Anthem Blue Cross Health Account Plan: Free Mail-Order Drug List
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- Angel Armstrong
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1 Free prescription drugs are available only through the Express Scripts mail-order program except where specifically noted. Listed drugs may change periodically; check with Express Scripts for updated information. Anticoagulants / antiplatelets Antiemetics / antivertigo agents Antiestrogens Blood pressure / heart health Aspirin / dipyridamole cilostazol clopidogrel dipyridamole prasugrel ticagrelor (Brilinta ) ticlopidine warfarin Zontivity aprepitant (Emend ) dimenhydrinate (injectable only, does not include OTC strengths) dolasetron (Anzemet ) granisetron (Sancuso ) meclizine (does not include OTC strengths) ondansetron prochlorperazine promethazine (does not include OTC strengths) scopolamine (Transderm Scop ) trimethobenzamide anastrozole exemestane letrozole tamoxifen raloxifene ACE inhibitors: benazepril; benazepril-hctz; captopril; captopril-hctz; enalapril; enalapril-hctz; fosinopril ;fosinopril-hctz; lisinopril; lisinopril- HCTZ; moexipril; moexipril-hctz; perindopril; quinapril; quinapril-hctz; ramipril; trandolapril Angiotensin receptor blockers: eprosartan mesylate (600mg only); irbesartan; irbesartan-hctz; losartan; losartan-hctz; olmesartan; olmesartan-hctz ; telmisartan ; telmisartan-hctz ; valsartan; valsartan-hctz Beta-blockers: acebutolol; atenolol; atenolol/chlorthalidone; betaxolol; bisoprolol; bisoprolol-hctz; carvedilol (Coreg CR ); labetalol; metoprolol; metoprolol- HCTZ; nadolol; nadolol-bendroflumethiazide; nebivolol (Bystolic ); pindolol; propranolol; sotalol; sotalol AF; timolol; timolol-hctz Calciumchannel blockers: amlodipine; diltiazem; felodipine; isradipine; nicardipine; nifedipine; nisoldipine; verapamil; verapamil ext. release Thiazide diuretics and related diuretics: amiloride; amiloride-hctz; chlorothiazide; chlorthalidone; eplerenone; furosemide; hydrochlorothiazide; indapamide; methyclothiazide; metolazone; spironolactone; spironolactone- HCTZ; triamterene; triamterene-hctz Miscellaneous: aliskiren (Tekturna ); aliskiren-hctz (Tekturna HCT ); 1
2 amlodipine/valsartan; cilostazol, clonidine; clonidine-chlorthalidone; doxazosin; digoxin, hydralazine HCl, minoxidil tablets only, guanfacine HCl; Anti-infectives Antimalarials Anti-ulcer agents Antivirals methyldopa; methyldopa-hctz; prazosin; reserpine; terazosin; amlodipine/benazepril; amlodipine/valsartan; amlodipine/valsartan/hydrochlorothiazide; olmesartan medoxomil/amlodipine/hctz, trandolapril/verapamil atovaquone (Mepron ) pentamidine (NebuPent ) posaconazole (Noxafil ) artemether/lumefantrine (Coartem ) atovaquone/proguanil chloroquine hydroxychloroquine mefloquine primaquine phosphate (Primaquine ) pyrimethamine-sulfadoxine quinine sulfate (does not include OTC strengths) H2-antagonists: cimetidine; famotidine; nizatidine; ranitidine (does not include OTC strengths)miscellaneous agents: misoprostol; sucralfate Proton pump inhibitors: esomeprazole; lansoprazole; omeprazole; pantoprazole; (does not include OTC strengths) metoclopramide HCl tablet, solution acyclovir amantadine famciclovir foscarnet ganciclovir oseltamivir (Tamiflu ) Free at retail and mail rimantadine valacyclovir valganciclovir zanamivir (Relenza ) Free at retail and mail 2
3 Arthritis / Pain methylprednisolone sodium succinate powder for injection methylprednisolone acetate suspension for injection methylprednisolone prednisolone acetate suspension (generic Pred Forte) prednisone indomethacin naproxen (does not include OTC strengths) naproxen delayed-release (does not include OTC strengths) naproxen sodium (does not include OTC strengths) diclofenac sodium diclofenac sodium ext-release diclofenac solution etodolac ibuprofen suspension (does not include OTC strengths) ibuprofen (does not include OTC strengths) ketoprofen ketorolac ophthalmic soln meloxicam nabumetone piroxicam sulindac Asthma therapies Bowel evacuant Calcium replacement montelukast zafirlukast albuterol sulfate tablet, syrup, inhalant solutiononly, (does not include oral inhaler ) aminophylline tablet Arnuity Elipta Flovent Diskus HFA budesonide inhalant suspension terbutaline theophylline ext-release tabs cromolyn sodium solution, inhalant solution ipratropium bromide solution, inhalant solution ipratropium/albuterol sulfate (Combivent ) guaifenesin/dyphylline elixir (does not include OTC strengths) polyethylene glycol 3350 combination such as Trilyte, (generics only), Gavilyte; sodium phosphate salts. Free at retail and mail calcium acetate (does not include OTC strengths) 3
4 Cancer (adjunctive agents) Cholesterollowering agents amifostine dexrazoxane epoetin alfa (Procrit ) filgrastim (Neupogen ) leucovorin mesna (Mesnex ) pegfilgrastim (Neulasta ) sargramostim (Leukine ) atorvastatin/amlodipine cholestyramine colesevelam (WelChol ) colestipol ezetimibe ezetimibe/simvastatin fenofibrate fenofibric acid gemfibrozil HMG-coA reductase inhibitors: atorvastatin; fluvastatin; lovastatin ; pravastatin; rosuvastatin; simvastatin niacin; niacin ER/simvastatin (does not include OTC strengths) omega-3-acid ethyl esters Contraceptives, non-oral Contraceptives, oral diaphragms medroxyprogesterone 150mg injectable intravaginal system (NuvaRing ) Apri (generic only) Estrostep Fe (generic only) Lybrel (generic only) Ortho Tri-Cyclen (generic only) Ovcon (generic only) Seasonale (generic only) TriNessa (generic only) Trivora (generic only) Yasmin (generic only) Seasonique (generic only) YAZ (generic only) Dental aids minocycline (Arestin ) 4
5 Diabetes Estrogen replacement acarbose glimeprimide glipizide glipizide ext-release glyburide glyburide, Micronized glyburide/metformin metformin HCl metformin ext-release nateglinide Glucagon insulin detemir (Levemir ) insulin lispro (Humalog ) insulin regular (Humulin R ) insulin NPH (Humulin N ) insulin NPH and insulinregular (Humulin 70/30 ) insulin NPL/insulin lispro (Humalog 50/50, Humalog MIX 75/25 ) insulin glargine (Lantus, Lantus Solostar ) One Touch test strips SureStep Insulin pen needles BD Ultrafine Isulin syringes BD Lancet device BD Lancets BD, Microlet conjugated estrogens (Premarin ) esterified estrogens/methyltestosterone estradiol estradiol gel (Divigel ) estradiol/norethindrone (CombiPatch ) estrogen/medroxyprogesterone (Premphase, Prempro ) ethinyl estradiol/norethindrone synthetic conjugated estrogens, A (Cenestin ) synthetic conjugated estrogens, B (Enjuvia ) 5
6 Fluoride preparations, oral and topical Cavarest Gel (generic only) Easygel (generic only) EtheDent (generic only) Fluoritab (generic only) Luride Lozi-Tabs (generic only) Neutragard (generic only) Phos-Flur (generic only) sodium fluoride (generic only) Gel-Kam (generic only) PreviDent Rinse (generic only) sodium fluoride (does not include OTC strengths) Gout allopurinol colchicine (Colcrys ) febuxostat (Uloric ) Heparin/low molecular weight heparin Iron replacement agents heparin low-molecular-weight heparin: dalteparin(fragmin ); enoxaparin; fondaparinux ferumoxytol (generic for Feraheme ) (does not include OTC strengths) FoliTab (generic only) (does not include OTC strengths) Foltrin (generic only) (does not include OTC strengths) Niferex Forte (generic only) (does not include OTC strengths) Miscellaneous agents isoxsuprine Osteoporosis Phosphate/ potassium replacement Prenatal vitamins (does not include OTC strengths) alendronate; calcitonin etidronate ibandronate raloxifene potassium bicarbonate/citric acid potassium chloride potassium phosphate potassium and sodium phosphate sodium phosphate Nata chew (generic only) Natafort (generic only) Natelle (generic only) Pre Care (generic only) Prenatal Plus, Prenatal RX (generic only) Prima Care (generic only) Vitafol-OB (generic only) 6
7 Prescription vitamins (does not include OTC strengths) Progestins Renal disease agents multivitamin w/ fluoride Strovite Advance, Strovite Plus (generic only) medroxyprogesterone norethindrone norethindrone acetate progesterone progesterone, micronized lanthanum (Fosrenol ) sevelamer carbonate Smoking cessation Vaccines Vitamin B Abbreviations: HCTZ = hydrochlorothiazide bupropion (generic for Zyban only) nicotine (Nicotrol Inhaler, Nicotrol Nasal Spray) varenicline (Chantix ) seasonal influenza vaccines (Note: Available free at participating retail pharmacies, not through mail service) Folgard RX (generic only) (does not include OTC strengths) Foltx (generic only) (does not include OTC strengths) Vitamin B1 thiamine (does not include OTC strengths) Vitamin B6 pyridoxine (does not include OTC strengths) Vitamin B12 Vitamin D cyanocobalamin injection (does not include OTC strengths) cyanocobalamin/folic acid (Foltrate ) (does not include OTC strengths) calcitriol (does not include OTC strengths) ergocalciferol (does not include OTC strengths) Vitamin K phytonadione (Mephyton ) (does not include OTC strengths) Vitamins with folic acid Weight loss agents Zinc replacement Mental Health therapeutic vitamins with minerals (does not include OTC strengths) benzphetamine diethylpropion phendimetrazine phentermine zinc sulfate (does not include OTC strengths) bupropion citalopram fluoxetine lamotrigine buspirone divalproex lithium 7
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