2021 Preventive medications and your plan
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
2021 Preventive medications and your plan Managing your health with preventive medications Your pharmacy benefit plan includes special coverage for generic preventive medications. These medications help protect against or manage a medical condition, such as: • Preventing blood clots and reducing the risk of a stroke • Preventing heart disease and reducing high blood pressure • Preventing osteoporosis (a disease that leads to an increased risk of bone fracture) Your health is important. Taking preventive medications as told by your healthcare provider can help you avoid serious illness and high healthcare costs.
Special coverage for generic preventive medications The drugs on your plan’s preventive medications list do not have a deductible. This means you’ll pay your copayment/coinsurance or nothing at all, depending on your plan. It can save you money and get the medications you need to help you live a healthier life. Your plan only offers this special coverage for generic drugs on the preventive medications list. Preventive medications are a group of products in your plan’s formulary which tells you what medications your plan covers. Please note that most medications on the formulary have a deductible, but generic preventive medications do not. To check the cost of any medication, see your benefit handbook or contact customer service at the member phone number on your ID card. Quality drives our decisions A group of doctors and pharmacists meets often to review medications and suggest coverage under pharmacy benefit plans. They also recommend which medications should be on plan’s generic preventive medications list. A list of generic preventive medications begins on the next page. Medications are listed by therapeutic category. Your specific plan may not cover all of the drugs. Please see your plan’s formulary for coverage details. Oral and self-injectable Specialty medications are labled with an SP note and may have limitations based on your plan benefit. For questions on injectable dose forms of preventive medications driven by your healthcare provider, please call the member phone number on your ID card.
Generic medications by therapeutic category
albuterol sulfate hfa ranolazine er
ANTIDEPRESSANTS
budesonide sus
Anticoagulants
citalopram cromolyn
escitalopram difil-g forte aspirin / dipyridamole
fluoxetine fluticasone / salmeterol diskus cilostazol
fluoxetine dr ipratropium clopidogrel
fluvoxamine ipratropium / albuterol dipyridamole
fluvoxamine er isoproteren aer enoxaparin SP
paroxetine levalbuterol neb fondaparinux SP
paroxetine er metaproterenol heparin
sertraline montelukast jantoven
terbutaline prasugrel
ANTIPSYCHOTICS
theophylline warfarin
aripiprazole theophylline cr
Cardiac Glycosides
aripiprazole odt theophylline er
chlorpromazine wixela inhub digitek
clozapine zafirlukast digox
clozapine odt zileuton er digoxin
compro
CANCER High blood pressure
fluphenazine
haloperidol anastrozole acebutolol
loxapine exemestane aliskiren
molindone letrozole amiloride
olanzapine raloxifene amiloride / hctz
olanzapine odt tamoxifen amlodipine
olanzapine / fluoxetine toremifene amlodipine / benazepril
paliperidone er amlodipine / valsartan
CARDIOVASCULAR/
perphenazine amlodipine/olmesartan
HEART DISEASE
prochlorperazine medoxomil
quetiapine Anti-Anginal Agents amlodipine / valsartan / hctz
quetiapine er atenolol
risperidone isosorbide dinitrate
atenolol / chlorthalidone
risperidone odt isosorbide dinitrate er
benazepril
thioridazine isosorbide mononitrate
benazepril / hctz
thiothixene isosorbide mononitrate er
betaxolol tablet
trifluoperazine minitran
bisoprolol
ziprasidone nitroglycerin
bisoprolol / hctz
nitroglycerin er
ASTHMA AND COPD bumetanide
nitroglycerin lingual
candesartan
albuterol sulfate nitroglycerin transdermal
candesartan / hctz
albuterol sulfate er nitro-time
captopril
petn
SP
Oral and self-injectable Specialty medications may have limitations based on your plan benefit
‡
Where differences are noted between this formulary and your benefit plan documents, the benefit plan documents will rulecaptopril / hctz nimodipine fenofibric acid DR
cartia xt nisoldipine er fluvastatin
carvedilol olmesartan fluvastatin er
carvedilol er olmesartan / amlodipine / hctz gemfibrozil
chlorothiazide olmesartan / hctz lovastatin
chlorthalidone perindopril niacin (Rx only)
clonidine phenozybenzamine niacin er
diltiazem cd pindolol niacor
diltiazem prazosin omega-3-acid ethyl esters
diltiazem er propranolol pravastatin
dilt-XR propranolol er prevalite
doxazosin propranolol / hctz rosuvastatin
enalapril quinapril simvastatin
enalapril / hctz quinapril / hctz
CONTRACEPTIVES ‡
eplerenone ramipril
eprosartan sotalol generic contraceptive patch
ethacrynic acid spironolactone generic emergency
ezide spironolactone / hctz contraceptives
felodipine er taztia xt generic injectable contraceptive
fosinopril telmisartan generic oral contraceptives
fosinopril / hctz telmisartan / amlodipine generic vaginal ring
furosemide telmisartan / hctz contraceptive
guanfacine terazosin
hydralazine tiadylt er DIABETES
hydrochlorothiazide timolol (tablet) Non-insulin
indapamide torsemide
irbesartan trandolapril acarbose
irbesartan / hctz trandolapril / verapamil er chlorpropamide
isradipine triamterene glimepiride
labetalol triamterene / hctz glipizide
lisinopril valsartan glipizide er
lisinopril / hctz valsartan / hctz glipizide xl
losartan potassium verapamil glipizide/metformin
losartan potassium / hctz verapamil er glyburide
matzim la verapamil sr glyburide micronized
methyclothiazide glyburide/metformin
High cholesterol metformin
methyldopa
methyldopa / hctz amlodipine/atorvastatin metformin er (not mod or osm)
metolazone atorvastatin miglitol
metoprolol er cholestyramine nateglinide
metoprolol cholestyramine light pioglitazone
minoxidil tablet colesevelam pioglitazone / metformin
moexipril colestipol pioglitazone / glimepride
nadolol ezetimibe repaglinide
nadolol / bendroflumethiazide ezetimibe / simvastatin repaglinide/metformin
nicardipine fenofibrate tolazamide
nifedipine fenofibrate micronized tolbutamide
nifedipine er fenofibric acid
SP
Oral and self-injectable Specialty medications may have limitations based on your plan benefit
‡
Where differences are noted between this formulary and your benefit plan documents, the benefit plan documents will rulemisoprostol ibandronate
ESTROGENS
nizatidine raloxifene
amabelz omeprazole risedronate
covaryx pantoprazole risedronate dr
covaryx hs pantoprazole dr
SMOKING DETERRENTS ‡
dotti rabeprazole tab
eemt sucralfate bupropion er
eemt hs HIV/AIDS nicotine gum
esterified estrogens/ nicotine lozenge
methltestosterone abacavir nicotine patch
esterified estrogens/ abacavir / lamivudine
TRANSPLANT ‡
methltestosterone ds abacavir / lamivudine /
esterified estrogens/ zidovudine azathioprine
methltestosterone hs atazanavir cyclosporine SP
estradiol didanosine cyclosporine modified SP
estradiol/norethindrone acetate efavirenz everolimus SP
fyavolv efavirenz/lamivudine/tenofovir gengraf SP
jinteli fosamprenavir mycophenolate SP
lopreeza lamivudine mycophenolic acid dr SP
mimvey lamivudine / zidovudine sirolimus SP
mimvey lo lopinavir / ritonavir tacrolimus cap SP
norethindrone acetate/ethinyl nevirapine
VITAMINS & HEMATINICS ‡
estradiol nevirapine ER
ritonavir Pediatric vitamins
GASTROINTESTINAL-ULCER stavudine with fluoride
DRUGS ‡ tenofovir
Generic Products
cimetidine zidovudine
Prenatal multivitamins
esomeprazole magnesium OSTEOPOROSIS
with iron and folic acid
famotidine
lansoprazole alendronate Generic Products
lansoprazole/amoxicillin/ calcitonin-salmon
etidronate di
clarithromycin
SP
Oral and self-injectable Specialty medications may have limitations based on your plan benefit
‡
Where differences are noted between this formulary and your benefit plan documents, the benefit plan documents will rule
This list should be used as a reference and may not include all medications.
Brand or generic availability may not be current due to changes in the market.
optumrx.com
OptumRx specializes in the delivery, clinical management and affordability of prescription medications and consumer health
products. We are an Optum® company — a leading provider of integrated health services. Learn more at optum.com.
All Optum trademarks and logos are owned by Optum, Inc. in the U.S. and other jurisdictions. All other trademarks are the
property of their respective owners.
©2020 Optum, Inc. All rights reserved. WF3429992-A_ORX_HDHP preventive generics-premium_09242020 82188C-072020
Preventive Generics - PremiumYou can also read
