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.

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.

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.

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 copay¹information, please visit www.caremark.com 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 www.caremark.com 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

§ 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 www.caremark.com 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

§ H₂RECEPTOR 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

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

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

ACANYA ACCU-CHEK STRIPS AND

metoprolol 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

COREG 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

nadolol

GELNIQUE

glimepiride glipizide glipizide ext-rel glipizide-metformin naratriptan

NASONEX NATAZIA

nateglinide

NEXIUM

DETROL DETROL LA DEXILANT

dicloxacillin

DIFFERIN

digoxin diltiazem ext-rel

DIOVAN DIOVAN HCT

doxazosin doxycycline hyclate

DUAC
NIASPAN

nifedipine ext-rel nitrofurantoin

NORDITROPIN NOVOLIN NOVOLOG NUVARING
HUMIRA HUMULIN R U-500

hydrochlorothiazide

ipratropium-albuterol inhalation solution itraconazole

SYNVISC-ONE

omeprazole azelastine

azithromycin

omeprazole-sodium bicarbonate capsule

ONETOUCH STRIPS AND KITS ³ONGLYZA ORTHO EVRA ORTHO TRI-CYCLEN LO

oxybutynin oxybutynin ext-rel

DUETACT DULERA

TAMIFLU

tamsulosin

TEKAMLO TEKTURNA TEKTURNA HCT

terazosin terbinafine tablet tetracycline timolol maleate solution torsemide

JANUMET JANUVIA
BD INSULIN SYRINGES

AND NEEDLES BENICAR BENICAR HCT BETASERON BETIMOL BETOPTIC S BEYAZ BONIVA

ENABLEX ENBREL ENJUVIA EPIDUO EPIPEN EPIPEN JR

erythromycin solution erythromycin-benzoyl peroxide erythromycins estradiol

KOMBIGLYZE XR

lansoprazole

LANTUS

latanoprost

pantoprazole 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

valacyclovir

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

fenofibrate finasteride

FLOVENT

quinapril quinapril- hydrochlorothiazide

MAXALT

medroxyprogesterone

VICTOZA

VIIBRYD VIVELLE-DOT

zolpidem zolpidem ext-rel

warfarin

WELCHOL
XARELTO

zafirlukast

PREFERRED ALTERNATIVES LIST

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

alendronate

ASMANEX, FLOVENT, PULMICORT FLEXHALER, QVAR
FOSAMAX PLUS D

ONETOUCH STRIPS AND KITS ³
ANGELIQ

estradiol-norethindrone, PREMPHASE, PREMPRO

ARMOUR THYROID ASCENSIA STRIPS AND KITS

levothyroxine, SYNTHROID

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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