Premera Blue Cross Maintenance Drug List Effective As Of 2013
Maintenance drugs are prescriptions commonly used to treat chronic or long-term conditions, such as high
blood presssure, heart disease, asthma, and diabetes. These conditions usually require regular, daily use
If a generic is available, it is listed in lowercase italics. If no generic is available, the brand name is listed in
UPPERCASE. A 30 day supply of a maintenance medication can be filled at a retail pharmacy up to two times
without penalty. Any additional refills at a retail pharmacy will be subject to 2 times the applicable retail copay.
To avoid this penalty, members can have a 90 day supply of the maintenance medication fulfilled by mail.
l This list does not include all of the many medicines available. l Your prescription benefit plan is not guaranteed to cover every product or category listed here. l This list is subject to change.
If you have questions about your prescription benefits, log on to your account at premera.com or call
customer service at the toll-free number on the back of your ID card. Allergies Contraceptives/ Hormone Replacement Alzheimer’s Disease Blood Modifiers
This document contains references to brand-name prescription drugs that are trademarked or are registered trademarks of pharmaceutical
manufacturers not affiliated with Premera Blue Cross. Premera Blue Cross Maintenance Drug List Continued Depression Test Strips/Lancets/Meters Digestive Enzymes Heart Disease & High Blood Pressure Ace Inhibitors Diuretics Diabetes Combinations Angiotensin II Receptor Antagonists Enlarged Prostate Antiarrhythmics Combinations Glaucoma
This document contains references to brand-name prescription drugs that are trademarked or are registered trademarks of pharmaceutical
manufacturers not affiliated with Premera Blue Cross. Premera Blue Cross Maintenance Drug List Continued Beta Blockers Irritable Bowel Syndrome Osteoporosis Overactive Bladder Calcium Channel Blockers Miscellaneous Cardiovascular Parkinson’s Disease Combinations High Cholesterol Respiratory Agents
This document contains references to brand-name prescription drugs that are trademarked or are registered trademarks of pharmaceutical
manufacturers not affiliated with Premera Blue Cross. Premera Blue Cross Maintenance Drug List Continued Ulcer/GERD Rheumatoid Arthritis Seizure Disorders Miscellaneous
This document contains references to brand-name prescription drugs that are trademarked or are registered trademarks of pharmaceutical
manufacturers not affiliated with Premera Blue Cross.
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