Generic Preventive Care/ Safe Harbor Drug Program List
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1 Preventive care/safe harbor drugs are drugs that can help keep you from developing a health condition or related complications of a health condition. The Generic Preventive Care/Safe Harbor Drug Program includes certain generic drugs in selected prescription drug categories. For applicable plans, the generic preventive care/safe harbor drugs included on this list are available at 100% coverage with the deductible waived, when purchased at network pharmacy. All generic drugs listed below are subject to the quantity and day supply limits included with your benefit plan (typically up to a 90 day supply at mail order). Please refer to your benefit plan for a complete list of benefits, including specific exclusions. acebutolol hcl afeditab cr alendronate sodium amlodipine besylate amlodipine besylate benazepril amlodipine atorvastatin amlodipine olmesartan amlodipine valsartan amlodipine valsartan hctz aspirin dipyridamole er atenolol atenolol chlorthalidone atorvastatin calcium bal care dha benazepril hcl benazepril hydrochlorothiazide betaxolol hcl bisoprolol fumarate bisoprolol hydrochlorothiazide calcium pnv candesartan cilexetil candesartan hydrochlorothiazid captopril captopril hydrochlorothiazide cartia xt chlorothiazide chlorthalidone cholestyramine cholestyramine light
2 classic prenatal clopidogrel c nate dha colestipol hcl complete natal dha completenate daily prenatal diltiazem 12hr er diltiazem 24hr cd diltiazem 24hr er diltiazem er diltiazem hcl dilt xr dipyridamole dothelle dha elite ob dha elite ob elite ob 400 enalapril maleate enalapril hydrochlorothiazide endur acin eprosartan mesylate ezetimibe ezetimibe simvastatin ezfe forte felodipine er fenofibrate fenofibric acid fluvastatin er fluvastatin sodium focalgin 90 dha focalgin ca folbecal folic acid folinatal plus b folivane ob folivane prx dha nf fosinopril sodium fosinopril hydrochlorothiazide
3 gemfibrozil hemenatal ob hemenatal ob + dha hydrochlorothiazide ibandronate sodium inatal advance inatal ultra indapamide infanate plus irbesartan irbesartan hydrochlorothiazide isradipine jantoven kpn lisinopril lisinopril hydrochlorothiazide losartan potassium losartan hydrochlorothiazide lovastatin macnatal cn dha matzim la methyclothiazide metolazone metoprolol succinate metoprolol tartrate metoprolol hydrochlorothiazide moexipril hcl moexipril hydrochlorothiazide mynatal mynatal advance mynatal plus mynatal z mynate 90 plus nadolol nadolol bendroflumethiazide natalvirt 90 dha natalvirt ca newgen niacin niacin er Generic Preventive Care/
4 niacin flush free niacin flush free niacin inositol niacinamide nicardipine hcl nifedical xl nifedipine nifedipine er nimodipine nisoldipine obstetrix dha olmesartan medoxomil olmesartan amlodipine hctz olmesartan hydrochlorothiazide one daily prenatal perindopril erbumine perry prenatal pindolol plain niacin pnv 29 1 pnv dha pnv dha + docusate pnv ferrous fumarate docu fa pnv omega pnv select pnv total pnv vp u pr natal 400 pr natal 400 ec pr natal 430 pr natal 430 ec prasugrel hcl pravastatin sodium prefol dha prena1 chew prena1 pearl prena1 true prenaissance prenaissance 90 dha prenaissance balance
5 prenaissance dha prenaissance next prenaissance plus prenaissance promise prenaplus prenatabs fa prenatabs rx prenatal prenatal + dha prenatal 19 prenatal ad prenatal complete prenatal formula prenatal low iron prenatal multi dha prenatal multivitamin prenatal multivitamins prenatal one daily prenatal plus prenatal vitamin prenatal vitamin plus low iron prenatal vitamins prenatal u preplus pretab prevalite propranolol hcl propranolol hcl er propranolol hydrochlorothiazid quinapril hcl quinapril hydrochlorothiazide raloxifene hcl ramipril relnate dha risedronate sodium risedronate sodium dr rosuvastatin calcium rulavite dha se natal 19 se tan dha
6 simvastatin slo niacin taron bc taron c dha taron prex prenatal taztia xt telmisartan telmisartan amlodipine telmisartan hydrochlorothiazid thrivite 19 ticlopidine hcl timolol maleate tl care dha tl select trandolapril trandolapril verapamil er triadvance trinatal gt trinatal rx 1 trinate tri tabs dha triveen duo dha triveen one triveen prx rnf trust natal dha ultimatecare one ultimatecare one nf valsartan valsartan hydrochlorothiazide vemavite prx 2 vena bal dha venatal fa verapamil er verapamil er pm verapamil hcl verapamil sr vinate care vinate ii vinate one vinate m
7 virt nate virt advance virt bal dha virt bal dha plus virt c dha virt care one virt nate virt nate dha virt pn virt pn dha virt pn plus virt select virt vite gt vitafol ob vol nate vol plus vol tab rx vp ch plus vp ch pnv vp era ob plus vp ggr b6 vp heme ob vp heme ob + dha vp heme one warfarin sodium women's prenatal + dha zatean ch zatean pn zatean pn dha zatean pn plus zingiber
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Generic Preventive Care/ Safe Harbor Drug Program List Preventive care/safe harbor drugs are drugs that can help keep you from developing a health condition or related complications of a health condition.
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Additional Drug Coverage
Additional Drug Coverage Additional prescription drug coverage Your plan includes extra coverage for certain drugs and supplies as shown below. These drugs are either not generally covered under Medicare