Preventive Medications OptumRx® Pharmacy Benefit Services

Your plan includes Core Preventive Medication coverage Core medications

This list contains drugs meeting the interpretation of the U.S. Department of Treasury’s clinical guidance and includes the following therapeutic categories:  Anti-estrogen (breast cancer prevention)  Vitamins (birth defect prevention)  Anti-coagulant (heart attack, stroke and blood  Antihypertensives (heart disease and stroke prevention) clot prevention)  Osteoporosis Therapy (osteoporosis prevention)  Anti-platelet (stroke prevention)  Multivitamins/Fluoride (tooth decay prevention)  Lipid/Cholesterol Lowering Agents (heart attack  Immunosuppressants (organ transplant and heart disease prevention) rejection prevention)

Money Saving Generics with $0 Copay

To get the most from your benefits, ask your doctor if there’s a generic medication that’s right for you. Generic preventive medications have a $0 copay through your pharmacy plan effective 1/1/14. The Food and Drug Administration (FDA) requires generics to be just as safe and effective as brand name drugs.

Quality Driven and Cost-Conscious PDL

As the pharmacy benefit manager for your UnitedHealthcare® health plan, OptumRx strives to offer you access to a broad choice of medications at a reasonable price.

The Preventive Medication List is a subset of products included within your Prescription Drug List (PDL). A PDL is the listing of medications covered by your health plan.

For a complete copy of your PDL or to check on the cost of a medication, simply:  Log in to www.uhcwest.com, and select Visit the Pharmacy  Call Customer Care at the toll-free member phone number on the back of your heath plan ID card

Proactive Therapy

Preventive medications help protect against or manage a medical condition. They may provide prenatal care, prevent osteoporosis or reduce risk of blood clots, stroke and heart disease.

Taking preventive medications as directed by your doctor can help avoid serious health problems. That may mean fewer doctor visits and hospitalizations, reducing your total health care costs.

For More Information If you have questions or would like additional information on the Preventive Medication List, please contact Customer Care at the toll-free member phone number on your health plan ID card. Generic Preventive Medications — Core List ($0 Copay) Alphabetical Listing A E M S acebutolol enalapril methyclothiazide simvastatin alendronate enalapril-hydrochlorothiazide methyldopa spironolactone amiloride enoxaparin methyldopa- spironolactone- amiloride- eplerenone hydrochlorothiazide hydrochlorothiazide hydrochlorothiazide eprosartan metolazone T amlodipine etidronate metoprolol succinate amlodipine-benazepril exemestane metoprolol tartrate tacrolimus anastrozole F metoprolol- tamoxifen atenolol hydrochlorothiazide terazosin atenolol-chlorthalidone felodipine ER minoxidil ticlopidine atorvastatin fenofibrate moexipril timolol* azathioprine fenofibric acid moexipril- torsemide B fluvastatin hydrochlorothiazide trandolapril fondaparinux mycophenolate trandolapril-verapamil benazepril fosinopril N triamterene- benazepril- fosinopril- hydrochlorothiazide hydrochlorothiazide hydrochlorothiazide nadolol V betaxolol* furosemide nadolol-bendroflumethazide bisoprolol G nicardipine valsartan- bisoprolol- nifedipine hydrochlorothiazide hydrochlorothiazide gemfibrozil nifedipine ER verapamil bumetanide guanabenz nimodipine verapamil ER C guanfacine nisoldipine W H P candesartan- warfarin hydrochlorothiazide heparin pediatric flouride calcitonin (salmon) hydralazine preparations captopril hydrochlorothiazide perindopril captopril-hydrochlorothiazide I pindolol carvedilol pravastatin chlorothiazide ibandronate prazosin cholestyramine indapamide prenatal vitamins cholestyramine light irbesartan propranolol cilostazol irbesartan- propranolol- clonidine hydrochlorothiazide hydrochlorothiazide clonidine patch isradipine Q clopidogrel L colestipol quinapril cyclosporine labetalol quinapril- letrozole D hydrochlorothiazide lisinopril R diltiazem lisinopril-hydrochlorothiazide diltiazem ER losartan ramipril dipyridamole losartan-hydrochlorothiazide reserpine doxazosin lovastatin

*Coverage is provided for oral formulations.

This list is intended as a reference and may not be all-inclusive. Generic availability may not be current due to changes in the market. The list will be updated annually. Generic Preventive Medications — Core List ($0 Copay) Therapeutic Category Listing

Breast Cancer Prevention candesartan- metoprolol tartrate Cardiovascular/ hydrochlorothiazide metoprolol- Heart Disease — anastrozole High Cholesterol exemestane captopril hydrochlorothiazide letrozole captopril-hydrochlorothiazide minoxidil atorvastatin tamoxifen carvedilol moexipril cholestyramine chlorothiazide moexipril- Cardiovascular/ cholestyramine light clonidine hydrochlorothiazide Heart Disease — colestipol clonidine patch nadolol Blood Clot/ fenofibrate diltiazem nadolol-bendroflumethazide Platelet Therapy fenofibric acid diltiazem ER nicardipine fluvastatin cilostazol doxazosin nifedipine gemfibrozil clopidogrel enalapril nifedipine ER lovastatin dipyridamole enalapril-hydrochlorothiazide nimodipine pravastatin enoxaparin eplerenone nisoldipine simvastatin eprosartan perindopril fondaparinux Immunosuppressant — felodipine ER pindolol heparin Organ Rejection ticlopidine fosinopril prazosin warfarin fosinopril- propranolol azathioprine hydrochlorothiazide propranolol- Cardiovascular/ cyclosporine furosemide hydrochlorothiazide Heart Disease — mycophenolate guanabenz quinapril High Blood Pressure tacrolimus guanfacine quinapril- Musculoskeletal — hydralazine hydrochlorothiazide acebutolol Osteoporosis amiloride hydrochlorothiazide ramipril amiloride- indapamide reserpine alendronate hydrochlorothiazide irbesartan spironolactone calcitonin (salmon) amlodipine irbesartan- spironolactone- etidronate amlodipine-benazepril hydrochlorothiazide hydrochlorothiazide ibandronate atenolol isradipine terazosin Vitamins atenolol-chlorthalidone labetalol timolol* benazepril lisinopril torsemide pediatric flouride benazepril- lisinopril-hydrochlorothiazide trandolapril preparations hydrochlorothiazide losartan trandolapril-verapamil prenatal vitamins betaxolol* losartan-hydrochlorothiazide triamterene- bisoprolol methyclothiazide hydrochlorothiazide bisoprolol- methyldopa valsartan- hydrochlorothiazide methyldopa- hydrochlorothiazide bumetanide hydrochlorothiazide verapamil metolazone verapamil ER metoprolol succinate

Medications are categorized by common therapeutic conditions in this reference guide for ease of reference only. These categories do not determine coverage for the medication for your condition. Your benefit plan determines how these medications may be covered for you. Where differences are noted between this reference guide and your benefit plan documents, the benefit plan documents will govern.

*Coverage is provided for oral formulations.

This list is intended as a reference and may not be all-inclusive. Generic availability may not be current due to changes in the market. The list will be updated annually.

For the most current PDL updates, visit myuhc.com or call toll-free member phone number on the back of your health plan ID card. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by UnitedHealthcare Insurance Company, United HealthCare Services, Inc. or their affiliates. Health Plan coverage provided by or through a UnitedHealthcare company. OptumRx is an affiliate of UnitedHealthcare Insurance Company. ©2013 OptumRx, Inc. UHC6652_130805