Coronary Artery Disease GLIPIZIDE/METFORMIN EPLERENONE ATORVASTATIN GLYBURIDE EPROSARTAN ATORVASTATIN/ GLYBURIDE MICRONIZED FELODIPINE AMLODIPINE GLYBURIDE/METFORMIN FOSINOPRIL CHOLESTYRAMINE INSULIN SYRINGES/PEN FOSINOPRIL W/ HCTZ CHOLESTYRAMINE LIGHT NEEDLES FUROSEMIDE COLESTIPOL LANCETS GUANABENZ EZETIMIBE METFORMIN GUANFACINE FENOFIBRATE METFORMIN ER HYDRALAZINE FENOFIBRIC ACID MIGLITOL HYDROCHLOROTHIAZIDE FLUVASTATIN NATEGLINIDE (HCTZ) GEMFIBROZIL PIOGLITAZONE INDAPAMIDE LOVASTATIN PIOGLITAZONE/ IRBESARTAN NIACIN ER GLIMEPIRIDE IRBESARTAN W/ HCTZ PRAVASTATIN PIOGLITAZONE/ ISOSORBIDE DINITRATE ROSUVASTATIN METFORMIN ISOSORBIDE SIMVASTATIN TOLAZAMIDE MONONITRATE TOLBUTAMIDE ISRADIPINE Depression LABETALOL BUPROPION Hypertension LISINOPRIL BUPROPION SR ACEBUTOLOL LISINOPRIL W/ HCTZ BUPROPION XL ACETAZOLAMIDE LOSARTAN CITALOPRAM AMILORIDE LOSARTAN W/ HCTZ DESVENLAFAXINE ER* AMILORIDE W/ HCTZ METHYCLOTHIAZIDE DULOXETINE AMLODIPINE METHYLDOPA ESCITALOPRAM ATENOLOL METHYLDOPA W/ HCTZ FLUOXETINE ATENOLOL W/ METOLAZONE FLUVOXAMINE CHLORTHALIDONE METOPROLOL SUCCINATE MAPROTELINE BENAZEPRIL METOPROLOL TARTRATE MIRTAZAPINE BENAZEPRIL W/ HCTZ METOPROLOL W/ HCTZ NEFAZODONE BENAZEPRIL/AMLODIPINE MINOXIDIL PAROXETINE BETAXOLOL MOEXIPRIL PHENELZINE BISOPROLOL MOEXIPRIL W/HCTZ SERTRALINE BISOPROLOL W/ HCTZ NADOLOL TRANYLCYPROMINE BUMETANIDE NADOLOL W/ TRAZODONE CANDESARTAN BENDROFLUMETHIAZIDE TRAZODONE CILEXETIL* NICARDIPINE VENLAFAXINE CAPTOPRIL NIFEDIPINE VENLAFAXINE XR CAPTOPRIL W/ HCTZ NIFEDIPINE ER CARVEDILOL NIMODIPINE Diabetes CHLOROTHIAZIDE NISOLDIPINE ACARBOSE CHLORTHALIDONE OLMESARTAN* CHLORPROPAMIDE CLONIDINE OLMESARTAN/ BLOOD SUGAR TEST DILTIAZEM AMLODIPINE W/HCTZ* STRIPS (LIFESCAN DILTIAZEM ER OLMESARTAN W/HCTZ* PRODUCTS) DILTIAZEM SR PERINDOPRIL GLIMEPIRIDE DOXAZOSIN PINDOLOL GLIPIZIDE ENALAPRIL PRAZOSIN GLIPIZIDE XL ENALAPRIL W/ HCTZ PROPRANOLOL PROPRANOLOL W/ HCTZ
QUINAPRIL TERAZOSIN QUINAPRIL W/ HCTZ TIMOLOL Only the generic versions of RAMIPRIL TORSEMIDE the medications on this list RESERPINE TRANDOLAPRIL are free. SOTALOL TRANDOLAPRIL/ SOTALOL AF VERAPAMIL *Prior Authorization or Step SPIRONOLACTONE TRIAMTERENE W/ HCTZ Therapy required SPIRONOLACTONE W/ VALSARTAN W/ HCTZ HCTZ VERAPAMIL TELMISARTAN VERAPAMIL SR W/AMLODIPINE*
HPRX01 Rev 10/13/2017