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

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venlafaxine hcl ............ 28venlafaxine hcl er 37.5 mg cap,-75 mg cap, -37.5 mg tab, -75mg tab. ................ 28venlafaxine hcl er 150 mg cap,-150 mg tab ............ 28VENLAFAXINE HCL ER 225MG TAB (BRAND) ...... 28venlafaxine hcl er 225 mg tab(generic) ............... 28VENTAVIS ............... 36verapamil er 120 mg tablet, -180mg tablet, -240 mg tablet . 33verapamil er pm. .......... 33verapamil hcl capsule sustainedaction, -tablet, -er 120 mgtablet, -er 240 mg tablet .. 33verapamil injection ........ 33veripred 20 .............. 42vestura .................. 85VFEND SUSPENSION. ... 10VH INS SYR 0.5 ML29GX1/2 .............. 75VH INS SYR 1 ML 29GX1/2 75VIBATIV 250 MG VIAL. .... 11VIBATIV 750 MG VIAL. .... 11VICTORY HIGH-LOWCONTROL SOLN. ...... 75VICTOZA 2-PAK .......... 42VICTOZA 3-PAK .......... 42VICTRELIS ............... 8VIDAZA ................. 19VIDEX ................... 8VIIBRYD 10 MG TABLET,-20 MG TABLET, -40 MGTABLET. ............... 30VIIBRYD TITRATION PACK 30VIMPAT INJECTION. ...... 27VIMPAT SOLUTION,-TABLET ............... 27vinacal .................. 88vinate az. ................ 88vinate az extra ............ 88vinate c. ................. 88vinate calcium . . . . . . . . . . . . 88vinate care ............... 88vinate gt ................. 88vinate ic ................. 88vinate ii. ................. 88vinate-m ................. 88vinate one ............... 88vinate pn care ............ 88vinate ultra ............... 88vinblastine ............... 19vincasar pfs .............. 19vincristine. ............... 19vinorelbine ............... 19viorele. .................. 85VIRACEPT 625 MG TABLET 8VIRACEPT POWDER, -250 MGTABLET. ................ 8VIRAMUNE ORAL SUSP ... 8VIRAMUNE XR. ........... 8VIREAD .................. 8virt-bal dha. .............. 88virt-pn ................... 88virt-pn dha ............... 88VISICOL ................ 47vitafol-ob ................ 88vitafol-pn ................ 88VITALET 23 GAUGELANCET ............... 75VITALET PRO LANCETS. .. 75VITALET PRO PLUSLANCETS. ............. 75VITALET THIN 26GAUGELANCET ............... 75vitaspire ................. 88vitazol ................... 37vol-nate ................. 88vol-plus. ................. 88vol-tab rx ................ 88VORAXAZE. ............. 19voriconazole. ............. 12voriconazole 50 mg tablet . . 10voriconazole 200 mg tablet . 10VOTRIENT. .............. 19vp-ch-pnv ................ 88vp-era ob plus ............ 88vp-ggr-b6. ............... 88VUMON. ................ 19WWALGREENS LANCETS .. 75WALGREENS THINLANCETS. ............. 75WALGREENS ULTRA THINLANCETS. ............. 75warfarin sodium tablet ..... 82WAVESENSE CONTROLSOLN NORMAL ........ 76WDMEDIC INS SYR 1 ML30GX5/16 ............. 76WD MEDIC SYR 0.3 ML30GX5/16 ............. 76WD MEDIC SYR 0.5 ML29GX1/2 .............. 76WD MEDIC SYR 0.5 ML30GX5/16 ............. 76WD MEDIC SYR 1 ML29GX1/2 .............. 76WDMEDIC SYRING 0.3 ML29GX1/2 .............. 76WEBCOL ALCOHOLPREPS ................ 76WELCHOL .............. 33W & F 26G LANCETS. .... 75W & F COLORED 21GLANCETS. ............. 75W&F COLORED LANCETS 75W&F THIN LANCETS ..... 75XXALKORI. ............... 19XARELTO ............... 82XELODA ................ 19XENAZINE .............. 29XEOMIN ................ 76XGEVA. ................. 45XOLAIR ................. 94XOPENEX. .............. 93XPRES CONTROL SOLUTIONNORMAL . . . . . . . . . . . . . . 76XTANDI ................. 19x-viate. .................. 40XYREM ................. 29YYERVOY ................ 19YF-VAX ................. 49Zzafirlukast. ............... 94zaleplon ................. 29ZALTRAP ................ 19zamicet. ................. 25128
ZANOSAR .............. 19zarah. ................... 85zatean-ch ................ 88zatean-pn ................ 88zatean-pn dha ............ 88zatean-pn plus. ........... 88ZAVESCA . . . . . . . . . . . . . . . 45ZELAPAR ............... 28ZELBORAF. ............. 19ZEMPLAR CAPSULE ..... 83ZEMPLAR INJECTION .... 83zenchent ................ 85zenchent fe .............. 85ZENPEP ................ 47zeosa ................... 85ZETIA. .................. 33ZIAGEN SOLUTION ....... 8zidovudine ................ 9ziprasidone hcl ........... 21ZIRGAN. ................ 92ZITHRANOL-RR. ......... 37zoden pd ................ 92ZOLADEX ............... 19zoledronic acid ........... 45ZOLINZA. ............... 19zolpidem tartrate .......... 29zolpidem tartrate er. ....... 29ZOMETA . . . . . . . . . . . . . . . . 45ZOMIG NASAL DROPS/SPRAYS ............... 26ZONALON .............. 40zonisamide. .............. 27ZORBTIVE .............. 47ZORTRESS 0.5 MG TABLET,-0.75 MG TABLET. ...... 19ZORTRESS 0.25 MGTABLET. ............... 19ZOSTAVAX .............. 49zovia 1-35e .............. 85zovia 1-50e .............. 85ZOVIRAX CREAM, -OINT. . 12ZYCLARA ............... 40ZYPREXA RELPREVV .... 21ZYTIGA ................. 19ZYVOX IV SOLUTION. .... 11ZYVOX ORAL SUSP,-TABLET ............... 11129
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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 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 126 and 127: SUSTIVA ................. 8SUTENT .
Page 128 and 129: ULT CFT 0.3 ML 29GX1/2(1/2) .......
Page 133: ®, SM Registered and Service Marks
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2013 Medicare HMO Blue ValueRx/PlusRx Formulary - Blue Cross ...

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