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Tier 1 Preventive Drugs the Following Preferred Drug List Is an Abbreviated Version of Commonly Generics: $0: -Day 1 Prescribed Medications

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Tier 1 Preventive Drugs the Following Preferred Drug List Is an Abbreviated Version of Commonly Generics: $0: -Day 1 Prescribed Medications Tier 1 Preventive Drugs The following Preferred Drug List is an abbreviated version of commonly Generics: $0: -Day 1 prescribed medications. This list is intended to be a guide and prescriber's should still use generics when possible. A E GARDASIL 9 SUSY NICOTINE LOZENGE GAVILYTE-C NICOTINE POLACRILEX ADACEL ECOTRIN (ALL STRENGTHS/FORMS) GAVILYTE-H NICOTINE TRANSDERMAL SYSTEM AFLURIA PRESERVATIVE FREE ECPIRIN 325 MG TAB DR GAVILYTE-N/FLAVOR PACK NORETHINDRONE AFLURIA PRESERVATIVE FREE SUSY 0.5ML ENGERIX-B GIANVI NORETHINDRONE & ETHINYL ESTRADIOL FERROUS FUMARATE AFLURIA QUADRIVALENT ENGERIX-B INJ 10MCG/0.5ML GOODSENSE ASPIRIN (ALL STRENGTHS/FORMS) NORETHINDRONE ACETATE/ETHINYL ESTRADIOL AFLURIA QUADRIVALENT SUSY 0.25ML ENGERIX-B INJ 20MCG/ML GOODSENSE NICOTINE GUM NORETHINDRONE ACETATE/ETHINYL ESTRADIOL/FERROUS FUMARATE AFLURIA SUSP ENGERIX-B SUSP 10MCG/0.5ML GOODSENSE NICOTINE POLACRILEX NORETHINDRONE/ETHINYL ESTRADIOL/FERROUS FUMARATE AMETHYST ENGERIX-B SUSP 20MCG/ML NORTREL 0.5/35 (28) ARANELLE ENPRESSE-28 NORTREL 1/35 ASPIR-LOW 81 MG TAB DR EQ NICOTINE H HAVRIX NORTREL 7/7/7 ASPIRIN 325 MG TAB ERYTHROMYCIN HAVRIX SUSP 1440EL U/ML NORWICH ASPIRIN 325 MG TAB ASPIRIN 81 MG CHEW TAB ERYTHROMYCIN OIN 5MG/GM HAVRIX SUSP 720EL U/0.5ML ASPIRIN ADULT LOW DOSE 81 MG TAB DR ETHYNODIOL DIACETATE/ETHINYL ESTRADIOL HEPLISAV-B ASPIRIN CHILDRENS 81 MG CHEW TAB EZ FLU SHOT-FLUCELVAX QUAD O HEPLISAV-B SOLN 20MCG/0.5ML OPTION 2 ASPIRIN EC 325 MG TAB DR EZ FLU SHOT-FLUCELVAX QUAD PSKT 0.5ML HEPLISAV-B SOSY 20MCG/0.5ML ORSYTHIA ASPIRIN EC 81 MG TAB DR ASPIRIN EC LOW DOSE 81 MG TAB F ASPIRIN EC LOW STRENGTH 81 MG TAB DR FA-8 800 MCG TAB I P INFANRIX PEG 3350/ELECTROLYTES ASPIRIN LOW DOSE 81 MG CHEW TAB FER-IRON PEG-3350/ELECTROLYTES ASPIRTAB 324 MG TAB DR FLUAD PEG-3350/NACL/NA BICARBONATE/KCL ASPIRTAB MAXIMUM STRENGTH 500 MG TAB FLUAD SUSY 0.5ML J JUNEL FE 1.5/30 PEG-PREP ATORVASTATIN CALCIUM FLUBLOK QUADRIVALENT FLUBLOK QUADRIVALENT SOSY 0.5ML JUNEL FE 24 PFIZER-BIONTECH COVID-19 VACC B FLUCELVAX QUADRIVALENT PNEUMOVAX 23 PNEUMOVAX 23 INJ 25MCG/0.5ML BALZIVA FLUCELVAX QUADRIVALENT SUSP K KELNOR 1/50 PRAVASTATIN SODIUM BAYER ASPIRIN (ALL STRENGTHS/FORMS) FLUCELVAX QUADRIVALENT SUSY 0.5ML KP BISACODYL PREVIFEM BEXSERO FLULAVAL QUADRIVALENT PREVNAR 13 BEXSERO SUSY FLULAVAL QUADRIVALENT SUSP PREVNAR 13 SUSP BISACODYL FLULAVAL QUADRIVALENT SUSY 0.5ML L LEVONORGESTREL/ETHINYL ESTRADIOL PROQUAD BISACODYL EC FLUORABON DRO LOVASTATIN PROQUAD SUSR BOOSTRIX FLUORITAB CHW 0.25MG F BUPROPION HYDROCHLORIDE ER (SR) FLUORITAB CHW 0.5MG F BUPROPION TAB FLUORITAB CHW 1MG F M R FLUORITAB DRO 0.125MG M-M-R II RA MAGNESIA C FLURA-DROPS DRO 0.25MG F MAGNESIUM CITRATE RA NICOTINE TRANSDERMAL SYSTEM REFILL MEDIQUE ASPIRIN 325 MG TAB RA NICOTINE TRANSDERMAL SYSTEM STARTER KIT CAMRESE FLUVASTATIN MEDROXYPR AC INJ 150MG/ML RALOXIFENE HYDROCHLORIDE CAMRESE LO FLUVASTATIN SODIUM ER MENACTRA RECLIPSEN CHANTIX FLUZONE HIGH-DOSE MENACTRA INJ RECOMBIVAX HB CHANTIX CONTINUING MONTHPAK FLUZONE HIGH-DOSE SUSY 0.5ML MENVEO RECOMBIVAX HB SUSP 10MCG/ML CHANTIX STARTING MONTH PAK FLUZONE QUADRIVALENT MENVEO SOLR RECOMBIVAX HB SUSP 40MCG/ML CITRATE OF MAGNESIA FLUZONE QUADRIVALENT SUSP 0.5ML MILK OF MAGNESIA RECOMBIVAX HB SUSP 5MCG/0.5ML CRYSELLE-28 FOLATE 400 MCG TAB FOLIC ACID 1 MG TAB MILK OF MAGNESIA CONCENTRATE RIVELSA D FOLIC ACID 400 MCG TAB MINIPRIN LOW DOSE | 81 MG TAB DR ROSUVASTATIN CALCIUM MODERNA COVID-19 VACCINE DAPTACEL FOLIC ACID 800 MCG TAB DESOGESTREL/ETHINYL ESTRADIOL S SHINGRIX DIPHTHERIA-TETANUS TOXOIDS DT G N NICOTINE SHINGRIX SUSR 50MCG/0.5ML DROSPIRENONE/ETHINYL ESTRADIOL GARDASIL 9 NICOTINE GUM SIMVASTATIN DROSPIRENONE/ETHINYL ESTRADIOL/LEVOMEFOLATE CALCIUM GARDASIL 9 SUSP ® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. SOD FLUORIDE DRO 0.5MG/ML A ALENDRONATE SODIUM TABS 70MG AMITRIPTYLINE HCL TABS 50MG SOD FLUORIDE TAB 0.5MG F ABACAVIR SULFATE-LAMIVUDINE TABS 600-300MG ALFENTANIL HCL SOLN 1000MCG/2ML AMITRIPTYLINE HCL TABS 75MG SOD FLUORIDE TAB 1MG F ACAMPROSATE CALCIUM TBEC 333MG ALFENTANIL HCL SOLN 2500MCG/5ML AMLODIPINE BESY-BENAZEPRIL HCL CAPS 10-20MG ST JOSEPH ASPIRIN (ALL STRENGTHS/FORMS) ACARBOSE TABS 100MG ALFUZOSIN HCL ER TB24 10MG AMLODIPINE BESY-BENAZEPRIL HCL CAPS 10-40MG ACARBOSE TABS 25MG ALISKIREN FUMARATE TABS 150MG AMLODIPINE BESY-BENAZEPRIL HCL CAPS 2.5-10MG T ACEBUTOLOL HCL CAPS 200MG ALISKIREN FUMARATE TABS 300MG AMLODIPINE BESY-BENAZEPRIL HCL CAPS 5-10MG TAMOXIFEN CITRATE ACEBUTOLOL HCL CAPS 400MG ALLOPURINOL SODIUM SOLR 500MG AMLODIPINE BESY-BENAZEPRIL HCL CAPS 5-20MG TENIVAC ACETAMINOPHEN-CODEINE #2 TABS 300-15MG ALLOPURINOL TABS 100MG AMLODIPINE BESY-BENAZEPRIL HCL CAPS 5-40MG TETANUS-DIPHTHERIA TOXOIDS TD ACETAMINOPHEN-CODEINE #3 TABS 300-30MG ALLOPURINOL TABS 300MG AMLODIPINE BESYLATE TABS 10MG THRIVE ACETAMINOPHEN-CODEINE #4 TABS 300-60MG ALMOTRIPTAN MALATE TABS 12.5MG AMLODIPINE BESYLATE TABS 2.5MG TRI-LEGEST FE ACETAMINOPHEN-CODEINE SOLN 120-12MG/5ML ALMOTRIPTAN MALATE TABS 6.25MG AMLODIPINE BESYLATE TABS 5MG TRI-LO-SPRINTEC ACETAZOLAMIDE ER CP12 500MG ALOSETRON HCL TABS 0.5MG AMLODIPINE BESYLATE-VALSARTAN TABS 10-160MG TRI-PREVIFEM ACETAZOLAMIDE SODIUM SOLR 500MG ALOSETRON HCL TABS 1MG AMLODIPINE BESYLATE-VALSARTAN TABS 10-320MG TRUMENBA ACETAZOLAMIDE TABS 125MG ALPRAZOLAM ER TB24 0.5MG AMLODIPINE BESYLATE-VALSARTAN TABS 5-160MG TRUMENBA SUSY ACETAZOLAMIDE TABS 250MG ALPRAZOLAM ER TB24 1MG AMLODIPINE BESYLATE-VALSARTAN TABS 5-320MG TWINRIX ACETIC ACID SOLN 0.25% ALPRAZOLAM ER TB24 2MG AMLODIPINE-ATORVASTATIN TABS 10-10MG TWINRIX SUSY 720-20ELU-MCG/ML ACETIC ACID SOLN 2% ALPRAZOLAM ER TB24 3MG AMLODIPINE-ATORVASTATIN TABS 10-20MG ACETYLCYSTEINE SOLN 10% ALPRAZOLAM TABS 0.25MG AMLODIPINE-ATORVASTATIN TABS 10-40MG V ACETYLCYSTEINE SOLN 20% ALPRAZOLAM TABS 0.5MG AMLODIPINE-ATORVASTATIN TABS 10-80MG VARIVAX ACETYLCYSTEINE SOLN 200MG/ML ALPRAZOLAM TABS 1MG AMLODIPINE-ATORVASTATIN TABS 2.5-10MG VARIVAX INJ 1350PFU/0.5ML ACYCLOVIR CAPS 200MG ALPRAZOLAM TABS 2MG AMLODIPINE-ATORVASTATIN TABS 2.5-20MG VELIVET ACYCLOVIR CREA 5% ALPRAZOLAM TBDP 0.25MG AMLODIPINE-ATORVASTATIN TABS 2.5-40MG Tier 2 ACYCLOVIR OINT 5% ALPRAZOLAM TBDP 0.5MG AMLODIPINE-ATORVASTATIN TABS 5-10MG Z Generics: ACYCLOVIR SODIUM SOLN 50MG/ML ALPRAZOLAM TBDP 1MG AMLODIPINE-ATORVASTATIN TABS 5-20MG ZOSTAVAX $15.00 - After ACYCLOVIR SUSP 200MG/5ML ALPRAZOLAM TBDP 2MG AMLODIPINE-ATORVASTATIN TABS 5-40MG ZOSTAVAX SUSR 19400UNT/0.65ML deductible ACYCLOVIR TABS 400MG ALPROSTADIL SOLN 500MCG/ML AMLODIPINE-ATORVASTATIN TABS 5-80MG ACYCLOVIR TABS 800MG ALTAFLUOR SOLN 0.25-0.4% AMLODIPINE-OLMESARTAN TABS 10-20MG ADAPALENE CREA 0.1% AMANTADINE HCL CAPS 100MG AMLODIPINE-OLMESARTAN TABS 10-40MG ADAPALENE GEL 0.1% AMANTADINE HCL SYRP 50MG/5ML AMLODIPINE-OLMESARTAN TABS 5-20MG ADAPALENE GEL 0.3% AMANTADINE HCL TABS 100MG AMLODIPINE-OLMESARTAN TABS 5-40MG ADAPALENE-BENZOYL PEROXIDE GEL 0.1-2.5% AMETHYST TABS 90-20MCG AMLODIPINE-VALSARTAN-HCTZ TABS 10-160-12.5MG ADENOSINE (DIAGNOSTIC) SOLN 3MG/ML AMIKACIN SULFATE SOLN 1GM/4ML AMLODIPINE-VALSARTAN-HCTZ TABS 10-160-25MG ADENOSINE SOLN 12MG/4ML AMIKACIN SULFATE SOLN 500MG/2ML AMLODIPINE-VALSARTAN-HCTZ TABS 10-320-25MG ADENOSINE SOLN 6MG/2ML AMILORIDE HCL TABS 5MG AMLODIPINE-VALSARTAN-HCTZ TABS 5-160-12.5MG ADRUCIL SOLN 2.5GM/50ML AMILORIDE-HYDROCHLOROTHIAZIDE TABS 5-50MG AMLODIPINE-VALSARTAN-HCTZ TABS 5-160-25MG ADRUCIL SOLN 500MG/10ML AMINOACETIC ACID SOLN 1.5% AMMONIUM LACTATE CREA 12% ADRUCIL SOLN 5GM/100ML AMINOCAPROIC ACID SOLN 0.25GM/ML AMMONIUM LACTATE LOTN 12% ALBENDAZOLE TABS 200MG AMINOCAPROIC ACID SOLN 250MG/ML AMNESTEEM CAPS 10MG ALBUTEROL SULFATE NEBU (2.5 MG/3ML)0.083% AMINOCAPROIC ACID TABS 1000MG AMNESTEEM CAPS 20MG ALBUTEROL SULFATE NEBU (5 MG/ML)0.5% AMINOCAPROIC ACID TABS 500MG AMNESTEEM CAPS 40MG ALBUTEROL SULFATE NEBU 0.63MG/3ML AMINOPHYLLINE SOLN 25MG/ML AMOXICILL-CLARITHRO-LANSOPRAZ MISC ALBUTEROL SULFATE NEBU 1.25MG/3ML AMIODARONE HCL SOLN 150MG/3ML AMOXICILLIN CAPS 250MG ALBUTEROL SULFATE SYRP 2MG/5ML AMIODARONE HCL SOLN 450MG/9ML AMOXICILLIN CAPS 500MG ALBUTEROL SULFATE TABS 2MG AMIODARONE HCL SOLN 900MG/18ML AMOXICILLIN SUSR 125MG/5ML ALBUTEROL SULFATE TABS 4MG AMIODARONE HCL TABS 200MG AMOXICILLIN SUSR 200MG/5ML ALCLOMETASONE DIPROPIONATE CREA 0.05% AMITRIPTYLINE HCL TABS 100MG AMOXICILLIN SUSR 250MG/5ML ALCLOMETASONE DIPROPIONATE OINT 0.05% AMITRIPTYLINE HCL TABS 10MG AMOXICILLIN SUSR 400MG/5ML ALENDRONATE SODIUM TABS 10MG AMITRIPTYLINE HCL TABS 150MG AMOXICILLIN TABS 500MG ALENDRONATE SODIUM TABS 35MG AMITRIPTYLINE HCL TABS 25MG AMOXICILLIN TABS 875MG ® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. AMOXICILLIN-POT CLAVULANATE SUSR 200-28.5MG/5ML ATENOLOL TABS 25MG BENAZEPRIL HCL TABS 20MG BUDESONIDE ER TB24 9MG AMOXICILLIN-POT CLAVULANATE SUSR 250-62.5MG/5ML ATENOLOL TABS 50MG BENAZEPRIL HCL TABS 40MG BUDESONIDE SUSP 0.25MG/2ML AMOXICILLIN-POT CLAVULANATE
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