CerpassRx 2022 Preventative Medicine List

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CATEGORY GENERIC MEDICINE BRAND-NAME MEDICINE

Preventive medications are defined as those prescribed to prevent the occurrence of a chronic disease or condition for those individuals with risk factors, or to prevent the recurrence of a disease or condition. Your plan values the impact these medications have on your health. You do not need to meet any deductible for preventive medications and your prescription benefits are paid immediately for these products. This list contains examples of preventive medications organized by therapy class. Medications may be added to or removed from the list periodically and the list is not all inclusive.

Anticoagulant and Hematological Agents

Anticonvulsant Agents

Antidiabetic Agents

Asthma Agents

anagrelidecilostazolclopidogreldipyridamoleenoxaparin

carbamazepinecarbamazepine ERdivalproexdivalproex DRdivalproex ERepitolethosuximidefelbamategabapentinlamotriginelamotrigine ERlevetiracetamlevetiracetam ER

acarbosealogliptinglimepirideglipizideglipizide erglipizide xlglipizide/metforminglyburideglyburide micronizedglyburide/metforminmetforminmetformin ermiglitolnateglinidepioglitazonepioglitazone/glimepiride

albuterolbudesonidecromolyn�uticasone/salmeterolipratropiumipratropium/albuterollevalbuterolmontelukastterbutalinetheochrontheophyllinetheophylline CRtheophylline ERza�rlukastde

pioglitazone/metforminrepagliniderepaglinide/metformintolazamidetolbutamide

BYDUREONBYETTAGLYXAMBIJANUMETJANUMET XRJANUVIAJARDIANCELYUMJEVLANTUS SOLOSTARNOVOLIN 70/30 FLEXPENNOVOLIN 70/30 MIXNOVOLIN NNOVOLIN RNOVOLOGNOVOLOG FLEXPENOZEMPIC

ADVAIR HFAANORO ELLIPTAARNUITY ELLIPTAASMANEXASMANEX TWISTHALERBREO ELLIPTACOMBIVENT RESPIMATDULERAFLOVENT DISKUSFLOVENT HFAINCRUSE ELLIPTAQVARQVAR REDIHALERSEREVENT DISKUSSPIRIVA HANDIHALERSPIRIVA RESPIMATSTIOLTO RESPIMAT

SYMBICORTTRELEGY ELLIPTA

RYBELSUSSYNJARDYSYNJARDY XRTOUJEOTRESIBATRIJARDY XRTRULICITY

oxcarbazepinephenobarbitalphenytoinprimidoneroweepraroweepra XRtiagabinetopiramatetopiramate ERvalproic acidvigabatrinvigadronezonisamide

ELIQUISXARELTO

jantovenprasugrelpentoxifylline ERwarfarin

CATEGORY GENERIC MEDICINE BRAND-NAME MEDICINE

CardiovasularAgents

ENTRESTOacebutololacetazolamideacetazolamide ERafeditab CRamiloride/HCTZamilorideamiodaroneamlodipineamlodipine/atorvastatinamlodipine/benazaprilamlodipine/olmesartanamlodipine/olmesartan/HCTZamlodipine/valsartanamlodipine/valsartan/HCTZatenololatenolol/chlorthalidonebenazaprilbenazapril/HCTZbetaxololbisoprololbisoprolol/HCTZbumetanidecandesartancandesartan/HCTZcaptoprilcaptopril/HCTZ/carvediolcartia XTchlorothiazidechlorthalidoneclonidinedigitekdigoxdigoxindiltiazemdiltiazem CDdiltiazem ERdisopyramidedofetilidedoxazosinenalaprilenalapril/HCTZeplerenoneethacrynic acidfelodipine ER�ecainidefosinoprilfosinopril/HCTZfurosemidehydralazinehydrochlorothiazideindapamideirbesartanirbesartan/HCTZisosorbide dinitrateisosorbide mononitrateisosorbide mononitrate ERisradipinelabetalollisinoprillisinopril/HCTZlosartanlosartan/HCTZmatzim LAmethazolamidemethyldopa

methyldopa/HCTZmetolazonemetoprolol succinate ERmetoprolol tartratemetoprolol/HCTZmexilietineminitranminoxidilmoexiprilmoexipril/HCTZnadololnicardipinenifedical XLnifedipinenifedipine ERnimodipinenisoldipinenisoldipine ERnitro-timenitroglycerinnitroglycerin ERnitroglycerin sublingualnitroglycerin transdermalolmesartanolmesartan/HCTZpaceroneperindoprilpindololprazosinpropafenonepropafenone erpropranololpropranolol erpropranolol/hctzquinaprilquinapril/hctzquinidinequinidine gluconate crquinidine gluconate erramiprilsorinesotalolspironolactonespironolactone/hctztaztia xttelmisartantelmisartan/amlodipinetelmisartan/hctzterazosintimololtorsemidetrandolapriltrandolapril/verapamiltrandolapril/verapamil ertriamterene/hctzvalsartanvalsartan/hctzverapamilverapamil crverapamil erverapamil saverapamil sr

CATEGORY GENERIC MEDICINE BRAND-NAME MEDICINE

Cholesterol Agents

atorvastatincholestyraminecholestyramine lightcolesevelamcolestipoezetimibeezetimibe/simvastatinfeno�bratefeno�bric acidfeno�bric acid DR

�uvastatin�uvastatin ERgem�brozillovastatinniacin ERomega-3-acidpravastatinprevaliterosuvastatinsimvastatin

Contraceptives altaveraaalyacen 1/35alyacen 7/7/7amethiaamethia loamethystapriaranelleashlynaaubraavianeazurettebalzivabekyreeblisovi fe 1/20blisovi 24 feblisovi fe 1.5/30briellyncamilacamresecamrese locaziantchatealcryselle-28cyclafem 1/35cyclafem 7/7/7cyreddasetta 1/35dasetta 7/7/7dayseedeblitanedrospirenone/ethinyl estradiolelinesteluryngemoquetteenpresse-28enskyceerrinestaryllafalminagianviheatherintrovalejencyclajolessajolivettejuleberjunel 1/20junel 1.5/30junel fe 24junel fe 1/20junel fe 1.5/30kaitlib fekarivakelnor 1/35

larin 1/20larin 1.5/30larin fe 1.5/30larissialayolis feleenalessinalevonestlevonorgestrel/ethinyl levora 0.15/30-28lorynalow-ogestrelluteralyzamarlissamicrogestin 1/20microgestin 1.5/30microgestin femicrogestin 24 femicrogestin fe 1.5/30mono-linyahmononessamyzilranecon 0.5/35-28necon 1/35necon 10/11-28necon 7/7/7nikkinora-benorlyrocnortrel 0.5/35 (28)nortrel 1/35nortrel 7/7/7orsythiaphilithpirmella 1/35pirmella 7/7/7portia-28previfemprogesteronereclipsensetlakinsharobelsprintec-28

NECON 1/50-28OGESTRELXULANE

Contraceptives sronyxsyedatarina FE 1/20tilia FEtri-estaryllatri-legest FETri-linyahtri-lo-sprintectri-previfemtri-sprintectrinessatrinessa lotrivora-28velivetvesturavienvaviorelevyfemlawymzya FEzarahzenchentzenchent FEzovia 1/35Ezovia 1/50E

Estrogens & Estrogen Combination Products

covaryxcovaryx hsdottieemtesteri�ed estrogens/methyltestosteroneestradiolestradiol/norethindrone

fyavolvjevantique lojintelilopreezamimveymimvey lonorethindrone acetate/ethinyl estradiol

ESTROPIPATEPREMARINPREMPRO

OsteoporosisAgents

alendronatecalcitoninibandronate

raloxifenerisendronate

TYMLOS

Ulcer Agents cimetidineesomeprazolefamotidinelansoprazolemisoprostolnizatidineomeprazoleomeprazole/sodium bicarbonatepantoprazolerabeprazoleranitidinesucralfate

CATEGORY GENERIC MEDICINE BRAND-NAME MEDICINE