A0168_ss_psp+_bdc_dl_030314.indd

Pharmacy Savings Program
SELECT GENERIC DRUG LIST
The Pharmacy Savings Program provides you with savings on select generic medications included on this list. The prices for DRUG NAME
these select generic medications are based on whether it is a ALLERGIES & COLD AND FLU
30-day supply* or 90-day supply* and its pricing tier: $5 for a 30-day supply and $10 for a 90-day supply $10 for a 30-day supply and, $20 for a 90-day supply $15 for a 30-day supply and $30 for a 90-day supply D-METHORPHAN HB/P-EPD HCL/BPM 15-30-3/5 LIQUID With the Pharmacy Savings Program you will also receive: D-METHORPHAN HB/P-EPD HCL/BPM 30-50-3MG LIQUID • Discounts on other generic and brand name medications D-METHORPHAN HB/PROMETH HCL 15-6.25/5 SYRUP GUAIFENESIN/D-METHORPHAN HB/PE 50-5-2.5/1 DROPS • Discounts on select human-equivalent pet medications *The day supply is based upon the average dispensing patterns for the specifi c drug and strength. The Program, as well as the prices and the list of covered drugs, can be modifi ed at any time without notice.
PHARMACY SAVINGS PROGRAM
MARCH 2014
C GENERIC DR
T GENERIC D UG LIS
DRUG NAME
DRUG NAME
PSEUDOEPHEDRINE/TRIPROLIDINE 60MG-2.5MG TAB ANTIBIOTIC & ANTI-INFECTIVE TREATMENTS
AMOXICILLIN/POTASSIUM CLAV 200-28.5/5 SUSP AMOXICILLIN/POTASSIUM CLAV 400-57MG/5 SUSP PHARMACY SAVINGS PROGRAM
MARCH 2014
C GENERIC DR
T GENERIC D UG LIS
DRUG NAME
DRUG NAME
POLYMYXIN B SULF/TRIMETHOPRIM 10K/ML-0.1 DROPS ARTHRITIS & PAIN
BUTALB/ACETAMINOPHEN/CAFFEINE 50-325-40 TAB PHARMACY SAVINGS PROGRAM
MARCH 2014
C GENERIC DR
T GENERIC D UG LIS
DRUG NAME
DRUG NAME
FUNGAL INFECTIONS
DIABETES
GASTROINTESTINAL HEALTH
PHENOBARB/HYOSCY/ATROPINE/SCOP 16.2 MG TAB PHARMACY SAVINGS PROGRAM
MARCH 2014
C GENERIC DR
T GENERIC D UG LIS
DRUG NAME
DRUG NAME
GLAUCOMA AND EYE CARE
HEART HEALTH & BLOOD PRESSURE
AMLODIPINE BESYLATE/BENAZEPRIL 5 MG-10 MG CAP AMLODIPINE BESYLATE/BENAZEPRIL 5 MG-20 MG CAP AMLODIPINE BESYLATE/BENAZEPRIL 10 MG-20MG CAP PHARMACY SAVINGS PROGRAM
MARCH 2014
C GENERIC DR
T GENERIC D UG LIS
DRUG NAME
DRUG NAME
PHARMACY SAVINGS PROGRAM
MARCH 2014
C GENERIC DR
T GENERIC D UG LIS
DRUG NAME
DRUG NAME
PHARMACY SAVINGS PROGRAM
MARCH 2014
C GENERIC DR
T GENERIC D UG LIS
DRUG NAME
DRUG NAME
MENS HEALTH
MENTAL & NEURO HEALTH
PHARMACY SAVINGS PROGRAM
MARCH 2014
C GENERIC DR
T GENERIC D UG LIS
DRUG NAME
DRUG NAME
VALPROIC ACID (AS SODIUM SALT) 250 MG/5ML SOLN OTHER MEDICAL CONDITIONS
ANTIPYRINE/BENZOCAINE/GLYCERIN 5.4 %-1.4% DROPS PHARMACY SAVINGS PROGRAM
MARCH 2014
C GENERIC DR
T GENERIC D UG LIS
DRUG NAME
DRUG NAME
PREDNISOLONE SOD PHOSPHATE 15 MG/5 ML SOLN THYROID CONDITIONS
SKIN CONDITIONS
VITAMINS AND NUTRITIONAL HEALTH
CHOLECALCIFEROL (VITAMIN D3) 50000 UNIT CAP CITRIC ACID/SODIUM CITRATE 334-500MG SOLN CYANOCOBALAMIN (VITAMIN B-12) 100 MCG TAB CYANOCOBALAMIN/FA/PYRIDOXINE 1-2.2-25MG TAB CYANOCOBALAMIN/FA/PYRIDOXINE 1-2.5-25MG TAB FE FUMARATE/VIT C/B12-IF/FA 110-0.5MG CAP FERROUS FUMARATE/FOLIC ACID 106 MG-1MG TAB FOLIC ACID/VIT BCOMP&C/CU/ZNOX 5-1.5-25MG TAB IRON,CARBONYL/VIT C/VIT B12/FA 100-250-1 TAB IRON/FA/VITAMIN B COMP W-C/MIN 106 MG-1MG TAB PHARMACY SAVINGS PROGRAM
MARCH 2014
C GENERIC DR
T GENERIC D UG LIS
DRUG NAME
DRUG NAME
MULTIVITAMINS WITH FLUORIDE 0.25 MG/ML DROPS MULTIVITAMINS WITH FLUORIDE 0.5 MG/ML DROPS MULTIVITS,THERAP W-FE,HEMATIN 27MG-0.8MG TAB PED MV A,C,D3 #21 W-FLUORIDE 0.25 MG/ML DROPS PNV W-O CA NO5/FE FUMARATE/FA 106.5-1MG CAP PNV W-O IRON/FA/CALCIUM/B6/B12 1-200-75 TAB PNV/FERROUS FUMARATE/FA/SE 27 MG-1 MG TAB POTASSIUM CITRATE/CITRIC ACID 1100-334/5 SOLN PRENATAL VIT/IRON BISGLYCIN/FA 27 MG-1 MG TAB PRENATAL VIT/IRON FUMARATE/FA 17MG-1MG TAB 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 VIT B CMPLX 3/FA/VIT C/BIOTIN 1MG-60MG TAB the terms and conditions outlined on this website. MSC is not responsible for providing or WOMEN’S HEALTH
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.
PHARMACY SAVINGS PROGRAM
MARCH 2014

Source: https://www.mypspplus.com/PDF/DrugListC.pdf