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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
Syprine (trientine) CHELATING AGENT BP
Synvisc-One (hylan G-F20-Synvisc-One)drugId:4811 - Non-Drug Product PA NON-DRUG PRODUCT
Synvisc (hylan G-F20-Synvisc)drugId:4810 - Non-Drug Product PA 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); See Table 20drugId:7106; See Table 71drugId:7107 PA 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); See Table 17drugId:2058; See Table 24drugId:1279; See Table 71drugId:4264 PA ANTIDEPRESSANTS
Symbicort (budesonide / formoterol)drugId:383 PA BRONCHODILATORS BP
Sylvant (siltuximab)drugId:4540 PA BIOLOGICAL
Sylatron (peginterferon alfa-2b-Sylatron) ANTIVIRALS
suvorexant; See Table 15drugId:4903; See Table 71drugId:4904 PA SEDATIVE, NON-BARBITURATE
Sutent (sunitinib)drugId:1917 PA CHEMOTHERAPY PD
Sustol (granisetron extended-release injection)drugId:5767 PA > 2 units/28 days ANTIEMETICS
Sustiva (efavirenz)drugId:590 ANTIVIRALS BP
Surmontil (trimipramine); See Table 17drugId:1765; See Table 71drugId:4160 PA < 6 years 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 - Non-Drug Product PA NON-DRUG PRODUCT
Sunosi (solriamfetol)drugId:7267 PA NARCOLEPSY AGENTS
sunitinibdrugId:1917 PA CHEMOTHERAPY PD
sumatriptan tabletdrugId:1915 PA > 18 units/month TRIPTAN #
sumatriptan nasal powderdrugId:5590 PA TRIPTAN
sumatriptan injection-ZembracedrugId:5599 PA TRIPTAN
sumatriptan injection-ImitrexdrugId:1914 PA TRIPTAN
sumatriptan 5 mg, 20 mg nasal spraydrugId:1913 PA TRIPTAN
sumatriptan 10 mg nasal spraydrugId:7335 PA TRIPTAN
sumatriptan / naproxendrugId:1916 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 ANTACIDS BP
succimer CHELATING AGENT
Subsys (fentanyl sublingual spray)drugId:2523 PA OPIOID ANALGESICS
Suboxone (buprenorphine / naloxone film ≤ 24 mg/day)drugId:2085 ALCOHOL AND DRUG CESSATION AGENT BP PD
Suboxone (buprenorphine / naloxone film)drugId:2050 PA > 90 days (> 24 mg/day and ≤ 32 mg/day) ALCOHOL AND DRUG CESSATION AGENT BP PD
Suboxone (buprenorphine / naloxone film)drugId:2049 PA > 32 mg/day ALCOHOL AND DRUG CESSATION AGENT BP PD
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); See Table 31drugId:104; See Table 71drugId:3080 PA < 6 years NONSTIMULANT ADHD AGENTS #
Stivarga (regorafenib)drugId:2646 PA CHEMOTHERAPY
stiripentol; See Table 20drugId:7132; See Table 71drugId:7133 PA 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); See Table 20drugId:5397; See Table 71drugId:5398 PA ANTICONVULSANTS
Spravato (esketamine); See Table 17drugId:7138; See Table 71drugId:7139 PA ANTIDEPRESSANTS
SporanoxdrugId:988 (itraconazole 100 mg capsule)drugId:988 FUNGICIDES #
Sporanox (itraconazole solution)drugId:7060 FUNGICIDES BP
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 PA HORMONE AGENTS PD
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
solriamfetoldrugId:7267 PA NARCOLEPSY AGENTS
Solosec (secnidazole)drugId:6523 PA ANTIBIOTICS
SolodyndrugId:1363 (minocycline extended-release 80 mg, 105 mg tablet)drugId:1363 ANTIBIOTICS #
Solodyn (minocycline extended-release 55 mg, 65 mg, 115 mg tablet)drugId:1364 ANTIBIOTICS BP
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 PA ANTIVIRALS PD
sofosbuvir / velpatasvir / voxilaprevirdrugId:6364 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 ENZYMES BP
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 IMMUNOMODULATOR BP
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 PA BENIGN PROSTATIC HYPERPLASIA AGENTS BP
Siliq (brodalumab)drugId:6042 PA IMMUNOMODULATOR
Silenor (doxepin tablet-Silenor); See Table 15drugId:2082; See Table 71drugId:4346 PA SEDATIVES BP
sildenafil oral suspensiondrugId:4793 PA CARDIOVASCULAR BP
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 ELECTROLYTES AND NUTRIENTS BP
sevelamer carbonate ELECTROLYTES AND NUTRIENTS #
sertraline; See Table 17drugId:1845; See Table 71drugId:3820 PA < 6 years 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); See Table 24drugId:1616; See Table 71drugId:4295 PA < 6 years and PA > 60 units/month ANTIPSYCHOTIC #
Seroquel XR (quetiapine extended-release 150 mg, 200 mg); See Table 24drugId:1617; See Table 71drugId:4294 PA < 6 years and PA > 30 units/month ANTIPSYCHOTIC #
Seroquel (quetiapine); See Table 24drugId:1618; See Table 71drugId:4293 PA < 6 years and PA > 90 units/month 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) CALCIMIMETIC BP
sennosidesdrugId:1842 LAXATIVES *
Semprex-D (acrivastine / pseudoephedrine)drugId:1608 PA DECONGESTANT
semaglutidedrugId:6613 PA DIABETIC AGENTS
Selzentry (maraviroc)drugId:1119 PA ANTIVIRALS
selinexordrugId:7300 PA CHEMOTHERAPY
selexipagdrugId:5401 PA CARDIOVASCULAR
selenium sulfide DERMATOLOGICAL *
selegiline transdermal patch; See Table 17drugId:1840; See Table 71drugId:3560 PA ANTIDEPRESSANTS
selegiline orally disintegrating tabletdrugId:1839 PA ANTIPARKINSON
selegiline capsule, tabletdrugId:2378 ANTIPARKINSON
Segluromet (ertugliflozin / metformin)drugId:6616 PA DIABETIC AGENTS
segesterone / ethinyl estradiol CONTRACEPTIVES
Seebri (glycopyrrolate inhalation powder)drugId:5393 PA > 1 inhaler/month BRONCHODILATORS
secukinumabdrugId:4908 PA IMMUNOMODULATOR
Secuado (asenapine transdermal); See Table 24drugId:7354; See Table 71drugId:7355 PA ANTIPSYCHOTIC
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 PA ANTIEMETICS BP
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, 20 mg tablet for premenstrual dysphoric disorder); See Table 17drugId:881; See Table 71drugId:3740 PA < 6 years ANTIDEPRESSANTS #
saquinavirdrugId:1832 ANTIVIRALS
sapropterindrugId:1831 PA ENZYMES
Saphris (asenapine sublingual tablet); See Table 24drugId:97; See Table 71drugId:4260 PA 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 DERMATOLOGICAL o
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); See Table 20drugId:1802; See Table 71drugId:4481 PA ANTICONVULSANTS BP

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


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Last updated 05/19/20

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