CareFirst Prescription Drug Program

Sample Notes Page - CareFirst BlueCross BlueShield

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Prescription Drug Detail

Brand Name

Brand Tier

Generic Name

Generic Tier

COZAAR

(Tier 3)

losartan

(Tier 1)

Prior Authorization Required: No

Quantity Limit: No

Category: High blood pressure & heart disease\angiotensin II blockers

Maintenance Drug: Yes

Notes: Generic available 4-9-2010

Attachments:

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Serving Maryland, the District of Columbia and portions of Virginia. CareFirst BlueCross BlueShield is the shared
business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueChoice, Inc.,
an affiliate company, also offers health benefit products and services on this site.

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