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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.


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MassHealth Drug List table
Drug - Brand Name (Generic Name) Class
Azulfidine EN-TabsdrugId:4864 # (sulfasalazine delayed-release)drugId:4864 GI ANTI-INFLAMMATORY
AzulfidinedrugId:1910 # (sulfasalazine)drugId:1910 GI ANTI-INFLAMMATORY
aztreonam injectiondrugId:120 ANTIBIOTICS
aztreonam ANTIBIOTICS
Azor (amlodipine / olmesartan)drugId:46 - PA CARDIOVASCULAR
Azopt (brinzolamide)drugId:375 - PA OPHTHALMIC PREPARATIONS
azithromycin ophthalmic solutiondrugId:119 BP - PA OPHTHALMIC PREPARATIONS
azithromycin; See Table 35drugId:117; See Table 66drugId:2622 ANTIBIOTICS
azilsartandrugId:2240 - PA CARDIOVASCULAR
azilsartan / chlorthalidonedrugId:2480 - PA CARDIOVASCULAR
Azilect (rasagiline)drugId:1640 - PA ANTIPARKINSON
Azelex (azelaic acid cream)drugId:112 - PA DERMATOLOGICAL
azelastine ophthalmic solutiondrugId:114 ANTIHISTAMINES
azelastine 137 mcg nasal spraydrugId:115 - PA > 1 inhaler/month NASAL PREPARATIONS
azelastine 0.15% nasal spraydrugId:116 - PA NASAL PREPARATIONS
azelastine/fluticasone propionatedrugId:2580 - PA NASAL PREPARATIONS
azelaic acid geldrugId:113 BP - PA DERMATOLOGICAL
azelaic acid foamdrugId:5106 - PA DERMATOLOGICAL
azelaic acid creamdrugId:112 - PA DERMATOLOGICAL
Azedra (iobenguane I 131)drugId:6980 ^ CHEMOTHERAPY
azathioprine injectiondrugId:5501 IMMUNOMODULATOR
azathioprine 75 mg, 100 mg tabletdrugId:2857 - PA IMMUNOMODULATOR
azathioprine 50 mg tabletdrugId:111 IMMUNOMODULATOR
Azasite (azithromycin ophthalmic solution)drugId:119 BP - PA OPHTHALMIC PREPARATIONS
AzactamdrugId:120 # (aztreonam injection)drugId:120 ANTIBIOTICS
azacitidinedrugId:110 CHEMOTHERAPY
Aygestin (norethindrone 5 mg) HORMONE REPLACEMENT THERAPY
axitinibdrugId:2484 - PA CHEMOTHERAPY
Axiron (testosterone 2% solution)drugId:2237 - PA HORMONE REPLACEMENT THERAPY
axicabtagene ciloleuceldrugId:6414 CO ^ - PA CHEMOTHERAPY
Axert (almotriptan)drugId:18 - PA TRIPTAN
Avycaz (ceftazidime / avibactam)drugId:4902 - PA ANTIBIOTICS
Avonex (interferon beta-1a-Avonex)drugId:825 MULTIPLE SCLEROSIS AGENTS
Avodart (dutasteride)drugId:586 - PA BENIGN PROSTATIC HYPERPLASIA AGENTS
AvitadrugId:1747 # (tretinoin-Avita)drugId:1747 - PA ≥ 22 years DERMATOLOGICAL
avelumabdrugId:6100 - PA CHEMOTHERAPY
Avelox (moxifloxacin tablet)drugId:1398 - PA ANTIBIOTICS
Avelox (moxifloxacin injection)drugId:2748 ANTIBIOTICS
Aveed (testosterone undecanoate)drugId:2954 ^ - PA HORMONE REPLACEMENT THERAPY
AVC (sulfanilamide)drugId:1909 ANTIBIOTICS
avatrombopagdrugId:6990 - PA HEMATOLOGIC
Avastin (bevacizumab)drugId:360 - PA CHEMOTHERAPY
AvaprodrugId:968 # (irbesartan)drugId:968 CARDIOVASCULAR
Avandia (rosiglitazone)drugId:1456 - PA DIABETIC AGENTS
AvalidedrugId:969 # (irbesartan / hydrochlorothiazide)drugId:969 CARDIOVASCULAR
Austedo (deutetrabenazine)drugId:6121 - PA NEUROLOGIC AGENT
Auryxia (ferric citrate) ELECTROLYTES AND NUTRIENTS
auranofin IMMUNOMODULATOR
Augmentin XR (amoxicillin / clavulanate extended-release)drugId:55 - 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
Augmentin (amoxicillin / clavulanate 125/31.25 mg/5 mL suspension)drugId:54 - PA ANTIBIOTICS
Aubagio (teriflunomide)drugId:2657 - PA MULTIPLE SCLEROSIS AGENTS
Atrovent HFA (ipratropium inhalation aerosol)drugId:833 BRONCHODILATORS
Atrovent # (ipratropium nasal spray) NASAL PREPARATIONS
atropine ophthalmic OPHTHALMIC PREPARATIONS
atropine injection ANTISPASMODICS,ANTICHOLINERGIC
Atripla (efavirenz / emtricitabine / tenofovir)drugId:591 ANTIVIRALS
Atralin (tretinoin 0.05% gel)drugId:2432 - PA DERMATOLOGICAL
atovaquone / proguanil ANTIMALARIALS
atovaquonedrugId:106 ANTIPARASITICS
atorvastatin 80 mgdrugId:2933 - PA > 30 units/month LIPID LOWERING AGENTS
atorvastatin 10 mg, 20 mg, 40 mgdrugId:105 - PA > 45 units/month LIPID LOWERING AGENTS
atomoxetine - PA < 6 years; See Table 31drugId:104; See Table 71drugId:3080 NONSTIMULANT ADHD AGENTS
Ativan # (lorazepam solution, tablet) - PA < 6 years; See Table 69drugId:1100; See Table 71drugId:4400 BENZODIAZEPINES
Atgam (antithymocyte globulin, equine)drugId:1112 BIOLOGICAL
atezolizumabdrugId:5593 - PA CHEMOTHERAPY
atenolol / chlorthalidonedrugId:103 CARDIOVASCULAR
atenololdrugId:102 CARDIOVASCULAR
Atelvia (risedronate delayed-release)drugId:2101 - PA ELECTROLYTES AND NUTRIENTS
atazanavir / cobicistatdrugId:4768 ANTIVIRALS
atazanavirdrugId:101 ANTIVIRALS
Atacand HCT (candesartan / hydrochlorothiazide)drugId:434 - PA CARDIOVASCULAR
Atacand (candesartan)drugId:433 - PA CARDIOVASCULAR
Astramorph-PF (morphine, injection-Astramorph-PF)drugId:1391 - PA > 120 mg/day OPIOID ANALGESICS
Astepro (azelastine 0.15% nasal spray)drugId:116 - PA NASAL PREPARATIONS
Astagraf XL (tacrolimus extended-release capsule)drugId:2838 IMMUNOMODULATOR
aspirin with buffers * ANALGESICS
aspirin extended-releasedrugId:5245 - PA ANTIPLATELET AGENT
aspirin * ANALGESICS
aspirin / omeprazoledrugId:5770 - PA ANTIPLATELET AGENT
aspirin / extended-release dipyridamoledrugId:100 ANTIPLATELET AGENT
asparaginase erwinia chrysanthemidrugId:2420 ^ - PA CHEMOTHERAPY
Asmanex Twisthaler (mometasone 220 mcg inhalation powder)drugId:1379 - PA < 12 years BRONCHODILATORS
Asmanex Twisthaler (mometasone 110 mcg inhalation powder)drugId:2663 - PA ≥ 12 years BRONCHODILATORS
Asmanex HFA (mometasone inhalation aerosol)drugId:5102 BRONCHODILATORS
asfotase alfadrugId:5300 - PA ENZYMES
asenapine - PA; See Table 24drugId:97; See Table 71drugId:4260 ANTIPSYCHOTIC
ascorbic aciddrugId:96 * ELECTROLYTES AND NUTRIENTS
Asclera (polidocanol)drugId:2934 - PA CARDIOVASCULAR
Asacol HD (mesalamine high dose delayed-release)drugId:1152 BP GI ANTI-INFLAMMATORY
Arzerra (ofatumumab)drugId:1270 - PA CHEMOTHERAPY
Arymo ER (morphine extended-release tablet-Arymo ER)drugId:6040 - PA OPIOID ANALGESICS
Artificial Tears (glycerin / propylene glycol)drugId:678 * OPHTHALMIC PREPARATIONS
ArthrotecdrugId:514 # (diclofenac / misoprostol)drugId:514 - PA < 60 years NONSTEROIDAL ANTI-INFLAMMATORY
artemether / lumefantrinedrugId:95 - PA > 24 units/365 days ANTIMALARIALS
arsenic trioxidedrugId:2697 CHEMOTHERAPY
Arranon (nelarabine)drugId:1182 - PA CHEMOTHERAPY
AromasindrugId:450 # (exemestane)drugId:450 CHEMOTHERAPY
Arnuity (fluticasone furoate inhalation powder)drugId:4760 - PA BRONCHODILATORS
Armonair (fluticasone propionate inhalation powder-Armonair)drugId:6340 - PA BRONCHODILATORS
armodafinildrugId:94 - PA CEREBRAL STIMULANTS
ArixtradrugId:904 # (fondaparinux)drugId:904 ANTICOAGULANTS
Aristospan (triamcinolone injection)drugId:1750 GLUCOCORTICOIDS
Aristada Initio (aripiprazole lauroxil 675 mg) PD - PA < 6 years and PA > 1 injection/month; See Table 24drugId:6861; See Table 71drugId:6860 ANTIPSYCHOTIC
Aristada (aripiprazole lauroxil 441 mg, 662 mg, 882 mg) PD - PA < 6 years and PA > 1 injection/month; See Table 24drugId:5240; See Table 71drugId:5241 ANTIPSYCHOTIC
Aristada (aripiprazole lauroxil 1,064 mg) PD - PA < 6 years and PA > 1 injection/2 months; See Table 24drugId:6300; See Table 71drugId:6301 ANTIPSYCHOTIC
aripiprazole tablet - PA < 6 years and PA > 30 units/month; See Table 24drugId:90; See Table 71drugId:4180 ANTIPSYCHOTIC
aripiprazole solution - PA < 6 years or ≥ 18 years and PA > 750 mL/month; See Table 24drugId:91; See Table 71drugId:4240 ANTIPSYCHOTIC
aripiprazole orally disintegrating tablet - PA; See Table 24drugId:92; See Table 71drugId:4220 ANTIPSYCHOTIC
aripiprazole lauroxil 675 mg PD - PA < 6 years and PA > 1 injection/month; See Table 24drugId:6861; See Table 71drugId:6860 ANTIPSYCHOTIC
aripiprazole lauroxil 441 mg, 662 mg, 882 mg PD - PA < 6 years and PA > 1 injection/month; See Table 24drugId:5240; See Table 71drugId:5241 ANTIPSYCHOTIC
aripiprazole lauroxil 1,064 mg PD - PA < 6 years and PA > 1 injection/2 months; See Table 24drugId:6300; See Table 71drugId:6301 ANTIPSYCHOTIC
aripiprazole extended-release injection - PA; See Table 24drugId:2717; See Table 71drugId:4200 ANTIPSYCHOTIC
ArimidexdrugId:69 # (anastrozole)drugId:69 CHEMOTHERAPY
Arikayce (amikacin liposome inhalation)drugId:7040 - PA ANTIBIOTICS
AriceptdrugId:559 # (donepezil 5 mg tablet)drugId:559 - PA < 18 years and PA > 30 units/month ALZHEIMER'S THERAPY
AriceptdrugId:2422 # (donepezil 10 mg tablet)drugId:2422 - PA < 18 years and PA > 60 units/month ALZHEIMER'S THERAPY
Aricept (donepezil 23 mg tablet)drugId:2247 - PA ALZHEIMER'S THERAPY
arformoteroldrugId:88 - PA BRONCHODILATORS
ArediadrugId:1474 # (pamidronate)drugId:1474 ELECTROLYTES AND NUTRIENTS
Arcapta (indacaterol)drugId:2357 - PA BRONCHODILATORS
Arcalyst (rilonacept)drugId:1434 - PA BIOLOGICAL
Arava # (leflunomide) IMMUNOMODULATOR
Aranesp (darbepoetin alfa)drugId:327 - PA HEMATINIC AGENT
Aralast NP (alpha-1-proteinase inhibitor, human-Aralast NP) ENZYMES
Aralast (alpha-1-proteinase inhibitor, human-Aralast) ENZYMES
Aquadeks (multivitamins / minerals / folic acid / coenzyme Q10-Aquadeks)drugId:2385 - PA HEMATINIC AGENT
Aquadeks (multivitamins / minerals / coenzyme Q10-Aquadeks)drugId:2380 - PA HEMATINIC AGENT
Aptivus (tipranavir)drugId:1709 ANTIVIRALS
Aptiom (eslicarbazepine) - PA; See Table 20drugId:2953; See Table 71drugId:3380 ANTICONVULSANTS
Aptensio XR (methylphenidate extended-release-Aptensio XR) - PA; See Table 31drugId:5100; See Table 71drugId:5101 CEREBRAL STIMULANTS
Apriso (mesalamine extended-release)drugId:1150 GI ANTI-INFLAMMATORY
aprepitant trifold packdrugId:87 BP - PA > 2 packs/28 days ANTIEMETICS
aprepitant injectable emulsiondrugId:6604 ANTIEMETICS
aprepitant 80 mgdrugId:85 - PA > 4 capsules/28 days ANTIEMETICS
aprepitant 40 mg and 125 mg capsuledrugId:86 - PA > 2 capsules/28 days ANTIEMETICS
aprepitant 125 mg powder for oral suspensiondrugId:5726 - PA > 6 units/28 days ANTIEMETICS
apremilastdrugId:2941 - PA IMMUNOMODULATOR
apraclonidinedrugId:84 OPHTHALMIC PREPARATIONS
apomorphinedrugId:83 ANTIPARKINSON
Apokyn (apomorphine)drugId:83 ANTIPARKINSON
Aplenzin (bupropion hydrobromide extended-release) - PA; See Table 17drugId:395; See Table 71drugId:3640 ANTIDEPRESSANTS
apixabandrugId:2721 - PA ANTICOAGULANTS
Apidra (insulin glulisine)drugId:810 DIABETIC AGENTS
Apexicon-E (diflorasone cream / emollient)drugId:520 - PA GLUCOCORTICOIDS
apalutamidedrugId:6682 - PA CHEMOTHERAPY
Anzemet (dolasetron tablet)drugId:557 - PA ANTIEMETICS
Anzemet (dolasetron injection)drugId:558 ANTIEMETICS
Anusol-HCdrugId:740 # (hydrocortisone hemorrhoidal cream)drugId:740 GLUCOCORTICOIDS
antithymocyte globulin, rabbitdrugId:1111 BIOLOGICAL
antithymocyte globulin, equinedrugId:1112 BIOLOGICAL
anti-inhibitor coagulant complex-Feiba VH ANTI-HEMOPHILIA AGENTS
anti-inhibitor coagulant complex-Feiba NF ANTI-HEMOPHILIA AGENTS
antihemophilic factor / von willebrand factor complex, human ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant-Xyntha ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant-Recombinate ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant pegylated-aucl-Jivi ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant pegylated-Adynovate ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant-Nuwiq ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant-Novoeight ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant-Kovaltry ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant-Kogenate ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant-Hemofil-M ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant-Helixate ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant-Advate ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant, single chain-Afstyla ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant, porcine sequence-Obizur ANTI-HEMOPHILIA AGENTS
antihemophilic factor, human-Monoclate-P ANTI-HEMOPHILIA AGENTS
antihemophilic factor, human-Koate-DVI ANTI-HEMOPHILIA AGENTS
antihemophilic factor, human-Humate-P ANTI-HEMOPHILIA AGENTS
Antara (fenofibrate capsule)drugId:468 LIPID LOWERING AGENTS
AntabusedrugId:549 # (disulfiram)drugId:549 ALCOHOL AND DRUG CESSATION AGENT
Anoro (umeclidinium / vilanterol)drugId:2952 - PA BRONCHODILATORS
anidulafungin ANTIBIOTICS
Angeliq (estradiol / drospirenone) HORMONE REPLACEMENT THERAPY
Androxy (fluoxymesterone) ANABOLIC STEROID
Androgel (testosterone 1% gel packet)drugId:2248 BP - PA HORMONE REPLACEMENT THERAPY
Androgel (testosterone 1.62% gel packet, pump)drugId:2280 - PA HORMONE REPLACEMENT THERAPY
Androderm (testosterone patch)drugId:1682 - PA HORMONE REPLACEMENT THERAPY
AncobondrugId:861 # (flucytosine)drugId:861 ANTIBIOTICS
anastrozoledrugId:69 CHEMOTHERAPY
Anascorp (centruroides immune F(ab’)2, equine) ^ ANTIDOTES
anakinradrugId:66 - PA IMMUNOMODULATOR
anagrelidedrugId:65 ANTIPLATELET AGENT
Anafranil (clomipramine) - PA; See Table 17drugId:272; See Table 71drugId:4002 ANTIDEPRESSANTS
Anadrol-50 (oxymetholone) ANABOLIC STEROID
Amrix (cyclobenzaprine extended-release)drugId:304 - PA MUSCLE RELAXANT
Ampyra (dalfampridine)drugId:320 - PA MULTIPLE SCLEROSIS AGENTS
ampicillin / sulbactamdrugId:64 ANTIBIOTICS
ampicillin; See Table 35drugId:63; See Table 66drugId:2623 ANTIBIOTICS
amphotericin B liposome ANTIBIOTICS
amphotericin B lipid complex ANTIBIOTICS
amphotericin B ANTIBIOTICS
amphetamine sulfate - PA; See Table 31drugId:4901; See Table 71drugId:4920 CEREBRAL STIMULANTS
amphetamine salts - PA < 3 years and PA > 90 units/month; See Table 31drugId:60; See Table 71drugId:3100 CEREBRAL STIMULANTS
amphetamine salts extended-release-Mydayis - PA; See Table 31drugId:6285; See Table 71drugId:6286 CEREBRAL STIMULANTS
amphetamine salts extended-release-Adderall XR BP PD - PA < 3 years and PA > 60 units/month; See Table 31drugId:59; See Table 71drugId:3000 CEREBRAL STIMULANTS
amphetamine extended-release oral suspension - PA; See Table 31drugId:6600; See Table 71drugId:6601 CEREBRAL STIMULANTS
amphetamine extended-release orally disintegrating tablet - PA; See Table 31drugId:5360; See Table 71drugId:5361 CEREBRAL STIMULANTS
amoxicillin / clavulanate extended-releasedrugId:55 - PA ANTIBIOTICS
amoxicillin / clavulanate chewable tablet, 200/28.5, 250/62.5, 400/57, 600/42.9 mg/5 mL suspension, tabletdrugId:6420 ANTIBIOTICS
amoxicillin / clavulanate 125/31.25 mg/5 mL suspensiondrugId:54 - PA ANTIBIOTICS
amoxicillindrugId:57 ANTIBIOTICS
amoxapine - PA < 6 years; See Table 17drugId:56; See Table 71drugId:4001 ANTIDEPRESSANTS
Ammonul # (sodium phenylacetate / sodium benzoate) ELECTROLYTES AND NUTRIENTS
ammonium lactate DERMATOLOGICAL
amlodipine / valsartan / hydrochlorothiazidedrugId:50 - PA CARDIOVASCULAR
amlodipine / valsartandrugId:48 CARDIOVASCULAR
amlodipine / telmisartandrugId:1661 - PA CARDIOVASCULAR
amlodipine / olmesartandrugId:46 - PA CARDIOVASCULAR
amlodipine / olmesartan / hydrochlorothiazidedrugId:1969 - PA CARDIOVASCULAR
amlodipine / benazeprildrugId:44 CARDIOVASCULAR
amlodipine / atorvastatin - PA; See Table 13drugId:42; See Table 18drugId:43 CARDIOVASCULAR/STATIN
amlodipinedrugId:41 CARDIOVASCULAR
amitriptyline tablet - PA < 6 years; See Table 17drugId:39; See Table 71drugId:4000 ANTIDEPRESSANTS
amitriptyline powder - PA; See Table 17drugId:6368; See Table 71drugId:6369 ANTIDEPRESSANTS
amitriptyline / perphenazine - PA < 6 years; See Table 24drugId:6320; See Table 71drugId:1512 ANTIPSYCHOTIC
amitriptyline / chlordiazepoxidedrugId:40 - PA < 6 years ANTIDEPRESSANTS
Amitiza (lubiprostone)drugId:1110 - PA CONSTIPATION AGENTS
amiodarone CARDIOVASCULAR
aminosalicylic aciddrugId:2500 TB PREPARATIONS
aminophylline BRONCHODILATORS
aminolevulinic acid ^ CHEMOTHERAPY
aminocaproic acid BP HEMATINIC AGENT
amino acid and electrolyte IV infusion ELECTROLYTES AND NUTRIENTS
amiloride / hydrochlorothiazidedrugId:34 CARDIOVASCULAR
amiloridedrugId:33 CARDIOVASCULAR
amikacin liposome inhalationdrugId:7040 - PA ANTIBIOTICS
amikacindrugId:32 ANTIBIOTICS
amifostinedrugId:2670 ANTIDOTES
amifampridinedrugId:7041 - PA POTASSIUM CHANNEL BLOCKER
Amicar (aminocaproic acid) BP HEMATINIC AGENT
Amerge (naratriptan)drugId:1175 - PA TRIPTAN
Ameluz (aminolevulinic acid) ^ CHEMOTHERAPY
amcinonide ointmentdrugId:4917 - PA GLUCOCORTICOIDS
amcinonide lotiondrugId:4916 GLUCOCORTICOIDS
amcinonide creamdrugId:31 - PA GLUCOCORTICOIDS
ambrisentandrugId:30 BP - PA CARDIOVASCULAR
Ambisome (amphotericin B liposome) ANTIBIOTICS
Ambien CR # (zolpidem extended-release tablet) - PA < 6 years and PA > 30 units/month; See Table 15drugId:1934; See Table 71drugId:4345 SEDATIVES
Ambien # (zolpidem 5 mg tablet) - PA < 6 years and PA > 45 units/month; See Table 15drugId:1933; See Table 71drugId:4344 SEDATIVES
Ambien # (zolpidem 10 mg tablet) - PA < 6 years and PA > 30 units/month; See Table 15drugId:1932; See Table 71drugId:4342 SEDATIVES
AmaryldrugId:931 # (glimepiride)drugId:931 DIABETIC AGENTS
amantadine immediate-release capsule, solution, tabletdrugId:29 ANTIPARKINSON
amantadine extended-release tabletdrugId:7006 - PA ANTIPARKINSON
amantadine extended-release capsuledrugId:6402 - PA ANTIPARKINSON
Alvesco (ciclesonide)drugId:230 BRONCHODILATORS
Alunbrig (brigatinib)drugId:6180 - PA CHEMOTHERAPY
aluminum hydroxidedrugId:28 * ANTACIDS
aluminum carbonate * GASTROINTESTINAL AGENT
Altreno (tretinoin 0.05% lotion)drugId:6900 - PA DERMATOLOGICAL
Altoprev (lovastatin extended-release)drugId:1107 - PA LIPID LOWERING AGENTS
AltacedrugId:2588 # (ramipril)drugId:2588 CARDIOVASCULAR
Alrex (loteprednol 0.2%)drugId:1105 - PA OPHTHALMIC PREPARATIONS
Alprolix (factor IX recombinant, Fc fusion protein) ANTI-HEMOPHILIA AGENTS
alprazolam powder - PA; See Table 69drugId:27; See Table 71drugId:4360 BENZODIAZEPINES
alprazolam - PA < 6 years; See Table 69drugId:25; See Table 71drugId:4358 BENZODIAZEPINES
alprazolam orally disintegrating tablet - PA; See Table 69drugId:24; See Table 71drugId:4357 BENZODIAZEPINES
alprazolam extended-release - PA < 6 years and PA > 60 units/month; See Table 69drugId:26; See Table 71drugId:4359 BENZODIAZEPINES
Alphanine SD (factor IX, human) ANTI-HEMOPHILIA AGENTS
Alphanate (antihemophilic factor / von willebrand factor complex, human) ANTI-HEMOPHILIA AGENTS
Alphagan P (brimonidine 0.1%, 0.15% eye drops)drugId:2505 BP OPHTHALMIC PREPARATIONS
alpha-1-proteinase inhibitor, human-Zemaira ENZYMES
alpha-1-proteinase inhibitor, human-Prolastin ENZYMES
alpha-1-proteinase inhibitor, human-Glassia ENZYMES
alpha-1-proteinase inhibitor, human-Aralast NP ENZYMES
alpha-1-proteinase inhibitor, human-Aralast ENZYMES
AloxidrugId:1473 # (palonosetron 0.25 mg/5 mL injection)drugId:1473 - PA > 2 units/28 days ANTIEMETICS
alosetrondrugId:19 - PA GASTROINTESTINAL AGENT
Alora (estradiol-Alora) HORMONE REPLACEMENT THERAPY
Alomide (lodoxamide)drugId:1095 - PA OPHTHALMIC PREPARATIONS
alogliptindrugId:2784 - PA DIABETIC AGENTS
alogliptin / pioglitazonedrugId:2783 - PA DIABETIC AGENTS
alogliptin / metformindrugId:2782 - PA DIABETIC AGENTS
Alocril (nedocromil)drugId:1180 - PA OPHTHALMIC PREPARATIONS
almotriptandrugId:18 - PA TRIPTAN
allopurinoldrugId:17 GOUT AGENTS
AlkerandrugId:5504 # (melphalan tablet)drugId:5504 CHEMOTHERAPY
AlkerandrugId:1138 # (melphalan hydrochloride injection)drugId:1138 CHEMOTHERAPY
alitretinoindrugId:16 - PA CHEMOTHERAPY
aliskirendrugId:13 BP - PA CARDIOVASCULAR
aliskiren / hydrochlorothiazidedrugId:14 - PA CARDIOVASCULAR
alirocumabdrugId:5119 - PA LIPID LOWERING AGENTS
Aliqopa (copanlisib)drugId:6500 - PA CHEMOTHERAPY
Alimta (pemetrexed)drugId:1492 CHEMOTHERAPY
Align (bifidobacterium infantis)drugId:6200 - PA ≥ 19 years GASTROINTESTINAL AGENT
alglucosidase alfadrugId:11 - PA ENZYMES
alfuzosin extended-releasedrugId:10 URINARY ANTISPASMODICS
alendronate tabletdrugId:7 ELECTROLYTES AND NUTRIENTS
alendronate solutiondrugId:2796 - PA ELECTROLYTES AND NUTRIENTS
alendronate effervescent tabletdrugId:2638 - PA ELECTROLYTES AND NUTRIENTS
alendronate / cholecalciferoldrugId:9 - PA ELECTROLYTES AND NUTRIENTS
alemtuzumab 30 mgdrugId:6110 CHEMOTHERAPY
alemtuzumab 12 mgdrugId:4782 ^ - PA MULTIPLE SCLEROSIS AGENTS
alectinibdrugId:5221 - PA CHEMOTHERAPY
Alecensa (alectinib)drugId:5221 - PA CHEMOTHERAPY
Aldurazyme (laronidase)drugId:1026 - PA ENZYMES
aldesleukindrugId:2307 CHEMOTHERAPY
Aldara (imiquimod 5% cream)drugId:783 - PA DERMATOLOGICAL
AldactonedrugId:1892 # (spironolactone tablet)drugId:1892 ALDOSTERONE ANTAGONISTS
AldactazidedrugId:1893 # (spironolactone / hydrochlorothiazide)drugId:1893 CARDIOVASCULAR
alclometasone cream, ointmentdrugId:4 GLUCOCORTICOIDS
alcaftadinedrugId:2173 - PA ANTIHISTAMINES
albuterol syrup, tabletdrugId:2193 BRONCHODILATORS
albuterol inhaler-VentolindrugId:3 BP - PA BRONCHODILATORS
albuterol inhaler-ProventildrugId:2 BP BRONCHODILATORS
albuterol inhaler-Proair HFAdrugId:1 BP BRONCHODILATORS
albuterol inhalation solutiondrugId:168 BRONCHODILATORS
albuterol inhalation powderdrugId:5109 BRONCHODILATORS
albuterol / ipratropium inhalation spraydrugId:2557 BRONCHODILATORS
albuterol / ipratropium inhalation solutiondrugId:835 BRONCHODILATORS
albumin, human solutions PLASMA PROTEINS
albiglutidedrugId:2946 - PA DIABETIC AGENTS
AlbenzadrugId:166 # (albendazole)drugId:166 ANTIPARASITICS
albendazoledrugId:166 ANTIPARASITICS
Akynzeo (netupitant / palonosetron capsule)drugId:4761 - PA > 2 capsules/28 days ANTIEMETICS
Akynzeo (fosnetupitant / palonosetron injection)drugId:6620 - PA > 2 vials/28 days ANTIEMETICS
Akten (lidocaine ophthalmic gel) OPHTHALMIC PREPARATIONS
Ajovy (fremanezumab-vfrm)drugId:7000 - PA BIOLOGICAL
Airduo (fluticasone / salmeterol inhalation powder)drugId:6120 - PA BRONCHODILATORS
Aimovig (erenumab-aooe)drugId:6661 - PA BIOLOGICAL
A-HydrocortdrugId:730 # (hydrocortisone injection)drugId:730 GLUCOCORTICOIDS
AgrylindrugId:65 # (anagrelide)drugId:65 ANTIPLATELET AGENT
AggrenoxdrugId:100 # (aspirin / extended-release dipyridamole)drugId:100 ANTIPLATELET AGENT
agalsidase betadrugId:162 - PA ENZYMES
Afstyla (antihemophilic factor, recombinant, single chain-Afstyla) ANTI-HEMOPHILIA AGENTS
Afrezza (insulin human inhalation powder)drugId:4900 - PA DIABETIC AGENTS
Afluria (influenza virus vaccine-Afluria)drugId:2046 1 BIOLOGICAL
aflibercept ^ OPHTHALMIC PREPARATIONS
Afinitor Disperz (everolimus tablets for oral suspension) - PA; See Table 20drugId:6880; See Table 57drugId:2795 CHEMOTHERAPY
Afinitor (everolimus-Afinitor) - PA; See Table 20drugId:448; See Table 57drugId:1954 CHEMOTHERAPY
afatinibdrugId:2843 - PA CHEMOTHERAPY
Aerospan (flunisolide inhalation aerosol)drugId:2920 - PA BRONCHODILATORS
Adzenys XR-ODT (amphetamine extended-release orally disintegrating tablet) - PA; See Table 31drugId:5360; See Table 71drugId:5361 CEREBRAL STIMULANTS
Adzenys ER (amphetamine extended-release oral suspension) - PA; See Table 31drugId:6600; See Table 71drugId:6601 CEREBRAL STIMULANTS
Adynovate (antihemophilic factor, recombinant pegylated-Adynovate) ANTI-HEMOPHILIA AGENTS
Advate (antihemophilic factor, recombinant-Advate) ANTI-HEMOPHILIA AGENTS
Advair (fluticasone / salmeterol inhalation aerosol, powder)drugId:896 BP - PA BRONCHODILATORS
AdrucildrugId:875 # (fluorouracil injection)drugId:875 CHEMOTHERAPY
AdriamycindrugId:571 # (doxorubicin)drugId:571 CHEMOTHERAPY
Adrenalin (epinephrine injection)drugId:606 ADRENERGICS
ado-trastuzumabdrugId:2781 - PA CHEMOTHERAPY
Admelog (insulin lispro-Admelog)drugId:6660 - PA DIABETIC AGENTS
Adlyxin (lixisenatide)drugId:5760 - PA DIABETIC AGENTS
adenovirus live vaccine delayed-release oral tabletsdrugId:2837 BIOLOGICAL
Adempas (riociguat)drugId:2883 - PA CARDIOVASCULAR
adefovirdrugId:161 - PA > 30 units/month ANTIVIRALS
Adderall XR (amphetamine salts extended-release-Adderall XR) BP PD - PA < 3 years and PA > 60 units/month; See Table 31drugId:59; See Table 71drugId:3000 CEREBRAL STIMULANTS
Adderall # (amphetamine salts) - PA < 3 years and PA > 90 units/month; See Table 31drugId:60; See Table 71drugId:3100 CEREBRAL STIMULANTS
Adcirca (tadalafil-Adcirca)drugId:1920 - PA CARDIOVASCULAR
Adcetris (brentuximab)drugId:2374 - PA CHEMOTHERAPY
adapalenedrugId:159 BP - PA DERMATOLOGICAL
adapalene / benzoyl peroxidedrugId:160 - PA DERMATOLOGICAL
adalimumabdrugId:158 PD - PA IMMUNOMODULATOR
AdalatdrugId:1213 # (nifedipine tablet)drugId:1213 CARDIOVASCULAR
Adagen (pegademase bovine)drugId:2682 - PA UNCLASSIFIED DRUG PRODUCTS
Adacel (diphtheria / tetanus toxoids / acellular pertussis vaccine)drugId:539 1 BIOLOGICAL
Aczone (dapsone gel)drugId:325 - PA DERMATOLOGICAL
acyclovir ointmentdrugId:156 - PA ANTIVIRALS
acyclovir injectiondrugId:2744 ANTIVIRALS
acyclovir creamdrugId:157 BP - PA ANTIVIRALS
acyclovir capsule, suspension, tabletdrugId:155 ANTIVIRALS
acyclovir buccal tabletdrugId:2945 - PA ANTIVIRALS
acyclovir / hydrocortisonedrugId:1973 - PA DERMATOLOGICAL
Acuvail (ketorolac 0.45% ophthalmic solution)drugId:999 - PA OPHTHALMIC PREPARATIONS
Acular LSdrugId:2271 # (ketorolac 0.4% ophthalmic solution)drugId:2271 OPHTHALMIC PREPARATIONS
AculardrugId:2270 # (ketorolac 0.5% ophthalmic solution)drugId:2270 OPHTHALMIC PREPARATIONS
ActosdrugId:1534 # (pioglitazone)drugId:1534 DIABETIC AGENTS
Actoplus Met XR (pioglitazone / metformin extended-release)drugId:1937 - PA DIABETIC AGENTS
Actoplus Met (pioglitazone / metformin)drugId:1536 - PA DIABETIC AGENTS
Actonel (risedronate)drugId:1439 - PA ELECTROLYTES AND NUTRIENTS
Activella # (estradiol / norethindrone-Activella) HORMONE REPLACEMENT THERAPY
Actiq (fentanyl transmucosal system)drugId:844 - PA OPIOID ANALGESICS
Actimmune (interferon gamma-1b)drugId:829 CHEMOTHERAPY
ActigalldrugId:1774 # (ursodiol)drugId:1774 BILE THERAPY
Acthib (haemophilus B conjugate vaccine-Acthib)drugId:693 1 BIOLOGICAL
Acthar (corticotropin)drugId:294 - PA HORMONE AGENTS
Actemra (tocilizumab)drugId:1719 - PA IMMUNOMODULATOR
acrivastine / pseudoephedrinedrugId:1608 - PA DECONGESTANT
aclidiniumdrugId:2649 - PA > 1 inhaler/month BRONCHODILATORS
acitretindrugId:153 DERMATOLOGICAL
Aciphex Sprinkle (rabeprazole delayed-release capsule)drugId:2882 - PA PROTON PUMP INHIBITORS
Aciphex (rabeprazole delayed-release tablet)drugId:1624 - PA PROTON PUMP INHIBITORS
acetylcysteine injection ^ ANTIDOTES
acetylcysteine MUCOLYTICS
acetylcholine chloridedrugId:1982 OPHTHALMIC PREPARATIONS
acetohydroxamic acid ANTIBIOTICS
acetic acid / hydrocortisonedrugId:149 OTIC PREPARATIONS
acetic acid / aluminum acetatedrugId:2107 OTIC PREPARATIONS
acetic aciddrugId:148 OTIC PREPARATIONS
acetazolamidedrugId:147 CARDIOVASCULAR
acetaminophendrugId:145 * - PA > 4 g/day ANALGESICS
acetaminophen / codeinedrugId:146 - PA < 12 years and PA > 4 g/day acetaminophen and PA > 360 mg/day codeine OPIOID ANALGESICS
Acetadote (acetylcysteine injection) ^ ANTIDOTES
acebutololdrugId:144 CARDIOVASCULAR
AccureticdrugId:1621 # (quinapril / hydrochlorothiazide)drugId:1621 CARDIOVASCULAR
AccuprildrugId:1620 # (quinapril)drugId:1620 CARDIOVASCULAR
AccunebdrugId:168 # (albuterol inhalation solution)drugId:168 BRONCHODILATORS
Accolate (zafirlukast)drugId:1816 - PA BRONCHODILATORS
acarbosedrugId:143 DIABETIC AGENTS
Acanya (clindamycin / benzoyl peroxide-Acanya)drugId:262 - PA DERMATOLOGICAL
acamprosatedrugId:142 ALCOHOL AND DRUG CESSATION AGENT
acalabrutinibdrugId:6483 - PA CHEMOTHERAPY
Abstral (fentanyl sublingual tablet)drugId:2157 - PA OPIOID ANALGESICS
Absorica (isotretinoin-Absorica)drugId:2881 - PA DERMATOLOGICAL
Abraxane (paclitaxel injectable suspension)drugId:1468 CHEMOTHERAPY
abobotulinumtoxinAdrugId:141 - PA BIOLOGICAL
abiraterone 250 mg, 500 mgdrugId:2297 BP - PA CHEMOTHERAPY
abiraterone 125 mgdrugId:6824 - PA CHEMOTHERAPY
Abilify Maintena (aripiprazole extended-release injection) - PA; See Table 24drugId:2717; See Table 71drugId:4200 ANTIPSYCHOTIC
Abilify Discmelt (aripiprazole orally disintegrating tablet) - PA; See Table 24drugId:92; See Table 71drugId:4220 ANTIPSYCHOTIC
Abilify # (aripiprazole tablet) - PA < 6 years and PA > 30 units/month; See Table 24drugId:90; See Table 71drugId:4180 ANTIPSYCHOTIC
Abilify # (aripiprazole solution) - PA < 6 years or ≥ 18 years and PA > 750 mL/month; See Table 24drugId:91; See Table 71drugId:4240 ANTIPSYCHOTIC
abemaciclibdrugId:6410 - PA CHEMOTHERAPY
Abelcet (amphotericin B lipid complex) ANTIBIOTICS
abataceptdrugId:140 - PA IMMUNOMODULATOR
abaloparatidedrugId:6362 - PA HORMONE AGENTS
abacavir / lamivudine / zidovudinedrugId:139 ANTIVIRALS
abacavir / lamivudinedrugId:138 ANTIVIRALS
abacavir / dolutegravir / lamivudinedrugId:4642 ANTIVIRALS
abacavirdrugId:137 ANTIVIRALS

MassHealth Drug List Footnotes
PA Prior authorization is required. The prescriber must obtain prior authorization for the drug in order for the pharmacy to receive payment. Note: Prior authorization applies to both the brand-name and the FDA "A"-rated generic equivalent of listed product.
 
# This designates a brand-name drug with FDA “A”-rated generic equivalents. Prior authorization is required for the brand, unless a particular form of that drug (for example, tablet, capsule, or liquid) does not have an FDA “A”-rated generic equivalent.
 
BP Brand Preferred over generic equivalents. In general, MassHealth requires a trial of the preferred drug or clinical rationale for prescribing the non-preferred drug generic equivalent.
 
CO Carve-Out. This agent is listed on the Acute Hospital Carve-Out Drugs List and is subject to additional monitoring and billing requirements.
 
PD Preferred Drug. In general, MassHealth requires a trial of the preferred drug or clinical rationale for prescribing a non-preferred drug within a therapeutic class.
 
* The generic OTC and, if any, generic prescription versions of the drug are payable under MassHealth without prior authorization.
 
o Prior-authorization status depends on the drug's formulation.
 
^ This drug is available through the health care professional who administers the drug. MassHealth does not pay for this drug to be dispensed through a retail pharmacy.
 
1 Product may be available through the Massachusetts Department of Public Health (DPH). Please check with DPH for availability. MassHealth does not pay for immunizing biologicals (i.e., vaccines) and tubercular (TB) drugs that are available free of charge through local boards of public health or through the Massachusetts Department of Public Health without prior authorization (130 CMR 406.413(C)). In cases where free vaccines are available to providers for specific populations (e.g. children, high risk, etc.), MassHealth will reimburse the provider only for individuals not eligible for the free vaccines. Notwithstanding the above, MassHealth will pay pharmacies for seasonal flu vaccine serum without prior authorization, if the vaccine is administered in the pharmacy.
 
2 Prior authorization status is gender specific.
 

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


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Last updated 07/15/19