CVS CAREMARK® MAINTENANCE DRUG LIST EFFECTIVE AS OF 09/02/2020 Maintenance drugs are prescriptions commonly used to treat conditions that are considered chronic or long-term. These conditions usually require regular, daily use of medicines. Examples of maintenance drugs are those used to treat high blood pressure, heart disease, asthma and diabetes. Due to the large number of available medicines, this list is not all inclusive. Please note that this list does not guarantee coverage and is subject to change. Your prescription benefit plan may not cover certain products or categories, regardless of their appearance on this list. Where a generic is available, it is listed by the generic name. If no generic is available, then the brand name appears. This list represents brand products in CAPS and generic products in lower case italics. If you have questions about your prescription benefits, please log on to your account at Caremark.com or call Customer Care at the number on your ID card. Attention pentoxifylline Depression Deficit/Hyperactivity prasugrel bupropion ticlopidine Disorder (ADHD) citalopram ZONTIVITY desvenlafaxine atomoxetine duloxetine clonidine er Cancer escitalopram guanfacine er anastrozole fluoxetine exemestane fluvoxamine Allergies letrozole mirtazapine desloratidine tamoxifen nefazodone levocetirizine toremifene paroxetine sertraline Alzheimer’s Disease Contraceptives trazodone donepezil ethinyl estradiol-desogestrel venlafaxine galantamine ethinyl estradiol-drospirenone APLENZIN memantine ethinyl estradiol-ethynodiol FETZIMA rivastigmine ethinyl estradiol- etonogestrel TRINTELLIX NAMZARIC ethinyl estradiol-levonorgestrel VIIBRYD ethinyl estradiol-norelgestromin Antipsychotics ethinyl estradiol-norethindrone Diabetes Aripiprazole ethinyl estradiol-norgestimate acarbose brexipiprazole ethinyl estradiol-norgestrel chlorpropamide loxapine ethinyl estradiol-drospirenone- glimepiride olanzapine levomefo glipizide paliperidone LO LOESTRIN glyburide quetiapine IR/ER NATAZIA metformin risperidone miglitol thiothixene Hormone Replacement nateglinide estradiol pioglitazone -Combinations estradiol gel repaglinidine Olanzapine/fluoxetine estradiol transdermal tolazamide ESTRING tolbutamide Blood Modifiers EVAMIST AVANDIA Anagrelide IMVEXXY CYCLOSET aspirin-dipyridamole MENEST SYMLIN cilostazol PREMARIN clopidogrel dipyridamole This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. ©2020 CVS Caremark. All rights reserved. 106-18393A 091820 1 of 3 -Combinations ZIOPTAN -Calcium Channel Blockers alogliptin/pioglitazone amlodipine glipizide/metformin -Combinations diltiazem glyburide/metformin dorzolamide/timolol felodipine pioglitazone/glimepiride COMBIGAN isradipine pioglitazone/metformin nicardipine Gout nifedipine -Test Strips/Lancets/Meters allopurinol nisoldipine glucose meter probenecid/colchicine verapamil glucose test strip insulin pump Heart Disease & High Blood -Combinations insulin syringes and needles Pressure amlodipine/atorvastatin ALBUSTIX amlodipine/hctz CHEMSTRIPS -Angiotensin-Converting-Enzyme amlodipine/olmesartan NOVA MAX PLUS KETONE (ACE) Inhibitors amlodipine/valsartan benazepril amlodipine/olmesartan/hctz Digestive Enzymes captopril amlodipine/valsartan/hctz enalapril pancrelipase atenolol/chlorthalidone fosinopril CREON benazepril/hctz lisinopril PANCREAZE bisoprolol/hctz moexipril ZENPEP candesartan/hctz perindopril clonidine/chlorthalidone quinapril Diuretics captopril/hctz ramipril enalapril/hctz acetazolamide trandolapril fosinopril/hctz amiloride irbesartan/hctz chlorthalidone -Angiotensin II Receptor lisinopril/hctz dyrenium Antagonists losartan/hctz hydrochlorothiazide (hctz) candesartan methyldopa/hctz methazolamide eprosartan metoprolol/hctz spironolactone irbesartan moexipril/hctz losartan nadolol/bendroflumethiazide -Combinations telmisartan olmesartan/hctz hctz/spironolactone valsartan propranolol/hctz hctz/triamterene EDARBI quinapril/hctz telmisartan/amlodipine Enlarged Prostate -Antiarrhythmics telmisartan/hctz Alfuzosin amiodarone trandolapril/verapamil Dutasteride disopyramide valsartan/hctz dutasteride/tamsulosin flecainide EDARBYCLOR finasteride mexiletine PRESTALIA silodosin propafenone TEKTURNA HCT tamsulosin quinidine gluconate terazosin quinidine sulfate -Miscellaneous Cardiovascular CARDURA XL MULTAQ aliskiren clonidine Glaucoma -Beta Blockers guanfacine betaxolol acebutolol hydralazine bimatoprost atenolol isoxsuprine brimonidine betaxolol methyldopa carbachol bisoprolol minoxidil carteolol carvedilol prazosin dorzolamide labetalol ranolazine latanoprost levatol reserpine levobunolol metoprolol BIDIL methazolamide nadolol metipranolol pindolol High Cholesterol phospholine propranolol atorvastatin timolol sotalol cholestyramine travoprost timolol colesevelam AZOPT BYSTOLIC colestipo LUMIGAN ezetimibe This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. ©2020 CVS Caremark. All rights reserved. 106-18393A 091820 2 of 3 ezetimibe/simvastatin Parkinson’s Disease Seizure Disorders fenofibrate micronized benztropine carbamazepine fluvastatin bromocriptine divalproex gemfibrozil carbidopa ethosuximide lovastatin carbidopa/levodopa felbamate omega-3-acid ethyl ester (fda carbidopa/levodopa/entacapone lamotrigine approved) entacapone levetiracetam niacin cr pramipexole oxcarbazepine pravastatin ropinirole primidone rosuvastatin tolcapone tiagabine simvastatin trihexyphenidyl topiramate LIVALO NEUPRO topiramate er VASCEPA RYTARY valproic acid XADAGO zonisamide Immune Disorders APTIOM azathioprine Respiratory Agents CELONTIN aminophylline PEGANONE Inflammatory Bowel Disease budesonide TROKENDI XR sulfasalazine budesonide/formoterol DIPENTUM cromolyn Thyroid dyphylline levothyroxine Gastrointestinal Agents fluticasone/salmeterol liothyronine formoterol thyroid AMITIZA ipratropium ipratropium/albuterol Ulcer/Gastroesophageal Kidney Disease metaproterenol Reflux Disease (GERD) calcitriol montelukast cimetidine calcium acetate terbutaline esomeprazole magnesium lanthanum carbonate theophylline famotidine tab sevelamer hcl zafirlukast lansoprazole sevelamer carbonate ADVAIR HFA nizatidine AURYXIA ALVESCO omeprazole VELPHORO ANORO ELLIPTA omeprazole/sodium bicarbonate ARCAPTA pantoprazole Miscellaneous ARNUITY ELLIPTA rabeprazole cevimeline ASMANEX ranitidine ergoloid mesylate BEVESPI sucralfate pilocarpine BREO ELLIPTA DEXILANT ursodiol BROVANA ESOMEPRAZOLE STRONTIUM CUVPOSA DULERA NASCOBAL FLOVENT INCRUSE ELLIPTA Osteoporosis QVAR REDIHALER alendronate SEEBRI NEOHALER calcitonin SEREVENT ibandronate SPIRIVA raloxifene STIOLTO RESPIMAT risedronate STRIVERDI BINOSTO TUDORZA FOSAMAX D UTIBRON ZYFLO Overactive Bladder darifenacin Rheumatoid Arthritis flavoxate leflunomide oxybutynin RIDAURA solifenacin tolterodine trospium TOVIAZ This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. ©2020 CVS Caremark. All rights reserved. 106-18393A 091820 3 of 3 .