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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
phenylephrine ADRENERGICS
Probuphine (buprenorphine implant)drugId:5591 PA ALCOHOL AND DRUG CESSATION AGENT
Palforzia (peanut allergen powder-dnfp)drugId:7373 PA ALLERGENS
peanut allergen powder-dnfpdrugId:7373 PA ALLERGENS
pentosan ANALGESICS
phenazopyridine ANALGESICS
Prialt (ziconotide)drugId:1819 PA ANALGESICS
Pyridium (phenazopyridine) ANALGESICS
PCE (erythromycin delayed-release tablet-PCE)drugId:5132 ANTIBIOTICS
penicillin G 0.6 million, 1.2 million, 2.4 million unitsdrugId:2625 ANTIBIOTICS
penicillin G 5 million, 20 million unitsdrugId:1499 ANTIBIOTICS #
penicillin G benzathine / penicillin G procainedrugId:2624 ANTIBIOTICS
penicillin VdrugId:1500 ANTIBIOTICS
PfizerpendrugId:1499 (penicillin G 5 million, 20 million units)drugId:1499 ANTIBIOTICS #
piperacillin / tazobactamdrugId:1537 ANTIBIOTICS #
plazomicindrugId:7014 PA ANTIBIOTICS
PrimaxindrugId:781 (imipenem / cilastatin)drugId:781 ANTIBIOTICS #
pyrazinamidedrugId:1611 ANTIBIOTICS
Pradaxa (dabigatran etexilate mesylate 110 mg)drugId:5286 PA > 70 capsules/365 days ANTICOAGULANTS
Pradaxa (dabigatran etexilate mesylate 75 mg, 150 mg)drugId:2081 PA ANTICOAGULANTS
Peganone (ethotoin); See Table 20drugId:669; See Table 71drugId:3420 ANTICONVULSANTS
perampanel; See Table 20drugId:2926; See Table 71drugId:4444 PA ANTICONVULSANTS
phenytoin chewable tablet; See Table 20drugId:1523; See Table 71drugId:4520 ANTICONVULSANTS #
phenytoin extended 200 mg and 300 mg capsule; See Table 20drugId:1526; See Table 71drugId:4524 ANTICONVULSANTS
phenytoin extended 30 mg and 100 mg capsule; See Table 20drugId:1525; See Table 71drugId:4523 ANTICONVULSANTS #
phenytoin injectiondrugId:2661 ANTICONVULSANTS ^
phenytoin suspension; See Table 20drugId:2938; See Table 71drugId:4522 ANTICONVULSANTS #
pregabalin; See Table 20drugId:1582; See Table 71drugId:4460 PA ANTICONVULSANTS
primidone; See Table 20drugId:1586; See Table 71drugId:4461 ANTICONVULSANTS #
Pamelor (nortriptyline); See Table 17drugId:1262; See Table 71drugId:4120 PA < 6 years ANTIDEPRESSANTS #
Parnate (tranylcypromine); See Table 17drugId:1741; See Table 71drugId:3540 PA < 6 years ANTIDEPRESSANTS #
paroxetine controlled-release; See Table 17drugId:1485; See Table 71drugId:3800 PA ANTIDEPRESSANTS
paroxetine hydrochloride; See Table 17drugId:1484; See Table 71drugId:3801 PA < 6 years ANTIDEPRESSANTS #
paroxetine mesylate; See Table 17drugId:1483; See Table 71drugId:3802 PA ANTIDEPRESSANTS
Paxil (paroxetine hydrochloride); See Table 17drugId:1484; See Table 71drugId:3801 PA < 6 years ANTIDEPRESSANTS #
Paxil CR (paroxetine controlled-release); See Table 17drugId:1485; See Table 71drugId:3800 PA ANTIDEPRESSANTS
Pexeva (paroxetine mesylate); See Table 17drugId:1483; See Table 71drugId:3802 PA ANTIDEPRESSANTS
phenelzine; See Table 17drugId:1515; See Table 71drugId:3580 PA < 6 years ANTIDEPRESSANTS #
Pristiq (desvenlafaxine succinate extended-release); See Table 17drugId:490; See Table 71drugId:3940 PA < 6 years and PA > 1 unit/day ANTIDEPRESSANTS #
protriptyline; See Table 17drugId:1606; See Table 71drugId:4140 PA < 6 years ANTIDEPRESSANTS
Prozac (fluoxetine 10 mg, 20 mg, 40 mg capsule, solution); See Table 17drugId:879; See Table 71drugId:3721 PA < 6 years ANTIDEPRESSANTS #
Prozac Weekly (fluoxetine 90 mg delayed-release capsule); See Table 17drugId:880; See Table 71drugId:3720 PA ANTIDEPRESSANTS
palifermin ANTIDOTES
palonosetron 0.25 mg/2 mL injectiondrugId:6614 PA > 2 units/28 days ANTIEMETICS
palonosetron 0.25 mg/5 mL injectiondrugId:1473 PA > 2 units/28 days ANTIEMETICS #
prochlorperazine ANTIEMETICS
Profilnine SD (factor IX complex human-Profilnine SD) ANTI-HEMOPHILIA AGENTS
Patanol (olopatadine 0.1% eye drops)drugId:1285 PA ANTIHISTAMINES
Pazeo (olopatadine 0.7% eye drops)drugId:4791 PA ANTIHISTAMINES
PhenergandrugId:1593 (promethazine)drugId:1593 ANTIHISTAMINES #
promethazinedrugId:1593 ANTIHISTAMINES #
primaquine ANTIMALARIALS
pyrimethaminedrugId:1614 PA ANTIMALARIALS BP
paromomycindrugId:1482 ANTIPARASITICS
pentamidine ANTIPARASITICS #
permethrindrugId:1510 ANTIPARASITICS *
permethrin creamdrugId:4700 ANTIPARASITICS #
Pin-X (pyrantel pamoate)drugId:6215 ANTIPARASITICS
piperonyl butoxide / pyrethrinsdrugId:1538 ANTIPARASITICS *
praziquanteldrugId:2358 ANTIPARASITICS BP
pyrantel pamoatedrugId:6215 ANTIPARASITICS
ParlodeldrugId:377 (bromocriptine 2.5 mg, 5 mg)drugId:377 ANTIPARKINSON #
pramipexoledrugId:1569 ANTIPARKINSON #
pramipexole extended-releasedrugId:1943 PA ANTIPARKINSON
PlavixdrugId:277 (clopidogrel)drugId:277 ANTIPLATELET AGENT #
prasugreldrugId:1571 ANTIPLATELET AGENT #
paliperidone extended-release 1-month injection; See Table 24drugId:1470; See Table 71drugId:4281 PA < 6 years, PA > 2 injections/month within the first 30 days of therapy and PA > 1 injection/month after 30 days of therapy ANTIPSYCHOTIC
paliperidone extended-release 3-month injection; See Table 24drugId:5121; See Table 71drugId:5122 PA < 6 years and PA > 1 injection/3 months ANTIPSYCHOTIC PD
paliperidone tablet; See Table 24drugId:1471; See Table 71drugId:4280 PA ANTIPSYCHOTIC
perphenazine; See Table 24drugId:6326; See Table 71drugId:1511 PA < 6 years ANTIPSYCHOTIC
Perseris (risperidone extended-release subcutaneous injection); See Table 24drugId:7007; See Table 71drugId:7009 PA ANTIPSYCHOTIC
pimavanserindrugId:5588 PA ANTIPSYCHOTIC
pimozide; See Table 24drugId:6327; See Table 71drugId:1532 PA < 6 years ANTIPSYCHOTIC #
povidonedrugId:1567 ANTISEPTICS *
Pamine (methscopolamine) ANTISPASMODICS,ANTICHOLINERGIC #
palivizumabdrugId:1472 PA ANTIVIRALS
Pegasys (peginterferon alfa-2a)drugId:2059 PA ANTIVIRALS
peginterferon alfa-2adrugId:2059 PA ANTIVIRALS
peginterferon alfa-2bdrugId:1490 PA ANTIVIRALS
peginterferon alfa-2b-Sylatron ANTIVIRALS
Pegintron (peginterferon alfa-2b)drugId:1490 PA ANTIVIRALS
penciclovirdrugId:1495 PA ANTIVIRALS
Pifeltro (doravirine)drugId:6986 ANTIVIRALS PD
Prevymis (letermovir)drugId:6615 PA ANTIVIRALS
Prezcobix (darunavir / cobicistat)drugId:4792 ANTIVIRALS PD
Prezista (darunavir)drugId:330 ANTIVIRALS PD
phenobarbitaldrugId:1516 BARBITURATES
Proscar (finasteride)drugId:857 PA BENIGN PROSTATIC HYPERPLASIA AGENTS
Panzyga (immune globulin IV, human-ifas)drugId:7104 PA BIOLOGICAL
Pediarix (diphtheria / tetanus toxoids / acellular pertussis / hepatitis B, recombinant / poliovirus, inactivated vaccine)drugId:700 BIOLOGICAL 1
Pedvaxhib (haemophilus B conjugate vaccine-Pedvaxhib)drugId:694 BIOLOGICAL 1
Pentacel (diphtheria / tetanus / acellular pertussis / poliovirus inactivated / haemophilus B conjugate vaccine)drugId:581 BIOLOGICAL 1
pneumococcal 13-valent conjugate vaccinedrugId:1542 BIOLOGICAL 1
pneumococcal vaccinedrugId:1544 BIOLOGICAL
Pneumovax (pneumococcal vaccine)drugId:1544 BIOLOGICAL
poliovirus vaccine, inactivateddrugId:1546 BIOLOGICAL 1
Prevnar 13 (pneumococcal 13-valent conjugate vaccine)drugId:1542 BIOLOGICAL 1
Privigen (immune globulin IV, human-Privigen)drugId:2197 PA BIOLOGICAL
Prolia (denosumab-Prolia)drugId:1967 PA BIOLOGICAL
Proquad (measles / mumps / rubella / varicella virus vaccine)drugId:1122 BIOLOGICAL 1
Perforomist (formoterol inhalation solution)drugId:906 PA BRONCHODILATORS
Proair Digihaler (albuterol inhalation powder-Proair Digihaler)drugId:7352 PA BRONCHODILATORS
Proair HFA (albuterol inhaler-Proair HFA)drugId:1 BRONCHODILATORS BP
Proair Respiclick (albuterol inhalation powder-Proair Respiclick)drugId:5109 BRONCHODILATORS
ProventildrugId:2 (albuterol inhaler-Proventil)drugId:2 BRONCHODILATORS #
Pulmicort (budesonide inhalation powder)drugId:380 BRONCHODILATORS
Pulmicort (budesonide inhalation suspension)drugId:381 PA BRONCHODILATORS
Parsabiv (etelcalcetide) CALCIMIMETIC ^
pentoxifylline CARDIOVASCULAR
perindoprildrugId:1509 CARDIOVASCULAR
phenoxybenzaminedrugId:5123 PA CARDIOVASCULAR
pindololdrugId:1533 CARDIOVASCULAR
polidocanoldrugId:2934 PA CARDIOVASCULAR ^
prazosin; See Table 18drugId:1573; See Table 19drugId:5164 CARDIOVASCULAR #
PrinivildrugId:1087 (lisinopril)drugId:1087 CARDIOVASCULAR #
ProcardiadrugId:2064 (nifedipine capsule)drugId:2064 CARDIOVASCULAR #
Procardia XLdrugId:1215 (nifedipine extended-release)drugId:1215 CARDIOVASCULAR #
propafenone CARDIOVASCULAR #
propranolol / hydrochlorothiazidedrugId:1603 CARDIOVASCULAR
propranolol extended-releasedrugId:1601 CARDIOVASCULAR #
propranolol immediate-releasedrugId:1600 CARDIOVASCULAR
propranolol long-acting capsuledrugId:6562 PA CARDIOVASCULAR
propranolol solutiondrugId:2959 PA CARDIOVASCULAR
patiromerdrugId:5320 PA > 30 units/month CHELATING AGENT
penicillamine capsule CHELATING AGENT BP
penicillamine tablet CHELATING AGENT #
paclitaxel injectable suspensiondrugId:1468 CHEMOTHERAPY
paclitaxel injectiondrugId:1467 CHEMOTHERAPY
Padcev (enfortumab vedotin-ejfv)drugId:7351 PA CHEMOTHERAPY
palbociclibdrugId:4940 PA CHEMOTHERAPY PD
panitumumabdrugId:1475 CHEMOTHERAPY
panobinostatdrugId:5105 PA CHEMOTHERAPY
Panretin (alitretinoin)drugId:16 PA CHEMOTHERAPY
pazopanibdrugId:1486 PA CHEMOTHERAPY
pegaspargasedrugId:2430 CHEMOTHERAPY ^
Pemazyre (pemigatinib)drugId:7455 PA CHEMOTHERAPY
pembrolizumabdrugId:4780 PA CHEMOTHERAPY
pemetrexeddrugId:1492 CHEMOTHERAPY
pemigatinibdrugId:7455 PA CHEMOTHERAPY
pentostatindrugId:2692 CHEMOTHERAPY
Perjeta (pertuzumab)drugId:2583 PA CHEMOTHERAPY
pertuzumabdrugId:2583 PA CHEMOTHERAPY
pexidartinibdrugId:7279 PA CHEMOTHERAPY
Piqray (alpelisib)drugId:7225 PA CHEMOTHERAPY
polatuzumab vedotin-piiqdrugId:7263 PA CHEMOTHERAPY
Polivy (polatuzumab vedotin-piiq)drugId:7263 PA CHEMOTHERAPY
pomalidomidedrugId:2787 PA CHEMOTHERAPY
Pomalyst (pomalidomide)drugId:2787 PA CHEMOTHERAPY
ponatinibdrugId:2724 PA CHEMOTHERAPY
Portrazza (necitumumab)drugId:5420 PA CHEMOTHERAPY
Poteligeo (mogamulizumab-kpkc)drugId:6924 PA CHEMOTHERAPY
pralatrexatedrugId:1568 CHEMOTHERAPY
procarbazinedrugId:1589 CHEMOTHERAPY
Proleukin (aldesleukin)drugId:2307 CHEMOTHERAPY
Provenge (sipuleucel-T)drugId:2288 PA CHEMOTHERAPY ^
Purixan (mercaptopurine oral suspension)drugId:4632 PA CHEMOTHERAPY
plecanatidedrugId:6043 PA CONSTIPATION AGENTS
prucalopridedrugId:7136 PA CONSTIPATION AGENTS
psylliumdrugId:1610 CONSTIPATION AGENTS *
Paragard (copper IUD) CONTRACEPTIVES
Pfizer COVID19 Vaccine (COVID EUA - December 11, 2020) COVID - 19 related Treatments and Vaccines COVID
phenylephrine / promethazine DECONGESTANT
pseudoephedrinedrugId:1607 PA > 240 mg/day DECONGESTANT *
petrolatum DERMATOLOGICAL *
Picato (ingenol gel)drugId:2521 PA DERMATOLOGICAL
pimecrolimusdrugId:1531 DERMATOLOGICAL BP
podofilox geldrugId:2261 PA DERMATOLOGICAL
podofilox solutiondrugId:1545 DERMATOLOGICAL #
Protopic (tacrolimus topical)drugId:1919 DERMATOLOGICAL BP
Prudoxin (doxepin cream-Prudoxin)drugId:568 PA DERMATOLOGICAL
pioglitazonedrugId:1534 DIABETIC AGENTS #
pioglitazone / metformindrugId:1536 DIABETIC AGENTS #
pioglitazone / metformin extended-releasedrugId:1937 DIABETIC AGENTS
pramlintidedrugId:1570 DIABETIC AGENTS
PrandindrugId:1642 (repaglinide)drugId:1642 DIABETIC AGENTS #
PrecosedrugId:143 (acarbose)drugId:143 DIABETIC AGENTS #
Proglycem (diazoxide) DIABETIC AGENTS BP
pamidronatedrugId:1474 ELECTROLYTES AND NUTRIENTS #
paricalcitol capsuledrugId:1481 PA ELECTROLYTES AND NUTRIENTS
paricalcitol injectiondrugId:5781 ELECTROLYTES AND NUTRIENTS ^
pediatric multivitaminsdrugId:1487 ELECTROLYTES AND NUTRIENTS *
Phos-Flur (sodium fluoride oral rinse) ELECTROLYTES AND NUTRIENTS
Phoslyra (calcium acetate) ELECTROLYTES AND NUTRIENTS
phytonadione ELECTROLYTES AND NUTRIENTS BP
potassium bicarbonate ELECTROLYTES AND NUTRIENTS
potassium chloride injection ELECTROLYTES AND NUTRIENTS
potassium chloride-Kaochlor ELECTROLYTES AND NUTRIENTS
potassium chloride-Kaon-CL ELECTROLYTES AND NUTRIENTS
potassium chloride-Klor-Con ELECTROLYTES AND NUTRIENTS #
potassium chloride-K-Tab ELECTROLYTES AND NUTRIENTS
potassium chloride-Micro-K ELECTROLYTES AND NUTRIENTS #
potassium citrate ELECTROLYTES AND NUTRIENTS #
potassium citrate / citric acid ELECTROLYTES AND NUTRIENTS
potassium citrate / sodium citrate / citric acid ELECTROLYTES AND NUTRIENTS
potassium phosphate / dibasic sodium phosphate / monobasic sodium phosphate ELECTROLYTES AND NUTRIENTS
potassium phosphate / sodium phosphate ELECTROLYTES AND NUTRIENTS
potassium phosphate / sodium phosphate / phosphorus ELECTROLYTES AND NUTRIENTS
potassium phosphate ELECTROLYTES AND NUTRIENTS *
prenatal vitaminsdrugId:1583 ELECTROLYTES AND NUTRIENTS *
pyridoxinedrugId:1613 ELECTROLYTES AND NUTRIENTS *
pyridoxine crystalsdrugId:7341 PA ELECTROLYTES AND NUTRIENTS
pasireotide injectable suspensiondrugId:4912 PA ENDOCRINE/METABOLIC AGENTS
pasireotidedrugId:2791 PA ENDOCRINE/METABOLIC AGENTS
Palynziq (pegvaliase-pqpz)drugId:6923 PA ENZYMES
Pancreaze DR (pancrelipase-Pancreaze DR)drugId:2565 ENZYMES
pancrelipase-Creon DRdrugId:1082 ENZYMES
pancrelipase-Pancreaze DRdrugId:2565 ENZYMES
pancrelipase-Pertzye DRdrugId:2730 ENZYMES
pancrelipase-ViokacedrugId:2597 ENZYMES
pancrelipase-Zenpep DRdrugId:1084 ENZYMES
pegvaliase-pqpzdrugId:6923 PA ENZYMES
Pertzye DR (pancrelipase-Pertzye DR)drugId:2730 ENZYMES
Procysbi (cysteamine delayed-release capsule)drugId:2861 PA ENZYMES
Procysbi (cysteamine delayed-release granule)drugId:7374 PA ENZYMES
Prolastin (alpha-1-proteinase inhibitor, human-Prolastin) ENZYMES
Pulmozyme (dornase alfa) ENZYMES
PenlacdrugId:233 (ciclopirox 8% nail lacquer)drugId:233 FUNGICIDES #
posaconazoledrugId:2928 PA FUNGICIDES BP
pregabalin extended-release; See Table 71drugId:6609; See Table 72drugId:6608 PA GABA ANALOGS
Pentasa (mesalamine controlled-release)drugId:1154 GI ANTI-INFLAMMATORY
Pandel (hydrocortisone probutate cream)drugId:732 PA GLUCOCORTICOIDS
PediapreddrugId:1578 (prednisolone 5 mg/5 mL oral solution)drugId:1578 GLUCOCORTICOIDS #
prednicarbate cream, ointmentdrugId:1574 GLUCOCORTICOIDS #
prednisolone 10 mg/5 mL oral solutiondrugId:1575 PA GLUCOCORTICOIDS
prednisolone 15 mg/5 mL, 25 mg/5 mL oral solutiondrugId:1576 GLUCOCORTICOIDS
prednisolone 20 mg/5 mL oral solutiondrugId:1579 PA GLUCOCORTICOIDS
prednisolone 5 mg/5 mL oral solutiondrugId:1578 GLUCOCORTICOIDS #
prednisolone orally disintegrating tabletdrugId:1577 PA GLUCOCORTICOIDS
prednisolone tabletdrugId:2199 GLUCOCORTICOIDS
prednisonedrugId:1581 GLUCOCORTICOIDS
prednisone delayed-releasedrugId:2645 PA GLUCOCORTICOIDS
pegloticasedrugId:6294 PA GOUT AGENTS
probeneciddrugId:1587 GOUT AGENTS
probenecid / colchicinedrugId:287 GOUT AGENTS
Pylera (bismuth subcitrate / metronidazole / tetracycline)drugId:367 H. PYLORI AGENTS
PepciddrugId:461 (famotidine tablet)drugId:461 H2 ANTAGONISTS * #
pegfilgrastimdrugId:1489 HEMATINIC AGENT
pegfilgrastim-bmezdrugId:7337 HEMATINIC AGENT
pegfilgrastim-cbqvdrugId:7012 HEMATINIC AGENT
pegfilgrastim-jmdbdrugId:6903 HEMATINIC AGENT
plerixafor HEMATINIC AGENT
Procrit (epoetin alfa-Procrit)drugId:611 PA HEMATINIC AGENT
Promacta (eltrombopag)drugId:594 PA HEMATINIC AGENT
protein C concentratedrugId:1605 PA HEMATINIC AGENT
prothrombin complex concentrate, human HEMOSTATICS
parathyroid hormonedrugId:5107 PA HORMONE AGENTS
pegvisomantdrugId:1491 PA HORMONE AGENTS
Prefest (estradiol / norgestimate) HORMONE REPLACEMENT THERAPY
Premarin (estrogens, conjugated) HORMONE REPLACEMENT THERAPY
Premphase (medroxyprogesterone / estrogens, conjugated-Premphase) HORMONE REPLACEMENT THERAPY
Prempro (medroxyprogesterone / estrogens, conjugated-Prempro) HORMONE REPLACEMENT THERAPY
progesterone capsule HORMONE REPLACEMENT THERAPY #
progesterone geldrugId:2587 PA HORMONE REPLACEMENT THERAPY
Prometrium (progesterone capsule) HORMONE REPLACEMENT THERAPY #
Provera (medroxyprogesterone tablet) HORMONE REPLACEMENT THERAPY #
Prograf (tacrolimus granules)drugId:7264 PA IMMUNOMODULATOR
Prograf (tacrolimus injection)drugId:2741 IMMUNOMODULATOR ^
PrografdrugId:1918 (tacrolimus immediate-release capsule)drugId:1918 IMMUNOMODULATOR #
Plenvu (polyethylene glycol-electrolyte solution-Plenvu)drugId:7137 PA LAXATIVES
polyethylene glycol 3350drugId:1547 LAXATIVES *
polyethylene glycol-electrolyte solution-ColytedrugId:2539 LAXATIVES #
polyethylene glycol-electrolyte solution-GolytelydrugId:1549 LAXATIVES #
polyethylene glycol-electrolyte solution-MoviprepdrugId:1551 LAXATIVES BP
polyethylene glycol-electrolyte solution-NulytelydrugId:1552 LAXATIVES #
polyethylene glycol-electrolyte solution-PlenvudrugId:7137 PA LAXATIVES
Prepopik (sodium picosulfate / magnesium oxide / anhydrous citric acid-Prepopik)drugId:2644 LAXATIVES
pitavastatin calciumdrugId:1962 PA LIPID LOWERING AGENTS
pitavastatin magnesiumdrugId:7109 PA LIPID LOWERING AGENTS
Praluent (alirocumab)drugId:5119 PA LIPID LOWERING AGENTS
PravacholdrugId:2736 (pravastatin 10 mg, 20 mg, 40 mg)drugId:2736 PA > 1.5 units/day LIPID LOWERING AGENTS #
PravacholdrugId:1572 (pravastatin 80 mg)drugId:1572 PA > 1 unit/day LIPID LOWERING AGENTS #
pravastatin 10 mg, 20 mg, 40 mgdrugId:2736 PA > 1.5 units/day LIPID LOWERING AGENTS #
pravastatin 80 mgdrugId:1572 PA > 1 unit/day LIPID LOWERING AGENTS #
PrevalitedrugId:228 (cholestyramine / aspartame-Prevalite)drugId:228 LIPID LOWERING AGENTS #
peginterferon beta-1adrugId:4631 PA MULTIPLE SCLEROSIS AGENTS
Plegridy (peginterferon beta-1a)drugId:4631 PA MULTIPLE SCLEROSIS AGENTS
pitolisantdrugId:7356 PA NARCOLEPSY AGENTS
Provigil (modafinil 100 mg); See Table 50drugId:1373; See Table 71drugId:7451 PA < 6 years and PA > 1.5 units/day NARCOLEPSY AGENTS #
Provigil (modafinil 200 mg); See Table 50drugId:7450; See Table 71drugId:7452 PA < 6 years and PA > 2 units/day NARCOLEPSY AGENTS #
Patanase (olopatadine nasal spray)drugId:1283 PA NASAL PREPARATIONS
Pennsaid (diclofenac topical solution)drugId:1944 PA NONSTEROIDAL ANTI-INFLAMMATORY
piroxicamdrugId:1540 NONSTEROIDAL ANTI-INFLAMMATORY #
pegaptanib OPHTHALMIC PREPARATIONS ^
phenylephrine / ketorolac OPHTHALMIC PREPARATIONS ^
Phospholine Iodide (echothiophate)drugId:587 OPHTHALMIC PREPARATIONS
pilocarpine eye dropsdrugId:2635 OPHTHALMIC PREPARATIONS #
PolytrimdrugId:2060 (trimethoprim / polymyxin B ophthalmic solution)drugId:2060 OPHTHALMIC PREPARATIONS #
Pred FortedrugId:1580 (prednisolone acetate 1% ophthalmic suspension-Pred Forte)drugId:1580 OPHTHALMIC PREPARATIONS #
Pred-G (gentamicin / prednisolone ophthalmic ointment, suspension)drugId:929 PA OPHTHALMIC PREPARATIONS
Pred Mild (prednisolone acetate 0.12% ophthalmic suspension)drugId:5001 OPHTHALMIC PREPARATIONS
prednisolone acetate 0.12% ophthalmic suspensiondrugId:5001 OPHTHALMIC PREPARATIONS
prednisolone acetate 1% ophthalmic suspension-OmnipreddrugId:2633 OPHTHALMIC PREPARATIONS #
prednisolone acetate 1% ophthalmic suspension-Pred FortedrugId:1580 OPHTHALMIC PREPARATIONS #
prednisolone sodium phosphate ophthalmic solutiondrugId:2618 OPHTHALMIC PREPARATIONS
Prolensa (bromfenac 0.07%)drugId:2788 PA OPHTHALMIC PREPARATIONS
proparacaine OPHTHALMIC PREPARATIONS
pentazocinedrugId:1502 OPIOID ANALGESICS
pentazocine / naloxonedrugId:1504 PA OPIOID ANALGESICS
PercocetdrugId:1323 (oxycodone / acetaminophen-Percocet)drugId:1323 PA > 80 mg/day OPIOID ANALGESICS #
pilocarpine PARASYMPATHETIC AGENTS #
pyridostigmine bromidedrugId:1612 PARASYMPATHETIC AGENTS #
pyridostigmine bromide 30 mg tabletdrugId:7226 PA PARASYMPATHETIC AGENTS
progesterone injection PROGESTERONE
pantoprazole 40 mg suspensiondrugId:2702 PA PROTON PUMP INHIBITORS BP
pantoprazole IVdrugId:1477 PROTON PUMP INHIBITORS #
pantoprazole tabletdrugId:1476 PA > 4 units/day PROTON PUMP INHIBITORS #
PrevaciddrugId:1021 (lansoprazole capsule)drugId:1021 PA > 1 unit/day PROTON PUMP INHIBITORS #
Prevacid Solutab (lansoprazole orally disintegrating tablet)drugId:1022 PA ≥ 2 years PROTON PUMP INHIBITORS BP
Prilosec (omeprazole suspension)drugId:2054 PA PROTON PUMP INHIBITORS
Protonix (pantoprazole 40 mg suspension)drugId:2702 PA PROTON PUMP INHIBITORS BP
ProtonixdrugId:1476 (pantoprazole tablet)drugId:1476 PA > 4 units/day PROTON PUMP INHIBITORS #
Protonix IVdrugId:1477 (pantoprazole IV)drugId:1477 PROTON PUMP INHIBITORS #
pirfenidonedrugId:4767 PA PULMONARY FIBROSIS AGENTS
patisirandrugId:6985 PA SMALL INTERFERING RNA AGENTS PD
Paser (aminosalicylic acid)drugId:2500 TB PREPARATIONS
Priftin (rifapentine)drugId:2501 TB PREPARATIONS
propylthiouracil THYROID PREPARATIONS
paroxetine 7.5 mg capsuledrugId:2839 PA UNCLASSIFIED DRUG PRODUCTS
pegademase bovinedrugId:2682 PA UNCLASSIFIED DRUG PRODUCTS
propantheline 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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