CVS CAREMARK MAINTENANCE DRUG LIST EFFECTIVE AS OF 06/06/2018

Transcription

1 CVS CAREMARK MAINTENANCE DRUG LIST EFFECTIVE AS OF 06/06/2018 Maintenance drugs are prescriptions commonly used to treat conditions that are considered chronic or long-term. These conditions usually require regular, daily use of medicines. Examples of maintenance drugs are those used to treat high blood pressure, heart disease, asthma and diabetes. Due to the large number of available medicines, this list is not all inclusive. Please note that this list does not guarantee coverage and is subject to change. Your prescription benefit plan may not cover certain products or categories, regardless of their appearance on this list. Where a generic is available, it is listed by the generic name. If no generic is available, then the brand name appears. This list represents brand products in CAPS and generic products in lower case italics. If you have questions about your prescription benefits, please log on to your account at Caremark.com or call Customer Care at the number on the back of your prescription ID card. Attention Deficit/Hyperactivity Disorder (ADHD) clonidine er guanfacine er STRATTERA Allergies desloratidine levocetirizine CLARINEX Alzheimer s Disease donepezil galantamine rivastigmine NAMENDA NAMZARIC Antipsychotics loxapine olanzapine paliperidone risperidone thiothixene ziprasidone ABILIFY EQUETRO LATUDA ORAP REXULTI SEROQUEL XR Olanzapine/fluoxetine Blood Modifiers anagrelide cilostazol clopidogrel dipyridamole pentoxifylline ticlopidine AGGRENOX BRILINTA EFFIENT ZONTIVITY Cancer anastrozole exemestane letrozole tamoxifen FARESTON Contraceptives/ Hormone Replacement estradiol estradiol estropipate estradiol gel estradiol transdermal ethinyl estradiol- desogestrel ethinyl estradiol- drospirenone ethinyl estradiol -ethynodiol ethinyl estradiol- levonorgestrel ethinyl estradiol-norelgestromin ethinyl estradiol- norethindrone ethinyl estradiol- norgestimate ethinyl estradiol- norgestrel raloxifene BEYAZ CENESTIN CLIMARA PRO COMBIPATCH ENJUVIA ESTRING EVAMIST FALESSA FEMHRT LO LOESTRIN MENEST NATAZIA NUVARING PREMARIN PREMPRO SAFYRAL Depression bupropion citalopram desvenlafaxine duloxetine escitalopram fluoxetine fluvoxamine mirtazapine nefazodone paroxetine sertraline trazodone venlafaxine APLENZIN BRINTELLIX FETZIMA OLEPTRO VIIBRYD Diabetes acarbose chlorpropamide glimepiride glipizide glyburide metformin nateglinide pioglitazone repaglinidine tolazamide tolbutamide ADLYXIN AVANDIA BYDUREON BYETTA CYCLOSET FARXIGA GLYSET INSULIN INVOKANA JANUVIA JARDIANCE NESINA ONGLYZA SYMLIN SYNJARDY IR/XR TANZEUM TRADJENTA TRULICITY VICTOZA 2018 CVS Caremark. All rights reserved A of 3

2 glipizide/metformin glyburide/metformin pioglitazone/glimepiride pioglitazone/metformin AVANDAMET AVANDARYL GLYXAMBI INVOKAMET IR/ XR JANUMET JENTADUETO IR/ XR JUVISYNC KAZANO KOMBIGLYZE XR OSENI PRANDIMET SOLIQUA XIGDUO XR XULTOPHY -Test Strips/Lancets/Meters glucose meter insulin pump insulin syringes and needles ALBUSTIX CHEMSTRIPS NOVA MAX PLUS KETONE Digestive Enzymes pancrelipase CREON PANCREAZE ZENPEP Diuretics acetazolamide amiloride chlorthalidone dyrenium hydrochlorothiazide (hctz) methazolamide spironolactone hctz/spironolactone hctz/triamterene Enlarged Prostate alfuzosin finasteride tamsulosin terazosin AVODART CARDURA XL JALYN RAPAFLO Glaucoma Betaxolol bimatoprost brimonidine carbachol carteolol dorzolamide latanoprost levobunolol methazolamide metipranolol phospholine timolol AZOPT LUMIGAN RESCULA TRAVATAN ZIOPTAN dorzolamide/timolol COMBIGAN SIMBRINZA Gout allopurinol probenecid/colchicine ULORIC ZURAMPIC Heart Disease & High Blood Pressure -Ace Inhibitors benazepril captopril enalapril fosinopril lisinopril moexipril perindopril quinapril ramipril trandolapril -Angiotensin II Receptor Antagonists candesartan eprosartan irbesartan losartan telmisartan valsartan EDARBI TEVETEN -Antiarrhythmics amiodarone disopyramide flecainide mexiletine propafenone quinidine gluconate quinidine sulfate MULTAQ -Beta Blockers acebutolol atenolol betaxolol bisoprolol carvedilol labetalol levatol metoprolol nadolol pindolol propranolol sotalol timolol BYSTOLIC -Calcium Channel Blockers amlodipine diltiazem felodipine isradipine nicardipine nifedipine nisoldipine verapamil amlodipine/atorvastatin amlodipine/hctz amlodipine/valsartan amlodipine/valsartan/hctz atenolol/chlorthalidone benazepril/ hctz bisoprolol/ hctz candesartan/ hctz clonidine/chlorthalidone captopril/ hctz enalapril/ hctz fosinopril/ hctz irbesartan/ hctz lisinopril / hctz losartan/ hctz methyldopa/ hctz metoprolol/ hctz moexipril/ hctz nadolol/bendroflumethiazide propranolol/ hctz quinapril/ hctz telmisartan/amlodipine telmisartan/hctz trandolapril/verapamil valsartan/hctz AMTURNIDE AZOR BENICAR HCT BYVALSON EDARBYCLOR ENTRESTO PRESTALIA TEKAMLO TEKTURNA HCT TEVETEN HCT TRIBENZOR -Miscellaneous Cardiovascular clonidine guanfacine hydralazine isoxsuprine methyldopa minoxidil prazosin reserpine BIDIL CORLANOR RANEXA TEKTURNA High Cholesterol atorvastatin cholestyramine colestipol fenofibrate micronized 2018 CVS Caremark. All rights reserved A of 3

3 fluvastatin gemfibrozil lovastatin omega-3-acid ethyl ester niacin cr pravastatin rosuvastatin simvastatin LIPTRUZET LIVALO SIMCOR VASCEPA VYTORIN WELCHOL ZETIA Immune Disorders azathioprine Inflammatory Bowel Disease sulfasalazine DIPENTUM Gastrointestinal Agents AMITIZA LINZESS TRULANCE Kidney Disease calcitriol calcium acetate AURYXIA FOSRENOL RENAGEL RENVELA VELPHORO Miscellaneous cevimeline ergoloid mesylate pilocarpine riluzole ursodiol BRISDELLE CUVPOSA DUAVEE NASCOBAL NUEDEXTA SAVELLA XIIDRA Osteoporosis alendronate calcitonin ibandronate risedronate ACTONEL Plus Calc BINOSTO FOSAMAX D Overactive Bladder darifenacin flavoxate oxybutynin Oxytrol tolterodine trospium MYRBETRIQ TOVIAZ VESICARE Parkinson s Disease benztropine bromocriptine carbidopa carbidopa/levodopa carbidopa/levodopa/entacapone entacapone pramipexole ropinirole tolcapone trihexyphenidyl NEUPRO RYTARY XADAGO Respiratory Agents aminophylline budesonide cromolyn dyphylline fluticasone/salmeterol (Airduo) formoterol ipratropium ipratropium/albuterol metaproterenol montelukast terbutaline theophylline zafirlukast ADVAIR AEROSPAN ALVESCO ANORO ELLIPTA ARCAPTA ARNUITY ELLIPTA ASMANEX BEVESPI BREO ELLIPTA BROVANA DALIRESP 500 mg DULERA FLOVENT INCRUSE ELLIPTA QVAR SEEBRI SEREVENT SPIRIVA STIOLTO RESPIMAT STRIVERDI SYMBICORT TUDORZA UTIBRON ZYFLO Rheumatoid Arthritis leflunomide RHEUMATREX RIDAURA Seizure Disorders carbamazepine divalproex ethosuximide felbamate lamotrigine levetiracetam oxcarbazepine primidone tiagabine topiramate topiramate er valproic acid zonisamide APTIOM CELONTIN PEGANONE TROKENDI XR Thyroid levothyroxine liothyronine thyroid THYROLAR Ulcer/Gastroesophageal Reflux Disease (GERD) Cimetidine esomeprazole magnesium famotidine tab lansoprazole nizatidine omeprazole omeprazole/sodium bicarbonate pantoprazole rabeprazole ranitidine sucralfate ACIPHEX SPRINKLE DEXILANT ESOMEPRAZOLE STRONTIUM 2018 CVS Caremark. All rights reserved A of 3

4 Albanian: KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë. Telefononi në (TTY: ملحوظة: إذا كنت تتحدث اذكر اللغة فإن خدمات المساعدة Arabic: اللغوية تتوافر لك بالمجان. اتصل برقم )رقم هاتف الصم والبكم: (. Bantu: ICITONDERWA: Nimba uvuga Ikirundi, uzohabwa serivisi zo gufasha mu ndimi, ku buntu. Woterefona (TTY: Bengali: লক ষ য কর ন যদ আপদন ব ল, কথ বলত প ত ন, হতল দন খ চ য় ভ ষ সহ য় পদ তষব উপলব ধ আত ফ ন কর ন ১ (TTY: ১ ) Chinese: 注意 : 如果您使用繁體中文, 您可以免費獲得語言援助服務 請致電 (TTY: ) Cushite: XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa (TTY: Dutch: AANDACHT: Als u nederlands spreekt, kunt u gratis gebruikmaken van de taalkundige diensten. Bel (TTY: French: ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le (ATS : German: ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: (TTY: Italian: ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero (TTY: Japanese: 注意事項 : 日本語を話される場合 無料の言語支援をご利用いただけます (TTY: ) まで お電話にてご連絡ください Korean: 주의 : 한국어를사용하시는경우, 언어지원서비스를무료로이용하실수있습니다 (TTY: ) 번으로전화해주십시오. Nepali: ध म न द न ह स: तऩ र इ ल न ऩ ल फ ल न ह न छ बन तऩ र इ क ननम तत ब ष सह मत स व हर नन श ल क र ऩभ उऩलब ध छ प न गन ह स (द द व र इ: ) Wann du [Deitsch (Pennsylvania German / Dutch)] schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch Schprooch. Ruf selli Nummer uff: Call (TTY: Polish: UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer (TTY: Romanian: ATENȚIE: Dacă vorbiți limba română, vă stau la dispoziție servicii de asistență lingvistică, gratuit. Sunați la (TTY: ). Russian: ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните (телетайп: Serbo-Croatian: OBAVJEŠTENJE: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su vam besplatno. Nazovite (TTY- Telefon za osobe sa oštećenim govorom ili sluhom: Spanish: ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (TTY: ܝ ܐ Syriac: ܢ ܠ ܫ ܢ ܐ ܐ ܬܘܪ ܢ ܟ ܐ ܗ ܡܙ ܡܝ ܬܘ ܙܘ ܗ ܪ ܐ : ܐ ܢ ܐ ܚܬܘ ܡ ܨܝ ܬܘ ܢ ܕܩ ܒܠܝ ܬܘ ܢ ܚ ܠܢ ܬ ܐ ܕܗ ܝ ܪܬ ܐ ܒܠ ܫ ܢ ܐ ܡ ܓ ܢ ܐܝ ܬ. ܩܪܘ ܢ ܥ ܠ ( (TTY: ܡ ܢܝ ܢ ܐ Tagalog: PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa (TTY: Ukrainian: УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної підтримки. Телефонуйте за номером (телетайп: Vietnamese: CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số (TTY:

5 Notice of Nondiscrimination and Accessibility: Discrimination is Against the Law Paramount complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Paramount does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Paramount provides: Free aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language interpreters Written information in other formats (large print, audio, accessible electronic formats, other formats) Free language services to people whose primary language is not English, such as: Qualified interpreters Information written in other languages If you need these services, contact Member Services at If you believe that Paramount has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance. You can file a grievance in person or by mail, fax, or . Member Services 1901 Indian Wood Circle, Maumee OH Phone: Toll Free: TTY: Fax: Paramount.MemberServices@ProMedica.org. If you need help filing a grievance, Member Services is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C , (TDD) Complaint forms are available at