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

MONOJECT INSUL SYR U1000.5 ML ................ 64MONOJECT INSUL SYR U1001 ML .................. 64MONOJECT PREFILL 0.9%FLUSH ................ 80MONOJECT PREFILL 0.9% NASYR................... 80MONOJECT SAFETYSYRINGE. ............. 65MONOJECT SYRINGE 0.3ML. ................... 65MONOJECT SYRINGE 0.5ML. ................... 65MONOJECT SYRINGE 1ML. ................... 65MONOLET LANCETS ..... 65mononessa .............. 84montelukast .............. 94morphine sulfate er capsulesustained action. ........ 24morphine sulfate er tabletsustained action. ........ 24morphine sulfate in dextrose 24morphine sulfate injection,-rectal, -solution, -tablet. .. 24MOZOBIL. .............. 49MS INS SYR 0.5 ML29GX1/2 .............. 65MS INS SYR 1 ML29GX1/2 .............. 65MS INS SYRINGE 1 ML30GX1/2 .............. 65MS INSULIN SYR 0.3 ML29GX1/2 .............. 65MS INSULIN SYR 1 ML31GX5/16 ............. 65MS INSULIN SYRINGE 0.3ML. ................... 65MS INSUL SYR 0.3 ML31GX5/16 ............. 65MS INSUL SYR 0.5 ML30GX1/2 .............. 65MS INSUL SYR 0.5 ML31GX5/16 ............. 65MS LANCETS. ........... 65MS PEN NEEDLE 6MM31G. .................. 65MS SUPER THINLANCETS. ............. 65MS THIN LANCETS ...... 65MULTAQ ................ 34multinatal plus ............ 86mupirocin cream .......... 14mupirocin oint . . . . . . . . . . . . 14MUSTARGEN. ........... 18MYCAMINE. ............. 12MYCOBUTIN ............. 9mycophenolate mofetil ..... 18mydral .................. 91MYFORTIC .............. 18MYGLUCOHEALTH 30GLANCETS. ............. 65MYLERAN ............... 18mynatal. ................. 86mynatal advance .......... 86mynatal plus ............. 86mynatal-z ................ 86mynate 90 plus ........... 86myorisan ................ 38myzilra .................. 84Nnabumetone. ............. 77nadolol-bendroflumethiazide 35nadolol tablet. ............ 32nafcillin 1 gm/ 50 ml inj .... 13nafcillin 1 gm add-van vial .. 13nafcillin 1 gm vial. ......... 13nafcillin 2 gm/ 100 ml inj ... 13nafcillin 2 gm add-vant vial, -2gm vial. ................ 13nafcillin 10 gm bulk vial, -10 gmvial .................... 13NAGLAZYME ............ 44nalbuphine ............... 20naloxone hcl injection ...... 29naltrexone hcl tablet ....... 29NAMENDA .............. 20naproxen e.c. tab, -tablet ... 77naproxen oral susp . . . . . . . . 78naproxen sodium tablet .... 78naratriptan hcl ............ 26NATACYN ............... 91nateglinide ............... 44nature-throid ............. 45NEBUPENT ............. 10necon ................... 84nefazodone hcl ........... 28neofrin .................. 91neomycin-bacitracin-poly-hc 90neomycin-bacitracinpolymyxin.............. 91neomycin-polymyxin b. ..... 95neomycin-polymyxindexameth.............. 90neomycin-polymyxingramicidin.............. 91neomycin-polymyxin-hc ophthdrops. ................. 90neomycin-polymyxin-hcsuspensions, (not oral) ... 41neomycin-polymyxinhydrocort.............. 41neomycin sulfate tablet. ..... 7neo-polycin .............. 91neostigmine methylsulfateinjection ............... 29NEULASTA . . . . . . . . . . . . . . 51NEUMEGA .............. 50NEUPOGEN 300 MCG/0.5 MLSYR................... 51NEUPOGEN 300 MCG/MLVIAL. .................. 51NEUPOGEN 480 MCG/0.8 MLSYR................... 51NEUPOGEN 480 MCG/1.6 MLVIAL. .................. 51neutragard advanced . . . . . . 81nevirapine ................ 8NEXAVAR ............... 18NEXGEN NORMAL CONTROLSOLUTION ............ 65next choice .............. 84next choice one dose ...... 84NIASPAN. ............... 33nicardipine hcl capsule. .... 32nicardipine injection ....... 32NICOTROL. ............. 30NICOTROL NS .......... 30nifediac cc ............... 32nifedical xl ............... 32nifedipine capsule. ........ 32nifedipine er. ............. 32115