Hormone Replacement Therapy List 800.622.4510 | www.wellsrx.com
Hormone Replacement Therapy
Medication Form Strength Package Size Oral/Sublingual Preparations
0.25mg Per Mini-Tab
Rapid Dissolve Anastrozole 0.5mg Per Mini-Tab Mini-Tab 1.2mg Per Mini-Tab
1.5mg Per Mini-Tab
Anastrozole (Commercial Product) Tablet 1mg Per Tablet
Clomiphene Citrate (Commercial Product) Tablet 50mg Per Tablet N-Dim (Commercial Product) Capsule 200mg Per Capsule
Rapid Dissolve Sermorelin Acetate 400mcg Per Tablet Mini-Tab
Rapid Dissolve Sermorelin Acetate/GHRP(2)/GHRP(6) 300mcg/300mcg/300mcg Per Tablet Mini-Tab
10mg Per Tablet Tamoxifen Citrate (Commercial Product) Tablet 20mg Per Tablet
Oral Thyroid Preparations N-Adrenal Complex (Commercial Product) Capsule Supplement Per Capsule
N-Adrenotone (Commercial Product) Capsule Supplement Per Capsule
Armour Thyroid® (Commercial Product) Tablet ¼ grain - 5 grain Per Tablet
Biotin/Finasteride Capsule 5mg/1mg Per Capsule
Finasteride Capsule 1.25mg Per Capsule
1mg Per Tablet Finasteride (Commercial Product) Tablet 5mg Per Tablet
1.5mg Per Capsule
Naltrexone Capsule 3.0mg Per Capsule
4.5mg Per Capsule
Published 5/17/2016. Prices subject to change WPN-4800-05172016 Hormone Replacement Therapy List 800.622.4510 | www.wellsrx.com
Medication Form Strength Package Size
Nature-Throid® (Commercial Product) Tablet ¼ grain - 4 grain Per Tablet
up to and including 59mcg* #30 / #60 / #90
60-90mcg* #30 / #60 / #90 T3 SR (Slow Release) or Capsule T3/T4 SR (Slow Release) 91mcg-120mcg* #30 / #60 / #90
121mcg and higher* #30 / #60 / #90
*Price is based on the total amount of mcgs of either T3 by iteslf or T3/T4 combined
30mg Per Capsule
60mg Per Capsule
Capsule Thyroid USP, Porcine SR (Slow Release) 90mg Per Capsule
120mg Per Capsule
WP-Thyroid® (Commercial Product) Tablet ¼ grain - 2 grain Per Tablet
For a complete list of topical & oral preparations, please see (Non-Sterile BHRT Formulary)
Injectable Preparations
9mg Per Kit*
Sermorelin Acetate, Lyophilized Vial Injectable 15mg Per Kit*
28mg Per Kit*
Sermorelin Acetate/GHRP(6) Injectable 6mg/3mg Per Kit* Lyophilized Vial
Sermorelin Acetate/GHRP(2) Injectable 9mg/3mg Per Kit* Lyophilized Vial
9mg/3.15mg/3.15mg Per Kit* Sermorelin Acetate/GHRP(2)/GHRP(6) Lyophilized Injectable Vial 9mg/9mg/9mg Per Kit*
Sermorelin Acetate/GHRP(2)/Theanine Injectable 15mg/5.4mg/75mg Per Kit* Lyophilized Vial
*Kit Includes: Vial of Medication, Diluent, Mixing Syringe/Needle (Injection supplies sold separately)
Published 5/17/2016. Prices subject to change WPN-4800-05172016 Hormone Replacement Therapy List 800.622.4510 | www.wellsrx.com
Medication Form Strength Package Size
20mg/mL 5mL Vial
50mg/mL 1mL Vial
1mL Vial 100mg/mL Testosterone Cypionate in Grapeseed Oil Injectable 5mL Vial
1mL Vial
200mg/mL 5mL Vial
10mL Vial
1mL Vial Testosterone Cypionate in Sesame Oil Injectable 200mg/mL 10mL Vial
Testosterone Cypionate/Anastrozole Injectable 200mg/1mg/mL 10mL Vial
Testosterone Enanthate In Grapeseed Oil Injectable 200mg/mL 10mL Vial
Testosterone Propionate Injectable 100mg/mL 10mL Vial
Injectable 200mg/mL 10mL Vial Ultra-Test (80% Cypionate/20% Propionate) Injectable 250mg/mL 10mL Vial
Tri-Test (50% Cyp/37.5% Enan/12.5% Prop) Injectable 200mg/mL 10mL Vial
Depo® Testosterone (Commercial Product) Injectable 200mg/mL 10mL Vial
Published 5/17/2016. Prices subject to change WPN-4800-05172016 Non-Sterile BHRT List 800.622.4510 | www.wellsrx.com
Non-Sterile BHRT (Bio-Identical Hormone Replacement Therapy)
Medication & Form Strength #30 QTY #60 QTY #90 QTY #180 QTY Min Price
25mg 3 3 3 3 3 50mg 3 3 3 3 3 3 3 3 3 3 Progesterone Capsules 75mg 100mg 3 3 3 3 3 Please specify one of the following: 3 3 3 3 3 - Progesterone in Olive Oil 125mg - Progesterone SR (Powder) 150mg 3 3 3 3 3 175mg 3 3 3 3 3 200mg 3 3 3 3 3
Progesterone (Retail Product) 100mg & 200mg Call For Pricing
1 Ingredient Capsule: Estriol (E3)/ 1 Ingredient (≤20mg) 3 3 3 3 3 Estradiol (E2)/DHEA/Testosterone/ Pregnenolone 1 Ingredient (>20mg) 3 3 3 3 3
2 Ingredients (≤20mg) 3 3 3 3 3 2 Ingredient Capsule: Estriol (E3)/Estradiol (E2)/DHEA/ Testosterone/Pregnenolone 2 Ingredients (>20mg) 3 3 3 3 3
3 Ingredients 3 3 3 3 3 3 Ingredient Capsule: (≤2.5mg/100mg/25mg) Estriol (E3)/ Estradiol (E2) / Progesterone/DHEA/ 3 Ingredients Testosterone/Pregnenolone 3 3 3 3 3 (>2.5mg/100mg/25mg)
4 Ingredients 4 Ingredient Capsule: 3 3 3 3 3 Estriol (E3)/Estradiol (E2)/ (≤1.25/100/5mg) Estrone (E1)/Progesterone/DHEA/ 4 Ingredients 3 3 3 3 3 Testosterone/Pregnenolone (>1.25/100/5mg)
1 Ingredient 3 3 3 3 Topical / Vaginal Female Cream/Gel (Tier 1) -up to and including: Estriol(E3)/ 2 Ingredients 3 3 3 3 Estradiol(E2)/Estrone(E1) 1.5mg/mL ea / Progesterone 40mg/mL / Testosterone 3 Ingredients 3 3 3 3 5mg/mL / DHEA 5mg/mL / 3 3 3 3 Pregnenolone 4 Ingredients 20mg/mL (Includes Vaginal Applicator) 5 Ingredients 3 3 3 3
Published 5/24/2016. Prices subject to change WPN-5000-05242016 Non-Sterile BHRT List 800.622.4510 | www.wellsrx.com
Medication & Form Strength #30 QTY #60 QTY #90 QTY #180 QTY Min Price
1 Ingredient 3 3 3 3 Topical/Vaginal Female Cream/Gel (Tier 2) - greater than and including: 2 Ingredients 3 3 3 3 Estriol(E3)/Estradiol(E2)/Estrone(E1) 3 3 3 3 1.6mg/mL ea/ Progesterone 41mg/mL/ 3 Ingredients Testosterone 25mg/mL/ DHEA 6mg/ 3 3 3 3 mL/ Pregnenolone 21mg/mL (Includes 4 Ingredients Vaginal Applicator) 5 Ingredients 3 3 3 3
MINI - 1 Ingredient 3 3 3 3 3
Mini-Inserts (Vaginal) Estriol/Estradiol MINI - 2 Ingredients 3 3 3 3 3 ≤1.5mg /Progesterone ≤40mg/ Testosterone ≤20mg / DHEA 3 3 3 3 3 ≤10mg / Pregnenolone ≤20mg MINI - 3 Ingredients
MINI - 4 Ingredients 3 3 3 3 3
MINI - 1 Ingredient 3 3 3 3 3
Mini-Troches (Oral): Estriol/Estradiol MINI - 2 Ingredients 3 3 3 3 3 ≤1.5mg/Progesterone ≤40mg/Testosterone ≤20mg/ 3 3 3 3 3 DHEA ≤10mg/Pregnenolone ≤20mg MINI - 3 Ingredients
MINI - 4 Ingredients 3 3 3 3 3
26-50mg/mL 3 3 3 3 (2.6%-5%) 51-100mg/mL Testosterone Cream/Gel 3 3 3 3 (5.1%-10%)
101-200mg/mL 3 3 3 3 (10.1%-20%)
20mg-100mg 3 3 3 3 Testosterone Troches (Oral) 101mg-200mg 3 3 3 3
Troches are scored, Mini-Troches are single dose
BHRT Topical Creams are Dispensed in Topi-Clicks. Pumps or syringes are available upon request
Published 5/24/2016. Prices subject to change WPN-5000-05242016 BHRT Sterile Implantable Pellets List 800.622.4510 | www.wellsrx.com
BHRT Sterile Implantable Pellets
Medication Form Strength Pellet Size (mm)
DHEA Pellet 25mg (3mm) 3mg (3mm) 6mg (3mm) 10mg (3mm) 12.5mg (3mm) 15mg (3mm) Estradiol Pellet 18mg (3mm) 20mg (3mm) 22mg (3mm) 25mg (3mm) 37.5mg (3mm) 50mg (3mm) 10mg (3mm) Estradiol/Estriol 50%/50% Pellet 15mg (3mm) 20mg (3mm) 50mg (3mm) Progesterone Pellet 100mg (3mm) 12.5mg (3mm) 18mg (3mm) 25mg (3mm)
37.5mg (3mm) 50mg (3mm)
Testosterone Pellet 62.5mg (3mm) 80mg (3mm) 87.5mg (3mm) 100mg (3mm)
100mg (4.5mm)
200mg (4.5mm)
Published 05/24/16. Prices subject to change. WPN-4600-05242016 BHRT Sterile Implantable Pellets List 800.622.4510 | www.wellsrx.com
Medication Form Strength Pellet Size (mm)
60mg/4mg (3mm)
Testosterone/Anastrozole Pellet 200mg/9mg (4.5mm)
200mg/20mg (4.5mm)
Testosterone/Finasteride Pellet 60mg/6mg (3mm)
Disposable - Each Plastic Tip (3mm)
Disposable - Each Plastic Tip (4.5mm) Trocar Kit for Pellet Insertion Trocar Disposable - Stainless Steel Tip Each (3mm & 4.5mm)
Reusable - Titanium Each (3mm & 4.5mm)
Published 05/24/16. Prices subject to change. WPN-4600-05242016 Male & Female Sexual Health List 800.622.4510 | www.wellsrx.com
Sexual Health - Male & Female
Medication Form Strength Package Size Male - Oral/Sublingual Preparations
Apomorphine *Must Ship Cold* Troche 6mg Per Troche
50iu/100mg Per Tablet Oxytocin/Sildenafil Chewable Tablet 125iu/100mg Per Tablet
50iu/100mg Per Troche Oxytocin/Sildenafil *Must Ship Cold* Troche 125iu/100mg Per Troche
Oxytocin/Tadalafil Chewable Tablet 125iu/25mg Per Tablet
125iu/20mg Per Troche Oxytocin/Tadalafil *Must Ship Cold* Troche 125iu/25mg Per Troche
Sildenafil/Testosterone *Must Ship Cold* Troche 100mg/10mg Per Troche
5mg/10mg Per Mini-Troche Tadalafil/Testosterone *Must Ship Cold* Mini-Troche 10mg/10mg Per Mini-Troche
Male Sexual Wellness Kit Call for Availability and Pricing
Troches are scored, Mini-Troches are single dose
Male - Injectable Preparations
20mcg/mL 10mL Vial Alprostadil (Prostaglandin, PGE1) Injectable *Must Ship Cold* 40mcg/mL 10mL Vial
Arginine/Carnitine/Citrulline/Lidocaine Injectable 100mg/100mg/100mg/10mg/mL 10mL Vial
30mg/1mg/mL 5mL Vial Bimix (Papaverine/Phentolamine) Injectable 30mg/1mg/mL 10mL Vial
Published 05/16/16. Prices subject to change. WPN-5200-05162016 Male & Female Sexual Health List 800.622.4510 | www.wellsrx.com
Medication Form Strength Package Size
2mL Vial
Injectable 17.65mg/0.59mg/5.9mcg 5mL Vial
10mL Vial
2mL Vial Trimix (Papaverine/Phentolamine/Alprostadil) *Must Ship Cold* Injectable 30mg/1mg/10mcg/mL 5mL Vial
10mL Vial
2mL Vial
Injectable 30mg/3mg/60mcg/mL 5mL Vial
10mL Vial
Phenylephrine (Rescue Vial) Injectable 10mg/mL 1mL Vial (Commercial Product)
Male Sexual Wellness Kit Call for Availability and Pricing
Female - Vaginal/Oral/Nasal Spray Preparations
Aminophylline/Arginine Gel 3%/6% 15mL
50iu Per Mini-Troche Oxytocin *Must Ship Cold* Mini-Troche 250iu Per Mini-Troche
10iu/Spray 15mL Bottle Oxytocin *Must Ship Cold* Nasal Spray (#180 Sprays) 60iu/Spray
Sildenafil/Aminophylline/Arginine Cream 2%/3%/6% 15mL
Sildenafil/Aminophylline/Arginine/Testosterone Cream 2%/3%/6%/0.1% 15mL
Vitamin E Cream 200iu/mL 15mL
Female Sexual Wellness Kit Call for Availability and Pricing
For additional female preparations, please see (Non-Sterile BHRT Formulary)
Published 05/16/16. Prices subject to change. WPN-5200-05162016 Aesthetic Dermatology List 800.622.4510 | www.wellsrx.com
Aesthetic Dermatology
Medication Form Strength Package Size
Facial Cream/Gel/Serum Preparations
Ascorbic Acid/CoQ10/DMAE/Estriol/Tretinoin Cream 5%/1%/3%/5%/0.01% 15gm
Ascorbic Acid/CoQ10/DMAE/Hyaluronic Acid/Lipoic Acid Cream 5%/1%/3%/0.1%/2% 15gm
Ascorbic Acid/DMAE/Estriol Cream 15%/3%/0.3% 15gm
Estriol With Aloe Vera Cream 0.3%/1% 15gm
Estriol/DMAE/Hyaluronic Acid Gel 0.3%/3%/0.05% 15gm
Hydroquinone/Hydrocortisone/Tretinoin Cream 6%/2.5%/0.05% 15gm
Hydroquinone/Vitamin D Cream 8%/10,000u/gm 15gm
Niacinamide Gel 4% 15gm
Skin-Tensive Therapy (W/Hyaluronic Acid) DMAE, Lipoic Acid, Ascorbic Acid, Vitamin E, Serum Call for Strength 15gm Vitamin A, Palmitoyl Pentapeptide
Tretinoin/CoQ10 Cream 0.025%/1% 15gm
The medications listed above are prepared in pumps (1 pump=0.25gm) unless otherwise noted on the prescription.
Topical/Oral Preparations
30gm BLT (Benzocaine/Lidocaine/Tetracaine) Cream 20%/6%/4% 60gm
Glycolic Acid (W/V) Topical Peel Solution 30% 30mL
25mg Per Capsule
Spironolactone (Commercial Product) Capsule 50mg Per Capsule
100mg Per Capsule
Published 05/24/16. Prices subject to change. WPN-5600-05242016 Weight Management, Lipotropics, Vitamin List 800.622.4510 | www.wellsrx.com
Weight Management/Lipotropics/Vitamin Therapies
Medication Form Strength Package Size
Oral/Sublingual Preparations
GOAL Capsule 75mg/75mg/75mg/75mg Per Capsule (Glutamine/Ornithine/Arginine/Lysine)
200iu Per Tablet Rapid Dissolve hCG 300iu Per Tablet Mini-Tablet 500iu Per Tablet
Rapid Dissolve hCG + B12(M) 500iu/300mcg Per Tablet Mini-Tablet
Sublingual hCG (Diluent/Dropper included) 11,562.5iu Per Vial Drops
MIC + Chromium Tablet 50mg/100mg/5mg/50mcg Per Tablet
Methylcobalamin/Pyridoxine/Folic Acid Tablet 2mg/25mg/2.5mg Per Tablet
Phendimetrazine (Commercial Product) Tablet 35mg Per Tablet
Phentermine HCL (Commercial Product) Tablet 37.5mg Per Tablet
Injectable Preparations Arginine-L Injectable 100mg/mL 30mL Vial
Carnitine-L Injectable 250mg/mL 30mL Vial
B-Complex (B2, B3, B6, B12(C)) + 2mg/20mg/2mg/ Injectable 30mL Vial Vitamin C 300mcg + 20mg/mL
Cyanocobalamin (B12) Injectable 1,000mcg/mL 10mL Vial (Commercial Product) Injectable 1,000mcg/mL 30mL Vial
GAC (Glutamine/Arginine/Carnitine) Injectable 25mg/100mg/200mg/mL 30mL Vial
GOAL 75mg/75mg/150mg/ (Glutamine/Ornithine/Arginine/Lysine) + Injectable 30mL Vial 150mg/mL + 10mg/mL Lidocaine
Glutathione-L *Must Ship Cold* Injectable 200mg/mL 30mL Vial
Published 5/17/2016. Prices subject to change WPN-4100-05172016 Weight Management, Lipotropics, Vitamin List 800.622.4510 | www.wellsrx.com
Medication Form Strength Package Size
Injectable 3,500iu Per Kit*
Injectable 5,000iu Per Kit*
Injectable 6,000iu Per Kit* hCG Lyophilized Vial Injectable 7,500iu Per Kit*
Injectable 11,000iu Per Kit*
Injectable 20,000iu Per Kit*
hCG + B12(C), Lyophilized Vial Injectable 10,000iu + 40mcg Per Kit*
*Kit Includes: Vial of Medication, Diluent, Mixing Syringe/Needle (Injection supplies sold separately)
Injectable 1,000mcg/mL 10mL Vial
Methylcobalamin (B12) Injectable 1,000mcg/mL 30mL Vial
Injectable 5,000mcg/mL 10mL Vial
MIC Combo Standard Injectable 15mg/50mg/100mg/mL 30mL Vial
15mg/50mg/100mg/mL + MIC/B12(M) Injectable 30mL Vial 1000mcg/mL
25mg/50mg/50mg/ MIC/Chromium/B12(M) Injectable 10mL Vial 25mcg/1mg/mL
15mg/50mg/100mg/2.5mg/ MIC/B-Complex (B2, B3, B6, B12(M)) Injectable 30mL Vial 0.4mg/2.5mg/0.25mg/mL
12.5mg/50mg/100mg/ MIC/B12(M) + Carnitine Injectable 30mL Vial 1mg/mL+ 50mg/mL
15mg/30mg/30mg/0.5mg/ MIC/B-Complex (B2, B3, B6, B12(M)) + Carnitine Injectable 20mg/20mg/0.5mg/mL + 30mL Vial + Lidocaine 85mg/mL + 20mg/mL
12.5mg/25mg/25mg/30mg/ 10mL Vial MIC/B-Complex (B1, B2, B6) + Carnitine + Injectable 2mg/2mg/25mg/12.5mg/ Arginine + Chromium + Lidocaine 0.2mg/20mg/mL 30mL Vial
MIC/B-Complex (B2, B3, B5, B12(M)) + Chromium 20mg/40mg/50mg/5mg/33mg/ Injectable 30mL Vial + Carnitine 2mg/1mg/25mcg/25mg/mL
Published 5/17/2016. Prices subject to change WPN-4100-05172016 Weight Management, Lipotropics, Vitamin List 800.622.4510 | www.wellsrx.com
Medication Form Strength Package Size
IC/B-Complex (B1, B2, B3, B5, B6, B12(C)) 25mg/25mg/5mg/2.5mg/ + Leucine + Carnitine + Chromium + Injectable 25mg/5mg/5mg/0.1mg/ 30mL Vial Lidocaine 1.5mg/25mg/25mcg/10mg/mL
Injectable 50,000iu/mL 5mL Vial Vitamin D3 in Sesame Oil Injectable 100,000iu/mL 5mL Vial
B12 Abbreviations - (C)=Cyanocobalamin (M)=Methylcobalamin, (H)=Hydroxocobalamin
Published 5/17/2016. Prices subject to change WPN-4100-05172016 Syringes, Needles, Misc. List 800.622.4510 | www.wellsrx.com
Syringes/Needles/Miscellaneous
Device Form Size Package Size Insulin / Subcutaneous Syringes Syringe w/Needle 28g x 1/2” 0.5mL Pack of 10 Syringe w/Needle 29g x 1/2” 0.5mL Pack of 10 Syringe w/Needle 29g x 1/2” 1mL Pack of 10 Syringe w/Needle 30g x 1/2” 1mL Pack of 10 Insulin Syringe Syringe w/Needle 30g x 5/16” 0.5mL Pack of 10 (SureComfort or UltiCare) Syringe w/Needle 30g x 5/16” 0.3mL Pack of 10 Syringe w/Needle 30g x 5/16” 1mL Pack of 10 Syringe w/Needle 31g x 5/16” 0.5mL Pack of 10 Syringe w/Needle 31g x 5/16” 1mL Pack of 10 BD Brand Insulin Syringes Syringe w/Needle Special Request Pack of 10
Intramuscular Syringes Syringe w/Needle 18g x 1.5” 3mL Each Syringe w/Needle 20g x 1” 3mL Each Syringe w/Needle 20g x 1.5” 3mL Each Syringe w/Needle 21g x 1” 3mL Each BD IM Syringes Syringe w/Needle 22g x 1” 3mL Each Syringe w/Needle 22g x 1.5” 3mL Each Syringe w/Needle 23g x 1” 3mL Each Syringe w/Needle 23g x 1.5” 3mL Each Syringe w/Needle 25g x 1” 3mL Each
Published 05/13/16. Prices subject to change. WPN-5400-05132016 Syringes, Needles, Misc. List 800.622.4510 | www.wellsrx.com
Device Form Size Package Size
Needles Needle 16g x 1” Each Needle 18g x 1” Each Needle 18g x 1.5” Each Needle 20g x 1” Each Needle 20g x 1.5” Each Needle 21g x 1” Each Needle 21g x 1.5” Each Needle 22g x 1” Each BD Needle Needle 22g x 1.5” Each Needle 23g x 1” Each Needle 23g x 1.5” Each Needle 25g x 5/8” Each Needle 25g x 1” Each Needle 25g x 1.5” Each Needle 27g x 0.5” Each Needle 27g x 1.25” Each
Miscellaneous Syringe w/o Needle 1mL Each Syringe w/o Needle 3mL Each BD Luer-Lok™ Syringe w/o Needle 5mL Each Syringe w/o Needle 10mL Each Alcohol Prep Pads Prep Pads Prep Pads #100 Pads BD - Sharps Container 1.4qt Sharps Each
Published 05/13/16. Prices subject to change. WPN-5400-05132016