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