Preventive medications In addition to supporting a healthy lifestyle, preventive medications can help people avoid many illnesses and conditions. HDHP options that include preventive medications can help achieve the goal of ongoing good health. For ConocoPhillips participants who enroll in the HDHP option is coverage for certain preventive prescription drugs (treating, for example, high cholesterol, hypertension, and other ailments). For ConocoPhillips participants who enroll in the HDHP option, coverage is provided for certain preventive prescription drugs. Participants will be reimbursed at 100 percent, up to $1,500 per person per year. A more extensive list of the preventive prescription drugs will be available at hr.conocophillips.com under the HDHP Web page for current employees. If you have any questions regarding this benefit, you may also contact Medco Member Services at 1 800 770-2810 or go online to www.medco.com. This list provides examples of the HDHP medical option’s preventive medications by drug category. This is not an all-inclusive list. Medications may be added to or removed from the list depending on different factors, including the intended purpose(s) of the medication and medication availability. Some of the prescription drugs on this list are considered always preventive while others are considered sometimes preventive but may also be prescribed for the treatment of an existing condition. The $1,500 preventive prescription drug allowance that ConocoPhillips provides is applicable only to medications that are prescribed for prevention and not for treating a diagnosed condition. Please call Medco to confirm that your medication is on the preventive medication list.
Medications on this list that are not covered under your plan are not eligible for the preventive medications program.
Preventive medications list This list includes both medications used always for prevention and medications used sometimes for prevention and sometimes for treatment.
Drug category
Examples of products
Anticoagulants/ antiplatelets
• • • • •
aspirin/dipyridamole (Aggrenox ®) clopidogrel (Plavix ®) dipyridamole (Persantine ®) ticlopidine (Ticlid ®) warfarin (Coumadin ®, Jantoven ®)
Antiemetics/ antivertigo agents
• • • • • • • • • • • • •
aprepitant (Emend ®) dimenhydrinate dolasetron (Anzemet ®) dronabinol (Marinol ®) granisetron (Kytril ®) meclizine (Antivert ®) ondansetron (Zofran ®, Zofran ODT ®) palonosetron (Aloxi ®) prochlorperazine (Compazine ®) promethazine (Phenergan ®) scopolamine (Transderm Scop ®; Scopace ®) thiethylperazine (Torecan ®) trimethobenzamide (Tigan ®)
Antiestrogens
• • • • •
anastrozole (Arimidex ®) exemestane (Aromasin ®) letrozole (Femara ®) tamoxifen (Nolvadex ®) raloxifene (Evista ®)
Antihypertensives
• ACE inhibitors: benazepril (Lotensin ®); benazepril-HCTZ (Lotensin HCT ®); captopril (Capoten ®); captopril-HCTZ (Capozide ®); enalapril (Vasotec ®); enalapril-HCTZ (Vaseretic ®); fosinopril (Monopril ®); fosinopril-HCTZ (Monopril-HCT ®); lisinopril (Prinivil ®, Zestril ®); lisinopril-HCTZ (Prinzide ®, Zestoretic ®); moexipril (Univasc ®); moexipril-HCTZ (Uniretic ®); perindopril (Aceon ®); quinapril (Accupril ®); quinapril-HCTZ (Accuretic ®); ramipril (Altace ®); trandolapril (Mavik ®)
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Drug category Antihypertensives (continued)
Examples of products • Angiotensin II receptor blockers: eprosartan (Teveten ®); eprosartan-HCTZ (Teveten HCT ®); losartan (Cozaar ®); losartan-HCTZ (Hyzaar ®); telmisartan (Micardis ®); telmisartan-HCTZ (Micardis HCT ®); valsartan (Diovan ®); valsartanHCTZ (Diovan HCT ®) • Beta blockers: acebutolol (Sectral ®); atenolol (Tenormin ®); atenololchlorthalidone (Tenoretic ®); betaxolol (Kerlone ®); bisoprolol (Zebeta ®); bisoprolol-HCTZ (Ziac ®); carteolol (Cartrol ®); labetalol (Normodyne ®, Trandate ®); metoprolol (Lopressor ®, Toprol-XL ®); metoprolol-HCTZ (Lopressor HCT ®, Dutoprol™); nadolol (Corgard ®); nadolol-bendroflumethiazide (Corzide ®); penbutolol (Levatol ®); pindolol (Visken ®); propranolol (Inderal ®, Inderal ® LA, InnoPran XL ®); timolol (Blocadren ®); timolol-HCTZ (Timolide ®) • Calcium channel blockers: amlodipine (Norvasc ®); bepridil (Vascor ®); diltiazem (Cardizem ®, Cardizem ® CD, Cardizem ® SR, Cartia XT ®, Tiazac ®); felodipine (Plendil ®); isradipine (DynaCirc ®, DynaCirc CR ®); nicardipine (Cardene ®, Cardene ® SR); nifedipine (Adalat ®, Adalat ® CC, Procardia ®, Procardia XL ®); nisoldipine (Sular ®); verapamil (Calan ®, Calan ® SR, Covera-HS ®, Isoptin SR ®, Verelan ®, Verelan PM ®) • Miscellaneous antihypertensives: aliskiren (Tekturna ®); carvedilol (Coreg ®, Coreg CR ®); clonidine (Catapres ®); clonidinechlorthalidone (Combipres ®, Clorpres ®); doxazosin (Cardura ®); enalapril-felodipine (Lexxel ®); hydralazine (Apresoline ®); methyldopa (Aldomet ®);
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Drug category
Examples of products
Antihypertensives (continued)
methyldopa-chlorothiazide (Aldoclor ®); methyldopa-HCTZ (Aldoril ®); prazosin (Minipress ®);prazosin-polythiazide (Minizide ®); trandolapril-verapamil (Tarka ®); amlodipine/benazepril (Lotrel ®); amlodipine/valsartan (Exforge ®); • Thiazide diuretics and related diuretics: amiloride (Midamor ®); amiloride-HCTZ (Moduretic ®); eplerenone (Inspra ®); hydrochlorothiazide (HydroDIURIL ®, Esidrix ®); indapamide (Lozol ®); metolazone (Zaroxolyn ®); spironolactone (Aldactone ®); spironolactone-HCTZ (Aldactazide ®); terazosin (Hytrin ®); triamterene (Dyrenium ®); triamterene-HCTZ (Dyazide ®, Maxzide ®)
Anti-infectives
• atovaquone (Mepron ®) • pentamidine (NebuPent ®, Pentam ®) • posaconazole (Noxafil ®)
Antimalarials
• • • • • • • • •
Anti-ulcer agents
• H2-antagonists: cimetidine (Tagamet ®); famotidine (Pepcid ®); nizatidine (Axid ®); ranitidine (Zantac ®)
atovaquone/proguanil (Malarone ®) chloroquine (Aralen ®) halofantrine (Halfan ®) hydroxychloroquine (Plaquenil ®) mefloquine (Lariam ®) primaquine pyrimethamine (Daraprim ®) pyrimethamine-sulfadoxine (Fansidar ®) quinine (Qualaquin ®)
• Miscellaneous agents: misoprostol (Cytotec ®); sucralfate (Carafate ®) • Proton pump inhibitors: esomeprazole (Nexium ®); omeprazole (Prilosec ®)
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Drug category
Examples of products
Antivirals
• • • • • • • • • •
acyclovir tablets (Zovirax ®) amantadine (Symmetrel ®) famciclovir (Famvir ®) foscarnet (Foscavir ®) ganciclovir (Cytovene ®) oseltamivir (Tamiflu ®) rimantadine (Flumadine ®) valacyclovir (Valtrex ®) valganciclovir (Valcyte ®) zanamivir (Relenza ®)
Asthma therapies
• montelukast (Singulair ®) • zafirlukast (Accolate ®) • zileuton (Zyflo™)
Bowel evacuant products
• polyethylene glycaol 3350 combination products (Colyte®, GoLYTELY®, HalfLytely®, NuLYTELY®, TriLyte®, MoviPrep® • sodium phoshate salts (Visicol®, Osmoprep®)
Calcium replacement products
• calcium acetate (PhosLo ®) • calcium chloride • calcium gluconate
Cancer (adjunctive agents)
• • • • • • • • •
Cholesterollowering agents
• atorvastatin/amlodipine (Caduet ®) • cholestyramine (LoCholest ®; Prevalite ®; Questran ®; Questran ® Light) • colesevelam (WelChol ®) • colestipol (Colestid ®)
amifostine (Ethyol ®) darbepoetin alfa (Aranesp ®) dexrazoxane (Zinecard ®, Totect ™) epoetin alfa (Epogen ®, Procrit ®) filgrastim (Neupogen ®) leucovorin mesna (Mesnex ®) pegfilgrastim (Neulasta ®) sargramostim (Leukine ®)
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Drug category
6
Examples of products
Cholesterollowering agents (continued)
• • • • •
Contraceptives, non-oral
• intravaginal system (NuvaRing ®) • transdermal system (Ortho Evra ®)
Contraceptives, oral
• • • • • • • • • • • •
Dental aids
• minocycline (Arestin ®) • tetracycline (Actisite ®)
Estrogen replacement products
• conjugated estrogens, tablets (Premarin ®) • esterified estrogens/methyltestosterone (Estratest ®, Estratest ® H.S., Syntest™ DS, Syntest™ HS)
ezetimibe (Zetia ®) ezetimibe/simvastatin (Vytorin ®) fenofibrate (Antara ®, Lofibra ®, TriCor ®) gemfibrozil (Lopid ®) HMG-coA reductase inhibitors: atorvastatin (Lipitor ®); fluvastatin (Lescol ®, Lescol ® XL); Lovastatin (Mevacor ®, Altocor ®); pravastatin (Pravachol ®); rosuvastatin (Crestor ®); simvastatin (Zocor ®) • niacin (Niacor ®, Niaspan ®); niacin/lovastatin (Advicor ®) • omega-3-acid ethyl esters (Omacor ®) • Trilipix®
Apri ® Estrostep Fe ® Lybrel ® Ortho Tri-Cyclen ® Ortho Tri-Cyclen ® Lo Ovcon ® Seasonale ® TriNessa ® Trivora ® Yasmin ® Seasonique ® YAZ ®
Drug category
Examples of products
Estrogen replacement products (continued)
• estradiol (Alora ®, Climara ®, Esclim ®, Estrace ® tablets, Estraderm ®, Vivelle ®) • estradiol gel (Estrogel ®, Elestrin™, Divigel ®) • estradiol acetate (Femtrace ®, Femring ®) • estradiol/levonorgestrel (Climara Pro ®) • estradiol/norethindrone (Activella ®, CombiPatch ®) • estradiol/norgestimate (Ortho-Prefest ®) • estrogen/medroxyprogesterone (Premphase ®, Prempro™) • ethinyl estradiol/norethindrone (Femhrt ®) • synthetic conjugated estrogens, A (Cenestin ®) • synthetic conjugated estrogens, B (Enjuvia™)
Fluoride preparations, oral and topical
• • • • • • • •
Gout
• allopurinol (Zyloprim ®)
Heparin/low molecular weight heparin products
• heparin, beef • heparin, porcine • low-molecular-weight heparin: dalteparin (Fragmin ®); enoxaparin (Lovenox ®); fondaparinux (Arixtra ®); tinzaparin (Innohep ®)
Iron replacement agents (prescription only)
• • • • •
EtheDent™ Fluoritab™ Luride Lozi-Tabs ® Pediaflor ® sodium fluoride Flurorinse® (topical) Gel-Kam ® (topical) PreviDent ® Rinse (topical)
Chromagen ® FoliTab™ Foltrin™ Niferex ® Forte Venofer ® 7
Drug category
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Examples of products
Magnesium replacement products (prescription only)
• magnesium chloride • magnesium sulfate
Miscellaneous agents
• isoxsuprine (Vasodilan ®) • hepatitis B immune globulin (HepaGam B™)
Osteoporosis
• alendronate (Fosamax ®); alendronate/cholecalciferol (Fosamax Plus D™) • calcitonin (Fortical ®, Miacalcin ®) • etidronate (Didronel ®) • ibandronate (Boniva ®) • raloxifene (Evista ®) • risedronate (Actonel ®) • zoledronic acid (Reclast ®)
Phosphate/ potassium replacement products
• potassium bicarbonate/citric acid (Effer-K ®, K-Lyte ®) • potassium chloride (K-Dur ®, K-Tab ®, Klotrix ®, Klor-Con ®, Slow-K ®) • potassium gluconate • potassium phosphate (Neutra-Phos ® K) • potassium and sodium phosphate (K-Phos ® Neutral, Neutra-Phos ®) • sodium phosphate
Prenatal vitamins
• • • • • • •
Natachew ® Natafort ® Natelle ® PreCare ® Prenatal Plus ®, Prenatal RX™ PrimaCare ® Vitafol-OB™
Prescription vitamins
• • • • •
Berocca ® multivitamin w/fluoride Strovite Advance ®, Strovite Plus ® Theragran ® Therobec™, Therobec Plus™
Drug category
Examples of products
Progestins
• medroxyprogesterone (Amen ®, Cycrin ®, Depo-Provera ®, Provera ®) • norethindrone (Aygestin ®) • progesterone • progesterone, micronized (Crinone ®, Prochieve ®, Prometrium ®)
Renal disease agents
• lanthanum (Fosrenol ®) • sevelamer (Renagel ®)
Smoking-cessation products (prescription only)
• bupropion (Zyban®) • nicotine products (Nicotrol® Inhaler, Nicotrol® Nasal Spray) • varenicline (Chantix™)
Vitamin A products
• Aquasol A ®
Vitamin B products
• Calafol ® Rx • Folgard RX™ • Foltx ®
Vitamin B1 products
• thiamine
Vitamin B6 products
• pyridoxine
Vitamin B12 products
• cyanocobalamin (Nascobal ®) • cyanocobalamin/folic acid (Foltrate®)
Vitamin D products
• calcitriol (Rocaltrol ®) • dihydrotachysterol (DHT™, Hytakerol ®) • ergocalciferol (Drisdol ®)
Vitamin K products
• phytonadione (Mephyton ®)
Vitamins with folic acid
• Folvite ® • therapeutic vitamins with minerals • Vicon Forte ® 9
Drug category
Examples of products
Weight-loss agents (Prior authorization may be required)
• benzphetamine (Didrex ®) • diethylpropion • orlistat (Xenical ®) • phendimetrazine (Bontril® PDM, Bontril® Slow-Release, Melfiat®-105, Prelu-2 ®) • phendimetrazine (Adipex-P®, Ionamin ®) • sibutramine (Meridia ®)
Zinc replacement products
• zinc chloride • zinc sulfate
Abbreviations: HCTZ = hydrochlorothiazide
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Medco Health Solutions, Inc., manages your prescription drug benefit for your employer or health plan.
www.medco.com Medco is a registered trademark of Medco Health Solutions, Inc. All other trademarks are the property of their respective owners. © 2010 Medco Health Solutions, Inc. All rights reserved. Preventive Drug Lists-1&2 9.10
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