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

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