Alaska.edu

Premera Blue Cross Maintenance Drug List
Effective As Of 2013
Maintenance drugs are prescriptions commonly used to treat chronic or long-term conditions, such as high blood presssure, heart disease, asthma, and diabetes. These conditions usually require regular, daily use If a generic is available, it is listed in lowercase italics. If no generic is available, the brand name is listed in UPPERCASE. A 30 day supply of a maintenance medication can be filled at a retail pharmacy up to two times without penalty. Any additional refills at a retail pharmacy will be subject to 2 times the applicable retail copay. To avoid this penalty, members can have a 90 day supply of the maintenance medication fulfilled by mail.
l This list does not include all of the many medicines available.
l Your prescription benefit plan is not guaranteed to cover every product or category listed here.
l This list is subject to change.
If you have questions about your prescription benefits, log on to your account at premera.com or call
customer service at the toll-free number on the back of your ID card.
Allergies
Contraceptives/
Hormone Replacement
Alzheimer’s Disease
Blood Modifiers
This document contains references to brand-name prescription drugs that are trademarked or are registered trademarks of pharmaceutical manufacturers not affiliated with Premera Blue Cross.
Premera Blue Cross Maintenance Drug List Continued
Depression
Test Strips/Lancets/Meters
Digestive Enzymes
Heart Disease & High
Blood Pressure
Ace Inhibitors
Diuretics
Diabetes
Combinations
Angiotensin II
Receptor Antagonists
Enlarged Prostate
Antiarrhythmics
Combinations
Glaucoma
This document contains references to brand-name prescription drugs that are trademarked or are registered trademarks of pharmaceutical manufacturers not affiliated with Premera Blue Cross.
Premera Blue Cross Maintenance Drug List Continued
Beta Blockers
Irritable Bowel Syndrome
Osteoporosis
Overactive Bladder
Calcium Channel Blockers
Miscellaneous Cardiovascular
Parkinson’s Disease
Combinations
High Cholesterol
Respiratory Agents
This document contains references to brand-name prescription drugs that are trademarked or are registered trademarks of pharmaceutical manufacturers not affiliated with Premera Blue Cross.
Premera Blue Cross Maintenance Drug List Continued
Ulcer/GERD
Rheumatoid Arthritis
Seizure Disorders
Miscellaneous
This document contains references to brand-name prescription drugs that are trademarked or are registered trademarks of pharmaceutical manufacturers not affiliated with Premera Blue Cross.

Source: https://www.alaska.edu/files/benefits/Maintenance-Drug-list_FINAL_11-2013.pdf