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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.


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MassHealth Drug List table
Drug - Brand Name (Generic Name) Class
Sabril (vigabatrin) BP - PA; See Table 20drugId:1802; See Table 71drugId:4481 ANTICONVULSANTS
saccharomyces boulardiidrugId:6207 - PA ≥ 19 years GASTROINTESTINAL AGENT
sacubitril / valsartandrugId:5125 - PA CARDIOVASCULAR
safinamidedrugId:6185 - PA ANTIPARKINSON
Safyral # (ethinyl estradiol / drospirenone / levomefolate-Safyral) CONTRACEPTIVES
Saizen (somatropin-Saizen)drugId:1886 - PA HORMONE AGENTS
Salagen # (pilocarpine) PARASYMPATHETIC AGENTS
salicylic aciddrugId:1827 o DERMATOLOGICAL
saliva substitute * ELECTROLYTES AND NUTRIENTS
salmeteroldrugId:1829 - PA BRONCHODILATORS
salsalatedrugId:1830 - PA NONSTEROIDAL ANTI-INFLAMMATORY
samarium Sm 153 lexidronam ^ CHEMOTHERAPY
Samsca (tolvaptan-Samsca)drugId:1728 - PA VASOPRESSIN ANTAGONISTS
Sancuso (granisetron transdermal system)drugId:685 - PA ANTIEMETICS
SandimmunedrugId:2092 # (cyclosporine)drugId:2092 IMMUNOMODULATOR
SandostatindrugId:1269 # (octreotide)drugId:1269 ENDOCRINE/METABOLIC AGENTS
Sandostatin LAR (octreotide injectable suspension)drugId:2497 ENDOCRINE/METABOLIC AGENTS
Santyl (collagenase) ENZYMES
Saphris (asenapine) - PA; See Table 24drugId:97; See Table 71drugId:4260 ANTIPSYCHOTIC
sapropterin ENZYMES
saquinavirdrugId:1832 ANTIVIRALS
Sarafem (fluoxetine 20 mg tablet for premenstrual dysphoric disorder) - PA; See Table 17drugId:2589; See Table 71drugId:3741 ANTIDEPRESSANTS
Sarafem # (fluoxetine 10 mg tablet for premenstrual dysphoric disorder) - PA < 6 years; See Table 17drugId:881; See Table 71drugId:3740 ANTIDEPRESSANTS
sargramostimdrugId:1833 HEMATINIC AGENT
sarilumabdrugId:6181 - PA IMMUNOMODULATOR
Savaysa (edoxaban)drugId:4795 - PA ANTICOAGULANTS
Savella (milnacipran)drugId:1358 - PA ANALGESICS
saxagliptin / metformin extended-releasedrugId:2103 - PA DIABETIC AGENTS
saxagliptindrugId:1834 - PA DIABETIC AGENTS
scopolamine ANTISPASMODICS,ANTICHOLINERGIC
scopolamine transdermal patchdrugId:1835 BP - PA ANTIEMETICS
Seasonique # (levonorgestrel / ethinyl estradiol-Seasonique) CONTRACEPTIVES
sebelipase alfadrugId:5388 - PA ENZYMES
secnidazoledrugId:6523 - PA ANTIBIOTICS
secobarbitaldrugId:1837 BARBITURATES
Seconal (secobarbital)drugId:1837 BARBITURATES
secukinumabdrugId:4908 - PA IMMUNOMODULATOR
Seebri (glycopyrrolate inhalation powder)drugId:5393 - PA > 1 inhaler/month BRONCHODILATORS
Segluromet (ertugliflozin / metformin)drugId:6616 - PA DIABETIC AGENTS
selegiline capsule, tabletdrugId:2378 ANTIPARKINSON
selegiline orally disintegrating tabletdrugId:1839 - PA ANTIPARKINSON
selegiline transdermal patch - PA; See Table 17drugId:1840; See Table 71drugId:3560 ANTIDEPRESSANTS
selenium sulfide * DERMATOLOGICAL
selexipagdrugId:5401 - PA CARDIOVASCULAR
Selzentry (maraviroc)drugId:1119 - PA ANTIVIRALS
semaglutidedrugId:6613 - PA DIABETIC AGENTS
Semprex-D (acrivastine / pseudoephedrine)drugId:1608 - PA DECONGESTANT
sennosidesdrugId:1842 * LAXATIVES
Sensipar (cinacalcet) BP CALCIMIMETIC
Sensorcaine # (bupivacaine) ANESTHETICS
Serevent (salmeterol)drugId:1829 - PA BRONCHODILATORS
Sernivo (betamethasone dipropionate spray)drugId:5396 - PA GLUCOCORTICOIDS
Seromycin (cycloserine)drugId:2498 TB PREPARATIONS
Seroquel # (quetiapine) - PA < 6 years and PA > 90 units/month; See Table 24drugId:1618; See Table 71drugId:4293 ANTIPSYCHOTIC
Seroquel XR # (quetiapine extended-release 150 mg, 200 mg) - PA < 6 years or ≥ 18 years old and PA > 30 units/month; See Table 24drugId:1617; See Table 71drugId:4294 ANTIPSYCHOTIC
Seroquel XR # (quetiapine extended-release 50 mg, 300 mg and 400 mg) - PA < 6 years or ≥ 18 years and PA > 60 units/month; See Table 24drugId:1616; See Table 71drugId:4295 ANTIPSYCHOTIC
Serostim (somatropin-Serostim)drugId:1887 - PA HORMONE AGENTS
sertaconazoledrugId:1843 - PA ANTIBIOTICS
sertraline - PA < 6 years; See Table 17drugId:1845; See Table 71drugId:3820 ANTIDEPRESSANTS
sevelamer carbonate BP ELECTROLYTES AND NUTRIENTS
sevelamer hydrochloride ELECTROLYTES AND NUTRIENTS
Shingrix (zoster vaccine recombinant, adjuvanted)drugId:6407 - PA < 50 years BIOLOGICAL
Signifor (pasireotide)drugId:2791 - PA ENDOCRINE/METABOLIC AGENTS
Signifor LAR (pasireotide injectable suspension)drugId:4912 - PA ENDOCRINE/METABOLIC AGENTS
Siklos (hydroxyurea)drugId:6821 HEMATOLOGIC
sildenafil 20 mg tabletdrugId:1848 - PA CARDIOVASCULAR
sildenafil oral suspensiondrugId:4793 - PA CARDIOVASCULAR
Silenor (doxepin tablet-Silenor) - PA; See Table 15drugId:2082; See Table 71drugId:4346 SEDATIVES
Siliq (brodalumab)drugId:6042 - PA IMMUNOMODULATOR
silodosindrugId:1849 - PA BENIGN PROSTATIC HYPERPLASIA AGENTS
siltuximabdrugId:4540 - PA BIOLOGICAL
SilvadenedrugId:1850 # (silver sulfadiazine-Silvadene)drugId:1850 ANTIBIOTICS
silver sulfadiazine-SilvadenedrugId:1850 ANTIBIOTICS
silver sulfadiazine-SSDdrugId:2534 ANTIBIOTICS
silver sulfadiazine-ThermazenedrugId:1852 ANTIBIOTICS
Simbrinza (brinzolamide / brimonidine tartrate ophthalmic suspension)drugId:2849 - PA OPHTHALMIC PREPARATIONS
simeprevirdrugId:2880 - PA ANTIVIRALS
simethicone * GASTROINTESTINAL AGENT
simple syrup * COMPOUNDING AGENT
Simponi (golimumab)drugId:681 - PA IMMUNOMODULATOR
Simponi Aria (golimumab for infusion)drugId:2850 - PA IMMUNOMODULATOR
Simulect (basiliximab)drugId:2382 BIOLOGICAL
simvastatin 5 mg, 10 mg, 20 mg, 40 mgdrugId:2737 - PA > 45 units/month LIPID LOWERING AGENTS
simvastatin 80 mgdrugId:1855 - PA > 30 units/month LIPID LOWERING AGENTS
sinecatechinsdrugId:1856 - PA ANTIVIRALS
SinemetdrugId:175 # (carbidopa / levodopa tablet)drugId:175 ANTIPARKINSON
Sinemet CRdrugId:1997 # (carbidopa / levodopa extended-release tablet)drugId:1997 ANTIPARKINSON
Singulair (montelukast granules)drugId:5129 - PA BRONCHODILATORS
SingulairdrugId:1383 # (montelukast tablet, chewable tablet)drugId:1383 BRONCHODILATORS
Sinuva (mometasone sinus implant)drugId:6684 - PA NASAL PREPARATIONS
sipuleucel-TdrugId:2288 ^ - PA CHEMOTHERAPY
sirolimusdrugId:1857 IMMUNOMODULATOR
Sirturo (bedaquiline)drugId:2851 - PA TB PREPARATIONS
sitagliptin / metformin extended-releasedrugId:2485 - PA DIABETIC AGENTS
sitagliptin / metformindrugId:1859 - PA DIABETIC AGENTS
sitagliptindrugId:1858 - PA DIABETIC AGENTS
Sitavig (acyclovir buccal tablet)drugId:2945 - PA ANTIVIRALS
Sivextro (tedizolid injection)drugId:4636 - PA ANTIBIOTICS
Sivextro (tedizolid tablet)drugId:4635 - PA ANTIBIOTICS
Skelaxin (metaxalone)drugId:1156 - PA MUSCLE RELAXANT
Sklice (ivermectin lotion)drugId:2584 - PA ANTIPARASITICS
Skyla (levonorgestrel-releasing intrauterine system 13.5 mg) CONTRACEPTIVES
sodium bicarbonate * ELECTROLYTES AND NUTRIENTS
sodium chloride 3.5%, 7% for inhalation - Non-Drug Product NON-DRUG PRODUCT
sodium chloride 6% for inhalation - Non-Drug Product NON-DRUG PRODUCT
sodium chloride for inhalation * - Non-Drug Product ELECTROLYTES AND NUTRIENTS
sodium chloride solution ELECTROLYTES AND NUTRIENTS
sodium chloride tablet * ELECTROLYTES AND NUTRIENTS
sodium citrate / citric acid ELECTROLYTES AND NUTRIENTS
sodium ferric gluconate complexdrugId:1865 - PA ELECTROLYTES AND NUTRIENTS
sodium fluoride chewable tablet, oral solution * ELECTROLYTES AND NUTRIENTS
sodium fluoride oral rinse ELECTROLYTES AND NUTRIENTS
sodium oxybatedrugId:1870 - PA SEDATIVES
sodium phenylacetate / sodium benzoate ELECTROLYTES AND NUTRIENTS
sodium phenylbutyrate powder ENZYMES
sodium phenylbutyrate tablet BP ENZYMES
sodium phosphate * GASTROINTESTINAL AGENT
sodium phosphatedrugId:1873 - PA LAXATIVES
sodium picosulfate / magnesium oxide / anhydrous citric acid-ClenpiqdrugId:6380 - PA LAXATIVES
sodium picosulfate / magnesium oxide / anhydrous citric acid-PrepopikdrugId:2644 - PA LAXATIVES
sodium polystyrene sulfonatedrugId:1874 CHELATING AGENT
sodium sulfate / potassium sulfate / magnesium sulfatedrugId:2086 - PA LAXATIVES
sofosbuvir / velpatasvir / voxilaprevirdrugId:6364 PD - PA ANTIVIRALS
sofosbuvir / velpatasvirdrugId:5540 PD - PA ANTIVIRALS
sofosbuvirdrugId:2879 PD - PA ANTIVIRALS
Solaraze (diclofenac 3% gel)drugId:508 - PA CHEMOTHERAPY
solifenacindrugId:1879 - PA URINARY ANTISPASMODICS
Soliqua (insulin glargine / lixisenatide)drugId:5766 - PA DIABETIC AGENTS
Soliris (eculizumab)drugId:589 - PA BIOLOGICAL
Solodyn (minocycline extended-release tablet)drugId:1364 - PA ANTIBIOTICS
Solosec (secnidazole)drugId:6523 - PA ANTIBIOTICS
Soltamox (tamoxifen solution)drugId:4980 - PA CHEMOTHERAPY
Solu-CortefdrugId:729 # (hydrocortisone injection-Solu-Cortef)drugId:729 GLUCOCORTICOIDS
Solu-MedroldrugId:964 # (methylprednisolone sodium succinate)drugId:964 GLUCOCORTICOIDS
Soma (carisoprodol)drugId:180 - PA MUSCLE RELAXANT
somatropin-GenotropindrugId:1880 PD - PA HORMONE AGENTS
somatropin-HumatropedrugId:1881 - PA HORMONE AGENTS
somatropin-NorditropindrugId:1882 - PA HORMONE AGENTS
somatropin-Nutropin AQdrugId:1884 - PA HORMONE AGENTS
somatropin-OmnitropedrugId:1885 - PA HORMONE AGENTS
somatropin-SaizendrugId:1886 - PA HORMONE AGENTS
somatropin-SerostimdrugId:1887 - PA HORMONE AGENTS
somatropin-ZomactondrugId:5002 - PA HORMONE AGENTS
somatropin-ZorbtivedrugId:1889 - PA HORMONE AGENTS
Somatuline (lanreotide)drugId:1020 ENDOCRINE/METABOLIC AGENTS
Somavert (pegvisomant)drugId:1491 - PA HORMONE AGENTS
Sonata # (zaleplon) - PA < 6 years and PA > 30 units/month; See Table 15drugId:1817; See Table 71drugId:4354 SEDATIVES
sonidegibdrugId:5284 - PA CHEMOTHERAPY
Soolantra (ivermectin cream)drugId:4813 - PA DERMATOLOGICAL
sorafenibdrugId:1890 - PA CHEMOTHERAPY
SoriatanedrugId:153 # (acitretin)drugId:153 DERMATOLOGICAL
Sorilux (calcipotriene foam)drugId:2560 - PA DERMATOLOGICAL
sotalol solutiondrugId:4913 - PA CARDIOVASCULAR
sotalol tabletdrugId:1891 CARDIOVASCULAR
Sotradecol (tetradecyl sulfate injection)drugId:2495 - PA CARDIOVASCULAR
Sotylize (sotalol solution)drugId:4913 - PA CARDIOVASCULAR
Sovaldi (sofosbuvir)drugId:2879 PD - PA ANTIVIRALS
spinosaddrugId:2239 - PA ANTIPARASITICS
Spinraza (nusinersen)drugId:6020 - PA BIOLOGICAL
Spiriva Handihaler (tiotropium inhalation powder)drugId:1708 - PA > 30 units/month BRONCHODILATORS
Spiriva Respimat (tiotropium inhalation solution)drugId:4640 - PA > 1 inhaler/month BRONCHODILATORS
spironolactone / hydrochlorothiazidedrugId:1893 CARDIOVASCULAR
spironolactone suspensiondrugId:6280 - PA ALDOSTERONE ANTAGONISTS
spironolactone tabletdrugId:1892 ALDOSTERONE ANTAGONISTS
SporanoxdrugId:988 # (itraconazole capsule, solution)drugId:988 FUNGICIDES
Spritam (levetiracetam tablet for oral suspension) - PA; See Table 20drugId:5397; See Table 71drugId:5398 ANTICONVULSANTS
Sprix (ketorolac nasal spray)drugId:2289 - PA NONSTEROIDAL ANTI-INFLAMMATORY
Sprycel (dasatinib)drugId:331 CHEMOTHERAPY
SSDdrugId:2534 # (silver sulfadiazine-SSD)drugId:2534 ANTIBIOTICS
Stalevo (carbidopa / levodopa / entacapone)drugId:176 - PA ANTIPARKINSON
Stamaril (yellow fever vaccine, live)drugId:6106 BIOLOGICAL
StarlixdrugId:1178 # (nateglinide)drugId:1178 DIABETIC AGENTS
stavudinedrugId:1894 ANTIVIRALS
Steglatro (ertugliflozin)drugId:6617 - PA DIABETIC AGENTS
Steglujan (ertugliflozin / sitagliptin)drugId:6618 - PA DIABETIC AGENTS
Stelara (ustekinumab)drugId:1777 - PA IMMUNOMODULATOR
Stimate (desmopressin-Stimate) HORMONE AGENTS
Stiolto (tiotropium / olodaterol)drugId:5112 - PA BRONCHODILATORS
Stivarga (regorafenib)drugId:2646 - PA CHEMOTHERAPY
Strattera # (atomoxetine) - PA < 6 years; See Table 31drugId:104; See Table 71drugId:3080 NONSTIMULANT ADHD AGENTS
Strensiq (asfotase alfa)drugId:5300 - PA ENZYMES
streptomycindrugId:2496 ANTIBIOTICS
streptozocindrugId:2700 CHEMOTHERAPY
Striant (testosterone buccal system)drugId:2647 - PA HORMONE REPLACEMENT THERAPY
Stribild (elvitegravir / cobicistat / emtricitabine / tenofovir disoproxil fumarate)drugId:2648 ANTIVIRALS
Striverdi (olodaterol)drugId:4641 - PA BRONCHODILATORS
StromectoldrugId:989 # (ivermectin tablet)drugId:989 ANTIPARASITICS
Sublocade (buprenorphine extended-release injection)drugId:6524 - PA ALCOHOL AND DRUG CESSATION AGENT
Suboxone (buprenorphine / naloxone film)drugId:2056 PD - PA > 180 days (> 16 mg/day and ≤ 24 mg/day) ALCOHOL AND DRUG CESSATION AGENT
Suboxone (buprenorphine / naloxone film)drugId:2049 PD - PA > 32 mg/day ALCOHOL AND DRUG CESSATION AGENT
Suboxone (buprenorphine / naloxone film)drugId:2050 PD - PA > 90 days (> 24 mg/day and ≤ 32 mg/day) ALCOHOL AND DRUG CESSATION AGENT
Suboxone (buprenorphine / naloxone film ≤ 16 mg/day)drugId:2085 PD ALCOHOL AND DRUG CESSATION AGENT
Subsys (fentanyl sublingual spray)drugId:2523 - PA OPIOID ANALGESICS
succimer CHELATING AGENT
sucralfate ANTACIDS
sucroferric oxyhydroxide ELECTROLYTES AND NUTRIENTS
Sufenta (sufentanil injection)drugId:2566 OPIOID ANALGESICS
sufentanil injectiondrugId:2566 OPIOID ANALGESICS
sufentanil powderdrugId:1897 - PA OPIOID ANALGESICS
Sular (nisoldipine)drugId:1219 - PA CARDIOVASCULAR
sulconazoledrugId:1898 - PA ANTIBIOTICS
sulfacetamide / prednisolone sodium acetate ophthalmic ointment, suspensiondrugId:1877 - PA OPHTHALMIC PREPARATIONS
sulfacetamide / prednisolone sodium phosphate ophthalmic solutiondrugId:2272 OPHTHALMIC PREPARATIONS
sulfacetamide ophthalmic ointment, solutiondrugId:1901 OPHTHALMIC PREPARATIONS
sulfacetamidedrugId:1899 - PA ≥ 22 years DERMATOLOGICAL
sulfadiazinedrugId:1906 ANTIBIOTICS
sulfamethoxazole / trimethoprim injectiondrugId:5661 ANTIBIOTICS
sulfamethoxazole / trimethoprim suspensiondrugId:5133 ANTIBIOTICS
sulfamethoxazole / trimethoprim tabletdrugId:1907 ANTIBIOTICS
SulfamylondrugId:1113 # (mafenide)drugId:1113 ANTIBIOTICS
sulfanilamidedrugId:1909 ANTIBIOTICS
sulfasalazinedrugId:1910 GI ANTI-INFLAMMATORY
sulfasalazine delayed-releasedrugId:4864 GI ANTI-INFLAMMATORY
SulfatrimdrugId:5133 # (sulfamethoxazole / trimethoprim suspension)drugId:5133 ANTIBIOTICS
sulindacdrugId:1912 NONSTEROIDAL ANTI-INFLAMMATORY
sumatriptan / naproxendrugId:1916 BP - PA TRIPTAN/NON STEROIDAL ANTI-INFLAMMATORY
sumatriptan injection-ImitrexdrugId:1914 - PA TRIPTAN
sumatriptan injection-SumaveldrugId:2245 - PA TRIPTAN
sumatriptan injection-ZembracedrugId:5599 - PA TRIPTAN
sumatriptan nasal powderdrugId:5590 - PA TRIPTAN
sumatriptan nasal spraydrugId:1913 - PA TRIPTAN
sumatriptan tabletdrugId:1915 - PA > 18 units/month TRIPTAN
Sumavel (sumatriptan injection-Sumavel)drugId:2245 - PA TRIPTAN
sunitinibdrugId:1917 - PA CHEMOTHERAPY
Supartz (hyaluronate-Supartz)drugId:4809 - PA; Non-Drug Product NON-DRUG PRODUCT
Supprelin LA (histrelin-Supprelin LA)drugId:710 - PA HORMONE AGENTS
Suprax (cefixime)drugId:196 - PA ANTIBIOTICS
Suprep Bowel Kit (sodium sulfate / potassium sulfate / magnesium sulfate)drugId:2086 - PA LAXATIVES
Surmontil # (trimipramine) - PA < 6 years; See Table 17drugId:1765; See Table 71drugId:4160 ANTIDEPRESSANTS
Sustiva (efavirenz)drugId:590 BP ANTIVIRALS
Sustol (granisetron extended-release injection)drugId:5767 - PA > 2 units/28 days ANTIEMETICS
Sutent (sunitinib)drugId:1917 - PA CHEMOTHERAPY
suvorexant - PA; See Table 15drugId:4903; See Table 71drugId:4904 SEDATIVE, NON-BARBITURATE
Sylatron (peginterferon alfa-2b-Sylatron) ANTIVIRALS
Sylvant (siltuximab)drugId:4540 - PA BIOLOGICAL
Symbicort (budesonide / formoterol)drugId:383 - PA BRONCHODILATORS
Symbyax (olanzapine / fluoxetine) - PA; See Table 17drugId:2058; See Table 24drugId:1279; See Table 71drugId:4264 ANTIDEPRESSANTS
Symdeko (tezacaftor / ivacaftor)drugId:6540 - PA CYSTIC FIBROSIS AGENTS
Symfi (efavirenz / lamivudine / tenofovir disoproxil fumarate)drugId:6782 - PA ANTIVIRALS
Symfi Lo (efavirenz / lamivudine / tenofovir disoproxil fumarate)drugId:6783 - PA ANTIVIRALS
Symlin (pramlintide)drugId:1570 - PA DIABETIC AGENTS
Symproic (naldemedine)drugId:6619 - PA CONSTIPATION AGENTS
Symtuza (darunavir / cobicistat / emtricitabine / tenofovir alafenamide)drugId:6822 - PA ANTIVIRALS
Synagis (palivizumab)drugId:1472 - PA ANTIVIRALS
Synalar (fluocinolone cream kit)drugId:5062 - PA GLUCOCORTICOIDS
Synalar (fluocinolone ointment kit)drugId:5063 - PA GLUCOCORTICOIDS
Synalar (fluocinolone solution kit)drugId:5064 - PA GLUCOCORTICOIDS
SynalardrugId:5060 # (fluocinolone 0.025% cream)drugId:5060 GLUCOCORTICOIDS
SynalardrugId:5061 # (fluocinolone ointment)drugId:5061 GLUCOCORTICOIDS
SynalardrugId:2632 # (fluocinolone solution)drugId:2632 GLUCOCORTICOIDS
Synalgos-DC (dihydrocodeine / aspirin / caffeine)drugId:525 - PA OPIOID ANALGESICS
Synarel (nafarelin)drugId:1420 - PA HORMONE AGENTS
Syndros (dronabinol solution)drugId:6361 - PA ANTIEMETICS
Synera (lidocaine / tetracaine)drugId:1075 - PA > 4 patches / month ANESTHETICS
Synercid (dalfopristin / quinupristin)drugId:2037 - PA ANTIBIOTICS
Synjardy (empagliflozin / metformin)drugId:5113 - PA DIABETIC AGENTS
Synjardy XR (empagliflozin / metformin extended-release)drugId:6107 - PA DIABETIC AGENTS
Synribo (omacetaxine mepesuccinate)drugId:2659 - PA CHEMOTHERAPY
Synthroid # (levothyroxine-Synthroid) THYROID PREPARATIONS
Synvisc (hylan G-F20-Synvisc)drugId:4810 - PA; Non-Drug Product NON-DRUG PRODUCT
Synvisc-One (hylan G-F20-Synvisc-One)drugId:4811 - PA; Non-Drug Product NON-DRUG PRODUCT
Syprine (trientine) BP CHELATING AGENT

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.
 
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 10/22/18