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Preferred Brand-Name Drugs (Tier 2)
(February, 2008)
This is the BCBSVT/TVHP Preferred Brand-Name Drug List (Tier 2). Use this list if your health plan includes the Three-Tier Prescription Drug Program.
This list reflects prescription drugs that are considered preferred brand name drugs; however, some of the drugs listed here require prior approval in order to be eligible for benefit.
Be sure to also check for Preferred Brand Name Drugs that have recent generic equivalents.
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ACIPHEX
ACTOS
ACTOPLUS MET
ACULAR
ADDERALL XR
AGENERASE
ALINIA
ALPHAGAN P
APIDRA
ARICEPT
ARIMIDEX
AROMASIN
ASACOL
ASTELIN
ATROVENT
AVANDAMET
AVANDIA
AVONEX
AZILECT
B
BENICAR
BENICAR HCT
BETASERON
BRAVELLE
C
CANASA
CARAC
CASODEX
CEENU
CELEBREX
CELLCEPT
CENESTIN
CETROTIDE
CIPRODEX
CLIMARA PRO
COMBIVENT
COMBIVIR
COMTAN
CONCERTA
CONDYLOX GEL
COPAXONE
CORTEF
CORTIFOAM
COZAAR
CREON
CRIXIVAN
CUPRIMINE
CYTOXAN
D
DAPSONE
DEPAKOTE
DEPAKOTE ER
DEPAKOTE SPRINKLE
DETROL
DILANTIN
DIPENTUM
DOVONEX
E
EFFEXOR XR
ELMIRON
EMCYT
ENBREL
ENTOCORT EC
EPIPEN
EPIVIR
EPIVIR -HBV
EPZICOM
ERGAMISOL
ESTRADERM
ESTRATEST
ESTRATEST HS
EVISTA
EVOXAC
EXELON
F
FARESTON
FEMARA
FINACEA
FLOMAX
FLOVENT
FLOVENT ROTADISK
FORTOVASE
FOSAMAX
FREESTYLE GLUCOMETER
FREESTYLE TEST STRIPS
G
GENOTROPIN
GLEEVEC
GLUCAGON
H
HEPSERA
HEXALEN
HIVID
HUMALOG
HUMIRA
HUMULIN
HYZAAR
I
IMITREX, all forms
INNOPRAN XL
INTAL INHALER
INTRON A
INVIRASE
K
KALETRA, capsule and solution
KEPPRA
L
LAMICTAL
LANTUS
LESCOL (to be removed 4/30/08)
LESCOL XL (to be removed 4/30/08)
LEUKERAN
LEVEMIR
LEXAPRO
LEXIVA
LIDODERM
LIPITOR
LOTEMAX
LOVENOX
LYSODREN
M
MAXALT
MEPHYTON
METHERGINE
METROGEL VAGINAL
MIACALCIN
MIGRANAL
MIRAPEX
MYLERAN | N
NAMENDA
NARDIL
NASONEX
NEUPOGEN
NEXAVAR
NEXIUM
NIASPAN
NILANDRON
NORDITROPIN
NORVIR
NOVOLIN
NOVOLOG
NOVOLOG MIX 70/30
NUVARING
O
ONE TOUCH GLUCOMETER
ONE TOUCH TEST STRIP
ORTHOVISC
OVIDE
OXSORALEN ULTRA
OXYTROL
P
PEGASYS
PEG-INTRON
PHOSLO
PLAN B
PLAVIX
PRANDIN
PRECISION GLUCOMETER
PRECISION TEST STRIPS
PRECOSE
PRED MILD
PREMARIN
PREMARIN CREAM
PREMPHASE
PREMPRO
PREVEN
PROCRIT
PROGRAF
PROVENTIL HFA
PROVIGIL
PULMICORT RESPULES
PULMOZYME
Q
QUIXIN
QVAR
R
RAPAMUNE
RAZADYNE
REBETRON
REBIF
RENAGEL
REQUIP
RESCRIPTOR
RESTASIS
REVATIO
REVLIMID
RIDAURA
RISPERDAL
S
SEREVENT
SEREVENT DISKUS
SEROQUEL
SINGULAIR
SKELAXIN
SPIRIVA
SPRYCEL
STALEVO
SUSTIVA
SUTENT
T
TARCEVA
TARGRETIN
TAZORAC
TEMODAR
TESLAC
THIOGUANINE I
TOBI
TOBRADEX
TOPAMAX
TREXALL
TRILEPTAL
TRIZIVIR
TRUSOPT
TRUVADA
TYZEKA
U
ULTRASE
ULTRASE MT
URSO
V
VALCYTE
VALTREX
VEPESID
VESANOID
VIAGRA
VIDEX
VIDEX EC
VIRACEPT
VIRAMUNE
VIREAD
VIVELLE
VOLMAX
VOLTAREN OPTHALMIC SOLUTION
VYTORIN
W
WELCHOL
X
XALATAN
XELODA
XENICAL
Y
YASMIN 28
YAZ
Z
ZERIT
ZETIA
ZIAGEN
ZOLINZA
ZOVIRAX TOPICAL
ZYPREXA
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