Drugs that are Not Covered* Current 10/1/21 In addition to this list, newly marketed prescription medications may not be covered until the Pharmacy & Therapeutics Committee has had an opportunity to review the medication, to determine whether the medication will be covered and if so, which tier will apply based on safety, efficacy and the availability of other products within that class of medications. The current list of newly marketed drugs can be found on our New to Market Drug list.
Abilify tablets albuterol HFA inhalers (authorized Apexicon E cream Abilify MyCite tablets generics for ProAir, Proventil, Ventolin Apidra vials Absorica capsules HFA inhalers) Apidra SoloStar injection Absorica LD capsules Aldactone tablets Aplenzin tablets Abstral sublingual tablets Aldara cream Apriso capsules Acanya gel and pump gel Alkindi sprinkle capsules Arava tablets Accupril tablets Allegra Children’s Allergy ODT Arazlo lotion acetaminophen 320.5 mg/caffeine 30 Allegra ODT, suspension and tablets Arestin microspheres mg/dihydrocodeine 16 mg Alltizal tablets Aricept tablets capsulesAciphex tablets alogliptin (authorized generic for Aricept ODT Aciphex Sprinkle capsules Nesina) Arimidex tablets Acticlate tablets alogliptin/metformin tablets (authorized Arixtra injection Active-Prep kits generic for Kazano) ArmonAir Digihaler inhaler Activella tablets alogliptin/pioglitazone (authorized ArmonAir Respiclick inhaler Actonel tablets generic for Oseni) Aromasin tablets Actoplus Met tablets Alphagan P 0.1% eye drops Arthrotec 50 and 75 tablets Actos tablets Altace capsules Asacol HD tablets Acuvail eye drops Altoprev tablets aspirin/omeprazole DR tablets acyclovir 5% topical cream Altreno lotion (authorized generic for Yosprala) Aczone 5% and 7.5% gels Alvesco inhaler Astepro 0.15% nasal spray adapalene 0.1% lotion Amaryl tablets Arymo ER tablets adapalene 0.1% pads Ambien tablets Atacand tablets adapalene 0.1% topical solution Ambien CR tablets Atelvia tablets (authorized generic for Plixda) amcinonide 0.1% cream and ointment Ativan tablets Adasuve inhalation powder Amerge tablets Atralin gel Adcirca tablets Amicar tablets Aurovela 24 Fe tablets Adderall tablets Amitiza capsules Auryxia tablets Adderall XR capsules amlodipine/atorvastatin tablets Auvi-Q injection Adhansia XR capsules amphetamine ER oral suspension Avalide tablets Adlyxin injection (authorized generic for Adzenys ER) Avandia tablets Admelog vials amphetamine sulfate tablets Avapro tablets Admelog SoloStar injection (authorized generic for Evekeo) Avidoxy DK kit Adoxa tablets Ampyra tablets Avodart capsules Adoxa Pak tablets Amrix ER capsules Azasan tablets Adrenaclick injection Amzeeq foam Azasite eye drops Adrenalin nasal spray Anafranil capsules azelastine 0.15% nasal spray Adzenys ER oral suspension Ana-Lex kit azelastine/fluticasone nasal spray Adzenys XR tablets Analpram Advanced kit Azelex cream Aerospan inhaler Analpram E kit Azilect tablets Aggrenox capsules Androderm patches azithromycin 1% eye drops AirDuo Digihaler inhaler AndroGel 1% and 1.62% gel Azopt eye drops AirDuo RespiClick inhaler Android capsules Azor tablets Ajovy injection Annovera vaginal ring baclofen 5 mg tablets Aklief cream Anodyne LPT kit Baclofen 2% in MaxDerm Base kit Aktipak gel Antara capsules Bactroban cream Ala-Scalp lotion Apadaz tablets Bafiertam capsules
If available, a generic version of a listed brand product is covered unless the generic is also listed (e.g., Abilify tabs are excluded but aripiprazole tabs are covered) *Please check member benefit documentation to determine inclusion in the Drugs Not Covered program.
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association
Drugs that are Not Covered*
Balcoltra tablets Capex shampoo clindamycin/tretinoin gel Baraclude tablets captopril-hydrochlorothiazide tablets clobetasol foams, liquids, lotions, and Beconase AQ nasal spray Carac cream shampoos Belsomra tablets Carafate oral suspension Clobex lotion, shampoo, and spray Benicar tablets Carafate tablets Clodan kit and shampoo Benicar HCT tablets carbinoxamine 6 mg tablet clotrimazole/betamethasone BenzaClin gel and gel pump Cardizem tablets dipropionate 1-0.05% lotion benzhydrocodone/acetaminophen Cardizem CD capsules Clozaril 100 mg tablet tablets (authorized generic for Apadaz) Cardizem LA 180, 240, 300, 360, and Colazal capsules benzoyl peroxide foams, kits, pledgets, 420 mg tablets colchicine capsules (authorized generic and washes Cardura tablets for Mitigare) benzonatate 150 mg capsules Cardura XL tablets Colcrys tablets Besivance eye drops carisoprodol tablets Coly-Mycin S ear drops betamethasone valerate 0.12% foam carisoprodol/ASA tablets Combigan eye drops Betapace tablets carisoprodol/ASA/codeine tablets Concerta tablets Betimol 0.25% and 0.5% eye drops CaroSpir oral suspension Conjupri tablets Betoptic S eye drops Casodex tablets Consensi tablets BI-EST progesterone compounding kit Catapres TTS patches Conzip capsules Blisovi 24 Fe tablets Cefaclor ER 500 mg tablet Copaxone injection Boniva tablets Celebrex capsules Cordran cream, lotion, and ointment brinzolamide eye drops Celexa tablets Coreg tablets Brisdelle capsules cephalexin tablets Coreg CR capsules BromSite eye drops Cervidil vaginal insert Coremino ER tablets Bryhali lotion chlordiazepoxide/clidinium capsules Cortef tablets budesonide-formoterol fumarate chlorzoxazone 250 mg tablet Cortisporin-TC ear drops inhalation aerosol (authorized generic chlorzoxazone 375 mg tablet Cosopt eye drops for Symbicort) chlorzoxazone 500 mg tablet (Axis Cosopt PF eye drops Bunavail buccal film brand ONLY) Cotempla XR-ODT Bupap tablets chlorzoxazone 750 mg tablet Cozaar tablets Buphenyl powder for solution Ciclodan 8% solution kit Crestor tablets buprenorphine patches (the authorized Ciclopirox 8% solution kit Crinone 8% vaginal gel generic for Butrans only) Ciloxan eye ointment Cuprimine capsules bupropion 450 mg ER tablet cimetidine tablets Cutaquig injection butalbital 50 mg/acetaminophen 300 Cipro oral suspension Cutivate 0.05% lotion mg capsules and tablets Cipro tablets Cuvitru injection butalbital 50 mg/acetaminophen 300 Clarinex tablets cyclobenzaprine 7.5 mg tablets mg/caffeine 40 mg capsules Clarinex-D tablets Cyclobenzaprine 2% in Microderm butalbital 50 mg/acetaminophen 325 clemastine oral syrup external cream compounding kit mg/caffeine 40 mg capsules Clenpiq oral solution Cyclobenzaprine 5% compounding kit Butrans patches Cleocin-T gel Cymbalta capsules Byetta injection Climara patches Cytomel tablets Caduet tablets Clindacin ETZ pledget kit Daklinza tablets calcipotriene/betamethasone Clindacin PAC pledget kit dapsone 5% gel dipropionate ointment Clindagel gel Daytrana patches calcipotriene/betamethasone clindamycin 1% gel (the authorized Dayvigo tablets dipropionate topical suspension generic for Clindagel only) DDAVP nasal spray (authorized generic for Taclonex) clindamycin 1.2%/benzoyl peroxide 5% DDAVP tablets Cambia powder packets gel and pump gel Demerol tablets Canasa suppositories clindamycin foam Demser capsules
If available, a generic version of a listed brand product is covered unless the generic is also listed (e.g., Abilify tabs are excluded but aripiprazole tabs are covered) *Please check member benefit documentation to determine inclusion in the Drugs Not Covered program.
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association
Drugs that are Not Covered*
DermacinRx – all products doxycycline monohydrate 150 mg Exalgo tablets Dermasorb kits tablet Exforge HCT tablets desloratadine ODT Drizalma Sprinkle capsules Exforge tablets Desonate gel droxidopa capsule Extavia injection desonide 0.05% gel Duaklir Pressair inhaler Extina foam desonide 0.05% lotion Duetact tablets Eysuvis eye drops DesOwen cream kit Duexis tablets Ezallor Sprinkle capsules desoximetasone 0.05% cream and duloxetine 40 mg enteric-coated Fabior foam ointment (authorized generic for capsules (generic for Irenka) Falessa kit Topicort) Duobrii lotion Femara tablets desvenlafaxine ER tablets (authorized Duragesic patches Femring vaginal ring generic for Khedezla) Durlaza capsules fenofibrate 40 and 120 mg tablets Detrol tablets Dutoprol tablets fenofibrate 50 and 150 mg capsules Detrol LA capsules Dyanavel XR oral suspension (authorized generic for Lipofen) dexamethasone 1.5 mg 6-day, 10-day, Dymista nasal spray fenofibric acid tablets (authorized and 13-day blister packs Dxevo tablets generic for Fibricor) dexchlorpheniramine oral syrup EC-Naprosyn tablets Fenoglide tablets (authorized generic for RyClora) EC-naproxen tablets fenoprofen 200 and 400 mg capsules Dexedrine Spansule Ecoza foam Fenortho 200 and 400 mg capsules Dexilant capsules Edarbi tablets fentanyl 37.5, 62.5, and 87.5 mcg DexPac 6-Day, 10-Day, and 13-Day Edarbyclor tablets patches blister packs Edluar sublingual tablets fentanyl buccal tablets (authorized dextroamphetamine 15 mg, 20 mg and Effexor XR capsules generic for Fentora) 30 mg tablets Effient tablets Fentora buccal tablets diclofenac 1% topical gel Elavil tablets Ferriprox Twice-a-Day tablets diclofenac 3% gel Elepsia XR tablets Fexmid tablets diclofenac epolamine patch Elidel cream Fibricor tablets diclofenac sodium ER 100 mg tablet Elocon cream Finacea foam Differin 0.1% cream, gel, and lotion fumarate tablet Fioricet capsules and tablets Differin 0.3% gel and gel pump Empricaine cream kit Fioricet with Codeine capsules diflorasone cream and ointment Enstilar foam Fiorinal capsules Diflucan tablets Entocort EC capsules Fiorinal with Codeine capsules Dilaudid tablets Epiduo Forte gel Firazyr injection Diovan tablets EpiPen injection Firdapse tablets Diovan HCT tablets EpiPen Jr injection Flector topical patches Dipentocaine cream compounding kit EPIsnap kit Flomax capsules Dipentum capsules Ergomar sublingual tablets Flonase nasal spray diphenhydramine elixir Esgic tablets Flolipid oral suspension Ditropan XL tablets esomeprazole magnesium 20 mg fluocinonide 0.1% cream Doral tablets capsules fluorouracil 0.5% cream (authorized Doryx tablets esomeprazole strontium capsules generic of Carac) Doryx MPC tablets Estrostep Fe tablets fluoxetine tablets doxycycline (all non-generic products) Eucrisa ointment flurandrenolide cream, lotion, and doxycycline biphasic-release 40 mg Evekeo ODT ointment capsule Evekeo tablets fluticasone propionate lotion doxycycline hyclate 50 mg tablets Evista tablets fluvoxamine ER capsules (generic for Targadox) Evoclin foam Focalin XR capsules doxycycline monohydrate 75 and 150 Evoxac capsules Forfivo XL tablets mg capsules Evzio 2 mg/0.4 mL autoinjector formoterol nebulizer solution
If available, a generic version of a listed brand product is covered unless the generic is also listed (e.g., Abilify tabs are excluded but aripiprazole tabs are covered) *Please check member benefit documentation to determine inclusion in the Drugs Not Covered program.
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association
Drugs that are Not Covered*
Fortamet tablets hydrocodone/acetaminophen 5-300 Kadian capsules Fortesta gel mg, 7.5-300 mg, 10-300 mg tablets Kapspargo Sprinkle capsules Fosamax Plus D tablets hydrocodone bitartrate ER 24 hr abuse Kapvay tablets Frova tablets deterrent (generic Hysingla ER) Karbinal ER oral suspension Gastrocrom oral solution hydrocortisone butyrate lipid cream Katerzia oral suspension Gelnique gel and gel pump (lipocream) Kazano tablets Gemtesa tablets hydrocortisone butyrate lotion K.B.G.L. in TeroDerm cream kit Genotropin injection hydromorphone ER tablets (generic for Keflex capsules Geodon capsules Exalgo) Kenalog topical spray Gimoti nasal spray Hysingla ER tablets Kerydin topical solution Glatopa injection Hyzaar tablets ketoconazole foam Gleevec tablets Ibudone tablets Ketodan foam Gloperba oral solution Ibuprofen Comfort Pac ketoprofen 25 mg capsules Glucophage tablets imipramine pamoate capsules ketorolac nasal spray tablets imiquimod 3.75% cream pump Khedezla tablets Glucotrol tablets imiquimod 3.75% cream Klonopin tablets Glucotrol XL tablets Imitrex injection, nasal spray, and Klor-Con 20 mEq powder packets Glumetza tablets tablets Kombiglyze XR tablets Glycate tablets Imitrex Statdose injection Kristalose powder packets glycopyrrolate 1.5 mg tablets Impeklo lotion lactulose powder packets Gocovri capsules Impoyz cream Lamisil AT spray GoNitro sublingual powder packets Inderal LA capsules lancets (certain high-cost Gralise tablets Inderal XL capsules manufacturers not covered) Granix injection Indocin suppositories lansoprazole 15 mg capsules Hailey 24 Fe tablets Incodin suspension lansoprazole ODT Halcion tablets indomethacin 20 mg capsules lansoprazole/amoxicillin/clarithromycin halobetasol propionate 0.05% foam (authorized generic for Tivorbex) triple therapy blister pack (generic for (authorized generic for Lexette) Innopran XL capsules Prevpac)Larin 24 Fe tablets halobetasol propionate 0.05% ointment Inova pads Lazanda nasal spray Halog cream Inspra tablets Lescol XL tablets Hemady tablets insulin lispro KwikPen injection levalbuterol inhaler Hemangeol 4.28 mg/mL oral solution (authorized generic for Humalog) levorphanol 3 mg tablets Hepsera tablet insulin lispro vials (authorized generic levocetirizine oral solution Horizant ER tablets for Humalog) Lexapro tablets Humalog vials Intermezzo sublingual tablets Lexette foam Humalog Junior KwikPen injection Intuniv tablets Lialda tablets Humalog KwikPen injection Inveltys eye drops Librax capsules Humalog KwikPen Mix 50/50 injection Ionsys transdermal system Licart 1.3% patch Humalog KwikPen Mix 75/50 injection Irenka capsules lidocaine 2% mucosal/urethral gel and Humalog Mix 50/50 vials Isordil tablets prefilled syringe Humalog Mix 75/25 vials isotretinoin 25 mg capsules lidocaine 5% ointment Humatrope injection isotretinoin 35 mg capsules lidocaine HCl 3% lotion Humulin 70/30 vials Istalol eye drops lidocaine/hydrocortisone kits Humulin 70/30 KwikPen injection Jatenzo capsules lidocaine/prilocaine kits Humulin N vials Jentadueto tablets lidocaine/tetracaine cream Humulin N KwikPen injection Jentadueto XR tablets Lidoderm patch Humulin R 100 units/mL vials Jornay PM capsules Linzess capsules Hycet oral solution Jublia topical solution Lipitor tablets Junel Fe 24 tablets Lipofen capsules
If available, a generic version of a listed brand product is covered unless the generic is also listed (e.g., Abilify tabs are excluded but aripiprazole tabs are covered) *Please check member benefit documentation to determine inclusion in the Drugs Not Covered program.
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association
Drugs that are Not Covered*
Locoid cream and lotion metoclopramide ODT Namenda XR capsules Locoid lipocream metoprolol succinate/ Namzaric ER capsules/titration pack Loestrin 1.5/30 21-day tablets hydrochlorothiazide tablets Naprelan tablets Loestrin 1/20 21-day tablets Metozolv ODT Naprosyn oral suspension Loestrin Fe 1/20 28-day tablets MetroCream 0.75% cream Naproxen Comfort Pac Lofibra 160 mg tablet metyrosine capsules naproxen DR tablets Lomedia 24 Fe tablets Mibelas 24 Fe chewable tablets naproxen oral suspension Lonhala Magnair inhalation solution Micardis tablets naproxen sodium ER / CR tablets Loprox cream kit Micardis HCT tablets (generic for Naprelan) Loprox shampoo MiCort-HC cream naproxen/esomeprazole magnesium Lortab elixir Microgestin 24 tablet FE 1/20 delayed-release tablets Lorzone tablets Migranal nasal spray Nasacort Allergy 24HR nasal spray LoSeasonique tablets Millipred oral solution and tablets Nasacort AQ nasal spray Lotrel capsules Millipred DP tablet packs Nascobal nasal spray Lotronex tablets Minastrin 24 Fe chewable tablets Nasonex nasal spray Lovaza capsules Minivelle patches Natesto nasal gel Lovenox injections Minocin capsules Neomycin/polymyxin/hydrocortisone luliconazole cream (authorized generic minocycline ER tablets suspension eye drops for Luzu) minocycline 50 mg, 75 mg, and 100 mg Nesina tablets Lunesta tablets tablets Neuac kit Luxiq foam Minolira tablets Neupogen injection Luzu cream Mirapex tablets Nevanac eye drops Lyrica capsules Mirapex ER tablets Nexium capsules Lyrica CR tablets Mircette 28-day tablets Nexium 10 mg, 20mg, and 40 mg Lyumjev vials 100 units/mL Mirvaso gel and gel pump granules Lyumjev Kwikpen 100 units/mL Mitigare 0.6 mg capsule Niacor tablets Lyumjev Kwikpen 200 units/mL Mobic tablets Niaspan tablets Malarone tablets mometasone nasal spray Niravam ODT Malarone Pediatric tablets Mondoxyne NL capsules Nocdurna sublingual tablets Marinol capsules Monodox capsules Noctiva nasal spray Maxalt tablets montelukast oral granules packet Nolix cream and lotion Maxalt MLT tablets Morgidox capsules and kits Norco tablets Melodetta 24 Fe chewable tablets Morphabond ER tablets norethindrone acetate 1 mg/ethinyl Medolor Pak kit morphine sulfate ER capsules (generic estradiol 20 mcg/ferrous fumarate (24) mefenamic acid 250 mg capsules for Kadian) chewable tablets meloxicam capsules (authorized Motegrity tablets Norgesic Forte tablets generic for Vivlodex) Motofen tablets Noritate cream memantine ER capsules Moxeza 0.5% eye drops Northera capsules meperidine tablets MS Contin tablets Norvasc tablets meprobamate tablets mupirocin 2% cream Nucynta IR tablets mesalamine enema kit Mydayis capsules Nudroxipak kits Mestinon syrup and tablets Mysoline tablets Nutropin AQ injection metformin ER (generic Fortamet) naftifine cream Nuvessa gel metformin ER (generic Glumetza) Naftin cream and gel Nuvigil tablets methotrexate 2.5 mg tablet Nalfon 200 mg capsules Obredon oral solution (antirheumatic version only) Nalfon 400 mg capsules Okebo capsules methylphenidate ER capsules (generic Nalfon 600 mg tablets olanzapine/fluoxetine capsules for Aptensio XR only) Nalocet tablets olopatadine 0.2% eye drops methylphenidate 72 mg ER tablets Namenda tablets Olux foam
If available, a generic version of a listed brand product is covered unless the generic is also listed (e.g., Abilify tabs are excluded but aripiprazole tabs are covered) *Please check member benefit documentation to determine inclusion in the Drugs Not Covered program.
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association
Drugs that are Not Covered*
Olux E foam paroxetine ER tablets Prinivil tablets Omeclamox-Pak blister packet Pataday eye drops Pristiq tablets Omega-3/D-3 kit Patanase nasal spray ProAir Digihaler inhaler omeprazole/sodium bicarbonate Patanol eye drops Proair HFA inhaler capsules and powder for suspension Paxil tablets Proair Respiclick inhaler (generic Zegerid) Paxil CR tablets Procardia XL tablets Omnaris nasal spray Pazeo eye drops Proctocort rectal cream Omnitrope injection penicillamine capsules Progesterone in HRT 10% cream Onexton gel Penlac nail lacquer compounding kit Ongentys capsules Pennsaid 2% solution Prolate oral solution Onglyza tablets Pentasa capsules Prolate tablets Onmel tablets Percocet tablets Prolensa eye drops Onzetra Xsail nasal powder Perforomist nebulizer solution Prometrium capsules Opana ER tablets Pertzye capsules Promiseb Complete kit Opana tablets Pexeva tablets Prostin E-2 vaginal suppository Oracea capsules phendimetrazine tablets Protonix granules for suspension and Oralair sublingual tablets Phexxi gel tablets Orapred ODT disintegrating tablets Physicians EZ Use B-12 Compliance Protopic ointment Orbivan capsules Injection Kit Proventil HFA inhaler Orphengesic Forte tablets pioglitazone/glimepiride tablets Provigil tablets Ortho Tri-Cyclen Lo 28-day tablets Plavix tablets Prozac capsules Ortikos capsules Plexion 9.8%-4.8% cleansing clothes Prozac Weekly capsules Oseni tablets Pliaglis cream Psorcon cream Osmolex ER tablets Plixda topical solution Pulmicort Flexhaler inhaler OsmoPrep tablets Ponstel capsules Pulmicort Respules Otovel ear drops Port-Prep kit Pylera blister packet Ovace 10% liquid wash potassium chloride (KCl) 20 mEq pyridostigmine 30 mg tablets Ovace Plus 9.8% foam and lotion powder packets Qbrelis oral solution Ovace Plus 10% gel and liquid wash Praluent injection Qbrexza topical cloth Ovcon-35 tablets Pramosone cream Qdolo oral solution Ovcon-50 tablets Prandin tablets Qelbree capsules Oxaydo tablets Pravachol tablets Qmiiz ODT Oxecta tablets Pred Forte eye drops Qnasl nasal spray Oxistat cream and lotion pregabalin ER Qnasl Children’s nasal spray oxycodone ER tablets (authorized prenatal vitamins (certain products only Quartette extended-cycle tablets generic for OxyContin) - see Appendix A) Quazepam tablets oxycodone/acetaminophen 5-300, Prepidil vaginal gel ranitidine (all dosage forms) 10-300 mg tablets Prestalia tablets Rasuvo autoinjectors oxycodone/acetaminophen oral Prevacid capsules Rayaldee capsules solution 10-300 mg/5ml Prevacid 24H capsules Rayos tablets OxyContin tablets Prevacid Solutab tablets Relador Pak kit oxymorphone ER tablets Prevpac blister packet Relador Pak Plus kit oxymorphone tablets Prikaan kits Relexxii tablets Oxytrol patch Prilolid kits Relistor injection and tablets Oxytrol for Women patch Prilovix kits Relafen DS tablets Ozobax oral solution Priloxx LP kits Relpax tablets Pancreaze capsules Prilosec capsules and granules for Reltone capsules Pancelipase 5,000 unit DR capsule suspension Remeron tablets Pandel cream Primlev tablets Remeron Soltab tablets
If available, a generic version of a listed brand product is covered unless the generic is also listed (e.g., Abilify tabs are excluded but aripiprazole tabs are covered) *Please check member benefit documentation to determine inclusion in the Drugs Not Covered program.
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association
Drugs that are Not Covered*
Renvela powder packets and tablets Solodyn tablets Tivorbex capsules Reprexain tablets Soma tablets tizanidine capsules Requip XL tablets Sorilux foam Tizanidine Comfort Pac kit Restoril capsules Sotilyze oral solution Tobi nebulizer solution Retin-A creams Spritam ODT Tofranil tablets Retin-A Micro gel and gel pump Sprix nasal spray Tofranil PM capsules Revatio tablets Steglujan tablets Tolsura capsules Rhinocort AQ nasal spray Strattera capsules Topicort 0.05% cream and ointment Rhofade cream Striant buccal system Topicort spray Riax foam Suboxone oral film Tosymra nasal spray Rilutek tablet Subsys sublingual spray Toviaz tablets Riomet oral solution sucralfate oral suspension Tradjenta tablets Riomet extended release oral sumatriptan/naproxen sodium tablets tramadol ER capsules suspension Sumavel Dosepro injection tramadol IR 100 mg tablets Risperdal oral solution and tablets Symbyax capsules Tranxene T-Tab tablets Risperdal M-Tab ODT Synalar cream, ointment, and topical trazodone 300 mg tablets Ritalin LA capsules solution Tretin-X cream Rosadan gel kit Synalar cream kit tretinoin microsphere gel Roszet tablets Synalar TS kit tretinoin 0.05% gel Rowasa enema kit Synalgos-DC capsules Trexall tablets Roxicodone tablets Syndros oral solution Treximet tablets RoxyBond tablets Taclonex ointment and topical Trezix 320.5-30-16 mg capsules RyClora oral solution suspension triamcinolone 0.05% ointment Rytary capsules Talicia capsules Trianex ointment Rythmol SR capsules TaperDex 6-Day and 12-Day blister triazolam tablets RyVent tablets packs Tribenzor tablets Ryzolt tablets Targadox tablets Tridesilon cream Saizen injection Tarina 24 Fe tablets Triglide tablets Samsca 30 mg tablets tavaborole topical solution Trilipix capsules Sanctura tablets Taytulla capsules Tudorza Pressair inhaler Sarafem tablets Tazorac 0.1% cream TussiCaps capsules Savaysa tablets Tecfidera capsules Tuxarin ER tablets Seebri Neohaler inhaler Tekturna HCT tablets Tuzistra XR oral suspension Semglee pen injection Tenormin tablets Twirla patches Semglee vials Testim gel Tyzine Pediatric 0.05% nasal drops Semprex-D capsules Testone CIK kit Uceris rectal foam Sernivo topical spray testosterone 1% gel and gel pump Uceris tablets Seroquel tablets (generics for Testim and Vogelxo Uloric tablets Seroquel XR tablets ONLY) Ultracet tablets Seysara tablets testosterone 2% (10 mg/actuation) gel Ultram tablets Siklos tablets (generic for Fortesta) Ultram ER tablets Singulair chewable tablets, granules, testosterone 30 mg buccal tablet Ultravate cream and tablets Testred capsules Ultravate lotion Sitavig buccal tablet Texacort topical solution Ultravate ointment Skelaxin tablets Tiazac capsules Ultravate X kit Solaraze 3% gel Tikosyn capsules Uroxatral tablets Solosec oral granules Timoptic Ocudose eye drops Urso 250 tablets Soluline kit Tirosint capsules Urso Forte tablets SoluPICC kit Tirosint-Sol oral solution Utibron Neohaler inhaler
If available, a generic version of a listed brand product is covered unless the generic is also listed (e.g., Abilify tabs are excluded but aripiprazole tabs are covered) *Please check member benefit documentation to determine inclusion in the Drugs Not Covered program.
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association
Drugs that are Not Covered*
Valcyte oral solution and tablets Xepi cream Zylet eye drops Valium tablets Xerese cream Zyloprim tablets Valtrex tablets Ximino capsules Zypitamag tablets Vanatol LQ oral solution Xodol tablets Zyprexa IntraMuscular injection Vanatol S oral solution Xolegel CorePak, Duo Kit, and topical Zyprexa tablets vancomycin 250 mg/5 mL oral solution gel Zyprexa Zydis ODT Vanos cream Xopenex nebulizer solution Zytiga 250 mg and 500 mg tablets Vaseretic tablets Xopenex HFA inhaler Zyvox oral suspension and tablets Vasotec tablets Xyosted autoinjector Veltin gel Yosprala tablets venlafaxine ER tablets Yupelri nebulizer solution Veramyst nasal spray Zanaflex capsules Verdeso foam Zafemy patch Veregen ointment Zecuity transdermal system Vesicare LS oral suspension Zegerid capsules and powder for Vibramycin capsules and powder for suspension suspension Zelapar ODT Vicodin tablets Zelnorm tablets Vicodin ES tablets Zembrace SymTouch injection Vicoprofen tablets Zenzedi 2.5 mg, 7.5 mg, 15 mg, 20 mg Viekira Pak tablets and 30 mg tablets Vigamox eye drops Zepatier tablets Vimovo tablets Zestoretic tablets Viokace tablets Zestril tablets Vivelle Dot patches Zetia tablets Vivlodex capsules Zetonna nasal spray Vogelxo gel and gel pump Ziac tablets Voltaren 1% topical gel Ziana gel Vumerity capsules Zilxi foam Vusion ointment Zinbryta injection Vytorin tablets Zipsor capsules Vyzulta eye drops Zithromax tablets Welchol tablets Zocor tablets Wellbutrin tablets Zofran ODT Wellbutrin SR tablets Zofran tablets Wellbutrin XL tablets Zohydro ER capsules Winlevi cream Zoloft tablets Wymzya Fe chewable tablet zolpidem sublingual tablets Wynzora cream Zolpimist oral spray Xadago tablets Zomacton injection Xalatan eye drops Zomig tablets Xanax tablets Zomig-ZMT ODT Xanax XR tablets Zorbtive injection Xartemis XR tablets Zorvolex capsules Xatmep oral solution Zovirax cream and ointment Xeloda tablets ZTlido patch Xelpros eye drops Zuplenz oral film Xembify injection Zyclara cream and cream pump Xenazine tablets Zyflo tablets
If available, a generic version of a listed brand product is covered unless the generic is also listed (e.g., Abilify tabs are excluded but aripiprazole tabs are covered) *Please check member benefit documentation to determine inclusion in the Drugs Not Covered program.
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association
Drugs that are Not Covered*
Appendix A: Excluded Prenatal VitaMedMD Rx RediChew Rx Vitamins Vitapearl Azeschew Vitatrue Azesco CitraNatal Assure CitraNatal Bloom CitraNatal DHA CitraNatal Harmony Duet DHA 400 Duet DHA Balanced Enbrace HR Kosher Prentate Plus Iron Natachew Neevo DHA Nestabs ABC Nestabs DHA Nestabs One OB Complete Gold OB Complete One OB Complete Petite OB Complete Premier Prefera OB One Pregen DHA PreGenna Prenara Prenate Prenate AM Prenate DHA Prenate Elite Prenate Enhance Prenate Essential Prenate Mini Prenate Pixie Prenate Restore Prenatrix Primacare Select-OB Select-OB + DHA Trinaz Tristart DHA Tristart Free Tristart One Vitafol Gummies Vitafol Ultra Vitafol Nano Vitafol-OB Vitafol-OB+ DHA Vitafol-One VitaMedMD One Rx
If available, a generic version of a listed brand product is covered unless the generic is also listed (e.g., Abilify tabs are excluded but aripiprazole tabs are covered) *Please check member benefit documentation to determine inclusion in the Drugs Not Covered program.
Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association