your preventiverxsm drug list: expanded plan€¦ · liptruzet livalo lovastatin lovaza niacin er...
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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
13017CAMENABC Rev. 02/14
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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