Post on 06-May-2022
1
Bold type = Brand-name drug[Plain type = Generic drug]
E = May be excluded from coverage *Coverage is provided for oral formulations
Therapeutic Drug Classes Requirements & Limits
Breast Cancer Prevention
Anastrozole
Arimidex E
Aromasin
Exemestane
Fareston
Femara E
Letrozole
Soltamox E
Tamoxifen
Cardiovascular/Heart Disease: Blood Clot/Platelet Therapy
Aggrenox
Arixtra
Aspirin-Dipyridamole
Bevyxxa
Brilinta
Cilostazol
Clopidogrel
Coumadin
Therapeutic Drug Classes Requirements & Limits
Dipyridamole
Effient E
Eliquis
Enoxaparin
Fragmin
Fondaparinux
Heparin
Jantoven
Lovenox
Persantine
Plavix E
Pletal
Pradaxa
Prasugrel
Savaysa
Ticlopidine
Warfarin
Xarelto
Zontivity
2018 Preventive Drug List forConsumer Driven Health PlansCore Plus ListEffective July 1, 2018
Core Plus Drug List
2
Bold type = Brand-name drug[Plain type = Generic drug]
E = May be excluded from coverage *Coverage is provided for oral formulations
Therapeutic Drug Classes Requirements & Limits
Cardiovascular/Heart Disease: High Blood Pressure
Accupril
Accuretic
Acebutolol
Aceon
Adalat CC
Afeditab
Aldactazide
Aldactone
Altace
Amiloride
Amiloride-Hydrochlorothiazide
Amlodipine
Amlodipine-Benazepril
Amlodipine-Olmesartan E
Amlodipine-Olmesartan-Hydrochlorothiazide E
Amlodipine-Valsartan
Amlodipine-Valsartan-Hydrochlorothiazide E
Amturnide E
Atacand
Atacand HCT
Atenolol
Atenolol-Chlorthalidone
Avalide
Avapro
Azor E
Benazepril
Benazepril-Hydrochlorothiazide
Benicar E
Benicar HCT E
Betaxolol*
Bidil
Bisoprolol
Therapeutic Drug Classes Requirements & Limits
Bisoprolol-Hydrochlorothiazide
Bumetanide
Bystolic
Byvalson
Calan
Calan SR
Candesartan
Candesartan-Hydrochlorothiazide
Captopril
Captopril-Hydrochlorothiazide
Cardene SR
Cardizem E
Cardizem CD E
Cardizem LA E
Cardura
Carospir
Cartia XT
Carvedilol
Carvedilol ER E
Catapres
Catapres TTS
Chlorothiazide
Clonidine
Clonidine Patch
Clorpress
Coreg
Coreg CR E
Corgard
Corzide
Covera HS
Cozaar
Demadex
Dilacor XR
3
Bold type = Brand-name drug[Plain type = Generic drug]
E = May be excluded from coverage *Coverage is provided for oral formulations
Therapeutic Drug Classes Requirements & Limits
Dilt CD
Dilt XR
Diltia XT
Diltiazem
Diltiazem ER
Diltzac ER
Diovan E
Diovan HCT E
Diuril
Doxazosin
Dutoprol E
Dyazide
Dynacirc CR
Dyrenium
Edarbi
Edarbyclor
Edecrin
Enalapril
Enalapril-Hydrochlorothiazide
Epaned
Eplerenone
Eprosartan
Ethacrynic Acid
Exforge E
Exforge HCT E
Felodipine ER
Fosinopril
Fosinopril-Hydrochlorothiazide
Furosemide
Guanfacine
Hydralazine
Hydrochlorothiazide
Hyzaar
Indapamide
Therapeutic Drug Classes Requirements & Limits
Inderal
Inderal LA E
Innopran XL
Inspra
Irbesartan
Irbesartan-Hydrochlorothiazide
Isoptin SR
Isradipine
Labetalol
Lasix
Levatol
Lisinopril
Lisinopril-Hydrochlorothiazide
Lopressor
Lopressor HCT
Losartan
Losartan-Hydrochlorothiazide
Lotensin
Lotensin HCT
Lotrel
Matzim LA
Mavik
Maxzide
Methyclothiazide
Methyldopa
Methyldopa-Hydrochlorothiazide
Metolazone
Metoprolol 37.5, 75 mg E
Metoprolol-Hydrochlorothiazide
Metoprolol Succinate
Metoprolol Tartrate
Micardis E
Micardis HCT E
Microzide
4
Bold type = Brand-name drug[Plain type = Generic drug]
E = May be excluded from coverage *Coverage is provided for oral formulations
Therapeutic Drug Classes Requirements & Limits
Midamor
Minipress
Minoxidil
Moexipril
Moexipril-Hydrochlorothiazide
Nadolol
Nadolol-Bendroflumethazide
Nicardipine
Nifedipine
Nifedipine ER
Nimodipine
Nisoldipine
Norvasc
Olmesartan
Olmesartan-Hydrochlorothiazide
Perindopril
Pindolol
Prazosin
Prestalia E
Prinivil
Procardia
Procardia XL
Propranolol
Propranolol-Hydrochlorothiazide
Qbrelis E
Quinapril
Quinapril-Hydrochlorothiazide
Ramipril
Reserpine
Sectral
Spironolactone
Spironolactone-Hydrochlorothiazide
Sular
Tarka
Therapeutic Drug Classes Requirements & Limits
Taztia XT
Tekturna
Tekturna HCT
Telmisartan
Telmisartan-Amlodipine E
Telmisartan-Hydrochlorothiazide
Tenex
Tenoretic E
Tenormin E
Terazosin
Teveten
Teveten HCT
Thalitone
Tiazac
Timolol*
Toprol XL
Torsemide
Trandate
Trandolapril
Trandolapril-Verapamil
Triamterene-Hydrochlorothiazide
Tribenzor E
Twynsta E
Uniretic
Univasc
Valsartan
Valsartan-Hydrochlorothiazide
Vaseretic E
Vasotec E
Verapamil
Verapamil ER
Verelan
Verelan PM
Zaroxolyn
5
Bold type = Brand-name drug[Plain type = Generic drug]
E = May be excluded from coverage *Coverage is provided for oral formulations
Therapeutic Drug Classes Requirements & Limits
Zebeta
Zestoretic E
Zestril E
Ziac
Cardiovascular/Heart Disease: High Cholesterol
Altoprev E
Antara E
Atorvastatin
Cholestyramine
Cholestyramine Light
Choline Fenofibrate E
Colestid
Colestipol
Crestor E
Ezetimibe
Fenofibrate 43, 50, 67, 130, 134, 150, 200 mg Capsule E
Fenofibrate 40, 48, 120, 145 mg Tablet E
Fenofibrate 54, 160 mg Tablet
Fenofibric Acid E
Fenoglide E
Fibricor E
Flolipid
Fluvastatin
Fluvastatin ER
Gemfibrozil
Lescol
Lescol XL E
Lipitor E
Lipofen E
Livalo E
Lofibra E
Lopid
Therapeutic Drug Classes Requirements & Limits
Lovastatin
Lovaza E
Mevacor
Niacin Extended-Release
Niacor
Niaspan
Omega-3 Acid Ethyl Esters
Pravachol
Pravastatin
Prevalite
Questran
Questran Light
Rosuvastatin
Simvastatin
Simvastatin/Ezetimibe
Tricor E
Triglide E
Trilipix E
Vascepa
Vytorin E
Welchol
Zetia E
Zocor
Diabetes: Diabetic Supplies
Contour Next EZ Meters
Contour Next Meters
Contour Next One Meters
Contour Next Test Strips
Diabetic Testing - Lancets
Insulin Needles/Syringes
OneTouch Diabetic Meters
OneTouch Diabetic Test Strips
6
Bold type = Brand-name drug[Plain type = Generic drug]
E = May be excluded from coverage *Coverage is provided for oral formulations
Therapeutic Drug Classes Requirements & Limits
Diabetes: Insulin
Admelog E
Afrezza E
Apidra
Basaglar
Fiasp E
Humalog
Humalog Junior
Humalog Mix 50/50
Humalog Mix 75/25
Humulin 50/50
Humulin 70/30
Humulin N
Humulin R
Lantus E
Levemir
Novolin 70/30
Novolin N
Novolin R
Novolog
Novolog Mix 70/30
Soliqua
Toujeo E
Tresiba E
Diabetes: Non-Insulin
Acarbose
ACTOplus Met
ACTOplus Met XR
Actos E
Adlyxin
Alogliptin E
Alogliptin-Metformin E
Alogliptin-Pioglitazone E
Amaryl
Therapeutic Drug Classes Requirements & Limits
Avandia
Bydureon
Bydureon BCise
Byetta
Cycloset
Diabeta
Duetact
Farxiga
Fortamet E
Glimepiride
Glipizide
Glipizide ER
Glipizide-Metformin
Glucophage
Glucophage XR
Glucotrol
Glucotrol XL
Glucovance
Glumetza E
Glyburide
Glyburide Micronized
Glyburide-Metformin
Glynase
Glyset
Glyxambi E
Invokamet
Invokamet XR
Invokana
Janumet
Janumet XR
Januvia
Jardiance
Jentadueto
Jentadueto XR
7
Bold type = Brand-name drug[Plain type = Generic drug]
E = May be excluded from coverage *Coverage is provided for oral formulations
Therapeutic Drug Classes Requirements & Limits
Kazano
Kombiglyze XR
Metformin
Metformin ER (generic Fortamet) E
Metformin ER (generic Glucophage XR)
Metformin ER (generic Glumetza) E
Miglitol
Nateglinide
Nesina
Onglyza
Oseni
Ozempic E
Pioglitazone
Pioglitazone-Glimepiride
Pioglitazone-Metformin
PrandiMet
Prandin
Precose
Qtern E
Repaglinide
Repaglinide-Metformin
Riomet
Segluromet E
Starlix
Steglatro E
Steglujan E
SymlinPen
Synjardy
Synjardy XR
Tolbutamide
Tradjenta
Trulicity
Victoza
Therapeutic Drug Classes Requirements & Limits
Xigduo XR E
Xultophy E
Immunosuppressant: Organ Rejection
Astagraf XL E
Azasan
Azathioprine
Cellcept E
Cyclosporine
Envarsus XR E
Gengraf
Imuran E
Mycophenolate
Mycophenolic Acid
Myfortic E
Neoral E
Prograf E
Rapamune E
Sandimmune E
Sirolimus
Tacrolimus
Zortress
Musculoskeletal: Osteoporosis
Actonel
Alendronate
Atelvia E
Binosto E
Boniva
Calcitonin (Salmon)
Didronel
Etidronate
Evista E
Forteo
Fortical
8
Bold type = Brand-name drug[Plain type = Generic drug]
E = May be excluded from coverage *Coverage is provided for oral formulations
Therapeutic Drug Classes Requirements & Limits
Ibandronate
Miacalcin
Raloxifene
Risedronate
Tymlos
Respiratory: Asthma/COPD
Accolate
Accuneb
Advair Diskus
Advair HFA
AirDuo RespiClick E
Albuterol Nebulized Solution
Albuterol Oral Tablet
Alvesco
Aminophylline
Anoro Ellipta
Arcapta Neohaler
ArmonAir RespiClick E
Arnuity Ellipta
Asmanex HFA
Asmanex Twisthaler
Atrovent HFA
Bevespi Aerosphere
Breo Ellipta
Brovana
Budesonide Nebulized Solution
Combivent Respimat
Cromolyn
Daliresp
Dulera E
Duoneb
Elixophyllin
Flovent Diskus
Therapeutic Drug Classes Requirements & Limits
Flovent HFA
Fluticasone/Salmeterol RespiClick
Foradil
Gastrocrom
Incruse Ellipta
Ipratropium
Ipratropium/Albuterol
Levalbuterol HFA
Levalbuterol Nebulized Solution E
Lufyllin
Metaproterenol
Montelukast
Perforomist
Proair HFA
Proair RespiClick
Proventil HFA
Pulmicort Flexhaler
Pulmicort Nebulized Solution
QVAR Redihaler
Seebri NeoHaler E
Serevent Diskus
Singulair E
Spiriva HandiHaler
Spiriva Respimat
Stiolto Respimat E
Striverdi Respimat
Symbicort
Terbutaline
Theo-24
Theophylline
Theophylline/Guaifenesin
Trelegy Ellipta E
Tudorza Pressair
9
Bold type = Brand-name drug[Plain type = Generic drug]
E = May be excluded from coverage *Coverage is provided for oral formulations
Therapeutic Drug Classes Requirements & Limits
Utibron NeoHaler E
Ventolin HFA
VoSpire ER
Xopenex HFA
Xopenex Nebulized Solution E
Zafirlukast
Zyflo
Zyflo CR
Therapeutic Drug Classes Requirements & Limits
Vitamins
Pediatric Flouride Preparations (for example: Florvite, Poly-Vi-Flor, Tri-Vi-Flor) - Brand Name and Generic Products
Prenatal Vitamins (for example: Citranatal Assure, Prenate DHA, Stuartnatal) - Brand Name and Generic Products
Clinical programs such as Notification/Prior Authorization, Step Therapy and Supply Limits may apply to listed medications based off your benefit plan. This list is intended as a reference and may not be all-inclusive. Brand or generic availability may not be current due to changes in the market. The list will be updated twice a year.
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IndexIndexA
Acarbose .................................................... 6Accolate ...................................................... 8Accuneb ...................................................... 8Accupril ....................................................... 2Accuretic ..................................................... 2Acebutolol .................................................. 2Aceon .......................................................... 2Actonel ........................................................ 7ACTOplus Met ........................................... 6ACTOplus Met XR .................................... 6Actos ............................................................ 6Adalat CC ................................................... 2Adlyxin ......................................................... 6Admelog ..................................................... 6Advair Diskus ............................................. 8Advair HFA.................................................. 8Afeditab ....................................................... 2Afrezza......................................................... 6Aggrenox .................................................... 1AirDuo RespiClick .................................... 8Albuterol Nebulized Solution ................. 8Albuterol Oral Tablet ................................ 8Aldactazide ................................................ 2Aldactone ................................................... 2Alendronate ................................................ 7Alogliptin ..................................................... 6Alogliptin-Metformin ................................ 6Alogliptin-Pioglitazone ............................. 6Altace ........................................................... 2Altoprev ....................................................... 5Alvesco ........................................................ 8Amaryl ......................................................... 6Amiloride ..................................................... 2Amiloride-Hydrochlorothiazide ............. 2Aminophylline ............................................ 8Amlodipine ................................................. 2Amlodipine-Benazepril ............................ 2Amlodipine-Olmesartan .......................... 2Amlodipine-Olmesartan-
Hydrochlorothiazide ............................. 2Amlodipine-Valsartan .............................. 2Amlodipine-Valsartan-
Hydrochlorothiazide ............................. 2Amturnide ................................................... 2Anastrozole ................................................ 1Anoro Ellipta ............................................... 8Antara .......................................................... 5
Apidra .......................................................... 6Arcapta Neohaler ..................................... 8Arimidex ...................................................... 1Arixtra .......................................................... 1ArmonAir RespiClick ............................... 8Arnuity Ellipta ............................................. 8Aromasin ..................................................... 1Asmanex HFA ............................................ 8Asmanex Twisthaler ................................. 8Aspirin-Dipyridamole ............................... 1Astagraf XL ................................................. 7Atacand ....................................................... 2Atacand HCT ............................................. 2Atelvia .......................................................... 7Atenolol ....................................................... 2Atenolol-Chlorthalidone .......................... 2Atorvastatin ................................................ 5Atrovent HFA .............................................. 8Avalide ......................................................... 2Avandia........................................................ 6Avapro ......................................................... 2Azasan......................................................... 7Azathioprine ............................................... 7Azor .............................................................. 2
B
Basaglar ...................................................... 6Benazepril .................................................. 2Benazepril-Hydrochlorothiazide ........... 2Benicar ........................................................ 2Benicar HCT .............................................. 2Betaxolol ..................................................... 2Bevespi Aerosphere................................. 8Bevyxxa....................................................... 1Bidil .............................................................. 2Binosto ........................................................ 7Bisoprolol .................................................... 2Bisoprolol-Hydrochlorothiazide ............ 2Boniva .......................................................... 7Breo Ellipta ................................................. 8Brilinta.......................................................... 1Brovana ....................................................... 8Budesonide Nebulized Solution ........... 8Bumetanide ................................................ 2Bydureon .................................................... 6Bydureon BCise ........................................ 6Byetta .......................................................... 6Bystolic ........................................................ 2
Byvalson ..................................................... 2
C
Calan ............................................................ 2Calan SR ..................................................... 2Calcitonin (Salmon) .................................. 7Candesartan .............................................. 2Candesartan-Hydrochlorothiazide ....... 2Captopril ..................................................... 2Captopril-Hydrochlorothiazide .............. 2Cardene SR................................................ 2Cardizem..................................................... 2Cardizem CD ............................................. 2Cardizem LA .............................................. 2Cardura ....................................................... 2Carospir....................................................... 2Cartia XT ..................................................... 2Carvedilol .................................................... 2Carvedilol ER ............................................. 2Catapres ..................................................... 2Catapres TTS ............................................ 2Cellcept ....................................................... 7Chlorothiazide ........................................... 2Cholestyramine ......................................... 5Cholestyramine Light .............................. 5Choline Fenofibrate .................................. 5Cilostazol .................................................... 1Clonidine ..................................................... 2Clonidine Patch ......................................... 2Clopidogrel ................................................. 1Clorpress .................................................... 2Colestid ....................................................... 5Colestipol .................................................... 5Combivent Respimat ............................... 8Contour Next EZ Meters ......................... 5Contour Next Meters ............................... 5Contour Next One Meters ...................... 5Contour Next Test Strips ........................ 5Coreg ........................................................... 2Coreg CR .................................................... 2Corgard ....................................................... 2Corzide ........................................................ 2Coumadin ................................................... 1Covera HS .................................................. 2Cozaar ......................................................... 2Crestor ......................................................... 5Cromolyn .................................................... 8Cycloset ...................................................... 6
11
Cyclosporine .............................................. 7
D
Daliresp ....................................................... 8Demadex .................................................... 2Diabeta ........................................................ 6Diabetic Testing - Lancets ...................... 5Didronel ....................................................... 7Dilacor XR ................................................... 2Dilt CD ......................................................... 3Dilt XR .......................................................... 3Diltia XT ....................................................... 3Diltiazem ..................................................... 3Diltiazem ER ............................................... 3Diltzac ER ................................................... 3Diovan .......................................................... 3Diovan HCT ................................................ 3Dipyridamole .............................................. 1Diuril ............................................................. 3Doxazosin ................................................... 3Duetact ........................................................ 6Dulera .......................................................... 8Duoneb ....................................................... 8Dutoprol ...................................................... 3Dyazide ....................................................... 3Dynacirc CR ............................................... 3Dyrenium .................................................... 3
E
Edarbi .......................................................... 3Edarbyclor .................................................. 3Edecrin ........................................................ 3Effient ........................................................... 1Eliquis .......................................................... 1Elixophyllin .................................................. 8Enalapril ...................................................... 3Enalapril-Hydrochlorothiazide ............... 3Enoxaparin ................................................. 1Envarsus XR ............................................... 7Epaned ........................................................ 3Eplerenone ................................................. 3Eprosartan .................................................. 3Ethacrynic Acid ......................................... 3Etidronate ................................................... 7Evista ........................................................... 7Exemestane ............................................... 1Exforge ........................................................ 3Exforge HCT .............................................. 3Ezetimibe .................................................... 5
F
Fareston ...................................................... 1Farxiga ......................................................... 6Felodipine ER ............................................ 3Femara ........................................................ 1Fenofibrate 40, 48, 120, 145 mg
Tablet ....................................................... 5Fenofibrate 43, 50, 67, 130, 134, 150,
200 mg Capsule ................................... 5Fenofibrate 54, 160 mg Tablet .............. 5Fenofibric Acid .......................................... 5Fenoglide .................................................... 5Fiasp ............................................................ 6Fibricor ........................................................ 5Flolipid ......................................................... 5Flovent Diskus ........................................... 8Flovent HFA ................................................ 8Fluticasone/Salmeterol RespiClick ...... 8Fluvastatin .................................................. 5Fluvastatin ER ............................................ 5Fondaparinux............................................. 1Foradil .......................................................... 8Fortamet .................................................6, 7Forteo .......................................................... 7Fortical ......................................................... 7Fosinopril .................................................... 3Fosinopril-Hydrochlorothiazide ............. 3Fragmin ....................................................... 1Furosemide ................................................ 3
G
Gastrocrom ................................................ 8Gemfibrozil ................................................. 5Gengraf ....................................................... 7Glimepiride ................................................. 6Glipizide ...................................................... 6Glipizide ER ................................................ 6Glipizide-Metformin .................................. 6Glucophage ...........................................6, 7Glucophage XR .....................................6, 7Glucotrol ..................................................... 6Glucotrol XL ............................................... 6Glucovance ................................................ 6Glumetza ................................................6, 7Glyburide .................................................... 6Glyburide Micronized .............................. 6Glyburide-Metformin ................................ 6Glynase ....................................................... 6Glyset ........................................................... 6Glyxambi ..................................................... 6
Guanfacine ................................................. 3
H
Heparin ........................................................ 1Humalog ..................................................... 6Humalog Junior......................................... 6Humalog Mix 50/50 ................................. 6Humalog Mix 75/25 ................................. 6Humulin 50/50 .......................................... 6Humulin 70/30 .......................................... 6Humulin N ................................................... 6Humulin R ................................................... 6Hydralazine ................................................ 3Hydrochlorothiazide ................................. 3Hyzaar ......................................................... 3
I
Ibandronate ................................................ 8Imuran ......................................................... 7Incruse Ellipta ............................................ 8Indapamide ................................................ 3Inderal .......................................................... 3Inderal LA ................................................... 3Innopran XL................................................ 3Inspra ........................................................... 3Insulin Needles/Syringes ........................ 5Invokamet ................................................... 6Invokamet XR ............................................ 6Invokana ...................................................... 6Ipratropium ................................................. 8Ipratropium/Albuterol .............................. 8Irbesartan ................................................... 3Irbesartan-Hydrochlorothiazide ............ 3Isoptin SR ................................................... 3Isradipine .................................................... 3
J
Jantoven ...................................................... 1Janumet ...................................................... 6Janumet XR ............................................... 6Januvia ........................................................ 6Jardiance .................................................... 6Jentadueto ................................................. 6Jentadueto XR ........................................... 6
K
Kazano ........................................................ 7Kombiglyze XR .......................................... 7
L
Labetalol ..................................................... 3
12
Lantus .......................................................... 6Lasix ............................................................. 3Lescol .......................................................... 5Lescol XL .................................................... 5Letrozole ..................................................... 1Levalbuterol HFA ...................................... 8Levalbuterol Nebulized Solution ........... 8Levatol ......................................................... 3Levemir ........................................................ 6Lipitor ........................................................... 5Lipofen ........................................................ 5Lisinopril ...................................................... 3Lisinopril-Hydrochlorothiazide .............. 3Livalo ............................................................ 5Lofibra ......................................................... 5Lopid ............................................................ 5Lopressor ................................................... 3Lopressor HCT .......................................... 3Losartan ...................................................... 3Losartan-Hydrochlorothiazide ............... 3Lotensin ...................................................... 3Lotensin HCT ............................................. 3Lotrel ............................................................ 3Lovastatin ................................................... 5Lovaza ......................................................... 5Lovenox ....................................................... 1Lufyllin ......................................................... 8
M
Matzim LA .................................................. 3Mavik ........................................................... 3Maxzide....................................................... 3Metaproterenol .......................................... 8Metformin ................................................... 7Metformin ER (generic Fortamet) ......... 7Metformin ER (generic
Glucophage XR) ................................... 7Metformin ER (generic Glumetza) ........ 7Methyclothiazide ....................................... 3Methyldopa ................................................ 3Methyldopa-Hydrochlorothiazide ......... 3Metolazone ................................................. 3Metoprolol 37.5, 75 mg ........................... 3Metoprolol Succinate ............................... 3Metoprolol Tartrate ................................... 3Metoprolol-Hydrochlorothiazide ........... 3Mevacor ...................................................... 5Miacalcin ..................................................... 8Micardis....................................................... 3Micardis HCT ............................................. 3
Microzide .................................................... 3Midamor ...................................................... 4Miglitol ......................................................... 7Minipress .................................................... 4Minoxidil ...................................................... 4Moexipril ..................................................... 4Moexipril-Hydrochlorothiazide .............. 4Montelukast ............................................... 8Mycophenolate ......................................... 7Mycophenolic Acid .................................. 7Myfortic ....................................................... 7
N
Nadolol ........................................................ 4Nadolol-Bendroflumethazide ................ 4Nateglinide ................................................. 7Neoral .......................................................... 7Nesina ......................................................... 7Niacin Extended-Release ....................... 5Niacor .......................................................... 5Niaspan ....................................................... 5Nicardipine ................................................. 4Nifedipine ................................................... 4Nifedipine ER ............................................. 4Nimodipine ................................................. 4Nisoldipine.................................................. 4Norvasc ....................................................... 4Novolin 70/30 ............................................ 6Novolin N .................................................... 6Novolin R .................................................... 6Novolog ....................................................... 6Novolog Mix 70/30 .................................. 6
O
Olmesartan ................................................ 4Olmesartan-Hydrochlorothiazide ......... 4Omega-3 Acid Ethyl Esters .................... 5OneTouch Diabetic Meters ..................... 5OneTouch Diabetic Test Strips .............. 5Onglyza ....................................................... 7Oseni ............................................................ 7Ozempic ...................................................... 7
P
Pediatric Flouride Preparations (for example: Florvite, Poly-Vi-Flor, Tri-Vi-Flor) - Brand Name and Generic Products ................................. 9
Perforomist ................................................. 8Perindopril .................................................. 4Persantine .................................................. 1
Pindolol ....................................................... 4Pioglitazone ............................................... 7Pioglitazone-Glimepiride ........................ 7Pioglitazone-Metformin ........................... 7Plavix ............................................................ 1Pletal ............................................................ 1Pradaxa ....................................................... 1PrandiMet ................................................... 7Prandin ........................................................ 7Prasugrel ..................................................... 1Pravachol .................................................... 5Pravastatin .................................................. 5Prazosin ...................................................... 4Precose ....................................................... 7Prenatal Vitamins (for example:
Citranatal Assure, Prenate DHA, Stuartnatal) - Brand Name and Generic Products ................................. 9
Prestalia ...................................................... 4Prevalite ....................................................... 5Prinivil .......................................................... 4Proair HFA .................................................. 8Proair RespiClick ...................................... 8Procardia .................................................... 4Procardia XL .............................................. 4Prograf ......................................................... 7Propranolol ................................................. 4Propranolol-Hydrochlorothiazide ......... 4Proventil HFA ............................................. 8Pulmicort Flexhaler .................................. 8Pulmicort Nebulized Solution ................ 8
Q
Qbrelis ......................................................... 4Qtern ............................................................ 7Questran ..................................................... 5Questran Light ........................................... 5Quinapril ..................................................... 4Quinapril-Hydrochlorothiazide .............. 4QVAR Redihaler ........................................ 8
R
Raloxifene ................................................... 8Ramipril ....................................................... 4Rapamune .................................................. 7Repaglinide ................................................ 7Repaglinide-Metformin ........................... 7Reserpine ................................................... 4Riomet ......................................................... 7Risedronate ................................................ 8Rosuvastatin .............................................. 5
13
S
Sandimmune ............................................. 7Savaysa ....................................................... 1Sectral ......................................................... 4Seebri NeoHaler ....................................... 8Segluromet ................................................. 7Serevent Diskus ........................................ 8Simvastatin ................................................. 5Simvastatin/Ezetimibe ............................. 5Singulair ...................................................... 8Sirolimus ..................................................... 7Soliqua ........................................................ 6Soltamox ..................................................... 1Spiriva HandiHaler ................................... 8Spiriva Respimat ....................................... 8Spironolactone .......................................... 4Spironolactone-Hydrochlorothiazide ... 4Starlix ........................................................... 7Steglatro ...................................................... 7Steglujan ..................................................... 7Stiolto Respimat ........................................ 8Striverdi Respimat .................................... 8Sular ............................................................. 4Symbicort ................................................... 8SymlinPen ................................................... 7Synjardy ...................................................... 7Synjardy XR ................................................ 7
T
Tacrolimus .................................................. 7Tamoxifen ................................................... 1Tarka ............................................................ 4Taztia XT ..................................................... 4Tekturna ...................................................... 4Tekturna HCT ............................................ 4Telmisartan ................................................. 4Telmisartan-Amlodipine .......................... 4Telmisartan-Hydrochlorothiazide.......... 4Tenex ........................................................... 4Tenoretic ..................................................... 4Tenormin ..................................................... 4Terazosin..................................................... 4Terbutaline .................................................. 8Teveten ........................................................ 4Teveten HCT .............................................. 4Thalitone ..................................................... 4Theo-24 ....................................................... 8Theophylline .............................................. 8Theophylline/Guaifenesin ...................... 8Tiazac .......................................................... 4Ticlopidine .................................................. 1
Timolol ......................................................... 4Tolbutamide ............................................... 7Toprol XL..................................................... 4Torsemide ................................................... 4Toujeo .......................................................... 6Tradjenta ..................................................... 7Trandate ...................................................... 4Trandolapril ................................................ 4Trandolapril-Verapamil ............................ 4Trelegy Ellipta ............................................ 9Tresiba ......................................................... 6Triamterene-Hydrochlorothiazide ......... 4Tribenzor ..................................................... 4Tricor ............................................................ 5Triglide ......................................................... 5Trilipix ........................................................... 5Trulicity ........................................................ 7Tudorza Pressair ....................................... 9Twynsta ....................................................... 4Tymlos ......................................................... 8
U
Uniretic ........................................................ 4Univasc ........................................................ 4Utibron NeoHaler E .................................. 9
V
Valsartan ..................................................... 4Valsartan-Hydrochlorothiazide .............. 4Vascepa ...................................................... 5Vaseretic ..................................................... 4Vasotec ........................................................ 4Ventolin HFA .............................................. 9Verapamil .................................................... 4Verapamil ER ............................................. 4Verelan ........................................................ 4Verelan PM ................................................. 4Victoza ......................................................... 7VoSpire ER ................................................. 9Vytorin ......................................................... 5
W
Warfarin ....................................................... 1Welchol ....................................................... 5
X
Xarelto ......................................................... 1Xigduo XR................................................... 7Xopenex HFA ............................................. 9Xopenex Nebulized Solution ................. 9Xultophy ...................................................... 7
Z
Zafirlukast ................................................... 9Zaroxolyn .................................................... 4Zebeta ......................................................... 5Zestoretic .................................................... 5Zestril ........................................................... 5Zetia ............................................................. 5Ziac............................................................... 5Zocor ........................................................... 5Zontivity ....................................................... 1Zortress ....................................................... 7Zyflo ............................................................. 9Zyflo CR ...................................................... 9
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