1
Blood Pressure/Heart Health (cont.)
30 QTY 90 QTY
Tier 3
$15 $30
AMLODIPINE BESYLATE 10MG TABS 30 90
DILTIAZEM 30MG TABS 60 180
DOXAZOSIN 1MG TABS 30 90
DOXAZOSIN 2MG TABS 30 90
DOXAZOSIN 4MG TABS 30 90
60 180
30 90
FOSINOPRIL 40MG TABS 30 90
FUROSEMIDE 10MG/ML ORAL SOLN 60ML
90 270
30 90
30 90
30 90
60 180
QUINAPRIL 20MG TABS 30 90
30 90
TORSEMIDE 10MG TABS 30 90
TORSEMIDE 20MG TABS 30 90
30 90
TRANDOLAPRIL 2MG TABS 30 90
TRANDOLAPRIL 4MG TABS 30 90
30 90
30 90
VERAPAMIL 40MG TABS 60 180
30 90
30 90
30 90
Cholesterol 30 QTY 90 QTY
Tier 2 $10 $20
LOVASTATIN 10MG TABS 30 90
LOVASTATIN 20MG TABS 30 90
LOVASTATIN 40MG TABS 30 90
PRAVASTATIN 10MG TABS 30 90
SIMVASTATIN 10MG TABS 30 90
SIMVASTATIN 20MG TABS 30 90
30 90
Tier 3 $15 $30
30 90
PRAVASTATIN 20MG TABS 30 90
SIMVASTATIN 40MG TABS 30 90
SIMVASTATIN 80MG TABS 30 90
Blood Pressure/Heart Health (cont.)
30 QTY 90 QTY
Tier 2
$10 $20
AMIODARONE 200MG TABS 30 90
30 90
30 90
60 180
60 180
BENAZEPRIL 10MG TABS 30 90
BENAZEPRIL 20MG TABS 30 90
BENAZEPRIL 40MG TABS 30 90
30 90
60 180
60 180
60 180
60 180
60 180
60 180
60 180
FOSINOPRIL 10MG TABS 30 90
FOSINOPRIL 20MG TABS 30 90
FUROSEMIDE 20MG TABS 60 180
60 180
30 90
ISOSORBIDE MONONITRATE 30MG ER TABS
30 90
ISOSORBIDE MONONITRATE 60MG ER TABS
30 90
30 90
LISINOPRIL 30MG TABS 30 90
LISINOPRIL 40MG TABS 30 90
30 90
30 90
30 90
30 90
METOPROLOL TARTRATE 100MG TABS 60 180
60 180
60 180
QUINAPRIL 10MG TABS 30 90
QUINAPRIL 40MG TABS 30 90
30 90
30 90
30 90
30 90
30 90
30 90
30 90
TRANDOLAPRIL 1MG TABS 30 90
30 90
VERAPAMIL 120MG TABS 30 90
30 90
WARFARIN SOD 1MG TABS 30 90
30 90
30 90
30 90
30 90
VALUE GENERICS
Antifungal
30 QTY 90 QTY
Tier 2 $10 $20
1 3
Tier 3 $15 $30
30 90
Antiviral
30 QTY 90 QTY
Tier 3 $15 $30
60 180
Arthritis or Pain
30 QTY 90 QTY
Tier 2 $10 $20
30 90
30 90
120 360
IBUPROFEN 400MG TABS 90 270
30 90
30 90
30 90
60 180
60 180
Tier 3 $15 $30
30 90
IBUPROFEN 800MG TABS 60 180
60 180
60 180
Asthma
30 QTY 90 QTY
Tier 2 $10 $20
Blood Pressure/Heart Health
30 QTY 90 QTY
Tier 1 $7.50 $15
ATENOLOL 100MG TABS 30 90
FUROSEMIDE 40MG TABS 60 180
FUROSEMIDE 80MG TABS 30 90
30 90
30 90
30 90
LISINOPRIL 10MG TABS 30 90
LISINOPRIL 20MG TABS 30 90
VERAPAMIL 80MG TABS 30 90
Supply Tier 1 Tier 2 Tier 3
30-day supply
$10
90-day supply
$20 $30
Rev. 09/29/23
The price for a generic drug is based on its tier
†
In addition to discounts on thousands of
brand-name and most generic medications,
members get even more savings on three
*
Value-priced medication list
Prescription
Savings Club
2
Value-priced medication list (cont.)
Mental Health (cont.)
30 QTY 90 QTY
Tier 3 $15 $30
30 90
BENZTROPINE 1MG TABS 60 180
60 180
60 180
30 90
30 90
30 90
30 90
30 90
30 90
IMIPRAMINE 10MG TABS 60 180
60 180
30 90
60 180
60 180
60 180
60 180
30 90
PAROXETINE 30MG TABS 30 90
30 90
60 180
30 90
SERTRALINE 100MG TABS 30 90
30 90
60 180
Mouth/Throat/Dental
30 QTY 90 QTY
Tier 2 $10 $20
473 1419
Tier 3 $15 $30
100 300
60 180
300 900
Skin Conditions
30 QTY 90 QTY
Tier 1 $7.50 $15
Tier 2 $10 $20
30 90
30 90
30 90
60 180
18
90 270
Tier 3 $15 $30
60 180
60 180
80 240
18
Thyroid Conditions
30 QTY 90 QTY
Tier 2 $10 $20
30 90
30 90
Tier 3 $15 $30
30 90
30 90
30 90
30 90
30 90
30 90
30 90
30 90
30 90
Infections
30 QTY 90 QTY
Tier 1 $7.50 $15
100 300
100 300
30 90
20 60
Tier 2 $10 $20
30 90
30 90
28 84
100 300
28 84
Tier 3 $15 $30
100 300
40 120
30 90
30 90
20 60
100 300
30 90
14 42
20 60
20 60
30 90
28 84
28 84
14 42
200 600
Medical Devices
30 QTY 90 QTY
Tier 3 $15 $30
PROCHAMBER AERO SPACER 1 3
Mental Health
30 QTY 90 QTY
Tier 1 $7.50 $15
AMITRIPTYLINE 10MG TABS 30 90
TRAZODONE 100MG TABS 30 90
Tier 2 $10 $20
30 90
30 90
BENZTROPINE 2MG TABS 30 90
BUSPIRONE 10MG TABS 60 180
60 180
30 90
30
90
30 90
30 90
30 90
90 270
90 270
90 270
30 90
30 90
30 90
30 90
PAROXETINE 10MG TABS 30 90
PAROXETINE 20MG TABS 30 90
30 90
30 90
30 90
30 90
VALUE GENERICS (cont.)
Cough/Cold/Allergy
30 QTY 90 QTY
Tier 1 $7.50 $15
100 300
LORATADINE 10MG TABS 30 90
12 36
Tier 2 $10 $20
30 90
30 90
30 90
240 720
Tier 3 $15 $30
30 90
120 360
16 48
PBM ALLERGY SYRUP 120 360
30 90
Diabetes
30 QTY 90 QTY
Tier 1 $7.50 $15
GLIMEPIRIDE 1MG TABS 30 90
GLIMEPIRIDE 2MG TABS 30 90
30 90
30 90
METFORMIN 1000MG TABS 60 180
90 270
90 270
60 180
Tier 2 $10 $20
GLIMEPIRIDE 4MG TABS 30 90
GLIPIZIDE 10MG TABS 60 180
30 90
30 90
30 90
30 90
60 180
60 180
Tier 3 $15 $30
GLIPIZIDE ER 10MG TABS 30 90
30 90
Ear/Eye Care
30 QTY 90 QTY
Tier 2 $10 $20
10 30
Tier 3 $15 $30
Gastrointestinal Health 30 QTY 90 QTY
Tier 1 $7.50 $15
60 180
Tier 2 $10 $20
60 180
FAMOTIDINE 20MG TABS 60 180
60 180
60 180
Tier 3 $15 $30
90 270
60 180
FAMOTIDINE 40MG TABS 30 90
Gout
30 QTY 90 QTY
Tier 2 $10 $20
ALLOPURINOL 100MG TABS 60 180
Tier 3 $15 $30
ALLOPURINOL 300MG TABS 60 180
3
Value-priced medication list (cont.)
Women’s Health
30 QTY 90 QTY
Tier 1 $7.50 $15
30 90
ESTRADIOL 1MG TABS 30 90
ESTRADIOL 2MG TABS 30 90
MEDROXYPROGESTERONE 10MG TABS 10 30
30 90
Tier 2 $10 $20
30 90
Tier 3 $15 $30
ALENDRONATE 10MG TABS 30 90
4 12
ALENDRONATE 70MG TABS 4 12
ESTARYLLA TABS 28S 29 87
60 180
VALUE GENERICS (cont.)
Vitamins and Nutritional Health
30 QTY 90 QTY
Tier 1 $7.50 $15
30 90
30 90
4 12
100 300
Tier 2 $10 $20
30 90
30 90
30 90
30 90
30 90
30 90
VINATE ONE TABS 30 90
Tier 3 $15 $30
30 90
30 90
60 180
30 90
PRENATAL PLUS TABS 30 90
TL GARD RX TABS 30 90
VINATE AZ TABS 30 90
30 90
30 90
Other
30 QTY 90 QTY
Tier 2 $10 $20
60 180
12 36
30 90
237 711
237 711
30 90
60 180
30 90
Tier 3 $15 $30
30 90
ISONIAZID 100MG TABS 100 300
PREDNISONE 1MG TABS 90 270
60 180
Program participants can save on retail prices for prescriptions purchased from participating Walgreens stores via the Walgreens
