Performance Drug List For the most up-to-date Performance Drug List visit www.caremark.com
The Caremark Performance Drug List is a guide within select therapeutic categories for clients, plan participants and health care providers. Generics should be considered the first line of prescribing. If there is no generic available, there may be more than one brand-name medicine to treat a condition. These preferred brand-name medicines are listed to help identify products that are clinically appropriate and cost-effective. Generics listed in therapeutic categories are for representational purposes only. This is not an all-inclusive list. This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics. PLAN PARTICIPANT HEALTH CARE PROVIDER
Your benefit plan provides you with a prescription benefit program
Your patient is covered under a prescription benefit plan administered by
administered by Caremark. Ask your doctor to consider prescribing, when
Caremark. As a way to help manage health care costs, authorize generic
medically appropriate, a preferred medicine from this list. Take this list
substitution whenever possible. If you believe a brand-name product is
along when you or a covered family member sees a doctor.
necessary, consider prescribing a brand name on this list.
Please note: Please note:
● Your specific prescription benefit plan design may not cover certain
● Generics should be considered the first line of prescribing.
categories, regardless of their appearance in this document.
● This drug list represents a summary of prescription coverage. It is
● For specific information regarding your prescription benefit coverage
not inclusive and does not guarantee coverage.
and copay1 information, please visit our Web site at www.caremark.com
● The plan participant’s specific prescription benefit plan may have
or contact a Caremark Customer Care representative.
a different copay for specific products on the list.
● Caremark may contact your doctor after receiving your prescription to
● Unless specifically indicated, drug list products will include all
request consideration of a drug list product or generic equivalent. This
may result in your doctor prescribing, when medically appropriate, adifferent brand-name product or generic equivalent in place of your
● Log in to www.caremark.com to check coverage and copay
information for a specific medicine. ANTI-INFECTIVES § MISCELLANEOUS § FIBRATES § ACE INHIBITOR/ CALCIUM CHANNEL ANTIBACTERIALS DIURETIC COMBINATIONS BLOCKER/ANTILIPEMIC COMBINATIONS § CEPHALOSPORINS § HMG-CoA REDUCTASE INHIBITORS § ANTIFUNGALS § DIGITALIS GLYCOSIDES § ERYTHROMYCINS/ MACROLIDES § DIURETICS ANTIVIRALS § ACE INHIBITOR/CALCIUM NIACINS/COMBINATIONS CHANNEL BLOCKERS § HERPES AGENTS § FLUOROQUINOLONES ANGIOTENSIN II § INFLUENZA AGENTS RECEPTOR ANTAGONISTS/ § BETA-BLOCKERS COMBINATIONS CARDIOVASCULAR CENTRAL NERVOUS § ACE INHIBITORS § PENICILLINS ANTIDEPRESSANTS ANTILIPEMICS § MISCELLANEOUS AGENTS § BILE ACID RESINS § CALCIUM CHANNEL § TETRACYCLINES CHOLESTEROL ABSORPTION BLOCKERS INHIBITORS nifedipine ext-relverapamil ext-relYour specific prescription benefit plan design may not cover certain categories, regardless of their appearance in this document. For specific information, visit our Web site at www.caremark.com or contact a Caremark Customer Care representative. § SELECTIVE SEROTONIN INSULINS § TRIPHASIC GENITOURINARY LONG ACTING REUPTAKE INHIBITORS § BENIGN PROSTATIC § EXTENDED CYCLE HYPERPLASIA LEUKOTRIENE RECEPTOR ANTAGONISTS CONTINUOUS NASAL ANTIHISTAMINES INSULIN SENSITIZERS TRANSDERMAL § SEROTONIN § URINARY NOREPINEPHRINE § NASAL STEROIDS INSULIN SENSITIZER/ ANTISPASMODICS REUPTAKE INHIBITORS BIGUANIDE (SNRIs) 3 COMBINATIONS ESTROGENS INSULIN SENSITIZER/ SULFONYLUREA § HYPNOTICS, COMBINATIONS STEROID/BETA AGONISTS NONBENZODIAZEPINES MEGLITINIDES HEMATOLOGIC § TRANSDERMAL, STEROID INHALANTS § SULFONYLUREAS ESTROGENS § ANTICOAGULANTS MIGRAINE SELECTIVE SEROTONIN AGONISTS RESPIRATORY § SULFONYLUREA/ BIGUANIDE § ORAL ESTROGEN/ ANAPHYLAXIS COMBINATIONS PROGESTINS TREATMENT AGENTS DERMATOLOGY MULTIPLE SCLEROSIS SUPPLIES § ANTICHOLINERGICS § PROGESTINS § ANTICHOLINERGIC/ ENDOCRINE AND BETA AGONISTS METABOLIC SELECTIVE ESTROGEN RECEPTOR MODULATORS ANDROGENS CALCIUM REGULATORS OPHTHALMIC § BISPHOSPHONATES § THYROID SUPPLEMENTS § ANTIHISTAMINES, § BETA-BLOCKERS, ANTIDIABETICS NONSEDATING NONSELECTIVE § BIGUANIDES § CALCITONINS GASTROINTESTINAL § ANTIHISTAMINE/ DECONGESTANTS PARATHYROID HORMONES BETA-BLOCKERS, 2 RECEPTOR INCRETIN MIMETIC AGENTS ANTAGONISTS SELECTIVE BETA AGONISTS CONTRACEPTIVES PROSTAGLANDINS § SHORT ACTING § MONOPHASIC § PROTON PUMP INHIBITORS § SYMPATHOMIMETICS QUICK REFERENCE PERFORMANCE DRUG LIST Your specific prescription benefit plan design may not cover certain categories, regardless of their appearance in this document. For specific information, visit our Web site at www.caremark.com or contact a Caremark Customer Care representative. FOR YOUR INFORMATION: Generics should be considered the first line of prescribing. This Caremark Drug List represents a summary of prescription coverage. It is not inclusive and does not guarantee coverage. Specific prescription benefit plan design may not cover certain categories, regardless of their appearance in this document. The plan participant’s prescription benefit plan may have a different copay for specific products on the list. Unless specifically indicated, drug list products will include all dosage forms. This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics. Generics listed in therapeutic categories are for representational purposes only. This is not an all-inclusive list. Listed products may be available generically in certain strengths or dosage forms. Dosage forms on this list will be consistent with the category and use where listed. Log in to www.caremark.com to check coverage and copay information for a specific medicine.
§ Generics are available in this class and should be considered the first line of prescribing.
1 Copayment, copay or coinsurance means the amount a plan participant is required to pay for a prescription in accordance with a Plan, which may be a deductible,
a percentage of the prescription price, a fixed amount or other charge, with the balance, if any, paid by a Plan.
2 Atacand should be reserved for patients who meet CHARM (Candesartan in Heart Failure - Assessment of Reduction in Mortality and Morbidity) trial criteria.
3 Indicates the proposed mechanism of action, based on the American Psychiatric Association Summary of Treatment Recommendations.
4 Higher copays may apply depending on the plan participant’s specific prescription benefit plan. Log in to www.caremark.com to find the copay under a specific plan.
5 An Accu-Chek or OneTouch blood glucose meter will be provided at no charge by the manufacturer to those individuals currently using a meter other than Accu-Chek or
OneTouch. For more information on how to obtain a blood glucose meter, call toll-free: 1-800-588-4456. Plan participants must have Caremark Mail Service Pharmacy benefits to qualify. Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information. Caremark may receive rebates, discounts and service fees from pharmaceutical manufacturers for certain listed products. This Caremark Drug List contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers that are not affiliated with Caremark. Listed products are for informational purposes only and are not intended to replace the clinical judgment of the prescriber.
2009 Caremark Rx, L.L.C. All rights reserved. www.caremark.com
TEXAS 4-H CENTER ADULT HEATH HISTORY FORM INSTRUCTIONS: Complete the entire form and bring with you to the Texas 4-H Center. This form will be turned in with any medication you bring, both prescription and non-prescription, to the health room upon your arrival. County _____________________________________Name ________________________________________________________Address ___________
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