UPMC Health Plan
Preventive Drug List
Drug Name
ADULT LOW DOSE ASPIRIN
ALOPHEN PILLS
ALTAVERA
ALYACEN
AMETHIA
AMETHIA LO
AMETHYST
APRI
ARANELLE
ASHLYNA
ASPIR 81
ASPIRIN
ASPIRIN E.C.
ASPIR-LOW
ASPIR-TRIN
AUBRA
AVIANE
AZURETTE
B COMPLETE
B COMPLEX
B COMPLEX W/C
B COMPLEX W-VITAMIN C
BALANCE B
BALANCE-B
BALANCED B-COMPLEX
BALZIVA
B-BALANCED
B-COMPLEX
B-COMPLEX & C
BEKYREE
BEYAZ
BISACODYL
BISA-LAX
BLISOVI 24 FE
BLISOVI FE
BRIELLYN
BUFFERED ASPIRIN
BUFFERIN
BUPROBAN
BUPROPION SR
CALCIUM
CALCIUM + D3
CALCIUM + VITAMIN D
CALCIUM CARBONATE
CALCIUM CARBONATE W/VITAMIN D
2/18/2017
UPMC Health Plan
Preventive Drug List
Drug Name
CALCIUM CITRATE PLUS
CALCIUM CITRATE W/VITAMIN D
CALVITE P&D
CAMILA
CAMRESE
CAMRESE LO
CAZIANT
CHANTIX
CHATEAL
CHILDREN'S ASPIRIN
CHILDREN'S VITAMIN D
CITRATE OF MAGNESIA
CITROMA
CITRUS CALCIUM WITH VIT D
CLEARLAX
COMPLEX B-100
CRYSELLE
CYCLAFEM
CYRED
DAILY PRENATAL
DASETTA
DAYSEE
DEBLITANE
DELTA D3
DELYLA
DESOGESTREL-ETHINYL ESTRADIOL
DESOGESTR-ETH ESTRAD ETH ESTRA
DIALYVITE 800
DROSPIRENONE-ETH ESTRA-LEVOMEF
DROSPIRENONE-ETHINYL ESTRADIOL
DUCODYL
D-VI-SOL
D-VITA
ECONTRA EZ
ECOTRIN
ECPIRIN
ELINEST
ELLA
EMOQUETTE
ENPRESSE
ENSKYCE
ENTERIC COATED ASPIRIN
ERRIN
ESTARYLLA
ETHYNODIOL-ETHINYL ESTRADIOL
2/18/2017
UPMC Health Plan
Preventive Drug List
Drug Name
FALLBACK SOLO
FALMINA
FARBEE W-C
FEMININE LAXATIVE
FEMYNOR
FLUOR-A-DAY
FLUORIDE
FLUORITAB
FOLIC ACID
FOLTABS 800
FULL SPECTRUM B
GAVILAX
GAVILYTE-C
GAVILYTE-G
GAVILYTE-H AND BISACODYL
GAVILYTE-N
GENTLE LAXATIVE
GENTLELAX
GIANVI
GILDAGIA
GILDESS
GILDESS 24 FE
GILDESS FE
GLYCOLAX
GYNOL II
HEALTHYLAX
HEATHER
HI-CAL
INTROVALE
JENCYCLA
JOLESSA
JOLIVETTE
JULEBER
JUNEL
JUNEL FE
KAITLIB FE
KARIVA
KELNOR 1-35
KIMIDESS
KOBEE
KPN
KURVELO
LARIN
LARIN FE
LARISSIA
2/18/2017
UPMC Health Plan
Preventive Drug List
Drug Name
LAXA CLEAR
LAXATIVE
LAXATIVE PEG 3350
LAYOLIS FE
LEENA
LESSINA
LEVONEST
LEVONORGESTREL
LEVONORGESTREL-ETH ESTRADIOL
LEVONORG-ETH ESTRAD ETH ESTRAD
LEVORA
LIQUID CALCIUM +D
LITE COAT ASPIRIN
LOMEDIA 24 FE
LORYNA
LOW DOSE ASPIRIN
LOW-OGESTREL
LUDENT FLUORIDE
LUTERA
LYZA
MAGNESIUM CITRATE
MARLISSA
MEDROXYPROGESTERONE ACETATE
MICROGESTIN
MICROGESTIN FE
MILK OF MAGNESIA
MINIPRIN
MIRALAX
MONO-LINYAH
MONONESSA
MULTIVITAMIN WITH FLUORIDE
MVC-FLUORIDE
MY WAY
MYZILRA
NECON
NEXT CHOICE ONE DOSE
NICORELIEF
NICOTINE
NICOTINE GUM
NICOTROL
NICOTROL NS
NIKKI
NORA-BE
NORETHINDRONE ACETATE
NORETHINDRONE-ETHIN ESTRADIOL
2/18/2017
UPMC Health Plan
Preventive Drug List
Drug Name
NORETHIN-ETH ESTRA FERROUS FUM
NORGESTIMATE-ETHINYL ESTRADIOL
NORLYROC
NORTREL
NTS
NUVARING
OCELLA
OGESTREL
OPCICON ONE-STEP
ORAL SALINE LAXATIVE
ORSYTHIA
OYSCO D
OYSTER SHELL CALCIUM W/VIT D
OYSTERCAL-D
PEG
PEG 3350-ELECTROLYTE
PEG-3350 WITH FLAVOR PACKS
PEG-PREP
PERRY PRENATAL TABLET
PHILITH
PHOSPHATE LAXATIVE
PIMTREA
PIRMELLA
POLYETHYLENE GLYCOL
PORTIA
POTEN B-150
POWDERLAX
PRENATAL
PRENATAL COMPLETE
PRENATAL FORMULA
PRENATAL MULTI + DHA
PRENATAL VITAMIN
PRENAVITE
PREVIFEM
PURELAX
QUASENSE
QUIT 2
QUIT 4
RAJANI
REACT
RECLIPSEN
RENA-VITE
RISACAL-D
SETLAKIN
SHAROBEL
2/18/2017
UPMC Health Plan
Preventive Drug List
Drug Name
SMOOTHLAX
SODIUM FLUORIDE
SPRINTEC
SRONYX
STOP SMOKING AID
STRESS FORMULA
STRESS FORMULA VITAMIN + IRON
SUPER B COMPLEX
SUPER B MAXI COMPLEX
SUPER B-COMPLEX W/VITAMIN C
SUPER CALCIUM W/VITAMIN D
SUPER QUINTS
SUPERPLEX-T
SYEDA
TARINA FE
TILIA FE
TOTAL B WITH C
TRI-BUFFERED ASPIRIN
TRI-ESTARYLLA
TRI-LEGEST FE
TRI-LINYAH
TRI-LO-ESTARYLLA
TRI-LO-MARZIA
TRI-LO-SPRINTEC
TRILYTE WITH FLAVOR PACKETS
TRINESSA
TRINESSA LO
TRIPLE-VITAMIN W-FLUORIDE
TRI-PREVIFEM
TRI-SPRINTEC
TRI-VITAMIN WITH FLUORIDE
TRIVORA
ULTRA B-100 COMPLEX
VELIVET
VESTURA
VIENVA
VIORELE
VIT B COMP W/C
VITA B COMP W/C
VITABEE W-C
VITAMIN B COMPLEX
VITAMIN B-COMPLEX & C
VITAMIN D
VITAMIN D2
VITAMIN D3
2/18/2017
UPMC Health Plan
Preventive Drug List
Drug Name
VITAMIN D-400
VITAMINS A,C,D & FLUORIDE
VYFEMLA
WERA
WOMAN'S LAXATIVE
WOMEN'S GENTLE LAXATIVE
WOMEN'S LAXATIVE
WYMZYA FE
XULANE
ZARAH
ZENCHENT
ZENCHENT FE
ZEOSA
ZOVIA
2/18/2017