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TIER
2 (Retail) $30.00 Co-Pay UP TO30 DAYS SUPPLY |
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Medication |
Generic for |
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Albuterol 4mg |
Proventil |
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Atenolol 25mg |
Tenormin |
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Atenolol/Chlorthalidone 100-25mg |
Tenoretic |
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Bisoprolol/HCTZ 10-6.25mg, 2.5-6.25mg, 5-6.25mg |
Ziac |
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Bumetanide 1mg |
Bumex |
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Captopril 50mg |
Capoten |
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Carbamazepine 200mg |
Tegretol |
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Clonidine 0.2mg, 0.3mg |
Catapress |
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Diltiazem ER-XR 120mg, 180mg |
Cardizem CD |
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Doxazosin 1mg, 2mg, 4mg, 8mg |
Cardura |
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Elocon Cream 0.1% |
Elocon Cream |
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Elocon Ointment 0.1% |
Elocon Ointment |
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Enalapril 2.5mg, 10mg, 20mg |
Vasotec |
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Estradiol 2mg |
Estrace |
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Famotidine 20mg |
Pepcid |
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Fluoxetine 10mg, 20mg |
Prozac |
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Fosinopril 20mg |
Monopril |
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Gemfibrozil 600mg |
Lopid |
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Glipizide ER 5mg |
Glucotrol XL |
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Glyburide Micronized 1.5mg, 3mg |
Glynase Prestab |
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Ibuprofen 800mg |
Motrin |
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Labetolol 100mg |
Trandate |
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Levothyroxine 0.15mg |
Synthroid |
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Lisinopril 2.5mg, 5mg, 10mg, 20mg, 30mg, 40mg |
Prinivil, Zestril |
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Lisinopril/Hydrochlorothiazede 10-12.5mg, 20-12.5mg, 20-25mg |
Prinzide, Zestoretic |
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Lovastatin 10mg |
Mevacor |
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Medroxyprogesterone 2.5mg |
Provera |
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Metformin 500mg |
Glucophage |
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Metoclopramide 10mg |
Reglan |
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Nadolol 20mg, 40mg |
Corgard |
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Naproxen 250mg, 375mg, 500mg |
Anaprox, Naprosyn |
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Nortriptyline 75mg |
Pamelor |
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Prazosin 1mg, 2mg |
Minipress |
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Prometrium 100mg, 200mg |
Prometrium |
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Ranitidine 150mg, 300mg |
Zantac |
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Rowasa Enema 4gm |
Rowasa Enema |
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Sotalol 160mg |
Betapace |
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Spironolactone 25mg |
Aldactone |
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Trazodone 150mg |
Desyrel |
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Triamterene/Hydrochlorothiazide 37.5-25mg |
Diazyde |
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Verapamil 40mg,120mg |
Calan |
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Verapamil SR 180mg, 240mg |
Calan SR |
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Warfarin 1mg, 2mg, 2.5mg, 3mg, 4mg, 5mg, 6mg, 7.5mg |
Coumadin |