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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
paclitaxel injectable suspensiondrugId:1468 CHEMOTHERAPY
paclitaxel injectiondrugId:1467 CHEMOTHERAPY
Padcev (enfortumab vedotin-ejfv)drugId:7351 PA CHEMOTHERAPY
palbociclibdrugId:4940 PA CHEMOTHERAPY PD
Palforzia (peanut allergen powder-dnfp)drugId:7373 PA ALLERGENS
palifermin ANTIDOTES
paliperidone extended-release 1-month injection; See Table 24drugId:1470; See Table 71drugId:4281 PA < 6 years, PA > 2 injections/month within the first 30 days of therapy and PA > 1 injection/month after 30 days of therapy ANTIPSYCHOTIC
paliperidone extended-release 3-month injection; See Table 24drugId:5121; See Table 71drugId:5122 PA < 6 years and PA > 1 injection/3 months ANTIPSYCHOTIC PD
paliperidone tablet; See Table 24drugId:1471; See Table 71drugId:4280 PA ANTIPSYCHOTIC
palivizumabdrugId:1472 PA ANTIVIRALS
palonosetron 0.25 mg/2 mL injectiondrugId:6614 PA > 2 units/28 days ANTIEMETICS
palonosetron 0.25 mg/5 mL injectiondrugId:1473 PA > 2 units/28 days ANTIEMETICS #
Palynziq (pegvaliase-pqpz)drugId:6923 PA ENZYMES
Pamelor (nortriptyline); See Table 17drugId:1262; See Table 71drugId:4120 PA < 6 years ANTIDEPRESSANTS #
pamidronatedrugId:1474 ELECTROLYTES AND NUTRIENTS #
Pamine (methscopolamine) ANTISPASMODICS,ANTICHOLINERGIC #
Pancreaze DR (pancrelipase-Pancreaze DR)drugId:2565 ENZYMES
pancrelipase-Creon DRdrugId:1082 ENZYMES
pancrelipase-Pancreaze DRdrugId:2565 ENZYMES
pancrelipase-Pertzye DRdrugId:2730 ENZYMES
pancrelipase-ViokacedrugId:2597 ENZYMES
pancrelipase-Zenpep DRdrugId:1084 ENZYMES
Pandel (hydrocortisone probutate cream)drugId:732 PA GLUCOCORTICOIDS
panitumumabdrugId:1475 CHEMOTHERAPY
panobinostatdrugId:5105 PA CHEMOTHERAPY
Panretin (alitretinoin)drugId:16 PA CHEMOTHERAPY
pantoprazole 40 mg suspensiondrugId:2702 PA PROTON PUMP INHIBITORS BP
pantoprazole IVdrugId:1477 PROTON PUMP INHIBITORS #
pantoprazole tabletdrugId:1476 PA > 120 units/month PROTON PUMP INHIBITORS #
Panzyga (immune globulin IV, human-ifas)drugId:7104 PA BIOLOGICAL
Paragard (copper IUD) CONTRACEPTIVES
parathyroid hormonedrugId:5107 PA HORMONE AGENTS
paricalcitol capsuledrugId:1481 PA ELECTROLYTES AND NUTRIENTS
paricalcitol injectiondrugId:5781 ELECTROLYTES AND NUTRIENTS ^
ParlodeldrugId:377 (bromocriptine 2.5 mg, 5 mg)drugId:377 ANTIPARKINSON #
Parnate (tranylcypromine); See Table 17drugId:1741; See Table 71drugId:3540 PA < 6 years ANTIDEPRESSANTS #
paromomycindrugId:1482 ANTIPARASITICS
paroxetine 7.5 mg capsuledrugId:2839 PA UNCLASSIFIED DRUG PRODUCTS
paroxetine controlled-release; See Table 17drugId:1485; See Table 71drugId:3800 PA ANTIDEPRESSANTS
paroxetine hydrochloride; See Table 17drugId:1484; See Table 71drugId:3801 PA < 6 years ANTIDEPRESSANTS #
paroxetine mesylate; See Table 17drugId:1483; See Table 71drugId:3802 PA ANTIDEPRESSANTS
Parsabiv (etelcalcetide) CALCIMIMETIC ^
Paser (aminosalicylic acid)drugId:2500 TB PREPARATIONS
pasireotide injectable suspensiondrugId:4912 PA ENDOCRINE/METABOLIC AGENTS
pasireotidedrugId:2791 PA ENDOCRINE/METABOLIC AGENTS
Patanase (olopatadine nasal spray)drugId:1283 PA NASAL PREPARATIONS
Patanol (olopatadine 0.1% eye drops)drugId:1285 PA ANTIHISTAMINES
patiromerdrugId:5320 PA > 30 units/month CHELATING AGENT
patisirandrugId:6985 PA SMALL INTERFERING RNA AGENTS
Paxil (paroxetine hydrochloride); See Table 17drugId:1484; See Table 71drugId:3801 PA < 6 years ANTIDEPRESSANTS #
Paxil CR (paroxetine controlled-release); See Table 17drugId:1485; See Table 71drugId:3800 PA ANTIDEPRESSANTS
Pazeo (olopatadine 0.7% eye drops)drugId:4791 PA ANTIHISTAMINES
pazopanibdrugId:1486 PA CHEMOTHERAPY
PCE (erythromycin delayed-release tablet-PCE)drugId:5132 ANTIBIOTICS
peanut allergen powder-dnfpdrugId:7373 PA ALLERGENS
PediapreddrugId:1578 (prednisolone 5 mg/5 mL oral solution)drugId:1578 GLUCOCORTICOIDS #
Pediarix (diphtheria / tetanus toxoids / acellular pertussis / hepatitis B, recombinant / poliovirus, inactivated vaccine)drugId:700 BIOLOGICAL 1
pediatric multivitaminsdrugId:1487 ELECTROLYTES AND NUTRIENTS *
Pedvaxhib (haemophilus B conjugate vaccine-Pedvaxhib)drugId:694 BIOLOGICAL 1
pegademase bovinedrugId:2682 PA UNCLASSIFIED DRUG PRODUCTS
Peganone (ethotoin); See Table 20drugId:669; See Table 71drugId:3420 ANTICONVULSANTS
pegaptanib OPHTHALMIC PREPARATIONS ^
pegaspargasedrugId:2430 CHEMOTHERAPY ^
Pegasys (peginterferon alfa-2a)drugId:2059 PA ANTIVIRALS
pegfilgrastimdrugId:1489 HEMATINIC AGENT
pegfilgrastim-bmezdrugId:7337 HEMATINIC AGENT
pegfilgrastim-cbqvdrugId:7012 HEMATINIC AGENT
pegfilgrastim-jmdbdrugId:6903 HEMATINIC AGENT
peginterferon alfa-2adrugId:2059 PA ANTIVIRALS
peginterferon alfa-2bdrugId:1490 PA ANTIVIRALS
peginterferon alfa-2b-Sylatron ANTIVIRALS
peginterferon beta-1adrugId:4631 PA MULTIPLE SCLEROSIS AGENTS
Pegintron (peginterferon alfa-2b)drugId:1490 PA ANTIVIRALS
pegloticasedrugId:6294 PA GOUT AGENTS
pegvaliase-pqpzdrugId:6923 PA ENZYMES
pegvisomantdrugId:1491 PA HORMONE AGENTS
Pemazyre (pemigatinib)drugId:7455 PA CHEMOTHERAPY
pembrolizumabdrugId:4780 PA CHEMOTHERAPY
pemetrexeddrugId:1492 CHEMOTHERAPY
pemigatinibdrugId:7455 PA CHEMOTHERAPY
penciclovirdrugId:1495 PA ANTIVIRALS
penicillamine capsule CHELATING AGENT BP
penicillamine tablet CHELATING AGENT #
penicillin G 0.6 million, 1.2 million, 2.4 million unitsdrugId:2625 ANTIBIOTICS
penicillin G 5 million, 20 million unitsdrugId:1499 ANTIBIOTICS #
penicillin G benzathine / penicillin G procainedrugId:2624 ANTIBIOTICS
penicillin VdrugId:1500 ANTIBIOTICS
PenlacdrugId:233 (ciclopirox 8% nail lacquer)drugId:233 FUNGICIDES #
Pennsaid (diclofenac topical solution)drugId:1944 PA NONSTEROIDAL ANTI-INFLAMMATORY
Pentacel (diphtheria / tetanus / acellular pertussis / poliovirus inactivated / haemophilus B conjugate vaccine)drugId:581 BIOLOGICAL 1
pentamidine ANTIPARASITICS #
Pentasa (mesalamine controlled-release)drugId:1154 GI ANTI-INFLAMMATORY
pentazocinedrugId:1502 OPIOID ANALGESICS
pentazocine / naloxonedrugId:1504 PA OPIOID ANALGESICS
pentosan ANALGESICS
pentostatindrugId:2692 CHEMOTHERAPY
pentoxifylline CARDIOVASCULAR
PepciddrugId:461 (famotidine tablet)drugId:461 H2 ANTAGONISTS * #
perampanel; See Table 20drugId:2926; See Table 71drugId:4444 PA ANTICONVULSANTS
PercocetdrugId:1323 (oxycodone / acetaminophen-Percocet)drugId:1323 PA > 80 mg/day OPIOID ANALGESICS #
Perforomist (formoterol inhalation solution)drugId:906 PA BRONCHODILATORS
perindoprildrugId:1509 CARDIOVASCULAR
Perjeta (pertuzumab)drugId:2583 PA CHEMOTHERAPY
permethrindrugId:1510 ANTIPARASITICS *
permethrin creamdrugId:4700 ANTIPARASITICS #
perphenazine; See Table 24drugId:6326; See Table 71drugId:1511 PA < 6 years ANTIPSYCHOTIC
Perseris (risperidone extended-release subcutaneous injection); See Table 24drugId:7007; See Table 71drugId:7009 PA ANTIPSYCHOTIC
pertuzumabdrugId:2583 PA CHEMOTHERAPY
Pertzye DR (pancrelipase-Pertzye DR)drugId:2730 ENZYMES
petrolatum DERMATOLOGICAL *
Pexeva (paroxetine mesylate); See Table 17drugId:1483; See Table 71drugId:3802 PA ANTIDEPRESSANTS
pexidartinibdrugId:7279 PA CHEMOTHERAPY
PfizerpendrugId:1499 (penicillin G 5 million, 20 million units)drugId:1499 ANTIBIOTICS #
phenazopyridine ANALGESICS
phenelzine; See Table 17drugId:1515; See Table 71drugId:3580 PA < 6 years ANTIDEPRESSANTS #
PhenergandrugId:1593 (promethazine)drugId:1593 ANTIHISTAMINES #
phenobarbitaldrugId:1516 BARBITURATES
phenoxybenzaminedrugId:5123 PA CARDIOVASCULAR
phenylephrine ADRENERGICS
phenylephrine / ketorolac OPHTHALMIC PREPARATIONS ^
phenylephrine / promethazine DECONGESTANT
phenytoin chewable tablet; See Table 20drugId:1523; See Table 71drugId:4520 ANTICONVULSANTS #
phenytoin extended 200 mg and 300 mg capsule; See Table 20drugId:1526; See Table 71drugId:4524 ANTICONVULSANTS
phenytoin extended 30 mg and 100 mg capsule; See Table 20drugId:1525; See Table 71drugId:4523 ANTICONVULSANTS #
phenytoin injectiondrugId:2661 ANTICONVULSANTS ^
phenytoin suspension; See Table 20drugId:2938; See Table 71drugId:4522 ANTICONVULSANTS #
Phos-Flur (sodium fluoride oral rinse) ELECTROLYTES AND NUTRIENTS
Phoslyra (calcium acetate) ELECTROLYTES AND NUTRIENTS
Phospholine Iodide (echothiophate)drugId:587 OPHTHALMIC PREPARATIONS
phytonadione ELECTROLYTES AND NUTRIENTS BP
Picato (ingenol gel)drugId:2521 PA DERMATOLOGICAL
Pifeltro (doravirine)drugId:6986 ANTIVIRALS PD
pilocarpine PARASYMPATHETIC AGENTS #
pilocarpine eye dropsdrugId:2635 OPHTHALMIC PREPARATIONS #
pimavanserindrugId:5588 PA ANTIPSYCHOTIC
pimecrolimusdrugId:1531 DERMATOLOGICAL BP
pimozide; See Table 24drugId:6327; See Table 71drugId:1532 PA < 6 years ANTIPSYCHOTIC #
pindololdrugId:1533 CARDIOVASCULAR
Pin-X (pyrantel pamoate)drugId:6215 ANTIPARASITICS
pioglitazonedrugId:1534 DIABETIC AGENTS #
pioglitazone / metformindrugId:1536 DIABETIC AGENTS #
pioglitazone / metformin extended-releasedrugId:1937 DIABETIC AGENTS
piperacillin / tazobactamdrugId:1537 ANTIBIOTICS #
piperonyl butoxide / pyrethrinsdrugId:1538 ANTIPARASITICS *
Piqray (alpelisib)drugId:7225 PA CHEMOTHERAPY
pirfenidonedrugId:4767 PA PULMONARY FIBROSIS AGENTS
piroxicamdrugId:1540 NONSTEROIDAL ANTI-INFLAMMATORY #
pitavastatin calciumdrugId:1962 PA LIPID LOWERING AGENTS
pitavastatin magnesiumdrugId:7109 PA LIPID LOWERING AGENTS
pitolisantdrugId:7356 PA NARCOLEPSY AGENTS
PlavixdrugId:277 (clopidogrel)drugId:277 ANTIPLATELET AGENT #
plazomicindrugId:7014 PA ANTIBIOTICS
plecanatidedrugId:6043 PA CONSTIPATION AGENTS
Plegridy (peginterferon beta-1a)drugId:4631 PA MULTIPLE SCLEROSIS AGENTS
Plenvu (polyethylene glycol-electrolyte solution-Plenvu)drugId:7137 PA LAXATIVES
plerixafor HEMATINIC AGENT
pneumococcal 13-valent conjugate vaccinedrugId:1542 BIOLOGICAL 1
pneumococcal vaccinedrugId:1544 BIOLOGICAL
Pneumovax (pneumococcal vaccine)drugId:1544 BIOLOGICAL
podofilox geldrugId:2261 PA DERMATOLOGICAL
podofilox solutiondrugId:1545 DERMATOLOGICAL #
polatuzumab vedotin-piiqdrugId:7263 PA CHEMOTHERAPY
polidocanoldrugId:2934 PA CARDIOVASCULAR ^
poliovirus vaccine, inactivateddrugId:1546 BIOLOGICAL 1
Polivy (polatuzumab vedotin-piiq)drugId:7263 PA CHEMOTHERAPY
polyethylene glycol 3350drugId:1547 LAXATIVES *
polyethylene glycol-electrolyte solution-ColytedrugId:2539 LAXATIVES #
polyethylene glycol-electrolyte solution-GolytelydrugId:1549 LAXATIVES #
polyethylene glycol-electrolyte solution-MoviprepdrugId:1551 LAXATIVES BP
polyethylene glycol-electrolyte solution-NulytelydrugId:1552 LAXATIVES #
polyethylene glycol-electrolyte solution-PlenvudrugId:7137 PA LAXATIVES
PolytrimdrugId:2060 (trimethoprim / polymyxin B ophthalmic solution)drugId:2060 OPHTHALMIC PREPARATIONS #
pomalidomidedrugId:2787 PA CHEMOTHERAPY
Pomalyst (pomalidomide)drugId:2787 PA CHEMOTHERAPY
ponatinibdrugId:2724 PA CHEMOTHERAPY
Portrazza (necitumumab)drugId:5420 PA CHEMOTHERAPY
posaconazoledrugId:2928 PA FUNGICIDES BP
potassium bicarbonate ELECTROLYTES AND NUTRIENTS
potassium chloride injection ELECTROLYTES AND NUTRIENTS
potassium chloride-Kaochlor ELECTROLYTES AND NUTRIENTS
potassium chloride-Kaon-CL ELECTROLYTES AND NUTRIENTS
potassium chloride-Klor-Con ELECTROLYTES AND NUTRIENTS #
potassium chloride-K-Tab ELECTROLYTES AND NUTRIENTS
potassium chloride-Micro-K ELECTROLYTES AND NUTRIENTS #
potassium citrate ELECTROLYTES AND NUTRIENTS #
potassium citrate / citric acid ELECTROLYTES AND NUTRIENTS
potassium citrate / sodium citrate / citric acid ELECTROLYTES AND NUTRIENTS
potassium phosphate / dibasic sodium phosphate / monobasic sodium phosphate ELECTROLYTES AND NUTRIENTS
potassium phosphate / sodium phosphate ELECTROLYTES AND NUTRIENTS
potassium phosphate / sodium phosphate / phosphorus ELECTROLYTES AND NUTRIENTS
potassium phosphate ELECTROLYTES AND NUTRIENTS *
Poteligeo (mogamulizumab-kpkc)drugId:6924 PA CHEMOTHERAPY
povidonedrugId:1567 ANTISEPTICS *
Pradaxa (dabigatran etexilate mesylate 110 mg)drugId:5286 PA > 70 capsules/365 days ANTICOAGULANTS
Pradaxa (dabigatran etexilate mesylate 75 mg, 150 mg)drugId:2081 PA ANTICOAGULANTS
pralatrexatedrugId:1568 CHEMOTHERAPY
Praluent (alirocumab)drugId:5119 PA LIPID LOWERING AGENTS
pramipexoledrugId:1569 ANTIPARKINSON #
pramipexole extended-releasedrugId:1943 PA ANTIPARKINSON
pramlintidedrugId:1570 DIABETIC AGENTS
PrandindrugId:1642 (repaglinide)drugId:1642 DIABETIC AGENTS #
prasugreldrugId:1571 ANTIPLATELET AGENT #
PravacholdrugId:2736 (pravastatin 10 mg, 20 mg, 40 mg)drugId:2736 PA > 1.5 units/day LIPID LOWERING AGENTS #
PravacholdrugId:1572 (pravastatin 80 mg)drugId:1572 PA > 1 unit/day LIPID LOWERING AGENTS #
pravastatin 10 mg, 20 mg, 40 mgdrugId:2736 PA > 1.5 units/day LIPID LOWERING AGENTS #
pravastatin 80 mgdrugId:1572 PA > 1 unit/day LIPID LOWERING AGENTS #
praziquanteldrugId:2358 ANTIPARASITICS BP
prazosin; See Table 18drugId:1573; See Table 19drugId:5164 CARDIOVASCULAR #
PrecosedrugId:143 (acarbose)drugId:143 DIABETIC AGENTS #
Pred FortedrugId:1580 (prednisolone acetate 1% ophthalmic suspension-Pred Forte)drugId:1580 OPHTHALMIC PREPARATIONS #
Pred-G (gentamicin / prednisolone ophthalmic ointment, suspension)drugId:929 PA OPHTHALMIC PREPARATIONS
Pred Mild (prednisolone acetate 0.12% ophthalmic suspension)drugId:5001 OPHTHALMIC PREPARATIONS
prednicarbate cream, ointmentdrugId:1574 GLUCOCORTICOIDS #
prednisolone 10 mg/5 mL oral solutiondrugId:1575 PA GLUCOCORTICOIDS
prednisolone 15 mg/5 mL, 25 mg/5 mL oral solutiondrugId:1576 GLUCOCORTICOIDS
prednisolone 20 mg/5 mL oral solutiondrugId:1579 PA GLUCOCORTICOIDS
prednisolone 5 mg/5 mL oral solutiondrugId:1578 GLUCOCORTICOIDS #
prednisolone acetate 0.12% ophthalmic suspensiondrugId:5001 OPHTHALMIC PREPARATIONS
prednisolone acetate 1% ophthalmic suspension-OmnipreddrugId:2633 OPHTHALMIC PREPARATIONS #
prednisolone acetate 1% ophthalmic suspension-Pred FortedrugId:1580 OPHTHALMIC PREPARATIONS #
prednisolone orally disintegrating tabletdrugId:1577 PA GLUCOCORTICOIDS
prednisolone sodium phosphate ophthalmic solutiondrugId:2618 OPHTHALMIC PREPARATIONS
prednisolone tabletdrugId:2199 GLUCOCORTICOIDS
prednisonedrugId:1581 GLUCOCORTICOIDS
prednisone delayed-releasedrugId:2645 PA GLUCOCORTICOIDS
Prefest (estradiol / norgestimate) HORMONE REPLACEMENT THERAPY
pregabalin extended-release; See Table 71drugId:6609; See Table 72drugId:6608 PA GABA ANALOGS
pregabalin; See Table 20drugId:1582; See Table 71drugId:4460 PA ANTICONVULSANTS
Premarin (estrogens, conjugated) HORMONE REPLACEMENT THERAPY
Premphase (medroxyprogesterone / estrogens, conjugated-Premphase) HORMONE REPLACEMENT THERAPY
Prempro (medroxyprogesterone / estrogens, conjugated-Prempro) HORMONE REPLACEMENT THERAPY
prenatal vitaminsdrugId:1583 ELECTROLYTES AND NUTRIENTS *
Prepopik (sodium picosulfate / magnesium oxide / anhydrous citric acid-Prepopik)drugId:2644 LAXATIVES
PrevaciddrugId:1021 (lansoprazole capsule)drugId:1021 PA > 30 units/month PROTON PUMP INHIBITORS #
Prevacid Solutab (lansoprazole orally disintegrating tablet)drugId:1022 PA ≥ 2 years PROTON PUMP INHIBITORS BP
PrevalitedrugId:228 (cholestyramine / aspartame-Prevalite)drugId:228 LIPID LOWERING AGENTS #
Prevnar 13 (pneumococcal 13-valent conjugate vaccine)drugId:1542 BIOLOGICAL 1
Prevymis (letermovir)drugId:6615 PA ANTIVIRALS
Prezcobix (darunavir / cobicistat)drugId:4792 ANTIVIRALS PD
Prezista (darunavir)drugId:330 ANTIVIRALS PD
Prialt (ziconotide)drugId:1819 PA ANALGESICS
Priftin (rifapentine)drugId:2501 TB PREPARATIONS
Prilosec (omeprazole suspension)drugId:2054 PA PROTON PUMP INHIBITORS
primaquine ANTIMALARIALS
PrimaxindrugId:781 (imipenem / cilastatin)drugId:781 ANTIBIOTICS #
primidone; See Table 20drugId:1586; See Table 71drugId:4461 ANTICONVULSANTS #
PrinivildrugId:1087 (lisinopril)drugId:1087 CARDIOVASCULAR #
Pristiq (desvenlafaxine succinate extended-release); See Table 17drugId:490; See Table 71drugId:3940 PA < 6 years and PA > 1 unit/day ANTIDEPRESSANTS #
Privigen (immune globulin IV, human-Privigen)drugId:2197 PA BIOLOGICAL
Proair Digihaler (albuterol inhalation powder-Proair Digihaler)drugId:7352 PA BRONCHODILATORS
Proair HFA (albuterol inhaler-Proair HFA)drugId:1 BRONCHODILATORS BP
Proair Respiclick (albuterol inhalation powder-Proair Respiclick)drugId:5109 BRONCHODILATORS
probeneciddrugId:1587 GOUT AGENTS
probenecid / colchicinedrugId:287 GOUT AGENTS
Probuphine (buprenorphine implant)drugId:5591 PA ALCOHOL AND DRUG CESSATION AGENT
procarbazinedrugId:1589 CHEMOTHERAPY
ProcardiadrugId:2064 (nifedipine capsule)drugId:2064 CARDIOVASCULAR #
Procardia XLdrugId:1215 (nifedipine extended-release)drugId:1215 CARDIOVASCULAR #
prochlorperazine ANTIEMETICS
Procrit (epoetin alfa-Procrit)drugId:611 PA HEMATINIC AGENT
Procysbi (cysteamine delayed-release capsule)drugId:2861 PA ENZYMES
Procysbi (cysteamine delayed-release granule)drugId:7374 PA ENZYMES
Profilnine SD (factor IX complex human-Profilnine SD) ANTI-HEMOPHILIA AGENTS
progesterone capsule HORMONE REPLACEMENT THERAPY #
progesterone geldrugId:2587 PA HORMONE REPLACEMENT THERAPY
progesterone injection PROGESTERONE
Proglycem (diazoxide) DIABETIC AGENTS BP
Prograf (tacrolimus granules)drugId:7264 PA IMMUNOMODULATOR
Prograf (tacrolimus injection)drugId:2741 IMMUNOMODULATOR ^
PrografdrugId:1918 (tacrolimus immediate-release capsule)drugId:1918 IMMUNOMODULATOR #
Prolastin (alpha-1-proteinase inhibitor, human-Prolastin) ENZYMES
Prolensa (bromfenac 0.07%)drugId:2788 PA OPHTHALMIC PREPARATIONS
Proleukin (aldesleukin)drugId:2307 CHEMOTHERAPY
Prolia (denosumab-Prolia)drugId:1967 PA BIOLOGICAL
Promacta (eltrombopag)drugId:594 PA HEMATINIC AGENT
promethazinedrugId:1593 ANTIHISTAMINES #
Prometrium (progesterone capsule) HORMONE REPLACEMENT THERAPY #
propafenone CARDIOVASCULAR #
propantheline URINARY ANTISPASMODICS
proparacaine OPHTHALMIC PREPARATIONS
propranolol / hydrochlorothiazidedrugId:1603 CARDIOVASCULAR
propranolol extended-releasedrugId:1601 CARDIOVASCULAR #
propranolol immediate-releasedrugId:1600 CARDIOVASCULAR
propranolol long-acting capsuledrugId:6562 PA CARDIOVASCULAR
propranolol solutiondrugId:2959 PA CARDIOVASCULAR
propylthiouracil THYROID PREPARATIONS
Proquad (measles / mumps / rubella / varicella virus vaccine)drugId:1122 BIOLOGICAL 1
Proscar (finasteride)drugId:857 PA BENIGN PROSTATIC HYPERPLASIA AGENTS
protein C concentratedrugId:1605 PA HEMATINIC AGENT
prothrombin complex concentrate, human HEMOSTATICS
Protonix (pantoprazole 40 mg suspension)drugId:2702 PA PROTON PUMP INHIBITORS BP
ProtonixdrugId:1476 (pantoprazole tablet)drugId:1476 PA > 120 units/month PROTON PUMP INHIBITORS #
Protonix IVdrugId:1477 (pantoprazole IV)drugId:1477 PROTON PUMP INHIBITORS #
Protopic (tacrolimus topical)drugId:1919 DERMATOLOGICAL BP
protriptyline; See Table 17drugId:1606; See Table 71drugId:4140 PA < 6 years ANTIDEPRESSANTS
Provenge (sipuleucel-T)drugId:2288 PA CHEMOTHERAPY ^
ProventildrugId:2 (albuterol inhaler-Proventil)drugId:2 BRONCHODILATORS #
Provera (medroxyprogesterone tablet) HORMONE REPLACEMENT THERAPY #
Provigil (modafinil 100 mg); See Table 50drugId:1373; See Table 71drugId:7451 PA < 6 years and PA > 1.5 units/day NARCOLEPSY AGENTS #
Provigil (modafinil 200 mg); See Table 50drugId:7450; See Table 71drugId:7452 PA < 6 years and PA > 2 units/day NARCOLEPSY AGENTS #
Prozac (fluoxetine 10 mg, 20 mg, 40 mg capsule, solution); See Table 17drugId:879; See Table 71drugId:3721 PA < 6 years ANTIDEPRESSANTS #
Prozac Weekly (fluoxetine 90 mg delayed-release capsule); See Table 17drugId:880; See Table 71drugId:3720 PA ANTIDEPRESSANTS
prucalopridedrugId:7136 PA CONSTIPATION AGENTS
Prudoxin (doxepin cream-Prudoxin)drugId:568 PA DERMATOLOGICAL
pseudoephedrinedrugId:1607 PA > 240 mg/day DECONGESTANT *
psylliumdrugId:1610 CONSTIPATION AGENTS *
Pulmicort (budesonide inhalation powder)drugId:380 BRONCHODILATORS
Pulmicort (budesonide inhalation suspension)drugId:381 PA BRONCHODILATORS
Pulmozyme (dornase alfa) ENZYMES
Purixan (mercaptopurine oral suspension)drugId:4632 PA CHEMOTHERAPY
Pylera (bismuth subcitrate / metronidazole / tetracycline)drugId:367 H. PYLORI AGENTS
pyrantel pamoatedrugId:6215 ANTIPARASITICS
pyrazinamidedrugId:1611 ANTIBIOTICS
Pyridium (phenazopyridine) ANALGESICS
pyridostigmine bromidedrugId:1612 PARASYMPATHETIC AGENTS #
pyridostigmine bromide 30 mg tabletdrugId:7226 PA PARASYMPATHETIC AGENTS
pyridoxinedrugId:1613 ELECTROLYTES AND NUTRIENTS *
pyridoxine crystalsdrugId:7341 PA ELECTROLYTES AND NUTRIENTS
pyrimethaminedrugId:1614 PA ANTIMALARIALS BP

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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