PureRx Standard - SBMA Benefits

PureRx Formulary

Last updated July 1, 2024

Virtual Health – PureRx Prescription Formulary.

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Rx List Tier 1 - $15 Copay

ACARBOSE TAB 100 MG
ACARBOSE TAB 25 MG
ACARBOSE TAB 50 MG
ACETAMINOPHEN W/ CODEINE TAB 300-15 MG
ACETAMINOPHEN W/ CODEINE TAB 300-30 MG
ACETAMINOPHEN W/ CODEINE TAB 300-60 MG
Acetaminophen Tab 500 MG
ACYCLOVIR CAP 200 MG
ACYCLOVIR TAB 400 MG
ACYCLOVIR TAB 800 MG
ALENDRONATE SODIUM TAB 10 MG
ALLOPURINOL TAB 100 MG
ALLOPURINOL TAB 300 MG
ALPRAZOLAM TAB 0.25 MG
ALPRAZOLAM TAB 0.5 MG
ALPRAZOLAM TAB 1 MG
ALPRAZOLAM TAB 2 MG
ALPRAZOLAM TAB ER 24HR 0.5 MG
AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML)
AMIODARONE HCL INJ 450 MG/9ML (50 MG/ML)
AMIODARONE HCL TAB 200 MG
AMITRIPTYLINE HCL TAB 10 MG
AMITRIPTYLINE HCL TAB 25 MG
AMITRIPTYLINE HCL TAB 50 MG
AMLODIPINE BESYLATE TAB 10 MG (BASE EQUIVALENT)
AMLODIPINE BESYLATE TAB 5 MG (BASE EQUIVALENT)
AMLODIPINE BESYLATE-BENAZEPRIL HCL CAP 10-20 MG
AMLODIPINE BESYLATE-BENAZEPRIL HCL CAP 2.5-10 MG
AMLODIPINE BESYLATE-BENAZEPRIL HCL CAP 5-10 MG
AMLODIPINE BESYLATE-BENAZEPRIL HCL CAP 5-20 MG
AMLODIPINE BESYLATE-BENAZEPRIL HCL CAP 5-40 MG
AMOXICILLIN & K CLAVULANATE FOR SUSP 200-28.5 MG/5ML
AMOXICILLIN & K CLAVULANATE TAB 875-125 MG
AMOXICILLIN (TRIHYDRATE) CAP 500 MG
AMOXICILLIN (TRIHYDRATE) CHEW TAB 125 MG
AMOXICILLIN (TRIHYDRATE) FOR SUSP 125 MG/5ML
AMOXICILLIN (TRIHYDRATE) FOR SUSP 200 MG/5ML
AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG/5ML
AMOXICILLIN (TRIHYDRATE) FOR SUSP 400 MG/5ML
AMOXICILLIN (TRIHYDRATE) TAB 500 MG
AMOXICILLIN (TRIHYDRATE) TAB 875 MG
ANASTROZOLE TAB 1 MG
Aripiprazole Tab 5 MG
Aspirin Chew Tab 81 MG
Aspirin Tab 325 MG
ATENOLOL TAB 100 MG
ATENOLOL TAB 25 MG
ATENOLOL TAB 50 MG
ATORVASTATIN CALCIUM TAB 10 MG (BASE EQUIVALENT)
ATORVASTATIN CALCIUM TAB 20 MG (BASE EQUIVALENT)
ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)
ATORVASTATIN CALCIUM TAB 80 MG (BASE EQUIVALENT)
AZITHROMYCIN IV FOR SOLN 500 MG
AZITHROMYCIN TAB 250 MG
BACLOFEN TAB 10 MG
BACLOFEN TAB 20 MG
B-COMPLEX W/ C & FOLIC ACID TAB 0.8 MG
B-COMPLEX W/ C & FOLIC ACID TAB ER
BENAZEPRIL HCL TAB 10 MG
BENAZEPRIL HCL TAB 20 MG
BENAZEPRIL HCL TAB 40 MG
BENAZEPRIL HCL TAB 5 MG
BENZONATATE CAP 100 MG
BENZONATATE CAP 200 MG
Benzoyl Peroxide Liq 10%
BENZTROPINE MESYLATE TAB 0.5 MG
BENZTROPINE MESYLATE TAB 1 MG
BENZTROPINE MESYLATE TAB 2 MG
BETHANECHOL CHLORIDE TAB 10 MG
BETHANECHOL CHLORIDE TAB 5 MG
BICALUTAMIDE TAB 50 MG
Brimonidine Tartrate Ophth Soln 0.2%
BUMETANIDE INJ 0.25 MG/ML
BUPROPION HCL TAB 100 MG
BUPROPION HCL TAB 75 MG
BUPROPION HCL TAB ER 12HR 100 MG
BUPROPION HCL TAB ER 12HR 150 MG
BUSPIRONE HCL TAB 10 MG
BUSPIRONE HCL TAB 15 MG
BUSPIRONE HCL TAB 5 MG
BUPROPION HCL TAB ER 24HR 300 MG
BUTALBITAL-ACETAMINOPHEN-CAFFEINE TAB 50-325-40 MG
CALCITRIOL CAP 0.25 MCG
Calcium Carb-Cholecalciferol Tab 600 MG-20 MCG (800 Unit)
CAPTOPRIL & HYDROCHLOROTHIAZIDE TAB 25-25 MG
Carbamide Peroxide 6.5% Otic Soln
CARBIDOPA & LEVODOPA TAB 10-100 MG
CARBIDOPA & LEVODOPA TAB 25-100 MG
CARBIDOPA & LEVODOPA TAB 25-250 MG
CARBIDOPA & LEVODOPA TAB ER 25-100 MG
CARISOPRODOL TAB 350 MG
CARVEDILOL TAB 25 MG
CEFADROXIL CAP 500 MG
CEFUROXIME SODIUM FOR INJ 750 MG
CEFUROXIME SODIUM FOR IV SOLN 1.5 GM
CELECOXIB CAP 100 MG
CELECOXIB CAP 200 MG
CELECOXIB CAP 50 MG
CEPHALEXIN CAP 250 MG
CEPHALEXIN CAP 500 MG
Cetirizine HCl Tab 10 MG
Chlorhexidine Gluconate Soln 0.12%
CHLOROTHIAZIDE TAB 500 MG
CHLORTHALIDONE TAB 25 MG
Cholecalciferol Tab 50 MCG (2000 Unit)
CILOSTAZOL TAB 100 MG
CILOSTAZOL TAB 50 MG
CIPROFLOXACIN 200 MG/100ML IN D5W
CIPROFLOXACIN 400 MG/200ML IN D5W
CIPROFLOXACIN HCL TAB 250 MG (BASE EQUIV)
CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV)
CITALOPRAM HYDROBROMIDE TAB 10 MG (BASE EQUIV)
CITALOPRAM HYDROBROMIDE TAB 20 MG (BASE EQUIV)
CITALOPRAM HYDROBROMIDE TAB 40 MG (BASE EQUIV)
CLINDAMYCIN HCL CAP 150 MG
CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 300 MG/50ML
CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 600 MG/50ML
CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 900 MG/50ML
CLINDAMYCIN PHOSPHATE IN NACL 0.9% IV SOLN 300 MG/50ML
CLINDAMYCIN PHOSPHATE IN NACL 0.9% IV SOLN 600 MG/50ML
CLINDAMYCIN PHOSPHATE INJ 300 MG/2ML
CLINDAMYCIN PHOSPHATE INJ 600 MG/4ML
CLINDAMYCIN PHOSPHATE INJ 900 MG/6ML
CLONAZEPAM TAB 0.5 MG
CLONAZEPAM TAB 1 MG
CLONAZEPAM TAB 2 MG
CLONIDINE HCL TAB 0.1 MG
CLONIDINE HCL TAB 0.2 MG
CLONIDINE HCL TAB 0.3 MG
CLOPIDOGREL BISULFATE TAB 75 MG (BASE EQUIV)
Clotrimazole Vaginal Cream 1%
CLOZAPINE TAB 25 MG
COBALAMIN COMBINATION TAB
Colchicine w/ Probenecid Tab 0.5-500 MG
Cyanocobalamin Inj 1000 MCG/ML
CYCLOBENZAPRINE HCL TAB 10 MG
CYCLOBENZAPRINE HCL TAB 5 MG
CYPROHEPTADINE HCL TAB 4 MG
Dexamethasone Tab 4 MG
DEXMETHYLPHENIDATE HCL TAB 2.5 MG
DEXMETHYLPHENIDATE HCL TAB 5 MG
Dextromethorphan-Guaifenesin Syrup 10-100 MG/5ML
DIAZEPAM TAB 10 MG
DIAZEPAM TAB 2 MG
DIAZEPAM TAB 5 MG
DIBUCAINE OINT 1%
DIBUCAINE PERIANAL OINTMENT 1%
Diclofenac Sodium Tab Delayed Release 75 MG
DICYCLOMINE HCL CAP 10 MG
DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML)
DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)
DILTIAZEM HCL IV SOLN 50 MG/10ML (5 MG/ML)
DILTIAZEM HCL TAB 30 MG
DILTIAZEM HCL TAB 60 MG
DILTIAZEM HCL TAB 90 MG
DIPHENOXYLATE W/ ATROPINE TAB 2.5-0.025 MG
Docusate Sodium Cap 100 MG
DONEPEZIL HYDROCHLORIDE TAB 10 MG
DONEPEZIL HYDROCHLORIDE TAB 5 MG
DOXAZOSIN MESYLATE TAB 1 MG
DOXAZOSIN MESYLATE TAB 2 MG
DOXAZOSIN MESYLATE TAB 4 MG
DOXAZOSIN MESYLATE TAB 8 MG
Doxepin HCl Cap 10 MG
DOXYCYCLINE HYCLATE CAP 100 MG
DOXYCYCLINE HYCLATE TAB 20 MG
DOXYCYCLINE HYCLATE TAB 100 MG
DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)
DUTASTERIDE CAP 0.5 MG
ENALAPRIL MALEATE TAB 10 MG
ENALAPRIL MALEATE TAB 2.5 MG
ENALAPRIL MALEATE TAB 20 MG
ENALAPRIL MALEATE TAB 5 MG
ENALAPRILAT IV INJ 1.25 MG/ML
ERGOCALCIFEROL CAP 1.25 MG (50000 UNIT)
ERGOCALCIFEROL CAP 50 MCG (2000 UNIT)
ESCITALOPRAM OXALATE TAB 10 MG (BASE EQUIV)
ESCITALOPRAM OXALATE TAB 5 MG (BASE EQUIV)
ESTRADIOL TAB 0.5 MG
ESTRADIOL TAB 1 MG
ESTRADIOL TAB 2 MG
ESZOPICLONE TAB 2 MG
ETHOSUXIMIDE (BULK) POWDER
ETHYNODIOL DIACETATE & ETHINYL ESTRADIOL TAB 1 MG-35 MCG
Ezetimibe Tab 10 MG
FAMOTIDINE IN NACL 0.9% IV SOLN 20 MG/50ML
FAMOTIDINE INJ 20 MG/2ML
FAMOTIDINE INJ 200 MG/20ML
FAMOTIDINE INJ 40 MG/4ML
FAMOTIDINE TAB 10 MG
FAMOTIDINE TAB 40 MG
FENOFIBRATE TAB 48 MG
FENOFIBRATE TAB 54 MG
FENOFIBRATE TAB 145 MG
FERROUS FUMARATE-FOLIC ACID TAB 324-1 MG
Fexofenadine HCl Tab 180 MG
FINASTERIDE TAB 1 MG
FINASTERIDE TAB 5 MG
FLUCONAZOLE IN NACL 0.9% INJ 100 MG/50ML
FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML
FLUCONAZOLE IN NACL 0.9% INJ 400 MG/200ML
FLUOXETINE HCL CAP 10 MG
FLUOXETINE HCL CAP 20 MG
FLUOXETINE HCL CAP 40 MG
FLUVOXAMINE MALEATE TAB 100 MG
FOLIC ACID CAP 0.8 MG
FOLIC ACID CAP 20 MG
FOLIC ACID TAB 1 MG
FOLIC ACID TAB 400 MCG
FOLIC ACID TAB 800 MCG
FOLIC ACID-VITAMIN B6-VITAMIN B12 TAB 0.5-5-0.2 MG
FOSINOPRIL SODIUM TAB 10 MG
FOSINOPRIL SODIUM TAB 20 MG
FOSINOPRIL SODIUM TAB 40 MG
FUROSEMIDE INJ 10 MG/ML
FUROSEMIDE ORAL SOLN 10 MG/ML
FUROSEMIDE TAB 20 MG
FUROSEMIDE TAB 40 MG
GABAPENTIN CAP 100 MG
GABAPENTIN CAP 300 MG
GABAPENTIN CAP 400 MG
GABAPENTIN TAB 600 MG
GABAPENTIN TAB 800 MG
GEMFIBROZIL TAB 600 MG
GLIMEPIRIDE TAB 1 MG
GLIMEPIRIDE TAB 2 MG
GLIMEPIRIDE TAB 4 MG
GLIPIZIDE TAB 10 MG
GLIPIZIDE TAB 5 MG
GLIPIZIDE TAB ER 24HR 2.5 MG
GLIPIZIDE TAB ER 24HR 5 MG
GLYBURIDE MICRONIZED TAB 1.5 MG
GLYBURIDE MICRONIZED TAB 3 MG
GLYBURIDE TAB 1.25 MG
GLYBURIDE TAB 2.5 MG
GLYBURIDE TAB 5 MG
GLYBURIDE-METFORMIN TAB 1.25-250 MG
GLYBURIDE-METFORMIN TAB 2.5-500 MG
GLYBURIDE-METFORMIN TAB 5-500 MG
GUANFACINE HCL TAB 1 MG
HALOPERIDOL LACTATE INJ 5 MG/ML
HALOPERIDOL TAB 0.5 MG
HYDRALAZINE HCL INJ 20 MG/ML
HYDRALAZINE HCL TAB 10 MG
HYDRALAZINE HCL TAB 100 MG
HYDRALAZINE HCL TAB 25 MG
HYDRALAZINE HCL TAB 50 MG
HYDROCHLOROTHIAZIDE CAP 12.5 MG
HYDROCHLOROTHIAZIDE TAB 12.5 MG
HYDROCHLOROTHIAZIDE TAB 25 MG
HYDROCHLOROTHIAZIDE TAB 50 MG
HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG
HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG
HYDROCODONE-ACETAMINOPHEN TAB 7.5-325 MG
HYDROCORTISONE ACETATE OINT 1%
HYDROCORTISONE CREAM 0.5%
HYDROCORTISONE CREAM 1%
HYDROCORTISONE CREAM 2.5%
HYDROCORTISONE LOTION 1%
HYDROCORTISONE OINT 0.5%
HYDROCORTISONE OINT 1%
HYDROCORTISONE TAB 5 MG
HYDROMORPHONE HCL INJ 2 MG/ML
HYDROMORPHONE HCL INJ 4 MG/ML
HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 1 MG/ML
HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 2 MG/ML
HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 4 MG/ML
HYDROMORPHONE HCL TAB 2 MG
HYDROMORPHONE HCL TAB 4 MG
HYDROMORPHONE HCL-NACL SOLN PREF SYR 1 MG/5ML-0.9%
HYDROMORPHONE HCL-NACL SOLN PREF SYR 1 MG/ML-0.9%
HYDROMORPHONE HCL-NACL SOLN PREF SYR 10 MG/50ML-0.9%
HYDROMORPHONE HCL-NACL SOLN PREF SYR 2 MG/ML-0.9%
HYDROMORPHONE HCL-NACL SOLN PREF SYR 5 MG/25ML-0.9%
HYDROMORPHONE HCL-NACL SOLN PREF SYR 6 MG/30ML-0.9%
HYDROXYZINE HCL TAB 10 MG
HYDROXYZINE HCL TAB 25 MG
HYDROXYZINE HCL TAB 50 MG
HYDROXYZINE PAMOATE CAP 25 MG
HYDROXYZINE PAMOATE CAP 50 MG
IBUPROFEN CAP 200 MG
IBUPROFEN CHEW TAB 100 MG
IBUPROFEN SUSP 100 MG/5ML
IBUPROFEN SUSP 40 MG/ML
IBUPROFEN TAB 100 MG
IBUPROFEN TAB 200 MG
IBUPROFEN TAB 400 MG
IBUPROFEN TAB 600 MG
IBUPROFEN TAB 800 MG
IBUPROFEN-DIPHENHYDRAMINE CITRATE TAB 200-38 MG
IBUPROFEN-DIPHENHYDRAMINE HCL CAP 200-25 MG
IMIPRAMINE HCL TAB 10 MG
IMIPRAMINE HCL TAB 25 MG
IMIPRAMINE HCL TAB 50 MG
INDAPAMIDE TAB 1.25 MG
INDAPAMIDE TAB 2.5 MG
INDOMETHACIN CAP 25 MG
INDOMETHACIN CAP 50 MG
IRBESARTAN TAB 75 MG
IRBESARTAN-HYDROCHLOROTHIAZIDE TAB 150-12.5 MG
Ketoconazole Shampoo 2%
LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML)
LABETALOL HCL TAB 100 MG
LAMOTRIGINE TAB 100 MG
LAMOTRIGINE TAB 200 MG
LAMOTRIGINE TAB 25 MG
LAMOTRIGINE TAB CHEWABLE DISPERSIBLE 5 MG
Lancets
Latanoprost Ophth Soln 0.005%
LETROZOLE TAB 2.5 MG
LEVETIRACETAM TAB 250 MG
LEVETIRACETAM TAB 500 MG
LEVOCETIRIZINE DIHYDROCHLORIDE TAB 5 MG
LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML
LEVOFLOXACIN IN D5W IV SOLN 500 MG/100ML
LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML
LEVOFLOXACIN TAB 250 MG
LEVONORGESTREL & ETHINYL ESTRADIOL TAB 0.1 MG-20 MCG
LEVONORGESTREL & ETHINYL ESTRADIOL TAB 0.15 MG-30 MCG
LEVOTHYROXINE SODIUM TAB 100 MCG
LEVOTHYROXINE SODIUM TAB 112 MCG
LEVOTHYROXINE SODIUM TAB 200 MCG
LEVOTHYROXINE SODIUM TAB 25 MCG
LEVOTHYROXINE SODIUM TAB 75 MCG
LEVOTHYROXINE SODIUM TAB 88 MCG
LISINOPRIL & HYDROCHLOROTHIAZIDE TAB 10-12.5 MG
LISINOPRIL & HYDROCHLOROTHIAZIDE TAB 20-12.5 MG
LISINOPRIL & HYDROCHLOROTHIAZIDE TAB 20-25 MG
LISINOPRIL TAB 10 MG
LISINOPRIL TAB 2.5 MG
LISINOPRIL TAB 20 MG
LISINOPRIL TAB 30 MG
LISINOPRIL TAB 40 MG
LISINOPRIL TAB 5 MG
LITHIUM CARBONATE CAP 150 MG
LITHIUM CARBONATE CAP 300 MG
LITHIUM CARBONATE CAP 600 MG
LITHIUM CARBONATE POWDER
LITHIUM CARBONATE TAB 300 MG
LITHIUM CARBONATE TAB ER 300 MG
LORAZEPAM INJ 2 MG/ML
LORAZEPAM INJ 4 MG/ML
LORAZEPAM TAB 0.5 MG
LORAZEPAM TAB 1 MG
LORAZEPAM TAB 2 MG
LOSARTAN POTASSIUM & HYDROCHLOROTHIAZIDE TAB 100-12.5 MG
LOSARTAN POTASSIUM & HYDROCHLOROTHIAZIDE TAB 100-25 MG
LOSARTAN POTASSIUM & HYDROCHLOROTHIAZIDE TAB 50-12.5 MG
LOSARTAN POTASSIUM TAB 100 MG
LOSARTAN POTASSIUM TAB 25 MG
LOSARTAN POTASSIUM TAB 50 MG
LOVASTATIN TAB 10 MG
LOVASTATIN TAB 20 MG
LOVASTATIN TAB 40 MG
Meclizine HCl Tab 25 MG
MEDROXYPROGESTERONE ACETATE TAB 10 MG
MEDROXYPROGESTERONE ACETATE TAB 2.5 MG
MEDROXYPROGESTERONE ACETATE TAB 5 MG
MEGESTROL ACETATE TAB 20 MG
MEGESTROL ACETATE TAB 40 MG
MELOXICAM TAB 15 MG
MELOXICAM TAB 7.5 MG
MEMANTINE HCL TAB 10 MG
MEMANTINE HCL TAB 5 MG
MEPERIDINE HCL INJ 100 MG/ML
MEPERIDINE HCL INJ 25 MG/ML
MEPERIDINE HCL INJ 50 MG/ML
METFORMIN HCL TAB 1000 MG
METFORMIN HCL TAB 500 MG
METFORMIN HCL TAB 850 MG
METFORMIN HCL TAB ER 24HR 500 MG
METFORMIN HCL TAB ER 24HR 750 MG
METHADONE HCL TAB 10 MG
METHADONE HCL TAB 5 MG
METHENAMINE MANDELATE (BULK) POWDER
METHIMAZOLE TAB 10 MG
METHIMAZOLE TAB 5 MG
METHOCARBAMOL TAB 500 MG
METHOCARBAMOL TAB 750 MG
METHOTREXATE SODIUM INJ 50 MG/2ML (25 MG/ML)
METHOTREXATE SODIUM INJ PF 100 MG/4ML (25 MG/ML)
METHOTREXATE SODIUM INJ PF 200 MG/8ML (25 MG/ML)
METHOTREXATE SODIUM INJ PF 250 MG/10ML (25 MG/ML)
METHOTREXATE SODIUM INJ PF 50 MG/2ML (25 MG/ML)
METHOTREXATE SODIUM TAB 2.5 MG (BASE EQUIV)
METHYLPHENIDATE HCL TAB 10 MG
METHYLPHENIDATE HCL TAB 5 MG
METHYLPREDNISOLONE SOD SUCC FOR INJ 125 MG (BASE EQUIV)
METHYLPREDNISOLONE SOD SUCC FOR INJ 40 MG (BASE EQUIV)
METHYLPREDNISOLONE TAB THERAPY PACK 4 MG (21)
METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT)
METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)
METOCLOPRAMIDE HCL TAB 5 MG (BASE EQUIVALENT)
Metoprolol Succinate Tab ER 24HR 25 MG (Tartrate Equiv)
Metoprolol Succinate Tab ER 24HR 50 MG (Tartrate Equiv)
METOPROLOL TARTRATE IV SOLN 5 MG/5ML
METOPROLOL TARTRATE TAB 100 MG
METOPROLOL TARTRATE TAB 25 MG
METOPROLOL TARTRATE TAB 37.5 MG
METOPROLOL TARTRATE TAB 50 MG
METRONIDAZOLE TAB 250 MG
METRONIDAZOLE TAB 500 MG
MIDODRINE HCL TAB 2.5 MG
MINOCYCLINE HCL CAP 50 MG
MINOXIDIL SOLN 2%
MINOXIDIL TAB 10 MG
MINOXIDIL TAB 2.5 MG
MIRTAZAPINE TAB 15 MG
MIRTAZAPINE TAB 30 MG
MIRTAZAPINE TAB 45 MG
MONTELUKAST SODIUM CHEW TAB 4 MG (BASE EQUIV)
MONTELUKAST SODIUM CHEW TAB 5 MG (BASE EQUIV)
MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV)
Mupirocin Oint 2%
MYCOPHENOLATE MOFETIL CAP 250 MG
NABUMETONE TAB 500 MG
NAPROXEN SODIUM CAP 220 MG
NAPROXEN SODIUM TAB 220 MG
NAPROXEN TAB 250 MG
NAPROXEN TAB 375 MG
NAPROXEN TAB 500 MG
NATEGLINIDE TAB 120 MG
NATEGLINIDE TAB 60 MG
Needle (Disp) 18 x 1″
NEOMYCIN-BACITRACIN-POLYMYXIN OINT
NEOMYCIN-POLYMYXIN-DEXAMETHASONE OPHTH SUSP 0.1%
NIFEDIPINE TAB ER 24HR 30 MG
Nirmatrelvir Tab 20 x 150 MG & Ritonavir Tab 10 x 100 MG Pak
Nitrofurantoin Monohydrate Macrocrystalline Cap 100 MG
NORETHINDRONE ACE & ETHINYL ESTRADIOL TAB 1 MG-20 MCG
NORGESTIMATE & ETHINYL ESTRADIOL TAB 0.25 MG-35 MCG
NORGESTIMATE-ETH ESTRAD TAB 0.18-25/0.215-25/0.25-25 MG-MCG
NORGESTIMATE-ETH ESTRAD TAB 0.18-35/0.215-35/0.25-35 MG-MCG
NORTRIPTYLINE HCL CAP 10 MG
NORTRIPTYLINE HCL CAP 25 MG
NORTRIPTYLINE HCL CAP 50 MG
NYSTATIN OINT 100000 UNIT/GM
OLANZAPINE TAB 10 MG
OLANZAPINE TAB 15 MG
OLANZAPINE TAB 2.5 MG
OLANZAPINE TAB 20 MG
OLANZAPINE TAB 5 MG
OLANZAPINE TAB 7.5 MG
OLMESARTAN MEDOXOMIL TAB 20 MG
OLMESARTAN MEDOXOMIL TAB 40 MG
OLMESARTAN MEDOXOMIL TAB 5 MG
OMEPRAZOLE CAP DELAYED RELEASE 20 MG
Omeprazole Cap Delayed Release 40 MG
ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)
ONDANSETRON HCL INJ 40 MG/20ML (2 MG/ML)
ONDANSETRON HCL TAB 8 MG
ONDANSETRON ORALLY DISINTEGRATING TAB 8 MG
OXCARBAZEPINE TAB 150 MG
OXYBUTYNIN CHLORIDE TAB 5 MG
OXYBUTYNIN CHLORIDE TAB ER 24HR 5 MG
OXYCODONE HCL TAB 10 MG
OXYCODONE HCL TAB 15 MG
OXYCODONE HCL TAB 5 MG
OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG
PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)
PAROXETINE HCL TAB 10 MG
PAROXETINE HCL TAB 30 MG
PAROXETINE HCL TAB 40 MG
PENICILLIN G POTASSIUM FOR INJ 5000000 UNIT
PENICILLIN G POTASSIUM INJ 20000 UNIT/ML IN DEXTROSE
PENICILLIN G POTASSIUM INJ 40000 UNIT/ML IN DEXTROSE
PENICILLIN G POTASSIUM INJ 60000 UNIT/ML IN DEXTROSE
PENICILLIN V POTASSIUM FOR SOLN 125 MG/5ML
PENICILLIN V POTASSIUM TAB 250 MG
PENICILLIN V POTASSIUM TAB 500 MG
PERPHENAZINE-AMITRIPTYLINE TAB 2-25 MG
Phenazopyridine HCl Tab 100 MG
PHENDIMETRAZINE TARTRATE TAB 35 MG
PHENTERMINE HCL CAP 15 MG
PHENTERMINE HCL CAP 30 MG
PHENTERMINE HCL CAP 37.5 MG
PHENTERMINE HCL TAB 37.5 MG
PHENYTOIN CHEW TAB 50 MG
PHENYTOIN SODIUM EXTENDED CAP 100 MG
PHENYTOIN SODIUM INJ 50 MG/ML
PIOGLITAZONE HCL TAB 15 MG (BASE EQUIV)
PIOGLITAZONE HCL TAB 30 MG (BASE EQUIV)
Polyethylene Glycol 3350 Oral Powder 17 GM/SCOOP
POLYMYXIN B-TRIMETHOPRIM OPHTH SOLN 10000 UNIT/ML-0.1%
Potassium Chloride Microencapsulated Crys ER Tab 10 mEq
Potassium Chloride Microencapsulated Crys ER Tab 20 mEq
Potassium Chloride Tab ER 10 mEq
PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.125 MG
PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.25 MG
PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.5 MG
PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.75 MG
PRAMIPEXOLE DIHYDROCHLORIDE TAB 1 MG
PRAMIPEXOLE DIHYDROCHLORIDE TAB 1.5 MG
PRAVASTATIN SODIUM TAB 10 MG
PRAVASTATIN SODIUM TAB 20 MG
PRAVASTATIN SODIUM TAB 40 MG
PRAVASTATIN SODIUM TAB 80 MG
PREDNISONE TAB 1 MG
PREDNISONE TAB 10 MG
PREDNISONE TAB 2.5 MG
PREDNISONE TAB 20 MG
PREDNISONE TAB 5 MG
PREDNISONE TAB 50 MG
PRENATAL VIT W/ FE FUMARATE-FA TAB 27-0.8 MG
PRIMIDONE TAB 250 MG
PRIMIDONE TAB 50 MG
PROMETHAZINE HCL INJ 25 MG/ML
PROMETHAZINE HCL INJ 50 MG/ML
PROMETHAZINE HCL TAB 12.5 MG
PROMETHAZINE HCL TAB 25 MG
PROMETHAZINE HCL TAB 50 MG
PROPAFENONE HCL TAB 150 MG
PROPAFENONE HCL TAB 225 MG
PROPRANOLOL HCL TAB 10 MG
PROPRANOLOL HCL TAB 20 MG
PROPRANOLOL HCL TAB 40 MG
PROPRANOLOL HCL TAB 80 MG
PSEUDOEPHEDRINE-IBUPROFEN TAB 30-200 MG
QUETIAPINE FUMARATE TAB 100 MG
QUETIAPINE FUMARATE TAB 200 MG
QUETIAPINE FUMARATE TAB 25 MG
QUETIAPINE FUMARATE TAB 300 MG
QUETIAPINE FUMARATE TAB 50 MG
QUINAPRIL HCL TAB 10 MG
QUINAPRIL HCL TAB 20 MG
QUINAPRIL HCL TAB 40 MG
QUINAPRIL HCL TAB 5 MG
RAMIPRIL CAP 1.25 MG
RAMIPRIL CAP 10 MG
RAMIPRIL CAP 2.5 MG
RAMIPRIL CAP 5 MG
RANITIDINE HCL TAB 150 MG
RANITIDINE HCL TAB 75 MG
REPAGLINIDE TAB 0.5 MG
REPAGLINIDE TAB 1 MG
REPAGLINIDE TAB 2 MG
RISPERIDONE TAB 0.25 MG
RISPERIDONE TAB 0.5 MG
RISPERIDONE TAB 1 MG
RISPERIDONE TAB 2 MG
RISPERIDONE TAB 3 MG
RISPERIDONE TAB 4 MG
ROPINIROLE HYDROCHLORIDE TAB 0.5 MG
ROPINIROLE HYDROCHLORIDE TAB 2 MG
ROPINIROLE HYDROCHLORIDE TAB 3 MG
ROPINIROLE HYDROCHLORIDE TAB 4 MG
ROPINIROLE HYDROCHLORIDE TAB 5 MG
Rosuvastatin Calcium Tab 20 MG
ROSUVASTATIN CALCIUM TAB 40 MG
Salsalate Tab 750 MG
SERTRALINE HCL TAB 25 MG
SILDENAFIL CITRATE TAB 20 MG
SIMVASTATIN TAB 10 MG
SIMVASTATIN TAB 20 MG
SIMVASTATIN TAB 5 MG
SIMVASTATIN TAB 80 MG
SPIRONOLACTONE TAB 100 MG
SPIRONOLACTONE TAB 25 MG
SPIRONOLACTONE TAB 50 MG
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 400-80 MG
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 800-160 MG
SULFASALAZINE TAB DELAYED RELEASE 500 MG
SULINDAC TAB 150 MG
SULINDAC TAB 200 MG
Syringe/Needle (Disp) 3 ML 23 x 1-1/2″
Tadalafil Tab 5 MG
TAMOXIFEN CITRATE TAB 10 MG (BASE EQUIVALENT)
TAMSULOSIN HCL CAP 0.4 MG
TEMAZEPAM CAP 15 MG
TEMAZEPAM CAP 30 MG
TERAZOSIN HCL CAP 1 MG (BASE EQUIVALENT)
TERAZOSIN HCL CAP 10 MG (BASE EQUIVALENT)
TERAZOSIN HCL CAP 2 MG (BASE EQUIVALENT)
TERAZOSIN HCL CAP 5 MG (BASE EQUIVALENT)
TERBINAFINE HCL CREAM 1%
TERBINAFINE HCL TAB 250 MG
TIZANIDINE HCL TAB 4 MG (BASE EQUIVALENT)
Tobramycin Ophth Soln 0.3%
TOPIRAMATE TAB 200 MG
TOPIRAMATE TAB 50 MG
TORSEMIDE TAB 10 MG
TORSEMIDE TAB 100 MG
TORSEMIDE TAB 20 MG
TORSEMIDE TAB 5 MG
TRAMADOL HCL TAB 50 MG
TRAMADOL-ACETAMINOPHEN TAB 37.5-325 MG
TRANDOLAPRIL TAB 1 MG
TRANDOLAPRIL TAB 2 MG
TRANDOLAPRIL TAB 4 MG
TRAZODONE HCL TAB 100 MG
TRAZODONE HCL TAB 150 MG
TRAZODONE HCL TAB 50 MG
Triamcinolone Acetonide Cream 0.025%
Triamcinolone Acetonide Cream 0.1%
Triamcinolone Acetonide Oint 0.025%
TRIAMTERENE & HYDROCHLOROTHIAZIDE CAP 37.5-25 MG
TRIAMTERENE & HYDROCHLOROTHIAZIDE TAB 37.5-25 MG
TRIAMTERENE & HYDROCHLOROTHIAZIDE TAB 75-50 MG
TRIAMTERENE POWDER
VALPROIC ACID CAP 250 MG
VENLAFAXINE HCL CAP ER 24HR 150 MG (BASE EQUIVALENT)
VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)
VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT)
VENLAFAXINE HCL TAB 100 MG (BASE EQUIVALENT)
VENLAFAXINE HCL TAB 25 MG (BASE EQUIVALENT)
VENLAFAXINE HCL TAB 37.5 MG (BASE EQUIVALENT)
VENLAFAXINE HCL TAB 50 MG (BASE EQUIVALENT)
VENLAFAXINE HCL TAB 75 MG (BASE EQUIVALENT)
VERAPAMIL HCL TAB 120 MG
VERAPAMIL HCL TAB 40 MG
VERAPAMIL HCL TAB 80 MG
VERAPAMIL HCL TAB ER 180 MG
VERAPAMIL HCL TAB ER 240 MG
WARFARIN SODIUM TAB 1 MG
WARFARIN SODIUM TAB 10 MG
WARFARIN SODIUM TAB 2 MG
WARFARIN SODIUM TAB 2.5 MG
WARFARIN SODIUM TAB 3 MG
WARFARIN SODIUM TAB 4 MG
WARFARIN SODIUM TAB 5 MG
WARFARIN SODIUM TAB 6 MG
WARFARIN SODIUM TAB 7.5 MG
ZALEPLON CAP 10 MG
ZALEPLON CAP 5 MG
ZOLPIDEM TARTRATE TAB 10 MG
ZOLPIDEM TARTRATE TAB 5 MG
ZONISAMIDE CAP 100 MG
ZONISAMIDE CAP 25 MG
ZONISAMIDE CAP 50 MG

Rx List Tier 2 - $30 Copay

ACETAMINOPHEN W/ CODEINE SOLN 120-12 MG/5ML
ACYCLOVIR SODIUM IV SOLN 50 MG/ML
Albuterol Sulfate Soln Nebu 0.083% (2.5 MG/3ML)
ALENDRONATE SODIUM TAB 35 MG
ALENDRONATE SODIUM TAB 70 MG
ALPRAZOLAM TAB ER 24HR 1 MG
ALPRAZOLAM TAB ER 24HR 2 MG
ALPRAZOLAM TAB ER 24HR 3 MG
AMANTADINE HCL CAP 100 MG
AMANTADINE HCL TAB 100 MG
AMILORIDE & HYDROCHLOROTHIAZIDE TAB 5-50 MG
AMIODARONE HCL IN DEXTROSE 5% IV SOLN 150 MG/100ML
AMIODARONE HCL INJ 900 MG/18ML (50 MG/ML)
AMITRIPTYLINE HCL TAB 100 MG
AMITRIPTYLINE HCL TAB 75 MG
AMLODIPINE BESYLATE-BENAZEPRIL HCL CAP 10-40 MG
AMLODIPINE BESYLATE-OLMESARTAN MEDOXOMIL TAB 10-20 MG
AMLODIPINE BESYLATE-OLMESARTAN MEDOXOMIL TAB 10-40 MG
AMLODIPINE BESYLATE-OLMESARTAN MEDOXOMIL TAB 5-20 MG
AMLODIPINE BESYLATE-OLMESARTAN MEDOXOMIL TAB 5-40 MG
AMLODIPINE BESYLATE TAB 2.5 MG (BASE EQUIVALENT)
AMLODIPINE BESYLATE-VALSARTAN TAB 10-320 MG
AMLODIPINE BESYLATE-VALSARTAN TAB 5-160 MG
AMLODIPINE BESYLATE-VALSARTAN TAB 5-320 MG
AMOXICILLIN & K CLAVULANATE FOR SUSP 400-57 MG/5ML
AMOXICILLIN & K CLAVULANATE FOR SUSP 600-42.9 MG/5ML
AMOXICILLIN & K CLAVULANATE TAB 500-125 MG
AMOXICILLIN (TRIHYDRATE) CHEW TAB 250 MG
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG
AMPHETAMINE-DEXTROAMPHETAMINE TAB 12.5 MG
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG
AMPHETAMINE-DEXTROAMPHETAMINE TAB 30 MG
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG
AMPHETAMINE-DEXTROAMPHETAMINE TAB 7.5 MG
AMPICILLIN CAP 500 MG
ARMODAFINIL TAB 50 MG
ATENOLOL & CHLORTHALIDONE TAB 100-25 MG
ATENOLOL & CHLORTHALIDONE TAB 50-25 MG
AZATHIOPRINE TAB 50 MG
AZITHROMYCIN FOR SUSP 100 MG/5ML
AZITHROMYCIN FOR SUSP 200 MG/5ML
AZITHROMYCIN TAB 500 MG
BALSALAZIDE DISODIUM CAP 750 MG
BENAZEPRIL & HYDROCHLOROTHIAZIDE TAB 10-12.5 MG
BENZHYDROCODONE HCL-ACETAMINOPHEN TAB 4.08-325 MG
BENZHYDROCODONE HCL-ACETAMINOPHEN TAB 6.12-325 MG
BENZHYDROCODONE HCL-ACETAMINOPHEN TAB 8.16-325 MG
BETHANECHOL CHLORIDE TAB 25 MG
BISOPROLOL & HYDROCHLOROTHIAZIDE TAB 10-6.25 MG
BISOPROLOL & HYDROCHLOROTHIAZIDE TAB 2.5-6.25 MG
BISOPROLOL & HYDROCHLOROTHIAZIDE TAB 5-6.25 MG
Blood Glucose Monitoring Kit w/ Device
BUMETANIDE TAB 0.5 MG
BUMETANIDE TAB 1 MG
BUMETANIDE TAB 2 MG
BUPROPION HCL (SMOKING DETERRENT) TAB ER 12HR 150 MG
BUPROPION HCL TAB ER 24HR 150 MG
BUPROPION HCL TAB ER 12HR 200 MG
BUSPIRONE HCL TAB 30 MG
BUSPIRONE HCL TAB 7.5 MG
BUTALBITAL-ASPIRIN-CAFFEINE TAB 50-325-40 MG
CALCITRIOL CAP 0.5 MCG
CAPTOPRIL & HYDROCHLOROTHIAZIDE TAB 50-25 MG
CAPTOPRIL TAB 12.5 MG
CAPTOPRIL TAB 25 MG
CARBAMAZEPINE CHEW TAB 100 MG
CARBAMAZEPINE SUSP 100 MG/5ML
CARBAMAZEPINE TAB 200 MG
CARBIDOPA & LEVODOPA TAB ER 50-200 MG
CARBINOXAMINE MALEATE TAB 4 MG
CARVEDILOL TAB 3.125 MG
CARVEDILOL TAB 12.5 MG
CARVEDILOL TAB 6.25 MG
CEFDINIR FOR SUSP 125 MG/5ML
CEFPROZIL FOR SUSP 125 MG/5ML
CEFUROXIME AXETIL TAB 250 MG
CELECOXIB CAP 400 MG
CEPHALEXIN FOR SUSP 125 MG/5ML
Chlordiazepoxide HCl Cap 25 MG
CHLOROTHIAZIDE TAB 250 MG
CHLORTHALIDONE TAB 50 MG
CIPROFLOXACIN HCL OPHTH SOLN 0.3% (BASE EQUIVALENT)
CIPROFLOXACIN HCL OTIC SOLN 0.2% (BASE EQUIVALENT)
CIPROFLOXACIN HCL TAB 750 MG (BASE EQUIV)
CLARITHROMYCIN TAB 250 MG
CLARITHROMYCIN TAB 500 MG
CLINDAMYCIN HCL CAP 300 MG
CLINDAMYCIN HCL CAP 75 MG
CLINDAMYCIN PHOSPHATE IN NACL 0.9% IV SOLN 900 MG/50ML
CLINDAMYCIN PHOSPHATE INJ 9 GM/60ML
CLINDAMYCIN PHOSPHATE SOLN 1%
CLONAZEPAM ORALLY DISINTEGRATING TAB 0.25 MG
CLONAZEPAM ORALLY DISINTEGRATING TAB 0.5 MG
CLOZAPINE TAB 100 MG
CLOZAPINE TAB 50 MG
CYCLOSPORINE IV SOLN 50 MG/ML
DANTROLENE SODIUM CAP 25 MG
DAPSONE TAB 25 MG
DESLORATADINE TAB 5 MG
DESMOPRESSIN ACETATE TAB 0.1 MG
DESMOPRESSIN ACETATE TAB 0.2 MG
DESOGEST-ETH ESTRAD & ETH ESTRAD TAB 0.15-0.02/0.01 MG(21/5)
DESOGESTREL & ETHINYL ESTRADIOL TAB 0.15 MG-30 MCG
DEXAMETHASONE TAB 1 MG
DEXMETHYLPHENIDATE HCL TAB 10 MG
DEXTROAMPHETAMINE SULFATE TAB 10 MG
DEXTROAMPHETAMINE SULFATE TAB 5 MG
DICLOFENAC POTASSIUM TAB 50 MG
DICYCLOMINE HCL TAB 20 MG
DIGOXIN TAB 125 MCG (0.125 MG)
DIGOXIN TAB 250 MCG (0.25 MG)
DILTIAZEM HCL 125 MG/125ML IN DEXTROSE 5% IV SOLN (1 MG/ML)
DILTIAZEM HCL CAP ER 24HR 120 MG
DILTIAZEM HCL CAP ER 24HR 180 MG
DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG
DILTIAZEM HCL COATED BEADS CAP ER 24HR 180 MG
DILTIAZEM HCL COATED BEADS CAP ER 24HR 240 MG
DILTIAZEM HCL COATED BEADS CAP ER 24HR 300 MG
DILTIAZEM HCL EXTENDED RELEASE BEADS CAP ER 24HR 120 MG
DILTIAZEM HCL EXTENDED RELEASE BEADS CAP ER 24HR 180 MG
DILTIAZEM HCL IV FOR SOLN 100 MG
DILTIAZEM HCL TAB 120 MG
DILTIAZEM HCL-SODIUM CHLORIDE IV SOLN 125 MG/125ML-0.7%
DILTIAZEM HCL-SODIUM CHLORIDE IV SOLN 125 MG/125ML-0.9%
DIPHENOXYLATE W/ ATROPINE LIQ 2.5-0.025 MG/5ML
DONEPEZIL HYDROCHLORIDE ORALLY DISINTEGRATING TAB 5 MG
DONEPEZIL HYDROCHLORIDE TAB 23 MG
DOXYCYCLINE HYCLATE CAP 50 MG
DOXYCYCLINE HYCLATE FOR INJ 100 MG
DOXYCYCLINE MONOHYDRATE CAP 100 MG
DOXYCYCLINE MONOHYDRATE CAP 50 MG
DOXYCYCLINE MONOHYDRATE FOR SUSP 25 MG/5ML
DOXYCYCLINE MONOHYDRATE TAB 100 MG
DOXYCYCLINE MONOHYDRATE TAB 50 MG
DROSPIRENONE-ETHINYL ESTRADIOL TAB 3-0.02 MG
DROSPIRENONE-ETHINYL ESTRADIOL TAB 3-0.03 MG
Emtricitabine-Tenofovir Disoproxil Fumarate Tab 200-300 MG
ENALAPRIL MALEATE & HYDROCHLOROTHIAZIDE TAB 10-25 MG
ENALAPRIL MALEATE & HYDROCHLOROTHIAZIDE TAB 5-12.5 MG
ENTACAPONE TAB 200 MG
ESCITALOPRAM OXALATE TAB 20 MG (BASE EQUIV)
ESZOPICLONE TAB 1 MG
ESZOPICLONE TAB 3 MG
ETHAMBUTOL HCL TAB 100 MG
ETHAMBUTOL HCL TAB 400 MG
ETHOSUXIMIDE CAP 250 MG
ETODOLAC TAB 400 MG
ETODOLAC TAB 500 MG
FAMCICLOVIR TAB 125 MG
FAMCICLOVIR TAB 250 MG
FAMOTIDINE TAB 20 MG
FENOFIBRATE MICRONIZED CAP 134 MG
FENOFIBRATE MICRONIZED CAP 200 MG
FENOFIBRATE MICRONIZED CAP 67 MG
FENOFIBRATE TAB 160 MG
FERROUS FUMARATE-FA-B COMPLEX-C-ZN-MG-MN-CU CAP 106-1 MG
FLECAINIDE ACETATE TAB 100 MG
FLECAINIDE ACETATE TAB 150 MG
FLECAINIDE ACETATE TAB 50 MG
FLUCONAZOLE FOR SUSP 10 MG/ML
FLUCONAZOLE TAB 100 MG
FLUCONAZOLE TAB 150 MG
FLUCONAZOLE TAB 50 MG
FLUDROCORTISONE ACETATE TAB 0.1 MG
FLUOXETINE HCL TAB 10 MG
FLURBIPROFEN SODIUM OPHTH SOLN 0.03%
FLUTAMIDE CAP 125 MG
FLUTICASONE PROPIONATE NASAL SUSP 50 MCG/ACT
FLUVOXAMINE MALEATE TAB 25 MG
FLUVOXAMINE MALEATE TAB 50 MG
FOSINOPRIL SODIUM & HYDROCHLOROTHIAZIDE TAB 20-12.5 MG
FOSPHENYTOIN SODIUM INJ 100 MG/2ML (PHENYTOIN EQUIV)
FUROSEMIDE TAB 80 MG
GALANTAMINE HYDROBROMIDE TAB 12 MG
GALANTAMINE HYDROBROMIDE TAB 4 MG
GALANTAMINE HYDROBROMIDE TAB 8 MG
GLIPIZIDE TAB ER 24HR 10 MG
GLIPIZIDE-METFORMIN HCL TAB 2.5-250 MG
GLIPIZIDE-METFORMIN HCL TAB 2.5-500 MG
GLIPIZIDE-METFORMIN HCL TAB 5-500 MG
GLYBURIDE MICRONIZED TAB 6 MG
GUANFACINE HCL TAB ER 24HR 1 MG (BASE EQUIV)
GUANFACINE HCL TAB ER 24HR 2 MG (BASE EQUIV)
GUANFACINE HCL TAB ER 24HR 3 MG (BASE EQUIV)
GUANFACINE HCL TAB ER 24HR 4 MG (BASE EQUIV)
HALOPERIDOL DECANOATE (BULK) POWDER
HALOPERIDOL LACTATE ORAL CONC 2 MG/ML
HALOPERIDOL TAB 1 MG
HALOPERIDOL TAB 10 MG
HALOPERIDOL TAB 2 MG
HALOPERIDOL TAB 5 MG
HYDROCODONE-ACETAMINOPHEN TAB 10-300 MG
HYDROCODONE-ACETAMINOPHEN TAB 5-300 MG
HYDROCODONE-ACETAMINOPHEN TAB 7.5-300 MG
HYDROCODONE-IBUPROFEN TAB 7.5-200 MG
HYDROCORTISONE ENEMA 100 MG/60ML
HYDROCORTISONE OINT 2.5%
HYDROCORTISONE PERIANAL CREAM 2.5%
HYDROCORTISONE SODIUM SUCCINATE PF FOR INJ 100 MG
HYDROCORTISONE TAB 10 MG
HYDROCORTISONE TAB 20 MG
HYDROMORPHONE HCL INJ 1 MG/ML
HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 10 MG/ML
HYDROMORPHONE HCL TAB 8 MG
HYDROMORPHONE HCL-NACL SOLN PREF SYR 15 MG/30ML-0.9%
HYDROMORPHONE HCL-NACL SOLN PREF SYR 25 MG/50ML-0.9%
HYDROMORPHONE HCL-NACL SOLN PREF SYR 30 MG/30ML-0.9%
HYDROMORPHONE HCL-NACL SOLN PREF SYR 50 MG/50ML-0.9%
HYDROMORPHONE HCL-NACL SOLN PREF SYR 55 MG/55ML-0.9%
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 18 MG/30ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 6 MG/30ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 10 MG/50ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 15 MG/30ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 20 MG/100ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 24 MG/30ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 25 MG/50ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 30 MG/150ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 30 MG/30ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 50 MG/50ML
HYDROXYCHLOROQUINE SULFATE TAB 200 MG
HYDROXYUREA CAP 500 MG
HYDROXYZINE HCL IM SOLN 25 MG/ML
HYDROXYZINE PAMOATE CAP 100 MG
INDOMETHACIN CAP ER 75 MG
INFLUENZA VAC TISS-CULT SUBUNT QUAD SUSP PREF SYR 0.5 ML
INFLUENZA VIRUS VAC SPLIT QUADRIVALENT SUSP PREF SYR 0.5ML
INFLUENZA VIRUS VACCINE SPLIT QUADRIVALENT INJ 0.5 ML
IRBESARTAN TAB 150 MG
IRBESARTAN TAB 300 MG
ISOSORBIDE DINITRATE TAB 10 MG
ISOSORBIDE DINITRATE TAB 20 MG
ISOSORBIDE DINITRATE TAB 30 MG
ISOSORBIDE DINITRATE TAB 5 MG
LABETALOL HCL IV SOLN 5 MG/ML
LABETALOL HCL TAB 200 MG LABETALOL HCL TAB 300 MG
LABETALOL HCL-DEXTROSE IV SOLN 200 MG/200ML-5%
GLIPIZIDE TAB ER 24HR 10 MG
GLIPIZIDE-METFORMIN HCL TAB 2.5-250 MG
GLIPIZIDE-METFORMIN HCL TAB 2.5-500 MG
GLIPIZIDE-METFORMIN HCL TAB 5-500 MG
GLYBURIDE MICRONIZED TAB 6 MG
GUANFACINE HCL TAB ER 24HR 1 MG (BASE EQUIV)
GUANFACINE HCL TAB ER 24HR 2 MG (BASE EQUIV)
GUANFACINE HCL TAB ER 24HR 3 MG (BASE EQUIV)
GUANFACINE HCL TAB ER 24HR 4 MG (BASE EQUIV)
HALOPERIDOL DECANOATE (BULK) POWDER
HALOPERIDOL LACTATE ORAL CONC 2 MG/ML
HALOPERIDOL TAB 1 MG
HALOPERIDOL TAB 10 MG
HALOPERIDOL TAB 2 MG
HALOPERIDOL TAB 5 MG
HYDROCODONE-ACETAMINOPHEN TAB 10-300 MG
HYDROCODONE-ACETAMINOPHEN TAB 5-300 MG
HYDROCODONE-ACETAMINOPHEN TAB 7.5-300 MG
HYDROCODONE-IBUPROFEN TAB 7.5-200 MG
HYDROCORTISONE ENEMA 100 MG/60ML
HYDROCORTISONE OINT 2.5%
HYDROCORTISONE PERIANAL CREAM 2.5%
HYDROCORTISONE SODIUM SUCCINATE PF FOR INJ 100 MG
HYDROCORTISONE TAB 10 MG
HYDROCORTISONE TAB 20 MG
HYDROMORPHONE HCL INJ 1 MG/ML
HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 10 MG/ML
HYDROMORPHONE HCL TAB 8 MG
HYDROMORPHONE HCL-NACL SOLN PREF SYR 15 MG/30ML-0.9%
HYDROMORPHONE HCL-NACL SOLN PREF SYR 25 MG/50ML-0.9%
HYDROMORPHONE HCL-NACL SOLN PREF SYR 30 MG/30ML-0.9%
HYDROMORPHONE HCL-NACL SOLN PREF SYR 50 MG/50ML-0.9%
HYDROMORPHONE HCL-NACL SOLN PREF SYR 55 MG/55ML-0.9%
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 18 MG/30ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 6 MG/30ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 10 MG/50ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 15 MG/30ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 20 MG/100ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 24 MG/30ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 25 MG/50ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 30 MG/150ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 30 MG/30ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 50 MG/50ML
HYDROXYCHLOROQUINE SULFATE TAB 200 MG
HYDROXYUREA CAP 500 MG
HYDROXYZINE HCL IM SOLN 25 MG/ML
HYDROXYZINE PAMOATE CAP 100 MG
INDOMETHACIN CAP ER 75 MG
INFLUENZA VAC TISS-CULT SUBUNT QUAD SUSP PREF SYR 0.5 ML
INFLUENZA VIRUS VAC SPLIT QUADRIVALENT SUSP PREF SYR 0.5ML
INFLUENZA VIRUS VACCINE SPLIT QUADRIVALENT INJ 0.5 ML
IRBESARTAN TAB 150 MG
IRBESARTAN TAB 300 MG
ISOSORBIDE DINITRATE TAB 10 MG
ISOSORBIDE DINITRATE TAB 20 MG
ISOSORBIDE DINITRATE TAB 30 MG
ISOSORBIDE DINITRATE TAB 5 MG
LABETALOL HCL IV SOLN 5 MG/ML
LABETALOL HCL TAB 200 MG LABETALOL HCL TAB 300 MG
LABETALOL HCL-DEXTROSE IV SOLN 200 MG/200ML-5%
GLIPIZIDE TAB ER 24HR 10 MG
GLIPIZIDE-METFORMIN HCL TAB 2.5-250 MG
GLIPIZIDE-METFORMIN HCL TAB 2.5-500 MG
GLIPIZIDE-METFORMIN HCL TAB 5-500 MG
GLYBURIDE MICRONIZED TAB 6 MG
GUANFACINE HCL TAB ER 24HR 1 MG (BASE EQUIV)
GUANFACINE HCL TAB ER 24HR 2 MG (BASE EQUIV)
GUANFACINE HCL TAB ER 24HR 3 MG (BASE EQUIV)
GUANFACINE HCL TAB ER 24HR 4 MG (BASE EQUIV)
HALOPERIDOL DECANOATE (BULK) POWDER
HALOPERIDOL LACTATE ORAL CONC 2 MG/ML
HALOPERIDOL TAB 1 MG
HALOPERIDOL TAB 10 MG
HALOPERIDOL TAB 2 MG
HALOPERIDOL TAB 5 MG
HYDROCODONE-ACETAMINOPHEN TAB 10-300 MG
HYDROCODONE-ACETAMINOPHEN TAB 5-300 MG
HYDROCODONE-ACETAMINOPHEN TAB 7.5-300 MG
HYDROCODONE-IBUPROFEN TAB 7.5-200 MG
HYDROCORTISONE ENEMA 100 MG/60ML
HYDROCORTISONE OINT 2.5%
HYDROCORTISONE PERIANAL CREAM 2.5%
HYDROCORTISONE SODIUM SUCCINATE PF FOR INJ 100 MG
HYDROCORTISONE TAB 10 MG
HYDROCORTISONE TAB 20 MG
HYDROMORPHONE HCL INJ 1 MG/ML
HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 10 MG/ML
HYDROMORPHONE HCL TAB 8 MG
HYDROMORPHONE HCL-NACL SOLN PREF SYR 15 MG/30ML-0.9%
HYDROMORPHONE HCL-NACL SOLN PREF SYR 25 MG/50ML-0.9%
HYDROMORPHONE HCL-NACL SOLN PREF SYR 30 MG/30ML-0.9%
HYDROMORPHONE HCL-NACL SOLN PREF SYR 50 MG/50ML-0.9%
HYDROMORPHONE HCL-NACL SOLN PREF SYR 55 MG/55ML-0.9%
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 18 MG/30ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 6 MG/30ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 10 MG/50ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 15 MG/30ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 20 MG/100ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 24 MG/30ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 25 MG/50ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 30 MG/150ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 30 MG/30ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 50 MG/50ML
HYDROXYCHLOROQUINE SULFATE TAB 200 MG
HYDROXYUREA CAP 500 MG
HYDROXYZINE HCL IM SOLN 25 MG/ML
HYDROXYZINE PAMOATE CAP 100 MG
INDOMETHACIN CAP ER 75 MG
INFLUENZA VAC TISS-CULT SUBUNT QUAD SUSP PREF SYR 0.5 ML
INFLUENZA VIRUS VAC SPLIT QUADRIVALENT SUSP PREF SYR 0.5ML
INFLUENZA VIRUS VACCINE SPLIT QUADRIVALENT INJ 0.5 ML
IRBESARTAN TAB 150 MG
IRBESARTAN TAB 300 MG
ISOSORBIDE DINITRATE TAB 10 MG
ISOSORBIDE DINITRATE TAB 20 MG
ISOSORBIDE DINITRATE TAB 30 MG
ISOSORBIDE DINITRATE TAB 5 MG
LABETALOL HCL IV SOLN 5 MG/ML
LABETALOL HCL TAB 200 MG LABETALOL HCL TAB 300 MG
LABETALOL HCL-DEXTROSE IV SOLN 200 MG/200ML-5%
LAMOTRIGINE TAB 150 MG
LAMOTRIGINE TAB CHEWABLE DISPERSIBLE 25 MG
LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 500 MG/100ML
LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)
LEVETIRACETAM ORAL SOLN 100 MG/ML
LEVETIRACETAM TAB 750 MG
LEVETIRACETAM TAB 1000 MG
LEVETIRACETAM TAB ER 24HR 500 MG
LEVETIRACETAM TAB ER 24HR 750 MG
LEVOFLOXACIN IV SOLN 25 MG/ML
LEVOFLOXACIN TAB 750 MG
LEVONORGESTREL & ETHINYL ESTRADIOL (91-DAY) TAB 0.15-0.03 MG
LEVONORGESTREL-ETH ESTRA TAB 0.05-30/0.075-40/0.125-30MG-MCG
LEVONORG-ETH EST TAB 0.1-0.02MG(84) & ETH EST TAB 0.01MG(7)
LEVONORG-ETH EST TAB 0.15-0.03MG(84) & ETH EST TAB 0.01MG(7)
LEVOTHYROXINE SODIUM TAB 125 MCG
LEVOTHYROXINE SODIUM TAB 137 MCG
LEVOTHYROXINE SODIUM TAB 150 MCG
LEVOTHYROXINE SODIUM TAB 175 MCG
LEVOTHYROXINE SODIUM TAB 50 MCG
Lidocaine-Prilocaine Cream 2.5-2.5%
LIOTHYRONINE SODIUM TAB 5 MCG
LITHIUM CARBONATE TAB ER 450 MG
Loperamide HCl Cap 2 MG
LORAZEPAM CONC 2 MG/ML
LOXAPINE SUCCINATE CAP 10 MG
LOXAPINE SUCCINATE CAP 25 MG
LOXAPINE SUCCINATE CAP 5 MG
LOXAPINE SUCCINATE CAP 50 MG
MEGESTROL ACETATE SUSP 40 MG/ML
METHADONE HCL TAB FOR ORAL SUSP 40 MG
METHENAMINE MANDELATE TAB 0.5 GM
METHOCARBAMOL INJ 1000 MG/10ML
METHYLDOPA & HYDROCHLOROTHIAZIDE TAB 250-25 MG
METHYLPHENIDATE HCL TAB 20 MG
METHYLPREDNISOLONE SOD SUCC FOR INJ 500 MG (BASE EQUIV)
METHYLPREDNISOLONE TAB 4 MG
Metoprolol Succinate Tab ER 24HR 100 MG (Tartrate Equiv)
METOPROLOL TARTRATE TAB 75 MG
MIDODRINE HCL TAB 5 MG
MINOCYCLINE HCL CAP 100 MG
MINOCYCLINE HCL CAP 75 MG
MINOXIDIL FOAM 5%
MINOXIDIL SOLN 5%
MIRTAZAPINE ORALLY DISINTEGRATING TAB 30 MG
MISOPROSTOL TAB 100 MCG
MODAFINIL TAB 100 MG
MODAFINIL TAB 200 MG
MYCOPHENOLATE MOFETIL TAB 500 MG
NABUMETONE TAB 750 MG
NALTREXONE HCL TAB 50 MG
NAPROXEN SODIUM TAB 275 MG
NAPROXEN SODIUM TAB 550 MG
NAPROXEN TAB EC 375 MG
NEOMYCIN-POLYMYXIN-DEXAMETHASONE OPHTH OINT 0.1%
NIFEDIPINE CAP 10 MG
NIFEDIPINE TAB ER 24HR 60 MG
NIFEDIPINE TAB ER 24HR 90 MG
NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 30 MG
NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 60 MG
NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 90 MG
NITROFURANTOIN MACROCRYSTALLINE CAP 50 MG
NIZATIDINE CAP 150 MG
NIZATIDINE CAP 300 MG
NORETHINDRONE & ETHINYL ESTRADIOL TAB 0.4 MG-35 MCG
NORETHINDRONE & ETHINYL ESTRADIOL TAB 0.5 MG-35 MCG
NORETHINDRONE & ETHINYL ESTRADIOL TAB 1 MG-35 MCG
NORETHINDRONE ACE & ETHINYL ESTRADIOL TAB 1.5 MG-30 MCG
NORETHINDRONE ACE & ETHINYL ESTRADIOL-FE TAB 1 MG-20 MCG
NORETHINDRONE ACE & ETHINYL ESTRADIOL-FE TAB 1.5 MG-30 MCG
NORETHINDRONE ACE-ETHINYL ESTRADIOL-FE TAB 1 MG-20 MCG (24)
NORETHINDRONE TAB 0.35 MG
NORETHINDRONE-ETH ESTRADIOL TAB 0.5-35/0.75-35/1-35 MG-MCG
NORETHINDRONE-ETH ESTRADIOL TAB 0.5-35/1-35 MG-MCG (10/11)
NORETHINDRONE-ETH ESTRADIOL TAB 0.5-35/1-35/0.5-35 MG-MCG
NORGESTREL & ETHINYL ESTRADIOL TAB 0.3 MG-30 MCG
NORTRIPTYLINE HCL CAP 75 MG
NYSTATIN CREAM 100000 UNIT/GM
NYSTATIN SUSP 100000 UNIT/ML
NYSTATIN TAB 500000 UNIT
NYSTATIN TOPICAL POWDER 100000 UNIT/GM
NYSTATIN-TRIAMCINOLONE OINT 100000-0.1 UNIT/GM-%
OLANZAPINE ORALLY DISINTEGRATING TAB 10 MG
OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG
OLMESARTAN MEDOXOMIL-HYDROCHLOROTHIAZIDE TAB 20-12.5 MG
OLMESARTAN MEDOXOMIL-HYDROCHLOROTHIAZIDE TAB 40-12.5 MG
OLMESARTAN MEDOXOMIL-HYDROCHLOROTHIAZIDE TAB 40-25 MG
OMEGA-3-ACID ETHYL ESTERS CAP 1 GM
ONDANSETRON HCL ORAL SOLN 4 MG/5ML
ONDANSETRON HCL TAB 4 MG
OXCARBAZEPINE TAB 300 MG
OXCARBAZEPINE TAB 600 MG
OXYBUTYNIN CHLORIDE SYRUP 5 MG/5ML
OXYBUTYNIN CHLORIDE TAB ER 24HR 10 MG
OXYBUTYNIN CHLORIDE TAB ER 24HR 15 MG
OXYCODONE HCL CAP 5 MG
OXYCODONE HCL TAB 20 MG
OXYCODONE HCL TAB 30 MG
OXYCODONE W/ ACETAMINOPHEN TAB 10-325 MG
OXYCODONE W/ ACETAMINOPHEN TAB 7.5-325 MG
PAROXETINE HCL TAB 20 MG
PEG 3350-KCl-Na Bicarb-NaCl-Na Sulfate For Soln 236 GM
PEG 3350-KCL-NA BICARB-NACL-NA SULFATE PACKET 227.1 GM
PENICILLIN V POTASSIUM FOR SOLN 250 MG/5ML
PERPHENAZINE TAB 16 MG
PERPHENAZINE TAB 2 MG
PERPHENAZINE TAB 4 MG
PERPHENAZINE TAB 8 MG
PERPHENAZINE-AMITRIPTYLINE TAB 4-50 MG
PILOCARPINE HCL TAB 5 MG
PIOGLITAZONE HCL-METFORMIN HCL TAB 15-500 MG
PIOGLITAZONE HCL-METFORMIN HCL TAB 15-850 MG
PIOGLITAZONE HCL TAB 45 MG (BASE EQUIV)
PIROXICAM CAP 10 MG
PIROXICAM CAP 20 MG
POTASSIUM CHLORIDE TAB ER 20 MEQ (1500 MG)
POTASSIUM CHLORIDE TAB ER 8 MEQ (600 MG)
PRAZOSIN HCL CAP 1 MG
PRAZOSIN HCL CAP 2 MG
OXCARBAZEPINE TAB 300 MG
OXCARBAZEPINE TAB 600 MG
OXYBUTYNIN CHLORIDE SYRUP 5 MG/5ML
OXYBUTYNIN CHLORIDE TAB ER 24HR 10 MG
OXYBUTYNIN CHLORIDE TAB ER 24HR 15 MG
OXYCODONE HCL CAP 5 MG
OXYCODONE HCL TAB 20 MG
OXYCODONE HCL TAB 30 MG
OXYCODONE W/ ACETAMINOPHEN TAB 10-325 MG
OXYCODONE W/ ACETAMINOPHEN TAB 7.5-325 MG
PAROXETINE HCL TAB 20 MG
PEG 3350-KCl-Na Bicarb-NaCl-Na Sulfate For Soln 236 GM
PEG 3350-KCL-NA BICARB-NACL-NA SULFATE PACKET 227.1 GM
PENICILLIN V POTASSIUM FOR SOLN 250 MG/5ML
PERPHENAZINE TAB 16 MG
PERPHENAZINE TAB 2 MG
PERPHENAZINE TAB 4 MG
PERPHENAZINE TAB 8 MG
PERPHENAZINE-AMITRIPTYLINE TAB 4-50 MG
PILOCARPINE HCL TAB 5 MG
PIOGLITAZONE HCL-METFORMIN HCL TAB 15-500 MG
PIOGLITAZONE HCL-METFORMIN HCL TAB 15-850 MG
PIOGLITAZONE HCL TAB 45 MG (BASE EQUIV)
PIROXICAM CAP 10 MG
PIROXICAM CAP 20 MG
POTASSIUM CHLORIDE TAB ER 20 MEQ (1500 MG)
POTASSIUM CHLORIDE TAB ER 8 MEQ (600 MG)
PRAZOSIN HCL CAP 1 MG
PRAZOSIN HCL CAP 2 MG
PRAZOSIN HCL CAP 5 MG
PREDNISONE TAB THERAPY PACK 5 MG (21)
Pregabalin Cap 75 MG
PROCHLORPERAZINE MALEATE TAB 10 MG (BASE EQUIVALENT)
PROCHLORPERAZINE MALEATE TAB 5 MG (BASE EQUIVALENT)
Progesterone Cap 200 MG
PROGESTERONE IM IN OIL 50 MG/ML
PROGESTERONE MICRONIZED CAP 100 MG
PROMETHAZINE & PHENYLEPHRINE SYRUP 6.25-5 MG/5ML
PROMETHAZINE HCL SYRUP 6.25 MG/5ML
PROMETHAZINE-DM SYRUP 6.25-15 MG/5ML
PROPAFENONE HCL TAB 300 MG
PROPRANOLOL HCL CAP ER 24HR 60 MG
PROPRANOLOL HCL CAP ER 24HR 80 MG
PROPRANOLOL HCL INJ 1 MG/ML
PROPRANOLOL HCL ORAL SOLN 20 MG/5ML
PROPRANOLOL HCL TAB 60 MG
Pseudoephed-Bromphen-DM Syrup 30-2-10 MG/5ML
PYRIDOSTIGMINE BROMIDE TAB 60 MG
QUETIAPINE FUMARATE TAB 400 MG
QUETIAPINE FUMARATE TAB ER 24HR 150 MG
QUETIAPINE FUMARATE TAB ER 24HR 200 MG
QUETIAPINE FUMARATE TAB ER 24HR 300 MG
QUETIAPINE FUMARATE TAB ER 24HR 400 MG
QUETIAPINE FUMARATE TAB ER 24HR 50 MG
QUINAPRIL-HYDROCHLOROTHIAZIDE TAB 10-12.5 MG
QUINAPRIL-HYDROCHLOROTHIAZIDE TAB 20-12.5 MG
QUINAPRIL-HYDROCHLOROTHIAZIDE TAB 20-25 MG
RALOXIFENE HCL TAB 60 MG
RANITIDINE HCL TAB 300 MG
RILUZOLE TAB 50 MG
RISPERIDONE ORALLY DISINTEGRATING TAB 0.5 MG
RISPERIDONE SOLN 1 MG/ML
RIVASTIGMINE TARTRATE CAP 1.5 MG (BASE EQUIVALENT)
RIVASTIGMINE TARTRATE CAP 3 MG (BASE EQUIVALENT)
RIVASTIGMINE TARTRATE CAP 4.5 MG (BASE EQUIVALENT)
RIVASTIGMINE TARTRATE CAP 6 MG (BASE EQUIVALENT)
ROPINIROLE HYDROCHLORIDE TAB 0.25 MG
ROPINIROLE HYDROCHLORIDE TAB 1 MG
ROSUVASTATIN CALCIUM TAB 5 MG
ROSUVASTATIN CALCIUM TAB 10 MG
SERTRALINE HCL TAB 50 MG
SERTRALINE HCL TAB 100 MG
SILDENAFIL CITRATE TAB 25 MG
SILDENAFIL CITRATE TAB 50 MG
SIMVASTATIN TAB 40 MG
Sodium Hypochlorite Soln 0.125%
SODIUM FLUORIDE PASTE 1.1%
SODIUM FLUORIDE RINSE 0.2%
SODIUM FLUORIDE-POTASSIUM NITRATE PASTE 1.1-5%
SULFACETAMIDE SODIUM-PREDNISOLONE OPHTH SOLN 10-0.23(0.25)%
SULFAMETHOXAZOLE-TRIMETHOPRIM IV SOLN 400-80 MG/5ML
SULFASALAZINE TAB 500 MG
SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML
SUMATRIPTAN SUCCINATE TAB 100 MG
TACROLIMUS CAP 0.5 MG
TELMISARTAN TAB 20 MG
TELMISARTAN TAB 80 MG
THYROID TAB 60 MG (1 GRAIN)
TIZANIDINE HCL CAP 2 MG (BASE EQUIVALENT)
TIZANIDINE HCL CAP 4 MG (BASE EQUIVALENT)
TIZANIDINE HCL CAP 6 MG (BASE EQUIVALENT)
TIZANIDINE HCL TAB 2 MG (BASE EQUIVALENT)
TOLTERODINE TARTRATE TAB 2 MG
TOPIRAMATE SPRINKLE CAP 15 MG
TOPIRAMATE SPRINKLE CAP 25 MG
TOPIRAMATE TAB 25 MG
TOPIRAMATE TAB 100 MG
TRIMETHOPRIM TAB 100 MG
TROSPIUM CHLORIDE TAB 20 MG
URSODIOL CAP 300 MG
URSODIOL TAB 250 MG
VALPROATE SODIUM ORAL SOLN 250 MG/5ML (BASE EQUIV)
VALSARTAN TAB 40 MG
VALSARTAN TAB 80 MG
VALSARTAN-HYDROCHLOROTHIAZIDE TAB 160-12.5 MG
VALSARTAN-HYDROCHLOROTHIAZIDE TAB 160-25 MG
VALSARTAN-HYDROCHLOROTHIAZIDE TAB 80-12.5 MG
VERAPAMIL HCL IV SOLN 2.5 MG/ML
VERAPAMIL HCL TAB ER 120 MG
ZIPRASIDONE HCL CAP 20 MG
ZIPRASIDONE HCL CAP 40 MG
ZIPRASIDONE HCL CAP 60 MG
ZIPRASIDONE HCL CAP 80 MG
ZOLPIDEM TARTRATE TAB ER 6.25 MG

Rx List Tier 3 - $50 Copay

ACETAZOLAMIDE CAP ER 12HR 500 MG
ACETAZOLAMIDE SODIUM FOR INJ 500 MG
ACETAZOLAMIDE TAB 125 MG
ACETAZOLAMIDE TAB 250 MG
ACYCLOVIR OINT 5%
ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)
Albuterol Sulfate Soln Nebu 1.25 MG/3ML (Base Equiv)
ALENDRONATE SODIUM ORAL SOLN 70 MG/75ML
ALPRAZOLAM ORALLY DISINTEGRATING TAB 0.25 MG
AMIODARONE HCL IN DEXTROSE 5% IV SOLN 450 MG/250ML
AMIODARONE HCL IN DEXTROSE 5% IV SOLN 900 MG/500ML
AMITRIPTYLINE HCL TAB 150 MG
AMLODIPINE BESYLATE-VALSARTAN TAB 10-160 MG
AMLODIPINE-VALSARTAN-HYDROCHLOROTHIAZIDE TAB 5-160-12.5 MG
Amphetamine-Dextroamphetamine Cap ER 24HR 25 MG
AMPHETAMINE-DEXTROAMPHETAMINE TAB 15 MG
ARMODAFINIL TAB 150 MG
ARMODAFINIL TAB 200 MG
ARMODAFINIL TAB 250 MG
Azelastine HCl Nasal Spray 0.1% (137 MCG/SPRAY)
AZITHROMYCIN TAB 600 MG
BACITRACIN-POLYMYXIN-NEOMYCIN-HC OPHTH OINT 1%
BACLOFEN TAB 5 MG
B-COMPLEX W/ C & FOLIC ACID TAB
BENAZEPRIL & HYDROCHLOROTHIAZIDE TAB 20-12.5 MG
BENAZEPRIL & HYDROCHLOROTHIAZIDE TAB 20-25 MG
Betamethasone Dipropionate Augmented Cream 0.05%
BETHANECHOL CHLORIDE TAB 50 MG
BUTALBITAL-ACETAMINOPHEN TAB 50-325 MG
BUTALBITAL-ACETAMINOPHEN-CAFF W/ COD CAP 50-325-40-30 MG
BUTALBITAL-ACETAMINOPHEN-CAFFEINE CAP 50-300-40 MG
BUTALBITAL-ASPIRIN-CAFF W/ CODEINE CAP 50-325-40-30 MG
CANDESARTAN CILEXETIL TAB 16 MG
CANDESARTAN CILEXETIL TAB 32 MG
CANDESARTAN CILEXETIL TAB 4 MG
CANDESARTAN CILEXETIL TAB 8 MG
CAPTOPRIL TAB 100 MG
CAPTOPRIL TAB 50 MG
CARBAMAZEPINE CAP ER 12HR 100 MG
CARBAMAZEPINE CAP ER 12HR 300 MG
CARBAMAZEPINE TAB ER 12HR 100 MG
CARBAMAZEPINE TAB ER 12HR 200 MG
CARBIDOPA & LEVODOPA ORALLY DISINTEGRATING TAB 10-100 MG
CARBIDOPA & LEVODOPA ORALLY DISINTEGRATING TAB 25-100 MG
CARBIDOPA & LEVODOPA ORALLY DISINTEGRATING TAB 25-250 MG
CARBIDOPA-LEVODOPA-ENTACAPONE TABS 12.5-50-200 MG
CARBIDOPA-LEVODOPA-ENTACAPONE TABS 18.75-75-200 MG
CARBIDOPA-LEVODOPA-ENTACAPONE TABS 25-100-200 MG
CARBIDOPA-LEVODOPA-ENTACAPONE TABS 31.25-125-200 MG
CARBIDOPA-LEVODOPA-ENTACAPONE TABS 37.5-150-200 MG
CARBIDOPA-LEVODOPA-ENTACAPONE TABS 50-200-200 MG
CARBINOXAMINE MALEATE SOLN 4 MG/5ML
CEFADROXIL FOR SUSP 500 MG/5ML
CEFDINIR CAP 300 MG
CEFDINIR FOR SUSP 250 MG/5ML
CEFPROZIL FOR SUSP 250 MG/5ML
CEFPROZIL TAB 250 MG
CEFPROZIL TAB 500 MG
CEFUROXIME AXETIL TAB 500 MG
CEFUROXIME SODIUM FOR INJ 7.5 GM
CEPHALEXIN FOR SUSP 250 MG/5ML
CEVIMELINE HCL CAP 30 MG
CHLORDIAZEPOXIDE-AMITRIPTYLINE TAB 10-25 MG
CHLORDIAZEPOXIDE-AMITRIPTYLINE TAB 5-12.5 MG
CHLORZOXAZONE TAB 500 MG
Cinacalcet HCl Tab 30 MG (Base Equiv)
CITALOPRAM HYDROBROMIDE ORAL SOLN 10 MG/5ML
CLARITHROMYCIN FOR SUSP 125 MG/5ML
CLINDAMYCIN PALMITATE HCL FOR SOLN 75 MG/5ML (BASE EQUIV)
CLINDAMYCIN PHOSPHATE LOTION 1%
CLINDAMYCIN PHOSPHATE SWAB 1%
CLINDAMYCIN PHOSPHATE VAGINAL CREAM 2%
CLONAZEPAM ORALLY DISINTEGRATING TAB 0.125 MG
CLONAZEPAM ORALLY DISINTEGRATING TAB 1 MG
CLONAZEPAM ORALLY DISINTEGRATING TAB 2 MG
CLONIDINE HCL INJ (FOR EPIDURAL INFUSION) 100 MCG/ML
CLONIDINE HCL TAB ER 12HR 0.1 MG
CLONIDINE TD PATCH WEEKLY 0.1 MG/24HR
CLONIDINE TD PATCH WEEKLY 0.2 MG/24HR
CLORAZEPATE DIPOTASSIUM TAB 3.75 MG
CLORAZEPATE DIPOTASSIUM TAB 7.5 MG
CLOZAPINE TAB 200 MG
CODEINE SULFATE TAB 30 MG
CYCLOBENZAPRINE HCL TAB 7.5 MG
CYCLOSPORINE MODIFIED CAP 25 MG
CYCLOSPORINE MODIFIED CAP 50 MG
CYPROHEPTADINE HCL SYRUP 2 MG/5ML
DANTROLENE SODIUM CAP 100 MG
DANTROLENE SODIUM CAP 50 MG
DAPSONE TAB 100 MG
DESVENLAFAXINE SUCCINATE TAB ER 24HR 100 MG (BASE EQUIV)
DESVENLAFAXINE SUCCINATE TAB ER 24HR 25 MG (BASE EQUIV)
DESVENLAFAXINE SUCCINATE TAB ER 24HR 50 MG (BASE EQUIV)
DEXAMETHASONE SODIUM PHOSPHATE OPHTH SOLN 0.1%
DEXTROAMPHETAMINE SULFATE CAP ER 24HR 10 MG
DEXTROAMPHETAMINE SULFATE CAP ER 24HR 5 MG
DIAZEPAM CONC 5 MG/ML
DIAZEPAM IM SOLUTION AUTO-INJ 10 MG/2ML
DIAZEPAM INJ 5 MG/ML
DICYCLOMINE HCL INJ 10 MG/ML
DILTIAZEM HCL CAP ER 24HR 240 MG
DILTIAZEM HCL EXTENDED RELEASE BEADS CAP ER 24HR 240 MG
DILTIAZEM HCL EXTENDED RELEASE BEADS CAP ER 24HR 300 MG
DILTIAZEM HCL EXTENDED RELEASE BEADS CAP ER 24HR 360 MG
DILTIAZEM HCL EXTENDED RELEASE BEADS CAP ER 24HR 420 MG
DISOPYRAMIDE PHOSPHATE CAP 100 MG
DISOPYRAMIDE PHOSPHATE CAP 150 MG
Dorzolamide HCl-Timolol Maleate Ophth Soln 2-0.5%
DOXAZOSIN MESYLATE (BULK) POWDER
DOXYCYCLINE MONOHYDRATE TAB 75 MG
Duloxetine HCl Enteric Coated Pellets Cap 60 MG (Base Eq)
EPLERENONE TAB 25 MG
EPLERENONE TAB 50 MG
ESTRADIOL & NORETHINDRONE ACETATE TAB 1-0.5 MG
ESTRADIOL CYPIONATE IM IN OIL 5 MG/ML
ESTRADIOL TD PATCH TWICE WEEKLY 0.025 MG/24HR
ESTRADIOL TD PATCH TWICE WEEKLY 0.0375 MG/24HR
ESTRADIOL TD PATCH TWICE WEEKLY 0.05 MG/24HR
ESTRADIOL TD PATCH TWICE WEEKLY 0.075 MG/24HR
ESTRADIOL TD PATCH TWICE WEEKLY 0.1 MG/24HR
ESTRADIOL TD PATCH WEEKLY 0.025 MG/24HR
ESTRADIOL TD PATCH WEEKLY 0.0375 MG/24HR (37.5 MCG/24HR)
ESTRADIOL TD PATCH WEEKLY 0.05 MG/24HR
ESTRADIOL TD PATCH WEEKLY 0.06 MG/24HR
ESTRADIOL TD PATCH WEEKLY 0.075 MG/24HR
ESTRADIOL TD PATCH WEEKLY 0.1 MG/24HR
ETHYNODIOL DIACETATE & ETHINYL ESTRADIOL TAB 1 MG-50 MCG
ETODOLAC CAP 200 MG
ETODOLAC CAP 300 MG
ETODOLAC TAB ER 24HR 400 MG
ETODOLAC TAB ER 24HR 500 MG
EZETIMIBE-SIMVASTATIN TAB 10-10 MG
EZETIMIBE-SIMVASTATIN TAB 10-20 MG
EZETIMIBE-SIMVASTATIN TAB 10-40 MG
EZETIMIBE-SIMVASTATIN TAB 10-80 MG
FAMCICLOVIR TAB 500 MG
FENOFIBRATE MICRONIZED CAP 130 MG
FENOFIBRATE MICRONIZED CAP 43 MG
FLUCONAZOLE FOR SUSP 40 MG/ML
FLUCONAZOLE TAB 200 MG
FLUOXETINE HCL SOLUTION 20 MG/5ML
FLUOXETINE HCL TAB 20 MG
FOLIC ACID INJ 5 MG/ML
FOSINOPRIL SODIUM & HYDROCHLOROTHIAZIDE TAB 10-12.5 MG
FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)
FUROSEMIDE ORAL SOLN 8 MG/ML
FUROSEMIDE-SODIUM CHLORIDE 0.9% IV SOLN 100 MG/100ML
GALANTAMINE HYDROBROMIDE CAP ER 24HR 16 MG
GALANTAMINE HYDROBROMIDE CAP ER 24HR 24 MG
GALANTAMINE HYDROBROMIDE CAP ER 24HR 8 MG
GLUCOSE BLOOD TEST STRIP
GUANFACINE HCL TAB 2 MG
HALOPERIDOL DECANOATE IM SOLN 50 MG/ML
HALOPERIDOL TAB 20 MG
HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML
HYDROCORTISONE VALERATE CREAM 0.2%
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 20 MG/100ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 100 MG/50ML
HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 36 MG/30ML
HYDROXYZINE HCL SYRUP 10 MG/5ML
INFLUENZA VAC TISSUE-CULTURED SUBUNIT QUADRIVALENT IM SUSP
INFLUENZA VAC TYPE A&B SURFACE ANT ADJ SUSP PREF SYR 0.5 ML
INFLUENZA VIRUS VAC SPLIT HIGH-DOSE PF SUSP PREF SYR 0.5ML
IRBESARTAN-HYDROCHLOROTHIAZIDE TAB 300-12.5 MG
ISOSORBIDE DINITRATE TAB ER 40 MG
Lactic Acid (Ammonium Lactate) Lotion 12%
LAMIVUDINE TAB 150 MG
LAMIVUDINE TAB 300 MG
LAMIVUDINE-ZIDOVUDINE TAB 150-300 MG
LAMOTRIGINE TAB ER 24HR 25 MG
LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 1000 MG/100ML
LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 1500 MG/100ML
LEVOCETIRIZINE DIHYDROCHLORIDE SOLN 2.5 MG/5ML (0.5 MG/ML)
LIDOCAINE-HYDROCORTISONE ACETATE PERIANAL CREAM 3-0.5%
LIOTHYRONINE SODIUM TAB 25 MCG
LIOTHYRONINE SODIUM TAB 50 MCG
MEDROXYPROGESTERONE ACETATE IM SUSP 150 MG/ML
MEDROXYPROGESTERONE ACETATE IM SUSP PREFILLED SYR 150 MG/ML
MEMANTINE HCL CAP ER 24HR 28 MG
MEMANTINE HCL CAP ER 24HR 7 MG
MEPERIDINE HCL TAB 100 MG
METAXALONE TAB 800 MG
METHENAMINE HIPPURATE TAB 1 GM
METHENAMINE MANDELATE TAB 1 GM
METHOTREXATE SODIUM INJ 250 MG/10ML (25 MG/ML)
METHOTREXATE SODIUM INJ PF 1000 MG/40ML (25 MG/ML)
METHYLDOPA & HYDROCHLOROTHIAZIDE TAB 250-15 MG
METHYLPHENIDATE HCL TAB ER 10 MG
METHYLPHENIDATE HCL TAB ER 20 MG
METHYLPREDNISOLONE ACETATE INJ SUSP 40 MG/ML
METHYLPREDNISOLONE ACETATE INJ SUSP 80 MG/ML
METHYLPREDNISOLONE SOD SUCC FOR INJ 1000 MG (BASE EQUIV)
METHYLPREDNISOLONE TAB 8 MG
METOCLOPRAMIDE HCL SOLN 5 MG/5ML (10 MG/10ML) (BASE EQUIV)
METOPROLOL & HYDROCHLOROTHIAZIDE TAB 100-25 MG
METOPROLOL & HYDROCHLOROTHIAZIDE TAB 50-25 MG
METOPROLOL SUCC CAP ER 24HR SPRINKLE 50 MG (TARTRATE EQUIV)
MIDAZOLAM-KETAMINE HCL-ONDANSETRON HCL TROCHE 3-25-2 MG
MIDODRINE HCL TAB 10 MG
MINOCYCLINE HCL TAB 100 MG
MINOCYCLINE HCL TAB 50 MG
MIRTAZAPINE ORALLY DISINTEGRATING TAB 15 MG
MIRTAZAPINE ORALLY DISINTEGRATING TAB 45 MG
MIRTAZAPINE TAB 7.5 MG
MISOPROSTOL TAB 200 MCG
MONTELUKAST SODIUM ORAL GRANULES PACKET 4 MG (BASE EQUIV)
MYCOPHENOLATE SODIUM TAB DR 180 MG (MYCOPHENOLIC ACID EQUIV)
MYCOPHENOLATE SODIUM TAB DR 360 MG (MYCOPHENOLIC ACID EQUIV)
Nebulizers
NEOMYCIN SULFATE TAB 500 MG
NEOMYCIN-BACITRAC ZN-POLYMYX 5(3.5)MG-400UNT-10000UNT OP OIN
NEOMYCIN-POLYMY-GRAMICID OP SOL 1.75-10000-0.025MG-UNT-MG/ML
Nicotine TD Patch 24HR 21 MG/24HR
NIFEDIPINE CAP 20 MG
NITROFURANTOIN MACROCRYSTALLINE CAP 100 MG
NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG
NORETHINDRONE & ETHINYL ESTRADIOL-FE CHEW TAB 0.4 MG-35 MCG
NORETHINDRONE & MESTRANOL TAB 1 MG-50 MCG
NORETHINDRONE ACETATE TAB 5 MG
NORETHINDRONE ACETATE-ETHINYL ESTRADIOL TAB 1 MG-5 MCG
NYSTATIN-TRIAMCINOLONE CREAM 100000-0.1 UNIT/GM-%
OLANZAPINE FOR IM INJ 10 MG
OLANZAPINE ORALLY DISINTEGRATING TAB 15 MG
OLANZAPINE ORALLY DISINTEGRATING TAB 20 MG
OLMESARTAN-AMLODIPINE-HYDROCHLOROTHIAZIDE TAB 20-5-12.5 MG
ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG
OXAPROZIN TAB 600 MG
OXYCODONE HCL CONC 100 MG/5ML (20 MG/ML)
OXYCODONE HCL SOLN 5 MG/5ML
OXYCODONE W/ ACETAMINOPHEN TAB 2.5-325 MG
OXYCODONE-ASPIRIN TAB 4.8355-325 MG
OXYMORPHONE HCL TAB 10 MG
OXYMORPHONE HCL TAB 5 MG
PAROXETINE HCL TAB ER 24HR 12.5 MG
PAROXETINE HCL TAB ER 24HR 25 MG
PAROXETINE HCL TAB ER 24HR 37.5 MG
PENICILLIN G POTASSIUM FOR INJ 20000000 UNIT
PENICILLIN G SODIUM FOR INJ 5000000 UNIT
PERPHENAZINE-AMITRIPTYLINE TAB 2-10 MG
PERPHENAZINE-AMITRIPTYLINE TAB 4-10 MG
PERPHENAZINE-AMITRIPTYLINE TAB 4-25 MG
PHENYTOIN SODIUM EXTENDED CAP 200 MG
PHENYTOIN SODIUM EXTENDED CAP 300 MG
PILOCARPINE HCL TAB 7.5 MG
PINDOLOL TAB 10 MG
PINDOLOL TAB 5 MG
PRAZOSIN HCL POWDER
PREDNISONE TAB THERAPY PACK 10 MG (21)
PREDNISONE TAB THERAPY PACK 10 MG (48)
PREDNISONE TAB THERAPY PACK 5 MG (48)
Pregabalin Cap 25 MG
PROGESTERONE MICRONIZED CAP 200 MG
PROMETHAZINE HCL SUPPOS 12.5 MG
PROMETHAZINE W/ CODEINE SYRUP 6.25-10 MG/5ML
PROMETHAZINE-PHENYLEPHRINE-CODEINE SYRUP 6.25-5-10 MG/5ML
PROPRANOLOL & HYDROCHLOROTHIAZIDE TAB 40-25 MG
PROPRANOLOL & HYDROCHLOROTHIAZIDE TAB 80-25 MG
PROPRANOLOL HCL CAP ER 24HR 120 MG
PROPRANOLOL HCL CAP ER 24HR 160 MG
RANITIDINE HCL CAP 150 MG
RANITIDINE HCL SYRUP 15 MG/ML (75 MG/5ML)
RIFAMPIN CAP 150 MG
RIFAMPIN CAP 300 MG
RISPERIDONE ORALLY DISINTEGRATING TAB 1 MG
RISPERIDONE ORALLY DISINTEGRATING TAB 2 MG
RIZATRIPTAN BENZOATE ORAL DISINTEGRATING TAB 5 MG (BASE EQ)
RIZATRIPTAN BENZOATE TAB 10 MG (BASE EQUIVALENT)
RIZATRIPTAN BENZOATE TAB 5 MG (BASE EQUIVALENT)
ROPINIROLE HYDROCHLORIDE TAB ER 24HR 2 MG (BASE EQUIVALENT)
ROPINIROLE HYDROCHLORIDE TAB ER 24HR 4 MG (BASE EQUIVALENT)
ROPIVACAINE-CLONIDINE-KETOROLAC PREF SYR 123-0.04-15 MG/50ML
SERTRALINE HCL ORAL CONCENTRATE FOR SOLUTION 20 MG/ML
SILDENAFIL CITRATE TAB 100 MG
SPIRONOLACTONE & HYDROCHLOROTHIAZIDE TAB 25-25 MG
Sulfacetamide Sodium Ophth Soln 10%
SUMATRIPTAN NASAL SPRAY 20 MG/ACT
SUMATRIPTAN NASAL SPRAY 5 MG/ACT
SUMATRIPTAN SUCCINATE TAB 25 MG
SUMATRIPTAN SUCCINATE TAB 50 MG
TACROLIMUS CAP 1 MG
TAMOXIFEN CITRATE TAB 20 MG (BASE EQUIVALENT)
TELMISARTAN TAB 40 MG
TELMISARTAN-HYDROCHLOROTHIAZIDE TAB 80-12.5 MG
Terconazole Vaginal Cream 0.4%
TERCONAZOLE VAGINAL CREAM 0.8%
Testosterone Cypionate IM Inj in Oil 200 MG/ML
TET TOX-DIPH-ACELL PERTUSS AD INJ 5-2.5-18.5 LF-LF-MCG/0.5ML
TET TOX-DIPH-ACELL PERTUSS AD INJ 5-2-15.5 LF-LF-MCG/0.5ML\
Thyroid Tab 30 MG (1/2 Grain)
TOLTERODINE TARTRATE CAP ER 24HR 2 MG
TOLTERODINE TARTRATE CAP ER 24HR 4 MG
TOLTERODINE TARTRATE TAB 1 MG
TRAMADOL HCL TAB ER 24HR 100 MG
TRAMADOL HCL TAB ER 24HR BIPHASIC RELEASE 100 MG
TRIMETHOBENZAMIDE HCL CAP 300 MG
URSODIOL TAB 500 MG
VALACYCLOVIR HCL TAB 1 GM
VALACYCLOVIR HCL TAB 500 MG
VALSARTAN TAB 160 MG
VALSARTAN TAB 320 MG
VALSARTAN-HYDROCHLOROTHIAZIDE TAB 320-25 MG
VALSARTAN-HYDROCHLOROTHIAZIDE TAB 320-12.5 MG
VERAPAMIL HCL CAP ER 24HR 120 MG
ZOLPIDEM TARTRATE TAB ER 12.5 MG

Rx List Tier 4 - $75 Copay

ALBUTEROL SULFATE AER POW BA 108 MCG/ACT (90 MCG BASE EQUIV)
ALENDRONATE SODIUM TAB 5 MG
ALPRAZOLAM ORALLY DISINTEGRATING TAB 0.5 MG
ALPRAZOLAM ORALLY DISINTEGRATING TAB 1 MG
AMIODARONE HCL TAB 100 MG
AMIODARONE HCL TAB 400 MG
AMLODIPINE BESYLATE-ATORVASTATIN CALCIUM TAB 10-10 MG
AMLODIPINE BESYLATE-ATORVASTATIN CALCIUM TAB 10-40 MG
AMLODIPINE BESYLATE-ATORVASTATIN CALCIUM TAB 5-10 MG
AMLODIPINE-VALSARTAN-HYDROCHLOROTHIAZIDE TAB 10-160-25 MG
AMLODIPINE-VALSARTAN-HYDROCHLOROTHIAZIDE TAB 10-320-25 MG
AMOXICILLIN & K CLAVULANATE CHEW TAB 200-28.5 MG
AMOXICILLIN & K CLAVULANATE FOR SUSP 250-62.5 MG/5ML
AMOXICILLIN & K CLAVULANATE TAB 250-125 MG
Amphetamine-Dextroamphetamine Cap ER 24HR 10 MG
Amphetamine-Dextroamphetamine Cap ER 24HR 20 MG
Amphetamine-Dextroamphetamine Cap ER 24HR 30 MG
Apixaban Tab 5 MG
APRACLONIDINE HCL OPHTH SOLN 0.5% (BASE EQUIVALENT)
ATROPINE SULFATE OPHTH SOLN 1%
BENAZEPRIL & HYDROCHLOROTHIAZIDE TAB 5-6.25 MG
BENZTROPINE MESYLATE INJ 1 MG/ML
Betamethasone Dipropionate Oint 0.05%
Bimatoprost Ophth Soln 0.01%
Budesonide-Formoterol Fumarate Dihyd Aerosol 160-4.5 MCG/ACT
Budesonide-Glycopyrrolate-Formoterol Aers 160-9-4.8 MCG/ACT
Buprenorphine HCl-Naloxone HCl SL Film 8-2 MG (Base Equiv)
BUTALBITAL-ASPIRIN-CAFFEINE CAP 50-325-40 MG
CANDESARTAN CILEXETIL-HYDROCHLOROTHIAZIDE TAB 32-12.5 MG
CAPTOPRIL & HYDROCHLOROTHIAZIDE TAB 25-15 MG
CARBAMAZEPINE CAP ER 12HR 200 MG
CARBAMAZEPINE TAB ER 12HR 400 MG
Cariprazine HCl Cap 1.5 MG (Base Equivalent)
CARISOPRODOL TAB 250 MG
CARISOPRODOL W/ ASPIRIN & CODEINE TAB 200-325-16 MG
CARISOPRODOL W/ ASPIRIN TAB 200-325 MG
Ciprofloxacin-Dexamethasone Otic Susp 0.3-0.1%
CLINDAMYCIN PHOSPHATE GEL 1%
Clobetasol Propionate Cream 0.05%
Clobetasol Propionate Oint 0.05%
CLONIDINE TD PATCH WEEKLY 0.3 MG/24HR
CLORAZEPATE DIPOTASSIUM TAB 15 MG
Continuous Blood Glucose System Sensor
COVID-19 (SARS-CoV-2)mRNA Vacc-Moderna IM Susp 50 MCG/0.5ML
COVID-19 mRNA Vac TriS-Pfizer IM Susp Pref Syr 30 MCG/0.3ML
COVID-19 mRNA Vac Tris-Sucrose-Pfizer IM Susp 30 MCG/0.3ML
COVID-19 mRNA Vaccine-Moderna IM Susp Pref Syr 50 MCG/0.5ML
CYCLOSPORINE MODIFIED CAP 100 MG
DANTROLENE SODIUM FOR IV SOLN 20 MG
DEXMETHYLPHENIDATE HCL CAP ER 24 HR 15 MG
DEXTROAMPHETAMINE SULFATE CAP ER 24HR 15 MG
DICLOFENAC SODIUM GEL 1%
DICLOFENAC W/ MISOPROSTOL TAB DELAYED RELEASE 50-0.2 MG
DICLOFENAC W/ MISOPROSTOL TAB DELAYED RELEASE 75-0.2 MG
DICYCLOMINE HCL ORAL SOLN 10 MG/5ML
DICYCLOMINE HYDROCHLORIDE (BULK) POWDER
DILTIAZEM HCL COATED BEADS CAP ER 24HR 360 MG
DILTIAZEM HCL COATED BEADS TAB ER 24HR 180 MG
DILTIAZEM HCL COATED BEADS TAB ER 24HR 240 MG
Drospirenone Tab 4 MG
Duloxetine HCl Enteric Coated Pellets Cap 20 MG (Base Eq)
Empagliflozin Tab 25 MG
Emtricitabine-Tenofovir Alafenamide Fumarate Tab 200-25 MG
ERGOCALCIFEROL SOLN 200 MCG/ML (8000 UNIT/ML)
ESCITALOPRAM OXALATE SOLN 5 MG/5ML (BASE EQUIV)
ESTRADIOL & NORETHINDRONE ACETATE TAB 0.5-0.1 MG
Estrogens, Conjugated Tab 0.45 MG
ETHOSUXIMIDE SOLN 250 MG/5ML
ETODOLAC TAB ER 24HR 600 MG
FAMOTIDINE FOR SUSP 40 MG/5ML
FLUNISOLIDE NASAL SOLN 25 MCG/ACT (0.025%)
FLUOXETINE HCL TAB 60 MG
Fluorometholone Ophth Susp 0.1%
Fluticasone-Salmeterol Aer Powder BA 100-50 MCG/ACT
Fluticasone-Salmeterol Aer Powder BA 113-14 MCG/ACT
GABAPENTIN ORAL SOLN 250 MG/5ML
HEPATITIS A VACCINE INJ SUSP 1440 EL UNIT/ML
HYDROCODONE-ACETAMINOPHEN TAB 2.5-325 MG
HYDROCODONE-IBUPROFEN TAB 5-200 MG
HYDROCORTISONE ACETATE W/ PRAMOXINE PERIANAL CREAM 2.5-1%
HYDROCORTISONE BUTYRATE CREAM 0.1%
HYDROCORTISONE BUTYRATE OINT 0.1%
HYDROCORTISONE BUTYRATE SOLN 0.1%
HYDROCORTISONE LOTION 2.5%
HYDROXYZINE HCL IM SOLN 50 MG/ML
INFLUENZA VAC RECOMB HA QUAD PF SOLN PREF SYR 0.5 ML
Influenza Vac Split High-Dose Quad PF Susp Pref Syr 0.7 ML
Insulin Degludec Soln Pen-Injector 200 Unit/ML
Insulin Glargine Soln Pen-Injector 100 Unit/ML
Insulin Glargine Soln Pen-Injector 300 Unit/ML (2 Unit Dial)
Insulin NPH (Human) (Isophane) Inj 100 Unit/ML
Insulin NPH Isophane & Regular Human Inj 100 Unit/ML (70-30)
LAMIVUDINE ORAL SOLN 10 MG/ML
LAMOTRIGINE TAB ER 24HR 100 MG
LAMOTRIGINE TAB ER 24HR 200 MG
LAMOTRIGINE TAB ER 24HR 50 MG
LEVALBUTEROL TARTRATE INHAL AEROSOL 45 MCG/ACT (BASE EQUIV)
LEVOFLOXACIN OPHTH SOLN 0.5%
Lidocaine Patch 5%
Lisdexamfetamine Dimesylate Cap 50 MG
Measles-Mumps-Rubella Virus Vaccines For Inj Soln
MEMANTINE HCL CAP ER 24HR 14 MG
MEMANTINE HCL CAP ER 24HR 21 MG
MEPERIDINE HCL TAB 50 MG
MERCAPTOPURINE TAB 50 MG
Metaxalone Tab 400 MG
Metaxalone Tab 800 MG
METFORMIN HCL TAB ER 24HR OSMOTIC 500 MG
METHENAMINE-HYOSC-METH BLUE-BENZ ACID-PHENYL SAL TAB 81.6MG
METHOTREXATE SODIUM FOR INJ 1 GM
METHYLPHENIDATE HCL CAP ER 10 MG (CD)
METHYLPHENIDATE HCL CAP ER 20 MG (CD)
METHYLPHENIDATE HCL CAP ER 24HR 20 MG (LA)
METHYLPHENIDATE HCL CAP ER 24HR 30 MG (LA)
METHYLPHENIDATE HCL CAP ER 24HR 40 MG (LA)
METHYLPHENIDATE HCL CAP ER 30 MG (CD)
METHYLPHENIDATE HCL CAP ER 60 MG (CD)
METHYLPHENIDATE HCL CHEW TAB 2.5 MG
METHYLPHENIDATE HCL SOLN 5 MG/5ML
METHYLPHENIDATE HCL TAB ER 24HR 27 MG
METHYLPHENIDATE HCL TAB ER 24HR 54 MG
METHYLPHENIDATE HCL TAB ER OSMOTIC RELEASE (OSM) 18 MG
METHYLPHENIDATE HCL TAB ER OSMOTIC RELEASE (OSM) 27 MG
METHYLPHENIDATE HCL TAB ER OSMOTIC RELEASE (OSM) 36 MG
METHYLPREDNISOLONE ACETATE INJ SUSP 50 MG/ML
METHYLPREDNISOLONE ACETATE-BUPIVACAINE INJ SUSP 40-5 MG/ML
METHYLPREDNISOLONE TAB 16 MG
METOPROLOL & HYDROCHLOROTHIAZIDE TAB 100-50 MG
METRONIDAZOLE CREAM 0.75%
METRONIDAZOLE GEL 0.75%
MINOCYCLINE HCL TAB 75 MG
Moxifloxacin HCl Tab 400 MG (Base Equiv)
MYCOPHENOLATE MOFETIL HCL FOR IV SOLN 500 MG (BASE EQUIV)
NEBIVOLOL HCI TAB 10 MG (BASE EQUIVALENT)
NEOMYCIN-POLYMYXIN B GU IRRIGATION SOLN
NEOMYCIN-POLYMYXIN-HC OTIC SOLN 1%
NEOMYCIN-POLYMYXIN-HC OTIC SUSP 3.5 MG/ML-10000 UNIT/ML-1%
Netarsudil Dimesylate-Latanoprost Ophth Soln 0.02-0.005%
Norelgestromin-Ethinyl Estradiol TD PTWK 150-35 MCG/24HR
NORETHINDRONE & ETHINYL ESTRADIOL-FE CHEW TAB 0.8 MG-25 MCG
NORETHINDRONE ACE-ETH ESTRADIOL-FE CHEW TAB 1 MG-20 MCG (24)
NORETHINDRONE ACETATE-ETHINYL ESTRADIOL TAB 0.5 MG-2.5 MCG
Ofloxacin Ophth Soln 0.3%
Olopatadine HCl-Mometasone Furoate Nasal Susp 665-25 MCG/ACT
OLMESARTAN-AMLODIPINE-HYDROCHLOROTHIAZIDE TAB 40-10-12.5 MG
OLMESARTAN-AMLODIPINE-HYDROCHLOROTHIAZIDE TAB 40-10-25 MG
OLMESARTAN-AMLODIPINE-HYDROCHLOROTHIAZIDE TAB 40-5-12.5 MG
OLMESARTAN-AMLODIPINE-HYDROCHLOROTHIAZIDE TAB 40-5-25 MG
Oseltamivir Phosphate Cap 75 MG (Base Equiv)
OXYMORPHONE HCL TAB ER 12HR 5 MG
PENICILLIN G PROCAINE INTRAMUSCULAR SUSP 600000 UNIT/ML
PHENDIMETRAZINE TARTRATE CAP ER 24HR 105 MG
PILOCARPINE HCL OPHTH SOLN 1%
PILOCARPINE HCL OPHTH SOLN 2%
PILOCARPINE HCL OPHTH SOLN 4%
PREDNISONE ORAL SOLN 5 MG/5ML
PROPAFENONE HCL CAP ER 12HR 225 MG
PROPAFENONE HCL CAP ER 12HR 325 MG
PROPRANOLOL HCL ORAL SOLN 40 MG/5ML
RANITIDINE HCL CAP 300 MG
Risedronate Sodium Tab 150 MG
RISPERIDONE ORALLY DISINTEGRATING TAB 3 MG
Rivaroxaban Tab 20 MG
RIVASTIGMINE TD PATCH 24HR 13.3 MG/24HR
RIVASTIGMINE TD PATCH 24HR 4.6 MG/24HR
RIVASTIGMINE TD PATCH 24HR 9.5 MG/24HR
RIZATRIPTAN BENZOATE ORAL DISINTEGRATING TAB 10 MG (BASE EQ)
ROPINIROLE HYDROCHLORIDE TAB ER 24HR 6 MG (BASE EQUIVALENT)
ROPINIROLE HYDROCHLORIDE TAB ER 24HR 8 MG (BASE EQUIVALENT)
SIMVASTATIN (BULK) POWDER
Sod Sulfate-Pot Sulf-Mg Sulf Oral Sol 17.5-3.13-1.6 GM/177ML
Sucralfate Tab 1 GM
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40 MG/5ML
SUMATRIPTAN SUCCINATE SOLUTION AUTO-INJECTOR 6 MG/0.5ML
SUMATRIPTAN SUCCINATE SOLUTION PREFILLED SYRINGE 6 MG/0.5ML\
Tadalafil Tab 10 MG
TELMISARTAN-HYDROCHLOROTHIAZIDE TAB 40-12.5 MG
TELMISARTAN-HYDROCHLOROTHIAZIDE TAB 80-25 MG
TEMAZEPAM CAP 7.5 MG
Tet-Diph-Acell Pertuss Ad Pref Syr 5-2.5-18.5 LF-MCG/0.5ML
TRAMADOL HCL TAB ER 24HR 200 MG
TRAZODONE HCL TAB 300 MG
Varicella Virus Vac Live For Subcutaneous Inj 1350 PFU/0.5ML
VERAPAMIL HCL CAP ER 24HR 180 MG
VERAPAMIL HCL CAP ER 24HR 240 MG
Vibegron Tab 75 MG
Vortioxetine HBr Tab 20 MG (Base Equiv)
Zoster Vac Recombinant Adjuvanted for IM Inj 50 MCG/0.5ML

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