QTY LIMIT COPAY (30 DAY/90 DAY) BENIGN PROSTATIC HYPERPLASIA FINASTERIDE $4/$8 $4/$8 $4/$8 $4/$8 $4/$8 $4/$8 $4/$8 $4/$8 $4/$8 $4/$8 $4/$8
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- Edmund Lyons
- 5 years ago
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1 2019 LiveWELL Health Plan PREVENTIVE DRUG LIST - GENERIC Names ( Copay) - ALPHABETICAL by DRUG CATEGORY You should always check with your prescriber and/or pharmacist to determine if these alternatives are appropriate for your treatment. DRUG CATEGORY GENERIC NAMES QTY LIMIT COPAY (30 DAY/90 DAY) BENIGN PROSTATIC HYPERPLASIA ALFUZOSIN HCL BENIGN PROSTATIC HYPERPLASIA DUTASTERIDE BENIGN PROSTATIC HYPERPLASIA FINASTERIDE BENIGN PROSTATIC HYPERPLASIA TAMSULOSIN HCL CHOLESTEROL ATORVASTATIN CALCIUM 1 IN 1 DAYS CHOLESTEROL LOVASTATIN 2 IN 1 DAYS CHOLESTEROL PRAVASTATIN SODIUM 1 IN 1 DAYS CHOLESTEROL ROSUVASTATIN CALCIUM 1 IN 1 DAYS CHOLESTEROL SIMVASTATIN 1 IN 1 DAYS CHOLESTEROL/TRIGLYCERIDES EZETIMIBE 1 IN 1 DAYS CHOLESTEROL/TRIGLYCERIDES FENOFIBRATE CHOLESTEROL/TRIGLYCERIDES FENOFIBRATE NANOCRYSTALLIZED CHOLESTEROL/TRIGLYCERIDES FENOFIBRATE,MICRONIZED CHOLESTEROL/TRIGLYCERIDES GEMFIBROZIL CHOLESTEROL/TRIGLYCERIDES NIACIN CHOLESTEROL/TRIGLYCERIDES OMEGA-3 ACID ETHYL ESTERS 4 IN 1 DAYS CHOLESTEROL/TRIGLYCERIDES OMEGA-3 ACID ETHYL ESTERS 4 IN 1 DAYS DIABETES GLIPIZIDE/METFORMIN HCL DIABETES GLYBURIDE/METFORMIN HCL DIABETES REPAGLINIDE/METFORMIN HCL DIABETES PIOGLITAZONE HCL DIABETES CHLORPROPAMIDE DIABETES GLIMEPIRIDE DIABETES GLIPIZIDE DIABETES GLIPIZIDE DIABETES GLIPIZIDE DIABETES GLYBURIDE DIABETES NATEGLINIDE DIABETES REPAGLINIDE DIABETES TOLAZAMIDE DIABETES TOLBUTAMIDE DIABETES METFORMIN HCL DIABETES METFORMIN HCL GLAUCOMA BETAXOLOL HCL GLAUCOMA BIMATOPROST 1 IN 12 DAYS GLAUCOMA BRIMONIDINE TARTRATE GLAUCOMA CARTEOLOL HCL GLAUCOMA DORZOLAMIDE HCL GLAUCOMA DORZOLAMIDE HCL/TIMOLOL MALEAT GLAUCOMA LATANOPROST GLAUCOMA LEVOBUNOLOL HCL GLAUCOMA METIPRANOLOL GLAUCOMA PILOCARPINE HCL GLAUCOMA TIMOLOL MALEATE GLAUCOMA TRAVOPROST (BENZALKONIUM) 1 IN 12 DAYS HIGH BLOOD PRESSURE BENAZEPRIL HCL HIGH BLOOD PRESSURE CAPTOPRIL HIGH BLOOD PRESSURE ENALAPRIL MALEATE HIGH BLOOD PRESSURE FOSINOPRIL SODIUM HIGH BLOOD PRESSURE LISINOPRIL HIGH BLOOD PRESSURE MOEXIPRIL HCL HIGH BLOOD PRESSURE QUINAPRIL HCL HIGH BLOOD PRESSURE RAMIPRIL
2 HIGH BLOOD PRESSURE TRANDOLAPRIL HIGH BLOOD PRESSURE AMLODIPINE BESYLATE HIGH BLOOD PRESSURE FELODIPINE HIGH BLOOD PRESSURE ISRADIPINE HIGH BLOOD PRESSURE NICARDIPINE HCL HIGH BLOOD PRESSURE NIMODIPINE HIGH BLOOD PRESSURE CARVEDILOL HIGH BLOOD PRESSURE CARVEDILOL PHOSPHATE HIGH BLOOD PRESSURE LABETALOL HCL HIGH BLOOD PRESSURE ACEBUTOLOL HCL HIGH BLOOD PRESSURE ATENOLOL HIGH BLOOD PRESSURE BISOPROLOL FUMARATE HIGH BLOOD PRESSURE METOPROLOL SUCCINATE HIGH BLOOD PRESSURE METOPROLOL TARTRATE HIGH BLOOD PRESSURE NADOLOL HIGH BLOOD PRESSURE PINDOLOL HIGH BLOOD PRESSURE PROPRANOLOL HCL HIGH BLOOD PRESSURE PROPRANOLOL HCL HIGH BLOOD PRESSURE SOTALOL HCL HIGH BLOOD PRESSURE SOTALOL HCL HIGH BLOOD PRESSURE SOTALOL HCL HIGH BLOOD PRESSURE TIMOLOL MALEATE HIGH BLOOD PRESSURE CHLORTHALIDONE HIGH BLOOD PRESSURE HYDROCHLOROTHIAZIDE HIGH BLOOD PRESSURE INDAPAMIDE HIGH BLOOD PRESSURE METOLAZONE HIGH BLOOD PRESSURE PHENOXYBENZAMINE HCL HIGH BLOOD PRESSURE IRBESARTAN HIGH BLOOD PRESSURE LOSARTAN POTASSIUM HIGH BLOOD PRESSURE OLMESARTAN MEDOXOMIL HIGH BLOOD PRESSURE VALSARTAN HIGH BLOOD PRESSURE IRBESARTAN/HYDROCHLOROTHIAZIDE HIGH BLOOD PRESSURE LOSARTAN/HYDROCHLOROTHIAZIDE HIGH BLOOD PRESSURE OLMESARTAN/HYDROCHLOROTHIAZIDE HIGH BLOOD PRESSURE VALSARTAN/HYDROCHLOROTHIAZIDE LUNG FUNC (COPD & ASTHMA) IPRATROPIUM/ALBUTEROL SULFATE MENTAL HEALTH CITALOPRAM HYDROBROMIDE MENTAL HEALTH ESCITALOPRAM OXALATE MENTAL HEALTH FLUOXETINE HCL MENTAL HEALTH FLUOXETINE HCL MENTAL HEALTH FLUVOXAMINE MALEATE MENTAL HEALTH PAROXETINE HCL
3 MENTAL HEALTH SERTRALINE HCL MENTAL HEALTH DESVENLAFAXINE SUCCINATE 1 IN 1 DAYS MENTAL HEALTH DULOXETINE HCL 2 IN 1 DAYS MENTAL HEALTH VENLAFAXINE HCL MENTAL HEALTH VENLAFAXINE HCL OSTEOPOROSIS ALENDRONATE SODIUM OSTEOPOROSIS ALENDRONATE SODIUM 75 IN 7 DAYS OSTEOPOROSIS ETIDRONATE DISODIUM OSTEOPOROSIS IBANDRONATE SODIUM OSTEOPOROSIS RALOXIFENE HCL 1 IN 1 DAYS PRENATAL VITAMINS PNV 112/IRON/FOLIC/OM3/DHA/EPA PRENATAL VITAMINS PNV 15/IRON FUM,PS/FOLIC ACID PRENATAL VITAMINS PNV 16/IRON FUM,PS/FOLIC/OM-3 PRENATAL VITAMINS PNV 16/IRON FUM,PS/FOLIC/OM-3 PRENATAL VITAMINS PNV 16/IRON FUM,PS/FOLIC/OM-3 PRENATAL VITAMINS PNV 19/IRON PS,HEME/FOLIC/DHA PRENATAL VITAMINS PNV 21/IRON PS,HEME PPEP/FOLIC PRENATAL VITAMINS PNV 21/IRON PS,HEME PPEP/FOLIC PRENATAL VITAMINS PNV 22/IRON,GLUC/FOLIC/DSS/DHA PRENATAL VITAMINS PNV 39/IRON/FOLIC/DOCUSATE/DHA PRENATAL VITAMINS PNV 39/IRON/FOLIC/DOCUSATE/DHA PRENATAL VITAMINS PNV 69/IRON/FOLIC/DOCUSATE/DHA PRENATAL VITAMINS PNV 69/IRON/FOLIC/DOCUSATE/DHA PRENATAL VITAMINS PNV 69/IRON/FOLIC/DOCUSATE/DHA PRENATAL VITAMINS PNV 79/IRON/FOLIC/LMFOLATE/DHA PRENATAL VITAMINS PNV 79/IRON/FOLIC/LMFOLATE/DHA PRENATAL VITAMINS PNV 80/IRON FUM/FOLIC/DSS/DHA PRENATAL VITAMINS PNV 80/IRON FUM/FOLIC/DSS/DHA PRENATAL VITAMINS PNV 80/IRON FUM/FOLIC/DSS/DHA PRENATAL VITAMINS PNV NO.118/IRON FUMARATE/FA PRENATAL VITAMINS PNV NO.5/FERROUS FUM/FOLIC AC PRENATAL VITAMINS PNV NO.5/FERROUS FUM/FOLIC AC PRENATAL VITAMINS PNV NO.66/IRON,CARB/FOLIC/DHA PRENATAL VITAMINS PNV WITH CALC63/IRON/FOLIC/B6 PRENATAL VITAMINS PNV, CALCIUM 62/IRON/FOLIC/DHA PRENATAL VITAMINS PNV, CALCIUM 70/IRON/FOLIC/DHA PRENATAL VITAMINS PNV,CAL64/IRON CB,G/FA/DSS/DHA PRENATAL VITAMINS PNV,CAL64/IRON CB,G/FA/DSS/DHA PRENATAL VITAMINS PNV,CALC 35/IRON/FOLIC/DSS/OM3 PRENATAL VITAMINS PNV,CALCIUM 72/IRON,CARB/FOLIC PRENATAL VITAMINS PNV,CALCIUM 72/IRON/FOLIC ACID PRENATAL VITAMINS PNV,CALCIUM 72/IRON/FOLIC ACID PRENATAL VITAMINS PNV,CALCIUM 72/IRON/FOLIC ACID PRENATAL VITAMINS PNV,CALCIUM37/IRON/FOLIC/OMEG3 PRENATAL VITAMINS PNV,CALCIUM37/IRON/FOLIC/OMEG3 PRENATAL VITAMINS PNV,CALCIUM37/IRON/FOLIC/OMEG3 PRENATAL VITAMINS PNV/FERROUS FUM/DOCUSATE/FOLIC PRENATAL VITAMINS PNV/IRON,CARB/DOCUSAT/FOLIC AC PRENATAL VITAMINS PNV105/IRON/FA/OMEGA 3/DHA/EPA PRENATAL VITAMINS PNV119/IRON FUM/FOLIC/DOCUSATE
4 PRENATAL VITAMINS PNV19/IRON BG,S.P/FOLIC AC/OM3 PRENATAL VITAMINS PNV20/IRON/FOLIC/DOCUSATE/OM3S PRENATAL VITAMINS PNV34/IRON/FOLIC ACID/DSS/DHA PRENATAL VITAMINS PNV38/IRON,CRB,G/FOLIC/DSS/DHA PRENATAL VITAMINS PNV38/IRON,CRB,G/FOLIC/DSS/DHA PRENATAL VITAMINS PNV55/IRON BISGL,SUCC#2/FA/OM3 PRENATAL VITAMINS PNV59/IRON,CARB,FUM/FA/DSS/DHA PRENATAL VITAMINS PNV67/IRON/FOLIC ACID/OMEGA-3 PRENATAL VITAMINS PNV72/IRON,GLUC/FOLIC/DSS/DHA PRENATAL VITAMINS PNV73/IRON,GLUC/FOLIC/DSS/DHA PRENATAL VITAMINS PNV81/IRON EDTA,PS/FOLIC/OMEG3 PRENATAL VITAMINS PNV81/IRON EDTA,PS/FOLIC/OMEG3 PRENATAL VITAMINS PNV94/SOD IRON EDTA,PS/FA/OMG3 PRENATAL VITAMINS PNV94/SOD IRON EDTA,PS/FA/OMG3 PRENATAL VITAMINS PNV94/SOD IRON EDTA,PS/FA/OMG3 PRENATAL VITAMINS PRENAT 115/IRON FUM/FOLIC/DSS PRENATAL VITAMINS PRENAT 115/IRON FUM/FOLIC/DSS PRENATAL VITAMINS PRENAT VIT 17/IRON/FOLIC/OM3,6 PRENATAL VITAMINS PRENAT VIT 17/IRON/FOLIC/OM3,6 PRENATAL VITAMINS PRENATAL 105/IRON/FOLIC AC/DHA PRENATAL VITAMINS PRENATAL 12/IRON/FOLIC/DSS/OM3 PRENATAL VITAMINS PRENATAL 25/IRON/FOLATE 6/DHA PRENATAL VITAMINS PRENATAL 26/IRON PS/FOLIC/DHA PRENATAL VITAMINS PRENATAL 34/IRON/FOLIC/DSS/DHA PRENATAL VITAMINS PRENATAL 34/IRON/FOLIC/DSS/DHA PRENATAL VITAMINS PRENATAL 34/IRON/FOLIC/DSS/DHA PRENATAL VITAMINS PRENATAL 53/IRON/FOLIC AC/OMG3 PRENATAL VITAMINS PRENATAL 53/IRON/FOLIC AC/OMG3 PRENATAL VITAMINS PRENATAL 54/IRON/FOLIC AC/OMG3 PRENATAL VITAMINS PRENATAL 54/IRON/FOLIC AC/OMG3 PRENATAL VITAMINS PRENATAL 57/IRON/FOLIC/DSS/DHA PRENATAL VITAMINS PRENATAL 57/IRON/FOLIC/DSS/DHA PRENATAL VITAMINS PRENATAL 59/IRON/FOLIC/DSS/DHA PRENATAL VITAMINS PRENATAL 68/IRON/FOLIC NO1/DHA PRENATAL VITAMINS PRENATAL 68/IRON/FOLIC NO1/DHA PRENATAL VITAMINS PRENATAL 68/IRON/FOLIC NO1/DHA PRENATAL VITAMINS PRENATAL 87/IRON BIS/FOLIC/DHA PRENATAL VITAMINS PRENATAL COMB NO.42/FOLIC ACID PRENATAL VITAMINS PRENATAL NO.52/IRON/FA/DHA PRENATAL VITAMINS PRENATAL NO.75/IRON/FOLATE NO1 PRENATAL VITAMINS PRENATAL NO.82/IRON/FOLATE NO2 PRENATAL VITAMINS PRENATAL NO115/IRON/FOLIC ACID PRENATAL VITAMINS PRENATAL NO13/IRON PS/FOLATE 1 PRENATAL VITAMINS PRENATAL NO4/IRON FUM,PS/FOLIC PRENATAL VITAMINS PRENATAL VIT 10/IRON/FOLIC/DHA PRENATAL VITAMINS PRENATAL VIT 10/IRON/FOLIC/DHA PRENATAL VITAMINS PRENATAL VIT 10/IRON/FOLIC/OM3 PRENATAL VITAMINS PRENATAL VIT 14/IRON FUM/FOLIC PRENATAL VITAMINS PRENATAL VIT 33/IRON/FOLIC/DHA PRENATAL VITAMINS PRENATAL VIT 48/IRON/FOLIC/OM3 PRENATAL VITAMINS PRENATAL VIT 55/IRON/FOLIC/OM3 PRENATAL VITAMINS PRENATAL VIT 60/IRON FUM/FOLIC PRENATAL VITAMINS PRENATAL VIT NO.109/IRON/FA PRENATAL VITAMINS PRENATAL VIT NO.127/IRON/FOLIC PRENATAL VITAMINS PRENATAL VIT NO.42/FOLATE NO.6 PRENATAL VITAMINS PRENATAL VIT,CAL 73/IRON/FOLIC
5 PRENATAL VITAMINS PRENATAL VIT,CAL 73/IRON/FOLIC PRENATAL VITAMINS PRENATAL VIT,CAL 73/IRON/FOLIC PRENATAL VITAMINS PRENATAL VIT,CAL 74/IRON/FOLIC PRENATAL VITAMINS PRENATAL VIT,CAL 74/IRON/FOLIC PRENATAL VITAMINS PRENATAL VIT,CAL 74/IRON/FOLIC PRENATAL VITAMINS PRENATAL VIT,CALC76/IRON/FOLIC PRENATAL VITAMINS PRENATAL VIT,CALC76/IRON/FOLIC PRENATAL VITAMINS PRENATAL VIT,CALC76/IRON/FOLIC PRENATAL VITAMINS PRENATAL VIT,CALC78/IRON/FOLIC PRENATAL VITAMINS PRENATAL VIT,CALC78/IRON/FOLIC PRENATAL VITAMINS PRENATAL VIT,CALC78/IRON/FOLIC PRENATAL VITAMINS PRENATAL VIT/IRON BISGLY/FOLIC PRENATAL VITAMINS PRENATAL VIT/IRON FUM/FOLIC AC PRENATAL VITAMINS PRENATAL VIT/IRON FUM/FOLIC AC PRENATAL VITAMINS PRENATAL VIT/IRON FUM/FOLIC AC PRENATAL VITAMINS PRENATAL VIT100/IRON/FOLIC/OM3 PRENATAL VITAMINS PRENATAL VIT108/IRON,CRB/FOLIC PRENATAL VITAMINS PRENATAL VIT128/IRON/FOLIC ACD PRENATAL VITAMINS PRENATAL VIT136/IRON/FOLIC ACD PRENATAL VITAMINS PRENATAL VIT22/IRON/FOLIC/OM3S PRENATAL VITAMINS PRENATAL VIT22/IRON/FOLIC/OM3S PRENATAL VITAMINS PRENATAL VIT27,CALCIUM/IRON/FA PRENATAL VITAMINS PRENATAL VIT39/IRON/FOLAT6/DHA PRENATAL VITAMINS PRENATAL VIT86/IRON/FOLIC ACID PRENATAL VITAMINS PRENATAL VITAMINS #45/IRON/FA PRENATAL VITAMINS PRENATAL VITS 8/IRON/FOLIC/DHA PRENATAL VITAMINS PRENATAL VITS 8/IRON/FOLIC/DHA PRENATAL VITAMINS PRENATAL VITS16/IRON/FOLIC/DSS PRENATAL VITAMINS PRENATAL VITS16/IRON/FOLIC/DSS PRENATAL VITAMINS PRENATAL VITS16/IRON/FOLIC/DSS PRENATAL VITAMINS PRENATAL VITS18/IRON/FOLIC/DSS PRENATAL VITAMINS PRENATAL VITS18/IRON/FOLIC/DSS PRENATAL VITAMINS PRENATAL VITS18/IRON/FOLIC/DSS PRENATAL VITAMINS PRENATAL,CALC NO.65/IRON/FOLIC PRENATAL VITAMINS PRENATAL,CALC.40/IRON/FOLATE 1 PRENATAL VITAMINS PRENATAL,CALC.40/IRON/FOLATE 1 PRENATAL VITAMINS PRENATAL,CALC.40/IRON/FOLATE 1 PRENATAL VITAMINS PRENATAL64/IRON/LMFOLATE/ALGAL PRENATAL VITAMINS PRENATAL71/IRON/FOLIC ACID/DHA SEIZURES CARBAMAZEPINE SEIZURES CARBAMAZEPINE SEIZURES CARBAMAZEPINE SEIZURES DIVALPROEX SODIUM SEIZURES DIVALPROEX SODIUM SEIZURES ETHOSUXIMIDE SEIZURES GABAPENTIN SEIZURES LEVETIRACETAM
6 SEIZURES OXCARBAZEPINE SEIZURES PHENYTOIN SEIZURES PHENYTOIN SODIUM EXTENDED SEIZURES PRIMIDONE SEIZURES TOPIRAMATE SEIZURES TOPIRAMATE SEIZURES VALPROIC ACID SEIZURES VALPROIC ACID (AS SODIUM SALT) SEIZURES ZONISAMIDE STROKE PREVENTION WARFARIN SODIUM STROKE PREVENTION WARFARIN SODIUM STROKE PREVENTION CILOSTAZOL STROKE PREVENTION CLOPIDOGREL BISULFATE STROKE PREVENTION CLOPIDOGREL BISULFATE 4 IN 30 DAYS STROKE PREVENTION DIPYRIDAMOLE STROKE PREVENTION PRASUGREL HCL 1 IN 1 DAYS THYROID LEVOTHYROXINE SODIUM THYROID LIOTHYRONINE SODIUM
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