CVS Caremark Value Generic Drug List

[Pages:4]CVS Caremark Value Generic Drug List

October 2010

The CVS Caremark Value Generic Drug List offers access to a 90-day supply of select maintenance generic medicines under your plan that can be filled either through a CVS/pharmacy retail store or through CVS Caremark Mail Service Pharmacy.

ALLERGY C-PHEN DROPS CYPROHEPTADINE 4 MG TABLET FEXOFENADINE 30 MG TABLET HYDROXYZINE 10 MG/5 ML SYRUP

ARTHRITIS & PAIN ALLOPURINOL 100 MG TABLET ALLOPURINOL 300 MG TABLET BACLOFEN 10 MG TABLET CHLORZOXAZONE 500 MG TABLET CYCLOBENZAPRINE 5 MG TABLET CYCLOBENZAPRINE 10 MG TABLET DEXAMETHASONE 0.5 MG TABLET DEXAMETHASONE 0.75 MG TABLET DEXAMETHASONE 4 MG TABLET DICLOFENAC 50 MG TABLET EC DICLOFENAC 75 MG TABLET EC IBUPROFEN 100 MG/5 ML SUSPENSION IBUPROFEN 400 MG TABLET IBUPROFEN 600 MG TABLET IBUPROFEN 800 MG TABLET INDOMETHACIN 25 MG CAPSULE INDOMETHACIN 50 MG CAPSULE KETOPROFEN 50 MG CAPSULE KETOPROFEN 75 MG CAPSULE LIDOCAINE 2% VISCOUS SOLUTION MELOXICAM 7.5 MG TABLET MELOXICAM 15 MG TABLET METHOCARBAMOL 500 MG TABLET NAPROXEN 250 MG TABLET

NAPROXEN 375 MG TABLET NAPROXEN 500 MG TABLET NAPROXEN SODIUM 275 MG TABLET NAPROXEN SODIUM 550 MG TABLET PIROXICAM 10 MG CAPSULE PIROXICAM 20 MG CAPSULE TIZANIDINE 2 MG TABLET TIZANIDINE 4 MG TABLET TRAMADOL 50 MG TABLET

ASTHMA ALBUTEROL 0.83 MG/ML SOLUTION ALBUTEROL 2 MG TABLET ALBUTEROL 4 MG TABLET ALBUTEROL 5 MG/ML SOLUTION ALBUTEROL SULFATE 2 MG/5 ML SYRUP IPRATROPIUM 0.02% SOLUTION THEOPHYLLINE 100 MG TABLET ER THEOPHYLLINE 200 MG TABLET ER

CHOLESTEROL LOVASTATIN 10 MG TABLET LOVASTATIN 20 MG TABLET LOVASTATIN 40 MG TABLET PRAVASTATIN 10 MG TABLET PRAVASTATIN 20 MG TABLET PRAVASTATIN 40 MG TABLET

DIABETES CHLORPROPAMIDE 100 MG TABLET GLIMEPIRIDE 1 MG TABLET GLIMEPIRIDE 2 MG TABLET GLIMEPIRIDE 4 MG TABLET

GLIPIZIDE 5 MG TABLET GLIPIZIDE 5 MG TABLET ER GLIPIZIDE 10 MG TABLET GLYBURIDE 1.25 MG TABLET GLYBURIDE 2.5 MG TABLET GLYBURIDE 5 MG TABLET GLYBURIDE MICRONIZED 1.5 MG TABLET GLYBURIDE MICRONIZED 3 MG TABLET GLYBURIDE MICRONIZED 6 MG TABLET GLYBURIDE-METFORMIN 5-500 MG TABLET METFORMIN 500 MG TABLET METFORMIN 500 MG TABLET ER METFORMIN 850 MG TABLET METFORMIN 1000 MG TABLET

FUNGAL INFECTIONS FLUCONAZOLE 100 MG TABLET FLUCONAZOLE 200 MG TABLET NYSTATIN 100,000 UNITS/GM OINTMENT TERBINAFINE 250 MG TABLET

GASTROINTESTINAL HEALTH CIMETIDINE 300 MG TABLET CIMETIDINE 400 MG TABLET CIMETIDINE 800 MG TABLET DICYCLOMINE 10 MG CAPSULE DICYCLOMINE 20 MG TABLET FAMOTIDINE 20 MG TABLET FAMOTIDINE 40 MG TABLET LACTULOSE 10 GM/15 ML SOLUTION METOCLOPRAMIDE 5 MG TABLET METOCLOPRAMIDE 5 MG/5 ML SYRUP

METOCLOPRAMIDE 10 MG TABLET PROCHLORPERAZINE 5 MG TABLET PROCHLORPERAZINE 10 MG TABLET PROMETHAZINE 6.25 MG/5 ML SYRUP PROMETHAZINE 12.5 MG TABLET PROMETHAZINE 25 MG TABLET RANITIDINE 150 MG TABLET RANITIDINE 300 MG TABLET

GLAUCOMA & EYE CARE ATROPINE 1% EYE DROPS CYCLOPENTOLATE 1% EYE DROPS FLURBIPROFEN 0.03% EYE DROPS LEVOBUNOLOL 0.5% EYE DROPS POLYMYXIN B-TRIMETHOPRIM EYE DROPS TIMOLOL 0.25% EYE DROPS TIMOLOL 0.5% EYE DROPS

HEART HEALTH & BLOOD PRESSURE AMIODARONE 200 MG TABLET ATENOLOL 100 MG TABLET ATENOLOL-CHLORTHALIDONE 50-25 MG TABLET ATENOLOL-CHLORTHALIDONE 100-25 TABLET BENAZEPRIL 5 MG TABLET BENAZEPRIL 10 MG TABLET BENAZEPRIL 20 MG TABLET BENAZEPRIL 40 MG TABLET BENAZEPRIL-HCTZ 10-12.5 MG TABLET BENAZEPRIL-HCTZ 20-12.5 MG TABLET BENAZEPRIL-HCTZ 20-25 MG TABLET BISOPROLOL-HCTZ 2.5-6.25 MG TABLET BISOPROLOL-HCTZ 5-6.25 MG TABLET BISOPROLOL-HCTZ 10-6.25 MG TABLET BUMETANIDE 0.5 MG TABLET BUMETANIDE 1 MG TABLET BUMETANIDE 2 MG TABLET CAPTOPRIL 50 MG TABLET

CAPTOPRIL 100 MG TABLET CARTIA XT 120 MG CAPSULE ER CARVEDILOL 3.125 MG TABLET CARVEDILOL 6.25 MG TABLET CARVEDILOL 12.5 MG TABLET CARVEDILOL 25 MG TABLET CHLORTHALIDONE 25 MG TABLET CHLORTHALIDONE 50 MG TABLET CLONIDINE 0.1 MG TABLET CLONIDINE 0.2 MG TABLET CLONIDINE 0.3 MG TABLET DIGOXIN 125 MCG TABLET DIGOXIN 250 MCG TABLET DILTIAZEM 30 MG TABLET DILTIAZEM 60 MG TABLET DILTIAZEM 90 MG TABLET DILTIAZEM 120 MG TABLET DOXAZOSIN 1 MG TABLET DOXAZOSIN 2 MG TABLET DOXAZOSIN 4 MG TABLET DOXAZOSIN 8 MG TABLET ENALAPRIL 2.5 MG TABLET ENALAPRIL 5 MG TABLET ENALAPRIL 10 MG TABLET ENALAPRIL 20 MG TABLET ENALAPRIL-HCTZ 5-12.5 MG TABLET ENALAPRIL-HCTZ 10-25 MG TABLET FOSINOPRIL 10 MG TABLET FOSINOPRIL 20 MG TABLET FOSINOPRIL 40 MG TABLET FUROSEMIDE 80 MG TABLET GUANFACINE 1 MG TABLET GUANFACINE 2 MG TABLET HYDRALAZINE 10 MG TABLET HYDRALAZINE 25 MG TABLET HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE

HYDROCHLOROTHIAZIDE 50 MG TABLET INDAPAMIDE 1.25 MG TABLET INDAPAMIDE 2.5 MG TABLET ISOSORBIDE DINITRATE 5 MG TABLET ISOSORBIDE DINITRATE 20 MG TABLET ISOSORBIDE MONONITRATE 20 MG TABLET ISOSORBIDE MONONITRATE 30 MG TABLET ER ISOSORBIDE MONONITRATE 60 MG TABLET ER ISOSORBIDE MONONITRATE 120 MG TABLET ER LABETALOL 100 MG TABLET LISINOPRIL 2.5 MG TABLET LISINOPRIL 5 MG TABLET LISINOPRIL 10 MG TABLET LISINOPRIL 20 MG TABLET LISINOPRIL 30 MG TABLET LISINOPRIL 40 MG TABLET LISINOPRIL-HCTZ 10-12.5 MG TABLET LISINOPRIL-HCTZ 20-12.5 MG TABLET LISINOPRIL-HCTZ 20-25 MG TABLET METHYLDOPA 250 MG TABLET METHYLDOPA 500 MG TABLET METOLAZONE 2.5 MG TABLET METOLAZONE 5 MG TABLET METOPROLOL 25 MG TABLET METOPROLOL 50 MG TABLET METOPROLOL 100 MG TABLET NADOLOL 20 MG TABLET NADOLOL 40 MG TABLET NITROGLYCERIN 2.5 MG CAPSULE ER NITROGLYCERIN 6.5 MG CAPSULE ER PINDOLOL 5 MG TABLET PINDOLOL 10 MG TABLET PRAZOSIN 1 MG CAPSULE PRAZOSIN 2 MG CAPSULE PRAZOSIN 5 MG CAPSULE PROPRANOLOL 10 MG TABLET

PROPRANOLOL 20 MG TABLET PROPRANOLOL 40 MG TABLET PROPRANOLOL 80 MG TABLET PROPRANOLOL-HCTZ 40-25 MG TABLET PROPRANOLOL-HCTZ 80-25 MG TABLET QUINAPRIL 5 MG TABLET QUINAPRIL 10 MG TABLET QUINAPRIL 20 MG TABLET QUINAPRIL 40 MG TABLET SOTALOL 80 MG TABLET SPIRONOLACTONE 25 MG TABLET TERAZOSIN 1 MG CAPSULE TERAZOSIN 2 MG CAPSULE TERAZOSIN 5 MG CAPSULE TERAZOSIN 10 MG CAPSULE TORSEMIDE 10 MG TABLET TORSEMIDE 20 MG TABLET TRIAMTERENE-HCTZ 37.5-25 MG CAPSULE TRIAMTERENE-HCTZ 37.5-25 MG TABLET VERAPAMIL 80 MG TABLET VERAPAMIL 120 MG TABLET VERAPAMIL 180 MG TABLET ER VERAPAMIL 240 MG TABLET ER WARFARIN 1 MG TABLET WARFARIN 2 MG TABLET WARFARIN 2.5 MG TABLET WARFARIN 3 MG TABLET WARFARIN 4 MG TABLET WARFARIN 5 MG TABLET WARFARIN 6 MG TABLET WARFARIN 7.5 MG TABLET WARFARIN 10 MG TABLET

MENTAL HEALTH & CENTRAL NERVOUS SYSTEM AMITRIPTYLINE 75 MG TABLET AMITRIPTYLINE 100 MG TABLET

AMITRIPTYLINE 150 MG TABLET BENZTROPINE 0.5 MG TABLET BENZTROPINE 1 MG TABLET BENZTROPINE 2 MG TABLET BUSPIRONE 5 MG TABLET BUSPIRONE 10 MG TABLET BUSPIRONE 15 MG TABLET CARBAMAZEPINE 200 MG TABLET CHLORPROMAZINE 25 MG TABLET CHLORPROMAZINE 50 MG TABLET CITALOPRAM 10 MG TABLET CITALOPRAM 20 MG TABLET CITALOPRAM 40 MG TABLET DOXEPIN 10 MG CAPSULE DOXEPIN 25 MG CAPSULE DOXEPIN 50 MG CAPSULE DOXEPIN 75 MG CAPSULE DOXEPIN 100 MG CAPSULE FLUOXETINE 10 MG CAPSULE FLUOXETINE 10 MG TABLET FLUOXETINE 20 MG CAPSULE FLUOXETINE 40 MG CAPSULE FLUPHENAZINE 1 MG TABLET FLUPHENAZINE 5 MG TABLET GABAPENTIN 100 MG CAPSULE HALOPERIDOL 0.5 MG TABLET HALOPERIDOL 1 MG TABLET HALOPERIDOL 2 MG TABLET HALOPERIDOL 5 MG TABLET HYDROXYZINE PAMOATE 25 MG CAPSULE IMIPRAMINE HCL 10 MG TABLET IMIPRAMINE HCL 25 MG TABLET LITHIUM CARBONATE 300 MG CAPSULE MIRTAZAPINE 15 MG TABLET NORTRIPTYLINE 10 MG CAPSULE NORTRIPTYLINE 25 MG CAPSULE

NORTRIPTYLINE 75 MG CAPSULE PAROXETINE HCL 10 MG TABLET PAROXETINE HCL 20 MG TABLET PAROXETINE HCL 30 MG TABLET PAROXETINE HCL 40 MG TABLET PERPHENAZINE-AMITRIPTYLINE 2 MG-10 MG

TABLET PERPHENAZINE-AMITRIPTYLINE 2 MG-25 MG

TABLET PERPHENAZINE-AMITRIPTYLINE 4 MG-25 MG

TABLET SERTRALINE 25 MG TABLET THIORIDAZINE 10 MG TABLET THIORIDAZINE 25 MG TABLET THIORIDAZINE 50 MG TABLET THIOTHIXENE 2 MG CAPSULE TRAZODONE 50 MG TABLET TRAZODONE 100 MG TABLET TRAZODONE 150 MG TABLET TRIHEXYPHENIDYL 2 MG TABLET ZONISAMIDE 25 MG CAPSULE

OTHER MEDICAL CONDITIONS CHLORHEXIDINE 0.12% RINSE CYTRA-2 ORAL SOLUTION CYTRA-K ORAL SOLUTION HYDROCORTISONE 20 MG TABLET ISONIAZID 300 MG TABLET MECLIZINE 12.5 MG TABLET MEGESTROL 20 MG TABLET METHYLPREDNISOLONE 4 MG TABLET OXYBUTYNIN 5 MG TABLET PREDNISOLONE 5 MG TABLET PREDNISONE 1 MG TABLET PREDNISONE 2.5 MG TABLET PREDNISONE 5 MG TABLET-DOSEPAK PREDNISONE 10 MG TABLET-DOSEPAK

SKIN CONDITIONS BETAMETHASONE DIPROPIONATE 0.05% CREAM BETAMETHASONE DIPROPIONATE 0.05%

OINTMENT BETAMETHASONE VALERATE 0.1% CREAM BETAMETHASONE VALERATE 0.1% LOTION BETAMETHASONE VALERATE 0.1% OINTMENT CLINDAMYCIN 1% SOLUTION DESONIDE 0.05% CREAM FLUOCINOLONE 0.025% CREAM FLUOCINOLONE 0.025% OINTMENT FLUOCINONIDE 0.05% CREAM HYDROCORTISONE 1% CREAM HYDROCORTISONE 2.5% CREAM HYDROCORTISONE 2.5% OINTMENT SELENIUM 2.5% LOTION-SHAMPOO TRIAMCINOLONE 0.025% CREAM TRIAMCINOLONE 0.1% CREAM TRIAMCINOLONE 0.1% OINTMENT TRIAMCINOLONE 0.5% CREAM TRIAMCINOLONE 0.5% OINTMENT

THYROID CONDITIONS LEVOTHYROXINE 25 MCG TABLET LEVOTHYROXINE 50 MCG TABLET LEVOTHYROXINE 75 MCG TABLET LEVOTHYROXINE 88 MCG TABLET LEVOTHYROXINE 100 MCG TABLET LEVOTHYROXINE 112 MCG TABLET LEVOTHYROXINE 125 MCG TABLET LEVOTHYROXINE 137 MCG TABLET LEVOTHYROXINE 150 MCG TABLET LEVOTHYROXINE 175 MCG TABLET LEVOTHYROXINE 200 MCG TABLET

VIRUSES ACYCLOVIR 200 MG CAPSULE

VITAMINS & NUTRITIONAL HEALTH FOLIC ACID 1 MG TABLET KLOR-CON 8 MEQ TABLET KLOR-CON 10 MEQ TABLET KLOR-CON M10 TABLET KLOR-CON M20 TABLET PHOSPHA 250 NEUTRAL TABLET

POLYVIT-IRON-FL 0.25 MG/ML DROPS POTASSIUM CHLORIDE 10% LIQUID S-F POTASSIUM CHLORIDE 20% LIQUID S-F PRENATABS RX TABLET SODIUM FLUORIDE 0.5 MG (1.1 MG) TABLET SODIUM FLUORIDE 0.5 MG/ML DROPS SODIUM FLUORIDE 1 MG (2.2 MG) TABLET SODIUM FLUORIDE DENTAL RINSE TRI-VIT-FLUOR-IRON 0.25 MG/ML DROPS

WOMEN'S HEALTH ALENDRONATE 35 MG TABLET ALENDRONATE 70 MG TABLET ESTRADIOL 0.5 MG TABLET ESTRADIOL 1 MG TABLET ESTRADIOL 2 MG TABLET ESTROPIPATE 0.625 (0.75 MG) TABLET ESTROPIPATE 1.25 (1.5 MG) TABLET MEDROXYPROGESTERONE 2.5 MG TABLET MEDROXYPROGESTERONE 5 MG TABLET MEDROXYPROGESTERONE 10 MG TABLET TAMOXIFEN 10 MG TABLET TAMOXIFEN 20 MG TABLET

This Value Generic Drug List represents a summary of prescriptions included in the plan's Value Generic Program. This is not an inclusive list. Products that are not represented on this list may be subject to plan-specific copayment or coinsurance. Void where prohibited by law.

Specific prescription benefit plan design may not cover certain categories or may be subject to additional charges or restrictions, regardless of their appearance in this document.

Log in to to check coverage and copay information for a specific medicine. For more details, contact CVS Caremark Customer Care at the toll-free number on your prescription benefit ID card.

Copayment, copay or coinsurance means the amount a plan member is required to pay for a prescription in accordance with a Plan, which may be a deductible, a percentage of the prescription price, a fixed amount or other charge, with the balance, if any, paid by a Plan. The Value Generic Drug List is based on commonly prescribed doses. This list is subject to change without notice.

CVS Caremark may receive rebates, discounts and service fees from pharmaceutical manufacturers for certain listed products. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

?2010 Caremark. All rights reserved. 106-040005a 1010

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