Current information for pharmacists about the MassHealth Pharmacy program
Number 35
March 28, 2008
Pharmacy Facts
MassHealth Pharmacy Program
www.mass.gov/masshealth/pharmacy
• Editor: Vic Vangel • Contributors: Chris Burke, Gary Gilmore, Paul Jeffrey, 
James Monahan, Chuck Young • 

MHDL Updates 

1. Additions 
The following newly marketed drugs have been added to the 
MassHealth Drug List. 

Allegra ODT (fexofenadine orally disintegrating tablet) – PA 
Bystolic (nebivolol) – PA 
Combigan (brimonidine/timolol, ophthalmic) 
Doribax (doripenem) 
Flector Patch (diclofenac topical patch) – PA 
Hyper RAB (rabies immune globulin IM, human) 
Intelence (etravirine) 
Ixempra (ixabepilone) 
Kuvan (sapropterin) 
Renvela (sevelamer) 
Sanctura XR (trospium extended-release) 
Somatuline (lanreotide) 
Tasigna (nilotinib) 
Tekturna HCT (aliskiren/hydrochlorothiazide) – PA 
Valstar (valrubicin) 
Veregen (sinecatechins) – PA 
Zyflo CR (zileuton extended-release) – PA 


2. New FDA “A”-Rated Generics 
The following FDA “A”-rated generic drugs have been added to 
the MassHealth Drug List. The brand name is listed with a # 
symbol, to indicate that prior authorization is required for the 
brand. 

New FDA “A” - Rated 
Generic Drug Generic Equivalent of 

albuterol/ipratopium Duoneb # 
alendronate Fosamax # 
balsalazide Colazal # 
ethinyl estradiol/ Estrostep FE # 

 norethindrone 
granisetron tablet – Kytril # – PA > 15 units/ 

PA > 15 units/month month 

3. 
Change in PA Status 
a. The PA requirements for Prevacid capsules and solutabs 
are changing. The following PA requirements are effective 
April 15, 2008. Please see Table 3 for a complete list of PA 
requirements for the Proton Pump Inhibitors. 
Prevacid (lansoprazole) capsule – PA = 2 years 
Prevacid SoluTab (lansoprazole, orally disintegrating tablet) 


– PA= 2 years 
b. The following PA requirements are effective April 15, 2008. 
clindamycin 300 mg – PA 
Zyvox (linezolid), oral – PA 
Zyflo (zileuton) – PA 


4. Updated MassHealth Nonlegend (OTC) Drug List 
The MassHealth Nonlegend (OTC) Drug List has been updated 
to include the following drug. 

cetirizine tablet 

5. Deletions 
a. The following drugs have been deleted from the 
MassHealth Drug List because they are now over-thecounter. 
Zyrtec (cetirizine) 
Zyrtec-D (cetirizine/pseudoephedrine) 


b. The following medications have been deleted from the 
MassHealth Drug List. MassHealth does not pay for legend 
or nonlegend preparations for cosmetic purposes. 
Drysol (aluminum chloride) 
Xerac AC (aluminum chloride) 


c. The following drugs have been deleted from the 
MassHealth Drug List because they were discontinued by 
the manufacturer. 
Estrostep 21 (ethinyl estradiol/norethindrone) 
Prevacid (lansoprazole) suspension 


6. Corrections 
a. The age restrictions for the following drugs have been 
added to the MassHealth Drug List. They were omitted in 
error. 
Zostavax (herpes zoster vaccine) – PA < 60 years 
Gardasil (human papillomavirus vaccine) – PA < 9 years 
and > 26 years 

b. The following drugs have been added to the MassHealth 
Drug List. They were omitted in error. 
HalfLytely (polyethylene glycol-electrolyte 

solution/bisacodyl) - PA 
Supprelin LA (histrelin) – PA 
Vantas (histrelin) – PA 


Please direct any questions or comments (or to be taken off of this fax 
distribution) to Victor Moquin of ACS at 617-423-9830.