This list provides examples of commonly prescribed preventive medications. It is not an all-inclusive list; however, many examples of the medications are listed in each category. This list does not indicate coverage. Please check with your plan administrator and/or benefit information materials if you have questions on coverage. Your cost share will be determined by your plan’s drug coverage and formulary plan. Coverage prior to the deductible being met may not be provided for every strength or dosage form of a listed medication. Please note: When feasible, brand names are shown in capitals in each category. If generic is available, it is listed in lowercase next to the brand name. If only generics are available (for example, brands are no longer available), they will only be listed in lowercase. 2025 Consumer Directed Healthcare (CDH) Preventive Medications - Standard Plus
ASTHMA/COPD ACCOLATE (zafirlukast) ADVAIR HFA AIRDUO DIGIHALER AIRSUPRA albuterol HFA albuterol nebulizer solution albuterol oral ANORO ELLIPTA ARNUITY ELLIPTA ASMANEX HFA ASMANEX TWISTHALER ATROVENT HFA BREO ELLIPTA BREZTRI AEROSPHERE BROVANA (arformoterol) budesonide oral inhalation COMBIVENT RESPIMAT cromolyn nebulizer solution DULERA FASENRA fluticasone/salmeterol formoterol INCRUSE ELLIPTA Inhaler and nebulizer assistive devices ipratropium/albuterol nebulizer solution
ASTHMA/COPD (CONTINUED) ipratropium nebulizer solution levabuterol nebulizer solution metaproterenol montelukast NUCALA OHTUVAYRE Peak flow meters QVAR REDIHALER roflumilast Spirometers SPIRIVA HANDIHALER (tiotropium cap-inhaler)
BONE DISEASE AND FRACTURES ACTONEL (risedronate) ATELVIA DR (risedronate DR)
BINOSTO DUAVEE EVISTA (raloxifene) FOSAMAX (alendronate) FOSAMAX D ibandronate oral RECLAST (zoledronic acid)
CAVITIES CLINPRO GEL-KAM periomed PREVIDENT sodium fluoride rinse, gel, cream, paste, tabs and drops COLONOSCOPY PREPARATION* gavilyte-c gavilyte-n GOLYTELY solution (PEG-3350/
SPIRIVA RESPIMAT STIOLTO RESPIMAT SYMBICORT (breyna, budesonide/formoterol) terbutaline oral
TEZSPIRE THEO-24 theophylline theophylline ER TRELEGY ELLIPTA wixela inhub
electrolytes, gavilyte-g) sodium, potassium and magnesium sulfates
XOLAIR YUPELRI zileuton ER ZYFLO
(over, please)
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DEPRESSION citalopram escitalopram fluoxetine fluoxetine DR fluvoxamine fluvoxamine ER PAXIL (paroxetine) PAXIL CR (paroxetine ER)
NON-INSULINS (continued) JANUMET XR JANUVIA JARDIANCE Lancets and lancing devices metformin metformin ER miglitol Misc. diabetic supplies (e.g. control solution, sensors, transmitters, insulin pumps and accessories, readers, pods, Tempo smart button) MOUNJARO nateglinide Needles OZEMPIC repaglinide RIOMET (metformin solution) RIOMET ER suspension SITAGLIPTIN SYMLINPEN SYNJARDY SYNJARDY XR Syringes Test strips TRIJARDY XR TRULICITY XIGDUO XR HEART DISEASE AND STROKE BLOOD THINNERS aspirin, 81 mg* & 325 mg aspirin/dipyridamole ER BRILINTA RYBELSUS saxagliptin saxagliptin/metformin
CHOLESTEROL LOWERING
HMG-COA REDUCTASE INHIBITORS* atorvastatin FLOLIPID suspension fluvastatin LESCOL XL (fluvastatin ER) LIVALO (pitavastatin) lovastatin
sertraline DIABETES
pravastatin rosuvastatin simvastatin ZYPITAMAG OTHER CHOLESTEROL LOWERING AGENTS CADUET (amlodipine/atorvastatin) colesevelam COLESTID (colestipol) ezetimibe ezetimibe/simvastatin FENOGLIDE (fenofibrate) FIBRICOR (fenofibric acid) LOPID (gemfibrozil) NEXLETOL NEXLIZET NIACOR niacin niacin ER QUESTRAN (cholestyramine) QUESTRAN LIGHT (cholestyramine light, prevalite) REPATHA TRILIPIX (fenofibric acid DR) VASCEPA (icosapent ethyl) HIGH BLOOD PRESSURE (HBP)
INSULINS HUMALOG HUMULIN INSULIN GLARGINE-YFGN LYUMJEV SEMGLEE-YFGN TOUJEO MAX SOLOSTAR TOUJEO SOLOSTAR TRESIBA TRESIBA FLEXTOUCH
INSULIN/GLP-1 RECEPTOR AGONIST COMBINATIONS SOLIQUA NON-INSULINS acarbose ACTOS (pioglitazone) ACTOPLUS MET (pioglitazone/metformin) BYDUREON BCISE BYETTA CYCLOSET DUETACT (pioglitazone/glimepiride) FARXIGA glimepiride glipizide glipizide/metformin Glucometers GLUCOTROL XL (glipizide ER) glyburide
ACE INHIBITORS ACCUPRIL (quinapril) ALTACE (ramipril) captopril fosinopril LOTENSIN (benazepril) moexipril perindopril trandolapril VASOTEC (enalapril) ZESTRIL (lisinopril)
clopidogrel dabigatran
dipyridamole DURLAZA ER EFFIENT (prasugrel) ELIQUIS
jantoven warfarin XARELTO ZONTIVITY
glyburide/metformin glyburide micronized
GLYXAMBI JANUMET
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ACE INHIBITORS / DIURETIC COMBINATIONS ACCURETIC (quinapril/HCTZ)
BETA BLOCKER / DIURETIC COMBINATIONS bisoprolol/HCTZ metoprolol/HCTZ propranolol/HCTZ TENORETIC (atenolol/chlorthalidone) CALCIUM CHANNEL BLOCKERS amlodipine CARDIZEM (diltiazem) CARDIZEM CD (cartia XT, diltiazem CD) CARDIZEM LA (diltiazem ER, matzim LA) felodipine ER isradipine nicardipine nifedipine PROCARDIA XL (nifedipine ER) SULAR ER (nisoldipine ER) TIAZAC ER (diltiazem ER, tiadylt ER, taztia XT) verapamil verapamil ER verapamil SR VERELAN PM (verapamil ER PM) DIURETICS chlorthalidone DIURIL suspension hydrochlorothiazide indapamide metolazone OTHER HBP & COMBINATIONS amlodipine/benazepril amlodipine/olmesartan amlodipine/olmesartan/HCTZ amlodipine/telmisartan amlodipine/valsartan amlodipine/valsartan/HCTZ Blood pressure monitors CADUET (amlodipine/atorvastatin) PRESTALIA trandolapril/verapamil ER
MALARIA ARAKODA
chloroquine mefloquine MALARONE (atovaquone/ proguanil) primaquine MIGRAINE PREVENTION AIMOVIG AJOVY EMGALITY 120mg QULIPTA MISC ANTIVIRALS
captopril/HCTZ fosinopril/HCTZ LOTENSIN HCT (benazepril/HCTZ)
VASERETIC (enalapril/HCTZ) ZESTORETIC (lisinopril/HCTZ) ANGIOTENSIN II RECEPTOR ANTAGONISTS candesartan
eprosartan irbesartan losartan
APRETUDE* BEYFORTUS DESCOVY*
olmesartan telmisartan valsartan ANGIOTENSIN II RECEPTOR ANTAGONISTS/DIURETIC COMBINATIONS candesartan/HCTZ irbesartan/HCTZ losartan/HCTZ
emtricitabine/ tenofovir disoproxil fumarate (TDF) 200mg/300mg* PREVYMIS
SYNAGIS OBESITY ADIPEX-P (phentermine) benzphetamine CONTRAVE diethylpropion diethylpropion ER
olmesartan/HCTZ telmisartan/HCTZ valsartan/HCTZ BETA BLOCKERS acebutolol
IMCIVREE LOMAIRA phendimetrazine phendimetrazine ER
betaxolol bisoprolol CORGARD (nadolol) LOPRESSOR (metoprolol tartrate) metoprolol succinate ER nebivolol pindolol propranolol propranolol ER TENORMIN (atenolol) timolol
PLENITY QSYMIA
WEGOVY XENICAL ZEPBOUND SMOKING-CESSATION*
bupropion SR 150mg CHANTIX (varenicline) NICODERM CQ (nicotine patches) NICORETTE (nicotine gum and lozenges) NICOTROL NS
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VACCINATION* Anthrax, BCG, Chikungunya, Cholera, COVID-19, Diphtheria, Haemophilus Influenza B, Hepatitis A and B, Human Papillomavirus, Influenza, Japanese Encephalitis, Measles, Meningococcal, Monkey/smallpox, Mumps, Pertussis, Pneumococcal, Poliovirus, Rabies, Respiratory syncytial virus, Rotavirus, Rubella,
Shingles, Tetanus, Tick-borne encephalitis, Typhoid, Varicella, Yellow Fever, Zoster VITAMINS OR MINERALS Folic acid* Prenatal vitamins Pediatric multivitamins with fluoride*
*Please note that some of these medications are also subject to the Affordable Care Act (ACA) and may be covered by your plan at 100%.
Express Scripts manages your prescription benefit for your employer, plan sponsor, or health plan. For specific questions on coverage, please call the phone number on your member ID card or visit our website express-scripts.com. © 2025 Express Scripts. All Rights Reserved. Express Scripts and the “E” Logo are trademarks of Express Scripts Strategic Development, Inc. All other trademarks are the property of their respective owners.
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