This plan is designed to save you money on your prescription drug

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This plan is designed to save you money on your prescription drug
Welcome...
This plan is designed to save you money on your
prescription drug costs!
Your Prescription Plan is recognized at most pharmacies in the United States.
This product guide has four tiers:
The first tier is preferred brand and generic drugs that will be available to you for $10 or less for the scheduled quantity
and dose.
The second tier is preferred brand and generic drugs that will be available to you for $20 or less for the scheduled
quantity and dose.
The third tier is preferred brand and generic drugs that will be available to you for $40 or less for the scheduled quantity
and dose.
The fourth tier is non-preferred brand and generic drugs that we have negotiated a special discount price for you.
To get the most out of this program you should ask your doctor to prescribe a drug within the first three tiers if possible.
Often times drugs within the same therapeutic class can be prescribed in place of an expensive brand name drug. Of
course if you choose the higher price non-preferred brand or generic name drug we have negotiated a substantial discount for you.
Please review this entire book. Read the “frequently asked questions” section for information about this plan. Feel free to
contact our customer service center if you have additional questions.
Our knowledgeable Help Desk and Customer Service department ensures that all physician, member, and pharmacy
calls are responded to swiftly and accurately.
FREQUENTLY ASKED QUESTIONS
Where can I use my card?
Your card is accepted at over 55,000 participating pharmacies throughout the United States. The network includes pharmacy chains,
such as CVS, Rite Aid, Medicine Shoppe, Walgreens, Wal-Mart, and more, as well as thousands of independent pharmacies throughout the country. Pharmacy location information can be obtained by contacting customer service. If a neighborhood pharmacy is not
already participating in our network, please have them call us. We will send them information about how then can participate in the
network so that you can take advantage of the savings as soon as possible.
What if my pharmacy doesn't recognize the card?
Pharmacies may not be familiar with every prescription program in which they participate. If the pharmacist does not recognize your
card or if you encounter a problem at the pharmacy, DO NOT leave without having the pharmacy call the toll-free number printed on
the ID card.
What is my average discount on Non-Preferred Drugs?
Members are currently receiving an average discount of approximately 19% on brand name drugs. There is no guaranteed percentage savings on every prescription purchase. The price paid depends upon the pharmacy and the type and quantity of drug purchased.
Pharmacies, just like other retail stores, compete against each other and may have special prices on some products. When this is the
case, we cannot discount the pharmacy's already low price, but a member will receive the advantage of the pharmacy's special pricing. THE MEMBER ALWAYS RECEIVES THE LOWER OF THE CONTRACT PRICE OR THE PHARMACY'S PRICE.
What is a generic drug?
Once a patent on a brand name drug expires, other drug companies may make a generic version of the drug, with the approval of the
Food and Drug Administration (FDA). The FDA's standards for quality are the same for all manufacturers. This means the generic
drug contains the same active ingredients as the brand name whose patent has expired, and that its as safe, potent and effective.
How can I keep my prescription drug costs down?
The use of generic prescription drugs, whenever available, is most cost effective. Don't be shy - discuss your prescription options with
your doctor. Ask whether an alternative, less expensive option would work for your condition.
How will I know if there's a generic equivalent available?
Simply ask your local pharmacist or call the Customer Service Department to find out about generic equivalents for your prescription.
Also ask your doctor to prescribe generics whenever possible and appropriate.
What is the difference between brand name and generic drugs?
The brand name is the trade name under which the product is advertised and sold, and is protected by patents so that it can only be
produced by one manufacturer for a pre-determined number of years. Once a patent expires, other companies may manufacture a
generic equivalent, providing they follow stringent FDA regulations for safety. Generic drugs are drugs for which the patent has expired, allowing other manufacturers to produce and distribute the product under a generic name. Generics are essentially a chemical
copy of their brand name equivalents. The color or shape may be different, but the active ingredients must be the same for both. The
preferred drug list contains only FDA approved generic medications.
What is a preferred drug list?
A preferred drug list is a list of recommended prescription medications that is created, reviewed and continually updated by a team of
physicians and pharmacists. The preferred drug list contains a wide range of generic and brand name preferred products that have
been approved by the Food and Drug Administration (FDA). Your doctor can use this list to select medications for your health care
needs, while helping you maximize your prescription drug benefit. A medication becomes a preferred drug based first on safety and
efficacy, then on cost-effectiveness.
What is the difference between a preferred brand name drug vs. a non-preferred brand name drug?
A preferred brand name drug is a medication that has been reviewed and approved by a group of physicians and pharmacists, and
has been selected for preferred status based on its proven clinical and cost effectiveness. A non-preferred brand name drug is a
medication that has been reviewed by the same team of physicians and pharmacists who determined that an alternative drug that is
clinically equivalent and most cost effective is available. These designations may change as new clinical information becomes available.
What drugs are considered preferred (formulary) on Discount Plans?
The Product Guide contains certain brand drugs for which the member's price is the scheduled amount listed. Drugs that are chemically or therapeutically similar to drugs listed on the Product Guide are not discounted. Prices are subject to change due to manufacturer price changes to pharmacies. On these drugs, the participant enjoys two distinct discounts; one through the pharmacy network
and the second through the manufacturer.
IMPORTANT: PRICES ARE SUBJECT TO CHANGE
Drugs may not necessarily be available at the prices shown in this book
Preferred Brand & Generic Drugs
$10 Tier
Non-Preferred
$20 Tier
$40 Tier
Discounts
PARKINSONS DRUGS
BENZTROPINE TAB 0.5MG-30EA
BENZTROPINE TAB 2MG-30EA
PARCOPA TAB 10-100MG-30EA
REQUIP TAB 5MG-30EA
ROPINIROLE TAB 0.25MG-30EA
SINEMET TAB 10-100MG-90EA
SINEMET TAB 25-250MG-90EA
AKINETON
AZILECT
BROMOCRIPTIN
CARB/LEVO
COMTAN
ELDEPRYL
MIRAPEX
PARCOPA
PARLODEL
EFFER-K TAB 10MEQ-30EA
EFFER-K TAB 20MEQ-40EA
K-EFFERVESCE TAB 25MEQ EF-60EA
KLOR-CON M15 TAB-30EA
KLOR-CON/EF TAB 25MEQ FR-60EA
KLOR-CON M20 TAB 20MEQ ER-90EA
MICRO-K CAP 8MEQ CR-30EA
POT CHLORIDE CAP 8MEQ ER-30EA
KAY CIEL
K-LYTE DS
NORMAL SALIN
ATABEX EC TAB-30EA
ATABEX TAB PRENATAL-30EA
GENTEX ADE TAB 28-1MG-30EA
INATAL ADV TAB-30EA
INATAL ULTRA TAB-30EA
MARNATAL-F CAP-30EA
MAXINATE TAB-30EA
M-VIT TAB 27-1MG-30EA
OBSTETRIX EC TAB-30EA
OBTREX TAB-30EA
O-CAL FA TAB-30EA
PRENAFIRST TAB-30EA
PRENAPLUS TAB-30EA
PRENATAL 19 TAB-30EA
PRENATAL TAB LOW IRON-30EA
PRENATAL TAB PLUS/FE-30EA
PRENATE PLUS TAB-30EA
SE-NATAL 19 TAB-30EA
SE-NATAL ONE TAB-30EA
TRIADVANCE TAB-30EA
TRINATAL RX TAB 1-30EA
TRINATAL TAB ULTRA-30EA
VINATE AZ EX TAB-30EA
VINATE AZ TAB-30EA
VINATE CAL TAB-30EA
VINATE GT TAB-30EA
VINATE IC CAP-31EA
VINATE II TAB-30EA
VINATE M TAB-30EA
VINATE ONE TAB-30EA
VINATE ULTRA TAB-30EA
VITA-PREN TAB-30EA
VOL-PLUS TAB-30EA
CAVAN ONE CAP OMEGA-30EA
CAVAN TAB PRENATAL-30EA
COMPLETE-RF TAB PRENATAL-90EA
CONCEPT DHA CAP-30EA
CONCEPT OB CAP-30EA
FOLBECAL TAB-30EA
FOLCAPS CAP OMEGA 3-30EA
FOLIVANE-OB CAP-30EA
NATAFORT TAB-30EA
NATELLE-EZ TAB-30EA
NESTABS TAB-30EA
OB-NATAL ONE CAP 27-1MG-30EA
PREFERA OB TAB-30EA
PRENATABS RX TAB-100EA
PRENATABS TAB OBN-90EA
PRENATAL TAB PLUS-30EA
PREQUE 10 TAB-30EA
PROTECTNATAL TAB-30EA
SE-CARE TAB CONCEIVE-30EA
TANDEM OB CAP-31EA
TARON-C DHA CAP-30EA
TARON-EC CAL TAB 28-1MG-30EA
TRICARE DHA CAP 301-30EA
TRIMESIS RX TAB-30EA
TRINATE TAB-90EA
TRIVEEN-TEN TAB-30EA
ULTIMATECARE CAP ONE-30EA
VINATE C TAB-30EA
VINATE PN TAB CARE-30EA
VOL-NATE TAB-90EA
VOL-TAB RX TAB-100EA
OPTINATE
PRIMACARE
ARMOUR THYRO TAB 240MG-30EA
LEVOTHROID TAB 125MCG-60EA
LEVOTHROID TAB 137MCG-30EA
LEVOTHROID TAB 175MCG-30EA
LEVOTHROID TAB 200MCG-30EA
LEVOTHROID TAB 88MCG-30EA
LEVOTHYROXIN TAB 125MCG-60EA
LEVOTHYROXIN TAB 137MCG-30EA
LEVOTHYROXIN TAB 175MCG-30EA
LEVOTHYROXIN TAB 200MCG-30EA
LEVOTHYROXIN TAB 300MCG-30EA
LEVOTHYROXIN TAB 88MCG-30EA
LEVOXYL TAB 125MCG-60EA
LEVOXYL TAB 137MCG-30EA
LEVOXYL TAB 175MCG-30EA
LEVOXYL TAB 88MCG-30EA
NATURE-THROI TAB 260MG-30EA
NATURE-THROI TAB 325MG-30EA
SYNTHROID TAB 137MCG-30EA
SYNTHROID TAB 175MCG-30EA
SYNTHROID TAB 200MCG-30EA
SYNTHROID TAB 300MCG-30EA
SYNTHROID TAB 88MCG-30EA
THYROLAR-1 TAB 60MG-30EA
THYROLAR-1/2 TAB 30MG-30EA
THYROLAR-1/4 TAB 15MG-30EA
THYROLAR-2 TAB 120MG-30EA
THYROLAR-3 TAB 180MG-30EA
WESTHROID TAB 260MG-30EA
WESTHROID TAB 325MG-30EA
ARMOUR THYRO TAB 300MG-30EA
ARMOUR THYRO TAB 60MG-180EA
CYTOMEL TAB 25MCG-30EA
CYTOMEL TAB 5MCG-30EA
LEVOTHROID TAB 150MCG-90EA
LEVOTHROID TAB 75MCG-90EA
LEVOTHYROXIN TAB 112MCG-90EA
LEVOTHYROXIN TAB 150MCG-90EA
LEVOTHYROXIN TAB 75MCG-90EA
LEVOXYL TAB 112MCG-90EA
LEVOXYL TAB 150MCG-90EA
LEVOXYL TAB 75MCG-90EA
LIOTHYRONINE TAB 25MCG-30EA
LIOTHYRONINE TAB 5MCG-30EA
METHIMAZOLE TAB 5MG-90EA
PROPYLTHIOUR TAB 50MG-180EA
TAPAZOLE TAB 5MG-90EA
TIROSINT CAP 100MCG-30EA
TIROSINT CAP 112MCG-30EA
TIROSINT CAP 125MCG-30EA
TIROSINT CAP 137MCG-30EA
TIROSINT CAP 13MCG-30EA
TIROSINT CAP 150MCG-30EA
TIROSINT CAP 25MCG-30EA
TIROSINT CAP 50MCG-30EA
TIROSINT CAP 75MCG-30EA
TIROSINT CAP 88MCG-30EA
CYTOMEL
LEVOTHYROXIN
LIOTHYRONINE
L-THYRONINE
TAPAZOLE
PRENATAL VITAMINS
CO-NATAL FA TAB 29-1MG-30EA
MYNATAL CAP-30EA
MYNATE 90 TAB PLUS-30EA
NATALVIT TAB 75-1MG-30EA
O-CAL TAB PRENATAL-30EA
PRENATABS FA TAB-30EA
SE-NATAL 90 TAB-30EA
VENATAL-FA TAB-30EA
$10 Tier
PERGOLIDE
PERMAX
REQUIP
SELEGILINE
SINEMET
SINEMET CR
STALEVO
TASMAR
$20 Tier
$40 Tier
Discounts
Prices are subject to change and may not fall into the tiers as shown above.
The discount tier is drugs listed without strength or quantity and typically include all drugs not listed in the first 3 tiers.
BENZOYL PER GEL 0.05 - 60GM
BENZOYL PER GEL 0.1 - 60GM
DESQUAM-X LIQ WASH 10% - 140GM
ERYTHROMYCIN GEL 0.02 - 30GM
AVITA CRE 0.025 - 20GM
BENZOYL PER GEL 0.025 - 60GM
BENZOYL PER LIQ WASH 10% - 227GM
BENZOYL PER LIQ WASH 2.5 - 227GM
BENZOYL PER LIQ WASH 5% - 227GM
CLINDAMYCIN SOL 0.01 - 60ML
ERYTHROMYCIN SOL 0.02 - 60ML
ACCUTANE
AMNESTEEM
AZELEX
BENZAC AC
CLARAVIS
CLENIA
CLEOCIN-T
CLINDAGEL
CLINDETS
DIFFERIN
ALPAIN TAB-30EA
ANABAR TAB-30EA
ANAPROX DS TAB 550MG-30EA
BIOREGESIC TAB 50-650MG-30EA
BUPAP TAB 50-650MG-30EA
BUT/APAP/CAF CAP-30EA
BUT/APAP/CAF TAB-30EA
BUT/ASA/CAFF CAP-20EA
CATAFLAM TAB 50MG-30EA
CEPHADYN TAB 50-650MG-30EA
COCET PLUS TAB 650-60MG-30EA
COCET TAB 650-30MG-30EA
DEMEROL TAB 100MG-30EA
DEMEROL TAB 50MG-20EA
DICLOFEN POT TAB 50MG-30EA
DOLOPHINE TAB 10MG-120EA
DURABAC CAP-30EA
EASPRIN TAB 975MG EC-30EA
ESGIC-PLUS TAB-30EA
ETODOLAC CAP 300MG-30EA
ETODOLAC TAB 400MG-30EA
FIORINAL CAP-20EA
FLEXTRA DS TAB 50-500MG-30EA
FLEXTRA-650 TAB-40EA
FRENADOL TAB-30EA
HYDROCOD/IBU TAB 7.5-200-30EA
IBUDONE TAB 10-200MG-20EA
INDOMETHACIN CAP 25MG-30EA
KETOPROFEN CAP 75MG-60EA
MELOXICAM TAB 7.5MG-30EA
MEPERITAB TAB 50MG-20EA
METHADONE TAB 10MG-120EA
MORPHINE SUL TAB 15MG-60EA
MS CONTIN TAB 15MG CR-30EA
MST 600 TAB-30EA
NABUMETONE TAB 500MG-30EA
NABUMETONE TAB 750MG-20EA
NALFON CAP 200MG-20EA
NAPROXEN DR TAB 500MG-30EA
NAPROXEN SOD TAB 550MG-30EA
NORCO TAB 5-325MG-30EA
ORAMORPH SR TAB 15MG-30EA
RELAGESIC TAB 50-650MG-30EA
REPREXAIN TAB 10-200MG-20EA
SEDAPAP TAB 50-650MG-30EA
STAFLEX TAB 55-500MG-30EA
STAGESIC CAP 500-5MG-30EA
TENCON TAB 50-650MG-30EA
TYLOX CAP 5-500MG-20EA
VICODIN HP TAB 10-660MG-60EA
VICOPROFEN TAB-30EA
VOLTAREN-XR TAB 100MG-15EA
ZORPRIN TAB 800MG CR-30EA
BUT/APAP/CAF CAP CODEINE-30EA
CELEBREX CAP 100MG-10EA
CELEBREX CAP 50MG-30EA
CODEINE SULF TAB 30MG-60EA
CODEINE SULF TAB 60MG-30EA
DURABAC TAB FORTE-30EA
ENDOCET TAB 7.5-500M-40EA
FIORICET/COD CAP-30EA
FLEXTRA CAP-30EA
HYDROCO/APAP TAB 7.5-500-30EA
HYDROMORPHON TAB 2MG-20EA
IBUDONE TAB 5-200MG-30EA
INDOMETHACIN CAP 50MG-60EA
LAGESIC TAB 66-600MG-30EA
LEVACET TAB-30EA
LEVORPHANOL TAB 2MG-30EA
MAGNACET TAB 10-400MG-6EA
METHADONE TAB 5MG-120EA
ORBIVAN CAP-30EA
PERCOCET TAB 7.5-500-40EA
PERCODAN TAB-20EA
REPREXAIN TAB 2.5-200-30EA
ROXICET TAB 5-500MG-30EA
ROXICODONE TAB 5MG-90EA
TOLMETIN SOD TAB 200MG-30EA
TRAMADOL HCL TAB 50MG-100EA
ULTRAM ER TAB 100MG-10EA
ZYDONE TAB 10-400MG-30EA
ZYDONE TAB 5-400MG-30EA
ACTIQ
AMIGESIC
ANAPROX DS
ANEXSIA
ANSAID
ARAVA
ARTHROTEC 50
ARTHROTEC 75
ASA/CODEINE
AVINZA
BALACET 325
BUT/APAP/CAF
BUTORPHANOL
CATAFLAM
CELEBREX
CHO MAG TRIS
CODEINE
CODEINE PHOS
CODEINE SULF
DARVOCET-N
DARVON
DARVON-N
DAYPRO
DEMEROL
DICLOFEN POT
DICLOFENAC
DIFLUNISAL
DILAUDID
DILAUDID-5
DOLGIC PLUS
DURABAC
DURAGESIC
EC-NAPROSYN
ENDOCET
ENDODAN
EQUAGESIC
ESGIC-PLUS
ETODOLAC
FELDENE
FENTANYL
FIORICET
FIORICET/COD
FIORINAL/COD
FLEXTRA
FLURBIPROFEN
HUMIRA
HUMIRA PEN
HYDROMORPHON
INDOCIN
INDOCIN SR
INDOMETHACIN
KADIAN
KETOPROFEN
LAGESIC
LEFLUNOMIDE
LEVORPHANOL
LODINE XL
DIETHYLPROP TAB 25MG-20EA
PHENTERMINE TAB 37.5MG-30EA
DIETHYLPROP TAB 75MG ER-20EA
PHENDIMETRAZ CAP 105MG ER-30EA
PHENDIMETRAZ TAB 35MG-90EA
PHENTERMINE CAP 15MG-15EA
ADIPEX-P
DIDREX
IONAMIN-15
IONAMIN-30
BUSPIRONE TAB 10MG-60EA
CLORAZ DIPOT TAB 7.5MG-30EA
HYDROXYZ HCL TAB 10MG-30EA
HYDROXYZ HCL TAB 25MG-30EA
HYDROXYZ PAM CAP 25MG-60EA
HYDROXYZ PAM CAP 50MG-60EA
LORAZEPAM TAB 1MG-60EA
TRANXENE T TAB 15MG-30EA
TRANXENE T TAB 3.75MG-90EA
TRANXENE T TAB 7.5MG-30EA
VISTARIL CAP 25MG-60EA
ALPRAZOLAM TAB 0.5MG ER-30EA
ALPRAZOLAM TAB 2MG ER-30EA
HYDROXYZ HCL TAB 50MG-30EA
XANAX XR TAB 0.5MG-30EA
XANAX XR TAB 2MG-30EA
ALPRAZOLAM
ATIVAN
BUSPAR
BUSPIRONE
CLORAZ DIPOT
LIBRIUM
LORAZEPAM
NIRAVAM
OXAZEPAM
TRANXENE T
TRANXENE-SD
VALIUM
VISTARIL
XANAX
XANAX XR
PRASCION
PRASCION AV
RETIN-A
ROSANIL
ROSULA
SOTRET
TRETINOIN
TRIAZ
VANOXIDE-HC
ZODERM
ANALGESICS
ANAPROX TAB 275MG-10EA
ASPIRIN CHW 81MG-30EA
ASPIRIN TAB 325MG EC-100EA
ASPIRIN TAB 325MG-30EA
ASPIRIN TAB 81MG EC-30EA
ASPIR-LOW TAB 81MG EC-30EA
CLINORIL TAB 200MG-14EA
DILAUDID TAB 2MG-20EA
ESGIC TAB-30EA
ETODOLAC TAB 500MG-14EA
HYDROCO/APAP TAB 5-500MG-30EA
IBUPROFEN TAB 400MG-40EA
IBUPROFEN TAB 600MG-30EA
IBUPROFEN TAB 800MG-30EA
LORCET PLUS TAB 7.5-650-30EA
MELOXICAM TAB 15MG-30EA
MORPHINE SUL TAB 15MG CR-30EA
NAPROSYN TAB 250MG-20EA
NAPROSYN TAB 375MG-30EA
NAPROXEN TAB 250MG-20EA
NAPROXEN TAB 375MG-30EA
NAPROXEN TAB 500MG-30EA
ROXICET TAB 5-325MG-30EA
TYLENOL/COD TAB #3-30EA
THYROID MEDICATIONS
ARMOUR THYRO TAB 120MG-10EA
ARMOUR THYRO TAB 15MG-30EA
ARMOUR THYRO TAB 180MG-30EA
ARMOUR THYRO TAB 30MG-30EA
ARMOUR THYRO TAB 90MG-30EA
LEVOTHROID TAB 100MCG-30EA
LEVOTHROID TAB 25MCG-30EA
LEVOTHROID TAB 50MCG-30EA
LEVOTHYROXIN TAB 100MCG-30EA
LEVOTHYROXIN TAB 25MCG-30EA
LEVOTHYROXIN TAB 50MCG-30EA
LEVOXYL TAB 100MCG-30EA
LEVOXYL TAB 25MCG-30EA
LEVOXYL TAB 50MCG-30EA
NATURE-THROI TAB 130MG-30EA
NATURE-THROI TAB 16.25MG-30EA
NATURE-THROI TAB 195MG-30EA
NATURE-THROI TAB 32.5MG-30EA
NATURE-THROI TAB 48.75MG-30EA
NATURE-THROI TAB 65MG-30EA
NATURE-THROI TAB 97.5MG-30EA
SYNTHROID TAB 100MCG-30EA
SYNTHROID TAB 25MCG-30EA
SYNTHROID TAB 50MCG-30EA
UNITHROID TAB 100MCG-30EA
WESTHROID TAB 130MG-30EA
WESTHROID TAB 16.25MG-30EA
WESTHROID TAB 195MG-30EA
WESTHROID TAB 32.5MG-30EA
WESTHROID TAB 48.75MG-30EA
WESTHROID TAB 65MG-30EA
WESTHROID TAB 97.5MG-30EA
Non-Preferred
ACNE PRODUCTS
AMANTADINE CAP 100MG-30EA
AMANTADINE TAB 100MG-10EA
BENZTROPINE TAB 1MG-60EA
PRAMIPEXOLE TAB 0.5MG-15EA
TRIHEXYPHEN TAB 2MG-60EA
POTASSIUM REPLACEMENT THERAPY
POT BICARBON CAP 99MG-30EA
Preferred Brand & Generic Drugs
LORCET
LORCET PLUS
LORTAB 10
LORTAB 7.5
MEPERIDINE
MEPERITAB
METHADONE
MOBIC
MORPHINE
MORPHINE SUL
MS CONTIN
NABUMETONE
NALBUPHINE
NALFON
NAPRELAN
NAPROSYN
NORCO
OPANA
ORAMORPH SR
ORUVAIL
OXAPROZIN
OXYCO/APAP
OXYCOD-APAP
OXYCONTIN
OXYFAST
PENTA/APAP
PERCOCET
PHRENILIN
PHRENILIN/
PIROXICAM
PONSTEL
PREVACID NAP
PROPO-N/APAP
RELAFEN
RIDAURA
ROXICET
ROXICODONE
STAFLEX
SUBOXONE
SUBUTEX
SYNALGOS DC
TALACEN
TALWIN NX
TOLMETIN SOD
TRAMADL/APAP
TRICOSAL
TYLENOL/COD
TYLOX
ULTRACET
ULTRAM
ULTRAM ER
VICODIN ES
VICODIN HP
VICOPROFEN
VOLTAREN-XR
ZEBUTAL
ZORPRIN
ANOREXIANTS
ANTIANXIETY AGENTS
ALPRAZOLAM TAB 0.25MG-30EA
ALPRAZOLAM TAB 0.5MG-30EA
ALPRAZOLAM TAB 1MG-30EA
ALPRAZOLAM TAB 2MG-30EA
BUSPIRONE TAB 15MG-30EA
BUSPIRONE TAB 5MG-30EA
CHLORDIAZEP CAP 10MG-30EA
CHLORDIAZEP CAP 25MG-30EA
DIAZEPAM TAB 10MG-30EA
DIAZEPAM TAB 2MG-15EA
DIAZEPAM TAB 5MG-30EA
LORAZEPAM TAB 0.5MG-30EA
LORAZEPAM TAB 2MG-30EA
OXAZEPAM CAP 10MG-20EA
VALIUM TAB 2MG-15EA
Prices are subject to change and may not fall into the tiers as shown above.
The discount tier is drugs listed without strength or quantity and typically include all drugs not listed in the first 3 tiers.
MERIDIA
PHENTERMINE
TENUATE
XENICAL
Preferred Brand & Generic Drugs
$10 Tier
Non-Preferred
$20 Tier
$40 Tier
Discounts
ANTIASTHMATIC & RESPIRATORY AGENTS
AMINOPHYLLIN TAB 200MG-30EA
DIFIL-G 400 TAB-14EA
DILEX-G 400 TAB-14EA
METAPROTEREN TAB 20MG-30EA
SUDAFD NASAL TAB DECONGES-40EA
SUDAFED 12HR TAB 120MG CR-15EA
SUDOGEST TAB 60MG-30EA
THEOPHYLLINE TAB 100MG CR-30EA
Preferred Brand & Generic Drugs
$10 Tier
Non-Preferred
$20 Tier
$40 Tier
Discounts
HYPNOTIC & SEDATIVE AGENTS
METAPROTEREN TAB 10MG-30EA
THEOPHYLLINE TAB 200MG CR-30EA
THEO-24 CAP 100MG CR-30EA
THEOPHYLLINE TAB 300MG ER-90EA
THEOPHYLLINE TAB 450MG ER-60EA
VENTOLIN HFA AER-8GM
ACCOLATE
ADVAIR DISKUS
AEROBID
AEROBID-M
ALBUTEROL
ALUPENT INH
ASMANEX
ATROVENT
AZMACORT
BRETHINE
COMBIVENT
DUONEB
FLONASE
FLOVENT
FLUNISOLIDE
FLUTICASONE
FORADIL
INTAL INH
AMOXICILLIN CHW 250MG-20EA
AMOXICILLIN TAB 875MG-30EA
AZITHROMYCIN TAB 250MG-6EA
BACTRIM DS TAB 800-160-20EA
BACTRIM TAB 400-80MG-30EA
BIAXIN TAB 250MG-14EA
CEFDINIR CAP 300MG-10EA
CEFUROXIME TAB 500MG-10EA
CEPHALEXIN CAP 500MG-30EA
CIPROFLOXACN TAB 500MG-20EA
CLARITHROMYC TAB 250MG-14EA
CLEOCIN CAP 150MG-30EA
CLINDAMYCIN CAP 150MG-30EA
DAPSONE TAB 25MG-15EA
DICLOXACILL CAP 500MG-20EA
DOXYCYC MONO CAP 100MG-10EA
DOXYCYC MONO TAB 100MG-14EA
ERY-TAB TAB 333MG EC-21EA
MEBENDAZOLE CHW 100MG-2EA
MINOCIN CAP 100MG-30EA
MINOCYCLINE CAP 100MG-30EA
MONODOX CAP 50MG-20EA
MYAMBUTOL TAB 100MG-30EA
NEOMYCIN TAB 500MG-6EA
SEPTRA DS TAB 800-160-20EA
SMZ/TMP DS TAB 800-160-20EA
ZITHROMAX TAB 250MG-6EA
ADOXA PAK TAB 1/100MG-14EA
ADOXA PAK TAB 2/100MG-14EA
ADOXA TAB 100MG-14EA
AMOX/K CLAV TAB 500MG-20EA
AMOX/K CLAV TAB 875MG-20EA
AUGMENTIN TAB 500MG-20EA
AZITHROMYCIN TAB 500MG-4EA
CEFADROXIL TAB 1GM-7EA
CEPHALEXIN TAB 250MG-30EA
CIPRO TAB 250MG-6EA
CIPROFLOXACN TAB 250MG-6EA
CLINDAMYCIN CAP 300MG-30EA
E.E.S. 400 TAB 400MG-28EA
ERYTHROM ETH TAB 400MG-28EA
ERYTHROMYCIN TAB 500MG BS-10EA
ORAXYL CAP 20MG-30EA
RIFADIN CAP 300MG-10EA
RIFAMPIN CAP 300MG-10EA
STROMECTOL TAB 3MG-6EA
SUPRAX TAB 400MG-1EA
TRIMETHOPRIM TAB 100MG-30EA
YODOXIN TAB 210MG-30EA
YODOXIN TAB 650MG-30EA
ZITHROMAX TAB TRI-PAK-4EA
ADOXA
ALINIA
AMIKACIN
AMOCLAN
AMOX/K CLAV
AMPHOTERICIN
AMPICILLIN
AUGMENTIN
AUGMENTIN XR
AVELOX
AZACTAM
AZACTAM/DEX
AZITHROMYCIN
BACITRACIN
BACTRIM DS
BIAXIN
CEDAX
CEFACLOR
CEFADROXIL
CEFAZOLIN
CEFOTAXIME
CEFPROZIL
CEFTIN
CEFTRIAXONE
CEFUROXIME
CIPRO
CIPRO XR
CIPROFLOXACN
CLEOCIN
CLINDAMYCIN
CLOTRIMAZOLE
DAPSONE
DECLOMYCIN
DEMECLOCYCL
DORYX
DOXYCYCLINE
DURICEF
DYNACIN
NASACORT AQ
NASONEX
PROLASTIN
PROVENTIL
PULMICORT
QVAR
RHINOCORT
SINGULAIR
SPIRIVA
TERBUTALINE
THEO-24
THEOPHYLLINE
TILADE
UNIPHYL
VOSPIRE ER
XOLAIR
ZYFLO
FLURAZEPAM CAP 30MG-3EA
HALCION TAB 0.25MG-2EA
PHENOBARB TAB 100MG-10EA
PHENOBARB TAB 15MG-100EA
PHENOBARB TAB 30MG-150EA
PHENOBARB TAB 32.4MG-120EA
PHENOBARB TAB 60MG-21EA
PHENOBARB TAB 97.2MG-30EA
RESTORIL CAP 30MG-30EA
ROZEREM TAB 8MG-1EA
SOMNOTE CAP 500MG-10EA
TEMAZEPAM CAP 30MG-30EA
TRIAZOLAM TAB 0.25MG-2EA
ZOLPIDEM TAB 5MG-20EA
ERYTHROMYCIN
ETHAMBUTOL
FLAGYL
FLOXIN
FORTAZ
GENTAMICIN
KEFLEX
KETEK
KETEK PAK
LEVAQUIN
LINCOCIN
LORABID
MEPRON
METRONIDAZOL
MINOCIN
MINOCYCLINE
MYCELEX
MYCOBUTIN
MYRAC
NAFCILLIN
NOROXIN
NYSTATIN
OFLOXACIN
OXACILLIN
PERIOSTAT
PRIMAXIN
RIFADIN
RIFAMATE
RIFAMPIN
RIFATER
SEPTRA DS
SOLODYN
SPECTRACEF
SUMYCIN
SUPRAX
TEQUIN
INFLAMMATORY BOWEL AGENTS
FLURAZEPAM CAP 15MG-30EA
PHENOBARB TAB 64.8MG-120EA
RESTORIL CAP 15MG-30EA
TEMAZEPAM CAP 15MG-30EA
ZOLPIDEM TAB 10MG-30EA
MEBARAL TAB 32MG-30EA
RESTORIL CAP 7.5MG-2EA
TEMAZEPAM CAP 7.5MG-2EA
AMBIEN
AMBIEN CR
AQUACHLORAL
BUTISOL SOD
DALMANE
HALCION
LUNESTA
MEBARAL
MEPHOBARB
PROSOM
RESTORIL
ROZEREM
SONATA
ANTIBIOTICS
AMOXICILLIN CAP 250MG-20EA
AMOXICILLIN TAB 500MG-12EA
AMPICILLIN CAP 250MG-10EA
AMPICILLIN CAP 500MG-20EA
CEFADROXIL CAP 500MG-10EA
CEFUROXIME TAB 250MG-10EA
CEPHALEXIN CAP 250MG-30EA
CIPRO TAB 750MG-10EA
CIPROFLOXACN TAB 750MG-10EA
DOXYCYCL HYC CAP 100MG-16EA
DOXYCYCL HYC CAP 50MG-30EA
ERY-TAB TAB 500MG EC-14EA
ERYTHROCIN TAB 250MG-20EA
ERYTHROCIN TAB 500MG-14EA
ERYTHROMYCIN CAP 250MG EC-15EA
ERYTHROMYCIN TAB 250MG BS-30EA
FLAGYL TAB 250MG-20EA
ISONIAZID TAB 300MG-30EA
KEFLEX CAP 250MG-30EA
METRONIDAZOL TAB 250MG-20EA
METRONIDAZOL TAB 500MG-8EA
PENICILLN VK TAB 250MG-30EA
PENICILLN VK TAB 250MG-30EA
TETRACYCLINE CAP 250MG-30EA
TETRACYCLINE CAP 500MG-30EA
VIBRAMYCIN CAP 100MG-16EA
ANTICONVULSANTS
CARBAMAZEPIN TAB 200MG ER-30EA
CARBAMAZEPIN TAB 200MG-60EA
CLONAZEPAM TAB 0.5MG-30EA
CLONAZEPAM TAB 1MG-30EA
CLONAZEPAM TAB 2MG-30EA
KLONOPIN TAB 2MG-30EA
CARBAMAZEPIN CHW 100MG-60EA
DILANTIN CAP 100MG-30EA
DILANTIN CHW 50MG-30EA
GABAPENTIN CAP 100MG-90EA
GABAPENTIN CAP 400MG-90EA
LAMOTRIGINE TAB 100MG-30EA
LAMOTRIGINE TAB 25MG-30EA
NEURONTIN CAP 100MG-90EA
PHENYTOIN EX CAP 100MG-30EA
TEGRETOL XR TAB 100MG-15EA
CLONAZEP ODT TAB 0.25MG-30EA
DEPAKENE CAP 250MG-120EA
DIVALPROEX TAB 500MG ER-30EA
GABAPENTIN CAP 300MG-90EA
LAMICTAL XR TAB 200MG-2EA
LAMOTRIGINE TAB 200MG-30EA
PEGANONE TAB 250MG-30EA
STAVZOR CAP 125MG-30EA
TEGRETOL XR TAB 200MG-30EA
TOPIRAMATE TAB 50MG-60EA
VALPROIC ACD CAP 250MG-120EA
CARBATROL
CELONTIN
DEPAKENE
DEPAKOTE
DILANTIN-125
FELBATOL
GABAPENTIN
GABITRIL
KEPPRA
KLONOPIN
LAMICTAL
LAMOTRIGINE
LYRICA
MYSOLINE
PEGANONE
PHENYTEK
PHENYTOIN
PRIMIDONE
TEGRETOL
TEGRETOL XR
TOPAMAX
TRILEPTAL
ZARONTIN
ZONEGRAN
ZONISAMIDE
AMITRIPTYLIN TAB 50MG-90EA
ANAFRANIL CAP 75MG-30EA
BUPROPION TAB 75MG-60EA
CELEXA TAB 40MG-45EA
CITALOPRAM TAB 20MG-30EA
CITALOPRAM TAB 40MG-45EA
FLUOXETINE CAP 10MG-30EA
MAPROTILINE TAB 25MG-30EA
MAPROTILINE TAB 50MG-30EA
MIRTAZAPINE TAB 15MG-30EA
MIRTAZAPINE TAB 30MG-30EA
NORTRIPTYLIN CAP 50MG-90EA
PAMELOR CAP 50MG-90EA
PAROXETINE TAB 30MG-30EA
PAROXETINE TAB 40MG-15EA
PAXIL TAB 30MG-30EA
PROZAC CAP 10MG-30EA
REMERON TAB 15MG-30EA
REMERON TAB 30MG-30EA
SERTRALINE TAB 100MG-30EA
SERTRALINE TAB 25MG-30EA
SERTRALINE TAB 50MG-30EA
AMOXAPINE TAB 25MG-30EA
AMOXAPINE TAB 50MG-30EA
ANAFRANIL CAP 25MG-120EA
ANAFRANIL CAP 50MG-150EA
BUDEPRION XL TAB 300MG-30EA
BUPROPION TAB 100MG SR-30EA
BUPROPION TAB 100MG-90EA
BUPROPN HCL TAB 300MG XL-30EA
CLOMIPRAMINE CAP 50MG-150EA
DOXEPIN HCL CAP 10MG-100EA
DOXEPIN HCL CAP 50MG-120EA
FLUOXETINE CAP 40MG-30EA
FLUOXETINE TAB 10MG-120EA
FLUOXETINE TAB 20MG-30EA
MIRTAZAPINE TAB 45MG-45EA
PAMELOR CAP 75MG-90EA
PAROXETINE TAB 20MG-60EA
PAXIL TAB 20MG-60EA
REMERON TAB 45MG-45EA
TRAZODONE TAB 150MG-90EA
VENLAFAXINE CAP 150MG ER-10EA
VENLAFAXINE CAP 150MGER-10EA
VENLAFAXINE TAB 75MG-30EA
WELLBUTRIN TAB 100MG SR-30EA
WELLBUTRIN TAB 100MG-90EA
WELLBUTRIN TAB 75MG-60EA
AMITRIPTYLIN
AMOXAPINE
ANAFRANIL
BUDEPRION
BUPROPION
CELEXA
CITALOPRAM
CLOMIPRAMINE
CYMBALTA
DESYREL
DOXEPIN HCL
EFFEXOR
FLUOXETINE
FLUVOXAMINE
IMIPRAM PAM
IMIPRAMINE
LEXAPRO
MARPLAN
NARDIL
NEFAZODONE
NORPRAMIN
NORTRIPTYLIN
PAMELOR
PARNATE
PAROXETINE
PAXIL
PAXIL CR
PEXEVA
PROZAC
PROZAC WEEKL
REMERON
SARAFEM
SERTRALINE
SINEQUAN
SURMONTIL
TOFRANIL
TOFRANIL-PM
TRANYLCYPROM
TRAZODONE
VENLAFAXINE
VIVACTIL
WELLBUTRIN
ZOLOFT
SULFASALAZIN TAB 500MG - 120EA
SULFAZINE TAB 500MG - 120EA
LAXATIVES
Prices are subject to change and may not fall into the tiers as shown above.
The discount tier is drugs listed without strength or quantity and typically include all drugs not listed in the first 3 tiers.
GLYCOLAX
GOLYTELY
HALFLYTELY
KRISTALOSE
MIRALAX
OSMOPREP
VISICOL
BISACODYL TAB 5MG EC-4EA
DOCUSATE CAL CAP 240MG-30EA
DOCUSATE SOD CAP 100MG-30EA
SENNA PLUS TAB 8.6-50MG-10EA
SENOKOT S TAB 8.6-50MG-10EA
MUSCLE RELAXANTS
METHOCARBAM TAB 500MG-30EA
METHOCARBAM TAB 750MG-30EA
ROBAXIN TAB 500MG-30EA
TIZANIDINE TAB 2MG-30EA
TIZANIDINE TAB 4MG-30EA
BACLOFEN TAB 10MG-60EA
BACLOFEN TAB 20MG-60EA
CHLORZOXAZON TAB 500MG-30EA
CYCLOBENZAPR TAB 10MG-90EA
CYCLOBENZAPR TAB 5MG-30EA
FLEXERIL TAB 5MG-30EA
PARAFON FORT TAB DSC-30EA
CARISOPRODOL TAB 350MG-100EA
ORPHENADRINE TAB 100MG ER-30EA
BACLOFEN
CARISOPRODOL
CYCLOBENZAPR
DANTRIUM
DANTROLENE
FLEXERIL
LIORESAL INT
NORGESIC
ORPH/ASA/CAF
ORPHEN CPD
AK-DILATE SOL 2.5% OP - 2ML
AK-PENTOLATE SOL 1% OP - 2ML
AK-TOB SOL 0.3% OP - 5ML
ATROPINE SUL OIN 1% OP 3GM
ATROPINE SUL SOL 1% OP - 5ML
BLEPH-10 SOL 10% OP - 5ML
BRIMONIDINE SOL 0.2% OP - 5ML
CROMOLYN SOD SOL 4% OP -10ML
CYCLOMYDRIL SOL OP - 2ML
ERYTHROMYCIN OIN OP - 3GM
FLUOROMETHOL SUS 0.1% OP - 5ML
FLUOR-OP SUS 0.1% OP - 5ML
FLURBIPROFEN SOL 0.03% OP - 2ML
FML FORTE SUS 0.25% OP - 5ML
FML LIQUIFLM SUS 0.1% OP - 5ML
GENOPTIC SOL 0.3% OP - 5ML
GENTAK OIN 0.3% OP - 3GM
GENTAK SOL 0.3% OP - 5ML
GENTAMICIN OIN 0.3% OP - 3GM
GENTAMICIN SOL 0.3% OP- 5ML
ISO CARBACHO SOL 1.5% OP - 5ML
ISO HOMATROP SOL 2% OP - 5ML
LEVOBUNOLOL SOL 0.25% OP - 10ML
METHADEX SUS 0.1% OP - 5ML
PHENYLEPHRIN SOL 2.5% OP - 3ML
POLYMYXIN B/ SOL TRIMETHP - 10ML
POLYTRIM SOL OP - 10ML
PREDNISOLONE SUS 1% OP - 5ML
TIMOPTIC SOL 0.5% OP - 10ML
TRIMETHOPRIM SOL POLYMYXN - 10ML
AK-POLY-BAC OIN OP - 3GM
CYCLOGYL SOL 1% OP - 5ML
DEXAMETH PHO SOL 0.1% OP - 5ML
FLAREX SUS 0.1% OP - 5ML
HOMATROPAIRE SOL 5% OP - 5ML
ISO HOMATROP SOL 5% OP - 5ML
ISO HYOSCINE SOL 0.25% OP - 5ML
ISOPTO CARP SOL 2% OP - 15ML
LEVOBUNOLOL SOL 0.5% OP 10ML
NEO/POLY/DEX SUS 0.1% OP - 5ML
NEO/POLY/GRA SOL OP - 10ML
PILOCAR SOL 1% OP - 15ML
PILOCAR SOL 2% OP - 15ML
PILOCAR SOL 6% OP - 15ML
PILOCARPINE SOL 1% OP - 15ML
PILOCARPINE SOL 2% OP - 15ML
PILOCARPINE SOL 6% OP 15ML
PRED MILD SUS 0.12% OP - 5ML
PRED SOD PHO SOL 1% OP - 5ML
PRED-G S.O.P OIN OP - 3GM
PRED-G SUS OP - 5ML
SOD SULFACET SOL 10% OP - 15ML
SULF/PRED NA SOL OP - 10ML
SULFACET SOD SOL 10% OP 15ML
VEXOL SUS 1% OP - 5ML
ACULAR
ACULAR LS
ALAMAST
ALOCRIL
ALOMIDE
ALPHAGAN P
ALREX
AZOPT
BETAGAN
BETAXOLOL
BETIMOL
BETOPTIC-S
BLEPHAMIDE
BOTOX
CARTEOLOL
CILOXAN
CIPROFLOXACN
CORTISPORIN
COSOPT
CYCLOGYL
ELESTAT
IOPIDINE
ISO ATROPINE
ISO CARBACHO
ISTALOL
KETOTIFEN
LACRISERT
LOTEMAX
LUMIGAN
MAXIDEX
MAXITROL
MYDRIACYL
NATACYN
NEO/POLY/HC
NEVANAC
OCUFLOX
AERO OTIC HC SOL - 10ML
ANTIPY/BENZO SOL OTIC - 10ML
AURODEX SOL OTIC - 15ML
AUROGUARD SOL - 15ML
CORTANE-B DRO AQ OTIC - 10ML
CORTANE-B DRO OTIC - 10ML
CYOTIC DRO - 10ML
OTIRX DRO - 10ML
ACETIC ACID SOL 2% OTIC - 15ML
ANTIBIOT EAR SOL 1% OTIC - 10ML
CORTOMYCIN SOL 1% OTIC - 10ML
CORTOMYCIN SUS 1% OTIC - 10ML
DERMOTIC OIL 0.0001 - 20ML
NEO/POLY/HC SUS 1% OTIC - 10ML
PRAMOTIC DRO 1-0.1% - 10ML
ZOTANE HC DRO AQUEOUS - 10ML
CIPRO HC
CIPRODEX
COLY-MYCIN-S
CORTIC-ND
CORTISPORIN
CRESYLATE
FLOXIN OTIC
ORPHENADRINE
ORPHENGESIC
PARAFON FORT
ROBAXIN-750
SKELAXIN
SOMA
OPHTHALMIC PRODUCTS
AK-CON SOL 0.1% OP - 15ML
AK-DILATE SOL 10% OP - 5ML
ATROPIN-CARE SOL 1% OP - 2ML
BAC/NEO/POLY OIN OP - 3GM
BACIT/POLYMY OIN OP - 3GM
NAPHAZOLE SOL 0.1% OP - 15ML
NAPHAZOLINE SOL 0.1% OP - 15ML
TIMOLOL MAL SOL 0.25% OP - 5ML
TIMOLOL MAL SOL 0.5% OP - 5ML
ANTIDEPRESSANTS
AMITRIPTYLIN TAB 10MG-60EA
AMITRIPTYLIN TAB 25MG-60EA
CELEXA TAB 10MG-10EA
CITALOPRAM TAB 10MG-10EA
FLUOXETINE CAP 20MG-30EA
NORTRIPTYLIN CAP 25MG-30EA
PAMELOR CAP 10MG-30EA
PAMELOR CAP 25MG-30EA
TOFRANIL TAB 10MG-10EA
TRAZODONE TAB 100MG-28EA
TRAZODONE TAB 50MG-30EA
ASACOL
AZULFIDINE
CANASA
COLAZAL
DIPENTUM
OTIC PRODUCTS
AUROTO SOL OTIC - 10ML
Prices are subject to change and may not fall into the tiers as shown above.
The discount tier is drugs listed without strength or quantity and typically include all drugs not listed in the first 3 tiers.
OPTIPRANOLOL
OPTIVAR
PATANOL
PHOSPHOLINE
PILOPINE HS
POLY-PRED
PRED FORTE
PROPINE
QUIXIN
RESTASIS
TOBRADEX
TOBREX
TRAVATAN
TRIFLURIDINE
Preferred Brand & Generic Drugs
$10 Tier
Non-Preferred
$20 Tier
$40 Tier
Discounts
$10 Tier
ENALAPR/HCTZ TAB 5-12.5MG-90EA
ENALAPRIL TAB 20MG-90EA
FOSINOPRIL TAB 20MG-90EA
HYDRALAZINE TAB 10MG-120EA
HYDRALAZINE TAB 50MG-60EA
INNOPRAN XL CAP 80MG-10EA
ISOPTIN SR TAB 120MG-30EA
ISOPTIN SR TAB 240MG-90EA
ISOSORB MONO TAB 120MG ER-30EA
ISRADIPINE CAP 2.5MG-30EA
LISINOPRIL TAB 30MG-60EA
LOPRESS HCT TAB 50-25MG-30EA
LOSARTAN POT TAB 100MG-15EA
LOSARTAN POT TAB 50MG-30EA
LOSARTAN/HCT TAB 100-12.5-15EA
LOSARTAN/HCT TAB 100-25-15EA
LOTENSIN TAB 20MG-60EA
MAVIK TAB 4MG-30EA
METHYLDOPA TAB 250MG-90EA
METHYLDOPA TAB 500MG-90EA
METOPRL/HCTZ TAB 50-25MG-30EA
METOPROLOL TAB 25MG ER-30EA
MEXILETINE CAP 200MG-61EA
MEXILETINE CAP 250MG-30EA
MICARDIS TAB 40MG-10EA
MINIPRESS CAP 2MG-90EA
NIFEDICAL XL TAB 30MG-30EA
NIFEDIPINE TAB 30MG ER-30EA
NITROGLYCER CAP 6.5MG CR-60EA
PERINDOPRIL TAB 4MG-15EA
PRAZOSIN HCL CAP 2MG-90EA
PROPRAN/HCTZ TAB 40/25-30EA
PROPRAN/HCTZ TAB 80/25-30EA
PROPRANOLOL TAB 20MG-180EA
QNAPRIL/HCTZ TAB 20-12.5-30EA
RYTHMOL TAB 150MG-60EA
SECTRAL CAP 400MG-30EA
TAMBOCOR TAB 150MG-30EA
TAZTIA XT CAP 180MG/24-30EA
TENORETIC TAB 100-90EA
TERAZOSIN CAP 5MG-60EA
TIAZAC CAP 180MG/24-30EA
TIMOLOL MAL TAB 10MG-60EA
TIMOLOL MAL TAB 20MG-30EA
TOPROL XL TAB 25MG-30EA
UNIRETIC TAB 15-12.5-30EA
UNIRETIC TAB 7.5-12.5-30EA
UNIVASC TAB 7.5MG-30EA
VASOTEC TAB 2.5MG-180EA
VERAPAMIL CAP 180MG ER-30EA
VERAPAMIL CAP 360MG SR-15EA
VERAPAMIL TAB 120MG ER-30EA
VERAPAMIL TAB 240MG ER-90EA
VERELAN CAP 180MG-30EA
VERELAN CAP 360MG SR-15EA
ZEBETA TAB 10MG-30EA
ZEBETA TAB 5MG-30EA
ZESTRIL TAB 30MG-60EA
DIFLUCAN TAB 200MG-2EA
FLUCONAZOLE TAB 150MG-2EA
FLUCONAZOLE TAB 200MG-2EA
MIDODRINE
MINITRAN
MONOKET
MONOPRIL
MONOPRIL HCT
NADOLOL
NIFEDIAC CC
NIFEDICAL XL
NIFEDIPINE
NITREK
NITRO-DUR
NITROGLYCER
NITROGLYCERI
NITROLINGUAL
NORPACE
NORVASC
PACERONE
PAPAVERINE
PLENDIL
PRINIVIL
PROAMATINE
PROCAINAMIDE
PROCANBID
PROCARDIA
PROCARDIA XL
PRONESTYL
PROPAFENONE
PROPRANOLOL
QUINAPRIL
RANEXA
RESERPINE
REVATIO
RYTHMOL
RYTHMOL SR
SECTRAL
SORINE
SOTALOL AF
SOTALOL HCL
SULAR
TAMBOCOR
TARKA
TAZTIA XT
TENEX
TENORMIN
TEVETEN
TEVETEN HCT
TIAZAC
TIKOSYN
TIMOLOL
TOPROL XL
TRACLEER
TRANDATE
UNIRETIC
UNIVASC
VASERETIC
VASOTEC
VERAPAMIL
VERELAN
VERELAN PM
ZEBETA
ZESTORETIC
ZESTRIL
ZIAC
$20 Tier
$40 Tier
CARDIOTEK-RX TAB-15EA
CENTRATEX CAP-30EA
FA-B6-B12 TAB-30EA
FABB TAB-30EA
FEROCON CAP-30EA
FERRAPLUS 90 TAB-30EA
FOLGARD RX TAB-30EA
FOLIC ACID TAB 1MG-100EA
FOLIVANE-F CAP-30EA
FOLIVANE-PLS CAP-30EA
FUMATINIC CAP-30EA
ICAR-C PLUS TAB-30EA
INTEGRA F CAP-30EA
POLY-IRON CAP 150MG-30EA
RE DUALVIT CAP PLUS-30EA
TANDEM PLUS CAP-30EA
TRICON CAP-30EA
CENFOL TAB-30EA
CORVITA 150 TAB-30EA
DIVISTA CAP-30EA
DROXIA CAP 200MG-30EA
DROXIA CAP 300MG-30EA
DROXIA CAP 400MG-30EA
FERRALET 90 TAB-30EA
FERREX 150 CAP FORTE PL-30EA
FERREX 28 TAB-28EA
FOLBEE TAB-30EA
FOLPACE RX TAB-30EA
FOLTRATE TAB-30EA
HEMATRON-AF TAB-30EA
HEMAX TAB SR-30EA
MAXARON FORT CAP-30EA
MULTIGEN TAB-30EA
MULTIGEN TAB FOLIC-30EA
TARON FORTE CAP-30EA
CALAFOL RX
CEREFOLIN
DROXIA
EPOGEN
LEUKINE
NASCOBAL
NEULASTA
PROCRIT
ESTRACE TAB 0.5MG-60EA
ESTRADIOL TAB 0.5MG-60EA
ESTRADIOL TAB 1MG-30EA
ESTROPIPATE TAB 0.75MG-30EA
AYGESTIN TAB 5MG-12EA
EST ESTROGEN TAB MTEST HS-30EA
EST ESTROGEN TAB MTEST-30EA
ESTRACE TAB 2MG-90EA
ESTRADIOL TAB 2MG-90EA
MEDROXYPR AC TAB 2.5MG-100EA
MENEST TAB 0.3MG-30EA
MENEST TAB 0.625MG-30EA
NORETHIN ACE TAB 5MG-12EA
PREMARIN TAB 0.625MG-10EA
PREMARIN TAB 0.9MG-14EA
PROVERA TAB 2.5MG-100EA
ACTIVELLA
CENESTIN
CLIMARA, CLIMARA PRO
COMBIPATCH
DELESTROGEN
ENJUVIA
ESSIAN
ESTRACE
ESTRADERM
ESTRADIOL
ESTRIOL
ESTROGEL
ESTRONE
FEMHRT
MOTOFEN
BIO-STATIN CAP 1000000-30EA
DIFLUCAN TAB 100MG-10EA
DIFLUCAN TAB 50MG-30EA
FLUCONAZOLE TAB 100MG-10EA
TERBINAFINE TAB 250MG-28EA
CETIRIZINE TAB 10MG-14EA
CYPROHEPTAD TAB 4MG-30EA
DIPHENHYDRAM CAP 25MG-30EA
DIPHENHYDRAM CAP 50MG-30EA
LODRANE 12HR TAB-20EA
LOHIST-12 TAB 12 HOUR-20EA
PROMETHAZINE TAB 12.5MG-20EA
Q-DRYL CAP 25MG-30EA
AEROHIST TAB 8-2.5MG-30EA
AHIST TAB 12MG-12EA
DEXCHLORPHEN TAB 4MG CR-30EA
ED-CHLOR-TAN TAB 8MG-30EA
PROMETHAZINE TAB 25MG-30EA
PROMETHAZINE TAB 50MG-30EA
RESPA-BR TAB 11MG-14EA
VAZOL LIQ 2MG/5ML - 180ML
ALA-HIST TAB 6-25MG-30EA
ALLEGRA ALRG TAB 180MG-30EA
ALLERGY RELF TAB 10MG-60EA
FEXOFENADINE TAB 180MG-30EA
FEXOFENADINE TAB 60MG-30EA
LEVOCETIRIZI TAB DHCL 5MG-10EA
LODRANE 24 CAP-12EA
LORATADINE TAB 10MG-60EA
PALGIC TAB 4MG-30EA
XYZAL TAB 5MG-10EA
MEFLOQUINE TAB 250MG - 4EA
ALLEGRA
BROVEX
BROVEX CT
CHLORPHENIR
CLARINEX
CLARINEX RDT
DIPHENHYDRAM
DYTAN
FEXOFENADINE
HISTEX IE
HISTEX PD 12
PHENERGAN
PROMETHAZINE
PROMETHEGAN
ZYRTEC
ANTIVERT TAB 12.5MG-30EA
SCOPACE TAB 0.4MG-30EA
TIGAN CAP 300MG-10EA
TRIMETHOBENZ CAP 300MG-10EA
ONDANSETRON TAB 4MG ODT-20EA
ONDANSETRON TAB 4MG-20EA
ONDANSETRON TAB 8MG ODT-15EA
ZOFRAN TAB 4MG-20EA
ANTIVERT
ANZEMET
EMEND
KYTRIL
MARINOL
TIGAN
ZOFRAN
METHOTREXATE TAB 2.5MG-30EA
TAMOXIFEN TAB 20MG-15EA
HYDREA CAP 500MG-50EA
HYDROXYUREA CAP 500MG-50EA
LEUCOVOR CA TAB 5MG-15EA
ADRUCIL
AROMASIN
CASODEX
CYTOXAN
DACARBAZINE
DEPO-PROVERA
ELIGARD
ELOXATIN
FEMARA
FLUTAMIDE
GLEEVEC
HEXALEN
HYDREA
INTRON-A
LUPRON
HALOPERIDOL TAB 0.5MG-60EA
LITHIUM CARB CAP 600MG-30EA
LITHIUM CARB TAB 300MG-60EA
LOXITANE CAP 5MG-30EA
PERPHENAZINE TAB 8MG-15EA
CHLORPROMAZ TAB 25MG-150EA
CLOZARIL TAB 25MG-45EA
HALOPERIDOL TAB 5MG-60EA
LITHIUM CARB CAP 300MG-120EA
LITHIUM CARB TAB 300MG ER-90EA
LITHIUM CARB TAB 450MG ER-45EA
LITHOBID TAB 300MG CR-90EA
LOXITANE CAP 10MG-30EA
LOXITANE CAP 25MG-30EA
NAVANE CAP 10MG-60EA
RISPERDAL TAB 4MG-30EA
RISPERIDONE TAB 1MG-15EA
RISPERIDONE TAB 2MG-15EA
ZYPREXA TAB 15MG-1EA
ABILIFY
CHLORPROMAZ
CLOZAPINE
CLOZARIL
EQUETRO
ESKALITH CR
FAZACLO
FLUPHENAZINE
GEODON
HALDOL DECAN
HALOPERIDOL
LITHOBID
LOXAPINE
ACYCLOVIR CAP 200MG - 30EA
ACYCLOVIR TAB 400MG - 30EA
CRIXIVAN CAP 100MG-30EA
FLUMADINE TAB 100MG-12EA
RESCRIPTOR TAB 100 MG-30EA
RETROVIR TAB 300MG-30EA
RIMANTADINE TAB 100MG-12EA
ACYCLOVIR
APTIVUS
COMBIVIR
COPEGUS
CRIXIVAN
CYTOVENE
DIDANOSINE
EMTRIVA
EPIVIR
EPZICOM
FAMVIR
FORTOVASE
FOSCAVIR
FUZEON
GANCICLOVIR
HEPSERA
HIVID
INVIRASE
KALETRA
LEXIVA
NORVIR
PEGASYS
PEG-INTRON
PREZISTA
ANTI-NAUSEANTS
ANTIVERT TAB 25MG-30EA
MECLIZINE TAB 12.5MG-30EA
MECLIZINE TAB 25MG-30EA
ANTINEOPLASTICS
Prices are subject to change and may not fall into the tiers as shown above.
The discount tier is drugs listed without strength or quantity and typically include all drugs not listed in the first 3 tiers.
LYSODREN
MEGESTROL AC
MITOMYCIN
MYLERAN
NEXAVAR
NILANDRON
NOLVADEX
SUTENT
TABLOID
TAMOXIFEN
TARCEVA
TARGRETIN
TREXALL
VELCADE
XELODA
ZOLADEX
ANTIPSYCHOTICS
LITHIUM CARB CAP 150MG-30EA
NAVANE CAP 2MG-30EA
LOXITANE
MOBAN
NAVANE
RISPERDAL
RISPERDAL M
SEROQUEL
ZYPREXA
ZYPREXA ZYDI
ANTIVIRALS
HORMONES
MEDROXYPR AC TAB 10MG-10EA
MEDROXYPR AC TAB 5MG-12EA
PROVERA TAB 10MG-10EA
PROVERA TAB 5MG-12EA
Discounts
ANTIHISTAMINES
HEMATOPOIETIC AGENTS
ED CYTE F TAB-30EA
FERREX 150 CAP FORTE-30EA
FERROTRIN CAP-30EA
FERROUS FUM TAB 324MG-30EA
FERROUS GLUC TAB 324MG-100EA
FERROUS GLUC TAB 325MG-40EA
FERROUS SULF TAB 325MG-100EA
FERROUS SULF TAB 325MG EC-30EA
METHYL-MAX CAP-30EA
POLY/IRON CAP 150 FORT-30EA
PRE-FOLIC TAB 1-100MG-30EA
Non-Preferred
ANTIDIARRHEALS
HEART/HIGH BLOOD PRESSURE MEDICATIONS
LISINOP/HCTZ TAB 20-12.5-30EA
LISINOP/HCTZ TAB 20-25MG-30EA
LISINOPRIL TAB 40MG-30EA
LISINOPRIL TAB 5MG-60EA
LOTENSIN HCT TAB 20-12.5-30EA
MAVIK TAB 1MG-26EA
METHYLD/HCTZ TAB 250/25-30EA
METOPROL TAR TAB 25MG-90EA
MINIPRESS CAP 1MG-30EA
MINIPRESS CAP 5MG-30EA
MOEXIPR/HCTZ TAB 15-25MG-15EA
MONOKET TAB 20MG-30EA
NADOLOL TAB 20MG-30EA
NICARDIPINE CAP 30MG-60EA
NIFEDIPINE CAP 10MG-14EA
NORPACE CAP 100MG-30EA
NORPACE CAP 150MG-30EA
PRAZOSIN HCL CAP 1MG-30EA
PRINIVIL TAB 5MG-60EA
PRINZIDE TAB 10-12.5-30EA
PRINZIDE TAB 20-12.5-30EA
PROCARDIA CAP 10MG-14EA
PROPRANOLOL CAP 80MG ER-14EA
PROPRANOLOL TAB 10MG-90EA
PROPRANOLOL TAB 60MG-10EA
QUINAPRIL TAB 10MG-30EA
QUINAPRIL TAB 40MG-30EA
QUINIDINE GL TAB 324MG CR-15EA
RAMIPRIL CAP 10MG-10EA
RESERPINE TAB 0.1MG-30EA
RESERPINE TAB 0.25MG-30EA
SECTRAL CAP 200MG-30EA
SOTALOL HCL TAB 80MG-60EA
TENORETIC TAB 50-30EA
TENORMIN TAB 25MG-90EA
TERAZOSIN CAP 2MG-30EA
TIMOLOL MAL TAB 5MG-30EA
UNIRETIC TAB 15-25MG-15EA
VERAPAMIL TAB 180MG ER-30EA
ZESTRIL TAB 40MG-30EA
Preferred Brand & Generic Drugs
FEMTRACE
MEGACE ES
MENEST
MENOSTAR
OGEN
PREFEST
PREMARIN
PREMPHASE
PREMPRO
PROGESTERONE
PROVERA
VIVELLE
VIVELLE-DOT
Prices are subject to change and may not fall into the tiers as shown above.
The discount tier is drugs listed without strength or quantity and typically include all drugs not listed in the first 3 tiers.
REBETOL
RESCRIPTOR
RETROVIR
REYATAZ
RIBAPAK
RIBASPHERE
TAMIFLU
TRIZIVIR
TRUVADA
VALCYTE
VALTREX
VIDEX EC
VIRRIBAVIRIN
SUSTIVA
ACEPT
VIRAMUNE
VIREAD
ZERIT
ZIAGEN
ZIDOVUDINE
Preferred Brand & Generic Drugs
$10 Tier
Non-Preferred
$20 Tier
$40 Tier
Discounts
Preferred Brand & Generic Drugs
$10 Tier
Non-Preferred
$20 Tier
$40 Tier
ENDOCRINE AND METABOLIC DRUGS - MISC.
BLOOD MODIFIERS
PERSANTINE TAB 25MG-60EA
PLETAL TAB 50MG-30EA
WARFARIN TAB 2.5MG-34EA
WARFARIN TAB 3MG-30EA
WARFARIN TAB 4MG-30EA
WARFARIN TAB 7.5MG-30EA
COUMADIN TAB 6MG-100EA
WARFARIN TAB 10MG-60EA
WARFARIN TAB 1MG-90EA
WARFARIN TAB 2MG-100EA
WARFARIN TAB 5MG-90EA
WARFARIN TAB 6MG-100EA
AGGRENOX
AGRYLIN
AMICAR
ANAGRELIDE
CILOSTAZOL
CLOPIDOGREL
COUMADIN
DIPYRIDAMOLE
AMPHETAMINE TAB 15MG-45EA
DEXMETHYLPH TAB 10MG-30EA
DEXMETHYLPH TAB 5MG-30EA
DEXTROAMPHET TAB 5MG-120EA
FOCALIN TAB 5MG-30EA
METHYLIN ER TAB 10MG-30EA
METHYLIN TAB 10MG-100EA
METHYLPHENID TAB 10MG ER-30EA
METHYLPHENID TAB 10MG-100EA
NUVIGIL TAB 150MG-2EA
ADDERALL
ADDERALL XR
AMPHETAMINE
CONCERTA
CYLERT
DAYTRANA
DESOXYN
DEXEDRINE
DEXTROAMPHET
DEXTROSTAT
FOCALIN
FOCALIN XR
COLESTID TAB 1GM-30EA
COLESTIPOL TAB 1GM-30EA
FENOFIBRIC TAB 35MG-30EA
FIBRICOR TAB 35MG-30EA
LOFIBRA CAP 67MG-30EA
LOVASTATIN TAB 40MG-45EA
MEVACOR TAB 40MG-45EA
SIMVASTATIN TAB 10MG-60EA
SIMVASTATIN TAB 80MG-100EA
ZOCOR TAB 10MG-60EA
ZOCOR TAB 80MG-100EA
ADVICOR
ALTOPREV
ANTARA
CHOLESTYRAM
COLESTID
COLESTID FLA
COLESTIPOL
CRESTOR
FENOFIBRATE
LESCOL
LESCOL XL
LIPITOR
LOFIBRA
LOPID
APRI TAB-28EA
AVIANE TAB-28EA
BALZIVA TAB-28EA
BREVICON TAB 0.5/35-28EA
CRYSELLE-28 TAB 28 TABS-28EA
CYCLESSA PAK-28EA
DESOGEN-28 TAB-28EA
ENPRESSE-28 TAB-28EA
ERRIN TAB 0.35MG-28EA
GILDESS FE TAB 1/20-28EA
JOLIVETTE TAB 0.35MG-28EA
JUNEL 1.5/30, 1/20, TAB-21EA
JUNEL FE TAB 1.5/30, 1/20 -28EA
KELNOR TAB 1/35-28EA
LEENA TAB-28EA
LEVORA-28 TAB 0.15/30-28EA
LOESTRIN 21 TAB 1.5/30-21EA
LOESTRIN FE TAB 1.5/30, 1/20 -28EA
LOESTRIN TAB 1/20-21-21EA
LOW-OGESTREL TAB-28EA
LUTERA TAB-28EA
MICROGESTIN TAB 1.5/30, 1/20 -21EA
MICROGESTIN TAB FE 1/20, 1.5/30 -28EA
MODICON TAB 0.5/35-28EA
NECON 7/7/7 TAB 28 DAY-28EA
NECON TAB 0.5/35-28EA
NECON TAB 1/35-28EA
NORDETTE-28 TAB-28EA
NORGEST/ETH TAB ESTRAD-28EA
NORINYL TAB 1+35-28EA
NOR-QD TAB 0.35MG-28EA
NORTREL TAB 1/35 -28EA
ORTHO MICRON TAB 0.35MG-28EA
ORTHO TRI- TAB CYCLEN-28EA
ORTHO-NOVUM TAB 1/35 -28-28EA
PORTIA-28 TAB-28EA
PREVIFEM TAB-28EA
TRI-NORINYL TAB 28-28EA
TRI-PREVIFEM TAB-28EA
TRI-SPRINTEC TAB-28EA
TRIVORA-28 TAB-28EA
VELIVET PAK-28EA
ZENCHENT TAB-28EA
ZOVIA 1/35E TAB-28EA
CYCLESSA
DEPO-PROVERA
DESOGEN-28
ESTROSTEP FE
KARIVA
LO/OVRAL-28
LOESTRIN
LOESTRIN 24
LOESTRIN FE
MEDROXYPR AC
MIRCETTE
MIRENA
MODICON
NORDETTE-28
NUVARING
OGESTREL
ORTHO EVRA
ORTHO TRI-CY
ORTHO-CEPT
ORTHO-NOVUM
OVCON 50
OVCON-35
OVRAL
SEASONALE
SEASONIQUE
TRI-LEVLEN
TRI-NORINYL
YASMIN 28
YAZ
ZEMPLAR
ZOMETA
FRAGMIN
HEPARIN
LOVENOX
PERSANTINE
PLAVIX
PLETAL
TICLID
TRENTAL
ALENDRONATE TAB 70MG-4EA
METHERGINE TAB 0.2MG-6EA
CLOMID TAB 50MG-5EA
FOSAMAX TAB 5MG-30EA
CALCITRIOL CAP 0.25MCG-30EA
CARNITOR TAB 330MG-30EA
ROCALTROL CAP 0.25MCG-30EA
ACTHAR HP
BUPHENYL
CABERGOLINE
CARNITOR
CLOMID
CYSTADANE
CYTADREN
DOSTINEX
EVISTA
FOLLISTIM AQ
GENOTROPIN
AZULFIDINE TAB 500MG-120EA
CIMETIDINE TAB 800MG-30EA
DIGEX NF CAP-30EA
ELIPHOS TAB 667MG-30EA
METOCLOPRAM TAB 10MG-120EA
OMEPRAZOLE TAB 20MG-28EA
PANTOPRAZOLE TAB 20MG-30EA
PANTOPRAZOLE TAB 40MG-30EA
PROPANTHELIN TAB 15MG-30EA
PROTONIX TAB 20MG-30EA
RANITIDINE TAB 150MG-30EA
REGLAN TAB 10MG-120EA
SULFASALAZIN TAB 500MG-120EA
ACTIGALL CAP 300MG-30EA
ANASPAZ TAB 0.125MG-30EA
CALC ACETATE CAP 667MG-30EA
GLYCOPYRROL TAB 2MG-20EA
HYOMAX TAB 0.125MG-30EA
HYOMAX-FT TAB 0.125MG-30EA
LEVSIN TAB 0.125MG-30EA
METOZOLV ODT TAB 5MG-30EA
OMEPRAZOLE CAP 20MG-60EA
OMEPRAZOLE CAP 40MG-28EA
PHOSLO CAP 667MG-30EA
RANITIDINE TAB 300MG-90EA
ROBINUL FORT TAB 2MG-20EA
URSODIOL CAP 300MG-30EA
ZANTAC TAB 300MG-90EA
ACIPHEX
ACTIGALL
ALKABEL-SR
AMITIZA
ATROPINE SUL
AXID
BELLA/OPIUM
BELLATAL ER
CARAFATE
CIMETIDINE
CYTOTEC
DONNATAL
FOSRENOL
GLYCOPYRROL
HELIDAC
HYOSCYAMINE
LEVBID
LEVSIN/SL
CYSTAGON CAP 50MG-30EA
METHENAM MAN TAB 500MG-30EA
TAMSULOSIN CAP 0.4MG-30EA
URECHOLINE TAB 5MG-30EA
UROQID #2 TAB-30EA
CYSTAGON CAP 150MG-30EA
ELMIRON CAP 100MG-7EA
FINASTERIDE TAB 5MG-30EA
MACRODANTIN CAP 25MG-15EA
THIOLA TAB 100MG-30EA
URETRON D/S TAB-30EA
USTELL CAP-20EA
AVODART
BETHANECHOL
BICITRA
CARDURA XL
CLEOCIN
CLEOCIN VAG
CLINDAMAX
CLINDAMYCIN
CLINDESSE
DETROL
DETROL LA
DITROPAN
ENABLEX
ESTRING
FEMRING
FINASTERIDE
FLAVOXATE
FLOMAX
FURADANTIN
GYNAZOLE-1
LITHOSTAT
MACROBID
MACRODANTIN
ACCUPRIL TAB 10MG-60EA
ACEBUTOLOL CAP 400MG-30EA
ACEON TAB 4MG-15EA
AMIODARONE TAB 200MG-60EA
ATACAND TAB 32MG-10EA
BENAZEPRIL TAB 20MG-60EA
BENAZEPRIL TAB 40MG-100EA
BETAPACE AF TAB 120MG-30EA
BISOPROL FUM TAB 10MG-30EA
BISOPROL FUM TAB 5MG-30EA
BYSTOLIC TAB 10MG-15EA
CALAN SR TAB 120MG-30EA
CALAN SR TAB 240MG-90EA
CARDIZEM CD CAP 120MG/24-30EA
CARDIZEM TAB 120MG-120EA
CARDIZEM TAB 60MG-90EA
CARDURA TAB 1MG-135EA
CARDURA TAB 4MG-90EA
CARVEDILOL TAB 12.5MG-90EA
CATAPRES TAB 0.3MG-240EA
CLONIDINE TAB 0.3MG-240EA
CORDARONE TAB 200MG-60EA
DILACOR XR CAP 240MG/24-30EA
DILTIAZEM CAP 120MG CD-30EA
DILTIAZEM CAP 120MG/24-30EA
DILTIAZEM CAP 180MG CD-30EA
DILTIAZEM CAP 180MG ER-30EA
DILTIAZEM CAP 180MG/24-30EA
DILTIAZEM CAP 240MG ER-30EA
DIOVAN HCT TAB 80/12.5-10EA
DIOVAN TAB 40MG-14EA
DOXAZOSIN TAB 4MG-90EA
ENALAPR/HCTZ TAB 10-25MG-90EA
ACCUPRIL
ACCURETIC
ACEON
ADALAT CC
AFEDITAB
ALTACE
AMIODARONE
ATACAND
ATACAND HCT
ATENOLOL
AVALIDE
AVAPRO
BENICAR
BENICAR HCT
BETAPACE
BETAPACE AF
BETAXOLOL
BIDIL
CADUET
CALAN
CALAN SR
CAPOTEN
CAPOZIDE
CAPTOPR/HCTZ
CARDENE
CARDENE SR
CARDIZEM
CARDIZEM CD
CARDIZEM LA
CARDURA
CARTIA XT
CATAPRES
CATAPRES-TTS
CLONIDINE
CLORPRES
CORDARONE
COREG
CORGARD
CORZIDE
COVERA-HS
COZAAR
CENTRAL NERVOUS SYSTEM STIMULANTS
METHYLIN TAB 5MG-30EA
METHYLPHENID TAB 5MG-30EA
RITALIN TAB 5MG-30EA
AMPHETAMINE TAB 10MG-30EA
AMPHETAMINE TAB 20MG-30EA
DEXTROAMPHET TAB 10MG-30EA
FOCALIN TAB 2.5MG-30EA
INTUNIV TAB 1MG-3EA
METADATE CD
METHYLIN
PEMOLINE
PROVIGIL
RITALIN
RITALIN LA
RITALIN SR
STRATTERA
CHOLESTEROL-LOWERING AGENTS
LOFIBRA CAP 200MG-2EA
PRAVACHOL TAB 10MG-30EA
PRAVACHOL TAB 20MG-16EA
PRAVASTATIN TAB 20MG-16EA
SIMVASTATIN TAB 20MG-15EA
TRILIPIX CAP 135MG-1EA
Discounts
LOFIBRA CAP 134MG-10EA
PRAVACHOL TAB 80MG-22EA
PRAVASTATIN TAB 40MG-30EA
PRAVASTATIN TAB 80MG-22EA
SIMVASTATIN TAB 40MG-30EA
SIMVASTATIN TAB 5MG-30EA
ZOCOR TAB 5MG-30EA
CONTRACEPTIVES
Prices are subject to change and may not fall into the tiers as shown above.
The discount tier is drugs listed without strength or quantity and typically include all drugs not listed in the first 3 tiers.
LOVASTATIN
MEVACOR
NIASPAN
OMACOR
PRAVACHOL
PRAVASTATIN
PREVALITE
QUESTRAN
TRICOR
TRIGLIDE
VYTORIN
WELCHOL
ZETIA
ZOCOR
HECTOROL
LEVOCARNITIN
NORDITROPIN
NOVAREL
OCTREOTIDE
SAIZEN
SENSIPAR
SOMAVERT
STIMATE
ZEMPLAR
GASTROINTESTINAL AGENTS
AXID CAP 150MG-10EA
BELLA ALK/PB TAB 16.2MG-30EA
BENTYL CAP 10MG-60EA
BENTYL TAB 20MG-30EA
DICYCLOMINE CAP 10MG-60EA
DICYCLOMINE TAB 20MG-30EA
DONNATAL TAB-30EA
FAMOTIDINE TAB 40MG-10EA
MAG OXIDE TAB 400MG-30EA
MAGNESIUM-OX TAB 400MG-30EA
MAG-OX 400 TAB 400MG-30EA
MAG-OXIDE TAB 400MG-30EA
METOCLOPRAM TAB 5MG-15EA
NIZATIDINE CAP 150MG-10EA
PEPCID TAB 40MG-10EA
REGLAN TAB 5MG-15EA
SODIUM BICAR TAB 650MG-180EA
LEVSINEX
LIBRAX
LOTRONEX
METOCLOPRAM
MISOPROSTOL
NEXIUM
NIZATIDINE
OMEPRAZOLE
PAMINE
GENITOURINARY PRODUCTS
CITROLITH TAB-30EA
DETROL LA CAP 4MG-1EA
K-PHOS TAB MF-30EA
K-PHOS TAB NO 2-30EA
OXYBUTYNIN TAB 5MG-30EA
PHENAZOPYRID TAB 100MG-10EA
PHENAZOPYRID TAB 200MG-20EA
PYRIDIUM TAB 100MG-10EA
PYRIDIUM TAB 200MG-20EA
MICONAZOLE 3
MONUROL
NALIDIXIC
NEGGRAM
NYSTATIN
OXYTROL
PROSCAR
PYRIDIUM
RIMSO-50
SANCTURA
TERAZOL 3, 7
TERCONAZOLE
THIOLA
URECHOLINE
URELIEF PLUS
URELLE
UREX
URISPAS
URITACT-EC
UROXATRAL
VESICARE
GOUT MEDICATIONS
ALLOPURINOL TAB 100MG - 30EA
ALLOPURINOL TAB 300MG - 30EA
ZYLOPRIM TAB 100MG-30EA
COLCHICINE TAB 0.6MG-20EA
ZYLOPRIM TAB 300MG-90EA
HEART/HIGH BLOOD PRESSURE MEDICATIONS
ACCUPRIL TAB 20MG-14EA
AMLODIPINE TAB 10MG-15EA
ATENOLOL TAB 100MG-30EA
ATENOLOL TAB 50MG-30EA
BETAPACE TAB 120MG-15EA
CALAN TAB 120MG-30EA
CAPTOPRIL TAB 12.5MG-30EA
CARVEDILOL TAB 3.125MG-30EA
CARVEDILOL TAB 6.25MG-30EA
CATAPRES TAB 0.1MG-30EA
CLONIDINE TAB 0.1MG-30EA
COREG TAB 3.125MG-30EA
COREG TAB 6.25MG-30EA
DIGOXIN TAB 0.125MG-30EA
DIGOXIN TAB 0.25MG-30EA
ENALAPRIL TAB 10MG-30EA
ENALAPRIL TAB 5MG-30EA
ISORDIL TAB 5MG-84EA
ISOSORB DIN TAB 30MG-30EA
LANOXIN TAB 0.125MG-30EA
LANOXIN TAB 0.25MG-30EA
LISINOPRIL TAB 10MG-30EA
LISINOPRIL TAB 2.5MG-10EA
LISINOPRIL TAB 20MG-30EA
METOPROL TAR TAB 100MG-30EA
METOPROL TAR TAB 50MG-30EA
PRINIVIL TAB 10MG-30EA
PRINIVIL TAB 20MG-30EA
QUINAPRIL TAB 20MG-14EA
TENORMIN TAB 100MG-30EA
TRANDATE TAB 100MG-30EA
ZESTRIL TAB 2.5MG-10EA
ZESTRIL TAB 20MG-30EA
ACCUPRIL TAB 5MG-30EA
ALTACE CAP 1.25MG-30EA
ALTACE CAP 10MG-10EA
AMLODIPINE TAB 5MG-30EA
ATENOL/CHLOR TAB 50-25MG-30EA
ATENOLOL TAB 25MG-90EA
BENAZEPRIL TAB 5MG-30EA
BETAPACE AF TAB 160MG-30EA
BETAPACE TAB 80MG-60EA
BISOPRL/HCTZ TAB 10/6.25-30EA
BISOPRL/HCTZ TAB 2.5/6.25-30EA
CALAN SR TAB 180MG-30EA
CALAN TAB 80MG-90EA
CAPTOPR/HCTZ TAB 50-15MG-30EA
CAPTOPRIL TAB 25MG-270EA
CAPTOPRIL TAB 50MG-180EA
CARDIZEM CD CAP 360MG/24-2EA
CARDIZEM TAB 30MG-120EA
CARDIZEM TAB 90MG-90EA
CARDURA TAB 2MG-30EA
CARDURA TAB 8MG-30EA
CARVEDILOL TAB 25MG-60EA
CATAPRES TAB 0.2MG-90EA
CLONIDINE TAB 0.2MG-90EA
CORGARD TAB 20MG-30EA
DILTIAZEM TAB 30MG-120EA
DOXAZOSIN TAB 2MG-30EA
DOXAZOSIN TAB 8MG-30EA
FOSINOP/HCTZ TAB 10/12.5-15EA
ISOPTIN SR TAB 180MG-30EA
ISOSORB DIN TAB 10MG-90EA
ISOSORB MONO TAB 20MG-30EA
LISINOP/HCTZ TAB 10-12.5-30EA
Prices are subject to change and may not fall into the tiers as shown above.
The discount tier is drugs listed without strength or quantity and typically include all drugs not listed in the first 3 tiers.
DIBENZYLINE
DILACOR XR
DILATRATE SR
DILTIAZEM
DIOVAN
DIOVAN HCT
DISOPYRAMIDE
DYNACIRC
DYNACIRC CR
ENALAPRIL
ETHMOZINE
FELODIPINE
FLECAINIDE
FOSINOP/HCTZ
HYTRIN
HYZAAR
IMDUR
INDERAL
INDERAL LA
INDERIDE
INNOPRAN XL
INSPRA
ISMO
ISOPTIN SR
ISORDIL
ISOSORB DIN
ISOSORB MONO
ISOXSUPRINE
ISRADIPINE
KERLONE
LEVATOL
LEXXEL
LOPRESS HCT
LOPRESSOR
LOTENSIN
LOTENSIN HCT
LOTREL
METOPRL/HCTZ
METOPROLOL
MEXILETINE
Preferred Brand & Generic Drugs
$10 Tier
Non-Preferred
$20 Tier
$40 Tier
Discounts
DENTAL/FLUORIDE AGENTS
CHLORHEX GLU SOL 0.0012 - 473ML
CONTROLRX CRE 0.011 - 51GM
DENTA 5000 CRE PLUS - 51GM
DENTAGEL GEL 0.011 - 56GM
FLUOR-A-DAY CHW 0.25MG FLUOR-A-DAY CHW 0.5MG
GEL-KAM GEL 0.004 - 122GM
LOZI-FLUR LOZ 1MG - 30EA
LURIDE CHW 0.5MG - 54EA
LURIDE CHW 1MG - 120EA
PERIDEX SOL 0.0012 - 473ML
PERIOGARD SOL 0.0012 - 473ML
PHOS-FLUR GEL 0.011 - 51GM
PREVIDENT GEL 1.1% CHR - 56GM
PREVIDENT GEL 1.1% MIN - 56GM
SF 5000 PLUS CRE 0.011 -51GM
SF GEL 0.011 - 56GM
SOD FLUORIDE TAB 1MG -30EA
DEXAMETHASON TAB 0.5MG-28EA
DEXAMETHASON TAB 0.75MG-10EA
DEXAMETHASON TAB 1.5MG-10EA
DEXAMETHASON TAB 4MG-10EA
MILLIPRED TAB 5MG-30EA
PREDNISONE TAB 10MG-30EA
PREDNISONE TAB 2.5MG-60EA
PREDNISONE TAB 20MG-20EA
PREDNISONE TAB 50MG-10EA
PREDNISONE TAB 5MG-100EA
ACTICIN CRE 0.05 - 60GM
AMMONIUM LAC CRE 0.12 - 280GM
GRANULEX AER - 113GM
LACLOTION LOT 0.12 - 225GM
LIDOCAINE GEL 2% JELLY - 30ML
PERMETHRIN CRE 0.05 - 60GM
SELENIUM SUL LOT 0.025 - 120ML
SILVADENE CRE 0.01 - 50GM
SILVER SULFA CRE 0.01 - 50GM
SSD AF CRE 0.01 - 50GM
SSD CRE 0.01 - 50GM
TBC AER - 113GM
THERMAZENE CRE 0.01 - 50GM
XYLOCAINE GEL 0.02 - 30ML
EURAX LOT 0.1 - 60ML
LACTIC ACID CRE E - 113GM
LACTIC ACID CRE VIT E - 113GM
LIDOCAINE CRE 0.03 - 28GM
LIDOCAINE OIN 0.05 - 35GM
LIDOCAINE SOL 0.04 - 50ML
SULFAMYLON CRE 85MG/GM - 57GM
ACCUZYME
ATOPICLAIR
AVAGE
BENOQUIN
BIAFINE
BIONECT
CARAC
CARMOL SCALP
CEROVEL
DOVONEX
EFUDEX
ELDOQUIN
ELIDEL
ELIMITE
ETHEZYME
FINACEA
FLUOROPLEX
KERALAC
KERALYT
LACTINOL
LEVULAN KERA
LIDAMANTLE
LIDOC/PRILOC
LIDOCAINE
LIDODERM
LUSTRA
LUSTRA-ULTRA
METROCREAM
METROGEL
METRONIDAZOL
NORITATE
CHLORPROPAM TAB 100MG-30EA
DIABETA TAB 2.5MG-90EA
DIABETA TAB 5MG-30EA
GLIMEPIRIDE TAB 2MG-90EA
GLIP/METFORM TAB 2.5-500M-10EA
GLIPIZIDE ER TAB 2.5MG-30EA
GLIPIZIDE TAB 10MG-120EA
GLIPIZIDE TAB 5MG-180EA
GLIPIZIDE XL TAB 2.5MG-30EA
GLUCOPHAGE TAB 1000MG-60EA
GLUCOTROL TAB 10MG-120EA
GLUCOTROL XL TAB 2.5MG-30EA
GLYBURIDE TAB 2.5MG-90EA
GLYBURIDE TAB 5MG-30EA
METFORMIN TAB 1000MG-60EA
METFORMIN TAB 500MG-60EA
TOLBUTAMIDE TAB 500MG-30EA
DIABETA TAB 1.25MG-120EA
GLIPIZIDE ER TAB 5MG-90EA
GLIPIZIDE XL TAB 5MG-90EA
GLUCOTROL XL TAB 5MG-90EA
GLYB/METFORM TAB 2.5-500-120EA
GLYBURIDE TAB 1.25MG-120EA
GLYSET TAB 25MG-30EA
GLYSET TAB 50MG-30EA
NATEGLINIDE TAB 120MG-21EA
PRANDIN TAB 2MG-10EA
ACTOPLUS MET
ACTOS
AMARYL
AVANDAMET
AVANDARYL
AVANDIA
DIABETA
DIABINESE
FORTAMET
GLIP/METFORM
GLUCOPHAGE
GLUCOTROL
GLUCOTROL XL
GLYBURID MCR
GLYNASE
GLYSET
METAGLIP
METFORMIN
PRANDIN
PRECOSE
RIOMET
STARLIX
ACETAZOLAMID TAB 250MG-30EA
ALDACTONE TAB 25MG-30EA
ALDACTONE TAB 50MG-30EA
AMILOR/HCTZ TAB 5-50-30EA
BUMETANIDE TAB 1MG-30EA
CHLORTHALID TAB 25MG-30EA
DEMADEX TAB 20MG-30EA
DEMADEX TAB 5MG-30EA
DYAZIDE CAP 37.5-25-30EA
FUROSEMIDE TAB 80MG-90EA
HYDROCHLOROT CAP 12.5MG-30EA
MICROZIDE CAP 12.5MG-30EA
SPIRONOLACT TAB 25MG-30EA
SPIRONOLACT TAB 50MG-30EA
TORSEMIDE TAB 20MG-30EA
TRIAM/HCTZ CAP 37.5-25-30EA
TRIAMT/HCTZ TAB 37.5-25-30EA
TRIAMT/HCTZ TAB 75-50MG-30EA
ALDACTAZIDE TAB 25/25-60EA
CHLORTHALID TAB 100MG-30EA
DEMADEX TAB 100MG-30EA
HYDROCHLOROT TAB 12.5MG-30EA
METHYCLOTHIA TAB 5MG-30EA
METOLAZONE TAB 2.5MG-30EA
NEPTAZANE TAB 25MG-30EA
SPIRONO/HCTZ TAB 25/25-60EA
ZAROXOLYN TAB 2.5MG-30EA
ZAROXOLYN TAB 5MG-30EA
ALDACTAZIDE
ALDACTONE
BUMEX
DEMADEX
DIAMOX
DYRENIUM
EDECRIN
MAXZIDE
METOLAZONE
TORSEMIDE
ZAROXOLYN
DIURETICS
CHLOROTHIAZ TAB 250MG-30EA
FUROSEMIDE TAB 20MG-30EA
FUROSEMIDE TAB 40MG-30EA
HYDROCHLOROT TAB 25MG-100EA
HYDROCHLOROT TAB 50MG-30EA
LASIX TAB 20MG-30EA
LASIX TAB 40MG-30EA
MAXZIDE-25 TAB-30EA
$20 Tier
$40 Tier
CORTEF TAB 20MG-38EA
CORTISONE AC TAB 25MG-30EA
HYDROCORT TAB 20MG-38EA
MEDROL TAB 16MG-4EA
MEDROL TAB 2MG-9EA
MEDROL TAB 8MG-11EA
METHYLPRED TAB 16MG-4EA
METHYLPRED TAB 8MG-11EA
PREDNISONE TAB 1MG-45EA
ZEMA-PAK PAK 10 DAY-21EA
ZEMA-PAK PAK 13 DAY-21EA
CORTEF TAB 10MG-60EA
CORTEF TAB 5MG-60EA
DEXAMETHASON TAB 1MG-30EA
DEXPAK PAK 10 DAY-21EA
DEXPAK PAK 13 DAY-21EA
DEXPAK PAK 6 DAY-21EA
FLUDROCORT TAB 0.1MG-30EA
HYDROCORT TAB 10MG-60EA
HYDROCORT TAB 5MG-60EA
MEDROL PAK 4MG-21EA
METHYLPRED PAK 4MG-21EA
METHYLPRED TAB 4MG-30EA
MILLIPRED DP PAK 5MG-30EA
ZEMA-PAK PAK 6 DAY-21EA
ARISTOCORT
BETAMETHASON
CELESTONE
CORTEF
DECADRON
DEXAMETH SOD
DEXAMETHASON
ENTOCORT EC
FLUDROCORT
HYDROCORTONE
MEDROL
METHYLPRED
PREDNISOLONE
PREDNISONE
STERAPRED
TRIAMCINOLON
ALAVERT ALRG TAB /SINUS-30EA
ALBATUSSIN CAP-30EA
ALDEX GS DM TAB-30EA
ALDEX GS TAB 30-190MG-30EA
ALLERGY RELF TAB D 24 HR-30EA
ALLERX-D TAB 120/2.5-30EA
ALLFEN CD TAB 400-10MG-30EA
ALLFEN CDX TAB 400-20MG-30EA
AMBIFED CD TAB-30EA
AMBIFED CDX TAB-30EA
AMBIFED-G CD TAB-30EA
AMBIFED-G TAB CDX-30EA
BROVEX CB TAB 10-4MG-30EA
BROVEX CBX TAB 20-4MG-30EA
BROVEX PB C TAB 10-4-10-30EA
BROVEX PB CX TAB 10-4-20-30EA
BROVEX SR CAP 9-90MG-30EA
CLARITIN-D TAB 5-120MG-30EA
COLDCOUGH SYP - 120ML
COTAB A TAB 4-10MG-30EA
COTAB AX TAB 4-20MG-30EA
COTABFLU TAB 20-4-500-30EA
DALLERGY PSE TAB-30EA
DEC-CHLORPHN LIQ - 30ML
DIHYDRO-CP SYP - 240ML
DONATUSSIN DRO - 30ML
DURAFLU TAB-20EA
G/P TAB 1200-75 - 30EA
G/P TAB 1200-75-30EA
GENEXA LA CAP 30-400MG-30EA
GILPHEX TR TAB 10-388MG-30EA
GILTUSS TR CAP 7-14-288-40EA
GILTUSS TR TAB-30EA
HYDROMET SYP 5-1.5/5 - 240ML
J-TAN D SR TAB 6-30MG-14EA
LODRANE D SUS - 120ML
LOHIST-12D TAB 6-45MG-60EA
LORATA-DINE TAB D 24HR-30EA
LORATADINE-D TAB 24 HR-30EA
MAXIFED CD TAB-30EA
MAXIFED CDX TAB-30EA
MAXIFED-G CD TAB-30EA
MAXIFED-G TAB CDX-30EA
MAXIFLU CD TAB-30EA
MAXIFLU CDX TAB-30EA
MAXIFLU DM TAB-30EA
MAXIPHEN CD TAB-30EA
MAXIPHEN CDX TAB-30EA
NALEX-A TAB-30EA
PHENA-PLUS TAB-30EA
PHENFLU CD TAB-30EA
PHENFLU CDX TAB-30EA
PHENFLU DM TAB-30EA
PHENYLHIST LIQ DH - 480ML
PROMETH VC/ SYP CODEINE - 240ML
PROTID TAB CR-30EA
RELCOF PE TAB-30EA
RESCON-JR TAB-30EA
RESPA C&C IR TAB-30EA
RESPA DM TAB 28-600MG-30EA
RESPA SA TAB-30EA
RESPA-A.R. TAB-60EA
R-TANNA TAB 9-25MG-30EA
SUDAHIST TAB 12-120MG-30EA
SUDATEX-DM TAB-30EA
TEKRAL TAB-20EA
TIME-HIST QD TAB-30EA
TUSSIGON TAB 5MG-40EA
TUSSO-DMR CAP 7-14-288-40EA
TUSSO-ZMR CAP 8-200MG-21EA
ZOTEX PE TAB-30EA
ACETYLCYST
AH-CHEW
ALLEGRA-D
ALLERX
BIOHIST LA
BROMAXEFED
CERON-DM
CLARINEX-D
CODEINE/GG
COFEX-DM
DALLERGY-JR
DRIHIST
DURAHIST D
DURATUSS
DURATUSS HD
DYTAN-D
DYTAN-HC
ENTEX PSE
GFN1000/DM50
GFN1200/DM60
GG/PSE
GUAIFEN/PSE
GUAIMAX-D
HISTUSSIN HC
HYDROCODONE
K-TAN
LEVALL G
LEVALL-12
MAXIFED DM
PSE/GG
QUAD-TUSS
RESCON-JR
RESPA DM
RESPI-TANN
RONDEC
RONDEC-DM
R-TANNA
RYNATAN
RYNATAN PED
SEMPREX-D
SYMTAN
TESSALON
TETRA TANN
TOURO DM
TRITUSS-ER
TUSSI-12D
TUSSIONEX
TUSSI-ORGANI
VIRATAN-DM
ZYRTEC-D
Discounts
COUGH/COLD/ALLERGY PRODUCTS
DIABETIC ORAL AGENTS
AMARYL TAB 1MG-30EA
AMARYL TAB 4MG-15EA
GLIMEPIRIDE TAB 1MG-30EA
GLIMEPIRIDE TAB 4MG-15EA
GLUCOPHAGE TAB XR 750MG-10EA
GLYNASE TAB 1.5MG-30EA
GLYNASE TAB 3MG-10EA
METFORMIN TAB 750MG ER-10EA
TOLAZAMIDE TAB 250MG-30EA
$10 Tier
Non-Preferred
CORTICOSTEROIDS - ORAL
FLUOR-A-DAY CHW 1MG - 30EA
GEL-KAM CON 0.0063 - 283GM
KARIGEL-N GEL 0.011 - 120ML
PHOS FLUR SOL 0.00044 - 473ML
PREVIDENT PST 5000 BST - 106ML
PREVIDENT SOL RINSE - 473ML
STAN FLUORID CON 0.0063 - 283GM
DERMATOLOGICAL AGENTS - MISC.
ALUMINUM CL SOL 0.2 - 35ML
ARZOL SILVER MIS NITR APP - 10EA
COAL TAR SOL USP - 120ML
DRYSOL SOL 0.2 - 35ML
HYPERCARE SOL 0.2 - 35ML
XERAC-AC SOL 0.0625 - 35ML
Preferred Brand & Generic Drugs
Prices are subject to change and may not fall into the tiers as shown above.
The discount tier is drugs listed without strength or quantity and typically include all drugs not listed in the first 3 tiers.
OVIDE
PANAFIL
PROPECIA
PROTOPIC
PRUDOXIN
PSORIATEC
RAPTIVA
RENOVA
SALEX
SANTYL
SELSEB
SOLAGE
SOLARAZE
SORIATANE
SULFAMYLON
TARGRETIN
TAZORAC
TRETINOIN EM
TRI-LUMA
UMECTA
UMECTA NAIL
UREA
VANAMIDE
VANIQA
XCLAIR
XENADERM
X-VIATE
ZIOX
ZONALON
ZOVIRAX
CHLORDEX GP SYP - 60ML
CODAL-DM SYP - 120ML
CODITUSS DM SYP - 120ML
DALLERGY SYP - 120ML
DEHISTINE SYP - 120ML
ED-A-HIST DM LIQ - 120ML
GANI-TUSS DM LIQ 100-10/5 - 180ML
GUIATUSS AC SYP 10-100/5 - 180ML
GUIATUSS DAC SOL - 120ML
IOPHEN C-NR LIQ 10-100/5 - 180ML
LODRANE 12D TAB 6-45MG - 14EA
MYTUSSIN AC SYP 10-100/5 - 120ML
NALEX-A LIQ - 100ML
P CHLOR GG SOL DROPS - 30ML
PRO-CLEAR CAP 200-9MG-30EA
PRO-RED SYP - 120ML
QV-ALLERGY SYP - 120ML
ALA-HIST D TAB 6-25-20-20EA
BENZONATATE CAP 100MG-20EA
BENZONATATE CAP 200MG-20EA
BPM PSEUDO TAB 6-45MG-60EA
BROMAX D TAB-14EA
BRONTEX TAB-30EA
BROVEX PSE TAB 4-40MG-30EA
BROVEX PSE TAB DM-30EA
CHERATUSSIN SOL DAC - 240ML
CHERATUSSIN SYP AC - 240ML
CHLOR-MES D SYP LIQUID - 240ML
DALLERGY JR CAP 4-20MG-30EA
DALLERGY TAB-20EA
DEC-CHLORPHN SYP DM - 120ML
DONATUSSIN SYP - 150ML
DONATUSSIN SYP DC - 240ML
DURAFLU TAB - 10EA
GFN1200/DM60 TAB /PSE 120 - 20EA
GFN550/PSE60 TAB-30EA
GUAIFENESIN LIQ DM - 240ML
IOPHEN DM-NR LIQ 10-100/5 - 240ML
LEMOHIST CAP PLUS-30EA
LODRANE 12D TAB 6-45MG-60EA
LODRANE 24D CAP 12-90MG-10EA
LOHIST-12D TAB 6-45MG - 50EA
MAXIFED TAB 60-400MG-20EA
MAXIPHEN DM TAB - 20EA
MAXIPHEN DM TAB-30EA
MINTUSS DR SYP - 180ML
MUCINEX D TAB 60-600MG-18EA
MUCINEX DM TAB 30-600ER-20EA
MYTUSSIN DAC SOL - 240ML
NALDEX TAB-30EA
NALEX-A TAB - 20EA
NOHIST TAB 8-20MG - 20EA
NOREL SR TAB - 20EA
ORGAN-I NR TAB 200MG - 60EA
PHENYLEPHRIN LIQ HD - 120ML
POLY HIST DM LIQ - 180ML
POLY HIST TAB FORTE - 20EA
POLY-TUSSIN SYP DM - 240ML
PROMETH VC SYP 6.25-5/5 - 180ML
PROMETH/COD SYP 6.25-10 - 120ML
PROMETHAZINE SYP DM - 240ML
PSE BROM DM SYP - 240ML
PYRIL/CHLOR/ TAB PHEN-20EA
RESPA-1ST TAB CR-30EA
RESPAHIST-II TAB 6-19MG-14EA
RESPAIRE-30 CAP-30EA
RU-HIST TAB FORTE-20EA
STAHIST TAB-30EA
TESSALON CAP 200MG-20EA
TESSALON PER CAP 100MG-20EA
TUSNEL CAP-30EA
ZOTEX-GP TAB-30EA
Prices are subject to change and may not fall into the tiers as shown above.
The discount tier is drugs listed without strength or quantity and typically include all drugs not listed in the first 3 tiers.

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