General Fund Medication List 8/18/21

Drug Name Trade/Generic Name Brand/Generic MG #30 $ Charge #60 $ Charge #90 $ Charge Rexulti Brexpiprazole Brand 1 mg tab $1,397.02 $2,788.04 $4,179.06 Rexulti Brexpiprazole Brand 2 mg tab $1,397.02 $2,788.04 $4,179.06 Rexulti Brexpiprazole Brand 4 mg tab $1,397.02 $2,788.04 $4,179.06 Drizalma Sprinkles Duloxetine Brand 20mg sprk $215.58 $425.15 $634.73 Drizalma Sprinkles Duloxetine Brand 30 mg sprk $215.58 $425.15 $634.73 Drizalma Sprinkles Duloxetine Brand 40 mg sprk $215.58 $425.15 $634.73 Drizalma Sprinkles Duloxetine Brand 60 mg sprk $215.58 $425.15 $634.73 Gralise Gabapentin Brand 300 mg tab $327.63 $649.26 $970.89 Gralise Gabapentin Brand 600 mg tab $327.63 $649.26 $970.89 Vyvanse Lisdexamfetamine Brand 10 mg cap $379.84 $753.68 $1,127.52 Vyvanse Lisdexamfetamine Brand 20 mg cap $379.84 $753.68 $1,127.52 Vyvanse Lisdexamfetamine Brand 30 mg cap $379.84 $753.68 $1,127.52 Latuda Lurasidone Brand 20 mg tab $1,508.58 $3,011.16 $4,513.75 Latuda Lurasidone Brand 40 mg tab $1,508.58 $3,011.16 $4,513.75 Latuda Lurasidone Brand 60 mg tab $1,508.58 $3,011.16 $4,513.75 Latuda Lurasidone Brand 80 mg tab $1,508.58 $3,011.16 $4,513.75 Latuda Lurasidone Brand 120 mg tab $2,248.83 $4,491.65 $6,734.48 Daytrana Methylphenidate Brand 10 mg patch $474.70 $943.40 $1,412.10 Daytrana Methylphenidate Brand 15 mg patch $474.70 $943.40 $1,412.10 Daytrana Methylphenidate Brand 20 mg patch $474.70 $943.40 $1,412.10 Oxtellar XR Oxcarbazepine Brand 150 mg tab $259.81 $513.62 $767.44 Oxtellar XR Oxcarbazepine Brand 300 mg tab $358.61 $711.23 $1,063.84 Oxtellar XR Oxcarbazepine Brand 600 mg tab $651.60 $1,297.20 $1,942.80 Ingrezza Velbenazine Brand 40 mg tab $7,218.93 $14,431.86 $21,644.79 Ingrezza Velbenazine Brand 80 mg tab $7,865.99 $15,725.98 $23,585.96 Viibryd Vilazodone Brand 10 mg tab $340.96 $675.92 $1,010.87 Viibryd Vilazodone Brand 20 mg tab $340.96 $675.92 $1,010.87 Viibryd Vilazodone Brand 40 mg tab $340.96 $675.92 $1,010.87 Trintellix Vortioxetine Brand 5 mg tab $478.06 $950.12 $1,422.18 Trintellix Vortioxetine Brand 10 mg tab $478.06 $950.12 $1,422.18 Trintellix Vortioxetine Brand 20 mg tab $478.06 $950.12 $1,422.18 Aripiprazole Abilify Generic 30 mg tab $18.67 $19.56 $25.34 Aripiprazole Abilify Generic 20 mg tab $17.29 $17.72 $22.58 Aripiprazole Abilify Generic 15 mg tab $16.42 $16.56 $20.84 Aripiprazole Abilify Generic 10 mg tab $15.55 $15.40 $19.10 Aripiprazole Abilify Generic 5 mg tab $14.89 $14.52 $17.78 Aripiprazole Abilify Generic 2 mg tab $14.38 $18.76 $16.76 Dextroamphetamine/Amphetamine Adderall Generic 5 mg tab $18.98 $19.98 $25.96 Dextroamphetamine/Amphetamine Adderall Generic 10 mg tab $18.98 $19.98 $25.96 Dextroamphetamine/Amphetamine Adderall Generic 15 mg tab $18.98 $19.98 $25.96 Dextroamphetamine/Amphetamine Adderall XR Generic 5 mg cap $22.19 $31.32 $43.98 Dextroamphetamine/Amphetamine Adderall XR Generic 10 mg cap $22.19 $31.32 $43.98 Dextroamphetamine/Amphetamine Adderall XR Generic 15 mg cap $22.19 $31.32 $43.98 Clomipramine Anafril Generic 25 mg cap $14.35 $20.70 $27.04 Clomipramine Anafril Generic 50 mg cap $16.39 $24.78 $25.87 Clomipramine Anafril Generic 75 mg cap $17.23 $26.46 $27.76 Trihexyphenidyl Artane Generic 2 mg tab $12.23 $14.46 $16.70 Trihexyphenidyl Artane Generic 5 mg tab $14.82 $14.43 $17.65 Hydroxyzine HCL Atarax Generic 50 mg tab $12.68 $15.36 $18.05 Hydroxyzine HCL Atarax Generic 25 mg tab $12.21 $14.43 $16.64 Hydroxyzine HCL Atarax Generic 10 mg tab $11.41 $12.83 $14.24 Lorazepam Ativan Generic 2mg $14.02 $18.05 $16.05 Lorazepam Ativan Generic 0.5mg $12.68 $15.36 $18.05 Lorazepam Ativan Generic 1mg $12.70 $15.40 $18.10 Diphenhydramine Benadryl Generic 50 mg cap $12.20 $14.39 $16.59 Diphenhydramine Benadryl Generic 25 mg cap $12.08 $14.16 $16.24 Paroxetine Brisdelle Generic 7.5 mg cap $112.81 $193.99 $287.99 Buspirone Buspar Generic 30 mg tab $15.27 $15.02 $18.53 Buspirone Buspar Generic 10 mg tab $12.27 $14.54 $16.80 Buspirone Buspar Generic 5 mg tab $11.67 $13.33 $15.00 Buspirone Buspar Generic 15 mg tab $12.85 $15.71 $18.56 Clonidine Catapres Generic 0.3 mg tab $14.01 $18.01 $16.01 Clonidine Catapres Generic 0.2 mg tab $13.25 $16.50 $14.50 Clonidine Catapres Generic 0.1 mg tab $12.16 $14.32 $16.48 Citalopram Celexa Generic 40 mg tab $12.21 $14.41 $16.62 Citalopram Celexa Generic 20 mg tab $11.75 $13.49 $15.24 Citalopram Celexa Generic 10 mg tab $11.12 $12.23 $13.35 Clozapine Clozaril Generic 100 mg tab $22.73 $32.21 $45.32 Clozapine Clozaril Generic 200 mg tab $43.11 $80.21 $117.32 Clozapine Clozaril Generic 50 mg tab $26.02 $34.04 $39.80 Clozapine Clozaril Generic 25 mg tab $16.59 $25.17 $26.32 Benztropine Cogentin Generic 2 mg tab $14.96 $14.61 $17.92 Benztropine Cogentin Generic 1 mg tab $14.06 $18.12 $16.12 Benztropine Cogentin Generic 0.5 mg tab $13.48 $16.97 $14.97 Methylphenidate Concerta Generic 18 mg tab $24.53 $35.22 $49.83 Methylphenidate Concerta Generic 27 mg tab $24.93 $35.88 $50.82 Methylphenidate Concerta Generic 36 mg tab $25.55 $36.92 $52.37 Methylphenidate Concerta Generic 54 mg tab $26.41 $38.35 $54.52 Duloxetine Cymbalta Generic 60 mg cap $17.29 $17.72 $22.58 Duloxetine Cymbalta Generic 30 mg cap $16.75 $17.00 $21.50 Duloxetine Cymbalta Generic 20 mg cap $15.09 $14.78 $18.17 Valproic Acid Depakene Generic 250 mg cap $18.66 $22.99 $30.99 Divalproex Sod DR Depakote Generic 500mg tab $17.51 $18.01 $23.01 Divalproex Sod DR Depakote Generic 250mg tab $14.02 $18.05 $16.05 Divalproex Sod DR Depakote Generic 125mg tab $12.26 $14.52 $16.78 Divalproex Sod ER Depakote ER Generic 500mg tab $14.98 $21.97 $22.71 Divalproex Sod ER Depakote ER Generic 250mg tab $16.25 $16.33 $20.49 Divalproex Sod DR Depakote Sprinkle Generic 125 mg sprk $19.20 $23.80 $32.20 Trazodone Desyrel Generic 150 mg tab $14.84 $14.46 $17.68 Trazodone Desyrel Generic 100 mg tab $12.82 $15.63 $18.45 Trazodone Desyrel Generic 50 mg tab $11.51 $13.02 $14.54 Trazodone Desyrel Generic 300 mg tab $41.28 $76.56 $111.84 Dexamphetamine Dexedrine Generic 5 mg cap $19.65 $24.48 $33.22 Dexamphetamine Dexedrine Generic 10 mg cap $22.18 $28.27 $32.59 Dexamphetamine Dexedrine Generic 15 mg cap $25.65 $33.47 $39.09 Venlafaxine Effexor Generic 25 mg tab $12.28 $14.55 $16.83 Venlafaxine Effexor Generic 100 mg tab $14.87 $14.49 $17.74 Venlafaxine Effexor Generic 75 mg tab $14.17 $18.33 $16.33 Venlafaxine Effexor Generic 50 mg tab $14.18 $18.35 $16.35 Venlafaxine Effexor Generic 37.5 mg tab $13.55 $17.09 $15.09 Venlafaxine XR Effexor XR Generic 150 mg cap $18.40 $19.20 $24.80 Venlafaxine XR Effexor XR Generic 75 mg cap $14.88 $14.51 $17.76 Venlafaxine XR Effexor XR Generic 37.5 mg cap $13.48 $16.96 $14.96 Amitriptyline Elavil Generic 150 mg tab $23.19 $32.98 $46.47 Amitriptyline Elavil Generic 100 mg tab $15.20 $14.94 $18.40 Amitriptyline Elavil Generic 75 mg tab $14.00 $17.99 $15.99 Amitriptyline Elavil Generic 50 mg tab $14.18 $18.35 $16.35 Amitriptyline Elavil Generic 25 mg tab $14.96 $14.61 $17.92 Amitriptyline Elavil Generic 10 mg tab $13.06 $16.12 $14.12 Lithium Carb Eskalith Generic 300 mg cap $12.84 $15.67 $18.51 Lithium Carb Eskalith Generic 600 mg cap $17.32 $17.76 $22.63 Lithium Carb Eskalith Generic 150 mg cap $13.75 $17.51 $15.51 Dexmethylphenidate Focalin Generic 5 mg tab $14.93 $21.86 $22.59 Dexmethylphenidate Focalin Generic 10 mg tab $16.64 $25.28 $26.44 Ziprasidone Geodon Generic 80 mg cap $19.16 $23.74 $32.11 Ziprasidone Geodon Generic 60 mg cap $19.16 $23.74 $32.11 Ziprasidone Geodon Generic 40 mg cap $18.16 $22.24 $29.86 Ziprasidone Geodon Generic 20 mg cap $18.16 $22.24 $29.86 Haloperidol Haldol Generic 0.5 mg tab $19.34 $24.01 $32.52 Haloperidol Haldol Generic 1 mg tab $22.18 $28.27 $32.58 Haloperidol Haldol Generic 2 mg tab $25.82 $33.73 $39.41 Haloperidol Haldol Generic 10 mg tab $17.61 $27.21 $28.61 Haloperidol Haldol Generic 5 mg tab $21.12 $26.68 $36.52 Guanfacine ER Intuniv Generic 1 mg tab $25.07 $36.12 $51.18 Guanfacine ER Intuniv Generic 2 mg tab $14.55 $21.09 $27.64 Guanfacine ER Intuniv Generic 3 mg tab $25.07 $36.12 $51.18 Paliperidone Invega Generic 9 mg tab $86.08 $146.93 $217.40 Paliperidone Invega Generic 6 mg tab $71.30 $120.93 $178.39 Paliperidone Invega Generic 3 mg tab $71.30 $120.93 $178.39 Paliperidone Invega Generic 1.5 mg tab $71.30 $120.93 $178.39 Clonazepam Klonopin Generic 2mg $11.40 $12.79 $14.19 Clonazepam Klonopin Generic 1mg $11.29 $12.57 $13.86 Clonazepam Klonopin Generic 0.5mg $10.65 $11.30 $11.94 Clonazepam ODT Klonopin Wafers Generic 0.125mg tab $25.52 $33.28 $38.85 Clonazepam ODT Klonopin Wafers Generic 0.25 tab $23.64 $33.73 $47.59 Lamotrigine Lamictal Generic 200 mg tab $16.45 $16.60 $20.90 Lamotrigine Lamictal Generic 150 mg tab $15.37 $15.16 $18.74 Lamotrigine Lamictal Generic 100 mg tab $13.94 $17.88 $15.88 Lamotrigine Lamictal Generic 25 mg tab $12.01 $14.01 $16.02 Lamotrigine ODT Lamictal ODT Generic 5 mg ODT $14.80 $14.40 $17.60 Lamotrigine ODT Lamictal ODT Generic 25 mg ODT $15.76 $15.70 $19.54 Lamotrigine ER Lamotrigine ER Generic 25 mg tab $18.16 $22.24 $29.86 Lamotrigine ER Lamotrigine ER Generic 50 mg tab $26.36 $34.54 $40.42 Lamotrigine ER Lamotrigine ER Generic 100 mg tab $26.58 $34.87 $40.84 Escitalopram Lexapro Generic 20 mg tab $15.08 $14.77 $18.15 Escitalopram Lexapro Generic 10 mg tab $13.20 $16.39 $14.39 Escitalopram Lexapro Generic 5 mg tab $12.27 $14.54 $16.80 Chlordiazepoxide Librium Generic 25 mg cap $14.16 $18.32 $16.32 Lithium Carb ER Lithobid Generic 450 mg tab $17.07 $17.42 $22.13 Lithium Carb ER Lithobid Generic 300 mg tab $15.45 $15.27 $18.91 Fluvoxamine Luvox Generic 100 mg tab $16.50 $24.99 $26.12 Fluvoxamine Luvox Generic 50 mg tab $18.99 $19.99 $25.98 Fluvoxamine Luvox Generic 25 mg tab $17.56 $18.08 $23.12 Fluvoxamine ER Luvox CR Generic 100 mg cap $209.64 $413.29 $616.93 Fluvoxamine ER Luvox CR Generic 150 mg cap $224.55 $443.10 $661.64 Thioridazine Mellaril Generic 100 mg tab $23.80 $34.00 $48.00 Thioridazine Mellaril Generic 50 mg tab $27.68 $36.52 $42.90 Thioridazine Mellaril Generic 25 mg tab $23.73 $30.59 $35.49 Thioridazine Mellaril Generic 10 mg tab $19.18 $23.78 $32.16 Methylphenidate Metadate CD Generic 10 mg cap $39.77 $73.53 $107.30 Methylphenidate Metadate CD Generic 20 mg cap $39.77 $73.53 $107.30 Methylphenidate Metadate CD Generic 30 mg cap $39.77 $73.53 $107.30 Methylphenidate Metadate ER Generic 10 mg tab $23.64 $30.46 $35.33 Methylphenidate Metadate ER Generic 20 mg tab $22.76 $32.27 $45.40 Thiothixene Navane Generic 10 mg cap $36.56 $67.12 $97.68 Thiothixene Navane Generic 5 mg tab $33.01 $49.35 $71.03 Thiothixene Navane Generic 2 mg tab $24.15 $34.58 $48.86 Thiothixene Navane Generic 1 mg tab $24.02 $31.03 $36.04 Gabapentin Neurontin Generic 600 mg tab $14.63 $14.17 $17.25 Gabapentin Neurontin Generic 400 mg cap $14.20 $18.41 $16.41 Gabapentin Neurontin Generic 300 mg cap $13.35 $16.70 $14.70 Gabapentin Neurontin Generic 100 mg cap $12.24 $14.48 $16.72 Gabapentin Neurontin Generic 800 mg cap $15.91 $15.88 $19.83 Nortriptyline Pamelor Generic 75 mg cap $15.76 $15.68 $19.52 Nortriptyline Pamelor Generic 50 mg cap $14.20 $18.41 $16.41 Nortriptyline Pamelor Generic 25 mg cap $13.38 $16.77 $14.77 Nortriptyline Pamelor Generic 10 mg cap $12.56 $15.11 $17.67 Paroxetine Paxil Generic 40 mg tab $15.24 $22.48 $23.29 Paroxetine Paxil Generic 30 mg tab $18.94 $19.92 $25.88 Paroxetine Paxil Generic 20 mg tab $16.84 $17.12 $21.68 Paroxetine Paxil Generic 10 mg tab $14.80 $14.40 $17.60 Paroxetine ER Paxil ER Generic 25 mg tab $27.34 $39.90 $56.85 Paroxetine ER Paxil ER Generic 12.5 mg tab $26.50 $38.50 $54.75 Desvenlafaxine Pristiq Generic 25 mg tab $25.46 $33.19 $38.74 Desvenlafaxine Pristiq Generic 50 mg tab $24.40 $31.60 $36.75 Desvenlafaxine Pristiq Generic 100 mg tab $24.40 $31.60 $36.75 Fluphenazine Prolixin Generic 10 mg tab $102.47 $175.79 $260.68 Fluphenazine Prolixin Generic 5 mg tab $82.51 $140.66 $207.99 Fluphenazine Prolixin Generic 2.5 mg tab $62.55 $119.10 $155.29 Fluphenazine Prolixin Generic 1 mg tab $42.53 $79.06 $115.59 Fluoxetine Prozac Generic 20 mg cap $12.32 $14.64 $16.97 Fluoxetine Prozac Generic 10 mg cap $12.03 $14.07 $16.10 Fluoxetine Prozac Generic 10 mg tab $14.71 $14.28 $17.41 Fluoxetine Prozac Generic 20 mg tab $14.71 $14.28 $17.41 Fluoxetine Prozac Generic 40 mg cap $13.23 $16.46 $14.46 Fluoxetine Prozac Weekly (4 caps each) Generic 90 mg cap $151.84 $297.69 $443.53 Mirtazapine Remeron Generic 7.5 mg tab $34.00 $51.00 $73.50 Mirtazapine Remeron Generic 45 mg tab $16.06 $16.08 $20.12 Mirtazapine Remeron Generic 15 mg tab $13.33 $16.66 $14.66 Mirtazapine Remeron Generic 30 mg tab $14.80 $14.40 $17.60 Mirtazapine Sol-tabs Remeron Generic 45 mg ODT $25.12 $36.20 $51.30 Mirtazapine Sol-tabs Remeron Generic 30 mg ODT $23.77 $33.95 $47.93 Mirtazapine Sol-tabs Remeron Generic 15 mg ODT $25.10 $32.65 $38.06 Risperidone Risperdal Generic 4 mg tab $13.87 $17.74 $15.74 Risperidone Risperdal Generic 3 mg tab $13.45 $16.90 $14.90 Risperidone Risperdal Generic 2 mg tab $12.76 $15.52 $18.28 Risperidone Risperdal Generic 1 mg tab $12.06 $14.11 $16.17 Risperidone Risperdal Generic 0.5 mg tab $11.86 $13.72 $15.58 Risperidone Risperdal Generic 0.25 mg tab $11.80 $13.60 $15.40 Risperidone ODT Risperdal M-Tab Generic 4 mg tab $41.64 $77.28 $112.92 Risperidone ODT Risperdal M-Tab Generic 3 mg tab $37.42 $68.84 $100.26 Risperidone ODT Risperdal M-Tab Generic 2 mg tab $33.44 $60.88 $88.33 Risperidone ODT Risperdal M-Tab Generic 1 mg tab $35.43 $53.38 $77.08 Risperidone ODT Risperdal M-Tab Generic 0.5 mg tab $29.32 $43.20 $61.80 Risperidone ODT Risperdal M-Tab Generic 0.25 mg tab $94.58 $161.89 $239.84 Methylphenidate Ritalin Generic 5 mg tab $14.26 $18.51 $16.51 Methylphenidate Ritalin Generic 10 mg tab $17.04 $17.38 $22.08 Methylphenidate Ritalin Generic 20 mg tab $14.25 $20.49 $26.74 Methylphenidate Ritalin LA Generic 10 mg cap $47.37 $88.75 $130.12 Methylphenidate Ritalin LA Generic 20 mg cap $64.52 $123.05 $160.50 Methylphenidate Ritalin LA Generic 30 mg cap $93.44 $159.89 $236.83 Quetiapine Seroquel Generic 300 mg tab $14.95 $21.90 $22.64 Quetiapine Seroquel Generic 100 mg tab $13.80 $17.60 $15.60 Quetiapine Seroquel Generic 50 mg tab $12.45 $14.90 $17.34 Quetiapine Seroquel Generic 400 mg tab $16.56 $25.12 $26.26 Quetiapine Seroquel Generic 200 mg tab $16.85 $17.13 $21.70 Quetiapine Seroquel Generic 25 mg tab $11.55 $13.10 $14.64 Quetiapine Fumarate ER Seroquel XR Generic 400 mg tab $14.43 $22.85 $31.28 Quetiapine Fumarate ER Seroquel XR Generic 300 mg tab $13.19 $20.39 $27.58 Quetiapine Fumarate ER Seroquel XR Generic 200 mg tab $12.08 $18.16 $24.25 Quetiapine Fumarate ER Seroquel XR Generic 150 mg tab $11.24 $16.48 $21.72 Quetiapine Fumarate ER Seroquel XR Generic 50 mg tab $8.88 $11.77 $14.65 Nefazodone Serzone Generic 150 mg tab $55.10 $104.20 $135.62 Nefazodone Serzone Generic 200 mg tab $57.46 $108.93 $141.86 Nefazodone Serzone Generic 100 mg tab $52.78 $99.55 $129.49 Nefazodone Serzone Generic 50 mg tab $25.04 $36.06 $51.09 Doxepin Silenor Generic 3 mg tab $221.84 $437.68 $653.53 Doxepin Silenor Generic 6 mg tab $221.84 $437.68 $653.53 Doxepin Sinequan Generic 50 mg cap $15.10 $22.21 $22.98 Doxepin Sinequan Generic 75 mg cap $18.93 $23.40 $31.60 Doxepin Sinequan Generic 25 mg cap $17.45 $17.94 $22.90 Doxepin Sinequan Generic 10 mg cap $15.66 $15.55 $19.32 Trifluroperazine Stelazine Generic 1 mg tab $16.26 $16.34 $20.51 Trifluroperazine Stelazine Generic 10 mg tab $34.08 $62.17 $90.25 Trifluroperazine Stelazine Generic 5 mg tab $29.23 $43.05 $61.58 Trifluroperazine Stelazine Generic 2 mg tab $24.98 $35.96 $50.94 Atomoxetine Strattera Generic 60 mg tab $23.73 $33.88 $47.81 Atomoxetine Strattera Generic 40 mg tab $23.85 $34.08 $48.11 Atomoxetine Strattera Generic 25 mg tab $22.11 $31.18 $43.76 Atomoxetine Strattera Generic 18 mg tab $22.93 $32.55 $45.83 Atomoxetine Strattera Generic 10 mg tab $22.23 $31.38 $44.06 Carbamazepine Tegretol Generic 100 mg tab $24.43 $31.65 $36.81 Carbamazepine Tegretol Generic 200 mg tab $14.73 $21.46 $22.15 Guanfacine Tenex Generic 1 mg tab $24.67 $35.45 $50.18 Guanfacine Tenex Generic 2 mg tab $34.08 $51.14 $73.70 Chlorpramazine Thorazine Generic 100 mg tab $74.20 $126.03 $186.05 Chlorpromazine Thorazine Generic 200 mg tab $117.92 $202.98 $301.47 Chlorpromazine Thorazine Generic 50 mg tab $53.67 $101.35 $131.86 Chlorpromazine Thorazine Generic 25 mg tab $41.01 $76.02 $111.03 Chlorpromazine Thorazine Generic 10 mg tab $31.52 $57.05 $82.57 Imipramine Tofranil Generic 10 mg tab $17.70 $18.26 $23.39 Imipramine Tofranil Generic 25 mg tab $13.91 $17.81 $15.81 Imipramine Tofranil PM Generic 75mg cap $101.78 $174.56 $258.85 Imipramine Tofranil PM Generic 100 mg cap $101.78 $174.56 $258.85 Imipramine Tofranil PM Generic 125 mg cap $101.78 $174.56 $258.85 Topiramate Topamax Generic 50 mg tab $11.86 $13.72 $15.58 Topiramate Topamax Generic 200 mg tab $16.09 $16.12 $20.18 Topiramate Topamax Generic 100 mg tab $13.44 $16.87 $14.87 Topiramate Topamax Generic 25 mg tab $13.06 $16.12 $14.12 Perphenazine Trilafon Generic 4 mg tab $15.99 $23.97 $24.97 Perphenazine Trilafon Generic 2 mg tab $18.75 $19.66 $25.50 Oxcarbazepine Trileptal Generic 600 mg tab $24.69 $32.04 $37.30 Oxcarbazepine Trileptal Generic 300 mg tab $16.54 $25.09 $26.22 Oxcarbazepine Trileptal Generic 150 mg tab $17.96 $18.61 $23.91 Diazepam Valium Generic 10mg tab $10.99 $11.98 $12.97 Diazepam Valium Generic 5mg tab $10.87 $11.75 $12.62 Diazepam Valium Generic 2mg tab $11.13 $12.27 $13.40 Hydroxyzine PAM Vistaril Generic 100 mg cap $22.25 $31.41 $44.12 Hydroxyzine PAM Vistaril Generic 25 mg cap $13.57 $17.15 $15.15 Hydroxyzine PAM Vistaril Generic 50 mg cap $17.19 $17.59 $22.38 Bupropion Wellbutrin Generic 75 mg tab $15.45 $15.26 $18.89 Bupropion Wellbutrin Generic 100 mg tab $16.12 $16.16 $20.24 Bupropion SR Wellbutrin SR Generic 200 mg tab $14.30 $18.60 $16.60 Bupropion SR Wellbutrin SR Generic 100 mg tab $13.15 $16.30 $14.30 Bupropion SR Wellbutrin SR Generic 150 mg tab $14.39 $18.78 $16.78 Bupropion XL Wellbutrin XL Generic 300 mg tab $17.82 $18.43 $23.64 Bupropion XL Wellbutrin XL Generic 150 mg tab $15.58 $15.44 $19.16 Alprazolam Xanax Generic 2mg $13.03 $16.07 $14.07 Alprazolam Xanax Generic 1mg $12.28 $14.55 $16.83 Alprazolam Xanax Generic 0.5mg $12.02 $14.03 $16.05 Alprazolam Xanax Generic 0.25mg $11.99 $13.98 $15.97 Sertraline Zoloft Generic 100 mg tab $13.86 $17.72 $15.72 Sertraline Zoloft Generic 50 mg tab $12.34 $14.68 $17.02 Sertraline Zoloft Generic 25 mg tab $11.49 $12.98 $14.47 Olanzapine Zyprexa Generic 20 mg tab $14.86 $21.72 $22.44 Olanzapine Zyprexa Generic 15 mg tab $14.02 $20.04 $26.06 Olanzapine Zyprexa Generic 2.5 mg tab $13.36 $16.72 $14.72 Olanzapine Zyprexa Generic 10 mg tab $16.27 $16.36 $20.54 Olanzapine Zyprexa Generic 7.5 mg tab $14.77 $14.36 $17.54 Olanzapine Zyprexa Generic 5 mg tab $13.99 $17.98 $15.98 Olanzapine ODT Zyprexa Zydis Generic 20 mg ODT $36.30 $54.83 $79.24 Olanzapine ODT Zyprexa Zydis Generic 10 mg ODT $27.36 $36.04 $42.30 Olanzapine ODT Zyprexa Zydis Generic 5 mg ODT $18.94 $23.41 $31.62 Olanzapine ODT Zyprexa Zydis Generic 15 mg ODT $31.93 $47.55 $68.33 Injectable and Liquids 8/18/21

Name Trade/Generic Name Brand/Generic Strength 1 Box/Vial 2 Boxes/Vials 3 Boxes/Vials Abilify Maintena Aripiprazole Brand 300mg $2,005.15 $4,010.29 $6,015.44 Abilify Maintena Aripiprazole Brand 400mg $2,671.53 $5,343.06 $8,014.59 Aristada Aripiprazole Lauroxil Brand 441mg $1,583.56 $3,167.12 $4,750.68 Aristada Aripiprazole Lauroxil Brand 662mg $2,374.13 $4,748.27 $7,122.40 Aristada Aripiprazole Lauroxil Brand 882mg $3,161.11 $6,322.22 $9,483.33 Aristada Initio Aripiprazole Lauroxil Brand 675mg $2,420.63 $4,841.27 $7,261.90 Invega Sustenna Paliperidone Palmitate Brand 117mg $1,646.50 $3,293.00 $4,939.50 Invega Sustenna Paliperidone Palmitate Brand 156mg $2,193.42 $4,386.83 $6,580.25 Invega Sustenna Paliperidone Palmitate Brand 234mg $3,287.05 $6,574.10 $9,861.15 Invega Trinza Paliperidone Palmitate Brand 410mg $4,927.52 $9,855.05 $14,782.57 Invega Trinza Paliperidone Palmitate Brand 546mg $6,568.25 $13,136.49 $19,704.74 Invega Trinza Paliperidone Palmitate Brand 819mg $9,849.16 $19,698.31 $29,547.47 Perseris Risperidone Brand 90mg/0.6ml $2,109.96 $4,219.92 $6,329.87 Perseris Risperidone Brand 120mg/0.8ml $2,811.29 $5,622.58 $8,433.87 Risperdal Consta Risperidone Brand 25mg $600.73 $1,201.45 $1,802.18 Risperdal Consta Risperidone Brand 37.5mg $898.13 $1,796.26 $2,694.39 Risperdal Consta Risperidone Brand 50mg $1,195.54 $2,391.07 $3,586.61 Fluphenazine Deconate Prolixin Generic 25mg/1ml (1x5ml) $71.64 $121.52 $179.28 Haloperidol Decanoate Haldol Decanoate Generic 50mg/1ml (SDV 1ml) $24.23 $31.34 $36.43 Haloperidol Decanoate Haldol Decanoate Generic 100mg/1ml (SDV 1ml) $29.59 $43.65 $62.48 Valproate Sodium Depacon Generic 100mg/1ml (1x5ml) $26.42 $34.61 $40.52 Valproic Acid Depakene Generic 250mg/5ml (473ml) $18.32 $22.47 $30.21 Wayne County Genoa Healthcare Pharmacy Locations

Covenant Community Care & Development Centers, Inc. & Southwest Solutions Wellness Center at McKinney Center 5716 Michigan Ave 19750 Burt Road, Suite P Detroit, MI 48210 Detroit, MI 48219 Phone: (313) 989-0536 Phone: 313-221-5494 Fax: (313) 894-2965 Fax: 313-736-5984 Hours: M: 8:30am-6:00pm; Tu: 8am-5pm; Hours: M,W,Th,Fri: 8:30-5pm; Tues 10am-6:30pm W, Th & Fr: 8:00am-4pm Closed for lunch: 1pm-1:30pm Closed for Lunch Daily: 12:30pm-1pm

Development Centers, Inc. Community Care Services 24424 W McNichols Rd 26184 West Outer Drive Detroit, MI 48219 Lincoln Park, MI 48146 Phone: (313) 989-0249 Phone: (734) 333-7027 Fax: (313) 537-7972 Fax: (313) 329-6365 Hours: Mon - Fri: 8:30am- 5pm Hours: Monday: 9am-6:30pm, Closed for Lunch: 1 - 1:30pm Tuesday-Thursday: 9am-5:30pm, Friday: 9am-5pm Closed for Lunch: M-Th:12pm-12:30pm, Fr:12pm-1pm

Southwest Solutions Lincoln Behavioral Services 1700 Waterman St 9327 Telegraph Rd. Detroit, MI 48209 Redford, MI 48239 Phone: (313) 842-9660 Phone: (313) 486-2579 Fax: (313) 842-9662 Fax: (313) 535-1934 Hours: M,W,Th,Fr: 9am-5pm, Tu: 9am-7pm Hours: M: 9:30am-6:00pm, Tu-Fr: 8:30am-5:00pm Closed for Lunch: 12:30pm-1pm Closed for Lunch Daily: 12:30pm-1:00pm

CNS Healthcare The Guidance Center 12800 E Warren Ave 13101 Allen Road, Bldg 4, Ste 511 Detroit, MI 48215 Southgate, MI 48195 Phone: (313) 347-2025 Phone: 734-374-2335 Fax: (313) 821-9015 Fax: 734-374-2339 Hours: Monday - Friday: 8:30am-5pm Hours: Mon - Fri: 8:30am- 5pm Closed for Lunch: 12:30pm-1pm Closed for Lunch Daily: 12:30pm-1:00pm