| drug_name,brand_name,tier,drug_class,covered_conditions,formulary_status,prior_auth_required,step_therapy_required,quantity_limit,days_supply_retail,days_supply_mail_order,bronze_copay,silver_copay,gold_copay,specialty_pharmacy_only,notes | |
| metformin,Glucophage,1,Biguanide,Type 2 Diabetes,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| lisinopril,Zestril,1,ACE Inhibitor,"Hypertension, Heart Failure",Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| amlodipine,Norvasc,1,Calcium Channel Blocker,Hypertension,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| atorvastatin,Lipitor,1,Statin,High Cholesterol,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| omeprazole,Prilosec,1,PPI,"GERD, Ulcers",Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| levothyroxine,Synthroid,1,Thyroid Hormone,Hypothyroidism,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| sertraline,Zoloft,1,SSRI,"Depression, Anxiety",Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| escitalopram,Lexapro,1,SSRI,"Depression, Anxiety",Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| fluoxetine,Prozac,1,SSRI,Depression,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| alprazolam,Xanax,1,Benzodiazepine,Anxiety,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| lorazepam,Ativan,1,Benzodiazepine,Anxiety,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| metoprolol,Lopressor,1,Beta Blocker,"Hypertension, Heart Failure",Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| carvedilol,Coreg,1,Beta Blocker,Heart Failure,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| furosemide,Lasix,1,Loop Diuretic,"Edema, Heart Failure",Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| hydrochlorothiazide,Microzide,1,Thiazide Diuretic,Hypertension,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| albuterol,ProAir,1,SABA,"Asthma, COPD",Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| montelukast,Singulair,1,Leukotriene Modifier,"Asthma, Allergies",Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| fluticasone nasal,Flonase,1,Intranasal Corticosteroid,Allergic Rhinitis,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| cetirizine,Zyrtec,1,Antihistamine,Allergies,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| loratadine,Claritin,1,Antihistamine,Allergies,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| amoxicillin,Amoxil,1,Penicillin Antibiotic,Bacterial Infections,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| azithromycin,Zithromax,1,Macrolide Antibiotic,Bacterial Infections,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| doxycycline,Vibramycin,1,Tetracycline Antibiotic,Bacterial Infections,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| ciprofloxacin,Cipro,1,Fluoroquinolone,Bacterial Infections,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| trimethoprim-sulfamethoxazole,Bactrim,1,Sulfonamide,"UTI, Infections",Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| gabapentin,Neurontin,1,Anticonvulsant,"Neuropathy, Seizures",Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| pregabalin,Lyrica,1,Anticonvulsant,"Neuropathy, Fibromyalgia",Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| tramadol,Ultram,1,Opioid Analgesic,Moderate Pain,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| ibuprofen,Advil,1,NSAID,"Pain, Inflammation",Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| naproxen,Aleve,1,NSAID,"Pain, Inflammation",Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| cyclobenzaprine,Flexeril,1,Muscle Relaxant,Muscle Spasm,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| prednisone,Deltasone,1,Corticosteroid,Inflammation,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| methylprednisolone,Medrol,1,Corticosteroid,Inflammation,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| pantoprazole,Protonix,1,PPI,GERD,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| lansoprazole,Prevacid,1,PPI,GERD,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| clopidogrel,Plavix,1,Antiplatelet,"CAD, Stroke Prevention",Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| warfarin,Coumadin,1,Anticoagulant,"Atrial Fibrillation, DVT",Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| digoxin,Lanoxin,1,Cardiac Glycoside,"Heart Failure, Afib",Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| spironolactone,Aldactone,1,Aldosterone Antagonist,"Heart Failure, HTN",Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| losartan,Cozaar,1,ARB,Hypertension,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| valsartan,Diovan,1,ARB,"Hypertension, Heart Failure",Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| glipizide,Glucotrol,1,Sulfonylurea,Type 2 Diabetes,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| glyburide,Diabeta,1,Sulfonylurea,Type 2 Diabetes,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| pioglitazone,Actos,1,TZD,Type 2 Diabetes,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| sitagliptin,Januvia,1,DPP-4 Inhibitor,Type 2 Diabetes,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| glimepiride,Amaryl,1,Sulfonylurea,Type 2 Diabetes,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| tamsulosin,Flomax,1,Alpha Blocker,BPH,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| finasteride,Proscar,1,5-Alpha Reductase Inhibitor,BPH,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| sildenafil,Viagra,1,PDE5 Inhibitor,Erectile Dysfunction,Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| tadalafil,Cialis,1,PDE5 Inhibitor,"Erectile Dysfunction, BPH",Covered,No,No,90-day max (retail),30,90,$15,$10,$5,No, | |
| fluticasone/salmeterol,Advair Diskus,2,ICS/LABA,"Asthma, COPD",Covered,No,No,No,30,90,$55,$40,$25,No, | |
| budesonide/formoterol,Symbicort,2,ICS/LABA,"Asthma, COPD",Covered,No,No,No,30,90,$55,$40,$25,No, | |
| tiotropium,Spiriva,2,LAMA,COPD,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| umeclidinium/vilanterol,Anoro Ellipta,2,LAMA/LABA,COPD,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| rosuvastatin,Crestor,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| ezetimibe,Zetia,2,Cholesterol Absorption Inhibitor,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| empagliflozin,Jardiance,2,SGLT-2 Inhibitor,"Type 2 Diabetes, Heart Failure",Covered,No,No,No,30,90,$55,$40,$25,No, | |
| canagliflozin,Invokana,2,SGLT-2 Inhibitor,Type 2 Diabetes,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| dapagliflozin,Farxiga,2,SGLT-2 Inhibitor,"Type 2 Diabetes, Heart Failure",Covered,No,No,No,30,90,$55,$40,$25,No, | |
| liraglutide,Victoza,2,GLP-1 RA,Type 2 Diabetes,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| dulaglutide,Trulicity,2,GLP-1 RA,Type 2 Diabetes,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| exenatide,Byetta,2,GLP-1 RA,Type 2 Diabetes,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| insulin glargine,Lantus/Basaglar,2,Long-acting Insulin,Diabetes,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| insulin aspart,NovoLog,2,Rapid-acting Insulin,Diabetes,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| insulin lispro,Humalog,2,Rapid-acting Insulin,Diabetes,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| apixaban,Eliquis,2,DOAC,"DVT, AFib",Covered,No,No,No,30,90,$55,$40,$25,No, | |
| rivaroxaban,Xarelto,2,DOAC,"DVT, AFib",Covered,No,No,No,30,90,$55,$40,$25,No, | |
| dabigatran,Pradaxa,2,DOAC,"DVT, AFib",Covered,No,No,No,30,90,$55,$40,$25,No, | |
| sacubitril/valsartan,Entresto,2,ARNI,Heart Failure,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| ivabradine,Corlanor,2,HCN Channel Blocker,Heart Failure,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| ranolazine,Ranexa,2,Anti-anginal,Chronic Angina,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| latanoprost,Xalatan,2,Prostaglandin,Glaucoma,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| bimatoprost,Lumigan,2,Prostaglandin,Glaucoma,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| memantine,Namenda,2,NMDA Antagonist,Alzheimer's Disease,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| donepezil,Aricept,2,AChE Inhibitor,Alzheimer's Disease,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| quetiapine,Seroquel,2,Atypical Antipsychotic,"Bipolar, Schizophrenia",Covered,No,No,No,30,90,$55,$40,$25,No, | |
| aripiprazole,Abilify,2,Atypical Antipsychotic,"Bipolar, Schizophrenia",Covered,No,No,No,30,90,$55,$40,$25,No, | |
| duloxetine,Cymbalta,2,SNRI,"Depression, Neuropathy",Covered,No,No,No,30,90,$55,$40,$25,No, | |
| venlafaxine,Effexor,2,SNRI,"Depression, Anxiety",Covered,No,No,No,30,90,$55,$40,$25,No, | |
| bupropion,Wellbutrin,2,NDRI,"Depression, Smoking Cessation",Covered,No,No,No,30,90,$55,$40,$25,No, | |
| semaglutide oral,Rybelsus,3,GLP-1 RA,Type 2 Diabetes,Covered,No,Yes,30 units/30 days,30,90,$110,$80,$55,No,Generic alternative available; preferred brand step therapy required first | |
| alogliptin,Nesina,3,DPP-4 Inhibitor,Type 2 Diabetes,Covered,No,Yes,30 units/30 days,30,90,$110,$80,$55,No,Generic alternative available; preferred brand step therapy required first | |
| saxagliptin,Onglyza,3,DPP-4 Inhibitor,Type 2 Diabetes,Covered,No,Yes,30 units/30 days,30,90,$110,$80,$55,No,Generic alternative available; preferred brand step therapy required first | |
| linagliptin,Tradjenta,3,DPP-4 Inhibitor,Type 2 Diabetes,Covered,No,Yes,30 units/30 days,30,90,$110,$80,$55,No,Generic alternative available; preferred brand step therapy required first | |
| ertugliflozin,Steglatro,3,SGLT-2 Inhibitor,Type 2 Diabetes,Covered,No,Yes,30 units/30 days,30,90,$110,$80,$55,No,Generic alternative available; preferred brand step therapy required first | |
| esomeprazole,Nexium,3,PPI,GERD,Covered,No,Yes,30 units/30 days,30,90,$110,$80,$55,No,Generic alternative available; preferred brand step therapy required first | |
| dexlansoprazole,Dexilant,3,PPI,GERD,Covered,No,Yes,30 units/30 days,30,90,$110,$80,$55,No,Generic alternative available; preferred brand step therapy required first | |
| desvenlafaxine,Pristiq,3,SNRI,Depression,Covered,No,Yes,30 units/30 days,30,90,$110,$80,$55,No,Generic alternative available; preferred brand step therapy required first | |
| levomilnacipran,Fetzima,3,SNRI,Depression,Covered,No,Yes,30 units/30 days,30,90,$110,$80,$55,No,Generic alternative available; preferred brand step therapy required first | |
| vilazodone,Viibryd,3,SSRI/5-HT1A,Depression,Covered,No,Yes,30 units/30 days,30,90,$110,$80,$55,No,Generic alternative available; preferred brand step therapy required first | |
| brexpiprazole,Rexulti,3,Atypical Antipsychotic,Depression adjunct,Covered,No,Yes,30 units/30 days,30,90,$110,$80,$55,No,Generic alternative available; preferred brand step therapy required first | |
| cariprazine,Vraylar,3,Atypical Antipsychotic,"Bipolar, Schizophrenia",Covered,No,Yes,30 units/30 days,30,90,$110,$80,$55,No,Generic alternative available; preferred brand step therapy required first | |
| lurasidone,Latuda,3,Atypical Antipsychotic,"Bipolar, Schizophrenia",Covered,No,Yes,30 units/30 days,30,90,$110,$80,$55,No,Generic alternative available; preferred brand step therapy required first | |
| lisdexamfetamine,Vyvanse,3,ADHD Stimulant,ADHD,Covered,No,Yes,30 units/30 days,30,90,$110,$80,$55,No,Generic alternative available; preferred brand step therapy required first | |
| amphetamine mixed salts XR,Adderall XR,3,ADHD Stimulant,ADHD,Covered,No,Yes,30 units/30 days,30,90,$110,$80,$55,No,Generic alternative available; preferred brand step therapy required first | |
| methylphenidate ER,Concerta,3,ADHD Stimulant,ADHD,Covered,No,Yes,30 units/30 days,30,90,$110,$80,$55,No,Generic alternative available; preferred brand step therapy required first | |
| atomoxetine,Strattera,3,SNRI (non-stimulant),ADHD,Covered,No,Yes,30 units/30 days,30,90,$110,$80,$55,No,Generic alternative available; preferred brand step therapy required first | |
| oxybutynin ER,Ditropan XL,3,Anticholinergic,Overactive Bladder,Covered,No,Yes,30 units/30 days,30,90,$110,$80,$55,No,Generic alternative available; preferred brand step therapy required first | |
| solifenacin,Vesicare,3,Anticholinergic,Overactive Bladder,Covered,No,Yes,30 units/30 days,30,90,$110,$80,$55,No,Generic alternative available; preferred brand step therapy required first | |
| mirabegron,Myrbetriq,3,Beta-3 Agonist,Overactive Bladder,Covered,No,Yes,30 units/30 days,30,90,$110,$80,$55,No,Generic alternative available; preferred brand step therapy required first | |
| adalimumab,Humira,4,TNF Inhibitor (Biologic),"RA, Crohn's, Psoriasis",Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| etanercept,Enbrel,4,TNF Inhibitor (Biologic),"RA, Psoriatic Arthritis",Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| infliximab,Remicade,4,TNF Inhibitor (Biologic),"Crohn's, UC, RA",Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| secukinumab,Cosentyx,4,IL-17A Inhibitor,"Psoriasis, PsA, AS",Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| ixekizumab,Taltz,4,IL-17A Inhibitor,"Psoriasis, PsA",Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| guselkumab,Tremfya,4,IL-23 Inhibitor,Plaque Psoriasis,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| risankizumab,Skyrizi,4,IL-23 Inhibitor,"Psoriasis, Crohn's",Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| ustekinumab,Stelara,4,IL-12/23 Inhibitor,"Psoriasis, Crohn's, UC",Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| tofacitinib,Xeljanz,4,JAK Inhibitor,"RA, UC, PsA",Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| upadacitinib,Rinvoq,4,JAK Inhibitor,"RA, AD, UC",Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| baricitinib,Olumiant,4,JAK Inhibitor,RA,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| abatacept,Orencia,4,T-Cell Costimulation Modulator,RA,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| tocilizumab,Actemra,4,IL-6 Inhibitor,"RA, Giant Cell Arteritis",Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| vedolizumab,Entyvio,4,Alpha-4-Beta-7 Integrin Inhibitor,"UC, Crohn's",Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| natalizumab,Tysabri,4,Alpha-4 Integrin Inhibitor,"MS, Crohn's",Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| ocrelizumab,Ocrevus,4,Anti-CD20 Monoclonal Antibody,Multiple Sclerosis,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| ofatumumab,Kesimpta,4,Anti-CD20 (SC),Multiple Sclerosis,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| siponimod,Mayzent,4,S1P Receptor Modulator,Secondary Progressive MS,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| ozanimod,Zeposia,4,S1P Receptor Modulator,"MS, UC",Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| fingolimod,Gilenya,4,S1P Receptor Modulator,Relapsing MS,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| semaglutide SC,Ozempic,4,GLP-1 RA,Type 2 Diabetes,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| semaglutide obesity,Wegovy,4,GLP-1 RA (Obesity),Obesity (BMI ≥ 30),Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| tirzepatide diabetes,Mounjaro,4,GIP/GLP-1 RA,Type 2 Diabetes,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| tirzepatide obesity,Zepbound,4,GIP/GLP-1 RA (Obesity),Obesity (BMI ≥ 30),Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| evolocumab,Repatha,4,PCSK9 Inhibitor,Familial Hypercholesterolemia,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| alirocumab,Praluent,4,PCSK9 Inhibitor,Familial Hypercholesterolemia,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| evinacumab,Evkeeza,4,ANGPTL3 Inhibitor,Homozygous FH,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| dupilumab,Dupixent,4,IL-4/IL-13 Inhibitor,"Atopic Dermatitis, Asthma",Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| mepolizumab,Nucala,4,IL-5 Antagonist,Severe Eosinophilic Asthma,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| benralizumab,Fasenra,4,IL-5 Receptor Antagonist,Severe Eosinophilic Asthma,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| omalizumab,Xolair,4,IgE Inhibitor,Severe Allergic Asthma,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| tezepelumab,Tezspire,4,TSLP Inhibitor,Severe Asthma,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| palovarotene,Sohonos,4,RAR-gamma Agonist,FOP,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| nusinersen,Spinraza,4,Antisense Oligonucleotide,SMA,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| risdiplam,Evrysdi,4,SMN2 Splicing Modifier,SMA,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| sacituzumab govitecan,Trodelvy,4,ADC (TROP-2),"TNBC, Urothelial Cancer",Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| trastuzumab deruxtecan,Enhertu,4,ADC (HER2),HER2+ Breast/Gastric Cancer,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| pembrolizumab,Keytruda,4,PD-1 Inhibitor,Multiple Cancers,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| nivolumab,Opdivo,4,PD-1 Inhibitor,Multiple Cancers,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| ipilimumab,Yervoy,4,CTLA-4 Inhibitor,Melanoma,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| somatropin,Genotropin,4,Growth Hormone,GH Deficiency,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| eculizumab,Soliris,4,C5 Complement Inhibitor,"PNH, aHUS",Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| ravulizumab,Ultomiris,4,C5 Complement Inhibitor,"PNH, aHUS",Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| idarucizumab,Praxbind,4,Dabigatran Reversal Agent,Anticoagulation Reversal,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| andexanet alfa,Andexxa,4,Factor Xa Reversal Agent,Anticoagulation Reversal,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| givosiran,Givlaari,4,siRNA,Acute Hepatic Porphyria,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| inclisiran,Leqvio,4,siRNA (PCSK9),High Cholesterol,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| patisiran,Onpattro,4,siRNA,hATTR Amyloidosis,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| eplontersen,Wainua,4,Antisense Oligonucleotide,hATTR Polyneuropathy,Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| zanubrutinib,Brukinsa,4,BTK Inhibitor,"CLL, MCL",Covered,Yes,Yes,Per PA approval,30,30,30% after deductible,20% after deductible,10% after deductible,Yes,Prior authorization required; specialty pharmacy dispensing only; refill every 28-30 days | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| isosorbide mononitrate,Imdur,1,Nitrate,Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dofetilide,Tikosyn,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| sotalol,Betapace,1,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| fluvastatin,Lescol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nebivolol,Bystolic,2,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| atenolol,Tenormin,1,Beta Blocker,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| felodipine,Plendil,1,DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| telmisartan,Micardis,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| azilsartan,Edarbi,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| lisinopril/HCTZ,Zestoretic,1,ACE Inhibitor/Diuretic Combo,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amlodipine/atorvastatin,Caduet,1,CCB/Statin Combo,HTN + Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pitavastatin,Livalo,2,Statin,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| simvastatin,Zocor,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| diltiazem ER,Cardizem CD,1,Non-DHP CCB,"Hypertension, Afib",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| amiodarone,Cordarone,1,Class III Antiarrhythmic,"Afib, VT",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| flecainide,Tambocor,1,Class IC Antiarrhythmic,Afib,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| digoxin 0.125mg,Lanoxin,1,Cardiac Glycoside,"Afib, CHF",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| pravastatin,Pravachol,1,Statin,High Cholesterol,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| propranolol,Inderal,1,Beta Blocker,"Hypertension, Tremor",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| dronedarone,Multaq,2,Class III Antiarrhythmic,Afib,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| bisoprolol,Zebeta,1,Beta Blocker,Heart Failure,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| ezetimibe/simvastatin,Vytorin,2,Cholesterol Combo,High Cholesterol,Covered,No,No,No,30,90,$55,$40,$25,No, | |
| nifedipine ER,Procardia XL,1,DHP CCB,"Hypertension, Angina",Covered,No,No,No,30,90,$15,$10,$5,No, | |
| nitroglycerin SL,Nitrostat,1,Nitrate,Acute Angina,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| hydralazine,Apresoline,1,Vasodilator,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| clonidine,Catapres,1,Central Alpha-2 Agonist,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| olmesartan,Benicar,3,ARB,Hypertension,Covered,No,Yes,No,30,90,$110,$80,$55,No,Step therapy required; generic preferred | |
| verapamil ER,Calan SR,1,Non-DHP CCB,Hypertension,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| metformin ER,Glucophage XR,1,Biguanide Extended-Release,Type 2 Diabetes,Covered,No,No,No,30,90,$15,$10,$5,No, | |
| irbesartan,Avapro,2,ARB,Hypertension,Covered,No,No,No,30,90,$55,$40,$25,No, | |