2018 Preventive medications and your plan
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1 For members 2018 Preventive medications and your plan Managing your health with preventive medications Your pharmacy benefit plan includes special coverage for preventive medications. These medications help protect against or manage a medical condition, such as: Preventing blood clots and reducing the risk of a stroke Preventing heart disease and reducing high blood pressure Preventing osteoporosis (a disease that leads to an increased risk of bone fracture) Your health is important. Taking preventive medications as directed by your healthcare provider can help you avoid serious illness and high healthcare costs. In this drug list, brand-name medications are shown in UPPERCASE (for example, CLOBEX) and generic medications in lowercase (for example, clobetasol).
2 Special coverage for preventive medications Drugs on your plan s list of preventive medications are not subject to a deductible. You ll pay your copayment/coinsurance or nothing at all, depending on your plan, so you can save money and get the medications you need to help you live a healthier life. Preventive medications are a group of products included within your plan s formulary which tells you what medications your plan covers. Please note that most medications on the formulary are subject to a deductible, but medications are an exception. To check the cost of any medication, refer to your benefit handbook or contact customer service at the toll-free member phone number on your member ID card. Potential savings with generic medications To get the most from your benefits, ask your doctor if a generic medication is right for you. Generics normally cost less than brand medications, and the Food and Drug Administration (FDA) requires them to be just as safe and effective. Quality drives our decisions Our committee of doctors and pharmacists meet often to review medications and consider coverage under pharmacy benefit plans. They also recommend which medications should be on your plan s list of preventive medications. A list of covered preventive medications begins on the next page. Medications are listed by therapeutic category. For questions on injectable preventive medications administered by your doctor or healthcare provider, please call the number on your ID card.
3 2018 Preventive medication list Expanded listing by therapeutic category ANTIPSYCHOTICS ABILIFY ADASUVE aripiprazole ARISTADA chlorpromazine clozapine CLOZARIL EQUETRO FANAPT FAZACLO fluphenazine GEODON haloperidol INVEGA LATUDA loxapine molindone NUPLAZID olanzapine olanzapine / fluoxetine paliperidone ER perphenazine prochlorperazine quetiapine REXULTI RIERDAL risperidone SAPHRIS SEROQUEL SEROQUEL XR SYMBYAX thioridazine thiothixene trifluoperazine VRAYLAR VERSACLOZ ziprasidone ZYPREXA ASTHMA AND COPD ACCOLATE ADVAIR DISKUS ADVAIR HFA AEROAN albuterol neb / syp / tab albuterol ER ANORO ELLIPTA ARCAPTA ARMONAIR ARNUITY ELPT ATROVENT HFA BEVEI BREO ELLIPTA BROVANA budesonide suspension COMBIVENT REIMAT cromolyn nebulizer solution DALIRE ELIXOPHYLLIN FLOVENT DISKUS FLOVENT HFA FLUTICASONE INH SALMETER FORADIL INCRUSE ELPT ipratropium inhalation solution ipratropium / albuterol isoproterenol levalbuterol neb LONHALA MAGNAIR metaproterenol montelukast PERFOROMIST NEB PROAIR HFA PROAIR REICLICK PULMICORT FLEXHALER SEEBRI NEOHALER SEREVENT DISKUS IRIVA STIOLTO REIMAT STRIVERDI REIMAT SYMBICORT terbutaline THEO-24 CR / ER theochron CR theophylline theophylline CR / ER TRELEGY ELLIPTA UTIBRON NEOHALER VENTOLIN HFA VOIRE ER XOPENEX SOLUTION zafirlukast zileuton ER ZYFLO ZYFLO CR CANCER anastrozole ARIMIDEX AROMASIN EVISTA exemestane FARESTON FEMARA letrozole raloxifene SOLTAMOX tamoxifen CARDIOVASCULAR/ HEART DISEASE Anti-Anginal Agents DILATRATE SR GONITRO ISORDIL isosorb dinitrate isosorbide dinitrate ER
4 isosorbide mononitrate isosorbide mononitrate ER minitran NITRO-BID NITRO-DUR nitroglycerin NITROLINGUAL R NITROMIST nitro-time petn RANEXA Anticoagulants AGGRENOX ARIXTRA ASA / dipyridamole BEVYXXA BRILINTA cilostazol clopidogrel COUMADIN dipyridamole DURLAZA EFFIENT ELIQUIS enoxaparin fondaparinux FRAGMIN heparin jantoven LOVENOX PERSANTINE PLAVIX PLETAL PRADAXA prasugrel SAVAYSA ticlopidine warfarin XARELTO YORALA ZONTIVITY Cardiac Glycosides digitek digox digoxin LANOXIN High Blood Pressure ACCUPRIL ACCURETIC acebutolol ACEON ADALAT CC afeditab CR ALDACTAZIDE ALDACTONE ALTACE amiloride amiloride / hctz amlodipine amlodipine / atorvastatin amlodipine / benazepril amlodipine / olmesartan amlodipine / valsartan ATACAND ATACAND HCT atenol / chlorthalidone atenolol AVALIDE AVAPRO benazepril benazepril / hctz BETAPACE BETAPACE AF betaxolol BIDIL bisoprolol bisoprolol / hctz bumetanide BUMEX BYSTOLIC BYVALSON CADUET CALAN CALAN SR candesartan candesartan / hctz captopril captopril / hctz CARDIZEM CARDIZEM CD CARDIZEM LA CARDURA cartia XT carvedilol CATAPRES CATAPRES TTS chlorothiazide chlorthalidone clonidine CLORPRES COREG COREG CR CORGARD CORZIDE COZAAR DEMADEX DEMSER DIBENZYLINE dilt-xr diltiazem diltiazem CD diltiazem ER DIURIL doxazosin DUTOPROL DYAZIDE DYRENIUM EDARBI EDARBYCLOR EDECRIN enalapril enalapril / hctz EPANED eplerenone eprosartan ethacrynic acid EXFORGE EXFORGE HCT ezide felodipine ER fosinopril fosinopril / hctz furosemide guanfacine HEMANGEOL hydralazine hydrochlorothiazide HYZAAR indapamide INDERAL LA INDERAL XL INNOPRAN XL INRA
5 irbesartan irbesartan / hctz isradipine labetalol LASIX lisinopril lisinopril / hctz LOPRESSOR LOPRESSOR HCT losartan losartan / hctz LOTENSIN LOTENSIN HCT LOTREL matzim LA MAVIK MAXZIDE MAXZIDE-25 methyclothiazide methyldopa methyldopa / hctz metolazone METOPRO / HCTZ metoprolol metoprolol ER metoprolol / hctz MICARDIS MICARDIS HCT MICROZIDE MINIPRESS minoxidil moexipril moexipril / hctz nadolol nadolol / bendroflumethiazide nicardipine nifedical XL nifedipine nifedipine ER nimodipine nisoldipine nisoldipine ER NYMALIZE olmesartan olmesartan / amlo / hctz olmesartan / hctz perindopril phenoxybenzamine pindolol prazosin hcl PRESTALIA PRINIVIL PROCARDIA PROCARDIA XL propranolol propranolol ER propranolol / hctz QBRELIS quinapril quinapril / hctz ramipril SECTRAL sotalol sotalol AF SOTYLIZE spironolactone spironolactone / hctz SULAR TARKA taztia XT TEKTURNA TEKTURNA HCT telmisartan telmisartan / amlodipine telmisartan / hctz TENEX TENORETIC TENORMIN terazosin TIAZAC timolol (tablet) torsemide trandolapril trandolapril / verapamil triamterene / hctz TWYNSTA valsartan valsartan / hctz VASERETIC VASOTEC VECAMYL verapamil verapamil ER / SR VERELAN VERELAN PM ZEBETA ZESTORETIC ZESTRIL ZIAC High cholesterol ALTOPREV ANTARA atorvastatin cholestyramine cholestyramine lite COLESTID colestipol ezetimibe ezetim / simva fenofibrate fenofibric fenofibric DR FENOGLIDE FIBRICOR FLOLIPID fluvastatin gemfibrozil JUXTAPID KYNAMRO LESCOL XL LIPOFEN LIVALO LOFIBRA LOPID lovastatin MEVACOR niacin ER (Rx) niacor NIAAN ER omega-3-acid (Rx) PRALUENT PRAVACHOL pravastatin prevalite QUESTRAN QUESTRAN LITE REPATHA rosuvastatin simvastatin TRICOR TRIGLIDE triklo TRILIPIX VASCEPA WELCHOL ZOCOR ZYPITAMAG
6 CONTRACEPTIVES This section lists contraceptive categories. Please note that brands and generics are eligible. CONTRACEPTIVE PATCH CONTRACEPTIVE RING (NUVARING) EMERGENCY CONTRACEPTIVES IMPLANT CONTRACEPTIVE INJECTABLE CONTRACEPTIVE IUDs ORAL CONTRACEPTIVES DIABETES Insulin AFREZZA HUMALOG HUMALOG KWIKPEN HUMALOG MIX HUMULIN LANTUS LANTUS SOLOSTAR TOUJEO Non-insulin acarbose ACTOPLUS MET ACTOPLUS MET XR ACTOS AMARYL BYDUREON BYETTA chlorpropamide CYCLOSET DIABETA DUETACT FORTAMET glimepiride glipizide glipizide / metformin glipizide ER glipizide XL GLUCOPHAGE GLUCOPHAGE XR GLUCOTROL GLUCOTROL XL GLUCOVANCE glyburide glyburide / metformin glyburide micronized GLYNASE GLYSET GLYXAMBI INVOKAMET INVOKAMET XR INVOKANA JANUMET JANUMET XR JANUVIA JARDIANCE JENTADUETO JENTADUETO XR metformin metformin ER miglitol nateglinide OZEMPIC pioglitazone pioglitazone / glimepride pioglitazone / metformin PRANDIN PRECOSE QTERN repaglinide RIOMET SOLIQUA SEGLUROMET STEGLATRO STEGLUJAN STARLIX SYMLIN SYNJARDY SYNJARDY XR tolazamide tolbutamide TRADJENTA TRULICITY VICTOZA XULTOPHY ESTROGENS ACTIVELLA ALORA amabelz ANGELIQ CLIMARA CLIMARA PRO COMBIPATCH covaryx covaryx HS DIVIGEL DUAVEE eemt eemt HS ELESTRIN est estrogen mtest est estrogen mtest HS estra / noreth ESTRACE (ORAL TAB) estrad val estradiol (oral tabs, patch) estrog / mtest ESTROGEL estropipate EVAMIST FEMHRT fyavolv jevantique jinteli lopreeza MENEST MENOSTAR mimvey mimvey lo MINIVELLE noreth / ethin PREFEST PREMPHASE PREMARIN (ORAL TAB) PREMPRO
7 GASTROINTESTINAL- ULCER DRUGS AXID cimetidine CYTOTEC DEXILANT esomeprazole ESOMEPRAZOLE 24.65MG AND 49.3MG famotidine lanso / amox / clarith lansoprazole misoprostol nizatidine OMECLAMOX omeppi omepra / bicar omeprazole pantoprazole PEPCID PREVPAC PRILOSEC PROTONIX PYLERA rabeprazole ranitidine sucralfate ZANTAC HIV/AIDS abacavir / lamivudine abacavir abacavir / lamivudine / zidovudine APTIVUS atazanavir ATRIPLA BIKTARVY COMBIVIR COMPLERA CIMDUO CRIXIVAN DESCOVY didanosine EDURANT efavirenz EMTRIVA EPIVIR EPZICOM EVOTAZ fosamprenavir FUZEON GENVOYA INTELENCE INVIRASE ISENTRESS JULUCA KALETRA lamivudine lamivudine / zidovudine LEXIVA lopinavir / ritonavir sol nevirapine nevirapine ER NORVIR ODEFSEY PREZCOBIX PREZISTA RESCRIPTOR RETROVIR REYATAZ ritonavir SELZENTRY stavudine STRIBILD SUSTIVA SYMFI LO tenofovir TIVICAY TRIUMEQ TRIZIVIR TRUVADA TYBOST VIDEX VIDEX EC VIRACEPT VIRAMUNE VIRAMUNE XR VIREAD VITEKTA ZERIT ZIAGEN zidovudine OSTEOPOROSIS ACTONEL alendronate ATELVIA BINOSTO BONIVA calcitonin spray etidronate EVISTA FORTEO FOSAMAX ibandronate MIACALCIN RAY raloxifene risedronate SMOKING DETERRENTS bupropion CHANTIX NICODERM CQ NICORETTE nicotine gum / lozenge / patch NICOTROL INH / NS ZYBAN TRANLANT ASTAGRAF XL AZASAN azathioprine CELLCEPT cyclosporine cyclosporine modified ENVARSUS XR gengraf IMURAN mycophenolate mycophenolic DR MYFORTIC NEORAL PROGRAF RAPAMUNE SANDIMMUNE sirolimus tacrolimus cap ZORTRESS
8 VITAMINS & ELECTROLYTES Pediatric vitamins with fluoride (for example; POLY-VI-FLOR, tri-vit / fl) generic products BRAND NAME PRODUCTS Prenatal multivitamins with iron and folic acid (for example; OB COMPLETE, prenatabs RX) generic products BRAND NAME PRODUCTS This list is intended as a reference and may not be all-inclusive. Brand or generic availability may not be current due to changes in the market. Use of generics may be required depending upon plan design. FutureScripts is a registered service mark of OptumRx, an Optum company. All other trademarks are the property of their respective owners FutureScripts. All rights reserved. WL2523-FS_ Preventive Standard
2019 Preventive medications and your plan
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2017 Preventive medications and your plan
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2018 Preventive medications and your plan
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