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Medicare drug alternatives

MedicareBlueSM Rx Drug
Alternatives
MedicareBlue Rx 3-Level Formulary is structured as follows:
The commonly used drugs listed in the table below would be covered at the Level 3 of the MedicareBlue Rx Formulary but were previously covered as formulary at Level 2 for Blue Cross Blue Shield of ND (BCBSND) members. For each of these drugs, there are clinically equivalent generic or alternative brand products on Levels 1 & 2 of the MedicareBlue Rx Formulary. The MedicareBlue Rx Formulary was reviewed and approved by the Pharmacy & Therapeutics Committee. Most members of this committee are practicing physicians or pharmacists. Please note that CMS (the part of the federal government that manages Medicare) excludes several classes of drugs from the Medicare Part D program. Some of these excluded classes are non-prescription drugs, drugs used for cosmetic purposes or hair growth, prescription vitamins and minerals (except for prenatal vitamins and fluoride preparations), drugs used for relief of cough and cold symptoms, drugs used for weight gain or weight loss, and drugs used to promote fertility. All drugs in the benzodiazepine and barbiturate classes are excluded; examples of these include Valium and phenobarbital. Any drug that can be covered by part B, based on the way it was prescribed, also cannot be covered under Medicare Part D. Key observations for the table below: • The information in this document is subject to change and is current as of March 8, 2006. MedicareBlue Rx may add or remove drugs from the formulary during the year. To get updated information about the drugs covered by MedicareBlue Rx, please visit the Website at 1-877-838-3827, 7 a.m. to 7 p.m. Central Time and 6 a.m. to 6 p.m. Mountain Time Monday through Friday. TTY/TDD users should call 1-800-693-3816. • Many of the drugs on this list are medications with short treatment duration (most of which involve a one-time treatment); therefore, physicians can quickly switch to Level 1 or Level 2 medications. • Members taking these medications may (a) ask their doctor to switch to another medication on a lower level, (b) continue with their current medications by paying a Level 3 cost share, or (c) ask to make an exception (generally, your request for an exception will only be approved if there is a medical reason for it). Drug Name
Preferred Brand Alternatives
(Covered on Level 3
Generic Alternatives
(Level 2 of MedicareBlue Rx
of MedicareBlue Rx formulary)
(Level 1 of MedicareBlue Rx formulary)
formulary)
antibiotic ear, aurobiotic-hc, cortomycin, neomycin/polymyxin/hc, oticin hc, otimar tretinoin, amnesteem, avita, benzagel wash, benzoyl peroxide 5/10, desquam-e, ethexderm ethexderm bpw-5, metronidazole, panoxyl, panoxyl aq, seba- phenytoin suspension, phenytoin extended acebutolol, atenolol, betaxolol, bisoprolol, labetolol, metoprolol, nadolol, pindolol, ak-pred, dexamethasone sodium phosphate, dexasol, fluor-op, fluorometholone, prednisol, prednisolone acetate 1%, prednisolone sodium Drug Name
Preferred Brand Alternatives
(covered on Level 3
Generic Alternatives
(Level 2 of MedicareBlue Rx
of MedicareBlue Rx formulary)
(Level 1 of MedicareBlue Rx formulary)
formulary)
chloroquine phosphate, hydroxychloroquine, mefloquine, quinerva, carbidopa & levodopa, amantadine, pergolide, benztropine, bromocriptine, clozapine, chlorpromazine, fluphenazine, perhenazine, prochorperazine, thioridazine, trifluoperazine, haloperidol, * Medications with short duration of treatment
For additional information regarding MedicareBlue Rx Formulary, including medication search alternatives or utilization management programs, please go to the Blue Cross Blue Shield website at This document presents a brief overview of some common prescription drugs and their generic and/or preferred brand alternatives under the MedicareBlue Rx 3-Level Formulary. The information in this document is subject to change and should not be used to determine whether your prescription drug expenses will be paid. The written Evidence of Coverage governs the benefits available.

Source: http://www.state.nd.us/ndpers/forms-and-publications/publications/medicare-blue-rx-drug-alternatives.pdf

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25 Hydroxy Vitamin D This information is provided for informational purposes only and is not intended to diagnosis, treat, cure, or prevent disease. Abnormal test values falling outside the Normal Range will be printed in bold and noted in the “Flag” column. Abnormal values should be reviewed by your primary physician and a copy of all testing should be included in your medical re

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