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

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ESTRACE VAGINALPRODUCTS. ........... 85estradiol adh. patch ....... 85estradiol-norethindroneacetat ................. 85estradiol tablet ........... 85estradiol valerate injection . . 85estropipate .............. 85ethambutol hcl. ............ 9ethosuximide capsule, -syrup 30etidronate disodium ....... 44etodolac capsule, -tablet, -tabletsustained action. ........ 77ETOPOPHOS ........... 16etoposide injection ........ 16EURAX ................. 38EVENCARE CONTROLSOLUTION ............ 58EVENCARE G2 CONTROLSOLUTION ............ 58EVENCARE G3 CONTROLSOLUTION ............ 58EVISTA. ................. 44EVOLUTION CONTROL SOLNNORMAL . . . . . . . . . . . . . . 58EXEL HYPO NEEDLE26GX0.5. .............. 58EXEL HYPO NEEDLE26GX1.5. .............. 58EXEL HYPO NEEDLE27GX0.5. .............. 58EXEL INS SYR U100 1 ML28GX1/2 .............. 58EXEL INSULIN PENNEEDLE. .............. 59EXEL INSULIN SYRINGE 27G-1 ML .................. 59EXEL INSULIN SYRN 27G-1/2ML. ................... 59EXEL INSUL PEN NEEDLES8MM .................. 58EXEL INSUL SYR 0.5 ML28GX1/2 .............. 59EXELON ADH. PATCH,-SOLUTION ............ 20EXEL U100 0.3 ML29GX1/2 .............. 59EXEL U100 0.3 ML30GX5/16 ............. 59EXEL U100 0.5 ML28GX1/2 .............. 59EXEL U100 0.5 ML29GX1/2 .............. 59EXEL U100 0.5 ML30GX5/16 ............. 59EXEL U100 1 ML30GX5/16 ............. 59EXEL U100 INS SYR 1 ML29GX1/2 .............. 59exemestane .............. 16EXFORGE .............. 35EXFORGE HCT .......... 35EXJADE 125 MG TABLET . 40EXJADE 250 MG TABLET, -500MG TABLET. ........... 40E-ZJECT COLOR 32GLANCETS. ............. 59E-ZJECT COLOR 33GLANCETS. ............. 59E-Z JECT COLOREDLANCETS. ............. 59E-Z JECT LANCETS ...... 59E-Z JECT SUPER THINLANCETS. ............. 59E-ZJECT THIN LANCETS .. 59EZ-LETS LANCETS 23G .. 59EZ SMART BLOOD GLUCOSELANCETS. ............. 59EZ SMART HIGH CONTROLSOLUTION ............ 59EZ SMART LOW CONTROLSOLUTION ............ 59EZ SMART NORMALCONTROL SOLN. ...... 59FFABRAZYME 35 MG VIAL . 44famciclovir 125 mg tablet, -500mg tablet. .............. 11famciclovir 250 mg tablet .. 11famotidine injection. ....... 46famotidine oral susp ....... 46famotidine tablet .......... 46FANAPT. ................ 21FARESTON .............. 16FASLODEX .............. 16FAST TAKE MONITORINGSYSTEM ............... 59FAST TAKE TEST STRIPS . 59FAZACLO ............... 21fe c ..................... 86felbamate. ............... 27felodipine er. ............. 32FEMHRT 0.5 MG-2.5 MCGTABLET. ............... 85fem ph .................. 85fenofibrate ............... 33fenoprofen calcium tablet. .. 77fentanyl ................. 24fentanyl 0.05 mg/ml ampul, -0.05mg/ml syringe, -0.05 mg/mlvial, -1 mg/20 ml vial, -100mcg/2 ml vial, -250 mcg/5 mlvial .................... 24fentanyl 2,500 mcg/50 mlvial .................... 24fentanyl citrate lozenge. .... 24FERRIPROX. ............ 40fexofenadine hcl .......... 92FIFTY50 ALCOHOL PREPPADS ................. 59FIFTY50 GLUCOSECONTROL SOLN. ...... 59FIFTY50 INS SYR 1 ML31GX5/16 ............. 59FIFTY50 INSULIN SYRINGE0.3 ML ................ 59FIFTY50 INSULIN SYRINGE0.5 ML ................ 59FIFTY50 PEN 31G X 3/16NEEDLE. .............. 59FIFTY50 PEN 31G X 5/16NEEDLE. .............. 59FIFTY50 SAFETY SEAL 30GLANCET ............... 59FIFTY50 SAFETY SEAL 32GLANCET ............... 59finasteride 5mg tablet. ..... 95FINE 30 UNIVERSAL 30GLANCETS. ............. 59FINGERSTIX LANCETS ... 59FIRAZYR ................ 48FIRMAGON ............. 16flavoxate hcl. ............. 95106
flecainide acetate ......... 31FLECTOR ............... 77FLOVENT DISKUS. ....... 94FLOVENT HFA 44 MCGINHALER .............. 94FLOVENT HFA 110 MCGINHALER .............. 94FLOVENT HFA 220 MCGINHALER .............. 94floxuridine. ............... 16FLUARIX 2011-2012. ..... 48fluconazole. .............. 12fluconazole 150 mg tablet .. 10fluconazole suspension, -50 mgtablet, -100 mg tablet, -200mg tablet. .............. 10flucytosine capsule ........ 10fludarabine 50 mg/2 ml vial . 16fludarabine 50mg vial ...... 16fludrocortisone acetatetablet. ................. 44FLULAVAL 2011-2012 .... 48flumazenil. ............... 29FLUMIST NASAL 2011-12VACCINE .............. 48flunisolide 0.025% spray ... 41flunisolide 29 mcg-0.025%spr .................... 41fluocinolone acetonide cream,-oil,shampoo,cleanser, -oint,-soln, top. .............. 38fluocinolone acetonide oil .. 41fluocinonide cream, -gel, -oint,-soln, top. .............. 38fluocinonide-e ............ 38fluocinonide emollient. ..... 38fluor-a-day chew tab ....... 81FLUOR-A-DAY ORALDROPS ............... 81fluoride. ................. 81fluoridex daily defense ..... 81fluoritab chew tab ......... 81fluorometholone ophth drops 90FLUOROPLEX ........... 39fluorouracil. .............. 16fluorouracil cream, -soln, top 39fluoxetine dr .............. 30fluoxetine hcl 10 mg capsule,-20 mg capsule ......... 30fluoxetine hcl 10 mg tablet. . 30fluoxetine hcl 20 mg tablet. . 30fluoxetine hcl 40 mg capsule 30fluoxetine hcl solution ...... 30fluphenazine decanoateinjection ............... 21fluphenazine hcl .......... 21flurazepam hcl ............ 29flurbiprofen sodium. ....... 91flurbiprofen tablet ......... 77flutamide ................ 16fluticasone propionate cream,-lotion, -oint. ............ 38fluticasone propionate nasalinhaled steroids ......... 41fluvastatin sodium 20 mgcap ................... 33fluvastatin sodium 40 mgcap ................... 33FLUVIRIN 2011-2012 ..... 48fluvoxamine maleate 25 mgtab .................... 30fluvoxamine maleate 50 mgtab .................... 30fluvoxamine maleate 100 mgtab .................... 30FLUZONE 2011-2012 .... 48FLUZONE 2011-2012 (PF) 48FLUZONE 2012-2013 .... 48FLUZONE HIGH-DOSE 2011-12 (PF) . . . . . . . . . . . . . . . . 48FLUZONE HIGH-DOSE 2012-13 .................... 48FLUZONE INTRADERMAL. 48FLUZONE INTRADERMAL2012-2013. ............ 48FLUZONE PEDI 2012-2013 48folbecal ................. 86folcal dha ................ 86folcaps omega-3 .......... 86folinatal plus b ............ 86folivane-ec calcium dha nf .. 86folivane-ob ............... 86folivane-prx dha nf. ........ 86FOLOTYN ............... 16fomepizole ............... 40fondaparinux 2.5 mg/0.5 mlsyr .................... 81fondaparinux 5 mg/0.4 ml syr 81fondaparinux 7.5 mg/0.6 mlsyr .................... 81fondaparinux 10 mg/0.8 mlsyr .................... 81FORADIL. ............... 93FORA HIGH CONTROLSOLUTION ............ 59FORA LANCETS ......... 59FORA LOW CONTROLSOLUTION ............ 59FORA NORMAL CONTROLSOLUTION ............ 59FORFIVO XL TABLET ..... 28FORTEO ................ 44FORTESTA .............. 83fortical .................. 44foscarnet sodium ......... 11fosinopril-hydrochlorothiazide 35fosinopril sodium. ......... 31fosphenytoin ............. 26FREESTYLE CONTROLSOLUTION ............ 59FREESTYLE LANCETS. ... 59FREESTYLE PREC 0.5 ML30GX5/16 ............. 59FREESTYLE PREC 0.5 ML31GX5/16 ............. 59FREESTYLE PREC 1 ML30GX5/16 ............. 59FREESTYLE PREC 1 ML31GX5/16 ............. 59FREESTYLE UNISTIK 2LANCETS. ............. 60furosemide injection ....... 34furosemide solution ....... 34furosemide tablet ......... 34FUSILEV ................ 17FUZEON ................. 8Ggabapentin capsule, -tablet . 27gabapentin solution ....... 27GABITRIL 12 MG TABLET -16MG TABLET. ........... 27galantamine hbr .......... 20107
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Medicare HMO Blue SM ValueRx (HMO)M
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How do I use the Formulary?There ar
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What do I do before I can talk to m
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Your Medicare Prescription Drug Cos
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Antiinfectives: Antiretrovirals and
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Antiinfectives: Oral Antifungal Dru
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Antiinfectives: Other Antiviral Dru
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Antiinfectives: Sulfonamideserythro
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Antineoplastic/Immunosuppressant Dr
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Antineoplastic/Immunosuppressant Dr
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Autonomic and CNS Medications: Anal
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Autonomic and CNS Medications:Antiv
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Autonomic and CNS Medications: CNSS
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Autonomic and CNS Medications:Other
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Autonomic and CNS Medications: Sele
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Cardiovascular Medications: Beta-Ad
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Cardiovascular Medications: Loop Di
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Cardiovascular Medications: OtherVa
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Dermatological Medications: OralDer
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Dermatological Medications: Topical
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Endocrine Medications: Glucocortico
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Endocrine Medications: Oral Hypogly
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Gastrointestinal Medications: Antis
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Immunologicals and VaccinesACTHIB T
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Immunologicals and Vaccines: Interf
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Medical (Miscellaneous) Supplies:Di
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Medical (Miscellaneous) Supplies:Di
Page 58 and 59: Medical (Miscellaneous) Supplies:Di
Page 80 and 81: Musculoskeletal Medications: Non-St
Page 82 and 83: Nutrition, Blood Modifiers, Electro
Page 84 and 85: Nutrition, Blood Modifiers, Electro
Page 86 and 87: Obstetrical and Gynecological Medic
Page 88 and 89: Obstetrical and GynecologicalMedica
Page 90 and 91: Obstetrical and Gynecological Medic
Page 92 and 93: Ophthalmic Medications: Antiglaucom
Page 94 and 95: Ophthalmic Medications: OtherOphtha
Page 96 and 97: Respiratory Medications: Other Drug
Page 98 and 99: IndexSymbols1ST CHOICE SUPER THINLA
Page 100 and 101: aminophylline 250 mg/10 mlvl ......
Page 102 and 103: BD PEN NEEDLE NANO32GX5/32 ........
Page 104 and 105: CLINIMIX E 2.75%-10%SOLUTION, -2.75
Page 106 and 107: disulfiram ................ 29dival
Page 110 and 111: GAMASTAN S-D. ......... 48GAMMAGARD
Page 112 and 113: IN CONTROL PEN NEEDLE6MM 31G. .....
Page 114 and 115: lactulose ................ 78LADY L
Page 116 and 117: metaproterenol sulfate syrup,-table
Page 118 and 119: NILANDRON ............ 18nimodipine
Page 120 and 121: PEGASYS PROCLICK 180MCG/0.5 .......
Page 122 and 123: PUB INSUL SYR 0.3 ML31GX5/16 ......
Page 124 and 125: SAPHRIS ............... 21SAVELLA.
Page 126 and 127: SUSTIVA ................. 8SUTENT .
Page 128 and 129: ULT CFT 0.3 ML 29GX1/2(1/2) .......
Page 130 and 131: venlafaxine hcl ............ 28venl
Page 133: ®, SM Registered and Service Marks
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2013 Medicare HMO Blue ValueRx/PlusRx Formulary - Blue Cross ...

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