BLUE - Formulary
RED - Non Formulary

Table of Contents Index Policy Information

Formulary Index

Numbers A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

B & O SUPPRETTES NO.15-A (CLASS II NARCOTICS)

B & O SUPPRETTES NO.16-A (CLASS II NARCOTICS)

b-caine/tan ac/menth/cpyrd (DRUGS AFFECTING THE THROAT AND MOUTH)

b-complex (INJECTABLE VITAMINS)

B-PLEX (VITAMINS & MINERALS & RELATED PRODUCTS)

B-PLEX PLUS (VITAMINS & MINERALS & RELATED PRODUCTS)

BABY CONVERSION PACK 1 (MEDICAL (MISCELLANEOUS) SUPPLIES)

BABY CONVERSION PACK 2 (MEDICAL (MISCELLANEOUS) SUPPLIES)

BABY NEBULIZER (MEDICAL (MISCELLANEOUS) SUPPLIES)

baciim (OTHER ANTIINFECTIVE DRUGS)

bacitracin (OTHER ANTIINFECTIVE DRUGS)

bacitracin (OPHTHALMIC TOPICAL ANTIBACTERIAL DRUGS)

bacitracin-polymyxin (OPHTHALMIC TOPICAL ANTIBACTERIAL DRUGS)

bacitracin/polymyxin b sulfate (OPHTHALMIC TOPICAL ANTIBACTERIAL DRUGS)

baclofen (DIRECT MUSCLE RELAXANTS)

BACMIN (VITAMINS & MINERALS & RELATED PRODUCTS)

BACTOCILL (PENICILLINS)

BACTRIM (SULFONAMIDES)

BACTRIM DS (SULFONAMIDES)

BACTROBAN (TOPICAL ANTIBACTERIAL DRUGS)

BACTROBAN NASAL (TOPICAL ANTIBACTERIAL DRUGS)

BAL IN OIL (DIAGNOSTIC PRODUCTS)

BALACALL DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

BALACET 325 (CLASS IV NARCOTICS)

balsalazide disodium (OTHER GI DRUGS)

BALTUSSIN (ANTITUSSIVE AND EXPECTORANT DRUGS)

BALZIVA (CONTRACEPTIVES)

BANZEL (OTHER ANTICONVULSANTS)

BARACLUDE (OTHER ANTIVIRAL DRUGS)

bcg vaccine (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

bcg vaccine (IMMUNOLOGICALS AND VACCINES)

BD ALLERGIST TRAY (MEDICAL (MISCELLANEOUS) SUPPLIES)

BD SAFETYGLIDE (DIABETIC SUPPLIES)

BD SAFETYGLIDE ALLERGY (MEDICAL (MISCELLANEOUS) SUPPLIES)

BE-FLEX PLUS (CNS MUSCLE RELAXANTS)

BEBULIN VH IMMUNO (HEMOSTATICS)

beclomethasone (OTHER DRUGS FOR ASTHMA)

BECONASE AQ (QL=3/rx) (DRUGS AFFECTING THE NOSE)

BELLADONNA (ANTISPASMODICS/DRUGS AFFECT GI MOTILITY)

belladonna alkaloids/phenobarb (ANTISPASMODICS/DRUGS AFFECT GI MOTILITY)

BELLADONNA-OPIUM (CLASS II NARCOTICS)

belladonna-phenobarbital (ANTISPASMODICS/DRUGS AFFECT GI MOTILITY)

benazepril (ANGIOTENSIN CONVERTING ENZYME INHIBITORS)

benazepril hcl (ANGIOTENSIN CONVERTING ENZYME INHIBITORS)

benazepril hcl-hctz (OTHER ANTIHYPERTENSIVES)

benazepril/amlodipine besylate (OTHER ANTIHYPERTENSIVES)

benazepril/hctz (OTHER ANTIHYPERTENSIVES)

BENCORT (TOPICAL CORTICOSTEROID DRUGS)

bendroflumethiazide/nadolol (OTHER ANTIHYPERTENSIVES)

BENEFIX (HEMOSTATICS)

BENICAR (ANGIOTENSIN II RECEPTOR ANTAGONISTS)

BENICAR HCT (OTHER ANTIHYPERTENSIVES)

BENSAL HP (OTHER TOPICAL ANTIFUNGALS)

BENTYL (ANTISPASMODICS/DRUGS AFFECT GI MOTILITY)

BENZACLIN (ANTIACNE DRUGS)

BENZAMYCIN (ANTIACNE DRUGS)

BENZAMYCINPAK (ANTIACNE DRUGS)

benzene hexachloride gamma (SCABICIDES)

benzoin (TOPICAL DERMATOLOGICAL DRUGS)

benzonatate (ANTITUSSIVE AND EXPECTORANT DRUGS)

BENZONATATE (ANTITUSSIVE AND EXPECTORANT DRUGS)

BENZOTIC (DRUGS AFFECTING THE EAR)

BENZOYL PEROXIDE (ANTIACNE DRUGS)

benzoyl peroxide/sulfur (ANTIACNE DRUGS)

BENZPHETAMINE HCL (APPETITE SUPPRESSANTS)

benztropine (ANTIPARKINSON ANTICHOLINERGIC DRUGS)

benztropine mesylate (ANTIPARKINSON ANTICHOLINERGIC DRUGS)

BENZYL BENZOATE (SCABICIDES)

beta-val (TOPICAL CORTICOSTEROID DRUGS)

BETADINE (OTHER OPHTHALMIC DRUGS)

BETAGAN (ANTIGLAUCOMA DRUGS)

betaine hcl (OTHER GENITOURINARY PRODUCTS)

betameth/propylene glycol (TOPICAL CORTICOSTEROID DRUGS)

betamethasone dipropionate (TOPICAL CORTICOSTEROID DRUGS)

betamethasone valerate (TOPICAL CORTICOSTEROID DRUGS)

betamethasone/betamethasone (GLUCOCORTICOID DRUGS)

betanate (TOPICAL CORTICOSTEROID DRUGS)

BETAPACE (OTHER ANTIARRHYTHMICS)

BETAPACE AF (OTHER ANTIARRHYTHMICS)

BETASERON (INTERFERONS)

BETASERON (PAR) (covered if prescribed by neurologist) (INTERFERONS)

betaxolol (ANTIGLAUCOMA DRUGS)

BETAXOLOL HCL (BETA-ADRENERGIC ANTAGONIST DRUGS)

betaxolol hcl (ANTIGLAUCOMA DRUGS)

bethanechol (CHOLINERGIC STIMULANTS)

bethanechol chloride (CHOLINERGIC STIMULANTS)

BETHANECHOL CHLORIDE (CHOLINERGIC STIMULANTS)

BETIMOL (ANTIGLAUCOMA DRUGS)

BETOPTIC S (ANTIGLAUCOMA DRUGS)

bexarotene (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

BIAFINE (TOPICAL DERMATOLOGICAL DRUGS)

BIAXIN (OTHER MACROLIDES)

BIAXIN XL (OTHER MACROLIDES)

bicalutamide (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

BICILLIN C-R (PENICILLINS)

BICILLIN L-A (PENICILLINS)

BICNU (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

BIDIL (OTHER VASODILATING DRUGS)

BILTRICIDE (ANTHELMINTICS)

bimatoprost (ANTIGLAUCOMA DRUGS)

BIONECT (TOPICAL DERMATOLOGICAL DRUGS)

BIOTUSS (ANTITUSSIVE AND EXPECTORANT DRUGS)

BISOPROLOL FUMARATE (BETA-ADRENERGIC ANTAGONIST DRUGS)

bisoprolol fumarate-hctz (OTHER ANTIHYPERTENSIVES)

BLANEX-A (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

BLENOXANE (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

bleomycin sulfate (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

BLEPH-10 (OPHTHALMIC TOPICAL ANTIBACTERIAL DRUGS)

BLEPHAMIDE (OPHTHALMIC ANTIINFECTIVE/CORTICOSTEROIDS)

BLEPHAMIDE S.O.P. (OPHTHALMIC ANTIINFECTIVE/CORTICOSTEROIDS)

BONIVA (Step Therapy-requires trial of alendronate prior to use) (OTHER ENDOCRINE DRUGS)

BONTRIL PDM (APPETITE SUPPRESSANTS)

BONTRIL SLOW-RELEASE (APPETITE SUPPRESSANTS)

borofair (DRUGS AFFECTING THE EAR)

bosentan (ENDOTHELIN RECPTR ANTAGONIST)

BOTOX (OTHER OPHTHALMIC DRUGS)

botulinum toxin a (OTHER OPHTHALMIC DRUGS)

botulinum toxin type b (DIRECT MUSCLE RELAXANTS)

BP 10-1 (ANTIACNE DRUGS)

BPM (ANTIHISTAMINES)

BPM PE (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

BPM PE DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

BPM PSEUDO (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

BRAVELLE (OVULATORY STIMULANTS)

breathing devices-peak meters (DIAGNOSTIC PRODUCTS)

breathing supplies (BETA-2 ADRENERGIC DRUGS)

BREVICON (CONTRACEPTIVES)

brimonidine tartrate (ANTIGLAUCOMA DRUGS)

brimonidine tartrate/timolol (ANTIGLAUCOMA DRUGS)

BROFED (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

BROMATAN PLUS (ANTITUSSIVE AND EXPECTORANT DRUGS)

BROMFED (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

BROMFED-DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

BROMFED-PD (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

BROMHIST (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

BROMHIST PDX (ANTITUSSIVE AND EXPECTORANT DRUGS)

BROMHIST-DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

BROMHIST-NR (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

BROMHIST-PDX (ANTITUSSIVE AND EXPECTORANT DRUGS)

bromocriptine mesylate (OTHER ANTIPARKINSON DRUGS)

BROMPHENIRAMINE MALEATE (ANTIHISTAMINES)

BROMPHENIRAMINE TANNATE (ANTIHISTAMINES)

BROMPHENIRAMINE-PHENYLEPHRINE (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

BROMPHENIRAMINE-PSEUDOEPHEDR (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

BROMPHENIRAMINE-PSEUDOEPHEDRIN (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

BROMPLEX DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

BROMSPIRO (ANTIHISTAMINES)

BRONCOMAR-1 (METHYL XANTHINE DRUGS)

BRONTEX (ANTITUSSIVE AND EXPECTORANT DRUGS)

BRONTUSS SF (ANTITUSSIVE AND EXPECTORANT DRUGS)

BROVANA (BETA-2 ADRENERGIC DRUGS)

BROVEX (ANTIHISTAMINES)

BROVEX ADT (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

BROVEX CT (ANTIHISTAMINES)

BROVEX PD (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

BROVEX PEB (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

BROVEX PEB DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

BROVEX PSB (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

BROVEX PSB DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

BROVEX PSE (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

BROVEX SR (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

BROVEX-D (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

BRYOPHYLLUM 2X (HOMEOPATHIC DRUGS)

BSS (OTHER OPHTHALMIC DRUGS)

BSS PLUS (OTHER OPHTHALMIC DRUGS)

BUBBLES THE FISH (MEDICAL (MISCELLANEOUS) SUPPLIES)

BUCALCIDE (DRUGS AFFECTING THE THROAT AND MOUTH)

BUCALSEP (DRUGS AFFECTING THE THROAT AND MOUTH)

budeprion sr (OTHER ANTIDEPRESSANTS)

budeprion xl (OTHER ANTIDEPRESSANTS)

BUDEPRION XL (OTHER ANTIDEPRESSANTS)

budesonide (OTHER GI DRUGS)

budesonide (OTHER DRUGS FOR ASTHMA)

budesonide/formoterol fum (OTHER DRUGS FOR ASTHMA)

bumetanide (LOOP DIURETICS)

BUMINATE (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

bupap (DRUGS TO PREVENT AND TREAT HEADACHES)

BUPHENYL (MISCELLANEOUS DRUGS)

bupivacaine (LOCAL ANESTHETICS)

bupivacaine hcl (LOCAL ANESTHETICS)

bupivacaine hcl-epinephrine (LOCAL ANESTHETICS)

bupivacaine hydrochloride/epi (LOCAL ANESTHETICS)

BUPRENEX (CLASS IV NARCOTICS)

buprenorphine (CLASS IV NARCOTICS)

BUPROBAN (SMOKING CESSATION PRODUCTS)

bupropion (OTHER ANTIDEPRESSANTS)

bupropion hcl (OTHER ANTIDEPRESSANTS)

BUPROPION HCL ER (SMOKING CESSATION PRODUCTS)

bupropion hcl sr (OTHER ANTIDEPRESSANTS)

BUPROPION HCL SR (OTHER ANTIDEPRESSANTS)

BUPROPION HCL SR (SMOKING CESSATION PRODUCTS)

bupropion xl (OTHER ANTIDEPRESSANTS)

BUPROPION XL (OTHER ANTIDEPRESSANTS)

BUSPAR (ANXIOLYTICS)

buspirone (ANXIOLYTICS)

buspirone hcl (ANXIOLYTICS)

BUSPIRONE HCL (ANXIOLYTICS)

busulfan (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

BUSULFEX (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

butalbital compound (DRUGS TO PREVENT AND TREAT HEADACHES)

butalbital compound-codeine (DRUGS TO PREVENT AND TREAT HEADACHES)

butalbital-apap-caffeine (DRUGS TO PREVENT AND TREAT HEADACHES)

BUTALBITAL-APAP-CAFFEINE (DRUGS TO PREVENT AND TREAT HEADACHES)

butalbital-aspirin-caffeine (DRUGS TO PREVENT AND TREAT HEADACHES)

butalbital-caff-apap-codeine (DRUGS TO PREVENT AND TREAT HEADACHES)

BUTISOL SODIUM (SEDATIVE/HYPNOTIC DRUGS)

butorphanol (ANALGESICS)

butorphanol (DRUGS TO PREVENT AND TREAT HEADACHES)

butorphanol tartrate (ANALGESICS)

butorphanol tartrate (DRUGS TO PREVENT AND TREAT HEADACHES)

BYETTA (INCRETIN MIMETICS)

BYSTOLIC (BETA-ADRENERGIC ANTAGONIST DRUGS)

Formulary Date: 05/13/2009 Update Date: 05/15/2009 V1.3.0