Note Title
Not Available Through Mail Order
Definition
This medication is not available through the mail order pharmacy.
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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.
MAKENA
THERAPEUTIC CLASS: Progestins
Select a strength to see details
275MG/1.1ML AUTOINJECT
275MG/1.1ML AUTOINJECT
Covered by a 3-Tier Plan as a Tier 2 Medication
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Note TitleRequires Specialty PharmacyDefinitionThis medication will only be covered through the pharmacy benefit when purchased through a specialty pharmacy that participates in our network. To find a specialty pharmacy, visit Specialty Network Pharmacy Contact Information in the Specialty Pharmacy section.
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Note TitlePrior Authorization RequiredDefinitionThis medication requires your doctor to obtain prior authorization from us in order to be covered through the pharmacy benefit.
250MG/ML INJ
250MG/ML INJ
Covered by a 3-Tier Plan as a Tier 2 Medication
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Note TitlePrior Authorization RequiredDefinitionThis medication requires your doctor to obtain prior authorization from us in order to be covered through the pharmacy benefit.
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Note TitleNot Available Through Mail OrderDefinitionThis medication is not available through the mail order pharmacy.
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Note TitleRequires Specialty PharmacyDefinitionThis medication will only be covered through the pharmacy benefit when purchased through a specialty pharmacy that participates in our network. To find a specialty pharmacy, visit Specialty Network Pharmacy Contact Information in the Specialty Pharmacy section.
1250MG/5ML INJ
1250MG/5ML INJ
Covered by a 3-Tier Plan as a Tier 3 Medication
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Note TitlePrior Authorization RequiredDefinitionThis medication requires your doctor to obtain prior authorization from us in order to be covered through the pharmacy benefit.
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Note TitleNot Available Through Mail OrderDefinitionThis medication is not available through the mail order pharmacy.
-
Note TitleRequires Specialty PharmacyDefinitionThis medication will only be covered through the pharmacy benefit when purchased through a specialty pharmacy that participates in our network. To find a specialty pharmacy, visit Specialty Network Pharmacy Contact Information in the Specialty Pharmacy section.
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
Eligible Medicare Members
Covered Alternative Medications