Save on your drugs with HealthyRx

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1 Save on your drugs with HealthyRx HealthyRx is a savings program offered through the UVa Hoo s Well program. It helps lower your costs on drugs for certain health conditions. Effective 4/1/17, you are enrolled in HealthyRx for the following conditions: Asthma COPD Congestive heart failure Coronary artery disease Diabetes High cholesterol High Blood pressure PAD Stroke HealthyRx and Hoo s Well Care Management work together! HealthyRx is a voluntary program for people who are enrolled in the UVa Health Plan and are taking part in the Hoo s Well Care Management program. Hoo s Well Care Management from ActiveHealth Management is all about helping you better manage your health condition. Depending on the level of care you need, you may: Get a call from a nurse coach who will work with you over the phone to improve your health Receive a letter inviting you to use the tools and resources at MyActiveHealth.com/hooswell Have the option to call and speak to a nurse coach at In order to save on drugs with HealthyRx, you need to participate in Hoo s Well Care Management at the level identified by ActiveHealth. If you opt out of the program, lower your level of participation, or choose to end your participation early, you will lose your HealthyRx savings. If you have questions about Hoo s Well Care Management, please call ActiveHealth at What drugs are covered? HealthyRx covers many Tier 1 and Tier 2 drugs. The amount you save depends on the drug and how you buy it: Retail (per 30 day supply) Mail Order (31-90 day supply) Tier 1 $0 (reduced from deductible + 20% coinsurance) $0 (reduced from deductible + 20% coinsurance) Tier 2 $15 (reduced from deductible + 20% coinsurance) $30 (reduced from deductible + 20% coinsurance) The following pages include a list of drugs covered by HealthyRx when you are enrolled in Basic Health. If you do not see your drug, you may be taking a Tier 3 drug. Tier 3 drugs are covered at your regular pharmacy program cost-sharing. If you are interested is switching to a Tier 1 or Tier 2 drug, contact your doctor to see if one is right for you.

2 The savings you ll receive through HealthyRx only apply to drugs related to the health condition(s) you are working to improve with Hoo s Well Care Management. If you have any questions regarding your pharmacy coverage, please call Aetna RX at HealthyRx drug list The list below is for those enrolled in Basic Health who use Aetna RX as their Pharmacy Benefit Manager. It contains some of the most common drugs used to treat the health conditions covered by the Hoo s Well Care Management program. Changes may occur to this list as generics become available throughout the year. Generic Drugs = lower case Brand-Name Drugs = UPPER CASE HealthyRx Disease Management Programs and Drug List Asthma - Adult & Pediatric and Chronic Obstructive Pulmonary Disease (COPD) DRUG CLASS TIER 1 TIER 2 Bronchodilators/ Combinations Inhaled Corticosteroids albuterol solution budesonide inhalation suspension ADVAIR, BREO ELLIPTA, COMBIVENT, DULERA, SYMBICORT ASMANEX, FLOVENT DISKUS, FLOVENT HFA, QVAR Oral Diabetes Medications Injectable Diabetes Medications Blood Glucose (BG) Monitors Diabetes (DM) - Adult & Pediatric acarbose, alogliptin, chlorpropamide, glimepiride, glipizide, glipizide/er, glipizide xl, glipizide/metformin, glyburide, glyburide micronized, glyburide/metformin, metformin, metformin/er, miglitol, nateglinide, pioglitazone, repaglinide, tolazamide INVOKANA, JANUMET, JANUMET XR, JANUVIA, JARDIANCE, JENTADUETO, KOMBIGLYZE, ONGLYZA, TRADJENTA HUMALOG products, HUMULIN products, LANTUS, LANTUS SOLOSTAR, LEVEMIR, LEVEMIR FLEXPEN, SYMLIN, SYMLINPEN, TOUJEO, TRULICITY, VICTOZA ONE TOUCH, FREESTYLE, PRECISION - monitors available free through BG monitor program BG Test Strips Diabetic Supplies (lancets & syringes) Insulin syringes (any generic), lancets (any generic), pen needles (any generic) FREESTYLE, ONE TOUCH, PRECISION BD insulin syringes, BD lancets, BD pen needles

3 enlapril, enalapril/hctz, fosinopril, fosinopril/hctz, lisinopril, lisinopril/hctz, moexipril, moexipril/hctz, perindopril, quinapril, quinapril/hctz, ramipril pravastatin, prevalite, rosuvastatin, simvastatin LIPTRUZET, VASEPA, ZETIA Hyperlipidemia (High Cholesterol) pravastatin, prevalite, rosuvastatin, simvastatin LIPTRUZET, VASEPA, ZETIA Hypertension (HTN) Adult & Pediatric enlapril, enalapril/hctz, fosinopril, fosinopril/hctz, lisinopril, lisinopril/hctz, moexipril, moexipril/hctz, perindopril, quinapril, quinapril/hctz, ramipril Coronary Artery Disease (CAD) enalapril, enalapril/hctz, fosinopril, fosinopril/hctz, lisinopril, lisinopril/hctz, moexipril, moexipril/hctz, perindopril, quinapril, quinapril/hctz, ramipril BYSTOLIC

4 BYSTOLIC pravastatin, prevalife, simvastatin. Cerebrovascular Disease (CVD) Stroke and Peripheral Artery Disease (PAD) propranolol, propanalol SR, propranolol/hctz, ANTARA, CRESTOR, LESCOL XL, LOVAZA, NIASPAN, SIMCOR, TRILIPIX, VYTORIN, WELCHOL, ZETIA BYSTOLIC, COREG CR, DUTOPROL Heart Failure (HF) enalapril, enalapril/hctz, fosinopril, fosinopril/hctz, lisinopril, lisinopril/hctz, moexipril, moexipril/hctz, perindopril, quinapril, quinapril/hctz, ramipril losartan/hctz, valsartan, valsartan/hctz EXFORGE, EXFORGE HCT, MICARDIS, MICARDIS HCT BYSTOLIC, COREG CR, DUTOPROL

5 pravastatin, prevalife, simvastatin ANTARA, CRESTOR, LESCOL XL, LOVAZA, NIASPAN, SIMCOR, TRILIPIX, VYTORIN, WELCHOL, ZETIA If you have any questions regarding your pharmacy coverage, please call Aetna RX Member Services Department at Representatives are available 24 hours a day, seven days a week to assist you. 5