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

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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
tolbutamide . . . . . . . . . . . . . . 44tolmetin sodium. .......... 78tolterodine tartrate ........ 95TOPCARE CLICKFINE 31G X1/4. ................... 72TOPCARE CLICKFINE 31G X5/16 .................. 72TOPCARE ULTRA COMFORTSYRINGE. ............. 72TOPCARE UNIVERSAL1 THINLANCET ............... 72topiragen ................ 27topiramate sprinkle, -tablet. . 27toposar. ................. 19topotecan hcl ............ 19TORISEL. ............... 19torsemide injection ........ 34torsemide tablet .......... 34TRACLEER .............. 36tramadol hcl. ............. 20tramadol hcl-acetaminophen 20tramadol hcl er ........... 20trandolapril. .............. 31tranexamic acid ........... 40tranexamic tab. ........... 40TRANSDERM-SCOP ..... 22tranylcypromine sulfate. .... 26TRAVATAN Z ............. 90travoprost ophth drops. .... 90trazodone hcl tablet ....... 28TREANDA 25 MG VIAL. ... 19TREANDA 100 MG VIAL .. 19TRECATOR. .............. 9TRELSTAR .............. 19TRELSTAR DEPOT ....... 19TRELSTAR LA. ........... 19tretinoin capsule . . . . . . . . . . 19tretinoin cream, -gel ....... 37trezix. ................... 25triadvance ............... 87triamcinolone acetonide cream,-lotion, -oint. ............ 39triamcinolone acetonide nasalinhaled steroids ......... 41triamcinolone acetonidepaste .................. 41triamterene-hctz .......... 36triamterenehydrochlorothiazid....... 36trianex. .................. 39triazolam. ................ 29tricitrates ................ 95triderm .................. 39trifluoperazine hcl ......... 21trifluridine ophth drops ..... 92trihexyphenidyl hcl elix ..... 20trihexyphenidyl hcl tablet ... 20TRIHIBIT ................ 49tri-legest fe. .............. 84TRILEPTAL SUSPENSION. 23trilyte with flavor packets ... 47trimesis rx. ............... 87trimethobenzamide hcl capsule,-injection ............... 22trimethoprim ............. 14trimipramine maleate capsule 30trinatal gt ................ 87trinatal rx 1. .............. 87trinatal ultra .............. 87trinate. .................. 87trinessa ................. 84TRIPEDIA ............... 49tri-previfem. .............. 84tri rx .................... 87TRISENOX .............. 19tri-sprintec ............... 84triveen-duo dha ........... 87triveen-one. .............. 87triveen-prx rnf. ............ 87triveen-ten ............... 87triveen-u ................. 87tri-vitamin with fluoride . . . . . 80trivora-28 ................ 84TRIZIVIR ................. 8trospium chloride ......... 95TRUECONTROL GLUCOSESOLUTION ............ 72TRUEPLUS 33G LANCETS 72TRUEPLUS LANCETS 28G 72TRUEPLUS SUPER THIN 28GLANCET ............... 72TRUEPLUS SYR 0.3ML29GX1/2 .............. 72TRUEPLUS SYR 0.3ML30GX5/16 ............. 72TRUEPLUS SYR 0.3ML31GX5/16 ............. 72TRUEPLUS SYR 0.5ML28GX1/2 .............. 72TRUEPLUS SYR 0.5ML29GX1/2 .............. 72TRUEPLUS SYR 0.5ML30GX5/16 ............. 72TRUEPLUS SYR 0.5ML31GX5/16 ............. 72TRUEPLUS SYR 1ML28GX1/2 .............. 72TRUEPLUS SYR 1ML29GX1/2 .............. 72TRUEPLUS SYR 1ML30GX5/16 ............. 72TRUEPLUS SYR 1ML31GX5/16 ............. 72TRUEPLUS ULTRA THIN 30GLANCET ............... 72TRUETEST CONTROL SOLNHIGH ................. 72TRUETEST CONTROL SOLNNORMAL . . . . . . . . . . . . . . 72TRUETEST CONTROLSOLUTION LOW ....... 72TRUETRACK GLUCOSECONTROL. ............ 72TRUVADA ................ 8TUDORZA .............. 94TWINRIX. ............... 49TWIST LANCETS. ........ 72TYGACIL ................ 10TYKERB ................ 19TYPHIM VI. .............. 49TYSABRI ................ 19TYVASO ................ 36TYZEKA. ................ 12TYZINE ................. 41Uu-kera e urea emollient ..... 39ULESFIA . . . . . . . . . . . . . . . . 38ULORIC. ................ 77ULTCARE INS SYR 1 ML30GX5/16 ............. 73ULTCARE INS SYR 1 ML31GX5/16 ............. 73125
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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 76 and 77: Medical (Miscellaneous) Supplies:Di
Page 78 and 79: 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 120 and 121: PEGASYS PROCLICK 180MCG/0.5 .......
Page 122 and 123: PUB INSUL SYR 0.3 ML31GX5/16 ......
Page 124 and 125: SAPHRIS ............... 21SAVELLA.
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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