HSA Preventive Drug List

2024 EpiphanyRx Preventive Drug List (4/1/2024) Your employer is working to reduce your health care costs by giving you tools to help you stay healthy and productive. The preventive medications below help protect against or manage some high-risk medical conditions. Taking these medications as directed by your prescriber can help avoid serious health problems. That may mean fewer doctor visits and hospitalizations, reducing your total health care costs. In the drug list below, generic drugs are shown in lowercase type. Brand name drugs are shown in uppercase type. ASTHMA AND OTHER RESPIRATORY CONDITIONS Tier 1 Tier 2 Tier 3 albuterol HFA inhaler ADVAIR HFA INHALER ACCOLATE TAB albuterol neb soln ALVESCO INHALER ACCUNEB NEB SOLN albuterol sulfate tab ANORO ELLIPTA INHALER ADVAIR DISKUS INHALER albuterol sulfate syrup ATROVENT HFA INHALER BROVANA NEB SOLN albuterol/ipratropium neb soln BREO ELLIPTA INHALER DALIRESP TAB aminophylline tab BREZTRI AEROSPHERE INHALER DUONEB NEB SOLN arformoterol tartrate neb soln COMBIVENT INHALER FLOVENT DISKUS INHALER ARNUITY ELLIPTA INHALER COMBIVENT RESPIMAT INHALER FLOVENT HFA INHALER ASMANEX HFA INHALER DULERA INHALER LEVALBUTEROL INHALER, XOPENEX ASMANEX INHALER ELIXOPHYLLIN ELIXIR HFA budesonide inh susp INCRUSE ELLIPTA INHALER LUFYLLIN TAB budesonide/formoterol inhaler LONHALA MAGNAIR SOLN PERFOROMIST NEB SOLN FLUTICASONE PROPIONATE DISKUS INHALER QVAR REDIHALER PULMICORT INH SUSP FLUTICASONE HFA INHALER SEREVENT DISKUS INHALER SINGULAIR CHEW TAB FLUTICASONE/SALMETEROL INHALER SPIRIVA RESPIMAT INHALER 1.25MCG SINGULAIR GRANULE PACK fluticasone/salmeterol inhaler, wixela STIOLTO INHALER SINGULAIR TAB formoterol fumarate neb soln THEOPHYLLINE ER TAB STRIVERDI RESPIMAT INHALER ipratropium neb soln TRELEGY ELLIPTA INHALER SYMBICORT INHALER levalbuterol neb soln THEO-24 CAP montelukast chew tab VOSPIRE ER TAB montelukast granule pack XOPENEX NEB SOLN