2014 CDHP Preventive Medication List
Preventive Prescription Drugs: A Good Choice
Prescription drugs that can help keep you from developing a health condition are called preventive prescription drugs. A
Consumer-Directed Health Plan (CDHP) that includes preventive medications can support the goal of ongoing good
health, helping to reduce your overall health care costs.
If your provider prescribes a preventive prescription drug on this list, you pay only a percentage of the total cost — right
from the beginning. The medications on this list will be covered as if the deductible has already been met and will only
be subject to coinsurance.
Is Your Drug a Preventive Prescription Drug?
The following is a list of the most commonly prescribed preventive drugs. The list is not all-inclusive and includes
examples of medications in each category. This list is periodically reviewed and updated.
For the member: Generic drugs are listed in lowercase letters. Example: atenolol. Generic medications contain the same
active ingredients as their corresponding brand-name medications, although they may look different in color or shape.
They have been FDA-approved under strict standards.
Brand-name drugs are listed in CAPITAL letters. Example: TENORMIN. In addition to using this list, you are
encouraged to ask your provider to prescribe generic drugs whenever appropriate.
ANTI-INFECTIVES
Fungal
fluconazole
itraconazole
ketoconazole
MEPRON
NEBUPENT
NOXAFIL
nystatin
PENTAM
terbinafine
terconazole
Malaria
chloroquine
hydroxychloroquine
MALARONE
mefloquine hcl
Viral
acyclovir
amantadine
famciclovir
RELENZA
rimantadine hcl
TAMIFLU
valacyclovir
CARDIOVASCULAR
MEDICATIONS
ACE Inhibitors &
Combinations
amlodipine besylatebenazepril
benazepril hcl
benazepril hcl-hctz
captopril-hctz
captopril
enalapril maleate
enalapril maleate-hctz
fosinopril-hctz
fosinopril sodium
lisinopril
lisinopril-hctz
moexipril hcl
moexipril-hctz
perindopril
quinapril hcl
quinapril-hctz
ramipril
TARKA
trandolapril
doxazosin
prazosin
terazosin
candesartan
DIOVAN
EDARBI
eprosartan
EXFORGE
EXFORGE HCT
irbesartan
irbesartan-hctz
losartan
losartan-hctz
MICARDIS
MICARDIS HCT
TEVETEN HCT
TRIBENZOR
valsartan-hctz
Angiotensin ll Receptor
Blockers & Combinations
Anticoagulants &
Antiplatelets
Alpha Blockers
AZOR
BENICAR
BENICAR HCT
candesartan-hctz
AGGRENOX
BRILINTA
cilostazol
clopidogrel
THIS DOCUMENT LIST IS EFFECTIVE JANUARY 1, 2014, THROUGH DECEMBER 31, 2014. THIS LIST IS SUBJECT TO
CHANGE.
dipyridamole
EFFIENT
ELIQUIS
enoxaparin
fondaparinux
FRAGMIN
jantoven
PRADAXA
ticlopidine
warfarin sodium
XARELTO
Beta Blockers &
Combinations
acebutolol hcl
atenolol
atenolol-chlorthalidone
betaxolol hcl
bisoprolol fumarate
bisoprolol-hctz
carvedilol
COREG CR
labetalol hcl
LEVATOL
metoprolol succinate
metoprolol tartrate
metoprolol-hctz
nadolol
nadolol-bendroflumethiazide
pindolol
propranolol hcl
propranolol-hctz
sotolol hcl
timolol maleate
Calcium Channel
Blockers & Combinations
afeditab cr
amlodipine besylate
amlodipine-atorvastatin
diltiazem hcl
felodipine er
isradipine
nicardipine hcl
nifedipine ER
nimodipine
nisoldipine er
verapamil er
verapamil hcl
Diuretics
amiloride hcl
amiloride hcl-hctz
bumetanide
chlorothiazide
chlorthalidone
DYRENIUM
furosemide
hydrochlorothiazide
indapamide
metolazone
methyclothiazide
spironolactone
spironolactone-hctz
torsemide
triamterene-hctz
High Cholesterol
Medications
ADVICOR
atorvastatin calcium
cholestyramine
cholestyramine light
colestipol hcl
CRESTOR
fenofibrate
fluvastatin
gemfibrozil
LESCOL XL
LIVALO
lovastatin
LOVAZA
NIACOR
NIASPAN
pravastatin sodium
PREVALITE
SIMCOR
simvastatin
TRICOR
VASCEPA
WELCHOL
ZETIA
Others
clonidine
guanfacine hcl
methyldopa
methyldopa-hctz
TEKTURNA
TEKTURNA HCT
VALTURNA
CAVITY
PREVENTION
sodium fluoride
PREVIDENT
DIABETES
MEDICATIONS
Insulin
APIDRA
APIDRA SOLOSTAR
HUMALOG
HUMALOG MIX 50/50
HUMALOG MIX 75/25
HUMULIN
HUMULIN 70/30
HUMULIN R
LANTUS cartridge, solostar
LANTUS vial
LEVEMIR
NOVOLIN
NOVOLOG
NOVOLOG MIX 70/30
Non-Insulin Agents
acarbose
BYDUREON
BYETTA
chlorpropamide
glimepiride
glipizide
glipizide er
glipizide-metformin
glyburide
glyburide-metformin hcl
GLUCAGEN
GLUCAGON
EMERGENCY KIT
glyburide
glyburide micronized
JANUMET/XR
JANUVIA
KAZANO
KOMBIGLYZE/XR
LIOVEL
metformin hcl
metformin hcl er
nateglinide
NESINA
ONGLYZA
pioglitazone
pioglitazone/metformin
PRANDIN
PROGLYCEM
RIOMET
SYMLIN
TRADJENTA
tolazamide
tolbutamide
VICTOZA
DIABETIC SUPPLIES
Lancets
Insulin needles and syringes
ACCU-CHEK strips
ASCENSIA
CHEMSTRIP K strips
FAST TAKE strips
ONE TOUCH strips
PRECISION XTRA strips
SURESTEP strips
SURESTEP PRO strips
GOUT PREVENTION
allopurinol
COLCRYS
NUTRITION
Anemia in Children
ferrous sulfate drops
Vitamins
pediatric multi-vit
w/fluoride
pediatric multi-vit
w/fluoride & iron
OBESITY
BELVIQ
diethylpropion
phendimetrazine
phentermine
QSYMIA
XENICAL
OBSTETRICAL &
GYNECOLOGICAL
MEDICATIONS
Breast Cancer Recurrence
Anastrozole
Exemestane
EVISTA
Letrozole
tamoxifen
Estrogen Replacement
CENESTIN
THIS DOCUMENT LIST IS EFFECTIVE JANUARY 1, 2014, THROUGH DECEMBER 31, 2014. THIS LIST IS SUBJECT TO
CHANGE.
COMBIPATCH
ENJUVIA
ESTRADERM
estradiol
estradiol/norethindrone
estropipate
methyltestosterone
PREMARIN
PREMARIN CREAM
PREMPHASE
PREMPRO
VAGIFEM
VIVELLE
VIVELLE-DOT
Prenatal Vitamins
prenatal vitamins
OSTEOPOROSIS
AGENTS
ACTONEL
ACTONEL WITH
CALCIUM
Alendronate
ATELVIA
BINOSTO
EVISTA
FORTEO
ibandronate sodium
MIACALCIN
RESPIRATORY
MEDICATIONS
Beta Agonists
ACCUNEB
albuterol
albuterol sulfate
ARCAPTA NEOHALER
BROVANA
FORADIL
levalbuterol
MAXAIR AUTOHALER
metaproterenol
PERFOROMIST
PROAIR HFA
PROVENTIL HFA
SEREVENT DISKUS
terbutaline sulfate
VENTOLIN HFA
XOPENEX
XOPENEX HFA
Corticosteroids
budesonide
AEROBID
AEROBID-M
ALVESCO
ASMANEX
AZMACORT
FLOVENT DISKUS
FLOVENT HFA
PULMICORT
PULMICORT
FLEXHALER
QVAR
Others
ADVAIR DISKUS
ADVAIR HFA
aminophylline
ATROVENT HFA
COMBIVENT
RESPIMAT
cromolyn sodium
DUONEB
DULERA
INTAL
ipratropium bromide
ipratropium-albuterol
montelukast
SPIRIVA
SYMBICORT
theophylline
TUDORZA
XOLAIR
zafirlukast
ZYFLO
SMOKING
CESSATION
bupropion sr 150 mg
CHANTIX
NICOTROL
THIS DOCUMENT LIST IS EFFECTIVE JANUARY 1, 2014, THROUGH DECEMBER 31, 2014. THIS LIST IS SUBJECT TO
CHANGE.