Preventive medications
In addition to a healthy lifestyle, preventive medications can help people avoid many illnesses and conditions. A consumer-directed health (CDH) plan that includes preventive medications can help support the goal of ongoing good health.
This list provides examples of your plan’s preventive medications by drug category. This is not an all-inclusive list. Coverage prior to the deductible being met may not be provided for every dosage form of a listed medication; please check with your plan administrator if you have questions. Medications may be added to or removed from the list (based on review of clinical experts), depending on different factors, including the intended purpose of the medication and its The medications listed below are used almost exclusively for treatment. However, they also have demonstrated long-term preventive benefits in terms of maintaining remission, preventing recurrent episodes of disease, or delaying/preventing surgery or long-term complications of a disease or condition.
Medications on this list that are not covered under
your plan are not eligible for the preventive
medication program.

Preventive medication list
This list includes medications used almost exclusively for treatment but with demonstrated long-term preventive benefits. Drug category
Examples of products
• bupropion (Aplenzin™, Wellbutrin XL ®, Wellbutrin SR ®, Wellbutrin ®) • desvenlafaxine ER (Pristiq™) • fluoxetine (Prozac ®, Prozac ® Weekly™) • fluvoxamine (Luvox ® CR) • paroxetine HCl (Paxil ®, Paxil CR ®) • paroxetine mesylate (Pexeva ®) • venlafaxine (Effexor ®, Effexor ® XR) Benign prostatic
Diabetes, insulin
• insulin aspart protamine/insulin aspart • insulin glulisine (Apidra ®) • insulin lispro protamine/insulin lispro (Humalog ®Mix 50/50, Humalog ®Mix 75/25) • insulin, NPH (Humulin ® N, Novolin ® N) • insulin, NPH/insulin, Regular (Humulin ® 50/50, Humulin ® 70/30, Novolin ® 50/50,Novolin ® 70/30) • insulin, NPH regular (Humulin ® N, Diabetes,
• glipizide (Glucotrol ®, Glucotrol XL ®) Drug category
Examples of products
• glipizide/metformin (Metaglip ®) noninsulin
• glyburide (DiaBeta ®, Micronase ®) hypoglycemic
• glyburide, micronized (Glynase ® PresTab ®) • glyburide/metformin (Glucovance ®) (continued)
• liraglutide (Victoza®)• metformin (Fortamet ®, Glucophage ®, Glucophage XR ®, Glumetza™) • miglitol (Glyset ®)• nateglinide (Starlix ®)• pioglitazone (Actos ®)• pioglitazone/glimepiride (Duetact™)• pioglitazone/metformin (ACTOplus met ®)• pioglitazone/metformin (ACTOplus metTM XR)• pramlintide (Symlin ®)• repaglinide (Prandin ®)• rosiglitazone (Avandia ®)• rosiglitazone/glimepiride (Avandaryl™)• rosiglitazone/metformin (Avandamet ®)• saxagliptin (Onglyza ™)• sitagliptin (Januvia™)• sitagliptin/metformin (Janumet™)• tolazamide • tolbutamide (Orinase ®) Immunosuppressants
• azathioprine (Imuran ®)• cyclosporine (Sandimmune ®)• cyclosporine, modified (Gengraf ®, Neoral ®)• mycophenolate mofetil (CellCept ®)• mycophenolic acid (Myfortic ®)• sirolimus (Rapamune ®)• tacrolimus (Prograf ®) corticosteroids
• budesonide (Pulmicort ®)• budesonide/formoterol (Symbicort ®)• flunisolide (Aerobid ®)• flunisolide/menthol (Aerobid ®-M)• fluticasone (Flovent ®, Flovent ® HFA)• fluticasone/salmeterol (Advair ®, Drug category
Examples of products

• C1-esterase inhibitor (Cinryze TM) Rheumatoid
• gold sodium thiomalate (Myochrysine ®) • penicillamine (Cuprimine ®, Depen ®)
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your prescription drug benefit.

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