Microsoft word - 102013 preventive drug list - bnsf.docx

BNSF Medical Program
Preventive Therapy Drug List
(10/01/13)
ANTICONVULSANTS
ORAL ANTIANGINAL AGENTS

COMBINATION ANTIHYPERLIPIDEMICS
SL and chewable formulations are not included TRANSDERMAL/TOPICAL ANTIANGINAL
DIABETES
DIAGNOSTIC AGENTS AND SUPPLIES
CORONARY ARTERY DISEASE
ANTIHYPERLIPIDEMICS
INJECTABLE DIABETES AGENTS
Over-the-Counter (OTC) products require a prescription.
ORAL DIABETES AGENTS
CARDIOVASCULAR CONDITIONS -
ANTIARRHYTHMIC AGENTS
* Products are not covered by the BNSF Medical Program ( ) CVS Caremark Formulary Exclusions – you may be required to pay the full cost.  Some strengths or dosage forms may not be included in the BNSF Medical Program Preventative 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. HYPERTENSION
ACE INHIBITORS/ANGIOTENSIN II RECEPTOR
BETA-BLOCKERS
ANTAGONISTS
CALCIUM CHANNEL BLOCKERS
HEMATOLOGIC AGENTS
ACE INHIBITOR/CALCIUM CHANNEL
BLOCKER COMBINATIONS
*Products are not covered by the BNSF Medical Program ( ) CVS Caremark Formulary Exclusions – you may be required to pay the full cost.  Some strengths or dosage forms may not be included in the BNSF Medical Program Preventative 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. DIURETICS
spironolactone/hydrochlorothiazide ANTIPSYCHOTICS
MENTAL HEALTH
ANTIDEPRESSANTS
OTHER ANTIHYPERTENSIVE AGENTS
olanzapine orally disintegrating tabs IMMUNIZING AGENTS
OSTEOPOROSIS
*Products are not covered by the BNSF Medical Program ( ) CVS Caremark Formulary Exclusions – you may be required to pay the full cost.  Some strengths or dosage forms may not be included in the BNSF Medical Program Preventative 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. PREVENTIVE CARE SERVICES
WOMEN'S HEALTH
AGENTS FOR CHEMICAL DEPENDENCY
ANTIESTROGENS
ANTICOAGULANTS/
AROMATASE INHIBITORS
PLATELET AGGREGATION INHIBITORS
ANTI-OBESITY AGENTS
CONTRACEPTIVES
LOW-DOSE MONOPHASIC PILLS
levonorgestrel/EE 0.1/20 and EE 10 VARIOUS CONDITIONS
ANTI-MALARIAL AGENTS
norethindrone acetate/EE 1/20 and iron SMOKING DETERRENTS
norethindrone acetate/EE 1.5/30 and DENTAL CARIES PREVENTION
HIGH-DOSE MONOPHASIC PILLS
Over-the-Counter (OTC) products require a prescription. HEREDITARY ANGIOEDEMA AGENTS
BIPHASIC PILLS
RESPIRATORY DISORDERS
IMMUNOSUPPRESSIVE AGENTS
TRIPHASIC PILLS
MULTIPLE SCLEROSIS AGENTS
FOUR-PHASIC
EXTENDED-CYCLE PILLS
ANTICOAGULANTS
*Products are not covered by the BNSF Medical Program ( ) CVS Caremark Formulary Exclusions – you may be required to pay the full cost.  Some strengths or dosage forms may not be included in the BNSF Medical Program Preventative 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. levonorgestrel/EE 0.15/30 and EE 10 EMERGENCY CONTRACEPTION
levonorgestrel - Next Choice One Dose TRANSDERMAL PATCH
CONTINUOUS-CYCLE PILLS
PRENATAL VITAMINS
MISCELLANEOUS CONTRACEPTIVES
PROGESTIN-ONLY PILLS
*Products are not covered by the BNSF Medical Program ( ) CVS Caremark Formulary Exclusions – you may be required to pay the full cost.  Some strengths or dosage forms may not be included in the BNSF Medical Program Preventative 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.

Source: http://m.bnsf.com/retirees/exempt-retirees/pdf/preventive-dl.pdf