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Sprint Preventive Therapy Drug List
(01/01/14)
CORONARY ARTERY DISEASE
ANTIHYPERLIPIDEMICS
cholestyramine/cholestyramine light
CALCIUM CHANNEL BLOCKERS
COMBINATION ANTIHYPERLIPIDEMICS
DIABETES
ACE INHIBITOR/CALCIUM CHANNEL
DIAGNOSTIC AGENTS AND SUPPLIES
BLOCKER COMBINATIONS
*Please note that injectable diabetes HYPERTENSION
BETA-BLOCKERS
ACE INHIBITORS/ANGIOTENSIN II RECEPTOR
ANTAGONISTS
Some strengths or dosage forms may not be included in the Sprint Preventive Therapy Drug List. Certain products or categories may not be covered, regardless of their appearance in this document. Please check with your plan provider. Please note: This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics. This Sprint Preventive Therapy Drug List is provided as a courtesy and CVS Caremark makes no representations regarding the suitability for your particular plan. The Sprint Preventive Therapy Drug List should be modified as necessary or desired by the plan sponsor with the advice of counsel, if appropriate. 106-26997a 031413 DIURETICS
OSTEOPOROSIS
WOMEN'S HEALTH
ANTIESTROGENS
spironolactone/hydrochlorothiazide AROMATASE INHIBITORS
PREVENTIVE CARE SERVICES
SMOKING DETERRENTS
CONTRACEPTIVES
ANTICOAGULANTS
LOW-DOSE MONOPHASIC PILLS
OTHER ANTIHYPERTENSIVE AGENTS
levonorgestrel/EE 0.1/20 and EE 10 norethindrone acetate/EE 1/20 and iron ANTICOAGULANTS/PLATELET AGGREGATION
INHIBITORS
norethindrone acetate/EE 1.5/30 and HIGH-DOSE MONOPHASIC PILLS
BIPHASIC PILLS
VARIOUS CONDITIONS
TRIPHASIC PILLS
DENTAL CARIES PREVENTION
IMMUNOSUPPRESSIVE AGENTS
norgestimate/EE 0.18-35/0.215-35/ Some strengths or dosage forms may not be included in the Sprint Preventive Therapy Drug List. Certain products or categories may not be covered, regardless of their appearance in this document. Please check with your plan provider. Please note: This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics. This Sprint Preventive Therapy Drug List is provided as a courtesy and CVS Caremark makes no representations regarding the suitability for your particular plan. The Sprint Preventive Therapy Drug List should be modified as necessary or desired by the plan sponsor with the advice of counsel, if appropriate. 106-26997a 031413 CONTINUOUS-CYCLE PILLS
FOUR-PHASIC
PROGESTIN-ONLY PILLS
EXTENDED-CYCLE PILLS
TRANSDERMAL PATCH
Prenatal Vitamins
(for example: Citranatal Assure, Prenate levonorgestrel/EE 0.15/30 and EE 10 MISCELLANEOUS CONTRACEPTIVES
Some strengths or dosage forms may not be included in the Sprint Preventive Therapy Drug List. Certain products or categories may not be covered, regardless of their appearance in this document. Please check with your plan provider. Please note: This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics. This Sprint Preventive Therapy Drug List is provided as a courtesy and CVS Caremark makes no representations regarding the suitability for your particular plan. The Sprint Preventive Therapy Drug List should be modified as necessary or desired by the plan sponsor with the advice of counsel, if appropriate. 106-26997a 031413

Source: http://www.sprint.com/hr/employeebenefits/docs/2014_CVS_Caremark_Preventive_Drug_List.pdf

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