Other
*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 |
| CHLORHEXIDINE GLUCONATE 0.12% | PERIDEX® | 473 | SOLUTION |
| HEMORRHOIDAL-HC 25MG | ANUSOL-HC® | 12 | SUPPOSITORY |
| LIDOCAINE VISCOUS 2% | XYLOCAINE® | 100 | SOLUTION |
| METHYLPREDNISOLONE 4MG | MEDROL® | 21 | TABLET |
| METHYLPREDNISOLONE DOSEPAK 4MG | MEDROL® | 21 | TABLET |
| *† PREDNISOLONE 15MG/5ML | ORAPRED® | 50 | SOLUTION |
| † PREDNISOLONE ACETATE 1% | PRED FORTE® | 5 | DROP |
| PREDNISONE 2.5MG | DELTASONE® | 30 | TABLET |
| PREDNISONE 5MG | DELTASONE® | 30 | TABLET |
| PREDNISONE 10MG | DELTASONE® | 30 | TABLET |
| PREDNISONE 20MG | DELTASONE® | 30 | TABLET |
| PREDNISONE DOSEPACK 5MG | STERAPRED® | 21 | TABLET |
| *† PREDNISONE DOSEPACK 5MG | STERAPRED® | 48 | TABLET |
| *† PREDNISONE DOSEPACK 10MG | STERAPRED DS® | 21 | TABLET |
| *† PREDNISONE DOSEPACK 10MG | STERAPRED DS® | 48 | TABLET |
| † SODIUM FLUORIDE 1.10% | ETHEDENT® | 56 | GEL |
| SODIUM FLUORIDE DENTAL 5000 | PREVIDENT PLS 5000® | 51 | CREAM |
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