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Selected Maintenance Medications Blue Shield of California Treatment Category BRAND NAME of Selected Maintenance Medication GENE

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Selected Maintenance Medications Blue Shield of California Treatment Category BRAND NAME of Selected Maintenance Medication GENE Selected Maintenance Medications Blue Shield of California BRAND NAME of selected GENERIC NAME of selected Treatment Category maintenance medication maintenance medication Alzheimer's Disease Aricept donepezil hcl Alzheimer's Disease Exelon rivastigmine Alzheimer's Disease Mestinon pyridostigmine bromide Namenda Alzheimer's Disease memantine hcl Namenda XR Alzheimer's Disease Razadyne galantamine hydrobromide Cuprimine Arthritis or Gout penicillamine Depen Arthritis or Gout Leflunomide leflunomide Arthritis or Gout Plaquenil hydroxychloroquine sulfate Arthritis or Gout Probenecid probenecid Arthritis or Gout Ridaura auranofin Arthritis or Gout Uloric febuxostat Arthritis or Gout Zyloprim allopurinol Asthma or COPD Accolate zafirlukast Asthma or COPD Advair fluticasone/salmeterol Aerobid Asthma or COPD flunisolide Aerobid-M Asthma or COPD Alvesco ciclesonide Asthma or COPD Aminophylline aminophylline Asthma or COPD Arcapta Neohaler indacaterol maleate Asthma or COPD Asmanex mometasone furoate Asthma or COPD Atrovent HFA ipratropium bromide Asthma or COPD Azmacort triamcinolone acetonide Asthma or COPD Breo Ellipta fluticasone/vilanterol Asthma or COPD Brovana arformoterol tartrate Combivent Asthma or COPD ipratropium/albuterol sulfate Combivent Respimat Asthma or COPD Daliresp roflumilast Asthma or COPD Dulera mometasone/formoterol Elixophyllin Asthma or COPD Uniphyl theophylline anhydrous Theo-24 Asthma or COPD Flovent fluticasone propionate Asthma or COPD Foradil, Perforomist formoterol fumarate Asthma or COPD Intal cromolyn sodium Asthma or COPD Lufyllin dyphylline Asthma or COPD Pulmicort budesonide Asthma or COPD QVAR beclomethasone dipropionate Asthma or COPD Serevent Diskus salmeterol xinafoate Asthma or COPD Singulair montelukast sodium Asthma or COPD Spiriva tiotropium bromide Asthma or COPD Symbicort budesonide/formoterol fumarate Asthma or COPD Tudorza Pressair aclidinium bromide Asthma or COPD Vospire ER albuterol sulfate Asthma or COPD Zyflo CR zileuton Asthma or COPD Dulera mometasone/formoterol Contraceptives (Birth control) Altavera levonorgestrel/ethinyl estradiol Contraceptives (Birth control) Alyacen norethindrone/ethinyl estradiol Contraceptives (Birth control) Amethyst levonorgestrel/ethinyl estradiol Contraceptives (Birth control) Apri desogestrel/ethinyl estradiol Contraceptives (Birth control) Aranelle norethindrone/ethinyl estradiol Contraceptives (Birth control) Aviane levonorgestrel/ethinyl estradiol desogestrel/ethinyl estradiol, ethinyl Contraceptives (Birth control) Azurette estradiol Contraceptives (Birth control) Balziva norethindrone/ethinyl estradiol drospirenone/ethinyl Contraceptives (Birth control) Beyaz estradiol/levomefolate Contraceptives (Birth control) Brevicon norethindrone/ethinyl estradiol Contraceptives (Birth control) Briellyn norethindrone/ethinyl estradiol Contraceptives (Birth control) Camila norethindrone Contraceptives (Birth control) Caziant desogestrel/ethinyl estradiol Contraceptives (Birth control) Cesia desogestrel/ethinyl estradiol Contraceptives (Birth control) Chateal levonorgestrel/ethinyl estradiol Contraceptives (Birth control) Cryselle norgestrel/ethinyl estradiol Contraceptives (Birth control) Cyclafem norethindrone/ethinyl estradiol Contraceptives (Birth control) Cyclessa desogestrel/ethinyl estradiol Contraceptives (Birth control) Dasetta norethindrone/ethinyl estradiol Contraceptives (Birth control) Desogen desogestrel/ethinyl estradiol Contraceptives (Birth control) Elinest norgestrel/ethinyl estradiol Contraceptives (Birth control) Emoquette desogestrel/ethinyl estradiol Contraceptives (Birth control) Enpresse levonorgestrel/ethinyl estradiol Contraceptives (Birth control) Enskyce desogestrel/ethinyl estradiol Contraceptives (Birth control) Errin norethindrone Contraceptives (Birth control) Estarylla norgestimate/ethinyl estradiol norethindrone/ethinyl estradiol/ferrous Contraceptives (Birth control) Estrostep Fe fumarate Contraceptives (Birth control) Falmina levonorgestrel/ethinyl estradiol norethindrone/ethinyl estradiol/ferrous Contraceptives (Birth control) Femcon Fe fumarate 2 of 16 Effective: 9/2013 norethindrone/ethinyl estradiol/ferrous Contraceptives (Birth control) Generess Fe fumarate Contraceptives (Birth control) Gianvi drospirenone/ethinyl estradiol Contraceptives (Birth control) Gildagia norethindrone/ethinyl estradiol Contraceptives (Birth control) Gildess norethindrone/ethinyl estradiol norethindrone/ethinyl estradiol/ferrous Contraceptives (Birth control) Gildess Fe fumarate Contraceptives (Birth control) Heather norethindrone Contraceptives (Birth control) Jencycla norethindrone Contraceptives (Birth control) Jolivette norethindrone Contraceptives (Birth control) Junel norethindrone/ethinyl estradiol norethindrone/ethinyl estradiol/ferrous Contraceptives (Birth control) Junel Fe fumarate desogestrel/ethinyl estradiol, ethinyl Contraceptives (Birth control) Kariva estradiol Contraceptives (Birth control) Kelnor 1-35 ethynodiol/ethinyl estradiol Contraceptives (Birth control) Kurvelo levonorgestrel/ethinyl estradiol Contraceptives (Birth control) Leena norethindrone/ethinyl estradiol Contraceptives (Birth control) Lessina levonorgestrel/ethinyl estradiol Contraceptives (Birth control) Levlen 28 levonorgestrel/ethinyl estradiol Contraceptives (Birth control) Levonest levonorgestrel/ethinyl estradiol Contraceptives (Birth control) Levora-28 levonorgestrel/ethinyl estradiol Contraceptives (Birth control) Loestrin norethindrone/ethinyl estradiol norethindrone/ethinyl estradiol/ferrous Contraceptives (Birth control) Loestrin 24 Fe fumarate norethindrone/ethinyl estradiol/ferrous Contraceptives (Birth control) Loestrin Fe fumarate norethindrone/ethinyl estradiol/ferrous Contraceptives (Birth control) Lo Loestrin FE fumarate norethindrone/ethinyl estradiol/ferrous Contraceptives (Birth control) Lo Minastrin Fe fumarate Contraceptives (Birth control) Lo-Ovral-28 norgestrel/ethinyl estradiol Contraceptives (Birth control) Loryna drospirenone/ethinyl estradiol Contraceptives (Birth control) Low-Ogestrel norgestrel/ethinyl estradiol Contraceptives (Birth control) Lutera levonorgestrel/ethinyl estradiol Contraceptives (Birth control) Lybrel levonorgestrel/ethinyl estradiol Contraceptives (Birth control) Marlissa levonorgestrel/ethinyl estradiol Contraceptives (Birth control) Microgestin norethindrone/ethinyl estradiol norethindrone/ethinyl estradiol/ferrous Contraceptives (Birth control) Microgestin Fe fumarate Contraceptives (Birth control) Micronor norethindrone 3 of 16 Effective: 9/2013 norethindrone/ethinyl estradiol/ferrous Contraceptives (Birth control) Minastrin 24 Fe fumarate desogestrel/ethinyl estradiol, ethinyl Contraceptives (Birth control) Mircette estradiol Contraceptives (Birth control) Modicon norethindrone/ethinyl estradiol Contraceptives (Birth control) Mono-linyah norgestimate/ethinyl estradiol Contraceptives (Birth control) Mononessa norgestimate/ethinyl estradiol Contraceptives (Birth control) Myzilra levonorgestrel/ethinyl estradiol estradiol valerate, dienogest/estradiol Contraceptives (Birth control) Natazia valerate, estradiol valerate Contraceptives (Birth control) Necon 0.
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