Accupril Accuretic Acebutolol Aceon Activella Actonel Adalat CC Advicor Afeditab CR Aggrenox Aldactone Aldomet Aldoril Alendronate Alora Altace Altoprev Amiloride/HCTZ Amlodipine Amlodipine/Benazepril Angeliq Antara Apresoline Atacand Atacand HCT Atenolol Atenolol/Chlorthalidone Avalide Avapro Azor Benazepril Benazepril/Hydrochlorothiazide Benicar Benicar HCT BiDil Bisoprolol Bisoprolol/Hydrochlorothiazide Blocadren Boniva Bumetanide Bystolic Caduet Calan Calan SR Calcitonin-Salmon Capoten Capozide Captopril Captopril/Hydrochlorothiazide Cardene Cardene SR Cardizem CD Cardizem LA Cardizem SR Cardura Cartia XT Cartrol Carvedilol Catapres Catapres-TTS Cenestin Chlorothiazide Chlorthalidone Cholestyramine Cholestyramine Light Climara Climara PRO Clonidine Clopidogrel Clorpres Colestid Colestipol Combipatch Coreg Coreg CR Corgard Corzide Coumadin Covera-HS Cozaar Crestor Demadex Didronel Dilacor XR Diltia XT Diltiazem Diltiazem ER Diltiazem SR Diovan Diovan HCT Dipyridamole Divigel Doxazosin Dyazide DynaCirc DynaCirc CR Edecrin Effient Enalapril Enalapril/Hydrochlorothiazide Enduron Enjuvia Estrace Estraderm Estradiol Estradiol Transdermal System Estropipate Estring Estradiol/Norethindrone Etidronate Evista 100-6926 10/09 2009 United HealthCare Services, Inc. Page 1 of 7
Exforge Exforge HCT Felodipine Felodipine ER Femara Femhrt Femring Fenofibrate Fenoglide Fibricor Forteo Fortical Fosamax Fosinopril Fosinopril/Hydrochlorothiazide Furosemide Gemfibrozil Guanabenz Guanfacine Hydralazine Hydralazine/HCTZ Hydrochlorothiazide Hytrin Hyzaar Indapamide Inderal Inderal LA Inderide InnoPran XL Isoptin SR Isradipine Jantoven Kerlone Labetalol Lasix Lescol Lescol XL Levatol Lexxel Lipitor Lipofen Lisinopril Lisinopril/Hydrochlorothiazide Livalo LoCHOLEST LoCHOLEST Light Lofibra Loniten Lopid Lopressor Lopressor HCT Lotensin Lotensin HCT Lotrel Lovastatin Lovaza Mavik Maxzide Menostar Methyclothiazide Methyldopa Methyldopa/Hydrochlorothiazide Metolazone Metoprolol Metoprolol/Hydrochlorothiazide Mevacor Miacalcin Micardis Micardis HCT Minipress Minoxidil Moexipril Moexipril/Hydrochlorothiazide Monopril Monopril HCT Monopril/Hydrochlorothiazide Nadolol Nadolol/Bendroflumethiazide Niacin Extended-Release Niacor Niaspan Nicardipine Nifedical XL Nifedipine Nifedipine ER Nimodipine Nislodipine Norvasc Ogen Ortho-Prefest Persantine Pindolol Plavix Plendil Pravachol Pravastatin Prazosin Premarin Premphase Prempro Prenatal Multivitamins with iron and folic acid (for example Prenate, Materna, Stuartnatal, Natalins, Nestabs FA) Prevalite Prinivil Prinzide Procardia XL Propranolol Propranolol ER 100-6926 10/09 2009 United HealthCare Services, Inc. Page 2 of 7
Propranolol/Hydrochlorothiazide Questran Questran Light Quinapril Quinapril/Hydrochlorothiazide Quinaretic Ramipril Reserpine Sectral Simcor Simvastatin Soltamox Spironolactone Spironolactone/HCTZ Sular Tamoxifen Tarka Taztia XT Tekturna Teleturna HCT Tenex Tenoretic Tenormin Terazosin Teveten Teveten HCT Tiazac Ticlid Ticlopidine Timolide Timolol Toprol XL Torsemide Trandate Trandolapril Triamterene/HCTZ Tricor Triglide TriLipix Uniretic Univasc Vagifem Valturna Vaseretic Vasotec Verapamil Verapamil ER Verapamil SR Verelan Verelan PM Visken Vivelle Vivelle-Dot Vytorin Warfarin WelChol Wytensin Zaroxolyn Zebeta Zestoretic Zestril Zetia Ziac Zocor 100-6926 10/09 2009 United HealthCare Services, Inc. Page 3 of 7
Aldomet Cardura Catapres Catapres-TTS Clonidine Doxazosin Guanabenz Guanfacine Hytrin Methyldopa Minipress Prazosin Reserpine Tenex Terazosin Wytensin Enzyme Inhibitors Accupril Aceon Altace Benazepril Capoten Captopril Enalapril Fosinopril Lisinopril Lotensin Mavik Moexipril Monopril Prinivil Quinapril Ramipril Trandolapril Univasc Vasotec Zestril Tekturna Atacand Avapro Benicar Cozaar Diovan Micardis Teveten Apresoline BiDil Hydralazine Hydralazine/Isosorbide Minoxidil Aldactone Amiloride Bumetanide Chlorothiazide Chlorthalidone Demadex Dyazide Edecrin Enduron Furosemide Hydrochlorothiazide Indapamide Lasix Maxzide Methylclothiazide Metolazone Spironolactone Spironolactone/HCTZ Torsemide Triamterene/HCTZ Zaroxolyn Adalat CC Afeditab CR Amlodipine Calan Calan SR Cardene Cardene SR Cardizem CD Cardizem LA Cardizem SR Cartia XT Covera-HS Dilacor XR Diltia XT Diltiazem Diltiazem ER Diltiazem SR DynaCirc DynaCirc CR Felodipine Isoptin SR 100-6926 10/09 2009 United HealthCare Services, Inc. Page 4 of 7
Isradipine Nicardipine Nifedical XL Nifedipine Nifedipine ER Nimodipine Nislodipine Norvasc Plendil Procardia XL Sular Taztia XT Tiazac Verapamil Verapamil ER Verapamil SR Verelan Verelan PM Acebutolol Atenolol Blocadren Bisoprolol Bystolic Cartrol Carvedilol Coreg Coreg CR Corgard Inderal Inderal LA InnoPran XL Kerlone Labetalol Levatol Lopressor Metoprolol Nadolol Pindolol Propranolol Propranolol ER Sectral Tenormin Timolol Toprol XL Trandate Visken Zebeta Accuretic Aldoril Amiloride/HCTZ Amlodipine/Benazepril Atacand HCT Atenolol/Chlorthalidone Avalide Azor Benazepril/Hydrochorothiazide Benicar HCT Bisoprolol/Hydrochlorothiazide Caduet Capozide Captopril/Hydrochlorothiazide Clorpres Corzide Diovan HCT Enalapril/Felodipine Enalapril/Hydrochlorothiazide Exforge Exforge HCT Fosinopril/Hydrochlorothiazide Hydralazine/HCTZ Hyzaar Inderide Lexxel Lisinopril/Hydrochlorothiazide Lopressor HCT Lotensin HCT Lotrel Methyldopa/Chlorothiazide Methyldopa/Hydrochlorothiazide Metoprolol/Hydrochlorothiazide Micardis HCT Moexipril/Hydrochlorothiazide Monopril HCT Nadolol/Bendroflumethiazide Propranolol/Hydrochlorothiazide Prinzide Quinapril/Hydrochlorothiazide Quinaretic Tarka Tekturna HCT Tenoretic Teveten HCT Timolide Uniretic Valturna Vaseretic Zestoretic Ziac 100-6926 10/09 2009 United HealthCare Services, Inc. Page 5 of 7
Cholestyramine Cholestyramine Light Colestid Colestipol LoCHOLEST LoCHOLEST Light Prevalite Questran Questran Light WelChol Niacin Extended Release Niacor Niaspan Simcor Advicor Vytorin Antara Fenofibrate Fenoglide Fibricor Gemfibrozil Lipofen Lofibra Lopid Tricor Triglide TriLipix Altoprev Crestor Lescol Lescol XL Lipitor Livalo Lovastatin Mevacor Pravachol Pravastatin Simvastatin Zocor Lovaza Zetia Actonel Alendronate Boniva Didronel Etidronate Fosamax Fosamax Plus D Alora Cenestin Climara Divigel Enjuvia Estrace Estraderm Estradiol Estradiol Transdermal System Estring Estropipate Evamist Femring Menostar Ogen Premarin Vagifem Vivelle Vivelle-Dot Activella Angeliq Climara PRO Combipatch Estradiol/Norethindrone Femhrt Ortho-Prefest Premphase Prempro 100-6926 10/09 2009 United HealthCare Services, Inc. Page 6 of 7
Calcitonin-Salmon Evista Forteo Fortical Miacalcin Femara Soltamox Tamoxifen Coumadin Jantoven Warfarin Aggrenox Clopidogrel Dipyridamole Effient Persantine Plavix Ticlid Ticlopidine (for example; Florvite, Poly-Vi-Flor,Tri-A-Vite F, Tri-Vi-Flor, Florvite, Vi-Daylin/F ADC, Soluvite-f) Generic Products Brand Name Products (for example Prenate, Materna, Stuartnatal, Natalins, Nestabs FA) Generic Products Brand Name Products 100-6926 10/09 2009 United HealthCare Services, Inc. Page 7 of 7