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Anthem may cover only certain clinically equivalent drugs to further reduce your health care costs. If drug is not on the drug formulary (list), you must pay the copayment for the non-formulary drug. For the latest Anthem Blue Cross drug formulary information, check with A/T/S Topical Solution (erythromycin)* Abilify Acanya Accu-Check product line Accutane (isotretinoin)* Aceon (perindopril)* Aci-Jel Jelly (acetic acid vaginal)* Actigall (ursodiol)* Activella 0.1-0.5 Activella 1.0-0.5 (estradiol/norethindrone)* Actonel Acto Plus Met, XR Actos Acular, LS (ketorolac)* Akne-Mycin Adalat CC (nifedipine ER)* Adderall (amphetamine/dextroamphetamine)* Adderall XR (amphetamine/dextroamphetamine^#) Advair Advicor Agenerase Akne-Mycin Albalon (naphazoline)* Aldactazide (spironolactone/HCTZ)* Aldactone (spironolactone)* Aldara† Aldomet (methyldopa)* Aldoril (methyldopa/HCTZ)* Alesse (aviane)* Alkeran Allegra (fexofenadine)* Allegra D^ (fexofenadine/PSE 12hr)* Alphagan, P (brimonidine)* Altace (ramipril)* Altabax Alupent (metaproterenol)* Amaryl (glimepiride)* Ambien (zolpidem)* Amerge (naratriptan)* Amevive* Amicar (aminocaproic acid)* amitriptyline amitriptyline/perphenazine Amoxil (amoxicillin)* Anafranil (clomipramine)* Analpram HC lotion Anaprox, DS (naproxen sodium, DS)* Androderm Androgel Anexsia (hydrocodone/APAP)* Ansaid (flurbiprofen)* Antabuse Antivert (meclizine)* Anturane (sulfinpyrazone)* Anusol HC 25mg Suppositories (hydrocortisone)* Apresazide (hydralazine/HCTZ)* Apresoline (hydralazine)* apri Arava (leflunomide)* Aricept Arimidex (anastrozole)† Aristocort Topical (triamcinolone-acetonide)* Armour Thyroid Aromasin† Artane (trihexyphenidyl)* Asacol, HD Asendin (amoxapine)* Asmanex Astelin (azelastine)† Astepro Atarax (hydroxyzine HCL)* Ativan (lorazepam)* Atrovent HFA Atrovent (ipatropiumbromide)* Augmentin, XR (amoxicillin/clavulanic acid)* Auralgan (antipyrine/benzocaine)* Avandamet Avandaryl Avandia Avinza Avodart Axid (nizatidine)* Aygestin (norethindrone)* Azasan Aza Site Azilect Azopt Azulfidine, Entabs (sulfasalazine, EC)*Bactrim DS (Sulfamethoxazole/trimethoprim, DS)* Bactroban Baraclude Benadryl (diphenhydramine 50mg)* Bentyl (dicyclomine)* Benzac, AC, W (benzoyl peroxide)* Benzaclin (benxoyl peroxide/clindamycin)* Benzagel, Wash (benzoyl peroxide)* Benzamycin (benzoyl peroxide/erythromycin)* Betagan (levobunolol)* Betimol Betoptic S Biaxin, XL (clarithromycin, er)* Bicitra (sodium citrate & citric acid)* Bi Dil Bleph-10 (sulfacetamide-sodium solution)* Blephamide Brethine (terbutaline)* Bumex (bumetanide)* Buspar (buspirone)* Byetta Cafergot Canasa Cardizem, CD, LA, SR (diltiazem)* Casodex (bicalutamide)* Catapres, TTS (clonidine)* Colazol colchicine Colyte (polyethylene glycol-electrolyte solution)* Combi Patch Combipres (clonidine/chlorthalidone)* Combivent Combivir Compazine Supp 25mg (prochlorperazine supp 25mg)* Compazine Tab (prochlorperazine)* Comtan Concerta Condylox Solution (podofilox solution)* Cordarone (amiodarone)* Coreg (carvedilol)* Coreg CR Corgard (nadolol)* Cortef (hydrocortisone)* Cortenema (hydrocortisone enema)* Cortifoam Cortisporin Ophth (bacitracin - polymyxin/neomycin- hc opth oint)* Cortisporin Otic (neomycin/polymixin/hydrocortisone)* Cosopt (dorzolamide/timolol)* Coumadin (warfarin) Cozaar (losartan)* Creon Crestor Crixivan Crolom (cromolyn sodium)* Cuprimine Cyclocort (amcinonide)* Cyclogyl (cyclopentolate)* Cylert (pemoline)* Cymbalta cyproheptadine Cytomel (liothyronine)* Cytotec (misoprostol)* Cytovene (ganciclovir)* Cytoxan (cyclophosphamide)* Cytra-2, Cytra-3 Cytra-KDalmane (flurazepam)* Danocrine (danazol)* Dantrium (dantrolene)* Dapsone Daraprim Darvocet-N (propoxyphene/APAP)* Darvon Compound (propoxyphene/aspirin/caffeine)* Daypro (oxaprozin)* DDAVP (desmopressin acetate)* Decadron (dexamethasone)* Deconamine S. (chlorpheniramine/pseudoephedrine)* Demadex (torsemide)* Demerol (meperidine)* Demulen 28 day (ethinyl estradiol/ethynodiol diacetate-zovia)* Depakene (valproic acid)* Depakote (divalproex) Depakote ER Depo-Provera 150mg (medroxyprogesterone)* Derma-Smoothe/FS Desogen (apri)* Desowen Cream (desonide)* Desoxyn (methamphetamine)* Desquam, E, X (benzoyl peroxide)* Desyrel (trazodone)* Detrol, LA Dexedrine, CR (dextroamphetamine)* Dextrostat (dextroamphetamine)* Diabeta (glyburide)* Diamox (acetazolamide)* Diastat† Dibenzyline Differin (adapalene)† Diflucan (fluconazole)* diflunisal Dilacor XR (diltiazem CR)* Dilantin (phenytoin) Dilaudid (hydromorphone)* diltia XT Diovan Diovan HCT Diprolene Ointment (betamet diprop/ prop gyl)* Diprosone (betamethasone dipropionate)* Disalcid (salsalate)* Ditropan (oxybutynin)* Dolophine (methadone)* Domeboro (acetic acid/aluminum acetate)* Donnatal (belladonna/phenobarbital)* Dostinex (cabergoline)* Dovonex cream Dovonex soln (calcipotriene)* Duac CS Duetact Dulera Duragesic (fentanyl)* Duratuss G (guaifenesin SR)* Duricef Caps/Tabs (cefadroxil)* Dyazide (triamterene/HCTZ)* Dynacin (minocycline)* Dynapen (dicloxacillin)*E. After the generic drug becomes available and notification requirements are met, this brand-name drug will become non-formulary/Tier 3 or may no longer be covered by your prescription drug plan. Or, you can compare individual Virginia medical insurance plans from providers like Anthem Blue Cross Blue Shield. You should talk to your doctor about getting a medication that is on the drug formulary. Check with If you've got health insurance questions, we've got answers. This list may change often, and at any time without notice. The inclusion of a particular drug on the formulary is not a guarantee of coverage. S.)* Starlix (nateglinide) Stelazine (trifluoperazine)* Strattera Suboxone SL tab, SL film Subutex (buprenorphine)* Sular 20, 30 & 40mg (nisoldipine)* Sular 8.5, 17, 25.5 & 34mg Sulfacet-R (sodium sulfacetamide/sulfur)* Sultrin (triple sulfa)* Sustiva Symbicort Symbyax Symlin Symmetrel (amantadine)* Synalar (fluocinolone acetonide)* Synthroid (levothyroxine)Tagamet (cimetidine)* Talacen (pentazocine/apap)* Talwin NX (pentazocine nx)* Tambocor (flecainide)* Tarka (trandolapril/verapamil)* Tavist syrup, 2.68mg tabs (clemastine fumarate)* Tazorac Tegretol (carbamazepine) Tegretol XR (carbamazepine ER) Tekturna, HCT Temodar† Temovate (clobetasol)* Tenex (guanfacine)* Tenoretic (atenolol/chlorthalidone)* Tenormin (atenolol)* Terazol (terconazole)* Teslac Tessalon Perles (benzonatate)* Testim Theo-24 Theochron (theophylline)* Thorazine Tab (chlorpromazine tab)* Ticlid (ticlopidine)* Tigan (trimethobenzamide)* Tilade Timoptic (timololophthalmic)* Timoptic XE (timolol)* Tobi Tobradex oint. (tobramycin/dexamethasone)* Tobrex Soln (tobramycin)* Tofranil (imipramine)* Tolectin (tolmetin)* Topamax Topicort (desoximetasone)* Toprol XL (metoprolol)* Toradol (ketorolac tromethamine)* Toviaz Trandate (labetalol)* Transderm-Scop Tranxene (clorazepate)* Trental (pentoxifylline)* Treximet Tricor (fenofibrate)* Tri Leven (levo norgestrel)* Tri-Vi-Flor (triple vitamins w/fluoride)* Tridesilon (desonide)* Trilafon (perphenazine)* Trileptal (oxcarbazepine)* Trilipix Trimox (amoxicillin)* Trimpex (trimethoprim)* Trinsicon (iron/intrinsic factor/B12)* Triphasil (trivora)* Trizivir Trusopt (dorzolamide)* Tussi-12 (phenyleph/chlorphen/carbeta)* Tussi-Organidin NR (guaifenesin/codeine)* Tussi-Organidin NR DM (guaifenesin/dextromethorphan)* Tussi Caps Tussionex Pennkinetic ER Twinject Tylenol w/Cod (codeine/APAP)* Tylox (oxycodone w/acetaminophen)* Tympagesic (pramoxine/hc/chloroxylenol)*Univasc (moexipril)* Urecholine (bethanechol)* Urised (meth/salicylate/atropine/hyos benzoic)* Urocit-K (potassium citrate)* Urogesic Blue (methenamine/hyosc-meth blue/sod biphos-phenyl sal)* Uroxatral V-Cillin K (penicillin V. The Anthem prescription drug formulary list is designed to help Anthem's customers determine which drugs are covered under their health plan. All health insurance plan prices remain the same whether you buy direct from an insurance company or utilize a broker. The following is the current (2011) Anthem Blue Cross Blue Shield Drug Formulary List. FastPost metformin muscle Re-Loader Activator 3.0 For Windows & Office 2018 Anthem Blue Cross Blue Shield Drug Formulary / Drug List.
     
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