Program Overview Drug Pricing Pharmacy Network FAQ's
Pharmacy Network
This program is designed to educate you on the use of generic and other low cost brand name drugs. This program is designed to help you find drugs within the same therapeutic class as a drug you may currently be taking. Most of all this program is designed to save you money on your prescription drug costs.
Drug quantities listed must be adhered to in order to receive Tier pricing. Any change in listed quantity may result in higher prices. Company cannot be responsible for changes in network pharmacies which accept this program.
Brand name drugs are signifed in UPPER case text. Generic drugs are signifed in Standard case text.
This formulary has the following tiers:
First Tier
DRUG NAME (DOSE)QTY
1ST CHOICE MIS LANCETS100.00
ABANEU-SL SUB30.00
ADRENAL C TAB FORMULA30.00
AGAMATRIX MIS 33G100.00
ALA CORT CRE 1%28.40
ALPRAZOLAM TAB 0.25MG30.00
ALTAFRIN SOL 10% OP5.00
ALTAFRIN SOL 2.5% OP15.00
AMITRIPTYLIN TAB 10MG30.00
AMITRIPTYLIN TAB 25MG30.00
AMOXICILLIN CAP 250MG30.00
AMOXICILLIN CHW 125MG30.00
AMOXICILLIN SUS 125/5ML150.00
AMOXICILLIN SUS 200/5ML100.00
AMPICILLIN INJ 125MG1.00
AMPICILLIN INJ 1GM1.00
AMPICILLIN INJ 250MG1.00
AMPICILLIN INJ 500MG1.00
AMPICILLIN SUS 125/5ML100.00
ANECTINE INJ 20MG/ML10.00
AT LAST MIS LANCETS100.00
ATENOLOL TAB 50MG30.00
ATIVAN INJ 2MG/ML1.00
ATIVAN INJ 4MG/ML1.00
AURORA LANCE MIS 30G100.00
AURORA LANCE MIS THIN 23G100.00
B6 FOLIC ACD CAP30.00
BD LANCET UF MIS 30G100.00
BENAZEPRIL TAB 20MG30.00
BENZALKONIUM SOL 50%1.00
BENZOIN CMPD TIN1.00
BIOCEL TAB30.00
BIOTUSS LIQ473.00
BIOTUSS LIQ PEDIATRC30.00
BORIC ACID GRA1.00
B-PLEX TAB30.00
B-PLEX PLUS TAB30.00
BUMETANIDE INJ 0.25/ML2.00
CARBAMAZEPIN TAB 200MG60.00
CARBOCAINE INJ 1%50.00
CARBOCAINE INJ 1% PF30.00
CARBOCAINE INJ 1.5% PF30.00
CARBOCAINE INJ 2% PF20.00
CARB-O-PHILC CRE /4028.35
CAREONE LANC MIS 28G100.00
CAREONE LANC MIS THIN 23G100.00
CASCARA EXT SAGRADA1.00
CAVAREST GEL 1.1%56.00
CAVIRINSE SOL 0.2%236.59
CEFAZOLIN INJ 1GM1.00
CITROLITH TAB30.00
CLEANLET 28G MIS LANCETS100.00
CLEARPLEX X GEL 10%45.00
CLORAZ DIPOT TAB 3.75MG30.00
CLOTRIMAZOLE SOL 1%10.00
COD LIVER OIL1.00
COMFORT MIS LANCETS100.00
COMFORT ASSU MIS LANC 28G100.00
COMFORT ASSU MIS LANC 33G100.00
COMFORTOUCH MIS LANCET100.00
CO-NATAL FA TAB 29-1MG30.00
CONSTULOSE SOL 10GM/15237.00
CVS LANCETS MIS 21G100.00
CVS LANCETS MIS ORIGINAL100.00
CVS LANCETS MIS THIN 26G100.00
CVS LANCETS MIS THIN 30G100.00
CVS LANCETS MIS THIN 33G100.00
CYCLOBENZAPR TAB 5MG30.00
DENTA 5000 CRE PLUS57.00
DENTA 5000 CRE PLUS 2PK57.00
DENTAGEL GEL 1.1%56.00
DEXAMETH PHO INJ 10MG/ML5.00
DEXAMETHASON TAB 0.5MG30.00
DEXAMETHASON TAB 0.75MG30.00
DEXAMETHASON TAB 1.5MG30.00
DIALYVITE TAB30.00
DIALYVITE/ TAB ZINC30.00
DIASTAR MIS LANCETS100.00
DIASTAR EASY MIS LANCETS100.00
DIAZEPAM TAB 2MG60.00
DIAZEPAM TAB 5MG60.00
DIPHEN/ATROP LIQ 2.5/560.00
DROPLET LANC MIS 30G100.00
EASY TOUCH MIS LANC/33G100.00
EASYGEL GEL 0.4%129.00
EASYGEL GEL 0.4%CHRY129.00
EASYGEL GEL 0.4%CITR129.00
EASYGEL GEL 0.4%MINT129.00
EASYTEST MIS LANCETS100.00
EASYTEST II MIS LANCETS100.00
EFFER-K TAB 25MEQ EF30.00
EPITOL TAB 200MG60.00
EQL LANCETS MIS 21G COLR100.00
EQL LANCETS MIS 33G COLR100.00
EQL LANCETS MIS THIN 26G100.00
EQL LANCETS MIS THIN 30G100.00
ERGOCALCIFER CAP 50000UNT4.00
ESTRADIOL TAB 1MG30.00
E-Z JECT MIS 21G100.00
E-Z JECT MIS 21G COLR100.00
E-Z JECT MIS 30G100.00
E-Z JECT MIS 32G COLR100.00
E-Z JECT MIS LANC 21G100.00
E-Z JECT MIS THIN 26G100.00
EZ SMART MIS LANCETS100.00
E-ZJECT LANC MIS 33G100.00
EZ-LETS 21G MIS LANCETS100.00
EZ-LETS 23G MIS LANCETS100.00
EZ-LETS 26G MIS LANCETS100.00
EZ-LETS 28G MIS LANCETS100.00
EZ-LETS 30G MIS LANCETS100.00
FAMOTIDINE TAB 40MG30.00
FE C PLUS TAB30.00
FENTANYL CIT INJ 2500MCG20.00
FEROTRINSIC CAP30.00
FERROCITE TAB PLUS30.00
FERROTRIN CAP30.00
FLUORABON DRO60.00
FLUORESCEIN/ SOL PROPARAC5.00
FLUORIDE CHW 0.25MG F30.00
FLUORIDE CHW 0.5MG F30.00
FLUORIDE CHW 1MG F30.00
FLUORIDEX GEL 1.1%56.00
FLUORIDEX GEL WHITENIN56.00
FLUORITAB CHW 0.25MG F30.00
FLUORITAB CHW 0.5MG F30.00
FLUORITAB CHW 1MG F30.00
FLUORITAB CHW 2.2MG30.00
FLUORITAB DRO 0.125MG30.00
FLUOXETINE CAP 10MG30.00
FLUPHENAZINE TAB 2.5MG30.00
FLURA-DROPS DRO 0.125MG30.00
FLURA-DROPS DRO 0.25MG F24.00
FLURBIPROFEN SOL 0.03% OP2.50
FOLIC ACID TAB 1MG30.00
FORA MIS LANCETS100.00
FUROSEMIDE TAB 20MG30.00
FUROSEMIDE TAB 40MG30.00
FUROSEMIDE TAB 80MG30.00
GENTLE-LET MIS 26G100.00
GENTLE-LET MIS 28G100.00
GENTLE-LET MIS LANCETS100.00
GLIMEPIRIDE TAB 1MG30.00
GLIMEPIRIDE TAB 2MG30.00
GLIPIZIDE ER TAB 2.5MG30.00
GLIPIZIDE ER TAB 5MG30.00
GLIPIZIDE XL TAB 2.5MG30.00
GLIPIZIDE XL TAB 5MG30.00
GLUCOCOM MIS 28G100.00
GLUCOCOM MIS 30G100.00
GLUCOCOM MIS 33G100.00
GLUCOSOURCE MIS LANCETS100.00
GLUTARALDEHY SOL 25%1.00
GLYBURID MCR TAB 1.5MG30.00
GLYBURID MCR TAB 3MG30.00
GLYBURIDE TAB 1.25MG30.00
GLYBURIDE TAB 2.5MG30.00
GNP LANCETS MIS100.00
GNP LANCETS MIS 21G100.00
GNP LANCETS MIS MICRO100.00
GNP LANCETS MIS SUP THIN100.00
GNP LANCETS MIS THIN100.00
GNP LANCETS MIS THIN 26G100.00
GUANFACINE TAB 1MG30.00
GUANFACINE TAB 2MG30.00
GUANIDINE TAB 125MG30.00
HALOPERIDOL TAB 0.5MG30.00
HALOPERIDOL TAB 1MG30.00
HEMATINIC PL TAB VIT/MIN30.00
HEMATINIC/FA TAB30.00
HEMATOGEN CAP30.00
HEMOCYTE TAB -PLUS30.00
HEMOCYTE-F TAB30.00
HLTHY ACCNTS MIS LANC 30G100.00
HYDROCHLOROT TAB 25MG30.00
HYDROCHLOROT TAB 50MG30.00
HYDROCORT CRE 2.5%20.00
HYDROCORT OIN 1%28.35
HYDROCORT OIN 2.5%28.35
HYDROCORT/AB OIN 1%28.35
HYDROXYZ HCL TAB 10MG30.00
IBUPROFEN TAB 400MG60.00
IBUPROFEN TAB 600MG90.00
IFEREX 150 CAP FORTE30.00
IMIPRAM HCL TAB 10MG30.00
IMIPRAM HCL TAB 25MG30.00
IMIPRAM HCL TAB 50MG30.00
INCONTROL MIS LANC 28G100.00
INCONTROL MIS LANC 30G100.00
INFLUENZA A SPR 09 H1N110.00
INSULIN SYRG MIS 0.5/27G10.00
INSULIN SYRG MIS 1ML/27G10.00
IPRATROPIUM SOL 0.02%INH75.00
ISOSORB MONO TAB 10MG30.00
JANTOVEN TAB 1MG30.00
JANTOVEN TAB 2.5MG30.00
JANTOVEN TAB 2MG30.00
JANTOVEN TAB 3MG30.00
JANTOVEN TAB 5MG30.00
KARIDIUM DRO 0.125MG30.00
KARIGEL GEL 0.5%56.00
KARIGEL-N GEL 1.1%56.00
KINNEY MIS LANCETS100.00
KINNEY THIN MIS LANCETS100.00
KROGER LANCE MIS100.00
KROGER LANCE MIS THIN100.00
KROGER LANCE MIS THIN 30G100.00
K-VESCENT POW 20MEQ30.00
LACTULOSE SOL 10GM/15237.00
LACTULOSE SOL 20GM/30237.00
LANCET ALTER MIS SITE 26G100.00
LANCET MICRO MIS THIN 33G100.00
LANCET STAND MIS 21G100.00
LANCET SUPER MIS THIN 30G100.00
LANCET ULTRA MIS 28G100.00
LANCET ULTRA MIS THIN 28G100.00
LANCETS MIS 21G100.00
LANCETS MIS 21G COLR100.00
LANCETS MIS 23G100.00
LANCETS MIS 26G100.00
LANCETS MIS ORIGINAL100.00
LANCETS MIS THIN100.00
LANCETS MIS THIN 26G100.00
LANCETS MIS THIN 30G100.00
LANCETS MICR MIS THIN 33G100.00
LANCETS SUPR MIS THIN 28G100.00
LANCETS THIN MIS100.00
LANCETS THIN MIS 26G100.00
LANCETS ULTR MIS THIN 28G100.00
LANCETS ULTR MIS THIN 30G100.00
LB LANCET MIS 28G100.00
LEVALBUTEROL NEB 1.25/0.51.00
LIDO/PRILOCN CRE 2.5-2.5%5.00
LIDOCAINE SOL 2% VISC100.00
LIDOCAINE SOL 4%50.00
LISINOP/HCTZ TAB 20-12.530.00
LITHIUM CARB CAP 150MG30.00
DRUG NAME (DOSE)QTY
LONGS LANCET MIS STANDARD100.00
LONGS LANCET MIS THIN100.00
LORAZEPAM INJ 2MG/ML1.00
LORAZEPAM INJ 4MG/ML1.00
LORAZEPAM TAB 0.5MG30.00
LUDENT CHW 0.25MG F30.00
LUDENT CHW 0.5MG F30.00
LUDENT CHW 1MG F30.00
LURIDE CHW 0.25MG F30.00
LURIDE CHW 0.5MG F30.00
LURIDE CHW 1MG F30.00
MAGNEBIND TAB 40030.00
MEDROXYPR AC TAB 5MG30.00
MEGESTROL AC TAB 20MG30.00
MEIJER MIS LANCETS100.00
MEIJER LANCE MIS COLOR100.00
MEIJER LANCE MIS UNIV 21G100.00
MEIJER LANCE MIS UNIV 30G100.00
MEIJER LANCE MIS UNIVERSA100.00
MELOXICAM TAB 7.5MG30.00
MELQUIN 3 SOL 3%29.57
METHADONE TAB 10MG30.00
METHADOSE CON 10MG/ML30.00
METHADOSE SF CON 10MG/ML30.00
METHIMAZOLE TAB 5MG30.00
METHOTREXATE INJ 100/4ML4.00
METHOTREXATE INJ 1GM/40ML4.00
METHOTREXATE INJ 200/8ML4.00
METHOTREXATE INJ 250/10ML4.00
METHYL SALIC LIQ1.00
MICRO THIN MIS LANC 33G100.00
MIDAZOLAM INJ 5MG/5ML5.00
MONOLET OPD MIS LANCETS100.00
MORPHINE SUL INJ 5MG/ML1.00
MULTIVIT/FL CHW 0.25MG30.00
MULTIVIT/FL CHW 0.5MG30.00
MULTIVIT/FL CHW 1MG30.00
MULT-VIT/FL CHW 0.5MG30.00
MVC-FLUORIDE CHW 0.25MG30.00
MVC-FLUORIDE CHW 0.5MG30.00
MVC-FLUORIDE CHW 1MG30.00
MYFERON 150 CAP FORTE30.00
MYGLUCOHEALT MIS LANC 30G100.00
MYNATAL CAP30.00
MYNATAL TAB30.00
MYNATAL TAB ADVANCE30.00
MYNATAL PLUS TAB30.00
MYNATAL-Z TAB30.00
MYNATE 90 TAB PLUS30.00
MYNEPHROCAPS CAP30.00
NAFRINSE CHW 1MG F30.00
NAFRINSE DRO 0.125MG30.00
NAPHAZOLINE SOL 0.1% OP15.00
NATALVIT TAB 75-1MG30.00
NATURE-THROI TAB 16.25MG30.00
NATURE-THROI TAB 32.5MG30.00
NATURE-THROI TAB 48.75MG30.00
NATURE-THROI TAB 65MG30.00
NATURE-THROI TAB 81.25MG30.00
NEPHRONEX TAB 1MG30.00
NEUTRAGARD GEL 1.1%56.00
NIVA-PLUS TAB30.00
NORTRIPTYLIN CAP 10MG30.00
NORTUSS-DE DRO30.00
NOVA SURE MIS LANCETS100.00
O-CAL TAB PRENATAL30.00
OMEPRAZOLE CAP 20MG30.00
OXYCODONE SOL 5MG/5ML5.00
PAPAVERINE INJ 30MG/ML2.00
PAROEX SOL 0.12%600.00
PC LANCETS MIS 30G100.00
PENICILLN VK SOL 125/5ML200.00
PERFECT 30G MIS LANCETS100.00
PHARMACY COU MIS LANCETS100.00
PHENAZO TAB 200MG90.00
PHENAZOPYRID TAB 100MG60.00
PHENYLEPHRIN SOL 10% OP5.00
PKU EASY TAB MICROTAB4.00
PNV FOLIC AC TAB + IRON30.00
POLOCAINE INJ -MPF 1%30.00
POLOCAINE INJ -MPF 2%20.00
POLY-IRON CAP 150 FORT30.00
POLYSACCHARI CAP IRON30.00
PR CREAM KIT1.00
PRECISION MIS 28G100.00
PRECISION MIS 28G(T)100.00
PREDNISONE TAB 2.5MG30.00
PRE-FOLIC TAB 1-100MG30.00
PRENATAL TAB LOW IRON30.00
PRENATAL+FE TAB 29-1MG30.00
PREVIDENT SOL RINSE236.59
PRIMIDONE TAB 50MG30.00
PROMETH/COD SYP 6.25-10118.00
PROMETHAZINE SOL 6.25/5ML118.00
PROMETHAZINE SYP 6.25/5ML118.00
PROMETHAZINE SYP DM118.00
PSS SAFE LAN MIS100.00
PSS SEL LANC MIS100.00
PX LANCETS MIS ULT THIN100.00
QC LANCETS MIS 28G100.00
QC LANCETS MIS 30G100.00
QUINAPRIL TAB 20MG30.00
QUINAPRIL TAB 40MG30.00
QUINIDINE SU TAB 200MG30.00
RA E-ZJECT MIS 28G100.00
RA E-ZJECT MIS 33G100.00
RA E-ZJECT MIS THIN 26G100.00
RA E-ZJECT MIS THIN 28G100.00
RA E-ZJECT MIS ULT THIN100.00
RANITIDINE INJ 150/6ML6.00
REALITY MIS LANCETS100.00
REALITY TRIG MIS LANCETS100.00
REGENECARE GEL4.00
RELADOR PAK CRE 2.5-2.5%5.00
RELION LANCE MIS STND 21G100.00
RELION LANCE MIS THIN 26G100.00
RELION LANCE MIS THIN 30G100.00
RELION MICRO MIS THIN 33G100.00
RELION ULTRA MIS THIN 32G100.00
RELION ULTRA MIS THIN PLS100.00
RENAL CAP SOFTGEL30.00
RENA-VITE RX TAB30.00
RENO CAP30.00
RIGHTEST MIS GL300100.00
ROBINUL INJ 0.4/2ML2.00
SAFETY SEAL MIS 28G100.00
SAFETY SEAL MIS 30G100.00
SB LANCETS MIS THIN100.00
SB LANCETS MIS ULTR THN100.00
SF GEL 1.1%56.00
SF 5000 PLUS CRE 1.1%57.00
SM B-COMPLEX TAB /VIT C30.00
SM LANCETS MIS 33G100.00
SMART SENSE MIS LANC 21G100.00
SMART SENSE MIS LANC 26G100.00
SMART SENSE MIS LANC 30G100.00
SMART SENSE MIS LANC 33G100.00
SOD FLUORIDE CHW 0.25MG F30.00
SOD FLUORIDE CHW 0.5MG F30.00
SOD FLUORIDE CHW 1.1MG30.00
SOD FLUORIDE CHW 1MG F30.00
SOD FLUORIDE CHW 2.2MG30.00
SOD FLUORIDE SOL 0.2%236.59
SOD FLUORIDE TAB 0.5MG F30.00
SOD FLUORIDE TAB 1MG F30.00
SPIRONOLACT TAB 25MG30.00
SSD CRE 1%20.00
STERILANCE MIS TL 28G100.00
STERILANCE MIS TL 30G100.00
STERILANCE MIS TL 32G100.00
SULF LIME SOL1.00
SUPER THIN MIS LANC 28G100.00
SUPER THIN MIS LANCETS100.00
SUREFLEX MIS LANCETS100.00
SURELITE MIS LANCETS100.00
TBC AER56.70
TECHLITE MIS LANC 30G100.00
TECHLITE MIS LANCETS100.00
TECHLITE AST MIS LANCETS100.00
TETCAINE SOL 0.5% OP12.00
TETRIX KIT1.00
TGT LANCET MIS 23G100.00
TGT LANCET MIS 26G100.00
TGT LANCET MIS 28G100.00
TGT LANCET MIS 30G100.00
TGT LANCET MIS 33G100.00
TGT LANCET MIS ALTERNAT100.00
THIN LANCETS MIS100.00
THIN LANCETS MIS 26G100.00
THIN LANCETS MIS 30G100.00
THINLETS MIS 28G(T)100.00
THINLETS GP MIS 26G100.00
TIMOLOL MAL SOL 0.5% OP5.00
TIMOLOL MAL TAB 5MG30.00
TL FOLATE TAB30.00
TL G-FOL OS TAB30.00
TRAZODONE TAB 100MG30.00
TRAZODONE TAB 150MG30.00
TRAZODONE TAB 50MG30.00
TRIAMCINOLON CRE 0.025%15.00
TRIAMCINOLON CRE 0.1%15.00
TRIAMCINOLON OIN 0.025%15.00
TRIAMCINOLON OIN 0.1%15.00
TRIAMT/HCTZ CAP 37.5-2530.00
TRIDERM CRE 0.1%15.00
TRIPHROCAPS CAP30.00
TRI-VIT/FE DRO /FL 0.2550.00
TRI-VIT/FL DRO 0.5MG50.00
TRI-VIT/FLUO DRO 0.5MG50.00
TRUPLUS LANC MIS 26G100.00
TRUPLUS LANC MIS 30G100.00
TRUPLUS LANC MIS 33G100.00
TURPENTINE SOL SPIRITS1.00
TUSSAFED EX LIQ118.00
ULTILET MIS 26G100.00
ULTRA TABS TAB30.00
UNILET MIS 21G100.00
UNILET CMFR MIS TCH 28G100.00
UNILET CMFR MIS TCH 30G100.00
UNILET EX II MIS 28G100.00
UNILET EXCEL MIS 23G100.00
UNILET G.P MIS SUPR 23G100.00
UNILET G.P. MIS 21G100.00
UNILET GP 28 MIS ULT THIN100.00
UNILET LANCE MIS 21G100.00
UNILET LANCT MIS 28G100.00
UNILET LANCT MIS 30G100.00
UNILET LANCT MIS 33G100.00
UNILET SUPER MIS 23G100.00
UNILET SUPER MIS G.P. 23G100.00
UNIVERSAL 1 MIS LANC 26G100.00
UNIVERSAL 1 MIS LANC 30G100.00
UROSEX TAB30.00
V-C FORTE CAP30.00
VERAPAMIL TAB 120MG30.00
VIC-FORTE CAP30.00
VINATE M TAB30.00
VIRT-CAPS CAP30.00
VITA S FORTE TAB30.00
VITAMIN D CAP 50000UNT4.00
VITAROCA PLU TAB30.00
VOL-CARE RX TAB30.00
W&F LANCETS MIS 21G100.00
W&F LANCETS MIS 26G100.00
WARFARIN TAB 1MG30.00
WARFARIN TAB 2.5MG30.00
WARFARIN TAB 2MG30.00
WARFARIN TAB 3MG30.00
WARFARIN TAB 5MG30.00
WESTHROID TAB 32.5MG30.00
WESTHROID TAB 65MG30.00
WHEAT GERM OIL1.00
WP THYROID TAB 16.25MG30.00
WP THYROID TAB 32.5MG30.00
WP THYROID TAB 48.75MG30.00
XOPENEX CONC NEB 1.25/0.51.00
XYLOCAINE INJ 1%20.00
Second Tier

Third Tier

Fourth Tier
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 * THIS IS NOT INSURANCE – DISCOUNTS ONLY Dispute Resolution Procedure  Terms & Conditions  Privacy Policy 
 * Pricing is subject to change without notice.
 * Pricing is only for quantities stated, additional quantities may incur higher costs.
 * Network pharmacies can be contracted at different rates resulting in some pricing differences.