Drug Cost Estimates Generics

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1 Cost Estimates Generics Note: The retail pharmacy prices displayed below are estimates only. The actual price of your prescription W/ CODEINE TAB MG ACYCLOVIR TAB 400 MG ALBUTEROL INHAL AEROSOL 90 MCG/ACT ALBUTEROL SULFATE SOLN NEBU 0.083% (2.5 MG/3ML) ALLOPURINOL TAB ALLOPURINOL TAB 300 MG ALPRAZOLAM TAB 0.25 MG ALPRAZOLAM TAB 0.5 MG ALPRAZOLAM TAB 1 MG AMITRIPTYLINE HCL TAB 10 MG AMITRIPTYLINE HCL TAB 25 MG AMITRIPTYLINE HCL TAB AMLODIPINE BESYLATE AMLODIPINE BESYLATE TAB 5 MG & K CLAVULANATE FOR SUSP MG/5ML $4.74 $17.66 $22.80 $18.91 $4.38 $5.91 $2.41 $3.87 $5.12 $3.04 $3.70 $3.40 $72.38 $55.24 $63.29 & K CLAVULANATE FOR SUSP MG/5ML & K CLAVULANATE TAB MG & K CLAVULANATE TAB MG (TRIHYDRATE) CAP 500 MG (TRIHYDRATE) CHEW TAB 400 MG (TRIHYDRATE) FOR SUSP 2/5ML (TRIHYDRATE) FOR SUSP 400 MG/5ML (TRIHYDRATE) TAB 875 MG ATENOLOL & CHLORTHALIDONE TAB MG ATENOLOL TAB $43.11 $41.77 $38.08 $2.80 $15.41 $3.71 $12.15 $14.88 $5.17 $6.06 ATENOLOL $3.17 ATENOLOL TAB $3.79 AZATHIOPRINE TAB $54.54

2 AZITHROMYCIN FOR SUSP /5ML AZITHROMYCIN FOR SUSP 200 MG/5ML AZITHROMYCIN TAB 2 AZITHROMYCIN TAB 500 MG BENZOCAINE- ANTIPYRINE OTIC SOLN % BENZONATATE CAP BUPROPION HCL TAB SR 12HR 1 BUPROPION HCL TAB SR 24HR 300 MG BUSPIRONE HCL TAB 15 MG BUTALBITAL- - CAFFEINE TAB MG CARISOPRODOL TAB 3 CEFPROZIL FOR SUSP 2/5ML CEPHALEXIN CAP 2 CEPHALEXIN CAP 500 MG CEPHALEXIN FOR SUSP 2/5ML CHLORHEXIDINE GLUCONATE SOLN 0.12% CIPROFLOXACIN HCL TAB 2 (BASE EQUIV) CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV) $34.96 $30.81 $31.64 $38.89 $1.71 $12.54 $64.51 $ $20.27 $6.91 $13.57 $60.24 $5.80 $6.99 $21.66 $5.50 $5.16 $8.17 CITALOPRAM HYDROBROMIDE TAB 10 MG (BASE EQUIV) CITALOPRAM HYDROBROMIDE TAB 20 MG (BASE EQUIV) CITALOPRAM HYDROBROMIDE TAB 40 MG (BASE EQUIV) CLINDAMYCIN HCL CAP 1 CLINDAMYCIN HCL CAP 300 MG CLONAZEPAM TAB 0.5 MG CLONAZEPAM TAB 1 MG CLONIDINE HCL TAB 0.1 MG CYCLOBENZAPRINE HCL DESOGEST-ETH ESTRAD & ETH ESTRAD TAB /0.01 MG(21/5) DESOGESTREL & ETHINYL ESTRADIOL TAB 0.15 MG-30 MCG $12.30 $12.04 $12.20 $14.33 $21.44 $6.17 $7.86 $5.14 $6.03 $76.25 $44.33 DIAZEPAM TAB 5 MG $1.83 DICLOFENAC SODIUM TAB DELAYED RELEASE 75 MG $19.34 DIGOXIN TAB MG $4.78 DIGOXIN TAB 0.25 MG $4.98 DOXYCYCLINE HYCLATE CAP DOXYCYCLINE HYCLATE TAB ENALAPRIL MALEATE ENALAPRIL MALEATE TAB 20 MG $3.56 $3.77 $7.96 $10.37

3 ESTRADIOL TAB 1 MG $7.82 FEXOFENADINE HCL TAB 180 MG FEXOFENADINE HCL TAB 60 MG FLUCONAZOLE TAB 1 FLUOXETINE HCL CAP 10 MG FLUOXETINE HCL CAP 20 MG FLUOXETINE HCL CAP 40 MG FLUTICASONE PROPIONATE NASAL SUSP 50 MCG/ACT $65.28 $64.48 $2.61 $9.33 $8.42 $29.24 $55.62 FOLIC ACID TAB 1 MG $4.53 FUROSEMIDE TAB 20 MG FUROSEMIDE TAB 40 MG GABAPENTIN CAP 300 MG GABAPENTIN TAB 600 MG GEMFIBROZIL TAB 600 MG GENTAMICIN SULFATE OPHTH SOLN 0.3% $3.17 $4.11 $35.45 $98.05 $20.26 $3.31 GLIMEPIRIDE TAB 4 MG $21.30 GLIPIZIDE TAB SR 24HR 10 MG GLIPIZIDE TAB SR 24HR 5 MG $31.38 $17.23 GLYBURIDE TAB 5 MG $15.63 GUAIFENESIN-CODEINE SOLN MG/5ML HYDROCHLORO THIAZIDE CAP 12.5 MG HYDROCHLORO THIAZIDE $3.20 $9.00 $2.36 HYDROCHLORO THIAZIDE TAB TAB MG TAB MG TAB 10-6 TAB MG TAB MG TAB HYDROXY- CHLOROQUINE SULFATE TAB 200 MG HYDROXYZINE HCL HYDROXYZINE PAMOATE CAP 25 MG $3.64 $28.42 $19.71 $8.54 $2.86 $6.21 $4.09 $20.37 $31.85 $6.16 IBUPROFEN TAB 600 MG $2.67 IBUPROFEN TAB 800 MG $3.68 INDOMETHACIN CAP 50 MG ISOSORBIDE MONONITRATE TAB SR 24HR 30 MG LEVONORGESTREL & ETHINYL ESTRADIOL TAB 0.10 MG-20 MCG LEVONORGESTREL & ETHINYL ESTRADIOL TAB 0.15 MG-30 MCG $22.38 $7.51 $50.77 $54.03

4 LEVONORGESTREL-ETH ESTRA TAB / / MG-MCG SODIUM TAB 100 MCG SODIUM TAB 112 MCG SODIUM TAB 125 MCG SODIUM TAB 150 MCG SODIUM TAB 175 MCG SODIUM TAB 200 MCG SODIUM TAB 25 MCG SODIUM TAB 50 MCG SODIUM TAB 75 MCG SODIUM TAB 88 MCG LISINOPRIL & HYDRO MG LISINOPRIL & HYDRO MG LISINOPRIL & HYDRO MG $42.99 $10.15 $11.71 $11.88 $11.73 $13.72 $14.02 $7.87 $9.03 $10.03 $10.47 $9.02 $12.32 $13.12 LISINOPRIL $7.84 LISINOPRIL TAB 2.5 MG $5.85 LISINOPRIL TAB 20 MG $9.65 LISINOPRIL TAB 40 MG $14.63 LISINOPRIL TAB 5 MG $6.77 LORATADINE $11.37 LORAZEPAM TAB 0.5 MG $6.10 LORAZEPAM TAB 1 MG $8.23 LOVASTATIN TAB 20 MG $17.26 LOVASTATIN TAB 40 MG $30.62 METFORMIN HCL TAB 1000 MG METFORMIN HCL TAB 500 MG METFORMIN HCL TAB SR 24HR 500 MG METHOTREXATE SODIUM TAB 2.5 MG (BASE EQUIV) METHYLPHENIDATE HCL METHYLPREDNISOLONE TAB 4 MG DOSE PACK METOCLOPRAMIDE HCL METOPROLOL SUCCINATE TAB SR 24HR 25 MG METOPROLOL TARTRATE TAB METOPROLOL TARTRATE METOPROLOL TARTRATE TAB METRONIDAZOLE TAB 500 MG MINOCYCLINE HCL CAP $15.02 $14.30 $20.88 $20.79 $28.92 $5.22 $5.81 $28.22 $5.03 $7.27 $3.40 $3.50 $52.68 MUPIROCIN OINT 2% $39.97 NABUMETONE TAB 7 $70.85 NAPROXEN TAB 500 MG $8.01 NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP NITROGLYCERIN SL TAB 0.4 MG $19.46 $4.65

5 NORETHINDRONE & ETHINYL ESTRADIOL TAB 1 MG-35 MCG NORETHINDRONE ACE & ETHINYL ESTRADIOL-FE TAB 1 MG-20 MCG NORETHINDRONE ACE & ETHINYL ESTRADIOL-FE TAB 1.5 MG-30 MCG NORETHINDRONE TAB 0.35 MG NORETHINDRONE-ETH ESTRADIOL TAB / /1-35 MG-MCG NORGESTIMATE & ETHINYL ESTRADIOL TAB 0.25 MG-35 MCG NORGESTIMATE-ETH ESTRAD TAB / / MG-MCG NORGESTREL & ETHINYL ESTRADIOL TAB 0.3 MG-30 MCG NYSTATIN SUSP UNIT/ML OMEPRAZOLE CAP DELAYED RELEASE 20 MG OXYCODONE HCL TAB 5 MG OXYCODONE W/ TAB MG TAB 20 MG TAB 30 MG TAB 40 MG $42.71 $49.20 $49.89 $50.85 $48.79 $49.92 $53.69 $48.46 $32.91 $41.41 $20.66 $5.26 $40.47 $39.53 $51.29 $48.22 PEG 3350-KCL-NA BICARB-NACL-NA SULFATE FOR SOLN 240 GM PENICILLIN V POTASSIUM TAB 500 MG PHENAZOPYRIDINE HCL TAB 200 MG POLYETHYLENE GLYCOL 3350 ORAL POWDER POLYMYXIN B- TRIMETHOPRIM OPHTH SOLN UNIT/ML- 0.1% POTASSIUM CHLORIDE MICROENCAPSULATED CRYS CR TAB 20 MEQ POTASSIUM CHLORIDE TAB CR 10 MEQ PRAVASTATIN SODIUM TAB 40 MG $13.98 $6.59 $2.59 $25.19 $7.45 $15.80 $10.81 $30.97 PREDNISONE $2.00 PREDNISONE TAB 20 MG $1.22 PREDNISONE TAB 5 MG $1.89 PRENATAL VIT W/ FE FUMARATE-FA TAB 27-1 MG PROCHLORPERAZINE MALEATE PROMETHAZINE HCL PROMETHAZINE W/ CODEINE SYRUP MG/5ML PROPOXYPHENE-N W/ APAP TAB RANITIDINE HCL TAB 1 SERTRALINE HCL TAB $3.82 $10.97 $10.19 $7.21 $6.88 $6.61 $24.37

6 SERTRALINE HCL TAB $23.10 SIMVASTATIN $16.47 SIMVASTATIN TAB 20 MG $22.31 SIMVASTATIN TAB 40 MG $21.87 SIMVASTATIN TAB 80 MG $21.93 SPIRONOLACTONE SULFAMETHOXAZOLE- TRIMETHOPRIM SUSP MG/5ML SULFAMETHOXAZOLE- TRIMETHOPRIM TAB MG $13.53 $12.18 $9.81 TEMAZEPAM CAP 15 MG $5.12 TETRACYCLINE HCL CAP 500 MG TOBRAMYCIN SULFATE OPHTH SOLN 0.3% TRAMADOL HCL TAB TRAZODONE HCL TAB $4.22 $3.22 $11.98 $5.75 TRAZODONE HCL TAB TRIAMCINOLONE ACETONIDE CREAM 0.1% TRIAMTERENE & HYDRO- CHLOROTHIAZIDE CAP MG TRIAMTERENE & HYDRO MG TRIAMTERENE & HYDRO- 75- VERAPAMIL HCL TAB CR 240 MG WARFARIN SODIUM TAB 2 MG WARFARIN SODIUM TAB 5 MG $3.92 $4.54 $6.68 $6.06 $2.55 $21.01 $19.33 $ Prime Therapeutics LLC 06/07

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