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December 2018
We’re excluding some Custom Select drugs, effective Jan. 1, 2019
Our goal at Blue Cross Blue Shield of Michigan and Blue Care Network is to provide our members with safe, high-quality prescription drug therapies. We continually review prescription drugs to provide the best value for our members, control costs and make sure our members are using the right medication for the right situation.
Because there are safe, effective and less-costly alternatives available, we’ll no longer cover some brand-name and generic drugs on the Custom Select Drug List, starting Jan. 1, 2019.
A member whose prescription drug plan uses the Custom Select Drug List will be responsible for the full cost if he or she fills a prescription for one of these drugs on or after Jan. 1, 2019.
For a complete list of covered drugs go to bcbsm.com/pharmacy and click on Drug lists.
Common use |
Drugs to be excluded
Jan. 1, 2019 |
Average cost per unit or package |
Covered generic alternatives |
Average cost
per unit or package |
Allergies |
Xyzal® |
$1 |
These drugs are available over the counter without a prescription. |
Zyrtec®solution |
$3 |
Diabetes |
Actoplus Met® XR |
$13 to $25 |
Actoplus Met® |
$2 |
Fortamet® |
$6 to $11 |
Glucophage®, Glucophage® XR |
<$1 |
Heart conditions |
Lanoxin® 62.5 and 187.5mcg |
$15 |
Lanoxin® 125 mcg, 250 mcg |
<$1 |
HIV |
Crixivan® |
$3 |
Go to bcbsm.com/pharmacy and click on Drug lists for a complete list of covered alternatives.
Members should discuss their treatment options with their doctor. |
Rescriptor® |
$3 |
Trizivir® |
$20 |
Videx® |
$27 |
Videx® EC |
$9 |
Viracept® |
$5 to $12 |
Migraines |
Migranal® nasal spray |
$551 |
Cafergot® |
$15 |
D.H.E. 45® |
$179 |
Generic triptans
(such as Imitrex®, Maxalt®, Zomig®) |
$10 to $20 |
Mood disorders |
Aplenzin® |
$52 to $156 |
Wellbutrin®, Wellbutrin® SR, Wellbutrin® XL |
<$1 |
Muscle relaxants |
Lorzone® |
$9 to $10 |
Flexeril® |
<$1 |
Norflex® |
Parafon Forte DSC® 500 mg |
Robaxin® |
Zanaflex® |
Overactive bladder |
Toviaz® |
$13 |
Detrol®, Detrol® LA |
$2 to $5 |
Ditropan®, Ditropan® XL |
Sanctura®, Sanctura® XR |
Skin conditions
|
Bactroban® cream |
$222 |
Bactroban® ointment |
$6 |
gentamicin cream, ointment |
$50 |
Denavir® |
$975 |
Zovirax® ointment |
$297 |
Desonate® |
$660 |
Dermacort®, Hytone® 2.5% |
$7 to $150 |
Desowen® |
Kenalog® 0.025% cream, lotion |
Valisone® lotion |
Florone®
Psorcon® |
$210 to $932 |
Aristocort®, Kenalog® 0.5% |
$5 to $80 |
Diprolene® cream, lotion |
Diprosone® cream, ointment |
Elocon® ointment |
Valisone® ointment |
Pandel® |
$1,287 |
Diprosone® lotion |
$8 to $100 |
Elocon® cream, lotion, solution |
Kenalog® ointment, spray |
Synalar® ointment |
Westcort® ointment |
Zyclara® |
$1,485 |
Efudex® |
$165 |
Protopic® |
$336 |
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