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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.
1MG/ML SYRINGE
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Note TitleNot Available Through Mail ServiceDefinitionThis medication is not available through the mail service pharmacy
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Note TitlePrior Authorization RequiredDefinitionThis medication requires your doctor to obtain prior authorization from us for prescription coverage of more than seven days, and/or for more than 21 day supply within a consecutive 60 day period. This is only available to members who have pharmacy benefits.
4MG/ML SYRINGE
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Note TitleNot Available Through Mail ServiceDefinitionThis medication is not available through the mail service pharmacy
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Note TitlePrior Authorization RequiredDefinitionThis medication requires your doctor to obtain prior authorization from us for prescription coverage of more than seven days, and/or for more than 21 day supply within a consecutive 60 day period. This is only available to members who have pharmacy benefits.
2MG/ML SYRINGE
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Note TitleNot Available Through Mail ServiceDefinitionThis medication is not available through the mail service pharmacy
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Note TitlePrior Authorization RequiredDefinitionThis medication requires your doctor to obtain prior authorization from us for prescription coverage of more than seven days, and/or for more than 21 day supply within a consecutive 60 day period. This is only available to members who have pharmacy benefits.
1MG/ML AMP
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Note TitleNot Available Through Mail ServiceDefinitionThis medication is not available through the mail service pharmacy
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Note TitlePrior Authorization RequiredDefinitionThis medication requires your doctor to obtain prior authorization from us for prescription coverage of more than seven days, and/or for more than 21 day supply within a consecutive 60 day period. This is only available to members who have pharmacy benefits.
2MG/ML AMP
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Note TitleNot Available Through Mail ServiceDefinitionThis medication is not available through the mail service pharmacy
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Note TitlePrior Authorization RequiredDefinitionThis medication requires your doctor to obtain prior authorization from us for prescription coverage of more than seven days, and/or for more than 21 day supply within a consecutive 60 day period. This is only available to members who have pharmacy benefits.
4MG/ML AMP
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Note TitleNot Available Through Mail ServiceDefinitionThis medication is not available through the mail service pharmacy
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Note TitlePrior Authorization RequiredDefinitionThis medication requires your doctor to obtain prior authorization from us for prescription coverage of more than seven days, and/or for more than 21 day supply within a consecutive 60 day period. This is only available to members who have pharmacy benefits.
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
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
Cost-Share Assistance Program 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