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,