October 2015 COMMONLY PRESCRIBED …

1 October 2015. COMMONLY PRESCRIBED PREFERRED DRUGS. This list is a sample of COMMONLY PRESCRIBED generic and preferred brand drugs for groups currently using the 2015 Standard Drug List or the 2015 Generics Plus Drug List. Refer to the Blue Cross and Blue Shield of Texas prescription drug lists (also known as a formulary) at for a more comprehensive and up-to-date list. The online drug list is updated quarterly. The drug list may contain medications not covered under your prescription drug benefit plan. In addition, prescription versions of over-the-counter (OTC) medications may not be covered based on your prescription drug benefit plan.

2 If you have questions about your prescription drug benefit, call the Customer Service number on the back of your ID card. Generic drugs are shown in lower-case type. Preferred brand drugs are shown in all CAPITAL LETTERS. ANTIHYPERTENSIVES PROPRANOLOL SOLN CHOLESTEROL. propranolol tabs Angiotensin Converting Enzyme (ACE) TIMOLOL TABS atorvastatin Inhibitors and Combinations cholestyramine Calcium Channel Blockers and choline fenofibrate delayed-release Combinations colestipol benazepril benazepril/hydrochlorothiazide CRESTOR. captopril amlodipine fenofibrate enalapril amlodipine/atorvastatin fenofibrate micronized enalapril/hydrochlorothiazide amlodipine/benazepril fenofibric acid delayed-release fosinopril amlodipine/valsartan gemfibrozil fosinopril/hydrochlorothiazide amlodipine/valsartan/hydrochlorothiazide lovastatin lisinopril diltiazem niacin ext-release lisinopril/hydrochlorothiazide diltiazem ext-release pravastatin moexipril felodipine ext-release simvastatin moexipril/hydrochlorothiazide nifedipine ext-release WELCHOL.

3 Perindopril verapamil 80 mg, 120 mg quinapril verapamil ext-release quinapril/hydrochlorothiazide DEPRESSION. ramipril trandolapril ASTHMA / COPD amitriptyline bupropion Angiotensin II Receptor Antagonist ADVAIR DISKUS bupropion ext-release (ARBs) and Combinations ADVAIR HFA citalopram albuterol mg/3mL, mg/3mL clomipramine BENICAR albuterol inhal soln, , desipramine BENICAR HCT albuterol syrup, tabs doxepin candesartan ANORO ELLIPTA duloxetine delayed-release candesartan/hydrochlorothiazide ARNUTIY ELLIPTA escitalopram irbesartan ASMANEX fluoxetine irbesartan/hydrochlorothiazide ATROVENT HFA fluvoxamine losartan BREO ELLIPTA imipramine losartan/hydrochlorothiazide budesonide mirtazapine telmisartan COMBIVENT RESPIMAT nortriptyline caps telmisartan/hydrochlorothiazide cromolyn inhal soln paroxetine valsartan DULERA paroxetine ext-release valsartan/hydrochlorothiazide FLOVENT DISKUS phenelzine FLOVENT HFA sertraline Beta Blockers and Combinations FORADIL AEROLIZER tranylcypromine

4 INCRUSE ELLIPTA trazadone ipratropium inhal soln venlafaxine acebutolol ipratropium/albuterol venlafaxine ext-release caps atenolol levalbuterol venlafaxine ext-release tabs, mg, 75 mg, atenolol/chlorthalidone montelukast 150 mg bisoprolol PROAIR HFA. bisoprolol/hydrochlorothiazide PROAIR RESPICLICK. carvedilol QVAR. INNOPRAN XL. SPIRIVA. labetolol SYMBICORT. metoprolol succinate ext-release terbutaline metoprolol tartrate theophylline ext-release nadolol VENTOLIN HFA. pindolol zafirlukast (over). propranolol ext-release Drug trademarks and servicemarks are the property of their respective third-party owners.

5 A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association October 2015. COMMONLY PRESCRIBED PREFERRED DRUGS. DIABETES. acarbose BAYER TEST STRIPS. BYDUREON. glimepiride glipizide glipizide ext-release glipizide/metformin GLUCAGON EMERGENCY KIT. glyburide glyburide/metformin glyburide, micronized INVOKAMET. INVOKANA. JANUMET. JANUMET XR. JANUVIA. JARDIANCE. KOMBIGLYZE XR. LANTUS. LEVEMIR. metformin metformin ext-release metformin ext-release OSM. nateglinide NOVOLIN 70/30. NOVOLIN N. NOVOLIN R. NOVOLOG.

6 NOVOLOG MIX 70/30. ONGLYZA. pioglitazone pioglitazone/metformin repaglinide ROCHE TEST STRIPS. TOUJEO SOLOSTAR. VICTOZA. Drug trademarks and servicemarks are the property of their respective third-party owners. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Associatio