2018 Preventive Drug List
Introduction In addition to a healthy lifestyle, preventive prescription drugs are important in helping people avoid many types of illnesses and complications from illnesses. This book contains a list of the most commonly prescribed preventive prescription drugs. It does not include all conditions that may be prevented with prescription drugs. The prescription drugs listed serve to maintain a person s health status and to avoid acute complications. This list is not all-inclusive and is subject to change. Important facts about this benefit Please refer to your plan documents for coverage on the selected products. Quantity limits, step therapy, prior authorizations and other coverage limitations may apply. Quantities are limited to a maximum 3-month supply per fill. Tier 3 medications listed on the Security Administrative Services Formulary will not be routinely covered. If a generic equivalent drug is available, the originator brand drug will not be covered (Example: simvastatin is covered, ZOCOR is not). The covered preventive drugs are divided into categories. The listed drugs in the categories include those which are always prescribed for prevention and those which are sometimes prescribed for prevention. Drugs used for treatment of an existing condition are typically not covered under the preventive prescription drug benefit. Note: Benefits vary by plan. Please refer to your Plan documents for information specific to your coverage.
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Asthma drugs Preventive Drug List Prevention of an asthma episode Albuterol solution Montelukast granules Albuterol Sulfate tablet Montelukast tablet chew Albuterol Sulfate ER tablet Proair HFA inhaler Anoro Ellipta inhaler Pulmicort Flexhaler Breo Ellipta inhaler Serevent Diskus Budesonide suspension Spiriva Handihaler Combivent Respimat inhal spray Spiriva Respimat inhaler Flovent Diskus Stiolto Respimat inhal spray Flovent HFA inhaler Symbicort inhaler Fluticasone-Salmeterol inhalation powder Terbutaline tablet Ipratroprium-Albuterol nebules Theochron ER tablet Ipratropium 0.02% solution Theophylline 80 Mg/15 Ml solution Levalbuterol nebules Theophylline ER tablet Metaproterenol tablet Ventolin HFA inhaler Metaproterenol Ml syrup Zafirlukast tablet Montelukast tablet Blood thinners Prevention of stroke, blood clot or repeat heart attack Clopidogrel tablet Prasugrel tablet Coumadin tablet Warfarin tablet Dipyridamole tablet Warfarin Powder Eliquis tablet Xarelto tablet Jantoven tablet Diabetes drugs and supplies Prevention of complications related to high blood sugar Acarbose tablet Januvia tablet Accu-Chek Aviva Plus meter Jardiance tablet Accu-Chek Aviva Plus test strip Lantus Accu-Chek Aviva Control solution Levemir Accu-Chek Compact Plus meter Metformin Hcl tablet Accu-Chek Compact Plus Control solution Metformin Hcl ER tablet Accu-Chek Compact Plus strips Nateglinide tablet Accu-Chek Fastclix lancets Novolin 70-30 Accu-Chek Multiclix lancets Novolin N Accu-Chek Nano Smartview meter Novolin R Accu-Chek Rapid D Novolog Accu-Chek Smartview Control solution Novolog Mix 70-30 Accu-Chek Smartview test strip Onetouch Delica lancing device Accu-Chek Softclix lancets Onetouch Ultra Control solution Alogliptin tablet Onetouch Ultra test strips Alogliptin -Metformin tablet Onetouch Ultramini meter Alogliptin -Pioglitazone tablet Onetouch Ultrasoft lancets Chlorpropamide tablet Onetouch Verio meter Glimepiride tablet Onetouch Verio test strips Glipizide tablet Pioglitazone Hcl tablet Glipizide ER tablet Pioglitazone-Glimepiride tablet Glipizide XL tablet Repaglinide tablet Glipizide-Metformin tablet Repaglinide-Metformin tablet Glucagon vial Synjardy tablet
Diabetes drugs and supplies (continued) Prevention of complications related to high blood sugar Glyburide Micro tablet Tolazamide tablet Glyburide-Metformin tablet Tolbutamide tablet Invokamet tablet Toujeo Invokana tablet Tresiba Janumet tablet Trulicity Janumet XR tablet Victoza Heart disease drugs Prevention of heart disease Aspirin-Dipyridamole Er tablet Isosorbide Mn tablet Amiodarone tablet Mexilitine capsule Digoxin tablet Nitroglycerin Sublingual tablet Digoxin oral solution Propafenone capsule Disopyramide capsule Quinidine tablet Dofetilide capsule Sotalol AF tablet Flecainide tablet Sotalol tablet Isosorbide Dn tablet High blood pressure drugs Prevention of stroke, complications due to high blood pressure and reoccurence of heart attack Acetazolamide tablet Isradipine capsule Afeditab CR tablet Labetalol tablet Amiloride tablet Lisinopril tablet Amiloride-Hctz tablet Lisinopril-Hctz tablet Amlodipine tablet Losartan tablet Amlodipine -Valsartan tablet Losartan-Hctz tablet Amlodipine -Valsartan-Hydrochlorothiazide tablet Matzim LA tablet Amlodipine-Benazepril tablet Methyclothiazide tablet Atenolol tablet Methyldopa tablet Atenolol-Chlorthalidone tablet Metolazone tablet Benazepril tablet Metoprolol Succ ER tablet Benazepril-Hctz tablet Metoprolol Tartrate tablet Betaxolol tablet Metoprolol-Hctz tablet Bisoprolol tablet Minoxidil tablet Bisoprolol-Hctz tablet Moexipril tablet Bumetanide tablet Moexipril-Hctz tablet Candesartan tablet Nadolol tablet Candesartan-Hctz tablet Nifedipine capsule Captopril tablet Nifedipine ER tablet Captopril-Hctz tablet Nimodipine capsule Cartia XT capsule Nisoldipine ER tablet Carvedilol tablet Perindopril tablet Chlorothiazide tablet Pindolol tablet Chlorthalidone tablet Prazosin capsule Clonidine Hcl tablet Propranolol tablet Dilt XR capsule Propranolol ER capsule Diltiazem tablet Propranolol-Hctz tablet Diltiazem 12Hr ER capsule Quinapril tablet Diltiazem 24Hr CD Capule Quinapril-Hctz tablet Diltiazem 24Hr ER capsule Ramipril capsule Diltiazem 24Hr ER tablet Spironolactone tablet Diltiazem ER capsule Spironolactone-Hctz tablet Enalapril tablet Telmisartan tablet Enalapril-Hctz tablet Telmisartan-Hctz tablet Epaned oral solution Terazosin capsule Eplerenone tablet Timolol tablet
High blood pressure drugs (continued) Prevention of stroke, complications due to high blood pressure and reoccurence of heart attack Eprosartan tablet Torsemide tablet Ethacrynic Acid tablet Trandolapril tablet Felodipine ER tablet Trandolapril -Verapamil ER tablet Fosinopril tablet Triamterene-Hctz capsule Fosinopril-Hctz tablet Triamterene-Hctz tablet Furosemide tablet Valsartan tablet Guanfacine tablet Valsartan-Hctz tablet Hydralazine tablet Verapamil tablet Hydrochlorothiazide capsule Verapamil ER capsule Hydrochlorothiazide tablet Verapamil ER PM capsule Indapamide tablet Verapamil ER tablet Irbesartan tablet Verapamil SR capsule Irbesartan-Hctz tablet High cholesterol drugs High cholesterol drugs (prevention of heart disease) Atorvastatin tablet Fenofibric Acid DR capsule Cholestyramine Fluvastatin capsule Cholestyramine Light Gemfibrozil tablet Colestipol tablet Lovastatin tablet Colestipol granules Niacin ER tablet Colestipol Micronized tablet Pravastatin tablet Ezetimibe tablet Prevalite Packet Fenofibrate capsule Prevalite Powder Fenofibrate tablet Rosuvastatin tablet Fenofibric Acid tablet Simvastatin tablet Osteoporosis (bone disease) drugs Prevention of bone fractures Alendronate tablet Raloxifene tablet Calcitonin (Salmon) Nasal spray Risedronate DR tablet Etidronate tablet Risedronate tablet Ibandronate tablet
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