Cardiovascular Agents
Antihyperlipidemics, HMG-CoA Reductase Inhibitors

Brand/Generic Name Dosage/Strength Status Restrictions Notes Relative Cost
Advicor
niacin-lovastatin		 500-20 mg tablet, ER multiphase 24 hr; 750-20 mg tablet, ER multiphase 24 hr; 1,000-20 mg tablet, ER multiphase 24 hr; 1,000-40 mg tablet, ER multiphase 24 hr   nonform.gif (625 bytes)

ql.gif

Not Applicable
Altoprev
lovastatin		 20 mg tablet extended release 24 hr; 40 mg tablet extended release 24 hr; 60 mg tablet extended release 24 hr; 10 mg tablet extended release 24 hr   approved.gif (510 bytes)

ql.gif

$$$
Crestor
rosuvastatin		 10 mg tablet; 20 mg tablet; 40 mg tablet   approved.gif (510 bytes)

ql.gif

NOTES_restrict.gif (377 bytes)

$$$$
Crestor
rosuvastatin		 5 mg tablet   approved.gif (510 bytes)

ql.gif

NOTES_restrict.gif (377 bytes)

$$$$
Lescol generic.gif (400 bytes)
fluvastatin		 40 mg capsule; 20 mg capsule   nonform.gif (625 bytes)

ql.gif st.gif

Not Applicable
Lescol XL generic.gif (400 bytes)
fluvastatin		 80 mg tablet extended release 24 hr   nonform.gif (625 bytes)

ql.gif st.gif

Not Applicable
Lipitor generic.gif (400 bytes)
atorvastatin		 80 mg tablet; 20 mg tablet; 40 mg tablet; 10 mg tablet   approved.gif (510 bytes)

ql.gif

$$$$$
Livalo
pitavastatin		 1 mg tablet; 2 mg tablet; 4 mg tablet   nonform.gif (625 bytes)

ql.gif st.gif

Not Applicable
Mevacor generic.gif (400 bytes)
lovastatin		 40 mg tablet; 20 mg tablet   approved.gif (510 bytes)  

$$
Pravachol generic.gif (400 bytes)
pravastatin		 tablet   approved.gif (510 bytes)  

$$
Pravigard Pac
Aspirin Buffered-Pravastatin		 Misc mg   nonform.gif (625 bytes)  

Not Applicable
Simcor
niacin-simvastatin		 1,000-40 mg tablet, ER multiphase 24 hr; 500-40 mg tablet, ER multiphase 24 hr   approved.gif (510 bytes)

ql.gif

$$$
Simcor
niacin-simvastatin		 500-20 mg tablet, ER multiphase 24 hr; 750-20 mg tablet, ER multiphase 24 hr; 1,000-20 mg tablet, ER multiphase 24 hr   approved.gif (510 bytes)

ql.gif

$$$
Zetia
ezetimibe		 10 mg tablet   nonform.gif (625 bytes)

ql.gif

Not Applicable
Zocor generic.gif (400 bytes)
simvastatin		 20 mg tablet; 10 mg tablet; 5 mg tablet; 40 mg tablet   approved.gif (510 bytes)

ql.gif

$$
Zocor generic.gif (400 bytes)
simvastatin		 80 mg tablet   approved.gif (510 bytes)

priorauth.gif (377 bytes) ql.gif

$$

Key for Product(s) Listed Above
Formulary Prior Authorization (PA may not be required for some benefit plans) Non-Formulary
(Third tier coverage applies for selected plans)		 Not Reimbursed
Quantity Limit Not available through mail order as 90-day supply* Step Therapy Generic Available. Brand name medication may be covered at a higher member cost or may not be covered for certain plans.
Notes $Relative cost compared to others in category Specialty distribution for selected plans (Fourth or fifth tier coverage applied for selected plans)

© 2002 Managed Markets Insight and Technology, LLC. All Rights Reserved