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

HAEMOLANCE PLUSLANCETS. ............. 61HAEMOLANCE,RETRACTABLE ......... 61HALAVEN ............... 17halobetasol propionate. .... 38halonate pac ............. 38haloperidol decanoate ..... 21haloperidol decanoate 100 . 21haloperidol injection . . . . . . . 21haloperidol lactate ........ 21haloperidol tablet ......... 21HAVRIX ................. 49HEALTHY ACCENTS PENTIP5MM 31G. ............. 61HEALTHY ACCENTS PENTIP6MM 31G. ............. 61HEALTHY ACCENTS PENTIP8MM 31G. ............. 61HEALTHY ACCENTS PENTP12MM 29G ............ 61HEALTHY ACCENTS UNILET30G. .................. 61heather. ................. 89hecoria 0.5 mg capsule, -1 mgcapsule ................ 17hecoria 5 mg capsule. ..... 17hemenatal ob. ............ 86hemenatal ob + dha ....... 86heparin-d5w 20,000 unit/500ml. .................... 82heparin-d5w 25,000 unit/500ml, --d5w 25,000 unit/250ml. .................... 82heparin iv flush 1 unit/ml syr, -ivflush 10 unit/ml sy, -lock flush10 units/ml, -iv flush 100 units/ml, -lock flush 100 unit/ml. 81heparin lock 10 units/ml vial,-flush 10 units/ml, -100 units/ml vial, -flush 100 unit/ml . 81heparin-ns 1,000 unit/500ml. .................... 82heparin-ns 2,000 unit/1,000ml. .................... 82heparin sod 1,000 unit/ml vial,-sod 5,000 unit/ml vial, -sod10,000 unit/ml vl, -sod 20,000unit/ml vl ............... 81heparin sod 2,000 unit/ml vial,-sod 2,500 unit/ml vial, -sod5,000 unit/ml syr, -sod 5,000unit/ 0.5 ml, -sod 5,000unit/0.5 ml. ............. 81heparin sodium in 0.45%nacl . . . . . . . . . . . . . . . . . . . 82HEPSERA. .............. 11HERCEPTIN. ............ 17HEXALEN ............... 17H&H THINLET LANCETS .. 61HIBERIX . . . . . . . . . . . . . . . . 49HM MICRO THIN 33GLANCETS. ............. 61HM ULTRA THIN 30GLANCETS. ............. 61homatropaire ............. 91homatropine ............. 91HORIZANT .............. 27hpr plus ................. 39HUMALOG .............. 43HUMALOG MIX 50-50 . . . . 43HUMALOG MIX 75-25 .... 43HUMAPEN LUXURA HD .. 61HUMAPEN MEMOIR ..... 61HUMATROPE. ........... 47HUMIRA 20 MG/0.4 MLSYRINGE. ............. 17HUMIRA 40 MG/0.8 ML PEN,-40 MG/0.8 ML SYRINGE,-CROHN’S STARTER PACK,-PSORIASIS STARTERPACK ................. 17HUMULIN 70-30 ......... 43HUMULIN N ............. 43HUMULIN R ............. 43HYALGAN ............... 78HYCAMTIN CAPSULE .... 17hydralazine hcl injection .... 36hydralazine hcl tablet ...... 36hydrochlorothiazide capsule,-tablet ................. 36hydrocodone-acetaminophen 25hydrocodone bit-ibuprofen. . 25hydrocortisone 1% cream .. 38hydrocortisone 1% cream, -plus1% cream, -2.5% cream,-lotion, -oint, -sol. ........ 39hydrocortisone-acetic acid. . 41hydrocortisone butyrate .... 39hydrocortisone rectal ...... 46hydrocortisone tablet ...... 42hydrocortisone valerate .... 39hydrogesic. .............. 25hydromorphone hcl injection,-rectal, -solution, -tablet. .. 24hydroxychloroquine sulfatetablet. ................. 13hydroxyurea capsule ....... 17hydroxyzine hcl injection. ... 23hydroxyzine hcl syrup, -tablet 23hydroxyzine pamoate capsule 23hypercare. ............... 39HYPER-SAL ............. 94HYPODERMIC NEEDLE,ALUMHUB .................. 61HY-VEE LANCETS ........ 61HY-VEE THIN LANCET .... 61Iibandronate sodium ....... 44ibuprofen oral susp. ....... 77ibuprofen tablet. .......... 77ibutilide fumarate. ......... 34ICLUSIG . . . . . . . . . . . . . . . . 17idarubicin hcl ............. 17ifosfamide 1 gm/ 20 ml vial, -3gm vial, -3 gm/ 60 ml vial . 17ifosfamide 1 gm vial ....... 17ifosfamide-mesna ......... 17ILARIS .................. 50imipenem-cilastatin sodium . 10imipramine hcl tablet. ...... 30imipramine pamoate ....... 30imiquimod cream. ......... 39IMOVAX RABIES VACCINE 49inatal advance ............ 86inatal gt ................. 86inatal ultra ............... 86INCIVEK ................. 8INCONTROL PEN NDL31GX3/16 ............. 61109