Ambetter 90-Day-Supply Maintenance Drug List

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1 Ambetter 90-Day-Supply Maintenance Drug List What is the Ambetter 90-Day-Supply Maintenance Drug List? Ambetter 90-Day-Supply Maintenance Drug List is a list of maintenance medications that are available for 90 day supply through mail order or through our Extended Day Supply Network. Maintenance medications are medications taken to treat chronic, long-term conditions, like high blood pressure, diabetes, heart disease, and asthma. In some cases, members with these conditions must take these medications daily. Purchasing these medications in a 90-day supply can make it easier to keep these medications on hand and take them as prescribed. How do I find a pharmacy that is participating in Extended Day Supply Network? To find a retail pharmacy that is participating in our Extended Day Supply Network, visit our website at Ambetter from Arkansas Health & Wellness. Click the For Members tab on the left, and then click Pharmacy Resources. There you will find a PDF with the Network Pharmacies participating in our 90-Day-Extended Supply Program. You can also take advantage of our mail order pharmacy, Homescripts, an Envolve Solution. For information regarding Homescripts, members can visit Homescripts.com. Are all formulary drugs covered for 90 day supply? No, certain specialty and non-specialty drugs are excluded from 90 day supply. Please consult the list below to determine if a drug is included. Keep in mind that just because a drug is included on this list does not mean that it is covered through your insurance plan; refer to your benefit materials to be sure your prescription is covered.

2 Ambetter 90-Day-Maintenece Drug List A Acebutolol HCl Acetazolamide Alendronate Sodium Allopurinol Alogliptin Benzoate Alogliptin-Metformin HCl Alogliptin-Pioglitazone Amantadine HCl Aminophylline Amiodarone HCl Amlodipine Besylate Amlodipine Besylate-Benazepril HCl Atenolol & Chlorthalidone Atenolol Atorvastatin Calcium B Baclofen Benazepril & Hydrochlorothiazide Benazepril HCl Benztropine Mesylate Bethanechol Chloride Bisoprolol & Hydrochlorothiazide Bisoprolol Fumarate Bumetanide Bupropion HCl Buspirone HCl C Canagliflozin Captopril & Hydrochlorothiazide Captopril Carbamazepine Carbidopa-Levodopa Carvedilol Chlorothiazide Chlorthalidone Cholestyramine Light Cholestyramine Cilostazol Citalopram Hydrobromide Clonidine HCl Clopidogrel Bisulfate Colestipol HCl D Desogestrel-Ethinyl Estradiol (Biphasic) Desogestrel-Ethinyl Estradiol (Triphasic) Desogestrel & Ethinyl Estradiol Diclofenac Potassium Diclofenac Sodium Diflunisal Digoxin Diltiazem HCl Diltiazem HCl Coated Beads Diltiazem HCl Extended Release Beads Dipyridamole Disopyramide Phosphate Divalproex Sodium Doxazosin Mesylate Drospirenone-Ethinyl Estradiol Duloxetine HCl E Enalapril Maleate & Hydrochlorothiazide Enalapril Maleate Escitalopram Oxalate Estradiol Estropipate Ethambutol HCl Ethosuximide Ethynodiol Diacet & Eth Estrad Etodolac

3 F Felodipine Fenofibrate Fenofibrate Micronized Ferrous Sulfate Finasteride Flecainide Acetate Fluoxetine HCl Flurbiprofen Folic Acid Fosinopril Sodium & Hydrochlorothiazide Fosinopril Sodium Furosemide G Gabapentin Gemfibrozil Glimepiride Glipizide Glipizide-Metformin HCl Glyburide Micronized Glyburide Glyburide-Metformin Guanfacine HCl H Hydralazine HCl Hydrochlorothiazide Hydroxychloroquine Sulfate Hydroxyzine HCl Hydroxyzine Pamoate I Ibuprofen Indapamide Indomethacin Irbesartan Irbesartan-Hydrochlorothiazide Isoniazid Isosorbide Dinitrate Isosorbide Mononitrate K Ketoprofen L Labetalol HCl Lamotrigine Leflunomide Levetiracetam Levonorgestrel & Eth Estradiol Levonorgestrel-Eth Estradiol (Triphasic) Levothyroxine Sodium Linagliptin Linagliptin-Metformin HCl Liothyronine Sodium Lisinopril & Hydrochlorothiazide Lisinopril Losartan Potassium & Hydrochlorothiazide Losartan Potassium Lovastatin M Medroxyprogesterone Acetate Meloxicam Metformin HCl Methimazole Methyldopa Metolazone Metoprolol & Hydrochlorothiazide Metoprolol Succinate Metoprolol Tartrate Mexiletine HCl Minoxidil Mirtazapine Montelukast Sodium N Nabumetone Nadolol

4 Naproxen Sodium Naproxen Nateglinide Niacin (Antihyperlipidemic) Nifedipine Nitroglycerin Norethindrone & Eth Estradiol Norethindrone & Mestranol Norethindrone Acet & Eth Estra Norethin Acet & Estrad-Fe Norethindrone-Eth Estradiol (Triphasic) Norethindrone-Eth Estradiol (Biphasic) Norgestimate-Ethinyl Estradiol Norgestimate-Ethinyl Estradiol (Triphasic) Norgestrel & Ethinyl Estradiol O Oxaprozin Oxcarbazepine Oxybutynin Chloride P Paroxetine HCl Pentoxifylline Phenytoin Phenytoin Sodium Extended Pindolol Pioglitazone HCl Pioglitazone HCl-Metformin HCl Piroxicam Potassium Chloride Potassium Chloride Microencapsulated Crystals CR Pravastatin Sodium Prazosin HCl Prenatal Vit w/ Ferrous Fumarate-Folic Acid Prenatal Vit w/ Iron Carbonyl-Folic Acid Primidone Propafenone HCl Propranolol & Hydrochlorothiazide Propranolol HCl Propylthiouracil Q Quinapril HCl R Ramipril Reserpine Ropinirole Hydrochloride Rosiglitazone Maleate Rosiglitazone Maleate-Metformin HCl Rosuvastatin Calcium S Selegiline HCl Sertraline HCl Simvastatin Sotalol HCl (AFIB/AFL) Sotalol HCl Spironolactone & Hydrochlorothiazide Spironolactone Sulfasalazine Sulindac T Tamoxifen Citrate Tamsulosin HCl Terazosin HCl Terbutaline Sulfate Theophylline Tiagabine HCl Timolol Maleate Tolmetin Sodium Topiramate Torsemide Trandolapril Trazodone HCl Triamterene & Hydrochlorothiazide Trihexyphenidyl HCl

5 U Ursodiol V Valproate Sodium Valproic Acid Valsartan Valsartan-Hydrochlorothiazide Venlafaxine HCl Verapamil HCl W Warfarin Sodium Z Zonisam 2018 Arkansas Health & Wellness Insurance Company. All rights reserved (TTY/TDD )

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