Drug List - M

M
Drug Name Tier Restrictions
M-OXY 1
MACRODANTIN 3 Prior authorization
MAG-OX 400 NC Over-the-counter
MAGIC MOUTHWASH SOLUTION 2
MAKENA 3 Prior Authorization
MALARONE 3 Travel
MALATHION LOT 0.5% 1
MARPLAN TAB 3
MATZIM LA TAB 240MG/24 3 Prior Authorization
MAXAIR AUTOHALER 3 Prior authorization, Quantity limit
MAXALT 3 Quantity limit
MAXALT-MLT 3 Quantity limit
MAXZIDE-25 3 Prior authorization
MEBENDAZOLE 2
MEDERMA GEL 2 Quantity limit
MEDROXYPROG INJ 1
MEFENAMIC ACID 1
MEFLOQUINE HCL 3 Travel
MEGACE 3 Prior authorization
MEGESTROL ACETATE 1
MEKINIST 3 Prior authorization
MELOXICAM 1
MEMANTINE 1
MENEST 2
MENOPUR INJ 75UNIT UD 3
MENOSTAR DIS 3
MENTAX 3 Prior authorization, Quantity limit, Step therapy
MEPERIDINE HCL 1
MEPHYTON 1
MEPRON 2
MERCAPTOPURINE 1
MESALAMINE ENE 1
MESTINON 2
METADATE CD 3 Prior authorization
METANX 3
METAXALONE TAB 800MG 1
METFORMIN EXTENDED RELEASE 1
METFORMIN HCL 1
METFORMIN/PIOGLITAZONE 1
METFORMIN/ROSIGLITAZONE 1
METHADONE HCL 1
METHADOSE 1
METHAZOLAMIDE 1
METHENAMINE HIP 1
METHENAMINE MAN E 1
METHERGINE 1
METHIMAZOLE 1
METHOCARBAMOL 1
METHOTREXATE 1
METHYLDOPA 1
METHYLERGON TAB 0.2MG 1
METHYLIN ER 1
METHYLIN SOL 2
METHYLIN TAB 1
METHYLPREDNISOLONE INJ 1
METHYLPREDNISOLONE PAK 1
METHYLPREDNISOLONE/ESTE 1
METOCLOPRAMIDE 1
METOCLOPRAMIDE HCL 1
METOLAZONE 1
METOPROLOL 1
METOPROLOL/HYDROCHLOROTHIAZ 1
METROGEL GEL 3 Quantity limit
METRONIDAZOL GEL 1
METRONIDAZOLE TABLETS 1 Quantity limit
MEXILETINE HCL 1
MIACALCIN 2
MICARDIS 2 Prior authorization
MICARDIS HCT 3 Prior authorization
MICROGESTIN 1*
MIDODRINE HCL 1
MIDRIN 3 Prior authorization
MIGRANAL 3 Prior authorizaton
MIMYX 2 Prior authorization, Quantity limit
MINASTRIN 24 CHW FE 3
MINITRAN DIS 1
MINIVELLE DIS 0.0375MG 3
MINOCIN 3 Prior authorization
MINOCYCLINE HCL 1
MINOXIDIL 1
MIRAPEX 3 Prior authorization
MIRCETTE 28 3
MIRENA IUD SYSTEM $0
MIRTAZAPINE 1
MIRVASO GEL 0.33% 3
MISOPROSTOL 1
MOBIC 3
MODAFINIL 1
MODICON 28 3 Prior authorization
MOEXIPRIL HCL 1
MOEXIPRIL/HYDROCHLOROTHIAZI 1
MOMETASONE CREAM 1
MOMETASONE FUROATE NASAL SPRAY NC
MONODOX 3 Prior authorization
MONOPRIL 3 Prior authorization
MONOVISC INJ 2 Quantity limit
MONTELUKAST 1
MONUROL PAK GRANULES 2
MORPHINE SULFATE 1
MOTRIN TAB 3 Prior authorization
MOVANTIK TAB 25MG 3
MOVIPREP NC
MOXEZA SOL 0.5% 3
MOXIFLOXACIN 1
MULTAQ 3
MULTI VITAMINE/FLUORIDE 1*
MULTIGEN 2
MUPIROCIN 1 Quantity limit
MUSE 3 Prior authorization, Quantity limit
MY WAY TAB 1.5MG
MYAMBUTOL 1
MYCOPHENOLATE $0
MYDRIACYL 3 Prior authorization
MYFORTIC $0
MYORISAN CAP 1
MYRBETRIQ 3
MYZILRA TAB 3