|
TIER
2 (Mail)
$40.00 Co-Pay UP TO 90 DAYS SUPPLY |
|
Medication |
Generic for |
| Albuterol 4mg |
Proventil |
| Atenolol 25mg |
Tenormin |
| Atenolol/Chlorthalidone 100-25mg |
Tenoretic |
| Captopril 50mg |
Capoten |
| Clonidine 0.2mg, 0.3mg |
Catapress |
| Enalapril 2.5mg, 10mg |
Vasotec |
| Estradiol 2mg |
Estrace |
| Fluoxetine 10mg, 20mg |
Prozac |
| Glipizide ER 5mg |
Glucotrol XL |
| Glyburide Micronized 1.5mg, 3mg |
Glynase Prestab |
| Ibuprofen 800mg |
Motrin |
| Levothyroxine 0.15mg |
Synthroid |
| Lisinopril 2.5mg, 5mg, 10mg |
Prinivil, Zestril |
| Medroxyprogesterone 2.5mg |
Provera |
| Metformin 500mg |
Glucophage |
| Metoclopramide 10mg |
Reglan |
| Naproxen 250mg, 375mg, 500mg |
Anaprox, Naprosyn |
| Nortriptyline 75mg |
Pamelor |
| Prazosin 1mg |
Minipress |
| Prometrium 100mg |
Prometrium |
| Ranitidine 300mg |
Zantac |
| Sotalol 160mg |
Betapace |
| Spironolactone 25mg |
Aldactone |
| Trazodone 150mg |
Desyrel |
| Triamterene/Hydrochlorothiazide 37.5-25mg |
Diazyde |
| Verapamil 40mg,120mg |
Calan |
| Verapamil SR 240mg |
Calan SR |
| Warfarin 1mg, 2mg, 5mg, 7.5mg |
Coumadin |