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

SUSTIVA ................. 8SUTENT ................ 18syeda ................... 84SYLATRON .............. 50SYLATRON 4-PACK ...... 50SYMBICORT 80-4.5 MCGINHALER .............. 94SYMBICORT 160-4.5 MCGINHALER .............. 94SYMLIN ................. 42SYMLINPEN 60. ......... 42SYMLINPEN 120. ........ 42SYNAREL ............... 89SYNRIBO ............... 18SYNTHROID. ............ 45SYNVISC. ............... 78SYNVISC-ONE. .......... 78SYPRINE. ............... 78syrex. ................... 80TTABLOID ................ 18tacrolimus 0.5 mg capsule, -1mg capsule. ............ 18tacrolimus 5 mg capsule ... 18TAMIFLU 30 MG GELCAP . 12TAMIFLU 45 MG GELCAP, -75MG GELCAP ........... 12TAMIFLU SUSPENSION .. 12tamoxifen citrate tablet ..... 18tamsulosin hcl ............ 95TARCEVA ............... 18TARGRETIN ............. 18taron a prenatal. .......... 87taron-bc ................. 87taron-c dha .............. 87taron-crystals. ............ 95taron-duo ec ............. 87taron-ec cal .............. 87taron ec calcium .......... 87taron-prex prenatal ........ 87TASIGNA. ............... 18TASMAR ................ 28TAZORAC ............... 37taztia xt. ................. 33TECHLITE AST LANCETS . 71TECHLITE BLOODLANCET ............... 71TEGRETOL XR 100 MGTABLET. ............... 23TEKAMLO ............... 35TEKTURNA. ............. 35TEKTURNA HCT ......... 35TELCARE CONTROLSOLUTION ............ 71temazepam .............. 29TEMODAR CAPSULE. .... 19TEMODAR INJECTION. ... 19TENIVAC ................ 49terazosin 1 mg capsule, -5 mgcapsule ................ 36terazosin 2 mg capsule, -10 mgcapsule ................ 36terbinafine hcl tablet ....... 10terbutaline sulfate injection,-tablet ................. 93terconazole .............. 15TERUMO INS SYR 0.3 ML29GX1/2 .............. 71TERUMO INS SYRINGE U100-1/2 ML ................ 71TERUMO INS SYRINGE U100-1/3 ML ................ 71TERUMO INS SYRINGE U100-1 ML .................. 71TERUMO INS SYRNG U100-1/2 ML ................ 71TERUMO SURGUARD SYR28G-1/2 ML. ........... 71TERUMO SURGUARD SYR28G-1 ML. ............. 71TERUMO SURGUARD SYR29G-0.3 ML ............ 72TERUMO SURGUARD SYR29G-1/2 ML. ........... 72TERUMO SURGUARD SYRN29G-1 ML. ............. 72TESTIM ................. 83testosterone cypionateinjection ............... 83testosterone enanthateinjection ............... 83TETANUS-DIPHTERIA-DECAVAC ............. 49TETANUS DIPHTHERIATOXOIDS .............. 49tetanus toxoid adsorbed. ... 49tetracycline hcl capsule .... 14THALOMID .............. 40theochron. ............... 93theophylline .............. 93theophylline anhydrous tabletsustained action. ........ 93THERACYS. ............. 19thermazene .............. 14THIN LANCET ........... 72THINLETS 28G(T)LANCETS. ............. 72THINLETS GP LANCETS .. 72THINPRO INS SYRIN U100-0.3ML. ................... 72THINPRO INS SYRIN U100-0.5ML. ................... 72THINPRO INS SYRIN U100-1ML. ................... 72thioridazine hcl ........... 21thiotepa injection. ......... 19thiothixene ............... 21tiagabine tablet ........... 27ticlopidine hcl ............ 78TIKOSYN. ............... 34tilia fe ................... 84timolol maleate ophth drops 90timolol maleate tablet ...... 32tinidazole tablet. ........... 7tizanidine hcl capsule, -tablet 76tl-assure one ............. 87tl-select ................. 87TOBI..................... 7TOBI PODHALER ......... 7tobramycin. ............... 7tobramycin-dexamethasone . 90tobramycin sulfate ophthdrops. ................. 91TODAY’S HEALTH SUPERTHIN 30G ............. 72TODAY’S HLTH PN NEEDLE6MM 31G. ............. 72TODAY’S HLTH PN NEEDLE8MM 31G. ............. 72TODAY’S HLTH ULTRA THINLANCET ............... 72TODAY’S HLT PN NEEDLE12MM 29G ............ 72tolazamide ............... 44124