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

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IndexSymbols1ST CHOICE SUPER THINLANCETS. ............. 511ST CHOICE THINLANCETS. ............. 511ST CHOICE ULTRA THINLANCETS. ............. 511ST TIER COMFORTOUCH28G LANCT. ........... 511ST TIER COMFORTOUCH30G LANCT. ........... 511ST TIER UNIFINE PENTP5MM 31G. ............. 511ST TIER UNIFINE PNTIP 4MM32G. .................. 511ST TIER UNIFINE PNTIP 6MM31G. .................. 511ST TIER UNIFINE PNTIP 8MM31G. .................. 511ST TIER UNIFINE PNTP12MM 29G ............ 512TEK CONTROLSOLUTION ............ 518-MOP. ................. 38Aabacavir .................. 8ABILIFY 20 MG TABLET, -30MG TABLET, -300 MG ERINJECTION ............ 21ABILIFY DISCMELT. ...... 21ABILIFY INJECTION,-SOLUTION, -2 MG TABLET,-5 MG TABLET, -10 MGTABLET, -15 MG TABLET. 21acarbose ................ 43ACCU-CHEK ACTIVEGLUCOSE SOL ........ 51ACCU-CHEK ACTIVE TESTSTRIP ................. 51ACCU-CHEK ADVANTAGEKIT. ................... 51ACCU-CHEK AVIVA PLUSMETER ................ 51ACCU-CHEK AVIVA PLUSTEST STRP ............ 51ACCU-CHEK AVIVASOLUTION ............ 51ACCU-CHEK AVIVA TESTSTRIPS. ............... 51ACCU-CHEK CMFRT CURVESOLN . . . . . . . . . . . . . . . . . 51ACCU-CHEK CMFRT CURVESTRIP ................. 51ACCU-CHEK COMFORTCURVE STRIP. ......... 51ACCU-CHEK COMPACT BLUECONTROL. ............ 51ACCU-CHEK COMPACTCARE KIT .............. 52ACCU-CHEK COMPACTDRUM STRIPS ......... 52ACCU-CHEK COMPACT PLUSKIT. ................... 52ACCU-CHEK COMPACTSTRIPS. ............... 52ACCU-CHEK COMPACT TESTDRUM. ................ 52ACCU-CHEK CONTROLSOLUTION ............ 52ACCU-CHEK FASTCLIXLANCETS. ............. 52ACCU-CHEK III DIABETESKIT. ................... 52ACCU-CHEK MULTICLIXLANCET ............... 52ACCU-CHEK MULTICLIXLANCET KIT. ........... 52ACCU-CHEK MULTICLIXLANCETS. ............. 52ACCU-CHEK NANOSMARTVIEW METER. ... 52ACCU-CHEK SAFE-T-PRO 23GLANCT ................ 52ACCU-CHEK SAFE-T-PROLANCETS. ............. 52ACCU-CHEK SAFE-T-PROPLUS 23G ............. 52ACCU-CHEK SMARTVIEWCONTRL SOL. ......... 52ACCU-CHEK SMARTVIEWSTRIP ................. 52ACCU-CHEK SMARTVIEWTEST STRIP. ........... 52ACCU-CHEK SOFTCLIXLANCETS. ............. 52ACCU-CHEK VOICEMATESYSTEM ............... 52ACCUTREND GLUCOSECONTROL. ............ 52acebutolol hcl capsule ..... 32acetaminophen-caffdihydrocodeine......... 25acetaminophen-codeine. ... 25acetasol hc .............. 41acetazolamide capsule sustainedaction, -tablet ........... 90acetazolamide sodium ..... 90acetic acid 0.25% irrig soln. 95acetic acid-aluminum ...... 41acetic acid otic drops. ..... 41acetylcysteine nebs ....... 94ACTEMRA. .............. 50ACTHIB ................. 48acticin. .................. 38ACTI-LANCE 23GLANCETS. ............. 52ACTI-LANCE 28GLANCETS. ............. 52ACTI-LANCE LITE 28GLANCETS. ............. 52ACTI-LANCE SPECIAL 17GLANCETS. ............. 52ACTI-LANCE UNIVERS 23GLANCETS. ............. 52ACTIMMUNE ............ 50ACTOS 15 MG TABLET ... 43ACTOS 30 MG TABLET, -45MG TABLET. ........... 43ACURA CONTROL SOLUTIONHIGH ................. 52ACURA CONTROL SOLUTIONLOW .................. 52ACURA CONTROL SOLUTIONNORMAL . . . . . . . . . . . . . . 52acyclovir. ................ 11acyclovir injection . . . . . . . . . 1196
acyclovir ointment ......... 11ADACEL ................ 48ADAGEN. ............... 40adapalene ............... 37ADCIRCA ............... 36adenosine injection. ....... 34adriamycin injection ....... 15adrucil .................. 15ADVAIR DISKUS ......... 94ADVAIR HFA. ............ 94ADVANCED TRAVEL LANCETS28G. .................. 52ADVANCE MICRO-DRAWCNTRL SOLN .......... 52ADVANCE MICRO-DRAWCONTRL SOLN ........ 52ADVANCE NORMALCONTROL SOLN. ...... 52ADVOCATE 26G LANCETS 52ADVOCATE 30G LANCETS 52ADVOCATE CONTROLSOLUTION HIGH. ...... 52ADVOCATE CONTROLSOLUTION LOW ....... 52ADVOCATE INS 0.3 ML30GX5/16 ............. 52ADVOCATE INS 0.3 ML31GX5/16 ............. 52ADVOCATE INS 0.5 ML30GX5/16 ............. 52ADVOCATE INS 0.5 ML31GX5/16 ............. 52ADVOCATE INS 1 ML31GX5/16 ............. 52ADVOCATE INS SYR 0.3ML29GX1/2 .............. 53ADVOCATE INS SYR 0.5ML29GX1/2 .............. 53ADVOCATE INS SYR 1 ML29GX1/2 .............. 53ADVOCATE INS SYR 1 ML30GX5/16 ............. 53ADVOCATE PEN NEEDLES5MM 31G. ............. 53ADVOCATE PEN NEEDLES8MM 31G. ............. 53ADVOCATE REDI-CODE+CTRL SOLN. ........... 53afeditab cr ............... 32AFINITOR ............... 15AFLURIA 2011-2012. ..... 48AFLURIA 2011-2012 (PF) . 48AGAMATRIX HIGH CONTROLSOLN . . . . . . . . . . . . . . . . . 53AGAMATRIX NORM-HICONTROL SOLN. ...... 53AGGRENOX ............ 78AIMSCO INS PEN NDL29GX1/2 .............. 53AIMSCO INS PEN NDL31GX3/16 ............. 53AIMSCO INS PEN NDL31GX5/16 ............. 53AIMSCO INS SYR 0.3 ML29GX1/2 .............. 53AIMSCO INS SYR 0.3 ML30GX5/16 ............. 53AIMSCO INS SYR 0.5 ML28GX1/2 .............. 53AIMSCO INS SYR 0.5 ML29GX1/2 .............. 53AIMSCO INS SYR 1 ML28GX1/2 .............. 53AIMSCO INS SYR 1 ML29GX1/2 .............. 53AIMSCO INS SYR 1 ML30GX5/16 ............. 53AIMSCO SYRING 0.3 ML31GX5/16 ............. 53AIMSCO SYRING 0.5 ML30GX5/16 ............. 53AIMSCO SYRING 0.5 ML31GX5/16 ............. 53AIMSCO ULTR-THIN II 28GLANCET ............... 53ak-con .................. 91akorn balanced salt. ....... 91ak-poly-bac .............. 91ALBENZA ................ 7albuterol sulfate nebs ...... 93albuterol sulfate syrup, -tablet,-tablet sustained action. .. 93alclometasone dipropionate. 38ALCOHOL 70% PADS .... 53ALCOHOL 70% PREPPADS ................. 53ALCOHOL 70% SWABS .. 53ALCOHOL PREP PADS ... 53ALCOHOL PREP PADS70%. .................. 53ALCOHOL PREP SWABS. 53ALCOHOL SWAB ........ 53ALCOHOL SWABS. ...... 53ALCOHOL WIPES ....... 53ALDURAZYME. .......... 44alendronate sodium 5 mg tablet,-10 mg tab, -40 mg tab. .. 44alendronate sodium 35 mg tab,-70 mg tab ............. 44alfentanil hydrochloride .... 24alfuzosin hcl. ............. 95ALIMTA ................. 15ALINIA .................. 10ALKERAN TABLET. ....... 15allopurinol sodium. ........ 77allopurinol tablet . . . . . . . . . . 77alprazolam er ............. 23alprazolam intensol ........ 23alprazolam odt. ........... 23alprazolam tablet. ......... 23alprazolam xr . . . . . . . . . . . . . 23alprostadil injection. ....... 35altafrin .................. 91altavera ................. 83ALTERNATE SITE 26GLANCETS. ............. 53ALTERNATE SITELANCETS. ............. 53alyacen. ................. 83amantadine .............. 11amcinonide .............. 38a-methapred ............. 42amethia ................. 83amethia lo ............... 83amethyst ................ 83amifostine ............... 15amikacin. ................. 7amiloride hcl tablet ........ 36amiloride-hydrochlorothiazide 36amino acids .............. 79aminocaproic acid injection,-syrup, -500 mg tab. ..... 4097
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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
Page 48 and 49: Gastrointestinal Medications: Antis
Page 50 and 51: Immunologicals and VaccinesACTHIB T
Page 52 and 53: Immunologicals and Vaccines: Interf
Page 54 and 55: 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 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 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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