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MassHealth Drug List table

Drug - Brand Name (Generic Name)	Class
abacavirdrugId:137	ANTIVIRALS
abacavir / dolutegravir / lamivudinedrugId:4642 PD	ANTIVIRALS
abacavir / lamivudinedrugId:138	ANTIVIRALS
abacavir / lamivudine / zidovudinedrugId:139	ANTIVIRALS
abaloparatidedrugId:6362 - PA	HORMONE AGENTS
abataceptdrugId:140 - PA	IMMUNOMODULATOR
Abelcet (amphotericin B lipid complex)	ANTIBIOTICS
abemaciclibdrugId:6410 - PA	CHEMOTHERAPY
Abilify # (aripiprazole tablet) - PA < 6 years and PA > 30 units/month; See Table 24drugId:90; See Table 71drugId:4180	ANTIPSYCHOTIC
Abilify Maintena (aripiprazole extended-release injection) - PA; See Table 24drugId:2717; See Table 71drugId:4200	ANTIPSYCHOTIC
Abilify Mycite (aripiprazole tablet with sensor) - PA; See Table 24drugId:7230; See Table 71drugId:7231	ANTIPSYCHOTIC
abiraterone 125 mgdrugId:6824 - PA	CHEMOTHERAPY
abiraterone 250 mg, 500 mgdrugId:2297 - PA	CHEMOTHERAPY
abobotulinumtoxinAdrugId:141 - PA	BIOLOGICAL
Abraxane (paclitaxel injectable suspension)drugId:1468	CHEMOTHERAPY
Absorica (isotretinoin-Absorica)drugId:2881 - PA	DERMATOLOGICAL
Abstral (fentanyl sublingual tablet)drugId:2157 - PA	OPIOID ANALGESICS
acalabrutinibdrugId:6483 - PA	CHEMOTHERAPY
acamprosatedrugId:142	ALCOHOL AND DRUG CESSATION AGENT
Acanya (clindamycin / benzoyl peroxide-Acanya)drugId:262 - PA	DERMATOLOGICAL
acarbosedrugId:143	DIABETIC AGENTS
Accolate (zafirlukast)drugId:1816 - PA	BRONCHODILATORS
AccunebdrugId:168 # (albuterol inhalation solution)drugId:168	BRONCHODILATORS
AccuprildrugId:1620 # (quinapril)drugId:1620	CARDIOVASCULAR
AccureticdrugId:1621 # (quinapril / hydrochlorothiazide)drugId:1621	CARDIOVASCULAR
acebutololdrugId:144	CARDIOVASCULAR
Acetadote (acetylcysteine injection) ^	ANTIDOTES
acetaminophen / codeinedrugId:146 - PA < 12 years and PA > 4 g/day acetaminophen and PA > 360 mg/day codeine	OPIOID ANALGESICS
acetaminophendrugId:145 * - PA > 4 g/day	ANALGESICS
acetazolamidedrugId:147	CARDIOVASCULAR
acetic aciddrugId:148	OTIC PREPARATIONS
acetic acid / aluminum acetatedrugId:2107	OTIC PREPARATIONS
acetic acid / hydrocortisonedrugId:149	OTIC PREPARATIONS
acetohydroxamic acid	ANTIBIOTICS
acetylcholine chloridedrugId:1982	OPHTHALMIC PREPARATIONS
acetylcysteine	MUCOLYTICS
acetylcysteine injection ^	ANTIDOTES
AciphexdrugId:1624 # (rabeprazole delayed-release tablet)drugId:1624 - PA > 30 units/month	PROTON PUMP INHIBITORS
Aciphex Sprinkle (rabeprazole delayed-release capsule)drugId:2882 - PA	PROTON PUMP INHIBITORS
acitretindrugId:153	DERMATOLOGICAL
aclidinium / formoteroldrugId:7330 - PA	BRONCHODILATORS
aclidiniumdrugId:2649 - PA > 1 inhaler/month	BRONCHODILATORS
acrivastine / pseudoephedrinedrugId:1608 - PA	DECONGESTANT
Actemra (tocilizumab)drugId:1719 - PA	IMMUNOMODULATOR
Acthar (corticotropin)drugId:294 - PA	HORMONE AGENTS
Acthib (haemophilus B conjugate vaccine-Acthib)drugId:693 1	BIOLOGICAL
ActigalldrugId:1774 # (ursodiol)drugId:1774	BILE THERAPY
Actimmune (interferon gamma-1b)drugId:829	CHEMOTHERAPY
Actiq (fentanyl transmucosal system)drugId:844 - PA	OPIOID ANALGESICS
Activella # (estradiol / norethindrone-Activella)	HORMONE REPLACEMENT THERAPY
Actonel (risedronate)drugId:1439 - PA	ELECTROLYTES AND NUTRIENTS
Actoplus Met (pioglitazone / metformin)drugId:1536 - PA	DIABETIC AGENTS
Actoplus Met XR (pioglitazone / metformin extended-release)drugId:1937 - PA	DIABETIC AGENTS
ActosdrugId:1534 # (pioglitazone)drugId:1534	DIABETIC AGENTS
AculardrugId:2270 # (ketorolac 0.5% ophthalmic solution)drugId:2270	OPHTHALMIC PREPARATIONS
Acular LSdrugId:2271 # (ketorolac 0.4% ophthalmic solution)drugId:2271	OPHTHALMIC PREPARATIONS
Acuvail (ketorolac 0.45% ophthalmic solution)drugId:999 - PA	OPHTHALMIC PREPARATIONS
acyclovir / hydrocortisonedrugId:1973 - PA	DERMATOLOGICAL
acyclovir buccal tabletdrugId:2945 - PA	ANTIVIRALS
acyclovir capsule, suspension, tabletdrugId:155	ANTIVIRALS
acyclovir creamdrugId:157 BP - PA	ANTIVIRALS
acyclovir injectiondrugId:2744	ANTIVIRALS
acyclovir ointmentdrugId:156 - PA	ANTIVIRALS
Aczone (dapsone 5% gel)drugId:325 - PA	DERMATOLOGICAL
Aczone (dapsone 7.5% gel)drugId:7306 BP - PA	DERMATOLOGICAL
Adacel (diphtheria / tetanus toxoids / acellular pertussis vaccine)drugId:539 1	BIOLOGICAL
Adagen (pegademase bovine)drugId:2682 - PA	UNCLASSIFIED DRUG PRODUCTS
Adakveo (crizanlizumab-tmca)drugId:7326 - PA	HEMATOLOGIC
AdalatdrugId:1213 # (nifedipine tablet)drugId:1213	CARDIOVASCULAR
adalimumabdrugId:158 PD - PA	IMMUNOMODULATOR
adapalene / benzoyl peroxidedrugId:160 - PA	DERMATOLOGICAL
adapalenedrugId:159 BP - PA	DERMATOLOGICAL
Adcetris (brentuximab)drugId:2374 - PA	CHEMOTHERAPY
Adcirca (tadalafil-Adcirca)drugId:1920 - PA	CARDIOVASCULAR
Adderall # (amphetamine salts) - PA < 3 years and PA > 90 units/month; See Table 31drugId:60; See Table 71drugId:3100	CEREBRAL STIMULANTS
Adderall XR (amphetamine salts extended-release-Adderall XR) BP PD - PA < 3 years and PA > 60 units/month; See Table 31drugId:59; See Table 71drugId:3000	CEREBRAL STIMULANTS
adefovirdrugId:161 - PA > 30 units/month	ANTIVIRALS
Adempas (riociguat)drugId:2883 - PA	CARDIOVASCULAR
adenovirus live vaccine delayed-release oral tabletsdrugId:2837	BIOLOGICAL
Adhansia XR (methylphenidate extended-release-Adhansia XR) - PA; See Table 31drugId:7232; See Table 71drugId:7233	CEREBRAL STIMULANTS
Adlyxin (lixisenatide)drugId:5760 - PA	DIABETIC AGENTS
Admelog (insulin lispro-Admelog)drugId:6660 - PA	DIABETIC AGENTS
ado-trastuzumabdrugId:2781 - PA	CHEMOTHERAPY
Adrenalin (epinephrine injection)drugId:606	ADRENERGICS
AdriamycindrugId:571 # (doxorubicin)drugId:571	CHEMOTHERAPY
AdrucildrugId:875 # (fluorouracil injection)drugId:875	CHEMOTHERAPY
Advair (fluticasone / salmeterol inhalation aerosol, powder)drugId:896 - PA	BRONCHODILATORS
Advate (antihemophilic factor, recombinant-Advate)	ANTI-HEMOPHILIA AGENTS
Adynovate (antihemophilic factor, recombinant pegylated-Adynovate)	ANTI-HEMOPHILIA AGENTS
Adzenys ER (amphetamine extended-release 1.25 mg/mL oral suspension) - PA; See Table 31drugId:6600; See Table 71drugId:6601	CEREBRAL STIMULANTS
Adzenys XR-ODT (amphetamine extended-release orally disintegrating tablet) - PA; See Table 31drugId:5360; See Table 71drugId:5361	CEREBRAL STIMULANTS
Aerospan (flunisolide inhalation aerosol)drugId:2920 - PA	BRONCHODILATORS
afatinibdrugId:2843 - PA	CHEMOTHERAPY
Afinitor (everolimus-Afinitor) BP - PA; See Table 20drugId:448; See Table 57drugId:1954	CHEMOTHERAPY
Afinitor Disperz (everolimus tablets for oral suspension) - PA; See Table 20drugId:6880; See Table 57drugId:2795	CHEMOTHERAPY
aflibercept ^	OPHTHALMIC PREPARATIONS
Afluria (influenza virus vaccine-Afluria)drugId:2046 1	BIOLOGICAL
Afrezza (insulin human inhalation powder)drugId:4900 - PA	DIABETIC AGENTS
Afstyla (antihemophilic factor, recombinant, single chain-Afstyla)	ANTI-HEMOPHILIA AGENTS
agalsidase betadrugId:162 - PA	ENZYMES
Aggrenox (aspirin / extended-release dipyridamole)drugId:100 BP	ANTIPLATELET AGENT
AgrylindrugId:65 # (anagrelide)drugId:65	ANTIPLATELET AGENT
A-HydrocortdrugId:730 # (hydrocortisone injection)drugId:730	GLUCOCORTICOIDS
Aimovig (erenumab-aooe)drugId:6661 - PA	BIOLOGICAL
Airduo (fluticasone / salmeterol inhalation powder)drugId:6120 - PA	BRONCHODILATORS
Ajovy (fremanezumab-vfrm)drugId:7000 - PA	BIOLOGICAL
Akten (lidocaine ophthalmic gel)	OPHTHALMIC PREPARATIONS
Akynzeo (fosnetupitant / palonosetron injection)drugId:6620 - PA > 2 vials/28 days	ANTIEMETICS
Akynzeo (netupitant / palonosetron capsule)drugId:4761 - PA > 2 capsules/28 days	ANTIEMETICS
albendazoledrugId:166	ANTIPARASITICS
AlbenzadrugId:166 # (albendazole)drugId:166	ANTIPARASITICS
albiglutidedrugId:2946 - PA	DIABETIC AGENTS
albumin, human solutions	PLASMA PROTEINS
albuterol / ipratropium inhalation solutiondrugId:835	BRONCHODILATORS
albuterol / ipratropium inhalation spraydrugId:2557	BRONCHODILATORS
albuterol inhalation powderdrugId:5109	BRONCHODILATORS
albuterol inhalation solutiondrugId:168	BRONCHODILATORS
albuterol inhaler-Proair HFAdrugId:1 BP	BRONCHODILATORS
albuterol inhaler-ProventildrugId:2	BRONCHODILATORS
albuterol inhaler-VentolindrugId:3 - PA	BRONCHODILATORS
albuterol syrup, tabletdrugId:2193	BRONCHODILATORS
alcaftadinedrugId:2173 - PA	ANTIHISTAMINES
alclometasone cream, ointmentdrugId:4	GLUCOCORTICOIDS
AldactazidedrugId:1893 # (spironolactone / hydrochlorothiazide)drugId:1893	CARDIOVASCULAR
AldactonedrugId:1892 # (spironolactone tablet)drugId:1892	ALDOSTERONE ANTAGONISTS
Aldara (imiquimod 5% cream)drugId:783 - PA	DERMATOLOGICAL
aldesleukindrugId:2307	CHEMOTHERAPY
Aldurazyme (laronidase)drugId:1026 - PA	ENZYMES
Alecensa (alectinib)drugId:5221 - PA	CHEMOTHERAPY
alectinibdrugId:5221 - PA	CHEMOTHERAPY
alemtuzumab 12 mgdrugId:4782 ^ - PA	MULTIPLE SCLEROSIS AGENTS
alemtuzumab 30 mgdrugId:6110	CHEMOTHERAPY
alendronate / cholecalciferoldrugId:9 - PA	ELECTROLYTES AND NUTRIENTS
alendronate effervescent tabletdrugId:2638 - PA	ELECTROLYTES AND NUTRIENTS
alendronate solutiondrugId:2796 - PA	ELECTROLYTES AND NUTRIENTS
alendronate tabletdrugId:7	ELECTROLYTES AND NUTRIENTS
alfuzosin extended-releasedrugId:10	URINARY ANTISPASMODICS
alglucosidase alfadrugId:11 - PA	ENZYMES
Align (bifidobacterium infantis)drugId:6200 - PA ≥ 19 years	GASTROINTESTINAL AGENT
Alimta (pemetrexed)drugId:1492	CHEMOTHERAPY
Aliqopa (copanlisib)drugId:6500 - PA	CHEMOTHERAPY
alirocumabdrugId:5119 - PA	LIPID LOWERING AGENTS
aliskiren / hydrochlorothiazidedrugId:14 - PA	CARDIOVASCULAR
aliskirendrugId:13 BP - PA	CARDIOVASCULAR
alitretinoindrugId:16 - PA	CHEMOTHERAPY
AlkerandrugId:1138 # (melphalan hydrochloride injection)drugId:1138	CHEMOTHERAPY
AlkerandrugId:5504 # (melphalan tablet)drugId:5504	CHEMOTHERAPY
allopurinoldrugId:17	GOUT AGENTS
almotriptandrugId:18 - PA	TRIPTAN
Alocril (nedocromil)drugId:1180 - PA	OPHTHALMIC PREPARATIONS
alogliptin / metformindrugId:2782 - PA	DIABETIC AGENTS
alogliptin / pioglitazonedrugId:2783 - PA	DIABETIC AGENTS
alogliptindrugId:2784 - PA	DIABETIC AGENTS
Alomide (lodoxamide)drugId:1095 - PA	OPHTHALMIC PREPARATIONS
Alora (estradiol-Alora)	HORMONE REPLACEMENT THERAPY
alosetrondrugId:19 - PA	GASTROINTESTINAL AGENT
AloxidrugId:1473 # (palonosetron 0.25 mg/5 mL injection)drugId:1473 - PA > 2 units/28 days	ANTIEMETICS
alpelisibdrugId:7225 - PA	CHEMOTHERAPY
alpha-1-proteinase inhibitor, human-Aralast	ENZYMES
alpha-1-proteinase inhibitor, human-Aralast NP	ENZYMES
alpha-1-proteinase inhibitor, human-Glassia	ENZYMES
alpha-1-proteinase inhibitor, human-Prolastin	ENZYMES
alpha-1-proteinase inhibitor, human-Zemaira	ENZYMES
Alphagan P (brimonidine 0.1%, 0.15% eye drops)drugId:2505 BP	OPHTHALMIC PREPARATIONS
Alphanate (antihemophilic factor / von willebrand factor complex, human)	ANTI-HEMOPHILIA AGENTS
Alphanine SD (factor IX, human)	ANTI-HEMOPHILIA AGENTS
alprazolam extended-release - PA < 6 years and PA > 60 units/month; See Table 69drugId:26; See Table 71drugId:4359	BENZODIAZEPINES
alprazolam orally disintegrating tablet - PA; See Table 69drugId:24; See Table 71drugId:4357	BENZODIAZEPINES
alprazolam - PA < 6 years; See Table 69drugId:25; See Table 71drugId:4358	BENZODIAZEPINES
alprazolam powder - PA; See Table 69drugId:27; See Table 71drugId:4360	BENZODIAZEPINES
Alprolix (factor IX recombinant, Fc fusion protein)	ANTI-HEMOPHILIA AGENTS
Alrex (loteprednol 0.2%)drugId:1105 - PA	OPHTHALMIC PREPARATIONS
AltacedrugId:2588 # (ramipril)drugId:2588	CARDIOVASCULAR
Altoprev (lovastatin extended-release)drugId:1107 - PA	LIPID LOWERING AGENTS
Altreno (tretinoin 0.05% lotion)drugId:6900 - PA	DERMATOLOGICAL
aluminum carbonate *	GASTROINTESTINAL AGENT
aluminum hydroxidedrugId:28 *	ANTACIDS
Alunbrig (brigatinib)drugId:6180 - PA	CHEMOTHERAPY
Alvesco (ciclesonide)drugId:230	BRONCHODILATORS
amantadine extended-release capsuledrugId:6402 - PA	ANTIPARKINSON
amantadine extended-release tabletdrugId:7006 - PA	ANTIPARKINSON
amantadine immediate-release capsule, solution, tabletdrugId:29	ANTIPARKINSON
AmaryldrugId:931 # (glimepiride)drugId:931	DIABETIC AGENTS
Ambien # (zolpidem 10 mg tablet) - PA < 6 years and PA > 30 units/month; See Table 15drugId:1932; See Table 71drugId:4342	SEDATIVES
Ambien # (zolpidem 5 mg tablet) - PA < 6 years and PA > 45 units/month; See Table 15drugId:1933; See Table 71drugId:4344	SEDATIVES
Ambien CR # (zolpidem extended-release tablet) - PA < 6 years and PA > 30 units/month; See Table 15drugId:1934; See Table 71drugId:4345	SEDATIVES
Ambisome (amphotericin B liposome)	ANTIBIOTICS
ambrisentandrugId:30 - PA	CARDIOVASCULAR
amcinonide creamdrugId:31 - PA	GLUCOCORTICOIDS
amcinonide lotiondrugId:4916	GLUCOCORTICOIDS
amcinonide ointmentdrugId:4917 - PA	GLUCOCORTICOIDS
Ameluz (aminolevulinic acid) ^	CHEMOTHERAPY
Amerge (naratriptan)drugId:1175 - PA	TRIPTAN
Amicar (aminocaproic acid) BP	HEMATINIC AGENT
amifampridinedrugId:7041 - PA	POTASSIUM CHANNEL BLOCKER
amifostinedrugId:2670	ANTIDOTES
amikacindrugId:32	ANTIBIOTICS
amikacin liposome inhalationdrugId:7040 - PA	ANTIBIOTICS
amiloridedrugId:33	CARDIOVASCULAR
amiloride / hydrochlorothiazidedrugId:34	CARDIOVASCULAR
amino acid and electrolyte IV infusion	ELECTROLYTES AND NUTRIENTS
aminocaproic acid BP	HEMATINIC AGENT
aminolevulinic acid ^	CHEMOTHERAPY
aminophylline	BRONCHODILATORS
aminosalicylic aciddrugId:2500	TB PREPARATIONS
amiodarone	CARDIOVASCULAR
Amitiza (lubiprostone)drugId:1110 - PA	CONSTIPATION AGENTS
amitriptyline / chlordiazepoxidedrugId:40 - PA < 6 years	ANTIDEPRESSANTS
amitriptyline / perphenazine - PA < 6 years; See Table 24drugId:6320; See Table 71drugId:1512	ANTIPSYCHOTIC
amitriptyline powder - PA; See Table 17drugId:6368; See Table 71drugId:6369	ANTIDEPRESSANTS
amitriptyline tablet - PA < 6 years; See Table 17drugId:39; See Table 71drugId:4000	ANTIDEPRESSANTS
amlodipinedrugId:41	CARDIOVASCULAR
amlodipine / atorvastatin - PA; See Table 13drugId:42; See Table 18drugId:43	CARDIOVASCULAR/STATIN
amlodipine / benazeprildrugId:44	CARDIOVASCULAR
amlodipine / olmesartan / hydrochlorothiazidedrugId:1969 - PA	CARDIOVASCULAR
amlodipine / olmesartandrugId:46 - PA	CARDIOVASCULAR
amlodipine / telmisartandrugId:1661 - PA	CARDIOVASCULAR
amlodipine / valsartandrugId:48	CARDIOVASCULAR
amlodipine / valsartan / hydrochlorothiazidedrugId:50 - PA	CARDIOVASCULAR
amlodipine suspensiondrugId:7260 - PA	CARDIOVASCULAR
ammonium lactate	DERMATOLOGICAL
Ammonul # (sodium phenylacetate / sodium benzoate)	ELECTROLYTES AND NUTRIENTS
amoxapine - PA < 6 years; See Table 17drugId:56; See Table 71drugId:4001	ANTIDEPRESSANTS
amoxicillindrugId:57	ANTIBIOTICS
amoxicillin / clavulanate 125/31.25 mg/5 mL suspensiondrugId:54 - PA	ANTIBIOTICS
amoxicillin / clavulanate chewable tablet, 200/28.5, 250/62.5, 400/57, 600/42.9 mg/5 mL suspension, tabletdrugId:6420	ANTIBIOTICS
amoxicillin / clavulanate extended-releasedrugId:55 - PA	ANTIBIOTICS
amphetamine extended-release 1.25 mg/mL oral suspension - PA; See Table 31drugId:6600; See Table 71drugId:6601	CEREBRAL STIMULANTS
amphetamine extended-release 2.5 mg/mL oral suspension - PA; See Table 31drugId:5383; See Table 71drugId:5384	CEREBRAL STIMULANTS
amphetamine extended-release orally disintegrating tablet - PA; See Table 31drugId:5360; See Table 71drugId:5361	CEREBRAL STIMULANTS
amphetamine salts extended-release-Adderall XR BP PD - PA < 3 years and PA > 60 units/month; See Table 31drugId:59; See Table 71drugId:3000	CEREBRAL STIMULANTS
amphetamine salts extended-release-Mydayis - PA; See Table 31drugId:6285; See Table 71drugId:6286	CEREBRAL STIMULANTS
amphetamine salts - PA < 3 years and PA > 90 units/month; See Table 31drugId:60; See Table 71drugId:3100	CEREBRAL STIMULANTS
amphetamine sulfate orally disintegrating tablet - PA; See Table 31drugId:7235; See Table 71drugId:7236	CEREBRAL STIMULANTS
amphetamine sulfate - PA; See Table 31drugId:4901; See Table 71drugId:4920	CEREBRAL STIMULANTS
amphotericin B	ANTIBIOTICS
amphotericin B lipid complex	ANTIBIOTICS
amphotericin B liposome	ANTIBIOTICS
ampicillin; See Table 35drugId:63; See Table 66drugId:2623	ANTIBIOTICS
ampicillin / sulbactamdrugId:64	ANTIBIOTICS
Ampyra (dalfampridine)drugId:320 - PA	MULTIPLE SCLEROSIS AGENTS
Amrix (cyclobenzaprine extended-release)drugId:304 - PA	MUSCLE RELAXANT
Anadrol-50 (oxymetholone)	ANABOLIC STEROID
Anafranil (clomipramine) - PA; See Table 17drugId:272; See Table 71drugId:4002	ANTIDEPRESSANTS
anagrelidedrugId:65	ANTIPLATELET AGENT
anakinradrugId:66 - PA	IMMUNOMODULATOR
Anascorp (centruroides immune F(ab’)2, equine) ^	ANTIDOTES
anastrozoledrugId:69	CHEMOTHERAPY
AncobondrugId:861 # (flucytosine)drugId:861	ANTIBIOTICS
Androderm (testosterone patch)drugId:1682 - PA	HORMONE REPLACEMENT THERAPY
Androgel (testosterone 1.62% gel packet, pump)drugId:2280 - PA	HORMONE REPLACEMENT THERAPY
Androgel (testosterone 1% gel packet)drugId:2248 BP - PA	HORMONE REPLACEMENT THERAPY
Androxy (fluoxymesterone)	ANABOLIC STEROID
Angeliq (estradiol / drospirenone)	HORMONE REPLACEMENT THERAPY
anidulafungin	ANTIBIOTICS
Annovera (segesterone / ethinyl estradiol)	CONTRACEPTIVES
Anoro (umeclidinium / vilanterol)drugId:2952 - PA	BRONCHODILATORS
AntabusedrugId:549 # (disulfiram)drugId:549	ALCOHOL AND DRUG CESSATION AGENT
Antara (fenofibrate capsule)drugId:468	LIPID LOWERING AGENTS
antihemophilic factor, human-Humate-P	ANTI-HEMOPHILIA AGENTS
antihemophilic factor, human-Koate-DVI	ANTI-HEMOPHILIA AGENTS
antihemophilic factor, human-Monoclate-P	ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant, porcine sequence-Obizur	ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant, single chain-Afstyla	ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant-Advate	ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant-Helixate	ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant-Hemofil-M	ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant-Kogenate	ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant-Kovaltry	ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant-Novoeight	ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant-Nuwiq	ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant pegylated-Adynovate	ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant pegylated-aucl-Jivi	ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant-Recombinate	ANTI-HEMOPHILIA AGENTS
antihemophilic factor, recombinant-Xyntha	ANTI-HEMOPHILIA AGENTS
antihemophilic factor / von willebrand factor complex, human	ANTI-HEMOPHILIA AGENTS
anti-inhibitor coagulant complex-Feiba NF	ANTI-HEMOPHILIA AGENTS
anti-inhibitor coagulant complex-Feiba VH	ANTI-HEMOPHILIA AGENTS
antithymocyte globulin, equinedrugId:1112	BIOLOGICAL
antithymocyte globulin, rabbitdrugId:1111	BIOLOGICAL
Anusol-HCdrugId:740 # (hydrocortisone hemorrhoidal cream)drugId:740	GLUCOCORTICOIDS
Anzemet (dolasetron injection)drugId:558	ANTIEMETICS
Anzemet (dolasetron tablet)drugId:557 - PA	ANTIEMETICS
Apadaz (benzhydrocodone / acetaminophen)drugId:7234 - PA	OPIOID ANALGESICS
apalutamidedrugId:6682 - PA	CHEMOTHERAPY
Apexicon-E (diflorasone cream / emollient)drugId:520 - PA	GLUCOCORTICOIDS
Apidra (insulin glulisine)drugId:810	DIABETIC AGENTS
apixabandrugId:2721 - PA	ANTICOAGULANTS
Aplenzin (bupropion hydrobromide extended-release) - PA; See Table 17drugId:395; See Table 71drugId:3640	ANTIDEPRESSANTS
Apokyn (apomorphine)drugId:83	ANTIPARKINSON
apomorphinedrugId:83	ANTIPARKINSON
apraclonidinedrugId:84	OPHTHALMIC PREPARATIONS
apremilastdrugId:2941 - PA	IMMUNOMODULATOR
aprepitant 125 mg powder for oral suspensiondrugId:5726 - PA > 6 units/28 days	ANTIEMETICS
aprepitant 40 mg and 125 mg capsuledrugId:86 - PA > 2 capsules/28 days	ANTIEMETICS
aprepitant 80 mgdrugId:85 - PA > 4 capsules/28 days	ANTIEMETICS
aprepitant injectable emulsiondrugId:6604	ANTIEMETICS
aprepitant trifold packdrugId:87 BP - PA > 2 packs/28 days	ANTIEMETICS
Apriso (mesalamine extended-release)drugId:1150 BP	GI ANTI-INFLAMMATORY
Aptensio XR (methylphenidate extended-release-Aptensio XR) - PA; See Table 31drugId:5100; See Table 71drugId:5101	CEREBRAL STIMULANTS
Aptiom (eslicarbazepine) - PA; See Table 20drugId:2953; See Table 71drugId:3380	ANTICONVULSANTS
Aptivus (tipranavir)drugId:1709	ANTIVIRALS
Aquadeks (multivitamins / minerals / coenzyme Q10-Aquadeks)drugId:2380 - PA	HEMATINIC AGENT
Aquadeks (multivitamins / minerals / folic acid / coenzyme Q10-Aquadeks)drugId:2385 - PA	HEMATINIC AGENT
Aralast (alpha-1-proteinase inhibitor, human-Aralast)	ENZYMES
Aralast NP (alpha-1-proteinase inhibitor, human-Aralast NP)	ENZYMES
Aranesp (darbepoetin alfa)drugId:327 - PA	HEMATINIC AGENT
Arava # (leflunomide)	IMMUNOMODULATOR
Arcalyst (rilonacept)drugId:1434 - PA	BIOLOGICAL
Arcapta (indacaterol)drugId:2357 - PA	BRONCHODILATORS
ArediadrugId:1474 # (pamidronate)drugId:1474	ELECTROLYTES AND NUTRIENTS
arformoteroldrugId:88 - PA	BRONCHODILATORS
Aricept (donepezil 23 mg tablet)drugId:2247 - PA	ALZHEIMER'S THERAPY
AriceptdrugId:2422 # (donepezil 10 mg tablet)drugId:2422 - PA < 18 years and PA > 60 units/month	ALZHEIMER'S THERAPY
AriceptdrugId:559 # (donepezil 5 mg tablet)drugId:559 - PA < 18 years and PA > 30 units/month	ALZHEIMER'S THERAPY
Arikayce (amikacin liposome inhalation)drugId:7040 - PA	ANTIBIOTICS
ArimidexdrugId:69 # (anastrozole)drugId:69	CHEMOTHERAPY
aripiprazole extended-release injection - PA; See Table 24drugId:2717; See Table 71drugId:4200	ANTIPSYCHOTIC
aripiprazole lauroxil 1,064 mg PD - PA < 6 years and PA > 1 injection/2 months; See Table 24drugId:6300; See Table 71drugId:6301	ANTIPSYCHOTIC
aripiprazole lauroxil 441 mg, 662 mg, 882 mg PD - PA < 6 years and PA > 1 injection/month; See Table 24drugId:5240; See Table 71drugId:5241	ANTIPSYCHOTIC
aripiprazole lauroxil 675 mg PD - PA < 6 years and PA > 1 injection/month; See Table 24drugId:6861; See Table 71drugId:6860	ANTIPSYCHOTIC
aripiprazole orally disintegrating tablet - PA; See Table 24drugId:92; See Table 71drugId:4220	ANTIPSYCHOTIC
aripiprazole solution - PA < 6 years or ≥ 18 years and PA > 750 mL/month; See Table 24drugId:91; See Table 71drugId:4240	ANTIPSYCHOTIC
aripiprazole tablet - PA < 6 years and PA > 30 units/month; See Table 24drugId:90; See Table 71drugId:4180	ANTIPSYCHOTIC
aripiprazole tablet with sensor - PA; See Table 24drugId:7230; See Table 71drugId:7231	ANTIPSYCHOTIC
Aristada (aripiprazole lauroxil 1,064 mg) PD - PA < 6 years and PA > 1 injection/2 months; See Table 24drugId:6300; See Table 71drugId:6301	ANTIPSYCHOTIC
Aristada (aripiprazole lauroxil 441 mg, 662 mg, 882 mg) PD - PA < 6 years and PA > 1 injection/month; See Table 24drugId:5240; See Table 71drugId:5241	ANTIPSYCHOTIC
Aristada Initio (aripiprazole lauroxil 675 mg) PD - PA < 6 years and PA > 1 injection/month; See Table 24drugId:6861; See Table 71drugId:6860	ANTIPSYCHOTIC
Aristospan (triamcinolone injection)drugId:1750	GLUCOCORTICOIDS
ArixtradrugId:904 # (fondaparinux)drugId:904	ANTICOAGULANTS
armodafinildrugId:94 - PA	NARCOLEPSY AGENTS
Armonair (fluticasone propionate inhalation powder-Armonair)drugId:6340 - PA	BRONCHODILATORS
Arnuity (fluticasone furoate inhalation powder)drugId:4760 - PA	BRONCHODILATORS
AromasindrugId:450 # (exemestane)drugId:450	CHEMOTHERAPY
Arranon (nelarabine)drugId:1182 - PA	CHEMOTHERAPY
arsenic trioxidedrugId:2697	CHEMOTHERAPY
artemether / lumefantrinedrugId:95 - PA > 24 units/365 days	ANTIMALARIALS
ArthrotecdrugId:514 # (diclofenac / misoprostol)drugId:514 - PA < 60 years	NONSTEROIDAL ANTI-INFLAMMATORY
Artificial Tears (glycerin / propylene glycol)drugId:678 *	OPHTHALMIC PREPARATIONS
Arymo ER (morphine extended-release tablet-Arymo ER)drugId:6040 - PA	OPIOID ANALGESICS
Arzerra (ofatumumab)drugId:1270 - PA	CHEMOTHERAPY
Asacol HD (mesalamine high dose delayed-release)drugId:1152 BP	GI ANTI-INFLAMMATORY
Asceniv (immune globulin IV, human-slra)drugId:7327 - PA	BIOLOGICAL
Asclera (polidocanol)drugId:2934 ^ - PA	CARDIOVASCULAR
ascorbic aciddrugId:96 *	ELECTROLYTES AND NUTRIENTS
ascorbic acid powderdrugId:7339 - PA	ELECTROLYTES AND NUTRIENTS
asenapine - PA; See Table 24drugId:97; See Table 71drugId:4260	ANTIPSYCHOTIC
asfotase alfadrugId:5300 - PA	ENZYMES
Asmanex HFA (mometasone inhalation aerosol)drugId:5102	BRONCHODILATORS
Asmanex Twisthaler (mometasone 110 mcg inhalation powder)drugId:2663 - PA ≥ 12 years	BRONCHODILATORS
Asmanex Twisthaler (mometasone 220 mcg inhalation powder)drugId:1379 - PA < 12 years	BRONCHODILATORS
asparaginase erwinia chrysanthemidrugId:2420 ^ - PA	CHEMOTHERAPY
Asparlas (calaspargase pegol-mknl)drugId:7328 ^ - PA	CHEMOTHERAPY
aspirin / extended-release dipyridamoledrugId:100 BP	ANTIPLATELET AGENT
aspirin *	ANALGESICS
aspirin with buffers *	ANALGESICS
Astagraf XL (tacrolimus extended-release capsule)drugId:2838	IMMUNOMODULATOR
Astepro (azelastine 0.15% nasal spray)drugId:116 - PA	NASAL PREPARATIONS
Astramorph-PF (morphine, injection-Astramorph-PF)drugId:1391 - PA > 120 mg/day	OPIOID ANALGESICS
Atacand (candesartan)drugId:433 - PA	CARDIOVASCULAR
Atacand HCT (candesartan / hydrochlorothiazide)drugId:434 - PA	CARDIOVASCULAR
atazanavirdrugId:101	ANTIVIRALS
atazanavir / cobicistatdrugId:4768	ANTIVIRALS
Atelvia (risedronate delayed-release)drugId:2101 - PA	ELECTROLYTES AND NUTRIENTS
atenololdrugId:102	CARDIOVASCULAR
atenolol / chlorthalidonedrugId:103	CARDIOVASCULAR
atezolizumabdrugId:5593 - PA	CHEMOTHERAPY
Atgam (antithymocyte globulin, equine)drugId:1112	BIOLOGICAL
Ativan # (lorazepam solution, tablet) - PA < 6 years; See Table 69drugId:1100; See Table 71drugId:4400	BENZODIAZEPINES
atomoxetine - PA < 6 years; See Table 31drugId:104; See Table 71drugId:3080	NONSTIMULANT ADHD AGENTS
atorvastatin 10 mg, 20 mg, 40 mgdrugId:105 - PA > 45 units/month	LIPID LOWERING AGENTS
atorvastatin 80 mgdrugId:2933 - PA > 30 units/month	LIPID LOWERING AGENTS
atovaquonedrugId:106	ANTIPARASITICS
atovaquone / proguanil	ANTIMALARIALS
Atralin (tretinoin 0.05% gel)drugId:2432 - PA	DERMATOLOGICAL
Atripla (efavirenz / emtricitabine / tenofovir)drugId:591	ANTIVIRALS
atropine injection	ANTISPASMODICS,ANTICHOLINERGIC
atropine ophthalmic	OPHTHALMIC PREPARATIONS
Atrovent # (ipratropium nasal spray)	NASAL PREPARATIONS
Atrovent HFA (ipratropium inhalation aerosol)drugId:833	BRONCHODILATORS
Aubagio (teriflunomide)drugId:2657 - PA	MULTIPLE SCLEROSIS AGENTS
Augmentin (amoxicillin / clavulanate 125/31.25 mg/5 mL suspension)drugId:54 - PA	ANTIBIOTICS
AugmentindrugId:6420 # (amoxicillin / clavulanate chewable tablet, 200/28.5, 250/62.5, 400/57, 600/42.9 mg/5 mL suspension, tablet)drugId:6420	ANTIBIOTICS
Augmentin XR (amoxicillin / clavulanate extended-release)drugId:55 - PA	ANTIBIOTICS
auranofin	IMMUNOMODULATOR
Auryxia (ferric citrate)	ELECTROLYTES AND NUTRIENTS
Austedo (deutetrabenazine)drugId:6121 - PA	NEUROLOGIC AGENT
AvalidedrugId:969 # (irbesartan / hydrochlorothiazide)drugId:969	CARDIOVASCULAR
Avandia (rosiglitazone)drugId:1456 - PA	DIABETIC AGENTS
AvaprodrugId:968 # (irbesartan)drugId:968	CARDIOVASCULAR
Avastin (bevacizumab)drugId:360 - PA	CHEMOTHERAPY
avatrombopagdrugId:6990 - PA	HEMATOLOGIC
AVC (sulfanilamide)drugId:1909	ANTIBIOTICS
Aveed (testosterone undecanoate)drugId:2954 ^ - PA	HORMONE REPLACEMENT THERAPY
Avelox (moxifloxacin injection)drugId:2748	ANTIBIOTICS
Avelox (moxifloxacin tablet)drugId:1398 - PA	ANTIBIOTICS
avelumabdrugId:6100 - PA	CHEMOTHERAPY
AvitadrugId:1747 # (tretinoin-Avita)drugId:1747 - PA ≥ 22 years	DERMATOLOGICAL
Avodart (dutasteride)drugId:586 - PA	BENIGN PROSTATIC HYPERPLASIA AGENTS
Avonex (interferon beta-1a-Avonex)drugId:825	MULTIPLE SCLEROSIS AGENTS
Avycaz (ceftazidime / avibactam)drugId:4902 - PA	ANTIBIOTICS
Axert (almotriptan)drugId:18 - PA	TRIPTAN
axicabtagene ciloleuceldrugId:6414 CO ^ - PA	CHEMOTHERAPY
Axiron (testosterone 2% solution)drugId:2237 - PA	HORMONE REPLACEMENT THERAPY
axitinibdrugId:2484 - PA	CHEMOTHERAPY
Aygestin (norethindrone 5 mg)	HORMONE REPLACEMENT THERAPY
azacitidinedrugId:110	CHEMOTHERAPY
AzactamdrugId:120 # (aztreonam injection)drugId:120	ANTIBIOTICS
Azasite (azithromycin ophthalmic solution)drugId:119 BP - PA	OPHTHALMIC PREPARATIONS
azathioprine 50 mg tabletdrugId:111	IMMUNOMODULATOR
azathioprine 75 mg, 100 mg tabletdrugId:2857 - PA	IMMUNOMODULATOR
azathioprine injectiondrugId:5501	IMMUNOMODULATOR
Azedra (iobenguane I 131)drugId:6980 ^	CHEMOTHERAPY
azelaic acid creamdrugId:112 - PA	DERMATOLOGICAL
azelaic acid foamdrugId:5106 - PA	DERMATOLOGICAL
azelaic acid geldrugId:113 BP - PA	DERMATOLOGICAL
azelastine / fluticasone propionatedrugId:2580	NASAL PREPARATIONS
azelastine 0.15% nasal spraydrugId:116 - PA	NASAL PREPARATIONS
azelastine 137 mcg nasal spraydrugId:115	NASAL PREPARATIONS
azelastine ophthalmic solutiondrugId:114	ANTIHISTAMINES
Azelex (azelaic acid cream)drugId:112 - PA	DERMATOLOGICAL
Azilect (rasagiline)drugId:1640 - PA	ANTIPARKINSON
azilsartan / chlorthalidonedrugId:2480 - PA	CARDIOVASCULAR
azilsartandrugId:2240 - PA	CARDIOVASCULAR
azithromycin; See Table 35drugId:117; See Table 66drugId:2622	ANTIBIOTICS
azithromycin ophthalmic solutiondrugId:119 BP - PA	OPHTHALMIC PREPARATIONS
Azopt (brinzolamide)drugId:375 - PA	OPHTHALMIC PREPARATIONS
Azor (amlodipine / olmesartan)drugId:46 - PA	CARDIOVASCULAR
aztreonam	ANTIBIOTICS
aztreonam injectiondrugId:120	ANTIBIOTICS
AzulfidinedrugId:1910 # (sulfasalazine)drugId:1910	GI ANTI-INFLAMMATORY
Azulfidine EN-TabsdrugId:4864 # (sulfasalazine delayed-release)drugId:4864	GI ANTI-INFLAMMATORY

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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 02/24/20