Preventive medications list This list provides examples of commonly prescribed preventive Medications, it is not an all-inclusive list; only examples of medicines in each category are listed. Coverage prior to the deductible being met may not be provided for every dosage form of a listed medication. This list does not indicate coverage. Please check with your plan administrator and/or benefit information materials if you have questions on coverage. Your cost share will be determined by your plan’s drug coverage and formulary plan. BONE DISEASE AND FRACTURES PERSANTINE VYTORIN ACTONEL, ATELVIA DIPYRIDAMOLE WELCHOL RISEDRONATE PLAVIX ZETIA CLOPIDOGREL BONIVA HIGH BLOOD PRESSURE IBANDRONATE PRADAXA EVISTA SAVAYSA ACE INHIBITORS: TICLOPIDINE RALOXIFENE XARELTO ACCUPRIL FOSAMAX, FOSAMAX PLUS D ZONTIVITY QUINAPRIL ALENDRONATE LOTENSIN RECLAST CHOLESTEROL LOWERING BENAZEPRIL ZOLEDRONIC ACID MEDICINES PRINIVIL, ZESTRIL CAVITIES HMG-COA REDUCTASE INHIBITORS: LISINOPRIL CLINPRO, PHOS-FLUR VASOTEC CRESTOR ENALAPRIL PREVIDENT ROSUVASTATIN ACE INHIBITORS/DIURETIC SODIUM FLUORIDE RINSE AND GEL LESCOL STANNOUS FLUORIDE PASTE AND RINSE COMBINATIONS: FLUVASTATIN COLONOSCOPY PREPARATION* LIPITOR ACCURETIC GOLYTELY, NULYTELY, MOVIPREP ATORVASTATIN QUINAPRIL/HCTZ LOVASTATIN POLYETHYLENE GLYCOL LOTENSIN HCT OSMOPREP PRAVACHOL BENAZEPRIL/HCTZ PRAVASTATIN PREPOPIK VASERETIC ZOCOR SUPREP ENALAPRIL/HCTZ SIMVASTATIN ZESTORETIC HEART DISEASE AND STROKE OTHER AGENTS: LISINOPRIL/HCTZ COLESTID BLOOD THINNER MEDICINES: ANGIOTENSIN II RECEPTOR COLESTIPOL ANTAGONISTS: ASPIRIN, 81 MG OR 325 MG LOPID AGGRENOX ATACAND GEMFIBROZIL ASPIRIN-DIPYRIDAMOLE ER CANDESARTAN BRILINTA PREVALITE, QUESTRAN AVAPRO COUMADIN CHOLESTYRAMINE IRBESARTAN TRICOR, ANTARA WARFARIN COZAAR FENOFIBRATE LOSARTAN DURLAZA ER TRILIPIX EFFIENT DIOVAN FENOFIBRIC ACID ELIQUIS VALSARTAN MG6754D (over, please) Preventive Medications List ANGIOTENSIN II RECEPTOR CALAN, VERELAN OBESITY ANTAGONISTS/ DIURETIC VERAPAMIL ADIPEX-P COMBINATIONS: CARDIZEM LA, TIAZAC ER PHENTERMINE ATACAND HCT DILTIAZEM BELVIQ CANDESARTAN/HCTZ NORVASC CONTRAVE AMLODIPINE AVALIDE DIETHYLPROPION IRBESARTAN/HCTZ DIURETICS: DIDREX DIOVAN HCT CHLORTHALIDONE BENZPHETAMINE VALSARTAN/HCTZ HYDROCHLOROTHIAZIDE PHENDIMETRAZINE HYZAAR INDAPAMIDE SAXENDA LOSARTAN/HCTZ METOLAZONE XENICAL BETA BLOCKERS: OTHER HIGH BLOOD PRESSURE SMOKING-CESSATION * MEDICINE COMBINATIONS: BYSTOLIC CHANTIX INDERAL LA, INNOPRAN XL AZOR NICOTROL/NICODERM CQ PROPRANOLOL CADUET NICOTINE PRODUCTS TENORMIN AMLODIPINE/ATORVASTATIN ZYBAN ATENOLOL EXFORGE HCT BUPROPION SR 150MG TOPROL XL AMLODIPINE/VALSARTAN/HCTZ IMMUNIZATION: * METOPROLOL LOTREL ZEBETA AMLODIPINE/BENAZEPRIL ANTHRAX BISOPROLOL DIPHTHERIA, PERTUSSIS, TETANUS, PRESTALIA HAEMOPHILUS INFLUENZAE B, BETA BLOCKERS/DIURETIC TARKA HEPATITIS A AND B, JE-VAX, TYPHIM, COMBINATIONS: TRANDOLAPRIL/VERAPAMIL VARICELLA, ZOSTER, HUMAN TRIBENZOR PAPILLOMAVIRUS, INFLUENZA, PROPRANOLOL/HCTZ TWYNSTA MEASLES, MENINGOCOCCAL, MUMPS, PNEUMOCOCCAL, POLIOVIRUS, CORZIDE AMLODIPINE/TELMISARTAN NADOLOL/BENDROFLUMETHIAZIDE ROTAVIRUS, RUBELLA LOPRESSOR HCT RESPIRATORY SYNCYTIAL VIRUS VITAMINS OR MINERALS METOPROLOL/HCTZ SYNAGIS FOLIC ACID* TENORETIC PRENATAL VITAMINS ATENOLOL/CHLORTHALIDONE MALARIA PEDIATRIC MULTIVITAMINS ZIAC CHLOROQUINE WITH FLUORIDE* BISOPROLOL/HCTZ MEFLOQUINE CALCIUM CHANNEL BLOCKERS: PRIMAQUINE MALARONE ADALAT CC, PROCARDIA XL ATOVAQUONE/PROGUANIL NIFEDIPINE *Please note that some of these medications are also subject to the Affordable Care Act (ACA) and may be covered by your plan at 100%. Express Scripts manages your prescription benefit for your employer, plan sponsor, or health plan. For specific questions on coverage, please call the phone number on your ID card or visit our website express-scripts.com. Please note: Brand names are shown in italics in each category. If generics are available, they are listed under the brand name. All rights in the product names of all third-party products appearing here, whether or not appearing with the trademark symbol, belong exclusively to their respective owners. CRP15_1293 MG6754D 8.16 MG6754D.