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In a high-deductible health plan like Boeing’s Advantage + health plan,federal rules permit certain preventive drugs to be paid without beingsubject to the plan’s deductible. For drugs on the preventive drug list, you pay only the generic, brandformulary, or brand non-formulary coinsurance percentage described inyour plan summary.This list is periodically reviewed and updated to ensure that the drugslisted meet the criteria for inclusion. Because this list is subject tochange, please log in to www.express-scripts.com/boeing to check thestatus of the medications you take.Medications must be covered by your plan to be eligible for the preventive medication program.
Preventive medications list
PDL4833D
Aacarboseacebutolol hclacetazolamideADVAIR DISKUSADVAIR HFAafeditab CRAGGRENOXalbuterolalbuterol sulfatealendronate sodiumamantadineamiloride hclamiloride hcl-hctzaminophyllineamlodipine atorvastatinamlodipine besylateamlodipine besylate-benazeprilAMTURNIDEanagrelideanastrozoleARCAPTA NEOHALERand metersASMANEXATELVIAatenololatenolol-chlorthalidoneatorvastatinatovaquone/proguanil hclATROVENT HFAAUVI-QAZOR
Bbenazepril hclbenazepril hcl-hctz
BENICARBENICAR HCTbetaxolol hclbisoprolol fumaratebisoprolol-hydrochlorothiazideBREO ELLIPTABRILINTAbudesonidebumetanidebuproban SRbupropion SRBYDUREONBYETTABYSTOLIC
Ccandesartan cilexetilcandesartan- hydrochlorothiazidecalcitonin, salmoncaptoprilcaptopril-hydrochlorothiazide CARTIA XT carvedilolCHANTIXchloroquine chlorothiazidechlorpropamidechlorthalidonecholestyraminecholestyramine light cilostazol clonidineclopidogrelcholestyraminecholestyramine lightcilostazol
The following section lists generic and brand formulary drugs.
Some brand drugs may change to non-formulary status during the year.
C (continued)clonidineclopidogrelCOARTEMcolestipol hclCOMBIVENTCOREG CRCRESTORcromolyn sodium
DDALIRESPDARAPRIMDEMSERDIBENZYLINEdifil-Gdilex-GDILT-CDDILTIA XTdiltiazem CDdiltiazem ERdiltiazem hcldiltiazem SRDILT-XRDILTZAC ERdipyridamoledoxazosinDULERAdyflex-Gdylix
EEFFIENTELIQUISenalapril maleateenalapril maleate-hctzenoxaparin sodium
epinephrine pen injectionEPIPENEPIPEN JR.eplerenoneepoprostenol sodiumetidronateEXFORGEEXFORGE HCTexemestane
FFASLODEXFAST TAKE TEST STRIPSfelodipine ERfenofibratefenofibrate micronizedfenofibric acidFLUMISTflu vaccinesfluvastatinfolic acidfondaparinux sodiumFORADILFORTICALFORTEOfosinopril sodiumfosinopril-hydrochlorothiazidefurosemide
Ggemfibrozilglimepirideglipizideglipizide ERglipizide XLglipizide-metforminglucose tabletsGLUCAGON EMERGENCY KIT
The following section lists generic and brand formulary drugs.
Some brand drugs may change to non-formulary status during the year.
G (continued)glucose tabletsGLUCAGON EMERGENCY KITglyburideglyburide micronizedglyburide-metformin hclguanabenz acetateguanfacine hcl
Hheparin sodiumHUMALOGHUMALOG MIX 50/50HUMALOG MIX 75/25HUMULINHUMULIN 70/30HUMULIN Rhydralazinehydrochloroquine sultatehydrochlorothiazide
Iibandronate sodiumimmune globulinsindapamideipratropium bromideipratropium-albuterolirbesartanirbesartan-hctzisradipine
JjantovenJANUMETJANUMET XRJANUVIAJENTADUETO
JUXTAPID
KKOMBIGLYZE XR
Llabetalol hclLANTUS SoloSTAR cartridgeLANTUS vialletrozolelevalbuterol hclLEVEMIRLIPOFENLIPTRUZETlisinoprillisinopril-hydrochlorothiazidelosartanlosartan-hctzlovastatinLOVAZA
Mmatzim LAmefloquine hclmetaproterenolmetformin hclmetformin hcl ERmetazolamidemethyclothiazidemethyldopamethyldopa-hydrochlorothiazidemetoprolol succinatemetoprolol tartratemetoprolol SRmetoprolol-hydrochlorothiazideminoxidilmoexipril hclmoexipril-hydrochlorothiazide
The following section lists generic and brand formulary drugs.
Some brand drugs may change to non-formulary status during the year.
M (continued)montelukast sodium
Nnadololnadolol-bendroflumethiazidenateglinidenicardipine hclnifediac ccnifedical XLnifedipine CRnifedipine ERnifedipine SRnimodipinenislodipine
OONE TOUCH strips and metersONGLYZA
Ppamidronatepapaverinepediatric multi-vit w/fluoridepediatric multi-vit w/fluoride& ironPERFOROMISTperindopril erbuminepindololpioglitazone hclpioglitazone hcl-glimeprimidepioglitazone hcl-metformin hclPNEUMOVAX 23PRADAXAPRANDIMETpravastatin sodiumprazosin
prenatal vitamin (generic)prevalitePRIMAQUINEPROAIR HFAPROGLYCEMpropranolol hclpropranolol SRpropranolol hcl w/hctzPULMICORT FLEXHALER
Qquinapril hclquinapril-hydrochlorothiazidequinine sulfateQVAR
Rraloxiphene hclramaprilRELENZArepaglinidereserpinerimantadine hclrisedronate sodiumRIOMET
SSEREVENTSIMCORsimvastatinsodium fluoridesorinesotalolsotalol AFspironolactoneSPIRIVA
The following section lists generic and brand formulary drugs.
Some brand drugs may change to non-formulary status during the year.
S (continued)spironolactone-hctzSURESTEP TEST STRIPSSYMBICORTSYMLINSYMLINPENSYNAGIS
TTAMIFLUtamoxifen citratetaztia xtTEKAMLOTEKTURNATEKTURNA HCTterazosinterbutaline sulfatetheochronticlopidine HCltimolol maleatetheophyllinetolazamidetolbutamidetorsemideTRADJENTA trandolapriltrandolapril-verapamiltriamterene-hctzTRIBENZORTRILIPIXTUDORZA
Vvalsartanvalsartan-hctzVALTURNA
VASCEPAVELETRIVENTOLIN HFAverapamil ERverapamil hclVYTORIN
Wwarfarin sodiumWELCHOL
XXARELTOXGEVA
ZzafirlukastZETIAzolendronic acidZOSTAVAX
The following section lists generic and brand formulary drugs.
Some brand drugs may change to non-formulary status during the year.
AACCOLATEACCU-CHEK strips and metersACCUNEBACCUPRILACCURETICACEONACTONELACTOPLUS METACTOPLUS MET XRACTOSADALAT CCADRENACLICKADVICORAEROBIDAEROBID-MAGRYLINALDACTAZIDEALDACTONEALTACEALTOPREVALVESCOAMARYLANTARAAPIDRAAPIDRA SOLOSTARARALEN PHOSPHATEAREDIAARIMIDEXARIXTRAAROMASINASCENTIA strips and metersATACANDATACAND HCTAVALIDEAVANDAMET
AVANDARYLAVANDIAAVAPRO
BBETAPACEBETAPACE AFBIDILBINOSTROBONIVABREEZE 2 strips and metersBRONCOMAR-1BROVANAbudesonide
CCADUETCALANCALAN SRCARDENECARDENE SRCARDIZEMCARDIZEM CDCARDIZEM LACARDURACARDURA XLCATAPRESCATAPRES TTSCLORPRESCOLESTIDCONTOUR STRIPS AND METERSCOREGCORGARDCORZIDECOVERA-HSCOZAARCYCLOSET
The following section lists non-formulary brand drugs.
Some brand drugs may change to non-formulary status during the year.
DDEMADEXDIABETADIAMOXDIDRONELDILACOR XRDIOVANDIOVAN HCTDIURILDUETACTDUONEBDYNACIRC CRDYAZIDEDYRENIUM
EEDARBIEDARBYCLOREDECRINENDURONEVISTA
FFARESTONFEMARAFENOGLIDEFIBRICORFLOLANFLOVENT DISKUSFLOVENT HFAFLUMADINEFORTAMETFOSAMAXFOSAMAX PLUS DFRAGMINFREE STYLE TEST STRIPS
GGANITEGASTROCROMGLUCAGENGLUCOPHAGEGLUCOPHAGE XRGLUCOTROLGLUCOTROL XLGLUCOVANCEGLUMETZAGLYNASEGLYSET
HHYTRINHYZAAR
IINDERALINDERAL LAINDERIDEINNOPRAN XLINOHEPINSPRAINTALINTROLIPRIVASKISOPTIN SR
JJUVISYNC
KKAZANOKERLONE
The following section lists non-formulary brand drugs.
Some brand drugs may change to non-formulary status during the year.
LLASIXLESCOLLESCOL XLLEVATOLLIPITORLIVALOLOFIBRALOPIDLOPRESSORLOPRESSOR HCTLOTENSINLOTENSIN HCTLOTRELLOVENOXLUFYLLINLUFYLLIN GG
MMALARONEMAVIKMAXAIR AUTOHALERMAXZIDEMETAGLIPMEVACORMIACALCIN nasal sprayMICARDISMICARDIS HCTMICRONASEMICROZIDEMIDAMORMINIPRESMONOPRILMONOPRIL HCT
NNEPTAZANENESINANEXICLON XRNIASPANNICOTROL NSNIMOTOPNORVASCNOVOLINNOVOLOGNOVOLOG MIX 70/30NYMALIZE
OOSENI
PPERSANTINEPLAVIXPLAQUINILPLENDILPLETALPRANDINPRAVACHOLPRECOSEPRECISION QID strips andmetersPRECISION PCX stripsPRECISION XTRA stripsPRECOSEPRESTIGE SMART strips andmetersPRINIVILPRINZIDEPROCARDIAPROCARDIA XL
The following section lists non-formulary brand drugs.
Some brand drugs may change to non-formulary status during the year.
PROGLYCEMPROLIAPROVENTIL HFAPULMICORT
QQUESTRANQUESTRAN LIGHTquinaretic
RRECLASTRELIONREMODULIN
SSECTRALSKELIDSINGULAIRSOLTAMOXSTARLIXSULAR
TTARKATENEXTENORETIC 100-25TENORETIC 50-25TENORMIN tabletTEVETENTEVETEN HCTTHALITONETHEO-24TIAZACTOPROL XLTRANDATETRIGLIDETRUETRACK strips and meters
TWYNSTA
UUNIPHYLUNIRETICUNIVASC
VVASERETICVASOTECVENTOLIN HFAVERELANVERELAN PMVERELAN SRVICTOZAVOSPIRE ER
XXOLAIRXOPENEXXOPENEX HFA
ZZAROXOLYNZEBETAZESTORETICZESTRILZIACZOCORZOMETAZYBANZYFLOZYFLO CR
The following section lists non-formulary brand drugs.
Some brand drugs may change to non-formulary status during the year.