Express Scripts No Cost Share Preventive Drug List HDHP

2025 CDH Preventive Medications - Standard Plus

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

DL_0017456B 303862

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