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

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 amlodipine glipizide NATAZIA amoxicillin SINGULAIR D glipizide ext-rel nateglinide amoxicillin-clavulanate SPIRIVA DETROL glipizide-metformin NEXIUM AMTURNIDE spironolactone- DETROL LA NIASPAN ANDRODERM hydrochlorothiazide DEXILANT H nifedipine ext-rel ANDROGEL sulfamethoxazole- dicloxacillin nitrofurantoin APIDRA HUMIRA trimethoprim DIFFERIN NORDITROPIN ASMANEX HUMULIN R U-500 sumatriptan digoxin NOVOLIN ASTEPRO hydrochlorothiazide SUPRAX diltiazem ext-rel NOVOLOG atenolol SYMBICORT DIOVAN I NUVARING AVELOX SYNTHROID DIOVAN HCT AVODART ipratropium-albuterol SYNVISC doxazosin O AVONEX inhalation solution SYNVISC-ONE doxycycline hyclate azelastine itraconazole omeprazole DUAC T azithromycin omeprazole-sodium DUETACT J bicarbonate capsule TAMIFLU

B DULERA JANUMET ONETOUCH STRIPS AND tamsulosin 3 BD INSULIN SYRINGES JANUVIA KITS TEKAMLO E ONGLYZA AND NEEDLES TEKTURNA ENABLEX ORTHO EVRA BENICAR K TEKTURNA HCT ENBREL ORTHO TRI-CYCLEN LO BENICAR HCT KOMBIGLYZE XR terazosin ENJUVIA oxybutynin BETASERON terbinafine tablet EPIDUO oxybutynin ext-rel BETIMOL L tetracycline

EPIPEN BETOPTIC S lansoprazole timolol maleate solution EPIPEN JR P BEYAZ LANTUS torsemide erythromycin solution BONIVA latanoprost pantoprazole TRAVATAN Z erythromycin-benzoyl BRAVELLE LEVEMIR paroxetine tretinoin peroxide brimonidine 0.2% levofloxacin paroxetine ext-rel TREXIMET erythromycins budesonide inhalation levothyroxine penicillin VK triamcinolone estradiol suspension LEXAPRO PRADAXA triamterene- estradiol-norethindrone bupropion LIPITOR PRANDIN hydrochlorothiazide estropipate bupropion ext-rel lisinopril pravastatin TRICOR ethinyl estradiol- BYETTA lisinopril- PREMARIN TRILIPIX drospirenone BYSTOLIC hydrochlorothiazide PREMPHASE trospium ethinyl estradiol- LO LOESTRIN FE PREMPRO levonorgestrel V C LOESTRIN 24 FE PRISTIQ ethinyl estradiol- PROAIR HFA CADUET losartan valacyclovir norgestimate PROMETRIUM calcitonin-salmon losartan- VALTURNA EVAMIST propranolol carvedilol hydrochlorothiazide VELTIN EVISTA PROVENTIL HFA venlafaxine cefaclor LOSEASONIQUE PULMICORT FLEXHALER cefdinir LUMIGAN venlafaxine ext-rel F cephalexin VENTOLIN HFA fenofibrate Q cholestyramine M VERAMYST finasteride CIPRO SUSPENSION MAXALT quinapril verapamil ext-rel FLOVENT medroxyprogesterone quinapril- VESICARE hydrochlorothiazide VICTOZA

VIIBRYD W X Z zolpidem VIVELLE-DOT zolpidem ext-rel

warfarin XARELTO zafirlukast ZOMIG WELCHOL ZETIA

PREFERRED ALTERNATIVES LIST DRUG NAME(S) PREFERRED ALTERNATIVE(S)* DRUG NAME(S) PREFERRED ALTERNATIVE(S)* ACIPHEX lansoprazole, omeprazole, omeprazole- FEMTRACE estradiol, estropipate, ENJUVIA, PREMARIN sodium bicarbonate capsule, pantoprazole FENOGLIDE fenofibrate, TRICOR, TRILIPIX ADVICOR SIMCOR FIRST TESTOSTERONE ANDRODERM, ANDROGEL ALORA estradiol, EVAMIST, VIVELLE-DOT FORTAMET metformin ext-rel ALTOPREV pravastatin FORTESTA ANDRODERM, ANDROGEL ALVESCO ASMANEX, FLOVENT, PULMICORT FLEXHALER, QVAR FOSAMAX PLUS D alendronate 3 ANGELIQ estradiol-norethindrone, PREMPHASE, PREMPRO FREESTYLE STRIPS AND KITS ACCU-CHEK STRIPS AND KITS , ONETOUCH STRIPS AND KITS 3 ARMOUR THYROID levothyroxine, SYNTHROID FROVA sumatriptan ASCENSIA STRIPS AND KITS ACCU-CHEK STRIPS AND KITS 3, ONETOUCH STRIPS AND KITS 3 GLUMETZA metformin ext-rel ATACAND, ATACAND HCT losartan, losartan-hydrochlorothiazide, BENICAR, HUMALOG NOVOLOG BENICAR HCT, DIOVAN, DIOVAN HCT, HUMALOG MIX 50/50 NOVOLOG MIX 70/30 MICARDIS, MICARDIS HCT HUMALOG MIX 75/25 NOVOLOG MIX 70/30 ATELVIA alendronate 70 mg HUMULIN NOVOLIN ATROVENT HFA SPIRIVA INNOPRAN XL atenolol, propranolol ext-rel AVAPRO, AVALIDE losartan, losartan-hydrochlorothiazide ISTALOL timolol maleate solution, BETIMOL AXERT naratriptan, sumatriptan, MAXALT, ZOMIG LIVALO pravastatin, simvastatin, CRESTOR, LIPITOR AXIRON ANDRODERM, ANDROGEL LUNESTA zolpidem AZELEX erythromycin solution MAXAIR PROAIR HFA, PROVENTIL HFA, VENTOLIN HFA BECONASE AQ flunisolide, fluticasone MENEST estradiol, estropipate, ENJUVIA, PREMARIN BENZAC AC, BENZAC W adapalene, clindamycin solution, clindamycin- benzoyl peroxide, erythromycin solution, MENOSTAR estradiol, EVAMIST, VIVELLE-DOT erythromycin-benzoyl peroxide, tretinoin, ACANYA, DIFFERIN, DUAC, EPIDUO, RETIN-A MICRO, OMNARIS flunisolide, fluticasone VELTIN OXYTROL oxybutynin ext-rel, trospium, DETROL, DETROL LA, BENZAGEL adapalene, clindamycin solution, clindamycin- ENABLEX, GELNIQUE, VESICARE benzoyl peroxide, erythromycin solution, PATANASE azelastine, ASTEPRO erythromycin-benzoyl peroxide, tretinoin, ACANYA, DIFFERIN, DUAC, EPIDUO, RETIN-A MICRO, PEXEVA citalopram, fluoxetine, paroxetine, paroxetine ext-rel, VELTIN sertraline, LEXAPRO, VIIBRYD BENZIQ adapalene, clindamycin solution, clindamycin- PRECISION XTRA STRIPS AND ACCU-CHEK STRIPS AND KITS 3, benzoyl peroxide, erythromycin solution, KITS ONETOUCH STRIPS AND KITS 3 erythromycin-benzoyl peroxide, tretinoin, ACANYA, DIFFERIN, DUAC, EPIDUO, RETIN-A MICRO, PREFEST estradiol-norethindrone, PREMPHASE, PREMPRO VELTIN RELION INSULIN NOVOLIN INSULIN CARDURA XL doxazosin, tamsulosin, terazosin, RAPAFLO RELPAX naratriptan, sumatriptan, MAXALT, ZOMIG CENESTIN estradiol, estropipate, ENJUVIA, PREMARIN RHINOCORT AQUA flunisolide, fluticasone CLINDAGEL erythromycin solution RIOMET metformin ext-rel DESQUAM E, DESQUAM X adapalene, clindamycin solution, clindamycin- ROZEREM zolpidem benzoyl peroxide, erythromycin solution, erythromycin-benzoyl peroxide, tretinoin, ACANYA, SANCTURA XR oxybutynin ext-rel, trospium, DETROL, DETROL LA, DIFFERIN, DUAC, EPIDUO, RETIN-A MICRO, ENABLEX, GELNIQUE, VESICARE VELTIN SKELID alendronate, ACTONEL DORAL zolpidem, zolpidem ext-rel STRIANT ANDRODERM, ANDROGEL DYNACIRC CR amlodipine, nifedipine ext-rel SUMAVEL DOSEPRO naratriptan, sumatriptan, MAXALT, ZOMIG EDARBI losartan, BENICAR, DIOVAN, MICARDIS SURE-TEST STRIPS AND KITS ACCU-CHEK STRIPS AND KITS 3, EDLUAR zolpidem ONETOUCH STRIPS AND KITS 3 ESTRASORB estradiol, EVAMIST, VIVELLE-DOT TESTIM ANDROGEL ESTROGEL estradiol, EVAMIST, VIVELLE-DOT TEVETEN, TEVETEN HCT losartan, losartan-hydrochlorothiazide

DRUG NAME(S) PREFERRED ALTERNATIVE(S)* DRUG NAME(S) PREFERRED ALTERNATIVE(S)* TOVIAZ oxybutynin ext-rel TRUE CARE STRIPS AND KITS, ACCU-CHEK STRIPS AND KITS 3, TRUETEST STRIPS AND KITS, ONETOUCH STRIPS AND KITS 3 TRADJENTA JANUVIA, ONGLYZA TRUETRACK STRIPS AND KITS TRIAZ adapalene, clindamycin solution, clindamycin- TWINJECT EPIPEN, EPIPEN JR benzoyl peroxide, erythromycin solution, erythromycin-benzoyl peroxide, tretinoin, ACANYA, VANOS clobetasol DIFFERIN, DUAC, EPIDUO, RETIN-A MICRO, VELTIN VYTORIN pravastatin, simvastatin, CRESTOR, LIPITOR TRIGLIDE fenofibrate, TRICOR, TRILIPIX XOPENEX HFA PROAIR HFA, PROVENTIL HFA, VENTOLIN HFA ZYFLO, ZYFLO CR zafirlukast, SINGULAIR

FOR YOUR INFORMATION: Generics should be considered the first line of prescribing. This drug list represents a summary of prescription coverage. It is not inclusive and does not guarantee coverage. Any brand drug for which a generic product becomes available may be designated as a non-preferred product. Specific prescription benefit plan design may not cover certain categories, regardless of their appearance in this document. The member's prescription benefit plan may have a different copay for specific products on the list. Unless specifically indicated, drug list products will include all dosage forms. This list represents brand products in CAPS and generic products in lowercase italics. Generics listed in therapeutic categories are for representational purposes only. This is not an all-inclusive list. Listed products may be available generically in certain strengths or dosage forms. Dosage forms on this list will be consistent with the category and use where listed. Log in to www.caremark.com to check coverage and copay information for a specific medicine.

* The preferred alternative products in this list are a broad representation within therapeutic categories of available treatment options and do not necessarily represent clinical equivalency. § Generics are available in this class and should be considered the first line of prescribing. 1 Copayment, copay or coinsurance means the amount a member is required to pay for a prescription in accordance with a Plan, which may be a deductible, a percentage of the prescription price, a fixed amount or other charge, with the balance, if any, paid by a Plan. 2 Indicates the proposed mechanism of action, based on the American Psychiatric Association Summary of Treatment Recommendations. 3 An Accu-Chek or OneTouch blood glucose meter will be provided at no charge by the manufacturer to those individuals currently using a meter other than Accu-Chek or OneTouch. For more information on how to obtain a blood glucose meter, call toll-free: 1-800-588-4456. Members must have CVS Caremark Mail Service Pharmacy benefits to qualify.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers. Listed products are for informational purposes only and are not intended to replace the clinical judgment of the prescriber.