Note Title
Not Available Through Mail Service
Definition
This medication is not available through the mail service pharmacy
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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.
MARGESIC-H
THERAPEUTIC CLASS: Hydrocodone Combinations
Select a strength to see details
CAPS
CAPS
Covered by a 3-Tier Plan as a Tier 1 Medication
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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
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Learn About Your Pharmacy Program
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Alternatives to Opioids
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