Consumer Directed Healthcare (CDH) Preventive Medicine List

This list provides examples of commonly prescribed preventive medicines. It is not an all-inclusive list; only examples of medicines in each category are listed. This list does not indicate coverage. Please check with your plan administrator and/or benefit information materials if you have questions on coverage. Your cost share will be determined by your plan’s drug coverage and formulary plan. Coverage prior to the deductible being met may not be provided for every dosage form of a listed medicine. Please note: When feasible, brand names are shown in capitals in each category. If generic is available, it is listed in lowercase next to the brand name. If only generics are available (for example, brands are no longer available), they will only be listed in lowercase.

BONE DISEASE AND FRACTURES HEART DISEASE AND STROKE OTHER AGENTS ACTONEL, ATELVIA (risedronate) COLESTID (colestipol) BLOOD THINNER MEDICINES BONIVA (ibandronate) ezetimibe DUAVEE aspirin, 81 mg & 325 mg* ezetimibe/simvastatin EVISTA (raloxifene) AGGRENOX LOPID (gemfibrozil) FOSAMAX, FOSAMAX D, BINOSTO (aspirin/dipyridamole ER) NIASPAN (niacin) (alendronate) BRILINTA PREVALITE, QUESTRAN RECLAST (zoledronic acid) clopidogrel (cholestyramine) COUMADIN (warfarin) REPATHA CAVITIES DURLAZA ER TRICOR, ANTARA (fenofibrate) CLINPRO EFFIENT TRILIPIX DR (fenofibric acid) GEL-KAM ELIQUIS WELCHOL PHOS-FLUR PERSANTINE (dipyridamole) PREVIDENT PRADAXA HIGH BLOOD PRESSURE Sodium fluoride rinse, gel, SAVAYSA ACE INHIBITORS cream, paste, tabs and drops ticlopidine Stannous fluoride rinse and gel XARELTO ACCUPRIL (quinapril) ZONTIVITY ACEON (perindopril) COLONOSCOPY PREPARATION* ALTACE (ramipril) COLYTE, GOLYTELY, NULYTELY CHOLESTEROL LOWERING captopril (polyethylene glycol) MEDICINES fosinopril MOVIPREP LOTENSIN (benazepril) HMG-COA REDUCTASE OSMOPREP MAVIK (trandolapril) INHIBITORS* PREPOPIK moexipril SUPREP ALTOPREV PRINIVIL, ZESTRIL (lisinopril) CRESTOR (rosuvastatin) VASOTEC (enalapril) LESCOL (fluvastatin) LIPITOR (atorvastatin) ACE INHIBITORS/ DIURETIC LIVALO COMBINATIONS lovastatin ACCURETIC (quinapril/HCTZ) PRAVACHOL (pravastatin) captopril/HCTZ ZOCOR (simvastatin) fosinopril/HCTZ LOTENSIN HCT (benazepril/HCTZ) moexipril/HCTZ DL47415K (over, please) CDH Preventive Medicine List

VASERETIC (enalapril/HCTZ) CALCIUM CHANNEL BLOCKERS OBESITY ZESTORETIC (lisinopril/HCTZ) ADALAT CC, PROCARDIA XL ADIPEX-P (phentermine) LOTENSIN HCT (benazepril/HCTZ) (nifedipine) BELVIQ ANGIOTENSIN II RECEPTOR CALAN, VERELAN (verapamil) BELVIQ XR ANTAGONISTS CARDENE (nicardipine) CONTRAVE CARDIZEM LA, TIAZAC ER diethylpropion AVAPRO (irbesartan) (diltiazem) REGIMEX (benzphetamine) candesartan felodipine ER LOMAIRA COZAAR (losartan) isradapine phendimetrazine DIOVAN (valsartan) NORVASC (amlodipine) SAXENDA EDARBI SULAR ER (nisoldipine) XENICAL MICARDIS (telmisartan) olmesartan DIURETICS SMOKING-CESSATION* ANGIOTENSIN II RECEPTOR chlorothiazide CHANTIX ANTAGONISTS/ DIURETIC chlorthalidone NICOTROL COMBINATIONS hydrochlorothiazide NICODERM CQ indapamide candesartan/HCTZ Nicotine gum, lozenges and metolazone AVALIDE (irbesartan/HCTZ) patches DIOVAN HCT (valsartan/HCTZ) OTHER HIGH BLOOD PRESSURE ZYBAN (bupropion SR 150mg) EDARBYCLOR MEDICINE COMBINATIONS IMMUNIZATION:* HYZAAR (losartan/HCTZ) amlodipine/olmesartan Antrax, BCG, Cholera, Diphtheria, MICARDIS HCT (telmisartan/HCTZ) amlodipine/olmesartan/HCTZ Haemophilus Influenza B, olmesartan/HCTZ BYVALSON Hepatitis A and B, Human BETA BLOCKERS CADUET (amlodipine/atorvastatin) Papillomavirus, Influenza, EXFORGE (amlodipine/valsartan) acebutolol Japanese Encephalitis, Measles, EXFORGE HCT betaxolol Meningococcal, Mumps, Pertussis, (amlodipine/valsartan/HCTZ) BYSTOLIC Pneumococcal, Poliovirus, Rabies, LOTREL (amlodipine/benazepril) CORGARD (nadolol) Rotavirus, Rubella, Tetanus, PRESTALIA INNOPRAN XL (propranolol) Typhoid, Varicella, Yellow Fever, TARKA (trandolapril/verapamil) TENORMIN (atenolol) Zoster TWYNSTA TOPROL XL, LOPRESSOR (amlodipine/telmisartan) VITAMINS OR MINERALS (metoprolol) ZEBETA (bisoprolol) RESPIRATORY SYNCYTIAL VIRUS folic acid* Prenatal vitamins BETA BLOCKER/DIURETIC SYNAGIS Pediatric multivitamins with COMBINATIONS MALARIA fluoride* CORZIDE chloroquine (nadolol/bendroflumethiazide) mefloquine LOPRESSOR HCT PRIMAQUINE (metoprolol/HCTZ) MALARONE propranolol/HCTZ (atovaquone/ proguanil) TENORETIC (atenolol/chlorthalidone) ZIAC (bisoprolol/HCTZ)

DL47415K CDH Preventive Medicine List

*Please note that some of these medicines are also subject to the Affordable Care Act (ACA) and may be covered by your plan at 100%.

Express Scripts manages your prescription benefit for your employer, plan sponsor, or health plan. For specific questions on coverage, please call the phone number on your member ID card or visit our website express-scripts.com. FPO All rights in the product names of all third-party products appearing here, whether or not appearing with the trademark symbol, belong exclusively to their respective owners.

DL47415K 8.17

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