Prmtmh3ahpmm-13.ahp-mm.121015

The following is a list of the most commonly prescribed maintenance drugs that are also on theExpress Scripts High Performance Formulary. Members who use these drugs will be targeted forSelect Home Delivery outreach. This is not an all-inclusive list of drugs that will be targeted, butrepresents the maintenance drugs that are on the High Performance Formulary. PLEASE NOTE: Not all of the drugs listed are covered by all prescription-drug benefit programs;
2013 Express Scripts
check your benefit materials and formulary for the specific drugs covered and the copayments
for your prescription-drug benefit program. For specific questions about your coverage, please
Maintenance Medications
call the phone number printed on your ID card. In addition to using this list, you are
encouraged to ask your doctor to prescribe generic drugs whenever appropriate.
On the High Performance Formulary
For the member: Generic medications contain the same active ingredients as their corresponding
brand-name medications, although they may look different in color or shape. They have been FDA-
approved under strict standards.
For Missouri Consolidated Health Care Plan
For the physician: Please prescribe preferred products and allow generic substitutions when
medically appropriate. Thank you.
A
enalapril-hydrochlorothiazide fosinopril-hydrochlorothiazide G
bisoprolol-hydrochlorothiazide covaryx h.s.
D
C
H
amiloride-hydrochlorothiazide calcitonin-salmon F
I
E
B
THIS DOCUMENT LIST IS EFFECTIVE JANUARY 1, 2013 THROUGH DECEMBER 31, 2013. THIS LIST IS SUBJECT TO CHANGE.
Brand-name drugs are listed in CAPITAL letters. Generic drugs are listed in lower case letters. Most generics are available at the lowest copayment.
You can get more information and updates to this document at our website at www.express-scripts.com.
2013 Express Scripts Holding Company
All Rights Reserved
PRMTMH3AHPMM-13 (10/15/12)
M
Q
J
R
O
K
P
S
U
V
L
N
W
Z
T
THIS DOCUMENT LIST IS EFFECTIVE JANUARY 1, 2013 THROUGH DECEMBER 31, 2013. THIS LIST IS SUBJECT TO CHANGE.
Brand-name drugs are listed in CAPITAL letters. Generic drugs are listed in lower case letters. Most generics are available at the lowest copayment.
You can get more information and updates to this document at our website at www.express-scripts.com.
2013 Express Scripts Holding Company
All Rights Reserved
PRMTMH3AHPMM-13 (10/15/12)

Source: http://www.mchcp.org/documents/maintenanceFormulary_AlphaOrder.pdf