For current members, please use the links below to locate information about the 2008 formulary.
| Blue Medicare HMO / Blue Medicare PPO |
| Blue Medicare Rx |
Drugs on the 2009 formulary can be found in the links below, and are also listed on the table below.
| 2009 Blue Medicare Rx Standard | 2009 Blue Medicare HMO Standard |
| 2009 Blue Medicare Rx Enhanced | 2009 Blue Medicare HMO Enhanced/PPO Enhanced/PPO Enhanced Plus |
To search for a generic or brand name drug, select the first letter of the drug from letters above the chart below. The index will display all the drugs beginning with that letter in alphabetical order, so that you can scan the list for your drug.
Table legend
'Tier' refers to the level of coverage for each medication. The tier levels are the
following:
| 1 | Tier 1 medications are generic medications and have the lowest copayment. |
| 2 | Tier 2 medications are preferred brand name medications and have the second-lowest copayment. |
| 3 | Tier 3 medications are non-preferred brand name medications and have the second-highest copayment. |
| 4 | Tier 4 medications are medications classified by BCBSNC as specialty drugs. Tier 4 medications are typically prescribed by a specialist, have unique uses, and may require special dosing and administration. Tier 4 medications generally cost more than other drugs, and members must pay a coinsurance amount for them. |
The drugs noted as requiring prior authorization may be covered under Medicare Part B or D depending upon the circumstances. Information may need to be submitted describing the use and setting of the drug to make the determination.
Quantity limits encourage the appropriate use and dose of prescribed medication based on the U.S. Food and Drug Administration (FDA) approved labeling and other medical literature. To receive a quantity of medication that exceeds the limit, the member must meet certain criteria.
The Drug Search information listed below refers to the 2009 formulary.
| Drug name | Tier | Generic equivalent | Notes |
|---|---|---|---|
| ABELCET | 4 | n/a | |
| ABILIFY | 2 | n/a | |
| ABILIFY DISC | 3 | n/a | |
| ABRAXANE | 4 | n/a | |
| acarbose | 1 | n/a | |
| ACCOLATE | 2 | n/a | |
| ACCUNEB | 3 | albuterol sulfate | Generic substitution allowed |
| ACCUPRIL | 3 | quinapril hcl | Generic substitution allowed |
| ACCURETIC | 3 | hydrochlorothiazide; quinapril hcl | Generic substitution allowed |
| ACCUTANE | 4 | isotretinoin | Generic substitution allowed |
| acebutolol | 1 | n/a | |
| ACEON | 2 | n/a | |
| acetazolamide | 1 | n/a | |
| acetic acid / hc otic | 1 | n/a | |
| acetic acid otic | 1 | n/a | |
| acetylcysteine | 1 | n/a | |
| ACIPHEX | 3 | n/a | |
| ACLOVATE | 3 | alclometasone dipropionate | Generic substitution allowed |
| ACTHIB | 2 | n/a | |
| acticin | 1 | n/a | |
| ACTIGALL | 3 | ursodiol | Generic substitution allowed |
| ACTIMMUNE | 4 | n/a | |
| ACTIQ | 4 | fentanyl citrate | Generic substitution allowed |
| ACTIVELLA | 3 | n/a | |
| ACTONEL | 3 | n/a | |
| ACTONEL WITH CALCIUM | 3 | n/a | |
| ACTOPLUS MET | 2 | n/a | |
| ACTOS | 2 | n/a | |
| ACULAR | 3 | n/a | |
| ACULAR LS | 3 | n/a | |
| ACULAR PF | 3 | n/a | |
| acyclovir sodium | 1 | n/a | |
| ADACEL | 2 | n/a | |
| ADAGEN | 4 | n/a | |
| ADALAT CC | 3 | nifedipine | Generic substitution allowed |
| ADDERALL | 3 | amphetamine aspartate; amphetamine sulfate; dextroamphetamine saccharate; dextroamphetamine sulfate | Generic substitution allowed |
| ADDERALL XR | 3 | n/a | |
| ADOXA | 3 | doxycycline monohydrate | Generic substitution allowed |
| ADOXA PAK | 3 | n/a | |
| adriamycin inj 10mg | 1 | n/a | |
| ADRIAMYCIN INJ 20MG | 2 | n/a | |
| adriamycin inj 2mg/ml | 1 | n/a | |
| adriamycin inj 50mg | 1 | n/a | |
| ADVAIR DISKUS | 2 | n/a | |
| ADVAIR HFA | 2 | n/a | |
| ADVICOR | 3 | n/a | |
| AEROBID | 3 | n/a | |
| AEROBID-M | 3 | n/a | |
| afeditab | 1 | n/a | |
| AGGRENOX | 3 | n/a | |
| AGRYLIN | 4 | anagrelide hydrochloride | Generic substitution allowed |
| a-hydrocort | 1 | n/a | |
| ak-con | 1 | n/a | |
| AKNE-MYCIN | 3 | n/a | |
| ak-poly-bac | 1 | n/a | |
| ak-tob | 1 | n/a | |
| ala-cort | 1 | n/a | |
| ALAMAST | 3 | n/a | |
| ALA-SCALP | 3 | n/a | |
| ALBALON | 3 | naphazoline hydrochloride | Generic substitution allowed |
| ALBENZA | 2 | n/a | |
| albuterol er tab | 1 | n/a | |
| albuterol neb | 1 | n/a | |
| albuterol syrup | 1 | n/a | |
| albuterol tab | 1 | n/a | |
| ALCAINE | 3 | proparacaine hydrochloride | Generic substitution allowed |
| alclometasone | 1 | n/a | |
| alcohol / d5w | 1 | n/a | |
| ALCOHOL PREP PAD | 2 | n/a | |
| ALDACTAZIDE 25/25 | 3 | hydrochlorothiazide; spironolactone | Generic substitution allowed |
| ALDACTAZIDE 50/50 | 3 | n/a | |
| ALDACTONE | 3 | spironolactone | Generic substitution allowed |
| ALDARA | 3 | n/a | |
| ALDURAZYME | 4 | n/a | |
| alendronate | 1 | n/a | |
| ALFERON N | 4 | n/a | |
| ALIMTA | 4 | n/a | |
| ALINIA | 2 | n/a | |
| ALKERAN INJ | 4 | n/a | |
| ALLEGRA SUSP | 3 | n/a | |
| ALLEGRA TAB | 3 | fexofenadine hydrochloride | Generic substitution allowed |
| ALLEGRA-D | 3 | n/a | |
| ALLOPURINOL INJ | 3 | n/a | |
| allopurinol tab | 1 | n/a | |
| ALOCRIL | 3 | n/a | |
| ALOMIDE | 3 | n/a | |
| ALOPRIM INJ | 3 | n/a | |
| ALORA | 3 | n/a | |
| ALOXI | 3 | n/a | |
| ALPHAGAN P | 2 | n/a | |
| ALREX | 3 | n/a | |
| ALTABAX | 3 | n/a | |
| ALTACE | 3 | ramipril | Generic substitution allowed |
| ALTOPREV | 2 | n/a | |
| ALUPENT INHALER | 3 | n/a | |
| ALVESCO | 3 | n/a | |
| amantadine | 1 | n/a | |
| AMARYL | 3 | glimepiride | Generic substitution allowed |
| AMBIEN | 3 | zolpidem tartrate | Generic substitution allowed |
| AMBIEN CR | 3 | n/a | |
| AMBISOME | 4 | n/a | |
| amcinonide | 1 | n/a | |
| AMERGE | 2 | n/a | |
| a-methapred | 1 | n/a | |
| AMEVIVE | 4 | n/a | |
| AMIFOSTINE | 4 | n/a | |
| amikacin | 1 | n/a | |
| AMIKIN 100/2ML | 3 | amikacin sulfate | Generic substitution allowed |
| amikin 1gm/4ml | 1 | n/a | |
| amiloride | 1 | n/a | |
| amiloride / hctz | 1 | n/a | |
| aminophylline | 1 | n/a | |
| AMINOSYN / D25 II 3.5% | 2 | n/a | |
| AMINOSYN / D25 II 4.25% | 2 | n/a | |
| AMINOSYN 10% | 2 | n/a | |
| AMINOSYN 3.5% | 2 | n/a | |
| AMINOSYN 5% | 2 | n/a | |
| AMINOSYN 7% | 2 | n/a | |
| AMINOSYN 7% / LYTES | 2 | n/a | |
| AMINOSYN 8.5 / LYTES | 3 | acetate; alanine; arginine; chloride ion; glycine; histidine; isoleucine; leucine; lysine; magnesium (+2); methionine; phenylalanine; phosphorus; potassium (+1); proline; serine; sodium (+1); threonine; tryptophan; tyrosine; valine | Generic substitution allowed |
| AMINOSYN 8.5% | 2 | n/a |