Your Pharmacy Program

Your Pharmacy Program

Effective January 1, 2012

Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association

Table of ContentsAbout This Guide and Online Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Mail Service Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Your Pharmacy Cost Share and ID Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Top Covered Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Quality Care Dosing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Prior Authorization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Specialty Pharmacy Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Step Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Non-Covered Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Medication Resource List Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

New Medication Approval Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

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Pharmacy Program OverviewOur pharmacy program is designed to provide you and your doctor with access to a wide variety of safe, clinically effective medications . We have carefully developed a substantial formulary that includes many medications at affordable cost share levels .

About This GuideThis guide is up-to-date as of January 1, 2012, and is subject to change . Keep this guide handy, and use it as a reference whenever you need coverage information about a specific medication . To get the most current coverage information about a specific medication, visit our website at www.bluecrossma.com/pharmacy .

•TopCoveredMedications—includes many commonly prescribed covered medications and your cost share tier that applies

•QualityCareDosing—includes a list of medications subject to Quality Care Dosing limits

•PriorAuthorization—includes a list of medications that require prior authorization

•SpecialtyPharmacyMedications—includes a list of medications that are available through pharmacies in the Specialty Pharmacy Network

•StepTherapy—includes a list of medications subject to step therapy

•MedicationResourceListIndex—includes all prescription medications listed in this booklet, along with the page(s) on which they can be found

Online ResourcesFrom our main website, www.bluecrossma.com, to the www.express-scripts.com website, we offer a variety of online resources to help you manage your medications .

•SearchforMedicationInformation . To learn whether your medications will be covered, you can visit www.bluecrossma.com/pharmacy, and use the MedicationLookUp feature, listed on the left-hand side of the page . You can use this tool before you enroll . (The medication information represents our standard pharmacy coverage; your individual coverage may vary .)

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•MemberCentral . Want more detailed information about your health care coverage, claims, or deductibles? You can log on to Member Central by going to our website, www.bluecrossma.com/member-central . To register, click CreateanAccount, on the upper right-hand side of the page .

– If you’re already registered, just log in with your username and password .

•ExpressScriptsOnline . Once registered with Member Central, you can also get immediate, online access to information about your specific pharmacy benefit by visiting Express Scripts Inc ., (ESI), our pharmacy management partner, at www.express-scripts.com . Once there, you’ll have access to:

– Price a Drug

– Find a Pharmacy

– Mail Service features (which allow you to order refills and renew prescriptions)

Mail Service PharmacyWith the Mail Service Pharmacy (administered by ESI), you can enjoy the convenience of having certain prescriptions delivered to you . Depending on your specific coverage, you can use the Mail Service Pharmacy to order up to a 90-day supply of certain long-term maintenance medications (like those used to treat high blood pressure), for less than you may normally pay at a retail pharmacy .

It’s convenient, cost-effective, and completely confidential .

If you would like to use the Mail Service Pharmacy, you can download an order form and find additional information on our website . Go to www.bluecrossma.com/pharmacy and choose MailServicePharmacy from the menu on the left-hand side . If you’d like our Mail Service Pharmacy brochure mailed to you, please call 1-800-262-BLUE(2583) .

3

Your Pharmacy Cost ShareOur pharmacy program formulary is based on a tiered cost share structure . When you fill a prescription, the amount you pay the pharmacy (your prescription cost share) is determined by the tier your medication is on . Medications are placed on tiers according to a variety of factors, including what they are used for, their cost, and whether equivalent or alternative medications are available . The pharmacy will advise you of the amount you owe . Usually, you will pay the least amount of cost share for Tier 1 medications and the most for Tier 3 medications .

Your cost share may include your copayment, co-insurance, deductibles, and maximums . For more about your specific prescription benefits, review the information in your benefit literature, which you should have received when you enrolled in your plan, or call the Member Service number listed on the front of your ID card, Monday through Friday, 8:00 a .m . to 9:00 p .m . ET .

Your ID CardYour ID card contains important information about your pharmacy benefits . Be sure to bring the card with you and give it to your pharmacist when you fill a prescription . A sample ID card is shown below .

JOHN Q PUBLIC

XXH88010124MEMBER SUFFIX: 00

HMO BlueTM

Copays OV 15BH 15 ER 40

Member Service 1-800-000-0000RxBin: 003858 PCN: A4RxGRP: MASA

(PA) prior authorization required (QCD) Quality Care Dosing limits apply

(ST) step therapy required4

Top Covered MedicationsOur pharmacy formulary includes over 4,000 covered prescription medications . The following sample list includes covered medications most commonly prescribed for our members .

This list is up-to-date as of January 1, 2012, and is subject to change at any time . You can find the most up-to-date information about a specific prescription medication on our website at www.bluecrossma.com/pharmacy .

Pleasenotethatthisisasampleoftopprescribedmedicationsbasedonourstandardformulary. For more information about your specific prescription benefits, review the information in your benefit literature, which you should have received when you enrolled in your plan, or call the Member Service number listed on the front of your ID card .

For members with a two-tier structure: The following covered medication list is based on a three-tier structure . All medications listed on Tier 3 are actually covered on your Tier 2 .

Abilify Tier 2Accu-Chek Aviva Tier 2Acetaminophen-Codeine Tier 1Actonel (QCD) (ST) Tier 2Actos (QCD) (ST) Tier 3Acyclovir Tier 1Advair Diskus (QCD) (ST) Tier 3Albuterol Sulfate Tier 1Alendronate Sodium (QCD) Tier 1Allopurinol Tier 1Alprazolam Tier 1Amitriptyline HCl Tier 1Amlodipine Besylate (QCD) Tier 1Amlodipine Besylate-Benazepril Tier 1Amox Tr-Potassium Clavulanate Tier 1Amoxicillin Tier 1Amphetamine Salt Combo Tier 1Apri Tier 1Aricept Tier 2Arimidex Tier 2Asacol Tier 2Astelin (QCD) Tier 2Atenolol Tier 1Atenolol-Chlorthalidone Tier 1Atripla Tier 2

Avalide (ST) Tier 2Avapro (ST) Tier 2Aviane Tier 1Azithromycin Tier 1Baclofen Tier 1Benicar (ST) Tier 2Benicar HCT (ST) Tier 2Benzonatate Tier 1Betamethasone Dipropionate Tier 1Bisoprolol Fumarate-HCTZ Tier 1Budeprion SR (QCD) Tier 1Budeprion XL (QCD) Tier 1Bupropion HCl Tier 1Bupropion HCl SR (QCD) Tier 1Bupropion XL (QCD) Tier 1Buspirone HCl Tier 1Butalbital-APAP-Caffeine Tier 1Byetta Tier 2Camila Tier 1Carisoprodol Tier 1Carvedilol Tier 1Cefdinir Tier 1Cefprozil Tier 1Cefuroxime Tier 1Celebrex (QCD) (ST) Tier 3

(PA) prior authorization required (QCD) Quality Care Dosing limits apply (ST) step therapy required 5

Cephalexin Tier 1Chantix Tier 2Cheratussin AC Tier 1Chlorhexidine Gluconate 0.12% Rinse Tier 1Cialis Tier 3Ciprofloxacin HCl Tier 1Citalopram HBr (QCD) Tier 1Clarithromycin Tier 1Clindamycin HCl Tier 1Clindamycin Phosphate Tier 1Clobetasol Propionate Tier 1Clonazepam Tier 1Clonidine HCl Tier 1Clotrimazole-Betamethasone Tier 1Colchicine Tier 1Combivent (QCD) Tier 2Concerta (QCD) Tier 2Crestor (QCD) (ST) Tier 2Cryselle Tier 1Cyclobenzaprine HCl Tier 1Cymbalta (QCD) (ST) Tier 3Desonide Tier 1Dexamethasone Tier 1Dextroamphetamine-Amphetamine (PA) Tier 1Diazepam Tier 1Diclofenac Sodium Tier 1Dicyclomine HCl Tier 1Differin Tier 3Digoxin Tier 1Dilt-CD Tier 1Diltiazem 24hr ER Tier 1Diovan (ST) Tier 2Diovan HCT (ST) Tier 2Divalproex Sodium Tier 1Divalproex Sodium ER Tier 1Doxazosin Mesylate Tier 1Doxycycline Hyclate Tier 1Duac CS Tier 3Enalapril Maleate Tier 1Enbrel (PA) (QCD) Tier 2Endocet Tier 1Enpresse Tier 1Epipen Tier 2Erythromycin Tier 1Estradiol (QCD) Tier 1

Etodolac Tier 1Evista Tier 2Fenofibrate Tier 1Fentanyl (PA) (QCD) Tier 1Finasteride Tier 1Flomax Tier 3Flovent HFA (QCD) Tier 2Fluconazole Tier 1Fluocinonide Tier 1Fluoxetine HCl (QCD) Tier 1Fluticasone Propionate (QCD) Tier 1Folic Acid Tier 1Furosemide Tier 1Gabapentin Tier 1Gemfibrozil Tier 1Glimepiride Tier 1Glipizide Tier 1Glipizide ER Tier 1Glipizide XL Tier 1Glyburide Tier 1Glyburide-Metformin HCl Tier 1Halflytely-Bisacodyl Tier 3Humalog Tier 2Humira (PA) (QCD) Tier 2Humulin N Tier 2Hydrochlorothiazide Tier 1Hydrocodone-Acetaminophen Tier 1Hydrocortisone Tier 1Hydromorphone HCl Tier 1Hydroxychloroquine Sulfate Tier 1Hydroxyzine HCl Tier 1Ibuprofen Tier 1Indomethacin Tier 1Iophen-C NR Tier 1Isosorbide Mononitrate Tier 1Januvia (ST) Tier 2Junel FE Tier 1Kariva Tier 1Ketoconazole Tier 1Klor-Con 10 Tier 1Klor-Con M20 Tier 1Labetalol HCl Tier 1Lamotrigine Tier 1Lansoprazole (QCD) (ST) Tier 1Lantus Tier 2

(PA) prior authorization required (QCD) Quality Care Dosing limits apply

(ST) step therapy required6

Lantus Solostar Tier 2Levetiracetam Tier 1Levitra Tier 3Levora-28 Tier 1Levothyroxine Sodium Tier 1Levoxyl Tier 1Lexapro (QCD) (ST) Tier 3Lidoderm Tier 2Lipitor (QCD) (ST) Tier 3Lisinopril Tier 1Lisinopril-HCTZ Tier 1Lithium Carbonate Tier 1Loestrin 24 FE Tier 3Lorazepam Tier 1Lovastatin (QCD) Tier 1Lovenox (QCD) Tier 3Low-Ogestrel Tier 1Lunesta (QCD) (ST) Tier 3Lutera Tier 1Lyrica (PA) Tier 3Medroxyprogesterone Acetate Tier 1Meloxicam (QCD) Tier 1Metadate CD (QCD) Tier 3Metformin HCl Tier 1Metformin HCl ER Tier 1Methadone HCl Tier 1Methocarbamol Tier 1Methotrexate Tier 1Methylin tablets (non chewable) Tier 1Methylphenidate HCl Tier 1Methylprednisolone Tier 1Metoclopramide HCl Tier 1Metoprolol Succinate Tier 1Metoprolol Tartrate Tier 1Metronidazole Tier 1Microgestin Tier 1Microgestin FE Tier 1Minocycline HCl Tier 1Mirtazapine Tier 1Mometasone Furoate Tier 1Morphine Sulfate (QCD) Tier 1Mupirocin Tier 1Nabumetone Tier 1Nadolol Tier 1Naproxen Tier 1

Necon Tier 1Neomycin-Polymyxin-HC Tier 1Niaspan Tier 2Nifedipine ER Tier 1Nitrofurantoin Mono-Macro Tier 1Nitroglycerin Tier 1Nortrel Tier 1Nortriptyline HCl Tier 1NovoLog Tier 2Nuvaring Tier 3Nystatin-Triamcinolone Tier 1Ocella Tier 1Ofloxacin Tier 1Omeprazole (PA) (QCD) Tier 1Ondansetron HCl (QCD) Tier 1Ondansetron ODT (QCD) Tier 1One Touch Ultra test strips (QCD) Tier 2Ortho Tri-Cyclen Lo Tier 3Oxcarbazepine Tier 1Oxybutynin Chloride ER Tier 1Oxycodone HCl Tier 1Oxycodone-Acetaminophen Tier 1OxyContin (QCD) Tier 2Pantoprazole Sodium (PA) (QCD) Tier 1Paroxetine HCl (QCD) Tier 1Patanol (QCD) Tier 3PEG-3350 with Flavor Packs Tier 1Penicillin V Potassium Tier 1Phenazopyridine HCl Tier 1Piroxicam Tier 1Plavix Tier 2Polymyxin B Sul-Trimethoprim Tier 1Potassium Chloride Tier 1Pravastatin Sodium (QCD) Tier 1Prednisolone Sodium Phosphate Tier 1Prednisone Tier 1Premarin tablets Tier 3Prempro Tier 2Prenatal Plus Tier 1ProAir HFA (QCD) Tier 2Prochlorperazine Maleate Tier 1Promethazine HCl Tier 1Promethazine-Codeine Tier 1Prometrium Tier 3Propoxyphene Nap-Acetaminophen Tier 1

(PA) prior authorization required (QCD) Quality Care Dosing limits apply (ST) step therapy required 7

Propranolol HCl Tier 1Provigil (ST) Tier 2Pulmicort Flexhaler (QCD) Tier 2Pulmicort Respules (QCD) Tier 2Quinapril HCl Tier 1Ramipril Tier 1Ranitidine HCl Tier 1Reclipsen Tier 1Relpax (QCD) (ST) Tier 3Restasis (QCD) Tier 3Risperidone Tier 1Ropinirole HCl Tier 1Roxicet tablets Tier 1Seroquel Tier 2Sertraline HCl (QCD) Tier 1Simvastatin (QCD) Tier 1Sodium Fluoride (Pediatric) Tier 1Spiriva (QCD) Tier 2Spironolactone Tier 1Sprintec Tier 1Strattera (QCD) (ST) Tier 3Suboxone Tier 2Sulfamethoxazole-Trimethoprim Tier 1Sumatriptan Succinate (non nasal spray) (QCD) Tier 1Symbicort (QCD) (ST) Tier 2Synthroid Tier 3Tamiflu Tier 3Tamoxifen Citrate Tier 1Temazepam Tier 1Terazosin HCl (QCD) Tier 1Testim Tier 2Tetracycline HCl Tier 1

Timolol Maleate Tier 1Tizanidine HCl Tier 1Tobramycin-Dexamethasone Tier 1Topiramate Tier 1Toprol XL Tier 3Tramadol HCl Tier 1Trazodone HCl Tier 1Tretinoin (PA) Tier 1Triamcinolone Acetonide Tier 1Triamterene-HCTZ Tier 1Tri-Lo-Sprintec Tier 1TriNessa Tier 1Tri-Sprintec Tier 1Trivora-28 Tier 1Tussionex Tier 3Uroxatral Tier 2Vagifem Tier 2Valacyclovir (QCD) Tier 1Valtrex (QCD) Tier 3Venlafaxine ER capsules Tier 1Verapamil HCl Tier 1Viagra Tier 3Vigamox (QCD) Tier 3Vivelle-Dot (QCD) Tier 3Warfarin Sodium Tier 1Xalatan Tier 2Yaz Tier 3Zetia (QCD) (ST) Tier 3Zolpidem Tartrate (QCD) Tier 1Zomig (QCD) (ST) Tier 2Zovia 1-35e Tier 1Zyprexa tablets Tier 2

* (non-covered medication) Quality Care Dosing limits apply for members with approved formulary exceptions** (new to market drug; non-covered while under review) quantity limits apply to members with approved formulary exceptions

(PA) prior authorization required(PA17) prior authorization required for members who are 17 years of age or older

(SP) medication is part of the specialty pharmacy network(SPO) benefits are not available for this medication when administered in an outpatient setting such as

a doctor’s office or hospital, unless the medication is obtained from a specialty pharmacy(ST) step therapy required8

Quality Care DosingOur Quality Care Dosing program helps to ensure that the quantity and dose of medications you receive comply with Food and Drug Administration (FDA) recommendations, as well as manufacturer and clinical information .

When you fill a prescription for one of the following medications, it is checked electronically in two ways:

•DoseConsolidation—Checks to see whether you’re taking two or more pills a day that can be replaced with one pill providing the same daily dosage .

•RecommendedMonthlyDosingLevel—Checks to see that your monthly dosage is consistent with the manufacturer’s and FDA’s monthly dosing recommendations and clinical information .

We will get your doctor’s approval before making any changes to your prescribed medications .

For the most up-to-date list of medications subject to Quality Care Dosing, along with associated dosing limits, please visit our website at www.bluecrossma.com/pharmacy and proceed to the QualityCareDosing section .

Please note: Your doctor may request an exception from the guidelines for medications that are subject to Quality Care Dosing (when medically necessary) .

Quality Care Dosing ListThis list of medications that are in our Quality Care Dosing program is up-to-date as of January 1, 2012, and may change from time to time .

Abstral * (PA)AcipHex * (PA)Actiq * (PA)Actonel (ST)Actonel with Calcium (ST)ACTOplus Met (ST)ACTOplus Met XR (ST)Actos (ST)Acular PFAcular/LS *

Adderall XRAdvair Discus (ST)Advair HFA (ST)Advicor (ST)Aerobid *Aerobid-M *Alamast *AlendronateAlocril *Alomide

* (non-covered medication) Quality Care Dosing limits apply for members with approved formulary exceptions** (new to market drug; non-covered while under review) quantity limits apply to members with approved formulary exceptions(PA) prior authorization required(PA17) prior authorization required for members who are 17 years of age or older(SP) medication is part of the specialty pharmacy network(SPO) benefits are not available for this medication when administered in an outpatient setting such as a doctor’s office or hospital, unless the medication is obtained from a specialty pharmacy(ST) step therapy required 9

Alora *Alrex *Alsuma (ST)Altoprev (ST)Alupent inhalerAlvesco *Ambien * (ST)Ambien CR * (ST)Amerge (ST)AmitizaAmlodipineAmpyra (PA) (SP)Anzemet *Aplenzin ER * (ST)Aranesp (PA) (SP) (SPO)Arava *Arcapta Neohaler **ArixtraAsmanex Twisthaler *AstelinAstepro *Atelvia * (ST)Atrovent (nasal spray)Atrovent HFAAvandamet (ST)Avandia (ST)Avinza *Avonex (SP) (SPO)Axert * (ST)AzelastineAzmacort *Beconase AQ *Betaseron (SP) (SPO)Boniva tablets * (ST)Budeprion SRBudeprion XLBudesonide (ampules)Bupropion SRBupropion XLButorphanol NSButrans *

CabergolineCaduet * (ST)Cardura *Cardura XL *Catapres TTSCelebrex (ST)Celexa * (ST)Cesamet *Ciclodin solution/kitCiclopirox nail lacquerCitalopramClimaraClimara ProClonidine patchCNL 8 nail kit *CombiventConcertaCopaxone (SP) (SPO)Crestor (ST)Crolom ophthalmicCromolyn ophthalmicCymbalta (ST)Dexilant * (PA)Dextroamphetamine/Amphetamine ERDiflucan (150 mg only)DoxazosinDulera (ST)Duragesic *Edluar * (ST)Effexor XR * (ST)Elestat *EmadineEmbeda *EmendEnbrel (PA) (SP) (SPO)EnoxaparinEpinastine OphthalmicEpogen (PA) (SP) (SPO)EstradermEstradiol patchEstrasorb *





Estrogel *Evamist *Exalgo *Extavia (SP)FamciclovirFamvir *Fentanyl oral/mucosal (PA)Fentanyl patchFentora * (PA)Flonase *Flovent/HFAFluconazole (150 mg only)FlunisolideFluoxetineFluoxetine DRFluticasoneFluvoxamineFocalin XR *FondaparinuxForadilForteo (PA) (SP) (SPO)Fosamax * (ST)Fosamax Plus D (ST)FragminFrova * (ST)Gilenya (PA) (SP)Glucose testing strips (all)GraliseGranisetronGranisolHumira (PA) (SP) (SPO)Hytrin *Imitrex (ST)Infergen (PA) (SP) (SPO)Ipratropium NSItraconazoleKadian *Ketorolac ophthalmicKytril *Lamisil *Lansoprazole (PA)

Lastacaft *LeflunomideLescol * (ST)Lescol XL * (ST)Lexapro (ST)Lipitor (ST)Livalo * (ST)LotronexLovastatinLovenoxLunesta (ST)Luvox CR * (ST)Lysteda *Maxair Autohaler *Maxalt * (ST)Maxalt-MLT * (ST)MeloxicamMenostar *Metadate CDMethylphenidate ERMevacor * (ST)MigranalMirtazapineMirtazapine Rapid DissolveMobic *Morphine Sulfate ERMoxezaMS ContinNaratriptanNasacort AQ *Nasonex *NebuPentNeulasta (PA) (SP)Neupogen (PA) (SP)Nexium * (PA)Norvasc *Omeprazole (PA)Omeprazole-Sod. Bicarbonate * (PA)Omnaris *OndansetronOndasetron ODT

* (non-covered medication) Quality Care Dosing limits apply for members with approved formulary exceptions** (new to market drug; non-covered while under review) quantity limits apply to members with approved formulary exceptions(PA) prior authorization required(PA17) prior authorization required for members who are 17 years of age or older(SP) medication is part of the specialty pharmacy network(SPO) benefits are not available for this medication when administered in an outpatient setting such as a doctor’s office or hospital, unless the medication is obtained from a specialty pharmacy(ST) step therapy required 11

Onsolis * (PA)Opana ER *Optivar *Oramorph SR *Oxycodone EROxyContinOxymorphone ERPantoprazole (PA)ParoxetineParoxetine CRPataday *Patanase *PatanolPaxil * (ST)Paxil CR * (ST)Pegasys (PA) (SP) (SPO)PEG-Intron (PA) (SP) (SPO)Penlac *Pexeva * (ST)Pravachol * (ST)PravastatinPrevacid * (PA)PrevpacPrilosec * (PA)Pristiq * (ST)ProAir HFAProcrit (PA) (SP) (SPO)Protonix * (PA)Proventil HFA *Prozac * (ST)Prozac Weekly * (ST)Pulmicort FlexhalerPulmicort RespulesQualaquinQutenza (SP)QVARRapafluxRebif (SP) (SPO)Relpax (ST)Remeron *Remeron Soltab *

RestasisRhinocort Aqua *Ritalin LA *Rozerem * (ST)Sancuso *Sarafem * (ST)SelfermaSerevent DiskusSertralineSilenor * (ST)Simcor * (ST)Simponi (PA) (SP)SimvastatinSonata (ST)SpirivaSporanox *Strattera (PA17)SumatriptanSumavel Dosepro * (ST)Symbicort (ST)SymbyaxTerazosinTerbinafineTerbinex *Treximet * (ST)Triamcinolone (nasal spray)ValacylovirValtrexVenlafaxine ER capsuleVenlafaxine ER tablet (ST)Ventolin HFA *Veramyst *VigamoxViibryd * (ST)VivelleVivelle-DotVytorin * (ST)Vyvanse *Wellbutrin SR * (ST)Wellbutrin XL * (ST)Xopenex HFA *





ZaleplonZegerid * (PA)Zetia (ST)Zocor * (ST)Zofran *Zofran ODT *Zoloft * (ST)

ZolpidemZolpimist * (ST)Zomig (ST)Zomig ZMT (ST)Zuplenz *ZymarZymaxid *

* (non-covered medication) prior authorization required for members with approved formulary exceptions** covered under medical benefit only(PA17) prior authorization required for members who are 17 years of age or older(PA30) prior authorization required for members who are 30 years of age or older(QCD) Quality Care Dosing limits apply(SP) medication is part of the specialty pharmacy network(SPO) benefits are not available for this medication when administered in an outpatient setting such as a doctor’s office or hospital, unless the medication is obtained from a specialty pharmacy 13

Prior AuthorizationYour doctor is required to obtain prior authorization before prescribing specific medications . This ensures that your doctor has determined that this medication is necessary to treat you, based on specific medical standards .

For the most up-to-date list of medications that require prior authorization, please visit our website, www.bluecrossma.com/pharmacy, click on PharmacyManagementProgram, and proceed to PriorAuthorization .

Another part of our prior authorization program is step therapy . Please refer to page 19 for a list of medications that require step therapy .

Prior Authorization ListThis list of medications that require prior authorization is up-to-date as of January 1, 2012, and may change from time to time .

Abstral * (QCD)AcipHex * (QCD)Actemra (SP)Actiq * (QCD)Adcirca (SP)Amevive **Amphetamines (e.g Amphetamine, Methamphetamine, Liquadd, Procentra)Ampyra (QCD) (SP)Aralast **Aralast NP **Aranesp (QCD) (SP) (SPO)Boniva syringe * (SP)Botulinum toxinCeredase **Cerezyme **Cimzia (SP) (SPO)Cinryze **Desoxyn (PA17)Dexilant * (QCD)Dextroamphetamines (e.g. Dexedrine) (PA17)Egrifta (SP)ElidelEnbrel (QCD) (SP) (SPO)

Enteral formulaEpogen (QCD) (SP) (SPO)Erbitux **EuflexxaFactor VIII, VIIIa, IX, XIII **Fentanyl oral/mucosal (QCD)Fentora * (QCD)Forteo (QCD) (SP) (SPO)Growth Hormone (SP) (SPO)Humira (QCD) (SP) (SPO)HyalganIlaris (SP)Incivek (SP)Interferons (alpha, gamma) (QCD) (SP) (SPO)IV Immunoglobulin **Kineret (SP) (SPO)Lansoprazole (QCD)Leukine (SP)LyricaMakena (SP)Neulasta (QCD) (SP)Neupogen (QCD) (SP)Nexium * (QCD)Nuvigil * (PA17)

* (non-covered medication) prior authorization required for members with approved formulary exceptions** covered under medical benefit only

(PA17) prior authorization required for members who are 17 years of age or older(PA30) prior authorization required for members who are 30 years of age or older

(QCD) Quality Care Dosing limits apply(SP) medication is part of the specialty pharmacy network

(SPO) benefits are not available for this medication when administered in an outpatient setting such as a doctor’s office or hospital, unless the medication is obtained from a specialty pharmacy14

Omeprazole (QCD)Omeprazole -Sod. Bicarbonate * (QCD)Onsolis * (QCD)Orencia (SP)OrthoviscPantoprazole (QCD)PradaxaPreservative-Free Morphine **Prevacid * (QCD)Prilosec * (QCD)Procrit (QCD) (SP) (SPO)Prolastin **Prolastin C **Proleukin (SP)Prolia (SP)Protonix * (QCD)ProtopicProvigil (PA17)Raptiva (SP)Reclast **

Remicade (SP)Respiratory SyncytialVirus IG/Synagis **Revatio (SP)Rituxan (SP)Simponi (QCD) (SP)Stelara * (SP)Strattera (PA17) (QCD)SupartzSynviscSynvisc OneTopical Retinoic Acid derivatives (e.g. Retin A) (PA30)TPN (total parenteral nutrition) **Tysabri **Vectibix **Victrelis (SP)Xgeva (SP)Xolair **Zegerid * (QCD)Zometa **

* (non-covered medication) step therapy required for members with approved formulary exceptions(PA) prior authorization required | (QCD) Quality Care Dosing limits apply(SPO) benefits are not available for this medication when administered in an outpatient setting such as a doctor’s office or hospital, unless the medication is obtained from a specialty pharmacy 15

Specialty Pharmacy MedicationsBlue Cross Blue Shield of Massachusetts has set up a network of retail specialty pharmacies to dispense certain medications classified as specialty . The following is a list of medications that can only be purchased from one of the pharmacies in this network in order for coverage to be available .

This list is up-to-date as of January 1, 2012 . You can find the latest information about your medications and look up pharmacy contact information by visiting www.bluecrossma.com/pharmacy .

Network Pharmacy InformationAccredo Health Group, Inc. 1-877-988-0058 www.accredo.comCVS Caremark, Inc. 1-866-846-3096 www.caremark.comCuraScript, a subsidiary of Express Scripts, Inc. 1-888-823-9070 www.curascript.comOncoMed, the Oncology Pharmacy 1-877-662-6633 www.oncomed.net

Network Pharmacy Information for Medications Most Commonly Used for FertilityAscend SpecialtyRx 1-800-850-9122 www.ascendspecialtyrx.comFreedom Fertility Pharmacy 1-866-297-9452 www.freedomfertility.comVillage Fertility Pharmacy 1-877-334-1610 www.villagefertilitypharmacy.com

Fertility MedicationsBravelle * (SPO)CetrotideClomidClomipheneEndometrinFollistim AQ * (SPO)Ganirelix (SPO)Gonal F/Gonal F RFF (SPO)Human Chorionic Gonadotropin (HCG) (SPO)Leuprolide (SPO)Leuprolide AcetateLupron DepotLupron Depot PedLuveris (SPO)Menopur (SPO)NovarelOvidrel

Pregnyl (SPO)Repronex (SPO)Serophene

Injectable MedicationsAbraxaneActemra (PA)ActharActimmune (PA) (SPO)Adriamycin PFSAdrucilAlferon N (PA)AlkeranApokynAranesp (PA) (QCD) (SPO)Arcalyst InjectionArediaArzerra

* (non-covered medication) step therapy required for members with approved formulary exceptions(PA) prior authorization required | (QCD) Quality Care Dosing limits apply


Avonex (QCD) (SPO)Betaseron (QCD) (SPO)BiCNuBleomycin SulfateBoniva Injection * (PA)BusulfexCamptosarCarboplatinCerubidineCimzia (PA) (SPO)CisplatinCladribineCopaxone (QCD) (SPO)CosmegenCyclophosphamideCytarabineCytoxanDacarbazineDactinomycinDaunorubicin HCLDaunoXomeDDAVP *DepocytDesmopressin AcetateDocetaxelDoxilDoxorubicin HClDTIC-DomeEgrifta (PA)EligardEllenceEloxatinElsparEnbrel (PA) (QCD) (SPO)EpirubicinEpogen (PA) (QCD) (SPO)EthyolEtopophosEtoposideExtavia * (QCD)FaslodexFirmagonFloxuridineFludara

Fludarabine phosphateFluorouracilForteo (PA) (QCD) (SPO)FUDRFusilev I.V.Fuzeon (SPO)GemcitabineGemzarGenotropin * (PA) (SPO)HerceptinHumatrope (PA) (SPO)Humira (PA) (QCD) (SPO)HycamtinIdamycin PFSIdarubicinIfexIfosfamideIfosfamide/MesnaIlaris (PA)Increlex (PA) (SPO)Infergen (PA) (QCD) (SPO)Intron A (PA) (SPO)IrinotecanIstodaxKineret (PA) (SPO)Leucovorin CalciumLeukine (PA)Leuprolide AcetateLeustatinLupron DepotLupron Depot-PedMakena (PA)MesnaMethotrexateMexnexMitomycinMitoxantroneMozobil (SPO)MustargenMylotargNavelbineNeosarNeulasta (PA) (QCD)Neumega

* (non-covered medication) step therapy required for members with approved formulary exceptions(PA) prior authorization required | (QCD) Quality Care Dosing limits apply(SPO) benefits are not available for this medication when administered in an outpatient setting such as a doctor’s office or hospital, unless the medication is obtained from a specialty pharmacy 17

Neupogen (PA) (QCD)NipentNorditropin * (PA) (SPO)Norditropin Flexpro * (PA) (SPO)Norditropin Nordiflex * (PA) (SPO)NovantroneNplateNutropin (PA) (SPO)Nutropin AQ (PA) (SPO)Nutropin AQ Nuspin (PA) (SPO)Octreotide injection (SPO)Omnitrope * (PA) (SPO)OncasparOntakOnxolOrencia (PA)OxaliplatinPaclitaxelPamidronatePamidronate disodiumPegasys (PA) (QCD) (SPO)Peg-Intron (PA) (QCD) (SPO)PhotofrinProcrit (PA) (QCD) (SPO)Proleukin (PA)Prolia (PA)Rebif (QCD) (SPO)Remicade (PA)Revatio (PA)Rituxan (PA)Saizen * (PA) (SPO)Sandostatin (SPO)Sandostatin-LARSerostim (PA) (SPO)Simponi (PA) (QCD)SimulectSomatulineSomavertStelara * (PA)Sylatron (PA)TarabineTaxolTaxotereTev-Tropin * (PA) (SPO)

TheraCysThiotepaThyrogenToposarTotectTrelstarTrelstar DepotTrelstar LAVelcadeVePesidVinBLAStineVinCRIStineVinorelbineVumonXgeva (PA)ZanosarZenapaxZinecardZoladexZorbtive (PA) (SPO)

Oral Medications8-MopAdcirca (PA)AfinitorAlkeranAmpyra (PA) (QCD)CarbagluCopegus (SPO)CystagonCytoxanEtoposideExjadeGilenyaGleevecHycamtinIncivek (PA)IressaKuvanLetairisMesnexNexavarOfortaOrfadinPromacta

* (non-covered medication) step therapy required for members with approved formulary exceptions(PA) prior authorization required | (QCD) Quality Care Dosing limits apply


Pulmozyme (SPO)Rebetol (SPO)Revatio (PA)RevlimidRibapak (SPO)Ribasphere (SPO)RibatabRibavirin (SPO)RilutekSabrilSprycelSucraidSutentTarcevaTasignaTemodarThalomid

TOBI (SPO)TracleerTykerbTyvasoVePesidVictrelis (PA)VotrientXalkoriXelodaXenazineZavescaZelborafZolinzaZytiga

TopicalPanretinQutenza (QCD)

* (non-covered medication) step therapy required for members with approved formulary exceptions** (new to market drug; non-covered while under review) quantity limits apply to members with approved formulary exceptions(QCD) Quality Care Dosing limits apply 19

Step TherapyStep therapy is a key part of our prior authorization program that allows us to help your doctor provide you with an appropriate and affordable drug treatment . Before coverage is allowed for certain costly “second-step” medications, we require that you first try an effective, but less expensive, “first-step” medication . Some medications may have multiple steps .

Step Therapy ListThis list is up-to-date as of January 1, 2012, and is subject to change at any time . For the most up-to-date list of medications that require step therapy, please visit our website www.bluecrossma.com/pharmacy, click on PharmacyManagementProgram, and proceed to StepTherapy .

Antidepressant DrugsAplenzin ER * (QCD)Celexa * (QCD)Cymbalta (QCD)Effexor *Effexor XR * (QCD)Lexapro (QCD)Luvox CR * (QCD)Paxil * (QCD)Paxil CR * (QCD)Pexeva * (QCD)Pristiq * (QCD)Prozac * (QCD)Prozac Weekly * (QCD)Sarafem * (QCD)Venlafaxine ER tablet (QCD)Viibryd * (QCD)Wellbutrin *Wellbutrin SR * (QCD)Wellbutrin XL * (QCD)Zoloft * (QCD)

Asthma ManagementAccolate *Advair Discus (QCD)Advair HFA (QCD)Dulera (QCD)SingulairSymbicort (QCD)

ZafirlukastZyflo *Zyflo CR *

Cholesterol TreatmentAdvicor (QCD)Altoprev * (QCD)Caduet * (QCD)Crestor (QCD)Lescol * (QCD)Lescol XL * (QCD)Lipitor (QCD)Livalo * (QCD)Mevacor * (QCD)Pravachol * (QCD)Simcor * (QCD)Vytorin * (QCD)Zetia (QCD)Zocor * (QCD)

Diabetes ManagementACTOplus met (QCD)Actoplus Met XR (QCD)Actos (QCD)Avandamet (QCD)AvandarylAvandia (QCD)DuetactJanumet

* (non-covered medication) step therapy required for members with approved formulary exceptions** (new to market drug; non-covered while under review) quantity limits apply to

members with approved formulary exceptions(QCD) Quality Care Dosing limits apply20

JanuviaKombiglyze XROnglyzaTradjenta *Victoza

GlaucomaLumiganTravatanTravatan ZXalatan

Heart/Blood Modifiers/CirculationAtacand *Atacand HCT *AvalideAvaproAzorBenicarBenicar HCTCozaar *DiovanDiovan HCTEdarbi *ExforgeExforge-HCTHyzaar *Micardis *Micardis HCT *Teveten *Teveten HCT *TribenzorTwynsta *Valturna *

Insomnia TreatmentAmbien * (QCD)Ambien CR * (QCD)Edluar * (QCD)Lunesta (QCD)Rozerem * (QCD)Sonata (QCD)Zolpimist * (QCD)

Migraine TreatmentAlsuma (QCD)Amerge (QCD)Axert * (QCD)Frova * (QCD)Imitrex (QCD)Maxalt * (QCD)Maxalt MLT * (QCD)Relpax (QCD)Sumavel Dosepro * (QCD)Treximet * (QCD)Zomig (QCD)Zomig ZMT (QCD)

Osteoporosis Treatment (Oral)Actonel (QCD)Actonel with Calcium (QCD)Atelvia DR * (QCD)Boniva tablets * (QCD)Fosamax * (QCD)Fosamax Plus D (QCD)

Overactive Bladder TreatmentDetrol *Detrol LA *Ditropan *Ditropan XL *Enablex *Gelnique *Oxytrol *Sanctura *Sanctura XR *Toviaz *Vesicare

Pain Relievers (Cox II Inhibitors)Celebrex (QCD)

Parkinson’s Disease TreatmentMirapexMirapex ER *Requip *Requip XL *

* (non-covered medication) step therapy required for members with approved formulary exceptions** (new to market drug; non-covered while under review) quantity limits apply to members with approved formulary exceptions(QCD) Quality Care Dosing limits apply 21

Prostate TreatmentAvodartJalyn *Proscar *

Topical TestosteroneAndrodermAndrogel *Axiron *Fortesta *

Treatment For GoutUloric

(PA) prior authorization required for members with approved formulary exceptions(QCD) Quality Care Dosing limits apply for members with approved formulary exceptions


a doctor’s office or hospital, unless the medication is obtained from a specialty pharmacy(ST) step therapy required for members with approved formulary exceptions22

Non-Covered MedicationsYour pharmacy program provides coverage for over 4,000 prescription medications . Most medications on our non-covered list have equally safe, effective, covered alternatives for treating the same medical conditions . Check with your doctor about appropriate alternatives if you currently take any of these medications .

For the most up-to-date list of medications that are not covered and their covered alternatives, please visit our website, www.bluecrossma.com/pharmacy, click on MedicationLookUp, and proceed to the MedicationsthatarenotCovered section .

Please note: Your doctor may request coverage for a non-covered medication if no covered alternative is appropriate for treating your condition .

Non-Covered Medication ListThis list of non-covered medications is up-to-date as of January 1, 2012, and may change from time to time .

Abilify DiscMeltAbstral (PA) (QCD)AcanyaAccolate (ST)AccuNebAccuprilAccureticAccutaneAceonAcipHex (PA) (QCD)ActigallActiq (PA) (QCD)ActivellaACTOplus Met XR (QCD) (ST)Acular (QCD)Acular LS (QCD)AcuvailAczoneAdalat CCAdderallAdoxa CKAdoxa TT

Aerobid (QCD)Aerobid-M (QCD)AiretAlamast (QCD)Alocril (QCD)AlodoxAloquinAlora (QCD)Alrex (QCD)AltabaxAltaceAltoprev (QCD) (ST)AluveaAlvesco (QCD)Ambien (QCD) (ST)Ambien CR (QCD) (ST)AmrixAmturnideAnafranilAnalpram AdvancedAnalpram-E kitAndrogel (ST)

(PA) prior authorization required for members with approved formulary exceptions(QCD) Quality Care Dosing limits apply for members with approved formulary exceptions(SP) medication is part of the specialty pharmacy network(SPO) benefits are not available for this medication when administered in an outpatient setting such as a doctor’s office or hospital, unless the medication is obtained from a specialty pharmacy(ST) step therapy required for members with approved formulary exceptions 23

AngeliqAntaraAnzemet (QCD)ApidraAplenzin ER (QCD) (ST)Appformin-DArava (QCD)Ascensia diabetic testing supplies (QCD)Asmanex Twisthaler (QCD)Assure Pro diabetic testing supplies (QCD)Astepro (QCD)Atacand (ST)Atacand HCT (ST)Atelvia (QCD) (ST)AtivanAtopiclairAtralinAtropenAugmentin XRAveloxAvidoxyAvidoxy DKAvinza (QCD)AvitaAxert (QCD) (ST)AxidAxiron (ST)AzasiteAzmacort (QCD)B-D diabetic testing supplies (QCD)Beconase AQ (QCD)BenzaClin kitBepreveBesivanceBionectBoniva syringe (PA) (SP)Boniva tablets (QCD) (ST)Bravelle (SP)BreviconBromdayBrovanaButrans (QCD)Bystolic

Caduet (QCD)CambiaCaphosolCapotenCardeneCardene SRCardizem CDCardizem LACardura XL (QCD)CataflamCeclorCeclor CDCedaxCelexa (QCD) (ST)Cem-UreaCenestinCentanyCentany ATCesamet (QCD)CetraxelChenodalChibroxin OcumeterCipro-XRCleanse and TreatCleervue-MCleocin TClindacin PACClindagelClindamaxClindareachClindetsClobeta + PlusCNL 8 nail kit (QCD)ColazalCombiganCombunoxCoregCoreg CRCozaar (ST)DalirespDarvocet N-100DayproDaytrana




DDAVPDemulenDepo-Sub Q Provera 104Derma-Smoothe/FSDermOticDesogenDesonil + PlusDesOwen kitDetrol (ST)Detrol LA (ST)Dexedrine (PA)Dexilant (PA) (QCD)Dilacor XRDilaudidDipentumDispermoxDitropan (ST)Ditropan XL (ST)DivigelDoryxDuragesic (QCD)DurezolDynabacDynacinDynacircDynacirc CRDytanEdarbi (ST)Edluar (QCD) (ST)Effexor (ST)Effexor XR (QCD) (ST)Elestat (QCD)ElestrinEletoneEmbeda (QCD)EmsamEnablex (ST)EnjuviaEpiCeramEpiduoEquetroErtaczoEstrace

Estrasorb (QCD)Estrogel (QCD)Evamist (QCD)EvoclinExacTech diabetic testing supplies (QCD)Exalgo (QCD)ExtaviaExtinaFactiveFamvir (QCD)FanaptFazaCloFemtraceFenoglideFentora (PA) (QCD)Fertinex (SP)FexmidFibracorFinacea PlusFioricetFiorinalFiorinal with CodeineFlagylFlagyl ERFlagyl IVFlectorFlonase (QCD)FocalinFocalin XR (QCD)Follistim AQ (SP) (SPO)FortametFortesta (ST)Fosamax (QCD) (ST)Freestyle diabetic supplies (QCD)Fresh KoteFrova (QCD) (ST)GelclairGelnique (ST)Genotropin (PA) (SP) (SPO)Glucometer diabetic supplies (QCD)GlucophageGlucophage XRGlumetza


HalonateHalotinHydrocortisone-Lidocaine kitHylatopicHylatopic PlusHylatopic Plus-AurstatHyliraHytrin (QCD)Hyzaar (ST)IB-StatIC400 kitIC800 kitImuranInderal LAInnoPran XLIntunivInvegaIquixIstalolJalyn (ST)Kadian (QCD)KapvayKeppra XRKeralyt complete kitKetocon + PlusKlonopinKytril (QCD)Lamictal ODTLamisil (QCD)Lamisil Granules (QCD)LastacaftLatudaLescol (QCD) (ST)Lescol XL (QCD) (ST)LevaquinLevlenLexxelLialdaLipofenLivalo (QCD) (ST)LodineLodine XLLofibra

LopressorLorabidLoSeasoniqueLotensinLotensin HCTLovazaLuvox CR (QCD) (ST)Lysteda (QCD)LytensoprilMavikMaxair Autohaler (QCD)Maxalt/Maxalt-MLT (QCD) (ST)MaxipimeMegace ESMenostar (QCD)MetaglipMetozolv ODTMetrogel kitMevacor (QCD) (ST)Micardis (ST)Micardis HCT (ST)MinocinMinocin Combo PackMirapex ER (ST)Mobic (QCD)MomexinMonodoxMonoprilMonopril HCTMorgidoxMoxatagNaprelanNaprosynNaprosyn ECNasacort AQ (QCD)Nasarel (QCD)Nasonex (QCD)NataziaNeosalusNeuproNeurontinNeutraSalNevanac




NexavirNexiclon XRNexium (PA) (QCD)NiravamNorditropin (PA) (SP) (SPO)NorinylNoroxinNor-Q-DNorvasc (QCD)NovacortNuCortNucyntaNucynta ERNuedextaNutriDoxNuvigil (PA)Ocudox kitOleptro EROluxOmeprazole/Sodium Bicarb (PA) (QCD)Omnaris (QCD)OmnicefOmnitrope (PA) (SP) (SPO)Onsolis (PA) (QCD)OpanaOpana ER (QCD)OptaseOptivar (QCD)OraceaOramorph SR (QCD)Orapred ODTOravigOrtho-PrefestOvconOxytrol (ST)PamelorPamine FQPancreazePaptasePataday (QCD)Patanase (QCD)Paxil (QCD) (ST)Paxil CR (QCD) (ST)

PCEPCE DispertabPediaderm AFPediaderm HCPediaderm TAPenlac (QCD)PennsaidPepcidPercocetPexeva (QCD) (ST)PlaquenilPram-HCAPramosone EPrandiMetPravachol (QCD) (ST)PR-CreamPrecision diabetic supplies (QCD)Prestige diabetic testing supplies (QCD)Prevacid (PA) (QCD)Prevacid NapraPACPrilosec (PA) (QCD)PrinivilPrinzidePristiq (QCD) (ST)Procentra (PA)Prodigy diabetic testing supplies (QCD)PromisebPromiseb LightProquin XRProtonix (PA) (QCD)Proventil HFA (QCD)Proventil inhaler (QCD)Proventil/RepetabProzac (QCD) (ST)Prozac Weekly (QCD) (ST)PurinetholQuixinRadiaPlex RxRadigelRaniclorRapafloRecothromRelafen


Remeron (QCD)Remeron Soltab (QCD)Requip (ST)Requip XL (ST)ResculaRestorilRetin-A Micro (PA30)Rhinocort Aqua (QCD)RinnoviRisperdal M-TabRitalinRitalin LA (QCD)Ritalin SRRosanilRozerem (QCD) (ST)RybixRybix ODTRynatanRythmolRyzoltSaizen (PA) (SP) (SPO)SalkeraSalvaxSalvax DuoSalvax Duo PlusSanctura (ST)Sanctura XR (ST)Sancuso (QCD)SaphrisSarafem (QCD) (ST)ScalacortSeasoniqueSenophyllineSilenor (QCD)Simcor (QCD) (ST)SinemetSkelidSof-Tact diabetic supplies (QCD)SolodynSoltamoxSomaSpectracefSporanox (QCD)

SprixStavzorStelara (PA) (SP)StriantSularSumadanSumavel Dosepro (QCD) (ST)SumaxinSumaxin TSTagametTekamloTekturnaTekturna HCTTenorminTequinTerbinex (QCD)TersiTetrixTeveten (ST)Teveten HCT (ST)Tev-Tropin (PA) (SP) (SPO)TherapentinTiamateTiazacTindamaxTirosintTofranilTornalateToviaz (ST)Tradjenta (ST)Tranxene T-TabTretin-X (PA)Treximet (QCD) (ST)TricorTriglideTri-LevlenTrilipixTrinalinTri-NorinylTriOxinTritecTropazoneTrueTest diabetic supplies (QCD)




TrueTrack diabetic supplies (QCD)Twynsta (ST)UltracetUltram/ERUltravate PACUramaxinUrea kitValiumValturna (ST)VanosVantinVasereticVasolexVasotecVecticalVectrinVeltin (PA30)Ventolin HFA (QCD)Veramyst (QCD)VeregenVicodinVicodin ESVimovoVirasalVoltarenVoltaren XRVusionVytorin (QCD) (ST)Vyvanse (QCD)WelcholWellbutrinWellbutrin SR (QCD) (ST)Wellbutrin XL (QCD) (ST)XanaxXanax XRX-ClairXenaderm

XereseXibromXifaxanXolegelXoloxXopenex HFA (QCD)Xopenex nebulesXyralidZanaflexZantacZebetaZegerid (PA) (QCD)ZelaparZenievaZestrilZianaZinoticZinotic ESZipsorZithromaxZmaxZocor (QCD) (ST)Zofran (QCD)Zofran ODT (QCD)Zoloft (QCD) (ST)Zolpimist (QCD) (ST)ZoviraxZ-PramZuplenz (QCD)Zyflo (ST)Zyflo CR (ST)ZymaxidZypramZyprexa IMZyprexa RelprevvZytopic

29

Medication Resource List Index8-Mop . . . . . . . . . . . . . . . . . . . 17

AAbilify . . . . . . . . . . . . . . . . . . . . 4Abilify DiscMelt . . . . . . . . . . 22Abraxane . . . . . . . . . . . . . . . . 15Abstral . . . . . . . . . . . . 8, 13, 22Acanya . . . . . . . . . . . . . . . . . . 22Accolate . . . . . . . . . . . . . 19, 22Accu-Chek Aviva . . . . . . . . . . 4AccuNeb . . . . . . . . . . . . . . . . 22Accupril . . . . . . . . . . . . . . . . . 22Accuretic . . . . . . . . . . . . . . . . 22Accutane . . . . . . . . . . . . . . . . 22Aceon . . . . . . . . . . . . . . . . . . . 22Acetaminophen-Codeine . . 4AcipHex . . . . . . . . . . . 8, 13, 22Actemra . . . . . . . . . . . . . 13, 15Acthar . . . . . . . . . . . . . . . . . . . 15Actigall . . . . . . . . . . . . . . . . . . 22Actimmune . . . . . . . . . . . . . . 15Actiq . . . . . . . . . . . . . . 8, 13, 22Activella . . . . . . . . . . . . . . . . . 22Actonel . . . . . . . . . . . . . 4, 8, 20Actonel with Calcium . . 8, 20ACTOplus met . . . . . . . . . . . 19ACTOplus Met . . . . . . . . . . . . 8Actoplus Met XR . . . . . . . . . 19ACTOplus Met XR . . . . 8, 22Actos . . . . . . . . . . . . . . . 4, 8, 19Acular . . . . . . . . . . . . . . . . . . . 22Acular LS . . . . . . . . . . . . . . . . 22Acular/LS . . . . . . . . . . . . . . . . 8Acular PF . . . . . . . . . . . . . . . . . 8Acuvail . . . . . . . . . . . . . . . . . . 22Acyclovir . . . . . . . . . . . . . . . . . . 4Aczone . . . . . . . . . . . . . . . . . . 22Adalat CC . . . . . . . . . . . . . . . 22Adcirca . . . . . . . . . . . . . . .13, 17Adderall . . . . . . . . . . . . . . . . . 22Adderall XR . . . . . . . . . . . . . . 8Adoxa CK . . . . . . . . . . . . . . . 22Adoxa TT . . . . . . . . . . . . . . . . 22Adriamycin PFS . . . . . . . . . . 15Adrucil . . . . . . . . . . . . . . . . . . 15

Advair Discus . . . . . . . . . .8, 19Advair Diskus . . . . . . . . . . . . . 4Advair HFA . . . . . . . . . . . .8, 19Advicor . . . . . . . . . . . . . . . .8, 19Aerobid . . . . . . . . . . . . . . . 8, 22Aerobid-M . . . . . . . . . . . . 8, 22Afinitor . . . . . . . . . . . . . . . . . . 17Airet . . . . . . . . . . . . . . . . . . . . 22Alamast . . . . . . . . . . . . . . 8, 22Albuterol Sulfate . . . . . . . . . . 4Alendronate . . . . . . . . . . . . . . 8Alendronate Sodium . . . . . . . 4Alferon N . . . . . . . . . . . . . . . . 15Alkeran . . . . . . . . . . . . . . .15, 17Allopurinol . . . . . . . . . . . . . . . . 4Alocril . . . . . . . . . . . . . . . . 8, 22Alodox . . . . . . . . . . . . . . . . . . 22Alomide . . . . . . . . . . . . . . . . . . 8Aloquin . . . . . . . . . . . . . . . . . . 22Alora . . . . . . . . . . . . . . . . . .9, 22Alprazolam . . . . . . . . . . . . . . . . 4Alrex . . . . . . . . . . . . . . . . . .9, 22Alsuma . . . . . . . . . . . . . . . 9, 20Altabax . . . . . . . . . . . . . . . . . . 22Altace . . . . . . . . . . . . . . . . . . . 22Altoprev . . . . . . . . . . . 9, 19, 22Alupent inhaler . . . . . . . . . . . . 9Aluvea . . . . . . . . . . . . . . . . . . . 22Alvesco . . . . . . . . . . . . . . . .9, 22Ambien . . . . . . . . . . . . 9, 20, 22Ambien CR . . . . . . . . 9, 20, 22Amerge . . . . . . . . . . . . . . 9, 20Amevive . . . . . . . . . . . . . . . . . 13Amitiza . . . . . . . . . . . . . . . . . . . 9Amitriptyline HCl . . . . . . . . . . 4Amlodipine . . . . . . . . . . . . . . . 9Amlodipine Besylate . . . . . . . 4Amlodipine Besylate-

Benazepril . . . . . . . . . . . . . . 4Amoxicillin . . . . . . . . . . . . . . . . 4Amox Tr-Potassium

Clavulanate . . . . . . . . . . . . . 4Amphetamines . . . . . . . . . . . 13Amphetamine Salt Combo . 4Ampyra . . . . . . . . . . . . 9, 13, 17Amrix . . . . . . . . . . . . . . . . . . . . 22

Amturnide . . . . . . . . . . . . . . . 22Anafranil . . . . . . . . . . . . . . . . 22Analpram Advanced . . . . . . 22Analpram-E kit . . . . . . . . . . . 22Androderm . . . . . . . . . . . . . . 21Androgel . . . . . . . . . . . . 21, 22Angeliq . . . . . . . . . . . . . . . . . . 23Antara . . . . . . . . . . . . . . . . . . . 23Anzemet . . . . . . . . . . . . . . .9, 23Apidra . . . . . . . . . . . . . . . . . . . 23Aplenzin ER . . . . . . . 9, 19, 23Apokyn . . . . . . . . . . . . . . . . . . 15Appformin-D . . . . . . . . . . . . . 23Apri . . . . . . . . . . . . . . . . . . . . . . 4Aralast . . . . . . . . . . . . . . . . . . 13Aralast NP . . . . . . . . . . . . . . . 13Aranesp . . . . . . . . . . . 9, 13, 15Arava . . . . . . . . . . . . . . . . . .9, 23Arcalyst Injection . . . . . . . . . 15Arcapta Neohaler . . . . . . . . . 9Aredia . . . . . . . . . . . . . . . . . . . 15Aricept . . . . . . . . . . . . . . . . . . . 4Arimidex . . . . . . . . . . . . . . . . . . 4Arixtra . . . . . . . . . . . . . . . . . . . . 9Arzerra . . . . . . . . . . . . . . . . . . 15Asacol . . . . . . . . . . . . . . . . . . . . 4Ascensia diabetic testing

supplies . . . . . . . . . . . . . . . 23Asmanex Twisthaler . . . .9, 23Assure Pro diabetic

testing supplies . . . . . . . . 23Astelin . . . . . . . . . . . . . . . . . 4, 9Astepro . . . . . . . . . . . . . . . .9, 23Atacand . . . . . . . . . . . . . 20, 23Atacand HCT . . . . . . . . 20, 23Atelvia . . . . . . . . . . . . . . . . .9, 23Atelvia DR . . . . . . . . . . . . . . . 20Atenolol . . . . . . . . . . . . . . . . . . 4Atenolol-Chlorthalidone . . . . 4Ativan . . . . . . . . . . . . . . . . . . . 23Atopiclair . . . . . . . . . . . . . . . . 23Atralin . . . . . . . . . . . . . . . . . . . 23Atripla . . . . . . . . . . . . . . . . . . . . 4Atropen . . . . . . . . . . . . . . . . . 23Atrovent . . . . . . . . . . . . . . . . . . 9Atrovent HFA . . . . . . . . . . . . . 9

30

Augmentin XR . . . . . . . . . . . 23Avalide . . . . . . . . . . . . . . . 4, 20Avandamet . . . . . . . . . . . .9, 19Avandaryl . . . . . . . . . . . . . . . . 19Avandia . . . . . . . . . . . . . . .9, 19Avapro . . . . . . . . . . . . . . . 4, 20Avelox . . . . . . . . . . . . . . . . . . . 23Aviane . . . . . . . . . . . . . . . . . . . . 4Avidoxy . . . . . . . . . . . . . . . . . . 23Avidoxy DK . . . . . . . . . . . . . . 23Avinza . . . . . . . . . . . . . . . . .9, 23Avita . . . . . . . . . . . . . . . . . . . . 23Avodart . . . . . . . . . . . . . . . . . . 21Avonex . . . . . . . . . . . . . . . .9, 16Axert . . . . . . . . . . . . . . 9, 20, 23Axid . . . . . . . . . . . . . . . . . . . . . 23Axiron . . . . . . . . . . . . . . . 21, 23Azasite . . . . . . . . . . . . . . . . . . 23Azelastine . . . . . . . . . . . . . . . . 9Azithromycin . . . . . . . . . . . . . . 4Azmacort . . . . . . . . . . . . . .9, 23Azor . . . . . . . . . . . . . . . . . . . . . 20

BBaclofen . . . . . . . . . . . . . . . . . 4B-D diabetic testing

supplies . . . . . . . . . . . . . . . 23Beconase AQ . . . . . . . . . .9, 23Benicar . . . . . . . . . . . . . . . 4, 20Benicar HCT . . . . . . . . . 4, 20BenzaClin kit . . . . . . . . . . . . 23Benzonatate . . . . . . . . . . . . . . 4Bepreve . . . . . . . . . . . . . . . . . 23Besivance . . . . . . . . . . . . . . . 23Betamethasone

Dipropionate . . . . . . . . . . . 4Betaseron . . . . . . . . . . . . .9, 16BiCNu . . . . . . . . . . . . . . . . . . 16Bionect . . . . . . . . . . . . . . . . . . 23Bisoprolol Fumarate-HCTZ 4Bleomycin Sulfate . . . . . . . . 16Boniva Injection . . . . . . . . . . 16Boniva syringe . . . . . . . 13, 23Boniva tablets . . . . . 9, 20, 23Botulinum toxin . . . . . . . . . . 13Bravelle . . . . . . . . . . . . . 15, 23Brevicon . . . . . . . . . . . . . . . . . 23Bromday . . . . . . . . . . . . . . . . 23

Brovana . . . . . . . . . . . . . . . . . 23Budeprion SR . . . . . . . . . . 4, 9Budeprion XL . . . . . . . . . . . 4, 9Budesonide . . . . . . . . . . . . . . 9Bupropion HCl . . . . . . . . . . . . 4Bupropion HCl SR . . . . . . . . 4Bupropion SR . . . . . . . . . . . . 9Bupropion XL . . . . . . . . . . . 4, 9Buspirone HCl . . . . . . . . . . . . 4Busulfex . . . . . . . . . . . . . . . . . 16Butalbital-APAP-Caffeine . . 4Butorphanol NS . . . . . . . . . . . 9Butrans . . . . . . . . . . . . . . .9, 23Byetta . . . . . . . . . . . . . . . . . . . . 4Bystolic . . . . . . . . . . . . . . . . . 23

CCabergoline . . . . . . . . . . . . . . 9Caduet . . . . . . . . . . . . 9, 19, 23Cambia . . . . . . . . . . . . . . . . . . 23Camila . . . . . . . . . . . . . . . . . . . 4Camptosar . . . . . . . . . . . . . . 16Caphosol . . . . . . . . . . . . . . . . 23Capoten . . . . . . . . . . . . . . . . . 23Carbaglu . . . . . . . . . . . . . . . . 17Carboplatin . . . . . . . . . . . . . . 16Cardene . . . . . . . . . . . . . . . . . 23Cardene SR . . . . . . . . . . . . . 23Cardizem CD . . . . . . . . . . . . 23Cardizem LA . . . . . . . . . . . . . 23Cardura . . . . . . . . . . . . . . . . . . 9Cardura XL . . . . . . . . . . . .9, 23Carisoprodol . . . . . . . . . . . . . . 4Carvedilol . . . . . . . . . . . . . . . . . 4Cataflam . . . . . . . . . . . . . . . . 23Catapres TTS . . . . . . . . . . . . . 9Ceclor . . . . . . . . . . . . . . . . . . . 23Ceclor CD . . . . . . . . . . . . . . . 23Cedax . . . . . . . . . . . . . . . . . . . 23Cefdinir . . . . . . . . . . . . . . . . . . 4Cefprozil . . . . . . . . . . . . . . . . . 4Cefuroxime . . . . . . . . . . . . . . . 4Celebrex . . . . . . . . . . . 4, 9, 20Celexa . . . . . . . . . . . . 9, 19, 23Cem-Urea . . . . . . . . . . . . . . . 23Cenestin . . . . . . . . . . . . . . . . 23Centany . . . . . . . . . . . . . . . . . 23Centany AT . . . . . . . . . . . . . . 23

Cephalexin . . . . . . . . . . . . . . . 5Ceredase . . . . . . . . . . . . . . . . 13Cerezyme . . . . . . . . . . . . . . . 13Cerubidine . . . . . . . . . . . . . . . 16Cesamet . . . . . . . . . . . . . .9, 23Cetraxel . . . . . . . . . . . . . . . . . 23Cetrotide . . . . . . . . . . . . . . . . 15Chantix . . . . . . . . . . . . . . . . . . . 5Chenodal . . . . . . . . . . . . . . . . 23Cheratussin AC . . . . . . . . . . . 5Chibroxin Ocumeter . . . . . . 23Chlorhexidine Gluconate

0.12% Rinse . . . . . . . . . . . 5Cialis . . . . . . . . . . . . . . . . . . . . . 5Ciclodin solution/kit . . . . . . . 9Ciclopirox nail lacquer . . . . . 9Cimzia . . . . . . . . . . . . . . . 13, 16Cinryze . . . . . . . . . . . . . . . . . . 13Ciprofloxacin HCl . . . . . . . . . 5Cipro-XR . . . . . . . . . . . . . . . . 23Cisplatin . . . . . . . . . . . . . . . . . 16Citalopram . . . . . . . . . . . . . . . . 9Citalopram HBr . . . . . . . . . . . 5Cladribine . . . . . . . . . . . . . . . 16Clarithromycin . . . . . . . . . . . . 5Cleanse and Treat . . . . . . . . 23Cleervue-M . . . . . . . . . . . . . . 23Cleocin T . . . . . . . . . . . . . . . . 23Climara . . . . . . . . . . . . . . . . . . . 9Climara Pro . . . . . . . . . . . . . . . 9Clindacin PAC . . . . . . . . . . . 23Clindagel . . . . . . . . . . . . . . . . 23Clindamax . . . . . . . . . . . . . . . 23Clindamycin HCl . . . . . . . . . . 5Clindamycin Phosphate . . . . 5Clindareach . . . . . . . . . . . . . . 23Clindets . . . . . . . . . . . . . . . . . 23Clobeta + Plus . . . . . . . . . . . 23Clobetasol Propionate . . . . . 5Clomid . . . . . . . . . . . . . . . . . . 15Clomiphene . . . . . . . . . . . . . . 15Clonazepam . . . . . . . . . . . . . . 5Clonidine HCl . . . . . . . . . . . . . 5Clonidine patch . . . . . . . . . . . 9Clotrimazole-

Betamethasone . . . . . . . . 5CNL 8 nail kit . . . . . . . . . .9, 23Colazal . . . . . . . . . . . . . . . . . . 23

31

Colchicine . . . . . . . . . . . . . . . . 5Combigan . . . . . . . . . . . . . . . 23Combivent . . . . . . . . . . . . . . 5, 9Combunox . . . . . . . . . . . . . . . 23Concerta . . . . . . . . . . . . . . . 5, 9Copaxone . . . . . . . . . . . . .9, 16Copegus . . . . . . . . . . . . . . . . 17Coreg . . . . . . . . . . . . . . . . . . . 23Coreg CR . . . . . . . . . . . . . . . 23Cosmegen . . . . . . . . . . . . . . . 16Cozaar . . . . . . . . . . . . . . 20, 23Crestor . . . . . . . . . . . . . 5, 9, 19Crolom ophthalmic . . . . . . . . 9Cromolyn ophthalmic . . . . . . 9Cryselle . . . . . . . . . . . . . . . . . . 5Cyclobenzaprine HCl . . . . . . 5Cyclophosphamide . . . . . . . 16Cymbalta . . . . . . . . . . . 5, 9, 19Cystagon . . . . . . . . . . . . . . . . 17Cytarabine . . . . . . . . . . . . . . . 16Cytoxan . . . . . . . . . . . . . .16, 17

DDacarbazine . . . . . . . . . . . . . 16Dactinomycin . . . . . . . . . . . . 16Daliresp . . . . . . . . . . . . . . . . . 23Darvocet N-100 . . . . . . . . . 23Daunorubicin HCL . . . . . . . 16DaunoXome . . . . . . . . . . . . . 16Daypro . . . . . . . . . . . . . . . . . . 23Daytrana . . . . . . . . . . . . . . . . 23DDAVP . . . . . . . . . . . . . . 16, 24Demulen . . . . . . . . . . . . . . . . 24Depocyt . . . . . . . . . . . . . . . . . 16Depo-Sub Q Provera 104 24Derma-Smoothe/FS . . . . . 24DermOtic . . . . . . . . . . . . . . . . 24Desmopressin Acetate . . . 16Desogen . . . . . . . . . . . . . . . . 24Desonide . . . . . . . . . . . . . . . . . 5Desonil + Plus . . . . . . . . . . . 24DesOwen kit . . . . . . . . . . . . . 24Desoxyn . . . . . . . . . . . . . . . . . 13Detrol . . . . . . . . . . . . . . . 20, 24Detrol LA . . . . . . . . . . . . 20, 24Dexamethasone . . . . . . . . . . 5Dexedrine . . . . . . . . . . . . . . . 24Dexilant . . . . . . . . . . . 9, 13, 24

Dextroamphetamine-Amphetamine . . . . . . . . . . 5

Dextroamphetamine/Amphetamine ER . . . . . . . 9

Dextroamphetamines . . . . . 13Diazepam . . . . . . . . . . . . . . . . 5Diclofenac Sodium . . . . . . . . 5Dicyclomine HCl . . . . . . . . . . 5Differin . . . . . . . . . . . . . . . . . . . 5Diflucan . . . . . . . . . . . . . . . . . . 9Digoxin . . . . . . . . . . . . . . . . . . . 5Dilacor XR . . . . . . . . . . . . . . . 24Dilaudid . . . . . . . . . . . . . . . . . 24Dilt-CD . . . . . . . . . . . . . . . . . . . 5Diltiazem 24hr ER . . . . . . . . 5Diovan . . . . . . . . . . . . . . . 5, 20Diovan HCT . . . . . . . . . . 5, 20Dipentum . . . . . . . . . . . . . . . . 24Dispermox . . . . . . . . . . . . . . . 24Ditropan . . . . . . . . . . . . . 20, 24Ditropan XL . . . . . . . . . 20, 24Divalproex Sodium . . . . . . . . 5Divalproex Sodium ER . . . . . 5Divigel . . . . . . . . . . . . . . . . . . 24Docetaxel . . . . . . . . . . . . . . . 16Doryx . . . . . . . . . . . . . . . . . . . 24Doxazosin . . . . . . . . . . . . . . . . 9Doxazosin Mesylate . . . . . . . 5Doxil . . . . . . . . . . . . . . . . . . . . 16Doxorubicin HCl . . . . . . . . . 16Doxycycline Hyclate . . . . . . . 5DTIC-Dome . . . . . . . . . . . . . 16Duac CS . . . . . . . . . . . . . . . . . 5Duetact . . . . . . . . . . . . . . . . . 19Dulera . . . . . . . . . . . . . . . . .9, 19Duragesic . . . . . . . . . . . . .9, 24Durezol . . . . . . . . . . . . . . . . . . 24Dynabac . . . . . . . . . . . . . . . . . 24Dynacin . . . . . . . . . . . . . . . . . 24Dynacirc . . . . . . . . . . . . . . . . . 24Dynacirc CR . . . . . . . . . . . . . 24Dytan . . . . . . . . . . . . . . . . . . . 24

EEdarbi . . . . . . . . . . . . . . . 20, 24Edluar . . . . . . . . . . . . . 9, 20, 24Effexor . . . . . . . . . . . . . . 19, 24Effexor XR . . . . . . . . 9, 19, 24

Egrifta . . . . . . . . . . . . . . . 13, 16Elestat . . . . . . . . . . . . . . . .9, 24Elestrin . . . . . . . . . . . . . . . . . . 24Eletone . . . . . . . . . . . . . . . . . . 24Elidel . . . . . . . . . . . . . . . . . . . . 13Eligard . . . . . . . . . . . . . . . . . . 16Ellence . . . . . . . . . . . . . . . . . . 16Eloxatin . . . . . . . . . . . . . . . . . 16Elspar . . . . . . . . . . . . . . . . . . . 16Emadine . . . . . . . . . . . . . . . . . . 9Embeda . . . . . . . . . . . . . . .9, 24Emend . . . . . . . . . . . . . . . . . . . 9Emsam . . . . . . . . . . . . . . . . . . 24Enablex . . . . . . . . . . . . . 20, 24Enalapril Maleate . . . . . . . . . 5Enbrel . . . . . . . . . . .5, 9, 13, 16Endocet . . . . . . . . . . . . . . . . . . 5Endometrin . . . . . . . . . . . . . . 15Enjuvia . . . . . . . . . . . . . . . . . . 24Enoxaparin . . . . . . . . . . . . . . . 9Enpresse . . . . . . . . . . . . . . . . . 5Enteral formula . . . . . . . . . . 13EpiCeram . . . . . . . . . . . . . . . 24Epiduo . . . . . . . . . . . . . . . . . . 24Epinastine Ophthalmic . . . . . 9Epipen . . . . . . . . . . . . . . . . . . . 5Epirubicin . . . . . . . . . . . . . . . 16Epogen . . . . . . . . . . . 9, 13, 16Equetro . . . . . . . . . . . . . . . . . 24Erbitux . . . . . . . . . . . . . . . . . . 13Ertaczo . . . . . . . . . . . . . . . . . . 24Erythromycin . . . . . . . . . . . . . 5Estrace . . . . . . . . . . . . . . . . . . 24Estraderm . . . . . . . . . . . . . . . . 9Estradiol . . . . . . . . . . . . . . . . . . 5Estradiol patch . . . . . . . . . . . . 9Estrasorb . . . . . . . . . . . . . .9, 24Estrogel . . . . . . . . . . . . . 10, 24Ethyol . . . . . . . . . . . . . . . . . . . 16Etodolac . . . . . . . . . . . . . . . . . . 5Etopophos . . . . . . . . . . . . . . . 16Etoposide . . . . . . . . . . . .16, 17Euflexxa . . . . . . . . . . . . . . . . . 13Evamist . . . . . . . . . . . . . 10, 24Evista . . . . . . . . . . . . . . . . . . . . 5Evoclin . . . . . . . . . . . . . . . . . . 24ExacTech diabetic

testing supplies . . . . . . . . 24

32

Exalgo . . . . . . . . . . . . . . 10, 24Exforge . . . . . . . . . . . . . . . . . 20Exforge-HCT . . . . . . . . . . . . 20Exjade . . . . . . . . . . . . . . . . . . 17Extavia . . . . . . . . . . . 10, 16, 24Extina . . . . . . . . . . . . . . . . . . . 24

FFactive . . . . . . . . . . . . . . . . . . 24Factor VIII, VIIIa, IX, XIII . . 13Famciclovir . . . . . . . . . . . . . . 10Famvir . . . . . . . . . . . . . . . 10, 24Fanapt . . . . . . . . . . . . . . . . . . 24Faslodex . . . . . . . . . . . . . . . . 16FazaClo . . . . . . . . . . . . . . . . . 24Femtrace . . . . . . . . . . . . . . . . 24Fenofibrate . . . . . . . . . . . . . . . 5Fenoglide . . . . . . . . . . . . . . . . 24Fentanyl . . . . . . . . . . . . . . . . . . 5Fentanyl oral/mucosal 10, 13Fentanyl patch . . . . . . . . . . . 10Fentora . . . . . . . . . . . 10, 13, 24Fertinex . . . . . . . . . . . . . . . . . 24Fexmid . . . . . . . . . . . . . . . . . . 24Fibracor . . . . . . . . . . . . . . . . . 24Finacea Plus . . . . . . . . . . . . . 24Finasteride . . . . . . . . . . . . . . . 5Fioricet . . . . . . . . . . . . . . . . . . 24Fiorinal . . . . . . . . . . . . . . . . . . 24Fiorinal with Codeine . . . . . 24Firmagon . . . . . . . . . . . . . . . . 16Flagyl . . . . . . . . . . . . . . . . . . . 24Flagyl ER . . . . . . . . . . . . . . . . 24Flagyl IV . . . . . . . . . . . . . . . . . 24Flector . . . . . . . . . . . . . . . . . . 24Flomax . . . . . . . . . . . . . . . . . . . 5Flonase . . . . . . . . . . . . . 10, 24Flovent HFA . . . . . . . . . . . . . . 5Flovent/HFA . . . . . . . . . . . . 10Floxuridine . . . . . . . . . . . . . . 16Fluconazole . . . . . . . . . . . .5, 10Fludara . . . . . . . . . . . . . . . . . . 16Fludarabine phosphate . . . 16Flunisolide . . . . . . . . . . . . . . . 10Fluocinonide . . . . . . . . . . . . . . 5Fluorouracil . . . . . . . . . . . . . . 16Fluoxetine . . . . . . . . . . . . . . . 10Fluoxetine DR . . . . . . . . . . . 10

Fluoxetine HCl . . . . . . . . . . . . 5Fluticasone . . . . . . . . . . . . . . 10Fluticasone Propionate . . . . 5Fluvoxamine . . . . . . . . . . . . . 10Focalin . . . . . . . . . . . . . . . . . . 24Focalin XR . . . . . . . . . . 10, 24Folic Acid . . . . . . . . . . . . . . . . . 5Follistim AQ . . . . . . . . . 15, 24Fondaparinux . . . . . . . . . . . . 10Foradil . . . . . . . . . . . . . . . . . . 10Fortamet . . . . . . . . . . . . . . . . 24Forteo . . . . . . . . . . . . 10, 13, 16Fortesta . . . . . . . . . . . . . .21, 24Fosamax . . . . . . . . .10, 20, 24Fosamax Plus D . . . . . 10, 20Fragmin . . . . . . . . . . . . . . . . . 10Freestyle diabetic supplies 24Fresh Kote . . . . . . . . . . . . . . 24Frova . . . . . . . . . . . . .10, 20, 24FUDR . . . . . . . . . . . . . . . . . . . 16Furosemide . . . . . . . . . . . . . . . 5Fusilev I.V. . . . . . . . . . . . . . . . 16Fuzeon . . . . . . . . . . . . . . . . . . 16

GGabapentin . . . . . . . . . . . . . . . 5Ganirelix . . . . . . . . . . . . . . . . . 15Gelclair . . . . . . . . . . . . . . . . . . 24Gelnique . . . . . . . . . . . . 20, 24Gemcitabine . . . . . . . . . . . . . 16Gemfibrozil . . . . . . . . . . . . . . . 5Gemzar . . . . . . . . . . . . . . . . . . 16Genotropin . . . . . . . . . . 16, 24Gilenya . . . . . . . . . . . . . . .10, 17Gleevec . . . . . . . . . . . . . . . . . 17Glimepiride . . . . . . . . . . . . . . . 5Glipizide . . . . . . . . . . . . . . . . . . 5Glipizide ER . . . . . . . . . . . . . . 5Glipizide XL . . . . . . . . . . . . . . 5Glucometer diabetic

supplies . . . . . . . . . . . . . . . 24Glucophage . . . . . . . . . . . . . 24Glucophage XR . . . . . . . . . . 24Glucose testing strips . . . . 10Glumetza . . . . . . . . . . . . . . . . 24Glyburide . . . . . . . . . . . . . . . . . 5Glyburide-Metformin HCl . . 5Gonal F/Gonal F RFF . . . . 15

Gralise . . . . . . . . . . . . . . . . . . 10Granisetron . . . . . . . . . . . . . . 10Granisol . . . . . . . . . . . . . . . . . 10Growth Hormone . . . . . . . . 13

HHalflytely-Bisacodyl . . . . . . . 5Halonate . . . . . . . . . . . . . . . . 25Halotin . . . . . . . . . . . . . . . . . . 25Herceptin . . . . . . . . . . . . . . . 16Humalog . . . . . . . . . . . . . . . . . 5Human Chorionic

Gonadotropin (HCG) . . . 15Humatrope . . . . . . . . . . . . . . 16Humira . . . . . . . . 5, 10, 13, 16Humulin N . . . . . . . . . . . . . . . . 5Hyalgan . . . . . . . . . . . . . . . . . 13Hycamtin . . . . . . . . . . . . .16, 17Hydrochlorothiazide . . . . . . . 5Hydrocodone-

Acetaminophen . . . . . . . . . 5Hydrocortisone . . . . . . . . . . . 5Hydrocortisone-

Lidocaine kit . . . . . . . . . . 25Hydromorphone HCl . . . . . . 5Hydroxychloroquine Sulfate 5Hydroxyzine HCl . . . . . . . . . . 5Hylatopic . . . . . . . . . . . . . . . . 25Hylatopic Plus . . . . . . . . . . . 25Hylatopic Plus-Aurstat . . . . 25Hylira . . . . . . . . . . . . . . . . . . . 25Hytrin . . . . . . . . . . . . . . . 10, 25Hyzaar . . . . . . . . . . . . . . 20, 25

IIB-Stat . . . . . . . . . . . . . . . . . . 25Ibuprofen . . . . . . . . . . . . . . . . . 5IC400 kit . . . . . . . . . . . . . . . . 25IC800 kit . . . . . . . . . . . . . . . . 25Idamycin PFS . . . . . . . . . . . . 16Idarubicin . . . . . . . . . . . . . . . . 16Ifex . . . . . . . . . . . . . . . . . . . . . 16Ifosfamide . . . . . . . . . . . . . . . 16Ifosfamide/Mesna . . . . . . . 16Ilaris . . . . . . . . . . . . . . . . 13, 16Imitrex . . . . . . . . . . . . . . . 10, 20Imuran . . . . . . . . . . . . . . . . . . 25

33

Incivek . . . . . . . . . . . . . . .13, 17Increlex . . . . . . . . . . . . . . . . . 16Inderal LA . . . . . . . . . . . . . . . 25Indomethacin . . . . . . . . . . . . . 5Infergen . . . . . . . . . . . . . 10, 16InnoPran XL . . . . . . . . . . . . . 25Interferons . . . . . . . . . . . . . . . 13Intron A . . . . . . . . . . . . . . . . . 16Intuniv . . . . . . . . . . . . . . . . . . . 25Invega . . . . . . . . . . . . . . . . . . . 25Iophen-C NR . . . . . . . . . . . . . 5Ipratropium NS . . . . . . . . . . 10Iquix . . . . . . . . . . . . . . . . . . . . 25Iressa . . . . . . . . . . . . . . . . . . . 17Irinotecan . . . . . . . . . . . . . . . 16Isosorbide Mononitrate . . . . 5Istalol . . . . . . . . . . . . . . . . . . . 25Istodax . . . . . . . . . . . . . . . . . . 16Itraconazole . . . . . . . . . . . . . 10IV Immunoglobulin . . . . . . . 13

JJalyn . . . . . . . . . . . . . . . . 21, 25Janumet . . . . . . . . . . . . . . . . . 19Januvia . . . . . . . . . . . . . . . 5, 20Junel FE . . . . . . . . . . . . . . . . . . 5

KKadian . . . . . . . . . . . . . . 10, 25Kapvay . . . . . . . . . . . . . . . . . . 25Kariva . . . . . . . . . . . . . . . . . . . . 5Keppra XR . . . . . . . . . . . . . . 25Keralyt complete kit . . . . . . 25Ketoconazole . . . . . . . . . . . . . 5Ketocon + Plus . . . . . . . . . . 25Ketorolac ophthalmic . . . . . 10Kineret . . . . . . . . . . . . . . 13, 16Klonopin . . . . . . . . . . . . . . . . 25Klor-Con 10 . . . . . . . . . . . . . . 5Klor-Con M20 . . . . . . . . . . . . 5Kombiglyze XR . . . . . . . . . . 20Kuvan . . . . . . . . . . . . . . . . . . . 17Kytril . . . . . . . . . . . . . . . . 10, 25

LLabetalol HCl . . . . . . . . . . . . . 5Lamictal ODT . . . . . . . . . . . . 25

Lamisil . . . . . . . . . . . . . . 10, 25Lamisil Granules . . . . . . . . . 25Lamotrigine . . . . . . . . . . . . . . . 5Lansoprazole . . . . . . 5, 10, 13Lantus . . . . . . . . . . . . . . . . . . . 5Lantus Solostar . . . . . . . . . . . 6Lastacaft . . . . . . . . . . . . 10, 25Latuda . . . . . . . . . . . . . . . . . . 25Leflunomide . . . . . . . . . . . . . 10Lescol . . . . . . . . . . . . 10, 19, 25Lescol XL . . . . . . . . 10, 19, 25Letairis . . . . . . . . . . . . . . . . . . 17Leucovorin Calcium . . . . . . 16Leukine . . . . . . . . . . . . . 13, 16Leuprolide . . . . . . . . . . . . . . . 15Leuprolide Acetate . . . 15, 16Leustatin . . . . . . . . . . . . . . . . 16Levaquin . . . . . . . . . . . . . . . . 25Levetiracetam . . . . . . . . . . . . 6Levitra . . . . . . . . . . . . . . . . . . . 6Levlen . . . . . . . . . . . . . . . . . . . 25Levora-28 . . . . . . . . . . . . . . . . 6Levothyroxine Sodium . . . . . 6Levoxyl . . . . . . . . . . . . . . . . . . . 6Lexapro . . . . . . . . . . . 6, 10, 19Lexxel . . . . . . . . . . . . . . . . . . . 25Lialda . . . . . . . . . . . . . . . . . . . 25Lidoderm . . . . . . . . . . . . . . . . . 6Lipitor . . . . . . . . . . . . . 6, 10, 19Lipofen . . . . . . . . . . . . . . . . . . 25Lisinopril . . . . . . . . . . . . . . . . . 6Lisinopril-HCTZ . . . . . . . . . . . 6Lithium Carbonate . . . . . . . . 6Livalo . . . . . . . . . . . . 10, 19, 25Lodine . . . . . . . . . . . . . . . . . . 25Lodine XL . . . . . . . . . . . . . . . 25Loestrin 24 FE . . . . . . . . . . . . 6Lofibra . . . . . . . . . . . . . . . . . . 25Lopressor . . . . . . . . . . . . . . . 25Lorabid . . . . . . . . . . . . . . . . . . 25Lorazepam . . . . . . . . . . . . . . . 6LoSeasonique . . . . . . . . . . . 25Lotensin . . . . . . . . . . . . . . . . . 25Lotensin HCT . . . . . . . . . . . . 25Lotronex . . . . . . . . . . . . . . . . 10Lovastatin . . . . . . . . . . . . .6, 10Lovaza . . . . . . . . . . . . . . . . . . 25Lovenox . . . . . . . . . . . . . . .6, 10

Low-Ogestrel . . . . . . . . . . . . . 6Lumigan . . . . . . . . . . . . . . . . . 20Lunesta . . . . . . . . . . . 6, 10, 20Lupron Depot . . . . . . . . 15, 16Lupron Depot Ped . . . . . . . 15Lupron Depot-Ped . . . . . . . 16Lutera . . . . . . . . . . . . . . . . . . . . 6Luveris . . . . . . . . . . . . . . . . . . 15Luvox CR . . . . . . . . . 10, 19, 25Lyrica . . . . . . . . . . . . . . . . .6, 13Lysteda . . . . . . . . . . . . . 10, 25Lytensopril . . . . . . . . . . . . . . . 25

MMakena . . . . . . . . . . . . . 13, 16Mavik . . . . . . . . . . . . . . . . . . . 25Maxair Autohaler . . . . . 10, 25Maxalt . . . . . . . . . . . . . . . 10, 20Maxalt/Maxalt-MLT . . . . . . 25Maxalt MLT . . . . . . . . . . . . . . 20Maxalt-MLT . . . . . . . . . . . . . . 10Maxipime . . . . . . . . . . . . . . . . 25Medroxyprogesterone

Acetate . . . . . . . . . . . . . . . . 6Megace ES . . . . . . . . . . . . . . 25Meloxicam . . . . . . . . . . . . .6, 10Menopur . . . . . . . . . . . . . . . . 15Menostar . . . . . . . . . . . . 10, 25Mesna . . . . . . . . . . . . . . . . . . 16Mesnex . . . . . . . . . . . . . . . . . 17Metadate CD . . . . . . . . . .6, 10Metaglip . . . . . . . . . . . . . . . . . 25Metformin HCl . . . . . . . . . . . . 6Metformin HCl ER . . . . . . . . 6Methadone HCl . . . . . . . . . . . 6Methocarbamol . . . . . . . . . . . 6Methotrexate . . . . . . . . . .6, 16Methylin tablets (non

chewable) . . . . . . . . . . . . . . 6Methylphenidate ER . . . . . . 10Methylphenidate HCl . . . . . . 6Methylprednisolone . . . . . . . 6Metoclopramide HCl . . . . . . 6Metoprolol Succinate . . . . . . 6Metoprolol Tartrate . . . . . . . . 6Metozolv ODT . . . . . . . . . . . 25Metrogel kit . . . . . . . . . . . . . 25Metronidazole . . . . . . . . . . . . . 6

34

Mevacor . . . . . . . . . . 10, 19, 25Mexnex . . . . . . . . . . . . . . . . . 16Micardis . . . . . . . . . . . . . 20, 25Micardis HCT . . . . . . . . 20, 25Microgestin . . . . . . . . . . . . . . . 6Microgestin FE . . . . . . . . . . . 6Migranal . . . . . . . . . . . . . . . . . 10Minocin . . . . . . . . . . . . . . . . . 25Minocin Combo Pack . . . . . 25Minocycline HCl . . . . . . . . . . 6Mirapex . . . . . . . . . . . . . . . . . 20Mirapex ER . . . . . . . . . . 20, 25Mirtazapine . . . . . . . . . . . .6, 10Mirtazapine Rapid

Dissolve . . . . . . . . . . . . . . . 10Mitomycin . . . . . . . . . . . . . . . 16Mitoxantrone . . . . . . . . . . . . 16Mobic . . . . . . . . . . . . . . . 10, 25Mometasone Furoate . . . . . . 6Momexin . . . . . . . . . . . . . . . . 25Monodox . . . . . . . . . . . . . . . . 25Monopril . . . . . . . . . . . . . . . . . 25Monopril HCT . . . . . . . . . . . . 25Morgidox . . . . . . . . . . . . . . . . 25Morphine Sulfate . . . . . . . . . . 6Morphine Sulfate ER . . . . . 10Moxatag . . . . . . . . . . . . . . . . . 25Moxeza . . . . . . . . . . . . . . . . . . 10Mozobil . . . . . . . . . . . . . . . . . . 16MS Contin . . . . . . . . . . . . . . . 10Mupirocin . . . . . . . . . . . . . . . . . 6Mustargen . . . . . . . . . . . . . . . 16Mylotarg . . . . . . . . . . . . . . . . . 16

NNabumetone . . . . . . . . . . . . . . 6Nadolol . . . . . . . . . . . . . . . . . . . 6Naprelan . . . . . . . . . . . . . . . . 25Naprosyn . . . . . . . . . . . . . . . . 25Naprosyn EC . . . . . . . . . . . . 25Naproxen . . . . . . . . . . . . . . . . . 6Naratriptan . . . . . . . . . . . . . . 10Nasacort AQ . . . . . . . . . 10, 25Nasarel . . . . . . . . . . . . . . . . . . 25Nasonex . . . . . . . . . . . . 10, 25Natazia . . . . . . . . . . . . . . . . . . 25Navelbine . . . . . . . . . . . . . . . 16NebuPent . . . . . . . . . . . . . . . 10

Necon . . . . . . . . . . . . . . . . . . . . 6Neomycin-Polymyxin-HC . . 6Neosalus . . . . . . . . . . . . . . . . 25Neosar . . . . . . . . . . . . . . . . . . 16Neulasta . . . . . . . . . 10, 13, 16Neumega . . . . . . . . . . . . . . . . 16Neupogen . . . . . . . . 10, 13, 17Neupro . . . . . . . . . . . . . . . . . . 25Neurontin . . . . . . . . . . . . . . . 25NeutraSal . . . . . . . . . . . . . . . 25Nevanac . . . . . . . . . . . . . . . . . 25Nexavar . . . . . . . . . . . . . . . . . 17Nexavir . . . . . . . . . . . . . . . . . . 26Nexiclon XR . . . . . . . . . . . . . 26Nexium . . . . . . . . . . .10, 13, 26Niaspan . . . . . . . . . . . . . . . . . . 6Nifedipine ER . . . . . . . . . . . . . 6Nipent . . . . . . . . . . . . . . . . . . . 17Niravam . . . . . . . . . . . . . . . . . 26Nitrofurantoin Mono-Macro 6Nitroglycerin . . . . . . . . . . . . . . 6Norditropin . . . . . . . . . . .17, 26Norditropin Flexpro . . . . . . . 17Norditropin Nordiflex . . . . . 17Norinyl . . . . . . . . . . . . . . . . . . 26Noroxin . . . . . . . . . . . . . . . . . 26Nor-Q-D . . . . . . . . . . . . . . . . 26Nortrel . . . . . . . . . . . . . . . . . . . 6Nortriptyline HCl . . . . . . . . . . 6Norvasc . . . . . . . . . . . . . 10, 26Novacort . . . . . . . . . . . . . . . . 26Novantrone . . . . . . . . . . . . . . 17Novarel . . . . . . . . . . . . . . . . . . 15NovoLog . . . . . . . . . . . . . . . . . 6Nplate . . . . . . . . . . . . . . . . . . . 17NuCort . . . . . . . . . . . . . . . . . . 26Nucynta . . . . . . . . . . . . . . . . . 26Nucynta ER . . . . . . . . . . . . . 26Nuedexta . . . . . . . . . . . . . . . . 26NutriDox . . . . . . . . . . . . . . . . 26Nutropin . . . . . . . . . . . . . . . . . 17Nutropin AQ . . . . . . . . . . . . . 17Nutropin AQ Nuspin . . . . . . 17Nuvaring . . . . . . . . . . . . . . . . . 6Nuvigil . . . . . . . . . . . . . . 13, 26Nystatin-Triamcinolone . . . . 6

OOcella . . . . . . . . . . . . . . . . . . . . 6Octreotide injection . . . . . . 17Ocudox kit . . . . . . . . . . . . . . . 26Ofloxacin . . . . . . . . . . . . . . . . . 6Oforta . . . . . . . . . . . . . . . . . . . 17Oleptro ER . . . . . . . . . . . . . . 26Olux . . . . . . . . . . . . . . . . . . . . . 26Omeprazole . . . . . . . . 6, 10, 14Omeprazole -Sod.

Bicarbonate . . . . . . . . . . . 14Omeprazole-Sod.

Bicarbonate . . . . . . . . . . . 10Omeprazole/Sodium

Bicarb . . . . . . . . . . . . . . . . 26Omnaris . . . . . . . . . . . . . 10, 26Omnicef . . . . . . . . . . . . . . . . . 26Omnitrope . . . . . . . . . . . .17, 26Oncaspar . . . . . . . . . . . . . . . . 17Ondansetron . . . . . . . . . . . . . 10Ondansetron HCl . . . . . . . . . 6Ondansetron ODT . . . . . . . . . 6Ondasetron ODT . . . . . . . . . 10One Touch Ultra test strips . 6Onglyza . . . . . . . . . . . . . . . . . 20Onsolis . . . . . . . . . . . 11, 14, 26Ontak . . . . . . . . . . . . . . . . . . . 17Onxol . . . . . . . . . . . . . . . . . . . 17Opana . . . . . . . . . . . . . . . . . . . 26Opana ER . . . . . . . . . . . .11, 26Optase . . . . . . . . . . . . . . . . . . 26Optivar . . . . . . . . . . . . . . .11, 26Oracea . . . . . . . . . . . . . . . . . . 26Oramorph SR . . . . . . . . .11, 26Orapred ODT . . . . . . . . . . . . 26Oravig . . . . . . . . . . . . . . . . . . . 26Orencia . . . . . . . . . . . . . . 14, 17Orfadin . . . . . . . . . . . . . . . . . . 17Ortho-Prefest . . . . . . . . . . . . 26Ortho Tri-Cyclen Lo . . . . . . . 6Orthovisc . . . . . . . . . . . . . . . . 14Ovcon . . . . . . . . . . . . . . . . . . . 26Ovidrel . . . . . . . . . . . . . . . . . . 15Oxaliplatin . . . . . . . . . . . . . . . 17Oxcarbazepine . . . . . . . . . . . . 6Oxybutynin Chloride ER . . . 6Oxycodone-Acetaminophen 6

35

Oxycodone ER . . . . . . . . . . . 11Oxycodone HCl . . . . . . . . . . . 6OxyContin . . . . . . . . . . . . . 6, 11Oxymorphone ER . . . . . . . . 11Oxytrol . . . . . . . . . . . . . . 20, 26

PPaclitaxel . . . . . . . . . . . . . . . . 17Pamelor . . . . . . . . . . . . . . . . . 26Pamidronate . . . . . . . . . . . . . 17Pamidronate disodium . . . . 17Pamine FQ . . . . . . . . . . . . . . 26Pancreaze . . . . . . . . . . . . . . . 26Panretin . . . . . . . . . . . . . . . . . 18Pantoprazole . . . . . . . . . 11, 14Pantoprazole Sodium . . . . . . 6Paptase . . . . . . . . . . . . . . . . . 26Paroxetine . . . . . . . . . . . . . . . 11Paroxetine CR . . . . . . . . . . . 11Paroxetine HCl . . . . . . . . . . . 6Pataday . . . . . . . . . . . . . .11, 26Patanase . . . . . . . . . . . . .11, 26Patanol . . . . . . . . . . . . . . . . 6, 11Paxil . . . . . . . . . . . . . 11, 19, 26Paxil CR . . . . . . . . . . 11, 19, 26PCE . . . . . . . . . . . . . . . . . . . . 26PCE Dispertab . . . . . . . . . . . 26Pediaderm AF . . . . . . . . . . . 26Pediaderm HC . . . . . . . . . . . 26Pediaderm TA . . . . . . . . . . . . 26PEG-3350 with Flavor

Packs . . . . . . . . . . . . . . . . . . 6Pegasys . . . . . . . . . . . . . . 11, 17Peg-Intron . . . . . . . . . . . . . . . 17PEG-Intron . . . . . . . . . . . . . . 11Penicillin V Potassium . . . . . 6Penlac . . . . . . . . . . . . . . .11, 26Pennsaid . . . . . . . . . . . . . . . . 26Pepcid . . . . . . . . . . . . . . . . . . 26Percocet . . . . . . . . . . . . . . . . 26Pexeva . . . . . . . . . . . 11, 19, 26Phenazopyridine HCl . . . . . . 6Photofrin . . . . . . . . . . . . . . . . 17Piroxicam . . . . . . . . . . . . . . . . . 6Plaquenil . . . . . . . . . . . . . . . . 26Plavix . . . . . . . . . . . . . . . . . . . . 6Polymyxin B Sul-

Trimethoprim . . . . . . . . . . . . 6

Potassium Chloride . . . . . . . 6Pradaxa . . . . . . . . . . . . . . . . . 14Pram-HCA . . . . . . . . . . . . . . 26Pramosone E . . . . . . . . . . . . 26PrandiMet . . . . . . . . . . . . . . . 26Pravachol . . . . . . . . . 11, 19, 26Pravastatin . . . . . . . . . . . . . . 11Pravastatin Sodium . . . . . . . 6PR-Cream . . . . . . . . . . . . . . . 26Precision diabetic

supplies . . . . . . . . . . . . . . . 26Prednisolone Sodium

Phosphate . . . . . . . . . . . . . 6Prednisone . . . . . . . . . . . . . . . 6Pregnyl . . . . . . . . . . . . . . . . . . 15Premarin tablets . . . . . . . . . . 6Prempro . . . . . . . . . . . . . . . . . . 6Prenatal Plus . . . . . . . . . . . . . 6Preservative-Free

Morphine . . . . . . . . . . . . . . 14Prestige diabetic testing

supplies . . . . . . . . . . . . . . . 26Prevacid . . . . . . . . . . 11, 14, 26Prevacid NapraPAC . . . . . . 26Prevpac . . . . . . . . . . . . . . . . . 11Prilosec . . . . . . . . . . 11, 14, 26Prinivil . . . . . . . . . . . . . . . . . . . 26Prinzide . . . . . . . . . . . . . . . . . 26Pristiq . . . . . . . . . . . . 11, 19, 26ProAir HFA . . . . . . . . . . . . 6, 11Procentra . . . . . . . . . . . . . . . . 26Prochlorperazine Maleate . . 6Procrit . . . . . . . . . . . . .11, 14, 17Prodigy diabetic testing

supplies . . . . . . . . . . . . . . . 26Prolastin . . . . . . . . . . . . . . . . . 14Prolastin C . . . . . . . . . . . . . . 14Proleukin . . . . . . . . . . . . . 14, 17Prolia . . . . . . . . . . . . . . . . 14, 17Promacta . . . . . . . . . . . . . . . . 17Promethazine-Codeine . . . . 6Promethazine HCl . . . . . . . . . 6Prometrium . . . . . . . . . . . . . . . 6Promiseb . . . . . . . . . . . . . . . . 26Promiseb Light . . . . . . . . . . 26Propoxyphene Nap-

Acetaminophen . . . . . . . . . 6Propranolol HCl . . . . . . . . . . . 7

Proquin XR . . . . . . . . . . . . . . 26Proscar . . . . . . . . . . . . . . . . . . 21Protonix . . . . . . . . . . 11, 14, 26Protopic . . . . . . . . . . . . . . . . . 14Proventil HFA . . . . . . . . .11, 26Proventil inhaler . . . . . . . . . . 26Proventil/Repetab . . . . . . . 26Provigil . . . . . . . . . . . . . . . . 7, 14Prozac . . . . . . . . . . . 11, 19, 26Prozac Weekly . . . . 11, 19, 26Pulmicort Flexhaler . . . . . 7, 11Pulmicort Respules . . . . . 7, 11Pulmozyme . . . . . . . . . . . . . . 18Purinethol . . . . . . . . . . . . . . . 26

QQualaquin . . . . . . . . . . . . . . . 11Quinapril HCl . . . . . . . . . . . . . 7Quixin . . . . . . . . . . . . . . . . . . . 26Qutenza . . . . . . . . . . . . . .11, 18QVAR . . . . . . . . . . . . . . . . . . . 11

RRadiaPlex Rx . . . . . . . . . . . . 26Radigel . . . . . . . . . . . . . . . . . . 26Ramipril . . . . . . . . . . . . . . . . . . 7Raniclor . . . . . . . . . . . . . . . . . 26Ranitidine HCl . . . . . . . . . . . . 7Rapaflo . . . . . . . . . . . . . . . . . . 26Rapaflux . . . . . . . . . . . . . . . . 11Raptiva . . . . . . . . . . . . . . . . . . 14Rebetol . . . . . . . . . . . . . . . . . 18Rebif . . . . . . . . . . . . . . . . . 11, 17Reclast . . . . . . . . . . . . . . . . . . 14Reclipsen . . . . . . . . . . . . . . . . . 7Recothrom . . . . . . . . . . . . . . 26Relafen . . . . . . . . . . . . . . . . . . 26Relpax . . . . . . . . . . . . 7, 11, 20Remeron . . . . . . . . . . . . . 11, 27Remeron Soltab . . . . . . 11, 27Remicade . . . . . . . . . . . . 14, 17Repronex . . . . . . . . . . . . . . . . 15Requip . . . . . . . . . . . . . . 20, 27Requip XL . . . . . . . . . . . 20, 27Rescula . . . . . . . . . . . . . . . . . 27

36

Respiratory SyncytialVirus IG/Synagis . . . . . . . . . . . . . . . 14

Restasis . . . . . . . . . . . . . . . 7, 11Restoril . . . . . . . . . . . . . . . . . . 27Retin-A Micro . . . . . . . . . . . . 27Revatio . . . . . . . . . . . 14, 17, 18Revlimid . . . . . . . . . . . . . . . . . 18Rhinocort Aqua . . . . . . . 11, 27Ribapak . . . . . . . . . . . . . . . . . 18Ribasphere . . . . . . . . . . . . . . 18Ribatab . . . . . . . . . . . . . . . . . . 18Ribavirin . . . . . . . . . . . . . . . . . 18Rilutek . . . . . . . . . . . . . . . . . . 18Rinnovi . . . . . . . . . . . . . . . . . . 27Risperdal M-Tab . . . . . . . . . . 27Risperidone . . . . . . . . . . . . . . . 7Ritalin . . . . . . . . . . . . . . . . . . . 27Ritalin LA . . . . . . . . . . . . . 11, 27Ritalin SR . . . . . . . . . . . . . . . 27Rituxan . . . . . . . . . . . . . . . 14, 17Ropinirole HCl . . . . . . . . . . . . 7Rosanil . . . . . . . . . . . . . . . . . . 27Roxicet tablets . . . . . . . . . . . . 7Rozerem . . . . . . . . . 11, 20, 27Rybix . . . . . . . . . . . . . . . . . . . . 27Rybix ODT . . . . . . . . . . . . . . . 27Rynatan . . . . . . . . . . . . . . . . . 27Rythmol . . . . . . . . . . . . . . . . . 27Ryzolt . . . . . . . . . . . . . . . . . . . 27

SSabril . . . . . . . . . . . . . . . . . . . . 18Saizen . . . . . . . . . . . . . . . . 17, 27Salkera . . . . . . . . . . . . . . . . . . 27Salvax . . . . . . . . . . . . . . . . . . . 27Salvax Duo . . . . . . . . . . . . . . 27Salvax Duo Plus . . . . . . . . . 27Sanctura . . . . . . . . . . . . 20, 27Sanctura XR . . . . . . . . . 20, 27Sancuso . . . . . . . . . . . . . . 11, 27Sandostatin . . . . . . . . . . . . . . 17Sandostatin-LAR . . . . . . . . . 17Saphris . . . . . . . . . . . . . . . . . . 27Sarafem . . . . . . . . . . 11, 19, 27Scalacort . . . . . . . . . . . . . . . . 27Seasonique . . . . . . . . . . . . . . 27Selferma . . . . . . . . . . . . . . . . 11

Senophylline . . . . . . . . . . . . . 27Serevent Diskus . . . . . . . . . 11Serophene . . . . . . . . . . . . . . . 15Seroquel . . . . . . . . . . . . . . . . . 7Serostim . . . . . . . . . . . . . . . . . 17Sertraline . . . . . . . . . . . . . . . . 11Sertraline HCl . . . . . . . . . . . . 7Silenor . . . . . . . . . . . . . . . 11, 27Simcor . . . . . . . . . . . 11, 19, 27Simponi . . . . . . . . . . .11, 14, 17Simulect . . . . . . . . . . . . . . . . . 17Simvastatin . . . . . . . . . . . . 7, 11Sinemet . . . . . . . . . . . . . . . . . 27Singulair . . . . . . . . . . . . . . . . . 19Skelid . . . . . . . . . . . . . . . . . . . 27Sodium Fluoride (Pediatric) 7Sof-Tact diabetic supplies . 27Solodyn . . . . . . . . . . . . . . . . . 27Soltamox . . . . . . . . . . . . . . . . 27Soma . . . . . . . . . . . . . . . . . . . 27Somatuline . . . . . . . . . . . . . . 17Somavert . . . . . . . . . . . . . . . . 17Sonata . . . . . . . . . . . . . . .11, 20Spectracef . . . . . . . . . . . . . . . 27Spiriva . . . . . . . . . . . . . . . . . 7, 11Spironolactone . . . . . . . . . . . . 7Sporanox . . . . . . . . . . . . . 11, 27Sprintec . . . . . . . . . . . . . . . . . . 7Sprix . . . . . . . . . . . . . . . . . . . . 27Sprycel . . . . . . . . . . . . . . . . . . 18Stavzor . . . . . . . . . . . . . . . . . . 27Stelara . . . . . . . . . . . 14, 17, 27Strattera . . . . . . . . . . . .7, 11, 14Striant . . . . . . . . . . . . . . . . . . . 27Suboxone . . . . . . . . . . . . . . . . 7Sucraid . . . . . . . . . . . . . . . . . . 18Sular . . . . . . . . . . . . . . . . . . . . 27Sulfamethoxazole-

Trimethoprim . . . . . . . . . . . . 7Sumadan . . . . . . . . . . . . . . . . 27Sumatriptan . . . . . . . . . . . . . 11Sumatriptan Succinate

(non nasal spray) . . . . . . . 7Sumavel Dosepro . 11, 20, 27Sumaxin . . . . . . . . . . . . . . . . . 27Sumaxin TS . . . . . . . . . . . . . . 27Supartz . . . . . . . . . . . . . . . . . . 14Sutent . . . . . . . . . . . . . . . . . . . 18

Sylatron . . . . . . . . . . . . . . . . . 17Symbicort . . . . . . . . . .7, 11, 19Symbyax . . . . . . . . . . . . . . . . 11Synthroid . . . . . . . . . . . . . . . . . 7Synvisc . . . . . . . . . . . . . . . . . . 14Synvisc One . . . . . . . . . . . . . 14

TTagamet . . . . . . . . . . . . . . . . . 27Tamiflu . . . . . . . . . . . . . . . . . . . 7Tamoxifen Citrate . . . . . . . . . . 7Tarabine . . . . . . . . . . . . . . . . . 17Tarceva . . . . . . . . . . . . . . . . . . 18Tasigna . . . . . . . . . . . . . . . . . . 18Taxol . . . . . . . . . . . . . . . . . . . . 17Taxotere . . . . . . . . . . . . . . . . . 17Tekamlo . . . . . . . . . . . . . . . . . 27Tekturna . . . . . . . . . . . . . . . . . 27Tekturna HCT . . . . . . . . . . . . 27Temazepam . . . . . . . . . . . . . . . 7Temodar . . . . . . . . . . . . . . . . . 18Tenormin . . . . . . . . . . . . . . . . 27Tequin . . . . . . . . . . . . . . . . . . . 27Terazosin . . . . . . . . . . . . . . . . 11Terazosin HCl . . . . . . . . . . . . . 7Terbinafine . . . . . . . . . . . . . . . 11Terbinex . . . . . . . . . . . . . . 11, 27Tersi . . . . . . . . . . . . . . . . . . . . . 27Testim . . . . . . . . . . . . . . . . . . . . 7Tetracycline HCl . . . . . . . . . . . 7Tetrix . . . . . . . . . . . . . . . . . . . . 27Teveten . . . . . . . . . . . . . . 20, 27Teveten HCT . . . . . . . . . 20, 27Tev-Tropin . . . . . . . . . . . . . 17, 27Thalomid . . . . . . . . . . . . . . . . . 18TheraCys . . . . . . . . . . . . . . . . 17Therapentin . . . . . . . . . . . . . . 27Thiotepa . . . . . . . . . . . . . . . . . 17Thyrogen . . . . . . . . . . . . . . . . 17Tiamate . . . . . . . . . . . . . . . . . . 27Tiazac . . . . . . . . . . . . . . . . . . . 27Timolol Maleate . . . . . . . . . . . 7Tindamax . . . . . . . . . . . . . . . . 27Tirosint . . . . . . . . . . . . . . . . . . 27Tizanidine HCl . . . . . . . . . . . . 7TOBI . . . . . . . . . . . . . . . . . . . . 18Tobramycin-Dexamethasone 7Tofranil . . . . . . . . . . . . . . . . . . 27

37

Topical Retinoic Acid derivatives . . . . . . . . . . . . . 14

Topiramate . . . . . . . . . . . . . . . . 7Toposar . . . . . . . . . . . . . . . . . . 17Toprol XL . . . . . . . . . . . . . . . . . 7Tornalate . . . . . . . . . . . . . . . . 27Totect . . . . . . . . . . . . . . . . . . . 17Toviaz . . . . . . . . . . . . . . . . 20, 27TPN . . . . . . . . . . . . . . . . . . . . . 14Tracleer . . . . . . . . . . . . . . . . . . 18Tradjenta . . . . . . . . . . . . 20, 27Tramadol HCl . . . . . . . . . . . . . 7Tranxene T-Tab . . . . . . . . . . . 27Travatan . . . . . . . . . . . . . . . . . 20Travatan Z . . . . . . . . . . . . . . . 20Trazodone HCl . . . . . . . . . . . . 7Trelstar . . . . . . . . . . . . . . . . . . 17Trelstar Depot . . . . . . . . . . . . 17Trelstar LA . . . . . . . . . . . . . . . 17Tretinoin . . . . . . . . . . . . . . . . . . 7Tretin-X . . . . . . . . . . . . . . . . . . 27Treximet . . . . . . . . . . 11, 20, 27Triamcinolone . . . . . . . . . . . . 11Triamcinolone Acetonide . . . 7Triamterene-HCTZ . . . . . . . . 7Tribenzor . . . . . . . . . . . . . . . . . 20Tricor . . . . . . . . . . . . . . . . . . . . 27Triglide . . . . . . . . . . . . . . . . . . 27Tri-Levlen . . . . . . . . . . . . . . . . 27Trilipix . . . . . . . . . . . . . . . . . . . 27Tri-Lo-Sprintec . . . . . . . . . . . . 7Trinalin . . . . . . . . . . . . . . . . . . 27TriNessa . . . . . . . . . . . . . . . . . . 7Tri-Norinyl . . . . . . . . . . . . . . . 27TriOxin . . . . . . . . . . . . . . . . . . . 27Tri-Sprintec . . . . . . . . . . . . . . . 7Tritec . . . . . . . . . . . . . . . . . . . . 27Trivora-28 . . . . . . . . . . . . . . . . 7Tropazone . . . . . . . . . . . . . . . 27TrueTest diabetic supplies . 27TrueTrack diabetic

supplies . . . . . . . . . . . . . . . 28Tussionex . . . . . . . . . . . . . . . . . 7Twynsta . . . . . . . . . . . . . . 20, 28Tykerb . . . . . . . . . . . . . . . . . . . 18Tysabri . . . . . . . . . . . . . . . . . . . 14Tyvaso . . . . . . . . . . . . . . . . . . . 18

UUloric . . . . . . . . . . . . . . . . . . . 21Ultracet . . . . . . . . . . . . . . . . . 28Ultram/ER . . . . . . . . . . . . . . 28Ultravate PAC . . . . . . . . . . . . 28Uramaxin . . . . . . . . . . . . . . . . 28Urea kit . . . . . . . . . . . . . . . . . 28Uroxatral . . . . . . . . . . . . . . . . . 7

VVagifem . . . . . . . . . . . . . . . . . . 7Valacyclovir . . . . . . . . . . . . . . . 7Valacylovir . . . . . . . . . . . . . . . 11Valium . . . . . . . . . . . . . . . . . . . 28Valtrex . . . . . . . . . . . . . . . . . 7, 11Valturna . . . . . . . . . . . . . 20, 28Vanos . . . . . . . . . . . . . . . . . . . 28Vantin . . . . . . . . . . . . . . . . . . . 28Vaseretic . . . . . . . . . . . . . . . . 28Vasolex . . . . . . . . . . . . . . . . . . 28Vasotec . . . . . . . . . . . . . . . . . 28Vectibix . . . . . . . . . . . . . . . . . . 14Vectical . . . . . . . . . . . . . . . . . . 28Vectrin . . . . . . . . . . . . . . . . . . 28Velcade . . . . . . . . . . . . . . . . . 17Veltin . . . . . . . . . . . . . . . . . . . . 28Venlafaxine ER capsule . . 11Venlafaxine ER capsules . . 7Venlafaxine ER tablet .11, 19Ventolin HFA . . . . . . . . .11, 28VePesid . . . . . . . . . . . . . .17, 18Veramyst . . . . . . . . . . . . .11, 28Verapamil HCl . . . . . . . . . . . . 7Veregen . . . . . . . . . . . . . . . . . 28Vesicare . . . . . . . . . . . . . . . . . 20Viagra . . . . . . . . . . . . . . . . . . . . 7Vicodin . . . . . . . . . . . . . . . . . . 28Vicodin ES . . . . . . . . . . . . . . . 28Victoza . . . . . . . . . . . . . . . . . . 20Victrelis . . . . . . . . . . . . . . 14, 18Vigamox . . . . . . . . . . . . . . . 7, 11Viibryd . . . . . . . . . . . . . . . .11, 19Vimovo . . . . . . . . . . . . . . . . . . 28VinBLAStine . . . . . . . . . . . . . 17VinCRIStine . . . . . . . . . . . . . 17Vinorelbine . . . . . . . . . . . . . . 17Virasal . . . . . . . . . . . . . . . . . . . 28

Vivelle . . . . . . . . . . . . . . . . . . . 11Vivelle-Dot . . . . . . . . . . . . . 7, 11Voltaren . . . . . . . . . . . . . . . . . 28Voltaren XR . . . . . . . . . . . . . . 28Votrient . . . . . . . . . . . . . . . . . . 18Vumon . . . . . . . . . . . . . . . . . . 17Vusion . . . . . . . . . . . . . . . . . . . 28Vytorin . . . . . . . . . . . 11, 19, 28Vyvanse . . . . . . . . . . . . . .11, 28

WWarfarin Sodium . . . . . . . . . . 7Welchol . . . . . . . . . . . . . . . . . 28Wellbutrin . . . . . . . . . . . 19, 28Wellbutrin SR . . . . . 11, 19, 28Wellbutrin XL . . . . . 11, 19, 28

XXalatan . . . . . . . . . . . . . . . .7, 20Xalkori . . . . . . . . . . . . . . . . . . 18Xanax . . . . . . . . . . . . . . . . . . . 28Xanax XR . . . . . . . . . . . . . . . 28X-Clair . . . . . . . . . . . . . . . . . . 28Xeloda . . . . . . . . . . . . . . . . . . 18Xenaderm . . . . . . . . . . . . . . . 28Xenazine . . . . . . . . . . . . . . . . 18Xerese . . . . . . . . . . . . . . . . . . 28Xgeva . . . . . . . . . . . . . . . . 14, 17Xibrom . . . . . . . . . . . . . . . . . . 28Xifaxan . . . . . . . . . . . . . . . . . . 28Xolair . . . . . . . . . . . . . . . . . . . . 14Xolegel . . . . . . . . . . . . . . . . . . 28Xolox . . . . . . . . . . . . . . . . . . . . 28Xopenex HFA . . . . . . . . .11, 28Xopenex nebules . . . . . . . . . 28Xyralid . . . . . . . . . . . . . . . . . . . 28

YYaz . . . . . . . . . . . . . . . . . . . . . . . 7

ZZafirlukast . . . . . . . . . . . . . . . 19Zaleplon . . . . . . . . . . . . . . . . . 12Zanaflex . . . . . . . . . . . . . . . . . 28Zanosar . . . . . . . . . . . . . . . . . 17Zantac . . . . . . . . . . . . . . . . . . . 28Zavesca . . . . . . . . . . . . . . . . . 18

38

Zebeta . . . . . . . . . . . . . . . . . . 28Zegerid . . . . . . . . . . . 12, 14, 28Zelapar . . . . . . . . . . . . . . . . . . 28Zelboraf . . . . . . . . . . . . . . . . . 18Zenapax . . . . . . . . . . . . . . . . . 17Zenieva . . . . . . . . . . . . . . . . . . 28Zestril . . . . . . . . . . . . . . . . . . . 28Zetia . . . . . . . . . . . . . . 7, 12, 19Ziana . . . . . . . . . . . . . . . . . . . . 28Zinecard . . . . . . . . . . . . . . . . . 17Zinotic . . . . . . . . . . . . . . . . . . . 28Zinotic ES . . . . . . . . . . . . . . . 28Zipsor . . . . . . . . . . . . . . . . . . . 28Zithromax . . . . . . . . . . . . . . . . 28

Zmax . . . . . . . . . . . . . . . . . . . . 28Zocor . . . . . . . . . . . . .12, 19, 28Zofran . . . . . . . . . . . . . . . 12, 28Zofran ODT . . . . . . . . . . 12, 28Zoladex . . . . . . . . . . . . . . . . . . 17Zolinza . . . . . . . . . . . . . . . . . . 18Zoloft . . . . . . . . . . . . .12, 19, 28Zolpidem . . . . . . . . . . . . . . . . 12Zolpidem Tartrate . . . . . . . . . 7Zolpimist . . . . . . . . .12, 20, 28Zometa . . . . . . . . . . . . . . . . . . 14Zomig . . . . . . . . . . . . . 7, 12, 20Zomig ZMT . . . . . . . . . . 12, 20Zorbtive . . . . . . . . . . . . . . . . . 17

Zovia 1-35e . . . . . . . . . . . . . . 7Zovirax . . . . . . . . . . . . . . . . . . 28Z-Pram . . . . . . . . . . . . . . . . . . 28Zuplenz . . . . . . . . . . . . . . 12, 28Zyflo . . . . . . . . . . . . . . . . 19, 28Zyflo CR . . . . . . . . . . . . . 19, 28Zymar . . . . . . . . . . . . . . . . . . . 12Zymaxid . . . . . . . . . . . . . 12, 28Zypram . . . . . . . . . . . . . . . . . . 28Zyprexa IM . . . . . . . . . . . . . . . 28Zyprexa Relprevv . . . . . . . . . 28Zyprexa tablets . . . . . . . . . . . . 7Zytiga . . . . . . . . . . . . . . . . . . . 18Zytopic . . . . . . . . . . . . . . . . . . 28

39

New Medication Approval ProcessOur Pharmacy and Therapeutics Committee, which is made up of pharmacists and doctors of various specialties, reviews the effectiveness and overall value of new medications approved by the FDA on an ongoing basis . The Committee provides expertise and advice to help us give our members prescription drug options that meet their medical needs and achieve desired treatment goals .

While under review, new medications will not be covered by your plan . As with other medications that are not covered, your doctor may request coverage when medically necessary .

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® Registered Marks of the Blue Cross and Blue Shield Association. © 2011 Blue Cross and Blue Shield of Massachusetts, Inc., and Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc.#109951M 55-0071 (10/11) 275M

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