Generics Plus Formulary - Blue Cross Blue Shield of Illinois
Generics Plus Formulary - Blue Cross Blue Shield of Illinois
Generics Plus Formulary - Blue Cross Blue Shield of Illinois
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
Drug Name Specialty<br />
sotalol (Betapace, Betapace AF –<br />
brands are NP)<br />
Prior Authorization<br />
Dispensing Limits<br />
OTHER HEART RELATED DRUGS<br />
ADCIRCA • • •<br />
clonidine (Catapres, Catapres-TTS –<br />
brands are NP)<br />
DIBENZYLINE<br />
digoxin tabs (Lanoxin – brand is NP)<br />
doxazosin (Cardura – brand is NP)<br />
eplerenone (Inspra – brand is NP)<br />
guanfacine (Tenex – brand is NP)<br />
hydralazine<br />
methyldopa<br />
midodrine (Proamatine – brand is NP)<br />
minoxidil<br />
prazosin (Minipress – brand is NP)<br />
sildenafil (Revatio – brand is NP) • • •<br />
terazosin<br />
TRACLEER • • •<br />
ERECTILE DYSFUNCTION<br />
CIALIS • •<br />
BEE STING KITS<br />
EPIPEN<br />
EPIPEN-JR<br />
RESPIRATORY AGENTS<br />
ANTIHISTAMINES<br />
AEROHIST<br />
cetirizine syrup<br />
cyproheptadine<br />
promethazine, NP = supp, 50 mg<br />
NASAL PRODUCTS<br />
azelastine (Astelin – brand is NP)<br />
fluticasone propionate (Flonase –<br />
brand is NP)<br />
ipratropium (Atrovent – brand is NP)<br />
•<br />
•<br />
•<br />
Step Therapy<br />
Drug Name Specialty<br />
triamcinolone (Nasacort AQ – brand is<br />
NP)<br />
COUGH/COLD/ALLERGY<br />
acetylcysteine<br />
ASTHMA/COPD<br />
albuterol inhal soln, 0.083%, 0.5%<br />
albuterol syrup, tabs<br />
albuterol 0.63 mg/3 mL,<br />
1.25 mg/3 mL (Accuneb – brand is<br />
NP)<br />
budesonide (Pulmicort Respules –<br />
brand is NP)<br />
cromolyn sodium inhal soln<br />
FLOVENT DISKUS<br />
FLOVENT HFA<br />
FORADIL AEROLIZER<br />
ipratropium inhal soln<br />
ipratropium/albuterol (Duoneb – brand<br />
is NP)<br />
montelukast (Singulair – brand is NP)<br />
PROAIR HFA<br />
QVAR<br />
SPIRIVA HANDIHALER<br />
SYMBICORT<br />
terbutaline<br />
theophylline ext-release<br />
VENTOLIN HFA<br />
zafirlukast (Accolate – brand is NP)<br />
<strong>Blue</strong> <strong>Cross</strong> and <strong>Blue</strong> <strong>Shield</strong> <strong>Generics</strong> <strong>Plus</strong> July 2013 Drug <strong>Formulary</strong> 7<br />
Prior Authorization<br />
Dispensing Limits<br />
OTHER RESPIRATORY DRUGS<br />
FIRAZYR • •<br />
KALYDECO • •<br />
PULMOZYME<br />
GASTROINTESTINAL DRUGS<br />
LAXATIVES<br />
lactulose<br />
•<br />
2013<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•<br />
Step Therapy
Change language