2022 preventive drug list
TRANSCRIPT
In addition to a healthy lifestyle, preventive prescription drugs are important in helping people avoid many types of illnesses and complications from illnesses. This book contains a list of the most commonly prescribed preventive prescription drugs. It does not include all conditions that may be prevented with prescription drugs. The prescription drugs listed here serve to maintain a person’s health status and help them avoid acute complications. This list is not all-inclusive and is subject to change.
Important facts about this benefit
• Quantity limits, step therapy, prior authorizations and other coverage limitations may apply on select products. Please refer to the formulary for the most current limitations.
• Quantities are limited to a maximum 3-month supply per fill.
• Tier 3 medications listed in the Security Health Plan Formulary are not routinely placed on the preventive list.
• If a generic equivalent product is available, the originator brand medication will not be covered (Example: simvastatin is covered, ZOCOR is not).
• This list is updated annually on a calendar year basis.
The covered preventive drugs are divided into medication categories. Drugs are considered preventive by Security Health Plan when taken by a person who has developed risk factors for a disease that has not yet become clinically apparent (e.g., blood pressure or cholesterol drugs to prevent heart attack or stroke). Taking these medications as directed by your prescriber can help avoid serious health problems.
Note: Please refer to your plan documents for specific information on the coverage of preventive medications.
You can view your Summary of Benefits and Certificate of Coverage or Policy online when you log in to your My Security Health Plan account. If you don’t have an account go to
www.securityhealth.org/registration.
Advair® Diskus Ipratropium 0.02% solution
Advair® HFA inhaler Levalbuterol nebules
Albuterol HFA inhaler Metaproterenol syrup
Albuterol nebules Montelukast granules
Albuterol Sulfate ER tablet Montelukast tablet
Albuterol Sulfate tablet Montelukast chewable tablet
Albuterol syrup QVAR® RediHaler
Anoro® Ellipta inhaler Serevent® Diskus
Arnuity® Ellipta inhaler Spiriva® Handihaler
Breo® Ellipta Inhaler Spiriva® Respimat inhaler
Breztri® HFA Inhaler Stiolto® Respimat inhaler
Budesonide suspension Striverdi® Inhaler
Combivent® Respimat inhaler Symbicort® HFA inhaler
Cromolyn nebules Terbutaline tablet
Flovent® Diskus Theophylline elixir
Flovent® HFA inhaler Theophylline ER tablet
Fluticasone‐Salmeterol inhaler (generic Airduo®) Theophylline tablet
Ipratroprium‐Albuterol nebules Trelegy® Ellipta inhaler
Zafirlukast tablet
Aspirin‐Dipyridamole ER capsule Eliquis® tablet
Brilinta® tablet Jantoven® tablet
Cilostazol tablet Prasugrel tablet
Clopidogrel tablet Warfarin tablet
Dipyridamole tablet Xarelto® tablet
Diabetic List:
Acarbose tablet Metformin tablet
Bydureon® injection Metformin ER tablet
Byetta® injection Nateglinide tablet
Farxiga® tablet Ozempic® injection
Glimepiride tablet Pioglitazone‐Glimepiride tablet
Glipizide tablet Pioglitazone tablet
Glipizide ER tablet Repaglinide tablet
Glipizide XL tablet Repaglinide‐Metformin tablet
Glipizide‐Metformin tablet Synjardy® tablet
Janumet® tablet Synjardy® XR tablet
Janumet® XR tablet Tolbutamide tablet
Januvia® tablet Tradjenta® tablet
Jardiance® tablet Trulicity® injection
Jentadueto® tablet Victoza® injection
Jentadueto® XR tablet Xigduo® XR tablet
Diabetes drugs and supplies
Prevention of complications related to high blood sugar
Preventive Drug ListAsthma and chronic obstructive pulmonary disease (COPD) drugs
Prevention of an asthma or COPD episode
Blood thinners
Prevention of stroke, blood clot or repeat heart attack
Diabetic Supply List
Alcohol prep pads Glucagon® emergency kit
Batteries Gvoke® Hypopen
Baqsimi® Nasal Spray Gvoke® Syringe
Chemstrips Insulin needles
Dexcom® G6 Insulin syringes
Diastix® (urine glucose test strips) Keto‐Diastix® (urine glucose‐acet test strip)
FreeStyle® control solution Lancets
FreeStyle® Freedom Lite meter Medisense Glucose & Ketone Control Solution
FreeStyle® Libre reader Novopen® Echo
FreeStyle® Libre sensors Novolog® Inpen
Freestyle® Libre 2 reader Pen Needles
Freestyle® Libre 2 sensors Precision® Neo meter
FreeStyle® Lite Meter Precision® Neo test strips
FreeStyle® Lite test strips Precision® Xtra beta ketone test strips
FreeStyle® Optium ketone strips Precision® Xtra meter
FreeStyle® test strips Precision® Xtra test strips
Trueplus® Ketone test strips
Insulin List
Fiasp® Novolin® N Flexpen
Fiasp® Flextouch Novolin® R
Fiasp® Penfill Novolin® R Flexpen
Humulin® R U‐500 Novolog®
Humulin® R U‐500 Kwikpen Novolog® Flexpen
Lantus® Novolog® Mix 70‐30
Lantus® Solostar Novolog® Mix 70‐30 Flexpen
Novolin® 70‐30 Toujeo® Max Solostar
Novolin® 70‐30 Flexpen Toujeo® Solostar
Novolin® N
Amiodarone tablet Isosorbide mononitrate tablet
Digoxin tablet Mexilitine capsule
Digoxin oral solution Nitroglycerin sublingual tablet
Disopyramide capsule Propafenone tablet
Dofetilide capsule Quinidine tablet
Flecainide tablet Sotalol AF tablet
Isosorbide Dinitrate tablet Sotalol tablet
Acetazolamide tablet Atenolol‐Chlorthalidone tablet
Acebutolol capsule Benazepril tablet
Amiloride tablet Benazepril‐HCTZ tablet
Amiloride‐HCTZ tablet Betaxolol tablet
Amlodipine tablet Bisoprolol tablet
Amlodipine ‐Valsartan tablet Bisoprolol‐HCTZ tablet
Amlodipine ‐Valsartan‐HCTZ tablet Bumetanide tablet
Amlodipine‐Benazepril tablet Candesartan tablet
Atenolol tablet Candesartan‐HCTZ tablet
High blood pressure drugs
Prevention of stroke, complications due to high blood pressure and reoccurrence of heart attack
Heart disease drugs
Prevention of heart disease
Diabetes drugs and supplies (continued)
Prevention of complications related to high blood sugar
Captopril tablet Losartan‐HCTZ tablet
Captopril‐HCTZ tablet Methyclothiazide tablet
Cartia® XT capsule Methyldopa tablet
Carvedilol tablet Metolazone tablet
Chlorothiazide tablet Metoprolol Succinate ER tablet
Chlorthalidone tablet Metoprolol Tartrate tablet
Clonidine tablet Metoprolol‐HCTZ tablet
Clonidine Transderm Patch Minoxidil tablet
Dilt® XR capsule Moexipril tablet
Diltiazem 12Hr ER capsule Nadolol tablet
Diltiazem 24Hr CD capsule Nifedipine ER tablet
Diltiazem 24Hr ER capsule Olmesartan tablet
Diltiazem ER capsule Olmesartan/HCTZ tablet
Diltiazem tablet Perindopril tablet
Doxazosin capsule Pindolol tablet
Enalapril tablet Prazosin capsule
Enalapril‐HCTZ tablet Propranolol tablet
Epaned oral solution Irbesartan tablet
Eplerenone tablet Propranolol ER capsule
Eprosartan tablet Propranolol‐HCTZ tablet
Ethacrynic Acid tablet Quinapril tablet
Felodipine ER tablet Quinapril‐HCTZ tablet
Fosinopril tablet Ramipril capsule
Fosinopril‐HCTZ tablet Spironolactone tablet
Furosemide solution Spironolactone‐HCTZ tablet
Furosemide tablet Telmisartan tablet
Guanfacine tablet Telmisartan‐HCTZ tablet
Hydralazine tablet Terazosin capsule
Hydrochlorothiazide capsule Timolol tablet
Hydrochlorothiazide tablet Torsemide tablet
Indapamide tablet Trandolapril tablet
Irbesartan‐HCTZ tablet Trandolapril ‐Verapamil ER tablet
Isradipine capsule Triamterene‐HCTZ capsule
Katerzia® suspension Triamterene‐HCTZ tablet
Labetalol tablet Valsartan tablet
Lisinopril tablet Valsartan‐HCTZ tablet
Lisinopril‐HCTZ tablet Verapamil tablet
Losartan tablet Verapamil ER tablet
Atorvastatin tablet Fenofibric Acid DR capsule
Cholestyramine for oral suspension Fluvastatin capsule
Cholestyramine Light for oral suspension Gemfibrozil tablet
Colestipol tablet Lovastatin tablet
Colestipol packet Niacin ER tablet
Colestipol granules Pravastatin tablet
Colestipol tablet Praluent® injection
Ezetimibe tablet Repatha® injection
Fenofibrate (54mg, 160mg) tablet Rosuvastatin tablet
Fenofibric Acid tablet Simvastatin tablet
Vascepa® capsule
High cholesterol drugs
High cholesterol drugs (prevention of heart disease)
High blood pressure drugs (continued)
Prevention of stroke, complications due to high blood pressure and reoccurrence of heart attack
Citalopram tablet Fluoxetine solution
Citalopram solution Paroxetine tablet (10, 20, 30 40 mg)
Escitalopram tablet Sertraline tablet
Escitalopram solution Sertraline solution
Fluoxetine capsule (10, 20, 40 mg)
Alendronate tablet Raloxifene tablet
Calcitonin (Salmon) Nasal spray Risedronate tablet
Ibandronate tablet
Prenatal vitamin tablets (generic versions only) Prenatal vitamin capsules (generic versions only)
Prenatal vitamins
Prevention of birth defects
Osteoporosis (bone disease) drugs
Prevention of bone fractures
Mental health drugs
Prevention of symptoms of anxiety, depression or other mood disorders
19902-007
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