CVS CAREMARK MAINTENANCE DRUG LIST –RXCLAIM/RECAP AS OF 07/01/2009
Provided below is a reference of the CVS Caremark proprietary list of standard maintenance drugs. Our Maintenance Drug List (MDL) includes medicines commonly used to treat chronic disease states with no therapeutic endpoint. In other words, therapy with these drugs is not considered curative. Maintenance drug categories include but are not limited to Proton Pump Inhibitors, Non-Sedating Antihistamines, Contraceptives, Antidepressants and Diabetic Supplies.
The baseline MDL includes Maintenance Drugs as indicated by Medi-Span®. RECAP clients do not utilize the Medi-Span indicator, however this list represents a close approximation of the maintenance medications used on that platform. The extended MDL accommodate CVS Caremark Business rules and federal laws. This list is used as a reference for all applicable CVS Caremark Clinical programs. To make sure the list is up to date, it is reviewed and updated daily (by an external source) as well as quarterly (by CVS Caremark Clinical staff). Below is an example of drugs which may appear on the list. Where a generic is available, it is listed by the generic name. If no generic is available, then the brand name appears.
BASE LINE
ABACAVIR AMANTADINE AURANOFIN ACAMPROSATE AMARYL AVALIDE ACARBOSE AMILORIDE AVANDAMET ACCOLATE AMINOPHYLLINE AVANDARYL ACCUPRIL AMIODARONE AVANDIA ACCURETIC AMITIZA AVAPRO ACEBUTOLOL AMLODIPINE/BENAZEPRIL AVODART ACEON AMLODIPINE AYGESTIN ACETAZOLAMIDE AMPRENAVIR AZASAN ACTIVELLA AMYLASE-LIPASE AZATHIOPRINE ACTONEL ANAGRELIDE AZILECT ACTOPLUS MET ANAKINRA AZMACORT ACTOS ANAPROX AZOR ADALAT CC ANDROID AZULFIDINE ADALIMUMAB ANDROXY BACLOFEN ADEFOVIR DIPIVOXIL ANSAID BENAZEPRIL ADVAIR ANTARA BENICAR ADVICOR APIDRA BENZTROPINE AEROBID ARAVA MESYLATE AFEDITAB ARCALYST BETAPACE AGGRENOX ARICEPT BETAXOLOL AGRYLIN ARIMIDEX BIDIL ALBUTEROL ARMOUR THYROID BIMATOPROST ALDACTAZIDE AROMASIN BISOPROLOL ALDACTONE ARTHROTEC BONIVA ALENDRONATE ASMANEX BRETHINE ALLOPURINOL ATACAND BRIMONIDINE TARTRATE ALORA ATAMET BRINZOLAMIDE ALTACE ATAZANAVIR BROMOCRIPTINE ALTOPREV ATENOLOL BROVANA ALVESCO ATROPINE SULFATE BUMETANIDE – 1 – 106-15818b 0609 This drug list represents a summary of prescription coverage. It is not inclusive and does not guarantee coverage. Specific prescription benefit plan design may not cover certain categories, regardless of their appearance on this list. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers that are not affiliated with CVS Caremark. BUMEX COVERA ELDEPRYL BUPROPION CREON EMTRICITABINE BYETTA CRESTOR ENABLEX BYSTOLIC CROMOLYN ENALAPRIL CADUET CYANOCOBALAMIN ENFUVIRTIDE CALAN CYCLOSPORINE ENJUVIA CALCITRIOL CYTOMEL ENTECAVIR CAPOTEN DAPSONE EPINEPHRINE CAPTOPRIL DARUNAVIR EPITOL CARBODOPA/LEVODOPA DAYPRO EPLERENONE CARBACHOL OPHTH DDAVP ERGOCALCIFEROL CARBAMAZEPINE DELAVIRDINE MESYLATE ERGOLOID MESYLATES CARBATROL DEMADEX ESCITALOPRAM CARDENE DEMECARIUM BROMIDE ESOMEPRAZOLE CARDIZEM DEPAKENE ESSIAN CARDURA DEPAKOTE ESTERIFIED ESTROGEN CARTEOLOL DESMOPRESSIN ESTRACE CARTIA DESOGESTREL ESTRADERM CARTROL DESVENLAFAXINE ESTRADIOL CARVEDILOL DETROL ESTRATEST CATAFLAM DIABETA ESTRIOL CATAPRES DIABINESE ESTROPIPATE CELEBREX DIAMOX ETANERCEPT CELLCEPT DIAMOX SEQUELS ETHINYL ESTRADIOL CENESTIN DIAZOXIDE ETHOSUXIMIDE CEVIMELINE DICLOFENAC ETHYNODIOL DIACETATE CHLORDIAZEPOXIDE DIDANOSINE ETONOGESTREL CHLORMADINONE DIFLUNISAL ETORICOXIB CHLOROQUINE DIGOXIN ETRAVIRINE PHOSPHATE DILACOR EVAMIST CHLOROTHIAZIDE DILANTIN EVISTA CHLORTHALID DILATRATE EXELON CHOLESTYRAMINE DILTIAZEM EXFORGE CILOSTAZOL DIOVAN FAMOTIDINE CIMETIDINE DIPENTUM FARESTON CISAPRIDE DIPIVEFRIN FELBATOL CITALOPRAM DISOPYRAMIDE FELDENE CLENBUTEROL DISULFIRAM FELODIPINE CLIMARA DITROPAN FEMARA CLINORIL DIVALPROEX FEMHRT CLODRONATE DISODIUM DORNASE FEMTRACE CLONAZEPAM DORZOLAMIDE FENOFIBRATE CLONIDINE DOXAZOSIN FENOGLIDE CLORPRES DROSPIRENONE FENOPROFEN COGNEX DUETACT FENOTEROL COLESTID DULOXETINE FINASTERIDE COLESTIPOL DYAZIDE FLAVOXATE COMBIPATCH DYGASE FLECAINIDE COMTAN DYNACIRC FLOMAX CORDARONE DYRENIUM FLOVENT COREG EC-NAPROSYN FLUDROCORTISONE CORGARD EDECRIN FLUOXETINE CORZIDE EFAVIRENZ FLURBIPROFEN COVARYX EFFER-K FLUVOXAMINE MALEATE – 2 – 106-15818b 0609 This drug list represents a summary of prescription coverage. It is not inclusive and does not guarantee coverage. Specific prescription benefit plan design may not cover certain categories, regardless of their appearance on this list. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers that are not affiliated with CVS Caremark. FOLIC ACID ISOCHRON LOVAZA FORADIL ISONIAZID LUFYLLIN FORTAMET ISOPTIN LYRICA FORTICAL ISORDIL MAGNESIUM FOSAMAX ISOSORB MAPROTILINE FOSAMPRENAVIR ISOSORBIDE DINITRATE MAVIK FOSINOPRIL ISOXSUPRINE MAXZIDE FOSRENOL ISRADIPINE MEBARAL FUROSEMIDE JANUMET MECLOFEN SOD GABAPENTIN JANUVIA MEDROXYPROGESTERONE GABARONE K-DUR MEGESTROL ACETATE GABITRIL KEPPRA MELOXICAM GALANTAMINE KERLONE MEMANTINE GANCICLOVIR KETOPROFEN MENEST GEMFIBROZIL KLONOPIN MENOSTAR GLATIRAMER ACETATE K-LOR MESALAMINE GLIMEPIRIDE KLOR-CON METAGLIP GLIPIZIDE/METFORMIN K-TABS METAPROTERENOL GLIPIZIDE KUVAN METFORMIN GLUCOPHAGE LABETALOL METHAZOLAMIDE GLUCOTROL LACTULOSE METHIMAZOLE GLUCOVANCE LAMICTAL METHITEST GLUMETZA LAMIVUDINE METHOTREXATE GLYBURIDE/METFORMIN LAMOTRIGINE METHYCLOTHIA GLYBURIDE LANOXIN METHYLDOPA GLYCRON LANSOPRAZOLE METIPRANOLOL GLYNASE LANTUS METOCLOPRAMIDE GLYSET LAPASE METOLAZONE GUANABENZ LASIX METOPROLOL GUANFACINE LATANOPROST MEVACOR HECTOROL LEFLUNOMIDE MEXILETINE HOMATROPINE LESCOL MIACALCIN HUMALOG LETAIRIS MICARDIS HUMULIN LEVALBUTEROL MICRO-K HYDRALAZINE LEVATOL MICRONASE HYDROCHLOROTHIAZIDE LEVEMIR MICROZIDE HYOSCYAMINE SULFATE LEVOBETAXOLOL MIDOL HYTRIN LEVOBUNOLOL MINIPRESS HYZAAR LEVOCARNITINE MINITRAN IBUPROFEN LEVOTHYROXINE MINOXIDIL ILOPROST LEVOXYL MIRAPEX IMDUR LIPITOR MIRTAZAPINE IMURAN LIPRAM MISOPROSTOL INCRELEX LISINOPRIL MOBIC INDAPAMIDE LITHIUM MOCLOBEMIDE INDERAL LA LODINE MOEXIPRIL INDINAVIR SULFATE LOFIBRA MONOKET INDOMETHACIN LOPID MONOPRIL INNOPRAN LOPINAVIR MYCOPHENOLATE INSPRA LOPRESSOR MOFETIL INTERFERON LOTENSIN MYFORTIC IPRATROPIUM LOTREL NABUMETONE ISMO LOTRONEX NADOLOL ISOCARBOXAZID LOVASTATIN NALFON – 3 – 106-15818b 0609 This drug list represents a summary of prescription coverage. It is not inclusive and does not guarantee coverage. Specific prescription benefit plan design may not cover certain categories, regardless of their appearance on this list. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers that are not affiliated with CVS Caremark. NAMENDA PAPAVERINE QUINARETIC NAPRELAN PARCOPA QUINIDINE NAPROXEN PARLODEL QVAR NATURE-THROID PAROXETINE RABEPRAZOLE SODIUM NEFAZODONE PENTOXIFYLLINE RALTEGRAVIR NELFINAVIR MESYLATE PENTOXIL RAMIPRIL NEORAL PERFOROMIST RANEXA NEURONTIN PERSANTINE RANITIDINE NEVIRAPINE PHENELZINE SULFATE RAPAMUNE NIACIN PHENOBARB RAUWOLFIA NIASPAN PHENOBARBITAL RAZADYNE NICARDIPINE PHENYTEK REBOXETINE MESYLATE NIFEDIAC PHENYTOIN RENAGEL NIFEDICAL PHOSLO REQUIP NIFEDIPINE PHYSOSTIGMINE RESERPINE NIMODIPINE PILOCARPINE REVATIO NIMOTOP PINDOLOL RILUTEK NISOLDIPINE PIROXICAM RITONAVIR NITISINONE PLARETASE RIVASTIGMINE NITRO-BID PLAVIX ROPINIROLE NITRO-DUR PLENDIL ROZEREM NITROGLYCERIN PLETAL RYTHMOL NIZATIDINE PONSTEL SACROSIDASE NORETHINDRONE POTASSIUM SALSALATE NORETHYNODREL PRANDIN SANCTURA NORGESTIMATE PRAVASTATIN SANDIMMUNE NORGESTREL PRAZOSIN SAQUINAVIR NORPACE PRECOSE SECTRAL NORTHYX PREFEST SELEGILINE NORVASC PREMARIN SENSIPAR NOVOLIN PREMPHASE SEREVENT NOVOLOG PREMPRO SERTRALINE NOXAFIL PREVACID SIMCOR OCTREOTIDE ACETATE PREVALITE SIMVASTATIN OGEN PRIMIDONE SINEMET OLSALAZINE PRINIVIL SINGULAIR OMEPRAZOLE PRINZIDE SIROLIMUS ORENCIA PROBENECID SLO-PHYLLIN ORTHO-EST PROCAINAMIDE SOLTAMOX ORUDIS PROCANBID SOMATROPIN OTILONIUM BROMIDE PROCARDIA SORINE OXAPROZIN PROCYCLIDINE SOTALOL OXCARBAZEPINE PROGRAF SPIRIVA OXTRIPHYLLINE PRONESTYL SPIRONOLACTONE OXYBUTYNIN PROPAFENONE STALEVO OXYTROL PROPRANOLOL STARLIX PACERONE PROPYLTHIOUR STAVUDINE PANCREASE PROSCAR STAVZOR PANCRECARB PROVERA STRATTERA PANCRELIPASE PROVIGIL SUCRALFATE PANCRON PROVIL SULAR PANGES PULMICORT SULFASALAZINE PANGESTYM QUESTRAN SULFAZINE PANTOPRAZOLE QUINAPRIL SULINDAC – 4 – 106-15818b 0609 This drug list represents a summary of prescription coverage. It is not inclusive and does not guarantee coverage. Specific prescription benefit plan design may not cover certain categories, regardless of their appearance on this list. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers that are not affiliated with CVS Caremark. SYMBICORT TIZANIDINE VASERETIC SYMLIN TOLAZAMIDE VASODILAN SYMLINPEN TOLBUTAMIDE VASOTEC SYNTHROID TOLMETIN VENLAFAXINE TAMBOCOR TOPAMAX VENTOLIN TAMOXIFEN TOPROL VERAPAMIL TAPAZOLE TORADOL ORAL VERELAN TARKA TORSEMIDE VESICARE TASMAR TRACLEER VIOKASE TAZTIA TRANDATE VIVELLE-DOT TEGRETOL TRANDOLAPRIL VOLTAREN TEKTURNA TRANYLCYPROMINE VOSPIRE ER TELBIVUDINE TRAVOPROST VYTORIN TENEX TRAZODONE WELCHOL TENOFOVIR DISOPROXIL TRENTAL WELLBUTRIN TENORETIC TRICOR ZALCITABINE TENORMIN TRIHEXYPHENIDATE ZANAFLEX TERAZOSIN TRILEPTAL ZARONTIN TERBUTALINE TRILOSTANE ZAROXOLYN TERIPARATIDE TRIMETHADIONE ZAVESCA TESTOSTERONE ULTRASE ZEBETA TESTRED UNIPHYL ZELAPAR TEVETEN UNIRETIC ZESTORETIC THALIDOMIDE UNITH DIRECT ZESTRIL THALITONE UNITHROID ZETIA THEOPHYLLINE UNIVASC ZIAC THYROID UNOPROSTONE ZIDOVUDINE THYROLAR URISPAS ZOCOR TIAZAC UROXATRAL ZONEGRAN TICLID URSODIOL ZONISAMIDE TICLOPIDINE VALGANCICLOVIR ZYFLO TIMOLIDE VALPROATE MAGNESIUM ZYLOPRIM TIMOLOL VALPROATE SODIUM TIPRANAVIR VALPROIC ACID
EXTENDED LIST These are additional drugs CVS Caremark recommends as considerations for inclusion to the Maintenance Drug List.
CONTRACEPTIVES
LEVONORGEST-ETH ESTRADIOL LEVONORGESTREL MEDROXYPROGESTERONE ACETATE
DIABETES-ANTIDIABETIC INSULIN
ACCU-CHECK KIT LANCET DEVICE PRODIGY DUO EASY TOUCH LANCETS ROSIGLITAZONE GLUCOSE TEST STRIPS ONETOUCH INSULIN SYRINGES PRANDIMET – 5 – 106-15818b 0609 This drug list represents a summary of prescription coverage. It is not inclusive and does not guarantee coverage. Specific prescription benefit plan design may not cover certain categories, regardless of their appearance on this list. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers that are not affiliated with CVS Caremark. NON-SEDATING ANTIHISTAMINE
ALLEGRA ALLEGRA-D CLARINEX FEXOFENADINE
ANTIDEPRESSANT
BUSPAR BUSPIRONE
– 6 – 106-15818b 0609 This drug list represents a summary of prescription coverage. It is not inclusive and does not guarantee coverage. Specific prescription benefit plan design may not cover certain categories, regardless of their appearance on this list. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers that are not affiliated with CVS Caremark.