4-Tier Drug Program Preferred Drug List Powered By: PHARMACY NETWORK Your prescription card is accepted at over 54,000 participating pharmacies throughout the United States. The network includes pharmacy chains, such as Welcome... CVS, Rite Aid, Medicine Shoppe, Walgreens, Wal-Mart, and more, as well as thousands of independent pharmacies throughout the country. This plan is designed to save you money ALBERTSONS KROGER PHARMACY on your prescription drug costs! A AND P PHARMACY LEGEND ARBOR DRUGS LEWIS FAMILY DRUG Your Prescription Plan is recognized at most pharmacies in the United States. ARROW CENTER LONG'S AURORA PHARMACY MARC'S BARTELL DRUGS MED-X DRUG BIG BEAR PHARMACY MEDIC DISCOUNT DRUG This product guide has four tiers: BI-LO PHARMACY MEDIC DRUG BI-MART PHARMACY MEDICAP PHARMACY The first tier is preferred brand and generic drugs that will be available to you for BROOKS PHARMACY MEDICINE SHOPPE, THE BROOKSHIRE BROS. MEIJER PHARMACY $10 or less for the scheduled quantity and dose. BROOKSHIRE PHARMACY METRO PHARMACY BRUNO'S PHARMACY MORE 4 FAMILY CASHWISE NCS HEALTHCARE The second tier is preferred brand and generic drugs that will be available to COSTCO OSCO DRUG you for $20 or less for the scheduled quantity and dose. CUB PHARMACY PAMIDA PHARMACY CVS PHARMACY PATHMARK PHARMACY DILLON PHARMACY PHAR-MOR DISCOUNT DRUG MART PRICE CHOPPER The third tier is preferred brand and generic drugs that will be available to you DOMINICK'S PHARMACY PUBLIX PHARMACY for $ 40 or less for the scheduled quantity and dose. DRUG EMPORIUM RAINBOW PHARMACY D & W FOOD CENTERS RITE AID PHARMACY EAGLE PHARMACY SAFEWAY PHARMACY The fourth tier is non-preferred brand and generic drugs that we have ECONOFOODS SAVE-ON ECKERD DRUG SAVE MART PHARMACY negotiated a special discount price for you. EDWARDS PHARMACY SCHNUCKS PHARMACY EPIC SEELY SNYDER DRUG FAGEN PHARMACY SENTRY DRUGS INC FAIRVIEW PHARMACY SENTRY DRUGS INC To get the most out of this program you should ask your doctor to prescribe a FARMCO DRUG CENTER SHOP'N SAVE drug within the first three tiers if possible. Often times drugs within the same FARMER JACK SHOPKO PHARMACY therapeutic class can be prescribed in place of an expensive brand name drug. FOOD TOWN PHARMACY SHOPRITE PHARMACY FRED MEYER PHARMACY STAR PHARMACY Of course if you choose the higher price non-preferred brand or generic name FRED'S PHARMACY STOP & SHOP drug we have negotiated a substantial discount for you. FRUTH PHARMACY TARGET PHARMACY FRY'S FOOD & DRUG TIMES PHARMACY FURR'S PHARMACY TOPS PHARMACY GENOVESE DRUG STORE UKROPS PHARMACY Please review this entire book. Read the “frequently asked questions” section GIANT EAGLE UNITED PHARMACY for information about this plan. Feel free to contact our customer service center GRAND UNION VON'S PHARMACY if you have additional questions. HARRIS TEETER WAL-MART PHARMACY HOMELAND PHARMACY WALDBAUM'S PHARMACY HORIZON PHARMACY WALGREENS HY-VEE PHARMACY WEGMAN PHARMACY Our knowledgeable Help Desk and Customer Service department ensures that KERR DRUG WEIS PHARMACY K MART PHARMACY WHITE DRUG all physician, member, and pharmacy calls are responded to swiftly and accu- KASH N' KARRY WINN DIXIE PHARMACY rately. Our prompt customer service help desk is available toll free from Monday KING SOOPERS through Friday - 8:30 a.m. to 8 p.m. (Eastern time). KINNEY DRUGS Preferred Brand & Generic Drugs Non-Preferred What is the difference between brand name and generic drugs? $10 Tier $20 Tier $40 Tier Discounts The brand name is the trade name under which the product is advertised and sold, and is protected by patents so that it can only be produced by one manu- ANALGESICS - ANTI-INFLAMMATORY facturer for a pre-determined number of years. Once a patent expires, other DICLOFENAC TAB DICLOFEN POT TAB DICLOFENAC TAB ARTHROTEC 50 TABS companies may manufacture a generic equivalent, providing they follow strin- 50MG EC - 30 TABS 50MG - 30 TABS 100MG ER - 30 TABS ARTHROTEC 75 TABS gent FDA regulations for safety. Generic drugs are drugs for which the patent DICLOFENAC TAB ETODOLAC CAP ETODOLAC CAP has expired, allowing other manufacturers to produce and distribute the product 75MG DR - 30 TABS 300MG - 30 CAPS 200MG - 30 CAPS CELEBREX CAPS under a generic name. Generics are essentially a chemical copy of their brand IBUPROFEN SUS ETODOLAC TAB ETODOLAC ER TAB ETODOLAC ER TABS name equivalents. The color or shape may be different, but the active ingredi- 100/5ML - 120 ML 400MG - 30 TABS 400MG - 30 TABS ents must be the same for both. The preferred drug list contains only FDA ap- INDOMETHACIN CAPS IBUPROFEN TAB ETODOLAC TAB ETODOLAC ER TAB proved generic medications. 400MG - 30 TABS 500MG - 30 TABS 500MG - 30 TABS KETOPROFEN CAPS IBUPROFEN TAB INDOMETHACIN LEFLUNOMIDE TAB NAPRELAN TABS What is a preferred drug list? 600MG - 30 TABS CAP 25MG - 30 CAPS 10MG - 30 TABS A preferred drug list is a list of recommended prescription medications that is PONSTEL CAPS created, reviewed and continually updated by a team of physicians and pharma- IBUPROFEN TAB INDOMETHACIN CAP LEFLUNOMIDE TAB 800MG - 30 TABS 50MG - 30 CAPS 20MG - 30 TABS cists. The preferred drug list contains a wide range of generic and brand name preferred products that have been approved by the Food and Drug Administra- KETOPROFEN CAP KETOROLAC TAB NALFON CAP 50MG - 30 CAPS 10MG - 30 TABS 200MG - 30 CAPS tion (FDA). Your doctor can use this list to select medications for your health care needs, while helping you maximize your prescription drug benefit. A medi- KETOPROFEN CAP MELOXICAM TAB cation becomes a preferred drug based first on safety and efficacy, then on 75MG - 15 CAPS 7.5MG - 30 TABS cost-effectiveness. MELOXICAM TAB NABUMETONE TAB 15MG - 30 TABS 500MG - 30 TABS What is the difference between a preferred brand name drug vs. a non- NAPROXEN TAB NABUMETONE TAB preferred 250MG - 30 TABS 750MG - 30 TABS brand name drug? NAPROXEN TAB NAPROXEN DR TAB A preferred brand name drug is a medication that has been reviewed and ap- 375MG - 30 TABS 375MG - 30 TABS proved by a group of physicians and pharmacists, and has been selected for NAPROXEN TAB NAPROXEN DR TAB preferred status based on its proven clinical and cost effectiveness. A non- 500MG - 30 TABS 500MG - 30 TABS preferred brand name drug is a medication that has been reviewed by the same PIROXICAM CAP NAPROXEN SOD TAB team of physicians and pharmacists who determined that an alternative drug 10MG - 30 CAPS 550MG - 30 TABS that is clinically equivalent and most cost effective is available. These designa- PIROXICAM CAP OXAPROZIN TAB tions may change as new clinical information becomes available. 20MG - 30 CAPS 600MG - 30 TABS SULINDAC TAB What drugs are considered preferred (formulary) on Discount Plans? 150MG - 30 TABS The Product Guide contains certain brand drugs for which the member's price is the scheduled amount listed. Drugs that are chemically or therapeutically similar SULINDAC TAB 200MG - 30 TABS to drugs listed on the Product Guide are not discounted. Prices are subject to ANALGESICS - NONNARCOTIC change due to manufacturer price changes to pharmacies. On these drugs, the participant enjoys two distinct discounts; one through the pharmacy network ASPIRIN TAB 325MG - ACUFLEX TAB - BUT/APAP/CAF DOLGIC LQ ELX 30 TABS 20 TABS TAB - 30 TABS and the second through the manufacturer. DOLGIC PLUS TABS ASPIRIN TAB 325MG BUT/ASA/CAFF DIFLUNISAL EC - 30 TABS CAP - 30 CAPS TAB 500MG - 30 TABS PHRENILIN CAP FORTE What if the brand drug I am taking is not discounted? If you are currently taking a medication that has similar active ingredients or is ASPIRIN TAB 81MG BUT/ASA/CAFF DURABAC ZEBUTAL used to treat the same conditions as the preferred brand drugs on the product EC - 30 TABS TAB - 30 TABS TAB FORTE - 28 TABS guide, it will still be discounted. You will pay the negotiated price for that drug. BUT/APAP/CAF BUTAL/APAP To take advantage of the potential program savings on listed preferred drugs, TAB - 30 TABS TAB 50-325 - 30 TABS you should ask your Pharmacist (where regulations permit) or a Doctor to change your medication, where medically appropriate, to a less expensive prod- uct listed in the product guide. FREQUENTLY ASKED QUESTIONS Preferred Brand & Generic Drugs Non-Preferred $10 Tier $20 Tier $40 Tier Discounts Where can I use my card? ANALGESICS - NONNARCOTIC Your card is accepted at over 54,000 participating pharmacies throughout the Q-PAP LIQ 160/5ML CEPHADYN TAB United States. The network includes pharmacy chains, such as CVS, Rite Aid, - 180 ML 650-50MG - 30 TABS Medicine Shoppe, Walgreens, Wal-Mart, and more, as well as thousands of independent pharmacies throughout the country. Pharmacy location information Q-PAP TAB 325MG FLEXTRA DS - 30 TABS TAB - 24 TABS can be obtained by contacting customer service. If a neighborhood pharmacy is not already participating in our network, please have them call us. We will send SALSALATE TAB 500MG - 30 TABS them information about how then can participate in the network so that you can take advantage of the savings as soon as possible. SALSALATE TAB 750MG - 30 TABS What if my pharmacy doesn't recognize the card? ANALGESICS - OPIOIDS (PAIN RELIEF) Pharmacies may not be familiar with every prescription program in which they APAP/CODEINE TAB APAP/CODEINE SOL BUT/APAP/CAF CAP AVINZA CAPS participate. If the pharmacist does not recognize your card or if you encounter a 300-15MG - 20 TABS 120-12/5 - CODEINE - 30 CAPS 360 ML BALACET 325 TABS problem at the pharmacy, DO NOT leave without having the pharmacy call the APAP/CODEINE TAB BUT/ASA/CAF/ CAP COD toll-free number printed on the ID card. 300-30MG - 30 TABS APAP/CODEINE TAB 30MG - 30 CAPS BUPRENEX INJ 300-60MG - HYDROCO/APAP TAB 30 TABS CAPITAL/COD SUS 120- BUTORPHANOL SOL What is my average discount on Non-Preferred Drugs? 10-500MG - 30 TABS 12/5 - 200 ML CODEINE SULF TAB COMBUNOX TABS Members are currently receiving an average discount of approximately 19% on HYDROCO/APAP TAB 30MG - 30 TABS CODEINE SULF brand name drugs.