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Physician and Pharmacist Reference Guide
Preferred Choice

The CVS Caremark Preferred Choice 3-Tier Formulary, formerly the PharmaCare Preferred Choice 3-Tier Formulary, 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.
HEALTH CARE PROVIDER
THERAPEUTIC CATEGORIES
Your patient is covered under a prescription benefit plan administered by CVS Caremark. As a way to help manage health care costs, authorize generic substitution whenever possible. If you believe a brand-name product is necessary,consider prescribing a brand name on this list. Please note:
● Generics should be considered the first line of prescribing.
Autonomic and Central Nervous System Agents ● This drug list represents a summary of prescription coverage. It is not inclusive ● The plan participant’s specific prescription benefit plan may have a different copay1 for specific products on the list. ● Unless specifically indicated, drug list products will include all dosage forms.
● Log in to www.caremark.com to check coverage and copay information for
PLAN PARTICIPANT
Your benefit plan provides you with a prescription benefit program administered by CVS Caremark. Ask your doctor to consider prescribing, when medically appropriate, a preferred medicine from this list. Take this list along when you or a covered family Please note:
● Your specific prescription benefit plan design may not cover certain categories, regardless of their appearance in this document.
● For specific information regarding your prescription benefit coverage and copay information, please visit www.caremark.com or contact a CVS Caremark Customer
● CVS Caremark may contact your doctor after receiving your prescription to request consideration of a drug list product or generic equivalent. This may result in your doctor prescribing, when medically appropriate, a different brand-name product or generic equivalent in place of your original prescription.
Your specific prescription benefit plan design may not cover certain categories, regardless of their appearance in this document. For specific information, visit www.caremark.com or contact a CVS Caremark Customer Care representative.
ANTIDIABETIC AGENTS
ANTITUSSIVE
SULFONAMIDES
ANTINEOPLASTIC
ANALGESICS, SALICYLATES
INSULINS
COMBINATIONS
Generally, self-administered
single source brand drugs
RAPID-ACTING INSULINS
TETRACYCLINES
indicated for the treatment
ANTICONVULSANTS
of cancer are formulary.
AUTONOMIC AND
CENTRAL NERVOUS
SYSTEM AGENTS
OTHER ANTI-INFECTIVES
INTERMEDIATE-ACTING
ALZHEIMER’S AGENTS
INSULINS
ANALGESICS, NARCOTIC
NASAL CORTICOSTEROIDS
LONG-ACTING INSULINS
NASAL ANTIHISTAMINES
ANTIFUNGAL AGENTS
ANTI-INFECTIVE AGENTS
ANTIPARKINSON AGENTS
ANTHELMINTICS
ANTIBIOTICS
ANTIVIRALS
CEPHALOSPORINS
ANALGESICS,
NON-NARCOTIC
OTHER DIABETIC AGENTS
MACROLIDES
ANALGESICS,
ALLERGY,
NONSTEROIDAL
COUGH & COLD
ANTI-INFLAMMATORY
ANXIOLYTICS, SEDATIVES,
ANTIHISTAMINE/
AND HYPNOTICS
DECONGESTANTS
PENICILLINS
QUINOLONES
Generally, self-administered
single source brand drugs
indicated for the treatment
of HIV are formulary.
Your specific prescription benefit plan design may not cover certain categories, regardless of their appearance in this document. For specific information, visit www.caremark.com or contact
a CVS Caremark Customer Care representative.
CEREBRAL STIMULANTS
ANTIMANIC AGENTS
CENTRALLY ACTING
COMBINATION
CONTRACEPTIVES
ANTIHYPERTENSIVES
EE = ethinyl estradiol
ME = mestranol
ANTIPSYCHOTIC AGENTS
MONOPHASIC
PERIPHERALLY ACTING
ANTIARRHYTHMICS
MIGRAINE AGENTS
CARDIOVASCULAR
DIRECT RENIN INHIBITORS
ANTICOAGULANTS/
ANTITHROMBOTICS
ALDOSTERONE
DIURETICS
ANTAGONISTS
OBSESSIVE-COMPULSIVE
ANGIOTENSIN II
DISORDER AGENTS
ANTAGONISTS
PSYCHOTHERAPEUTIC
ANTILIPEMICS
ANTIDEPRESSANTS
ANGIOTENSIN
CONVERTING ENZYME
INHIBITORS
BIPHASIC
PULMONARY
HYPERTENSION
TRIPHASIC
VASODILATORS
ANTI-ADRENERGIC
BETA-ADRENERGIC
BLOCKERS
CALCIUM CHANNEL
BLOCKERS
OTHER CARDIOVASCULAR
Your specific prescription benefit plan design may not cover certain categories, regardless of their appearance in this document. For specific information, visit www.caremark.com or contact
a CVS Caremark Customer Care representative.
EXTENDED CYCLE
TOPICAL ANTI-
DIAGNOSTICS
HEMATOPOIETIC
IMMUNOLOGIC AGENTS
INFLAMMATORY AGENTS
GROWTH FACTORS
LOW POTENCY
CONTINUOUS
GASTROINTESTINAL
PROGESTIN ONLY
HORMONES
INTERMEDIATE POTENCY
ANTISPASMODIC/
ANDROGENS
GI MOTILITY
IMMUNOSUPPRESSIVE
EMERGENCY
ANTIESTROGENS/
CONTRACEPTION
ANTIANDROGENS
CONTRACEPTIVE DEVICES
ANTIULCER
ESTROGENS
CORTICOSTEROIDS
HIGH POTENCY
OPHTHALMICS
ANTI-ALLERGIC AGENTS
BOWEL EVACUANTS
DERMATOLOGICALS
HIGHEST POTENCY
DIGESTANTS
ESTROGEN AND
ANTI-GLAUCOMA AGENTS
PROGESTERONE
COMBINATIONS
OTHER GI PRODUCTS
DERMATOLOGICALS
PROGESTINS
ANALGESICS
ANTI-INFECTIVE/
ANTIVIRAL AGENTS
ANTIBIOTICS
SELECTIVE RECEPTOR
MODULATORS
FUNGICIDES
GOUT AGENTS
Your specific prescription benefit plan design may not cover certain categories, regardless of their appearance in this document. For specific information, visit www.caremark.com or contact
a CVS Caremark Customer Care representative.
ANTI-INFECTIVE AND
OSTEOPOROSIS AGENTS
ANTI-ASTHMATIC AGENTS
SKELETAL MUSCLE
VAGINAL PREPARATIONS
ANTI-INFLAMMATORY
RELAXANTS
ANTILEUKOTRIENES
COMBINATIONS
CORTICOSTEROIDS
VITAMINS
ANTI-INFECTIVE AND
ANTI-INFLAMMATORY
VITAMIN D/ANALOGUES
COMBINATIONS
SYMPATHOMIMETICS
THYROID AND
MISCELLANEOUS
ANTI-INFLAMMATORY
ANTITHYROID AGENTS
XANTHINE DERIVATIVES
PHOSPHATE BINDER
OTHER RESPIRATORY/
URINARY AGENTS
ASTHMA AGENTS
BETA-BLOCKERS
RESPIRATORY/ASTHMA
ANAPHYLAXIS
TREATMENT AGENTS
FOR YOUR INFORMATION: Generics should be considered the first line of prescribing. This 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 beavailable generically in certain strengths or dosage forms. Dosage forms on this list will be consistent with the category and use where listed. This is not a complete list of all formulary products. Any brand-name drug for which a generic product becomes available may be designated as a nonformulary product. Log in to www.caremark.com to check coverage and copay information for a
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.
Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.
CVS Caremark may receive rebates, discounts and service fees from pharmaceutical manufacturers for certain listed products.
This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers that are not affiliated with CVS Caremark. Listed products are for informational purposes only and are not intended to replace the clinical judgment of the prescriber.
2009 Caremark. All rights reserved. CMK-PC PHYS/PHAR REF-0709 www.caremark.com

Source: https://www.csms.org/upload/files/07-07-09%20Caremark%20Preferred%20Drug%20list.pdf

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