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High Deductible Health Plan (HDHP) - Health Savings Account (HSA) CARDIOVASCULAR
ANTIHYPERLIPIDEMICS
ORAL DIABETES
CONDITIONS – OTHER
ANTIARRHYTHMIC
ORAL ANTIANGINAL
COMBINATION
ANTIHYPERLIPIDEMICS
DIABETES
TRANSDERMAL/TOPICAL
DIAGNOSTIC AGENTS
ANTIANGINAL AGENTS
HYPERTENSION
CORONARY ARTERY
INJECTABLE DIABETES
INHIBITORS/ANGIOTENSI
ANTIHYPERLIPIDEMICS
RECEPTOR
ANTAGONISTS
ANTARA Some strengths or dosage forms may not be included in the Preventive Drug List. Please note: This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics. If you choose a brand name alternative when a less expensive generic is available, your out of pocket cost may increase. This Preventive Drug List is provided as a courtesy and CVS Caremark makes no representations regarding the suitability for your particular plan. The Preventive Drug List should be modified as necessary or desired by the plan sponsor with the advice of counsel, if appropriate High Deductible Health Plan (HDHP) - Health Savings Account (HSA) BETA-BLOCKERS
CALCIUM CHANNEL
INHIBITORS/ANGIOTENSI
BLOCKERS
RECEPTOR
ANTAGONISTS
DIURETICS
spironolactone/hydrochlorothiazide ANTIHYPERTENSIVE
AGENTS-OTHER
CALCIUM CHANNEL
BLOCKERS
OSTEOPOROSIS
ACE INHIBITOR/CALCIUM
CHANNEL BLOCKER
COMBINATIONS
BETA-BLOCKERS
Some strengths or dosage forms may not be included in the Preventive Drug List. Please note: This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics. If you choose a brand name alternative when a less expensive generic is available, your out of pocket cost may increase. This Preventive Drug List is provided as a courtesy and CVS Caremark makes no representations regarding the suitability for your particular plan. The Preventive Drug List should be modified as necessary or desired by the plan sponsor with the advice of counsel, if appropriate High Deductible Health Plan (HDHP) - Health Savings Account (HSA) IMMUNIZING AGENTS
WOMEN'S HEALTH
CONTINUOUS-CYCLE PILLS
CONTRACEPTIVES
PROGESTIN-ONLY PILLS
RESPIRATORY

LOW-DOSE MONOPHASIC PILLS
DISORDERS
EMERGENCY CONTRACEPTION
TRANSDERMAL PATCH
MISCELLANEOUS CONTRACEPTIVES
HIGH-DOSE MONOPHASIC PILLS
BIPHASIC PILLS
TRIPHASIC PILLS
PRENATAL VITAMINS
ANTICOAGULANTS
ANTICOAGULANTS/PLAT
ELET AGGREGATION
INHIBITORS
FOUR-PHASIC
EXTENDED-CYCLE PILLS
Some strengths or dosage forms may not be included in the Preventive Drug List. Please note: This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics. If you choose a brand name alternative when a less expensive generic is available, your out of pocket cost may increase. This Preventive Drug List is provided as a courtesy and CVS Caremark makes no representations regarding the suitability for your particular plan. The Preventive Drug List should be modified as necessary or desired by the plan sponsor with the advice of counsel, if appropriate

Source: http://www.nrgpowerup.com/Documents/2014/NRG%20Preventive%20Drug%20List%20OCTOBER%202013.pdf