Non-Covered Drug Listing*

What is a Non-Covered drug?

A non-covered drug is a prescription drug reviewed by the Blue Cross of Idaho Pharmacy and Therapeutics Committee and not approved for coverage.

*This is not an all inclusive list of non-covered drugs and not all benefit plans are subject to the Non-Covered Drug List. Please review your member policy or contact customer service if you need assistance.

Covered Formulary Alternatives

This list may not contain all the covered alternatives available on the Blue Cross of Idaho drug formulary. Please use the prescription drug formulary search tool for additional information.

Some brand name medications are available under multiple names. This list may not include all of the brand names that are available for a specific drug.

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A C D E K L N P R S T V X Z

	Non-Covered Drug Name	Covered Formulary Alternatives

A		Return to Top
	Aciphex	omeprazole, Prevacid
	Acthar H.P. gel	No suggested alternative
	Ambien CR	estazolam, flurazepam, Lunesta, oxazepam, temazepam, triazolam, zaleplon, zolpidem
	Amrix	cylobenzaprine
C		Return to Top
	Calomist	cyanocobalamin
	Clarinex & Clarinex Reditab	fexofenadine
	Claritin	fexofenadine
D		Return to Top
	Doryx	doxycycline
E		Return to Top
	Edluar	estazolam, flurazepam, Lunesta, oxazepam, temazepam, triazolam, zaleplon, zolpidem
K		Return to Top
	Kapidex	omeprazole, Prevacid
L		Return to Top
	Latisse	FDA approved for cosmetic use only. No covered formulary alternative.
	Lovaza	No suggested alternative
N		Return to Top
	Nexium	omeprazole, Prevacid
	Niacor	No suggested alternative
P		Return to Top
	pantoprazole	omeprazole, Prevacid
NEW	Prevacid 15 mg	No suggested alternative - available OTC
	Prilosec brand name	omeprazole, Prevacid
	Propecia	FDA approved for cosmetic use only. No covered formulary alternative.
	Protonix	omeprazole, Prevacid
R		Return to Top
	Renova	tretinoin
	Rogaine	FDA approved for cosmetic use only. No covered formulary alternative.
	Rozerem	estazolam, flurazepam, Lunesta, oxazepam, temazepam, triazolam, zaleplon, zolpidem
S		Return to Top
	Savella	Lyrica (Step Therapy Required)
	Semprex-D	Allegra-D
T		Return to Top
	Treximet	sumatriptan, naproxen
V		Return to Top
	Vaniqa	FDA approved for cosmetic use only. No covered formulary alternative.
	Venlafaxine ER tablets	Effexor XR
	Vytorin	lovastatin, pravastatin, simvastatin, Crestor, Lipitor, Altoprev, Lescol XL, Zetia
X		Return to Top
	Xanax XR	alprazolam
	Xyzal	fexofenadine
Z		Return to Top
	Zegerid	omeprazole, Prevacid
	Zyban brand name	bupropion
	Zyflo CR	Accolate, Singulair
	Zyrtec & Zyrtec-D	fexofenadine, Allegra-D

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