Guia de medicinas ValueScript Rx

Transcripción

1 Enero de 06 Guia de medicinas ValueScript Rx Contenido Introducción...I Introducción... II Lista de medicinas... II roceso de excepción...ii Su parte de los gastos... III Beneficios de Farmacia rogramas para la Administración de la utilización... IV Notificación... IV Cómo utilizar la Guía de medicinas...x Abreviación/ Claves de acrónimos...xi Lista de medicinas... Medicinas para enfermedades infecciosas. Medicinas para el cáncer...4 Medicinas para las hormonas, la diabetes y enfermedades relacionadas...5 Medicinas para las enfermedades circulatorias y del corazón... 9 Medicinas para las enfermedades respiratorias... Medicinas para las enfermedades gastrointestinales...4 Medicinas para el tracto genitourinario...5 Medicinas para las enfermedades del Sistema Nervioso Central... 6 Medicinas para el alivio del dolor... 9 Medicinas para las enfermedades neuromusculares... Suplementos...3 Medicinas para modificar la sangre...3 roductos de uso tópico Categorías misceláneas...7 Índice...9 Hable con su médico para que le prescriba medicinas del formulario, que pueden ayudar a reducir los gastos a su cargo. Esta lista puede guiarle a usted y a su médico en cuanto a la selección de las medicinas adecuadas. El formulario de medicinas se actualiza regularmente. Visita la página de Internet para obtener la información más actualizada. ara buscar el nombre de una medicina dentro de este documento DF, utilice las teclas Control F en su teclado, o vaya a Edit (Cambiar) el menú desplegable y seleccione Find/Search (Buscar/Encontrar). Ingrese la palabra o frase que busca y haga clic en Search (Buscar). 30 FL rime Therapeutics LLC/6

2 Introducción Florida Blue se complace en presentar la Guia de medicinas ValueScript Rx. Esta es una guia general que incluye una lista integral de medicinas que pueden estar cubiertas por su plan. Ya que la cobertura de medicinas varía según el plan que compró o el que le ofrece su empleador, es importante que consulte los documentos de su plan para ver más información sobre la cobertura. Cuando nos referimos a "documentos del plan" nos estamos refiriendo a uno o más de los siguientes documentos: Folleto de beneficios, Certificado de cobertura, Contrato, Manual del asegurado o Endoso de medicinas recetadas. Si es un miembro actual, recomendamos que inicie sesión en su cuenta de miembro para obtener información específica sobre su cobertura de medicinas. Visite y haga clic en la pestaña de Miembros. Una vez que se registre, puede buscar una medicina por nombre y comparar costos en diferentes farmacias. odrá ver avisos que indican si una medicina requiere autorización previa o no está cubierta por su plan. If you wish to obtain this brochure in English, please call the customer service number on the back of your ID card and ask to be transferred to a bilingual representative. NOTA: Tanto usted como su médico deben decidir si le pueden prescribir una medicina recetada. Todas y cada una de las decisiones que requieren o estén relacionadas con una opinión o capacitación médica profesional independiente o con la necesidad de una medicina recetada, deben tomarlas únicamente usted y su médico tratante de acuerdo con la relación paciente/médico. Consejos importantes y autas de cobertura Al seguir estas sencillas pautas, puede estar seguro que está recibiendo el máximo beneficio de su plan. Cuando reciba sus medicinas recetadas, pregunte a su médico o farmacéutico si tiene disponible una medicina genérica equivalente. Las medicinas genéricas son menos caras y la mayoría están cubiertas a menos que se excluyan específicamente en los documentos de su plan. Las medicinas de marca están cubiertas por su plan solo si están incluidas en la lista de medicinas. Las medicinas de marca que no están incluidas en la lista de medicinas no están cubiertas. Si está tomando actualmente una medicina, tome un momento para revisar la lista de medicinas y determinar si está cubierta. Si no, verifique con su médico para entender las opciones de disponibilidad y revise la sección del ROCESO DE EXCECIÓN de esta Guia para conocer los procedimientos de excepción. Si usted o su proveedor solicitan una medicina recetada de marca cuando se encuentra disponible una medicina recetada genérica; usted será responsable de lo siguiente: () la diferencia en costo entre la medicina genérica y la medicina de marca que recibió; y () el costo compartido aplicable a la medicina de marca que recibió, como se indica en el lan de beneficios. ValueScript es un plan de farmacia con un formulario cerrado. Esto significa que cualquier medicina que no esté en el formulario (incluida en la lista de medicinas) no está cubierta. Lleve esta guia con usted cuando visite a su médico o proveedor de salud para saber cuáles medicinas se encuentran incluidas en la lista de medicinas y el costo de las diferentes opciones. Lista de medicinas Qué necesita saber sobre medicinas genéricas? Florida Blue recomienda el uso de medicinas genéricas como una manera de prescribir medicinas de alta calidad a un costo reducido. Las medicinas genéricas son tan seguras y efectivas como su contraparte de marca, y suelen ser considerablemente más baratas. Florida Blue es una marca registrada de Blue Cross and Blue Shield of Florida. Florida Blue HMO es una marca registrada de Health Options, Inc., una afiliada de Blue Cross and Blue Shield of Florida, Inc. Estas compañías son licenciatarias independientes de Blue Cross and Blue Shield Association. Guía de medicinas ValueScript Rx de Florida Blue para enero de 06 II

3 La Administración de Alimentos y Drogas de los Estados Unidos (Food and Drug Administration, FDA) aprobó que las medicinas genéricas pueden ser sustituidas por su contraparte de marca debido a que: Contienen el(los) mismo(s) ingrediente(s) activo(s) de la medicina de marca. Son idénticas en cuanto a concentración, dosis y vías de administración. Son terapeúticamente equivalentes y se espera que tengan el mismo efecto clinico y perfil de seguridad. Cambios al formulario Esta guia incluye la lista de medicinas que refleja las recomendaciones actuales de Florida Blue. Es desarrollada en conjunto con rime Therapeutics National harmacy & Therapeutics Committee. Florida Blue se reserva el derecho de agregar, eliminar o cambiar el nivel de cualquier medicina en esta Guia de medicinas en cualquier momento. La lista de medicinas se revisa cada tres meses para examinar las medicinas nuevas y la información más reciente sobre las medicinas que ya se encuentran en el Mercado en relación con la seguridad, la eficacia y su uso actual en la terapia. ara encontrar la información más actualizada sobre las modificaciones a las medicinas incluidas en la guia de medicinas: Visite el sitio de Internet Las guias de medicinas actualizadas se publican periódicamente durante todo el año. Hay varias razones para hacer cambios a las medicinas incluidas en la Guia de medicinas ValueScript Rx El nivel de una medicina de marca que se incluye en la lista de medicinas puede incrementarse (cambiar a un nivel más alto) cuando una medicina genérica bioequivalente es aprobada por la FDA. Las medicinas recetadas más recientes no podrán estar cubiertas hasta que el harmacy & Therapeutics Committee (Comité de Farmacia y Terapéutica) haya tenido la oportunidad de revisar la medicación, para determinar si la medicina estará cubierta y, en caso afirmativo, en qué nivel se aplicará con base en la seguridad, la eficacia y la disponibilidad de otros productos dentro de esa clase de medicinas. Solicitud para agregar medicinas al formulario Los médicos pueden solicitar agregar una medicina a la lista del formulario mediante la presentación de una solicitud por escrito a Florida Blue. Envíe la solicitud por correo a: Florida Blue Attn: harmacy rograms.o. Box 798 Jacksonville, FL Florida Blue es una marca registrada de Blue Cross and Blue Shield of Florida. Florida Blue HMO es una marca registrada de Health Options, Inc., una afiliada de Blue Cross and Blue Shield of Florida, Inc. Estas compañías son licenciatarias independientes de Blue Cross and Blue Shield Association. IIIGuía de medicinas ValueScript Rx de Florida Blue para enero 06

4 roceso de excepción Conforme a 45 C.F.R. 56., si una medicina no está cubierta en nuestro formulario, puede solicitar una excepción. Hemos establecido el proceso para solicitudes de excepción estándares y solicitudes de excepción aceleradas, como se describe a continuación. Solicitud de excepción estándar ara solicitar una excepción estándar, usted, su designado o el médico que prescribe (u otra persona autorizada para prescribir recetas) puede enviar una solicitud de excepción al completar y enviar el Formulario de solicitud de excepción de cobertura en el enlace que aparece a continuación. Le notificaremos a usted o su designado y al médico que prescribe (u otra persona autorizada para extender recetas) acerca de nuestra decision dentro de las 7 horas posteriores a la fecha en que recibimos su solicitud. Si aprobamos la excepción, proporcionaremos cobertura para la medicina exceptuada mientras dure la prescripción, con reabastecimientos incluidos. Solicitud de excepción acelerada uede solicitar una excepción acelerada si las circuntancias la exigen. Las circunstancias lo exigen cuando:. sufre de una condición médica que puede poner en peligro su vida, su salud o la capacidad de recobrar la máxima mejoría; o. se encuentra actualmente bajo un tratamiento que requiere una medicina que no esta cubierta en nuestro formulario. ara solicitar una excepción acelerada, usted, su designado o el medico que prescribe (u otra persona autorizada para prescribir recetas) puede enviar una solicitud de excepción al completar y enviar el Formulario de solicitud de excepción de cobertura en el enlace que aparece a continuación. Le notificaremos a usted o su designado y al médico que prescribe (u otra persona autorizada para prescribir recetas) nuestra decisión dentro de las 7 horas posteriores a la fecha en que recibimos su solicitud. Si aprobamos la excepción, proporcionaremos la cobertura para la medicina exceptuada para la duración de la exigencia. Formulario de solicitud de excepción de cobertura Qué ocurre si es denegada la solicitud de excepción? Si denegamos su solicitud estándar o acelerada para una excepción, usted, la persona que haya designado o el médico que prescribe (u otra persona autorizada para prescribir recetas) puede solicitar una revision de la solicitud original y nuestra denegación para una organización de revision externa independiente.. Si la solicitud de excepción original es una solicitud estándar, le notificaremos a usted o su designado y al médico que prescribe (u otra persona autorizada para extender recetas) nuestra decisión dentro de las 7 horas posteriores a la fecha en que recibimos su solicitud. Si aprobamos la excepción, proporcionaremos cobertura para la medicina exceptuada mientas dure la prescripción,. Si la solicitud de excepción original es una solicitud acelerada, le notificaremos a usted o su designado y al médico que prescribe (u otra persona autorizada para prescribir recetas) nuestra decisión dentro de las 7 horas posteriores a la fecha en que recibimos su solicitud. Si aprobamos la excepción, proporcionaremos cobertura para la medicina exceptuada mientras dure la exigencia. Florida Blue es una marca registrada de Blue Cross and Blue Shield of Florida. Florida Blue HMO es una marca registrada de Health Options, Inc., una afiliada de Blue Cross and Blue Shield of Florida, Inc. Estas compañías son licenciatarias independientes de Blue Cross and Blue Shield Association. Guía de medicinas ValueScript Rx de Florida Blue para enero de 06 IV

5 Su parte de los gastos Su costo compartido dependerá de cual es el nivel de costo compartido de la medicina asignada a: Nivel : Medicinas genéricas, medicinas de marca y suministros de bajo costo Nivel : Medicinas genéricas, medicinas de marca y suministros de bajo costo Nivel 3: Medicinas recetadas genéricas y medicinas de marca de alto costo Beneficios de farmacia rograma Condition Care Rx El rograma Condition Care Rx está diseñado para ayudar a controlar el costo de las medicinas utilizadas para el tratamiento de ciertos estados crónicos y cumplir con las indicaciones que garanticen la efectividad de la medicina. Si usted tiene el rograma Condition Care Rx como parte de sus beneficios, puede comprar las medicinas de la Lista "Condition Care Rx rogram Value List" a un costo reducido. uede encontrar una lista de medicinas que son parte del rograma Condition Care Rx en: Condition Care Rx rogram Value List NOTA: Consulte su lan de beneficios para determinar si el rograma Condition Care Rx aplica a su plan y ver el costo compartido aplicable. uede encontrar más información disponible sobre la cobertura al ingresar en la sección de miembros en Vacunas Algunas vacunas que están cubiertas bajo su cobertura de Beneficios preventivos pueden ser administradas por farmacéuticos certificados. No todas las farmacias brindan servicios de administración de vacunas. Es importante que se comunique con la farmacia para verificar la disponibilidad de la administración de vacunas. uede encontrar una lista de las vacunas que están cubiertas bajo su beneficio de farmacia en: harmacy Benefit Vaccines List Farmacia de pedido por correo Si recibe sus medicinas recetadas a través de una farmacia de pedido por correo puede reducir el costo que paga por sus medicinas recetadas. Consulte los documentos del plan para determinar si su plan brinda el beneficio de pedido por correo. Los miembros que tienen beneficios de farmacia a través de Florida Blue pueden acceder e imprimir el Formulario de pedido por correo en nuestro sitio de Internet NOTA: Si la receta original se surtió en una farmacia que no es una farmacia de pedido por correo, debe enviar una nueva receta original para un suministro de tres meses o un suministro para no menos de dos meses junto con el Formulario de inscripción y pedido por correo. Es posible que no puedan transferirse las recetas de una farmacia de venta al por menor a una farmacia de pedido por correo. Medicinas que no están cubiertas ValueScript es un plan de farmacia con un formulario cerrado. Esto significa que cualquier medicina que no esté en el formulario (incluida en la lista de medicinas) no está cubierta. Las razones por las cuales algunas medicinas no están cubiertas: Florida Blue es una marca registrada de Blue Cross and Blue Shield of Florida. Florida Blue HMO es una marca registrada de Health Options, Inc., una afiliada de Blue Cross and Blue Shield of Florida, Inc. Estas compañías son licenciatarias independientes de Blue Cross and Blue Shield Association. VGuía de medicinas ValueScript Rx de Florida Blue para enero 06

6 La medicina demostró tener efectos adversos excesivos y/o hay alternativas más seguras; La medicina tiene una alternativa preferida o se encuentra disponible sin receta (over-the-counter, OTC) La medicina ya no se comercializa La medicina tiene una formulación equivalente genérica de clasificación AB ampliamente disponible/distribuida; Medicina reempacada: se refiere al producto farmacéutico que se retira del envase del fabricante original (originador de la marca) y que otro fabricante reempaca con un Código nacional de medicina (NDC) diferente. Además, cualquier otra medicina que no aparezca en la guia de medicinas puede aparecer en una lista de ciertas medicinas que no están cubiertas en la Lista de medicinas no cubiertas NOTA: ara determinar las exclusiones de las medicinas que aplican a su plan, consulte los documentos del plan. La información de la cobertura también está disponible al ingresar a la sección de miembros dewww.floridablue.com Medicinas para quimoterapía oral Las medicinas para quimoterapía oral son medicinas recetadas por un médico para eliminar o disminuir el crecimiento de células cancerosas de una manera consistente con los estándares nacionales aceptados. uede encontrar un listado de estas medicinas en: Lista de medicinas para quimoterapía oral. Medicinas sin receta (over-the-counter, OTC) Una medicina sin receta puede ser un tratamiento adecuado para algunas condiciones y pueden tener un costo alternativo menor de algunas medicinas comúnmente recetadas. Su beneficio de farmacia puede ofrecer cobertura para ciertas medicinas sin receta. Algunos grupos pueden personalizar su plan de farmacia para excluir la cobertura de medicinas sin receta, por lo que es importante consultar los documentos de su plan para determinar si las medicinas sin receta están cubiertas bajo su plan. Sólo aquellas medicinas sin receta prescritas por su médico y designadas en el formulario con "OTC" entre parentesis después del nombre de la medicina son elegibles para cobertura. NOTA: Consulte los documentos de su plan para determinar si este beneficio aplica a su plan. La información de la cobertura también está disponible al ingresar a la sección Members (Miembros) de Servicios preventivos de la Ley de rotección al paciente y cuidados de salud a bajo precio (atient rotection and Affordable Care Act, ACA), Medicinas preventivas: ciertos servicios de atención preventivos, medicinas y vacunas están cubiertos sin costo compartido cuando se compran en una farmacia participante. La lista de medicinas cubiertas por su plan aparece en: Lista de medicinas preventivas Servicios preventivos para la mujer: algunas medicinas anticonceptivas o dispositivos (por ejemplo, anticonceptivos orales, anticonceptivos de emergencia y diafragmas) están cubiertos sin costo compartido cuándo se compran en una farmacia participante. La lista de medicinas cubiertas por su plan aparece en: Lista de servicios preventivos para la mujer Medicinas de farmacias especializadas Las medicinas de Farmacias especializadas son inyectables, de infusión, orales o para inhalar, con costos muy altos, que generalmente requieren supervisión y monitoreo cuidadoso de la terapia del paciente. NOTA: Consulte los documentos del plan para obtener información sobre cómo las medicinas de Farmacia especializada están cubiertas bajo su plan. Las medicinas especializadas están divididas en dos categorías: Medicinas especializadas auto-administrables: los pacientes de Farmacia especializada se administran las medicinas ellos mismos. Dado que estas medicinas están destinadas a autoadministrarse, no pueden ser cubiertas Florida Blue es una marca registrada de Blue Cross and Blue Shield of Florida. Florida Blue HMO es una marca registrada de Health Options, Inc., una afiliada de Blue Cross and Blue Shield of Florida, Inc. Estas compañías son licenciatarias independientes de Blue Cross and Blue Shield Association. Guía de medicinas ValueScript Rx de Florida Blue para enero de 06 VI

7 si se administran en un consultorio médico. Si estas medicinas no se obtienen en un participante de farmacia especializada, fuera de la red la cobertura no está disponible. El listado actual de Medicinas especializadas autoadministrables aparece aquí Medicinas especializadas administradas por un proveedor: estas medicinas requieren ser administradas por un médico. Las medicinas de Farmacia Especializada son ordenadas por un proveedor y administradas en el consultorio médico o establecimiento ambulatorio. Las medicinas administradas por un médico están cubiertas bajo su beneficio médico. Estas medicinas pueden obtenerse de cualquier proveedor de atencióm médica dentro de la red. El listado actual de Medicinas especializadas administradas por el proveedor aparece aquí. NOTA: Hemos notificado medicinas que pueden estar cubiertas como autoadministradas y/o administradas por el proveedor. Estos productos de Farmacia especializada se pueden obtener en establecimiento ambulatorio. roveedores participantes de Farmacia especializada Su red para Farmacias especializadas se limitan a los siguientes proveedores de Farmacias especializadas participantes. A menos que se indique a continuación, cualquier otra farmacia es considerada una Farmacia especializada no participante aún si participa en la red de Florida Blue para medicinas de Farmacia no especializada. Caremark Specialty harmacy Services Todos los productos Teléfono: Fax Farmacia Especializada Caremark Caremark Hemophilia Services roductos para la hemofilia Teléfono: (De lunes a viernes, de 9:00 a.m. to 7:30 p.m. EST) Fax: Caremark Hemophilia rime Therapeutics Specialty harmacy (rime Specialty harmacy Teléfono: MEDS (6337) Fax: TTY 7 rime Specialty harmacy rime Therapeutics Specialty harmacy (rime Specialty harmacy (rime Specialty harmacy) es una subsidiaria propiedad absoluta de rime Therapeutics LLC. NOTA: Las medicinas de Farmacia especializada no están cubiertas cuando se adquieren a través de las farmacias por correo. Si recibe una receta escrita directamente de su proveedor para una medicina administrada por un proveedor puede comunicarse con el departamento de servicio al cliente si necesita ayuda. Suministro para tres meses Además puede recibir un suministro para tres meses de medicinas a través de farmacia de orden por correo, es posible reciba un suministro hasta de tres meses de su medicina a través de una farmacia de venta al por menor participante. Consulte los documentos de su plan para determinar si su plan incluye estos beneficios. rogramas sobre la administración del uso rograma rior Authorization (Autorización previa) El rograma rior Authorization recomienda el uso apropiado, seguro y de costo efectivo de las medicinas. Si está tomando o se le recetó una medicina que está incluida en el rograma rior Authorization, su médico necesitará enviar un formulario de solicitud para que su receta sea considerada como cubierta. Si no solicita y/o recibe aprobación previa, la medicina no será cubierta. Las medicinas que requieren autorización previa para cobertura se indican en la columna de autorización previa que sigue al nombre del producto en la lista de medicinas. Florida Blue es una marca registrada de Blue Cross and Blue Shield of Florida. Florida Blue HMO es una marca registrada de Health Options, Inc., una afiliada de Blue Cross and Blue Shield of Florida, Inc. Estas compañías son licenciatarias independientes de Blue Cross and Blue Shield Association. VIIGuía de medicinas ValueScript Rx de Florida Blue para enero 06

8 NOTIFICACIÓN: Algunos grupos pueden personalizar su plan de farmacia para excluir los requisitos de autorización previa, por lo que es importante consultar los documentos del plan para determinar si los requisitos de autorización previa aplican a su plan. Información sobre la cobertura se encuentra disponible al ingresar en la sección de miembros de Cómo obtener Autorización previa La información sobre rior Authorization y el formulario de como obtener la aprobación de autorización previa se puede encontrar aquí: Información y formularios del rograma rior Authorization NOTA: Se requiere que su proveedor complete y envie el formulario de rior Authorization para que se haga la determinación de la cobertura.. Una vez que se hace la decisión, se le informará a usted y/o su médico.. Si se hace la decisión para la autorización de la cobertura, la(s) medicina(s) y/o los suministros pueden obtenerse de una farmacia participante o en un lugar adecuado si la(s) medicina(s) se administra(n) por un profesional de la salud. La aprobación de la autorización previa no elimina el costo compartido. 3. Si se hace la decisión de denegar la autorización, puede obtener la medicina recetada, suministros o medicinas sin receta (OTC), pero tendrá que pagar el costo completo de la medicina y no tendrá derecho a reembolso en virtud de su plan. NOTA: Usted tiene derecho a solicitar un apelación si se deniega la autorización previa. Consulte la subsección How to Appeal an Adverse Benefit Determination (Cómo apelar una Determinación adversa) de la sección Complaint and Grievance rocess (roceso de quejas y apelaciones) en su Folleto de beneficios o Contrato actual para ver la información sobre como presentar un apelación. rograma Responsible Quantity (Cantidad Responsable) El rograma Responsible Quantity recomienda el uso adecuado, seguro y económico de medicinas al establecer una cantidad máxima por mes para una medicina o suministro. Las limitaciones de cantidad se basan en las pautas de la Administración de alimentos y medicinas y recomendaciones de dosificación del fabricante. Las medicinas sujetas a este programa se indican en la columna que limita la cantidad, al lado del nombre del producto en la lista de medicinas. La información sobre el rgrama Responsible Quantity y los pasos para cómo obtener una excepción se pueden encontrar aquí: Información sobre el rograma Responsible Quantity Solicitud de excepción U/M Si, por razones médicas, usted necesita una cantidad de medicinas fuera de los límites del rograma Responsible Quantity o necesita un nivel de excepción para anticonceptivos, su médico puede enviar una solicitud de excepción para completar uno de los formularios que aparecen a continuación: Formulario de autorización previa Formulario de autorización para Formulario de Solicitud de Excepción para el nivel de Anticonceptivo Notificación Esta Guia de medicinas no extiende, varía, altera, reemplaza, o elimina ninguna de las cláusulas, beneficios, exlusiones, limitaciones, o condiciones contenidas en el Folleto de beneficios, el Contrato o el Endoso de medicinas recetadas. En el caso de alguna discrepancia entre la Guia de medicinas y las cláusulas contenidas en el Folleto de Beneficios, el Contrato o el Endoso de medicinas recetadas, las cláusulas contenidas en el Folleto de beneficios, el Contrato o el Endoso de medicinas recetadas prevalecerán en la medida necesaria para cumplir con el objetivo de Florida Blue y Florida Blue HMO. Florida Blue es una marca registrada de Blue Cross and Blue Shield of Florida. Florida Blue HMO es una marca registrada de Health Options, Inc., una afiliada de Blue Cross and Blue Shield of Florida, Inc. Estas compañías son licenciatarias independientes de Blue Cross and Blue Shield Association. Guia de medicinas ValueScript Rx de Florida Blue para enero del 06

9 Como utilizar la Guia de medicinas La lista de medicinas se organiza dentro de amplias categorías (por ejemplo, Antibacteriales). A continuación se describen las columnas incluidas en la lista de medicinas. Column. : indica el nombre de la medicina Las medicinas genéricas aparecen en letras minúsculas Información separada para las medicinas se muestran para cada concentración y forma. Nota: Las medicinas auto-administradas inyectables se designan en la lista de medicinas con "inj" seguido del nombre de la medicina (por ejemplo enoxaparin inj). Column. : indica el nivel y si la medicina está en la lista de preventivos o en la lista del rograma Condition Care Rx: : Medicinas del rograma Condition Care Rx : Medicinas preventivas Nivel : Medicinas genéricas, medicinas de marca y suministros con el menor costo Nivel : Medicinas genéricas, medicinas de marca y suministros de bajo costo Nivel 3: Medicinas genéricas y medicinas de marca de alto costo Column 3. : indica si la medicina es especializada autoadministrable. Column 4. rior Authorization (): indica si el requisito de una autorización previa se solicita para la medicina. Si está presente un indicador en la columna, entonces se aplica el requisito de autorización previa. Column 5. Responsible Quantity (): indica si aplican límites de cantidad para la medicina. Si está presente un indicador en la columna, entonces se aplica el requisito de limites de cantidad. Column 6. : indica si la medicina tiene distribución limitada. Si está presente un indicador en la columna, la medicina puede estar disponible sólo en algunas farmacias. Si necesita más información consulte el directorio de farmacia. Florida Blue es una marca registrada de Blue Cross and Blue Shield of Florida. Florida Blue HMO es una marca registrada de Health Options, Inc., una afiliada de Blue Cross and Blue Shield of Florida, Inc. Estas compañías son licenciatarias independientes de Blue Cross and Blue Shield Association. XIGuia de medicinas ValueScript Rx de Florida Blue para enero del 06

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11 Abreviatura/siglas Caps... cápsulas (capsules) chew tabs... tabletas masticables (chewable tablets) conc...concentrado (concentrate) crm...crema (cream) ext-release...liberación lenta (extended-release) inhal...inhalación (inhalation) inj...injección (injection) lotn... loción (lotion) N...no preferida (non-preferred) ODT...tabletas que se desintregan oralmente (orally disintegrating tablets) oint...pomada (ointment) OSM...liberación osmótica (osmotic-release) OTC.sin receta (over-the-counter) A...Requiere autorización previa (rior Authorization required) QL...rograma de cantidad responsable (Responsible Quantity rogram) aplica un límite de cantidad SI...Medicinas autoinyectables (Self-Administered Injectables) SL...Sublingual (Sublingual) S..Farmacia especializada (Specialty harmacy) Soln...solución (solution) Supp...supositorios (suppositories) Susp...suspensión (suspension) Tabs...tabletas (tablets) Este documento es una traducción de su original escrito en inglés. Los términos en inglés prevalecerán en caso de alguna disputa con respecto al significado de este documento o sus términos. en caso de alguna disputa con respecto al significado de este documento o sus Florida Blue es una marca registrada de Blue Cross and Blue Shield of Florida. Florida Blue HMO es una marca registrada de Health Options, Inc., una afiliada de Blue Cross and Blue Shield of Florida, Inc. Estas compañías son licenciatarias independientes de Blue Cross and Blue Shield Association. V Guia de medicinas ValueScript Rx de Florida Blue para enero de 06

12 06 AGENTES ANTIINFEIOSOS ENICILINAS AMOXICILLIN - amoxicillin (trihydrate) chew tab 50 mg amoxicillin (trihydrate) cap 50 mg amoxicillin (trihydrate) cap 500 mg amoxicillin (trihydrate) for susp 5 mg/5ml amoxicillin (trihydrate) for susp 00 mg/5ml amoxicillin (trihydrate) for susp 50 mg/5ml amoxicillin (trihydrate) for susp 400 mg/5ml amoxicillin (trihydrate) tab 500 mg amoxicillin (trihydrate) tab 875 mg amoxicillin & k clavulanate chew tab mg amoxicillin & k clavulanate chew tab mg amoxicillin & k clavulanate for susp mg/5ml amoxicillin & k clavulanate for susp mg/5ml (Augmentin) amoxicillin & k clavulanate for susp mg/5ml amoxicillin & k clavulanate for susp mg/5ml (Augmentin es-600) amoxicillin & k clavulanate tab sr hr mg (Augmentin xr) amoxicillin & k clavulanate tab 50-5 mg amoxicillin & k clavulanate tab mg (Augmentin) amoxicillin & k clavulanate tab mg (Augmentin) AMICILLIN - ampicillin for susp 5 mg/5ml AMICILLIN - ampicillin for susp 50 mg/5ml ampicillin cap 50 mg ampicillin cap 500 mg AUGMENTIN - amoxicillin & k clavulanate for susp mg/5ml dicloxacillin sodium cap 50 mg dicloxacillin sodium cap 500 mg penicillin v potassium for soln 5 mg/5ml penicillin v potassium for soln 50 mg/5ml penicillin v potassium tab 50 mg penicillin v potassium tab 500 mg CEFALOSORINAS CEDAX - ceftibuten cap 400 mg 3 cefaclor cap 50 mg cefaclor cap 500 mg cefadroxil cap 500 mg cefadroxil for susp 50 mg/5ml cefadroxil for susp 500 mg/5ml cefadroxil tab gm cefdinir cap 300 mg cefdinir for susp 5 mg/5ml cefdinir for susp 50 mg/5ml cefixime for susp 00 mg/5ml (Suprax) cefixime for susp 00 mg/5ml (Suprax) cefpodoxime proxetil for susp 50 mg/5ml cefpodoxime proxetil for susp 00 mg/5ml cefpodoxime proxetil tab 00 mg cefpodoxime proxetil tab 00 mg cefprozil for susp 5 mg/5ml cefprozil for susp 50 mg/5ml cefprozil tab 50 mg cefprozil tab 500 mg cefuroxime axetil tab 50 mg (Ceftin) cefuroxime axetil tab 500 mg (Ceftin) Guia de medicinas ValueScript de Florida Blue para enero de 06

13 06 cephalexin cap 50 mg (Keflex) cephalexin cap 500 mg (Keflex) cephalexin cap 750 mg (Keflex) cephalexin for susp 5 mg/5ml cephalexin for susp 50 mg/5ml SECTRACEF - cefditoren pivoxil tab 00 mg (base equivalent) SECTRACEF - cefditoren pivoxil tab 400 mg (base equivalent) 3 3 SURAX - cefixime chew tab 00 mg 3 SURAX - cefixime chew tab 00 mg 3 SURAX - cefixime for susp 00 mg/5ml 3 SURAX - cefixime for susp 00 mg/5ml 3 SURAX - cefixime for susp 500 mg/5ml 3 MACRÓLIDOS azithromycin for susp 00 mg/5ml (Zithromax) azithromycin for susp 00 mg/5ml (Zithromax) azithromycin tab 50 mg (Zithromax) azithromycin tab 500 mg (Zithromax) azithromycin tab 600 mg (Zithromax) clarithromycin for susp 5 mg/5ml clarithromycin for susp 50 mg/5ml (Biaxin) clarithromycin tab sr 4hr 500 mg clarithromycin tab 50 mg (Biaxin) clarithromycin tab 500 mg (Biaxin) DIFICID - fidaxomicin tab 00 mg ERY-TAB - erythromycin tab delayed release 50 mg ERY-TAB - erythromycin tab delayed release 333 mg ERY-TAB - erythromycin tab delayed release 500 mg ERYTHROMYCIN BASE - erythromycin tab 50 mg ERYTHROMYCIN BASE - erythromycin tab 500 mg ERYTHROMYCIN ETHYLSUINA - erythromycin ethylsuccinate tab 400 mg erythromycin w/ delayed release particles cap 50 mg ZITHROMAX - azithromycin powd pack for susp gm TETRACICLINAS demeclocycline hcl tab 50 mg demeclocycline hcl tab 300 mg doxycycline hyclate cap 50 mg doxycycline hyclate cap 00 mg (Vibramycin) doxycycline hyclate tab delayed release 75 mg doxycycline hyclate tab delayed release 00 mg doxycycline hyclate tab delayed release 50 mg doxycycline hyclate tab 0 mg doxycycline hyclate tab 00 mg doxycycline monohydrate cap 50 mg doxycycline monohydrate cap 75 mg (Monodox) doxycycline monohydrate cap 00 mg (Monodox) doxycycline monohydrate cap 50 mg (Adoxa) doxycycline monohydrate for susp 5 mg/5ml (Vibramycin) doxycycline monohydrate tab 50 mg (Adoxa) doxycycline monohydrate tab 75 mg (Adoxa) doxycycline monohydrate tab 00 mg (Adoxa pak /00) doxycycline monohydrate tab 50 mg (Adoxa pak /50) Guia de medicinas ValueScript de Florida Blue para enero de 06

14 06 minocycline hcl cap 50 mg (Minocin) minocycline hcl cap 75 mg (Minocin) minocycline hcl cap 00 mg (Minocin) minocycline hcl tab sr 4hr 45 mg minocycline hcl tab sr 4hr 90 mg minocycline hcl tab sr 4hr 35 mg minocycline hcl tab 50 mg minocycline hcl tab 75 mg minocycline hcl tab 00 mg TETRACYCLINE HCL - tetracycline hcl cap 50 mg TETRACYCLINE HCL - tetracycline hcl cap 500 mg FLUOROQUINOLONAS ciprofloxacin for oral susp 50 mg/5ml (5%) (5 gm/00ml) (Cipro) ciprofloxacin for oral susp 500 mg/5ml (0%) (0 gm/00ml) (Cipro) ciprofloxacin hcl tab 50 mg (base equiv) (Cipro) ciprofloxacin hcl tab 500 mg (base equiv) (Cipro) ciprofloxacin hcl tab 750 mg (base equiv) ciprofloxacin-ciprofloxacin hcl tab sr 4hr 500 mg (base eq) (Cipro xr) ciprofloxacin-ciprofloxacin hcl tab sr 4hr 000 mg(base eq) (Cipro xr) FACTIVE - gemifloxacin mesylate tab 30 mg (base equiv) levofloxacin oral soln 5 mg/ml (Levaquin) levofloxacin tab 50 mg (Levaquin) levofloxacin tab 500 mg (Levaquin) levofloxacin tab 750 mg (Levaquin) moxifloxacin hcl tab 400 mg (base equiv) (Avelox) AMINOGLUCÓSIDOS 3 BETHKIS - tobramycin nebu soln 300 mg/4ml neomycin sulfate tab 500 mg paromomycin sulfate cap 50 mg TOBI ODHALER - tobramycin inhal cap 8 mg tobramycin nebu soln 300 mg/5ml (Tobi) SULFONAMIDAS SULFADIAZINE - sulfadiazine tab 500 mg AGENTES ANTIMICOBACTERIANOS CYCLOSERINE - cycloserine cap 50 mg ethambutol hcl tab 00 mg (Myambutol) ethambutol hcl tab 400 mg (Myambutol) ISONIAZID - isoniazid syrup 50 mg/5ml isoniazid tab 00 mg 3 isoniazid tab 300 mg ASER - aminosalicylic acid cr granules 3 packet 4 gm RIFTIN - rifapentine tab 50 mg pyrazinamide tab 500 mg rifabutin cap 50 mg (Mycobutin) RIFAMATE - isoniazid & rifampin cap mg rifampin cap 50 mg (Rifadin) rifampin cap 300 mg (Rifadin) SIRTURO - bedaquiline fumarate tab 00 mg (base equiv) ANTIMICÓTICOS fluconazole for susp 0 mg/ml (Diflucan) fluconazole for susp 40 mg/ml (Diflucan) fluconazole tab 50 mg (Diflucan) fluconazole tab 00 mg (Diflucan) 3 Guia de medicinas ValueScript de Florida Blue para enero de 06 3

15 06 fluconazole tab 50 mg (Diflucan) fluconazole tab 00 mg (Diflucan) flucytosine cap 50 mg (Ancobon) flucytosine cap 500 mg (Ancobon) griseofulvin microsize susp 5 mg/5ml griseofulvin microsize tab 500 mg (Grifulvin v) griseofulvin ultramicrosize tab 5 mg (Gris-peg) griseofulvin ultramicrosize tab 50 mg (Gris-peg) itraconazole cap 00 mg (Sporanox) NOXAFIL - posaconazole susp 40 mg/ml nystatin tab unit SORANOX - itraconazole oral soln 0 mg/ml terbinafine hcl tab 50 mg (Lamisil) voriconazole for susp 40 mg/ml (Vfend) voriconazole tab 50 mg (Vfend) voriconazole tab 00 mg (Vfend) ANTIVIRALES abacavir sulfate tab 300 mg (base equiv) (Ziagen) abacavir sulfate-lamivudinezidovudine tab mg (Trizivir) acyclovir cap 00 mg (Zovirax) acyclovir susp 00 mg/5ml (Zovirax) acyclovir tab 400 mg (Zovirax) acyclovir tab 800 mg (Zovirax) adefovir dipivoxil tab 0 mg (Hepsera) ATIVUS - tipranavir cap 50 mg ATIVUS - tipranavir oral soln 00 mg/ ml ATRILA - efavirenz-emtricitabinetenofovir df tab mg BARACLUDE - entecavir oral soln 0.05 mg/ml COMLERA - emtricitabine-rilpivirinetenofovir df tab mg CRIXIVAN - indinavir sulfate cap 00 mg CRIXIVAN - indinavir sulfate cap 400 mg didanosine delayed release capsule 5 mg (Videx ec) didanosine delayed release capsule 00 mg (Videx ec) didanosine delayed release capsule 50 mg (Videx ec) didanosine delayed release capsule 400 mg (Videx ec) EDURANT - rilpivirine hcl tab 5 mg (base equivalent) EMTRIVA - emtricitabine caps 00 mg EMTRIVA - emtricitabine soln 0 mg/ml entecavir tab 0.5 mg (Baraclude) entecavir tab mg (Baraclude) EIVIR HBV - lamivudine oral soln 5 mg/ml (hbv) EZICOM - abacavir sulfate-lamivudine tab mg EVOTAZ - atazanavir sulfate-cobicistat tab mg (base equiv) famciclovir tab 5 mg (Famvir) famciclovir tab 50 mg (Famvir) famciclovir tab 500 mg (Famvir) FUZEON - enfuvirtide for inj 90 mg HARVONI - ledipasvir-sofosbuvir tab mg HESERA - adefovir dipivoxil tab 0 mg 3 INTELENCE - etravirine tab 5 mg INTELENCE - etravirine tab 00 mg INTELENCE - etravirine tab 00 mg 4 Guia de medicinas ValueScript de Florida Blue para enero de 06

16 06 INVIRASE - saquinavir mesylate cap 00 mg INVIRASE - saquinavir mesylate tab 500 mg ISENTRESS - raltegravir potassium chew tab 5 mg (base equiv) ISENTRESS - raltegravir potassium chew tab 00 mg (base equiv) ISENTRESS - raltegravir potassium packet for susp 00 mg (base equiv) ISENTRESS - raltegravir potassium tab 400 mg (base equiv) KALETRA - lopinavir-ritonavir soln mg/5ml (80-0 mg/ml) KALETRA - lopinavir-ritonavir tab 00-5 mg KALETRA - lopinavir-ritonavir tab mg lamivudine oral soln 0 mg/ml (Epivir) lamivudine tab 00 mg (hbv) (Epivir hbv) lamivudine tab 50 mg (Epivir) lamivudine tab 300 mg (Epivir) lamivudine-zidovudine tab mg (Combivir) LEXIVA - fosamprenavir calcium susp 50 mg/ml (base equiv) LEXIVA - fosamprenavir calcium tab 700 mg (base equiv) NEVIRAINE - nevirapine susp 50 mg/5ml nevirapine tab sr 4hr 400 mg (Viramune xr) nevirapine tab 00 mg (Viramune) NORVIR - ritonavir cap 00 mg NORVIR - ritonavir oral soln 80 mg/ml NORVIR - ritonavir tab 00 mg EG-INTRON - peginterferon alfa-b for inj kit 50 mcg/0.5ml EG-INTRON - peginterferon alfa-b for inj kit 80 mcg/0.5ml EG-INTRON - peginterferon alfa-b for inj kit 0 mcg/0.5ml EG-INTRON - peginterferon alfa-b for inj kit 50 mcg/0.5ml EG-INTRON REDIEN - peginterferon alfa-b for inj kit 50 mcg/0.5ml EG-INTRON REDIEN - peginterferon alfa-b for inj kit 80 mcg/0.5ml EG-INTRON REDIEN - peginterferon alfa-b for inj kit 0 mcg/0.5ml EG-INTRON REDIEN - peginterferon alfa-b for inj kit 50 mcg/0.5ml EG-INTRON REDIEN AK 4 - peginterferon alfa-b for inj kit 50 mcg/0.5ml EG-INTRON REDIEN AK 4 - peginterferon alfa-b for inj kit 80 mcg/0.5ml EG-INTRON REDIEN AK 4 - peginterferon alfa-b for inj kit 0 mcg/0.5ml EG-INTRON REDIEN AK 4 - peginterferon alfa-b for inj kit 50 mcg/0.5ml EGASYS - peginterferon alfa-a inj 80 mcg/ml EGASYS - peginterferon alfa-a inj 80 mcg/0.5ml EGASYS ROCLICK - peginterferon alfa-a inj 35 mcg/0.5ml EGASYS ROCLICK - peginterferon alfa-a inj 80 mcg/0.5ml EGINTRON - peginterferon alfa-b for inj kit 50 mcg/0.5ml EGINTRON - peginterferon alfa-b for inj kit 80 mcg/0.5ml EGINTRON - peginterferon alfa-b for inj kit 0 mcg/0.5ml EGINTRON - peginterferon alfa-b for inj kit 50 mcg/0.5ml Guia de medicinas ValueScript de Florida Blue para enero de 06 5

17 06 REZCOBIX - darunavir-cobicistat tab mg REZISTA - darunavir ethanolate susp 00 mg/ml (base equiv) REZISTA - darunavir ethanolate tab 75 mg (base equiv) REZISTA - darunavir ethanolate tab 50 mg (base equiv) REZISTA - darunavir ethanolate tab 600 mg (base equiv) REZISTA - darunavir ethanolate tab 800 mg (base equiv) RELENZA DISKHALER - zanamivir aero powder breath activated 5 mg/ blister RESCRITOR - delavirdine mesylate tab 00 mg RESCRITOR - delavirdine mesylate tab 00 mg REYATAZ - atazanavir sulfate cap 50 mg (base equiv) REYATAZ - atazanavir sulfate cap 00 mg (base equiv) REYATAZ - atazanavir sulfate cap 300 mg (base equiv) REYATAZ - atazanavir sulfate oral powder packet 50 mg (base equiv) RIBATAB - ribavirin tab 400 mg & ribavirin tab 600 mg dose pack RIBATAB - ribavirin tab 400 mg RIBATAB - ribavirin tab 600 mg ribavirin cap 00 mg (Rebetol) ribavirin tab 00 mg (Copegus) rimantadine hydrochloride tab 00 mg (Flumadine) SELZENTRY - maraviroc tab 50 mg SELZENTRY - maraviroc tab 300 mg SOVALDI - sofosbuvir tab 400 mg stavudine cap 5 mg (Zerit) stavudine cap 0 mg (Zerit) stavudine cap 30 mg (Zerit) stavudine cap 40 mg (Zerit) stavudine for oral soln mg/ml (Zerit) STRIBILD - elvitegrav-cobicisemtricitab-tenofov tab mg SUSTIVA - efavirenz cap 50 mg SUSTIVA - efavirenz cap 00 mg SUSTIVA - efavirenz tab 600 mg TAMIFLU - oseltamivir phosphate cap 30 mg (base equiv) TAMIFLU - oseltamivir phosphate cap 45 mg (base equiv) TAMIFLU - oseltamivir phosphate cap 75 mg (base equiv) TAMIFLU - oseltamivir phosphate for susp 6 mg/ml (base equiv) TIVICAY - dolutegravir sodium tab 50 mg (base equiv) TRIUMEQ - abacavir-dolutegravirlamivudine tab mg TRUVADA - emtricitabine-tenofovir disoproxil fumarate tab mg TYBOST - cobicistat tab 50 mg TYZEKA - telbivudine tab 600 mg 3 valacyclovir hcl tab 500 mg (Valtrex) valacyclovir hcl tab gm (Valtrex) VALCYTE - valganciclovir hcl for soln 50 mg/ml (base equiv) valganciclovir hcl tab 450 mg (Valcyte) VICTRELIS - boceprevir cap 00 mg VIDEX - didanosine for soln gm VIDEX - didanosine for soln 4 gm VIRACET - nelfinavir mesylate tab 50 mg VIRACET - nelfinavir mesylate tab 65 mg VIRAMUNE - nevirapine susp 50 mg/5ml 6 Guia de medicinas ValueScript de Florida Blue para enero de 06

18 06 VIRAMUNE XR - nevirapine tab sr 4hr 00 mg VIREAD - tenofovir disoproxil fumarate oral powder 40 mg/gm VIREAD - tenofovir disoproxil fumarate tab 50 mg VIREAD - tenofovir disoproxil fumarate tab 00 mg VIREAD - tenofovir disoproxil fumarate tab 50 mg VIREAD - tenofovir disoproxil fumarate tab 300 mg VITEKTA - elvitegravir tab 85 mg VITEKTA - elvitegravir tab 50 mg ZIAGEN - abacavir sulfate soln 0 mg/ml (base equiv) zidovudine cap 00 mg (Retrovir) zidovudine syrup 0 mg/ml (Retrovir) zidovudine tab 300 mg ANTIALÚDICOS atovaquone-proguanil hcl tab mg (Malarone) atovaquone-proguanil hcl tab mg (Malarone) chloroquine phosphate tab 50 mg chloroquine phosphate tab 500 mg (Aralen) COARTEM - artemether-lumefantrine tab mg DARARIM - pyrimethamine tab 5 mg hydroxychloroquine sulfate tab 00 mg (laquenil) mefloquine hcl tab 50 mg RIMAQUINE HOSHATE - primaquine phosphate tab 6.3 mg (5 mg base) quinine sulfate cap 34 mg (Qualaquin) AMEBICIDAS YODOXIN - iodoquinol tab 0 mg YODOXIN - iodoquinol tab 650 mg ANTIHELMÍNTICOS ALBENZA - albendazole tab 00 mg BILTRICIDE - praziquantel tab 600 mg ivermectin tab 3 mg (Stromectol) STROMECTOL - ivermectin tab 3 mg 3 AGENTES ANTIINFEIOSOS, MISC. ALINIA - nitazoxanide for susp 00 mg/5ml ALINIA - nitazoxanide tab 500 mg atovaquone susp 750 mg/5ml (Mepron) CAYSTON - aztreonam lysine for inhal soln 75 mg (base equivalent) clindamycin hcl cap 75 mg (Cleocin) clindamycin hcl cap 50 mg (Cleocin) clindamycin hcl cap 300 mg (Cleocin) clindamycin palmitate hcl for soln 75 mg/5ml (base equiv) (Cleocin pediatric gr) DASONE - dapsone tab 5 mg DASONE - dapsone tab 00 mg KETEK - telithromycin tab 300 mg 3 KETEK - telithromycin tab 400 mg 3 linezolid tab 600 mg (Zyvox) metronidazole cap 375 mg (Flagyl) metronidazole tab 50 mg (Flagyl) metronidazole tab 500 mg (Flagyl) NEBUENT - pentamidine isethionate for nebulization soln 300 mg RIMSOL - trimethoprim hcl oral soln 50 mg/5ml (base equiv) SIVEXTRO - tedizolid phosphate tab 00 mg sulfamethoxazole-trimethoprim susp mg/5ml sulfamethoxazole-trimethoprim tab mg (Bactrim) Guia de medicinas ValueScript de Florida Blue para enero de 06 7

19 06 sulfamethoxazole-trimethoprim tab mg (Bactrim ds) tinidazole tab 50 mg (Tindamax) tinidazole tab 500 mg (Tindamax) trimethoprim tab 00 mg vancomycin hcl cap 5 mg (Vancocin hcl) vancomycin hcl cap 50 mg (Vancocin hcl) XIFAXAN - rifaximin tab 550 mg ZYVOX - linezolid for susp 00 mg/5ml ZYVOX - linezolid tab 600 mg BIOLÓGICOS ACTHIB - haemophilus b polysaccharide conjugate vaccine for inj AFLURIA F influenza virus vaccine split pf susp pref syringe 0.5 ml AFLURIA F influenza virus vaccine split pf susp pref syringe 0.5 ml AFLURIA F influenza virus vaccine split pf susp pref syringe 0.5 ml AFLURIA F influenza virus vaccine split pf susp pref syringe 0.5 ml AFLURIA influenza virus vaccine split im susp AFLURIA influenza virus vaccine split im susp AFLURIA influenza virus vaccine split im susp AFLURIA influenza virus vaccine split im susp BEXSERO - meningococcal vac b (recomb adsorbed) inj prefilled syringe CERVARIX - human papillomavirus (hpv) bival (type 6, 8) recmb vac inj COMVAX - haemophilus b polysac conjhepatitis b (recomb) vac im susp ENGERIX-B - hepatitis b vaccine (recombinant) susp 0 mcg/0.5ml ENGERIX-B - hepatitis b vaccine (recombinant) susp 0 mcg/ml ENGERIX-B - hepatitis b vaccine (recombinant) 0 mcg/0.5ml ENGERIX-B - hepatitis b vaccine (recombinant) 0 mcg/ml FLUARIX QUADRIVALENT 03 - influenza virus vac split quadrivalent susp pref syr 0.5ml FLUARIX QUADRIVALENT 04 - influenza virus vac split quadrivalent susp pref syr 0.5ml FLUARIX influenza virus vaccine split pf susp pref syringe 0.5 ml FLUARIX influenza virus vaccine split pf susp pref syringe 0.5 ml FLUARIX influenza virus vaccine split pf susp pref syringe 0.5 ml FLUARIX influenza virus vaccine split pf susp pref syringe 0.5 ml FLUBLOK influenza virus vac recombinant hemagglutinin (ha) inj FLUBLOK influenza virus vac recombinant hemagglutinin (ha) inj FLUCELVAX influenza virus vac tiss-cult subunit susp pref syr 0.5 ml FLUCELVAX influenza virus vac tiss-cult subunit susp pref syr 0.5 ml FLUCELVAX influenza virus vac tiss-cult subunit susp pref syr 0.5 ml 8 Guia de medicinas ValueScript de Florida Blue para enero de 06

20 06 FLULAVAL QUADRIVALENT 0 - influenza virus vac split quadrivalent susp pref syr 0.5ml FLULAVAL QUADRIVALENT 0 - influenza virus vaccine split quadrivalent im inj FLULAVAL influenza virus vaccine split im susp FLULAVAL influenza virus vaccine split im susp FLULAVAL influenza virus vaccine split im susp FLULAVAL influenza virus vaccine split im susp FLUMIST QUADRIVALENT - influenza virus vaccine live quadrivalent intranasal susp FLUVIRIN F influenza virus vac types a & b pf susp prefilled syr 0.5 ml FLUVIRIN F influenza virus vac types a & b pf susp prefilled syr 0.5 ml FLUVIRIN F influenza virus vac types a & b pf susp prefilled syr 0.5 ml FLUVIRIN F influenza virus vac types a & b pf susp prefilled syr 0.5 ml FLUVIRIN influenza virus vaccine types a & b surface antigen im susp FLUVIRIN influenza virus vaccine types a & b surface antigen im susp FLUVIRIN influenza virus vaccine types a & b surface antigen im susp FLUVIRIN influenza virus vaccine types a & b surface antigen im susp FLUZONE HIGH-DOSE F 0 - influenza virus vac split high-dose pf susp pref syr 0.5ml FLUZONE HIGH-DOSE F 0 - influenza virus vac split high-dose pf susp pref syr 0.5ml FLUZONE HIGH-DOSE F 03 - influenza virus vac split high-dose pf susp pref syr 0.5ml FLUZONE HIGH-DOSE F 04 - influenza virus vac split high-dose pf susp pref syr 0.5ml FLUZONE F influenza virus vaccine split pf susp pref syringe 0.5 ml FLUZONE F influenza virus vaccine split pf susp pref syringe 0.5 ml FLUZONE F influenza virus vaccine split pf susp pref syringe 0.5 ml FLUZONE F influenza virus vaccine split pf susp pref syringe 0.5 ml FLUZONE QUADRIVALENT 03 - influenza virus vac split quadrivalent susp pref syr 0.5 ml FLUZONE QUADRIVALENT 03 - influenza virus vac split quadrivalent susp pref syr 0.5ml FLUZONE QUADRIVALENT 03 - influenza virus vaccine split quadrivalent inj 0.5 ml FLUZONE QUADRIVALENT 04 - influenza virus vac split quadrivalent susp pref syr 0.5 ml FLUZONE QUADRIVALENT 04 - influenza virus vac split quadrivalent susp pref syr 0.5ml FLUZONE QUADRIVALENT 04 - influenza virus vaccine split quadrivalent im inj Guia de medicinas ValueScript de Florida Blue para enero de 06 9

21 06 FLUZONE QUADRIVALENT 04 - influenza virus vaccine split quadrivalent inj 0.5 ml FLUZONE SLIT influenza virus vaccine split im susp FLUZONE SLIT influenza virus vaccine split im susp FLUZONE SLIT influenza virus vaccine split im susp FLUZONE SLIT influenza virus vaccine split im susp GARDASIL - human papillomavirus (hpv) quadrivalent recombinant vac inj GARDASIL 9 - human papillomavirus (hpv) 9-valent recomb vac im susp GARDASIL 9 - human papillomavirus (hpv) 9-valent recomb vac susp pref syr HAVRIX - hepatitis a vaccine inj susp 70 el unit/0.5ml HAVRIX - hepatitis a vaccine inj susp 440 el unit/ml HIBERIX - haemophilus b polysaccharide conjugate vac for inj 0 mcg INFLUENZA A (HN) MONOVA - influenza a (hn) monovalent vaccine live intranasal liquid M-M-R II W/DILUENT 0 DOS - measles, mumps & rubella virus vaccines for inj MEDICAL ROVIDER EZ FLU S - influenza virus vac tiss-cult subunit pref syr kit 0.5 ml MEDICAL ROVIDER EZ FLU S - influenza virus vac types a & b pf pref syringe kit 0.5 ml MENACTRA - meningococcal (a, c, y, and w-35) conjugate vaccine inj MENHIBRIX - meningococcal (c & y)- haemophilus b tet tox conj vac for inj MENOMUNE-A/C/Y/W-35 - meningococcal vaccine a, c, y, and w-35 inj MENVEO - meningococcal (a, c, y, and w-35) oligo conj vac for inj EDVAX HIB - haemophilus b polysaccharide conj vac im susp 7.5 mcg/0.5 ml NEUMOVAX 3 - pneumococcal vaccine polyvalent inj 5 mcg/0.5ml NEUMOVAX 3/ DOSE - pneumococcal vaccine polyvalent inj 5 mcg/0.5ml NEUMOVAX 3/5 DOSE - pneumococcal vaccine polyvalent inj 5 mcg/0.5ml REVNAR 3 - pneumococcal 3-valent conjugate vaccine inj ROQUAD - measles-mumps-rubellavaricella virus vaccines for inj RECOMBIVAX HB - hepatitis b vaccine (recombinant) susp 5 mcg/0.5ml RECOMBIVAX HB - hepatitis b vaccine (recombinant) susp 0 mcg/ml RECOMBIVAX HB - hepatitis b vaccine (recombinant) susp 40 mcg/ml TRUMENBA - meningococcal group b vaccine im susp prefilled syringe TWINRIX - hepatitis a (inact)-hep b (recomb) vac inj 70-0 elu-mcg/ml VAQTA - hepatitis a vaccine inj susp 5 unit/0.5ml VAQTA - hepatitis a vaccine inj susp 50 unit/ml VARIVAX - varicella virus vac live for subcutaneous inj 350 pfu/0.5ml ZOSTAVAX - zoster vaccine live for inj 9400 unit/0.65ml ADACEL - tet tox-diph-acell pertuss ad inj lf-lf-mcg/0.5ml BOOSTRIX - tet tox-diph-acell pertuss ad inj lf-lf-mcg/0.5ml 0 Guia de medicinas ValueScript de Florida Blue para enero de 06

22 06 DATACEL - diph, acellular pert & tet tox inj 5 lf-0 mcg-5 lf/0.5ml DIHTHERIA/TETANUS TOXOID - diphtheria-tetanus tox adsorbed (dt) im inj 5-5 unit/0.5ml INFANRIX - diph, acellular pert & tet tox inj 5 lf-58 mcg-0 lf/0.5ml KINRIX - diph-tetanus tox ad-acell pert & polio virus, ipv vac inj EDIARIX - diph-tetanus tox-acell perthepatitis b-polio ipv vac inj ENTACEL - diph-ac per-tet tox adpoliov-haemoph b poly vac for im susp QUADRACEL - diph-tetanus tox ad-acell pert & polio virus, ipv vac inj TENIVAC - tetanus-diphtheria toxoids (td) inj 5- lfu TETANUS/DIHTHERIA TOXOID - tetanus-diphtheria toxoids (td) inj - lf/0.5ml GAMMAGARD LIQUID - immune globulin (human) iv or subcutaneous soln gm/0ml GAMMAGARD LIQUID - immune globulin (human) iv or subcutaneous soln.5 gm/5ml GAMMAGARD LIQUID - immune globulin (human) iv or subcutaneous soln 5 gm/50ml GAMMAGARD LIQUID - immune globulin (human) iv or subcutaneous soln 0 gm/00ml GAMMAGARD LIQUID - immune globulin (human) iv or subcutaneous soln 0 gm/00ml GAMMAGARD LIQUID - immune globulin (human) iv or subcutaneous soln 30 gm/300ml GAMMAKED - immune globulin (human) iv or subcutaneous soln gm/0ml GAMMAKED - immune globulin (human) iv or subcutaneous soln.5 gm/5ml GAMMAKED - immune globulin (human) iv or subcutaneous soln 5 gm/50ml GAMMAKED - immune globulin (human) iv or subcutaneous soln 0 gm/00ml GAMMAKED - immune globulin (human) iv or subcutaneous soln 0 gm/00ml GAMUNEX-C - immune globulin (human) iv or subcutaneous soln gm/0ml GAMUNEX-C - immune globulin (human) iv or subcutaneous soln.5 gm/5ml GAMUNEX-C - immune globulin (human) iv or subcutaneous soln 5 gm/50ml GAMUNEX-C - immune globulin (human) iv or subcutaneous soln 0 gm/00ml GAMUNEX-C - immune globulin (human) iv or subcutaneous soln 0 gm/00ml GAMUNEX-C - immune globulin (human) iv or subcutaneous soln 40 gm/400ml HIZENTRA - immune globulin (human) subcutaneous inj gm/5ml HIZENTRA - immune globulin (human) subcutaneous inj gm/0ml HIZENTRA - immune globulin (human) subcutaneous inj 4 gm/0ml HIZENTRA - immune globulin (human) subcutaneous inj 0 gm/50ml AGENTES ANTINEOLÁSICOS AGENTES ANTINEOLÁSICOS ACTIMMUNE - interferon gamma-b inj 00 mcg/0.5ml ( unit/0.5ml) Guia de medicinas ValueScript de Florida Blue para enero de 06

23 06 AFINITOR - everolimus tab.5 mg AFINITOR - everolimus tab 5 mg AFINITOR - everolimus tab 7.5 mg AFINITOR - everolimus tab 0 mg AFINITOR DISERZ - everolimus tab for oral susp mg AFINITOR DISERZ - everolimus tab for oral susp 3 mg AFINITOR DISERZ - everolimus tab for oral susp 5 mg ALKERAN - melphalan tab mg anastrozole tab mg (Arimidex) ARIMIDEX - anastrozole tab mg AROMASIN - exemestane tab 5 mg bicalutamide tab 50 mg (Casodex) BOSULIF - bosutinib tab 00 mg BOSULIF - bosutinib tab 500 mg capecitabine tab 50 mg (Xeloda) capecitabine tab 500 mg (Xeloda) CARELSA - vandetanib tab 00 mg CARELSA - vandetanib tab 300 mg CASODEX - bicalutamide tab 50 mg CEENU - lomustine cap 0 mg CEENU - lomustine cap 40 mg CEENU - lomustine cap 00 mg COMETRIQ - cabozantinib s-mal cap x 80 mg & x 0 mg (00 dose) kit COMETRIQ - cabozantinib s-mal cap x 80 mg & 3 x 0 mg (40 dose) kit COMETRIQ - cabozantinib s-malate cap 3 x 0 mg (60 mg dose) kit EMCYT - estramustine phosphate sodium cap 40 mg ERIVEDGE - vismodegib cap 50 mg ETOOSIDE - etoposide cap 50 mg exemestane tab 5 mg (Aromasin) FARESTON - toremifene citrate tab 60 mg (base equivalent) FARYDAK - panobinostat lactate cap 0 mg (base equivalent) FARYDAK - panobinostat lactate cap 5 mg (base equivalent) FARYDAK - panobinostat lactate cap 0 mg (base equivalent) FEMARA - letrozole tab.5 mg flutamide cap 5 mg GILOTRIF - afatinib dimaleate tab 0 mg (base equivalent) GILOTRIF - afatinib dimaleate tab 30 mg (base equivalent) GILOTRIF - afatinib dimaleate tab 40 mg (base equivalent) GLEEVEC - imatinib mesylate tab 00 mg (base equivalent) GLEEVEC - imatinib mesylate tab 400 mg (base equivalent) GLEOSTINE - lomustine cap 0 mg GLEOSTINE - lomustine cap 40 mg GLEOSTINE - lomustine cap 00 mg HEXALEN - altretamine cap 50 mg HYCAMTIN - topotecan hcl cap 0.5 mg (base equiv) HYCAMTIN - topotecan hcl cap mg (base equiv) HYDREA - hydroxyurea cap 500 mg hydroxyurea cap 500 mg (Hydrea) IBRANCE - palbociclib cap 75 mg IBRANCE - palbociclib cap 00 mg IBRANCE - palbociclib cap 5 mg ICLUSIG - ponatinib hcl tab 5 mg (base equiv) ICLUSIG - ponatinib hcl tab 45 mg (base equiv) IMBRUVICA - ibrutinib cap 40 mg INLYTA - axitinib tab mg INLYTA - axitinib tab 5 mg Guia de medicinas ValueScript de Florida Blue para enero de 06

24 06 INTRON A - interferon alfa-b inj unit/ml INTRON A - interferon alfa-b inj unit/ml INTRON A - interferon alfa-b for inj unit INTRON A - interferon alfa-b for inj unit INTRON A - interferon alfa-b for inj unit INTRON A W/DILUENT - interferon alfa-b for inj unit INTRON A W/DILUENT - interferon alfa-b for inj unit INTRON A W/DILUENT - interferon alfa-b for inj unit JAKAFI - ruxolitinib phosphate tab 5 mg (base equivalent) JAKAFI - ruxolitinib phosphate tab 0 mg (base equivalent) JAKAFI - ruxolitinib phosphate tab 5 mg (base equivalent) JAKAFI - ruxolitinib phosphate tab 0 mg (base equivalent) JAKAFI - ruxolitinib phosphate tab 5 mg (base equivalent) LENVIMA 0MG DAILY DOSE - lenvatinib cap therapy pack 0 mg (0 mg daily dose) LENVIMA 4MG DAILY DOSE - lenvatinib cap therapy pack 0 & 4 mg (4 mg daily dose) LENVIMA 0MG DAILY DOSE - lenvatinib cap therapy pack 0 () mg (0 mg daily dose) LENVIMA 4MG DAILY DOSE - lenvatinib cap therapy pack 0 () & 4 mg (4 mg daily dose) letrozole tab.5 mg (Femara) LEUCOVORIN CALCIUM - leucovorin calcium tab 0 mg 3 3 LEUCOVORIN CALCIUM - leucovorin calcium tab 5 mg leucovorin calcium tab 5 mg leucovorin calcium tab 5 mg LEUKERAN - chlorambucil tab mg leuprolide acetate inj kit 5 mg/ml LOMUSTINE - lomustine cap 0 mg LOMUSTINE - lomustine cap 40 mg LOMUSTINE - lomustine cap 00 mg LYNARZA - olaparib cap 50 mg LYSODREN - mitotane tab 500 mg MATULANE - procarbazine hcl cap 50 mg MEGACE ORAL - megestrol acetate susp 40 mg/ml megestrol acetate susp 40 mg/ml (Megace oral) megestrol acetate tab 0 mg megestrol acetate tab 40 mg MEKINIST - trametinib dimethyl sulfoxide tab 0.5 mg (base equivalent) MEKINIST - trametinib dimethyl sulfoxide tab mg (base equivalent) mercaptopurine tab 50 mg MESNEX - mesna tab 400 mg methotrexate sodium for inj gm methotrexate sodium inj pf 5 mg/ml methotrexate sodium inj 5 mg/ml methotrexate sodium tab.5 mg (base equiv) MYLERAN - busulfan tab mg NEXAVAR - sorafenib tosylate tab 00 mg (base equivalent) NILANDRON - nilutamide tab 50 mg OMALYST - pomalidomide cap mg OMALYST - pomalidomide cap mg OMALYST - pomalidomide cap 3 mg OMALYST - pomalidomide cap 4 mg Guia de medicinas ValueScript de Florida Blue para enero de 06 3

25 06 URIXAN - mercaptopurine susp 000 mg/00ml (0 mg/ml) SRYCEL - dasatinib tab 0 mg SRYCEL - dasatinib tab 50 mg SRYCEL - dasatinib tab 70 mg SRYCEL - dasatinib tab 80 mg SRYCEL - dasatinib tab 00 mg SRYCEL - dasatinib tab 40 mg STIVARGA - regorafenib tab 40 mg SUTENT - sunitinib malate cap.5 mg (base equivalent) SUTENT - sunitinib malate cap 5 mg (base equivalent) SUTENT - sunitinib malate cap 37.5 mg (base equivalent) SUTENT - sunitinib malate cap 50 mg (base equivalent) SYLATRON - peginterferon alfa-b for inj kit 00 mcg SYLATRON - peginterferon alfa-b for inj kit 300 mcg SYLATRON - peginterferon alfa-b for inj kit 600 mcg SYLATRON - peginterferon alfa-b for inj kit 4 x 00 mcg SYLATRON - peginterferon alfa-b for inj kit 4 x 300 mcg TABLOID - thioguanine tab 40 mg TAFINLAR - dabrafenib mesylate cap 50 mg (base equivalent) TAFINLAR - dabrafenib mesylate cap 75 mg (base equivalent) tamoxifen citrate tab 0 mg (base equivalent) tamoxifen citrate tab 0 mg (base equivalent) TARCEVA - erlotinib hcl tab 5 mg (base equivalent) TARCEVA - erlotinib hcl tab 00 mg (base equivalent) TARCEVA - erlotinib hcl tab 50 mg (base equivalent) TARGRETIN - bexarotene cap 75 mg TASIGNA - nilotinib hcl cap 50 mg (base equivalent) TASIGNA - nilotinib hcl cap 00 mg (base equivalent) TEMODAR - temozolomide cap 5 mg TEMODAR - temozolomide cap 0 mg TEMODAR - temozolomide cap 00 mg TEMODAR - temozolomide cap 40 mg TEMODAR - temozolomide cap 80 mg TEMODAR - temozolomide cap 50 mg temozolomide cap 5 mg (Temodar) temozolomide cap 0 mg (Temodar) temozolomide cap 00 mg (Temodar) temozolomide cap 40 mg (Temodar) temozolomide cap 80 mg (Temodar) temozolomide cap 50 mg (Temodar) tretinoin cap 0 mg TREXALL - methotrexate sodium tab 5 mg (base equiv) TREXALL - methotrexate sodium tab 7.5 mg (base equiv) TREXALL - methotrexate sodium tab 0 mg (base equiv) TREXALL - methotrexate sodium tab 5 mg (base equiv) TYKERB - lapatinib ditosylate tab 50 mg (base equiv) VOTRIENT - pazopanib hcl tab 00 mg (base equiv) XALKORI - crizotinib cap 00 mg XALKORI - crizotinib cap 50 mg XELODA - capecitabine tab 50 mg XELODA - capecitabine tab 500 mg XTANDI - enzalutamide cap 40 mg 4 Guia de medicinas ValueScript de Florida Blue para enero de 06

26 06 ZELBORAF - vemurafenib tab 40 mg (base equivalent) ZOLINZA - vorinostat cap 00 mg ZYDELIG - idelalisib tab 00 mg ZYDELIG - idelalisib tab 50 mg ZYKADIA - ceritinib cap 50 mg ZYTIGA - abiraterone acetate tab 50 mg FÁRMACOS ENDOCRINOS Y METABÓLICOS CORTICOSTEROIDES budesonide cap sr 4hr 3 mg (Entocort ec) CORTISONE ACETATE - cortisone acetate tab 5 mg DEXAMETHASONE - dexamethasone soln 0.5 mg/5ml DEXAMETHASONE - dexamethasone tab mg DEXAMETHASONE - dexamethasone tab mg dexamethasone elixir 0.5 mg/5ml dexamethasone tab 0.5 mg dexamethasone tab 0.75 mg dexamethasone tab.5 mg dexamethasone tab 4 mg dexamethasone tab 6 mg fludrocortisone acetate tab 0. mg hydrocortisone tab 5 mg (Cortef) hydrocortisone tab 0 mg (Cortef) hydrocortisone tab 0 mg (Cortef) methylprednisolone tab 4 mg dose pack (Medrol dosepak) methylprednisolone tab 4 mg (Medrol) methylprednisolone tab 8 mg (Medrol) methylprednisolone tab 6 mg (Medrol) methylprednisolone tab 3 mg (Medrol) prednisolone sod phos orally disintegr tab 0 mg (base eq) (Orapred odt) prednisolone sod phos orally disintegr tab 5 mg (base eq) (Orapred odt) prednisolone sod phos orally disintegr tab 30 mg (base eq) (Orapred odt) prednisolone sod phosph oral soln 6.7 mg/5ml (5 mg/5ml base) (ediapred) prednisolone sod phosphate oral soln 5 mg/5ml (base equiv) prednisolone syrup 5 mg/5ml (usp solution equivalent) REDNISONE - prednisone oral soln 5 mg/5ml REDNISONE - prednisone tab 50 mg prednisone tab mg prednisone tab.5 mg prednisone tab 5 mg prednisone tab 0 mg prednisone tab 0 mg ANDRÓGENOS-ANABÓLICOS ANADROL-50 - oxymetholone tab 50 mg ANDRODERM - testosterone td patch 4hr mg/4hr ANDRODERM - testosterone td patch 4hr 4 mg/4hr ANDROGEL - testosterone td gel 5 mg/.5gm (%) ANDROGEL - testosterone td gel 50 mg/5gm (%) ANDROGEL - testosterone td gel 0.5 mg/.5gm (.6%) ANDROGEL - testosterone td gel 40.5 mg/.5gm (.6%) ANDROGEL UM - testosterone td gel.5 mg/act (%) ANDROGEL UM - testosterone td gel 0.5 mg/act (.6%) 3 Guia de medicinas ValueScript de Florida Blue para enero de 06 5

27 06 ANDROID - methyltestosterone cap 0 3 mg ANDROXY - fluoxymesterone tab 0 mg 3 danazol cap 50 mg danazol cap 00 mg danazol cap 00 mg oxandrolone tab.5 mg (Oxandrin) oxandrolone tab 0 mg (Oxandrin) testosterone cypionate im inj in oil 00 mg/ml (Depo-testosterone) testosterone cypionate im inj in oil 00 mg/ml (Depo-testosterone) testosterone enanthate im inj in oil 00 mg/ml ESTRÓGENOS CLIMARA RO - estradiollevonorgestrel td patch weekly mg/day DIVIGEL - estradiol td gel 0.5 mg/0.5gm (0.%) DIVIGEL - estradiol td gel 0.5 mg/0.5gm (0.%) DIVIGEL - estradiol td gel mg/gm (0.%) estradiol & norethindrone acetate tab mg (Activella) estradiol & norethindrone acetate tab -0.5 mg (Activella) estradiol tab 0.5 mg (Estrace) estradiol tab mg (Estrace) estradiol tab mg (Estrace) estradiol td patch twice weekly 0.05 mg/4hr (Vivelle-dot) estradiol td patch twice weekly mg/4hr (Vivelle-dot) estradiol td patch twice weekly 0.05 mg/4hr (Vivelle-dot) estradiol td patch twice weekly mg/4hr (Vivelle-dot) estradiol td patch twice weekly 0. mg/4hr (Vivelle-dot) estradiol td patch weekly 0.05 mg/4hr (Climara) estradiol td patch weekly mg/4hr (37.5 mcg/4hr) (Climara) estradiol td patch weekly 0.05 mg/4hr (Climara) estradiol td patch weekly 0.06 mg/4hr (Climara) estradiol td patch weekly mg/4hr (Climara) estradiol td patch weekly 0. mg/4hr (Climara) estropipate tab 0.75 mg estropipate tab.5 mg MENEST - esterified estrogens tab 0.3 mg MENEST - esterified estrogens tab 0.65 mg MENEST - esterified estrogens tab.5 mg MENEST - esterified estrogens tab.5 mg norethindrone acetate-ethinyl estradiol tab 0.5 mg-.5 mcg (Femhrt low dose) norethindrone acetate-ethinyl estradiol tab mg-5 mcg REMARIN - estrogens, conjugated tab 0.3 mg REMARIN - estrogens, conjugated tab 0.45 mg REMARIN - estrogens, conjugated tab 0.65 mg REMARIN - estrogens, conjugated tab 0.9 mg REMARIN - estrogens, conjugated tab.5 mg REMHASE - conj est 0.65(4)/conj est-medroxypro ac tab mg(4) 6 Guia de medicinas ValueScript de Florida Blue para enero de 06

28 06 REMRO - conjugated estrogenmedroxyprogest acetate tab mg REMRO - conjugated estrogenmedroxyprogest acetate tab mg REMRO - conjugated estrogenmedroxyprogest acetate tab mg REMRO - conjugated estrogenmedroxyprogest acetate tab mg ANTICONCETIVOS desogest-eth estrad & eth estrad tab /0.0 mg(/5) (Mircette) desogest-ethin est tab / / mgmg (Cyclessa) desogestrel & ethinyl estradiol tab 0.5 mg-30 mcg (Desogen) drospirenone-ethinyl estradiol tab mg (Yaz) drospirenone-ethinyl estradiol tab mg (Yasmin 8) ELLA - ulipristal acetate tab 30 mg ethynodiol diacetate & ethinyl estradiol tab mg-35 mcg levonorg-eth est tab mg(84) & eth est tab 0.0mg(7) (Loseasonique) levonorg-eth est tab mg(84) & eth est tab 0.0mg(7) (Seasonique) levonorgestrel & ethinyl estradiol (9- day) tab mg levonorgestrel & ethinyl estradiol tab 0. mg-0 mcg levonorgestrel & ethinyl estradiol tab 0.5 mg-30 mcg levonorgestrel tab.5 mg levonorgestrel-eth estra tab / /0.5-30mg-mcg levonorgestrel-ethinyl estradiol (continuous) tab 90-0 mcg norelgestromin-ethinyl estradiol td ptwk mcg/4hr (Ortho evra) norethindrone & ethinyl estradiol tab 0.4 mg-35 mcg (Ovcon-35) norethindrone & ethinyl estradiol tab 0.5 mg-35 mcg (Brevicon-8) norethindrone & ethinyl estradiol tab mg-35 mcg (Norinyl +35) norethindrone & ethinyl estradiol-fe chew tab 0.4 mg-35 mcg (Femcon fe) norethindrone & ethinyl estradiol-fe chew tab 0.8 mg-5 mcg (Generess fe) norethindrone ac-ethinyl estrad-fe tab -0/-30/-35 mg-mcg (Estrostep fe) norethindrone ace & ethinyl estradiol tab mg-0 mcg (Loestrin /0-) norethindrone ace & ethinyl estradiol tab.5 mg-30 mcg (Loestrin.5/30-) norethindrone ace & ethinyl estradiolfe tab mg-0 mcg (Loestrin fe /0) norethindrone ace & ethinyl estradiolfe tab.5 mg-30 mcg (Loestrin fe.5/30) norethindrone ace-ethinyl estradiol-fe tab mg-0 mcg (4) norethindrone tab 0.35 mg (Nor-qd) norethindrone-eth estradiol tab / /-35 mg-mcg (Orthonovum 7/7/7) norethindrone-eth estradiol tab /-35/ mg-mcg (Trinorinyl 8) norgestimate & ethinyl estradiol tab 0.5 mg-35 mcg (Ortho-cyclen) norgestimate-eth estrad tab /0.5-35/ mg-mcg (Ortho tri-cyclen) norgestrel & ethinyl estradiol tab 0.3 mg-30 mcg Guia de medicinas ValueScript de Florida Blue para enero de 06 7

29 06 NUVARING - etonogestrel-ethinyl estradiol va ring mg/4hr ROGESTINAS medroxyprogesterone acetate tab.5 mg (rovera) medroxyprogesterone acetate tab 5 mg (rovera) medroxyprogesterone acetate tab 0 mg (rovera) MEGACE ES - megestrol acetate susp 65 mg/5ml norethindrone acetate tab 5 mg (Aygestin) progesterone micronized cap 00 mg (rometrium) progesterone micronized cap 00 mg (rometrium) ANTIDIABÉTICOS ANTIDIABÉTICOS acarbose tab 5 mg (recose) acarbose tab 50 mg (recose) acarbose tab 00 mg (recose) BYDUREON - exenatide extended release for inj susp mg BYDUREON - exenatide extended release for susp pen-injector mg BYETTA - exenatide soln pen-injector 5 mcg/0.0ml BYETTA - exenatide soln pen-injector 0 mcg/0.04ml CHLORROAMIDE - chlorpropamide tab 00 mg CHLORROAMIDE - chlorpropamide tab 50 mg CYCLOSET - bromocriptine mesylate tab 0.8 mg (base equivalent) glimepiride tab mg (Amaryl) glimepiride tab mg (Amaryl) glimepiride tab 4 mg (Amaryl) glipizide tab sr 4hr.5 mg (Glucotrol xl) glipizide tab sr 4hr 5 mg (Glucotrol xl) glipizide tab sr 4hr 0 mg (Glucotrol xl) glipizide tab 5 mg (Glucotrol) glipizide tab 0 mg (Glucotrol) glipizide-metformin hcl tab.5-50 mg glipizide-metformin hcl tab mg glipizide-metformin hcl tab mg GLUCAGEN HYOKIT - glucagon hcl 3 (rdna) for inj mg (base equiv) GLUCAGON EMERGENCY KIT - glucagon (rdna) for inj kit mg GLYBURIDE - glyburide tab.5 mg GLYBURIDE - glyburide tab.5 mg GLYBURIDE - glyburide tab 5 mg glyburide micronized tab.5 mg (Glynase) glyburide micronized tab 3 mg (Glynase) glyburide micronized tab 6 mg (Glynase) glyburide tab.5 mg glyburide tab.5 mg glyburide tab 5 mg glyburide-metformin tab.5-50 mg (Glucovance) glyburide-metformin tab mg (Glucovance) glyburide-metformin tab mg (Glucovance) GLYSET - miglitol tab 5 mg 3 GLYSET - miglitol tab 50 mg 3 GLYSET - miglitol tab 00 mg 3 INVOKAMET - canagliflozin-metformin hcl tab mg INVOKAMET - canagliflozin-metformin hcl tab mg 8 Guia de medicinas ValueScript de Florida Blue para enero de 06

30 06 INVOKAMET - canagliflozin-metformin hcl tab mg INVOKAMET - canagliflozin-metformin hcl tab mg INVOKANA - canagliflozin tab 00 mg INVOKANA - canagliflozin tab 300 mg JANUMET - sitagliptin-metformin hcl tab mg JANUMET - sitagliptin-metformin hcl tab mg JANUMET XR - sitagliptin-metformin hcl tab sr 4hr mg JANUMET XR - sitagliptin-metformin hcl tab sr 4hr mg JANUMET XR - sitagliptin-metformin hcl tab sr 4hr mg JANUVIA - sitagliptin phosphate tab 5 mg (base equiv) JANUVIA - sitagliptin phosphate tab 50 mg (base equiv) JANUVIA - sitagliptin phosphate tab 00 mg (base equiv) KOMBIGLYZE XR - saxagliptinmetformin hcl tab sr 4hr mg KOMBIGLYZE XR - saxagliptinmetformin hcl tab sr 4hr mg KOMBIGLYZE XR - saxagliptinmetformin hcl tab sr 4hr mg metformin hcl tab sr 4hr 500 mg (Glucophage xr) metformin hcl tab sr 4hr 750 mg (Glucophage xr) metformin hcl tab 500 mg (Glucophage) metformin hcl tab 850 mg (Glucophage) metformin hcl tab 000 mg (Glucophage) nateglinide tab 60 mg (Starlix) nateglinide tab 0 mg (Starlix) NESINA - alogliptin benzoate tab 6.5 mg (base equiv) NESINA - alogliptin benzoate tab.5 mg (base equiv) NESINA - alogliptin benzoate tab 5 mg (base equiv) ONGLYZA - saxagliptin hcl tab.5 mg (base equiv) ONGLYZA - saxagliptin hcl tab 5 mg (base equiv) pioglitazone hcl tab 5 mg (base equiv) (Actos) pioglitazone hcl tab 30 mg (base equiv) (Actos) pioglitazone hcl tab 45 mg (base equiv) (Actos) pioglitazone hcl-glimepiride tab 30- mg (Duetact) pioglitazone hcl-glimepiride tab 30-4 mg (Duetact) pioglitazone hcl-metformin hcl tab mg (Actoplus met) pioglitazone hcl-metformin hcl tab mg (Actoplus met) RANDIN - repaglinide tab 0.5 mg 3 RANDIN - repaglinide tab mg 3 RANDIN - repaglinide tab mg 3 ROGLYCEM - diazoxide susp 50 mg/ ml repaglinide tab 0.5 mg (randin) repaglinide tab mg (randin) repaglinide tab mg (randin) SYMLINEN 0 - pramlintide acetate pen-inj 700 mcg/.7ml (000 mcg/ ml) SYMLINEN 60 - pramlintide acetate pen-inj 500 mcg/.5ml (000 mcg/ ml) tolazamide tab 50 mg Guia de medicinas ValueScript de Florida Blue para enero de 06 9

31 06 TOLBUTAMIDE - tolbutamide tab 500 mg 3 TRADJENTA - linagliptin tab 5 mg VICTOZA - liraglutide soln pen-injector 8 mg/3ml (6 mg/ml) Insulinas de acción rápida AIDRA - insulin glulisine inj 00 unit/ ml AIDRA SOLOSTAR - insulin glulisine soln pen-injector inj 00 unit/ml NOVOLOG - insulin aspart inj 00 unit/ ml NOVOLOG FLEXEN - insulin aspart soln pen-injector 00 unit/ml NOVOLOG ENFILL - insulin aspart inj 00 unit/ml NOVOLOG ENFILL - insulin aspart soln cartridge 00 unit/ml Insulinas de acción corta NOVOLIN R - insulin regular (human) inj 00 unit/ml NOVOLIN R RELION - insulin regular (human) inj 00 unit/ml RELION R - insulin regular (human) inj 00 unit/ml Insulinas de acción intermedia NOVOLIN N - insulin isophane (human) inj 00 unit/ml NOVOLIN N RELION - insulin isophane (human) inj 00 unit/ml NOVOLIN 70/30 - insulin isophane & regular (human) inj 00 unit/ml (70-30) NOVOLIN 70/30 RELION - insulin isophane & regular (human) inj 00 unit/ml (70-30) NOVOLOG MIX 70/30 - insulin aspart prot & aspart (human) inj 00 unit/ml (70-30) 3 3 NOVOLOG MIX 70/30 REFILL - insulin aspart prot & aspart sus pen-inj 00 unit/ml (70-30) Insulinas basales LANTUS - insulin glargine inj 00 unit/ ml LANTUS SOLOSTAR - insulin glargine soln pen-injector 00 unit/ml LEVEMIR - insulin detemir inj 00 unit/ ml LEVEMIR FLEXEN - insulin detemir soln pen-injector 00 unit/ml LEVEMIR FLEXTOUCH - insulin detemir soln pen-injector 00 unit/ml TOUJEO SOLOSTAR - insulin glargine soln pen-injector 300 unit/ml AGENTES TIROIDEOS levothyroxine sodium tab 5 mcg (Synthroid) levothyroxine sodium tab 50 mcg (Synthroid) levothyroxine sodium tab 75 mcg (Synthroid) levothyroxine sodium tab 88 mcg (Synthroid) levothyroxine sodium tab 00 mcg (Synthroid) levothyroxine sodium tab mcg (Synthroid) levothyroxine sodium tab 5 mcg (Synthroid) levothyroxine sodium tab 37 mcg (Synthroid) levothyroxine sodium tab 50 mcg (Synthroid) levothyroxine sodium tab 75 mcg (Synthroid) levothyroxine sodium tab 00 mcg (Synthroid) levothyroxine sodium tab 300 mcg (Synthroid) 0 Guia de medicinas ValueScript de Florida Blue para enero de 06

32 06 liothyronine sodium tab 5 mcg (Cytomel) liothyronine sodium tab 5 mcg (Cytomel) liothyronine sodium tab 50 mcg (Cytomel) methimazole tab 5 mg (Tapazole) methimazole tab 0 mg (Tapazole) propylthiouracil tab 50 mg SYNTHROID - levothyroxine sodium tab 5 mcg SYNTHROID - levothyroxine sodium tab 50 mcg SYNTHROID - levothyroxine sodium tab 75 mcg SYNTHROID - levothyroxine sodium tab 88 mcg SYNTHROID - levothyroxine sodium tab 00 mcg SYNTHROID - levothyroxine sodium tab mcg SYNTHROID - levothyroxine sodium tab 5 mcg SYNTHROID - levothyroxine sodium tab 37 mcg SYNTHROID - levothyroxine sodium tab 50 mcg SYNTHROID - levothyroxine sodium tab 75 mcg SYNTHROID - levothyroxine sodium tab 00 mcg SYNTHROID - levothyroxine sodium tab 300 mcg THYROLAR- - liotrix (t3-t4) tab 60 mg (.5-50 mcg) THYROLAR-/ - liotrix (t3-t4) tab 30 mg (6.5-5 mcg) THYROLAR-/4 - liotrix (t3-t4) tab 5 mg (3.-.5 mcg) THYROLAR- - liotrix (t3-t4) tab 0 mg (5-00 mcg) THYROLAR-3 - liotrix (t3-t4) tab 80 mg ( mcg) OXITÓCICOS methylergonovine maleate tab 0. mg 3 3 AGENTES ENDOCRINOS Y METABÓLICOS, MISC. alendronate sodium tab 5 mg alendronate sodium tab 0 mg alendronate sodium tab 35 mg alendronate sodium tab 70 mg (Fosamax) cabergoline tab 0.5 mg calcitonin (salmon) nasal soln 00 unit/ act (Miacalcin) calcitriol cap 0.5 mcg (Rocaltrol) calcitriol cap 0.5 mcg (Rocaltrol) calcitriol oral soln mcg/ml (Rocaltrol) CARBAGLU - carglumic acid tab 00 mg CYSTADANE - betaine powder for oral solution desmopressin acetate inj 4 mcg/ml (Ddavp) desmopressin acetate nasal soln 0.0% (refrigerated) (Ddavp) desmopressin acetate nasal spray soln 0.0% (Ddavp) desmopressin acetate nasal spray soln 0.0% (refrigerated) desmopressin acetate tab 0. mg (Ddavp) desmopressin acetate tab 0. mg (Ddavp) doxercalciferol cap 0.5 mcg (Hectorol) doxercalciferol cap mcg (Hectorol) doxercalciferol cap.5 mcg (Hectorol) FORTEO - teriparatide (recombinant) inj 600 mcg/.4ml Guia de medicinas ValueScript de Florida Blue para enero de 06

33 06 ibandronate sodium tab 50 mg (base equivalent) (Boniva) INCRELEX - mecasermin inj 40 mg/4ml (0 mg/ml) KUVAN - sapropterin dihydrochloride powder packet 00 mg KUVAN - sapropterin dihydrochloride powder packet 500 mg levocarnitine oral soln gm/0ml (0%) (Carnitor) levocarnitine tab 330 mg (Carnitor) NORDITROIN CARTRIDGE - somatropin inj 5 mg/.5ml NORDITROIN FLEXRO - somatropin inj 5 mg/.5ml NORDITROIN FLEXRO - somatropin inj 0 mg/.5ml NORDITROIN FLEXRO - somatropin inj 5 mg/.5ml NORDITROIN FLEXRO - somatropin inj 30 mg/3ml NORDITROIN NORDIFLEX EN - somatropin inj 30 mg/3ml octreotide acetate inj 50 mcg/ml (0.05 mg/ml) (Sandostatin) octreotide acetate inj 00 mcg/ml (0. mg/ml) (Sandostatin) octreotide acetate inj 00 mcg/ml (0. mg/ml) (Sandostatin) octreotide acetate inj 500 mcg/ml (0.5 mg/ml) (Sandostatin) octreotide acetate inj 000 mcg/ml ( mg/ml) (Sandostatin) ORFADIN - nitisinone cap mg ORFADIN - nitisinone cap 5 mg ORFADIN - nitisinone cap 0 mg OSHENA - ospemifene tab 60 mg 3 paricalcitol cap mcg (Zemplar) paricalcitol cap mcg (Zemplar) paricalcitol cap 4 mcg raloxifene hcl tab 60 mg (Evista) RAVICTI - glycerol phenylbutyrate liquid. gm/ml risedronate sodium tab delayed release 35 mg (Atelvia) risedronate sodium tab 5 mg (Actonel) risedronate sodium tab 30 mg (Actonel) risedronate sodium tab 35 mg (Actonel) risedronate sodium tab 50 mg (Actonel) SAMSCA - tolvaptan tab 5 mg SAMSCA - tolvaptan tab 30 mg SENSIAR - cinacalcet hcl tab 30 mg (base equiv) SENSIAR - cinacalcet hcl tab 60 mg (base equiv) SENSIAR - cinacalcet hcl tab 90 mg (base equiv) sodium phenylbutyrate oral powder 3 gm/teaspoonful (Buphenyl) SOMAVERT - pegvisomant for inj 0 mg (as protein) SOMAVERT - pegvisomant for inj 5 mg (as protein) SOMAVERT - pegvisomant for inj 0 mg (as protein) SOMAVERT - pegvisomant for inj 5 mg (as protein) SOMAVERT - pegvisomant for inj 30 mg (as protein) STIMATE - desmopressin acetate nasal soln.5 mg/ml SYNAREL - nafarelin acetate nasal soln mg/ml 3 ZEMLAR - paricalcitol cap mcg 3 ZEMLAR - paricalcitol cap mcg 3 AGENTES CARDIOVASCULARES CARDIOTÓNICOS Guia de medicinas ValueScript de Florida Blue para enero de 06

34 06 DIGOXIN - digoxin oral soln 0.05 mg/ml digoxin tab 5 mcg (0.5 mg) (Lanoxin) digoxin tab 50 mcg (0.5 mg) (Lanoxin) AGENTES ANTIANGINOSOS ISOSORBIDE DINITRATE - isosorbide dinitrate tab 30 mg isosorbide dinitrate tab cr 40 mg isosorbide dinitrate tab 5 mg (Isordil titradose) isosorbide dinitrate tab 0 mg isosorbide dinitrate tab 0 mg isosorbide mononitrate tab sr 4hr 30 mg isosorbide mononitrate tab sr 4hr 60 mg isosorbide mononitrate tab sr 4hr 0 mg isosorbide mononitrate tab 0 mg isosorbide mononitrate tab 0 mg NITRO-BID - nitroglycerin oint % nitroglycerin cap cr.5 mg nitroglycerin cap cr 6.5 mg nitroglycerin cap cr 9 mg nitroglycerin td patch 4hr 0. mg/hr (Nitro-dur) nitroglycerin td patch 4hr 0. mg/hr (Nitro-dur) nitroglycerin td patch 4hr 0.4 mg/hr (Nitro-dur) nitroglycerin td patch 4hr 0.6 mg/hr (Nitro-dur) nitroglycerin tl soln 0.4 mg/spray (400 mcg/spray) (Nitrolingual pumpspr) NITROSTAT - nitroglycerin sl tab 0.3 mg NITROSTAT - nitroglycerin sl tab 0.4 mg NITROSTAT - nitroglycerin sl tab 0.6 mg RANEXA - ranolazine tab sr hr 500 mg RANEXA - ranolazine tab sr hr 000 mg 3 3 BETABLOQUEANTES acebutolol hcl cap 00 mg (Sectral) acebutolol hcl cap 400 mg (Sectral) atenolol tab 5 mg (Tenormin) atenolol tab 50 mg (Tenormin) atenolol tab 00 mg (Tenormin) betaxolol hcl tab 0 mg (Kerlone) betaxolol hcl tab 0 mg (Kerlone) bisoprolol fumarate tab 5 mg (Zebeta) bisoprolol fumarate tab 0 mg (Zebeta) BYSTOLIC - nebivolol hcl tab.5 mg 3 (base equivalent) BYSTOLIC - nebivolol hcl tab 5 mg 3 (base equivalent) BYSTOLIC - nebivolol hcl tab 0 mg 3 (base equivalent) BYSTOLIC - nebivolol hcl tab 0 mg 3 (base equivalent) carvedilol tab 3.5 mg (Coreg) carvedilol tab 6.5 mg (Coreg) carvedilol tab.5 mg (Coreg) carvedilol tab 5 mg (Coreg) labetalol hcl tab 00 mg (Trandate) labetalol hcl tab 00 mg (Trandate) labetalol hcl tab 300 mg (Trandate) LEVATOL - penbutolol sulfate tab 0 mg 3 metoprolol succinate tab sr 4hr 5 mg (Toprol xl) metoprolol succinate tab sr 4hr 50 mg (Toprol xl) Guia de medicinas ValueScript de Florida Blue para enero de 06 3

35 06 metoprolol succinate tab sr 4hr 00 mg (Toprol xl) metoprolol succinate tab sr 4hr 00 mg (Toprol xl) metoprolol tartrate tab 5 mg metoprolol tartrate tab 50 mg (Lopressor) metoprolol tartrate tab 00 mg (Lopressor) nadolol tab 0 mg (Corgard) nadolol tab 40 mg (Corgard) nadolol tab 80 mg (Corgard) pindolol tab 5 mg pindolol tab 0 mg RORANOLOL HCL - propranolol hcl oral soln 0 mg/5ml propranolol hcl cap sr 4hr 60 mg (Inderal la) propranolol hcl cap sr 4hr 80 mg (Inderal la) propranolol hcl cap sr 4hr 0 mg (Inderal la) propranolol hcl cap sr 4hr 60 mg (Inderal la) propranolol hcl tab 0 mg propranolol hcl tab 0 mg propranolol hcl tab 40 mg propranolol hcl tab 60 mg propranolol hcl tab 80 mg sotalol hcl (afib/afl) tab 80 mg (Betapace af) sotalol hcl (afib/afl) tab 0 mg (Betapace af) sotalol hcl (afib/afl) tab 60 mg (Betapace af) sotalol hcl tab 80 mg (Betapace) sotalol hcl tab 0 mg (Betapace) sotalol hcl tab 60 mg (Betapace) sotalol hcl tab 40 mg TIMOLOL MALEATE - timolol maleate tab 5 mg TIMOLOL MALEATE - timolol maleate tab 0 mg TIMOLOL MALEATE - timolol maleate tab 0 mg BLOQUEADORES DE LOS CANALES DE CALCIO amlodipine besylate tab.5 mg (Norvasc) amlodipine besylate tab 5 mg (Norvasc) amlodipine besylate tab 0 mg (Norvasc) diltiazem hcl cap sr hr 60 mg diltiazem hcl cap sr hr 90 mg diltiazem hcl cap sr hr 0 mg diltiazem hcl cap sr 4hr 0 mg diltiazem hcl cap sr 4hr 80 mg diltiazem hcl cap sr 4hr 40 mg diltiazem hcl coated beads cap sr 4hr 0 mg (Cardizem cd) diltiazem hcl coated beads cap sr 4hr 80 mg (Cardizem cd) diltiazem hcl coated beads cap sr 4hr 40 mg (Cardizem cd) diltiazem hcl coated beads cap sr 4hr 300 mg (Cardizem cd) diltiazem hcl coated beads cap sr 4hr 360 mg (Cardizem cd) diltiazem hcl coated beads tab sr 4hr 80 mg (Cardizem la) diltiazem hcl coated beads tab sr 4hr 40 mg (Cardizem la) diltiazem hcl coated beads tab sr 4hr 300 mg (Cardizem la) diltiazem hcl coated beads tab sr 4hr 360 mg (Cardizem la) diltiazem hcl coated beads tab sr 4hr 40 mg (Cardizem la) diltiazem hcl extended release beads cap sr 4hr 0 mg (Tiazac) 4 Guia de medicinas ValueScript de Florida Blue para enero de 06

36 06 diltiazem hcl extended release beads cap sr 4hr 80 mg (Tiazac) diltiazem hcl extended release beads cap sr 4hr 40 mg (Tiazac) diltiazem hcl extended release beads cap sr 4hr 300 mg (Tiazac) diltiazem hcl extended release beads cap sr 4hr 360 mg (Tiazac) diltiazem hcl extended release beads cap sr 4hr 40 mg (Tiazac) diltiazem hcl tab 30 mg (Cardizem) diltiazem hcl tab 60 mg (Cardizem) diltiazem hcl tab 90 mg diltiazem hcl tab 0 mg (Cardizem) felodipine tab sr 4hr.5 mg felodipine tab sr 4hr 5 mg felodipine tab sr 4hr 0 mg isradipine cap.5 mg isradipine cap 5 mg nicardipine hcl cap 0 mg nicardipine hcl cap 30 mg nifedipine cap 0 mg (rocardia) nifedipine cap 0 mg nifedipine tab sr 4hr 30 mg (Adalat cc) nifedipine tab sr 4hr 60 mg (Adalat cc) nifedipine tab sr 4hr 90 mg (Adalat cc) nifedipine tab sr 4hr osmotic 30 mg (rocardia xl) nifedipine tab sr 4hr osmotic 60 mg (rocardia xl) nifedipine tab sr 4hr osmotic 90 mg (rocardia xl) nimodipine cap 30 mg NISOLDIINE ER - nisoldipine tab sr 4hr 5.5 mg nisoldipine tab sr 4hr 8.5 mg (Sular) nisoldipine tab sr 4hr 7 mg (Sular) nisoldipine tab sr 4hr 34 mg (Sular) VERAAMIL HCL - verapamil hcl tab 40 mg verapamil hcl cap sr 4hr 00 mg (Verelan pm) verapamil hcl cap sr 4hr 0 mg (Verelan) verapamil hcl cap sr 4hr 80 mg (Verelan) verapamil hcl cap sr 4hr 00 mg (Verelan pm) verapamil hcl cap sr 4hr 40 mg (Verelan) verapamil hcl cap sr 4hr 300 mg (Verelan pm) verapamil hcl cap sr 4hr 360 mg (Verelan) verapamil hcl tab cr 0 mg (Calan sr) verapamil hcl tab cr 80 mg (Calan sr) verapamil hcl tab cr 40 mg (Calan sr) verapamil hcl tab 80 mg (Calan) verapamil hcl tab 0 mg (Calan) ANTIARRÍTMICOS amiodarone hcl tab 00 mg amiodarone hcl tab 00 mg (Cordarone) amiodarone hcl tab 400 mg disopyramide phosphate cap 00 mg (Norpace) disopyramide phosphate cap 50 mg (Norpace) flecainide acetate tab 50 mg flecainide acetate tab 00 mg flecainide acetate tab 50 mg mexiletine hcl cap 50 mg mexiletine hcl cap 00 mg mexiletine hcl cap 50 mg Guia de medicinas ValueScript de Florida Blue para enero de 06 5

37 06 MULTAQ - dronedarone hcl tab 400 mg 3 (base equivalent) propafenone hcl cap sr hr 5 mg (Rythmol sr) propafenone hcl cap sr hr 35 mg (Rythmol sr) propafenone hcl cap sr hr 45 mg (Rythmol sr) propafenone hcl tab 50 mg (Rythmol) propafenone hcl tab 5 mg (Rythmol) propafenone hcl tab 300 mg quinidine gluconate tab cr 34 mg QUINIDINE SULFATE - quinidine sulfate tab 00 mg QUINIDINE SULFATE ER - quinidine sulfate tab cr 300 mg quinidine sulfate tab 300 mg TIKOSYN - dofetilide cap 5 mcg (0.5 mg) TIKOSYN - dofetilide cap 50 mcg (0.5 mg) TIKOSYN - dofetilide cap 500 mcg (0.5 mg) ANTIHIERTENSIVOS amlodipine besylate-benazepril hcl cap.5-0 mg (Lotrel) amlodipine besylate-benazepril hcl cap 5-0 mg (Lotrel) amlodipine besylate-benazepril hcl cap 5-0 mg (Lotrel) amlodipine besylate-benazepril hcl cap 5-40 mg (Lotrel) amlodipine besylate-benazepril hcl cap 0-0 mg (Lotrel) amlodipine besylate-benazepril hcl cap 0-40 mg (Lotrel) amlodipine besylate-valsartan tab 5-60 mg (Exforge) amlodipine besylate-valsartan tab 5-30 mg (Exforge) amlodipine besylate-valsartan tab 0-60 mg (Exforge) amlodipine besylate-valsartan tab 0-30 mg (Exforge) amlodipine-valsartanhydrochlorothiazide tab mg (Exforge hct) amlodipine-valsartanhydrochlorothiazide tab mg (Exforge hct) amlodipine-valsartanhydrochlorothiazide tab mg (Exforge hct) amlodipine-valsartanhydrochlorothiazide tab mg (Exforge hct) amlodipine-valsartanhydrochlorothiazide tab mg (Exforge hct) atenolol & chlorthalidone tab 50-5 mg (Tenoretic 50) atenolol & chlorthalidone tab 00-5 mg (Tenoretic 00) benazepril & hydrochlorothiazide tab mg benazepril & hydrochlorothiazide tab 0-.5 mg (Lotensin hct) benazepril & hydrochlorothiazide tab 0-.5 mg (Lotensin hct) benazepril & hydrochlorothiazide tab 0-5 mg (Lotensin hct) benazepril hcl tab 5 mg benazepril hcl tab 0 mg (Lotensin) benazepril hcl tab 0 mg (Lotensin) benazepril hcl tab 40 mg (Lotensin) BENICAR - olmesartan medoxomil tab 5 mg BENICAR - olmesartan medoxomil tab 0 mg BENICAR - olmesartan medoxomil tab 40 mg 6 Guia de medicinas ValueScript de Florida Blue para enero de 06

38 06 bisoprolol & hydrochlorothiazide tab mg (Ziac) bisoprolol & hydrochlorothiazide tab mg (Ziac) bisoprolol & hydrochlorothiazide tab mg (Ziac) candesartan cilexetil tab 4 mg (Atacand) candesartan cilexetil tab 8 mg (Atacand) candesartan cilexetil tab 6 mg (Atacand) candesartan cilexetil tab 3 mg (Atacand) candesartan cilexetilhydrochlorothiazide tab 6-.5 mg (Atacand hct) candesartan cilexetilhydrochlorothiazide tab 3-.5 mg (Atacand hct) candesartan cilexetilhydrochlorothiazide tab 3-5 mg (Atacand hct) captopril tab.5 mg captopril tab 5 mg captopril tab 50 mg captopril tab 00 mg CATORIL/HYDROCHLOROTHIA - captopril & hydrochlorothiazide tab 5-5 mg CATORIL/HYDROCHLOROTHIA - captopril & hydrochlorothiazide tab 50-5 mg clonidine hcl tab 0. mg (Catapres) clonidine hcl tab 0. mg (Catapres) clonidine hcl tab 0.3 mg (Catapres) clonidine hcl td patch weekly 0. mg/4hr (Catapres-tts-) clonidine hcl td patch weekly 0. mg/4hr (Catapres-tts-) clonidine hcl td patch weekly 0.3 mg/4hr (Catapres-tts-3) DIBENZYLINE - phenoxybenzamine hcl cap 0 mg doxazosin mesylate tab mg (Cardura) doxazosin mesylate tab mg (Cardura) doxazosin mesylate tab 4 mg (Cardura) doxazosin mesylate tab 8 mg (Cardura) EDARBI - azilsartan medoxomil tab 40 mg EDARBI - azilsartan medoxomil tab 80 mg enalapril maleate & hydrochlorothiazide tab 5-.5 mg enalapril maleate & hydrochlorothiazide tab 0-5 mg (Vaseretic) enalapril maleate tab.5 mg (Vasotec) enalapril maleate tab 5 mg (Vasotec) enalapril maleate tab 0 mg (Vasotec) enalapril maleate tab 0 mg (Vasotec) eplerenone tab 5 mg (Inspra) eplerenone tab 50 mg (Inspra) eprosartan mesylate tab 600 mg (Teveten) fosinopril sodium & hydrochlorothiazide tab 0-.5 mg fosinopril sodium & hydrochlorothiazide tab 0-.5 mg fosinopril sodium tab 0 mg fosinopril sodium tab 0 mg fosinopril sodium tab 40 mg guanfacine hcl tab mg (Tenex) guanfacine hcl tab mg (Tenex) hydralazine hcl tab 0 mg hydralazine hcl tab 5 mg hydralazine hcl tab 50 mg hydralazine hcl tab 00 mg Guia de medicinas ValueScript de Florida Blue para enero de 06 7

39 06 irbesartan tab 75 mg (Avapro) irbesartan tab 50 mg (Avapro) irbesartan tab 300 mg (Avapro) irbesartan-hydrochlorothiazide tab mg (Avalide) irbesartan-hydrochlorothiazide tab mg (Avalide) lisinopril & hydrochlorothiazide tab 0-.5 mg (Zestoretic) lisinopril & hydrochlorothiazide tab 0-.5 mg (Zestoretic) lisinopril & hydrochlorothiazide tab 0-5 mg (Zestoretic) lisinopril tab.5 mg (Zestril) lisinopril tab 5 mg (rinivil) lisinopril tab 0 mg (rinivil) lisinopril tab 0 mg (rinivil) lisinopril tab 30 mg (Zestril) lisinopril tab 40 mg (Zestril) losartan potassium & hydrochlorothiazide tab mg (Hyzaar) losartan potassium & hydrochlorothiazide tab mg (Hyzaar) losartan potassium & hydrochlorothiazide tab 00-5 mg (Hyzaar) losartan potassium tab 5 mg (Cozaar) losartan potassium tab 50 mg (Cozaar) losartan potassium tab 00 mg (Cozaar) methyldopa tab 50 mg methyldopa tab 500 mg metoprolol & hydrochlorothiazide tab 50-5 mg (Lopressor hct) metoprolol & hydrochlorothiazide tab 00-5 mg (Lopressor hct) metoprolol & hydrochlorothiazide tab mg minoxidil tab.5 mg minoxidil tab 0 mg moexipril hcl tab 7.5 mg moexipril hcl tab 5 mg moexipril-hydrochlorothiazide tab mg moexipril-hydrochlorothiazide tab 5-.5 mg moexipril-hydrochlorothiazide tab 5-5 mg nadolol & bendroflumethiazide tab 40-5 mg (Corzide) nadolol & bendroflumethiazide tab 80-5 mg (Corzide) perindopril erbumine tab mg perindopril erbumine tab 4 mg (Aceon) perindopril erbumine tab 8 mg (Aceon) prazosin hcl cap mg (Minipress) prazosin hcl cap mg (Minipress) prazosin hcl cap 5 mg (Minipress) RORANOLOL/ HYDROCHLOROTH - propranolol & hydrochlorothiazide tab 80-5 mg quinapril hcl tab 5 mg (Accupril) quinapril hcl tab 0 mg (Accupril) quinapril hcl tab 0 mg (Accupril) quinapril hcl tab 40 mg (Accupril) quinapril-hydrochlorothiazide tab 0-.5 mg (Accuretic) quinapril-hydrochlorothiazide tab 0-.5 mg (Accuretic) quinapril-hydrochlorothiazide tab 0-5 mg (Accuretic) ramipril cap.5 mg (Altace) ramipril cap.5 mg (Altace) 8 Guia de medicinas ValueScript de Florida Blue para enero de 06

40 06 ramipril cap 5 mg (Altace) ramipril cap 0 mg (Altace) telmisartan tab 0 mg (Micardis) telmisartan tab 40 mg (Micardis) telmisartan tab 80 mg (Micardis) telmisartan-amlodipine tab 40-5 mg (Twynsta) telmisartan-amlodipine tab 40-0 mg (Twynsta) telmisartan-amlodipine tab 80-5 mg (Twynsta) telmisartan-amlodipine tab 80-0 mg (Twynsta) telmisartan-hydrochlorothiazide tab mg (Micardis hct) telmisartan-hydrochlorothiazide tab mg (Micardis hct) telmisartan-hydrochlorothiazide tab 80-5 mg (Micardis hct) terazosin hcl cap mg terazosin hcl cap mg terazosin hcl cap 5 mg terazosin hcl cap 0 mg trandolapril tab mg (Mavik) trandolapril tab mg (Mavik) trandolapril tab 4 mg (Mavik) trandolapril-verapamil hcl tab cr -40 mg (Tarka) trandolapril-verapamil hcl tab cr -80 mg (Tarka) trandolapril-verapamil hcl tab cr -40 mg (Tarka) trandolapril-verapamil hcl tab cr 4-40 mg (Tarka) valsartan tab 40 mg (Diovan) valsartan tab 80 mg (Diovan) valsartan tab 60 mg (Diovan) valsartan tab 30 mg (Diovan) valsartan-hydrochlorothiazide tab mg (Diovan hct) valsartan-hydrochlorothiazide tab mg (Diovan hct) valsartan-hydrochlorothiazide tab 60-5 mg (Diovan hct) valsartan-hydrochlorothiazide tab mg (Diovan hct) valsartan-hydrochlorothiazide tab 30-5 mg (Diovan hct) VECAMYL - mecamylamine hcl tab.5 mg DIURÉTICOS ACETAZOLAMIDE - acetazolamide tab 5 mg acetazolamide cap sr hr 500 mg (Diamox) acetazolamide tab 50 mg amiloride & hydrochlorothiazide tab 5-50 mg amiloride hcl tab 5 mg bumetanide tab 0.5 mg bumetanide tab mg bumetanide tab mg chlorothiazide tab 500 mg CHLORTHALIDONE - chlorthalidone tab 5 mg CHLORTHALIDONE - chlorthalidone tab 50 mg 3 DYRENIUM - triamterene cap 50 mg 3 DYRENIUM - triamterene cap 00 mg 3 EDECRIN - ethacrynic acid tab 5 mg 3 furosemide oral soln 0 mg/ml furosemide tab 0 mg (Lasix) furosemide tab 40 mg (Lasix) furosemide tab 80 mg (Lasix) hydrochlorothiazide cap.5 mg (Microzide) hydrochlorothiazide tab.5 mg Guia de medicinas ValueScript de Florida Blue para enero de 06 9

41 06 hydrochlorothiazide tab 5 mg hydrochlorothiazide tab 50 mg indapamide tab.5 mg indapamide tab.5 mg methazolamide tab 5 mg (Neptazane) methazolamide tab 50 mg (Neptazane) METHYCLOTHIAZIDE - methyclothiazide tab 5 mg metolazone tab.5 mg metolazone tab 5 mg metolazone tab 0 mg spironolactone & hydrochlorothiazide tab 5-5 mg (Aldactazide) spironolactone tab 5 mg (Aldactone) spironolactone tab 50 mg (Aldactone) spironolactone tab 00 mg (Aldactone) torsemide tab 5 mg (Demadex) torsemide tab 0 mg (Demadex) torsemide tab 0 mg (Demadex) torsemide tab 00 mg (Demadex) triamterene & hydrochlorothiazide cap mg (Dyazide) triamterene & hydrochlorothiazide tab mg (Maxzide-5) triamterene & hydrochlorothiazide tab mg (Maxzide) 3 VASORESORES EIEN -AK - epinephrine solution auto-injector 0.3 mg/0.3ml (:000) EIEN-JR -AK - epinephrine solution auto-injector 0.5 mg/0.3ml (:000) midodrine hcl tab.5 mg midodrine hcl tab 5 mg midodrine hcl tab 0 mg ANTIHIERLIIDÉMICOS atorvastatin calcium tab 0 mg (base equivalent) (Lipitor) atorvastatin calcium tab 0 mg (base equivalent) (Lipitor) atorvastatin calcium tab 40 mg (base equivalent) (Lipitor) atorvastatin calcium tab 80 mg (base equivalent) (Lipitor) cholestyramine light powder packets 4 gm cholestyramine light powder 4 gm/dose (Questran light) cholestyramine powder packets 4 gm (Questran) cholestyramine powder 4 gm/dose (Questran) choline fenofibrate cap dr 45 mg (fenofibric acid equiv) (Trilipix) choline fenofibrate cap dr 35 mg (fenofibric acid equiv) (Trilipix) colestipol hcl granule packets 5 gm (Colestid flavored) colestipol hcl granules 5 gm (Colestid flavored) colestipol hcl tab gm (Colestid) CRESTOR - rosuvastatin calcium tab 5 mg CRESTOR - rosuvastatin calcium tab 0 mg CRESTOR - rosuvastatin calcium tab 0 mg CRESTOR - rosuvastatin calcium tab 40 mg fenofibrate micronized cap 43 mg fenofibrate micronized cap 67 mg (Lofibra) fenofibrate micronized cap 30 mg fenofibrate micronized cap 34 mg (Lofibra) fenofibrate micronized cap 00 mg (Lofibra) fenofibrate tab 48 mg (Tricor) 30 Guia de medicinas ValueScript de Florida Blue para enero de 06

42 06 fenofibrate tab 54 mg (Lofibra) fenofibrate tab 45 mg (Tricor) fenofibrate tab 60 mg (Lofibra) fluvastatin sodium cap 0 mg (Lescol) fluvastatin sodium cap 40 mg (Lescol) gemfibrozil tab 600 mg (Lopid) JUXTAID - lomitapide mesylate cap 5 mg (base equiv) JUXTAID - lomitapide mesylate cap 0 mg (base equiv) JUXTAID - lomitapide mesylate cap 0 mg (base equiv) JUXTAID - lomitapide mesylate cap 30 mg (base equiv) JUXTAID - lomitapide mesylate cap 40 mg (base equiv) JUXTAID - lomitapide mesylate cap 60 mg (base equiv) LIVALO - pitavastatin calcium tab mg (base equiv) LIVALO - pitavastatin calcium tab mg (base equiv) LIVALO - pitavastatin calcium tab 4 mg (base equiv) lovastatin tab 0 mg lovastatin tab 0 mg lovastatin tab 40 mg (Mevacor) niacin tab cr 500 mg (antihyperlipidemic) (Niaspan) niacin tab cr 750 mg (antihyperlipidemic) (Niaspan) niacin tab cr 000 mg (antihyperlipidemic) (Niaspan) NIACOR - niacin (antihyperlipidemic) 3 tab 500 mg omega-3-acid ethyl esters cap gm (Lovaza) pravastatin sodium tab 0 mg pravastatin sodium tab 0 mg (ravachol) pravastatin sodium tab 40 mg (ravachol) pravastatin sodium tab 80 mg (ravachol) simvastatin tab 5 mg (Zocor) simvastatin tab 0 mg (Zocor) simvastatin tab 0 mg (Zocor) simvastatin tab 40 mg (Zocor) simvastatin tab 80 mg (Zocor) VASCEA - icosapent ethyl cap gm 3 WELCHOL - colesevelam hcl packet for susp 3.75 gm WELCHOL - colesevelam hcl tab 65 mg ZETIA - ezetimibe tab 0 mg AGENTES CARDIOVASCULARES, MISC. ADEMAS - riociguat tab 0.5 mg ADEMAS - riociguat tab mg ADEMAS - riociguat tab.5 mg ADEMAS - riociguat tab mg ADEMAS - riociguat tab.5 mg amlodipine besylate-atorvastatin calcium tab.5-0 mg (Caduet) amlodipine besylate-atorvastatin calcium tab.5-0 mg (Caduet) amlodipine besylate-atorvastatin calcium tab.5-40 mg (Caduet) amlodipine besylate-atorvastatin calcium tab 5-0 mg (Caduet) amlodipine besylate-atorvastatin calcium tab 5-0 mg (Caduet) amlodipine besylate-atorvastatin calcium tab 5-40 mg (Caduet) amlodipine besylate-atorvastatin calcium tab 5-80 mg (Caduet) amlodipine besylate-atorvastatin calcium tab 0-0 mg (Caduet) Guia de medicinas ValueScript de Florida Blue para enero de 06 3

43 06 amlodipine besylate-atorvastatin calcium tab 0-0 mg (Caduet) amlodipine besylate-atorvastatin calcium tab 0-40 mg (Caduet) amlodipine besylate-atorvastatin calcium tab 0-80 mg (Caduet) LETAIRIS - ambrisentan tab 5 mg LETAIRIS - ambrisentan tab 0 mg OSUMIT - macitentan tab 0 mg sildenafil citrate tab 0 mg (Revatio) TRACLEER - bosentan tab 6.5 mg TRACLEER - bosentan tab 5 mg VENTAVIS - iloprost inhalation solution 0 mcg/ml VENTAVIS - iloprost inhalation solution 0 mcg/ml AGENTES RESIRATORIOS ANTIHISTAMÍNICOS carbinoxamine maleate soln 4 mg/5ml carbinoxamine maleate tab 4 mg cetirizine hcl oral soln mg/ml (5 mg/5ml) clemastine fumarate tab.68 mg cyproheptadine hcl syrup mg/5ml cyproheptadine hcl tab 4 mg desloratadine tab orally disintegrating.5 mg (Clarinex reditabs) desloratadine tab orally disintegrating 5 mg (Clarinex reditabs) desloratadine tab 5 mg (Clarinex) diphenhydramine hcl cap 50 mg diphenhydramine hcl elixir.5 mg/5ml levocetirizine dihydrochloride soln.5 mg/5ml (0.5 mg/ml) (Xyzal) levocetirizine dihydrochloride tab 5 mg (Xyzal) loratadine rapidly-disintegrating tab 0 mg (Claritin) loratadine syrup 5 mg/5ml loratadine tab 0 mg promethazine hcl suppos.5 mg promethazine hcl suppos 5 mg promethazine hcl suppos 50 mg promethazine hcl syrup 6.5 mg/5ml promethazine hcl tab.5 mg promethazine hcl tab 5 mg promethazine hcl tab 50 mg AGENTES NASALES SISTÉMICOS Y TÓICOS azelastine hcl nasal spray 0.% (37 mcg/spray) azelastine hcl nasal spray 0.5% (05.5 mcg/spray) (Astepro) flunisolide nasal soln 5 mcg/act (0.05%) (Flunisolide) fluticasone propionate nasal susp 50 mcg/act ipratropium bromide nasal soln 0.03% ( mcg/spray) (Atrovent) ipratropium bromide nasal soln 0.06% (4 mcg/spray) (Atrovent) olopatadine hcl nasal soln 0.6% (atanase) triamcinolone acetonide nasal aerosol suspension 55 mcg/act TOS/RESFRÍO/ALERGIA acetylcysteine inhal soln 0% acetylcysteine inhal soln 0% benzonatate cap 00 mg (Tessalon perles) benzonatate cap 50 mg (Zonatuss) benzonatate cap 00 mg chlorpheniramine w/ codeine liquid -0 mg/5ml hydrocod polst-chlorphen polst cr susp 0-8 mg/5ml (Tussionex pennkineti) hydrocodone w/ homatropine syrup 5-.5 mg/5ml 3 Guia de medicinas ValueScript de Florida Blue para enero de 06

44 06 hydrocodone w/ homatropine tab 5-.5 mg loratadine & pseudoephedrine tab sr hr 5-0 mg loratadine & pseudoephedrine tab sr 4hr 0-40 mg promethazine w/ codeine syrup mg/5ml promethazine-dm syrup mg/5ml pseudoeph-chlorphen w/ hydrocodone soln mg/5ml (Zutripro) pseudoephed-bromphen-dm syrup mg/5ml sodium chloride soln nebu 0.9% sodium chloride soln nebu 3% sodium chloride soln nebu 7% (Hypersal) sodium chloride soln nebu 0% AGENTES ANTIASMÁTICOS Y BRONCODILATADORES albuterol sulfate soln nebu 0.083% (.5 mg/3ml) albuterol sulfate soln nebu 0.5% (5 mg/ml) albuterol sulfate soln nebu 0.63 mg/3ml (base equiv) albuterol sulfate soln nebu.5 mg/3ml (base equiv) albuterol sulfate syrup mg/5ml albuterol sulfate tab sr hr 4 mg (Vospire er) albuterol sulfate tab sr hr 8 mg (Vospire er) albuterol sulfate tab mg albuterol sulfate tab 4 mg ALVESCO - ciclesonide inhal aerosol 80 mcg/act ALVESCO - ciclesonide inhal aerosol 60 mcg/act ARCATA NEOHALER - indacaterol maleate inhal powder cap 75 mcg (base equiv) ATROVENT HFA - ipratropium bromide hfa inhal aerosol 7 mcg/act BREO ELLITA - fluticasone furoatevilanterol aero powd ba 00-5 mcg/ inh BREO ELLITA - fluticasone furoatevilanterol aero powd ba 00-5 mcg/ inh BROVANA - arformoterol tartrate soln nebu 5 mcg/ml (base equiv) budesonide inhalation susp 0.5 mg/ml (ulmicort) budesonide inhalation susp 0.5 mg/ml (ulmicort) COMBIVENT RESIMAT - ipratropium-albuterol inhal aerosol soln 0-00 mcg/act 3 3 DALIRES - roflumilast tab 500 mcg DULERA - mometasone furoateformoterol fumarate aerosol 00-5 mcg/act DULERA - mometasone furoateformoterol fumarate aerosol 00-5 mcg/act dyphylline-guaifenesin liqd mg/5ml epinephrine hcl inj mg/ml epinephrine hcl soln prefilled syringe 0. mg/ml FORADIL AEROLIZER - formoterol fumarate inhal cap mcg INCRUSE ELLITA - umeclidinium br aero powd breath act 6.5 mcg/inh (base eq) ipratropium bromide inhal soln 0.0% ipratropium-albuterol nebu soln (3) mg/3ml Guia de medicinas ValueScript de Florida Blue para enero de 06 33

45 06 levalbuterol hcl soln nebu conc.5 mg/0.5ml (base equiv) (Xopenex concentrate) levalbuterol hcl soln nebu 0.3 mg/3ml (base equiv) (Xopenex) levalbuterol hcl soln nebu 0.63 mg/3ml (base equiv) (Xopenex) levalbuterol hcl soln nebu.5 mg/3ml (base equiv) (Xopenex) LUFYLLIN - dyphylline tab 400 mg 3 montelukast sodium chew tab 4 mg (base equiv) (Singulair) montelukast sodium chew tab 5 mg (base equiv) (Singulair) montelukast sodium oral granules packet 4 mg (base equiv) (Singulair) montelukast sodium tab 0 mg (base equiv) (Singulair) ROAIR HFA - albuterol sulfate inhal aero 08 mcg/act (90mcg base equiv) ROAIR RESICLICK - albuterol sulfate aer pow ba 08 mcg/act (90 mcg base equiv) ULMICORT - budesonide inhalation susp mg/ml ULMICORT FLEXHALER - budesonide inhal aero powd 90 mcg/ act (breath activated) ULMICORT FLEXHALER - budesonide inhal aero powd 80 mcg/ act (breath activated) QVAR - beclomethasone dipropionate inhal aero soln 40 mcg/act QVAR - beclomethasone dipropionate inhal aero soln 80 mcg/act SEREVENT DISKUS - salmeterol xinafoate aer pow ba 50 mcg/dose (base equiv) SIRIVA HANDIHALER - tiotropium bromide monohydrate inhal cap 8 mcg (base equiv) SIRIVA RESIMAT - tiotropium bromide monohydrate inhal aerosol.5 mcg/act SYMBICORT - budesonide-formoterol fumarate dihyd aerosol mcg/act SYMBICORT - budesonide-formoterol fumarate dihyd aerosol mcg/ act terbutaline sulfate tab.5 mg terbutaline sulfate tab 5 mg theophylline soln 80 mg/5ml theophylline tab sr hr 00 mg theophylline tab sr hr 00 mg theophylline tab sr hr 300 mg theophylline tab sr hr 450 mg theophylline tab sr 4hr 400 mg theophylline tab sr 4hr 600 mg VENTOLIN HFA - albuterol sulfate inhal aero 08 mcg/act (90mcg base equiv) zafirlukast tab 0 mg (Accolate) zafirlukast tab 0 mg (Accolate) ZYFLO CR - zileuton tab sr hr 600 mg AGENTES RESIRATORIOS, MISC. ESBRIET - pirfenidone cap 67 mg KALYDECO - ivacaftor tab 50 mg ULMOZYME - dornase alfa inhal soln mg/ml AGENTES GASTROINTESTINALES LAXANTES bisacodyl tab & peg 3350-kcl-sod bicarb-nacl for soln kit lactulose solution 0 gm/5ml OSMORE - sod phos mono-sod phos di tabs gm(.5gm na phos) peg 3350-kcl-sod bicarb-nacl for soln 40 gm (Nulytely/flavor pack) peg 3350-kcl-na bicarb-nacl-na sulfate for soln 36 gm (Golytely) Guia de medicinas ValueScript de Florida Blue para enero de 06

46 06 peg 3350-kcl-na bicarb-nacl-na sulfate for soln 40 gm (Colyte-flavor packs) REOIK - sod picosulfate-mg oxidecitric acid pack 0 mg-3.5 gm- gm SURE BOWEL RE - sodium sulfate-potassium sulfate-magnesium sulfate oral soln ANTIDIARREICOS diphenoxylate w/ atropine tab mg (Lomotil) loperamide hcl cap mg FÁRMACOS ARA LA ÚLCERA amoxicillin cap-clarithro tablansopraz cap dr therapy pack (revpac) CANTIL - mepenzolate bromide tab 5 mg CARAFATE - sucralfate susp gm/0ml cimetidine hcl soln 300 mg/5ml cimetidine tab 00 mg cimetidine tab 300 mg cimetidine tab 400 mg cimetidine tab 800 mg dicyclomine hcl cap 0 mg (Bentyl) dicyclomine hcl tab 0 mg (Bentyl) esomeprazole magnesium cap delayed release 0 mg (base eq) (Nexium) esomeprazole magnesium cap delayed release 40 mg (base eq) (Nexium) famotidine for susp 40 mg/5ml (epcid) famotidine tab 0 mg (epcid) famotidine tab 40 mg (epcid) glycopyrrolate tab mg (Robinul) glycopyrrolate tab mg (Robinul forte) hyoscyamine sulfate elixir 0.5 mg/5ml hyoscyamine sulfate soln 0.5 mg/ml hyoscyamine sulfate tab disp 0.5 mg (Anaspaz) hyoscyamine sulfate tab sl 0.5 mg (Levsin/sl) hyoscyamine sulfate tab sr hr mg (Levbid) hyoscyamine sulfate tab 0.5 mg (Levsin) lansoprazole cap delayed release 5 mg (revacid) lansoprazole cap delayed release 30 mg (revacid) methscopolamine bromide tab.5 mg (amine) methscopolamine bromide tab 5 mg (amine forte) misoprostol tab 00 mcg (Cytotec) misoprostol tab 00 mcg (Cytotec) NEXIUM - esomeprazole magnesium cap delayed release 0 mg (base eq) NEXIUM - esomeprazole magnesium cap delayed release 40 mg (base eq) nizatidine cap 50 mg nizatidine cap 300 mg (Axid) nizatidine oral soln 5 mg/ml omeprazole cap delayed release 0 mg (rilosec) omeprazole cap delayed release 0 mg (rilosec) omeprazole cap delayed release 40 mg (rilosec) omeprazole-sodium bicarbonate cap 0-00 mg (Zegerid) omeprazole-sodium bicarbonate cap mg (Zegerid) pantoprazole sodium ec tab 0 mg (base equiv) (rotonix) pantoprazole sodium ec tab 40 mg (base equiv) (rotonix) RILOSEC OTC - omeprazole magnesium delayed release tab 0 mg (base equiv) Guia de medicinas ValueScript de Florida Blue para enero de 06 35

47 06 ROANTHELINE BROMIDE - propantheline bromide tab 5 mg rabeprazole sodium ec tab 0 mg (Aciphex) ranitidine hcl cap 50 mg ranitidine hcl cap 300 mg ranitidine hcl syrup 5 mg/ml (75 mg/5ml) ranitidine hcl tab 50 mg (Zantac) ranitidine hcl tab 300 mg (Zantac) sucralfate tab gm (Carafate) SYMAX DUOTAB - hyoscyamine sulfate tab cr mg (0.5 mg ir/0.5 mg cr) ANTIEMÉTICOS ANZEMET - dolasetron mesylate tab 50 mg ANZEMET - dolasetron mesylate tab 00 mg CESAMET - nabilone cap mg dronabinol cap.5 mg (Marinol) dronabinol cap 5 mg (Marinol) dronabinol cap 0 mg (Marinol) EMEND - aprepitant capsule therapy pack 80 & 5 mg EMEND - aprepitant capsule 40 mg EMEND - aprepitant capsule 80 mg EMEND - aprepitant capsule 5 mg granisetron hcl tab mg meclizine hcl tab.5 mg meclizine hcl tab 5 mg ondansetron hcl oral soln 4 mg/5ml (Zofran) ondansetron hcl tab 4 mg (Zofran) ondansetron hcl tab 8 mg (Zofran) ondansetron hcl tab 4 mg ondansetron orally disintegrating tab 4 mg (Zofran odt) ondansetron orally disintegrating tab 8 mg (Zofran odt) TRANSDERM-SCO - scopolamine td patch 7hr mg/3days trimethobenzamide hcl cap 300 mg (Tigan) AYUDA DIGESTIVA CREON - pancrelipase (lip-prot-amyl) dr cap unit CREON - pancrelipase (lip-prot-amyl) dr cap unit CREON - pancrelipase (lip-prot-amyl) dr cap unit CREON - pancrelipase (lip-prot-amyl) dr cap unit CREON - pancrelipase (lip-prot-amyl) dr cap unit ZENE - pancrelipase (lip-prot-amyl) dr cap unit ZENE - pancrelipase (lip-prot-amyl) dr cap unit ZENE - pancrelipase (lip-prot-amyl) dr cap unit ZENE - pancrelipase (lip-prot-amyl) dr cap unit ZENE - pancrelipase (lip-prot-amyl) dr cap unit ZENE - pancrelipase (lip-prot-amyl) dr cap unit ZENE - pancrelipase (lip-prot-amyl) dr cap unit 3 AGENTES GASTROINTESTINALES - MISC. alosetron hcl tab 0.5 mg (base equiv) (Lotronex) alosetron hcl tab mg (base equiv) (Lotronex) AMITIZA - lubiprostone cap 8 mcg 3 AMITIZA - lubiprostone cap 4 mcg 3 ASACOL HD - mesalamine tab delayed release 800 mg 36 Guia de medicinas ValueScript de Florida Blue para enero de 06

48 06 balsalazide disodium cap 750 mg (Colazal) calcium acetate (phosphate binder) cap 667 mg (69 mg ca) (hoslo) calcium acetate (phosphate binder) tab 667 mg (Eliphos) CANASA - mesalamine suppos 000 mg CHENODAL - chenodiol tab 50 mg CIMZIA - certolizumab pegol for inj kit x 00 mg CIMZIA - certolizumab pegol inj kit x 00 mg/ml CIMZIA STARTER KIT - certolizumab pegol inj kit 6 x 00 mg/ml cromolyn sodium oral conc 00 mg/5ml (Gastrocrom) DELZICOL - mesalamine cap dr 400 mg DIENTUM - olsalazine sodium cap 50 3 mg FOSRENOL - lanthanum carbonate chew 3 tab 500 mg FOSRENOL - lanthanum carbonate chew 3 tab 750 mg FOSRENOL - lanthanum carbonate chew 3 tab 000 mg lactulose (encephalopathy) solution 0 gm/5ml LIALDA - mesalamine tab delayed release. gm LINZESS - linaclotide cap 45 mcg 3 LINZESS - linaclotide cap 90 mcg 3 LOTRONEX - alosetron hcl tab 0.5 mg (base equiv) LOTRONEX - alosetron hcl tab mg (base equiv) mesalamine enema 4 gm metoclopramide hcl soln 5 mg/5ml (0 mg/0ml) metoclopramide hcl tab 5 mg (Reglan) metoclopramide hcl tab 0 mg (Reglan) 3 3 ENTASA - mesalamine cap cr 50 mg ENTASA - mesalamine cap cr 500 mg RENVELA - sevelamer carbonate packet 0.8 gm RENVELA - sevelamer carbonate packet.4 gm RENVELA - sevelamer carbonate tab 800 mg sulfasalazine tab delayed release 500 mg (Azulfidine en-tabs) sulfasalazine tab 500 mg (Azulfidine) ursodiol cap 300 mg (Actigall) ursodiol tab 50 mg (Urso 50) ursodiol tab 500 mg (Urso forte) AGENTES GENITOURINARIOS ANTIINFEIOSOS URINARIOS methenamine hippurate tab gm (Hiprex) MONUROL - fosfomycin tromethamine powd pack 3 gm (base equivalent) nitrofurantoin macrocrystalline cap 50 mg (Macrodantin) nitrofurantoin macrocrystalline cap 00 mg (Macrodantin) nitrofurantoin monohydrate macrocrystalline cap 00 mg (Macrobid) nitrofurantoin susp 5 mg/5ml (Furadantin) ANTIESASMÓDICOS URINARIOS bethanechol chloride tab 5 mg (Urecholine) bethanechol chloride tab 0 mg (Urecholine) bethanechol chloride tab 5 mg (Urecholine) bethanechol chloride tab 50 mg (Urecholine) ENABLEX - darifenacin hydrobromide tab sr 4hr 7.5 mg (base equiv) 3 Guia de medicinas ValueScript de Florida Blue para enero de 06 37

49 06 ENABLEX - darifenacin hydrobromide tab sr 4hr 5 mg (base equiv) flavoxate hcl tab 00 mg oxybutynin chloride syrup 5 mg/5ml oxybutynin chloride tab sr 4hr 5 mg (Ditropan xl) oxybutynin chloride tab sr 4hr 0 mg (Ditropan xl) oxybutynin chloride tab sr 4hr 5 mg (Ditropan xl) oxybutynin chloride tab 5 mg tolterodine tartrate cap sr 4hr mg (Detrol la) tolterodine tartrate cap sr 4hr 4 mg (Detrol la) tolterodine tartrate tab mg (Detrol) tolterodine tartrate tab mg (Detrol) TOVIAZ - fesoterodine fumarate tab sr 4hr 4 mg TOVIAZ - fesoterodine fumarate tab sr 4hr 8 mg trospium chloride cap sr 4hr 60 mg trospium chloride tab 0 mg VESICARE - solifenacin succinate tab 5 mg VESICARE - solifenacin succinate tab 0 mg RODUCTOS VAGINALES AVC - sulfanilamide vaginal cream 5% CLEOCIN - clindamycin phosphate vaginal suppos 00 mg clindamycin phosphate vaginal cream % (Cleocin) ENCARE - nonoxynol-9 vaginal suppos 00 mg GYNAZOLE- - butoconazole nitrate (one dose) vaginal cream % metronidazole vaginal gel 0.75% (Metrogel-vaginal) 3 OTIONS CONCETROL VAGINA - nonoxynol-9 gel 4% OTIONS GYNOL II VAGINAL - nonoxynol-9 gel 3% REMARIN - estrogens, conjugated vaginal cream 0.65 mg/gm SHUR-SEAL - nonoxynol-9 gel % terconazole vaginal cream 0.4% (Terazol 7) terconazole vaginal cream 0.8% (Terazol 3) terconazole vaginal suppos 80 mg TODAY SONGE - nonoxynol-9 vaginal sponge 000 mg VAGIFEM - estradiol vaginal tab 0 mcg VCF VAGINAL CONTRACETIVE - nonoxynol-9 film 8% VCF VAGINAL CONTRACETIVE - nonoxynol-9 foam.5% AGENTES GENITOURINARIOS, MISC. acetic acid irrigation soln 0.5% alfuzosin hcl tab sr 4hr 0 mg (Uroxatral) AVODART - dutasteride cap 0.5 mg 3 CYSTAGON - cysteamine bitartrate cap 50 mg CYSTAGON - cysteamine bitartrate cap 50 mg finasteride tab 5 mg (roscar) K-HOS NO - potassium & sodium acid phosphates tab mg phenazopyridine hcl tab 00 mg (yridium) phenazopyridine hcl tab 00 mg (yridium) pot & sod citrates w/ cit ac soln mg/5ml potassium citrate & citric acid powder pack mg 38 Guia de medicinas ValueScript de Florida Blue para enero de 06

50 06 potassium citrate & citric acid soln mg/5ml potassium citrate tab cr 5 meq (540 mg) (Urocit-k 5) potassium citrate tab cr 0 meq (080 mg) (Urocit-k 0) potassium citrate tab cr 5 meq (60 mg) (Urocit-k 5) RAAFLO - silodosin cap 4 mg 3 RAAFLO - silodosin cap 8 mg 3 sodium chloride irrigation soln 0.9% sodium citrate & citric acid soln mg/5ml (Shohls solution modi) tamsulosin hcl cap 0.4 mg (Flomax) FÁRMACOS ARA EL SISTEMA NERVIOSO CENTRAL AGENTES ANSIOLÍTICOS alprazolam orally disintegrating tab 0.5 mg (Niravam) alprazolam orally disintegrating tab 0.5 mg alprazolam orally disintegrating tab mg alprazolam orally disintegrating tab mg alprazolam tab sr 4hr 0.5 mg (Xanax xr) alprazolam tab sr 4hr mg (Xanax xr) alprazolam tab sr 4hr mg (Xanax xr) alprazolam tab sr 4hr 3 mg (Xanax xr) alprazolam tab 0.5 mg (Xanax) alprazolam tab 0.5 mg (Xanax) alprazolam tab mg (Xanax) alprazolam tab mg (Xanax) buspirone hcl tab 5 mg buspirone hcl tab 7.5 mg buspirone hcl tab 0 mg buspirone hcl tab 5 mg buspirone hcl tab 30 mg chlordiazepoxide hcl cap 5 mg chlordiazepoxide hcl cap 0 mg chlordiazepoxide hcl cap 5 mg clorazepate dipotassium tab 3.75 mg (Tranxene t) clorazepate dipotassium tab 7.5 mg (Tranxene t) clorazepate dipotassium tab 5 mg (Tranxene t) DIAZEAM - diazepam soln mg/ml diazepam conc 5 mg/ml diazepam tab mg (Valium) diazepam tab 5 mg (Valium) diazepam tab 0 mg (Valium) hydroxyzine hcl syrup 0 mg/5ml hydroxyzine hcl tab 0 mg hydroxyzine hcl tab 5 mg hydroxyzine hcl tab 50 mg hydroxyzine pamoate cap 5 mg (Vistaril) hydroxyzine pamoate cap 50 mg (Vistaril) lorazepam conc mg/ml (Lorazepam intensol) lorazepam tab 0.5 mg (Ativan) lorazepam tab mg (Ativan) lorazepam tab mg (Ativan) meprobamate tab 00 mg meprobamate tab 400 mg oxazepam cap 0 mg oxazepam cap 5 mg oxazepam cap 30 mg ANTIDERESIVOS Guia de medicinas ValueScript de Florida Blue para enero de 06 39

51 06 amitriptyline hcl tab 0 mg amitriptyline hcl tab 5 mg amitriptyline hcl tab 50 mg amitriptyline hcl tab 75 mg amitriptyline hcl tab 00 mg amitriptyline hcl tab 50 mg AMOXAINE - amoxapine tab 5 mg 3 AMOXAINE - amoxapine tab 50 mg 3 AMOXAINE - amoxapine tab 00 mg 3 AMOXAINE - amoxapine tab 50 mg 3 bupropion hcl tab sr hr 00 mg (Wellbutrin sr) bupropion hcl tab sr hr 50 mg (Wellbutrin sr) bupropion hcl tab sr hr 00 mg (Wellbutrin sr) bupropion hcl tab sr 4hr 50 mg (Wellbutrin xl) bupropion hcl tab sr 4hr 300 mg (Wellbutrin xl) bupropion hcl tab 75 mg (Wellbutrin) bupropion hcl tab 00 mg (Wellbutrin) citalopram hydrobromide oral soln 0 mg/5ml citalopram hydrobromide tab 0 mg (base equiv) (Celexa) citalopram hydrobromide tab 0 mg (base equiv) (Celexa) citalopram hydrobromide tab 40 mg (base equiv) (Celexa) clomipramine hcl cap 5 mg (Anafranil) clomipramine hcl cap 50 mg (Anafranil) clomipramine hcl cap 75 mg (Anafranil) desipramine hcl tab 0 mg (Norpramin) desipramine hcl tab 5 mg (Norpramin) desipramine hcl tab 50 mg (Norpramin) desipramine hcl tab 75 mg (Norpramin) desipramine hcl tab 00 mg (Norpramin) desipramine hcl tab 50 mg (Norpramin) DOXEIN HCL - doxepin hcl cap 75 mg doxepin hcl cap 0 mg doxepin hcl cap 5 mg doxepin hcl cap 50 mg doxepin hcl cap 00 mg doxepin hcl cap 50 mg doxepin hcl conc 0 mg/ml duloxetine hcl enteric coated pellets cap 0 mg (Cymbalta) duloxetine hcl enteric coated pellets cap 30 mg (Cymbalta) duloxetine hcl enteric coated pellets cap 60 mg (Cymbalta) EMSAM - selegiline td patch 4hr 6 mg/4hr EMSAM - selegiline td patch 4hr 9 mg/4hr EMSAM - selegiline td patch 4hr mg/4hr escitalopram oxalate soln 5 mg/5ml (base equiv) (Lexapro) escitalopram oxalate tab 5 mg (base equiv) (Lexapro) escitalopram oxalate tab 0 mg (base equiv) (Lexapro) escitalopram oxalate tab 0 mg (base equiv) (Lexapro) fluoxetine hcl cap delayed release 90 mg (rozac weekly) fluoxetine hcl cap 0 mg (rozac) fluoxetine hcl cap 0 mg (rozac) fluoxetine hcl cap 40 mg (rozac) fluoxetine hcl solution 0 mg/5ml fluoxetine hcl tab 0 mg 40 Guia de medicinas ValueScript de Florida Blue para enero de 06

52 06 fluoxetine hcl tab 0 mg fluvoxamine maleate cap sr 4hr 00 mg fluvoxamine maleate cap sr 4hr 50 mg fluvoxamine maleate tab 5 mg fluvoxamine maleate tab 50 mg fluvoxamine maleate tab 00 mg imipramine hcl tab 0 mg (Tofranil) imipramine hcl tab 5 mg (Tofranil) imipramine hcl tab 50 mg (Tofranil) imipramine pamoate cap 75 mg (Tofranil-pm) imipramine pamoate cap 00 mg (Tofranil-pm) imipramine pamoate cap 5 mg (Tofranil-pm) imipramine pamoate cap 50 mg (Tofranil-pm) MAROTILINE HCL - maprotiline hcl tab 5 mg MAROTILINE HCL - maprotiline hcl tab 50 mg MAROTILINE HCL - maprotiline hcl tab 75 mg MARLAN - isocarboxazid tab 0 mg 3 mirtazapine orally disintegrating tab 5 mg (Remeron soltab) mirtazapine orally disintegrating tab 30 mg (Remeron soltab) mirtazapine orally disintegrating tab 45 mg (Remeron soltab) mirtazapine tab 7.5 mg mirtazapine tab 5 mg (Remeron) mirtazapine tab 30 mg (Remeron) mirtazapine tab 45 mg (Remeron) nefazodone hcl tab 50 mg nortriptyline hcl cap 0 mg (amelor) nortriptyline hcl cap 5 mg (amelor) nortriptyline hcl cap 50 mg (amelor) nortriptyline hcl cap 75 mg (amelor) paroxetine hcl tab sr 4hr.5 mg (axil cr) paroxetine hcl tab sr 4hr 5 mg (axil cr) paroxetine hcl tab sr 4hr 37.5 mg (axil cr) paroxetine hcl tab 0 mg (axil) paroxetine hcl tab 0 mg (axil) paroxetine hcl tab 30 mg (axil) paroxetine hcl tab 40 mg (axil) AXIL - paroxetine hcl oral susp 0 mg/5ml (base equiv) phenelzine sulfate tab 5 mg (Nardil) protriptyline hcl tab 5 mg protriptyline hcl tab 0 mg sertraline hcl oral conc 0 mg/ml (Zoloft) sertraline hcl tab 5 mg (Zoloft) sertraline hcl tab 50 mg (Zoloft) sertraline hcl tab 00 mg (Zoloft) tranylcypromine sulfate tab 0 mg (arnate) trazodone hcl tab 50 mg trazodone hcl tab 00 mg trazodone hcl tab 50 mg trazodone hcl tab 300 mg venlafaxine hcl cap sr 4hr 37.5 mg (base equivalent) (Effexor xr) venlafaxine hcl cap sr 4hr 75 mg (base equivalent) (Effexor xr) venlafaxine hcl cap sr 4hr 50 mg (base equivalent) (Effexor xr) VENLAFAXINE HCL ER - venlafaxine hcl tab sr 4hr 5 mg (base equivalent) venlafaxine hcl tab sr 4hr 37.5 mg (base equivalent) (Venlafaxine hcl er) Guia de medicinas ValueScript de Florida Blue para enero de 06 4

53 06 venlafaxine hcl tab sr 4hr 75 mg (base equivalent) (Venlafaxine hcl er) venlafaxine hcl tab sr 4hr 50 mg (base equivalent) (Venlafaxine hcl er) venlafaxine hcl tab 5 mg venlafaxine hcl tab 37.5 mg venlafaxine hcl tab 50 mg venlafaxine hcl tab 75 mg venlafaxine hcl tab 00 mg VIIBRYD - vilazodone hcl tab starter kit 0 (7) & 0 (7) & 40 (6) mg VIIBRYD - vilazodone hcl tab 0 mg VIIBRYD - vilazodone hcl tab 0 mg VIIBRYD - vilazodone hcl tab 40 mg ANTISICÓTICOS ABILIFY - aripiprazole tab mg ABILIFY - aripiprazole tab 5 mg ABILIFY - aripiprazole tab 0 mg ABILIFY - aripiprazole tab 5 mg ABILIFY - aripiprazole tab 0 mg ABILIFY - aripiprazole tab 30 mg aripiprazole tab mg (Abilify) aripiprazole tab 5 mg (Abilify) aripiprazole tab 0 mg (Abilify) aripiprazole tab 5 mg (Abilify) aripiprazole tab 0 mg (Abilify) aripiprazole tab 30 mg (Abilify) chlorpromazine hcl tab 0 mg chlorpromazine hcl tab 5 mg chlorpromazine hcl tab 50 mg chlorpromazine hcl tab 00 mg chlorpromazine hcl tab 00 mg clozapine tab 5 mg (Clozaril) clozapine tab 50 mg clozapine tab 00 mg (Clozaril) clozapine tab 00 mg FANAT - iloperidone tab mg FANAT - iloperidone tab mg FANAT - iloperidone tab 4 mg FANAT - iloperidone tab 6 mg FANAT - iloperidone tab 8 mg FANAT - iloperidone tab 0 mg FANAT - iloperidone tab mg FANAT TITRATION ACK - iloperidone tab mg & mg & 4 mg & 6 mg titration pak fluphenazine hcl tab mg fluphenazine hcl tab.5 mg fluphenazine hcl tab 5 mg fluphenazine hcl tab 0 mg haloperidol lactate oral conc mg/ml haloperidol tab 0.5 mg haloperidol tab mg haloperidol tab mg haloperidol tab 5 mg haloperidol tab 0 mg haloperidol tab 0 mg INVEGA - paliperidone tab sr 4hr.5 mg INVEGA - paliperidone tab sr 4hr 3 mg INVEGA - paliperidone tab sr 4hr 6 mg INVEGA - paliperidone tab sr 4hr 9 mg LATUDA - lurasidone hcl tab 0 mg LATUDA - lurasidone hcl tab 40 mg LATUDA - lurasidone hcl tab 60 mg LATUDA - lurasidone hcl tab 80 mg LATUDA - lurasidone hcl tab 0 mg LITHIUM - lithium oral solution 8 meq/5ml LITHIUM CARBONATE - lithium carbonate cap 600 mg lithium carbonate cap 50 mg (Lithium carbonate) 4 Guia de medicinas ValueScript de Florida Blue para enero de 06

54 06 lithium carbonate cap 300 mg lithium carbonate cap 600 mg (Lithium carbonate) lithium carbonate tab cr 300 mg (Lithobid) lithium carbonate tab cr 450 mg lithium carbonate tab 300 mg loxapine succinate cap 5 mg loxapine succinate cap 0 mg loxapine succinate cap 5 mg loxapine succinate cap 50 mg olanzapine orally disintegrating tab 5 mg (Zyprexa zydis) olanzapine orally disintegrating tab 0 mg (Zyprexa zydis) olanzapine orally disintegrating tab 5 mg (Zyprexa zydis) olanzapine orally disintegrating tab 0 mg (Zyprexa zydis) olanzapine tab.5 mg (Zyprexa) olanzapine tab 5 mg (Zyprexa) olanzapine tab 7.5 mg (Zyprexa) olanzapine tab 0 mg (Zyprexa) olanzapine tab 5 mg (Zyprexa) olanzapine tab 0 mg (Zyprexa) perphenazine tab mg perphenazine tab 4 mg perphenazine tab 8 mg perphenazine tab 6 mg prochlorperazine maleate tab 5 mg (base equivalent) (Compazine) prochlorperazine maleate tab 0 mg (base equivalent) (Compazine) prochlorperazine suppos 5 mg quetiapine fumarate tab 5 mg (Seroquel) quetiapine fumarate tab 50 mg (Seroquel) quetiapine fumarate tab 00 mg (Seroquel) quetiapine fumarate tab 00 mg (Seroquel) quetiapine fumarate tab 300 mg (Seroquel) quetiapine fumarate tab 400 mg (Seroquel) risperidone orally disintegrating tab 0.5 mg risperidone orally disintegrating tab 0.5 mg (Risperdal m-tab) risperidone orally disintegrating tab mg (Risperdal m-tab) risperidone orally disintegrating tab mg (Risperdal m-tab) risperidone orally disintegrating tab 3 mg (Risperdal m-tab) risperidone orally disintegrating tab 4 mg (Risperdal m-tab) risperidone soln mg/ml (Risperdal) risperidone tab 0.5 mg (Risperdal) risperidone tab 0.5 mg (Risperdal) risperidone tab mg (Risperdal) risperidone tab mg (Risperdal) risperidone tab 3 mg (Risperdal) risperidone tab 4 mg (Risperdal) SAHRIS - asenapine maleate sl tab.5 3 mg (base equiv) SAHRIS - asenapine maleate sl tab 5 mg (base equiv) SAHRIS - asenapine maleate sl tab 0 mg (base equiv) SEROQUEL XR - quetiapine fumarate tab sr 4hr 50 mg SEROQUEL XR - quetiapine fumarate tab sr 4hr 50 mg SEROQUEL XR - quetiapine fumarate tab sr 4hr 00 mg Guia de medicinas ValueScript de Florida Blue para enero de 06 43

55 06 SEROQUEL XR - quetiapine fumarate tab sr 4hr 300 mg SEROQUEL XR - quetiapine fumarate tab sr 4hr 400 mg thioridazine hcl tab 0 mg thioridazine hcl tab 5 mg thioridazine hcl tab 50 mg thioridazine hcl tab 00 mg thiothixene cap mg thiothixene cap mg thiothixene cap 5 mg thiothixene cap 0 mg trifluoperazine hcl tab mg trifluoperazine hcl tab mg trifluoperazine hcl tab 5 mg trifluoperazine hcl tab 0 mg ziprasidone hcl cap 0 mg (Geodon) ziprasidone hcl cap 40 mg (Geodon) ziprasidone hcl cap 60 mg (Geodon) ziprasidone hcl cap 80 mg (Geodon) HINÓTICOS estazolam tab mg estazolam tab mg eszopiclone tab mg (Lunesta) eszopiclone tab mg (Lunesta) eszopiclone tab 3 mg (Lunesta) HENOBARBITAL - phenobarbital tab 5 mg HENOBARBITAL - phenobarbital tab 30 mg HENOBARBITAL - phenobarbital tab 60 mg HENOBARBITAL - phenobarbital tab 00 mg phenobarbital elixir 0 mg/5ml phenobarbital tab 6. mg phenobarbital tab 3.4 mg phenobarbital tab 64.8 mg phenobarbital tab 97. mg ROZEREM - ramelteon tab 8 mg temazepam cap 7.5 mg (Restoril) temazepam cap 5 mg (Restoril) temazepam cap.5 mg (Restoril) temazepam cap 30 mg (Restoril) zaleplon cap 5 mg (Sonata) zaleplon cap 0 mg (Sonata) zolpidem tartrate tab cr 6.5 mg (Ambien cr) zolpidem tartrate tab cr.5 mg (Ambien cr) zolpidem tartrate tab 5 mg (Ambien) zolpidem tartrate tab 0 mg (Ambien) TRASTORNO OR DÉFICIT DE ATENCIÓN E HIERACTIVIDAD (ADHD)/ANTINARCOLÉTICOS/ AGENTES CONTRA LA OBESIDAD/ANOREXÍGENOS amphetamine-dextroamphetamine cap sr 4hr 5 mg (Adderall xr) amphetamine-dextroamphetamine cap sr 4hr 0 mg (Adderall xr) amphetamine-dextroamphetamine cap sr 4hr 5 mg (Adderall xr) amphetamine-dextroamphetamine cap sr 4hr 0 mg (Adderall xr) amphetamine-dextroamphetamine cap sr 4hr 5 mg (Adderall xr) amphetamine-dextroamphetamine cap sr 4hr 30 mg (Adderall xr) amphetamine-dextroamphetamine tab 5 mg (Adderall) amphetamine-dextroamphetamine tab 7.5 mg (Adderall) amphetamine-dextroamphetamine tab 0 mg (Adderall) amphetamine-dextroamphetamine tab.5 mg (Adderall) 44 Guia de medicinas ValueScript de Florida Blue para enero de 06

56 06 amphetamine-dextroamphetamine tab 5 mg (Adderall) amphetamine-dextroamphetamine tab 0 mg (Adderall) amphetamine-dextroamphetamine tab 30 mg (Adderall) caffeine citrate oral soln 60 mg/3ml (0 mg/ml base equiv) clonidine hcl tab sr hr 0. mg (Kapvay) dexmethylphenidate hcl cap sr 4 hr 5 mg (Focalin xr) dexmethylphenidate hcl cap sr 4 hr 0 mg (Focalin xr) dexmethylphenidate hcl cap sr 4 hr 5 mg (Focalin xr) dexmethylphenidate hcl cap sr 4 hr 0 mg (Focalin xr) dexmethylphenidate hcl cap sr 4 hr 30 mg (Focalin xr) dexmethylphenidate hcl cap sr 4 hr 40 mg (Focalin xr) dexmethylphenidate hcl tab.5 mg (Focalin) dexmethylphenidate hcl tab 5 mg (Focalin) dexmethylphenidate hcl tab 0 mg (Focalin) dextroamphetamine sulfate cap sr 4hr 5 mg (Dexedrine) dextroamphetamine sulfate cap sr 4hr 0 mg (Dexedrine) dextroamphetamine sulfate cap sr 4hr 5 mg (Dexedrine) dextroamphetamine sulfate oral solution 5 mg/5ml (rocentra) dextroamphetamine sulfate tab 5 mg dextroamphetamine sulfate tab 0 mg guanfacine hcl tab sr 4hr mg (base equiv) (Intuniv) guanfacine hcl tab sr 4hr mg (base equiv) (Intuniv) guanfacine hcl tab sr 4hr 3 mg (base equiv) (Intuniv) guanfacine hcl tab sr 4hr 4 mg (base equiv) (Intuniv) methamphetamine hcl tab 5 mg (Desoxyn) methylphenidate hcl cap cr 0 mg (Metadate cd) methylphenidate hcl cap cr 0 mg (Metadate cd) methylphenidate hcl cap cr 30 mg (Metadate cd) methylphenidate hcl cap cr 40 mg (Metadate cd) methylphenidate hcl cap cr 50 mg (Metadate cd) methylphenidate hcl cap cr 60 mg (Metadate cd) methylphenidate hcl cap sr 4hr 0 mg (Ritalin la) methylphenidate hcl cap sr 4hr 30 mg (Ritalin la) methylphenidate hcl cap sr 4hr 40 mg (Ritalin la) methylphenidate hcl chew tab.5 mg (Methylin) methylphenidate hcl chew tab 5 mg (Methylin) methylphenidate hcl chew tab 0 mg (Methylin) methylphenidate hcl soln 5 mg/5ml (Methylin) methylphenidate hcl soln 0 mg/5ml (Methylin) methylphenidate hcl tab cr 0 mg methylphenidate hcl tab 5 mg (Ritalin) methylphenidate hcl tab 0 mg (Ritalin) Guia de medicinas ValueScript de Florida Blue para enero de 06 45

57 06 methylphenidate hcl tab 0 mg (Ritalin) modafinil tab 00 mg (rovigil) modafinil tab 00 mg (rovigil) NUVIGIL - armodafinil tab 50 mg NUVIGIL - armodafinil tab 50 mg NUVIGIL - armodafinil tab 00 mg NUVIGIL - armodafinil tab 50 mg STRATTERA - atomoxetine hcl cap 0 mg (base equiv) STRATTERA - atomoxetine hcl cap 8 mg (base equiv) STRATTERA - atomoxetine hcl cap 5 mg (base equiv) STRATTERA - atomoxetine hcl cap 40 mg (base equiv) STRATTERA - atomoxetine hcl cap 60 mg (base equiv) STRATTERA - atomoxetine hcl cap 80 mg (base equiv) STRATTERA - atomoxetine hcl cap 00 mg (base equiv) VYVANSE - lisdexamfetamine dimesylate cap 0 mg VYVANSE - lisdexamfetamine dimesylate cap 0 mg VYVANSE - lisdexamfetamine dimesylate cap 30 mg VYVANSE - lisdexamfetamine dimesylate cap 40 mg VYVANSE - lisdexamfetamine dimesylate cap 50 mg VYVANSE - lisdexamfetamine dimesylate cap 60 mg VYVANSE - lisdexamfetamine dimesylate cap 70 mg AGENTES SICOTERAÉUTICOS Y NEUROLÓGICOS, MISC. acamprosate calcium tab delayed release 333 mg AMYRA - dalfampridine tab sr hr 0 mg AUBAGIO - teriflunomide tab 7 mg AUBAGIO - teriflunomide tab 4 mg BETASERON - interferon beta-b for inj kit 0.3 mg bupropion hcl (smoking deterrent) tab sr hr 50 mg (Zyban) CHANTIX - varenicline tartrate tab 0.5 mg (base equiv) CHANTIX - varenicline tartrate tab mg (base equiv) CHANTIX CONTINUING MONTH - varenicline tartrate tab mg (base equiv) CHANTIX STARTING MONTH A - varenicline tartrate tab 0.5 mg x & tab mg x 4 pack COAXONE - glatiramer acetate soln prefilled syringe 0 mg/ml COAXONE - glatiramer acetate soln prefilled syringe 40 mg/ml disulfiram tab 50 mg (Antabuse) disulfiram tab 500 mg (Antabuse) donepezil hydrochloride orally disintegrating tab 5 mg donepezil hydrochloride orally disintegrating tab 0 mg donepezil hydrochloride tab 5 mg (Aricept) donepezil hydrochloride tab 0 mg (Aricept) donepezil hydrochloride tab 3 mg (Aricept) ergoloid mesylates tab mg EXELON - rivastigmine td patch 4hr 4.6 mg/4hr EXELON - rivastigmine td patch 4hr 9.5 mg/4hr 46 Guia de medicinas ValueScript de Florida Blue para enero de 06

58 06 EXELON - rivastigmine td patch 4hr 3.3 mg/4hr fluoxetine hcl (pmdd) cap 0 mg fluoxetine hcl (pmdd) cap 0 mg galantamine hydrobromide cap sr 4hr 8 mg (Razadyne er) galantamine hydrobromide cap sr 4hr 6 mg (Razadyne er) galantamine hydrobromide cap sr 4hr 4 mg (Razadyne er) galantamine hydrobromide tab 4 mg (Razadyne) galantamine hydrobromide tab 8 mg (Razadyne) galantamine hydrobromide tab mg (Razadyne) glatiramer acetate soln prefilled syringe 0 mg/ml (Copaxone) NAMENDA XR - memantine hcl cap sr 4hr 7 mg NAMENDA XR - memantine hcl cap sr 4hr 4 mg NAMENDA XR - memantine hcl cap sr 4hr mg NAMENDA XR - memantine hcl cap sr 4hr 8 mg NAMENDA XR TITRATION ACK - memantine hcl cap sr 4hr 7 mg & 4 mg & mg & 8 mg pack nicotine polacrilex gum mg nicotine polacrilex gum 4 mg nicotine td patch 4hr 7 mg/4hr nicotine td patch 4hr 4 mg/4hr nicotine td patch 4hr mg/4hr olanzapine-fluoxetine hcl cap 3-5 mg (Symbyax) olanzapine-fluoxetine hcl cap 6-5 mg (Symbyax) olanzapine-fluoxetine hcl cap 6-50 mg (Symbyax) olanzapine-fluoxetine hcl cap -5 mg (Symbyax) olanzapine-fluoxetine hcl cap -50 mg (Symbyax) ORA - pimozide tab mg 3 ORA - pimozide tab mg 3 LEGRIDY - peginterferon beta-a soln pen-injector 5 mcg/0.5ml LEGRIDY - peginterferon beta-a soln prefilled syringe 5 mcg/0.5ml LEGRIDY STARTER ACK - peginterferon beta-a soln pen-inj 63 & 94 mcg/0.5ml pack LEGRIDY STARTER ACK - peginterferon beta-a soln pref syr 63 & 94 mcg/0.5ml pack REBIF - interferon beta-a inj mcg/0.5ml (mu/ml) (44 mcg/ml) REBIF - interferon beta-a inj 44 mcg/0.5ml (4mu/ml) (88 mcg/ml) REBIF REBIDOSE - interferon beta-a inj mcg/0.5ml (mu/ml) (44 mcg/ ml) REBIF REBIDOSE - interferon beta-a inj 44 mcg/0.5ml (4mu/ml) (88 mcg/ ml) REBIF REBIDOSE TITRATION - interferon beta-a inj 6 x 8.8 mcg/0.ml & 6 x mcg/0.5ml REBIF TITRATION ACK - interferon beta-a inj 6 x 8.8 mcg/0.ml & 6 x mcg/0.5ml rivastigmine tartrate cap.5 mg (Exelon) rivastigmine tartrate cap 3 mg (Exelon) rivastigmine tartrate cap 4.5 mg (Exelon) rivastigmine tartrate cap 6 mg (Exelon) SAVELLA - milnacipran hcl tab.5 mg Guia de medicinas ValueScript de Florida Blue para enero de 06 47

59 06 SAVELLA - milnacipran hcl tab 5 mg SAVELLA - milnacipran hcl tab 50 mg SAVELLA - milnacipran hcl tab 00 mg SAVELLA TITRATION ACK - milnacipran hcl tab.5 mg (5) & 5 mg (8) & 50 mg (4) pak TECFIDERA - dimethyl fumarate capsule delayed release 0 mg TECFIDERA - dimethyl fumarate capsule delayed release 40 mg TECFIDERA STARTER ACK - dimethyl fumarate capsule dr starter pack 0 mg & 40 mg XYREM - sodium oxybate oral solution 500 mg/ml ANALGÉSICOS Y ANESTÉSICOS ANALGÉSICOS NO NARCÓTICOS aspirin chew tab 8 mg aspirin tab delayed release 8 mg butalbital-acetaminophen tab mg butalbital-acetaminophen-caffeine cap mg butalbital-acetaminophen-caffeine tab mg (Esgic) butalbital-aspirin-caffeine cap mg (Fiorinal) diflunisal tab 500 mg salsalate tab 500 mg (Disalcid) salsalate tab 750 mg (Disalcid) ANALGÉSICOS NARCÓTICOS acetaminophen w/ codeine soln 0- mg/5ml acetaminophen w/ codeine tab mg (Tylenol/codeine) acetaminophen w/ codeine tab mg (Tylenol/codeine #3) acetaminophen w/ codeine tab mg (Tylenol/codeine #4) buprenorphine hcl sl tab mg (base equiv) buprenorphine hcl sl tab 8 mg (base equiv) buprenorphine hcl-naloxone hcl sl tab -0.5 mg (base equiv) buprenorphine hcl-naloxone hcl sl tab 8- mg (base equiv) butalbital-acetaminophen-caff w/ cod cap mg butalbital-aspirin-caff w/ codeine cap mg (Fiorinal/codeine #3) butorphanol tartrate nasal soln 0 mg/ ml BUTRANS - buprenorphine td patch weekly 5 mcg/hr BUTRANS - buprenorphine td patch weekly 0 mcg/hr BUTRANS - buprenorphine td patch weekly 5 mcg/hr BUTRANS - buprenorphine td patch weekly 0 mcg/hr codeine sulfate tab 5 mg (Codeine sulfate) codeine sulfate tab 30 mg (Codeine sulfate) codeine sulfate tab 60 mg (Codeine sulfate) fentanyl citrate lozenge on a handle 00 mcg (Actiq) fentanyl citrate lozenge on a handle 400 mcg (Actiq) fentanyl citrate lozenge on a handle 600 mcg (Actiq) fentanyl citrate lozenge on a handle 800 mcg (Actiq) fentanyl citrate lozenge on a handle 00 mcg (Actiq) fentanyl citrate lozenge on a handle 600 mcg (Actiq) 48 Guia de medicinas ValueScript de Florida Blue para enero de 06

60 06 fentanyl td patch 7hr mcg/hr (Duragesic) fentanyl td patch 7hr 5 mcg/hr (Duragesic) fentanyl td patch 7hr 50 mcg/hr (Duragesic) fentanyl td patch 7hr 75 mcg/hr (Duragesic) fentanyl td patch 7hr 00 mcg/hr (Duragesic) hydrocodone-acetaminophen soln mg/5ml (Hycet) hydrocodone-acetaminophen tab.5-35 mg hydrocodone-acetaminophen tab 0-35 mg (Norco) hydrocodone-acetaminophen tab mg (Xodol) hydrocodone-acetaminophen tab mg (Xodol) hydrocodone-acetaminophen tab 5-35 mg (Norco) hydrocodone-acetaminophen tab mg (Norco) hydrocodone-acetaminophen tab mg (Xodol) hydrocodone-ibuprofen tab.5-00 mg (Reprexain) hydrocodone-ibuprofen tab 5-00 mg (Reprexain) hydrocodone-ibuprofen tab mg (Vicoprofen) hydrocodone-ibuprofen tab 0-00 mg (Ibudone) hydromorphone hcl liqd mg/ml (Dilaudid) hydromorphone hcl tab er 4hr deter 8 mg (Exalgo) hydromorphone hcl tab er 4hr deter mg (Exalgo) hydromorphone hcl tab er 4hr deter 6 mg (Exalgo) hydromorphone hcl tab mg (Dilaudid) hydromorphone hcl tab 4 mg (Dilaudid) hydromorphone hcl tab 8 mg (Dilaudid) methadone hcl conc 0 mg/ml (Methadose) methadone hcl soln 5 mg/5ml (Methadone hcl) methadone hcl soln 0 mg/5ml (Methadone hcl) methadone hcl tab for oral susp 40 mg methadone hcl tab 5 mg (Dolophine hcl) methadone hcl tab 0 mg (Dolophine) MORHINE SULFATE - morphine sulfate tab 5 mg MORHINE SULFATE - morphine sulfate tab 30 mg morphine sulfate (concentrate) oral soln 0 mg/ml morphine sulfate cap sr 4hr 0 mg (Kadian) morphine sulfate cap sr 4hr 0 mg (Kadian) morphine sulfate cap sr 4hr 30 mg (Kadian) morphine sulfate cap sr 4hr 50 mg (Kadian) morphine sulfate cap sr 4hr 60 mg (Kadian) morphine sulfate cap sr 4hr 80 mg (Kadian) morphine sulfate cap sr 4hr 00 mg (Kadian) morphine sulfate oral soln 0 mg/5ml morphine sulfate oral soln 0 mg/5ml Guia de medicinas ValueScript de Florida Blue para enero de 06 49

61 06 morphine sulfate tab cr 5 mg (Ms contin) morphine sulfate tab cr 30 mg (Ms contin) morphine sulfate tab cr 60 mg (Ms contin) morphine sulfate tab cr 00 mg (Ms contin) morphine sulfate tab cr 00 mg (Ms contin) NUCYNTA ER - tapentadol hcl tab sr hr 50 mg NUCYNTA ER - tapentadol hcl tab sr hr 00 mg NUCYNTA ER - tapentadol hcl tab sr hr 50 mg NUCYNTA ER - tapentadol hcl tab sr hr 00 mg NUCYNTA ER - tapentadol hcl tab sr hr 50 mg oxycodone hcl cap 5 mg oxycodone hcl conc 00 mg/5ml (0 mg/ml) (Oxycodone hcl) oxycodone hcl soln 5 mg/5ml (Oxycodone hcl) oxycodone hcl tab 5 mg (Roxicodone) oxycodone hcl tab 0 mg oxycodone hcl tab 5 mg (Roxicodone) oxycodone hcl tab 0 mg oxycodone hcl tab 30 mg (Roxicodone) oxycodone w/ acetaminophen tab.5-35 mg (ercocet) oxycodone w/ acetaminophen tab 5-35 mg (ercocet) oxycodone w/ acetaminophen tab mg (ercocet) oxycodone w/ acetaminophen tab 0-35 mg (ercocet) oxycodone-aspirin tab mg (ercodan) oxycodone-ibuprofen tab mg OXYCONTIN - oxycodone hcl tab er hr deter 0 mg OXYCONTIN - oxycodone hcl tab er hr deter 5 mg OXYCONTIN - oxycodone hcl tab er hr deter 0 mg OXYCONTIN - oxycodone hcl tab er hr deter 30 mg OXYCONTIN - oxycodone hcl tab er hr deter 40 mg OXYCONTIN - oxycodone hcl tab er hr deter 60 mg OXYCONTIN - oxycodone hcl tab er hr deter 80 mg oxymorphone hcl tab sr hr 5 mg oxymorphone hcl tab sr hr 7.5 mg oxymorphone hcl tab sr hr 0 mg oxymorphone hcl tab sr hr 5 mg oxymorphone hcl tab sr hr 0 mg oxymorphone hcl tab sr hr 30 mg oxymorphone hcl tab sr hr 40 mg oxymorphone hcl tab 5 mg (Opana) oxymorphone hcl tab 0 mg (Opana) ROXICET - oxycodone w/ acetaminophen soln 5-35 mg/5ml SUBOXONE - buprenorphine hclnaloxone hcl sl film -0.5 mg (base equiv) SUBOXONE - buprenorphine hclnaloxone hcl sl film 4- mg (base equiv) SUBOXONE - buprenorphine hclnaloxone hcl sl film 8- mg (base equiv) SUBOXONE - buprenorphine hclnaloxone hcl sl film -3 mg (base equiv) tramadol hcl tab sr 4hr 00 mg (Ultram er) 50 Guia de medicinas ValueScript de Florida Blue para enero de 06

62 06 tramadol hcl tab sr 4hr 00 mg (Ultram er) tramadol hcl tab sr 4hr 300 mg (Ultram er) tramadol hcl tab sr 4hr biphasic release 00 mg tramadol hcl tab sr 4hr biphasic release 00 mg tramadol hcl tab sr 4hr biphasic release 300 mg tramadol hcl tab 50 mg (Ultram) tramadol-acetaminophen tab mg (Ultracet) ANALGÉSICOS ANTIINFLAMATORIOS ACTEMRA - tocilizumab subcutaneous soln prefilled syringe 6 mg/0.9ml CELEBREX - celecoxib cap 00 mg 3 CELEBREX - celecoxib cap 00 mg 3 CELEBREX - celecoxib cap 400 mg 3 celecoxib cap 50 mg (Celebrex) celecoxib cap 00 mg (Celebrex) celecoxib cap 00 mg (Celebrex) celecoxib cap 400 mg (Celebrex) diclofenac potassium tab 50 mg diclofenac sodium tab delayed release 5 mg diclofenac sodium tab delayed release 50 mg diclofenac sodium tab delayed release 75 mg diclofenac sodium tab sr 4hr 00 mg (Voltaren-xr) diclofenac w/ misoprostol tab delayed release mg (Arthrotec 50) diclofenac w/ misoprostol tab delayed release mg (Arthrotec 75) ENBREL - etanercept for subcutaneous inj kit 5 mg ENBREL - etanercept subcutaneous soln prefilled syringe 5 mg/0.5ml ENBREL - etanercept subcutaneous soln prefilled syringe 50 mg/ml ENBREL SURECLICK - etanercept subcutaneous solution auto-injector 50 mg/ml etodolac cap 00 mg etodolac cap 300 mg etodolac tab sr 4hr 400 mg etodolac tab sr 4hr 500 mg etodolac tab sr 4hr 600 mg etodolac tab 400 mg etodolac tab 500 mg FENOROFEN CALCIUM - fenoprofen 3 calcium tab 600 mg flurbiprofen tab 50 mg flurbiprofen tab 00 mg HUMIRA - adalimumab prefilled syringe kit 0 mg/0.ml HUMIRA - adalimumab prefilled syringe kit 0 mg/0.4ml HUMIRA - adalimumab prefilled syringe kit 40 mg/0.8ml HUMIRA EDIATRIC CROHNS D - adalimumab prefilled syringe kit 40 mg/0.8ml HUMIRA EN - adalimumab peninjector kit 40 mg/0.8ml HUMIRA EN-CROHNS DISEASE - adalimumab pen-injector kit 40 mg/0.8ml HUMIRA EN-SORIASIS STAR - adalimumab pen-injector kit 40 mg/0.8ml ibuprofen susp 00 mg/5ml ibuprofen tab 400 mg ibuprofen tab 600 mg ibuprofen tab 800 mg indomethacin cap cr 75 mg Guia de medicinas ValueScript de Florida Blue para enero de 06 5

63 06 indomethacin cap 5 mg indomethacin cap 50 mg ketoprofen cap 50 mg ketoprofen cap 75 mg ketorolac tromethamine tab 0 mg KINERET - anakinra subcutaneous soln prefilled syringe 00 mg/0.67ml leflunomide tab 0 mg (Arava) leflunomide tab 0 mg (Arava) MECLOFENAMATE SODIUM - meclofenamate sodium cap 50 mg MECLOFENAMATE SODIUM - meclofenamate sodium cap 00 mg mefenamic acid cap 50 mg (onstel) meloxicam tab 7.5 mg (Mobic) meloxicam tab 5 mg (Mobic) nabumetone tab 500 mg nabumetone tab 750 mg NAROXEN - naproxen susp 5 mg/5ml naproxen sodium tab 75 mg (Anaprox) naproxen sodium tab 550 mg (Anaprox ds) naproxen tab ec 375 mg (Ec-naprosyn) naproxen tab ec 500 mg (Ec-naprosyn) naproxen tab 50 mg (Naprosyn) naproxen tab 375 mg (Naprosyn) naproxen tab 500 mg (Naprosyn) oxaprozin tab 600 mg (Daypro) piroxicam cap 0 mg (Feldene) piroxicam cap 0 mg (Feldene) SIMONI - golimumab subcutaneous soln auto-injector 50 mg/0.5ml SIMONI - golimumab subcutaneous soln auto-injector 00 mg/ml SIMONI - golimumab subcutaneous soln prefilled syringe 50 mg/0.5ml 3 3 SIMONI - golimumab subcutaneous soln prefilled syringe 00 mg/ml sulindac tab 50 mg sulindac tab 00 mg tolmetin sodium cap 400 mg RODUCTOS ARA LA MIGRAÑA acetaminophen-isometheptenedichloral cap mg AXERT - almotriptan malate tab 6.5 mg AXERT - almotriptan malate tab.5 mg ERGOMAR - ergotamine tartrate sl tab mg FROVA - frovatriptan succinate tab.5 mg (base equivalent) IMITREX - sumatriptan nasal spray 5 mg/act IMITREX - sumatriptan nasal spray 0 mg/act isometheptene-caffeine-acetaminophen tab mg (rodrin) MIGRANAL - dihydroergotamine mesylate nasal spray 4 mg/ml naratriptan hcl tab mg (base equiv) (Amerge) naratriptan hcl tab.5 mg (base equiv) (Amerge) RELAX - eletriptan hydrobromide tab 0 mg (base equivalent) 3 RELAX - eletriptan hydrobromide tab 40 mg (base equivalent) rizatriptan benzoate orally disintegrating tab 5 mg (Maxalt-mlt) rizatriptan benzoate orally disintegrating tab 0 mg (Maxaltmlt) rizatriptan benzoate tab 5 mg (Maxalt) rizatriptan benzoate tab 0 mg (Maxalt) SUMATRITAN SUINATE - sumatriptan succinate inj 4 mg/0.5ml 5 Guia de medicinas ValueScript de Florida Blue para enero de 06

64 06 sumatriptan succinate inj 6 mg/0.5ml (Imitrex) sumatriptan succinate solution autoinjector 4 mg/0.5ml (Imitrex statdose sys) sumatriptan succinate solution autoinjector 6 mg/0.5ml (Imitrex statdose sys) sumatriptan succinate solution cartridge 4 mg/0.5ml (Imitrex statdose ref) sumatriptan succinate solution cartridge 6 mg/0.5ml (Imitrex statdose ref) sumatriptan succinate tab 5 mg (Imitrex) sumatriptan succinate tab 50 mg (Imitrex) sumatriptan succinate tab 00 mg (Imitrex) zolmitriptan orally disintegrating tab.5 mg (Zomig zmt) zolmitriptan orally disintegrating tab 5 mg (Zomig zmt) zolmitriptan tab.5 mg (Zomig) zolmitriptan tab 5 mg (Zomig) ZOMIG - zolmitriptan nasal spray.5 mg/spray unit ZOMIG - zolmitriptan nasal spray 5 mg/ spray unit AGENTES ARA LA GOTA allopurinol tab 00 mg (Zyloprim) allopurinol tab 300 mg (Zyloprim) colchicine w/ probenecid tab mg COLCRYS - colchicine tab 0.6 mg probenecid tab 500 mg FÁRMACOS NEUROMUSCULARES ANTICONVULSIVOS carbamazepine cap sr hr 00 mg (Carbatrol) carbamazepine cap sr hr 00 mg (Carbatrol) carbamazepine cap sr hr 300 mg (Carbatrol) carbamazepine chew tab 00 mg carbamazepine susp 00 mg/5ml (Tegretol) carbamazepine tab sr hr 00 mg (Tegretol-xr) carbamazepine tab sr hr 400 mg (Tegretol-xr) carbamazepine tab 00 mg (Tegretol) CELONTIN - methsuximide cap 300 mg 3 clonazepam orally disintegrating tab 0.5 mg clonazepam orally disintegrating tab 0.5 mg clonazepam orally disintegrating tab 0.5 mg clonazepam orally disintegrating tab mg clonazepam orally disintegrating tab mg clonazepam tab 0.5 mg (Klonopin) clonazepam tab mg (Klonopin) clonazepam tab mg (Klonopin) DIASTAT ACUDIAL - diazepam rectal gel delivery system 0 mg DIASTAT ACUDIAL - diazepam rectal gel delivery system 0 mg DIASTAT EDIATRIC - diazepam rectal gel delivery system.5 mg DILANTIN - phenytoin sodium extended cap 30 mg DILANTIN - phenytoin sodium extended cap 00 mg divalproex sodium cap sprinkle 5 mg (Depakote sprinkles) Guia de medicinas ValueScript de Florida Blue para enero de 06 53

65 06 divalproex sodium tab delayed release 5 mg (Depakote) divalproex sodium tab delayed release 50 mg (Depakote) divalproex sodium tab delayed release 500 mg (Depakote) divalproex sodium tab sr 4 hr 50 mg (Depakote er) divalproex sodium tab sr 4 hr 500 mg (Depakote er) ethosuximide cap 50 mg (Zarontin) ethosuximide soln 50 mg/5ml (Zarontin) felbamate susp 600 mg/5ml (Felbatol) felbamate tab 400 mg (Felbatol) felbamate tab 600 mg (Felbatol) gabapentin cap 00 mg (Neurontin) gabapentin cap 300 mg (Neurontin) gabapentin cap 400 mg (Neurontin) gabapentin oral soln 50 mg/5ml (Neurontin) gabapentin tab 600 mg (Neurontin) gabapentin tab 800 mg (Neurontin) lamotrigine orally disintegrating tab 5 mg (Lamictal odt) lamotrigine orally disintegrating tab 50 mg (Lamictal odt) lamotrigine orally disintegrating tab 00 mg (Lamictal odt) lamotrigine orally disintegrating tab 00 mg (Lamictal odt) lamotrigine tab chewable dispersible 5 mg (Lamictal chewable di) lamotrigine tab chewable dispersible 5 mg (Lamictal chewable di) lamotrigine tab sr 4hr 5 mg (Lamictal xr) lamotrigine tab sr 4hr 50 mg (Lamictal xr) lamotrigine tab sr 4hr 00 mg (Lamictal xr) lamotrigine tab sr 4hr 00 mg (Lamictal xr) lamotrigine tab sr 4hr 50 mg (Lamictal xr) lamotrigine tab sr 4hr 300 mg (Lamictal xr) lamotrigine tab 5 mg (Lamictal) lamotrigine tab 00 mg (Lamictal) lamotrigine tab 50 mg (Lamictal) lamotrigine tab 00 mg (Lamictal) levetiracetam oral soln 00 mg/ml (Keppra) levetiracetam tab sr 4hr 500 mg (Keppra xr) levetiracetam tab sr 4hr 750 mg (Keppra xr) levetiracetam tab 50 mg (Keppra) levetiracetam tab 500 mg (Keppra) levetiracetam tab 750 mg (Keppra) levetiracetam tab 000 mg (Keppra) LYRICA - pregabalin cap 5 mg LYRICA - pregabalin cap 50 mg LYRICA - pregabalin cap 75 mg LYRICA - pregabalin cap 00 mg LYRICA - pregabalin cap 50 mg LYRICA - pregabalin cap 00 mg LYRICA - pregabalin cap 5 mg LYRICA - pregabalin cap 300 mg ONFI - clobazam suspension.5 mg/ml 3 oxcarbazepine susp 300 mg/5ml (60 mg/ml) (Trileptal) oxcarbazepine tab 50 mg (Trileptal) oxcarbazepine tab 300 mg (Trileptal) oxcarbazepine tab 600 mg (Trileptal) EGANONE - ethotoin tab 50 mg 3 54 Guia de medicinas ValueScript de Florida Blue para enero de 06

66 06 phenytoin chew tab 50 mg (Dilantin infatabs) phenytoin sodium extended cap 00 mg (Dilantin) phenytoin sodium extended cap 00 mg (henytek) phenytoin sodium extended cap 300 mg (henytek) phenytoin susp 5 mg/5ml (Dilantin-5) primidone tab 50 mg (Mysoline) primidone tab 50 mg (Mysoline) SABRIL - vigabatrin tab 500 mg tiagabine hcl tab mg (Gabitril) tiagabine hcl tab 4 mg (Gabitril) topiramate sprinkle cap 5 mg (Topamax sprinkle) topiramate sprinkle cap 5 mg (Topamax sprinkle) topiramate tab 5 mg (Topamax) topiramate tab 50 mg (Topamax) topiramate tab 00 mg (Topamax) topiramate tab 00 mg (Topamax) valproate sodium syrup 50 mg/5ml (base equiv) (Depakene) valproic acid cap 50 mg (Depakene) zonisamide cap 5 mg (Zonegran) zonisamide cap 50 mg zonisamide cap 00 mg (Zonegran) AGENTES ANTIARKINSONIANOS AMANTADINE HCL - amantadine hcl tab 00 mg amantadine hcl cap 00 mg amantadine hcl syrup 50 mg/5ml AZILECT - rasagiline mesylate tab 0.5 mg (base equiv) AZILECT - rasagiline mesylate tab mg (base equiv) 3 3 benztropine mesylate tab 0.5 mg benztropine mesylate tab mg benztropine mesylate tab mg bromocriptine mesylate cap 5 mg (arlodel) bromocriptine mesylate tab.5 mg carbidopa & levodopa orally disintegrating tab 0-00 mg carbidopa & levodopa orally disintegrating tab 5-00 mg carbidopa & levodopa orally disintegrating tab 5-50 mg carbidopa & levodopa tab cr 5-00 mg (Sinemet cr) carbidopa & levodopa tab cr mg (Sinemet cr) carbidopa & levodopa tab 0-00 mg (Sinemet) carbidopa & levodopa tab 5-00 mg (Sinemet) carbidopa & levodopa tab 5-50 mg (Sinemet) carbidopa tab 5 mg (Lodosyn) entacapone tab 00 mg (Comtan) LODOSYN - carbidopa tab 5 mg 3 pramipexole dihydrochloride tab sr 4hr mg (Mirapex er) pramipexole dihydrochloride tab sr 4hr 0.75 mg (Mirapex er) pramipexole dihydrochloride tab sr 4hr.5 mg (Mirapex er) pramipexole dihydrochloride tab 0.5 mg (Mirapex) pramipexole dihydrochloride tab 0.5 mg (Mirapex) pramipexole dihydrochloride tab 0.5 mg (Mirapex) pramipexole dihydrochloride tab 0.75 mg (Mirapex) Guia de medicinas ValueScript de Florida Blue para enero de 06 55

67 06 pramipexole dihydrochloride tab mg (Mirapex) pramipexole dihydrochloride tab.5 mg (Mirapex) ropinirole hydrochloride tab sr 4hr mg (base equivalent) (Requip xl) ropinirole hydrochloride tab sr 4hr 4 mg (base equivalent) (Requip xl) ropinirole hydrochloride tab sr 4hr 6 mg (base equivalent) (Requip xl) ropinirole hydrochloride tab sr 4hr 8 mg (base equivalent) (Requip xl) ropinirole hydrochloride tab sr 4hr mg (base equivalent) (Requip xl) ropinirole hydrochloride tab 0.5 mg (Requip) ropinirole hydrochloride tab 0.5 mg (Requip) ropinirole hydrochloride tab mg (Requip) ropinirole hydrochloride tab mg (Requip) ropinirole hydrochloride tab 3 mg (Requip) ropinirole hydrochloride tab 4 mg (Requip) ropinirole hydrochloride tab 5 mg (Requip) selegiline hcl cap 5 mg (Eldepryl) selegiline hcl tab 5 mg TASMAR - tolcapone tab 00 mg 3 tolcapone tab 00 mg (Tasmar) trihexyphenidyl hcl elixir 0.4 mg/ml trihexyphenidyl hcl tab mg trihexyphenidyl hcl tab 5 mg AGENTES NEUROMUSCULARES riluzole tab 50 mg (Rilutek) AGENTES ARA LA TERAIA MUSCULOESQUELÉTICA baclofen tab 0 mg baclofen tab 0 mg carisoprodol tab 350 mg (Soma) chlorzoxazone tab 500 mg (arafon forte dsc) cyclobenzaprine hcl tab 5 mg cyclobenzaprine hcl tab 7.5 mg (Fexmid) cyclobenzaprine hcl tab 0 mg DANTROLENE SODIUM - dantrolene sodium cap 00 mg dantrolene sodium cap 5 mg (Dantrium) dantrolene sodium cap 50 mg (Dantrium) metaxalone tab 800 mg (Skelaxin) methocarbamol tab 500 mg (Robaxin) methocarbamol tab 750 mg (Robaxin-750) orphenadrine citrate tab sr hr 00 mg orphenadrine w/ aspirin & caffeine tab mg tizanidine hcl cap mg (Zanaflex) tizanidine hcl cap 4 mg (Zanaflex) tizanidine hcl cap 6 mg (Zanaflex) tizanidine hcl tab mg tizanidine hcl tab 4 mg (Zanaflex) AGENTES ANTIMIASTÉNICOS GUANIDINE HCL - guanidine hcl tab 5 mg MESTINON - pyridostigmine bromide syrup 60 mg/5ml MESTINON TIMESAN - pyridostigmine bromide tab cr 80 mg pyridostigmine bromide tab cr 80 mg (Mestinon timespan) pyridostigmine bromide tab 60 mg (Mestinon) RODUCTOS NUTRICIONALES 3 56 Guia de medicinas ValueScript de Florida Blue para enero de 06

68 06 VITAMINAS cholecalciferol cap 000 unit cholecalciferol cap unit cholecalciferol chew tab 400 unit cholecalciferol chew tab 000 unit cholecalciferol drops 5000 unit/ml (000 unit/0.ml) cholecalciferol drops 400 unit/0.03ml (per drop) cholecalciferol oral liquid 400 unit/ml cholecalciferol tab 400 unit cholecalciferol tab 000 unit ergocalciferol cap unit (Drisdol) MEHYTON - phytonadione tab 5 mg MULTIVITAMINAS ACTIVE OB - prenatal w/o a w/fe cbnfa-dha cap mg ATABEX EC - prenatal vit w/ dss-iron carbonyl-fa tab dr 9- mg B-NEXA - prenatal w/ calcium-vit b6-faginger tab. mg BAL-CARE DHA - prenat w/fe polyna fered-fa tab 7- & omega cap dr 430mg B FOLINATAL LUS B - prenatal w/ calcium carbonate-b6-b-fa tab mg B MULTINATAL LUS - prenatal w/o a vit w/ fe fum-fa tab chew 40- mg B MULTINATAL LUS - prenatal w/o a vit w/ fe fumarate-fa tab 30- mg C-NATE DHA - prenatal vit w/ fe fumfa-omega 3 cap mg CALCIUM NV - prenatal w/o vit a w/ fe fum-fa-omega 3 cap mg CHOICE-OB+DHA - prenatal mv w/fe poly-fa chw 9- mg & dha cap 50 mg pak CITRANATAL ASSURE - prenat w/o a w/fecbn-fegl-dss-fa tab & dha cap 300 mg pack CITRANATAL B-CALM - prenat w/o a w/fecbn-feglu-fa tab 0- mg & vit b6 tab pak CITRANATAL DHA - prenat w/o a w/ fecbn-fegl-dss-fa tab & dha cap 50 mg pack CITRANATAL HARMONY - prenat w/ o a w/fe fum-fe cbn-dss-fa-dha cap mg CITRANATAL HARMONY - prenatal w/o a w/fe cbn-dss-fa-dha cap mg CITRANATAL RX - prenatal w/o a w/ fe carbonyl-fe gluc-dss-fa tab 7-mg CITRANATAL 90 DHA - prenat w/o a w/fecbn-fegl-dss-fa tab 90 &dha cap 300mg pak CO-NATAL FA - prenatal vit w/ fe fumarate-fa tab 9- mg COMLETE NATAL DHA - prenat-fe bis-fe prot succ-fa-ca tab & omega 3 cap 50 pk COMLETENATE - prenatal vit w/ fe fumarate-fa chew tab 9- mg CONCET DHA - prenatal w/fe fum-fe poly -fa-omega 3 cap mg CONCET OB - prenatal w/o a w/fe fumfe poly-fa cap mg DUET DHA - prenat w/fe poly-na feredfa tab 5- & omega cap 400 mg DUET DHA BALANCED - prenat w/fe poly-na fered-fa tab 5- & omega cap 67 mg DUET DHA BALANCED - prenat w/fe poly-na fered-fa tab 7- & omega cap dr 380mg DUET DHA prenat w/fe poly-na fered-fa tab 5- & omega cap 400 mg ELITE-OB - prenatal vit w/ iron carbonyl-fa tab mg ENBRACE HR - prenatal vit w/ fe gly cys-fa-omega 3 fatty acids cap Guia de medicinas ValueScript de Florida Blue para enero de 06 57

69 06 EXTRA-VIRT LUS DHA - prenatal w/o vit a w/ fe fum-doc-fa-dha cap mg FOCALGIN CA - prenat w/o a w/fecbnfegl-dss-fa tab & dha cap 300 mg pack FOCALGIN 90 DHA - prenat w/o a w/ fecbn-fegl-dss-fa tab 90 &dha cap 300mg pak FOCALGIN-B - prenatal w/ calcium-vit b6-fa-ginger tab. mg FOLBECAL - prenatal w/ calcium carbonate-b6-b-fa tab mg FOLCAL DHA - prenatal w/o vit a w/ fe fum-dss-fa-dha cap mg FOLCAS OMEGA 3 - prenatal vit w/ fe cbn-fe asp glyc-fa-omega 3 cap 7-mg FOLET DHA - prenat w/fecbn-bisgmethylf-dss tab dr & dha cap pak FOLET ONE - prenat w/o a w/fecbnbisg-methylf-dss-dha cap mg FOLIVANE-OB - prenatal w/o a w/fe fum-fe poly-fa cap mg HEMENATAL OB - prenat vit-fe poly cmplx-fe heme poly-fa tab 8-6- mg HEMENATAL OB + DHA - prenat-fe poly cmplx-fe heme poly-fa tab & omega 3 cap pck INATAL ADVANCE - prenatal vit w/ dss-iron carbonyl-fa tab 90- mg INATAL GT - prenatal vit w/ dss-iron carbonyl-fa tab 90- mg INATAL ULTRA - prenatal vit w/ dssiron carbonyl-fa tab 90- mg INFANATE BALANCE - prenatal w/o a w/fe cbn-dss-fa-dha cap mg INFANATE LUS - prenat w/o a w/fe fum-fe cbn-dss-fa-dha cap mg L-METHYLFOLATE NV DHA - prenat w/fe fum-l methylfolate-fa-dha cap mg LEVOMEFOLATE DHA - prenat w/ fe fum-l methylfolate-fa-dha cap mg M-VIT - prenatal vit w/ fe fumarate-fa tab 7- mg MACNATAL CN DHA - prenatal w/o a w/fe cbn-dss-fa-dha cap mg MARNATAL-F - prenatal w/o vit a w/ fe polysac cmplx-fa cap 60- mg MYNATAL - prenatal multivitamins & minerals w/ iron & fa cap mg MYNATAL ADVANCE - prenatal vit w/ dss-iron carbonyl-fa tab 90- mg MYNATAL LUS - prenatal vit w/ fe fumarate-fa tab 65- mg MYNATAL ULTRACALET - prenatal vit w/ dss-iron carbonyl-fa tab 90- mg MYNATAL-Z - prenatal vit w/ fe fumarate-fa tab 65- mg MYNATE 90 LUS - prenatal vit w/ dssfe fumarate-fa tab cr 90- mg NATACHEW - prenatal vit w/ fe fum-fe bisglycin-fa chew tab 8- mg NATAL-V RX - prenatal vit w/ iron carbonyl-fa tab 9- mg NATALVIRT CA - prenat w/o a w/fecbnfegl-dss-fa tab & dha cap 300 mg pack NATALVIRT 90 DHA - prenat w/o a w/fecbn-fegl-dss-fa tab 90 &dha cap 300mg pak NATALVIT - prenatal vit w/ fe fumaratefa tab 75- mg NATELLE ONE - prenatal w/o vit a w/ fe fum-fa-omega 3 cap mg NEEVO DHA - prenat w/o a w/fefummethylfol-omegas cap 7-.3 mg NESTABS - prenatal vit w/o vit a w/ fe bisglycinate-fa tab 3- mg NESTABS ABC - prenatal w/o vit a w/fe polysac-fa-ca tab & omega 3 cap 58 Guia de medicinas ValueScript de Florida Blue para enero de 06

70 06 NESTABS DHA - prenat w/o a w/ fe bisglyc-fa tab 3- mg & omega cap pack NEWGEN - prenatal vit w/o vit a w/ fe bisglycinate-fa tab 3- mg NEXA LUS - prenatal w/o vit a w/ fe fum-doc-fa-dha cap mg NIVA-LUS - prenatal vit w/ fe fumarate-fa tab 7- mg NUTRI-TAB OB - prenatal vit w/o vit a w/ fe bisglycinate-fa tab 3- mg NUTRI-TAB OB + DHA - prenat w/o a w/ fe bisglyc-fa tab 3- mg & omega cap pack O-CAL FA - prenatal vit w/ fe fumaratefa tab 7- mg O-CAL RENATAL - prenatal vit w/ fe fumarate-fa tab 5- mg OB COMLETE - prenatal vit w/ iron carbonyl-fa tab mg OB COMLETE ONE - prenatal w/ o a w/fecbn-fe asp glyc-fa-fish cap mg OB COMLETE ETITE - prenat w/ o a w/fecbn-feaspglyc-fa-omega cap mg OB COMLETE REMIER - prenatal vit w/ fe cbn-fe asp glyc-fa tab mg OB COMLETE/DHA - prenat w/ iron cbn-fe asp glyc-fa-omega cap mg OB-NATAL ONE - prenatal vit w/ fe cbn-fe asp glyc-fa-omega 3 cap 7-mg OBSTETRIX DHA - prenat w/fecbn-fadss tab 9- mg & omega 3 cap 387 mg pak OBSTETRIX EC - prenatal vit w/ dssiron carbonyl-fa tab 9- mg AIRE OB - prenat w/ fe poly cmplx-fe asp-fe gly-fa tab & dha cap pak NV FERROUS FUMARATE/DOCU - prenatal vit w/ dss-fe fumarate-fa tab 9- mg NV FOLIC ACID + IRON MUL - prenatal vit w/ fe fumarate-fa tab 7- mg NV OB+DHA - prenat w/o a w/fecbnfegl-dss-fa tab & dha cap 50 mg pack NV RENATAL LUS MULTIVI - prenatal vit w/ fe fumarate-fa tab 7- mg NV TABS 9- - prenatal vit w/ iron carbonyl-fa tab 9- mg NV-DHA - prenat w/o a w/fefummethfol-fa-dha cap mg NV-DHA+DOCUSATE - prenatal w/o vit a w/ fe fum-dss-fa-dha cap mg NV-FIRST - prenatal mv w/ fe polysac cmplx-fa-dha cap mg NV-OB/DHA - prenatal mv w/fe fum-fa tab 65- mg & dha cap 50 mg pack NV-OMEGA - prenat w/o a w/ fe fumerate-methylfolate-fa-omega 3 cap NV-SELECT - prenatal vit w/ fe fummethylfolate-fa tab mg NV-TOTAL - prenat w/ fe cbn-fe bisglyc-fa-fish oil cap mg NV-V-U - prenatal w/o a vit w/ fe fumarate-fa cap mg R NATAL prenat-fe bis-fe prot succ-fa-ca tab & omega 3 cap 400 pk R NATAL 400 EC - prenat-fe bis-fe prot succ-fa-ca tab & omega cap dr 400 pk R NATAL prenat-fe bis-fe prot succ-fa-ca tab & omega 3 cap 430 pk R NATAL 430 EC - prenat-fe bis-fe prot succ-fa-ca tab & omega cap dr 430 pk REFERA OB - prenat vit-fe poly cmplxfe heme poly-fa tab 8-6- mg Guia de medicinas ValueScript de Florida Blue para enero de 06 59

71 06 REFERA OB + DHA - prenat-fe poly cmplx-fe heme poly-fa tab & omega 3 cap pck REFERAOB +DHA - prenat-fe poly cmplx 8mg-fe heme poly-fa tab&dha cap pack REFERAOB ONE - prenat-fe poly cmplx-fe heme poly-fa-dha cap mg REFOL-DHA - prenatal w/o vit a w/ fe fum-dss-fa-dha cap mg RENAISSANCE - prenatal w/o vit a w/ fe fum-dss-fa-dha cap mg RENAISSANCE BALANCE - prenatal w/o vit a w/ fe cbn-dss-fa-dha cap mg RENAISSANCE DHA - prenat w/o a w/fecbn-fegl-dss-fa tab & dha cap 50 mg pack RENAISSANCE HARMONY DHA - prenat w/fe poly-na fered-fa tab 7- & omega cap dr 380mg RENAISSANCE NEXT - prenatal w/ calcium-vit b6-fa-ginger tab. mg RENAISSANCE NEXT-B - prenatal w/ calcium-vit b6-fa-ginger tab. mg RENAISSANCE LUS - prenatal w/o a w/fe cbn-dss-fa-dha cap mg RENAISSANCE ROMISE - prenat w/ o a w/fecbn-fegl-dss-fa tab & dha cap 300 mg pack RENAISSANCE 90 DHA - prenat w/o a w/fecbn-fegl-dss-fa tab 90 &dha cap 300mg pak RENALUS - prenatal vit w/ fe fumarate-fa tab 7- mg RENATA - prenatal w/o a vit w/ fe fumfa tab chew 9- mg RENATABS FA - prenatal vit w/ fe fumarate-fa tab 9- mg RENATABS RX - prenatal vit w/ iron carbonyl-fa tab 9- mg RENATAL - prenatal vit w/ fe fumarate-fa tab 7- mg RENATAL AD - prenatal vit w/ dssiron carbonyl-fa tab 90- mg RENATAL LOW IRON - prenatal vit w/ fe fumarate-fa tab 7- mg RENATAL LUS - prenatal vit w/ fe fumarate-fa tab 7- mg RENATAL LUS IRON - prenatal vit w/ iron carbonyl-fa tab 9- mg RENATAL VITAMINS LUS - prenatal vit w/ fe fumarate-fa tab 7- mg RENATAL 9 - prenatal vit w/ dss-fe fumarate-fa tab 9- mg RENATAL 9 - prenatal vit w/ fe fumarate-fa chew tab 9- mg RENATAL-U - prenatal w/o a vit w/ fe fumarate-fa cap mg RENATE - prenat mv & min w/ l- methylfolate-fa chew tab mg RENATE AM - prenatal w/ calcium-vit b6-vit b-fa-ginger tab mg RENATE DHA - prenat w/o a w/feaspgmethfol-fa-dha cap mg RENATE DHA - prenat w/o a w/fefummethfol-fa-dha cap mg RENATE ELITE - prenatal vit w/ fe fum-methylfolate-fa tab mg RENATE ELITE - prenatal w/ fe asp gly-l methylfol-fa tab mg RENATE ENHANCE - prenat w/ o a w/fefum-methfol-fa-dha cap mg RENATE ESSENTIAL - prenat w/ o a w/feasp-methylf-fa-omeg cap mg RENATE ESSENTIAL - prenat w/ o a w/feaspg-methfol-fa-dha cap mg RENATE MINI - prenat w/o a w/fecbnmethylf-fa-dha cap mg 60 Guia de medicinas ValueScript de Florida Blue para enero de 06

72 06 RENATE MINI - prenat w/oa w/fecbfeasp-meth-fa-dha cap mg RENATE IXIE - prenat w/o a w/feaspg-methfol-fa-dha cap mg RENATE RESTORE - prenat w/ o a w/fefum-methfol-fa-dha cap mg RENATE STAR - prenatal vit w/ fe asparto glycinate-fa tab 0- mg RENA CHEW - prenat w/ b-b6-b- d3-folic acid chew tab.4 mg RENA EARL - prenat w/oa w/fefumna fered-fa-dha cap cr mg RENA LUS/QUATREFOLIC - prenat w/o a w/ fe chelate-l methylfolfa tab & dha cap pk RENA/QUATREFOLIC - prenat w/o a w/fefum-methfol-fa-dha cap mg RENEXA - prenatal w/o vit a w/ fe fumdss-fa-dha cap mg RELUS - prenatal vit w/ fe fumarate-fa tab 7- mg REQUE 0 - prenatal mv w/fe carbonyldss-fa-dha tab mg RETAB - prenatal vit w/ fe fumarate-fa tab 9- mg ROVIDA DHA - prenat w/o a w/fe fumfe poly-fa-dha cap mg ROVIDA OB - prenatal w/o a w/fe fumfe poly-fa cap mg UREFE OB LUS - prenatal w/o a w/fe fum-fe poly-fa cap mg R-NATAL OB - prenatal w/o a w/fe cbnfa-dha cap mg RELNATE DHA - prenatal vit w/ fe fumfa-omega 3 cap mg SE-NATAL 9 - prenatal vit w/ dss-fe fumarate-fa tab 9- mg SE-NATAL 9 - prenatal vit w/ fe fumarate-fa chew tab 9- mg SE-TAN DHA - prenatal w/fe fum-fe poly -fa-omega 3 cap 5-5- mg SELECT-OB - prenat w/ fepolycmplxmethylfol-fa chew tab mg SELECT-OB - prenatal vit w/ fe polysac cmplx-fa chew tab 9- mg SELECT-OB+DHA - prenatal mv w/fe poly-fa chw 9- mg & dha cap 50 mg pak SETON ET-EC - prenat-fe bis-fe prot succ-fa-ca tab & omega cap dr 430 pk SETONET - prenat-fe bis-fe prot succ-faca tab & omega 3 cap 430 pk TARON-BC - prenat w/o a w/ fe cbnyl-fa tab 0- mg & vit b6 tab pak TARON-C DHA - prenatal w/fe fum-fe poly -fa-omega 3 cap mg TARON-DUO EC - prenat-fe bis-fe prot succ-fa-ca tab & omega cap dr 400 pk TARON-REX - prenatal w/o vit a w/ fe fum-dss-fa-dha cap mg THRIVITE 9 - prenatal vit w/ dss-fe fumarate-fa tab 9- mg TL FOLATE - prenatal vit w/ fe fummethylfolate-fa tab mg TL-CARE DHA - prenatal w/fe fumaratefa-dss-fish oil cap mg TL-SELECT - prenatal w/o vit a w/ fe fum-dss-fa-dha cap mg TL-SELECT DHA - prenatal w/o vit a w/ fe fum-doc-fa-dha cap mg TRI-TABS DHA - prenat w/o a w/ fe bisglyc-fa tab 3- mg & omega cap pack TRIADVANCE - prenatal vit w/ dss-iron carbonyl-fa tab 90- mg TRICARE - prenatal vit w/ fe fumarate-fa tab 7- mg Guia de medicinas ValueScript de Florida Blue para enero de 06 6

73 06 TRICARE RENATAL COMLEAT - prenat w/o a fefum-fa tab 7- mg & fish oil chew cap pak TRICARE RENATAL DHA ONE - prenatal w/fe fumarate-fa-dss-fish oil cap mg TRINATAL GT - prenatal vit w/ dss-iron carbonyl-fa tab 90- mg TRINATAL RX - prenatal vit w/ fe fumarate-fa tab 60- mg TRINATAL ULTRA - prenatal vit w/ dss-iron carbonyl-fa tab 90- mg TRINATE - prenatal vit w/ fe fumarate-fa tab 8- mg TRISTART DHA - prenat w/o a w/fecbnmethylf-fa-dha cap mg TRIVEEN-DUO DHA - prenat-fe bis-fe prot succ-fa-ca tab & omega 3 cap 400 pk TRIVEEN-RX RNF - prenatal w/o vit a w/ fe fum-dss-fa-dha cap mg ULTIMATE OB DHA - prenat w/ fe poly cmplx-fe asp-fe gly-fa tab & dha cap pak ULTIMATECARE ONE - prenatal vit w/ fe cbn-fe asp glyc-fa-omega 3 cap 7-mg ULTIMATECARE ONE NF - prenatal w/ fe cbnyl-fe asp glyc-fa-dss-omega cap 0-7- mg ULTRA TABS - prenatal vit w/ dss-iron carbonyl-fa tab 90- mg V-NATAL - prenatal vit w/o vit a w/ fe bisglycinate-fa tab 3- mg V-NATAL DHA - prenat w/o a w/ fe bisglyc-fa tab 3- mg & omega cap pack VEMAVITE-RX - prenatal w/o vit a w/ fe fum-dss-fa-dha cap mg VENA-BAL DHA - prenat w/fe polyna fered-fa tab 7- & omega cap dr 430mg VENATAL-FA - prenatal vit w/ fe fumarate-fa tab 9- mg VINACAL - prenatal w/o a w/ fe carbonyl-fe gluc-dss-fa tab 7-mg VINACAL B - prenat w/o a w/fecbnfeglu-fa tab 0- mg & vit b6 tab pak VINATE AZ EXTRA - prenatal vit w/ fe bisglycinate chelate-fa tab 9- mg VINATE C - prenatal w/o a vit w/ fe fumarate-fa tab 30- mg VINATE CALCIUM - prenatal vit w/ iron carbonyl-fe gluc-fa tab 7- mg VINATE CARE - prenatal w/o a vit w/ fe fum-fa tab chew 40- mg VINATE DHA RF - prenat w/o a w/ fefum-methylfol-omegas cap 7-.3 mg VINATE GT - prenatal vit w/ dss-iron carbonyl-fa tab 90- mg VINATE IC - prenatal w/o a w/fe fum-fe poly-fa cap mg VINATE II - prenatal vit w/ fe bisglycinate chelate-fa tab 9- mg VINATE M - prenatal vit w/ sel-fe fumarate-fa tab 7- mg VINATE ONE - prenatal vit w/ fe fumarate-fa tab 60- mg VINATE ULTRA - prenatal vit w/ dssiron carbonyl-fa tab 90- mg VIRT NATE - prenatal vit w/ fe fumarate-fa tab 8- mg VIRT-ADVANCE - prenatal vit w/ dssiron carbonyl-fa tab 90- mg VIRT-BAL DHA LUS - prenat w/fe poly-na fered-fa tab 7- & omega cap dr 380mg VIRT-C DHA - prenatal w/fe fum-fe poly -fa-omega 3 cap mg 6 Guia de medicinas ValueScript de Florida Blue para enero de 06

74 06 VIRT-CARE ONE - prenatal vit w/ fe cbn-fe asp glyc-fa-omega 3 cap 7-mg VIRT-N - prenatal vit w/ fe fummethylfolate-fa tab mg VIRT-N DHA - prenat w/o a w/fefummethfol-fa-dha cap mg VIRT-N LUS - prenat w/o a w/ fe fumerate-methylfolate-fa-omega 3 cap VIRT-SELECT - prenatal w/o vit a w/ fe fum-dss-fa-dha cap mg VIRT-VITE GT - prenatal vit w/ dss-iron carbonyl-fa tab 90- mg VIRTREX - prenatal w/o vit a w/ fe fum-dss-fa-dha cap mg VITA-REN - prenatal vit w/ docusateiron-fa tab 65- mg VITAFOL ULTRA - prenat w/fe polymethylfol-fa-dha cap mg VITAFOL-NANO - prenatal w/o a w/ fefum-l methylfol-fa tab mg VITAFOL-OB - prenatal vit w/ fe fumarate-fa tab 65- mg VITAFOL-OB+DHA - prenatal mv w/fe fum-fa tab 65- mg & dha cap 50 mg pack VITAFOL-ONE - prenatal mv w/ fe polysac cmplx-fa-dha cap mg VITAFOL-N - prenatal vit w/ fe fumarate-fa tab 65- mg VITAMEDMD ONE RX/QUATREFO - prenat w/o a w/fefum-methfol-fa-dha cap mg VITAMEDMD LUS RX/QUATRE - prenat w/o a w/ fe chelate-l methylfolfa tab & dha cap pk VITAMEDMD REDICHEW RX - prenat w/ b-b6-b-d3-folic acid chew tab.4 mg VITAEARL - prenat w/oa w/fefum-na fered-fa-dha cap cr mg VIVA DHA - prenatal vit w/ fe fum-faomega 3 cap mg VOL-NATE - prenatal vit w/ fe fumaratefa tab 8- mg VOL-LUS - prenatal vit w/ fe fumaratefa tab 7- mg VOL-TAB RX - prenatal vit w/ iron carbonyl-fa tab 9- mg V CH ULTRA - prenat w/o a w/fe fumfe cbn-dss-fa-dha cap mg V-CH LUS - prenatal w/o a w/fe cbndss-fa-dha cap mg V-CH-NV - prenatal w/o vit a w/ fe cbn-dss-fa-dha cap mg V-GGR-B6 RENATAL - prenatal w/ calcium-vit b6-fa-ginger tab. mg V-HEME OB - prenat vit-fe poly cmplxfe heme poly-fa tab 8-6- mg V-HEME OB + DHA - prenat-fe poly cmplx-fe heme poly-fa tab & omega 3 cap pck V-HEME ONE - prenat-fe poly cmplxfe heme poly-fa-dha cap mg V-NV-DHA - prenatal vit w/ fe fumfa-omega 3 cap mg ZATEAN-CH - prenatal w/o a w/fe cbndss-fa-dha cap mg ZATEAN-N - prenatal vit w/ fe fummethylfolate-fa tab mg ZATEAN-N DHA - prenat w/o a w/fefum-methfol-fa-dha cap mg ZATEAN-N LUS - prenat w/o a w/ fe fumerate-methylfolate-fa-omega 3 cap ZINGIBER - prenatal w/ calcium-vit b6- fa-ginger tab. mg MINERALES Y ELECTROLITOS pot bicarbonate & chloride effer tab 5 meq Guia de medicinas ValueScript de Florida Blue para enero de 06 63

75 06 pot phos monobasic w/sod phos di & monobas tab mg (K-phos neutral) potassium bicarbonate effer tab 5 meq potassium chloride cap cr 8 meq (Micro-k) potassium chloride cap cr 0 meq (Micro-k) OTASSIUM CHLORIDE ER - potassium chloride tab cr 8 meq (600 mg) potassium chloride microencapsulated crys cr tab 0 meq potassium chloride microencapsulated crys cr tab 0 meq potassium chloride oral liq 0% (0 meq/5ml) potassium chloride oral liq 0% (40 meq/5ml) potassium chloride powder packet 0 meq potassium chloride tab cr 8 meq (600 mg) (K-tab) potassium chloride tab cr 0 meq (Ktab) SODIUM FLUORIDE - sodium fluoride tab mg f (from. mg naf) sodium fluoride chew tab 0.5 mg f (from 0.55 mg naf) (Luride) sodium fluoride chew tab 0.5 mg f (from. mg naf) (Luride) sodium fluoride chew tab mg f (from. mg naf) (Luride) sodium fluoride soln 0.5 mg/drop f (0.75 mg/drop naf) sodium fluoride soln 0.5 mg/ml f (from. mg/ml naf) (Luride) NUTRIENTES acetylcysteine cap 600 mg AGENTES HEMATOLÓGICOS AGENTES HEMATOOYÉTICOS ARANES ALBUMIN FREE - darbepoetin alfa-polysorbate 80 soln inj 0 mcg/0.4ml ARANES ALBUMIN FREE - darbepoetin alfa-polysorbate 80 soln inj 5 mcg/ml ARANES ALBUMIN FREE - darbepoetin alfa-polysorbate 80 soln inj 5 mcg/0.4ml ARANES ALBUMIN FREE - darbepoetin alfa-polysorbate 80 soln inj 40 mcg/ml ARANES ALBUMIN FREE - darbepoetin alfa-polysorbate 80 soln inj 40 mcg/0.4ml ARANES ALBUMIN FREE - darbepoetin alfa-polysorbate 80 soln inj 60 mcg/ml ARANES ALBUMIN FREE - darbepoetin alfa-polysorbate 80 soln inj 60 mcg/0.3ml ARANES ALBUMIN FREE - darbepoetin alfa-polysorbate 80 soln inj 00 mcg/ml ARANES ALBUMIN FREE - darbepoetin alfa-polysorbate 80 soln inj 00 mcg/0.5ml ARANES ALBUMIN FREE - darbepoetin alfa-polysorbate 80 soln inj 50 mcg/0.3ml ARANES ALBUMIN FREE - darbepoetin alfa-polysorbate 80 soln inj 00 mcg/ml ARANES ALBUMIN FREE - darbepoetin alfa-polysorbate 80 soln inj 00 mcg/0.4ml ARANES ALBUMIN FREE - darbepoetin alfa-polysorbate 80 soln inj 300 mcg/ml ARANES ALBUMIN FREE - darbepoetin alfa-polysorbate 80 soln inj 300 mcg/0.6ml 64 Guia de medicinas ValueScript de Florida Blue para enero de 06

76 06 ARANES ALBUMIN FREE - darbepoetin alfa-polysorbate 80 soln inj 500 mcg/ml carbonyl iron susp 5 mg/.5ml (elemental iron) cyanocobalamin inj 000 mcg/ml DROXIA - hydroxyurea cap 00 mg DROXIA - hydroxyurea cap 300 mg DROXIA - hydroxyurea cap 400 mg ferrous sulfate elixir 0 mg/5ml (44 mg/5ml elemental fe) ferrous sulfate soln 75 mg/ml (5 mg/ ml elemental fe) folic acid tab 400 mcg folic acid tab 800 mcg folic acid tab mg LEUKINE - sargramostim lyophilized for inj 50 mcg NEULASTA - pegfilgrastim inj 6 mg/0.6ml NEULASTA DELIVERY KIT - pegfilgrastim inj 6 mg/0.6ml 3 NEUOGEN - filgrastim inj 300 mcg/ml NEUOGEN - filgrastim inj 480 mcg/.6ml (300 mcg/ml) NEUOGEN - filgrastim inj 300 mcg/0.5ml (600 mcg/ml) NEUOGEN - filgrastim inj 480 mcg/0.8ml (600 mcg/ml) ROCRIT - epoetin alfa inj 000 unit/ml ROCRIT - epoetin alfa inj 3000 unit/ml ROCRIT - epoetin alfa inj 4000 unit/ml ROCRIT - epoetin alfa inj 0000 unit/ml ROCRIT - epoetin alfa inj 0000 unit/ml ROCRIT - epoetin alfa inj unit/ml ROMACTA - eltrombopag olamine tab.5 mg (base equiv) ROMACTA - eltrombopag olamine tab 5 mg (base equiv) ROMACTA - eltrombopag olamine tab 50 mg (base equiv) ROMACTA - eltrombopag olamine tab 75 mg (base equiv) ZAVESCA - miglustat cap 00 mg ANTICOAGULANTES ELIQUIS - apixaban tab.5 mg ELIQUIS - apixaban tab 5 mg enoxaparin sodium inj 30 mg/0.3ml (Lovenox) enoxaparin sodium inj 40 mg/0.4ml (Lovenox) enoxaparin sodium inj 60 mg/0.6ml (Lovenox) enoxaparin sodium inj 80 mg/0.8ml (Lovenox) enoxaparin sodium inj 00 mg/ml (Lovenox) enoxaparin sodium inj 0 mg/0.8ml (Lovenox) enoxaparin sodium inj 50 mg/ml (Lovenox) enoxaparin sodium inj 300 mg/3ml (Lovenox) fondaparinux sodium inj.5 mg/0.5ml (Arixtra) fondaparinux sodium inj 5 mg/0.4ml (Arixtra) fondaparinux sodium inj 7.5 mg/0.6ml (Arixtra) fondaparinux sodium inj 0 mg/0.8ml (Arixtra) heparin sodium (porcine) inj 5000 unit/ml RADAXA - dabigatran etexilate mesylate cap 75 mg (etexilate base eq) RADAXA - dabigatran etexilate mesylate cap 50 mg (etexilate base eq) warfarin sodium tab mg (Coumadin) Guia de medicinas ValueScript de Florida Blue para enero de 06 65

77 06 warfarin sodium tab mg (Coumadin) warfarin sodium tab.5 mg (Coumadin) warfarin sodium tab 3 mg (Coumadin) warfarin sodium tab 4 mg (Coumadin) warfarin sodium tab 5 mg (Coumadin) warfarin sodium tab 6 mg (Coumadin) warfarin sodium tab 7.5 mg (Coumadin) warfarin sodium tab 0 mg (Coumadin) XARELTO - rivaroxaban tab 0 mg XARELTO - rivaroxaban tab 5 mg XARELTO - rivaroxaban tab 0 mg XARELTO STARTER ACK - rivaroxaban tab starter therapy pack 5 mg & 0 mg HEMOSTÁTICOS tranexamic acid tab 650 mg (Lysteda) AGENTES HEMATOLÓGICOS, MISC. ADVATE - antihemophilic factor rahfpfm for inj 50 unit ADVATE - antihemophilic factor rahfpfm for inj 500 unit ADVATE - antihemophilic factor rahfpfm for inj 000 unit ADVATE - antihemophilic factor rahfpfm for inj 500 unit ADVATE - antihemophilic factor rahfpfm for inj 000 unit ADVATE - antihemophilic factor rahfpfm for inj 3000 unit ADVATE - antihemophilic factor rahfpfm for inj 4000 unit AGGRENOX - aspirin-dipyridamole cap sr hr 5-00 mg ALHANATE/VON WILLEBRAND - antihemophilic factor/vwf (human) for inj 50 unit 3 ALHANATE/VON WILLEBRAND - antihemophilic factor/vwf (human) for inj 500 unit ALHANATE/VON WILLEBRAND - antihemophilic factor/vwf (human) for inj 000 unit ALHANATE/VON WILLEBRAND - antihemophilic factor/vwf (human) for inj 500 unit ALHANATE/VON WILLEBRAND - antihemophilic factor/vwf (human) for inj 000 unit ALHANINE SD - coagulation factor ix for inj 500 unit ALHANINE SD - coagulation factor ix for inj 000 unit ALHANINE SD - coagulation factor ix for inj 500 unit ALROLIX - coagulation factor ix (recomb) (rfixfc) for inj 500 unit ALROLIX - coagulation factor ix (recomb) (rfixfc) for inj 000 unit ALROLIX - coagulation factor ix (recomb) (rfixfc) for inj 000 unit ALROLIX - coagulation factor ix (recomb) (rfixfc) for inj 3000 unit anagrelide hcl cap 0.5 mg (Agrylin) anagrelide hcl cap mg BEBULIN - factor ix complex for inj unit BEBULIN VH - factor ix complex for inj unit BENEFIX - coagulation factor ix (recombinant) for inj 50 unit BENEFIX - coagulation factor ix (recombinant) for inj 500 unit BENEFIX - coagulation factor ix (recombinant) for inj 000 unit BENEFIX - coagulation factor ix (recombinant) for inj 000 unit 66 Guia de medicinas ValueScript de Florida Blue para enero de 06

78 06 BENEFIX - coagulation factor ix (recombinant) for inj 3000 unit BRILINTA - ticagrelor tab 90 mg 3 cilostazol tab 50 mg (letal) cilostazol tab 00 mg (letal) CINRYZE - c esterase inhibitor (human) for iv inj 500 unit clopidogrel bisulfate tab 75 mg (base equiv) (lavix) clopidogrel bisulfate tab 300 mg (base equiv) (lavix) CORIFACT - factor xiii concentrate (human) for inj kit unit dipyridamole tab 5 mg (ersantine) dipyridamole tab 50 mg (ersantine) dipyridamole tab 75 mg (ersantine) EFFIENT - prasugrel hcl tab 5 mg (base equiv) EFFIENT - prasugrel hcl tab 0 mg (base equiv) ELOCTATE - antihemophilic factor (recomb) rfviiifc for inj 50 unit ELOCTATE - antihemophilic factor (recomb) rfviiifc for inj 500 unit ELOCTATE - antihemophilic factor (recomb) rfviiifc for inj 750 unit ELOCTATE - antihemophilic factor (recomb) rfviiifc for inj 000 unit ELOCTATE - antihemophilic factor (recomb) rfviiifc for inj 500 unit ELOCTATE - antihemophilic factor (recomb) rfviiifc for inj 000 unit ELOCTATE - antihemophilic factor (recomb) rfviiifc for inj 3000 unit FEIBA - antiinhibitor coagulant complex for inj FEIBA NF - antiinhibitor coagulant complex for inj FIRAZYR - icatibant acetate inj 30 mg/3ml (base equivalent) 3 3 HELIXATE FS - antihemophilic factor (recombinant) for inj kit 50 unit HELIXATE FS - antihemophilic factor (recombinant) for inj kit 500 unit HELIXATE FS - antihemophilic factor (recombinant) for inj kit 000 unit HELIXATE FS - antihemophilic factor (recombinant) for inj kit 000 unit HELIXATE FS - antihemophilic factor (recombinant) for inj kit 3000 unit HEMOFIL M - antihemophilic factor (human) for inj unit HEMOFIL M - antihemophilic factor (human) for inj 50 unit HEMOFIL M - antihemophilic factor (human) for inj unit HEMOFIL M - antihemophilic factor (human) for inj 500 unit HEMOFIL M - antihemophilic factor (human) for inj 000 unit HEMOFIL M - antihemophilic factor (human) for inj 700 unit HEMOFIL M - antihemophilic factor (human) for inj unit HEMOFIL M - antihemophilic factor (human) for inj unit HUMATE- - antihemophilic factor/vwf (human) for inj unit HUMATE- - antihemophilic factor/vwf (human) for inj unit HUMATE- - antihemophilic factor/vwf (human) for inj unit KOATE-DVI - antihemophilic factor (human) for inj 50 unit KOATE-DVI - antihemophilic factor (human) for inj 500 unit KOATE-DVI - antihemophilic factor (human) for inj 000 unit KOGENATE FS - antihemophilic factor (recombinant) for inj kit 50 unit Guia de medicinas ValueScript de Florida Blue para enero de 06 67

79 06 KOGENATE FS - antihemophilic factor (recombinant) for inj kit 500 unit KOGENATE FS - antihemophilic factor (recombinant) for inj kit 000 unit KOGENATE FS - antihemophilic factor (recombinant) for inj kit 000 unit KOGENATE FS - antihemophilic factor (recombinant) for inj kit 3000 unit KOGENATE FS BIO-SET - antihemophilic factor (recombinant) for inj kit 50 unit KOGENATE FS BIO-SET - antihemophilic factor (recombinant) for inj kit 500 unit KOGENATE FS BIO-SET - antihemophilic factor (recombinant) for inj kit 000 unit KOGENATE FS BIO-SET - antihemophilic factor (recombinant) for inj kit 000 unit KOGENATE FS BIO-SET - antihemophilic factor (recombinant) for inj kit 3000 unit MONOCLATE- - antihemophilic factor (human) for inj kit 50 unit MONOCLATE- - antihemophilic factor (human) for inj kit 500 unit MONOCLATE- - antihemophilic factor (human) for inj kit 000 unit MONOCLATE- - antihemophilic factor (human) for inj kit 500 unit MONONINE - coagulation factor ix for inj 50 unit MONONINE - coagulation factor ix for inj 500 unit MONONINE - coagulation factor ix for inj 000 unit NOVOSEVEN RT - coagulation factor viia (recomb) for inj mg (000 mcg) NOVOSEVEN RT - coagulation factor viia (recomb) for inj mg (000 mcg) NOVOSEVEN RT - coagulation factor viia (recomb) for inj 5 mg (5000 mcg) NOVOSEVEN RT - coagulation factor viia (recomb) for inj 8 mg (8000 mcg) OBIZUR - antihemophilic factor (recomb porc) rpfviii for inj 500 unit pentoxifylline tab cr 400 mg ROFILNINE SD - factor ix complex for inj 500 unit ROFILNINE SD - factor ix complex for inj 000 unit ROFILNINE SD - factor ix complex for inj 500 unit RECOMBINATE - antihemophilic factor (recombinant) for inj unit RECOMBINATE - antihemophilic factor (recombinant) for inj unit RECOMBINATE - antihemophilic factor (recombinant) for inj unit RECOMBINATE - antihemophilic factor (recombinant) for inj unit RECOMBINATE - antihemophilic factor (recombinant) for inj unit RIXUBIS - coagulation factor ix (recombinant) for inj 50 unit RIXUBIS - coagulation factor ix (recombinant) for inj 500 unit RIXUBIS - coagulation factor ix (recombinant) for inj 000 unit RIXUBIS - coagulation factor ix (recombinant) for inj 000 unit RIXUBIS - coagulation factor ix (recombinant) for inj 3000 unit TRETTEN - coagulation factor xiii a- subunit for inj unit WILATE - antihemophilic factor/vwf (human) for inj unit WILATE - antihemophilic factor/vwf (human) for inj unit XYNTHA - antihemophilic factor recombinant paf for inj kit 50 unit 68 Guia de medicinas ValueScript de Florida Blue para enero de 06

80 06 XYNTHA - antihemophilic factor recombinant paf for inj kit 500 unit XYNTHA - antihemophilic factor recombinant paf for inj kit 000 unit XYNTHA - antihemophilic factor recombinant paf for inj kit 000 unit XYNTHA SOLOFUSE - antihemophilic factor recombinant paf for inj kit 50 unit XYNTHA SOLOFUSE - antihemophilic factor recombinant paf for inj kit 500 unit XYNTHA SOLOFUSE - antihemophilic factor recombinant paf for inj kit 000 unit XYNTHA SOLOFUSE - antihemophilic factor recombinant paf for inj kit 000 unit XYNTHA SOLOFUSE - antihemophilic factor recombinant paf for inj kit 3000 unit RODUCTOS TÓICOS AGENTES OFTÁLMICOS ALOCRIL - nedocromil sodium ophth 3 soln % ALOMIDE - lodoxamide tromethamine 3 ophth soln 0.% ALREX - loteprednol etabonate ophth 3 susp 0.% apraclonidine hcl ophth soln 0.5% (base equivalent) (Iopidine) ATROINE SULFATE - atropine sulfate ophth oint % atropine sulfate ophth soln % (Isopto atropine) azelastine hcl ophth soln 0.05% AZOT - brinzolamide ophth susp % 3 BACITRACIN - bacitracin ophth oint 500 unit/gm bacitracin-polymyxin b ophth oint bacitracin-polymyxin-neomycin-hc ophth oint % BEREVE - bepotastine besilate ophth soln.5% BESIVANCE - besifloxacin hcl ophth susp 0.6% (base equiv) BETADINE OHTHALMIC RE - povidone-iodine ophth soln 5% betaxolol hcl ophth soln 0.5% brimonidine tartrate ophth soln 0.5% (Alphagan p) brimonidine tartrate ophth soln 0.% bromfenac sodium ophth soln 0.09% (base equivalent) bromfenac sodium ophth soln 0.09% (base equiv) (once-daily) carteolol hcl ophth soln % ciprofloxacin hcl ophth soln 0.3% (Ciloxan) cromolyn sodium ophth soln 4% cyclopentolate hcl ophth soln % (Cyclogyl) cyclopentolate hcl ophth soln % (Cyclogyl) dexamethasone sodium phosphate ophth soln 0.% diclofenac sodium ophth soln 0.% dorzolamide hcl ophth soln % (Trusopt) dorzolamide hcl-timolol maleate ophth soln mg/ml (Cosopt) DUREZOL - difluprednate ophth emulsion 0.05% EMADINE - emedastine difumarate ophth soln 0.05% (base equiv) epinastine hcl ophth soln 0.05% (Elestat) erythromycin ophth oint 5 mg/gm fluorometholone ophth susp 0.% (Fml liquifilm) Guia de medicinas ValueScript de Florida Blue para enero de 06 69

81 06 flurbiprofen sodium ophth soln 0.03% (Ocufen) gatifloxacin ophth soln 0.5% (Zymaxid) gentamicin sulfate ophth oint 0.3% gentamicin sulfate ophth soln 0.3% (Garamycin) homatropine hbr ophth soln 5% (Isopto homatropine) ILEVRO - nepafenac ophth susp 0.3% 3 ketorolac tromethamine ophth soln 0.4% (Acular ls) ketorolac tromethamine ophth soln 0.5% (Acular) LASTACAFT - alcaftadine ophth soln 0.5% latanoprost ophth soln 0.005% (Xalatan) levobunolol hcl ophth soln 0.5% (Betagan) levofloxacin ophth soln 0.5% LUMIGAN - bimatoprost ophth soln 0.0% LUMIGAN - bimatoprost ophth soln 0.03% NATACYN - natamycin ophth susp 5% neomycin-bacitrac zn-polymyx 5(3.5)mg-400unt-0000unt op oin neomycin-polymy-gramicid op sol mg-unt-mg/ml (Neosporin) neomycin-polymyxin-dexamethasone ophth oint 0.% (Maxitrol) neomycin-polymyxin-dexamethasone ophth susp 0.% (Maxitrol) ofloxacin ophth soln 0.3% (Ocuflox) ATADAY - olopatadine hcl ophth soln 0.% ATANOL - olopatadine hcl ophth soln 0.% HOSHOLINE IODIDE - echothiophate iodide ophth for soln 0.5% pilocarpine hcl ophth soln % (Isopto carpine) pilocarpine hcl ophth soln % (Isopto carpine) pilocarpine hcl ophth soln 4% (Isopto carpine) polymyxin b-trimethoprim ophth soln 0000 unit/ml-0.% (olytrim) prednisolone acetate ophth susp % (red forte) proparacaine hcl ophth soln 0.5% (Alcaine) SIMBRINZA - brinzolamide-brimonidine tartrate ophth susp -0.% sulfacetamide sodium ophth soln 0% (Bleph-0) sulfacetamide sodium-prednisolone ophth soln 0-0.3(0.5)% tetracaine hcl ophth soln 0.5% timolol maleate ophth gel forming soln 0.5% (Timoptic-xe) timolol maleate ophth gel forming soln 0.5% (Timoptic-xe) timolol maleate ophth soln 0.5% (Timoptic) timolol maleate ophth soln 0.5% (Timoptic) TOBRADEX - tobramycindexamethasone ophth oint % tobramycin ophth soln 0.3% (Tobrex) tobramycin-dexamethasone ophth susp % (Tobradex) TRAVATAN Z - travoprost ophth soln 0.004% (benzalkonium free) (bak free) trifluridine ophth soln % (Viroptic) tropicamide ophth soln 0.5% Guia de medicinas ValueScript de Florida Blue para enero de 06

82 06 tropicamide ophth soln % (Mydriacyl) VEXOL - rimexolone ophth susp % 3 VIGAMOX - moxifloxacin hcl ophth soln 0.5% (base equiv) ZIOTAN - tafluprost ophth soln 0.005% ZIRGAN - ganciclovir ophth gel 0.5% 3 ZYMAXID - gatifloxacin ophth soln 0.5% AGENTES ÓTICOS acetic acid otic soln % ACETIC ACID/ALUMINUM ACET - acetic acid % in aluminum acetate otic soln antipyrine-benzocaine otic soln 54-4 mg/ml (5.4-.4%) antipyrine-benzocaine-polycosanol otic sol % (Treagan otic) CIRODEX - ciprofloxacindexamethasone otic susp % COLY-MYCIN S - neomycin-colistin-hcthonzonium otic susp mg/ ml fluocinolone acetonide (otic) oil 0.0% (Dermotic) hydrocortisone w/ acetic acid otic soln -% neomycin-polymyxin-hc otic soln % (Cortisporin) neomycin-polymyxin-hc otic susp 3.5 mg/ml-0000 unit/ml-% ofloxacin otic soln 0.3% pramoxine-chloroxylenol otic liquid -0.% (ramotic) 3 3 AGENTES BUCALES/DENTALES/DE LA GARGANTA benzocaine dental soln 0% cevimeline hcl cap 30 mg (Evoxac) chlorhexidine gluconate soln 0.% (eridex) clotrimazole troche 0 mg lidocaine hcl laryngotracheal soln 4% (Lta 360 kit) lidocaine hcl viscous soln % nystatin susp unit/ml ORAVIG - miconazole buccal tab 50 mg 3 (mouth-throat) pilocarpine hcl tab 5 mg (Salagen) pilocarpine hcl tab 7.5 mg (Salagen) triamcinolone acetonide dental paste 0.% AGENTES ANORRECTALES CORTIFOAM - hydrocortisone acetate rectal foam 90 mg/dose hydrocortisone acetate suppos 5 mg (Anusol-hc) hydrocortisone acetate suppos 30 mg (roctocort) hydrocortisone acetate w/ pramoxine rectal cream -% (Analpram-hc) hydrocortisone acetate w/ pramoxine rectal cream.5-% (Analpram-hc) hydrocortisone enema 00 mg/60ml (Cortenema) hydrocortisone rectal cream % (roctocort) hydrocortisone rectal cream.5% (Anusol-hc) lidocaine-hydrocortisone acetate rectal cream kit 3-0.5% lidocaine-hydrocortisone acetate rectal cream 3-0.5% ROCTOFOAM HC - hydrocortisone acetate w/ pramoxine rectal foam -% RECTIV - nitroglycerin oint 0.4% 3 DERMATOLÓGICOS acitretin cap 0 mg (Soriatane) acitretin cap 7.5 mg (Soriatane) acitretin cap 5 mg (Soriatane) Guia de medicinas ValueScript de Florida Blue para enero de 06 7

83 06 acyclovir oint 5% (Zovirax) adapalene cream 0.% (Differin) adapalene gel 0.% (Differin) adapalene gel 0.3% (Differin) alclometasone dipropionate cream 0.05% (Aclovate) alclometasone dipropionate oint 0.05% benzoyl peroxide cloth 6% benzoyl peroxide gel 5% benzoyl peroxide gel 0% benzoyl peroxide liq.5% benzoyl peroxide liq 7% benzoyl peroxide liq 0% benzoyl peroxide liq 5.5% benzoyl peroxide lotion 6% benzoyl peroxide-erythromycin gel 5-3% (Benzamycin) betamethasone dipropionate augmented cream 0.05% (Diprolene af) betamethasone dipropionate augmented gel 0.05% betamethasone dipropionate augmented lotion 0.05% (Diprolene) betamethasone dipropionate augmented oint 0.05% (Diprolene) betamethasone dipropionate cream 0.05% betamethasone dipropionate lotion 0.05% betamethasone dipropionate oint 0.05% betamethasone valerate aerosol foam 0.% (Luxiq) betamethasone valerate cream 0.% betamethasone valerate lotion 0.% betamethasone valerate oint 0.% calcipotriene cream 0.005% (Dovonex) calcipotriene oint 0.005% calcipotriene soln 0.005% (50 mcg/ml) calcipotriene-betamethasone dipropionate oint % (Taclonex) ciclopirox gel 0.77% ciclopirox olamine cream 0.77% (base equiv) ciclopirox olamine susp 0.77% (base equiv) ciclopirox shampoo % (Loprox shampoo) ciclopirox solution 8% (enlac Nail Lacquer) CLARAVIS - isotretinoin cap 30 mg clindamycin phosph-benzoyl peroxide (refrig) gel. ()-5% (Duac) clindamycin phosphate foam % (Evoclin) clindamycin phosphate gel % (Cleocin-t) clindamycin phosphate lotion % (Cleocin-t) clindamycin phosphate soln % (Cleocin-t) clindamycin phosphate swab % (Cleocin-t) clindamycin phosphate-benzoyl peroxide gel -5% (Benzaclin) clobetasol propionate cream 0.05% (Temovate) clobetasol propionate emollient base cream 0.05% (Temovate e) clobetasol propionate emulsion foam 0.05% (Olux-e) clobetasol propionate foam 0.05% (Olux) clobetasol propionate gel 0.05% (Temovate) 7 Guia de medicinas ValueScript de Florida Blue para enero de 06

84 06 clobetasol propionate lotion 0.05% (Clobex) clobetasol propionate oint 0.05% (Temovate) clobetasol propionate shampoo 0.05% (Clobex) clobetasol propionate soln 0.05% (Temovate) clobetasol propionate spray 0.05% (Clobex) clotrimazole cream % clotrimazole soln % clotrimazole w/ betamethasone cream -0.05% (Lotrisone) clotrimazole w/ betamethasone lotion -0.05% DENAVIR - penciclovir cream % 3 desonide cream 0.05% (Desowen) desonide lotion 0.05% (Desowen) desonide oint 0.05% (Desowen) desoximetasone cream 0.5% (Topicort) desoximetasone gel 0.05% (Topicort) desoximetasone oint 0.5% (Topicort) diclofenac sodium (actinic keratoses) gel 3% (Solaraze) diclofenac sodium soln.5% econazole nitrate cream % ELIDEL - pimecrolimus cream % 3 ERTACZO - sertaconazole nitrate cream 3 % erythromycin gel % (Erygel) erythromycin pads % erythromycin soln % EURAX - crotamiton cream 0% 3 FINACEA - azelaic acid gel 5% fluocinolone acetonide cream 0.0% fluocinolone acetonide cream 0.05% (Synalar) fluocinolone acetonide oil 0.0% (body oil) (Derma-smoothe/fs bod) fluocinolone acetonide oil 0.0% (scalp oil) (Derma-smoothe/fs sca) fluocinolone acetonide oint 0.05% (Synalar) fluocinolone acetonide soln 0.0% (Synalar) fluocinonide cream 0.05% fluocinonide cream 0.% (Vanos) fluocinonide emulsified base cream 0.05% fluocinonide gel 0.05% fluocinonide oint 0.05% fluocinonide soln 0.05% fluorouracil cream 5% (Efudex) fluorouracil soln % fluorouracil soln 5% fluticasone propionate cream 0.05% (Cutivate) fluticasone propionate lotion 0.05% (Cutivate) fluticasone propionate oint 0.005% halobetasol propionate cream 0.05% (Ultravate) halobetasol propionate oint 0.05% (Ultravate) hydrocortisone butyrate cream 0.% (Locoid) hydrocortisone butyrate hydrophilic lipo base cream 0.% (Locoid lipocream) hydrocortisone butyrate oint 0.% (Locoid) hydrocortisone butyrate soln 0.% (Locoid) hydrocortisone cream % Guia de medicinas ValueScript de Florida Blue para enero de 06 73

85 06 hydrocortisone cream.5% hydrocortisone lotion % (Ala scalp) hydrocortisone lotion.5% hydrocortisone oint % hydrocortisone oint.5% hydrocortisone valerate cream 0.% hydrocortisone valerate oint 0.% (Westcort) imiquimod cream 5% (Aldara) iodoquinol-hydrocortisone in aloe vehicle cream -.9% (Vytone) isotretinoin cap 0 mg isotretinoin cap 0 mg isotretinoin cap 40 mg ketoconazole cream % ketoconazole foam % (Extina) ketoconazole shampoo % (Nizoral) lactic acid (ammonium lactate) cream % (Lac-hydrin) lactic acid (ammonium lactate) lotion % (Lac-hydrin) lidocaine hcl gel % lidocaine hcl soln 4% (Xylocaine) lidocaine oint 5% lidocaine patch 5% (Lidoderm) lidocaine-prilocaine cream.5-.5% (Emla) lindane lotion % lindane shampoo % malathion lotion 0.5% (Ovide) MENTAX - butenafine hcl cream % 3 methoxsalen rapid cap 0 mg (Oxsoralen ultra) metronidazole cream 0.75% (Metrocream) metronidazole gel 0.75% metronidazole gel % (Metrogel) metronidazole lotion 0.75% (Metrolotion) mometasone furoate cream 0.% (Elocon) mometasone furoate oint 0.% (Elocon) mometasone furoate solution 0.% (lotion) (Elocon) mupirocin calcium cream % (Bactroban) mupirocin oint % (Bactroban) naftifine hcl cream % (Naftin) NAFTIN - naftifine hcl cream % 3 nystatin cream unit/gm nystatin oint unit/gm nystatin topical powder nystatin-triamcinolone cream unit/gm-% nystatin-triamcinolone oint unit/gm-% OXISTAT - oxiconazole nitrate cream % 3 OXISTAT - oxiconazole nitrate lotion % 3 ANRETIN - alitretinoin gel 0.% 3 permethrin cream 5% (Elimite) podofilox soln 0.5% (Condylox) prednicarbate cream 0.% (Dermatop) prednicarbate oint 0.% (Dermatop) salicylic acid cream 6% salicylic acid film forming liquid 7.5% (Virasal) salicylic acid film-forming soln 8.5% (Ultrasal-er) salicylic acid foam 6% (Salvax) salicylic acid gel 6% (Keralyt) salicylic acid lotion 6% salicylic acid shampoo 6% (Salex) selenium sulfide lotion.5% 74 Guia de medicinas ValueScript de Florida Blue para enero de 06

86 06 selenium sulfide-pyrithione zinc in urea shampoo.5% silver nitrate-potassium nitrate applicator 75-5% (Arzol silver nitrate) silver sulfadiazine cream % (Silvadene) SKLICE - ivermectin lotion 0.5% 3 STELARA - ustekinumab soln prefilled syringe 45 mg/0.5ml STELARA - ustekinumab soln prefilled syringe 90 mg/ml sulfacetamide sodium cleansing gel 0% (Ovace plus wash) sulfacetamide sodium liquid 0% (Ovace wash) sulfacetamide sodium lotion 0% (acne) (Klaron) sulfacetamide sodium shampoo 0% (Ovace plus) sulfacetamide sodium w/ sulfur cleanser % (lexion cleanser) sulfacetamide sodium w/ sulfur cleanser 0-% (Avar ls cleanser) sulfacetamide sodium w/ sulfur cream % (lexion) sulfacetamide sodium w/ sulfur cream 0-% (Avar-e ls) sulfacetamide sodium w/ sulfur cream 0-5% sulfacetamide sodium w/ sulfur emulsion 0-% sulfacetamide sodium w/ sulfur emulsion 0-5% sulfacetamide sodium w/ sulfur foam 0-5% (Clarifoam ef) sulfacetamide sodium w/ sulfur lotion % (lexion) sulfacetamide sodium w/ sulfur lotion 0-5% sulfacetamide sodium w/ sulfur susp 8-4% (Sumaxin ts) sulfacetamide sodium w/ sulfur wash 9-4% (Sumaxin wash) sulfacetamide sodium w/ sulfur wash 9-4.5% (Sumadan wash) tacrolimus oint 0.03% (rotopic) tacrolimus oint 0.% (rotopic) TAZORAC - tazarotene cream 0.05% TAZORAC - tazarotene cream 0.% TAZORAC - tazarotene gel 0.05% TAZORAC - tazarotene gel 0.% tretinoin cream 0.05% (Retin-a) tretinoin cream 0.05% (Retin-a) tretinoin cream 0.% (Retin-a) tretinoin gel 0.0% (Retin-a) tretinoin gel 0.05% (Retin-a) tretinoin microsphere gel 0.04% (Retin-a micro) tretinoin microsphere gel 0.% (Retina micro pump) triamcinolone acetonide aerosol soln (Kenalog) triamcinolone acetonide cream 0.05% triamcinolone acetonide cream 0.% triamcinolone acetonide cream 0.5% triamcinolone acetonide lotion 0.05% triamcinolone acetonide lotion 0.% triamcinolone acetonide oint 0.05% triamcinolone acetonide oint 0.% trypsin w/ castor oil & peruvian balsam spray (Granulex) ULESFIA - benzyl alcohol lotion 5% 3 urea in lactic acid vehicle foam 35% (Hydro 35) VALCHLOR - mechlorethamine hcl gel 0.06% (base equivalent) VOLTAREN - diclofenac sodium gel % Guia de medicinas ValueScript de Florida Blue para enero de 06 75

87 06 ZOVIRAX - acyclovir cream 5% RODUCTOS MISCELÁNEOS ANTÍDOTOS CHEMET - succimer cap 00 mg EXJADE - deferasirox tab for oral susp 5 mg EXJADE - deferasirox tab for oral susp 50 mg EXJADE - deferasirox tab for oral susp 500 mg FERRIROX - deferiprone tab 500 mg naloxone hcl inj 0.4 mg/ml naltrexone hcl tab 50 mg (Revia) SUMINISTROS ARA LA DIABETES ASCENSIA AUTODISC TEST ST - glucose blood test disk BAYER BREEZE TEST DISC - glucose blood test disk BAYER CONTOUR BLOOD GLUCO - glucose blood test strip BAYER CONTOUR NEXT BLOOD - glucose blood test strip GLUCAGEN DIAGNOSTIC - glucagon hcl (rdna) diagnostic for inj mg (base equiv) DISOSITIVOS MÉDICOS AU-CHEK FASTCLIX LANCET - kit AU-CHEK FASTCLIX LANCET - AU-CHEK MULTICLIX LANC - kit AU-CHEK MULTICLIX LANCE - AU-CHEK SAFE-T-RO LANC - AU-CHEK SAFE-T-RO LUS - AU-CHEK SOFT TOUCH LANC - 3 AU-CHEK SOFTCLIX LANCET - lancet devices AU-CHEK SOFTCLIX LANCET - kit AU-CHEK SOFTCLIX LANCET - ACTI-LANCE LANCETS 8G - ACTI-LANCE LITE SAFETY LA - ACTI-LANCE SECIAL SAFETY - ACTI-LANCE UNIVERSAL SAFE - ADJUSTABLE LANCING DEVICE - lancet devices ADVOCATE INSULIN EN NEED - insulin pen needle 9 g x.7 mm ADVOCATE INSULIN EN NEED - insulin pen needle 3 g x 5 mm (3/6") ADVOCATE INSULIN EN NEED - insulin pen needle 3 g x 8 mm (/3" or 5/6") ADVOCATE INSULIN SYRINGE/ - insulin syringe/needle u ml 9 x /" ADVOCATE INSULIN SYRINGE/ - insulin syringe/needle u ml 30 ADVOCATE INSULIN SYRINGE/ - insulin syringe/needle u-00 / ml 3 ADVOCATE INSULIN SYRINGE/ - insulin syringe/needle u-00 / ml 9 x /" ADVOCATE INSULIN SYRINGE/ - insulin syringe/needle u-00 / ml 30 ADVOCATE INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 9 x /" 76 Guia de medicinas ValueScript de Florida Blue para enero de 06

88 06 ADVOCATE INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 30 x 5/6" ADVOCATE INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 3 x 5/6" ADVOCATE INSULIN SYRINGE/ - insulin syringe/needle u ml 3 ADVOCATE LANCETS - ADVOCATE LANCETS 30G - ADVOCATE LANCING DEVICE - lancet devices ADVOCATE RAID-SAFE LANCI - lancet devices ADVOCATE SAFETY LANCETS - ADVOCATE SAFETY LANCETS - AF LANCETS SUER THIN - AGAMATRIX ULTRA-THIN LANC - ALTERNATE SITE LANCING DE - lancet devices ANTI-STICK INSULIN SYRING - insulin syringe/needle u-00 / ml 8 x /" ANTI-STICK INSULIN SYRING - insulin syringe/needle u-00 / ml 9 x /" ANTI-STICK INSULIN SYRING - insulin syringe/needle u-00 ml 9 x /" ANTI-STICK TUBERCULIN SYR - tuberculin/allergy syringe/needle (disp) ml 5 x 5/8" ANTI-STICK TUBERCULIN SYR - tuberculin/allergy syringe/needle (disp) ml 7 x /" AQUA LANCE ADJUSTABLE LAN - lancet devices ASSURE COMFORT LANCETS UL - ASSURE HAEMOLANCE LUS HI - ASSURE HAEMOLANCE LUS LO - ASSURE HAEMOLANCE LUS MI - ASSURE HAEMOLANCE LUS NO - ASSURE HAEMOLANCE LUS E - ASSURE ID INSULIN SAFETY - insulin syringe/needle u-00 / ml 9 x /" ASSURE ID INSULIN SAFETY - insulin syringe/needle u-00 ml 9 x /" ASSURE LANCE LANCETS - ASSURE LANCE LANCETS G - ASSURE LANCE LUS SAFETY - ASSURE LANCETS - AT LAST LANCETS - AURORA LANCET SUER THIN - AURORA LANCET THIN 3G - AURORA EN NEEDLES 9GX - insulin pen needle 9 g x mm (/") AURORA EN NEEDLES 3G X - insulin pen needle 3 g x 6 mm (/4") AURORA EN NEEDLES 3G X - insulin pen needle 3 g x 8 mm (/3" or 5/6") AURORA UNIFINE ENTIS/MI - insulin pen needle 3 g x 5 mm (3/6") AURORA UNIFINE ENTIS/3 - insulin pen needle 3 g x 4 mm (5/3") AUTO-LANCET - lancet devices AUTO-LANCET MINI - lancet devices Guia de medicinas ValueScript de Florida Blue para enero de 06 77

89 06 AUTOLET IMRESSION - lancet devices AUTOLET IMRESSION LANCIN - lancet devices AUTOLET MINI - lancet devices B-D INSULIN SYRINGE MICRO - insulin syringe/needle u-00 ml 8 x /" B-D INSULIN SYRINGE ULTRA - insulin syringe/needle u ml 30 x /" B-D INSULIN SYRINGE ULTRA - insulin syringe/needle u-00 ml 3 x 5/6" B-D INSULIN SYRINGE ULTRA - insulin syringe/needle u ml 3 BAYER BREEZE BLOOD GLUC - blood glucose monitoring kit w/ device BAYER CONTOUR BLOOD GLUCO - blood glucose monitoring kit w/ device BAYER CONTOUR LINK BLOOD - blood glucose monitoring kit w/ device BAYER CONTOUR NEXT BLOOD - blood glucose monitoring kit w/ device BAYER CONTOUR NEXT EZ BLO - blood glucose monitoring kit w/ device BAYER CONTOUR NEXT LINK B - blood glucose monitoring kit w/ device BAYER CONTOUR NEXT LINK W - blood glucose monitoring kit w/ device BAYER CONTOUR NEXT USB BL - blood glucose monitoring kit w/ device BAYER CONTOUR USB BLOOD G - blood glucose monitoring kit w/ device BAYER MICROLET LANCETS - BAYER MICROLET LANCING - lancet devices BD LO-DOSE INSULIN SYRIN - insulin syringe/needle u-00 / ml 8 x /" BD ALLERGY/SYRINGE NEEDLE - tuberculin/allergy syringe/needle (disp) ml 8 x /" BD ALLERGY/SYRINGE/NEEDLE - tuberculin/allergy syringe/needle (disp) ml 8 x /" BD AUTOSHIELD DUO 30G X 3 - insulin pen needle 30 g x 5 mm (3/6") BD AUTOSHIELD 9G X 3/6" - insulin pen needle 9 g x 5 mm (3/6") BD AUTOSHIELD 9G X 5/6" - insulin pen needle 9 g x 8 mm (5/6") BD DISOSABLE NEEDLE REGU - needle (disp) 5 x " BD DISOSABLE NEEDLE 3GX - needle (disp) 3 x " BD DISOSABLE NEEDLE 7GX - needle (disp) 7 x -/4" BD DISOSABLE NEEDLE/30GX - needle (disp) 30 x " BD ECLISE NEEDLE 5G X - needle (disp) 5 x -/" BD ECLISE NEEDLE 5GX" - needle (disp) 5 x " BD ECLISE NEEDLE 30G X - needle (disp) 30 x /" BD ECLISE NEEDLE/G X - needle (disp) x -/" BD ECLISE NEEDLE/5G X - needle (disp) 5 x 5/8" BD ECLISE 8G X -/" - needle (disp) 8 x -/" BD HYODERMIC NEEDLE REGU - needle (disp) 8 x -/" BD HYODERMIC NEEDLE REGU - needle (disp) x " BD HYODERMIC NEEDLE REGU - needle (disp) x -/" BD HYODERMIC NEEDLE REGU - needle (disp) 3 x -/" 78 Guia de medicinas ValueScript de Florida Blue para enero de 06

90 06 BD HYODERMIC NEEDLE REGU - needle (disp) 5 x 5/8" BD INSULIN SYRINGE LUER-L - insulin syringe (disp) u-00 ml BD INSULIN SYRINGE MICROF - insulin syringe/needle u ml 8 x /" BD INSULIN SYRINGE MICROF - insulin syringe/needle u-00 / ml 8 x /" BD INSULIN SYRINGE MICROF - insulin syringe/needle u-00 ml 7 x 5/8" BD INSULIN SYRINGE MICROF - insulin syringe/needle u-00 ml 8 x /" BD INSULIN SYRINGE SAFETY - insulin syringe/needle u-00 / ml 9 x /" BD INSULIN SYRINGE SAFETY - insulin syringe/needle u-00 ml 9 x /" BD INSULIN SYRINGE SAFETY - insulin syringe/needle u ml 3 BD INSULIN SYRINGE SLI T - insulin syringe (disp) u-00 ml BD INSULIN SYRINGE U-40/ - insulin syringe/needle u-40 ml 5 x 5/8" BD INSULIN SYRINGE ULTRAF - insulin syringe/needle u ml 9 x /" BD INSULIN SYRINGE ULTRAF - insulin syringe/needle u ml 30 x /" BD INSULIN SYRINGE ULTRAF - insulin syringe/needle u-00 / ml 3 BD INSULIN SYRINGE ULTRAF - insulin syringe/needle u-00 / ml 9 x /" BD INSULIN SYRINGE ULTRAF - insulin syringe/needle u-00 / ml 30 x /" BD INSULIN SYRINGE ULTRAF - insulin syringe/needle u ml 3 x 5/64" BD INSULIN SYRINGE ULTRAF - insulin syringe/needle u-00 ml 9 x /" BD INSULIN SYRINGE ULTRAF - insulin syringe/needle u-00 ml 30 x /" BD INSULIN SYRINGE ULTRAF - insulin syringe/needle u-00 ml 3 x 5/6" BD INSULIN SYRINGE ULTRAF - insulin syringe/needle u ml 3 BD INSULIN SYRINGE ULTRAF - insulin syringe/needle u-00 / ml 3 x 5/64" BD INSULIN SYRINGE ULTRAF - insulin syringe/needle u-00 ml 3 x 5/64" BD INSULIN SYRINGE/DETACH - insulin syringe/needle u-00 ml 5 x 5/8" BD INSULIN SYRINGE/DETACH - insulin syringe/needle u-00 ml 5 x " BD INSULIN SYRINGE/DETACH - insulin syringe/needle u-00 ml 6 x /" BD INSULIN SYRINGE/U-00/ - insulin syringe/needle u-00 / ml 30 x /" BD INSULIN SYRINGE/U-00/ - insulin syringe/needle u-00 ml 7 x /" BD INSULIN SYRINGE/U-00/ - insulin syringe/needle u-00 ml 8 x /" BD INSULIN SYRINGE/U-00/ - insulin syringe/needle u-00 ml 7.5 x 5/8" BD INSULIN SYRINGE/U-00/ - insulin syringe/needle u-00 ml 9 x /" Guia de medicinas ValueScript de Florida Blue para enero de 06 79

91 06 BD INTEGRA INSULIN SYRING - insulin syringe/needle u-00 ml 9 x /" BD INTEGRA SYRINGE/RETRAC - insulin syringe/needle u-00 ml 5 x " BD LANCET DEVICE - lancet devices BD LANCET ULTRAFINE 30G - BD LANCET ULTRAFINE 33G - BD MICROTAINER LANCETS - BD NEEDLE/8G -/" - needle (disp) 8 x -/" BD NEEDLE/0G X " - needle (disp) 0 x " BD NEEDLE/G -/" - needle (disp) x -/" BD NEEDLE/G X -/" - needle (disp) x -/" BD NEEDLE/5G X 5/8" - needle (disp) 5 x 5/8" BD NEEDLE/5G X 7/8" - needle (disp) 5 x 7/8" BD NEEDLE/7G X /" - needle (disp) 7 x /" BD NEEDLE/30G X /" - needle (disp) 30 x /" BD EN NEEDLE/MINI/ULTRAF - insulin pen needle 3 g x 5 mm (3/6") BD EN NEEDLE/NANO/ULTRA - insulin pen needle 3 g x 4 mm (5/3") BD EN NEEDLE/SHORT/ULTRA - insulin pen needle 3 g x 8 mm (/3" or 5/6") BD EN NEEDLE/ULTRAFINE/ - insulin pen needle 9 g x.7 mm BD EN NEEDLES SHORT/ULTR - insulin pen needle 3 g x 8 mm (/3" or 5/6") BD LASTIAK SYRINGES ALL - tuberculin/allergy syringe/needle (disp) ml 8 x /" BD SAFETY-LOK INSULIN SYR - insulin syringe/needle u-00 ml 9 x /" BD SAFETYGLIDE ALLERGY S - tuberculin/allergy syringe/needle (disp) ml 6 x 3/8" BD SAFETYGLIDE ALLERGY SY - tuberculin/allergy syringe/needle (disp) ml 7 x /" BD SAFETYGLIDE HYODERMIC - needle (disp) 5 x 5/8" BD SAFETYGLIDE INSULIN SY - insulin syringe/needle u-00 / ml 30 BD SAFETYGLIDE G X " - needle (disp) x " BD ML TUBERCULIN SYRINGE - tuberculin/allergy syringe/needle (disp) ml 6 x 3/8" BD ML TUBERCULIN SYRINGE - tuberculin/allergy syringe/needle (disp) ml 7 x /" BULLSEYE MINI SAFETY LANC - BULLSEYE SAFETY LANCETS - CARDIOCOM LANCING DEVICE - lancet devices CAREFINE EN NEEDLE 3GX4 - insulin pen needle 3 g x 4 mm (5/3") CAREFINE EN NEEDLES 9GX - insulin pen needle 9 g x mm (/") CAREFINE EN NEEDLES 30GX - insulin pen needle 30 g x 8 mm (/3" or 5/6") CAREFINE EN NEEDLES 3GX - insulin pen needle 3 g x 6 mm (/4") 80 Guia de medicinas ValueScript de Florida Blue para enero de 06

92 06 CAREFINE EN NEEDLES 3GX - insulin pen needle 3 g x 8 mm (/3" or 5/6") CAREFINE EN NEEDLES 3GX - insulin pen needle 3 g x 5 mm (/5" or 3/6") CAREFINE EN NEEDLES 3GX - insulin pen needle 3 g x 6 mm (/4") CAREONE ADVANCED LANCING - lancet devices CAREONE INSULIN SYRINGES/ - insulin syringe/needle u ml 30 x /" CAREONE INSULIN SYRINGES/ - insulin syringe/needle u-00 / ml 3 CAREONE INSULIN SYRINGES/ - insulin syringe/needle u-00 / ml 30 x /" CAREONE INSULIN SYRINGES/ - insulin syringe/needle u-00 ml 30 x /" CAREONE INSULIN SYRINGES/ - insulin syringe/needle u-00 ml 3 x 5/6" CAREONE INSULIN SYRINGES/ - insulin syringe/needle u ml 3 CAREONE LANCET THIN - CAREONE LANCET ULTRA THIN - CAREONE ULTIGUARD INSULIN - insulin syringe/needle u ml 9 x /" CAREONE ULTIGUARD INSULIN - insulin syringe/needle u ml 30 CAREONE ULTIGUARD INSULIN - insulin syringe/needle u-00 / ml 9 x /" CAREONE ULTIGUARD INSULIN - insulin syringe/needle u-00 / ml 30 CAREONE ULTIGUARD INSULIN - insulin syringe/needle u-00 ml 9 x /" CAREONE ULTIGUARD INSULIN - insulin syringe/needle u-00 ml 30 x 5/6" CAREONE UNIFINE ENTIS - insulin pen needle 9 g x mm (/") CAREONE UNIFINE ENTIS - insulin pen needle 3 g x 5 mm (3/6") CAREONE UNIFINE ENTIS - insulin pen needle 3 g x 6 mm (/4") CAREONE UNIFINE ENTIS - insulin pen needle 3 g x 8 mm (/3" or 5/6") CAREONE UNIFINE ENTIS - insulin pen needle 3 g x 4 mm (5/3") CAREONE UNIFINE ENTIS - insulin pen needle 9 g x mm (/") CAREONE UNIFINE ENTIS 3 - insulin pen needle 3 g x 5 mm (3/6") CAREONE UNIFINE ENTIS 3 - insulin pen needle 3 g x 6 mm (/4") CAREONE UNIFINE ENTIS 3 - insulin pen needle 3 g x 8 mm (/3" or 5/6") CAYA - diaphragm arc-spring CLEANLET LANCETS 8G - CLEVER CHEK LANCETS ULTRA - CLEVER CHOICE COMFORT EZ - insulin pen needle 3 g x 5 mm (3/6") CLEVER CHOICE COMFORT EZ - insulin pen needle 3 g x 6 mm (/4") CLEVER CHOICE COMFORT EZ - insulin pen needle 3 g x 8 mm (/3" or 5/6") CLEVER CHOICE COMFORT EZ - insulin pen needle 3 g x 4 mm (5/3") CLEVER CHOICE COMFORT EZ - insulin pen needle 3 g x 5 mm (/5" or 3/6") Guia de medicinas ValueScript de Florida Blue para enero de 06 8

93 06 CLEVER CHOICE COMFORT EZ - insulin pen needle 3 g x 6 mm (/4") CLEVER CHOICE COMFORT EZ - insulin pen needle 3 g x 8 mm CLEVER CHOICE COMFORT EZ - insulin pen needle 33 g x 4 mm (5/3") CLEVER CHOICE COMFORT EZ - insulin pen needle 33 g x 5 mm (/5" or 3/6") CLEVER CHOICE COMFORT EZ - insulin pen needle 33 g x 6 mm (/4") CLEVER CHOICE COMFORT EZ - insulin pen needle 33 g x 8 mm (/3" or 5/6") CLEVER CHOICE COMFORT EZ - insulin syringe/needle u ml 9 x /" CLEVER CHOICE COMFORT EZ - insulin syringe/needle u ml 30 CLEVER CHOICE COMFORT EZ - insulin syringe/needle u ml 30 x /" CLEVER CHOICE COMFORT EZ - insulin syringe/needle u-00 / ml 3 CLEVER CHOICE COMFORT EZ - insulin syringe/needle u-00 / ml 8 x /" CLEVER CHOICE COMFORT EZ - insulin syringe/needle u-00 / ml 9 x /" CLEVER CHOICE COMFORT EZ - insulin syringe/needle u-00 / ml 30 CLEVER CHOICE COMFORT EZ - insulin syringe/needle u-00 / ml 30 x /" CLEVER CHOICE COMFORT EZ - insulin syringe/needle u-00 ml 8 x /" CLEVER CHOICE COMFORT EZ - insulin syringe/needle u-00 ml 9 x /" CLEVER CHOICE COMFORT EZ - insulin syringe/needle u-00 ml 30 x 5/6" CLEVER CHOICE COMFORT EZ - insulin syringe/needle u-00 ml 30 x /" CLEVER CHOICE COMFORT EZ - insulin syringe/needle u-00 ml 3 x 5/6" CLEVER CHOICE COMFORT EZ - insulin syringe/needle u ml 3 CLICKFINE EN NEEDLE UNIV - insulin pen needle 3 g x 6 mm (/4") CLICKFINE EN NEEDLE UNIV - insulin pen needle 3 g x 8 mm (/3" or 5/6") CLICKFINE EN NEEDLE 3GX - insulin pen needle 3 g x 4 mm (5/3") CLICKFINE EN NEEDLES/3G - insulin pen needle 3 g x 6 mm (/4") CLICKFINE EN NEEDLES/3G - insulin pen needle 3 g x 8 mm (/3" or 5/6") CLICKFINE UNIVERSAL EN N - insulin pen needle 3 g x 6 mm (/4") CLICKFINE UNIVERSAL EN N - insulin pen needle 3 g x 8 mm (/3" or 5/6") CLOSERCARE - lancet devices COAGUCHEK LANCETS - COMFORT ASSIST INSULIN SY - insulin syringe/needle u ml 9 x /" COMFORT ASSIST INSULIN SY - insulin syringe/needle u ml 30 8 Guia de medicinas ValueScript de Florida Blue para enero de 06

94 06 COMFORT ASSIST INSULIN SY - insulin syringe/needle u-00 / ml 3 COMFORT ASSIST INSULIN SY - insulin syringe/needle u-00 / ml 9 x /" COMFORT ASSIST INSULIN SY - insulin syringe/needle u-00 / ml 30 COMFORT ASSIST INSULIN SY - insulin syringe/needle u-00 ml 9 x /" COMFORT ASSIST INSULIN SY - insulin syringe/needle u-00 ml 30 x 5/6" COMFORT ASSIST INSULIN SY - insulin syringe/needle u-00 ml 3 x 5/6" COMFORT ASSIST INSULIN SY - insulin syringe/needle u ml 3 COMFORT ASSURED LANCETS M - COMFORT ASSURED LANCETS S - COMFORT LANCETS - CVS INSULIN SYRINGE/0.3ML - insulin syringe/needle u ml 9 x /" CVS INSULIN SYRINGE/0.3ML - insulin syringe/needle u ml 30 x /" CVS INSULIN SYRINGE/0.5ML - insulin syringe/needle u-00 / ml 9 x /" CVS INSULIN SYRINGE/0.5ML - insulin syringe/needle u-00 / ml 30 x /" CVS INSULIN SYRINGE/ML/ - insulin syringe/needle u-00 ml 9 x /" CVS LANCETS MICRO THIN 33 - CVS LANCETS ORIGINAL - CVS LANCETS THIN 6G - CVS LANCETS ULTRA THIN 30 - CVS LANCETS G - CVS LANCING DEVICE - lancet devices CVS ULTRA THIN LANCETS - DIASTAR EASY TEST II LANC - DIASTAR EASY TEST LANCETS - DIDGET - blood glucose monitoring kit w/ device DROLET LANCETS ULTRA THI - DROLET LANCING DEVICE - lancet devices DRUG MART ADJUSTABLE LANC - lancet devices DRUG MART LANCETS THIN - DRUG MART LANCETS ULTRA T - DRUG MART ON-THE-GO LANCE - DRUG MART ULTRA COMFORT I - insulin syringe/needle u ml 9 x /" DRUG MART ULTRA COMFORT I - insulin syringe/needle u ml 30 DRUG MART ULTRA COMFORT I - insulin syringe/needle u-00 / ml 3 DRUG MART ULTRA COMFORT I - insulin syringe/needle u-00 / ml 30 DRUG MART ULTRA COMFORT I - insulin syringe/needle u-00 ml 9 x /" Guia de medicinas ValueScript de Florida Blue para enero de 06 83

95 06 DRUG MART ULTRA COMFORT I - insulin syringe/needle u-00 ml 30 x 5/6" DRUG MART ULTRA COMFORT I - insulin syringe/needle u ml 3 DRUG MART UNIFINE ENTIS - insulin pen needle 9 g x mm (/") DRUG MART UNIFINE ENTIS - insulin pen needle 3 g x 5 mm (3/6") DRUG MART UNIFINE ENTIS - insulin pen needle 3 g x 6 mm (/4") DRUG MART UNIFINE ENTIS - insulin pen needle 3 g x 8 mm (/3" or 5/6") DRUG MART UNIFINE ENTIS - insulin pen needle 3 g x 4 mm (5/3") DRUG MART UNILET LANCETS - DUANE READE LANCET ALTERN - DUANE READE LANCET SUER - DUANE READE LANCET ULTRA - DUANE READE UNIFINE ENTI - insulin pen needle 9 g x mm (/") DUANE READE UNIFINE ENTI - insulin pen needle 3 g x 6 mm (/4") DUANE READE UNIFINE ENTI - insulin pen needle 3 g x 8 mm (/3" or 5/6") E-Z JECT LANCETS - E-Z JECT LANCETS COLOR - E-Z JECT LANCETS SUER TH - E-Z JECT LANCETS THIN 6G - E-Z JECT LANCETS G - E-ZJECT LANCETS MICRO-THI - EASY COMFORT INSULIN SYRI - insulin syringe/needle u ml 30 EASY COMFORT INSULIN SYRI - insulin syringe/needle u-00 / ml 30 EASY COMFORT INSULIN SYRI - insulin syringe/needle u-00 / ml 30 x /" EASY COMFORT INSULIN SYRI - insulin syringe/needle u-00 ml 30 x 5/6" EASY COMFORT INSULIN SYRI - insulin syringe/needle u-00 ml 30 x /" EASY COMFORT LANCETS - EASY COMFORT LANCETS 30G/ - EASY COMFORT EN NEEDLES - insulin pen needle 3 g x 5 mm (3/6") EASY COMFORT EN NEEDLES - insulin pen needle 3 g x 6 mm (/4") EASY COMFORT EN NEEDLES - insulin pen needle 3 g x 8 mm (/3" or 5/6") EASY COMFORT EN NEEDLES - insulin pen needle 3 g x 4 mm (5/3") EASY MINI LANCING DEVICE - lancet devices EASY TOUCH ALLERGY TRAY S - tuberculin/allergy syringe/needle (disp) ml 6 x 3/8" EASY TOUCH ALLERGY TRAY S - tuberculin/allergy syringe/needle (disp) ml 7 x /" EASY TOUCH INSULIN SYRING - insulin syringe/needle u ml 30 EASY TOUCH INSULIN SYRING - insulin syringe/needle u ml 30 x /" 84 Guia de medicinas ValueScript de Florida Blue para enero de 06

96 06 EASY TOUCH INSULIN SYRING - insulin syringe/needle u-00 / ml 7 x /" EASY TOUCH INSULIN SYRING - insulin syringe/needle u-00 / ml 3 EASY TOUCH INSULIN SYRING - insulin syringe/needle u-00 / ml 8 x /" EASY TOUCH INSULIN SYRING - insulin syringe/needle u-00 / ml 9 x /" EASY TOUCH INSULIN SYRING - insulin syringe/needle u-00 / ml 30 EASY TOUCH INSULIN SYRING - insulin syringe/needle u-00 / ml 30 x /" EASY TOUCH INSULIN SYRING - insulin syringe/needle u-00 ml 7 x /" EASY TOUCH INSULIN SYRING - insulin syringe/needle u-00 ml 8 x /" EASY TOUCH INSULIN SYRING - insulin syringe/needle u-00 ml 9 x /" EASY TOUCH INSULIN SYRING - insulin syringe/needle u-00 ml 30 x 5/6" EASY TOUCH INSULIN SYRING - insulin syringe/needle u-00 ml 30 x /" EASY TOUCH INSULIN SYRING - insulin syringe/needle u-00 ml 3 x 5/6" EASY TOUCH INSULIN SYRING - insulin syringe/needle u ml 3 EASY TOUCH LANCETS G/R - EASY TOUCH LANCETS 3G/R - EASY TOUCH LANCETS 6G/R - EASY TOUCH LANCETS 6G/U - EASY TOUCH LANCETS 6G/TW - EASY TOUCH LANCETS 8G/R - EASY TOUCH LANCETS 8G/U - EASY TOUCH LANCETS 8G/TW - EASY TOUCH LANCETS 30G/BU - EASY TOUCH LANCETS 30G/R - EASY TOUCH LANCETS 30G/U - EASY TOUCH LANCETS 30G/TW - EASY TOUCH LANCETS 3G/R - EASY TOUCH LANCETS 3G/U - EASY TOUCH LANCETS 3G/TW - EASY TOUCH LANCETS 33G/TW - EASY TOUCH LANCING DEVICE - lancet devices EASY TOUCH EN NEEDLES 9 - insulin pen needle 9 g x mm (/") EASY TOUCH EN NEEDLES 3 - insulin pen needle 3 g x 6 mm (/4") EASY TOUCH EN NEEDLES 3 - insulin pen needle 3 g x 8 mm (/3" or 5/6") EASY TOUCH EN NEEDLES 3 - insulin pen needle 3 g x 4 mm (5/3") Guia de medicinas ValueScript de Florida Blue para enero de 06 85

97 06 EASY TOUCH EN NEEDLES 3 - insulin pen needle 3 g x 5 mm (/5" or 3/6") EASY TOUCH EN NEEDLES 3 - insulin pen needle 3 g x 6 mm (/4") EASY TOUCH EN NEEDLES/3 - insulin pen needle 3 g x 5 mm (3/6") EASY TOUCH SAFETY LANCETS - EASY TOUCH 3GX5MM - insulin pen needle 3 g x 5 mm (/5" or 3/6") EASY TOUCH 3GX6MM - insulin pen needle 3 g x 6 mm (/4") EASY TWIST & CA LANCETS - EASYTEST II LANCETS - EASYTEST LANCETS - ELITE-THIN INSULIN SYRING - insulin syringe/needle u-00 / ml 3 ELITE-THIN INSULIN SYRING - insulin syringe/needle u-00 / ml 8 ELITE-THIN INSULIN SYRING - insulin syringe/needle u-00 / ml 8 x /" ELITE-THIN INSULIN SYRING - insulin syringe/needle u-00 / ml 9 ELITE-THIN INSULIN SYRING - insulin syringe/needle u-00 / ml 9 x /" ELITE-THIN INSULIN SYRING - insulin syringe/needle u-00 / ml 30 ELITE-THIN INSULIN SYRING - insulin syringe/needle u-00 ml 8 x 5/6" ELITE-THIN INSULIN SYRING - insulin syringe/needle u-00 ml 8 x /" ELITE-THIN INSULIN SYRING - insulin syringe/needle u-00 ml 9 x /" ELITE-THIN INSULIN SYRING - insulin syringe/needle u-00 ml 9 x 5/6" ELITE-THIN INSULIN SYRING - insulin syringe/needle u-00 ml 30 x 5/6" ELITE-THIN INSULIN SYRING - insulin syringe/needle u-00 ml 3 x 5/6" ELITE-THIN INSULIN SYRING - insulin syringe/needle u ml 3 EMBRACE LANCETS ULTRA THI - EQL COLOR LANCETS MICRO T - EQL COLOR LANCETS G - EQL INSULIN SYRINGE/U-00 - insulin syringe/needle u ml 9 x /" EQL INSULIN SYRINGE/U-00 - insulin syringe/needle u-00 / ml 9 x /" EQL INSULIN SYRINGE/U-00 - insulin syringe/needle u-00 ml 9 x /" EQL INSULIN SYRINGE/0.3ML - insulin syringe/needle u ml 9 x /" EQL INSULIN SYRINGE/0.3ML - insulin syringe/needle u ml 30 EQL INSULIN SYRINGE/0.3ML - insulin syringe/needle u ml 3 EQL INSULIN SYRINGE/0.5ML - insulin syringe/needle u-00 / ml 3 86 Guia de medicinas ValueScript de Florida Blue para enero de 06

98 06 EQL INSULIN SYRINGE/0.5ML - insulin syringe/needle u-00 / ml 9 x /" EQL INSULIN SYRINGE/0.5ML - insulin syringe/needle u-00 / ml 30 EQL INSULIN SYRINGE/ML/ - insulin syringe/needle u-00 ml 9 x /" EQL INSULIN SYRINGE/ML/3 - insulin syringe/needle u-00 ml 30 x 5/6" EQL INSULIN SYRINGE/ML/3 - insulin syringe/needle u-00 ml 3 x 5/6" EQL SHORT EN NEEDLES 3G - insulin pen needle 3 g x 8 mm (/3" or 5/6") EQL SUER THIN LANCETS 30 - EQL THIN LANCETS 6G - EQL ULTRA COMFORT INSULIN - insulin syringe/needle u-00 ml 30 x 5/6" EQL ULTRA COMFORT INSULIN - insulin syringe/needle u ml 3 EQL ULTRA SHORT EN NEEDL - insulin pen needle 3 g x 6 mm (/4") EXCEL COMFORT OINT INSUL - insulin pen needle 3 g x 4 mm (/6") EXEL COMFORT OINT INSULI - insulin pen needle 9 g x mm (/") EXEL COMFORT OINT INSULI - insulin pen needle 3 g x 6 mm (/4") EXEL COMFORT OINT INSULI - insulin pen needle 3 g x 8 mm (/3" or 5/6") EXEL COMFORT OINT INSULI - insulin syringe/needle u ml 9 x /" EXEL COMFORT OINT INSULI - insulin syringe/needle u ml 30 EXEL COMFORT OINT INSULI - insulin syringe/needle u-00 / ml 8 x /" EXEL COMFORT OINT INSULI - insulin syringe/needle u-00 / ml 9 x /" EXEL COMFORT OINT INSULI - insulin syringe/needle u-00 / ml 30 EXEL COMFORT OINT INSULI - insulin syringe/needle u-00 ml 8 x /" EXEL COMFORT OINT INSULI - insulin syringe/needle u-00 ml 9 x /" EXEL COMFORT OINT INSULI - insulin syringe/needle u-00 ml 30 x 5/6" EZ SMART BLOOD GLUCOSE LA - EZ-LETS LANCETS G - EZ-LETS LANCETS 3G - EZ-LETS LANCETS 6G SUER - EZ-LETS LANCETS 8G ULTRA - EZ-LETS LANCETS 30G - FC FEMALE CONDOM - condoms - female FC FEMALE CONDOM - condoms - female FEMCA - cervical cap mm FEMCA - cervical cap 6 mm FEMCA - cervical cap 30 mm FIFTY50 LANCING DEVICE - lancet devices FIFTY50 EN NEEDLES 3G X - insulin pen needle 3 g x 5 mm (3/6") Guia de medicinas ValueScript de Florida Blue para enero de 06 87

99 06 FIFTY50 EN NEEDLES 3G X - insulin pen needle 3 g x 8 mm (/3" or 5/6") FIFTY50 SAFETY SEAL LANCE - FIFTY50 SUERIOR COMFORT - insulin syringe/needle u-00 / ml 3 FIFTY50 SUERIOR COMFORT - insulin syringe/needle u-00 ml 3 x 5/6" FIFTY50 SUERIOR COMFORT - insulin syringe/needle u ml 3 FINE 30 - FINGERSTIX LANCETS - FORA LANCETS - FORA LANCING DEVICE - lancet devices FREDS HARMACY AUTOLET LA - lancet devices FREDS HARMACY UNIFINE E - insulin pen needle 3 g x 5 mm (3/6") FREDS HARMACY UNIFINE E - insulin pen needle 3 g x 8 mm (/3" or 5/6") FREDS HARMACY UNIFINE E - insulin pen needle 3 g x 4 mm (5/3") FREDS HARMACY UNILET LAN - FREESTYLE LANCETS - FREESTYLE RECISION INSUL - insulin syringe/needle u-00 / ml 3 FREESTYLE RECISION INSUL - insulin syringe/needle u-00 / ml 30 FREESTYLE RECISION INSUL - insulin syringe/needle u-00 ml 30 x 5/6" FREESTYLE RECISION INSUL - insulin syringe/needle u-00 ml 3 x 5/6" FREESTYLE UNISTICK II LAN - GENTLE-LET G LANCETS - GENTLE-LET LANCETS GENERA - GENTLE-LET LANCETS SAFETY - GLOBAL EASE INJECT EN NE - insulin pen needle 9 g x mm (/") GLOBAL EASE INJECT EN NE - insulin pen needle 3 g x 5 mm (3/6") GLOBAL EASE INJECT EN NE - insulin pen needle 3 g x 8 mm (/3" or 5/6") GLOBAL EASE INJECT EN NE - insulin pen needle 3 g x 4 mm (5/3") GLOBAL INJECT EASE INSULI - insulin syringe/needle u ml 9 x /" GLOBAL INJECT EASE INSULI - insulin syringe/needle u ml 30 GLOBAL INJECT EASE INSULI - insulin syringe/needle u ml 30 x /" GLOBAL INJECT EASE INSULI - insulin syringe/needle u-00 / ml 3 GLOBAL INJECT EASE INSULI - insulin syringe/needle u-00 / ml 8 x /" GLOBAL INJECT EASE INSULI - insulin syringe/needle u-00 / ml 9 x /" GLOBAL INJECT EASE INSULI - insulin syringe/needle u-00 / ml Guia de medicinas ValueScript de Florida Blue para enero de 06

100 06 GLOBAL INJECT EASE INSULI - insulin syringe/needle u-00 / ml 30 x /" GLOBAL INJECT EASE INSULI - insulin syringe/needle u-00 ml 8 x /" GLOBAL INJECT EASE INSULI - insulin syringe/needle u-00 ml 9 x /" GLOBAL INJECT EASE INSULI - insulin syringe/needle u-00 ml 30 x 5/6" GLOBAL INJECT EASE INSULI - insulin syringe/needle u-00 ml 30 x /" GLOBAL INJECT EASE INSULI - insulin syringe/needle u-00 ml 3 x 5/6" GLOBAL INJECT EASE INSULI - insulin syringe/needle u ml 3 GLOBAL INJECT EASE LANCET - GLOBAL LANCING DEVICE - lancet devices GLUCOCOM LANCETS 8G - GLUCOCOM LANCETS 30G - GLUCOCOM LANCETS 33G - GLUCOLET AUTOMATIC LANC - lancet devices GLUCORO INSULIN SYRINGE/ - insulin syringe/needle u ml 30 GLUCORO INSULIN SYRINGE/ - insulin syringe/needle u ml 30 x /" GLUCORO INSULIN SYRINGE/ - insulin syringe/needle u-00 / ml 3 GLUCORO INSULIN SYRINGE/ - insulin syringe/needle u-00 / ml 30 GLUCORO INSULIN SYRINGE/ - insulin syringe/needle u-00 / ml 30 x /" GLUCORO INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 30 x 5/6" GLUCORO INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 30 x /" GLUCORO INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 3 x 5/6" GLUCORO INSULIN SYRINGE/ - insulin syringe/needle u ml 3 GLUCOSOURCE LANCET DEVICE - lancet devices GLUCOSOURCE LANCETS - GMATE LANCETS 30G - GMATE LANCING DEVICE - lancet devices GN CLICKFINE EN NEEDLE - insulin pen needle 3 g x 8 mm (/3" or 5/6") GN CLICKFINE UNIVERSAL - insulin pen needle 3 g x 6 mm (/4") GN CLICKFINE UNIVERSAL - insulin pen needle 3 g x 8 mm (/3" or 5/6") GN INSULIN SYRINGE/0.3ML - insulin syringe/needle u ml 9 x /" GN INSULIN SYRINGE/0.3ML - insulin syringe/needle u ml 30 GN INSULIN SYRINGE/0.3ML - insulin syringe/needle u ml 3 GN INSULIN SYRINGE/0.5ML - insulin syringe/needle u-00 / ml 3 Guia de medicinas ValueScript de Florida Blue para enero de 06 89

101 06 GN INSULIN SYRINGE/0.5ML - insulin syringe/needle u-00 / ml 8 x /" GN INSULIN SYRINGE/0.5ML - insulin syringe/needle u-00 / ml 9 x /" GN INSULIN SYRINGE/0.5ML - insulin syringe/needle u-00 / ml 30 GN INSULIN SYRINGE/ML/ - insulin syringe/needle u-00 ml 8 x /" GN INSULIN SYRINGE/ML/ - insulin syringe/needle u-00 ml 9 x /" GN INSULIN SYRINGE/ML/3 - insulin syringe/needle u-00 ml 30 x 5/6" GN INSULIN SYRINGE/ML/3 - insulin syringe/needle u-00 ml 3 x 5/6" GN LANCETS - GN LANCETS MICRO THIN 33 - GN LANCETS SUER THIN 30 - GN LANCETS THIN - GN LANCETS THIN 6G - GN LANCETS G - GN MICRO THIN LANCETS 33 - GN SUER THIN LANCETS/30 - GN ULTRA COMFORT INSULIN - insulin syringe/needle u ml 9 x /" GN ULTRA COMFORT INSULIN - insulin syringe/needle u ml 30 GN ULTRA COMFORT INSULIN - insulin syringe/needle u-00 / ml 3 GN ULTRA COMFORT INSULIN - insulin syringe/needle u-00 / ml 8 x /" GN ULTRA COMFORT INSULIN - insulin syringe/needle u-00 / ml 9 x /" GN ULTRA COMFORT INSULIN - insulin syringe/needle u-00 / ml 30 GN ULTRA COMFORT INSULIN - insulin syringe/needle u-00 ml 8 x /" GN ULTRA COMFORT INSULIN - insulin syringe/needle u-00 ml 9 x /" GN ULTRA COMFORT INSULIN - insulin syringe/needle u-00 ml 30 x 5/6" GN ULTRA COMFORT INSULIN - insulin syringe/needle u-00 ml 3 x 5/6" GN ULTRA COMFORT INSULIN - insulin syringe/needle u ml 3 H&H THINLET LANCETS 6G - H&H THINLET SUER THIN LA - H-E-B IN CONTROL EN NEED - insulin pen needle 3 g x 5 mm (3/6") H-E-B IN CONTROL EN NEED - insulin pen needle 3 g x 6 mm (/4") H-E-B IN CONTROL EN NEED - insulin pen needle 3 g x 8 mm (/3" or 5/6") H-E-B IN CONTROL EN NEED - insulin pen needle 3 g x 4 mm (5/3") H-E-B INCONTROL ADVANCED - lancet devices H-E-B INCONTROL LANCETS S - 90 Guia de medicinas ValueScript de Florida Blue para enero de 06

102 06 H-E-B INCONTROL LANCETS U - H-E-B INCONTROL EN NEEDL - insulin pen needle 9 g x mm (/") HAEMOLANCE - HAEMOLANCE LOW FLOW LANCE - HAEMOLANCE LUS - HAEMOLANCE LUS HIGH FLOW - HAEMOLANCE LUS LOW FLOW - HAEMOLANCE LUS MAX FLOW - HAEMOLANCE LUS EDIATRIC - HEALTH CARE LANCING DEVIC - lancet devices HEALTHWISE LANCETS 30G - HEALTHWISE LANCING EN - lancet devices HEALTHWISE MINI EN NEEDL - insulin pen needle 3 g x 6 mm (/4") HEALTHWISE EN NEEDLES 9 - insulin pen needle 9 g x mm (/") HEALTHWISE SHORT EN NEED - insulin pen needle 3 g x 8 mm (/3" or 5/6") HEALTHWISE UNIFINE ENTI - insulin pen needle 3 g x 4 mm (5/3") HEALTHY AENTS AUTOLET I - lancet devices HEALTHY AENTS UNIFINE - insulin pen needle 9 g x mm (/") HEALTHY AENTS UNIFINE - insulin pen needle 3 g x 5 mm (3/6") HEALTHY AENTS UNIFINE - insulin pen needle 3 g x 6 mm (/4") HEALTHY AENTS UNIFINE - insulin pen needle 3 g x 8 mm (/3" or 5/6") HEALTHY AENTS UNIFINE - insulin pen needle 3 g x 4 mm (5/3") HEALTHY AENTS UNILET LA - HM LANCETS MICRO THIN 33G - HM LANCETS ULTRA THIN 30G - HY-VEE LANCETS - HY-VEE THIN LANCETS - INSULIN SYRINGE/U-00/0.3 - insulin syringe/needle u ml 9 x /" INSULIN SYRINGE/U-00/0.5 - insulin syringe/needle u-00 / ml 8 x /" INSULIN SYRINGE/U-00/0.5 - insulin syringe/needle u-00 / ml 9 x /" INSULIN SYRINGE/U-00/ML - insulin syringe/needle u-00 ml 8 x /" INSULIN SYRINGE/U-00/ML - insulin syringe/needle u-00 ml 9 x /" INSULIN SYRINGE/U-00/ML - insulin syringe/needle u-00 ml 30 x 5/6" INSULIN SYRINGE/U-00/ML - insulin syringe/needle u-00 ml 3 x 5/6" INSULIN SYRINGE/0.3ML/9G - insulin syringe/needle u ml 9 x /" INSULIN SYRINGE/0.3ML/9G - insulin syringe/needle u ml 9 x " INSULIN SYRINGE/0.3ML/30G - insulin syringe/needle u ml 30 INSULIN SYRINGE/0.3ML/3G - insulin syringe/needle u ml 3 Guia de medicinas ValueScript de Florida Blue para enero de 06 9

103 06 INSULIN SYRINGE/0.5ML/7G - insulin syringe/needle u-00 / ml 7 x /" INSULIN SYRINGE/0.5ML/8G - insulin syringe/needle u-00 / ml 8 x /" INSULIN SYRINGE/0.5ML/9G - insulin syringe/needle u-00 / ml 9 x /" INSULIN SYRINGE/0.5ML/30G - insulin syringe/needle u-00 / ml 30 INSULIN SYRINGE/0.5ML/30G - insulin syringe/needle u-00 / ml 30 x /" INSULIN SYRINGE/0.5ML/3G - insulin syringe/needle u-00 / ml 3 INSULIN SYRINGE/ML/8G X - insulin syringe/needle u-00 ml 8 x /" INSULIN SYRINGE/ML/9G X - insulin syringe/needle u-00 ml 9 x /" INSULIN SYRINGE/ML/30G X - insulin syringe/needle u-00 ml 30 x 5/6" INSULIN SYRINGE/ML/3G X - insulin syringe/needle u-00 ml 3 x 5/6" INSUEN EN NEEDLES 3G X - insulin pen needle 3 g x 4 mm (5/3") INSUEN SENSITIVE 3GX6MM - insulin pen needle 3 g x 6 mm (/4") INSUEN SENSITIVE 3GX8MM - insulin pen needle 3 g x 8 mm INSUEN ULTRAFIN 9GXMM - insulin pen needle 9 g x mm (/") INSUEN ULTRAFIN 30GX8MM - insulin pen needle 30 g x 8 mm (/3" or 5/6") INSUEN ULTRAFIN 3GX6MM - insulin pen needle 3 g x 6 mm (/4") INSUEN ULTRAFIN 3GX8MM - insulin pen needle 3 g x 8 mm (/3" or 5/6") INSUEN 33GX4MM - insulin pen needle 33 g x 4 mm (5/3") KINNEY LANCETS - KINNEY THIN LANCETS - KINRAY INSULIN SYRINGE R - insulin syringe/needle u-00 / ml 3 KINRAY INSULIN SYRINGE R - insulin syringe/needle u-00 ml 3 x 5/6" KINRAY INSULIN SYRINGE R - insulin syringe/needle u ml 3 KINRAY INSULIN SYRINGE/0. - insulin syringe/needle u-00 / ml 9 x /" KMART VALU LUS INSULIN S - insulin syringe (disp) u ml KMART VALU LUS INSULIN S - insulin syringe (disp) u-00 / ml KMART VALU LUS INSULIN S - insulin syringe (disp) u-00 ml KROGER INSULIN SYRINGE/U- - insulin syringe/needle u ml 30 x /" KROGER INSULIN SYRINGE/0. - insulin syringe/needle u ml 9 x /" KROGER INSULIN SYRINGE/0. - insulin syringe/needle u ml 30 KROGER INSULIN SYRINGE/0. - insulin syringe/needle u-00 / ml 3 KROGER INSULIN SYRINGE/0. - insulin syringe/needle u-00 / ml 9 x /" 9 Guia de medicinas ValueScript de Florida Blue para enero de 06

104 06 KROGER INSULIN SYRINGE/0. - insulin syringe/needle u-00 / ml 30 KROGER INSULIN SYRINGE/0. - insulin syringe/needle u ml 3 KROGER INSULIN SYRINGE/M - insulin syringe/needle u-00 ml 9 x /" KROGER INSULIN SYRINGE/M - insulin syringe/needle u-00 ml 30 x 5/6" KROGER INSULIN SYRINGE/M - insulin syringe/needle u-00 ml 3 x 5/6" KROGER LANCETS - KROGER LANCETS MICRO THIN - KROGER LANCETS SUER THIN - KROGER LANCETS THIN - KROGER LANCETS THIN 6G - KROGER LANCETS ULTRATHIN - KROGER LANCETS G - KROGER LANCING DEVICE - lancet devices KROGER EN NEEDLES 9G X - insulin pen needle 9 g x mm (/") KROGER EN NEEDLES 3G X - insulin pen needle 3 g x 8 mm (/3" or 5/6") KROGER EN NEEDLES 3GX/ - insulin pen needle 3 g x 6 mm (/4") LADY LITE LANCETS - LANCET DEVICE ADJUSTABLE - lancet devices LANCET DEVICE WITH EJECTO - lancet devices LANCETS - LANCETS MICRO THIN 33G - LANCETS SAFETY SEAL G - LANCETS SAFETY SEAL 6G - LANCETS SAFETY SEAL 8G - LANCETS SAFETY SEAL 30G - LANCETS SUER THIN 8G - LANCETS THIN - LANCETS TWIST TO - LANCETS ULTRA FINE - LANCETS ULTRA THIN - LANCETS ULTRA THIN 30G - LANCETS 6G TWIST TO - LANCETS 8G - LANCETS 30G - LANCETS 30G TWIST TO - LANCETS 30G/TWIST TO - LANCETS 3G TWIST TO - LANCETS 33G UNIVERSAL DES - LANCING DEVICE - lancet devices LANCING DEVICE ADJUSTABLE - lancet devices LANZO - lancet devices LEADER ADVANCED LANCING D - lancet devices LEADER INSULIN SYRINGE/0. - insulin syringe/needle u ml 9 x /" LEADER INSULIN SYRINGE/0. - insulin syringe/needle u ml 30 LEADER INSULIN SYRINGE/0. - insulin syringe/needle u-00 / ml 3 LEADER INSULIN SYRINGE/0. - insulin syringe/needle u-00 / ml 8 x /" Guia de medicinas ValueScript de Florida Blue para enero de 06 93

105 06 LEADER INSULIN SYRINGE/0. - insulin syringe/needle u-00 / ml 9 x /" LEADER INSULIN SYRINGE/0. - insulin syringe/needle u-00 / ml 30 LEADER INSULIN SYRINGE/0. - insulin syringe/needle u ml 3 LEADER INSULIN SYRINGE/M - insulin syringe/needle u-00 ml 8 x /" LEADER INSULIN SYRINGE/M - insulin syringe/needle u-00 ml 9 x /" LEADER INSULIN SYRINGE/M - insulin syringe/needle u-00 ml 30 x 5/6" LEADER INSULIN SYRINGE/M - insulin syringe/needle u-00 ml 3 x 5/6" LEADER LANCETS COLORED - LEADER SUER THIN LANCET - LEADER THIN LANCETS - LEADER UNIFINE ENTIS L - insulin pen needle 3 g x 5 mm (3/6") LEADER UNIFINE ENTIS L - insulin pen needle 3 g x 8 mm (/3" or 5/6") LEADER UNIFINE ENTIS/MI - insulin pen needle 3 g x 5 mm (3/6") LEADER UNIFINE ENTIS/NA - insulin pen needle 3 g x 4 mm (5/3") LEADER UNIFINE ENTIS/L - insulin pen needle 3 g x 4 mm (5/3") LIBERTY MEDICAL LANCETS 3 - LIBERTY MINI LANCING DEVI - lancet devices LIFESCAN UNISTIK II LANCE - LIFESCAN UNISTIK DEE - LITE TOUCH LANCETS - LITE TOUCH LANCING DEVICE - lancet devices LITE TOUCH LANCING EN - lancet devices LITE TOUCH EN NEEDLES/3 - insulin pen needle 3 g x 5 mm (3/6") LITETOUCH INSULIN SYRINGE - insulin syringe/needle u ml 9 x /" LITETOUCH INSULIN SYRINGE - insulin syringe/needle u ml 30 LITETOUCH INSULIN SYRINGE - insulin syringe/needle u-00 / ml 3 LITETOUCH INSULIN SYRINGE - insulin syringe/needle u-00 / ml 8 x /" LITETOUCH INSULIN SYRINGE - insulin syringe/needle u-00 / ml 9 x /" LITETOUCH INSULIN SYRINGE - insulin syringe/needle u-00 / ml 30 LITETOUCH INSULIN SYRINGE - insulin syringe/needle u-00 ml 8 x /" LITETOUCH INSULIN SYRINGE - insulin syringe/needle u-00 ml 9 x /" LITETOUCH INSULIN SYRINGE - insulin syringe/needle u-00 ml 30 x 5/6" LITETOUCH INSULIN SYRINGE - insulin syringe/needle u-00 ml 3 x 5/6" 94 Guia de medicinas ValueScript de Florida Blue para enero de 06

106 06 LITETOUCH INSULIN SYRINGE - insulin syringe/needle u ml 3 LITETOUCH LANCETS MICRO T - LITETOUCH EN NEEDLES 9G - insulin pen needle 9 g x.7 mm LITETOUCH EN NEEDLES 3G - insulin pen needle 3 g x 6 mm (/4") LITETOUCH EN NEEDLES 3G - insulin pen needle 3 g x 8 mm (/3" or 5/6") LIVE BETTER ADVANCED LANC - lancet devices LIVE BETTER LANCET SUER - LIVE BETTER LANCET ULTRA - LIVE BETTER EN NEEDLES - insulin pen needle 9 g x mm (/") LIVE BETTER EN NEEDLES 3 - insulin pen needle 3 g x 6 mm (/4") LIVE BETTER EN NEEDLES 3 - insulin pen needle 3 g x 8 mm (/3" or 5/6") LONGS INSULIN SYRINGE/0.5 - insulin syringe/needle u-00 / ml 3 LONGS LANCETS STANDARD - LONGS LANCETS THIN - LONGS LANCETS ULTRA THIN - MAGELLAN INSULIN SAFETY S - insulin syringe/needle u ml 9 x /" MAGELLAN INSULIN SAFETY S - insulin syringe/needle u ml 30 MAGELLAN INSULIN SAFETY S - insulin syringe/needle u-00 / ml 9 x /" MAGELLAN INSULIN SAFETY S - insulin syringe/needle u-00 / ml 30 MAGELLAN INSULIN SAFETY S - insulin syringe/needle u-00 ml 9 x /" MAGELLAN INSULIN SAFETY S - insulin syringe/needle u-00 ml 30 x 5/6" MAGELLAN TUBERCULIN SAFET - tuberculin/allergy syringe/needle (disp) ml 7 x /" MAGELLAN TUBERCULIN SAFET - tuberculin/allergy syringe/needle (disp) ml 8 x /" MAXI-COMFORT INSULIN SYRI - insulin syringe/needle u-00 / ml 8 x /" MAXI-COMFORT INSULIN SYRI - insulin syringe/needle u-00 ml 8 x /" MD SAFETYGLIDE 7G X 5/8" - needle (disp) 7 x 5/8" MEDI-LANCE LANCETS - MEDIC INSULIN SYRINGE/0.3 - insulin syringe/needle u ml 30 MEDIC INSULIN SYRINGE/0.5 - insulin syringe/needle u-00 / ml 30 MEDICHOICE RE-SET SAFETY - MEDICHOICE SAFETY LANCET - MEDICINE SHOE LANCETS - MEDICINE SHOE LANCETS T - MEDICINE SHOE EN NEEDL - insulin pen needle 9 g x mm (/") MEDICINE SHOE EN NEEDL - insulin pen needle 3 g x 6 mm (/4") Guia de medicinas ValueScript de Florida Blue para enero de 06 95

107 06 MEDICINE SHOE EN NEEDL - insulin pen needle 3 g x 8 mm (/3" or 5/6") MEDISENSE THIN LANCETS - MEDLANCE LUS EXTRA LANCE - MEDLANCE LUS LANCETS - MEDLANCE LUS LANCETS LIT - MEDLANCE LUS LITE LANCET - MEDLANCE LUS SECIAL LAN - MEDLANCE LUS SUERLITE 3 - MEDLANCE LUS UNIVERSAL L - MEDLANCE LUS/LITE 5G - MEDLANCE/EXTRA - MEDLANCE/LITE - MEDLANCE/UNIVERSAL - MEIJER COLOR LANCETS UNIV - MEIJER LANCETS - MEIJER LANCETS THIN - MEIJER LANCETS UNIVERSAL - MEIJER EN NEEDLES 9G X - insulin pen needle 9 g x mm (/") MEIJER EN NEEDLES 3G X - insulin pen needle 3 g x 6 mm (/4") MEIJER EN NEEDLES 3G X - insulin pen needle 3 g x 8 mm (/3" or 5/6") MEIJER SUER THIN LANCETS - MICROLET LANCETS - MICROTAINER SAFETY FLOW L - MINI LANCING DEVICE - lancet devices MONOJECT HYO/ALUM HUB/LU - needle (disp) 8 x " MONOJECT HYO/ALUM HUB/LU - needle (disp) 8 x -/" MONOJECT HYO/ALUM HUB/LU - needle (disp) 0 x -/" MONOJECT HYO/ALUM HUB/8 - needle (disp) 8 x -/" MONOJECT INSULIN SYRINGE - insulin syringe (disp) u-00 ml MONOJECT INSULIN SYRINGE/ - insulin syringe (disp) u-00 ml MONOJECT INSULIN SYRINGE/ - insulin syringe/needle u ml 9 x /" MONOJECT INSULIN SYRINGE/ - insulin syringe/needle u ml 30 MONOJECT INSULIN SYRINGE/ - insulin syringe/needle u-00 / ml 8 x /" MONOJECT INSULIN SYRINGE/ - insulin syringe/needle u-00 / ml 9 x /" MONOJECT INSULIN SYRINGE/ - insulin syringe/needle u-00 / ml 30 MONOJECT INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 5 x 5/8" MONOJECT INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 7 x /" MONOJECT INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 8 x /" MONOJECT INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 9 x /" MONOJECT INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 30 x 5/6" 96 Guia de medicinas ValueScript de Florida Blue para enero de 06

108 06 MONOJECT INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 3 x 5/6" MONOJECT MAGELLAN SAFETY - needle (disp) 8 x " MONOJECT MAGELLAN SAFETY - needle (disp) 8 x -/" MONOJECT MAGELLAN SAFETY - needle (disp) 0 x " MONOJECT MAGELLAN SAFETY - needle (disp) 0 x -/" MONOJECT MAGELLAN SAFETY - needle (disp) x 5/8" MONOJECT MAGELLAN SAFETY - needle (disp) x " MONOJECT MAGELLAN SAFETY - needle (disp) x -/" MONOJECT MAGELLAN SAFETY - needle (disp) x " MONOJECT MAGELLAN SAFETY - needle (disp) x -/" MONOJECT MAGELLAN SAFETY - needle (disp) 3 x 5/8" MONOJECT MAGELLAN SAFETY - needle (disp) 3 x " MONOJECT MAGELLAN SAFETY - needle (disp) 5 x 5/8" MONOJECT MAGELLAN SAFETY - needle (disp) 5 x " MONOJECT TB SYRINGE-NDL - tuberculin/allergy syringe/needle (disp) ml 6 x 3/8" MONOJECT TB SYRINGE-NDL - tuberculin/allergy syringe/needle (disp) ml 7 x /" MONOJECT TUBERCULIN SAFET - tuberculin/allergy syringe/needle (disp) ml 5 x 5/8" MONOJECT TUBERCULIN SAFET - tuberculin/allergy syringe/needle (disp) ml 8 x /" MONOJECT TUBERCULIN SYRIN - tuberculin/allergy syringe/needle (disp) ml 5 x 5/8" MONOJECT TUBERCULIN SYRIN - tuberculin/allergy syringe/needle (disp) ml 6 x 3/8" MONOJECT TUBERCULIN SYRIN - tuberculin/allergy syringe/needle (disp) ml 7 x /" MONOJECT TUBERCULIN SYRIN - tuberculin/allergy syringe/needle (disp) ml 8 x /" MONOJECT ULTRA COMFORT IN - insulin syringe/needle u ml 9 x /" MONOJECT ULTRA COMFORT IN - insulin syringe/needle u ml 30 MONOJECT ULTRA COMFORT IN - insulin syringe/needle u-00 / ml 3 MONOJECT ULTRA COMFORT IN - insulin syringe/needle u-00 / ml 8 x /" MONOJECT ULTRA COMFORT IN - insulin syringe/needle u-00 / ml 9 x /" MONOJECT ULTRA COMFORT IN - insulin syringe/needle u-00 / ml 30 MONOJECT ULTRA COMFORT IN - insulin syringe/needle u-00 ml 8 x /" MONOJECT ULTRA COMFORT IN - insulin syringe/needle u-00 ml 9 x /" MONOJECT ULTRA COMFORT IN - insulin syringe/needle u-00 ml 30 x 5/6" MONOJECT ULTRA COMFORT IN - insulin syringe/needle u ml 3 MONOLET LANCETS - Guia de medicinas ValueScript de Florida Blue para enero de 06 97

109 06 MONOLET OD LANCETS - MONOLETTOR SAFETY LANCETS - MOORE MED MONOJECT INSULI - insulin syringe/needle u-00 / ml 8 x /" MOORE MED MONOJECT INSULI - insulin syringe/needle u-00 / ml 9 x /" MOORE MED MONOJECT INSULI - insulin syringe/needle u-00 ml 8 x /" MOORE MED MONOJECT INSULI - insulin syringe/needle u-00 ml 9 x /" MS INSULIN SYRINGE/0.3ML/ - insulin syringe/needle u ml 9 x /" MS INSULIN SYRINGE/0.3ML/ - insulin syringe/needle u ml 30 MS INSULIN SYRINGE/0.3ML/ - insulin syringe/needle u ml 3 MS INSULIN SYRINGE/0.5ML/ - insulin syringe/needle u-00 / ml 3 MS INSULIN SYRINGE/0.5ML/ - insulin syringe/needle u-00 / ml 9 x /" MS INSULIN SYRINGE/0.5ML/ - insulin syringe/needle u-00 / ml 30 MS INSULIN SYRINGE/ML/9 - insulin syringe/needle u-00 ml 9 x /" MS INSULIN SYRINGE/ML/30 - insulin syringe/needle u-00 ml 30 x 5/6" MS INSULIN SYRINGE/ML/3 - insulin syringe/needle u-00 ml 3 x 5/6" MULTI-LANCET DEVICE - lancet devices MYGLUCOHEALTH MGH SOFTLAN - NETGROU LANCETS - NOVA SAFETY LANCETS 3G - NOVA SAFETY LANCETS 8G - NOVA SUREFLEX LANCETS - NOVA SUREFLEX LANCING DEV - lancet devices NOVOFINE AUTOCOVER 30GX8M - insulin pen needle 30 g x 8 mm (/3" or 5/6") NOVOFINE LUS 3GX4MM - insulin pen needle 3 g x 4 mm (5/3") NOVOFINE 30GX8MM - insulin pen needle 30 g x 8 mm (/3" or 5/6") NOVOFINE 3GX6MM - insulin pen needle 3 g x 6 mm (/4") NOVOTWIST 30GX8MM - insulin pen needle 30 g x 8 mm (/3" or 5/6") NOVOTWIST 3GX5MM - insulin pen needle 3 g x 5 mm (/5" or 3/6") OMNIFLEX DIAHRAGM - diaphragms ON CALL LANCETS - ON CALL LANCING DEVICE - lancet devices ON CALL LUS LANCETS - ON CALL LUS LANCING DEVI - lancet devices ONETOUCH CLUB LANCETS FIN - ONETOUCH COMBO ACK - ONETOUCH DELICA LANCETS E - ONETOUCH DELICA LANCETS F - 98 Guia de medicinas ValueScript de Florida Blue para enero de 06

110 06 ONETOUCH DELICA LANCING D - lancet devices ONETOUCH FINEOINT LANCET - ONETOUCH LANCETS - ONETOUCH SURESOFT LANCING - misc. ONETOUCH ULTRASOFT LANCET - ORSINI INSULIN SYRINGE/U- - insulin syringe/needle u-00 / ml 9 x /" ORSINI INSULIN SYRINGE/U- - insulin syringe/needle u-00 / ml 30 ORSINI INSULIN SYRINGE/U- - insulin syringe/needle u-00 ml 30 x 5/6" ORTHO DIAHRAGM COIL SRI - diaphragm coil spring kit 50 mm ORTHO DIAHRAGM COIL SRI - diaphragm coil spring kit 00 mm ORTHO DIAHRAGM COIL SRI - diaphragm coil spring kit 05 mm ORTHO DIAHRAGM FLAT SRI - diaphragm flat spring kit 55 mm ORTHO DIAHRAGM FLAT SRI - diaphragm flat spring kit 60 mm ORTHO DIAHRAGM FLAT SRI - diaphragm flat spring kit 65 mm ORTHO DIAHRAGM FLAT SRI - diaphragm flat spring kit 70 mm ORTHO DIAHRAGM FLAT SRI - diaphragm flat spring kit 75 mm ORTHO DIAHRAGM FLAT SRI - diaphragm flat spring kit 80 mm ORTHO DIAHRAGM FLAT SRI - diaphragm flat spring kit 85 mm ORTHO DIAHRAGM FLAT SRI - diaphragm flat spring kit 90 mm ORTHO DIAHRAGM FLAT SRI - diaphragm flat spring kit 95 mm C LANCETS SUER THIN 30G - C UNIFINE ENTIS 9G X - insulin pen needle 9 g x mm (/") C UNIFINE ENTIS 3G X - insulin pen needle 3 g x 5 mm (3/6") C UNIFINE ENTIS 3G X - insulin pen needle 3 g x 6 mm (/4") C UNIFINE ENTIS 3G X - insulin pen needle 3 g x 8 mm (/3" or 5/6") EN NEEDLES 9G X MM - insulin pen needle 9 g x mm (/") EN NEEDLES 9GX/" - insulin pen needle 9 g x mm (/") EN NEEDLES 30GX5/6" - insulin pen needle 30 g x 8 mm (/3" or 5/6") EN NEEDLES 3G X /4" SH - insulin pen needle 3 g x 6 mm (/4") EN NEEDLES 3G X 3/6" - insulin pen needle 3 g x 5 mm (3/6") EN NEEDLES 3G X 6MM - insulin pen needle 3 g x 6 mm (/4") EN NEEDLES 3GX5/6" - insulin pen needle 3 g x 8 mm (/3" or 5/6") ERFECT LANCETS 30G - ERFECT RESSURE ACTIVATE - HARMACIST CHOICE ULTRA T - HARMACY COUNTER LANCETS - RECISION SURE-DOSE INSUL - insulin syringe/needle u ml 30 RECISION SURE-DOSE INSUL - insulin syringe/needle u-00 / ml 30 x 3/8" Guia de medicinas ValueScript de Florida Blue para enero de 06 99

111 06 RECISION SURE-DOSE INSUL - insulin syringe/needle u-00 / ml 8 x /" RECISION SURE-DOSE INSUL - insulin syringe/needle u-00 / ml 9 x /" RECISION SURE-DOSE INSUL - insulin syringe/needle u-00 ml 8 x /" RECISION SURE-DOSE LUS - insulin syringe/needle u ml 9 x /" RECISION SURE-DOSE LUS - insulin syringe/needle u-00 ml 9 x /" RECISION THIN LANCETS - RECISION THINS G LANCET - RECISION ULTRA LANCET - REFERRED LUS INSULIN SY - insulin syringe/needle u ml 9 x /" REFERRED LUS INSULIN SY - insulin syringe/needle u ml 30 REFERRED LUS INSULIN SY - insulin syringe/needle u-00 / ml 8 x /" REFERRED LUS INSULIN SY - insulin syringe/needle u-00 / ml 9 x /" REFERRED LUS INSULIN SY - insulin syringe/needle u-00 / ml 30 REFERRED LUS INSULIN SY - insulin syringe/needle u-00 ml 8 x /" REFERRED LUS INSULIN SY - insulin syringe/needle u-00 ml 9 x /" REFERRED LUS INSULIN SY - insulin syringe/needle u-00 ml 30 x 5/6" REFERRED LUS LANCETS CO - REFERRED LUS LANCETS SU - REFERRED LUS LANCETS TH - REFERRED LUS UNIFINE E - insulin pen needle 9 g x mm (/") REFERRED LUS UNIFINE E - insulin pen needle 3 g x 5 mm (3/6") REFERRED LUS UNIFINE E - insulin pen needle 3 g x 6 mm (/4") REFERRED LUS UNIFINE E - insulin pen needle 3 g x 8 mm (/3" or 5/6") REFERRED LUS UNIFINE E - insulin pen needle 3 g x 4 mm (5/3") RENTIF CAVITY-RIM CERVIC - cervical cap mm RENTIF CAVITY-RIM CERVIC - cervical cap 5 mm RENTIF CAVITY-RIM CERVIC - cervical cap 8 mm RENTIF CAVITY-RIM CERVIC - cervical cap 3 mm RENTIF FITTING SET - cervical caps RODIGY INSULIN MINI EN - insulin pen needle 3 g x 5 mm (3/6") RODIGY INSULIN SHORT EN - insulin pen needle 3 g x 8 mm (/3" or 5/6") RODIGY INSULIN SYRING/U- - insulin syringe/needle u ml 3 RODIGY INSULIN SYRINGE/ - insulin syringe/needle u-00 / ml 3 RODIGY INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 8 x /" RODIGY LANCING DEVICE - lancet devices 00 Guia de medicinas ValueScript de Florida Blue para enero de 06

112 06 RODIGY RESSURE ACTIVATE - RODIGY TWIST TO LANCETS - SS SELECT G LANCETS - SS SELECT SAFETY LANCETS - X ADVANCED LANCING DEVIC - lancet devices X EXTRA SHORT EN NEEDLE - insulin pen needle 3 g x 6 mm (/4") X INSULIN SYRINGE/U-00/ - insulin syringe/needle u ml 30 x /" X INSULIN SYRINGE/U-00/ - insulin syringe/needle u-00 / ml 3 X INSULIN SYRINGE/U-00/ - insulin syringe/needle u-00 / ml 30 x /" X INSULIN SYRINGE/U-00/ - insulin syringe/needle u-00 ml 30 x /" X INSULIN SYRINGE/U-00/ - insulin syringe/needle u-00 ml 3 X INSULIN SYRINGE/U-00/ - insulin syringe/needle u ml 3 X LANCET AUTO INJECTOR - lancet devices X LANCETS - X LANCETS ULTRA THIN - X MINI EN NEEDLES 3GX5 - insulin pen needle 3 g x 5 mm (3/6") X EN NEEDLE 9GXMM - insulin pen needle 9 g x mm (/") X EN NEEDLE 3GX8MM - insulin pen needle 3 g x 8 mm (/3" or 5/6") X SHORTLENGTH EN NEEDLE - insulin pen needle 3 g x 8 mm (/3" or 5/6") QC ADVANCED LANCING DEVIC - lancet devices QC INSULIN SYRINGE 0.5ML/ - insulin syringe/needle u-00 / ml 9 g QC INSULIN SYRINGE 0.5ML/ - insulin syringe/needle u-00 / ml 30 g QC INSULIN SYRINGE/0.3ML/ - insulin syringe/needle u ml 9 g QC INSULIN SYRINGE/0.3ML/ - insulin syringe/needle u ml 9 x /" QC INSULIN SYRINGE/0.5ML/ - insulin syringe/needle u-00 / ml 3 QC INSULIN SYRINGE/0.5ML/ - insulin syringe/needle u-00 / ml 9 x /" QC INSULIN SYRINGE/ML/9 - insulin syringe/needle u-00 ml 9 x /" QC INSULIN SYRINGE/ML/30 - insulin syringe/needle u-00 ml 30 g QC INSULIN SYRINGE/ML/3 - insulin syringe/needle u-00 ml 3 x 5/6" QC LANCETS SUER THIN - QC LANCETS ULTRA THIN - QC EN NEEDLES 9G X MM - insulin pen needle 9 g x mm (/") QC EN NEEDLES 3G X 6MM - insulin pen needle 3 g x 6 mm (/4") QC EN NEEDLES 3G X 8MM - insulin pen needle 3 g x 8 mm (/3" or 5/6") QC UNIFINE ENTIS 3GX4M - insulin pen needle 3 g x 4 mm (5/3") RA E-ZJECT COLOR LANCETS - RA E-ZJECT LANCETS THIN - RA E-ZJECT LANCETS ULTRA - RA E-ZJECT LANCETS 8G - Guia de medicinas ValueScript de Florida Blue para enero de 06 0

113 06 RA INSULIN SYRINGE/U-00/ - insulin syringe/needle u-00 / ml 30 RA INSULIN SYRINGE/U-00/ - insulin syringe/needle u-00 ml 30 RA INSULIN SYRINGE/0.5ML/ - insulin syringe/needle u-00 / ml 9 x /" RA INSULIN SYRINGE/ML/9 - insulin syringe/needle u-00 ml 9 x /" RA LANCING DEVICE - lancet devices RA EN NEEDLES 3G X 5MM - insulin pen needle 3 g x 5 mm (3/6") RA EN NEEDLES 3G X 8MM - insulin pen needle 3 g x 8 mm (/3" or 5/6") REALITY INSULIN SYRINGE/U - insulin syringe/needle u-00 / ml 8 x /" REALITY INSULIN SYRINGE/U - insulin syringe/needle u-00 / ml 9 x /" REALITY INSULIN SYRINGE/U - insulin syringe/needle u-00 ml 8 x /" REALITY INSULIN SYRINGE/U - insulin syringe/needle u-00 ml 9 x /" REALITY LANCETS - REALITY TRIGGER LANCETS - RELION INSULIN SYRINGE/U - insulin syringe/needle u-00 / ml 9 g RELION INSULIN SYRINGE/U- - insulin syringe/needle u ml 9 g RELION INSULIN SYRINGE/U- - insulin syringe/needle u ml 30 g RELION INSULIN SYRINGE/U- - insulin syringe/needle u ml 9 x /" RELION INSULIN SYRINGE/U- - insulin syringe/needle u ml 30 RELION INSULIN SYRINGE/U- - insulin syringe/needle u-00 / ml 30 g RELION INSULIN SYRINGE/U- - insulin syringe/needle u-00 / ml 3 RELION INSULIN SYRINGE/U- - insulin syringe/needle u-00 / ml 9 x /" RELION INSULIN SYRINGE/U- - insulin syringe/needle u-00 / ml 30 RELION INSULIN SYRINGE/U- - insulin syringe/needle u-00 ml 9 x /" RELION INSULIN SYRINGE/U- - insulin syringe/needle u-00 ml 30 g RELION INSULIN SYRINGE/U- - insulin syringe/needle u-00 ml 30 x 5/6" RELION INSULIN SYRINGE/U- - insulin syringe/needle u-00 ml 3 x 5/6" RELION INSULIN SYRINGE/U- - insulin syringe/needle u ml 3 RELION LANCETS - RELION LANCETS MICRO-THIN - RELION LANCETS STANDARD - RELION LANCETS THIN 6G - RELION LANCETS ULTRA-THIN - RELION LANCING DEVICE - lancet devices 0 Guia de medicinas ValueScript de Florida Blue para enero de 06

114 06 RELION MINI EN NEEDLES 3 - insulin pen needle 3 g x 6 mm (/4") RELION EN NEEDLES 9GX - insulin pen needle 9 g x mm (/") RELION EN NEEDLES 3GX8M - insulin pen needle 3 g x 8 mm (/3" or 5/6") RELION EN NEEDLES 3GX4M - insulin pen needle 3 g x 4 mm (5/3") RELION SHORT EN NEEDLES - insulin pen needle 3 g x 8 mm (/3" or 5/6") RELION THIN LANCETS - RELION ULTRA THIN LANCETS - RELION ULTRA THIN LUS LA - RENEW ADVANCED LANCING CA - RENEW ADVANCED LANCING DE - lancet devices REXALL LANCETS ULTRA THIN - RIGHTEST GD500 LANCING DE - lancet devices RIGHTEST GL300 LANCETS - SAFE-T-LANCE LOW FLOW 5G - SAFE-T-LANCE NORMAL FLOW - SAFE-T-LANCE LUS SAFETY - SAFESNA ALLERGY SYRINGE/ - tuberculin/allergy syringe/needle (disp) ml 7 x /" SAFESNA INSULIN SYRINGE/ - insulin syringe/needle u ml 30 SAFESNA INSULIN SYRINGE/ - insulin syringe/needle u-00 / ml 9 x /" SAFESNA INSULIN SYRINGE/ - insulin syringe/needle u-00 / ml 30 SAFESNA INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 8 x /" SAFESNA INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 9 x /" SAFESNA TUBERCULIN SYRIN - tuberculin/allergy syringe/needle (disp) ml 5 x 5/8" SAFESNA TUBERCULIN SYRIN - tuberculin/allergy syringe/needle (disp) ml 7 x /" SAFETY LANCET MM - SAFETY LANCET G/RESSUR - SAFETY LANCET 8G/RESSUR - SAFETY LANCETS - SAFETY LANCETS G - SAFETY LANCETS 8G - SAFETY LET LANCETS - SAFETY SEAL LANCETS 8G - SAFETY SEAL LANCETS 30G - SAFETY-GLIDE INSULIN SYRI - insulin syringe/needle u ml 9 x /" SAFETY-LOK SAFETY SYRINGE - tuberculin/allergy syringe/needle (disp) ml 5 x 5/8" SAFETY-LOK TB SYRINGE ER - tuberculin/allergy syringe/needle (disp) ml 7 x /" SASCARE TWIST TO LANCET - SB INSULIN SYRINGE/U-00/ - insulin syringe/needle u-00 / ml 9 x /" SB INSULIN SYRINGE/U-00/ - insulin syringe/needle u-00 / ml 30 Guia de medicinas ValueScript de Florida Blue para enero de 06 03

115 06 SB INSULIN SYRINGE/U-00/ - insulin syringe/needle u-00 ml 9 x /" SB INSULIN SYRINGE/U-00/ - insulin syringe/needle u-00 ml 30 SB INSULIN SYRINGE/U-00/ - insulin syringe/needle u-00 ml 3 SB LANCETS THIN - SB LANCETS ULTRA THIN - SCHNUCKS INSULIN SYRINGE - insulin syringe/needle u-00 / ml 9 x /" SCHNUCKS INSULIN SYRINGE - insulin syringe/needle u-00 / ml 30 SELECT-LITE LANCING DEVIC - lancet devices SHOKO AUTOLET LANCING DE - lancet devices SHOKO ON-THE-GO COMFORT - SHOKO UNIFINE ENTIS E - insulin pen needle 9 g x mm (/") SHOKO UNIFINE ENTIS E - insulin pen needle 3 g x 5 mm (3/6") SHOKO UNIFINE ENTIS E - insulin pen needle 3 g x 8 mm (/3" or 5/6") SHOKO UNIFINE ENTIS E - insulin pen needle 3 g x 4 mm (5/3") SHOKO UNILET LANCETS SU - SHOKO UNILET LANCETS ULT - SIMLE DIAGNOSTICS LANCIN - lancet devices SINGLE-LET - SM INSULIN SYRINGE/U-00/ - insulin syringe/needle u ml 9 x /" SM INSULIN SYRINGE/U-00/ - insulin syringe/needle u ml 30 SM INSULIN SYRINGE/U-00/ - insulin syringe/needle u-00 / ml 8 x /" SM INSULIN SYRINGE/U-00/ - insulin syringe/needle u-00 / ml 9 x /" SM INSULIN SYRINGE/U-00/ - insulin syringe/needle u-00 / ml 30 SM INSULIN SYRINGE/U-00/ - insulin syringe/needle u-00 ml 8 x /" SM INSULIN SYRINGE/U-00/ - insulin syringe/needle u-00 ml 9 x /" SM INSULIN SYRINGE/U-00/ - insulin syringe/needle u-00 ml 30 SM INSULIN SYRINGE/0.3ML/ - insulin syringe/needle u ml 3 SM INSULIN SYRINGE/0.5ML/ - insulin syringe/needle u-00 / ml 3 SM INSULIN SYRINGE/ML/3 - insulin syringe/needle u-00 ml 3 x 5/6" SM LANCETS G - SM MICRO THIN LANCETS 33G - SM SUER THIN LANCETS 30G - SM THIN LANCETS 6G - SM ULTRA COMFORT INSULIN - insulin syringe/needle u-00 ml 30 x 5/6" SMART DIABETES VANTAGE LA - lancet devices SMART DIABETES VANTAGE UN - SMART SENSE COLOR LANCETS - SMART SENSE STANDARD LANC - SMART SENSE SUER THIN LA - 04 Guia de medicinas ValueScript de Florida Blue para enero de 06

116 06 SMART SENSE THIN LANCETS - SMARTEST LANCETS 8G - SOLUS V LANCING DEVICE - lancet devices SOLUS V RESSURE ACTIVAT - SOLUS V TWIST LANCETS 30 - STERILANCE TL - SUER THIN LANCETS - SURE COMFORT INSULIN SYRI - insulin syringe/needle u ml 9 x /" SURE COMFORT INSULIN SYRI - insulin syringe/needle u ml 30 SURE COMFORT INSULIN SYRI - insulin syringe/needle u ml 30 x /" SURE COMFORT INSULIN SYRI - insulin syringe/needle u-00 / ml 3 SURE COMFORT INSULIN SYRI - insulin syringe/needle u-00 / ml 8 x /" SURE COMFORT INSULIN SYRI - insulin syringe/needle u-00 / ml 9 x /" SURE COMFORT INSULIN SYRI - insulin syringe/needle u-00 / ml 30 SURE COMFORT INSULIN SYRI - insulin syringe/needle u-00 / ml 30 x /" SURE COMFORT INSULIN SYRI - insulin syringe/needle u-00 ml 8 x /" SURE COMFORT INSULIN SYRI - insulin syringe/needle u-00 ml 9 x /" SURE COMFORT INSULIN SYRI - insulin syringe/needle u-00 ml 30 x 5/6" SURE COMFORT INSULIN SYRI - insulin syringe/needle u-00 ml 30 x /" SURE COMFORT INSULIN SYRI - insulin syringe/needle u-00 ml 3 x 5/6" SURE COMFORT INSULIN SYRI - insulin syringe/needle u ml 3 SURE COMFORT LANCETS 8G - SURE COMFORT LANCETS 30G - SURE COMFORT LANCING EN - lancet devices SURE COMFORT EN NEEDLES - insulin pen needle 9 g x.7 mm SURE COMFORT EN NEEDLES - insulin pen needle 30 g x 8 mm (/3" or 5/6") SURE COMFORT EN NEEDLES - insulin pen needle 3 g x 5 mm (3/6") SURE COMFORT EN NEEDLES - insulin pen needle 3 g x 8 mm (/3" or 5/6") SURE COMFORT EN NEEDLES - insulin pen needle 3 g x 4 mm (5/3") SURE COMFORT EN NEEDLES - insulin pen needle 3 g x 6 mm (/4") SURE-FINE EN NEEDLES 9G - insulin pen needle 9 g x.7 mm SURE-FINE EN NEEDLES 3G - insulin pen needle 3 g x 5 mm (3/6") SURE-FINE EN NEEDLES 3G - insulin pen needle 3 g x 8 mm (/3" or 5/6") SURE-JECT INSULIN SYRINGE - insulin syringe/needle u ml 9 x /" Guia de medicinas ValueScript de Florida Blue para enero de 06 05

117 06 SURE-JECT INSULIN SYRINGE - insulin syringe/needle u ml 30 SURE-JECT INSULIN SYRINGE - insulin syringe/needle u-00 / ml 3 SURE-JECT INSULIN SYRINGE - insulin syringe/needle u-00 / ml 8 x /" SURE-JECT INSULIN SYRINGE - insulin syringe/needle u-00 / ml 9 x /" SURE-JECT INSULIN SYRINGE - insulin syringe/needle u-00 / ml 30 SURE-JECT INSULIN SYRINGE - insulin syringe/needle u-00 ml 8 x /" SURE-JECT INSULIN SYRINGE - insulin syringe/needle u-00 ml 9 x /" SURE-JECT INSULIN SYRINGE - insulin syringe/needle u-00 ml 30 x 5/6" SURE-JECT INSULIN SYRINGE - insulin syringe/needle u-00 ml 3 x 5/6" SURE-JECT INSULIN SYRINGE - insulin syringe/needle u ml 3 SURE-LANCE FLAT LANCETS - SURE-LANCE LANCETS 6G - SURE-LANCE THIN LANCETS - SURE-LANCE ULTRA THIN LAN - SURE-EN - lancet devices SURE-TOUCH LANCETS UNIVER - SURELITE LANCETS - TECHLITE AST LANCETS - TECHLITE LANCETS - TECHLITE LANCETS 30G - TERUMO ALLERGY SYRINGE M - tuberculin/allergy syringe/needle (disp) ml 7 x /" TERUMO INSULIN SYRINGE/U- - insulin syringe/needle u ml 9 x /" TERUMO INSULIN SYRINGE/U- - insulin syringe/needle u-00 / ml 7 x /" TERUMO INSULIN SYRINGE/U- - insulin syringe/needle u-00 / ml 8 x /" TERUMO INSULIN SYRINGE/U- - insulin syringe/needle u-00 ml 8 x /" TERUMO INSULIN SYRINGE/0. - insulin syringe/needle u-00 / ml 30 x 3/8" TERUMO INSULIN SYRINGE/0. - insulin syringe/needle u-00 / ml 9 x /" TERUMO INSULIN SYRINGE/M - insulin syringe/needle u-00 ml 7 x /" TERUMO INSULIN SYRINGE/M - insulin syringe/needle u-00 ml 9 x /" TERUMO SURGUARD INSULIN S - insulin syringe/needle u ml 9 x /" TERUMO SURGUARD INSULIN S - insulin syringe/needle u-00 / ml 8 x /" TERUMO SURGUARD INSULIN S - insulin syringe/needle u-00 / ml 9 x /" TERUMO SURGUARD INSULIN S - insulin syringe/needle u-00 ml 8 x /" 06 Guia de medicinas ValueScript de Florida Blue para enero de 06

118 06 TERUMO SURGUARD INSULIN S - insulin syringe/needle u-00 ml 9 x /" TGT ADVANCED LANCING DEVI - lancet devices TGT LANCET ALTERNATE SITE - TGT LANCET MICRO THIN 33G - TGT LANCET SUER THIN 30G - TGT LANCET THIN 3G - TGT LANCET THIN 6G - TGT LANCET ULTRA THIN 8G - TGT LANCET ULTRA THIN 30G - TGT LANCING DEVICE - lancet devices THINLETS G LANCETS - THINLETS LANCET - THINRO INSULIN SYRINGE/0 - insulin syringe/needle u ml 9 x /" THINRO INSULIN SYRINGE/0 - insulin syringe/needle u-00 / ml 30 x 3/8" THINRO INSULIN SYRINGE/0 - insulin syringe/needle u-00 / ml 8 x /" THINRO INSULIN SYRINGE/0 - insulin syringe/needle u-00 / ml 9 x /" THINRO INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 8 x /" THINRO INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 9 x /" TODAYS HEALTH ADVANCED LA - lancet devices TODAYS HEALTH MINI EN NE - insulin pen needle 3 g x 6 mm (/4") TODAYS HEALTH ORIGINAL E - insulin pen needle 9 g x mm (/") TODAYS HEALTH SHORT EN N - insulin pen needle 3 g x 8 mm (/3" or 5/6") TODAYS HEALTH SUER THIN - TODAYS HEALTH ULTRA THIN - TOCARE CLICKFINE UNIVERS - insulin pen needle 3 g x 6 mm (/4") TOCARE CLICKFINE UNIVERS - insulin pen needle 3 g x 8 mm (/3" or 5/6") TOCARE ULTRA COMFORT INS - insulin syringe/needle u ml 9 x /" TOCARE ULTRA COMFORT INS - insulin syringe/needle u ml 30 TOCARE ULTRA COMFORT INS - insulin syringe/needle u-00 / ml 3 TOCARE ULTRA COMFORT INS - insulin syringe/needle u-00 / ml 9 x /" TOCARE ULTRA COMFORT INS - insulin syringe/needle u-00 / ml 30 TOCARE ULTRA COMFORT INS - insulin syringe/needle u-00 ml 9 x /" TOCARE ULTRA COMFORT INS - insulin syringe/needle u-00 ml 30 x 5/6" TOCARE ULTRA COMFORT INS - insulin syringe/needle u-00 ml 3 x 5/6" TOCARE ULTRA COMFORT INS - insulin syringe/needle u ml 3 Guia de medicinas ValueScript de Florida Blue para enero de 06 07

119 06 TOCO INSULIN SYRINGE/U- - insulin syringe/needle u ml 9 x /" TOCO INSULIN SYRINGE/U- - insulin syringe/needle u-00 / ml 8 x /" TOCO INSULIN SYRINGE/U- - insulin syringe/needle u-00 / ml 9 x /" TOCO INSULIN SYRINGE/U- - insulin syringe/needle u-00 ml 8 x /" TOCO INSULIN SYRINGE/U- - insulin syringe/needle u-00 ml 9 x /" TRAVEL LANCETS 30G - TRUEDRAW LANCING DEVICE - lancet devices TRUELUS INSULIN SYRINGE/ - insulin syringe/needle u ml 9 x /" TRUELUS INSULIN SYRINGE/ - insulin syringe/needle u ml 30 TRUELUS INSULIN SYRINGE/ - insulin syringe/needle u-00 / ml 3 TRUELUS INSULIN SYRINGE/ - insulin syringe/needle u-00 / ml 8 x /" TRUELUS INSULIN SYRINGE/ - insulin syringe/needle u-00 / ml 9 x /" TRUELUS INSULIN SYRINGE/ - insulin syringe/needle u-00 / ml 30 TRUELUS INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 8 x /" TRUELUS INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 9 x /" TRUELUS INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 30 x 5/6" TRUELUS INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 3 x 5/6" TRUELUS INSULIN SYRINGE/ - insulin syringe/needle u ml 3 TRUELUS LANCETS 6G - TRUELUS LANCETS 8G - TRUELUS LANCETS 8G SUE - TRUELUS LANCETS 30G - TRUELUS LANCETS 30G ULTR - TRUELUS LANCETS 33G - TRUELUS LANCETS 33G MICR - TRUELUS SAFETY LANCETS - ULTI-LANCE AUTO-ADJUST DE - lancet devices ULTI-LANCE AUTOMATIC/ CLE - lancet devices ULTI-LANCE MINI ADJUSTABL - lancet devices ULTICARE INSULIN SAFETY S - insulin syringe/needle u-00 / ml 9 x /" ULTICARE INSULIN SAFETY S - insulin syringe/needle u-00 ml 9 x /" ULTICARE INSULIN SYRINGE - insulin syringe/needle u-00 / ml 3 ULTICARE INSULIN SYRINGE - insulin syringe/needle u-00 ml 3 x 5/6" ULTICARE INSULIN SYRINGE - insulin syringe/needle u ml 3 08 Guia de medicinas ValueScript de Florida Blue para enero de 06

120 06 ULTICARE INSULIN SYRINGE/ - insulin syringe/needle u ml 9 x /" ULTICARE INSULIN SYRINGE/ - insulin syringe/needle u ml 30 ULTICARE INSULIN SYRINGE/ - insulin syringe/needle u ml 30 x /" ULTICARE INSULIN SYRINGE/ - insulin syringe/needle u-00 / ml 3 ULTICARE INSULIN SYRINGE/ - insulin syringe/needle u-00 / ml 8 x /" ULTICARE INSULIN SYRINGE/ - insulin syringe/needle u-00 / ml 9 x /" ULTICARE INSULIN SYRINGE/ - insulin syringe/needle u-00 / ml 30 ULTICARE INSULIN SYRINGE/ - insulin syringe/needle u-00 / ml 30 x /" ULTICARE INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 8 x /" ULTICARE INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 9 x /" ULTICARE INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 30 x 5/6" ULTICARE INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 30 x /" ULTICARE INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 3 x 5/6" ULTICARE INSULIN SYRINGE/ - insulin syringe/needle u ml 3 ULTICARE MICRO EN NEEDLE - insulin pen needle 3 g x 4 mm (5/3") ULTICARE MINI EN NEEDLES - insulin pen needle 3 g x 6 mm (/4") ULTICARE ORIGINAL EN NEE - insulin pen needle 9 g x mm (/") ULTICARE EN NEEDLES/9G - insulin pen needle 9 g x.7 mm ULTICARE SHORT EN NEEDLE - insulin pen needle 3 g x 8 mm (/3" or 5/6") ULTICARE THIN LANCETS 30G - ULTICARE TUBERCULIN SAFET - tuberculin/allergy syringe/needle (disp) ml 5 x 5/8" ULTICARE TUBERCULIN SAFET - tuberculin/allergy syringe/needle (disp) ml 5 x " ULTIGUARD INSULIN SYRINGE - insulin syringe/needle u ml 9 x /" ULTIGUARD INSULIN SYRINGE - insulin syringe/needle u ml 30 ULTIGUARD INSULIN SYRINGE - insulin syringe/needle u-00 / ml 9 x /" ULTIGUARD INSULIN SYRINGE - insulin syringe/needle u-00 / ml 30 ULTIGUARD INSULIN SYRINGE - insulin syringe/needle u-00 ml 9 x /" ULTIGUARD INSULIN SYRINGE - insulin syringe/needle u-00 ml 30 x 5/6" ULTILET BASIC LANCETS 30G - ULTILET CLASSIC LANCETS - Guia de medicinas ValueScript de Florida Blue para enero de 06 09

121 06 ULTILET INSULIN SYRINGE/S - insulin syringe/needle u ml 30 ULTILET INSULIN SYRINGE/S - insulin syringe/needle u-00 / ml 3 ULTILET INSULIN SYRINGE/S - insulin syringe/needle u-00 / ml 30 ULTILET INSULIN SYRINGE/S - insulin syringe/needle u-00 ml 30 x 5/6" ULTILET INSULIN SYRINGE/S - insulin syringe/needle u-00 ml 3 x 5/6" ULTILET INSULIN SYRINGE/S - insulin syringe/needle u ml 3 ULTILET LANCETS - ULTILET LANCETS 33G - ULTILET OERATING DEVICE - lancet devices ULTILET EN NEEDLE 3GX4M - insulin pen needle 3 g x 4 mm (5/3") ULTILET SAFETY LANCETS 3 - ULTILET SHORT EN NEEDLES - insulin pen needle 3 g x 5 mm (3/6") ULTILET SHORT EN NEEDLES - insulin pen needle 3 g x 8 mm (/3" or 5/6") ULTILET ULTI-LANCE ADJ DE - lancet devices ULTRA COMFORT INSULIN SYR - insulin syringe/needle u ml 30 ULTRA COMFORT INSULIN SYR - insulin syringe/needle u-00 / ml 3 ULTRA COMFORT INSULIN SYR - insulin syringe/needle u-00 / ml 8 x /" ULTRA COMFORT INSULIN SYR - insulin syringe/needle u-00 / ml 9 x /" ULTRA COMFORT INSULIN SYR - insulin syringe/needle u-00 / ml 30 x /" ULTRA COMFORT INSULIN SYR - insulin syringe/needle u-00 ml 9 x /" ULTRA COMFORT INSULIN SYR - insulin syringe/needle u-00 ml 30 x /" ULTRA COMFORT INSULIN SYR - insulin syringe/needle u-00 ml 3 x 5/6" ULTRA INSULIN SYRINGE/U- - insulin syringe/needle u-00 / ml 9 x /" ULTRA THIN LANCETS 8G - ULTRA THIN LANCETS 30G - ULTRA-COMFORT INSULIN SYR - insulin syringe/needle u ml 9 x /" ULTRA-COMFORT INSULIN SYR - insulin syringe/needle u ml 30 ULTRA-COMFORT INSULIN SYR - insulin syringe/needle u-00 / ml 3 ULTRA-COMFORT INSULIN SYR - insulin syringe/needle u-00 / ml 8 x /" ULTRA-COMFORT INSULIN SYR - insulin syringe/needle u-00 / ml 9 x /" ULTRA-COMFORT INSULIN SYR - insulin syringe/needle u-00 / ml 30 ULTRA-COMFORT INSULIN SYR - insulin syringe/needle u-00 ml 8 x /" 0 Guia de medicinas ValueScript de Florida Blue para enero de 06

122 06 ULTRA-COMFORT INSULIN SYR - insulin syringe/needle u-00 ml 9 x /" ULTRA-COMFORT INSULIN SYR - insulin syringe/needle u-00 ml 30 x 5/6" ULTRA-COMFORT INSULIN SYR - insulin syringe/needle u-00 ml 3 x 5/6" ULTRA-COMFORT INSULIN SYR - insulin syringe/needle u ml 3 ULTRA-THIN II AUTO LANCET - ULTRA-THIN II INSULIN SYR - insulin syringe/needle u ml 9 x /" ULTRA-THIN II INSULIN SYR - insulin syringe/needle u ml 30 ULTRA-THIN II INSULIN SYR - insulin syringe/needle u-00 / ml 3 ULTRA-THIN II INSULIN SYR - insulin syringe/needle u-00 / ml 9 x /" ULTRA-THIN II INSULIN SYR - insulin syringe/needle u-00 / ml 30 ULTRA-THIN II INSULIN SYR - insulin syringe/needle u-00 ml 9 x /" ULTRA-THIN II INSULIN SYR - insulin syringe/needle u-00 ml 30 x 5/6" ULTRA-THIN II INSULIN SYR - insulin syringe/needle u-00 ml 3 x 5/6" ULTRA-THIN II INSULIN SYR - insulin syringe/needle u ml 3 ULTRA-THIN II LANCETS 8G - ULTRA-THIN II LANCETS 30G - ULTRA-THIN II MINI EN NE - insulin pen needle 3 g x 5 mm (3/6") ULTRA-THIN II EN NEEDLES - insulin pen needle 9 g x.7 mm ULTRA-THIN II EN NEEDLES - insulin pen needle 3 g x 8 mm (/3" or 5/6") ULTRA-THIN II SAFETY AUTO - UNIFINE ENTIS LUS 9GX - insulin pen needle 9 g x mm (/") UNIFINE ENTIS LUS 3GX - insulin pen needle 3 g x 5 mm (3/6") UNIFINE ENTIS LUS 3GX - insulin pen needle 3 g x 6 mm (/4") UNIFINE ENTIS LUS 3GX - insulin pen needle 3 g x 8 mm (/3" or 5/6") UNIFINE ENTIS LUS 3GX - insulin pen needle 3 g x 4 mm (5/3") UNIFINE ENTIS 9GXMM - insulin pen needle 9 g x mm (/") UNIFINE ENTIS 3G X 3/ - insulin pen needle 3 g x 5 mm (3/6") UNIFINE ENTIS 3G X 6MM - insulin pen needle 3 g x 6 mm (/4") UNIFINE ENTIS 3G X 8MM - insulin pen needle 3 g x 8 mm (/3" or 5/6") UNIFINE ENTIS 3GX5MM - insulin pen needle 3 g x 5 mm (3/6") UNIFINE ENTIS 3GX6MM - insulin pen needle 3 g x 6 mm (/4") UNIFINE ENTIS 3GX8MM - insulin pen needle 3 g x 8 mm (/3" or 5/6") UNIFINE ENTIS 3GX4MM - insulin pen needle 3 g x 4 mm (5/3") UNILET COMFORTOUCH LANCET - Guia de medicinas ValueScript de Florida Blue para enero de 06

123 06 UNILET EXCELITE - UNILET EXCELITE II - UNILET G.. LANCET - UNILET G.. SUERLITE LAN - UNILET G 8 ULTRA THIN - UNILET LANCET - UNILET LANCETS MICRO-THIN - UNILET LANCETS SUER-THIN - UNILET LANCETS ULTRA-THIN - UNILET SUERLITE LANCET - UNISTIK SAFETY LANCETS 8 - UNISTIK SAFETY LANCETS 30 - UNISTIK 3 GENTLE - UNIVERSAL LANCETS THIN - UNIVERSAL LANCETS ULTRA - V-R MONOJECT INSULIN SYRI - insulin syringe/needle u ml 9 x /" V-R MONOJECT INSULIN SYRI - insulin syringe/needle u-00 / ml 8 x /" V-R MONOJECT INSULIN SYRI - insulin syringe/needle u-00 / ml 9 x /" V-R MONOJECT INSULIN SYRI - insulin syringe/needle u-00 ml 8 x /" V-R MONOJECT INSULIN SYRI - insulin syringe/needle u-00 ml 9 x /" VALUE HEALTH INSULIN SYRI - insulin syringe/needle u-00 / ml 9 x /" VALUE HEALTH INSULIN SYRI - insulin syringe/needle u-00 ml 9 x /" VALUE LUS LANCETS STANDA - VALUE LUS LANCETS SUER - VALUE LUS LANCETS THIN - VALUE LUS LANCING DEVICE - lancet devices VALUMARK LANCET SUER THI - VALUMARK LANCET ULTRA THI - VALUMARK EN NEEDLES 9GX - insulin pen needle 9 g x mm (/") VALUMARK EN NEEDLES 3G - insulin pen needle 3 g x 6 mm (/4") VALUMARK EN NEEDLES 3G - insulin pen needle 3 g x 8 mm (/3" or 5/6") VANISHOINT INSULIN SYRIN - insulin syringe/needle u-00 / ml 30 x /" VANISHOINT INSULIN SYRIN - insulin syringe/needle u-00 ml 9 x /" VIDA MIA AUTOLET LANCING - lancet devices VIDA MIA UNIFINE ENTIS - insulin pen needle 9 g x mm (/") VIDA MIA UNIFINE ENTIS - insulin pen needle 3 g x 6 mm (/4") VIDA MIA UNIFINE ENTIS - insulin pen needle 3 g x 4 mm (5/3") VIDA MIA UNILET LANCETS S - VIDA MIA UNILET LANCETS U - Guia de medicinas ValueScript de Florida Blue para enero de 06

124 06 VIDA MIA UNIFINE ENTIS - insulin pen needle 3 g x 8 mm (/3" or 5/6") VITALET RO LANCETS - VITALET RO LUS LANCETS - V INSULIN SYRINGE/U-00/ - insulin syringe/needle u ml 9 x /" W&F LANCETS COLORED G - W&F LANCETS 6G - WALGREENS ADVANCED TRAVEL - WALGREENS COMFORT ASSURED - WALGREENS LANCETS - WALGREENS THIN LANCETS - WALGREENS ULTRA THIN LANC - WD MEDIC INSULIN SYRINGE/ - insulin syringe/needle u ml 9 x /" WD MEDIC INSULIN SYRINGE/ - insulin syringe/needle u ml 30 WD MEDIC INSULIN SYRINGE/ - insulin syringe/needle u-00 / ml 9 x /" WD MEDIC INSULIN SYRINGE/ - insulin syringe/needle u-00 / ml 30 WD MEDIC INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 9 x /" WD MEDIC INSULIN SYRINGE/ - insulin syringe/needle u-00 ml 30 x 5/6" WEGMANS UNIFINE ENTIS - insulin pen needle 3 g x 5 mm (3/6") WEGMANS UNIFINE ENTIS - insulin pen needle 3 g x 6 mm (/4") WEGMANS UNIFINE ENTIS - insulin pen needle 3 g x 8 mm (/3" or 5/6") WEGMANS UNIFINE ENTIS - insulin pen needle 3 g x 4 mm (5/3") WIDE-SEAL SILICONE DIAHR - diaphragm wide seal 60 mm WIDE-SEAL SILICONE DIAHR - diaphragm wide seal 65 mm WIDE-SEAL SILICONE DIAHR - diaphragm wide seal 70 mm WIDE-SEAL SILICONE DIAHR - diaphragm wide seal 75 mm WIDE-SEAL SILICONE DIAHR - diaphragm wide seal 80 mm WIDE-SEAL SILICONE DIAHR - diaphragm wide seal 85 mm WIDE-SEAL SILICONE DIAHR - diaphragm wide seal 90 mm WIDE-SEAL SILICONE DIAHR - diaphragm wide seal 95 mm YALE NEEDLES - needle (disp) 8 x " YALE NEEDLES - needle (disp) x " YALE NEEDLES G X " - needle (disp) x " YALE NEEDLES G X -/" - needle (disp) x -/" YALE NEEDLES 5G X -/" - needle (disp) 5 x -/" YALE NEEDLES 6G X /" - needle (disp) 6 x /" YALE NEEDLES 6G X 3/8" - needle (disp) 6 x 3/8" ML ALLERGIST SYRINGE DET - tuberculin/allergy syringe/needle (disp) ml 7 x /" ML ALLERGY SYRINGE - tuberculin/ allergy syringe/needle (disp) ml 7 x /" Guia de medicinas ValueScript de Florida Blue para enero de 06 3

125 06 ML ALLERGY SYRINGE 8G X - tuberculin/allergy syringe/needle (disp) ml 8 x /" ML TB SYRINGE/5G X 5/8" - tuberculin/allergy syringe/needle (disp) ml 5 x 5/8" ML TB SYRINGE/6G X 3/8" - tuberculin/allergy syringe/needle (disp) ml 6 x 3/8" ML TB SYRINGE/7G X /" - tuberculin/allergy syringe/needle (disp) ml 7 x /" ML TUBERCULIN SYRINGE DE - tuberculin/allergy syringe/needle (disp) ml 5 x 5/8" ML TUBERCULIN SYRINGE DE - tuberculin/allergy syringe/needle (disp) ml 6 x 3/8" ML VANISHOINT TUBERCULI - tuberculin/allergy syringe/needle (disp) ml 5 x 5/8" ML VANISHOINT TUBERCULI - tuberculin/allergy syringe/needle (disp) ml 5 x " ML VANISHOINT TUBERCULI - tuberculin/allergy syringe/needle (disp) ml 7 x /" ST CHOICE LANCETS SUER - ST CHOICE LANCETS THIN - ST CHOICE LANCETS ULTRA - ST CHOICE EN NEEDLES 3 - insulin pen needle 3 g x 6 mm (/4") ST CHOICE EN NEEDLES 3 - insulin pen needle 3 g x 8 mm (/3" or 5/6") ST TIER UNIFINE ENTIS - insulin pen needle 9 g x mm (/") ST TIER UNIFINE ENTIS - insulin pen needle 3 g x 5 mm (3/6") ST TIER UNIFINE ENTIS - insulin pen needle 3 g x 6 mm (/4") ST TIER UNIFINE ENTIS - insulin pen needle 3 g x 8 mm (/3" or 5/6") ST TIER UNIFINE ENTIS - insulin pen needle 3 g x 4 mm (5/3") ST TIER UNILET COMFORTOU - VARIAS CLASES azathioprine tab 50 mg (Imuran) CURIMINE - penicillamine cap 50 mg cyclosporine cap 5 mg (Sandimmune) cyclosporine cap 00 mg (Sandimmune) CYCLOSORINE MODIFIED - cyclosporine modified cap 50 mg cyclosporine modified cap 5 mg (Neoral) cyclosporine modified cap 00 mg (Neoral) cyclosporine modified oral soln 00 mg/ml (Neoral) irrigation solution, physiological lactated ringer's for irrigation mycophenolate mofetil cap 50 mg (Cellcept) mycophenolate mofetil for oral susp 00 mg/ml (Cellcept) mycophenolate mofetil tab 500 mg (Cellcept) mycophenolate sodium tab dr 80 mg (mycophenolic acid equiv) (Myfortic) mycophenolate sodium tab dr 360 mg (mycophenolic acid equiv) (Myfortic) HYSIOSOL IRRIGATION H 7 - irrigation solution, physiological RAAMUNE - sirolimus oral soln mg/ ml 3 REVLIMID - lenalidomide caps.5 mg REVLIMID - lenalidomide cap 5 mg 4 Guia de medicinas ValueScript de Florida Blue para enero de 06

126 06 REVLIMID - lenalidomide cap 0 mg REVLIMID - lenalidomide cap 5 mg REVLIMID - lenalidomide cap 0 mg REVLIMID - lenalidomide cap 5 mg ringer's solution for irrigation sirolimus tab 0.5 mg (Rapamune) sirolimus tab mg (Rapamune) sirolimus tab mg (Rapamune) sodium polystyrene sulfonate oral susp 5 gm/60ml (Sps) sodium polystyrene sulfonate powder (Kayexalate) sodium polystyrene sulfonate rectal susp 30 gm/0ml SYRINE - trientine hcl cap 50 mg 3 tacrolimus cap 0.5 mg (rograf) tacrolimus cap mg (rograf) tacrolimus cap 5 mg (rograf) THALOMID - thalidomide cap 50 mg THALOMID - thalidomide cap 00 mg THALOMID - thalidomide cap 50 mg THALOMID - thalidomide cap 00 mg water for irrigation, sterile irrigation soln ZORTRESS - everolimus tab 0.5 mg ZORTRESS - everolimus tab 0.5 mg ZORTRESS - everolimus tab 0.75 mg Guia de medicinas ValueScript de Florida Blue para enero de 06 5

127 06 INDEX A abacavir sulfate-lamivudine-zidovudine tab mg (Trizivir)... 4 abacavir sulfate tab 300 mg (base equiv) (Ziagen)... 4 ABILIFY -aripiprazole tab mg... 4 ABILIFY -aripiprazole tab 5 mg... 4 ABILIFY -aripiprazole tab 0 mg... 4 ABILIFY -aripiprazole tab 5 mg... 4 ABILIFY -aripiprazole tab 0 mg... 4 ABILIFY -aripiprazole tab 30 mg... 4 acamprosate calcium tab delayed release 333 mg acarbose tab 5 mg (recose)...8 acarbose tab 50 mg (recose)...8 acarbose tab 00 mg (recose)...8 AU-CHEK FASTCLIX LANCET AU-CHEK FASTCLIX LANCET - kit...76 AU-CHEK MULTICLIX LANCE AU-CHEK MULTICLIX LANC - kit...76 AU-CHEK SAFE-T-RO LANC AU-CHEK SAFE-T-RO LUS AU-CHEK SOFTCLIX LANCET -lancet devices AU-CHEK SOFTCLIX LANCET AU-CHEK SOFTCLIX LANCET - kit...76 AU-CHEK SOFT TOUCH LANC acebutolol hcl cap 00 mg (Sectral)... 3 acebutolol hcl cap 400 mg (Sectral)... 3 acetaminophen-isometheptene-dichloral cap mg...5 acetaminophen w/ codeine soln 0- mg/5ml...48 acetaminophen w/ codeine tab mg (Tylenol/ codeine) acetaminophen w/ codeine tab mg (Tylenol/ codeine #3) acetaminophen w/ codeine tab mg (Tylenol/ codeine #4) ACETAZOLAMIDE -acetazolamide tab 5 mg... 9 acetazolamide cap sr hr 500 mg (Diamox)...9 acetazolamide tab 50 mg... 9 ACETIC ACID/ALUMINUM ACET -acetic acid % in aluminum acetate otic soln... 7 acetic acid irrigation soln 0.5% acetic acid otic soln %... 7 acetylcysteine cap 600 mg...64 acetylcysteine inhal soln 0%... 3 acetylcysteine inhal soln 0%... 3 acitretin cap 0 mg (Soriatane)... 7 acitretin cap 7.5 mg (Soriatane)... 7 acitretin cap 5 mg (Soriatane)... 7 ACTEMRA -tocilizumab subcutaneous soln prefilled syringe 6 mg/0.9ml...5 ACTHIB -haemophilus b polysaccharide conjugate vaccine for inj... 8 ACTI-LANCE LANCETS 8G ACTI-LANCE LITE SAFETY LA ACTI-LANCE SECIAL SAFETY ACTI-LANCE UNIVERSAL SAFE ACTIMMUNE -interferon gamma-b inj 00 mcg/0.5ml ( unit/0.5ml)... ACTIVE OB -prenatal w/o a w/fe cbn-fa-dha cap mg acyclovir cap 00 mg (Zovirax)... 4 acyclovir oint 5% (Zovirax)... 7 acyclovir susp 00 mg/5ml (Zovirax)...4 acyclovir tab 400 mg (Zovirax)... 4 acyclovir tab 800 mg (Zovirax)... 4 ADACEL -tet tox-diph-acell pertuss ad inj lf-lfmcg/0.5ml...0 adapalene cream 0.% (Differin)... 7 adapalene gel 0.% (Differin)...7 adapalene gel 0.3% (Differin)...7 adefovir dipivoxil tab 0 mg (Hepsera)...4 ADEMAS -riociguat tab 0.5 mg... 3 ADEMAS -riociguat tab mg... 3 ADEMAS -riociguat tab.5 mg... 3 ADEMAS -riociguat tab mg... 3 ADEMAS -riociguat tab.5 mg... 3 ADJUSTABLE LANCING DEVICE -lancet devices ADVATE -antihemophilic factor rahf-pfm for inj 50 unit...66 ADVATE -antihemophilic factor rahf-pfm for inj 500 unit...66 ADVATE -antihemophilic factor rahf-pfm for inj 000 unit...66 ADVATE -antihemophilic factor rahf-pfm for inj 500 unit...66 ADVATE -antihemophilic factor rahf-pfm for inj 000 unit...66 ADVATE -antihemophilic factor rahf-pfm for inj 3000 unit...66 ADVATE -antihemophilic factor rahf-pfm for inj 4000 unit...66 ADVOCATE INSULIN EN NEED -insulin pen needle 9 g x.7 mm...76 ADVOCATE INSULIN EN NEED -insulin pen needle 3 g x 5 mm (3/6")...76 ADVOCATE INSULIN EN NEED -insulin pen needle 3 g x 8 mm (/3" or 5/6")...76 ADVOCATE INSULIN SYRINGE/ -insulin syringe/needle u-00 / ml ADVOCATE INSULIN SYRINGE/ -insulin syringe/needle u-00 / ml 9 x /" Guia de medicinas ValueScript de Florida Blue para enero de 06

128 06 ADVOCATE INSULIN SYRINGE/ -insulin syringe/needle u-00 / ml ADVOCATE INSULIN SYRINGE/ -insulin syringe/needle u ml 9 x /" ADVOCATE INSULIN SYRINGE/ -insulin syringe/needle u ml ADVOCATE INSULIN SYRINGE/ -insulin syringe/needle u-00 ml 9 x /" ADVOCATE INSULIN SYRINGE/ -insulin syringe/needle u-00 ml ADVOCATE INSULIN SYRINGE/ -insulin syringe/needle u-00 ml ADVOCATE INSULIN SYRINGE/ -insulin syringe/needle u ml ADVOCATE LANCETS 30G ADVOCATE LANCETS ADVOCATE LANCING DEVICE -lancet devices ADVOCATE RAID-SAFE LANCI -lancet devices ADVOCATE SAFETY LANCETS ADVOCATE SAFETY LANCETS AFINITOR DISERZ -everolimus tab for oral susp mg... AFINITOR DISERZ -everolimus tab for oral susp 3 mg... AFINITOR DISERZ -everolimus tab for oral susp 5 mg... AFINITOR -everolimus tab.5 mg... AFINITOR -everolimus tab 5 mg... AFINITOR -everolimus tab 7.5 mg... AFINITOR -everolimus tab 0 mg... AF LANCETS SUER THIN AFLURIA 0-0 -influenza virus vaccine split im susp...8 AFLURIA influenza virus vaccine split im susp...8 AFLURIA influenza virus vaccine split im susp...8 AFLURIA influenza virus vaccine split im susp...8 AFLURIA F 0-0 -influenza virus vaccine split pf susp pref syringe 0.5 ml...8 AFLURIA F influenza virus vaccine split pf susp pref syringe 0.5 ml...8 AFLURIA F influenza virus vaccine split pf susp pref syringe 0.5 ml...8 AFLURIA F influenza virus vaccine split pf susp pref syringe 0.5 ml...8 AGAMATRIX ULTRA-THIN LANC AGGRENOX -aspirin-dipyridamole cap sr hr 5-00 mg ALBENZA -albendazole tab 00 mg...7 albuterol sulfate soln nebu 0.083% (.5 mg/3ml) albuterol sulfate soln nebu 0.5% (5 mg/ ml) albuterol sulfate soln nebu 0.63 mg/3ml (base equiv)...33 albuterol sulfate soln nebu.5 mg/3ml (base equiv)...33 albuterol sulfate syrup mg/5ml albuterol sulfate tab mg albuterol sulfate tab 4 mg albuterol sulfate tab sr hr 4 mg (Vospire er)...33 albuterol sulfate tab sr hr 8 mg (Vospire er)...33 alclometasone dipropionate cream 0.05% (Aclovate)...7 alclometasone dipropionate oint 0.05%... 7 alendronate sodium tab 5 mg... alendronate sodium tab 0 mg... alendronate sodium tab 35 mg... alendronate sodium tab 70 mg (Fosamax)... alfuzosin hcl tab sr 4hr 0 mg (Uroxatral)...38 ALINIA -nitazoxanide for susp 00 mg/5ml... 7 ALINIA -nitazoxanide tab 500 mg...7 ALKERAN -melphalan tab mg... allopurinol tab 00 mg (Zyloprim)...53 allopurinol tab 300 mg (Zyloprim)...53 ALOCRIL -nedocromil sodium ophth soln % ALOMIDE -lodoxamide tromethamine ophth soln 0.% alosetron hcl tab 0.5 mg (base equiv) (Lotronex) alosetron hcl tab mg (base equiv) (Lotronex) ALHANATE/VON WILLEBRAND -antihemophilic factor/ vwf (human) for inj 50 unit ALHANATE/VON WILLEBRAND -antihemophilic factor/ vwf (human) for inj 500 unit ALHANATE/VON WILLEBRAND -antihemophilic factor/ vwf (human) for inj 000 unit ALHANATE/VON WILLEBRAND -antihemophilic factor/ vwf (human) for inj 500 unit ALHANATE/VON WILLEBRAND -antihemophilic factor/ vwf (human) for inj 000 unit ALHANINE SD -coagulation factor ix for inj 500 unit...66 ALHANINE SD -coagulation factor ix for inj 000 unit...66 ALHANINE SD -coagulation factor ix for inj 500 unit...66 alprazolam orally disintegrating tab 0.5 mg alprazolam orally disintegrating tab mg...39 alprazolam orally disintegrating tab mg...39 alprazolam orally disintegrating tab 0.5 mg (Niravam)...39 alprazolam tab 0.5 mg (Xanax) alprazolam tab 0.5 mg (Xanax) alprazolam tab mg (Xanax) Guia de medicinas ValueScript de Florida Blue para enero de 06 7

129 06 alprazolam tab mg (Xanax) alprazolam tab sr 4hr 0.5 mg (Xanax xr)...39 alprazolam tab sr 4hr mg (Xanax xr)...39 alprazolam tab sr 4hr mg (Xanax xr)...39 alprazolam tab sr 4hr 3 mg (Xanax xr)...39 ALROLIX -coagulation factor ix (recomb) (rfixfc) for inj 500 unit ALROLIX -coagulation factor ix (recomb) (rfixfc) for inj 000 unit ALROLIX -coagulation factor ix (recomb) (rfixfc) for inj 000 unit ALROLIX -coagulation factor ix (recomb) (rfixfc) for inj 3000 unit ALREX -loteprednol etabonate ophth susp 0.% ALTERNATE SITE LANCING DE -lancet devices ALVESCO -ciclesonide inhal aerosol 80 mcg/ act...33 ALVESCO -ciclesonide inhal aerosol 60 mcg/ act...33 AMANTADINE HCL -amantadine hcl tab 00 mg amantadine hcl cap 00 mg...55 amantadine hcl syrup 50 mg/5ml amiloride & hydrochlorothiazide tab 5-50 mg... 9 amiloride hcl tab 5 mg...9 amiodarone hcl tab 00 mg... 5 amiodarone hcl tab 400 mg... 5 amiodarone hcl tab 00 mg (Cordarone)...5 AMITIZA -lubiprostone cap 8 mcg AMITIZA -lubiprostone cap 4 mcg amitriptyline hcl tab 0 mg amitriptyline hcl tab 5 mg amitriptyline hcl tab 50 mg amitriptyline hcl tab 75 mg amitriptyline hcl tab 00 mg amitriptyline hcl tab 50 mg amlodipine besylate-atorvastatin calcium tab.5-0 mg (Caduet)...3 amlodipine besylate-atorvastatin calcium tab.5-0 mg (Caduet)...3 amlodipine besylate-atorvastatin calcium tab.5-40 mg (Caduet)...3 amlodipine besylate-atorvastatin calcium tab 5-0 mg (Caduet)...3 amlodipine besylate-atorvastatin calcium tab 5-0 mg (Caduet)...3 amlodipine besylate-atorvastatin calcium tab 5-40 mg (Caduet)...3 amlodipine besylate-atorvastatin calcium tab 5-80 mg (Caduet)...3 amlodipine besylate-atorvastatin calcium tab 0-0 mg (Caduet)...3 amlodipine besylate-atorvastatin calcium tab 0-0 mg (Caduet)...3 amlodipine besylate-atorvastatin calcium tab 0-40 mg (Caduet)...3 amlodipine besylate-atorvastatin calcium tab 0-80 mg (Caduet)...3 amlodipine besylate-benazepril hcl cap.5-0 mg (Lotrel)...6 amlodipine besylate-benazepril hcl cap 5-0 mg (Lotrel)...6 amlodipine besylate-benazepril hcl cap 5-0 mg (Lotrel)...6 amlodipine besylate-benazepril hcl cap 5-40 mg (Lotrel)...6 amlodipine besylate-benazepril hcl cap 0-0 mg (Lotrel)...6 amlodipine besylate-benazepril hcl cap 0-40 mg (Lotrel)...6 amlodipine besylate tab.5 mg (Norvasc)...4 amlodipine besylate tab 5 mg (Norvasc)...4 amlodipine besylate tab 0 mg (Norvasc)...4 amlodipine besylate-valsartan tab 5-60 mg (Exforge)... 6 amlodipine besylate-valsartan tab 5-30 mg (Exforge)... 6 amlodipine besylate-valsartan tab 0-60 mg (Exforge)... 6 amlodipine besylate-valsartan tab 0-30 mg (Exforge)... 6 amlodipine-valsartan-hydrochlorothiazide tab mg (Exforge hct)... 6 amlodipine-valsartan-hydrochlorothiazide tab mg (Exforge hct)...6 amlodipine-valsartan-hydrochlorothiazide tab mg (Exforge hct)... 6 amlodipine-valsartan-hydrochlorothiazide tab mg (Exforge hct)... 6 amlodipine-valsartan-hydrochlorothiazide tab mg (Exforge hct)... 6 AMOXAINE -amoxapine tab 5 mg AMOXAINE -amoxapine tab 50 mg AMOXAINE -amoxapine tab 00 mg AMOXAINE -amoxapine tab 50 mg amoxicillin & k clavulanate chew tab mg... amoxicillin & k clavulanate chew tab mg... amoxicillin & k clavulanate for susp mg/5ml... amoxicillin & k clavulanate for susp mg/5ml... amoxicillin & k clavulanate for susp mg/5ml (Augmentin)... amoxicillin & k clavulanate for susp mg/5ml (Augmentin es-600)... amoxicillin & k clavulanate tab 50-5 mg... amoxicillin & k clavulanate tab mg (Augmentin)... 8 Guia de medicinas ValueScript de Florida Blue para enero de 06

130 06 amoxicillin & k clavulanate tab mg (Augmentin)... amoxicillin & k clavulanate tab sr hr mg (Augmentin xr)... AMOXICILLIN -amoxicillin (trihydrate) chew tab 50 mg... amoxicillin cap-clarithro tab-lansopraz cap dr therapy pack (revpac) amoxicillin (trihydrate) cap 50 mg... amoxicillin (trihydrate) cap 500 mg... amoxicillin (trihydrate) for susp 5 mg/5ml... amoxicillin (trihydrate) for susp 00 mg/5ml... amoxicillin (trihydrate) for susp 50 mg/5ml... amoxicillin (trihydrate) for susp 400 mg/5ml... amoxicillin (trihydrate) tab 500 mg... amoxicillin (trihydrate) tab 875 mg... amphetamine-dextroamphetamine cap sr 4hr 5 mg (Adderall xr)...44 amphetamine-dextroamphetamine cap sr 4hr 0 mg (Adderall xr)...44 amphetamine-dextroamphetamine cap sr 4hr 5 mg (Adderall xr)...44 amphetamine-dextroamphetamine cap sr 4hr 0 mg (Adderall xr)...44 amphetamine-dextroamphetamine cap sr 4hr 5 mg (Adderall xr)...44 amphetamine-dextroamphetamine cap sr 4hr 30 mg (Adderall xr)...44 amphetamine-dextroamphetamine tab 5 mg (Adderall) amphetamine-dextroamphetamine tab 7.5 mg (Adderall) amphetamine-dextroamphetamine tab 0 mg (Adderall) amphetamine-dextroamphetamine tab.5 mg (Adderall) amphetamine-dextroamphetamine tab 5 mg (Adderall) amphetamine-dextroamphetamine tab 0 mg (Adderall) amphetamine-dextroamphetamine tab 30 mg (Adderall) AMICILLIN -ampicillin for susp 5 mg/5ml... AMICILLIN -ampicillin for susp 50 mg/5ml... ampicillin cap 50 mg... ampicillin cap 500 mg... AMYRA -dalfampridine tab sr hr 0 mg ANADROL-50 -oxymetholone tab 50 mg... 5 anagrelide hcl cap mg...66 anagrelide hcl cap 0.5 mg (Agrylin)...66 anastrozole tab mg (Arimidex)... ANDRODERM -testosterone td patch 4hr mg/4hr... 5 ANDRODERM -testosterone td patch 4hr 4 mg/4hr... 5 ANDROGEL UM -testosterone td gel.5 mg/act (%)...5 ANDROGEL UM -testosterone td gel 0.5 mg/act (.6%)...5 ANDROGEL -testosterone td gel 5 mg/.5gm (%)...5 ANDROGEL -testosterone td gel 50 mg/5gm (%)...5 ANDROGEL -testosterone td gel 0.5 mg/.5gm (.6%)...5 ANDROGEL -testosterone td gel 40.5 mg/.5gm (.6%)...5 ANDROID -methyltestosterone cap 0 mg...6 ANDROXY -fluoxymesterone tab 0 mg... 6 antipyrine-benzocaine otic soln 54-4 mg/ml (5.4-.4%)... 7 antipyrine-benzocaine-polycosanol otic sol % (Treagan otic)...7 ANTI-STICK INSULIN SYRING -insulin syringe/needle u-00 / ml 8 x /" ANTI-STICK INSULIN SYRING -insulin syringe/needle u-00 / ml 9 x /" ANTI-STICK INSULIN SYRING -insulin syringe/needle u-00 ml 9 x /" ANTI-STICK TUBERCULIN SYR -tuberculin/allergy syringe/needle (disp) ml 5 x 5/8" ANTI-STICK TUBERCULIN SYR -tuberculin/allergy syringe/needle (disp) ml 7 x /" ANZEMET -dolasetron mesylate tab 50 mg ANZEMET -dolasetron mesylate tab 00 mg AIDRA -insulin glulisine inj 00 unit/ml...0 AIDRA SOLOSTAR -insulin glulisine soln pen-injector inj 00 unit/ml... 0 apraclonidine hcl ophth soln 0.5% (base equivalent) (Iopidine) ATIVUS -tipranavir cap 50 mg... 4 ATIVUS -tipranavir oral soln 00 mg/ml...4 AQUA LANCE ADJUSTABLE LAN -lancet devices ARANES ALBUMIN FREE -darbepoetin alfa-polysorbate 80 soln inj 0 mcg/0.4ml ARANES ALBUMIN FREE -darbepoetin alfa-polysorbate 80 soln inj 5 mcg/ml ARANES ALBUMIN FREE -darbepoetin alfa-polysorbate 80 soln inj 5 mcg/0.4ml ARANES ALBUMIN FREE -darbepoetin alfa-polysorbate 80 soln inj 40 mcg/ml ARANES ALBUMIN FREE -darbepoetin alfa-polysorbate 80 soln inj 40 mcg/0.4ml ARANES ALBUMIN FREE -darbepoetin alfa-polysorbate 80 soln inj 60 mcg/ml ARANES ALBUMIN FREE -darbepoetin alfa-polysorbate 80 soln inj 60 mcg/0.3ml ARANES ALBUMIN FREE -darbepoetin alfa-polysorbate 80 soln inj 00 mcg/ml Guia de medicinas ValueScript de Florida Blue para enero de 06 9

131 06 ARANES ALBUMIN FREE -darbepoetin alfa-polysorbate 80 soln inj 00 mcg/0.5ml ARANES ALBUMIN FREE -darbepoetin alfa-polysorbate 80 soln inj 50 mcg/0.3ml ARANES ALBUMIN FREE -darbepoetin alfa-polysorbate 80 soln inj 00 mcg/ml ARANES ALBUMIN FREE -darbepoetin alfa-polysorbate 80 soln inj 00 mcg/0.4ml ARANES ALBUMIN FREE -darbepoetin alfa-polysorbate 80 soln inj 300 mcg/ml ARANES ALBUMIN FREE -darbepoetin alfa-polysorbate 80 soln inj 300 mcg/0.6ml ARANES ALBUMIN FREE -darbepoetin alfa-polysorbate 80 soln inj 500 mcg/ml ARCATA NEOHALER -indacaterol maleate inhal powder cap 75 mcg (base equiv) ARIMIDEX -anastrozole tab mg... aripiprazole tab mg (Abilify)... 4 aripiprazole tab 5 mg (Abilify)... 4 aripiprazole tab 0 mg (Abilify)... 4 aripiprazole tab 5 mg (Abilify)... 4 aripiprazole tab 0 mg (Abilify)... 4 aripiprazole tab 30 mg (Abilify)... 4 AROMASIN -exemestane tab 5 mg... ASACOL HD -mesalamine tab delayed release 800 mg ASCENSIA AUTODISC TEST ST -glucose blood test disk aspirin chew tab 8 mg...48 aspirin tab delayed release 8 mg ASSURE COMFORT LANCETS UL ASSURE HAEMOLANCE LUS HI ASSURE HAEMOLANCE LUS LO ASSURE HAEMOLANCE LUS MI ASSURE HAEMOLANCE LUS NO ASSURE HAEMOLANCE LUS E ASSURE ID INSULIN SAFETY -insulin syringe/needle u-00 / ml 9 x /" ASSURE ID INSULIN SAFETY -insulin syringe/needle u-00 ml 9 x /" ASSURE LANCE LANCETS G ASSURE LANCE LANCETS ASSURE LANCE LUS SAFETY ASSURE LANCETS ATABEX EC -prenatal vit w/ dss-iron carbonyl-fa tab dr 9- mg...57 atenolol & chlorthalidone tab 50-5 mg (Tenoretic 50)... 6 atenolol & chlorthalidone tab 00-5 mg (Tenoretic 00)... 6 atenolol tab 5 mg (Tenormin)... 3 atenolol tab 50 mg (Tenormin)... 3 atenolol tab 00 mg (Tenormin)... 3 AT LAST LANCETS atorvastatin calcium tab 0 mg (base equivalent) (Lipitor)...30 atorvastatin calcium tab 0 mg (base equivalent) (Lipitor)...30 atorvastatin calcium tab 40 mg (base equivalent) (Lipitor)...30 atorvastatin calcium tab 80 mg (base equivalent) (Lipitor)...30 atovaquone-proguanil hcl tab mg (Malarone)... 7 atovaquone-proguanil hcl tab mg (Malarone)... 7 atovaquone susp 750 mg/5ml (Mepron)... 7 ATRILA -efavirenz-emtricitabine-tenofovir df tab mg... 4 ATROINE SULFATE -atropine sulfate ophth oint % atropine sulfate ophth soln % (Isopto atropine)...69 ATROVENT HFA -ipratropium bromide hfa inhal aerosol 7 mcg/act AUBAGIO -teriflunomide tab 7 mg AUBAGIO -teriflunomide tab 4 mg AUGMENTIN -amoxicillin & k clavulanate for susp mg/5ml... AURORA LANCET SUER THIN AURORA LANCET THIN 3G AURORA EN NEEDLES 9GX -insulin pen needle 9 g x mm (/") AURORA EN NEEDLES 3G X -insulin pen needle 3 g x 6 mm (/4")...77 AURORA EN NEEDLES 3G X -insulin pen needle 3 g x 8 mm (/3" or 5/6")...77 AURORA UNIFINE ENTIS/3 -insulin pen needle 3 g x 4 mm (5/3")...77 AURORA UNIFINE ENTIS/MI -insulin pen needle 3 g x 5 mm (3/6")...77 AUTO-LANCET -lancet devices AUTO-LANCET MINI -lancet devices...77 AUTOLET IMRESSION -lancet devices AUTOLET IMRESSION LANCIN -lancet devices AUTOLET MINI -lancet devices...78 AVC -sulfanilamide vaginal cream 5% AVODART -dutasteride cap 0.5 mg AXERT -almotriptan malate tab 6.5 mg...5 AXERT -almotriptan malate tab.5 mg...5 azathioprine tab 50 mg (Imuran)... 4 azelastine hcl nasal spray 0.% (37 mcg/ spray)...3 azelastine hcl nasal spray 0.5% (05.5 mcg/spray) (Astepro)... 3 azelastine hcl ophth soln 0.05%...69 AZILECT -rasagiline mesylate tab 0.5 mg (base equiv)...55 AZILECT -rasagiline mesylate tab mg (base equiv)...55 azithromycin for susp 00 mg/5ml (Zithromax)... 0 Guia de medicinas ValueScript de Florida Blue para enero de 06

132 06 azithromycin for susp 00 mg/5ml (Zithromax)... azithromycin tab 50 mg (Zithromax)... azithromycin tab 500 mg (Zithromax)... azithromycin tab 600 mg (Zithromax)... AZOT -brinzolamide ophth susp % B BACITRACIN -bacitracin ophth oint 500 unit/ gm bacitracin-polymyxin b ophth oint...69 bacitracin-polymyxin-neomycin-hc ophth oint % baclofen tab 0 mg baclofen tab 0 mg BAL-CARE DHA -prenat w/fe poly-na fered-fa tab 7- & omega cap dr 430mg balsalazide disodium cap 750 mg (Colazal) BARACLUDE -entecavir oral soln 0.05 mg/ml... 4 BAYER BREEZE BLOOD GLUC -blood glucose monitoring kit w/ device...78 BAYER BREEZE TEST DISC -glucose blood test disk BAYER CONTOUR BLOOD GLUCO -blood glucose monitoring kit w/ device...78 BAYER CONTOUR BLOOD GLUCO -glucose blood test strip...76 BAYER CONTOUR LINK BLOOD -blood glucose monitoring kit w/ device...78 BAYER CONTOUR NEXT BLOOD -blood glucose monitoring kit w/ device...78 BAYER CONTOUR NEXT BLOOD -glucose blood test strip...76 BAYER CONTOUR NEXT EZ BLO -blood glucose monitoring kit w/ device...78 BAYER CONTOUR NEXT LINK B -blood glucose monitoring kit w/ device...78 BAYER CONTOUR NEXT LINK W -blood glucose monitoring kit w/ device...78 BAYER CONTOUR NEXT USB BL -blood glucose monitoring kit w/ device...78 BAYER CONTOUR USB BLOOD G -blood glucose monitoring kit w/ device...78 BAYER MICROLET LANCETS BAYER MICROLET LANCING -lancet devices BD ALLERGY/SYRINGE/NEEDLE -tuberculin/allergy syringe/needle (disp) ml 8 x /" BD ALLERGY/SYRINGE NEEDLE -tuberculin/allergy syringe/needle (disp) ml 8 x /" BD AUTOSHIELD DUO 30G X 3 -insulin pen needle 30 g x 5 mm (3/6")...78 BD AUTOSHIELD 9G X 3/6" -insulin pen needle 9 g x 5 mm (3/6")...78 BD AUTOSHIELD 9G X 5/6" -insulin pen needle 9 g x 8 mm (5/6")...78 BD DISOSABLE NEEDLE/30GX -needle (disp) 30 x " BD DISOSABLE NEEDLE 7GX -needle (disp) 7 x -/4"...78 BD DISOSABLE NEEDLE 3GX -needle (disp) 3 x " BD DISOSABLE NEEDLE REGU -needle (disp) 5 x " BD ECLISE 8G X -/" -needle (disp) 8 x -/"...78 BD ECLISE NEEDLE/G X -needle (disp) x -/"...78 BD ECLISE NEEDLE/5G X -needle (disp) 5 x 5/8" BD ECLISE NEEDLE 5GX" -needle (disp) 5 x " BD ECLISE NEEDLE 5G X -needle (disp) 5 x -/"...78 BD ECLISE NEEDLE 30G X -needle (disp) 30 x /" BD HYODERMIC NEEDLE REGU -needle (disp) 8 x -/"...78 BD HYODERMIC NEEDLE REGU -needle (disp) x -/"...78 BD HYODERMIC NEEDLE REGU -needle (disp) 3 x -/"...78 BD HYODERMIC NEEDLE REGU -needle (disp) 5 x 5/8" BD HYODERMIC NEEDLE REGU -needle (disp) x " BD INSULIN SYRINGE/DETACH -insulin syringe/needle u-00 ml 5 x 5/8" BD INSULIN SYRINGE/DETACH -insulin syringe/needle u-00 ml 6 x /" BD INSULIN SYRINGE/DETACH -insulin syringe/needle u-00 ml 5 x " BD INSULIN SYRINGE/U-00/ -insulin syringe/needle u-00 / ml 30 x /" BD INSULIN SYRINGE/U-00/ -insulin syringe/needle u-00 ml 7 x /" BD INSULIN SYRINGE/U-00/ -insulin syringe/needle u-00 ml 8 x /" BD INSULIN SYRINGE/U-00/ -insulin syringe/needle u-00 ml 7.5 x 5/8" BD INSULIN SYRINGE/U-00/ -insulin syringe/needle u-00 ml 9 x /" BD INSULIN SYRINGE LUER-L -insulin syringe (disp) u-00 ml BD INSULIN SYRINGE MICROF -insulin syringe/needle u-00 / ml 8 x /" BD INSULIN SYRINGE MICROF -insulin syringe/needle u ml 8 x /" BD INSULIN SYRINGE MICROF -insulin syringe/needle u-00 ml 7 x 5/8" BD INSULIN SYRINGE MICROF -insulin syringe/needle u-00 ml 8 x /" Guia de medicinas ValueScript de Florida Blue para enero de 06

133 06 B-D INSULIN SYRINGE MICRO -insulin syringe/needle u-00 ml 8 x /" BD INSULIN SYRINGE SAFETY -insulin syringe/needle u-00 / ml 9 x /" BD INSULIN SYRINGE SAFETY -insulin syringe/needle u-00 ml 9 x /" BD INSULIN SYRINGE SAFETY -insulin syringe/needle u ml BD INSULIN SYRINGE SLI T -insulin syringe (disp) u-00 ml BD INSULIN SYRINGE U-40/ -insulin syringe/needle u-40 ml 5 x 5/8" BD INSULIN SYRINGE ULTRAF -insulin syringe/needle u-00 / ml BD INSULIN SYRINGE ULTRAF -insulin syringe/needle u-00 / ml 9 x /" BD INSULIN SYRINGE ULTRAF -insulin syringe/needle u-00 / ml 30 x /" BD INSULIN SYRINGE ULTRAF -insulin syringe/needle u-00 / ml 3 x 5/64" BD INSULIN SYRINGE ULTRAF -insulin syringe/needle u ml 9 x /" BD INSULIN SYRINGE ULTRAF -insulin syringe/needle u ml 30 x /" BD INSULIN SYRINGE ULTRAF -insulin syringe/needle u ml 3 x 5/64" BD INSULIN SYRINGE ULTRAF -insulin syringe/needle u-00 ml 9 x /" BD INSULIN SYRINGE ULTRAF -insulin syringe/needle u-00 ml 30 x /" BD INSULIN SYRINGE ULTRAF -insulin syringe/needle u-00 ml BD INSULIN SYRINGE ULTRAF -insulin syringe/needle u ml BD INSULIN SYRINGE ULTRAF -insulin syringe/needle u-00 ml 3 x 5/64" B-D INSULIN SYRINGE ULTRA -insulin syringe/needle u ml 30 x /" B-D INSULIN SYRINGE ULTRA -insulin syringe/needle u-00 ml B-D INSULIN SYRINGE ULTRA -insulin syringe/needle u ml BD INTEGRA INSULIN SYRING -insulin syringe/needle u-00 ml 9 x /" BD INTEGRA SYRINGE/RETRAC -insulin syringe/needle u-00 ml 5 x " BD LANCET DEVICE -lancet devices BD LANCET ULTRAFINE 30G BD LANCET ULTRAFINE 33G BD LO-DOSE INSULIN SYRIN -insulin syringe/needle u-00 / ml 8 x /" BD MICROTAINER LANCETS BD ML TUBERCULIN SYRINGE -tuberculin/allergy syringe/needle (disp) ml 6 x 3/8" BD ML TUBERCULIN SYRINGE -tuberculin/allergy syringe/needle (disp) ml 7 x /" BD NEEDLE/8G -/" -needle (disp) 8 x -/"...80 BD NEEDLE/G -/" -needle (disp) x -/"...80 BD NEEDLE/G X -/" -needle (disp) x -/"...80 BD NEEDLE/5G X 5/8" -needle (disp) 5 x 5/8" BD NEEDLE/5G X 7/8" -needle (disp) 5 x 7/8" BD NEEDLE/7G X /" -needle (disp) 7 x /" BD NEEDLE/30G X /" -needle (disp) 30 x /" BD NEEDLE/0G X " -needle (disp) 0 x "...80 BD EN NEEDLE/MINI/ULTRAF -insulin pen needle 3 g x 5 mm (3/6")...80 BD EN NEEDLE/NANO/ULTRA -insulin pen needle 3 g x 4 mm (5/3")...80 BD EN NEEDLE/SHORT/ULTRA -insulin pen needle 3 g x 8 mm (/3" or 5/6") BD EN NEEDLE/ULTRAFINE/ -insulin pen needle 9 g x.7 mm...80 BD EN NEEDLES SHORT/ULTR -insulin pen needle 3 g x 8 mm (/3" or 5/6") BD LASTIAK SYRINGES ALL -tuberculin/allergy syringe/needle (disp) ml 8 x /" BD SAFETYGLIDE ALLERGY S -tuberculin/allergy syringe/needle (disp) ml 6 x 3/8" BD SAFETYGLIDE ALLERGY SY -tuberculin/allergy syringe/needle (disp) ml 7 x /" BD SAFETYGLIDE G X " -needle (disp) x " BD SAFETYGLIDE HYODERMIC -needle (disp) 5 x 5/8" BD SAFETYGLIDE INSULIN SY -insulin syringe/needle u-00 / ml BD SAFETY-LOK INSULIN SYR -insulin syringe/needle u-00 ml 9 x /" BEBULIN -factor ix complex for inj unit...66 BEBULIN VH -factor ix complex for inj unit...66 benazepril & hydrochlorothiazide tab mg... 6 benazepril & hydrochlorothiazide tab 0-.5 mg (Lotensin hct)...6 benazepril & hydrochlorothiazide tab 0-.5 mg (Lotensin hct)...6 benazepril & hydrochlorothiazide tab 0-5 mg (Lotensin hct)...6 benazepril hcl tab 5 mg...6 benazepril hcl tab 0 mg (Lotensin)... 6 benazepril hcl tab 0 mg (Lotensin)... 6 benazepril hcl tab 40 mg (Lotensin)... 6 BENEFIX -coagulation factor ix (recombinant) for inj 50 unit...66 Guia de medicinas ValueScript de Florida Blue para enero de 06

134 06 BENEFIX -coagulation factor ix (recombinant) for inj 500 unit...66 BENEFIX -coagulation factor ix (recombinant) for inj 000 unit...66 BENEFIX -coagulation factor ix (recombinant) for inj 000 unit...66 BENEFIX -coagulation factor ix (recombinant) for inj 3000 unit...67 BENICAR -olmesartan medoxomil tab 5 mg... 6 BENICAR -olmesartan medoxomil tab 0 mg... 6 BENICAR -olmesartan medoxomil tab 40 mg... 6 benzocaine dental soln 0%...7 benzonatate cap 00 mg... 3 benzonatate cap 00 mg (Tessalon perles)...3 benzonatate cap 50 mg (Zonatuss)...3 benzoyl peroxide cloth 6%...7 benzoyl peroxide-erythromycin gel 5-3% (Benzamycin)...7 benzoyl peroxide gel 5%...7 benzoyl peroxide gel 0%...7 benzoyl peroxide liq.5%...7 benzoyl peroxide liq 5.5%...7 benzoyl peroxide liq 7%...7 benzoyl peroxide liq 0%...7 benzoyl peroxide lotion 6%... 7 benztropine mesylate tab 0.5 mg benztropine mesylate tab mg benztropine mesylate tab mg BEREVE -bepotastine besilate ophth soln.5% BESIVANCE -besifloxacin hcl ophth susp 0.6% (base equiv)...69 BETADINE OHTHALMIC RE -povidone-iodine ophth soln 5% betamethasone dipropionate augmented cream 0.05% (Diprolene af)...7 betamethasone dipropionate augmented gel 0.05%... 7 betamethasone dipropionate augmented lotion 0.05% (Diprolene)... 7 betamethasone dipropionate augmented oint 0.05% (Diprolene)... 7 betamethasone dipropionate cream 0.05%... 7 betamethasone dipropionate lotion 0.05%... 7 betamethasone dipropionate oint 0.05%...7 betamethasone valerate aerosol foam 0.% (Luxiq)... 7 betamethasone valerate cream 0.%...7 betamethasone valerate lotion 0.%...7 betamethasone valerate oint 0.%...7 BETASERON -interferon beta-b for inj kit 0.3 mg betaxolol hcl ophth soln 0.5% betaxolol hcl tab 0 mg (Kerlone)...3 betaxolol hcl tab 0 mg (Kerlone)...3 bethanechol chloride tab 5 mg (Urecholine) bethanechol chloride tab 0 mg (Urecholine) bethanechol chloride tab 5 mg (Urecholine) bethanechol chloride tab 50 mg (Urecholine) BETHKIS -tobramycin nebu soln 300 mg/4ml... 3 BEXSERO -meningococcal vac b (recomb adsorbed) inj prefilled syringe...8 bicalutamide tab 50 mg (Casodex)... BILTRICIDE -praziquantel tab 600 mg... 7 bisacodyl tab & peg 3350-kcl-sod bicarb-nacl for soln kit bisoprolol & hydrochlorothiazide tab mg (Ziac)...7 bisoprolol & hydrochlorothiazide tab mg (Ziac)...7 bisoprolol & hydrochlorothiazide tab mg (Ziac)...7 bisoprolol fumarate tab 5 mg (Zebeta)... 3 bisoprolol fumarate tab 0 mg (Zebeta)... 3 B-NEXA -prenatal w/ calcium-vit b6-fa-ginger tab. mg BOOSTRIX -tet tox-diph-acell pertuss ad inj lflf-mcg/0.5ml...0 BOSULIF -bosutinib tab 00 mg... BOSULIF -bosutinib tab 500 mg... B FOLINATAL LUS B -prenatal w/ calcium carbonateb6-b-fa tab mg...57 B MULTINATAL LUS -prenatal w/o a vit w/ fe fumaratefa tab 30- mg...57 B MULTINATAL LUS -prenatal w/o a vit w/ fe fum-fa tab chew 40- mg...57 BREO ELLITA -fluticasone furoate-vilanterol aero powd ba 00-5 mcg/inh...33 BREO ELLITA -fluticasone furoate-vilanterol aero powd ba 00-5 mcg/inh...33 BRILINTA -ticagrelor tab 90 mg brimonidine tartrate ophth soln 0.% brimonidine tartrate ophth soln 0.5% (Alphagan p) bromfenac sodium ophth soln 0.09% (base equivalent) bromfenac sodium ophth soln 0.09% (base equiv) (once-daily)...69 bromocriptine mesylate cap 5 mg (arlodel)...55 bromocriptine mesylate tab.5 mg BROVANA -arformoterol tartrate soln nebu 5 mcg/ml (base equiv) budesonide cap sr 4hr 3 mg (Entocort ec)... 5 budesonide inhalation susp 0.5 mg/ml (ulmicort) Guia de medicinas ValueScript de Florida Blue para enero de 06 3

135 06 budesonide inhalation susp 0.5 mg/ml (ulmicort) BULLSEYE MINI SAFETY LANC BULLSEYE SAFETY LANCETS bumetanide tab 0.5 mg...9 bumetanide tab mg...9 bumetanide tab mg...9 buprenorphine hcl-naloxone hcl sl tab -0.5 mg (base equiv)...48 buprenorphine hcl-naloxone hcl sl tab 8- mg (base equiv)...48 buprenorphine hcl sl tab mg (base equiv)...48 buprenorphine hcl sl tab 8 mg (base equiv)...48 bupropion hcl (smoking deterrent) tab sr hr 50 mg (Zyban) bupropion hcl tab 75 mg (Wellbutrin)...40 bupropion hcl tab 00 mg (Wellbutrin)...40 bupropion hcl tab sr hr 00 mg (Wellbutrin sr)...40 bupropion hcl tab sr hr 50 mg (Wellbutrin sr)...40 bupropion hcl tab sr hr 00 mg (Wellbutrin sr)...40 bupropion hcl tab sr 4hr 50 mg (Wellbutrin xl) bupropion hcl tab sr 4hr 300 mg (Wellbutrin xl) buspirone hcl tab 5 mg buspirone hcl tab 7.5 mg buspirone hcl tab 0 mg buspirone hcl tab 5 mg buspirone hcl tab 30 mg butalbital-acetaminophen-caffeine cap mg butalbital-acetaminophen-caffeine tab mg (Esgic) butalbital-acetaminophen-caff w/ cod cap mg butalbital-acetaminophen tab mg butalbital-aspirin-caffeine cap mg (Fiorinal)...48 butalbital-aspirin-caff w/ codeine cap mg (Fiorinal/codeine #3)...48 butorphanol tartrate nasal soln 0 mg/ml BUTRANS -buprenorphine td patch weekly 5 mcg/ hr BUTRANS -buprenorphine td patch weekly 0 mcg/ hr BUTRANS -buprenorphine td patch weekly 5 mcg/ hr BUTRANS -buprenorphine td patch weekly 0 mcg/ hr BYDUREON -exenatide extended release for inj susp mg... 8 BYDUREON -exenatide extended release for susp peninjector mg...8 BYETTA -exenatide soln pen-injector 5 mcg/0.0ml...8 BYETTA -exenatide soln pen-injector 0 mcg/0.04ml...8 BYSTOLIC -nebivolol hcl tab.5 mg (base equivalent)...3 BYSTOLIC -nebivolol hcl tab 5 mg (base equivalent)...3 BYSTOLIC -nebivolol hcl tab 0 mg (base equivalent)...3 BYSTOLIC -nebivolol hcl tab 0 mg (base equivalent)...3 C cabergoline tab 0.5 mg... caffeine citrate oral soln 60 mg/3ml (0 mg/ml base equiv)...45 calcipotriene-betamethasone dipropionate oint % (Taclonex)... 7 calcipotriene cream 0.005% (Dovonex)... 7 calcipotriene oint 0.005%...7 calcipotriene soln 0.005% (50 mcg/ml)...7 calcitonin (salmon) nasal soln 00 unit/act (Miacalcin)... calcitriol cap 0.5 mcg (Rocaltrol)... calcitriol cap 0.5 mcg (Rocaltrol)... calcitriol oral soln mcg/ml (Rocaltrol)... calcium acetate (phosphate binder) cap 667 mg (69 mg ca) (hoslo) calcium acetate (phosphate binder) tab 667 mg (Eliphos)...37 CALCIUM NV -prenatal w/o vit a w/ fe fum-fa-omega 3 cap mg CANASA -mesalamine suppos 000 mg...37 candesartan cilexetil-hydrochlorothiazide tab 6-.5 mg (Atacand hct)...7 candesartan cilexetil-hydrochlorothiazide tab 3-.5 mg (Atacand hct)...7 candesartan cilexetil-hydrochlorothiazide tab 3-5 mg (Atacand hct)...7 candesartan cilexetil tab 4 mg (Atacand)...7 candesartan cilexetil tab 8 mg (Atacand)...7 candesartan cilexetil tab 6 mg (Atacand)...7 candesartan cilexetil tab 3 mg (Atacand)...7 CANTIL -mepenzolate bromide tab 5 mg capecitabine tab 50 mg (Xeloda)... capecitabine tab 500 mg (Xeloda)... CARELSA -vandetanib tab 00 mg... CARELSA -vandetanib tab 300 mg... CATORIL/HYDROCHLOROTHIA -captopril & hydrochlorothiazide tab 5-5 mg...7 CATORIL/HYDROCHLOROTHIA -captopril & hydrochlorothiazide tab 50-5 mg...7 captopril tab.5 mg...7 captopril tab 5 mg Guia de medicinas ValueScript de Florida Blue para enero de 06

136 06 captopril tab 50 mg...7 captopril tab 00 mg...7 CARAFATE -sucralfate susp gm/0ml CARBAGLU -carglumic acid tab 00 mg... carbamazepine cap sr hr 00 mg (Carbatrol)...53 carbamazepine cap sr hr 00 mg (Carbatrol)...53 carbamazepine cap sr hr 300 mg (Carbatrol)...53 carbamazepine chew tab 00 mg...53 carbamazepine susp 00 mg/5ml (Tegretol)...53 carbamazepine tab 00 mg (Tegretol) carbamazepine tab sr hr 00 mg (Tegretolxr)...53 carbamazepine tab sr hr 400 mg (Tegretolxr)...53 carbidopa & levodopa orally disintegrating tab 0-00 mg carbidopa & levodopa orally disintegrating tab 5-00 mg carbidopa & levodopa orally disintegrating tab 5-50 mg carbidopa & levodopa tab cr 5-00 mg (Sinemet cr)...55 carbidopa & levodopa tab cr mg (Sinemet cr)...55 carbidopa & levodopa tab 0-00 mg (Sinemet)...55 carbidopa & levodopa tab 5-00 mg (Sinemet)...55 carbidopa & levodopa tab 5-50 mg (Sinemet)...55 carbidopa tab 5 mg (Lodosyn) carbinoxamine maleate soln 4 mg/5ml...3 carbinoxamine maleate tab 4 mg... 3 carbonyl iron susp 5 mg/.5ml (elemental iron) CARDIOCOM LANCING DEVICE -lancet devices CAREFINE EN NEEDLE 3GX4 -insulin pen needle 3 g x 4 mm (5/3")...80 CAREFINE EN NEEDLES 9GX -insulin pen needle 9 g x mm (/")...80 CAREFINE EN NEEDLES 3GX -insulin pen needle 3 g x 6 mm (/4")...80 CAREFINE EN NEEDLES 3GX -insulin pen needle 3 g x 6 mm (/4")...8 CAREFINE EN NEEDLES 30GX -insulin pen needle 30 g x 8 mm (/3" or 5/6")...80 CAREFINE EN NEEDLES 3GX -insulin pen needle 3 g x 8 mm (/3" or 5/6")...8 CAREFINE EN NEEDLES 3GX -insulin pen needle 3 g x 5 mm (/5" or 3/6")...8 CAREONE ADVANCED LANCING -lancet devices... 8 CAREONE INSULIN SYRINGES/ -insulin syringe/needle u-00 / ml CAREONE INSULIN SYRINGES/ -insulin syringe/needle u-00 / ml 30 x /"... 8 CAREONE INSULIN SYRINGES/ -insulin syringe/needle u ml 30 x /"... 8 CAREONE INSULIN SYRINGES/ -insulin syringe/needle u-00 ml 30 x /"... 8 CAREONE INSULIN SYRINGES/ -insulin syringe/needle u-00 ml CAREONE INSULIN SYRINGES/ -insulin syringe/needle u ml CAREONE LANCET THIN CAREONE LANCET ULTRA THIN CAREONE ULTIGUARD INSULIN -insulin syringe/needle u-00 / ml 9 x /"... 8 CAREONE ULTIGUARD INSULIN -insulin syringe/needle u-00 / ml CAREONE ULTIGUARD INSULIN -insulin syringe/needle u ml 9 x /"... 8 CAREONE ULTIGUARD INSULIN -insulin syringe/needle u ml CAREONE ULTIGUARD INSULIN -insulin syringe/needle u-00 ml 9 x /"... 8 CAREONE ULTIGUARD INSULIN -insulin syringe/needle u-00 ml CAREONE UNIFINE ENTIS -insulin pen needle 9 g x mm (/")...8 CAREONE UNIFINE ENTIS 3 -insulin pen needle 3 g x 5 mm (3/6")...8 CAREONE UNIFINE ENTIS 3 -insulin pen needle 3 g x 6 mm (/4")...8 CAREONE UNIFINE ENTIS 3 -insulin pen needle 3 g x 8 mm (/3" or 5/6")...8 CAREONE UNIFINE ENTIS -insulin pen needle 9 g x mm (/")...8 CAREONE UNIFINE ENTIS -insulin pen needle 3 g x 5 mm (3/6")...8 CAREONE UNIFINE ENTIS -insulin pen needle 3 g x 6 mm (/4")...8 CAREONE UNIFINE ENTIS -insulin pen needle 3 g x 4 mm (5/3")...8 CAREONE UNIFINE ENTIS -insulin pen needle 3 g x 8 mm (/3" or 5/6")...8 carisoprodol tab 350 mg (Soma)...56 carteolol hcl ophth soln %...69 carvedilol tab 3.5 mg (Coreg)... 3 carvedilol tab 6.5 mg (Coreg)... 3 carvedilol tab.5 mg (Coreg)... 3 carvedilol tab 5 mg (Coreg)... 3 CASODEX -bicalutamide tab 50 mg... CAYA -diaphragm arc-spring...8 CAYSTON -aztreonam lysine for inhal soln 75 mg (base equivalent)...7 CEDAX -ceftibuten cap 400 mg... CEENU -lomustine cap 0 mg... CEENU -lomustine cap 40 mg... Guia de medicinas ValueScript de Florida Blue para enero de 06 5

137 06 CEENU -lomustine cap 00 mg... cefaclor cap 50 mg... cefaclor cap 500 mg... cefadroxil cap 500 mg... cefadroxil for susp 50 mg/5ml... cefadroxil for susp 500 mg/5ml... cefadroxil tab gm... cefdinir cap 300 mg... cefdinir for susp 5 mg/5ml... cefdinir for susp 50 mg/5ml... cefixime for susp 00 mg/5ml (Suprax)... cefixime for susp 00 mg/5ml (Suprax)... cefpodoxime proxetil for susp 50 mg/5ml... cefpodoxime proxetil for susp 00 mg/5ml... cefpodoxime proxetil tab 00 mg... cefpodoxime proxetil tab 00 mg... cefprozil for susp 5 mg/5ml... cefprozil for susp 50 mg/5ml... cefprozil tab 50 mg... cefprozil tab 500 mg... cefuroxime axetil tab 50 mg (Ceftin)... cefuroxime axetil tab 500 mg (Ceftin)... CELEBREX -celecoxib cap 00 mg... 5 CELEBREX -celecoxib cap 00 mg... 5 CELEBREX -celecoxib cap 400 mg... 5 celecoxib cap 50 mg (Celebrex)... 5 celecoxib cap 00 mg (Celebrex)... 5 celecoxib cap 00 mg (Celebrex)... 5 celecoxib cap 400 mg (Celebrex)... 5 CELONTIN -methsuximide cap 300 mg cephalexin cap 50 mg (Keflex)... cephalexin cap 500 mg (Keflex)... cephalexin cap 750 mg (Keflex)... cephalexin for susp 5 mg/5ml... cephalexin for susp 50 mg/5ml... CERVARIX -human papillomavirus (hpv) bival (type 6, 8) recmb vac inj...8 CESAMET -nabilone cap mg...36 cetirizine hcl oral soln mg/ml (5 mg/5ml)... 3 cevimeline hcl cap 30 mg (Evoxac)... 7 CHANTIX CONTINUING MONTH -varenicline tartrate tab mg (base equiv) CHANTIX STARTING MONTH A -varenicline tartrate tab 0.5 mg x & tab mg x 4 pack...46 CHANTIX -varenicline tartrate tab 0.5 mg (base equiv)...46 CHANTIX -varenicline tartrate tab mg (base equiv)...46 CHEMET -succimer cap 00 mg CHENODAL -chenodiol tab 50 mg chlordiazepoxide hcl cap 5 mg chlordiazepoxide hcl cap 0 mg chlordiazepoxide hcl cap 5 mg chlorhexidine gluconate soln 0.% (eridex)...7 chloroquine phosphate tab 50 mg... 7 chloroquine phosphate tab 500 mg (Aralen)...7 chlorothiazide tab 500 mg...9 chlorpheniramine w/ codeine liquid -0 mg/5ml...3 chlorpromazine hcl tab 0 mg...4 chlorpromazine hcl tab 5 mg...4 chlorpromazine hcl tab 50 mg...4 chlorpromazine hcl tab 00 mg...4 chlorpromazine hcl tab 00 mg...4 CHLORROAMIDE -chlorpropamide tab 00 mg... 8 CHLORROAMIDE -chlorpropamide tab 50 mg... 8 CHLORTHALIDONE -chlorthalidone tab 5 mg... 9 CHLORTHALIDONE -chlorthalidone tab 50 mg... 9 chlorzoxazone tab 500 mg (arafon forte dsc) CHOICE-OB+DHA -prenatal mv w/fe poly-fa chw 9- mg & dha cap 50 mg pak...57 cholecalciferol cap 000 unit...57 cholecalciferol cap unit...57 cholecalciferol chew tab 400 unit cholecalciferol chew tab 000 unit cholecalciferol drops 400 unit/0.03ml (per drop) cholecalciferol drops 5000 unit/ml (000 unit/0.ml) cholecalciferol oral liquid 400 unit/ml cholecalciferol tab 400 unit...57 cholecalciferol tab 000 unit...57 cholestyramine light powder 4 gm/dose (Questran light)...30 cholestyramine light powder packets 4 gm cholestyramine powder 4 gm/dose (Questran)...30 cholestyramine powder packets 4 gm (Questran)...30 choline fenofibrate cap dr 45 mg (fenofibric acid equiv) (Trilipix) choline fenofibrate cap dr 35 mg (fenofibric acid equiv) (Trilipix)...30 ciclopirox gel 0.77%...7 ciclopirox olamine cream 0.77% (base equiv)...7 ciclopirox olamine susp 0.77% (base equiv)...7 ciclopirox shampoo % (Loprox shampoo)... 7 ciclopirox solution 8% (enlac Nail Lacquer)... 7 cilostazol tab 50 mg (letal) cilostazol tab 00 mg (letal) cimetidine hcl soln 300 mg/5ml Guia de medicinas ValueScript de Florida Blue para enero de 06

138 06 cimetidine tab 00 mg cimetidine tab 300 mg cimetidine tab 400 mg cimetidine tab 800 mg CIMZIA -certolizumab pegol for inj kit x 00 mg CIMZIA -certolizumab pegol inj kit x 00 mg/ ml...37 CIMZIA STARTER KIT -certolizumab pegol inj kit 6 x 00 mg/ml...37 CINRYZE -c esterase inhibitor (human) for iv inj 500 unit...67 CIRODEX -ciprofloxacin-dexamethasone otic susp %...7 ciprofloxacin-ciprofloxacin hcl tab sr 4hr 000 mg(base eq) (Cipro xr)...3 ciprofloxacin-ciprofloxacin hcl tab sr 4hr 500 mg (base eq) (Cipro xr)... 3 ciprofloxacin for oral susp 50 mg/5ml (5%) (5 gm/00ml) (Cipro)... 3 ciprofloxacin for oral susp 500 mg/5ml (0%) (0 gm/00ml) (Cipro)... 3 ciprofloxacin hcl ophth soln 0.3% (Ciloxan)...69 ciprofloxacin hcl tab 750 mg (base equiv)... 3 ciprofloxacin hcl tab 50 mg (base equiv) (Cipro)...3 ciprofloxacin hcl tab 500 mg (base equiv) (Cipro)...3 citalopram hydrobromide oral soln 0 mg/5ml...40 citalopram hydrobromide tab 0 mg (base equiv) (Celexa) citalopram hydrobromide tab 0 mg (base equiv) (Celexa) citalopram hydrobromide tab 40 mg (base equiv) (Celexa) CITRANATAL ASSURE -prenat w/o a w/fecbn-fegl-dss-fa tab & dha cap 300 mg pack...57 CITRANATAL B-CALM -prenat w/o a w/fecbn-feglu-fa tab 0- mg & vit b6 tab pak CITRANATAL DHA -prenat w/o a w/fecbn-fegl-dss-fa tab & dha cap 50 mg pack CITRANATAL 90 DHA -prenat w/o a w/fecbn-fegl-dss-fa tab 90 &dha cap 300mg pak...57 CITRANATAL HARMONY -prenatal w/o a w/fe cbn-dss-fadha cap mg...57 CITRANATAL HARMONY -prenat w/o a w/fe fum-fe cbndss-fa-dha cap mg...57 CITRANATAL RX -prenatal w/o a w/ fe carbonyl-fe glucdss-fa tab 7-mg CLARAVIS -isotretinoin cap 30 mg... 7 clarithromycin for susp 5 mg/5ml... clarithromycin for susp 50 mg/5ml (Biaxin)... clarithromycin tab 50 mg (Biaxin)... clarithromycin tab 500 mg (Biaxin)... clarithromycin tab sr 4hr 500 mg... CLEANLET LANCETS 8G clemastine fumarate tab.68 mg... 3 CLEOCIN -clindamycin phosphate vaginal suppos 00 mg CLEVER CHEK LANCETS ULTRA CLEVER CHOICE COMFORT EZ -insulin pen needle 3 g x 8 mm...8 CLEVER CHOICE COMFORT EZ -insulin pen needle 3 g x 5 mm (3/6")...8 CLEVER CHOICE COMFORT EZ -insulin pen needle 3 g x 6 mm (/4")...8 CLEVER CHOICE COMFORT EZ -insulin pen needle 3 g x 4 mm (5/3")...8 CLEVER CHOICE COMFORT EZ -insulin pen needle 3 g x 6 mm (/4")...8 CLEVER CHOICE COMFORT EZ -insulin pen needle 33 g x 4 mm (5/3")...8 CLEVER CHOICE COMFORT EZ -insulin pen needle 33 g x 6 mm (/4")...8 CLEVER CHOICE COMFORT EZ -insulin pen needle 3 g x 8 mm (/3" or 5/6")...8 CLEVER CHOICE COMFORT EZ -insulin pen needle 3 g x 5 mm (/5" or 3/6")...8 CLEVER CHOICE COMFORT EZ -insulin pen needle 33 g x 5 mm (/5" or 3/6")...8 CLEVER CHOICE COMFORT EZ -insulin pen needle 33 g x 8 mm (/3" or 5/6")...8 CLEVER CHOICE COMFORT EZ -insulin syringe/needle u-00 / ml CLEVER CHOICE COMFORT EZ -insulin syringe/needle u-00 / ml 8 x /"... 8 CLEVER CHOICE COMFORT EZ -insulin syringe/needle u-00 / ml 9 x /"... 8 CLEVER CHOICE COMFORT EZ -insulin syringe/needle u-00 / ml CLEVER CHOICE COMFORT EZ -insulin syringe/needle u-00 / ml 30 x /"... 8 CLEVER CHOICE COMFORT EZ -insulin syringe/needle u ml 9 x /"... 8 CLEVER CHOICE COMFORT EZ -insulin syringe/needle u ml CLEVER CHOICE COMFORT EZ -insulin syringe/needle u ml 30 x /"... 8 CLEVER CHOICE COMFORT EZ -insulin syringe/needle u-00 ml 8 x /"... 8 CLEVER CHOICE COMFORT EZ -insulin syringe/needle u-00 ml 9 x /"... 8 CLEVER CHOICE COMFORT EZ -insulin syringe/needle u-00 ml CLEVER CHOICE COMFORT EZ -insulin syringe/needle u-00 ml 30 x /"... 8 CLEVER CHOICE COMFORT EZ -insulin syringe/needle u-00 ml CLEVER CHOICE COMFORT EZ -insulin syringe/needle u ml Guia de medicinas ValueScript de Florida Blue para enero de 06 7

139 06 CLICKFINE EN NEEDLE 3GX -insulin pen needle 3 g x 4 mm (5/3")...8 CLICKFINE EN NEEDLES/3G -insulin pen needle 3 g x 6 mm (/4")...8 CLICKFINE EN NEEDLES/3G -insulin pen needle 3 g x 8 mm (/3" or 5/6")...8 CLICKFINE EN NEEDLE UNIV -insulin pen needle 3 g x 6 mm (/4")...8 CLICKFINE EN NEEDLE UNIV -insulin pen needle 3 g x 8 mm (/3" or 5/6")...8 CLICKFINE UNIVERSAL EN N -insulin pen needle 3 g x 6 mm (/4")...8 CLICKFINE UNIVERSAL EN N -insulin pen needle 3 g x 8 mm (/3" or 5/6")...8 CLIMARA RO -estradiol-levonorgestrel td patch weekly mg/day...6 clindamycin hcl cap 75 mg (Cleocin)...7 clindamycin hcl cap 50 mg (Cleocin)...7 clindamycin hcl cap 300 mg (Cleocin)...7 clindamycin palmitate hcl for soln 75 mg/5ml (base equiv) (Cleocin pediatric gr)... 7 clindamycin phosphate-benzoyl peroxide gel -5% (Benzaclin)...7 clindamycin phosphate foam % (Evoclin)... 7 clindamycin phosphate gel % (Cleocin-t)... 7 clindamycin phosphate lotion % (Cleocint)... 7 clindamycin phosphate soln % (Cleocint)... 7 clindamycin phosphate swab % (Cleocint)... 7 clindamycin phosphate vaginal cream % (Cleocin)...38 clindamycin phosph-benzoyl peroxide (refrig) gel. ()-5% (Duac)...7 clobetasol propionate cream 0.05% (Temovate)...7 clobetasol propionate emollient base cream 0.05% (Temovate e)...7 clobetasol propionate emulsion foam 0.05% (Oluxe)... 7 clobetasol propionate foam 0.05% (Olux)... 7 clobetasol propionate gel 0.05% (Temovate)...7 clobetasol propionate lotion 0.05% (Clobex)...73 clobetasol propionate oint 0.05% (Temovate)...73 clobetasol propionate shampoo 0.05% (Clobex)...73 clobetasol propionate soln 0.05% (Temovate)...73 clobetasol propionate spray 0.05% (Clobex)...73 clomipramine hcl cap 5 mg (Anafranil) clomipramine hcl cap 50 mg (Anafranil) clomipramine hcl cap 75 mg (Anafranil) clonazepam orally disintegrating tab 0.5 mg clonazepam orally disintegrating tab 0.5 mg clonazepam orally disintegrating tab 0.5 mg clonazepam orally disintegrating tab mg clonazepam orally disintegrating tab mg clonazepam tab 0.5 mg (Klonopin) clonazepam tab mg (Klonopin) clonazepam tab mg (Klonopin) clonidine hcl tab 0. mg (Catapres)...7 clonidine hcl tab 0. mg (Catapres)...7 clonidine hcl tab 0.3 mg (Catapres)...7 clonidine hcl tab sr hr 0. mg (Kapvay)...45 clonidine hcl td patch weekly 0. mg/4hr (Cataprestts-)...7 clonidine hcl td patch weekly 0. mg/4hr (Cataprestts-)...7 clonidine hcl td patch weekly 0.3 mg/4hr (Cataprestts-3)...7 clopidogrel bisulfate tab 75 mg (base equiv) (lavix) clopidogrel bisulfate tab 300 mg (base equiv) (lavix) clorazepate dipotassium tab 3.75 mg (Tranxene t) clorazepate dipotassium tab 7.5 mg (Tranxene t) clorazepate dipotassium tab 5 mg (Tranxene t) CLOSERCARE -lancet devices... 8 clotrimazole cream % clotrimazole soln % clotrimazole troche 0 mg... 7 clotrimazole w/ betamethasone cream -0.05% (Lotrisone) clotrimazole w/ betamethasone lotion -0.05%...73 clozapine tab 50 mg...4 clozapine tab 00 mg...4 clozapine tab 5 mg (Clozaril)... 4 clozapine tab 00 mg (Clozaril)... 4 C-NATE DHA -prenatal vit w/ fe fum-fa-omega 3 cap mg COAGUCHEK LANCETS COARTEM -artemether-lumefantrine tab 0-0 mg...7 codeine sulfate tab 5 mg (Codeine sulfate) codeine sulfate tab 30 mg (Codeine sulfate) codeine sulfate tab 60 mg (Codeine sulfate) Guia de medicinas ValueScript de Florida Blue para enero de 06

140 06 colchicine w/ probenecid tab mg...53 COLCRYS -colchicine tab 0.6 mg colestipol hcl granule packets 5 gm (Colestid flavored) colestipol hcl granules 5 gm (Colestid flavored) colestipol hcl tab gm (Colestid) COLY-MYCIN S -neomycin-colistin-hc-thonzonium otic susp mg/ml... 7 COMBIVENT RESIMAT -ipratropium-albuterol inhal aerosol soln 0-00 mcg/act...33 COMETRIQ -cabozantinib s-malate cap 3 x 0 mg (60 mg dose) kit... COMETRIQ -cabozantinib s-mal cap x 80 mg & x 0 mg (00 dose) kit... COMETRIQ -cabozantinib s-mal cap x 80 mg & 3 x 0 mg (40 dose) kit... COMFORT ASSIST INSULIN SY -insulin syringe/needle u-00 / ml COMFORT ASSIST INSULIN SY -insulin syringe/needle u-00 / ml 9 x /" COMFORT ASSIST INSULIN SY -insulin syringe/needle u-00 / ml COMFORT ASSIST INSULIN SY -insulin syringe/needle u ml 9 x /"... 8 COMFORT ASSIST INSULIN SY -insulin syringe/needle u ml COMFORT ASSIST INSULIN SY -insulin syringe/needle u-00 ml 9 x /" COMFORT ASSIST INSULIN SY -insulin syringe/needle u-00 ml COMFORT ASSIST INSULIN SY -insulin syringe/needle u-00 ml COMFORT ASSIST INSULIN SY -insulin syringe/needle u ml COMFORT ASSURED LANCETS M COMFORT ASSURED LANCETS S COMFORT LANCETS COMLERA -emtricitabine-rilpivirine-tenofovir df tab mg... 4 COMLETE NATAL DHA -prenat-fe bis-fe prot succ-fa-ca tab & omega 3 cap 50 pk COMLETENATE -prenatal vit w/ fe fumarate-fa chew tab 9- mg...57 COMVAX -haemophilus b polysac conj-hepatitis b (recomb) vac im susp...8 CO-NATAL FA -prenatal vit w/ fe fumarate-fa tab 9- mg CONCET DHA -prenatal w/fe fum-fe poly -fa-omega 3 cap mg CONCET OB -prenatal w/o a w/fe fum-fe poly-fa cap mg COAXONE -glatiramer acetate soln prefilled syringe 0 mg/ml...46 COAXONE -glatiramer acetate soln prefilled syringe 40 mg/ml...46 CORIFACT -factor xiii concentrate (human) for inj kit unit...67 CORTIFOAM -hydrocortisone acetate rectal foam 90 mg/ dose...7 CORTISONE ACETATE -cortisone acetate tab 5 mg... 5 CREON -pancrelipase (lip-prot-amyl) dr cap unit CREON -pancrelipase (lip-prot-amyl) dr cap unit CREON -pancrelipase (lip-prot-amyl) dr cap unit CREON -pancrelipase (lip-prot-amyl) dr cap unit CREON -pancrelipase (lip-prot-amyl) dr cap unit CRESTOR -rosuvastatin calcium tab 5 mg CRESTOR -rosuvastatin calcium tab 0 mg CRESTOR -rosuvastatin calcium tab 0 mg CRESTOR -rosuvastatin calcium tab 40 mg CRIXIVAN -indinavir sulfate cap 00 mg...4 CRIXIVAN -indinavir sulfate cap 400 mg...4 cromolyn sodium ophth soln 4% cromolyn sodium oral conc 00 mg/5ml (Gastrocrom) CURIMINE -penicillamine cap 50 mg...4 CVS INSULIN SYRINGE/ML/ -insulin syringe/needle u-00 ml 9 x /" CVS INSULIN SYRINGE/0.5ML -insulin syringe/needle u-00 / ml 9 x /" CVS INSULIN SYRINGE/0.5ML -insulin syringe/needle u-00 / ml 30 x /" CVS INSULIN SYRINGE/0.3ML -insulin syringe/needle u ml 9 x /" CVS INSULIN SYRINGE/0.3ML -insulin syringe/needle u ml 30 x /" CVS LANCETS G CVS LANCETS MICRO THIN CVS LANCETS ORIGINAL CVS LANCETS THIN 6G CVS LANCETS ULTRA THIN CVS LANCING DEVICE -lancet devices...83 CVS ULTRA THIN LANCETS cyanocobalamin inj 000 mcg/ml...65 cyclobenzaprine hcl tab 5 mg cyclobenzaprine hcl tab 0 mg cyclobenzaprine hcl tab 7.5 mg (Fexmid) cyclopentolate hcl ophth soln % (Cyclogyl)...69 cyclopentolate hcl ophth soln % (Cyclogyl)...69 CYCLOSERINE -cycloserine cap 50 mg...3 CYCLOSET -bromocriptine mesylate tab 0.8 mg (base equivalent)...8 cyclosporine cap 5 mg (Sandimmune)...4 cyclosporine cap 00 mg (Sandimmune)...4 Guia de medicinas ValueScript de Florida Blue para enero de 06 9

141 06 cyclosporine modified cap 5 mg (Neoral)...4 cyclosporine modified cap 00 mg (Neoral)...4 CYCLOSORINE MODIFIED -cyclosporine modified cap 50 mg...4 cyclosporine modified oral soln 00 mg/ml (Neoral)...4 cyproheptadine hcl syrup mg/5ml... 3 cyproheptadine hcl tab 4 mg...3 CYSTADANE -betaine powder for oral solution... CYSTAGON -cysteamine bitartrate cap 50 mg CYSTAGON -cysteamine bitartrate cap 50 mg D DALIRES -roflumilast tab 500 mcg danazol cap 50 mg...6 danazol cap 00 mg...6 danazol cap 00 mg...6 dantrolene sodium cap 5 mg (Dantrium)...56 dantrolene sodium cap 50 mg (Dantrium)...56 DANTROLENE SODIUM -dantrolene sodium cap 00 mg DASONE -dapsone tab 5 mg... 7 DASONE -dapsone tab 00 mg... 7 DATACEL -diph, acellular pert & tet tox inj 5 lf-0 mcg-5 lf/0.5ml... DARARIM -pyrimethamine tab 5 mg...7 DELZICOL -mesalamine cap dr 400 mg demeclocycline hcl tab 50 mg... demeclocycline hcl tab 300 mg... DENAVIR -penciclovir cream % desipramine hcl tab 0 mg (Norpramin)...40 desipramine hcl tab 5 mg (Norpramin)...40 desipramine hcl tab 50 mg (Norpramin)...40 desipramine hcl tab 75 mg (Norpramin)...40 desipramine hcl tab 00 mg (Norpramin)...40 desipramine hcl tab 50 mg (Norpramin)...40 desloratadine tab 5 mg (Clarinex)...3 desloratadine tab orally disintegrating.5 mg (Clarinex reditabs)...3 desloratadine tab orally disintegrating 5 mg (Clarinex reditabs)... 3 desmopressin acetate inj 4 mcg/ml (Ddavp)... desmopressin acetate nasal soln 0.0% (refrigerated) (Ddavp)... desmopressin acetate nasal spray soln 0.0% (Ddavp)... desmopressin acetate nasal spray soln 0.0% (refrigerated)... desmopressin acetate tab 0. mg (Ddavp)... desmopressin acetate tab 0. mg (Ddavp)... desogest-eth estrad & eth estrad tab /0.0 mg(/5) (Mircette)...7 desogest-ethin est tab / / mg-mg (Cyclessa)... 7 desogestrel & ethinyl estradiol tab 0.5 mg-30 mcg (Desogen)...7 desonide cream 0.05% (Desowen)...73 desonide lotion 0.05% (Desowen)...73 desonide oint 0.05% (Desowen)...73 desoximetasone cream 0.5% (Topicort)...73 desoximetasone gel 0.05% (Topicort) desoximetasone oint 0.5% (Topicort)...73 DEXAMETHASONE -dexamethasone soln 0.5 mg/5ml...5 DEXAMETHASONE -dexamethasone tab mg... 5 DEXAMETHASONE -dexamethasone tab mg... 5 dexamethasone elixir 0.5 mg/5ml... 5 dexamethasone sodium phosphate ophth soln 0.% dexamethasone tab 0.5 mg...5 dexamethasone tab 0.75 mg...5 dexamethasone tab.5 mg...5 dexamethasone tab 4 mg...5 dexamethasone tab 6 mg...5 dexmethylphenidate hcl cap sr 4 hr 5 mg (Focalin xr)...45 dexmethylphenidate hcl cap sr 4 hr 0 mg (Focalin xr)...45 dexmethylphenidate hcl cap sr 4 hr 5 mg (Focalin xr)...45 dexmethylphenidate hcl cap sr 4 hr 0 mg (Focalin xr)...45 dexmethylphenidate hcl cap sr 4 hr 30 mg (Focalin xr)...45 dexmethylphenidate hcl cap sr 4 hr 40 mg (Focalin xr)...45 dexmethylphenidate hcl tab.5 mg (Focalin) dexmethylphenidate hcl tab 5 mg (Focalin) dexmethylphenidate hcl tab 0 mg (Focalin) dextroamphetamine sulfate cap sr 4hr 5 mg (Dexedrine) dextroamphetamine sulfate cap sr 4hr 0 mg (Dexedrine) dextroamphetamine sulfate cap sr 4hr 5 mg (Dexedrine) dextroamphetamine sulfate oral solution 5 mg/5ml (rocentra)...45 dextroamphetamine sulfate tab 5 mg dextroamphetamine sulfate tab 0 mg DIASTAR EASY TEST II LANC DIASTAR EASY TEST LANCETS Guia de medicinas ValueScript de Florida Blue para enero de 06

142 06 DIASTAT ACUDIAL -diazepam rectal gel delivery system 0 mg...53 DIASTAT ACUDIAL -diazepam rectal gel delivery system 0 mg...53 DIASTAT EDIATRIC -diazepam rectal gel delivery system.5 mg diazepam conc 5 mg/ml DIAZEAM -diazepam soln mg/ml diazepam tab mg (Valium) diazepam tab 5 mg (Valium) diazepam tab 0 mg (Valium) DIBENZYLINE -phenoxybenzamine hcl cap 0 mg... 7 diclofenac potassium tab 50 mg... 5 diclofenac sodium (actinic keratoses) gel 3% (Solaraze) diclofenac sodium ophth soln 0.% diclofenac sodium soln.5%...73 diclofenac sodium tab delayed release 5 mg... 5 diclofenac sodium tab delayed release 50 mg... 5 diclofenac sodium tab delayed release 75 mg... 5 diclofenac sodium tab sr 4hr 00 mg (Voltarenxr)...5 diclofenac w/ misoprostol tab delayed release mg (Arthrotec 50)... 5 diclofenac w/ misoprostol tab delayed release mg (Arthrotec 75)... 5 dicloxacillin sodium cap 50 mg... dicloxacillin sodium cap 500 mg... dicyclomine hcl cap 0 mg (Bentyl)...35 dicyclomine hcl tab 0 mg (Bentyl) didanosine delayed release capsule 5 mg (Videx ec)... 4 didanosine delayed release capsule 00 mg (Videx ec)... 4 didanosine delayed release capsule 50 mg (Videx ec)... 4 didanosine delayed release capsule 400 mg (Videx ec)... 4 DIDGET -blood glucose monitoring kit w/ device...83 DIFICID -fidaxomicin tab 00 mg... diflunisal tab 500 mg DIGOXIN -digoxin oral soln 0.05 mg/ml... 3 digoxin tab 5 mcg (0.5 mg) (Lanoxin)... 3 digoxin tab 50 mcg (0.5 mg) (Lanoxin)... 3 DILANTIN -phenytoin sodium extended cap 30 mg DILANTIN -phenytoin sodium extended cap 00 mg diltiazem hcl cap sr hr 60 mg... 4 diltiazem hcl cap sr hr 90 mg... 4 diltiazem hcl cap sr hr 0 mg... 4 diltiazem hcl cap sr 4hr 0 mg... 4 diltiazem hcl cap sr 4hr 80 mg... 4 diltiazem hcl cap sr 4hr 40 mg... 4 diltiazem hcl coated beads cap sr 4hr 0 mg (Cardizem cd)...4 diltiazem hcl coated beads cap sr 4hr 80 mg (Cardizem cd)...4 diltiazem hcl coated beads cap sr 4hr 40 mg (Cardizem cd)...4 diltiazem hcl coated beads cap sr 4hr 300 mg (Cardizem cd)...4 diltiazem hcl coated beads cap sr 4hr 360 mg (Cardizem cd)...4 diltiazem hcl coated beads tab sr 4hr 80 mg (Cardizem la)... 4 diltiazem hcl coated beads tab sr 4hr 40 mg (Cardizem la)... 4 diltiazem hcl coated beads tab sr 4hr 300 mg (Cardizem la)... 4 diltiazem hcl coated beads tab sr 4hr 360 mg (Cardizem la)... 4 diltiazem hcl coated beads tab sr 4hr 40 mg (Cardizem la)... 4 diltiazem hcl extended release beads cap sr 4hr 0 mg (Tiazac)... 4 diltiazem hcl extended release beads cap sr 4hr 80 mg (Tiazac)... 5 diltiazem hcl extended release beads cap sr 4hr 40 mg (Tiazac)... 5 diltiazem hcl extended release beads cap sr 4hr 300 mg (Tiazac)... 5 diltiazem hcl extended release beads cap sr 4hr 360 mg (Tiazac)... 5 diltiazem hcl extended release beads cap sr 4hr 40 mg (Tiazac)... 5 diltiazem hcl tab 90 mg... 5 diltiazem hcl tab 30 mg (Cardizem)...5 diltiazem hcl tab 60 mg (Cardizem)...5 diltiazem hcl tab 0 mg (Cardizem)...5 DIENTUM -olsalazine sodium cap 50 mg diphenhydramine hcl cap 50 mg...3 diphenhydramine hcl elixir.5 mg/5ml... 3 diphenoxylate w/ atropine tab mg (Lomotil)...35 DIHTHERIA/TETANUS TOXOID -diphtheria-tetanus tox adsorbed (dt) im inj 5-5 unit/0.5ml... dipyridamole tab 5 mg (ersantine)...67 dipyridamole tab 50 mg (ersantine)...67 dipyridamole tab 75 mg (ersantine)...67 disopyramide phosphate cap 00 mg (Norpace)... 5 disopyramide phosphate cap 50 mg (Norpace)... 5 disulfiram tab 50 mg (Antabuse)...46 disulfiram tab 500 mg (Antabuse)...46 divalproex sodium cap sprinkle 5 mg (Depakote sprinkles) Guia de medicinas ValueScript de Florida Blue para enero de 06 3

143 06 divalproex sodium tab delayed release 5 mg (Depakote)...54 divalproex sodium tab delayed release 50 mg (Depakote)...54 divalproex sodium tab delayed release 500 mg (Depakote)...54 divalproex sodium tab sr 4 hr 50 mg (Depakote er)...54 divalproex sodium tab sr 4 hr 500 mg (Depakote er)...54 DIVIGEL -estradiol td gel 0.5 mg/0.5gm (0.%)...6 DIVIGEL -estradiol td gel 0.5 mg/0.5gm (0.%)...6 DIVIGEL -estradiol td gel mg/gm (0.%)... 6 donepezil hydrochloride orally disintegrating tab 5 mg donepezil hydrochloride orally disintegrating tab 0 mg donepezil hydrochloride tab 5 mg (Aricept) donepezil hydrochloride tab 0 mg (Aricept) donepezil hydrochloride tab 3 mg (Aricept) dorzolamide hcl ophth soln % (Trusopt)...69 dorzolamide hcl-timolol maleate ophth soln mg/ml (Cosopt) doxazosin mesylate tab mg (Cardura)...7 doxazosin mesylate tab mg (Cardura)...7 doxazosin mesylate tab 4 mg (Cardura)...7 doxazosin mesylate tab 8 mg (Cardura)...7 doxepin hcl cap 0 mg...40 doxepin hcl cap 5 mg...40 doxepin hcl cap 50 mg...40 doxepin hcl cap 00 mg...40 doxepin hcl cap 50 mg...40 doxepin hcl conc 0 mg/ml...40 DOXEIN HCL -doxepin hcl cap 75 mg...40 doxercalciferol cap 0.5 mcg (Hectorol)... doxercalciferol cap mcg (Hectorol)... doxercalciferol cap.5 mcg (Hectorol)... doxycycline hyclate cap 50 mg... doxycycline hyclate cap 00 mg (Vibramycin)... doxycycline hyclate tab delayed release 75 mg... doxycycline hyclate tab delayed release 00 mg... doxycycline hyclate tab delayed release 50 mg... doxycycline hyclate tab 0 mg... doxycycline hyclate tab 00 mg... doxycycline monohydrate cap 50 mg... doxycycline monohydrate cap 50 mg (Adoxa)... doxycycline monohydrate cap 75 mg (Monodox)... doxycycline monohydrate cap 00 mg (Monodox)... doxycycline monohydrate for susp 5 mg/5ml (Vibramycin)... doxycycline monohydrate tab 50 mg (Adoxa)... doxycycline monohydrate tab 75 mg (Adoxa)... doxycycline monohydrate tab 00 mg (Adoxa pak /00)... doxycycline monohydrate tab 50 mg (Adoxa pak /50)... dronabinol cap.5 mg (Marinol) dronabinol cap 5 mg (Marinol) dronabinol cap 0 mg (Marinol) DROLET LANCETS ULTRA THI DROLET LANCING DEVICE -lancet devices drospirenone-ethinyl estradiol tab mg (Yasmin 8)... 7 drospirenone-ethinyl estradiol tab mg (Yaz)...7 DROXIA -hydroxyurea cap 00 mg DROXIA -hydroxyurea cap 300 mg DROXIA -hydroxyurea cap 400 mg DRUG MART ADJUSTABLE LANC -lancet devices DRUG MART LANCETS THIN DRUG MART LANCETS ULTRA T DRUG MART ON-THE-GO LANCE DRUG MART ULTRA COMFORT I -insulin syringe/needle u-00 / ml DRUG MART ULTRA COMFORT I -insulin syringe/needle u-00 / ml DRUG MART ULTRA COMFORT I -insulin syringe/needle u ml 9 x /" DRUG MART ULTRA COMFORT I -insulin syringe/needle u ml DRUG MART ULTRA COMFORT I -insulin syringe/needle u-00 ml 9 x /" DRUG MART ULTRA COMFORT I -insulin syringe/needle u-00 ml DRUG MART ULTRA COMFORT I -insulin syringe/needle u ml DRUG MART UNIFINE ENTIS -insulin pen needle 9 g x mm (/")...84 DRUG MART UNIFINE ENTIS -insulin pen needle 3 g x 5 mm (3/6")...84 DRUG MART UNIFINE ENTIS -insulin pen needle 3 g x 6 mm (/4")...84 DRUG MART UNIFINE ENTIS -insulin pen needle 3 g x 4 mm (5/3")...84 DRUG MART UNIFINE ENTIS -insulin pen needle 3 g x 8 mm (/3" or 5/6")...84 DRUG MART UNILET LANCETS Guia de medicinas ValueScript de Florida Blue para enero de 06

144 06 DUANE READE LANCET ALTERN DUANE READE LANCET SUER DUANE READE LANCET ULTRA DUANE READE UNIFINE ENTI -insulin pen needle 9 g x mm (/")...84 DUANE READE UNIFINE ENTI -insulin pen needle 3 g x 6 mm (/4")...84 DUANE READE UNIFINE ENTI -insulin pen needle 3 g x 8 mm (/3" or 5/6")...84 DUET DHA BALANCED -prenat w/fe poly-na fered-fa tab 7- & omega cap dr 380mg DUET DHA BALANCED -prenat w/fe poly-na fered-fa tab 5- & omega cap 67 mg DUET DHA -prenat w/fe poly-na fered-fa tab 5- & omega cap 400 mg DUET DHA 400 -prenat w/fe poly-na fered-fa tab 5- & omega cap 400 mg DULERA -mometasone furoate-formoterol fumarate aerosol 00-5 mcg/act...33 DULERA -mometasone furoate-formoterol fumarate aerosol 00-5 mcg/act...33 duloxetine hcl enteric coated pellets cap 0 mg (Cymbalta)...40 duloxetine hcl enteric coated pellets cap 30 mg (Cymbalta)...40 duloxetine hcl enteric coated pellets cap 60 mg (Cymbalta)...40 DUREZOL -difluprednate ophth emulsion 0.05% dyphylline-guaifenesin liqd mg/5ml...33 DYRENIUM -triamterene cap 50 mg... 9 DYRENIUM -triamterene cap 00 mg... 9 E EASY COMFORT INSULIN SYRI -insulin syringe/needle u-00 / ml EASY COMFORT INSULIN SYRI -insulin syringe/needle u-00 / ml 30 x /" EASY COMFORT INSULIN SYRI -insulin syringe/needle u ml EASY COMFORT INSULIN SYRI -insulin syringe/needle u-00 ml EASY COMFORT INSULIN SYRI -insulin syringe/needle u-00 ml 30 x /" EASY COMFORT LANCETS 30G/ EASY COMFORT LANCETS EASY COMFORT EN NEEDLES -insulin pen needle 3 g x 5 mm (3/6") EASY COMFORT EN NEEDLES -insulin pen needle 3 g x 6 mm (/4") EASY COMFORT EN NEEDLES -insulin pen needle 3 g x 4 mm (5/3") EASY COMFORT EN NEEDLES -insulin pen needle 3 g x 8 mm (/3" or 5/6") EASY MINI LANCING DEVICE -lancet devices EASYTEST II LANCETS EASYTEST LANCETS EASY TOUCH ALLERGY TRAY S -tuberculin/allergy syringe/needle (disp) ml 6 x 3/8" EASY TOUCH ALLERGY TRAY S -tuberculin/allergy syringe/needle (disp) ml 7 x /" EASY TOUCH 3GX6MM -insulin pen needle 3 g x 6 mm (/4")...86 EASY TOUCH 3GX5MM -insulin pen needle 3 g x 5 mm (/5" or 3/6") EASY TOUCH INSULIN SYRING -insulin syringe/needle u-00 / ml 7 x /" EASY TOUCH INSULIN SYRING -insulin syringe/needle u-00 / ml EASY TOUCH INSULIN SYRING -insulin syringe/needle u-00 / ml 8 x /" EASY TOUCH INSULIN SYRING -insulin syringe/needle u-00 / ml 9 x /" EASY TOUCH INSULIN SYRING -insulin syringe/needle u-00 / ml EASY TOUCH INSULIN SYRING -insulin syringe/needle u-00 / ml 30 x /" EASY TOUCH INSULIN SYRING -insulin syringe/needle u ml EASY TOUCH INSULIN SYRING -insulin syringe/needle u ml 30 x /" EASY TOUCH INSULIN SYRING -insulin syringe/needle u-00 ml 7 x /" EASY TOUCH INSULIN SYRING -insulin syringe/needle u-00 ml 8 x /" EASY TOUCH INSULIN SYRING -insulin syringe/needle u-00 ml 9 x /" EASY TOUCH INSULIN SYRING -insulin syringe/needle u-00 ml EASY TOUCH INSULIN SYRING -insulin syringe/needle u-00 ml 30 x /" EASY TOUCH INSULIN SYRING -insulin syringe/needle u-00 ml EASY TOUCH INSULIN SYRING -insulin syringe/needle u ml EASY TOUCH LANCETS 30G/BU EASY TOUCH LANCETS G/R EASY TOUCH LANCETS 3G/R EASY TOUCH LANCETS 6G/R EASY TOUCH LANCETS 8G/R EASY TOUCH LANCETS 30G/R EASY TOUCH LANCETS 3G/R EASY TOUCH LANCETS 6G/U EASY TOUCH LANCETS 8G/U EASY TOUCH LANCETS 30G/U EASY TOUCH LANCETS 3G/U EASY TOUCH LANCETS 6G/TW EASY TOUCH LANCETS 8G/TW EASY TOUCH LANCETS 30G/TW EASY TOUCH LANCETS 3G/TW EASY TOUCH LANCETS 33G/TW Guia de medicinas ValueScript de Florida Blue para enero de 06 33

145 06 EASY TOUCH LANCING DEVICE -lancet devices EASY TOUCH EN NEEDLES/3 -insulin pen needle 3 g x 5 mm (3/6")...86 EASY TOUCH EN NEEDLES 9 -insulin pen needle 9 g x mm (/")...85 EASY TOUCH EN NEEDLES 3 -insulin pen needle 3 g x 6 mm (/4")...85 EASY TOUCH EN NEEDLES 3 -insulin pen needle 3 g x 4 mm (5/3")...85 EASY TOUCH EN NEEDLES 3 -insulin pen needle 3 g x 6 mm (/4")...86 EASY TOUCH EN NEEDLES 3 -insulin pen needle 3 g x 8 mm (/3" or 5/6")...85 EASY TOUCH EN NEEDLES 3 -insulin pen needle 3 g x 5 mm (/5" or 3/6")...86 EASY TOUCH SAFETY LANCETS EASY TWIST & CA LANCETS econazole nitrate cream %...73 EDARBI -azilsartan medoxomil tab 40 mg... 7 EDARBI -azilsartan medoxomil tab 80 mg... 7 EDECRIN -ethacrynic acid tab 5 mg... 9 EDURANT -rilpivirine hcl tab 5 mg (base equivalent)...4 EFFIENT -prasugrel hcl tab 5 mg (base equiv)...67 EFFIENT -prasugrel hcl tab 0 mg (base equiv)...67 ELIDEL -pimecrolimus cream %...73 ELIQUIS -apixaban tab.5 mg...65 ELIQUIS -apixaban tab 5 mg...65 ELITE-OB -prenatal vit w/ iron carbonyl-fa tab mg ELITE-THIN INSULIN SYRING -insulin syringe/needle u-00 / ml ELITE-THIN INSULIN SYRING -insulin syringe/needle u-00 / ml ELITE-THIN INSULIN SYRING -insulin syringe/needle u-00 / ml 8 x /" ELITE-THIN INSULIN SYRING -insulin syringe/needle u-00 / ml ELITE-THIN INSULIN SYRING -insulin syringe/needle u-00 / ml 9 x /" ELITE-THIN INSULIN SYRING -insulin syringe/needle u-00 / ml ELITE-THIN INSULIN SYRING -insulin syringe/needle u-00 ml ELITE-THIN INSULIN SYRING -insulin syringe/needle u-00 ml 8 x /" ELITE-THIN INSULIN SYRING -insulin syringe/needle u-00 ml 9 x /" ELITE-THIN INSULIN SYRING -insulin syringe/needle u-00 ml ELITE-THIN INSULIN SYRING -insulin syringe/needle u-00 ml ELITE-THIN INSULIN SYRING -insulin syringe/needle u-00 ml ELITE-THIN INSULIN SYRING -insulin syringe/needle u ml ELLA -ulipristal acetate tab 30 mg... 7 ELOCTATE -antihemophilic factor (recomb) rfviiifc for inj 50 unit ELOCTATE -antihemophilic factor (recomb) rfviiifc for inj 500 unit ELOCTATE -antihemophilic factor (recomb) rfviiifc for inj 750 unit ELOCTATE -antihemophilic factor (recomb) rfviiifc for inj 000 unit ELOCTATE -antihemophilic factor (recomb) rfviiifc for inj 500 unit ELOCTATE -antihemophilic factor (recomb) rfviiifc for inj 000 unit ELOCTATE -antihemophilic factor (recomb) rfviiifc for inj 3000 unit EMADINE -emedastine difumarate ophth soln 0.05% (base equiv) EMBRACE LANCETS ULTRA THI EMCYT -estramustine phosphate sodium cap 40 mg... EMEND -aprepitant capsule 40 mg EMEND -aprepitant capsule 80 mg EMEND -aprepitant capsule 5 mg EMEND -aprepitant capsule therapy pack 80 & 5 mg EMSAM -selegiline td patch 4hr 6 mg/4hr EMSAM -selegiline td patch 4hr 9 mg/4hr EMSAM -selegiline td patch 4hr mg/4hr EMTRIVA -emtricitabine caps 00 mg... 4 EMTRIVA -emtricitabine soln 0 mg/ml...4 ENABLEX -darifenacin hydrobromide tab sr 4hr 7.5 mg (base equiv) ENABLEX -darifenacin hydrobromide tab sr 4hr 5 mg (base equiv) enalapril maleate & hydrochlorothiazide tab 5-.5 mg... 7 enalapril maleate & hydrochlorothiazide tab 0-5 mg (Vaseretic)...7 enalapril maleate tab.5 mg (Vasotec)... 7 enalapril maleate tab 5 mg (Vasotec)... 7 enalapril maleate tab 0 mg (Vasotec)... 7 enalapril maleate tab 0 mg (Vasotec)... 7 ENBRACE HR -prenatal vit w/ fe gly cys-fa-omega 3 fatty acids cap...57 ENBREL -etanercept for subcutaneous inj kit 5 mg... 5 ENBREL -etanercept subcutaneous soln prefilled syringe 5 mg/0.5ml... 5 ENBREL -etanercept subcutaneous soln prefilled syringe 50 mg/ml... 5 ENBREL SURECLICK -etanercept subcutaneous solution auto-injector 50 mg/ml...5 ENCARE -nonoxynol-9 vaginal suppos 00 mg Guia de medicinas ValueScript de Florida Blue para enero de 06

146 06 ENGERIX-B -hepatitis b vaccine (recombinant) 0 mcg/0.5ml...8 ENGERIX-B -hepatitis b vaccine (recombinant) 0 mcg/ ml...8 ENGERIX-B -hepatitis b vaccine (recombinant) susp 0 mcg/0.5ml...8 ENGERIX-B -hepatitis b vaccine (recombinant) susp 0 mcg/ml...8 enoxaparin sodium inj 30 mg/0.3ml (Lovenox) enoxaparin sodium inj 40 mg/0.4ml (Lovenox) enoxaparin sodium inj 60 mg/0.6ml (Lovenox) enoxaparin sodium inj 80 mg/0.8ml (Lovenox) enoxaparin sodium inj 00 mg/ml (Lovenox) enoxaparin sodium inj 0 mg/0.8ml (Lovenox) enoxaparin sodium inj 50 mg/ml (Lovenox) enoxaparin sodium inj 300 mg/3ml (Lovenox) entacapone tab 00 mg (Comtan) entecavir tab 0.5 mg (Baraclude)... 4 entecavir tab mg (Baraclude)... 4 epinastine hcl ophth soln 0.05% (Elestat)...69 epinephrine hcl inj mg/ml epinephrine hcl soln prefilled syringe 0. mg/ ml EIEN-JR -AK -epinephrine solution auto-injector 0.5 mg/0.3ml (:000) EIEN -AK -epinephrine solution auto-injector 0.3 mg/0.3ml (:000) EIVIR HBV -lamivudine oral soln 5 mg/ml (hbv)... 4 eplerenone tab 5 mg (Inspra)... 7 eplerenone tab 50 mg (Inspra)... 7 eprosartan mesylate tab 600 mg (Teveten)... 7 EZICOM -abacavir sulfate-lamivudine tab mg...4 EQL COLOR LANCETS G EQL COLOR LANCETS MICRO T EQL INSULIN SYRINGE/ML/ -insulin syringe/needle u-00 ml 9 x /" EQL INSULIN SYRINGE/ML/3 -insulin syringe/needle u-00 ml EQL INSULIN SYRINGE/ML/3 -insulin syringe/needle u-00 ml EQL INSULIN SYRINGE/0.5ML -insulin syringe/needle u-00 / ml EQL INSULIN SYRINGE/0.5ML -insulin syringe/needle u-00 / ml 9 x /" EQL INSULIN SYRINGE/0.5ML -insulin syringe/needle u-00 / ml EQL INSULIN SYRINGE/0.3ML -insulin syringe/needle u ml 9 x /" EQL INSULIN SYRINGE/0.3ML -insulin syringe/needle u ml EQL INSULIN SYRINGE/0.3ML -insulin syringe/needle u ml EQL INSULIN SYRINGE/U-00 -insulin syringe/needle u-00 / ml 9 x /" EQL INSULIN SYRINGE/U-00 -insulin syringe/needle u ml 9 x /" EQL INSULIN SYRINGE/U-00 -insulin syringe/needle u-00 ml 9 x /" EQL SHORT EN NEEDLES 3G -insulin pen needle 3 g x 8 mm (/3" or 5/6") EQL SUER THIN LANCETS EQL THIN LANCETS 6G EQL ULTRA COMFORT INSULIN -insulin syringe/needle u-00 ml EQL ULTRA COMFORT INSULIN -insulin syringe/needle u ml EQL ULTRA SHORT EN NEEDL -insulin pen needle 3 g x 6 mm (/4") ergocalciferol cap unit (Drisdol) ergoloid mesylates tab mg ERGOMAR -ergotamine tartrate sl tab mg...5 ERIVEDGE -vismodegib cap 50 mg... ERTACZO -sertaconazole nitrate cream %...73 ERY-TAB -erythromycin tab delayed release 50 mg... ERY-TAB -erythromycin tab delayed release 333 mg... ERY-TAB -erythromycin tab delayed release 500 mg... ERYTHROMYCIN BASE -erythromycin tab 50 mg... ERYTHROMYCIN BASE -erythromycin tab 500 mg... ERYTHROMYCIN ETHYLSUINA -erythromycin ethylsuccinate tab 400 mg... erythromycin gel % (Erygel) erythromycin ophth oint 5 mg/gm erythromycin pads %...73 erythromycin soln %...73 erythromycin w/ delayed release particles cap 50 mg... ESBRIET -pirfenidone cap 67 mg escitalopram oxalate soln 5 mg/5ml (base equiv) (Lexapro)...40 escitalopram oxalate tab 5 mg (base equiv) (Lexapro)...40 escitalopram oxalate tab 0 mg (base equiv) (Lexapro)...40 escitalopram oxalate tab 0 mg (base equiv) (Lexapro)...40 esomeprazole magnesium cap delayed release 0 mg (base eq) (Nexium) Guia de medicinas ValueScript de Florida Blue para enero de 06 35

147 06 esomeprazole magnesium cap delayed release 40 mg (base eq) (Nexium) estazolam tab mg...44 estazolam tab mg...44 estradiol & norethindrone acetate tab mg (Activella)... 6 estradiol & norethindrone acetate tab -0.5 mg (Activella)... 6 estradiol tab 0.5 mg (Estrace)... 6 estradiol tab mg (Estrace)... 6 estradiol tab mg (Estrace)... 6 estradiol td patch twice weekly 0.05 mg/4hr (Vivelledot)...6 estradiol td patch twice weekly mg/4hr (Vivelle-dot)...6 estradiol td patch twice weekly 0.05 mg/4hr (Vivelledot)...6 estradiol td patch twice weekly mg/4hr (Vivelledot)...6 estradiol td patch twice weekly 0. mg/4hr (Vivelledot)...6 estradiol td patch weekly 0.05 mg/4hr (Climara)...6 estradiol td patch weekly 0.05 mg/4hr (Climara)...6 estradiol td patch weekly 0.06 mg/4hr (Climara)...6 estradiol td patch weekly mg/4hr (Climara)...6 estradiol td patch weekly 0. mg/4hr (Climara)...6 estradiol td patch weekly mg/4hr (37.5 mcg/4hr) (Climara)...6 estropipate tab 0.75 mg...6 estropipate tab.5 mg...6 eszopiclone tab mg (Lunesta) eszopiclone tab mg (Lunesta) eszopiclone tab 3 mg (Lunesta) ethambutol hcl tab 00 mg (Myambutol)...3 ethambutol hcl tab 400 mg (Myambutol)...3 ethosuximide cap 50 mg (Zarontin) ethosuximide soln 50 mg/5ml (Zarontin)...54 ethynodiol diacetate & ethinyl estradiol tab mg-35 mcg... 7 etodolac cap 00 mg... 5 etodolac cap 300 mg... 5 etodolac tab 400 mg... 5 etodolac tab 500 mg... 5 etodolac tab sr 4hr 400 mg...5 etodolac tab sr 4hr 500 mg...5 etodolac tab sr 4hr 600 mg...5 ETOOSIDE -etoposide cap 50 mg... EURAX -crotamiton cream 0% EVOTAZ -atazanavir sulfate-cobicistat tab mg (base equiv)... 4 EXCEL COMFORT OINT INSUL -insulin pen needle 3 g x 4 mm (/6")...87 EXEL COMFORT OINT INSULI -insulin pen needle 9 g x mm (/")...87 EXEL COMFORT OINT INSULI -insulin pen needle 3 g x 6 mm (/4")...87 EXEL COMFORT OINT INSULI -insulin pen needle 3 g x 8 mm (/3" or 5/6")...87 EXEL COMFORT OINT INSULI -insulin syringe/needle u-00 / ml 8 x /" EXEL COMFORT OINT INSULI -insulin syringe/needle u-00 / ml 9 x /" EXEL COMFORT OINT INSULI -insulin syringe/needle u-00 / ml EXEL COMFORT OINT INSULI -insulin syringe/needle u ml 9 x /" EXEL COMFORT OINT INSULI -insulin syringe/needle u ml EXEL COMFORT OINT INSULI -insulin syringe/needle u-00 ml 8 x /" EXEL COMFORT OINT INSULI -insulin syringe/needle u-00 ml 9 x /" EXEL COMFORT OINT INSULI -insulin syringe/needle u-00 ml EXELON -rivastigmine td patch 4hr 4.6 mg/4hr EXELON -rivastigmine td patch 4hr 9.5 mg/4hr EXELON -rivastigmine td patch 4hr 3.3 mg/4hr exemestane tab 5 mg (Aromasin)... EXJADE -deferasirox tab for oral susp 5 mg EXJADE -deferasirox tab for oral susp 50 mg EXJADE -deferasirox tab for oral susp 500 mg EXTRA-VIRT LUS DHA -prenatal w/o vit a w/ fe fum-docfa-dha cap mg...58 E-Z JECT LANCETS COLOR E-Z JECT LANCETS G E-Z JECT LANCETS E-ZJECT LANCETS MICRO-THI E-Z JECT LANCETS SUER TH E-Z JECT LANCETS THIN 6G EZ-LETS LANCETS G EZ-LETS LANCETS 3G EZ-LETS LANCETS 30G EZ-LETS LANCETS 6G SUER EZ-LETS LANCETS 8G ULTRA EZ SMART BLOOD GLUCOSE LA F FACTIVE -gemifloxacin mesylate tab 30 mg (base equiv)...3 famciclovir tab 5 mg (Famvir)...4 famciclovir tab 50 mg (Famvir)...4 famciclovir tab 500 mg (Famvir)...4 famotidine for susp 40 mg/5ml (epcid) Guia de medicinas ValueScript de Florida Blue para enero de 06

148 06 famotidine tab 0 mg (epcid) famotidine tab 40 mg (epcid) FANAT -iloperidone tab mg...4 FANAT -iloperidone tab mg...4 FANAT -iloperidone tab 4 mg...4 FANAT -iloperidone tab 6 mg...4 FANAT -iloperidone tab 8 mg...4 FANAT -iloperidone tab 0 mg...4 FANAT -iloperidone tab mg...4 FANAT TITRATION ACK -iloperidone tab mg & mg & 4 mg & 6 mg titration pak...4 FARESTON -toremifene citrate tab 60 mg (base equivalent)... FARYDAK -panobinostat lactate cap 0 mg (base equivalent)... FARYDAK -panobinostat lactate cap 5 mg (base equivalent)... FARYDAK -panobinostat lactate cap 0 mg (base equivalent)... FC FEMALE CONDOM -condoms - female FC FEMALE CONDOM -condoms - female FEIBA -antiinhibitor coagulant complex for inj...67 FEIBA NF -antiinhibitor coagulant complex for inj...67 felbamate susp 600 mg/5ml (Felbatol)...54 felbamate tab 400 mg (Felbatol)...54 felbamate tab 600 mg (Felbatol)...54 felodipine tab sr 4hr.5 mg...5 felodipine tab sr 4hr 5 mg...5 felodipine tab sr 4hr 0 mg...5 FEMARA -letrozole tab.5 mg... FEMCA -cervical cap mm FEMCA -cervical cap 6 mm FEMCA -cervical cap 30 mm fenofibrate micronized cap 43 mg fenofibrate micronized cap 30 mg fenofibrate micronized cap 67 mg (Lofibra)...30 fenofibrate micronized cap 34 mg (Lofibra)...30 fenofibrate micronized cap 00 mg (Lofibra)...30 fenofibrate tab 54 mg (Lofibra)...3 fenofibrate tab 60 mg (Lofibra)...3 fenofibrate tab 48 mg (Tricor)...30 fenofibrate tab 45 mg (Tricor)...3 FENOROFEN CALCIUM -fenoprofen calcium tab 600 mg... 5 fentanyl citrate lozenge on a handle 00 mcg (Actiq)...48 fentanyl citrate lozenge on a handle 400 mcg (Actiq)...48 fentanyl citrate lozenge on a handle 600 mcg (Actiq)...48 fentanyl citrate lozenge on a handle 800 mcg (Actiq)...48 fentanyl citrate lozenge on a handle 00 mcg (Actiq)...48 fentanyl citrate lozenge on a handle 600 mcg (Actiq)...48 fentanyl td patch 7hr mcg/hr (Duragesic) fentanyl td patch 7hr 5 mcg/hr (Duragesic) fentanyl td patch 7hr 50 mcg/hr (Duragesic) fentanyl td patch 7hr 75 mcg/hr (Duragesic) fentanyl td patch 7hr 00 mcg/hr (Duragesic) FERRIROX -deferiprone tab 500 mg ferrous sulfate elixir 0 mg/5ml (44 mg/5ml elemental fe) ferrous sulfate soln 75 mg/ml (5 mg/ml elemental fe) FIFTY50 LANCING DEVICE -lancet devices FIFTY50 EN NEEDLES 3G X -insulin pen needle 3 g x 5 mm (3/6")...87 FIFTY50 EN NEEDLES 3G X -insulin pen needle 3 g x 8 mm (/3" or 5/6")...88 FIFTY50 SAFETY SEAL LANCE FIFTY50 SUERIOR COMFORT -insulin syringe/needle u-00 / ml FIFTY50 SUERIOR COMFORT -insulin syringe/needle u-00 ml FIFTY50 SUERIOR COMFORT -insulin syringe/needle u ml FINACEA -azelaic acid gel 5% finasteride tab 5 mg (roscar)...38 FINE FINGERSTIX LANCETS FIRAZYR -icatibant acetate inj 30 mg/3ml (base equivalent)...67 flavoxate hcl tab 00 mg...38 flecainide acetate tab 50 mg...5 flecainide acetate tab 00 mg...5 flecainide acetate tab 50 mg...5 FLUARIX 0-0 -influenza virus vaccine split pf susp pref syringe 0.5 ml... 8 FLUARIX influenza virus vaccine split pf susp pref syringe 0.5 ml... 8 FLUARIX influenza virus vaccine split pf susp pref syringe 0.5 ml... 8 FLUARIX influenza virus vaccine split pf susp pref syringe 0.5 ml... 8 FLUARIX QUADRIVALENT 03 -influenza virus vac split quadrivalent susp pref syr 0.5ml...8 FLUARIX QUADRIVALENT 04 -influenza virus vac split quadrivalent susp pref syr 0.5ml...8 FLUBLOK influenza virus vac recombinant hemagglutinin (ha) inj...8 FLUBLOK influenza virus vac recombinant hemagglutinin (ha) inj...8 Guia de medicinas ValueScript de Florida Blue para enero de 06 37

149 06 FLUCELVAX influenza virus vac tiss-cult subunit susp pref syr 0.5 ml...8 FLUCELVAX influenza virus vac tiss-cult subunit susp pref syr 0.5 ml...8 FLUCELVAX influenza virus vac tiss-cult subunit susp pref syr 0.5 ml...8 fluconazole for susp 0 mg/ml (Diflucan)... 3 fluconazole for susp 40 mg/ml (Diflucan)... 3 fluconazole tab 50 mg (Diflucan)... 3 fluconazole tab 00 mg (Diflucan)... 3 fluconazole tab 50 mg (Diflucan)... 4 fluconazole tab 00 mg (Diflucan)... 4 flucytosine cap 50 mg (Ancobon)... 4 flucytosine cap 500 mg (Ancobon)... 4 fludrocortisone acetate tab 0. mg... 5 FLULAVAL 0-0 -influenza virus vaccine split im susp...9 FLULAVAL influenza virus vaccine split im susp...9 FLULAVAL influenza virus vaccine split im susp...9 FLULAVAL influenza virus vaccine split im susp...9 FLULAVAL QUADRIVALENT 0 -influenza virus vaccine split quadrivalent im inj...9 FLULAVAL QUADRIVALENT 0 -influenza virus vac split quadrivalent susp pref syr 0.5ml...9 FLUMIST QUADRIVALENT -influenza virus vaccine live quadrivalent intranasal susp... 9 flunisolide nasal soln 5 mcg/act (0.05%) (Flunisolide)...3 fluocinolone acetonide cream 0.0%...73 fluocinolone acetonide cream 0.05% (Synalar)...73 fluocinolone acetonide oil 0.0% (body oil) (Dermasmoothe/fs bod)...73 fluocinolone acetonide oil 0.0% (scalp oil) (Dermasmoothe/fs sca) fluocinolone acetonide oint 0.05% (Synalar)...73 fluocinolone acetonide (otic) oil 0.0% (Dermotic)... 7 fluocinolone acetonide soln 0.0% (Synalar)...73 fluocinonide cream 0.05%...73 fluocinonide cream 0.% (Vanos) fluocinonide emulsified base cream 0.05% fluocinonide gel 0.05% fluocinonide oint 0.05%...73 fluocinonide soln 0.05% fluorometholone ophth susp 0.% (Fml liquifilm) fluorouracil cream 5% (Efudex)...73 fluorouracil soln %...73 fluorouracil soln 5%...73 fluoxetine hcl cap delayed release 90 mg (rozac weekly) fluoxetine hcl cap 0 mg (rozac)...40 fluoxetine hcl cap 0 mg (rozac)...40 fluoxetine hcl cap 40 mg (rozac)...40 fluoxetine hcl (pmdd) cap 0 mg fluoxetine hcl (pmdd) cap 0 mg fluoxetine hcl solution 0 mg/5ml...40 fluoxetine hcl tab 0 mg...40 fluoxetine hcl tab 0 mg...4 fluphenazine hcl tab mg...4 fluphenazine hcl tab.5 mg...4 fluphenazine hcl tab 5 mg...4 fluphenazine hcl tab 0 mg...4 flurbiprofen sodium ophth soln 0.03% (Ocufen) flurbiprofen tab 50 mg...5 flurbiprofen tab 00 mg...5 flutamide cap 5 mg... fluticasone propionate cream 0.05% (Cutivate)...73 fluticasone propionate lotion 0.05% (Cutivate)...73 fluticasone propionate nasal susp 50 mcg/ act... 3 fluticasone propionate oint 0.005% fluvastatin sodium cap 0 mg (Lescol)... 3 fluvastatin sodium cap 40 mg (Lescol)... 3 FLUVIRIN 0-0 -influenza virus vaccine types a & b surface antigen im susp... 9 FLUVIRIN influenza virus vaccine types a & b surface antigen im susp... 9 FLUVIRIN influenza virus vaccine types a & b surface antigen im susp... 9 FLUVIRIN influenza virus vaccine types a & b surface antigen im susp... 9 FLUVIRIN F 0-0 -influenza virus vac types a & b pf susp prefilled syr 0.5 ml...9 FLUVIRIN F influenza virus vac types a & b pf susp prefilled syr 0.5 ml...9 FLUVIRIN F influenza virus vac types a & b pf susp prefilled syr 0.5 ml...9 FLUVIRIN F influenza virus vac types a & b pf susp prefilled syr 0.5 ml...9 fluvoxamine maleate cap sr 4hr 00 mg...4 fluvoxamine maleate cap sr 4hr 50 mg...4 fluvoxamine maleate tab 5 mg... 4 fluvoxamine maleate tab 50 mg... 4 fluvoxamine maleate tab 00 mg... 4 FLUZONE HIGH-DOSE F 0 -influenza virus vac split high-dose pf susp pref syr 0.5ml... 9 FLUZONE HIGH-DOSE F 0 -influenza virus vac split high-dose pf susp pref syr 0.5ml... 9 FLUZONE HIGH-DOSE F 03 -influenza virus vac split high-dose pf susp pref syr 0.5ml... 9 FLUZONE HIGH-DOSE F 04 -influenza virus vac split high-dose pf susp pref syr 0.5ml Guia de medicinas ValueScript de Florida Blue para enero de 06

150 06 FLUZONE F 0-0 -influenza virus vaccine split pf susp pref syringe 0.5 ml...9 FLUZONE F influenza virus vaccine split pf susp pref syringe 0.5 ml...9 FLUZONE F influenza virus vaccine split pf susp pref syringe 0.5 ml...9 FLUZONE F influenza virus vaccine split pf susp pref syringe 0.5 ml...9 FLUZONE QUADRIVALENT 04 -influenza virus vaccine split quadrivalent im inj...9 FLUZONE QUADRIVALENT 03 -influenza virus vaccine split quadrivalent inj 0.5 ml... 9 FLUZONE QUADRIVALENT 04 -influenza virus vaccine split quadrivalent inj 0.5 ml... 0 FLUZONE QUADRIVALENT 03 -influenza virus vac split quadrivalent susp pref syr 0.5 ml... 9 FLUZONE QUADRIVALENT 03 -influenza virus vac split quadrivalent susp pref syr 0.5ml... 9 FLUZONE QUADRIVALENT 04 -influenza virus vac split quadrivalent susp pref syr 0.5 ml... 9 FLUZONE QUADRIVALENT 04 -influenza virus vac split quadrivalent susp pref syr 0.5ml... 9 FLUZONE SLIT 0-0 -influenza virus vaccine split im susp... 0 FLUZONE SLIT influenza virus vaccine split im susp... 0 FLUZONE SLIT influenza virus vaccine split im susp... 0 FLUZONE SLIT influenza virus vaccine split im susp... 0 FOCALGIN-B -prenatal w/ calcium-vit b6-fa-ginger tab. mg...58 FOCALGIN CA -prenat w/o a w/fecbn-fegl-dss-fa tab & dha cap 300 mg pack FOCALGIN 90 DHA -prenat w/o a w/fecbn-fegl-dss-fa tab 90 &dha cap 300mg pak...58 FOLBECAL -prenatal w/ calcium carbonate-b6-b-fa tab mg FOLCAL DHA -prenatal w/o vit a w/ fe fum-dss-fa-dha cap mg FOLCAS OMEGA 3 -prenatal vit w/ fe cbn-fe asp glyc-faomega 3 cap 7-mg FOLET DHA -prenat w/fecbn-bisg-methylf-dss tab dr & dha cap pak...58 FOLET ONE -prenat w/o a w/fecbn-bisg-methylf-dss-dha cap mg folic acid tab 400 mcg folic acid tab 800 mcg folic acid tab mg FOLIVANE-OB -prenatal w/o a w/fe fum-fe poly-fa cap mg fondaparinux sodium inj.5 mg/0.5ml (Arixtra) fondaparinux sodium inj 5 mg/0.4ml (Arixtra) fondaparinux sodium inj 7.5 mg/0.6ml (Arixtra) fondaparinux sodium inj 0 mg/0.8ml (Arixtra) FORADIL AEROLIZER -formoterol fumarate inhal cap mcg...33 FORA LANCETS FORA LANCING DEVICE -lancet devices FORTEO -teriparatide (recombinant) inj 600 mcg/.4ml... fosinopril sodium & hydrochlorothiazide tab 0-.5 mg... 7 fosinopril sodium & hydrochlorothiazide tab 0-.5 mg... 7 fosinopril sodium tab 0 mg...7 fosinopril sodium tab 0 mg...7 fosinopril sodium tab 40 mg...7 FOSRENOL -lanthanum carbonate chew tab 500 mg FOSRENOL -lanthanum carbonate chew tab 750 mg FOSRENOL -lanthanum carbonate chew tab 000 mg FREDS HARMACY AUTOLET LA -lancet devices FREDS HARMACY UNIFINE E -insulin pen needle 3 g x 5 mm (3/6") FREDS HARMACY UNIFINE E -insulin pen needle 3 g x 4 mm (5/3") FREDS HARMACY UNIFINE E -insulin pen needle 3 g x 8 mm (/3" or 5/6") FREDS HARMACY UNILET LAN FREESTYLE LANCETS FREESTYLE RECISION INSUL -insulin syringe/needle u-00 / ml FREESTYLE RECISION INSUL -insulin syringe/needle u-00 / ml FREESTYLE RECISION INSUL -insulin syringe/needle u-00 ml FREESTYLE RECISION INSUL -insulin syringe/needle u-00 ml FREESTYLE UNISTICK II LAN FROVA -frovatriptan succinate tab.5 mg (base equivalent)...5 furosemide oral soln 0 mg/ml...9 furosemide tab 0 mg (Lasix)...9 furosemide tab 40 mg (Lasix)...9 furosemide tab 80 mg (Lasix)...9 FUZEON -enfuvirtide for inj 90 mg... 4 G gabapentin cap 00 mg (Neurontin) gabapentin cap 300 mg (Neurontin) gabapentin cap 400 mg (Neurontin) gabapentin oral soln 50 mg/5ml (Neurontin)...54 gabapentin tab 600 mg (Neurontin) gabapentin tab 800 mg (Neurontin) Guia de medicinas ValueScript de Florida Blue para enero de 06 39

151 06 galantamine hydrobromide cap sr 4hr 8 mg (Razadyne er) galantamine hydrobromide cap sr 4hr 6 mg (Razadyne er) galantamine hydrobromide cap sr 4hr 4 mg (Razadyne er) galantamine hydrobromide tab 4 mg (Razadyne)...47 galantamine hydrobromide tab 8 mg (Razadyne)...47 galantamine hydrobromide tab mg (Razadyne)...47 GAMMAGARD LIQUID -immune globulin (human) iv or subcutaneous soln gm/0ml... GAMMAGARD LIQUID -immune globulin (human) iv or subcutaneous soln.5 gm/5ml... GAMMAGARD LIQUID -immune globulin (human) iv or subcutaneous soln 5 gm/50ml... GAMMAGARD LIQUID -immune globulin (human) iv or subcutaneous soln 0 gm/00ml... GAMMAGARD LIQUID -immune globulin (human) iv or subcutaneous soln 0 gm/00ml... GAMMAGARD LIQUID -immune globulin (human) iv or subcutaneous soln 30 gm/300ml... GAMMAKED -immune globulin (human) iv or subcutaneous soln gm/0ml... GAMMAKED -immune globulin (human) iv or subcutaneous soln.5 gm/5ml... GAMMAKED -immune globulin (human) iv or subcutaneous soln 5 gm/50ml... GAMMAKED -immune globulin (human) iv or subcutaneous soln 0 gm/00ml... GAMMAKED -immune globulin (human) iv or subcutaneous soln 0 gm/00ml... GAMUNEX-C -immune globulin (human) iv or subcutaneous soln gm/0ml... GAMUNEX-C -immune globulin (human) iv or subcutaneous soln.5 gm/5ml... GAMUNEX-C -immune globulin (human) iv or subcutaneous soln 5 gm/50ml... GAMUNEX-C -immune globulin (human) iv or subcutaneous soln 0 gm/00ml... GAMUNEX-C -immune globulin (human) iv or subcutaneous soln 0 gm/00ml... GAMUNEX-C -immune globulin (human) iv or subcutaneous soln 40 gm/400ml... GARDASIL -human papillomavirus (hpv) quadrivalent recombinant vac inj... 0 GARDASIL 9 -human papillomavirus (hpv) 9-valent recomb vac im susp... 0 GARDASIL 9 -human papillomavirus (hpv) 9-valent recomb vac susp pref syr...0 gatifloxacin ophth soln 0.5% (Zymaxid) gemfibrozil tab 600 mg (Lopid)... 3 gentamicin sulfate ophth oint 0.3% gentamicin sulfate ophth soln 0.3% (Garamycin) GENTLE-LET G LANCETS GENTLE-LET LANCETS GENERA GENTLE-LET LANCETS SAFETY GILOTRIF -afatinib dimaleate tab 0 mg (base equivalent)... GILOTRIF -afatinib dimaleate tab 30 mg (base equivalent)... GILOTRIF -afatinib dimaleate tab 40 mg (base equivalent)... glatiramer acetate soln prefilled syringe 0 mg/ml (Copaxone) GLEEVEC -imatinib mesylate tab 00 mg (base equivalent)... GLEEVEC -imatinib mesylate tab 400 mg (base equivalent)... GLEOSTINE -lomustine cap 0 mg... GLEOSTINE -lomustine cap 40 mg... GLEOSTINE -lomustine cap 00 mg... glimepiride tab mg (Amaryl)... 8 glimepiride tab mg (Amaryl)... 8 glimepiride tab 4 mg (Amaryl)... 8 glipizide-metformin hcl tab.5-50 mg... 8 glipizide-metformin hcl tab mg... 8 glipizide-metformin hcl tab mg... 8 glipizide tab 5 mg (Glucotrol)... 8 glipizide tab 0 mg (Glucotrol)... 8 glipizide tab sr 4hr.5 mg (Glucotrol xl)... 8 glipizide tab sr 4hr 5 mg (Glucotrol xl)...8 glipizide tab sr 4hr 0 mg (Glucotrol xl)... 8 GLOBAL EASE INJECT EN NE -insulin pen needle 9 g x mm (/")...88 GLOBAL EASE INJECT EN NE -insulin pen needle 3 g x 5 mm (3/6")...88 GLOBAL EASE INJECT EN NE -insulin pen needle 3 g x 4 mm (5/3")...88 GLOBAL EASE INJECT EN NE -insulin pen needle 3 g x 8 mm (/3" or 5/6")...88 GLOBAL INJECT EASE INSULI -insulin syringe/needle u-00 / ml GLOBAL INJECT EASE INSULI -insulin syringe/needle u-00 / ml 8 x /" GLOBAL INJECT EASE INSULI -insulin syringe/needle u-00 / ml 9 x /" GLOBAL INJECT EASE INSULI -insulin syringe/needle u-00 / ml GLOBAL INJECT EASE INSULI -insulin syringe/needle u-00 / ml 30 x /" GLOBAL INJECT EASE INSULI -insulin syringe/needle u ml 9 x /" GLOBAL INJECT EASE INSULI -insulin syringe/needle u ml GLOBAL INJECT EASE INSULI -insulin syringe/needle u ml 30 x /" GLOBAL INJECT EASE INSULI -insulin syringe/needle u-00 ml 8 x /" GLOBAL INJECT EASE INSULI -insulin syringe/needle u-00 ml 9 x /" Guia de medicinas ValueScript de Florida Blue para enero de 06

152 06 GLOBAL INJECT EASE INSULI -insulin syringe/needle u-00 ml GLOBAL INJECT EASE INSULI -insulin syringe/needle u-00 ml 30 x /" GLOBAL INJECT EASE INSULI -insulin syringe/needle u-00 ml GLOBAL INJECT EASE INSULI -insulin syringe/needle u ml GLOBAL INJECT EASE LANCET GLOBAL LANCING DEVICE -lancet devices...89 GLUCAGEN DIAGNOSTIC -glucagon hcl (rdna) diagnostic for inj mg (base equiv) GLUCAGEN HYOKIT -glucagon hcl (rdna) for inj mg (base equiv)... 8 GLUCAGON EMERGENCY KIT -glucagon (rdna) for inj kit mg... 8 GLUCOCOM LANCETS 8G GLUCOCOM LANCETS 30G GLUCOCOM LANCETS 33G GLUCOLET AUTOMATIC LANC -lancet devices GLUCORO INSULIN SYRINGE/ -insulin syringe/needle u-00 / ml GLUCORO INSULIN SYRINGE/ -insulin syringe/needle u-00 / ml GLUCORO INSULIN SYRINGE/ -insulin syringe/needle u-00 / ml 30 x /" GLUCORO INSULIN SYRINGE/ -insulin syringe/needle u ml GLUCORO INSULIN SYRINGE/ -insulin syringe/needle u ml 30 x /" GLUCORO INSULIN SYRINGE/ -insulin syringe/needle u-00 ml GLUCORO INSULIN SYRINGE/ -insulin syringe/needle u-00 ml 30 x /" GLUCORO INSULIN SYRINGE/ -insulin syringe/needle u-00 ml GLUCORO INSULIN SYRINGE/ -insulin syringe/needle u ml GLUCOSOURCE LANCET DEVICE -lancet devices GLUCOSOURCE LANCETS GLYBURIDE -glyburide tab.5 mg... 8 GLYBURIDE -glyburide tab.5 mg... 8 GLYBURIDE -glyburide tab 5 mg... 8 glyburide-metformin tab.5-50 mg (Glucovance)... 8 glyburide-metformin tab mg (Glucovance)... 8 glyburide-metformin tab mg (Glucovance)... 8 glyburide micronized tab.5 mg (Glynase)...8 glyburide micronized tab 3 mg (Glynase)... 8 glyburide micronized tab 6 mg (Glynase)... 8 glyburide tab.5 mg...8 glyburide tab.5 mg...8 glyburide tab 5 mg...8 glycopyrrolate tab mg (Robinul) glycopyrrolate tab mg (Robinul forte) GLYSET -miglitol tab 5 mg...8 GLYSET -miglitol tab 50 mg...8 GLYSET -miglitol tab 00 mg... 8 GMATE LANCETS 30G GMATE LANCING DEVICE -lancet devices GN CLICKFINE EN NEEDLE -insulin pen needle 3 g x 8 mm (/3" or 5/6")...89 GN CLICKFINE UNIVERSAL -insulin pen needle 3 g x 6 mm (/4")...89 GN CLICKFINE UNIVERSAL -insulin pen needle 3 g x 8 mm (/3" or 5/6")...89 GN INSULIN SYRINGE/ML/ -insulin syringe/needle u-00 ml 8 x /" GN INSULIN SYRINGE/ML/ -insulin syringe/needle u-00 ml 9 x /" GN INSULIN SYRINGE/ML/3 -insulin syringe/needle u-00 ml GN INSULIN SYRINGE/ML/3 -insulin syringe/needle u-00 ml GN INSULIN SYRINGE/0.5ML -insulin syringe/needle u-00 / ml GN INSULIN SYRINGE/0.5ML -insulin syringe/needle u-00 / ml 8 x /" GN INSULIN SYRINGE/0.5ML -insulin syringe/needle u-00 / ml 9 x /" GN INSULIN SYRINGE/0.5ML -insulin syringe/needle u-00 / ml GN INSULIN SYRINGE/0.3ML -insulin syringe/needle u ml 9 x /" GN INSULIN SYRINGE/0.3ML -insulin syringe/needle u ml GN INSULIN SYRINGE/0.3ML -insulin syringe/needle u ml GN LANCETS G GN LANCETS GN LANCETS MICRO THIN GN LANCETS SUER THIN GN LANCETS THIN 6G GN LANCETS THIN GN MICRO THIN LANCETS GN SUER THIN LANCETS/ GN ULTRA COMFORT INSULIN -insulin syringe/needle u-00 / ml GN ULTRA COMFORT INSULIN -insulin syringe/needle u-00 / ml 8 x /" GN ULTRA COMFORT INSULIN -insulin syringe/needle u-00 / ml 9 x /" GN ULTRA COMFORT INSULIN -insulin syringe/needle u-00 / ml GN ULTRA COMFORT INSULIN -insulin syringe/needle u ml 9 x /" GN ULTRA COMFORT INSULIN -insulin syringe/needle u ml Guia de medicinas ValueScript de Florida Blue para enero de 06 4

153 06 GN ULTRA COMFORT INSULIN -insulin syringe/needle u-00 ml 8 x /" GN ULTRA COMFORT INSULIN -insulin syringe/needle u-00 ml 9 x /" GN ULTRA COMFORT INSULIN -insulin syringe/needle u-00 ml GN ULTRA COMFORT INSULIN -insulin syringe/needle u-00 ml GN ULTRA COMFORT INSULIN -insulin syringe/needle u ml granisetron hcl tab mg...36 griseofulvin microsize susp 5 mg/5ml...4 griseofulvin microsize tab 500 mg (Grifulvin v)... 4 griseofulvin ultramicrosize tab 5 mg (Grispeg)...4 griseofulvin ultramicrosize tab 50 mg (Grispeg)...4 guanfacine hcl tab mg (Tenex)...7 guanfacine hcl tab mg (Tenex)...7 guanfacine hcl tab sr 4hr mg (base equiv) (Intuniv) guanfacine hcl tab sr 4hr mg (base equiv) (Intuniv) guanfacine hcl tab sr 4hr 3 mg (base equiv) (Intuniv) guanfacine hcl tab sr 4hr 4 mg (base equiv) (Intuniv) GUANIDINE HCL -guanidine hcl tab 5 mg GYNAZOLE- -butoconazole nitrate (one dose) vaginal cream %...38 H H&H THINLET LANCETS 6G H&H THINLET SUER THIN LA HAEMOLANCE HAEMOLANCE LOW FLOW LANCE HAEMOLANCE LUS HIGH FLOW HAEMOLANCE LUS HAEMOLANCE LUS LOW FLOW HAEMOLANCE LUS MAX FLOW HAEMOLANCE LUS EDIATRIC halobetasol propionate cream 0.05% (Ultravate) halobetasol propionate oint 0.05% (Ultravate) haloperidol lactate oral conc mg/ml... 4 haloperidol tab 0.5 mg...4 haloperidol tab mg...4 haloperidol tab mg...4 haloperidol tab 5 mg...4 haloperidol tab 0 mg...4 haloperidol tab 0 mg...4 HARVONI -ledipasvir-sofosbuvir tab mg...4 HAVRIX -hepatitis a vaccine inj susp 70 el unit/0.5ml...0 HAVRIX -hepatitis a vaccine inj susp 440 el unit/ ml...0 HEALTH CARE LANCING DEVIC -lancet devices... 9 HEALTHWISE LANCETS 30G HEALTHWISE LANCING EN -lancet devices... 9 HEALTHWISE MINI EN NEEDL -insulin pen needle 3 g x 6 mm (/4")...9 HEALTHWISE EN NEEDLES 9 -insulin pen needle 9 g x mm (/")...9 HEALTHWISE SHORT EN NEED -insulin pen needle 3 g x 8 mm (/3" or 5/6")... 9 HEALTHWISE UNIFINE ENTI -insulin pen needle 3 g x 4 mm (5/3")...9 HEALTHY AENTS AUTOLET I -lancet devices... 9 HEALTHY AENTS UNIFINE -insulin pen needle 9 g x mm (/")...9 HEALTHY AENTS UNIFINE -insulin pen needle 3 g x 5 mm (3/6")...9 HEALTHY AENTS UNIFINE -insulin pen needle 3 g x 6 mm (/4")...9 HEALTHY AENTS UNIFINE -insulin pen needle 3 g x 4 mm (5/3")...9 HEALTHY AENTS UNIFINE -insulin pen needle 3 g x 8 mm (/3" or 5/6")...9 HEALTHY AENTS UNILET LA H-E-B INCONTROL ADVANCED -lancet devices H-E-B INCONTROL LANCETS S H-E-B INCONTROL LANCETS U H-E-B IN CONTROL EN NEED -insulin pen needle 3 g x 5 mm (3/6")...90 H-E-B IN CONTROL EN NEED -insulin pen needle 3 g x 6 mm (/4")...90 H-E-B IN CONTROL EN NEED -insulin pen needle 3 g x 4 mm (5/3")...90 H-E-B IN CONTROL EN NEED -insulin pen needle 3 g x 8 mm (/3" or 5/6")...90 H-E-B INCONTROL EN NEEDL -insulin pen needle 9 g x mm (/")...9 HELIXATE FS -antihemophilic factor (recombinant) for inj kit 50 unit HELIXATE FS -antihemophilic factor (recombinant) for inj kit 500 unit HELIXATE FS -antihemophilic factor (recombinant) for inj kit 000 unit HELIXATE FS -antihemophilic factor (recombinant) for inj kit 000 unit HELIXATE FS -antihemophilic factor (recombinant) for inj kit 3000 unit HEMENATAL OB + DHA -prenat-fe poly cmplx-fe heme poly-fa tab & omega 3 cap pck Guia de medicinas ValueScript de Florida Blue para enero de 06

154 06 HEMENATAL OB -prenat vit-fe poly cmplx-fe heme poly-fa tab 8-6- mg HEMOFIL M -antihemophilic factor (human) for inj 50 unit...67 HEMOFIL M -antihemophilic factor (human) for inj 500 unit...67 HEMOFIL M -antihemophilic factor (human) for inj 000 unit...67 HEMOFIL M -antihemophilic factor (human) for inj 700 unit...67 HEMOFIL M -antihemophilic factor (human) for inj unit...67 HEMOFIL M -antihemophilic factor (human) for inj unit...67 HEMOFIL M -antihemophilic factor (human) for inj unit...67 HEMOFIL M -antihemophilic factor (human) for inj unit...67 heparin sodium (porcine) inj 5000 unit/ml HESERA -adefovir dipivoxil tab 0 mg...4 HEXALEN -altretamine cap 50 mg... HIBERIX -haemophilus b polysaccharide conjugate vac for inj 0 mcg... 0 HIZENTRA -immune globulin (human) subcutaneous inj gm/5ml... HIZENTRA -immune globulin (human) subcutaneous inj gm/0ml... HIZENTRA -immune globulin (human) subcutaneous inj 4 gm/0ml... HIZENTRA -immune globulin (human) subcutaneous inj 0 gm/50ml... HM LANCETS MICRO THIN 33G HM LANCETS ULTRA THIN 30G homatropine hbr ophth soln 5% (Isopto homatropine) HUMATE- -antihemophilic factor/vwf (human) for inj unit...67 HUMATE- -antihemophilic factor/vwf (human) for inj unit...67 HUMATE- -antihemophilic factor/vwf (human) for inj unit...67 HUMIRA -adalimumab prefilled syringe kit 0 mg/0.ml... 5 HUMIRA -adalimumab prefilled syringe kit 0 mg/0.4ml... 5 HUMIRA -adalimumab prefilled syringe kit 40 mg/0.8ml... 5 HUMIRA EDIATRIC CROHNS D -adalimumab prefilled syringe kit 40 mg/0.8ml... 5 HUMIRA EN -adalimumab pen-injector kit 40 mg/0.8ml... 5 HUMIRA EN-CROHNS DISEASE -adalimumab peninjector kit 40 mg/0.8ml... 5 HUMIRA EN-SORIASIS STAR -adalimumab peninjector kit 40 mg/0.8ml... 5 HYCAMTIN -topotecan hcl cap 0.5 mg (base equiv)... HYCAMTIN -topotecan hcl cap mg (base equiv)... hydralazine hcl tab 0 mg...7 hydralazine hcl tab 5 mg...7 hydralazine hcl tab 50 mg...7 hydralazine hcl tab 00 mg...7 HYDREA -hydroxyurea cap 500 mg... hydrochlorothiazide cap.5 mg (Microzide)... 9 hydrochlorothiazide tab.5 mg...9 hydrochlorothiazide tab 5 mg...30 hydrochlorothiazide tab 50 mg...30 hydrocodone-acetaminophen soln mg/5ml (Hycet) hydrocodone-acetaminophen tab.5-35 mg hydrocodone-acetaminophen tab mg (Norco) hydrocodone-acetaminophen tab 5-35 mg (Norco) hydrocodone-acetaminophen tab 0-35 mg (Norco) hydrocodone-acetaminophen tab mg (Xodol)...49 hydrocodone-acetaminophen tab mg (Xodol)...49 hydrocodone-acetaminophen tab mg (Xodol)...49 hydrocodone-ibuprofen tab 0-00 mg (Ibudone)...49 hydrocodone-ibuprofen tab.5-00 mg (Reprexain) hydrocodone-ibuprofen tab 5-00 mg (Reprexain) hydrocodone-ibuprofen tab mg (Vicoprofen)...49 hydrocodone w/ homatropine syrup 5-.5 mg/5ml...3 hydrocodone w/ homatropine tab 5-.5 mg hydrocod polst-chlorphen polst cr susp 0-8 mg/5ml (Tussionex pennkineti)... 3 hydrocortisone acetate suppos 5 mg (Anusolhc)... 7 hydrocortisone acetate suppos 30 mg (roctocort)...7 hydrocortisone acetate w/ pramoxine rectal cream -% (Analpram-hc)...7 hydrocortisone acetate w/ pramoxine rectal cream.5-% (Analpram-hc)...7 hydrocortisone butyrate cream 0.% (Locoid) hydrocortisone butyrate hydrophilic lipo base cream 0.% (Locoid lipocream)...73 hydrocortisone butyrate oint 0.% (Locoid) Guia de medicinas ValueScript de Florida Blue para enero de 06 43

155 06 hydrocortisone butyrate soln 0.% (Locoid) hydrocortisone cream %...73 hydrocortisone cream.5%...74 hydrocortisone enema 00 mg/60ml (Cortenema)...7 hydrocortisone lotion.5%...74 hydrocortisone lotion % (Ala scalp) hydrocortisone oint % hydrocortisone oint.5%...74 hydrocortisone rectal cream.5% (Anusolhc)... 7 hydrocortisone rectal cream % (roctocort)...7 hydrocortisone tab 5 mg (Cortef)...5 hydrocortisone tab 0 mg (Cortef)...5 hydrocortisone tab 0 mg (Cortef)...5 hydrocortisone valerate cream 0.% hydrocortisone valerate oint 0.% (Westcort) hydrocortisone w/ acetic acid otic soln -%... 7 hydromorphone hcl liqd mg/ml (Dilaudid)...49 hydromorphone hcl tab er 4hr deter 8 mg (Exalgo) hydromorphone hcl tab er 4hr deter mg (Exalgo) hydromorphone hcl tab er 4hr deter 6 mg (Exalgo) hydromorphone hcl tab mg (Dilaudid) hydromorphone hcl tab 4 mg (Dilaudid) hydromorphone hcl tab 8 mg (Dilaudid) hydroxychloroquine sulfate tab 00 mg (laquenil)...7 hydroxyurea cap 500 mg (Hydrea)... hydroxyzine hcl syrup 0 mg/5ml hydroxyzine hcl tab 0 mg...39 hydroxyzine hcl tab 5 mg...39 hydroxyzine hcl tab 50 mg...39 hydroxyzine pamoate cap 5 mg (Vistaril)...39 hydroxyzine pamoate cap 50 mg (Vistaril)...39 hyoscyamine sulfate elixir 0.5 mg/5ml hyoscyamine sulfate soln 0.5 mg/ml hyoscyamine sulfate tab disp 0.5 mg (Anaspaz) hyoscyamine sulfate tab 0.5 mg (Levsin) hyoscyamine sulfate tab sl 0.5 mg (Levsin/ sl) hyoscyamine sulfate tab sr hr mg (Levbid) HY-VEE LANCETS HY-VEE THIN LANCETS I ibandronate sodium tab 50 mg (base equivalent) (Boniva)... IBRANCE -palbociclib cap 75 mg... IBRANCE -palbociclib cap 00 mg... IBRANCE -palbociclib cap 5 mg... ibuprofen susp 00 mg/5ml... 5 ibuprofen tab 400 mg... 5 ibuprofen tab 600 mg... 5 ibuprofen tab 800 mg... 5 ICLUSIG -ponatinib hcl tab 5 mg (base equiv)... ICLUSIG -ponatinib hcl tab 45 mg (base equiv)... ILEVRO -nepafenac ophth susp 0.3%...70 IMBRUVICA -ibrutinib cap 40 mg... imipramine hcl tab 0 mg (Tofranil)...4 imipramine hcl tab 5 mg (Tofranil)...4 imipramine hcl tab 50 mg (Tofranil)...4 imipramine pamoate cap 75 mg (Tofranilpm)...4 imipramine pamoate cap 00 mg (Tofranilpm)...4 imipramine pamoate cap 5 mg (Tofranilpm)...4 imipramine pamoate cap 50 mg (Tofranilpm)...4 imiquimod cream 5% (Aldara) IMITREX -sumatriptan nasal spray 5 mg/act...5 IMITREX -sumatriptan nasal spray 0 mg/ act...5 INATAL ADVANCE -prenatal vit w/ dss-iron carbonyl-fa tab 90- mg INATAL GT -prenatal vit w/ dss-iron carbonyl-fa tab 90- mg INATAL ULTRA -prenatal vit w/ dss-iron carbonyl-fa tab 90- mg...58 INCRELEX -mecasermin inj 40 mg/4ml (0 mg/ ml)... INCRUSE ELLITA -umeclidinium br aero powd breath act 6.5 mcg/inh (base eq) indapamide tab.5 mg...30 indapamide tab.5 mg indomethacin cap cr 75 mg... 5 indomethacin cap 5 mg...5 indomethacin cap 50 mg...5 INFANATE BALANCE -prenatal w/o a w/fe cbn-dss-fa-dha cap mg INFANATE LUS -prenat w/o a w/fe fum-fe cbn-dss-fadha cap mg...58 INFANRIX -diph, acellular pert & tet tox inj 5 lf-58 mcg-0 lf/0.5ml... INFLUENZA A (HN) MONOVA -influenza a (hn) monovalent vaccine live intranasal liquid...0 INLYTA -axitinib tab mg... INLYTA -axitinib tab 5 mg Guia de medicinas ValueScript de Florida Blue para enero de 06

156 06 INSULIN SYRINGE/0.5ML/7G -insulin syringe/needle u-00 / ml 7 x /"... 9 INSULIN SYRINGE/0.5ML/8G -insulin syringe/needle u-00 / ml 8 x /"... 9 INSULIN SYRINGE/0.5ML/9G -insulin syringe/needle u-00 / ml 9 x /"... 9 INSULIN SYRINGE/0.5ML/30G -insulin syringe/needle u-00 / ml INSULIN SYRINGE/0.5ML/30G -insulin syringe/needle u-00 / ml 30 x /"... 9 INSULIN SYRINGE/0.5ML/3G -insulin syringe/needle u-00 / ml INSULIN SYRINGE/0.3ML/9G -insulin syringe/needle u ml 9 x /"... 9 INSULIN SYRINGE/0.3ML/30G -insulin syringe/needle u ml INSULIN SYRINGE/0.3ML/3G -insulin syringe/needle u ml INSULIN SYRINGE/0.3ML/9G -insulin syringe/needle u ml 9 x "... 9 INSULIN SYRINGE/ML/8G X -insulin syringe/needle u-00 ml 8 x /"... 9 INSULIN SYRINGE/ML/9G X -insulin syringe/needle u-00 ml 9 x /"... 9 INSULIN SYRINGE/ML/30G X -insulin syringe/needle u-00 ml INSULIN SYRINGE/ML/3G X -insulin syringe/needle u-00 ml INSULIN SYRINGE/U-00/0.5 -insulin syringe/needle u-00 / ml 8 x /"... 9 INSULIN SYRINGE/U-00/0.5 -insulin syringe/needle u-00 / ml 9 x /"... 9 INSULIN SYRINGE/U-00/0.3 -insulin syringe/needle u ml 9 x /"... 9 INSULIN SYRINGE/U-00/ML -insulin syringe/needle u-00 ml 8 x /"... 9 INSULIN SYRINGE/U-00/ML -insulin syringe/needle u-00 ml 9 x /"... 9 INSULIN SYRINGE/U-00/ML -insulin syringe/needle u-00 ml INSULIN SYRINGE/U-00/ML -insulin syringe/needle u-00 ml INSUEN 33GX4MM -insulin pen needle 33 g x 4 mm (5/3")...9 INSUEN EN NEEDLES 3G X -insulin pen needle 3 g x 4 mm (5/3")...9 INSUEN SENSITIVE 3GX8MM -insulin pen needle 3 g x 8 mm...9 INSUEN SENSITIVE 3GX6MM -insulin pen needle 3 g x 6 mm (/4")...9 INSUEN ULTRAFIN 9GXMM -insulin pen needle 9 g x mm (/")... 9 INSUEN ULTRAFIN 3GX6MM -insulin pen needle 3 g x 6 mm (/4")...9 INSUEN ULTRAFIN 30GX8MM -insulin pen needle 30 g x 8 mm (/3" or 5/6")...9 INSUEN ULTRAFIN 3GX8MM -insulin pen needle 3 g x 8 mm (/3" or 5/6")...9 INTELENCE -etravirine tab 5 mg... 4 INTELENCE -etravirine tab 00 mg... 4 INTELENCE -etravirine tab 00 mg... 4 INTRON A -interferon alfa-b for inj unit...3 INTRON A -interferon alfa-b for inj unit...3 INTRON A -interferon alfa-b for inj unit...3 INTRON A -interferon alfa-b inj unit/ ml...3 INTRON A -interferon alfa-b inj unit/ ml...3 INTRON A W/DILUENT -interferon alfa-b for inj unit...3 INTRON A W/DILUENT -interferon alfa-b for inj unit...3 INTRON A W/DILUENT -interferon alfa-b for inj unit...3 INVEGA -paliperidone tab sr 4hr.5 mg...4 INVEGA -paliperidone tab sr 4hr 3 mg...4 INVEGA -paliperidone tab sr 4hr 6 mg...4 INVEGA -paliperidone tab sr 4hr 9 mg...4 INVIRASE -saquinavir mesylate cap 00 mg... 5 INVIRASE -saquinavir mesylate tab 500 mg...5 INVOKAMET -canagliflozin-metformin hcl tab mg... 8 INVOKAMET -canagliflozin-metformin hcl tab mg... 9 INVOKAMET -canagliflozin-metformin hcl tab mg... 8 INVOKAMET -canagliflozin-metformin hcl tab mg... 9 INVOKANA -canagliflozin tab 00 mg... 9 INVOKANA -canagliflozin tab 300 mg... 9 iodoquinol-hydrocortisone in aloe vehicle cream -.9% (Vytone)...74 ipratropium-albuterol nebu soln (3) mg/3ml...33 ipratropium bromide inhal soln 0.0% ipratropium bromide nasal soln 0.03% ( mcg/spray) (Atrovent)... 3 ipratropium bromide nasal soln 0.06% (4 mcg/spray) (Atrovent)... 3 irbesartan-hydrochlorothiazide tab mg (Avalide)... 8 irbesartan-hydrochlorothiazide tab mg (Avalide)... 8 irbesartan tab 75 mg (Avapro)...8 irbesartan tab 50 mg (Avapro)...8 irbesartan tab 300 mg (Avapro)...8 irrigation solution, physiological... 4 ISENTRESS -raltegravir potassium chew tab 5 mg (base equiv)...5 Guia de medicinas ValueScript de Florida Blue para enero de 06 45

157 06 ISENTRESS -raltegravir potassium chew tab 00 mg (base equiv)... 5 ISENTRESS -raltegravir potassium packet for susp 00 mg (base equiv)...5 ISENTRESS -raltegravir potassium tab 400 mg (base equiv)...5 isometheptene-caffeine-acetaminophen tab mg (rodrin)... 5 ISONIAZID -isoniazid syrup 50 mg/5ml...3 isoniazid tab 00 mg...3 isoniazid tab 300 mg...3 ISOSORBIDE DINITRATE -isosorbide dinitrate tab 30 mg... 3 isosorbide dinitrate tab cr 40 mg...3 isosorbide dinitrate tab 0 mg... 3 isosorbide dinitrate tab 0 mg... 3 isosorbide dinitrate tab 5 mg (Isordil titradose)...3 isosorbide mononitrate tab 0 mg...3 isosorbide mononitrate tab 0 mg...3 isosorbide mononitrate tab sr 4hr 30 mg...3 isosorbide mononitrate tab sr 4hr 60 mg...3 isosorbide mononitrate tab sr 4hr 0 mg... 3 isotretinoin cap 0 mg...74 isotretinoin cap 0 mg...74 isotretinoin cap 40 mg...74 isradipine cap.5 mg... 5 isradipine cap 5 mg... 5 itraconazole cap 00 mg (Sporanox)... 4 ivermectin tab 3 mg (Stromectol)...7 J JAKAFI -ruxolitinib phosphate tab 5 mg (base equivalent)...3 JAKAFI -ruxolitinib phosphate tab 0 mg (base equivalent)...3 JAKAFI -ruxolitinib phosphate tab 5 mg (base equivalent)...3 JAKAFI -ruxolitinib phosphate tab 0 mg (base equivalent)...3 JAKAFI -ruxolitinib phosphate tab 5 mg (base equivalent)...3 JANUMET -sitagliptin-metformin hcl tab mg... 9 JANUMET -sitagliptin-metformin hcl tab mg... 9 JANUMET XR -sitagliptin-metformin hcl tab sr 4hr mg... 9 JANUMET XR -sitagliptin-metformin hcl tab sr 4hr mg...9 JANUMET XR -sitagliptin-metformin hcl tab sr 4hr mg...9 JANUVIA -sitagliptin phosphate tab 5 mg (base equiv)...9 JANUVIA -sitagliptin phosphate tab 50 mg (base equiv)...9 JANUVIA -sitagliptin phosphate tab 00 mg (base equiv)...9 JUXTAID -lomitapide mesylate cap 5 mg (base equiv)...3 JUXTAID -lomitapide mesylate cap 0 mg (base equiv)...3 JUXTAID -lomitapide mesylate cap 0 mg (base equiv)...3 JUXTAID -lomitapide mesylate cap 30 mg (base equiv)...3 JUXTAID -lomitapide mesylate cap 40 mg (base equiv)...3 JUXTAID -lomitapide mesylate cap 60 mg (base equiv)...3 K KALETRA -lopinavir-ritonavir soln mg/5ml (80-0 mg/ml)... 5 KALETRA -lopinavir-ritonavir tab 00-5 mg... 5 KALETRA -lopinavir-ritonavir tab mg... 5 KALYDECO -ivacaftor tab 50 mg KETEK -telithromycin tab 300 mg... 7 KETEK -telithromycin tab 400 mg... 7 ketoconazole cream % ketoconazole foam % (Extina)...74 ketoconazole shampoo % (Nizoral) ketoprofen cap 50 mg...5 ketoprofen cap 75 mg...5 ketorolac tromethamine ophth soln 0.5% (Acular)...70 ketorolac tromethamine ophth soln 0.4% (Acular ls) ketorolac tromethamine tab 0 mg... 5 KINERET -anakinra subcutaneous soln prefilled syringe 00 mg/0.67ml...5 KINNEY LANCETS KINNEY THIN LANCETS KINRAY INSULIN SYRINGE/0. -insulin syringe/needle u-00 / ml 9 x /"... 9 KINRAY INSULIN SYRINGE R -insulin syringe/needle u-00 / ml KINRAY INSULIN SYRINGE R -insulin syringe/needle u-00 ml KINRAY INSULIN SYRINGE R -insulin syringe/needle u ml KINRIX -diph-tetanus tox ad-acell pert & polio virus, ipv vac inj... KMART VALU LUS INSULIN S -insulin syringe (disp) u-00 / ml... 9 KMART VALU LUS INSULIN S -insulin syringe (disp) u ml... 9 KMART VALU LUS INSULIN S -insulin syringe (disp) u-00 ml... 9 KOATE-DVI -antihemophilic factor (human) for inj 50 unit...67 KOATE-DVI -antihemophilic factor (human) for inj 500 unit Guia de medicinas ValueScript de Florida Blue para enero de 06

158 06 KOATE-DVI -antihemophilic factor (human) for inj 000 unit...67 KOGENATE FS -antihemophilic factor (recombinant) for inj kit 50 unit KOGENATE FS -antihemophilic factor (recombinant) for inj kit 500 unit KOGENATE FS -antihemophilic factor (recombinant) for inj kit 000 unit KOGENATE FS -antihemophilic factor (recombinant) for inj kit 000 unit KOGENATE FS -antihemophilic factor (recombinant) for inj kit 3000 unit KOGENATE FS BIO-SET -antihemophilic factor (recombinant) for inj kit 50 unit KOGENATE FS BIO-SET -antihemophilic factor (recombinant) for inj kit 500 unit KOGENATE FS BIO-SET -antihemophilic factor (recombinant) for inj kit 000 unit KOGENATE FS BIO-SET -antihemophilic factor (recombinant) for inj kit 000 unit KOGENATE FS BIO-SET -antihemophilic factor (recombinant) for inj kit 3000 unit KOMBIGLYZE XR -saxagliptin-metformin hcl tab sr 4hr mg...9 KOMBIGLYZE XR -saxagliptin-metformin hcl tab sr 4hr mg...9 KOMBIGLYZE XR -saxagliptin-metformin hcl tab sr 4hr mg...9 K-HOS NO -potassium & sodium acid phosphates tab mg...38 KROGER INSULIN SYRINGE/0. -insulin syringe/needle u-00 / ml KROGER INSULIN SYRINGE/0. -insulin syringe/needle u-00 / ml 9 x /"... 9 KROGER INSULIN SYRINGE/0. -insulin syringe/needle u-00 / ml KROGER INSULIN SYRINGE/0. -insulin syringe/needle u ml 9 x /"... 9 KROGER INSULIN SYRINGE/0. -insulin syringe/needle u ml KROGER INSULIN SYRINGE/0. -insulin syringe/needle u ml KROGER INSULIN SYRINGE/M -insulin syringe/needle u-00 ml 9 x /" KROGER INSULIN SYRINGE/M -insulin syringe/needle u-00 ml KROGER INSULIN SYRINGE/M -insulin syringe/needle u-00 ml KROGER INSULIN SYRINGE/U- -insulin syringe/needle u ml 30 x /"... 9 KROGER LANCETS G KROGER LANCETS KROGER LANCETS MICRO THIN KROGER LANCETS SUER THIN KROGER LANCETS THIN 6G KROGER LANCETS THIN KROGER LANCETS ULTRATHIN KROGER LANCING DEVICE -lancet devices KROGER EN NEEDLES 3GX/ -insulin pen needle 3 g x 6 mm (/4") KROGER EN NEEDLES 9G X -insulin pen needle 9 g x mm (/")...93 KROGER EN NEEDLES 3G X -insulin pen needle 3 g x 8 mm (/3" or 5/6")...93 KUVAN -sapropterin dihydrochloride powder packet 00 mg... KUVAN -sapropterin dihydrochloride powder packet 500 mg... L labetalol hcl tab 00 mg (Trandate)... 3 labetalol hcl tab 00 mg (Trandate)... 3 labetalol hcl tab 300 mg (Trandate)... 3 lactated ringer's for irrigation...4 lactic acid (ammonium lactate) cream % (Lachydrin) lactic acid (ammonium lactate) lotion % (Lachydrin) lactulose (encephalopathy) solution 0 gm/5ml...37 lactulose solution 0 gm/5ml...34 LADY LITE LANCETS lamivudine oral soln 0 mg/ml (Epivir)...5 lamivudine tab 50 mg (Epivir)...5 lamivudine tab 300 mg (Epivir)...5 lamivudine tab 00 mg (hbv) (Epivir hbv)... 5 lamivudine-zidovudine tab mg (Combivir)... 5 lamotrigine orally disintegrating tab 5 mg (Lamictal odt)...54 lamotrigine orally disintegrating tab 50 mg (Lamictal odt)...54 lamotrigine orally disintegrating tab 00 mg (Lamictal odt)...54 lamotrigine orally disintegrating tab 00 mg (Lamictal odt)...54 lamotrigine tab chewable dispersible 5 mg (Lamictal chewable di) lamotrigine tab chewable dispersible 5 mg (Lamictal chewable di) lamotrigine tab 5 mg (Lamictal) lamotrigine tab 00 mg (Lamictal) lamotrigine tab 50 mg (Lamictal) lamotrigine tab 00 mg (Lamictal) lamotrigine tab sr 4hr 5 mg (Lamictal xr)...54 lamotrigine tab sr 4hr 50 mg (Lamictal xr)...54 lamotrigine tab sr 4hr 00 mg (Lamictal xr)...54 lamotrigine tab sr 4hr 00 mg (Lamictal xr)...54 Guia de medicinas ValueScript de Florida Blue para enero de 06 47

159 06 lamotrigine tab sr 4hr 50 mg (Lamictal xr)...54 lamotrigine tab sr 4hr 300 mg (Lamictal xr)...54 LANCET DEVICE ADJUSTABLE -lancet devices LANCET DEVICE WITH EJECTO -lancet devices LANCETS 30G/TWIST TO LANCETS 8G LANCETS 30G LANCETS 6G TWIST TO LANCETS 30G TWIST TO LANCETS 3G TWIST TO LANCETS 33G UNIVERSAL DES LANCETS LANCETS MICRO THIN 33G LANCETS SAFETY SEAL G LANCETS SAFETY SEAL 6G LANCETS SAFETY SEAL 8G LANCETS SAFETY SEAL 30G LANCETS SUER THIN 8G LANCETS THIN LANCETS TWIST TO LANCETS ULTRA FINE LANCETS ULTRA THIN 30G LANCETS ULTRA THIN LANCING DEVICE ADJUSTABLE -lancet devices LANCING DEVICE -lancet devices lansoprazole cap delayed release 5 mg (revacid)...35 lansoprazole cap delayed release 30 mg (revacid)...35 LANTUS -insulin glargine inj 00 unit/ml... 0 LANTUS SOLOSTAR -insulin glargine soln pen-injector 00 unit/ml... 0 LANZO -lancet devices LASTACAFT -alcaftadine ophth soln 0.5% latanoprost ophth soln 0.005% (Xalatan) LATUDA -lurasidone hcl tab 0 mg...4 LATUDA -lurasidone hcl tab 40 mg...4 LATUDA -lurasidone hcl tab 60 mg...4 LATUDA -lurasidone hcl tab 80 mg...4 LATUDA -lurasidone hcl tab 0 mg...4 LEADER ADVANCED LANCING D -lancet devices LEADER INSULIN SYRINGE/0. -insulin syringe/needle u-00 / ml LEADER INSULIN SYRINGE/0. -insulin syringe/needle u-00 / ml 8 x /" LEADER INSULIN SYRINGE/0. -insulin syringe/needle u-00 / ml 9 x /" LEADER INSULIN SYRINGE/0. -insulin syringe/needle u-00 / ml LEADER INSULIN SYRINGE/0. -insulin syringe/needle u ml 9 x /" LEADER INSULIN SYRINGE/0. -insulin syringe/needle u ml LEADER INSULIN SYRINGE/0. -insulin syringe/needle u ml LEADER INSULIN SYRINGE/M -insulin syringe/needle u-00 ml 8 x /" LEADER INSULIN SYRINGE/M -insulin syringe/needle u-00 ml 9 x /" LEADER INSULIN SYRINGE/M -insulin syringe/needle u-00 ml LEADER INSULIN SYRINGE/M -insulin syringe/needle u-00 ml LEADER LANCETS COLORED LEADER SUER THIN LANCET LEADER THIN LANCETS LEADER UNIFINE ENTIS/MI -insulin pen needle 3 g x 5 mm (3/6")...94 LEADER UNIFINE ENTIS/NA -insulin pen needle 3 g x 4 mm (5/3")...94 LEADER UNIFINE ENTIS/L -insulin pen needle 3 g x 4 mm (5/3")...94 LEADER UNIFINE ENTIS L -insulin pen needle 3 g x 5 mm (3/6")...94 LEADER UNIFINE ENTIS L -insulin pen needle 3 g x 8 mm (/3" or 5/6")...94 leflunomide tab 0 mg (Arava)... 5 leflunomide tab 0 mg (Arava)... 5 LENVIMA 4MG DAILY DOSE -lenvatinib cap therapy pack 0 & 4 mg (4 mg daily dose)...3 LENVIMA 4MG DAILY DOSE -lenvatinib cap therapy pack 0 () & 4 mg (4 mg daily dose)...3 LENVIMA 0MG DAILY DOSE -lenvatinib cap therapy pack 0 mg (0 mg daily dose)... 3 LENVIMA 0MG DAILY DOSE -lenvatinib cap therapy pack 0 () mg (0 mg daily dose)...3 LETAIRIS -ambrisentan tab 5 mg...3 LETAIRIS -ambrisentan tab 0 mg...3 letrozole tab.5 mg (Femara)...3 LEUCOVORIN CALCIUM -leucovorin calcium tab 0 mg... 3 LEUCOVORIN CALCIUM -leucovorin calcium tab 5 mg... 3 leucovorin calcium tab 5 mg... 3 leucovorin calcium tab 5 mg... 3 LEUKERAN -chlorambucil tab mg...3 LEUKINE -sargramostim lyophilized for inj 50 mcg...65 leuprolide acetate inj kit 5 mg/ml...3 levalbuterol hcl soln nebu conc.5 mg/0.5ml (base equiv) (Xopenex concentrate)...34 levalbuterol hcl soln nebu 0.3 mg/3ml (base equiv) (Xopenex)...34 levalbuterol hcl soln nebu 0.63 mg/3ml (base equiv) (Xopenex)...34 levalbuterol hcl soln nebu.5 mg/3ml (base equiv) (Xopenex)...34 LEVATOL -penbutolol sulfate tab 0 mg Guia de medicinas ValueScript de Florida Blue para enero de 06

160 06 LEVEMIR FLEXEN -insulin detemir soln pen-injector 00 unit/ml...0 LEVEMIR FLEXTOUCH -insulin detemir soln pen-injector 00 unit/ml... 0 LEVEMIR -insulin detemir inj 00 unit/ml... 0 levetiracetam oral soln 00 mg/ml (Keppra) levetiracetam tab 50 mg (Keppra) levetiracetam tab 500 mg (Keppra) levetiracetam tab 750 mg (Keppra) levetiracetam tab 000 mg (Keppra) levetiracetam tab sr 4hr 500 mg (Keppra xr)...54 levetiracetam tab sr 4hr 750 mg (Keppra xr)...54 levobunolol hcl ophth soln 0.5% (Betagan)...70 levocarnitine oral soln gm/0ml (0%) (Carnitor)... levocarnitine tab 330 mg (Carnitor)... levocetirizine dihydrochloride soln.5 mg/5ml (0.5 mg/ ml) (Xyzal)...3 levocetirizine dihydrochloride tab 5 mg (Xyzal)...3 levofloxacin ophth soln 0.5% levofloxacin oral soln 5 mg/ml (Levaquin)... 3 levofloxacin tab 50 mg (Levaquin)...3 levofloxacin tab 500 mg (Levaquin)...3 levofloxacin tab 750 mg (Levaquin)...3 LEVOMEFOLATE DHA -prenat w/fe fum-l methylfolate-fadha cap mg...58 levonorgestrel & ethinyl estradiol (9-day) tab mg... 7 levonorgestrel & ethinyl estradiol tab 0. mg-0 mcg... 7 levonorgestrel & ethinyl estradiol tab 0.5 mg-30 mcg... 7 levonorgestrel-eth estra tab / /0.5-30mg-mcg...7 levonorgestrel-ethinyl estradiol (continuous) tab 90-0 mcg... 7 levonorgestrel tab.5 mg... 7 levonorg-eth est tab mg(84) & eth est tab 0.0mg(7) (Loseasonique)...7 levonorg-eth est tab mg(84) & eth est tab 0.0mg(7) (Seasonique)... 7 levothyroxine sodium tab 5 mcg (Synthroid)...0 levothyroxine sodium tab 50 mcg (Synthroid)...0 levothyroxine sodium tab 75 mcg (Synthroid)...0 levothyroxine sodium tab 88 mcg (Synthroid)...0 levothyroxine sodium tab 00 mcg (Synthroid)...0 levothyroxine sodium tab mcg (Synthroid)...0 levothyroxine sodium tab 5 mcg (Synthroid)...0 levothyroxine sodium tab 37 mcg (Synthroid)...0 levothyroxine sodium tab 50 mcg (Synthroid)...0 levothyroxine sodium tab 75 mcg (Synthroid)...0 levothyroxine sodium tab 00 mcg (Synthroid)...0 levothyroxine sodium tab 300 mcg (Synthroid)...0 LEXIVA -fosamprenavir calcium susp 50 mg/ml (base equiv)...5 LEXIVA -fosamprenavir calcium tab 700 mg (base equiv)...5 LIALDA -mesalamine tab delayed release. gm LIBERTY MEDICAL LANCETS LIBERTY MINI LANCING DEVI -lancet devices lidocaine hcl gel %...74 lidocaine hcl laryngotracheal soln 4% (Lta 360 kit)... 7 lidocaine hcl soln 4% (Xylocaine) lidocaine hcl viscous soln %...7 lidocaine-hydrocortisone acetate rectal cream 3-0.5%...7 lidocaine-hydrocortisone acetate rectal cream kit 3-0.5%...7 lidocaine oint 5%...74 lidocaine patch 5% (Lidoderm)...74 lidocaine-prilocaine cream.5-.5% (Emla) LIFESCAN UNISTIK DEE LIFESCAN UNISTIK II LANCE lindane lotion % lindane shampoo % linezolid tab 600 mg (Zyvox)...7 LINZESS -linaclotide cap 45 mcg...37 LINZESS -linaclotide cap 90 mcg...37 liothyronine sodium tab 5 mcg (Cytomel)... liothyronine sodium tab 5 mcg (Cytomel)... liothyronine sodium tab 50 mcg (Cytomel)... lisinopril & hydrochlorothiazide tab 0-.5 mg (Zestoretic)...8 lisinopril & hydrochlorothiazide tab 0-.5 mg (Zestoretic)...8 lisinopril & hydrochlorothiazide tab 0-5 mg (Zestoretic)...8 lisinopril tab 5 mg (rinivil)... 8 lisinopril tab 0 mg (rinivil)... 8 lisinopril tab 0 mg (rinivil)... 8 Guia de medicinas ValueScript de Florida Blue para enero de 06 49

161 06 lisinopril tab.5 mg (Zestril)...8 lisinopril tab 30 mg (Zestril)...8 lisinopril tab 40 mg (Zestril)...8 LITETOUCH INSULIN SYRINGE -insulin syringe/needle u-00 / ml LITETOUCH INSULIN SYRINGE -insulin syringe/needle u-00 / ml 8 x /" LITETOUCH INSULIN SYRINGE -insulin syringe/needle u-00 / ml 9 x /" LITETOUCH INSULIN SYRINGE -insulin syringe/needle u-00 / ml LITETOUCH INSULIN SYRINGE -insulin syringe/needle u ml 9 x /" LITETOUCH INSULIN SYRINGE -insulin syringe/needle u ml LITETOUCH INSULIN SYRINGE -insulin syringe/needle u-00 ml 8 x /" LITETOUCH INSULIN SYRINGE -insulin syringe/needle u-00 ml 9 x /" LITETOUCH INSULIN SYRINGE -insulin syringe/needle u-00 ml LITETOUCH INSULIN SYRINGE -insulin syringe/needle u-00 ml LITETOUCH INSULIN SYRINGE -insulin syringe/needle u ml LITE TOUCH LANCETS LITETOUCH LANCETS MICRO T LITE TOUCH LANCING DEVICE -lancet devices LITE TOUCH LANCING EN -lancet devices LITE TOUCH EN NEEDLES/3 -insulin pen needle 3 g x 5 mm (3/6")...94 LITETOUCH EN NEEDLES 9G -insulin pen needle 9 g x.7 mm...95 LITETOUCH EN NEEDLES 3G -insulin pen needle 3 g x 6 mm (/4")...95 LITETOUCH EN NEEDLES 3G -insulin pen needle 3 g x 8 mm (/3" or 5/6")...95 lithium carbonate cap 300 mg lithium carbonate cap 50 mg (Lithium carbonate)...4 lithium carbonate cap 600 mg (Lithium carbonate)...43 LITHIUM CARBONATE -lithium carbonate cap 600 mg... 4 lithium carbonate tab cr 450 mg lithium carbonate tab cr 300 mg (Lithobid)...43 lithium carbonate tab 300 mg...43 LITHIUM -lithium oral solution 8 meq/5ml... 4 LIVALO -pitavastatin calcium tab mg (base equiv)...3 LIVALO -pitavastatin calcium tab mg (base equiv)...3 LIVALO -pitavastatin calcium tab 4 mg (base equiv)...3 LIVE BETTER ADVANCED LANC -lancet devices LIVE BETTER LANCET SUER LIVE BETTER LANCET ULTRA LIVE BETTER EN NEEDLES -insulin pen needle 9 g x mm (/")...95 LIVE BETTER EN NEEDLES 3 -insulin pen needle 3 g x 6 mm (/4")...95 LIVE BETTER EN NEEDLES 3 -insulin pen needle 3 g x 8 mm (/3" or 5/6")...95 L-METHYLFOLATE NV DHA -prenat w/fe fum-l methylfolate-fa-dha cap mg...58 LODOSYN -carbidopa tab 5 mg LOMUSTINE -lomustine cap 0 mg... 3 LOMUSTINE -lomustine cap 40 mg... 3 LOMUSTINE -lomustine cap 00 mg... 3 LONGS INSULIN SYRINGE/0.5 -insulin syringe/needle u-00 / ml LONGS LANCETS STANDARD LONGS LANCETS THIN LONGS LANCETS ULTRA THIN loperamide hcl cap mg...35 loratadine & pseudoephedrine tab sr hr 5-0 mg loratadine & pseudoephedrine tab sr 4hr 0-40 mg loratadine rapidly-disintegrating tab 0 mg (Claritin)... 3 loratadine syrup 5 mg/5ml... 3 loratadine tab 0 mg...3 lorazepam conc mg/ml (Lorazepam intensol) lorazepam tab 0.5 mg (Ativan)...39 lorazepam tab mg (Ativan)...39 lorazepam tab mg (Ativan)...39 losartan potassium & hydrochlorothiazide tab mg (Hyzaar)... 8 losartan potassium & hydrochlorothiazide tab mg (Hyzaar)... 8 losartan potassium & hydrochlorothiazide tab 00-5 mg (Hyzaar)... 8 losartan potassium tab 5 mg (Cozaar)... 8 losartan potassium tab 50 mg (Cozaar)... 8 losartan potassium tab 00 mg (Cozaar)... 8 LOTRONEX -alosetron hcl tab 0.5 mg (base equiv)...37 LOTRONEX -alosetron hcl tab mg (base equiv)...37 lovastatin tab 0 mg... 3 lovastatin tab 0 mg... 3 lovastatin tab 40 mg (Mevacor)... 3 loxapine succinate cap 5 mg...43 loxapine succinate cap 0 mg...43 loxapine succinate cap 5 mg...43 loxapine succinate cap 50 mg...43 LUFYLLIN -dyphylline tab 400 mg...34 LUMIGAN -bimatoprost ophth soln 0.0% Guia de medicinas ValueScript de Florida Blue para enero de 06

162 06 LUMIGAN -bimatoprost ophth soln 0.03% LYNARZA -olaparib cap 50 mg...3 LYRICA -pregabalin cap 5 mg...54 LYRICA -pregabalin cap 50 mg...54 LYRICA -pregabalin cap 75 mg...54 LYRICA -pregabalin cap 00 mg...54 LYRICA -pregabalin cap 50 mg...54 LYRICA -pregabalin cap 00 mg...54 LYRICA -pregabalin cap 5 mg...54 LYRICA -pregabalin cap 300 mg...54 LYSODREN -mitotane tab 500 mg...3 M MACNATAL CN DHA -prenatal w/o a w/fe cbn-dss-fa-dha cap mg MAGELLAN INSULIN SAFETY S -insulin syringe/needle u-00 / ml 9 x /" MAGELLAN INSULIN SAFETY S -insulin syringe/needle u-00 / ml MAGELLAN INSULIN SAFETY S -insulin syringe/needle u ml 9 x /" MAGELLAN INSULIN SAFETY S -insulin syringe/needle u ml MAGELLAN INSULIN SAFETY S -insulin syringe/needle u-00 ml 9 x /" MAGELLAN INSULIN SAFETY S -insulin syringe/needle u-00 ml MAGELLAN TUBERCULIN SAFET -tuberculin/allergy syringe/needle (disp) ml 7 x /" MAGELLAN TUBERCULIN SAFET -tuberculin/allergy syringe/needle (disp) ml 8 x /" malathion lotion 0.5% (Ovide) MAROTILINE HCL -maprotiline hcl tab 5 mg... 4 MAROTILINE HCL -maprotiline hcl tab 50 mg... 4 MAROTILINE HCL -maprotiline hcl tab 75 mg... 4 MARNATAL-F -prenatal w/o vit a w/ fe polysac cmplx-fa cap 60- mg MARLAN -isocarboxazid tab 0 mg... 4 MATULANE -procarbazine hcl cap 50 mg...3 MAXI-COMFORT INSULIN SYRI -insulin syringe/needle u-00 / ml 8 x /" MAXI-COMFORT INSULIN SYRI -insulin syringe/needle u-00 ml 8 x /" MD SAFETYGLIDE 7G X 5/8" -needle (disp) 7 x 5/8" meclizine hcl tab.5 mg meclizine hcl tab 5 mg MECLOFENAMATE SODIUM -meclofenamate sodium cap 50 mg...5 MECLOFENAMATE SODIUM -meclofenamate sodium cap 00 mg...5 MEDICAL ROVIDER EZ FLU S -influenza virus vac tisscult subunit pref syr kit 0.5 ml...0 MEDICAL ROVIDER EZ FLU S -influenza virus vac types a & b pf pref syringe kit 0.5 ml... 0 MEDICHOICE RE-SET SAFETY MEDICHOICE SAFETY LANCET MEDICINE SHOE LANCETS MEDICINE SHOE LANCETS T MEDICINE SHOE EN NEEDL -insulin pen needle 9 g x mm (/") MEDICINE SHOE EN NEEDL -insulin pen needle 3 g x 6 mm (/4") MEDICINE SHOE EN NEEDL -insulin pen needle 3 g x 8 mm (/3" or 5/6") MEDIC INSULIN SYRINGE/0.5 -insulin syringe/needle u-00 / ml MEDIC INSULIN SYRINGE/0.3 -insulin syringe/needle u ml MEDI-LANCE LANCETS MEDISENSE THIN LANCETS MEDLANCE/EXTRA MEDLANCE/LITE MEDLANCE/UNIVERSAL MEDLANCE LUS/LITE 5G MEDLANCE LUS EXTRA LANCE MEDLANCE LUS LANCETS MEDLANCE LUS LANCETS LIT MEDLANCE LUS LITE LANCET MEDLANCE LUS SECIAL LAN MEDLANCE LUS SUERLITE MEDLANCE LUS UNIVERSAL L medroxyprogesterone acetate tab.5 mg (rovera)... 8 medroxyprogesterone acetate tab 5 mg (rovera)... 8 medroxyprogesterone acetate tab 0 mg (rovera)... 8 mefenamic acid cap 50 mg (onstel)...5 mefloquine hcl tab 50 mg... 7 MEGACE ES -megestrol acetate susp 65 mg/5ml...8 MEGACE ORAL -megestrol acetate susp 40 mg/ ml...3 megestrol acetate susp 40 mg/ml (Megace oral)...3 megestrol acetate tab 0 mg... 3 megestrol acetate tab 40 mg... 3 MEIJER COLOR LANCETS UNIV MEIJER LANCETS MEIJER LANCETS THIN MEIJER LANCETS UNIVERSAL MEIJER EN NEEDLES 9G X -insulin pen needle 9 g x mm (/")...96 MEIJER EN NEEDLES 3G X -insulin pen needle 3 g x 6 mm (/4")...96 MEIJER EN NEEDLES 3G X -insulin pen needle 3 g x 8 mm (/3" or 5/6")...96 MEIJER SUER THIN LANCETS Guia de medicinas ValueScript de Florida Blue para enero de 06 5

163 06 MEKINIST -trametinib dimethyl sulfoxide tab 0.5 mg (base equivalent)...3 MEKINIST -trametinib dimethyl sulfoxide tab mg (base equivalent)...3 meloxicam tab 7.5 mg (Mobic)... 5 meloxicam tab 5 mg (Mobic)... 5 MENACTRA -meningococcal (a, c, y, and w-35) conjugate vaccine inj...0 MENEST -esterified estrogens tab 0.3 mg... 6 MENEST -esterified estrogens tab 0.65 mg... 6 MENEST -esterified estrogens tab.5 mg... 6 MENEST -esterified estrogens tab.5 mg... 6 MENHIBRIX -meningococcal (c & y)-haemophilus b tet tox conj vac for inj... 0 MENOMUNE-A/C/Y/W-35 -meningococcal vaccine a, c, y, and w-35 inj...0 MENTAX -butenafine hcl cream %...74 MENVEO -meningococcal (a, c, y, and w-35) oligo conj vac for inj... 0 MEHYTON -phytonadione tab 5 mg meprobamate tab 00 mg meprobamate tab 400 mg mercaptopurine tab 50 mg...3 mesalamine enema 4 gm MESNEX -mesna tab 400 mg... 3 MESTINON -pyridostigmine bromide syrup 60 mg/5ml...56 MESTINON TIMESAN -pyridostigmine bromide tab cr 80 mg...56 metaxalone tab 800 mg (Skelaxin) metformin hcl tab 500 mg (Glucophage)...9 metformin hcl tab 850 mg (Glucophage)...9 metformin hcl tab 000 mg (Glucophage)...9 metformin hcl tab sr 4hr 500 mg (Glucophage xr)...9 metformin hcl tab sr 4hr 750 mg (Glucophage xr)...9 methadone hcl conc 0 mg/ml (Methadose)...49 methadone hcl soln 5 mg/5ml (Methadone hcl) methadone hcl soln 0 mg/5ml (Methadone hcl) methadone hcl tab for oral susp 40 mg...49 methadone hcl tab 0 mg (Dolophine) methadone hcl tab 5 mg (Dolophine hcl) methamphetamine hcl tab 5 mg (Desoxyn)...45 methazolamide tab 5 mg (Neptazane) methazolamide tab 50 mg (Neptazane) methenamine hippurate tab gm (Hiprex)...37 methimazole tab 5 mg (Tapazole)... methimazole tab 0 mg (Tapazole)... methocarbamol tab 750 mg (Robaxin-750) methocarbamol tab 500 mg (Robaxin) methotrexate sodium for inj gm...3 methotrexate sodium inj 5 mg/ml... 3 methotrexate sodium inj pf 5 mg/ml... 3 methotrexate sodium tab.5 mg (base equiv)...3 methoxsalen rapid cap 0 mg (Oxsoralen ultra) methscopolamine bromide tab.5 mg (amine) methscopolamine bromide tab 5 mg (amine forte) METHYCLOTHIAZIDE -methyclothiazide tab 5 mg methyldopa tab 50 mg...8 methyldopa tab 500 mg...8 methylergonovine maleate tab 0. mg... methylphenidate hcl cap cr 0 mg (Metadate cd) methylphenidate hcl cap cr 0 mg (Metadate cd) methylphenidate hcl cap cr 30 mg (Metadate cd) methylphenidate hcl cap cr 40 mg (Metadate cd) methylphenidate hcl cap cr 50 mg (Metadate cd) methylphenidate hcl cap cr 60 mg (Metadate cd) methylphenidate hcl cap sr 4hr 0 mg (Ritalin la) methylphenidate hcl cap sr 4hr 30 mg (Ritalin la) methylphenidate hcl cap sr 4hr 40 mg (Ritalin la) methylphenidate hcl chew tab.5 mg (Methylin) methylphenidate hcl chew tab 5 mg (Methylin) methylphenidate hcl chew tab 0 mg (Methylin) methylphenidate hcl soln 5 mg/5ml (Methylin) methylphenidate hcl soln 0 mg/5ml (Methylin) methylphenidate hcl tab cr 0 mg...45 methylphenidate hcl tab 5 mg (Ritalin)...45 methylphenidate hcl tab 0 mg (Ritalin)...45 methylphenidate hcl tab 0 mg (Ritalin)...46 methylprednisolone tab 4 mg dose pack (Medrol dosepak)... 5 methylprednisolone tab 4 mg (Medrol)... 5 methylprednisolone tab 8 mg (Medrol)... 5 methylprednisolone tab 6 mg (Medrol)... 5 methylprednisolone tab 3 mg (Medrol)... 5 metoclopramide hcl soln 5 mg/5ml (0 mg/0ml) metoclopramide hcl tab 5 mg (Reglan) metoclopramide hcl tab 0 mg (Reglan) metolazone tab.5 mg Guia de medicinas ValueScript de Florida Blue para enero de 06

164 06 metolazone tab 5 mg metolazone tab 0 mg metoprolol & hydrochlorothiazide tab mg... 8 metoprolol & hydrochlorothiazide tab 50-5 mg (Lopressor hct)... 8 metoprolol & hydrochlorothiazide tab 00-5 mg (Lopressor hct)... 8 metoprolol succinate tab sr 4hr 5 mg (Toprol xl)... 3 metoprolol succinate tab sr 4hr 50 mg (Toprol xl)... 3 metoprolol succinate tab sr 4hr 00 mg (Toprol xl)... 4 metoprolol succinate tab sr 4hr 00 mg (Toprol xl)... 4 metoprolol tartrate tab 5 mg...4 metoprolol tartrate tab 50 mg (Lopressor)...4 metoprolol tartrate tab 00 mg (Lopressor)... 4 metronidazole cap 375 mg (Flagyl)...7 metronidazole cream 0.75% (Metrocream)...74 metronidazole gel 0.75% metronidazole gel % (Metrogel)...74 metronidazole lotion 0.75% (Metrolotion) metronidazole tab 50 mg (Flagyl)...7 metronidazole tab 500 mg (Flagyl)...7 metronidazole vaginal gel 0.75% (Metrogelvaginal)...38 mexiletine hcl cap 50 mg... 5 mexiletine hcl cap 00 mg... 5 mexiletine hcl cap 50 mg... 5 MICROLET LANCETS MICROTAINER SAFETY FLOW L midodrine hcl tab.5 mg midodrine hcl tab 5 mg midodrine hcl tab 0 mg MIGRANAL -dihydroergotamine mesylate nasal spray 4 mg/ml...5 MINI LANCING DEVICE -lancet devices...96 minocycline hcl cap 50 mg (Minocin)...3 minocycline hcl cap 75 mg (Minocin)...3 minocycline hcl cap 00 mg (Minocin)...3 minocycline hcl tab 50 mg...3 minocycline hcl tab 75 mg...3 minocycline hcl tab 00 mg...3 minocycline hcl tab sr 4hr 45 mg...3 minocycline hcl tab sr 4hr 90 mg...3 minocycline hcl tab sr 4hr 35 mg...3 minoxidil tab.5 mg... 8 minoxidil tab 0 mg... 8 mirtazapine orally disintegrating tab 5 mg (Remeron soltab)...4 mirtazapine orally disintegrating tab 30 mg (Remeron soltab)...4 mirtazapine orally disintegrating tab 45 mg (Remeron soltab)...4 mirtazapine tab 7.5 mg... 4 mirtazapine tab 5 mg (Remeron)...4 mirtazapine tab 30 mg (Remeron)...4 mirtazapine tab 45 mg (Remeron)...4 misoprostol tab 00 mcg (Cytotec)...35 misoprostol tab 00 mcg (Cytotec)...35 ML ALLERGIST SYRINGE DET -tuberculin/allergy syringe/needle (disp) ml 7 x /"... 3 ML ALLERGY SYRINGE 8G X -tuberculin/allergy syringe/needle (disp) ml 8 x /"... 4 ML ALLERGY SYRINGE -tuberculin/allergy syringe/ needle (disp) ml 7 x /"...3 ML TB SYRINGE/5G X 5/8" -tuberculin/allergy syringe/ needle (disp) ml 5 x 5/8"...4 ML TB SYRINGE/6G X 3/8" -tuberculin/allergy syringe/ needle (disp) ml 6 x 3/8"...4 ML TB SYRINGE/7G X /" -tuberculin/allergy syringe/ needle (disp) ml 7 x /"...4 ML TUBERCULIN SYRINGE DE -tuberculin/allergy syringe/needle (disp) ml 5 x 5/8"... 4 ML TUBERCULIN SYRINGE DE -tuberculin/allergy syringe/needle (disp) ml 6 x 3/8"... 4 ML VANISHOINT TUBERCULI -tuberculin/allergy syringe/needle (disp) ml 5 x 5/8"... 4 ML VANISHOINT TUBERCULI -tuberculin/allergy syringe/needle (disp) ml 7 x /"... 4 ML VANISHOINT TUBERCULI -tuberculin/allergy syringe/needle (disp) ml 5 x "... 4 M-M-R II W/DILUENT 0 DOS -measles, mumps & rubella virus vaccines for inj...0 modafinil tab 00 mg (rovigil) modafinil tab 00 mg (rovigil) moexipril hcl tab 7.5 mg...8 moexipril hcl tab 5 mg...8 moexipril-hydrochlorothiazide tab mg... 8 moexipril-hydrochlorothiazide tab 5-.5 mg... 8 moexipril-hydrochlorothiazide tab 5-5 mg... 8 mometasone furoate cream 0.% (Elocon) mometasone furoate oint 0.% (Elocon) mometasone furoate solution 0.% (lotion) (Elocon)...74 MONOCLATE- -antihemophilic factor (human) for inj kit 50 unit MONOCLATE- -antihemophilic factor (human) for inj kit 500 unit MONOCLATE- -antihemophilic factor (human) for inj kit 000 unit MONOCLATE- -antihemophilic factor (human) for inj kit 500 unit MONOJECT HYO/ALUM HUB/LU -needle (disp) 8 x -/"...96 MONOJECT HYO/ALUM HUB/LU -needle (disp) 0 x -/"...96 Guia de medicinas ValueScript de Florida Blue para enero de 06 53

165 06 MONOJECT HYO/ALUM HUB/LU -needle (disp) 8 x " MONOJECT HYO/ALUM HUB/8 -needle (disp) 8 x -/"...96 MONOJECT INSULIN SYRINGE/ -insulin syringe/needle u-00 / ml 8 x /" MONOJECT INSULIN SYRINGE/ -insulin syringe/needle u-00 / ml 9 x /" MONOJECT INSULIN SYRINGE/ -insulin syringe/needle u-00 / ml MONOJECT INSULIN SYRINGE/ -insulin syringe/needle u ml 9 x /" MONOJECT INSULIN SYRINGE/ -insulin syringe/needle u ml MONOJECT INSULIN SYRINGE/ -insulin syringe/needle u-00 ml 5 x 5/8" MONOJECT INSULIN SYRINGE/ -insulin syringe/needle u-00 ml 7 x /" MONOJECT INSULIN SYRINGE/ -insulin syringe/needle u-00 ml 8 x /" MONOJECT INSULIN SYRINGE/ -insulin syringe/needle u-00 ml 9 x /" MONOJECT INSULIN SYRINGE/ -insulin syringe/needle u-00 ml MONOJECT INSULIN SYRINGE/ -insulin syringe/needle u-00 ml MONOJECT INSULIN SYRINGE/ -insulin syringe (disp) u-00 ml MONOJECT INSULIN SYRINGE -insulin syringe (disp) u-00 ml MONOJECT MAGELLAN SAFETY -needle (disp) 8 x -/"...97 MONOJECT MAGELLAN SAFETY -needle (disp) 0 x -/"...97 MONOJECT MAGELLAN SAFETY -needle (disp) x 5/8" MONOJECT MAGELLAN SAFETY -needle (disp) x -/"...97 MONOJECT MAGELLAN SAFETY -needle (disp) x -/"...97 MONOJECT MAGELLAN SAFETY -needle (disp) 3 x 5/8" MONOJECT MAGELLAN SAFETY -needle (disp) 5 x 5/8" MONOJECT MAGELLAN SAFETY -needle (disp) 8 x " MONOJECT MAGELLAN SAFETY -needle (disp) 0 x " MONOJECT MAGELLAN SAFETY -needle (disp) x " MONOJECT MAGELLAN SAFETY -needle (disp) x " MONOJECT MAGELLAN SAFETY -needle (disp) 3 x " MONOJECT MAGELLAN SAFETY -needle (disp) 5 x " MONOJECT TB SYRINGE-NDL -tuberculin/allergy syringe/needle (disp) ml 6 x 3/8" MONOJECT TB SYRINGE-NDL -tuberculin/allergy syringe/needle (disp) ml 7 x /" MONOJECT TUBERCULIN SAFET -tuberculin/allergy syringe/needle (disp) ml 5 x 5/8" MONOJECT TUBERCULIN SAFET -tuberculin/allergy syringe/needle (disp) ml 8 x /" MONOJECT TUBERCULIN SYRIN -tuberculin/allergy syringe/needle (disp) ml 5 x 5/8" MONOJECT TUBERCULIN SYRIN -tuberculin/allergy syringe/needle (disp) ml 6 x 3/8" MONOJECT TUBERCULIN SYRIN -tuberculin/allergy syringe/needle (disp) ml 7 x /" MONOJECT TUBERCULIN SYRIN -tuberculin/allergy syringe/needle (disp) ml 8 x /" MONOJECT ULTRA COMFORT IN -insulin syringe/needle u-00 / ml MONOJECT ULTRA COMFORT IN -insulin syringe/needle u-00 / ml 8 x /" MONOJECT ULTRA COMFORT IN -insulin syringe/needle u-00 / ml 9 x /" MONOJECT ULTRA COMFORT IN -insulin syringe/needle u-00 / ml MONOJECT ULTRA COMFORT IN -insulin syringe/needle u ml 9 x /" MONOJECT ULTRA COMFORT IN -insulin syringe/needle u ml MONOJECT ULTRA COMFORT IN -insulin syringe/needle u-00 ml 8 x /" MONOJECT ULTRA COMFORT IN -insulin syringe/needle u-00 ml 9 x /" MONOJECT ULTRA COMFORT IN -insulin syringe/needle u-00 ml MONOJECT ULTRA COMFORT IN -insulin syringe/needle u ml MONOLET LANCETS MONOLET OD LANCETS MONOLETTOR SAFETY LANCETS MONONINE -coagulation factor ix for inj 50 unit...68 MONONINE -coagulation factor ix for inj 500 unit...68 MONONINE -coagulation factor ix for inj 000 unit...68 montelukast sodium chew tab 4 mg (base equiv) (Singulair) montelukast sodium chew tab 5 mg (base equiv) (Singulair) montelukast sodium oral granules packet 4 mg (base equiv) (Singulair) montelukast sodium tab 0 mg (base equiv) (Singulair) MONUROL -fosfomycin tromethamine powd pack 3 gm (base equivalent) MOORE MED MONOJECT INSULI -insulin syringe/needle u-00 / ml 8 x /" Guia de medicinas ValueScript de Florida Blue para enero de 06

166 06 MOORE MED MONOJECT INSULI -insulin syringe/needle u-00 / ml 9 x /" MOORE MED MONOJECT INSULI -insulin syringe/needle u-00 ml 8 x /" MOORE MED MONOJECT INSULI -insulin syringe/needle u-00 ml 9 x /" morphine sulfate cap sr 4hr 0 mg (Kadian)...49 morphine sulfate cap sr 4hr 0 mg (Kadian)...49 morphine sulfate cap sr 4hr 30 mg (Kadian)...49 morphine sulfate cap sr 4hr 50 mg (Kadian)...49 morphine sulfate cap sr 4hr 60 mg (Kadian)...49 morphine sulfate cap sr 4hr 80 mg (Kadian)...49 morphine sulfate cap sr 4hr 00 mg (Kadian)...49 morphine sulfate (concentrate) oral soln 0 mg/ ml MORHINE SULFATE -morphine sulfate tab 5 mg MORHINE SULFATE -morphine sulfate tab 30 mg morphine sulfate oral soln 0 mg/5ml morphine sulfate oral soln 0 mg/5ml morphine sulfate tab cr 5 mg (Ms contin) morphine sulfate tab cr 30 mg (Ms contin) morphine sulfate tab cr 60 mg (Ms contin) morphine sulfate tab cr 00 mg (Ms contin) morphine sulfate tab cr 00 mg (Ms contin) moxifloxacin hcl tab 400 mg (base equiv) (Avelox)... 3 MS INSULIN SYRINGE/0.5ML/ -insulin syringe/needle u-00 / ml MS INSULIN SYRINGE/0.5ML/ -insulin syringe/needle u-00 / ml 9 x /" MS INSULIN SYRINGE/0.5ML/ -insulin syringe/needle u-00 / ml MS INSULIN SYRINGE/0.3ML/ -insulin syringe/needle u ml 9 x /" MS INSULIN SYRINGE/0.3ML/ -insulin syringe/needle u ml MS INSULIN SYRINGE/0.3ML/ -insulin syringe/needle u ml MS INSULIN SYRINGE/ML/9 -insulin syringe/needle u-00 ml 9 x /" MS INSULIN SYRINGE/ML/30 -insulin syringe/needle u-00 ml MS INSULIN SYRINGE/ML/3 -insulin syringe/needle u-00 ml MULTAQ -dronedarone hcl tab 400 mg (base equivalent)...6 MULTI-LANCET DEVICE -lancet devices mupirocin calcium cream % (Bactroban)...74 mupirocin oint % (Bactroban) M-VIT -prenatal vit w/ fe fumarate-fa tab 7- mg mycophenolate mofetil cap 50 mg (Cellcept)...4 mycophenolate mofetil for oral susp 00 mg/ml (Cellcept)...4 mycophenolate mofetil tab 500 mg (Cellcept)...4 mycophenolate sodium tab dr 80 mg (mycophenolic acid equiv) (Myfortic)... 4 mycophenolate sodium tab dr 360 mg (mycophenolic acid equiv) (Myfortic)... 4 MYGLUCOHEALTH MGH SOFTLAN MYLERAN -busulfan tab mg... 3 MYNATAL ADVANCE -prenatal vit w/ dss-iron carbonyl-fa tab 90- mg MYNATAL LUS -prenatal vit w/ fe fumarate-fa tab 65- mg MYNATAL -prenatal multivitamins & minerals w/ iron & fa cap mg...58 MYNATAL ULTRACALET -prenatal vit w/ dss-iron carbonyl-fa tab 90- mg MYNATAL-Z -prenatal vit w/ fe fumarate-fa tab 65- mg MYNATE 90 LUS -prenatal vit w/ dss-fe fumarate-fa tab cr 90- mg N nabumetone tab 500 mg...5 nabumetone tab 750 mg...5 nadolol & bendroflumethiazide tab 40-5 mg (Corzide)...8 nadolol & bendroflumethiazide tab 80-5 mg (Corzide)...8 nadolol tab 0 mg (Corgard)...4 nadolol tab 40 mg (Corgard)...4 nadolol tab 80 mg (Corgard)...4 naftifine hcl cream % (Naftin) NAFTIN -naftifine hcl cream % naloxone hcl inj 0.4 mg/ml...76 naltrexone hcl tab 50 mg (Revia) NAMENDA XR -memantine hcl cap sr 4hr 7 mg NAMENDA XR -memantine hcl cap sr 4hr 4 mg NAMENDA XR -memantine hcl cap sr 4hr mg NAMENDA XR -memantine hcl cap sr 4hr 8 mg NAMENDA XR TITRATION ACK -memantine hcl cap sr 4hr 7 mg & 4 mg & mg & 8 mg pack...47 NAROXEN -naproxen susp 5 mg/5ml...5 naproxen sodium tab 75 mg (Anaprox)...5 Guia de medicinas ValueScript de Florida Blue para enero de 06 55

167 06 naproxen sodium tab 550 mg (Anaprox ds)... 5 naproxen tab ec 375 mg (Ec-naprosyn)... 5 naproxen tab ec 500 mg (Ec-naprosyn)... 5 naproxen tab 50 mg (Naprosyn)...5 naproxen tab 375 mg (Naprosyn)...5 naproxen tab 500 mg (Naprosyn)...5 naratriptan hcl tab mg (base equiv) (Amerge)... 5 naratriptan hcl tab.5 mg (base equiv) (Amerge)... 5 NATACHEW -prenatal vit w/ fe fum-fe bisglycin-fa chew tab 8- mg NATACYN -natamycin ophth susp 5% NATALVIRT CA -prenat w/o a w/fecbn-fegl-dss-fa tab & dha cap 300 mg pack NATALVIRT 90 DHA -prenat w/o a w/fecbn-fegl-dss-fa tab 90 &dha cap 300mg pak...58 NATALVIT -prenatal vit w/ fe fumarate-fa tab 75- mg NATAL-V RX -prenatal vit w/ iron carbonyl-fa tab 9- mg nateglinide tab 60 mg (Starlix)... 9 nateglinide tab 0 mg (Starlix)... 9 NATELLE ONE -prenatal w/o vit a w/ fe fum-fa-omega 3 cap mg NEBUENT -pentamidine isethionate for nebulization soln 300 mg...7 NEEVO DHA -prenat w/o a w/fefum-methylfol-omegas cap 7-.3 mg...58 nefazodone hcl tab 50 mg...4 neomycin-bacitrac zn-polymyx 5(3.5)mg-400unt-0000unt op oin...70 neomycin-polymy-gramicid op sol mg-unt-mg/ml (Neosporin)...70 neomycin-polymyxin-dexamethasone ophth oint 0.% (Maxitrol) neomycin-polymyxin-dexamethasone ophth susp 0.% (Maxitrol) neomycin-polymyxin-hc otic soln % (Cortisporin)... 7 neomycin-polymyxin-hc otic susp 3.5 mg/ml-0000 unit/ml-%... 7 neomycin sulfate tab 500 mg... 3 NESINA -alogliptin benzoate tab 6.5 mg (base equiv)...9 NESINA -alogliptin benzoate tab.5 mg (base equiv)...9 NESINA -alogliptin benzoate tab 5 mg (base equiv)...9 NESTABS ABC -prenatal w/o vit a w/fe polysac-fa-ca tab & omega 3 cap...58 NESTABS DHA -prenat w/o a w/ fe bisglyc-fa tab 3- mg & omega cap pack NESTABS -prenatal vit w/o vit a w/ fe bisglycinate-fa tab 3- mg...58 NETGROU LANCETS NEULASTA DELIVERY KIT -pegfilgrastim inj 6 mg/0.6ml NEULASTA -pegfilgrastim inj 6 mg/0.6ml...65 NEUOGEN -filgrastim inj 300 mcg/ml NEUOGEN -filgrastim inj 480 mcg/.6ml (300 mcg/ ml) NEUOGEN -filgrastim inj 300 mcg/0.5ml (600 mcg/ ml) NEUOGEN -filgrastim inj 480 mcg/0.8ml (600 mcg/ ml) NEVIRAINE -nevirapine susp 50 mg/5ml...5 nevirapine tab 00 mg (Viramune)... 5 nevirapine tab sr 4hr 400 mg (Viramune xr)...5 NEWGEN -prenatal vit w/o vit a w/ fe bisglycinate-fa tab 3- mg...59 NEXA LUS -prenatal w/o vit a w/ fe fum-doc-fa-dha cap mg NEXAVAR -sorafenib tosylate tab 00 mg (base equivalent)...3 NEXIUM -esomeprazole magnesium cap delayed release 0 mg (base eq)...35 NEXIUM -esomeprazole magnesium cap delayed release 40 mg (base eq)...35 niacin tab cr 500 mg (antihyperlipidemic) (Niaspan)...3 niacin tab cr 750 mg (antihyperlipidemic) (Niaspan)...3 niacin tab cr 000 mg (antihyperlipidemic) (Niaspan)...3 NIACOR -niacin (antihyperlipidemic) tab 500 mg... 3 nicardipine hcl cap 0 mg...5 nicardipine hcl cap 30 mg...5 nicotine polacrilex gum mg nicotine polacrilex gum 4 mg nicotine td patch 4hr 7 mg/4hr nicotine td patch 4hr 4 mg/4hr nicotine td patch 4hr mg/4hr nifedipine cap 0 mg... 5 nifedipine cap 0 mg (rocardia)... 5 nifedipine tab sr 4hr 30 mg (Adalat cc)... 5 nifedipine tab sr 4hr 60 mg (Adalat cc)... 5 nifedipine tab sr 4hr 90 mg (Adalat cc)... 5 nifedipine tab sr 4hr osmotic 30 mg (rocardia xl)... 5 nifedipine tab sr 4hr osmotic 60 mg (rocardia xl)... 5 nifedipine tab sr 4hr osmotic 90 mg (rocardia xl)... 5 NILANDRON -nilutamide tab 50 mg...3 nimodipine cap 30 mg... 5 NISOLDIINE ER -nisoldipine tab sr 4hr 5.5 mg... 5 nisoldipine tab sr 4hr 8.5 mg (Sular)... 5 nisoldipine tab sr 4hr 7 mg (Sular) Guia de medicinas ValueScript de Florida Blue para enero de 06

168 06 nisoldipine tab sr 4hr 34 mg (Sular)... 5 NITRO-BID -nitroglycerin oint %...3 nitrofurantoin macrocrystalline cap 50 mg (Macrodantin) nitrofurantoin macrocrystalline cap 00 mg (Macrodantin) nitrofurantoin monohydrate macrocrystalline cap 00 mg (Macrobid)...37 nitrofurantoin susp 5 mg/5ml (Furadantin) nitroglycerin cap cr.5 mg...3 nitroglycerin cap cr 6.5 mg...3 nitroglycerin cap cr 9 mg...3 nitroglycerin td patch 4hr 0. mg/hr (Nitrodur)... 3 nitroglycerin td patch 4hr 0. mg/hr (Nitrodur)... 3 nitroglycerin td patch 4hr 0.4 mg/hr (Nitrodur)... 3 nitroglycerin td patch 4hr 0.6 mg/hr (Nitrodur)... 3 nitroglycerin tl soln 0.4 mg/spray (400 mcg/spray) (Nitrolingual pumpspr)...3 NITROSTAT -nitroglycerin sl tab 0.3 mg... 3 NITROSTAT -nitroglycerin sl tab 0.4 mg... 3 NITROSTAT -nitroglycerin sl tab 0.6 mg... 3 NIVA-LUS -prenatal vit w/ fe fumarate-fa tab 7- mg nizatidine cap 50 mg...35 nizatidine cap 300 mg (Axid) nizatidine oral soln 5 mg/ml NORDITROIN CARTRIDGE -somatropin inj 5 mg/.5ml... NORDITROIN FLEXRO -somatropin inj 5 mg/.5ml... NORDITROIN FLEXRO -somatropin inj 0 mg/.5ml... NORDITROIN FLEXRO -somatropin inj 5 mg/.5ml... NORDITROIN FLEXRO -somatropin inj 30 mg/3ml... NORDITROIN NORDIFLEX EN -somatropin inj 30 mg/3ml... norelgestromin-ethinyl estradiol td ptwk mcg/4hr (Ortho evra)...7 norethindrone & ethinyl estradiol-fe chew tab 0.4 mg-35 mcg (Femcon fe)...7 norethindrone & ethinyl estradiol-fe chew tab 0.8 mg-5 mcg (Generess fe)... 7 norethindrone & ethinyl estradiol tab 0.5 mg-35 mcg (Brevicon-8)... 7 norethindrone & ethinyl estradiol tab mg-35 mcg (Norinyl +35)...7 norethindrone & ethinyl estradiol tab 0.4 mg-35 mcg (Ovcon-35)... 7 norethindrone ace & ethinyl estradiol-fe tab mg-0 mcg (Loestrin fe /0)...7 norethindrone ace & ethinyl estradiol-fe tab.5 mg-30 mcg (Loestrin fe.5/30)...7 norethindrone ace & ethinyl estradiol tab mg-0 mcg (Loestrin /0-)...7 norethindrone ace & ethinyl estradiol tab.5 mg-30 mcg (Loestrin.5/30-)... 7 norethindrone ace-ethinyl estradiol-fe tab mg-0 mcg (4)... 7 norethindrone acetate-ethinyl estradiol tab mg-5 mcg... 6 norethindrone acetate-ethinyl estradiol tab 0.5 mg-.5 mcg (Femhrt low dose)...6 norethindrone acetate tab 5 mg (Aygestin)...8 norethindrone ac-ethinyl estrad-fe tab -0/-30/-35 mg-mcg (Estrostep fe)... 7 norethindrone-eth estradiol tab / /-35 mgmcg (Ortho-novum 7/7/7)...7 norethindrone-eth estradiol tab /-35/ mgmcg (Tri-norinyl 8)...7 norethindrone tab 0.35 mg (Nor-qd)... 7 norgestimate & ethinyl estradiol tab 0.5 mg-35 mcg (Ortho-cyclen)... 7 norgestimate-eth estrad tab /0.5-35/ mg-mcg (Ortho tri-cyclen)... 7 norgestrel & ethinyl estradiol tab 0.3 mg-30 mcg... 7 nortriptyline hcl cap 0 mg (amelor)... 4 nortriptyline hcl cap 5 mg (amelor)... 4 nortriptyline hcl cap 50 mg (amelor)... 4 nortriptyline hcl cap 75 mg (amelor)... 4 NORVIR -ritonavir cap 00 mg...5 NORVIR -ritonavir oral soln 80 mg/ml... 5 NORVIR -ritonavir tab 00 mg...5 NOVA SAFETY LANCETS 3G NOVA SAFETY LANCETS 8G NOVA SUREFLEX LANCETS NOVA SUREFLEX LANCING DEV -lancet devices NOVOFINE AUTOCOVER 30GX8M -insulin pen needle 30 g x 8 mm (/3" or 5/6") NOVOFINE 3GX6MM -insulin pen needle 3 g x 6 mm (/4")...98 NOVOFINE 30GX8MM -insulin pen needle 30 g x 8 mm (/3" or 5/6") NOVOFINE LUS 3GX4MM -insulin pen needle 3 g x 4 mm (5/3") NOVOLIN 70/30 -insulin isophane & regular (human) inj 00 unit/ml (70-30)... 0 NOVOLIN 70/30 RELION -insulin isophane & regular (human) inj 00 unit/ml (70-30)...0 NOVOLIN N -insulin isophane (human) inj 00 unit/ ml...0 NOVOLIN N RELION -insulin isophane (human) inj 00 unit/ml...0 NOVOLIN R -insulin regular (human) inj 00 unit/ ml...0 Guia de medicinas ValueScript de Florida Blue para enero de 06 57

169 06 NOVOLIN R RELION -insulin regular (human) inj 00 unit/ ml...0 NOVOLOG FLEXEN -insulin aspart soln pen-injector 00 unit/ml...0 NOVOLOG -insulin aspart inj 00 unit/ml...0 NOVOLOG MIX 70/30 -insulin aspart prot & aspart (human) inj 00 unit/ml (70-30)...0 NOVOLOG MIX 70/30 REFILL -insulin aspart prot & aspart sus pen-inj 00 unit/ml (70-30)... 0 NOVOLOG ENFILL -insulin aspart inj 00 unit/ ml...0 NOVOLOG ENFILL -insulin aspart soln cartridge 00 unit/ml...0 NOVOSEVEN RT -coagulation factor viia (recomb) for inj mg (000 mcg) NOVOSEVEN RT -coagulation factor viia (recomb) for inj mg (000 mcg) NOVOSEVEN RT -coagulation factor viia (recomb) for inj 5 mg (5000 mcg) NOVOSEVEN RT -coagulation factor viia (recomb) for inj 8 mg (8000 mcg) NOVOTWIST 30GX8MM -insulin pen needle 30 g x 8 mm (/3" or 5/6") NOVOTWIST 3GX5MM -insulin pen needle 3 g x 5 mm (/5" or 3/6") NOXAFIL -posaconazole susp 40 mg/ml... 4 NUCYNTA ER -tapentadol hcl tab sr hr 50 mg NUCYNTA ER -tapentadol hcl tab sr hr 00 mg NUCYNTA ER -tapentadol hcl tab sr hr 50 mg NUCYNTA ER -tapentadol hcl tab sr hr 00 mg NUCYNTA ER -tapentadol hcl tab sr hr 50 mg NUTRI-TAB OB + DHA -prenat w/o a w/ fe bisglyc-fa tab 3- mg & omega cap pack...59 NUTRI-TAB OB -prenatal vit w/o vit a w/ fe bisglycinate-fa tab 3- mg NUVARING -etonogestrel-ethinyl estradiol va ring mg/4hr... 8 NUVIGIL -armodafinil tab 50 mg NUVIGIL -armodafinil tab 50 mg NUVIGIL -armodafinil tab 00 mg NUVIGIL -armodafinil tab 50 mg nystatin cream unit/gm nystatin oint unit/gm nystatin susp unit/ml...7 nystatin tab unit... 4 nystatin topical powder...74 nystatin-triamcinolone cream unit/gm- % nystatin-triamcinolone oint unit/gm- % O OB COMLETE/DHA -prenat w/ iron cbn-fe asp glyc-faomega cap mg...59 OB COMLETE ONE -prenatal w/o a w/fecbn-fe asp glycfa-fish cap mg OB COMLETE ETITE -prenat w/o a w/fecbn-feaspglycfa-omega cap mg OB COMLETE REMIER -prenatal vit w/ fe cbn-fe asp glyc-fa tab mg OB COMLETE -prenatal vit w/ iron carbonyl-fa tab mg...59 OBIZUR -antihemophilic factor (recomb porc) rpfviii for inj 500 unit OB-NATAL ONE -prenatal vit w/ fe cbn-fe asp glyc-faomega 3 cap 7-mg OBSTETRIX DHA -prenat w/fecbn-fa-dss tab 9- mg & omega 3 cap 387 mg pak OBSTETRIX EC -prenatal vit w/ dss-iron carbonyl-fa tab 9- mg...59 O-CAL FA -prenatal vit w/ fe fumarate-fa tab 7- mg O-CAL RENATAL -prenatal vit w/ fe fumarate-fa tab 5- mg octreotide acetate inj 50 mcg/ml (0.05 mg/ml) (Sandostatin)... octreotide acetate inj 00 mcg/ml (0. mg/ml) (Sandostatin)... octreotide acetate inj 00 mcg/ml (0. mg/ml) (Sandostatin)... octreotide acetate inj 500 mcg/ml (0.5 mg/ml) (Sandostatin)... octreotide acetate inj 000 mcg/ml ( mg/ml) (Sandostatin)... ofloxacin ophth soln 0.3% (Ocuflox) ofloxacin otic soln 0.3%...7 olanzapine-fluoxetine hcl cap 3-5 mg (Symbyax)...47 olanzapine-fluoxetine hcl cap 6-5 mg (Symbyax)...47 olanzapine-fluoxetine hcl cap 6-50 mg (Symbyax)...47 olanzapine-fluoxetine hcl cap -5 mg (Symbyax)...47 olanzapine-fluoxetine hcl cap -50 mg (Symbyax)...47 olanzapine orally disintegrating tab 5 mg (Zyprexa zydis) olanzapine orally disintegrating tab 0 mg (Zyprexa zydis) olanzapine orally disintegrating tab 5 mg (Zyprexa zydis) olanzapine orally disintegrating tab 0 mg (Zyprexa zydis) olanzapine tab.5 mg (Zyprexa) olanzapine tab 5 mg (Zyprexa) olanzapine tab 7.5 mg (Zyprexa) Guia de medicinas ValueScript de Florida Blue para enero de 06

170 06 olanzapine tab 0 mg (Zyprexa) olanzapine tab 5 mg (Zyprexa) olanzapine tab 0 mg (Zyprexa) olopatadine hcl nasal soln 0.6% (atanase)...3 omega-3-acid ethyl esters cap gm (Lovaza)...3 omeprazole cap delayed release 0 mg (rilosec)...35 omeprazole cap delayed release 0 mg (rilosec)...35 omeprazole cap delayed release 40 mg (rilosec)...35 omeprazole-sodium bicarbonate cap 0-00 mg (Zegerid)...35 omeprazole-sodium bicarbonate cap mg (Zegerid)...35 OMNIFLEX DIAHRAGM -diaphragms...98 ON CALL LANCETS ON CALL LANCING DEVICE -lancet devices ON CALL LUS LANCETS ON CALL LUS LANCING DEVI -lancet devices ondansetron hcl oral soln 4 mg/5ml (Zofran)...36 ondansetron hcl tab 4 mg...36 ondansetron hcl tab 4 mg (Zofran) ondansetron hcl tab 8 mg (Zofran) ondansetron orally disintegrating tab 4 mg (Zofran odt)...36 ondansetron orally disintegrating tab 8 mg (Zofran odt)...36 ONETOUCH CLUB LANCETS FIN ONETOUCH COMBO ACK ONETOUCH DELICA LANCETS E ONETOUCH DELICA LANCETS F ONETOUCH DELICA LANCING D -lancet devices ONETOUCH FINEOINT LANCET ONETOUCH LANCETS ONETOUCH SURESOFT LANCING - misc ONETOUCH ULTRASOFT LANCET ONFI -clobazam suspension.5 mg/ml ONGLYZA -saxagliptin hcl tab.5 mg (base equiv)...9 ONGLYZA -saxagliptin hcl tab 5 mg (base equiv)...9 OSUMIT -macitentan tab 0 mg... 3 OTIONS CONCETROL VAGINA -nonoxynol-9 gel 4% OTIONS GYNOL II VAGINAL -nonoxynol-9 gel 3% ORA -pimozide tab mg...47 ORA -pimozide tab mg...47 ORAVIG -miconazole buccal tab 50 mg (mouththroat)...7 ORFADIN -nitisinone cap mg... ORFADIN -nitisinone cap 5 mg... ORFADIN -nitisinone cap 0 mg... orphenadrine citrate tab sr hr 00 mg orphenadrine w/ aspirin & caffeine tab mg ORSINI INSULIN SYRINGE/U- -insulin syringe/needle u-00 / ml 9 x /" ORSINI INSULIN SYRINGE/U- -insulin syringe/needle u-00 / ml ORSINI INSULIN SYRINGE/U- -insulin syringe/needle u-00 ml ORTHO DIAHRAGM COIL SRI -diaphragm coil spring kit 50 mm...99 ORTHO DIAHRAGM COIL SRI -diaphragm coil spring kit 00 mm...99 ORTHO DIAHRAGM COIL SRI -diaphragm coil spring kit 05 mm...99 ORTHO DIAHRAGM FLAT SRI -diaphragm flat spring kit 55 mm...99 ORTHO DIAHRAGM FLAT SRI -diaphragm flat spring kit 60 mm...99 ORTHO DIAHRAGM FLAT SRI -diaphragm flat spring kit 65 mm...99 ORTHO DIAHRAGM FLAT SRI -diaphragm flat spring kit 70 mm...99 ORTHO DIAHRAGM FLAT SRI -diaphragm flat spring kit 75 mm...99 ORTHO DIAHRAGM FLAT SRI -diaphragm flat spring kit 80 mm...99 ORTHO DIAHRAGM FLAT SRI -diaphragm flat spring kit 85 mm...99 ORTHO DIAHRAGM FLAT SRI -diaphragm flat spring kit 90 mm...99 ORTHO DIAHRAGM FLAT SRI -diaphragm flat spring kit 95 mm...99 OSMORE -sod phos mono-sod phos di tabs gm(.5gm na phos)...34 OSHENA -ospemifene tab 60 mg... oxandrolone tab.5 mg (Oxandrin)... 6 oxandrolone tab 0 mg (Oxandrin)... 6 oxaprozin tab 600 mg (Daypro)... 5 oxazepam cap 0 mg...39 oxazepam cap 5 mg...39 oxazepam cap 30 mg...39 oxcarbazepine susp 300 mg/5ml (60 mg/ml) (Trileptal)...54 oxcarbazepine tab 50 mg (Trileptal) oxcarbazepine tab 300 mg (Trileptal) oxcarbazepine tab 600 mg (Trileptal) OXISTAT -oxiconazole nitrate cream %...74 OXISTAT -oxiconazole nitrate lotion % oxybutynin chloride syrup 5 mg/5ml oxybutynin chloride tab 5 mg...38 Guia de medicinas ValueScript de Florida Blue para enero de 06 59

171 06 oxybutynin chloride tab sr 4hr 5 mg (Ditropan xl) oxybutynin chloride tab sr 4hr 0 mg (Ditropan xl) oxybutynin chloride tab sr 4hr 5 mg (Ditropan xl) oxycodone-aspirin tab mg (ercodan) oxycodone hcl cap 5 mg...50 oxycodone hcl conc 00 mg/5ml (0 mg/ml) (Oxycodone hcl) oxycodone hcl soln 5 mg/5ml (Oxycodone hcl) oxycodone hcl tab 0 mg...50 oxycodone hcl tab 0 mg...50 oxycodone hcl tab 5 mg (Roxicodone)...50 oxycodone hcl tab 5 mg (Roxicodone)...50 oxycodone hcl tab 30 mg (Roxicodone)...50 oxycodone-ibuprofen tab mg...50 oxycodone w/ acetaminophen tab.5-35 mg (ercocet)...50 oxycodone w/ acetaminophen tab 5-35 mg (ercocet)...50 oxycodone w/ acetaminophen tab mg (ercocet)...50 oxycodone w/ acetaminophen tab 0-35 mg (ercocet)...50 OXYCONTIN -oxycodone hcl tab er hr deter 0 mg OXYCONTIN -oxycodone hcl tab er hr deter 5 mg OXYCONTIN -oxycodone hcl tab er hr deter 0 mg OXYCONTIN -oxycodone hcl tab er hr deter 30 mg OXYCONTIN -oxycodone hcl tab er hr deter 40 mg OXYCONTIN -oxycodone hcl tab er hr deter 60 mg OXYCONTIN -oxycodone hcl tab er hr deter 80 mg oxymorphone hcl tab 5 mg (Opana) oxymorphone hcl tab 0 mg (Opana) oxymorphone hcl tab sr hr 5 mg...50 oxymorphone hcl tab sr hr 7.5 mg...50 oxymorphone hcl tab sr hr 0 mg...50 oxymorphone hcl tab sr hr 5 mg...50 oxymorphone hcl tab sr hr 0 mg...50 oxymorphone hcl tab sr hr 30 mg...50 oxymorphone hcl tab sr hr 40 mg...50 AIRE OB -prenat w/ fe poly cmplx-fe asp-fe gly-fa tab & dha cap pak...59 ANRETIN -alitretinoin gel 0.%...74 pantoprazole sodium ec tab 0 mg (base equiv) (rotonix) pantoprazole sodium ec tab 40 mg (base equiv) (rotonix) paricalcitol cap 4 mcg... paricalcitol cap mcg (Zemplar)... paricalcitol cap mcg (Zemplar)... paromomycin sulfate cap 50 mg...3 paroxetine hcl tab 0 mg (axil)... 4 paroxetine hcl tab 0 mg (axil)... 4 paroxetine hcl tab 30 mg (axil)... 4 paroxetine hcl tab 40 mg (axil)... 4 paroxetine hcl tab sr 4hr.5 mg (axil cr)...4 paroxetine hcl tab sr 4hr 5 mg (axil cr)... 4 paroxetine hcl tab sr 4hr 37.5 mg (axil cr)...4 ASER -aminosalicylic acid cr granules packet 4 gm...3 ATADAY -olopatadine hcl ophth soln 0.%...70 ATANOL -olopatadine hcl ophth soln 0.%...70 AXIL -paroxetine hcl oral susp 0 mg/5ml (base equiv)...4 C LANCETS SUER THIN 30G C UNIFINE ENTIS 9G X -insulin pen needle 9 g x mm (/")...99 C UNIFINE ENTIS 3G X -insulin pen needle 3 g x 5 mm (3/6") C UNIFINE ENTIS 3G X -insulin pen needle 3 g x 6 mm (/4") C UNIFINE ENTIS 3G X -insulin pen needle 3 g x 8 mm (/3" or 5/6")...99 EDIARIX -diph-tetanus tox-acell pert-hepatitis b-polio ipv vac inj... EDVAX HIB -haemophilus b polysaccharide conj vac im susp 7.5 mcg/0.5 ml...0 EGANONE -ethotoin tab 50 mg EGASYS -peginterferon alfa-a inj 80 mcg/ ml...5 EGASYS -peginterferon alfa-a inj 80 mcg/0.5ml...5 EGASYS ROCLICK -peginterferon alfa-a inj 35 mcg/0.5ml...5 EGASYS ROCLICK -peginterferon alfa-a inj 80 mcg/0.5ml...5 EG-INTRON -peginterferon alfa-b for inj kit 50 mcg/0.5ml...5 EG-INTRON -peginterferon alfa-b for inj kit 80 mcg/0.5ml...5 EG-INTRON -peginterferon alfa-b for inj kit 0 mcg/0.5ml...5 EG-INTRON -peginterferon alfa-b for inj kit 50 mcg/0.5ml...5 EGINTRON -peginterferon alfa-b for inj kit 50 mcg/0.5ml...5 EGINTRON -peginterferon alfa-b for inj kit 80 mcg/0.5ml...5 EGINTRON -peginterferon alfa-b for inj kit 0 mcg/0.5ml Guia de medicinas ValueScript de Florida Blue para enero de 06

172 06 EGINTRON -peginterferon alfa-b for inj kit 50 mcg/0.5ml...5 EG-INTRON REDIEN AK 4 -peginterferon alfa-b for inj kit 50 mcg/0.5ml... 5 EG-INTRON REDIEN AK 4 -peginterferon alfa-b for inj kit 80 mcg/0.5ml... 5 EG-INTRON REDIEN AK 4 -peginterferon alfa-b for inj kit 0 mcg/0.5ml... 5 EG-INTRON REDIEN AK 4 -peginterferon alfa-b for inj kit 50 mcg/0.5ml... 5 EG-INTRON REDIEN -peginterferon alfa-b for inj kit 50 mcg/0.5ml... 5 EG-INTRON REDIEN -peginterferon alfa-b for inj kit 80 mcg/0.5ml... 5 EG-INTRON REDIEN -peginterferon alfa-b for inj kit 0 mcg/0.5ml... 5 EG-INTRON REDIEN -peginterferon alfa-b for inj kit 50 mcg/0.5ml... 5 peg 3350-kcl-na bicarb-nacl-na sulfate for soln 40 gm (Colyte-flavor packs)...35 peg 3350-kcl-na bicarb-nacl-na sulfate for soln 36 gm (Golytely)...34 peg 3350-kcl-sod bicarb-nacl for soln 40 gm (Nulytely/flavor pack) penicillin v potassium for soln 5 mg/5ml... penicillin v potassium for soln 50 mg/5ml... penicillin v potassium tab 50 mg... penicillin v potassium tab 500 mg... EN NEEDLES 9GX/" -insulin pen needle 9 g x mm (/") EN NEEDLES 3G X 3/6" -insulin pen needle 3 g x 5 mm (3/6") EN NEEDLES 30GX5/6" -insulin pen needle 30 g x 8 mm (/3" or 5/6")...99 EN NEEDLES 3GX5/6" -insulin pen needle 3 g x 8 mm (/3" or 5/6")...99 EN NEEDLES 3G X /4" SH -insulin pen needle 3 g x 6 mm (/4")...99 EN NEEDLES 9G X MM -insulin pen needle 9 g x mm (/")...99 EN NEEDLES 3G X 6MM -insulin pen needle 3 g x 6 mm (/4") ENTACEL -diph-ac per-tet tox ad-poliov-haemoph b poly vac for im susp... ENTASA -mesalamine cap cr 50 mg ENTASA -mesalamine cap cr 500 mg pentoxifylline tab cr 400 mg ERFECT LANCETS 30G ERFECT RESSURE ACTIVATE perindopril erbumine tab mg...8 perindopril erbumine tab 4 mg (Aceon)... 8 perindopril erbumine tab 8 mg (Aceon)... 8 permethrin cream 5% (Elimite)...74 perphenazine tab mg...43 perphenazine tab 4 mg...43 perphenazine tab 8 mg...43 perphenazine tab 6 mg...43 HARMACIST CHOICE ULTRA T HARMACY COUNTER LANCETS phenazopyridine hcl tab 00 mg (yridium) phenazopyridine hcl tab 00 mg (yridium) phenelzine sulfate tab 5 mg (Nardil)... 4 phenobarbital elixir 0 mg/5ml...44 HENOBARBITAL -phenobarbital tab 5 mg HENOBARBITAL -phenobarbital tab 30 mg HENOBARBITAL -phenobarbital tab 60 mg HENOBARBITAL -phenobarbital tab 00 mg phenobarbital tab 6. mg phenobarbital tab 3.4 mg phenobarbital tab 64.8 mg phenobarbital tab 97. mg phenytoin chew tab 50 mg (Dilantin infatabs) phenytoin sodium extended cap 00 mg (Dilantin)...55 phenytoin sodium extended cap 00 mg (henytek)...55 phenytoin sodium extended cap 300 mg (henytek)...55 phenytoin susp 5 mg/5ml (Dilantin-5)...55 HOSHOLINE IODIDE -echothiophate iodide ophth for soln 0.5%...70 HYSIOSOL IRRIGATION H 7 -irrigation solution, physiological... 4 pilocarpine hcl ophth soln % (Isopto carpine) pilocarpine hcl ophth soln % (Isopto carpine) pilocarpine hcl ophth soln 4% (Isopto carpine) pilocarpine hcl tab 5 mg (Salagen)... 7 pilocarpine hcl tab 7.5 mg (Salagen)... 7 pindolol tab 5 mg... 4 pindolol tab 0 mg... 4 pioglitazone hcl-glimepiride tab 30- mg (Duetact)...9 pioglitazone hcl-glimepiride tab 30-4 mg (Duetact)...9 pioglitazone hcl-metformin hcl tab mg (Actoplus met)... 9 pioglitazone hcl-metformin hcl tab mg (Actoplus met)... 9 pioglitazone hcl tab 5 mg (base equiv) (Actos)...9 pioglitazone hcl tab 30 mg (base equiv) (Actos)...9 pioglitazone hcl tab 45 mg (base equiv) (Actos)...9 piroxicam cap 0 mg (Feldene)... 5 piroxicam cap 0 mg (Feldene)... 5 Guia de medicinas ValueScript de Florida Blue para enero de 06 6

173 06 LEGRIDY -peginterferon beta-a soln pen-injector 5 mcg/0.5ml...47 LEGRIDY -peginterferon beta-a soln prefilled syringe 5 mcg/0.5ml LEGRIDY STARTER ACK -peginterferon beta-a soln pen-inj 63 & 94 mcg/0.5ml pack LEGRIDY STARTER ACK -peginterferon beta-a soln pref syr 63 & 94 mcg/0.5ml pack NEUMOVAX 3/ DOSE -pneumococcal vaccine polyvalent inj 5 mcg/0.5ml...0 NEUMOVAX 3/5 DOSE -pneumococcal vaccine polyvalent inj 5 mcg/0.5ml...0 NEUMOVAX 3 -pneumococcal vaccine polyvalent inj 5 mcg/0.5ml...0 NV-DHA+DOCUSATE -prenatal w/o vit a w/ fe fum-dssfa-dha cap mg...59 NV-DHA -prenat w/o a w/fefum-methfol-fa-dha cap mg NV FERROUS FUMARATE/DOCU -prenatal vit w/ dss-fe fumarate-fa tab 9- mg NV-FIRST -prenatal mv w/ fe polysac cmplx-fa-dha cap mg NV FOLIC ACID + IRON MUL -prenatal vit w/ fe fumarate-fa tab 7- mg NV-OB/DHA -prenatal mv w/fe fum-fa tab 65- mg & dha cap 50 mg pack...59 NV OB+DHA -prenat w/o a w/fecbn-fegl-dss-fa tab & dha cap 50 mg pack...59 NV-OMEGA -prenat w/o a w/ fe fumerate-methylfolate-faomega 3 cap...59 NV RENATAL LUS MULTIVI -prenatal vit w/ fe fumarate-fa tab 7- mg NV-SELECT -prenatal vit w/ fe fum-methylfolate-fa tab mg NV TABS 9- -prenatal vit w/ iron carbonyl-fa tab 9- mg NV-TOTAL -prenat w/ fe cbn-fe bisglyc-fa-fish oil cap mg NV-V-U -prenatal w/o a vit w/ fe fumarate-fa cap mg...59 podofilox soln 0.5% (Condylox) polymyxin b-trimethoprim ophth soln 0000 unit/ ml-0.% (olytrim) OMALYST -pomalidomide cap mg...3 OMALYST -pomalidomide cap mg...3 OMALYST -pomalidomide cap 3 mg...3 OMALYST -pomalidomide cap 4 mg...3 pot & sod citrates w/ cit ac soln mg/5ml...38 potassium bicarbonate effer tab 5 meq...64 potassium chloride cap cr 8 meq (Microk) potassium chloride cap cr 0 meq (Microk) OTASSIUM CHLORIDE ER -potassium chloride tab cr 8 meq (600 mg) potassium chloride microencapsulated crys cr tab 0 meq potassium chloride microencapsulated crys cr tab 0 meq potassium chloride oral liq 0% (0 meq/5ml) potassium chloride oral liq 0% (40 meq/5ml) potassium chloride powder packet 0 meq potassium chloride tab cr 0 meq (K-tab)...64 potassium chloride tab cr 8 meq (600 mg) (Ktab)...64 potassium citrate & citric acid powder pack mg potassium citrate & citric acid soln mg/5ml...39 potassium citrate tab cr 5 meq (540 mg) (Urocit-k 5) potassium citrate tab cr 0 meq (080 mg) (Urocit-k 0) potassium citrate tab cr 5 meq (60 mg) (Urocit-k 5) pot bicarbonate & chloride effer tab 5 meq pot phos monobasic w/sod phos di & monobas tab mg (K-phos neutral) RADAXA -dabigatran etexilate mesylate cap 75 mg (etexilate base eq)...65 RADAXA -dabigatran etexilate mesylate cap 50 mg (etexilate base eq)...65 pramipexole dihydrochloride tab 0.5 mg (Mirapex) pramipexole dihydrochloride tab 0.5 mg (Mirapex) pramipexole dihydrochloride tab 0.5 mg (Mirapex) pramipexole dihydrochloride tab 0.75 mg (Mirapex) pramipexole dihydrochloride tab mg (Mirapex) pramipexole dihydrochloride tab.5 mg (Mirapex) pramipexole dihydrochloride tab sr 4hr mg (Mirapex er) pramipexole dihydrochloride tab sr 4hr 0.75 mg (Mirapex er) pramipexole dihydrochloride tab sr 4hr.5 mg (Mirapex er) pramoxine-chloroxylenol otic liquid -0.% (ramotic)... 7 RANDIN -repaglinide tab 0.5 mg...9 RANDIN -repaglinide tab mg...9 RANDIN -repaglinide tab mg...9 pravastatin sodium tab 0 mg...3 pravastatin sodium tab 0 mg (ravachol)... 3 pravastatin sodium tab 40 mg (ravachol) Guia de medicinas ValueScript de Florida Blue para enero de 06

174 06 pravastatin sodium tab 80 mg (ravachol)... 3 prazosin hcl cap mg (Minipress)...8 prazosin hcl cap mg (Minipress)...8 prazosin hcl cap 5 mg (Minipress)...8 RECISION SURE-DOSE INSUL -insulin syringe/needle u-00 / ml 30 x 3/8" RECISION SURE-DOSE INSUL -insulin syringe/needle u-00 / ml 8 x /" RECISION SURE-DOSE INSUL -insulin syringe/needle u-00 / ml 9 x /" RECISION SURE-DOSE INSUL -insulin syringe/needle u ml RECISION SURE-DOSE INSUL -insulin syringe/needle u-00 ml 8 x /" RECISION SURE-DOSE LUS -insulin syringe/needle u ml 9 x /" RECISION SURE-DOSE LUS -insulin syringe/needle u-00 ml 9 x /" RECISION THIN LANCETS RECISION THINS G LANCET RECISION ULTRA LANCET prednicarbate cream 0.% (Dermatop)...74 prednicarbate oint 0.% (Dermatop)...74 prednisolone acetate ophth susp % (red forte) prednisolone sod phos orally disintegr tab 0 mg (base eq) (Orapred odt)... 5 prednisolone sod phos orally disintegr tab 5 mg (base eq) (Orapred odt)... 5 prednisolone sod phos orally disintegr tab 30 mg (base eq) (Orapred odt)... 5 prednisolone sod phosphate oral soln 5 mg/5ml (base equiv)...5 prednisolone sod phosph oral soln 6.7 mg/5ml (5 mg/5ml base) (ediapred)... 5 prednisolone syrup 5 mg/5ml (usp solution equivalent)... 5 REDNISONE -prednisone oral soln 5 mg/5ml...5 REDNISONE -prednisone tab 50 mg...5 prednisone tab mg...5 prednisone tab.5 mg...5 prednisone tab 5 mg...5 prednisone tab 0 mg...5 prednisone tab 0 mg...5 REFERA OB + DHA -prenat-fe poly cmplx-fe heme polyfa tab & omega 3 cap pck...60 REFERAOB +DHA -prenat-fe poly cmplx 8mg-fe heme poly-fa tab&dha cap pack REFERAOB ONE -prenat-fe poly cmplx-fe heme poly-fadha cap mg...60 REFERA OB -prenat vit-fe poly cmplx-fe heme poly-fa tab 8-6- mg REFERRED LUS INSULIN SY -insulin syringe/needle u-00 / ml 8 x /" REFERRED LUS INSULIN SY -insulin syringe/needle u-00 / ml 9 x /" REFERRED LUS INSULIN SY -insulin syringe/needle u-00 / ml REFERRED LUS INSULIN SY -insulin syringe/needle u ml 9 x /" REFERRED LUS INSULIN SY -insulin syringe/needle u ml REFERRED LUS INSULIN SY -insulin syringe/needle u-00 ml 8 x /" REFERRED LUS INSULIN SY -insulin syringe/needle u-00 ml 9 x /" REFERRED LUS INSULIN SY -insulin syringe/needle u-00 ml REFERRED LUS LANCETS CO REFERRED LUS LANCETS SU REFERRED LUS LANCETS TH REFERRED LUS UNIFINE E -insulin pen needle 9 g x mm (/")...00 REFERRED LUS UNIFINE E -insulin pen needle 3 g x 5 mm (3/6")...00 REFERRED LUS UNIFINE E -insulin pen needle 3 g x 6 mm (/4")...00 REFERRED LUS UNIFINE E -insulin pen needle 3 g x 4 mm (5/3")...00 REFERRED LUS UNIFINE E -insulin pen needle 3 g x 8 mm (/3" or 5/6")...00 REFOL-DHA -prenatal w/o vit a w/ fe fum-dss-fa-dha cap mg REMARIN -estrogens, conjugated tab 0.3 mg... 6 REMARIN -estrogens, conjugated tab 0.45 mg... 6 REMARIN -estrogens, conjugated tab 0.65 mg... 6 REMARIN -estrogens, conjugated tab 0.9 mg... 6 REMARIN -estrogens, conjugated tab.5 mg... 6 REMARIN -estrogens, conjugated vaginal cream 0.65 mg/gm REMHASE -conj est 0.65(4)/conj est-medroxypro ac tab mg(4)... 6 REMRO -conjugated estrogen-medroxyprogest acetate tab mg... 7 REMRO -conjugated estrogen-medroxyprogest acetate tab mg... 7 REMRO -conjugated estrogen-medroxyprogest acetate tab mg... 7 REMRO -conjugated estrogen-medroxyprogest acetate tab mg... 7 RENA/QUATREFOLIC -prenat w/o a w/fefum-methfolfa-dha cap mg... 6 RENA CHEW -prenat w/ b-b6-b-d3-folic acid chew tab.4 mg... 6 RENAISSANCE BALANCE -prenatal w/o vit a w/ fe cbndss-fa-dha cap mg...60 Guia de medicinas ValueScript de Florida Blue para enero de 06 63

175 06 RENAISSANCE DHA -prenat w/o a w/fecbn-fegl-dss-fa tab & dha cap 50 mg pack...60 RENAISSANCE 90 DHA -prenat w/o a w/fecbn-fegl-dssfa tab 90 &dha cap 300mg pak...60 RENAISSANCE HARMONY DHA -prenat w/fe poly-na fered-fa tab 7- & omega cap dr 380mg...60 RENAISSANCE NEXT-B -prenatal w/ calcium-vit b6-faginger tab. mg RENAISSANCE NEXT -prenatal w/ calcium-vit b6-faginger tab. mg RENAISSANCE LUS -prenatal w/o a w/fe cbn-dss-fadha cap mg...60 RENAISSANCE -prenatal w/o vit a w/ fe fum-dss-fa-dha cap mg RENAISSANCE ROMISE -prenat w/o a w/fecbn-fegldss-fa tab & dha cap 300 mg pack...60 RENA EARL -prenat w/oa w/fefum-na fered-fa-dha cap cr mg...6 RENA LUS/QUATREFOLIC -prenat w/o a w/ fe chelate-l methylfol-fa tab & dha cap pk...6 RENALUS -prenatal vit w/ fe fumarate-fa tab 7- mg RENATABS FA -prenatal vit w/ fe fumarate-fa tab 9- mg RENATABS RX -prenatal vit w/ iron carbonyl-fa tab 9- mg RENATAL AD -prenatal vit w/ dss-iron carbonyl-fa tab 90- mg...60 RENATAL LOW IRON -prenatal vit w/ fe fumarate-fa tab 7- mg...60 RENATAL LUS IRON -prenatal vit w/ iron carbonyl-fa tab 9- mg RENATAL LUS -prenatal vit w/ fe fumarate-fa tab 7- mg RENATAL 9 -prenatal vit w/ dss-fe fumarate-fa tab 9- mg RENATAL 9 -prenatal vit w/ fe fumarate-fa chew tab 9- mg...60 RENATAL -prenatal vit w/ fe fumarate-fa tab 7- mg RENATAL-U -prenatal w/o a vit w/ fe fumarate-fa cap mg...60 RENATAL VITAMINS LUS -prenatal vit w/ fe fumaratefa tab 7- mg...60 RENATA -prenatal w/o a vit w/ fe fum-fa tab chew 9- mg RENATE AM -prenatal w/ calcium-vit b6-vit b-fa-ginger tab mg RENATE DHA -prenat w/o a w/feaspg-methfol-fa-dha cap mg...60 RENATE DHA -prenat w/o a w/fefum-methfol-fa-dha cap mg RENATE ELITE -prenatal vit w/ fe fum-methylfolate-fa tab mg...60 RENATE ELITE -prenatal w/ fe asp gly-l methylfol-fa tab mg RENATE ENHANCE -prenat w/o a w/fefum-methfol-fadha cap mg...60 RENATE ESSENTIAL -prenat w/o a w/feaspg-methfol-fadha cap mg...60 RENATE ESSENTIAL -prenat w/o a w/feasp-methylf-faomeg cap mg...60 RENATE MINI -prenat w/oa w/fecb-feasp-meth-fa-dha cap mg...6 RENATE MINI -prenat w/o a w/fecbn-methylf-fa-dha cap mg RENATE IXIE -prenat w/o a w/feaspg-methfol-fa-dha cap mg...6 RENATE -prenat mv & min w/ l-methylfolate-fa chew tab mg...60 RENATE RESTORE -prenat w/o a w/fefum-methfol-fadha cap mg...6 RENATE STAR -prenatal vit w/ fe asparto glycinate-fa tab 0- mg... 6 RENEXA -prenatal w/o vit a w/ fe fum-dss-fa-dha cap mg... 6 RENTIF CAVITY-RIM CERVIC -cervical cap mm RENTIF CAVITY-RIM CERVIC -cervical cap 5 mm RENTIF CAVITY-RIM CERVIC -cervical cap 8 mm RENTIF CAVITY-RIM CERVIC -cervical cap 3 mm RENTIF FITTING SET -cervical caps RELUS -prenatal vit w/ fe fumarate-fa tab 7- mg... 6 REOIK -sod picosulfate-mg oxide-citric acid pack 0 mg-3.5 gm- gm...35 REQUE 0 -prenatal mv w/fe carbonyl-dss-fa-dha tab mg... 6 RETAB -prenatal vit w/ fe fumarate-fa tab 9- mg... 6 REVNAR 3 -pneumococcal 3-valent conjugate vaccine inj...0 REZCOBIX -darunavir-cobicistat tab mg...6 REZISTA -darunavir ethanolate susp 00 mg/ml (base equiv)...6 REZISTA -darunavir ethanolate tab 75 mg (base equiv)...6 REZISTA -darunavir ethanolate tab 50 mg (base equiv)...6 REZISTA -darunavir ethanolate tab 600 mg (base equiv)...6 REZISTA -darunavir ethanolate tab 800 mg (base equiv)...6 RIFTIN -rifapentine tab 50 mg...3 RILOSEC OTC -omeprazole magnesium delayed release tab 0 mg (base equiv) RIMAQUINE HOSHATE -primaquine phosphate tab 6.3 mg (5 mg base)...7 primidone tab 50 mg (Mysoline) Guia de medicinas ValueScript de Florida Blue para enero de 06

176 06 primidone tab 50 mg (Mysoline)...55 RIMSOL -trimethoprim hcl oral soln 50 mg/5ml (base equiv)...7 R NATAL 400 EC -prenat-fe bis-fe prot succ-fa-ca tab & omega cap dr 400 pk R NATAL 430 EC -prenat-fe bis-fe prot succ-fa-ca tab & omega cap dr 430 pk R NATAL 400 -prenat-fe bis-fe prot succ-fa-ca tab & omega 3 cap 400 pk R NATAL 430 -prenat-fe bis-fe prot succ-fa-ca tab & omega 3 cap 430 pk ROAIR HFA -albuterol sulfate inhal aero 08 mcg/act (90mcg base equiv)...34 ROAIR RESICLICK -albuterol sulfate aer pow ba 08 mcg/act (90 mcg base equiv)...34 probenecid tab 500 mg...53 prochlorperazine maleate tab 5 mg (base equivalent) (Compazine) prochlorperazine maleate tab 0 mg (base equivalent) (Compazine) prochlorperazine suppos 5 mg ROCRIT -epoetin alfa inj 000 unit/ml ROCRIT -epoetin alfa inj 3000 unit/ml ROCRIT -epoetin alfa inj 4000 unit/ml ROCRIT -epoetin alfa inj 0000 unit/ml ROCRIT -epoetin alfa inj 0000 unit/ml ROCRIT -epoetin alfa inj unit/ml ROCTOFOAM HC -hydrocortisone acetate w/ pramoxine rectal foam -%... 7 RODIGY INSULIN MINI EN -insulin pen needle 3 g x 5 mm (3/6") RODIGY INSULIN SHORT EN -insulin pen needle 3 g x 8 mm (/3" or 5/6")...00 RODIGY INSULIN SYRING/U- -insulin syringe/needle u ml RODIGY INSULIN SYRINGE/ -insulin syringe/needle u-00 / ml RODIGY INSULIN SYRINGE/ -insulin syringe/needle u-00 ml 8 x /" RODIGY LANCING DEVICE -lancet devices RODIGY RESSURE ACTIVATE RODIGY TWIST TO LANCETS ROFILNINE SD -factor ix complex for inj 500 unit...68 ROFILNINE SD -factor ix complex for inj 000 unit...68 ROFILNINE SD -factor ix complex for inj 500 unit...68 progesterone micronized cap 00 mg (rometrium)... 8 progesterone micronized cap 00 mg (rometrium)... 8 ROGLYCEM -diazoxide susp 50 mg/ml...9 ROMACTA -eltrombopag olamine tab.5 mg (base equiv)...65 ROMACTA -eltrombopag olamine tab 5 mg (base equiv)...65 ROMACTA -eltrombopag olamine tab 50 mg (base equiv)...65 ROMACTA -eltrombopag olamine tab 75 mg (base equiv)...65 promethazine-dm syrup mg/5ml promethazine hcl suppos.5 mg...3 promethazine hcl suppos 5 mg...3 promethazine hcl suppos 50 mg...3 promethazine hcl syrup 6.5 mg/5ml...3 promethazine hcl tab.5 mg... 3 promethazine hcl tab 5 mg... 3 promethazine hcl tab 50 mg... 3 promethazine w/ codeine syrup mg/5ml...33 propafenone hcl cap sr hr 5 mg (Rythmol sr)...6 propafenone hcl cap sr hr 35 mg (Rythmol sr)...6 propafenone hcl cap sr hr 45 mg (Rythmol sr)...6 propafenone hcl tab 300 mg...6 propafenone hcl tab 50 mg (Rythmol)... 6 propafenone hcl tab 5 mg (Rythmol)... 6 ROANTHELINE BROMIDE -propantheline bromide tab 5 mg...36 proparacaine hcl ophth soln 0.5% (Alcaine) RORANOLOL/HYDROCHLOROTH -propranolol & hydrochlorothiazide tab 80-5 mg...8 propranolol hcl cap sr 4hr 60 mg (Inderal la)... 4 propranolol hcl cap sr 4hr 80 mg (Inderal la)... 4 propranolol hcl cap sr 4hr 0 mg (Inderal la)... 4 propranolol hcl cap sr 4hr 60 mg (Inderal la)... 4 RORANOLOL HCL -propranolol hcl oral soln 0 mg/5ml...4 propranolol hcl tab 0 mg...4 propranolol hcl tab 0 mg...4 propranolol hcl tab 40 mg...4 propranolol hcl tab 60 mg...4 propranolol hcl tab 80 mg...4 propylthiouracil tab 50 mg... ROQUAD -measles-mumps-rubella-varicella virus vaccines for inj...0 protriptyline hcl tab 5 mg...4 protriptyline hcl tab 0 mg...4 ROVIDA DHA -prenat w/o a w/fe fum-fe poly-fa-dha cap mg... 6 ROVIDA OB -prenatal w/o a w/fe fum-fe poly-fa cap mg... 6 pseudoeph-chlorphen w/ hydrocodone soln mg/5ml (Zutripro)...33 Guia de medicinas ValueScript de Florida Blue para enero de 06 65

177 06 pseudoephed-bromphen-dm syrup mg/5ml...33 SS SELECT G LANCETS SS SELECT SAFETY LANCETS ULMICORT -budesonide inhalation susp mg/ml...34 ULMICORT FLEXHALER -budesonide inhal aero powd 90 mcg/act (breath activated) ULMICORT FLEXHALER -budesonide inhal aero powd 80 mcg/act (breath activated) ULMOZYME -dornase alfa inhal soln mg/ ml...34 UREFE OB LUS -prenatal w/o a w/fe fum-fe poly-fa cap mg... 6 URIXAN -mercaptopurine susp 000 mg/00ml (0 mg/ ml)... 4 X ADVANCED LANCING DEVIC -lancet devices... 0 X EXTRA SHORT EN NEEDLE -insulin pen needle 3 g x 6 mm (/4")... 0 X INSULIN SYRINGE/U-00/ -insulin syringe/needle u-00 / ml X INSULIN SYRINGE/U-00/ -insulin syringe/needle u-00 / ml 30 x /"... 0 X INSULIN SYRINGE/U-00/ -insulin syringe/needle u ml 30 x /"... 0 X INSULIN SYRINGE/U-00/ -insulin syringe/needle u-00 ml 30 x /"... 0 X INSULIN SYRINGE/U-00/ -insulin syringe/needle u-00 ml X INSULIN SYRINGE/U-00/ -insulin syringe/needle u ml X LANCET AUTO INJECTOR -lancet devices... 0 X LANCETS X LANCETS ULTRA THIN X MINI EN NEEDLES 3GX5 -insulin pen needle 3 g x 5 mm (3/6")...0 X EN NEEDLE 9GXMM -insulin pen needle 9 g x mm (/")...0 X EN NEEDLE 3GX8MM -insulin pen needle 3 g x 8 mm (/3" or 5/6")...0 X SHORTLENGTH EN NEEDLE -insulin pen needle 3 g x 8 mm (/3" or 5/6")... 0 pyrazinamide tab 500 mg...3 pyridostigmine bromide tab cr 80 mg (Mestinon timespan) pyridostigmine bromide tab 60 mg (Mestinon) Q QC ADVANCED LANCING DEVIC -lancet devices... 0 QC INSULIN SYRINGE/0.5ML/ -insulin syringe/needle u-00 / ml QC INSULIN SYRINGE/0.5ML/ -insulin syringe/needle u-00 / ml 9 x /"... 0 QC INSULIN SYRINGE/0.3ML/ -insulin syringe/needle u ml 9 g...0 QC INSULIN SYRINGE/ML/30 -insulin syringe/needle u-00 ml 30 g...0 QC INSULIN SYRINGE/0.3ML/ -insulin syringe/needle u ml 9 x /"... 0 QC INSULIN SYRINGE/ML/9 -insulin syringe/needle u-00 ml 9 x /"... 0 QC INSULIN SYRINGE/ML/3 -insulin syringe/needle u-00 ml QC INSULIN SYRINGE 0.5ML/ -insulin syringe/needle u-00 / ml 9 g...0 QC INSULIN SYRINGE 0.5ML/ -insulin syringe/needle u-00 / ml 30 g...0 QC LANCETS SUER THIN QC LANCETS ULTRA THIN QC EN NEEDLES 9G X MM -insulin pen needle 9 g x mm (/")...0 QC EN NEEDLES 3G X 6MM -insulin pen needle 3 g x 6 mm (/4")...0 QC EN NEEDLES 3G X 8MM -insulin pen needle 3 g x 8 mm (/3" or 5/6")...0 QC UNIFINE ENTIS 3GX4M -insulin pen needle 3 g x 4 mm (5/3")...0 QUADRACEL -diph-tetanus tox ad-acell pert & polio virus, ipv vac inj... quetiapine fumarate tab 5 mg (Seroquel)...43 quetiapine fumarate tab 50 mg (Seroquel)...43 quetiapine fumarate tab 00 mg (Seroquel) quetiapine fumarate tab 00 mg (Seroquel) quetiapine fumarate tab 300 mg (Seroquel) quetiapine fumarate tab 400 mg (Seroquel) quinapril hcl tab 5 mg (Accupril)... 8 quinapril hcl tab 0 mg (Accupril)...8 quinapril hcl tab 0 mg (Accupril)...8 quinapril hcl tab 40 mg (Accupril)...8 quinapril-hydrochlorothiazide tab 0-.5 mg (Accuretic)... 8 quinapril-hydrochlorothiazide tab 0-.5 mg (Accuretic)... 8 quinapril-hydrochlorothiazide tab 0-5 mg (Accuretic)... 8 quinidine gluconate tab cr 34 mg... 6 QUINIDINE SULFATE ER -quinidine sulfate tab cr 300 mg... 6 QUINIDINE SULFATE -quinidine sulfate tab 00 mg... 6 quinidine sulfate tab 300 mg... 6 quinine sulfate cap 34 mg (Qualaquin)...7 QVAR -beclomethasone dipropionate inhal aero soln 40 mcg/act...34 QVAR -beclomethasone dipropionate inhal aero soln 80 mcg/act Guia de medicinas ValueScript de Florida Blue para enero de 06

178 06 R rabeprazole sodium ec tab 0 mg (Aciphex)...36 RA E-ZJECT COLOR LANCETS RA E-ZJECT LANCETS 8G RA E-ZJECT LANCETS THIN RA E-ZJECT LANCETS ULTRA RA INSULIN SYRINGE/0.5ML/ -insulin syringe/needle u-00 / ml 9 x /"... 0 RA INSULIN SYRINGE/ML/9 -insulin syringe/needle u-00 ml 9 x /"... 0 RA INSULIN SYRINGE/U-00/ -insulin syringe/needle u-00 / ml RA INSULIN SYRINGE/U-00/ -insulin syringe/needle u-00 ml RA LANCING DEVICE -lancet devices... 0 raloxifene hcl tab 60 mg (Evista)... ramipril cap.5 mg (Altace)...8 ramipril cap.5 mg (Altace)...8 ramipril cap 5 mg (Altace)...9 ramipril cap 0 mg (Altace)...9 RANEXA -ranolazine tab sr hr 500 mg...3 RANEXA -ranolazine tab sr hr 000 mg...3 ranitidine hcl cap 50 mg...36 ranitidine hcl cap 300 mg...36 ranitidine hcl syrup 5 mg/ml (75 mg/5ml)...36 ranitidine hcl tab 50 mg (Zantac) ranitidine hcl tab 300 mg (Zantac) RAAFLO -silodosin cap 4 mg...39 RAAFLO -silodosin cap 8 mg...39 RAAMUNE -sirolimus oral soln mg/ml... 4 RA EN NEEDLES 3G X 5MM -insulin pen needle 3 g x 5 mm (3/6")...0 RA EN NEEDLES 3G X 8MM -insulin pen needle 3 g x 8 mm (/3" or 5/6")...0 RAVICTI -glycerol phenylbutyrate liquid. gm/ ml... REALITY INSULIN SYRINGE/U -insulin syringe/needle u-00 / ml 8 x /"... 0 REALITY INSULIN SYRINGE/U -insulin syringe/needle u-00 / ml 9 x /"... 0 REALITY INSULIN SYRINGE/U -insulin syringe/needle u-00 ml 8 x /"... 0 REALITY INSULIN SYRINGE/U -insulin syringe/needle u-00 ml 9 x /"... 0 REALITY LANCETS REALITY TRIGGER LANCETS REBIF -interferon beta-a inj mcg/0.5ml (mu/ml) (44 mcg/ml) REBIF -interferon beta-a inj 44 mcg/0.5ml (4mu/ml) (88 mcg/ml) REBIF REBIDOSE -interferon beta-a inj mcg/0.5ml (mu/ml) (44 mcg/ml) REBIF REBIDOSE -interferon beta-a inj 44 mcg/0.5ml (4mu/ml) (88 mcg/ml) REBIF REBIDOSE TITRATION -interferon beta-a inj 6 x 8.8 mcg/0.ml & 6 x mcg/0.5ml REBIF TITRATION ACK -interferon beta-a inj 6 x 8.8 mcg/0.ml & 6 x mcg/0.5ml RECOMBINATE -antihemophilic factor (recombinant) for inj unit...68 RECOMBINATE -antihemophilic factor (recombinant) for inj unit...68 RECOMBINATE -antihemophilic factor (recombinant) for inj unit...68 RECOMBINATE -antihemophilic factor (recombinant) for inj unit...68 RECOMBINATE -antihemophilic factor (recombinant) for inj unit...68 RECOMBIVAX HB -hepatitis b vaccine (recombinant) susp 5 mcg/0.5ml... 0 RECOMBIVAX HB -hepatitis b vaccine (recombinant) susp 0 mcg/ml... 0 RECOMBIVAX HB -hepatitis b vaccine (recombinant) susp 40 mcg/ml... 0 RECTIV -nitroglycerin oint 0.4%...7 RELENZA DISKHALER -zanamivir aero powder breath activated 5 mg/blister... 6 RELION INSULIN SYRINGE/U -insulin syringe/needle u-00 / ml 9 g...0 RELION INSULIN SYRINGE/U- -insulin syringe/needle u-00 / ml 30 g...0 RELION INSULIN SYRINGE/U- -insulin syringe/needle u-00 / ml RELION INSULIN SYRINGE/U- -insulin syringe/needle u-00 / ml 9 x /"... 0 RELION INSULIN SYRINGE/U- -insulin syringe/needle u-00 / ml RELION INSULIN SYRINGE/U- -insulin syringe/needle u ml 9 g...0 RELION INSULIN SYRINGE/U- -insulin syringe/needle u ml 30 g...0 RELION INSULIN SYRINGE/U- -insulin syringe/needle u-00 ml 30 g...0 RELION INSULIN SYRINGE/U- -insulin syringe/needle u ml 9 x /"... 0 RELION INSULIN SYRINGE/U- -insulin syringe/needle u ml RELION INSULIN SYRINGE/U- -insulin syringe/needle u-00 ml 9 x /"... 0 RELION INSULIN SYRINGE/U- -insulin syringe/needle u-00 ml RELION INSULIN SYRINGE/U- -insulin syringe/needle u-00 ml RELION INSULIN SYRINGE/U- -insulin syringe/needle u ml RELION LANCETS RELION LANCETS MICRO-THIN RELION LANCETS STANDARD RELION LANCETS THIN 6G RELION LANCETS ULTRA-THIN Guia de medicinas ValueScript de Florida Blue para enero de 06 67

179 06 RELION LANCING DEVICE -lancet devices... 0 RELION MINI EN NEEDLES 3 -insulin pen needle 3 g x 6 mm (/4")...03 RELION EN NEEDLES 9GX -insulin pen needle 9 g x mm (/")...03 RELION EN NEEDLES 3GX4M -insulin pen needle 3 g x 4 mm (5/3") RELION EN NEEDLES 3GX8M -insulin pen needle 3 g x 8 mm (/3" or 5/6") RELION R -insulin regular (human) inj 00 unit/ ml...0 RELION SHORT EN NEEDLES -insulin pen needle 3 g x 8 mm (/3" or 5/6")...03 RELION THIN LANCETS RELION ULTRA THIN LANCETS RELION ULTRA THIN LUS LA RELNATE DHA -prenatal vit w/ fe fum-fa-omega 3 cap mg... 6 RELAX -eletriptan hydrobromide tab 0 mg (base equivalent)...5 RELAX -eletriptan hydrobromide tab 40 mg (base equivalent)...5 RENEW ADVANCED LANCING CA RENEW ADVANCED LANCING DE -lancet devices RENVELA -sevelamer carbonate packet 0.8 gm RENVELA -sevelamer carbonate packet.4 gm RENVELA -sevelamer carbonate tab 800 mg repaglinide tab 0.5 mg (randin)...9 repaglinide tab mg (randin)...9 repaglinide tab mg (randin)...9 RESCRITOR -delavirdine mesylate tab 00 mg...6 RESCRITOR -delavirdine mesylate tab 00 mg...6 REVLIMID -lenalidomide cap 5 mg... 4 REVLIMID -lenalidomide cap 0 mg... 5 REVLIMID -lenalidomide cap 5 mg... 5 REVLIMID -lenalidomide cap 0 mg... 5 REVLIMID -lenalidomide cap 5 mg... 5 REVLIMID -lenalidomide caps.5 mg...4 REXALL LANCETS ULTRA THIN REYATAZ -atazanavir sulfate cap 50 mg (base equiv)...6 REYATAZ -atazanavir sulfate cap 00 mg (base equiv)...6 REYATAZ -atazanavir sulfate cap 300 mg (base equiv)...6 REYATAZ -atazanavir sulfate oral powder packet 50 mg (base equiv)... 6 RIBATAB -ribavirin tab 400 mg... 6 RIBATAB -ribavirin tab 600 mg... 6 RIBATAB -ribavirin tab 400 mg & ribavirin tab 600 mg dose pack... 6 ribavirin cap 00 mg (Rebetol)... 6 ribavirin tab 00 mg (Copegus)...6 rifabutin cap 50 mg (Mycobutin)... 3 RIFAMATE -isoniazid & rifampin cap mg...3 rifampin cap 50 mg (Rifadin)... 3 rifampin cap 300 mg (Rifadin)... 3 RIGHTEST GD500 LANCING DE -lancet devices RIGHTEST GL300 LANCETS riluzole tab 50 mg (Rilutek)...56 rimantadine hydrochloride tab 00 mg (Flumadine)...6 ringer's solution for irrigation... 5 risedronate sodium tab delayed release 35 mg (Atelvia)... risedronate sodium tab 5 mg (Actonel)... risedronate sodium tab 30 mg (Actonel)... risedronate sodium tab 35 mg (Actonel)... risedronate sodium tab 50 mg (Actonel)... risperidone orally disintegrating tab 0.5 mg risperidone orally disintegrating tab 0.5 mg (Risperdal m-tab) risperidone orally disintegrating tab mg (Risperdal m-tab) risperidone orally disintegrating tab mg (Risperdal m-tab) risperidone orally disintegrating tab 3 mg (Risperdal m-tab) risperidone orally disintegrating tab 4 mg (Risperdal m-tab) risperidone soln mg/ml (Risperdal) risperidone tab 0.5 mg (Risperdal) risperidone tab 0.5 mg (Risperdal) risperidone tab mg (Risperdal) risperidone tab mg (Risperdal) risperidone tab 3 mg (Risperdal) risperidone tab 4 mg (Risperdal) rivastigmine tartrate cap.5 mg (Exelon) rivastigmine tartrate cap 3 mg (Exelon) rivastigmine tartrate cap 4.5 mg (Exelon) rivastigmine tartrate cap 6 mg (Exelon) RIXUBIS -coagulation factor ix (recombinant) for inj 50 unit...68 RIXUBIS -coagulation factor ix (recombinant) for inj 500 unit...68 RIXUBIS -coagulation factor ix (recombinant) for inj 000 unit...68 RIXUBIS -coagulation factor ix (recombinant) for inj 000 unit...68 RIXUBIS -coagulation factor ix (recombinant) for inj 3000 unit...68 rizatriptan benzoate orally disintegrating tab 5 mg (Maxalt-mlt) Guia de medicinas ValueScript de Florida Blue para enero de 06

180 06 rizatriptan benzoate orally disintegrating tab 0 mg (Maxalt-mlt)...5 rizatriptan benzoate tab 5 mg (Maxalt)... 5 rizatriptan benzoate tab 0 mg (Maxalt)... 5 R-NATAL OB -prenatal w/o a w/fe cbn-fa-dha cap mg... 6 ropinirole hydrochloride tab 0.5 mg (Requip)...56 ropinirole hydrochloride tab 0.5 mg (Requip)...56 ropinirole hydrochloride tab mg (Requip)...56 ropinirole hydrochloride tab mg (Requip)...56 ropinirole hydrochloride tab 3 mg (Requip)...56 ropinirole hydrochloride tab 4 mg (Requip)...56 ropinirole hydrochloride tab 5 mg (Requip)...56 ropinirole hydrochloride tab sr 4hr mg (base equivalent) (Requip xl)...56 ropinirole hydrochloride tab sr 4hr 4 mg (base equivalent) (Requip xl)...56 ropinirole hydrochloride tab sr 4hr 6 mg (base equivalent) (Requip xl)...56 ropinirole hydrochloride tab sr 4hr 8 mg (base equivalent) (Requip xl)...56 ropinirole hydrochloride tab sr 4hr mg (base equivalent) (Requip xl)...56 ROXICET -oxycodone w/ acetaminophen soln 5-35 mg/5ml...50 ROZEREM -ramelteon tab 8 mg S SABRIL -vigabatrin tab 500 mg SAFESNA ALLERGY SYRINGE/ -tuberculin/allergy syringe/needle (disp) ml 7 x /" SAFESNA INSULIN SYRINGE/ -insulin syringe/needle u-00 / ml 9 x /" SAFESNA INSULIN SYRINGE/ -insulin syringe/needle u-00 / ml SAFESNA INSULIN SYRINGE/ -insulin syringe/needle u ml SAFESNA INSULIN SYRINGE/ -insulin syringe/needle u-00 ml 8 x /" SAFESNA INSULIN SYRINGE/ -insulin syringe/needle u-00 ml 9 x /" SAFESNA TUBERCULIN SYRIN -tuberculin/allergy syringe/needle (disp) ml 5 x 5/8" SAFESNA TUBERCULIN SYRIN -tuberculin/allergy syringe/needle (disp) ml 7 x /" SAFE-T-LANCE LOW FLOW 5G SAFE-T-LANCE NORMAL FLOW SAFE-T-LANCE LUS SAFETY SAFETY-GLIDE INSULIN SYRI -insulin syringe/needle u ml 9 x /" SAFETY LANCET G/RESSUR SAFETY LANCET 8G/RESSUR SAFETY LANCET MM SAFETY LANCETS G SAFETY LANCETS 8G SAFETY LANCETS SAFETY LET LANCETS SAFETY-LOK SAFETY SYRINGE -tuberculin/allergy syringe/needle (disp) ml 5 x 5/8" SAFETY-LOK TB SYRINGE ER -tuberculin/allergy syringe/needle (disp) ml 7 x /" SAFETY SEAL LANCETS 8G SAFETY SEAL LANCETS 30G salicylic acid cream 6%...74 salicylic acid film forming liquid 7.5% (Virasal) salicylic acid film-forming soln 8.5% (Ultrasaler)...74 salicylic acid foam 6% (Salvax)...74 salicylic acid gel 6% (Keralyt) salicylic acid lotion 6%...74 salicylic acid shampoo 6% (Salex) salsalate tab 500 mg (Disalcid) salsalate tab 750 mg (Disalcid) SAMSCA -tolvaptan tab 5 mg... SAMSCA -tolvaptan tab 30 mg... SAHRIS -asenapine maleate sl tab.5 mg (base equiv)...43 SAHRIS -asenapine maleate sl tab 5 mg (base equiv)...43 SAHRIS -asenapine maleate sl tab 0 mg (base equiv)...43 SASCARE TWIST TO LANCET SAVELLA -milnacipran hcl tab.5 mg SAVELLA -milnacipran hcl tab 5 mg SAVELLA -milnacipran hcl tab 50 mg SAVELLA -milnacipran hcl tab 00 mg SAVELLA TITRATION ACK -milnacipran hcl tab.5 mg (5) & 5 mg (8) & 50 mg (4) pak SB INSULIN SYRINGE/U-00/ -insulin syringe/needle u-00 / ml 9 x /" SB INSULIN SYRINGE/U-00/ -insulin syringe/needle u-00 / ml SB INSULIN SYRINGE/U-00/ -insulin syringe/needle u-00 ml 9 x /" SB INSULIN SYRINGE/U-00/ -insulin syringe/needle u-00 ml SB INSULIN SYRINGE/U-00/ -insulin syringe/needle u-00 ml SB LANCETS THIN SB LANCETS ULTRA THIN SCHNUCKS INSULIN SYRINGE -insulin syringe/needle u-00 / ml 9 x /" SCHNUCKS INSULIN SYRINGE -insulin syringe/needle u-00 / ml SELECT-LITE LANCING DEVIC -lancet devices Guia de medicinas ValueScript de Florida Blue para enero de 06 69

181 06 SELECT-OB+DHA -prenatal mv w/fe poly-fa chw 9- mg & dha cap 50 mg pak...6 SELECT-OB -prenatal vit w/ fe polysac cmplx-fa chew tab 9- mg...6 SELECT-OB -prenat w/ fepolycmplx-methylfol-fa chew tab mg... 6 selegiline hcl cap 5 mg (Eldepryl)...56 selegiline hcl tab 5 mg selenium sulfide lotion.5%...74 selenium sulfide-pyrithione zinc in urea shampoo.5% SELZENTRY -maraviroc tab 50 mg... 6 SELZENTRY -maraviroc tab 300 mg... 6 SE-NATAL 9 -prenatal vit w/ dss-fe fumarate-fa tab 9- mg... 6 SE-NATAL 9 -prenatal vit w/ fe fumarate-fa chew tab 9- mg...6 SENSIAR -cinacalcet hcl tab 30 mg (base equiv)... SENSIAR -cinacalcet hcl tab 60 mg (base equiv)... SENSIAR -cinacalcet hcl tab 90 mg (base equiv)... SEREVENT DISKUS -salmeterol xinafoate aer pow ba 50 mcg/dose (base equiv)...34 SEROQUEL XR -quetiapine fumarate tab sr 4hr 50 mg SEROQUEL XR -quetiapine fumarate tab sr 4hr 50 mg SEROQUEL XR -quetiapine fumarate tab sr 4hr 00 mg SEROQUEL XR -quetiapine fumarate tab sr 4hr 300 mg SEROQUEL XR -quetiapine fumarate tab sr 4hr 400 mg sertraline hcl oral conc 0 mg/ml (Zoloft)... 4 sertraline hcl tab 5 mg (Zoloft)...4 sertraline hcl tab 50 mg (Zoloft)...4 sertraline hcl tab 00 mg (Zoloft)...4 SE-TAN DHA -prenatal w/fe fum-fe poly -fa-omega 3 cap 5-5- mg... 6 SETON ET-EC -prenat-fe bis-fe prot succ-fa-ca tab & omega cap dr 430 pk... 6 SETONET -prenat-fe bis-fe prot succ-fa-ca tab & omega 3 cap 430 pk...6 SHOKO AUTOLET LANCING DE -lancet devices SHOKO ON-THE-GO COMFORT SHOKO UNIFINE ENTIS E -insulin pen needle 9 g x mm (/")...04 SHOKO UNIFINE ENTIS E -insulin pen needle 3 g x 5 mm (3/6")...04 SHOKO UNIFINE ENTIS E -insulin pen needle 3 g x 4 mm (5/3")...04 SHOKO UNIFINE ENTIS E -insulin pen needle 3 g x 8 mm (/3" or 5/6")...04 SHOKO UNILET LANCETS SU SHOKO UNILET LANCETS ULT SHUR-SEAL -nonoxynol-9 gel % sildenafil citrate tab 0 mg (Revatio)...3 silver nitrate-potassium nitrate applicator 75-5% (Arzol silver nitrate) silver sulfadiazine cream % (Silvadene)...75 SIMBRINZA -brinzolamide-brimonidine tartrate ophth susp -0.%...70 SIMLE DIAGNOSTICS LANCIN -lancet devices SIMONI -golimumab subcutaneous soln auto-injector 50 mg/0.5ml... 5 SIMONI -golimumab subcutaneous soln auto-injector 00 mg/ml...5 SIMONI -golimumab subcutaneous soln prefilled syringe 50 mg/0.5ml... 5 SIMONI -golimumab subcutaneous soln prefilled syringe 00 mg/ml... 5 simvastatin tab 5 mg (Zocor)...3 simvastatin tab 0 mg (Zocor)...3 simvastatin tab 0 mg (Zocor)...3 simvastatin tab 40 mg (Zocor)...3 simvastatin tab 80 mg (Zocor)...3 SINGLE-LET sirolimus tab 0.5 mg (Rapamune)... 5 sirolimus tab mg (Rapamune)... 5 sirolimus tab mg (Rapamune)... 5 SIRTURO -bedaquiline fumarate tab 00 mg (base equiv)...3 SIVEXTRO -tedizolid phosphate tab 00 mg... 7 SKLICE -ivermectin lotion 0.5%...75 SMART DIABETES VANTAGE LA -lancet devices SMART DIABETES VANTAGE UN SMARTEST LANCETS 8G SMART SENSE COLOR LANCETS SMART SENSE STANDARD LANC SMART SENSE SUER THIN LA SMART SENSE THIN LANCETS SM INSULIN SYRINGE/0.5ML/ -insulin syringe/needle u-00 / ml SM INSULIN SYRINGE/0.3ML/ -insulin syringe/needle u ml SM INSULIN SYRINGE/ML/3 -insulin syringe/needle u-00 ml SM INSULIN SYRINGE/U-00/ -insulin syringe/needle u-00 / ml 8 x /" SM INSULIN SYRINGE/U-00/ -insulin syringe/needle u-00 / ml 9 x /" SM INSULIN SYRINGE/U-00/ -insulin syringe/needle u-00 / ml SM INSULIN SYRINGE/U-00/ -insulin syringe/needle u ml 9 x /" Guia de medicinas ValueScript de Florida Blue para enero de 06

182 06 SM INSULIN SYRINGE/U-00/ -insulin syringe/needle u ml SM INSULIN SYRINGE/U-00/ -insulin syringe/needle u-00 ml 8 x /" SM INSULIN SYRINGE/U-00/ -insulin syringe/needle u-00 ml 9 x /" SM INSULIN SYRINGE/U-00/ -insulin syringe/needle u-00 ml SM LANCETS G SM MICRO THIN LANCETS 33G SM SUER THIN LANCETS 30G SM THIN LANCETS 6G SM ULTRA COMFORT INSULIN -insulin syringe/needle u-00 ml sodium chloride irrigation soln 0.9%...39 sodium chloride soln nebu 0.9%...33 sodium chloride soln nebu 3%...33 sodium chloride soln nebu 0%...33 sodium chloride soln nebu 7% (Hypersal) sodium citrate & citric acid soln mg/5ml (Shohls solution modi) sodium fluoride chew tab 0.5 mg f (from 0.55 mg naf) (Luride)...64 sodium fluoride chew tab 0.5 mg f (from. mg naf) (Luride)...64 sodium fluoride chew tab mg f (from. mg naf) (Luride)...64 SODIUM FLUORIDE -sodium fluoride tab mg f (from. mg naf)...64 sodium fluoride soln 0.5 mg/drop f (0.75 mg/drop naf)...64 sodium fluoride soln 0.5 mg/ml f (from. mg/ml naf) (Luride)...64 sodium phenylbutyrate oral powder 3 gm/teaspoonful (Buphenyl)... sodium polystyrene sulfonate oral susp 5 gm/60ml (Sps)... 5 sodium polystyrene sulfonate powder (Kayexalate)...5 sodium polystyrene sulfonate rectal susp 30 gm/0ml...5 SOLUS V LANCING DEVICE -lancet devices SOLUS V RESSURE ACTIVAT SOLUS V TWIST LANCETS SOMAVERT -pegvisomant for inj 0 mg (as protein)... SOMAVERT -pegvisomant for inj 5 mg (as protein)... SOMAVERT -pegvisomant for inj 0 mg (as protein)... SOMAVERT -pegvisomant for inj 5 mg (as protein)... SOMAVERT -pegvisomant for inj 30 mg (as protein)... sotalol hcl (afib/afl) tab 80 mg (Betapace af)... 4 sotalol hcl (afib/afl) tab 0 mg (Betapace af)... 4 sotalol hcl (afib/afl) tab 60 mg (Betapace af)... 4 sotalol hcl tab 40 mg...4 sotalol hcl tab 80 mg (Betapace)... 4 sotalol hcl tab 0 mg (Betapace)...4 sotalol hcl tab 60 mg (Betapace)...4 SOVALDI -sofosbuvir tab 400 mg... 6 SECTRACEF -cefditoren pivoxil tab 00 mg (base equivalent)... SECTRACEF -cefditoren pivoxil tab 400 mg (base equivalent)... SIRIVA HANDIHALER -tiotropium bromide monohydrate inhal cap 8 mcg (base equiv)...34 SIRIVA RESIMAT -tiotropium bromide monohydrate inhal aerosol.5 mcg/act spironolactone & hydrochlorothiazide tab 5-5 mg (Aldactazide)...30 spironolactone tab 5 mg (Aldactone) spironolactone tab 50 mg (Aldactone) spironolactone tab 00 mg (Aldactone) SORANOX -itraconazole oral soln 0 mg/ml... 4 SRYCEL -dasatinib tab 0 mg... 4 SRYCEL -dasatinib tab 50 mg... 4 SRYCEL -dasatinib tab 70 mg... 4 SRYCEL -dasatinib tab 80 mg... 4 SRYCEL -dasatinib tab 00 mg... 4 SRYCEL -dasatinib tab 40 mg... 4 stavudine cap 5 mg (Zerit)... 6 stavudine cap 0 mg (Zerit)... 6 stavudine cap 30 mg (Zerit)... 6 stavudine cap 40 mg (Zerit)... 6 stavudine for oral soln mg/ml (Zerit)... 6 ST CHOICE LANCETS SUER ST CHOICE LANCETS THIN ST CHOICE LANCETS ULTRA ST CHOICE EN NEEDLES 3 -insulin pen needle 3 g x 6 mm (/4")...4 ST CHOICE EN NEEDLES 3 -insulin pen needle 3 g x 8 mm (/3" or 5/6")...4 STELARA -ustekinumab soln prefilled syringe 45 mg/0.5ml STELARA -ustekinumab soln prefilled syringe 90 mg/ ml...75 STERILANCE TL STIMATE -desmopressin acetate nasal soln.5 mg/ ml... STIVARGA -regorafenib tab 40 mg... 4 STRATTERA -atomoxetine hcl cap 0 mg (base equiv)...46 STRATTERA -atomoxetine hcl cap 8 mg (base equiv)...46 STRATTERA -atomoxetine hcl cap 5 mg (base equiv)...46 Guia de medicinas ValueScript de Florida Blue para enero de 06 7

183 06 STRATTERA -atomoxetine hcl cap 40 mg (base equiv)...46 STRATTERA -atomoxetine hcl cap 60 mg (base equiv)...46 STRATTERA -atomoxetine hcl cap 80 mg (base equiv)...46 STRATTERA -atomoxetine hcl cap 00 mg (base equiv)...46 STRIBILD -elvitegrav-cobicis-emtricitab-tenofov tab mg...6 STROMECTOL -ivermectin tab 3 mg... 7 ST TIER UNIFINE ENTIS -insulin pen needle 9 g x mm (/")...4 ST TIER UNIFINE ENTIS -insulin pen needle 3 g x 5 mm (3/6")... 4 ST TIER UNIFINE ENTIS -insulin pen needle 3 g x 6 mm (/4")... 4 ST TIER UNIFINE ENTIS -insulin pen needle 3 g x 4 mm (5/3")... 4 ST TIER UNIFINE ENTIS -insulin pen needle 3 g x 8 mm (/3" or 5/6")...4 ST TIER UNILET COMFORTOU SUBOXONE -buprenorphine hcl-naloxone hcl sl film -0.5 mg (base equiv)...50 SUBOXONE -buprenorphine hcl-naloxone hcl sl film 4- mg (base equiv)...50 SUBOXONE -buprenorphine hcl-naloxone hcl sl film 8- mg (base equiv)...50 SUBOXONE -buprenorphine hcl-naloxone hcl sl film -3 mg (base equiv)...50 sucralfate tab gm (Carafate) sulfacetamide sodium cleansing gel 0% (Ovace plus wash) sulfacetamide sodium liquid 0% (Ovace wash) sulfacetamide sodium lotion 0% (acne) (Klaron) sulfacetamide sodium ophth soln 0% (Bleph-0)...70 sulfacetamide sodium-prednisolone ophth soln 0-0.3(0.5)% sulfacetamide sodium shampoo 0% (Ovace plus)...75 sulfacetamide sodium w/ sulfur cleanser 0-% (Avar ls cleanser)...75 sulfacetamide sodium w/ sulfur cleanser % (lexion cleanser)...75 sulfacetamide sodium w/ sulfur cream 0-5%...75 sulfacetamide sodium w/ sulfur cream 0-% (Avar-e ls) sulfacetamide sodium w/ sulfur cream % (lexion) sulfacetamide sodium w/ sulfur emulsion 0-%...75 sulfacetamide sodium w/ sulfur emulsion 0-5%...75 sulfacetamide sodium w/ sulfur foam 0-5% (Clarifoam ef) sulfacetamide sodium w/ sulfur lotion 0-5%...75 sulfacetamide sodium w/ sulfur lotion % (lexion) sulfacetamide sodium w/ sulfur susp 8-4% (Sumaxin ts) sulfacetamide sodium w/ sulfur wash 9-4.5% (Sumadan wash) sulfacetamide sodium w/ sulfur wash 9-4% (Sumaxin wash) SULFADIAZINE -sulfadiazine tab 500 mg...3 sulfamethoxazole-trimethoprim susp mg/5ml...7 sulfamethoxazole-trimethoprim tab mg (Bactrim)... 7 sulfamethoxazole-trimethoprim tab mg (Bactrim ds)...8 sulfasalazine tab delayed release 500 mg (Azulfidine en-tabs) sulfasalazine tab 500 mg (Azulfidine)...37 sulindac tab 50 mg... 5 sulindac tab 00 mg... 5 sumatriptan succinate inj 6 mg/0.5ml (Imitrex) sumatriptan succinate solution auto-injector 4 mg/0.5ml (Imitrex statdose sys) sumatriptan succinate solution auto-injector 6 mg/0.5ml (Imitrex statdose sys) sumatriptan succinate solution cartridge 4 mg/0.5ml (Imitrex statdose ref)...53 sumatriptan succinate solution cartridge 6 mg/0.5ml (Imitrex statdose ref)...53 SUMATRITAN SUINATE -sumatriptan succinate inj 4 mg/0.5ml... 5 sumatriptan succinate tab 5 mg (Imitrex) sumatriptan succinate tab 50 mg (Imitrex) sumatriptan succinate tab 00 mg (Imitrex) SUER THIN LANCETS SURAX -cefixime chew tab 00 mg... SURAX -cefixime chew tab 00 mg... SURAX -cefixime for susp 00 mg/5ml... SURAX -cefixime for susp 00 mg/5ml... SURAX -cefixime for susp 500 mg/5ml... SURE BOWEL RE -sodium sulfate-potassium sulfate-magnesium sulfate oral soln SURE COMFORT INSULIN SYRI -insulin syringe/needle u-00 / ml SURE COMFORT INSULIN SYRI -insulin syringe/needle u-00 / ml 8 x /" SURE COMFORT INSULIN SYRI -insulin syringe/needle u-00 / ml 9 x /" SURE COMFORT INSULIN SYRI -insulin syringe/needle u-00 / ml Guia de medicinas ValueScript de Florida Blue para enero de 06

184 06 SURE COMFORT INSULIN SYRI -insulin syringe/needle u-00 / ml 30 x /" SURE COMFORT INSULIN SYRI -insulin syringe/needle u ml 9 x /" SURE COMFORT INSULIN SYRI -insulin syringe/needle u ml SURE COMFORT INSULIN SYRI -insulin syringe/needle u ml 30 x /" SURE COMFORT INSULIN SYRI -insulin syringe/needle u-00 ml 8 x /" SURE COMFORT INSULIN SYRI -insulin syringe/needle u-00 ml 9 x /" SURE COMFORT INSULIN SYRI -insulin syringe/needle u-00 ml SURE COMFORT INSULIN SYRI -insulin syringe/needle u-00 ml 30 x /" SURE COMFORT INSULIN SYRI -insulin syringe/needle u-00 ml SURE COMFORT INSULIN SYRI -insulin syringe/needle u ml SURE COMFORT LANCETS 8G SURE COMFORT LANCETS 30G SURE COMFORT LANCING EN -lancet devices SURE COMFORT EN NEEDLES -insulin pen needle 9 g x.7 mm SURE COMFORT EN NEEDLES -insulin pen needle 3 g x 5 mm (3/6") SURE COMFORT EN NEEDLES -insulin pen needle 3 g x 4 mm (5/3") SURE COMFORT EN NEEDLES -insulin pen needle 3 g x 6 mm (/4") SURE COMFORT EN NEEDLES -insulin pen needle 30 g x 8 mm (/3" or 5/6") SURE COMFORT EN NEEDLES -insulin pen needle 3 g x 8 mm (/3" or 5/6") SURE-FINE EN NEEDLES 9G -insulin pen needle 9 g x.7 mm...05 SURE-FINE EN NEEDLES 3G -insulin pen needle 3 g x 5 mm (3/6")...05 SURE-FINE EN NEEDLES 3G -insulin pen needle 3 g x 8 mm (/3" or 5/6")...05 SURE-JECT INSULIN SYRINGE -insulin syringe/needle u-00 / ml SURE-JECT INSULIN SYRINGE -insulin syringe/needle u-00 / ml 8 x /" SURE-JECT INSULIN SYRINGE -insulin syringe/needle u-00 / ml 9 x /" SURE-JECT INSULIN SYRINGE -insulin syringe/needle u-00 / ml SURE-JECT INSULIN SYRINGE -insulin syringe/needle u ml 9 x /" SURE-JECT INSULIN SYRINGE -insulin syringe/needle u ml SURE-JECT INSULIN SYRINGE -insulin syringe/needle u-00 ml 8 x /" SURE-JECT INSULIN SYRINGE -insulin syringe/needle u-00 ml 9 x /" SURE-JECT INSULIN SYRINGE -insulin syringe/needle u-00 ml SURE-JECT INSULIN SYRINGE -insulin syringe/needle u-00 ml SURE-JECT INSULIN SYRINGE -insulin syringe/needle u ml SURE-LANCE FLAT LANCETS SURE-LANCE LANCETS 6G SURE-LANCE THIN LANCETS SURE-LANCE ULTRA THIN LAN SURELITE LANCETS SURE-EN -lancet devices SURE-TOUCH LANCETS UNIVER SUSTIVA -efavirenz cap 50 mg...6 SUSTIVA -efavirenz cap 00 mg...6 SUSTIVA -efavirenz tab 600 mg... 6 SUTENT -sunitinib malate cap.5 mg (base equivalent)...4 SUTENT -sunitinib malate cap 5 mg (base equivalent)...4 SUTENT -sunitinib malate cap 37.5 mg (base equivalent)...4 SUTENT -sunitinib malate cap 50 mg (base equivalent)...4 SYLATRON -peginterferon alfa-b for inj kit 00 mcg...4 SYLATRON -peginterferon alfa-b for inj kit 300 mcg...4 SYLATRON -peginterferon alfa-b for inj kit 600 mcg...4 SYLATRON -peginterferon alfa-b for inj kit 4 x 00 mcg...4 SYLATRON -peginterferon alfa-b for inj kit 4 x 300 mcg...4 SYMAX DUOTAB -hyoscyamine sulfate tab cr mg (0.5 mg ir/0.5 mg cr) SYMBICORT -budesonide-formoterol fumarate dihyd aerosol mcg/act...34 SYMBICORT -budesonide-formoterol fumarate dihyd aerosol mcg/act...34 SYMLINEN 0 -pramlintide acetate pen-inj 700 mcg/.7ml (000 mcg/ml)...9 SYMLINEN 60 -pramlintide acetate pen-inj 500 mcg/.5ml (000 mcg/ml)...9 SYNAREL -nafarelin acetate nasal soln mg/ ml... SYNTHROID -levothyroxine sodium tab 5 mcg... SYNTHROID -levothyroxine sodium tab 50 mcg... SYNTHROID -levothyroxine sodium tab 75 mcg... SYNTHROID -levothyroxine sodium tab 88 mcg... Guia de medicinas ValueScript de Florida Blue para enero de 06 73

185 06 SYNTHROID -levothyroxine sodium tab 00 mcg... SYNTHROID -levothyroxine sodium tab mcg... SYNTHROID -levothyroxine sodium tab 5 mcg... SYNTHROID -levothyroxine sodium tab 37 mcg... SYNTHROID -levothyroxine sodium tab 50 mcg... SYNTHROID -levothyroxine sodium tab 75 mcg... SYNTHROID -levothyroxine sodium tab 00 mcg... SYNTHROID -levothyroxine sodium tab 300 mcg... SYRINE -trientine hcl cap 50 mg... 5 T TABLOID -thioguanine tab 40 mg... 4 tacrolimus cap 0.5 mg (rograf)...5 tacrolimus cap mg (rograf)...5 tacrolimus cap 5 mg (rograf)...5 tacrolimus oint 0.03% (rotopic)...75 tacrolimus oint 0.% (rotopic)...75 TAFINLAR -dabrafenib mesylate cap 50 mg (base equivalent)...4 TAFINLAR -dabrafenib mesylate cap 75 mg (base equivalent)...4 TAMIFLU -oseltamivir phosphate cap 30 mg (base equiv)...6 TAMIFLU -oseltamivir phosphate cap 45 mg (base equiv)...6 TAMIFLU -oseltamivir phosphate cap 75 mg (base equiv)...6 TAMIFLU -oseltamivir phosphate for susp 6 mg/ml (base equiv)...6 tamoxifen citrate tab 0 mg (base equivalent)... 4 tamoxifen citrate tab 0 mg (base equivalent)... 4 tamsulosin hcl cap 0.4 mg (Flomax)...39 TARCEVA -erlotinib hcl tab 5 mg (base equivalent)...4 TARCEVA -erlotinib hcl tab 00 mg (base equivalent)...4 TARCEVA -erlotinib hcl tab 50 mg (base equivalent)...4 TARGRETIN -bexarotene cap 75 mg...4 TARON-BC -prenat w/o a w/ fe cbnyl-fa tab 0- mg & vit b6 tab pak...6 TARON-C DHA -prenatal w/fe fum-fe poly -fa-omega 3 cap mg... 6 TARON-DUO EC -prenat-fe bis-fe prot succ-fa-ca tab & omega cap dr 400 pk... 6 TARON-REX -prenatal w/o vit a w/ fe fum-dss-fa-dha cap mg... 6 TASIGNA -nilotinib hcl cap 50 mg (base equivalent)...4 TASIGNA -nilotinib hcl cap 00 mg (base equivalent)...4 TASMAR -tolcapone tab 00 mg...56 TAZORAC -tazarotene cream 0.05% TAZORAC -tazarotene cream 0.% TAZORAC -tazarotene gel 0.05% TAZORAC -tazarotene gel 0.% TECFIDERA -dimethyl fumarate capsule delayed release 0 mg...48 TECFIDERA -dimethyl fumarate capsule delayed release 40 mg...48 TECFIDERA STARTER ACK -dimethyl fumarate capsule dr starter pack 0 mg & 40 mg TECHLITE AST LANCETS TECHLITE LANCETS 30G TECHLITE LANCETS telmisartan-amlodipine tab 40-5 mg (Twynsta)... 9 telmisartan-amlodipine tab 80-5 mg (Twynsta)... 9 telmisartan-amlodipine tab 40-0 mg (Twynsta)... 9 telmisartan-amlodipine tab 80-0 mg (Twynsta)... 9 telmisartan-hydrochlorothiazide tab mg (Micardis hct)... 9 telmisartan-hydrochlorothiazide tab mg (Micardis hct)... 9 telmisartan-hydrochlorothiazide tab 80-5 mg (Micardis hct)... 9 telmisartan tab 0 mg (Micardis)...9 telmisartan tab 40 mg (Micardis)...9 telmisartan tab 80 mg (Micardis)...9 temazepam cap 7.5 mg (Restoril)...44 temazepam cap 5 mg (Restoril)...44 temazepam cap.5 mg (Restoril)...44 temazepam cap 30 mg (Restoril)...44 TEMODAR -temozolomide cap 5 mg... 4 TEMODAR -temozolomide cap 0 mg... 4 TEMODAR -temozolomide cap 00 mg... 4 TEMODAR -temozolomide cap 40 mg... 4 TEMODAR -temozolomide cap 80 mg... 4 TEMODAR -temozolomide cap 50 mg... 4 temozolomide cap 5 mg (Temodar)... 4 temozolomide cap 0 mg (Temodar)... 4 temozolomide cap 00 mg (Temodar)... 4 temozolomide cap 40 mg (Temodar)... 4 temozolomide cap 80 mg (Temodar)... 4 temozolomide cap 50 mg (Temodar)... 4 TENIVAC -tetanus-diphtheria toxoids (td) inj 5- lfu... terazosin hcl cap mg...9 terazosin hcl cap mg...9 terazosin hcl cap 5 mg...9 terazosin hcl cap 0 mg Guia de medicinas ValueScript de Florida Blue para enero de 06

186 06 terbinafine hcl tab 50 mg (Lamisil)... 4 terbutaline sulfate tab.5 mg...34 terbutaline sulfate tab 5 mg...34 terconazole vaginal cream 0.4% (Terazol 7) terconazole vaginal cream 0.8% (Terazol 3) terconazole vaginal suppos 80 mg TERUMO ALLERGY SYRINGE M -tuberculin/allergy syringe/needle (disp) ml 7 x /" TERUMO INSULIN SYRINGE/0. -insulin syringe/needle u-00 / ml 30 x 3/8" TERUMO INSULIN SYRINGE/0. -insulin syringe/needle u-00 / ml 9 x /" TERUMO INSULIN SYRINGE/M -insulin syringe/needle u-00 ml 7 x /" TERUMO INSULIN SYRINGE/M -insulin syringe/needle u-00 ml 9 x /" TERUMO INSULIN SYRINGE/U- -insulin syringe/needle u-00 / ml 7 x /" TERUMO INSULIN SYRINGE/U- -insulin syringe/needle u-00 / ml 8 x /" TERUMO INSULIN SYRINGE/U- -insulin syringe/needle u ml 9 x /" TERUMO INSULIN SYRINGE/U- -insulin syringe/needle u-00 ml 8 x /" TERUMO SURGUARD INSULIN S -insulin syringe/needle u-00 / ml 8 x /" TERUMO SURGUARD INSULIN S -insulin syringe/needle u-00 / ml 9 x /" TERUMO SURGUARD INSULIN S -insulin syringe/needle u ml 9 x /" TERUMO SURGUARD INSULIN S -insulin syringe/needle u-00 ml 8 x /" TERUMO SURGUARD INSULIN S -insulin syringe/needle u-00 ml 9 x /" testosterone cypionate im inj in oil 00 mg/ml (Depotestosterone)... 6 testosterone cypionate im inj in oil 00 mg/ml (Depotestosterone)... 6 testosterone enanthate im inj in oil 00 mg/ ml... 6 TETANUS/DIHTHERIA TOXOID -tetanus-diphtheria toxoids (td) inj - lf/0.5ml... tetracaine hcl ophth soln 0.5%...70 TETRACYCLINE HCL -tetracycline hcl cap 50 mg...3 TETRACYCLINE HCL -tetracycline hcl cap 500 mg...3 TGT ADVANCED LANCING DEVI -lancet devices TGT LANCET ALTERNATE SITE TGT LANCET MICRO THIN 33G TGT LANCET SUER THIN 30G TGT LANCET THIN 3G TGT LANCET THIN 6G TGT LANCET ULTRA THIN 8G TGT LANCET ULTRA THIN 30G TGT LANCING DEVICE -lancet devices THALOMID -thalidomide cap 50 mg...5 THALOMID -thalidomide cap 00 mg...5 THALOMID -thalidomide cap 50 mg...5 THALOMID -thalidomide cap 00 mg...5 theophylline soln 80 mg/5ml...34 theophylline tab sr hr 00 mg theophylline tab sr hr 00 mg theophylline tab sr hr 300 mg theophylline tab sr hr 450 mg theophylline tab sr 4hr 400 mg theophylline tab sr 4hr 600 mg THINLETS G LANCETS THINLETS LANCET THINRO INSULIN SYRINGE/0 -insulin syringe/needle u-00 / ml 30 x 3/8" THINRO INSULIN SYRINGE/0 -insulin syringe/needle u-00 / ml 8 x /" THINRO INSULIN SYRINGE/0 -insulin syringe/needle u-00 / ml 9 x /" THINRO INSULIN SYRINGE/0 -insulin syringe/needle u ml 9 x /" THINRO INSULIN SYRINGE/ -insulin syringe/needle u-00 ml 8 x /" THINRO INSULIN SYRINGE/ -insulin syringe/needle u-00 ml 9 x /" thioridazine hcl tab 0 mg thioridazine hcl tab 5 mg thioridazine hcl tab 50 mg thioridazine hcl tab 00 mg thiothixene cap mg thiothixene cap mg thiothixene cap 5 mg thiothixene cap 0 mg THRIVITE 9 -prenatal vit w/ dss-fe fumarate-fa tab 9- mg... 6 THYROLAR-/ -liotrix (t3-t4) tab 30 mg (6.5-5 mcg)... THYROLAR-/4 -liotrix (t3-t4) tab 5 mg (3.-.5 mcg)... THYROLAR- -liotrix (t3-t4) tab 60 mg (.5-50 mcg)... THYROLAR- -liotrix (t3-t4) tab 0 mg (5-00 mcg)... THYROLAR-3 -liotrix (t3-t4) tab 80 mg ( mcg)... tiagabine hcl tab mg (Gabitril)...55 tiagabine hcl tab 4 mg (Gabitril)...55 TIKOSYN -dofetilide cap 5 mcg (0.5 mg)... 6 TIKOSYN -dofetilide cap 50 mcg (0.5 mg)... 6 TIKOSYN -dofetilide cap 500 mcg (0.5 mg)... 6 timolol maleate ophth gel forming soln 0.5% (Timoptic-xe) timolol maleate ophth gel forming soln 0.5% (Timopticxe) Guia de medicinas ValueScript de Florida Blue para enero de 06 75

187 06 timolol maleate ophth soln 0.5% (Timoptic)...70 timolol maleate ophth soln 0.5% (Timoptic)...70 TIMOLOL MALEATE -timolol maleate tab 5 mg... 4 TIMOLOL MALEATE -timolol maleate tab 0 mg... 4 TIMOLOL MALEATE -timolol maleate tab 0 mg... 4 tinidazole tab 50 mg (Tindamax)... 8 tinidazole tab 500 mg (Tindamax)... 8 TIVICAY -dolutegravir sodium tab 50 mg (base equiv)...6 tizanidine hcl cap mg (Zanaflex) tizanidine hcl cap 4 mg (Zanaflex) tizanidine hcl cap 6 mg (Zanaflex) tizanidine hcl tab mg...56 tizanidine hcl tab 4 mg (Zanaflex)...56 TL-CARE DHA -prenatal w/fe fumarate-fa-dss-fish oil cap mg... 6 TL FOLATE -prenatal vit w/ fe fum-methylfolate-fa tab mg... 6 TL-SELECT DHA -prenatal w/o vit a w/ fe fum-doc-fa-dha cap mg... 6 TL-SELECT -prenatal w/o vit a w/ fe fum-dss-fa-dha cap mg... 6 TOBI ODHALER -tobramycin inhal cap 8 mg...3 TOBRADEX -tobramycin-dexamethasone ophth oint %...70 tobramycin-dexamethasone ophth susp % (Tobradex)...70 tobramycin nebu soln 300 mg/5ml (Tobi)...3 tobramycin ophth soln 0.3% (Tobrex) TODAYS HEALTH ADVANCED LA -lancet devices TODAYS HEALTH MINI EN NE -insulin pen needle 3 g x 6 mm (/4")...07 TODAYS HEALTH ORIGINAL E -insulin pen needle 9 g x mm (/")...07 TODAYS HEALTH SHORT EN N -insulin pen needle 3 g x 8 mm (/3" or 5/6") TODAYS HEALTH SUER THIN TODAYS HEALTH ULTRA THIN TODAY SONGE -nonoxynol-9 vaginal sponge 000 mg tolazamide tab 50 mg... 9 TOLBUTAMIDE -tolbutamide tab 500 mg... 0 tolcapone tab 00 mg (Tasmar)...56 tolmetin sodium cap 400 mg... 5 tolterodine tartrate cap sr 4hr mg (Detrol la) tolterodine tartrate cap sr 4hr 4 mg (Detrol la) tolterodine tartrate tab mg (Detrol)...38 tolterodine tartrate tab mg (Detrol)...38 TOCARE CLICKFINE UNIVERS -insulin pen needle 3 g x 6 mm (/4")...07 TOCARE CLICKFINE UNIVERS -insulin pen needle 3 g x 8 mm (/3" or 5/6")...07 TOCARE ULTRA COMFORT INS -insulin syringe/needle u-00 / ml TOCARE ULTRA COMFORT INS -insulin syringe/needle u-00 / ml 9 x /" TOCARE ULTRA COMFORT INS -insulin syringe/needle u-00 / ml TOCARE ULTRA COMFORT INS -insulin syringe/needle u ml 9 x /" TOCARE ULTRA COMFORT INS -insulin syringe/needle u ml TOCARE ULTRA COMFORT INS -insulin syringe/needle u-00 ml 9 x /" TOCARE ULTRA COMFORT INS -insulin syringe/needle u-00 ml TOCARE ULTRA COMFORT INS -insulin syringe/needle u-00 ml TOCARE ULTRA COMFORT INS -insulin syringe/needle u ml TOCO INSULIN SYRINGE/U- -insulin syringe/needle u-00 / ml 8 x /" TOCO INSULIN SYRINGE/U- -insulin syringe/needle u-00 / ml 9 x /" TOCO INSULIN SYRINGE/U- -insulin syringe/needle u ml 9 x /" TOCO INSULIN SYRINGE/U- -insulin syringe/needle u-00 ml 8 x /" TOCO INSULIN SYRINGE/U- -insulin syringe/needle u-00 ml 9 x /" topiramate sprinkle cap 5 mg (Topamax sprinkle) topiramate sprinkle cap 5 mg (Topamax sprinkle) topiramate tab 5 mg (Topamax) topiramate tab 50 mg (Topamax) topiramate tab 00 mg (Topamax) topiramate tab 00 mg (Topamax) torsemide tab 5 mg (Demadex) torsemide tab 0 mg (Demadex) torsemide tab 0 mg (Demadex) torsemide tab 00 mg (Demadex) TOUJEO SOLOSTAR -insulin glargine soln pen-injector 300 unit/ml... 0 TOVIAZ -fesoterodine fumarate tab sr 4hr 4 mg TOVIAZ -fesoterodine fumarate tab sr 4hr 8 mg TRACLEER -bosentan tab 6.5 mg... 3 TRACLEER -bosentan tab 5 mg... 3 TRADJENTA -linagliptin tab 5 mg... 0 tramadol-acetaminophen tab mg (Ultracet)... 5 tramadol hcl tab 50 mg (Ultram) Guia de medicinas ValueScript de Florida Blue para enero de 06

188 06 tramadol hcl tab sr 4hr biphasic release 00 mg... 5 tramadol hcl tab sr 4hr biphasic release 00 mg... 5 tramadol hcl tab sr 4hr biphasic release 300 mg... 5 tramadol hcl tab sr 4hr 00 mg (Ultram er)...50 tramadol hcl tab sr 4hr 00 mg (Ultram er)...5 tramadol hcl tab sr 4hr 300 mg (Ultram er)...5 trandolapril tab mg (Mavik)...9 trandolapril tab mg (Mavik)...9 trandolapril tab 4 mg (Mavik)...9 trandolapril-verapamil hcl tab cr -40 mg (Tarka)... 9 trandolapril-verapamil hcl tab cr -80 mg (Tarka)... 9 trandolapril-verapamil hcl tab cr -40 mg (Tarka)... 9 trandolapril-verapamil hcl tab cr 4-40 mg (Tarka)... 9 tranexamic acid tab 650 mg (Lysteda)...66 TRANSDERM-SCO -scopolamine td patch 7hr mg/3days...36 tranylcypromine sulfate tab 0 mg (arnate)...4 TRAVATAN Z -travoprost ophth soln 0.004% (benzalkonium free) (bak free)...70 TRAVEL LANCETS 30G trazodone hcl tab 50 mg... 4 trazodone hcl tab 00 mg... 4 trazodone hcl tab 50 mg... 4 trazodone hcl tab 300 mg... 4 tretinoin cap 0 mg...4 tretinoin cream 0.05% (Retin-a)...75 tretinoin cream 0.05% (Retin-a)...75 tretinoin cream 0.% (Retin-a)...75 tretinoin gel 0.0% (Retin-a) tretinoin gel 0.05% (Retin-a) tretinoin microsphere gel 0.04% (Retin-a micro) tretinoin microsphere gel 0.% (Retin-a micro pump) TRETTEN -coagulation factor xiii a-subunit for inj unit...68 TREXALL -methotrexate sodium tab 5 mg (base equiv)...4 TREXALL -methotrexate sodium tab 7.5 mg (base equiv)...4 TREXALL -methotrexate sodium tab 0 mg (base equiv)...4 TREXALL -methotrexate sodium tab 5 mg (base equiv)...4 TRIADVANCE -prenatal vit w/ dss-iron carbonyl-fa tab 90- mg...6 triamcinolone acetonide aerosol soln (Kenalog)...75 triamcinolone acetonide cream 0.05% triamcinolone acetonide cream 0.% triamcinolone acetonide cream 0.5% triamcinolone acetonide dental paste 0.%... 7 triamcinolone acetonide lotion 0.05% triamcinolone acetonide lotion 0.% triamcinolone acetonide nasal aerosol suspension 55 mcg/act...3 triamcinolone acetonide oint 0.05% triamcinolone acetonide oint 0.% triamterene & hydrochlorothiazide cap mg (Dyazide) triamterene & hydrochlorothiazide tab mg (Maxzide-5) triamterene & hydrochlorothiazide tab mg (Maxzide)...30 TRICARE RENATAL COMLEAT -prenat w/o a fefum-fa tab 7- mg & fish oil chew cap pak...6 TRICARE RENATAL DHA ONE -prenatal w/fe fumaratefa-dss-fish oil cap mg... 6 TRICARE -prenatal vit w/ fe fumarate-fa tab 7- mg... 6 trifluoperazine hcl tab mg...44 trifluoperazine hcl tab mg...44 trifluoperazine hcl tab 5 mg...44 trifluoperazine hcl tab 0 mg...44 trifluridine ophth soln % (Viroptic) trihexyphenidyl hcl elixir 0.4 mg/ml...56 trihexyphenidyl hcl tab mg trihexyphenidyl hcl tab 5 mg trimethobenzamide hcl cap 300 mg (Tigan) trimethoprim tab 00 mg...8 TRINATAL GT -prenatal vit w/ dss-iron carbonyl-fa tab 90- mg...6 TRINATAL RX -prenatal vit w/ fe fumarate-fa tab 60- mg... 6 TRINATAL ULTRA -prenatal vit w/ dss-iron carbonyl-fa tab 90- mg...6 TRINATE -prenatal vit w/ fe fumarate-fa tab 8- mg... 6 TRISTART DHA -prenat w/o a w/fecbn-methylf-fa-dha cap mg... 6 TRI-TABS DHA -prenat w/o a w/ fe bisglyc-fa tab 3- mg & omega cap pack... 6 TRIUMEQ -abacavir-dolutegravir-lamivudine tab mg... 6 TRIVEEN-DUO DHA -prenat-fe bis-fe prot succ-fa-ca tab & omega 3 cap 400 pk...6 TRIVEEN-RX RNF -prenatal w/o vit a w/ fe fum-dss-fadha cap mg...6 tropicamide ophth soln 0.5%...70 tropicamide ophth soln % (Mydriacyl)...7 trospium chloride cap sr 4hr 60 mg Guia de medicinas ValueScript de Florida Blue para enero de 06 77

189 06 trospium chloride tab 0 mg TRUEDRAW LANCING DEVICE -lancet devices TRUELUS INSULIN SYRINGE/ -insulin syringe/needle u-00 / ml TRUELUS INSULIN SYRINGE/ -insulin syringe/needle u-00 / ml 8 x /" TRUELUS INSULIN SYRINGE/ -insulin syringe/needle u-00 / ml 9 x /" TRUELUS INSULIN SYRINGE/ -insulin syringe/needle u-00 / ml TRUELUS INSULIN SYRINGE/ -insulin syringe/needle u ml 9 x /" TRUELUS INSULIN SYRINGE/ -insulin syringe/needle u ml TRUELUS INSULIN SYRINGE/ -insulin syringe/needle u-00 ml 8 x /" TRUELUS INSULIN SYRINGE/ -insulin syringe/needle u-00 ml 9 x /" TRUELUS INSULIN SYRINGE/ -insulin syringe/needle u-00 ml TRUELUS INSULIN SYRINGE/ -insulin syringe/needle u-00 ml TRUELUS INSULIN SYRINGE/ -insulin syringe/needle u ml TRUELUS LANCETS 6G TRUELUS LANCETS 8G TRUELUS LANCETS 30G TRUELUS LANCETS 33G TRUELUS LANCETS 33G MICR TRUELUS LANCETS 8G SUE TRUELUS LANCETS 30G ULTR TRUELUS SAFETY LANCETS TRUMENBA -meningococcal group b vaccine im susp prefilled syringe... 0 TRUVADA -emtricitabine-tenofovir disoproxil fumarate tab mg...6 trypsin w/ castor oil & peruvian balsam spray (Granulex) TWINRIX -hepatitis a (inact)-hep b (recomb) vac inj 70-0 elu-mcg/ml...0 TYBOST -cobicistat tab 50 mg... 6 TYKERB -lapatinib ditosylate tab 50 mg (base equiv)...4 TYZEKA -telbivudine tab 600 mg... 6 U ULESFIA -benzyl alcohol lotion 5%...75 ULTICARE INSULIN SAFETY S -insulin syringe/needle u-00 / ml 9 x /" ULTICARE INSULIN SAFETY S -insulin syringe/needle u-00 ml 9 x /" ULTICARE INSULIN SYRINGE/ -insulin syringe/needle u-00 / ml ULTICARE INSULIN SYRINGE/ -insulin syringe/needle u-00 / ml 8 x /" ULTICARE INSULIN SYRINGE/ -insulin syringe/needle u-00 / ml 9 x /" ULTICARE INSULIN SYRINGE/ -insulin syringe/needle u-00 / ml ULTICARE INSULIN SYRINGE/ -insulin syringe/needle u-00 / ml 30 x /" ULTICARE INSULIN SYRINGE/ -insulin syringe/needle u ml 9 x /" ULTICARE INSULIN SYRINGE/ -insulin syringe/needle u ml ULTICARE INSULIN SYRINGE/ -insulin syringe/needle u ml 30 x /" ULTICARE INSULIN SYRINGE/ -insulin syringe/needle u-00 ml 8 x /" ULTICARE INSULIN SYRINGE/ -insulin syringe/needle u-00 ml 9 x /" ULTICARE INSULIN SYRINGE/ -insulin syringe/needle u-00 ml ULTICARE INSULIN SYRINGE/ -insulin syringe/needle u-00 ml 30 x /" ULTICARE INSULIN SYRINGE/ -insulin syringe/needle u-00 ml ULTICARE INSULIN SYRINGE/ -insulin syringe/needle u ml ULTICARE INSULIN SYRINGE -insulin syringe/needle u-00 / ml ULTICARE INSULIN SYRINGE -insulin syringe/needle u-00 ml ULTICARE INSULIN SYRINGE -insulin syringe/needle u ml ULTICARE MICRO EN NEEDLE -insulin pen needle 3 g x 4 mm (5/3")...09 ULTICARE MINI EN NEEDLES -insulin pen needle 3 g x 6 mm (/4")...09 ULTICARE ORIGINAL EN NEE -insulin pen needle 9 g x mm (/")...09 ULTICARE EN NEEDLES/9G -insulin pen needle 9 g x.7 mm...09 ULTICARE SHORT EN NEEDLE -insulin pen needle 3 g x 8 mm (/3" or 5/6") ULTICARE THIN LANCETS 30G ULTICARE TUBERCULIN SAFET -tuberculin/allergy syringe/needle (disp) ml 5 x 5/8" ULTICARE TUBERCULIN SAFET -tuberculin/allergy syringe/needle (disp) ml 5 x " ULTIGUARD INSULIN SYRINGE -insulin syringe/needle u-00 / ml 9 x /" ULTIGUARD INSULIN SYRINGE -insulin syringe/needle u-00 / ml ULTIGUARD INSULIN SYRINGE -insulin syringe/needle u ml 9 x /" ULTIGUARD INSULIN SYRINGE -insulin syringe/needle u ml ULTIGUARD INSULIN SYRINGE -insulin syringe/needle u-00 ml 9 x /" ULTIGUARD INSULIN SYRINGE -insulin syringe/needle u-00 ml Guia de medicinas ValueScript de Florida Blue para enero de 06

190 06 ULTI-LANCE AUTO-ADJUST DE -lancet devices ULTI-LANCE AUTOMATIC/ CLE -lancet devices ULTI-LANCE MINI ADJUSTABL -lancet devices ULTILET BASIC LANCETS 30G ULTILET CLASSIC LANCETS ULTILET INSULIN SYRINGE/S -insulin syringe/needle u-00 / ml ULTILET INSULIN SYRINGE/S -insulin syringe/needle u-00 / ml ULTILET INSULIN SYRINGE/S -insulin syringe/needle u ml ULTILET INSULIN SYRINGE/S -insulin syringe/needle u-00 ml ULTILET INSULIN SYRINGE/S -insulin syringe/needle u-00 ml ULTILET INSULIN SYRINGE/S -insulin syringe/needle u ml ULTILET LANCETS 33G ULTILET LANCETS ULTILET OERATING DEVICE -lancet devices... 0 ULTILET EN NEEDLE 3GX4M -insulin pen needle 3 g x 4 mm (5/3")...0 ULTILET SAFETY LANCETS ULTILET SHORT EN NEEDLES -insulin pen needle 3 g x 5 mm (3/6")...0 ULTILET SHORT EN NEEDLES -insulin pen needle 3 g x 8 mm (/3" or 5/6")...0 ULTILET ULTI-LANCE ADJ DE -lancet devices... 0 ULTIMATECARE ONE NF -prenatal w/fe cbnyl-fe asp glyc-fa-dss-omega cap 0-7- mg... 6 ULTIMATECARE ONE -prenatal vit w/ fe cbn-fe asp glycfa-omega 3 cap 7-mg...6 ULTIMATE OB DHA -prenat w/ fe poly cmplx-fe asp-fe glyfa tab & dha cap pak...6 ULTRA-COMFORT INSULIN SYR -insulin syringe/needle u-00 / ml ULTRA-COMFORT INSULIN SYR -insulin syringe/needle u-00 / ml 8 x /"... 0 ULTRA-COMFORT INSULIN SYR -insulin syringe/needle u-00 / ml 9 x /"... 0 ULTRA-COMFORT INSULIN SYR -insulin syringe/needle u-00 / ml ULTRA COMFORT INSULIN SYR -insulin syringe/needle u-00 / ml ULTRA COMFORT INSULIN SYR -insulin syringe/needle u-00 / ml 8 x /"... 0 ULTRA COMFORT INSULIN SYR -insulin syringe/needle u-00 / ml 9 x /"... 0 ULTRA COMFORT INSULIN SYR -insulin syringe/needle u-00 / ml 30 x /"... 0 ULTRA-COMFORT INSULIN SYR -insulin syringe/needle u ml 9 x /"... 0 ULTRA-COMFORT INSULIN SYR -insulin syringe/needle u ml ULTRA-COMFORT INSULIN SYR -insulin syringe/needle u-00 ml 8 x /"... 0 ULTRA-COMFORT INSULIN SYR -insulin syringe/needle u-00 ml 9 x /"... ULTRA-COMFORT INSULIN SYR -insulin syringe/needle u-00 ml ULTRA-COMFORT INSULIN SYR -insulin syringe/needle u-00 ml 3... ULTRA-COMFORT INSULIN SYR -insulin syringe/needle u ml 3... ULTRA COMFORT INSULIN SYR -insulin syringe/needle u ml ULTRA COMFORT INSULIN SYR -insulin syringe/needle u-00 ml 9 x /"... 0 ULTRA COMFORT INSULIN SYR -insulin syringe/needle u-00 ml 30 x /"... 0 ULTRA COMFORT INSULIN SYR -insulin syringe/needle u-00 ml ULTRA INSULIN SYRINGE/U- -insulin syringe/needle u-00 / ml 9 x /"... 0 ULTRA TABS -prenatal vit w/ dss-iron carbonyl-fa tab 90- mg... 6 ULTRA-THIN II AUTO LANCET -... ULTRA-THIN II INSULIN SYR -insulin syringe/needle u-00 / ml 3... ULTRA-THIN II INSULIN SYR -insulin syringe/needle u-00 / ml 9 x /"... ULTRA-THIN II INSULIN SYR -insulin syringe/needle u-00 / ml ULTRA-THIN II INSULIN SYR -insulin syringe/needle u ml 9 x /"... ULTRA-THIN II INSULIN SYR -insulin syringe/needle u ml ULTRA-THIN II INSULIN SYR -insulin syringe/needle u-00 ml 9 x /"... ULTRA-THIN II INSULIN SYR -insulin syringe/needle u-00 ml ULTRA-THIN II INSULIN SYR -insulin syringe/needle u-00 ml 3... ULTRA-THIN II INSULIN SYR -insulin syringe/needle u ml 3... ULTRA-THIN II LANCETS 8G -... ULTRA-THIN II LANCETS 30G -... ULTRA-THIN II MINI EN NE -insulin pen needle 3 g x 5 mm (3/6")... ULTRA-THIN II EN NEEDLES -insulin pen needle 9 g x.7 mm... ULTRA-THIN II EN NEEDLES -insulin pen needle 3 g x 8 mm (/3" or 5/6")... ULTRA-THIN II SAFETY AUTO -... ULTRA THIN LANCETS 8G ULTRA THIN LANCETS 30G UNIFINE ENTIS 3G X 3/ -insulin pen needle 3 g x 5 mm (3/6")... Guia de medicinas ValueScript de Florida Blue para enero de 06 79

191 06 UNIFINE ENTIS 9GXMM -insulin pen needle 9 g x mm (/")... UNIFINE ENTIS 3GX5MM -insulin pen needle 3 g x 5 mm (3/6")... UNIFINE ENTIS 3GX6MM -insulin pen needle 3 g x 6 mm (/4")... UNIFINE ENTIS 3GX4MM -insulin pen needle 3 g x 4 mm (5/3")... UNIFINE ENTIS 3G X 6MM -insulin pen needle 3 g x 6 mm (/4")... UNIFINE ENTIS 3GX8MM -insulin pen needle 3 g x 8 mm (/3" or 5/6")... UNIFINE ENTIS 3G X 8MM -insulin pen needle 3 g x 8 mm (/3" or 5/6")... UNIFINE ENTIS LUS 9GX -insulin pen needle 9 g x mm (/")... UNIFINE ENTIS LUS 3GX -insulin pen needle 3 g x 5 mm (3/6")... UNIFINE ENTIS LUS 3GX -insulin pen needle 3 g x 6 mm (/4")... UNIFINE ENTIS LUS 3GX -insulin pen needle 3 g x 4 mm (5/3")... UNIFINE ENTIS LUS 3GX -insulin pen needle 3 g x 8 mm (/3" or 5/6")... UNILET COMFORTOUCH LANCET -... UNILET EXCELITE II -... UNILET EXCELITE -... UNILET G.. LANCET -... UNILET G.. SUERLITE LAN -... UNILET G 8 ULTRA THIN -... UNILET LANCET -... UNILET LANCETS MICRO-THIN -... UNILET LANCETS SUER-THIN -... UNILET LANCETS ULTRA-THIN -... UNILET SUERLITE LANCET -... UNISTIK 3 GENTLE -... UNISTIK SAFETY LANCETS UNISTIK SAFETY LANCETS UNIVERSAL LANCETS THIN -... UNIVERSAL LANCETS ULTRA -... urea in lactic acid vehicle foam 35% (Hydro 35) ursodiol cap 300 mg (Actigall) ursodiol tab 50 mg (Urso 50)...37 ursodiol tab 500 mg (Urso forte)...37 V VAGIFEM -estradiol vaginal tab 0 mcg valacyclovir hcl tab gm (Valtrex)... 6 valacyclovir hcl tab 500 mg (Valtrex)...6 VALCHLOR -mechlorethamine hcl gel 0.06% (base equivalent)...75 VALCYTE -valganciclovir hcl for soln 50 mg/ml (base equiv)...6 valganciclovir hcl tab 450 mg (Valcyte)...6 valproate sodium syrup 50 mg/5ml (base equiv) (Depakene)...55 valproic acid cap 50 mg (Depakene)...55 valsartan-hydrochlorothiazide tab mg (Diovan hct)...9 valsartan-hydrochlorothiazide tab mg (Diovan hct)...9 valsartan-hydrochlorothiazide tab 60-5 mg (Diovan hct)...9 valsartan-hydrochlorothiazide tab mg (Diovan hct)...9 valsartan-hydrochlorothiazide tab 30-5 mg (Diovan hct)...9 valsartan tab 40 mg (Diovan)...9 valsartan tab 80 mg (Diovan)...9 valsartan tab 60 mg (Diovan)...9 valsartan tab 30 mg (Diovan)...9 VALUE HEALTH INSULIN SYRI -insulin syringe/needle u-00 / ml 9 x /"... VALUE HEALTH INSULIN SYRI -insulin syringe/needle u-00 ml 9 x /"... VALUE LUS LANCETS STANDA -... VALUE LUS LANCETS SUER -... VALUE LUS LANCETS THIN -... VALUE LUS LANCING DEVICE -lancet devices... VALUMARK LANCET SUER THI -... VALUMARK LANCET ULTRA THI -... VALUMARK EN NEEDLES 3G -insulin pen needle 3 g x 6 mm (/4")... VALUMARK EN NEEDLES 3G -insulin pen needle 3 g x 8 mm (/3" or 5/6")... VALUMARK EN NEEDLES 9GX -insulin pen needle 9 g x mm (/")... vancomycin hcl cap 5 mg (Vancocin hcl)... 8 vancomycin hcl cap 50 mg (Vancocin hcl)... 8 VANISHOINT INSULIN SYRIN -insulin syringe/needle u-00 / ml 30 x /"... VANISHOINT INSULIN SYRIN -insulin syringe/needle u-00 ml 9 x /"... VAQTA -hepatitis a vaccine inj susp 5 unit/0.5ml...0 VAQTA -hepatitis a vaccine inj susp 50 unit/ ml...0 VARIVAX -varicella virus vac live for subcutaneous inj 350 pfu/0.5ml...0 VASCEA -icosapent ethyl cap gm...3 VCF VAGINAL CONTRACETIVE -nonoxynol-9 film 8% VCF VAGINAL CONTRACETIVE -nonoxynol-9 foam.5% VECAMYL -mecamylamine hcl tab.5 mg... 9 VEMAVITE-RX -prenatal w/o vit a w/ fe fum-dss-fa-dha cap mg... 6 VENA-BAL DHA -prenat w/fe poly-na fered-fa tab 7- & omega cap dr 430mg Guia de medicinas ValueScript de Florida Blue para enero de 06

192 06 VENATAL-FA -prenatal vit w/ fe fumarate-fa tab 9- mg... 6 venlafaxine hcl cap sr 4hr 37.5 mg (base equivalent) (Effexor xr)...4 venlafaxine hcl cap sr 4hr 75 mg (base equivalent) (Effexor xr)...4 venlafaxine hcl cap sr 4hr 50 mg (base equivalent) (Effexor xr)...4 VENLAFAXINE HCL ER -venlafaxine hcl tab sr 4hr 5 mg (base equivalent)...4 venlafaxine hcl tab 5 mg...4 venlafaxine hcl tab 37.5 mg... 4 venlafaxine hcl tab 50 mg...4 venlafaxine hcl tab 75 mg...4 venlafaxine hcl tab 00 mg...4 venlafaxine hcl tab sr 4hr 37.5 mg (base equivalent) (Venlafaxine hcl er)... 4 venlafaxine hcl tab sr 4hr 75 mg (base equivalent) (Venlafaxine hcl er)... 4 venlafaxine hcl tab sr 4hr 50 mg (base equivalent) (Venlafaxine hcl er)... 4 VENTAVIS -iloprost inhalation solution 0 mcg/ ml...3 VENTAVIS -iloprost inhalation solution 0 mcg/ ml...3 VENTOLIN HFA -albuterol sulfate inhal aero 08 mcg/act (90mcg base equiv)...34 verapamil hcl cap sr 4hr 0 mg (Verelan)...5 verapamil hcl cap sr 4hr 80 mg (Verelan)...5 verapamil hcl cap sr 4hr 40 mg (Verelan)...5 verapamil hcl cap sr 4hr 360 mg (Verelan)...5 verapamil hcl cap sr 4hr 00 mg (Verelan pm)...5 verapamil hcl cap sr 4hr 00 mg (Verelan pm)...5 verapamil hcl cap sr 4hr 300 mg (Verelan pm)...5 verapamil hcl tab cr 0 mg (Calan sr)...5 verapamil hcl tab cr 80 mg (Calan sr)...5 verapamil hcl tab cr 40 mg (Calan sr)...5 verapamil hcl tab 80 mg (Calan)... 5 verapamil hcl tab 0 mg (Calan)... 5 VERAAMIL HCL -verapamil hcl tab 40 mg... 5 VESICARE -solifenacin succinate tab 5 mg VESICARE -solifenacin succinate tab 0 mg VEXOL -rimexolone ophth susp %... 7 VICTOZA -liraglutide soln pen-injector 8 mg/3ml (6 mg/ ml)... 0 VICTRELIS -boceprevir cap 00 mg... 6 VIDA MIA AUTOLET LANCING -lancet devices... VIDA MIA UNIFINE ENTIS -insulin pen needle 9 g x mm (/")... VIDA MIA UNIFINE ENTIS -insulin pen needle 3 g x 6 mm (/4")... VIDA MIA UNIFINE ENTIS -insulin pen needle 3 g x 4 mm (5/3")... VIDA MIA UNILET LANCETS S -... VIDA MIA UNILET LANCETS U -... VIDA MIA UNIFINE ENTIS -insulin pen needle 3 g x 8 mm (/3" or 5/6")...3 VIDEX -didanosine for soln gm... 6 VIDEX -didanosine for soln 4 gm... 6 VIGAMOX -moxifloxacin hcl ophth soln 0.5% (base equiv)...7 VIIBRYD -vilazodone hcl tab 0 mg... 4 VIIBRYD -vilazodone hcl tab 0 mg... 4 VIIBRYD -vilazodone hcl tab 40 mg... 4 VIIBRYD -vilazodone hcl tab starter kit 0 (7) & 0 (7) & 40 (6) mg... 4 VINACAL B -prenat w/o a w/fecbn-feglu-fa tab 0- mg & vit b6 tab pak...6 VINACAL -prenatal w/o a w/ fe carbonyl-fe gluc-dss-fa tab 7-mg... 6 VINATE AZ EXTRA -prenatal vit w/ fe bisglycinate chelatefa tab 9- mg...6 VINATE CALCIUM -prenatal vit w/ iron carbonyl-fe gluc-fa tab 7- mg... 6 VINATE CARE -prenatal w/o a vit w/ fe fum-fa tab chew 40- mg...6 VINATE C -prenatal w/o a vit w/ fe fumarate-fa tab 30- mg... 6 VINATE DHA RF -prenat w/o a w/fefum-methylfol-omegas cap 7-.3 mg... 6 VINATE GT -prenatal vit w/ dss-iron carbonyl-fa tab 90- mg... 6 VINATE IC -prenatal w/o a w/fe fum-fe poly-fa cap mg... 6 VINATE II -prenatal vit w/ fe bisglycinate chelate-fa tab 9- mg...6 VINATE M -prenatal vit w/ sel-fe fumarate-fa tab 7- mg... 6 VINATE ONE -prenatal vit w/ fe fumarate-fa tab 60- mg... 6 VINATE ULTRA -prenatal vit w/ dss-iron carbonyl-fa tab 90- mg...6 VIRACET -nelfinavir mesylate tab 50 mg...6 VIRACET -nelfinavir mesylate tab 65 mg...6 VIRAMUNE -nevirapine susp 50 mg/5ml... 6 VIRAMUNE XR -nevirapine tab sr 4hr 00 mg...7 VIREAD -tenofovir disoproxil fumarate oral powder 40 mg/ gm...7 VIREAD -tenofovir disoproxil fumarate tab 50 mg...7 VIREAD -tenofovir disoproxil fumarate tab 00 mg...7 VIREAD -tenofovir disoproxil fumarate tab 50 mg...7 Guia de medicinas ValueScript de Florida Blue para enero de 06 8

193 06 VIREAD -tenofovir disoproxil fumarate tab 300 mg...7 VIRT-ADVANCE -prenatal vit w/ dss-iron carbonyl-fa tab 90- mg...6 VIRT-BAL DHA LUS -prenat w/fe poly-na fered-fa tab 7- & omega cap dr 380mg... 6 VIRT-CARE ONE -prenatal vit w/ fe cbn-fe asp glyc-faomega 3 cap 7-mg VIRT-C DHA -prenatal w/fe fum-fe poly -fa-omega 3 cap mg... 6 VIRT NATE -prenatal vit w/ fe fumarate-fa tab 8- mg... 6 VIRT-N DHA -prenat w/o a w/fefum-methfol-fa-dha cap mg VIRT-N LUS -prenat w/o a w/ fe fumerate-methylfolatefa-omega 3 cap VIRT-N -prenatal vit w/ fe fum-methylfolate-fa tab mg VIRTREX -prenatal w/o vit a w/ fe fum-dss-fa-dha cap mg VIRT-SELECT -prenatal w/o vit a w/ fe fum-dss-fa-dha cap mg VIRT-VITE GT -prenatal vit w/ dss-iron carbonyl-fa tab 90- mg...63 VITAFOL-NANO -prenatal w/o a w/ fefum-l methylfol-fa tab mg VITAFOL-OB+DHA -prenatal mv w/fe fum-fa tab 65- mg & dha cap 50 mg pack...63 VITAFOL-OB -prenatal vit w/ fe fumarate-fa tab 65- mg VITAFOL-ONE -prenatal mv w/ fe polysac cmplx-fa-dha cap mg VITAFOL-N -prenatal vit w/ fe fumarate-fa tab 65- mg VITAFOL ULTRA -prenat w/fe poly-methylfol-fa-dha cap mg VITALET RO LANCETS VITALET RO LUS LANCETS VITAMEDMD ONE RX/QUATREFO -prenat w/ o a w/fefum-methfol-fa-dha cap mg VITAMEDMD LUS RX/QUATRE -prenat w/o a w/ fe chelate-l methylfol-fa tab & dha cap pk...63 VITAMEDMD REDICHEW RX -prenat w/ b-b6-b-d3- folic acid chew tab.4 mg VITAEARL -prenat w/oa w/fefum-na fered-fa-dha cap cr mg VITA-REN -prenatal vit w/ docusate-iron-fa tab 65- mg VITEKTA -elvitegravir tab 85 mg... 7 VITEKTA -elvitegravir tab 50 mg... 7 VIVA DHA -prenatal vit w/ fe fum-fa-omega 3 cap mg V-NATAL DHA -prenat w/o a w/ fe bisglyc-fa tab 3- mg & omega cap pack... 6 V-NATAL -prenatal vit w/o vit a w/ fe bisglycinate-fa tab 3- mg...6 VOL-NATE -prenatal vit w/ fe fumarate-fa tab 8- mg VOL-LUS -prenatal vit w/ fe fumarate-fa tab 7- mg VOL-TAB RX -prenatal vit w/ iron carbonyl-fa tab 9- mg VOLTAREN -diclofenac sodium gel % voriconazole for susp 40 mg/ml (Vfend)... 4 voriconazole tab 50 mg (Vfend)... 4 voriconazole tab 00 mg (Vfend)... 4 VOTRIENT -pazopanib hcl tab 00 mg (base equiv)...4 V-CH LUS -prenatal w/o a w/fe cbn-dss-fa-dha cap mg V-CH-NV -prenatal w/o vit a w/ fe cbn-dss-fa-dha cap mg V CH ULTRA -prenat w/o a w/fe fum-fe cbn-dss-fa-dha cap mg V-GGR-B6 RENATAL -prenatal w/ calcium-vit b6-faginger tab. mg V-HEME OB + DHA -prenat-fe poly cmplx-fe heme polyfa tab & omega 3 cap pck...63 V-HEME OB -prenat vit-fe poly cmplx-fe heme poly-fa tab 8-6- mg V-HEME ONE -prenat-fe poly cmplx-fe heme poly-fa-dha cap mg...63 V INSULIN SYRINGE/U-00/ -insulin syringe/needle u ml 9 x /"... 3 V-NV-DHA -prenatal vit w/ fe fum-fa-omega 3 cap mg V-R MONOJECT INSULIN SYRI -insulin syringe/needle u-00 / ml 8 x /"... V-R MONOJECT INSULIN SYRI -insulin syringe/needle u-00 / ml 9 x /"... V-R MONOJECT INSULIN SYRI -insulin syringe/needle u ml 9 x /"... V-R MONOJECT INSULIN SYRI -insulin syringe/needle u-00 ml 8 x /"... V-R MONOJECT INSULIN SYRI -insulin syringe/needle u-00 ml 9 x /"... VYVANSE -lisdexamfetamine dimesylate cap 0 mg VYVANSE -lisdexamfetamine dimesylate cap 0 mg VYVANSE -lisdexamfetamine dimesylate cap 30 mg VYVANSE -lisdexamfetamine dimesylate cap 40 mg VYVANSE -lisdexamfetamine dimesylate cap 50 mg VYVANSE -lisdexamfetamine dimesylate cap 60 mg VYVANSE -lisdexamfetamine dimesylate cap 70 mg W W&F LANCETS COLORED G Guia de medicinas ValueScript de Florida Blue para enero de 06

194 06 W&F LANCETS 6G WALGREENS ADVANCED TRAVEL WALGREENS COMFORT ASSURED WALGREENS LANCETS WALGREENS THIN LANCETS WALGREENS ULTRA THIN LANC warfarin sodium tab mg (Coumadin) warfarin sodium tab mg (Coumadin) warfarin sodium tab.5 mg (Coumadin) warfarin sodium tab 3 mg (Coumadin) warfarin sodium tab 4 mg (Coumadin) warfarin sodium tab 5 mg (Coumadin) warfarin sodium tab 6 mg (Coumadin) warfarin sodium tab 7.5 mg (Coumadin) warfarin sodium tab 0 mg (Coumadin) water for irrigation, sterile irrigation soln... 5 WD MEDIC INSULIN SYRINGE/ -insulin syringe/needle u-00 / ml 9 x /"... 3 WD MEDIC INSULIN SYRINGE/ -insulin syringe/needle u-00 / ml WD MEDIC INSULIN SYRINGE/ -insulin syringe/needle u ml 9 x /"... 3 WD MEDIC INSULIN SYRINGE/ -insulin syringe/needle u ml WD MEDIC INSULIN SYRINGE/ -insulin syringe/needle u-00 ml 9 x /"... 3 WD MEDIC INSULIN SYRINGE/ -insulin syringe/needle u-00 ml WEGMANS UNIFINE ENTIS -insulin pen needle 3 g x 5 mm (3/6")...3 WEGMANS UNIFINE ENTIS -insulin pen needle 3 g x 6 mm (/4")...3 WEGMANS UNIFINE ENTIS -insulin pen needle 3 g x 4 mm (5/3")...3 WEGMANS UNIFINE ENTIS -insulin pen needle 3 g x 8 mm (/3" or 5/6")...3 WELCHOL -colesevelam hcl packet for susp 3.75 gm... 3 WELCHOL -colesevelam hcl tab 65 mg... 3 WIDE-SEAL SILICONE DIAHR -diaphragm wide seal 60 mm... 3 WIDE-SEAL SILICONE DIAHR -diaphragm wide seal 65 mm... 3 WIDE-SEAL SILICONE DIAHR -diaphragm wide seal 70 mm... 3 WIDE-SEAL SILICONE DIAHR -diaphragm wide seal 75 mm... 3 WIDE-SEAL SILICONE DIAHR -diaphragm wide seal 80 mm... 3 WIDE-SEAL SILICONE DIAHR -diaphragm wide seal 85 mm... 3 WIDE-SEAL SILICONE DIAHR -diaphragm wide seal 90 mm... 3 WIDE-SEAL SILICONE DIAHR -diaphragm wide seal 95 mm... 3 WILATE -antihemophilic factor/vwf (human) for inj unit...68 WILATE -antihemophilic factor/vwf (human) for inj unit...68 X XALKORI -crizotinib cap 00 mg...4 XALKORI -crizotinib cap 50 mg...4 XARELTO -rivaroxaban tab 0 mg...66 XARELTO -rivaroxaban tab 5 mg...66 XARELTO -rivaroxaban tab 0 mg...66 XARELTO STARTER ACK -rivaroxaban tab starter therapy pack 5 mg & 0 mg XELODA -capecitabine tab 50 mg...4 XELODA -capecitabine tab 500 mg...4 XIFAXAN -rifaximin tab 550 mg...8 XTANDI -enzalutamide cap 40 mg... 4 XYNTHA -antihemophilic factor recombinant paf for inj kit 50 unit XYNTHA -antihemophilic factor recombinant paf for inj kit 500 unit XYNTHA -antihemophilic factor recombinant paf for inj kit 000 unit XYNTHA -antihemophilic factor recombinant paf for inj kit 000 unit XYNTHA SOLOFUSE -antihemophilic factor recombinant paf for inj kit 50 unit XYNTHA SOLOFUSE -antihemophilic factor recombinant paf for inj kit 500 unit XYNTHA SOLOFUSE -antihemophilic factor recombinant paf for inj kit 000 unit XYNTHA SOLOFUSE -antihemophilic factor recombinant paf for inj kit 000 unit XYNTHA SOLOFUSE -antihemophilic factor recombinant paf for inj kit 3000 unit XYREM -sodium oxybate oral solution 500 mg/ ml...48 Y YALE NEEDLES G X -/" -needle (disp) x -/"...3 YALE NEEDLES 5G X -/" -needle (disp) 5 x -/"...3 YALE NEEDLES 6G X /" -needle (disp) 6 x /"... 3 YALE NEEDLES 6G X 3/8" -needle (disp) 6 x 3/8"... 3 YALE NEEDLES G X " -needle (disp) x "... 3 YALE NEEDLES -needle (disp) 8 x "... 3 YALE NEEDLES -needle (disp) x "... 3 YODOXIN -iodoquinol tab 0 mg... 7 YODOXIN -iodoquinol tab 650 mg... 7 Z zafirlukast tab 0 mg (Accolate)...34 zafirlukast tab 0 mg (Accolate)...34 Guia de medicinas ValueScript de Florida Blue para enero de 06 83

195 06 zaleplon cap 5 mg (Sonata) zaleplon cap 0 mg (Sonata) ZATEAN-CH -prenatal w/o a w/fe cbn-dss-fa-dha cap mg ZATEAN-N DHA -prenat w/o a w/fefum-methfol-fa-dha cap mg...63 ZATEAN-N LUS -prenat w/o a w/ fe fumeratemethylfolate-fa-omega 3 cap...63 ZATEAN-N -prenatal vit w/ fe fum-methylfolate-fa tab mg ZAVESCA -miglustat cap 00 mg ZELBORAF -vemurafenib tab 40 mg (base equivalent)...5 ZEMLAR -paricalcitol cap mcg... ZEMLAR -paricalcitol cap mcg... ZENE -pancrelipase (lip-prot-amyl) dr cap unit ZENE -pancrelipase (lip-prot-amyl) dr cap unit ZENE -pancrelipase (lip-prot-amyl) dr cap unit ZENE -pancrelipase (lip-prot-amyl) dr cap unit ZENE -pancrelipase (lip-prot-amyl) dr cap unit ZENE -pancrelipase (lip-prot-amyl) dr cap unit ZENE -pancrelipase (lip-prot-amyl) dr cap unit ZETIA -ezetimibe tab 0 mg...3 ZIAGEN -abacavir sulfate soln 0 mg/ml (base equiv)...7 zidovudine cap 00 mg (Retrovir)... 7 zidovudine syrup 0 mg/ml (Retrovir)... 7 zidovudine tab 300 mg... 7 ZINGIBER -prenatal w/ calcium-vit b6-fa-ginger tab. mg ZIOTAN -tafluprost ophth soln 0.005%... 7 ziprasidone hcl cap 0 mg (Geodon)...44 ziprasidone hcl cap 40 mg (Geodon)...44 ziprasidone hcl cap 60 mg (Geodon)...44 ziprasidone hcl cap 80 mg (Geodon)...44 ZIRGAN -ganciclovir ophth gel 0.5%...7 ZITHROMAX -azithromycin powd pack for susp gm... ZOLINZA -vorinostat cap 00 mg...5 zolmitriptan orally disintegrating tab.5 mg (Zomig zmt) zolmitriptan orally disintegrating tab 5 mg (Zomig zmt) zolmitriptan tab.5 mg (Zomig) zolmitriptan tab 5 mg (Zomig) zolpidem tartrate tab cr 6.5 mg (Ambien cr)...44 zolpidem tartrate tab cr.5 mg (Ambien cr)...44 zolpidem tartrate tab 5 mg (Ambien) zolpidem tartrate tab 0 mg (Ambien) ZOMIG -zolmitriptan nasal spray.5 mg/spray unit...53 ZOMIG -zolmitriptan nasal spray 5 mg/spray unit...53 zonisamide cap 50 mg...55 zonisamide cap 5 mg (Zonegran)...55 zonisamide cap 00 mg (Zonegran)...55 ZORTRESS -everolimus tab 0.5 mg... 5 ZORTRESS -everolimus tab 0.5 mg... 5 ZORTRESS -everolimus tab 0.75 mg... 5 ZOSTAVAX -zoster vaccine live for inj 9400 unit/0.65ml...0 ZOVIRAX -acyclovir cream 5%...76 ZYDELIG -idelalisib tab 00 mg... 5 ZYDELIG -idelalisib tab 50 mg... 5 ZYFLO CR -zileuton tab sr hr 600 mg...34 ZYKADIA -ceritinib cap 50 mg...5 ZYMAXID -gatifloxacin ophth soln 0.5%...7 ZYTIGA -abiraterone acetate tab 50 mg... 5 ZYVOX -linezolid for susp 00 mg/5ml...8 ZYVOX -linezolid tab 600 mg Guia de medicinas ValueScript de Florida Blue para enero de 06