Preventive medications list
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1 Preventive medications list In addition to a healthy lifestyle, preventive medications can help people avoid many illnesses and conditions. A consumer-directed health (CDH) plan that includes preventive medications can help support the goal of ongoing good health. This list provides examples of commonly prescribed preventive medications. The medications are categorized based on the medical conditions that they are used to prevent. This is not an all-inclusive list; only examples of medicines in each category are listed. Coverage prior to the deductible being met may not be provided for every dosage form of a listed medication. This list does not indicate coverage. Please check with your plan administrator and/or benefit information materials if you have questions on coverage. Your cost share will be determined by your plan s drug coverage and formulary plan. This list is periodically reviewed and updated to ensure that the drugs listed meet the criteria for inclusion. Medications on this list that are not covered under your plan are not eligible for the preventive medication program. PDL6014D
2 ASTHMA/COPD ACCOLATE ZAFIRLUKAST ANORO ELLIPTA ARNUITY ELLIPTA ASMANEX HFA BREO ELLIPTA COMBIVENT RESPIMAT DULERA GASTROCROM CROMOLYN SODIUM INCRUSE ELLIPTA PROAIR HFA, VENTOLIN HFA PULMICORT BUDESONIDE QVAR SEREVENT DISKUS SINGULAIR MONTELUKAST SPIRIVA STRIVERDI RESPIMAT SYMBICORT ZYFLO CR RESPIRATORY SUPPLIES NEBULIZERS AND INHALER ASSISTIVE DEVICES BONE DISEASE AND FRACTURES ACTONEL RISEDRONATE BONIVA IBANDRONATE EVISTA RALOXIFENE FOSAMAX, FOSAMAX PLUS D ALENDRONATE RECLAST ZOLEDRONIC ACID CAVITIES STANNOUS FLUORIDE PASTE AND RINSE CLINPRO, PHOS-FLUR SODIUM FLUORIDE PASTE AND RINSE COLONOSCOPY PREPARATION GOLYTELY, NULYTELY, MOVIPREP POLYETHYLENE GLYCOL OSMOPREP, SUPREP PREPOPIK DIABETES INSULINS: AFREZZA HUMALOG, 50/50, 75/25 HUMULIN LANTUS, LANTUS SOLOSTAR LEVEMIR TOUJEO SOLOSTAR NON-INSULIN MEDICINES: ACTOS, DUETACT, ACTOPLUS MET PIOGLITAZONE AND COMBINATIONS AMARYL GLIMEPIRIDE AVANDIA AVANDAMET, AVANDARYL BYETTA DIABETA, GLYNASE, GLUCOVANCE GLYBURIDE AND COMBINATIONS DIABETIC SUPPLIES TEST STRIPS, SYRINGES, NEEDLES AND LANCETS FORTAMET, GLUCOPHAGE METFORMIN GLUCOTROL GLIPIZIDE AND COMBINATIONS GLYXAMBI
3 INVOKANA JANUVIA, JANUMET JARDIANCE JENTADUETO PRANDIN REPAGLINIDE STARLIX NATEGLINIDE SYMLINPEN TRADJENTA TRULICITY XIGDUO XR HEART DISEASE AND STROKE BLOOD THINNER MEDICINES: ASPIRIN, 81 MG OR 325 MG AGGRENOX ASPIRIN-DIPYRIDAMOLE ER BRILINTA COUMADIN WARFARIN EFFIENT ELIQUIS PERSANTINE DIPYRIDAMOLE PLAVIX CLOPIDOGREL PRADAXA SAVAYSA TICLID TICLOPIDINE XARELTO ZONTIVITY CHOLESTEROL LOWERING MEDICINES HMG-COA REDUCTASE INHIBITORS: CRESTOR LIPITOR ATORVASTATIN MEVACOR LOVASTATIN PRAVACHOL PRAVASTATIN ZOCOR SIMVASTATIN OTHER AGENTS: ADVICOR COLESTID COLESTIPOL LOPID GEMFIBROZIL PREVALITE, QUESTRAN CHOLESTYRAMINE SIMCOR TRICOR, ANTARA FENOFIBRATE TRILIPIX DR FENOFIBRIC ACID VYNTORIN WELCHOL ZETIA HIGH BLOOD PRESSURE ACE INHIBITORS: ACCUPRIL QUINAPRIL LOTENSIN BENAZEPRIL PRINIVIL, ZESTRIL LISINOPRIL VASOTEC ENALAPRIL
4 ACE INHIBITORS/DIURETIC COMBINATIONS: ACCURETIC QUINAPRIL/HCTZ LOTENSIN HCT BENAZEPRIL/HCTZ VASERETIC ENALAPRIL/HCTZ ZESTORETIC LISINOPRIL/HCTZ ANGIOTENSIN II RECEPTOR ANTAGONISTS: ATACAND CANDESARTAN AVAPRO IRBESARTAN COZAAR LOSARTAN DIOVAN VALSARTAN ANGIOTENSIN II RECEPTOR ANTAGONISTS/ DIURETIC COMBINATIONS: ATACAND HCT CANDESARTAN/HCTZ AVALIDE IRBESARTAN/HCTZ DIOVAN HCT VALSARTAN/HCTZ HYZAAR LOSARTAN/HCTZ BETA BLOCKERS: BYSTOLIC INDERAL LA, INNOPRAN XL PROPRANOLOL TENORMIN ATENOLOL TOPROL XL METOPROLOL ZEBETA BISOPROLOL BETA BLOCKERS/DIURETIC COMBINATIONS: PROPRANOLOL/HCTZ CORZIDE NADOLOL/BENDROFLUMETHIAZIDE LOPRESSOR HCT METOPROLOL/HCTZ TENORETIC ATENOLOL/CHLORTHALIDONE ZIAC BISOPROLOL/HCTZ CALCIUM CHANNEL BLOCKERS: ADALAT CC, PROCARDIA XL NIFEDIPINE CALAN, VERELAN VERAPAMIL CARDIZEM LA, TIAZAC ER DILTIAZEM NORVASC AMLODIPINE SULAR ER NISOLDIPINE DIURETICS: CHLORTHALIDONE HYDROCHLOROTHIAZIDE INDAPAMIDE METOLAZONE OTHER HIGH BLOOD PRESSURE MEDICINE COMBINATIONS: AZOR CADUET AMLODIPINE/ATORVASTATIN
5 EXFORGE HCT AMLODIPINE/VALSARTAN/HCTZ LOTREL AMLODIPINE/BENAZEPRIL TARKA TRANDOLAPRIL/VERAPAMIL TRANDOLAPRIL TRIBENZOR TWYNSTA AMLODIPINE/TELMISARTAN RESPIRATORY SYNCYTIAL VIRUS SYNAGIS MALARIA CHLOROQUINE MEFLOQUINE PRIMAQUINE MALARONE ATOVAQUONE/PROGUANIL OBESITY DIETHYLPROPION ADIPEX-P PHENTERMINE BELVIQ BONTRIL PDM PHENDIMETRAZINE CONTRAVE SAXENDA XENICAL SMOKING-CESSATION * CHANTIX NICOTROL/NICODERM CQ NICOTINE PRODUCTS ZYBAN BUPROPION SR 150MG IMMUNIZATION: * DIPHTHERIA, PERTUSSIS, TETANUS, HAEMOPHILUS INFLUENZAE B, HEPATITIS A AND B, JE-VAX, TYPHIM, VARICELLA, ZOSTER, HUMAN PAPILLOMAVIRUS, INFLUENZA, MEASLES, MENINGOCOCCAL, MUMPS, PNEUMOCOCCAL, POLIOVIRUS, ROTAVIRUS, RUBELLA VITAMINS OR MINERALS FOLIC ACID* PRENATAL VITAMINS PEDIATRIC MULTIVITAMINS WITH FLUORIDE* *Please note that some of these medications are also subject to the Affordable Care Act (ACA) and may be covered by your plan at 100%.
6 Express Scripts manages your prescription benefit for your employer, plan sponsor, or health plan. For specific questions on coverage, please call the phone number on your ID card or visit our website Express-Scripts.com. Please note: Brand names are shown in italics in each category. If generic is available, it is listed under the brand name. All rights in the product names of all third-party products appearing here, whether or not appearing with the trademark symbol, belong exclusively to their respective owners. CRP15_1293 PDL6014D 8.15 OPTION 2 * PDL6014D* * PDL6014D*
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