The savings you want on the prescriptions you need.

Transcription

1 The savings you want on the prescriptions you need. This program can save you money on more than 5,000 medications. For more information on the Prescription Savings Club, speak with your pharmacist or visit: GoodNeighborPharmacy.com Use it at thousands of participating locations from coast to coast. Get to know your neighbor.

2 Join the Good Neighbor Pharmacy Prescription Savings Club and pay as low as $ 4.99 on more than 300 generic medications! Now you can enjoy great cost-savings on name brand and generic medications, along with the customer service and personalized care that only a locally-owned pharmacy can offer. Just show your Prescription Savings Club card at any participating Good Neighbor Pharmacy nationwide. What is the Good Neighbor Pharmacy Prescription Savings Club? Through the Good Neighbor Pharmacy Prescription Savings Club, you can save on more than 5,000 name brand and generic medications at your locally-owned participating Good Neighbor Pharmacy. Your club card is good at over 4,000 participating locations across the country. Who can enroll? Our program is open to people of all ages. And it s ideal for people without prescription drug benefits or those with inadequate coverage. No prior authorization is required; simply show your card and enjoy great savings. People who receive healthcare benefits from Medicare, Medicaid or TRICARE are not eligible. Is there an annual membership fee as part of the program? There is a $ 9.99 annual membership fee for the program. Is this program the same as an insurance benefit? No. This program is not an insurance benefit. This program is a Prescription Savings Club that offers voluntary enrollment, requires an annual membership fee and provides exclusive discounts on prescription medications. How much will my medications cost? As a member, you will receive exclusive discounts on many of your brand-name prescription medications. In addition, more than 300 generic prescription medications are available to you at the following low costs: 30-day supply of one medication: $ day supply of one medication: $10.99 Day s supply is limited by specific metric quantities based upon commonly prescribed dosing. What types of medications are offered for as low as $ 4.99? The Prescription Savings Club offers many popular medications for: Allergies Antifungal Treatments Arthritis and Pain High Blood Pressure High Cholesterol Diabetes Gastrointestinal Health Skin Conditions Antibiotic Treatments Antiviral Treatments Asthma and COPD Heart Health Cough and Cold Eye Care Mental Health Thyroid Conditions To find out if your medications are covered, ask the pharmacist at your local Good Neighbor Pharmacy. How do I enroll? Enrollment is easy! Simply fill out the form below and give it to your Good Neighbor Pharmacy pharmacist. Or, visit GoodNeighborPharmacy.com/ PrescriptionSavingsClub. Your personalized Prescription Savings Club card will be mailed to your home within a couple weeks of initial enrollment. Your annual membership fee will be automatically added to the price of your first prescription. Start saving today! Join the Good Neighbor Pharmacy Prescription Savings Club today and start enjoying big savings on many of the medications you need. MALE NAME ADDRESS FEMALE CITY STATE ZIP PHONE # SIGNATURE DOB Prescription Savings Club

3 INTRODUCTION The Prescription Savings Club provides its members with significant savings on prescription medications. The medications listed are available in metric quantities of commonly prescribed doses in up to 30-day and 90-day supplies. It is recommended that you share this list of medications with your physician. Specifically, ask your physician if a generic alternative is available and clinically appropriate for you. This list is subject to change. A Acyclovir 200mg Albuterol 0.083% nebulizer solution... 75ml 225ml Albuterol 2mg/5ml syrup ml 360ml Allopurinol 100mg Allopurinol 300mg Amlodipine 2.5mg Amlodipine 5mg Amlodipine 10mg Amoxicillin 125mg/5ml... 80ml 240ml Amoxicillin 125mg/5ml ml 300ml Amoxicillin 125mg/5ml ml 450ml Amoxicillin 200mg/5ml... 50ml 150ml Amoxicillin 200mg/5ml ml 300ml Amoxicillin 200mg/5ml... 75ml 225ml Amoxicillin 250mg Amoxicillin 250mg/5ml ml 300ml Amoxicillin 250mg/5ml ml 450ml Amoxicillin 250mg/5ml... 80ml 240ml Amoxicillin 400mg/5ml ml 300ml Amoxicillin 400mg/5ml... 50ml 150ml Amoxicillin 400mg/5ml... 75ml 225ml Amoxicillin 500mg Antipyrine/Benzocaine otic... 10ml 30ml Atenolol 100mg Atenolol 25mg Atenolol 50mg Atenolol-Chlorthalidone 100mg-25mg $9.00/30 day Albuterol 0.5% nebulizer solution... 20ml 60ml B Baclofen 10mg Benazepril 10mg Benazepril 20mg Benazepril 40mg Benazepril 5mg Benzonatate 100mg Benztropine 2mg Bisoprolol-HCTZ 2.5mg-6.25mg Bisoprolol-HCTZ 5mg-6.25mg Bisoprolol-HCTZ 10mg-6.25mg Bumetanide 0.5mg Bumetanide 1mg Buspirone 10mg Buspirone 5mg C Carvedilol 12.5mg Carvedilol 25mg Carvedilol 3.125mg Carvedilol 6.25mg Cephalexin 250mg Cephalexin 500mg Chlorhexidine Gluconate 0.12% solution ml 1419ml Ciprofloxacin 250mg Ciprofloxacin 500mg Citalopram 20mg Citalopram 40mg Clonidine 0.1mg Clonidine 0.2mg Cyclobenzaprine 10mg Cyclobenzaprine 5mg D Dexamethasone 0.5mg Dexamethasone 0.75mg Dexamethasone 4mg Diclofenac DR 75mg Dicyclomine 10mg Dicyclomine 20mg E Enalapril 10mg Enalapril 2.5mg Enalapril 20mg Enalapril 5mg Enalapril-HCTZ 5mg-12.5mg Erythromycin ophthalmic ointment gm 10.5gm Estradiol 0.5mg Estradiol 1mg Estradiol 2mg Ethedent 0.25mg chewable F Famotidine 20mg Fluconazole 150mg Fluoxetine 10mg Fluoxetine 10mg tablet Fluoxetine 20mg Fluoxetine 40mg Folic Acid 1mg Furosemide 20mg Furosemide 40mg Furosemide 80mg G Gentamicin 0.1% cream... 15gm 45gm Gentamicin 0.1% ointment... 15gm 45gm Gentamicin 0.3% ophthalmic solution... 5ml 15ml Glimepiride 1mg Glimepiride 2mg Glimepiride 4mg Glipizide 10mg Glipizide 5mg Glyburide 2.5mg Glyburide 5mg Glyburide, micronized 3mg Glyburide, micronized 6mg Guanfacine 1mg H Haloperidol 0.5mg Haloperidol 1mg Haloperidol 2mg Hydralazine 10mg Hydralazine 25mg Hydrochlorothiazide (HCTZ) 12.5mg Hydrochlorothiazide (HCTZ) 25mg Hydrochlorothiazide (HCTZ) 50mg Hydrocortisone 1% cream... 30gm 90gm Hydrocortisone 2.5% cream... 30gm 90gm

4 I Ibuprofen 100mg/5ml suspension ml 360ml Ibuprofen 400mg Ibuprofen 600mg Ibuprofen 800mg Indapamide 1.25mg Indapamide 2.5mg Indomethacin 25mg Ipratropium 0.02% nebulizer solution ml 187.5ml Isoniazid 300mg Isosorbide Mononitrate ER 30mg Isosorbide Mononitrate ER 60mg L Lactulose syrup ml 711ml Lamotrigine 25mg Lamotrigine 100mg Lamotrigine 150mg Lamotrigine 200mg Levobunolol 0.5% ophthalmic solution... 5ml 15ml Lidocaine 2% viscous solution ml 300ml Lisinopril 2.5mg Lisinopril 5mg Lisinopril 10mg Lisinopril 20mg Lisinopril 40mg Lisinopril-HCTZ 10mg-12.5mg Lisinopril-HCTZ 20mg-12.5mg Lisinopril-HCTZ 20mg-25mg Lithium Carbonate 300mg Loratadine 10mg Lovastatin 10mg Lovastatin 20mg M Mag 64 64mg Magnesium Oxide 400mg Medroxyprogesterone Acetate 2.5mg Medroxyprogesterone Acetate 5mg Medroxyprogesterone Acetate 10mg Megestrol 20mg Meloxicam 15mg Meloxicam 7.5mg Metformin 1000mg Metformin 500mg Metformin 850mg Metformin ER 500mg Methyldopa 250mg Metoclopramide 5mg Metoclopramide 10mg Metoclopramide syrup... 60ml 180ml Metoprolol Tartrate 100mg Metoprolol Tartrate 25mg Metoprolol Tartrate 50mg N Naproxen 375mg Naproxen 500mg Neomycin/Polymyxin/Dexamethasone 0.1% ophthalmic ointment gm 10.5gm 0.1% ophthalmic suspension... 5ml 15ml Nortriptyline 10mg Nortriptyline 25mg Nystatin cream... 15gm 45gm Nystatin cream... 30gm 90gm P Paroxetine 10mg Paroxetine 20mg Penicillin VK 125mg/5ml ml 300ml Penicillin VK 125mg/5ml ml 600ml Penicillin VK 250mg Penicillin VK 250mg/5ml ml 300ml Phenazopyridine 100mg Polymyxin Sulfate/TMP ophthalmic solution... 10ml 30ml Prednisone 2.5mg tablet Prednisone 5mg tablet Prochlorperazine 5mg Prochlorperazine 10mg Promethazine 25mg tabs Promethazine DM Syrup ml 360ml Promethazine plain syrup ml 540ml Propranolol 10mg Propranolol 20mg Propranolol 40mg R 30-day 90 day Ranitidine 150mg Ranitidine 300mg S Silver Sulfadiazine 1% cream... 50gm 150gm Simvastatin 5mg Simvastatin 10mg Simvastatin 20mg Simvastatin 40mg Simvastatin 80mg SMZ-TMP 200mg-40mg/5ml ml 360ml SMZ-TMP 400mg-80mg SMZ-TMP DS 800mg-160mg Sotalol HCL 80mg Spironolactone 25mg T Terazosin 10mg Terazosin 1mg Terazosin 2mg Terazosin 5mg Terbinafine 250mg Timolol Maleate 0.25% ophthalmic solution... 5ml 15ml Timolol Maleate 0.5% ophthalmic solution... 5ml 15ml Tobramycin 0.3% ophthalmic solution... 5ml 15ml Trazodone 100mg Trazodone 150mg Trazodone 50mg Triamcinolone 0.025% cream... 15gm 45gm Triamcinolone 0.1% cream... 15gm 45gm Triamcinolone 0.1% cream... 80gm 240gm Triamcinolone 0.1% ointment... 15gm 45gm Triamcinolone 0.1% ointment... 80gm 240gm Triamcinolone 0.5% cream... 15gm 45gm Triamterene-HCTZ 37.5mg-25mg (tablets) Triamterene-HCTZ 75mg-50mg Trihexyphenidyl 2mg V Verapamil 120mg Verapamil 80mg Vol-Plus (prenatal)

5 W Warfarin 1mg Warfarin 2mg Warfarin 2.5mg Warfarin 3mg Warfarin 4mg Warfarin 5mg Warfarin 6mg Warfarin 7.5mg Warfarin 10mg Women s Health Available for $ Day for $27.99 Alendronate SOD 35mg Alendronate SOD 70mg Clomiphene 50mg Mononessa 28-Day Trinessa 28-Day Tamoxifen 10mg Tamoxifen 20mg Men s Health Available for $ Day for $27.99 Finasteride 5mg