Skip the deductible - Aetna

1 skip the deductibleReduce your out-of-pocket costs forthe medicine you need 2018 Chronic Medicine H (7/17)2 Receive medicine for chronic conditions without first having tomeet your deductible Chronic medicine treats ongoing conditions such as high blood pressure, high cholesterol,diabetes, asthma or depression. Your plan includes a special feature that can help you manage the cost of the medicine you need. We understand how important it is to take the medicine your doctor prescribes. The Aetna chronic medications feature makes it easier for you to do that. Health benefits and health insurance plans are offered, administered and/or underwritten by Aetna Health Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company Aetna HealthAssurance Pennsylvania Inc. and/or Aetna Life Insurance Company ( Aetna ). In Florida, by Aetna Health Inc. and/or Aetna Life Insurance Company.

2 In Utah and Wyoming by Aetna Health of Utah Inc. and Aetna Life Insurance Company. In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT 06156. Each insurer has sole financial responsibility for its own products. Chronic medications will not be applied to your deductible . Your only cost will be your copayment or coinsurance. Category Generic medicine Brand-name medicine Antihypertensive medicine (high blood pressure) Angiotensin-converting enzyme(ACE) inhibitors/ combinations benazepril benazepril/ hydrochlorothiazide (HCTZ) captopril captopril/HCTZ enalapril enalapril/HCTZ fosinopril fosinopril/HCTZ lisinopril lisinopril/HCTZ moexipril moexipril/HCTZ perindopril quinapril quinapril/HCTZ ramipril trandolapril trandolapril/ verapamil ACCUPRIL ACCURETIC ACEON ALTACE EPANED LOTENSIN LOTENSIN HCT MAVIK PRINIVIL PRINZIDE QBRELIS TARK A UNIRETIC UNIVASC VASERETIC VASOTEC ZESTORETIC ZESTRIL Angiotensin II receptor antagonists/renininhibitor combinations amlodipine/ olmesartan amlodipine/valsartanamlodipine/ valsartan/HCTZ candesartan candesartan/HCTZ eprosartan irbesartan irbesartan/HCTZ losartan losartan/HCTZ olmesartan olmesartan/HCTZ olmesartan/ amlodipine/HCTZ telmisartan telmisartan/HCTZ valsartan valsartan/HCTZ ATAC AND ATAC AND HC T AVALIDE AVAPRO A ZOR BENICAR BENICAR HCT COZ A AR DIOVAN DIOVAN HC T EDARBI EDARBYCLOR EXFORGE EXFORGE HCT HYZAAR MICARDIS MICARDIS

3 HCT TEKTURNA TEKTURNA HCT TRIBENZOR T W YNS TA VALTURNA Alpha-adrenergic/ beta-adrenergic blockers acebutolol atenolol atenolol/chlorthalidone betaxolol bisoprolol bisoprolol/HCTZ carvedilol doxazosin labetalol metoprolol metoprolol/HCTZ metoprolol ER nadolol nadolol/ bendroflumethiazide prazosin propranolol propranolol ER propranolol/HCTZ pindolol sorine sotalol sotalol AF terazosin timolol BE TAPACE BETAPACE AF BYSTOLIC BY VALSON CARDURA COREG COREG CR CORGARD CORZIDE DUTOPROL INDERAL LA INNOPRAN XL KERLONE LE VATOL LOPRESSOR LOPRESSOR HCT MINIPRESS SECTRAL SOTYLIZE TENORMIN TENORETIC TOPROL XL ZEBE TA ZIAC 3 4 Category Generic medicine Brand-name medicine Calcium channel blockers/ miscellaneous combinations afeditab CR amlodipine amlodipine/benazepril cartia XT diltiazem diltiazem CD/ER/XR dilt-XR ethacrynic acid felodipine ER isradapine matzim LA nicardipine nifedical XL nifedipine nifedipine ER nimodipine nisoldipine nisoldipine ER taztia XT telmisartan/amlodipine verapamil verapamil ER ADALAT CC CALAN CALAN SR CARDENE SR CARDIZEM CARDIZEM CD/LA COVER A-HS LOTREL NORVASC NYMALIZE PRESTALIA PROCARDIA PROCARDIA XL SULAR TIAZAC VERELAN PM Diuretics acetazolamide acetazolamide ER amiloride amiloride/HCTZ bumetanide chlorothiazide chlorthalidone eplerenone ethacrynic acid furosemide HCTZ indapamide methazolamide methyclothiazide metolazone spironolactone spironolactone/HCTZ torsemide triamterene/HCTZ ALDACTAZIDE ALDACTONE BUMEX DEMADEX DIAMOX DIURIL DYAZIDE DYRENIUM EDECRIN INSPRA INTROL KEVEYIS LASIX MAXZIDE MICROZIDE NEPTAZANE ZAROXOLYN Antihypertensive miscellaneous clonidine guanfacine hydralazine methyldopa methyldopa/HCTZ minoxidil C ATAPRES CLORPRES DEMSER DIBENZYLINE NEXICLON XR TENEX VECAMYL

4 Antihyperlipidemia medicine (high cholesterol) HMG-CoA reductase inhibitors (statins)/ miscellaneous amlodipine besylate/ atorvastatin atorvastatin ezetimibe ezetimibe-simvastatin fluvastatin fluvastatin ER lovastatin pravastatin rosuvastatin simvastatin ALTOPRE V CADUET CRESTOR LESCOL XL LIPITOR LIVALO MEVACOR PRAVACHOL TRIGLIDE V Y TORIN ZETIA ZOCOR Miscellaneous Antihyperlipidemics none JUX TAPID KYNAMRO PRALUENT REPATHA Bile acid sequestrants/fibric acids/miscellaneous other antihyperlipidemics cholestyramin colestipol fenofibrate fenofibric fenofibric DR gemfibrozil omega-3 acid niacin ER prevalite ANTARA COLESTID FENOGLIDE FIBRICOR LIPOFEN LOFIBR A LOPID LOVAZA NIACOR NIASPAN QUESTRAN QUESTRAN LITE TRICOR TRIGLIDE TRILIPIX VA SCEPA WELCHOL Category Generic medicine Brand-name medicine Anti-angina isosorbide dinitrate isosorbide dinitrate ER isosorbide mononitrate

5 Isosorbide mononitrate ER minitran nitroglycerin nitroglycerin ER nitroglycerin lingual nitroglycerin transdermal nitro-time DIL ATR ATE-SR IMDUR ISORDIL TITRADOSE NITRO-BID NITRO-DUR NITROLINGUAL pumpspray NITROMIST NITRONAL NITROSTAT RANEXA Cardiac glycosides/ miscellaneous other digoxin LANOXIN Anti-asthmatics (asthma)/COPD albuterol albuterol ER aminophylline budesonide cromolyn sodium fluticasone/salmeterol ipratropium bromide ipratropium bromide/ albuterol levalbuterol HCl levalbuterol tartrate HFA metaproterenol sulfate montelukast sodium terbutaline sulfate theochron theophylline theophylline ER zafirlukast zileuton ER ACCOL ATE ADVAIR DISKUS ADVAIR HFA AEROSPAN AIRDUO RESPICLICK ALVESCO ANORO ELLIPTA ARCAPTA NEOHALER ARNUITY ELLIPTA ASMANEX HFA ASMANEX TWISTHALER ATROVENT HFA BEVESPI AEROSPHERE BREO ELLIPTA BROVANA COMBIVENT RESPIMAT DALIRESP DULERA ELIXOPHYLLIN FLOVENT DISKUS FLOVENT HFA INCRUSE ELLIPTA ISUPREL LUFYLLIN MAXAIR AUTOHALER PERFOROMIST PROAIR HFA PROAIR RESPICLICK PROVENTIL HFA PULMICORT FLEXHALER PULMICORT QVAR SEEBRI NEOHALER SEREVENT DISKUS SINGULAIR SPIRIVA HANDIHALER STIOLTO RESPIMAT STRIVERDI RESPIMAT SYMBICORT THEO-24 TUDORZA PRESSAIR UTIBRON NEOHALER

6 VENTOLIN HFA VOSPIRE ER XOPENEX XOPENEX CONC XOPENEX HFA ZYFLO ZYFLO CR Antidiabetic medicine Insulins none AFREZZA APIDRA APIDRA SOLOSTAR BASAGLAR KWIKPEN HUMALOG products HUMULIN products LANTUS LANTUS SOLOSTAR LEVEMIR LEVEMIR FLEXPEN LEVEMIR FLEXTOUCH NOVOLIN products NOVOLOG products RELION products SOLIQUA TOUJEO SOLOSTAR TRESIBA XULTOPHY Category Generic medicine Brand-name medicine Antidiabetic orals/ injectables acarbose alogliptin alogliptin/metformin alogliptin/pioglitazone chlorpropamide glimepiride glipizide glipizide ER glipizide XL glipizide/metformin HCl glyburide glyburide micronized glyburide/metformin HCl metformin HCl metformin HCl ER miglitol nateglinide pioglitazone HCl pioglitazone HCl/ metformin pioglitazone HCl/ glimepiride repaglinide repaglinide/metformin tolazamide tolbutamide ACTOPLUS MET ACTOPLUS MET XR ACTOS ADLYXIN AMARYL AVANDARYL AVANDIA BYDUREON BYE T TA CYCLOSET DUE TAC T FARXIGA FORTAME T GLUCAGEN HYPOKIT GLUCAGON EMERGENCY KIT GLUCOPHAGE GLUCOPHAGE XR GLUCOTROL GLUCOTROL XL GLUCOVANCE GLUMETZA GLYNASE GLYSE T GLY X AMBI INVOKAMET INVOKANA JANUMET JANUMET XR JANUVIA JARDIANCE JENTADUETO JENTADUETO XR KAZANO KOMBIGLYZE XR KORLYM NESINA ONGLY Z A OSENI PRANDIN PRECOSE PROGLYCEM RIOMET STARLIX SYMLIN SYMLINPEN SYNJARDY TANZEUM TRADJENTA TRULICITY VIC TOZ A XIGDUO XR Diabetic supplies (diabetes)

7 Insulin syringes any generic lancets any generic pen needles any generic BD insulin syringes BD pen needles FREESTYLE glucose test strips FREESTYLE INSULINX glucose test strips FREESTYLE LITE glucose test strips ONETOUCH VERIO glucose test strips ONETOUCH ULTRA glucose test strips PRECISION XTRA glucose test strips PRECISION XTRA ketone test strips ALL OTHER BRANDS glucose test strips ALL OTHER BRANDS insulin syringes ALL OTHER BRANDS lancets ALL OTHER BRANDS pen needles Category Generic medicine Brand-name medicine Antidepressants amitriptyline HCl amoxapine bupropion HCl bupropion HCl ER bupropion HCl XL citalopram clomipramine HCl desipramine HCl desvenlafaxine ER doxepin HCl duloxetine HCl escitalopram fluoxetine DR fluoxetine HCl fluvoxamine fluvoxamine ER imipramine HCl imipramine maprotiline HCl mirtazapine mirtazapine ODT nefazodone HCl nortriptyline HCl paroxetine HCl paroxetine HCl ER phenelzine sulfate protriptyline HCl sertraline HCl tranylcypromine trazodone HCl venlafaxine HCl venlafaxine HCl ER ANAFRANIL APLENZIN BRINTELLIX CELEXA CYMBALTA EFFEXOR XR EL AVIL EMSAM FETZIMA FORFIVO XL IRENKA KHEDEZLA LEXAPRO MARPLAN NARDIL NORPRAMIN PAMELOR PARNATE PA XIL PA X I L- C R PEXEVA PRISTIQ PROZAC PROZAC WEEKLY REMERON REMERON SOLTAB SURMONTIL TOFRANIL TRINTELLIX VIIBRYD VIVACTIL WELLBUTRIN WELLBUTRIN SR WELLBUTRIN XL ZOLOFT Antipsychotics aripiprazole chlorpromazine HCl clozapine clozapine ODT compro

8 Fluphenazine HCl haloperidol lithium carbonate lithium carbonate ER loxapine olanzapine olanzapine/fluoxetine olanzapine ODT paliperidone ER perphenazine prochlorperazine quetiapine risperidone risperidone M-Tab risperidone ODT thioridazine HCl thiothixene trifluoperazine HCl ziprasidone HCl ABILIFY ADASUVE CLOZ ARIL EQUETRO FANAPT FAZACLO GEODON INVEGA L ATUDA LITHOBID NUPLAZID RE XULTI RISPERDAL RISPERDAL M-TAB SAPHRIS SEROQUEL SEROQUEL XR SYMBYA X VERSACLOZ VRAYLAR ZYPREXA ZYPREXA ZYDIS - -- - --Please remember that this is not a complete list of medications covered under your plan. Because there are thousands of medications included in your pharmacy benefit, we only list the most common ones. Certain drugs such as those for smoking cessation or vitamins may not be covered by your particular pharmacy plan. Diabetic supplies may be covered under your medical plan. If you have any questions about your pharmacy benefits, please visit and log in to your member website.

9 If you don t have access to our website, call the toll-free number on your member ID check coverage and copay information for a specific medicine, visit and log in to your member website. For more details, please call the toll-free number on your member ID Pharmacy Management refers to an internal business unit of Aetna Health Management, LLC. This is not an inclusive list. Products that are not represented on this list may be subject to plan-specific copayment or coinsurance. Void where prohibited by law. Void in the State of prescription benefits plan design may not cover certain categories or may be subject to additional charges or restrictions, regardless of their appearance in this document. Aetna may receive rebates, discounts and service fees from pharmaceutical manufacturers for certain listed privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

10 Information is believed to be accurate as of the production date; however, it is subject to change. For questions, please call the toll-free number on your member ID card. Policy forms issued in Oklahoma include: HMO OK COC-5 09/07, HMO/OK GA-3 11/01, HMO OK POS RIDER 08/07, GR-23, GR-29 form issued in Missouri include: AL HGrpPol 01R5, HI HGrpAg 01, HO HGrpPol 2017 Aetna Inc. H (7/17)