Smith RX - SBMA Benefits

SmithRx Formulary

Last updated July 1, 2023

Virtual Health – SmithRx Prescription Formulary.

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Rx List Tier 1 - $10 or Less

Accu-Chek FastClix Lancet Does not apply Kit
Accu-Chek Guide Me Does not apply Kit w/Device
Acetaminophen Extra Strength Oral Tablet 500 MG
Acetaminophen Oral Tablet 325 MG
Acetaminophen-Codeine Oral Tablet 300-30 MG
Acyclovir Oral Tablet 400 MG
Alendronate Sodium Oral Tablet 70 MG
Allopurinol Oral Tablet 100 MG
ALPRAZolam Oral Tablet 0.25 MG
ALPRAZolam Oral Tablet 0.5 MG
ALPRAZolam Oral Tablet 1 MG
Amitriptyline HCl Oral Tablet 10 MG
Amitriptyline HCl Oral Tablet 25 MG
amLODIPine Besylate Oral Tablet 10 MG
amLODIPine Besylate Oral Tablet 2.5 MG
amLODIPine Besylate Oral Tablet 5 MG
Amoxicillin Oral Capsule 500 MG
Amoxicillin Oral Suspension Reconstituted 250 MG/5ML
Amoxicillin Oral Suspension Reconstituted 400 MG/5ML
Amoxicillin Oral Tablet 500 MG
Amoxicillin Oral Tablet 875 MG
Anastrozole Oral Tablet 1 MG
Aqueous Vitamin D Oral Liquid 10 MCG/ML
Aspirin Low Dose Oral Tablet Delayed Release 81 MG
Aspirin Oral Tablet 325 MG
Aspirin Oral Tablet Delayed Release 81 MG
Atenolol Oral Tablet 25 MG
Atenolol Oral Tablet 50 MG
Atorvastatin Calcium Oral Tablet 10 MG
Atorvastatin Calcium Oral Tablet 20 MG
Azithromycin Oral Tablet 250 MG
Azithromycin Oral Tablet 500 MG
Baclofen Oral Tablet 10 MG
Banophen Oral Capsule 50 MG
Banophen Oral Tablet 25 MG
BD Luer-Lok Syringe Does not apply Miscellaneous 22G X 1″ 3 ML
BD Luer-Lok Syringe Does not apply Miscellaneous 25G X 1″ 3 ML
Benzonatate Oral Capsule 100 MG
Benzoyl Peroxide External Gel 5 %
busPIRone HCl Oral Tablet 10 MG
busPIRone HCl Oral Tablet 15 MG
busPIRone HCl Oral Tablet 5 MG
Carvedilol Oral Tablet 12.5 MG
Carvedilol Oral Tablet 25 MG
Carvedilol Oral Tablet 3.125 MG
Carvedilol Oral Tablet 6.25 MG
cefTRIAXone Sodium Injection Solution Reconstituted 500 MG
Cephalexin Oral Capsule 500 MG
Cetirizine HCl Oral Tablet 10 MG
Chest Congestion Relief Oral Tablet 400 MG
Childrens Ibuprofen Oral Suspension 100 MG/5ML
Chlorhexidine Gluconate Mouth/Throat Solution 0.12 %
Ciprofloxacin HCl Oral Tablet 500 MG
Citalopram Hydrobromide Oral Tablet 10 MG
Citalopram Hydrobromide Oral Tablet 20 MG
Citalopram Hydrobromide Oral Tablet 40 MG
clonazePAM Oral Tablet 0.5 MG
clonazePAM Oral Tablet 1 MG
cloNIDine HCl Oral Tablet 0.1 MG
cloNIDine HCl Oral Tablet 0.2 MG
CVS Saline Nasal Spray Nasal Solution 0.65 %
CVS Vitamin B-12 Oral Tablet 1000 MCG
Cyanocobalamin Injection Solution 1000 MCG/ML
Cyclobenzaprine HCl Oral Tablet 10 MG
Cyclobenzaprine HCl Oral Tablet 5 MG
Cyclopentolate HCl Ophthalmic Solution 1 %
D3 Super Strength Oral Capsule 50 MCG (2000 UT)
D3-1000 Oral Capsule 25 MCG (1000 UT)
Dexamethasone Oral Solution 0.5 MG/5ML
Dexamethasone Oral Tablet 2 MG
Dexamethasone Oral Tablet 4 MG
Dexamethasone Oral Tablet 6 MG
diazePAM Oral Tablet 5 MG
Diclofenac Sodium Oral Tablet Delayed Release 50 MG
Diclofenac Sodium Oral Tablet Delayed Release 75 MG
Dicyclomine HCl Oral Tablet 20 MG
Diphenoxylate-Atropine Oral Tablet 2.5-0.025 MG
Docusate Sodium Oral Capsule 100 MG
Dodex Injection Solution 1000 MCG/ML
Doxycycline Hyclate Oral Tablet 100 MG
DULoxetine HCl Oral Capsule Delayed Release Particles 30 MG
Ear Wax Removal Kit Otic Solution 6.5 %
EQ Aspirin Adult Low Dose Oral Tablet Delayed Release 81 MG
EQ Pain Reliever Oral Tablet 500 MG
EQ Space Chamber Anti-Static Does not apply Device
Escitalopram Oxalate Oral Tablet 10 MG
Escitalopram Oxalate Oral Tablet 5 MG
Famotidine Oral Tablet 20 MG
FeroSul Oral Tablet 325 (65 Fe) MG
Ferrous Sulfate Oral Elixir 220 (44 Fe) MG/5ML
Ferrous Sulfate Oral Tablet 325 (65 Fe) MG
Ferrous Sulfate Oral Tablet Delayed Release 325 (65 Fe) MG
Fish Oil Oral Capsule 1000 MG
Fluconazole Oral Tablet 100 MG
Fluconazole Oral Tablet 150 MG
FLUoxetine HCl Oral Capsule 10 MG
FLUoxetine HCl Oral Capsule 20 MG
Folic Acid Oral Tablet 1 MG
Furosemide Oral Tablet 20 MG
Furosemide Oral Tablet 40 MG
Gabapentin Oral Capsule 100 MG
Gabapentin Oral Capsule 300 MG
Gabapentin Oral Capsule 400 MG
Glimepiride Oral Tablet 4 MG
glipiZIDE Oral Tablet 10 MG
glipiZIDE Oral Tablet 5 MG
guaiFENesin Oral Liquid 100 MG/5ML
hydroCHLOROthiazide Oral Capsule 12.5 MG
hydroCHLOROthiazide Oral Tablet 12.5 MG
hydroCHLOROthiazide Oral Tablet 25 MG
hydroCHLOROthiazide Oral Tablet 50 MG
HYDROcodone-Acetaminophen Oral Tablet 5-325 MG
HYDROcodone-Acetaminophen Oral Tablet 7.5-325 MG
Hydrocortisone External Cream 0.5 %
Ibuprofen Oral Suspension 100 MG/5ML
Ibuprofen Oral Tablet 600 MG
Ibuprofen Oral Tablet 800 MG
Indomethacin Oral Capsule 50 MG
lamoTRIgine Oral Tablet 100 MG
Levocetirizine Dihydrochloride Oral Tablet 5 MG
levoFLOXacin Oral Tablet 500 MG
levoFLOXacin Oral Tablet 750 MG
Lisinopril Oral Tablet 10 MG
Lisinopril Oral Tablet 2.5 MG
Lisinopril Oral Tablet 20 MG
Lisinopril Oral Tablet 30 MG
Lisinopril Oral Tablet 40 MG
Lisinopril Oral Tablet 5 MG
Lisinopril-hydroCHLOROthiazide Oral Tablet 10-12.5 MG
Lisinopril-hydroCHLOROthiazide Oral Tablet 20-25 MG
Lithium Carbonate Oral Capsule 300 MG
Lithium Carbonate Oral Capsule 600 MG
Loratadine Oral Tablet 10 MG
LORazepam Oral Tablet 0.5 MG
LORazepam Oral Tablet 1 MG
Losartan Potassium Oral Tablet 25 MG
Losartan Potassium Oral Tablet 50 MG
Lovastatin Oral Tablet 20 MG
Lovastatin Oral Tablet 40 MG
Magnesium Oxide Oral Tablet 400 (240 Mg) MG
Mapap Arthritis Pain Oral Tablet Extended Release 650 MG
Meclizine HCl Oral Tablet 12.5 MG
medroxyPROGESTERone Acetate Oral Tablet 10 MG
Meloxicam Oral Tablet 15 MG
Meloxicam Oral Tablet 7.5 MG
metFORMIN HCl ER Oral Tablet Extended Release 24 Hour 500 MG
metFORMIN HCl Oral Tablet 1000 MG
metFORMIN HCl Oral Tablet 500 MG
Methocarbamol Oral Tablet 500 MG
Methocarbamol Oral Tablet 750 MG
Methotrexate Sodium (PF) Injection Solution 50 MG/2ML
methylPREDNISolone Oral Tablet 4 MG
Metoprolol Tartrate Oral Tablet 100 MG
Metoprolol Tartrate Oral Tablet 25 MG
Metoprolol Tartrate Oral Tablet 50 MG
metroNIDAZOLE Oral Tablet 500 MG
Miconazole 7 Vaginal Cream 2 %
Minoxidil Oral Tablet 2.5 MG
Moderna COVID-19 Bival Booster Intramuscular Suspension 50 MCG/0.5ML
Moderna COVID-19 Vaccine Intramuscular Suspension 100 MCG/0.5ML
Montelukast Sodium Oral Tablet 10 MG
Mucus Relief Oral Tablet Extended Release 12 Hour 600 MG
Naproxen Oral Tablet 375 MG
Naproxen Oral Tablet 500 MG
Niacin Oral Tablet 500 MG
Omeprazole Oral Capsule Delayed Release 20 MG
Ondansetron HCl Oral Tablet 4 MG
Ondansetron HCl Oral Tablet 8 MG
Ondansetron Oral Tablet Disintegrating 4 MG
OneTouch Delica Plus Lancet33G Does not apply Miscellaneous
oxyCODONE HCl Oral Tablet 5 MG
oxyCODONE-Acetaminophen Oral Tablet 5-325 MG
Oysco 500+D Oral Tablet 500-5 MG-MCG
Paxlovid (300/100) Oral Tablet Therapy Pack 20 x 150 MG & 10 x 100MG
Penicillin V Potassium Oral Tablet 250 MG
Pfizer COVID-19 Vac Bivalent Intramuscular Suspension 30 MCG/0.3ML
Pfizer COVID-19 Vac-TriS 5-11y Intramuscular Suspension 10 MCG/0.2ML
Pfizer-BioNT COVID-19 Vac-TriS Intramuscular Suspension 30 MCG/0.3ML
Phenazopyridine HCl Oral Tablet 200 MG
Pravastatin Sodium Oral Tablet 10 MG
prednisoLONE Sodium Phosphate Oral Solution 15 MG/5ML
predniSONE Oral Tablet 10 MG
predniSONE Oral Tablet 20 MG
predniSONE Oral Tablet 5 MG
predniSONE Oral Tablet 50 MG
Prenatal Oral Tablet 27-0.8 MG
Promethazine HCl Oral Solution 6.25 MG/5ML
Promethazine HCl Oral Syrup 6.25 MG/5ML
Promethazine HCl Oral Tablet 12.5 MG
Promethazine HCl Oral Tablet 25 MG
Promethazine-DM Oral Syrup 6.25-15 MG/5ML
Propranolol HCl Oral Tablet 10 MG
Pseudoeph-Bromphen-DM Oral Syrup 30-2-10 MG/5ML
QUEtiapine Fumarate Oral Tablet 100 MG
QUEtiapine Fumarate Oral Tablet 25 MG
QUEtiapine Fumarate Oral Tablet 50 MG
RA Cetirizine Oral Tablet 10 MG
risperiDONE Oral Tablet 0.5 MG
risperiDONE Oral Tablet 1 MG
Rosuvastatin Calcium Oral Tablet 10 MG
Senna Oral Tablet 8.6 MG
Sertraline HCl Oral Tablet 100 MG
Sertraline HCl Oral Tablet 25 MG
Sertraline HCl Oral Tablet 50 MG
Sildenafil Citrate Oral Tablet 50 MG
Simethicone Oral Tablet Chewable 80 MG
Simvastatin Oral Tablet 10 MG
Simvastatin Oral Tablet 20 MG
Simvastatin Oral Tablet 40 MG
SM Pain Reliever Ex St Oral Tablet 500 MG
Sodium Bicarbonate Oral Tablet 650 MG
Sodium Fluoride 5000 Plus Dental Cream 1.1 %
Sodium Fluoride Dental Gel 1.1 %
Spironolactone Oral Tablet 25 MG
Stool Softener Oral Capsule 100 MG
Sulfamethoxazole-Trimethoprim Oral Tablet 400-80 MG
Sulfamethoxazole-Trimethoprim Oral Tablet 800-160 MG
Tadalafil Oral Tablet 5 MG
Tamsulosin HCl Oral Capsule 0.4 MG
Terbinafine HCl Oral Tablet 250 MG
tiZANidine HCl Oral Tablet 4 MG
Topiramate Oral Tablet 25 MG
Topiramate Oral Tablet 50 MG
traMADol HCl Oral Tablet 50 MG
traZODone HCl Oral Tablet 50 MG
Triamcinolone Acetonide External Cream 0.1 %
Triamcinolone Acetonide External Ointment 0.1 %
Triazolam Oral Tablet 0.25 MG
valACYclovir HCl Oral Tablet 500 MG
Vitamin B-12 Oral Tablet 1000 MCG
Vitamin D (Cholecalciferol) Oral Capsule 50 MCG (2000 UT)
Vitamin D (Ergocalciferol) Oral Capsule 1.25 MG (50000 UT)
Vitamin D Oral Tablet 50 MCG (2000 UT)
Vitamin D3 Oral Capsule 1.25 MG (50000 UT)
Vitamin D3 Oral Capsule 50 MCG (2000 UT)
Vitamin D3 Oral Tablet 25 MCG (1000 UT)
Zolpidem Tartrate Oral Tablet 10 MG
Zolpidem Tartrate Oral Tablet 5 MG

Rx List Tier 2 - $25 or less

Accu-Chek Guide Does not apply Kit w/Device
Accu-Chek Softclix Lancets Does not apply Miscellaneous
Acetaminophen-Codeine Oral Tablet 300-30 MG
Acetaminophen-Codeine Oral Tablet 300-60 MG
Acyclovir Oral Tablet 400 MG
Afluria Quadrivalent Intramuscular Suspension
Afluria Quadrivalent Intramuscular Suspension Prefilled Syringe 0.5 ML
Alahist PE Oral Tablet 2-7.5 MG
Albuterol Sulfate Inhalation Nebulization Solution (2.5 MG/3ML) 0.083%
Albuterol Sulfate Oral Syrup 2 MG/5ML
Allopurinol Oral Tablet 100 MG
Allopurinol Oral Tablet 300 MG
ALPRAZolam Oral Tablet 0.25 MG
ALPRAZolam Oral Tablet 0.5 MG
ALPRAZolam Oral Tablet 1 MG
Amiodarone HCl Oral Tablet 200 MG
Amitriptyline HCl Oral Tablet 10 MG
Amitriptyline HCl Oral Tablet 25 MG
Amitriptyline HCl Oral Tablet 50 MG
amLODIPine Besy-Benazepril HCl Oral Capsule 10-20 MG
amLODIPine Besy-Benazepril HCl Oral Capsule 5-20 MG
Amoxicillin Oral Capsule 250 MG
Amoxicillin Oral Capsule 500 MG
Amoxicillin Oral Suspension Reconstituted 200 MG/5ML
Amoxicillin Oral Suspension Reconstituted 400 MG/5ML
Amoxicillin Oral Tablet 500 MG
Amoxicillin Oral Tablet 875 MG
Amoxicillin-Pot Clavulanate Oral Tablet 875-125 MG
Armour Thyroid Oral Tablet 15 MG
Atenolol Oral Tablet 100 MG
Atenolol Oral Tablet 25 MG
Atenolol Oral Tablet 50 MG
Atorvastatin Calcium Oral Tablet 10 MG
Atorvastatin Calcium Oral Tablet 20 MG
Atorvastatin Calcium Oral Tablet 40 MG
Atorvastatin Calcium Oral Tablet 80 MG
Aviane Oral Tablet 0.1-20 MG-MCG
Azithromycin Oral Tablet 250 MG
Azithromycin Oral Tablet 500 MG
Baclofen Oral Tablet 10 MG
Benazepril HCl Oral Tablet 40 MG
Benzonatate Oral Capsule 100 MG
Benzonatate Oral Capsule 200 MG
Brimonidine Tartrate Ophthalmic Solution 0.2 %
buPROPion HCl ER (SR) Oral Tablet Extended Release 12 Hour 100 MG
buPROPion HCl ER (SR) Oral Tablet Extended Release 12 Hour 150 MG
buPROPion HCl ER (SR) Oral Tablet Extended Release 12 Hour 200 MG
buPROPion HCl Oral Tablet 75 MG
busPIRone HCl Oral Tablet 10 MG
busPIRone HCl Oral Tablet 15 MG
Butalbital-APAP-Caffeine Oral Tablet 50-325-40 MG
Carvedilol Oral Tablet 12.5 MG
Carvedilol Oral Tablet 25 MG
Carvedilol Oral Tablet 3.125 MG
Carvedilol Oral Tablet 6.25 MG
Cefadroxil Oral Capsule 500 MG
Cefdinir Oral Capsule 300 MG
Celecoxib Oral Capsule 100 MG
Celecoxib Oral Capsule 200 MG
Cephalexin Oral Capsule 500 MG
Cetirizine HCl Oral Solution 1 MG/ML
chlordiazePOXIDE HCl Oral Capsule 10 MG
chlordiazePOXIDE HCl Oral Capsule 25 MG
Chlorthalidone Oral Tablet 25 MG
Ciprofloxacin HCl Ophthalmic Solution 0.3 %
Ciprofloxacin HCl Oral Tablet 500 MG
Citalopram Hydrobromide Oral Tablet 20 MG
Citalopram Hydrobromide Oral Tablet 40 MG
Clindamycin HCl Oral Capsule 150 MG
clonazePAM Oral Tablet 1 MG
clonazePAM Oral Tablet 2 MG
cloNIDine HCl Oral Tablet 0.1 MG
Clopidogrel Bisulfate Oral Tablet 75 MG
Clotrimazole External Cream 1 %
Colchicine Oral Tablet 0.6 MG
Comfort EZ Insulin Syringe Does not apply Miscellaneous 29G X 1/2″ 1 ML
Cyanocobalamin Injection Solution 1000 MCG/ML
Cyclobenzaprine HCl Oral Tablet 10 MG
Cyclobenzaprine HCl Oral Tablet 5 MG
Dasetta 7/7/7 Oral Tablet 0.5/0.75/1-35 MG-MCG
Deconex DMX Oral Tablet 10-17.5-400 MG
Deconex IR Oral Tablet 10-385 MG
Dexamethasone Oral Tablet 2 MG
diazePAM Oral Tablet 10 MG
Diclofenac Sodium Oral Tablet Delayed Release 75 MG
Dicyclomine HCl Oral Capsule 10 MG
Dicyclomine HCl Oral Tablet 20 MG
Doxepin HCl Oral Capsule 10 MG
Doxycycline Hyclate Oral Capsule 100 MG
Doxycycline Hyclate Oral Tablet 100 MG
Doxycycline Monohydrate Oral Capsule 100 MG
Doxycycline Monohydrate Oral Tablet 100 MG
DULoxetine HCl Oral Capsule Delayed Release Particles 30 MG
DULoxetine HCl Oral Capsule Delayed Release Particles 60 MG
EQ Sinus 12-Hour Oral Tablet Extended Release 12 Hour 120 MG
EQ Space Chamber Anti-Static L Does not apply Device
Erythromycin Ophthalmic Ointment 5 MG/GM
Escitalopram Oxalate Oral Tablet 10 MG
Escitalopram Oxalate Oral Tablet 20 MG
Escitalopram Oxalate Oral Tablet 5 MG
Estarylla Oral Tablet 0.25-35 MG-MCG
Estradiol Oral Tablet 0.5 MG
Estradiol Oral Tablet 1 MG
Euthyrox Oral Tablet 88 MCG
Eye Allergy Itch Relief Ophthalmic Solution 0.2 %
Ezetimibe Oral Tablet 10 MG
Famotidine Oral Tablet 20 MG
Famotidine Oral Tablet 40 MG
Fenofibrate Oral Tablet 145 MG
Fenofibrate Oral Tablet 160 MG
Ferrex 150 Oral Capsule 150 MG
Ferrous Sulfate Oral Tablet Delayed Release 325 (65 Fe) MG
Finasteride Oral Tablet 1 MG
Finasteride Oral Tablet 5 MG
Florastor Oral Capsule 250 MG
Fluarix Quadrivalent Intramuscular Suspension Prefilled Syringe 0.5 ML
Fluconazole Oral Tablet 100 MG
Fluconazole Oral Tablet 150 MG
Flulaval Quadrivalent Intramuscular Suspension Prefilled Syringe 0.5 ML
FLUoxetine HCl Oral Capsule 10 MG
FLUoxetine HCl Oral Capsule 20 MG
FLUoxetine HCl Oral Capsule 40 MG
Fluzone Quadrivalent Intramuscular Suspension Prefilled Syringe 0.5 ML
Folic Acid Oral Tablet 1 MG
FreeStyle Lancets Does not apply Miscellaneous
FreeStyle Lite Does not apply Kit w/Device
Furosemide Oral Tablet 20 MG
Furosemide Oral Tablet 40 MG
Gabapentin Oral Capsule 100 MG
Gabapentin Oral Capsule 300 MG
Gabapentin Oral Capsule 400 MG
Glimepiride Oral Tablet 2 MG
Glimepiride Oral Tablet 4 MG
glipiZIDE ER Oral Tablet Extended Release 24 Hour 2.5 MG
glipiZIDE ER Oral Tablet Extended Release 24 Hour 5 MG
glipiZIDE Oral Tablet 10 MG
glipiZIDE Oral Tablet 5 MG
glyBURIDE Oral Tablet 2.5 MG
GNP All Day Allergy-D Oral Tablet Extended Release 12 Hour 5-120 MG
GNP Lidocaine Pain Relief External Patch 4 %
guaiFENesin-Codeine Oral Solution 100-10 MG/5ML
Histex PD Oral Liquid 0.938 MG/ML
hydrALAZINE HCl Oral Tablet 25 MG
hydroCHLOROthiazide Oral Capsule 12.5 MG
hydroCHLOROthiazide Oral Tablet 12.5 MG
hydroCHLOROthiazide Oral Tablet 50 MG
HYDROcodone-Acetaminophen Oral Tablet 10-325 MG
HYDROcodone-Acetaminophen Oral Tablet 5-325 MG
HYDROcodone-Acetaminophen Oral Tablet 7.5-325 MG
Hydrocortisone External Cream 2.5 %
hydrOXYzine HCl Oral Tablet 10 MG
hydrOXYzine HCl Oral Tablet 25 MG
hydrOXYzine Pamoate Oral Capsule 25 MG
hydrOXYzine Pamoate Oral Capsule 50 MG
Hyoscyamine Sulfate Oral Tablet 0.125 MG
IBU Oral Tablet 800 MG
Ibuprofen Oral Tablet 600 MG
Ibuprofen Oral Tablet 800 MG
Isosorbide Mononitrate ER Oral Tablet Extended Release 24 Hour 30 MG
lamoTRIgine Oral Tablet 100 MG
lamoTRIgine Oral Tablet 150 MG
lamoTRIgine Oral Tablet 200 MG
Latanoprost Ophthalmic Solution 0.005 %
Levocetirizine Dihydrochloride Oral Tablet 5 MG
levoFLOXacin Oral Tablet 500 MG
levoFLOXacin Oral Tablet 750 MG
Levonorgestrel-Ethinyl Estrad Oral Tablet 0.15-30 MG-MCG
Levothyroxine Sodium Oral Tablet 100 MCG
Levothyroxine Sodium Oral Tablet 125 MCG
Levothyroxine Sodium Oral Tablet 150 MCG
Levothyroxine Sodium Oral Tablet 25 MCG
Levothyroxine Sodium Oral Tablet 50 MCG
Levothyroxine Sodium Oral Tablet 75 MCG
Levothyroxine Sodium Oral Tablet 88 MCG
Lidocaine Viscous HCl Mouth/Throat Solution 2 %
Lisinopril Oral Tablet 10 MG
Lisinopril Oral Tablet 20 MG
Lisinopril Oral Tablet 30 MG
Lisinopril Oral Tablet 40 MG
Lisinopril-hydroCHLOROthiazide Oral Tablet 10-12.5 MG
Lisinopril-hydroCHLOROthiazide Oral Tablet 20-12.5 MG
Lisinopril-hydroCHLOROthiazide Oral Tablet 20-25 MG
LORazepam Oral Tablet 0.5 MG
LORazepam Oral Tablet 1 MG
Losartan Potassium Oral Tablet 100 MG
Losartan Potassium Oral Tablet 50 MG
Losartan Potassium-HCTZ Oral Tablet 100-25 MG
Losartan Potassium-HCTZ Oral Tablet 50-12.5 MG
Meclizine HCl Oral Tablet 25 MG
medroxyPROGESTERone Acetate Oral Tablet 10 MG
Meloxicam Oral Tablet 15 MG
metFORMIN HCl ER Oral Tablet Extended Release 24 Hour 500 MG
metFORMIN HCl ER Oral Tablet Extended Release 24 Hour 750 MG
metFORMIN HCl Oral Tablet 1000 MG
metFORMIN HCl Oral Tablet 500 MG
metFORMIN HCl Oral Tablet 850 MG
Methadone HCl Oral Tablet 5 MG
methIMAzole Oral Tablet 10 MG
methIMAzole Oral Tablet 5 MG
Methocarbamol Oral Tablet 500 MG
Methocarbamol Oral Tablet 750 MG
Methotrexate Sodium Oral Tablet 2.5 MG
Methylphenidate HCl Oral Tablet 5 MG
methylPREDNISolone Oral Tablet Therapy Pack 4 MG
Metoprolol Succinate ER Oral Tablet Extended Release 24 Hour 100 MG
Metoprolol Succinate ER Oral Tablet Extended Release 24 Hour 25 MG
Metoprolol Succinate ER Oral Tablet Extended Release 24 Hour 50 MG
Metoprolol Tartrate Oral Tablet 100 MG
Metoprolol Tartrate Oral Tablet 25 MG
Metoprolol Tartrate Oral Tablet 50 MG
metroNIDAZOLE Oral Tablet 250 MG
metroNIDAZOLE Oral Tablet 500 MG
Minoxidil Oral Tablet 2.5 MG
Mirtazapine Oral Tablet 15 MG
Mirtazapine Oral Tablet 30 MG
Mirtazapine Oral Tablet 45 MG
Mono-Linyah Oral Tablet 0.25-35 MG-MCG
Montelukast Sodium Oral Tablet 10 MG
Montelukast Sodium Oral Tablet Chewable 4 MG
Montelukast Sodium Oral Tablet Chewable 5 MG
Mupirocin External Ointment 2 %
Naproxen Oral Tablet 250 MG
Naproxen Oral Tablet 500 MG
Neomycin-Polymyxin-Dexameth Ophthalmic Ointment 3.5-10000-0.1
Nicotine Transdermal Patch 24 Hour 14 MG/24HR
Nicotine Transdermal Patch 24 Hour 7 MG/24HR
NIFEdipine ER Osmotic Release Oral Tablet Extended Release 24 Hour 30 MG
Nitrofurantoin Macrocrystal Oral Capsule 100 MG
Nitrofurantoin Monohyd Macro Oral Capsule 100 MG
Nitroglycerin Sublingual Tablet Sublingual 0.4 MG
Norgestimate-Eth Estradiol Oral Tablet 0.25-35 MG-MCG
Nortriptyline HCl Oral Capsule 10 MG
Nortriptyline HCl Oral Capsule 50 MG
NP Thyroid Oral Tablet 30 MG
Nystatin Mouth/Throat Suspension 100000 UNIT/ML
Ofloxacin Ophthalmic Solution 0.3 %
OLANZapine Oral Tablet 10 MG
OLANZapine Oral Tablet 7.5 MG
Olmesartan Medoxomil Oral Tablet 20 MG
Omeprazole Oral Capsule Delayed Release 20 MG
Omeprazole Oral Capsule Delayed Release 40 MG
Omeprazole Oral Tablet Delayed Release 20 MG
Ondansetron HCl Oral Tablet 4 MG
Ondansetron Oral Tablet Disintegrating 4 MG
Ondansetron Oral Tablet Disintegrating 8 MG
OneTouch Verio Flex System Does not apply Kit w/Device
OneTouch Verio Reflect Does not apply Kit w/Device
Oxybutynin Chloride ER Oral Tablet Extended Release 24 Hour 15 MG
oxyCODONE HCl Oral Tablet 5 MG
oxyCODONE-Acetaminophen Oral Tablet 5-325 MG
Pantoprazole Sodium Oral Tablet Delayed Release 40 MG
PARoxetine HCl Oral Tablet 10 MG
PARoxetine HCl Oral Tablet 20 MG
PARoxetine HCl Oral Tablet 40 MG
PEG-3350/Electrolytes Oral Solution Reconstituted 236 GM
Penicillin V Potassium Oral Tablet 500 MG
Phenazopyridine HCl Oral Tablet 100 MG
Phenazopyridine HCl Oral Tablet 200 MG
Phendimetrazine Tartrate Oral Tablet 35 MG
Phentermine HCl Oral Capsule 15 MG
Phentermine HCl Oral Capsule 37.5 MG
Phentermine HCl Oral Tablet 37.5 MG
Pioglitazone HCl Oral Tablet 15 MG
Pioglitazone HCl Oral Tablet 30 MG
Polymyxin B-Trimethoprim Ophthalmic Solution 10000-0.1 UNIT/ML-%
Portia-28 Oral Tablet 0.15-30 MG-MCG
Potassium Chloride ER Oral Tablet Extended Release 20 MEQ
Pramipexole Dihydrochloride Oral Tablet 1.5 MG
Pravastatin Sodium Oral Tablet 10 MG
Pravastatin Sodium Oral Tablet 20 MG
Pravastatin Sodium Oral Tablet 40 MG
Prazosin HCl Oral Capsule 1 MG
predniSONE Oral Tablet 1 MG
predniSONE Oral Tablet 10 MG
predniSONE Oral Tablet 20 MG
predniSONE Oral Tablet 5 MG
predniSONE Oral Tablet Therapy Pack 10 MG (21)
predniSONE Oral Tablet Therapy Pack 5 MG (21)
PreviDent 5000 Booster Plus Dental Paste 1.1 %
Promethazine HCl Oral Syrup 6.25 MG/5ML
Promethazine HCl Oral Tablet 12.5 MG
Promethazine HCl Oral Tablet 25 MG
Promethazine-DM Oral Syrup 6.25-15 MG/5ML
Propranolol HCl Oral Tablet 40 MG
Pseudoeph-Bromphen-DM Oral Syrup 30-2-10 MG/5ML
QUEtiapine Fumarate ER Oral Tablet Extended Release 24 Hour 50 MG
risperiDONE Oral Tablet 2 MG
risperiDONE Oral Tablet 4 MG
rOPINIRole HCl Oral Tablet 1 MG
rOPINIRole HCl Oral Tablet 2 MG
Rosuvastatin Calcium Oral Tablet 20 MG
Rosuvastatin Calcium Oral Tablet 40 MG
Sertraline HCl Oral Tablet 100 MG
Sertraline HCl Oral Tablet 25 MG
Sertraline HCl Oral Tablet 50 MG
Sildenafil Citrate Oral Tablet 100 MG
Sildenafil Citrate Oral Tablet 50 MG
Simvastatin Oral Tablet 10 MG
Simvastatin Oral Tablet 20 MG
Simvastatin Oral Tablet 40 MG
Sodium Fluoride 5000 PPM Dental Paste 1.1 %
Spironolactone Oral Tablet 25 MG
Spironolactone Oral Tablet 50 MG
Sprintec 28 Oral Tablet 0.25-35 MG-MCG
Sronyx Oral Tablet 0.1-20 MG-MCG
Sucralfate Oral Tablet 1 GM
Sulfamethoxazole-Trimethoprim Oral Suspension 200-40 MG/5ML
Sulfamethoxazole-Trimethoprim Oral Tablet 800-160 MG
SUMAtriptan Succinate Oral Tablet 100 MG
SUMAtriptan Succinate Oral Tablet 25 MG
SUMAtriptan Succinate Oral Tablet 50 MG
Tamsulosin HCl Oral Capsule 0.4 MG
Temazepam Oral Capsule 30 MG
Timolol Maleate Ophthalmic Solution 0.5 %
tiZANidine HCl Oral Capsule 2 MG
tiZANidine HCl Oral Tablet 4 MG
Tobramycin Ophthalmic Solution 0.3 %
Topiramate Oral Tablet 100 MG
Topiramate Oral Tablet 25 MG
Topiramate Oral Tablet 50 MG
traMADol HCl Oral Tablet 50 MG
traZODone HCl Oral Tablet 100 MG
traZODone HCl Oral Tablet 150 MG
traZODone HCl Oral Tablet 50 MG
Tri-Estarylla Oral Tablet 0.18/0.215/0.25 MG-35 MCG
Tri-Linyah Oral Tablet 0.18/0.215/0.25 MG-35 MCG
Tri-Sprintec Oral Tablet 0.18/0.215/0.25 MG-35 MCG
Triamcinolone Acetonide External Cream 0.1 %
Triamcinolone Acetonide External Cream 0.5 %
Triamcinolone Acetonide External Ointment 0.1 %
Triamterene-HCTZ Oral Capsule 37.5-25 MG
Triamterene-HCTZ Oral Tablet 37.5-25 MG
Urea 20 Intensive Hydrating External Cream 20 %
Uro-MP Oral Capsule 118 MG
Vanacof Oral Liquid 30-1-12.5 MG/5ML
Venlafaxine HCl ER Oral Capsule Extended Release 24 Hour 37.5 MG
Venlafaxine HCl ER Oral Capsule Extended Release 24 Hour 75 MG
Venlafaxine HCl Oral Tablet 37.5 MG
Venlafaxine HCl Oral Tablet 75 MG
Verapamil HCl Oral Tablet 120 MG
Vienva Oral Tablet 0.1-20 MG-MCG
Vitamin D (Ergocalciferol) Oral Capsule 1.25 MG (50000 UT)
Zolpidem Tartrate Oral Tablet 10 MG

Rx List Tier 3 - $50 or Less

Accu-Chek Guide In Vitro Strip
Acetaminophen-Codeine Oral Tablet 300-30 MG
Acyclovir Oral Capsule 200 MG
Acyclovir Oral Tablet 400 MG
Adacel Intramuscular Suspension 5-2-15.5 LF-MCG/0.5
Albuterol Sulfate HFA Inhalation Aerosol Solution 108 (90 Base) MCG/ACT
Albuterol Sulfate Inhalation Nebulization Solution (2.5 MG/3ML) 0.083%
Albuterol Sulfate Inhalation Nebulization Solution 1.25 MG/3ML
Allopurinol Oral Tablet 100 MG
Allopurinol Oral Tablet 300 MG
Amitriptyline HCl Oral Tablet 25 MG
Amitriptyline HCl Oral Tablet 50 MG
amLODIPine Besy-Benazepril HCl Oral Capsule 10-40 MG
amLODIPine Besy-Benazepril HCl Oral Capsule 5-40 MG
amLODIPine-Olmesartan Oral Tablet 5-20 MG
Amoxicillin-Pot Clavulanate Oral Suspension Reconstituted 200-28.5 MG/5ML
Amoxicillin-Pot Clavulanate Oral Suspension Reconstituted 400-57 MG/5ML
Amoxicillin-Pot Clavulanate Oral Suspension Reconstituted 600-42.9 MG/5ML
Amoxicillin-Pot Clavulanate Oral Tablet 500-125 MG
Amoxicillin-Pot Clavulanate Oral Tablet 875-125 MG
Amphetamine-Dextroamphetamine Oral Tablet 10 MG
Amphetamine-Dextroamphetamine Oral Tablet 20 MG
Amphetamine-Dextroamphetamine Oral Tablet 30 MG
Amphetamine-Dextroamphetamine Oral Tablet 5 MG
ARIPiprazole Oral Tablet 5 MG
Armour Thyroid Oral Tablet 180 MG
Armour Thyroid Oral Tablet 30 MG
Armour Thyroid Oral Tablet 60 MG
Atorvastatin Calcium Oral Tablet 40 MG
Azithromycin Oral Tablet 500 MG
Baclofen Oral Tablet 10 MG
Benazepril HCl Oral Tablet 20 MG
Benazepril HCl Oral Tablet 40 MG
Benazepril-hydroCHLOROthiazide Oral Tablet 20-12.5 MG
Benzonatate Oral Capsule 100 MG
Bisoprolol Fumarate Oral Tablet 5 MG
Blisovi FE 1/20 Oral Tablet 1-20 MG-MCG
Boostrix Intramuscular Suspension 5-2.5-18.5 LF-MCG/0.5
Boostrix Intramuscular Suspension Prefilled Syringe 5-2.5-18.5 LF-MCG/0.5
buPROPion HCl ER (SR) Oral Tablet Extended Release 12 Hour 100 MG
buPROPion HCl ER (SR) Oral Tablet Extended Release 12 Hour 150 MG
buPROPion HCl ER (SR) Oral Tablet Extended Release 12 Hour 200 MG
buPROPion HCl ER (XL) Oral Tablet Extended Release 24 Hour 150 MG
buPROPion HCl ER (XL) Oral Tablet Extended Release 24 Hour 300 MG
buPROPion HCl Oral Tablet 75 MG
busPIRone HCl Oral Tablet 10 MG
busPIRone HCl Oral Tablet 5 MG
Butalbital-APAP-Caffeine Oral Tablet 50-325-40 MG
Calcitriol Oral Capsule 0.25 MCG
Carvedilol Oral Tablet 25 MG
Cefdinir Oral Capsule 300 MG
Cefdinir Oral Suspension Reconstituted 250 MG/5ML
Cefixime Oral Capsule 400 MG
Cefuroxime Axetil Oral Tablet 500 MG
Celecoxib Oral Capsule 100 MG
Celecoxib Oral Capsule 200 MG
Cephalexin Oral Capsule 500 MG
Cetirizine HCl Oral Solution 1 MG/ML
Cetirizine HCl Oral Tablet 10 MG
Ciprofloxacin HCl Ophthalmic Solution 0.3 %
Clindamycin HCl Oral Capsule 150 MG
Clindamycin HCl Oral Capsule 300 MG
cloNIDine HCl Oral Tablet 0.1 MG
Clopidogrel Bisulfate Oral Tablet 75 MG
CVS Nicotine Transdermal Patch 24 Hour 7 MG/24HR
Cyclobenzaprine HCl Oral Tablet 7.5 MG
Cyproheptadine HCl Oral Tablet 4 MG
Dasetta 1/35 Oral Tablet 1-35 MG-MCG
Depo-SubQ Provera 104 Subcutaneous Suspension Prefilled Syringe 104 MG/0.65ML
Dexmethylphenidate HCl Oral Tablet 5 MG
Diclofenac Sodium External Gel 1 %
Diclofenac Sodium Oral Tablet Delayed Release 75 MG
Dicyclomine HCl Oral Tablet 20 MG
Dilt-XR Oral Capsule Extended Release 24 Hour 180 MG
dilTIAZem HCl ER Beads Oral Capsule Extended Release 24 Hour 180 MG
dilTIAZem HCl ER Beads Oral Capsule Extended Release 24 Hour 240 MG
dilTIAZem HCl ER Coated Beads Oral Capsule Extended Release 24 Hour 120 MG
dilTIAZem HCl Oral Tablet 30 MG
Donepezil HCl Oral Tablet 10 MG
Dorzolamide HCl-Timolol Mal Ophthalmic Solution 22.3-6.8 MG/ML
Doxazosin Mesylate Oral Tablet 4 MG
Doxycycline Hyclate Oral Capsule 100 MG
Doxycycline Hyclate Oral Capsule 50 MG
Doxycycline Hyclate Oral Tablet 20 MG
Doxycycline Monohydrate Oral Capsule 100 MG
Doxycycline Monohydrate Oral Tablet 100 MG
Drospirenone-Ethinyl Estradiol Oral Tablet 3-0.03 MG
DULoxetine HCl Oral Capsule Delayed Release Particles 20 MG
DULoxetine HCl Oral Capsule Delayed Release Particles 30 MG
DULoxetine HCl Oral Capsule Delayed Release Particles 60 MG
Escitalopram Oxalate Oral Tablet 20 MG
Estradiol Oral Tablet 1 MG
Estradiol Oral Tablet 2 MG
Eszopiclone Oral Tablet 1 MG
FaBB Oral Tablet 2.2-25-1 MG
Famotidine Oral Tablet 40 MG
Ferrous Sulfate Oral Syrup 300 (60 Fe) MG/5ML
Finasteride Oral Tablet 5 MG
Flucelvax Quadrivalent Intramuscular Suspension Prefilled Syringe 0.5 ML
FLUoxetine HCl Oral Capsule 20 MG
FLUoxetine HCl Oral Capsule 40 MG
FLUoxetine HCl Oral Tablet 10 MG
Fluticasone Propionate External Cream 0.05 %
Fluticasone Propionate Nasal Suspension 50 MCG/ACT
Furosemide Oral Tablet 80 MG
Gabapentin Oral Capsule 100 MG
Gabapentin Oral Capsule 300 MG
Gabapentin Oral Tablet 600 MG
Glimepiride Oral Tablet 2 MG
glipiZIDE ER Oral Tablet Extended Release 24 Hour 5 MG
glipiZIDE Oral Tablet 10 MG
glipiZIDE Oral Tablet 5 MG
glyBURIDE-metFORMIN Oral Tablet 2.5-500 MG
guanFACINE HCl ER Oral Tablet Extended Release 24 Hour 1 MG
guanFACINE HCl ER Oral Tablet Extended Release 24 Hour 2 MG
Hailey FE 1/20 Oral Tablet 1-20 MG-MCG
hydrALAZINE HCl Oral Tablet 100 MG
HYDROcodone-Acetaminophen Oral Tablet 10-325 MG
HYDROcodone-Acetaminophen Oral Tablet 5-325 MG
HYDROcodone-Acetaminophen Oral Tablet 7.5-325 MG
Hydrocortisone Acetate Rectal Suppository 25 MG
Hydrocortisone External Cream 2.5 %
Hydroxychloroquine Sulfate Oral Tablet 200 MG
hydrOXYzine HCl Oral Tablet 25 MG
hydrOXYzine HCl Oral Tablet 50 MG
hydrOXYzine Pamoate Oral Capsule 50 MG
Ibuprofen Oral Tablet 800 MG
Insulin Aspart FlexPen Subcutaneous Solution Pen-injector 100 UNIT/ML
Integra F Oral Capsule 125-1 MG
Irbesartan Oral Tablet 300 MG
Isosorbide Mononitrate ER Oral Tablet Extended Release 24 Hour 30 MG
Jencycla Oral Tablet 0.35 MG
Junel 1/20 Oral Tablet 1-20 MG-MCG
Junel FE 1.5/30 Oral Tablet 1.5-30 MG-MCG
Junel FE 1/20 Oral Tablet 1-20 MG-MCG
Ketoconazole External Shampoo 2 %
Ketorolac Tromethamine Oral Tablet 10 MG
Labetalol HCl Oral Tablet 100 MG
Labetalol HCl Oral Tablet 300 MG
Lactulose Encephalopathy Oral Solution 10 GM/15ML
lamoTRIgine Oral Tablet 100 MG
Larin 1/20 Oral Tablet 1-20 MG-MCG
Latanoprost Ophthalmic Solution 0.005 %
Levocetirizine Dihydrochloride Oral Tablet 5 MG
Levothyroxine Sodium Oral Tablet 125 MCG
Levothyroxine Sodium Oral Tablet 137 MCG
Levothyroxine Sodium Oral Tablet 175 MCG
Levothyroxine Sodium Oral Tablet 200 MCG
Levothyroxine Sodium Oral Tablet 25 MCG
Lidocaine-Prilocaine External Cream 2.5-2.5 %
Lisinopril Oral Tablet 20 MG
Lisinopril Oral Tablet 30 MG
Lisinopril-hydroCHLOROthiazide Oral Tablet 20-12.5 MG
Lisinopril-hydroCHLOROthiazide Oral Tablet 20-25 MG
Loratadine Oral Tablet 10 MG
LORazepam Oral Tablet 0.5 MG
Losartan Potassium Oral Tablet 100 MG
Losartan Potassium Oral Tablet 25 MG
Losartan Potassium Oral Tablet 50 MG
Losartan Potassium-HCTZ Oral Tablet 100-12.5 MG
Losartan Potassium-HCTZ Oral Tablet 100-25 MG
Losartan Potassium-HCTZ Oral Tablet 50-12.5 MG
Lovastatin Oral Tablet 10 MG
Lovastatin Oral Tablet 20 MG
Meclizine HCl Oral Tablet 25 MG
medroxyPROGESTERone Acetate Intramuscular Suspension 150 MG/ML
medroxyPROGESTERone Acetate Oral Tablet 2.5 MG
metFORMIN HCl ER Oral Tablet Extended Release 24 Hour 500 MG
metFORMIN HCl Oral Tablet 1000 MG
metFORMIN HCl Oral Tablet 500 MG
metFORMIN HCl Oral Tablet 850 MG
Methadone HCl Oral Tablet 10 MG
Methocarbamol Oral Tablet 750 MG
Methotrexate Sodium Oral Tablet 2.5 MG
Methylphenidate HCl Oral Tablet 10 MG
Methylphenidate HCl Oral Tablet 20 MG
Metoclopramide HCl Oral Tablet 5 MG
Metoprolol Succinate ER Oral Tablet Extended Release 24 Hour 25 MG
Metoprolol Succinate ER Oral Tablet Extended Release 24 Hour 50 MG
Metoprolol Tartrate Oral Tablet 100 MG
metroNIDAZOLE Oral Tablet 250 MG
Microgestin 1/20 Oral Tablet 1-20 MG-MCG
Mirtazapine Oral Tablet 30 MG
Montelukast Sodium Oral Tablet 10 MG
Montelukast Sodium Oral Tablet Chewable 5 MG
Mupirocin External Ointment 2 %
Neomycin-Bacitracin Zn-Polymyx Ophthalmic Ointment 3.5-400-10000
Neomycin-Polymyxin-Dexameth Ophthalmic Suspension 3.5-10000-0.1
Nicotine Transdermal Patch 24 Hour 14 MG/24HR
NIFEdipine ER Oral Tablet Extended Release 24 Hour 60 MG
NIFEdipine ER Oral Tablet Extended Release 24 Hour 90 MG
Nitrofurantoin Monohyd Macro Oral Capsule 100 MG
Nitroglycerin Sublingual Tablet Sublingual 0.3 MG
Norethin Ace-Eth Estrad-FE Oral Tablet 1-20 MG-MCG
Norethindrone Acet-Ethinyl Est Oral Tablet 1-20 MG-MCG
Norethindrone Acetate Oral Tablet 5 MG
Norethindrone Oral Tablet 0.35 MG
Norlyda Oral Tablet 0.35 MG
NP Thyroid Oral Tablet 120 MG
NP Thyroid Oral Tablet 15 MG
NP Thyroid Oral Tablet 60 MG
Nystatin Mouth/Throat Suspension 100000 UNIT/ML
Ofloxacin Otic Solution 0.3 %
OLANZapine Oral Tablet 2.5 MG
Olmesartan Medoxomil-HCTZ Oral Tablet 20-12.5 MG
Omega-3-acid Ethyl Esters Oral Capsule 1 GM
Omeprazole Oral Capsule Delayed Release 20 MG
Omeprazole Oral Capsule Delayed Release 40 MG
Ondansetron Oral Tablet Disintegrating 4 MG
Ondansetron Oral Tablet Disintegrating 8 MG
Oseltamivir Phosphate Oral Capsule 75 MG
Oxybutynin Chloride ER Oral Tablet Extended Release 24 Hour 5 MG
oxyCODONE HCl Oral Tablet 15 MG
oxyCODONE-Acetaminophen Oral Tablet 10-325 MG
Pantoprazole Sodium Oral Tablet Delayed Release 40 MG
PARoxetine HCl Oral Tablet 10 MG
PARoxetine HCl Oral Tablet 20 MG
Phendimetrazine Tartrate Oral Tablet 35 MG
Phentermine HCl Oral Capsule 30 MG
Phentermine HCl Oral Tablet 37.5 MG
Pioglitazone HCl Oral Tablet 15 MG
Polyethylene Glycol 3350 Oral Powder 17 GM/SCOOP
Potassium Chloride Crys ER Oral Tablet Extended Release 20 MEQ
Pramipexole Dihydrochloride Oral Tablet 0.125 MG
Pramipexole Dihydrochloride Oral Tablet 0.5 MG
Pravastatin Sodium Oral Tablet 40 MG
predniSONE Oral Tablet 5 MG
Primidone Oral Tablet 50 MG
Progesterone Oral Capsule 100 MG
Propranolol HCl ER Oral Capsule Extended Release 24 Hour 60 MG
Propranolol HCl Oral Tablet 10 MG
Propranolol HCl Oral Tablet 20 MG
Pseudoeph-Bromphen-DM Oral Syrup 30-2-10 MG/5ML
Restora RX Oral Capsule 60-1.25 MG
Rizatriptan Benzoate Oral Tablet 10 MG
Rizatriptan Benzoate Oral Tablet Disintegrating 10 MG
Rizatriptan Benzoate Oral Tablet Disintegrating 5 MG
rOPINIRole HCl Oral Tablet 0.25 MG
Rosuvastatin Calcium Oral Tablet 10 MG
Rosuvastatin Calcium Oral Tablet 20 MG
Rosuvastatin Calcium Oral Tablet 5 MG
Sertraline HCl Oral Tablet 100 MG
Sildenafil Citrate Oral Tablet 100 MG
Sildenafil Citrate Oral Tablet 50 MG
Simvastatin Oral Tablet 80 MG
Spironolactone Oral Tablet 100 MG
Spironolactone Oral Tablet 25 MG
Spironolactone Oral Tablet 50 MG
sulfaSALAzine Oral Tablet 500 MG
SUMAtriptan Succinate Oral Tablet 100 MG
SUMAtriptan Succinate Oral Tablet 25 MG
Sure Comfort Pen Needles Does not apply Miscellaneous 32G X 4 MM
Synthroid Oral Tablet 125 MCG
Synthroid Oral Tablet 200 MCG
Synthroid Oral Tablet 25 MCG
Tamsulosin HCl Oral Capsule 0.4 MG
Terconazole Vaginal Cream 0.8 %
Testosterone Cypionate Intramuscular Solution 200 MG/ML
tiZANidine HCl Oral Capsule 2 MG
Topiramate Oral Tablet 100 MG
Topiramate Oral Tablet 25 MG
Topiramate Oral Tablet 50 MG
traMADol HCl Oral Tablet 50 MG
traZODone HCl Oral Tablet 100 MG
traZODone HCl Oral Tablet 150 MG
Tri-Lo-Mili Oral Tablet 0.18/0.215/0.25 MG-25 MCG
Tri-Lo-Sprintec Oral Tablet 0.18/0.215/0.25 MG-25 MCG
Triamcinolone Acetonide External Cream 0.1 %
Triamterene Oral Capsule 50 MG
Triamterene-HCTZ Oral Capsule 37.5-25 MG
valACYclovir HCl Oral Tablet 1 GM
valACYclovir HCl Oral Tablet 500 MG
Valproic Acid Oral Capsule 250 MG
Valsartan Oral Tablet 160 MG
Valsartan Oral Tablet 320 MG
Valsartan Oral Tablet 40 MG
Valsartan Oral Tablet 80 MG
Valsartan-hydroCHLOROthiazide Oral Tablet 160-25 MG
Valsartan-hydroCHLOROthiazide Oral Tablet 320-25 MG
Venlafaxine HCl ER Oral Capsule Extended Release 24 Hour 150 MG
Venlafaxine HCl Oral Tablet 37.5 MG
Venlafaxine HCl Oral Tablet 75 MG
Vios LC Plus Does not apply Miscellaneous
Zolpidem Tartrate ER Oral Tablet Extended Release 12.5 MG

Rx List Tier 4 - $75 or Less

Albuterol Sulfate HFA Inhalation Aerosol Solution 108 (90 Base) MCG/ACT
Albuterol Sulfate Inhalation Nebulization Solution (2.5 MG/3ML) 0.083%
Allegra-D Allergy & Congestion Oral Tablet Extended Release 12 Hour 60-120 MG
ALPRAZolam ER Oral Tablet Extended Release 24 Hour 1 MG
ALPRAZolam ER Oral Tablet Extended Release 24 Hour 2 MG
Altavera Oral Tablet 0.15-30 MG-MCG
amLODIPine Besy-Benazepril HCl Oral Capsule 10-20 MG
Amoxicillin-Pot Clavulanate Oral Suspension Reconstituted 400-57 MG/5ML
Amphetamine-Dextroamphetamine Oral Tablet 15 MG
Amphetamine-Dextroamphetamine Oral Tablet 30 MG
Anastrozole Oral Tablet 1 MG
Armour Thyroid Oral Tablet 30 MG
Atorvastatin Calcium Oral Tablet 80 MG
azaTHIOprine Oral Tablet 50 MG
Azelastine HCl Nasal Solution 0.1 %
Baclofen Oral Tablet 10 MG
BD Pen Needle Nano 2nd Gen Does not apply Miscellaneous 32G X 4 MM
BD Pen Needle Nano U/F Does not apply Miscellaneous 32G X 4 MM
BD Pen Needle Short U/F Does not apply Miscellaneous 31G X 8 MM
Benazepril HCl Oral Tablet 20 MG
buPROPion HCl ER (SR) Oral Tablet Extended Release 12 Hour 100 MG
buPROPion HCl ER (XL) Oral Tablet Extended Release 24 Hour 300 MG
busPIRone HCl Oral Tablet 30 MG
busPIRone HCl Oral Tablet 7.5 MG
Butalbital-APAP-Caffeine Oral Capsule 50-300-40 MG
Calcium Acetate (Phos Binder) Oral Capsule 667 MG
Cefdinir Oral Suspension Reconstituted 125 MG/5ML
Celecoxib Oral Capsule 200 MG
Cephalexin Oral Suspension Reconstituted 250 MG/5ML
Cetirizine HCl Oral Tablet Chewable 10 MG
Chlorzoxazone Oral Tablet 500 MG
Clarithromycin Oral Tablet 500 MG
Clindamycin HCl Oral Capsule 300 MG
Clindamycin Phosphate External Solution 1 %
Clorazepate Dipotassium Oral Tablet 7.5 MG
Clotrimazole-Betamethasone External Cream 1-0.05 %
Comp Air Compressor Nebulizer Does not apply Miscellaneous
Contour Test In Vitro Strip
Cryselle-28 Oral Tablet 0.3-30 MG-MCG
Dexmethylphenidate HCl Oral Tablet 10 MG
Diclofenac Potassium Oral Tablet 50 MG
Doxepin HCl Oral Capsule 25 MG
DULoxetine HCl Oral Capsule Delayed Release Particles 30 MG
DULoxetine HCl Oral Capsule Delayed Release Particles 60 MG
Enalapril Maleate Oral Tablet 10 MG
Engerix-B Injection Suspension Prefilled Syringe 20 MCG/ML
Estarylla Oral Tablet 0.25-35 MG-MCG
Euthyrox Oral Tablet 125 MCG
Euthyrox Oral Tablet 88 MCG
Fenofibrate Oral Tablet 145 MG
Fenofibrate Oral Tablet 160 MG
fentaNYL Transdermal Patch 72 Hour 25 MCG/HR
Flublok Quadrivalent Intramuscular Solution Prefilled Syringe 0.5 ML
FreeStyle Lite Test In Vitro Strip
Gabapentin Oral Capsule 300 MG
Gabapentin Oral Tablet 600 MG
Gabapentin Oral Tablet 800 MG
glipiZIDE ER Oral Tablet Extended Release 24 Hour 10 MG
guanFACINE HCl Oral Tablet 1 MG
Hailey 24 Fe Oral Tablet 1-20 MG-MCG(24)
Havrix Intramuscular Suspension 1440 EL U/ML
HYDROcodone-Acetaminophen Oral Tablet 10-325 MG
HYDROcodone-Acetaminophen Oral Tablet 5-325 MG
HYDROcodone-Acetaminophen Oral Tablet 7.5-325 MG
Hydrocortisone (Perianal) External Cream 2.5 %
Hydroxychloroquine Sulfate Oral Tablet 200 MG
hydrOXYzine HCl Oral Tablet 25 MG
hydrOXYzine Pamoate Oral Capsule 50 MG
Indapamide Oral Tablet 2.5 MG
Ipratropium Bromide Nasal Solution 0.03 %
Ipratropium Bromide Nasal Solution 0.06 %
Kurvelo Oral Tablet 0.15-30 MG-MCG
Labetalol HCl Oral Tablet 200 MG
lamoTRIgine Oral Tablet 25 MG
levETIRAcetam Oral Tablet 1000 MG
Levothyroxine Sodium Oral Tablet 100 MCG
Levothyroxine Sodium Oral Tablet 112 MCG
Levothyroxine Sodium Oral Tablet 125 MCG
Levothyroxine Sodium Oral Tablet 137 MCG
Levothyroxine Sodium Oral Tablet 150 MCG
Levothyroxine Sodium Oral Tablet 50 MCG
Levothyroxine Sodium Oral Tablet 75 MCG
Levothyroxine Sodium Oral Tablet 88 MCG
Lidocaine External Ointment 5 %
Lisinopril-hydroCHLOROthiazide Oral Tablet 20-12.5 MG
Loryna Oral Tablet 3-0.02 MG
Losartan Potassium-HCTZ Oral Tablet 100-25 MG
Losartan Potassium-HCTZ Oral Tablet 50-12.5 MG
Lutera Oral Tablet 0.1-20 MG-MCG
Marlissa Oral Tablet 0.15-30 MG-MCG
medroxyPROGESTERone Acetate Intramuscular Suspension Prefilled Syringe 150 MG/ML
medroxyPROGESTERone Acetate Oral Tablet 5 MG
Mefloquine HCl Oral Tablet 250 MG
metFORMIN HCl ER Oral Tablet Extended Release 24 Hour 500 MG
methIMAzole Oral Tablet 5 MG
Metoprolol Succinate ER Oral Tablet Extended Release 24 Hour 100 MG
Mili Oral Tablet 0.25-35 MG-MCG
Minocycline HCl Oral Capsule 100 MG
Na Sulfate-K Sulfate-Mg Sulf Oral Solution 17.5-3.13-1.6 GM/177ML
Nebivolol HCl Oral Tablet 10 MG
Neomycin-Polymyxin-HC Otic Solution 3.5-10000-1
Neomycin-Polymyxin-HC Otic Suspension 3.5-10000-1
Nicotine Step 1 Transdermal Patch 24 Hour 21 MG/24HR
NIFEdipine ER Oral Tablet Extended Release 24 Hour 60 MG
NIFEdipine ER Osmotic Release Oral Tablet Extended Release 24 Hour 90 MG
Nikki Oral Tablet 3-0.02 MG
Norethindrone-Eth Estradiol Oral Tablet 1-5 MG-MCG
Norgestim-Eth Estrad Triphasic Oral Tablet 0.18/0.215/0.25 MG-35 MCG
Norgestimate-Eth Estradiol Oral Tablet 0.25-35 MG-MCG
NP Thyroid Oral Tablet 15 MG
NP Thyroid Oral Tablet 30 MG
Olmesartan Medoxomil Oral Tablet 40 MG
Omega-3-acid Ethyl Esters Oral Capsule 1 GM
Ondansetron HCl Oral Tablet 8 MG
OneTouch Verio In Vitro Strip
OXcarbazepine Oral Tablet 300 MG
oxyCODONE HCl Oral Tablet 10 MG
oxyCODONE HCl Oral Tablet 15 MG
oxyCODONE-Acetaminophen Oral Tablet 10-325 MG
oxyCODONE-Acetaminophen Oral Tablet 5-325 MG
PARoxetine HCl Oral Tablet 40 MG
Phendimetrazine Tartrate ER Oral Capsule Extended Release 24 Hour 105 MG
Pioglitazone HCl Oral Tablet 30 MG
Pioglitazone HCl Oral Tablet 45 MG
PNV-DHA Oral Capsule 27-0.6-0.4-300 MG
Polyethylene Glycol 3350 Oral Powder 17 GM/SCOOP
Potassium Chloride ER Oral Capsule Extended Release 10 MEQ
Pravastatin Sodium Oral Tablet 40 MG
Prazosin HCl Oral Capsule 2 MG
ProAir HFA Inhalation Aerosol Solution 108 (90 Base) MCG/ACT
ProAir RespiClick Inhalation Aerosol Powder Breath Activated 108 (90 Base) MCG/ACT
Procto-Med HC External Cream 2.5 %
QUEtiapine Fumarate ER Oral Tablet Extended Release 24 Hour 300 MG
QUEtiapine Fumarate Oral Tablet 300 MG
Rosuvastatin Calcium Oral Tablet 40 MG
Sertraline HCl Oral Tablet 100 MG
Spironolactone Oral Tablet 100 MG
Spironolactone Oral Tablet 50 MG
Sprintec 28 Oral Tablet 0.25-35 MG-MCG
Sronyx Oral Tablet 0.1-20 MG-MCG
Tamoxifen Citrate Oral Tablet 20 MG
tiZANidine HCl Oral Capsule 4 MG
Topiramate Oral Tablet 50 MG
traZODone HCl Oral Tablet 150 MG
Tri-Estarylla Oral Tablet 0.18/0.215/0.25 MG-35 MCG
Tri-Sprintec Oral Tablet 0.18/0.215/0.25 MG-35 MCG
valACYclovir HCl Oral Tablet 1 GM
Valsartan Oral Tablet 80 MG
Venlafaxine HCl ER Oral Capsule Extended Release 24 Hour 150 MG
Venlafaxine HCl ER Oral Capsule Extended Release 24 Hour 75 MG
Ventolin HFA Inhalation Aerosol Solution 108 (90 Base) MCG/ACT
Verapamil HCl Oral Tablet 80 MG
Vienva Oral Tablet 0.1-20 MG-MCG
Vuity Ophthalmic Solution 1.25 %
Warfarin Sodium Oral Tablet 7.5 MG
Ziprasidone HCl Oral Capsule 80 MG

Rx List – $75 or More

Adderall XR Oral Capsule Extended Release 24 Hour 30 MG
Admelog SoloStar Subcutaneous Solution Pen-injector 100 UNIT/ML
Adzenys XR-ODT Oral Tablet Extended Release Disintegrating 12.5 MG
AirDuo Digihaler Inhalation Aerosol Powder Breath Activated 113-14 MCG/ACT
Albuterol Sulfate HFA Inhalation Aerosol Solution 108 (90 Base) MCG/ACT
Alogliptin Benzoate Oral Tablet 25 MG
Alphagan P Ophthalmic Solution 0.1 %
ALPRAZolam ER Oral Tablet Extended Release 24 Hour 0.5 MG
Alvesco Inhalation Aerosol Solution 160 MCG/ACT
Amitriptyline HCl Oral Tablet 100 MG
amLODIPine Besy-Benazepril HCl Oral Capsule 5-40 MG
amLODIPine Besylate-Valsartan Oral Tablet 5-160 MG
Amphetamine-Dextroamphet ER Oral Capsule Extended Release 24 Hour 15 MG
Amphetamine-Dextroamphet ER Oral Capsule Extended Release 24 Hour 20 MG
Amphetamine-Dextroamphet ER Oral Capsule Extended Release 24 Hour 25 MG
Amphetamine-Dextroamphet ER Oral Capsule Extended Release 24 Hour 30 MG
Amphetamine-Dextroamphetamine Oral Tablet 10 MG
Amphetamine-Dextroamphetamine Oral Tablet 15 MG
Amphetamine-Dextroamphetamine Oral Tablet 20 MG
Amphetamine-Dextroamphetamine Oral Tablet 30 MG
Angeliq Oral Tablet 0.5-1 MG
Anoro Ellipta Inhalation Aerosol Powder Breath Activated 62.5-25 MCG/ACT
Apri Oral Tablet 0.15-30 MG-MCG
Armodafinil Oral Tablet 150 MG
Armodafinil Oral Tablet 250 MG
Ashlyna Oral Tablet 0.15-0.03 &0.01 MG
Atenolol-Chlorthalidone Oral Tablet 50-25 MG
Azstarys Oral Capsule 52.3-10.4 MG
Baclofen Oral Tablet 20 MG
Basaglar KwikPen Subcutaneous Solution Pen-injector 100 UNIT/ML
Belbuca Buccal Film 900 MCG
Benazepril-hydroCHLOROthiazide Oral Tablet 20-12.5 MG
Bicillin L-A Intramuscular Suspension Prefilled Syringe 2400000 UNIT/4ML
Biktarvy Oral Tablet 50-200-25 MG
Bisoprolol Fumarate Oral Tablet 5 MG
Bisoprolol-hydroCHLOROthiazide Oral Tablet 10-6.25 MG
Blisovi 24 Fe Oral Tablet 1-20 MG-MCG(24)
Blisovi FE 1/20 Oral Tablet 1-20 MG-MCG
Breztri Aerosphere Inhalation Aerosol 160-9-4.8 MCG/ACT
Budesonide Inhalation Suspension 1 MG/2ML
Budesonide-Formoterol Fumarate Inhalation Aerosol 160-4.5 MCG/ACT
Bumetanide Oral Tablet 1 MG
Buprenorphine HCl Sublingual Tablet Sublingual 8 MG
buPROPion HCl ER (SR) Oral Tablet Extended Release 12 Hour 150 MG
buPROPion HCl ER (XL) Oral Tablet Extended Release 24 Hour 150 MG
buPROPion HCl ER (XL) Oral Tablet Extended Release 24 Hour 300 MG
buPROPion HCl ER (XL) Oral Tablet Extended Release 24 Hour 450 MG
Camrese Oral Tablet 0.15-0.03 &0.01 MG
Candesartan Cilexetil-HCTZ Oral Tablet 16-12.5 MG
carBAMazepine ER Oral Tablet Extended Release 12 Hour 400 MG
Cefdinir Oral Suspension Reconstituted 250 MG/5ML
Cefpodoxime Proxetil Oral Tablet 200 MG
Cephalexin Oral Tablet 500 MG
Ciprofloxacin-Dexamethasone Otic Suspension 0.3-0.1 %
Clenpiq Oral Solution 10-3.5-12 MG-GM -GM/160ML
Clindamycin Phos-Benzoyl Perox External Gel 1-5 %
Clindamycin Phosphate External Gel 1 %
Clindamycin Phosphate External Lotion 1 %
cloNIDine Transdermal Patch Weekly 0.3 MG/24HR
Creon Oral Capsule Delayed Release Particles 36000-114000 UNIT
Cyclobenzaprine HCl ER Oral Capsule Extended Release 24 Hour 15 MG
cycloSPORINE Modified Oral Capsule 100 MG
cycloSPORINE Ophthalmic Emulsion 0.05 %
Desvenlafaxine Succinate ER Oral Tablet Extended Release 24 Hour 100 MG
Desvenlafaxine Succinate ER Oral Tablet Extended Release 24 Hour 50 MG
Dexcom G6 Sensor Does not apply Miscellaneous
Dexmethylphenidate HCl ER Oral Capsule Extended Release 24 Hour 10 MG
Dexmethylphenidate HCl ER Oral Capsule Extended Release 24 Hour 5 MG
Dextroamphetamine Sulfate ER Oral Capsule Extended Release 24 Hour 10 MG
Dextroamphetamine Sulfate Oral Tablet 10 MG
Divigel Transdermal Gel 0.75 MG/0.75GM
Doxycycline Hyclate Oral Tablet 50 MG
Doxycycline Monohydrate Oral Capsule 100 MG
Drospiren-Eth Estrad-Levomefol Oral Tablet 3-0.02-0.451 MG
Drospirenone-Ethinyl Estradiol Oral Tablet 3-0.02 MG
Drospirenone-Ethinyl Estradiol Oral Tablet 3-0.03 MG
EC-Naproxen Oral Tablet Delayed Release 500 MG
Eliquis Oral Tablet 2.5 MG
Eliquis Oral Tablet 5 MG
Ella Oral Tablet 30 MG
EluRyng Vaginal Ring 0.12-0.015 MG/24HR
Emtricitabine-Tenofovir DF Oral Tablet 200-300 MG
Enalapril Maleate Oral Tablet 20 MG
Enskyce Oral Tablet 0.15-30 MG-MCG
Entresto Oral Tablet 24-26 MG
EPINEPHrine Injection Solution Auto-injector 0.3 MG/0.3ML
Estradiol Oral Tablet 2 MG
Estradiol Transdermal Patch Twice Weekly 0.0375 MG/24HR
Estradiol Transdermal Patch Twice Weekly 0.1 MG/24HR
Estradiol Transdermal Patch Weekly 0.05 MG/24HR
Estradiol Vaginal Cream 0.1 MG/GM
Estradiol Valerate Intramuscular Oil 20 MG/ML
Estradiol-Norethindrone Acet Oral Tablet 1-0.5 MG
Etodolac Oral Capsule 300 MG
Etodolac Oral Tablet 400 MG
Famotidine Oral Suspension Reconstituted 40 MG/5ML
Fenofibrate Oral Tablet 120 MG
Fenofibric Acid Oral Capsule Delayed Release 135 MG
Flovent Diskus Inhalation Aerosol Powder Breath Activated 100 MCG/ACT
Fluocinonide External Solution 0.05 %
FLUoxetine HCl Oral Capsule Delayed Release 90 MG
FLUoxetine HCl Oral Tablet 20 MG
FLUoxetine HCl Oral Tablet 60 MG
Fluticasone Furoate-Vilanterol Inhalation Aerosol Powder Breath Activated 100-25 MCG/ACT
Fluticasone Furoate-Vilanterol Inhalation Aerosol Powder Breath Activated 200-25 MCG/ACT
Fluticasone Propionate Nasal Suspension 50 MCG/ACT
Fluticasone-Salmeterol Inhalation Aerosol Powder Breath Activated 250-50 MCG/ACT
fluvoxaMINE Maleate Oral Tablet 100 MG
FreeStyle Libre 14 Day Sensor Does not apply Miscellaneous
FreeStyle Libre 2 Sensor Does not apply Miscellaneous
FreeStyle Libre 3 Sensor Does not apply Miscellaneous
FreeStyle Lite Test In Vitro Strip
Gabapentin Oral Capsule 400 MG
Gabapentin Oral Tablet 600 MG
Gabapentin Oral Tablet 800 MG
Gemtesa Oral Tablet 75 MG
Hailey FE 1.5/30 Oral Tablet 1.5-30 MG-MCG
Humira Pen Subcutaneous Pen-injector Kit 40 MG/0.4ML
HYDROcodone-Acetaminophen Oral Tablet 10-325 MG
HYDROcodone-Ibuprofen Oral Tablet 10-200 MG
Hydrocortisone Oral Tablet 10 MG
hydrOXYzine HCl Oral Tablet 25 MG
Hyoscyamine Sulfate Oral Tablet Disintegrating 0.125 MG
Insulin Glargine Solostar Subcutaneous Solution Pen-injector 100 UNIT/ML
Insulin Glargine-yfgn Subcutaneous Solution Pen-injector 100 UNIT/ML
Insulin Lispro (1 Unit Dial) Subcutaneous Solution Pen-injector 100 UNIT/ML
Insulin Lispro Injection Solution 100 UNIT/ML
Invokana Oral Tablet 100 MG
Ipratropium-Albuterol Inhalation Solution 0.5-2.5 (3) MG/3ML
Irbesartan Oral Tablet 150 MG
Irbesartan-hydroCHLOROthiazide Oral Tablet 300-12.5 MG
Jaimiess Oral Tablet 0.15-0.03 &0.01 MG
Januvia Oral Tablet 100 MG
Jardiance Oral Tablet 25 MG
Jencycla Oral Tablet 0.35 MG
Jolessa Oral Tablet 0.15-0.03 MG
Junel 1/20 Oral Tablet 1-20 MG-MCG
Junel FE 1.5/30 Oral Tablet 1.5-30 MG-MCG
Junel FE 1/20 Oral Tablet 1-20 MG-MCG
Keppra XR Oral Tablet Extended Release 24 Hour 500 MG
Ketoconazole External Cream 2 %
Lantus SoloStar Subcutaneous Solution Pen-injector 100 UNIT/ML
Lantus Subcutaneous Solution 100 UNIT/ML
Larin Fe 1/20 Oral Tablet 1-20 MG-MCG
Latuda Oral Tablet 40 MG
levETIRAcetam ER Oral Tablet Extended Release 24 Hour 500 MG
levETIRAcetam ER Oral Tablet Extended Release 24 Hour 750 MG
levETIRAcetam Oral Tablet 1000 MG
levETIRAcetam Oral Tablet 750 MG
Levonorgest-Eth Estrad 91-Day Oral Tablet 0.15-0.03 MG
Levonorgestrel-Ethinyl Estrad Oral Tablet 90-20 MCG
Levothyroxine Sodium Oral Tablet 175 MCG
Levothyroxine Sodium Oral Tablet 200 MCG
Linzess Oral Capsule 145 MCG
Linzess Oral Capsule 290 MCG
Liothyronine Sodium Oral Tablet 25 MCG
Lo Loestrin Fe Oral Tablet 1 MG-10 MCG / 10 MCG
Loryna Oral Tablet 3-0.02 MG
Losartan Potassium-HCTZ Oral Tablet 100-12.5 MG
Lumigan Ophthalmic Solution 0.01 %
Lyllana Transdermal Patch Twice Weekly 0.1 MG/24HR
Memantine HCl ER Oral Capsule Extended Release 24 Hour 14 MG
Methylphenidate HCl ER (OSM) Oral Tablet Extended Release 18 MG
Methylphenidate HCl ER (OSM) Oral Tablet Extended Release 27 MG
Methylphenidate HCl ER (OSM) Oral Tablet Extended Release 36 MG
Methylphenidate HCl ER (OSM) Oral Tablet Extended Release 54 MG
Methylphenidate HCl ER (OSM) Oral Tablet Extended Release 72 MG
Methylphenidate HCl Oral Tablet 20 MG
metroNIDAZOLE External Cream 0.75 %
metroNIDAZOLE Vaginal Gel 0.75 %
Mibelas 24 Fe Oral Tablet Chewable 1-20 MG-MCG(24)
Microgestin 1.5/30 Oral Tablet 1.5-30 MG-MCG
Microgestin FE 1.5/30 Oral Tablet 1.5-30 MG-MCG
Midodrine HCl Oral Tablet 10 MG
Minocycline HCl Oral Capsule 100 MG
Modafinil Oral Tablet 200 MG
Mounjaro Subcutaneous Solution Pen-injector 10 MG/0.5ML
Mounjaro Subcutaneous Solution Pen-injector 12.5 MG/0.5ML
Mounjaro Subcutaneous Solution Pen-injector 15 MG/0.5ML
Mounjaro Subcutaneous Solution Pen-injector 2.5 MG/0.5ML
Mounjaro Subcutaneous Solution Pen-injector 5 MG/0.5ML
Myfembree Oral Tablet 40-1-0.5 MG
Naltrexone HCl Oral Tablet 50 MG
Naproxen Sodium Oral Tablet 550 MG
Nebivolol HCl Oral Tablet 10 MG
Neomycin-Polymyxin-HC Otic Suspension 3.5-10000-1
Neupro Transdermal Patch 24 Hour 2 MG/24HR
Nextstellis Oral Tablet 3-14.2 MG
Norethindrone Acet-Ethinyl Est Oral Tablet 1-20 MG-MCG
Norethindrone Acetate Oral Tablet 5 MG
Norethindrone Oral Tablet 0.35 MG
Nortriptyline HCl Oral Capsule 10 MG
NovoLIN 70/30 ReliOn Subcutaneous Suspension (70-30) 100 UNIT/ML
NP Thyroid Oral Tablet 60 MG
NP Thyroid Oral Tablet 90 MG
Nubeqa Oral Tablet 300 MG
Nurtec Oral Tablet Disintegrating 75 MG
Nuvessa Vaginal Gel 1.3 %
Nystatin-Triamcinolone External Cream 100000-0.1 UNIT/GM-%
Odefsey Oral Tablet 200-25-25 MG
Olmesartan Medoxomil-HCTZ Oral Tablet 40-12.5 MG
Olmesartan Medoxomil-HCTZ Oral Tablet 40-25 MG
Olmesartan-amLODIPine-HCTZ Oral Tablet 40-10-12.5 MG
Olmesartan-amLODIPine-HCTZ Oral Tablet 40-10-25 MG
Omega-3-acid Ethyl Esters Oral Capsule 1 GM
Orgovyx Oral Tablet 120 MG
Orilissa Oral Tablet 150 MG
OXcarbazepine Oral Tablet 300 MG
oxyCODONE HCl Oral Tablet 10 MG
oxyCODONE HCl Oral Tablet 15 MG
oxyCODONE HCl Oral Tablet 30 MG
oxyCODONE-Acetaminophen Oral Tablet 10-325 MG
Ozempic (0.25 or 0.5 MG/DOSE) Subcutaneous Solution Pen-injector 2 MG/1.5ML
Ozempic (1 MG/DOSE) Subcutaneous Solution Pen-injector 4 MG/3ML
Ozempic (2 MG/DOSE) Subcutaneous Solution Pen-injector 8 MG/3ML
Pioglitazone HCl-metFORMIN HCl Oral Tablet 15-850 MG
Pneumovax 23 Injection Injectable 25 MCG/0.5ML
Pravastatin Sodium Oral Tablet 80 MG
prednisoLONE Acetate Ophthalmic Suspension 1 %
ProAir Digihaler Inhalation Aerosol Powder Breath Activated 108 (90 Base) MCG/ACT
Progesterone Oral Capsule 100 MG
Propranolol HCl ER Oral Capsule Extended Release 24 Hour 80 MG
Propranolol HCl Oral Tablet 60 MG
Propranolol HCl Oral Tablet 80 MG
Pulmicort Flexhaler Inhalation Aerosol Powder Breath Activated 180 MCG/ACT
Qsymia Oral Capsule Extended Release 24 Hour 3.75-23 MG
QUEtiapine Fumarate ER Oral Tablet Extended Release 24 Hour 150 MG
Quviviq Oral Tablet 25 MG
Qvar RediHaler Inhalation Aerosol Breath Activated 40 MCG/ACT
Rhopressa Ophthalmic Solution 0.02 %
Rizatriptan Benzoate Oral Tablet 10 MG
rOPINIRole HCl Oral Tablet 3 MG
Rybelsus Oral Tablet 7 MG
Saxenda Subcutaneous Solution Pen-injector 18 MG/3ML
Semglee (yfgn) Subcutaneous Solution Pen-injector 100 UNIT/ML
Shingrix Intramuscular Suspension Reconstituted 50 MCG/0.5ML
Slynd Oral Tablet 4 MG
Spironolactone Oral Tablet 100 MG
Spironolactone Oral Tablet 50 MG
Steglatro Oral Tablet 15 MG
Stiolto Respimat Inhalation Aerosol Solution 2.5-2.5 MCG/ACT
Sutab Oral Tablet 1479-225-188 MG
Synthroid Oral Tablet 75 MCG
Tacrolimus External Ointment 0.1 %
Tacrolimus Oral Capsule 1 MG
Tarina FE 1/20 EQ Oral Tablet 1-20 MG-MCG
Testosterone Cypionate Intramuscular Solution 200 MG/ML
Tirosint Oral Capsule 150 MCG
Topiramate Oral Capsule Sprinkle 25 MG
Toujeo Max SoloStar Subcutaneous Solution Pen-injector 300 UNIT/ML
Toujeo SoloStar Subcutaneous Solution Pen-injector 300 UNIT/ML
Tretinoin External Cream 0.025 %
Tri-Lo-Estarylla Oral Tablet 0.18/0.215/0.25 MG-25 MCG
Tri-Lo-Marzia Oral Tablet 0.18/0.215/0.25 MG-25 MCG
Triamcinolone Acetonide External Cream 0.1 %
Trintellix Oral Tablet 10 MG
Trulicity Subcutaneous Solution Pen-injector 1.5 MG/0.5ML
valACYclovir HCl Oral Tablet 1 GM
valACYclovir HCl Oral Tablet 500 MG
Valsartan Oral Tablet 160 MG
Valsartan Oral Tablet 320 MG
Valsartan-hydroCHLOROthiazide Oral Tablet 320-25 MG
Valsartan-hydroCHLOROthiazide Oral Tablet 80-12.5 MG
Venlafaxine HCl ER Oral Capsule Extended Release 24 Hour 150 MG
Venlafaxine HCl ER Oral Tablet Extended Release 24 Hour 150 MG
Verapamil HCl ER Oral Capsule Extended Release 24 Hour 180 MG
Verapamil HCl ER Oral Capsule Extended Release 24 Hour 240 MG
Verapamil HCl ER Oral Tablet Extended Release 180 MG
Viorele Oral Tablet 0.15-0.02/0.01 MG (21/5)
Vraylar Oral Capsule 1.5 MG
Vyvanse Oral Capsule 30 MG
Vyvanse Oral Capsule 60 MG
Vyvanse Oral Capsule 70 MG
Warfarin Sodium Oral Tablet 5 MG
Wellbutrin SR Oral Tablet Extended Release 12 Hour 150 MG
Winlevi External Cream 1 %
Wixela Inhub Inhalation Aerosol Powder Breath Activated 250-50 MCG/ACT
Xofluza (80 MG Dose) Oral Tablet Therapy Pack 1 x 80 MG
Xulane Transdermal Patch Weekly 150-35 MCG/24HR
Yasmin 28 Oral Tablet 3-0.03 MG
Zafemy Transdermal Patch Weekly 150-35 MCG/24HR
Zonisamide Oral Capsule 100 MG
Zoryve External Cream 0.3 %
ZTlido External Patch 1.8 %
Zubsolv Sublingual Tablet Sublingual 5.7-1.4 MG

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