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) |
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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 |
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 |
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 |
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 |
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 |
verapamil hydrochloride |
zafirlukast |
trihexyphenidyl |
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 |
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