Enhanced zero dollar drug list
Effective July 1, 2023
The Enhanced Zero Doller Drug List includes drugs on our Value Formulary offered at no cost share.
This list is not a complete list and does not contain any prior authorization, step therapy or quantity level limit requirements. Refer to your respective formulary for a complete list of drugs on our drug page.
Drug names(s) |
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| alendronate sodium | alendronate sodium (QLL) | aliskiren |
| amitriptyline hydrochloride | amlodipine besylate/benazepril hydrochloride | amlodipine besylate/valsartan |
| aripiprazole | atorvastatin calcium (QLL) | azasan |
| azathioprine | benazepril hydrochloride | benazepril hydrochloride/hydrochlorothiazide |
| bupropion hydrochloride | bupropion hydrochloride er (sr) | bupropion hydrochloride er (xl) |
| calcitonin salmon | captopril | chlorpromazine hydrochloride |
| citalopram | citalopram hydrobromide | clomipramine hydrochloride |
| clozapine | desipramine hydrochloride | desvenlafaxine er |
| doxepin hydrochloride | duloxetine hydrochloride | enalapril maleate |
| enalapril maleate/hydrochlorothiazide | escitalopram oxalate | fluoxetine hydrochloride |
| fluphenazine hydrochloride | fluvoxamine maleate | fosinopril sodium |
| glimepiride | glipizide | glipizide er |
| glipizide xl | glyburide | haloperidol |
| ibandronate sodium (QLL) | imipramine hydrochloride | irbesartan |
| irbesartan/hydrochlorothiazide | lisinopril | lisinopril/hydrochlorothiazide |
| lithium carbonate | losartan potassium | losartan potassium/hydrochlorothiazide |
| loxapine | loxapine succinate | metformin hydrochloride |
| metformin hydrochloride er (QLL) | mirtazapine | nateglinide |
| nortriptyline hydrochloride | olanzapine (QLL) | olmesartan medoxomil |
| paliperidone er (QLL) | paroxetine hydrochloride | perphenazine |
| pioglitazone hydrochloride | protriptyline hydrochloride | quetiapine fumarate |
| quetiapine fumarate er (QLL) | quinapril hydrochloride | ramipril |
| risperidone | rosuvastatin calcium (QLL) | sertraline hydrochloride |
| simvastatin (QLL) | sulfasalazine | thiothixene |
| trazodone hydrochloride | trazodone hydrochloride (PA) | trifluoperazine hydrochloride |
| valsartan | valsartan/hydrochlorothiazide | venlafaxine hydrochloride |
| venlafaxine hydrochloride er | ziprasidone hydrochloride | |