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About This Guide
The Massachusetts Medical Society
Aetna Inc.
Blue Cross Blue Shield
of Massachusetts, Inc.
Boston Medical Center
HealthNet Plan
Fallon Community Health Plan
ii
Harvard Pilgrim Health Care
Health New England
Neighborhood Health Plan
of Massachusetts
Network Health
Office of Medicaid/MassHealth
Tufts Health Plan
The above organizations are pleased to present the 13th edition of the Massa chusetts
Outpatient Formulary Guide. This guide is intended to assist physicians by
providing the participating health plans’ commonly prescribed outpatient formulary
drugs in a readily accessible, pocket-sized format. It does not reflect the comprehensive
formularies of the participating health plans. Contraceptives have been
removed from this guide. The plans indicated that the choice of contraceptive medication
is generally driven by the patient’s preference based on the copayment level.
Additionally, state-mandated HIV drugs are not included in this version of the
guide. Individual plans should be contacted for complete formulary lists or for further
information about drug coverage. Health plan contact information is provided
in this section.
Formulary information changes frequently. Although the information in this guide
is current as of April 2010, individual plans should be contacted for the most up-todate
information. Inclusion of any drug in a plan’s formulary shall not be construed as a
commitment on the part of that plan to continue to offer that drug. This guide should
not be used after May 2011.
The information contained in this guide has been provided by, and is at the sole discretion
of, each individual health plan. Formulary information is proprietary information
of each plan and may not be used or reproduced for any purpose without the plan’s
express permission.
The Massachusetts Medical Society accepts no responsibility for the accuracy
and scope of the information contained in this guide, nor for the acts or omissions
of any medical provider based upon reliance, in whole or in part, on the information
contained herein.