TIER 2 (Retail)
$30.00 Co-Pay

UP TO30 DAYS SUPPLY 
 

Medication

Generic for

Albuterol 4mg

Proventil

Atenolol 25mg

Tenormin

Atenolol/Chlorthalidone 100-25mg

Tenoretic

Bisoprolol/HCTZ 10-6.25mg, 2.5-6.25mg, 5-6.25mg

Ziac

Bumetanide 1mg

Bumex

Captopril 50mg

Capoten

Carbamazepine 200mg

Tegretol

Clonidine 0.2mg, 0.3mg

Catapress

Diltiazem ER-XR 120mg, 180mg

Cardizem CD

Doxazosin 1mg, 2mg, 4mg, 8mg

Cardura

Elocon Cream 0.1%

Elocon Cream

Elocon Ointment 0.1%

Elocon Ointment

Enalapril 2.5mg, 10mg, 20mg

Vasotec

Estradiol 2mg

Estrace

Famotidine 20mg

Pepcid

Fluoxetine 10mg, 20mg

Prozac

Fosinopril 20mg

Monopril

Gemfibrozil 600mg

Lopid

Glipizide ER 5mg

Glucotrol XL

Glyburide Micronized 1.5mg, 3mg

Glynase Prestab

Ibuprofen 800mg

Motrin

Labetolol 100mg

Trandate

Levothyroxine 0.15mg

Synthroid

Lisinopril 2.5mg, 5mg, 10mg, 20mg, 30mg, 40mg

Prinivil, Zestril

Lisinopril/Hydrochlorothiazede 10-12.5mg, 20-12.5mg, 20-25mg

Prinzide, Zestoretic

Lovastatin 10mg

Mevacor

Medroxyprogesterone 2.5mg

Provera

Metformin 500mg

Glucophage

Metoclopramide 10mg

Reglan

Nadolol 20mg, 40mg

Corgard

Naproxen 250mg, 375mg, 500mg

Anaprox, Naprosyn

Nortriptyline 75mg

Pamelor

Prazosin 1mg, 2mg

Minipress

Prometrium 100mg, 200mg

Prometrium

Ranitidine 150mg, 300mg

Zantac

Rowasa Enema 4gm

Rowasa Enema

Sotalol 160mg

Betapace

Spironolactone 25mg

Aldactone

Trazodone 150mg

Desyrel

Triamterene/Hydrochlorothiazide 37.5-25mg

Diazyde

Verapamil 40mg,120mg

Calan

Verapamil SR 180mg, 240mg

Calan SR

Warfarin 1mg, 2mg, 2.5mg, 3mg, 4mg, 5mg, 6mg, 7.5mg

Coumadin