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