Medications
| Medications included on plan | Generic for | Common price (derived from local, published prices) |
| ACYCLOVIR 400mg/1 | Zovirax 400 mg | $11.00 |
| ACYCLOVIR 800mg/1 | Zovirax 800 mg | $17.82 |
| ALBUTEROL SULFATE 2.5mg/3mL – 60 VIAL in 1 CARTON | Proventil | $22.00 |
| ALLOPURINOL 300mg/1 | Zyloprim | $22.00 |
| AMIODARONE HYDROCHLORIDE 200mg/1 | Cordarone 200 mg | $27.00 |
| AMITRIPTYLINE HYDROCHLORIDE 10mg/1 | Elavil 10 mg | $12.20 |
| AMITRIPTYLINE HYDROCHLORIDE 25mg/1 | Elavil 25 mg | $15.00 |
| AMITRIPTYLINE HYDROCHLORIDE 50mg/1 | Elavil | $21.00 |
| AMLODIPINE BESYLATE 10mg/1 | Norvasc | $11.00 |
| AMLODIPINE BESYLATE 5mg/1 | NORVASC 5 MG | $11.00 |
| AMOXICILLIN; CLAVULANATE POTASSIUM 875mg/1; 125mg/1 | Augmentin 875/125 MG | $33.00 |
| AMOXICILLIN 500mg/1 | Amoxil | $15.00 |
| ARIPIPRAZOLE 15mg/1 | ABILIFY 15 MG | $295.00 |
| ARIPIPRAZOLE 30mg/1 | Abilify 30 mg | $416.00 |
| ARIPIPRAZOLE 5mg/1 | Abilify | $253.00 |
| ATENOLOL 100mg/1 | Tenormin | $10.00 |
| ATENOLOL 25mg/1 | TENORMIN 25 MG | $10.00 |
| ATORVASTATIN CALCIUM 10mg/1 | LIPITOR 10 MG | $35.30 |
| ATORVASTATIN CALCIUM 20mg/1 | Lipitor 20 mg | $36.84 |
| ATORVASTATIN CALCIUM 40mg/1 | Lipitor 40 mg | $18.43 |
| AZELASTINE HYDROCHLORIDE 137ug/.137mL | Astelin NS | $39.52 |
| AZITHROMYCIN MONOHYDRATE 250mg/1 | Zithromax | $21.00 |
| BACLOFEN 10mg/1 | Baclofen 10 mg | $28.00 |
| BENZONATATE 100mg/1 | Tessalon Perles | $21.00 |
| BUPROPION HYDROCHLORIDE 150mg/1 | Wellbutrin SR 150 mg | $41.00 |
| BUSPIRONE HYDROCHLORIDE 30mg/1 | BUSPAR 30 MG | $67.00 |
| BUSPIRONE HYDROCHLORIDE 7.5mg/1 | BUSPAR 7.5 MG | $63.00 |
| CARBIDOPA; LEVODOPA 25mg/1; 100mg/1 | Sinemet | $23.00 |
| CARVEDILOL 12.5mg/1 | Coreg | $13.93 |
| CARVEDILOL 25mg/1 | Coreg 25 mg | $17.00 |
| CEFADROXIL 500mg/1 | Duricef 500 mg | $18.00 |
| CEFDINIR 300mg/1 | OMNICEF 300 MG | $59.00 |
| CELECOXIB 100mg/1 | Celebrex 100 mg | $25.94 |
| CELECOXIB 200mg/1 | Celebrex 200 mg | $64.58 |
| CEPHALEXIN 500mg/1 | Keflex 500 mg | $11.85 |
| CIPROFLOXACIN HYDROCHLORIDE 250mg/1 | CIPRO 250MG | $25.00 |
| CIPROFLOXACIN HYDROCHLORIDE 500mg/1 | Cipro 500 mg | $25.00 |
| CIPROFLOXACIN HYDROCHLORIDE 750mg/1 | Cipro 750 mg | $21.00 |
| CITALOPRAM HYDROBROMIDE 20mg/1 | Celexa 20 mg | $10.00 |
| CITALOPRAM HYDROBROMIDE 40mg/1 | Celexa 40 mg | $11.00 |
| CLOPIDOGREL BISULFATE 75mg/1 | Plavix | $21.00 |
| CYCLOBENZAPRINE HYDROCHLORIDE 10mg/1 | FLEXERIL 10 MG | $10.00 |
| DIVALPROEX SODIUM 500mg/1 | Depakote | $84.00 |
| DOXYCYCLINE HYCLATE 100mg/1 | Vibramycin | $21.00 |
| DULOXETINE HYDROCHLORIDE 30mg/1 | CYMBALTA 30 MG | $52.00 |
| DULOXETINE HYDROCHLORIDE 60mg/1 | Cymbalta 60 mg | $54.00 |
| ESCITALOPRAM OXALATE 10mg/1 | Lexapro 10 mg | $49.00 |
| ESCITALOPRAM OXALATE 20mg/1 | LEXAPRO 20 MG | $49.00 |
| ESOMEPRAZOLE MAGNESIUM 40mg/1 | NEXIUM 40 MG | $47.00 |
| ESTRADIOL 0.025mg/d | Vivelle dot 0.025 MG | $85.00 |
| ESTRADIOL 1mg/1 | Estrace 1 mg | $12.00 |
| ESTRADIOL 2mg/1 | Estrace | $14.00 |
| FINASTERIDE 5mg/1 | PROSCAR 5 MG | $21.00 |
| FLUCONAZOLE 150mg/1 | DIFLUCAN 150 MG | $12.48 |
| FLUOXETINE HYDROCHLORIDE 10mg/1 | Prozac | $15.00 |
| FLUOXETINE HYDROCHLORIDE 20mg/1 | Prozac | $15.00 |
| FLUOXETINE HYDROCHLORIDE 40mg/1 | Prozac | $17.00 |
| FLUTICASONE PROPIONATE 50ug/1 | Flonase nasal spray | $16.00 |
| FUROSEMIDE 40mg/1 | Lasix | $10.00 |
| GABAPENTIN 300mg/1 | Gabapentin | $15.00 |
| GABAPENTIN 400mg/1 | Neurontin | $15.00 |
| GLIMEPIRIDE 2mg/1 | Amaryl | $14.61 |
| GLIMEPIRIDE 4mg/1 | Amaryl | $25.00 |
| GLIPIZIDE 10mg/1 | Glucotrol 10 mg | $11.63 |
| GLIPIZIDE 5mg/1 | $10.72 | |
| GLYBURIDE; METFORMIN HYDROCHLORIDE 5mg/1; 500mg/1 | Glucovance | $22.58 |
| HYDROCHLOROTHIAZIDE 12.5mg/1 | MICROZIDE 12.5 MG | $9.58 |
| HYDROCHLOROTHIAZIDE 25mg/1 | HYDRODIURIL 25 MG | $9.58 |
| HYDROCHLOROTHIAZIDE 50mg/1 | Hydroduril | $9.58 |
| HYDROXYZINE PAMOATE 50mg/1 | Vistaril | $10.35 |
| HYDROXYZINE PAMOATE 50mg/1 | Vistaril 50 mg | $10.35 |
| INDOMETHACIN 25mg/1 | Indocin 25 mg | $9.43 |
| ISOSORBIDE MONONITRATE 30mg/1 | Imdur | $16.21 |
| ISOSORBIDE MONONITRATE 60mg/1 | Imdur 60 mg | $16.21 |
| KETOROLAC TROMETHAMINE 60mg/2mL | Toradol | |
| LAMOTRIGINE 100mg/1 | Lamictal 100 mg | $44.48 |
| LAMOTRIGINE 25mg/1 | Lamictal | $37.18 |
| LEVOFLOXACIN 500mg/1 | Levaquin | $53.40 |
| Lipitor (Atorvastatin) 40mg | Lipitor | $45.37 |
| LISINOPRIL; HYDROCHLOROTHIAZIDE 10mg/1; 12.5mg/1 | Zestoretic | $10.17 |
| HYDROCHLOROTHIAZIDE; LISINOPRIL 12.5mg/1; 10mg/1 | $10.17 | |
| LISINOPRIL 10mg/1 | Zestril 10 mg | $6.31 |
| LISINOPRIL 20mg/1 | ZESTRIL 20 MG | $6.31 |
| LISINOPRIL 40mg/1 | zestril 40 mg | $6.31 |
| LISINOPRIL 5mg/1 | Zestril | $6.31 |
| LITHIUM CARBONATE 150mg/1 | ESKALITH 150 MG | $11.41 |
| LITHIUM CARBONATE 300mg/1 | ESKALITH 300 MG | $11.41 |
| LITHIUM CARBONATE 600mg/1 | Eskalith 600 mg | $11.41 |
| LITHIUM CARBONATE 600mg/1 | ESKALITH 600 MG | $11.41 |
| LORATADINE 10mg/1 | CLARITIN 10 MG | $47.86 |
| LOSARTAN POTASSIUM; HYDROCHLOROTHIAZIDE 50mg/1; 12.5mg/1 | Hyzaar 50/12.5 | $24.11 |
| LOSARTAN POTASSIUM 100mg/1 | Cozaar | $22.81 |
| LOSARTAN POTASSIUM 100mg/1 | Cozaar 100 mg | $22.81 |
| LOSARTAN POTASSIUM 50mg/1 | Cozaar | $22.81 |
| LOVASTATIN 20mg/1 | $16.97 | |
| LOVASTATIN 40mg/1 | Mevacor | $26.04 |
| Meclizine HCL 12.5 mg 12.5mg/1 | Bonine 12.5 mg | $11.34 |
| MELOXICAM 15mg/1 | Mobic 15 mg | $13.51 |
| MELOXICAM 7.5mg/1 | Mobic | $18.42 |
| METFORMIN HYDROCHLORIDE 1000mg/1 | Glucophage 1000 mg | $21.47 |
| METFORMIN HYDROCHLORIDE XR 500mg/1 | GLUCOPHAGE XR 500 MG | $14.24 |
| METOPROLOL SUCCINATE 100mg/1 | Toprol XL 100 mg | $24.40 |
| METOPROLOL SUCCINATE 25mg/1 | Toprol XL 25 mg | $16.09 |
| METOPROLOL SUCCINATE 50mg/1 | Toprol XL | $13.04 |
| METOPROLOL TARTRATE 50mg/1 | Lopressor 50 mg | $13.04 |
| METRONIDAZOLE 500mg/1 | Flagyl | $11.00 |
| MONTELUKAST SODIUM 10mg/1 | SINGULAIR 10 MG | $70.47 |
| MUPIROCIN 20mg/g – 1 TUBE | BACTROBAN OINT 2% | $19.26 |
| NAPROXEN 500mg/1 | Naprosyn 500 mg | $11.33 |
| Norgestimate and Ethinyl Estradiol | Ortho Tri Cyclen (BIRTH CONTROL) | $19.82 |
| OLMESARTAN MEDOXOMIL 40mg/1 | Benicar 40 mg | $64.80 |
| OMEPRAZOLE 20mg/1 | Prilosec 20 mg | $62.93 |
| ONDANSETRON HYDROCHLORIDE 4mg/1 | Zofran 4 mg | $46.79 |
| PANTOPRAZOLE SODIUM 40mg/1 | Protonix | $30.50 |
| PAROXETINE HYDROCHLORIDE HEMIHYDRATE 20mg/1 | PAXIL 20 MG | $19.08 |
| PRAVASTATIN SODIUM 20mg/1 | PRAVACHOL 20 MG | $14.00 |
| PREDNISONE 20mg/1 | PREDNISONE 20 MG | $6.90 |
| Prilosec (Omeprazole DR) 40mg | Prilosec 40 mg | $62.93 |
| QUETIAPINE FUMARATE 25mg/1 | Seroquel 25 mg | $42.98 |
| QUETIAPINE FUMARATE 100mg/1 | Seroquel | $66.60 |
| QUETIAPINE FUMARATE 200mg/1 | Seroquel 200 mg | $117.60 |
| QUETIAPINE FUMARATE 300mg/1 | Seroquel 300 mg | $151.50 |
| QUINAPRIL HYDROCHLORIDE 40mg/1 | ACCUPRIL 40 MG | $16.72 |
| RAMIPRIL 10mg/1 | ALTACE 10 MG | $26.12 |
| RANITIDINE HYDROCHLORIDE 300mg/1 | Zantac 300mg | $33.12 |
| RISPERIDONE 2mg/1 | Risperdal | $63.72 |
| RISPERIDONE 4mg/1 | Risperdal | $95.40 |
| RIZATRIPTAN BENZOATE 10mg/1 (9 pills) | Maxalt 10 mg | $94.50 |
| ROSUVASTATIN CALCIUM 10mg/1 | CRESTOR 10 MG | $84.00 |
| ROSUVASTATIN CALCIUM 20mg/1 | Crestor 20mg | $84.00 |
| ROSUVASTATIN CALCIUM 40mg/1 | CRESTOR 40 MG | $85.00 |
| SERTRALINE HYDROCHLORIDE 25mg/1 | Zoloft | $17.93 |
| SERTRALINE HYDROCHLORIDE 50mg/1 | ZOLOFT 50 MG | $17.54 |
| SERTRALINE HYDROCHLORIDE 100mg/1 | Zoloft | $17.10 |
| SILDENAFIL CITRATE 20mg/1 (30 pills) | Revatio 20 mg | $19.00 |
| SIMVASTATIN 20mg/1 | Zocor 20 mg | $14.00 |
| SIMVASTATIN 40mg/1 | Zocor | $17.00 |
| SULFAMETHOXAZOLE; TRIMETHOPRIM 800mg/1; 160mg/1 | Septra | $11.41 |
| SUMATRIPTAN SUCCINATE 25mg/1 (9 pills) | Imitrex 25 mg | $72.72 |
| Tadalafil 5mg x 30 pills | Cialis | $108.45 |
| TAMSULOSIN HYDROCHLORIDE 0.4mg/1 | Flomax | $20.29 |
| TERBINAFINE HYDROCHLORIDE 250mg/1 | Lamisil | $31.17 |
| TIZANIDINE HYDROCHLORIDE 4mg/1 | Zanaflex 4 mg | $16.42 |
| TOPIRAMATE 100mg/1 | Topamax | $97.44 |
| TOPIRAMATE 200mg/1 | Topamax 200 mg | $120.68 |
| TOPIRAMATE 25mg/1 | Topamax 25 mg | $46.95 |
| TOPIRAMATE 50mg/1 | TOPAMAX 50 MG | $61.64 |
| TRAZODONE HYDROCHLORIDE 100mg/1 | DESYREL 100 MG | $13.14 |
| TRAZODONE HYDROCHLORIDE 150mg/1 | Desyrel 150 mg | $19.46 |
| TRAZODONE HYDROCHLORIDE 50mg/1 | Desyrel | $12.49 |
| Tri-Lo-Sprintec (Norgestimate and Ethinyl Estradiol) | ORTHO TRI CYCLEN LO | $29.00 |
| TRIAMCINOLONE ACETONIDE 0.25mg/g 15 g in 1 TUBE | Aristocort/kenalog | $11.00 |
| TRIAMCINOLONE ACETONIDE 1mg/g – 30 g in 1 TUBE (67877-251-30) | Aristocort/ Kenalog | $13.00 |
| VALACYCLOVIR HYDROCHLORIDE 500mg/1 | VALTREX 500 MG | $36.00 |
| VENLAFAXINE HYDROCHLORIDE 150mg/1 | Effexor XR 150 mg | $350.00 |
| VENLAFAXINE HYDROCHLORIDE 37.5mg/1 | EFFEXOR XR 37.5 MG | $31.00 |
| VENLAFAXINE HYDROCHLORIDE 75mg/1 | Effexor XR 75mg | $28.85 |
| VERAPAMIL HYDROCHLORIDE 240mg/1 | ISOPTIN ER 240 MG | $16.00 |