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Medication Lookup
The results below have been sorted using a 2-tier plan. For the most accurate search results, check your plan details and choose another tier plan from the drop-down menu near the search bar.
10MG/0.2ML INJ
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Note TitleStep TherapyDefinitionThis medication is covered through the pharmacy benefit, and is part of our Step Therapy program, which helps your doctor provide you with safe, effective, and affordable medications.
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Note TitleNot Available Through Mail ServiceDefinitionThis medication is not available through the mail service pharmacy
12.5MG/0.25ML INJ
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Note TitleStep TherapyDefinitionThis medication is covered through the pharmacy benefit, and is part of our Step Therapy program, which helps your doctor provide you with safe, effective, and affordable medications.
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Note TitleNot Available Through Mail ServiceDefinitionThis medication is not available through the mail service pharmacy
15MG/0.3ML INJ
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Note TitleStep TherapyDefinitionThis medication is covered through the pharmacy benefit, and is part of our Step Therapy program, which helps your doctor provide you with safe, effective, and affordable medications.
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Note TitleNot Available Through Mail ServiceDefinitionThis medication is not available through the mail service pharmacy
17.5MG/0.35ML INJ
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Note TitleStep TherapyDefinitionThis medication is covered through the pharmacy benefit, and is part of our Step Therapy program, which helps your doctor provide you with safe, effective, and affordable medications.
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Note TitleNot Available Through Mail ServiceDefinitionThis medication is not available through the mail service pharmacy
20MG/0.4ML INJ
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Note TitleStep TherapyDefinitionThis medication is covered through the pharmacy benefit, and is part of our Step Therapy program, which helps your doctor provide you with safe, effective, and affordable medications.
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Note TitleNot Available Through Mail ServiceDefinitionThis medication is not available through the mail service pharmacy
22.5MG/0.45ML INJ
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Note TitleStep TherapyDefinitionThis medication is covered through the pharmacy benefit, and is part of our Step Therapy program, which helps your doctor provide you with safe, effective, and affordable medications.
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Note TitleNot Available Through Mail ServiceDefinitionThis medication is not available through the mail service pharmacy
27.5MG/0.55ML INJ
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Note TitleStep TherapyDefinitionThis medication is covered through the pharmacy benefit, and is part of our Step Therapy program, which helps your doctor provide you with safe, effective, and affordable medications.
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Note TitleNot Available Through Mail ServiceDefinitionThis medication is not available through the mail service pharmacy
30MG/0.6ML INJ
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Note TitleStep TherapyDefinitionThis medication is covered through the pharmacy benefit, and is part of our Step Therapy program, which helps your doctor provide you with safe, effective, and affordable medications.
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Note TitleNot Available Through Mail ServiceDefinitionThis medication is not available through the mail service pharmacy
25MG/0.5ML INJ
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Note TitleStep TherapyDefinitionThis medication is covered through the pharmacy benefit, and is part of our Step Therapy program, which helps your doctor provide you with safe, effective, and affordable medications.
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Note TitleNot Available Through Mail ServiceDefinitionThis medication is not available through the mail service pharmacy
7.5MG/0.15ML INJ
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Note TitleStep TherapyDefinitionThis medication is covered through the pharmacy benefit, and is part of our Step Therapy program, which helps your doctor provide you with safe, effective, and affordable medications.
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Note TitleNot Available Through Mail ServiceDefinitionThis medication is not available through the mail service pharmacy
Prior Authorization Forms
Massachusetts Standard Form for Hepatitis-C Medication Prior Authorization Requests
Massachusetts Standard Form for Medication Prior Authorization Requests
Massachusetts Standard Form for Synagis® Medication Prior Authorization Requests
Important Information
Affordable Care Act (ACA) Medication List
Chronic Condition Management Medication List
Medical Benefit Prior Authorization Medication List
Over-the-Counter Exclusion Medication List
Quality Care Dosing Guidelines
Learn About Your Pharmacy Program
Learn About Your Pharmacy Program
Affordable Care Act (ACA) Medication List
Chronic Condition Management Medication List
Health Savings Account (HSA) Preventive Medication List
Lower-Cost, Brand-Name Insulins Medication List
Medical Benefit Prior Authorization Medication List
No-Cost Generic Medications List
Over-the-Counter Exclusion Medication List
Specialty Pharmacy
Specialty Pharmacy Medication List
5-Tier Specialty Pharmacy Medication List
6-Tier Specialty Pharmacy Medication List