PRESCRIPTION DRUG CHECKLIST
Choice Plus Prescription Drug Worksheet
Optimizing your Prescription Drug Benefits
If you currently take a non-preferred brand drug, you may wish to talk to your doctor to see if you can switch to a preferred or generic drug and pay less.
Choice Plus Preferred Drug List
(Effective January 1, 2009)
|Aerobid® Inhaler |Humalog® Insulin (all varieties) |
|Aerobid-M® Inhaler |Levemir® Insulin |
|Arixtra® |Novolin® Insulin (all varieties) |
|Atacand® |NovoLog® Insulin (all varieties) |
|Atacand® HCT |Relpax® |
|Flovent® Inhaler |Serevent® Inhaler |
|Humulin® Insulin (all varieties) |Symbicort® Inhaler |
Anzemet (dolasetron) has been removed from the preferred list because Zofran (ondansetron) a similar drug is now available as a generic. Ask your physician if the generic will work for you.
Nasonex (mometasone) has been removed from the preferred list because Flonase (fluticasone) a similar drug is now available as a generic. Ask your physician if the generic will work for you.
Questions to Ask My Doctor:
1. Are there any generic medicines that would work as well, that I could substitute for any brand medicines on my list?
2. If not, are there any medicines on the preferred drug list that I could substitute? (See examples above.)
| |Potential Generic Substitutions or Preferred Drugs (TBD by Physician) |
|My Current Medications: | |
|1. |1. |
|2. |2. |
|3. |3. |
|4. |4. |
|5. |5. |
|6. |6. |
|7. |7. |
|8. |8. |
|9. |9. |
|10. |10. |
|Choice Plus Preferred Drug List |Ask your doctor if you can substitute |
|Effective January 1, 2009 |for these* |
| | |
|Angiotensin II Receptor Antagonists |
|Atacand® (candesartan) |Avapro® (irbesartan) |
|AtacandHCT® (candesartan & hydrochlorothiazide) |Benicar® (olmesartan) |
| |Cozaar® (losartan) |
| |Diovan® (valsartan) |
| |Micardis® (telmisartan) |
| |Teveten® (eprosartan) |
| | |
|Inhaled Steroids |
|Aerobid® Inhaler (flunisolide) |Pulmicort® Turbohaler or Respules (budesonide) |
|Aerobid-M® Inhaler (flunisolide) | |
|Flovent® Inhaler (fluticasone) | |
| | |
|Insulins |
|Humulin® Insulins (any variety) | |
|Humalog® Insulin (any variety) | |
|Novolin® Insulin (any variety) | |
|NovoLog® Insulin (any variety) | |
| | |
|Long Acting Insulin |
|Levemir® Insulin |Lantus® Insulin |
| | |
|Respiratory Inhalant |
|Symbicort® Inhaler (budesonide/formoterol) |Advair® Inhaler (fluticasone propionate/salmeterol) |
| | |
|Selective Xa Inhibitor |
|Arixtra® (fondaparinux) |Fragmin® (dalteparin) |
| |Innohep® (tinzaparin) |
| |Lovenox® (enoxaparin) |
| | |
|Serotonin 5-HT1 Receptor Agonists |
|Relpax® (eletriptan) |Amerge® (naratriptan) |
| |Axert® (almotriptan) |
| |Frova® (frovatriptan) |
| |Imitrex® (sumatriptan) |
| |Maxalt® (rizatriptan) |
| |Zomig® (zolmitriptan) |
| | |
| | |
| | |
*Therapies may NOT always be substitutable within each drug category. Please discuss with your physician if a substitution may be right for you.
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