Express Scripts No Cost Share Preventive Drug List HDHP

2025 CDH Preventive Medications - Standard Plus

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

DL_0017456B 303862

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