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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
Syprine (trientine) BP CHELATING AGENT
Synvisc-One (hylan G-F20-Synvisc-One)drugId:4811 - PA; Non-Drug Product NON-DRUG PRODUCT
Synvisc (hylan G-F20-Synvisc)drugId:4810 - PA; Non-Drug Product NON-DRUG PRODUCT
Synthroid # (levothyroxine-Synthroid) THYROID PREPARATIONS
Synribo (omacetaxine mepesuccinate)drugId:2659 - PA CHEMOTHERAPY
Synjardy XR (empagliflozin / metformin extended-release)drugId:6107 - PA DIABETIC AGENTS
Synjardy (empagliflozin / metformin)drugId:5113 - PA DIABETIC AGENTS
Synercid (dalfopristin / quinupristin)drugId:2037 - PA ANTIBIOTICS
Synera (lidocaine / tetracaine)drugId:1075 - PA > 4 patches / month ANESTHETICS
Syndros (dronabinol solution)drugId:6361 - PA ANTIEMETICS
Synarel (nafarelin)drugId:1420 - PA HORMONE AGENTS
Synalgos-DC (dihydrocodeine / aspirin / caffeine)drugId:525 - PA OPIOID ANALGESICS
SynalardrugId:2632 # (fluocinolone solution)drugId:2632 GLUCOCORTICOIDS
SynalardrugId:5061 # (fluocinolone ointment)drugId:5061 GLUCOCORTICOIDS
SynalardrugId:5060 # (fluocinolone 0.025% cream)drugId:5060 GLUCOCORTICOIDS
Synalar (fluocinolone solution kit)drugId:5064 - PA GLUCOCORTICOIDS
Synalar (fluocinolone ointment kit)drugId:5063 - PA GLUCOCORTICOIDS
Synalar (fluocinolone cream kit)drugId:5062 - PA GLUCOCORTICOIDS
Synagis (palivizumab)drugId:1472 - PA ANTIVIRALS
Symtuza (darunavir / cobicistat / emtricitabine / tenofovir alafenamide)drugId:6822 - PA ANTIVIRALS
Symproic (naldemedine)drugId:6619 - PA CONSTIPATION AGENTS
Sympazan (clobazam film) - PA; See Table 20drugId:7106; See Table 71drugId:7107 ANTICONVULSANTS
Symlin (pramlintide)drugId:1570 - PA DIABETIC AGENTS
Symjepi (epinephrine injection)drugId:7105 ADRENERGICS
Symfi Lo (efavirenz / lamivudine / tenofovir disoproxil fumarate)drugId:6783 - PA ANTIVIRALS
Symfi (efavirenz / lamivudine / tenofovir disoproxil fumarate)drugId:6782 - PA ANTIVIRALS
Symdeko (tezacaftor / ivacaftor)drugId:6540 - PA CYSTIC FIBROSIS AGENTS
Symbyax (olanzapine / fluoxetine) - PA; See Table 17drugId:2058; See Table 24drugId:1279; See Table 71drugId:4264 ANTIDEPRESSANTS
Symbicort (budesonide / formoterol)drugId:383 - PA BRONCHODILATORS
Sylvant (siltuximab)drugId:4540 - PA BIOLOGICAL
Sylatron (peginterferon alfa-2b-Sylatron) ANTIVIRALS
suvorexant - PA; See Table 15drugId:4903; See Table 71drugId:4904 SEDATIVE, NON-BARBITURATE
Sutent (sunitinib)drugId:1917 - PA CHEMOTHERAPY
Sustol (granisetron extended-release injection)drugId:5767 - PA > 2 units/28 days ANTIEMETICS
Sustiva (efavirenz)drugId:590 BP ANTIVIRALS
Surmontil # (trimipramine) - PA < 6 years; See Table 17drugId:1765; See Table 71drugId:4160 ANTIDEPRESSANTS
Suprep (sodium sulfate / potassium sulfate / magnesium sulfate)drugId:2086 - PA LAXATIVES
Suprax (cefixime)drugId:196 - PA ANTIBIOTICS
Supprelin LA (histrelin-Supprelin LA)drugId:710 - PA HORMONE AGENTS
Supartz (hyaluronate-Supartz)drugId:4809 - PA; Non-Drug Product NON-DRUG PRODUCT
sunitinibdrugId:1917 - PA CHEMOTHERAPY
Sumavel (sumatriptan injection-Sumavel)drugId:2245 - PA TRIPTAN
sumatriptan tabletdrugId:1915 - PA > 18 units/month TRIPTAN
sumatriptan nasal spraydrugId:1913 - PA TRIPTAN
sumatriptan nasal powderdrugId:5590 - PA TRIPTAN
sumatriptan injection-ZembracedrugId:5599 - PA TRIPTAN
sumatriptan injection-SumaveldrugId:2245 - PA TRIPTAN
sumatriptan injection-ImitrexdrugId:1914 - PA TRIPTAN
sumatriptan / naproxendrugId:1916 BP - PA TRIPTAN/NON STEROIDAL ANTI-INFLAMMATORY
sulindacdrugId:1912 NONSTEROIDAL ANTI-INFLAMMATORY
SulfatrimdrugId:5133 # (sulfamethoxazole / trimethoprim suspension)drugId:5133 ANTIBIOTICS
sulfasalazine delayed-releasedrugId:4864 GI ANTI-INFLAMMATORY
sulfasalazinedrugId:1910 GI ANTI-INFLAMMATORY
sulfanilamidedrugId:1909 ANTIBIOTICS
SulfamylondrugId:1113 # (mafenide)drugId:1113 ANTIBIOTICS
sulfamethoxazole / trimethoprim tabletdrugId:1907 ANTIBIOTICS
sulfamethoxazole / trimethoprim suspensiondrugId:5133 ANTIBIOTICS
sulfamethoxazole / trimethoprim injectiondrugId:5661 ANTIBIOTICS
sulfadiazinedrugId:1906 ANTIBIOTICS
sulfacetamidedrugId:1899 - PA ≥ 22 years DERMATOLOGICAL
sulfacetamide ophthalmic ointment, solutiondrugId:1901 OPHTHALMIC PREPARATIONS
sulfacetamide / prednisolone sodium phosphate ophthalmic solutiondrugId:2272 OPHTHALMIC PREPARATIONS
sulfacetamide / prednisolone sodium acetate ophthalmic ointment, suspensiondrugId:1877 - PA OPHTHALMIC PREPARATIONS
sulconazoledrugId:1898 - PA FUNGICIDES
Sular (nisoldipine)drugId:1219 - PA CARDIOVASCULAR
sufentanil powderdrugId:1897 - PA OPIOID ANALGESICS
sufentanil injectiondrugId:2566 OPIOID ANALGESICS
Sufenta (sufentanil injection)drugId:2566 OPIOID ANALGESICS
sucroferric oxyhydroxide ELECTROLYTES AND NUTRIENTS
sucralfate tablet ANTACIDS
sucralfate suspension BP ANTACIDS
succimer CHELATING AGENT
Subsys (fentanyl sublingual spray)drugId:2523 - PA OPIOID ANALGESICS
Suboxone (buprenorphine / naloxone film ≤ 24 mg/day)drugId:2085 BP PD ALCOHOL AND DRUG CESSATION AGENT
Suboxone (buprenorphine / naloxone film)drugId:2050 BP PD - PA > 90 days (> 24 mg/day and ≤ 32 mg/day) ALCOHOL AND DRUG CESSATION AGENT
Suboxone (buprenorphine / naloxone film)drugId:2049 BP PD - PA > 32 mg/day ALCOHOL AND DRUG CESSATION AGENT
Sublocade (buprenorphine extended-release injection)drugId:6524 - PA ALCOHOL AND DRUG CESSATION AGENT
StromectoldrugId:989 # (ivermectin tablet)drugId:989 ANTIPARASITICS
Striverdi (olodaterol)drugId:4641 - PA BRONCHODILATORS
Stribild (elvitegravir / cobicistat / emtricitabine / tenofovir disoproxil fumarate)drugId:2648 ANTIVIRALS
Striant (testosterone buccal system)drugId:2647 - PA HORMONE REPLACEMENT THERAPY
streptozocindrugId:2700 CHEMOTHERAPY
streptomycindrugId:2496 ANTIBIOTICS
Strensiq (asfotase alfa)drugId:5300 - PA ENZYMES
Strattera # (atomoxetine) - PA < 6 years; See Table 31drugId:104; See Table 71drugId:3080 NONSTIMULANT ADHD AGENTS
Stivarga (regorafenib)drugId:2646 - PA CHEMOTHERAPY
stiripentol - PA; See Table 20drugId:7132; See Table 71drugId:7133 ANTICONVULSANTS
Stiolto (tiotropium / olodaterol)drugId:5112 - PA BRONCHODILATORS
Stimate (desmopressin-Stimate) HORMONE AGENTS
Stelara (ustekinumab)drugId:1777 - PA IMMUNOMODULATOR
Steglujan (ertugliflozin / sitagliptin)drugId:6618 - PA DIABETIC AGENTS
Steglatro (ertugliflozin)drugId:6617 - PA DIABETIC AGENTS
stavudinedrugId:1894 ANTIVIRALS
StarlixdrugId:1178 # (nateglinide)drugId:1178 DIABETIC AGENTS
Stamaril (yellow fever vaccine, live)drugId:6106 BIOLOGICAL
Stalevo (carbidopa / levodopa / entacapone)drugId:176 - PA ANTIPARKINSON
SSDdrugId:2534 # (silver sulfadiazine-SSD)drugId:2534 ANTIBIOTICS
Sprycel (dasatinib)drugId:331 CHEMOTHERAPY
Sprix (ketorolac nasal spray)drugId:2289 - PA NONSTEROIDAL ANTI-INFLAMMATORY
Spritam (levetiracetam tablet for oral suspension) - PA; See Table 20drugId:5397; See Table 71drugId:5398 ANTICONVULSANTS
Spravato (esketamine) - PA; See Table 17drugId:7138; See Table 71drugId:7139 ANTIDEPRESSANTS
SporanoxdrugId:988 # (itraconazole 100 mg capsule)drugId:988 FUNGICIDES
Sporanox (itraconazole solution)drugId:7060 BP FUNGICIDES
spironolactone tabletdrugId:1892 ALDOSTERONE ANTAGONISTS
spironolactone suspensiondrugId:6280 - PA ALDOSTERONE ANTAGONISTS
spironolactone / hydrochlorothiazidedrugId:1893 CARDIOVASCULAR
Spiriva Respimat (tiotropium inhalation solution)drugId:4640 - PA > 1 inhaler/month BRONCHODILATORS
Spiriva Handihaler (tiotropium inhalation powder)drugId:1708 - PA > 30 units/month BRONCHODILATORS
Spinraza (nusinersen)drugId:6020 - PA BIOLOGICAL
spinosaddrugId:2239 - PA ANTIPARASITICS
Sovaldi (sofosbuvir)drugId:2879 - PA ANTIVIRALS
Sotylize (sotalol solution)drugId:4913 - PA CARDIOVASCULAR
Sotradecol (tetradecyl sulfate injection)drugId:2495 - PA CARDIOVASCULAR
sotalol tabletdrugId:1891 CARDIOVASCULAR
sotalol solutiondrugId:4913 - PA CARDIOVASCULAR
Sorilux (calcipotriene foam)drugId:2560 - PA DERMATOLOGICAL
SoriatanedrugId:153 # (acitretin)drugId:153 DERMATOLOGICAL
sorafenibdrugId:1890 - PA CHEMOTHERAPY
Soolantra (ivermectin cream)drugId:4813 - PA DERMATOLOGICAL
sonidegibdrugId:5284 - PA CHEMOTHERAPY
Somavert (pegvisomant)drugId:1491 - PA HORMONE AGENTS
Somatuline (lanreotide)drugId:1020 ENDOCRINE/METABOLIC AGENTS
somatropin-ZorbtivedrugId:1889 - PA HORMONE AGENTS
somatropin-ZomactondrugId:5002 - PA HORMONE AGENTS
somatropin-SerostimdrugId:1887 - PA HORMONE AGENTS
somatropin-SaizendrugId:1886 - PA HORMONE AGENTS
somatropin-OmnitropedrugId:1885 - PA HORMONE AGENTS
somatropin-Nutropin AQdrugId:1884 - PA HORMONE AGENTS
somatropin-NorditropindrugId:1882 - PA HORMONE AGENTS
somatropin-HumatropedrugId:1881 - PA HORMONE AGENTS
somatropin-GenotropindrugId:1880 PD - PA HORMONE AGENTS
Soma (carisoprodol)drugId:180 - PA MUSCLE RELAXANT
Solu-MedroldrugId:964 # (methylprednisolone sodium succinate)drugId:964 GLUCOCORTICOIDS
Solu-CortefdrugId:729 # (hydrocortisone injection-Solu-Cortef)drugId:729 GLUCOCORTICOIDS
Soltamox (tamoxifen solution)drugId:4980 - PA CHEMOTHERAPY
Solosec (secnidazole)drugId:6523 - PA ANTIBIOTICS
Solodyn (minocycline extended-release 55 mg, 65 mg, 80 mg, 105 mg, 115 mg tablet)drugId:1364 BP ANTIBIOTICS
Soliris (eculizumab)drugId:589 - PA BIOLOGICAL
Soliqua (insulin glargine / lixisenatide)drugId:5766 - PA DIABETIC AGENTS
solifenacindrugId:1879 URINARY ANTISPASMODICS
Solaraze (diclofenac 3% gel)drugId:508 - PA CHEMOTHERAPY
sofosbuvirdrugId:2879 - PA ANTIVIRALS
sofosbuvir / velpatasvirdrugId:5540 PD - PA ANTIVIRALS
sofosbuvir / velpatasvir / voxilaprevirdrugId:6364 PD - PA ANTIVIRALS
sodium zirconium cyclosilicatedrugId:6905 - PA > 30 units/month CHELATING AGENT
sodium sulfate / potassium sulfate / magnesium sulfatedrugId:2086 - PA LAXATIVES
sodium polystyrene sulfonatedrugId:1874 CHELATING AGENT
sodium picosulfate / magnesium oxide / anhydrous citric acid-PrepopikdrugId:2644 LAXATIVES
sodium picosulfate / magnesium oxide / anhydrous citric acid-ClenpiqdrugId:6380 - PA LAXATIVES
sodium phosphate * GASTROINTESTINAL AGENT
sodium phosphatedrugId:1873 LAXATIVES
sodium phenylbutyrate tablet BP ENZYMES
sodium phenylbutyrate powder ENZYMES
sodium phenylacetate / sodium benzoate ELECTROLYTES AND NUTRIENTS
sodium oxybatedrugId:1870 - PA SEDATIVES
sodium fluoride oral rinse ELECTROLYTES AND NUTRIENTS
sodium fluoride * ELECTROLYTES AND NUTRIENTS
sodium ferric gluconate complexdrugId:1865 - PA ELECTROLYTES AND NUTRIENTS
sodium citrate / citric acid ELECTROLYTES AND NUTRIENTS
sodium chloride tablet * ELECTROLYTES AND NUTRIENTS
sodium chloride solution ELECTROLYTES AND NUTRIENTS
sodium chloride for inhalation * - Non-Drug Product ELECTROLYTES AND NUTRIENTS
sodium chloride 6% for inhalation - Non-Drug Product NON-DRUG PRODUCT
sodium chloride 3.5%, 7% for inhalation - Non-Drug Product NON-DRUG PRODUCT
sodium bicarbonate * ELECTROLYTES AND NUTRIENTS
Slynd (drospirenone) CONTRACEPTIVES
Skyrizi (risankizumab-rzaa)drugId:7227 - PA IMMUNOMODULATOR
Skyla (levonorgestrel-releasing intrauterine system 13.5 mg) CONTRACEPTIVES
Sklice (ivermectin lotion)drugId:2584 - PA ANTIPARASITICS
Skelaxin (metaxalone)drugId:1156 - PA MUSCLE RELAXANT
Sivextro (tedizolid tablet)drugId:4635 - PA ANTIBIOTICS
Sivextro (tedizolid injection)drugId:4636 - PA ANTIBIOTICS
Sitavig (acyclovir buccal tablet)drugId:2945 - PA ANTIVIRALS
sitagliptin / metformin extended-releasedrugId:2485 DIABETIC AGENTS
sitagliptin / metformindrugId:1859 DIABETIC AGENTS
sitagliptindrugId:1858 DIABETIC AGENTS
Sirturo (bedaquiline)drugId:2851 - PA TB PREPARATIONS
sirolimus tabletdrugId:1857 IMMUNOMODULATOR
sirolimus solutiondrugId:7080 BP IMMUNOMODULATOR
sipuleucel-TdrugId:2288 ^ - PA CHEMOTHERAPY
siponimoddrugId:7184 - PA MULTIPLE SCLEROSIS AGENTS
Sinuva (mometasone sinus implant)drugId:6684 - PA NASAL PREPARATIONS
SingulairdrugId:1383 # (montelukast tablet, chewable tablet)drugId:1383 BRONCHODILATORS
Singulair (montelukast granules)drugId:5129 - PA BRONCHODILATORS
Sinemet CRdrugId:1997 # (carbidopa / levodopa extended-release tablet)drugId:1997 ANTIPARKINSON
SinemetdrugId:175 # (carbidopa / levodopa tablet)drugId:175 ANTIPARKINSON
sinecatechinsdrugId:1856 - PA ANTIVIRALS
simvastatin 80 mgdrugId:1855 - PA > 30 units/month LIPID LOWERING AGENTS
simvastatin 5 mg, 10 mg, 20 mg, 40 mgdrugId:2737 - PA > 45 units/month LIPID LOWERING AGENTS
Simulect (basiliximab)drugId:2382 BIOLOGICAL
Simponi Aria (golimumab for infusion)drugId:2850 - PA IMMUNOMODULATOR
Simponi (golimumab)drugId:681 - PA IMMUNOMODULATOR
simple syrup * COMPOUNDING AGENT
simethicone * GASTROINTESTINAL AGENT
Simbrinza (brinzolamide / brimonidine tartrate ophthalmic suspension)drugId:2849 - PA OPHTHALMIC PREPARATIONS
silver sulfadiazine-ThermazenedrugId:1852 ANTIBIOTICS
silver sulfadiazine-SSDdrugId:2534 ANTIBIOTICS
silver sulfadiazine-SilvadenedrugId:1850 ANTIBIOTICS
SilvadenedrugId:1850 # (silver sulfadiazine-Silvadene)drugId:1850 ANTIBIOTICS
siltuximabdrugId:4540 - PA BIOLOGICAL
silodosindrugId:1849 BP - PA BENIGN PROSTATIC HYPERPLASIA AGENTS
Siliq (brodalumab)drugId:6042 - PA IMMUNOMODULATOR
Silenor (doxepin tablet-Silenor) - PA; See Table 15drugId:2082; See Table 71drugId:4346 SEDATIVES
sildenafil oral suspensiondrugId:4793 BP - PA CARDIOVASCULAR
sildenafil 20 mg tabletdrugId:1848 - PA CARDIOVASCULAR
Siklos (hydroxyurea)drugId:6821 HEMATOLOGIC
Signifor LAR (pasireotide injectable suspension)drugId:4912 - PA ENDOCRINE/METABOLIC AGENTS
Signifor (pasireotide)drugId:2791 - PA ENDOCRINE/METABOLIC AGENTS
Shingrix (zoster vaccine recombinant, adjuvanted)drugId:6407 - PA < 50 years BIOLOGICAL
sevelamer hydrochloride BP ELECTROLYTES AND NUTRIENTS
sevelamer carbonate ELECTROLYTES AND NUTRIENTS
sertraline - PA < 6 years; See Table 17drugId:1845; See Table 71drugId:3820 ANTIDEPRESSANTS
sertaconazoledrugId:1843 - PA FUNGICIDES
Serostim (somatropin-Serostim)drugId:1887 - PA HORMONE AGENTS
Seroquel XR # (quetiapine extended-release 50 mg, 300 mg and 400 mg) - PA < 6 years and PA > 60 units/month; See Table 24drugId:1616; See Table 71drugId:4295 ANTIPSYCHOTIC
Seroquel XR # (quetiapine extended-release 150 mg, 200 mg) - PA < 6 years and PA > 30 units/month; See Table 24drugId:1617; See Table 71drugId:4294 ANTIPSYCHOTIC
Seroquel # (quetiapine) - PA < 6 years and PA > 90 units/month; See Table 24drugId:1618; See Table 71drugId:4293 ANTIPSYCHOTIC
Seromycin (cycloserine)drugId:2498 TB PREPARATIONS
Sernivo (betamethasone dipropionate spray)drugId:5396 - PA GLUCOCORTICOIDS
Serevent (salmeterol)drugId:1829 - PA BRONCHODILATORS
Sensorcaine # (bupivacaine) ANESTHETICS
Sensipar (cinacalcet) BP CALCIMIMETIC
sennosidesdrugId:1842 * LAXATIVES
Semprex-D (acrivastine / pseudoephedrine)drugId:1608 - PA DECONGESTANT
semaglutidedrugId:6613 - PA DIABETIC AGENTS
Selzentry (maraviroc)drugId:1119 - PA ANTIVIRALS
selexipagdrugId:5401 - PA CARDIOVASCULAR
selenium sulfide * DERMATOLOGICAL
selegiline transdermal patch - PA; See Table 17drugId:1840; See Table 71drugId:3560 ANTIDEPRESSANTS
selegiline orally disintegrating tabletdrugId:1839 - PA ANTIPARKINSON
selegiline capsule, tabletdrugId:2378 ANTIPARKINSON
Segluromet (ertugliflozin / metformin)drugId:6616 - PA DIABETIC AGENTS
Seebri (glycopyrrolate inhalation powder)drugId:5393 - PA > 1 inhaler/month BRONCHODILATORS
secukinumabdrugId:4908 - PA IMMUNOMODULATOR
Seconal (secobarbital)drugId:1837 BARBITURATES
secobarbitaldrugId:1837 BARBITURATES
secnidazoledrugId:6523 - PA ANTIBIOTICS
sebelipase alfadrugId:5388 - PA ENZYMES
Seasonique # (levonorgestrel / ethinyl estradiol-Seasonique) CONTRACEPTIVES
scopolamine transdermal patchdrugId:1835 BP - PA ANTIEMETICS
scopolamine ANTISPASMODICS,ANTICHOLINERGIC
saxagliptin / metformin extended-releasedrugId:2103 DIABETIC AGENTS
saxagliptindrugId:1834 DIABETIC AGENTS
Savella (milnacipran)drugId:1358 - PA ANALGESICS
Savaysa (edoxaban)drugId:4795 - PA ANTICOAGULANTS
sarilumabdrugId:6181 - PA IMMUNOMODULATOR
sargramostimdrugId:1833 HEMATINIC AGENT
Sarafem # (fluoxetine 10 mg tablet for premenstrual dysphoric disorder) - PA < 6 years; See Table 17drugId:881; See Table 71drugId:3740 ANTIDEPRESSANTS
Sarafem (fluoxetine 20 mg tablet for premenstrual dysphoric disorder) - PA; See Table 17drugId:2589; See Table 71drugId:3741 ANTIDEPRESSANTS
saquinavirdrugId:1832 ANTIVIRALS
sapropterindrugId:1831 - PA ENZYMES
Saphris (asenapine) - PA; See Table 24drugId:97; See Table 71drugId:4260 ANTIPSYCHOTIC
Santyl (collagenase) ENZYMES
Sandostatin LAR (octreotide injectable suspension)drugId:2497 ENDOCRINE/METABOLIC AGENTS
SandostatindrugId:1269 # (octreotide)drugId:1269 ENDOCRINE/METABOLIC AGENTS
SandimmunedrugId:2092 # (cyclosporine)drugId:2092 IMMUNOMODULATOR
Sancuso (granisetron transdermal system)drugId:685 - PA ANTIEMETICS
Samsca (tolvaptan-Samsca)drugId:1728 - PA VASOPRESSIN ANTAGONISTS
samarium Sm 153 lexidronam ^ CHEMOTHERAPY
salsalatedrugId:1830 - PA NONSTEROIDAL ANTI-INFLAMMATORY
salmeteroldrugId:1829 - PA BRONCHODILATORS
saliva substitute * ELECTROLYTES AND NUTRIENTS
salicylic aciddrugId:1827 o DERMATOLOGICAL
Salagen # (pilocarpine) PARASYMPATHETIC AGENTS
Saizen (somatropin-Saizen)drugId:1886 - PA HORMONE AGENTS
Safyral # (ethinyl estradiol / drospirenone / levomefolate-Safyral) CONTRACEPTIVES
safinamidedrugId:6185 - PA ANTIPARKINSON
sacubitril / valsartandrugId:5125 - PA CARDIOVASCULAR
saccharomyces boulardiidrugId:6207 - PA ≥ 19 years GASTROINTESTINAL AGENT
Sabril (vigabatrin) BP - PA; See Table 20drugId:1802; See Table 71drugId:4481 ANTICONVULSANTS

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 11/18/19