Cardiovascular Agents
Calcium Channel Blockers

Brand/Generic Name Dosage/Strength Status Restrictions Notes Relative Cost
Adalat CC
nifedipine		 90 mg tablet extended release; 60 mg tablet extended release; 30 mg tablet extended release   approved.gif (510 bytes)

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$$
Calan generic.gif (400 bytes)
verapamil		 80 mg tablet; 120 mg tablet   approved.gif (510 bytes)  

$
Calan SR generic.gif (400 bytes)
verapamil		 tablet extended release   approved.gif (510 bytes)  

$$
Cardene SR generic.gif (400 bytes)
nicardipine		 60 mg capsule, extended release; 30 mg capsule, extended release; 45 mg capsule, extended release   nonform.gif (625 bytes)  

Not Applicable
Cardizem generic.gif (400 bytes)
diltiazem HCl		 30 mg tablet; 120 mg tablet; 90 mg tablet; 60 mg tablet   approved.gif (510 bytes)  

$
Cardizem CD generic.gif (400 bytes)
diltiazem HCl		 240 mg capsule,extended release 24hr   approved.gif (510 bytes)

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$$$
Cardizem CD generic.gif (400 bytes)
diltiazem HCl		 360 mg capsule,extended release 24hr; 120 mg capsule,extended release 24hr   approved.gif (510 bytes)

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$$$
Cardizem CD generic.gif (400 bytes)
diltiazem HCl		 360 mg capsule,extended release 24hr; 300 mg capsule,extended release 24hr; 300 mg capsule,extended release 24hr; 180 mg capsule,extended release 24hr; 240 mg capsule,extended release 24hr; 120 mg capsule,extended release 24hr   approved.gif (510 bytes)

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$$$
Cardizem LA generic.gif (400 bytes)
diltiazem HCl		 120 mg tablet extended release 24 hr; 180 mg tablet extended release 24 hr; 240 mg tablet extended release 24 hr; 300 mg tablet extended release 24 hr; 300 mg tablet extended release 24 hr; 360 mg tablet extended release 24 hr; 420 mg tablet extended release 24 hr   nonform.gif (625 bytes)

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Not Applicable
Cardizem LA generic.gif (400 bytes)
diltiazem HCl		 120 mg tablet extended release 24 hr; 360 mg tablet extended release 24 hr; 420 mg tablet extended release 24 hr   nonform.gif (625 bytes)

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Not Applicable
Cardizem LA generic.gif (400 bytes)
diltiazem HCl		 240 mg tablet extended release 24 hr   nonform.gif (625 bytes)

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Not Applicable
Cardizem SR
diltiazem HCl		 capsule,extended release 12 hr   approved.gif (510 bytes)  

$$$
Cartia XT generic.gif (400 bytes)
diltiazem HCl		 300 mg capsule,extended release 24hr; 120 mg capsule,extended release 24hr; 240 mg capsule,extended release 24hr; 180 mg capsule,extended release 24hr   approved.gif (510 bytes)  

$$
Dilacor XR generic.gif (400 bytes)
diltiazem HCl		 240 mg capsule,ext release degradable   approved.gif (510 bytes)  

$$$
Diltia XT generic.gif (400 bytes)
diltiazem HCl		 120 mg capsule,ext release degradable; 180 mg capsule,ext release degradable; 240 mg capsule,ext release degradable   approved.gif (510 bytes)  

$$$
DynaCirc CR
isradipine		 10 mg tablet extended release 24hr   nonform.gif (625 bytes)

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Not Applicable
DynaCirc CR
isradipine		 5 mg tablet extended release 24hr   nonform.gif (625 bytes)

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Not Applicable
Isoptin generic.gif (400 bytes)
verapamil		 40 mg tablet; 120 mg tablet; 80 mg tablet   approved.gif (510 bytes)  

$
Isoptin SR generic.gif (400 bytes)
verapamil		 tablet extended release   approved.gif (510 bytes)  

$
Nimotop generic.gif (400 bytes)
nimodipine		 30 mg capsule   approved.gif (510 bytes)  

$$$$$
Norvasc generic.gif (400 bytes)
amlodipine		 10 mg tablet; 5 mg tablet; 2.5 mg tablet   approved.gif (510 bytes)  

$$
Plendil generic.gif (400 bytes)
felodipine		 10 mg tablet extended release 24 hr; 5 mg tablet extended release 24 hr; 2.5 mg tablet extended release 24 hr   approved.gif (510 bytes)

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$$
Procardia generic.gif (400 bytes)
nifedipine		 10 mg capsule   approved.gif (510 bytes)  

$
Procardia XL generic.gif (400 bytes)
nifedipine		 30 mg tablet extended release 24hr; 90 mg tablet extended release 24hr   approved.gif (510 bytes)

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$$$
Procardia XL generic.gif (400 bytes)
nifedipine		 60 mg tablet extended release 24hr   approved.gif (510 bytes)

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$$$
Sular generic.gif (400 bytes)
nisoldipine		 20 mg tablet extended release 24 hr; 40 mg tablet extended release 24 hr; 10 mg tablet extended release 24 hr; 8.5 mg tablet extended release 24 hr; 17 mg tablet extended release 24 hr; 25.5 mg tablet extended release 24 hr; 34 mg tablet extended release 24 hr   approved.gif (510 bytes)

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$$
Sular generic.gif (400 bytes)
nisoldipine		 30 mg tablet extended release 24 hr   approved.gif (510 bytes)

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$$
Sular generic.gif (400 bytes)
nisoldipine		 20 mg tablet extended release 24 hr; 40 mg tablet extended release 24 hr; 10 mg tablet extended release 24 hr; 8.5 mg tablet extended release 24 hr; 17 mg tablet extended release 24 hr; 25.5 mg tablet extended release 24 hr; 34 mg tablet extended release 24 hr   approved.gif (510 bytes)

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$$$
Sular
nisoldipine		 20 mg tablet extended release 24 hr; 40 mg tablet extended release 24 hr; 10 mg tablet extended release 24 hr; 8.5 mg tablet extended release 24 hr; 17 mg tablet extended release 24 hr; 25.5 mg tablet extended release 24 hr; 34 mg tablet extended release 24 hr   approved.gif (510 bytes)

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$$$
Tiazac generic.gif (400 bytes)
diltiazem HCl		 300 mg capsule, extended release; 420 mg capsule, extended release; 120 mg capsule, extended release; 180 mg capsule, extended release; 240 mg capsule, extended release; 360 mg capsule, extended release   approved.gif (510 bytes)

$$$
Vascor
Bepridil HCl		 Tab - 200mg   nonform.gif (625 bytes)  

Not Applicable
Vascor
Bepridil HCl		 Tab - 300mg   nonform.gif (625 bytes)  

Not Applicable
Verelan generic.gif (400 bytes)
verapamil		 120 mg capsule,ext rel. pellets 24 hr; 360 mg capsule,ext rel. pellets 24 hr; 240 mg capsule,ext rel. pellets 24 hr; 180 mg capsule,ext rel. pellets 24 hr   approved.gif (510 bytes)  

$$
Verelan PM generic.gif (400 bytes)
verapamil		 100 mg capsule, 24 hr ER pellet CT; 200 mg capsule, 24 hr ER pellet CT; 300 mg capsule, 24 hr ER pellet CT   approved.gif (510 bytes)

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Not Applicable

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)

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