Anthem Blue Cross Health Account Plan Free Mail

Anthem Blue Cross Health Account Plan Free Mail

Anthem Blue Cross Health Account Plan:
Free Mail-Order Drug List
Free prescription drugs are available only through the Express Scripts mail-order program.
Listed drugs may change periodically; check with Express Scripts for updated information.
Drug Category
Examples of Products
Anticoagulants /
antiplatelets
x
x
x
x
x
x
x
Aspirin / dipyridamole (Aggrenox®)
clopidogrel
dipyridamole
prasugrel (EffientŒ)
ticagrelor (BrilintaŒ)
ticlopidine
warfarin
Antiemetics /
antivertigo agents
x
x
x
x
x
x
x
x
x
x
aprepitant (Emend®)
dimenhydrinate (injectable only)
dolasetron (Anzemet®)
granisetron (Sancuso®)
meclizine
ondansetron
prochlorperazine
promethazine
scopolamine (Transderm Scop®; Scopace®)
trimethobenzamide
Antiestrogens
x
x
x
x
x
anastrozole
exemestane
letrozole
tamoxifen
raloxifene (Evista®)
Blood pressure /
heart health
x ACE inhibitors: benazepril; benazepril-HCTZ; captopril; captopril-HCTZ;
enalapril; enalapril-HCTZ; fosinopril ;fosinopril-HCTZ; lisinopril; lisinoprilHCTZ; moexipril; moexipril-HCTZ; perindopril; quinapril; quinapril-HCTZ;
ramipril; trandolapril
x Angiotensin II receptor blockers: eprosartan mesylate (600mg only); irbesartan;
irbesartan-HCTZ; losartan; losartan-HCTZ; olmesartan (Benicar®); olmesartan-HCTZ
(Benicar HCT®); telmisartan (Micardis®); telmisartan-HCTZ (Micardis HCT®);
valsartan; valsartan-HCTZ
x Beta-blockers: acebutolol; atenolol; atenolol/chlorthalidone; betaxolol; bisoprolol;
bisoprolol-HCTZ; carvedilol (Coreg CR®); labetalol; metoprolol; metoprololHCTZ; nadolol; nadolol-bendroflumethiazide; nebivolol (BystolicŒ ); pindolol;
propranolol; sotalol; sotalol AF; timolol; timolol-HCTZ
x Calcium channel blockers: amlodipine; diltiazem; felodipine; isradipine;
nicardipine; nifedipine; nisoldipine; verapamil; verapamil ext. release
x Thiazide diuretics and related diuretics: amiloride; amiloride-HCTZ;
chlorothiazide; chlorthalidone; eplerenone; furosemide; hydrochlorothiazide;
indapamide; methyclothiazide; metolazone; spironolactone; spironolactoneHCTZ; triamterene; triamterene-HCTZ
x Miscellaneous: aliskiren (Tekturna®); aliskiren-HCTZ (Tekturna HCT®);
amlodipine/valsartan (Azor®); cilostazol, clonidine; clonidine-chlorthalidone;
doxazosin; digoxin, hydralazine HCl, minoxidil tablets only, guanfacine HCl;
Updated February 20, 2013
1
Anthem Blue Cross Health Account Plan:
Free Mail-Order Drug List
Drug Category
Examples of Products
enalapril-felodipine; hydralazine; methyldopa; methyldopa-HCTZ; prazosin;
reserpine; terazosin; amlodipine/benazepril; amlodipine/valsartan
(Exforge®); amlodipine/valsartan/hydrochlorothiazide (Exforge HCT®);
olmesartan medoxomil/amlodipine/HCTZ (Tribenzor®);
telmisartan/amlodipine (Twynsta®); trandolapril/verapamil (Tarka®)
Anti-infectives
x
x
x
atovaquone (Mepron®)
pentamidine (NebuPent®)
posaconazole (Noxafil®)
Antimalarials
x
x
x
x
x
x
x
x
x
artemether/lumefantrine (Coartem®)
atovaquone/proguanil
chloroquine
hydroxychloroquine
mefloquine
primaquine phosphate (Primaquine®)
pyrimethamine (Daraprim®)
pyrimethamine-sulfadoxine (Fansidar®)
quinine (Qualaquin®)
x
x
x
x
H2-antagonists: cimetidine; famotidine; nizatidine; ranitidine
Miscellaneous agents: misoprostol; sucralfate
Proton pump inhibitors: esomeprazole (Nexium ®); lansoprazole;
omeprazole; pantoprazole;
metoclopramide HCl tablet, solution
x
x
x
x
x
x
x
x
x
x
acyclovir
amantadine
famciclovir
foscarnet
ganciclovir
oseltamivir (Tamiflu®)
rimantadine
valacyclovir
valganciclovir (Valcyte®)
zanamivir (Relenza®)
Anti-ulcer agents
Antivirals
Updated February 20, 2013
2
Anthem Blue Cross Health Account Plan:
Free Mail-Order Drug List
Drug Category
Examples of Products
Arthritis / Pain
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
methylprednisolone sodium succinate powder for injection
methylprednisolone acetate suspension for injection
methylprednisolone
prednisolone acetate suspension (generic Pred Forte)
prednisone
indomethacin
naproxen
naproxen delayed-release
naproxen sodium
diclofenac sodium
diclofenac sodium ext-release
diclofenac solution
etodolac
ibuprofen suspension
ibuprofen
ketoprofen
ketorolac ophthalmic soln
meloxicam
nabumetone
piroxicam
sulindac
Asthma therapies
x
x
x
x
x
x
x
x
x
x
x
montelukast
zafirlukast
albuterol sulfate tablet, syrup, inhalant solution
aminophylline tablet
budesonide inhalant suspension (Pulmicort Respules)
terbutaline
theophylline ext-release tabs
cromolyn sodium solution, inhalant solution
ipratropium bromide solution, inhalant solution
ipratropium/albuterol sulfate
guaifenesin/dyphylline elixir
x
polyethylene glycol 3350 combination products such as Colyte®, Trilyte®,
(generics only), Gavilyte; sodium phosphate salts. Free at retail and mail
x
x
calcium acetate
Bowel evacuant
products
Calcium replacement
products
Updated February 20, 2013
3
Anthem Blue Cross Health Account Plan:
Free Mail-Order Drug List
Drug Category
Examples of Products
Cancer
(adjunctive agents)
x
x
x
x
x
x
x
x
x
amifostine
darbepoetin alfa (Aranesp®)
dexrazoxane
epoetin alfa (Procrit®)
filgrastim (Neupogen®)
leucovorin
mesna (Mesnex®)
pegfilgrastim (Neulasta®)
sargramostim (Leukine®)
x
x
x
x
x
x
x
x
x
x
x
x
atorvastatin/amlodipine
cholestyramine
colesevelam (WelChol®)
colestipol
ezetimibe (Zetia®)
ezetimibe/simvastatin (Vytorin®)
fenofibrate (Antara®, FenoglideŒ, Lipofen®, TriCor®, Triglide®)
fenofibric acid (TriLipixŒ)
gemfibrozil
HMG-coA reductase inhibitors: atorvastatin; fluvastatin; lovastatin
(Altoprev®); pravastatin; rosuvastatin (Crestor®); simvastatin
niacin (Niaspan®); niacin ER/simvastatin (Simcor®)
omega-3-acid ethyl esters (Lovaza®)
Contraceptives,
non-oral
x
x
x
diaphragms (Ortho-DiaphragmŒ)
medroxyprogesterone 150mg injectable
intravaginal system (NuvaRing®)
Contraceptives, oral
x
x
x
x
x
x
x
x
x
x
x
Apri® (generic only)
Estrostep Fe® (generic only)
Lybrel® (generic only)
Ortho Tri-Cyclen® (generic only)
Ovcon® (generic only)
Seasonale® (generic only)
TriNessa® (generic only)
Trivora® (generic only)
Yasmin® (generic only)
Seasonique ® (generic only)
YAZ® (generic only)
Dental aids
x
minocycline (Arestin®)
Cholesterollowering agents
Updated February 20, 2013
4
Anthem Blue Cross Health Account Plan:
Free Mail-Order Drug List
Drug Category
Examples of Products
Diabetes
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
acarbose
glimeprimide
glipizide
glipizide ext-release
glyburide
glyburide, Micronized
glyburide/metformin
metformin HCl
metformin ext-release
nateglinide
Glucagon
insulin aspart (Novolog®)
insulin aspart protamine human /insulin aspart (Novolog® 70/30)
insulin detemir (Levemir®)
insulin lispro (Humalog®)
insulin regular (Humulin R®)
insulin NPH (Humulin N®)
insulin NPH and insulin regular (Humulin 70/30®)
insulin NPL/insulin lispro (Humalog 50/50®, Humalog MIX 75/25®)
insulin glargine (Lantus®, Lantus Solostar®)
insulin glulisine (Apida®, Apidra Solstar®)
Accu-Chek® test strips
One Touch® test strips
SureStep®, SureStep Pro® test strips
Insulin pen needles – BD Ultrafine
Isulin syringes – BD
Lancet device – BD
Lancets – BD, Microlet
Estrogen
replacement
products
x
x
x
x
x
x
x
x
x
x
conjugated estrogens (Premarin®)
esterified estrogens/methyltestosterone
estradiol (Climara®, Estraderm®, Vivelle®, Vivelle DOT®)
estradiol gel (Divigel®)
estradiol MTDS (EvamistΠ)
estradiol/norethindrone (CombiPatch®)
estrogen/medroxyprogesterone (Premphase®, PremproŒ )
ethinyl estradiol/norethindrone (generic for Femhrt®)
synthetic conjugated estrogens, A (Cenestin®)
synthetic conjugated estrogens, B (EnjuviaŒ)
Updated February 20, 2013
5
Anthem Blue Cross Health Account Plan:
Free Mail-Order Drug List
Drug Category
Examples of Products
Fluoride
preparations, oral
and topical
x
x
x
x
x
x
x
x
x
x
Cavarest GelΠ(generic only)
EasygelΠ(generic only)
EtheDentΠ(generic only)
FluoritabΠ(generic only)
Luride Lozi-Tabs® (generic only)
Neutragard® (generic only)
Phos-Flur® (generic only)
sodium fluoride (generic only)
Gel-Kam® (generic only)
PreviDent® Rinse (generic only)
Gout
x
x
x
allopurinol
colchicine (Colcrys®)
febuxostat (Uloric ®)
x
x
heparin
low-molecular-weight heparin: dalteparin (Fragmin®); enoxaparin;
fondaparinux
x
x
x
x
ferumoxytol (generic for FerahemeŒ)
FoliTabΠ(generic only)
FoltrinΠ(generic only)
Niferex® Forte (generic only)
Heparin/low
molecular weight
heparin products
Iron replacement
agents
Magnesium
replacement
products
x
Miscellaneous agents
x
isoxsuprine
Osteoporosis
x
x
x
x
x
alendronate;
calcitonin
etidronate
ibandronate (Boniva®) generic oral, brand injectable only
raloxifene (Evista®)
Phosphate/
potassium
replacement
products
x
x
x
x
x
potassium bicarbonate/citric acid
potassium chloride
potassium phosphate
potassium and sodium phosphate
sodium phosphate
Updated February 20, 2013
6
Anthem Blue Cross Health Account Plan:
Free Mail-Order Drug List
Drug Category
Examples of Products
Prenatal vitamins
x
x
x
x
x
x
x
Nata chew® (generic only)
Natafort® (generic only)
Natelle® (generic only)
Pre Care® (generic only)
Prenatal Plus®, Prenatal RXŒ (generic only)
Prima Care® (generic only)
Vitafol-OBΠ(generic only)
Prescription vitamins
x
x
x
x
multivitamin w/ fluoride
Strovite Advance®, Strovite Plus® (generic only)
Theragran® (generic only)
TherobecΠ, Therobec PlusΠ(generic only)
Progestins
x
x
x
x
x
medroxyprogesterone
norethindrone
norethindrone acetate
progesterone
progesterone, micronized (Crinone®, Endometrin®)
Renal disease agents
x
x
lanthanum (Fosrenol®)
sevelamer carbonate (Renvela®)
Smoking cessation
products
x
x
x
bupropion (generic for Zyban only)
nicotine products (Nicotrol® Inhaler, Nicotrol® Nasal Spray)
varenicline (ChantixŒ)
Vaccines
x seasonal influenza vaccines (Note: Available free at participating retail
pharmacies, not through mail service)
Vitamin B products
x
x
Folgard RXΠ(generic only)
Foltx® (generic only)
Vitamin B1 products
x
thiamine
Vitamin B6 products
x
pyridoxine
Vitamin B12
products
x
x
cyanocobalamin injection
cyanocobalamin/folic acid (Foltrate®)
Vitamin D products
x
x
calcitriol
ergocalciferol
Vitamin K products
x
phytonadione (Mephyton®)
Vitamins with
folic acid
x
therapeutic vitamins with minerals
x
x
x
x
x
benzphetamine
diethylpropion
orlistat (Xenical®)
phendimetrazine
phentermine
Weight loss agents
Updated February 20, 2013
7
Anthem Blue Cross Health Account Plan:
Free Mail-Order Drug List
Drug Category
Examples of Products
Zinc replacement
products
x
zinc sulfate
x
x
x
x
x
x
x
bupropion
citalopram
fluoxetine
lamotrigine
buspirone
divalproex
lithium
Mental Health
Abbreviations: HCTZ = hydrochlorothiazide
Updated February 20, 2013
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