2026 CDH Preventive Medications - Standard Plus
OBESITY ADIPEX-P (phentermine) benzphetamine CONTRAVE diethylpropion diethylpropion ER IMCIVREE LOMAIRA phendimetrazine phendimetrazine ER PLENITY QSYMIA (phentermine/ topiramate ER) WEGOVY XENICAL ZEPBOUND pens SMOKING-CESSATION* bupropion SR 150mg CHANTIX (varenicline)
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*
NICODERM CQ (nicotine patches) NICORETTE (nicotine gum and lozenges) NICOTROL NS
*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 Pharmacy Benefit Services 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 Evernorth Health Services. All Rights Reserved. All trademarks are the property of their respective owners.
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