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Preferred Drug List January 2012 Preferred Drug List The Preferred Drug List, administered by CVS Caremark on behalf of Marriott International, is a guide within select therapeutic categories for clients, plan members and health care providers. Generics should be considered the first line of prescribing. If there is no generic available, there may be more than one brand-name medicine to treat a condition. These preferred brand-name medicines are listed to help identify products that are clinically appropriate and cost-effective. Generics listed in therapeutic categories are for representational purposes only. This is not an all-inclusive list. This list represents brand products in CAPS and generic products in lowercase italics. PLAN MEMBER HEALTH CARE PROVIDER Your benefit plan provides you with a prescription benefit program Your patient is covered under a prescription benefit plan administered by CVS Caremark. Ask your doctor to consider administered by CVS Caremark. As a way to help manage health prescribing, when medically appropriate, a preferred medicine from care costs, authorize generic substitution whenever possible. If you this list. Take this list along when you or a covered family member believe a brand-name product is necessary, consider prescribing a sees a doctor. brand name on this list. Please note: Please note: • Your specific prescription benefit plan design may not cover • Generics should be considered the first line of prescribing. certain categories, regardless of their appearance in this document. • This drug list represents a summary of prescription coverage. It is not inclusive and does not guarantee coverage. • For specific information regarding your prescription benefit coverage and copay1 information, please visit • The member's prescription benefit plan may have a different www.caremark.com or contact a CVS Caremark Customer copay for specific products on the list. Care representative. • Unless specifically indicated, drug list products will include all dosage forms. • CVS Caremark may contact your doctor after receiving your prescription to request consideration of a drug list product or • Log in to www.caremark.com to check coverage and copay generic equivalent. This may result in your doctor prescribing, information for a specific medicine. when medically appropriate, a different brand-name product or generic equivalent in place of your original prescription. • Any brand drug for which a generic product becomes available may be designated as a non-preferred product. ANALGESICS § PENICILLINS nitrofurantoin ANGIOTENSIN II RECEPTOR § BETA-BLOCKERS amoxicillin sulfamethoxazole- ANTAGONIST / DIRECT atenolol VISCOSUPPLEMENTS amoxicillin-clavulanate trimethoprim RENIN INHIBITOR carvedilol SYNVISC dicloxacillin COMBINATIONS metoprolol CARDIOVASCULAR SYNVISC-ONE penicillin VK VALTURNA metoprolol succinate ext-rel § ACE INHIBITORS nadolol ANTI-INFECTIVES § TETRACYCLINES ANTILIPEMICS propranolol fosinopril doxycycline hyclate § BILE ACID RESINS BYSTOLIC ANTIBACTERIALS lisinopril minocycline COREG CR § CEPHALOSPORINS cholestyramine quinapril tetracycline WELCHOL ramipril cefaclor § CALCIUM CHANNEL cefdinir § ANTIFUNGALS § ACE INHIBITOR / CHOLESTEROL BLOCKERS cephalexin fluconazole DIURETIC COMBINATIONS ABSORPTION INHIBITORS amlodipine SUPRAX itraconazole ZETIA diltiazem ext-rel fosinopril- terbinafine tablet nifedipine ext-rel § ERYTHROMYCINS / hydrochlorothiazide § FIBRATES verapamil ext-rel MACROLIDES ANTIVIRALS lisinopril- fenofibrate azithromycin hydrochlorothiazide § HERPES AGENTS TRICOR CALCIUM CHANNEL clarithromycin quinapril- acyclovir TRILIPIX BLOCKER / ANTILIPEMIC clarithromycin ext-rel hydrochlorothiazide COMBINATIONS valacyclovir erythromycins § HMG-CoA REDUCTASE CADUET § ANGIOTENSIN II § INFLUENZA AGENTS INHIBITORS § FLUOROQUINOLONES RECEPTOR ANTAGONISTS / amantadine pravastatin § DIGITALIS GLYCOSIDES ciprofloxacin ext-rel DIURETIC COMBINATIONS rimantadine simvastatin digoxin ciprofloxacin tablet losartan / losartan- RELENZA CRESTOR levofloxacin hydrochlorothiazide DIRECT RENIN INHIBITORS / TAMIFLU LIPITOR AVELOX BENICAR / BENICAR HCT DIURETIC COMBINATIONS CIPRO SUSPENSION § MISCELLANEOUS DIOVAN / DIOVAN HCT NIACINS / COMBINATIONS TEKTURNA / MICARDIS / clindamycin NIASPAN TEKTURNA HCT MICARDIS HCT metronidazole SIMCOR Your specific prescription benefit plan design may not cover certain categories, regardless of their appearance in this document. For specific information, visit www.caremark.com or contact a CVS Caremark Customer Care representative. DIRECT RENIN INHIBITOR / MULTIPLE SCLEROSIS BD INSULIN SYRINGES HUMAN GROWTH RESPIRATORY CALCIUM CHANNEL AGENTS AND NEEDLES HORMONES ANAPHYLAXIS TREATMENT BLOCKER COMBINATIONS AVONEX ONETOUCH STRIPS AND NORDITROPIN 3 AGENTS TEKAMLO BETASERON KITS § PROGESTINS, ORAL COPAXONE EPIPEN CALCIUM REGULATORS DIRECT RENIN INHIBITOR / medroxyprogesterone EPIPEN JR CALCIUM CHANNEL ENDOCRINE AND § BISPHOSPHONATES PROMETRIUM § ANTICHOLINERGICS BLOCKER / DIURETIC METABOLIC alendronate SELECTIVE ESTROGEN COMBINATIONS ACTONEL SPIRIVA ANDROGENS RECEPTOR MODULATORS AMTURNIDE BONIVA § ANTICHOLINERGIC / BETA ANDRODERM EVISTA AGONIST COMBINATIONS § DIURETICS ANDROGEL § CALCITONINS § THYROID SUPPLEMENTS furosemide calcitonin-salmon ipratropium-albuterol ANTIDIABETICS hydrochlorothiazide levothyroxine inhalation solution PARATHYROID HORMONES metolazone § BIGUANIDES SYNTHROID COMBIVENT spironolactone- metformin FORTEO BETA AGONISTS, hydrochlorothiazide metformin ext-rel GASTROINTESTINAL CONTRACEPTIVES INHALANTS torsemide § H2 RECEPTOR triamterene- § BIGUANIDE / § MONOPHASIC § SHORT ACTING SULFONYLUREA ANTAGONISTS hydrochlorothiazide ethinyl estradiol- albuterol ranitidine COMBINATIONS PROAIR HFA drospirenone CENTRAL NERVOUS glipizide-metformin BEYAZ § PROTON PUMP PROVENTIL HFA SYSTEM LO LOESTRIN FE INHIBITORS VENTOLIN HFA DIPEPTIDYL PEPTIDASE-4 LOESTRIN 24 FE ANTIDEPRESSANTS (DPP-4) INHIBITORS lansoprazole LONG ACTING omeprazole § SELECTIVE SEROTONIN JANUVIA § TRIPHASIC FORADIL omeprazole-sodium REUPTAKE INHIBITORS ONGLYZA ethinyl estradiol- SEREVENT bicarbonate capsule (SSRIs) norgestimate DIPEPTIDYL PEPTIDASE-4 pantoprazole § LEUKOTRIENE RECEPTOR citalopram ORTHO TRI-CYCLEN LO (DPP-4) INHIBITOR / DEXILANT ANTAGONISTS fluoxetine BIGUANIDE COMBINATIONS FOUR PHASE NEXIUM zafirlukast paroxetine paroxetine ext-rel JANUMET NATAZIA SINGULAIR GENITOURINARY sertraline KOMBIGLYZE XR § EXTENDED CYCLE § NASAL ANTIHISTAMINES LEXAPRO § BENIGN PROSTATIC INCRETIN MIMETIC AGENTS azelastine VIIBRYD ethinyl estradiol- HYPERPLASIA BYETTA levonorgestrel ASTEPRO doxazosin § SEROTONIN VICTOZA LOSEASONIQUE finasteride NOREPINEPHRINE § NASAL STEROIDS tamsulosin REUPTAKE INHIBITORS INSULINS TRANSDERMAL flunisolide terazosin (SNRIs) 2 APIDRA ORTHO EVRA fluticasone AVODART HUMULIN R U-500 triamcinolone venlafaxine RAPAFLO LANTUS VAGINAL NASONEX venlafaxine ext-rel LEVEMIR NUVARING VERAMYST CYMBALTA § URINARY NOVOLIN PRISTIQ ESTROGENS ANTISPASMODICS STEROID / BETA AGONIST NOVOLOG oxybutynin § MISCELLANEOUS § ORAL COMBINATIONS INSULIN SENSITIZERS oxybutynin ext-rel AGENTS estradiol ADVAIR trospium ACTOS estropipate DULERA bupropion DETROL SYMBICORT ENJUVIA bupropion ext-rel INSULIN SENSITIZER / DETROL LA PREMARIN mirtazapine BIGUANIDE COMBINATIONS ENABLEX § STEROID INHALANTS § HYPNOTICS, ACTOPLUS MET § TRANSDERMAL GELNIQUE budesonide inhalation VESICARE NONBENZODIAZEPINES estradiol suspension INSULIN SENSITIZER / EVAMIST ASMANEX zolpidem SULFONYLUREA HEMATOLOGIC VIVELLE-DOT FLOVENT zolpidem ext-rel COMBINATIONS § ANTICOAGULANTS PULMICORT FLEXHALER DUETACT § ESTROGEN / QVAR MIGRAINE warfarin PROGESTINS, ORAL § SELECTIVE SEROTONIN § MEGLITINIDES COUMADIN estradiol-norethindrone TOPICAL AGONISTS PRADAXA nateglinide PREMPHASE XARELTO DERMATOLOGY naratriptan PRANDIN PREMPRO sumatriptan § ACNE § SULFONYLUREAS IMMUNOLOGIC MAXALT FERTILITY REGULATORS adapalene AGENTS ZOMIG glimepiride clindamycin solution OVULATION STIMULANTS, glipizide SELECTIVE SEROTONIN GONADOTROPINS BIOLOGIC DISEASE- clindamycin-benzoyl glipizide ext-rel MODIFYING AGENTS peroxide AGONIST / NONSTEROIDAL BRAVELLE erythromycin solution ANTI-INFLAMMATORY SUPPLIES FOLLISTIM AQ ENBREL HUMIRA erythromycin-benzoyl DRUG (NSAID) ACCU-CHEK STRIPS AND peroxide COMBINATIONS KITS 3 tretinoin TREXIMET ACANYA Your specific prescription benefit plan design may not cover certain categories, regardless of their appearance in this document. For specific information, visit www.caremark.com or contact a CVS Caremark Customer Care representative. DIFFERIN OPHTHALMIC BETA-BLOCKERS, § PROSTAGLANDINS § SYMPATHOMIMETICS DUAC § BETA-BLOCKERS, SELECTIVE latanoprost brimonidine 0.2% EPIDUO NONSELECTIVE BETOPTIC S LUMIGAN ALPHAGAN P RETIN-A MICRO timolol maleate solution TRAVATAN Z VELTIN BETIMOL QUICK REFERENCE DRUG LIST A ciprofloxacin ext-rel fluconazole metformin QVAR ciprofloxacin tablet flunisolide metformin ext-rel ACANYA R ACCU-CHEK STRIPS AND citalopram fluoxetine metolazone clarithromycin fluticasone metoprolol ramipril KITS 3 clarithromycin ext-rel FOLLISTIM AQ metoprolol succinate ext-rel ranitidine ACTONEL clindamycin FORADIL metronidazole RAPAFLO ACTOPLUS MET clindamycin solution FORTEO MICARDIS RELENZA ACTOS clindamycin-benzoyl fosinopril MICARDIS HCT RETIN-A MICRO acyclovir peroxide fosinopril- minocycline rimantadine adapalene COMBIVENT hydrochlorothiazide mirtazapine ADVAIR COPAXONE furosemide S albuterol COREG CR N alendronate SEREVENT COUMADIN G nadolol ALPHAGAN P sertraline CRESTOR GELNIQUE naratriptan amantadine SIMCOR CYMBALTA glimepiride NASONEX simvastatin
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