| Medication Name |
Avg. Market Price |
Avg. Cost Member |
Avg. Cost for the Plan |
| AKATINOL 10MG TABL-ORAL\\MEMANTINE HCL |
$ 0.70 |
$ 0.12 |
$ 0.44 |
| ALDACTONE 25MG TABL-ORAL\\SPIRONOLACTONE |
$ 0.69 |
$ 0.11 |
$ 0.44 |
| APROVEL 150MG TABL-ORAL\\IRBESARTAN |
$ 2.20 |
$ 0.39 |
$ 1.37 |
| APROVEL 300MG TABL-ORAL\\IRBESARTAN (FA) |
$ 1.68 |
$ 0.49 |
$ 0.85 |
| CELEBRA 200MG CAPS-ORAL\\CELECOXIB |
$ 2.50 |
$ 0.41 |
$ 1.59 |
| CILOSTAL 100MG TABL-ORAL\\CILOSTAZOL |
$ 1.60 |
$ 0.26 |
$ 1.02 |
| CO-APROVEL\\ IRBERSARTAN HIDROCLOROTIAZIDA 300/12.5MG |
$ 1.80 |
$ 0.54 |
$ 0.90 |
| CO-APROVEL\\ IRBERSARTAN HIDROCLOROTIAZIDA 300/25MG |
$ 1.79 |
$ 0.52 |
$ 0.91 |
| CONCOR 5MG TABL-ORAL\\BISOPROLOL FUMARATE |
$ 1.87 |
$ 0.29 |
$ 1.21 |
| CONTROLIP 160MG CAPS-ORAL\\FENOFIBRATE |
$ 1.68 |
$ 0.28 |
$ 1.06 |
| CORDARONE 200MG TABL-ORAL\\AMIODARONE HCL |
$ 0.66 |
$ 0.11 |
$ 0.42 |
| COREG 6.25MG TABL-ORAL\\CARVEDILOL |
$ 0.73 |
$ 0.12 |
$ 0.47 |
| CRESTOR 10MG TABL-ORAL\\ROSUVASTATIN CALCIUM |
$ 1.71 |
$ 0.49 |
$ 0.89 |
| CRESTOR 20MG TABL-ORAL\\ROSUVASTATIN CALCIUM |
$ 2.71 |
$ 0.76 |
$ 1.41 |
| DILANTIN 100MG CAPS-ORAL\\PHENYTOIN SODIUM |
$ 0.25 |
$ 0.04 |
$ 0.16 |
| DUODART 0.5MG; 0.4MG \\ DUTASTERIDE AND TAMSULOSIN HYDROCHLORIDE |
$ 2.40 |
$ 0.39 |
$ 1.53 |
| ELIQUIS 5 MG TABLET-ORAL \\ APIXABAN |
$ 1.86 |
$ 0.30 |
$ 1.18 |
| EUTIROX 100mcg TABL-ORAL\\LEVOTHYROXINE SODIUM |
$ 0.34 |
$ 0.06 |
$ 0.22 |
| EUTIROX 50mcg TABL-ORAL\\LEVOTHYROXINE SODIUM |
$ 0.18 |
$ 0.03 |
$ 0.12 |
| EUTIROX 75mcg TABL-ORAL\\LEVOTHYROXINE SODIUM |
$ 0.26 |
$ 0.04 |
$ 0.17 |
| EXELON PATCH-TOPIC\\RIVASTIGMINE TARTRATE |
$ 6.42 |
$ 1.04 |
$ 4.10 |
| EXFORGE 10/320/25MG \\ AMLODIPINE BESYLATE HCT |
$ 2.16 |
$ 0.63 |
$ 1.09 |
| EXFORGE 10/320MG \\ AMLODIPINE BESYLATE |
$ 2.04 |
$ 0.60 |
$ 1.04 |
| EXFORGE 5/320MG \\ AMLODIPINE BESYLATE |
$ 2.05 |
$ 0.60 |
$ 1.04 |
| GABAPENTIN 300MG CAPS-ORAL |
$ 1.10 |
$ 0.18 |
$ 0.70 |
| ISOPTIN 120MG TABL-ORAL\\VERAPAMIL HCL |
$ 1.10 |
$ 0.18 |
$ 0.70 |
| KEPPRA 1GM TABL-ORAL\\LEVETIRACETAM |
$ 3.31 |
$ 0.54 |
$ 2.11 |
| KEPPRA 500MG TABL-ORAL\\LEVETIRACETAM |
$ 1.63 |
$ 0.27 |
$ 1.03 |
| LAMICTAL 100MG TABL-ORAL\\LAMOTRIGINE |
$ 2.89 |
$ 0.47 |
$ 1.85 |
| LASIX 40MG TABL-ORAL\\FUROSEMIDE (FA) |
$ 0.47 |
$ 0.14 |
$ 0.24 |
| LIPITOR 10MG TABL-ORAL\\ATORVASTATIN CALCIUM |
$ 1.44 |
$ 0.42 |
$ 0.73 |
| LIPITOR 20MG TABL-ORAL\\ATORVASTATIN CALCIUM |
$ 2.45 |
$ 0.70 |
$ 1.26 |
| LISINOPRIL 20MG TABL-ORAL |
$ 0.51 |
$ 0.08 |
$ 0.32 |
| NATRILIX SR´ 1.5MG TABL-ORAL\\INDAPAMIDE |
$ 0.77 |
$ 0.13 |
$ 0.49 |
| NEBILET 5MG TABL-ORAL\\NEBIVOLOL HCL |
$ 1.76 |
$ 0.28 |
$ 1.12 |
| NEURONTIN 300MG CAPS-ORAL\\GABAPENTIN |
$ 1.69 |
$ 0.27 |
$ 1.08 |
| NEXIUM 20MG CAPS-ORAL\\ESOMEPRAZOLE MAGNESIUM |
$ 1.84 |
$ 0.52 |
$ 0.95 |
| NEXIUM 40MG CAPS-ORAL\\ESOMEPRAZOLE MAGNESIUM |
$ 2.61 |
$ 0.76 |
$ 1.33 |
| NORVASC \\ AMOLODIPINE 5MG |
$ 0.88 |
$ 0.25 |
$ 0.45 |
| OMEPRAZOLE 20MG TABL-ORAL |
$ 0.87 |
$ 0.18 |
$ 0.51 |
| PLAVIX 75 MG TABL-ORAL\\CLOPIDOGREL BISULFATE |
$ 3.55 |
$ 1.03 |
$ 1.81 |
| SINEMET 25*250MG TABL-ORAL\\CARBIDOPA+LEVODOPA |
$ 1.28 |
$ 0.21 |
$ 0.81 |
| TAFIL 0.5MG TABL-ORAL\\ALPRAZOLAM |
$ 0.48 |
$ 0.08 |
$ 0.30 |
| TAMSULOSIN 0.4MG CAP |
$ 1.55 |
$ 0.25 |
$ 0.99 |
| TENORMIN 100MG TABL-ORAL\\ATENOLOL |
$ 0.72 |
$ 0.21 |
$ 0.37 |
| TORSEMIDE 10MG TABL-ORAL |
$ 0.62 |
$ 0.10 |
$ 0.40 |
| TRAMACET 37.5*325MG TABL-ORAL\\TRAMADOL HCL+ACETAMINOPHEN |
$ 2.22 |
$ 0.36 |
$ 1.42 |