Reducing your out-of-pocket costs for the medicine you need Preventive and Chronic Medicine List

Transcription

1 Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Reducing your out-of-pocket costs for the medicine you need Preventive and Chronic Medicine List E (11/14)

2 Forget the deductible just pay your copay or coinsurance when buying certain medicine. If you have certain conditions such as hypertension, high cholesterol, diabetes, asthma, osteoporosis or depression, you ll be interested in a special feature that can help you manage the cost of the medicine you need. We understand how important it is to take the medicine prescribed by your doctor, and the Aetna preventive and chronic medicine feature makes it easier for you to do that. Health benefits and health insurance plans are offered, administered and/or underwritten by Aetna Health Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). In Florida, by Aetna Health Inc. and/or Aetna Life Insurance Company. In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT Each insurer has sole financial responsibility for its own products. 2

3 Forget the deductible just pay your copay or coinsurance when buying certain medicine. Category Generic medicine Brand-name medicine Antihypertensive medicine (high blood pressure) Angiotensinconverting enzyme (ACE) inhibitors benazepril benazepril/ hydrochlorothiazide (HCTZ) captopril captopril/hctz enalapril enalapril/hctz fosinopril fosinopril/hctz lisinopril lisinopril/hctz moexipril moexipril/hctz perindopril quinapril quinapril/hctz ramipril trandolapril ACCUPRIL ACCURETIC ACEON ALTACE EPANED LOTENSIN LOTENSIN HCT MAVIK PRINIVIL PRINZIDE UNIRETIC UNIVASC VASERETIC VASOTEC ZESTORETIC ZESTRIL Angiotensin II receptor antagonists/renin inhibitors/ combinations candesartan candesartan/hctz eprosartan irbesartan irbesartan/hctz losartan losartan/hctz telmisartan telmisartan/hctz valsartan valsartan/hctz AMTURNIDE ATACAND ATACAND HCT AVALIDE AVAPRO BENICAR BENICAR HCT COZAAR DIOVAN DIOVAN HCT EXFORGE EXFORGE HCT EDARBI EDARBYCLOR HYZAAR MICARDIS MICARDIS HCT TEVETEN TEVETEN HCT TEKAMLO TEKTURNA TEKTURNA HCT 3

4 Category Generic medicine Brand-name medicine Alpha-adrenergic/ beta-adrenergic blockers acebutolol atenolol atenolol/chlorthalidone betaxolol bisoprolol bisoprolol/hctz carvedilol doxazosin labetalol metoprolol metoprolol/hctz metoprolol ER nadolol nadolol/ bendroflumethiazide prazosin propranolol propranolol ER/SR/LA propranolol/hctz pindolol sorine sotalol sotalol AF terazosin timolol BETAPACE BETAPACE AF BYSTOLIC CARDURA COREG COREG CR CORGARD CORZIDE DUTOPROL KERLONE LEVATOL INDERAL LA INNOPRAN XL LOPRESSOR LOPRESSOR HCT MINIPRESS SECTRAL TENORMIN TENORETIC TOPROL XL TRANDATE ZEBETA ZIAC Calcium channel blockers/ miscellaneous combinations afeditab CR amlodipine amlodipine/benazepril cartia XT diltiazem diltiazem CD/ER/XR dilt-xr felodipine ER isradipine matzim LA nicardipine nifediac CC nifedipine nifedipine ER nimodipine nisoldipine nisoldipine ER taztia XT telmisartan/amlodipine verapamil verapamil ER ADALAT CC AZOR CALAN CALAN SR CARDENE SR CARDIZEM CD/LA CARDIZEM COVERA HS EXFORGE EXFORGE HCT ISOPTIN SR LOTREL NORVASC NYMALIZE PROCARDIA PROCARDIA XL SULAR TIAZAC TRIBENZOR TWYNSTA VERELAN SR/PM Diuretics acetazolamide amiloride amiloride/hctz bumetanide chlorothiazide chlorthalidone eplerenone furosemide HCTZ indapamide methazolamide methyclothiazide metolazone spironolactone spironolactone/hctz torsemide triamterene/hctz ALDACTAZIDE ALDACTONE DEMADEX DIAMOX DIURIL DYAZIDE DYRENIUM EDECRIN INTROL INSPRA LASIX MAXZIDE MICROZIDE NEPTAZANE ZAROXOLYN Antihypertensive miscellaneous clonidine guanfacine hydralazine methyldopa methyldopa/hctz minoxidil reserpine CATAPRES CLORPRES DEMSER DIBENZYLINE TENEX VECAMYL Antihyperlipidemia medicine (high cholesterol) HMG-CoA reductase inhibitors (statins)/ miscellaneous amlodipine besylate/ atorvastatin atorvastatin fluvastatin lovastatin pravastatin simvastatin ADVICOR ALTOPREV CADUET CRESTOR LESCOL LESCOL XL LIPITOR LIPTRUZET LIVALO MEVACOR PRAVACHOL SIMCOR ZETIA ZOCOR 4

5 Category Generic medicine Brand-name medicine Bile acid sequestrants/ fibric acids/ miscellaneous antihyperlipidemics cholestyramine colestipol fenofibrate fenofibric fenofibric DR gemfibrozil niacin ER omega-3 acid prevalite ANTARA COLESTID FENOGLIDE FIBRICOR JUXTAPID KYNAMRO LIPOFEN LOFIBRA LOPID LOVAZA NIACOR NIASPAN QUESTRAN QUESTRAN LITE TRICOR TRIGLIDE TRILIPIX WELCHOL VASCEPA VYTORIN Anti-angina isoditrate ER isosorbide dinitrate isosorbide dinitrate ER isosorbide mononitrate isosorbide mononitrate ER minitran nitroglycerin nitroglycerin ER nitroglycerin lingual spray nitroglycerin transdermal nitro-time DILATRATE SR IMDUR ISORDIL TITRADOSE NITRO-BID NITRO-DUR NITROLINGUAL PUMPSPRAY NITROMIST NITRONAL NITROSTAT RANEXA Cardiac glycosides digoxin LANOXIN Anti-asthmatics (asthma) albuterol albuterol ER aminophylline budesonide cromolyn sodium ipratropium bromide ipratropium BR/albuterol levalbuterol HCI metaproterenol sulfate montelukast sodium terbutaline sulfate theochron theophylline theophylline ER zafirlukast ACCOLATE ADVAIR DISKUS ADVAIR HFA AEROSPAN ALVESCO ANORO ELLIPTA ARCAPTA NEOHALER ASMANEX TWISTHALER ATROVENT HFA BREO ELLIPTA BROVANA COMBIVENT RESPIMAT DALIRESP DULERA ELIXOPHYLLIN FLOVENT DISKUS FLOVENT HFA FORADIL AEROLIZER ISUPREL LUFYLLIN PERFOROMIST PROAIR HFA PROVENTIL HFA PULMICORT FLEXHALER PULMICORT QVAR SEREVENT DISKUS SINGULAIR SPIRIVA HANDIHALER STRIVERDI RESPIMAT SYMBICORT THEO-24 TUDORZA PRESSAIR VENTOLIN HFA VOSPIRE ER XOPENEX XOPENEX CONC XOPENEX HFA ZYFLO ZYFLO CR Anti-asthma devices none PEAK FLOW METERS/DEVICES ASTHMA SPACERS Antidiabetic medicine Insulins none APIDRA SOLOSTAR APIDRA HUMALOG PRODUCTS HUMULIN PRODUCTS LANTUS LANTUS SOLOSTAR LEVEMIR LEVEMIR FLEXPEN LEVEMIR FLEXTOUCH NOVOLIN PRODUCTS NOVOLOG PRODUCTS RELION PRODUCTS 5

6 Category Generic medicine Brand-name medicine Antidiabetic orals/ injectables acarbose chlorpropamide glimepiride glipizide glipizide ER glipizide XL glipizide/metformin HCl glyburide glyburide micronized glyburide/metformin HCl metformin HCl metformin HCl ER nateglinide pioglitazone HCl pioglitazone HCl/ metformin HCl pioglitazone HCl/ glimepiride repaglinide tolazamide tolbutamide ACTOPLUS MET ACTOPLUS MET XR ACTOS AMARYL AVANDAMET AVANDARYL AVANDIA BYDUREON BYETTA CYCLOSET DIABETA DUETACT FARXIGA FORTAMET GLUCAGEN GLUCAGEN HYPOKIT GLUCAGON EMERGENCY KIT GLUCOPHAGE GLUCOPHAGE XR GLUCOTROL GLUCOTROL XL GLUCOVANCE GLUMETZA GLYNASE GLYSET INVOKAMET INVOKANA JANUMET JANUMET XR JANUVIA JARDIANCE JENTADUETO KAZANO KOMBIGLYZE XR KORLYM NESINA ONGLYZA OSENI PRANDIMET PRANDIN PRECOSE PROGLYCEM RIOMET STARLIX SYMLINPEN TANZEUM TRADJENTA VICTOZA Diabetic supplies (diabetes) insulin syringes any generic lancets any generic pen needles any generic BD insulin syringes BD lancets BD pen needles FREESTYLE glucose test strips FREESTYLE INSULINX FREESTYLE LITE ONETOUCH BASIC ONETOUCH FASTTAKE ONETOUCH PROFILE ONETOUCH VERIO ONETOUCH VERIO IQ ONETOUCH ULTRA PRECISION QID PRECISION SOF-TACT PRECISION XTRA ketone test strips SURESTEP glucose test strips ALL OTHER BRANDS ALL OTHER BRANDS insulin syringes ALL OTHER BRANDS lancets ALL OTHER BRANDS pen needles 6

7 Category Generic medicine Brand-name medicine Antidepressants amitriptyline HCI amoxapine bupropion HCI bupropion HCI ER bupropion HCI XL citalopram clomipramine HCI desipramine HCI desvenlafaxine ER doxepin HCI duloxetine HCI escitalopram fluoxetine DR fluoxetine HCI fluvoxamine fluvoxamine ER imipramine HCI imipramine maprotiline HCI mirtazapine mirtazapine ODT nefazodone HCI nortriptyline HCI paroxetine HCI paroxetine HCI ER phenelzine sulfate protriptyline HCI sertraline HCI tranylcypromine trazodone HCI venlafaxine HCI venlafaxine HCI ER ANAFRANIL APLENZIN BRINTELLIX CELEXA CYMBALTA DESVENLAFAXINE ER EFFEXOR XR EMSAM FETZIMA FLUOXETINE HCL FORFIVO XL KHEDEZLA LEXAPRO LUVOX CR MARPLAN NARDIL NORPRAMIN OLEPTRO PAMELOR PARNATE PAXIL PAXIL CR PEXEVA PRISTIQ PROZAC PROZAC WEEKLY REMERON REMERON SOLTAB SURMONTIL TOFRANIL TOFRANIL-PM TRAZAMINE VENLAFAXINE ER VIIBRYD VIVACTIL WELLBUTRIN WELLBUTRIN SR WELLBUTRIN XL ZOLOFT Antipsychotics chlorpromazine HCI clozapine clozapine ODT compro fluphenazine HCI haloperidol lithium carbonate lithium carbonate ER lithium citrate loxapine olanzapine olanzapine ODT perphenazine prochlorperazine quetiapine risperidone risperidone m-tab risperidone ODT thioridazine HCI thiothixene trifluoperazine HCI ziprasidone HCI ABILIFY ABILIFY DISCMELT ADASUVE CLOZARIL COMPAZINE EQUETRO FANAPT FAZACLO GEODON INVEGA LATUDA LITHOBID RISPERDAL RISPERDAL M-TAB SAPHRIS SEROQUEL SEROQUEL XR VERSACLOZ ZYPREXA ZYPREXA ZYDIS Blood-thinning agents anagrelide argatroban cilostazol clopidogrel dipyridamole enoxaparin fondaparinux heparin jantoven warfarin ticlopidine AGGRENOX AGRYLIN BRILINTA ARIXTRA COUMADIN EFFIENT ELIQUIS FRAGMIN IPRIVASK LOVENOX PERSANTINE PLAVIX PRADAXA XARELTO ZONTIVITY Osteoporosis agents alendronate calcitonin spray etidronate fortical spray ibandronate pamidronate raloxifene risedronate zoledronic ACTONEL ATELVIA BINOSTO BONIVA EVISTA FORTEO FOSAMAX FOSAMAX PLUS D MIACALCIN INJECTION MIACALCIN SPRAY PROLIA RECLAST XGEVA ZOMETA Prenatal multivitamin with folic acid many choices available many choices available Pediatric vitamins with fluoride many choices available many choices available Smoking-cessation medicine buproban bupropion SR CHANTIX NICOTROL INHALER NICOTROL NS 7

8 Please remember that this is not a complete list of medications covered under your plan. Because there are thousands of medications included in your pharmacy benefit, we only list the most common ones. Certain drugs such as those for smoking cessation or vitamins may not be covered by your particular pharmacy plan. Diabetic supplies may be covered under your medical plan. If you have any questions about your pharmacy benefits, please visit and log in to your secure member website. If you don t have access to our website, call the toll-free number on your member ID card. To check coverage and copay information for a specific medicine, visit and log in to your secure member website. For more details, please call the toll-free number on your member ID card. Aetna Pharmacy Management refers to an internal business unit of Aetna Health Management, LLC. This is not an inclusive list. Products that are not represented on this list may be subject to plan-specific copayment or coinsurance. Void where prohibited by law. Specific prescription benefits plan design may not cover certain categories or may be subject to additional charges or restrictions, regardless of their appearance in this document. Aetna may receive rebates, discounts and service fees from pharmaceutical manufacturers for certain listed products. Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information. Information is believed to be accurate as of the production date; however, it is subject to change. For questions, please call the toll-free number on your member ID card Aetna Inc E (11/14)