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Hr.amaisd.org

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

Source: http://hr.amaisd.org/files/5013/3737/7458/TX_Formulary_Update.pdf

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