Gastrointestinal Health

*Due to state laws, these drugs are not covered under the 30-day program in MN and WI; however, they have been competitively priced. Please ask your pharmacist for specific pricing in these states.

†Due to state laws, these drugs are not covered under the 90-day program in MN and WI; however, they have been competitively priced. Please ask your pharmacist for specific pricing in these states.

$4 prescriptions are for up to a 30-day supply at commonly prescribed dosages. List subject to change.

GENERIC NAME

BRAND NAME

QTY

FORM

DICYCLOMINE 10MG

BENTYL®

90

CAPSULE

DICYCLOMINE 20MG

BENTYL®

60

TABLET

FAMOTIDINE 20MG

PEPCID®

60

TABLET

LACTULOSE 10GM/15ML

CHRONULAC®

240

SYRUP

METOCLOPRAMIDE 5MG/5ML

REGLAN®

60

SYRUP

METOCLOPRAMIDE 10MG

REGLAN®

60

TABLET

PHENAZOPYRIDINE 100MG

PYRIDIUM®

6

TABLET

PROMETHAZINE 25MG

PHENERGAN®

12

TABLET

SODIUM CITRATE/CITRIC ACID

BICITRA®

180

SOLUTION


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