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📋 Full Formulary

Complete medication lists — scroll or search below

ACUTE FORMULARY — 37 Medications (Silver/Gold Tier)

All medications below are $0 co-pay

MedicationDosageFormQtyCost
AMOXICILLIN250 MGCAPSULE30$0
AMOXICILLIN400 MG/5 MLSUSPENSION200$0
AMOXICILLIN500 MGCAPSULE30$0
AMOXICILLIN875 MGTABLET20$0
AMOXICILLIN/POTASSIUM CLAV875-125 MGTABLET14$0
AZITHROMYCIN250 MGTABLET6$0
AZITHROMYCIN500 MGTABLET6$0
BACITRACIN500 UNIT/GOINTMENT28$0
BENZONATATE100 MGCAPSULE30$0
BENZONATATE200 MGCAPSULE15$0
CEPHALEXIN500 MGCAPSULE20$0
CIPROFLOXACIN HCL500 MGTABLET14$0
CYPROHEPTADINE HCL4 MGTABLET21$0
FLUCONAZOLE150 MGTABLET1$0
GUAIFENESIN/CODEINE PHOSPHATE100-10 MG/5LIQUID118$0
HYDROCODONE/ACETAMINOPHEN10 MG-300 MGTABLET12$0
HYDROCORTISONE1%CREAM28$0
IBUPROFEN400 MGTABLET20$0
IBUPROFEN600 MGTABLET20$0
IBUPROFEN800 MGTABLET20$0
MECLIZINE HCL12.5 MGTABLET20$0
MECLIZINE HCL25 MGTABLET20$0
METHYLPREDNISOLONE4 MGTABLET21$0
METRONIDAZOLE500 MGTABLET21$0
NAPROXEN250 MGTABLET30$0
NAPROXEN375 MGTABLET20$0
NAPROXEN500 MGTABLET20$0
OFLOXACIN0.3%DROPS5$0
POLYMYXIN B SULF/TRIMETHOPRIM10000-1/MLDROPS10$0
PREDNISONE10 MGTABLET30$0
PREDNISONE20 MGTABLET30$0
PREDNISONE5 MGTABLET30$0
PREDNISONE50 MGTABLET30$0
PROMETHAZINE HCL25 MGTABLET12$0
PROMETHAZINE HCL/CODEINE6.25-10/5SYRUP200$0
SULFAMETHOXAZOLE/TRIMETHOPRIM800-160 MGTABLET14$0
TRIAMCINOLONE ACETONIDE0.025%OINTMENT15$0
COMPLETE PREMIUM-0 — 1000+ Medications (Platinum/Titanium)

All medications below are $0 member cost. Use CTRL+F or filter box above.

MedicationDosageFormRetail QtyHD QtyCost
ACUTE MEDICATIONS
ACETAMINOPHEN WITH CODEINE120-12 MG/5SOLUTION4730$0
ACETAMINOPHEN WITH CODEINE300 MG-15 MGTABLET300$0
ACETAMINOPHEN WITH CODEINE300 MG-30 MGTABLET300$0
ALPRAZOLAM0.25 MGTABLET300$0
ALPRAZOLAM0.5 MGTABLET300$0
ALPRAZOLAM1 MGTABLET300$0
AMOXICILLIN125 MGCHEWABLE TABLET560$0
AMOXICILLIN250 MGCHEWABLE TABLET280$0
AMOXICILLIN125 MG/5 MLSUSPENSION2000$0
AMOXICILLIN200 MG/5 MLSUSPENSION2000$0
AMOXICILLIN250 MG/5 MLSUSPENSION2000$0
AMOXICILLIN400 MG/5 MLSUSPENSION2000$0
AMOXICILLIN250 MGCAPSULE300$0
AMOXICILLIN500 MGCAPSULE300$0
AMOXICILLIN875 MGTABLET280$0
AMOXICILLIN/POTASSIUM CLAV200-28.5/5SUSPENSION500$0
AMOXICILLIN/POTASSIUM CLAV250-62.5/5SUSPENSION500$0
AMOXICILLIN/POTASSIUM CLAV400-57 MG/5SUSPENSION500$0
AMOXICILLIN/POTASSIUM CLAV600-42.9/5SUSPENSION500$0
AMOXICILLIN/POTASSIUM CLAV875-125 MGTABLET140$0
AMPICILLIN TRIHYDRATE500 MGCAPSULE280$0
AZITHROMYCIN250 MGTABLET60$0
AZITHROMYCIN500 MGTABLET60$0
BENZPHETAMINE HCL50 MGTABLET300$0
BROMPHENIRAMINE/PSEUDOEPHED/DM2-30-10/5SYRUP1180$0
CEFDINIR125 MG/5 MLSUSPENSION1000$0
CEPHALEXIN250 MGCAPSULE400$0
CEPHALEXIN500 MGCAPSULE200$0
CEPHALEXIN125 MG/5 MLSUSPENSION1000$0
CEPHALEXIN250 MG/5 MLSUSPENSION1000$0
CHLORDIAZEPOXIDE HCL5 MGCAPSULE150$0
CHLORDIAZEPOXIDE HCL10 MGCAPSULE150$0
CIPROFLOXACIN0.3%EYE DROPS50$0
CIPROFLOXACIN HCL250 MG/5 MLSUSPENSION1000$0
CIPROFLOXACIN HCL500 MGTABLET140$0
CLINDAMYCIN HCL75 MG/5 MLSOLUTION1000$0
CLONAZEPAM0.5 MGTABLET300$0
CLONAZEPAM1 MGTABLET300$0
CLONAZEPAM2 MGTABLET300$0
DEXMETHYLPHENIDATE HCL10 MGTABLET300$0
DEXTROAMPHETAMINE/AMPHETAMINE5 MGTABLET300$0
DEXTROAMPHETAMINE/AMPHETAMINE7.5 MGTABLET300$0
DEXTROAMPHETAMINE/AMPHETAMINE10 MGTABLET300$0
DEXTROAMPHETAMINE/AMPHETAMINE12.5 MGTABLET300$0
DEXTROAMPHETAMINE/AMPHETAMINE20 MGTABLET300$0
DEXTROAMPHETAMINE/AMPHETAMINE30 MGTABLET300$0
DIAZEPAM2 MGTABLET300$0
DIAZEPAM5 MGTABLET300$0
DIAZEPAM10 MGTABLET300$0
DILTIAZEM HCL120 MGCAPSULE ER300$0
DOXYCYCLINE HYCLATE100 MGCAPSULE300$0
DOXYCYCLINE MONOHYDRATE100 MGTABLET300$0
ERYTHROMYCIN BASE5 MG/GOINTMENT3.50$0
FLUPHENAZINE HCL10 MGTABLET300$0
HYDROCORTISONE0.5%CREAM280$0
HYDROCORTISONE1%CREAM280$0
HYDROCORTISONE2.5%CREAM280$0
HYDROCORTISONE1%OINTMENT300$0
HYDROMORPHONE HCL2 MGTABLET300$0
HYDROMORPHONE HCL4 MGTABLET300$0
IBANDRONATE SODIUM150 MGTABLET30$0
LEVOFLOXACIN500 MGTABLET210$0
LEVOFLOXACIN750 MGTABLET150$0
LIDOCAINE HCL2%SOLUTION1000$0
LORAZEPAM0.5 MGTABLET300$0
LORAZEPAM1 MGTABLET300$0
MEPERIDINE HCL50 MG/5 MLSOLUTION2100$0
METHADONE HCL5 MGTABLET300$0
METHADONE HCL10 MGTABLET300$0
METHYLPHENIDATE HCL5 MGTABLET300$0
METHYLPHENIDATE HCL10 MGTABLET300$0
METHYLPREDNISOLONE4 MGTABLET210$0
METRONIDAZOLE250 MGTABLET280$0
MONTELUKAST SODIUM4 MGCHEWABLE TABLET210$0
OFLOXACIN0.3%DROPS50$0
OSELTAMIVIR PHOSPHATE6 MG/MLSUSPENSION600$0
OXYCODONE HCL5 MGTABLET300$0
OXYCODONE HCL10 MGTABLET300$0
OXYCODONE HCL15 MGTABLET300$0
OXYCODONE HCL20 MGTABLET300$0
OXYCODONE/ACETAMINOPHEN5-325 MGTABLET300$0
OXYCODONE/ACETAMINOPHEN7.5-325 MGTABLET300$0
PENICILLIN V POTASSIUM250 MGTABLET140$0
PENICILLIN V POTASSIUM500 MGTABLET200$0
PHENDIMETRAZINE TARTRATE35 MGTABLET300$0
PHENTERMINE HCL15 MGCAPSULE300$0
PHENTERMINE HCL37.5 MGCAPSULE300$0
PROMETHAZINE HCL6.25 MG/5 MLSYRUP2400$0
PROMETHAZINE HCL/CODEINE6.25-10/5SYRUP2000$0
TESTOSTERONE1.25 G (1%)GEL PUMP750$0
TESTOSTERONE ENANTHATE200 MG/MLOIL10$0
TRAMADOL HCL50 MGTABLET300$0
TRAMADOL HCL/ACETAMINOPHEN37.5-325 MGTABLET630$0
TRIAZOLAM0.25 MGTABLET300$0
ZALEPLON5 MGCAPSULE300$0
ZALEPLON10 MGCAPSULE300$0
ZOLPIDEM TARTRATE5 MGTABLET300$0
ZOLPIDEM TARTRATE10 MGTABLET300$0
CHRONIC MEDICATIONS (partial - use filter to search)
NOTE: The full chronic formulary contains 1000+ medications.Use the search on the main page or filter box above to find specific drugs. All are $0.