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Preventive medications
In addition to supporting a healthy lifestyle, preventive medications can help people avoid many illnesses and conditions. HDHP options that include preventive medications can help achieve the goal of ongoing good health. For ConocoPhillips participants who enroll in the HDHP option is coverage for certain preventive prescription drugs (treating, for example, high cholesterol, hypertension, and other ailments). For ConocoPhillips participants who enroll in the HDHP option, coverage is provided for certain preventive prescription drugs. Participants will be reimbursed at 100 percent, up to $1,500 per person per year. A more extensive list of the preventive prescription drugs will be available at hr.conocophillips.com under the HDHP Web page for current employees. If you have any questions regarding this benefit, you may also contact Medco Member Services at 1 800 770-2810 or go online to www.medco.com.
This list provides examples of the HDHP medical option’s preventivemedications by drug category. This is not an all-inclusive list. Medicationsmay be added to or removed from the list depending on different factors,including the intended purpose(s) of the medication and medicationavailability.
Some of the prescription drugs on this list are considered alwayspreventive while others are considered sometimes preventive but mayalso be prescribed for the treatment of an existing condition. The $1,500preventive prescription drug allowance that ConocoPhillips provides isapplicable only to medications that are prescribed for prevention and notfor treating a diagnosed condition. Please call Medco to confirm thatyour medication is on the preventive medication list. Medications on this list that are not covered under your plan are not eligible for the preventive medications program. Preventive medications list This list includes both medications used always for prevention and medications used sometimes for prevention and sometimes for treatment. Drug category Examples of products Anticoagulants/
• aspirin/dipyridamole (Aggrenox ®)
antiplatelets
• warfarin (Coumadin ®, Jantoven ®)
Antiemetics/ antivertigo agents
• ondansetron (Zofran ®, Zofran ODT ®)
• prochlorperazine (Compazine ®)
• scopolamine (Transderm Scop ®; Scopace ®)
Antiestrogens Antihypertensives
• ACE inhibitors: benazepril (Lotensin ®);
benazepril-HCTZ (Lotensin HCT ®); captopril(Capoten ®); captopril-HCTZ (Capozide ®);enalapril (Vasotec ®); enalapril-HCTZ (Vaseretic ®); fosinopril (Monopril ®); fosinopril-HCTZ (Monopril-HCT ®); lisinopril(Prinivil ®, Zestril ®); lisinopril-HCTZ (Prinzide ®,Zestoretic ®); moexipril (Univasc ®); moexipril-HCTZ (Uniretic ®); perindopril (Aceon ®); quinapril (Accupril ®); quinapril-HCTZ(Accuretic ®); ramipril (Altace ®); trandolapril(Mavik ®)
Drug category Examples of products Antihypertensives
• Angiotensin II receptor blockers: eprosartan
(continued)
(Teveten ®); eprosartan-HCTZ (Teveten HCT ®);losartan (Cozaar ®); losartan-HCTZ (Hyzaar ®);telmisartan (Micardis ®); telmisartan-HCTZ(Micardis HCT ®); valsartan (Diovan ®); valsartan-HCTZ (Diovan HCT ®)
• Beta blockers: acebutolol (Sectral ®);
atenolol (Tenormin ®); atenolol-chlorthalidone (Tenoretic ®); betaxolol(Kerlone ®); bisoprolol (Zebeta ®); bisoprolol-HCTZ (Ziac ®); carteolol (Cartrol ®);labetalol (Normodyne ®, Trandate ®);metoprolol (Lopressor ®, Toprol-XL ®);metoprolol-HCTZ (Lopressor HCT ®,Dutoprol™); nadolol (Corgard ®); nadolol-bendroflumethiazide (Corzide ®);penbutolol (Levatol ®); pindolol (Visken ®);propranolol (Inderal ®, Inderal ® LA, InnoPran XL ®); timolol (Blocadren ®); timolol-HCTZ (Timolide ®)
(Norvasc ®); bepridil (Vascor ®); diltiazem(Cardizem ®, Cardizem ® CD, Cardizem ® SR,Cartia XT ®, Tiazac ®); felodipine (Plendil ®);isradipine (DynaCirc ®, DynaCirc CR ®);nicardipine (Cardene ®, Cardene ® SR);nifedipine (Adalat ®, Adalat ® CC, Procardia ®, Procardia XL ®); nisoldipine(Sular ®); verapamil (Calan ®, Calan ® SR,Covera-HS ®, Isoptin SR ®, Verelan ®, Verelan PM ®)
• Miscellaneous antihypertensives: aliskiren
(Tekturna ®); carvedilol (Coreg ®, Coreg CR ®); clonidine (Catapres ®); clonidine-chlorthalidone (Combipres ®, Clorpres ®);doxazosin (Cardura ®); enalapril-felodipine(Lexxel ®); hydralazine (Apresoline ®);methyldopa (Aldomet ®);
Drug category Examples of products Antihypertensives
methyldopa-chlorothiazide (Aldoclor ®);
(continued)
methyldopa-HCTZ (Aldoril ®); prazosin(Minipress ®);prazosin-polythiazide (Minizide ®); trandolapril-verapamil (Tarka ®); amlodipine/benazepril (Lotrel ®);amlodipine/valsartan (Exforge ®);
• Thiazide diuretics and related diuretics:
amiloride (Midamor ®); amiloride-HCTZ(Moduretic ®); eplerenone (Inspra ®);hydrochlorothiazide (HydroDIURIL ®, Esidrix ®); indapamide (Lozol ®); metolazone(Zaroxolyn ®); spironolactone (Aldactone ®);spironolactone-HCTZ (Aldactazide ®);terazosin (Hytrin ®); triamterene (Dyrenium ®); triamterene-HCTZ (Dyazide ®, Maxzide ®)
Anti-infectives
• pentamidine (NebuPent ®, Pentam ®)
Antimalarials
• atovaquone/proguanil (Malarone ®)
• hydroxychloroquine (Plaquenil ®)
• pyrimethamine-sulfadoxine (Fansidar ®)
Anti-ulcer agents
• H2-antagonists: cimetidine (Tagamet ®);
famotidine (Pepcid ®); nizatidine (Axid ®);ranitidine (Zantac ®)
(Cytotec ®); sucralfate (Carafate ®)
(Nexium ®); omeprazole (Prilosec ®)
Drug category Examples of products Antivirals
• acyclovir tablets (Zovirax ®)
Asthma therapies Bowel evacuant
• polyethylene glycaol 3350 combination
products
products (Colyte®, GoLYTELY®, HalfLytely®,NuLYTELY®, TriLyte®, MoviPrep®
• sodium phoshate salts (Visicol®, Osmoprep®)
replacement products Cancer (adjunctive
• dexrazoxane (Zinecard ®, Totect ™)
• epoetin alfa (Epogen ®, Procrit ®)
Cholesterol-
• atorvastatin/amlodipine (Caduet ®)
lowering agents
• cholestyramine (LoCholest ®; Prevalite ®;Questran ®; Questran ® Light)
Drug category Examples of products Cholesterol- lowering agents
• ezetimibe/simvastatin (Vytorin ®)
(continued)
• fenofibrate (Antara ®, Lofibra ®, TriCor ®)
• HMG-coA reductase inhibitors: atorvastatin
(Lipitor ®); fluvastatin (Lescol ®, Lescol ® XL); Lovastatin (Mevacor ®, Altocor ®); pravastatin (Pravachol ®); rosuvastatin(Crestor ®); simvastatin (Zocor ®)
• niacin (Niacor ®, Niaspan ®); niacin/lovastatin
• omega-3-acid ethyl esters (Omacor ®)• Trilipix®
Contraceptives,
• intravaginal system (NuvaRing ®)
non-oral
• transdermal system (Ortho Evra ®)
Contraceptives,
• Estrostep Fe ®• Lybrel ®• Ortho Tri-Cyclen ®• Ortho Tri-Cyclen ® Lo• Ovcon ®• Seasonale ®• TriNessa ®• Trivora ®• Yasmin ®• Seasonique ®• YAZ ®
Dental aids
• minocycline (Arestin ®)• tetracycline (Actisite ®)
Estrogen
• conjugated estrogens, tablets (Premarin ®)
replacement
• esterified estrogens/methyltestosterone
products
(Estratest ®, Estratest ® H.S., Syntest™ DS,Syntest™ HS)
Drug category Examples of products Estrogen
• estradiol (Alora ®, Climara ®, Esclim ®, replacement Estrace ® tablets, Estraderm ®, Vivelle ®)
products
• estradiol gel (Estrogel ®, Elestrin™, Divigel ®)
(continued)
• estradiol acetate (Femtrace ®, Femring ®)• estradiol/levonorgestrel (Climara Pro ®)• estradiol/norethindrone (Activella ®,
• estradiol/norgestimate (Ortho-Prefest ®)• estrogen/medroxyprogesterone
• ethinyl estradiol/norethindrone (Femhrt ®)• synthetic conjugated estrogens, A
Fluoride preparations, oral and topical Heparin/low molecular weight heparin products
• low-molecular-weight heparin: dalteparin
(Fragmin ®); enoxaparin (Lovenox ®);fondaparinux (Arixtra ®); tinzaparin (Innohep ®)
Iron replacement (prescription only) Drug category Examples of products Magnesium replacement products (prescription only) Miscellaneous
• hepatitis B immune globulin (HepaGam B™)
Osteoporosis
alendronate/cholecalciferol (Fosamax Plus D™)
• calcitonin (Fortical ®, Miacalcin ®)
Phosphate/ potassium replacement
• potassium chloride (K-Dur ®, K-Tab ®,products Klotrix ®, Klor-Con ®, Slow-K ®)
• potassium gluconate• potassium phosphate (Neutra-Phos ® K)• potassium and sodium phosphate
(K-Phos ® Neutral, Neutra-Phos ®)
Prenatal vitamins
• Natachew ®• Natafort ®• Natelle ®• PreCare ®• Prenatal Plus ®, Prenatal RX™• PrimaCare ®• Vitafol-OB™
Prescription vitamins
• multivitamin w/fluoride• Strovite Advance ®, Strovite Plus ®• Theragran ®• Therobec™, Therobec Plus™
Drug category Examples of products Progestins
• medroxyprogesterone (Amen ®, Cycrin ®,Depo-Provera ®, Provera ®)
• progesterone, micronized (Crinone ®,Prochieve ®, Prometrium ®)
Renal disease Smoking-cessation products
• nicotine products (Nicotrol® Inhaler,
(prescription only) Vitamin A products Vitamin B products Vitamin B1 products Vitamin B6 products Vitamin B12 products
• cyanocobalamin/folic acid (Foltrate®)
Vitamin D products
• dihydrotachysterol (DHT™, Hytakerol ®)
Vitamin K products Vitamins with folic acid Drug category Examples of products Weight-loss agents (Prior authorization may be required)
• phendimetrazine (Bontril® PDM, Bontril®Slow-Release, Melfiat®-105, Prelu-2 ®)
• phendimetrazine (Adipex-P®, Ionamin ®)
Zinc replacement products
Abbreviations: HCTZ = hydrochlorothiazide
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Medco Health Solutions, Inc., manages your prescription drug benefit for your employer or health plan. www.medco.com Medco is a registered trademark of Medco Health Solutions, Inc. All other trademarks are the property of their respective owners. 2010 Medco Health Solutions, Inc. All rights reserved.
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