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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
D.H.E. 45 (dihydroergotamine injection)drugId:526 PA ANALGESICS
dabigatran etexilate mesylate 110 mgdrugId:5286 PA > 70 capsules/365 days ANTICOAGULANTS
dabigatran etexilate mesylate 75 mg, 150 mgdrugId:2081 PA ANTICOAGULANTS
dabrafenibdrugId:2823 PA CHEMOTHERAPY
dacarbazinedrugId:319 CHEMOTHERAPY
DacogendrugId:332 (decitabine)drugId:332 CHEMOTHERAPY #
dacomitinibdrugId:7048 PA CHEMOTHERAPY
dactinomycindrugId:2674 CHEMOTHERAPY #
dalbavancindrugId:4623 PA ANTIBIOTICS
dalfampridinedrugId:320 PA MULTIPLE SCLEROSIS AGENTS
dalfopristin / quinupristindrugId:2037 PA ANTIBIOTICS
Daliresp (roflumilast)drugId:2282 PA IMMUNOMODULATOR
dalteparindrugId:321 ANTICOAGULANTS
Dalvance (dalbavancin)drugId:4623 PA ANTIBIOTICS
danazol HORMONE AGENTS
Dantrium (dantrolene injection solution)drugId:4645 MUSCLE RELAXANT ^
DantriumdrugId:323 (dantrolene capsule)drugId:323 MUSCLE RELAXANT #
dantrolene capsuledrugId:323 MUSCLE RELAXANT #
dantrolene injection solutiondrugId:4645 MUSCLE RELAXANT ^
dantrolene injection suspensiondrugId:4634 MUSCLE RELAXANT ^
dapagliflozindrugId:2923 DIABETIC AGENTS
dapagliflozin / metformin extended-releasedrugId:4841 DIABETIC AGENTS
dapagliflozin / saxagliptindrugId:6406 PA DIABETIC AGENTS
dapsone geldrugId:325 PA DERMATOLOGICAL
dapsone tabletdrugId:324 ANTIBIOTICS
Daptacel (diphtheria / tetanus toxoids / acellular pertussis vaccine)drugId:536 BIOLOGICAL 1
daptomycindrugId:326 PA ANTIBIOTICS
Daraprim (pyrimethamine)drugId:1614 PA ANTIMALARIALS BP
daratumumab / hyaluronidase-fihjdrugId:7387 PA CHEMOTHERAPY
daratumumabdrugId:5244 PA CHEMOTHERAPY
darbepoetin alfadrugId:327 PA HEMATINIC AGENT
darifenacindrugId:328 PA URINARY ANTISPASMODICS
darolutamidedrugId:7289 PA CHEMOTHERAPY
darunavir / cobicistat / emtricitabine / tenofovir alafenamidedrugId:6822 ANTIVIRALS PD
darunavir / cobicistatdrugId:4792 ANTIVIRALS PD
darunavirdrugId:330 ANTIVIRALS PD
Darzalex (daratumumab)drugId:5244 PA CHEMOTHERAPY
Darzalex Faspro (daratumumab / hyaluronidase-fihj)drugId:7387 PA CHEMOTHERAPY
dasatinibdrugId:331 CHEMOTHERAPY
daunorubicin, conventionaldrugId:2676 CHEMOTHERAPY
daunorubicin / cytarabinedrugId:6412 PA CHEMOTHERAPY
Daurismo (glasdegib)drugId:7100 PA CHEMOTHERAPY
DayprodrugId:1309 (oxaprozin)drugId:1309 NONSTEROIDAL ANTI-INFLAMMATORY #
Daytrana (methylphenidate transdermal); See Table 31drugId:955; See Table 71drugId:3060 PA CEREBRAL STIMULANTS
Dayvigo (lemborexant); See Table 15drugId:7388; See Table 71drugId:7389 PA SEDATIVE NON-BARBITURATE
DDAVPdrugId:476 (desmopressin-DDAVP)drugId:476 HORMONE AGENTS #
DecadrondrugId:2491 (dexamethasone solution, tablet)drugId:2491 GLUCOCORTICOIDS #
decitabinedrugId:332 CHEMOTHERAPY #
deferasirox 125 mg, 250 mg, 500 mgdrugId:333 ANTIDOTES BP
deferasirox 90 mg, 180 mg, 360 mgdrugId:4942 ANTIDOTES #
deferipronedrugId:2483 PA ANTIDOTES
deferoxaminedrugId:334 CHELATING AGENT #
deflazacortdrugId:6720 PA GLUCOCORTICOIDS
degarelixdrugId:335 PA CHEMOTHERAPY
Dekas Bariatric (multivitamins / minerals / folic acid / coenzyme Q10-Dekas Bariatric)drugId:6605 PA ELECTROLYTES AND NUTRIENTS
Dekas Essential (multivitamin-Dekas Essential)drugId:5623 PA HEMATINIC AGENT
Dekas Plus (multivitamins / minerals / coenzyme Q10-Dekas Plus)drugId:5621 PA HEMATINIC AGENT
Dekas Plus (multivitamins / minerals / folic acid / coenzyme Q10-Dekas Plus)drugId:5622 PA HEMATINIC AGENT
delafloxacin injectiondrugId:6480 PA ANTIBIOTICS
delafloxacin tabletdrugId:6481 PA ANTIBIOTICS
delavirdinedrugId:336 ANTIVIRALS
Delestrogen (estradiol-Delestrogen) HORMONE REPLACEMENT THERAPY #
Delstrigo (doravirine / lamivudine / tenofovir disoproxil fumarate)drugId:6981 ANTIVIRALS PD
Delzicol DRdrugId:2720 (mesalamine capsule)drugId:2720 GI ANTI-INFLAMMATORY #
DemadexdrugId:1732 (torsemide)drugId:1732 CARDIOVASCULAR #
demeclocyclinedrugId:337 ANTIBIOTICS
Demerol (meperidine)drugId:1144 PA OPIOID ANALGESICS
Demser (metyrosine) CARDIOVASCULAR BP
Denavir (penciclovir)drugId:1495 PA ANTIVIRALS
denosumab-ProliadrugId:1967 PA BIOLOGICAL
denosumab-XgevadrugId:2180 PA BIOLOGICAL
DepacondrugId:1780 (valproate)drugId:1780 ANTICONVULSANTS #
Depakene (valproic acid); See Table 20drugId:1782; See Table 71drugId:4506 PA < 6 years ANTICONVULSANTS #
Depakote (divalproex immediate-release); See Table 20drugId:552; See Table 71drugId:3320 PA < 6 years ANTICONVULSANTS #
Depakote (divalproex sprinkle capsule); See Table 20drugId:2315; See Table 71drugId:3360 PA < 6 years ANTICONVULSANTS #
Depakote ER (divalproex extended-release); See Table 20drugId:550; See Table 71drugId:3340 PA < 6 years ANTICONVULSANTS #
Depen (penicillamine tablet) CHELATING AGENT #
Depo-estradiol (estradiol-Depo-estradiol) HORMONE REPLACEMENT THERAPY
Depo-MedroldrugId:966 (methylprednisolone acetate)drugId:966 GLUCOCORTICOIDS #
Depo-Provera (medroxyprogesterone vial) CONTRACEPTIVES #
Depo-SubQ Provera 104 (medroxyprogesterone syringe) CONTRACEPTIVES
Depo-Testosterone (testosterone cypionate)drugId:1680 PA HORMONE REPLACEMENT THERAPY
Derma-Smoothe-FSdrugId:867 (fluocinolone body oil, scalp oil)drugId:867 GLUCOCORTICOIDS #
DermatopdrugId:1574 (prednicarbate cream, ointment)drugId:1574 GLUCOCORTICOIDS #
Dermotic (fluocinolone oil, otic drops) OTIC PREPARATIONS #
Descovy (emtricitabine / tenofovir alafenamide)drugId:5381 ANTIVIRALS PD
DesferaldrugId:334 (deferoxamine)drugId:334 CHELATING AGENT #
desipramine; See Table 17drugId:2620; See Table 71drugId:4020 PA ANTIDEPRESSANTS
desirudindrugId:2989 PA ANTICOAGULANTS
desloratadine / pseudoephedrinedrugId:474 PA ANTIHISTAMINES
desloratadine orally disintegrating tabletdrugId:2749 PA ANTIHISTAMINES
desloratadine syrup, tabletdrugId:339 ANTIHISTAMINES #
desmopressin-DDAVPdrugId:476 HORMONE AGENTS #
desmopressin-NocdurnadrugId:6984 PA HORMONE AGENTS
desmopressin-NoctivadrugId:6612 PA HORMONE AGENTS
desmopressin-Stimate HORMONE AGENTS
Desonate (desonide gel)drugId:485 PA GLUCOCORTICOIDS
desonide creamdrugId:484 GLUCOCORTICOIDS #
desonide geldrugId:485 PA GLUCOCORTICOIDS
desonide lotion, ointmentdrugId:2528 GLUCOCORTICOIDS
DesowendrugId:484 (desonide cream)drugId:484 GLUCOCORTICOIDS #
desoximetasone 0.05% cream, ointmentdrugId:5021 PA GLUCOCORTICOIDS
desoximetasone 0.25% cream, ointment, spray, 0.05% geldrugId:488 PA GLUCOCORTICOIDS
Desoxyn (methamphetamine); See Table 31drugId:1165; See Table 71drugId:3142 PA CEREBRAL STIMULANTS
desvenlafaxine extended-release-Khedezla; See Table 17drugId:2907; See Table 71drugId:3922 PA ANTIDEPRESSANTS
desvenlafaxine extended-release; See Table 17drugId:2777; See Table 71drugId:3920 PA ANTIDEPRESSANTS
desvenlafaxine succinate extended-release; See Table 17drugId:490; See Table 71drugId:3940 PA < 6 years and PA > 1 unit/day ANTIDEPRESSANTS #
DetroldrugId:1726 (tolterodine immediate-release)drugId:1726 URINARY ANTISPASMODICS #
Detrol LAdrugId:1725 (tolterodine extended-release)drugId:1725 URINARY ANTISPASMODICS #
deutetrabenazinedrugId:6121 PA NEUROLOGIC AGENT
dexamethasone injectiondrugId:5131 GLUCOCORTICOIDS
dexamethasone intravitreal implantdrugId:494 OPHTHALMIC PREPARATIONS ^
dexamethasone ophthalmic insertdrugId:7181 OPHTHALMIC PREPARATIONS ^
dexamethasone ophthalmic suspensiondrugId:493 OPHTHALMIC PREPARATIONS
dexamethasone sodium phosphate ophthalmic solutiondrugId:4919 OPHTHALMIC PREPARATIONS
dexamethasone solution, tabletdrugId:2491 GLUCOCORTICOIDS #
dexamethasone tablet packdrugId:492 PA GLUCOCORTICOIDS
dexchlorpheniramine solutiondrugId:7220 PA ANTIHISTAMINES
Dexedrine (dextroamphetamine 5 mg, 10 mg, 15 mg capsule); See Table 31drugId:500; See Table 71drugId:3140 PA < 3 years and PA > 3 units/day CEREBRAL STIMULANTS #
Dexilant (dexlansoprazole)drugId:496 PA > 30 units/month PROTON PUMP INHIBITORS BP
dexlansoprazoledrugId:496 PA > 30 units/month PROTON PUMP INHIBITORS BP
dexmethylphenidate extended-release; See Table 31drugId:498; See Table 71drugId:3020 PA < 3 years and PA > 2 units/day CEREBRAL STIMULANTS BP PD
dexmethylphenidate; See Table 31drugId:497; See Table 71drugId:3101 PA < 3 years and PA > 3 units/day CEREBRAL STIMULANTS #
dexrazoxane ANTIDOTES
Dextenza (dexamethasone ophthalmic insert)drugId:7181 OPHTHALMIC PREPARATIONS ^
dextrindrugId:6205 GASTROINTESTINAL AGENT *
dextroamphetamine 2.5 mg, 7.5 mg, 15 mg, 20 mg, 30 mg tablet; See Table 31drugId:2819; See Table 71drugId:3121 PA CEREBRAL STIMULANTS
dextroamphetamine 5 mg, 10 mg, 15 mg capsule; See Table 31drugId:500; See Table 71drugId:3140 PA < 3 years and PA > 3 units/day CEREBRAL STIMULANTS #
dextroamphetamine 5 mg, 10 mg tablet; See Table 31drugId:2968; See Table 71drugId:3120 PA < 3 years and PA > 3 units/day CEREBRAL STIMULANTS
dextroamphetamine solution; See Table 31drugId:501; See Table 71drugId:3141 PA < 3 years and PA > 30 mL/day CEREBRAL STIMULANTS
dextromethorphan / quinidinedrugId:2177 PA MULTIPLE SCLEROSIS AGENTS
dextrose ELECTROLYTES AND NUTRIENTS
Diacomit (stiripentol); See Table 20drugId:7132; See Table 71drugId:7133 PA ANTICONVULSANTS
DiamoxdrugId:147 (acetazolamide)drugId:147 CARDIOVASCULAR #
Diastat (diazepam rectal gel)drugId:503 PA > 5 kits (10 syringes) /month BENZODIAZEPINES
diazepam nasal spraydrugId:7384 PA > 10 units/month BENZODIAZEPINES
diazepam powder; See Table 69drugId:506; See Table 71drugId:4382 PA BENZODIAZEPINES
diazepam rectal geldrugId:503 PA > 5 kits (10 syringes) /month BENZODIAZEPINES
diazepam solution, tablet; See Table 69drugId:504; See Table 71drugId:4381 PA < 6 years BENZODIAZEPINES
diazoxide DIABETIC AGENTS BP
dichlorphenamidedrugId:5260 PA UNCLASSIFIED DRUG PRODUCTS
Diclegis (doxylamine / pyridoxine delayed-release)drugId:2778 PA ANTIEMETICS BP
diclofenac / misoprostoldrugId:514 PA < 60 years NONSTEROIDAL ANTI-INFLAMMATORY #
diclofenac 1% geldrugId:512 NONSTEROIDAL ANTI-INFLAMMATORY #
diclofenac 18 mg, 35 mg capsuledrugId:2894 PA NONSTEROIDAL ANTI-INFLAMMATORY
diclofenac 25 mg capsuledrugId:511 PA NONSTEROIDAL ANTI-INFLAMMATORY
diclofenac 3% geldrugId:508 PA CHEMOTHERAPY
diclofenac extended-releasedrugId:513 NONSTEROIDAL ANTI-INFLAMMATORY #
diclofenac eye dropsdrugId:2269 OPHTHALMIC PREPARATIONS
diclofenac powder for solutiondrugId:1953 PA NONSTEROIDAL ANTI-INFLAMMATORY
diclofenac tabletdrugId:2117 NONSTEROIDAL ANTI-INFLAMMATORY
diclofenac topical patch-FlectordrugId:509 PA NONSTEROIDAL ANTI-INFLAMMATORY BP
diclofenac topical patch-LicartdrugId:7454 PA NONSTEROIDAL ANTI-INFLAMMATORY
diclofenac topical solutiondrugId:1944 PA NONSTEROIDAL ANTI-INFLAMMATORY
dicloxacillindrugId:515 ANTIBIOTICS
dicyclominedrugId:516 ANTISPASMODICS,ANTICHOLINERGIC #
didanosinedrugId:517 ANTIVIRALS #
dienestrol HORMONE REPLACEMENT THERAPY
difenoxin / atropinedrugId:6111 PA ANTIDIARRHEALS
Differin (adapalene)drugId:159 PA DERMATOLOGICAL BP
Dificid (fidaxomicin)drugId:2283 PA ANTIBIOTICS
diflorasone cream / emollientdrugId:520 PA GLUCOCORTICOIDS
diflorasone creamdrugId:4918 PA GLUCOCORTICOIDS
diflorasone ointmentdrugId:2207 PA GLUCOCORTICOIDS
DiflucandrugId:860 (fluconazole)drugId:860 FUNGICIDES #
diflunisaldrugId:521 NONSTEROIDAL ANTI-INFLAMMATORY
difluprednatedrugId:522 PA OPHTHALMIC PREPARATIONS
digoxin CARDIOVASCULAR #
dihydrocodeine / acetaminophen / caffeinedrugId:5142 PA OPIOID ANALGESICS
dihydrocodeine / aspirin / caffeinedrugId:525 PA OPIOID ANALGESICS
dihydroergotamine injectiondrugId:526 PA ANALGESICS
dihydroergotamine nasal spraydrugId:527 PA ANALGESICS
Dilantin (phenytoin extended 30 mg and 100 mg capsule); See Table 20drugId:1525; See Table 71drugId:4523 ANTICONVULSANTS #
Dilantin-125 (phenytoin suspension); See Table 20drugId:2938; See Table 71drugId:4522 ANTICONVULSANTS #
Dilantin Infatab (phenytoin chewable tablet); See Table 20drugId:1523; See Table 71drugId:4520 ANTICONVULSANTS #
Dilatrate-SR (isosorbide dinitrate extended-release capsule)drugId:977 CARDIOVASCULAR
DilaudiddrugId:754 (hydromorphone)drugId:754 PA > 32 mg/day OPIOID ANALGESICS #
diltiazem 120 mg, 180 mg, 240 mg, 300 mg-Cardizem CDdrugId:531 CARDIOVASCULAR #
diltiazem 360 mg-Cardizem CDdrugId:2299 PA CARDIOVASCULAR
diltiazem-CardizemdrugId:528 CARDIOVASCULAR #
diltiazem extended-release tabletdrugId:529 CARDIOVASCULAR #
diltiazem-Tiazac ERdrugId:533 CARDIOVASCULAR #
dimenhydrinate injectiondrugId:2677 ANTIHISTAMINES
dimercaprol ANTIDOTES ^
dimethyl fumaratedrugId:2793 PA MULTIPLE SCLEROSIS AGENTS BP PD
dimethyl sulfoxide liquiddrugId:7161 PA ANALGESICS
dimethyl sulfoxide solutiondrugId:2694 ANALGESICS
DiovandrugId:1785 (valsartan)drugId:1785 CARDIOVASCULAR #
Diovan HCTdrugId:1786 (valsartan / hydrochlorothiazide)drugId:1786 CARDIOVASCULAR #
Dipentum (olsalazine)drugId:1286 GI ANTI-INFLAMMATORY
diphenhydraminedrugId:541 ANTIHISTAMINES * #
diphenoxylate / atropinedrugId:542 ANTIDIARRHEALS #
diphtheria / tetanus / acellular pertussis / poliovirus inactivated / haemophilus B conjugate vaccinedrugId:581 BIOLOGICAL 1
diphtheria / tetanus toxoids / acellular pertussis / hepatitis B, recombinant / poliovirus, inactivated vaccinedrugId:700 BIOLOGICAL 1
diphtheria / tetanus toxoids / acellular pertussis / poliovirus, inactivated vaccinedrugId:535 BIOLOGICAL 1
diphtheria / tetanus toxoids / acellular pertussis vaccinedrugId:539 BIOLOGICAL 1
diphtheria / tetanus toxoid vaccinedrugId:1686 BIOLOGICAL 1
DiprolenedrugId:353 (betamethasone dipropionate, augmented lotion)drugId:353 GLUCOCORTICOIDS #
DiprolenedrugId:5022 (betamethasone dipropionate, augmented ointment)drugId:5022 GLUCOCORTICOIDS #
Diprolene AFdrugId:2204 (betamethasone dipropionate, augmented cream)drugId:2204 GLUCOCORTICOIDS #
dipyridamoledrugId:545 ANTIPLATELET AGENT
disopyramide controlled-release CARDIOVASCULAR
disopyramide immediate-release CARDIOVASCULAR #
disulfiramdrugId:549 ALCOHOL AND DRUG CESSATION AGENT #
Ditropan XLdrugId:1314 (oxybutynin extended-release tablet)drugId:1314 URINARY ANTISPASMODICS #
DiurildrugId:221 (chlorothiazide)drugId:221 CARDIOVASCULAR #
divalproex extended-release; See Table 20drugId:550; See Table 71drugId:3340 PA < 6 years ANTICONVULSANTS #
divalproex immediate-release; See Table 20drugId:552; See Table 71drugId:3320 PA < 6 years ANTICONVULSANTS #
divalproex sprinkle capsule; See Table 20drugId:2315; See Table 71drugId:3360 PA < 6 years ANTICONVULSANTS #
Divigel (estradiol-Divigel) HORMONE REPLACEMENT THERAPY
Docefrez (docetaxel-Docefrez)drugId:2985 CHEMOTHERAPY
docetaxel-DocefrezdrugId:2985 CHEMOTHERAPY
docetaxel-TaxoteredrugId:553 CHEMOTHERAPY #
docusate enemadrugId:555 CONSTIPATION AGENTS
docusate sodiumdrugId:554 CONSTIPATION AGENTS *
dofetilide CARDIOVASCULAR #
dolasetron injectiondrugId:558 ANTIEMETICS
dolasetron tabletdrugId:557 PA ANTIEMETICS
Dolophine (methadone oral-Dolophine)drugId:1163 PA OPIOID ANALGESICS
dolutegravir / lamivudinedrugId:7240 ANTIVIRALS PD
dolutegravir / rilpivirinedrugId:6781 ANTIVIRALS PD
dolutegravir tablet for suspensiondrugId:7459 ANTIVIRALS
dolutegravir tabletdrugId:2852 PA > 1 unit/day ANTIVIRALS
donepezil 10 mg tablet; See Table 56drugId:2422; See Table 71drugId:7399 PA < 6 years and PA > 2 units/day ALZHEIMER'S THERAPY #
donepezil 23 mg tablet; See Table 56drugId:2247; See Table 71drugId:7400 PA ALZHEIMER'S THERAPY
donepezil 5 mg tablet; See Table 56drugId:559; See Table 71drugId:7401 PA < 6 years and PA > 1 unit/day ALZHEIMER'S THERAPY #
donepezil orally disintegrating tablet; See Table 56drugId:560; See Table 71drugId:7402 PA < 6 years and PA > 1 unit/day ALZHEIMER'S THERAPY
Doptelet (avatrombopag)drugId:6990 PA HEMATOLOGIC
doravirine / lamivudine / tenofovir disoproxil fumaratedrugId:6981 ANTIVIRALS PD
doravirinedrugId:6986 ANTIVIRALS PD
DoribaxdrugId:561 (doripenem)drugId:561 ANTIBIOTICS #
doripenemdrugId:561 ANTIBIOTICS #
dornase alfa ENZYMES
Doryx (doxycycline hyclate delayed-release 50 mg, 80 mg, 120 mg, 200 mg tablet)drugId:2900 PA ANTIBIOTICS
dorzolamidedrugId:563 OPHTHALMIC PREPARATIONS #
dorzolamide / timololdrugId:564 OPHTHALMIC PREPARATIONS #
dorzolamide / timolol, preservative freedrugId:2517 PA OPHTHALMIC PREPARATIONS
double antibiotic ointment (bacitracin / polymyxin B topical ointment)drugId:6260 ANTIBIOTICS *
Dovato (dolutegravir / lamivudine)drugId:7240 ANTIVIRALS PD
DovonexdrugId:420 (calcipotriene cream)drugId:420 PA > 60 grams/month DERMATOLOGICAL #
doxazosin extended-releasedrugId:566 PA BENIGN PROSTATIC HYPERPLASIA AGENTS
doxazosin immediate-release; See Table 18drugId:565; See Table 19drugId:5163 CARDIOVASCULAR #
doxepin capsule, oral concentrate; See Table 17drugId:2040; See Table 71drugId:4040 PA < 6 years ANTIDEPRESSANTS
doxepin cream-PrudoxindrugId:568 PA DERMATOLOGICAL
doxepin cream-ZonalondrugId:569 PA DERMATOLOGICAL
doxepin tablet-Silenor; See Table 15drugId:2082; See Table 71drugId:4346 PA SEDATIVES BP
doxercalciferol capsuledrugId:570 PA ELECTROLYTES AND NUTRIENTS
doxercalciferol injectiondrugId:5780 ELECTROLYTES AND NUTRIENTS ^
DoxildrugId:2689 (doxorubicin liposomal injection)drugId:2689 CHEMOTHERAPY #
doxorubicindrugId:571 CHEMOTHERAPY #
doxorubicin liposomal injectiondrugId:2689 CHEMOTHERAPY #
doxycycline calcium syrupdrugId:2903 ANTIBIOTICS
doxycycline hyclate 100 mg capsuledrugId:575 ANTIBIOTICS #
doxycycline hyclate 20 mg, 100 mg tabletdrugId:2902 ANTIBIOTICS
doxycycline hyclate 50 mg capsuledrugId:2901 ANTIBIOTICS
doxycycline hyclate 75 mg, 150 mg tabletdrugId:6141 PA ANTIBIOTICS
doxycycline hyclate delayed-release 50 mg, 80 mg, 120 mg, 200 mg tabletdrugId:2900 PA ANTIBIOTICS
doxycycline hyclate delayed-release 75 mg, 100 mg, 150 mg tabletdrugId:574 PA ANTIBIOTICS
doxycycline hyclate injectiondrugId:2301 ANTIBIOTICS
doxycycline monohydrate 150 mg capsuledrugId:576 PA ANTIBIOTICS
doxycycline monohydrate 150 mg tabletdrugId:2905 PA ANTIBIOTICS
doxycycline monohydrate 40 mg capsuledrugId:579 PA ANTIBIOTICS
doxycycline monohydrate 50 mg, 100 mg capsuledrugId:2899 ANTIBIOTICS
doxycycline monohydrate 50 mg, 75 mg, 100 mg tabletdrugId:2300 ANTIBIOTICS
doxycycline monohydrate 75 mg capsuledrugId:2906 PA ANTIBIOTICS
doxycycline monohydrate suspensiondrugId:2904 ANTIBIOTICS #
doxylamine / pyridoxine delayed-releasedrugId:2778 PA ANTIEMETICS BP
doxylamine / pyridoxine extended-releasedrugId:6680 PA ANTIEMETICS
doxylamine SEDATIVE, NON-BARBITURATE *
Drizalma (duloxetine sprinkle capsule); See Table 17drugId:7346; See Table 71drugId:7347 PA CEREBRAL STIMULANTS
dronabinol capsuledrugId:582 PA ANTIEMETICS
dronedarone CARDIOVASCULAR
droperidol ANTIPSYCHOTIC
drospirenone CONTRACEPTIVES
Droxia (hydroxyurea)drugId:760 HEMATOLOGIC
droxidopadrugId:4630 PA ADRENERGICS
Duac (clindamycin / benzoyl peroxide-Duac)drugId:264 PA DERMATOLOGICAL
Duaklir (aclidinium / formoterol)drugId:7330 PA BRONCHODILATORS
Duavee (estrogens, conjugated/bazedoxifene) ESTROGENS
Duetact (glimepiride / pioglitazone)drugId:1535 PA DIABETIC AGENTS
Duexis (ibuprofen / famotidine)drugId:2363 PA < 60 years NONSTEROIDAL ANTI-INFLAMMATORY
dulaglutidedrugId:4814 DIABETIC AGENTS PD
Dulera (mometasone / formoterol)drugId:1958 PA BRONCHODILATORS
duloxetine 20 mg, 30 mg, 60 mg capsule; See Table 17drugId:585; See Table 71drugId:3960 PA < 6 years ANTIDEPRESSANTS #
duloxetine 40 mg capsule; See Table 17drugId:4910; See Table 71drugId:4911 PA PSYCHOSTIMULANTS-ANTIDEPRESSAN
duloxetine sprinkle capsule; See Table 17drugId:7346; See Table 71drugId:7347 PA CEREBRAL STIMULANTS
Duobrii (halobetasol / tazarotene lotion)drugId:7134 PA GLUCOCORTICOIDS
Duopa (carbidopa / levodopa enteral suspension)drugId:5104 PA ANTIPARKINSON
dupilumabdrugId:6101 PA BIOLOGICAL
Dupixent (dupilumab)drugId:6101 PA BIOLOGICAL
DuraclondrugId:2750 (clonidine injection)drugId:2750 ANALGESICS #
Duragesic (fentanyl 75, 100 mcg/hr transdermal system)drugId:4800 PA OPIOID ANALGESICS
DuragesicdrugId:845 (fentanyl 12, 25, 50 mcg/hr transdermal system)drugId:845 PA > 50 mcg/hr and PA > 10 patches/month OPIOID ANALGESICS #
Duramorph (morphine, injection-Duramorph)drugId:1392 PA > 120 mg/day OPIOID ANALGESICS
Durezol (difluprednate)drugId:522 PA OPHTHALMIC PREPARATIONS
Durolane (hyaluronate-Durolane)drugId:6381 - Non-Drug Product PA NON-DRUG PRODUCT
durvalumabdrugId:6122 PA CHEMOTHERAPY
dutasteride / tamsulosindrugId:1960 PA BENIGN PROSTATIC HYPERPLASIA AGENTS
dutasteridedrugId:586 PA BENIGN PROSTATIC HYPERPLASIA AGENTS
duvelisibdrugId:7002 PA CHEMOTHERAPY
Dyanavel XR (amphetamine extended-release 2.5 mg/mL oral suspension); See Table 31drugId:5383; See Table 71drugId:5384 PA CEREBRAL STIMULANTS
DyazidedrugId:1755 (hydrochlorothiazide / triamterene)drugId:1755 CARDIOVASCULAR #
Dymista (azelastine / fluticasone propionate)drugId:2580 NASAL PREPARATIONS BP
Dysport (abobotulinumtoxinA)drugId:141 PA BIOLOGICAL

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


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Last updated 11/02/20

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