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CerpassRx2019 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 indiviudals 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

anagrelidecilostazolclopidogreldipyridamolejantoven

warfarin AGGRENOXBRILINTAEFFIENTELIQUISPRADAXA

SAVAYSAXARELTOZONTIVITY

Anticonvulsant Agents

carbamazepinecarbamazepine ERdivalproexdivalproex DRdivalproex ERepitolethosuximidefelbamategabapentinlamotriginelamotrigine ER

levetiracetamlevetiracetam ERoxcarbazepinephenobarbitalphenytoinprimidonetiagabinetopiramatetopiramate ERvalproic acidzonisamide

APTIOMBANZELBRIVIACTCELONTINFYCOMPAGABITRIL

ONFI

PEGANONE

POTIGA

SPRITAMVIMPAT

Antidiabetic Agents

acarbosealogliptinchlorpropamideglimepirideglipizideglipizide erglipizide xlglipizide/metforminglyburideglyburide micronizedglyburide/metforminmetforminmetformin ermiglitolnateglinidepioglitazonepioglitazone/glimepiridepioglitazone/metforminrepagliniderepaglinide/metformintolazamidetolbutamide

ACTOPLUS MET XRAFREZZA

BYETTA

BYDUREONCYCLOSETGLYXAMBIHUMALOGHUMALOG KWIKPENHUMALOG MIX 50/50HUMALOG MIX 50/50 KWIKPENHUMALOG MIX 75/25HUMALOG MIX 75/25 KWIKPENHUMULIN 70/30HUMULIN 70/30 KWIKPENHUMULIN NHUMULIN N KWIKPENHUMULIN RHUMULIN R U-500HUMULIN R U-500 KWIKPEN

INVOKANA XR

INVOKAMETINVOKANA

JANUMETJANUMET XRJANUVIA

JARDIANCEJENTADUETOJENTADUETO XR

LANTUSLANTUS SOLOSTAR

OZEMPIC

SYMLIN PENSYNJARDY

TOUJEOTRADJENTA

TRULICITY

CATEGORY GENERIC MEDICINE BRAND-NAME MEDICINE

Asthma Agents albuterolalbuterol ERbudesonidecromolynipratropiumipratropium/albuterollevalbuterolmetaproterenolmontelukastterbutalinetheochrontheophyllinetheophylline CRtheophylline ERtheophylline SRzafirlukast

CardiovasularAgents

acebutololacetazolamideacetazolamide ERafeditab CRamiloride/HCTZamilorideamiodaroneamlodipineamlodipine/atorvastatinamlodipine/benazaprilamlodipine/olmesartanamlodipine/olmesartan/HCTZamlodipine/valsartanamlodipine/valsartan/HCTZatenololatenolol/chlorthalidonebenazaprilbenazapril/HCTZbetaxololbisoprololbudesonidebisoprolol/HCTZbumetanidecandesartancandesartan/HCTZcaptoprilcaptopril/HCTZ/carvediol

chlorothiazidechlorthalidoneclonidine

digoxinditl-XR

digitekdigox

diltiazemdiltiazem CDdiltiazem ERdisopyramidedofetilidedoxazosinenalaprilenalapril/HCTZeplerenoneeprosartanethacrynic acidezidefelodipine ERflecainidefosinoprilfosinopril/HCTZfurosemidehydralazinehydrochlorothiazideindapamideirbesartanirbesartan/HCTZisosorbide dinitrateisosorbide dinitrate ERisosorbide dinitrate ERisosorbide dinitrate SAisosorbide mononitrateisosorbide mononitrate ERisradipinelabetalol

ADVAIR DISKUSADVAIR HFAAEROSPANANORO ELLIPTA

PERFOROMISTPROAIR HFAPROAIR RESPICLICK

ARCAPTA NEOHALERARNUITY ELLIPTAATROVENT HFA

BREO ELLIPTABROVANACOMBIVENT RESPIMATDALIRESP

PULMICORT FLEXHALER

SEREVENT DISKUSSPIRIVA HANDIHALERSPIRIVA RESPIMATSTIOLTO RESPIMATSTRIVERDI RESPIMATSYMBICORTTHEO-24VENTOLIN HFA

FLOVENT DISKUSFLOVENT HFAINCRUSE ELLIPTA

ALDACTAZIDEBIDIL

TEKTURNA

TEKTURNA HCT

BYSTOLICBYVALSONCARDIZEM LACLORPRESCOREG CRDILATRATE SRDIURILDUTOPROLDYRENIUMEDARBIEDARBYCLORENTRESTOEPANEDHEMANGEOL

INNOPRAN XL

LANOXINLEVATOLMULTAQNITRO-BIDNITRO-DURNITROMIST

NORPACE CRPRESTALIAQBRELISRANEXASOTYLIZE

CATEGORY GENERIC MEDICINE BRAND-NAME MEDICINE

CardiovasularAgents

lisinoprillisinopril/HCTZlosartanlosartan/HCTZmatzim LAmethazolamidemethyclothiazidemethyldopamethyldopa/HCTZmetolazonemetoprolol succinate ERmetoprolol tartratemetoprolol/HCTZmexilietineminitranminoxidilmoexipril

Cholesterol Agents

ALTOPREVANTARALIPOFENLIVALOTRIGLIDEVASCEPA

atorvastatincholestyraminecholestyramine light

colesevelamcolestipol

fenofibrate

ezetimibeezetimibe/simvastatin

fenofibric acidfenofibric acid DRfluvastatinfluvastatin ERgemfibrozillovastatin

niacin ERomega-3-acid

pravastatinprevaliterosuvastatinsimvastatin

moexipril/HCTZnadololnadolol/bendroflumethiazidenicardipinenifediac CCnifedical XLnifedipinenifedipine ERnimodipinenisoldipinenisoldipine ERnitro-timenitroglycerinnitroglycerin ERnitroglycerin lingualnitroglycerin transdermalolmesartanolmesartan/HCTZpaceroneperindopril

pindololprazosinpropafenonepropafenone erpropranololpropranolol erpropranolol/hctzquinaprilquinapril/hctzquinidinequinidine gluconate crquinidine gluconate erramiprilsorinesotalolspironolactonespironolactone/hctztaztia xttelmisartantelmisartan/amlodipinetelmisartan/hctzterazosintimololtorsemidetrandolapriltrandolapril/verapamiltrandolapril/verapamil ertriamterene/hctzvalsartanvalsartan/hctzverapamilverapamil crverapamil erverapamil saverapamil sr

gildess 1/20

FALESSANATAZIANUVARINGQUARTETTE

CATEGORY GENERIC MEDICINE BRAND-NAME MEDICINE

Contraceptives altaveraalyacen 1/35alyacen 7/7/7amethiaamethia loamethystapriaranelleashlynaaubraavianeazurettebalzivabekyreeblisovi fe 1/20blisovi 24 feblisovi fe 1.5/30briellyncamilacamresecamrese locaziantcesiachatealcryselle-28cyclafem 1/35cyclafem 7/7/7cyreddasetta 1/35dasetta 7/7/7dayseedeblitanedelyladesogestrel/ethinyl estradioldrospirenone/ethinyl estradiol

jencyclajolessajolivette

juleberjunel 1/20junel 1.5/30junel fe 24junel fe 1/20junel fe 1.5/30kaitlib fekarivakelnor 1/35kimidisskurvelo larinlarin 1/20larin 1.5/30larin fe 1.5/30larissialayolis feleenalessinalevonestlevonorgestrel/ethinyl estradiollevora 0.15/30-28lomedia 24 felorynalow-ogestrelluteralyzamarlissamedroxyprogesterone acetatemicrogestin 1/20microgestin 1.5/30

elinestemoquetteenpresse-28enskyceerrinestaryllafalminagianvigildagia

gildess 1.5/30gildess fe 1/20gildess 24 fegildess fe 1.5/30

microgestin femicrogestin 24 fe

heatherintrovale

microgestin fe 1.5/30mono-linyamononessamyzilranecon 0.5/35-28necon 1/35necon 1/50-28necon 10/11-28necon 7/7/7nikkinora-benorethindronenorethindrone acetate/ethinyl estradiolnorgestimate/ethinyl estradiolnorlyrocnortrel 0.5/35 (28)nortrel 1/35nortrel 7/7/7ocellaogestrel

Estrogens & Estrogen Combination Products

OsteoporosisAgents

ALORAANGELIQUECLIMARA PROCOMBIPATCHDIVIGELDUAVEEELESTRINEVAMIST

BINOSTO

FORTICALFOSAMAX PLUS D

MENESTMENOSTAR

MINIVELLEPREFESTPREMARINPREMPHASEPREMPRO

CATEGORY GENERIC MEDICINE BRAND-NAME MEDICINE

Contraceptives orsythiaphilithpimtrapirmella 1/35pirmella 7/7/7portia-28previfemprogesteronereclipsensetlakinsharobelsoliasprintec-28sronyxsyedatarina FE 1/20tilia FEtri-estaryllatri-legest FETri-linyahTri-lo-estaryllaTri-lo-marzia

tri-lo-sprintectri-previfemtri-sprintectrinessatrinessa lotrivora-28

covaryxcovaryx hseemtesterified estrogens/methyltestosteroneestradiolestradiol/norethindroneestropipatefyavolv

jevantique lo

jintelilopreezamimveymimvey lonorethindrone acetate/ethinyl estradiol

alendronatecalcitoninibandronateraloxifenerisendronate

velivetvesturavienvaviorelevyfemlawymzya FExulanezarahzenchentzenchent FEzovia 1/35Ezovia 1/50E

Ulcer Agents DEXILANTcimetidineesomeprazolefamotidinelansoprazolemisoprostolnizatidineomeprazoleomeprazole/sodium bicarbonatepantoprazolerabeprazoleranitidinesucralfate