36283A 50930 FNL Fully Covered Drug List Vanguard

Vanguard Fully Covered Drug List

Below is a list of the most commonly used generic drugs and the associated therapeutic class that will be fully covered for each qualifying disease state. This list is not all inclusive. For any generic drugs that fall within the disease states below that are not included on the list, contact CVS Caremark? to confirm eligibility. If you are currently taking a brand-name drug in one of these categories, ask your doctor if a generic option may be appropriate for you.

DISEASE STATE GENERIC DRUG NAME

THERAPEUTIC CLASS

Hypertension

ACEBUTOLOL HCL ACETAZOLAMIDE AFEDITAB CR ALISKIREN AMILORIDE HCL AMILORIDE-HYDROCHLOROTHIAZIDE AMLODIPINE BESYLATE AMLODIPINE BESYLATE-BENAZEP AMLODIPINE/OLMESARTAN AMLODIPINE/ OLMESARTAN/HYDROCHLOROTHIAZIDE AMLODIPINE-VALSARTAN AMLODIPINE-VALSARTAN-HCTZ ATENOLOL ATENOLOL-CHLORTHALIDONE BENAZEPRIL HCL BENAZEPRIL-HYDROCHLOROTHIAZIDE BETAXOLOL HCL BISOPROLOL FUMARATE BISOPROLOL-HYDROCHLOROTHIAZIDE BUMETANIDE CANDESARTAN CILEXETIL CANDESARTAN-HYDROCHLOROTHIAZIDE CAPTOPRIL CAPTOPRIL-HYDROCHLOROTHIAZIDE CARTIA XT CARVEDILOL CARVEDILOL ER CHLOROTHIAZIDE CHLORTHALIDONE CLONIDINE CLONIDINE HCL DILT-CD DILTIAZEM 12HR ER DILTIAZEM 24HR CD DILTIAZEM 24HR ER DILTIAZEM ER DILTIAZEM HCL DILT-XR DOXAZOSIN MESYLATE ENALAPRIL MALEATE

Beta Blockers Diuretics/Diuretic Combinations CCB Direct Renin Inhibitors Diuretics/Diuretic Combinations Diuretics/Diuretic Combinations Vasodilators Antihypertensives - Misc. Antihypertensives - Misc. Antihypertensives - Misc. Antihypertensives - Misc. Antihypertensives - Misc. Beta Blockers Antihypertensives - Misc. ACE Inhibitors Antihypertensives - Misc. Beta Blockers Beta Blockers Antihypertensives - Misc. Diuretics/Diuretic Combinations Angiotensin II Receptor Antagonists Antihypertensives - Misc. ACE Inhibitors Antihypertensives - Misc. CCB Beta Blockers Beta Blockers Diuretics/Diuretic Combinations Diuretics/Diuretic Combinations Antiadrenergics Antiadrenergics CCB CCB CCB CCB CCB CCB CCB Antiadrenergics ACE Inhibitors

ACE (Angiotensin-converting-enzyme). CCB (Calcium channel blocker). DPP-4 (dipeptidyl peptidase 4). Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information. The information contained in this communication is provided in summary form. It is not intended for use as the sole basis of clinical treatment, as a substitute for reading the original research, nor as a substitute for the knowledge, skill and judgment of the medical provider. This document contains confidential and proprietary information of CVS Caremark and may not be reproduced, distributed or printed without written permission from CVS Caremark. This list is subject to change. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. ?2020 CVS Caremark. All rights reserved. 106-36283A 011420

DISEASE STATE Hypertension

GENERIC DRUG NAME

ENALAPRIL-HYDROCHLOROTHIAZIDE EPROSARTAN MESYLATE FELODIPINE ER FOSINOPRIL SODIUM FOSINOPRIL-HYDROCHLOROTHIAZIDE FUROSEMIDE GUANFACINE HCL HYDRALAZINE HCL HYDROCHLOROTHIAZIDE INDAPAMIDE IRBESARTAN IRBESARTAN-HYDROCHLOROTHIAZIDE ISRADIPINE LABETALOL HCL LISINOPRIL LISINOPRIL-HYDROCHLOROTHIAZIDE LOSARTAN POTASSIUM LOSARTAN-HYDROCHLOROTHIAZIDE MATZIM LA METHAZOLAMIDE METHYLDOPA METOLAZONE METOPROLOL SUCCINATE METOPROLOL TARTRATE METOPROLOL-HYDROCHLOROTHIAZIDE MINOXIDIL MOEXIPRIL HCL NADOLOL NICARDIPINE HCL NIFEDIAC CC NIFEDICAL XL NIFEDIPINE NIFEDIPINE ER NIMODIPINE NISOLDIPINE OLMESARTAN OLMESARTAN/HYDROCHLOROTHIAZIDE PERINDOPRIL ERBUMINE PINDOLOL PRAZOSIN HCL PROPRANOLOL HCL PROPRANOLOL HCL ER PROPRANOLOL-HYDROCHLOROTHIAZIDE

THERAPEUTIC CLASS

Antihypertensives - Misc. Angiotensin II Receptor Antagonists CCB ACE Inhibitors Antihypertensives - Misc. Diuretics/Diuretic Combinations Antiadrenergics Vasodilators Diuretics/Diuretic Combinations Diuretics/Diuretic Combinations Angiotensin II Receptor Antagonists Antihypertensives - Misc. CCB Beta Blockers ACE Inhibitors Antihypertensives - Misc. Angiotensin II Receptor Antagonists Antihypertensives - Misc. CCB Diuretics/Diuretic Combinations Antiadrenergics Diuretics/Diuretic Combinations Beta Blockers Beta Blockers Antihypertensives - Misc. Vasodilators ACE Inhibitors Beta Blockers CCB CCB CCB CCB CCB CCB CCB Angiotensin II Receptor Antagonists Antihypertensives - Misc. ACE Inhibitors Beta Blockers Antiadrenergics Beta Blockers Beta Blockers Antihypertensives - Misc.

ACE (Angiotensin-converting-enzyme). CCB (Calcium channel blocker). DPP-4 (dipeptidyl peptidase 4). Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information. The information contained in this communication is provided in summary form. It is not intended for use as the sole basis of clinical treatment, as a substitute for reading the original research, nor as a substitute for the knowledge, skill and judgment of the medical provider. This document contains confidential and proprietary information of CVS Caremark and may not be reproduced, distributed or printed without written permission from CVS Caremark. This list is subject to change. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. ?2020 CVS Caremark. All rights reserved. 106-36283A 011420

DISEASE STATE Hypertension

DISEASE STATE Diabetes

GENERIC DRUG NAME

QUINAPRIL HCL QUINAPRIL-HYDROCHLOROTHIAZIDE RAMIPRIL SOTALOL SOTALOL AF SPIRONOLACTONE SPIRONOLACTONE-HCTZ TAZTIA XT TELMISARTAN TELMISARTAN-AMLODIPINE TELMISARTAN-HYDROCHLOROTHIAZIDE TERAZOSIN HCL TIMOLOL MALEATE TORSEMIDE TRANDOLAPRIL TRANDOLAPRIL-VERAPAMIL ER TRIAMTERENE-HYDROCHLOROTHIAZIDE

VALSARTAN VALSARTAN-HYDROCHLOROTHIAZIDE VERAPAMIL ER VERAPAMIL ER PM VERAPAMIL HCL VERAPAMIL SR GENERIC DRUG NAME

ACARBOSE ALOGLIPTIN ALOGLIPTIN/METFORMIN ALOGLIPTIN/PIOGLITAZONE GLIMEPIRIDE GLIPIZIDE GLIPIZIDE ER GLIPIZIDE XL GLIPIZIDE-METFORMIN GLYBURIDE GLYBURIDE MICRONIZED GLYBURIDE-METFORMIN HCL METFORMIN HCL METFORMIN HCL ER MIGLITOL NATEGLINIDE PIOGLITAZONE HCL PIOGLITAZONE-GLIMEPIRIDE PIOGLITAZONE-METFORMIN REPAGLINIDE

TOLBUTAMIDE

THERAPEUTIC CLASS

ACE Inhibitors Antihypertensives - Misc. ACE Inhibitors Beta Blockers Beta Blockers Diuretics/Diuretic Combinations Diuretics/Diuretic Combinations CCB Angiotensin II Receptor Antagonists Antihypertensives - Misc. Antihypertensives - Misc. Antiadrenergics Beta Blockers Diuretics/Diuretic Combinations ACE Inhibitors Antihypertensives - Misc. Diuretics/Diuretic Combinations Angiotensin II Receptor Antagonists Antihypertensives - Misc. CCB CCB CCB CCB THERAPEUTIC CLASS

Alpha-Glucosidase Inhibitor DPP-4 Inhibitors Combination products Combination products Sulfonylureas Sulfonylureas Sulfonylureas Sulfonylureas Combination products Sulfonylureas Sulfonylureas Combination products Biguanides Biguanides Alpha-Glucosidase Inhibitor Meglitinide Analogues DPP-4 Inhibitors Combination products Combination products Meglitinide Analogues

Sulfonylureas

ACE (Angiotensin-converting-enzyme). CCB (Calcium channel blocker). DPP-4 (dipeptidyl peptidase 4). Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information. The information contained in this communication is provided in summary form. It is not intended for use as the sole basis of clinical treatment, as a substitute for reading the original research, nor as a substitute for the knowledge, skill and judgment of the medical provider. This document contains confidential and proprietary information of CVS Caremark and may not be reproduced, distributed or printed without written permission from CVS Caremark. This list is subject to change. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. ?2020 CVS Caremark. All rights reserved. 106-36283A 011420

DISEASE STATE Cholesterol

DISEASE STATE Heart Failure

GENERIC DRUG NAME

AMLODIPINE-ATORVASTATIN ATORVASTATIN CALCIUM CHOLESTYRAMINE CHOLESTYRAMINE LIGHT COLESTIPOL HCL COLESEVELAM HCL EZETIMIBE EZETIMIBE/SIMVASTATIN FENOFIBRATE FENOFIBRIC ACID DELAYED-REL FLUVASTATIN SODIUM GEMFIBROZIL LOVASTATIN NIACIN ER OMEGA-3 ACID ETHYL ESTERS PRAVASTATIN SODIUM PREVALITE ROSUVASTATIN SIMVASTATIN GENERIC DRUG NAME

ACETAZOLAMIDE AMILORIDE HCL AMILORIDE-HYDROCHLOROTHIAZIDE BENAZEPRIL HCL BUMETANIDE CANDESARTAN CILEXETIL CAPTOPRIL CARVEDILOL CARVEDILOL ER CHLORTHALIDONE DIGITEK DIGOX DIGOXIN ENALAPRIL MALEATE EPLERENONE FOSINOPRIL SODIUM FUROSEMIDE HYDROCHLOROTHIAZIDE INDAPAMIDE IRBESARTAN LISINOPRIL LOSARTAN POTASSIUM METHAZOLAMIDE METOLAZONE METOPROLOL SUCCINATE

THERAPEUTIC CLASS

CCB/Statin Combination HMG CoA Reductase Inhibitors (Statins) Bile Acid Sequestrants Bile Acid Sequestrants Bile Acid Sequestrants Bile Acid Sequestrants Antihyperlipidemics Antihyperlipidemic Combinations Fibric Acid Derivatives Fibric Acid Derivatives HMG CoA Reductase Inhibitors (Statins) Fibric Acid Derivatives HMG CoA Reductase Inhibitors (Statins) Nicotinic Acid Derivatives Omega-3-acid Ethyl Ester HMG CoA Reductase Inhibitors (Statins) Bile Acid Sequestrants HMG CoA Reductase Inhibitors (Statins) HMG CoA Reductase Inhibitors (Statins) THERAPEUTIC CLASS

Diuretics/Diuretic Combinations Diuretics/Diuretic Combinations Diuretics/Diuretic Combinations ACE Inhibitors Diuretics/Diuretic Combinations Angiotensin II Receptor Antagonists ACE Inhibitors Beta Blockers Beta Blockers Diuretics/Diuretic Combinations Cardiac Glycosides Cardiac Glycosides Cardiac Glycosides ACE Inhibitors Selective aldosterone receptor antagonist ACE Inhibitors Diuretics/Diuretic Combinations Diuretics/Diuretic Combinations Diuretics/Diuretic Combinations Angiotensin II Receptor Antagonists ACE Inhibitors Angiotensin II Receptor Antagonists Diuretics/Diuretic Combinations Diuretics/Diuretic Combinations Beta Blockers

ACE (Angiotensin-converting-enzyme). CCB (Calcium channel blocker). DPP-4 (dipeptidyl peptidase 4). Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information. The information contained in this communication is provided in summary form. It is not intended for use as the sole basis of clinical treatment, as a substitute for reading the original research, nor as a substitute for the knowledge, skill and judgment of the medical provider. This document contains confidential and proprietary information of CVS Caremark and may not be reproduced, distributed or printed without written permission from CVS Caremark. This list is subject to change. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. ?2020 CVS Caremark. All rights reserved. 106-36283A 011420

DISEASE STATE Heart Failure

GENERIC DRUG NAME

METOPROLOL TARTRATE PERINDOPRIL ERBUMINE QUINAPRIL HCL RAMIPRIL SPIRONOLACTONE SPIRONOLACTONE-HCTZ TELMISARTAN TORSEMIDE TRANDOLAPRIL TRIAMTERENE-HYDROCHLOROTHIAZIDE VALSARTAN

THERAPEUTIC CLASS

Beta Blockers ACE Inhibitors ACE Inhibitors ACE Inhibitors Diuretics/Diuretic Combinations Diuretics/Diuretic Combinations Angiotensin II Receptor Antagonists Diuretics/Diuretic Combinations ACE Inhibitors Diuretics/Diuretic Combinations Angiotensin II Receptor Antagonists

ACE (Angiotensin-converting-enzyme). CCB (Calcium channel blocker). DPP-4 (dipeptidyl peptidase 4). Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information. The information contained in this communication is provided in summary form. It is not intended for use as the sole basis of clinical treatment, as a substitute for reading the original research, nor as a substitute for the knowledge, skill and judgment of the medical provider. This document contains confidential and proprietary information of CVS Caremark and may not be reproduced, distributed or printed without written permission from CVS Caremark. This list is subject to change. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. ?2020 CVS Caremark. All rights reserved. 106-36283A 011420

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