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

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PEGASYS PROCLICK 180MCG/0.5 .............. 50PEGINTRON 50 MCG KIT. 50PEGINTRON 80 MCG KIT,-120 MCG KIT, -150 MCGKIT. ................... 50PEGINTRON REDIPEN . . . 50penicillin g k 5 million unit .. 13penicillin gk 20 million unit. . 13penicillin g procaine ....... 13penicillin g sodium ........ 13penicillin v potassium ...... 13PEN NEEDLE 6MM 31G .. 66PEN NEEDLE 30G X 5/16. 66PEN NEEDLE 31G X 3/16. 66PEN NEEDLE 31G X 5/16. 66PEN NEEDLES 5MM 31G . 66PEN NEEDLES 6MM 31G . 66PEN NEEDLES 8MM 31G . 66PEN NEEDLES 12MM 29G 66PEN NEEDLES 29G ...... 66PEN NEEDLES 31G ...... 66PENTACEL . . . . . . . . . . . . . . 49PENTASA ............... 46pentazocine-acetaminophen 20pentazocine-naloxone hcl. .. 20pentostatin. .............. 18pentoxifylline tablet sustainedaction ................. 35PERFOROMIST. ......... 93perindopril erbumine. ...... 31periogard ................ 41perio med. ............... 81PERJETA ................ 18permethrin cream ......... 38perphenazine. ............ 21perphenazine-amitriptyline .. 28PHARMACIST CHOICE 28GLANCETS. ............. 66PHARMACIST CHOICE 30GLANCETS. ............. 66PHARM CHOICE ALCOHOLPREP PADS. ........... 66phenadoz. ............... 22phenelzine sulfate tablet. ... 26phenobarbital elix, -tablet ... 27phenylephrine hcl ophthdrops. ................. 91phenytoin injection ........ 26phenytoin oral susp. ....... 26phenytoin sodium extended. 26phenytoin tablet chew ..... 26philith ................... 84phospha 250 neutral ...... 82PHOSPHOLINE IODIDE .. 90physostigmine salicylateinjection ............... 29PICATO ................. 39pilocarpine hcl ophth drops . 90pilocarpine hcl tablet ...... 41pindolol ................. 32pioglitazone-glimepiride .... 44pioglitazone hcl 15mg tablet 44pioglitazone hcl 30mg tablet,-45mg tab. ............. 44pioglitazone-metformin ..... 44piperacil-tazobact injection . 13piroxicam capsule ......... 78PLASTIC INSULINCARTRIDGE . . . . . . . . . . . 66PNEUMOVAX 23 VIAL .... 49pnv-dha ................. 86pnv-dha + docusate ....... 86pnv ob+dha .............. 86pnv-omega. .............. 86pnv-select ............... 86pnv-total. ................ 86POCKETCHEM EZ CONTROLSOLUTION ............ 66podofilox ................ 39polycin-b ................ 91poly-dex ................. 90polyethylene glycol 3350. .. 46polymyxin b sulfate injection 10polymyxin b sul-trimethoprim 91POMALYST .............. 18portia ................... 84potassium acetate injection . 82potassium bicarbonate. .... 82potassium chl-normal saline. 80potassium chloride-nacl .... 80potassium chloride sa capsule,-sa tablet. .............. 82potassium citrate-citric acid. 95potassium citrate TABLETSUSTAINED ACTION. ... 95potassium cl injection. ..... 82potassium cl solution ...... 82POTIGA. ................ 27PRADAXA ............... 82pramipexole dihydrochloride 28PRANDIN ............... 44prascion. ................ 37prascion fc. .............. 37pravastatin sodium ........ 33prazosin hcl .............. 36pre-attached lta kit ......... 7PRECISION CONTROLSOLUTION ............ 66PRECISION SURE DOSESYRINGE. ............. 67PRECISION THINS 28GLANCETS. ............. 67PRECISION THINS GPLANCETS. ............. 67PRECISION ULTRA 28GLANCETS. ............. 67PRED MILD ............. 90prednicarbate ............ 39prednisolone 5 mg/5 ml soln,-6.7 mg/5 ml soln, -15 mg/5 mlsoln, 25mg/5ml soln ..... 42prednisolone 15 mg/5 mlsoln . . . . . . . . . . . . . . . . . . . 42prednisolone acetate ophthdrops. ................. 90prednisolone sodium phosphateophth drops ............ 90prednisone intensol ....... 42prednisone solution ....... 42prednisone tab(in conveniencepackage), -tablet ........ 42PREFERRED PLUS 0.3 ML30GX5/16 ............. 67PREFERRED PLUS 0.5 ML29GX1/2 .............. 67PREFERRED PLUS COLOREDLANCETS. ............. 67PREFERRED PLUSLANCETS. ............. 67PREFERRED PLUS SYRINGE0.3 ML ................ 67118
PREFERRED PLUS SYRINGE0.5 ML ................ 67PREFERRED PLUS SYRINGE1 ML .................. 67PREFERRED PLUS THINLANCETS. ............. 67PREFPLS INS SYR 1 ML30GX5/16 ............. 67PREF PLUS SYR 0.5 ML30GX5/16 ............. 67PREF PLUS SYRING 1 ML29GX1/2 .............. 67PREMARIN INJECTION . . . 85PREMARIN TABLET, -VAGINALPRODUCTS. ........... 85prenafirst ................ 86prenaissance. ............ 87prenaissance balance. ..... 87prenaissance next. ........ 87prenaissance plus. ........ 87prenaplus. ............... 87prenatabs fa ............. 87prenatabs rx. ............. 87prenatal 19 .............. 87prenatal ad. .............. 87prenatal low iron .......... 87prenatal plus ............. 87prenatal-u. ............... 87prenate plus. ............. 87PREP EASE ALCOHOLPADS ................. 67PRESSURE ACTIVATED 21GLANCETS. ............. 67PRESSURE ACTIVATED 28GLANCETS. ............. 67PRESTIGE GLUCOSECONTROL. ............ 67prevalite ................. 33previfem ................. 84PREVNAR 13 ............ 49PREZISTA 75 MG TABLET,-800MG TABLET, -100MGSUSP .................. 8PREZISTA 150 MG TABLET,-400 MG TABLET, -600 MGTABLET. ................ 8PRIFTIN. ................. 9PRIMAQUINE. ........... 13primidone tablet .......... 27PRISTIQ ER ............. 28pr natal 400. ............. 86pr natal 400 ec ........... 86pr natal 430. ............. 86pr natal 430 ec ........... 86PROAIR HFA ............ 93probenecid .............. 77probenecid-colchicine ..... 77procainamide hcl injection .. 31prochlorperazine edisylateinjection ............... 22prochlorperazine maleaterectal .................. 22prochlorperazine maleatetablet. ................. 22PROCRIT 2,000 UNITS/ML VIAL, -3,000 UNITS/MLVIAL, -4,000 UNITS/ML VIAL,-10,000 UNITS/ML VIAL . 49PROCRIT 20,000 UNITS/MLVIAL, -40,000 UNITS/MLVIAL. .................. 49procto-pak ............... 46proctosol-hc ............. 46proctozone-hc ............ 47PRODIGY CONTROLSOLUTION ............ 67PRODIGY CONTROLSOLUTION LOW ....... 67PRODIGY INS SYR 1ML28GX1/2 .............. 67PRODIGY MINI PEN NDL31GX3/16 ............. 67PRODIGY PEN NEEDLE29GX1/2 .............. 67PRODIGY PEN NEEDLE31GX5/16 ............. 67PRODIGY PRESSUREACTIVATED 28G. ....... 67PRODIGY PRESSURE ACTIVELANCET ............... 67PRODIGY SAFETYLANCETS. ............. 67PRODIGY SYRNG 0.5 ML31GX5/16 ............. 67PRODIGY SYRNG 1 ML29GX1/2 .............. 67PRODIGY SYRNGE 0.3ML31GX5/16 ............. 67PRODIGY TWIST TOP 28GLANCET ............... 67progesterone capsule, -oil 50mg/ml vl ............... 89progesterone oil 50 mg/ml vl 89PROGLYCEM. ........... 42PROGRAF INJECTION. ... 18PROLASTIN C . . . . . . . . . . . 95PROLEUKIN. ............ 50PROLIA ................. 45PROMACTA ............. 49promethazine hcl injection .. 92promethazine hcl rectal .... 22promethazine hcl syrup,-tablet ................. 92promethazine vc .......... 92promethegan ............. 22propafenone hcl .......... 31propantheline bromide tablet 46proparacaine hcl ophthdrops. ................. 91propranolol hcl capsulesustained action, -tablet .. 32propranolol hcl injection. ... 32propranolol hcl solution .... 32propranololhydrochlorothiazid....... 35propylthiouracil tablet ...... 41PROQUAD .............. 49PROSTIGMIN ........... 29PROTOPIC .............. 39protriptyline hcl . . . . . . . . . . . 29PROVENTIL HFA ......... 93prudoxin ................. 39PSS SELECT GPLANCETS. ............. 67PSS SELECT SAFETYLANCETS. ............. 67PUB INS SYRIN 0.3 ML30GX1/2 .............. 67PUB INS SYRINGE 1 ML30GX1/2 .............. 67PUB INSULIN SYR 1 ML31GX5/16 ............. 67119
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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 70 and 71: 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 114 and 115: lactulose ................ 78LADY L
Page 116 and 117: metaproterenol sulfate syrup,-table
Page 118 and 119: NILANDRON ............ 18nimodipine
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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