accessing your prescription drug information (continued)
• Pharmacy locator — fi nd a participating
• Coverage exception requests — initiate a
request for prior authorization or Non-formulary Consideration by following the instructions
• Online customer service — use email to contact
a CVS Caremark service representative for any questions about your prescription drug benefi t. • Methods of payment — pay by credit card,
check, or money order. Or use Bill Me Later®for mail-order prescriptions. Visit capbluecross.com to learn more.
The Preferred Medication List is an abbreviated
You can easily identify generic, preferred brand,
version of the Formulary list containing the names
or non-preferred brand drugs on the Preferred
of some of the most commonly prescribed drugs
Medication List as they will have the following
The Capital BlueCross formulary serves as a
reference for all prescription drug benefi t designs
ranging from an open formulary to aclosed formulary. • A closed formularyprovides access to both
generic (tier-one) and preferred brand-name
(tier-two) drugs. You or your physician may
request coverage for medically necessary non-preferred drugs through the Non-formulary
Members are encouraged to use generic or
preferred brand drugs which are typically less
expensive than non-preferred brand drugs.
An Open FormularyPlan provides access to
To help maximize the value of your prescription
generic (tier-one), preferred brand (tier-two),
drug benefi t, the names of the preferred formulary
and non-preferred brand-name (tier-three)
Alternatives Alternatives Drug Name Drug Name risperidone oxybutymin, -er omeprazole, pantoprazole perindopril phenytoin omeprazole, pantoprazole (QLL) enalapril, lisinopril alendronate (QLL) beclomethasone valerate amphetamine combinations enalapril, -hctz eplerenone estradiol alendronate (QLL) fexofenadine, -PSE ER brimonidine galantamine, ARICEPT, NAMENDA zolpidem (QLL) risperidone amlodipine (QLL) fenofi brate fexofenadine, -PSE ER ibuprofen, naproxen tamsulosin fl uoxetine (QLL) lisinopril/-hctz, BENICAR HCT (EPA), fl uticasone nasal spray (QLL) gabapentin galantamine, -ER lisinopril, BENICAR (EPA), gemfi brozil risperidone glimepiride glipizide, -er azithromycin glyburide, -metformin enalapril, lisinopril losartan/hctz clindamycin/benzoyl peroxide sumatriptan (QLL) bisoprolol, -hctz methylphenidate alendronate (QLL) metformin buprenorphine bupropion, -sr, -xl levetiracetam lamotrigine carvedilol, metoprolol xl carbidopa/levodopa ciprofl oxacin, AVELOX carvedilol levetiracetam meloxicam (QLL), nabumetone levothyroxine citalopram (QLL) citalopram (QLL) simvastatin (QLL), CRESTOR (EPA, QLL), fexofenadine lisinopril, -hctz methylphenidate er lovastatin (QLL) carvedilol, metoprolol xl dorzolamide/timolol zaleplon (QLL), zolpidem (QLL) warfarin gabapentin losartan meloxicam (QLL) venlafaxine metformin, -er Alternatives Alternatives Drug Name Drug Name metoprolol, -xl metaxalone pramipexole mirtazapine nateglinide amiodarone methylphenidate er, CONCERTA sumatriptan tablets (QLL) fl uticasone nasal spray (QLL) fl uticasone nasal spray (QLL) omeprazole, pantoprazole (QLL) levothyroxine tacrolimus omeprazole fl uticasone (QLL) topiramate ondansetron (QLL) tramadol, -ER (QLL) sumatriptan (QLL) + naproxen fentanyl triamterene -hctz tri-sprintec fenofi brate tri-sprintec oxybutynin, -er valacyclovir pantoprazole (QLL) venlafaxine paroxetine (QLL) fl uticasone (QLL) paroxetine, -CR (QLL) verapamil, -sr oxybutynin, -er pravastatin (QLL) lansoprazole (QLL) venlafaxine warfarin fexofenadine quinapril, quinaretic ramipril zaleplon (QLL) sumatriptan (QLL), MAXALT/-MLT (EPA, zolpidem (QLL) sumatriptan (QLL) fl uticasone (QLL) risperidone risperidone ropinirole G: Generics QLL: Quantity Level Limit P: Preferred Brands PAR: Prior Authorization Required zaleplon (QLL), zolpidem (QLL) NP: Non-preferred Brands EPA: Enhanced Prior Authorization carbamazepine, gabapentin granisetron, ondansetron
This list is not all-inclusive and does not guarantee coverage. Please
risperidone
check your Certifi cate of Coverage for detailed information regarding
individual drug coverage, pharmaceutical management procedures, benefi t limitations and exclusions.
The preferred medication list does not apply to Medicare Advantage or
risperidone risperidone sertraline simvastatin (QLL)
Preventive medications In addition to a healthy lifestyle, preventive medications can help people avoid many illnesses and conditions. A consumer-directed health (CDH) plan that includespreventive medications can help support the goal ofongoing good health. This list provides examples of your plan’s preventivemedications by drug category. This is not an all-inclusive list. Coverage prior t
Peri-operative Dexamethasone for Control of Pain After Total Knee Adam Rosen, DO*, Pam Pulido, RN, BSN†, Michelle Munro, BS†, Suzanne Daneshvari, RN, CCRC†, and Steven N. Copp, MD* *Scripps Clinic Division of Orthopaedics, La Jolla, CA †Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Abstract Despite great advances made in TKA implant design and surgical
accessing your prescription drug information (continued)
• Pharmacy locator — fi nd a participating
• Coverage exception requests — initiate a
request for prior authorization or Non-formulary Consideration by following the instructions
• Online customer service — use email to contact
a CVS Caremark service representative for any questions about your prescription drug benefi t.