Optimum Value Medication List Generics Are Cheaper Than Brand-Names

PHARMACY BENEFITS

Find out if your medication is on the list Are you on a medication to prevent or manage a condition? Looking for ways to save? Take a look at the value-based medications on the back of this flyer. If you see your drug on the list, you can save.

Optimum Medications that offer the best value In addition to leading a healthy lifestyle, the medications listed on the back of Value this flyer can help prevent many illnesses and conditions for people who have risk factors. They can also prevent the recurrence of a disease or condition for people who have recovered. This list includes drugs used to treat an acute, Medication sudden-onset or existing illness, injury or condition.

List Following your doctor’s treatment plan—including taking prescribed medications as directed—can help you live a healthier life today and avoid serious illness and high health care costs down the road.

If your medication is on this list, your prescription medication benefit helps you save money and stay on your treatment plan. Under some plans, you may SEE HOW YOUR not need to pay a copay, coinsurance and/or deductible for the medications in this list. BENEFITS CAN Questions? HELP YOU SAVE. Call the Customer Service number on your member ID card.

Science. Insights. Solutions.™ PHARMACY BENEFITS

Optimum Value Medication List Generics are cheaper than brand-names. So ask your doctor if it’s okay for you to take a generic instead.

Brand or or Brand or or Brand or or Brand or or Drug Name Name Drug Name Name Drug Name Name Drug Name Name Generic? Generic? Generic? Generic?

® Cardiovascular: ACE ACEInhibitors Inhibitors methyldopa-HCTZ Generic citalopramfluoxetine HBR DR Generic HumalogHumulin Mix 70-30 75-25® Brand nicardipine Generic fluoxetine DRHCL Generic Humulin N® Brand benazepril HCL HCL Generic Humulin 70-30® Brand nifedipine Generic fluoxetinefluvoxamine HCL maleate Generic Humulin R® Brand captopril Generic Humulin N® Brand nicardipine CC CC Generic fluvoxamineparoxetine HCL maleate Generic Lantus® Brand enalapril maleate maleate Generic Humulin R® Brand nifedipine XL XL Generic paroxetinesertraline HCL Generic Lantus Solostar® Brand fosinoprilfosinopril sodiumsodium sodium Generic Lantus® Brand nimodipine Generic sertralinevenlafaxinesertraline HCLHCL HCL Generic LantusLevemir Solostar®® Brand lisinoprillisinopril Generic nisoldipine Generic venlafaxinevenlafaxine HCLHCL XR Generic Levemir® Brand moexipril HCL HCL Generic Osteoporosis prazosin Generic venlafaxinevenlafaxine XRXR Generic perindopril erbumine erbumine Generic Depression: Tricyclic Antidepressants Osteoporosisalendronate Generic propranolol/HCTZ Generic quinapril HCL HCL Generic Depression:amitriptyline Tricyclic HCL Antidepressants Generic alendronateIbandronate Generic terazosinterazosin Generic ramiprilramipril Generic amitriptylineamoxapine HCL Generic IbandronateRespiratory:Ibandronate Inhaled CorticosteroidsGeneric verapamilverapamil Generic trandolapriltrandolapril Generic amoxapineclomipramine HCL Generic Respiratory:Asmanex® Inhaled Corticosteroids Brand verapamilverapamil SRSR SR Generic clomipraminedesipramine HCL Generic Cardiovascular: Alpha Alpha Methyldopa Methyldopa Asmanex®budesonide BrandGeneric Cardiovascular: Diuretics & combos Cardiovascular: Diuretics & combos desipraminedoxepin HCL HCL Generic ® clonidine HCL HCL Generic budesonideDulera GenericBrand amiloride HCL HCL Generic doxepinimipramine HCL HCL Generic ® clonidine patches patches Generic Pulmicort®Pulmicort Brand amiloride HCL-HCTZ HCL-HCTZ Generic imipramineimipramine HCLHCL pamoate Generic ® guanfacine HCL HCL Generic Pulmicort Flexhaler® Flexhaler Brand benazepril HCL-HCTZ HCL-HCTZ Generic imipraminenortriptylineimipramine pamoatepamoate HCL Generic ® methyldopa Generic Qvar®Qvar Brand bumetanide Generic nortriptylineprotriptyline HCL HCL Generic Symbicort® Brand Cardiovascular: Beta Beta Blockers Blockers Respiratory: Miscellaneous captopril-HCTZ Generic trimipramine maleate Generic captopril-HCTZ Generic protriptyline HCL Generic Respiratory: Miscellaneous acebutolol HCL HCL Generic albuterol sulfate Generic chlorothiazide Generic trimipramineDiabetes:trimipramine Antihyperglycemics maleatemaleate Generic atenolol-chlorthalidone Generic albuterol sulfate sulfate ER Generic chlorthalidone Generic ® Diabetes:Byetta Antihyperglycemics Brand albuterol sulfate ER Generic atenolol Generic Atrovent HFA® Brand enalapril maleate-HCTZ maleate-HCTZ Generic chlorpropamide Generic ® betaxolol HCL Generic Byetta® Brand Combivent®Atrovent HFA Brand betaxolol HCL Generic eplerenone Generic eplerenone Generic glimepiride Generic ® bisoprolol fumarate Generic chlorpropamide Generic elixophyllinCombivent GenericBrand bisoprolol fumarate Generic fosinopril-hydrochlorothiazide Generic fosinopril-hydrochlorothiazidefosinopril-hydrochlorothiazide Generic glipizide Generic bisoprolol fumarate-HCTZ Generic glimepiride Generic ipratropiumelixophyllinipratropium bromidebromide Generic bisoprolol fumarate-HCTZ Generic furosemide Generic furosemidefurosemide Generic glipizide ER Generic carvedilol Generic glipizide Generic levalbuterolipratropiumlevalbuterol concentrateconcentrate bromide Generic carvedilol Generic hydrochlorothiazide Generic hydrochlorothiazide Generic glipizide XL Generic labetalol HCL Generic glipizide ER Generic metaproterenollevalbuterol concentrate sulfate Generic labetalollabetalol HCLHCL Generic indapamide Generic indapamideindapamide Generic glipizide-metformin Generic metoprolol-hydrochlorothiazide Generic glipizide XL Generic montelukastmetaproterenol sulfate Generic metoprolol-hydrochlorothiazide Generic lisinopril-HCTZ Generic lisinopril-HCTZlisinopril-HCTZ Generic glyburide Generic metoprolol succinate Generic glipizide-metformin Generic Spirivamontelukast Spinhaler® BrandGeneric metoprolol succinate Generic metolazone Generic metolazone Generic glyburide micronized Generic ® metoprolol tartrate Generic glyburide Generic theophyllineSpirivatheophylline Spinhaler GenericBrand metoprolol tartrate Generic moexipril-hydrochlorothiazide Generic moexipril-hydrochlorothiazide Generic Janumet® Brand nadolol Generic glyburide micronized Generic theophyllinetheophylline CRCR Generic nadolol Generic quinapril-hydrochlorothiazide Generic quinapril-hydrochlorothiazide Generic Janumet XR® Brand theophylline CR Generic nadolol-bendroflumethiazide Generic Janumet® Brand theophyllinetheophylline ERER Generic nadolol-bendroflumethiazide Generic spironolactone Generic spironolactonespironolactone Generic Januvia® Brand theophylline ER Generic pindolol Generic Janumet XR® Brand zafirlukastzafirlukast Generic pindolol Generic spironolactone-HCTZ Generic spironolactone-HCTZspironolactone-HCTZ Generic metformin HCL Generic zafirlukast Generic propranolol HCL Generic Januvia® Brand propranolol HCL Generic torsemide Generic Respiratory: Short/Long-Acting Beta Agonists torsemidetorsemide Generic metformin HCL ER Generic Respiratory: Short/Long-Acting Beta propranolol HCL ER Generic metformin HCL Generic propranolol HCL ER Generic triamterene-HCTZ Generic Foradil®Agonists Brand triamterene-HCTZtriamterene-HCTZ Generic nateglinide Generic sorine Generic metformin HCL ER Generic sorinesorine Generic ProairForadil HFA®® Brand Cardiovascular: Other Other pioglitazone Generic sotalol Generic nateglinide Generic sotalolsotalol Generic SereventProair HFA Diskus®® Brand clopidogrel Generic pioglitazone-metformin Generic sotalol AF Generic clopidogrel Generic pioglitazone Generic sotalolsotalol AFAF Generic VentolinSerevent HFA® Diskus ® Brand dipyridamole Generic Proglycem® Brand timolol maleate Generic dipyridamole Generic pioglitazone-metformin Generic timololtimolol maleatemaleate Generic Ventolin HFA® Brand warfarin Generic repaglinide Generic Cardiovascular: CCB, ARB, Alpha warfarin Generic Proglycem® Brand Cardiovascular: CCB, ARB, Alpha Blockers Blockers tolazamide Generic Cholesterol: Bile Bile Acid/Fibric Acid/Fibric Acid Meds Acid Meds repagliniderepaglinide Generic amlodipine Generic amlodipine Generic tolazamideDiabetes:tolazamide Blood Sugar DiagnosticsGeneric cholestyramine Generic amlodipine-benazepril Generic ® cholestyramine light light Generic Diabetes:ONETOUCH Blood UltraMini Sugar DiagnosticsMeter* Brand diltiazem Generic diltiazem Generic ® colestipol HCL HCL Generic ONETOUCH®ONETOUCH UltraMini Ultra TM2 Meter* Meter* Brand diltiazem SA Generic diltiazem SA Generic fenofibrate Generic ® fenofibratefenofibrate Generic ONETOUCH®ONETOUCH Ultra® Verio 2 Meter* IQ Meter* Brand diltiazem 24HR ER Generic diltiazem 24HR ER Generic gemfibrozil Generic ® gemfibrozil Generic ONETOUCH®LifeScan Brand Verio® Test IQ Meter*Strips ** Brand doxazosin Generic doxazosin Generic prevalite Generic ® prevalite Generic LifeScan Brand Brand Test Test Strips® Discs ** ** Brand felodipinefelodipine Generic Cholesterol: Statins Glucagen Hypokit® Brand Cholesterol: Statins LifeScan Brand Test Discs® ** Brand hydralazine Generic ® atorvastatin Generic GlucagenGlucagon Hypokit® Emergency Kit Brand irbesartanirbesartan Generic atorvastatin Generic lovastatin Generic GlucagonDiabetes: Emergency Insulins Kit® Brand irbesartan-HCTZirbesartan-HCTZ Generic lovastatinlovastatin Generic pravastatin sodium Generic Diabetes:Humalog Insulins® Brand isradipineisradipine Generic pravastatin sodium Generic simvastatin Generic Humalog Mix 50-50® Brand losartanlosartan Generic simvastatinsimvastatin Generic Humalog® Brand ® Depression: SSRIs Humalog Mix Mix 50-50® 75-25 Brand losartan-HCTZlosartan-HCTZ Generic Depression: SSRIs methazolamide Generic citalopram Generic methazolamide Generic citalopram Generic citalopram HBR Generic

This list does not pertain to provisions of federal health care reform, the Affordable Care Act. It does not includeinclude allall productsproducts availableavailable forfor treatingtreating thethe aboveabove statedstated medicalmedical conditionsconditions andand isis subjectsubject toto change.change. Brand-name medications may move from preferred to non-preferred status and in that case will be removed from this list.