2013 PersonalCare Pharmacy Savings Program
The chart below represents approved drug classes for the PersonalCare Pharmacy Savings Program. Examples are provided within each approved drug class to assist you. There may be generic equivalents for the brand-name examples listed. Talk to your doctor about whether a generic alternative would be right for you. If you have one of these conditions and are currently taking any of the applicable medications listed, but are not currently enrolled in a Coventry PersonalCare Condition Support program, please contact customer service using the number on your insurance ID card for more information. Note: The PersonalCare Pharmacy Savings Program does not apply to Tier 3 drugs. This is the most current list at the time of printing as is subject to change. Condition Chronic Obstructive Pulmonary Disease Heart Failure Coronary Artery Disease Diabetes Drug class Inhaled Corticosteroids (COPD Metered Dose Inhalers ONLY) Beta-Blockers and Combinations
Atenolol, Bisoprolol, Carvedilol, Labetalol, Metoprolol, Metoprolol ER, Nadolol,
Methylxanthines Ace Inhibitors and Combinations
Benazepril, Benazepril/Hydrochlorothiazide, Captopril, Captopril/Hydrochlorothiazide, Enalapril, Enalapril/
Hydrochlorothiazide, Fosinopril, Fosinopril/Hydrochlorothiazide, Lisinopril, Lisinopril/Hydrochlorothiazide, Moexipril,
Moexipril/Hydrochlorothiazide, Quinapril, Quinapril/Hydrochlorothiazide, Ramipril, Trandolapril
Leukotriene Modifiers Long Acting Beta Agonists Angiotensin Receptor Blockers and Combinations
Benicar®, Benicar HCT®, Micardis®, Micardis HCT®
Combinations: Combinations: Hydralazine with Isosorbide in Cholesterol/Triglyceride Lowering Therapy African Americans or Intolerant to ACEI/ARB
Atorvastatin, Lovastatin, Pravastatin, Simvastatin, Fenofibrate, Gemfibrozil
Agonists and Inhaled Corticosteroids Agonists and Inhaled Corticosteroids
Niaspan®, Simcor®, Altoprev®, Crestor®, Trilipix®
2012 Coventry Health Care, Inc. All rights reserved. CVTY.PC.RXSAVE.2013.GUIDE.1012
2013 PersonalCare Pharmacy Savings Program – Prescription Drug Guidelines Condition Chronic Obstructive Pulmonary Disease Heart Failure Coronary Artery Disease Diabetes Drug class Anticholinergics Loop Diuretics Antiplatelets, Thienopyridine, Biguanides and Combinations Combinations: P2Y12 Platelet Inhibitors: Potassium Sparing Diuretics Calcium Channel Blockers and Sulfonylureas Combinations Nitroglycerin as Needed and Thiazolidinediones (TZDs) Long Acting Nitrates Glucagon Like Peptide-1s Dipeptidyl Peptidase-4s (DPP4s)
2012 Coventry Health Care, Inc. All rights reserved. CVTY.PC.RXSAVE.2013.GUIDE.1012
2013 PersonalCare Pharmacy Savings Program – Prescription Drug Guidelines Condition Chronic Obstructive Pulmonary Disease Heart Failure Coronary Artery Disease Diabetes Drug class Alpha Glucosidase Inhibitors Combinations: Anticholinergics Potassium Sparing Diuretics Nitroglycerin as Needed and Long Acting Nitrates Glinide’s
Brand versions of generically available drugs are covered according to the member’s Prescription Drug Rider.
Some drugs on this list require Prior Approval and/or have quantity limits. Waiver or reduction of the member copay does not imply that coverage is guaranteed.
PLEASE NOTE: This is not meant to be a complete or most updated list of the drugs included in the program and covered under your plan. Brand names are listed for informational reference and there may be generics available. Ask your doctor whether a generic alternative would be right for you. All information is subject to change.
2012 Coventry Health Care, Inc. All rights reserved. CVTY.PC.RXSAVE.2013.GUIDE.1012
MEDIKAMENTOESE UND CHIRURGISCHE MOEGLICHKEITENKOPFHAAR ZU ERHALTEN UND WIEDERHERZUSTELLEN Was verursacht Haarausfall? Es gibt viele Ursachen für Haarausfall bei Frauen und Männern. Die meisten Männer mit Haarausfall leidet unter genetisch bedingter androgenetischer Alope-zie, der “maennlichen Kahlheit”. Das Hormon Dihydrotestosteron (DHT) ist bei praedisponier-ten Maennern fuer dieses P