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Maintenance Medication List. Effective January 1, 2018

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Maintenance Medication List. Effective January 1, 2018 UnitedHealthcare Medication List Maintenance Medication List. Effective January 1, 2018 Below is a list of all the therapeutic classes of medications included in home delivery programs. The most commonly prescribed medications are included under each therapeutic class. It is not inclusive of all maintenance medications that may be included in home delivery programs. The maintenance medication list was determined by taking into consideration chronic, long-term use of a medication, frequency of dose changes and other clinical factors. If you have questions or are not sure if your medication needs to be filled with OptumRx® home delivery, call Customer Service at the phone number listed on your plan ID card. Drug Name Drug Name Drug Name ADHD ARCAPTA NEOHALER SYMBICORT GUANFACINE ER ARNUITY ELLIPTA THEO-24 INTUNIV+ ASMANEX TWISTHALER THEOCHRON Agents used for Dry Mouth ASMANEX HFA THEOPHYLLINE ANHYDROUS CAPHOSOL ATROVENT HFA TUDORZA PRESSAIR CEVIMELINE BEVESPI AEROSPHERE UTIBRON NEOHALER* EVOXAC BREO ELLIPTA ZILEUTON ER GELCLAIR BROVANA ZAFIRLUKAST NEUTRASAL BUDESONIDE NEB ZYFLO NUMOISYN COMBIVENT RESPIMAT ZYFLO CR ORAFATE DALIRESP Blood Clots/Prevention PILOCARPINE DULERA* ELIQUIS SALAGEN DUONEB PRADAXA Alzheimer’s Disease DYLIX SAVAYSA ARICEPT ELIXOPHYLLIN XARELTO ARICEPT 23 MG* FLOVENT DISKUS Benign Prostatic Hyperplasia (BPH) ARICEPT ODT FLOVENT HFA ALFUZOSIN HCL DONEPEZIL HCL FLUTICASONE/SALMETEROL (GENERIC AVODART+ EXELON+ AIRDUO RESPICLICK) CARDURA XL GALANTAMINE HBR INCRUSE ELLIPTA DOXAZOSIN MEMANTINE IPRATROPIUM BROMIDE DUTASTERIDE NAMENDA IPRATROPIUM-ALBUTEROL DUTASTERIDE/TAMSULOSIN* NAMENDA XR* LUFYLLIN FINASTERIDE NAMZARIC* MONTELUKAST SODIUM FLOMAX+ RAZADYNE PERFOROMIST JALYN* RAZADYNE ER PULMICORT PROSCAR RIVASTIGMINE PULMICORT FLEXHALER RAPAFLO Asthma/Chronic Obstructive Pulmonary QVAR TAMSULOSIN HCL Disease (COPD) SEEBRI NEOHALER* TERAZOSIN ACCOLATE SEREVENT DISKUS UROXATRAL + ADVAIR DISKUS SINGULAIR Breast Cancer Prevention ADVAIR HFA SPIRIVA HANDIHALER ANASTROZOLE AIRDUO RESPICLICK* SPIRIVA RESPIMAT ARIMIDEX+ ALVESCO STIOLTO RESPIMAT* AROMASIN ANORO ELLIPTA STRIVERDI RESPIMAT Page 1 of 7 Drug Name Drug Name Drug Name Breast Cancer Prevention continued… ROSUVASTAIN ENSKYCE FARESTON QUESTRAN ERRIN FEMARA+ QUESTRAN LIGHT ESTARYLLA LETROZOLE ROSUVASTATIN ESTRADIOL-FOLIC ACID* SOLTAMOX* SIMVASTATIN ESTROSTEP FE TAMOXIFEN CITRATE TRICOR* FALESSA KIT* Chest Pain TRIGLIDE* FALMINA IMDUR TRILIPIX* FAYOSIM* ISORDIL VASCEPA FEMYNOR ISOSORBIDE DINITRATE VYTORIN* GENERESS FE* ISOSORBIDE MONONITRATE WELCHOL GIANVI MINITRAN ZETIA+ GILDAGIA NITROGLYCERIN ZOCOR HEATHER NITROGLYCERIN PATCH Constipation INTROVALE NITRO-DUR AMITIZA ISIBLOOM RANEXA LINZESS JENCYCLA Cholesterol/Lipid Lowering MOVANTIK JOLESSA ALTOPREV* RELISTOR TABLET* JOLIVETTE ANTARA* TRULANCE JULEBER ATORVASTATIN CALCIUM Contraceptive JUNEL 24 FE CHOLESTYRAMINE ALTAVERA JUNEL CHOLESTYRAMINE LIGHT ALYACEN JUNEL FE COLESTID AMETHIA KARIVA COLESTIPOL HCL AMETHIA LO KELNOR 1-35 CRESTOR+ APRI KIMIDESS EZETIMIBE ARANELLE KURVELO EZETIMIBE/SIMVASTATIN AVIANE LARISSIA FENOFIBRATE 43, 50, 67, 130, AZURETTE LEENA 134, 150, 200 MG CAPSULE* BALZIVA LESSINA FENOFIBRATE 40 MG, 45 MG, 120MG, BEKYREE LEVONEST 145 MG TABLET* BEYAZ* LEVONORGESTREL-ETHINYL ESTRADIOL FENOFIBRATE 54, 160 MG TABLET BLISOVI 24 FE LEVONORGESTREL-ETHINYL ESTRADIOL FENOFIBRIC ACID* BLISOVI FE 150-30 (84) FENOGLIDE BREVICON LEVORA-28 FLOLIPID BRIELLYN LILLOW FLUVASTATIN ER CAMILA LO LOESTRIN FE FLUVASTATIN SODIUM CAMRESE LO MEDIA 24 FE GEMFIBROZIL CAMRESE LO LOESTRIN LESCOL CAZIANT LOESTRIN FE LESCOL XL+ CHATEAL LORYNA LIPITOR+ CRYSELLE LOSEASONIQUE LIPOFEN* CYCLAFEM LOW-OGESTREL LIVALO CYCLESSA LUTERA LOPID CYRED MARLISSA LOVASTATIN DASETTA MIBELAS 24 FE* LOVAZA+ DAYSEE MICROGESTIN MEVACOR DESOGEN MICROGESTIN FE NIACOR DROSPIRENONE-ETHINYL ESTRADIOL-FOLIC MICRONOR NIASPAN ACID* MIRCETTE OMEGA-3-ACID ETHYL ESTERS DROSPIRENONE-ETHINYL ESTRADIOL MONO-LINYAH PRAVACHOL ELINEST MONONESSA PRAVASTATIN SODIUM EMOQUETTE MYZILRA PREVALITE ENPRESSE NATAZIA Page 2 of 7 Drug Name Drug Name Drug Name Contraceptive continued… VIENVA WELLBUTRIN SR+ NECON VIORELE WELLBUTRIN XL+ NORA-BE WERA ZOLOFT+ NORETHINDRONE WYMZYA FE Diabetes NORETHINDRONE-ETHINYL ESTRADIOL- XULANE ACARBOSE FERROUS FUMARATE YASMIN ACTOPLUS MET XR NORGESTIMATE-ETHINYL ESTADIOL YAZ ACTOS+ NORGESTIMATE ETHINYL ESTRADIOL LO ZARAH ADLYXIN NORGESTREL-ETHINY ESTRADIOL ZENCHENT AFREZZA* NORINYL ZENCHENT FE ALOGLIPTIN* NORLYDA ZEOSA ALOGLIPTIN-METFORMIN* NORTREL ZOVIA 1-35E ALOGLIPTIN-PIOGLITAZONE* NUVARING ZOVIA 1-50E AMARYL OCELLA Depression APIDRA OGESTREL APLENZIN* APIDRA SOLOSTAR ORSYTHIA BUDEPRION BASAGLAR ORTHO TRI-CYCLEN BUDEPRION XL BYDUREON + ORTHO TRI-CYCLEN LO BUPROPION BYETTA ORTHO-CEPT CELEXA+ CYCLOSET ORTHO-CYCLEN CITALOPRAM DIABETA ORTHO-NOVUM CYMBALTA+ DUETACT OVCON-35 DESVENLAFAXINE (GENERIC PRISTIQ) FARXIGA PHILITH DULOXETINE FORTAMET* PORTIA EFFEXOR GLIMEPIRIDE PREVIFEM EFFEXOR XR+ GLIPIZIDE QUARTETTE* ESCITALOPRAM GLIPIZIDE ER QUASENSE FETZIMA GLIPIZIDE-METFORMIN RANJANI* FLUVOXAMINE GLUCOPHAGE RECLIPSEN FORFIVO XL* GLUCOPHAGE XR RIVELSA* KHEDEZLA* GLUCOTROL SAFYRAL* LEXAPRO+ GLUCOTROL XL SEASONIQUE LUVOX CR GLUCOVANCE SETLAKIN MAPROTILINE GLUMETZA* SPRINTEC MIRTAZAPINE GLYBURIDE SRONYX NEFAZODONE GLYBURIDE MICRONIZED SYEDA OLEPTRO* GLYBURIDE-METFORMIN TAYTULLA* PAROXETINE GLYNASE TILIA FE PAROXETINE ER GLYSET TRI-ESTARYLLA PAXIL GLYXAMBI* TRI-FEMYNOR PAXIL CR HUMALOG TRI-LEGEST FE PEXEVA HUMALOG MIX 50-50 TRI-LINYAH PRISTIQ HUMALOG MIX 75-25 TRINESSA PROZAC+ HUMULIN 70-30 TRI-LO-ESTARYLLA REMERON HUMULIN N TRI-LO-MARZIA REMERON SOLUTAB HUMULIN R TRI-LO SPRINTEC SERTRALINE INVOKAMET TRI-NORINYL TRAZODONE INVOKAMET XR TRI-PREVIFEM TRINTELLIX* INVOKANA TRI-SPRINTEC VENLAFAXINE JANUMET TRINESSA LO VENLAFAXINE ER CAPSULE JANUMET XR TRIVORA-28 VIIBRYD JANUVIA VELIVET WELLBUTRIN+ JARDIANCE VESTURA Page 3 of 7 Drug Name Drug Name Drug Name Diabetes continued… TAPAZOLE Heart Failure JENTADUETO Fibromyalgia CORLANOR JENTADUETO XR* SAVELLA ENTRESTO KAZANO Glaucoma Heart Rhythm KOMBIGLYZE XR ALPHAGAN P AMIODARONE HCL LANTUS* APRACLONIDINE HCL BETAPACE+ LANTUS SOLOSTAR* AZOPT BETAPACE AF LEVEMIR BETAGAN CORDARONE LEVEMIR FLEXPEN BETAXOLOL HCL 0.5% DIGOXIN METFORMIN HCL BETIMOL DISOPYRAMIDE PHOSPHATE METFORMIN HCL ER BETOPTIC S 0.25 % DOFETILIDE METFORMIN SR MODIFIED-RELEASE* BIMATOPROST 0.03%* FLECAINIDE ACETATE MIGLITOL BRIMONIDINE TARTRATE OPHTHALMIC LANOXIN NATEGLINIDE SOLUTION MEXILETINE HCL NESINA CARTEOLOL HCL 1% MULTAQ NOVOLOG COMBIGAN 0.2%-0.5% NORPACE NOVOLOG FLEXPEN COSOPT 2%-0.5% NORPACE CR NOVOLOG MIX 70-30 COSOPT PF 2%-0.5%* PACERONE NOVOLOG MIX 70-30 FLEXPEN DORZOLAMIDE HCL 2 % PROPAFENONE HCL ONGLYZA DORZOLAMIDE-TIMOLOL 2%-0.5% QUINIDINE GLUCONATE OSENI IOPIDINE QUINIDINE SULFATE PIOGLITAZONE HCL ISOPTO CARBACHOL OPHTHALMIC RYTHMOL PIOGLITAZONE-GLIMEPIRIDE ISOPTO CARPINE RYTHMOL SR PIOGLITAZONE-METFORMIN LATANOPROST SOTALOL AF PRANDIMET LEVOBUNOLOL HCL OPHTHALMIC SOLUTION TAMBOCOR PRANDIN LUMIGAN 0.01% TIKOSYN PRECOSE METIPRANOLOL 0.3% High Blood Pressure REPAGLINIDE-METFORMIN MIOSTAT 0.01% ACCUPRIL RIOMET PHOSPHOLINE IODIDE ACCURETIC SOLIQUA PILOCARPINE HCL ACEBUTOLOL HCL STARLIX PILOPINE HS ACEON SYNJARDY SIMBRINZA* ADALAT CC SYNJARDY XR TIMOLOL MALEATE OPHTHALMIC SOLUTION ALDACTAZIDE TANZEUM TIMOPTIC ALDACTONE TOUJEO* TIMOPTIC OCUDOSE ALTACE TRADJENTA TIMOPTIC-XE AMILORIDE HCL TRESIBA* TRAVATAN Z AMILORIDE-HYDROCHLOROTHIAZIDE TRULICITY TRAVOPROST AMLODIPINE BESYLATE VICTOZA TRUSOPT 2% AMLODIPINE BESYLATE-BENAZAPRIL XIGDUO XR* XALATAN AMLODIPINE BESYLATE-VALARTAN XULTOPHY* ZIOPTAN AMLODIPINE BESYLATE-VALARTAN- Diabetic Supplies Gout HYDROCHLOROTHIAZIDE* INSULIN SYRINGE ALLOPURINOL AMLODIPINE-OLMESARTAN* LANCETS COLCHICINE CAPSULE* AMLODIPINE-OLMESARTAN- HYDROCHLOROHTHIZIE* PEN NEEDLE COLCHICINE TABLET* AMTURNIDE* TEST STRIPS COLCRYS* ATACAND Diarrhea DUZALLO* ATACAND HCT ALOSETRON MITIGARE ATENOLOL LOTRONEX PROBENECID ATENOLOL-CHLORTHALIDONE VIBERZI PROBENECID-COLCHICINE AVALIDE Elevated Thyroid Hormone ULORIC AVAPRO METHIMAZOLE ZURAMPIC AZOR* PROPYLTHIOURACIL ZYLOPRIM Page 4 of 7 Drug Name Drug Name Drug Name High Blood Pressure continued… EDARBI MINIPRESS BENAZEPRIL HCL EDARBYCLOR MINOXIDIL BENAZEPRIL-HYDROCHLOROTHIAZIDE EDECRIN MOEXIPRIL HCL BENICAR+ ENALAPRIL MALEATE MOEXIPRIL-HYDROCHLOROTHIAZIDE BENICAR HCT+ ENALAPRIL-HYDROCHLOROTHIAZIDE NADOLOL BETAXOLOL HCL EPLERENONE NADOLOL-BENDROFLUMETHIAZIDE BISOPROLOL FUMARATE EPROSARTAN NEPTAZANE BISOPROLOL-HYDROCHLOROTHIAZIDE ETHACRYNIC ACID NICARDIPINE HCL BUMETANIDE EXFORGE+ NIFEDIPINE BYVALSON* EXFORGE HCT* NIFEDIPINE ER CALAN FELODIPINE ER NIMODIPINE CALAN SR FOSINOPRIL SODIUM NISOLDIPINE CANDESARTAN CILEXETIL FOSINOPRIL-HYDROCHLOROTHIAZIDE NORVASC CANDESARTAN-HYDROCHLOROTHIZIDE FUROSEMIDE OLMESARTAN CAPTOPRIL GUANFACINE HCL OLMESARTAN-HYDROCHLOROTHIAZIDE CAPTOPRIL-HYDROCHLOROTHIAZIDE HYDRALAZINE HCL PERINDOPRIL ERBUMINE CARDENE SR HYDROCHLOROTHIAZIDE PINDOLOL CARDIZEM+ HYZAAR PRAZOSIN HCL CARDIZEM CD+ INDAPAMIDE PRINIVIL CARDIZEM LA+ INDERAL LA* PROCARDIA CARDURA INNOPRAN XL PROCARDIA XL CARTIA XT INSPRA PROPRANOLOL HCL CARVEDILOL IRBESARTAN PROPRANOLOL-HYDROCHLOROTHIAZIDE CATAPRES IRBESARTAN-HYDROCHLOROTHIAZIDE QBRELIS* CATAPRES -TTS ISRADIPINE QUINAPRIL HCL CHLOROTHIAZIDE KERLONE QUINAPRIL-HYDROCHLOROTHIAZIDE CHLORTHALIDONE LABETALOL HCL RAMIPRIL CLONIDINE PATCH LASIX RESERPINE CLONIDINE HCL LEVATOL SECTRAL CLORPRES LISINOPRIL SOTALOL COREG LISINOPRIL-HYDROCHLOROTHIAZIDE SPIRONOLACTONE COREG CR* LOPRESSOR SPIRONOLACTONE-HCTZ CORGARD LOPRESSOR HCT SULAR CORZIDE LOSARTAN POTASSIUM
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