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

LIDOCAINE VISCOUS 2%

XYLOCAINE®

 100

SOLUTION

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

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