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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
abacavirdrugId:137 ANTIVIRALS #
abacavir / dolutegravir / lamivudinedrugId:4642 ANTIVIRALS PD
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); See Table 24drugId:90; See Table 71drugId:4180 PA < 6 years and PA > 30 units/month ANTIPSYCHOTIC #
Abilify Maintena (aripiprazole extended-release injection); See Table 24drugId:2717; See Table 71drugId:4200 PA ANTIPSYCHOTIC
Abilify Mycite (aripiprazole tablet with sensor); See Table 24drugId:7230; See Table 71drugId:7231 PA 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
Absorica LD (isotretinoin micronized)drugId:7368 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 / 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 BIOLOGICAL 1
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 OPHTHALMIC PREPARATIONS
acyclovir / hydrocortisonedrugId:1973 DERMATOLOGICAL
acyclovir buccal tabletdrugId:2945 PA ANTIVIRALS
acyclovir capsule, suspension, tabletdrugId:155 ANTIVIRALS #
acyclovir cream, ointmentdrugId:157 ANTIVIRALS BP
acyclovir injectiondrugId:2744 ANTIVIRALS
Aczone (dapsone 5% gel)drugId:325 PA DERMATOLOGICAL
Aczone (dapsone 7.5% gel)drugId:7306 PA DERMATOLOGICAL BP
Adacel (diphtheria / tetanus toxoids / acellular pertussis vaccine)drugId:539 BIOLOGICAL 1
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 PA IMMUNOMODULATOR PD
adapalene / benzoyl peroxidedrugId:160 PA DERMATOLOGICAL
adapalenedrugId:159 PA DERMATOLOGICAL BP
Adcetris (brentuximab)drugId:2374 PA CHEMOTHERAPY
Adcirca (tadalafil-Adcirca)drugId:1920 PA CARDIOVASCULAR
Adderall (amphetamine salts); See Table 31drugId:60; See Table 71drugId:3100 PA < 3 years and PA > 90 units/month CEREBRAL STIMULANTS #
Adderall XR (amphetamine salts extended-release-Adderall XR); See Table 31drugId:59; See Table 71drugId:3000 PA < 3 years and PA > 60 units/month CEREBRAL STIMULANTS BP PD
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); See Table 31drugId:7232; See Table 71drugId:7233 PA 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)drugId:897 PA BRONCHODILATORS
Advair (fluticasone / salmeterol inhalation powder-Advair)drugId:896 PA BRONCHODILATORS BP
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); See Table 31drugId:6600; See Table 71drugId:6601 PA CEREBRAL STIMULANTS
Adzenys XR-ODT (amphetamine extended-release orally disintegrating tablet); See Table 31drugId:5360; See Table 71drugId:5361 PA CEREBRAL STIMULANTS
afatinibdrugId:2843 PA CHEMOTHERAPY
Afinitor (everolimus 2.5 mg, 5 mg, 7.5 mg, 10 mg); See Table 20drugId:448; See Table 57drugId:1954 PA CHEMOTHERAPY BP
Afinitor Disperz (everolimus tablets for oral suspension); See Table 20drugId:6880; See Table 57drugId:2795 PA CHEMOTHERAPY
aflibercept OPHTHALMIC PREPARATIONS ^
Afluria (influenza virus vaccine-Afluria)drugId:2046 BIOLOGICAL 1
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 ANTIPLATELET AGENT BP
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-Airduo)drugId:6120 PA BRONCHODILATORS
Ajovy (fremanezumab-vfrm for migraine prophylaxis)drugId:7000 PA BIOLOGICAL PD
Aklief (trifarotene)drugId:7369 PA DERMATOLOGICAL
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 powder-Proair DigihalerdrugId:7352 PA BRONCHODILATORS
albuterol inhalation powder-Proair RespiclickdrugId:5109 BRONCHODILATORS
albuterol inhalation solutiondrugId:168 BRONCHODILATORS #
albuterol inhaler-Proair HFAdrugId:1 BRONCHODILATORS BP
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 PA CARDIOVASCULAR BP
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 OPHTHALMIC PREPARATIONS BP
Alphanate (antihemophilic factor / von willebrand factor complex, human) ANTI-HEMOPHILIA AGENTS
Alphanine SD (factor IX, human) ANTI-HEMOPHILIA AGENTS
alprazolam extended-release; See Table 69drugId:26; See Table 71drugId:4359 PA < 6 years and PA > 60 units/month BENZODIAZEPINES #
alprazolam orally disintegrating tablet; See Table 69drugId:24; See Table 71drugId:4357 PA BENZODIAZEPINES
alprazolam; See Table 69drugId:25; See Table 71drugId:4358 PA < 6 years BENZODIAZEPINES #
alprazolam powder; See Table 69drugId:27; See Table 71drugId:4360 PA 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 inhaler)drugId:230 PA 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); See Table 15drugId:1932; See Table 71drugId:4342 PA < 6 years and PA > 30 units/month SEDATIVES #
Ambien (zolpidem 5 mg tablet); See Table 15drugId:1933; See Table 71drugId:4344 PA < 6 years and PA > 45 units/month SEDATIVES #
Ambien CR (zolpidem extended-release tablet); See Table 15drugId:1934; See Table 71drugId:4345 PA < 6 years and PA > 30 units/month 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) HEMATINIC AGENT BP
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 HEMATINIC AGENT BP
aminolevulinic acid CHEMOTHERAPY ^
aminophylline BRONCHODILATORS
aminosalicylic aciddrugId:2500 TB PREPARATIONS
amiodarone CARDIOVASCULAR #
Amitiza (lubiprostone)drugId:1110 PA CONSTIPATION AGENTS
amitriptyline / chlordiazepoxide; See Table 69drugId:7366; See Table 71drugId:40 PA < 6 years ANTIDEPRESSANTS
amitriptyline / perphenazine; See Table 24drugId:6320; See Table 71drugId:1512 PA < 6 years ANTIPSYCHOTIC
amitriptyline powder; See Table 17drugId:6368; See Table 71drugId:6369 PA ANTIDEPRESSANTS
amitriptyline tablet; See Table 17drugId:39; See Table 71drugId:4000 PA < 6 years ANTIDEPRESSANTS
amlodipinedrugId:41 CARDIOVASCULAR #
amlodipine / atorvastatin; See Table 13drugId:42; See Table 18drugId:43 PA 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; See Table 17drugId:56; See Table 71drugId:4001 PA < 6 years 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; See Table 31drugId:6600; See Table 71drugId:6601 PA CEREBRAL STIMULANTS
amphetamine extended-release 2.5 mg/mL oral suspension; See Table 31drugId:5383; See Table 71drugId:5384 PA CEREBRAL STIMULANTS
amphetamine extended-release orally disintegrating tablet; See Table 31drugId:5360; See Table 71drugId:5361 PA CEREBRAL STIMULANTS
amphetamine salts extended-release-Adderall XR; See Table 31drugId:59; See Table 71drugId:3000 PA < 3 years and PA > 60 units/month CEREBRAL STIMULANTS BP PD
amphetamine salts extended-release-Mydayis; See Table 31drugId:6285; See Table 71drugId:6286 PA CEREBRAL STIMULANTS
amphetamine salts; See Table 31drugId:60; See Table 71drugId:3100 PA < 3 years and PA > 90 units/month CEREBRAL STIMULANTS #
amphetamine sulfate orally disintegrating tablet; See Table 31drugId:7235; See Table 71drugId:7236 PA CEREBRAL STIMULANTS
amphetamine sulfate; See Table 31drugId:4901; See Table 71drugId:4920 PA 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
Amzeeq (minocycline foam)drugId:7344 PA ANTIBIOTICS
Anadrol-50 (oxymetholone) ANABOLIC STEROID
Anafranil (clomipramine); See Table 17drugId:272; See Table 71drugId:4002 PA 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 PA HORMONE REPLACEMENT THERAPY BP
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 PD
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 ANTICOAGULANTS PD
Aplenzin (bupropion hydrobromide extended-release); See Table 17drugId:395; See Table 71drugId:3640 PA < 6 years and PA > 30 units/month 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 PA > 2 packs/28 days ANTIEMETICS BP
Apriso (mesalamine extended-release)drugId:1150 GI ANTI-INFLAMMATORY BP
Aptensio XR (methylphenidate extended-release-Aptensio XR); See Table 31drugId:5100; See Table 71drugId:5101 PA CEREBRAL STIMULANTS
Aptiom (eslicarbazepine); See Table 20drugId:2953; See Table 71drugId:3380 PA 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; See Table 24drugId:2717; See Table 71drugId:4200 PA ANTIPSYCHOTIC
aripiprazole lauroxil 1,064 mg; See Table 24drugId:6300; See Table 71drugId:6301 PA < 6 years and PA > 1 injection/2 months ANTIPSYCHOTIC PD
aripiprazole lauroxil 441 mg, 662 mg, 882 mg; See Table 24drugId:5240; See Table 71drugId:5241 PA < 6 years and PA > 1 injection/month ANTIPSYCHOTIC PD
aripiprazole lauroxil 675 mg; See Table 24drugId:6861; See Table 71drugId:6860 PA < 6 years and PA > 1 injection/month ANTIPSYCHOTIC PD
aripiprazole orally disintegrating tablet; See Table 24drugId:92; See Table 71drugId:4220 PA ANTIPSYCHOTIC
aripiprazole solution; See Table 24drugId:91; See Table 71drugId:4240 PA < 6 years or ≥ 18 years and PA > 750 mL/month ANTIPSYCHOTIC
aripiprazole tablet; See Table 24drugId:90; See Table 71drugId:4180 PA < 6 years and PA > 30 units/month ANTIPSYCHOTIC #
aripiprazole tablet with sensor; See Table 24drugId:7230; See Table 71drugId:7231 PA ANTIPSYCHOTIC
Aristada (aripiprazole lauroxil 1,064 mg); See Table 24drugId:6300; See Table 71drugId:6301 PA < 6 years and PA > 1 injection/2 months ANTIPSYCHOTIC PD
Aristada (aripiprazole lauroxil 441 mg, 662 mg, 882 mg); See Table 24drugId:5240; See Table 71drugId:5241 PA < 6 years and PA > 1 injection/month ANTIPSYCHOTIC PD
Aristada Initio (aripiprazole lauroxil 675 mg); See Table 24drugId:6861; See Table 71drugId:6860 PA < 6 years and PA > 1 injection/month ANTIPSYCHOTIC PD
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 GI ANTI-INFLAMMATORY BP
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 sublingual tablet; See Table 24drugId:97; See Table 71drugId:4260 PA ANTIPSYCHOTIC
asenapine transdermal; See Table 24drugId:7354; See Table 71drugId:7355 PA 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 ANTIPLATELET AGENT BP
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); See Table 69drugId:1100; See Table 71drugId:4400 PA < 6 years BENZODIAZEPINES #
atomoxetine; See Table 31drugId:104; See Table 71drugId:3080 PA < 6 years 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
avapritinibdrugId:7360 PA CHEMOTHERAPY
AvaprodrugId:968 (irbesartan)drugId:968 CARDIOVASCULAR #
Avastin (bevacizumab)drugId:360 PA CHEMOTHERAPY
avatrombopagdrugId:6990 PA HEMATOLOGIC
AVC (sulfanilamide)drugId:1909 ANTIBIOTICS
Aveed (testosterone undecanoate injection)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
axicabtagene ciloleuceldrugId:6414 PA CHEMOTHERAPY CO ^
axitinibdrugId:2484 PA CHEMOTHERAPY PD
Aygestin (norethindrone 5 mg) HORMONE REPLACEMENT THERAPY
Ayvakit (avapritinib)drugId:7360 PA CHEMOTHERAPY
azacitidinedrugId:110 CHEMOTHERAPY #
AzactamdrugId:120 (aztreonam injection)drugId:120 ANTIBIOTICS #
Azasite (azithromycin ophthalmic solution)drugId:119 PA OPHTHALMIC PREPARATIONS BP
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 foamdrugId:5106 PA DERMATOLOGICAL
azelaic acid geldrugId:113 PA DERMATOLOGICAL BP
azelastine / fluticasone propionatedrugId:2580 NASAL PREPARATIONS BP
azelastine 0.15% nasal spraydrugId:116 PA NASAL PREPARATIONS
azelastine 137 mcg nasal spraydrugId:115 NASAL PREPARATIONS
azelastine ophthalmic solutiondrugId:114 ANTIHISTAMINES
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 PA OPHTHALMIC PREPARATIONS BP
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 #

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


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Last updated 08/03/20

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