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MOST COMMONLY PRESCRIBED DRUGS
(Preferred Drug List)
Effective January 1, 2008
The Blue Cross and Blue Shield of Texas most commonly If you are currently taking a drug that is not shown on this list, prescribed preferred drugs are listed below. This list does not
call Customer Service at the number located on the back of your include all of the preferred drugs that are included in your
BCBSTX member ID card. They can tell you what your copayment prescription benefit.
will be. If you are taking one of the brand-name drugs shown in parentheses, tell your pharmacist that you would like the generic The drugs listed below are grouped into broad categories. Each version. Generic drugs are just as safe and effective as brand- category includes two alphabetical lists of drugs.
name drugs, and you may wish to consider using the generic • The first list shows generic drugs in bold, lower-case
version since you wil usual y pay the lowest copayment for them. type, fol owed (in parentheses) by their most common brand-name(s). The brand-name drugs (in parentheses) are This list has been updated for 2008, however, this list may not usual y non-preferred, and are shown for information only.
reflect the preferred drug list that was finalized on your plan’s start date and updated as of your anniversary date. A copy of • The second list shows brand-name drugs in all the Preferred Drug List is available on the Blue Cross and Blue Shield of Texas web site, www.bcbstx.com.
In most cases, generic drugs – whether included on this list or not – are available at the lowest copayment. The brand-name This list was current at the time of printing and is subject
drugs (shown in all CAPITAL LETTERS) are available at the middle to change.
copayment. Non-preferred brand-name drugs require the highest copayment. Some are shown in parentheses, others are not listed.
Drug coverage is dependent on individual plan benefits.
ANTI-INFECTIVE DRUGS
acyclovir (Zovirax)
amoxicillin
amoxicillin/potassium clavulanate – 12 hour
dosing (Augmentin)
ampicillin
DIABETES, HORMONES AND
azithromycin (Zithromax)
RELATED DRUGS
cefadroxil (Duricef)
calcitonin-salmon nasal – Fortical
cefdinir (Omnicef))
desmopressin (DDVAP)
cefprozil (Cefzil)
dexamethasone (Decadron)
cefuroxime axetil tablets (Ceftin)
esterified estrogens/methyltestosterone
cephalexin (Keflex)
estradiol patches (Climara)
ciprofloxacin tablets (Cipro)
estradiol tablets (Estrace)
clindamycin (Cleocin)
estropipate (Ogen)
doxycycline hyclate
glimepiride (Amaryl)
erythromycin delayed-release (Eryc)
glipizide (Glucotrol)
erythromycin ethylsuccinate
glipizide extended-release (Glucotrol XL)
fluconazole (Diflucan)
glyburide (Diabeta, Micronase)
griseofulvin microsize suspension (Grifulvin V)
glyburide/metformin (Glucovance)
hydroxychloroquine (Plaquenil)
hydrocortisone tablets, 20 mg (Cortef)
itraconazole capsules (Sporanox)
levothyroxine – includes Levoxyl (Synthroid)
ketoconazole (Nizoral)
medroxyprogesterone acetate (Provera)
metronidazole (Flagyl)
metformin (Glucophage)
minocycline capsules, tablets
metformin extended-release (Glucophage XR)
nitrofurantoin monohydrate/macrocrystals
methylprednisolone (Medrol)
norethindrone acetate (Aygestin)
penicillin v potassium
oral contraceptives – all generics
ribavirin capsules (Rebetol)
ribavirin tablets (Copegus)
prednisone
terbinafine (Lamisil)
prednisolone sodium phosphate solution
tetracycline
trimethoprim/sulfamethoxazole (Bactrim, Septra)
thyroid (Armour Thyroid)
* Standardly not covered for fully insured business. Some exceptions may apply. Please check your specific plan documents.
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of Blue Cross and Blue Shield Association.
HEART AND CIRCULATORY DRUGS
amiodarone (Cordarone)
amlodipine (Norvasc)
amlodipine/benazepril (Lotrel)
atenolol (Tenormin)
atenolol/chlorthalidone (Tenoretic)
benazepril (Lotensin)
benazepril/hydrochlorothiazide (Lotensin HCT)
ALLERGIES, ASTHMA, COPD DRUGS
bisoprolol/hydrochlorothiazide (Ziac)
bumetanide (Bumex)
albuterol inhaler (Proventil)
captopril (Capoten)
codeine/guaifenesin solution, syrup, tablets
captopril/hydrochlorothiazide (Capozide)
cyproheptadine
GENITOURINARY DRUGS
carvedilol
fexofenadine (Allegra)
chlorthalidone tablets, 25 mg, 50 mg
flunisolide nasal spray
clindamycin vaginal cream (Cleocin)
cholestyramine (Questran, Questran Light)
fluticasone (Flonase)
finasteride (Proscar)
clonidine (Catapres)
ipratropium bromide nebulization solution
metrogel vaginal gel (Metrogel Vaginal)
digoxin (Lanoxin)
promethazine syrup, tablets (Phenergan)
oxybutynin (Ditropan)
diltiazem extended-release
promethazine suppositories (Phenergan)
terconazole (Terazol 3, 7)
theophylline extended-release
doxazosin (Cardura)
enalapril (Vasotec)
enalapril/hydrochlorothiazide (Vaseretic)
flecainide (Tambocor)
furosemide (Lasix)
gemfibrozil (Lopid)
guanfacine (Tenex)
hydrochlorothiazide
ALZHEIMER’S DISEASE; EMOTIONAL,
indapamide (Lozol)
MENTAL AND NERVOUS
isosorbide mononitrate extended-release
CONDITIONS, AND SLEEP
alprazolam (Xanax)
labetalol (Trandate)
amitriptyline
lisinopril (Prinivil, Zestril)
amphetamine/dextroamphetamine mixed salts
lisinopril/hydrochlorothiazide
bupropion (Wellbutrin)
lovastatin (Mevacor)
bupropion extended-release (Wellbutrin SR/
metoprolol succinate (Toprol XL)
metoprolol tartrate (Lopressor)
buspirone (Buspar)
nadolol (Corgard)
citalopram (Celexa)
nifedipine extended-release
clozapine tablets 25 mg, 100 mg (Clozaril)
dextroamphetamine (Dexedrine)
nitroglycerin sublingual tablets, patches
GASTROINTESTINAL DRUGS
dextroamphetamine extended-release
pravastatin (Pravachol)
cimetidine (Tagamet), 200 mg not covered
diazepam (Valium)
prazosin (Minipress)
dicyclomine (Bentyl)
doxepin (Sinequan)
propranolol (Inderal)
famotidine (Pepcid), 20 mg not covered
fluoxetine (Prozac)
propranolol/extended-release (Inderal LA)
hyoscyamine (Levsin)
hydroxyzine hcl (Atarax)
quinapril (Accupril)
hyoscyamine extended-release
hydroxyzine pamoate (Vistaril)
quinapril/hydrochlorothiazide (Accuretic)
imipramine hcl (Tofranil)
lactulose
simvastatin (Zocor)
lithium carbonate capsules
mesalamine enema (Rowasa)
sotalol (Betapace, Betapace AF)
lithium carbonate extended-release
metoclopramide (Reglan)
spironolactone (Aldactone)
misoprostol (Cytotec)
spironolactone/hydrochlorothiazide
lorazepam (Ativan)
omeprazole delayed-release (Prilosec),
methylphenidate (Ritalin)
terazosin (Hytrin)
methylphenidate extended-release (Ritalin SR)
ondansetron HCL (Zofran)
triamterene/hydrochlorothiazide
mirtazapine (Remeron)
ranitidine (Zantac), 150 mg not covered
nortriptyline (Pamelor)
verapamil (Calan)
sucralfate tablets (Carafate)
paroxetine hcl (Paxil)
verapamil extended-release (Calan SR, Verelan)
sulfasalazine (Azulfidine)
phenobarbital
prochlorperazine suppositories, 25 mg; tablets
sertraline (Zoloft)
temazepam (Restoril)
* Standardly not covered for fully insured business. Some exceptions may apply. Please check your specific plan documents.
trazodone (Desyrel)
baclofen
venlafaxine (Effexor)
benztropine
bromocriptine (Parlodel)
carbamazepine (Tegretol)
carbidopa/levodopa (Sinemet)
carbidopa/levodopa extended-release
clonazepam (Klonopin)
cyclobenzaprine (Flexeril)
EAR, MOUTH, THROAT, AND
gabapentin capsules, tablets (Neurontin)
SKIN DRUGS*
gabapentin tablets (Gabarone)
benzocaine/antipyrine ear soln
lamotigine (Lamictal)
betamethasone dipropionate, augmented, cream,
methocarbamol (Robaxin)
gel, ointment (Diprolene)
phenytoin sodium extended (Dilantin)
betamethasone dipropionate (Diprosone)
primidone (Mysoline)
clindamycin (Cleocin T)
tizanidine (Zanaflex)
clobetasol (Temovate)
valproic acid (Depakene)
desonide (DesOwen)
ARTHRITIS AND PAIN RELIEF DRUGS
zonisamide (Zonegran)
desoximetasone (Topicort)
acetaminophen/codeine (Tylenol with Codeine)
econazole (Spectazole)
acetaminophen/isometheptene/
erythromycin gel (Erygel)
dichloralphenazone (Midrin)
fluocinonide (Lidex)
allopurinol (Zyloprim)
halobetasol (Ultravate)
butalbital/acetaminophen/caffeine (Fioricet)
hydrocortisone valerate (Westcort)
butalbital/aspirin/caffeine (Fiorinal)
ketoconazole cream
butalbital/aspirin/caffeine/codeine
lidocaine viscous
metronidazole 0.75% (Metrocream/Metrogel)
diclofenac sodium delayed-release (Voltaren)
mometasone (Elocon)
etodolac (Lodine)
SUPPLEMENTS
mupirocin ointment (Bactroban)
fentanyl patches (Duragesic)
potassium chloride extended-release
neomycin/polymyxin B/hydrocortisone ear
hydrocodone/acetaminophen
prenatal multivitamins with 1 mg folic acid
nystatin cream, ointment, powder
ibuprofen, suspension (Motrin), 100 mg/5 mL
BLOOD MODIFYING DRUGS
nystatin/triamcinolone
silver sulfadiazine (Silvadene)
indomethacin capsules (Indocin)
cilostazol (Pletal)
tretinoin (Retin-A)
meloxicam (Mobic)
folic acid
triamcinolone acetonide (Kenalog)
methotrexate
pentoxifylline extended-release (Trental)
morphine sulfate extended-release (MS Contin)
warfarin (Coumadin)
nabumetone (Relafen)
naproxen (Naprosyn)
naproxen sodium (Anaprox)
oxycodone (Roxicodone)
EYE DRUGS
oxycodone extended-release (Oxycontin)
ciprofloxacin solution (Ciloxan)
oxycodone/acetaminophen (Percocet)
gentamicin ointment, solution
piroxicam (Feldene)
ketoprofen fumarate (Zaditor)
propoxyphene napsylate/acetaminophen
polymyxin B/trimethoprim solution (Polytrim)
prednisolone acetate suspension (Pred Forte)
sulfacetamide sodium (Bleph-10)
timolol maleate gel-forming solution (Timoptic-XE)
timolol maleate solution (Timoptic)
DIABETIC SUPPLIES
tobramycin solution (Tobrex)
PARKINSON’S DISEASE;
NEUROMUSCULAR AND
SEIZURE DRUGS
amantadine (Symmetrel)
* Standardly not covered for fully insured business. Some exceptions may apply. Please check your specific plan documents.
Prime Therapeutics LLC is the pharmacy benefit manager for Blue Cross and Blue Shield of Texas.
46849-0907 Prime Therapeutics LLC 01/08

Source: http://www.stanton.esc18.net/2008%20Most%20Commonly%20Prescribed.pdf