Transcription of Value-Priced Medication List - Walgreens
1 Rev. 5/1/20 Price may be as low as: Value-Priced Medication List In addition to discounts on thousands of brand-name and most generic medications, members get even more savings on three tiers of Value-Priced generics.* The price for a generic drug is based on its tier and whether it s a 30-day or 90-day supply. $5 30-day $10 supply 90-day supply value GENERICS Antifungal 30 QTY 90 QTY Tier 2 $10 $20 FLUCONAZOLE 150MG TAB 1 3 TERBINAFINE 250MG TAB 30 90 Antiviral 30 QTY 90 QTY Tier 3 $15 $30 ACYCLOVIR 200MG CAP 60 180 Arthritis or Pain 30 QTY 90 QTY Tier 1 $5 $10 INDOMETHACIN 50MG CAP 30 90 Tier 2 $10 $20 CYCLOBENZAPRINE 5MG TAB 30 90 CYCLOBENZAPRINE 10MG TAB 30 90 IBUPROFEN 100MG/5ML ORAL SUSP 120 360 IBUPROFEN 400MG TAB 90 270 IBUPROFEN 600MG TAB 60 180 IBUPROFEN 800MG TAB 60 180 INDOMETHACIN 25MG CAP 60 180 MELOXICAM TAB 30 90 MELOXICAM 15MG TAB 30 90 NAPROXEN 250MG TAB 60 180 NAPROXEN 500MG TAB 60 180 NAPROXEN 375MG TAB 60 180 Tier 3 $15 $30 BACLOFEN 10MG TAB 30 90 DICLOFENAC SODIUM 75MG EC TAB 60 180 KETOPROFEN 50MG CAP 90 270 KETOPROFEN 75MG CAP 60 180 KETOROLAC 30MG/ML INJ.
2 2ML 15 45 NAPROXEN DR 500MG TAB 60 180 Asthma 30 QTY 90 QTY Tier 2 $10 $20 ALBUTEROL INH SOLN 25X3ML AMINOPHYLLINE 100MG TAB AMINOPHYLLINE 200MG TAB DYPHYLLINE-GG 100-100 ELIXIR IPRATROPIUM INHAL SOLN 60 X 75 60 60 240 75 225 180 180 720 225 Tier 3 $15 $30 DYPHYLLIN-GG TAB 30 90 Blood Pressure/Heart Health 30 QTY 90 QTY Tier 1 $5 $10 ATENOLOL 100MG TAB FUROSEMIDE 20MG TAB FUROSEMIDE 40MG TAB FUROSEMIDE 80MG TAB HYDRALAZINE 10MG TAB HYDROCHLOROTHIAZIDE 25MG TAB HYDROCHLOROTHIAZIDE 50MG TAB 30 60 60 30 60 30 30 90 180 180 90 90 90 90 Blood Pressure/Heart Health (cont.) 30 QTY 90 QTY Tier 1 $5 $10 LISINOPRIL 10MG TAB 30 90 LISINOPRIL 20MG TAB 30 90 TRIAMTERENE 75MG/ HCTZ 50MG TAB 30 90 VERAPAMIL 80MG TAB 30 90 Tier 2 $10 $20 AMILORIDE 5MG / HCTZ 50MG TAB 30 90 AMIODARONE 200MG TAB 30 90 AMLODIPINE BESYLATE TAB 30 90 AMLODIPINE BESYLATE 5MG TAB 30 90 ATENOLOL 25MG TAB 60 180 ATENOLOL 50MG TAB 60 180 BENAZEPRIL 5MG TAB 30 90 BENAZEPRIL 10MG TAB 30 90 BENAZEPRIL 20MG TAB 30 90 BENAZEPRIL 40MG TAB 30 90 BISOPROLOL FUMARATE 5MG TAB 30 90 CARVEDILOL TAB 60 180 CARVEDILOL TAB 60 180 CARVEDILOL TAB 60 180 CARVEDILOL 25MG TAB 60 180 CLONIDINE TAB 60 180 CLONIDINE TAB 60 180 CLONIDINE TAB 60 180 DILTIAZEM 30MG TAB 60 180 ENALAPRIL TAB 60 180 ENALAPRIL 5MG TAB 60 180 ENALAPRIL-HCTZ TAB 60 180 FOSINOPRIL 10MG TAB 30 90 FOSINOPRIL 20MG TAB 30 90 GUANFACINE 1MG TAB 60 180 HYDRALAZINE 25MG TAB 60 180 HYDROCHLOROTHIAZIDE CAP 30 90 INDAPAMIDE TAB 30 90 INDAPAMIDE TAB 30 90
3 ISOSORBIDE DINITRATE SL TAB 30 90 LISINOPRIL 30MG TAB 30 90 LISINOPRIL 40MG TAB 30 90 LISINOPRIL-HCTZ 10 TAB 30 90 LISINOPRIL-HCTZ 20 TAB 30 90 LISINOPRIL-HCTZ 20/25MG TAB 30 90 METOPROLOL TARTR ATE 25MG TAB 60 180 METOPROLOL TARTR ATE 50MG TAB 60 180 METOPROLOL TARTR ATE 100MG TAB 60 180 QUINAPRIL 5MG TAB 30 90 QUINAPRIL 10MG TAB 30 90 QUINAPRIL 40MG TAB 30 90 SOTALOL 120MG TAB 60 180 SPIRONOLACTONE 25MG TAB 30 90 SPIRONOLACTONE 50MG TAB 30 90 TERAZOSIN 1MG CAP 30 90 TERAZOSIN 2MG CAP 30 90 TERAZOSIN 5MG CAP 30 90 TERAZOSIN 10MG CAP 30 90 Blood Pressure/Heart Health (cont.) 30 QTY 90 QTY Tier 2 $10 $20 TRANDOLAPRIL 1MG TAB 30 90 TRANDOLAPRIL 4MG TAB 30 90 TRIAMTERENE HCTZ 25MG CAP 30 90 VERAPAMIL 120MG TAB 30 90 WARFARIN SOD 1MG TAB 30 90 WARFARIN SOD TAB 30 90 WARFARIN SOD 2MG TAB 30 90 WARFARIN SOD 3MG TAB2 30 90 WARFARIN SOD 4MG TAB 30 90 WARFARIN SOD 5MG TAB 30 90 WARFARIN SOD 6MG TAB 30 90 WARFARIN SOD TAB 30 90 WARFARIN SOD 10MG** TAB 30 90 Tier 3 $15 $30 AMLODIPINE BESYLATE 10MG TAB 30 90 ATENOLOL/CHLORTHALIDONE 50/25 TAB 30 90 DILTIAZEM 60MG TAB 60 180 DOX AZOSIN 2MG TAB 30 90 DOX AZOSIN 4MG TAB 30 90 ENALAPRIL-HCTZ 10-25MG TAB 30 90 FOSINOPRIL 40MG TAB 30 90 FUROSEMIDE 10MG/ML ORAL SOLN 60ML 90 270 HYDROCHLOROTHIAZIDE TAB 30 90 ISOSORBIDE DINITRATE 5MG SUBL TAB 120 360 METHYLDOPA 250MG TAB 60 180 PRAZOSIN 1MG CAP 30 90 PROPRANOLOL 60MG TAB 60 180 QUINAPRIL 20MG TAB 30 90 RAMIPRIL CAP 30 90 TICLOPIDINE 250MG TAB 60 180 TORSEMIDE 5MG TAB 30 90 TORSEMIDE 10MG TAB 30 90
4 TORSEMIDE 20MG TAB 30 90 TRANDOLAPRIL 2MG TAB 30 90 TRIAMTERENE HCTZ 25MG TAB 30 90 VERAPAMIL 40MG TAB 60 180 Cholesterol 30 QTY 90 QTY Tier 2 $10 $20 LOVASTATIN 10MG TAB 30 90 LOVASTATIN 20MG TAB 30 90 LOVASTATIN 40MG TAB 30 90 PR AVASTATIN 10MG TAB 30 90 PR AVASTATIN 20MG TAB 30 90 SIMVASTATIN 5MG TAB 30 90 SIMVASTATIN 10MG TAB 30 90 SIMVASTATIN 20MG TAB 30 90 Tier 3 $15 $30 FENOFIBR ATE 54MG TAB 30 90 SIMVASTATIN 40MG TAB 30 90 SIMVASTATIN 80MG TAB 30 90 1 Value-Priced Medication List (cont.) Cough/Cold/Allergy 30 QTY 90 QTY Tier 1 $5 $10 ALLER-CHLOR 4MG TAB LOR ATADINE 10MG TAB PROMETHAZINE 25MG TAB SILDEC PE-DM SYRUP SILDEC-PE SYRUP 100 30 12 120 120 300 90 36 360 360 Tier 2 $10 $20 BENZONATATE 100MG CAP DE-CHLOR DM LIQUID DE-CHLOR DR SYRUP DIPHENHYDRAMINE 50MG CAP PHENYLTOLOX AMINE PE CPM SYRUP PROMETHAZINE TAB PROMETHAZINE 50MG TAB PROMETHAZINE DM SYRUP 30 120 180 30 240 30 60 180 90 360 540 90 720 90 180 540 Tier 3 $15 $30 BENZONATATE 200MG CAP CETIRIZINE 1MG/ML SYRUP CYPROHEPTADINE 2MG/5ML SYRUP DEHISTINE SYRUP FLUTICASONE NASAL SP (120 INH)
5 16GM NOHIST TAB ORGAN-I NR 200MG TAB PBM ALLERGY SYRUP QUARTUSS DM DROPS 30ML QV-ALLERGY SYRUP REME TUSSIN DM SYRUP SUPRESS-DX PED DROPS 30ML TRIPOHIST LIQUID 30 30 120 240 16 30 120 120 30 240 150 30 120 90 90 360 720 48 90 360 360 90 720 450 90 360 Diabetes 30 QTY 90 QTY Tier 1 $5 $10 GLIMEPIRIDE 1MG TAB GLIMEPIRIDE 2MG TAB GLIPIZIDE 5MG TAB GLYBURIDE TAB GLYBURIDE MICRO TAB GLYBURIDE MICRO 3MG TAB METFORMIN 500MG TAB METFORMIN 850MG TAB METFORMIN 1000MG TAB METFORMIN ER 500MG 24HR TAB 30 30 30 30 30 30 90 90 60 60 90 90 90 90 90 90 270 270 180 180 Tier 2 $10 $20 GLIMEPIRIDE 4MG TAB GLIPIZIDE 10MG TAB GLIPIZIDE ER TAB GLIPIZIDE ER 5MG TAB GLYBURIDE TAB GLYBURIDE 5MG TAB GLYBURIDE MICRO 6MG TAB GLYBURIDE/METFORMIN TAB GLYBURIDE/METFORMIN TAB 30 60 60 30 30 30 30 60 60 90 180 180 90 90 90 90 180 180 Tier 3 $15 $30 GLIPIZIDE ER 10MG TAB 30 90 Ear Care 30 QTY 90 QTY Tier 2 $10 $20 ANTIPYRINE BENZOCAINE OTIC SOL 15ML ERYTHROMYCIN OPHTH OINT GENTAMICIN OPHTH SOLN 5ML LEVOBUNOLOL OPTH SOLN 5ML POLYMYXIN-B/TRIMETHOPRIMOPHTH SOLN SULFACETAMIDE NA 10% OPH SOL 15ML TIMOLOL MALEATE.
6 25% OPHTH SOL 5ML TIMOLOL MALEATE OPHTH SOLN 5ML 15 5 5 10 15 5 5 45 15 15 30 45 15 15 Tier 3 $15 $30 BACITRACIN/POLYMYX OPHTHOINT Gastrointestinal Health (cont.) 30 QTY 90 QTY Tier 2 $10 $20 DOC-Q-LACE 100MG CAP FAMOTIDINE 20MG TAB METOCLOPRAMIDE 5MG TAB METOCLOPRAMIDE 10MG TAB RANITIDINE 150MG TAB RANITIDINE 300MG TAB 60 60 60 60 60 30 180 180 180 180 180 90 Tier 3 $15 $30 CIMETIDINE ORAL LIQ 300MG/5ML DICYCLOMINE 10MG CAP DICYCLOMINE 20MG TAB FAMOTIDINE 40MG TAB 240 90 60 30 720 270 180 90 Gout 30 QTY 90 QTY Tier 2 $10 $20 ALLOPURINOL 100MG TAB ALLOPURINOL 300MG TAB 60 60 180 180 Infections 30 QTY 90 QTY Tier 1 $5 $10 AMOXICILLIN 250MG CAP AMOXICILLIN 500MG CAP AMOXICILLIN 200MG/5ML SUSP 75ML AMOXICILLIN 200MG/5ML SUSP 100ML AMOXICILLIN 250MG/5ML SUSP 80ML AMOXICILLIN 250MG/5ML SUSP 100ML AMOXICILLIN 400MG/5ML SUSP 50ML AMOXICILLIN 400MG/5ML SUSP 75ML AMOXICILLIN 400MG/5ML SUSP 100ML CEPHALEXIN 250MG CAP CIPROFLOXACIN 250MG TAB CIPROFLOXACIN 500MG TAB PENICILLIN VK 250MG TAB PENICILLIN VK 500MG TAB 30 30 100 100 150 150 100 100 100 28 14 20 30 20 90 90 300 300 450 450 300
7 300 300 84 42 60 90 60 Tier 2 $10 $20 AMOXICILLIN 125MG CHEWABLE TAB AMOXICILLIN 125MG/5ML SUSP 80ML AMOXICILLIN 125MG/5ML SUSP 100ML AMOXICILLIN 125MG/5ML SUSP 150ML AMOXICILLIN 250MG/5ML SUSP 150ML AMPICILLIN 250MG CAP CEPHALEXIN 500MG CAP METRONIDAZOLE 250MG TAB PENICILLIN VK 125MG/5ML SOLN 100ML PENICILLIN VK 125MG/5ML SOLN 200ML PENICILLIN VK 250MG/5ML SOLN 100ML PENICILLIN VK 250MG/5ML SOLN 200ML SMZ/TMP REGULAR STRENGTH TAB SULFAMETH/TRIMETHOPRIM 800/160 TAB 30 150 150 150 150 40 30 28 200 200 100 100 28 28 90 450 450 450 450 120 90 84 600 600 300 300 84 84 Tier 3 $15 $30 AMOX-CLAV 200MG/5ML SUSP 100ML AMOX-CLAV 400MG/5ML SUSP 100ML AMOXICILLIN 250MG CHEW TAB AMOXICILLIN 875MG TAB CEFPROZIL 125MG/5ML SUSP 50ML CEFPROZIL 125MG/5ML SUSP 75ML CEFPROZIL 125MG/5ML SUSP 100ML CIPROFLOX ACIN 750MG TAB CLINDAMYCIN 150MG CAP CLINDAMYCIN 300MG CAP METRONIDAZOLE 500MG TAB TRIMETHOPRIM 100MG TAB 100 100 40 20 100 100 100 20 30 28 14 30 300 300 120 60 300 300 300 60 90 84 42 90 Medical Devices 30 QTY 90 QTY Tier 3 $15 $30 PROCHAMBER AERO SPACER 1 3 Mental Health (cont.)
8 30 QTY 90 QTY Tier 2 $10 $20 BENZTROPINE TAB 30 90 BENZTROPINE 2MG TAB 30 90 BUSPIRONE 5MG TAB 60 180 BUSPIRONE 10MG TAB 60 180 CITALOPRAM 10MG TAB 30 90 CITALOPRAM 20MG TAB 30 90 CITALOPRAM 40MG TAB 30 90 FLUOXETINE 10MG CAP 30 90 FLUOXETINE 20MG CAP 30 90 GABAPENTIN 100MG CAP 90 270 HALOPERIDOL 1MG TAB 30 90 HYDROXYZINE PAMOATE 25MG CAP 90 270 LITHIUM CARBONATE 300MG CAP 90 270 METHOCARBAMOL 500MG TAB 30 90 MIRTAZAPINE 15MG TAB 30 90 NORTRIPTYLINE 10MG CAP 30 90 NORTRIPTYLINE 25MG CAP 30 90 PAROXETINE 10MG TAB 30 90 PAROXETINE 20MG TAB 30 90 PROCHLORPERAZINE 5MG TAB 30 90 PROCHLORPERAZINE 10MG TAB 30 90 SERTRALINE 25MG TAB 30 90 TRAZODONE 50MG TAB 30 90 TRAZODONE 150MG TAB 30 90 Tier 3 $15 $30 AMITRIPTYLINE 50MG TAB 30 90 BENZTROPINE 1MG TAB 60 180 CLOZAPINE 25MG TAB 30 90 DOXEPIN 10MG CAP 30 90 DOXEPIN 25MG CAP 30 90 DOXEPIN HCL 10MG/ML CONC 118ML 90 270 FLUOXETINE 40MG CAP 30 90 FLUPHENAZINE
9 TAB 30 90 FLUVOX AMINE 25MG TAB 30 90 HALOPERIDOL TAB 60 180 HALOPERIDOL 2MG TAB 30 90 HYDROXYZINE 10MG/5ML SYRUP 240 720 HYDROXYZINE HCL 50MG TAB 30 90 IMIPRAMINE 10MG TAB 60 180 IMIPRAMINE 25MG TAB 60 180 IMIPRAMINE 50MG TAB 30 90 LITHIUM CARBONATE 150MG CAP 60 180 LITHIUM CARBONATE 300MG TAB 60 180 LITHIUM CARBONATE 600MG CAP 60 180 METHOCARBAMOL 750MG TAB 60 180 NORTRIPTYLINE 75MG CAP 30 90 PAROXETINE 30MG TAB 30 90 PRAMIPEXOLE TAB 30 90 PRIMIDONE 50MG TAB 60 180 SERTRALINE 50MG TAB 30 90 SERTRALINE 100MG TAB 30 90 TRIHEXYPHENIDYL 2MG TAB 60 180 TRIHEXYPHENIDYL 5MG TAB 90 270 Mouth/Throat/Dental 30 QTY 90 QTY Tier 2 $10 $20 CHLORHEXIDINE ORAL RINSE 473ML 473 LIDOCAINE VISCOUS 2% ORAL SOL 100ML 100 1419 300 Tier 3 $15 $30 PILOCARPINE 5MG TAB 90 SF 5000 PLUS CREAM 51GM 60 STANNOUS FLUORIDE RINSE 300 270 180 900 Skin Conditions 30 QTY 90 QTY Tier 1 $5 $10 TRIAMCINOLONE CREAM 15GM 15 45 Tier 2 $10 $20 HYDROCORTISONE 1% CREAM HYDROCORTISONE CREAM 30GM 30 90 HYDROCORTISONE OINT 60 180 SELENIUM SULFIDE SHAMPOO (LOTN) 118 354 TRIAMCINOLONE CREAM 15GM 15 45 TRIAMCINOLONE CREAM 80GM 80 240 Gastrointestinal Health 30 QTY 90 QTY Tier 1 METOCLOPRAMIDE HCL 5MG/5ML SOLN 60 180 $5 $10 Mental Health 30 QTY 90 QTY Tier 1 $5 $10 AMITRIPTYLINE 10MG TAB TRAZODONE 100MG TAB 30 30 90 90 Tier 2 $10 $20 AMITRIPTYLINE 25MG TAB 30 90 2 Value-Priced Medication List (cont.)
10 value BRAND NAME -Skin Conditions (cont.) 30 QTY 90 QTY Tier 3 $15 $30 BENZOYL PEROXIDE 5% AQ GEL 60GM BETAMETHASONE VAL CRM 15GM HYPERCARE 20% SOL DAB-O-MATIC 60ML MELQUIN 3% SOLN 30ML MOMETASONE OINT 15GM MOMETASONE OINT 45GM MOMETASONE TOPICAL SOLN 60ML NYSTATIN OINT 15GM SALICYLIC AC 6% SHAMPOO 177ML TRIAMCINOLONE OINT 80GM UREA 50% NAIL GEL 18ML 60 15 60 30 15 45 60 15 177 80 18 180 45 180 90 45 135 180 45 531 240 54 Thyroid Conditions 30 QTY 90 QTY Tier 2 $10 $20 LEVOTHROID TAB LEVOTHYROXINE (25 MCG) TAB LEVOTHYROXINE (50 MCG) TAB LEVOTHYROXINE (75 MCG) TAB LEVOTHYROXINE (100 MCG) TAB LEVOTHYROXINE (112 MCG) TAB LEVOTHYROXINE (125 MCG) TAB LEVOTHYROXINE (137 MCG) TAB LEVOTHYROXINE (150 MCG) TAB LEVOTHYROXINE (175 MCG) TAB LEVOTHYROXINE (200 MCG) TAB LEVOTHYROXINE (300 MCG) TAB METHIMAZOLE 5MG TAB 2 30 90 30 30 30 30 30 30 30 30 30 30 30 30 30 90 90 90 90 90 90 90 90 90 90 90 90 90 Tier 3 $15 $30 LEVOTHYROXINE (88 MCG) TAB METHIMAZOLE 10MG TAB 30 30 90 90 Urinary Health 30 QTY 90 QTY Tier 3 $15 $30 OXYBUTYNIN 5MG/5ML SYRUP 240 720 Vitamins and Nutritional Health 30 QTY 90 QTY Tier 1 $5 $10 FLUORIDE F CHEWABLE TAB FOLIC ACID 1MG TAB MULTI-VITA-F CHEW TAB MULTIVITS W/FL 1MG & IRON CHEW TAB NATALCARE PLUS TAB (1MG FOLIC ACID)
