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Members with a three-tier pharmacy
plan have three options for copayments
for generic drugs, brand-names
and medications not included
on the Preferred Medication List. You
always pay the lowest for generic
drugs covered on the Preferred
Medication List. Quarterly, our panel
of doctors and pharmacists reviews
the list and adds new drugs to help
ensure that you get prescription coverage
that is safe and effective.
Effective 6/1/01:
Depakote ER
Gleevec
Lotemax
Videx EC
Viracept
Xeloda
| | Effective dates
shown:
Trileptal oral solution (6/19/01)
Capex 0.01% Shampoo (7/10/01)
Valcyte (8/14/01)
Campath (8/21/01)
Rapamune (8/21/01)
Nexium (10/15/01)
| | Effective 9/4/01:
Advair
Altace
Peg Intron
Zaditor
|
Effective 1/1/02:
Accupril**
Accuretic**
Amicar**
Baycol**
Beconase, AQ**
Bellergal-S
Betagan
Depo-testosterone
Dilaudid
Dilacor XR
Elimite 5% cream
| | Eulexin
Floxin**
Humatin
K-DUR
Klonopin
Levaquin**
Luride-SF
Neo-synephrine
ophthalmic drops
Neptazane
Nitro Dur 0.1; 0.2;
0.4; and 0.6
patches
| | Polytrim
ophthalmic drops
Prenate Advance**
Prozac
Quibron
Revia
Rhinocort, AQ**
Roxanol
Roxanol, T
Tapazole
Tequin**
Topicort LP
Vancenase, AQ**
|
*Brand name deleted only except for those marked (**)
**Alternative drug remains on the list.
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