Thyroid
*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 |
| LEVOTHYROXINE 25MCG | SYNTHROID® | 30 | TABLET |
| LEVOTHYROXINE 50MCG | SYNTHROID® | 30 | TABLET |
| † LEVOTHYROXINE 75MCG | SYNTHROID® | 30 | TABLET |
| † LEVOTHYROXINE 88MCG | SYNTHROID® | 30 | TABLET |
| † LEVOTHYROXINE 100MCG | SYNTHROID® | 30 | TABLET |
| *† LEVOTHYROXINE 112MCG | SYNTHROID® | 30 | TABLET |
| *† LEVOTHYROXINE 125MCG | SYNTHROID® | 30 | TABLET |
| *† LEVOTHYROXINE 137MCG | SYNTHROID® | 30 | TABLET |
| *† LEVOTHYROXINE 150MCG | SYNTHROID® | 30 | TABLET |
| *† LEVOTHYROXINE 175MCG | SYNTHROID® | 30 | TABLET |
| *† LEVOTHYROXINE 200MCG | SYNTHROID® | 30 | TABLET |
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