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2020 Home Delivery and CVS 90-Day Supply List

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2020 Home Delivery and CVS 90-Day Supply List This is not an all-inclusive list of long-term medicines, and is subject to change at Express Scripts’ discretion. Not all of the drugs listed are covered by all prescription plans; check your benefit materials and formulary for the specific drugs covered and the copayments for your prescription plan. For specific questions about your coverage, please call the phone number printed on your member ID card. For the member: FDA-approved generic medications meet strict standards and contain 2020 Home Delivery, CVS and Walgreens the same active ingredients as their corresponding brand-name medications, although 90-Day Supply List they may have a different appearance. For the physician: Please prescribe preferred products and allow generic substitutions when medically appropriate. A Aplenzin Binosto Carvedilol Cyred Apri Bisoprolol Fumarate Carvedilol ER Cyred EQ Acarbose Aranelle Bisoprolol-Hydrochlorothiazide Casodex Cytotec Accolate Arava Blisovi 24 Fe Catapres Accupril Arcapta Neohaler Blisovi Fe Catapres-TTS D Accuretic Aricept Boniva Tablets Caverject Acebutolol HCl Armonair Respiclick Breo Ellipta Caziant Daliresp Acetazolamide Armour Thyroid Brevicon Cequa Darifenacin ER Actigall Arnuity Ellipta Briellyn Cevimeline HCl Dasetta Active OB Aromasin Brilinta Chateal Daysee Activella Ashlyna Brimonidine Tartrate Eye Drops Chateal EQ Deblitane Actonel Asmanex Bromocriptine Mesylate Chlorothiazide Delyla Actoplus Met Asmanex HFA Budesonide Chlorpropamide Demadex Actoplus Met XR Aspirin-Dipyridamole ER Bumetanide Chlorthalidone Denta 5000 Plus Actos Atelvia Buphenyl Cholestyramine Dentagel Adalat CC Atenolol Bupropion HCl Cholestyramine Light Depen Advair Diskus Atenolol-Chlorthalidone Bupropion HCl ER Cilostazol Depo-Provera 150 mg Advair HFA Atomoxetine HCl Bupropion HCl SR Cimetidine Depo-Subq Provera 104 Aerospan Atorvastatin Calcium Bupropion XL Cinacalcet HCl Desmopressin Acetate Afeditab CR Atrovent Buspirone HCl Citalopram HBr Tablets and Nasal Spray Afirmelle Atrovent HFA Bydureon Citranatal 90 DHA Desogen Afrezza Aubra Bydureon Bcise Citranatal Assure Desvenlafaxine ER Aggrenox Aubra EQ Byetta Citranatal B-Calm Desvenlafaxine Fumarate ER Agrylin Aurovela Bystolic Citranatal DHA Desvenlafaxine Succinate ER Airduo Respiclick Aurovela 24 Fe Byvalson Citranatal Harmony Dexilant Albuterol Sulfate Aurovela Fe Citranatal Rx Diamox Sequels Tablets and Syrup Avandamet C Climara Digox Aldactazide Avandia Clinpro 5000 Digoxin Aldactone Aviane Cabergoline Clonidine Dilatrate-SR Alendronate Sodium Aygestin Cadeau DHA Clonidine HCl Diltiazem 12 HR ER Alfuzosin HCl ER Ayuna Caduet Clonidine HCl ER Diltiazem 24 HR CD Aliskiren Azilect Calan Clonidine Patch Diltiazem 24 HR ER Allopurinol Azopt Calan SR Clopidogrel Diltiazem 24 HR LA Alora Azulfidine Calcitonin-Salmon C-Nate DHA Diltiazem 24 HR XR Alphagan P Azurette Calcitriol Oral Colesevelam HCl Diltiazem HCl Altace Calcium PNV Colestid Diltiazem HCl ER Altavera B Calcium-Folic Acid Plus D Colestipol HCl Dilt-XR Alyacen Camila Combigan Dipyridamole Amabelz Bal-Care DHA Camrese Combipatch Disopyramide Phosphate Amaryl Bal-Care DHA Essential Camrese Lo Combivent Respimat Ditropan XL Amethia Balcoltra Candesartan Cilexetil Complete Natal DHA Diuril Amethia Lo Balziva Candesartan-Hydrochlorothiazide Completenate Divigel Amethyst Basaglar Kwikpen Captopril Comtan Donepezil HCl Amiloride HCl Bekyree Captopril-Hydrochlorothiazide Concept DHA Donepezil HCl ODT Amiloride-Hydrochlorothiazide Benazepril HCl Carafate Concept OB Dorzolamide HCl Amiodarone HCl Benazepril-Hydrochlorothiazide Carbidopa Contrave ER Dorzolamide-Timolol Amitiza Betagan Carbidopa-Levodopa Cordarone Dothelle DHA Amlodipine Besylate Betapace Carbidopa-Levodopa ER Coreg Dotti Amlodipine Besylate-Benazepril Betapace AF Carbidopa-Levodopa-Entacapone Coreg ER Doxazosin Mesylate Amlodipine-Atorvastatin Betaxolol HCl Cardizem Corgard Doxercalciferol Amlodipine-Olmesartan Betimol Cardizem CD Corlanor Drisdol Amlodipine-Valsartan Betoptic S Cardizem LA Cromolyn Sodium Drospirenone-E.Estradiol- Amlodipine-Valsartan-HCTZ Bevespi Aerosphere Cardura Oral Concentrate Levomefol Anagrelide HCl Beyaz Cardura XL Cryselle Drospirenone-Ethinyl Estradiol Anastrozole Bicalutamide Carnitor Cyanocobalamin Injection Duavee Angeliq Bidil Carnitor SF Cyclafem Duet DHA 400 Anoro Ellipta Bijuva Carteolol HCl Cyclessa Duet DHA Balanced Antara Bimatoprost Cartia XT Cycloset Duetact (continued) This is not an all-inclusive list of long-term medicines, and is subject to change at Express Scripts’ discretion. Generics drugs are usually available at the lowest copayment. © 2019 Express Scripts. All Rights Reserved. Page 1 DL466313-KEY CRP1910_001131.1 (10/01/19) All trademarks are the property of their respective owners. Dulera Femhrt Glycate Jevantique Lo Lo Loestrin Fe Duloxetine HCl Femynor Glycopyrrolate Jinteli Lodosyn Dutasteride Fenofibrate Glynase Jolessa Lomedia 24 Fe Dutasteride-Tamsulosin Fenofibric Acid Glyset Jolivette Lonhala Magnair Refill Dyazide Fenoglide Glyxambi Juleber Lopid Dyrenium Fetzima Grastek Junel Lopreeza Fibricor Guanfacine HCl Junel Fe Lopressor E Finasteride Guanfacine HCl ER Junel Fe 24 Lopressor HCT Flavoxate HCl Loryna Edarbi Flecainide Acetate H K Losartan Potassium Edarbyclor Flolipid Losartan-Hydrochlorothiazide Edecrin Flomax Hailey K Effervescent Loseasonique Edex Flovent Diskus Hailey 24 Fe Kaitlib Fe Lotensin Effer-K Flovent HFA Heather Kalliga Lotensin HCT Effient Fludrocortisone Acetate Hectorol Kapvay Lovastatin Elestrin Flunisolide Hemenatal OB Kariva Lovaza Elinest Fluoridex Hemenatal OB + DHA Katerzia Low-Ogestrel Eliquis Fluoridex Daily Defense Humalog Kelnor Lo-Zumandimine Elite-OB Fluoridex Sensitivity Relief Humalog Junior Kwikpen Khedezla Lumigan Elixophyllin Fluoxetine HCl Humalog Kwikpen Kimidess Lutera Emoquette Fluoxetine HCl DR Humalog Mix Klor-Con Lyza Enablex Flutamide Humalog Mix Kwikpen Klor-Con EF Enalapril Maleate Fluticasone Propionate Humulin N Klor-Con M M Enalapril-Hydrochlorothiazide Fluticasone-Salmeterol Humulin N Kwikpen Klor-Con Sprinkle Enbrace HR Fluvastatin Sodium Humulin R Kosher Prenatal Plus Iron Macnatal CN DHA Enjuvia Fluvastatin Sodium ER Humulin R Kwikpen K-Sol Marlissa Enpresse Fluvoxamine Maleate Hydralazine HCl K-Tab ER Marnatal-F Enskyce Fluvoxamine Maleate ER Hydrochlorothiazide Kurvelo Matzim LA Entacapone Focalgin 90 DHA Hydroxychloroquine Sulfate Maxinate Entresto Focalgin Ca L Maxzide Eplerenone Folet DHA I Medroxyprogesterone Acetate Eprosartan Mesylate Folet One Labetalol HCl Melodetta 24 Fe Ergoloid Mesylates Folic Acid 1 mg Ibandronate Sodium Lanoxin Memantine HCl Errin Folivane-OB Imvexxy Lansoprazole Memantine HCl ER Escitalopram Oxalate Foradil Incassia Lantus Menest Esomeprazole Magnesium Forfivo XL Incruse Ellipta Lantus Solostar Menostar Esomeprazole Strontium Fortamet Indapamide Larin Mesalamine DR Estarylla Fortical Innopran XL Larin 24 Fe Mestinon Estrace Fosamax Inspra Larin Fe Metaproterenol Sulfate Estradiol Fosamax Plus D Introvale Larissia Metformin HCl Estradiol Transdermal Patch Fosinopril Sodium Invokamet Lasix Metformin HCl ER Estradiol-Norethindrone Tablets Fosinopril-Hydrochlorothiazide Invokamet XR Latanoprost Methazolamide Estring Fulvestrant Invokana Layolis Fe Methimazole Estropipate Furosemide Ipratropium Bromide Leena Methyclothiazide Estrostep Fe Fyavolv Ipratropium-Albuterol Leflunomide Methyldopa Ethacrynic Acid Irbesartan Lescol Methyldopa-Hydrochlorothiazide Ethynodiol-Ethinyl Estradiol G Irbesartan-Hydrochlorothiazide Lescol XL Metipranolol Etidronate Disodium Isibloom Lessina Metolazone Euthyrox Galantamine HBr Isochron Letrozole Metoprolol Succinate Evamist Galantamine HBr ER Isopto Carpine Levemir Metoprolol Tartrate Evista Gastrocrom Isordil Levemir Flextouch Metoprolol-Hydrochlorothiazide Evoxac Gelnique Isordil Titradose Levitra Mexiletine HCl Exelon Gemfibrozil Isosorbide Dinitrate Levobunolol HCl Miacalcin Exemestane Generess Fe Isosorbide Dinitrate ER Levocarnitine Mibelas 24 Fe Extra-Virt Plus DHA Gianvi Isosorbide Mononitrate Levomefolate DHA Microgestin Ezetimibe Gildagia Isosorbide Mononitrate ER Levonest Microgestin 24 Fe Ezetimibe-Simvastatin Gildess Isoxsuprine HCl Levonorgestrel-E.Estradiol Microgestin Fe Gildess 24 Fe Isradipine Levonorgestrel-Ethinyl Estradiol Microzide F Gildess Fe Levora-28 Miglitol Glimepiride J Levo-T Mili Falmina Glipizide Levothyroxine Sodium Mimvey Famotidine Glipizide ER Jalyn Levoxyl Mimvey Lo Fareston Glipizide XL Janumet Lialda Minipress Farxiga Glipizide-Metformin Janumet XR Lillow Minitran Faslodex Glucotrol Januvia Linzess Minivelle Fayosim Glucotrol XL Jardiance Liothyronine Sodium Minoxidil Febuxostat Glucovance Jasmiel Lipofen Mirapex Felodipine ER Glyburide Jencycla Lisinopril Mirapex ER Femara Glyburide Micronized Jentadueto Lisinopril-Hydrochlorothiazide Mircette Femcon Fe Glyburide-Metformin HCl Jentadueto XR Livalo Mirtazapine (continued) This is not an all-inclusive list of long-term medicines, and is subject to change at Express Scripts’ discretion. Generics drugs are usually available at the lowest copayment. © 2019 Express Scripts. All Rights Reserved. Page 2 DL466313-KEY CRP1910_001131.1 (10/01/19) All trademarks are the property of their respective owners. M-Natal Plus Norlyroc Pioglitazone-Metformin Procardia Robinul Forte Modicon Norpace Pirmella Procardia XL Rocaltrol Moexipril HCl Norpace CR PNV 29-1 Proglycem Rocklatan Moexipril-Hydrochlorothiazide Nor-Q-D PNV OB+DHA Propafenone HCl Ropinirole HCl Mometasone Furoate Nortrel PNV-DHA Propafenone HCl ER Ropinirole
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