Physicians Plus

Maintenance Drug List Physicians Plus Insurance Corporation allows you to get a three-month supply of a variety of prescription drugs. This helps you make fewer trips to the pharmacy to refill prescriptions that you expect to take on a regular basis. Each prescription that is filled in this way requires you to pay three copays at the time of filling that prescription. To get started, ask your doctor to write you a new prescription with the quantity needed to last three months. If you have any questions, please call Physicians Plus Pharmacy Services at (608) 260-7803 or (800) 545-5015. Medication Name/Strength A Acebutolol 200 mg cap Acebutolol 400 mg cap Acetazolamide 125 mg tab Alendronate 5 mg tab Alendronate 10 mg tab Alendronate 70 mg tab Allopurinol 100 mg tab Allopurinol 300 mg tab Amantadine 100 mg cap Amiloride HCl-HCTZ 5-50 mg tab Amiodarone HCl 200 mg tab Amlodipine 10 mg tab Amlodipine Besylate 2.5 mg tab Amlodipine Besylate 5 mg tab Anastrozole 1 mg tab Armour Thyroid tab (all strengths) Atenolol 25 mg tab Atenolol 50 mg tab Atenolol 100 mg tab Atenolol-Chlorthalidone 50-25 mg tab Atenolol-Chlorthalidone 100-25 mg tab Azathioprine 50 mg tab B

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P+5395-1210

Benazepril HCl 5 mg tab Benazepril HCl 10 mg tab Benazepril HCl 20 mg tab Benazepril HCl 40 mg tab Benazepril-HCTZ 5-6.25 mg tab Benazepril-HCTZ 10-12.5 mg tab Benazepril-HCTZ 20-12.5 mg tab

Medication Name/Strength Benazepril-HCTZ 20-25 mg tab Benztropine Mes 0.5 mg tab Benztropine Mes 2 mg tab Bisoprolol-HCTZ 2.5-6.25 mg tab Bisoprolol-HCTZ 5-6.25 mg tab Bisoprolol-HCTZ 10-6.25 mg tab Bumetanide 0.5 mg tab Bumetanide 1 mg tab Bumetanide 2 mg tab Bupropion HCl 75 mg tab Bupropion HCl 100 mg tab Buspirone HCl 5 mg tab Buspirone HCl 10 mg tab Buspirone HCl 15 mg tab C Calcitriol 0.25 mcg cap Calcitriol 0.5 mcg cap Captopril 12.5 mg tab Captopril 25 mg tab Captopril 50 mg tab Captopril 100 mg tab Carbamazepine 100 mg tab chew Carbamazepine 200 mg tab Carbidopa-Levo ER 50-200 mg tab Carbidopa-Levodopa 25-100 mg tab Carvedilol 3.125 mg tab Carvedilol 6.25 mg tab Carvedilol 12.5 mg tab Cetirizine HCl 5 mg tab Cetirizine HCl 10 mg tab Chlorthalidone 25 mg tab Continued on next page

Medication Name/Strength Chlorthalidone 50 mg tab Cilostazol 50 mg tab Cimeditine 200 mg tab Cimeditine 300 mg tab Cimeditine 400 mg tab Cimeditine 800 mg tab Citalopram HBr 10 mg tab Citalopram HBr 20 mg tab Citalopram HBr 40 mg tab Clonidine HCl 0.1 mg tab Clonidine HCl 0.2 mg tab Clonidine HCl 0.3 mg tab Cyproheptadine 4 mg tab D Diclofenac Pot 50 mg tab Diclofenac Sod 25 mg tab EC Diclofenac Sod 50 mg tab EC Diclofenac Sod 75 mg tab EC Diclofenac Sod 100 mg SA tab Dicyclomine 10 mg cap Dicyclomine 20 mg tab Digitek 125 mcg tab Digitek 250 mcg tab Digoxin 125 mcg tab Digoxin 250 mcg tab Diltiazem 30 mg tab Diltiazem 60 mg tab Diltiazem 90 mg tab Diltiazem 120 mg tab Divalproex Sod DR 125 mg tab Divalproex Sod DR 250 mg tab Divalproex Sod DR 500 mg tab Donepezil HCl 5 mg tab Donepezil HCl 10 mg tab Doxazosin Mesylate 1 mg tab Doxazosin Mesylate 2 mg tab Doxazosin Mesylate 4 mg tab Doxazosin Mesylate 8 mg tab Doxepin 10 mg cap Doxepin 25 mg cap Doxepin 50 mg cap Doxepin 75 mg cap Doxepin 100 mg cap

2650 Novation Parkwy Madison, WI 53713 www.pplusic.com Member Service: 608-282-8900 or 800-545-5015 NursePlus: 866-PPLUSRN (866-775-8776)

Medication Name/Strength E Enalapril Maleate 2.5 mg tab Enalapril Maleate 5 mg tab Enalapril Maleate 10 mg tab Enalapril Maleate 20 mg tab Enalapril-HCTZ 5-12.5 mg tab Enalapril-HCTZ 10-25 mg tab Estradiol 0.5 mg tab Estradiol 1 mg tab Estradiol 2 mg tab Estropipate 0.625 (0.75 mg) tab Estropipate 1.25 (1.5 mg) tab F Famotidine 20 mg tab Famotidine 40 mg tab Finasteride 5 mg tab Flecainide Acetate 50 mg tab Flecainide Acetate 100 mg tab Flecainide Acetate 150 mg tab Fludrocortisone 0.1 mg tab Fluoxetine HCl 10 mg cap Fluoxetine HCl 10 mg tab Fluoxetine HCl 20 mg cap Fluoxetine HCl 20 mg tab Fluoxetine HCl 40 mg cap Folic Acid 400 mcg tab Folic Acid 1 mg tab Fosinopril Sodium 10 mg tab Fosinopril Sodium 20 mg tab Fosinopril Sodium 40 mg tab Furosemide 20 mg tab Furosemide 40 mg tab Furosemide 80 mg tab G Gabapentin 100 mg cap Gabapentin 300 mg cap Gabapentin 400 mg cap Gemfibrozil 600 mg tab Glimepiride 1 mg tab Glimepiride 2 mg tab Glimepiride 4 mg tab Glipizide 5 mg tab Glipizide 10 mg tab Glipizide ER 2.5 mg tab Glipizide ER 5 mg tab Glipizide ER 10 mg tab Glyburide 1.25 mg tab Continued on next page

Medication Name/Strength

Medication Name/Strength

Glyburide 2.5 mg tab Glyburide 5 mg tab Glyburide Micronized 1.5 mg tab Glyburide Micronized 3 mg tab Glyburide Micronized 6 mg tab Glyburide-Metformin 1.25-250 mg tab Glyburide-Metformin 2.5-500 mg tab Glyburide-Metformin 5-500 mg tab Guanfacine 1 mg tab Guanfacine 2 mg tab

L Labetalol HCl 100 mg tab Labetalol HCl 200 mg tab Labetalol HCl 300 mg tab Lamotrigine 25 mg tab Lamotrigine 100 mg tab Lamotrigine 150 mg tab Lamotrigine 200 mg tab Letrozole 2.5 mg tab Levetiracetam 250 mg tab Levetiracetam 500 mg tab Levetiracetam 750 mg tab Levothyroid tab (all strengths) Levothyroxine tab (all strengths) Levoxyl tab (all strengths) Lisinopril 2.5 mg tab Lisinopril 5 mg tab Lisinopril 10 mg tab Lisinopril 20 mg tab Lisinopril 30 mg tab Lisinopril 40 mg tab Lisinopril-HCTZ 10-12.5 mg tab Lisinopril-HCTZ 20-12.5 mg tab Lisinopril-HCTZ 20-25 mg tab Lithium Carbonate 150 mg cap Lithium Carbonate 300 mg cap Lithium Carbonate ER 300 mg tab Lithium Carbonate ER 450 mg tab Loratadine 10 mg tab Losartan Potassium 25 mg tab Losartan Potassium 50 mg tab Losartan Potassium 100 mg tab Losartan-HCTZ 50-12.5 mg tab Losartan-HCTZ 100-12.5 mg tab Losartan-HCTZ 100-25 mg tab

H Hydralazine 10 mg tab Hydralazine 25 mg tab Hydralazine 50 mg tab Hydralazine 100 mg tab Hydrochlorothiazide 25 mg tab Hydrochlorothiazide 50 mg tab Hydrocortisone 20 mg tab Hydroxychloroquine 200 mg tab Hydroxyzine HCl 10 mg tab Hydroxyzine HCl 25 mg tab Hydroxyzine HCl 50 mg tab Hydroxyzine Pam 25 mg cap Hydroxyzine Pam 50 mg cap I Ibuprofen 400 mg tab Ibuprofen 600 mg tab Ibuprofen 800 mg tab Indapamide 1.25 mg tab Indomethacin 25 mg cap Indomethacin 50 mg cap Isoniazid 300 mg tab Isosorbide DN 10 mg tab Isosorbide DN 20 mg tab J Jantoven 1 mg tab Jantoven 2 mg tab Jantoven 2.5 mg tab Jantoven 3 mg tab Jantoven 4 mg tab Jantoven 5 mg tab K 2650 Novation Parkwy Madison, WI 53713 www.pplusic.com Member Service: 608-282-8900 or 800-545-5015 NursePlus: 866-PPLUSRN (866-775-8776)

Ketoprofen 50 mg cap Ketoprofen 75 mg cap

M Meclizine 12.5 mg tab Meclizine 25 mg tab Medroxyprogesterone 2.5 mg tab Medroxyprogesterone 5 mg tab Medroxyprogesterone 10 mg tab Meloxicam 7.5 mg tab Meloxicam 15 mg tab Metformin HCl 500 mg tab Metformin HCl 850 mg tab Metformin HCl 1,000 mg tab Metformin HCl ER 500 mg tab Metformin HCl ER 750 mg tab Methimazole 5 mg tab Continued on next page

Medication Name/Strength

Medication Name/Strength

Methimazole 10 mg tab Methotrexate 2.5 mg tab Methyldopa 250 mg tab Methyldopa 500 mg tab Metoclopramide 5 mg tab Metoclopramide 10 mg tab Metolazone 2.5 mg tab Metoprolol 25 mg tab Metoprolol 50 mg tab Metoprolol 100 mg tab Minoxidil 2.5 mg tab Minoxidil 10 mg tab Mirtazapine 15 mg tab Mirtazapine 30 mg tab Mirtazapine 45 mg tab

Pramipexole 0.5 mg tab Pramipexole 1 mg tab Pramipexole 1.5 mg tab Pravastatin Sodium 10 mg tab Pravastatin Sodium 20 mg tab Pravastatin Sodium 40 mg tab Pravastatin Sodium 80 mg tab Prazosin 1 mg cap Prazosin 2 mg cap Prazosin 5 mg cap Prednisone 1 mg tab Prednisone 2.5 mg tab Prednisone 5 mg tab Prednisone 10 mg tab Prednisone 20 mg tab Primidone 50 mg tab Primidone 250 mg tab Propafenone HCl 150 mg tab Propranolol 10 mg tab Propranolol 20 mg tab Propranolol 40 mg tab Propranolol 80 mg tab Propylthiouracil 50 mg tab

N Nabumetone 500 mg tab Nabumetone 750 mg tab Nadolol 20 mg tab Nadolol 40 mg tab Nadolol 80 mg tab Naproxen 250 mg tab Naproxen 375 mg tab Naproxen 375 mg tab EC Naproxen 500 mg tab Naproxen 500 mg tab EC Naproxen Sodium 550 mg tab O Omeprazole DR 10 mg cap Omeprazole DR 40 mg cap Oxaprozin 600 mg tab Oxcarbazepine 150 mg tab Oxybutynin 5 mg tab P

2650 Novation Parkwy Madison, WI 53713 www.pplusic.com Member Service: 608-282-8900 or 800-545-5015 NursePlus: 866-PPLUSRN (866-775-8776)

Pacerone 200 mg tab Pantoprazole Sod DR 20 mg tab Pantoprazole Sod DR 40 mg tab Paroxetine HCl 10 mg tab Paroxetine HCl 20 mg tab Paroxetine HCl 30 mg tab Paroxetine HCl 40 mg tab Phenytoin Sod EXT 100 mg cap Pindolol 5 mg tab Potassium CL ER 8 MEQ tab Pramipexole 0.125 mg tab Pramipexole 0.25 mg tab

Q Quinapril 5 mg tab Quinapril 10 mg tab Quinapril 20 mg tab Quinapril 40 mg tab R Ramipril 2.5 mg cap Ramipril 5 mg cap Ramipril 10 mg cap Ranitidine 150 mg tab Ranitidine 300 mg cap Ranitidine 300 mg tab Ropinirole HCl 0.25 mg tab Ropinirole HCl 0.5 mg tab Ropinirole HCl 1 mg tab Ropinirole HCl 2 mg tab Ropinirole HCl 3 mg tab S Salsalate 750 mg tab Sertraline HCl 25 mg tab Sertraline HCl 50 mg tab Sertraline HCl 100 mg tab Simvastatin 5 mg tab Continued on next page

Medication Name/Strength

Medication Name/Strength

Simvastatin 10 mg tab Simvastatin 20 mg tab Simvastatin 40 mg tab Simvastatin 80 mg tab Sotalol 120 mg tab Sotalol 160 mg tab Sotalol 80 mg tab Spironolactone 25 mg tab Spironolactone-HCTZ 25-25 tab Sucralfate 1 gm tab Sulindac 150 mg tab Sulindac 200 mg tab Synthroid tab (all strengths)

Venlafaxine HCl ER 75 mg cap Venlafaxine HCl ER 150 mg cap Verapamil 40 mg tab Verapamil 80 mg tab

T Tamoxifen 10 mg tab Tamoxifen 20 mg tab Tamsulosin HCl 0.4 mg cap Terazosin 1 mg cap Terazosin 2 mg cap Terazosin 5 mg cap Terazosin 10 mg cap Theophylline ER 200 mg tab Theophylline ER 300 mg tab Thyroid 32.5 mg tab Thyroid 65 mg tab Thyroid 130 mg tab Thyroid 195 mg tab Topiramate 25 mg tab Topiramate 50 mg tab Topiramate 100 mg tab Topiramate 200 mg tab Torsemide 10 mg tab Trazodone 50 mg tab Triamterene-HCTZ 37.5-25 mg tab Triamterene-HCTZ 75-50 mg tab Trihexyphenidyl 2 mg tab

W Warfarin Sodium 1 mg tab Warfarin Sodium 2 mg tab Warfarin Sodium 2.5 mg tab Warfarin Sodium 3 mg tab Warfarin Sodium 4 mg tab Warfarin Sodium 5 mg tab Warfarin Sodium 6 mg tab Warfarin Sodium 7.5 mg tab Warfarin Sodium 10 mg tab Z Zonisamide 25 mg cap Zonisamide 50 mg cap Zonisamide 100 mg cap

U Unithyroid tab (all strengths) Unithyroid Direct tab (all strengths) V

2650 Novation Parkwy Madison, WI 53713 www.pplusic.com Member Service: 608-282-8900 or 800-545-5015 NursePlus: 866-PPLUSRN (866-775-8776)

Valproic Acid 250 mg cap Venlafaxine HCl 25 mg tab Venlafaxine HCl 37.5 mg tab Venlafaxine HCl 50 mg tab Venlafaxine HCl 75 mg tab Venlafaxine HCl 100 mg tab Venlafaxine HCl ER 37.5 mg cap

Please review your pharmacy schedule of benefits to check whether this program is available to you. Visit RxManager at www.pplusic.com to determine how the drug is covered on your particular formulary. Not all dosage forms and strengths are included. Physicians Plus reserves the right to change this list and drug formulary at any time without notice.