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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
droxidopadrugId:4630 - PA ADRENERGICS
donepezil 10 mg tabletdrugId:2422 - PA < 18 years and PA > 60 units/month ALZHEIMER'S THERAPY
donepezil 23 mg tabletdrugId:2247 - PA ALZHEIMER'S THERAPY
donepezil 5 mg tabletdrugId:559 - PA < 18 years and PA > 30 units/month ALZHEIMER'S THERAPY
donepezil orally disintegrating tabletdrugId:560 - PA < 18 years and PA > 30 units/month ALZHEIMER'S THERAPY
D.H.E. 45 (dihydroergotamine injection)drugId:526 - PA ANALGESICS
dihydroergotamine injectiondrugId:526 - PA ANALGESICS
dihydroergotamine nasal spraydrugId:527 - PA ANALGESICS
dimethyl sulfoxide liquiddrugId:7161 - PA ANALGESICS
dimethyl sulfoxide solutiondrugId:2694 ANALGESICS
DuraclondrugId:2750 # (clonidine injection)drugId:2750 ANALGESICS
dalbavancindrugId:4623 - PA ANTIBIOTICS
dalfopristin / quinupristindrugId:2037 - PA ANTIBIOTICS
Dalvance (dalbavancin)drugId:4623 - PA ANTIBIOTICS
dapsone tabletdrugId:324 ANTIBIOTICS
daptomycindrugId:326 - PA ANTIBIOTICS
delafloxacin injectiondrugId:6480 - PA ANTIBIOTICS
delafloxacin tabletdrugId:6481 - PA ANTIBIOTICS
demeclocyclinedrugId:337 ANTIBIOTICS
dicloxacillindrugId:515 ANTIBIOTICS
Dificid (fidaxomicin)drugId:2283 - PA ANTIBIOTICS
DoribaxdrugId:561 # (doripenem)drugId:561 ANTIBIOTICS
doripenemdrugId:561 ANTIBIOTICS
Doryx (doxycycline hyclate delayed-release 50 mg, 120 mg, 200 mg tablet)drugId:2900 - PA ANTIBIOTICS
double antibiotic ointment (bacitracin / polymyxin B topical ointment)drugId:6260 * ANTIBIOTICS
doxycycline calcium syrupdrugId:2903 ANTIBIOTICS
doxycycline hyclate 100 mg capsuledrugId:575 ANTIBIOTICS
doxycycline hyclate 20 mg, 100 mg tabletdrugId:2902 ANTIBIOTICS
doxycycline hyclate 50 mg capsuledrugId:2901 ANTIBIOTICS
doxycycline hyclate 75 mg, 150 mg tabletdrugId:6141 - PA ANTIBIOTICS
doxycycline hyclate delayed-release 50 mg, 120 mg, 200 mg tabletdrugId:2900 - PA ANTIBIOTICS
doxycycline hyclate delayed-release 75 mg, 100 mg, 150 mg tabletdrugId:574 - PA ANTIBIOTICS
doxycycline hyclate injectiondrugId:2301 ANTIBIOTICS
doxycycline monohydrate 150 mg capsuledrugId:576 - PA ANTIBIOTICS
doxycycline monohydrate 150 mg tabletdrugId:2905 - PA ANTIBIOTICS
doxycycline monohydrate 40 mg capsuledrugId:579 - PA ANTIBIOTICS
doxycycline monohydrate 50 mg, 100 mg capsuledrugId:2899 ANTIBIOTICS
doxycycline monohydrate 50 mg, 75 mg, 100 mg tabletdrugId:2300 ANTIBIOTICS
doxycycline monohydrate 75 mg capsuledrugId:2906 - PA ANTIBIOTICS
doxycycline monohydrate suspensiondrugId:2904 ANTIBIOTICS
dabigatran etexilate mesylate 110 mgdrugId:5286 - PA > 70 capsules/365 days ANTICOAGULANTS
dabigatran etexilate mesylate 75 mg, 150 mgdrugId:2081 - PA ANTICOAGULANTS
dalteparindrugId:321 ANTICOAGULANTS
desirudindrugId:2989 - PA ANTICOAGULANTS
DepacondrugId:1780 # (valproate)drugId:1780 ANTICONVULSANTS
Depakene # (valproic acid) - PA < 6 years; See Table 20drugId:1782; See Table 71drugId:4506 ANTICONVULSANTS
Depakote # (divalproex immediate-release) - PA < 6 years; See Table 20drugId:552; See Table 71drugId:3320 ANTICONVULSANTS
Depakote # (divalproex sprinkle capsule) - PA < 6 years; See Table 20drugId:2315; See Table 71drugId:3360 ANTICONVULSANTS
Depakote ER # (divalproex extended-release) - PA < 6 years; See Table 20drugId:550; See Table 71drugId:3340 ANTICONVULSANTS
Diacomit (stiripentol) - PA; See Table 20drugId:7132; See Table 71drugId:7133 ANTICONVULSANTS
Dilantin # (phenytoin extended 30 mg and 100 mg capsule); See Table 20drugId:1525; See Table 71drugId:4523 ANTICONVULSANTS
Dilantin-125 # (phenytoin suspension); See Table 20drugId:2938; See Table 71drugId:4522 ANTICONVULSANTS
Dilantin Infatab # (phenytoin chewable tablet); See Table 20drugId:1523; See Table 71drugId:4520 ANTICONVULSANTS
divalproex extended-release - PA < 6 years; See Table 20drugId:550; See Table 71drugId:3340 ANTICONVULSANTS
divalproex immediate-release - PA < 6 years; See Table 20drugId:552; See Table 71drugId:3320 ANTICONVULSANTS
divalproex sprinkle capsule - PA < 6 years; See Table 20drugId:2315; See Table 71drugId:3360 ANTICONVULSANTS
desipramine - PA; See Table 17drugId:2620; See Table 71drugId:4020 ANTIDEPRESSANTS
desvenlafaxine extended-release-Khedezla - PA; See Table 17drugId:2907; See Table 71drugId:3922 ANTIDEPRESSANTS
desvenlafaxine extended-release - PA; See Table 17drugId:2777; See Table 71drugId:3920 ANTIDEPRESSANTS
desvenlafaxine succinate extended-release - PA; See Table 17drugId:490; See Table 71drugId:3940 ANTIDEPRESSANTS
doxepin capsule, oral concentrate - PA < 6 years; See Table 17drugId:2040; See Table 71drugId:4040 ANTIDEPRESSANTS
duloxetine 20 mg, 30 mg, 60 mg - PA < 6 years; See Table 17drugId:585; See Table 71drugId:3960 ANTIDEPRESSANTS
difenoxin / atropinedrugId:6111 - PA ANTIDIARRHEALS
diphenoxylate / atropinedrugId:542 ANTIDIARRHEALS
deferasirox 125 mg, 250 mg, 500 mgdrugId:333 BP ANTIDOTES
deferasirox 90 mg, 180 mg, 360 mgdrugId:4942 ANTIDOTES
deferipronedrugId:2483 - PA ANTIDOTES
dexrazoxane ANTIDOTES
dimercaprol ^ ANTIDOTES
Diclegis (doxylamine / pyridoxine delayed-release)drugId:2778 BP - PA ANTIEMETICS
dolasetron injectiondrugId:558 ANTIEMETICS
dolasetron tabletdrugId:557 - PA ANTIEMETICS
doxylamine / pyridoxine delayed-releasedrugId:2778 BP - PA ANTIEMETICS
doxylamine / pyridoxine extended-releasedrugId:6680 - PA ANTIEMETICS
dronabinol capsuledrugId:582 - PA ANTIEMETICS
dronabinol solutiondrugId:6361 - PA ANTIEMETICS
desloratadine / pseudoephedrinedrugId:474 - PA ANTIHISTAMINES
desloratadine orally disintegrating tabletdrugId:2749 - PA ANTIHISTAMINES
desloratadine syrup, tabletdrugId:339 ANTIHISTAMINES
dexchlorpheniramine solutiondrugId:7220 - PA ANTIHISTAMINES
dimenhydrinate injectiondrugId:2677 ANTIHISTAMINES
diphenhydraminedrugId:541 * ANTIHISTAMINES
Daraprim (pyrimethamine)drugId:1614 - PA ANTIMALARIALS
Duopa (carbidopa / levodopa enteral suspension)drugId:5104 - PA ANTIPARKINSON
dipyridamoledrugId:545 ANTIPLATELET AGENT
Durlaza (aspirin extended-release)drugId:5245 - PA ANTIPLATELET AGENT
daclatasvirdrugId:5103 - PA ANTIVIRALS
Daklinza (daclatasvir)drugId:5103 - PA ANTIVIRALS
darunavirdrugId:330 ANTIVIRALS
darunavir / cobicistatdrugId:4792 ANTIVIRALS
darunavir / cobicistat / emtricitabine / tenofovir alafenamidedrugId:6822 - PA ANTIVIRALS
dasabuvir / ombitasvir / paritaprevir / ritonavir extended-releasedrugId:5596 - PA ANTIVIRALS
delavirdinedrugId:336 ANTIVIRALS
Delstrigo (doravirine / lamivudine / tenofovir disoproxil fumarate)drugId:6981 ANTIVIRALS
Denavir (penciclovir)drugId:1495 - PA ANTIVIRALS
Descovy (emtricitabine / tenofovir alafenamide)drugId:5381 PD ANTIVIRALS
didanosinedrugId:517 ANTIVIRALS
dolutegravir / lamivudinedrugId:7240 PD ANTIVIRALS
dolutegravir / rilpivirinedrugId:6781 PD ANTIVIRALS
dolutegravirdrugId:2852 - PA > 30 units/month ANTIVIRALS
doravirinedrugId:6986 ANTIVIRALS
doravirine / lamivudine / tenofovir disoproxil fumaratedrugId:6981 ANTIVIRALS
Dovato (dolutegravir / lamivudine)drugId:7240 PD ANTIVIRALS
doxazosin extended-releasedrugId:566 - PA BENIGN PROSTATIC HYPERPLASIA AGENTS
dutasteride / tamsulosindrugId:1960 - PA BENIGN PROSTATIC HYPERPLASIA AGENTS
Diastat (diazepam rectal gel)drugId:503 - PA > 5 kits (10 syringes) /month BENZODIAZEPINES
diazepam powder - PA; See Table 69drugId:506; See Table 71drugId:4382 BENZODIAZEPINES
diazepam rectal geldrugId:503 - PA > 5 kits (10 syringes) /month BENZODIAZEPINES
diazepam solution, tablet - PA < 6 years; See Table 69drugId:504; See Table 71drugId:4381 BENZODIAZEPINES
Daptacel (diphtheria / tetanus toxoids / acellular pertussis vaccine)drugId:536 1 BIOLOGICAL
denosumab-ProliadrugId:1967 - PA BIOLOGICAL
denosumab-XgevadrugId:2180 - PA BIOLOGICAL
diphtheria / tetanus / acellular pertussis / poliovirus inactivated / haemophilus B conjugate vaccinedrugId:581 1 BIOLOGICAL
diphtheria / tetanus toxoids / acellular pertussis / hepatitis B, recombinant / poliovirus, inactivated vaccinedrugId:700 1 BIOLOGICAL
diphtheria / tetanus toxoids / acellular pertussis / poliovirus, inactivated vaccinedrugId:535 1 BIOLOGICAL
diphtheria / tetanus toxoids / acellular pertussis vaccinedrugId:539 1 BIOLOGICAL
diphtheria / tetanus toxoid vaccinedrugId:1686 1 BIOLOGICAL
dupilumabdrugId:6101 - PA BIOLOGICAL
Dupixent (dupilumab)drugId:6101 - PA BIOLOGICAL
Dysport (abobotulinumtoxinA)drugId:141 - PA BIOLOGICAL
Dulera (mometasone / formoterol)drugId:1958 - PA BRONCHODILATORS
DemadexdrugId:1732 # (torsemide)drugId:1732 CARDIOVASCULAR
Demser (metyrosine) CARDIOVASCULAR
DiamoxdrugId:147 # (acetazolamide)drugId:147 CARDIOVASCULAR
Dilatrate-SR (isosorbide dinitrate extended-release capsule)drugId:977 CARDIOVASCULAR
diltiazem 120 mg, 180 mg, 240 mg, 300 mg-Cardizem CDdrugId:531 CARDIOVASCULAR
diltiazem 360 mg-Cardizem CDdrugId:2299 - PA CARDIOVASCULAR
diltiazem-CardizemdrugId:528 CARDIOVASCULAR
diltiazem extended-release tabletdrugId:529 CARDIOVASCULAR
diltiazem-Tiazac ERdrugId:533 CARDIOVASCULAR
DiovandrugId:1785 # (valsartan)drugId:1785 CARDIOVASCULAR
Diovan HCTdrugId:1786 # (valsartan / hydrochlorothiazide)drugId:1786 CARDIOVASCULAR
disopyramide controlled-release CARDIOVASCULAR
disopyramide immediate-release CARDIOVASCULAR
DiurildrugId:221 # (chlorothiazide)drugId:221 CARDIOVASCULAR
doxazosin immediate-release; See Table 18drugId:565; See Table 19drugId:5163 CARDIOVASCULAR
DyazidedrugId:1755 # (hydrochlorothiazide / triamterene)drugId:1755 CARDIOVASCULAR
Daytrana (methylphenidate transdermal) - PA; See Table 31drugId:955; See Table 71drugId:3060 CEREBRAL STIMULANTS
Desoxyn (methamphetamine) - PA; See Table 31drugId:1165; See Table 71drugId:3142 CEREBRAL STIMULANTS
Dexedrine # (dextroamphetamine 5 mg, 10 mg, 15 mg capsule) - PA < 3 years and PA > 90 units/month; See Table 31drugId:500; See Table 71drugId:3140 CEREBRAL STIMULANTS
dexmethylphenidate extended-release BP PD - PA < 3 years and PA > 60 units/month; See Table 31drugId:498; See Table 71drugId:3020 CEREBRAL STIMULANTS
dexmethylphenidate - PA < 3 years and PA > 90 units/month; See Table 31drugId:497; See Table 71drugId:3101 CEREBRAL STIMULANTS
dextroamphetamine 2.5 mg, 7.5 mg, 15 mg, 20 mg, 30 mg tablet - PA; See Table 31drugId:2819; See Table 71drugId:3121 CEREBRAL STIMULANTS
dextroamphetamine 5 mg, 10 mg, 15 mg capsule - PA < 3 years and PA > 90 units/month; See Table 31drugId:500; See Table 71drugId:3140 CEREBRAL STIMULANTS
dextroamphetamine 5 mg, 10 mg tablet - PA < 3 years and PA > 90 units/month; See Table 31drugId:2968; See Table 71drugId:3120 CEREBRAL STIMULANTS
dextroamphetamine solution - PA < 3 years and PA > 900 mL/month; See Table 31drugId:501; See Table 71drugId:3141 CEREBRAL STIMULANTS
Dyanavel XR (amphetamine extended-release oral suspension) - PA; See Table 31drugId:5383; See Table 71drugId:5384 CEREBRAL STIMULANTS
deferoxaminedrugId:334 CHELATING AGENT
Depen (penicillamine-Depen) CHELATING AGENT
DesferaldrugId:334 # (deferoxamine)drugId:334 CHELATING AGENT
dabrafenibdrugId:2823 - PA CHEMOTHERAPY
dacarbazinedrugId:319 CHEMOTHERAPY
DacogendrugId:332 # (decitabine)drugId:332 CHEMOTHERAPY
dacomitinibdrugId:7048 - PA CHEMOTHERAPY
dactinomycindrugId:2674 CHEMOTHERAPY
daratumumabdrugId:5244 - PA CHEMOTHERAPY
Darzalex (daratumumab)drugId:5244 - PA CHEMOTHERAPY
dasatinibdrugId:331 CHEMOTHERAPY
daunorubicin, conventionaldrugId:2676 CHEMOTHERAPY
daunorubicin / cytarabinedrugId:6412 - PA CHEMOTHERAPY
Daurismo (glasdegib)drugId:7100 - PA CHEMOTHERAPY
decitabinedrugId:332 CHEMOTHERAPY
degarelixdrugId:335 - PA CHEMOTHERAPY
diclofenac 3% geldrugId:508 - PA CHEMOTHERAPY
Docefrez (docetaxel-Docefrez)drugId:2985 CHEMOTHERAPY
docetaxel-DocefrezdrugId:2985 CHEMOTHERAPY
docetaxel-TaxoteredrugId:553 CHEMOTHERAPY
DoxildrugId:2689 # (doxorubicin liposomal injection)drugId:2689 CHEMOTHERAPY
doxorubicindrugId:571 CHEMOTHERAPY
doxorubicin liposomal injectiondrugId:2689 CHEMOTHERAPY
durvalumabdrugId:6122 - PA CHEMOTHERAPY
duvelisibdrugId:7002 - PA CHEMOTHERAPY
docusate enemadrugId:555 CONSTIPATION AGENTS
docusate sodiumdrugId:554 * CONSTIPATION AGENTS
Depo-Provera # (medroxyprogesterone vial) CONTRACEPTIVES
Depo-SubQ Provera 104 (medroxyprogesterone syringe) CONTRACEPTIVES
dapsone geldrugId:325 - PA DERMATOLOGICAL
Differin (adapalene)drugId:159 BP - PA DERMATOLOGICAL
DovonexdrugId:420 # (calcipotriene cream)drugId:420 - PA > 60 grams/month DERMATOLOGICAL
doxepin cream-PrudoxindrugId:568 - PA DERMATOLOGICAL
doxepin cream-ZonalondrugId:569 - PA DERMATOLOGICAL
Duac (clindamycin / benzoyl peroxide-Duac)drugId:264 - PA DERMATOLOGICAL
dapagliflozindrugId:2923 DIABETIC AGENTS
dapagliflozin / metformin extended-releasedrugId:4841 DIABETIC AGENTS
dapagliflozin / saxagliptindrugId:6406 - PA DIABETIC AGENTS
Duetact (glimepiride / pioglitazone)drugId:1535 - PA DIABETIC AGENTS
dulaglutidedrugId:4814 - PA DIABETIC AGENTS
Dekas Bariatric (multivitamins / minerals / folic acid / coenzyme Q10-Dekas Bariatric)drugId:6605 - PA ELECTROLYTES AND NUTRIENTS
doxercalciferol capsuledrugId:570 - PA ELECTROLYTES AND NUTRIENTS
doxercalciferol injectiondrugId:5780 ^ ELECTROLYTES AND NUTRIENTS
dornase alfa ENZYMES
Duavee (estrogens, conjugated/bazedoxifene) ESTROGENS
DiflucandrugId:860 # (fluconazole)drugId:860 FUNGICIDES
Delzicol DRdrugId:2720 # (mesalamine capsule)drugId:2720 GI ANTI-INFLAMMATORY
Dipentum (olsalazine)drugId:1286 - PA GI ANTI-INFLAMMATORY
DecadrondrugId:2491 # (dexamethasone solution, tablet)drugId:2491 GLUCOCORTICOIDS
deflazacortdrugId:6720 - PA GLUCOCORTICOIDS
Depo-MedroldrugId:966 # (methylprednisolone acetate)drugId:966 GLUCOCORTICOIDS
Derma-Smoothe-FSdrugId:867 # (fluocinolone body oil, scalp oil)drugId:867 GLUCOCORTICOIDS
DermatopdrugId:1574 # (prednicarbate cream, ointment)drugId:1574 GLUCOCORTICOIDS
Desonate (desonide gel)drugId:485 - PA GLUCOCORTICOIDS
desonide creamdrugId:484 GLUCOCORTICOIDS
desonide geldrugId:485 - PA GLUCOCORTICOIDS
desonide lotion, ointmentdrugId:2528 GLUCOCORTICOIDS
DesowendrugId:484 # (desonide cream)drugId:484 GLUCOCORTICOIDS
desoximetasone 0.05% cream, ointmentdrugId:5021 - PA GLUCOCORTICOIDS
desoximetasone 0.25% cream, ointment, spray, 0.05% geldrugId:488 - PA GLUCOCORTICOIDS
dexamethasone injectiondrugId:5131 GLUCOCORTICOIDS
dexamethasone solution, tabletdrugId:2491 GLUCOCORTICOIDS
dexamethasone tablet packdrugId:492 - PA GLUCOCORTICOIDS
diflorasone cream / emollientdrugId:520 - PA GLUCOCORTICOIDS
diflorasone creamdrugId:4918 - PA GLUCOCORTICOIDS
diflorasone ointmentdrugId:2207 - PA GLUCOCORTICOIDS
DiprolenedrugId:353 # (betamethasone dipropionate, augmented lotion)drugId:353 GLUCOCORTICOIDS
DiprolenedrugId:5022 # (betamethasone dipropionate, augmented ointment)drugId:5022 GLUCOCORTICOIDS
Diprolene AFdrugId:2204 # (betamethasone dipropionate, augmented cream)drugId:2204 GLUCOCORTICOIDS
Duobrii (halobetasol / tazarotene lotion)drugId:7134 - PA GLUCOCORTICOIDS
Duzallo (lesinurad / allopurinol)drugId:6382 - PA GOUT AGENTS
darbepoetin alfadrugId:327 - PA HEMATINIC AGENT
Dekas Essential (multivitamin-Dekas Essential)drugId:5623 - PA HEMATINIC AGENT
Dekas Plus (multivitamins / minerals / coenzyme Q10-Dekas Plus)drugId:5621 - PA HEMATINIC AGENT
Dekas Plus (multivitamins / minerals / folic acid / coenzyme Q10-Dekas Plus)drugId:5622 - PA HEMATINIC AGENT
Doptelet (avatrombopag)drugId:6990 - PA HEMATOLOGIC
Droxia (hydroxyurea)drugId:760 HEMATOLOGIC
DDAVPdrugId:476 # (desmopressin-DDAVP)drugId:476 HORMONE AGENTS
desmopressin-DDAVPdrugId:476 HORMONE AGENTS
desmopressin-NocdurnadrugId:6984 - PA HORMONE AGENTS
desmopressin-NoctivadrugId:6612 - PA HORMONE AGENTS
desmopressin-Stimate HORMONE AGENTS
Delestrogen # (estradiol-Delestrogen) HORMONE REPLACEMENT THERAPY
Depo-estradiol (estradiol-Depo-estradiol) HORMONE REPLACEMENT THERAPY
Depo-Testosterone (testosterone cypionate)drugId:1680 - PA HORMONE REPLACEMENT THERAPY
Divigel (estradiol-Divigel) HORMONE REPLACEMENT THERAPY
Daliresp (roflumilast)drugId:2282 - PA IMMUNOMODULATOR
dalfampridinedrugId:320 - PA MULTIPLE SCLEROSIS AGENTS
dextromethorphan / quinidinedrugId:2177 - PA MULTIPLE SCLEROSIS AGENTS
dimethyl fumaratedrugId:2793 - PA MULTIPLE SCLEROSIS AGENTS
Dantrium (dantrolene injection solution)drugId:4645 ^ MUSCLE RELAXANT
DantriumdrugId:323 # (dantrolene capsule)drugId:323 MUSCLE RELAXANT
dantrolene capsuledrugId:323 MUSCLE RELAXANT
dantrolene injection solutiondrugId:4645 ^ MUSCLE RELAXANT
dantrolene injection suspensiondrugId:4634 ^ MUSCLE RELAXANT
Dymista (azelastine / fluticasone propionate)drugId:2580 NASAL PREPARATIONS
deutetrabenazinedrugId:6121 - PA NEUROLOGIC AGENT
Durolane (hyaluronate-Durolane)drugId:6381 - PA; Non-Drug Product NON-DRUG PRODUCT
DayprodrugId:1309 # (oxaprozin)drugId:1309 NONSTEROIDAL ANTI-INFLAMMATORY
diclofenac / misoprostoldrugId:514 - PA < 60 years NONSTEROIDAL ANTI-INFLAMMATORY
diclofenac 1% geldrugId:512 NONSTEROIDAL ANTI-INFLAMMATORY
diclofenac 18 mg, 35 mg capsuledrugId:2894 - PA NONSTEROIDAL ANTI-INFLAMMATORY
diclofenac 25 mg capsuledrugId:511 - PA NONSTEROIDAL ANTI-INFLAMMATORY
diclofenac extended-releasedrugId:513 NONSTEROIDAL ANTI-INFLAMMATORY
diclofenac powder for solutiondrugId:1953 - PA NONSTEROIDAL ANTI-INFLAMMATORY
diclofenac tabletdrugId:2117 NONSTEROIDAL ANTI-INFLAMMATORY
diclofenac topical patchdrugId:509 - PA NONSTEROIDAL ANTI-INFLAMMATORY
diclofenac topical solutiondrugId:1944 - PA NONSTEROIDAL ANTI-INFLAMMATORY
Duexis (ibuprofen / famotidine)drugId:2363 - PA < 60 years NONSTEROIDAL ANTI-INFLAMMATORY
dexamethasone intravitreal implantdrugId:494 ^ OPHTHALMIC PREPARATIONS
dexamethasone ophthalmic insertdrugId:7181 ^ OPHTHALMIC PREPARATIONS
dexamethasone ophthalmic suspensiondrugId:493 - PA OPHTHALMIC PREPARATIONS
dexamethasone sodium phosphate ophthalmic solutiondrugId:4919 OPHTHALMIC PREPARATIONS
Dextenza (dexamethasone ophthalmic insert)drugId:7181 ^ OPHTHALMIC PREPARATIONS
diclofenac eye dropsdrugId:2269 OPHTHALMIC PREPARATIONS
difluprednatedrugId:522 - PA OPHTHALMIC PREPARATIONS
dorzolamide / timololdrugId:564 OPHTHALMIC PREPARATIONS
dorzolamide / timolol, preservative freedrugId:2517 - PA OPHTHALMIC PREPARATIONS
Durezol (difluprednate)drugId:522 - PA OPHTHALMIC PREPARATIONS
Demerol (meperidine)drugId:1144 - PA OPIOID ANALGESICS
dihydrocodeine / acetaminophen / caffeinedrugId:5142 - PA OPIOID ANALGESICS
dihydrocodeine / aspirin / caffeinedrugId:525 - PA OPIOID ANALGESICS
DilaudiddrugId:754 # (hydromorphone)drugId:754 - PA > 32 mg/day OPIOID ANALGESICS
Dolophine (methadone oral-Dolophine)drugId:1163 - PA OPIOID ANALGESICS
Duragesic (fentanyl 75, 100 mcg/hr transdermal system)drugId:4800 - PA OPIOID ANALGESICS
DuragesicdrugId:845 # (fentanyl 12, 25, 50 mcg/hr transdermal system)drugId:845 - PA > 50 mcg/hr and PA > 10 patches/month OPIOID ANALGESICS
Duramorph (morphine, injection-Duramorph)drugId:1392 - PA > 120 mg/day OPIOID ANALGESICS
Dermotic # (fluocinolone oil, otic drops) OTIC PREPARATIONS
Dexilant (dexlansoprazole)drugId:496 BP - PA > 30 units/month PROTON PUMP INHIBITORS
dexlansoprazoledrugId:496 BP - PA > 30 units/month PROTON PUMP INHIBITORS
duloxetine 40 mg - PA; See Table 17drugId:4910; See Table 71drugId:4911 PSYCHOSTIMULANTS-ANTIDEPRESSAN
doxepin tablet-Silenor - PA; See Table 15drugId:2082; See Table 71drugId:4346 SEDATIVES
dichlorphenamidedrugId:5260 - PA UNCLASSIFIED DRUG PRODUCTS
darifenacindrugId:328 - PA URINARY ANTISPASMODICS
DetroldrugId:1726 # (tolterodine immediate-release)drugId:1726 URINARY ANTISPASMODICS
Detrol LAdrugId:1725 # (tolterodine extended-release)drugId:1725 URINARY ANTISPASMODICS
Ditropan XLdrugId:1314 # (oxybutynin extended-release tablet)drugId:1314 URINARY ANTISPASMODICS

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 11/25/19