Maintenance drug list

Effective January 1, 2023

The Maintenance Drug List includes drugs that are commonly used to treat conditions that are considered chronic or long-term such as high cholesterol, high blood pressure, asthma, diabetes, or heart disease. Depending on your specific prescription drug benefit plan, these medications may require a 90-day supply through Home Delivery or a preferred retail pharmacy.

This list is not a complete list, does not guarantee coverage, and does not include applicable prior authorization, step therapy or quantity level limit program requirements for the drug that are included in this list.

Refer to your respective formulary for the programs tied to these drugs on our drug page.

Key:

UPPERCASE names = Brand

lowercase names = Generic


Drug names(s)

acarbose

ACCOLATE

ACCUPRIL

ACCURETIC

acebutolol hcl

acetazolamide

acetazolamide er

ACIPHEX

ACIPHEX SPRINKLE

ACTIGALL

ACTIVELLA

ACTONEL

ACTOPLUS MET

ACTOS

ADLYXIN

ADVAIR DISKUS

ADVAIR HFA

afeditab cr

afirmelle

AIRDUO DIGIHALER

AIRDUO RESPICLICK

ALDACTAZIDE

ALDACTONE

ALENDRONATE  SOL

alendronate  tab

alfuzosin hcl er

aliskiren

allopurinol

ALOGLIPTIN

ALOGLIPTIN/METFORMIN HCL

ALOGLIPTIN/PIOGLITAZONE

ALORA

alosetron hcl

ALPHAGAN P

ALTACE

altavera

ALTOPREV

ALVESCO

alyacen

amabelz

amantadine hcl

AMARYL

amethia

amethia lo

amethyst

amiloride hcl

amiloride/hctz

amiodarone hcl

AMITIZA

amlodipine besylate

amlodipine besylate / atorvastatin calcium

amlodipine besylate/benazepril hcl

amlodipine besylate/valsartan

amlodipine/olmesartan medoxomil

amlodipine/valsartan/hctz

ANASPAZ

ANGELIQ

ANORO ELLIPTA

ANTARA

apri

APRISO

aranelle

ARCAPTA NEOHALER

arformoterol tartrate

ARMONAIR DIGIHALER

ARNUITY ELLIPTA

ashlyna

ASMANEX HFA

ASMANEX TWISTHALER

aspirin/dipyridamole

aspirin/dipyridamole er

ASPIRIN/OMEPRAZOLE

ATACAND

ATACAND HCT

ATELVIA

atenolol

atenolol/chlorthalidone

atorvastatin calcium

ATROVENT HFA

aubra

aubra eq

aurovela

aurovela 24 fe

aurovela fe

AURYXIA

AVALIDE

AVANDIA

AVAPRO

aviane

AVODART

AYGESTIN

ayuna

AZILECT

AZOPT

AZOR

AZULFIDINE

AZULFIDINE EN-TABS

azurette

BALCOLTRA

balziva

bekyree

benazepril hcl

benazepril hcl/hctz

BENICAR

BENICAR HCT

benztropine mesylate

BETAPACE

BETAPACE AF

betaxolol hcl

BETIMOL

BETOPTIC-S

BEVESPI AEROSPHERE

BEYAZ

BIDIL

BIJUVA

bimatoprost

BINOSTO

bisoprolol fumarate

bisoprolol fumarate/hctz

blisovi 24 fe

blisovi fe

BONIVA

BREO ELLIPTA

BREZTRI AEROSPHERE

briellyn

BRILINTA

brimonidine tartrate

brimonidine tartrate/timolol maleate

brinzolamide

bromocriptine mesylate

BROVANA

budesonide

BUDESONIDE/FORMOTEROL FUMARATE DIHYDRATE

bumetanide

BUMEX

BYDUREON BCISE

BYDUREON PEN

BYETTA

BYSTOLIC

CADUET

CALAN SR

calcitonin salmon

calcitriol

calcium acetate

calphron

camila

camrese

camrese lo

candesartan cilexetil

candesartan cilexetil/hctz

captopril

CAPTOPRIL/HCTZ

carbidopa

carbidopa/levodopa

carbidopa/levodopa er

CARDIZEM

CARDIZEM CD

CARDIZEM LA

CARDURA

CARDURA XL

CAROSPIR

CARTEOLOL HCL

cartia xt

carvedilol

carvedilol phosphate er

CATAPRES

CATAPRES-TTS

cavarest

caziant

cevimeline hcl

charlotte 24 fe

chateal

chateal eq

chlorthalidone

cholestyramine

cholestyramine light

cilostazol

cimetidine

cimetidine hcl

CLIMARA

CLIMARA PRO

clinpro 5000

clonidine hcl

clopidogrel

colesevelam hcl

COLESTID

COLESTID FLAVORED

colestipol hcl

COMBIGAN

COMBIPATCH

COMTAN

CONJUPRI

constulose

COREG

COREG CR

CORGARD

COSOPT

COSOPT PF

COZAAR

CREON

CRESTOR

cromolyn sodium

cryselle-28

cyclafem

CYCLOSET

cyclosporine

cyred

cyred eq

CYTOTEC

dabigatran etexilate

DALIRESP

dapsone

darifenacin hydrobromide er

dasetta

daysee

deblitane

delyla

DELZICOL

denta 5000 plus

dentagel

desogestrel/ethinyl estradiol

DETROL

DETROL LA

DEXILANT

DEXLANSOPRAZOLE

DHIVY

digitek

DIGOXIN  SOL 50MCG/ML

digoxin 

DILATRATE SR

dilt-xr

diltiazem cd

diltiazem hcl

diltiazem hcl er

DIOVAN

DIOVAN HCT

DIPENTUM

dipyridamole

disopyramide phosphate

DITROPAN XL

DIURIL

DIVIGEL

dofetilide

dolishale

dorzolamide hcl

dorzolamide hcl/timolol maleate

dotti

doxazosin

doxazosin mesylate

doxercalciferol

DRISDOL

drospirenone/ethinyl estradiol

drospirenone/ethinyl estradiol/levomefolate calcium

DUAKLIR PRESSAIR

DUAVEE

DUETACT

DULERA

DUOPA

DURLAZA

dutasteride

dutasteride/tamsulosin hcl

DUTOPROL

DYRENIUM

ed-spaz

EDARBI

EDARBYCLOR

EDECRIN

EFFIENT

ELESTRIN

elinest

ELIQUIS

ELIXOPHYLLIN

eluryng

emoquette

ENABLEX

enalapril maleate

enalapril maleate

enalapril maleate/hctz

enpresse-28

enskyce

entacapone

ENTRESTO

enulose

EPANED

eplerenone

ergocalciferol

errin

esomeprazole magnesium

ESOMEPRAZOLE STRONTIUM

estarylla

ESTRACE

estradiol

estradiol/norethindrone acetate

ESTRING

ESTROGEL

ESTROSTEP FE

ethacrynic acid

ethynodiol diacetate/ethinyl estradiol

etonogestrel/ethinyl estradiol

EVAMIST

EVISTA

EVOXAC

EXFORGE

EXFORGE HCT

EZALLOR SPRINKLE

ezetimibe

EZETIMIBE/ROSUVASTATIN

ezetimibe/simvastatin

falmina

famotidine

FARXIGA

fayosim

febuxostat

felodipine er

FEMHRT

FEMRING

femynor

fenofibrate  cap

fenofibrate cap 43mg

fenofibrate  tab

fenofibrate micronized cap

fenofibric acid dr

FENOGLIDE

fesoterodine fumarate er

FIBRICOR

finasteride

finzala

flecainide acetate

FLOLIPID

FLOMAX

FLOVENT DISKUS

FLOVENT HFA

fluoride

fluoritab

fluticasone/salmeterol aer 

FLUTIC/SALME INH 

FLUTICASONE FUROATE /VILANTEROL ELLIPTA

FLUTICASONE PROPIONATE HFA

fluticasone propionate/ salmeterol diskus

fluvastatin

fluvastatin sodium er

folic acid

formoterol fumarate

FORTAMET

FOSAMAX

FOSAMAX PLUS D

fosinopril sodium

fosinopril sodium/hctz

FOSRENOL

furosemide   sol

furosemide   tab

fyavolv

GASTROCROM

GELNIQUE

gemfibrozil

gemmily

GEMTESA

GENERESS FE

generlac

gianvi

glimepiride

glipizide

glipizide er

glipizide xl

glipizide/metformin hcl

GLUCOTROL

GLUCOTROL XL

GLUMETZA

glyburide

glyburide micronized

glyburide/metformin hcl

GLYNASE

GLYXAMBI

guanfacine hcl

hailey

hailey 24 fe

hailey fe

heather

hydralazine hcl

hydrochlorothiazide

HYZAAR

ibandronate sodium

iclevia

icosapent ethyl

IMVEXXY MAINTENANCE PACK

incassia

INCRUSE ELLIPTA

indapamide

INDERAL LA

INDERAL XL

INNOPRAN XL

INSPRA

INTRAROSA

introvale

INVOKAMET

INVOKAMET XR

INVOKANA

ipratropium bromide

irbesartan

irbesartan/hctz

isibloom

ISOPTO CARPINE

ISORDIL TITRADOSE

isosorbide dinitrate

isosorbide dinitrate/

hydralazine hcl

isosorbide mononitrate

isosorbide mononitrate er

isradipine

ISTALOL

jaimiess

JALYN

JANUMET

JANUMET XR

JANUVIA

JARDIANCE

jasmiel

jencycla

JENTADUETO

JENTADUETO XR

jinteli

jolessa

juleber

junel

junel fe

junel fe 24

K-TAB

kaitlib fe

kalliga

KAPSPARGO SPRINKLE

kariva

KATERZIA

KAZANO

kelnor

klor-con

KOMBIGLYZE XR

KRISTALOSE

kurvelo

labetalol hcl

LACTULOSE   PAK 10GM

lactulose sol

LANOXIN

lansoprazole

lansoprazole odt

lanthanum carbonate

larin

larin 24 fe

larin fe

larissia

LASIX

latanoprost  sol 0.005%

layolis fe

leena

LESCOL XL

lessina

LEVAMLODIPINE

LEVBID

LEVOBUNOLOL HCL

levonest

levonorgestrel/ethinyl estradiol

levora

LEVSIN

LEVSIN/SL

LIALDA

lillow

LINZESS

LIPITOR

LIPOFEN

lisinopril

lisinopril/hctz

LIVALO

LO LOESTRIN FE

lo-zumandimine

LODOSYN

loestrin

lojaimiess

LOKELMA

LOPID

LOPRESSOR

loryna

losartan potassium

losartan potassium/hctz

LOSEASONIQUE

LOTENSIN

LOTENSIN HCT

LOTREL

LOTRONEX

lovastatin

LOVAZA

low-ogestrel

LUBIPROSTONE

LUMIGAN

lutera

lyleq

lyllana

lyza

marlissa

matzim la

MAVIK

MAXZIDE

MAXZIDE-25

medroxyprogesterone acetate

megestrol acetate

melodetta 24 fe

MENEST

MENOSTAR

merzee

mesalamine dr

mesalamine er

metformin hcl

metformin hcl

metformin hcl er

metformin hcl er

methazolamide

methyldopa tab

METHYLDOPA/hctz

metolazone

metoprolol succinate er

metoprolol tartrate

metoprolol/hctz

mexiletine hcl

mibelas 24 fe

MICARDIS

MICARDIS HCT

microgestin

microgestin 24 fe

microgestin fe

miglitol

mili

mimvey

MINASTRIN 24 FE

MINIPRESS

minitran

MINIVELLE

minoxidil

MIRAPEX

MIRAPEX ER

MIRCETTE

misoprostol

moexipril hcl

mono-linyah

montelukast sodium

MOTEGRITY

MULTAQ

MYRBETRIQ

nadolol

nafrinse

NASCOBAL

NATAZIA

nateglinide

nebivolol hcl

necon

NESINA

NEUPRO

NEXIUM

NEXLETOL

NEXLIZET

NEXTSTELLIS

niacin er

NIASPAN

nicardipine hcl

nifedipine

nifedipine er

nikki

nisoldipine tab  er

NITRO-BID

NITRO-DUR

NITRO-TIME

NITROGLYCERIN ER

nitroglycerin transdermal

NIZATIDINE

NIZATIDINE

nora-be

norethindrone

norethindrone & ethinyl estradiol ferrous fumarate

norethindrone acetate

norethindrone acetate/ethinyl estradiol

norethindrone/ethinyl estradiol/ferrous fumarate

norgestimate/ethinyl estradiol

norlyda

norlyroc

NORPACE

NORPACE CR

nortrel

NORVASC

nulev

NUVARING

nylia

nymyo

ocella

olmesartan medoxomil

olmesartan medoxomil /amlodipine/hctz

olmesartan medoxomil/hctz

omega-3-acid ethyl esters

omeprazole

omeprazole/sodium bicarbonate

ONGENTYS

ONGLYZA

orsythia

ORTHO MICRONOR

ORTHO TRI-CYCLEN LO

oscimin

oscimin sr

OSENI

OSMOLEX ER

OSPHENA

oxybutynin chloride

oxybutynin chloride er

OZEMPIC

pacerone

PANCREAZE

pantoprazole sodium

paricalcitol

PARLODEL

PENTASA

pentoxifylline cr

pentoxifylline er

PERFOROMIST

perindopril erbumine

periomed

PERTZYE

philith

PHOSLYRA

pilocarpine hcl

pimtrea

pindolol

pioglitazone hcl

pioglitazone hcl-glimepiride

pioglitazone hcl/metformin hcl

pirmella

PLAVIX

portia-28

potassium chloride

potassium chloride cr

potassium chloride sr

PRADAXA

pramipexole dihydrochloride

pramipexole dihydrochloride er

prasugrel

PRAVACHOL

pravastatin sodium

prazosin hcl

PRECOSE

PREFEST

PREMARIN

PREMPHASE

PREMPRO

PRESTALIA

PREVACID

PREVACID SOLUTAB

prevalite

PREVIDENT 5000 BOOSTER PLUS

PREVIDENT 5000 DRY MOUTH

PREVIDENT 5000 ORTHO DEFENSE

PREVIDENT 5000 PLUS

PREVIDENT FLUORIDE

PREVIDENT RINSE

previfem

PRILOSEC

PRINIVIL

probenecid

probenecid/colchicine

PROCARDIA

PROCARDIA XL

progesterone

PROMETRIUM

propafenone hcl

propafenone hcl er

propranolol sol

propranolol hcl er

propranolol hcl

PROPRANOLOL/hctz

PROSCAR

PROTONIX

PROVERA

PULMICORT

PULMICORT FLEXHALER

QBRELIS

QTERN

QUARTETTE

QUESTRAN

QUESTRAN LIGHT

quinapril hcl

quinapril/hctz

quinidine gluconate cr

quinidine gluconate er

QUINIDINE SU TAB

QVAR REDIHALER

rabeprazole sodium

RABEPRAZOLE SODIUM DR SPRINKLE

raloxifene hcl

ramipril

RANEXA

ranolazine er

RAPAFLO

rasagiline mesylate

RAYALDEE

reclipsen

RELTONE

RENAGEL

RENVELA

repaglinide

RESTASIS

RESTASIS MULTIDOSE

RHOPRESSA

RIOMET

RIOMET ER

risedronate sodium

risedronate sodium dr

rivelsa

ROCALTROL

ROCKLATAN

ropinirole er

ropinirole hcl

rosuvastatin calcium

ROSZET

RYBELSUS

RYTARY

RYTHMOL SR

SAFYRAL

SALAGEN

SAVAYSA

SEASONIQUE

SEGLUROMET

selegiline hcl

SEREVENT DISKUS

setlakin

sevelamer tab

sodium fluoride 5000 plus

sharobel

silodosin

SIMBRINZA

simliya

simpesse

simvastatin

SINEMET

SINGULAIR

SLYND

SOAANZ

sod fluoride chw

sodium fluoride dro

sodium fluoride sol

SOD FLUORIDE TAB F

sodium fluoride gel 1.1%

solia

solifenacin succinate

sorine

sotalol hcl

sotalol hcl af

SOTYLIZE

SPIRIVA HANDIHALER

SPIRIVA RESPIMAT

spironolactone

spironolactone/hctz

sprintec 28

sronyx

STALEVO

STARLIX

STEGLATRO

STEGLUJAN

STIOLTO RESPIMAT

STRIVERDI RESPIMAT

SULAR

sulfasalazine

syeda

SYMAX DUOTAB

symax-sl

symax-sr

SYMBICORT

SYMLINPEN

SYNJARDY

SYNJARDY XR

tamsulosin hcl

tarina 24 fe

tarina fe

TARKA

TASMAR

taysofy

TAYTULLA

taztia xt

TEKTURNA

TEKTURNA HCT

telmisartan

telmisartan/amlodipine

telmisartan/hctz

TENORETIC

TENORMIN

terazosin hcl

THEO-24

theophylline

theophylline cr

theophylline tab er

tiadylt er

TIAZAC

TIKOSYN

tilia fe

timolol maleate

TIMOPTIC

TIMOPTIC OCUDOSE

TIMOPTIC-XE

TOLBUTAMIDE

tolcapone

tolterodine tartrate

tolterodine tartrate er

TOPROL XL

torsemide

TOVIAZ

TRADJENTA

trandolapril

TRANDOLAPRIL/VERAPAMIL HCL ER

TRAVATAN Z

travoprost

TRELEGY ELLIPTA

tri femynor

tri-estarylla

tri-legest fe

tri-linyah

tri-lo-estarylla

tri-lo-marzia

tri-lo-mili

tri-lo-sprintec

tri-mili

tri-nymyo

tri-previfem

tri-sprintec

tri-vylibra

tri-vylibra lo

triamterene

triamterene/hctz

TRIBENZOR

TRICOR

TRIHEXYPHEN SOL 0.4MG/ML

trihexyphenidyl hcl

TRIJARDY XR

TRILIPIX

trinessa

trivora-28

trospium chloride

trospium chloride er

TRULANCE

TRULICITY

TRUSOPT

TUDORZA PRESSAIR

tulana

TWIRLA

TWYNSTA

TYBLUME

tydemy

ULORIC

UROXATRAL

URSO 250

URSO FORTE

URSODIOL CAP

ursodiol cap

ursodiol tab

UTIBRON NEOHALER

VAGIFEM

valsartan

valsartan/hctz

VASCEPA

VASERETIC

VASOTEC

VELIVET

VELPHORO

VELTASSA

verapamil cap er

verapamil cap sr

VERAPAMIL CAP 360MG SR

verapamil tab er

verapamil tab sr

verapamil hcl

verapamil hcl cr

verapamil hcl sa

VERELAN

VERELAN PM

VERQUVO

VESICARE

VESICARE LS

vestura

VICTOZA

vienva

VIOKACE

viorele

vitamin d

VIVELLE-DOT

volnea

vyfemla

vylibra

VYTORIN

VYZULTA

WELCHOL

wera

wixela inhub

wymzya fe

XADAGO

XALATAN

XARELTO

XELPROS

XIGDUO XR

XIIDRA

xulane

YASMIN 28

YAZ

YOSPRALA

YUPELRI

yuvafem

zafemy

zafirlukast

zarah

ZEGERID

ZELAPAR

ZEMPLAR

ZENPEP

ZESTORETIC

ZESTRIL

ZETIA

ZIAC

ZIOPTAN

ZOCOR

ZONTIVITY

zovia

zumandimine

ZYLOPRIM

ZYPITAMAG