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

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lactulose ................ 78LADY LITE LANCETS ..... 63LAMISIL 125 MG GRANULESPACKET . . . . . . . . . . . . . . . 10LAMISIL 187.5 MG GRANULESPACK ................. 10LAMISIL SOLUTION ...... 12lamivudine ................ 8lamivudine-zidovudine. ...... 8lamotrigine. .............. 27lamotrigine er. ............ 27LANCETS ............... 63LANCETS 26G X 1.8MM .. 63LANCETS 28G. .......... 63LANCETS 30G. .......... 63LANCETS THIN .......... 63LANCETS ULTRA THIN. ... 63LANOXIN TABLET ........ 35lansoprazole capsule sustainedaction ................. 47LANTUS ................ 43LANTUS SOLOSTAR. ..... 43latanoprost. .............. 90LATUDA. ................ 21LEADER COLOREDLANCETS. ............. 63LEADER INS SYR 0.3 ML29GX1/2 .............. 63LEADER INS SYR 0.5 ML28GX1/2 .............. 63LEADER INS SYR 0.5 ML29GX1/2 .............. 63LEADER INS SYR 0.5 ML30GX1/2 .............. 63LEADER INS SYR 1 ML28GX1/2 .............. 63LEADER INS SYR 1 ML29GX1/2 .............. 63LEADER INS SYR 1 ML30GX1/2 .............. 63LEADER INS SYR 1 ML30GX5/16 ............. 63LEADER INS SYR 1 ML31GX5/16 ............. 63LEADER INSULIN SYRINGE0.3 ML ................ 63LEADER PEN NEEDLE 6MM31G. .................. 63LEADER PEN NEEDLES 12MM29G. .................. 63LEADER PEN NEEDLES31G. .................. 63LEADER SUPER THINLANCETS. ............. 63LEADER SYRING 0.3 ML31GX5/16 ............. 63LEADER SYRING 0.5 ML31GX5/16 ............. 63LEADER THIN LANCETS .. 63leena. ................... 84leflunomide .............. 17lessina .................. 84LETAIRIS ................ 36letrozole ................. 17leucovorin calcium injection. 17leucovorin calcium tablet ... 17LEUKERAN. ............. 17LEUKINE. ............... 51leuprolide acetate injection . 89levalbuterol concentrate. ... 93LEVEMIR. ............... 43levetiracetam injection ..... 27levetiracetam solution, -tablet,-tablet sustained action. .. 27levobunolol hcl ........... 90levocarnitine injection ...... 83levocarnitine solution, -tablet 83levocetirizine dihydrochloridesolution ................ 92levocetirizine dihydrochloridetablet. ................. 92levofloxacin-d5w injection .. 13levofloxacin injection. ...... 13levofloxacin ophth drops ... 91levofloxacin solution, -tablet. 13levomefolate dha. ......... 86levomefolatepnv .......... 86levonest ................. 84levonorgestrel ............ 84levonorgestrel-eth estradiol . 84levonorg-eth estrad ethestrad ................. 84levora-28 ................ 84levorphanol tartrate tablet .. 24levothroid. ............... 45LEVOTHYROXINE 100 MCGVIAL. .................. 45levothyroxine 500 mcg vial. . 45levothyroxine sodium tablet . 45levoxyl. .................. 45LEXIVA ORAL SUSP. ...... 8LEXIVA TABLET ........... 8LIBERTY CONTROL SOLNNORMAL . . . . . . . . . . . . . . 63LIBERTY CONTROLSOLUTION HIGH. ...... 63LIBERTY LEV 1 GLUCOSECTRL SOL ............. 63LIBERTY LEV 2 GLUCOSECTRL SOL ............. 63lidocaine hcl cream, -oint,-dental, -gel, -lotion ....... 7lidocaine hcl-dextrose. ...... 7lidocaine hcl-epinephrine .... 7lidocaine hcl injection ....... 7lidocaine hcl viscous. ....... 7lidocaine-hydrocortisone cream,-kit . . . . . . . . . . . . . . . . . . . . 39lidocaine-hydrocortisonerectal .................. 46lidocaine-prilocaine. ........ 7LIDODERM. .............. 7LIFESCAN FINE POINTLANCETS. ............. 63LIFESCAN UNISTIK 2LANCETS. ............. 63lindane .................. 38LINZESS CAPSULE ...... 46liothyronine sodium injection 45liothyronine sodium tablet .. 45LIPODOX ............... 17LIPODOX 50 ............ 17liposyn iii ................ 80lisinopril-hydrochlorothiazide 35lisinopril tablet ............ 31LITE TOUCH 30GLANCETS. ............. 63LITE TOUCH INSULIN 0.3 MLSYR................... 63LITE TOUCH INSULIN 0.5 MLSYR................... 63LITE TOUCH INSULIN 1 MLSYR................... 63112
LITE TOUCH INSULIN SYR 0.3ML. ................... 63LITE TOUCH INSULIN SYR 0.5ML. ................... 63LITE TOUCH INSULIN SYR 1ML. ................... 63LITE TOUCH PEN NEEDLE29G. .................. 63LITE TOUCH PEN NEEDLE31G. .................. 63lithium. .................. 29lithium carbonate capsule,-tablet, -tablet sustainedaction ................. 29LIVE BETTER PEN NEEDLE6MM 31G. ............. 63LIVE BETTER PEN NEEDLES8MM .................. 63LIVE BETTER PEN NEEDLES12MM ................. 63LIVE BETTER SUPER THINLANCET ............... 63LIVE BETTER ULTRA THINLANCET ............... 63LODOSYN .............. 28LONGS LANCETS 21G . . . 63LONGS THIN LANCETS26G. .................. 63LONGS THIN LANCETS30G. .................. 64loperamide capsule ....... 45lorazepam injection, -solution,-tablet ................. 23lorazepam intensol ........ 23loryna ................... 84losartan-hydrochlorothiazide 35losartan potassium ........ 31LOTRONEX ............. 46lovastatin 10 mg tablet. .... 33lovastatin 20 mg tablet, -40 mgtablet. ................. 33LOVAZA................. 33low-ogestrel. ............. 84loxapine ................. 21lozi-flur .................. 81ludent fluoride ............ 81lugol’s solution ........... 45LUPRON DEPOT 3.75 MG KIT,-7.5 MG KIT, -22.5 MG 3MOKIT, --4 MONTH KIT ..... 89LUPRON DEPOT 11.25 MG3MO KIT. .............. 89LUPRON DEPOT 45 MG 6MOKIT. ................... 17LUPRON DEPOT-PED .... 89lutera ................... 84LYRICA ................. 27LYSINE HCL ............. 80LYSODREN. ............. 17Mmacnatal cn dha . . . . . . . . . . 86mafenide acetate ......... 14MAGELLAN INSULINSYRINGE 1 ML. ........ 64MAGELLAN INSUL SYRINGE0.5 ML ................ 64magnesium sulfate injection. 80MAJOR COMFORTLANCETS. ............. 64MAKENA ................ 89malathion ................ 38mannitol injection ......... 80maprotiline hcl. ........... 28marlissa ................. 84MARPLAN. .............. 26MATULANE. ............. 17matzim la ................ 32MAXI-COMFORT INS 0.5 ML28G. .................. 64MAXI-COMFORT INS 1 ML28GX1/2 .............. 64MAXIMA CONTROLSOLUTION ............ 64meclizine hcl tablet ........ 22meclofenamate sodiumcapsule ................ 77MEDI-LANCE LANCETS. .. 64MEDISENSE CONTROLSOLUTION ............ 64MEDISENSE GLUC-KETCONT SOL ............ 64MEDISENSE H-L CONTROLSOLUTION ............ 64MEDISENSE H-M-L CONTROLSOLN . . . . . . . . . . . . . . . . . 64MEDISENSE MID CONTROLSOLUTION ............ 64MEDISENSE THINLANCETS. ............. 64MEDLANCE PLUS 21GLANCETS. ............. 64MEDLANCE PLUS 30GLANCETS. ............. 64MEDLANCE PLUS EXTRALANCETS. ............. 64MEDLANCE PLUS LITE 25GLANCETS. ............. 64MEDLANCE PLUS LITELANCETS. ............. 64MEDLANCE PLUS UNIVERSALLANCET ............... 64MEDPOINT CONTROLSOLUTION ............ 64medroxyprogesterone acetateinjection, -tablet ......... 89mefenamic acid capsule. ... 77mefloquine hcl. ........... 13megestrol acetate oral susp,-tablet ................. 17MEIJER LANCETS. ....... 64MEIJER THIN GAUGELANCETS. ............. 64meloxicam oral susp ....... 77meloxicam tablet .......... 77melphalan hcl ............ 17MENACTRA ............. 49MENEST ................ 85MENOMUNE-A-C-Y-W-135 49MENVEO A-C-Y-W-135-DIP 49meperidine hcl injection,-solution, -tablet ......... 24meperitab. ............... 24meprobamate ............ 23MEPRON ............... 10mercaptopurine tablet ..... 17meropenem vial. .......... 10mesalamine kit, -rectal ..... 46mesna .................. 17MESNEX TABLET ........ 17MESTINON SYRUP, -TABLETSUSTAINED ACTION. ... 29metadate er .............. 25113
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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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Page 64 and 65: 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 108 and 109: ESTRACE VAGINALPRODUCTS. ..........
Page 110 and 111: GAMASTAN S-D. ......... 48GAMMAGARD
Page 112 and 113: IN CONTROL PEN NEEDLE6MM 31G. .....
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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