Preventive medications list

In addition to a healthy lifestyle, preventive medications can help people avoid many illnesses and conditions. A consumer-directed health (CDH) plan that includes preventive medications can help support the goal of ongoing good health. This list provides examples of your plan’s preventive medications. The medications are categorized based on the medical conditions that they are used to prevent. This is not an all-inclusive list; only examples of medicines in each category are listed. Coverage prior to the deductible being met may not be provided for every dosage form of a listed medication. Please check with your plan administrator if you have questions. This list is periodically reviewed by clinical experts. Medications may be added to or removed from the list based on different factors, including the intended purpose of the medication and its availability. Medications on this list that are not covered under your plan are not eligible for the preventive medication program.

This list includes medications sometimes used for prevention and sometimes for treatment. ANEMIA IN CHILDREN FORADIL SPIRIVA FERROUS SULFATE LIQUID DROPS FOR FORMOTEROL FUMARATE TIOTROPIUM BROMIDE INFANTS (SUCH AS FER-IN-SOL) BRONCOMAR-1 ACCOLATE GUAIFEN/THEOP ANHYD/P-EPHED ZAFIRLUKAST ASTHMA DIFIL-G, DIFIL-G FORTE, DILEX-G, ZYFLO CR ACETYLCYSTEINE DYPHYLLINE-GG ZILEUTON AMINOPHYLLINE GUAIFENESIN/DYPHYLLINE BONE DISEASE AND FRACTURES BUMETADINE ARCAPTA NEOHALER METAPROTERENOL SULFATE INDACATEROL MALEATE FOSAMAX, FOSAMAX PLUS D TERBUTALINE SULFATE ATROVENT HFA ALENDRONATE ACCUNEB, PROAIR HFA, PROVENTIL IPRATROPIUM BROMIDE FORTICAL, MIACALCIN HFA, VENTOLIN HFA, VOSPIRE ER COMBIVENT, DUONEB CALCITONIN ALBUTEROL SULFATE IPRATROPIUM/ALBUTEROL SULFATE XGEVA BROVANA XOPENEX DENOSUMAB ARFORMOTEROL TARTRATE LEVALBUTEROL HCL BONIVA QVAR XOPENEX HFA IBANDRONATE BECLOMETHASONE DIPROPIONATE LEVALBUTEROL TARTRATE EVISTA PULMICORT, PULMICORT FLEXHALER ASMANEX RALOXIFENE BUDESONIDE MOMETASONE FUROATE ACTONEL SYMBICORT DULERA RISEDRONATE BUDESONIDE/FORMOTEROL FUMARATE MOMETASONE/FORMOTEROL FORTEO ALVESCO SINGULAIR TERIPARATIDE CICLESONIDE MONTELUKAST SKELID INTAL, NASALCROM XOLAIR TILUDRONATE DISODIUM CROMOLYN SODIUM OMALIZUMAB RECLAST DYLIX, LUFYLLIN MAXAIR AUTOHALER ZOLEDRONIC ACID DYPHYLLINE PIRBUTEROL ACETATE CAVITIES FLOVENT DISKUS, FLOVENT HFA SEREVENT DISKUS FLUTICASONE PROPIONATE SALMETEROL XINAFOATE PREVIDENT ADVAIR DISKUS, ADVAIR HFA ELIXOPHYLLIN, THEO-24, SODIUM FLUORIDE FLUTICASONE/SALMETEROL THEOCHRON THEOPHYLLINE ANHYDROUS

ML6779B continued on reverse side Preventive Medications List

DIABETES, COMPLICATIONS OF FRAGMIN HIGH BLOOD PRESSURE MEDICINES DALTEPARIN INSULINS: LOVENOX ACE INHIBITORS AND NOVOLOG, NOVOLOG 70/30 ENOXAPARIN COMBINATIONS: ARIXTRA ASPART, ASPART PROTAMINE MIX LOTENSIN, LOTENSIN HCT LEVEMIR FONDAPARINUX EFFIENT BENAZEPRIL DETEMIR VASOTEC, VASERETIC LANTUS, LANTUS SOLOSTAR PRASUGREL XARELTO ENALAPRIL GLARGINE MONOPRIL, MONOPRIL HCT RIVAROXABAN APIDRA, APIDRA SOLOSTAR BRILINTA FOSINOPRIL GLULISINE PRINIVIL, PRINZIDE, ZESTRIL, HUMULIN, NOVOLIN TICAGRELOR COUMADIN, JANTOVEN ZESTORETIC INSULIN LISINOPRIL HUMALOG, 50/50, 75/25 WARFARIN ACCUPRIL, ACCURETIC LISPRO, LISPRO PROTAMINE MIX CHOLESTEROL LOWERING QUINAPRIL NON-INSULIN MEDICINES: MEDICINES ACE RECEPTOR BLOCKERS AND BYETTA HMG-COA REDUCTASE INHIBITORS: COMBINATIONS: EXENATIDE EDARBI AMARYL LIPITOR ATORVASTATIN AZILSARTAN GLIMEPIRIDE ATACAND, ATACAND HCT GLUCOTROL, METAGLIP MEVACOR, ALTOPREV LOVASTATIN CANDESARTAN GLIPIZIDE AND COMBINATIONS TEVETEN, TEVETEN HCT DIABETA, GLYNASE, GLUCOVANCE PRAVACHOL PRAVASTATIN EPROSARTAN GLYBURIDE AND COMBINATIONS AVAPRO, AVALIDE TRADJENTA CRESTOR ROSUVASTATIN IRBESARTAN LINAGLIPTIN COZAAR, HYZAAR VICTOZA ZOCOR SIMVASTATIN LOSARTAN LIRAGLUTIDE BENICAR, BENICAR HCT FORTAMET, GLUCOPHAGE, GLUMETZA OTHER AGENTS: OLMESARTAN METFORMIN MICARDIS, MICARDIS HCT STARLIX PREVALITE, QUESTRAN CHOLESTYRAMINE TELMISARTAN NATEGLINIDE DIOVAN, DIOVAN HCT ACTOS, DUETACT, ACTOPLUS MET WELCHOL COLESEVELAM VALSARTAN PIOGLITAZONE AND COMBINATIONS SYMLIN COLESTID BETA BLOCKERS AND COLESTIPOL PRAMLINTIDE COMBINATIONS: PRANDIN ZETIA EZETIMIBE TENORMIN, TENORETIC REPAGLINIDE AVANDIA, AVANDAMET, AVANDARYL VYTORIN ATENOLOL EZETIMIBE/SIMVASTATIN ZEBETA, ZIAC ROSIGLITAZONE AND COMBINATIONS ONGLYZA, KOMBIGLYZE XR FENOGLIDE, LIPOFEN, TRICOR, BISOPROLOL LOPRESSOR, TOPROL XL SAXAGLIPTIN AND COMBINATIONS ANTARA, TRIGLIDE JANUVIA, JANUMET FENOFIBRATE METOPROLOL BYSTOLIC SITAGLIPTIN AND COMBINATIONS TRILIPIX FENOFIBRIC ACID NEBIVOLOL HEART DISEASE AND STROKE LOPID INDERAL LA, INNOPRAN XL PROPRANOLOL BLOOD THINNER MEDICINES: GEMFIBROZIL NIACOR, NIASPAN ER BETAPACE, BETAPACE AF, SORINE ASPIRIN, 81 MG OR 325 MG NIACIN ` SOTALOL HCL HEPARIN ADVICOR CALCIUM CHANNEL BLOCKERS: AGGRENOX NIACIN/LOVASTATIN ASA/DIPYRIDAMOLE SIMCOR NORVASC PLATEL NIACIN ER/SIMVASTATIN AMLODIPINE CILOSTAZOL LOVAZA CARDIZEM, CARDIZEM LA, CARTIA XT, PLAVIX OMEGA-3-ACID ETHYL ESTERS TIAZAC ER CLOPIDOGREL DILTIAZEM Preventive Medications List

ADALAT CC, PROCARDIA HIGH BLOOD PRESSURE MEDICINES SMOKING-CESSATION THERAPY NIFEDIPINE MISCELLANEOUS: ZYBAN NIMOTOP HYDRALAZINE BUPROPION NIMODIPINE MINOXIDIL NICOTROL SULAR TEKTURNA, TEKTURNA HCT, NICOTINE PRODUCTS NISOLDIPINE CHANTIX CALAN, COVERA HS, ISOPTIN SR, TEKAMLO, AMTURNIDE, VALTURNA ALISKIREN AND COMBINATIONS VARENICLINE VERELAN LOTREL VERAPAMIL AMLODIPINE/BENAZEPRIL VITAMINS OR MINERALS, DIURETICS AND COMBINATIONS: AZOR LOW LEVELS OF AMLODIPINE/OLMESARTAN FOLIC ACID, 0.4 TO 0.8 MG ACETAZOLAMIDE SODIUM HYDROCHLOROTHIAZIDE TRIBENZOR MULTIVITAMIN PRODUCTS AMLODIPINE/OLMESARTAN/ INDAPAMIDE PRESCRIPTION PRENATAL VITAMINS HYDROCHLOROTHIAZIDE DIAMOX SEQUELS TWYNSTA ACETAZOLAMIDE AMLODIPINE/TELMISARTAN MIDAMOR EXFORGE AMILORIDE AMLODIPINE/VALSARTAN EDECRIN SODIUM EXFORGE HCT ETHACRYNATE SODIUM AMLODIPINE/VALSARTAN/ EDECRIN HYDROCHLOROTHIAZIDE ETHACRYNIC ACID COREG, COREG CR LASIX CARVEDILOL FUROSEMIDE CATAPRES, CLORPRES NEPTAZANE CLONIDINE METHAZOLAMIDE CARDURA ZAROXOLYN DOXAZOSIN METOLAZONE TRANDATE ALDACTONE LABETALOL HCL SPIRONOLACTONE DEMSER DEMADEX METYROSINE TORSEMIDE DIBENZYLINE DYAZIDE, MAXZIDE PHENOXYBENZAMINE HCL TRIAMTERENE-HCTZ HYTRIN TERAZOSIN

ML6779B LIST 1+2+3 - DIABETES 1.17