Operating Engineers (Local 12) Health & Welfare Fund Prescription Drug Plan

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Rosalind Rose
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1 July 2018 Operating Engineers (Local 12) Health & Welfare Fund Prescription Drug Plan Preferred Brand, Non-Preferred Brand and Generic Drug List This summary prescription drug list is intended as an aid to members and health care providers to minimize member copayments 1 under the Operating Engineers Health & Welfare Fund prescription drug plan administered by CVS Caremark. This is only a summary of some of the more commonly prescribed medications showing Non-Preferred Brand drugs (highest copay 1 ), the comparable Preferred Brand drugs (lower copay 1 ) and the generic equivalents (lowest copay 1 ). Generic drugs should be considered the first line of prescribing. If there is no generic available, there often are more than one brand-name medications to treat a condition. These Preferred Brand-Name medicines are listed to help identify products that are clinically appropriate and cost-effective. This is not an all-inclusive list. A complete list of Preferred Brand drugs can be obtained by logging into In this list, Brand-Name medications are shown in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics. PLAN MEMBER Ask your doctor to consider prescribing generic drugs whenever possible. If you request a brand-name drug for which a generic drug is available, you will have to pay the appropriate copay 1 plus 50% of the difference in price between the brand-name drug and the generic drug. If there is no generic available for a specific medication, ask your doctor to consider a Preferred Brand drug from this list, when medically appropriate, as opposed to a Non-Preferred Brand drug. Take this list along when you or a covered family member sees a doctor. The copays 1 under your prescription drug benefit plan are as follows: Drug Type Retail Pharmacy (Up to 30-day supply) Mail Pharmacy (Up to 90-day supply) Tier 1: Generic $10 $25 Tier 2: Preferred Brand $25 $62.50 Tier 3: Non-Preferred Brand $40 $100 Please note: Generics should be considered the first line of prescribing. This drug list represents a summary of prescription coverage. It is not all-inclusive and does not guarantee coverage. Unless specifically indicated, drug list products will include all dosage forms. Log in to to check coverage and copay 1 information for a specific medicine. PREFERRED BRAND AND GENERIC OPTIONS LIST ABILIFY ABSTRAL aripiprazole, clozapine, olanzapine, quetiapine, risperidone, ziprasidone, LATUDA, VRAYLAR fentanyl transmucosal lozenge, FENTORA, SUBSYS ACCU-CHEK STRIPS AND KITS 2 ONETOUCH ULTRA STRIPS AND KITS 3, ACTOS ADDERALL XR AEROSPAN ALCORTIN A ALLISON MEDICAL INSULIN SYRINGES 4 pioglitazone amphetamine-dextroamphetamine mixed salts ext-rel, methylphenidate ext-rel, APTENSIO XR, MYDAYIS, QUILLIVANT XR, VYVANSE ARNUITY ELLIPTA, ASMANEX, FLOVENT DISKUS, FLOVENT HFA, PULMICORT FLEXHALER, QVAR BD ULTRAFINE INSULIN SYRINGES ALOQUIN ALORA ALTOPREV ALVESCO AMRIX ANDROGEL 1% ANGELIQ ANTARA APEXICON E APIDRA estradiol, DIVIGEL, EVAMIST, MINIVELLE ARNUITY ELLIPTA, ASMANEX, FLOVENT DISKUS, FLOVENT HFA, PULMICORT FLEXHALER, QVAR cyclobenzaprine estradiol-norethindrone, PREMPHASE, PREMPRO desoximetasone, fluocinonide FIASP, HUMALOG, NOVOLOG

2 ARMOUR THYROID ARTHROTEC ASACOL HD levothyroxine, SYNTHROID celecoxib; diclofenac sodium, meloxicam or naproxen WITH esomeprazole, lansoprazole, omeprazole, pantoprazole or balsalazide, sulfasalazine, sulfasalazine delayed-rel, APRISO, LIALDA, PENTASA ASCENSIA STRIPS AND KITS 2 ONETOUCH ULTRA STRIPS AND KITS 3, ATACAND, ATACAND HCT AXERT AZELEX BECONASE AQ BENSAL HP BENZAC AC BENZIQ BETAPACE, BETAPACE AF eletriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan, ONZETRA XSAIL, ZEMBRACE SYMTOUCH, ZOMIG NASAL SPRAY sotalol BREEZE 2 STRIPS AND KITS 2 ONETOUCH ULTRA STRIPS AND KITS 3, butalbital-acetaminophencaffeine capsule BYDUREON BYETTA CAFERGOT CARAC CARDIZEM CARDIZEM CD CARDIZEM LA (and its generics) CARNITOR CARNITOR SF CLINDAGEL clobetasol spray CLOBEX SPRAY COLAZAL CONTOUR NEXT STRIPS AND KITS 2 diclofenac sodium, naproxen OZEMPIC, TRULICITY, VICTOZA OZEMPIC, TRULICITY, VICTOZA eletriptan, ergotamine-caffeine, naratriptan, rizatriptan, sumatriptan, zolmitriptan, ONZETRA XSAIL, ZEMBRACE SYMTOUCH, ZOMIG NASAL SPRAY fluorouracil cream 5%, fluorouracil solution, imiquimod, PICATO, TOLAK, ZYCLARA levocarnitine levocarnitine erythromycin solution clobetasol foam clobetasol foam balsalazide ONETOUCH ULTRA STRIPS AND KITS 3, CONTOUR STRIPS AND KITS 2 ONETOUCH ULTRA STRIPS AND KITS 3, CRESTOR CYMBALTA DELZICOL DETROL LA DEXPAK DIOVAN, DIOVAN HCT DORAL DUTOPROL DYRENIUM EDARBI, EDARBYCLOR EDLUAR E.E.S. GRANULES ENABLEX ERYPED EVZIO EXFORGE EXFORGE HCT FANAPT FEMRING FIORICET CAPSULE fluorouracil cream 0.5% FML LIQUIFILM FORTAMET FORTESTA FOSAMAX PLUS D FOSRENOL desvenlafaxine ext-rel, duloxetine, venlafaxine, venlafaxine ext-rel capsule, FETZIMA balsalazide, sulfasalazine, sulfasalazine delayed-rel, APRISO, LIALDA, PENTASA dexamethasone, methylprednisolone, prednisolone solution, prednisone metoprolol succinate ext-rel WITH hydrochlorothiazide amiloride erythromycins erythromycins naloxone injection, NARCAN NASAL SPRAY amlodipine-olmesartan, amlodipine-telmisartan, amlodipine-valsartan amlodipine-, olmesartan-amlodipine-hydrochlorothiazide aripiprazole, clozapine, olanzapine, quetiapine, risperidone, ziprasidone, LATUDA, VRAYLAR estradiol, ESTRACE CREAM, ESTRING, PREMARIN CREAM diclofenac sodium, naproxen fluorouracil cream 5%, fluorouracil solution, imiquimod, PICATO, TOLAK, ZYCLARA dexamethasone, prednisolone acetate 1%, DUREZOL, FLAREX, FML FORTE, FML S.O.P., MAXIDEX, PRED MILD metformin, metformin ext-rel alendronate, ibandronate, risedronate calcium acetate, lanthanum carbonate, sevelamer carbonate, PHOSLYRA, VELPHORO

3 FREESTYLE STRIPS AND KITS 2 ONETOUCH ULTRA STRIPS AND KITS 3, FROVA GELNIQUE GLUMETZA INDOCIN INNOPRAN XL INTERMEZZO INTUNIV ISTALOL JALYN KAZANO KOMBIGLYZE XR LANOXIN TABLET (125 MCG and 250 MCG only) LESCOL XL LIPITOR LIVALO LUNESTA MACRODANTIN Matzim LA MENEST MENOSTAR MIACALCIN INJECTION MIACALCIN NASAL SPRAY MICARDIS, MICARDIS HCT MILLIPRED MINOCIN NAPRELAN NATESTO NESINA eletriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan, ONZETRA XSAIL, ZEMBRACE SYMTOUCH, ZOMIG NASAL SPRAY metformin, metformin ext-rel celecoxib, diclofenac sodium, meloxicam, naproxen atenolol, carvedilol, metoprolol succinate ext-rel, metoprolol tartrate, nadolol, pindolol, propranolol, propranolol ext-rel, BYSTOLIC, COREG CR amphetamine-dextroamphetamine mixed salts ext-rel, atomoxetine, guanfacine ext-rel, methylphenidate ext-rel, APTENSIO XR, MYDAYIS, QUILLIVANT XR, VYVANSE timolol maleate solution, BETIMOL dutasteride-tamsulosin; dutasteride or finasteride WITH alfuzosin ext-rel, doxazosin, tamsulosin, terazosin, RAPAFLO JANUMET, JANUMET XR, JENTADUETO, JANUMET, JANUMET XR, JENTADUETO, digoxin nitrofurantoin estradiol, estropipate, PREMARIN estradiol alendronate, calcitonin-salmon, ibandronate, risedronate, FORTEO calcitonin-salmon dexamethasone, methylprednisolone, prednisolone solution, prednisone minocycline celecoxib, diclofenac sodium, meloxicam, naproxen JANUVIA, TRADJENTA NEXIUM NILANDRON NITROMIST NORITATE NORVASC NOVACORT NOVO NORDISK NEEDLES 4 OLEPTRO OLUX-E OMNARIS ONGLYZA OSENI OWEN MUMFORD NEEDLES 4 OXYTROL PANCREAZE bicalutamide, ZYTIGA nitroglycerin lingual spray, nitroglycerin sublingual metronidazole, FINACEA, SOOLANTRA amlodipine trazodone clobetasol foam JANUVIA, TRADJENTA JANUMET, JANUMET XR, JENTADUETO, CREON, VIOKACE, ZENPEP PENNSAID diclofenac sodium, diclofenac sodium gel 1%, diclofenac sodium solution, meloxicam, naproxen PERRIGO NEEDLES 4 PERTZYE PEXEVA PLAVIX PRADAXA PRECISION XTRA STRIPS AND KITS 2 PRED FORTE PREFERAOB PREFEST PRENATAL PLUS PREVACID PROTONIX PROTOPIC PROVENTIL HFA QNASL QSYMIA RAYOS RELION INSULIN RELISTOR RIMSO-50 RIOMET CREON, VIOKACE, ZENPEP citalopram, escitalopram, fluoxetine, paroxetine HCl, paroxetine HCl ext-rel, sertraline, TRINTELLIX, VIIBRYD clopidogrel, prasugrel, BRILINTA warfarin, ELIQUIS, XARELTO ONETOUCH ULTRA STRIPS AND KITS 3, dexamethasone, prednisolone acetate 1%, DUREZOL, FLAREX, FML FORTE, FML S.O.P., MAXIDEX, PRED MILD generic prenatal vitamins, CITRANATAL estradiol-norethindrone, PREMPHASE, PREMPRO generic prenatal vitamins, CITRANATAL tacrolimus, ELIDEL levalbuterol tartrate CFC-free aerosol, PROAIR HFA, BELVIQ, BELVIQ XR, CONTRAVE, SAXENDA dexamethasone, methylprednisolone, prednisolone solution, prednisone HUMULIN INSULIN, NOVOLIN INSULIN MOVANTIK Consult doctor metformin, metformin ext-rel

4 ROZEREM STRIANT SURE-TEST STRIPS AND KITS 2 ONETOUCH ULTRA STRIPS AND KITS 3, TANZEUM TESTIM testosterone gel 1% 5 TRICOR TRIGLIDE TRILIPIX TRIVIDIA INSULIN SYRINGES 4 OZEMPIC, TRULICITY, VICTOZA BD ULTRAFINE INSULIN SYRINGES TRUETEST STRIPS AND KITS 2 ONETOUCH ULTRA STRIPS AND KITS 3, TRUETRACK STRIPS AND KITS 2 TUDORZA ULTIMED INSULIN SYRINGES 4 ULTIMED NEEDLES 4 UROXATRAL VALCYTE VALTREX ONETOUCH ULTRA STRIPS AND KITS 3, ATROVENT HFA, INCRUSE ELLIPTA, SPIRIVA BD ULTRAFINE INSULIN SYRINGES alfuzosin ext-rel, doxazosin, tamsulosin, terazosin, RAPAFLO valganciclovir acyclovir, valacyclovir Vanoxide-HC venlafaxine ext-rel tablet (except 225 mg) VENLAFAXINE EXT-REL TABLET (except 225 MG) VENTOLIN HFA VIAGRA VITAFOL-ONE VOGELXO XOPENEX HFA ZEGERID ZETONNA ZONEGRAN ZYFLO, ZYFLO CR desvenlafaxine ext-rel, duloxetine, venlafaxine, venlafaxine ext-rel capsule, FETZIMA desvenlafaxine ext-rel, duloxetine, venlafaxine, venlafaxine ext-rel capsule, FETZIMA levalbuterol tartrate CFC-free aerosol, PROAIR HFA, CIALIS generic prenatal vitamins, CITRANATAL levalbuterol tartrate CFC-free aerosol, PROAIR HFA, carbamazepine, carbamazepine ext-rel, divalproex sodium, divalproex sodium ext-rel, gabapentin, lamotrigine, lamotrigine ext-rel, levetiracetam, levetiracetam ext-rel, oxcarbazepine, phenobarbital, phenytoin, phenytoin sodium extended, tiagabine, topiramate, valproic acid, zonisamide, FYCOMPA, OXTELLAR XR, TROKENDI XR, VIMPAT montelukast, zafirlukast, zileuton ext-rel PREFERRED BRAND AND GENERIC PRODUCTS IN ALPHABETICAL ORDER A ABILIFY MAINTENA ACANYA acitretin ACUVAIL acyclovir adapalene ADVAIR albuterol inhalation solution alendronate alfuzosin ext-rel allopurinol alosetron ALPHAGAN P amantadine amiloride AMITIZA amlodipine amlodipine-atorvastatin amlodipine-olmesartan amlodipine-telmisartan amlodipine-valsartan amlodipine-valsartanhydrochlorothiazide amoxicillin amoxicillin-clavulanate amphetaminedextroamphetamine mixed salts amphetaminedextroamphetamine mixed salts ext-rel ANDRODERM ANORO ELLIPTA APRISO APTENSIO XR aripiprazole ARISTADA armodafinil ARNUITY ELLIPTA ASMANEX atenolol atomoxetine atorvastatin ATRALIN ATROVENT HFA azelastine azithromycin AZOPT B balsalazide BASAGLAR BD ULTRAFINE INSULIN SYRINGES AND NEEDLES BELBUCA BELSOMRA BELVIQ BELVIQ XR BENZACLIN benzoyl peroxide BESIVANCE BETIMOL BETOPTIC S BEVESPI AEROSPHERE bicalutamide BIDIL BREO ELLIPTA BRILINTA brimonidine bromfenac budesonide capsule budesonide inhalation suspension BUNAVAIL buprenorphine-naloxone sublingual tablet bupropion bupropion ext-rel BUTRANS BYSTOLIC C calcipotriene calcitonin-salmon calcium acetate CANASA candesartan candesartanhydrochlorothiazide carbamazepine carbamazepine ext-rel carbidopa-levodopa carbidopa-levodopa ext-rel carbidopa-levodopaentacapone carvedilol cefdinir cefprozil cefuroxime axetil celecoxib cephalexin cholestyramine CIALIS ciclopirox CILOXAN OINTMENT CIPRODEX ciprofloxacin ciprofloxacin ext-rel citalopram CITRANATAL clarithromycin clarithromycin ext-rel CLIMARA PRO clindamycin clindamycin solution clindamycin-benzoyl peroxide clobetasol cream, foam, gel, lotion, ointment, shampoo clocortolone clopidogrel clotrimazole clozapine codeine-acetaminophen colchicine tablet COLCRYS COMBIGAN COMBIPATCH COMBIVENT RESPIMAT CONTRAVE COREG CR CORLANOR CORTIFOAM CREON CRINONE cromolyn sodium cyclobenzaprine D DALIRESP darifenacin ext-rel desonide desoximetasone desvenlafaxine ext-rel dexamethasone

5 DEXCOM CONTINUOUS GLUCOSE MONITORING SYSTEM diazepam rectal gel DICLEGIS diclofenac diclofenac sodium diclofenac sodium gel 1% diclofenac sodium solution diclofenac sodiummisoprostol dicloxacillin DIFFERIN DIFICID digoxin diltiazem ext-rel 6 dipyridamole ext-rel-aspirin divalproex sodium divalproex sodium ext-rel DIVIGEL donepezil dorzolamide dorzolamide-timolol doxazosin doxycycline hyclate dronabinol DUAVEE DULERA duloxetine DUREZOL dutasteride dutasteride-tamsulosin E econazole eletriptan ELIDEL ELIQUIS EMVERM ENDOMETRIN ENSTILAR entacapone ENTRESTO EPIDUO epinephrine auto-injector EPIPEN EPIPEN JR EPISIL eprosartan ergotamine-caffeine erythromycin erythromycin solution erythromycin-benzoyl peroxide erythromycins escitalopram esomeprazole ESTRACE CREAM estradiol estradiol-norethindrone ESTRING estropipate eszopiclone ethinyl estradioldrospirenone ethinyl estradioldrospirenone-levomefolate ethinyl estradiollevonorgestrel ethinyl estradiolnorelgestromin ethinyl estradiolnorethindrone acetate ethinyl estradiol-norgestimate ethosuximide EVAMIST ezetimibe ezetimibe-simvastatin F FARXIGA fenofibrate fenofibric acid fentanyl transdermal fentanyl transmucosal lozenge FENTORA FETZIMA FIASP FINACEA finasteride FLAREX FLOVENT DISKUS FLOVENT HFA fluconazole flunisolide fluocinonide fluorouracil cream 5% fluorouracil solution fluoxetine fluticasone fluvastatin FML FORTE FML S.O.P. fosinopril fosinopril-hydrochlorothiazide furosemide FYCOMPA G gabapentin galantamine galantamine ext-rel gentamicin glimepiride glipizide glipizide ext-rel glipizide-metformin GLUCAGEN HYPOKIT GLUCAGON EMERGENCY KIT GLYXAMBI GRALISE granisetron GRASTEK guanfacine ext-rel H HUMALOG HUMALOG MIX HUMULIN 70/30 HUMULIN N HUMULIN R HUMULIN R U-500 hydrochlorothiazide hydrocodone-acetaminophen hydrocortisone hydrocortisone butyrate hydrocortisone enema hydromorphone hydromorphone ext-rel HYSINGLA ER I ibandronate ILEVRO imiquimod INCRUSE ELLIPTA INVOKAMET INVOKAMET XR INVOKANA ipratropium inhalation solution ipratropium-albuterol inhalation solution irbesartan irbesartanhydrochlorothiazide itraconazole ivermectin J JANUMET JANUMET XR JANUVIA JARDIANCE JENTADUETO JUBLIA K ketoconazole ketorolac L lactulose lamotrigine lamotrigine ext-rel lansoprazole lanthanum carbonate LANTUS LASTACAFT latanoprost LATUDA levalbuterol tartrate CFC-free aerosol LEVEMIR levetiracetam levetiracetam ext-rel levocarnitine levofloxacin levothyroxine LIALDA linezolid LINZESS lisinopril lisinopril-hydrochlorothiazide LO LOESTRIN FE losartan losartan-hydrochlorothiazide lovastatin LUMIGAN LUZU LYRICA M MAXIDEX meclizine medroxyprogesterone megestrol acetate meloxicam memantine mesalamine rectal suspension metformin metformin ext-rel methadone methoxsalen methylphenidate methylphenidate ext-rel methylprednisolone metoclopramide metolazone metoprolol succinate ext-rel metoprolol tartrate metronidazole MINASTRIN 24 FE MINIVELLE minocycline MIRAPEX ER mirtazapine mometasone montelukast morphine morphine ext-rel morphine suppository MOVANTIK MOXEZA moxifloxacin MULTAQ MUSE MYDAYIS MYRBETRIQ N nadolol NAFTIN naloxone injection NAMZARIC naproxen naratriptan NARCAN NASAL SPRAY NATAZIA nateglinide neomycin-polymyxin B- bacitracin-hydrocortisone neomycin-polymyxin B- dexamethasone NEUPRO NEVANAC niacin ext-rel nifedipine ext-rel nitrofurantoin nitroglycerin lingual spray nitroglycerin sublingual NOVOLIN 70/30 NOVOLIN N NOVOLIN R NOVOLOG NOVOLOG MIX 70/30 NUCYNTA NUCYNTA ER NUEDEXTA NUVARING nystatin O ofloxacin olanzapine olmesartan olmesartan-amlodipinehydrochlorothiazide olmesartanhydrochlorothiazide olopatadine omega-3 acid ethyl esters omeprazole OMNIPOD INSULIN INFUSION PUMP ondansetron ONETOUCH ULTRA STRIPS AND KITS 3 ONETOUCH VERIO STRIPS AND KITS 3 ONZETRA XSAIL ORACEA oseltamivir OSPHENA oxcarbazepine OXTELLAR XR oxybutynin oxybutynin ext-rel oxycodone oxycodone-acetaminophen OXYCONTIN OZEMPIC P pantoprazole paroxetine HCl paroxetine HCl ext-rel paroxetine mesylate PAZEO peg 3350-electrolytes penicillin VK PENTASA PERFOROMIST phenobarbital phenytoin phenytoin sodium extended PHOSLYRA PICATO pindolol pioglitazone pioglitazone-glimepiride pioglitazone-metformin potassium chloride liquid pramipexole prasugrel pravastatin PRED MILD prednisolone acetate 1% prednisolone solution prednisone PREMARIN PREMARIN CREAM PREMPHASE PREMPRO prenatal vitamins primidone PROAIR HFA probenecid

6 prochlorperazine PROCTOFOAM-HC progesterone, micronized promethazine propranolol propranolol ext-rel PULMICORT FLEXHALER PYLERA Q QTERN quetiapine QUILLIVANT XR quinapril quinapril-hydrochlorothiazide QVAR R RAGWITEK raloxifene ramipril RANEXA ranitidine RAPAFLO rasagiline RELENZA repaglinide RESTASIS RETIN-A MICRO risedronate risperidone rivastigmine rivastigmine transdermal rizatriptan ropinirole ropinirole ext-rel rosuvastatin S SAFYRAL SANCUSO SAVELLA SAXENDA selegiline SEREVENT sertraline sevelamer carbonate SILENOR SIMBRINZA simvastatin SOLIQUA SOOLANTRA sotalol SPIRIVA spironolactonehydrochlorothiazide STIOLTO RESPIMAT STRIVERDI RESPIMAT SUBOXONE FILM SUBSYS sulfacetamide sulfamethoxazoletrimethoprim sulfasalazine sulfasalazine delayed-rel sumatriptan SUPRAX SUPREP SYMBICORT SYMLINPEN SYNJARDY SYNJARDY XR SYNTHROID T TACLONEX SUSPENSION tacrolimus tamsulosin TAZORAC TEKTURNA TEKTURNA HCT telmisartan telmisartanhydrochlorothiazide terazosin terbinafine tablet testosterone gel testosterone solution tetracycline tiagabine timolol maleate solution TOBRADEX OINTMENT TOBRADEX ST tobramycin tobramycin-dexamethasone TOLAK tolterodine tolterodine ext-rel topiramate torsemide TOUJEO TOVIAZ TRADJENTA tramadol tramadol ext-rel TRAVATAN Z trazodone TRELEGY ELLIPTA TRESIBA tretinoin TREXIMET triamcinolone triamterenehydrochlorothiazide trimethobenzamide TRINTELLIX TROKENDI XR trospium trospium ext-rel TRULICITY U UCERIS ULORIC V valacyclovir valganciclovir valproic acid valsartan VARUBI VASCEPA VELPHORO VELTASSA venlafaxine venlafaxine ext-rel capsule verapamil ext-rel VESICARE VIBERZI VICTOZA VIIBRYD VIMPAT VIOKACE VISTOGARD VRAYLAR VYVANSE W warfarin WELCHOL X XARELTO XIFAXAN 550 MG XIGDUO XR XIIDRA Z zafirlukast ZEMBRACE SYMTOUCH ZENPEP zileuton ext-rel ziprasidone zolmitriptan zolpidem zolpidem ext-rel zolpidem sublingual ZOMIG NASAL SPRAY zonisamide ZUBSOLV ZYCLARA ZYLET * The Preferred Drug options in this list are a broad representation within therapeutic categories of available treatment options and do not necessarily represent clinical equivalency. 1 Copayment, copay or coinsurance means the amount a member is required to pay for a prescription in accordance with a Plan, which may be a deductible, a percentage of the prescription price, a fixed amount or other charge, with the balance, if any, paid by a Plan. 2 ONETOUCH brand test strips are the only preferred options. 3 A ONETOUCH blood glucose meter may be provided at no charge by the manufacturer to those individuals currently using a meter other than ONETOUCH. For more information on how to obtain a blood glucose meter, call: BD ULTRAFINE syringes and needles are the only preferred options. 5 Listing reflects the authorized generics for TESTIM and VOGELXO. 6 Listing does not include generic CARDIZEM LA. Plan member privacy is important to us. Our employees are trained regarding the appropriate way to handle members' private health information. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers. Listed products are for informational purposes only and are not intended to replace the clinical judgment of the prescriber. The document is subject to state-specific regulations and rules, including, but not limited to, those regarding generic substitution, controlled substance schedules, preference for brands and mandatory generics whenever applicable. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission All rights reserved. OPENJ

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