2013 Medicare HMO Blue ValueRx/PlusRx Formulary - Blue Cross ...

cytra-2 .................. 82cytra-3 .................. 95cytra-k .................. 95Dd5%-1/4ns-kcl 10 meq/l iv sol,-d5%-1/4ns-kcl 30 meq/l ivsol, -d5%-1/4ns-kcl 40 meq/liv sol .................. 79d5w-kcl 30 meq/l iv solution,-d5w/kcl 30 meq/l ivsolution ................ 79dacarbazine .............. 16DACOGEN .............. 16danazol capsule .......... 83dantrolene sodium capsule . 76DAPSONE TABLET ........ 7DAPTACEL .............. 48DARAPRIM .............. 13daunorubicin . . . . . . . . . . . . . 16DECAVAC ............... 48delflex with 1.5% dextrose. . 79delflex with 2.5% dextrose. . 79delflex with 4.25% dextrose. 79DELZICOL .............. 46demeclocycline hcl tablet. .. 14DEMSER. ............... 33DENAVIR. ............... 11denta 5000 plus .......... 81dentagel. ................ 81depade. ................. 29DEPOCYT. .............. 16desipramine hcl tablet ..... 29desloratadine. ............ 92desloratadine odt ......... 92desmopressin ac injection .. 44desmopressin ac nasal drops/sprays, -solution, -tablet .. 44desonide cream, -lotion, -oint 38desoximetasone cream, -gel,-oint ................... 38DESVENLAFAXINE ER. ... 28DETROL ................ 95DETROL LA ............. 95dexamethasone elix. ....... 42dexamethasone intensol. ... 42dexamethasone sodiumphosphate injection ...... 42dexamethasone sodiumphosphate ophth drops. .. 90dexamethasone tablet ..... 42dexchlorpheniramine maleate 92dexmethylphenidate hcl .... 25dexrazoxane. ............. 16dextroamphetamineamphetamineer 10mg cap, -er15mg cap, -er 25mg cap, -er5mg cap ............... 25dextroamphetamineamphetamineer 20mg cap, -er30mg cap .............. 25dextroamphetamine sulfatecapsule sustained action,-tablet ................. 25dextrose 2.5%-wateriv soln, -25%-watersyringe, -30%-water ivsoln, -40%-water iv soln,-50%-water abboject,-50%-water iv soln,-50%-water syringe,-50%-water vial, -70%-water ivsoln . . . . . . . . . . . . . . . . . . . 79dextrose 5%-1/2ns-kcl. .... 79dextrose 5%-1/3ns-kcl. .... 79dextrose 5%-1/4ns iv solution,-5%-sod chloride 0.2%, -5%-1/3ns iv solution, -d10%-1/2nssoln/excel cont, -5%-1/2ns ivsolution, -2.5%-1/2ns iv soln,-5%-ns iv solution ....... 80dextrose 5%-electrolyte #48 80dextrose 5%-ns-kcl. ....... 80dextrose 5%-water iv soln,-10%-water iv solution. ... 80dextrose 10%-1/4ns. ...... 79dextrose 10%-ns iv solution. 79dextrose in lactated ringers . 80dextrose in ringers injection . 80diazepam injection, -solution,-tablet ................. 23diazepam rectal. .......... 27DIBENZYLINE ........... 33diclofenac- misoprost ...... 77diclofenac potassium ...... 77diclofenac sodium e.c. tab,-tablet sustained action. .. 77diclofenac sodium ophthdrops. ................. 91dicloxacillin sodium. ....... 13dicyclomine hcl capsule, -syrup,-tablet ................. 46didanosine ................ 8DIFICID ................. 10diflorasone diacetate ...... 38diflunisal tablet ........... 78digoxin injection .......... 35digoxin solution ........... 35digoxin tablet. ............ 35dihydroergotamine mesylateinjection ............... 26DILANTIN 30 MGCAPSULE ............. 26dilt-cd ................... 32diltiazem 24hr cd ......... 32diltiazem 24hr er .......... 32diltiazem 125 mg/25 ml vial, -50mg/10 ml vial ........... 32diltiazem er .............. 32diltiazem hcl tablet ........ 32diltiazem injection . . . . . . . . . 32dilt-xr. ................... 32diltzac er ................ 32dimenhydrinate injection. ... 22DIOVAN. ................ 31diphenhydramine 50 mg/mlvial .................... 92diphenhydramine hcl capsule 92diphenhydramine hcl elix, -50mg/ml syrng ............ 92diphenoxylate-atropine ..... 45DIPHTHERIA-TETANUSTOXOID ............... 48dipyridamole tablet ........ 78diskets .................. 24disopyramide phosphate ... 31103