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BlueSaver Generic Preventive Care Drug Program List

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BlueSaver Generic Preventive Care

Drug Program List

Preventive care drugs are drugs that can help keep you from developing a health condition or related complications of a health condition. The Generic Preventive Care Drug Program includes certain generic preventive care drugs used for the following conditions: Cardiovascular Disease, Osteoporosis, Prenatal Care, Diabetes, and Asthma. For applicable BlueSaver plans, the generic preventive care drugs included on this list are available at 100% coverage, with the deductible waived.

All generic drugs listed below are subject to the quantity and day supply limits included with your benefit plan (typically a 90-day supply). Please refer to your benefit plan for a complete list of benefits, including specific exclusions.

G

ENERIC

N

AME

D

RUG

C

LASSIFICATION

ACARBOSE Prevention of Diabetes-Related Complications

ACEBUTOLOL HCL Prevention of Cardiovascular Disease

ADRENALIN CHLORIDE Prevention of Asthma-Related Complications

AFEDITAB CR Prevention of Cardiovascular Disease

ALBUTEROL SULFATE Prevention of Asthma-Related Complications

ALENDRONATE SODIUM Prevention of Osteoporosis

AMILORIDE HCL Prevention of Cardiovascular Disease

AMILORIDE HCL-HCTZ Prevention of Cardiovascular Disease

AMINOPHYLLINE Prevention of Asthma-Related Complications

AMLODIPINE BESYLATE Prevention of Cardiovascular Disease

AMLODIPINE BESYLATE-BENAZEPRIL Prevention of Cardiovascular Disease

AMLODIPINE-ATORVASTATIN Prevention of Cardiovascular Disease

ATENOLOL Prevention of Cardiovascular Disease

ATENOLOL-CHLORTHALIDONE Prevention of Cardiovascular Disease

ATORVASTATIN CALCIUM Prevention of Cardiovascular Disease

BENAZEPRIL HCL Prevention of Cardiovascular Disease

BENAZEPRIL-HYDROCHLOROTHIAZIDE Prevention of Cardiovascular Disease

BETAXOLOL HCL Prevention of Cardiovascular Disease

BISOPROLOL FUMARATE Prevention of Cardiovascular Disease

BISOPROLOL-HYDROCHLOROTHIAZIDE Prevention of Cardiovascular Disease

BUDESONIDE Prevention of Asthma-Related Complications

CALCITONIN-SALMON Prevention of Osteoporosis

CALNA Prevention of Prenatal Complications

CAPTOPRIL Prevention of Cardiovascular Disease

CAPTOPRIL-HYDROCHLOROTHIAZIDE Prevention of Cardiovascular Disease

CARTIA XT Prevention of Cardiovascular Disease

CARVEDILOL Prevention of Cardiovascular Disease

CAVAN ONE OMEGA Prevention of Prenatal Complications

CAVAN-ALPHA KIT Prevention of Prenatal Complications

® ®

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CAVAN-EC SOD DHA Prevention of Prenatal Complications

CAVAN-HEME OB Prevention of Prenatal Complications

CHLOROTHIAZIDE Prevention of Cardiovascular Disease

CHLOROTHIAZIDE SODIUM Prevention of Cardiovascular Disease

CHLORPROPAMIDE Prevention of Diabetes-Related Complications

CHLORTHALIDONE Prevention of Cardiovascular Disease

CHOLESTYRAMINE Prevention of Cardiovascular Disease

CHOLESTYRAMINE LIGHT Prevention of Cardiovascular Disease

CLONIDINE Prevention of Cardiovascular Disease

CLONIDINE HCL Prevention of Cardiovascular Disease

CLOPIDOGREL Prevention of Cardiovascular Disease

CLORPRES Prevention of Cardiovascular Disease

COLESTIPOL HCL Prevention of Cardiovascular Disease

COMPLETE NATAL DHA Prevention of Prenatal Complications

COMPLETENATE Prevention of Prenatal Complications

CO-NATAL FA Prevention of Prenatal Complications

COPD Prevention of Asthma-Related Complications

CROMOLYN SODIUM Prevention of Asthma-Related Complications

DAILY PRENATAL Prevention of Prenatal Complications

DIFIL-G FORTE Prevention of Asthma-Related Complications

DILT-CD Prevention of Cardiovascular Disease

DILTIA XT Prevention of Cardiovascular Disease

DILTIAZEM 24HR CD Prevention of Cardiovascular Disease

DILTIAZEM 24HR ER Prevention of Cardiovascular Disease

DILTIAZEM ER Prevention of Cardiovascular Disease

DILTIAZEM HCL Prevention of Cardiovascular Disease

DILT-XR Prevention of Cardiovascular Disease

DILTZAC ER Prevention of Cardiovascular Disease

DIPYRIDAMOLE Prevention of Cardiovascular Disease

ED-BRON G Prevention of Asthma-Related Complications

ELITE OB DHA Prevention of Prenatal Complications

ELITE-OB Prevention of Prenatal Complications

ENALAPRIL MALEATE Prevention of Cardiovascular Disease

ENALAPRIL-HYDROCHLOROTHIAZIDE Prevention of Cardiovascular Disease

EPHEDRINE SULFATE Prevention of Asthma-Related Complications

EPINEPHRINE Prevention of Asthma-Related Complications

EPROSARTAN MESYLATE Prevention of Cardiovascular Disease

ETIDRONATE DISODIUM Prevention of Osteoporosis

EZFE FORTE Prevention of Prenatal Complications

FELODIPINE ER Prevention of Cardiovascular Disease

FENOFIBRATE Prevention of Cardiovascular Disease

FENOFIBRIC ACID Prevention of Cardiovascular Disease

FLUVASTATIN SODIUM Prevention of Cardiovascular Disease

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FOLCAL DHA Prevention of Prenatal Complications

FOLCAPS OMEGA-3 Prevention of Prenatal Complications

FOLIC ACID Prevention of Prenatal Complications

FOLINATAL PLUS B Prevention of Prenatal Complications

FOLIVANE-EC CALCIUM DHA NF Prevention of Prenatal Complications

FOLIVANE-OB Prevention of Prenatal Complications

FOLIVANE-PRX DHA NF Prevention of Prenatal Complications

FORTICAL Prevention of Osteoporosis

FOSINOPRIL SODIUM Prevention of Cardiovascular Disease

FOSINOPRIL-HYDROCHLOROTHIAZIDE Prevention of Cardiovascular Disease

GEMFIBROZIL Prevention of Cardiovascular Disease

GENTEX ADE Prevention of Prenatal Complications

GLIMEPIRIDE Prevention of Diabetes-Related Complications

GLIPIZIDE Prevention of Diabetes-Related Complications

GLIPIZIDE ER Prevention of Diabetes-Related Complications

GLIPIZIDE XL Prevention of Diabetes-Related Complications

GLIPIZIDE-METFORMIN Prevention of Diabetes-Related Complications

GLYBURIDE Prevention of Diabetes-Related Complications

GLYBURIDE MICRONIZED Prevention of Diabetes-Related Complications

GLYBURIDE-METFORMIN HCL Prevention of Diabetes-Related Complications

GUANFACINE HCL Prevention of Cardiovascular Disease

HEMENATAL OB Prevention of Prenatal Complications

HEMENATAL OB + DHA Prevention of Prenatal Complications

HYDROCHLOROTHIAZIDE Prevention of Cardiovascular Disease

IBANDRONATE SODIUM Prevention of Osteoporosis

INATAL ADVANCE Prevention of Prenatal Complications

INATAL GT Prevention of Prenatal Complications

INATAL ULTRA Prevention of Prenatal Complications

INDAPAMIDE Prevention of Cardiovascular Disease

IPRATROPIUM BROMIDE Prevention of Asthma-Related Complications

IPRATROPIUM-ALBUTEROL Prevention of Asthma-Related Complications

IRBESARTAN Prevention of Cardiovascular Disease

IRBESARTAN-HYDROCHLOROTHIAZIDE Prevention of Cardiovascular Disease

ISRADIPINE Prevention of Cardiovascular Disease

JANTOVEN Prevention of Cardiovascular Disease

KPN Prevention of Prenatal Complications

LABETALOL HCL Prevention of Cardiovascular Disease

LEVALBUTEROL HCL Prevention of Asthma-Related Complications

LISINOPRIL Prevention of Cardiovascular Disease

LISINOPRIL-HYDROCHLOROTHIAZIDE Prevention of Cardiovascular Disease

LOSARTAN POTASSIUM Prevention of Cardiovascular Disease

LOSARTAN-HYDROCHLOROTHIAZIDE Prevention of Cardiovascular Disease

LOVASTATIN Prevention of Cardiovascular Disease

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MATZIM LA Prevention of Cardiovascular Disease

METAPROTERENOL SULFATE Prevention of Asthma-Related Complications

METFORMIN HCL Prevention of Diabetes-Related Complications

METFORMIN HCL ER Prevention of Diabetes-Related Complications

METHYCLOTHIAZIDE Prevention of Cardiovascular Disease

METHYLDOPA Prevention of Cardiovascular Disease

METHYLDOPA-HYDROCHLOROTHIAZIDE Prevention of Cardiovascular Disease

METOLAZONE Prevention of Cardiovascular Disease

METOPROLOL SUCCINATE Prevention of Cardiovascular Disease

METOPROLOL TARTRATE Prevention of Cardiovascular Disease

METOPROLOL-HYDROCHLOROTHIAZIDE Prevention of Cardiovascular Disease

MOEXIPRIL HCL Prevention of Cardiovascular Disease

MOEXIPRIL-HYDROCHLOROTHIAZIDE Prevention of Cardiovascular Disease

MONTELUKAST SODIUM Prevention of Asthma-Related Complications

MYNATAL Prevention of Prenatal Complications

MYNATAL ADVANCE Prevention of Prenatal Complications

MYNATAL PLUS Prevention of Prenatal Complications

MYNATAL-Z Prevention of Prenatal Complications

MYNATE 90 PLUS Prevention of Prenatal Complications

NADOLOL Prevention of Cardiovascular Disease

NADOLOL-BENDROFLUMETHIAZIDE Prevention of Cardiovascular Disease

NATEGLINIDE Prevention of Diabetes-Related Complications

NICARDIPINE HCL Prevention of Cardiovascular Disease

NIFEDIAC CC Prevention of Cardiovascular Disease

NIFEDICAL XL Prevention of Cardiovascular Disease

NIFEDIPINE ER Prevention of Cardiovascular Disease

NISOLDIPINE Prevention of Cardiovascular Disease

NUTRI-TAB OB Prevention of Prenatal Complications

NUTRI-TAB OB + DHA Prevention of Prenatal Complications

OB-NATAL ONE Prevention of Prenatal Complications

OBSTETRIX DHA Prevention of Prenatal Complications

PERINDOPRIL ERBUMINE Prevention of Cardiovascular Disease

PERRY PRENATAL Prevention of Prenatal Complications

PINDOLOL Prevention of Cardiovascular Disease

PIOGLITAZONE Prevention of Diabetes-Related Complications

PIOGLITAZONE-METFORMIN Prevention of Diabetes-Related Complications

PNV OB+DHA Prevention of Prenatal Complications

PNV-DHA Prevention of Prenatal Complications

PNV-DHA + DOCUSATE Prevention of Prenatal Complications

PNV-OMEGA Prevention of Prenatal Complications

PNV-SELECT Prevention of Prenatal Complications

PNV-TOTAL Prevention of Prenatal Complications

PR NATAL 400 Prevention of Prenatal Complications

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PR NATAL 430 Prevention of Prenatal Complications

PR NATAL 430 EC Prevention of Prenatal Complications

PRAVASTATIN SODIUM Prevention of Cardiovascular Disease

PRENA1 Prevention of Prenatal Complications

PRENA1 CHEW Prevention of Prenatal Complications

PRENA1 PLUS Prevention of Prenatal Complications

PRENAFIRST Prevention of Prenatal Complications

PRENAISSANCE Prevention of Prenatal Complications

PRENAISSANCE BALANCE Prevention of Prenatal Complications

PRENAISSANCE NEXT Prevention of Prenatal Complications

PRENAISSANCE PLUS Prevention of Prenatal Complications

PRENAPLUS Prevention of Prenatal Complications

PRENATABS FA Prevention of Prenatal Complications

PRENATABS RX Prevention of Prenatal Complications

PRENATAL 19 Prevention of Prenatal Complications

PRENATAL AD Prevention of Prenatal Complications

PRENATAL COMPLETE Prevention of Prenatal Complications

PRENATAL FORMULA Prevention of Prenatal Complications

PRENATAL LOW IRON Prevention of Prenatal Complications

PRENATAL MULTI + DHA Prevention of Prenatal Complications

PRENATAL PLUS Prevention of Prenatal Complications

PRENATAL PLUS DHA Prevention of Prenatal Complications

PRENATAL VITAMINS Prevention of Prenatal Complications

PRENATAL-U Prevention of Prenatal Complications

PRENAVITE Prevention of Prenatal Complications

PREVALITE Prevention of Cardiovascular Disease

PROPRANOLOL HCL Prevention of Cardiovascular Disease

PROPRANOLOL-HYDROCHLOROTHIAZIDE Prevention of Cardiovascular Disease

QUINAPRIL HCL Prevention of Cardiovascular Disease

QUINAPRIL-HYDROCHLOROTHIAZIDE Prevention of Cardiovascular Disease

RAMIPRIL Prevention of Cardiovascular Disease

RELNATE DHA Prevention of Prenatal Complications

SE-CARE Prevention of Prenatal Complications

SE-CARE CONCEIVE Prevention of Prenatal Complications

SE-CARE GESTURE Prevention of Prenatal Complications

SE-NATAL 19 Prevention of Prenatal Complications

SE-NATAL 90 Prevention of Prenatal Complications

SE-NATAL ONE Prevention of Prenatal Complications

SE-PLETE DHA Prevention of Prenatal Complications

SE-TAN DHA Prevention of Prenatal Complications

SETONET Prevention of Prenatal Complications

SETONET-EC Prevention of Prenatal Complications

SIMVASTATIN Prevention of Cardiovascular Disease

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SPIRONOLACTONE-HCTZ Prevention of Cardiovascular Disease

TARON A PRENATAL Prevention of Prenatal Complications

TARON EC CALCIUM Prevention of Prenatal Complications

TARON-BC Prevention of Prenatal Complications

TARON-C DHA Prevention of Prenatal Complications

TARON-DUO EC Prevention of Prenatal Complications

TARON-EC CAL Prevention of Prenatal Complications

TARON-PREX PRENATAL Prevention of Prenatal Complications

TAZTIA XT Prevention of Cardiovascular Disease

TERBUTALINE SULFATE Prevention of Asthma-Related Complications

THEOCHRON Prevention of Asthma-Related Complications

THEOPHYLLINE Prevention of Asthma-Related Complications

THEOPHYLLINE ANHYDROUS Prevention of Asthma-Related Complications

TIAZAC Prevention of Cardiovascular Disease

TICLOPIDINE HCL Prevention of Cardiovascular Disease

TIMOLOL MALEATE Prevention of Cardiovascular Disease

TL-SELECT Prevention of Prenatal Complications

TOLAZAMIDE Prevention of Diabetes-Related Complications

TOLBUTAMIDE Prevention of Diabetes-Related Complications

TRANDOLAPRIL Prevention of Cardiovascular Disease

TRI RX Prevention of Prenatal Complications

TRIADVANCE Prevention of Prenatal Complications

TRIAMTERENE-HCTZ Prevention of Cardiovascular Disease

TRIMESIS RX Prevention of Prenatal Complications

TRINATAL GT Prevention of Prenatal Complications

TRINATAL RX 1 Prevention of Prenatal Complications

TRINATAL ULTRA Prevention of Prenatal Complications

TRINATE Prevention of Prenatal Complications

TRIVEEN-DUO DHA Prevention of Prenatal Complications

TRIVEEN-ONE Prevention of Prenatal Complications

TRIVEEN-PRX RNF Prevention of Prenatal Complications

TRIVEEN-TEN Prevention of Prenatal Complications

TRIVEEN-U Prevention of Prenatal Complications

ULTIMATE OB DHA Prevention of Prenatal Complications

ULTIMATECARE ADVANTAGE Prevention of Prenatal Complications

ULTIMATECARE ONE Prevention of Prenatal Complications

ULTIMATECARE ONE NF Prevention of Prenatal Complications

VALSARTAN-HYDROCHLOROTHIAZIDE Prevention of Cardiovascular Disease

VEMAVITE-PRX 2 Prevention of Prenatal Complications

VENA-BAL DHA Prevention of Prenatal Complications

VENATAL COMPLETE DHA Prevention of Prenatal Complications

VENATAL-FA Prevention of Prenatal Complications

VERAPAMIL ER Prevention of Cardiovascular Disease

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VERAPAMIL HCL Prevention of Cardiovascular Disease

VINACAL Prevention of Prenatal Complications

VINATE AZ Prevention of Prenatal Complications

VINATE AZ EXTRA Prevention of Prenatal Complications

VINATE C Prevention of Prenatal Complications

VINATE CALCIUM Prevention of Prenatal Complications

VINATE CARE Prevention of Prenatal Complications

VINATE GT Prevention of Prenatal Complications

VINATE IC Prevention of Prenatal Complications

VINATE II Prevention of Prenatal Complications

VINATE ONE Prevention of Prenatal Complications

VINATE PN CARE Prevention of Prenatal Complications

VINATE ULTRA Prevention of Prenatal Complications

VINATE-M Prevention of Prenatal Complications

VIRT-BAL DHA Prevention of Prenatal Complications

VIRT-BAL DHA PLUS Prevention of Prenatal Complications

VIRT-PN Prevention of Prenatal Complications

VIRT-PN DHA Prevention of Prenatal Complications

VITAFOL-OB Prevention of Prenatal Complications

VITAFOL-PN Prevention of Prenatal Complications

VITASPIRE Prevention of Prenatal Complications

V-NATAL Prevention of Prenatal Complications

V-NATAL DHA Prevention of Prenatal Complications

VOL-NATE Prevention of Prenatal Complications

VOL-PLUS Prevention of Prenatal Complications

VOL-TAB RX Prevention of Prenatal Complications

VP-CH-PNV Prevention of Prenatal Complications

VP-ERA OB PLUS Prevention of Prenatal Complications

VP-GGR-B6 Prevention of Prenatal Complications

WARFARIN SODIUM Prevention of Cardiovascular Disease

ZAFIRLUKAST Prevention of Asthma-Related Complications

ZATEAN-CH Prevention of Prenatal Complications

ZATEAN-PN Prevention of Prenatal Complications

ZATEAN-PN DHA Prevention of Prenatal Complications

ZATEAN-PN PLUS Prevention of Prenatal Complications

References

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