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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
Gilotrif (afatinib)drugId:2843 - PA CHEMOTHERAPY
Glassia (alpha-1-proteinase inhibitor, human-Glassia) ENZYMES
Gocovri (amantadine extended-release capsule)drugId:6402 - PA ANTIPARKINSON
GablofendrugId:2166 # (baclofen injection)drugId:2166 MUSCLE RELAXANT
Giazo (balsalazide 1.1 gram tablet)drugId:2723 - PA GI ANTI-INFLAMMATORY
Gynazole-1 (butoconazole) ANTIBIOTICS
Gastrocrom # (cromolyn oral) BRONCHODILATORS
Gel-One (crossed-linked hyaluronate)drugId:4802 - PA; Non-Drug Product NON-DRUG PRODUCT
Genvoya (elvitegravir / cobicistat / emtricitabine / tenofovir alafenamide)drugId:5250 PD ANTIVIRALS
Glyxambi (empagliflozin / linagliptin)drugId:4771 - PA DIABETIC AGENTS
Gilenya (fingolimod)drugId:2102 BP - PA MULTIPLE SCLEROSIS AGENTS
gabapentin capsule, solution, tablet - PA < 6 years; See Table 20drugId:917; See Table 71drugId:3480 ANTICONVULSANTS
gabapentin enacarbildrugId:2285 - PA GABA ANALOGS
gabapentin extended-releasedrugId:2366 - PA GABA ANALOGS
Gralise (gabapentin extended-release)drugId:2366 - PA GABA ANALOGS
gabapentin powder - PA; See Table 71drugId:6373; See Table 72drugId:6372 ANTICONVULSANTS
galantamine extended-release capsuledrugId:919 - PA < 18 years and PA > 30 units/month ALZHEIMER'S THERAPY
galantamine solutiondrugId:2251 - PA ALZHEIMER'S THERAPY
galantamine tabletdrugId:920 - PA < 18 years and PA > 60 units/month ALZHEIMER'S THERAPY
galcanezumab-gnlmdrugId:7003 - PA BIOLOGICAL
galsulfasedrugId:921 - PA ENZYMES
ganciclovir injectiondrugId:922 ANTIVIRALS
ganciclovir ophthalmic gel OPHTHALMIC PREPARATIONS
gatifloxacin ophthalmic solutiondrugId:1976 - PA OPHTHALMIC PREPARATIONS
gefitinibdrugId:924 - PA CHEMOTHERAPY
gelatin COMPOUNDING AGENT
gemcitabinedrugId:926 CHEMOTHERAPY
GemzardrugId:926 # (gemcitabine)drugId:926 CHEMOTHERAPY
gemfibrozildrugId:927 LIPID LOWERING AGENTS
gemtuzumab ozogamicindrugId:6342 - PA CHEMOTHERAPY
gentamicin / prednisolone ophthalmic ointment, suspensiondrugId:929 - PA OPHTHALMIC PREPARATIONS
gentamicin injectiondrugId:2636 ANTIBIOTICS
gentamicin ophthalmic ointment, solutiondrugId:928 OPHTHALMIC PREPARATIONS
gentamicin topical cream, ointmentdrugId:5901 ANTIBIOTICS
gilteritinibdrugId:7108 - PA CHEMOTHERAPY
glasdegibdrugId:7100 - PA CHEMOTHERAPY
glatiramer 20 mgdrugId:930 BP MULTIPLE SCLEROSIS AGENTS
glatiramer 40 mgdrugId:6840 MULTIPLE SCLEROSIS AGENTS
glecaprevir / pibrentasvirdrugId:6360 PD - PA ANTIVIRALS
glimepiridedrugId:931 DIABETIC AGENTS
glimepiride / pioglitazonedrugId:1535 - PA DIABETIC AGENTS
glipizidedrugId:932 DIABETIC AGENTS
GlucotroldrugId:932 # (glipizide)drugId:932 DIABETIC AGENTS
glipizide / metformindrugId:935 DIABETIC AGENTS
glipizide extended-releasedrugId:933 DIABETIC AGENTS
Glucotrol XLdrugId:933 # (glipizide extended-release)drugId:933 DIABETIC AGENTS
glucagon DIABETIC AGENTS
glucose productsdrugId:6745 - PA ≥ 19 years DIABETIC AGENTS
glyburidedrugId:674 DIABETIC AGENTS
glyburide / metformindrugId:676 DIABETIC AGENTS
GlucovancedrugId:676 # (glyburide / metformin)drugId:676 DIABETIC AGENTS
glyburide, micronizeddrugId:675 DIABETIC AGENTS
GlynasedrugId:675 # (glyburide, micronized)drugId:675 DIABETIC AGENTS
glycerin * COMPOUNDING AGENT
glycerin / propylene glycoldrugId:678 * OPHTHALMIC PREPARATIONS
glycerol phenylbutyratedrugId:2789 - PA ENZYMES
glycopyrrolate / formoteroldrugId:5700 - PA BRONCHODILATORS
glycopyrrolate 1 mg tabletdrugId:679 ANTISPASMODICS,ANTICHOLINERGIC
glycopyrrolate 1.5 mg tabletdrugId:2888 - PA ANTISPASMODICS,ANTICHOLINERGIC
glycopyrrolate 2 mg tabletdrugId:2908 ANTISPASMODICS,ANTICHOLINERGIC
glycopyrrolate inhalation powderdrugId:5393 - PA > 1 inhaler/month BRONCHODILATORS
glycopyrrolate inhalation solutiondrugId:6742 - PA BRONCHODILATORS
glycopyrrolate injectiondrugId:5940 - PA ANTISPASMODICS,ANTICHOLINERGIC
glycopyrrolate oral solutiondrugId:2163 - PA ANTISPASMODICS,ANTICHOLINERGIC
glycopyrronium clothdrugId:6987 - PA DERMATOLOGICAL
gold sodium thiomalate IMMUNOMODULATOR
golimumabdrugId:681 - PA IMMUNOMODULATOR
golimumab for infusiondrugId:2850 - PA IMMUNOMODULATOR
goserelindrugId:682 - PA CHEMOTHERAPY
granisetron extended-release injectiondrugId:5767 - PA > 2 units/28 days ANTIEMETICS
granisetron injectiondrugId:683 ANTIEMETICS
granisetron tabletdrugId:684 - PA ANTIEMETICS
granisetron transdermal systemdrugId:685 - PA ANTIEMETICS
grass pollen allergen extractdrugId:4789 - PA ALLERGENS
griseofulvin 125 mg, 250 mg tabletdrugId:686 FUNGICIDES
Gris-PegdrugId:686 # (griseofulvin 125 mg, 250 mg tablet)drugId:686 FUNGICIDES
griseofulvin 500 mg tabletdrugId:687 FUNGICIDES
Grifulvin VdrugId:687 # (griseofulvin 500 mg tablet)drugId:687 FUNGICIDES
griseofulvin suspensiondrugId:2306 FUNGICIDES
guanabenz CARDIOVASCULAR
guanfacine - PA < 3 years; See Table 18drugId:5162; See Table 71drugId:691 CARDIOVASCULAR
guanfacine extended-release - PA < 3 years; See Table 31drugId:692; See Table 71drugId:3082 NONSTIMULANT ADHD AGENTS
guanidine PARASYMPATHETIC AGENTS
guselkumabdrugId:6289 - PA IMMUNOMODULATOR
Gardasil 9 (human papillomavirus 9-valent vaccine)drugId:4770 1 - PA < 9 years and PA ≥ 46 years BIOLOGICAL
Gelsyn (hyaluronate-Gelsyn)drugId:5620 - PA; Non-Drug Product NON-DRUG PRODUCT
Genvisc (hyaluronate-Genvisc)drugId:5340 - PA; Non-Drug Product NON-DRUG PRODUCT
GleevecdrugId:779 # (imatinib)drugId:779 CHEMOTHERAPY
Gamastan S/D (immune globulin IM, human-Gamastan S/D)drugId:2683 - PA BIOLOGICAL
Gammagard (immune globulin injection, human-Gammagard)drugId:2198 - PA BIOLOGICAL
Gammaked (immune globulin injection, human-Gammaked)drugId:2641 - PA BIOLOGICAL
Gamunex-C (immune globulin injection, human-Gamunex-C)drugId:2167 - PA BIOLOGICAL
Gammagard S/D (immune globulin IV, human-Gammagard S/D)drugId:787 - PA BIOLOGICAL
Gammaplex (immune globulin IV, human-Gammaplex)drugId:2381 - PA BIOLOGICAL
GlucophagedrugId:1158 # (metformin)drugId:1158 DIABETIC AGENTS
Glucophage XRdrugId:1159 # (metformin extended-release-Glucophage XR)drugId:1159 DIABETIC AGENTS
Glumetza (metformin extended-release-Glumetza)drugId:2987 - PA DIABETIC AGENTS
Galafold (migalastat)drugId:6982 - PA ENZYMES
GlysetdrugId:1356 # (miglitol)drugId:1356 DIABETIC AGENTS
Gonitro (nitroglycerin sublingual powder)drugId:5722 - PA CARDIOVASCULAR
Gazyva (obinutuzumab)drugId:2887 - PA CHEMOTHERAPY
Gelnique (oxybutynin gel)drugId:1315 - PA URINARY ANTISPASMODICS
GolytelydrugId:1549 # (polyethylene glycol-electrolyte solution-Golytely)drugId:1549 LAXATIVES
Genotropin (somatropin-Genotropin)drugId:1880 PD - PA HORMONE AGENTS
Granix (TBO-filgrastim)drugId:2889 - PA HEMATINIC AGENT
Gattex (teduglutide injection)drugId:2722 - PA GASTROINTESTINAL AGENT
Gabitril (tiagabine) - PA; See Table 20drugId:2617; See Table 71drugId:4500 ANTICONVULSANTS
Geodon # (ziprasidone capsule) - PA < 6 years and PA > 60 units/month; See Table 24drugId:1926; See Table 71drugId:4290 ANTIPSYCHOTIC
Geodon (ziprasidone injection)drugId:1925 ANTIPSYCHOTIC

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