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Performance Drug List
For the most up-to-date Performance Drug List visit www.caremark.com
The Caremark Performance Drug List is a guide within select therapeutic categories for clients and their plan participants.
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 and
not meant to be all-inclusive. This list represents brand products in CAPS and generic products in lowercase italics.
PLAN PARTICIPANT
HEALTH CARE PROVIDER
Your benefit plan provides you with a prescription benefit program Your patient is covered under a prescription benefit plan administered by administered by Caremark. Ask your doctor to consider prescribing, when Caremark. As a way to help manage health care costs, authorize generic medically appropriate, a preferred medicine from this list. Take this list substitution whenever possible. If you believe a brand-name product is along when you or a covered family member sees a doctor.
necessary, consider prescribing a brand name on this list. Please note:
Please note:
● Your specific prescription benefit plan design may not cover certain ● Generics should be considered the first line of prescribing.
categories, regardless of their appearance in this document.
● This drug list is not inclusive nor does it guarantee coverage, but ● For specific information regarding your prescription benefit coverage represents a summary of prescription coverage.
and copay1 information, please visit our Web site at www.caremark.com
● The plan participant’s specific prescription benefit plan may have or contact a Caremark Customer Care representative.
a different copay1 for specific products on the list. ● Caremark may contact your doctor after receiving your prescription to ● Unless specifically indicated, drug list products will include all request consideration of a drug list product or generic equivalent. This may result in your doctor prescribing, when medically appropriate, adifferent brand-name product or generic equivalent in place of your ● Log in to www.caremark.com to check coverage and copayments1
ANTI-INFECTIVES
§ MISCELLANEOUS
CHOLESTEROL ABSORPTION
§ ACE INHIBITOR/
CALCIUM CHANNEL
INHIBITORS
ANTIBACTERIALS
DIURETIC COMBINATIONS
BLOCKER/ANTILIPEMIC
COMBINATIONS
§ CEPHALOSPORINS
§ FIBRATES
§ ANTIFUNGALS
§ DIGITALIS GLYCOSIDES
§ HMG-CoA REDUCTASE
§ ERYTHROMYCINS/
INHIBITORS
MACROLIDES
§ DIURETICS
ANTIVIRALS
§ ACE INHIBITOR/CALCIUM
CHANNEL BLOCKERS
§ HERPES AGENTS
NIACINS/COMBINATIONS
§ FLUOROQUINOLONES
ANGIOTENSIN II
§ INFLUENZA AGENTS
RECEPTOR ANTAGONISTS/
COMBINATIONS
§ BETA-BLOCKERS
CARDIOVASCULAR
CENTRAL NERVOUS
§ ACE INHIBITORS
§ PENICILLINS
ANTIDEPRESSANTS
ANTILIPEMICS
§ MISCELLANEOUS AGENTS
ANTILIPEMIC
COMBINATIONS
§ TETRACYCLINES
§ BILE ACID RESINS
§ CALCIUM CHANNEL
BLOCKERS
diltiazem ext-relnifedipine ext-relverapamil ext-rel Your specific prescription benefit plan design may not cover certain categories, regardless of their appearance in this document.
For specific information, visit our Web site at www.caremark.com or contact a Caremark Customer Care representative.

§ SELECTIVE SEROTONIN
INSULIN SENSITIZERS
ESTROGENS
§ URINARY
NASAL ANTIHISTAMINES
REUPTAKE INHIBITORS
ANTISPASMODICS
INSULIN SENSITIZER/
BIGUANIDE
§ NASAL STEROIDS
COMBINATIONS
INSULIN SENSITIZER/
§ TRANSDERMAL,
SULFONYLUREA
ESTROGENS
COMBINATIONS
§ SEROTONIN
STEROID/BETA AGONISTS
NOREPINEPHRINE
MEGLITINIDES
HEMATOLOGIC
REUPTAKE INHIBITORS
§ ANTICOAGULANTS
(SNRIs) 3
§ SULFONYLUREAS
STEROID INHALANTS
ORAL ESTROGEN/
PROGESTINS
RESPIRATORY
§ HYPNOTICS,
§ SULFONYLUREA/
ANAPHYLAXIS
NONBENZODIAZEPINES
BIGUANIDE
TREATMENT AGENTS
COMBINATIONS
§ PROGESTINS
DERMATOLOGY
MIGRAINE
SUPPLIES
§ ANTICHOLINERGICS
SELECTIVE ESTROGEN
SELECTIVE SEROTONIN
RECEPTOR MODULATORS
AGONISTS
§ ANTICHOLINERGIC/
BETA AGONISTS
§ THYROID SUPPLEMENTS
MULTIPLE SCLEROSIS
BISPHOSPHONATES
GASTROINTESTINAL
§ ANTIHISTAMINES,
OPHTHALMIC
NONSEDATING
2 RECEPTOR
§ BETA-BLOCKERS,
ANTAGONISTS
ENDOCRINE AND
NONSELECTIVE
METABOLIC
§ ANTIHISTAMINE/
DECONGESTANTS
CONTRACEPTIVES
§ PROTON PUMP
ANDROGENS
INHIBITORS
BETA-BLOCKERS,
§ MONOPHASIC
SELECTIVE
BETA AGONISTS
ANTIDIABETICS
§ SHORT ACTING
§ BIGUANIDES
PROSTAGLANDINS
§ TRIPHASIC
GENITOURINARY
§ EXTENDED CYCLE
INCRETIN MIMETIC AGENTS
§ BENIGN PROSTATIC
§ SYMPATHOMIMETICS
HYPERPLASIA
LONG ACTING
INSULINS
TRANSDERMAL
LEUKOTRIENE RECEPTOR
ANTAGONISTS
QUICK REFERENCE PERFORMANCE DRUG LIST
Your specific prescription benefit plan design may not cover certain categories, regardless of their appearance in this document.
For specific information, visit our Web site at www.caremark.com or contact a Caremark Customer Care representative.

FOR YOUR INFORMATION: Generics should be considered the first line of prescribing. This Caremark Drug List is not inclusive nor does it guarantee coverage, but represents a
summary of prescription 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 1 for specific products on the list. Unless otherwise indicated, drug list products will include all dosage forms.
This list represents brand products in CAPS and generic products in lowercase italics. Generics listed in therapeutic categories are for representational purposes only and are not
meant to be all-inclusive. Listed products may be available generically in certain strengths or dosage forms. Dosage forms on this list will be consistent with the category and use
where listed. Log in to www.caremark.com to check coverage and copayments for a specific medicine.
§ Generics are available in this class and should be considered as the first line of prescribing.
Copayment or copay 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.
Atacand should be reserved for patients who meet CHARM (Candesartan in Heart Failure - Assessment of Reduction in Mortality and Morbidity) trial criteria.
Indicates the proposed mechanism of action, based on the American Psychiatric Association Summary of Treatment Recommendations.
Higher copayments may apply depending on the plan participant’s specific prescription benefit plan. Log in to www.caremark.com to find the copayment under a
specific plan.
An Accu-Chek or OneTouch blood glucose meter will be provided at no charge by the manufacturer to those individuals currently using a meter other than Accu-Chek orOneTouch. For more information on how to obtain a blood glucose meter, call toll-free: 1-800-588-4456. Participants must have Caremark Mail Service benefits to qualify.
Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.
Caremark may receive rebates, discounts and service fees from pharmaceutical manufacturers for certain listed products.
This Caremark Drug List contains prescription brand-name medicines that are registered or trademarks of pharmaceutical manufacturers that are not affiliated with Caremark Rx, L.L.C.
Listed products are for informational purposes only and are not intended to replace the clinical judgment of the prescriber.
2008 Caremark Rx, L.L.C. All rights reserved.
www.caremark.com

Source: http://www.bcitpa.com/eConcept/pdf/PerformanceDL0408.pdf

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