Find a drug
2008 formulary

For current members, please use the links below to locate information about the 2008 formulary.

Blue Medicare HMO / Blue Medicare PPO
Blue Medicare Rx
2009 formulary

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.
Prior authorization and quantity limits

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.

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
Drug name Tier Generic equivalent Notes
ABELCET 4 n/a

Prior authorization required

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

Prior authorization required

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

Prior authorization required

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

Prior authorization required

ADRIAMYCIN INJ 20MG 2 n/a

Prior authorization required

adriamycin inj 2mg/­ml 1 n/a

Prior authorization required

adriamycin inj 50mg 1 n/a

Prior authorization required

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

Prior authorization required

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

Prior authorization required

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

Prior authorization required

amcinonide 1 n/a  
AMERGE 2 n/a

Quantity limitations apply

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

Prior authorization required

AMINOSYN /­ D25 II 4.25% 2 n/a

Prior authorization required

AMINOSYN 10% 2 n/a

Prior authorization required

AMINOSYN 3.5% 2 n/a

Prior authorization required

AMINOSYN 5% 2 n/a

Prior authorization required

AMINOSYN 7% 2 n/a

Prior authorization required

AMINOSYN 7% /­ LYTES 2 n/a

Prior authorization required

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

Prior authorization required

Generic substitution allowed
AMINOSYN 8.5% 2 n/a