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 and their plan participants. 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 and not meant to be all-inclusive. This list represents brand products in CAPS 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 is not inclusive nor does it guarantee coverage, but
● For specific information regarding your prescription benefit coverage
represents a summary of prescription 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 copay1 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 copayments1 ANTI-INFECTIVES § MISCELLANEOUS CHOLESTEROL ABSORPTION § ACE INHIBITOR/ CALCIUM CHANNEL INHIBITORS ANTIBACTERIALS DIURETIC COMBINATIONS BLOCKER/ANTILIPEMIC COMBINATIONS § CEPHALOSPORINS § FIBRATES § ANTIFUNGALS § DIGITALIS GLYCOSIDES § HMG-CoA REDUCTASE § ERYTHROMYCINS/ INHIBITORS MACROLIDES § DIURETICS ANTIVIRALS § ACE INHIBITOR/CALCIUM CHANNEL BLOCKERS § HERPES AGENTS NIACINS/COMBINATIONS § FLUOROQUINOLONES ANGIOTENSIN II § INFLUENZA AGENTS RECEPTOR ANTAGONISTS/ COMBINATIONS § BETA-BLOCKERS CARDIOVASCULAR CENTRAL NERVOUS § ACE INHIBITORS § PENICILLINS ANTIDEPRESSANTS ANTILIPEMICS § MISCELLANEOUS AGENTS ANTILIPEMIC COMBINATIONS § TETRACYCLINES § BILE ACID RESINS § CALCIUM CHANNEL BLOCKERS diltiazem ext-relnifedipine 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 INSULIN SENSITIZERS ESTROGENS § URINARY NASAL ANTIHISTAMINES REUPTAKE INHIBITORS ANTISPASMODICS INSULIN SENSITIZER/ BIGUANIDE § NASAL STEROIDS COMBINATIONS INSULIN SENSITIZER/ § TRANSDERMAL, SULFONYLUREA ESTROGENS COMBINATIONS § SEROTONIN STEROID/BETA AGONISTS NOREPINEPHRINE MEGLITINIDES HEMATOLOGIC REUPTAKE INHIBITORS § ANTICOAGULANTS (SNRIs) 3 § SULFONYLUREAS STEROID INHALANTS ORAL ESTROGEN/ PROGESTINS RESPIRATORY § HYPNOTICS, § SULFONYLUREA/ ANAPHYLAXIS NONBENZODIAZEPINES BIGUANIDE TREATMENT AGENTS COMBINATIONS § PROGESTINS DERMATOLOGY MIGRAINE SUPPLIES § ANTICHOLINERGICS SELECTIVE ESTROGEN SELECTIVE SEROTONIN RECEPTOR MODULATORS AGONISTS § ANTICHOLINERGIC/ BETA AGONISTS § THYROID SUPPLEMENTS MULTIPLE SCLEROSIS BISPHOSPHONATES GASTROINTESTINAL § ANTIHISTAMINES, OPHTHALMIC NONSEDATING 2 RECEPTOR § BETA-BLOCKERS, ANTAGONISTS ENDOCRINE AND NONSELECTIVE METABOLIC § ANTIHISTAMINE/ DECONGESTANTS CONTRACEPTIVES § PROTON PUMP ANDROGENS INHIBITORS BETA-BLOCKERS, § MONOPHASIC SELECTIVE BETA AGONISTS ANTIDIABETICS § SHORT ACTING § BIGUANIDES PROSTAGLANDINS § TRIPHASIC GENITOURINARY § EXTENDED CYCLE INCRETIN MIMETIC AGENTS § BENIGN PROSTATIC § SYMPATHOMIMETICS HYPERPLASIA LONG ACTING INSULINS TRANSDERMAL LEUKOTRIENE RECEPTOR ANTAGONISTS 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 is not inclusive nor does it guarantee coverage, but represents a summary of prescription 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 1 for specific products on the list. Unless otherwise indicated, drug list products will include all dosage forms. This list represents brand products in CAPS and generic products in lowercase italics. Generics listed in therapeutic categories are for representational purposes only and are not meant to be all-inclusive. 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 copayments for a specific medicine.
§ Generics are available in this class and should be considered as the first line of prescribing.
Copayment or copay 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.
Atacand should be reserved for patients who meet CHARM (Candesartan in Heart Failure - Assessment of Reduction in Mortality and Morbidity) trial criteria.
Indicates the proposed mechanism of action, based on the American Psychiatric Association Summary of Treatment Recommendations.
Higher copayments may apply depending on the plan participant’s specific prescription benefit plan. Log in to www.caremark.com to find the copayment under a specific plan.
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 orOneTouch. For more information on how to obtain a blood glucose meter, call toll-free: 1-800-588-4456. Participants must have Caremark Mail Service 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 prescription brand-name medicines that are registered or trademarks of pharmaceutical manufacturers that are not affiliated with Caremark Rx, L.L.C. Listed products are for informational purposes only and are not intended to replace the clinical judgment of the prescriber.
2008 Caremark Rx, L.L.C. All rights reserved. www.caremark.com
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GARY M. ANNUNZIATA, D.O., F.A.C.P. ANH T. DUONG, M.D. JONATHAN C. LIN, M.D., MPH INFORMED CONSENT FOR COLONOSCOPY YOU HAVE BEEN SCHEDULED FOR A COLONOSCOPY FOR THE PURPOSE OF EXAMINING YOUR COLON (LARGE INTESTINE) AND (IF APPLICABLE) REMOVING A POLYP OR POLYPS. THE COLONOSCOPIC EXAMINATION IS DONE BY INSERTING A LONG FLEXIBLE TUBE INTO THE RECTUM AND BEYOND. IN MANY CASES, T