Philips Electronics

Your Philips Electronics prescription benefit plan includes a $0 copay* for generic drugs within the following therapeutic classes: Asthma, COPD, Depression, Diabetes, Heart Failure, Hyperlipidemia (Cholesterol Lowering) and Hypertension. Please see below for a list of generic drugs available for a $0 copay:

ASTHMA FLUVOXAMINE CHLOROTHIAZ ALBUTER .5ML IMIPRAM HCL CHLORTHALID ALBUTER 3ML IMIPRAM PAM DIGOXIN ALBUTEROL IMIPRAMINE H DIGOXIN PED AMINOPHYLLIN MAPROTILINE DIURETIC TAB BUDESONIDE MIRTAZAPINE ODT ENALAPR/HCTZ CROMOLYN MIRTAZAPINE TAB ENALAPRIL CROMOLYN #60 NEFAZODONE TAB ENALAPRILAT CROMOLYN SOD NORTRIPTYLIN EPLERENONE CROMOLYN#120 OLANZA/FLUOX EPROSART MES DG 200 PAROXETIN ER ESMOLOL HCL DIFIL G FORT PAROXETINE FOSINOP/HCTZ DIFIL-G 400 PAROXETINE ER FOSINOPRIL DILEX-G PERPHEN/AMIT FUROSEMIDE DYFLEX-G PHENELZINE HCTZ/TRIAMT DY-G PROTRIPTYLIN HYDROCHLOROT DYPHYLLIN GG SERTRALINE HYDRO-TABS TAB DYPHYLLINE TRANYLCYPROM INDAPAMIDE DYPHYLLIN-GG ELX TRAZODONE IRBESAR/HCTZ LEVALBUTEROL TRIMIPRAMINE IRBESARTAN METAPROTEREN VENLAFAXINE LABETALOL MONTELUKAST WELLBUTRIN XL LISINOPRIL/HCTZ TERBUTALINE ZOLOFT LISINOPRIL THEOCHRON LOSARTAN THEOPHYL DIABETES LOSARTAN POT THEOPHYL/D5W ACARBOSE LOSARTAN/HCT THEOPHYLLINE CHLORPROPAM MANNITOL ZAFIRLUKAST GLIMEPIRIDE METHAZOLAMID GLIP/METFORM METHYCLOTHIA COPD GLIPIZIDE METOLAZONE ALBUTER .5ML GLIPIZIDE ER METOPRL/HCTZ ALBUTER/IPRA SOL GLIPIZIDE XL METOPROL ER ALBUTEROL GLYB/METFORM METOPROL TAR BUDESONIDE RES GLYBURID MCR METOPROLO ER BUDESONIDE GLYBURIDE METOPROLOL IPRATROP.02% SOL GLYBURIDE(D) METOPROLOLOL IPRATROPIUM SOL 0.02% GLYBURIDE(M) MOEXIPR/HCTZ IPRATROPIUM SOL GLYCRON MOEXIPRIL IPRATROPIUM/ SOL ALBUTER MCR GLYBURID NADOLOL LEVALBUTEROL METFORMIN NADOLOL/BEND LEVALBUTEROL METFORMIN ER OSMITROL METAPROTEREN METFORMIN XR OSMITROL VFX METAPROTEREN NATEGLINIDE PERINDOPRIL TERBUTALINE PIOGLIT/GLIM PINDOLOL TERBUTALINE PIOGLITAZONE PROPRAN/HCTZ TOLAZAMIDE PROPRANOLOL DEPRESSION TOLBUTAMIDE QNAPRIL/HCTZ AMITRIPTYLIN QUINAPRIL BUDEPR 24 XL HEART FAILURE RAMIPRIL BUDEPRION ACEBUTOLOL RAMIPRIL (A) BUDEPRION SR ACETAZOLAMID SORINE BUDEPRION XL AMILOR/HCTZ SOTALOL AF BUPROPION AMILORIDE SOTALOL HCL BUPROPION ER AMLOD/BENAZE SPIRONO/HCTZ BUPROPION XL ATENOL/CHLOR SPIRONOLACT BUPROPN HCL ATENOLOL TIMOLOL MAL CDP/AMITRIP BENAZEP/HCTZ TORSEMIDE CITALOPRAM BENAZEPR HCT TRANDO/VERAP CLOMIPRAMINE BENAZEPRIL TRANDOLAPRIL TAB DESIPRAMINE BETAXOLOL TRIAMT/HCTZ CAP DOXEPIN HCL BISOPRL/HCTZ VALSART/HCTZ DOXEPIN HCL BISOPROL FUM VALSARTN HCT DUO-VIL BISOPROLOL ESCITALOPRAM BUMETANIDE HYPERLIPIDEMIA/ FLUOXET CANDESAR/HCT CHOLESTEROL LOWERING FLUOXETIN(P) CAPTOPRIL AMLOD/ATORVA FLUOXETINE CARVEDILOL ATORVASTATIN

*Copay, copayment or coinsurance means the amount a plan member is required to pay for a prescription in accordance with a Plan, which may be a deductible, a percentage of the prescription price, a fixed amount or other charge, with the balance, if any, paid by a Plan. *Please note that dosages may vary ©2015 CVS/caremark. All rights reserved. 106-33450a 011915 1 of 2

Philips Electronics

CHOLESTYRAM LISINOPRIL COLESTIPOL LOSARTAN COLESTIPOL LOSARTAN POT FENOFIBRATE LOSARTAN/HCT FENOFIBRIC MANNITOL FLUVASTATIN MATZIM LA GEMFIBROZIL METHAZOLAMID LOVASTATIN METHYCLOTHIA NIACOR METHYLD/HCTZ PRAVASTATIN METHYLDOPA PREVALITE METHYLDOPATE SIMVASTATIN METOLAZONE METOPRL/HCTZ HYPERTENSION METOPROL ER ACEBUTOLOL METOPROL TAR ACETAZOLAMID METOPROLO ER AFEDITAB METOPROLOL AMILOR/HCTZ METOPROLOLOL AMILORIDE MINOXIDIL AMLOD/ATORVA MOEXIPR/HCTZ AMLOD/BENAZE MOEXIPRIL AMLODIPINE NADOLOL ATENOL/CHLOR NADOLOL/BEND ATENOLOL NICARDIPINE BENAZEP/HCTZ NIFEDIAC CC BENAZEPR HCT NIFEDICAL XL BENAZEPRIL NIFEDIPIN CC BETAXOLOL NIFEDIPIN XL BISOPRL/HCTZ NIFEDIPINE BISOPRO/HCTZ NIMODIPINE BISOPROL FUM NISOLDIPINE BISOPROLOL OSMITROL BUMETANIDE OSMITROL VFX CANDESAR/HCT PERINDOPRIL CAPTOPR/HCTZ PINDOLOL CAPTOPRIL PRAZOSIN HCL CARTIA XT PROPRAN/HCTZ CARVEDILOL PROPRANOLOL CHLOROTHIAZ QNAPRIL/HCTZ CHLORTHALID QUINAPRIL CLONIDINE QUINARETIC CLONIDIN-TTS RAMIPRIL CLORPRES RAMIPRIL (A) DILT-CD RAUWOLFIA/BENDROFL DILTIAZEM RESERPINE DILTIAZEM CD SORINE DILTIAZEM ER SOTALOL AF DILTIAZEM LA SOTALOL HCL DILTIAZEM XR SPIRONO/HCTZ DILT-XR SPIRONOLACT DILTZAC SPIRONOLACTO DIURETIC TAB TAZTIA XT DOXAZOSIN TERAZOSIN ENALAPR/HCTZ TIMOLOL ENALAPRIL TIMOLOL MAL ENALAPRILAT TORSEMIDE EPROSART TRANDO/VERAP ESMOLOL HCL TRANDOLAPRIL FELODIPINE TRIAMT/HCTZ FENOLDOPAM VALSART/HCTZ FOSINOP/HCTZ VALSARTN HCT FOSINOPRIL VERAPAMIL FUROSEMIDE VERAPAMIL ER GUANABENZ VERAPAMIL PM GUANFACINE VERAPAMIL SR HCTZ/TRIAMT WATER TAB HYDRALAZINE HYDROCHLOROT HYDRO-TABS INDAPAMIDE IRBESAR/HCTZ IRBESARTAN ISRADIPINE LABETALOL LISINOP/HCTZ