|
TIER
3 (Mail)
$60.00 Co-Pay UP TO 90 DAYS SUPPLY |
|
| Medication |
Generic for |
| Bumetanide 1mg |
Bumex |
| Carbamazepine 200mg |
Tegretol |
| Diltiazem ER-XR 120mg, 180mg |
Cardizem CD |
| Doxazosin 1mg, 2mg, 4mg |
Cardura |
| Diltiazem ER-XR 240mg |
Cardizem CD |
| Famotidine 20mg |
Pepcid |
| Gemfibrozil 600mg |
Lopid |
| Labetolol 100mg |
Trandate |
| Lisinopril 20mg, 30mg, 40mg |
Prinivil, Zestril |
| Lisinopril/Hydrochlorothiazede 10-12.5mg, 20-12.5mg, 20-25mg |
Prinzide, Zestoretic |
| Nadolol 20mg, 40mg |
Corgard |
| Rowasa Enema 4gm |
Rowasa |
| Prazosin 2mg |
Minipress |
| Verapamil 40mg, 120mg |
Calan |
| Verapamil SR 180mg |
Calan SR |
| Warfarin 2.5mg, 3mg, 4mg, 6mg |
Coumadin |