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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 CAPS
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Note TitleNot Available Through Mail OrderDefinitionThis medication is not available through the mail order pharmacy.
20MG CAPS
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Note TitleNot Available Through Mail OrderDefinitionThis medication is not available through the mail order pharmacy.
40MG CAPS
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Note TitleNot Available Through Mail OrderDefinitionThis medication is not available through the mail order pharmacy.
30MG CAPS
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Note TitleNot Available Through Mail OrderDefinitionThis medication is not available through the mail order 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® Prior Authorization Requests
Important Information
Learn About Your Pharmacy Program
Medical Benefit Prior Authorization Medication List
Quality Care Dosing Guidelines
Affordable Care Act (ACA) Covered Medication List
HSA Preventive Medication List
Learn About Your Pharmacy Program
Value-Based Benefit Medications List
Quality Care Dosing Guidelines
Medical Benefit Prior Authorization Medication List
Specialty Pharmacy
Specialty Pharmacy Medication List
5-Tier Specialty Pharmacy Medication List
6-Tier Specialty Pharmacy Medication List
Alternatives to Opioids
For Federal Employee Program Members
View the Federal Employee Program Basic Option Formulary