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

sotalol af ................ 34sotret ................... 38SPIRIVA. ................ 94spironolactone-hctz ....... 36spironolactone tablet ...... 36sprintec ................. 84SPRYCEL ............... 18sps ..................... 35sronyx. .................. 84ssd ..................... 14stagesic ................. 25stannous fluoride dental/mucousmembrn products. ....... 81stavudine ................. 8STERILANCE TL TWIST 30GLANCET ............... 70STERILANCE TL TWIST 32GLANCET ............... 70sterile water for injection, -forinjection ampul, -for injectionvial .................... 80STIMATE ................ 45STIVARGA. .............. 18STRATTERA 10 MG CAPSULE,-18 MG CAPSULE, -25MG CAPSULE, -80 MGCAPSULE, -100 MGCAPSULE ............. 29STRATTERA 40 MG CAPSULE,-60 MG CAPSULE ...... 29STRIBILD ................ 8STROMECTOL. ........... 7sublimaze. ............... 24SUBOXONE. ............ 25SUCRAID ............... 47sucralfate oral susp, -tablet . 46sufenta .................. 20sufentanil citrate injection .. 20sulfacetamide-prednisolone. 90sulfacetamide sodium lotion 37sulfacetamide sodium oint .. 91sulfacetamide sodium ophthdrops. ................. 91sulfacetamide sodium-sulfur 37sulfacleanse 8-4 .......... 37sulfadiazine tablet ......... 14sulfamethoxazole-trimethopriminjection ............... 14sulfamethoxazole-trimethoprimoral susp, -tablet ........ 14sulfamide ................ 91SULFAMYLON . . . . . . . . . . . 14sulfasalazine dr . . . . . . . . . . . 47sulfasalazine tablet ........ 47sulfazine. ................ 47sulfazine ec .............. 47sulindac tablet. ........... 78sumatriptan 4 mg/0.5 ml cart,-4 mg/0.5 ml inject, -4 mg/0.5ml kit, -4 mg/0.5 ml refill, -4mg/0.5 ml vial, -6 mg/0.5 mlrefill, -6 mg/0.5 ml syrng .. 26sumatriptan 6 mg/0.5 ml inject,-6 mg/0.5 ml vial ........ 26sumatriptan succinate tablet 26SUPARTZ ............... 78SUPER THIN 28GLANCETS. ............. 70SUPER THIN 30GLANCETS. ............. 70SUPER THIN 33GLANCETS. ............. 70SUPER THIN LANCETS. .. 70SUPRAX . . . . . . . . . . . . . . . . . 9SUPREME II CONTROLSOLUTION ............ 70SURECHEK GLUCOSECONTROL SOLN. ...... 71SURE COMFORT 0.3 MLSYRINGE. ............. 70SURE COMFORT 0.5 MLSYRINGE. ............. 71SURE COMFORT 1 MLSYRINGE. ............. 71SURE COMFORT 3/10 MLSYRINGE. ............. 71SURE COMFORT 28GLANCETS. ............. 71SURE COMFORT 30GLANCETS. ............. 71SURE COMFORT 31G PENNEEDLE. .............. 71SURE COMFORT ALCOHOLPREP PADS. ........... 71SURE COMFORT PEN NDL29GX1/2 .............. 71SURE COMFORT PEN NDL31GX3/16 ............. 71SURE EDGE GLUCOSECONTROL SOLN. ...... 71SURE-FINE PEN NEEDLES5MM .................. 71SURE-FINE PEN NEEDLES8MM .................. 71SURE-FINE PEN NEEDLES12.7MM ............... 71SURE-JECT INSULIN SYR 0.3ML. ................... 71SURE-JECT INSULIN SYR 0.5ML. ................... 71SURE-JECT INSULINSYRINGE 1 ML. ........ 71SURE-JECT INSUL SYR U1001 ML .................. 71SURE-JECT INSU SYR U1000.3 ML ................ 71SURE-JECT INSU SYR U1000.5 ML ................ 71SURE-JECT INSU SYR U100 1ML. ................... 71SURE-LANCE 26GLANCETS. ............. 71SURE-LANCE FLATLANCETS. ............. 71SURE-LANCE THINLANCET ............... 71SURE-LANCE ULTRA THIN30G. .................. 71SURELITE LANCET REGBODY ................. 71SURE-PREP ALCOHOL PREPPADS ................. 71SURESTEP GLUC CONTROLSOLN . . . . . . . . . . . . . . . . . 71SURESTEP PRO CONTROLSOLN . . . . . . . . . . . . . . . . . 71SURESTEP PRO LINEARITYKIT. ................... 71SURESTEP PRO TESTSTRIPS. ............... 71SURESTEP TEST STRIPS . 71SURE-TEST EASYPLUS MINISOLN . . . . . . . . . . . . . . . . . 71SURE-TOUCH LANCET ... 71123