Preventive Drug List What is a Preventive Drug List?
It’s a list of drugs that may help prevent serious
illnesses and complications. IRS guidelines for high-
What Happens at the Pharmacy?
deductible health plans provide that preventive
care, including prescription medications used for
The pharmacist enters your prescription into
preventive purposes, can be excluded from the
the computer system. If your medication is
deductible. Taking preventive drugs, as directed by
on the Preventive Drug List, the system will
your doctor, may help you live a healthier life
tell the pharmacist which copayment applies
today. It may also help you avoid serious illness in
to your prescription or if you have reached
If your pharmacy benefit covers medications on the
Preventive Drug List, you will pay a copayment for
them until you meet your out-of-pocket maximum.
Once you reach your out-of-pocket maximum, we
will cover your prescription drugs, including your
What Medications are Included?
Generic, preferred brand and non-preferred brand medications are listed below. For the lowest out-of-pocket
expense, you should always consider generics if you and your doctor decide they are right for you. We list
generic drugs in this document in lower-case letters followed by (g). Consider brand-name drugs if no generic
drugs are available to treat your condition. We list brand-name medications in this document in all capital
letters. We denote non-preferred brand-name medications with an (NP). ANTI-OBESITY AGENTS ASTHMA CONTRACEPTIVES CORONARY ARTERY DISEASE ANTIHYPERLIPIDEMICS BLOOD THINNERS COMBINATION ANTIHYPERLIPIDEMICS DEPRESSION HYPERTENSION ACE INHIBITORS/ ANGIOTENSIN II RECEPTOR ANTAGONISTS DIABETES
pioglitazone/glimepiride (g) AVAPRO (NP)
FLUORIDE SUPPLEMENTS CALCIUM CHANNEL BLOCKERS IMMUNIZING AGENTS ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS BETA-BLOCKERS OTHER ANTIHYPERTENSIVE AGENTS DIURETICS SMOKING DETERRENTS VITAMINS OSTEOPOROSIS
MIACALCIN nasal spray (NP) NICODERM (NP)
Your benefit document defines actual benefits available and may exclude coverage for certain drugs listed herein. Check
your benefit information to verify coverage. Or, view personal benefit information through our website. This list may
contain trademarks or registered trademarks of pharmaceutical manufacturers that are not affiliated with your health
plan. This list may change or expand from time to time without prior notice.
Eff 04-01-13 Rev 04-23-13
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