Preventive Drug Class List - Premera Blue Cross

Preventive Drug Class ListThe classes of medications below are included on Starbucks Preventive Drug List. If you are enrolledin the Premera Gold or Silver plans, generic versions of these preventive drugs are always coveredat 100% (even if you haven’t met the deductible), and the cost for brand-name preventive drugs isreduced by 50%. If you are enrolled in the Health Savings Plan (HSP), all preventive drugs are coveredat 100%. Contraceptives are covered at the preventive level on all plans.Lowercase names=genericUppercase names=brand-nameACE inhibitors(Angiotensin-converting enzyme inhibitors)ACE inhibitors treat a variety of conditions, such as highblood pressure, scleroderma and migraines.EXAMPLES INCLUDEbenazeprilamlodipine/benazeprilbenazepril/hctzlisinoprillisinopril/hctzAngiotensin IIreceptor blockers(ARBs)Angiotensin II receptor blockers areused to treat conditions such as highblood pressure and heart failure.EXAMPLES INCLUDEirbesartanlosartanMICARDISAnti-adrenergicAnti-hypertensivesAnti-adrenergic anti-hypertensive drugsare used alone or with other drugs totreat high blood pressure (hypertension).EXAMPLES INCLUDEclonidinedoxazosinmethyldopaAnti-anginal agentsAnti-anginal agents, also known as nitrates, are drugsused to prevent chest pain (angina) in people with acertain heart condition (coronary artery disease).Long-acting nitrates:isosorbide dinitrateisosorbide mononitrateDILATRATE-SREXAMPLES INCLUDERapid-acting nitrates:nitroglycerinAnti-asthmaticsAnti-asthmatic drugs are used to treatwheezing and shortness of breath caused bybreathing problems, such as asthma, chronicobstructive pulmonary disease.EXAMPLES INCLUDEalbuterol sulfatealbuterol sulfate SRPROAIR HFAMiscellaneous anti-hypertensivesAnti-hypertensive medications are used with or withoutother medications to treat high blood pressure.EXAMPLES INCLUDEhydralazinehydralazine/hctzminoxidilAnti-arrhythmic drugsAnti-arrhythmic drugs are used to treat irregularheartbeat problems (arrhythmias). This oftenhappens after a person has had a heart attack.EXAMPLES INCLUDEamiodaronesotalol AFdisopyramidequinidineflecainideAnti-hyperlipidemicAnti-hyperlipidemic drugs are used along witha proper diet to help lower “bad” cholesterol(LD) and fats (triglycerides) and raise “good”cholesterol (HDL) in the blood. This group ofdrugs is also commonly referred to as “statins.”EXAMPLES INCLUDEcholestyraminecolestipolfenofibratelovastatinsimvastatinCRESTOR

Beta-blockers(hypertension)Beta blockers, also known as betaadrenergicblocking agents, treat highblood pressure, glaucoma and migraines.EXAMPLES INCLUDEBlood thinning agentsBlood thinning agents are used to treat bloodclots, such as in deep vein thrombosis-DVT orpulmonary embolus-PE. They also prevent newclots from forming in your body.EXAMPLES INCLUDEacebutololatenololatenolol/hctzCOREG CRcilostazoldipyridamoleclopidogrelwarfarinPRADAXACalcium channel blockersCalcium channel blockers, also called calciumantagonists, treat a variety of conditions, such as highblood pressure, migraines and Raynaud’s disease.EXAMPLES INCLUDEafeditab CRamlodipinecartia XTnimodipinediltiazem ERverapamil ERCardiac glycosidesCardiac glycosides are used, usually alongwith other medications, to treat heartfailure and heart rhythm problems. They arealso used to treat a certain type of irregularheartbeat (chronic atrial fibrillation).EXAMPLES INCLUDEdigoxinContraceptives(Birth Control)These products include combinations of estrogenand progestin drugs and devices used toprevent pregnancies.apriavianeEXAMPLES INCLUDElevoragianvijunel FeBEYAZAnti-diabetic drugsAnti-diabetic drugs are an important way of treatinggestational, type 1 and type 2 diabetes mellitus.EXAMPLES INCLUDEacarbosechlorpropamideglimepiridemetforminAPIDRADiabetic suppliesDiabetic supplies include syringes and other itemsthat you may need to give yourself insulin. Blood andurine glucose test strips are also included.lancetsneedles/syringesEXAMPLES INCLUDEACCU-CHEK STRIPSONE-TOUCH STRIPSGeneric 2 nd generation anti-depressantsThese medications are used by people to preventthe reoccurence of a disease (major depressivedisorder) from which a person has recovered.citalopramfluoxetineEXAMPLES INCLUDEparoxetinebupropionsertralineDiureticsDiuretics, commonly known as “water pills,” areused to treat high blood pressure and reducethe swelling and water build-up caused byvarious medical problems, including heart failure.Diuretics also help to make breathing easier.acetazolamideamiloride/hctzamilorideEXAMPLES INCLUDEhydrochlorothiazidetriamterene/hctzfurosemideThis is not a complete list of medications covered under yourplan. If you have questions about your pharmacy benefit,please visit mysbuxben.com, go to Premera Online and thento the Pharmacy section. If you’d like to speak with a PremeraPartner Services representative, please call 877-728-9020.An Independent Licensee of the Blue Cross Blue Shield Association025212 (08-2014)