Maintenance drug list

Effective July 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

ALTACE

ATACAND

ACCOLATE

altavera

ATACAND HCT

ACCUPRIL

ALTOPREV

ATELVIA

ACCURETIC

ALVESCO

atenolol

acebutolol hydrochloride

alyacen 1/35

ASMANEX TWISTHALER

acetazolamide

alyacen 7/7/7

aspirin/dipyridamole

acetazolamide er

amabelz

aspirin/dipyridamole er

ACIPHEX

amantadine hydrochloride

ASPIRIN/OMEPRAZOLE

ACIPHEX SPRINKLE

AMARYL

atenolol/chlorthalidone

ACTIVELLA

amethia

atorvastatin calcium

ACTONEL

amethyst

ATROVENT HFA

ACTOPLUS MET

AMILOR/HYDROCHLOROTHIAZIDE TAB

aubra

ACTOS

amiloride hydrochloride

aubra eq

ADVAIR DISKUS

amiodarone hydrochloride

aurovela

ADVAIR HFA

AMITIZA

aurovela 24 fe

afirmelle

amlodipine besylate

aurovela fe

AIRDUO DIGIHALER

amlodipine besylate/atorvastatin calcium

AURYXIA

AIRDUO RESPICLICK

amlodipine besylate/benazepril hydrochloride

AVALIDE

ALDACTAZIDE

amlodipine besylate/valsartan

AVANDIA

ALDACTONE

amlodipine/olmesartan medoxomil

AVAPRO

ALENDRONATE SOL
70/75ML

amlodipine/valsartan/ hydrochlorothiazide

aviane

alendronate tab

ANASPAZ

AVODART

ALENDRONATE TAB 5MG

ANGELIQ

AYGESTIN

alfuzosin hydrochloride er

ANORO ELLIPTA

ayuna

aliskiren

ANTARA

AZILECT

allopurinol tab

apri

AZOPT

ALLOPURINOL TAB

APRISO

AZOR

ALOGLIPTIN

aranelle

AZULFIDINE

ALOGLIPTIN/METFORMIN HYDROCHLORIDE

arformoterol tartrate

AZULFIDINE EN-TABS

ALOGLIPTIN/PIOGLITAZONE

ARMONAIR DIGIHALER

BETOPTIC-S

ALORA

ARNUITY ELLIPTA

BEVESPI AEROSPHERE

alosetron hydrochloride

ashlyna

BEYAZ

ALPHAGAN P

ASMANEX HFA

BIDIL

azurette

camrese

COLESTID

BALCOLTRA

camrese lo

colestipol hydrochloride

balziva

candesartan cilexetil

COMBIGAN

benazepril hydrochloride

candesartan cilexetil/ hydrochlorothiazide

COMBIPATCH

benazepril hydrochloride /hydrochlorothiazide

captopril

COMTAN

BENICAR

CAPTOPRIL/

HYDROCHLOROTHIAZIDE

CONJUPRI

BENICAR HCT

carbidopa

constulose

benztropine mesylate

carbidopa/levodopa er

COREG

BETAPACE

CARBIDOPA/LEVODOPA TAB

COREG CR

BETAPACE AF

CARBIDOPA/LEVODOPA TAB/ ENTACAP

CORGARD

betaxolol hydrochloride

CARDIZEM

COSOPT

BETIMOL

CARDIZEM CD

COSOPT PF

BIJUVA

CARDIZEM LA

COZAAR

bimatoprost

CARDURA

CREON

BINOSTO

CARDURA XL

CRESTOR

bisoprolol fumarate

CAROSPIR

cromolyn sodium

bisoprolol

fumarate/hydrochlorothiazide

CARTEOLOL

HYDROCHLORIDE

cryselle-28

blisovi 24 fe

cartia xt

cyclafem 1/35

blisovi fe

carvedilol

cyclafem 7/7/7

BONIVA

carvedilol phosphate er

CYCLOSET

BREO ELLIPTA

CATAPRES-TTS-1

cyclosporine

BREZTRI AEROSPHERE

CATAPRES-TTS-2

cyred

briellyn

CATAPRES-TTS-3

cyred eq

BRILINTA

cavarest

CYTOTEC

brimonidine tartrate

caziant

dabigatran etexilate

brimonidine tartrate/timolol maleate

cevimeline hydrochloride

DALIRESP

brinzolamide

charlotte 24 fe

dapsone

bromocriptine mesylate

chateal

darifenacin hydrobromide er

BROVANA

chateal eq

dasetta

budesonide

chlorthalidone

daysee

BUDESONIDE/FORMOTEROL

cholestyramine

deblitane

bumetanide

cholestyramine light

delyla

BUMEX

cilostazol

DELZICOL

BYSTOLIC

cimetidine

denta 5000 plus

CADUET

CLIMARA

dentagel

CALAN SR

CLIMARA PRO

desogestrel/ethinyl estradiol

calcitonin salmon

clinpro 5000

DETROL

calcitriol

CLONIDINE ER

DETROL LA

calcium acetate

clonidine hydrochloride

DEXILANT

calphron

clopidogrel

dexlansoprazole

camila

colesevelam hydrochloride

DHIVY

digitek

dutasteride

EVOXAC

digox

dutasteride/tamsulosin hydrochloride

EXFORGE

DIGOXIN SOL 50MCG/ML

DYRENIUM

EXFORGE HCT

digoxin sol 50mcg/ml

EDARBI

EZALLOR SPRINKLE

digoxin tab

EDARBYCLOR

ezetimibe

DILATRATE SR

EDECRIN

EZETIMIBE/ROSUVASTATIN

dilt-xr

EFFIENT

ezetimibe/simvastatin

diltiazem cd

ELESTRIN

falmina

diltiazem hydrochloride er

elinest

famotidine

diltiazem hydrochloride

ELIQUIS

FARXIGA

DIOVAN

elixophyllin

fayosim

DIOVAN HCT

eluryng

febuxostat

DIPENTUM

emoquette

felodipine er

dipyridamole

ENABLEX

FEMHRT

DITROPAN XL

enalapril maleate

FEMRING

DIURIL

enalapril maleate /hydrochlorothiazide

femynor

DIVIGEL

enpresse-28

FENOFIBRATE MICR CAP

dofetilide

enskyce

fenofibrate cap

dolishale

entacapone

FENOFIBRATE CAP

dorzol/timol sol 2-0.5%op

ENTRESTO

fenofibrate tab

DORZOL/TIMOL SOL 22.3- 6.8

enulose

fenofibrate micronized cap

DORZOLAMIDE SOL 2%

EPANED

FENOFIBRIC ACID

dorzolamide sol 2% op

eplerenone

fenofibric acid dr

dorzolamide hydrochloride

ergocalciferol

FENOGLIDE

dorzolamide hydrochloride /timolol maleate

errin

fesoterodine fumarate er

dorzolamide hydrochloride /timolol maleate pf

esomeprazole magnesium

FIBRICOR

dotti

estarylla

finasteride

doxazosin

ESTRACE

finzala

doxercalciferol

estradiol

flecainide acetate

DRISDOL

estradiol/norethindrone acetate

FLOLIPID

drospirenone/ethinyl estradiol

ESTRING

FLOMAX

drospirenone/ethinyl estradiol/levomefolate calcium

ESTROGEL

FLOVENT DISKUS

DUAKLIR PRESSAIR

ESTROSTEP FE

FLOVENT HFA

DUAVEE

ethacrynic acid

fluoride

DUETACT

ethynodiol diacetate/ethinyl estradiol

fluoritab

DULERA

etonogestrel/ethinyl estradiol

fluticasone/salmeterol aer

DUOPA

EVAMIST

FLUTICASONE/SALMETEROL INH

DURLAZA

EVISTA

FLUTICASONE FUROATE /VILANTEROL ELLIPTA

FLUTICASONE PROPIONATE HFA

haloette

jencycla

fluticasone

propionate/salmeterol diskus

heather

JENTADUETO

FLUTICASONE PROPIONATE /SALMETEROL HFA

hydralazine hydrochloride

JENTADUETO XR

fluvastatin

hydrochlorothiazide

jinteli

fluvastatin sodium er

HYZAAR

jolessa

folic acid

ibandronate sodium

juleber

formoterol fumarate

iclevia

junel 1.5/30

FORTAMET

icosapent ethyl

junel 1/20

FOSAMAX

IMVEXXY MAINTENANCE PACK

junel fe 1.5/30

FOSAMAX PLUS D

incassia

junel fe 1/20

fosinopril sodium

INCRUSE ELLIPTA

junel fe 24

fosinopril

sodium/hydrochlorothiazide

indapamide

just right 5000

FOSRENOL

INDERAL LA

K-TAB

furosemide sol

INDERAL XL

kaitlib fe

furosemide

INNOPRAN XL

kalliga

fyavolv

INSPRA

KAPSPARGO SPRINKLE

GASTROCROM

INTRAROSA

kariva

GELNIQUE

introvale

KATERZIA

gemfibrozil

INVOKAMET

KAZANO

gemmily

INVOKAMET XR

kelnor 1/35

GEMTESA

INVOKANA

kelnor 1/50

GENERESS FE

ipratropium bromide

klor-con

generlac

irbesartan

klor-con m

glimepiride

irbesartan/hydrochlorothiazide

KOMBIGLYZE XR

glipizide

isibloom

KRISTALOSE

glipizide er

ISOPTO CARPINE

kurvelo

glipizide xl

ISORDIL TITRADOSE

labetalol hydrochloride

glipizide/metformin hydrochloride

ISOSORBIDE MONO TAB 10MG

LACTULOSE PAK

GLUCOTROL

isosorbide dinitrate

lactulose sol

GLUCOTROL XL

isosorbide dinitrate/hydralazine hydrochloride

LANOXIN

GLUMETZA

isosorbide mononitrate er

lansoprazole

glyburide

isradipine

lansoprazole odt

glyburide micronized

ISTALOL

lanthanum carbonate

glyburide/metformin hydrochloride

jaimiess

larin 1.5/30

GLYNASE

JALYN

larin 1/20

GLYXAMBI

JANUMET

larin 24 fe

guanfacine hydrochloride

JANUMET XR

larin fe 1.5/30

hailey

JANUVIA

larin fe 1/20

hailey 24 fe

JARDIANCE

larissia

hailey fe

jasmiel

LASIX

latanoprost sol

LUMIGAN

minitran

layolis fe

lutera

MINIVELLE

leena

lyleq

minoxidil

LESCOL XL

lyllana

MIRAPEX

lessina

lyza

MIRAPEX ER

LEVAMLODIPINE

marlissa

MIRCETTE

LEVBID

matzim la

misoprostol

LEVOBUNOLOL HYDROCHLORIDE

MAVIK

moexipril hydrochloride

levonest

MAXZIDE

mono-linyah

levonorgestrel and ethinyl estradiol

medroxyprogesterone acetate

montelukast sodium

levora 0.15/30-28

megestrol acetate

MOTEGRITY

LIALDA

melodetta 24 fe

MULTAQ

lillow

MENEST

MYRBETRIQ

LINZESS

MENOSTAR

nadolol

LIPITOR

merzee

NASCOBAL

LIPOFEN

mesalamine dr

NATAZIA

lisinopril

mesalamine er

nateglinide

lisinopril/hydrochlorothiazide

metformin hydrochloride

nebivolol

LIVALO

metformin hydrochloride er

nebivolol hydrochloride

LO LOESTRIN FE

methazolamide

necon 0.5/35-28

lo-zumandimine

METHYLDOPA TAB

necon 1/35

LODOSYN

methyldopa tab

NESINA

loestrin 1.5/30-21

METHYLDOPA/HYDROCHLOROTHIAZIDE

NEUPRO

loestrin 1/20-21

metolazone

NEXICLON XR

loestrin fe 1.5/30

metoprolol succinate er

NEXIUM

loestrin fe 1/20

metoprolol tartrate

NEXLETOL

lojaimiess

metoprolol/hydrochlorothiazide

NEXLIZET

LOKELMA

mexiletine hydrochloride

NEXTSTELLIS

LOPID

mibelas 24 fe

niacin er

LOPRESSOR

MICARDIS

NIASPAN

loryna

MICARDIS HYDROCHLOROTHIAZIDE

nicardipine
hydrochloride

losartan potassium

microgestin 1.5/30

nifedipine

losartan

potassium/hydrochlorothiazide

microgestin 1/20

nifedipine er

LOSEASONIQUE

microgestin 24 fe

nikki

LOTENSIN

microgestin fe 1.5/30

nisoldipine tab er

LOTENSIN HCT

microgestin fe 1/20

NITRO-BID

LOTREL

miglitol

NITRO-DUR

LOTRONEX

mili

NITRO-TIME

lovastatin

mimvey

NITROGLYCERIN ER

LOVAZA

lubiprostone

nitroglycerin
transdermal

low-ogestrel

MINASTRIN 24 FE

NIZATIDINE

lubiprostone

MINIPRESS

nora-be

norethindrone

pacerone

prazosin hydrochloride

norethindrone acetate

PANCREAZE

PRECOSE

norethindrone acetate/ethinyl estradiol

pantoprazole sodium

PREFEST

norethindrone acetate/ethinyl estradiol/ferrous fumarate

paricalcitol

PREMARIN

norgestimate/ethinyl estradiol

PARLODEL

PREMPHASE

norlyda

PENTASA

PREMPRO

norlyroc

pentoxifylline cr

PRESTALIA

NORPACE

pentoxifylline er

PREVACID

NORPACE CR

PEPCID

PREVACID SOLUTAB

nortrel 0.5/35 (28)

PERFOROMIST

prevalite

nortrel 1/35

perindopril tab

PREVIDENT 5000

nortrel 7/7/7

PERINDOPRIL TAB 8MG

PREVIDENT FLUORIDE

NORVASC

periomed

PREVIDENT RINSE

nulev

PERTZYE

previfem

NUVARING

philith

PRILOSEC

nylia 1/35

PHOSLYRA

PRINIVIL

nylia 7/7/7

pilocarpine hydrochloride

probenecid

nymyo

pimtrea

probenecid/colchicine

ocella

pindolol

PROCARDIA XL

olmesartan medoxomil

pioglitazone hydrochloride

progesterone

olmesartan medoxomil /amlodipine/

hydrochlorothiazide

pioglitazone hydrochloride- glimepiride

PROMETRIUM

olmesartan

medoxomil/hydrochlorothiazide

pioglitazone

hydrochloride/metformin hydrochloride

propafenone hydrochloride

omega-3-acid ethyl esters

pirmella 1/35

PROPRANOLOL SOL

omeprazole

pirmella 7/7/7

propranolol tab

omeprazole/sodium
bicarbonate

PLAVIX

propranolol hydrochloride er

ONGENTYS

portia-28

propranolol hydrochloride oral soln 20 mg/5ml

ONGLYZA

potassium chloride cap er

propranolol hydrochloride

orsythia

POTASSIUM CHLORIDE TAB ER

PROPRANOLOL/

HYDROCHLOROTHIAZIDE

ORTHO MICRONOR

potassium chloride tab er

PROSCAR

ORTHO TRI-CYCLEN LO

potassium chloride

PROTONIX

oscimin

potassium chloride cr

PROVERA

oscimin sr

potassium chloride sr

PULMICORT

OSENI

PRADAXA

PULMICORT FLEXHALER

OSMOLEX ER

pramipexole dihydrochloride

QBRELIS

OSPHENA

pramipexole dihydrochloride er

quinapril/hydrochlorothiazide tab

oxybutynin chloride

prasugrel

QTERN

oxybutynin chloride er

pravastatin sodium

QUARTETTE

OXYTROL

prazosin hydrochloride

QUESTRAN

QUESTRAN LIGHT

sevelamer carbonate

SYMBICORT

quinapril hydrochloride

sf 5000 plus

SYMLINPEN

quinidine gluconate cr

sharobel

SYNJARDY

quinidine gluconate er

silodosin

SYNJARDY XR

QUINIDINE SU TAB 200MG

SIMBRINZA

tafluprost

QUINIDINE SU TAB 300MG

simliya

tamsulosin hydrochloride

QVAR REDIHALER

simpesse

tarina 24 fe

rabeprazole sodium

simvastatin

tarina fe 1/20

RABEPRAZOLE SODIUM DR SPRINKLE

SINEMET

tarina fe 1/20 eq

raloxifene hydrochloride

SINGULAIR

TARKA

ramipril

SLYND

TASMAR

RANEXA

SOAANZ

taysofy

ranolazine er

sodium fluoride chw

TAYTULLA

RAPAFLO

sodium fluoride dro 0.5mg/ml

taztia xt

rasagiline mesylate

sodium fluoride sol 0.2%mint

TEKTURNA

RAYALDEE

SODIUM FLUORIDE TAB 0.5MG F

TEKTURNA HCT

reclipsen

SODIUM FLUORIDE TAB 1MG F

telmisartan

RELTONE

sodium fluor gel 1.1%

telmisartan/amlodipine

RENAGEL

sodium fluoride 1.1

telmisartan/hydrochlorothiazide

RENVELA

sodium fluoride 5000 plus

TENORETIC

repaglinide

sodium fluoride 5000 ppm

TENORMIN

RESTASIS

sodium fluoride 5000 ppm dry mouth

terazosin hydrochloride

RESTASIS MULTIDOSE

solia

THEO-24

RHOPRESSA

solifenacin succinate

theophylline

RIOMET

sorine

theophylline cr

risedronate sodium

sotalol hydrochloride

THEOPHYLLINE TAB ER

risedronate sodium dr

sotalol hydrochloride af

tiadylt er

rivelsa

SOTYLIZE

TIAZAC

ROCALTROL

SPIRIVA HANDIHALER

TIKOSYN

ROCKLATAN

SPIRIVA RESPIMAT

tilia fe

roflumilast

spironolactone

timolol maleate

ropinirole er

spironolactone/hydrochlorothiazide

timolol maleate in ocudose

ropinirole hydrochloride

sprintec 28

timolol maleate ophthalmic gel forming

rosuvastatin calcium

sronyx

TIMOPTIC

ROSZET

STALEVO

TIMOPTIC OCUDOSE

RYTARY

STARLIX

TIMOPTIC-XE

RYTHMOL SR

STEGLATRO

TOLBUTAMIDE

SAFYRAL

STEGLUJAN

tolcapone

SALAGEN

STIOLTO RESPIMAT

tolterodine tartrate

SAVAYSA

STRIVERDI RESPIMAT

tolterodine tartrate er

SEASONIQUE

SULAR

TOPROL XL

SEGLUROMET

sulfasalazine

torsemide

selegiline hydrochloride

syeda

TOVIAZ

SEREVENT DISKUS

SYMAX DUOTAB

TRADJENTA

setlakin

symax-sl

trandolapril

SEVELAMER

symax-sr

TRANDOLAPRIL/VERAPAMIL HYDROCHLORIDE ER

TRAVATAN Z

ULORIC

vyfemla

travoprost

UROXATRAL

vylibra

TRELEGY ELLIPTA

URSO 250

VYTORIN

tri femynor

URSO FORTE

VYZULTA

tri-estarylla

URSODIOL CAP

WELCHOL

tri-legest fe

ursodiol cap

wera

tri-linyah

ursodiol tab

wixela inhub

tri-lo-estarylla

UTIBRON NEOHALER

wymzya fe

tri-lo-marzia

VAGIFEM

XADAGO

tri-lo-mili

valsartan

XALATAN

tri-lo-sprintec

valsartan/hydrochlorothiazide

XARELTO

tri-mili

VASCEPA

XELPROS

tri-nymyo

VASERETIC

XIGDUO XR

tri-previfem

VASOTEC

XIIDRA

tri-sprintec

VELIVET

xulane

tri-vylibra

VELPHORO

YASMIN 28

tri-vylibra lo

VELTASSA

YAZ

triamterene

VERAPAMIL CAP ER

YOSPRALA

triamterene/

hydrochlorothiazide

verapamil cap er

YUPELRI

TRIBENZOR

verapamil tab er

yuvafem

TRICOR

verapamil tab sr

zafemy

TRIHEXYPHEN SOL
0.4MG/ML

verapamil hydrochloride

zafirlukast

trihexyphenidyl
hydrochloride

verapamil hydrochloride cr

zarah

TRIJARDY XR

verapamil hydrochloride sa

ZELAPAR

TRILIPIX

verapamil hydrochloride tab er 240 mg

ZEMPLAR

TRILIPIX

verapamil hydrochloride

ZENPEP

trinessa

VERELAN

ZESTORETIC

trivora-28

VERELAN PM

ZESTRIL

trospium chloride

VERQUVO

ZETIA

trospium chloride er

VESICARE

ZIAC

TRULANCE

VESICARE LS

ZIOPTAN

TRUSOPT

vestura

ZOCOR

TUDORZA PRESSAIR

vienva

ZONTIVITY

tulana

VIOKACE

zovia 1/35

TWIRLA

viorele

zumandimine

TWYNSTA

vitamin d

ZYLOPRIM

TYBLUME

VIVELLE-DOT

ZYPITAMAG

tydemy

volnea