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

RELI ON 31G X 1/4NEEDLES ............. 68RELION INS SYR 0.3 ML29GX1/2 .............. 69RELION INS SYR 0.3 ML30GX5/16 ............. 69RELION INS SYR 0.5 ML29GX1/2 .............. 69RELION INS SYR 1 ML29GX1/2 .............. 69RELION INS SYR 1 ML30GX5/16 ............. 69RELION INS SYR 1 ML31GX5/16 ............. 69RELI-ON INSULIN 0.3 MLSYR................... 69RELI-ON INSULIN 0.5 MLSYR................... 69RELI-ON INSULIN 1 MLSYR................... 69RELION INSULIN SYR 0.3ML. ................... 69RELION INSULIN SYR 0.5ML. ................... 69RELION INSULIN SYRINGE 1ML. ................... 69RELION LANCETS ....... 69RELION MINI PEN 31G X 1/4NDL. .................. 69RELION PEN 29G NEEDLE 69RELION PEN 29G X 1/2NEEDLE. .............. 69RELION PEN 31G NEEDLE 69RELION PEN 31G X 5/16NEEDLE. .............. 69RELION SYR 0.5 ML30GX5/16 ............. 69RELION SYRING 0.3 ML31GX5/16 ............. 69RELION SYRING 0.5 ML31GX5/16 ............. 69RELION THIN LANCETS .. 69RELION ULTRA THIN 30GLANCETS. ............. 69RELION ULTRA THIN PLUS33G. .................. 69RELION ULTRA THIN PLUSLANCETS. ............. 69RELISTOR. .............. 47relnate dha. .............. 87remeven ................. 39REMICADE. ............. 18REMODULIN ............ 36RENEW ADVANCED MICRO-LANCETS. ............. 69RENVELA ............... 78reprexain ................ 25RESCRIPTOR ............ 8reserpine tablet ........... 35RESTASIS. .............. 92RETROVIR INJECTION. .... 8REVATIO INJECTION ..... 36REVLIMID ............... 18revonto. ................. 76REYATAZ 100 MG CAPSULE 8REYATAZ 150 MG CAPSULE,-200 MG CAPSULE, -300 MGCAPSULE .............. 8ribapak 200-400 mgdosepack .............. 11ribapak 400-400 mg dosepack,-400-600 mg, -600-400 mg,-600-600 mg ........... 11ribasphere 600 mg tablet .. 11ribasphere capsule, -200 mgtablet, -400 mg tablet .... 11ribavirin capsule, -tablet .... 11RIDAURA ............... 78rifampin capsule ........... 9rifampin injection. .......... 9RIGHTEST CONTROL SOLNNORMAL . . . . . . . . . . . . . . 69RIGHTEST CONTROLSOLUTION HIGH. ...... 69RIGHTEST GL300LANCETS. ............. 69RILUTEK . . . . . . . . . . . . . . . . 76rimantadine hcl ........... 11ringers injection. .......... 80ringers irrigation .......... 80RISPERDAL CONSTA 12.5 MGSYR, -25 MG SYR. ...... 21RISPERDAL CONSTA 37.5 MGSYR, -50 MG SYR. ...... 21risperidone. .............. 21risperidone m-tab ......... 21risperidone odt ........... 21RITUXAN. ............... 18rivastigmine .............. 20rizatriptan. ............... 26romycin ................. 91ropinirole hcl ............. 28rosadan cream, -gel ....... 37ROTARIX. ............... 49ROTATEQ ............... 49ROXICET SOLUTION ..... 24roxicet tablet ............. 24SSABRIL ................. 27SAFESNAP INSULIN SYRINGE1 ML .................. 69SAFESNAP INSUL SYRINGE0.3 ML ................ 69SAFESNAP INSUL SYRINGE0.5 ML ................ 69SAFE-T-LANCE 21GLANCETS. ............. 69SAFE-T-LANCE 25GLANCETS. ............. 69SAFE-T-LANCE PLUSLANCETS. ............. 69SAFETY 21G LANCETS ... 69SAFETY 28G LANCETS ... 69SAFETY LANCET 2MM. ... 69SAFETY LANCETS ....... 69SAFETY-LET LANCETS. ... 69SAFETY SEAL 30GLANCETS. ............. 69SAFETY SYRINGE W-SHIELD3 ML .................. 69SAIZEN ................. 47salicylic acid soln, top ..... 39saline 0.45% soln-excel con,-0.45% soln, -saline 0.9% solnexcelcont, -0.9% solution, -cl2.5 meq/ml vial, -3% iv soln,-5% iv soln ............. 80saline flush. .............. 80salsalate tablet ........... 78SAMSCA. ............... 45SANDOSTATIN LAR ...... 18SANTYL. ................ 39121