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This program is designed to educate you on the use of generic and other low cost brand name drugs. This program is designed to help you find drugs within the same therapeutic class as a drug you may currently be taking. Most of all, this program is designed to save you money on your prescription drug costs.

Tiers indicate retail pharmacy pricing and position. Drug quantities listed must be adhered to in order to receive tier pricing at participating retail network pharmacies. Any change in quantity may result in higher prices. Company cannot be responsible for changes in network pharmacies which accept this program.

Drug pricing is based on the quantity indicated. This may or may not be a 30 day supply based on how your Doctor prescribed your dosage. Quantities greater than those listed will result in a higher member cost.

* Pricing is subject to change without notice.
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First Tier
Drug NameRetail QtyRetail
O-CAL TAB PRENATAL30$7.35
Ondansetron HCl Inj 2 MG/ML10$7.69
Ophthalmic Irrigation Solution18$7.85
ORAMAGICRX SUS60$8.69
ORASEP SOL30$9.71
Orphenadrine Citrate Tab CR 100 MG30$6.15
OTIX DROPS SOL1$6.80
Oxacillin Sodium For Soln 250 MG/5ML100$7.13
Oxaprozin Tab 600 MG30$9.44
Oxybutynin Chloride Tab 5 MG30$5.47
Oxycodone HCl Cap 5 MG30$7.20
Oxycodone HCl Tab 5 MG30$6.72
Oxycodone HCl Tab 5 MG30$6.72
Oxycodone HCl Tab 5 MG30$6.72
Oxycodone w/ Acetaminophen Cap 5-500 MG30$7.83
Oxycodone w/ Acetaminophen Tab 5-325 MG30$7.94
Oxycodone w/ Acetaminophen Tab 5-325 MG30$7.94
Oxytetracycline-Polymyxin B Ophth Oint4$8.82

Second Tier
Drug NameRetail QtyRetail
OBSTETRIX TAB -10030$13.97
OBTREX TAB30$13.08
O-CAL FA TAB30$10.50
Ofloxacin Otic Soln 0.3%10$15.00
Omeprazole Cap Delayed Release 10 MG30$15.87
OMNII GEL 0.4% GRA122$10.14
OMNII GEL 0.4%CINN122$10.14
OMNII GEL 0.4%MINT122$10.14
OMNII GEL 0.4%NATU122$10.14
OMNII GEL 0.4%RASP122$10.14
OMNII MED GEL 0.4%210$10.15
ONE TOUCH MIS LANCETS200$14.55
ONE TOUCH US MIS LANCETS100$12.10
OPHTHETIC SOL 0.5% OP15$16.55
ORASEP SPR30$10.23
ORATUSS 12 TAB30$18.89
OXACILLIN INJ 1GM1$13.55
Oxazepam Cap 10 MG30$10.14
Oxazepam Cap 15 MG30$13.76
Oxcarbazepine Tab 150 MG30$13.56
Oxcarbazepine Tab 300 MG30$20.00
OXIPLEN RX CAP30$17.39
OXIPLEN RX TAB30$18.85
OXYCODONE TAB 10MG30$17.15
Oxycodone HCl Tab 15 MG30$13.92
Oxycodone HCl Tab 30 MG30$19.99
Oxycodone w/ Acetaminophen Tab 7.5-325 MG30$14.97
Oxycodone w/ Acetaminophen Tab 7.5-325 MG30$14.97
Oxycodone w/ Acetaminophen Tab 7.5-500 MG30$15.60
Oxycodone w/ Acetaminophen Tab 7.5-500 MG30$15.60
OXYIR CAP 5MG30$13.01

Third Tier
Drug NameRetail QtyRetail
OB COMPLETE TAB30$42.31
OCL SOL4050$43.53
OCTRON INJ10$47.99
OCUFEN SOL 0.03% OP2$22.02
OCUPRESS SOL 1% OP5$31.24
OCUSERT DIS PILO-208$42.01
OCUSERT DIS PILO-408$41.99
Ofloxacin Ophth Soln 0.3%10$33.09
OGEN TAB 0.62530$36.34
OGEN TAB 1.2530$39.20
OLEYL ALCOH LIQ NF100$20.37
OMACOR CAP 1GM30$36.68
Omeprazole Cap Delayed Release 20 MG30$20.20
Omeprazole Cap Delayed Release 40 MG30$49.50
OMNIHIST II TAB LA30$25.26
ONE TOUCH TES25$29.12
ONE TOUCH TES ULTRA25$29.12
OPANA INJ 1MG/ML10$31.08
OPANA ER TAB 5MG30$38.10
OPTINATE MIS30$40.86
OPTIPRANOLOL SOL 0.3% OP5$24.83
OPTIUM TES50$45.28
OPTIVAR DRO 0.05%3$43.21
Oral Wound Care Products - For Soln Rinse210$22.19
ORAMORPH SR TAB 15MG30$28.30
ORAP TAB 1MG30$34.55
ORAP TAB 2MG30$45.15
Orphenadrine Citrate Tab SR 12HR 100 MG30$21.41
Orphenadrine w/ Aspirin & Caffeine Tab 25-385-30 MG30$22.97
ORTHO EVRA DIS WEEK1$27.66
ORTHO MICRON TAB DIALPAK28$34.00
ORTHO TRI- TAB CYCLEN28$31.31
ORTHO-CYCLEN TAB 0.25/3528$31.31
ORTHO-NOVUM TAB 7/7/7-2121$28.71
ORTHO-NOVUM TAB 7/7/7-2828$28.64
OSTIVA TAB30$31.46
OVCON 35 FE CHW28$46.10
OVCON-35 21 TAB21$32.31
OVCON-35 28 TAB28$41.10
OVRETTE 28 TAB 0.075MG28$36.77
OXACILLIN INJ 2GM1$20.25
Oxazepam Cap 30 MG30$26.68
Oxcarbazepine Tab 600 MG30$33.51
OXICAL MIS112$31.98
OXISTAT CRE 1%15$33.00
Oxybutynin Chloride Syrup 5 MG/5ML473$26.56
OXYCODONE TAB 20MG30$26.57
Oxycodone HCl Conc 20 MG/ML30$20.46
Oxycodone HCl Conc 20 MG/ML30$20.46
Oxycodone HCl Conc 20 MG/ML30$20.46
Oxycodone HCl Soln 5 MG/5ML500$30.75
Oxycodone HCl Tab SR 12HR 10 MG30$36.03
Oxycodone w/ Acetaminophen Tab 10-325 MG30$21.00
Oxycodone w/ Acetaminophen Tab 10-325 MG30$21.00
Oxycodone w/ Acetaminophen Tab 10-650 MG30$22.19
Oxycodone w/ Acetaminophen Tab 10-650 MG30$22.19
Oxycodone w/ Aspirin Tab Full Strength30$29.59
Oxycodone-Ibuprofen Tab 5-400 MG30$36.13
OXYCONTIN TAB 10MG CR30$49.04

Fourth Tier
Drug NameRetail QtyRetail
OB COMPLETE CAP WITH DHA

$56.29
OCTREOSCAN KIT

$2611.88
Octreotide Acetate Inj 0.2 MG/ML

$74.55
Octreotide Acetate Inj 1 MG/ML

$360.75
OCUFLOX SOL 0.3% OP

$54.18
Ofloxacin Tab 200 MG

$60.41
Ofloxacin Tab 300 MG

$71.32
Ofloxacin Tab 400 MG

$138.09
OGEN TAB 2.5

$84.42
OLUX AER 0.05%

$214.71
OLUX OLUX-E MIS COMP PK

$328.35
OLUX-E AER 0.05%

$337.65
OMNARIS SPR

$96.82
OMNICEF CAP 300MG

$170.86
OMNICEF SUS 125MG/5

$58.64
OMNICEF SUS 250MG/5

$175.39
OMNIPAQUE INJ 140MG/ML

$366.24
OMNIPAQUE INJ 180MG/ML

$216.91
OMNIPAQUE INJ 210MG/ML

$463.14
OMNIPAQUE INJ 240MG/ML

$2033.03
OMNIPAQUE INJ 300MG/ML

$4382.90
OMNIPAQUE INJ 350MG/ML

$4448.75
OMNIPRED SUS 1% OP

$69.74
OMNISCAN INJ 287MG/ML

$644.08
OMNISCAN KIT SAFEPAK

$1123.52
OMNITROPE INJ 5.8MG

$1885.54
ONCASPAR INJ 750IU/ML

$2856.35
ONDANSETRON SOL 32MG/50M

$394.25
ONDANSETRON SOL HCL

$211.38
ONDANSETRON TAB 24MG

$2782.66
Ondansetron HCl Inj 32 MG/50ML

$182.69
Ondansetron HCl Tab 4 MG

$295.50
Ondansetron HCl Tab 8 MG

$486.00
Ondansetron Orally Disintegrating Tab 4 MG

$531.81
Ondansetron Orally Disintegrating Tab 8 MG

$883.82
ONE TOUCH MIS COMBO

$68.26
ONTAK INJ 150/ML

$1481.75
OPANA TAB 10MG

$164.35
OPANA TAB 5MG

$91.75
OPANA ER TAB 10MG

$70.64
OPANA ER TAB 15MG

$96.90
OPANA ER TAB 20MG

$123.16
OPANA ER TAB 30MG

$176.06
OPANA ER TAB 40MG

$228.97
OPANA ER TAB 7.5MG

$54.37
Ophthalmic Irrigation Solution - Intraocular

$76.38
Ophthalmic Irrigation Solution - Intraocular

$207.12
OPIUM TIN 10%

$99.63
OPTASE GEL

$60.05
OPTIMARK INJ 330.9MG/

$296.11
OPTIRAY 300 INJ 64%

$1076.66
OPTIRAY 350 INJ 74%

$2694.32
OPTISON INJ 10MG/ML

$600.88
ORACEA CAP 40MG

$194.42
ORACIT SOL

$135.43
ORAMORPH SR TAB 100MG

$138.62
ORAMORPH SR TAB 30MG

$66.80
ORAMORPH SR TAB 60MG

$89.13
ORAPRED SOL 15MG/5ML

$252.76
ORAPRED ODT TAB 10MG

$103.38
ORAPRED ODT TAB 15MG

$154.07
ORAPRED ODT TAB 30MG

$218.37
ORATUSS LIQ 20-75MG/

$73.88
ORFADIN CAP 10MG

$8059.18
ORFADIN CAP 2MG

$1614.04
ORFADIN CAP 5MG

$4030.97
ORGANIDIN NR LIQ 100/5ML

$197.40
Orphenadrine Citrate Inj 30 MG/ML

$169.53
Orphenadrine w/ Aspirin & Caffeine Tab 50-770-60 MG

$61.93
ORTHO TRI-CY TAB LO

$77.50
ORTHO-CEPT TAB 28

$50.88
ORTHOCLONE INJ OKT3

$1188.82
ORTHO-NOVUM TAB 1/35-28

$51.07
ORTHO-NOVUM TAB 1/50-28

$50.89
ORTHO-NOVUM TAB 10/11-28

$55.25
ORTHOVISC INJ 15MG/ML

$248.09
ORUVAIL CAP 200MG ER

$91.47
OSMOGLYN SOL 50%

$366.20
OSMOPREP TAB 1.5GM

$75.56
OTIC EDGE SOL OTIC

$142.52
OTICIN HC DRO

$56.52
OTILAM EAR LIQ DROPS

$50.77
OTILAM NR SOL 1.4-5.4%

$57.04
OVACE AER 10%

$144.73
OVACE CRE 10%

$60.28
OVACE GEL 10%

$60.28
OVACE WASH LIQ

$71.21
OVACE WASH LIQ PLUS 10%

$170.48
OVCON 50 TAB 28

$69.13
OVIDE LOT 0.5%

$111.10
OVIDREL INJ

$84.44
OVIDREL INJ 250MCG

$66.39
OVRAL TAB -28

$52.83
OXACILLIN INJ 10GM

$67.68
OXANDRIN TAB 10MG

$726.49
OXANDRIN TAB 2.5MG

$216.18
Oxandrolone Tab 10 MG

$424.89
Oxandrolone Tab 2.5 MG

$127.41
OXISTAT LOT 1%

$51.67
OXSORALEN LOT 1%

$498.48
OXSORALEN-UL CAP 10MG

$965.21
Oxybutynin Chloride Tab SR 24HR 10 MG

$71.34
Oxybutynin Chloride Tab SR 24HR 15 MG

$75.02
Oxybutynin Chloride Tab SR 24HR 5 MG

$63.84
OXYCEL COTTN PAD 2""X1""X1""

$425.05
OXYCEL GAUZE PAD 18""X2""

$580.69
OXYCEL GAUZE PAD 3""X3""

$488.47
OXYCEL GAUZE PAD 36""X1/2""

$694.84
OXYCEL GAUZE PAD 5""X1/2""

$303.42
Oxycodone HCl Tab SR 12HR 20 MG

$66.20
Oxycodone HCl Tab SR 12HR 40 MG

$115.14
Oxycodone HCl Tab SR 12HR 80 MG

$213.88
OXYCONTIN TAB 15MG

$82.18
OXYCONTIN TAB 160MG CR

$483.44
OXYCONTIN TAB 20MG CR

$91.33
OXYCONTIN TAB 30MG

$146.40
OXYCONTIN TAB 40MG CR

$159.81
OXYCONTIN TAB 60MG

$264.79
OXYCONTIN TAB 80MG CR

$298.29
Oxytocin Inj 10 Unit/ML

$87.38
OXYTROL DIS 3.9MG/24

$180.65

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