Medication Guide July 2009

Transcription

1 Blue Cross and Blue Shield of Florida Medication Guide July 2009 CONTENTS PAGE Introduction Preface... 1 Preferred Medication List... 1 Pharmacy Benefit Programs... 1 Using The Medication Guide... 2 Prior Authorization... 3 Responsible Quantity Program (Formerly Called Responsible Rx)... 4 Responsible Steps Program... 8 Covered Over The Counter (Otc) Drugs Drugs That Are Not Covered... 9 Three Month Supply... 9 Mail Order Pharmacy... 9 Self-Administered Injectable Drugs... 9 Specialty Pharmacy Products Formulary Addition Request Notice Non-Preferred Brand Name Prescription Drugs And Possible Preferred Alternative(S) Alphabetical Drug List Preferred Medication List Anti-Infective Drugs Cancer Drugs Hormones, Diabetes And Related Drugs Heart And Circulatory Drugs Respiratory Drugs Gastrointestinal Drugs Genitourinary Drugs Central Nervous System Drugs Pain Relief Drugs Neuromuscular Drugs Supplements Blood Modifying Drugs Topical Drugs Miscellaneous Categories This Medication Guide was current at time of printing and is subject to change. Please visit our web site, for the most current information. BCBS Florida Order Number Prime Therapeutics LLC 05/09

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3 Introduction Blue Cross and Blue Shield of Florida and Health Options, Inc. is pleased to present the July 2009 Medication Guide. The Medication Guide includes an abbreviated listing of Brand and Generic Prescription Drugs that may be covered under your plan. Please refer to your Policy, Benefit Booklet, Certificate of Coverage or Pharmacy Program Endorsement for complete coverage details. This Guide may also be available to you by visiting or by calling the customer service number listed on your identification card. For the hearing impaired, call Florida TTY Relay Service 711. We reserve the right to add or remove or change the tier of any prescription drug in this Medication Guide at any time. Note: The decision concerning whether a Prescription Drug should be prescribed must be made by you and your Physician. Any and all decisions that require or pertain to independent professional medical judgments or training, or the need for, and dosage of, a Prescription Drug, must be made solely by you and your treating Physician in accordance with the patient/physician relationship. Preface PREFERRED MEDICATION LIST The Medication Guide includes a list of prescription drugs, insulin, and diabetic supplies that reflect the current recommendations of Blue Cross and Blue Shield of Florida and Health Options, Inc.. This list is the Preferred Medication List, and is developed in conjunction with Prime Therapeutics National Pharmacy & Therapeutics Committee. Currently, all covered Generic Prescription Drugs are considered Preferred. There are no Non-Preferred Generic Drugs at this time. You may pay a lower amount for Brand Prescription Drugs on the Preferred Medication List than for Brands not on the list. For your out-of-pocket expenses to be as low as possible, please consider asking your Physician to prescribe Generic Drugs, or if necessary, Brand Prescription Drugs on the Preferred Medication List whenever appropriate. PHARMACY BENEFIT PROGRAMS To understand in which prescription benefit program you are enrolled, please refer to your Policy, Benefit Booklet, Certificate of Coverage or Pharmacy Program Endorsement or call the number on your member ID card for more information. 2 TIER BENEFIT Tier 1: Generic Prescription Drugs whether listed in this Medication Guide or not. Tier 2: Brand Prescription Drugs whether listed in this Medication Guide or not. 3 TIER BENEFIT Tier 1: Generic Prescription Drugs whether listed in this Medication Guide or not. Tier 2: Brand Prescription Drugs listed on the Preferred Medication List. Tier 3: Brand Prescription Drugs not listed on the Preferred Medication List. Newly marketed Brand Prescription Drugs are on tier 3, but will be reviewed for possible addition to the Preferred Medication List within six months of becoming available on the market. To save the most money on prescription drugs, take this Medication Guide with you each time you visit your physician. Consider asking your physician to prescribe drugs on the Preferred Medication List, if appropriate. When you have your prescriptions filled, ask your pharmacist if a generic drug is available. Generic drugs save you the most money. The tier level of a Brand Prescription Drug included on the Preferred Medication List may increase (change from tier 2 to tier 3) when an FDA-approved bioequivalent Generic Prescription Drug becomes available. Generic Only Prescription Drug Benefit Certain pharmacy benefit plans do not provide coverage for Brand Prescription Drugs. Please refer to your Policy, Benefit Booklet, Certificate of Coverage or Pharmacy Program Endorsement or call the number on your member ID card to verify if your plan provides this coverage. Blue Cross and Blue Shield of Florida and Health Options, Inc. July 2009 Medication Guide 1

4 USING THE MEDICATION GUIDE The Preferred Medication List is organized into broad categories, e.g., Anti-infective Drugs. Within most categories, drugs are sub-grouped by drug class e.g., penicillins, or use for a specific medical condition, e.g., Diabetes. Generic Prescription Drugs are shown in lowercase boldface type followed by a reference brand (in parentheses) to assist in product recognition. Some generic products have no reference brand. Brand reference drugs typically are 2nd tier in the 2 Tier Benefit and 3rd tier in the 3 Tier Benefit. Example: lovastatin (Mevacor) Because most prescriptions are written for the brand drug even when generics exist, we have included many highly prescribed brand drugs (in parentheses) when generics exist, followed by the generic name in bold. Example: (Mevacor) lovastatin Brand Prescription Drugs are shown in capital letters. Key caps... capsules chew tabs... chewable tablets conc... concentrate crm... cream delayed-release... enteric-coated ext-release... extended-release inj... injection lotn lotion neb... nebulization NP... non-preferred ODT...orally disintegrating tabs OTC... over-the-counter drug oint... ointment PA... prior authorization required QL... Responsible Quantity Program quantity limit applies RS.. Responsible Steps Program prerequisite drug required SI... self injectable drug program soln... solution supp... suppositories susp... suspension tabs... tablets Example: NEXIUM Separate drug entries are required for some dosage forms or routes of administration including extended-release, delayedrelease, rectal, injectable, otic, ophthalmic, vaginal, nasal, orally disintegrating, patches, and topical products. Example: estradiol patches (Climara) estradiol tabs (Estrace) Cost Index Dollar signs are based upon Average Wholesale Price (AWP) or Maximum Allowable Cost (MAC) and range from one ($) to five ($$$$$), ranking drugs from least to most expensive. Within the same dollar sign, drugs are listed alphabetically. Dollar signs for maintenance drugs are typically based upon a 30 day supply at a commonly prescribed dosage. For drugs not taken 30 days per month, a more appropriate basis is used to determine dollar signs. $ $20.00 or less $$ $20.01 to $40 $$$ $40.01 to $80 $$$$ $80.01 to $160 $$$$$.... More than $160 Generic Drugs Blue Cross and Blue Shield of Florida and Health Options, Inc. encourages the use of Generic Drugs as a way to provide highquality drugs at reduced cost. Generic Drugs are as safe and effective as their Brand Name counterparts, and are usually less expensive. A Food and Drug Administration (FDA) approved generic drug may be substituted for its Brand Name counterpart because it: Contains the same active ingredient(s) as the brand drug Is identical in strength, dosage form, and route of administration Is therapeutically equivalent and can be expected to have the same clinical effect and safety profile For members with the 3 Tier Benefit, Preferred Brand Drugs listed typically move from tier 2 to tier 3 after a generic equivalent approved by the FDA becomes available. 2 Blue Cross and Blue Shield of Florida and Health Options, Inc. July 2009 Medication Guide

5 PRIOR AUTHORIZATION Drugs selected for Prior Authorization (PA) may require that specific clinical criteria are met before the drugs will be covered under your pharmacy and/or medical benefits. The following drugs, and generic versions if available, may be subject to PA as of July 1, If a drug has a generic version, the generic name is shown in parentheses. Drugs on the Preferred Medication List that may require PA for coverage are designated with PA following the product name. Note: Not all drugs on the following list are on the Preferred Medication List. This list is subject to change. Certain benefit plans do not provide coverage for all drugs listed on this Prior Authorization List. Please refer to your Policy, Benefit Booklet, Certificate of Coverage or Pharmacy Program Endorsement or call the number on your member ID card to verify if your plan provides this coverage. Actiq Advate Alferon N Aloxi Alphanate Alphanate VWB Alphanine SD Amevive Aralast Aranesp Arcalyst Avastin Bebulin VH Benefix Boniva injection Botox Bravelle Calcium EDTA Ceredase Cerezyme Cetrotide chorionic gonadotropin (Novarel, Pregnyl) Cimzia Delatestryl Depo-Provera Depo-Testosterone Dexferrum Eligard Enbrel Epogen Fabrazyme Feiba VH Immuno Fentanyl citrate transmucosal Fentora Ferrlecit Fertinex Follistim AQ Forteo Genotropin Geref Glukor Gonal-F Gonic Helixate FS Hemofil M Herceptin Humate P Humatrope Humira Immune Globulin Increlex Infed Infergen Intron A Kineret Koate DVI Kogenate FS Kuvan Lamisil (terbinafine) Leukine Lucentis Lupron (leuprolide) Lupron Depot Macugen Monarc M Monoclate P Mononine Myobloc Neulasta Neumega Neupogen Norditropin NovoSeven NovoSeven RT Noxafil Nplate Nutropin Nutropin AQ Nuvigil Omnitrope Orencia Ovidrel Pegasys Peg-Intron Penlac (ciclopirox) Plenaxis Privigen Procrit Profilnine SD Prolastin Proplex T Provigil Reclast Recombinate Refacto Relistor Remicade Repronex Revatio Revlimid Rituxan Roferon A Saizen Sandostatin (octreotide) Sandostatin LAR Depot Serostim Sporanox (itraconazole) Supprelin LA Synagis Synarel Tev-Tropin Trelstar Depot Trelstar LA Vantas Venofer Vfend Viadur Vidaza Visudyne Vivitrol Xolair Xyntha Xyrem Zavesca Zemaira Zoladex Zometa Zorbtive Zyvox Blue Cross and Blue Shield of Florida and Health Options, Inc. July 2009 Medication Guide 3

6 To obtain prior coverage authorization: You or your doctor must call Blue Cross and Blue Shield of Florida to obtain prior authorization before the Drug is dispensed to you. If you call, we may request that you have your doctor contact us regarding the Prescription Drug, Supply or OTC Drug being prescribed. If the doctor calls, specific medical documentation may be required. This information may include, but is not limited to, your name, date of birth, doctor s name and doctor s telephone number and documentation regarding the rationale for the prescribed Drug at the requested dosage. Once we make a decision, you and/or your doctor will be informed of the decision. If the decision is made to authorize coverage, the Covered Prescription Drugs and Supplies or Covered OTC Drugs may be obtained from a Participating Pharmacy or at the appropriate location if the Drugs(s) will be administered by a health professional. You will be required to pay the amount as listed in the Schedule of Benefits. If a decision is made to deny authorization, you are free to purchase the Prescription Drug, Supplies or OTC Drug, but you will have to pay the full cost of the medication and will not be entitled to reimbursement under your plan. You have the right to request an appeal if coverage authorization is denied. Please refer to the How to Appeal an Adverse Benefit Determination subsection of the Claims Processing and Appeal and Grievance Process section in the current Benefit Booklet for information on how to file an appeal. To request an appeal if coverage authorization is denied: 1. You or your doctor may ask us to review a denial of coverage authorization. A request for reconsideration may be initiated by calling the customer service number on your Identification Card or by writing to us at the address on your Identification Card. 2. Upon receipt of the request for reconsideration, we will review the initial coverage decision and mail you a letter setting forth our reconsideration decision. RESPONSIBLE QUANTITY PROGRAM (Formerly Called Responsible Rx) Drugs included in this program allow a maximum quantity per one month for one co-payment or coinsurance. Quantity limits are typically developed based upon FDA-approved drug labeling and nationally recognized therapeutic clinical guidelines. The following drugs have quantity limits as of July 1, These drugs are designated in the Preferred Medication List with QL following the product name. Note: Not all drugs on the following list are on the Preferred Medication List. This list is subject to change. * Dispensing Limit is for 90 days Brand/ Generic Name Strength Dispensing Limit Per 30-day Supply Abilify tabs Abilify Discmelt tabs Abilify oral solution ml Aciphex tabs Actiq units Actonel... 5 mg, 30 mg tabs Actonel mg... 4 tabs Actonel mg... 2 tabs Actonel mg... 1 tab Actonel with Calcium day blister pack Adderall (amphetamine-dextroamphetamine mixed salts). 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, 30 mg tabs Adderall (amphetamine-dextroamphetamine mixed salts) mg tabs Adderall XR caps Advair Diskus blisters Advair HFA... 1 canister Aerobid, Aerobid M... 3 canisters Alvesco mcg... 1 canister Alvesco mcg... 2 canisters Ambien (zolpidem) tabs Ambien CR tabs Amerge... 1 mg tabs Amerge mg... 9 tabs Amphetamine-dextroamphetamine mixed salts ext-release caps 4 Blue Cross and Blue Shield of Florida and Health Options, Inc. July 2009 Medication Guide

7 Brand/Generic Name Strength Dispensing Limit per 30-day Supply Anzemet mg tabs Anzemet mg... 7 tabs Arixtra syringes* Asmanex... 1 canister Atrovent (ipratropium) %... 2 inhalers Atrovent (ipratropium) %... 3 inhalers Atrovent HFA... 2 canisters Avinza caps Axert mg tabs Axert mg tabs Azmacort... 3 canisters Bancap-HC (hydrocodone-acetaminophen) caps Beconase AQ... 2 inhalers Boniva mg tabs Boniva mg... 1 tab Byetta.... pre-filled pen (60 doses)... 1 pen Capital and Codeine ml Celebrex mg, 100 mg, 200 mg caps Celebrex mg caps Cesamet caps Combivent... 2 canisters Combunox (oxycodone-ibuprofen) tabs Concerta mg, 27 mg, 54 mg tabs Concerta mg tabs Cymbalta mg, 30 mg caps Cymbalta mg caps Darvocet N-50 (propoxyphene napsylate-acetaminophen) tabs Darvocet N-100 (propoxyphene napsylate-acetaminophen) tabs Daytrana patches Detrol tabs Detrol LA caps Dexedrine Spansule (dextroamphetamine sulfate ext-release) caps Ditropan XL (oxybutynin ext-release)... 5 mg tabs Ditropan XL (oxybutynin ext-release) mg, 15 mg tabs Dolgic LQ ml Dolgic Plus tabs Duragesic (fentanyl transdermal patch) patches Effexor (venlafaxine) tabs Effexor XR mg, 150 mg caps Effexor XR mg caps Emend mg, 125 mg... 6 caps Emend Therapy Pack... 2 Therapy Packs Enablex tabs Esgic (butalbital-acetaminophen-caffeine) caps or tabs Esgic Plus (butalbital-acetaminophen-caffeine) caps or tabs Fentanyl citrate transmucosal units Fentora tabs Fioricet (butalbital-acetaminophen-caffeine) tabs Fioricet w/codeine (butalbital-acetaminophen-caffeine-codeine) caps Fiorinal (butalbital-aspirin-caffeine) tabs Fiorinal (butalbital-aspirin-caffeine) caps Fiorinal w/codeine (butalbital-aspirin-caffeine-codeine) caps Flonase (fluticasone)... 1 inhaler Flovent HFA mcg, 220 mcg... 2 canisters Flovent HFA mcg... 1 canister flunisolide nasal soln mcg/spray... 3 inhalers Flunisolide nasal soln mcg/spray... 3 inhalers Focalin (dexmethylphenidate) tabs Focalin XR caps Foradil Aerolizer... 1 blister pack (12 or 60) Fosamax oral soln ml (4 bottles) Fosamax (alendronate)... 5 mg, 10 mg, 40 mg tabs Fosamax (alendronate) mg, 70 mg... 4 tabs Blue Cross and Blue Shield of Florida and Health Options, Inc. July 2009 Medication Guide 5

8 Brand/Generic Name Strength Dispensing Limit per 30-day Supply Fosamax Plus D tabs Fragmin... syringe, all strengths syringes* Fragmin... vial, all strengths vials* Frova tabs Geodon caps Hycet ml Ibudone tabs Imitrex... nasal soln, 5 mg spray units Imitrex... nasal soln, 20 mg spray units Imitrex (sumatriptan) mg tabs Imitrex (sumatriptan) mg tabs Imitrex (sumatriptan) mg... 9 tabs Imitrex... syringe, 4 mg/0.5 ml... 6 ml (12 inj) Imitrex... syringe, 6 mg/0.5 ml... 4 ml (8 inj) Imitrex (sumatriptan).... vial, 6 mg/0.5 ml ml (8 inj) Innohep... vials, 2 ml vials * Invega... 3 mg, 9 mg tabs Invega... 6 mg tabs Intal Inhaler... 3 canisters Janumet tabs Januvia tabs Kadian mg, 20 mg, 30 mg, 50 mg, 60 mg, 80 mg, 200 mg caps Kadian mg caps Kapidex caps ketorolac tabs Kytril (granisetron) mg tabs Lorcet (hydrocodone-acetaminophen) caps Lorcet Plus (hydrocodone-acetaminophen) tabs Lortab (hydrocodone-acetaminophen) , 5-500, tabs Lortab (hydrocodone-acetaminophen) tabs Lortab elixir (hydrocodone-acetaminophen) ml Lovenox... syringe, all strengths syringes * Lovenox... vial, 300 mg/3 ml vials * Lumigan ml Lunesta tabs Lyrica mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg caps Lyrica mg, 300 mg caps Magnacet tabs Maxair Autohaler... 1 canister Maxalt, Maxalt-MLT... 5 mg tabs Maxalt, Maxalt-MLT mg tabs Maxidone (hydrocodone-acetaminophen) tabs Metadate CD caps Migranal ampules MS Contin (morphine sulfate ext-release) mg, 30 mg, 60 mg tabs MS Contin (morphine sulfate ext-release) mg, 200 mg tabs Nasacort AQ... 1 inhaler Nasonex... 2 inhalers Nexium mg, 40 mg packets/caps Norco (hydrocodone-acetaminophen) tabs Nuvigil tabs Omnaris... 1 inhaler ondansetron mg... 7 tabs Opana ER tabs Oramorph SR mg, 30 mg, 60 mg tabs Oramorph SR mg tabs oxybutynin syrup ml oxybutynin tabs tabs OxyContin (oxycodone ext-release) tabs Oxytrol... 8 patches Percocet (oxycodone-acetaminophen) , 5-325, , tabs Percocet (oxycodone-acetaminophen) tabs Percocet (oxycodone-acetaminophen) tabs 6 Blue Cross and Blue Shield of Florida and Health Options, Inc. July 2009 Medication Guide

9 Brand/Generic Name Strength Dispensing Limit per 30-day Supply Percodan (oxycodone-aspirin) tabs Phrenilin Forte caps Prevacid caps Prevacid SoluTab tabs Prilosec (omeprazole delayed-release ) caps Prilosec suspension packet mg packs Prilosec suspension packet mg packs Primalev tabs Pristiq tabs ProAir HFA... 2 canisters Protonix (pantoprazole delayed-release) packets/caps Proventil HFA... 2 canisters Provigil tabs Pulmicort Flexhaler mcg... 1 canister Pulmicort Flexhaler mcg... 2 canisters Qvar mcg... 1 canister Qvar mcg... 3 canisters Relenza discs/6 months Relpax mg tabs Relpax mg... 6 tabs Reprexain (hydrocodone-ibuprofen) tabs Rhinocort Aqua... 2 inhalers Risperdal (risperidone) mg, 0.5 mg, 1 mg, 2 mg, 3 mg tabs Risperdal (risperidone) mg tabs Risperdal oral soln (risperidone) ml Risperdal M-tab (risperidone) mg, 1 mg, 2 mg, 3 mg tabs Risperdal M-tab (risperidone)... 4 mg tabs Ritalin (methylphenidate) mg, 10 mg tabs Ritalin (methylphenidate) mg tabs Ritalin LA caps Ritalin SR (methylphenidate ext-release) tabs Roxicet (oxycodone-acetaminophen) tabs Roxicet soln ml Rozerem tabs Ryzolt tabs Sanctura tabs Sanctura XR caps Sancuso patches Seroquel mg, 50 mg, 100 mg, 200 mg tabs Seroquel mg, 400 mg tabs Seroquel XR mg, 300 mg, 400 mg tabs Seroquel XR mg, 200 mg tabs Serevent Diskus... 1 package Spiriva Handihaler caps Sonata (zaleplon) caps Strattera mg, 18 mg, 25 mg, 40 mg, 60 mg caps Strattera mg, 100 mg caps Sumatriptan... nasal soln, 5 mg spray units Sumatriptan.... nasal soln, 20 mg spray units Sumatriptan... syringe, 6 mg/0.5 ml... 4 ml (8 inj) Sumatriptan... syringe, 4 mg/0.5 ml... 6 ml (12 inj) Symbicort... 1 canister Symbyax caps Tamiflu... susp, 12 mg/ ml ml/6 months Tamiflu mg caps/6 months Tamiflu mg, 75 mg caps/6 months Toviaz tabs Travatan, Travatan Z ml Treximet tabs Tylenol w/codeine (acetaminophen-codeine) tabs Tylenol w/codeine elixir (acetaminophen-codeine) ml Tylox (oxycodone-acetaminophen) caps Ultram ER tabs Blue Cross and Blue Shield of Florida and Health Options, Inc. July 2009 Medication Guide 7

10 Brand/Generic Name Strength Dispensing Limit per 30-day Supply Venlafaxine ER mg tabs Venlafaxine ER mg, 150 mg, 225 mg tabs Ventolin HFA... 2 canisters Veramyst... 1 inhaler Vesicare tabs Vicodin (hydrocodone-acetaminophen) tabs Vicodin ES (hydrocodone-acetaminophen) tabs Vicodin HP (hydrocodone-acetaminophen) tabs Vicoprofen (hydrocodone-ibuprofen) tabs Vyvanse caps Xalatan ml Xopenex HFA canisters Zegerid mg, 40 mg packets/caps Zofran (ondansetron)... oral soln ml (2 bottles) Zofran, Zofran ODT (ondansetron)... 4 mg tabs Zofran, Zofran ODT (ondansetron)... 8 mg tabs Zomig... nasal soln units Zomig, Zomig ZMT mg tabs Zomig, Zomig ZMT mg... 9 tabs Zydone tabs Zyprexa, Zyprexa Zydis tabs RESPONSIBLE STEPS PROGRAM Drugs included in this program require you try another designated or prerequisite drug first in order for the Responsible Steps drug to be covered under your pharmacy benefit. If for medical reasons, you cannot use the prerequisite drug and require the Responsible Steps medication, your physician may request a prior authorization for you to have the Responsible Steps medication covered. These medications are designated in the Preferred Medication List with RS following the product name. Medications in the Responsible Steps Program effective July 1, 2009 are listed below. The medications in the Responsible Steps Program are subject to change. Accupril Accuretic Aceon Aciphex Advicor Altace Altoprev Ambien Ambien CR Atacand Atacand HCT Avalide Avandamet Avandaryl Avandia Avapro Azor Benicar Benicar HCT Byetta Capoten Capozide Celebrex Celexa Cozaar Crestor Cymbalta Diovan Diovan HCT Effexor Effexor XR Elidel Exforge Exforge HCT Hyzaar Kapidex Lescol Lescol XL Lexapro Lipitor Lotensin Lotensin HCT Lunesta Luvox CR Mavik Mevacor Micardis Micardis HCT Monopril Monopril HCT Nexium pantoprazole delayed-release Paxil Paxil CR Pexeva Pravachol Prevacid Prevacid SoluTab Prilosec Prinivil Prinzide Pristiq Protonix Protopic Prozac Remeron Remeron SolTab Rozerem Simcor Sonata Tekturna Tekturna HCT Teveten Teveten HCT Uniretic Univasc Vaseretic Vasotec Venlafaxine ER Vytorin Wellbutrin Wellbutrin SR Wellbutrin XL Zegerid Zestoretic Zestril Zocor Zoloft 8 Blue Cross and Blue Shield of Florida and Health Options, Inc. July 2009 Medication Guide

11 COVERED OVER THE COUNTER (OTC) DRUGS Your pharmacy benefit may provide coverage for select OTC Drugs. A select OTC Drug may be covered if it is prescribed by your Physician. Only those OTC Drugs designated on the Preferred Medication List with OTC following the product name are eligible for coverage. DRUGS THAT ARE NOT COVERED Your pharmacy benefit may not cover select medications. Some of the reasons a medication may not be covered are: The Drug has been shown to have excessive adverse effects and/or safer alternatives The Drug has a preferred formulary alternative or over-the-counter (OTC) alternative The following Drugs may not be covered. Please refer to your Policy, Benefit Booklet, Certificate of Coverage or Pharmacy Program Endorsement for complete coverage details. Coverage details may also be available to you by visiting or by calling the customer service number listed on your identification card. Drugs that may not be covered Aciphex, Kapidex, Prevacid, Prevacid SoluTab, Protonix, Zegerid Allegra, Allegra-D, Clarinex, Clarinex-D, Xyzal Beconase AQ, Flonase, Nasacort AQ, Omnaris, Rhinocort AQ, Veramyst Treximet Vyvanse Preferred Alternative(s) that may be covered omeprazole delayed-release QL, Nexium QL,RS fexofenadine, loratadine, loratadine-pseudoephedrine ext-release flunisolide QL, fluticasone QL, Nasonex QL sumatriptan QL, naproxen QL, Maxalt QL methylphenidate ext-release QL, Adderall XR QL, Strattera QL THREE MONTH SUPPLY In addition to being able to obtain up to a three month supply of medication through our mail order pharmacy, you may be able to receive up to a three month supply of your medication through a participating retail pharmacy. Please refer to your Policy, Benefit Booklet, Certificate of Coverage or Pharmacy Program Endorsement for complete coverage details. MAIL ORDER PHARMACY The procedure for filling a Covered Prescription Drug, Covered OTC medication, or Covered Prescription Supply from the Mail Order Pharmacy Program is as follows: 1. For the first Mail Order Pharmacy Prescription order, you must complete the Registration and Prescription Order Form included in the Mail Order Pharmacy Brochure, and mail it to the Mail Order Pharmacy address with the applicable Mail Order Deductible, Coinsurance and/or Copayment(s). A Mail Order Pharmacy Brochure was included with the membership package provided to you. Additional Mail Order Pharmacy Brochures can be obtained by calling the customer service number your member ID card You must submit a new, original 90-Day Supply Prescription with a quantity of up to a 90-Day Supply and not less than a 60-Day Supply along with the Registration and Prescription Order Form, if the original Prescription was filled at a Pharmacy other than the Mail Order Pharmacy. Prescriptions may not be transferred from a Retail Pharmacy to the Mail Order Pharmacy. Once a Prescription has been filled through the Mail Order Pharmacy, you can call the Mail Order Pharmacy to order refills. For additional details on how to obtain Covered Prescription Drugs and Supplies from the Mail Order Pharmacy, please refer to the Mail Order Pharmacy Brochure. SELF-ADMINISTERED INJECTABLE DRUGS The following list of self-administered injectable drugs may not be included in your pharmacy benefit program. Please refer to your Policy, Benefit Booklet, Certificate of Coverage or Pharmacy Program Endorsement or call the number on your member ID card for more information. Self-administered injectable drugs are designated in the Preferred Medication List with SI following the product name. If a drug has a generic version, the generic name is shown in parentheses. Arixtra QL Byetta QL,RS cyanocobalamin DDAVP (desmopressin) 4 mcg/ml D.H.E. 45 (dihydroergotamine) EpiPen, EpiPen Jr Fragmin QL Glucagon products Imitrex (sumatriptan) QL Innhep QL Insulins Lovenox QL Miacalcin Prostigmin (neostigmine) Relistor PA Symlin Blue Cross and Blue Shield of Florida and Health Options, Inc. July 2009 Medication Guide 9

12 SPECIALTY PHARMACY PRODUCTS To verify coverage for Specialty Pharmacy Products, refer to your Policy, Benefit Booklet, Certificate of Coverage or Pharmacy Program Endorsement or call the customer service number on your member ID card. Only those Self-administered Specialty Pharmacy Products identified in this Medication Guide with an SP following the product name will be available through participating BCBSF/HOI Specialty Pharmacies or through Non-Participating Pharmacies. If a Drug has a Generic version, the Generic name is shown in parentheses. Participating Specialty Pharmacy Providers Caremark Specialty Pharmacy Services All Products Phone: Fax: Accredo Health Hemophilia and Products Noted With * Phone: Fax: The Preferred Medication List designates between Self-administered and Provider-administered Specialty Products Self-Administered Specialty Pharmacy Products Patients administer these Specialty Pharmacy Products themselves. The following self-administered Specialty Pharmacy Products may not be included in your pharmacy benefit. Drugs indicated below with PA after the name may require prior authorization. Specialty Pharmacy Products may not be covered when purchased through the Mail Order Pharmacy. If Specialty Drugs are purchased at a pharmacy other than the Specialty Pharmacies listed above, your cost share may be higher. Actimmune Advate PA Alphanate PA Alphanate VWB PA Alphanine SD PA Aranesp PA Arcalyst PA Avonex Bebulin VH PA Benefix PA Betaseron Bravelle PA Cetrotide PA chorionic gonadotropin (Novarel, Pregnyl) PA Copaxone Enbrel PA Epogen PA Exjade Feiba VH Immuno PA Fertinex PA Follistim AQ PA Forteo PA Fuzeon Genotropin PA Geref PA Gonal-F PA Gonic PA Helixate FS PA Hemophil M PA Pulmozyme Humate-P PA Plenaxis PA Humatrope PA Procrit PA Humira PA Profilnine SD PA Increlex PA Proplex T PA Infergen PA Rebif Intron A PA Recombinate PA Kineret PA Refacto PA Koate DVI PA Repronex PA Kogenate FS PA Revatio PA Kuvan PA Revlimid PA Letairis Roferon-A PA Leukine PA Saizen PA Lupron (leuprolide) PA Sandostatin Monarc M PA (octreotide) PA Monoclate-P PA Serostim PA Mononine PA Somavert Neulasta PA Synarel PA Neumega PA Tev-Tropin PA Neupogen PA Tracleer Norditropin PA Ventavis Novoseven PA Vidaza PA NovoSeven RT PA Vivaglobin PA Nutropin PA Xenazine Nutropin AQ PA Xyntha PA Omnitrope PA Xyrem PA Ovidrel PA Zavesca PA Pegasys PA Zorbtive PA Peg-Intron PA Provider-Administered Specialty Pharmacy Products Provider-administered Specialty Pharmacy Products are covered under your medical benefit. These Specialty Pharmacy Products are ordered by a Provider and administered in an office or outpatient setting. Drugs indicated below with PA after the name require prior authorization. Adagen* Aldurazyme Aloxi PA Amevive PA Aralast PA Avastin PA Boniva PA Botox PA Ceredase PA Cerezyme PA Cimzia PA Cinryze Elaprase Eligard PA Fabrazyme PA Flolan (epoprostenol) Herceptin PA Immune Globulin (IV) PA Lucentis PA Lupron Depot PA Macugen PA Myobloc PA Myozyme Naglazyme Orencia PA Prolastin PA Reclast PA Remicade PA Remodulin Rituxan PA Sandostatin LAR Depot PA Soliris Somatuline Depot Supprelin LA PA Synagis PA Thyrogen Trelstar Depot PA Trelstar LA PA Tysabri Vantas PA Viadur PA Vidaza PA Visudyne PA Vivitrol PA Xolair PA Zemaira PA Zoladex PA Zometa PA 10 Blue Cross and Blue Shield of Florida and Health Options, Inc. July 2009 Medication Guide

13 FORMULARY ADDITION REQUEST Physicians may request the addition of a drug to the Preferred Medication List by submitting a written request to Blue Cross and Blue Shield of Florida and Health Options, Inc. Please mail to: Blue Cross and Blue Shield of Florida and Health Options, Inc. Attn: Pharmacy Programs P.O. Box 1798 Jacksonville, FL NOTICE This Medication Guide shall not extend, vary, alter, replace, or waive any of the provisions, benefits, exclusions, limitations, or conditions contained in the Policy, Benefit Booklet, Certificate of Coverage or Pharmacy Program Endorsement. In the event of any inconsistencies between the Medication Guide and the provisions contained in the Policy, Benefit Booklet, Certificate of Coverage or Pharmacy Program Endorsement, the provisions contained in the Policy, Benefit Booklet, Certificate of Coverage or Pharmacy Program Endorsement shall control to the extent necessary to effectuate the intent of Blue Cross and Blue Shield of Florida and Health Options, Inc. NON-PREFERRED BRAND NAME PRESCRIPTION DRUGS AND POSSIBLE PREFERRED ALTERNATIVE(S) In the event you are prescribed a Prescription Drug that is not preferred, we have included a list of possible preferred alternatives that your Physician may prescribe if appropriate. Please speak with your Physician concerning whether alternatives are appropriate for you. The decision concerning whether a Prescription Drug should be prescribed must be made by you and your Physician. Any and all decisions that require or pertain to independent professional medical judgments or training, or the need for, and dosage of, a Prescription Drug, must be made solely by you and your treating Physician in accordance with the patient/physician relationship. The Brand Drugs noted are some of the most commonly prescribed. Your prescribed Brand Drug may not be listed; however, it still will be covered if it is not excluded by your plan. Refer to your Policy, Benefit Booklet, Certificate of Coverage or Pharmacy Program to determine if a particular Prescription Drug is covered. There are no Non-Preferred Generic Prescription Drugs at this time. This is only a partial listing of Non-Preferred Brand Name Prescription Drugs. Non-Preferred Brand Medication Abilify QL QL, RS Aciphex omeprazole Advicor RS QL, RS Ambien CR zolpidem Antara Astepro Atacand RS Atacand HCT RS Avalide RS Avapro RS Avinza QL Boniva QL QL, RS Celebrex diclofenac, Clarinex Concerta QL Coreg CR Cozaar RS Possible Preferred Alternative(s) haloperidol, risperidone QL, Geodon QL, Seroquel QL, Seroquel XR QL delayed-release QL, pantoprazole delayed-release QL, RS QL, RS, Nexium lovastatin, pravastatin, simvastatin, Crestor RS QL, zalpelon QL QL, RS, Lunesta fenofibrate micronized caps (67 mg, 134 mg, 200 mg), fenofibrate tabs (54 mg, 160 mg), Tricor Astelin Benicar RS, Diovan RS, Micardis RS Benicar HCT RS, Diovan HCT RS, Micardis HCT RS Benicar HCT RS, Diovan HCT RS, Micardis HCT RS Benicar RS, Diovan RS, Micardis RS fentanyl patches QL, morphine sulfate ext-release QL, oxycodone ext-release QL, Oxycontin QL alendronate QL, etidronate, Actonel QL, Fosamax Plus D QL etodolac, ibuprofen, meloxicam, naproxen, oxaprozin fexofenadine methylphenidate ext-release QL, Adderall XR QL, Strattera QL carvedilol Benicar RS, Diovan RS, Micardis RS Blue Cross and Blue Shield of Florida and Health Options, Inc. July 2009 Medication Guide 11

14 QL, RS Cymbalta bupropion, Daytrana QL Focalin XR QL Hyzaar RS Kadian QL Lipitor RS Lyrica QL Metadate CD QL Nasocort AQ QL Pataday Pexeva RS QL, RS Prevacid omeprazole QL, RS Pristiq bupropion, Proventil HFA QL Rhinocort Aqua QL Skelaxin Trilipix Veramyst QL Vyvanse QL Vytorin RS Xyzal QL, RS Zegerid omeprazole Zyprexa QL bupropion ext-release, citalopram, fluoxetine, mirtazapine, paroxetine, paroxetine ext-release, sertraline, Effexor XR QL, RS, Lexapro RS QL, RS, Venlafaxine ER methylphenidate ext-release QL, Adderall XR QL, Strattera QL methylphenidate ext-release QL, Adderall XR QL, Strattera QL Benicar HCT RS, Diovan HCT RS, Micardis HCT RS fentanyl patches QL, morphine sulfate ext-release QL, oxycodone ext-release QL, Oxycontin QL lovastatin, pravastatin, simvastatin, Crestor RS gabapentin methylphenidate ext-release QL, Adderall XR QL, Strattera QL flunisolide QL, fluticasone QL, Nasonex QL Astelin bupropion, bupropion ext-release, citalopram, fluoxetine, mirtazapine, paroxetine, paroxetine ext-release, sertraline, Effexor XR QL, RS, Lexapro RS delayed-release QL, pantoprazole delayed-release QL, RS QL, RS, Nexium bupropion ext-release, citalopram, fluoxetine, mirtazapine, paroxetine, paroxetine ext-release, sertraline, Effexor XR QL, RS, Lexapro RS QL, RS, Venelafaxine ER ProAir HFA QL, Ventolin HFA QL flunisolide QL, fluticasone QL, Nasonex QL baclofen, cyclobenzaprine, orphenadrine citrate ext-release, tizanidine fenofibrate micronized caps (67 mg, 134 mg, 200 mg), fenofibrate tabs (54 mg, 160 mg), Tricor flunisolide QL, fluticasone QL, Nasonex QL methylphenidate ext-release QL, Adderall XR QL, Strattera QL lovastatin, pravastatin, simvastatin, Crestor RS, Zetia fexofenadine delayed-release QL, pantoprazole delayed-release QL, RS QL, RS, Nexium haloperidol, risperidone QL, Geodon QL, Seroquel QL, Seroquel XR QL PA Drug may require that specific clinical criteria are met before the drugs will be covered under your pharmacy and/or medical benefits See PRIOR AUTHORIZATION QL Drug limited to a maximum quantity per one month for one co-payment or coinsurance see RESPONSIBLE QUANTITY PROGRAM RS Drug require you to try another designated or prerequisite drug first see RESPONSIBLE STEPS PROGRAM 12 Blue Cross and Blue Shield of Florida and Health Options, Inc. July 2009 Medication Guide

15 Product Page Product Page Index a 8-MOP hard gelatin caps acarbose (Precose) ACCOLATE (Accupril) quinapril acebutolol (Sectral) acetaminophen/codeine (Tylenol w/codeine) QL acetaminophen/isometheptene/dichloralphenazone (Midrin) acetazolamide acetazolamide ext-release (Diamox Sequels) acetic acid ear soln acetylcysteine ACID JELLY ACTIMMUNE SP ACTIQ PA, QL ACTIVELLA 0.5/0.1 mg ACTONEL QL ACTOS ACULAR ACULAR LS acyclovir oral (Zovirax) (Adalat CC) nifedipine ext-release ADDERALL XR QL ADVAIR DISKUS QL ADVAIR HFA QL AFINITOR ALBENZA albuterol sulfate inhal soln albuterol sulfate syrup, tabs alclometasone (Aclovate) ALDARA alendronate tabs (Fosamax) QL ALINIA ALKERAN ALLEGRA-D 12 hr, 24 hr (Allegra) fexofenadine allopurinol ALPHAGAN P ALPRAZOLAM INTENSOL alprazolam (Xanax) aluminum chloride soln (Drysol) amantadine caps, syrup AMANTADINE tabs (Ambien) zolpidem QL amiloride/hydrochlorothiazide amiloride (Midamor) amiodarone amitriptyline amlodipine/benazepril (Lotrel) amlodipine (Norvasc) AMOXAPINE amoxicillin AMOXICILLIN chew tabs, 400 mg amoxicillin/potassium clavulanate (Augmentin) AMOXIL drops amphetamine/dextroamphetamine mixed salts (Adderall) QL.. 31 ampicillin caps AMPICILLIN susp anagrelide (Agrylin) ANCOBON ANDROGEL ANDROXY ANTABUSE anthralin (Dritho-Creme HP) APIDRA SI APTIVUS ARANESP PA, SP ARICEPT ARICEPT ODT ARIMIDEX AROMASIN ASACOL ASCENSIA AUTODISC TEST STRIPS ASCENSIA BREEZE 2 TEST DISKS ASCENSIA BREEZE/BREEZE 2 MONITORING KITS ASCENSIA CONTOUR MONITORING KIT ASCENSIA CONTOUR TEST STRIPS ASCENSIA ELITE TEST STRIPS ASMANEX QL ASTELIN atenolol/chlorthalidone (Tenoretic) atenolol (Tenormin) ATRIPLA atropine sulfate oint, soln (Isopto Atropine) ATROVENT HFA QL (Augmentin) amoxicillin/potassium clavulanate AUGMENTIN susp AVANDAMET RS AVANDIA RS AVC crm AVELOX AVODART AVONEX SP azathioprine (Imuran) AZILECT azithromycin (Zithromax) b bacitracin eye oint bacitracin/polymyxin B eye oint baclofen BACTROBAN crm balsalazide (Colazal) Blue Cross and Blue Shield of Florida and Health Options, Inc. July 2009 Medication Guide 13

16 Product Page Product Page BARACLUDE benazepril/hydrochlorothiazide (Lotensin HCT) benazepril (Lotensin) BENICAR HCT RS BENICAR RS BENZACLIN benzocaine/antipyrine benztropine betamethasone dipropionate betamethasone dipropionate, augmented (Diprolene) betamethasone valerate (Betapace) sotalol BETAXOLOL eye soln, 0.5% BETIMOL (Biaxin) clarithromycin BILTRICIDE BIO-THROID bisoprolol/hydrochlorothiazide (Ziac) bisoprolol (Zebeta) BLEPHAMIDE BLEPHAMIDE S.O.P brimonidine eye soln, 0.2% bromocriptine (Parlodel) brompheniramine/pseudoephedrine ext-release caps, 6/ bumetanide (Bumex) bupropion ext-release 12 hr (Wellbutrin SR) bupropion ext-release 24 hr (Wellbutrin XL) bupropion ext-release (Zyban) bupropion (Wellbutrin) buspirone (Buspar) butalbital/acetaminophen/caffeine caps, 50/325/40 (Esgic) QL butalbital/acetaminophen/caffeine tabs, 50/325/40 (Fioricet) QL butalbital/acetaminophen/caffeine tabs, 50/500/40 (Esgic Plus) QL butalbital/acetaminophen tabs, 50/325 (Phrenilin) butalbital/acetaminophen tabs, 50/650 (Sedapap) butalbital/aspirin/caffeine caps, 50/325/40 (Fiorinal) QL butalbital/aspirin/caffeine/codeine caps (Fiorinal w/codeine) QL butalbital/aspirin/caffeine tabs, 50/325/40 QL BYETTA QL, RS, SI c cabergoline (Calan) verapamil calcipotriene soln (Dovonex) calcitonin-salmon nasal includes Fortical calcitriol (Rocaltrol) calcium acetate (Phoslo) CANASA CAPEX captopril (Capoten) captopril/hydrochlorothiazide CARAFATE susp carbamazepine ext-release 200 mg, 400 mg (Tegretol-XR) carbamazepine (Tegretol) carbidopa/levodopa ext-release (Sinemet CR) carbidopa/levodopa ODT (Parcopa) carbidopa/levodopa (Sinemet) (Cardizem) diltiazem (Cardizem CD) diltiazem ext-release carteolol eye soln carvedilol (Coreg) CASODEX CATAPRES-TTS CEENU cefadroxil cefdinir (Omnicef) cefpodoxime (Vantin) cefprozil cefuroxime (Ceftin) CELLCEPT CELONTIN cephalexin (Keflex) CHANTIX CHEMET chloral hydrate syrup chlorhexidine oral rinse (Peridex) chloroquine phosphate (Aralen) chlorothiazide chlorpromazine chlorthalidone 25 mg, 50 mg chlorzoxazone cholestyramine (Questran, Questran Light) ciclopirox (Loprox) cilostazol (Pletal) CILOXAN oint cimetidine CIPRODEX ciprofloxacin soln (Ciloxan) ciprofloxacin tabs (Cipro) CIPRO susp citalopram (Celexa) clarithromycin (Biaxin) CLEOCIN PEDIATRIC CLEOCIN vaginal supp clindamycin (Cleocin) clindamycin (Cleocin-T) clindamycin vaginal crm (Cleocin) clobetasol (Olux) clobetasol (Temovate) clomiphene (Clomid) clomipramine (Anafranil) clonazepam (Klonopin) clonidine (Catapres) Blue Cross and Blue Shield of Florida and Health Options, Inc. July 2009 Medication Guide

17 Product Page Product Page clozapine 25 mg, 50 mg, 100 mg (Clozaril) codeine/guaifenesin soln, 10/100 per 5 ml codeine/guaifenesin tabs, 10/300 (Brontex) CODEINE SULFATE 15 mg codeine sulfate 30 mg, 60 mg colchicine COMBIVENT QL COMBIVIR COMTAN CONDYLOX gel COPAXONE SP (Copegus) ribavirin tabs cortisone acetate CRESTOR RS CRIXIVAN cromolyn sodium inhal soln cromolyn sodium soln (Crolom) CUPRIMINE cyanocobalamin inj SI cyclobenzaprine (Flexeril) CYCLOGYL 0.5%, 2% cyclopentolate soln (Cyclogyl) CYCLOPHOSPHAMIDE tabs cyclosporine modified caps, 25 mg, 100 mg; soln (Neoral) cyclosporine (Sandimmune) cyproheptadine CYSTAGON d danazol dantrolene (Dantrium) DAPSONE DARAPRIM (DDAVP) desmopressin tabs demeclocycline (Declomycin) (Depakote) divalproex delayed-release (Depakote ER) divalproex ext-release DERMA-SMOOTHE/FS oil desipramine (Norpramin) desmopressin inj (DDAVP) SI desmopressin nasal (DDAVP) desmopressin tabs (DDAVP) desogestrel/ethinyl estradiol (Cyclessa) desogestrel/ethinyl estradiol (Mircette) desogestrel/ethinyl estradiol (Ortho-Cept) desonide (Desowen) desoximetasone (Topicort) DETROL LA QL DETROL QL DEXAMETHASONE elixir, soln; tabs, 1 mg, 2 mg dexamethasone sodium phosphate eye soln dexamethasone tabs, 0.5 mg, 0.75 mg, 1.5 mg, 4 mg, 6 mg dextroamphetamine ext-release (Dexedrine Spansule) QL dextroamphetamine tabs, 5 mg DIASTAT DIAZEPAM INTENSOL DIAZEPAM oral soln, 5 mg/5 ml diazepam tabs (Valium) diclofenac eye soln (Voltaren) diclofenac sodium delayed-release 50 mg, 75 mg (Voltaren) DICLOFENAC SODIUM delayed-release tabs, 25 mg diclofenac sodium ext-release (Voltaren-XR) dicloxacillin dicyclomine (Bentyl) didanosine delayed-release (Videx EC) diflorasone DIFLUNISAL DIGOXIN soln digoxin tabs (Lanoxin) DILANTIN 30 mg DILANTIN INFATABS diltiazem (Cardizem) diltiazem ext-release (Cardizem CD) diltiazem ext-release (Dilacor XR) diltiazem ext-release (Tiazac) DIOVAN HCT RS DIOVAN RS diphenoxylate/atropine (Lomotil) disopyramide ext-release 150 mg (Norpace CR) disopyramide (Norpace) divalproex delayed-release (Depakote) divalproex ext-release (Depakote ER) DIVIGEL dorzolamide/timolol maleate (Cosopt) dorzolamide (Trusopt) DOVONEX crm doxazosin (Cardura) doxepin caps, oral soln doxepin crm (Zonalon) doxycycline hyclate DRITHO-SCALP drospirenone/ethinyl estradiol (Yasmin) DROXIA DUAC CS (Duragesic) fentanyl patches QL (Dynacin) minocycline tabs e econazole EFFEXOR XR QL, RS ELMIRON EMCYT EMEND caps QL EMTRIVA enalapril/hydrochlorothiazide (Vaseretic) enalapril (Vasotec) Blue Cross and Blue Shield of Florida and Health Options, Inc. July 2009 Medication Guide 15

18 Product Page Product Page ENBREL PA, SP ENTOCORT EC EPIPEN JR SI EPIPEN SI EPIVIR EPIVIR-HBV EPZICOM ergocalciferol (Drisdol) ERGOMAR ERY-TAB erythromycin/benzoyl peroxide (Benzamycin) ERYTHROMYCIN delayed-release caps erythromycin ethylsuccinate erythromycin eye oint erythromycin gel erythromycin/sulfisoxazole (Pediazole) erythromycin topical pads, soln, 2% estazolam estradiol/norethindrone acetate 1/0.5 mg (Activella) estradiol patches (Climara) estradiol tabs (Estrace) estropipate (Ogen) ethambutol (Myambutol) ethosuximide (Zarontin) ethynodiol/ethinyl estradiol (Demulen) etodolac etoposide caps EVISTA EXELON caps, soln EXELON patches EXFORGE RS EXJADE oral susp SP f famciclovir (Famvir) famotidine (Pepcid) FANSIDAR FARESTON FELBATOL felodipine ext-release FEMARA FEMHRT fenofibrate micronized, caps, 67 mg, 134 mg, 200 mg (Lofibra) fenofibrate tabs, 54 mg, 160 mg (Lofibra) FENTANYL CITRATE transmucosal PA, QL fentanyl patches (Duragesic) QL fexofenadine (Allegra) FINACEA, NP = Finacea Plus finasteride (Proscar) flecainide (Tambocor) FLOMAX (Flonase) fluticasone QL FLOVENT HFA QL fluconazole (Diflucan) fludrocortisone flunisolide 25 mcg/spray QL FLUOCINOLONE crm, 0.025%; oint, soln fluocinonide fluorometholone susp (FML Liquifilm) fluorouracil crm, soln, 5% (Efudex) fluoxetine (Prozac) FLUPHENAZINE HCL soln, 2.5 mg/5 ml, 5 mg/ml fluphenazine hcl tabs flurbiprofen soln (Ocufen) flutamide fluticasone (Flonase) QL fluticasone propionate (Cutivate) FML folic acid tabs, 1 mg FORTEO PA, SP (Fosamax) alendronate tabs QL FOSAMAX PLUS D QL FOSAMAX soln QL fosinopril/hydrochlorothiazide (Monopril HCT) fosinopril (Monopril) FURADANTIN furosemide soln, 10 mg/ml; tabs (Lasix) FUZEON SP g gabapentin caps, tabs (Neurontin) GABITRIL galantamine ext-release (Razadyne ER) galantamine tabs (Razadyne) GANCICLOVIR GANTRISIN PEDIATRIC gemfibrozil (Lopid) gentamicin eye oint, soln gentamicin topical GEODON QL GLEEVEC glimepiride (Amaryl) glipizide ext-release (Glucotrol XL) glipizide (Glucotrol) GLUCAGON EMERGENCY KIT SI (Glucophage) metformin (Glucovance) glyburide/metformin GLYBURIDE, distributor of Diabeta glyburide/metformin (Glucovance) glyburide (Micronase) glyburide micronized (Glynase) glycopyrrolate (Robinul) GLYSET GRIFULVIN V tabs griseofulvin microsize susp (Grifulvin V) guanfacine (Tenex) Blue Cross and Blue Shield of Florida and Health Options, Inc. July 2009 Medication Guide