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 2MG

COGENTIN®

30

TABLET

BUSPIRONE 5MG

BUSPAR®

60

TABLET

*† BUSPIRONE 10MG

BUSPAR®

60

TABLET

CARBAMAZAPINE 200MG

TEGRETOL®

60

TABLET

CITALOPRAM 20MG

CELEXA®

30

TABLET

CITALOPRAM 40MG

CELEXA®

30

TABLET

FLUOXETINE 10MG

PROZAC®

30

TABLET

FLUOXETINE 10MG

PROZAC®

30

CAPSULE

FLUOXETINE 20MG

PROZAC®

30

CAPSULE

*† FLUOXETINE 40MG

PROZAC®

30

CAPSULE

HALOPERIDOL 0.5MG

HALDOL®

30

TABLET

HALOPERIDOL 1MG

HALDOL®

30

TABLET

HALOPERIDOL 2MG

HALDOL®

30

TABLET

LITHIUM CARBONATE 300MG

ESKALITH®

90

CAPSULE

NORTRIPTYLIN 10MG

PAMELOR®

30

CAPSULE

*† PAROXETINE 10MG

PAXIL®

30

TABLET

*† PAROXETINE 20mg

PAXIL®

30

TABLET

PROCHLORPERAZINE 10MG

COMPAZINE®

30

TABLET

TRAZODONE 50MG

DESYREL®

30

TABLET

TRAZODONE 100MG

DESYREL®

30

TABLET

TRAZODONE 150MG

DESYREL®

30

TABLET

TRIHEXYPHENIDYL 2MG

ARTANE®

60

TABLET


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