colestipol tab LIVALO TAB ezetimibe tab LOPID TAB ezetimibe/simvastatin tab LOVAZA CAP fenofibrate cap 67mg, 134mg, 200mg MEVACOR TAB fenofibrate tab 48mg, 54mg, 145mg, NIASPAN ER TAB 160mg PRAVACHOL TAB fenofibric acid DR cap QUESTRAN LITE POWDER / PACK fluvastatin cap QUESTRAN POWDER / PACK fluvastatin ER tab TRICOR TAB gemfibrozil tab VASCEPA CAP icosapent ethyl cap VYTORIN TAB lovastatin tab* WELCHOL PACK / TAB niacin ER tab ZOCOR TAB omega-3-acid ethyl esters cap pravastatin tab* rosuvastatin tab* simvastatin tab* OSTEOPOROSIS (BONE DISEASE) Tier 1 Tier 2 Tier 3 alendronate sodium oral soln ALENDRONATE TAB 40mg ACTONEL TAB alendronate tab FORTICAL NASAL SPRAY ATELVIA TAB calcitonin nasal spray NATPARA INJ BONIVA TAB 150mg ibandronate tab 150mg TERIPARATIDE INJ FOSAMAX TAB risedronate DR tab TYMLOS INJ SKELID TAB *This drug is also on the ACA List ($0 copay). Page 10 of 10