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Rx Outreach Medication List September 2020 Rx Outreach Medication* Similar Medication Available Strengths 30-Day Supply 90-Day Supply 180-Day Supply Acamprosate Calcium DR tablet Campral® 333mg $45 for up to 90 tablets Acyclovir capsule Zovirax® 200mg $10 $13 $20 Acyclovir tablet Zovirax® 400mg, 800mg $10 $13 $20 Acyclovir 5% Ointment Zovirax® 15g $40 per tube Acyclovir 5% Ointment Zovirax® 30g $65 per tube Albuterol Inhalation Solution Proventil® / Ventolin® 0.083%/3mL $15 for up to 75 vials Albuterol Sulfate HFA ProAir HFA® / Proventil® HFA / Ventolin® 90mcg (200 inhalations) $35 per inhaler canister Alclometasone Dipropionate Cream Aclovate® 15gm (0.05%) $15 per tube Alendronate tablet Fosamax® 70mg (once a week dosage) $20 (limit 12) $40 (limit 24) ER tablet Uroxatral® 10mg (see Uroxatral®) $16 up to 30 tabs / $35 up to 90 tabs Allopurinol tablet Zyloprim® / Aloprim® 100mg, 300mg $10 $13 $20 Alprazolam tablet (CS) Xanax® / Niravam® 0.25mg, 0.5mg, 1mg, 2mg $9 for up to 90 tablets Alprazolam XR tablet (CS) Xanax XR® / Niravam® 0.5mg, 1mg $16 up to 30 tabs / $35 up to 90 tabs Alprazolam XR tablet (CS) Xanax XR® / Niravam® 2mg, 3mg $21 up to 30 tabs / $50 up to 90 tabs Amantadine tablet Symmetrel® 100mg $14 $30 n/a tablet HCL Elavil® 10mg $15 for up to 90 tablets Amitriptyline tablet Elavil® 25mg, 50mg $20 for up to 90 tablets Amitriptyline tablet Elavil® 75mg, 100mg $16 up to 30 tabs / $35 up to 90 tabs Amitriptyline tablet Elavil® 150mg $20 up to 30 tabs / $50 up to 90 tabs Amlodipine tablet Norvasc® 2.5mg, 5mg, 10mg $11 $20 $40 Amlodipine/Benazepril capsule Lotrel® 5/10mg, 5/20mg, 10/20mg $22 up to 30 caps / $45 up to 90 caps Amlodipine/Benazepril capsule Lotrel® 10/40mg $12 up to 30 caps / $26 up to 90 caps Amlodipine/Olmesartan tablet Azor® 5/20mg, 5/40mg, 10/20mg, 10/40mg $35 for up to 30 tablets Amlodipine/Valsartan tablet Exforge® 5/160mg, 5/320mg, 10/160mg, 10/320mg $25 for up to 30 tablets 5/160/12.5mg, 5/160/25mg, 10/160/12.5mg, 10/160/25mg, $60 for up to 30 tablets Amlodipine/Valsartan/HCTZ tablet Exforge HCT® 10/320/25mg tablet Asendin® 100mg $32 for up to 30 tablets Anastrozole tablet Arimidex® 1mg $14 up to 30 tabs / $30 up to 90 tabs Aricept® tablet Donepezil 23mg $25 tablet Abilify® 2mg, 5mg, 10mg, 15mg, 20mg, 30mg $25 up to 30 tabs / $60 up to 90 tabs Armodafinil tablet (CS) Nuvigil® 50mg, 150mg, 200mg, 250mg $35 for up to 30 tablets Artificial Tears 1.4% drops (OTC) N/A 15ml bottle (No prescription required) $9 per bottle Aspirin EC tablet (OTC) Bufferin® / Ecotrin® 325mg (No prescription required) $7 for a bottle of 100 Aspirin EC tablet (OTC) Ecotrin® 81mg (No prescription required) $9 for a bottle of 120 tablet Tenormin® 25mg, 50mg, 100mg $7 $9 $18 Atenolol/Chlorthalidone tablet Tenoretic® 50/25mg, 100/25mg $10 $13 $20 Atomoxetine HCL capsule Strattera® 10mg, 18mg, 25mg $90 for up to 30 capsules Atomoxetine HCL capsule Strattera® 40mg, 60mg $95 for up to 30 capsules Atomoxetine HCL capsule Strattera® 80mg, 100mg $98 for up to 30 capsules Atorvastatin tablet Lipitor® 10mg, 20mg, 40mg, 80mg $12 $25 $45 Azathioprine tablet Imuran® / Azasan® 50mg $14 up to 30 tabs / $30 up to 90 tabs Azelastine nasal spray Astelin® 137mcg $30 per nasal spray Baclofen tablet Lioresal® 10mg, 20mg $9 $15 n/a Balsalazide Disodium capsule Colazal® / Giazo® 750mg $14 up to 30 caps / $30 up to 90 caps Banzel® Rufinamide 200mg, 400mg tablets; 40mg/mL Oral Suspension Refer to Patient Forms on Website Benazepril tablet Lotensin® 5mg, 10mg, 20mg, 40mg $10 $13 $20 Benazepril/HCTZ tablet Lotensin HCT® 5/6.25mg, 10/12.5mg, 20/12.5mg, 20/25mg $12 $25 $45 Benzonatate capsule Tessalon® / Zonatuss® 100mg $12 for up to 30 capsules Benzonatate capsule Tessalon Perles® 200mg $15 for up to 30 capsules Benztropine tablet Cogentin® 0.5mg, 1mg, 2mg $20 Betamethasone Dipropionate Cream, Aug Diprolene® AF / Alphatrex®/ Diprosone®/ Del-Beta® 15gm $25 per tube Bethanechol tablet Urecholine® 5mg, 10mg, 25mg, 50mg $12 $25 n/a Bicalutamide tablet Casodex® 50mg $12 $35 $65 /HCTZ tablet Ziac® 2.5/6.25mg, 5/6.25mg, 10/6.25mg $10 $13 $20 Blood Glucose Monitor (Prodigy® Autocode) N/A N/A (No prescription required) One free monitor annually Blood Glucose Monitor Control Sol, Low (Prodigy®) N/A 4ml. Vial (No prescription required) $5 per vial Blood Glucose Test Strips (Prodigy®) N/A Box of 50 (No prescription required) $15 per box Blood Glucose Twist Top Lancets 28G (Prodigy®) N/A Box of 100; min order - 2 boxes (No prescription required) $5 per box; min order $10 Tartrate 0.2% Solution N/A 0.2%/10ml dropper $15 per dropper tablet Parlodel® 2.5mg $65 for up to 30 tablets Budesonide EC capsule Entocort EC(R)® 3mg $50 for up to 30 capsules Budesonide Inhalation Solution Pulmicort Respules® 0.25mg/2mL $32 for up to 10 vials Budesonide Inhalation Solution Pulmicort Respules® 0.5mg/2mL $37 for up to 10 vials Budesonide Nasal Spray OTC Rhinocort® Allergy OTC 8.6g/32mcg (No prescription required) $22 per bottle (min. 2 bottles) Bumetanide tablet Bumex® 0.5mg, 1mg, 2mg $13 up to 30 tabs / $30 up to 90 tabs Buprenorphine/Naloxone tablet (CS) Zubsolv®/ Suboxone® 2mg/0.5mg (opioid dependence treatment only) $50 for up to 30 tablets Buprenorphine/Naloxone tablet (CS) Zubsolv®/ Suboxone® 8mg/2mg (opioid dependence treatment only) $50 for up to 28 tablets Bupropion HCL SR tablet Wellbutrin SR® 100mg, 150mg, 200mg $30 $65 n/a Bupropion HCL tablet Wellbutrin® 75mg $17 $40 n/a Bupropion HCL tablet Wellbutrin® 100mg $17 up to 30 tabs / $40 up to 90 tabs Bupropion HCL XL tablet Wellbutrin XL® / Zyban® 150mg, $33 for up to 90 tablets Bupropion HCL XL tablet Wellbutrin XL® / Zyban® 300mg $45 for up to 90 tablets tablet BuSpar® 5mg, 10mg, 15mg $11 $20 n/a Buspirone tablet BuSpar® 30mg $26 $35 n/a Buspirone tablet BuSpar® 7.5mg $11 up to 30 tabs / $20 up to 90 tabs Calcitonin-Salmon Nasal Spray Miacalcin® 200 units per spray $65 for two (2) bottles Calcitriol capsule Rocaltrol® 0.25mcg $17 for up to 30 capsules Calcitriol capsule Rocaltrol® 0.5mcg $20 for up to 30 capsules Calcium Acetate capsule PhosLo® Gelcap 667mg $13 up to 30 caps / $25 up to 90 caps Candesartan Cilexetil-HCTZ tablet Atacand HCT® 16/12.5mg $40 for up to 30 tablets Candesartan Cilexetil-HCTZ tablet Atacand HCT® 32/12.5mg, 32/25mg $40 for up to 30 tablets Candesartan Cilexetil tablet Atacand® 16mg, 32mg $40 for up to 30 tablets Candesartan Cilexetil tablet Atacand® 4mg, 8mg $30 for up to 30 tablets Capecitabine tablet Xeloda® 150mg $25 for up to 28 tablets Capecitabine tablet Xeloda® 500mg $45 for up to 28 tablets Capsaicin Cream, 0.025% (OTC) Zostrix® 60gm (No prescription required) $12 per tube Captopril tablet Capoten® 100mg $24 up to 30 tabs / $55 up to 90 tabs Captopril tablet Capoten® 12.5mg, 25mg, 50mg $17 up to 30 tabs / $40 up to 90 tabs Carbamazepine ER tablet Tegretol XR® / Equetro® 200mg, 400mg $13 up to 30 tabs / $25 up to 90 tabs Carbamazepine tablet Tegretol® / Epitol® 200mg $13 up to 30 tabs / $25 up to 90 tabs Carbidopa / Levodopa SR tablet Sinemet CR® 25/100mg, 50/200mg $22 $55 n/a Carbidopa / Levodopa tablet Sinemet® / Parcopa® 10/100mg, 25/100mg, 25/250mg $19 $45 $85 12.5/50/200mg, 18.75/75/200mg, 25/100/200mg, Carbidopa/Levodopa/Entacapone tablet Stalevo® $45 for up to 60 tablets 31.25/125/200mg, 37.5/150/200mg, 50/200/200mg tablet Coreg® 3.125mg, 6.25mg, 12.5mg, 25mg $10 $13 $20 Celecoxib capsule Celebrex® 400mg $30 for up to 30 capsules Celecoxib capsule Celebrex® 50mg, 100mg, 200mg $15 for up to 30 capsules Cetirizine HCL tablet - OTC Zyrtec® OTC / Alleroff® 10mg (no prescription required) $10 per bottle of 100 tabs (min. 2 bottles) Cevimeline HCL capsule Evoxac® 30mg $31 up to 30 caps / $80 up to 90 caps Chlordiazepoxide capsule (CS) Librium® 5mg, 10mg, 25mg $15 for up to 180 capsules HCL tablet Thorazine® 10mg, 25mg, 50mg, 100m, 200mg $16 $35 n/a Chlorthalidone tablet Hygroton® 25mg, 50mg $16 up to 30 tabs / $35 up to 90 tabs Chlorzoxazone tablet Parafon Forte® DSC / Lorzone® / Parafon® 500mg $14 up to 30 tabs / $25 up to 90 tabs Cilostazol tablet Pletal® 50mg, 100mg $14 $30 $55 Citalopram tablet Celexa® 10mg, 20mg, 40mg $11 $20 n/a Clindamycin HCL capsule Cleocin® 150mg $19 $45 $85 Clobetasol cream 0.05% Temovate® 30g $20 per tube Clomiphene Citrate tablet Clomid® / Serophene® 50mg $30 for up to 30 tablets capsule Anafranil® 25mg, 50mg, 75mg $40 Clonazepam tablet (CS) Klonopin® 0.5mg $9 for up to 90 tablets Clonazepam tablet (CS) Klonopin® 1mg, 2mg $10 for up to 90 tablets HCL tablet Catapres® 0.1mg, 0.2mg, 0.3mg $10 $13 $20 Clonidine patch Catapres-TTS® -3 0.3mg/day $80 per pack of 4 Clopidogrel tablet Plavix® 75mg $8 up to 30 tabs / $18 up to 90 tabs Clotrimazole/Betamethasone Cream Lotrisone® 15g (1%/0.05%) $15 per tube Colesevelam HCL tablet Welchol® 625mg $65 for up to 60 tablets Colestipol Micronized tablet Colestid® 1gm $60 for up to 60 tablets tablet Flexeril® 5mg, 10mg $12 $25 n/a Dalfampridine ER tablet Ampyra® 10mg $60 for up to 60 tablets Darifenacin ER tablet Enablex® 7.5mg, 15mg $60 for up to 30 tablets Desonide ointment 0.05% Tridesilon® 60gm $65 per tube Desvenlafaxine Succ ER tablet Pristiq® 25mg, 50mg, 100mg $40 for up to 30 tablets Dexmethylphenidate HCL tablet (CS) Focalin® 2.5mg $17 up to 30 tabs (30 day supply only) Dexmethylphenidate HCL tablet (CS) Focalin® 5mg $22 up to 30 tabs (30 day supply only) Dexmethylphenidate HCL tablet (CS) Focalin® 10mg $25 up to 30 tabs (30 day supply only) Dextroamphetamine-Amphetamine ER capsule (CS) Dexedrine® 5mg, 10mg, 15mg, 20mg $70 up to 30 caps (30 day supply only) Dextroamphetamine-Amphetamine ER capsule (CS) Dexedrine® 25mg, 30mg $80 up to 30 caps (30 day supply only) Dextroamphetamine-Amphetamine tablet (CS) Adderall® XR 5mg, 10mg, 15mg, 20mg, 30mg $20 up to 30 caps (30 day supply only) Dextroamphetamine sulfate ER capsule (CS) Adderall® XR 5mg, 10mg $50 up to 30 caps (30 day supply only) Dextroamphetamine sulfate ER capsule (CS) Adderall® 15mg $60 up to 30 caps (30 day supply only) Diazepam tablet (CS) Valium® 2mg, 5mg, 10mg $8 for up to 90 tablets Diclofenac Sodium EC tablet Voltaren Gel® 50mg, 75mg $12 $25 n/a Diclofenac Sodium ER tablet Voltaren® / Zorvolex® 100mg $17 $40 n/a Diclofenac Sodium 1% gel Voltaren XR® 100g tube $35 per tube Dicyclomine capsule Bentyl® 10mg $10 $13 $20 Dicyclomine tablet Bentyl® 20mg $10 $13 $20 tablet Lanoxin® / Digitek® 0.125mg, 0.25mg $16 up to 30 tabs / $35 up to 90 tabs ER capsule (24hr) (Dilt-XR) Dilacor XR®/Cardizem CD®/Cartia XT®/Dilt-XR®/Diltia XT® 120mg, 180mg, 240mg $18 up to 30 caps / $40 up to 90 caps Diltiazem ER capsule (Dilt-CD) Cardizem CD®/Dilacor XR®/Cartia XT®/Dilt-XR®/Diltia XT® 120mg, 180mg, 240mg, 300mg, 360mg $18 up to 30 caps / $40 up to 90 caps Diltiazem ER capsule (24hr)(Dilt-CD) Tiazac®/Cardizem CD®/Dilacor XR® 360mg $18 up to 30 caps / $40 up to 90 caps Diphenoxylate/Atropine tablet (CS) Lomotil®/Lonox® 2.5/0.025mg $25 for up to 120 tablets Divalproex NA DR tablet Depakote® 125mg, 250mg, 500mg $16 $35 $65 Divalproex SOD ER tablet Depakote ER® 250mg, 500mg $23 for up to 30 tablets Dofetilide capsule Tikosyn® 125mcg, 250mcg, 500 mcg $25 up to 30 caps / $65 up to 90 caps DOK™ soft gel (OTC) Docusate Sodium 250mg (No prescription required) $9 per bottle (100 ct.) Donepezil tablet Aricept® 5mg, 10mg $15 n/a Donnatal® elixir (CS) (mint or grape) N/A 16.2/0.1037/0.0194/0.0065mg $0* n/a Donnatal® tablet (CS) N/A 16.2/0.1037/0.0194/0.0065mg $0* n/a Dorzolamide HCL 2% Solution Trusopt® 10ml dropper $15 per bottle Mesylate tablet Cardura® 1mg, 2mg, 4mg, 8mg $16 up to 30 tabs / $35 up to 90 tabs capsule Sinequan® 10mg $12 up to 30 caps / $25 up to 90 caps Doxepin capsule Sinequan® 25mg, 50mg $16 up to 30 caps / $35 up to 90 caps Doxepin capsule Sinequan® 75mg, 100mg $25 up to 30 caps / $60 up to 90 caps Doxycycline Hyclate capsule Vibramycin® 50mg, 100mg $0* n/a Duloxetine HCL DR capsule Cymbalta® 20mg, 30mg, 60mg $19 $45 n/a capsule Avodart® 0.5mg $35 up to 30 caps / $85 up to 90 caps Dutoprol tablet Succinate ER/HCTZ 25/12.5mg, 50/12.5mg, 100/12.5mg $0* n/a Dyrenium capsule Triamterene 50mg, 100mg $0* n/a Econazole Nitrate 1% cream Spectazole® 15g tube $15 per tube Econazole Nitrate 1% cream Spectazole® 30g tube $20 per tube Eletriptan HBR tablet Relpax® 20mg $40 per 6 tablets/up to 60 tablets Eletriptan HBR tablet Relpax® 40mg $40 per 6 tablets/up to 30 tablets Enalapril Maleate Tablet Vasotec® 2.5mg, 5mg, 10mg, 20mg $10 $13 $20 Enalapril / HCTZ tablet Vaseretic® 5/12.5mg, 10/25mg $10 $13 $20 Entecavir tablet Baraclude® 0.5mg, 1mg $45 for up to 30 tablets Epinephrine Auto Injector Adrenaclick / Epipen® / Epipen Jr® 0.15mg/0.15mL, 0.3mg/0.3mL $30 for a 2 unit pack Eplerenone tablet Inspra® 25mg, 50mg $25 $65 n/a Escitalopram tablet Lexapro® 5mg, 10mg, 20mg $9 $15 n/a Esomeprazole DR capsule Nexium® 20mg, 40mg $20 for up to 30 capsules Estradiol 0.01% Cream Estrace® 42.5g / 0.01% $50 per tube Estradiol tablet Estrace® 0.5mg, 1mg, 2mg $10 $13 $20 Eszopiclone tablet (CS) Lunesta® 1mg, 2mg, 3mg $18 up to 30 tabs / $40 up to 90 tabs Etodolac capsule Lodine® 200mg, 300mg $18 up to 30 caps / $40 up to 90 caps Etodolac tablet Lodine® 400mg $18 up to 30 tabs / $40 up to 90 tabs Etodolac tablet Lodine® 500mg $19 up to 30 tabs / $45 up to 90 tabs Exemestane tablet Aromasin® 25mg $18 up to 30 tabs / $40 up to 90 tabs Ezetimibe tablet Zetia® 10mg $30 for up to 30 tablets Famciclovir tablet Famvir® 250mg $45 for up to 60 tablets Famciclovir tablet Famvir® 500mg $55 for up to 60 tablets Famotidine tablet Pepcid® 20mg, 40mg $10 $13 $20 Febuxostat tablet Uloric® 40mg, 80mg $30 for up to 30 tablets Felodipine ER tablet Plendil® ER 10mg $26 for up to 30 tablets Felodipine ER tablet Plendil® ER 2.5mg, 5mg $16 for up to 30 tablets Fenofibrate, micronized capsule Lofibra® (micronized) 134mg $25 $70 n/a Fenofibrate tablet Tricor® 145mg $55 for up to 30 tablets Fenofibrate tablet Tricor® 48mg $19 up to 30 tabs / $45 up to 90 tabs Fenofibrate tablet Tricor® / Lipofen® / Lofibra® 54mg, 160mg $22 $55 $95 Fenofibric Acid DR capsule Trilipix® 135mg $55 for up to 30 capsules Ferrous Sulfate EC tablet Iron 325mg (No prescription required) $6 per bottle 100 tabs (min 2 bottles) Fexofenadine OTC tablet Allegra® OTC 60mg, 180mg (No prescription required) $40 for 100 tablets tablet Propecia® 1mg $11 for up to 30 tablets Finasteride tablet Proscar® 5mg $12 $25 $45 Flecainide Acetate tablet Tambocor® 50mg, 100mg, 150mg $16 up to 30 tabs / $35 up to 90 tabs Fluconazole tablet Diflucan® 100mg, 200mg $35 for up to 30 tablets Fluocinonide topical solution Vanos® 0.05% 60ml $30 per bottle Fluoxetine capsule Prozac® / Sarafem® 10mg, 20mg, 40mg $9 $15 n/a Fluticasone Nasal Spray Flonase® 50mcg $15 per nasal spray Fluticasone / diskus Advair Diskus® 100 / 50mcg $100 per diskus Fluticasone / Salmeterol diskus Advair Diskus® 250 / 50mcg $120 per diskus Fluticasone / Salmeterol diskus Advair Diskus® 500 / 50mcg $150 per diskus Fluticasone / Salmeterol Inhaler Advair®, AirDuo RespiClick® 55/14mcg, 113/14mcg, 232/14mcg (60 inhalations) $90 per inhaler canister Fluvoxamine Maleate tablet Luvox® 100mg $12 up to 30 tabs / $25 up to 90 tabs Folic Acid tablet N/A 1mg $10 $13 $20 Furosemide tablet Lasix® 20mg, 40mg, 80mg $7 $9 $18 Gabapentin capsule Neurontin® / Gabarone® 100mg, 300mg, 400mg $25 for up to 270 capsules Gabapentin tablet Neurontin® / Gabarone® 600mg, 800mg $45 for up to 270 tablets Galantamine tablet Razadyne ER® 4mg, 8mg, 12mg $25 for up to 60 tablets Galantamine ER capsule Razadyne ER® 8mg $35 for up to 30 capsules Galantamine ER capsule Razadyne® 16mg, 24mg $40 for up to 30 capsules Gemfibrozil tablet Lopid® 600mg $14 $30 $55 Glimepiride tablet Amaryl® 1mg, 2mg, 4mg $10 $13 $20 Glipizide ER tablet Glucotrol XL® 2.5mg, 5mg, 10mg $16 $35 $65 Glipizide tablet Glucotrol® 5mg, 10mg $10 $13 $20 Glyburide tablet Diabeta® / Micronase® 1.25mg, 2.5mg, 5mg $10 $13 $20 Glyburide, micronized tablet Glynase® / PresTab® 1.5mg, 3mg, 6mg $10 $13 $20 Glyburide/Metformin tablet Glucovance® 1.25/250mg, 2.5/500mg, 5/500mg $14 $30 $55 ER tablet Intuniv® / Tenex® 1mg, 2mg, 3mg, 4mg $50 for up to 60 tablets Halobetasol Prop ointment, 0.05% Ultravate® 15gm $35 per tube tablet Haldol® 0.5mg, 1mg, 2mg, 5mg $12 $25 n/a Hydralazine tablet Apresoline® 10mg, 25mg, 50mg, 100mg $12 $25 $45 Hydrochlorothiazide capsule Microzide® 12.5mg $10 $13 $20 Hydrochlorothiazide tablet Hydrodiuril® 25mg, 50mg $10 $13 $20 Hydrocortisone tablet Cortef® 5mg $9 up to 30 tabs / $15 up to 90 tabs Hydrocortisone tablet Cortef® 10mg $12 up to 30 tabs / $25 up to 90 tabs Hydroxychloroquine tablet Plaquenil® 200mg $14 up to 30 tabs / $30 up to 90 tabs Hydroxyurea capsule Hydrea® / Droxia® 500mg $12 up to 30 caps / $25 up to 90 caps HCL tablet Atarax® 10mg, 25mg, 50mg $12 $25 n/a Hydroxyzine Pamoate capsule Vistaril® 25mg, 50mg $12 $25 n/a Ibuprofen tablet Advil® / Motrin® 400mg, 600mg, 800mg $11 $20 n/a Imatinib tablet Gleevec® 100mg $50 for up to 30 tablets Indapamide tablet Lozol® 1.25mg, 2.5mg $10 $13 $20 Indomethacin capsule Indocin® 25mg $9 up to 30 caps / $15 up to 90 caps Indomethacin capsule Indocin® 50mg $11 up to 30 caps / $20 up to 90 caps Indomethacin ER capsule Indocin SR® 75mg $11 up to 30 caps / $20 up to 90 caps Insulin Syringes (Prodigy®) N/A 28G 12.7mm - 1cc, 31G 8mm - 1/2cc, 31G 8mm - 1/3cc $13 per box of 100 Ipratropium / Albuterol Inhalation Solution DuoNeb® 0.5-3(2.5)mg / 3mL vial $25 for up to 90 vials Irbesartan tablet Avapro® 75mg, 150mg, 300mg $14 $30 $55 Irbesartan / HCTZ tablet Avalide® 150mg/12.5mg, 300mg/12.5mg $14 $30 $55 Isoniazid tablet Isoniazid / INH® / Nydrazid® 300mg $20 Isosorbide Mononitrate ER tablet Imdur® / Monoket® 30mg, 60mg $9 up to 30 tabs / $15 up to 90 tabs Isosorbide Mononitrate ER tablet Imdur® / Monoket® 120mg $11 up to 30 tabs / $20 up to 90 tabs Isosorbide Mononitrate tablet Monoket® / Imdur® 10mg, 20mg $10 $13 $20 Jantoven® (Warfarin) tablet Coumadin mg: 1, 2, 2.5, 3, 4, 5, 6, 7.5, 10 $12 $25 n/a Kapvay ER® tablet Clonidine ER 0.1mg $0* Supported through a partnership Ketotifen Fumarate OTC Solution Alaway®/Zaditor®/Zyrtec Itchy Eye®/Claritin Eye® 0.025% / 5mL (No prescription required) $9 per dropper Klor-Con packet Potassium Chloride ER 20meq $18 up to 30 pkts / $40 up to 90 pkts HCL tablet Trandate®/Normodyne® 100mg, 200mg, 300mg $14 up to 30 tabs / $30 up to 90 tabs Lactulose Oral Solution Enulose® / Constulose®/ Generlac® 10gm/15mL $10 per bottle Lamotrigine ER tablet Lamictal XR® 25mg $35 for up to 30 tablets Lamotrigine ER tablet Lamictal XR® 50mg, 100mg $40 for up to 30 tablets Lamotrigine ER tablet Lamictal XR® 200mg $45 for up to 30 tablets Lamotrigine tablet Lamictal® 25mg, 100mg, 150mg, 200mg $14 $30 $55 Lancets 28G Twist Top (Prodigy®) OTC N/A Box of 100; min order - 2 boxes (No prescription required) $5 per box; min order $10 Lanoxin® tablet Digoxin / Digitek® .0625mg, .125mg, .1875mg, .25mg $0* Supported through a partnership Lansoprazole DR capsule Prevacid® 30mg $20 for up to 30 capsules Latanoprost 0.005% Solution Xalatan® 2.5ml dropper $45 (limit 3) n/a Leflunomide tablet Arava® 10mg, 20mg $40 for up to 30 tablets Letrozole tablet Femara® 2.5mg $14 $30 $55 Levalbuterol Solution Xopenex® 1.25mg/3mL $30 for up to 30 vials Levetiracetam ER tablet Keppra XR® 500mg, 750mg $25 for up to 60 tablets Levetiracetam tablet Keppra® 1000mg $11 up to 30 tabs / $20 up to 90 tabs Levetiracetam tablet Keppra® 250mg, 500mg, 750mg $21 $50 $95 Levocetirizine tablet Xyzal® 5mg $16 $35 $65 Levothyroxine tablet Levoxyl®/Synthroid® Levothroid®/Unithroid®/Tirosint® mcg: 25, 50, 75, 88, 100, 112, 125, 137, 150, 175, 200, 300 $10 $13 $20 Lidocaine 2% viscous solution Xylocaine® Viscous 2% 100ml $7 per bottle Lidocaine 5% patch Lidoderm® 5% of lidocaine per patch $99 for box of 30 patches Liothyronine Sodium tablet Cytomel® 5mcg, 25mcg $15 up to 30 tabs / $35 up to 90 tabs Liothyronine Sodium tablet Cytomel® 50mcg $20 up to 30 tabs / $45 up to 90 tabs Lisinopril tablet Zestril® / Prinivil® 2.5mg, 5mg, 10mg, 20mg, 30mg, 40mg $7 $9 $18 Lisinopril/HCTZ tablet Zestoretic® / Prinzide® 10/12.5mg, 20/12.5mg, 20/25mg $7 $9 $18 Lithium Carbonate capsule Eskalith® 150mg, 300mg $10 for up to 270 capsules Lithium Carbonate ER tablet Lithobid ER® / Eskalith® CR 300mg, 450mg $16 $35 n/a Loperamide capsule Imodium® 2mg $9 for up to 30 capsules Loratadine OTC tablet Claritin® OTC / Alavert® 10mg (No prescription required) $10 per bottle of 100 tabs (min 2 bottles) Lorazepam tablet (CS) Ativan® 0.5mg $12 $25 n/a Lorazepam tablet (CS) Ativan® 1mg, 2mg $14 $30 n/a Losartan Potassium tablet Cozaar® 25mg, 50mg, 100mg $11 $20 $40 Losartan/HCTZ tablet Hyzaar® 50/12.5mg, 100/12.5mg, 100/25mg $12 $25 $45 Lovastatin tablet Mevacor® 10mg, 20mg, 40mg $7 $9 $18 capsule Loxitane® 5mg, 10mg $20 for up to 60 capsules Loxapine capsule Loxitane® 25mg, 50mg $45 for up to 60 capsules Magnesium Oxide tablet (OTC) MaxOx® / Uro-Mag® 400mg (No prescription required) $8 for a bottle of 120 Meclizine HCL tablet Antivert®/Dramamine II®/Meclicot®/Meni-D®/Bonine® 12.5mg $12 $25 $50 Meclizine HCL tablet Antivert®/Dramamine II®/Meclicot®/Meni-D®/Bonine® 25mg $14 $30 $55 Medroxyprogesterone tablet Provera® 2.5mg, 5mg, 10mg $9 $15 n/a Melatonin tablet (OTC) N/A 5mg (No prescription required) $13 per 2 bottles (60 ct) Meloxicam tablet Mobic®/Vivlodex® 7.5mg, 15mg $11 $20 n/a Memantine HCL tablet Namenda® 5mg, 10mg $25 for up to 60 tablets Meprobamate tablet (CS) Equanil® 200mg, 400mg $40 for up to 180 tablets Mesalamine DR tablet Lialda® 1.2g $85 for up to 60 tablets Metformin HCL ER tablet Glucophage XR®/Glumetza®/Fortamet® 500mg, 750mg $10 $13 $20 Metformin HCL tablet Glucophage® 500mg, 850mg, 1000mg $10 $13 $20 Methimazole tablet Northyx® 5mg, 10mg $9 for up to 30 tablets Methocarbamol tablet Robaxin® 500mg, 750mg $9 up to 30 tabs / $15 up to 90 tabs Methotrexate tablet Rheumatrex® / MTX® 2.5mg $20 per 12 tablets Methylphenidate CD capsule (CS) Metadate CD® 10mg $65 up to 30 capsules (30-day supply only) Methylphenidate CD capsule (CS) Metadate CD® 20mg, 30mg $75 up to 30 capsules (30-day supply only) Methylphenidate CD capsule (CS) Metadate CD® 40mg, 50mg, 60mg $95 up to 30 capsules (30-day supply only) Methylphenidate LA capsule (CS) Ritalin® LA 20mg, 30mg, 40mg $115 up to 30 capsules (30-day supply only) Methylphenidate tablet (CS) Ritalin® 5mg, 10mg $15 up to 30 tablets (30-day supply only) Methylphenidate tablet (CS) Ritalin® 20mg $25 up to 30 tablets (30-day supply only) Methylphenidate LA capsule (CS) Ritalin® LA 10mg $85 up to 30 capsules (30-day supply only) Metoclopramide HCL tablet Reglan® 5mg, 10mg (1 Fill Only / No Refills) $11 $20 n/a Metolazone tablet Zaroxolyn® / Mykrox® 2.5mg, 5mg $35 for up to 30 tablets Metoprolol Succinate ER tablet Toprol-XL® 25mg, 50mg, 100mg $16 $35 $65 Metoprolol Succinate ER tablet Toprol-XL® 200mg $20 $45 $85 Metoprolol Tartrate tablet Lopressor® 25mg, 50mg, 100mg $10 $13 $20 Metoprolol Tartrate/HCTZ tablet Lopressor HCT® 50mg/25mg, 10mg/25mg $0* Supported through a partnership HCL tablet Proamatine® / Orvaten® 2.5mg, 5mg, 10mg $16 up to 30 tabs / $35 up to 90 tabs Minocycline capsule Minocin/Dynacin®/Myrac®/Solodyn®/Ximino® 50mg, 75mg, 100mg $19 $45 $85 tablet Remeron® 15mg, 30mg, 45mg $14 $30 n/a Modafinil tablet (CS) Provigil® 100mg, 200mg $35 $80 n/a Mometasone Furoate Cream Elocon® 15gm $15 per tube Mometasone Furoate Ointment Elocon® 15gm $15 per tube Montelukast Sodium tablet Singulair® 10mg, 5mg chewable $17 up to 30 tabs / $40 up to 90 tabs Mupirocin 2% ointment Bactroban® 22g $13 per tube Mycophenolate Mofetil capsule CellCept® 250mg $65 for up to 180 capsules Mycophenolate Mofetil tablet CellCept® 500mg $65 for up to 180 tablets Mycophenolic Acid DR tablet Myfortic 180mg $55 for up to 60 tablets Mycophenolic Acid DR tablet Myfortic 360mg $36 for up to 30 tablets Nabumetone tablet Relafen® 500mg, 750mg $17 $40 n/a Naltrexone HCL tablet Revia® 50mg $30 for up to 30 tablets Naproxen Sodium tablet Anaprox® DS/ Aleve /Aflaxen®/Naprelan® 550mg $13 $25 n/a Naproxen tablet Naprosyn® 250mg, 375mg, 500mg $10 $20 n/a ER tablet Niaspan® ER 500mg $45 for up to 30 tablets Niacin ER tablet Niaspan® ER 1000mg $50 for up to 30 tablets Niacin SA capsule (OTC) N/A 250mg (No prescription required) $9 for a bottle of 100 Nifedipine capsule Procardia® / Nifediac ® / Adalat® 10mg $15 for up to 30 capsules Nifedipine capsule Procardia® / Nifediac® / Adalat® 20mg $20 for up to 30 capsules Nifedipine ER tablet Procardia® XL/Adalat® CC/Afeditab® CR/Nifediac® CC 30mg, 60mg, 90mg $21 $50 $95 Nilandron® tablet Nilutamide 150mg $0* through partnership (90 days) Nitroglycerin SA capsule N/A 2.5mg $20 for up to 60 capsules Nitroglycerin SA capsule N/A 6.5mg, 9mg $25 for up to 60 capsules Nitroglycerin SL tablet Nitrostat® 0.3mg, 0.4mg, 0.6mg $20 per bottle of 100 tabs Norethindrone Acetate tablet Aygestin® 5mg $25 for up to 30 tablets Norethindrone tablet Ortho Micronor®/Camila®/Errin® 28's (0.35mg) $15 $35 $65 Norethindrone/Ethinyl Estradiol tablet Ovcon® 35/Balziva/Briellyn/Femcon FE 28's (0.4mg/0.035mg) $15 $35 $65 HCL capsule Pamelor® / Aventyl® 10mg, 25mg, 50mg, 75mg $11 $20 n/a Nyamyc® Topical Powder Nystatin 100,000U/g (60g bottle) $25 per bottle Nystatin tablet N/A 500,000 units $16 up to 30 tabs / $35 up to 90 tabs Nystatin/Triamcinolone ointment Mycolog II® 30gm $20 per tube tablet Zyprexa® 2.5mg, 5mg, 7.5mg, 10mg $13 up to 30 tabs / $25 up to 90 tabs Olanzapine tablet Zyprexa® 15mg, 20mg $21 up to 30 tabs / $50 up to 90 tabs Olmesartan Medoxomil tablet Benicar® 20mg $0* Supported through a partnership Olmesartan Medoxomil tablet Benicar® 5mg, 40mg $15 for up to 90 tablets Olopatadine Nasal Spray Patanase® 665mcg $55 per bottle (240 sprays) Olmesartan/HCTZ tablet Benicar HCT® 20/12.5mg, 40/12.5mg, 40/25mg $30 for up to 90 tablets Olopatadine 0.2% solution Patanol®/Pataday®/Pazeo® 0.2% / 2.5ml $40 per dropper Omega-3-acid ethyl esters capsule Lovaza® / Omtryg® 1gm $80 for up to 120 capsules Omeprazole capsule Prilosec® 10mg, 20mg, 40mg $16 $35 $65 Ondansetron tablet Zofran® 4mg, 8mg $25 up to 30 tabs / $72 up to 90 tabs Ondansetron / Ondansetron ODT tablet Zofran ODT® 4mg, 8mg $25 up to 30 tabs / $72 up to 90 tabs Oxandrolone tablet (CS) Oxandrin® 2.5mg, 10mg (Requires statement of diagnosis by provider) $25 up to 30 tabs / $72 up to 90 tabs Oxcarbazepine tablet Trileptal® 150mg, 300mg, 600mg $15 $30 n/a Oxybutynin Chloride ER tablet Ditropan XL® 5mg, 10mg, 15mg $19 $45 $85 Oxybutynin tablet Ditropan® 5mg $10 $13 $20 Pacerone® tablet Cordarone® / Amiodarone 100mg, 200mg, 400mg $12 $25 $45 Panretin® gel 0.1% Alitretinoin 60gm $0 Supported through partnership Pantoprazole tablet Protonix® 20mg, 40mg $11 $20 n/a Paroxetine ER tablet Paxil CR® 12.5mg, 25mg, 37.5mg $45 for up to 30 tablets Paroxetine HCL tablet Paxil® (HCL) 10mg, 20mg, 30mg, 40mg $11 $20 n/a ER tablet Trental® / Pentoxil® 400mg $15 $30 $55 tablet Trilafon® 2mg, 4mg $20 for up to 30 tablets Perphenazine tablet Trilafon® 8mg, 16mg $35 for up to 30 tablets Phenelzine sulfate tablet Nardil 15mg $60 for up to 120 tablets Phentermine capsule (CS) Adipex-P® 15mg, 30mg $16 up to 30 caps / $35 up to 90 caps Phenytoin Sodium capsule Dilantin® 100mg $20 for up to 180 capsules Pioglitazone HCL tablet Actos® 15mg, 30mg, 45mg $12 $25 n/a Plaquenil® tablet Hydroxychloroquine 200mg (Letter of necessity required) $0 supported through partnership PNV Prenatal Multivitamin+ Iron & Folic Acid tablet N/A 27mg/1mg $9 for up to 30 tablets Polystyrene Sulfonate Powder Kalexate®/ Kionex® 454g $40 per can Potassium Chloride ER tablet Klor-Con® / K-Dur® / K-tab® 600mg (8mEQ), 750mg (10mEQ), 1500mg (20mEQ) $13 up to 30 tabs / $25 up to 90 tabs Potassium Citrate ER tablet Urocit-K® 540mg (5mEQ), 1080mg (10mEQ) $9 up to 30 tabs / $15 up to 90 tabs Pramipexole ER tablet Mirapex ER® 0.375mg, 0.75mg, 1.5mg, 3mg, 4.5mg $100 for up to 30 tablets Pramipexole ER tablet Mirapex ER® 2.25mg $120 for up to 30 tablets Pramipexole tablet Mirapex® 0.125mg, 0.25mg, 0.5mg, 1mg, 1.5mg $25 for up to 180 tablets Prasugrel tablet Effient® 5mg, 10mg $30 for up to 30 tablets Pravastatin tablet Pravachol® 10mg, 20mg, 40mg, 80mg $12 up to 30 tabs / $25 up to 90 tabs capsule Minipress® 1mg, 2mg $11 up to 30 caps / $20 up to 90 caps Prazosin capsule Minipress® 5mg $18 up to 30 caps / $40 up to 90 caps Prednisone tablet Deltasone® 1mg, 2.5mg, 5mg, 10mg, 20mg, 50mg $9 $20 n/a Pregabalin capsule Lyrica® 50mg, 75mg, 100mg, 150mg, 200mg, 225mg, 300mg $20 for up to 90 capsules Prevalite® Powder Cholestyramine / Questran® 4g/5.5g dose packet $12 for up to 30 packets Prevalite® Powder Cholestyramine / Questran® 4g/5.5g powder can (231g) $25 per can Primidone tablet Mysoline® 50mg $10 for up to 60 tablets Primidone tablet Mysoline® 250mg $16 for up to 60 tablets tablet N/A 5mg, 10mg $10 $13 $20 Progesterone capsule Prometrium® 100mg, 200mg $30 for up to 30 capsules HCL tablet Rythmol® 150mg, 225mg $18 $40 $75 Propafenone HCL tablet Rythmol® 300mg $12 up to 30 tabs / $22 up to 90 tabs HCL ER capsule Inderal® LA / Inderal®XL / InnoPran® XL 60mg, 80mg, 120mg 160mg $45 for up to 30 capsules Propranolol tablet Inderal® 10mg $11 up to 30 tabs / $20 up to 90 tabs Propranolol tablet Inderal® 20mg $14 up to 30 tabs / $30 up to 90 tabs Propranolol tablet Inderal® 40mg $18 up to 30 tabs / $40 up to 90 tabs Propranolol tablet Inderal® 80mg $22 up to 30 tabs / $55 up to 90 tabs Propylthiouracil tablet N/A 50mg $19 up to 30 tabs / $45 up to 90 tabs Pyridostigmine BR tablet Mestinon® 60mg $17 up to 30 tabs / $37 up to 90 tabs Fumarate ER tablet Seroquel XR® 50mg $12 up to 30 tabs / $25 up to 90 tabs Quetiapine Fumarate ER tablet Seroquel XR® 150mg, 200mg $14 up to 30 tabs / $30 up to 90 tabs Quetiapine Fumarate ER tablet Seroquel XR® 300mg, 400mg $16 up to 30 tabs / $35 up to 90 tabs Quetiapine Fumarate tablet Seroquel® 25mg, 50mg, 100mg $12 up to 30 tabs / $25 up to 90 tabs Quetiapine Fumarate tablet Seroquel® 200mg, 300mg $18 up to 30 tabs / $40 up to 90 tabs Quetiapine Fumarate tablet Seroquel® 400mg $21 up to 30 tabs / $50 up to 90 tabs Quinapril tablet Accupril® 5mg, 10mg, 20mg, 40mg $15 $30 $55 Quinapril/HCTZ tablet Accuretic® 10/12.5mg, 20/12.5mg, 20/25mg $14 up to 30 tabs / $30 up to 90 tabs Rabeprazole Sodium DR tablet Aciphex® 20mg $25 for up to 90 tablets Raloxifene tablet Evista® 60mg $45 for up to 30 tablets Ramipril capsule Altace® 1.25mg, 2.5mg, 5mg, 10mg $12 $25 $45 Ranitidine tablet Zantac® / Taladine® 150mg, 300mg Currently Unavailable / Products Recalled Ranolazine ER tablet Ranexa® 1000mg $63 for up to 60 tablets Ranolazine ER tablet Ranexa® 500mg $53 for up to 60 tablets Rasagiline Mesylate tablet Azilect® 0.5mg $80 for up to 30 tablets Rasagiline Mesylate tablet Azilect® 1mg $100 for up to 30 tablets Repaglinide tablet Prandin® 0.5mg, 1mg, 2mg $18 up to 30 tabs / $40 up to 90 tabs Risedronate Sodium tablet Actonel® / Atelvia® 150mg (once a month dosage) $80 per dosage Risedronate Sodium tablet Actonel® / Atelvia® 35mg (once a week dosage) $50 per pack of 4 tablets tablet Risperdal® 0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg $20 $45 n/a Rivastigmine Tartrate capsule Exelon® 1.5mg, 3mg, 4.5mg, 6mg $50 for up to 60 capsules Rizatriptan tablet Maxalt® / Maxalt-MLT 5mg, 10mg $25 for up to 18 tablets Ropinirole ER tablet Requip XL® 2mg $25 for up to 30 tablets Ropinirole ER tablet Requip XL® 4mg $40 for up to 30 tablets Ropinirole ER tablet Requip XL® 6mg $50 for up to 30 tablets Ropinirole ER tablet Requip XL® 8mg,12mg $60 for up to 30 tablets Ropinirole HCL tablet Requip® 0.25mg, 0.5mg, 1mg, 2mg, 4mg, 5mg $20 $45 $85 Rosuvastatin Calcium tablet Crestor® 5mg, 10mg, 20mg, 40mg $16 up to 30 tabs / $35 up to 90 tabs Salagen® tablet Pilocarpine 5mg, 7.5mg $0 Supported through partnership Sertraline tablet Zoloft® 25mg, 50mg, 100mg $13 $25 n/a Sevelamer Carbonate tablet Renvela® 800mg $29 up to 30 tabs / $75 up to 90 tabs Sildenafil Citrate tablet Revatio® 20mg $15 for up to 30 tablets Sildenafil Citrate tablet Viagra® 25mg, 50mg, 100mg $20 for up to 30 tablets Silodosin capsule Rapaflo® 4mg, 8mg $55 for up to 60 capsules Simvastatin tablet Zocor® 5mg, 10mg, 20mg, 40mg, 80mg $10 $20 $35 Solifenacin tablet Vesicare® 5mg, 10mg $0 Supported through partnership tablet Sorine® / Betapace 80mg,120mg,160mg, 240mg $10 $20 n/a Spironolactone tablet Aldactone® 25mg, 50mg, 100mg $11 $20 $30 Spironolactone/HCTZ tablet Aldactazide® 25mg/25mg $18 up to 30 tabs / $40 up to 90 tabs Sprintec® tablet Ortho-Cyclen® / Estarylla / Mononessa / Previfem 28's $35 (limit 3) $65 (limit 6) Sucralfate tablet Carafate® 1gm $30 for up to 120 tablets Sulfamethoxazole/Trimethoprim DS Bactrim® DS / Septra® DS 800mg/160mg $10 $13 $20 Sulfasalazine tablet Sulfazine® / Azulfidine® 500mg $9 up to 30 tabs / $13 up to 90 tabs Sulfasalazine DR tablet Azulfidine EN-tabs / Sulfazine EC® 500mg $11 up to 30 tabs / $20 up to 90 tabs Sumatriptan Succ tablet Imitrex® 25mg $35 for up to 72 tablets Sumatriptan Succ tablet Imitrex® 50mg $35 for up to 54 tablets Sumatriptan Succ tablet Imitrex® 100mg $35 for up to 27 tablets Tacrolimus capsule Prograf® / Astagraf XL® 0.5mg, 1mg $20 for up to 60 capsules Tacrolimus capsule Prograf® / Astagraf XL® 5mg $80 for up to 60 capsules Tadalafil tablet Cialis® 2.5mg, 5mg $15 for up to 30 tablets Tadalafil tablet Cialis® 10mg $30 for up to 30 tablets Tadalafil tablet Adcirca® / Cialis® 20mg $30 for up to 30 tablets Tamoxifen Citrate tablet Soltamox® 10mg $13 up to 30 tabs / $25 up to 90 tabs Tamoxifen Citrate tablet Soltamox® 20mg $16 up to 30 tabs / $35 up to 90 tabs capsule Flomax® 0.4mg $14 $30 $55 Tazarotene 0.1% cream Tazorac® 30g $90 per tube Telmisartan tablet Micardis® 20mg, 40mg, 80mg $16 $35 $65 Telmesartan HCTZ tablet Micardis HCT® 40/12.5mg, 80/12.5mg, 80/25mg $40 for up to 30 tablets Temazepam capsule (CS) Restoril® 15mg, 30mg $10 up to 30 caps / $16 up to 90 caps Tenofovir Disoproxil Fumarate tablet Viread® 300mg $25 for up to 30 tablets capsule Hytrin® 1mg, 2mg, 5mg, 10mg $10 $13 $20 Testosterone Cypionate Solution (CS) Depo® - Testosterone 200mg/ml - 1ml vial $20 per vial Testosterone Gel packet (CS) Vogelxo® / AndroGel® / Testim® / Fortesta® 50mg (5g of gel per packet) $25 for a carton of 30 packets Testosterone Gel packet (CS) AndroGel® 1.62% (1.25g of gel per packet) $75 for up to 15 packets Testosterone Gel pump (CS) Vogelxo® / AndroGel® / Testim® / Fortesta® 88g pump (12.5mg per pump actuation) $25 for a carton of 2 pumps Testosterone Gel pump (CS) AndroGel® 1.62% 88g pump 1.62% (20.25mg per pump actuation) $70 per pump Testosterone Gel tube (CS) Vogelxo® 50mg (5g of gel per tube) $25 for a carton of 30 tubes Theophylline ER tablet Theochron 300mg, 450mg $0 Supported through partnership HCL tablet Zanaflex® 2mg, 4mg $17 $40 n/a Tolterodine ER capsule Detrol LA® 2mg, 4mg $60 for up to 30 capsules Tolterodine Tartrate tablet Detrol® 1mg, 2mg $30 for up to 30 tablets Topiramate ER capsule Qudexy XR® / Trokendi XR® 25mg, 50mg, 100mg, 150mg, 200mg $10 $25 $45 Topiramate tablet Topamax® / Topiragen® 25mg, 50mg, 100mg, 200mg $16 $35 $65 Tramadol HCL ER tablet (CS) Ultram® ER/Ryzolt®/ConZip® 100mg, 200mg $40 for up to 30 tablets Tramadol HCL ER tablet (CS) Ultram® ER/Ryzolt®/ConZip® 300mg $60 for up to 30 tablets Tramadol tablet (CS) Ultram® 50mg $7 for up to 90 tablets Tramadol/Acetaminophen tablet (CS) Ultracet® 37.5mg/325mg $30 for up to 120 tablets Trandolapril tablet Mavik® 1mg, 2mg, 4mg $14 $30 $55 tablet Desyrel® 50mg, 100mg, 150mg $7 $10 n/a Tretinoin 0.025% cream Avita® 20g $40 per tube Tretinoin 0.05% cream Retin-A® 20g $50 per tube Tri-Sprintec® tablet Ortho-Tri-Cyclen®/Tri-Estarylla/Tri-Previfem 28's $35 (limit 3) $65 (limit 6) Triamcinolone cream 0.1% N/A 454gm (0.1%) $18 per jar Triamcinolone cream Kenalog® 30gm (0.1%) $12 per tube Triamcinolone ointment 0.1% N/A 454gm (0.1%) $20 per jar Triamcinolone ointment N/A 80gm (0.10%) $20 per tube Triamterene/HCTZ capsule Dyazide® 37.5/25mg $10 $13 $20 Triamterene/HCTZ tablet Maxzide® 37.5/25mg, 75/50mg $10 $13 $20 Trospium Chloride tablet Sanctura® 20mg $50 for up to 60 tablets Uroxatral® tablet Alfuzosin HCL ER 10mg $0 Supported through partnership Ursodiol capsule Actigall® 300mg $45 for up to 30 capsules Ursodiol tablet Urso 250® 250mg $30 for up to 30 tablets Ursodiol tablet Urso Forte® 500mg $45 for up to 30 tablets Valacyclovir HCL tablet Valtrex® 1gm $30 up to 30 tabs / $75 up to 90 tabs Valacyclovir HCL tablet Valtrex® 500mg $21 up to 30 tabs / $50 up to 90 tabs Valproic acid capsule Depakene® / Stavzor® 250mg $20 $50 $80 Valsartan tablet Diovan® 40mg, 80mg $14 up to 30 tabs / $30 up to 90 tabs Valsartan tablet Diovan® 160mg, 320mg $18 up to 30 tabs / $40 up to 90 tabs Valsartan/HCTZ tablet Diovan HCT® 80/12.5mg, 160/12.5mg, 160/25mg, 320/12.5mg, 320/25mg $16 $35 $65 Vandazole 0.75% Gel Metronidazole Vaginal 70g tube $30 per tube Venlafaxine ER capsule Effexor XR® 37.5mg, 75mg, 150mg $19 $45 n/a Venlafaxine tablet Effexor® 25mg, 37.5mg, 50mg, 75mg, 100mg $19 $45 n/a Verapamil ER capsule Verelan® 120mg, 180mg, 240mg $21 up to 30 caps / $50 up to 90 caps Verapamil SR tablet Calan-SR® / Isoptin-SR® 120mg, 180mg, 240mg $12 $25 $40 Verapamil tablet Calan® 40mg, 80mg, 120mg $8 up to 30 tabs / $12 up to 90 tabs Vitamin B-6 tablet (OTC) N/A 50mg (No prescription required) $11 for a bottle of 100 Vitamin B-6 tablet (OTC) N/A 100mg (No prescription required) $7 for a bottle of 100 Vitamin D3 tablet (OTC) (cholecalciferol) N/A 400IU (No prescription required) $11 for a bottle of 100 Vitamin D3 capsule (OTC) N/A 50,000IU (No prescription required) $15 for 12 capsules Zafirlukast tablet Accolate® 10mg, 20mg $30 for 60 tablets Zaleplon capsule (CS) Sonata® 5mg, 10mg $16 up to 30 caps / $35 up to 90 caps Zidovudine tablet AZT / Retrovir® 300mg $30 for up to 60 tablets capsule Geodon® 20mg, 40mg, 60mg, 80mg $26 up to 30 caps / $65 up to 90 caps Zolpidem Tartrate ER tablet (CS) Ambien CR® 6.25mg, 12.5mg $25 up to 30 tabs / $72 up to 90 tabs Zolpidem Tartrate tablet (CS) Ambien® 5mg, 10mg $14 $30 n/a Zonegran® capsule Zonisamide 25mg Letter of necessity required $30 n/a Zonegran® capsule Zonisamide 100mg Letter of necessity required $20 for up to 90 capsules Zonisamide capsule Zonegran® 50mg, 100mg $18 for up to 90 capsules (CS) Controlled Substance

Rx Outreach is a fully licensed pharmacy. Rx Outreach reserves the right to add or delete medicines available, change fees, or discontinue the program at any time These are the only medications we offer at this time. If a medication is not on this list, it is not currently available from Rx Outreach. All prescriptions are evaluated by a pharmacist before being filled. For some medications, the quantity may be less because of dose restrictions set by therapeutic guidelines and state regulations.

Rx Outreach, Inc. / P. O. Box 66536 / St. Louis, MO 63166-6536 / 888-RXO-1234 / www.rxoutreach.org