Blue Cross and Blue Shield of Vermont - Wellness Drug List ASTHMA
Blue Cross and Blue Shield of Vermont - Wellness Drug List ASTHMA
Blue Cross and Blue Shield of Vermont - Wellness Drug List ASTHMA
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ACCOLATE<br />
ACCUNEB<br />
ADRENALIN CL<br />
ADVAIR DISKUS<br />
ADVAIR HFA<br />
AEROBID AEROSOL<br />
AEROBID-M AEROSOL<br />
AIRET<br />
ALBUTEROL<br />
ALBUTEROL SULF HFA<br />
ALBUTEROL SULFATE<br />
ALBUTEROL SULFATE ER<br />
ALUPENT<br />
ALVESCO<br />
AMINOPHYLLINE<br />
AMINOPHYLLINE ANHYDROUS PWD<br />
AMINOPHYLLINE POWDER<br />
ASMANEX<br />
ATROVENT HFA<br />
AZMACORT<br />
BRETHINE<br />
BRONCHIAL MIST<br />
BRONCOMAR<br />
BROVANA<br />
BUDESONIDE<br />
COMBIVENT<br />
COPD TABLET<br />
CROMOLYN NEBULIZER SOLUTION<br />
CROMOLYN SODIUM POWDER<br />
DIFIL-G<br />
DIFIL-G FORTE<br />
DILEX-G<br />
DUONEB SOLN<br />
DY-G LIQUID<br />
DYLIX<br />
DYPHYLLINE GG<br />
DYPHYLLINE GG ES<br />
ED-BRON G LIQUID<br />
ELIXOPHYLLIN ELIX<br />
EPHEDRINE HCL POWDER<br />
EPHEDRINE SULFATE POWDER<br />
EPINEPHRINE<br />
EPINEPHRINE MIST<br />
FLOVENT DISKUS<br />
FLOVENT HFA<br />
FLUNISOLIDE POWDER<br />
FORADIL AEROLIZER<br />
INTAL<br />
<strong>Blue</strong> <strong>Cross</strong> <strong>and</strong> <strong>Blue</strong> <strong>Shield</strong> <strong>of</strong> <strong>Vermont</strong> - <strong>Wellness</strong> <strong>Drug</strong> <strong>List</strong><br />
Updated: February 2012<br />
<strong>ASTHMA</strong><br />
INTAL NEBULIZER SOLUTION<br />
IPRAT-ALBUT<br />
IPRATROPIUM BR<br />
IPRATROPIUM BROMIDE POWDER<br />
ISOPROTERENOL<br />
ISUPREL<br />
JAY-PHYL SYRUP<br />
LEVALBUTEROL<br />
LUFYLLIN<br />
LUFYLLIN-GG ELIXIR<br />
MAXAIR AUTOHALER<br />
METAPROTERENOL<br />
METAPROTERENOL SULFATE POWDER<br />
PERFOROMIST SOLN<br />
PRIMATENE MIST<br />
PROAIR HFA<br />
PROVENTIL<br />
PROVENTIL HFA<br />
PULMICORT<br />
QVAR INHALER<br />
RELION VENTOLIN HFA<br />
S-2 2.25% SOLUTION<br />
SENOPHYLLINE<br />
SEREVENT DISKUS<br />
SINGULAIR<br />
SPIRIVA 18 MCG CP-HANDIHALER<br />
SYMBICORT<br />
TERBUTALINE SULFATE<br />
TERBUTALINE SULFATE POWDER<br />
THEO-24 ER<br />
THEOCHRON ER<br />
THEOCHRON SA<br />
THEO-DUR SA<br />
THEOPHYLLINE<br />
THEOPHYLLINE ER<br />
THEOPHYLLINE SA<br />
UNIPHYL TABLET<br />
UNIPHYL CR<br />
VENTOLIN<br />
VENTOLIN HFA<br />
VENTOLIN SOLUTION<br />
VOSPIRE ER<br />
XOLAIR<br />
XOPENEX HFA<br />
XOPENEX SOLUTION<br />
ZYFLO<br />
ZYFLO CR<br />
Page 1 <strong>of</strong> 8
ACARBOSE<br />
ACTOPLUS MET<br />
ACTOPLUS MET XR<br />
ACTOS<br />
AMARYL<br />
APIDRA<br />
APIDRA SOLOSTAR<br />
APPFORMIN-D<br />
AVANDAMET<br />
AVANDARYL<br />
AVANDIA<br />
BYETTA<br />
CHLORPROPAMIDE<br />
DIABETA<br />
DUETACT<br />
FORTAMET ER<br />
GLIMEPIRIDE<br />
GLIPIZIDE<br />
GLIPIZIDE ER<br />
GLIPIZIDE POWDER<br />
GLIPIZIDE XL<br />
GLIPIZIDE-METFORMIN<br />
GLUCAGEN<br />
GLUCAGON EMERGENCY KIT<br />
GLUCOPHAGE<br />
GLUCOPHAGE XR<br />
GLUCOSE<br />
GLUCOSE 40% GEL<br />
GLUCOSE BITS CHEW<br />
GLUCOSE CHEWABLE<br />
GLUCOTROL<br />
GLUCOTROL XL<br />
GLUCOVANCE<br />
GLUMETZA ER<br />
GLYBURIDE<br />
GLYBURIDE MICRO<br />
GLYBURIDE-METFORMIN<br />
GLYNASE<br />
GLYSET 100<br />
HUMALOG<br />
HUMALOG MIX<br />
HUMULIN<br />
HUMULIN N<br />
JANUMET<br />
JANUVIA<br />
LANTUS<br />
LANTUS SOLOSTAR<br />
LEVEMIR<br />
<strong>Blue</strong> <strong>Cross</strong> <strong>and</strong> <strong>Blue</strong> <strong>Shield</strong> <strong>of</strong> <strong>Vermont</strong> - <strong>Wellness</strong> <strong>Drug</strong> <strong>List</strong><br />
Updated: February 2012<br />
DIABETES<br />
METAGLIP<br />
METFORMIN HCL<br />
METFORMIN HCL ER<br />
MICRONASE<br />
NATEGLINIDE<br />
NOVOLIN<br />
NOVOLIN N<br />
NOVOLIN R<br />
NOVOLOG<br />
NOVOLOG MIX<br />
ONGLYZA<br />
PRANDIMET<br />
PRANDIN<br />
PRECOSE<br />
PROGLYCEM<br />
RELION NOVOLIN<br />
RELION NOVOLIN N<br />
RIOMET<br />
STARLIX<br />
SYMLIN<br />
SYMLINPEN<br />
TOLAZAMIDE<br />
TOLBUTAMIDE<br />
VICTOZA<br />
ADVICOR<br />
ALTOPREV<br />
ANTARA<br />
CHOLESTYRAMINE<br />
COLESTID<br />
COLESTIPOL HCL<br />
CRESTOR<br />
FENOFIBRATE<br />
FENOFIBRIC ACID<br />
FENOGLIDE<br />
FIBRICOR<br />
GEMFIBROZIL<br />
LESCOL<br />
LIPITOR<br />
LIPOFEN<br />
LIVALO<br />
LOFIBRA<br />
LOPID<br />
LOVASTATIN<br />
LOVAZA<br />
MEVACOR<br />
NIASPAN ER<br />
HYPERLIPIDEMIA<br />
Page 2 <strong>of</strong> 8
<strong>Blue</strong> <strong>Cross</strong> <strong>and</strong> <strong>Blue</strong> <strong>Shield</strong> <strong>of</strong> <strong>Vermont</strong> - <strong>Wellness</strong> <strong>Drug</strong> <strong>List</strong><br />
Updated: February 2012<br />
HYPERLIPIDEMIA continued...<br />
PRAVACHOL<br />
PRAVASTATIN SODIUM<br />
PREVALITE PACKET<br />
QUESTRAN LIGHT<br />
SIMCOR<br />
SIMVASTATIN<br />
TRICOR<br />
TRIGLIDE<br />
TRILIPIX DR<br />
VYTORIN<br />
WELCHOL<br />
ZETIA<br />
ZOCOR<br />
HYPERTENSION<br />
ACCURETIC<br />
ACEBUTOLOL<br />
ACEBUTOLOL HCL POWDER<br />
ACEON<br />
ADALAT CC<br />
AFEDITAB CR<br />
AGGRENOX SA<br />
ALDACTAZIDE<br />
ALDACTONE<br />
ALTACE<br />
AMILORIDE HCL<br />
AMILORIDE HCL-HCTZ<br />
AMLODIPINE BESYLATE<br />
AMLODIPINE-BENAZEPRIL<br />
ATACAND<br />
ATACAND HCT<br />
ATENOLOL<br />
ATENOLOL POWDER<br />
ATENOLOL-CHLORTHALIDONE<br />
AVALIDE<br />
AVAPRO<br />
AZOR<br />
BENAZEPRIL HCL<br />
BENAZEPRIL-HCTZ<br />
BENICAR<br />
BENICAR HCT<br />
BETAXOLOL<br />
BISOPROLOL FUMARATE<br />
BISOPROLOL-HCTZ<br />
BUMETANIDE<br />
BUMEX<br />
BYSTOLIC<br />
CADUET<br />
CALAN<br />
CALAN SR<br />
CAPOTEN<br />
CAPOZIDE<br />
CAPTOPRIL<br />
CAPTOPRIL-HCTZ<br />
CARDENE<br />
CARDENE SR<br />
CARDENE SR SA<br />
CARDIZEM<br />
CARDIZEM CD<br />
CARDIZEM LA<br />
CARDIZEM SR<br />
CARTIA XT<br />
CARVEDILOL<br />
CHLOROTHIAZIDE<br />
CHLOROTHIAZIDE SOD<br />
CHLORTHALIDONE<br />
CHOLESTYRAMINE LIGHT<br />
CLORPRES<br />
COREG<br />
COREG CR<br />
CORGARD<br />
CORZIDE<br />
COUMADIN<br />
COVERA-HS ER<br />
COZAAR<br />
DEMADEX<br />
DILACOR XR<br />
DILT XR<br />
DILT-CD<br />
DILT-CD ER<br />
DILTIA XT<br />
DILTIAZEM<br />
DILTIAZEM 24HR CD<br />
DILTIAZEM ER<br />
DILTIAZEM HCL<br />
DILTIAZEM HCL ER<br />
DILTIAZEM HCL SA<br />
DILTIAZEM XR<br />
DILT-XR SA<br />
DILTZAC ER 120 MG<br />
DIOVAN<br />
DIOVAN HCT<br />
DIURIL<br />
DIURIL SODIUM<br />
Page 3 <strong>of</strong> 8
<strong>Blue</strong> <strong>Cross</strong> <strong>and</strong> <strong>Blue</strong> <strong>Shield</strong> <strong>of</strong> <strong>Vermont</strong> - <strong>Wellness</strong> <strong>Drug</strong> <strong>List</strong><br />
Updated: February 2012<br />
HYPERTENSION continued...<br />
DYAZIDE<br />
DYNACIRC<br />
DYNACIRC CR<br />
DYRENIUM<br />
EDECRIN<br />
EFFIENT<br />
ENALAPRIL MALEATE<br />
ENALAPRIL-HCTZ<br />
ENDURON<br />
EPLERENONE<br />
EXFORGE<br />
EXFORGE HCT<br />
FELODIPINE ER<br />
FOSINOPRIL SODIUM<br />
FOSINOPRIL-HCTZ<br />
FUROSEMIDE<br />
HYDRA-ZIDE<br />
HYDROCHLOROTHIAZIDE<br />
HYZAAR<br />
INDAPAMIDE<br />
INDERAL<br />
INDERAL LA<br />
INDERAL LA SA<br />
INNOPRAN XL<br />
INSPRA<br />
ISOPTIN SR<br />
ISRADIPINE<br />
JANTOVEN<br />
KERLONE<br />
LABETALOL HCL<br />
LASIX<br />
LESCOL XL<br />
LEVATOL<br />
LISINOPRIL<br />
LISINOPRIL-HCTZ<br />
LOPRESSOR<br />
LOPRESSOR HCT<br />
LOSARTAN POTASSIUM<br />
LOSARTAN-HCTZ<br />
LOTENSIN<br />
LOTENSIN HCT<br />
LOTREL<br />
LYTENSOPRIL<br />
MAVIK<br />
MAXZIDE<br />
METHYCLOTHIAZIDE<br />
METHYLDOPA-HCTZ<br />
METOLAZONE<br />
METOPROLOL<br />
METOPROLOL SUCC ER<br />
METOPROLOL TARTRATE<br />
METOPROLOL-HCTZ<br />
MICARDIS<br />
MICARDIS HCT<br />
MICROZIDE<br />
MIDAMOR<br />
MOEXIPRIL HCL<br />
MOEXIPRIL-HCTZ<br />
MONOPRIL<br />
MONOPRIL HCT<br />
NADOLOL<br />
NADOLOL-BENDROFLU<br />
NATURETIN<br />
NICARDIPINE<br />
NIFEDIAC CC<br />
NIFEDICAL XL<br />
NIFEDIPINE ER<br />
NIFEDIPINE POWDER<br />
NIFEDIPINE XL<br />
NIMODIPINE<br />
NIMOTOP<br />
NISOLDIPINE ER<br />
NORMODYNE<br />
NORVASC<br />
PERINDOPRIL ERBUMINE<br />
PINDOLOL<br />
PLAVIX<br />
PLENDIL SA<br />
PLENDIL ER<br />
PREVALITE<br />
PRINIVIL<br />
PRINZIDE<br />
PROCARDIA XL<br />
PROPRANOLOL<br />
PROPRANOLOL ER<br />
PROPRANOLOL HCL<br />
PROPRANOLOL SA<br />
PROPRANOLOL-HCTZ<br />
QUESTRAN LIGHT POWDER<br />
QUESTRAN POWDER<br />
QUINAPRIL<br />
QUINAPRIL-HCTZ<br />
QUINARETIC<br />
RAMIPRIL<br />
SECTRAL<br />
SPIRONOLACTONE<br />
Page 4 <strong>of</strong> 8
<strong>Blue</strong> <strong>Cross</strong> <strong>and</strong> <strong>Blue</strong> <strong>Shield</strong> <strong>of</strong> <strong>Vermont</strong> - <strong>Wellness</strong> <strong>Drug</strong> <strong>List</strong><br />
Updated: February 2012<br />
HYPERTENSION continued...<br />
SPIRONOLACTONE POWDER<br />
SPIRONOLACTONE-HCTZ<br />
SULAR<br />
TARKA ER<br />
TAZTIA XT<br />
TEKTURNA<br />
TEKTURNA HCT<br />
TENORETIC<br />
TENORMIN<br />
TEVETEN<br />
TEVETEN HCT<br />
THALITONE<br />
TIAZAC ER<br />
TICLID<br />
TICLOPIDINE<br />
TIMOLOL MALEATE<br />
TOPROL XL<br />
TOPROL XL SA<br />
TORSEMIDE<br />
TRANDATE<br />
TRANDOLAPRIL<br />
TRANDOLAPR-VERAPAM ER<br />
TRIAMTERENE POWDER<br />
TRIAMTERENE-HCTZ<br />
TWYNSTA<br />
UNIRETIC<br />
UNIVASC<br />
VALTURNA<br />
VASERETIC<br />
VASOTEC<br />
VERAPAMIL<br />
VERAPAMIL ER<br />
VERAPAMIL ER PM<br />
VERAPAMIL HCL POWDER<br />
VERELAN<br />
VERELAN PM<br />
WARFARIN SODIUM<br />
ZAROXOLYN<br />
ZEBETA<br />
ZESTORETIC<br />
ZESTRIL<br />
ZIAC<br />
ADVANCED CARE PLUS<br />
ADVANCED NATALCARE<br />
ADVANCED-RF NATALCARE<br />
PRENATAL<br />
ATABEX EC<br />
ATABEX PRENATAL<br />
BP FOLINATAL PLUS B<br />
BP MULTINATAL PLUS<br />
CAL-NATE<br />
CARENATAL DHA<br />
CAVAN ONE OMEGA<br />
CAVAN-ALPHA KIT COMBO PACK<br />
CAVAN-EC SOD DHA VITAMINS<br />
CHEWABLE PRENATAL<br />
CITRANATAL 90 DHA PACK<br />
CITRANATAL ASSURE COMBO PACK<br />
CITRANATAL B-CALM PACK<br />
CITRANATAL DHA PACK<br />
CITRANATAL HARMONY CAPSULE<br />
CITRANATAL RX<br />
COMBI RX<br />
COMPLETE NATAL DHA<br />
COMPLETENATE<br />
COMPLETE-RF PRENATAL<br />
CO-NATAL FA<br />
CONCEPT DHA<br />
CONCEPT OB<br />
CVS PRENATAL VITAMIN<br />
DOCOSAVIT SOFTGEL<br />
DUET DHA COMPLETE COMBO PACK<br />
DUET DHA EC PRENATAL VITS<br />
DUET DHA EC STUARTNATAL VITS<br />
DUET DHA FERRAZONE EC OMEGA-3<br />
DUET DHA STUARTNATAL VITAMINS<br />
DUET DHA VITAMINS<br />
DUET STUART NATAL CHEWABLE TAB<br />
DUET STUARTNATAL<br />
EDGE OB<br />
ELITE OB DHA SOFTGEL<br />
ELITE-OB CAPLET<br />
EQL PRENATAL FORMULA<br />
FEMECAL OB<br />
FEMECAL OB PLUS DHA COMBO PACK<br />
FOLBECAL<br />
FOLCAL DHA SOFTGEL<br />
FOLCAPS CARE ONE CAPSULE<br />
FOLCAPS OMEGA-3 CAPSULE<br />
FOLIC ACID<br />
FOLIVANE-EC CALCIUM DHA COMBO<br />
FOLIVANE-OB CAPSULE<br />
FOLIVANE-PRX DHA NF CAPSULE<br />
Page 5 <strong>of</strong> 8
<strong>Blue</strong> <strong>Cross</strong> <strong>and</strong> <strong>Blue</strong> <strong>Shield</strong> <strong>of</strong> <strong>Vermont</strong> - <strong>Wellness</strong> <strong>Drug</strong> <strong>List</strong><br />
Updated: February 2012<br />
PRENATAL continued...<br />
FOLTABS 90 PLUS DHA PACK<br />
FOLTABS PRENATAL<br />
FOLTABS PRENATAL PLUS DHA<br />
GENTEX ADE<br />
GESTICARE<br />
GESTICARE DHA COMBO PACK<br />
GESTICARE DHA DR COMBO PACK<br />
GNP PRENATAL VITAMINS<br />
HIP PRENATAL<br />
ICAR PRENATAL COMBO PACK<br />
INATAL ADVANCE<br />
INATAL GT<br />
INATAL ULTRA<br />
KOLNATAL DHA DR COMBO PACK<br />
LACTOCAL-F<br />
MARNATAL-F CAPSULE<br />
MARNATAL-F PLUS COMBO PACK<br />
MATERNA<br />
MATERNITY VITAMIN<br />
MAXINATE<br />
MISSION PRENATAL<br />
MISSION PRENATAL FA<br />
MISSION PRENATAL HP<br />
MULTIFOL PLUS<br />
MULTI-NATE 30<br />
MULTI-NATE 30 DHA 430 MG VIT<br />
MULTI-NATE 30 DHA PRENATAL VIT<br />
MULTI-NATE DHA EXTRA PRENATAL<br />
MULTI-NATE DHA EXTRA PRENATAL<br />
MULTIVITAMIN WITH MINERALS CAP<br />
M-VIT CAPLET<br />
MYNATAL ADVANCE<br />
MYNATAL CAPSULE<br />
MYNATAL PLUS CAPTAB<br />
MYNATAL ULTRACAPLET<br />
MYNATAL-Z CAPTAB<br />
MYNATE 90 PLUS CAPLET SA<br />
NATACAPS CAPSULE<br />
NATACHEW CHEW<br />
NATACHEW CHEW<br />
NATAFORT<br />
NATALCARE GLOSSTABS<br />
NATALCARE PIC<br />
NATALCARE PIC FORTE<br />
NATALCARE PLUS<br />
NATALCARE RX<br />
NATALCARE THREE<br />
NATALVIT<br />
NATATAB FA<br />
NATATAB RX<br />
NATELLE<br />
NATELLE C<br />
NATELLE ONE CAPSULE<br />
NATELLE PLUS COMBO PACK<br />
NATELLE PREFER<br />
NATELLE-EZ<br />
NEEVO CAPLET<br />
NEEVO DHA CAPSULE<br />
NIFEREX-PN FORTE<br />
NOVANATAL<br />
NOVASTART<br />
NUTRINATE CHEW<br />
NUTRISPIRE<br />
NUTRISPIRE<br />
OB COMPLETE 400 SOFTGEL<br />
OB COMPLETE CAPLET<br />
OB COMPLETE DHA SOFTGEL<br />
OB-NATAL ONE PRENATAL CAPSULE<br />
OB-NATAL ONE PRENATAL CAPSULE<br />
OBSTETRIX DHA COMBO PAK<br />
OBSTETRIX EC CAPLET<br />
OBTREX DHA PRENATAL VITAMIN<br />
OBTREX PRENATAL CAPLET<br />
O-CAL FA<br />
O-CAL PRENATAL<br />
OPTINATE COMBO PACK<br />
P-D NATAL PLUS<br />
P-D NATAL PLUS-FOLIC ACID TAB<br />
PERRY PRENATAL CAPSULE<br />
PNV-DHA PLUS SOFTGEL<br />
PNV-DHA SOFTGEL<br />
PNV-IRON<br />
PNV-SELECT<br />
POLY IRON PN<br />
POLY IRON PN FORTE<br />
PR NATAL EC COMBO PACK<br />
PR NATAL COMBO PACK<br />
PRECARE CHEWABLE<br />
PRECARE CONCEIVE<br />
PRECARE PREMIER CAPLETS<br />
PREFERA-OB<br />
PREFERA-OB ONE SOFTGEL<br />
PREFERA-OB PLUS DHA COMBO PACK<br />
PREMESIS RX<br />
PRENACARE<br />
PRENAFIRST<br />
Page 6 <strong>of</strong> 8
<strong>Blue</strong> <strong>Cross</strong> <strong>and</strong> <strong>Blue</strong> <strong>Shield</strong> <strong>of</strong> <strong>Vermont</strong> - <strong>Wellness</strong> <strong>Drug</strong> <strong>List</strong><br />
Updated: February 2012<br />
PRENATAL continued...<br />
PRENAPLUS<br />
PRENATABS FA<br />
PRENATABS RX<br />
PRENATAL 1 PLUS 1<br />
PRENATAL 19<br />
PRENATAL AD<br />
PRENATAL COMPLETE CAPLET<br />
PRENATAL FORMULA<br />
PRENATAL LOW IRON<br />
PRENATAL MR 90 FE SA<br />
PRENATAL MTR<br />
PRENATAL MULTIVIT W IRON TB<br />
PRENATAL PLUS<br />
PRENATAL PLUS DHA<br />
PRENATAL PLUS IRON<br />
PRENATAL RX<br />
PRENATAL RX 1<br />
PRENATAL S<br />
PRENATAL VITAMIN<br />
PRENATAL VITAMIN FORMULA TB<br />
PRENATAL WITH IRON<br />
PRENATAL Z<br />
PRENATAL-FOLIC ACID TAB<br />
PRENATAL-H CAPSULE<br />
PRENATAL-U CAPSULE<br />
PRENATE DHA SOFTGEL<br />
PRENATE ELITE<br />
PRENATE ESSENTIAL SOFTGEL<br />
PRENATE PLUS<br />
PRENAVITE<br />
PRENEXA CAPSULE<br />
PREQUE 10<br />
PREVITE RX<br />
PRIMACARE ADVANTAGE COMBO PACK<br />
PRIMACARE COMBO PACK<br />
PRIMACARE ONE SOFTGEL<br />
PRIMACARE ONE SOFTGEL<br />
PRUET DHA EC PRENATAL VITAMINS<br />
PRUET DHA EC PRENATAL VITS<br />
PRUET DHA PRENATAL VITAMINS<br />
PRUET DHA VITAMINS<br />
PUB PRENATAL VITAMINS<br />
PV PRENATAL FORMULA<br />
QC PRENATAL<br />
RE DUALVIT OB CAPSULE<br />
RE OB + DHA PACK<br />
RE OB 90 + DHA PACK<br />
RE PRENATAL MULTIVIT W-IRON TB<br />
RE PREVIT+DHA SOFTGEL<br />
RE-NATA 29 OB PRENATAL<br />
RE-NATA 29 PRENATAL<br />
RENATE CAPLET<br />
RENATE DHA 430 MG PRENATAL VIT<br />
RENATE DHA EXTRA PRENATAL VITS<br />
RENATE DHA EXTRA VITAMINS<br />
RENATE DHA PRENATAL VITAMINS<br />
RIGHT STEP PRENATAL VIT TAB<br />
ROVIN-NV<br />
ROVIN-NV DHA CAPSULE<br />
SE-CARE CHEWABLE<br />
SE-CARE CONCEIVE<br />
SE-CARE GESTURE<br />
SELECT-OB + DHA PACK<br />
SELECT-OB CAPLET<br />
SE-NATAL 19<br />
SE-NATAL 19 CHEWABLE<br />
SE-NATAL 90 DR<br />
SE-NATAL ONE<br />
SE-PLETE DHA SOFTGEL<br />
SE-TAN DHA CAPSULE<br />
SETONET PRENATAL VITAMIN<br />
SETONET-EC PRENATAL VITAMINS<br />
STRONGSTART TAB CHEW<br />
STUART PRENATAL<br />
TANDEM DHA CAPSULE<br />
TANDEM OB CAPSULE<br />
TANDEM OB CAPSULE<br />
TARON A PRENATAL DHA COMB PACK<br />
TARON EC CALCIUM DHA COMB PACK<br />
TARON-C DHA CAPSULE<br />
TARON-EC CAL<br />
TARON-EC CAL<br />
TARON-PREX PRENATAL DHA CAP<br />
TRI RX<br />
TRIADVANCE<br />
TRICARE DHA 301 CAPSULE<br />
TRICARE PRENATAL<br />
TRICARE PRENATAL DHA ONE SFTGL<br />
TRIFERA OB<br />
TRIMESIS RX<br />
TRINATAL RX 1<br />
TRINATE<br />
TRIVEEN-ONE CAPSULE<br />
TRIVEEN-PRX RNF CAPSULE<br />
TRIVEEN-U CAPSULE<br />
TRUST NATAL DHA<br />
Page 7 <strong>of</strong> 8
<strong>Blue</strong> <strong>Cross</strong> <strong>and</strong> <strong>Blue</strong> <strong>Shield</strong> <strong>of</strong> <strong>Vermont</strong> - <strong>Wellness</strong> <strong>Drug</strong> <strong>List</strong><br />
Updated: February 2012<br />
PRENATAL continued...<br />
ULTIMATECARE ADVANTAGE COMBO<br />
ULTIMATECARE COMBO PACK<br />
ULTIMATECARE ONE CAPSULE<br />
ULTIMATECARE ONE NF CAPSULE<br />
ULTRA NATALCARE<br />
VINACAL PRENATAL<br />
VINATAL FORTE<br />
VINATE AZ<br />
VINATE AZ EXTRA S<br />
VINATE C<br />
VINATE CALCIUM PRENATAL<br />
VINATE CARE CHEWABLE<br />
VINATE GT<br />
VINATE IC CAPSULE<br />
VINATE II<br />
VINATE III<br />
VINATE ONE<br />
VINATE PN CARE<br />
VINATE ULTRA<br />
VINATE-M<br />
VITAFOL-OB CAPLET<br />
VITAFOL-OB+DHA COMBO PACK<br />
VITAFOL-PN CAPLET<br />
VITANATAL OB + DHA COMBO PACK<br />
VITAPHIL + DHA PACK<br />
VITAPHIL AIDE CAPLET<br />
VITAPHIL CAPLET<br />
VITASPIRE<br />
VIVA DHA PRENATAL SOFTGEL<br />
VYNATAL-FA<br />
ZATEAN-PN<br />
ZATEAN-PN DHA CAPSULE<br />
ZATEAN-PN PLUS SOFTGEL<br />
OSTEOPOROSIS<br />
ACTONEL<br />
ACTONEL WITH CALCIUM<br />
ALENDRONATE SODIUM<br />
AREDIA<br />
BONIVA<br />
DIDRONEL<br />
ETIDRONATE DISODIUM<br />
EVISTA<br />
FOSAMAX<br />
FOSAMAX PLUS D<br />
PAMIDRONATE<br />
PAMIDRONATE DISOD<br />
RECLAST<br />
SKELID<br />
ZOMETA<br />
Page 8 <strong>of</strong> 8
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