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Prmtcdhcpdl-13.np-pdl.12110

2013 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
Adrenolytics-Central &
ENDOCRINE MEDICATIONS
Thiazide Combinations
Diuretics
Influenza Agents
Antidiabetic - Amylin Analogs
Angiotensin II Receptor
Antagonists
Biguanides
CARDIOVASCULAR
MEDICATIONS
ACE Inhibitors
Angiotensin II Receptor
Calcium Regulators
Antagonists & Thiazides
Calcium Channel Blockers
HMG CoA Reductase Inhibitors
Angiotensin II Receptor
Antag & Ca Channel Blocker
Combinations
Diabetic Other
Antiadrenergic
ACE Inhibitors & Calcium
Antihypertensives
Hypolipoproteinemics
Channel Blocker Combinations
Dipeptidyl Peptidase-4
Inhibitors & Combos
ACE Inhibitors &
Beta Blocker & Diuretic
Thiazide/Thiazide-Like
Combinations
Incretin Mimetic Agents
Insulin
Direct Renin Inhibitors
& Combos
Beta Blockers
THIS DOCUMENT LIST IS EFFECTIVE JANUARY 1, 2013 THROUGH DECEMBER 31, 2013. 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.
2013 Express Scripts Holding Company
PRMTCDHCPDL-13 (11/01/12)
All Rights Reserved
Folic Acid/Folates
OTHER PREVENTIVE MEDICATIONS
Other Drugs Affecting
Coagulation
The following section lists the nonpreferred medications. These are drugs that are available to the member at a higher cost.
Ped Mv W/ Fluoride
pediatric multi-vit w/fluoride
A
G
Insulin Sensitizing Agents
Platelet Aggregation
Meglitinide Analogues
Q
Inhibitors
Sulfonylurea-Biguanide
Combinations
Thrombin Inhibitor
Sulfonylureas
R
OBSTETRICAL &
GYNECOLOGICAL MEDICATIONS
H
Hormone Receptor
S
Modulators
I
Thiazolidinedione-Biguanide
Prenatal Vitamins
Combinations
RESPIRATORY MEDICATIONS
IMMUNOLOGICALS & VACCINES
Adrenergic Combinations
K
T
Antiasthmatic - Monoclonal
Antibodies
Anti-Inflammatory Agents
Antimalarials
B
L
Beta Adrenergics
albuterol
Antiviral Monoclonal
Antibodies
C
Immune Serums
Immunologicals & Vaccines
Bronchodilators -
Anticholinergics
Leukotriene Modulators
M
U
Steroid Inhalants
V
N
Xanthines
W
D
SMOKING CESSATION
P
X
DIABETIC SUPPLIES
Diagnostic Tests
Z
F
NUTRITION & BLOOD
MODIFIERS

Coumarin Anticoagulants
THIS DOCUMENT LIST IS EFFECTIVE JANUARY 1, 2013 THROUGH DECEMBER 31, 2013. 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.
2013 Express Scripts Holding Company
PRMTCDHCPDL-13 (11/01/12)
All Rights Reserved

Source: http://slunews.org/Documents/hr/benefits/2013%20Preventive%20Care%20Drug%20List%20for%20QHDHP%20by%20Therapy%20Class.pdf

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SECRETARIA DE SALUD MODIFICACION a la Norma Oficial Mexicana NOM-021-SSA2-1994, Para la prevención y control del complejoteniosis/cisticercosis en el primer nivel de atención médica, para quedar como NOM-021-SSA2-1994, Para laPrevención y control del binomio teniosis/cisticercosis en el primer nivel de atención médica. MODIFICACION a la Norma Oficial Mexicana NOM-021-SSA2-1994, Para l

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