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Network Providers can use myBlue Provider to check member benefits, including prescription drug benefits. Non-network and out-of-state providers can find a member's specific prescription drug formulary details by entering the Member ID and the provider's NPI on this prescription drug search page.

These changes have effective dates of June 15, 2013.

Proton Pump Inhibitor (PPI)

Medication	Current Status	New Status	Effective Date
Aciphex	Category 4	Non-covered	June 15, 2013
Dexilant	Category 4	Non-covered	June 15, 2013
Nexium	Category 4	Non-covered	June 15, 2013

These changes have effective dates of January 1, 2013.

Acne

Medication	Current Status	New Status	Effective Date
Minocycline ER	Category 4	Non-covered	January 1, 2013
Solodyn	Category 4	Non-covered	January 1, 2013

Antipsychotic

Medication	Current Status	New Status	Effective Date
Abilify	Category 3	Category 4	January 1, 2013

High Blood Pressure

Medication	Current Status	New Status	Effective Date
Atacand	Category 3	Category 4	January 1, 2013
Atacand HCT	Category 3	Category 4	January 1, 2013
Avalide	Category 3	Category 4	January 1, 2013
Avapro	Category 3	Category 4	January 1, 2013
Azor	Category 2	Category 4	January 1, 2013
Benicar	Category 2	Category 4	January 1, 2013
Benicar HCT	Category 2	Category 4	January 1, 2013
Diovan	Category 2	Category 4	January 1, 2013
Diovan HCT	Category 2	Category 4	January 1, 2013
Micardis	Category 3	Category 4	January 1, 2013
Micardis HCT	Category 3	Category 4	January 1, 2013
Teveten	Category 3	Category 4	January 1, 2013
Teveten HCT	Category 3	Category 4	January 1, 2013

These changes have effective dates of November 1, 2012.

Antimycobacterial

Medication	Current Status	New Status	Effective Date
Ethambutol	Category 1	Category 2	November 1, 2012

Antiviral

Medication	Current Status	New Status	Effective Date
Baraclude Solution	Category 3	Category 4	November 1, 2012
Baraclude Tablet	Category 2	Category 4	November 1, 2012
Tamiflu	Category 3	Category 4	November 1, 2012

Irritable Bowel Agents

Medication	Current Status	New Status	Effective Date
Budesonide Capsule	Category 2	Category 4	November 1, 2012

Prostatic Hypertrophy Agents

Medication	Current Status	New Status	Effective Date
Tamsulosin	Category 2	Category 1	November 1, 2012

These changes have effective dates of January 1, 2012

Antianginal Agents

Medication	Current Status	New Status	Effective Date
Amyl Nitrite	Category 2	Category 4	January 1, 2012
Dilatrate SR	Category 2	Category 4	January 1, 2012
Isordil Titradose	Category 2	Category 4	January 1, 2012
Nitro-Dur	Category 2	Category 4	January 1, 2012

Antiarrhythmics

Medication	Current Status	New Status	Effective Date
Norpace CR	Category 2	Category 4	January 1, 2012
Pacerone 100MG	Category 2	Category 4	January 1, 2012
Rythmol SR	Category 2	Category 4	January 1, 2012
Tikosyn	Category 2	Category 3	January 1, 2012

Antibiotics

Medication	Current Status	New Status	Effective Date
Proquin XR	Category 2	Category 4	January 1, 2012

Antihypertensives

Medication	Current Status	New Status	Effective Date
Reserpine	Category 1	Category 4	January 1, 2012
Demser	Category 2	Category 4	January 1, 2012
Losartan Potassium	Category 2	Category 1	January 1, 2012
Losartan Potassium/ Hydrochlorothiazide	Category 2	Category 1	January 1, 2012

Antimyobacterial Agents

Medication	Current Status	New Status	Effective Date
Paser	Category 2	Category 4	January 1, 2012
Priftin	Category 2	Category 4	January 1, 2012
Rifater	Category 2	Category 4	January 1, 2012
Seromycin	Category 2	Category 4	January 1, 2012
Trecator	Category 2	Category 4	January 1, 2012

Antivirals

Medication	Current Status	New Status	Effective Date
Tyzeka	Category 2	Category 3	January 1, 2012

Cephalosporins

Medication	Current Status	New Status	Effective Date
Cedax	Category 3	Category 4	January 1, 2012
Spectracef	Category 3	Category 4	January 1, 2012

Endocrine and Metabolic Agents - Misc.

Medication	Current Status	New Status	Effective Date
Actonel	Category 2	Category 3	January 1, 2012

Fluoroquinolones

Medication	Current Status	New Status	Effective Date
Avelox	Category 3	Category 4	January 1, 2012
Avelox ABC Pack	Category 3	Category 4	January 1, 2012
Factive	Category 3	Category 4	January 1, 2012
Levaquin	Category 2	Category 4	January 1, 2012
Noroxin	Category 3	Category 4	January 1, 2012

Tetracyclines

Medication	Current Status	New Status	Effective Date
Doxycycline	Category 2	Category 4	January 1, 2012
Alodox Convenience Kit	Category 2	Category 4	January 1, 2012
Morgidox	Category 1	Category 4	January 1, 2012
Ocudox Kit	Category 2	Category 4	January 1, 2012

Ulcer Drugs

Medication	Current Status	New Status	Effective Date
Cantil	Category 2	Not Covered	January 1, 2012
Pamine FQ Kit	Category 2	Not Covered	January 1, 2012

Urinary Anti-Infectives

Medication	Current Status	New Status	Effective Date
Methenamine Mandelate	Category 2	Category 4	January 1, 2012
Monurol	Category 2	Category 4	January 1, 2012
Phosphasal	Category 1	Category 4	January 1, 2012
Uretron D/S	Category 1	Category 4	January 1, 2012
Urin D/S	Category 1	Category 4	January 1, 2012
Urogesic-Blue	Category 2	Category 4	January 1, 2012
Ustell	Category 2	Category 4	January 1, 2012
Uticap	Category 2	Category 4	January 1, 2012
Utira-C	Category 1	Category 4	January 1, 2012
Utrona-C	Category 1	Category 4	January 1, 2012

Changes below show effective dates in the second half of 2011

Antihyperlipidemics

Medication	Current Status	New Status	Effective Date
Advicor	Category 3	Category 4	December 1, 2011
Altoprev	Category 3	Category 4	December 1, 2011
Crestor	Category 3	Category 4	December 1, 2011
Lescol	Category 3	Category 4	December 1, 2011
Lescol XL	Category 3	Category 4	December 1, 2011
Lipitor	Category 2	Category 4	December 1, 2011
Niaspan	Category 2	Category 4	December 1, 2011
Vytorin	Category 2	Category 4	December 1, 2011

Cardiovascular Agents - Misc.

Medication	Current Status	New Status	Effective Date
Caduet	Category 2	Category 3	December 1, 2011