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MassHealth Drug List table

Drug - Brand Name (Generic Name)	Class
paclitaxel injectable suspensiondrugId:1468	CHEMOTHERAPY
paclitaxel injectiondrugId:1467	CHEMOTHERAPY
palbociclibdrugId:4940 - PA	CHEMOTHERAPY
palifermin	ANTIDOTES
paliperidone extended-release 1-month injection - PA < 6 years, PA > 2 units/month within the first 30 days of therapy and PA > 1 unit/month after 30 days of therapy; See Table 24drugId:1470; See Table 71drugId:4281	ANTIPSYCHOTIC
paliperidone extended-release 3-month injection - PA < 6 years and PA > 1 unit/3 months; See Table 24drugId:5121; See Table 71drugId:5122	ANTIPSYCHOTIC
paliperidone tablet - PA; See Table 24drugId:1471; See Table 71drugId:4280	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) - PA < 6 years; See Table 17drugId:1262; See Table 71drugId:4120	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 20 mg tabletdrugId:1476 - PA > 30 units/month	PROTON PUMP INHIBITORS
pantoprazole 40 mg suspensiondrugId:2702 - PA	PROTON PUMP INHIBITORS
pantoprazole 40 mg tabletdrugId:2183 - PA > 60 units/month	PROTON PUMP INHIBITORS
pantoprazole IVdrugId:1477	PROTON PUMP INHIBITORS
Panzyga (immune globulin IV, human-ifas)drugId:7104 - PA	BIOLOGICAL
Parafon Forte DSCdrugId:226 # (chlorzoxazone 500 mg)drugId:226 - PA < 18 years	MUSCLE RELAXANT
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) - PA < 6 years; See Table 17drugId:1741; See Table 71drugId:3540	ANTIDEPRESSANTS
paromomycindrugId:1482	ANTIPARASITICS
paroxetine 7.5 mg capsuledrugId:2839 - PA	UNCLASSIFIED DRUG PRODUCTS
paroxetine controlled-release - PA; See Table 17drugId:1485; See Table 71drugId:3800	ANTIDEPRESSANTS
paroxetine hydrochloride - PA < 6 years; See Table 17drugId:1484; See Table 71drugId:3801	ANTIDEPRESSANTS
paroxetine mesylate - PA; See Table 17drugId:1483; See Table 71drugId:3802	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
Pataday (olopatadine 0.2% eye drops)drugId:1284 - PA	ANTIHISTAMINES
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) - PA < 6 years; See Table 17drugId:1484; See Table 71drugId:3801	ANTIDEPRESSANTS
Paxil CR (paroxetine controlled-release) - PA; See Table 17drugId:1485; See Table 71drugId:3800	ANTIDEPRESSANTS
Pazeo (olopatadine 0.7% eye drops)drugId:4791 - PA	ANTIHISTAMINES
pazopanibdrugId:1486 - PA	CHEMOTHERAPY
PCE (erythromycin delayed-release tablet-PCE)drugId:5132	ANTIBIOTICS
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 1	BIOLOGICAL
pediatric multivitaminsdrugId:1487 *	ELECTROLYTES AND NUTRIENTS
Pedvaxhib (haemophilus B conjugate vaccine-Pedvaxhib)drugId:694 1	BIOLOGICAL
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-cbqvdrugId:7012 - PA	HEMATINIC AGENT
pegfilgrastim-jmdbdrugId:6903 - PA	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
pembrolizumabdrugId:4780 - PA	CHEMOTHERAPY
pemetrexeddrugId:1492	CHEMOTHERAPY
penbutololdrugId:1494 - PA	CARDIOVASCULAR
penciclovirdrugId:1495 - PA	ANTIVIRALS
penicillamine-Cuprimine BP	CHELATING AGENT
penicillamine-Depen	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 1	BIOLOGICAL
pentamidine	ANTIPARASITICS
Pentasa (mesalamine controlled-release)drugId:1154 - PA	GI ANTI-INFLAMMATORY
pentazocinedrugId:1502	OPIOID ANALGESICS
pentazocine / naloxonedrugId:1504 - PA	OPIOID ANALGESICS
pentosan	ANALGESICS
pentostatindrugId:2692	CHEMOTHERAPY
pentoxifylline	CARDIOVASCULAR
Pepcid (famotidine suspension)drugId:5602 - PA	H2 ANTAGONISTS
PepciddrugId:461 # (famotidine tablet)drugId:461 *	H2 ANTAGONISTS
perampanel - PA; See Table 20drugId:2926; See Table 71drugId:4444	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
perindopril / amlodipinedrugId:5287 - PA	CARDIOVASCULAR
Perjeta (pertuzumab)drugId:2583 - PA	CHEMOTHERAPY
permethrindrugId:1510 *	ANTIPARASITICS
permethrin creamdrugId:4700	ANTIPARASITICS
perphenazine - PA < 6 years; See Table 24drugId:6326; See Table 71drugId:1511	ANTIPSYCHOTIC
Perseris (risperidone extended-release subcutaneous injection) - PA; See Table 24drugId:7007; See Table 71drugId:7009	ANTIPSYCHOTIC
pertuzumabdrugId:2583 - PA	CHEMOTHERAPY
Pertzye DR (pancrelipase-Pertzye DR)drugId:2730	ENZYMES
petrolatum *	DERMATOLOGICAL
Pexeva (paroxetine mesylate) - PA; See Table 17drugId:1483; See Table 71drugId:3802	ANTIDEPRESSANTS
PfizerpendrugId:1499 # (penicillin G 5 million, 20 million units)drugId:1499	ANTIBIOTICS
phenazopyridine	ANALGESICS
phenelzine - PA < 6 years; See Table 17drugId:1515; See Table 71drugId:3580	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 BP	ELECTROLYTES AND NUTRIENTS
Picato (ingenol gel)drugId:2521 - PA	DERMATOLOGICAL
Pifeltro (doravirine)drugId:6986	ANTIVIRALS
pilocarpine	PARASYMPATHETIC AGENTS
pilocarpine eye dropsdrugId:2635	OPHTHALMIC PREPARATIONS
pimavanserindrugId:5588 - PA	ANTIPSYCHOTIC
pimecrolimusdrugId:1531 BP	DERMATOLOGICAL
pimozide - PA < 6 years; See Table 24drugId:6327; See Table 71drugId:1532	ANTIPSYCHOTIC
pindololdrugId:1533	CARDIOVASCULAR
Pin-X (pyrantel pamoate)drugId:6215	ANTIPARASITICS
pioglitazonedrugId:1534	DIABETIC AGENTS
pioglitazone / metformin extended-releasedrugId:1937 - PA	DIABETIC AGENTS
pioglitazone / metformindrugId:1536 - PA	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
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 1	BIOLOGICAL
pneumococcal vaccinedrugId:1544	BIOLOGICAL
Pneumovax (pneumococcal vaccine)drugId:1544	BIOLOGICAL
podofilox geldrugId:2261 - PA	DERMATOLOGICAL
podofilox solutiondrugId:1545	DERMATOLOGICAL
polidocanoldrugId:2934 - PA	CARDIOVASCULAR
poliovirus vaccine, inactivateddrugId:1546 1	BIOLOGICAL
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
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 BP - PA	FUNGICIDES
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 - PA	DIABETIC AGENTS
PrandindrugId:1642 # (repaglinide)drugId:1642	DIABETIC AGENTS
prasugreldrugId:1571 - PA	ANTIPLATELET AGENT
PravacholdrugId:2736 # (pravastatin 10 mg, 20 mg, 40 mg)drugId:2736 - PA > 45 units/month	LIPID LOWERING AGENTS
PravacholdrugId:1572 # (pravastatin 80 mg)drugId:1572 - PA > 30 units/month	LIPID LOWERING AGENTS
pravastatin 10 mg, 20 mg, 40 mgdrugId:2736 - PA > 45 units/month	LIPID LOWERING AGENTS
pravastatin 80 mgdrugId:1572 - PA > 30 units/month	LIPID LOWERING AGENTS
praziquanteldrugId:2358 BP	ANTIPARASITICS
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 BP - PA; See Table 20drugId:1582; See Table 71drugId:4460	ANTICONVULSANTS
pregabalin extended-release - PA; See Table 71drugId:6609; See Table 72drugId:6608	GABA ANALOGS
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
Prestalia (perindopril / amlodipine)drugId:5287 - PA	CARDIOVASCULAR
PrevaciddrugId:1021 # (lansoprazole capsule)drugId:1021 - PA ≥ 2 years	PROTON PUMP INHIBITORS
Prevacid Solutab (lansoprazole orally disintegrating tablet)drugId:1022 BP - PA ≥ 2 years	PROTON PUMP INHIBITORS
PrevalitedrugId:228 # (cholestyramine / aspartame-Prevalite)drugId:228	LIPID LOWERING AGENTS
Prevnar 13 (pneumococcal 13-valent conjugate vaccine)drugId:1542 1	BIOLOGICAL
Prevpac (lansoprazole / amoxicillin / clarithromycin)drugId:1023 - PA	H. PYLORI AGENTS
Prevymis (letermovir)drugId:6615 - PA	ANTIVIRALS
Prezcobix (darunavir / cobicistat)drugId:4792	ANTIVIRALS
Prezista (darunavir)drugId:330	ANTIVIRALS
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) - PA; See Table 17drugId:490; See Table 71drugId:3940	ANTIDEPRESSANTS
Privigen (immune globulin IV, human-Privigen)drugId:2197 - PA	BIOLOGICAL
Proair HFA (albuterol inhaler-Proair HFA)drugId:1 BP	BRONCHODILATORS
Proair Respiclick (albuterol inhalation powder)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
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
Prograf (tacrolimus injection)drugId:2741 ^	IMMUNOMODULATOR
PrografdrugId:1918 # (tacrolimus oral)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 1	BIOLOGICAL
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
ProtonixdrugId:1476 # (pantoprazole 20 mg tablet)drugId:1476 - PA > 30 units/month	PROTON PUMP INHIBITORS
ProtonixdrugId:2183 # (pantoprazole 40 mg tablet)drugId:2183 - PA > 60 units/month	PROTON PUMP INHIBITORS
Protonix IVdrugId:1477 # (pantoprazole IV)drugId:1477	PROTON PUMP INHIBITORS
Protopic (tacrolimus topical)drugId:1919 BP	DERMATOLOGICAL
protriptyline - PA < 6 years; See Table 17drugId:1606; See Table 71drugId:4140	ANTIDEPRESSANTS
Provenge (sipuleucel-T)drugId:2288 ^ - PA	CHEMOTHERAPY
Proventil (albuterol inhaler-Proventil)drugId:2 BP	BRONCHODILATORS
Provera # (medroxyprogesterone tablet)	HORMONE REPLACEMENT THERAPY
Provigil (modafinil)drugId:1373 - PA	CEREBRAL STIMULANTS
Prozac # (fluoxetine 10 mg, 20 mg, 40 mg capsule, solution) - PA < 6 years; See Table 17drugId:879; See Table 71drugId:3721	ANTIDEPRESSANTS
Prozac Weekly (fluoxetine 90 mg delayed-release capsule) - PA; See Table 17drugId:880; See Table 71drugId:3720	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
PulmicortdrugId:381 # (budesonide inhalation suspension)drugId:381	BRONCHODILATORS
Pulmozyme (dornase alfa)	ENZYMES
Purixan (mercaptopurine oral suspension)drugId:4632 - PA	CHEMOTHERAPY
Pylera (bismuth subcitrate / metronidazole / tetracycline)drugId:367 - PA	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
pyrimethaminedrugId:1614 - PA	ANTIMALARIALS

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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 10/09/19