Blue Cross Blue Shield and Blue Care Network Preferred ...

Blue Cross Blue Shield and Blue Care Network Preferred Alternatives -- December 2019

The Blue Cross and BCN Preferred Alternatives list is a helpful guide when selecting alternative prescription drugs. This list is intended as a reference guide and doesn't dictate coverage. Some Blue Cross and BCN members don't have coverage for tier 3 (non-preferred) agents, or the suggested alternatives. The brand (trade) names for the preferred alternatives are listed for reference. The generic equivalent will be dispensed when the member fills a prescription. The brand may not be covered or may require a higher copay. Prior approval or step therapy may be required for tier 3 drugs or preferred alternatives.

Members should refer to their specific drug benefit information at pharmacy for a full list of covered drugs and requirements.

Tier 3

Preferred alternatives

ABSTRAL

Actiq, MSIR, Opana IR, oxycodone IR, Roxanol

ACIPHEX SPRINKLE Aciphex, Nexium, Prevacid, Prilosec/Prilosec OTC**, Protonix, Zantac

ACTOPLUS MET XR ActoPlus MET, Glucophage/XR plus Actos

ACUVAIL

Acular, Bromday, Ocufen, Voltaren ophth

ADZENYS ER, XR- Adderall XR (brand BCN only), Metadate

ODT

CD, Methylin

AEMCOLO

Bactrim DS, Cipro, Vibramycin, Zithromax

AFREZZA

Fiasp/Flextouch, Novolin, Novolog

AKYNZEO

Emend plus Zofran, Kytril

ALREX

Decadron ophthalmic, FML, Inflamase/Forte, Pred Forte, Pred Mild

ALTABAX

Bactroban, OTC triple antibiotic ointment

ALTRENO

Avita, Retin-A

ANADROL-50

Procrit

ANGELIQ

A generic estradiol plus a generic progestin, FemHRT, Premphase, Prempro

ANTARA 30, 90MG Antara, Fenoglide, Lofibra, Lopid, Tricor, Trilipix

APLENZIN

Celexa, Effexor/XR, Pristiq, Prozac, Wellbutrin/SR/XL, Zoloft

APRISO

Asacol HD, Azulfidine/En-Tab, Colazal, Delzicol, Lialda, Pentasa

APTENSIO XR

Adderall/XR (Brand BCN only), Concerta, Focalin/XR, Metadate CD, Ritalin/LA/SR, Strattera

APTIOM

Dilantin, Keppra, Tegretol, Topamax, Trileptal

ARAKODA

Aralen, Lariam, Malarone, Monodox, Primaquine, Vibramycin

ARANESP

Procrit

Tier 3

ARCAPTA NEOHALER ARMONAIR RESPICLICK ARMOUR THYROID ASTAGRAF XL AUBAGIO

AURYXIA AUSTEDO AVANDIA

AVC AVITA GEL AZASAN AZASITE

AZELEX BALCOLTRA

BASAGLAR KWIKPEN U-100 BAXDELA BECONASE AQ

BELBUCA

BELSOMRA

BELVIQ, XR

Preferred alternatives

Anoro Ellipta, Serevent Diskus, Spiriva/Respimat

Arnuity Ellipta, Asmanex, Flovent HFA, Pulmicort Flexhaler/solution, Qvar

Nature-throid, NP Thyroid

Prograf capsules

Avonex, Copaxone, Gilenya, Plegridy, Rebif, Tecfidera

OTC Tums, Phoslo, Renagel, Renvela

Xenazine

Actos, Glucophage, a sulfonylurea (Amaryl, Diabeta, Glucotrol/XL)

Diflucan oral, Terazol vaginal

Retin-A, Tazorac

Imuran

Ciloxan, Ocuflox, Quixin, Vigamox, Zymaxid

Benzaclin, Differin, Retin-A, Tazorac

Generic monophasic contraceptives with iron (Femcon Fe, Generess Fe, Loestrin Fe, Loestrin 24 Fe, Minastrin 24 Fe, etc.)

Lantus (all forms), Levemir (all forms), Toujeo (all forms), Tresiba Flextouch

Avelox, Cipro/XR, Floxin, Levaquin, Zyvox

Flonase, Nasalide, Nasonex, OTC Nasacort, OTC Rhinocort, Patanase

Butrans, Duragesic, Exalgo, methadone, MS Contin, Opana ER, Ultram ER

Ambien/CR, Intermezzo, Lunesta, Restoril, Sonata

Adipex-P, Bontril, Didrex, OTC Alli, Tenuate

** May be covered with a prescription for some Blue Cross members.

NOTE: This document serves as a quick reference guide. For the most current list of covered medications and requirements, visit pharmacy.

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Tier 3

Preferred alternatives

BEPREVE

Alocril, Elestat, Optivar, OTC Zaditor, Patanol

BESIVANCE

Ciloxan, Ocuflox, Quixin, Vigamox, Zymaxid

BETASERON

Avonex, Copaxone, Gilenya, Plegridy, Rebif, Tecfidera

BETHKIS

Tobi

BEVESPI AEROSPHERE

Anoro Ellipta, Serevent Diskus, Spiriva/Respimat, Stiolto Respimat, Trelegy Ellipta

BEVYXXA

Arixtra, heparin, Lovenox

BIJUVA

A generic estradiol plus a generic progestin, FemHRT, Premphase, Prempro

BINOSTO

Actonel, Atelvia, Boniva, Fosamax

BONJESTA

OTC doxylamine plus OTC vitamin B6, Zofran/ODT

BRIVIACT

Depakote/ER, Keppra/XR, Lamictal/ODT, Tegretol, Topamax, Trileptal

BROVANA

Anoro Ellipta, Serevent Diskus, Spiriva/Respimat

BRYHALI

Clobevate, Clobex, Diprolene gel, ointment; Olux/-E, Ultravate cream, ointment

BUNAVAIL

Suboxone

BYSTOLIC

Cardioselective beta-blockers: Lopressor, Tenormin, Toprol XL, etc

CARAC

Aldara, Efudex, Tolak

CARDURA XL

Avodart, Cardura, Flomax, Hytrin, Jalyn, Uroxatral

CAROSPIR

Aldactone

CAYSTON

Tobi

CEQUA

Restasis, Xiidra

CESAMET

Kytril, Marinol, Zofran/ODT

CHENODAL

Actigall, Urso

CHORIONIC GONADOTROPIN

Pregnyl

CIMZIA SYRINGE

Actemra Actpen/syringe, Cosentyx, Enbrel, Humira, methotrexate, Otezla, Rinvoq, Stelara, Skyrizi, Tremfya, Xeljanz/XR

CIPRO HC

ciprofloxacin 0.2% dropperette, Ciprodex, Cortisporin, Floxin otic, Otovel

CLARINEX-D, SYRUP OTC Claritin**, OTC Zyrtec**, Xyzal

CLENPIQ CLEOCIN VAGINAL OVULES CLIMARA PRO

CLINDESSE

Colyte, Golytely, Peg-Prep, Nulytely Cleocin vaginal cream, Metrogel-Vaginal

Alora, Estrogel, Climara or Vivelle-Dot, plus a generic progestin; or FemHRT Cleocin vaginal cream, Metrogel-vaginal

Tier 3

Preferred alternatives

COLCHICINE CAPSULES

Colchicine tablets, Colcrys

COLESTID

Colestid, Questran/Light, Welchol

COLY-MYCIN S

Cortisporin, Floxin Otic

COLYTE FLAVORED Colyte, Golytely, Peg-Prep, Nulytely

COMBIGAN

Alphagan plus Timoptic

COMBIPATCH

Alora, Estrogel, Climara or Vivelle-Dot, plus a generic progestin; or FemHRT

CONTRAVE ER

Adipex-P, Bontril, Didrex, OTC Alli, Tenuate

CONZIP, TRAMADOL ER

Ryzolt, Ultram/ER

CORTIFOAM

Cortenema, Proctocort cream, Proctocort suppositories, Proctofoam-HC

CORTISPORIN

Bactroban, gentamicin

CYCLOSET

Actos, Glucophage, a DPP-4 inhibitor (Januvia, Tradjenta), an SGLT-2 inhibitor (Farxiga, Invokana, Invokamet, Jardiance), a sulfonylurea (Amaryl, Glucotrol/XL, Glynase)

DALIRESP

Advair, Anoro Ellipta, Breo Ellipta, Serevent Diskus, Spiriva/Respimat, Symbicort, Trelegy Ellipta

DAYTRANA

Adderall/XR (Brand BCN only), Concerta, Focalin/XR, Metadate CD, Ritalin/LA/SR, Strattera

DELESTROGEN 10MG/ML

Delestrogen 20mg/mL, 40mg/mL

DENAVIR

Famvir, Valtrex, Zovirax

DESONATE

Elocon, Locoid, Synalar solution

DESVENLAFAXINE Generic SSRI/SNRI (Celexa, Effexor/XR,

ER

Pristiq, Prozac, Zoloft, etc.)

DEXILANT

Aciphex, Nexium, Prevacid, Prilosec/Prilosec OTC**, Protonix

DIACOMIT

Depakote, Onfi, Topamax

DIFICID

Flagyl, Vancocin

DIPENTUM

Asacol HD, Azulfidine/En-Tab, Colazal, Delzicol, Lialda, Pentasa

DIVIGEL

Alora, Climara, Estrace, Estrogel, VivelleDot

DOPTELET

Mulpleta

DORYX MPC

Minocin, Monodox, tetracycline, Vibramycin

DUAVEE

Climara, Estrace or Premarin plus a progestin; Effexor/XR, Paxil

DUOBRII

Ultravate cream/ointment plus Tazorac

** May be covered with a prescription for some Blue Cross members.

NOTE: This document serves as a quick reference guide. For the most current list of covered medications and requirements, visit pharmacy.

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Tier 3

DUPIXENT

DUREZOL DUTOPROL DYANAVEL XR DYMISTA ECOZA

EDARBI

EDARBYCLOR EDEX EDLUAR ELESTRIN ELIGARD EMFLAZA EMSAM EMVERM ENDOMETRIN ENSTILAR ENVARSUS XR EPANED EPIDIOLEX EPIDUO FORTE

EPOGEN EQUETRO ERTACZO

EUCRISA

Preferred alternatives

For asthma: Advair, Dulera, Symbicort For atopic dermatitis: Cellcept, generic topical steroids, Gengraf/Neoral, Elidel, Imuran, methotrexate, Protopic For chronic rhinosinusitis with nasal polyposis: Flonase; Nasalide, Nasonex, OTC Nasacort, OTC Rhinocort

Decadron ophthalmic, FML, Inflamase/Forte, Pred Forte

Toprol XL plus HCTZ

Adderall XR (brand BCN only), Metadate CD, Methylin

Astelin plus Flonase; Nasalide, Nasonex, OTC Nasacort, OTC Rhinocort, Patanase

Diflucan, Lamisil, Nizoral, OTC Clotrimazole, OTC Miconazole, Spectazole, Sporanox

Atacand/HCT, Avalide, Avapro, Benicar/HCT, Cozaar, Exforge, Hyzaar, Micardis/HCT

Atacand HCT, Benicar HCT, Generic ARB (such as Cozaar) plus chlorthalidone

Caverject, Cialis, Levitra, Muse, Staxyn, Viagra

Ambien/CR, Intermezzo, Lunesta, Restoril, Sonata

Alora, Climara, Estrace, Estrogel, VivelleDot

Lupron/Depot, Trelstar/LA/Depot

Prednisone, Prednisolone

Celexa, Effexor/XR, Lexapro, Paxil, Pristiq, Prozac, Wellbutrin/SR/XL

Albenza

Crinone 8%

Dovonex plus Diprolene/Diprosone; Taclonex ointment

Prograf capsules

Vasotec

Depakene, Keppra, Topamax

Benzaclin, Benzamycin, Epiduo, OTC benzoyl peroxide plus Differin; Retin-A, Tazorac

Procrit

Abilify, Lamictal/ODT, Lithium, Tegretol/XR

Monistat-Derm, Naftin, Nizoral, OTC Lamisil AT, OTC Lotrimin Ultra, Spectazole

Elidel, generic topical steroids, Protopic

Tier 3

Preferred alternatives

EVAMIST

Alora, Climara, Estrace, Estrogel, VivelleDot

EXELDERM

Lotrimin, Monistat-Derm, Naftin, Nizoral, Spectazole

EXTAVIA

Avonex, Copaxone, Gilenya, Plegridy, Rebif, Tecfidera

FABIOR

Differin, Retin-A, Tazorac

FACTIVE

Avelox, Erythromycin, Levaquin, Vibramycin, Zithromax

FANAPT

Abilify, Clozaril, Geodon, Invega, Risperdal, Seroquel/XR, Zyprexa

FAZACLO, CLOZAPINE ODT 150MG, 200MG

Abilify, Clozaril, Geodon, Invega, Risperdal, Seroquel/XR, Zyprexa

FEMRING

Alora, Climara, Estring, Estrogel, VivelleDot

FENOPROFEN CALCIUM 200MG, 400MG

Generic NSAIDs [Celebrex, Lodine, Mobic Motrin (Rx only), Naprosyn (Rx only), Voltaren, etc.]

FENORTHO

Generic NSAIDs [Celebrex, Lodine, Mobic Motrin (Rx only), Naprosyn (Rx only), Voltaren, etc.]

FENTORA

Actiq, MSIR, Opana IR, oxycodone IR, Roxanol

FERRIPROX

Desferal

FETZIMA

Generic SSRI/SNRI (Celexa, Effexor/XR, Pristiq, Prozac, Zoloft, etc.), Wellbutrin/SR/XL

FINACEA FOAM

Metrocream, Metrogel topical, Metrolotion, Retin-A, Tazorac

FIRVANQ

Vancocin

FLAREX

Decadron ophthalmic, FML, Inflamase/Forte, Pred Forte, Pred Mild

FLECTOR PATCH

Generic NSAIDs [Lodine/XL, Mobic, Motrin (Rx only), Naprosyn (Rx only), Voltaren oral], Lidoderm, OTC topical analgesic balms (i.e. trolamine salicylate); Voltaren gel

FLOLIPID

Crestor, Lescol/XL, Lipitor, Mevacor, Pravachol, Vytorin, Zocor

FLUOROPLEX

Aldara, Efudex, Tolak

FLUOROURACIL 0.5% CREAM

Aldara, Efudex, Tolak

FLUTICASONESALMETEROL RESPICLICK

Advair, Breo Ellipta, Serevent Diskus, Spiriva/Respimat, Symbicort

FOLLISTIM AQ

Gonal-F/RFF/Redi-Ject

FORFIVO XL,

Generic SSRI/SNRI (Celexa, Effexor/XR,

BUPROPION XL 450 Pristiq, Prozac, Zoloft, etc.),

MG

Wellbutrin/SR/XL

FOSAMAX PLUS D Actonel, Atelvia, Boniva, Fosamax plus OTC Vitamin D

** May be covered with a prescription for some Blue Cross members.

NOTE: This document serves as a quick reference guide. For the most current list of covered medications and requirements, visit pharmacy.

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Tier 3

Preferred alternatives

FOSRENOL

OTC Tums, Phoslo, Renagel, Renvela

FRAGMIN

Lovenox

FYCOMPA

Depakote/ER, Lamictal/ODT, Tegretol, Topamax, Trileptal

GALZIN

OTC zinc supplements

GELNIQUE, PUMP Detrol/LA, Ditropan/XL, Enablex, Sanctura/XR

GONITRO

nitroglycerin, Nitrostat

GRALISE

Cymbalta, Generic tricyclic antidepressant (TCA) (Adapin, Elavil, Sinequan, Tofranil), Neurontin, Ultram/ER

GRASTEK

Accolate, Clarinex, Flonase, Nasonex, OTC Claritin**, OTC Nasacort, OTC Zyrtec**, Singulair, Xyzal

GYNAZOLE-1

Diflucan 150mg, OTC Lotrimin, OTC Monistat, Terazol

HALOG

Apexicon, Cyclocort, Diprosone, Topicort, Valisone

HARVONI

Epclusa (genotypes 5 and 6), Epclusa or Zepatier (genotypes 1 and 4)

HEMANGEOL

Inderal

HETLIOZ

Ambien/CR, Intermezzo, OTC melatonin, Restoril, Sonata

HORIZANT

Generic TCA (Adapin, Elavil, Sinequan, Tofranil), Mirapex, Neurontin, Requip

HUMALOG JUNIOR Fiasp/Flextouch, Novolin, Novolog KWIKPEN

HUMATROPE

Genotropin, Norditropin Flexpro, Nutropin AQ NuSpin

HYSINGLA ER

Butrans, Duragesic, Exalgo, methadone, MS Contin, Opana ER

ILEVRO

Acular, Bromday, Ocufen, Voltaren ophth

IMVEXXY

Estrace cream, Estring, Premarin, Vagifem

INBRIJA

Azilect, Comtan, Eldepryl, Mirapex/ER, Requip/XL, Sinemet/CR, Tasmar

INCRUSE ELLIPTA Anoro Ellipta, Serevent, Spiriva/Respimat, Stiolto Respimat, Trelegy Ellipta

INDERAL XL

Inderal/LA, Inderide

INNOPRAN XL

Inderal/LA, Inderide

INTRAROSA

Estring, Premarin, Vagifem

INVELTYS

Decadron ophthalmic, FML, Inflamase/Forte, Pred Forte, Pred Mild

IOPIDINE DROPPERETTE

Alphagan, Alphagan P

JADENU, SPRINKLE Desferal

JORNAY PM

Adderall/XR (brand BCN only), Concerta, Metadate CD, Ritalin/LA/SR, Strattera

KADIAN

Butrans, Duragesic, Exalgo, methadone, MS Contin, Opana ER

Tier 3

Preferred alternatives

KARBINAL ER

Clarinex, Histex PD, OTC Claritin**, OTC Zyrtec**, Palgic, Xyzal

KATERZIA

Norvasc

KEVEYIS

Diamox

KEVZARA

Actemra Actpen/syringe, Enbrel, Humira, methotrexate, Rinvoq, Xeljanz/XR

KINERET

Actemra Actpen/syringe, Enbrel, Humira, methotrexate, Rinvoq, Xeljanz/XR

LANOXIN 62.5, 187.5MCG

Lanoxin 125mg, 250mg

LASTACAFT

Alocril, Elestat, Optivar, OTC Zaditor, Patanol

LATUDA

Abilify, Clozaril, Geodon, Invega, Risperdal, Seroquel/XR, Zyprexa

LEVORPHANOL TARTRATE 3MG

Duragesic, Exalgo, levorphanol 2mg, MS Contin

LIPOFEN, FENOFIBRATE 50MG, 150MG

Antara, Fenoglide, Lofibra, Lopid, Tricor, Trilipix

LIVALO

Crestor, Lescol/XL, Lipitor, Mevacor, Pravachol, Vytorin, Zocor

LO LOESTRIN FE

Generic biphasic contraceptives (Loseasonique, Mircette, etc)

LOMAIRA

Adipex-P, Bontril, Didrex, OTC Alli, Tenuate

LONHALA MAGNAIR Anoro Ellipta, Serevent Diskus, Spiriva/Respimat, Stiolto Respimat

LOTEMAX GEL, OINTMENT

Decadron ophthalmic, FML, Inflamase/Forte, Pred Forte, Pred Mild

LOTEMAX SM

Decadron ophthalmic, FML, Inflamase/Forte, Pred Forte, Pred Mild

LUCEMYRA

Catapres

LUPANETA PACK

Lupron/Depot plus Ortho Micronor or NorQD

LUZU,

Diflucan, Lamisil, Naftin, Nizoral, OTC

LULICONAZOLE 1% Clotrimazole, OTC Miconazole, Sporanox

CREAM

LYRICA CR

generic TCA (Adapin, Elavil, Sinequan, Tofranil), Neurontin

MARPLAN

Nardil, Parnate

MAVENCLAD

Avonex, Copaxone, Gilenya, Plegridy, Rebif, Tecfidera

MAVYRET

Epclusa or Zepatier (genotypes 1 and 4), Epclusa (genotypes 2-3, 5-6)

MAXIDEX

Decadron ophthalmic, FML, Inflamase/Forte, Pred Forte, Pred Mild

MENEST

Alora, Climara, Estrace, Estrogel, VivelleDot

MENOSTAR

Alora, Climara, Estrace, Estrogel, VivelleDot

** May be covered with a prescription for some Blue Cross members.

NOTE: This document serves as a quick reference guide. For the most current list of covered medications and requirements, visit pharmacy.

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Tier 3

Preferred alternatives

METHITEST

Androderm, Androgel, Android, Axiron, Delatestryl, Depo-Testosterone, Testim, Testred, Vogelxo

METHYLPHENIDATE Adderall/XR (brand BCN only), Concerta, ER 72MG, RELEXXI Metadate CD, Ritalin/LA/SR, Strattera

MIRCERA MITIGARE MONUROL

MOTEGRITY

MOTOFEN MOVANTIK

MOVIPREP MOXATAG MYALEPT

MYRBETRIQ

NAFTIN 2% GEL

NALFON

NAMZARIC NASCOBAL

NATAZIA NATESTO

NEBUSAL NEUPRO NEVANAC NICOTROL, NS

NOCDURNA

NOCTIVA

NORITATE NORTHERA NOVAREL NUCYNTA NUCYNTA ER

Procrit

Colchicine tablets, Colcrys

Avelox, Bactrim/DS, Cipro, Levaquin, Macrobid

Amitiza, Linzess, Lactulose, OTC fiber, OTC laxatives, OTC stool softeners

Imodium, Lomotil

Amitiza, lactulose, Linzess, OTC fiber, OTC stimulant laxatives, OTC stool softeners

Colyte, Golytely, Peg-Prep, Nulytely

Amoxil capsules

Crestor, Insulin, Lescol/XL, Lipitor, Mevacor, Pravachol, Vytorin, Zocor

Detrol/LA, Ditropan/XL, Enablex, Sanctura/XR

Lotrimin, Monistat-derm, Naftin, Nizoral, Nystatin

Generic NSAIDs [Celebrex, Lodine, Mobic Motrin (Rx only), Naprosyn (Rx only), Voltaren, etc.]

Aricept/ODT, Exelon, Namenda/solution

Cyanocobalamin injection, OTC Cyanocobalamin tabs (Vitamin B-12)

Mircette, Ortho Tri-Cyclen, Yasmin, Yaz

Androderm, Androgel, Android, Axiron, Delatestryl, Depo-Testosterone, Testim, Testred, Vogelxo

generic sodium chloride inhalation

Mirapex/ER, Neurontin, Requip/XL

Acular, Bromday, Ocufen, Voltaren ophth

OTC nicotine products (gum, lozenge, patch) (covered with Rx); Zyban

Detrol/LA, Ditropan/XL, Enablex, Sanctura/XR

Detrol/LA, Ditropan/XL, Enablex, Sanctura/XR

Metrocream, Metrogel, Metrolotion

Florinef, Proamatine

Pregnyl

MSIR, Opana IR, oxycodone IR, Ultram

Butrans, Duragesic, methadone, MS contin, Opana ER, Ultram ER

Tier 3

NUZYRA TABLET

NYMALIZE OBREDON ODACTRA

OFEV OLUMIANT

OMNARIS

OMNITROPE

ONEXTON ONZETRA XSAIL

ORACEA, DOXYCYCLINE IRDR ORALAIR

ORAVIG

ORENCIA CLICKJET/SUBQ

OSMOPREP OSPHENA OTREXUP OXISTAT LOTION

OXTELLAR XR

OXYCODONE HCL ER OXYCONTIN

PANCREAZE PANDEL

PAREMYD PAZEO

PENNSAID 2%

Preferred alternatives

Generic doxycycline, azithromycin, clarithomycin, erythromycin, cephalexin

Nimotop

Hycodan

Accolate, Clarinex, Flonase, Nasonex, OTC Claritin**, OTC Nasacort, OTC Zyrtec**, Singulair, Xyzal

Esbriet

Actemra Actpen/syringe, Enbrel, Humira, methotrexate, Rinvoq, Xeljanz, Xeljanz XR

Flonase, Nasalide, Nasonex, OTC Nasacort, OTC Rhinocort, Patanase

Genotropin, Norditropin Flexpro, Nutropin AQ NuSpin

Benzaclin, Benzamycin, Duac

Amerge, Axert, Frova, Imitrex, Maxalt/MLT, Relpax, Zomig/ZMT

Minocin, Monodox, tetracycline, Vibramycin

Accolate, Clarinex, Flonase, Nasonex, OTC Claritin**, OTC Nasacort, OTC Zyrtec**, Singulair, Xyzal

Diflucan, Mycelex Troche, Nystatin, Sporanox

Actemra Actpen/syringe, Cosentyx, Enbrel, Humira, methotrexate, Rinvoq, Stelara, Xeljanz/XR

Colyte, Golytely, Peg-Prep, Nulytely

Estring or Vagifem plus a progestin

Enbrel, Humira, methotrexate, Trexall

Diflucan, Lamisil, Naftin, Nizoral, OTC Clotrimazole, OTC Miconazole, Oxistat cream, Spectazole, Sporanox

Depakote/ER, Lamictal/ODT, Neurontin, Tegretol/XR, Topamax, Trileptal

Butrans, Duragesic, Exalgo, methadone, MS Contin, Opana ER

Butrans, Duragesic, Exalgo, methadone, MS Contin, Opana ER

Creon, Viokase, Zenpep

Aristocort, Cloderm, Cordran, Elocon, Locoid, Synalar, Topicort

Cyclogyl, Isopto Atropine plus Mydriacyl

Alocril, Elestat, Optivar, OTC Zaditor, Pataday, Patanol

Generic NSAIDs [Lodine/XL, Mobic, Motrin (Rx only), Naprosyn (Rx only), Voltaren oral/XR], OTC topical analgesic balms (i.e. trolamine salicylate), Pennsaid 1.5%, Voltaren gel

** May be covered with a prescription for some Blue Cross members.

NOTE: This document serves as a quick reference guide. For the most current list of covered medications and requirements, visit pharmacy.

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