2021 Service Benefit Plan Specialty Drug List

Prescription Drug Guide October 2021

Prescription drugs are classified as either a Brand drug or a Generic drug. The Brand or Generi c status provided is by a nationally recognized company providing drug product information. The Brand/Generic status for a specific drug/specific marketer can sometimes change over the life of a product in the marketplace and change from

  Prescription, Drug, Generic, Negeri, Prescription drug, Generic drugs, Ge neric

SourceRx 1.0 Four Tier Prescription Drug List, October 2021

SourceRx 1.0 Four Tier Prescription Drug List, October 2021 II Member Prescription Benefit The prescription benefit is multi-tiered, placing prescription drugs into one of four tier levels. Tier 1 primarily contains preferred (lowest cost) generic drugs. Based on cost considerations , there may be brands placed into this tier on occasion as well.

  Prescription, Four, Tier, Sourcerx 1, Sourcerx, 0 four tier prescription

BCBSTX Health Insurance Marketplace 6 Tier Drug List ...

Shoppers: To find drug estimates go to https://www.myprime.com/en/plan-preview/medicines/find-medicine.html Members: Log in to your plan to find current drug pricing ...

Blue Cross and Blue Shield of Alabama Source+Rx 1.0 ...

Affordable Care Act Drugs marked with a dot in the ACA column may have limited or $0 member cost-sharing under the Affordable Care Act if certain criteria are met. Examples of categories of drugs that may be subject to limited or $0 member cost share include aspirin, breast cancer prevention drugs, fluoride supplements, folic acid supplements,

  Care

Capital Health Plan NetResults Formulary

clinical or cost advantage over non-preferred drugs within the same therapeutic category. Coverage and copayment/co-insurance levels vary depending on the plan. Drugs that require Prior Authorization, Step Therapy, or that have Dispensing Limits or are considered Limited Distribution are noted in the Prescription Drug List. Limitations

  Advantage

BCBSMT Health Insurance Marketplace 6 Tier Drug List ...

Some drugs in the same dosage form may be used to treat more than one medical condition. In these instances, ... Compounded medications: Your benefit plan does not provide coverage for compounded medications. Please ... medication with a dot under the step therapy column. Some plans may have step therapy programs on additional

  Form, Medication, Compounded

Health Insurance Marketplace 6 Tier Drug List

BCBSIL Health Insurance Marketplace 6 Tier Drug List January 2022 IV ACA Preventive (ACA): Medicines marked in the ACA column are under the Affordable Care Act coverage of preventive services. These products have limited or $0 member cost-sharing (copay or co-insurance), when

Rx90 (Maintenance) Drug List Effective January 1, 2021

amlodipine besylate tab 10 mg (base equivalent) (Norvasc) amlodipine besylate-benazepril hcl cap 2.5-10 mg amlodipine besylate-benazepril hcl cap 5-10 mg (Lotrel) amlodipine besylate-benazepril hcl cap 5-20 mg (Lotrel) amlodipine besylate-benazepril hcl cap 5-40 mg amlodipine besylate-benazepril hcl cap 10-20 mg (Lotrel)

  Amlodipine, Besylate, Amlodipine besylate

Blue Cross and Blue Shield of Kansas Formulary for ...

Blue Cross and Blue Shield of Kansas (BCBSKS) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. BCBSKS does not exclude people or treat them differently because of race,

  Blue, Origin

MEDICARE PART D TIER EXCEPTION INFORMATION

Fax: 800-693-6703 Phone: 800-693-6651 Please read all instructions below before completing the attached form. • Please complete the attached Request for a Lower Copay* (Tier Exception Form) • To prevent delays in the review process please complete all requested fields. • Completed forms should be faxed to: 800-693-6703

  Form

DRUG NAME: Cytarabine - BC Cancer

Cytarabine DRUG NAME: Cytarabine SYNONYM(S): 1-B-arabinofuranosylcytosine, 1 arabinosylcytosine, 1 ara-C, 1 cytosine arabinoside 1 COMMON TRADE NAME(S): CYTOSAR® CLASSIFICATION: antimetabolite 1 Special pediatric considerations are noted when applicable, otherwise adult provisions apply.

  Name, Drug, Drug name, Cytarabine, Cytarabine drug name

DRUG NAME: Hydroxyurea - BC Cancer

DRUG NAME: Hydroxyurea SYNONYM(S): hydroxycarbamide 1 ... The table includes adverse events that presented during drug treatment but may not necessarily have a causal relationship with the drug. Because clinical trials are conducted under very specific conditions, the adverse event ... increased cytarabine therapeutic and toxic effects ...

  Name, Drug, Drug name, Cytarabine

DRUG NAME Gemcitabine - BC Cancer

DRUG NAME: Gemcitabine ... Gemcitabine, a pyrimidine analog, is structurally similar to cytarabine, but has a wider spectrum of antitumour activity due to its different cellular pharmacology and mechanism of action.1 Gemcitabine is metabolized intracellularly to two active metabolites, gemcitabine diphosphate (dFdCDP) and gemcitabine ...

  Name, Drug, Drug name, Cytarabine

NSSG Chemotherapy Protocol

DRUG REGIMEN Days 1 to 7 G-CSF subcutaneous. As per local policy (up to 28 days). (e.g. Filgrastim 0.5microgram/kg/day) Days 2 to 6 FLUDARABINE 30 mg/m2 daily in 100 mL sodium chloride 0.9% intravenous infusion over 30 minutes (5 doses). Fludarabine infusion must precede the administration of cytarabine by 4 hours.

  Drug, Cytarabine

DRUG NAME: Fludarabine

DRUG NAME: Fludarabine SYNONYM(S): 9-B-D-arabinofuranosyl-2-fluoroadenine 5’-monophosphate, 1 FAMP, 2,3 2-fluoro-ara-A Monophosphate, 3 2-fluoro-ara-AMP, 1,3 fludarabine phosphate, 1 NSC-312887 1. COMMON TRADE NAME(S): FLUDARA CLASSIFICATION: antimetabolite. 1. Special pediatric considerations are noted when applicable, otherwise adult ...

  Name, Drug, Drug name

Blue Cross and BCN utilization management medical drug …

Lists any preferred products that a member must try and fail before receiving a drug. When a cell is blank, there is no preferred product information for that drug. Note: Medical benefit drug policies are a source for Blue Cross and BCN medical policy information. Medical policies are not to be used to determine benefits or reimbursement.

  Management, Medical, Drug, Utilization, And bcn utilization management medical drug

CYTARABINE (ARA-C) HIGH DOSE

CYTARABINE Prof HD Authorised by Myeloid Lead Adam Mead Oct 2019 Version 4.2 1 of 3 CYTARABINE (ARA-C) HIGH DOSE INDICATION Consolidation chemotherapy for AML in remission. Consider dose reduction to 1.5g/m2 for patient ≥60 years old and for patient under 60 years old with co-morbidities at the discretion of clinician and as discussed at the MDT.

  Cytarabine