PSC Value-priced medication list - Walgreens

Rev. 09/29/23

Prescription

Savings Club

Value-priced medication list

In addition to discounts on thousands of

brand-name and most generic medications,

members get even more savings on three

tiers of value-priced generics.*

Supply

Tier 1

Tier 2

Tier 3

30-day supply

$7.50

$10

$15

90-day supply

$15

$20

$30

The price for a generic drug is based on its tier

and whether it¡¯s a 30-day or 90-day supply.?

VALUE GENERICS

Antifungal

Tier 2

FLUCONAZOLE 150MG TABS

Tier 3

TERBINAFINE 250MG TABS

Antiviral

Tier 3

ACYCLOVIR 200MG CAPS

Arthritis or Pain

30 QTY 90 QTY

$10

1

$15

30

$20

3

$30

90

30 QTY 90 QTY

$15

60

$30

180

30 QTY 90 QTY

Tier 2

CYCLOBENZAPRINE 10MG TABS

CYCLOBENZAPRINE 5MG TABS

IBUPROFEN 100MG/5ML ORALSUSP

IBUPROFEN 400MG TABS

INDOMETHACIN 50MG CAPS

MELOXICAM 15MG TABS

MELOXICAM 7.5MG TABS

NAPROXEN 250MG TABS

NAPROXEN 375MG TABS

$10

30

30

120

90

30

30

30

60

60

$20

90

90

360

270

90

90

90

180

180

Tier 3

BACLOFEN 10MG TABS

IBUPROFEN 800MG TABS

INDOMETHACIN 25MG CAPS

NAPROXEN 500MG TABS

$15

30

60

60

60

$30

90

180

180

180

Asthma

Tier 2

ALBUTEROL 0.083% INH SOLN 30 X 3ML

IPRATROPIUM INHAL SOLN 25 X 2.5ML

Blood Pressure/Heart Health

Tier 1

ATENOLOL 100MG TABS

FUROSEMIDE 40MG TABS

FUROSEMIDE 80MG TABS

HYDRALAZINE 10MG TABS

HYDROCHLOROTHIAZIDE 25MG TABS

HYDROCHLOROTHIAZIDE 50MG TABS

LISINOPRIL 10MG TABS

LISINOPRIL 20MG TABS

VERAPAMIL 80MG TABS

30 QTY 90 QTY

$10

75

75

$20

225

225

30 QTY 90 QTY

$7.50

30

60

30

30

30

30

30

30

30

$15

90

180

90

90

90

90

90

90

90

Blood Pressure/Heart Health (cont.) 30 QTY 90 QTY

Blood Pressure/Heart Health (cont.) 30 QTY 90 QTY

Tier 2

Tier 3

AMIODARONE 200MG TABS

AMLODIPINE BESYLATE 2.5MG TABS

AMLODIPINE BESYLATE 5MG TABS

ATENOLOL 25MG TABS

ATENOLOL 50MG TABS

BENAZEPRIL 10MG TABS

BENAZEPRIL 20MG TABS

BENAZEPRIL 40MG TABS

BENAZEPRIL 5MG TABS

CARVEDILOL 12.5MG TABS

CARVEDILOL 25MG TABS

CARVEDILOL 3.125MG TABS

CARVEDILOL 6.25MG TABS

CLONIDINE 0.1MG TABS

CLONIDINE 0.2MG TAB

CLONIDINE 0.3MG TABS

FOSINOPRIL 10MG TABS

FOSINOPRIL 20MG TABS

FUROSEMIDE 20MG TABS

HYDRALAZINE 25MG TABS

HYDROCHLOROTHIAZIDE 12.5MG CAPS

ISOSORBIDE MONONITRATE 30MG ER TABS

ISOSORBIDE MONONITRATE 60MG ER TABS

LISINOPRIL 2.5MG TABS

LISINOPRIL 30MG TABS

LISINOPRIL 40MG TABS

LISINOPRIL 5MG TABS

LISINOPRIL-HCTZ 10/12.5MG TABS

LISINOPRIL-HCTZ 20/12.5MG TABS

LISINOPRIL-HCTZ 20/25MG TABS

METOPROLOL TARTRATE 100MG TABS

METOPROLOL TARTRATE 25MG TABS

METOPROLOL TARTRATE 50MG TABS

QUINAPRIL 10MG TABS

QUINAPRIL 40MG TABS

QUINAPRIL 5MG TABS

SPIRONOLACTONE 25MG TABS

SPIRONOLACTONE 50MG TABS

TERAZOSIN 10MG (TEN MG) CAPS

TERAZOSIN 1MG CAPS

TERAZOSIN 2MG CAPS

TERAZOSIN 5MG CAPS

TRANDOLAPRIL 1MG TABS

TRIAMTERENE 37.5MG/ HCTZ 25MG CAPS

VERAPAMIL 120MG TABS

WARFARIN SOD 10MG (TEN MG) TB WHITE

WARFARIN SOD 1MG TABS

WARFARIN SOD 2.5MG TABS (GREEN)

WARFARIN SOD 2MG TABS (PURPLE)

WARFARIN SOD 5MG TABS

WARFARIN SOD 7.5MG TABS (YELLOW)

$10

30

30

30

60

60

30

30

30

30

60

60

60

60

60

60

60

30

30

60

60

30

30

30

30

30

30

30

30

30

30

60

60

60

30

30

30

30

30

30

30

30

30

30

30

30

30

30

30

30

30

30

$20

90

90

90

180

180

90

90

90

90

180

180

180

180

180

180

180

90

90

180

180

90

90

90

90

90

90

90

90

90

90

180

180

180

90

90

90

90

90

90

90

90

90

90

90

90

90

90

90

90

90

90

AMLODIPINE BESYLATE 10MG TABS

DILTIAZEM 30MG TABS

DOXAZOSIN 1MG TABS

DOXAZOSIN 2MG TABS

DOXAZOSIN 4MG TABS

ENALAPRIL-HCTZ 5-12.5MG TABS

ENALAPRIL-HCTZ 10-25MG TABS

FOSINOPRIL 40MG TABS

FUROSEMIDE 10MG/ML ORAL SOLN 60ML

HYDROCHLOROTHIAZIDE 12.5MG TABS

INDAPAMIDE 1.25MG TABS

INDAPAMIDE 2.5MG TABS

METHYLDOPA 250MG TABS

QUINAPRIL 20MG TABS

RAMIPRIL 1.25MG CAPS

TORSEMIDE 10MG TABS

TORSEMIDE 20MG TABS

TORSEMIDE 5MG TABS

TRANDOLAPRIL 2MG TABS

TRANDOLAPRIL 4MG TABS

TRIAMTERENE 37.5MG/ HCTZ 25MG TABS

TRIAMTERENE 75MG/ HCTZ 50MG TABS

VERAPAMIL 40MG TABS

WARFARIN SOD 3MG TABS (TAN)

WARFARIN SOD 4MG TABS (BLUE)

WARFARIN SOD 6MG TAB (BLUISH GREEN)

Cholesterol

$15

30

60

30

30

30

60

30

30

90

30

30

30

60

30

30

30

30

30

30

30

30

30

60

30

30

30

$30

90

180

90

90

90

180

90

90

270

90

90

90

180

90

90

90

90

90

90

90

90

90

180

90

90

90

30 QTY 90 QTY

Tier 2

LOVASTATIN 10MG TABS

LOVASTATIN 20MG TABS

LOVASTATIN 40MG TABS

PRAVASTATIN 10MG TABS

SIMVASTATIN 10MG TABS

SIMVASTATIN 20MG TABS

SIMVASTATIN 5MG TABS

$10

30

30

30

30

30

30

30

$20

90

90

90

90

90

90

90

Tier 3

FENOFIBRATE 54MG TABS

PRAVASTATIN 20MG TABS

SIMVASTATIN 40MG TABS

SIMVASTATIN 80MG TABS

$15

30

30

30

30

$30

90

90

90

90

1

Value-priced medication list (cont.)

VALUE GENERICS (cont.)

Cough/Cold/Allergy

Tier 1

CHLORPHENIRAMINE 4MG TABS

LORATADINE 10MG TABS

PROMETHAZINE 25MG TABS

Tier 2

BENZONATATE 100MG CAPS

DIPHENHYDRAMINE 50MG CAPS

PROMETHAZINE 12.5MG TABS

PROMETHAZINE DM SYRUP

30 QTY 90 QTY

$7.50

100

30

12

$10

30

30

30

240

$15

300

90

36

$20

90

90

90

720

Tier 3

BENZONATATE 200MG CAPS

CETIRIZINE 1MG/ML SYRUP

$15

30

120

$30

90

360

FLUTICASONE 50MCG NAS SP(120SP) RX

16

120

30

48

360

90

PBM ALLERGY SYRUP

SUPRESS-DX PED DROPS 30ML

Diabetes

Tier 1

GLIMEPIRIDE 1MG TABS

GLIMEPIRIDE 2MG TABS

GLIPIZIDE 5MG TABS

GLYBURIDE 1.25MG TABS

METFORMIN 1000MG TABS

METFORMIN 500MG TABS

METFORMIN 850MG TABS

METFORMIN ER 500MG 24HR TABS

Tier 2

GLIMEPIRIDE 4MG TABS

GLIPIZIDE 10MG TABS

GLIPIZIDE ER 5MG TABS

GLYBURIDE 2.5MG TABS

GLYBURIDE 5MG TABS

GLYBURIDE MICRO 1.5MG TABS

GLYBURIDE/METFORMIN 1.25/250MG TABS

GLYBURIDE/METFORMIN 2.5/500MG TABS

Tier 3

GLIPIZIDE ER 10MG TABS

GLYBURIDE MICRO 3MG TABS

Ear/Eye Care

Tier 2

GENTAMICIN 0.3% OPHTH SOLUTION

POLYMYXIN-B/TRIMETHOPRIMOPHTH SOL

TIMOLOL MALEATE 0.25% OPHTH SOL 5ML

Tier 3

BACITRACIN/POLYMYX OPHTHOINT 3.5GM

TIMOLOL MALEATE 0.5% OPHTH SOLN 5ML

Gastrointestinal Health

Tier 1

METOCLOPRAMIDE HCL 5MG/5ML SOLN

30 QTY 90 QTY

$7.50

150

100

100

30

20

$15

450

300

300

90

60

Tier 2

AMOXICILLIN 125MG CHEWABLE TABS

AMOXICILLIN 250MG/5ML SUSP 150ML

AMOXICILLIN 250MG CAPS

CEPHALEXIN 250MG CAPS

PENICILLIN VK 250MG/5ML SOLN 100ML

$10

30

150

30

28

100

$20

90

450

90

84

300

SULFAMETH/TRIMETHOPRIM 800/160MG TABS

28

84

Tier 3

AMOX-CLAV 200MG/5ML SUSP 100ML

AMOXICILLIN 250MG CHEW TABS

AMOXICILLIN 500MG TABS

AMOXICILLIN 500MG CAPS

AMOXICILLIN 875MG TABS

CEFPROZIL 125MG/5ML SUSP 75ML

CEPHALEXIN 500MG CAPS

CIPROFLOXACIN 250MG TABS

CIPROFLOXACIN 500MG TABS

CIPROFLOXACIN 750MG TABS

CLINDAMYCIN 150MG CAPS

CLINDAMYCIN 300MG CAPS

METRONIDAZOLE 250MG TABS

METRONIDAZOLE 500MG TABS

PENICILLIN VK 125MG/5ML SOLN 200ML

$15

100

40

30

30

20

100

30

14

20

20

30

28

28

14

200

$30

300

120

90

90

60

300

90

42

60

60

90

84

84

42

600

$15

90

90

90

90

180

270

270

180

$10

30

60

30

30

30

30

$20

90

180

90

90

90

90

60

60

180

180

Mental Health

$30

90

90

Tier 1

AMITRIPTYLINE 10MG TABS

TRAZODONE 100MG TABS

$7.50

30

30

$15

90

90

Tier 2

AMITRIPTYLINE 25MG TABS

BENZTROPINE 0.5MG TABS

BENZTROPINE 2MG TABS

BUSPIRONE 10MG TABS

BUSPIRONE 5MG TABS

CITALOPRAM 10MG TABS

CITALOPRAM 20MG TABS

$10

30

30

30

60

60

30

30

$20

90

90

90

180

180

90

CITALOPRAM 40MG TABS

FLUOXETINE 10MG CAPS

FLUOXETINE 20MG CAPS

GABAPENTIN 100MG CAPS

HYDROXYZINE PAMOATE 25MG CAPS

LITHIUM CARBONATE 300MG CAPS

METHOCARBAMOL 500MG TABS

MIRTAZAPINE 15MG TABS

NORTRIPTYLINE 10MG CAPS

NORTRIPTYLINE 25MG CAPS

PAROXETINE 10MG TABS

PAROXETINE 20MG TABS

SERTRALINE 25MG TABS

TEMAZEPAM 15MG CAPS

30

30

30

90

90

90

30

30

30

30

30

30

30

30

30

30

$15

30

30

30 QTY 90 QTY

$10

$20

5

10

5

15

30

15

$15

3.5

5

$30

10.5

15

30 QTY 90 QTY

$15

180

Tier 2

DOC-Q-LACE 100MG CAPS

FAMOTIDINE 20MG TABS

METOCLOPRAMIDE 10MG TABS

METOCLOPRAMIDE 5MG TABS

$10

60

60

60

60

$20

180

180

180

180

Tier 3

DICYCLOMINE 10MG CAPS

DICYCLOMINE 20MG TABS

FAMOTIDINE 40MG TABS

$15

90

60

30

$30

270

180

90

Tier 2

ALLOPURINOL 100MG TABS

Tier 3

ALLOPURINOL 300MG TABS

30 QTY 90 QTY

Tier 1

AMOXICILLIN 125MG/5ML SUSP 150ML

AMOXICILLIN 200MG/5ML SUSP 100ML

AMOXICILLIN 400MG/5ML SUSP 100ML

PENICILLIN VK 250MG TABS

PENICILLIN VK 500MG TABS

$7.50

30

30

30

30

60

90

90

60

$7.50

60

Gout

Infections

30 QTY 90 QTY

$10

60

$15

60

$20

180

$30

180

Medical Devices

Tier 3

PROCHAMBER AERO SPACER

TRAZODONE 150MG (HUNDRED-FIFTY) TAB

TRAZODONE 50MG TABS

30 QTY 90 QTY

$15

1

$30

3

30 QTY 90 QTY

90

90

90

90

270

270

270

90

90

90

90

90

90

90

90

90

90

Mental Health (cont.)

Tier 3

AMITRIPTYLINE 50MG TABS

BENZTROPINE 1MG TABS

CHLORDIAZEPOXIDE 10MG CAPS

CHLORDIAZEPOXIDE 25MG CAPS

DOXEPIN 10MG CAPS

DOXEPIN 25MG CAPS

FLUOXETINE 40MG CAPS

FLUVOXAMINE 25MG TABS

HALOPERIDOL 1MG TABS

HYDROXYZINE HCL 50MG TABS

IMIPRAMINE 10MG TABS

IMIPRAMINE 25MG TABS

IMIPRAMINE 50MG TABS

LITHIUM CARBONATE 150MG CAPS

LITHIUM CARBONATE 300MG TABS

LITHIUM CARBONATE 600MG CAPS

METHOCARBAMOL 750MG TABS

NORTRIPTYLINE 75MG CAPS

PAROXETINE 30MG TABS

PRAMIPEXOLE 0.25MG TABS

PRIMIDONE 50MG TABS

PROCHLORPERAZINE 5MG TABS

SERTRALINE 100MG TABS

SERTRALINE 50MG TABS

TRIHEXYPHENIDYL 2MG TABS

Mouth/Throat/Dental

30 QTY 90 QTY

$15

30

60

60

60

30

30

30

30

30

30

60

60

30

60

60

60

60

30

30

30

60

30

30

30

60

$30

90

180

180

180

90

90

90

90

90

90

180

180

90

180

180

180

180

90

90

90

180

90

90

90

180

30 QTY 90 QTY

Tier 2

CHLORHEXIDINE 0.12% ORAL RINSE

$10

473

$20

1419

Tier 3

LIDOCAINE 2% VISC ORAL SOLUTION

SF 5000 PLUS 1.1% CREAM 51GM

STANNOUS FLUORIDE 0.63% RINSE

$15

100

60

300

$30

300

180

900

Skin Conditions

30 QTY 90 QTY

Tier 1

TRIAMCINOLONE 0.025% CREAM 80GM

$7.50

15

$15

45

Tier 2

HYDROCORTISONE 1% CREAM 28.35GM

$10

30

$20

90

HYDROCORTISONE 1% OINTMENT 28.35GM

30

30

60

18

90

$15

60

60

15

80

15

18

90

90

180

54

270

$30

180

180

45

240

45

54

HYDROCORTISONE 2.5% CREAM 30GM

HYDROCORTISONE 2.5% OINT 28.35GM

SELENIUM SULFIDE 2.5% SHAMPOO(LOTN)

TRIAMCINOLONE 0.1% CREAM 80GM

Tier 3

BENZOYL PEROXIDE 2.5% GEL 60GM

BENZOYL PEROXIDE 5% AQ GEL 60GM

NYSTATIN OINTMENT 15GM

TRIAMCINOLONE 0.1% OINTMENT 80GM

TRIAMCINOLONE 0.5% CREAM 15GM

UREA 50% NAIL GEL 18ML

Thyroid Conditions

Tier 2

LEVOTHYROXINE 0.025MG (25MCG) TABS

METHIMAZOLE 5MG TABS

Tier 3

LEVOTHROID 0.05MG TABS (REFORM)

LEVOTHYROXINE 0.075MG (75MCG) TABS

LEVOTHYROXINE 0.100MG (100MCG) TABS

LEVOTHYROXINE 0.137MG (137MCG) TABS

LEVOTHYROXINE 0.150MG (150MCG) TABS

LEVOTHYROXINE SOD 0.088MG(88MCG) TABS

LEVOTHYROXINE SOD 0.112MG(112MCG) TABS

LEVOTHYROXINE SOD 0.125MG(125MCG) TABS

METHIMAZOLE 10MG TABS

30 QTY 90 QTY

$10

$20

30

30

90

90

$15

30

30

30

30

30

30

30

30

30

$30

90

90

90

90

90

90

90

90

90

2

Value-priced medication list (cont.)

VALUE GENERICS (cont.)

Vitamins and Nutritional Health

Tier 1

FLUORIDE 0.5MG F CHEWABLE TABS

FOLIC ACID 1MG TABS

VIT D 50,000 IU D2 (ERGO) CAPS (RX)

VITAMIN B-12 100MCG TABS

30 QTY 90 QTY

$7.50

30

30

4

100

$15

90

90

12

300

Tier 2

HEMATINIC/ FA TABS

MULTIVIT/F 0.25MG CHEWABLE TABS

MULTI-VITA-F 0.5MG CHEW TABS

$10

30

30

30

$20

90

90

90

MULTIVITAMINS W/ FL 1.0MG CHEW TABS

POLY-IRON 150 FORTE CAPS

POTASSIUM CL MICRO 10MEQ ER TABS

RENA-VITE RX TABS

VINATE ONE TABS

30

45

30

30

30

90

135

90

90

90

Tier 3

FE C PLUS TABS

HEMATINIC PLUS TABS

POLY-IRON 150 CAPS

POTASSIUM CL 10MEQ ER TABS

PRENATAL PLUS TABS

TL GARD RX TABS

VINATE AZ TABS

VIRT-CAPS CAPS

VIRT-VITE TABS

$15

30

30

60

30

30

30

30

30

30

$30

90

90

180

90

90

90

90

90

90

Women¡¯s Health

Tier 1

ESTRADIOL 0.5MG TABS

ESTRADIOL 1MG TABS

ESTRADIOL 2MG TABS

MEDROXYPROGESTERONE 10MG TABS

MEDROXYPROGESTERONE 5MG TABS

30 QTY 90 QTY

$7.50

30

30

30

10

30

$15

90

90

90

30

90

$10

5

$20

15

MEDROXYPROGESTERONE 2.5MG TABS WHITE

30

90

Tier 3

ALENDRONATE 10MG TABS

ALENDRONATE 35MG TABS

ALENDRONATE 70MG TABS

ESTARYLLA TABS 28S

MEGESTROL ACETATE 20MG TABS

$15

30

4

4

29

60

$30

90

12

12

87

180

Tier 2

CLOMIPHENE CITRATE 50MG TABS

Other

30 QTY 90 QTY

Tier 2

DEXAMETHASONE 0.5MG TABS

DEXAMETHASONE 0.75MG TABS

FINASTERIDE 5MG TABS

$10

60

12

30

$20

180

36

90

GENERLAC 10GM/15ML ORAL/RECTAL SOL

PREDNISONE 2.5MG TABS

PREDNISONE 5MG TABS

237

237

30

60

30

711

711

90

180

90

Tier 3

DEXAMETHASONE 1MG TABS

ISONIAZID 100MG TABS

PREDNISONE 1MG TABS

PREDNISONE 2.5MG TABS

$15

30

100

90

60

$30

90

300

270

180

LACTULOSE 10GM/15ML SOLUTION

PREDNISOLONE SOD PHOS 15MG/5ML SOL

*List of drugs is not all-inclusive. Ask your Walgreens pharmacist if your medication is a value-priced generic.

?The day supply is based on the average quantity dispensed for the specific drug and strength as indicated in the list. Larger quantities cost more.

Drug names are the property of their respective owners.

Program participants can save on retail prices for prescriptions purchased from participating Walgreens stores via the Walgreens

Prescription Savings Club program. Cannot be combined with any form of insurance or other pharmacy benefit program. Actual savings will vary.

For details, see RxSavingsClub.

Walgreens Prescription Savings Club Program (¡°Program¡±) is NOT Insurance. Membership fee required ($20 individual or $35 family per year) and

must be paid at a participating Walgreens or Duane Reade store located in the United States, excluding stores in Connecticut, Massachusetts,

Mississippi and Washington (each a ¡°Provider¡±). Program offers Members the right to purchase specified healthcare items or services from Providers

at a discounted rate. Amount of the discount may vary based on type of item/service Member purchases, but Providers will not charge the Member

more than the discounted rate. The Program does not make any payments to Providers. Member is entirely responsible for paying discounted price

to the Provider at time of service. Membership may be canceled within 30 days of the enrollment effective date for a full refund. To request: (i) a list

of participating Providers (name, city, state) and/or (ii) the full terms and conditions of the Program before joining, call 866-922-7312 or visit

RxSavingsClub. WAGDCO, LLC, 104 Wilmot Rd., Deerfield, IL 60015 is a discount medical plan organization regulated by

State Insurance Commissioners.

3538980-9443 | ?2023 Walgreen Co. All rights reserved. Revised: 9/29/23

3

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