See Table 71drugId:4240 PA < 6 years or ≥ 18 years and PA > 25 mL/day ANTIPSYCHOTIC A90
aripiprazole tablet; See Table 24drugId:90; See Table 71drugId:4180 PA < 6 years and PA > 2 units/day ANTIPSYCHOTIC A90, #
aripiprazole tablet with sensor; See Table 24drugId:7230; See Table 71drugId:7231 PA ANTIPSYCHOTIC
Aristada (aripiprazole lauroxil 1,064 mg); See Table 24drugId:6300; See Table 71drugId:6301 PA < 6 years and PA > 1 injection/56 days ANTIPSYCHOTIC PD
Aristada (aripiprazole lauroxil 441 mg, 662 mg, 882 mg); See Table 24drugId:5240; See Table 71drugId:5241 PA < 6 years and PA > 1 injection/28 days ANTIPSYCHOTIC PD
Aristada Initio (aripiprazole lauroxil 675 mg); See Table 24drugId:6861; See Table 71drugId:6860 PA < 6 years and PA > 1 injection/28 days ANTIPSYCHOTIC PD
ArixtradrugId:904 (fondaparinux)drugId:904 ANTICOAGULANTS #
armodafinil; See Table 50drugId:94; See Table 71drugId:7449 PA < 6 years and PA > 1 unit/day NARCOLEPSY AGENTS #
Armonair Digihaler (fluticasone propionate inhalation powder-Armonair Digihaler)drugId:7486 PA BRONCHODILATORS
Arnuity (fluticasone furoate inhalation powder)drugId:4760 BRONCHODILATORS
AromasindrugId:450 (exemestane)drugId:450 CHEMOTHERAPY A90, #
Arranon (nelarabine)drugId:1182 PA CHEMOTHERAPY MB
arsenic trioxidedrugId:2697 CHEMOTHERAPY #
artemether / lumefantrinedrugId:95 PA > 24 units/365 days ANTIMALARIALS
artesunatedrugId:8042 PA ANTIMALARIALS
ArthrotecdrugId:514 (diclofenac / misoprostol)drugId:514 PA < 60 years NONSTEROIDAL ANTI-INFLAMMATORY A90, #
artificial tearsdrugId:678 OPHTHALMIC PREPARATIONS *, A90
Arzerra (ofatumumab vial)drugId:1270 PA CHEMOTHERAPY MB
Asacol HDdrugId:1152 (mesalamine high dose delayed-release)drugId:1152 GI ANTI-INFLAMMATORY A90, #
Asceniv (immune globulin IV, human-slra)drugId:7327 PA BIOLOGICAL
asciminibdrugId:8210 PA CHEMOTHERAPY
Asclera (polidocanol)drugId:2934 PA CARDIOVASCULAR MB
ascorbic aciddrugId:96 ELECTROLYTES AND NUTRIENTS *, M90
asenapine sublingual tablet; See Table 24drugId:97; See Table 71drugId:4260 PA ANTIPSYCHOTIC A90
asenapine transdermal; See Table 24drugId:7354; See Table 71drugId:7355 PA ANTIPSYCHOTIC
asfotase alfadrugId:5300 PA ENZYMES
Asmanex HFA (mometasone inhalation aerosol)drugId:5102 BRONCHODILATORS
Asmanex Twisthaler (mometasone 110 mcg inhalation powder)drugId:2663 PA ≥ 12 years BRONCHODILATORS
Asmanex Twisthaler (mometasone 220 mcg inhalation powder)drugId:1379 PA < 12 years BRONCHODILATORS
asparaginase erwinia chrysanthemidrugId:8407 PA ANTINEOPLASTICS MB
asparaginase erwinia chrysanthemi-rywndrugId:7981 PA CHEMOTHERAPY MB
Asparlas (calaspargase pegol-mknl)drugId:7328 PA CHEMOTHERAPY MB
aspirin / extended-release dipyridamoledrugId:100 ANTIPLATELET AGENT M90
aspirin 325 mg, 500 mg, 650 mgdrugId:8221 ANALGESICS *, A90
aspirin 81 mgdrugId:98 ANTIPLATELET AGENT *, M90
aspirin suppositorydrugId:8220 ANALGESICS *
aspirin with buffersdrugId:99 ANALGESICS *, A90
Aspruzyo (ranolazine extended-release granules)drugId:8563 PA CARDIOVASCULAR
Astagraf XL (tacrolimus extended-release capsule)drugId:2838 IMMUNOMODULATOR
Astramorph-PF (morphine, injection-Astramorph-PF)drugId:1391 PA > 120 mg/day OPIOID ANALGESICS
Atacand (candesartan)drugId:433 PA CARDIOVASCULAR M90
Atacand HCT (candesartan / hydrochlorothiazide)drugId:434 PA CARDIOVASCULAR M90
atazanavir / cobicistatdrugId:4768 ANTIVIRALS
atazanavirdrugId:101 ANTIVIRALS A90, #
Atelvia (risedronate delayed-release)drugId:2101 PA ELECTROLYTES AND NUTRIENTS BP, M90
atenolol / chlorthalidonedrugId:103 CARDIOVASCULAR M90, #
atenololdrugId:102 CARDIOVASCULAR M90, #
atezolizumabdrugId:5593 PA CHEMOTHERAPY MB
Atgam (antithymocyte globulin, equine)drugId:1112 BIOLOGICAL
AtivandrugId:7662 (lorazepam injection)drugId:7662 BENZODIAZEPINES #
Ativan (lorazepam solution, tablet); See Table 69drugId:1100; See Table 71drugId:4400 PA < 6 years BENZODIAZEPINES #
atomoxetine; See Table 31drugId:104; See Table 71drugId:3080 PA < 6 years NONSTIMULANT ADHD AGENTS A90, #
Atorvaliq (atorvastatin suspension)drugId:8564 PA LIPID LOWERING AGENTS
atorvastatin 10 mg, 20 mg, 40 mg tabletdrugId:105 PA > 1.5 units/day LIPID LOWERING AGENTS M90, #
atorvastatin 80 mg tabletdrugId:2933 PA > 1 unit/day LIPID LOWERING AGENTS M90, #
atorvastatin suspensiondrugId:8564 PA LIPID LOWERING AGENTS
atovaquone / proguanil ANTIMALARIALS A90, #
atovaquonedrugId:106 ANTIPARASITICS A90, #
Atralin (tretinoin 0.05% gel)drugId:2432 PA DERMATOLOGICAL A90
AtripladrugId:591 (efavirenz / emtricitabine / tenofovir)drugId:591 ANTIVIRALS A90, #
atropine ophthalmic OPHTHALMIC PREPARATIONS A90, #
Atrovent (ipratropium nasal spray) NASAL PREPARATIONS A90, #
Atrovent HFA (ipratropium inhalation aerosol)drugId:833 BRONCHODILATORS
AubagiodrugId:2657 (teriflunomide)drugId:2657 PA > 1 unit/day MULTIPLE SCLEROSIS AGENTS A90, #
Augmentin (amoxicillin / clavulanate 125/31.25 mg/5 mL suspension)drugId:54 PA ANTIBIOTICS
AugmentindrugId:6420 (amoxicillin / clavulanate chewable tablet, 200/28.5, 250/62.5, 400/57, 600/42.9 mg/5 mL suspension, tablet)drugId:6420 ANTIBIOTICS A90, #
Augmentin XR (amoxicillin / clavulanate extended-release)drugId:55 PA ANTIBIOTICS A90
Auryxia (ferric citrate)drugId:4762 PA HEMATINIC AGENT
Austedo (deutetrabenazine)drugId:6121 PA NEUROLOGIC AGENT
Austedo XR (deutetrabenazine extended-release)drugId:8701 PA NEUROLOGIC AGENT
Auvelity (dextromethorphan / bupropion); See Table 17drugId:8481; See Table 71drugId:8522 PA ANTIDEPRESSANTS
Auvi-Q (epinephrine auto-injection-Auvi-Q)drugId:2718 PA ADRENERGICS
avacopandrugId:8159 PA IMMUNOMODULATOR
avalglucosidase alfa-ngptdrugId:8122 PA ENZYMES MB
AvalidedrugId:969 (irbesartan / hydrochlorothiazide)drugId:969 CARDIOVASCULAR M90, #
avapritinibdrugId:7360 PA CHEMOTHERAPY
AvaprodrugId:968 (irbesartan)drugId:968 CARDIOVASCULAR M90, #
Avastin (bevacizumab)drugId:360 PA CHEMOTHERAPY MB
avatrombopagdrugId:6990 PA HEMATOLOGIC
Aveed (testosterone undecanoate injection)drugId:2954 PA HORMONE REPLACEMENT THERAPY MB
Avelox (moxifloxacin injection)drugId:2748 ANTIBIOTICS
avelumabdrugId:6100 PA CHEMOTHERAPY MB
AvitadrugId:1747 (tretinoin-Avita)drugId:1747 PA ≥ 22 years DERMATOLOGICAL A90, #
AvodartdrugId:586 (dutasteride)drugId:586 BENIGN PROSTATIC HYPERPLASIA AGENTS M90, #
Avonex (interferon beta-1a-Avonex)drugId:825 MULTIPLE SCLEROSIS AGENTS
Avsola (infliximab-axxq)drugId:7386 PA IMMUNOMODULATOR
Avycaz (ceftazidime / avibactam)drugId:4902 PA ANTIBIOTICS
axicabtagene ciloleuceldrugId:6414 PA CHEMOTHERAPY CO, MB
axitinibdrugId:2484 PA CHEMOTHERAPY
Aygestin (norethindrone 5 mg) HORMONE REPLACEMENT THERAPY A90
Ayvakit (avapritinib)drugId:7360 PA CHEMOTHERAPY
azacitidine tabletdrugId:7565 PA CHEMOTHERAPY
azacitidine vialdrugId:110 CHEMOTHERAPY MB
AzactamdrugId:120 (aztreonam injection)drugId:120 ANTIBIOTICS #
Azasite (azithromycin ophthalmic solution)drugId:119 PA OPHTHALMIC PREPARATIONS BP
azathioprine 50 mg tabletdrugId:111 IMMUNOMODULATOR A90, #
azathioprine 75 mg, 100 mg tabletdrugId:2857 PA IMMUNOMODULATOR A90
azathioprine injectiondrugId:5501 IMMUNOMODULATOR MB
Azedra (iobenguane I 131)drugId:6980 CHEMOTHERAPY MB
azelaic acid foamdrugId:5106 PA DERMATOLOGICAL
azelaic acid geldrugId:113 PA DERMATOLOGICAL A90
azelastine / fluticasone propionatedrugId:2580 NASAL PREPARATIONS BP, M90
azelastine 0.15% nasal spraydrugId:116 PA NASAL PREPARATIONS A90
azelastine 137 mcg nasal spraydrugId:115 NASAL PREPARATIONS A90
azelastine ophthalmic solutiondrugId:114 ANTIHISTAMINES A90
Azilect (rasagiline)drugId:1640 PA > 1 unit/day ANTIPARKINSON A90
azilsartandrugId:2240 CARDIOVASCULAR
azilsartan / chlorthalidonedrugId:2480 CARDIOVASCULAR
azithromycindrugId:2622 ANTIBIOTICS A90, #
azithromycin injection, suspension, tabletdrugId:117 ANTIBIOTICS A90, #
azithromycin ophthalmic solutiondrugId:119 PA OPHTHALMIC PREPARATIONS BP
azithromycin powder packetdrugId:8041 PA ANTIBIOTICS A90
Azopt (brinzolamide)drugId:375 OPHTHALMIC PREPARATIONS BP, M90
AzordrugId:46 (amlodipine / olmesartan)drugId:46 CARDIOVASCULAR M90, #
Azstarys (serdexmethylphenidate / dexmethylphenidate); See Table 31drugId:7977; See Table 71drugId:7978 PA CEREBRAL STIMULANTS
aztreonam injectiondrugId:120 ANTIBIOTICS #
AzulfidinedrugId:1910 (sulfasalazine)drugId:1910 GI ANTI-INFLAMMATORY A90, #
Azulfidine EN-TabsdrugId:4864 (sulfasalazine delayed-release)drugId:4864 GI ANTI-INFLAMMATORY A90, #

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

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Last updated 04/01/24