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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
gabapentin capsule, solution, tablet; See Table 20drugId:917; See Table 71drugId:3480 PA < 6 years and PA > 3600 mg/day ANTICONVULSANTS #
gabapentin enacarbildrugId:2285 PA GABA ANALOGS
gabapentin extended-releasedrugId:2366 PA GABA ANALOGS
gabapentin powder; See Table 71drugId:6373; See Table 72drugId:6372 PA ANTICONVULSANTS
Gabitril (tiagabine)drugId:2617 PA ANTICONVULSANTS A90
GablofendrugId:2166 (baclofen injection)drugId:2166 MUSCLE RELAXANT #
Galafold (migalastat)drugId:6982 PA ENZYMES
galantamine extended-release capsuledrugId:919 PA > 1 unit/day ALZHEIMER'S THERAPY A90, #
galantamine solutiondrugId:2251 PA ALZHEIMER'S THERAPY A90
galantamine tabletdrugId:920 PA > 2 units/day ALZHEIMER'S THERAPY A90
galsulfasedrugId:921 PA ENZYMES MB
Gamastan S/D (immune globulin IM, human-Gamastan S/D)drugId:2683 PA BIOLOGICAL
Gamifant (emapalumab-lzsg)drugId:7223 PA BIOLOGICAL
Gammagard (immune globulin injection, human-Gammagard)drugId:2198 PA BIOLOGICAL
Gammagard S/D (immune globulin IV, human-Gammagard S/D)drugId:787 PA BIOLOGICAL
Gammaked (immune globulin injection, human-Gammaked)drugId:2641 PA BIOLOGICAL
Gammaplex (immune globulin IV, human-Gammaplex)drugId:2381 PA BIOLOGICAL
Gamunex-C (immune globulin injection, human-Gamunex-C)drugId:2167 PA BIOLOGICAL
ganciclovir injectiondrugId:922 ANTIVIRALS
ganciclovir ophthalmic gel OPHTHALMIC PREPARATIONS
Gardasil 9 (human papillomavirus 9-valent vaccine)drugId:4770 PA < 9 years and PA ≥ 46 years BIOLOGICAL 1
Gastrocrom (cromolyn oral) BRONCHODILATORS A90, #
gatifloxacin ophthalmic solutiondrugId:1976 PA OPHTHALMIC PREPARATIONS A90
Gattex (teduglutide injection)drugId:2722 PA GASTROINTESTINAL AGENT BP
Gavreto (pralsetinib)drugId:7660 PA CHEMOTHERAPY
Gazyva (obinutuzumab)drugId:2887 PA CHEMOTHERAPY MB
gefitinibdrugId:924 PA CHEMOTHERAPY
gelatin capsule, emptydrugId:925 COMPOUNDING AGENT
Gelnique (oxybutynin gel)drugId:1315 URINARY ANTISPASMODICS BP
Gel-One (hyaluronate, crossed-linked)drugId:4802 PA HYALURONAN MB
Gelsyn (hyaluronate-Gelsyn)drugId:5620 PA HYALURONAN MB
gemcitabine premixed infusiondrugId:7284 PA CHEMOTHERAPY MB
gemcitabine vialdrugId:926 CHEMOTHERAPY
gemfibrozildrugId:927 LIPID LOWERING AGENTS M90, #
Gemtesa (vibegron)drugId:7781 PA ADRENERGICS
gemtuzumab ozogamicindrugId:6342 PA CHEMOTHERAPY
Genabio (COVID-19 antigen self-test)drugId:8461 - Non-Drug Product PA > 8 tests/28 days DIAGNOSTICS PHE
Generess Fe (ethinyl estradiol / norethindrone / ferrous fumarate chewable 0.8 mg / 25 mcg) CONTRACEPTIVES M90, #
Genotropin (somatropin-Genotropin)drugId:1880 PA HORMONE AGENTS PD
gentamicin / prednisolone ophthalmic ointmentdrugId:7963 PA OPHTHALMIC PREPARATIONS
gentamicin / prednisolone ophthalmic suspensiondrugId:929 OPHTHALMIC PREPARATIONS
gentamicin injectiondrugId:2636 ANTIBIOTICS
gentamicin ophthalmic ointment, solutiondrugId:928 OPHTHALMIC PREPARATIONS A90
gentamicin topical cream, ointmentdrugId:5901 ANTIBIOTICS A90
Genvisc (hyaluronate-Genvisc)drugId:5340 PA HYALURONAN MB
Genvoya (elvitegravir / cobicistat / emtricitabine / tenofovir alafenamide)drugId:5250 ANTIVIRALS PD
Geodon (ziprasidone capsule); See Table 24drugId:1926; See Table 71drugId:4290 PA < 6 years and PA > 2 units/day ANTIPSYCHOTIC A90, #
GeodondrugId:1925 (ziprasidone injection)drugId:1925 ANTIPSYCHOTIC #
Gilenya (fingolimod capsule)drugId:2102 PA SPHINGOSINE 1-PHOSPHATE RECEPTOR MODULATOR BP, A90
Gilotrif (afatinib)drugId:2843 PA CHEMOTHERAPY
gilteritinibdrugId:7108 PA CHEMOTHERAPY
Gimoti (metoclopramide nasal spray)drugId:8112 PA GASTROINTESTINAL AGENT
Givlaari (givosiran)drugId:7504 PA SMALL INTERFERING RNA AGENTS PD, MB
glasdegibdrugId:7100 PA CHEMOTHERAPY
Glassia (alpha-1-proteinase inhibitor, human-Glassia) ENZYMES MB
glecaprevir / pibrentasvirdrugId:6360 PA ANTIVIRALS PD
GleevecdrugId:779 (imatinib)drugId:779 CHEMOTHERAPY A90, #
Gleostine (lomustine)drugId:8405 PA ONCOLOGY AGENTS
glimepiride / pioglitazonedrugId:1535 PA DIABETIC AGENTS BP, M90
glimepiridedrugId:931 DIABETIC AGENTS M90, #
glipizide / metformindrugId:935 DIABETIC AGENTS M90
glipizide extended-releasedrugId:933 DIABETIC AGENTS M90, #
glipizidedrugId:932 DIABETIC AGENTS M90, #
Gloperba (colchicine solution)drugId:7331 PA GOUT AGENTS
Glucagen (glucagon vial-Glucagen)drugId:7370 DIABETIC AGENTS
glucagon auto-injection, prefilled syringe, vial-GvokedrugId:7363 DIABETIC AGENTS
glucagon nasal powderdrugId:7367 DIABETIC AGENTS PD
glucagon vialdrugId:671 DIABETIC AGENTS
glucagon vial-GlucagendrugId:7370 DIABETIC AGENTS
glucose productsdrugId:6745 PA ≥ 19 years DIABETIC AGENTS A90
GlucotroldrugId:932 (glipizide)drugId:932 DIABETIC AGENTS M90, #
Glucotrol XLdrugId:933 (glipizide extended-release)drugId:933 DIABETIC AGENTS M90, #
Glumetza (metformin extended-release, gastric tablet)drugId:2987 PA DIABETIC AGENTS BP, M90
glyburide, micronizeddrugId:675 DIABETIC AGENTS M90, #
glyburide / metformindrugId:676 DIABETIC AGENTS M90
glyburidedrugId:674 DIABETIC AGENTS M90
glycerol phenylbutyratedrugId:2789 PA ENZYMES
glycopyrrolate / formoteroldrugId:5700 PA BRONCHODILATORS
glycopyrrolate 1.5 mg tabletdrugId:2888 PA ANTISPASMODICS,ANTICHOLINERGIC A90
glycopyrrolate 1 mg, 2 mg tabletdrugId:679 ANTISPASMODICS,ANTICHOLINERGIC A90
glycopyrrolate inhalation solutiondrugId:6742 PA BRONCHODILATORS
glycopyrrolate injectiondrugId:5940 PA ANTISPASMODICS,ANTICHOLINERGIC
glycopyrrolate orally disintegrating tabletdrugId:8206 PA ANTISPASMODICS,ANTICHOLINERGIC
glycopyrrolate oral solutiondrugId:2163 PA ANTISPASMODICS,ANTICHOLINERGIC A90
glycopyrrolate powderdrugId:7188 PA ANTISPASMODICS,ANTICHOLINERGIC
glycopyrronium clothdrugId:6987 PA DERMATOLOGICAL
GlynasedrugId:675 (glyburide, micronized)drugId:675 DIABETIC AGENTS M90, #
Glyxambi (empagliflozin / linagliptin)drugId:4771 PA DIABETIC AGENTS
Gocovri (amantadine extended-release capsule)drugId:6402 PA ANTIPARKINSON
gold sodium thiomalate IMMUNOMODULATOR
golimumab for infusiondrugId:2850 PA IMMUNOMODULATOR
golimumabdrugId:681 PA IMMUNOMODULATOR
golodirsendrugId:7496 PA BIOLOGICAL
GolytelydrugId:1549 (polyethylene glycol-electrolyte solution-Golytely)drugId:1549 LAXATIVES A90, #
Gonitro (nitroglycerin sublingual powder)drugId:5722 PA CARDIOVASCULAR
Gralise (gabapentin extended-release)drugId:2366 PA GABA ANALOGS
granisetron extended-release injectiondrugId:5767 PA > 2 units/28 days ANTIEMETICS
granisetron injectiondrugId:683 ANTIEMETICS
granisetron tabletdrugId:684 PA > 2 tablets/28 days ANTIEMETICS A90
granisetron transdermal systemdrugId:685 PA ANTIEMETICS
Granix (TBO-filgrastim)drugId:2889 PA HEMATINIC AGENT
grass pollen allergen extractdrugId:4789 PA ALLERGENS
griseofulvin powderdrugId:7739 PA FUNGICIDES
griseofulvin suspension, tabletdrugId:2306 FUNGICIDES A90
guanfacine; See Table 18drugId:5162; See Table 71drugId:691 PA < 3 years CARDIOVASCULAR A90
guanfacine extended-release; See Table 31drugId:692; See Table 71drugId:3082 PA < 3 years NONSTIMULANT ADHD AGENTS A90, #
guselkumabdrugId:6289 PA IMMUNOMODULATOR
Gvoke (glucagon auto-injection, prefilled syringe, vial-Gvoke)drugId:7363 DIABETIC AGENTS
Gynazole-1 (butoconazole) ANTIBIOTICS A90

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

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Last updated 04/13/23