B

PA = Prior Authorization is required; QL = Quantity limits apply; ST = Step Therapy applies; 
RD = Specialty Formulary, please refer to Specialty Pharmacy Program section for additional information;
OTC = Over-the-counter Product, may be covered if a prescription is written, and it is filled at a retail or mailorder pharmacy

Medications written in all CAPITAL letters are Brand names.
Medications written in all lower case letters are available generically. The brand name is listed in parenthesis for reference only.


B
bacitracin
bacitracin/polymyxin b (Polysporin)
baclofen (Lioresal)
balsalazide (Colazal)
balziva (Ovcon-35)
BANZEL
BARACLUDE, RD
BAYER BREEZE2
BAYER CONTOUR
belladonna/phenobarbital (Donnatal)
benazepril (Lotensin)
benazepril/amlodipine (Lotrel)
benazepril/hydrochlorothiazide (Lotensin HCT)
BENZACLIN
benzonatate (Tessalon)
benzoyl peroxide (Brevoxyl)
benzoyl peroxide/clindamycin (Benzaclin, Duac)
benzoyl peroxide/hydrocortisone
benztropine (Cogentin)
betamethasone dipropionate cream/gel/lotion/oint, 0.05% (Diprosone, Diprolene)
betamethasone valerate cream/lotion/oint, 0.1% (Valisone) 
BETASERON, QL, RD
betaxolol (Kerlone)
bethanechol (Urecholine)
BETOPTIC S
bicalutamide (Casodex)
bisoprolol (Zebeta)
bisoprolol/ hydrochlorothiazide (Ziac)
BLEPHAMIDE
BRAVELLE, reproductive specialist only, RD
brevicon (Modicon)
brimonidine (Alphagan, Alphagan P)
bromocriptine (Parlodel)
brompheniramine/codeine soln (Nalex AC)
brompheniramine/dihydrocodeine/phenylephrine (Poly-Tussin DHC)
BROVANA, age > 40, QL
budesonide neb soln (Pulmicort)
bumetanide (Bumex)
buprenorphine (Subutex), PA 
bupropion (Wellbutrin)
bupropion extended release (Wellbutrin SR, Wellbutrin XL) 
bupropion extended release (Zyban), QL
buspirone (Buspar)
butalbital/acetaminophen (Phrenilin)
butorphanol (Stadol NS), QL
BYETTA, QL


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