Pharmacy Savings Program

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Transcription:

Pharmacy Savings Program SELECT GENERICS DRUG LIST The Pharmacy Savings Program provides you with savings on select generic medications included on this list. The prices for these select generic medications are based on whether it is a 30-day supply* or 90-day supply* and its pricing tier: Tier 1 $5 for a 30-day supply and $10 for a 90-day supply Tier 2 $10 for a 30-day supply and, $20 for a 90-day supply Tier 3 $15 for a 30-day supply and $30 for a 90-day supply ALLERGIES & COLD AND FLU BENZONATATE 100 MG CAP 30 90 1 BENZONATATE 200 MG CAP 30 90 3 CYPROHEPTADINE HCL 2 MG/5 ML SYRUP 120 360 3 DIPHENHYDRAMINE HCL 12.5MG/5ML LIQUID 118 354 2 DIPHENHYDRAMINE HCL 50 MG CAP 30 90 2 GUAIFEN/DEXTROMETHORPHAN/PE 50-5-2.5/1 DROPS 30 90 3 HYDROXYZINE HCL 10 MG TAB 60 180 3 HYDROXYZINE HCL 25 MG TAB 30 90 2 HYDROXYZINE HCL 50 MG TAB 30 90 3 With the Pharmacy Savings Program you will also receive: Discounts on other generic and brand name medications Flu Shots: $24.99 Discounts on select human-equivalent pet medications *The day supply is based upon the average dispensing patterns for the specific drug and strength. The Program, as well as the prices and the list of covered drugs, can be modified at any time without notice. HYDROXYZINE PAMOATE 25 MG CAP 90 270 3 HYDROXYZINE PAMOATE 50 MG CAP 30 90 2 LORATADINE 10 MG TAB 30 90 1 PROMETHAZINE HCL 12.5 MG TAB 30 90 2 PROMETHAZINE HCL 25 MG TAB 12 36 1 PROMETHAZINE HCL 50 MG TAB 60 180 2 PROMETHAZINE/DEXTROMETHORPHAN 6.25-15/5 SYRUP 180 540 2 PHARMACY SAVINGS PROGRAM 1

ANTIBIOTIC & ANTI-INFECTIVE TREATMENTS ACYCLOVIR 200 MG CAP 60 180 2 ACYCLOVIR 400 MG TAB 60 180 3 AMOXICILLIN 125 MG TAB 30 90 2 AMOXICILLIN 125 MG/5ML SUSP 150 450 2 AMOXICILLIN 200 MG/5ML SUSP 100 300 1 AMOXICILLIN 250 MG CAP 30 90 1 AMOXICILLIN 250 MG/5ML SUSP 150 450 1 AMOXICILLIN 400 MG/5ML SUSP 75 225 1 AMOXICILLIN 500 MG CAP 30 90 1 AMOXICILLIN 500 MG TAB 30 90 3 AMOXICILLIN 875 MG TAB 20 60 3 AMPICILLIN TRIHYDRATE 250 MG CAP 40 120 2 AMPICILLIN TRIHYDRATE 500 MG CAP 30 90 3 CEFADROXIL 500 MG CAP 20 60 3 CEPHALEXIN 250 MG CAP 28 84 1 CEPHALEXIN 500 MG CAP 30 90 1 CIPROFLOXACIN HCL 250 MG TAB 14 42 1 CIPROFLOXACIN HCL 500 MG TAB 20 60 1 CLINDAMYCIN HCL 150 MG CAP 30 90 3 CLINDAMYCIN HCL 300 MG CAP 28 84 3 GENTAMICIN SULFATE 0.3 % DROPS 5 15 2 ISONIAZID 100 MG TAB 100 300 2 ISONIAZID 300 MG TAB 30 90 1 METRONIDAZOLE 250 MG TAB 28 84 2 METRONIDAZOLE 500 MG TAB 14 42 3 MINOCYCLINE HCL 50 MG CAP 60 180 3 PENICILLIN V POTASSIUM 125 MG/5ML SOLN 200 600 1 PENICILLIN V POTASSIUM 250 MG TAB 30 90 1 PENICILLIN V POTASSIUM 500 MG TAB 20 60 1 POLYMYXIN B SULF/TRIMETHOPRIM 10000-1/ML DROPS 10 30 2 SMZ/TMP 400MG-80MG TAB 28 84 1 SMZ/TMP 800-160 MG TAB 20 60 2 TOBRAMYCIN 0.3 % DROPS 5 15 2 ARTHRITIS & PAIN CYCLOBENZAPRINE HCL 5 MG TAB 30 90 2 CYCLOBENZAPRINE HCL 10 MG TAB 30 90 2 FLURBIPROFEN 50 MG TAB 60 180 3 IBUPROFEN 100 MG/5ML SUSP 120 360 2 IBUPROFEN 400 MG TAB 90 270 2 IBUPROFEN 600 MG TAB 60 180 2 IBUPROFEN 800 MG TAB 60 180 2 INDOMETHACIN 25 MG CAP 60 180 2 INDOMETHACIN 50 MG CAP 30 90 2 KETOPROFEN 50 MG CAP 90 270 3 KETOPROFEN 75 MG CAP 60 180 3 KETOROLAC TROMETHAMINE 30 MG/ML SYRINGE 15 45 3 MELOXICAM 7.5 MG TAB 30 90 2 MELOXICAM 15 MG TAB 30 90 2 METHOCARBAMOL 500 MG TAB 30 90 2 METHOCARBAMOL 750 MG TAB 60 180 3 NAPROXEN 250 MG TAB 60 180 1 PHARMACY SAVINGS PROGRAM 2

NAPROXEN 375 MG TAB 60 180 1 NAPROXEN 375 MG TAB EC 60 180 3 NAPROXEN 500 MG TAB 60 180 2 TIZANIDINE HCL 4 MG TAB 30 90 3 TRAMADOL HCL 50 MG TAB 120 360 3 ASTHMA ALBUTEROL SULFATE 2 MG/5 ML SYRUP 120 360 1 ALBUTEROL SULFATE 2.5 MG/3ML VIAL-NEB 75 225 2 IPRATROPIUM BROMIDE 0.2 MG/ML SOLN 75 225 2 DIABETES GLIMEPIRIDE 1 MG TAB 30 90 1 GLIMEPIRIDE 2 MG TAB 30 90 1 GLIMEPIRIDE 4 MG TAB 30 90 1 GLIPIZIDE 5 MG TAB 30 90 1 GLIPIZIDE 10 MG TAB 60 180 1 GLIPIZIDE ER 10 MG TAB 30 90 3 GLIPIZIDE ER 5 MG TAB 30 90 3 GLYBURIDE 2.5 MG TAB 30 90 2 GLYBURIDE 5 MG TAB 30 90 2 GLYBURIDE,MICRONIZED 1.5 MG TAB 30 90 2 GLYBURIDE,MICRONIZED 3 MG TAB 30 90 2 GLYBURIDE/METFORMIN HCL 5 MG-500MG TAB 90 270 3 METFORMIN HCL 500 MG TAB 90 270 1 METFORMIN HCL ER 500 MG TAB 60 180 1 METFORMIN HCL 850 MG TAB 90 270 1 METFORMIN HCL 1000 MG TAB 90 270 1 FUNGAL INFECTIONS CLOTRIMAZOLE 1 % CRM 30 90 1 FLUCONAZOLE 150 MG TAB 1 3 2 TERBINAFINE HCL 250 MG TAB 30 90 2 GASTROINTESTINAL HEALTH CIMETIDINE 300 MG TAB 60 180 3 CIMETIDINE HCL 300 MG/5ML SOLN 240 720 3 DICYCLOMINE HCL 10 MG CAP 90 270 2 DICYCLOMINE HCL 20 MG TAB 60 180 2 DOCUSATE SODIUM 100 MG CAP 60 180 2 FAMOTIDINE 20 MG TAB 60 180 2 FAMOTIDINE 40 MG TAB 30 90 3 LACTULOSE 10 G/15 ML SOLN 473 1419 3 LACTULOSE 10 GM/15 ML SYRUP 237 711 2 MECLIZINE HCL 12.5 MG TAB 30 90 2 MECLIZINE HCL 25 MG TAB 30 90 3 METOCLOPRAMIDE HCL 10 MG TAB 60 180 2 METOCLOPRAMIDE HCL 10 MG/10ML SOLN 60 180 1 METOCLOPRAMIDE HCL 5 MG TAB 60 180 2 METOCLOPRAMIDE HCL 5 MG/5 ML SOLN 60 180 1 NIZATIDINE 150 MG CAP 60 180 3 OMEPRAZOLE 20 MG CAP 30 90 3 PANTOPRAZOLE SODIUM 40 MG TAB 30 90 1 PROCHLORPERAZINE MALEATE 5 MG TAB 30 90 2 PROCHLORPERAZINE MALEATE 10 MG TAB 30 90 2 RANITIDINE HCL 15 MG/ML SYRUP 120 360 3 PHARMACY SAVINGS PROGRAM 3

RANITIDINE HCL 150 MG TAB 60 180 2 RANITIDINE HCL 300 MG TAB 30 90 2 GLAUCOMA AND EYE CARE FLUTICASONE PROPIONATE 50 MCG SUSP 16 48 3 KETOROLAC TROMETHAMINE 0.5 % DROPS 5 15 3 TIMOLOL MALEATE 0.25 % DROPS 5 15 2 TIMOLOL MALEATE 0.5 % DROPS 5 15 2 TROPICAMIDE 1 % DROPS 15 45 3 HEART HEALTH & BLOOD PRESSURE AMIODARONE HCL 200 MG TAB 30 90 2 AMLODIPINE BESYLATE 2.5 MG TAB 30 90 2 AMLODIPINE BESYLATE 5 MG TAB 30 90 2 AMLODIPINE BESYLATE 10 MG TAB 30 90 2 AMLODIPINE BESYLATE/BENAZEPRIL 5 MG-10 MG CAP 30 90 3 AMLODIPINE BESYLATE/BENAZEPRIL 10 MG-20MG CAP 30 90 3 ATENOLOL 25 MG TAB 60 180 2 ATENOLOL 50 MG TAB 60 180 2 ATENOLOL 100 MG TAB 30 90 1 ATORVASTATIN CALCIUM 10 MG TAB 30 90 3 ATORVASTATIN CALCIUM 20 MG TAB 30 90 3 ATORVASTATIN CALCIUM 40 MG TAB 30 90 3 ATORVASTATIN CALCIUM 80 MG TAB 30 90 3 BENAZEPRIL HCL 5 MG TAB 30 90 2 BENAZEPRIL HCL 10 MG TAB 30 90 2 BENAZEPRIL HCL 20 MG TAB 30 90 2 BENAZEPRIL HCL 40 MG TAB 30 90 2 BISOPROLOL/HCTZ 2.5-6.25MG TAB 30 90 2 BISOPROLOL/HCTZ 5-6.25MG TAB 30 90 2 BISOPROLOL/HCTZ 10-6.25MG TAB 30 90 2 CARVEDILOL 3.125 MG TAB 60 180 2 CARVEDILOL 6.25 MG TAB 60 180 2 CARVEDILOL 12.5 MG TAB 60 180 2 CARVEDILOL 25 MG TAB 60 180 2 CLONIDINE HCL 0.1 MG TAB 60 180 2 CLONIDINE HCL 0.2 MG TAB 60 180 2 CLONIDINE HCL 0.3 MG TAB 60 180 2 CLOPIDOGREL BISULFATE 75 MG TAB 30 90 1 DILTIAZEM HCL 30 MG TAB 60 180 2 DILTIAZEM HCL 120 MG CAP 30 90 3 DIPYRIDAMOLE 25 MG TAB 60 180 3 ENALAPRIL-HCTZ 5-12.5 MG TAB 60 180 3 ENALAPRIL-HCTZ 10-25 MG TAB 30 90 3 FOSINOPRIL SODIUM 20 MG TAB 30 90 2 FOSINOPRIL SODIUM 40 MG TAB 30 90 2 FUROSEMIDE 10 MG/ML SOLN 90 270 3 FUROSEMIDE 20 MG TAB 60 180 1 FUROSEMIDE 40 MG TAB 60 180 1 FUROSEMIDE 80 MG TAB 30 90 1 GEMFIBROZIL 600 MG TAB 60 180 3 GUANFACINE HCL 1 MG TAB 30 90 2 GUANFACINE HCL 2 MG TAB 30 90 2 HCTZ 12.5 MG TAB 30 90 3 PHARMACY SAVINGS PROGRAM 4

HYDRALAZINE HCL 10 MG TAB 60 180 2 HYDRALAZINE HCL 25 MG TAB 60 180 2 HYDRALAZINE HCL 50 MG TAB 90 270 3 HYDROCHLOROTHIAZIDE 12.5 MG CAP 30 90 2 HYDROCHLOROTHIAZIDE 25 MG TAB 30 90 1 HYDROCHLOROTHIAZIDE 50 MG TAB 30 90 1 INDAPAMIDE 1.25 MG TAB 30 90 2 INDAPAMIDE 2.5 MG TAB 30 90 2 ISOSORBIDE MONONITRATE 10 MG TAB 60 180 3 ISOSORBIDE MONONITRATE 20 MG TAB 60 180 3 ISOSORBIDE MONONITRATE 30 MG TAB 30 90 2 ISOSORBIDE MONONITRATE 60 MG TAB 30 90 2 LISINOPRIL 2.5 MG TAB 30 90 1 LISINOPRIL 5 MG TAB 30 90 1 LISINOPRIL 10 MG TAB 30 90 1 LISINOPRIL 20 MG TAB 30 90 1 LISINOPRIL 30 MG TAB 30 90 1 LISINOPRIL 40 MG TAB 30 90 1 LISINOPRIL-HCTZ 10-12.5 MG TAB 30 90 1 LISINOPRIL-HCTZ 20-12.5 MG TAB 30 90 1 LISINOPRIL-HCTZ 20-25 MG TAB 30 90 1 LOSARTAN POTASSIUM 25 MG TAB 30 90 3 LOSARTAN POTASSIUM 50 MG TAB 30 90 3 LOSARTAN POTASSIUM 100 MG TAB 30 90 1 LOSARTAN/HCTZ 100-12.5MG TAB 30 90 3 LOVASTATIN 10 MG TAB 30 90 1 LOVASTATIN 20 MG TAB 30 90 1 LOVASTATIN 40 MG TAB 30 90 1 METHYLDOPA 250 MG TAB 60 180 3 METHYLDOPA 500 MG TAB 60 180 3 METOPROLOL TARTRATE 25 MG TAB 60 180 2 METOPROLOL TARTRATE 50 MG TAB 60 180 2 METOPROLOL TARTRATE 100 MG TAB 60 180 2 PRAZOSIN HCL 1 MG CAP 30 90 2 QUINAPRIL HCL 5 MG TAB 30 90 2 QUINAPRIL HCL 40 MG TAB 30 90 2 RAMIPRIL 1.25 MG CAP 30 90 3 RAMIPRIL 2.5 MG CAP 30 90 3 SIMVASTATIN 5 MG TAB 30 90 2 SIMVASTATIN 10 MG TAB 30 90 2 SIMVASTATIN 20 MG TAB 30 90 2 SIMVASTATIN 40 MG TAB 30 90 3 SIMVASTATIN 80 MG TAB 30 90 3 SOTALOL HCL 160 MG TAB 60 180 3 SPIRONOLACTONE 25 MG TAB 30 90 2 SPIRONOLACTONE 50 MG TAB 30 90 2 TERAZOSIN HCL 1 MG CAP 30 90 2 TERAZOSIN HCL 2 MG CAP 30 90 2 TERAZOSIN HCL 5 MG CAP 30 90 2 TERAZOSIN HCL 10 MG CAP 30 90 2 TORSEMIDE 10 MG TAB 30 90 3 TORSEMIDE 20 MG TAB 30 90 3 PHARMACY SAVINGS PROGRAM 5

TRANDOLAPRIL 1 MG TAB 30 90 3 TRANDOLAPRIL 2 MG TAB 30 90 2 TRIAMTERENE/HCTZ 37.5-25 MG CAP 30 90 2 TRIAMTERENE/HCTZ 75/50 TAB 30 90 3 TRIAMTERENE-HCTZ 37.5-25 MG TAB 30 90 3 VERAPAMIL HCL 40 MG TAB 60 180 3 VERAPAMIL HCL 80 MG TAB 30 90 1 VERAPAMIL HCL 120 MG TAB 30 90 2 WARFARIN SODIUM 2.5 MG TAB 30 90 1 WARFARIN SODIUM 4 MG TAB 30 90 1 MENS HEALTH FINASTERIDE 5 MG TAB 30 90 3 MENTAL & NEURO HEALTH AMITRIPTYLINE HCL 10 MG TAB 30 90 1 AMITRIPTYLINE HCL 25 MG TAB 30 90 2 BENZTROPINE MESYLATE 2 MG TAB 30 90 2 BUSPIRONE HCL 5 MG TAB 60 180 2 BUSPIRONE HCL 10 MG TAB 60 180 2 BUSPIRONE HCL 15 MG TAB 60 180 3 CITALOPRAM HBR 10 MG TAB 30 90 1 CITALOPRAM HBR 20 MG TAB 30 90 1 CITALOPRAM HBR 40 MG TAB 30 90 1 CLOZAPINE 25 MG TAB 30 90 3 DIVALPROEX SODIUM 125 MG TAB 90 270 3 DOXEPIN HCL 10 MG/ML ORAL CONC 90 270 3 ESCITALOPRAM OXALATE 5 MG TAB 30 90 2 ESCITALOPRAM OXALATE 10 MG TAB 30 90 2 ESCITALOPRAM OXALATE 20 MG TAB 30 90 2 FLUOXETINE HCL 10 MG CAP 30 90 1 FLUOXETINE HCL 20 MG CAP 30 90 1 FLUOXETINE HCL 20 MG/5 ML SOLN 150 450 3 FLUOXETINE HCL 40 MG CAP 30 90 2 FLUPHENAZINE HCL 1 MG TAB 60 180 2 FLUPHENAZINE HCL 2.5 MG TAB 30 90 3 FLUVOXAMINE MALEATE 25 MG TAB 30 90 3 GABAPENTIN 100 MG CAP 90 270 2 GABAPENTIN 300 MG CAP 90 270 3 GABAPENTIN 400 MG CAP 90 270 3 HALOPERIDOL 0.5 MG TAB 30 90 1 HALOPERIDOL 1 MG TAB 30 90 1 HALOPERIDOL LACTATE 2 MG/ML ORAL CONC 135 405 3 IMIPRAMINE HCL 25 MG TAB 60 180 3 LAMOTRIGINE 100 MG TAB 30 90 1 LAMOTRIGINE 150 MG TAB 30 90 1 LITHIUM CARBONATE 150 MG CAP 60 180 3 LITHIUM CARBONATE 300 MG CAP 90 270 2 LITHIUM CARBONATE 300 MG TAB 60 180 3 LITHIUM CARBONATE 600 MG CAP 60 180 3 MIRTAZAPINE 15 MG TAB 30 90 3 MIRTAZAPINE 30 MG TAB 30 90 3 NORTRIPTYLINE HCL 10 MG CAP 30 90 2 NORTRIPTYLINE HCL 25 MG CAP 30 90 2 PHARMACY SAVINGS PROGRAM 6

NORTRIPTYLINE HCL 75 MG CAP 30 90 3 OXCARBAZEPINE 150 MG TAB 90 270 3 PAROXETINE HCL 10 MG TAB 30 90 2 PAROXETINE HCL 20 MG TAB 30 90 2 PAROXETINE HCL 30 MG TAB 30 90 3 PAROXETINE HCL 40 MG TAB 30 90 3 PRAMIPEXOLE DI-HCL 0.125 MG TAB 30 90 3 PRAMIPEXOLE DI-HCL 0.25 MG TAB 30 90 3 PRAMIPEXOLE DI-HCL 0.5 MG TAB 60 180 3 PRIMIDONE 50 MG TAB 60 180 3 RISPERIDONE 0.25 MG TAB 60 180 3 RISPERIDONE 0.5 MG TAB 30 90 1 RISPERIDONE 1 MG TAB 30 90 1 ROPINIROLE HCL 0.25 MG TAB 60 180 3 ROPINIROLE HCL 3 MG TAB 30 90 3 SERTRALINE HCL 25 MG TAB 30 90 2 SERTRALINE HCL 50 MG TAB 30 90 3 SERTRALINE HCL 100 MG TAB 30 90 3 THIORIDAZINE HCL 10 MG TAB 60 180 2 TRAZODONE HCL 100 MG TAB 30 90 1 TRAZODONE HCL 150 MG TAB 30 90 2 TRAZODONE HCL 50 MG TAB 30 90 2 TRIHEXYPHENIDYL HCL 2 MG TAB 60 180 2 OTHER MEDICAL CONDITIONS CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH 473 1419 2 DEXAMETHASONE 0.75 MG TAB 12 36 2 DEXAMETHASONE 1.5 MG TAB 45 135 3 DEXAMETHASONE 4 MG TAB 30 90 2 LIDOCAINE HCL 2 % SOLN 100 300 2 LIDOCAINE HCL 40 MG/ML SOLN 50 150 2 OXYBUTYNIN CHLORIDE 5 MG/5 ML SYRUP 240 720 3 PREDNISOLONE 15 MG/5 ML SOLN 30 90 2 PREDNISOLONE SOD PHOSPHATE 15 MG/5 ML SOLN 60 180 3 PREDNISONE 2.5 MG TAB 60 180 2 PREDNISONE 5 MG TAB 30 90 2 PREDNISONE 10 MG TAB 30 90 2 PREDNISONE 20 MG TAB 10 30 1 SKIN CONDITIONS HYDROCORTISONE 1 % CRM 28.4 85.2 2 HYDROCORTISONE 1 % OINT 28.35 85.05 2 HYDROCORTISONE 2.5 % CRM 30 90 2 HYDROCORTISONE 2.5 % OINT 60 180 3 HYDROQUINONE 30 MG/ML SOLN 30 90 3 MOMETASONE FUROATE 0.1 % OINT 15 45 3 SALICYLIC ACID 6 % SHAMPOO 177 531 3 TRIAMCINOLONE ACETONIDE 0.025 % CRM 15 45 1 TRIAMCINOLONE ACETONIDE 0.1 % CRM 80 240 2 TRIAMCINOLONE ACETONIDE 0.1 % OINT 80 240 3 TRIAMCINOLONE ACETONIDE 0.5 % CRM 15 45 2 UREA 40 % LOTION 236.6 709.8 3 DEXAMETHASONE 0.5 MG TAB 60 180 2 PHARMACY SAVINGS PROGRAM 7

VITAMINS AND NUTRITIONAL HEALTH CYANOCOBALAMIN (VITAMIN B-12) 100 MCG TAB 100 300 1 CYANOCOBALAMIN/FOLIC AC/VIT B6 1-2.2-25MG TAB 30 90 3 ERGOCALCIFEROL (VITAMIN D2) 50000 UNIT CAP 4 12 1 FERROUS FUMARATE/FOLIC ACID 106 MG-1MG TAB 30 90 2 FLUORIDE (SODIUM) 0.25(0.55) TAB 120 360 2 FLUORIDE (SODIUM) 0.5(1.1)MG TAB 30 90 1 FLUORIDE (SODIUM) 1.1 % CRM 60 180 3 FLUORIDE (SODIUM) 1MG(2.2MG) TAB 30 90 2 FOLIC ACID 1 MG TAB 30 90 1 ESTRADIOL 0.5 MG TAB 30 90 1 ESTRADIOL 1 MG TAB 30 90 1 ESTRADIOL 2 MG TAB 30 90 2 HYDROCORTISONE 5 MG TAB 50 150 3 LETROZOLE 2.5 MG TAB 30 90 2 MEDROXYPROGESTERONE 10 MG TAB 10 30 1 MEDROXYPROGESTERONE 5 MG TAB 30 90 1 MEDROXYPROGESTERONE 2.5 MG TAB 30 90 2 MEGESTROL ACETATE 20 MG TAB 30 90 2 PREVIFEM TAB 28 84 3 FOLIC ACID/VIT BCOMP,C/CU/ZINC 5-1.5-25MG TAB 30 90 3 IRON PS COMPLEX/B12/FOLIC ACID 150-25-1 CAP 45 135 2 IRON,CARB/VIT C/VIT B12/FOLIC 100-250-1 TAB 30 90 3 IRON/FOLIC AC/VIT BCOMP,C/MIN 106 MG-1MG TAB 30 90 3 MAGNESIUM OXIDE 400 MG TAB 30 90 2 PEDI MULTIVIT NO.17 W-FLUORIDE 1 MG TAB 30 90 3 PNV/FERROUS FUM/FOLIC ACID/SEL 27 MG-1 MG TAB 30 90 2 POTASSIUM CHLORIDE 10 MEQ TAB 30 90 3 PRENATAL LOW IRON TAB 30 90 1 PRENATAL PLUS TAB 30 90 2 WOMEN S HEALTH ALENDRONATE SODIUM 10 MG TAB 30 90 3 ALENDRONATE SODIUM 35 MG TAB 4 12 3 ALENDRONATE SODIUM 70 MG TAB 4 12 3 ANASTROZOLE 1 MG TAB 30 90 3 CLOMIPHENE CITRATE 50 MG TAB 5 15 2 This discount program is NOT health insurance and is not intended as a substitute for insurance. This program provides savings on a select group of prescription medications purchased from a participating pharmacy. This program is administered by Medical Security Card Company (MSC), LLC, 4911 E. Broadway Boulevard, Tucson, AZ 85711, 1-866-223-9675 and is marketed by your participating pharmacy. This program is not available in all states. This program does not make payments directly to any provider. You are obligated to pay for all services at the time of the service. This program is governed by the terms and conditions outlined on this website. MSC is not responsible for providing or guaranteeing service or for the quality of service rendered. Participating pharmacies are subject to change without notice and are not available in all areas. Prescriptions paid for in whole or in part by publicly funded health care programs, such as Medicare or Medicaid, are ineligible. Membership discount cannot be combined with any insurance. A0168_SS_PSP+BDC_DL_031518 PHARMACY SAVINGS PROGRAM 8

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