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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    B    C    D    E    F    G    H    I    J    K    L    M    N    O    P    Q    R    S    T    U    V    W    X    Z    
 
 Non-Covered Drug NameCovered Formulary Alternatives
 
A
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 Aciphexomeprazole dr cap, lansoprazole 30mg, pantoprazole
 Acthar H.P. gel (Major Medical Drug)No suggested alternative
 AcuvailNo suggested alternative
 Allegra 180 mgNo suggested alternative since OTC options available
 Allegra 30 mgNo suggested alternative since OTC options available
 Allegra 60 mgNo suggested alternative since OTC options available
 Allegra D 12hr and 24hrNo suggested alternative since OTC options available
 Alprazolam SRalprazolam regular release tablet
 Ambien CRestazolam, flurazepam, Lunesta, oxazepam, temazepam, triazolam, zaleplon, zolpidem
 Amoxicillin ER (generic for Moxatag)penicillins
 Amrixcyclobenzaprine
 Any drug that has a version available over the counter (OTC)No suggested alternative if available OTC
 AptiomNo suggested alternative
 ArcaptaForadil Aerolizer, Serevent Diskus
 Asmalpred Plusdexamethasone, Prednisone, Medrol
B
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NEWBelviq (lorcaserin)No suggested alternative
 BrintellixNo suggested alternative
NEWBrisdelle (paroxetine capsules)No suggested alternative
C
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 CalomistNo suggested alternative since OTC options available
 Cambiadiclofenac
 Cefditoren Pivoxilcephalosporins
 Cetirizine 5mg & 10mgNo suggested alternative since OTC options available
 Cetraxal Oticciprofloxacin otic
 ClarinexNo suggested alternative since OTC options available
 Clarinex & Clarinex ReditabNo suggested alternative since OTC options available
 Clarinex-DNo suggested alternative since OTC options available
 ClaritinNo suggested alternative since OTC options available
 Corticotropin (Major Medical Drug)No suggested alternative
D
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 DesloratadineNo suggested alternative since OTC options available
 Dexilant (formerly known as Kapidex)omeprazole dr cap, lansoprazole 30mg, pantoprazole
NEWDiclegisNo suggested alternative
 Doryx (doxycycline DR)doxycycline
 Doxycycline DR (generic Doryx)doxycycline
 DuaveeNo suggested alternative
 DuexisNo suggested alternative since OTC options available
E
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 Edluarestazolam, flurazepam, Lunesta, oxazepam, temazepam, triazolam, zaleplon, zolpidem
 ErivedgeNo suggested alternative
 ExalgoNo suggested alternative
F
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NEWFabior AerosolNo suggested alternative
 Famotidine 20 mgNo suggested alternative since OTC options available
NEWFarxigaNo suggested alternative
 FetzimaNo suggested alternative
 Fexofenadine 180 mgNo suggested alternative since OTC options available
 Fexofenadine 30 mgNo suggested alternative since OTC options available
 Fexofenadine 60 mgNo suggested alternative since OTC options available
NEWFinasteride (generic for Propecia)FDA approved for cosmetic use only. No covered formulary alternative.
NEWFulyzaq (crofelemer)No suggested alternative
G
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NEWGattex (teduglutide)No suggested alternative
 Gralise ERgabapentin immediate release
H
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 Horizant & Horizant ERropinirole
I
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 IC400 and IC800 (Ibuprofen - Caffeine - B1 - B2 - B6 - B12) 400mg - 65mg and 800mg - 65mg Combination PackageNo suggested alternative
 Imodium (loperamide)No suggested alternative since OTC options available
 IncrelexSee Growth Hormone Listing
 Injectable B12No suggested alternative
 Injectafer (Major Medical Drug)No suggested alternative
 Intermezzoestazolam, flurazepam, Lunesta, oxazepam, temazepam, triazolam, zaleplon, zolpidem
NEWInvokana (canagliflozin)No suggested alternative
J
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 JentaduetoJanuvia or Onglyza in addition to metformin
NEWJuxtapid (lomitapide)No suggested alternative
K
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NEWKynamro (mipomersen)No suggested alternative
L
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 LatisseFDA approved for cosmetic use only. No covered formulary alternative.
 Lazandafentanyl
 Levocetirizine (generic Xyzal)No suggested alternative
 LimbrelNo suggested alternative
NEWLiptruzetatorvastatin, lovastatin, pravastatin, simvastatin, Crestor, Altoprev, Lescol XL, Zetia
 Livalosimvastatin, Crestor, Lipitor
 LovazaNo suggested alternative
 LystedaNo suggested alternative
M
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 Medical FoodNo suggested alternative
 Metozolv ODTmetoclopramide
 Minocycline ER (generic Solodyn)minocycline
NEWMirvasoNo suggested alternative
 Moxatagpenicillins
N
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NEWNaftin Gel 2%No suggested alternative
NEWNasacort AQ and/or Nasacort Allergy 24HR (OTC)No suggested alternative since OTC options available
 Nexiumomeprazole dr cap, lansoprazole 30mg, pantoprazole
 NiacorNo suggested alternative
 Nizoral Shampoo (ketaconazole)No suggested alternative since OTC options available
 Nutritional SupplementsNo suggested alternative
O
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 Oleptro ERtrazodone
 Omega-3-acid ethyl esters 1 gm (generic for Lovaza)No suggested alternative
 Omeprazole/Sodium Bicarbonate (generic for Zegerid)No suggested alternative since OTC options available
 Onsolisfentanyl
 Orbivanbutalbital/acetaminophen/caffeine
P
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 Pediaderm AF Kitnystatin cream
 Pediaderm TA 0.1% Kittriamcinolone 0.1% cream
 Pepcid 20mg (famotidine 20mg)No suggested alternative since OTC options available
 Pinnacaine Oticantipyrine/benz/glycerin otic
 Prevacid 15 mgNo suggested alternative since OTC options available
 Prilosec OTC brand nameomeprazole dr cap, lansoprazole 30mg, pantoprazole
 PropeciaFDA approved for cosmetic use only. No covered formulary alternative.
 Protonix brand nameomeprazole dr cap, lansoprazole 30mg, pantoprazole
 Pseudoephedrine/Fexofenadine 12hr and 24 hrNo suggested alternative since OTC options available
Q
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 QutenzaNo suggested alternative
R
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NEWRavictiNo suggested alternative
 Renovatretinoin
 ReziraPrescription Cough Syrups + OTC cold/allergy preperations
NEWRiax AerosolNo suggested alternative
 RogaineFDA approved for cosmetic use only. No covered formulary alternative.
 Rozeremestazolam, flurazepam, Lunesta, oxazepam, temazepam, triazolam, zaleplon, zolpidem
 Rybix ODTtramadol
 Ryzolt ERtramadol ER
S
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NEWSelrx Shampoo 2.3%No suggested alternative
 Semprex-DNo suggested alternative since OTC options available
 Silenordoxepin
 Solodynminocycline
 Sprix Nasal SprayKetorolac oral tablets with a quantity limit
NEWStendra (avanafil)No suggested alternative
 Subsysfentanyl
T
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 Tagamet 200mg (cimetidine)No suggested alternative since OTC options available
 TradjentaJanuvia, Onglyza
NEWTretin-X Cream 0.075% CreamNo suggested alternative
 Treximetsumatriptan, naproxen
NEWTrokendi XRtopiramate
U
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NEWUtopic Cream 41%No suggested alternative
V
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 VaniqaFDA approved for cosmetic use only. No covered formulary alternative.
NEWVascepa (icosapent ethyl)No suggested alternative
 Venlafaxine ER Tablets by Upstate PharmaVenlafaxine ER capsules (generic for Effexor XR)
 VimovoNaproxen + either omeprazole, lansoprazole 30mg, or pantoprazole
 Virasal 27.5 %No suggested alternative
 Vosol 2% Oticacetic acid otic
NEWVytone Cream 1-1.9%No suggested alternative
 Vytorinatorvastatin, lovastatin, pravastatin, simvastatin, Crestor, Altoprev, Lescol XL, Zetia
W
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 Weight Loss/Appetite SuppressantsNo suggested alternative
X
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 XyremNo suggested alternative
 XyzalNo suggested alternative
Z
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 Zantac 150mg (ranitidine) OTCNo suggested alternative since OTC options available
NEWZecuitysumatriptan
 ZegeridNo suggested alternative since OTC options available
 Zipsordiclofenac
 Zohydro ERNo suggested alternative
 Zolpidem ER (generic for Ambien CR)estazolam, flurazepam, Lunesta, oxazepam, temazepam, triazolam, zaleplon, zolpidem
NEWZorvolexdiclofenac
 ZutriproPrescription Cough Syrups + OTC cold/allergy preperations
 Zyban brand namebupropion
 ZyclaraNo suggested alternative
 Zyflo CRAccolate, Singulair
 Zyrtec & Zyrtec-DNo suggested alternative since OTC options available