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

isoniazid injection, -syrup,-tablet .................. 9isosorbide dinitrate ........ 34isosorbide mononitrate. .... 34isosorbide mononitrate er .. 34isradipine ................ 32ISTODAX. ............... 17itraconazole capsule. ...... 10IXEMPRA ............... 17IXIARO. ................. 49JJAKAFI .................. 17jantoven ................. 82JANUMET . . . . . . . . . . . . . . . 43JANUMET XR ............ 43JANUVIA ................ 43jevantique ............... 85JE-VAX. ................. 49JEVTANA ................ 17jinteli. ................... 85jolessa .................. 84jolivette. ................. 89junel .................... 84junel fe .................. 84JUVISYNC. .............. 43KKADCYLA . . . . . . . . . . . . . . . 17KALETRA 100-25 MGTABLET. ................ 8KALETRA SOLUTION, -200-50MG TABLET. ............ 8kalexate ................. 35KALYDECO TABLET ...... 95kanamycin sulfate injection .. 7kariva ................... 84kcl 10 meq in d5w-1/4 ns, -kcl10 meq in d5w-1/4 ns, -kcl 20meq in d5w-1/4 ns, -kcl 5 meqin d5w-1/4 ns. .......... 80kcl 20 meq in d5w-lactringer. ................. 82kcl 20 meq in d5w solution,-d5w/kcl 40 meq/l ivsolution, -kcl 40 meq in d5wsolution ................ 82kcl 40 meq in d5w-lactringer. ................. 82KEEP FIT SAFETY 21GLANCETS. ............. 62KEEP FIT SAFETY 23GLANCETS. ............. 62KEEP FIT SAFETY 26GLANCETS. ............. 62KEEP FIT SAFETY LANCETS28G. .................. 62KEEP FIT TWIST 30GLANCETS. ............. 62KEEP FIT TWIST 32GLANCETS. ............. 62KEEP FIT TWIST 33GLANCETS. ............. 62KEEP FIT TWIST LANCETS28G. .................. 62k effervescent ............ 82kelnor 1-35 .............. 84KEPIVANCE ............. 49ketamine hcl .............. 7KETEK .................. 10ketoconazole ............. 12ketoconazole tablet. ....... 10ketodan foam. ............ 12ketoprofen capsule, -capsulesustained action. ........ 77ketorolac 0.4% ophthsolution ................ 91ketorolac 0.5% ophthsolution ................ 91ketorolac injection. ........ 77ketorolac tablet ........... 77KINERET. ............... 50KINNEY BRAND 23GLANCETS. ............. 62KINRAY INS SYR 1 ML31GX5/16 ............. 62KINRAY SYRING 0.3 ML31GX5/16 ............. 62KINRAY SYRING 0.5 ML31GX5/16 ............. 62KINRIX. ................. 49kionex oral susp .......... 35klor-con 8. ............... 82klor-con 10 .............. 82klor-con 20 meq packet .... 82klor-con-ef ............... 82klor-con m10 ............. 82klor-con m15 ............. 82klor-con m20 ............. 82KMART VALU PLUS SYR 1/2ML. ................... 62KMART VALU PLUS SYR 3/10ML. ................... 62KMART VALU PLUS SYRINGE1 ML .................. 62KN THIN LANCETS. ...... 62KOMBIGLYZE XR ........ 43KORLYM ................ 44K-PHOS M.F.. ............ 95K-PHOS NO.2 ........... 95K-PHOS ORIGINAL ...... 95KROGER INS SYR 0.3 ML30GX5/16 ............. 62KROGER INS SYR 0.5 ML29GX1/2 .............. 62KROGER INS SYR 1 ML29GX1/2 .............. 62KROGER INS SYR 1 ML31GX5/16 ............. 62KROGER INS SYRINGE 3/10ML. ................... 62KROGER INSULIN SYRINGE 1ML. ................... 62KROGER LANCETS ...... 62KROGER PEN NEEDLES29G. .................. 62KROGER PEN NEEDLES 31GX 5/16. ................ 62KROGER SUPER THINLANCETS. ............. 62KROGER SYR 0.5 ML30GX5/16 ............. 62KROGER SYRING 0.3 ML31GX5/16 ............. 63KROGER SYRING 0.5 ML31GX5/16 ............. 63KROGER THIN LANCETS . 63KRYSTEXXA ............. 77KUVAN. ................. 44Llabetalol hcl injection ...... 32labetalol hcl tablet. ........ 32LACRISERT ............. 91lactated ringers injection ... 80lactated ringers solution. ... 80111