4_dollar_drug_list.pdf

WAL-MART / SAM'S CLUB $4 PROGRAM
List Effective January 17th, 2007
( Applies to up to a 30 day supply at commonly prescribed dosages.)
Therapeutic Category
Drug Name
Therapeutic Category
Drug Name
ANTI INFLAMMATORY BETAMETHASONE DIP 0.05% CREAM 15GM ANTI INFLAMMATORY BETAMETHASONE DIP 0.05% CREAM 45GM ANTI INFLAMMATORY BETAMETHASONE VAL 0.1% CREAM 15GM ANTI INFLAMMATORY BETAMETHASONE VAL 0.1% CREAM 45GM ANTI INFLAMMATORY BETAMETHASONE VAL 0.1% OINTMENT 15GM ANTI INFLAMMATORY BETAMETHASONE VAL 0.1% OINTMENT 45GM ANTI INFLAMMATORY DEXAMETHASONE .5MG TABLET ANTI INFLAMMATORY DEXAMETHASONE 0.75MG TABLET ANTI INFLAMMATORY DEXAMETHASONE 4MG TABLET* ANTI INFLAMMATORY FLUOCINONIDE 0.05% CREAM 15GM ANTI INFLAMMATORY FLUOCINONIDE 0.05% CREAM 30GM ANTI INFLAMMATORY FLUOCINOLONE ACET 0.01% SOLUTION 60 ANTI INFLAMMATORY HYDROCORTISONE 1% CREAM 30GM ANTI INFLAMMATORY HYDROCORTISONE 2.5% CREAM 30GM ANTI INFLAMMATORY HYDROCORTISONE AC 25MG SUPPOSITORY ANTI INFLAMMATORY IBUPROFEN 100/5ML SUSPENSION*
ANTI INFLAMMATORY INDOMETHACIN 25MG CAPSULE*
POLYMIXIN SULF/TMP SOLUTION*
SELENIUM SUL 2.5% LOTION*
ANTI INFLAMMATORY MELOXICAM 7.5 MG TABLET ANTI INFLAMMATORY METHYLPREDNISOLONE 4MG TABLET ANTI INFLAMMATORY METHYLPREDNISOLONE 4MG DOSEPACK ANTI INFLAMMATORY NAPROXEN 375MG TABLET*
ANTI INFLAMMATORY NAPROXEN 500MG TABLET*
ANTI INFLAMMATORY PREDNISONE 10MG DOSEPACK 48CT*
ANTI INFLAMMATORY PREDNISONE 10MG DOSEPACK 21CT ANTI INFLAMMATORY PREDNISONE 2.5MG TABLET ANTI INFLAMMATORY PREDNISONE 5MG DOSEPACK 48CT*
ANTI INFLAMMATORY PREDNISONE 5MG 6 DAY DOSEPACK ANTI INFLAMMATORY TRIAMCINOLONE 0.025% CREAM 15GM ANTI INFLAMMATORY TRIAMCINOLONE 0.025% CREAM 80GM ANTI INFLAMMATORY TRIAMCINOLONE 0.1% CREAM 15GM ANTI INFLAMMATORY TRIAMCINOLONE 0.1% CREAM 80GM ANTI INFLAMMATORY TRIAMCINOLONE 0.1% OINTMENT 15GM ANTI INFLAMMATORY TRIAMCINOLONE 0.1% OINTMENT 80GM FLUOXETINE 10MG TABLET*
ANTI INFLAMMATORY TRIAMCINOLONE 0.5% CREAM15GM AMOXICILLIN 200MG/5ML SUS 100ML*
PAROXETINE 10MG TABLET*
PAROXETINE 20MG TABLET*
AMOXICILLIN 200MG/5ML SUS 75ML*
Generics under this program are subject to change anytime.
List Effective January 17th, 2007
( Applies to up to a 30 day supply at commonly prescribed dosages.)
Therapeutic Category
Drug Name
Therapeutic Category
Drug Name
HCTZ 12.5MG CAPSULE*
LITHIUM CARB 300MG CAPSULE*
LISINOPRIL-HCTZ 20-12.5 TABLET*
LISINOPRIL-HCTZ 20-25MG TABLET*
METHYLDOPA 250MG TABLET*
METHYLDOPA 500MG TABLET*
METOPROLOL 100MG TABLET*
SOTALOL HCL 80MG TABLET*
SPIRONOLACTONE 25MG TABLET*
WARFARIN 5MG TABLET*
WARFARIN 5MG COMPLIANCE PACK*
LOVASTATIN 10MG TABLET*
LOVASTATIN 20MG TABLET*
DILTIAZEM 90MG TABLET*
PRAVASTATIN 40MG TABLET*
Generics under this program are subject to change anytime.
List Effective January 17th, 2007
( Applies to up to a 30 day supply at commonly prescribed dosages.)
Therapeutic Category
Drug Name
Therapeutic Category
Drug Name
CERON DROPS 1OZ*
GUAIFENEX DM ER*
CHLORPROPAMIDE 100MG TABLET*
ESTROPIPATE 1.5MG TABLET*
GLIPIZIDE 10MG TABLET*
ONCOLOGY/CANCER MEGESTROL 20MG TABLET*
CARBAMAZEPINE 200MG TABLET*
METFORMIN 1000MG TABLET*
METFORMIN 500MG ER TABLET*
LEVOTHYROXIN 175MCG TABLET*
CIMETIDINE 800MG TABLET*
LEVOTHYROXINE 200MCG TABLET*
ETHEDENT 0.25MG CHEWABLE TABLETS*
HYOSCYAMINE 0.125/ML DROPS*
KLORCON M10 TABLET*
NATALCARE PIC TABLET*
PROMETHAZINE 25MG TABLET*
NATALCARE PLUS TABLET*
PROMETHAZINE 6.25/5ML SYRUP*
PRENATAL RX TABLET*
This program offers up to a 30–day supply of generic drugs on the current list of covered drugs at commonly prescribed dosages for $4 for each prescription fill or refill. Your participation in certain prescription drug coverage plans may entitle you to pay even less than $4 for certain of these generic drugs. If you are eligible, you will be charged the lowest applicable amount. Certain generic drugs are priced higher in CA, CO, HI, MN, MT, PA, TN, WI, and WY due to state laws. Program not available in North Dakota. You can get these prescription drug savings whether or not you have any prescription drug coverage through your company, under Medicare or any other plan. The list of covered generic drugs is subject to change. Not all generic prescription drugs are covered by this program. Only prescriptions filled in person are eligible for the $4 program. This price does not apply to prescriptions filled by mail order. There is a $4 minimum per prescription for covered generics, even if less than the commonly prescribed dosage is purchased. Prescriptions refilled may be ordered online or by telephone, but must be picked up in person at a participating Wal-Mart pharmacy. See your Wal-Mart pharmacist for further details.
* These prescriptions are priced higher than $4 in CO, CA, HI, MN, MT, PA, TN, WI, AND WY due to state laws. Customers in these states
should see their Wal-mart or Sam's Club pharmacist for price details.

Source: http://zone.medschool.pitt.edu/sites/hoep/ninthstreetclinic/Shared%20Documents/Walmart%20Generics.pdf