Prmt-102anp-05 - a.n.p.0410.5.qxd

The following is a list of the most commonly prescribed generic and brand-name drugs included
on the 2005 Express Scripts National Preferred Drug List. This is not a complete list of all
prescription drugs on the preferred drug list or covered under the Empire Plan.
specific questions about your prescriptions, coverage and copayments, please call The EmpirePlan Prescription Drug Program toll free at 1-877-7-NYSHIP (1-877-769-7447). Members areencouraged to ask their doctor to prescribe generic versions of brand-name drugs wheneverappropriate as this will result in a lower copayment.
Prescription Drug Program PLEASE NOTE: The symbol * next to a brand-name drug signifies non-preferred status
when a generic version is available, and mandatory generic substitution will apply.
2005 Express Scripts National Preferred Drug List
Utilization of non-preferred prescription drugs will result in the member paying a higher
copayment.
THIS DOCUMENT IS EFFECTIVE JANUARY 1, 2005 THROUGH DECEMBER 31, 2005. THIS LIST IS SUBJECT TO CHANGE.
The symbol [G] next to a drug name signifies that a generic is available for one or more strengths of the brand medication. Generic versions of brand drugs are available at the lowest copayment.
You can get more information about your prescription drug benefits by calling The Empire Plan Prescription Drug Program toll free at 1-877-7 NYSHIP (1-877-769-7447).
This document is on the New York State Department of Civil Service Web site at www.cs.state.ny.us. Click on Employee Benefits and choose your group-specific benefits.
2005 Express Scripts, Inc.
PRMT-102ANP-05 (10/04)
All Rights Reserved
Examples of Non-Preferred Brand Name Drugs
with 2005 Express Scripts National Preferred Drug List Alternatives
The following is a list of some non-preferred medications that are covered under your benefit but require a higher copayment with examples of alternative generic and brand drugs included on the Express Scripts National Preferred Drug List.
Column 1 lists examples of non-preferred brand drugs.
Column 2 lists selected 2005 Express Scripts National Preferred Drug List alternatives requiring a lower copayment.
Non-Preferred
Express Scripts National
Non-Preferred
Express Scripts National
Preferred Drug List Alternatives
Preferred Drug List Alternatives
benazepril, enalapril, fosinopril, lisinopril, benazepril, enalapril, fosinopril, lisinopril, benazepril, enalapril, fosinopril, lisinopril, Abilify, Risperdal (non M-Tab), Seroquel, albuterol inh, Maxair Auto, Proventil HFA The symbol [G] next to a drug name indicates that a generic is available for at least one or more strengths of the brand medication.
The symbol [INJ] next to a drug name indicates that the drug is available in injectable form only.
The symbol [PA] next to a drug name indicates that prior authorization is required.
The symbol [SNRI] stands for Serotonin-Norepinephrine Reuptake Inhibitor.
For the member: Generic medications contain the same active ingredients as their corresponding brand name medications,
although they may look different in color or shape. They have been FDA-approved under strict standards.
For the physician: Please prescribe preferred products and allow generic substitutions when medically appropriate. Thank you.
Brand name drugs are listed in CAPITAL letters.
Generic drugs are listed in lower case letters.
THIS DOCUMENT IS EFFECTIVE JANUARY 1, 2005 THROUGH DECEMBER 31, 2005. THIS LIST IS SUBJECT TO CHANGE.
The symbol [G] next to a drug name signifies that a generic is available for one or more strengths of the brand medication. Generic versions of brand drugs are available at the lowest copayment.
You can get more information about your prescription drug benefits by calling The Empire Plan Prescription Drug Program toll free at 1-877-7 NYSHIP (1-877-769-7447).
This document is on the New York State Department of Civil Service Web site at www.cs.state.ny.us. Click on Employee Benefits and choose your group-specific benefits.
2005 Express Scripts, Inc.
PRMT-102ANP-05 (10/04)
All Rights Reserved

Source: http://www.pef.org/archive/healthbenefits/pdffiles/prmt102anp0504104.pdf