Preferred Drug List

January 2012 Preferred Drug List The Preferred Drug List, administered by CVS Caremark on behalf of Marriott International, is a guide within select therapeutic categories for clients, plan members and health care providers. Generics should be considered the first line of prescribing. If there is no generic available, there may be more than one brand-name medicine to treat a condition. These preferred brand-name medicines are listed to help identify products that are clinically appropriate and cost-effective. Generics listed in therapeutic categories are for representational purposes only. This is not an all-inclusive list. This list represents brand products in CAPS and generic products in lowercase italics. <ul style="display: flex;"><li style="flex:1">PLAN MEMBER </li><li style="flex:1">HEALTH CARE PROVIDER </li></ul>Your benefit plan provides you with a prescription benefit program administered by CVS Caremark. Ask your doctor to consider prescribing, when medically appropriate, a preferred medicine from this list. Take this list along when you or a covered family member sees a doctor. Your patient is covered under a prescription benefit plan administered by CVS Caremark. As a way to help manage health care costs, authorize generic substitution whenever possible. If you believe a brand-name product is necessary, consider prescribing a brand name on this list. <ul style="display: flex;"><li style="flex:1">Please note: </li><li style="flex:1">Please note: </li></ul>Your specific prescription benefit plan design may not cover certain categories, regardless of their appearance in this document. Generics should be considered the first line of prescribing. <ul style="display: flex;"><li style="flex:1">•</li><li style="flex:1">•</li></ul>This drug list represents a summary of prescription coverage. It is not inclusive and does not guarantee coverage. •For specific information regarding your prescription benefit •coverage and copay1 information, please visit <a href="/goto?url=http://www.caremark.com" target="_blank">www.caremark.com </a>or contact a CVS Caremark Customer Care representative. The member's prescription benefit plan may have a different copay for specific products on the list. •Unless specifically indicated, drug list products will include all dosage forms. •CVS Caremark may contact your doctor after receiving your •prescription to request consideration of a drug list product or generic equivalent. This may result in your doctor prescribing, when medically appropriate, a different brand-name product or generic equivalent in place of your original prescription. Log in to <a href="/goto?url=http://www.caremark.com" target="_blank">www.caremark.com </a>to check coverage and copay information for a specific medicine. •Any brand drug for which a generic product becomes available may be designated as a non-preferred product. •§ PENICILLINS amoxicillin amoxicillin-clavulanate dicloxacillin penicillin VK nitrofurantoin sulfamethoxazole- trimethoprim ANGIOTENSIN II RECEPTOR § BETA-BLOCKERS ANALGESICS ANTAGONIST / DIRECT RENIN INHIBITOR COMBINATIONS atenolol carvedilol metoprolol VISCOSUPPLEMENTS SYNVISC SYNVISC-ONE CARDIOVASCULAR VALTURNA metoprolol succinate ext-rel nadolol propranolol BYSTOLIC COREG CR § ACE INHIBITORS ANTI-INFECTIVES § TETRACYCLINES doxycycline hyclate minocycline ANTILIPEMICS § BILE ACID RESINS cholestyramine fosinopril lisinopril quinapril ramipril ANTIBACTERIALS § CEPHALOSPORINS cefaclor cefdinir cephalexin SUPRAX tetracycline WELCHOL § CALCIUM CHANNEL BLOCKERS § ANTIFUNGALS fluconazole itraconazole terbinafine tablet CHOLESTEROL § ACE INHIBITOR / DIURETIC COMBINATIONS fosinopril- hydrochlorothiazide lisinopril- hydrochlorothiazide quinapril- hydrochlorothiazide ABSORPTION INHIBITORS amlodipine diltiazem ext-rel nifedipine ext-rel verapamil ext-rel ZETIA § ERYTHROMYCINS / MACROLIDES azithromycin clarithromycin clarithromycin ext-rel erythromycins § FIBRATES ANTIVIRALS § HERPES AGENTS acyclovir valacyclovir fenofibrate TRICOR TRILIPIX CALCIUM CHANNEL BLOCKER / ANTILIPEMIC COMBINATIONS § HMG-CoA REDUCTASE INHIBITORS pravastatin simvastatin CRESTOR LIPITOR CADUET § ANGIOTENSIN II RECEPTOR ANTAGONISTS / DIURETIC COMBINATIONS losartan / losartan- hydrochlorothiazide BENICAR / BENICAR HCT DIOVAN / DIOVAN HCT MICARDIS / § INFLUENZA AGENTS § FLUOROQUINOLONES § DIGITALIS GLYCOSIDES digoxin amantadine rimantadine RELENZA TAMIFLU ciprofloxacin ext-rel ciprofloxacin tablet levofloxacin AVELOX CIPRO SUSPENSION DIRECT RENIN INHIBITORS / DIURETIC COMBINATIONS § MISCELLANEOUS clindamycin metronidazole NIACINS / COMBINATIONS TEKTURNA / TEKTURNA HCT NIASPAN SIMCOR MICARDIS HCT Your specific prescription benefit plan design may not cover certain categories, regardless of their appearance in this document. For specific information, visit <a href="/goto?url=http://www.caremark.com" target="_blank">www.caremark.com </a>or contact a CVS Caremark Customer Care representative. DIRECT RENIN INHIBITOR / CALCIUM CHANNEL BLOCKER COMBINATIONS MULTIPLE SCLEROSIS AGENTS AVONEX BETASERON COPAXONE BD INSULIN SYRINGES AND NEEDLES HUMAN GROWTH HORMONES NORDITROPIN RESPIRATORY ANAPHYLAXIS TREATMENT AGENTS EPIPEN ONETOUCH STRIPS AND KITS 3 TEKAMLO § PROGESTINS, ORAL medroxyprogesterone PROMETRIUM CALCIUM REGULATORS § BISPHOSPHONATES alendronate ACTONEL BONIVA DIRECT RENIN INHIBITOR / CALCIUM CHANNEL BLOCKER / DIURETIC COMBINATIONS EPIPEN JR ENDOCRINE AND METABOLIC § ANTICHOLINERGICS SPIRIVA SELECTIVE ESTROGEN RECEPTOR MODULATORS EVISTA ANDROGENS ANDRODERM ANDROGEL AMTURNIDE § ANTICHOLINERGIC / BETA AGONIST COMBINATIONS ipratropium-albuterol inhalation solution COMBIVENT § DIURETICS furosemide hydrochlorothiazide metolazone spironolactone- hydrochlorothiazide torsemide § CALCITONINS calcitonin-salmon § THYROID SUPPLEMENTS levothyroxine SYNTHROID ANTIDIABETICS § BIGUANIDES metformin PARATHYROID HORMONES FORTEO BETA AGONISTS, INHALANTS § SHORT ACTING GASTROINTESTINAL metformin ext-rel CONTRACEPTIVES § MONOPHASIC ethinyl estradiol- drospirenone BEYAZ LO LOESTRIN FE LOESTRIN 24 FE § H2 RECEPTOR ANTAGONISTS ranitidine § BIGUANIDE / SULFONYLUREA COMBINATIONS triamterene- hydrochlorothiazide albuterol PROAIR HFA PROVENTIL HFA VENTOLIN HFA glipizide-metformin CENTRAL NERVOUS SYSTEM § PROTON PUMP INHIBITORS lansoprazole omeprazole omeprazole-sodium bicarbonate capsule pantoprazole DEXILANT DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITORS JANUVIA ANTIDEPRESSANTS LONG ACTING FORADIL SEREVENT § SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) citalopram fluoxetine paroxetine paroxetine ext-rel sertraline LEXAPRO VIIBRYD § TRIPHASIC ethinyl estradiol- norgestimate ORTHO TRI-CYCLEN LO ONGLYZA DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITOR / BIGUANIDE COMBINATIONS JANUMET KOMBIGLYZE XR § LEUKOTRIENE RECEPTOR ANTAGONISTS zafirlukast NEXIUM FOUR PHASE NATAZIA SINGULAIR GENITOURINARY § NASAL ANTIHISTAMINES azelastine ASTEPRO § EXTENDED CYCLE ethinyl estradiol- levonorgestrel § BENIGN PROSTATIC HYPERPLASIA doxazosin finasteride tamsulosin terazosin INCRETIN MIMETIC AGENTS BYETTA VICTOZA § SEROTONIN LOSEASONIQUE § NASAL STEROIDS flunisolide fluticasone triamcinolone NASONEX VERAMYST NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIs) 2 INSULINS APIDRA HUMULIN R U-500 LANTUS LEVEMIR TRANSDERMAL ORTHO EVRA AVODART RAPAFLO venlafaxine VAGINAL NUVARING venlafaxine ext-rel CYMBALTA PRISTIQ § URINARY ANTISPASMODICS oxybutynin oxybutynin ext-rel trospium DETROL DETROL LA ENABLEX NOVOLIN NOVOLOG ESTROGENS § ORAL estradiol estropipate ENJUVIA PREMARIN STEROID / BETA AGONIST COMBINATIONS ADVAIR DULERA SYMBICORT § MISCELLANEOUS AGENTS bupropion bupropion ext-rel mirtazapine INSULIN SENSITIZERS ACTOS INSULIN SENSITIZER / BIGUANIDE COMBINATIONS § STEROID INHALANTS GELNIQUE VESICARE ACTOPLUS MET § TRANSDERMAL estradiol EVAMIST VIVELLE-DOT budesonide inhalation suspension ASMANEX FLOVENT PULMICORT FLEXHALER QVAR § HYPNOTICS, NONBENZODIAZEPINES zolpidem zolpidem ext-rel INSULIN SENSITIZER / SULFONYLUREA COMBINATIONS HEMATOLOGIC § ANTICOAGULANTS warfarin COUMADIN PRADAXA XARELTO DUETACT § ESTROGEN / PROGESTINS, ORAL estradiol-norethindrone PREMPHASE PREMPRO MIGRAINE § SELECTIVE SEROTONIN AGONISTS naratriptan sumatriptan MAXALT ZOMIG § MEGLITINIDES nateglinide PRANDIN TOPICAL DERMATOLOGY § ACNE adapalene clindamycin solution clindamycin-benzoyl peroxide erythromycin solution erythromycin-benzoyl peroxide IMMUNOLOGIC AGENTS § SULFONYLUREAS glimepiride glipizide FERTILITY REGULATORS OVULATION STIMULANTS, GONADOTROPINS BRAVELLE FOLLISTIM AQ BIOLOGIC DISEASE- MODIFYING AGENTS ENBREL HUMIRA SELECTIVE SEROTONIN AGONIST / NONSTEROIDAL ANTI-INFLAMMATORY DRUG (NSAID) COMBINATIONS TREXIMET glipizide ext-rel SUPPLIES ACCU-CHEK STRIPS AND KITS 3 tretinoin ACANYA Your specific prescription benefit plan design may not cover certain categories, regardless of their appearance in this document. For specific information, visit <a href="/goto?url=http://www.caremark.com" target="_blank">www.caremark.com </a>or contact a CVS Caremark Customer Care representative. DIFFERIN DUAC EPIDUO RETIN-A MICRO VELTIN OPHTHALMIC § BETA-BLOCKERS, NONSELECTIVE timolol maleate solution BETIMOL BETA-BLOCKERS, SELECTIVE BETOPTIC S § PROSTAGLANDINS latanoprost LUMIGAN § SYMPATHOMIMETICS brimonidine 0.2% ALPHAGAN P TRAVATAN Z QUICK REFERENCE DRUG LIST ciprofloxacin ext-rel ciprofloxacin tablet citalopram clarithromycin clarithromycin ext-rel clindamycin clindamycin solution clindamycin-benzoyl peroxide COMBIVENT COPAXONE fluconazole flunisolide fluoxetine fluticasone FOLLISTIM AQ FORADIL FORTEO fosinopril fosinopril- hydrochlorothiazide furosemide metformin metformin ext-rel metolazone QVAR AACANYA ACCU-CHEK STRIPS AND Rmetoprolol ramipril ranitidine RAPAFLO RELENZA RETIN-A MICRO rimantadine KITS 3 metoprolol succinate ext-rel metronidazole MICARDIS MICARDIS HCT minocycline ACTONEL ACTOPLUS MET ACTOS acyclovir adapalene mirtazapine ADVAIR albuterol S NCOREG CR COUMADIN CRESTOR CYMBALTA SEREVENT sertraline SIMCOR simvastatin SINGULAIR SPIRIVA spironolactone- hydrochlorothiazide sulfamethoxazole- trimethoprim sumatriptan SUPRAX SYMBICORT SYNTHROID SYNVISC alendronate ALPHAGAN P amantadine amlodipine amoxicillin amoxicillin-clavulanate AMTURNIDE ANDRODERM ANDROGEL APIDRA ASMANEX ASTEPRO atenolol AVELOX AVODART AVONEX Gnadolol GELNIQUE glimepiride glipizide glipizide ext-rel glipizide-metformin naratriptan NASONEX NATAZIA nateglinide NEXIUM DDETROL DETROL LA DEXILANT dicloxacillin DIFFERIN digoxin diltiazem ext-rel DIOVAN DIOVAN HCT doxazosin doxycycline hyclate DUAC NIASPAN Hnifedipine ext-rel nitrofurantoin NORDITROPIN NOVOLIN NOVOLOG NUVARING HUMIRA HUMULIN R U-500 hydrochlorothiazide Iipratropium-albuterol inhalation solution itraconazole OSYNVISC-ONE omeprazole azelastine azithromycin Tomeprazole-sodium bicarbonate capsule ONETOUCH STRIPS AND KITS 3 ONGLYZA ORTHO EVRA ORTHO TRI-CYCLEN LO oxybutynin oxybutynin ext-rel DUETACT DULERA JTAMIFLU tamsulosin TEKAMLO TEKTURNA TEKTURNA HCT terazosin terbinafine tablet tetracycline timolol maleate solution torsemide BJANUMET JANUVIA BD INSULIN SYRINGES AND NEEDLES BENICAR BENICAR HCT BETASERON BETIMOL BETOPTIC S BEYAZ BONIVA EENABLEX ENBREL ENJUVIA EPIDUO EPIPEN EPIPEN JR erythromycin solution erythromycin-benzoyl peroxide erythromycins estradiol KKOMBIGLYZE XR Llansoprazole LANTUS latanoprost Ppantoprazole paroxetine paroxetine ext-rel penicillin VK PRADAXA PRANDIN pravastatin PREMARIN PREMPHASE PREMPRO PRISTIQ PROAIR HFA PROMETRIUM propranolol PROVENTIL HFA PULMICORT FLEXHALER TRAVATAN Z tretinoin BRAVELLE LEVEMIR TREXIMET triamcinolone triamterene- hydrochlorothiazide TRICOR brimonidine 0.2% budesonide inhalation suspension bupropion bupropion ext-rel BYETTA levofloxacin levothyroxine LEXAPRO LIPITOR lisinopril estradiol-norethindrone estropipate ethinyl estradiol- drospirenone ethinyl estradiol- levonorgestrel ethinyl estradiol- norgestimate EVAMIST TRILIPIX trospium lisinopril- BYSTOLIC hydrochlorothiazide LO LOESTRIN FE LOESTRIN 24 FE losartan V Cvalacyclovir VALTURNA VELTIN CADUET calcitonin-salmon carvedilol cefaclor cefdinir cephalexin cholestyramine CIPRO SUSPENSION losartan- hydrochlorothiazide LOSEASONIQUE LUMIGAN EVISTA venlafaxine venlafaxine ext-rel VENTOLIN HFA VERAMYST verapamil ext-rel VESICARE F Qfenofibrate finasteride FLOVENT Mquinapril quinapril- hydrochlorothiazide MAXALT medroxyprogesterone VICTOZA Your specific prescription benefit plan design may not cover certain categories, regardless of their appearance in this document. For specific information, visit <a href="/goto?url=http://www.caremark.com" target="_blank">www.caremark.com </a>or contact a CVS Caremark Customer Care representative. VIIBRYD VIVELLE-DOT zolpidem zolpidem ext-rel ZOMIG <ul style="display: flex;"><li style="flex:1">W</li><li style="flex:1">X</li><li style="flex:1">Z</li></ul>warfarin WELCHOL XARELTO zafirlukast ZETIA PREFERRED ALTERNATIVES LIST <ul style="display: flex;"><li style="flex:1">DRUG NAME(S) </li><li style="flex:1">PREFERRED ALTERNATIVE(S)* </li><li style="flex:1">DRUG NAME(S) </li><li style="flex:1">PREFERRED ALTERNATIVE(S)* </li></ul>estradiol, estropipate, ENJUVIA, PREMARIN fenofibrate, TRICOR, TRILIPIX ANDRODERM, ANDROGEL metformin ext-rel ACIPHEX lansoprazole, omeprazole, omeprazole- sodium bicarbonate capsule, pantoprazole FEMTRACE FENOGLIDE ADVICOR ALORA SIMCOR FIRST TESTOSTERONE FORTAMET estradiol, EVAMIST, VIVELLE-DOT ALTOPREV ALVESCO pravastatin <ul style="display: flex;"><li style="flex:1">FORTESTA </li><li style="flex:1">ANDRODERM, ANDROGEL </li></ul>alendronate ASMANEX, FLOVENT, PULMICORT FLEXHALER, QVAR FOSAMAX PLUS D <ul style="display: flex;"><li style="flex:1">FREESTYLE STRIPS AND KITS </li><li style="flex:1">ACCU-CHEK STRIPS AND KITS 3, </li></ul>ONETOUCH STRIPS AND KITS 3 ANGELIQ estradiol-norethindrone, PREMPHASE, PREMPRO ARMOUR THYROID ASCENSIA STRIPS AND KITS levothyroxine, SYNTHROID FROVA sumatriptan ACCU-CHEK STRIPS AND KITS 3, ONETOUCH STRIPS AND KITS 3 GLUMETZA HUMALOG HUMALOG MIX 50/50 HUMALOG MIX 75/25 HUMULIN metformin ext-rel NOVOLOG ATACAND, ATACAND HCT losartan, losartan-hydrochlorothiazide, BENICAR, BENICAR HCT, DIOVAN, DIOVAN HCT, MICARDIS, MICARDIS HCT NOVOLOG MIX 70/30 NOVOLOG MIX 70/30 ATELVIA alendronate 70 mg NOVOLIN ATROVENT HFA AVAPRO, AVALIDE AXERT SPIRIVA INNOPRAN XL ISTALOL

Preferred Drug List

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