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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
Tabloid (thioguanine)drugId:1693 CHEMOTHERAPY
Taclonex (betamethasone / calcipotriene ointment, scalp suspension)drugId:421 PA GLUCOCORTICOIDS
tacrolimus extended-release capsuledrugId:2838 IMMUNOMODULATOR
tacrolimus extended-release tabletdrugId:5249 PA IMMUNOMODULATOR
tacrolimus granulesdrugId:7264 PA IMMUNOMODULATOR
tacrolimus immediate-release capsuledrugId:1918 IMMUNOMODULATOR #
tacrolimus injectiondrugId:2741 IMMUNOMODULATOR ^
tacrolimus topicaldrugId:1919 DERMATOLOGICAL BP
tadalafil-AdcircadrugId:1920 PA CARDIOVASCULAR
tadalafil-CialisdrugId:2373 PA BENIGN PROSTATIC HYPERPLASIA AGENTS
tafamidisdrugId:7269 PA TRANSTHYRETIN STABILIZER
tafenoquinedrugId:7261 ANTIMALARIALS
Tafinlar (dabrafenib)drugId:2823 PA CHEMOTHERAPY
tafluprostdrugId:2524 PA OPHTHALMIC PREPARATIONS
tagraxofusp-erzsdrugId:7182 PA CHEMOTHERAPY
Tagrisso (osimertinib)drugId:5301 PA CHEMOTHERAPY
Takhzyro (lanadelumab-flyo)drugId:7008 PA BIOLOGICAL
talazoparibdrugId:7045 PA CHEMOTHERAPY
Talicia (omeprazole / amoxicillin / rifabutin)drugId:7380 PA H. PYLORI AGENTS
taliglucerase alfadrugId:2558 PA ENZYMES
talimogene laherparepvecdrugId:5440 PA CHEMOTHERAPY ^
Taltz (ixekizumab)drugId:5399 PA IMMUNOMODULATOR PD
Talwin (pentazocine)drugId:1502 OPIOID ANALGESICS
Talzenna (talazoparib)drugId:7045 PA CHEMOTHERAPY
Tambocor (flecainide) CARDIOVASCULAR #
TamifludrugId:1303 (oseltamivir 30mg)drugId:1303 PA > 20 units/ claim and PA > 40 units/ 365 days ANTIVIRALS #
TamifludrugId:1305 (oseltamivir 45 mg and 75 mg)drugId:1305 PA > 10 units/ claim and PA > 20 units/ 365 days ANTIVIRALS #
TamifludrugId:2314 (oseltamivir suspension)drugId:2314 PA > 180 mL/ claim and PA > 360 mL/ 365 days ANTIVIRALS #
tamoxifen solutiondrugId:4980 PA CHEMOTHERAPY
tamoxifen tabletdrugId:1921 CHEMOTHERAPY
tamsulosindrugId:1922 BENIGN PROSTATIC HYPERPLASIA AGENTS #
Tanzeum (albiglutide)drugId:2946 PA DIABETIC AGENTS
Tapazole (methimazole) THYROID PREPARATIONS #
tapentadol extended-releasedrugId:2369 PA OPIOID ANALGESICS
tapentadoldrugId:1923 PA OPIOID ANALGESICS
Tarceva (erlotinib)drugId:619 PA CHEMOTHERAPY BP
TargretindrugId:361 (bexarotene)drugId:361 CHEMOTHERAPY #
Tarka (trandolapril / verapamil)drugId:4812 PA CARDIOVASCULAR
Tasigna (nilotinib)drugId:1216 CHEMOTHERAPY
tasimelteondrugId:2960 PA SEDATIVE, NON-BARBITURATE
Tasmar (tolcapone)drugId:1722 PA ANTIPARKINSON
tavaboroledrugId:4629 PA FUNGICIDES
Tavalisse (fostamatinib)drugId:6823 PA HEMATOLOGIC
TaxoteredrugId:553 (docetaxel-Taxotere)drugId:553 CHEMOTHERAPY #
Taytulla (ethinyl estradiol / norethindrone / ferrous fumarate) CONTRACEPTIVES
tazarotene foamdrugId:2841 PA DERMATOLOGICAL
tazarotenedrugId:1657 PA DERMATOLOGICAL
tazemetostatdrugId:7381 PA CHEMOTHERAPY
Tazorac (tazarotene)drugId:1657 PA DERMATOLOGICAL
Tazverik (tazemetostat)drugId:7381 PA CHEMOTHERAPY
TBO-filgrastimdrugId:2889 PA HEMATINIC AGENT
Tecentriq (atezolizumab)drugId:5593 PA CHEMOTHERAPY
Tecfidera (dimethyl fumarate)drugId:2793 PA MULTIPLE SCLEROSIS AGENTS
tedizolid injectiondrugId:4636 PA ANTIBIOTICS
tedizolid tabletdrugId:4635 PA ANTIBIOTICS
teduglutide injectiondrugId:2722 PA GASTROINTESTINAL AGENT
Teflaro (ceftaroline)drugId:2179 PA ANTIBIOTICS
tegaseroddrugId:7302 PA CONSTIPATION AGENTS
Tegretol (carbamazepine-Tegretol); See Table 20drugId:170; See Table 71drugId:3280 PA < 6 years ANTICONVULSANTS #
Tegretol XR (carbamazepine extended-release-Tegretol XR); See Table 20drugId:2192; See Table 71drugId:3220 PA < 6 years ANTICONVULSANTS #
Tegsedi (inotersen)drugId:6988 PA OLIGONUCLEOTIDE AGENTS
Tekturna (aliskiren)drugId:13 PA CARDIOVASCULAR BP
Tekturna HCT (aliskiren / hydrochlorothiazide)drugId:14 PA CARDIOVASCULAR
telavancindrugId:1949 PA ANTIBIOTICS
telmisartan / hydrochlorothiazidedrugId:1663 PA CARDIOVASCULAR
telmisartandrugId:1660 PA CARDIOVASCULAR
telotristat ethyldrugId:6108 PA ANTIDIARRHEALS
temazepam 22.5 mg; See Table 69drugId:1666; See Table 71drugId:4351 PA BENZODIAZEPINES
temazepam 7.5 mg, 15 mg, 30 mg; See Table 69drugId:1665; See Table 71drugId:4352 PA < 6 years and PA >30 units/month BENZODIAZEPINES #
Temixys (lamivudine / tenofovir disoproxil fumarate)drugId:7277 PA ANTIVIRALS
TemodardrugId:1667 (temozolomide)drugId:1667 CHEMOTHERAPY #
TemovatedrugId:269 (clobetasol propionate cream, ointment)drugId:269 GLUCOCORTICOIDS #
Temovate EdrugId:5035 (clobetasol propionate / emollient)drugId:5035 GLUCOCORTICOIDS #
temozolomidedrugId:1667 CHEMOTHERAPY #
temsirolimusdrugId:1668 CHEMOTHERAPY #
Tenex (guanfacine); See Table 18drugId:5162; See Table 71drugId:691 PA < 3 years CARDIOVASCULAR #
teniposidedrugId:2699 CHEMOTHERAPY
Tenivac (diphtheria / tetanus toxoid vaccine)drugId:1686 BIOLOGICAL 1
tenofovir alafenamidedrugId:5768 PA ANTIVIRALS
tenofovir disoproxil fumarate powder; See Table 38drugId:2489; See Table 44drugId:5821 PA ≥ 13 years ANTIVIRALS
tenofovir disoproxil fumarate tablet; See Table 38drugId:1669; See Table 44drugId:5820 PA > 30 units/month ANTIVIRALS #
TenoreticdrugId:103 (atenolol / chlorthalidone)drugId:103 CARDIOVASCULAR #
TenormindrugId:102 (atenolol)drugId:102 CARDIOVASCULAR #
Terazol (terconazole) ANTIBIOTICS #
terazosin; See Table 18drugId:1670; See Table 19drugId:5165 CARDIOVASCULAR
terbinafine tabletdrugId:1672 FUNGICIDES #
terbutaline BRONCHODILATORS
terconazole ANTIBIOTICS #
teriflunomidedrugId:2657 PA MULTIPLE SCLEROSIS AGENTS
teriparatidedrugId:1678 PA HORMONE AGENTS
tesamorelindrugId:5626 PA OTHER HORMONES
Testim (testosterone 1% gel tube)drugId:1684 PA HORMONE REPLACEMENT THERAPY
Testopel (testosterone intramuscular pellet)drugId:1685 PA HORMONE REPLACEMENT THERAPY
testosterone 1.62% gel packet, pumpdrugId:2280 PA HORMONE REPLACEMENT THERAPY
testosterone 1% gel packetdrugId:2248 PA HORMONE REPLACEMENT THERAPY BP
testosterone 1% gel tube, packet, pumpdrugId:2948 PA HORMONE REPLACEMENT THERAPY
testosterone 1% gel tubedrugId:1684 PA HORMONE REPLACEMENT THERAPY
testosterone 2% gel pumpdrugId:2241 PA HORMONE REPLACEMENT THERAPY
testosterone 2% solutiondrugId:2237 PA HORMONE REPLACEMENT THERAPY
testosterone buccal systemdrugId:2647 PA HORMONE REPLACEMENT THERAPY
testosterone cypionatedrugId:1680 PA HORMONE REPLACEMENT THERAPY
testosterone enanthatedrugId:7050 PA HORMONE REPLACEMENT THERAPY
testosterone intramuscular pelletdrugId:1685 PA HORMONE REPLACEMENT THERAPY
testosterone patchdrugId:1682 PA HORMONE REPLACEMENT THERAPY
testosterone powderdrugId:2311 PA HORMONE REPLACEMENT THERAPY
testosterone undecanoate capsuledrugId:7371 PA HORMONE REPLACEMENT THERAPY
testosterone undecanoate injectiondrugId:2954 PA HORMONE REPLACEMENT THERAPY ^
tetanus immune globulin IM, humandrugId:1687 BIOLOGICAL
tetrabenazinedrugId:1688 PA NEUROLOGIC AGENT
tetracaine OPHTHALMIC PREPARATIONS
tetracyclinedrugId:1689 ANTIBIOTICS
tetradecyl sulfate injectiondrugId:2495 PA CARDIOVASCULAR
tezacaftor / ivacaftordrugId:6540 PA CYSTIC FIBROSIS AGENTS
thalidomidedrugId:1690 IMMUNOMODULATOR
Thalomid (thalidomide)drugId:1690 IMMUNOMODULATOR
theophyllinedrugId:1691 BRONCHODILATORS
Theracys (BCG live, intravesical)drugId:127 CHEMOTHERAPY
ThermazenedrugId:1852 (silver sulfadiazine-Thermazene)drugId:1852 ANTIBIOTICS #
thiaminedrugId:1692 ELECTROLYTES AND NUTRIENTS *
thioguaninedrugId:1693 CHEMOTHERAPY
Thiola (tiopronin) CHELATING AGENT
thioridazine; See Table 24drugId:6328; See Table 71drugId:1694 PA < 6 years ANTIPSYCHOTIC
thiothixene; See Table 24drugId:6329; See Table 71drugId:1696 PA < 6 years ANTIPSYCHOTIC #
Thymoglobulin (antithymocyte globulin, rabbit)drugId:1111 BIOLOGICAL
thyroid THYROID PREPARATIONS
Thyrolar (liotrix) THYROID PREPARATIONS
tiagabine; See Table 20drugId:2617; See Table 71drugId:4500 PA ANTICONVULSANTS
Tiazac ERdrugId:533 (diltiazem-Tiazac ER)drugId:533 CARDIOVASCULAR #
Tibsovo (ivosidenib)drugId:6925 PA CHEMOTHERAPY
ticagrelordrugId:2359 ANTIPLATELET AGENT
ticarcillin / clavulanatedrugId:1699 ANTIBIOTICS
Tigan (trimethobenzamide) ANTIEMETICS #
tigecyclinedrugId:1701 PA ANTIBIOTICS
Tiglutik (riluzole suspension)drugId:7010 PA AMYOTROPHIC LATERAL SCLEROSIS AGENTS
Tikosyn (dofetilide) CARDIOVASCULAR #
tildrakizumab-asmndrugId:7004 PA IMMUNOMODULATOR
Timentin (ticarcillin / clavulanate)drugId:1699 ANTIBIOTICS
timolol-IstaloldrugId:1703 OPHTHALMIC PREPARATIONS BP
timolol ophthalmic gel forming solutiondrugId:2211 PA OPHTHALMIC PREPARATIONS
timolol ophthalmic unit dose solutiondrugId:2210 PA OPHTHALMIC PREPARATIONS
timolol tabletdrugId:5020 CARDIOVASCULAR
timolol-TimopticdrugId:1704 OPHTHALMIC PREPARATIONS #
TimopticdrugId:1704 (timolol-Timoptic)drugId:1704 OPHTHALMIC PREPARATIONS #
Timoptic Ocudose (timolol ophthalmic unit dose solution)drugId:2210 PA OPHTHALMIC PREPARATIONS
Timoptic-XE (timolol ophthalmic gel forming solution)drugId:2211 PA OPHTHALMIC PREPARATIONS
Tindamax (tinidazole)drugId:1706 PA ANTIPARASITICS
tinidazoledrugId:1706 PA ANTIPARASITICS
tiopronin CHELATING AGENT
tiotropium / olodateroldrugId:5112 PA BRONCHODILATORS
tiotropium inhalation powderdrugId:1708 PA > 30 units/month BRONCHODILATORS
tiotropium inhalation solutiondrugId:4640 PA > 1 inhaler/month BRONCHODILATORS
tipranavirdrugId:1709 ANTIVIRALS
Tirosint (levothyroxine-Tirosint) THYROID PREPARATIONS
tisagenlecleuceldrugId:6404 PA CHEMOTHERAPY CO ^
Tivicay (dolutegravir)drugId:2852 PA > 30 units/month ANTIVIRALS
tizanidine capsuledrugId:1711 PA MUSCLE RELAXANT
tizanidine tabletdrugId:1712 MUSCLE RELAXANT #
TobidrugId:1713 (tobramycin inhalation solution-Tobi)drugId:1713 ANTIBIOTICS #
Tobi Podhaler (tobramycin inhalation powder)drugId:2794 PA ANTIBIOTICS
Tobradex (tobramycin 0.3% / dexamethasone 0.1%, ophthalmic ointment)drugId:2275 PA OPHTHALMIC PREPARATIONS
TobradexdrugId:1717 (tobramycin 0.3% / dexamethasone 0.1%, ophthalmic suspension)drugId:1717 OPHTHALMIC PREPARATIONS #
Tobradex ST (tobramycin 0.3% / dexamethasone 0.05%, ophthalmic suspension)drugId:2088 PA OPHTHALMIC PREPARATIONS
tobramycin / loteprednol ophthalmic suspensiondrugId:1718 PA OPHTHALMIC PREPARATIONS
tobramycin 0.3% / dexamethasone 0.05%, ophthalmic suspensiondrugId:2088 PA OPHTHALMIC PREPARATIONS
tobramycin 0.3% / dexamethasone 0.1%, ophthalmic ointmentdrugId:2275 PA OPHTHALMIC PREPARATIONS
tobramycin 0.3% / dexamethasone 0.1%, ophthalmic suspensiondrugId:1717 OPHTHALMIC PREPARATIONS #
tobramycin inhalation powderdrugId:2794 PA ANTIBIOTICS
tobramycin inhalation solution-BethkisdrugId:2884 PA ANTIBIOTICS
tobramycin inhalation solution-Kitabis PakdrugId:4781 ANTIBIOTICS BP
tobramycin inhalation solution-TobidrugId:1713 ANTIBIOTICS #
tobramycin injectiondrugId:2630 ANTIBIOTICS
tobramycin ophthalmic ointmentdrugId:1716 PA OPHTHALMIC PREPARATIONS
tobramycin ophthalmic solutiondrugId:1715 OPHTHALMIC PREPARATIONS #
Tobrex (tobramycin ophthalmic ointment)drugId:1716 PA OPHTHALMIC PREPARATIONS
TobrexdrugId:1715 (tobramycin ophthalmic solution)drugId:1715 OPHTHALMIC PREPARATIONS #
tocilizumabdrugId:1719 PA IMMUNOMODULATOR
tofacitinib extended-releasedrugId:5407 PA IMMUNOMODULATOR PD
tofacitinibdrugId:2660 PA IMMUNOMODULATOR PD
Tofranil (imipramine hydrochloride); See Table 17drugId:782; See Table 71drugId:4060 PA < 6 years ANTIDEPRESSANTS #
Tofranil-PM (imipramine pamoate); See Table 17drugId:2308; See Table 71drugId:4080 PA ANTIDEPRESSANTS
Tolak (fluorouracil 4% cream)drugId:5503 PA CHEMOTHERAPY
tolazamidedrugId:1720 DIABETIC AGENTS
tolbutamidedrugId:1721 DIABETIC AGENTS
tolcaponedrugId:1722 PA ANTIPARKINSON
tolmetindrugId:1723 PA NONSTEROIDAL ANTI-INFLAMMATORY
tolnaftatedrugId:1724 FUNGICIDES *
Tolsura (itraconazole 65 mg capsule)drugId:7011 PA FUNGICIDES
tolterodine extended-releasedrugId:1725 URINARY ANTISPASMODICS #
tolterodine immediate-releasedrugId:1726 URINARY ANTISPASMODICS #
tolvaptan-JynarquedrugId:6801 PA VASOPRESSIN ANTAGONISTS
tolvaptan-SamscadrugId:1728 PA VASOPRESSIN ANTAGONISTS
Topamax (topiramate); See Table 20drugId:1729; See Table 71drugId:4503 PA < 6 years ANTICONVULSANTS #
Topamax (topiramate sprinkle capsule); See Table 20drugId:2316; See Table 71drugId:4504 PA < 6 years ANTICONVULSANTS #
Topicort (desoximetasone 0.05% cream, ointment)drugId:5021 PA GLUCOCORTICOIDS
Topicort (desoximetasone 0.25% cream, ointment, spray, 0.05% gel)drugId:488 PA GLUCOCORTICOIDS
topiramate extended-release capsule-Qudexy XR; See Table 20drugId:2943; See Table 71drugId:4502 PA ANTICONVULSANTS
topiramate extended-release capsule-Trokendi XR; See Table 20drugId:2859; See Table 71drugId:4505 PA ANTICONVULSANTS
topiramate; See Table 20drugId:1729; See Table 71drugId:4503 PA < 6 years ANTICONVULSANTS #
topiramate powder; See Table 20drugId:7120; See Table 71drugId:7121 PA ANTICONVULSANTS
topiramate sprinkle capsule; See Table 20drugId:2316; See Table 71drugId:4504 PA < 6 years ANTICONVULSANTS #
topotecandrugId:1730 CHEMOTHERAPY #
Toprol XLdrugId:1337 (metoprolol extended-release tablet)drugId:1337 CARDIOVASCULAR #
toremifenedrugId:1731 CHEMOTHERAPY #
ToriseldrugId:1668 (temsirolimus)drugId:1668 CHEMOTHERAPY #
torsemidedrugId:1732 CARDIOVASCULAR #
Tosymra (sumatriptan 10 mg nasal spray)drugId:7335 PA TRIPTAN
Totect (dexrazoxane) ANTIDOTES
Toujeo (insulin glargine-Toujeo)drugId:4914 DIABETIC AGENTS
Toviaz (fesoterodine)drugId:850 URINARY ANTISPASMODICS BP
Tracleer (bosentan)drugId:372 PA CARDIOVASCULAR BP
Tradjenta (linagliptin)drugId:2293 DIABETIC AGENTS
tramadol / acetaminophendrugId:1737 PA ANALGESICS
tramadol 100 mgdrugId:7359 PA ANALGESICS
tramadol 50 mgdrugId:1735 PA < 12 years and PA > 400 mg/day ANALGESICS #
tramadol extended-release capsuledrugId:2362 PA ANALGESICS
tramadol extended-release tabletdrugId:1736 PA ANALGESICS
trametinibdrugId:2845 PA CHEMOTHERAPY
trandolaprildrugId:1738 CARDIOVASCULAR
trandolapril / verapamildrugId:4812 PA CARDIOVASCULAR
tranexamic acid tablet HEMOSTATICS #
Transderm-Scop (scopolamine transdermal patch)drugId:1835 PA ANTIEMETICS BP
Tranxene (clorazepate); See Table 69drugId:278; See Table 71drugId:4380 PA < 6 years BENZODIAZEPINES #
tranylcypromine; See Table 17drugId:1741; See Table 71drugId:3540 PA < 6 years ANTIDEPRESSANTS #
trastuzumabdrugId:1742 CHEMOTHERAPY
Travasol (amino acid and electrolyte IV infusion) ELECTROLYTES AND NUTRIENTS
Travatan Z (travoprost 0.004% eye drop)drugId:1743 OPHTHALMIC PREPARATIONS BP
travoprost 0.004% eye dropdrugId:1743 OPHTHALMIC PREPARATIONS BP
trazodone 300 mg tablet; See Table 17drugId:2062; See Table 71drugId:3862 PA ANTIDEPRESSANTS
trazodone 50 mg, 100 mg, 150 mg; See Table 17drugId:1744; See Table 71drugId:3861 PA < 6 years ANTIDEPRESSANTS
Treanda (bendamustine)drugId:134 CHEMOTHERAPY
Trecator (ethionamide)drugId:2499 TB PREPARATIONS
Trelegy (fluticasone furoate / umeclidinium / vilanterol)drugId:6408 PA BRONCHODILATORS
Trelstar (triptorelin)drugId:1766 PA CHEMOTHERAPY
Tremfya (guselkumab)drugId:6289 PA IMMUNOMODULATOR
treprostinil inhalation solutiondrugId:1746 PA CARDIOVASCULAR
treprostinil injectiondrugId:1745 PA CARDIOVASCULAR BP
treprostinil tabletdrugId:2940 PA CARDIOVASCULAR
Tresiba (insulin degludec)drugId:5302 DIABETIC AGENTS
tretinoin 0.05% geldrugId:2432 PA DERMATOLOGICAL
tretinoin 0.05% lotiondrugId:6900 PA DERMATOLOGICAL
tretinoin-AvitadrugId:1747 PA ≥ 22 years DERMATOLOGICAL #
tretinoin capsuledrugId:5135 CHEMOTHERAPY
tretinoin microspheresdrugId:1749 PA DERMATOLOGICAL
tretinoin-Retin-AdrugId:1748 PA ≥ 22 years DERMATOLOGICAL BP
Tretten (factor XIII A-subunit recombinant) ANTI-HEMOPHILIA AGENTS
Treximet (sumatriptan / naproxen)drugId:1916 PA TRIPTAN/NON STEROIDAL ANTI-INFLAMMATORY
triamcinolone, oral GLUCOCORTICOIDS
triamcinolone 0.025% cream, lotiondrugId:1753 GLUCOCORTICOIDS
triamcinolone 0.05% ointmentdrugId:2527 PA GLUCOCORTICOIDS
triamcinolone 0.1% creamdrugId:5029 GLUCOCORTICOIDS
triamcinolone 0.1% lotion, 0.025% ointmentdrugId:5028 GLUCOCORTICOIDS
triamcinolone 0.1% ointment, 0.5% creamdrugId:5030 GLUCOCORTICOIDS
triamcinolone 0.5% ointmentdrugId:5032 GLUCOCORTICOIDS
triamcinolone extended-release injectable suspensiondrugId:6415 PA GLUCOCORTICOIDS
triamcinolone injectiondrugId:1750 GLUCOCORTICOIDS
triamcinolone ophthalmic suspension OPHTHALMIC PREPARATIONS ^
triamcinolone OTC nasal spraydrugId:6241 PA > 1 inhaler/month NASAL PREPARATIONS
triamcinolone paste GLUCOCORTICOIDS #
triamcinolone spraydrugId:2526 PA GLUCOCORTICOIDS
triamterenedrugId:5247 PA CARDIOVASCULAR
triazolam; See Table 69drugId:1757; See Table 71drugId:4353 PA < 6 years and PA > 30 units/month BENZODIAZEPINES #
Tribenzor (amlodipine / olmesartan / hydrochlorothiazide)drugId:1969 PA CARDIOVASCULAR
triclabendazoledrugId:7283 PA ANTIPARASITICS
TricordrugId:467 (fenofibrate 48 mg, 145 mg tablet)drugId:467 LIPID LOWERING AGENTS #
trientine CHELATING AGENT BP
Triesence (triamcinolone ophthalmic suspension) OPHTHALMIC PREPARATIONS ^
trifarotenedrugId:7369 PA DERMATOLOGICAL
Triferic (ferric pyrophosphate citrate)drugId:6021 ELECTROLYTES AND NUTRIENTS ^
trifluoperazine; See Table 24drugId:6330; See Table 71drugId:1760 PA < 6 years ANTIPSYCHOTIC
trifluridine OPHTHALMIC PREPARATIONS #
trifluridine / tipiracildrugId:5261 PA CHEMOTHERAPY
Triglide (fenofibrate 160 mg tablet)drugId:472 LIPID LOWERING AGENTS
trihexyphenidyldrugId:1762 ANTIPARKINSON
Trikafta (elexacaftor / tezacaftor / ivacaftor)drugId:7278 PA CYSTIC FIBROSIS AGENTS
Trileptal (oxcarbazepine); See Table 20drugId:1311; See Table 71drugId:4442 PA < 6 years ANTICONVULSANTS #
TrilipixdrugId:837 (fenofibric acid)drugId:837 LIPID LOWERING AGENTS #
Triluron (hyaluronate-Triluron)drugId:7268 - Non-Drug Product PA NON-DRUG PRODUCT
trimethobenzamide ANTIEMETICS #
trimethoprim / polymyxin B ophthalmic solutiondrugId:2060 OPHTHALMIC PREPARATIONS #
trimethoprim tabletdrugId:4886 ANTIBIOTICS
trimipramine; See Table 17drugId:1765; See Table 71drugId:4160 PA < 6 years ANTIDEPRESSANTS #
Tri-Norinyl (ethinyl estradiol / norethindrone-Tri-Norinyl) CONTRACEPTIVES #
Trintellix (vortioxetine); See Table 17drugId:2885; See Table 71drugId:3881 PA ANTIDEPRESSANTS
triple antibiotic ointment (neomycin / bacitracin / polymyxin B topical ointment)drugId:1994 ANTIBIOTICS *
Triptodur (triptorelin)drugId:6486 PA HORMONE AGENTS
triptorelindrugId:1766 PA CHEMOTHERAPY
TrisenoxdrugId:2697 (arsenic trioxide)drugId:2697 CHEMOTHERAPY #
Triumeq (abacavir / dolutegravir / lamivudine)drugId:4642 ANTIVIRALS PD
Trivisc (hyaluronate-Trivisc)drugId:6926 - Non-Drug Product PA NON-DRUG PRODUCT
TrizivirdrugId:139 (abacavir / lamivudine / zidovudine)drugId:139 ANTIVIRALS #
Trogarzo (ibalizumab-uiyk)drugId:6687 PA ANTIVIRALS
Trokendi XR (topiramate extended-release capsule-Trokendi XR); See Table 20drugId:2859; See Table 71drugId:4505 PA ANTICONVULSANTS
tropicamide OPHTHALMIC PREPARATIONS #
trospium extended-releasedrugId:1769 PA URINARY ANTISPASMODICS
trospium immediate-releasedrugId:1770 URINARY ANTISPASMODICS
Trulance (plecanatide)drugId:6043 PA CONSTIPATION AGENTS
Trulicity (dulaglutide)drugId:4814 DIABETIC AGENTS PD
Trumenba (meningococcal group B vaccine-Trumenba)drugId:4815 BIOLOGICAL 1
TrusoptdrugId:563 (dorzolamide)drugId:563 OPHTHALMIC PREPARATIONS #
Truvada (emtricitabine / tenofovir disoproxil fumarate)drugId:597 ANTIVIRALS
Truxima (rituximab-abbs)drugId:7382 PA CHEMOTHERAPY
Tudorza (aclidinium)drugId:2649 PA > 1 inhaler/month BRONCHODILATORS
Turalio (pexidartinib)drugId:7279 PA CHEMOTHERAPY
Twinrix (hepatitis A, inactivated / hepatitis B recombinant)drugId:2627 BIOLOGICAL 1
Twynsta (amlodipine / telmisartan)drugId:1661 PA CARDIOVASCULAR
Tybost (cobicistat)drugId:4816 ANTIVIRALS
Tygacil (tigecycline)drugId:1701 PA ANTIBIOTICS
Tykerb (lapatinib)drugId:1025 CHEMOTHERAPY
Tylenol / CodeinedrugId:146 (acetaminophen / codeine)drugId:146 PA < 12 years and PA > 4 g/day acetaminophen and PA > 360 mg/day codeine OPIOID ANALGESICS #
Tymlos (abaloparatide)drugId:6362 PA HORMONE AGENTS
Typhim VI (typhoid vaccine injection)drugId:1771 BIOLOGICAL
typhoid vaccine capsuledrugId:2628 BIOLOGICAL
typhoid vaccine injectiondrugId:1771 BIOLOGICAL
Tysabri (natalizumab)drugId:1177 MULTIPLE SCLEROSIS AGENTS
Tyvaso (treprostinil inhalation solution)drugId:1746 PA CARDIOVASCULAR

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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