Advantage Value for Diabetes Eligible Drug List
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- Katrina Richard
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1 Advantage Value for Diabetes Eligible Drug List This list includes drugs that are covered by your prescription benefit plan managed by CVS Caremark when filled at a network pharmacy (including retail, mail and specialty). Eligible Drugs/Supplies You pay Diabetes drugs Copay: $0 tier 1 / $15 tier 2 / $30 tier 3 Hypertensive (blood pressure) drugs Copay: $0 tier 1 / $15 tier 2 / $30 tier 3 Cholesterol drugs Copay: $0 tier 1 / $15 tier 2 / $30 tier 3 Depression drugs Copay: $0 tier 1 / $15 tier 2 / $30 tier 3 Diabetes supplies (including test strips, syringes, lancets and more) 0% coinsurance, deductible waived Drug Class Drug Brand Name Tier Antidiabetic Medications * ALPHA-GLUCOSIDASE INHIBITORS ACARBOSE 1 * ALPHA-GLUCOSIDASE INHIBITORS MIGLITOL 1 * ALPHA-GLUCOSIDASE INHIBITORS GLYSET 3 * ALPHA-GLUCOSIDASE INHIBITORS PRECOSE 3 * ANTIDIABETIC - AMYLIN ANALOGS SYMLINPEN 2 * ANTIDIABETIC COMBINATIONS GLIPIZIDE/METFORMIN HCL 1 * ANTIDIABETIC COMBINATIONS GLYBURIDE/METFORMIN HCL 1 * ANTIDIABETIC COMBINATIONS PIOGLITAZONE HCL/METFORMI 1 * ANTIDIABETIC COMBINATIONS PIOGLITAZONE HCL-GLIMEPIR 1 * ANTIDIABETIC COMBINATIONS REPAGLINIDE/METFORMIN HYD 1 * ANTIDIABETIC COMBINATIONS INVOKAMET 2 * ANTIDIABETIC COMBINATIONS INVOKAMET XR 2 * ANTIDIABETIC COMBINATIONS JANUMET 2 * ANTIDIABETIC COMBINATIONS JANUMET XR 2 * ANTIDIABETIC COMBINATIONS JENTADUETO 2 * ANTIDIABETIC COMBINATIONS JENTADUETO XR 2 * ANTIDIABETIC COMBINATIONS QTERN 2 * ANTIDIABETIC COMBINATIONS SOLIQUA 2 * ANTIDIABETIC COMBINATIONS XIGDUO XR 2 * ANTIDIABETIC COMBINATIONS ACTOPLUS MET 3 * ANTIDIABETIC COMBINATIONS ACTOPLUS MET XR 3 * ANTIDIABETIC COMBINATIONS DUETACT 3 * ANTIDIABETIC COMBINATIONS GLUCOVANCE 3 * ANTIDIABETIC COMBINATIONS XULTOPHY 3 BIGUANIDES METFORMIN HCL 1 BIGUANIDES METFORMIN HCL ER 1 BIGUANIDES GLUCOPHAGE 3 BIGUANIDES GLUCOPHAGE XR 3 * DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITORS JANUVIA 2 * DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITORS TRADJENTA 2 DOPAMINE RECEPTOR AGONISTS - ANTIDIABETIC CYCLOSET 3 * INCRETIN MIMETIC AGENTS (GLP-1 RECEPTOR AGONISTS) TRULICITY 2 * INCRETIN MIMETIC AGENTS (GLP-1 RECEPTOR AGONISTS) VICTOZA 2 * INSULIN BASAGLAR KWIKPEN 2 * INSULIN HUMULIN R U * INSULIN LEVEMIR 2 * INSULIN NOVOLIN 70/
2 * INSULIN NOVOLIN N 2 * INSULIN NOVOLIN R 2 * INSULIN NOVOLOG 2 * INSULIN NOVOLOG MIX 70/30 2 * INSULIN TRESIBA FLEXTOUCH 2 * INSULIN SENSITIZING AGENTS PIOGLITAZONE HCL 1 * INSULIN SENSITIZING AGENTS AVANDIA 3 * MEGLITINIDE ANALOGUES NATEGLINIDE 1 * MEGLITINIDE ANALOGUES REPAGLINIDE 1 * MEGLITINIDE ANALOGUES PRANDIN 3 * MEGLITINIDE ANALOGUES STARLIX 3 * SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITORS FARXIGA 2 * SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITORS INVOKANA 2 * SULFONYLUREAS CHLORPROPAMIDE 1 * SULFONYLUREAS GLIMEPIRIDE 1 * SULFONYLUREAS GLIPIZIDE 1 * SULFONYLUREAS GLIPIZIDE ER 1 * SULFONYLUREAS GLYBURIDE 1 * SULFONYLUREAS GLYBURIDE MICRONIZED 1 * SULFONYLUREAS TOLAZAMIDE 1 * SULFONYLUREAS AMARYL 3 * SULFONYLUREAS GLUCOTROL 3 * SULFONYLUREAS GLUCOTROL XL 3 * SULFONYLUREAS GLYNASE 3 Antihypertensive Medications ACE INHIBITORS BENAZEPRIL HCL 1 ACE INHIBITORS CAPTOPRIL 1 ACE INHIBITORS ENALAPRIL MALEATE 1 ACE INHIBITORS FOSINOPRIL SODIUM 1 ACE INHIBITORS LISINOPRIL 1 ACE INHIBITORS MOEXIPRIL HCL 1 ACE INHIBITORS PERINDOPRIL ERBUMINE 1 ACE INHIBITORS QUINAPRIL HCL 1 ACE INHIBITORS RAMIPRIL 1 ACE INHIBITORS TRANDOLAPRIL 1 ACE INHIBITORS ACCUPRIL 3 ACE INHIBITORS ACEON 3 ACE INHIBITORS ALTACE 3 ACE INHIBITORS LOTENSIN 3 ACE INHIBITORS MAVIK 3 ACE INHIBITORS MONOPRIL 3 ACE INHIBITORS PRINIVIL 3 ACE INHIBITORS UNIVASC 3 ACE INHIBITORS VASOTEC 3 ACE INHIBITORS ZESTRIL 3 ALPHA-BETA BLOCKERS CARVEDILOL 1 ALPHA-BETA BLOCKERS LABETALOL HCL 1 ALPHA-BETA BLOCKERS COREG CR 2 ALPHA-BETA BLOCKERS COREG 3 ANGIOTENSIN II RECEPTOR ANTAGONISTS CANDESARTAN CILEXETIL 1 ANGIOTENSIN II RECEPTOR ANTAGONISTS EPROSARTAN MESYLATE
3 ANGIOTENSIN II RECEPTOR ANTAGONISTS IRBESARTAN 1 ANGIOTENSIN II RECEPTOR ANTAGONISTS LOSARTAN POTASSIUM 1 ANGIOTENSIN II RECEPTOR ANTAGONISTS OLMESARTAN MEDOXOMIL 1 ANGIOTENSIN II RECEPTOR ANTAGONISTS TELMISARTAN 1 ANGIOTENSIN II RECEPTOR ANTAGONISTS VALSARTAN 1 ANGIOTENSIN II RECEPTOR ANTAGONISTS AVAPRO 3 ANGIOTENSIN II RECEPTOR ANTAGONISTS COZAAR 3 ANGIOTENSIN II RECEPTOR ANTAGONISTS MICARDIS 3 ANGIOTENSIN II RECEPTOR ANTAGONISTS TEVETEN 3 ANTIADRENERGIC ANTIHYPERTENSIVES CLONIDINE HCL 1 ANTIADRENERGIC ANTIHYPERTENSIVES DOXAZOSIN MESYLATE 1 ANTIADRENERGIC ANTIHYPERTENSIVES GUANFACINE HCL 1 ANTIADRENERGIC ANTIHYPERTENSIVES METHYLDOPA 1 ANTIADRENERGIC ANTIHYPERTENSIVES METHYLDOPATE HCL 1 ANTIADRENERGIC ANTIHYPERTENSIVES PRAZOSIN HCL 1 ANTIADRENERGIC ANTIHYPERTENSIVES TERAZOSIN HCL 1 ANTIADRENERGIC ANTIHYPERTENSIVES CARDURA 3 ANTIADRENERGIC ANTIHYPERTENSIVES CATAPRES 3 ANTIADRENERGIC ANTIHYPERTENSIVES CATAPRES-TTS 3 ANTIADRENERGIC ANTIHYPERTENSIVES MINIPRESS 3 ANTIHYPERTENSIVE COMBINATIONS AMLODIPINE BESYLATE/BENAZ 1 ANTIHYPERTENSIVE COMBINATIONS AMLODIPINE BESYLATE/VALSA 1 ANTIHYPERTENSIVE COMBINATIONS AMLODIPINE/OLMESARTAN MED 1 ANTIHYPERTENSIVE COMBINATIONS AMLODIPINE/VALSARTAN/HCTZ 1 ANTIHYPERTENSIVE COMBINATIONS ATENOLOL/CHLORTHALIDONE 1 ANTIHYPERTENSIVE COMBINATIONS BENAZEPRIL HCL/HYDROCHLOR 1 ANTIHYPERTENSIVE COMBINATIONS BISOPROLOL FUMARATE/HCTZ 1 ANTIHYPERTENSIVE COMBINATIONS CANDESARTAN CILEXETIL/HYD 1 ANTIHYPERTENSIVE COMBINATIONS CAPTOPRIL/HYDROCHLOROTHIA 1 ANTIHYPERTENSIVE COMBINATIONS CLORPRES 1 ANTIHYPERTENSIVE COMBINATIONS ENALAPRIL MALEATE/HYDROCH 1 ANTIHYPERTENSIVE COMBINATIONS FOSINOPRIL SODIUM/HYDROCH 1 ANTIHYPERTENSIVE COMBINATIONS IRBESARTAN/HYDROCHLOROTHI 1 ANTIHYPERTENSIVE COMBINATIONS LISINOPRIL/HYDROCHLOROTHI 1 ANTIHYPERTENSIVE COMBINATIONS LOSARTAN POTASSIUM/HYDROC 1 ANTIHYPERTENSIVE COMBINATIONS METHYLDOPA/HYDROCHLOROTHI 1 ANTIHYPERTENSIVE COMBINATIONS METOPROLOL/HYDROCHLOROTHI 1 ANTIHYPERTENSIVE COMBINATIONS MOEXIPRIL/HYDROCHLOROTHIA 1 ANTIHYPERTENSIVE COMBINATIONS NADOLOL/BENDROFLUMETHIAZI 1 ANTIHYPERTENSIVE COMBINATIONS OLMESARTAN MEDOXOMIL/AMLO 1 ANTIHYPERTENSIVE COMBINATIONS OLMESARTAN MEDOXOMIL/HYDR 1 ANTIHYPERTENSIVE COMBINATIONS PROPRANOLOL/HYDROCHLOROTH 1 ANTIHYPERTENSIVE COMBINATIONS QUINAPRIL/HYDROCHLOROTHIA 1 ANTIHYPERTENSIVE COMBINATIONS TELMISARTAN/AMLODIPINE 1 ANTIHYPERTENSIVE COMBINATIONS TELMISARTAN/HYDROCHLOROTH 1 ANTIHYPERTENSIVE COMBINATIONS TRANDOLAPRIL/VERAPAMIL HC 1 ANTIHYPERTENSIVE COMBINATIONS VALSARTAN/HYDROCHLOROTHIA 1 ANTIHYPERTENSIVE COMBINATIONS TEKTURNA HCT 2 ANTIHYPERTENSIVE COMBINATIONS ACCURETIC 3 ANTIHYPERTENSIVE COMBINATIONS AVALIDE 3 ANTIHYPERTENSIVE COMBINATIONS AZOR 3 ANTIHYPERTENSIVE COMBINATIONS CORZIDE 3 ANTIHYPERTENSIVE COMBINATIONS HYZAAR 3 ANTIHYPERTENSIVE COMBINATIONS LOPRESSOR HCT 3 ANTIHYPERTENSIVE COMBINATIONS LOTENSIN HCT 3 ANTIHYPERTENSIVE COMBINATIONS LOTREL
4 ANTIHYPERTENSIVE COMBINATIONS MICARDIS HCT 3 ANTIHYPERTENSIVE COMBINATIONS TARKA 3 ANTIHYPERTENSIVE COMBINATIONS TENORETIC 3 ANTIHYPERTENSIVE COMBINATIONS TRIBENZOR 3 ANTIHYPERTENSIVE COMBINATIONS TWYNSTA 3 ANTIHYPERTENSIVE COMBINATIONS VASERETIC 3 ANTIHYPERTENSIVE COMBINATIONS ZESTORETIC 3 ANTIHYPERTENSIVE COMBINATIONS ZIAC 3 BETA BLOCKERS CARDIO-SELECTIVE ACEBUTOLOL HCL 1 BETA BLOCKERS CARDIO-SELECTIVE ATENOLOL 1 BETA BLOCKERS CARDIO-SELECTIVE BETAXOLOL HCL 1 BETA BLOCKERS CARDIO-SELECTIVE BISOPROLOL FUMARATE 1 BETA BLOCKERS CARDIO-SELECTIVE METOPROLOL SUCCINATE EXT-REL 1 BETA BLOCKERS CARDIO-SELECTIVE METOPROLOL TARTRATE 1 BETA BLOCKERS CARDIO-SELECTIVE BYSTOLIC 2 BETA BLOCKERS CARDIO-SELECTIVE LOPRESSOR 3 BETA BLOCKERS CARDIO-SELECTIVE TENORMIN 3 BETA BLOCKERS CARDIO-SELECTIVE TOPROL XL 3 BETA BLOCKERS NON-SELECTIVE NADOLOL 1 BETA BLOCKERS NON-SELECTIVE PINDOLOL 1 BETA BLOCKERS NON-SELECTIVE PROPRANOLOL HCL 1 BETA BLOCKERS NON-SELECTIVE PROPRANOLOL HCL ER 1 BETA BLOCKERS NON-SELECTIVE SOTALOL HCL 1 BETA BLOCKERS NON-SELECTIVE SOTALOL HCL (AF) 1 BETA BLOCKERS NON-SELECTIVE TIMOLOL MALEATE 1 BETA BLOCKERS NON-SELECTIVE INDERAL LA 3 BETA BLOCKERS NON-SELECTIVE INDERAL XL 3 BETA BLOCKERS NON-SELECTIVE INNOPRAN XL 3 CALCIUM CHANNEL BLOCKERS AMLODIPINE BESYLATE 1 CALCIUM CHANNEL BLOCKERS DILTIAZEM HCL 1 CALCIUM CHANNEL BLOCKERS DILTIAZEM ER 1 CALCIUM CHANNEL BLOCKERS FELODIPINE ER 1 CALCIUM CHANNEL BLOCKERS ISRADIPINE 1 CALCIUM CHANNEL BLOCKERS NICARDIPINE HCL 1 CALCIUM CHANNEL BLOCKERS NIFEDIPINE 1 CALCIUM CHANNEL BLOCKERS NIFEDIPINE ER 1 CALCIUM CHANNEL BLOCKERS NIMODIPINE 1 CALCIUM CHANNEL BLOCKERS NISOLDIPINE ER 1 CALCIUM CHANNEL BLOCKERS VERAPAMIL HCL 1 CALCIUM CHANNEL BLOCKERS VERAPAMIL HCL ER 1 CALCIUM CHANNEL BLOCKERS CALAN 3 CALCIUM CHANNEL BLOCKERS CALAN SR 3 CALCIUM CHANNEL BLOCKERS PROCARDIA 3 CALCIUM CHANNEL BLOCKERS PROCARDIA XL 3 CALCIUM CHANNEL BLOCKERS SULAR 3 CALCIUM CHANNEL BLOCKERS TIAZAC 3 CALCIUM CHANNEL BLOCKERS VERELAN 3 CARBONIC ANHYDRASE INHIBITORS ACETAZOLAMIDE 1 CARBONIC ANHYDRASE INHIBITORS ACETAZOLAMIDE ER 1 CARBONIC ANHYDRASE INHIBITORS METHAZOLAMIDE 1 CARBONIC ANHYDRASE INHIBITORS DIAMOX 3 CARBONIC ANHYDRASE INHIBITORS KEVEYIS 3 CARBONIC ANHYDRASE INHIBITORS NEPTAZANE 3 DIRECT RENIN INHIBITORS TEKTURNA
5 DIURETIC COMBINATIONS AMILORIDE/HYDROCHLOROTHIA 1 DIURETIC COMBINATIONS SPIRONOLACTONE/HYDROCHLOR 1 DIURETIC COMBINATIONS TRIAMTERENE/HYDROCHLOROTH 1 DIURETIC COMBINATIONS ALDACTAZIDE 3 DIURETIC COMBINATIONS DYAZIDE 3 DIURETIC COMBINATIONS MAXZIDE 3 LOOP DIURETICS BUMETANIDE 1 LOOP DIURETICS ETHACRYNIC ACID 1 LOOP DIURETICS FUROSEMIDE 1 LOOP DIURETICS TORSEMIDE 1 LOOP DIURETICS BUMEX 3 LOOP DIURETICS DEMADEX 3 LOOP DIURETICS EDECRIN 3 LOOP DIURETICS LASIX 3 POTASSIUM SPARING DIURETICS AMILORIDE HCL 1 POTASSIUM SPARING DIURETICS SPIRONOLACTONE 1 POTASSIUM SPARING DIURETICS ALDACTONE 3 THIAZIDES AND THIAZIDE-LIKE DIURETICS CHLOROTHIAZIDE 1 THIAZIDES AND THIAZIDE-LIKE DIURETICS CHLORTHALIDONE 1 THIAZIDES AND THIAZIDE-LIKE DIURETICS HYDROCHLOROTHIAZIDE 1 THIAZIDES AND THIAZIDE-LIKE DIURETICS INDAPAMIDE 1 THIAZIDES AND THIAZIDE-LIKE DIURETICS METHYCLOTHIAZIDE 1 THIAZIDES AND THIAZIDE-LIKE DIURETICS METOLAZONE 1 THIAZIDES AND THIAZIDE-LIKE DIURETICS DIURIL 3 THIAZIDES AND THIAZIDE-LIKE DIURETICS LOZOL 3 THIAZIDES AND THIAZIDE-LIKE DIURETICS MICROZIDE 3 VASODILATORS HYDRALAZINE HCL 1 VASODILATORS MINOXIDIL 1 Cholesterol Lowering Medications ANTIHYPERLIPIDEMICS - COMBINATIONS EZETIMIBE/SIMVASTATIN 1 ANTIHYPERLIPIDEMICS - COMBINATIONS VYTORIN 3 ANTIHYPERLIPIDEMICS - MISC. VASCEPA 2 ANTIHYPERLIPIDEMICS - MISC. KYNAMRO 3 ANTIHYPERLIPIDEMICS - MISC. LOVAZA 3 BILE ACID SEQUESTRANTS CHOLESTYRAMINE 1 BILE ACID SEQUESTRANTS COLESTIPOL HCL 1 BILE ACID SEQUESTRANTS WELCHOL 2 BILE ACID SEQUESTRANTS COLESTID 3 BILE ACID SEQUESTRANTS QUESTRAN 3 CARDIOVASCULAR AGENTS MISC. - COMBINATIONS AMLODIPINE BESYLATE/ATORV 1 CARDIOVASCULAR AGENTS MISC. - COMBINATIONS BIDIL 2 CARDIOVASCULAR AGENTS MISC. - COMBINATIONS ENTRESTO 2 CARDIOVASCULAR AGENTS MISC. - COMBINATIONS CADUET 3 FIBRIC ACID DERIVATIVES FENOFIBRATE 1 FIBRIC ACID DERIVATIVES FENOFIBRIC ACID 1 FIBRIC ACID DERIVATIVES GEMFIBROZIL 1 FIBRIC ACID DERIVATIVES ANTARA 3 FIBRIC ACID DERIVATIVES FENOGLIDE 3 FIBRIC ACID DERIVATIVES FIBRICOR
6 FIBRIC ACID DERIVATIVES LIPOFEN 3 FIBRIC ACID DERIVATIVES LOFIBRA 3 FIBRIC ACID DERIVATIVES LOPID 3 FIBRIC ACID DERIVATIVES TRILIPIX 3 HMG COA REDUCTASE INHIBITORS ATORVASTATIN CALCIUM 1 HMG COA REDUCTASE INHIBITORS FLUVASTATIN 1 HMG COA REDUCTASE INHIBITORS FLUVASTATIN ER 1 HMG COA REDUCTASE INHIBITORS LOVASTATIN 1 HMG COA REDUCTASE INHIBITORS PRAVASTATIN SODIUM 1 HMG COA REDUCTASE INHIBITORS ROSUVASTATIN CALCIUM 1 HMG COA REDUCTASE INHIBITORS SIMVASTATIN 1 HMG COA REDUCTASE INHIBITORS ADVICOR 3 HMG COA REDUCTASE INHIBITORS LESCOL 3 HMG COA REDUCTASE INHIBITORS SIMCOR 3 HMG COA REDUCTASE INHIBITORS ZOCOR 3 INTESTINAL CHOLESTEROL ABSORPTION INHIBITORS EZETIMIBE 1 NICOTINIC ACID DERIVATIVES NIACIN EXT-REL 1 NICOTINIC ACID DERIVATIVES NIASPAN 3 PROPROTEIN CONVERTASE SUBTILISIN/KEXIN TYPE 9 INHIBITORS PRALUENT 2 PROPROTEIN CONVERTASE SUBTILISIN/KEXIN TYPE 9 INHIBITORS REPATHA 2 Anti-Depressants ALPHA-2 RECEPTOR ANTAGONISTS (TETRACYCLICS) MIRTAZAPINE 1 ALPHA-2 RECEPTOR ANTAGONISTS (TETRACYCLICS) MIRTAZAPINE ODT 1 ALPHA-2 RECEPTOR ANTAGONISTS (TETRACYCLICS) REMERON 3 ALPHA-2 RECEPTOR ANTAGONISTS (TETRACYCLICS) REMERON SOLTAB 3 ANTIDEPRESSANTS - MISC. BUPROPION HCL 1 ANTIDEPRESSANTS - MISC. BUPROPION HCL SR 1 ANTIDEPRESSANTS - MISC. BUPROPION HCL XL 1 ANTIDEPRESSANTS - MISC. MAPROTILINE HCL 1 ANTIDEPRESSANTS - MISC. WELLBUTRIN 3 ANTIDEPRESSANTS - MISC. WELLBUTRIN SR 3 ANTIDEPRESSANTS - MISC. WELLBUTRIN XL 3 COMBINATION PSYCHOTHERAPEUTICS CHLORDIAZEPOXIDE/AMITRIPT 1 COMBINATION PSYCHOTHERAPEUTICS OLANZAPINE/FLUOXETINE 1 COMBINATION PSYCHOTHERAPEUTICS PERPHENAZINE/AMITRIPTYLIN 1 COMBINATION PSYCHOTHERAPEUTICS SYMBYAX 3 MONOAMINE OXIDASE INHIBITORS (MAOIS) PHENELZINE SULFATE 1 MONOAMINE OXIDASE INHIBITORS (MAOIS) TRANYLCYPROMINE SULFATE 1 MONOAMINE OXIDASE INHIBITORS (MAOIS) EMSAM 3 MONOAMINE OXIDASE INHIBITORS (MAOIS) MARPLAN 3 MONOAMINE OXIDASE INHIBITORS (MAOIS) NARDIL 3 MONOAMINE OXIDASE INHIBITORS (MAOIS) PARNATE 3 SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) CITALOPRAM HYDROBROMIDE 1 SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) ESCITALOPRAM OXALATE 1 SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) FLUOXETINE HCL 1 SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) FLUVOXAMINE MALEATE 1 SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) FLUVOXAMINE MALEATE ER 1 SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) PAROXETINE HCL 1 SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) PAROXETINE HCL ER
7 SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) SERTRALINE HCL 1 SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) FLUOXETINE HCL 60MG 2 SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) CELEXA 3 SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) LEXAPRO 3 SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) LUVOX CR 3 SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) PAXIL 3 SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) PAXIL CR 3 SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) PEXEVA 3 SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) PROZAC 3 SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) ZOLOFT 3 SEROTONIN MODULATORS NEFAZODONE HCL 1 SEROTONIN MODULATORS TRAZODONE HCL 1 SEROTONIN MODULATORS TRINTELLIX 2 SEROTONIN MODULATORS VIIBRYD 2 SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS) DESVENLAFAXINE ER 1 SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS) DULOXETINE HCL 1 SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS) VENLAFAXINE HCL 1 SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS) VENLAFAXINE HCL ER CAP 1 SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS) DESVENLAFAXINE FUMARATE ER 3 SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS) FETZIMA 3 SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS) KHEDEZLA 3 SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS) PRISTIQ 3 TRICYCLIC AGENTS AMITRIPTYLINE HCL 1 TRICYCLIC AGENTS AMOXAPINE 1 TRICYCLIC AGENTS CLOMIPRAMINE HCL 1 TRICYCLIC AGENTS DESIPRAMINE HCL 1 TRICYCLIC AGENTS DOXEPIN HCL 1 TRICYCLIC AGENTS IMIPRAMINE HCL 1 TRICYCLIC AGENTS IMIPRAMINE PAMOATE 1 TRICYCLIC AGENTS NORTRIPTYLINE HCL 1 TRICYCLIC AGENTS PROTRIPTYLINE HCL 1 TRICYCLIC AGENTS TRIMIPRAMINE MALEATE 1 TRICYCLIC AGENTS ANAFRANIL 3 TRICYCLIC AGENTS ELAVIL 3 TRICYCLIC AGENTS NORPRAMIN 3 TRICYCLIC AGENTS PAMELOR 3 TRICYCLIC AGENTS SURMONTIL 3 TRICYCLIC AGENTS TOFRANIL 3 TRICYCLIC AGENTS TOFRANIL-PM 3 Diabetes Supplies ALCOHOL SWABS 0% BD ULTRAFINE INSULIN SYRINGES 1 0% CALIBRATION SOLUTIONS 0% LANCET DEVICES & LANCETS 0% ONETOUCH ULTRA STRIPS AND KITS 2,3 0% ONETOUCH VERIO STRIPS AND KITS 2,3 0% Notes: 1 BD ULTRAFINE syringes and needles are the only preferred options. 2 A ONETOUCH blood glucose meter may be provided at no charge by the manufacturer to those individuals using a meter other 3 ONETOUCH brand test strips are the only preferred options. *Drugs used to determine eligibility for the Advantage Value for Diabetes program 2017 CVS Caremark. All rights reserved. This document contains confidential and proprietary information of CVS Caremark and may not be reproduced, distributed or printed without written permission from CVS Caremark. This list is subject to change. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark
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