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Mg906199 assurant.8

MG906199 Assurant.8 10/29/04 6:21 PM Page a Rx Preferred
Drug Guide
Please bring this guide
with you to your next
doctor visit.

2004 Medco Health Solutions, Inc. All rights reserved.
Medco manages your prescription drug benefit at the request of your plan sponsor.
MG906199 Assurant.8 10/29/04 6:21 PM Page c THE BENEFITS OF THE RX PREFERRED DRUG GUIDE
The Rx Preferred Drug Guide is a list of medications which may be covered under your prescription
drug plan.* This list was reviewed by an independent group of practicing doctors and pharmacists, and
it contains medications made by most pharmaceutical manufacturers. It includes medications for many
covered conditions.
*Please Note: Not all the medications in this guide are covered by all pharmacy benefit programs. Check your
benefit materials for the specific covered medications and your co-payment information. For specific questions
about your pharmacy benefit program, please call the phone number printed on your prescription ID card.

SAVING MONEY ON PRESCRIPTIONS
Your plan may prefer some medications over others. These are called plan-preferred drugs, and their
co-payment may be lower. The amount of your co-payment depends on which drug your doctor
prescribes for you.
Higher co-payment for plan-preferred, brand-name drugs Highest co-payment for nonpreferred, brand-name drugs Your doctor may be able to help you save money by prescribing generic and
plan-preferred drugs. So be sure to bring this guide with you on every visit to your
doctor.
This guide lists only the most common drugs. For an updated and complete listing of
plan-preferred drugs, you can visit the “My Benefits” section of our website — www.medco.com
and click the Learn about formularies link.
FINDING LOWER CO-PAYMENT VERSIONS
This guide lists medications two ways to help you find some generic and plan-preferred
brand-name drugs.
ALPHABETICALLY BY DRUG CATEGORY (SUCH AS RESPIRATORY)
Within each category, medications are listed in order of their cost to your plan sponsor, from lowest to
highest. The $ and ! symbols next to each medication show the cost of that medication compared with
others in the same category:
ALPHABETICALLY BY BRAND NAMEAfter each nonpreferred brand-name drug, you will find possible generic and plan-preferred brand-name versions.
GENERIC DRUGS
When a generic version of a brand-name drug is available, it may have one of the following symbols:
Means only the generic version is plan-preferred; the brand-name product may have the highest co-payment. Means both brand-name and generic versions are plan-preferred, but the generic version may havea lower co-payment.
Means generic products in drug category may have lower co-payment. Brand products in drugcategory have highest co-payment.
SAFETY CONSIDERATION SYMBOLS
Here is a quick guide for you and your doctor, which explains our safety symbols. These symbols
appear next to certain medications.
Means that a dose lower than the manufacturer’s guidelines is often recommended for people 65and older. Means that use by people 65 and older is associated with increased risk; safer alternatives may beavailable. If used, the dosage should generally be lowered.
Means weigh risk of birth defects or other adverse outcomes. Means do not use in pregnancy.
This information is in effect at the time of printing and may be subject to change.
MG906199 Assurant.8 10/29/04 6:21 PM Page 1 SECTION I: THERAPEUTIC DRUG CATEGORIES
ANTI-INFECTIVES (Antibiotics/Antifungals)
Oral Penicillins
Oral Quinolones
Vaginal Antifungals
+ amoxicillin trihydrate
+ ampicillin trihydrate
+ ciprofloxacin
+ nystatin tablet
+ dicloxacillin sodium
+ penicillin v potassium
+ amoxicillin trihydrate/
+ ofloxacin
Oral Sulfas
+ erythromycin
Oral Tetracyclines
+ sulfamethoxazole/
+ doxycycline hyclate
+ tetracycline HCl
+ sulfisoxazole
+ doxycycline monohydrate
+ sulfadiazine
+ minocycline HCl
Oral Urinary Tract Agents
Oral Cephalosporins
+ trimethoprim
+ cefaclor
+ cefadroxil
+ nitrofurantoin macrocrystal
+ cephalexin monohydrate
+ nitrofurantoin/
+ cephradine
Oral Antifungals
+ cefuroxime axetil
Oral Erythromycins
+ erythromycin base enteric
+ fluconazole
+ griseofulvin ultramicrosize
+ erythromycin ethylsuccinate
+ ketoconazole tablet
+ erythromycin
+ nystatin
+ erythromycin stearate
Oral Misc. Agents
+ clindamycin HCl
+ neomycin sulfate
= Lowest relative cost to plan sponsor.
= Means that a dose lower than the manufacturer’s guidelines is often ! ! ! ! ! = Highest relative cost to plan sponsor.
recommended for people 65 and older.
= Means only the generic version is plan-preferred; ▲ = Means that use by people 65 and older is associated with increased risk; safer the brand-name product may have the highest co-payment.
alternatives may be available. If used, the dosage should generally be lowered.
= Means both brand-name and generic versions are plan-preferred, = Means weigh risk of birth defects or other adverse outcomes.
but the generic version may have a lower co-payment.
= Means generic products in drug category may have lower co-payment. Brand products in drug category have highest co-payment.
MG906199 Assurant.8 10/29/04 6:21 PM Page 2 CENTRAL NERVOUS SYSTEM MEDICATIONS
Hypnotic Agents
Antipsychotics
Miscellaneous Neurological
+ chloral hydrate
+ chlorpromazine HCl
+temazepam
+ fluphenazine HCl
+triazolam
+ haloperidol
Tricyclic Antidepressants
+ haloperidol lactate
+amitriptyline HCl
Miscellaneous Psychotherapeutic
+ perphenazine
+doxepin HCl
+ thiothixene
+imipramine HCl
+ thiothixene HCl
+ nortriptyline HCl
+clomipramine HCl
+ trifluoperazine HCl
+ desipramine HCl
+ methylphenidate extended
+ loxapine succinate
Miscellaneous Antidepressants
+ trazodone HCl
+ bupropion HCl tablet
+ maprotiline HCl
+ mirtazapine tablet, rapid
Migraine & Cluster Headache
Anxiolytics
+ bupropion HCl tablet,
+ alprazolam
+chlordiazepoxide HCl
+diazepam
+ lorazepam
+ buspirone HCl
+clorazepate
+ oxazepam
+ fluoxetine HCl
Anticonvulsants
+ paroxetine HCl
+ gabapentin
+fluvoxamine maleate
MG906199 Assurant.8 10/29/04 6:21 PM Page 3 CARDIOVASCULAR (Blood Pressure/Heart/Cholesterol)
Beta Blockers
Nitroglycerin Patches
+ reserpine
+ atenolol
+ nitroglycerin transdermal
+ terazosin HCl
+ metoprolol tartrate
ACE Inhibitors/Other
+ nadolol
Antihypertensive Combinations
Angiotensin II Blockers
+ pindolol
+ atenolol/chlorthalidone
+ propranolol HCl
+ captopril
+ propranolol HCl capsule,
+ captopril/
+ timolol maleate
+ hydralazine HCl/
+ acebutolol HCl
+methyldopa/
+ labetalol HCl
+ propranolol HCl
Antilipidemics
+ bisoprolol fumarate
+ gemfibrozil
+ reserpine/
+lovastatin
Calcium Blockers
+ cholestyramine/aspartame
+ diltiazem HCl
+ benazepril HCl
+ cholestyramine/sucrose
+ verapamil HCl
+ benazepril HCl/
+ fenofibrate, micronized
+ verapamil HCl tablet,
+ enalapril maleate
+ diltiazem HCl capsule,
+ lisinopril
+lisinopril/
+ diltiazem HCl capsule,
+moexipril HCl
+ verapamil HCl capsule,
Dihydropyridines
+ nifedipine
+ nifedipine tablet, sustained
+ fosinopril sodium
+ nifedipine tablet, sustained
Adrenergic Antagonists &
Related Drugs
+ clonidine HCl
+ doxazosin mesylate
+ guanfacine HCl
+methyldopa
+ prazosin HCl
DERMATOLOGICALS (Topical Medications)
Topical Acne Drugs
Topical Corticosteroid Drugs
Miscellaneous Dermatological
+ betamethasone
+ betamethasone
+ tretinoin
+ betamethasone
Androgen Drugs
+ desoximetasone cream
Psoriasis and Eczema Drugs
+ betamethasone
Keratolytic Drugs
! ! ! ! !
MG906199 Assurant.8 10/29/04 6:22 PM Page 4 ENDOCRINE (Diabetes/Hormones/Contraceptives)
Insulin Therapy
+estradiol patch
+norethindrone-mestranol
+norgestimate-ethinyl
+norgestrel-ethinyl
Oral Hypoglycemics
Oral Contraceptives (OC)
+ glipizide
+ glipizide tablet, sustained
Note: For patients with OC coverage, the following medications are preferred by + glyburide
+ glyburide, micronized
Blood Glucose Test Strips
+ metformin HCl
+ metformin HCl tablet,
+desogestrel-ethinyl
+ glyburide/metformin HCl
+desog-et estra/ethin estra
+ethynodiol d-ethinyl
+levonorgestrel-ethinyl
Estrogens/Combinations
+estradiol tablet
+estropipate
+norethindrone
+norethindrone a-e
+norethindrone-ethinyl
G. I. (Ulcer) Generic products in drug category may have lower co-payment. Brand products in drug category have highest co-payment.
Ulcer Drugs
Other G. I. Drugs
+ cimetidine HCl liquid
+sucralfate
+ cimetidine tablet
+ famotidine
+ ranitidine HCl
+misoprostol
NSAIDS (Pain Relievers)
+naproxen sodium
+ketoprofen capsule,
+diclofenac sodium
+piroxicam
+etodolac
+sulindac
NSAID COX-2 Inhibitors
+ibuprofen
+oxaprozin
+indomethacin
+etodolac tablet, sustained
+indomethacin capsule,
+nabumetone
+ketoprofen
+naproxen sodium tablet,
+naproxen
+tolmetin sodium
MG906199 Assurant.8 10/29/04 6:22 PM Page 5 OPHTHALMIC MEDICATIONS
Glaucoma Medication
Corticosteroid Medications
Miscellaneous
+ dipivefrin HCl
+ prednisolone acetate
+ brimonidine tartrate
Antibacterial
+ ofloxacin drops
+ ciprofloxacin HCl drops
RESPIRATORY (Allergy/Asthma)
Antihistamines/Combinations
All antihistamine and
+ isoetharine HCl solution,
antihistamine/decongestant
combinations are considered
+ acetylcysteine vial,
non-preferred. Generics and
over-the-counter (OTC) options
Inhaled Steroids
+ ipratropium bromide
are available.
Beta Agonists Oral
+ albuterol sulfate
+ metaproterenol sulfate
Nasal Corticosteroids
+Vospire ER
+ flunisolide
+ terbutaline sulfate
Beta Agonists Inhalers
+ albuterol aerosol (gm)
+ albuterol sulfate solution,
Miscellaneous Pulmonary Agents
+ metaproterenol sulfate
+ cromolyn sodium ampul
Generic products in drug category may have lower co-payment. Brand products in drug category
ROLOGICAL MEDICATIONS
have highest co-payment.
Anticholinergic Antispasmodics
+ oxybutynin
VITAMINS
Prenatal Vitamins
MISCELLANEOUS
+ calcitonin, salmon, synthetic
MG906199 Assurant.8 10/29/04 6:22 PM Page 6 SECTION II: NONPREFERRED DRUGS AND THEIR POSSIBLE PLAN-PREFERRED ALTERNATIVES
Nonpreferred Product
Possible Plan-preferred Products
Nonpreferred Product
Possible Plan-preferred Products
estradiol (generic), estropipate (generic), albuterol sulfate solution, non-oral (generic) nifedipine ER (generic), Norvasc® (Pfizer) lovastatin (generic), Lipitor® (Pfizer), flurazepam (generic), triazolam (generic), lovastatin (generic), Lipitor® (Pfizer), bupropion HCl (generic),fluoxetine HCl (generic) (Pfizer), Biaxin® (Abbott Laboratories), nifedipine ER (generic), Norvasc® (Pfizer) Benicar HCT® (Sankyo), Diovan HCT®(Novartis), Hyzaar® (Merck) nifedipine ER (generic), Norvasc® (Pfizer) estradiol (generic), estropipate (generic), cimetidine (generic), famotidine (generic), estradiol (generic), estropipate (generic), nifedipine ER (generic), Norvasc® (Pfizer) diltiazem HCl capsule, sustained release Abilify® (Bristol-Myers Squibb), Risperdal® atenolol tablet (generic), propranolol HClcapsule, sustained action (generic) cefaclor capsule (hard, soft, etc.) (generic), Lamisil® (Novartis), Sporanox® (Janssen) Lamisil® (Novartis), Sporanox® (Janssen) fluoxetine (generic), paroxetine (generic) If “generic” appears after the brand-name drug, please consider the generic. The brand name is listed for reference only. (Brand nonpreferred.) MG906199 Assurant.8 10/29/04 6:22 PM Page 7 Nonpreferred Product
Possible Plan-preferred Products
Nonpreferred Product
Possible Plan-preferred Products
lovastatin (generic), Lipitor® (Pfizer), lovastatin (generic), Lipitor® (Pfizer), lovastatin (generic), Lipitor® (Pfizer), metoprolol tartrate (generic), atenolol(generic), acebutolol HCl (generic) fluoxetine (generic), paroxetine (generic) (generic), Omnicef® (Abbott Laboratories) (generic), Omnicef® (Abbott Laboratories) (generic), paroxetine HCl (generic),Zoloft® (Pfizer) albuterol aerosol (gm) (generic),Proventil HFA® (Schering), Xopenex® benazepril HCl (generic), enalapril maleate (generic), lisinopril (generic), Accupril®(Pfizer), Altace® (Monarch Pharmaceutical) (generic), lisinopril/hydrochlorothiazide estradiol (generic), estropipate (generic) lovastatin (generic), Lipitor® (Pfizer), Premarin® (Wyeth), Estring® (Pharmacia) (generic), Omnicef® (Abbott Laboratories) (generic), bisoprolol/hydrochlorothiazide If “generic” appears after the brand-name drug, please consider the generic. The brand name is listed for reference only. (Brand nonpreferred.)

Source: https://www.groupselffunded.com/Docs/MG9061993tierFICFBICandJA110804.pdf

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