Pv1 Generic (Preventive) Drug List

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PV1 Generic (Preventive) Drug List
These drugs are covered in full for HSA qualifying plans and some large group commercial
PPO plans. Please contact Customer Service at the number on the back of your ID card to see
if your plan qualifies.
Ace Inhibitors
Antiarrhythmic Agents
Blood Thinning Agents
Oral Antidiabetic Agents
(hypertension)
(diabetes)
amiodarone
warfarin
disopyramide
cilostazol
benazepril
acarbose
flecainide
clopidogrel
benazepril / amlodipine
chlorpropamide
mexiletine
dipyridamole
captopril
glimepiride
propafenone
ticlopidine
enalapril
glipizide
quinidine gluconate CR
fosinopril
glipizide ER
Calcium Channel Blockers
quinidine sulfate
lisinopril
glipizide XL
(hypertension)
quinidine sulfate CR
moexipril
glipizide / metformin
sotalol
quinapril
glyburide
amlodipine
ramipril
glyburide micronized
amlodipine / benazepril
Antihyperlipidemics
trandolapril
glyburide / metformin
diltiazem
(high cholesterol)
benazepril / HCTZ
metformin
diltiazem ER
captopril / HCTZ
metformin ER
atorvastatin
diltiazem CR
enalapril / HCTZ
tolazamide
cholestyramine
felodipine
fosinopril / HCTZ
tolbutamide
cholestyramine light
isradipine
lisinopril / HCTZ
colestipol
nicardipine
Angiotensin II Receptor
moexipril / HCTZ
fenofibrate
nifedipine
Blockers (ARBs)
quinapril / HCTZ
fluvastatin
nifedipine ER
gemfibrozil
nisoldipine
candesartan
Adrenergic Agents
lovastatin
nimodipine
eprosartan
(hypertension)
pravastatin
verapamil
irbesartan
simvastatin
verapamil CR
clonidine
losartan
doxazosin
candesartan / HCTZ
Beta-Blockers
Diuretics (hypertension)
guanabenz
eprosartan / HCTZ
(hypertension)
guanfacine immediate release
irbesartan / HCTZ
amiloride
methyldopa
losartan / HCTZ
bumetanide
acebutolol
prazosin
valsartan / HCTZ
chlorothiazide
atenolol
reserpine
chlorthalidone
atenolol / chlorthalidone
Miscellaneous
terazosin
eplerenone
betaxolol
methyldopa / HCTZ
furosemide
bisoprolol
pentoxifylline CR
hydrochlorothiazide (HCTZ)
carvedilol
digoxin
Vasodilators (chest pain)
indapamide
labetalol
methyclothiazide
hydralazine
metoprolol succinate
metolazone
isosorbide dintrate
metoprolol tartrate
spironolactone
isosorbide mononitrate
nadolol
torsemide
nitroglycerin
nadolol / bendroflumethiazide
amiloride / HCTZ
nitroglycerin transdermal patch
pindolol
spironolactone / HCTZ
hydralazine / HCTZ
propranolol
triamterene / HCTZ
timolol
atenolol / HCTZ
bisoprolol / HCTZ
metoprolol / HCTZ
This is not a complete list of medications covered under your plan.
propranolol / HCTZ
This list represents certain common generic medications that are covered
in full for HSA-qualified and some large group commercial PPO plans and
is subject to change without prior notification. Brand name medications
are not covered under this PV1 Generic (Preventive) Drug List. If you
have questions about your pharmacy benefit, please visit
MyPharmacyPlus. If you don’t have access to our web site, please call
the customer service number listed on the back of your ID card.
An Independent Licensee of the Blue Cross Blue Shield Association
025458 (10-2014)

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