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Performance Drug List
The CVS Caremark Performance Drug List 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.
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 administered by CVS Caremark. Ask your doctor to consider prescribing, by CVS Caremark. As a way to help manage health care costs, authorize when medically appropriate, a preferred medicine from this list. Take this generic substitution whenever possible. If you believe a brand-name list along when you or a covered family member sees a doctor.
product is 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 represents a summary of prescription coverage. It is ● For specific information regarding your prescription benefit coverage not inclusive and does not guarantee coverage. and copay1 information, please visit www.caremark.com or contact a
● The plan participant’s specific prescription benefit plan may have CVS Caremark Customer Care representative.
a different copay for specific products on the list. ● CVS Caremark may contact your doctor after receiving your prescription ● Unless specifically indicated, drug list products will include all 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 ● Log in to www.caremark.com to check coverage and copay
information for a specific medicine.
● Any brand drug for which a generic product becomes available may be ANTI-INFECTIVES
§ MISCELLANEOUS
§ ACE INHIBITOR/
§ FIBRATES
CALCIUM CHANNEL
ANTIBACTERIALS
DIURETIC COMBINATIONS
BLOCKER/ANTILIPEMIC
COMBINATIONS
§ CEPHALOSPORINS
§ ANTIFUNGALS
§ HMG-CoA REDUCTASE
§ DIGITALIS GLYCOSIDES
INHIBITORS
§ DIURETICS
§ ERYTHROMYCINS/
MACROLIDES
ANTIVIRALS
§ ACE INHIBITOR/CALCIUM
CHANNEL BLOCKERS
§ HERPES AGENTS
NIACINS/COMBINATIONS
ANGIOTENSIN II
§ INFLUENZA AGENTS
RECEPTOR ANTAGONISTS/
§ FLUOROQUINOLONES
COMBINATIONS
§ BETA-BLOCKERS
CENTRAL NERVOUS
CARDIOVASCULAR
ANTILIPEMICS
metoprolol succinate ext-relnadolol ANTIDEPRESSANTS
§ PENICILLINS
§ ACE INHIBITORS
§ BILE ACID RESINS
§ MISCELLANEOUS AGENTS
CHOLESTEROL ABSORPTION
§ CALCIUM CHANNEL
INHIBITORS
§ TETRACYCLINES
BLOCKERS
nifedipine 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 www.caremark.com or contact a CVS Caremark Customer Care representative.
§ SELECTIVE SEROTONIN
INCRETIN MIMETIC
§ TRIPHASIC
GENITOURINARY
LEUKOTRIENE RECEPTOR
REUPTAKE INHIBITORS
ANTAGONISTS
§ BENIGN PROSTATIC
§ EXTENDED CYCLE
HYPERPLASIA
INSULINS
NASAL ANTIHISTAMINES
CONTINUOUS
§ NASAL STEROIDS
§ SEROTONIN
§ URINARY
TRANSDERMAL
NOREPINEPHRINE
ANTISPASMODICS
REUPTAKE INHIBITORS
INSULIN SENSITIZERS
(SNRIs) 2
STEROID/BETA AGONISTS
INSULIN SENSITIZER/
BIGUANIDE
ESTROGENS
COMBINATIONS
STEROID INHALANTS
§ HYPNOTICS,
INSULIN SENSITIZER/
NONBENZODIAZEPINES
SULFONYLUREA
COMBINATIONS
§ TRANSDERMAL,
HEMATOLOGIC
MIGRAINE
MEGLITINIDES
ESTROGENS
§ ANTICOAGULANTS
§ SELECTIVE SEROTONIN
DERMATOLOGY
AGONISTS
§ SULFONYLUREAS
RESPIRATORY
§ ORAL ESTROGEN/
ANAPHYLAXIS
PROGESTINS
SELECTIVE SEROTONIN
§ SULFONYLUREA/
TREATMENT AGENTS
AGONIST/NONSTEROIDAL
BIGUANIDE
ANTI-INFLAMMATORY
COMBINATIONS
DRUG (NSAID)
§ ANTICHOLINERGICS
COMBINATIONS
SUPPLIES
§ PROGESTINS
§ ANTICHOLINERGIC/
ENDOCRINE AND
BETA AGONISTS
METABOLIC
SELECTIVE ESTROGEN
OPHTHALMIC
RECEPTOR MODULATORS
ANDROGENS
§ BETA-BLOCKERS,
NONSELECTIVE
CALCIUM REGULATORS
§ THYROID SUPPLEMENTS
§ ANTIHISTAMINES,
ANTIDIABETICS
§ BISPHOSPHONATES
NONSEDATING
BETA-BLOCKERS,
§ BIGUANIDES
SELECTIVE
GASTROINTESTINAL
§ ANTIHISTAMINE/
DECONGESTANTS
2 RECEPTOR
PROSTAGLANDINS
DIPEPTIDYL PEPTIDASE-4
§ CALCITONINS
ANTAGONISTS
(DPP-4) INHIBITORS
PARATHYROID HORMONES
BETA AGONISTS
§ PROTON PUMP
§ SHORT ACTING
§ SYMPATHOMIMETICS
DIPEPTIDYL PEPTIDASE-4
INHIBITORS
CONTRACEPTIVES
(DPP-4) INHIBITOR/
§ MONOPHASIC
BIGUANIDE
COMBINATIONS
LONG ACTING
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.
QUICK REFERENCE DRUG LIST
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.
PREFERRED ALTERNATIVES LIST
DRUG NAME
PREFERRED ALTERNATIVE(S)*
DRUG NAME
PREFERRED ALTERNATIVE(S)*
estradiol, CLIMARA, ESTRADERM, VIVELLE-DOT estradiol, CLIMARA, ESTRADERM, VIVELLE-DOT estradiol, CLIMARA, ESTRADERM, VIVELLE-DOT pravastatin, simvastatin, CRESTOR, LIPITOR clindamycin solution, erythromycin solution estradiol-norethindrone, PREMPHASE, PREMPRO estradiol, estropipate, ENJUVIA, PREMARIN estradiol-norethindrone, PREMPHASE, PREMPRO ACCU-CHEK STRIPS AND KITS4, ONETOUCH STRIPS ACCU-CHEK STRIPS AND KITS4, ONETOUCH STRIPS clindamycin solution, erythromycin solution, estradiol, estropipate, ENJUVIA, PREMARIN erythromycin-benzoyl peroxide, tretinoin, BENZACLIN, estradiol, CLIMARA, ESTRADERM, VIVELLE-DOT DIFFERIN, DUAC CS, RETIN-A MICRO, ZIANA clindamycin solution, erythromycin solution, erythromycin-benzoyl peroxide, tretinoin, BENZACLIN, DIFFERIN, DUAC CS, RETIN-A MICRO, ZIANA citalopram, fluoxetine, paroxetine, paroxetine ext-rel, clindamycin solution, erythromycin solution, erythromycin-benzoyl peroxide, tretinoin, BENZACLIN, DIFFERIN, DUAC CS, RETIN-A MICRO, ZIANA ACCU-CHEK STRIPS AND KITS4, ONETOUCH STRIPS AND KITS4 clindamycin solution, erythromycin solution, erythromycin-benzoyl peroxide, tretinoin, BENZACLIN, estradiol-norethindrone, PREMPHASE, PREMPRO DIFFERIN, DUAC CS, RETIN-A MICRO, ZIANA doxazosin, terazosin, FLOMAX doxazosin, terazosin, FLOMAX estradiol, estropipate, ENJUVIA, PREMARIN clindamycin solution, erythromycin solution, erythromycin-benzoyl peroxide, tretinoin, BENZACLIN, DIFFERIN, DUAC CS, RETIN-A MICRO, ZIANA * The preferred alternative products in this list are a broad representation within therapeutic categories of available treatment options and do not necessarily represent clinical equivalency. Your specific prescription benefit plan design may not cover certain products, regardless of their appearance in this document. For specific information, visit www.caremark.com or contact
a CVS Caremark Customer Care representative.
DRUG NAME
PREFERRED ALTERNATIVE(S)*
DRUG NAME
PREFERRED ALTERNATIVE(S)*
ACCU-CHEK STRIPS AND KITS4, ONETOUCH STRIPS ACCU-CHEK STRIPS AND KITS4, ONETOUCH STRIPS doxazosin, terazosin, FLOMAX clindamycin solution, erythromycin solution, clindamycin solution, erythromycin solution, erythromycin-benzoyl peroxide, tretinoin, BENZACLIN, erythromycin-benzoyl peroxide, tretinoin, BENZACLIN, DIFFERIN, DUAC CS, RETIN-A MICRO, ZIANA DIFFERIN, DUAC CS, RETIN-A MICRO, ZIANA * The preferred alternative products in this list are a broad representation within therapeutic categories of available treatment options and do not necessarily represent clinical equivalency.
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. Any brand drug for which a generic product becomes available may be designated as a non-preferred product. 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 intherapeutic categories are for representational purposes only. This is not an all-inclusive list. 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 copay information for a specific medicine.
§ Generics are available in this class and should be considered the first line of prescribing.
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.
2 Indicates the proposed mechanism of action, based on the American Psychiatric Association Summary of Treatment Recommendations.
3 Higher copays may apply depending on the plan participant’s specific prescription benefit plan. Log in to www.caremark.com to find the copay under a specific plan.
4 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 or OneTouch. For more
information on how to obtain a blood glucose meter, call toll-free: 1-800-588-4456. Plan participants must have CVS Caremark Mail Service Pharmacy benefits to qualify.
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.
2010 Caremark Rx, L.L.C. All rights reserved. 15045-1-0110 www.caremark.com

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