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Prmtcdhcpdl-14.np-pdl.13100

2014 Express Scripts National Preferred
Preventive Drug List by Therapy Class
Prescription Drugs: You Make the Choices, We Make it Easy
Preventive Prescription Drugs: A Good Choice
Prescription drugs that can help keep you from developing a health condition are called preventive prescription drugs. They can help you maintain your quality of life and avoidexpensive treatment, helping to reduce your overall healthcare costs.
If your doctor prescribes a preventive prescription drug, you pay only a percentage of the total cost – right from the beginning.
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 does not guarantee coverage. Not all the drugs listed are covered by allprescription-drug benefit programs; check your benefit materials for the specific drugs covered and the copayment information for your prescription-drug benefit program.
For the member: Generic drugs are listed in lower case 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 doctor to prescribe generic drugs wheneverappropriate.
Some drugs are marked with a symbol “*”. The symbol * next to a drug signifies subject to nonpreferred status when generic is available throughout the year.
For the physician: Please prescribe preferred (Best Buy) products and allow generic substitutions when medically appropriate. Thank you.
NOTE: This list does not indicate coverage. You or your doctor may be asked to prove that the drug you're taking is being used for prevention. This list does not include
all conditions that may be prevented with preventive prescription drugs or all preventive drugs available. Your plan sponsor believes that these drugs satisfy the
requirements for preventive care as outlined by the U.S. Treasury Department but cannot ensure that the Treasury Department would agree that all of these drugs satisfy
the definition of preventive care.

BEST BUY MEDICATIONS
The following list of drugs represents the preferred medications under the Preventive care list. Preferred medications are generic or brand-name drugsavailable to members at the lower cost.
ANTIVIRAL DRUGS
Beta Blockers
Direct Renin Inhibitors
Adrenolytics-Central &
& Combos
Influenza Agents
Thiazide Combinations
ENDOCRINE MEDICATIONS
Angiotensin II Receptor
Diuretics
CARDIOVASCULAR
Antagonists
MEDICATIONS
Antidiabetic - Amylin Analogs
ACE Inhibitors
Angiotensin II Receptor
Biguanides
Antagonists & Thiazides
Calcium Channel Blockers
Angiotensin II Receptor
Antag & Ca Channel Blocker
Calcium Regulators
Combinations
HMG CoA Reductase Inhibitors
Antiadrenergic
Antihypertensives
ACE Inhibitors & Calcium
Channel Blocker Combinations
Diabetic Other
Hypolipoproteinemics
Beta Blocker & Diuretic
ACE Inhibitors &
Combinations
Thiazide/Thiazide-Like
Dipeptidyl Peptidase-4
Inhibitors & Combos
Incretin Mimetic Agents
THIS DOCUMENT LIST IS EFFECTIVE JANUARY 1, 2014 THROUGH DECEMBER 31, 2014. THIS LIST IS SUBJECT TO CHANGE.
Check your benefit materials for copayment information. Copayments vary based on formulary status.
For specific questions about your coverage, please call the phone number printed on your ID card.
You can get more information and updates to this document at our website at www.express-scripts.com.
2014 Express Scripts Holding Company
PRMTCDHCPDL-14 (10/01/13)
All Rights Reserved
Insulin
OTHER PREVENTIVE MEDICATIONS
NUTRITION & BLOOD
MODIFIERS
The following section lists the nonpreferred medications. These are drugs that are available to the member at a higher cost.
Coumarin Anticoagulants
A
F
Folic Acid/Folates
Insulin Sensitizing Agents
Other Drugs Affecting
Coagulation
Meglitinide Analogues
G
Ped Mv W/ Fluoride
Sulfonylurea-Biguanide
Q
Combinations
Platelet Aggregation
Sulfonylureas
Inhibitors
R
Thrombin Inhibitor
Thiazolidinedione-Biguanide
H
S
OBSTETRICAL &
Combinations
GYNECOLOGICAL MEDICATIONS
Hormone Receptor
I
Modulators
IMMUNOLOGICALS & VACCINES
Prenatal Vitamins
Antiasthmatic - Monoclonal
Antibodies
T
RESPIRATORY MEDICATIONS
B
Antimalarials
K
Adrenergic Combinations
Antiviral Monoclonal
Anti-Inflammatory Agents
C
L
Antibodies
Beta Adrenergics
Immune Serums
Immunologicals & Vaccines
U
Bronchodilators -
Anticholinergics
V
Leukotriene Modulators
M
Steroid Inhalants
W
Xanthines
D
N
X
SMOKING CESSATION
Z
DIABETIC SUPPLIES
P
Diagnostic Tests
THIS DOCUMENT LIST IS EFFECTIVE JANUARY 1, 2014 THROUGH DECEMBER 31, 2014. THIS LIST IS SUBJECT TO CHANGE.
Check your benefit materials for copayment information. Copayments vary based on formulary status.
For specific questions about your coverage, please call the phone number printed on your ID card.
You can get more information and updates to this document at our website at www.express-scripts.com.
2014 Express Scripts Holding Company
PRMTCDHCPDL-14 (10/01/13)
All Rights Reserved

Source: http://kapstonelongviewhealth.com/forms-docs/2014_HSAPreventiveDrugs.pdf

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