Benefits.inventivhealth.com

High Deductible Health Plan (HDHP) - Health Savings Account (HSA)
Preventive Therapy Drug List
(10/01/11)
ANTICONVULSANTS
ORAL ANTIANGINAL AGENTS

COMBINATION ANTIHYPERLIPIDEMICS
DIABETES
SL and chewable formulations are not included DIAGNOSTIC AGENTS
TRANSDERMAL/TOPICAL ANTIANGINAL
INJECTABLE DIABETES AGENTS
CORONARY ARTERY DISEASE
ANTIHYPERLIPIDEMICS
Over-the-Counter (OTC) products do not require a prescription. Coverage may vary by plan.
ORAL DIABETES AGENTS
CARDIOVASCULAR CONDITIONS -
ANTIARRHYTHMIC AGENTS
Some strengths or dosage forms may not be included in the HDHP - HSA Preventive Therapy Drug List. Please note: This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics. This HDHP - HSA Preventive Therapy Drug List is provided as a courtesy and CVS Caremark makes no representations regarding the suitability for your particular plan. The HDHP - HSA Preventive Therapy Drug List should be modified as necessary or desired by the plan sponsor with the advice of counsel, if appropriate. HEMATOLOGIC AGENTS

CALCIUM CHANNEL BLOCKERS
ACE INHIBITOR/CALCIUM CHANNEL
BLOCKER COMBINATIONS
HYPERTENSION
BETA-BLOCKERS
ACE INHIBITORS/ANGIOTENSIN II RECEPTOR
ANTAGONISTS
lisinopril Some strengths or dosage forms may not be included in the HDHP - HSA Preventive Therapy Drug List. Please note: This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics. This HDHP - HSA Preventive Therapy Drug List is provided as a courtesy and CVS Caremark makes no representations regarding the suitability for your particular plan. The HDHP - HSA Preventive Therapy Drug List should be modified as necessary or desired by the plan sponsor with the advice of counsel, if appropriate. DIURETICS
spironolactone/hydrochlorothiazide IMMUNIZING AGENTS
OTHER ANTIHYPERTENSIVE AGENTS
MENTAL HEALTH
ANTIDEPRESSANTS
ANTIPSYCHOTICS
Some strengths or dosage forms may not be included in the HDHP - HSA Preventive Therapy Drug List. Please note: This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics. This HDHP - HSA Preventive Therapy Drug List is provided as a courtesy and CVS Caremark makes no representations regarding the suitability for your particular plan. The HDHP - HSA Preventive Therapy Drug List should be modified as necessary or desired by the plan sponsor with the advice of counsel, if appropriate. ANTICOAGULANTS
ANTICOAGULANTS/PLATELET AGGREGATION
INHIBITORS
SMOKING DETERRENTS
VARIOUS CONDITIONS
OSTEOPOROSIS
ANTI-MALARIAL AGENTS
Over-the-Counter (OTC) products do not require a prescription. Coverage may vary by plan. RESPIRATORY DISORDERS
DENTAL CARIES PREVENTION
HEREDITARY ANGIOEDEMA AGENTS
PREVENTIVE CARE SERVICES
AGENTS FOR CHEMICAL DEPENDENCY
IMMUNOSUPPRESSIVE AGENTS
ANTI-OBESITY AGENTS
Some strengths or dosage forms may not be included in the HDHP - HSA Preventive Therapy Drug List. Please note: This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics. This HDHP - HSA Preventive Therapy Drug List is provided as a courtesy and CVS Caremark makes no representations regarding the suitability for your particular plan. The HDHP - HSA Preventive Therapy Drug List should be modified as necessary or desired by the plan sponsor with the advice of counsel, if appropriate. MULTIPLE SCLEROSIS AGENTS
WOMEN'S HEALTH
AROMATASE INHIBITORS
PRENATAL VITAMINS
Some strengths or dosage forms may not be included in the HDHP - HSA Preventive Therapy Drug List. Please note: This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics. This HDHP - HSA Preventive Therapy Drug List is provided as a courtesy and CVS Caremark makes no representations regarding the suitability for your particular plan. The HDHP - HSA Preventive Therapy Drug List should be modified as necessary or desired by the plan sponsor with the advice of counsel, if appropriate.

Source: http://benefits.inventivhealth.com/2012/wp-content/uploads/2011/10/HSA_Only_Preventive_Drug_List.pdf

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