Mental 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 |
| AMITRIPTYLINE 10MG | ELAVIL® | 30 | TABLET |
| AMITRIPTYLINE 25MG | ELAVIL® | 30 | TABLET |
| AMITRIPTYLINE 50MG | ELAVIL® | 30 | TABLET |
| AMITRIPTYLINE 75MG | ELAVIL® | 30 | TABLET |
| AMITRIPTYLINE 100MG | ELAVIL® | 30 | TABLET |
| BENZTROPINE 0.5MG | COGENTIN® | 60 | TABLET |
| BENZTROPINE 1MG | COGENTIN® | 60 | TABLET |
| BENZTROPINE 2MG | COGENTIN® | 30 | TABLET |
| BUSPIRONE 5MG | BUSPAR® | 60 | TABLET |
| BUSPIRONE 10MG | BUSPAR® | 60 | TABLET |
| BUSPIRONE 15MG | BUSPAR® | 30 | TABLET |
| † CARBAMAZEPINE CHEWABLE 100MG | TEGRETOL® | 60 | TABLET |
| CARBAMAZAPINE 200MG | TEGRETOL® | 60 | TABLET |
| CITALOPRAM 20MG | CELEXA® | 30 | TABLET |
| CITALOPRAM 40MG | CELEXA® | 30 | TABLET |
| CITALOPRAM HBR 10MG | CELEXA® | 30 | TABLET |
| DOXEPIN HCL 10MG | SINEQUAN® | 30 | CAPSULE |
| DOXEPIN HCL 25MG | SINEQUAN® | 30 | CAPSULE |
| DOXEPIN HCL 50MG | SINEQUAN® | 30 | CAPSULE |
| DOXEPIN HCL 75MG | SINEQUAN® | 30 | CAPSULE |
| DOXEPIN HCL 100MG | SINEQUAN® | 30 | CAPSULE |
| FLUOXETINE 10MG | PROZAC® | 30 | TABLET |
| FLUOXETINE 10MG | PROZAC® | 30 | CAPSULE |
| FLUOXETINE 20MG | PROZAC® | 30 | CAPSULE |
| *† FLUOXETINE 40MG | PROZAC® | 30 | CAPSULE |
| FLUPHENAZINE 1MG | PROLIXIN® | 30 | TABLET |
| † GABAPENTIN 100MG | NEURONTIN® | 90 | CAPSULE |
| HALOPERIDOL 0.5MG | HALDOL® | 30 | TABLET |
| HALOPERIDOL 1MG | HALDOL® | 30 | TABLET |
| HALOPERIDOL 2MG | HALDOL® | 30 | TABLET |
| HALOPERIDOL 5MG | HALDOL® | 30 | TABLET |
| *† HYDROXYZINE HCL 10MG/5ML | ATARAX® | 120 | SYRUP |
| HYDROXYZINE PAMOATE 25MG | VISTARIL® | 30 | CAPSULE |
| HYDROXYZINE PAMOATE 50MG | VISTARIL® | 30 | CAPSULE |
| LITHIUM CARBONATE 300MG | ESKALITH® | 90 | CAPSULE |
| NORTRIPTYLIN 10MG | PAMELOR® | 30 | CAPSULE |
| NORTRIPTYLIN 25MG | PAMELOR® | 30 | CAPSULE |
| NORTRIPTYLIN 50MG | PAMELOR® | 30 | CAPSULE |
| NORTRIPTYLIN 75MG | PAMELOR® | 30 | CAPSULE |
| *† PAROXETINE 10MG | PAXIL® | 30 | TABLET |
| *† PAROXETINE 20mg | PAXIL® | 30 | TABLET |
| PROCHLORPERAZINE 5MG | COMPAZINE® | 30 | TABLET |
| PROCHLORPERAZINE 10MG | COMPAZINE® | 30 | TABLET |
| † THIORIDAZINE 25MG | MELLARIL® | 30 | TABLET |
| *† THIORIDAZINE 50MG | MELLARIL® | 30 | TABLET |
| THIOTHIXENE 2MG | NAVANE® | 30 | CAPSULE |
| TRAZODONE 50MG | DESYREL® | 30 | TABLET |
| TRAZODONE 100MG | DESYREL® | 30 | TABLET |
| TRAZODONE 150MG | DESYREL® | 30 | TABLET |
| TRIHEXYPHENIDYL 2MG | ARTANE® | 60 | TABLET |
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