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Z6_VA6HBFH208MFF0IN2GAUFG30B3

Home > Pharmacy > Requirements & Policies > OTC Benefit Exclusions

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Z7_VA6HBFH208MFF0IN2GAUFG30R6

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OTC Benefit Exclusions

These medications are excluded from coverage because they have a safe and effective over-the-counter equivalent members can purchase without a prescription. Exceptions are not available for these medications.

Z7_VA6HBFH208MFF0IN2GAUFG30R3

Massachusetts Standard Form for Medication Prior Authorization Requests (eForm)

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