2020 Preventive Medications

Managing your patient's health with preventive medications Your patient's pharmacy benefit plan includes special coverage for generic preventive medications. These medications help protect against or manage a medical condition, such as: • Preventing blood clots and reducing the risk of a stroke • Preventing heart disease and reducing high blood pressure • Preventing osteoporosis (a disease that leads to an increased risk of bone fracture) Your patient's health is important. Taking preventive medications can help them avoid serious illness and high healthcare costs. Special coverage for generic preventive medications The drugs on your patient's plan’s preventive medications list do not have a Generic medications by therapeutic category deductible. This means they'll pay their copayment/coinsurance or nothing at all, depending on their plan. It can save them money and get the medications they need to help them live a healthier life. nitroglycerin ANTIDEPRESSANTS ASTHMA AND COPD nitroglycerin er Your patient's plan only offers this special coverage for generic drugs on the citalopram albuterol sulfate nitroglycerin lingual preventive medications list. Preventive medications are a group of products in escitalopram albuterol sulfate er nitroglycerin transdermal their plan’s formulary which tells them what medications their plan covers. fluoxetine budesonide nitro-time Please note that most medications on the formulary have a deductible, but fluoxetine dr cromolyn petn generic preventive medications do not. To check the cost of any medication, fluvoxamine difil-g forte ranolazine er fluvoxamine er fluticasone / salmeterol diskus your patient should see their benefit handbook or contact customer service at Anticoagulants paroxetine ipratropium the phone number on their member ID card. paroxetine er ipratropium / albuterol aspirin / dipyridamole sertraline isoproteren aer cilostazol Quality drives our decisions levalbuterol clopidogrel ANTIPSYCHOTICS A group of doctors and pharmacists meets often to review medications and metaproterenol dipyridamole SP suggest coverage under pharmacy benefit plans. They also recommend which aripiprazole montelukast enoxaparin SP medications should be on plan’s generic preventive medications list. aripiprazole odt terbutaline fondaparinux chlorpromazine theochron heparin clozapine theophylline jantoven clozapine odt theophylline cr prasugrel compro theophylline er warfarin fluphenazine wixela inhub Cardiac Glycosides haloperidol zafirlukast loxapine zileuton er digitek molindone digox CANCER olanzapine digoxin olanzapine odt anastrozole High blood pressure olanzapine / fluoxetine exemestane A list of generic preventive medications begins on the next page. Medications paliperidone er letrozole acebutolol are listed by therapeutic category. Your patient's specific plan may not cover all perphenazine raloxifene afeditab cr of the drugs. Please see your patient's plan’s formulary for coverage details. Oral prochlorperazine tamoxifen aliskiren and self-injectable Specialty medications are labeled with an SP note and may quetiapine fumarate toremifene amiloride have limitations based on your patient's plan benefit. For questions on injectable quetiapine fumarate er amiloride / hctz CARDIOVASCULAR/ dose forms of preventive medications driven by their healthcare provider, your risperidone amlodipine HEART DISEASE patient should call the phone number on their member ID card. risperidone m-tab amlodipine / benazepril risperidone odt Anti-Anginal Agents amlodipine / valsartan thioridazine amlodipine/olmesartan isosorbide dinitrate thiothixene medoxomil isosorbide dinitrate er trifluoperazine amlodipine / valsartan / hctz isosorbide mononitrate ziprasidone atenolol isosorbide mononitrate er atenolol / chlorthalidone minitran benazepril

SP Oral and self-injectable Specialty medications may have limitations based on your patient's plan benefit ‡ Where differences are noted between this formulary and your patient's benefit plan documents, the benefit plan documents will rule benazepril / hctz methyldopa / hctz valsartan / hctz glipizide norethindrone acetate/ethinyl ritonavir SP betaxolol metolazone verapamil glipizide er estradiol stavudine SP bisoprolol metoprolol er verapamil er glipizide xl tenofovir SP GASTROINTESTINAL-ULCER bisoprolol / hctz metoprolol verapamil sr glipizide/metformin zidovudine SP DRUGS ‡ bumetanide metoprolol / hctz glyburide High cholesterol OSTEOPOROSIS candesartan minoxidil tablet glyburide micronized cimetidine candesartan / hctz moexipril amlodipine/atorvastatin glyburide/metformin famotidine alendronate captopril moexipril / hctz atorvastatin metformin lansoprazole calcitonin-salmon captopril / hctz nadolol cholestyramine metformin er (not mod or osm) lansoprazole odt etidronate di cartia xt nadolol / bendroflumethiazide cholestyramine light miglitol lansoprazole/amoxicillin/ ibandronate carvedilol nicardipine colesevelam nateglinide clarithromycin risedronate chlorothiazide nifedipine colestipol pioglitazone misoprostol risedronate dr chlorthalidone ezetimibe pioglitazone / metformin nifedipine er nizatidine SMOKING DETERRENTS ‡ clonidine nimodipine ezetimibe / simvastatin pioglitazone / glimepride omeprazole diltiazem cd nisoldipine fenofibrate repaglinide pantoprazole bupropion er diltiazem nisoldipine er fenofibrate micronized repaglinide/metformin pantoprazole dr nicotine gum diltiazem er olmesartan fenofibric acid tolazamide rabeprazole nicotine lozenge dilt-XR olmesartan / amlodipine / hctz fenofibric acid DR tolbutamide ranitidine nicotine patch doxazosin olmesartan / hctz fluvastatin ESTROGENS sucralfate TRANSPLANT ‡ enalapril perindopril gemfibrozil enalapril / hctz phenozybenzamine lovastatin amabelz HIV/AIDS azathioprine eplerenone pindolol niacin er covaryx abacavir SP cyclosporine SP eprosartan prazosin niacor covaryx hs abacavir / lamivudine SP cyclosporine modifiedSP ethacrynic acid propranolol omega-3-acid ethyl esters dotti abacavir / lamivudine / gengraf SP SP ezide propranolol er pravastatin eemt zidovudine SP mycophenolate SP felodipine er propranolol / hctz prevalite eemt hs atazanavir SP mycophenolic acid dr SP fosinopril quinapril rosuvastatin esterified estrogens/ didanosine SP sirolimus SP fosinopril / hctz quinapril / hctz simvastatin methltestosterone efavirenz SP tacrolimus cap furosemide ramipril triklo esterified estrogens/ SP fosamprenavir VITAMINS & HEMATINICS ‡ guanfacine SP sotalol CONTRACEPTIVES ‡ methltestosterone ds lamivudine hydralazine spironolactone esterified estrogens/ lamivudine / zidovudine SP Pediatric vitamins hydrochlorothiazide spironolactone / hctz generic contraceptive patch methltestosterone hs lopinavir / ritonavir SP with fluoride indapamide generic emergency SP taztia xt estradiol nevirapine Generic Products irbesartan telmisartan contraceptives estradiol/norethindrone acetate nevirapine ER SP irbesartan / hctz telmisartan / amlodipine generic injectable contraceptive estropipate Prenatal multivitamins isradipine telmisartan / hctz generic oral contraceptives fyavolv with iron and folic acid labetalol terazosin DIABETES jevantique lo Generic Products lisinopril timolol (tablet) jinteli lisinopril / hctz torsemide Non-insulin lopreeza losartan potassium trandolapril acarbose mimvey losartan potassium / hctz trandolapril / verapamil er chlorpropamide mimvey lo matzim la triamterene glimepiride methyclothiazide triamterene / hctz methyldopa valsartan

SP Oral and self-injectable Specialty medications may have limitations based on your patient's plan benefit SP Oral and self-injectable Specialty medications may have limitations based on your patient's plan benefit ‡ Where differences are noted between this formulary and your patient's benefit plan documents, the benefit plan documents will rule ‡ Where differences are noted between this formulary and your patient's benefit plan documents, the benefit plan documents will rule This list should be used as a reference and may not include all medications. Brand or generic availability may not be current due to changes in the market.

optumrx.com

OptumRx specializes in the delivery, clinical management and affordability of prescription medications and consumer health products. We are an Optum® company — a leading provider of integrated health services. Learn more at optum.com.

All Optum trademarks and logos are owned by Optum, Inc. in the U.S. and other jurisdictions. All other trademarks are the property of their respective owners.