Preventive medications list In a high-deductible health plan like Boeing’s Advantage + health plan, federal rules permit certain preventive drugs to be paid without being subject to the plan’s deductible. For drugs on the preventive drug list, you pay only the generic, brand formulary, or brand non-formulary coinsurance percentage described in your plan summary. This list is periodically reviewed and updated to ensure that the drugs listed meet the criteria for inclusion. Because this list is subject to change, please log in to www.medco.com/boeing to check the status of the medications you take. Medications must be covered by your plan to be eligible for the preventive medication program.

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The following section lists generic and brand formulary drugs.

A acarbose ACCU-CHEK strips and meters acebutolol hcl acetazolamide ACTONEL ACTONEL WITH CALCIUM ACTOPLUS MET XR ADVAIR DISKUS ADVAIR HFA afeditab CR AGGRENOX albuterol albuterol sulfate alendronate ALTOPREV ALVESCO amiloride hcl amiloride hcl-hctz aminophylline amlodipine besylate amlodipine besylate-benazepril AMTURNIDE anagrelide anastrozole ANTARA APIDRA APIDRA SOLOSTAR ASCENSIA/GLUCOMETER strips and meters ASMANEX ATACAND ATACAND HCT atenolol

atenolol-chlorthalidone atorvastatin atovaquone/proguanil hcl ATROVENT HFA AZOR

B benazepril hcl benazepril hcl-hctz BENICAR BENICAR HCT betaxolol hcl BIDIL bisoprolol fumarate bisoprolol-hydrochlorothiazide BRILINTA budesonide bumetanide buproban SR bupropion SR BYDUREON BYETTA BYSTOLIC

C calcitonin, salmon captopril captopril-hydrochlorothiazide CARTIA XT carvedilol CHANTIX chloroquine chlorothiazide chlorpropamide chlorthalidone

Some brand drugs may change to non-formulary status during the year.

The following section lists generic and brand formulary drugs.

C (continued)

E

cholestyramine cholestyramine light cilostazol clonidine clopidogrel COARTEM colestipol hcl COMBIVENT COREG CR CRESTOR cromolyn sodium

EFFIENT enalapril maleate enalapril maleate-hctz enoxaparin sodium epinephrine pen injection EPIPEN EPIPEN JR. eplerenone etidronate EXFORGE EXFORGE HCT exemestane

D DALIRESP DARAPRIM DEMSER DIBENZYLINE difil-G dilex-G DILT-CD DILTIA XT diltiazem CD diltiazem ER diltiazem hcl diltiazem SR DILT-XR dipyridamole doxazosin DUETACT DULERA dyflex-G dylix

F FANSIDAR felodipine ER fenofibrate fenofibrate micronized fenofibric acid FENOGLIDE FLUMIST flu vaccines fluvastatin folic acid FORADIL fortical FORTEO fosinopril sodium fosinopril-hydrochlorothiazide furosemide

G gemfibrozil glimepiride

Some brand drugs may change to non-formulary status during the year.

The following section lists generic and brand formulary drugs.

G (continued) glipizide glipizide ER glipizide XL glipizide-metformin glucose tablets GLUCAGON EMERGENCY KIT glyburide glyburide micronized glyburide-metformin hcl guanabenz acetate guanfacine hcl

H HUMALOG HUMALOG MIX 50/50 HUMALOG MIX 75/25 HUMULIN HUMULIN 70/30 HUMULIN R hydralazine hydralazine/hctz hydrochlorothiazide

I ibandronate sodium indapamide ipratropium bromide ipratropium-albuterol irbesartan irbesartan-hctz isradipine

J JANTOVEN

JANUMET JANUVIA JENTADUETO

K KOMBIGLYZE

L labetalol hcl LANTUS SoloSTAR cartridge LANTUS vial letrozole levalbuterol hcl LEVATOL LEVEMIR LIPOFEN lisinopril lisinopril-hydrochlorothiazide losartan losartan-hctz lovastatin LOVAZA

M MALARONE matzim LA mefloquine hcl metaproterenol metformin hcl metformin hcl ER metazolamide methiazide methyclothiazide methyldopa methyldopahydrochlorothiazide

Some brand drugs may change to non-formulary status during the year.

The following section lists generic and brand formulary drugs.

M (continued) metoprolol succinate metoprolol tartrate metoprolol SR metoprolol-hydrochlorothiazide MICARDIS MICARDIS HCT minoxidil moexipril hcl moexipril-hydrochlorothiazide montelukast sodium

N nadolol nadolol-bendroflumethiazide nateglinide NIASPAN nicardipine hcl NICOTROL NICOTROL NS nifediac cc nifedical XL nifedipine CR nifedipine ER nifedipine SR nislodipine NOVOLOG NOVOLOG MIX 70/30

O ONE TOUCH strips and meters ONGLYZA

P pamidronate pediatric multi-vit w/fluoride

pediatric multi-vit w/fluoride & iron pentoxifylline PERFOROMIST perindopril erbumine pindolol pioglitazone hcl pioglitazone hcl-glimeprimide pioglitazone hcl-metformin hcl PNEUMOVAX 23 PRADAXA PRANDIN PRANDIMET pravastatin sodium prazosin PRECISION XTRA prenatal vitamin (generic) prevalite PROAIR HFA PROGLYCEM propranolol hcl propranolol SR propranolol hcl w/hctz PULMICORT

Q QUALAQUIN quinapril hcl quinaretic quinapril-hydrochlorothiazide QVAR

R RELENZA reserpine rimantadine hcl

Some brand drugs may change to non-formulary status during the year.

The following section lists generic and brand formulary drugs.

R (continued) RIOMET

S SEREVENT SIMCOR simvastatin sodium fluoride sorin sotalol AF spironolactone SPIRIVA spironolactone-hctz SYMBICORT SYMLIN SYMLINPEN SYNAGIS

T TAMIFLU tamoxifen citrate TEKAMLO TEKTURNA TEKTURNA HCT terazosin terbutaline sulfate theochron timolol theophylline tolazamide tolbutamide torsemide TRADJENTA trandolapril trandolapril-verapamil

triamterene-hctz TRIBE

V valsartan valsartan-hctz VENTOLIN HFA verapamil ER verapamil hcl VICTOZA VYTORIN

W warfarin sodium WELCHOL

X XARELTO XGEVA

Z zafirlukast ZETIA ZOSTAVAX

Some brand drugs may change to non-formulary status during the year.

The following section lists non-formulary brand drugs.

A

BROVANA

ACCOLATE ACCUNEB ACCUPRIL ACCURETIC ACEON ACTOS ADALAT CC ADVICOR AEROBID AEROBID-M ALDACTAZIDE ALDACTONE ALTACE AMARYL APIDRA AREDIA ARIMIDEX ARIXTRA AROMASIN ATACAND ATACAND HCT ATELVIA AVALIDE AVANDAMET AVANDARYL AVANDIA AVAPRO

C

B BETAPACE BETAPACE AF BONIVA BRONCOMAR-1

CADUET CALAN CALAN SR CARDENE CARDENE SR CARDIZEM CARDIZEM CD CARDIZEM LA CARDURA CATAPRES CATAPRES TTS CLORPRES COLESTID COREG CORGARD CORZIDE COUMADIN tablets COVERA-HS COZAAR CYCLOSET

D DEMADEX DIABETA DIAMOX DIDRONEL DILACOR XR DIOVAN DIOVAN HCT DIURIL DUETACT DUONEB

Some brand drugs may change to non-formulary status during the year.

The following section lists non-formulary brand drugs. DYNACIRC CR DYAZIDE DYRENIUM

E EDARBI EDECRIN

F FARESTON FEMARA FIBRICOR FLUMADINE FLOVENT DISKUS FLOVENT HFA FORTAMET FOSAMAX FOSAMAX PLUS D FRAGMIN

G GANITE GASTROCROM GLUCAGEN GLUCOPHAGE GLUCOPHAGE XR GLUCOTROL GLUCOTROL XL GLUCOVANCE GLUMETZA GLYNASE GLYSET

H

I INDERAL INDERAL LA INDERIDE INNOPRAN XL INSPRA INTAL INTROL IPRIVASK ISOPTIN SR

J JUVISYNC

K KERLONE

L LARIUM LASIX LESCOL LESCOL XL LEVITOL LIPITOR LIVALO LOFIBRA LOPID LOPRESSOR LOPRESSOR HCT LOTENSIN LOTENSIN HCT LOTREL LOVENOX

HYZAAR Some brand drugs may change to non-formulary status during the year.

The following section lists non-formulary brand drugs.

M MALARONE MAVIK MAXAIR AUTOHALER MAXZIDE METAGLIP MEVACOR MIACALCIN nasal spray MICRONASE MICROZIDE MIDAMOR MINIPRES MONOPRIL MONOPRIL HCT

PRINIVIL PRINZIDE PROCARDIA PROCARDIA XL PROGLYCEM PROLIA PROVENTIL HFA PULMICORT

Q QUESTRAN QUESTRAN LIGHT

R RECLAST

N

S

NEXICLON XR NIMOTOP NORVASC NOVOLIN

SECTRAL SKELID SINGULAIR STARLIX SULAR

P PERSANTINE PLAVIX PLAQUINIL PLENDIL PLETAL PRAVACHOL PRECOSE PRECISION QID strips and meters PRECOSE PRESTIGE SMART strips and meters

T TARKA TENEX TENORETIC 100 TENORETIC 50 TENORMIN tablet TEVETEN TEVETEN HCT THALITONE THEO-24 TIAZAC

Some brand drugs may change to non-formulary status during the year.

The following section lists non-formulary brand drugs.

T (continued) TOPROL XL TRANDATE TRIGLIDE TRUETRACK strips and meters

U UNIPHYL UNIRETIC UNIVASC

V VASERETIC VASOTEC VERELAN VERELAN PM VERELAN SR VOSPIRE ER

X XOLAIR XOPENEX XOPENEX HFA

Z ZAROXOLYN ZEBETA ZESTORETIC ZESTRIL ZIAC ZOCOR ZOMETA ZYBAN ZYFLO ZYFLO CR Some brand drugs may change to non-formulary status during the year.

Notes

Express Scripts manages your prescription benefit for your employer, plan sponsor, or health plan. Medco is now a part of the Express Scripts family of pharmacies. All rights in the product names of all third-party products appearing here, whether or not appearing with the trademark symbol, belong exclusively to their respective owners. PDL6898B 10.12

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