your preventiverxsm drug list: expanded plan€¦ · liptruzet livalo lovastatin lovaza niacin er...

Birth controlAll generic versions are included:BeyazGeneress-FELomedia 24 FELo Minastrin Fe medroxyprogesterone 150mg/mlMinastrin 24 FeNataziaNuvaringOrtho EvraQuartetteSkyla

Blood clotsBrilintaCoumadinEliquisenoxaparinfondaparinuxFragminheparinInnohepPradaxawarfarinXarelto

Bowel prep (laxatives)ColyteGolytelyHalflytelyMoviprepOCLOsmopreppeg 3350/electrolytesPrepopikSuclearSuprepTrilyteVisicol

Breast canceranastrozoleexemestaneFarestonletrozoletamoxifen citrate

DiabetesDiabetic supplies, including blood sugar meters, test strips and lancets require a prescription to be covered by this plan.ActoPlusMet XRApidraAvandametAvandarylAvandiaBydureonByettachlorpropamideCyclosetglimepirideglipizideglipizide er/xlglipizide with metformin hclGlumetzaglyburideglyburide with metformin hclglyburide, micronizedGlysetHumalogHumulinInvokanaJanumetJanumet XRJanuviaJentaduetoJuvisyncKazanoKombiglyze XRKorlymLantusLevemirmetformin hclmetformin hcl ernateglinideNesinaNovolinNovologOnglyzaOsenipioglitazonepioglitazone-glimepiridepioglitazone-metforminPrandimetrepaglinideRiometSymlin

tolazamidetolbutamideTradjentaVictoza

FluRelenzaTamiflu

Gout allopurinolColcrysprobenecidprobenecid/colchicineUloric

Heart health and high blood pressureacebutolol hclacetazolamideafeditab crAldactazide 50-50mgamiloride hclamiloride/hctzamlodipine besylateamlodipine/benazeprilAmturnideatenololatenolol/chlorthalidoneAvalide 300/25mgAzorbenazepril hclbenazepril hcl/hctzBenicarBenicar HCTbetaxolol hclBidilbisoprolol fumaratebisoprolol fumarate/hctzbumetanideBystoliccandesartancandesartan/hctzcaptoprilcaptopril/hctzCardene SRCardizem LA 120mgcartia xtcarvedilolchlorothiazidechlorthalidoneclonidine hclClorpresCoreg CRCovera-HS

digoxinDilatrate SRdilt-cddiltiazem hcldiltiazem hcl erDiovanDiurildoxazosin mesylateDutoprolDynacirc CRDyreniumEdarbiEdarbyclorEdecrinenalapril maleateenalapril/hctzEpanedeplerenoneeprosartanExforgeExforge HCTfelodipine erfosinopril sodiumfosinopril/hctzfurosemideguanabenz acetateguanfacine hclhydralazine hclhydralazine/hctzhydrochlorothiazideindapamideInnopran XLirbesartanirbesartan/hctzIsordil 40mgisosorbide dinitrateisosorbide dinitrate erisosorbide mononitrateisosorbide mononitrate erisradipinelabetalol hclLanoxinlevatollisinoprillisinopril/hctzlosartanlosartan/hctzMatzim LAmethazolamidemethyclothiazidemethyldopamethyldopa/hctzmetolazonemetoprolol succinate ermetoprolol tartrate

metoprolol/hctzMicardis HCTminoxidilmoexipril hclmoexipril/hctznadololnadolol/ bendroflumethiazideNexiclon XRnicardipine hclnifedipinenifedipine ernimodipinenisoldipineNitro-BidNitro-Dur 0.3, 0.8mg/hrnitroglycerinNitroglycerin 400mcg Spraynitroglycerin erNitroglycerin Lingualnitroglycerin sprayNitrostatNymalizeperindoprilpindololprazosin hclpropranolol hclpropranolol hcl erpropranolol/hctzquinapril hclquinapril/hctzramiprilRanexasotalol hclsotalol hcl afspironolactonespironolactone/hctzTarkaTaztia XTTekamloTekturnaTekturna HCTtelmisartanterazosin hclTeveten 400mgTeveten HCTthalitonetimolol maleatetorsemidetrandolapriltriamterene/hctzTribenzorTwynsta

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Your PreventiveRxSM Drug List:Expanded Plan

The PreventiveRx Plus Plan covers drugs that may keep you healthy because they may prevent illness and other health conditions. The products on this list are FREE as a benefit of your High Deductible Health Plan.

This list includes only prescription products. Brand-name drugs are listed with a first capital letter. Non-brand drugs (generics) are in lowercase letters. Most brand-name drugs that have a generic equivalent available are not covered under this program.

Your PreventiveRxSM Drug List:Expanded Plan

valsartan/hctzValturnaVecamylverapamil hclverapamil hcl er

High cholesterolAdvicorAltoprevAntara 30, 90mg atorvastatinatorvastatin/amlodipinecholestyraminecholestyramine lightcolestipol hclCrestorfenofibratefenofibric acid, drFenoglidefluvastatingemfibrozilLescol XLLipofenLiptruzetLivalolovastatinLovazaniacin ER NiacorNiaspanpravastatinPrevaliteSimcorsimvastatinTriglideVascepaVytorinWelcholZetia

Malariaatovaquone/proguanilchloroquineDaraprimhydroxychloroquinemefloquine hclprimaquinequinine sulfate capsule

Nausea, vomitingAloxiAntivert 50mgAnzemetCesametchlorpromazine hclDiclegisdimenhydrinatedronabinolEmend

granisetron hclondansetron hclondansetron odtprochlorperazinepromethazine hclScopaceTransderm-Scoptrimethobenzamide hclZuplenz

OsteoporosisActonelalendronate sodiumAloraAngeliqAtelviaBinostoCenestinClimara ProCombipatchEnjuviaest. estrogens with methyltestosteroneEstradermestradiolestradiol/norethindrone acetate estropipateEvistaFemHRT 0.5mg/2.5mcgFemtraceForteoforticalFosamax Plus Dibandronate medroxyprogesterone acetateMenestMenostarMiacalcinMinivelleOgenPrefestPremarinPremphasePremproProliaVivelle-Dotzoledronic acid (generic Reclast)

RSV (respiratory syncytial virus)Synagis

Stopping smokingbupropion hcl sr (generic Zyban only)Chantix

Nicotrol inhalerNicotrol NS

StrokeAggrenoxcilostazolclopidogrel bisulfatedipyridamoleEffientticlopidine hcl

VaccinesAll brand and generic versions are included.

VitaminsAll generic versions are included:Prenatal vitamins (taken during pregnancy)Prescription multivitamins with fluoridePrescription multivitamins with fluoride and iron

Weight loss benzphetamine hcldiethylpropion hcldiethylpropion hcl erphendimetrazinephentermine hclQsymiaRegimexSuprenza ODTXenical

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