Blue Cross and Blue Shield of Texas 2012 Drug Guide Updates 2nd Quarter 2012 Effective date of changes: January 1, 2012 or the group’s anniversary date
This document is provided to help members and providers understand the 2012 Preferred Drug Guide Updates. The list includes possible generic and/or preferred brand alternative medications. Similar or related medications may be included in this document. Drugs without Preferred Brand Alternatives or Generic Options are, in most cases, considered Specialty Drug Products. It is the sole responsibility of the prescriber to select the most appropriate therapy.
This list was current at the time of printing and is subject to change. Coverage is subject to the limitations noted in your benefits booklet.
* Generic equivalents of the Non-Preferred Brand, if available will be shown in bold. Brand-Name Medications Moved to Third-Tier Copay (Non-Preferred Status) in 2012 NON-PREFERRED BRAND PREFERRED BRAND ALTERNATIVE GENERIC OPTIONS estradiol/norethindrone, estradiol, estropipate
metformin, glipizide er, glimepiride, glyburide
disulfiram donepezil, galantamine, rivastigmine tartrate donepezil, galantamine, rivastigmine tartrate anastrozole, letrozole, exemestane exemestane
levocetirizine dihydrochloride, azelastine
estradiol, estropipate, estradiol valerate
adapalene, tretinoin, claravis, benzoyl peroxide
Asacol, Asacol HD, Pentasa, Canasa, Lialda
sertraline, citalopram, fluoxetine, venlafaxine ext-release budesonide, prednisone, dexamethasone,
erythromycin ethylsuccinate, azithromycin,
clarithromycin, clarithromycin ext-release
rivastigmine
anastrozole, letrozole, exemestane tamsulosin
Prime Therapeutics is the pharmacy benefit manager for Blue Cross and Blue Shield of Texas.
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of Blue Cross and Blue Shield Association.
41722-C TX Prime Therapeutics LLC 03/12
Blue Cross and Blue Shield of Texas Drug List Updates, 2nd Quarter 2012 — Page 1 of 2
NON-PREFERRED BRAND PREFERRED BRAND ALTERNATIVE GENERIC OPTIONS
sertraline, citalopram, fluoxetine, paroxetine
ciprofloxacin, levofloxacin methylergonovine
ropinirole, pramipexole dihydrochloride
tranylcypromine, phenelzine
fluticasone, triamcinolone acetonide, flunisolide
estradiol, estropipate, estradiol valerate
estradiol, estropipate, estradiol valerate
budesonide ursodiol ursodiol voriconazole latanoprost Brand-Name Medications Added to Preferred Status in 2012
** Specialty medication tiers may vary. Please refer to your plans specialty benefit information or call the Pharmacy Programs number on the back of your card.
Prime Therapeutics is the pharmacy benefit manager for Blue Cross and Blue Shield of Texas.
41722-C TX Prime Therapeutics LLC 03/12
Blue Cross and Blue Shield of Texas Drug List Updates, 2nd Quarter 2012 — Page 2 of 2
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