Effective 2/3/2020 Guide to low-cost prescriptions drugs ... · Effective 2/3/2020 Effective...
Transcript of Effective 2/3/2020 Guide to low-cost prescriptions drugs ... · Effective 2/3/2020 Effective...
©2020 Walmart Apollo, LLC | Page 1 of 3
*Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Higher dosages cost more. Prices for some drugscovered by the Prescription Program may be higher or vary in some states including, but not necessarily limited to, CA and MN. For important information regarding Walmart’s Patient accessibility program, including the availability of language interpretive services, please see the last page.† Prepackaged drugs are covered only in unit sizes specified on Drug List (back page). Other restrictions may apply. See Program Details or your Walmart Pharmacist for details.Program pricing may be limited to select manufacturers of a covered drug and is available as long as supplies from such manufacturers are in stock at the dispensing pharmacy.
Art Revised 01/20/2020 08:10PMEffective 2/3/2020
Effective 2/3/2020
$1090 Day Qty
GLIMEPIRIDE 1MG, 2MG, 4MG 90GLIPIZIDE 5MG, 10MG 180
METFORMIN 500MG, 850MG, 1000MG 180METFORMIN ER 500MG TAB 360
$2490 Day Qty
GLIPIZIDE ER 2.5MG 90
180 GLYBURIDE/METFORMIN 2.5/500MG, 5/500MG
$3890 Day Qty
PIOGLITAZONE 45MG 90
$24Cholesterol 90 Day Qty
FENOFIBRATE 145MG 90SIMVASTATIN 10MG, 20MG, 40MG 90
ATORVASTATIN 10MG, 20MG, 40MG 90
$10Heart Health & Blood Pressure 90 Day QtyATENOLOL 25MG, 50MG, 100MG 90BENAZEPRIL 20MG, 40MG 90
180 CARVEDILOL 3.125MG, 6.25MG, 12.5MG, 25MGCLONIDINE 0.1MG, 0.3MG 180FUROSEMIDE 20MG, 40MG, 80MG 90HYDRALAZINE 10MG, 25MG, 50MG 270
90 HYDROCHLOROTHIAZIDE 12.5MG, 25MG, 50MG TAB
HYDROCHLOROTHIAZIDE 12.5MG CAP 90INDAPAMIDE 1.25MG 90
90 ISOSORBIDE MONONITRATE ER 30MG, 60MG
90 LISINOPRIL 2.5MG, 5MG, 10MG, 20MG, 30MGLISINOPRIL/HCTZ 20/25MG 90LOSARTAN/HCT 50/12.5MG TAB 90METOPROLOL TART 25MG, 50MG, 100MG 180RAMIPRIL 2.5MG, 5MG, 10MG 90
90 TRIAMTERENE/HCTZ 37.5/25MG, 75/50MG TAB90 WARFARIN 1MG, 2MG, 2.5MG, 3MG,5MG, 6MG,
7.5MG, 10MG
$24Heart Health & Blood Pressure 90 Day QtyAMIODARONE 200MG 90AMLODIPINE 2.5MG, 5MG, 10MG 90BISOPROLOL 5MG 90CILOSTAZOL 50MG, 100MG 180DIGOXIN 0.125MG 90DILTIAZEM ER 120MG CAP (24 HOUR) 90DILTIAZEM 30MG, 60MG, 120MG 180DOXAZOSIN 1MG, 2MG, 4MG, 8MG 90ENALAPRIL 2.5MG, 10MG, 20MG 90LOSARTAN 25MG, 50MG, 100MG 90METOPROLOL ER 25MG, ER 50MG 90MINOXIDIL 10MG TAB 90TORSEMIDE 20MG, 100MG 90TRIAMTERENE/HCTZ 37.5/25MG CAP 90VALSARTAN/HCTZ 160/12.5MG, 160/25MG 90VERAPAMIL ER 120MG, 180MG, 240MG TAB 90
Continued
Heart
Diabetes
prescriptionsCall 1-800-2REFILL for details. †*
$1090 day
Guide to low-cost prescriptionsMail-order drugs available delivered to you starting at:
PIOGLITAZONE 15MG, 30 MG 90
METFORMIN ER 750MG TAB 180
*Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Higher dosages cost more. Prices for some drugscovered by the Prescription Program may be higher or vary in some states including, but not necessarily limited to, CA and MN. For important information regarding Walmart’s Patient accessibility program, including the availability of language interpretive services, please see the last page.† Prepackaged drugs are covered only in unit sizes specified on Drug List (back page). Other restrictions may apply. See Program Details or your Walmart Pharmacist for details.Program pricing may be limited to select manufacturers of a covered drug and is available as long as supplies from such manufacturers are in stock at the dispensing pharmacy.
Art Revised 01/20/2020 08:10PMEffective 2/3/2020©2020 Walmart Apollo, LLC | Page 2 of 3
$1090 Day Qty
90 AMITRIPTYLINE 10MG, 25MG, 50MG, 75MGBUSPIRONE 5MG, 10MG 180CITALOPRAM 10MG, 20MG, 40MG 90FLUOXETINE 10MG TAB 90FLUOXETINE 20MG, 40MG CAP 90LITHIUM CARB 300MG CAP 180NORTRIPTYLINE 10MG, 25MG, 50MG 90PAROXETINE 20MG, 30MG 90
90 RISPERIDONE 0.25MG, 0.5MG, 1MG, 2MG, 3MG, 4MG
TRAZODONE 50MG, 100MG, 150MG 90TRIHEXYPHENIDYL 2MG TAB 180
$2490 Day Qty
AMANTADINE 100MG 180CARB/LEVO 10/100MG, 25/100MG 270DIVALPROEX DR 250MG TAB 180DONEPEZIL 5MG, 10MG 90LAMOTRIGINE 100MG, 200MG 90LAMOTRIGINE 25MG, 150MG 180LEVETIRACETAM 500MG 180LITHIUM CARB ER 300MG, 450MG TAB 180MIRTAZAPINE 15MG, 30MG, 45MG 90OLANZAPINE 2.5MG, 5MG, 7.5MG, 10MG, 15MG, 20MG 90 OXCARBAZEPINE 300MG 180PAROXETINE 40MG 90PRAMIPEXOLE 0.125MG, 0.25MG, 0.5MG, 1MG, 1.5MG 90 PRIMIDONE 250MG TAB 180PRIMIDONE 50MG TAB 90QUETIAPINE 25MG, 50MG, 100MG, 200MG, 300MG 90 ROPINIROLE 0.25MG, 0.5MG, 1MG, 2MG, 3MG, 4MG 90 SERTRALINE 25MG, 100MG 90
180TOPIRAMATE 25MG, 50MG, 100MG, 200MG TRIHEXYPHENIDYL 5MG TAB 180ZONISAMIDE 50MG CAP 180
$3890 Day Qty
180 BUPROPION ER/SR 100MG, 150MG, 200MG TABBUPROPION XL 150MG TAB 90DULOXETINE 20MG, 30MG, 60MG 90ESCITALOPRAM 5MG, 10MG, 20MG 90VENLAFAXINE 37.5MG TAB 180VENLAFAXINE 75MG, 100MG TAB 180
$10Digestion 90 Day QtyMETOCLOPRAMIDE 5MG, 10MG 270
$38Digestion 90 Day QtyOMEPRAZOLE 20MG CAP 90OMEPRAZOLE DR 40MG 90
$10Thyroid 90 Day Qty
90 LEVOTHYROXINE 25MCG, 50MCG, 75MCG, 88MCG 100MCG, 112MCG, 125MCG, 137MCG, 150MCG, 175MCG, 200MCG
$10Vitamin & Nutrition 90 Day QtyFOLIC ACID 1MG 90
$24Vitamin & Nutrition 90 Day QtyFOLBEE TAB 90
$24Family Planning 90 Day QtyNORETHINDRONE TAB 0.35 MG 84SPRINTEC 28 TAB 28 DAY 84TRI-SPRINTEC TAB 84
Mental Health Other Therapeutic Categories
dosages. H e. Pstates.
drugs.
drugs.
plan.
Walmart’s Prescription Program Details
English Translation:Accessibility & Non-Discrimination
Complaints or Grievances
Walmart’s Prescription Program Details
Accessibility & Non-Discrimination
Complaints or Grievances