Maintenance Medication List July 1, 2018 Below is a list of all the therapeutic classes of medications that may be maintenance medications. The most commonly prescribed medications are listed and grouped by the conditions they may treat. Not all covered maintenance drugs are included in this list. Maintenance medications are used for long-term conditions and should be taken regularly. If you have questions or are not sure if your medication needs to be filled at WakeMed pharmacy, call customer service at the phone number listed on your member ID card. ADHD GUANFACINE ER INTUNIV+ Agents Used For Dry Mouth CAPHOSOL CEVIMELINE EVOXAC GELCLAIR NEUTRASAL NUMOISYN ORAFATE PILOCARPINE SALAGEN Alzheimer s Disease ARICEPT ARICEPT 23 MG* ARICEPT ODT DONEPEZIL HCL EXELON+ GALANTAMINE HBR MEMANTINE MEMANTINE ER* NAMENDA NAMENDA XR* NAMZARIC* RAZADYNE RAZADYNE ER RIVASTIGMINE Asthma/Chronic Obstructive Pulmonary Disease (Copd) ACCOLATE ADVAIR DISKUS ADVAIR HFA AIRDUO RESPICLICK* ALVESCO ANORO ELLIPTA ARCAPTA NEOHALER ARNUITY ELLIPTA ASMANEX TWISTHALER ASMANEX HFA ATROVENT HFA BEVESPI AEROSPHERE BREO ELLIPTA BROVANA BUDESONIDE NEB COMBIVENT RESPIMAT DALIRESP DULERA* DUONEB ELIXOPHYLLIN FLOVENT DISKUS FLOVENT HFA FLUTICASONE/SALMETEROL (GENERIC AIRDUO RESPICLICK) INCRUSE ELLIPTA IPRATROPIUM BROMIDE IPRATROPIUM-ALBUTEROL LONHALA MAGNAIR* MONTELUKAST SODIUM PERFOROMIST PULMICORT NEBULIZED SOLUTION PULMICORT FLEXHALER QVAR REDIHALER SEEBRI NEOHALER* SEREVENT DISKUS SINGULAIR+ SPIRIVA HANDIHALER SPIRIVA RESPIMAT STIOLTO RESPIMAT* STRIVERDI RESPIMAT SYMBICORT THEO-24 THEOPHYLLINE ANHYDROUS TRELEGY ELLIPTA* TUDORZA PRESSAIR UTIBRON NEOHALER* ZILEUTON ER ZAFIRLUKAST ZYFLO ZYFLO CR Blood Clots/Prevention BEVYXXA ELIQUIS PRADAXA SAVAYSA XARELTO Benign Prostatic Hyperplasia (Bph) ALFUZOSIN HCL AVODART+ CARDURA XL DOXAZOSIN DUTASTERIDE DUTASTERIDE/TAMSULOSIN* FINASTERIDE FLOMAX+ JALYN* PROSCAR RAPAFLO TAMSULOSIN HCL TERAZOSIN UROXATRAL Breast Cancer Prevention ANASTROZOLE ARIMIDEX+ AROMASIN FARESTON FEMARA+ LETROZOLE SOLTAMOX* TAMOXIFEN CITRATE Chest Pain IMDUR ISORDIL ISOSORBIDE DINITRATE ISOSORBIDE MONONITRATE MINITRAN NITROGLYCERIN NITROGLYCERIN PATCH NITRO-DUR RANEXA Page 1 of 7
Cholesterol/Lipid Lowering ALTOPREV* ANTARA* ATORVASTATIN CALCIUM CHOLESTYRAMINE CHOLESTYRAMINE LIGHT COLESTID COLESTIPOL HCL CRESTOR+ EZETIMIBE EZETIMIBE/SIMVASTATIN FENOFIBRATE 43, 50, 67, 130, 134, 150, 200 MG CAPSULE* FENOFIBRATE 40 MG, 45 MG, 120MG, 145 MG TABLET* FENOFIBRATE 54, 160 MG TABLET FENOFIBRIC ACID* FENOGLIDE FLOLIPID FLUVASTATIN ER FLUVASTATIN SODIUM GEMFIBROZIL LESCOL LESCOL XL+ LIPITOR+ LIPOFEN* LIVALO LOPID LOVASTATIN LOVAZA+ MEVACOR NIACOR NIASPAN OMEGA-3-ACID ETHYL ESTERS PRAVACHOL PRAVASTATIN SODIUM PREVALITE ROSUVASTAIN QUESTRAN QUESTRAN LIGHT ROSUVASTATIN SIMVASTATIN TRICOR* TRIGLIDE* TRILIPIX* VASCEPA VYTORIN* WELCHOL ZETIA+ ZOCOR Constipation AMITIZA LINZESS MOVANTIK RELISTOR TABLET* TRULANCE SYMPROIC* Contraceptive ALTAVERA ALYACEN AMETHIA AMETHIA LO APRI ARANELLE AVIANE AZURETTE BALZIVA BEKYREE BEYAZ* BLISOVI 24 FE BLISOVI FE BREVICON BRIELLYN CAMRESE CAMRESE LO CAZIANT CHATEAL CRYSELLE CYCLAFEM CYRED DASETTA DAYSEE DESOGEN DROSPIRENONE-ETHINYL ESTRADIOL-FOLIC ACID* DROSPIRENONE-ETHINYL ESTRADIOL ELINEST EMOQUETTE ENPRESSE ENSKYCE ERRIN ESTARYLLA ESTRADIOL-FOLIC ACID* ESTROSTEP FE FALESSA KIT* FALMINA FAYOSIM* FEMYNOR GENERESS FE* GIANVI HEATHER INTROVALE ISIBLOOM JENCYCLA JOLESSA JOLIVETTE JULEBER JUNEL 24 FE JUNEL JUNEL FE KARIVA KELNOR 1-35 KIMIDESS KURVELO LARISSIA LEENA LESSINA LEVONEST LEVONORGESTREL-ETHINYL ESTRADIOL LEVONORGESTREL-ETHINYL ESTRADIOL 150-30 (84) LEVORA-28 LILLOW LO LOESTRIN FE LOESTRIN FE LORYNA LOSEASONIQUE LOW-OGESTREL LUTERA MARLISSA MIBELAS 24 FE* MICROGESTIN MICROGESTIN FE MIRCETTE MONO-LINYAH MONONESSA MYZILRA NATAZIA NECON NORA-BE NORETHINDRONE NORETHINDRONE-ETHINYL ESTRADIOL-FERROUS FUMARATE NORGESTIMATE-ETHINYL ESTADIOL NORGESTIMATE ETHINYL ESTRADIOL LO NORGESTREL-ETHINY ESTRADIOL NORLYDA NORTREL NUVARING OCELLA OGESTREL ORSYTHIA ORTHO TRI-CYCLEN ORTHO TRI-CYCLEN LO+ ORTHO-CYCLEN ORTHO-NOVUM PHILITH PORTIA PREVIFEM QUARTETTE* QUASENSE RAJANI* RECLIPSEN RIVELSA* SAFYRAL* SEASONIQUE Page 2 of 7
Contraceptive continued SETLAKIN SPRINTEC SRONYX SYEDA TAYTULLA* TILIA FE TRI-ESTARYLLA TRI FEMYNOR TRI-LEGEST FE TRI-LINYAH TRINESSA TRI-LO-ESTARYLLA TRI-LO-MARZIA TRI-LO SPRINTEC TRI-NORINYL TRI-PREVIFEM TRI-SPRINTEC TRINESSA LO TRIVORA-28 VELIVET VESTURA VIENVA VIORELE WERA WYMZYA FE XULANE YASMIN YAZ ZARAH ZENCHENT ZOVIA 1-35E Depression APLENZIN* BUPROPION CELEXA+ CITALOPRAM CYMBALTA+ DESVENLAFAXINE (GENERIC PRISTIQ) DULOXETINE EFFEXOR EFFEXOR XR+ ESCITALOPRAM FETZIMA FLUVOXAMINE FORFIVO XL* KHEDEZLA* LEXAPRO+ LUVOX CR MAPROTILINE MIRTAZAPINE NEFAZODONE PAROXETINE PAROXETINE ER PAXIL PAXIL CR PEXEVA PRISTIQ PROZAC+ REMERON REMERON SOLUTAB SERTRALINE TRAZODONE TRINTELLIX VENLAFAXINE VENLAFAXINE ER CAPSULE VIIBRYD WELLBUTRIN+ WELLBUTRIN SR+ WELLBUTRIN XL+ ZOLOFT+ Diabetes ACARBOSE ACTOPLUS MET XR ACTOS+ ADLYXIN ADMELOG* AFREZZA* ALOGLIPTIN* ALOGLIPTIN-METFORMIN* ALOGLIPTIN-PIOGLITAZONE* AMARYL APIDRA APIDRA SOLOSTAR BASAGLAR BYDUREON BYETTA CYCLOSET DIABETA DUETACT FARXIGA FIASP* FORTAMET* GLIMEPIRIDE GLIPIZIDE GLIPIZIDE ER GLIPIZIDE-METFORMIN GLUCOPHAGE GLUCOPHAGE XR GLUCOTROL GLUCOTROL XL GLUCOVANCE GLUMETZA* GLYBURIDE GLYBURIDE MICRONIZED GLYBURIDE-METFORMIN GLYNASE GLYSET GLYXAMBI* HUMALOG HUMALOG JR HUMALOG MIX 50-50 HUMALOG MIX 75-25 HUMULIN 70-30 HUMULIN N HUMULIN R INVOKAMET INVOKAMET XR INVOKANA JANUMET JANUMET XR JANUVIA JARDIANCE JENTADUETO JENTADUETO XR* KAZANO KOMBIGLYZE XR LANTUS* LANTUS SOLOSTAR* LEVEMIR LEVEMIR FLEXPEN METFORMIN HCL METFORMIN HCL ER METFORMIN SR MODIFIED-RELEASE* MIGLITOL NATEGLINIDE NESINA NOVOLOG NOVOLOG FLEXPEN NOVOLOG MIX 70-30 NOVOLOG MIX 70-30 FLEXPEN ONGLYZA OSENI OZEMPIC* PIOGLITAZONE HCL PIOGLITAZONE-GLIMEPIRIDE PIOGLITAZONE-METFORMIN PRANDIMET PRANDIN PRECOSE QTERN* REPAGLINIDE-METFORMIN RIOMET SEGLUROMET* SOLIQUA STARLIX STEGLATRO* STEGLUJAN* SYNJARDY SYNJARDY XR TOUJEO* TRADJENTA TRESIBA* TRULICITY VICTOZA Page 3 of 7
Diabetes continued XIGDUO XR* XULTOPHY* Diabetic Supplies INSULIN SYRINGE LANCETS PEN NEEDLE TEST STRIPS Diarrhea ALOSETRON LOTRONEX VIBERZI Elevated Thyroid Hormone METHIMAZOLE PROPYLTHIOURACIL TAPAZOLE Fibromyalgia SAVELLA Glaucoma ALPHAGAN P APRACLONIDINE HCL AZOPT BETAGAN BETAXOLOL HCL 0.5% BETIMOL BETOPTIC S 0.25 % BIMATOPROST 0.03%* BRIMONIDINE TARTRATE OPHTHALMIC SOLUTION CARTEOLOL HCL 1% COMBIGAN 0.2%-0.5% COSOPT 2%-0.5% COSOPT PF 2%-0.5%* DORZOLAMIDE HCL 2 % DORZOLAMIDE-TIMOLOL 2%-0.5% IOPIDINE ISOPTO CARPINE LATANOPROST LEVOBUNOLOL HCL OPHTHALMIC SOLUTION LUMIGAN 0.01% METIPRANOLOL 0.3% MIOSTAT 0.01% PHOSPHOLINE IODIDE PILOCARPINE HCL SIMBRINZA* TIMOLOL MALEATE OPHTHALMIC SOLUTION TIMOPTIC TIMOPTIC OCUDOSE TIMOPTIC-XE TRAVATAN Z TRUSOPT 2% VYZULTA* XALATAN ZIOPTAN Gout ALLOPURINOL COLCHICINE CAPSULE* COLCHICINE TABLET* COLCRYS* DUZALLO MITIGARE PROBENECID PROBENECID-COLCHICINE ULORIC ZURAMPIC ZYLOPRIM Heart Failure CORLANOR ENTRESTO Heart Rhythm AMIODARONE HCL BETAPACE+ BETAPACE AF CORDARONE DIGOXIN DISOPYRAMIDE PHOSPHATE DOFETILIDE FLECAINIDE ACETATE LANOXIN MEXILETINE HCL MULTAQ NORPACE NORPACE CR PACERONE PROPAFENONE HCL QUINIDINE GLUCONATE QUINIDINE SULFATE RYTHMOL RYTHMOL SR SOTALOL AF TIKOSYN High Blood Pressure ACCUPRIL ACCURETIC ACEBUTOLOL HCL ACEON ADALAT CC ALDACTAZIDE ALDACTONE ALTACE AMILORIDE HCL AMILORIDE-HYDROCHLOROTHIAZIDE AMLODIPINE BESYLATE AMLODIPINE BESYLATE-BENAZAPRIL AMLODIPINE BESYLATE-VALARTAN AMLODIPINE BESYLATE-VALARTAN- HYDROCHLOROTHIAZIDE* AMLODIPINE-OLMESARTAN* AMLODIPINE-OLMESARTAN- HYDROCHLOROHTHIZIE* AMTURNIDE* ATACAND ATACAND HCT ATENOLOL ATENOLOL-CHLORTHALIDONE AVALIDE AVAPRO AZOR* BENAZEPRIL HCL BENAZEPRIL-HYDROCHLOROTHIAZIDE BENICAR+ BENICAR HCT+ BETAXOLOL HCL BISOPROLOL FUMARATE BISOPROLOL-HYDROCHLOROTHIAZIDE BUMETANIDE BYVALSON* CALAN CALAN SR CANDESARTAN CILEXETIL CANDESARTAN-HYDROCHLOROTHIZIDE CAPTOPRIL CAPTOPRIL-HYDROCHLOROTHIAZIDE CARDENE SR CARDIZEM+ CARDIZEM CD+ CARDIZEM LA+ CARDURA CARTIA XT CARVEDILOL CARVEDILOL ER* CAROSPIR CATAPRES CATAPRES-TTS CHLOROTHIAZIDE CHLORTHALIDONE CLONIDINE PATCH CLONIDINE HCL CLORPRES COREG COREG CR* CORGARD CORZIDE COZAAR DEMADEX DIBENZYLINE DILTIAZEM 24HR CD DILTIAZEM 24HR ER DILTIAZEM HCL DILT-XR DILTZAC ER DIOVAN+ DIOVAN HCT+ DOXAZOSIN MESYLATE DUTOPROL* DYAZIDE DYRENIUM Page 4 of 7
High Blood Pressure continued EDARBI EDARBYCLOR EDECRIN ENALAPRIL MALEATE ENALAPRIL-HYDROCHLOROTHIAZIDE EPLERENONE EPROSARTAN ETHACRYNIC ACID EXFORGE+ EXFORGE HCT* FELODIPINE ER FOSINOPRIL SODIUM FOSINOPRIL-HYDROCHLOROTHIAZIDE FUROSEMIDE GUANFACINE HCL HYDRALAZINE HCL HYDROCHLOROTHIAZIDE HYZAAR INDAPAMIDE INDERAL LA* INNOPRAN XL INSPRA IRBESARTAN IRBESARTAN-HYDROCHLOROTHIAZIDE ISRADIPINE KERLONE LABETALOL HCL LASIX LEVATOL LISINOPRIL LISINOPRIL-HYDROCHLOROTHIAZIDE LOPRESSOR LOPRESSOR HCT LOSARTAN POTASSIUM LOSARTAN-HYDROCHLOROTHIAZIDE LOTENSIN LOTENSIN HCT LOTREL MATZIM LA MAVIK MAXZIDE METHYCLOTHIAZIDE METHYLDOPA METHYLDOPA-HYDROCHLOROTHIAZIDE METOLAZONE METOPROLOL EXTENDED-RELEASE/ HYDROCHLOROTHIAZIDE* METOPROLOL SUCCINATE METOPROLOL TARTRATE METOPROLOL-HYDROCHLOROTIAZIDE MICARDIS+ MICARDIS HCT+ MICROZIDE MINIPRESS MINOXIDIL MOEXIPRIL HCL MOEXIPRIL-HYDROCHLOROTHIAZIDE NADOLOL NADOLOL-BENDROFLUMETHIAZIDE NEPTAZANE NICARDIPINE HCL NIFEDIPINE NIFEDIPINE ER NIMODIPINE NISOLDIPINE NORVASC OLMESARTAN OLMESARTAN-HYDROCHLOROTHIAZIDE PERINDOPRIL ERBUMINE PINDOLOL PRAZOSIN HCL PRINIVIL PROCARDIA PROCARDIA XL PROPRANOLOL HCL PROPRANOLOL-HYDROCHLOROTHIAZIDE QUINAPRIL HCL QUINAPRIL-HYDROCHLOROTHIAZIDE RAMIPRIL RESERPINE SECTRAL SOTALOL SPIRONOLACTONE SPIRONOLACTONE-HCTZ SULAR TARKA TAZTIA XT TEKTURNA TEKTURNA HCT TENEX TENORETIC+ TENORMIN+ TERAZOSIN HCL TEVETEN TEVETEN HCT TIAZAC TIMOLOL MALEATE TOPROL XL TORSEMIDE TRANDATE TRANDOLAPRIL TRANDOLAPRIL-VERAPAMIL TRIAMTERENE TRIAMTERENE-HCTZ TRIBENZOR* TWYNSTA* UNIRETIC UNIVASC VALSARTAN VALSARTAN-HYDROCHLOROTHIAZIDE VASERETIC+ VASOTEC+ VERAPAMIL ER VERAPAMIL ER PM VERAPAMIL HCL VERELAN VERELAN PM ZAROXOLYN ZEBETA ZESTORETIC+ ZESTRIL+ ZIAC Hormone Replacement ACTIVELLA ALORA ANGELIQ CLIMARA CLIMARA PRO COMBIPATCH COVARYX H.S. DIVIGEL EEMT H.S. ESTRACE ESTRACE CREAM ESTRADIOL TABLET ESTRADIOL TRANSDERMAL PATCH* ESTRADIOL-NORETHINDRONE PATCH ESTRADIOL VAGINAL CREAM* ESTRING ESTROGEL ESTROPIPATE EVAMIST FEMRING JINTELI MEDROXYPROGESTERONE MENEST MENOSTAR MIMVEY MINIVELLE NORETHINDRONE ACETATE PREFEST PREMARIN PREMPHASE PREMPRO PROGESTERONE PROMETRIUM PROVERA VAGIFEM+ VIVELLE-DOT YUVAFEM Inflammatory Bowel Disease APRISO ASACOL HD* AZULFIDINE Page 5 of 7
Inflammatory Bowel Disease BALSALAZIDE DISODIUM CANASA COLAZAL DELZICOL* DIPENTUM GIAZO* LIALDA MESALAMINE ENEMA MESALAMINE TABLET* PENTASA* ROWASA SF ROWASA SULFASALAZINE Irritable Bowel Disease HYOSCYAMINE SR Myasthenia Gravis MESTINON MYTELASE PYRIDOSTIGMINE BROMIDE Neuropathic Pain GABAPENTIN GRALISE* HORIZANT* LYRICA LYRICA CR* Osteoporosis ACTONEL ALENDRONATE SODIUM ATELVIA* BINOSTO* BONIVA ETIDRONATE DISODIUM EVISTA+ IBANDRONATE SODIUM RISEDRONATE Overactive Bladder DARIFENACIN ER* DETROL* DETROL LA* DITROPAN XL ENABLEX* GELNIQUE* MYRBETRIQ* OXYBUTYNIN OXYBUTYNIN CHLORIDE ER OXYTROL* SANCTURA* TOLTERODINE TARTRATE* TOLTERODINE TARTRATE ER* TOVIAZ TROSPIUM CHLORIDE* VESICARE* Pancreatic Enzyme Replacement CREON PANCREAZE PERTZYE ULTRESA VIOKACE ZENPEP Parkinson s Disease AZILECT BENZTROPINE MESYLATE BROMOCRIPTINE MESYLATE CARBIDOPA CARBIDOPA-LEVODOPA CARBIDOPA-LEVODOPA-ENTACAPONE COMTAN ENTACAPONE GABAPENTIN GOCOVRI* LODOSYN LYRICA MIRAPEX MIRAPEX ER* NEUPRO PARLODEL* PRAMIPEXOLE DIHYDROCHLORIDE ER* PRAMIPEXOLE DIHYDROCHLORIDE RASAGILINE REQUIP REQUIP XL* ROPINIROLE HCL ROPINIROLE HCL ER* RYTARY* SELEGILINE HCL SINEMET SINEMET CR STALEVO TASMAR TRIHEXYPHENIDYL HCL XADAGO* ZELAPAR Phosphate Binding Agents AURYXIA CALCIUM ACETATE FOSRENOL+ LANTHANUM PHOSLO PHOSLYRA RENAGEL RENVELA SEVELAMER VELPHORO Potassium Replacement KLOR-CON K-TAB POTASSIUM CHLORIDE Rheumatoid Arthritis ARAVA HYDROXYCHLOROQUINE LEFLUNOMIDE PLAQUENIL RIDAURA Seizures APTIOM BANZEL BRIVACT CARBAMAZEPINE CARBAMAZEPINE ER CARBATROL CELONTIN DEPAKENE DEPAKOTE DEPAKOTE ER DEPAKOTE SPRINKLE DILANTIN DIVALPROEX SODIUM DIVALPROEX SODIUM ER ETHOSUXIMIDE FELBAMATE FELBATOL GABAPENTIN GABITRIL KEPPRA KEPPRA XR LAMICTAL LAMICTAL ODT LAMICTAL XR LAMOTRIGINE LAMOTRIGINE ER LAMOTRIGINE ODT LEVETIRACETAM LEVETIRACETAM ER LYRICA MYSOLINE NEURONTIN OXCARBAZEPINE OXTELLAR XR* PEGANONE PHENYTOIN PRIMIDONE SPRITAM* STAVZOR TEGRETOL TEGRETOL XR TIAGABINE HCL TOPAMAX TOPIRAMATE TOPIRAMATE ER SPRINKLE* TROKENDI XR* TRILEPTAL VALPROIC ACID VIMPAT ZARONTIN Page 6 of 7
Seizures continued ZONEGRAN ZONISAMIDE Stroke And Heart Attack Prevention AGGRENOX ASPIRIN-DIPYRIDAMOLE BRILINTA CILOSTAZOL CLOPIDOGREL DIPYRIDAMOLE EFFIENT PENTOXIFYLLINE PERSANTINE PLAVIX+ PLETAL PRASUGREL TICLOPIDINE HCL TRENTAL YOSPRALA* ZONTIVITY Testosterone Replacement ANDRODERM ANDROID METHYLTESTOSTERONE CAPSULE TESTRED Thyroid Hormone Replacement ARMOUR THYROID CYTOMEL LEVOTHROID LEVOTHYROXINE SODIUM LEVOXYL LIOTHYRONINE SODIUM SYNTHROID THYROLAR TIROSINT* Ulcers, Heartburn And Reflux ACIPHEX+ ACIPHEX SPRINKLE* DEXILANT LANSOPRAZOLE* ESOMEPRAZOLE* NEXIUM* OMEPRAZOLE OMEPRAZOLE/SODIUM BICARBONATE* PANTOPRAZOLE PREVACID* PREVACID SOLUTAB PRILOSEC+ RABEPRAZOLE ZEGERID* Vitamins DECARA DRISDOL FOLIC ACID NASCOBAL Women's Health BRISDELLE* DUAVEE INTRAROSA OSPHENA PAROXETINE ER* SARAFEM optumrx.com * Brand and/or generic may be excluded from coverage. Lower-cost options are available and covered. This is not a complete list of medications, and not all medications listed may be covered under your plan. OptumRx specializes in the delivery, clinical management and affordability of prescription medications and consumer health products. We are an Optum company a leading provider of integrated health services. Learn more at optum.com/optumrx. All Optum trademarks and logos are owned by Optum, Inc. All other trademarks are the property of their respective owners. M54076-D 5/18 2018 Optum, Inc. All Rights Reserved. 78975-102018 Page 7 of 7