These discount programs are NOT health insurance policies and are not intended as a substitute for insurance. The programs do not qualify as a minimum creditable coverage under Massachusetts law or where prohibited by law. The programs only provide for discounts on health services from participating pharmacies, and the range of the discounts will vary depending on the health services received. The programs do not make payments to pharmacies of health care services. Members are required to pay for all health care services, but will receive a discount from the contracted pharmacies. Except in the states of California, Utah, and Washington, these are custom-branded programs, provided and administered by Medical Security Card Company, LLC, (MSC), 4911 E. Broadway Boulevard, Tucson, AZ 85711, 1-866- 435-7958, www.scriptsave.com and marketed by Kmart. These programs are not available in all states and the terms of each program may vary from state to state. Each program is governed by the applicable terms of the membership agreement provided upon activation and made available at www.kmartprescriptionsavingsclub.com. MSC is not responsible for providing or guaranteeing pharmacy services or for the quality of such rendered services. Participating pharmacies are subject to change without notice and are not available in all areas. The program contracts are not protected by any state guaranty fund. 2 An annual fee of $10 is payable at the time of initial enrollment and enrollment renewal. The program, as well as the prices and the list of covered drugs, can be modified at any time without notice. 2 Notwithstanding the above, the programs, as described above and available in the states of California, Utah, and Washington, are custom-branded and operated directly by Kmart. The applicable terms relating to any such Kmart custom-branded and operated program shall also be available at www. KmartPrescriptionSavingsClub.com. MSC may participate or assist in the administration of such programs. For questions, please call 1-866-435-7958, log on to www.kmartprescriptionsavingsclub.com or see the pharmacist for further details. REVISED MAY 1, 2015 Preferred generic drugs supply* for $5 or $10 supply* for $10, $15, $20 or $30 *The day supply is based upon the average dispensing patterns for the specific drug and strength. supply price starts at $5. supply price starts at $10. a Select drugs for a 30-Day Supply are priced at $10; b Select drugs for a 90-Day Supply are priced at $15; c Select drugs for a 90-Day Supply are priced at $20; d Select drugs for a 90-Day Supply are priced at $30. ALLERGIES & COLD AND FLU BENZONATATE 100 MG CAP 14 42 CETIRIZINE HCL 5 MG TAB 30 90 CETIRIZINE HCL 10 MG TAB 30 90 CHLORPHENIRAMINE MALEATE 4 MG TAB 100 300 CLEMASTINE FUMARATE 1.34 MG TAB 30 90 b DIPHENHYDRAMINE HCL 50 MG CAP 90 270 b D-METHORPHAN HB/PROMETH HCL 15-6.25/5 SYRUP 120 360 Select Women s and Men s Health prescription medications are available in up to a 30- day supply for $12.00 each or in up to a supply for $36.00 each (see last page). 1
GUAIFENESIN/DEXTROMETHORPHAN 100-10MG/5 LIQUID 180 540 b LORATADINE 10 MG TAB 30 90 PROMETHAZINE HCL 25 MG TAB 12 36 PROMETHAZINE HCL 50 MG TAB 20 60 b PROMETHAZINE HCL 6.25MG/5ML SYRUP 180 540 b ANTIBIOTIC & ANTI-INFECTIVE TREATMENTS ACYCLOVIR 200 MG CAP 30 90 b AMOXICILLIN 250 MG CAP 30 90 b AMOXICILLIN 500 MG CAP 30 90 AMOXICILLIN 125 MG/5ML SUSP 150 450 b AMOXICILLIN 200 MG/5ML SUSP 100 300 b AMOXICILLIN 250 MG/5ML SUSP 150 450 b AMOXICILLIN 400 MG/5ML SUSP 100 300 AMOXICILLIN 125 MG TAB 20 60 b AMPICILLIN TRIHYDRATE 250 MG CAP 28 84 b AMPICILLIN TRIHYDRATE 500 MG CAP 28 84 b BACITRACIN ZINC 500 UNIT/G OINT 30 90 b BACITRACIN ZINC 500 UNIT/G PACKET 30 90 b CEPHALEXIN 250 MG CAP 28 84 b CEPHALEXIN 500 MG CAP 30 90 b CIPROFLOXACIN HCL 250 MG TAB 14 42 b CIPROFLOXACIN HCL 500 MG TAB 20 60 b ISONIAZID 300 MG TAB 30 a 90 c PENICILLIN V POTASSIUM 250 MG TAB 30 90 b PENICILLIN V POTASSIUM 250 MG/5ML SOLN 100 300 b SMZ/TMP 400MG-80MG TAB 28 84 b SMZ/TMP 800-160 MG TAB 20 60 b ARTHRITIS & PAIN ASPIRIN 81 MG TAB 120 360 b CYCLOBENZAPRINE HCL 5 MG TAB 30 90 CYCLOBENZAPRINE HCL 10 MG TAB 30 90 DIBUCAINE 1 % OINT 30 90 b IBUPROFEN 400 MG TAB 90 270 b IBUPROFEN 600 MG TAB 60 180 b IBUPROFEN 800 MG TAB 30 90 b MELOXICAM 7.5 MG TAB 30 90 MELOXICAM 15 MG TAB 30 90 NAPROXEN 250 MG TAB 60 180 b NAPROXEN 375 MG TAB 60 180 b NAPROXEN 500 MG TAB 60 180 b NAPROXEN 375 MG TAB EC 60 180 b NAPROXEN SODIUM 275 MG TAB 30 90 b 2 2
ASTHMA ALBUTEROL SULFATE 2 MG/5 ML SYRUP 120 360 b ALBUTEROL SULFATE 2.5 MG/3ML VIAL-NEB 75 225 b IPRATROPIUM BROMIDE 0.2 MG/ML SOLN 75 225 b DIABETES GLIMEPIRIDE 1 MG TAB 30 90 GLIMEPIRIDE 2 MG TAB 30 90 GLIMEPIRIDE 4 MG TAB 30 90 GLIPIZIDE 5 MG TAB 30 90 GLIPIZIDE 10 MG TAB 60 180 GLYBURIDE 1.25 MG TAB 30 90 b GLYBURIDE 2.5 MG TAB 30 a 90 c GLYBURIDE 5 MG TAB 30 a 90 c GLYBURIDE, MICRONIZED 1.5 MG TAB 30 90 GLYBURIDE, MICRONIZED 3 MG TAB 30 90 GLYBURIDE,MICRONIZED 6 MG TAB 30 90 GLYBURIDE/METFORMIN HCL 1.25-250MG TAB 60 a 180 d GLYBURIDE/METFORMIN HCL 2.5-500 MG TAB 60 a 180 d GLYBURIDE/METFORMIN HCL 5 MG-500MG TAB 90 a 270 d METFORMIN HCL 500 MG TAB 60 180 METFORMIN HCL 750 MG TAB 60 a 180 d METFORMIN HCL 850 MG TAB 60 180 METFORMIN HCL 1000 MG TAB 60 180 METFORMIN HCL ER 500 MG TAB 60 180 b FUNGAL INFECTIONS FLUCONAZOLE 150 MG TAB 1 3 b TERBINAFINE HCL 250 MG TAB 30 a 90 d GASTROINTESTINAL HEALTH CIMETIDINE 300 MG TAB 30 a 90 d CIMETIDINE 400 MG TAB 30 a 90 d DICYCLOMINE HCL 10 MG CAP 90 270 b DICYCLOMINE HCL 20 MG TAB 60 180 b DOCUSATE CALCIUM 240 MG CAP 30 90 DOCUSATE SODIUM 100 MG CAP 100 300 b FAMOTIDINE 20 MG TAB 60 180 b FAMOTIDINE 40 MG TAB 30 a 90 c LACTULOSE 10 G/15 ML SOLN 237 711 b LACTULOSE 20 G/30 ML SOLN 237 711 b LACTULOSE 10 GM/15 ML SYRUP 237 711 b METOCLOPRAMIDE HCL 5 MG/5 ML SOLN 60 180 METOCLOPRAMIDE HCL 10 MG/10ML SOLN 60 180 METOCLOPRAMIDE HCL 10 MG TAB 60 180 3 3
OMEPRAZOLE 20 MG CAP 30 a 90 d PROCHLORPERAZINE MALEATE 5 MG TAB 40 120 b PROCHLORPERAZINE MALEATE 10 MG TAB 30 90 RANITIDINE HCL 15 MG/ML SYRUP 100 300 b RANITIDINE HCL 150 MG TAB 60 180 RANITIDINE HCL 300 MG TAB 30 90 GLAUCOMA & EYE CARE FLURBIPROFEN SODIUM 0.03 % DROPS 2 6 b FLUTICASONE PROPIONATE 50 MCG SUSP 16 a 48 c NAPHAZOLINE HCL 0.1 % DROPS 15 45 b TIMOLOL MALEATE 0.25 % DROPS 5 15 TIMOLOL MALEATE 0.5 % DROPS 5 15 b HEART HEALTH & BLOOD PRESSURE AMLODIPINE BESYLATE 2.5 MG TAB 30 90 AMLODIPINE BESYLATE 5 MG TAB 30 90 AMLODIPINE BESYLATE 10 MG TAB 30 a 90 c ATENOLOL 25 MG TAB 30 90 ATENOLOL 50 MG TAB 30 90 ATENOLOL 100 MG TAB 30 90 BENAZEPRIL HCL 5 MG TAB 30 90 b BENAZEPRIL HCL 10 MG TAB 30 90 b BENAZEPRIL HCL 20 MG TAB 30 90 b BENAZEPRIL HCL 40 MG TAB 30 90 b BISOPROLOL FUMARATE/HCTZ 2.5-6.25MG TAB 30 90 b BISOPROLOL FUMARATE/HCTZ 5-6.25MG TAB 30 90 b BISOPROLOL FUMARATE/HCTZ 10-6.25MG TAB 30 90 b CARVEDILOL 3.125 MG TAB 60 180 CARVEDILOL 6.25 MG TAB 60 180 CARVEDILOL 12.5 MG TAB 60 180 CARVEDILOL 25 MG TAB 60 180 b CLONIDINE HCL 0.1 MG TAB 30 90 CLONIDINE HCL 0.2 MG TAB 30 90 DILTIAZEM HCL 30 MG TAB 60 180 DILTIAZEM HCL 60 MG TAB 60 a 180 c DILTIAZEM HCL 90 MG TAB 60 a 180 c DILTIAZEM HCL 120 MG TAB 30 a 90 c ENALAPRIL MALEATE 5 MG TAB 30 90 b ENALAPRIL-HCTZ 10-25 MG TAB 30 90 b FOSINOPRIL SODIUM 20 MG TAB 30 a 90 d FOSINOPRIL SODIUM 40 MG TAB 30 a 90 d FUROSEMIDE 20 MG TAB 30 90 FUROSEMIDE 40 MG TAB 30 90 4 4
FUROSEMIDE 80 MG TAB 30 90 GEMFIBROZIL 600 MG TAB 60 a 180 d GUANFACINE HCL 1 MG TAB 30 90 GUANFACINE HCL 2 MG TAB 30 90 b HYDRALAZINE HCL 25 MG TAB 30 90 b HYDROCHLOROTHIAZIDE 12.5 MG CAP 30 90 HYDROCHLOROTHIAZIDE 25 MG TAB 30 90 HYDROCHLOROTHIAZIDE 50 MG TAB 30 90 INDAPAMIDE 1.25 MG TAB 30 90 INDAPAMIDE 2.5 MG TAB 30 90 LISINOPRIL 2.5 MG TAB 30 90 LISINOPRIL 5 MG TAB 30 90 LISINOPRIL 10 MG TAB 30 90 LISINOPRIL 20 MG TAB 30 90 LISINOPRIL 30 MG TAB 30 90 LISINOPRIL 40 MG TAB 30 a 90 c LISINOPRIL-HCTZ 10-12.5 MG TAB 30 90 LISINOPRIL-HCTZ 20-12.5 MG TAB 30 90 LISINOPRIL-HCTZ 20-25 MG TAB 30 a 90 c LOSARTAN POTASSIUM 50 MG TAB 30 a 90 d LOVASTATIN 10 MG TAB 30 90 LOVASTATIN 20 MG TAB 30 90 LOVASTATIN 40 MG TAB 30 90 METOPROLOL TARTRATE 25 MG TAB 60 180 METOPROLOL TARTRATE 50 MG TAB 60 180 METOPROLOL TARTRATE 100 MG TAB 60 180 b PRAZOSIN HCL 1 MG CAP 30 a 90 c PROPRANOLOL HCL 10 MG TAB 60 180 PROPRANOLOL HCL 20 MG TAB 60 a 180 c PROPRANOLOL HCL 40 MG TAB 60 180 QUINAPRIL HCL 5 MG TAB 30 a 90 d SIMVASTATIN 10 MG TAB 30 90 SIMVASTATIN 20 MG TAB 30 a 90 c SIMVASTATIN 40 MG TAB 30 a 90 c SIMVASTATIN 80 MG TAB 30 90 SOTALOL HCL 80 MG TAB 30 a 90 d SPIRONOLACTONE 25 MG TAB 30 90 TERAZOSIN HCL 1 MG CAP 30 90 TERAZOSIN HCL 2 MG CAP 30 90 TERAZOSIN HCL 5 MG CAP 30 90 TERAZOSIN HCL 10 MG CAP 30 90 TORSEMIDE 10 MG TAB 30 90 b 5 5
TRIAMTERENE-HCTZ 37.5-25 MG TB 30 a 90 c VERAPAMIL HCL 80 MG TAB 30 90 VERAPAMIL HCL 120 MG TAB 30 90 VERAPAMIL HCL 180 MG TAB 30 a 90 c WARFARIN SODIUM 1 MG TAB 30 a 90 c WARFARIN SODIUM 2 MG TAB 30 a 90 c WARFARIN SODIUM 2.5 MG TAB 30 a 90 c WARFARIN SODIUM 3 MG TAB 30 a 90 c WARFARIN SODIUM 4 MG TAB 30 a 90 c WARFARIN SODIUM 5 MG TAB 30 a 90 c WARFARIN SODIUM 6 MG TAB 30 a 90 c WARFARIN SODIUM 7.5 MG TAB 30 a 90 c WARFARIN SODIUM 10 MG TAB 30 a 90 c MENTAL & NEURO HEALTH AMITRIPTYLINE HCL 10 MG TAB 30 90 b AMITRIPTYLINE HCL 25 MG TAB 30 90 b AMITRIPTYLINE HCL 50 MG TAB 30 a 90 d AMITRIPTYLINE HCL 75 MG TAB 30 a 90 d BUSPIRONE HCL 5 MG TAB 60 180 BUSPIRONE HCL 10 MG TAB 60 180 b CITALOPRAM HBR 20 MG TAB 30 90 CITALOPRAM HBR 40 MG TAB 30 90 DOXEPIN HCL 10 MG CAP 30 a 90 d FLUOXETINE HCL 20 MG CAP 30 90 FLUOXETINE HCL 40 MG CAP 30 a 90 c FLUPHENAZINE HCL 1 MG TAB 30 90 FLUPHENAZINE HCL 2.5 MG TAB 30 90 GABAPENTIN 100 MG CAP 90 a 270 c GABAPENTIN 400 MG CAP 90 a 270 d HALOPERIDOL 0.5 MG TAB 30 90 HALOPERIDOL 1 MG TAB 30 a 90 c HALOPERIDOL 2 MG TAB 30 90 b LITHIUM CARBONATE 150 MG CAP 90 270 b LITHIUM CARBONATE 300 MG CAP 90 270 b NORTRIPTYLINE HCL 10 MG CAP 30 90 NORTRIPTYLINE HCL 25 MG CAP 30 90 b PAROXETINE HCL 10 MG TAB 30 90 b PAROXETINE HCL 20 MG TAB 30 90 b PRAMIPEXOLE DI-HCL 0.5 MG TAB 30 a 90 d SERTRALINE HCL 25 MG TAB 30 90 b SERTRALINE HCL 50 MG TAB 30 90 b SERTRALINE HCL 100 MG TAB 30 90 b 6 6
TRAZODONE HCL 50 MG TAB 30 90 TRAZODONE HCL 100 MG TAB 30 90 TRAZODONE HCL 150 MG TAB 30 90 b ZONISAMIDE 25 MG CAP 30 a 90 d OTHER MEDICAL CONDITIONS ALLOPURINOL 100 MG TAB 30 90 b ALLOPURINOL 300 MG TAB 30 a 90 d CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH 473 1419 DEXAMETHASONE 0.5 MG TAB 30 90 b DEXAMETHASONE 0.75 MG TAB 12 36 b DEXAMETHASONE 4 MG TAB 6 18 b LIDOCAINE HCL 2% SOLN 100 300 b PHENAZOPYRIDINE HCL 100 MG TAB 6 18 b PREDNISOLONE 15 MG/5 ML SOLN 120 360 b PREDNISONE 2.5 MG TAB 30 90 SKIN CONDITIONS HYDROCORTISONE 1 % CRM 30 90 b HYDROCORTISONE 1 % PACKET 30 90 b HYDROCORTISONE 2.5 % CRM 30 90 b HYDROCORTISONE 2.5 % OINT 28 84 b HYDROCORTISONE/ALOE VERA 1 % CRM 30 90 b THYROID CONDITIONS LEVOTHYROXINE 25 MCG TAB 30 a 90 d LEVOTHYROXINE 50 MCG TAB 30 a 90 d LEVOTHYROXINE 75 MCG TAB 30 a 90 d LEVOTHYROXINE 88 MCG TAB 30 a 90 d LEVOTHYROXINE 100 MCG TAB 30 a 90 d LEVOTHYROXINE 112 MCG TAB 30 a 90 d LEVOTHYROXINE 125 MCG TAB 30 a 90 d LEVOTHYROXINE 150 MCG TAB 30 a 90 d METHIMAZOLE 5 MG TAB 30 90 VITAMINS & NUTRITIONAL HEALTH BETA-CAROTENE(A) W-C & E/MIN CAP 30 90 b BETA-CAROTENE(A) W-C & E/SE CAP 30 90 b CALCIUM CARBONATE/VITAMIN D3 600 MG-200 TAB 60 180 b CITRIC ACID/SODIUM CITRATE 334-500MG SOLN 180 540 CO-NATAL FA TAB 30 90 b ERGOCALCIFEROL (VITAMIN D2) 50000 UNIT CAP 4 12 FOLIC ACID 1 MG TAB 30 90 FOLIC ACID/VITAMIN B COMP W-C 1 MG-100MG TAB 30 90 b MAGNESIUM CHLORIDE 64 MG TAB 60 180 b MAGNESIUM OXIDE 400 MG TAB 30 90 b 7 7
MULTIVIT/FOLIC ACID/ZINC/VIT C 400-50-500 CAP 30 90 b MULTIVITAMIN WITH MINERALS CAP 30 90 b MULTIVITAMINS WITH MIN NO.7/FA 1 MG CAP 30 90 b MULTIVITAMINS,THER W-MINERALS CAP 30 90 b MEDROXYPROGESTERONE 2.5 MG TAB 30 90 MEDROXYPROGESTERONE 5 MG TAB 30 90 MEDROXYPROGESTERONE 10 MG TAB 10 30 MEGESTROL ACETATE 20 MG TAB 30 90 b MULTIVITS-MINERALS/FA/LYCOPENE 0.4MG-600 CAP 30 90 b POTASSIUM CITRATE/CITRIC ACID 1100-334/5 SOLN 180 540 b PRENATABS RX TAB 30 a 90 d PRENATAL PLUS TAB 30 a 90 d SOD/POT/K CIT/SOD CIT/CIT ACID 500-550/5 SOLN 180 540 b SODIUM FLUORIDE 0.25 (0.55) TAB 90 270 b SODIUM FLUORIDE 0.5 (1.1)MG TAB 90 270 b SODIUM FLUORIDE 1MG (2.2MG) TAB 90 270 b VIT B CMPLX 3/FA/VIT C/BIOTIN 1MG-60MG TAB 30 90 b VIT B COMPLEX & C NO.19/FA/D3 800-2000 TAB 30 90 b VIT C/VIT E AC/LUT/MINERAL 1 60-30-6 CAP 30 90 b VITAMIN A/VIT C/VIT E/SELENIUM CAP 30 90 b WOMEN S HEALTH ALENDRONATE SODIUM 5 MG TAB 30 90 b ESTRADIOL 0.5 MG TAB 30 90 Select Women s and Men s Health prescription medications are available in up to a supply* for $12.00 each or up to a supply* for $36.00 each. WOMEN S HEALTH Supply Supply ALENDRONATE SODIUM 10 MG TAB 30 90 ALENDRONATE SODIUM 35 MG TAB 4 12 ALENDRONATE SODIUM 70 MG TAB 4 12 DESOGESTREL-ETHINYL ESTRADIOL 0.15-0.03 TAB 28 84 LEVONORGESTREL-ETHIN ESTRADIOL 0.1-0.02 TAB 28 84 TAMOXIFEN CITRATE 10 MG TAB 60 180 MEN S HEALTH Supply Supply FINASTERIDE 5 MG TAB 30 90 A0158_KMART_CLASS_DL_050415 ESTRADIOL 1 MG TAB 30 a 90 c ESTRADIOL 2 MG TAB 30 90 8 8