2017 Preventive medications and your plan
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1 Managing your health with preventive medications Your pharmacy benefit plan includes special coverage for preventive medications. These drugs help protect against or manage a medical condition, such as: Preventing blood clots and reducing the risk of a stroke Preventing heart disease and reducing high blood pressure Preventing osteoporosis (a disease that leads to an increased risk of bone fracture) Your health is important. Taking preventive medications as directed by your health care provider can help you avoid serious illness and high health care costs.
2 Special coverage for preventive medications Drugs on your plan s list of preventive medications are not subject to a deductible. You ll pay your copayment/coinsurance or nothing at all, depending on your plan. So you can save money and get the medications you need to help you live a healthier life. Preventive medications are a subset of products included within your plan s formulary, or list of prescription drugs, which tells you what medications your plan covers. Please note that most medications on the Formulary are subject to a deductible. Preventive medications are an exception. To check the cost of any medication, refer to your benefit handbook or contact customer service at the toll-free member phone number on your benefit plan ID card. Potential savings with generic medications To get the most from your benefits, ask your doctor if a generic medication is right for you. Generics normally cost less than brand medications, and the Food and Drug Administration (FDA) requires them to be just as safe and effective. Quality drives our decisions Our committee of independent doctors and pharmacists meets regularly to review medications and consider how they should be covered by your pharmacy benefit plan. They also recommend which medications should be on your plan s list of preventive medications. A list of covered preventive medications begins on the next page. Medications are listed by therapeutic category. To help you tell generic and brand drugs apart, all generics start with a lowercase letter. For questions on injectable dose forms of preventive medications administered by your healthcare provider, please call the number on the back of your membership card for more information. OptumRx optumrx.com
3 2017 Preventive medication list Expanded listing by therapeutic category ANTIPSYCHOTICS Abilify Adasuve aripiprazole chlorpromazine clozapine Clozaril Equetro Fanapt Fazaclo fluphenazine Geodon haloperidol Invega Latuda loxapine molindone olanzapine olanzapine / fluoxetine paliperidone ER perphenazine prochlorperazine quetiapine Rexulti Risperdal risperidone Saphris Seroquel Seroquel XR Symbyax thioridazine thiothixene trifluoperazine Vraylar Versacloz ziprasidone Zyprexa ASTHMA AND COPD Accolate Advair Diskus Advair HFA Aerospan albuterol albuterol ER Alvesco Anoro Ellipta Arcapta Arnuity ELPT Asmanex Asmanex HFA Atrovent HFA Bevespi Breo Ellipta Brovana budesonide suspension Combivent Respimat cromolyn nebulizer solution Daliresp Dulera Elixophyllin Flovent Diskus Flovent HFA Foradil Incruse ELPT ipratropium inhalation solution ipratropium / albuterol isoproterenol levalbuterol neb Lufyllin metaproterenol montelukast Perforomist Neb Proair HFA Proair Respiclick Proventil HFA Pulmicort Pulmicort Flexhaler Qvar Serevent Diskus Singulair Spiriva Stiolto Respimat Striverdi Respimat Symbicort terbutaline Theo-24 CR / ER theochron CR theophylline theophylline CR / ER Tudorza Pres Ventolin HFA Vospire ER Xopenex HFA Xopenex Solution
4 zafirlukast Zyflo Zyflo CR CANCER anastrozole Arimidex Aromasin Evista exemestane Fareston Femara letrozole raloxifene Soltamox tamoxifen CARDIOVASCULAR/ HEART DISEASE Anticoagulants Aggrenox Arixtra ASA/Dipyridamole Brilinta cilostazol clopidogrel Coumadin dipyridamole Durlaza Effient Eliquis enoxaparin fondaparinux Fragmin heparin jantoven Lovenox Persantine Plavix Pletal Pradaxa Savaysa ticlopidine warfarin Xarelto Zontivity High Blood Pressure Accupril Accuretic acebutolol Aceon Adalat CC afeditab CR Aldactazide Aldactone Altace amiloride amiloride / hctz amlodipine amlodipine / atorvastatin amlodipine / benazepril amlodipine / valsartan Amturnide Atacand Atacand hct atenol / chlorthalidone atenolol Avalide Avapro Azor benazepril benazepril / hctz Benicar Benicar HCT Betapace Betapace AF betaxolol Bidil bisoprolol bisoprolol / hctz bumetanide Bumex Bystolic Byvalson Caduet Calan Calan SR candesartan candesartan / hctz captopril captopril / hctz Cardene SR Cardizem Cardizem CD Cardizem LA Cardura cartia XT carvedilol Catapres Catapres TTS chlorothiazide chlorthalidone clonidine Clorpres Coreg Coreg CR Corgard Corzide Cozaar Demadex Demser Dibenzyline dilt-xr OptumRx optumrx.com
5 diltiazem diltiazem CD diltiazem ER Diovan Diovan HCT Diuril doxazosin Dutoprol Dyazide Dyrenium Edarbi Edarbyclor Edecrin enalapril enalapril / hctz Epaned eplerenone eprosartan ethacrynic acid Exforge Exforge HCT ezide felodipine ER fosinopril fosinopril / hctz furosemide guanfacine Hemangeol hydralazine hydrochlorothiazide Hyzaar indapamide Inderal LA Inderal XL Innopran XL Inspra irbesartan irbesartan / hctz isradipine Kerlone labetalol Lasix Levatol lisinopril lisinopril / hctz Lopressor Lopressor HCT losartan losartan / hctz Lotensin Lotensin HCT Lotrel matzim LA Mavik Maxzide Maxzide-25 methyclothiazide methyldopa methyldopa / hctz metolazone metoprolol metoprolol ER metoprolol / hctz Micardis Micardis HCT Microzide Minipress minoxidil moexipril moexipril / hctz nadolol nadolol / bendroflumethiazide nicardipine nifedical XL nifedipine nifedipine ER nimodipine nisoldipine nisoldipine ER Norvasc Nymalize perindopril phenoxybenzamine pindolol prazosin hcl Prestalia Prinivil Procardia Procardia XL propranolol propranolol ER propranolol / hctz Qbrelis quinapril quinapril / hctz ramipril reserpine Sectral sotalol sotalol AF spironolactone spironolactone / hctz Sular Tarka taztia XT Tekamlo Tekturna Tekturna HCT telmisartan telmisartan / amlodipine telmisartan / hctz Tenex Tenoretic Tenormin terazosin Teveten Teveten HCT
6 Tiazac timolol (tablet) Toprol XL torsemide trandolapril trandolapril / verapamil triamterene / hctz Tribenzor Twynsta valsartan valsartan / hctz Vaseretic Vasotec Vecamyl verapamil verapamil ER / SR Verelan Verelan PM Zaroxolyn Zebeta Zestoretic Zestril Ziac High cholesterol Advicor Altoprev Antara atorvastatin cholestyramine cholestyramine lite Colestid colestipol Crestor fenofibrate fenofibric fenofibric DR Fenoglide Fibricor fluvastatin gemfibrozil Juxtapid Kynamro Lescol Lescol XL Lipitor Lipofen Livalo Lofibra Lopid lovastatin Lovaza Mevacor niacin ER (Rx) niacor Niaspan ER omega-3-acid (Rx) Praluent Pravachol pravastatin prevalite Questran Questran Lite Repatha rosuvastatin Simcor simvastatin Tricor Triglide Trilipix Vascepa Vytorin Welchol Zetia Zocor DIABETES Insulin Afrezza Apidra Humalog Humalog KwikPen Humalog Mix Humulin Lantus Lantus Solostar Levemir Novolin Novolin Relion Novolog Novolog Mix Toujeo Tresiba Flex Non-insulin acarbose Actoplus Met Actoplus Met XR Actos Alogliptin Alogliptin/Metformin Alogliptin/Pioglitazone Amaryl Avandamet Avandaryl Avandia Bydureon Byetta chlorpropamide Cycloset Diabeta OptumRx optumrx.com
7 Duetact Farxiga Fortamet glimepiride glipizide glipizide / metformin glipizide ER glipizide XL Glucophage Glucophage XR Glucotrol Glucotrol XL Glucovance Glumetza glyburide glyburide / metformin glyburide micronized Glynase Glyset Glyxambi Invokamet Invokamet XR Invokana Janumet Janumet XR Januvia Jardiance Jentadueto Kazano Kombiglyze XR metformin metformin ER miglitol nateglinide Nesina Onglyza Oseni pioglitazone pioglitazone / glimepride pioglitazone / metformin Prandimet Prandin Precose repaglinide Riomet Starlix Symlin Synjardy Tanzeum tolazamide tolbutamide Tradjenta Trulicity Victoza Xigduo XR Supplies Blood Glucose Test Strips Control Solution - for Diabetic Meters Insulin Pen Needles Insulin Needles / Syringes Lancets HIV/AIDS abacavir abacavir / lamivudine / zidovudine Aptivus Atripla Combivir Complera Crixivan Descovy didanosine Edurant Emtriva Epivir Epzicom Evotaz Fuzeon Genvoya Intelence Invirase Isentress Kaletra lamivudine lamivudine / zidovudine Lexiva nevirapine nevirapine ER Norvir Odefsey Prezcobix Prezista Rescriptor Retrovir Reyataz Selzentry stavudine Stribild Sustiva Tivicay Triumeq Trizivir Truvada Tybost Videx Videx EC Viracept Viramune Viramune XR Viread Vitekta Zerit Ziagen zidovudine
8 MULTIPLE SCLEROSIS Ampyra Aubagio Avonex Betaseron Copaxone Extavia Gilenya glatopa Plegridy Rebif Tecfidera OSTEOPOROSIS Actonel alendronate Atelvia Binosto Boniva calcitonin spray etidronate Evista Forteo Fosamax Fosamax D ibandronate Miacalcin Spray raloxifene risedronate TRANLANT Astagraf XL Azasan azathioprine Cellcept cyclosporine cyclosporine modified Envarsus XR gengraf Imuran mycophenolate mycophenolic DR Myfortic Neoral Prograf Rapamune Sandimmune sirolimus tacrolimus cap Zortress VITAMINS & ELECTROLYTES Pediatric vitamins with fluoride (for example; Poly-Vi-Flor, Tri-Vi-Flor) Generic Products Brand Name Products Prenatal multivitamins with iron and folic acid (for example; OB Complete, prenatabs FA) Generic Products Brand Name Products This list is intended as a reference and may not be all-inclusive. Brand or generic availability may not be current due to changes in the market. Use of generics may be required depending upon plan design. optumrx.com OptumRx specializes in the delivery, clinical management and affordability of prescription medications and consumer health products. We are an Optum company a leading provider of integrated health services. Learn more at optum.com. All Optum trademarks and logos are owned by Optum, Inc. All other brand or product names are trademarks or registered marks of their respective owners Optum, Inc. All rights reserved. ORX2523_ D Preventive Standard
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CRITERIA Trial of two generic formulary products from the following: atomoxetine or ADHD stimulant medication.
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Hypertension is also an important risk factor in the development of chronic kidney disease and heart failure.
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ARBS MEDICATION(S) SUBJECT TO STEP THERAPY DIOVAN HCT MG TAB, DIOVAN HCT MG TABLET
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ACEBUTOLOL HCL 100MG TABLET GENERIC BETA BLOCKERS ALISKIREN 150MG TABLET RASILAZ RENIN INHIBITOR
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