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Zero Dollar Copay List

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Zero Dollar Copay List Zero Dollar Copay List The following drugs, when covered, are available at zero dollar copay under the pharmacy benefit. This list does not imply formulary coverage. Prior authorization and step therapy may apply. Coverage should be verified by reviewing the Preferred Drug List (PDL) on the Healthy Blue website. The list may change throughout the year. Effective for all members on September 15, 2020 BRAND NAME GENERIC DRUG NAME CATEGORY ACCUPRIL QUINAPRIL HCL Blood Pressure/Heart Health ACCURETIC QUINAPRIL/HYDROCHLOROTHIAZIDE Blood Pressure/Heart Health ACEBUTOLOL HCL ACEBUTOLOL HCL Blood Pressure/Heart Health ACEON PERINDOPRIL ERBUMINE Blood Pressure/Heart Health ACETAZOLAMIDE ACETAZOLAMIDE Blood Pressure/Heart Health ACETAZOLAMIDE SODIUM ACETAZOLAMIDE SODIUM Blood Pressure/Heart Health ADALAT CC NIFEDIPINE Blood Pressure/Heart Health ADENOCARD ADENOSINE Blood Pressure/Heart Health ADENOSINE ADENOSINE Blood Pressure/Heart Health AFEDITAB CR NIFEDIPINE Blood Pressure/Heart Health ALDACTAZIDE SPIRONOLACT/HYDROCHLOROTHIAZID Blood Pressure/Heart Health ALDACTONE SPIRONOLACTONE Blood Pressure/Heart Health ALPROSTADIL ALPROSTADIL Blood Pressure/Heart Health ALTACE RAMIPRIL Blood Pressure/Heart Health AMILORIDE HCL AMILORIDE HCL Blood Pressure/Heart Health AMILORIDE- AMILORIDE/HYDROCHLOROTHIAZIDE Blood Pressure/Heart Health HYDROCHLOROTHIAZIDE AMIODARONE HCL AMIODARONE HCL Blood Pressure/Heart Health AMLODIPINE BESYLATE AMLODIPINE BESYLATE Blood Pressure/Heart Health AMLODIPINE ESYLATE- AMLODIPINE BESYLATE/BENAZEPRIL Blood Pressure/Heart Health BENAZEPRIL AMLODIPINE- AMLODIPINE BES/OLMESARTAN MED Blood Pressure/Heart Health OLMESARTAN AMLODIPINE-VALSARTAN AMLODIPINE BESYLATE/VALSARTAN Blood Pressure/Heart Health AMLODIPINE-VALSARTAN- AMLODIPINE/VALSARTAN/HCTHIAZID Blood Pressure/Heart Health HCTZ AMTURNIDE ALISKIREN/AMLODIPIN/HCTHIAZIDE Blood Pressure/Heart Health ATACAND CANDESARTAN CILEXETIL Blood Pressure/Heart Health ATACAND HCT CANDESARTAN/HYDROCHLOROTHIAZID Blood Pressure/Heart Health ATENOLOL ATENOLOL Blood Pressure/Heart Health ATENOLOL- ATENOLOL/CHLORTHALIDONE Blood Pressure/Heart Health CHLORTHALIDONE AVALIDE IRBESARTAN/HYDROCHLOROTHIAZIDE Blood Pressure/Heart Health AVAPRO IRBESARTAN Blood Pressure/Heart Health AZOR AMLODIPINE BES/OLMESARTAN MED Blood Pressure/Heart Health BENAZEPRIL HCL BENAZEPRIL HCL Blood Pressure/Heart Health BENAZEPRIL- BENAZEPRIL/HYDROCHLOROTHIAZIDE Blood Pressure/Heart Health HYDROCHLOROTHIAZIDE BENICAR OLMESARTAN MEDOXOMIL Blood Pressure/Heart Health WEBMBSC-0334-20 Healthy Blue Zero Dollar Copay List Page 2 of 20 BRAND NAME GENERIC DRUG NAME CATEGORY BENICAR HCT OLMESARTAN/HYDROCHLOROTHIAZIDE Blood Pressure/Heart Health BETAPACE SOTALOL HCL Blood Pressure/Heart Health BETAPACE AF SOTALOL HCL Blood Pressure/Heart Health BETAXOLOL HCL BETAXOLOL HCL Blood Pressure/Heart Health BIDIL ISOSORBIDE DINIT/HYDRALAZINE Blood Pressure/Heart Health BISOPROLOL FUMARATE BISOPROLOL FUMARATE Blood Pressure/Heart Health BISOPROLOL- BISOPROLOL/HYDROCHLOROTHIAZIDE Blood Pressure/Heart Health HYDROCHLOROTHIAZIDE BREVIBLOC ESMOLOL HCL Blood Pressure/Heart Health BREVIBLOC ESMOLOL IN SODIUM CHLORIDE, ISO Blood Pressure/Heart Health BUMETANIDE BUMETANIDE Blood Pressure/Heart Health BYSTOLIC NEBIVOLOL HCL Blood Pressure/Heart Health BYVALSON NEBIVOLOL HCL/VALSARTAN Blood Pressure/Heart Health CALAN VERAPAMIL HCL Blood Pressure/Heart Health CALAN SR VERAPAMIL HCL Blood Pressure/Heart Health CANDESARTAN CILEXETIL CANDESARTAN CILEXETIL Blood Pressure/Heart Health CANDESARTAN- CANDESARTAN/HYDROCHLOROTHIAZID Blood Pressure/Heart Health HYDROCHLOROTHIAZID CAPTOPRIL CAPTOPRIL Blood Pressure/Heart Health CAPTOPRIL- CAPTOPRIL/HYDROCHLOROTHIAZIDE Blood Pressure/Heart Health HYDROCHLOROTHIAZIDE CARDENE I.V. NICARDIPINE HCL Blood Pressure/Heart Health CARDIZEM DILTIAZEM HCL Blood Pressure/Heart Health CARDIZEM CD DILTIAZEM HCL Blood Pressure/Heart Health CARDIZEM LA DILTIAZEM HCL Blood Pressure/Heart Health CARDURA DOXAZOSIN MESYLATE Blood Pressure/Heart Health CARDURA XL DOXAZOSIN MESYLATE Blood Pressure/Heart Health CAROSPIR SPIRONOLACTONE Blood Pressure/Heart Health CARTIA XT DILTIAZEM HCL Blood Pressure/Heart Health CARVEDILOL CARVEDILOL Blood Pressure/Heart Health CARVEDILOL ER CARVEDILOL PHOSPHATE Blood Pressure/Heart Health CATAPRES CLONIDINE HCL Blood Pressure/Heart Health CATAPRES-TTS 1 CLONIDINE Blood Pressure/Heart Health CATAPRES-TTS 2 CLONIDINE Blood Pressure/Heart Health CATAPRES-TTS 3 CLONIDINE Blood Pressure/Heart Health CHLOROTHIAZIDE CHLOROTHIAZIDE Blood Pressure/Heart Health CHLOROTHIAZIDE SODIUM CHLOROTHIAZIDE SODIUM Blood Pressure/Heart Health CHLORTHALIDONE CHLORTHALIDONE Blood Pressure/Heart Health CLEVIPREX CLEVIDIPINE BUTYRATE Blood Pressure/Heart Health CLONIDINE CLONIDINE Blood Pressure/Heart Health CLONIDINE HCL CLONIDINE HCL Blood Pressure/Heart Health CLORPRES CLONIDINE HCL/CHLORTHALIDONE Blood Pressure/Heart Health CORDARONE AMIODARONE HCL Blood Pressure/Heart Health COREG CARVEDILOL Blood Pressure/Heart Health COREG CR CARVEDILOL PHOSPHATE Blood Pressure/Heart Health CORGARD NADOLOL Blood Pressure/Heart Health CORLOPAM FENOLDOPAM MESYLATE Blood Pressure/Heart Health CORVERT IBUTILIDE FUMARATE Blood Pressure/Heart Health CORZIDE NADOLOL/BENDROFLUMETHIAZIDE Blood Pressure/Heart Health COZAAR LOSARTAN POTASSIUM Blood Pressure/Heart Health WEBMBSC-0334-20 Healthy Blue Zero Dollar Copay List Page 3 of 20 BRAND NAME GENERIC DRUG NAME CATEGORY DEMADEX TORSEMIDE Blood Pressure/Heart Health DEMSER METYROSINE Blood Pressure/Heart Health DIAMOX SEQUELS ACETAZOLAMIDE Blood Pressure/Heart Health DIBENZYLINE PHENOXYBENZAMINE HCL Blood Pressure/Heart Health DIGITEK DIGOXIN Blood Pressure/Heart Health DIGOX DIGOXIN Blood Pressure/Heart Health DIGOXIN DIGOXIN Blood Pressure/Heart Health DILATRATE-SR ISOSORBIDE DINITRATE Blood Pressure/Heart Health DILTIAZEM 12HR ER DILTIAZEM HCL Blood Pressure/Heart Health DILTIAZEM 24HR CD DILTIAZEM HCL Blood Pressure/Heart Health DILTIAZEM 24HR ER DILTIAZEM HCL Blood Pressure/Heart Health DILTIAZEM ER DILTIAZEM HCL Blood Pressure/Heart Health DILTIAZEM HCL DILTIAZEM HCL Blood Pressure/Heart Health DILT-XR DILTIAZEM HCL Blood Pressure/Heart Health DIOVAN VALSARTAN Blood Pressure/Heart Health DIOVAN HCT VALSARTAN/HYDROCHLOROTHIAZIDE Blood Pressure/Heart Health DISOPYRAMIDE DISOPYRAMIDE PHOSPHATE Blood Pressure/Heart Health PHOSPHATE DIURETIC SOFTGEL PAMABROM Blood Pressure/Heart Health DIURIL CHLOROTHIAZIDE Blood Pressure/Heart Health DOFETILIDE DOFETILIDE Blood Pressure/Heart Health DOXAZOSIN MESYLATE DOXAZOSIN MESYLATE Blood Pressure/Heart Health DUTOPROL METOPROLOL SU/HYDROCHLOROTHIAZ Blood Pressure/Heart Health DYAZIDE TRIAMTERENE/HYDROCHLOROTHIAZID Blood Pressure/Heart Health DYRENIUM TRIAMTERENE Blood Pressure/Heart Health EDARBI AZILSARTAN MEDOXOMIL Blood Pressure/Heart Health EDARBYCLOR AZILSARTAN MED/CHLORTHALIDONE Blood Pressure/Heart Health EDECRIN ETHACRYNIC ACID Blood Pressure/Heart Health ENALAPRIL MALEATE ENALAPRIL MALEATE Blood Pressure/Heart Health ENALAPRILAT ENALAPRILAT DIHYDRATE Blood Pressure/Heart Health ENALAPRIL- ENALAPRIL/HYDROCHLOROTHIAZIDE Blood Pressure/Heart Health HYDROCHLOROTHIAZIDE EPANED ENALAPRIL MALEATE Blood Pressure/Heart Health EPLERENONE EPLERENONE Blood Pressure/Heart Health EPROSARTAN MESYLATE EPROSARTAN MESYLATE Blood Pressure/Heart Health ESMOLOL HCL ESMOLOL HCL Blood Pressure/Heart Health ESMOLOL HCL-WATER ESMOLOL HCL IN STERILE WATER Blood Pressure/Heart Health ETHACRYNATE SODIUM ETHACRYNATE SODIUM Blood Pressure/Heart Health ETHACRYNIC ACID ETHACRYNIC ACID Blood Pressure/Heart Health EXFORGE AMLODIPINE BESYLATE/VALSARTAN Blood Pressure/Heart Health EXFORGE HCT AMLODIPINE/VALSARTAN/HCTHIAZID Blood Pressure/Heart Health FELODIPINE ER FELODIPINE Blood Pressure/Heart Health FLECAINIDE ACETATE FLECAINIDE ACETATE Blood Pressure/Heart Health FOSINOPRIL SODIUM FOSINOPRIL SODIUM Blood Pressure/Heart Health FOSINOPRIL- FOSINOPRIL/HYDROCHLOROTHIAZIDE Blood Pressure/Heart Health HYDROCHLOROTHIAZIDE FUROSEMIDE FUROSEMIDE Blood Pressure/Heart Health GONITRO NITROGLYCERIN Blood Pressure/Heart Health GUANFACINE HCL GUANFACINE HCL Blood Pressure/Heart Health HEMANGEOL PROPRANOLOL HCL Blood Pressure/Heart Health WEBMBSC-0334-20 Healthy Blue Zero Dollar Copay List Page 4 of 20 BRAND NAME GENERIC DRUG NAME CATEGORY HYDRALAZINE HCL HYDRALAZINE HCL Blood Pressure/Heart Health HYDROCHLOROTHIAZIDE HYDROCHLOROTHIAZIDE Blood Pressure/Heart Health HYZAAR LOSARTAN/HYDROCHLOROTHIAZIDE Blood Pressure/Heart Health IBUTILIDE FUMARATE IBUTILIDE FUMARATE Blood Pressure/Heart Health INDAPAMIDE INDAPAMIDE Blood Pressure/Heart Health INDERAL LA PROPRANOLOL HCL Blood Pressure/Heart Health INDERAL XL PROPRANOLOL HCL Blood Pressure/Heart Health INNOPRAN XL PROPRANOLOL HCL Blood Pressure/Heart Health INSPRA EPLERENONE Blood Pressure/Heart Health IRBESARTAN IRBESARTAN Blood Pressure/Heart Health IRBESARTAN- IRBESARTAN/HYDROCHLOROTHIAZIDE Blood Pressure/Heart Health HYDROCHLOROTHIAZIDE ISOCHRON ISOSORBIDE DINITRATE Blood Pressure/Heart Health ISORDIL ISOSORBIDE DINITRATE Blood Pressure/Heart Health ISORDIL TITRADOSE ISOSORBIDE DINITRATE Blood Pressure/Heart Health ISOSORBIDE DINITRATE ISOSORBIDE DINITRATE Blood Pressure/Heart Health ISOSORBIDE DINITRATE ER ISOSORBIDE DINITRATE Blood Pressure/Heart Health ISOSORBIDE ISOSORBIDE MONONITRATE Blood Pressure/Heart Health MONONITRATE ISOSORBIDE ISOSORBIDE MONONITRATE Blood Pressure/Heart Health MONONITRATE ER ISOXSUPRINE HCL ISOXSUPRINE HCL Blood Pressure/Heart Health ISRADIPINE ISRADIPINE Blood Pressure/Heart Health LABETALOL HCL
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