Johns Hopkins Pharmacy Medication Access List

Drug Name 30 Day - $11 90 Day - $18 Drug Name 30 Day - $11 90 Day - $18 Antibiotic Diabetes (continued)

Amoxicillin 125mg/5ml suspension 150 ml N/A Glyburide 2.5mg tablets 30 90 Amoxicillin 200mg/5ml suspension 100 ml N/A Glyburide 5mg tablets 30 90 Amoxicillin 250mg/5ml suspension 100 ml N/A Glyburide Micro 3mg tablets 30 90 Amoxicillin 400mg/5ml suspension 100 ml N/A Glyburide Micro 6mg tablets 30 90 Amoxicillin 250mg capsules 30 N/A Metformin 500mg tablets 60 180 Amoxicillin 500mg capsules 30 N/A Metformin 850mg tablets 60 180 Cephalexin 250mg capsules 28 N/A Metformin 1000mg tablets 60 180 Cephalexin 500mg capsules 30 N/A Metformin 500mg ER tablets 60 180 Ciprofloxacin 250mg tablets 14 N/A Ciprofloxacin 500mg tablets 20 N/A Ear Care Penicillin VK 125mg/5ml suspension 200 ml N/A Penicillin VK 250mg/5ml suspension 200 ml N/A Antipyr/Benzocaine solution 10 ml N/A Penicillin VK 250mg tablets 28 N/A SMZ/TMP 400/80mg tablets 20 N/A Fungal Infections SMZ/TMP 800/160mg tablets 28 N/A Fluconazole 150mg tablets 1 N/A Arthritis Nystatin cream 15 gm N/A Allopurinol 100mg tablets 30 90 Gastrointestinal Cyclobenzaprine 5mg tablets 90 270 Cyclobenzaprine 10mg tablets 90 270 Dicyclomine 10mg capsules 120 360 Dexamethasone 0.5mg tablets 30 N/A Lactulose 10gm/15ml solution 237 ml N/A Dexamethasone 0.75mg tablets 12 N/A Metoclopramide 10mg tablets 60 180 Dexamethasone 4mg tablets 40 N/A Metoclopramide 5mg/5ml syrup 60 ml 180 ml Ibuprofen 100mg/5ml suspension 120 ml N/A Prochlorperazine 10mg tablets 30 90 Ibuprofen 400mg tablets 60 N/A Promethazine 25mg tablets 30 90 Ibuprofen 600mg tablets 60 N/A Promethazine 6.25mg/5ml syrup 180 ml N/A Ibuprofen 800mg tablets 60 N/A Ranitidine 150mg tablets 60 180 Indomethacin 25mg capsules 60 N/A Ranitidine 300mg tablets 30 90 Meloxicam 7.5mg tablets 30 N/A Meloxicam 15mg tablets 30 N/A Glaucoma/Eye Care Naproxen 375mg tablets 60 180 Naproxen 500mg tablets 60 180 Gentamicin 3% solution 5 ml 15 ml Polymyxin B/TMP solution 10 ml N/A Asthma Timolol 0.25% solution 5 ml 15 ml Timolol 0.5% solution 5 ml 15 ml Albuterol 0.83mg/ml solution 75 ml 225 ml Tobramycin ophthalmic solution 5 ml 15 ml Albuterol sulf 2mg/5ml syrup 120 ml 360 ml Heart/Blood Pressure Cholesterol Atenolol 25mg tablets 30 90 Atorvastatin 10mg tablets 30 90 Atenolol 50mg tablets 30 90 Atorvastatin 20mg tablets 30 90 Atenolol 100mg tablets 30 90 Atorvastatin 40mg tablets 30 90 Benazepril 5mg tablets 30 90 Atorvastatin 80mg tablets 30 90 Benazepril 10mg tablets 30 90 Lovastatin 10mg tablets 30 90 Benazepril 20mg tablets 30 90 Lovastatin 20mg tablets 30 90 Benazepril 40mg tablets 30 90 Simvastatin 10mg tablets 30 90 Bisoprolol/HCTZ 2.5/6.25mg tablets 30 90 Simvastatin 20mg tablets 30 90 Bisoprolol/HCTZ 5/6.25mg tablets 30 90 Simvastatin 40mg tablets 30 90 Bisoprolol/HCTZ 10/6.25mg tablets 30 90 Simvastatin 80mg tablets 30 90 Carvedilol 3.125mg tablets 60 180 Carvedilol 6.25mg tablets 60 180 Cold/Flu/Allergy Carvedilol 12.5mg tablets 60 180 Carvedilol 25mg tablets 60 180 Benzonatate 100mg capsules 14 N/A Clonidine 0.1mg tablets 60 180 Loratadine 10mg tablets 30 90 Clonidine 0.2mg tablets 60 180 Promethazine DM syrup 120 ml N/A Enalapril/HCTZ 5/12.5mg tablets 30 90 Furosemide 20mg tablets 30 90 Diabetes Furosemide 40mg tablets 30 90 Furosemide 80mg tablets 30 90 Glimepiride 1mg tablets 30 90 Guanfacine 1mg tablets 30 90 Glimepiride 2mg tablets 30 90 Hydralazine 10mg tablets 60 180 Glimepiride 4mg tablets 30 90 Hydralazine 25mg tablets 60 180 Glipizide 5mg tablets 30 90 Glipizide 10mg tablets 60 180 continued on back Johns Hopkins Pharmacy Medication Access List

Drug Name 30 Day - $11 90 Day - $18 Drug Name 30 Day - $11 90 Day - $18 Heart/Blood Pressure (cont.) Misc. Conditions

Hydrochlorothiazide 10mg tablets 30 90 Methylprednisolone 4mg Dosepak tablets 21 N/A Hydrochlorothiazide 12.5mg capsules 30 90 Prednisone 2.5mg tablets 30 N/A Hydrochlorothiazide 25mg tablets 30 90 Prednisone 5mg tablets 30 N/A Indapamide 1.25mg tablets 30 N/A Prednisone 10mg tablets 30 N/A Indapamide 2.5mg tablets 30 N/A Prednisone 20mg tablets 30 N/A Lisinopril 2.5mg tablets 30 90 Lisinopril 5mg tablets 30 90 Mouth/Throat/Dental Lisinopril 10mg tablets 30 90 Lisinopril 20mg tablets 30 90 Chlorhexidine Gluconate 12% solution 473 ml N/A Lisinopril/HCTZ 10/12.5mg tablets 30 90 Lidocaine 2% Viscous solution 100 ml N/A Lisinopril/HCTZ 20/12.5mg tablets 30 90 Lisinopril/HCTZ 20/25mg tablets 30 90 Skin Conditions Methyldopa 250mg tablets 60 180 Metoprolol tartrate 25mg tablets 60 180 Hydrocortisone 2.5% cream 20 gm N/A Metoprolol tartrate 50mg tablets 60 180 Triamcinolone 0.025% cream 80 gm N/A Metoprolol tartrate 100mg tablets 60 180 Triamcinolone 0.1% cream 15 gm N/A Nitrostat sublingual 0.4mg tablets 25 N/A Triamcinolone 0.1% ointment 15 gm N/A Propranolol 10mg tablets 60 180 Triamcinolone 0.5% cream 15 gm N/A Propranolol 20mg tablets 60 180 Sotalol 80mg tablets 30 90 Spironolactone 25mg tablets 30 90 Viruses Terazosin 1mg capsules 30 90 Terazosin 2mg capsules 30 90 Acyclovir 200mg capsules 30 N/A Terazosin 5mg capsules 30 90 Terazosin 10mg capsules 30 90 Vitamins/Nutritional Triamterene/HCTZ 37.5/25 tablets 30 90 Triamterene/HCTZ 75/50 tablets 30 90 Folic Acid 1mg tablets 30 90 Verapamil 80mg tablets 30 90 Prenatal Plus tablets 30 90 Verapamil 120mg tablets 30 90 Warfarin 1mg tablets 30 N/A Women's Health Warfarin 2mg tablets 30 N/A Warfarin 2.5mg tablets 30 N/A Alendronate 35mg tablets 4 12 Warfarin 3mg tablets 30 N/A Alendronate 70mg tablets 4 12 Warfarin 4mg tablets 30 N/A Clomiphene Citrate 50mg tablets 5 N/A Warfarin 5mg tablets 30 N/A Estradiol 0.5mg tablets 30 90 Warfarin 6mg tablets 30 N/A Estradiol 1mg tablets 30 90 Warfarin 7.5mg tablets 30 N/A Estradiol 2mg tablets 30 90 Warfarin 10mg tablets 30 N/A Medroxyprogesterone 2.5mg tablets 30 90 Medroxyprogesterone 5mg tablets 30 90 Mental Health Medroxyprogesterone 10mg tablets 10 30 Megestrol 20mg tablets 30 90 Amitriptyline 10mg tablets 30 90 Buspirone 5mg tablets 30 180 Buspirone 10mg tablets 30 180 Carbamazepine 200mg tablets 30 180 Citalopram 20mg tablets 30 90 To be eligible for the Generic Drug Program, you must not have any Citalopram 40mg tablets 30 90 prescription drug insurance or benefits through: private insurance, Fluoxetine 10mg capsules 30 90 employer-sponsored insurance, HMOs, Medicaid, Medicare Fluoxetine 20mg capsules 30 90 prescription coverage (part B and Part D), State Pharmacy Assistance Fluoxetine 40mg capsules 30 90 Programs (SPAP, SCHIP, PACE, etc.), coverage under federal or state Fluphenazine 1mg tablets 30 90 exchanges, or veterans assistance. Haloperidol 0.5mg tablets 30 90 Haloperidol 1mg tablets 30 90 You also must reside in the United States and have a treating Haloperidol 2mg tablets 30 90 physician licensed in the United States. The program is offered to Lithium Carbonate 300mg capsules 90 270

Nortriptyline 10mg capsules 30 90 all patients regardless of age or income. Discounts offered through Nortriptyline 25mg capsules 30 90 the Generic Drug Program are not insurance and are not intended Paroxetine 10mg tablets 30 90 to substitute for insurance. Paroxetine 20mg tablets 30 90 Sertraline 25mg tablets 30 90 This prescription list is subject to change without notice. Trazodone 50mg tablets 30 90 Trazodone 100mg tablets 30 90 Trazodone 150mg tablets 30 90