Transcription
Preventive medications listIn a high-deductible health plan like Boeing’s Advantage health plan,federal rules permit certain preventive drugs to be paid without beingsubject to the plan’s deductible.For drugs on the preventive drug list, you pay only the generic, brandformulary, or brand non-formulary coinsurance percentage described inyour plan summary.This list is periodically reviewed and updated to ensure that the drugslisted meet the criteria for inclusion. Because this list is subject tochange, please log in to www.express-scripts.com/boeing to check thestatus of the medications you take.Medications must be covered by your plan to be eligible for thepreventive medication program.PDL4833D
The following section lists generic and brand formulary drugs.Aacarboseacebutolol hclacetazolamideADVAIR DISKUSADVAIR HFAafeditab CRAGGRENOXalbuterolalbuterol sulfatealendronate sodiumamantadineamiloride hclamiloride hcl-hctzaminophyllineamlodipine atorvastatinamlodipine besylateamlodipine RCAPTA NEOHALERand eatorvastatinatovaquone/proguanil hclATROVENT HFAAUVI-QAZORBbenazepril hclbenazepril hcl-hctzBENICARBENICAR HCTbetaxolol hclbisoprolol fumaratebisoprolol-hydrochlorothiazideBREO ELLIPTABRILINTAbudesonidebumetanidebuproban SRbupropion SRBYDUREONBYETTABYSTOLICCcandesartan cilexetilcandesartanhydrochlorothiazidecalcitonin, salmoncaptoprilcaptopril-hydrochlorothiazideCARTIA ropamidechlorthalidonecholestyraminecholestyramine holestyramine lightcilostazolSome brand drugs may change to non-formulary status during the year.
The following section lists generic and brand formulary drugs.clonidineclopidogrelCOARTEMcolestipol hclCOMBIVENTCOREG CRCRESTORcromolyn sodiumepinephrine pen injectionEPIPENEPIPEN JR.eplerenoneepoprostenol sodiumetidronateEXFORGEEXFORGE fil-Gdilex-GDILT-CDDILTIA XTdiltiazem CDdiltiazem ERdiltiazem hcldiltiazem SRDILT-XRDILTZAC FAST TAKE TEST STRIPSfelodipine ERfenofibratefenofibrate micronizedfenofibric acidFLUMISTflu vaccinesfluvastatinfolic acidfondaparinux sodiumFORADILFORTICALFORTEOfosinopril sodiumfosinopril-hydrochlorothiazidefurosemideC (continued)EEFFIENTELIQUISenalapril maleateenalapril maleate-hctzenoxaparin sodiumGgemfibrozilglimepirideglipizideglipizide ERglipizide XLglipizide-metforminglucose tabletsGLUCAGON EMERGENCY KITSome brand drugs may change to non-formulary status during the year.
The following section lists generic and brand formulary drugs.G (continued)JUXTAPIDglucose tabletsGLUCAGON EMERGENCY KITglyburideglyburide micronizedglyburide-metformin hclguanabenz acetateguanfacine hclKHheparin sodiumHUMALOGHUMALOG MIX 50/50HUMALOG MIX 75/25HUMULINHUMULIN 70/30HUMULIN Rhydralazinehydrochloroquine sultatehydrochlorothiazideIibandronate sodiumimmune globulinsindapamideipratropium ctzisradipineJjantovenJANUMETJANUMET XRJANUVIAJENTADUETOKOMBIGLYZE XRLlabetalol hclLANTUS SoloSTAR cartridgeLANTUS vialletrozolelevalbuterol AZAMmatzim LAmefloquine hclmetaproterenolmetformin hclmetformin hcl -hydrochlorothiazidemetoprolol succinatemetoprolol tartratemetoprolol SRmetoprolol-hydrochlorothiazideminoxidilmoexipril hclmoexipril-hydrochlorothiazideSome brand drugs may change to non-formulary status during the year.
The following section lists generic and brand formulary drugs.M (continued)montelukast denicardipine hclnifediac ccnifedical XLnifedipine CRnifedipine ERnifedipine SRnimodipinenislodipineprenatal vitamin (generic)prevalitePRIMAQUINEPROAIR HFAPROGLYCEMpropranolol hclpropranolol SRpropranolol hcl w/hctzPULMICORT FLEXHALERQquinapril hclquinapril-hydrochlorothiazidequinine sulfateQVARORONE TOUCH strips and metersONGLYZAraloxiphene hclramaprilRELENZArepaglinidereserpinerimantadine hclrisedronate sodiumRIOMETPpamidronatepapaverinepediatric multi-vit w/fluoridepediatric multi-vit w/fluoride& ironPERFOROMISTperindopril erbuminepindololpioglitazone hclpioglitazone hcl-glimeprimidepioglitazone hcl-metformin hclPNEUMOVAX 23PRADAXAPRANDIMETpravastatin sodiumprazosinSSEREVENTSIMCORsimvastatinsodium fluoridesorinesotalolsotalol AFspironolactoneSPIRIVASome brand drugs may change to non-formulary status during the year.
The following section lists generic and brand formulary drugs.S (continued)spironolactone-hctzSURESTEP TEST ifen citratetaztia xtTEKAMLOTEKTURNATEKTURNA HCTterazosinterbutaline sulfatetheochronticlopidine HCltimolol OLIN HFAverapamil ERverapamil hclVYTORINWwarfarin onic acidZOSTAVAXVvalsartanvalsartan-hctzVALTURNASome brand drugs may change to non-formulary status during the year.
The following section lists non-formulary brand drugs.AACCOLATEACCU-CHEK strips and metersACCUNEBACCUPRILACCURETICACEONACTONELACTOPLUS METACTOPLUS MET XRACTOSADALAT RAAPIDRA SOLOSTARARALEN PHOSPHATEAREDIAARIMIDEXARIXTRAAROMASINASCENTIA strips and metersATACANDATACAND BETAPACE AFBIDILBINOSTROBONIVABREEZE 2 strips and N SRCARDENECARDENE SRCARDIZEMCARDIZEM CDCARDIZEM LACARDURACARDURA XLCATAPRESCATAPRES TTSCLORPRESCOLESTIDCONTOUR STRIPS AND me brand drugs may change to non-formulary status during the year.
The following section lists non-formulary brand drugs.DGDEMADEXDIABETADIAMOXDIDRONELDILACOR XRDIOVANDIOVAN HCTDIURILDUETACTDUONEBDYNACIRC EGLUCOPHAGE XRGLUCOTROLGLUCOTROL ORFLOLANFLOVENT DISKUSFLOVENT HFAFLUMADINEFORTAMETFOSAMAXFOSAMAX PLUS DFRAGMINFREE STYLE TEST STRIPSHHYTRINHYZAARIINDERALINDERAL LAINDERIDEINNOPRAN XLINOHEPINSPRAINTALINTROLIPRIVASKISOPTIN SRJJUVISYNCKKAZANOKERLONESome brand drugs may change to non-formulary status during the year.
The following section lists non-formulary brand drugs.LNLASIXLESCOLLESCOL OR HCTLOTENSINLOTENSIN HCTLOTRELLOVENOXLUFYLLINLUFYLLIN GGNEPTAZANENESINANEXICLON XRNIASPANNICOTROL NSNIMOTOPNORVASCNOVOLINNOVOLOGNOVOLOG MIX 70/30NYMALIZEMMALARONEMAVIKMAXAIR AUTOHALERMAXZIDEMETAGLIPMEVACORMIACALCIN nasal sprayMICARDISMICARDIS IL ANDINPRAVACHOLPRECOSEPRECISION QID strips andmetersPRECISION PCX stripsPRECISION XTRA stripsPRECOSEPRESTIGE SMART strips andmetersPRINIVILPRINZIDEPROCARDIAPROCARDIA XLSome brand drugs may change to non-formulary status during the year.
The following section lists non-formulary brand drugs.PROGLYCEMPROLIAPROVENTIL HFAPULMICORTQQUESTRANQUESTRAN C 100-25TENORETIC 50-25TENORMIN tabletTEVETENTEVETEN HCTTHALITONETHEO-24TIAZACTOPROL XLTRANDATETRIGLIDETRUETRACK strips and TECVENTOLIN HFAVERELANVERELAN PMVERELAN SRVICTOZAVOSPIRE ERXXOLAIRXOPENEXXOPENEX AZYBANZYFLOZYFLO CRSome brand drugs may change to non-formulary status during the year.
Express Scripts manages your prescription benefit for The Boeing Company.All rights in the product names of all third-party products appearing here,whether or not appearing with the trademark symbol, belong exclusively totheir respective owners.PDL4833D 9.14*0000000PDL4833D**0000000PDL4833D*
LANTUS vial letrozole levalbuterol hcl LEVEMIR LIPOFEN LIPTRUZET lisinopril lisinopril-hydrochlorothiazide losartan losartan-hctz lovastatin LOVAZA M matzim LA mefloquine hcl metaproterenol metformin hcl metformin hcl ER metazolamide methyclothiazide methyldopa methyldopa-hydrochlorothiazide
