High deductible plan? - We have you covered. CerpassRx 2021 Preventative Medicine List
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High deductible plan? We have you covered. CerpassRx 2021 Preventative Medicine List www.cerpassrx.com
Preventive medications are defined as those prescribed to prevent the occurrence of a chronic disease or condition for those
individuals 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.
CATEGORY GENERIC MEDICINE BRAND-NAME MEDICINE
Anticoagulant and anagrelide jantoven ELIQUIS
Hematological cilostazol prasugrel XARELTO
Agents clopidogrel pentoxifylline ER
dipyridamole warfarin
enoxaparin
Anticonvulsant carbamazepine oxcarbazepine CELONTIN
Agents carbamazepine ER phenobarbital PEGANONE
divalproex phenytoin
divalproex DR primidone
divalproex ER roweepra
epitol roweepra XR
ethosuximide tiagabine
felbamate topiramate
gabapentin topiramate ER
lamotrigine valproic acid
lamotrigine ER vigabatrin
levetiracetam vigadrone
levetiracetam ER zonisamide
Antidiabetic acarbose pioglitazone/metformin BYDUREON NOVOLIN R
Agents alogliptin repaglinide BYETTA NOVOLOG
glimepiride repaglinide/metformin GLYXAMBI NOVOLOG FLEXPEN
glipizide tolazamide INVOKAMET OZEMPIC
glipizide er tolbutamide INVOKANA RYBELSUS
glipizide xl INVOKANA XR SYNJARDY
glipizide/metformin JANUMET SYNJARDY XR
glyburide JANUMET XR TOUJEO
glyburide micronized JANUVIA TRESIBA
glyburide/metformin JARDIANCE TRIJARDY XR
metformin LANTUS TRULICITY
metformin er LYUMJEV
miglitol LANTUS SOLOSTAR
nateglinide NOVOLIN 70/30
pioglitazone FLEXPEN
pioglitazone/glimepiride NOVOLIN 70/30 MIX
Asthma Agents albuterol ADVAIR HFA SYMBICORT
budesonide ANORO ELLIPTA TRELEGY ELLIPTA
cromolyn ARNUITY ELLIPTA
fluticasone/salmeterol ASMANEX
ipratropium ASMANEX TWISTHALER
ipratropium/albuterol BREO ELLIPTA
levalbuterol COMBIVENT RESPIMAT
montelukast DULERA
terbutaline FLOVENT DISKUS
theochron FLOVENT HFA
theophylline INCRUSE ELLIPTA
theophylline CR QVAR
theophylline ER QVAR REDIHALER
zafirlukastde SEREVENT DISKUS
SPIRIVA HANDIHALER
SPIRIVA RESPIMAT
STIOLTO RESPIMATCATEGORY GENERIC MEDICINE BRAND-NAME MEDICINE
Cardiovasular acebutolol methyldopa/HCTZ ENTRESTO
Agents acetazolamide metolazone
acetazolamide ER metoprolol succinate ER
afeditab CR metoprolol tartrate
amiloride/HCTZ metoprolol/HCTZ
amiloride mexilietine
amiodarone minitran
amlodipine minoxidil
amlodipine/atorvastatin moexipril
amlodipine/benazapril moexipril/HCTZ
amlodipine/olmesartan nadolol
amlodipine/olmesar- nicardipine
tan/HCTZ nifedical XL
amlodipine/valsartan nifedipine
amlodipine/valsartan/HCTZ nifedipine ER
atenolol nimodipine
atenolol/chlorthalidone nisoldipine
benazapril nisoldipine ER
benazapril/HCTZ nitro-time
betaxolol nitroglycerin
bisoprolol nitroglycerin ER
bisoprolol/HCTZ nitroglycerin sublingual
bumetanide nitroglycerin transdermal
candesartan olmesartan
candesartan/HCTZ olmesartan/HCTZ
captopril pacerone
captopril/HCTZ/carvediol perindopril
cartia XT pindolol
chlorothiazide prazosin
chlorthalidone propafenone
clonidine propafenone er
digitek propranolol
digox propranolol er
digoxin propranolol/hctz
diltiazem quinapril
diltiazem CD quinapril/hctz
diltiazem ER quinidine
disopyramide quinidine gluconate cr
dofetilide quinidine gluconate er
doxazosin ramipril
enalapril sorine
enalapril/HCTZ sotalol
eplerenone spironolactone
ethacrynic acid spironolactone/hctz
felodipine ER taztia xt
flecainide telmisartan
fosinopril telmisartan/amlodipine
fosinopril/HCTZ telmisartan/hctz
furosemide terazosin
hydralazine timolol
hydrochlorothiazide torsemide
indapamide trandolapril
irbesartan trandolapril/verapamil
irbesartan/HCTZ trandolapril/verapamil er
isosorbide dinitrate triamterene/hctz
isosorbide mononitrate valsartan
isosorbide mononitrate ER valsartan/hctz
isradipine verapamil
labetalol verapamil cr
lisinopril verapamil er
lisinopril/HCTZ verapamil sa
losartan verapamil sr
losartan/HCTZ
matzim LA
methazolamide
methyldopaCATEGORY GENERIC MEDICINE BRAND-NAME MEDICINE
Cholesterol atorvastatin fluvastatin NEXLETOL
Agents cholestyramine fluvastatin ER NEXLIZET
cholestyramine light gemfibrozil
colesevelam lovastatin
colestipo niacin ER
lezetimibe omega-3-acid
ezetimibe/simvastatin pravastatin
fenofibrate prevalite
fenofibric acid rosuvastatin
fenofibric acid DR simvastatin
Contraceptives altavera larin 1/20 NECON 1/50-28
aalyacen 1/35 larin 1.5/30 OGESTREL
alyacen 7/7/7 larin fe 1.5/30 XULANE
amethia larissia
amethia lo layolis fe
amethyst leena
apri lessina
aranelle levonest
ashlyna levonorgestrel/ethinyl
aubra levora 0.15/30-28
aviane loryna
azurette low-ogestrel
balziva lutera
bekyree lyza
blisovi fe 1/20 marlissa
blisovi 24 fe microgestin 1/20
blisovi fe 1.5/30 microgestin 1.5/30
briellyn microgestin fe
camila microgestin 24 fe
camrese microgestin fe 1.5/30
camrese lo mono-linyah
caziant mononessa
chateal myzilra
cryselle-28 necon 0.5/35-28
cyclafem 1/35 necon 1/35
cyclafem 7/7/7 necon 10/11-28
cyred necon 7/7/7
dasetta 1/35 nikki
dasetta 7/7/7 nora-be
daysee norlyroc
deblitane nortrel 0.5/35 (28)
drospirenone/ethinyl estradiol nortrel 1/35
elinest nortrel 7/7/7
eluryng orsythia
emoquette philith
enpresse-28 pirmella 1/35
enskyce pirmella 7/7/7
errin portia-28
estarylla previfem
falmina progesterone
gianvi reclipsen
heather setlakin
introvale sharobel
jencycla sprintec-28
jolessa
jolivette
juleber
junel 1/20
junel 1.5/30
junel fe 24
junel fe 1/20
junel fe 1.5/30
kaitlib fe
kariva
kelnor 1/35CATEGORY GENERIC MEDICINE BRAND-NAME MEDICINE
Contraceptives sronyx
syeda
tarina FE 1/20
tilia FE
tri-estarylla
tri-legest FE
Tri-linyah
tri-lo-sprintec
tri-previfem
tri-sprintec
trinessa
trinessa lo
trivora-28
velivet
vestura
vienva
viorele
vyfemla
wymzya FE
zarah
zenchent
zenchent FE
zovia 1/35E
zovia 1/50E
Estrogens & covaryx fyavolv DIVIGEL
Estrogen covaryx hs jevantique lo ESTROPIPATE
Combination dotti jinteli PREMARIN
Products eemt lopreeza PREMPHASE
esterified estrogens/ mimvey PREMPRO
methyltestosterone mimvey lo
estradiol norethindrone acetate/
estradiol/norethindrone ethinyl estradiol
Osteoporosis alendronate raloxifene TYMLOS
Agents calcitonin risendronate
ibandronate
Ulcer Agents cimetidine
esomeprazole
famotidine
lansoprazole
misoprostol
nizatidine
omeprazole
omeprazole/sodium bicarbonate
pantoprazole
rabeprazole
ranitidine
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