Alll 1JTIUN BfiOWAHD COUNl Y Mf]VH3L HS c ca tamaranmiddotmiddot

The following is a brief overview of your p l1armacy be nef it To he lp keep your costs lower

Broward pays a port ion of t he cost and you pay t l1e rest

Table 1 You can choose from three copayment and three prescription-fill methods

Copayments 1 Prescription-Fill Methods

ller Retail Up to a 30-day supply

9~DayatRetail Program Up to a 90-day supply

Mall Up to a 90-day supply

1 Generics generally have the lowest copayment $5 $10 $10

2 Preferred bra nds brand-name medications on the PML $25 $50 $50

3 Non-preferred brands brand-name medications not on the PML

$40 $80 $80

Getting Your Prescriptions Filled 30-Day Supply Nationwide Pharmacy Network You have access to more than 62000 chain and independent pharmacies including

bull Walgreens bull Target bull Costco bull The Medicine Shoppe bull CVS bull Walmart bull Publix Super Markets bull Winn-Dixie Stores Inc

Inc

90-Day Supply Convenient Mail Service Pharmacy Catamaran mail service is an easy way to receive up to a 90-day supply of your maintenance medication delivered by mail to your door Standard shipping is free Orders are shipped in confidential tamper-evident packaging f rom Catamaran mail service pharmacies

Convenient 90-day at Retail Program This program allows you to obtain a 90-day supply of your maintenance medication at any of more than 45000 participating commun ity pharmacies

Diabet ic Supplies Receive all of your prescribed diabetic therapy and supplies (eg meters lancets test strips insulin needles and syringes) for one copayment when you fill a ll of your diabetic therapy and supplies on the same day

Specialty Medications Certain medication used for treating complex health conditions must be obtained through BriovaRx Specialty Pharmacy The following condit ions may require medications that fall under Specialty Pharmacy which include but are not limited to

bull Crohns Disease bull Growth Hormone Deficiency bull HIV AIDS bull Oral Oncology bull PsoriasisPsoriatic Arthritis bull Rheumatoid Arthritis bull Respiratory Syncytial Virus (RSV) bull Vira l Hepatitis

Call BriovaRx at (800) 850-9122 for additional details

mycatamaranrxcom Find answers on mycatamaranrxoom with features designed so you can

bull Check your benefit coverage and copays bull Find a loca l network pharmacy bull Find generic and formulary alternatives bull Learn more about your medication

Catalyst Customer care Center If you have a question about your pharmacy benefit call the Catalyst Rx Customer Care Center toll-free at (855) 356-3216 24 hours a day 7 days a week TTY (888) 411-0767

copy 2012 Catamaran Corp and its affiliated companies

Members will be required to pay the difference in cost between a brand and generic drug if the member requests a brand when a generic equiva lent is available The Catamaran PML is a list of medicatio ns preferred by your plan that can help you maximize your pharmacy benefit by minimizing yo ur prescription costs You can view the PML online by

visiting n~tamaranrxcont

Third and subsequent fills of maintenance medications must be transitioned to the 90-day at retail program or mail service

I

C catamaranmiddotmiddot

Advantage Formulary Preferred Drug List

- January 2013 shy

The CatamaranTM Preferred Drug List is a guide identifying preferred brand-name medicines within select therapeutic categories The Preferred Drug List may not include all drugs covered by your prescription drug benefit Generic medicines are available within many of the therapeutic categories listed in addition to categories not listed and should be considered as the first line of prescribing Generics listed are for representational purposes only Branded products are listed in CAPS and generic products in lowercase italics

For benefit coverage or restrictions please check your benefit plan document(s) This listing is revised periodically as new drugs and new prescribing information becomes available It is recommended that you bring this list of medications when you or a covered family member sees a physician or other healthcare provider

ORAL ANTI-INFECTIVES (ANTIFUNGALS ANTIBIOTICS)

ANTIFUNGALS fluconazole itraconazote ketoconazote terbinaflne LAMISIL GRANULES NOXAFIL SPORANOX SOLUTION

CEPHALOSPORINS cefactor cefdinir cephalexin CEFTIN SUSPENSION

PENICILLINS amoxicillin amoxicillinjclavulanate penicillinvk AUGMENTIN SUSPENSION

QUINOLONES clprofloxacin ciprofloxacin ER tevofloxacin AVELOX AVELOX ABC CIPRO SUSPENSION

TETRACYCLINES doxycycline mlnocycline VIBRAMYCIN SUSPENSION

ANHINFLAMMATORY

NSAIDS ibuprofen meloxicam naproxen VIMOVO

COX-2 INHIBITORS CELEBREX

AUTO-IMMUNE

ENBREL HUMIRA

catamaran Preferred Drug List - Effective January 1 2013

CARDIOVASCULAR (BLOOD PRESSURE HEART CHOLESTEROL)

ACE-INHIBITORS fosinopril isinopril quinapril ramipril

ANGIOTENSIN II RECEPTOR BLOCKERSRENIN INHIBITORSRELATED DRUGS irbesartan losartan losartan-hct valsartan valsartan-hct AMTURNIOE MICARDIS MICARDIS HCT TEKAMLO TEKTURNA TEKTURNA HCT VALTURNA

BETA BLOCKERS atenolol carvedilol metoprool metoprolol ER COREG CR SYSTOLIC

CALCIUM BLOCKERS amlodipine diltiazern ER nifedipine ER verapamil ER

NITRATES amp NITRITES isosoroide dinitrate nitroglycerin DILATRATE SR NITRO-OUR NITROLINGUAL PUMPSPRAY NITROSTAT

ANTIHYPERTENSIVE COMBINATIONS lisinopril-hct trandolapril-verapamil BIDIL TARKA AZOR EXFORGE EXFORGE HCT TRIBENZOR TWYNSTA

ANTILIPEMICS HMG-COA REDUCTASE INHIBITORS atorvastatin lovastatin pravastatin simvastatin ALTOPREVCRESTOR

FIBRATES fenofibrate LIPOFEN

BILE ACID SEQUESTRANTS cholestyramine WELCHQL

CHOLESTEROL ABSORPTION INHIBITORRELATED DRUGS ZETIA VYTORIN

NIACINNIACIN COMBINATIONS NIASPAN SIMCOR

OMEGA-3 FATIY ACIDS LOVAZA

DERMATOLOGICALS

ACNE adapalene clindamycin tretinoin ACANYA ACZONE ATRALIN AZELEX BENZACLIN BENZACLIN CARE KIT BENZACLIN W PUMP DIFFERIN DUAC EPIDUO FINACEA METROGEL ORACEA TAZORAC VELTIN

TOPICAL ANTIINFLAMMATORY AGENTS clobetasol halobetasol hydrocortisone acetate triamcinolone ANUSOL-HC CREAM CAPEX CLOBEX CORDRAN TAPE CORTIFOAM HALOG KENALOG SPRAY LOCOID LIPOCREAM LOCOID LOTION PRAMOSONE

DIABETIC SUPPLIES

ACCU-CHECK FASTTAKE ONETOUCH SURESTEP INSULIN SYRINGES LANCETS PEN NEEDLES

ENDOCRINE (CONTRACEPTIVES HORMONES DIABETES)

CONTRACEPTIVE AGENTS ethinyl estradio-norgestimate levonorgestrel medroxyprogesterone acetate BEYAZ CRINONE DEPO-PROVERA ELLA ENDOMETRIN LOESTRIN 24 FE LO LOESTRIN FE YAZ NATAliA NUVARING SAFYRAL

ESTROGENSESTROGEN COMBINATIONS estradiol estradiol-norethindrone acetate CENESTIN CLIMARA COMBIPATCH ENJUVIA ESTRACE CREAM ESTRING EVAMIST PREMARIN TABLETS PREMPHASE PREMPRO VAGIFEM VIVELLE-DOT

TESTOSTERONE AGENTS testosterone cypionate testosterone enanthate ANDROGEL ANDROXY METHITEST

INSULIN APIDRALANTUS NOVOLIN NOVOLOG

NON-INSULIN HYPOGLYCEMIC AGENTS BIGUANIDETHIAZOLIDINEDIONE (TZDs) pioglitazone poglitazone-metforrnin

SULFONYLURWTZDs COMBINATIONS DUETACT

DIPEPTIDYL PEPTIDASE-41NHIBITORS (DPP-4) JANUVIA ONGLYZA TRADJENTA

DPP-4HMG-COA REDUCTASE INHIBITOR COMBINAllONS JUVISYNC

BIGUANIDES metforrnin metforrnin ER RIOMET

BIGUANIDEDPP-4 COMBINATIONS JANUMET JANUMET XR JENTADUETO KOMBIGLVZE XR

BIGUANIDESULFONYLUREA COMBINATIONS gipizide-metforrnln

BIGUANIDE INSUUN SECRETAGOGUE COMBINAllONS PRANDIMET

INCRETIN MIMETICS BYDUREON BYETTA

AMYUN ANALOGS SYMLIN

ANTIHYPOGLYCEMIC AGENTS GLUCAGON

SULFONYLUREAS glimiperide gipizide glipizide ER

214-091312-4 2012 catamaran Inc All rights reserved catamaran Is a registered trademark of catamaran Inc

C catamaran

GASTROINTESTINAL

PROTON PUMP INHIBITORS lansoprazole omeprazole pantoprazole NEXIUM

ULCER DRUGS nizatidine sucralfate AXID SOLUTION CARAFATE SUSPENSION PYLERA

GROWTH HORMONE

NORDITROPIN NUTROPIN

HEPATITIS C

ANTNIRALS ribavirin RIBAPAK

INTERFERONS PEGASYS PEG-INTRON

PROTEASE INHIBITORS INCIVEK VICTRELIS

MULTIPLE SCLEROSIS

AMPYRA AVON EX COPAXONE REBIF

NEUROLOGICALS

ALZHEIMERS DISEASE donepezil rivastigmine EXELON PATCH NAMENDA

ANTICONVULSANTSANTISEIZURE carbamazepine carbamazepine ER divalproex gabapentin lamotrigine levetiracetam levetiracetam ER oxcarbazepine BANZEL CELONTIN DIASTAT PEDIATRIC DILANTIN INFATABS GABITRIL LAMICTAL ODT LAMICTAL STARTER KIT LAMICTAL XR LYRICA PEGANONE TEGRETOL XR TRILEPTAL SUSPENSION VIMPAT

MIGRAINEHEADACHE naratriptan sumatriptan CAFERGOT ERGOMAR MAXALT RELPAX

OPHTHALMIC$

ANTI-ALLERGIC AGENTS azelastine ketotifen PATADAY PATANOL

ANTI-GLAUCOMA AGENTS betaxolol brimonidine latanoprost ALPHAGAN P AZOPT BETOPTIC-S COMBIGAN LUMIGAN TRAVATAN Z

ANTI-INFECTIVES ciprofloxacin ofloxacin tobramycin BESIVANCE CILOXAN MOXEZA NATACYN TOBREX VIGAMOX ZYMAXID

ANTI-INFLAMMATORY AGENTS cromolyn sodium diclofenac sodium ketorolac ACUVAIL BROMDAY NEVANAC

Catamaran Preferred Drug List- Effective January 1 2013

CORllCOSTEROIDSRELATED AGENTS prednisolone acetate tobramycindexmethasone ALREX BLEPHAMIDE SOP DUREZOL FML LOTEMAX OZURDEX PREO MILD RETISERT TOBRADEX TOBRADEX ST ZYLET

MIOTICS pilocarpine ISOPTO CARBACHOL PHOSPHOLINE IODINE PILOPINE HS

MISCELLANEOUS LACRISERT RESTASIS

OSTEOPOROSIS THERAPY

BISPHOSPHONATES alendronate ibandronate FOSAMAX PLUS D

SELECTIVE ESTROGEN RECEPTOR MODULATOR EVISTA

PSYCHOTHERAPEUTICS

ATYPICAL ANTIPSYCHOTICS clozapine olanzapine quetiapine risperidone ziprasidone ABILIFY CLOZARIL LATUDA SEROQUEL XR

CNS STIMULANTS amphetamine-dextroamphetamine methylphenidate methylphenidate ER DAYTRANA INTUNIV METADATE CD VYVANSE

SNRI ANTIDEPRESSANTS venlafaxine venlafaxine ER CYMBALTA PRISTIQ

SSRI ANTIDEPRESSANTS citalopram escitalopram fluoxetine paroxetine paroxetine ER sertraline PAXIL SUSPENSION

RESPIRATORY

ANAPHYLAXIS TREATMENT AGENTS EPIPEN lWINJECT

ANTICHOLIN ERGICS ipratropium ATROVENT HFA SPIRIVA

ANTICHOLINERGICBETA AGONIST COMBINATIONS ipratropium-albuterol COMBIVENT

BETA AGONIST BRONCHODILATORS albuterol levalbuterol solution FORADIL PERFOROMIST PROAIR SEREVENT VENTOLIN HFA

LEUKOTRIENE RECEPTOR ANTAGONISTS montelukast zafirlukast PULMONARY CORTICOSTEROIDS budesonide ALVESCO ASMAN EX PULMICORT QVAR

NASAL ANTIHISTAMINES azelastine ASTEPRO ASTELIN

NASAL CORTICOSTEROIDS fluticasone triamcinolone NASONEX

STEROIDBETA AGONIST COMBINATIONS ADVAIR DULERA SYMBICORT

UROLOGICALS

BENIGN PROSTATIC HYPERPLASIA (BPH) finasteride tamsulosin RAPAFLO

URINARY ANTISPASMODICS oxybutynin oxybutynin ER tolterodine DETROL LA ENABLEX GELNIQUE OXYTROL SANCTURA XR TOVIAZ VESICARE

Formulary Disclaimer Coverage for some drugs may be limited to specific dosage forms andor strengths The benefit design determines what is covered and the applicable co-payment The

medications listed on this formulary are subject to change pursuant to the formulary management activities of Catamaran The presence ofa medication on this formulary list does not guarantee coverage

214-091312-4 10 2012 Catamaran Inc All rights reserved Catamaran is a registered trade mark of Catamaran Inc

C catamaran

GASTROINTESTINAL

PROTON PUMP INHIBITORS lansoprazole omeprazole pantoprazole NEXIUM

ULCER DRUGS nizatidine sucralfate AXID SOLUTION CARAFATE SUSPENSION PYLERA

GROWTH HORMONE

NORDITROPIN NUTROPIN

HEPATITIS C

ANTNIRALS ribavirin RIBAPAK

INTERFERONS PEGASYS PEG-INTRON

PROTEASE INHIBITORS INCIVEK VICTRELIS

MULTIPLE SCLEROSIS

AMPYRA AVON EX COPAXONE REBIF

NEUROLOGICALS

ALZHEIMERS DISEASE donepezil rivastigmine EXELON PATCH NAMENDA

ANTICONVULSANTSANTISEIZURE carbamazepine carbamazepine ER divalproex gabapentin lamotrigine levetiracetam levetiracetam ER oxcarbazepine BANZEL CELONTIN DIASTAT PEDIATRIC DILANTIN INFATABS GABITRIL LAMICTAL ODT LAMICTAL STARTER KIT LAMICTAL XR LYRICA PEGANONE TEGRETOL XR TRILEPTAL SUSPENSION VIMPAT

MIGRAINEHEADACHE naratriptan sumatriptan CAFERGOT ERGOMAR MAXALT RELPAX

OPHTHALMIC$

ANTI-ALLERGIC AGENTS azelastine ketotifen PATADAY PATANOL

ANTI-GLAUCOMA AGENTS betaxolol brimonidine latanoprost ALPHAGAN P AZOPT BETOPTIC-S COMBIGAN LUMIGAN TRAVATAN Z

ANTI-INFECTIVES ciprofloxacin ofloxacin tobramycin BESIVANCE CILOXAN MOXEZA NATACYN TOBREX VIGAMOX ZYMAXID

ANTI-INFLAMMATORY AGENTS cromolyn sodium diclofenac sodium ketorolac ACUVAIL BROMDAY NEVANAC

Catamaran Preferred Drug List- Effective January 1 2013

CORllCOSTEROIDSRELATED AGENTS prednisolone acetate tobramycindexmethasone ALREX BLEPHAMIDE SOP DUREZOL FML LOTEMAX OZURDEX PREO MILD RETISERT TOBRADEX TOBRADEX ST ZYLET

MIOTICS pilocarpine ISOPTO CARBACHOL PHOSPHOLINE IODINE PILOPINE HS

MISCELLANEOUS LACRISERT RESTASIS

OSTEOPOROSIS THERAPY

BISPHOSPHONATES alendronate ibandronate FOSAMAX PLUS D

SELECTIVE ESTROGEN RECEPTOR MODULATOR EVISTA

PSYCHOTHERAPEUTICS

ATYPICAL ANTIPSYCHOTICS clozapine olanzapine quetiapine risperidone ziprasidone ABILIFY CLOZARIL LATUDA SEROQUEL XR

CNS STIMULANTS amphetamine-dextroamphetamine methylphenidate methylphenidate ER DAYTRANA INTUNIV METADATE CD VYVANSE

SNRI ANTIDEPRESSANTS venlafaxine venlafaxine ER CYMBALTA PRISTIQ

SSRI ANTIDEPRESSANTS citalopram escitalopram fluoxetine paroxetine paroxetine ER sertraline PAXIL SUSPENSION

RESPIRATORY

ANAPHYLAXIS TREATMENT AGENTS EPIPEN lWINJECT

ANTICHOLIN ERGICS ipratropium ATROVENT HFA SPIRIVA

ANTICHOLINERGICBETA AGONIST COMBINATIONS ipratropium-albuterol COMBIVENT

BETA AGONIST BRONCHODILATORS albuterol levalbuterol solution FORADIL PERFOROMIST PROAIR SEREVENT VENTOLIN HFA

LEUKOTRIENE RECEPTOR ANTAGONISTS montelukast zafirlukast PULMONARY CORTICOSTEROIDS budesonide ALVESCO ASMAN EX PULMICORT QVAR

NASAL ANTIHISTAMINES azelastine ASTEPRO ASTELIN

NASAL CORTICOSTEROIDS fluticasone triamcinolone NASONEX

STEROIDBETA AGONIST COMBINATIONS ADVAIR DULERA SYMBICORT

UROLOGICALS

BENIGN PROSTATIC HYPERPLASIA (BPH) finasteride tamsulosin RAPAFLO

URINARY ANTISPASMODICS oxybutynin oxybutynin ER tolterodine DETROL LA ENABLEX GELNIQUE OXYTROL SANCTURA XR TOVIAZ VESICARE

Formulary Disclaimer Coverage for some drugs may be limited to specific dosage forms andor strengths The benefit design determines what is covered and the applicable co-payment The

medications listed on this formulary are subject to change pursuant to the formulary management activities of Catamaran The presence ofa medication on this formulary list does not guarantee coverage

214-091312-4 10 2012 Catamaran Inc All rights reserved Catamaran is a registered trade mark of Catamaran Inc