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Mclennan County 2017-2018 Chronic and Preventive Medication List TIER ONE TIER TWO Preferred Generic Medications Preferred Brand-Name Medications

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Mclennan County 2017-2018 Chronic and Preventive Medication List TIER ONE TIER TWO Preferred Generic Medications Preferred Brand-Name Medications The medications listed below are used to prevent chronic conditions and illnesses and are not subject to your HDHP deductible. You will only be responsible for the tiered cost-share. McLennan County 2017-2018 Chronic and Preventive Medication List TIER ONE TIER TWO Preferred generic medications Preferred brand-name medications Blood Thinning Agents (anticoagulants & antiplatelets) Anagrelide Dipyridamole BRILINTA® XARELTO® Aspirin/Dipyridamole Jantoven COUMADIN® XARELTO® STARTER PACK Cilostazol Ticlopidine ELIQUIS® Clopidogrel Prasugrel Diabetes (insulins) Warfarin HUMALOG® LANTUS® SOLOSTAR HUMALOG® KWIKPEN LEVEMIR® HUMALOG® JUNIOR KWIKPEN LEVEMIR® FLEXTOUCH HUMALOG® MIX 50/50 NOVOLIN® 70/30 HUMALOG® MIX 50/50 KWIKPEN NOVOLIN® N HUMALOG® MIX 75/25 NOVOLIN® R HUMALOG® MIX 75/25 KWIKPEN NOVOLOG® HUMULIN® 70/30 NOVOLOG® FLEXPEN HUMULIN® 70/30 PEN NOVOLOG® MIX 70/30 HUMULIN® N NOVOLOG® MIX 70/30 HUMULIN® N U-100 PEN PREFILLED FLEXPEN HUMULIN® R NOVOLOG® PENFILL HUMULIN® R U-500 TOUJEO® SOLOSTAR HUMULIN® R U-500 KWIKPEN TRESIBA® FLEXTOUCH LANTUS® , Diabetes (oral agents) tr Acarbose Glyburide/Metformin JANUMET® Chlorpropamide Glyburide Micronized JANUMET® XR Glimepiride Metformin JANUVIA® Glipizide Metformin ER JENTADUETO® Glipizide/Metformin pioglitazone TRADJENTA® Glipizide XL Tolazamide Glyburide Tolbutamide Heart Disease (antianginal agents) Digox Isosorbide Mononitrate ER DILATRATE® SR Digoxin Nitro-bid LANOXIN® Isosorbide Dinitrate Nitroglycerin ER NITRO-DUR® Isosorbide Dinitrate ER Nitroglycerin Lingual Spray Isosorbide Mononitrate Nitroglycerin Transdermal Heart Disease, Hypertension (calcium channel blockers) Amlodipine Nifedipine Diltiazem CD Nifedipine ER Diltiazem Nimodipine Diltiazem ER Verapamil Diltzac Verapamil ER Nifediac CC Verapamil SR This list is subject to change and does not guarantee coverage. Page | 1 The medications listed below are used to prevent chronic conditions and illnesses and are not subject to your HDHP deductible. You will only be responsible for the tiered cost-share. McLennan County 2017-2018 Chronic and Preventive Medication List TIER ONE TIER TWO Preferred generic medications Preferred brand-name medications High Cholesterol (HMG CoA reductase inhibitors) Atorvastatin Pravastatin Lovastatin Rosuvastatin Simvastatin High Cholesterol (other antihyperlipidemics) Cholestyramine Fenofibrate Micronized COLESTID® FLAVORED GRANULES Cholestyramine Light Fenofibric Acid DR Colestipol Gemfibrozil Colestipol granules Niacin ER Prevalite Fenofibrate Hypertension (ACE inhibitors) Benazepril Lisinopril Captopril Quinapril Enalapril Ramipril Fosinopril Hypertension (angiotensin II receptor antagonists) Candesartan Losartan Irbesartan Valsartan Hypertension (beta-blockers) Acebutolol Metoprolol Tartrate Atenolol Nadolol Betaxolol Pindolol Bisoprolol Propranolol Carvedilol Propranolol ER Labetalol Sotalol Metoprolol Succinate ER Timolol Hypertension (combination agents) Amlodipine/Benazepril Irbesartan/HCTZ Atenolol/Chlorthalidone Lisinopril/HCTZ Benazepril/HCTZ Losartan/HCTZ Bisoprolol/HCTZ Metoprolol/HCTZ Candesartan/HCTZ Nadolol/Bendroflumethiazide Captopril/ HCTZ Propranolol/HCTZ Enalapril/HCTZ Quinapril/HCTZ Fosinopril/HCTZ Valsartan/HCTZ This list is subject to change and does not guarantee coverage. Page | 2 The medications listed below are used to prevent chronic conditions and illnesses and are not subject to your HDHP deductible. You will only be responsible for the tiered cost-share. McLennan County 2017-2018 Chronic and Preventive Medication List TIER ONE TIER TWO Preferred generic medications Preferred brand-name medications Hypertension (diurectics) Amiloride Indapamide ALDACTAZIDE® Amiloride/HCTZ Methyclothiazide DIURIL® Bumetanide Metolazone Chlorothiazide Spironolactone Chlorthalidone Spironolactone/HCTZ Furosemide Torsemide Hydrochlorothiazide Triamterene/HCTZ Hypertension (miscellaneous agents) Clonidine Methyldopa Clorpres Methyldopa/HCTZ Guanfacine Minoxidil Hydralazine Reserpine Osteoporosis Alendronate Ibandronate Calcitonin-Salmon Risedronate Etidronate Respiratory (antiasthmatics) Albuterol Theophylline CR ADVAIR® DISKUS FORADIL® AEROLIZER Albuterol ER Theophylline ER ADVAIR® HFA PROAIR® HFA Budesonide Ventolin HFA ARCAPTA™ NEOHALER PROAIR® RESPICLICK Cromolyn Sodium ASMANEX® HFA PULMICORT FLEXHALER™ Ipratropium Bromide ASMANEX® TWISTHALER QVAR® Ipratropium Bromide/Albuterol ATROVENT® HFA SEREVENT® DISKUS Metaproterenol COMBIVENT® RESPIMAT SPIRIVA® HANDIHALER Montelukast ELIXOPHYLLIN® SPIRIVA® RESPIMAT Terbutaline FLOVENT® DISKUS THEO-24® Theophylline FLOVENT® HFA Fluticasone/Salmeterol inhaler (generic AirDuo™ Respiclick) Diabetic Supplies Accu-Chek® control solution CONTROL SOLUTION (ALL OTHER BRANDS) Accu-Chek® lancets LANCETS (ALL OTHER BRANDS) Accu-Chek® test strips TEST STRIPS (ALL OTHER BRANDS) Insulin syringes Pen needles Asthma Supplies PEAK FLOW METERS SPACERS AND MASKS This list is subject to change and does not guarantee coverage. Page | 3 .
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