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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
grass pollen allergen extractdrugId:4789 PA ALLERGENS
galantamine extended-release capsuledrugId:919 PA > 1 unit/day ALZHEIMER'S THERAPY #
galantamine solutiondrugId:2251 PA ALZHEIMER'S THERAPY
galantamine tabletdrugId:920 PA < 18 years and PA > 2 units/day ALZHEIMER'S THERAPY #
gentamicin injectiondrugId:2636 ANTIBIOTICS
gentamicin topical cream, ointmentdrugId:5901 ANTIBIOTICS
Gynazole-1 (butoconazole) ANTIBIOTICS
gabapentin capsule, solution, tablet; See Table 20drugId:917; See Table 71drugId:3480 PA < 6 years ANTICONVULSANTS #
gabapentin powder; See Table 71drugId:6373; See Table 72drugId:6372 PA ANTICONVULSANTS
Gabitril (tiagabine); See Table 20drugId:2617; See Table 71drugId:4500 PA ANTICONVULSANTS
granisetron extended-release injectiondrugId:5767 PA > 2 units/28 days ANTIEMETICS
granisetron injectiondrugId:683 ANTIEMETICS
granisetron tabletdrugId:684 PA > 2 tablets/28 days ANTIEMETICS
granisetron transdermal systemdrugId:685 PA ANTIEMETICS
Gocovri (amantadine extended-release capsule)drugId:6402 PA ANTIPARKINSON
Geodon (ziprasidone capsule); See Table 24drugId:1926; See Table 71drugId:4290 PA < 6 years and PA > 2 units/day ANTIPSYCHOTIC #
GeodondrugId:1925 (ziprasidone injection)drugId:1925 ANTIPSYCHOTIC #
glycopyrrolate 1.5 mg tabletdrugId:2888 PA ANTISPASMODICS,ANTICHOLINERGIC
glycopyrrolate 1 mg, 2 mg tabletdrugId:679 ANTISPASMODICS,ANTICHOLINERGIC
glycopyrrolate injectiondrugId:5940 PA ANTISPASMODICS,ANTICHOLINERGIC
glycopyrrolate oral solutiondrugId:2163 PA ANTISPASMODICS,ANTICHOLINERGIC
glycopyrrolate powderdrugId:7188 PA ANTISPASMODICS,ANTICHOLINERGIC
ganciclovir injectiondrugId:922 ANTIVIRALS #
Genvoya (elvitegravir / cobicistat / emtricitabine / tenofovir alafenamide)drugId:5250 ANTIVIRALS PD
glecaprevir / pibrentasvirdrugId:6360 PA ANTIVIRALS PD
galcanezumab-gnlm for cluster headachedrugId:7385 PA BIOLOGICAL PD
galcanezumab-gnlm for migraine prophylaxisdrugId:7003 PA BIOLOGICAL
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
Gardasil 9 (human papillomavirus 9-valent vaccine)drugId:4770 PA < 9 years and PA ≥ 46 years BIOLOGICAL 1
golodirsendrugId:7496 PA BIOLOGICAL
Gastrocrom (cromolyn oral) BRONCHODILATORS #
glycopyrrolate / formoteroldrugId:5700 PA BRONCHODILATORS
glycopyrrolate inhalation powderdrugId:5393 PA > 1 inhaler/month BRONCHODILATORS
glycopyrrolate inhalation solutiondrugId:6742 PA BRONCHODILATORS
Gonitro (nitroglycerin sublingual powder)drugId:5722 PA CARDIOVASCULAR
guanabenz CARDIOVASCULAR
guanfacine; See Table 18drugId:5162; See Table 71drugId:691 PA < 3 years CARDIOVASCULAR
Gazyva (obinutuzumab)drugId:2887 PA CHEMOTHERAPY
gefitinibdrugId:924 PA CHEMOTHERAPY
gemcitabine-InfugemdrugId:7284 PA CHEMOTHERAPY
gemcitabine vialdrugId:926 CHEMOTHERAPY
gemtuzumab ozogamicindrugId:6342 PA CHEMOTHERAPY
Gilotrif (afatinib)drugId:2843 PA CHEMOTHERAPY
gilteritinibdrugId:7108 PA CHEMOTHERAPY
glasdegibdrugId:7100 PA CHEMOTHERAPY
GleevecdrugId:779 (imatinib)drugId:779 CHEMOTHERAPY #
goserelindrugId:682 PA CHEMOTHERAPY
gelatin COMPOUNDING AGENT
glycerin COMPOUNDING AGENT *
glycopyrronium clothdrugId:6987 PA DERMATOLOGICAL
glimepiridedrugId:931 DIABETIC AGENTS #
glimepiride / pioglitazonedrugId:1535 PA DIABETIC AGENTS
glipizidedrugId:932 DIABETIC AGENTS #
glipizide / metformindrugId:935 DIABETIC AGENTS
glipizide extended-releasedrugId:933 DIABETIC AGENTS #
Glucagen (glucagon vial)drugId:7370 DIABETIC AGENTS
glucagon auto-injection, prefilled syringedrugId:7363 PA DIABETIC AGENTS
glucagon nasal powderdrugId:7367 DIABETIC AGENTS PD
glucagon vialdrugId:7370 DIABETIC AGENTS
GlucophagedrugId:1158 (metformin)drugId:1158 DIABETIC AGENTS #
Glucophage XRdrugId:1159 (metformin extended-release-Glucophage XR)drugId:1159 DIABETIC AGENTS #
glucose productsdrugId:6745 PA ≥ 19 years DIABETIC AGENTS
GlucotroldrugId:932 (glipizide)drugId:932 DIABETIC AGENTS #
Glucotrol XLdrugId:933 (glipizide extended-release)drugId:933 DIABETIC AGENTS #
Glumetza (metformin extended-release-Glumetza)drugId:2987 PA DIABETIC AGENTS
glyburidedrugId:674 DIABETIC AGENTS
glyburide, micronizeddrugId:675 DIABETIC AGENTS #
glyburide / metformindrugId:676 DIABETIC AGENTS
GlynasedrugId:675 (glyburide, micronized)drugId:675 DIABETIC AGENTS #
GlysetdrugId:1356 (miglitol)drugId:1356 DIABETIC AGENTS #
Glyxambi (empagliflozin / linagliptin)drugId:4771 PA DIABETIC AGENTS
Gvoke (glucagon auto-injection, prefilled syringe)drugId:7363 PA DIABETIC AGENTS
Galafold (migalastat)drugId:6982 PA ENZYMES
galsulfasedrugId:921 PA ENZYMES
Glassia (alpha-1-proteinase inhibitor, human-Glassia) ENZYMES
glycerol phenylbutyratedrugId:2789 PA ENZYMES
Grifulvin VdrugId:687 (griseofulvin 500 mg tablet)drugId:687 FUNGICIDES #
griseofulvin 125 mg, 250 mg tabletdrugId:686 FUNGICIDES #
griseofulvin 500 mg tabletdrugId:687 FUNGICIDES #
griseofulvin suspensiondrugId:2306 FUNGICIDES
Gris-PegdrugId:686 (griseofulvin 125 mg, 250 mg tablet)drugId:686 FUNGICIDES #
gabapentin enacarbildrugId:2285 PA GABA ANALOGS
gabapentin extended-releasedrugId:2366 PA GABA ANALOGS
Gralise (gabapentin extended-release)drugId:2366 PA GABA ANALOGS
Gattex (teduglutide injection)drugId:2722 PA GASTROINTESTINAL AGENT
Gloperba (colchicine solution)drugId:7331 PA GOUT AGENTS
Granix (TBO-filgrastim)drugId:2889 PA HEMATINIC AGENT
Genotropin (somatropin-Genotropin)drugId:1880 PA HORMONE AGENTS PD
gold sodium thiomalate IMMUNOMODULATOR
golimumab for infusiondrugId:2850 PA IMMUNOMODULATOR
golimumabdrugId:681 PA IMMUNOMODULATOR
guselkumabdrugId:6289 PA IMMUNOMODULATOR
GolytelydrugId:1549 (polyethylene glycol-electrolyte solution-Golytely)drugId:1549 LAXATIVES #
gemfibrozildrugId:927 LIPID LOWERING AGENTS #
Gilenya (fingolimod)drugId:2102 PA MULTIPLE SCLEROSIS AGENTS BP
glatiramerdrugId:930 MULTIPLE SCLEROSIS AGENTS BP
GablofendrugId:2166 (baclofen injection)drugId:2166 MUSCLE RELAXANT #
Gel-One (crossed-linked hyaluronate)drugId:4802 - Non-Drug Product PA NON-DRUG PRODUCT
Gelsyn (hyaluronate-Gelsyn)drugId:5620 - Non-Drug Product PA NON-DRUG PRODUCT
Genvisc (hyaluronate-Genvisc)drugId:5340 - Non-Drug Product PA NON-DRUG PRODUCT
guanfacine extended-release; See Table 31drugId:692; See Table 71drugId:3082 PA < 3 years NONSTIMULANT ADHD AGENTS #
ganciclovir ophthalmic gel OPHTHALMIC PREPARATIONS
gatifloxacin ophthalmic solutiondrugId:1976 PA OPHTHALMIC PREPARATIONS
gentamicin / prednisolone ophthalmic ointment, suspensiondrugId:929 PA OPHTHALMIC PREPARATIONS
gentamicin ophthalmic ointment, solutiondrugId:928 OPHTHALMIC PREPARATIONS
guanidine PARASYMPATHETIC AGENTS
Givlaari (givosiran)drugId:7504 PA (effective 01/01/2021) SMALL INTERFERING RNA AGENTS PD
givosirandrugId:7504 PA (effective 01/01/2021) SMALL INTERFERING RNA AGENTS PD
Gelnique (oxybutynin gel)drugId:1315 URINARY ANTISPASMODICS

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


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Last updated 01/11/21

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