|
TIER
1 (Retail)
$10.00 Co-Pay UP TO 30 DAYS SUPPLY |
|
| Medication |
Generic for |
| Albuterol 2mg |
Proventil |
| Albuterol 90mcg Inhaler | Proventil |
| Allopurinol 100mg, 300mg | Zyloprim |
| Amitriptyline 10mg, 25mg, 50mg, 75mg, 100mg |
Elavil |
| Atenolol 50mg, 100mg |
Tenormin |
| Atenolol/Chlorthalidone 50-25mg |
Tenoretic |
| Benztropine 0.5mg, 1mg, 2mg |
Cogentin |
| Captopril 12.5mg, 25mg |
Capoten |
| Clonidine 0.1mg |
Catapress |
| Digoxin 0.25mg |
Lanoxin |
| Doxazosin 1mg, 2mg, 4mg, 8mg |
Cardura |
| Enalapril 5mg |
Vasotec |
| Estradiol 0.5mg, 1mg |
Estrace |
| Folic Acid 1mg |
Folacin |
| Furosemide 20mg, 40mg, 80mg |
Lasix |
| Glipizide 5mg, 10mg |
Glucotrol |
| Glyburide 5mg |
Micronase, Diabeta |
| Hydrochlorothiazide 25mg, 50mg |
Microzide |
| Ibuprofen 400mg, 600mg |
Motrin |
| Indapamide 1.25mg, 2.5mg |
Lozol |
| Medroxyprogesterone 5mg, 10mg |
Provera |
| Metformin ER 500mg |
Glucophage XR, Fortamet |
| Metoprolol 50mg, 100mg |
Lopressor |
| Nortriptyline 25mg, 50mg |
Pamelor |
| Potassium Chloride 10mEq |
K-Dur |
| Prednisone 5mg, 10mg, 20mg |
Deltasone |
| Propranolol 10mg, 20mg, 40mg |
Inderal |
| Trazodone 50mg, 100mg |
Desyrel |
| Triamterene/Hydrochlorothiazide 75-50mg |
Maxzide |
| Verapamil 80mg |
Calan |