Rx Outreach Medication List Rx Outreach Medication Available Strengths 90-Day Supply 180-Day Supply

Transcription

1 Rx Outreach Medication List Rx Outreach Medication Available Strengths 90-Day Supply 180-Day Supply Allergies/Asthma Albuterol Inhalation Solution 0.083%/3mL $15 for up to 75 vials Azelastine nasal spray 137mcg $30 per nasal spray Budesonide Inhalation Solution 0.25mg/2mL $32 for up to 10 vials Budesonide Inhalation Solution 0.5mg/2mL $37 for up to 10 vials Budesonide nasal spray 8.6g/32mcg $62 per nasal spray Cetirizine HCl tablet - OTC 10mg (no prescription required) $10 per bottle of 100 tablets (minimum 2 bottles) Epinephrine Auto Injector 0.15mg/0.15mL, 0.3mg/0.3mL $200 for a 2 unit pack Fexofenadine OTC tablet 60mg, 180mg (no prescription required) $40 for 100 tablets Fluticasone nasal spray 50mcg $15 per nasal spray Hydrocortisone tablet 5mg $15 for up to 90 tablets Hydrocortisone tablet 10mg Hydroxyzine HCL tablet 25mg, 50mg $25 n/a Hydroxyzine pamoate capsule 25mg, 50mg $25 n/a Ipratropium/Albuterol Inhalation Solution 0.5mg/3.0mg vial $25 for up to 90 vials Ketotifen Fumerate OTC Solution 0.025%/5mL (no prescription required) $9 per dropper Loratadine OTC tablet 10mg (no prescription required) $10 per bottle of 100 tablets (minimum 2 bottles) Levocetirizine tablet 5mg $35 $65 Montelukast Sodium tablet 10mg, 5mg chewable ProAir RespiClick Powder Inhaler 0.65g (200 inhalations) $35 per inhaler canister Theophylline ER tablet 100mg, 200mg, 300mg $20 for 90 tablets Zafirlukast tablet 10mg, 20mg $30 for 60 tablets Anti-Anxiety Alprazolam tablet (CS) 0.25mg, 0.5mg, 1mg, 2mg $9 for up to 90 tablets n/a Buspirone tablet 5mg, 10mg, 15mg $20 n/a Buspirone tablet 30mg $35 n/a Chlordiazepoxide capsule (CS) 5mg, 10mg, 25mg $15 for up to 180 capsules n/a Clonazepam tablet (CS) 0.5mg $9 for up to 90 tablets n/a Clonazepam tablet (CS) 1mg, 2mg $10 for up to 90 tablets n/a Diazepam tablet (CS) 2mg, 5mg, 10mg $8 for up to 90 tablets n/a Lorazepam tablet (CS) 0.5mg $25 Lorazepam tablet (CS) 1mg, 2mg $30 n/a Antimicrobial/Antiviral/Antifungal Acyclovir capsule 200mg $20 Acyclovir tablet 400mg, 800mg $20 Clindamycin HCL capsule 150mg $45 $85 Fluconazole tablet 100mg, 200mg $35 for up to 30 tablets Isoniazid tablet 300mg $20 Minocycline capsule 50mg, 75mg, 100mg $45 $85 Nyamyc Topical Powder 100,000U/g (30g bottle) $30 per bottle Nystatin tablet units Sulfamethoxazole/Trimethoprim DS 800mg/160mg $20 Valacyclovir HCl tablet $50 for up to 90 tablets Valacyclovir HCl tablet 1gm $75 for up to 90 tablets Arthritis/Pain Azathioprine tablet 50mg Celecoxib capsule 50mg, 100mg $15 for up to 30 capsules Celecoxib capsule 200mg, 400mg $35 for up to 30 capsules Diclofenac EC tablet 50mg, 75mg $25 n/a Diclofenac ER tablet 100mg $40 n/a Etodolac capsule 200mg, 300mg $40 for up to 90 caps n/a Etodolac tablet 400mg, n/a Hydroxychloroquine tablet 200mg $22 for up to 30 tablets Ibuprofen tablet 400mg, 600mg, 800mg $20 n/a Meloxicam tablet 7.5mg, 15mg $20 n/a Methotrexate tablet 2.5mg $20 per 12 tablets n/a Nabumetone tablet, 750mg $40 n/a Naproxen Sodium tablet 550mg $25 n/a Naproxen tablet 250mg, 375mg, $20 n/a Sulfasalazine DR tablet Tramadol tablet (CS) 50mg $7 for up to 90 tablets n/a Tramadol HCl ER tablet (CS) 100mg, 200mg $40 for up to 30 tablets n/a Tramadol HCl ER tablet (CS) 300mg $60 for up to 30 tablets n/a Tramadol/Acetaminophen tablet (CS) 37.5mg/325mg $30 for up to 120 tablets n/a

2 Cancer Anastrozole tablet 1mg $30 for up to 90 tablets Hexalen capsule 50mg $40 for a 30-day supply n/a Hydroxyurea capsule $25 for up to 90 caps n/a Letrozole tablet 2.5mg $30 $55 Nilandron tablet 150mg $0* n/a Panretin gel 0.1% 60gm $40 per tube Tamoxifen Citrate tablet 10mg, 20mg $25 $45 Cholesterol/Triglycerides Atorvastatin tablet 10mg, 20mg 40mg, 80mg $25 $45 Fenofibrate tablet 48mg, 54mg, 160mg $55 $95 Fenofibrate tablet 145mg $55 for up to 30 tablets Fenofibrate, micronized capsule 134mg $70 n/a Fenofibric acid DR capsule 135mg $60 for up to 30 capsules Gemfibrozil tablet 600mg $30 $55 Lovastatin tablet 10mg, 20mg, 40mg $9 $18 Niacin ER tablet $45 for up to 30 tablets Niacor tablet $25 for up to 180 tablets Omega-3-acid ethyl esters capsule 1gm $80 for up to 120 capsules Pravastatin tablet 10mg, 20mg, 40mg, 80mg Prevalite Powder 4g/5.5g dose packet $25 for a carton of 42 packets Prevalite Powder 4g/5.5g dose packet $35 for a carton of 60 packets Prevalite Powder 4g/5.5g powder can (231g) $25 per can Simvastatin tablet 5mg, 10mg, 20mg, 40mg, 80mg $20 $35 Dermatology Alclometasone Dipropionate Cream 15gm $15 per tube Betamethasone Dipropionate Cream, 15gm $25 per tube Mometasone Furoate Cream 15gm $15 per tube Mometasone Furoate Ointment 15gm $15 per tube Diabetes Blood Glucose Monitor (Prodigy N/A (No prescription required) One free monitor annually Blood Glucose Monitor Control Sol., Low 4ml. Vial (No prescription required) $5 per vial Blood Glucose Strips, No Coding Box of 50 (No prescription required) $15 per box Blood Glucose Twist Top Lancets 28G Box of 100; min order - 2 boxes (No prescription required) $5 per box; min order $10 Glimepiride tablet 1mg, 2mg, 4mg $20 Glipizide ER tablet 2.5mg, 5mg, 10mg $35 $65 Glipizide tablet 5mg, 10mg $20 Glyburide tablet 1.25mg, 2.5mg, 5mg $20 Glyburide, micronized tablet 1.5mg, 3mg, 6mg $20 Glyburide/Metformin tablet 1.25/250mg, 2.5/, 5/ $30 $55 Insulin Syringes (Prodigy ) 28G 12.7mm-1cc, 31G 8mm-1/2cc, 31G 8mm-1/3cc $13 for a box of 100 Metformin HCL ER tablet, 750mg $20 Metformin HCL tablet, 850mg, 1000mg $20 Pioglitazone HCL tablet 15mg, 30mg, 45mg $25 n/a Rapaglinide tablet 0.5mg, 1mg, 2mg Gastrointestinal AcipHex tablet 20mg $10 for up to 30 tablets Balsalazide Disodium capsule 750mg $40 for up to 90 capsules Dicyclomine capsule 10mg $20 Dicyclomine tablet 20mg $20 Diphenoxylate/Atropine tablet (CS) 2.5/0.025mg $35 n/a Donnatal elixir (CS) (mint or grape) 16.2/0.1037/0.0194/0.0065mg $0* n/a Donnatal tablet (CS) 16.2/0.1037/0.0194/0.0065mg $0* n/a Esomeprazole DR capsule 20mg, 40mg $40 for up to 30 capsules Famotidine tablet 20mg, 40mg $20 Lactulose Oral Solution 10gm/15mL $10 per bottle Meclizine HCL tablet 12.5mg, 25mg $30 $55 Metoclopramide HCL tablet 5mg, 10mg (limit 1 fill; no refills) $20 n/a Omeprazole capsule 10mg, 20mg, 40mg $35 $65 Ondansetron / Ondansetron ODT tablet 4mg $50 for up to 135 tabs n/a Ondansetron / Ondansetron ODT tablet 8mg $50 for up to 90 tabs n/a Pantoprazole tablet 20mg, 40mg $20 n/a Prochlorperazine tablet 5mg, 10mg $20 Ranitidine tablet 150mg, 300mg $20 Sucralfate tablet 1gm $30 for up to 120 tablets Sulfasalazine tablet $50 $95 Heart/Circulation Cilostazol tablet 50mg, 100mg $30 $55 Clopidogrel tablet 75mg

3 Heart/Circulation (cont'd) Digoxin tablet 0.125mg, 0.25mg Flecainide Acetate tablet 100mg, 150mg Folic Acid tablet 1mg $20 Isosorbide Mononitrate ER tablet 30mg, 60mg 120mg $20 Isosorbide Mononitrate tablet 10mg, 20mg $20 Jantoven (Warfarin) tablet mg: 1, 2, 2.5, 3, 4, 5, 6, 7.5, 10 $25 n/a Lanoxin tablet.0625mg,.1875mg $0* n/a Nitroglycerin SA capsule 2.5mg, 6.5mg, 9mg $45 $85 Pacerone tablet 100mg, 200mg, 400mg $25 $45 Pentoxifylline ER tablet 400mg $30 $55 Potassium Chloride ER tablet 8mEQ, 10mEQ, 20mEQ Potassium Citrate tablet 5mEQ, 10mEQ $15 for up to 90 tablets Propafenone HCL tablet 150mg, 225mg, 300mg $40 $75 Sorine tablet 80mg, 120mg, 160mg, 240mg $20 n/a Hormones Androxy tablet (CS) 10mg $40 n/a Estradiol tablet 0.5mg, 1mg, 2 mg $20 Estropipate tablet 0.625(0.75mg), 1.25(1.5mg) $20 Medroxyprogesterone tablet 2.5mg, 5mg, 10mg $15 n/a Norethindrone Acetate tablet 5mg $75 for up to 50 tablets Prednisone tablet 1mg, 2.5mg, 5mg, 10mg, 20mg, 50mg $20 n/a Testosterone Gel packet (CS) 50mg (5g of gel per packet) $75 for a carton of 30 packets n/a Testosterone Gel pump (CS) 75g pump - 2 pumps per carton (12.5mg per pump actuation) $95 for a carton of 2 pumps n/a Testosterone Gel tube (CS) 50mg (5g of gel per tube) $75 for a carton of 30 tubes n/a Hypertension/Hypotension Amlodipine tablet 2.5mg, 5mg, 10mg $20 $40 Amlodipine/Benazepril capsule 5/10mg, 5/20mg, 10/20mg $50 for up to 90 capsules Amlodipine/Valsartan tablet 5/160mg, 5/320mg, 10/160mg, 10/320mg $25 for up to 30 tablets Amlodipine/Valsartan/HCTZ tablet 5/160/12.5mg, 5/160/25mg, 10/160/12.5mg, 10/160/25mg, 10/320/25mg $60 for up to 30 tablets Atenolol tablet 25mg, 50mg, 100mg $9 $18 Atenolol/Chlorthalidone tablet 50/25mg, 100/25mg $20 Benazepril tablet 5mg, 10mg, 20mg, 40mg $20 Benazepril/HCTZ tablet 5/6.25mg, 10/12.5mg, 20/12.5mg, 20/25mg $25 $45 Bisoprolol/HCTZ tablet 2.5/6.25mg, 5/6.25mg, 10/6.25mg $20 Candesartan Cilexetil tablet 4mg, 8mg, 16mg $30 for up to 30 tablets Candesartan Cilexetil tablet 32mg $40 for up to 30 tablets Candesartan Cilexetil-HCTZ tablet 16/12.5mg Candesartan Cilexetil-HCTZ tablet 32/12.5mg, 32/25mg $45 for up to 90 tablets Captopril tablet 12.5mg, 25mg, 50mg, 100mg Carvedilol tablet 3.125mg, 6.25mg, 12.5mg, 25mg $20 Chlorthalidone tablet 25mg, 50mg $30 $55 Clonidine HCL tablet 0.1mg, 0.2mg, 0.3mg $20 Clonidine patch 0.3mg/day $80 per pack of 4 Dibenzyline capsule 10mg $0* n/a Diltiazem ER capsule (24hr) (Dilt-XR) 120mg, 180mg, 240mg $40 for up to 90 capsules Diltiazem ER capsule (Dilt-CD) 120mg, 180mg, 240mg, 300mg $40 for up to 90 capsules Doxazosin Mesylate tablet 1mg, 2mg, 4mg, 8mg Dutoprol tablet 25/12.5mg, 50/12.5mg, 100/12.5mg $0* n/a Dyrenium capsule 50mg, 100mg $0 n/a Enalapril Maleate tablet 2.5mg, 5mg, 10mg, 20mg $20 Enalapril/HCTZ tablet 5/12.5mg, 10/25mg $20 Eplerenone tablet 25mg, 50mg $35 for a 30-day supply Felodipine ER tablet 2.5mg, 5mg Felodipine ER tablet 10mg $70 for up to 90 tablets Furosemide tablet 20mg, 40mg, 80mg $9 $18 Hydralazine tablet 10mg, 25mg, 50mg $25 $45 Hydrochlorothiazide capsule 12.5mg $20 Hydrochlorothiazide tablet 25mg, 50mg $20 Indapamide tablet 1.25mg, 2.5mg $20 Irbesartan tablet 75mg, 150mg, 300mg $30 $55 Irbesartan/HCTZ tablet 150mg/12.5mg, 300mg/12.5mg $30 $55 Labetalol HCL tablet 100mg, 200mg, 300mg $30 for up to 90 tablets Lisinopril tablet 2.5mg, 5mg, 10mg, 20mg, 30mg, 40mg $9 $18 Lisinopril/HCTZ tablet 10/12.5mg, 20/12.5mg, 20/25mg $9 $18 Losartan Potassium tablet 25mg, 50mg, 100mg $20 $40 Losartan/HCTZ tablet 50/12.5mg, 100/12.5mg, 100/25mg $25 $45

4 Hypertension/Hypotension (cont'd) Metolazone tablet 2.5mg, 5mg $35 $65 Metoprolol Succinate ER tablet 25mg, 50mg, 100mg $35 $65 Metoprolol Succinate ER tablet 200mg $45 $85 Metoprolol Tartrate tablet 25mg, 50mg, 100mg $20 Midodrine HCl tablet 2.5mg, 5mg, 10mg Nifedipine ER tablet 30mg, 60mg $50 $95 Prazosin capsule 1mg, 2mg, 5mg $20 $40 Propranolol tablet 10mg, 20mg, 40mg, 80mg $20 Propranololl HCL ER capsule 60mg, 80mg, 120mg, 160mg $45 for up to 90 capsules Quinapril tablet 5mg, 10mg, 20mg, 40mg $30 $55 Quinapril/HCTZ tablet 10/12.5mg, 20/12.5mg, 20/25mg $30 for up to 90 tablets Ramipril capsule 1.25mg, 2.5mg, 5mg, 10mg $25 $45 Sildenafil Citrate tablet 20mg $20 for up to 30 tablets Spironolactone tablet 25mg $20 Spironolactone/HCTZ tablet 25mg/25mg Telmisartan tablet 20mg, 40mg, 80mg $35 $65 Terazosin capsule 1mg, 2mg, 5mg, 10mg $20 Trandolapril tablet 1mg, 2mg, 4mg $30 $55 Triamterene/HCTZ capsule 37.5/25mg $20 Triamterene/HCTZ tablet 37.5/25mg, 75/50mg $20 Valsartan tablet 40mg, 80mg $30 for 90 tablets Valsartan tablet 160mg, 320mg $40 for 90 tablets Valsartan/HCTZ tablet 80/12.5mg, 160/12.5mg, 160/25mg, 320/12.5mg, 320/25mg $35 $65 Verapamil SR tablet 120mg, 180mg, 240mg $25 $40 Verapamil tablet 40mg, 80mg, 120mg $20 Immunosuppressant Mycophenolate Mofetil capsule 250mg $65 for up to 180 capsules Mycophenolate Mofetil tablets $65 for up to 180 tablets Tacrolimus capsule 0.5mg $60 for up to 90 capsules Tacrolimus capsule 1mg $75 for up to 90 capsules Insomnia Eszopiclone tablet (CS) 1mg, 2mg, 3mg n/a Temazepam capsule (CS) 15mg, 30mg $16 for up to 90 capsules n/a Zaleplon capsule (CS) 5mg, 10mg $35 for up to 90 capsules n/a Zolpidem Tartrate tablet (CS) 5mg, 10mg $30 n/a Zolpidem Tartrate ER tablet (CS) 6.25mg, 12.5mg $45 for up to 30 tablets n/a Mental Health Amitriptyline tablet 10mg, 25mg, 50mg, 75mg, 100mg, 150mg $20 n/a Bupropion HCL tablet 75mg $40 n/a Bupropion HCL tablet 100mg n/a Bupropion HCL SR tablet 100mg, 150mg, 200mg $65 n/a Bupropion HCL XL tablet 150mg, 300mg $65 n/a Chlorpromazine HCL tablet 10mg, 25mg, 50mg, 100m, 200mg $35 n/a Citalopram tablet 10mg, 20mg, 40mg $20 n/a Doxepin capsule 10mg, 25mg, 50mg, 75mg, 100mg $25 n/a Duloxetine HCL DR capsule 20mg, 30mg, 60mg $45 n/a Escitalopram tablet 5mg, 10mg, 20mg $15 n/a Fluoxetine capsule 10mg, 20mg, 40mg $15 n/a Haloperidol tablet 0.5mg, 1mg, 2mg, 5mg $25 n/a Lithium Carbonate capsule 300mg $10 for up to 270 capsules n/a Lithium Carbonate ER tablet 300mg, 450mg $35 n/a Mirtazapine tablet 15mg, 30mg, 45mg $30 n/a Nortriptyline HCL capsule 10mg, 25mg, 50mg, 75mg $20 n/a Olanzapine tablet 2.5mg, 5mg, 7.5mg, 10mg n/a Olanzapine tablet 15mg, 20mg $50 for up to 90 tablets n/a Parnate tablet 10mg $0* n/a Paroxetine HCL tablet 10mg, 20mg, 30mg, 40mg $20 n/a Quetiapine Fumarate tablet 25mg, 50mg, 100mg n/a Quetiapine Fumarate tablet 200mg, 300mg n/a Quetiapine Fumarate tablet 400mg $50 for up to 90 tablets n/a Risperidone tablet 0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg $45 n/a Sertraline tablet 25mg, 50mg, 100mg $25 n/a Trazodone tablet 50mg, 100mg, 150mg $10 n/a Trifluoperazine HCl tablet 1mg, 2mg, 5mg, 10mg $50 n/a Venlafaxine tablet 25mg, 37.5mg, 50mg, 75mg, 100mg $45 n/a Venlafaxine ER capsule 37.5mg, 75mg, 150mg $45 n/a Ziprasidone capsule 20mg, 40mg, 60mg, 80mg $65 for up to 90 capsules n/a

5 Muscle Relaxers Baclofen tablet 10mg, 20mg $15 n/a Chlorzoxazone tablet n/a Cyclobenzaprine tablet 5mg, 10mg $25 n/a Methocarbamol tablet, 750mg $15 for up to 90 tablets n/a Tizanidine HCL tablet 2mg, 4mg $55 n/a Neurology Amantadine tablet 100mg $30 n/a Benztropine tablet 0.5mg, 1mg, 2mg $20 Carbamazepine tablet 200mg Carbamazepine ER tablet 200mg, 400mg Carbidopa/Levodopa/Entacapone tablet 12.5/50mg, 18.75/75mg, 25/100mg, 31.25/125mg, 37.5/150mg, 50/200mg $45 for up to 60 tablets Carbidopa / Levodopa SR tablet 25/100mg, 50/200mg $45 $85 Carbidopa / Levodopa tablet 10/100mg, 25/100mg, 25/250mg $45 $85 Divalproex NA DR tablet 125mg, 250mg, $35 $65 Divalproex SOD ER tablet 250mg $65 for up to 90 tablets Divalproex SOD ER tablet $95 for up to 90 tablets Donepezil tablet 5mg, 10mg $15 n/a Gabapentin capsule 100mg, 300mg, 400mg $25 for up to 270 capsules Gabapentin tablet 600mg, 800mg $45 for up to 270 tablets Guanfacine ER tablet 1mg, 2mg, 3mg, 4mg $50 for up to 60 tablets Lamotrigine tablet 25mg, 100mg, 150mg, 200mg $30 $55 Levetiracetam tablet 250mg,, 750mg $50 $95 Levetiracetam tablet 1000mg Levetiracetam ER tablet, 750mg $80 for up to 180 tablets Memantine HCL tablet 5mg, 10mg $25 for up to 60 tablets Modafinil tablet (CS) 100mg, 200mg $80 n/a Oxcarbazepine tablet 150mg, 300mg, 600mg $30 n/a Phenytoin Sodium capsule 100mg $20 for up to 180 capsules Pramipexole tablet 0.125mg, 0.25mg, 0.5mg, 1mg, 1.5mg $25 for up to 180 tablets Qudexy XR capsule 25mg, 50mg, 100mg, 150mg, 200mg $50 $95 Rivastigmine tartrate capsule 1.5mg, 3mg, 4.5mg, 6mg $50 for up to 60 capsules Ropinirole HCL tablet 0.25mg, 0.5mg, 1mg, 2mg $45 $85 Sumatriptan Succ tablet 25mg $35 for up to 72 tablets n/a Sumatriptan Succ tablet 50mg $35 for up to 54 tablets n/a Sumatriptan Succ tablet 100mg $35 for up to 27 tablets n/a Topiramate tablet 25mg, 50mg, 100mg, 200mg $35 $65 Valproic acid capsule 250mg $35 $65 Zonegran capsule 25mg, 100mg $20 for up to 90 capsules Zonisamide capsule 50mg $20 for up to 90 capsules Nutritional/Metabolic Ferrous Sulfate EC tablet Folgard tablet (OTC) Folgard OS tablet 325mg (no prescription required) 2000IU D3/800mcg folic acid/12mg B6/120mcg B12 (no prescription required) calcium/1.1mg folic acid/300iu D3/12.5mg B6/250mcg B12/100mg magnesium/1.5mg boron Folgard RX tablet 2.2mg folic acid/25mg B6/1mg B12 $30 for 90 tablets Folic Acid 2.2 tablet 2.2mg folic acid/25mg B6/500mcg B12 $9 for 90 tablets Ophthalmic Brimonidine Tartrate 0.2% Solution 0.2%/10ml dropper $15 per dropper Dorzolamide HCl 2% Solution 10ml dropper $15 per dropper Dorzolamide/Timolol Solution 2%/0.5% 10ml dropper $15 per dropper Latanoprost 0.005% Solution 2.5ml dropper $45 (limit 3) n/a Oral Contraceptives Norethindrone tablet 28's (0.35mg) $35 $65 Norethindrone/Ethinyl Estradiol tablet 28's (0.4mg/0.035mg) $35 $65 Sprintec tablet 28's $35 (limit 3) $65 (limit 6) Tri-Sprintec tablet 28's $35 (limit 3) $65 (limit 6) Prostate Bicalutamide tablet 50mg $35 $65 Dutasteride capsule 0.5mg $40 for up to 30 capsules Finasteride tablet 5mg $25 $45 Tamsulosin capsule 0.4mg $30 $55 Uroxatral tablet 10mg $0* n/a Thyroid Levothyroxine tablet mcg: 25, 50, 75, 88, 100, 112, 125, 137, 150, 175, 200, 300 $20 Propylthiouracil tablet SSKI oral solution SSKI oral solution 50mg 1g/ml dropper 8 fl. oz. bottle (237ml) $6 per bottle of 100 tablets (minimum 2 bottles) $25 for 60 tablets $22 for 60 tablets $45 for up to 90 tablets $20 per dropper $35 per bottle

6 Miscellaneous Alendronate tablet 70mg (Once a week dosage) $20 (limit 12) $40 (limit 24) Allopurinol tablet 100mg, 300mg $20 Benzonatate capsule 100mg $12 for up to 30 capsules Benzonatate capsule 200mg $15 for up to 30 capsules Bethanechol tablet 5mg, 10mg, 25mg $25 n/a Bethanechol tablet 50mg $45 n/a Calcium acetate tablet 667mg Fortical Nasal Spray 2200 IU/ml (3.7mL bottle) $45 for bottle Levalbuterol Solution 1.25mg/3mL $55 for up to 24 vials Oxandrolone tablet (CS) 2.5mg, 10mg (Requires statement of diagnosis by provider) $50 for up to 30 tablets n/a Oxybutynin tablet 5mg $20 Oxybutynin Chloride ER tablet 5mg, 10mg, 15mg $45 $85 Raloxifene tablet 60mg $65 for up to 30 tablets Risedronate Sodium tablet 35mg (once a week dosage) $50 per pack of 4 tablets Risedronate Sodium tablet 35mg (once a week dosage) $75 per pack of 12 tablets Risedronate Sodium tablet 150mg (once a month dosage) $80 per dosage Tolterodine Tartrate tablet 1mg, 2mg $30 for up to 30 tablets Important Reminders: If you want to order a new prescription for a 6-month supply, please ask your doctor to write it for a 180-day supply. You need to tell us if you want a 180-day supply. Rx Outreach is a fully licensed pharmacy. Rx Outreach reserves the right to add or delete medicines available, change fees, or discontinue the program at any time. Rx Outreach does not accept returns of unused medicine dispenses pursuant to a valid prescription or refund fees for any such prescription. You are responsible for the package upon delivery. All prescriptions are evaluated by a pharmacist before being filled. The quantity may be limited based on dose restrictions set by therapeutic guidelines and state regulations. We cannot ship controlled substances to a P.O. Box or doctor's office. Your shipping address for these must be a deliverable U.S. Postal Service street address Rx Outreach. All Rights Reserved Rx Outreach / P. O. Box / St. Louis, MO RXO DLRXO0216