Your Prescription Benefit

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1 Your Prescription Benefit

2 {Begin_Tag} {EPSIIA_Tag}W_ The CVS Caremark Commitment to Plan Participants Making the Most of Your Prescription Benefit Program Your Prescription Benefit Plan Getting Your Prescription Filled Helpful Tips The CVS Caremark Difference Advantages of Generics Common Brand with Generics Available CVS Caremark Specialty Network for Chronic or Genetic Conditions State of Tennessee Drug List Mail Service Order Form Find more information online You can always access the most up-to-date information on your prescription benefits at Once you ve registered, you can: View your plan s preferred drug list Check drug costs Print extra Prescription Cards Request new prescriptions using FastStartH Refill prescriptions Sign up for ReadyFill at MailF (automatic prescription refill program) Find prescription savings tips Print a claim form Be sure to have your Prescription Card with ID number with you when you register. For information about Plan Member Rights and Responsibilities, visit the Customer Care page at Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information IDX * * * * What you ll find inside:

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13 October 2013 State of Tennessee Drug List The State of Tennessee Drug List is a list of preferred drugs for your prescription benefit. This list includes Generics and Preferred Brand drugs. Generic drugs are in lowercase italics. Not all covered generics are listed. Those listed are examples of what may be prescribed. Preferred Brand drugs are in CAPS. These are the most cost-effective brand-name drugs for you. Non-preferred Brand drugs are not listed. Most of these brand-name drugs are covered but will cost you the most. Generics are available in drug classes marked with and should be considered the first line of prescribing. If there is no generic available, there may be more than one brand-name drug to treat a condition. PLAN MEMBER Ask your doctor to consider prescribing a generic drug or a preferred brand-name drug from this list, if medically appropriate. Take this list along when you see your doctor. Please note: If you have questions about your prescription coverage or copays1 you can: Visit or Contact a CVS Caremark Customer Care representative toll-free at TNRX (8679). For mail service, CVS Caremark may contact your doctor after getting your prescription. They may ask your doctor to consider a preferred brand drug or a generic. Your doctor may choose, when medically appropriate, to prescribe a different brand-name drug or generic in place of your original prescription. Any brand-name drug for which a generic product becomes available may be designated as a non-preferred product. HEALTH CARE PROVIDER Your patient is covered under a prescription benefit plan administered by CVS Caremark. As a way to help manage health care costs, authorize generic substitution whenever possible. If you believe a brand-name product is necessary, consider prescribing a brand name on this list. 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 information for a specific medicine. For specific information, visit or contact a CVS Caremark Customer Care representative toll-free at TNRX (8679).

14 ANALGESICS NSAIDs diclofenac meloxicam naproxen NSAIDs, COMBINATIONS VIMOVO SUPRAX ERYTHROMYCINS / MACROLIDES azithromycin clarithromycin clarithromycin ext-rel erythromycins COX-2 INHIBITORS CELEBREX FLUOROQUINOLONES ciprofloxacin ext-rel ciprofloxacin tablet levofloxacin AVELOX CIPRO SUSPENSION GOUT allopurinol probenecid COLCRYS ULORIC PENICILLINS amoxicillin amoxicillin-clavulanate dicloxacillin penicillin VK OPIOID ANALGESICS codeine-acetaminophen fentanyl transdermal fentanyl transmucosal lozenge hydrocodone-acetaminophen hydromorphone methadone morphine morphine ext-rel morphine suppository oxycodone oxycodone-acetaminophen tramadol tramadol ext-rel AVINZA EXALGO FENTORA KADIAN LAZANDA NUCYNTA NUCYNTA ER OPANA ER OXYCONTIN TETRACYCLINES doxycycline hyclate minocycline tetracycline NSAIDs, TOPICAL PENNSAID VOLTAREN GEL VISCOSUPPLEMENTS GEL-ONE (PA) HYALGAN (PA) ORTHOVISC (PA) ANTI-INFECTIVES ANTIBACTERIALS CEPHALOSPORINS cefdinir cefprozil cefuroxime axetil cephalexin ANTIFUNGALS fluconazole itraconazole (PA) terbinafine tablet (PA) ANTIRETROVIRAL AGENTS ANTIRETROVIRAL COMBINATIONS ATRIPLA TRUVADA FUSION INHIBITORS FUZEON (PA) INTEGRASE INHIBITORS ISENTRESS NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS EDURANT INTELENCE RESCRIPTOR SUSTIVA VIRAMUNE XR NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS EMTRIVA NUCLEOTIDE REVERSE TRANSCRIPTASE INHIBITORS VIREAD PROTEASE INHIBITORS KALETRA NORVIR PREZISTA REYATAZ ANTIVIRALS CYTOMEGALOVIRUS AGENTS VALCYTE HEPATITIS B AGENTS BARACLUDE EPIVIR-HBV HEPATITIS C AGENTS ribavirin (PA) INCIVEK (PA) REBETOL SOLUTION (PA) VICTRELIS (PA) HERPES AGENTS acyclovir valacyclovir INFLUENZA AGENTS amantadine rimantadine RELENZA (QL) TAMIFLU (QL) MISCELLANEOUS clindamycin metronidazole nitrofurantoin sulfamethoxazole-trimethoprim ANTINEOPLASTIC AGENTS ALKYLATING AGENTS ALKERAN HEXALEN LEUKERAN MYLERAN TEMODAR (PA) ANTIMETABOLITES thioguanine XELODA (PA) HORMONAL ANTINEOPLASTIC AGENTS ANTIESTROGENS FARESTON FASLODEX LUTEINIZING HORMONERELEASING HORMONE (LHRH) AGONISTS LUPRON DEPOT (PA) For specific information, visit or contact a CVS Caremark Customer Care representative toll-free at TNRX (8679).

15 TRELSTAR (PA) ZOLADEX (PA) KINASE INHIBITORS AFINITOR (PA) GLEEVEC (PA) NEXAVAR (PA) SPRYCEL (PA) SUTENT (PA) TARCEVA (PA) TASIGNA (PA) TYKERB (PA) VOTRIENT (PA) MISCELLANEOUS LYSODREN MATULANE TARGRETIN CAPSULE ZOLINZA (PA) CARDIOVASCULAR ACE INHIBITORS fosinopril lisinopril quinapril ramipril ACE INHIBITOR / DIURETIC COMBINATIONS fosinopril-hydrochlorothiazide lisinopril-hydrochlorothiazide quinapril-hydrochlorothiazide ANGIOTENSIN II RECEPTOR ANTAGONISTS / DIURETIC COMBINATIONS candesartan / candesartanhydrochlorothiazide eprosartan irbesartan / irbesartanhydrochlorothiazide losartan / losartanhydrochlorothiazide valsartan-hydrochlorothiazide BENICAR / BENICAR HCT DIOVAN MICARDIS / MICARDIS HCT ANGIOTENSIN II RECEPTOR ANTAGONIST / CALCIUM CHANNEL BLOCKER COMBINATIONS AZOR EXFORGE ANGIOTENSIN II RECEPTOR ANTAGONIST / CALCIUM CHANNEL BLOCKER / DIURETIC COMBINATIONS EXFORGE HCT TRIBENZOR ANTIARRHYTHMICS TIKOSYN (PA) ANTILIPEMICS BILE ACID RESINS cholestyramine WELCHOL CHOLESTEROL ABSORPTION INHIBITORS ZETIA FIBRATES fenofibrate ANTARA LIPOFEN TRILIPIX HMG-CoA REDUCTASE INHIBITORS / COMBINATIONS atorvastatin fluvastatin lovastatin pravastatin simvastatin CRESTOR LESCOL XL VYTORIN NIACINS / COMBINATIONS NIASPAN SIMCOR OMEGA-3 FATTY ACIDS LOVAZA BETA-BLOCKERS atenolol carvedilol metoprolol metoprolol succinate ext-rel nadolol propranolol propranolol ext-rel BYSTOLIC COREG CR CALCIUM CHANNEL BLOCKERS amlodipine diltiazem ext-rel nifedipine ext-rel verapamil ext-rel CALCIUM CHANNEL BLOCKER / ANTILIPEMIC COMBINATIONS amlodipine-atorvastatin DIGITALIS GLYCOSIDES digoxin DIRECT RENIN INHIBITORS / DIURETIC COMBINATIONS TEKTURNA / TEKTURNA HCT DIRECT RENIN INHIBITOR / CALCIUM CHANNEL BLOCKER COMBINATIONS TEKAMLO DIRECT RENIN INHIBITOR / CALCIUM CHANNEL BLOCKER / DIURETIC COMBINATIONS AMTURNIDE DIURETICS furosemide hydrochlorothiazide metolazone spironolactonehydrochlorothiazide torsemide triamterene-hydrochlorothiazide PULMONARY ARTERIAL HYPERTENSION ENDOTHELIN RECEPTOR ANTAGONISTS LETAIRIS (PA) TRACLEER (PA) PHOSPHODIESTERASE INHIBITORS sildenafil (PA) ADCIRCA (PA) PROSTAGLANDIN VASODILATORS REMODULIN (PA) TYVASO (PA) VENTAVIS (PA) CENTRAL NERVOUS SYSTEM ANTICONVULSANTS LAMICTAL ODT LYRICA SABRIL (PA) VIMPAT ANTIDEMENTIA donepezil galantamine galantamine ext-rel For specific information, visit or contact a CVS Caremark Customer Care representative toll-free at TNRX (8679).

16 rivastigmine EXELON PATCH NAMENDA ANTIDEPRESSANTS MONOAMINE OXIDASE INHIBITORS (MAOIs) MARPLAN SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) citalopram escitalopram fluoxetine paroxetine paroxetine ext-rel sertraline VIIBRYD SEROTONIN NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIs) 2 venlafaxine venlafaxine ext-rel CYMBALTA PRISTIQ MISCELLANEOUS AGENTS bupropion bupropion ext-rel mirtazapine trazodone ANTIPARKINSONIAN AGENTS carbidopa-levodopa carbidopa-levodopa ext-rel carbidopa-levodopa-entacapone entacapone pramipexole ropinirole ropinirole ext-rel selegiline AZILECT NEUPRO ANTIPSYCHOTICS ATYPICALS clozapine olanzapine quetiapine risperidone ziprasidone ABILIFY LATUDA RISPERDAL CONSTA SEROQUEL XR ATTENTION DEFICIT HYPERACTIVITY DISORDER DAYTRANA FOCALIN XR INTUNIV QUILLIVANT XR STRATTERA VYVANSE HYPNOTICS, NONBENZODIAZEPINES zolpidem (QL) zolpidem ext-rel (QL) MIGRAINE SELECTIVE SEROTONIN AGONISTS naratriptan (QL) rizatriptan (QL) sumatriptan (QL) zolmitriptan (QL) SUMAVEL DOSEPRO (QL) ZOMIG NASAL SPRAY (QL) SELECTIVE SEROTONIN AGONIST / NONSTEROIDAL ANTI-INFLAMMATORY DRUG (NSAID) COMBINATIONS TREXIMET (QL) MULTIPLE SCLEROSIS AGENTS AVONEX (PA) BETASERON (PA) COPAXONE (PA) NARCOLEPSY NUVIGIL (PA) ENDOCRINE AND METABOLIC ANDROGENS ANDRODERM (PA) AXIRON (PA) FORTESTA (PA) ANTIDIABETICS BIGUANIDES metformin metformin ext-rel DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITOR / BIGUANIDE COMBINATIONS JANUMET JANUMET XR JENTADUETO INCRETIN MIMETIC AGENTS BYDUREON VICTOZA INSULINS APIDRA HUMULIN R U-500 LANTUS LEVEMIR NOVOLIN 70/30 NOVOLIN N NOVOLIN R NOVOLOG NOVOLOG MIX 70/30 INSULIN SENSITIZERS pioglitazone INSULIN SENSITIZER / BIGUANIDE COMBINATIONS pioglitazone-metformin INSULIN SENSITIZER / SULFONYLUREA COMBINATIONS pioglitazone-glimepiride MEGLITINIDES nateglinide PRANDIN SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITORS INVOKANA SULFONYLUREAS glimepiride glipizide glipizide ext-rel BIGUANIDE / SULFONYLUREA COMBINATIONS glipizide-metformin SUPPLIES ACCU-CHEK STRIPS AND KITS 3 BD INSULIN SYRINGES AND NEEDLES ONETOUCH STRIPS AND KITS 3 DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITORS JANUVIA TRADJENTA CALCIUM REGULATORS BISPHOSPHONATES alendronate ibandronate For specific information, visit or contact a CVS Caremark Customer Care representative toll-free at TNRX (8679).

17 ACTONEL ATELVIA PHOSLYRA RENVELA CALCITONINS calcitonin-salmon PROGESTINS, ORAL medroxyprogesterone progesterone, micronized PARATHYROID HORMONES FORTEO (PA) CONTRACEPTIVES MONOPHASIC ethinyl estradiol-drospirenone BEYAZ LO LOESTRIN FE LOESTRIN 24 FE TRIPHASIC ethinyl estradiol-norgestimate ORTHO TRI-CYCLEN LO FOUR PHASE NATAZIA EXTENDED CYCLE ethinyl estradiol-levonorgestrel TRANSDERMAL ORTHO EVRA VAGINAL NUVARING ESTROGENS ORAL estradiol estropipate PREMARIN TRANSDERMAL estradiol DIVIGEL EVAMIST VIVELLE-DOT VAGINAL PREMARIN CREAM VAGIFEM ESTROGEN / PROGESTINS, ORAL estradiol-norethindrone PREMPHASE PREMPRO HUMAN GROWTH HORMONES HUMATROPE (PA) NORDITROPIN (PA) PHOSPHATE BINDER AGENTS calcium acetate FOSRENOL SELECTIVE ESTROGEN RECEPTOR MODULATORS EVISTA THYROID SUPPLEMENTS levothyroxine SYNTHROID GASTROINTESTINAL ANTIEMETICS dronabinol granisetron meclizine metoclopramide ondansetron prochlorperazine promethazine trimethobenzamide SANCUSO ZUPLENZ H2 RECEPTOR ANTAGONISTS ranitidine INFLAMMATORY BOWEL DISEASE ORAL AGENTS ASACOL HD LIALDA PENTASA RECTAL AGENTS CANASA CORTIFOAM IRRITABLE BOWEL SYNDROME AMITIZA LOTRONEX 4 LAXATIVES peg 3350-electrolytes MOVIPREP SUPREP PANCREATIC ENZYMES CREON ULTRESA VIOKACE ZENPEP PROTON PUMP INHIBITORS lansoprazole omeprazole omeprazole-sodium bicarbonate capsule pantoprazole DEXILANT (ST) NEXIUM (ST) GENITOURINARY BENIGN PROSTATIC HYPERPLASIA alfuzosin ext-rel doxazosin finasteride tamsulosin terazosin AVODART RAPAFLO URINARY ANTISPASMODICS oxybutynin oxybutynin ext-rel tolterodine trospium trospium ext-rel GELNIQUE VESICARE HEMATOLOGIC ANTICOAGULANTS warfarin PRADAXA XARELTO PLATELET AGGREGATION INHIBITORS clopidogrel AGGRENOX BRILINTA EFFIENT IMMUNOLOGIC AGENTS BIOLOGIC DISEASEMODIFYING AGENTS ENBREL (PA) HUMIRA (PA) IMMUNOMODULATORS INTERFERONS INTRON A (PA) PEGASYS (PA) PEGINTRON (PA) SYLATRON (PA) IMMUNOSUPPRESSANTS ANTIMETABOLITES AZASAN MYFORTIC For specific information, visit or contact a CVS Caremark Customer Care representative toll-free at TNRX (8679).

18 RAPAMYCIN DERIVATIVES RAPAMUNE NUTRITIONAL PRENATAL VITAMINS prenatal vitamins CITRANATAL RESPIRATORY ANAPHYLAXIS TREATMENT AGENTS EPIPEN EPIPEN JR ANTICHOLINERGICS SPIRIVA ANTICHOLINERGIC / BETA AGONIST COMBINATIONS ipratropium-albuterol inhalation solution COMBIVENT RESPIMAT BETA AGONISTS, INHALANTS SHORT ACTING albuterol PROAIR HFA PROVENTIL HFA LONG ACTING ARCAPTA NEOHALER FORADIL SEREVENT LEUKOTRIENE RECEPTOR ANTAGONISTS montelukast zafirlukast NASAL ANTIHISTAMINES azelastine ASTEPRO NASAL STEROIDS flunisolide fluticasone triamcinolone NASONEX STEROID / BETA AGONIST COMBINATIONS ADVAIR DULERA SYMBICORT STEROID INHALANTS budesonide inhalation suspension ASMANEX FLOVENT DISKUS FLOVENT HFA PULMICORT FLEXHALER QVAR TOPICAL DERMATOLOGY ACNE adapalene (PA2) benzoyl peroxide clindamycin solution clindamycin-benzoyl peroxide erythromycin solution erythromycin-benzoyl peroxide tretinoin (PA2) ACANYA DIFFERIN (PA2) EPIDUO RETIN-A MICRO (PA2) VELTIN (PA2) ACTINIC KERATOSIS fluorouracil imiquimod CARAC PICATO SOLARAZE ZYCLARA ANTIPSORIATICS calcipotriene OXSORALEN-ULTRA SORIATANE SORILUX TAZORAC (PA) CORTICOSTEROIDS Low Potency desonide hydrocortisone LOCAL ANALGESICS LIDODERM ROSACEA metronidazole sulfacetamide-sulfur FINACEA METROGEL ORACEA OPHTHALMIC ANTIALLERGICS azelastine cromolyn sodium ALREX LASTACAFT PATADAY ANTI-INFECTIVES ciprofloxacin erythromycin gentamicin levofloxacin ofloxacin sulfacetamide tobramycin MOXEZA VIGAMOX ANTI-INFECTIVE / ANTI-INFLAMMATORY COMBINATIONS neomycin-polymyxin Bbacitracin-hydrocortisone neomycin-polymyxin Bdexamethasone tobramycin-dexamethasone TOBRADEX ST ZYLET Medium Potency mometasone triamcinolone LOCOID LIPOCREAM LOCOID LOTION ANTI-INFLAMMATORIES Nonsteroidal diclofenac ketorolac BROMDAY High Potency desoximetasone fluocinonide APEXICON E Steroidal dexamethasone DUREZOL LOTEMAX Very High Potency clobetasol CLOBEX SPRAY BETA-BLOCKERS Nonselective timolol maleate solution BETIMOL IMMUNOMODULATORS ELIDEL (ST) PROTOPIC (ST) Selective BETOPTIC S For specific information, visit or contact a CVS Caremark Customer Care representative toll-free at TNRX (8679).

19 CARBONIC ANHYDRASE INHIBITORS dorzolamide AZOPT CARBONIC ANHYDRASE INHIBITOR / BETA-BLOCKER COMBINATIONS dorzolamide-timolol COSOPT PF IMMUNOMODULATORS RESTASIS PROSTAGLANDINS latanoprost TRAVATAN Z ZIOPTAN SYMPATHOMIMETICS brimonidine ALPHAGAN P SYMPATHOMIMETIC / BETABLOCKER COMBINATIONS COMBIGAN QUICK REFERENCE DRUG LIST A ABILIFY ACANYA ACCU-CHEK STRIPS AND KITS 3 ACTONEL acyclovir adapalene (PA2) ADCIRCA (PA) ADVAIR AFINITOR (PA) AGGRENOX albuterol alendronate alfuzosin ext-rel ALKERAN allopurinol ALPHAGAN P ALREX amantadine AMITIZA amlodipine amlodipine-atorvastatin amoxicillin amoxicillin-clavulanate AMTURNIDE ANDRODERM (PA) ANTARA APEXICON E APIDRA ARCAPTA NEOHALER ASACOL HD ASMANEX ASTEPRO ATELVIA atenolol atorvastatin ATRIPLA AVELOX AVINZA AVODART AVONEX (PA) AXIRON (PA) AZASAN azelastine AZILECT azithromycin AZOPT AZOR B BARACLUDE BD INSULIN SYRINGES AND NEEDLES BENICAR BENICAR HCT benzoyl peroxide BETASERON (PA) BETIMOL BETOPTIC S BEYAZ BRILINTA brimonidine BROMDAY budesonide inhalation suspension bupropion bupropion ext-rel BYDUREON BYSTOLIC C calcipotriene calcitonin-salmon calcium acetate CANASA candesartan candesartanhydrochlorothiazide CARAC carbidopa-levodopa carbidopa-levodopa ext-rel carbidopa-levodopa-entacapone carvedilol cefdinir cefprozil cefuroxime axetil CELEBREX cephalexin cholestyramine CIPRO SUSPENSION ciprofloxacin ciprofloxacin ext-rel ciprofloxacin tablet citalopram CITRANATAL clarithromycin clarithromycin ext-rel clindamycin clindamycin solution clindamycin-benzoyl peroxide clobetasol CLOBEX SPRAY clopidogrel clozapine codeine-acetaminophen COLCRYS COMBIGAN COMBIVENT RESPIMAT COPAXONE (PA) COREG CR CORTIFOAM COSOPT PF CREON CRESTOR cromolyn sodium CYMBALTA D DAYTRANA desonide desoximetasone dexamethasone DEXILANT (ST) diclofenac dicloxacillin DIFFERIN (PA2) digoxin diltiazem ext-rel DIOVAN DIVIGEL For specific information, visit or contact a CVS Caremark Customer Care representative toll-free at TNRX (8679).

20 donepezil dorzolamide dorzolamide-timolol doxazosin doxycycline hyclate dronabinol DULERA DUREZOL E EDURANT EFFIENT ELIDEL (ST) EMTRIVA ENBREL (PA) entacapone EPIDUO EPIPEN EPIPEN JR EPIVIR-HBV eprosartan erythromycin erythromycin solution erythromycin-benzoyl peroxide erythromycins escitalopram estradiol estradiol-norethindrone estropipate ethinyl estradiol-drospirenone ethinyl estradiol-levonorgestrel ethinyl estradiol-norgestimate EVAMIST EVISTA EXALGO EXELON PATCH EXFORGE EXFORGE HCT F FARESTON FASLODEX fenofibrate fentanyl transdermal fentanyl transmucosal lozenge FENTORA FINACEA finasteride FLOVENT DISKUS FLOVENT HFA fluconazole flunisolide fluocinonide fluorouracil fluoxetine fluticasone fluvastatin FOCALIN XR FORADIL FORTEO (PA) FORTESTA (PA) fosinopril fosinopril-hydrochlorothiazide FOSRENOL furosemide FUZEON (PA) G galantamine galantamine ext-rel GELNIQUE GEL-ONE (PA) gentamicin GLEEVEC (PA) glimepiride glipizide glipizide ext-rel glipizide-metformin granisetron H HEXALEN HUMATROPE (PA) HUMIRA (PA) HUMULIN R U-500 HYALGAN (PA) hydrochlorothiazide hydrocodone-acetaminophen hydrocortisone hydromorphone I ibandronate imiquimod INCIVEK (PA) INTELENCE INTRON A (PA) INTUNIV INVOKANA ipratropium-albuterol inhalation solution irbesartan irbesartan-hydrochlorothiazide ISENTRESS itraconazole (PA) J JANUMET JANUMET XR JANUVIA JENTADUETO K KADIAN KALETRA ketorolac L LAMICTAL ODT lansoprazole LANTUS LASTACAFT latanoprost LATUDA LAZANDA LESCOL XL LETAIRIS (PA) LEUKERAN LEVEMIR levofloxacin levothyroxine LIALDA LIDODERM LIPOFEN lisinopril lisinopril-hydrochlorothiazide LO LOESTRIN FE LOCOID LIPOCREAM LOCOID LOTION LOESTRIN 24 FE losartan losartan-hydrochlorothiazide LOTEMAX LOTRONEX 4 lovastatin LOVAZA LUPRON DEPOT (PA) LYRICA LYSODREN M MARPLAN MATULANE meclizine medroxyprogesterone meloxicam metformin metformin ext-rel methadone metoclopramide metolazone metoprolol metoprolol succinate ext-rel METROGEL metronidazole MICARDIS MICARDIS HCT minocycline mirtazapine mometasone montelukast morphine For specific information, visit or contact a CVS Caremark Customer Care representative toll-free at TNRX (8679).

21 morphine ext-rel morphine suppository MOVIPREP MOXEZA MYFORTIC MYLERAN N nadolol NAMENDA naproxen naratriptan (QL) NASONEX NATAZIA nateglinide neomycin-polymyxin Bbacitracin-hydrocortisone neomycin-polymyxin Bdexamethasone NEUPRO NEXAVAR (PA) NEXIUM (ST) NIASPAN nifedipine ext-rel nitrofurantoin NORDITROPIN (PA) NORVIR NOVOLIN 70/30 NOVOLIN N NOVOLIN R NOVOLOG NOVOLOG MIX 70/30 NUCYNTA NUCYNTA ER NUVARING NUVIGIL (PA) O ofloxacin olanzapine omeprazole omeprazole-sodium bicarbonate capsule ondansetron ONETOUCH STRIPS AND KITS 3 OPANA ER ORACEA ORTHO EVRA ORTHO TRI-CYCLEN LO ORTHOVISC (PA) OXSORALEN-ULTRA oxybutynin oxybutynin ext-rel oxycodone oxycodone-acetaminophen OXYCONTIN (QL) P pantoprazole paroxetine paroxetine ext-rel PATADAY peg 3350-electrolytes PEGASYS (PA) PEGINTRON (PA) penicillin VK PENNSAID PENTASA PHOSLYRA PICATO pioglitazone pioglitazone-glimepiride pioglitazone-metformin PRADAXA pramipexole PRANDIN pravastatin PREMARIN PREMARIN CREAM PREMPHASE PREMPRO prenatal vitamins PREZISTA PRISTIQ PROAIR HFA probenecid prochlorperazine progesterone, micronized promethazine propranolol propranolol ext-rel PROTOPIC (ST) PROVENTIL HFA PULMICORT FLEXHALER Q quetiapine QUILLIVANT XR quinapril quinapril-hydrochlorothiazide QVAR R ramipril ranitidine RAPAFLO RAPAMUNE REBETOL SOLUTION (PA) RELENZA (QL) REMODULIN (PA) RENVELA RESCRIPTOR RESTASIS RETIN-A MICRO (PA2) REYATAZ ribavirin (PA) rimantadine RISPERDAL CONSTA risperidone rivastigmine rizatriptan (QL) ropinirole ropinirole ext-rel S SABRIL (PA) SANCUSO selegiline SEREVENT SEROQUEL XR sertraline sildenafil (PA) SIMCOR simvastatin SOLARAZE SORIATANE SORILUX SPIRIVA spironolactonehydrochlorothiazide SPRYCEL (PA) STRATTERA sulfacetamide sulfacetamide-sulfur sulfamethoxazole-trimethoprim sumatriptan (QL) SUMAVEL DOSEPRO (QL) SUPRAX SUPREP SUSTIVA SUTENT (PA) SYLATRON (PA) SYMBICORT SYNTHROID T TAMIFLU (QL) tamsulosin TARCEVA (PA) TARGRETIN CAPSULE TASIGNA (PA) TAZORAC (PA) TEKAMLO TEKTURNA TEKTURNA HCT TEMODAR (PA) terazosin terbinafine tablet (PA) tetracycline thioguanine TIKOSYN (PA) For specific information, visit or contact a CVS Caremark Customer Care representative toll-free at TNRX (8679).

22 timolol maleate solution TOBRADEX ST tobramycin tobramycin-dexamethasone tolterodine torsemide TRACLEER (PA) TRADJENTA tramadol tramadol ext-rel TRAVATAN Z trazodone TRELSTAR (PA) tretinoin (PA2) TREXIMET (QL) triamcinolone triamterene-hydrochlorothiazide TRIBENZOR TRILIPIX trimethobenzamide trospium trospium ext-rel TRUVADA TYKERB (PA) TYVASO (PA) U ULORIC ULTRESA VOTRIENT (PA) VYTORIN VYVANSE V VAGIFEM valacyclovir VALCYTE valsartan-hydrochlorothiazide VELTIN (PA2) venlafaxine venlafaxine ext-rel VENTAVIS (PA) verapamil ext-rel VESICARE VICTOZA VICTRELIS (PA) VIGAMOX VIIBRYD VIMOVO VIMPAT VIOKACE VIRAMUNE XR VIREAD VIVELLE-DOT VOLTAREN GEL W warfarin WELCHOL X XARELTO XELODA (PA) Z zafirlukast ZENPEP ZETIA ZIOPTAN ziprasidone ZOLADEX (PA) ZOLINZA (PA) zolmitriptan (QL) zolpidem (QL) zolpidem ext-rel (QL) ZOMIG NASAL SPRAY (QL) ZUPLENZ ZYCLARA ZYLET For specific information, visit or contact a CVS Caremark Customer Care representative toll-free at TNRX (8679).

23 FOR YOUR INFORMATION: Generics should be considered the first line of prescribing. This drug list is a list of preferred drugs for your prescription benefit. It is not all-inclusive and does not guarantee coverage. Any brand drug for which a generic product becomes available may be designated as a non-preferred product. This list represents brand products in CAPS and generic products in lowercase italics. Not all covered generics are listed. Those listed are examples of what may be prescribed. Unless specifically indicated, drug list products will include all dosage forms. Listed products may be available generically in certain strengths or dosage forms. Dosage forms on this list will be consistent with the category and use where listed. Log in to to check coverage and copay information for a specific medicine. Generics are available in this class and should be considered the first line of prescribing. 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 Indicates the proposed mechanism of action, based on the American Psychiatric Association Summary of Treatment Recommendations. 3 An Accu-Chek or OneTouch blood glucose meter will be provided at no charge by the manufacturer to those individuals currently using a meter other than Accu-Chek or OneTouch. For more information on how to obtain a free blood glucose meter, call toll-free: Members must have CVS Caremark Mail Service Pharmacy benefits to qualify. 4 For safety reasons, to prescribe Lotronex, the physician must be enrolled in the Prescribing Program for Lotronex. Physicians must understand the benefits and risks of treatment with Lotronex for severe diarrhea-predominant IBS, including the information in the Prescribing Information, Medication Guide and Patient-Physician Agreement for Lotronex. To enroll or for more information on the Prescribing Program for Lotronex, call or visit to complete the Physician Enrollment Form. (PA) Prior Authorization required. (PA2) Prior Authorization required for 36 years of age and older. (QL) Quantity Limits apply. (ST) Step Therapy required. 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 CDL For specific information, visit or contact a CVS Caremark Customer Care representative toll-free at TNRX (8679).

24 2010-CVS-NU JOHN Q SAMPLE 2215 SANDERS RD NBT NORTHBROOK, IL CVS Caremark 2700 Milan Court Birmingham, AL or call 0 For a complete listing of Caremark participating retail pharmacies and other Caremark Services, visit our website at

University of Alaska Preferred Drug List

January 2013 University of Alaska Preferred Drug List The University of Alaska Preferred Drug List is a guide within select therapeutic categories for clients, plan members and health care providers. Generics