drug list

PREFERRED GENERIC DRUG LIST

your home for family health

your home

for family

health

1

REVISED SEPTEMBER 8, 2014DRUG CLASSIFICATION/DRUG NAME

30-day Supply*

$5 or $10a

90-day Supply*$10, $15b,

$20c or $30d

ALLERGIES & COLD AND FLU

BENZONATATE 100 MG CAP 14 42

CETIRIZINE HCL 5 MG TAB 30 90

CETIRIZINE HCL 10 MG TAB 30 90

CHLORPHENIRAMINE MALEATE 4 MG TAB 100 300

CLEMASTINE FUMARATE 1.34 MG TAB 30 90b

CYPROHEPTADINE HCL 4 MG TAB 30a 90d

DIPHENHYDRAMINE HCL 50 MG CAP 90 270b

Preferred generic drugs 30-day supply* for $5 or $10 90-day supply* for $10, $15, $20 or $30 *The day supply is based upon the average dispensing patterns for the specifi c drug and strength. 30-day supply price starts at $5. 90-day supply price starts at $10.

aSelect drugs for a 30-Day Supply are priced at $10; bSelect drugs for a 90-Day Supply are priced at $15; cSelect drugs for a 90-Day Supply are priced at $20; dSelect drugs for a 90-Day Supply are priced at $30.

Select Womens and Mens Health prescription medications are available in up to a 30-day supply for $12.00 each or in up to a 90-day supply for $36.00 each (see last page).

Prices may be different in Puerto Rico. Please see your Kmart Pharmacist.

These discount programs are NOT health insurance policies and are not intended as a substitute for insurance. The programs do not qualify as a minimum creditable coverage under Massachusetts law or where prohibited by law. The programs only provide for discounts on health services from participating pharmacies, and the range of the discounts will vary depending on the health services received. The programs do not make payments to pharmacies of health care services. Members are required to pay for all health care services, but will receive a discount from the contracted pharmacies. Except in the states of California, Utah, and Washington, these are custom-branded programs, provided and administered by Medical Security Card Company, LLC, (MSC), 4911 E. Broadway Boulevard, Tucson, AZ 85711, 1-866-435-7958, www.scriptsave.com and marketed by Kmart.

These programs are not available in all states and the terms of each program may vary from state to state. Each program is governed by the applicable terms of the membership agreement provided upon activation and made available at www.KmartPrescriptionSavingsClub.com. MSC is not responsible for providing or guaranteeing pharmacy services or for the quality of such rendered services. Participating pharmacies are subject to change without notice and are not available in all areas. The program contracts are not protected by any state guaranty fund.2

An annual fee of $10 is payable at the time of initial enrollment and enrollment renewal. The program, as well as the prices and the list of covered drugs, can be modifi ed at any time without notice.

2Notwithstanding the above, the programs, as described above and available in the states of California, Utah, and Washington, are custom-branded and operated directly by Kmart. The applicable terms relating to any such Kmart custom-branded and operated program shall also be available at www.KmartPrescriptionSavingsClub.com. MSC may participate or assist in the administration of such programs.

For questions, please call 1-866-435-7958, log on to www.KmartPrescriptionSavingsClub.com or see the

pharmacist for further details.

2PREFERRED GENERIC DRUG LIST

your home for family health2

DRUG CLASSIFICATION/DRUG NAME 30-day Supply*

$5 or $10a


$20c or $30d

D-METHORPHAN HB/PROMETH HCL 15-6.25/5 SYRUP 120 360

FLUTICASONE PROP 50 MCG SPRAY 16a 48c

GUAIFENESIN/DEXTROMETHORPHAN 100-10MG/5 LIQUID 180 540b

LORATADINE 10 MG TAB 30 90

PROMETHAZINE HCL 12.5 MG TAB 12 36

PROMETHAZINE HCL 25 MG TAB 12 36

PROMETHAZINE HCL 50 MG TAB 20 60b

PROMETHAZINE HCL 6.25MG/5ML SYRUP 180 540b

ANTIBIOTIC & ANTI-INFECTIVE TREATMENTS

ACYCLOVIR 200 MG CAP 30 90b

AMOXICILLIN 250 MG CAP 30 90b

AMOXICILLIN 500 MG CAP 30 90

AMOXICILLIN 125 MG/5ML SUSP 150 450b



AMOXICILLIN 400 MG/5ML SUSP 100 300

AMOXICILLIN 125 MG TAB 20 60b

AMPICILLIN TRIHYDRATE 250 MG CAP 28 84b

AMPICILLIN TRIHYDRATE 500 MG CAP 28 84b

BACITRACIN ZINC 500 UNIT/G OINT 30 90b

BACITRACIN ZINC 500 UNIT/G PACKET 30 90b


$5 or $10a


$20c or $30d

CEPHALEXIN 250 MG CAP 28 84b

CEPHALEXIN 500 MG CAP 30 90b

CIPROFLOXACIN HCL 250 MG TAB 14 42

CIPROFLOXACIN HCL 500 MG TAB 20 60b

ECONAZOLE NITRATE 1 % CRM 15 45b

ISONIAZID 300 MG TAB 30 90b

PENICILLIN V POTASSIUM 250 MG TAB 30 90b

PENICILLIN V POTASSIUM 250 MG/5ML SOLN 100 300b

PENICILLIN V POTASSIUM 500 MG TAB 20 60

SMZ/TMP 400MG-80MG TAB 28 84b

SMZ/TMP 800-160 MG TAB 20 60b

ARTHRITIS & PAIN

ASPIRIN 81 MG TAB 120 360b

BACLOFEN 10 MG TAB 30 90

BACLOFEN 20 MG TAB 30 90

CYCLOBENZAPRINE HCL 5 MG TAB 30 90

CYCLOBENZAPRINE HCL 10 MG TAB 30 90

DIBUCAINE 1 % OINT 30 90b

IBUPROFEN 400 MG TAB 90 270b






$5 or $10a


$20c or $30d

MELOXICAM 7.5 MG TAB 30 90

MELOXICAM 15 MG TAB 30 90

NAPROXEN 250 MG TAB 60 180b



NAPROXEN SODIUM 275 MG TAB 30 90b

ASTHMA

ALBUTEROL SULFATE 2 MG/5 ML SYRUP 120 360b

ALBUTEROL SULFATE 2.5 MG/3ML VIAL-NEB 75 225b

IPRATROPIUM BROMIDE 0.2 MG/ML SOLN 75 225b

DIABETES

GLIMEPIRIDE 1 MG TAB 30 90



GLIPIZIDE 5 MG TAB 30 90

GLIPIZIDE 10 MG TAB 60 180

GLYBURIDE 1.25 MG TAB 30 90b

GLYBURIDE 2.5 MG TAB 30a 90c

GLYBURIDE 5 MG TAB 30a 90c

GLYBURIDE, MICRONIZED 1.5 MG TAB 30 90

GLYBURIDE, MICRONIZED 3 MG TAB 30 90


$5 or $10a


$20c or $30d

GLYBURIDE,MICRONIZED 6 MG TAB 30 90

GLYBURIDE/METFORMIN HCL 1.25-250MG TAB 60a 180d

GLYBURIDE/METFORMIN HCL 2.5-500 MG TAB 60a 180d

GLYBURIDE/METFORMIN HCL 5 MG-500MG TAB 90 270b

METFORMIN HCL 500 MG TAB 60 180b

METFORMIN HCL 850 MG TAB 60 180

METFORMIN HCL 1000 MG TAB 60 180

METFORMIN HCL ER 500 MG TAB 60 180

METFORMIN HCL ER 750 MG TAB 60a 180d

FUNGAL INFECTIONS

FLUCONAZOLE 150 MG TAB 1 3b

GASTROINTESTINAL HEALTH

CIMETIDINE 300 MG TAB 30 90

CIMETIDINE 400 MG TAB 30 90

DICYCLOMINE HCL 10 MG CAP 90 270b

DICYCLOMINE HCL 20 MG TAB 60 180b

DOCUSATE CALCIUM 240 MG CAP 30 90

DOCUSATE SODIUM 100 MG CAP 100 300b

FAMOTIDINE 20 MG TAB 60 180

FAMOTIDINE 40 MG TAB 30a 90c

LACTULOSE 10 G/15 ML SOLN 237 711b




$5 or $10a


$20c or $30d

LACTULOSE 20 G/30 ML SOLN 237 711b

LACTULOSE 10 GM/15 ML SYRUP 237 711b

METOCLOPRAMIDE HCL 5 MG/5 ML SOLN 60 180

METOCLOPRAMIDE HCL 10 MG/10ML SOLN 60 180

METOCLOPRAMIDE HCL 5 MG TAB 60 180b

METOCLOPRAMIDE HCL 10 MG TAB 60 180

OMEPRAZOLE 20 MG CAP 30 90b

PANTOPRAZOLE SODIUM 40 MG TAB 30a 90d

PROCHLORPERAZINE MALEATE 5 MG TAB 40 120b

PROCHLORPERAZINE MALEATE 10 MG TAB 30 90

RANITIDINE HCL 15 MG/ML SYRUP 100 300b

RANITIDINE HCL 150 MG TAB 60 180

RANITIDINE HCL 300 MG TAB 30 90

GLAUCOMA & EYE CARE

DICLOFENAC SODIUM 0.1 % DROPS 2 6b

FLURBIPROFEN SODIUM 0.03 % DROPS 2 6b

NAPHAZOLINE HCL 0.1 % DROPS 15 45b

TIMOLOL MALEATE 0.25 % DROPS 5 15

TIMOLOL MALEATE 0.5 % DROPS 5 15b

HEART HEALTH & BLOOD PRESSURE

AMLODIPINE BESYLATE 2.5 MG TAB 30 90


$5 or $10a


$20c or $30d

AMLODIPINE BESYLATE 5 MG TAB 30 90

AMLODIPINE BESYLATE 10 MG TAB 30 90

ATENOLOL 25 MG TAB 30 90



BENAZEPRIL HCL 5 MG TAB 30 90b




BISOPROLOL FUMARATE/HCTZ 2.5-6.25MG TAB 30 90b

BISOPROLOL FUMARATE/HCTZ 5-6.25MG TAB 30 90b

BISOPROLOL FUMARATE/HCTZ 10-6.25MG TAB 30 90b

BUMETANIDE 0.5 MG TAB 30a 90d

BUMETANIDE 1 MG TAB 30a 90d

CARVEDILOL 3.125 MG TAB 60 180



CARVEDILOL 25 MG TAB 60 180b

CLONIDINE HCL 0.1 MG TAB 30 90

CLONIDINE HCL 0.2 MG TAB 30 90

DILTIAZEM HCL 30 MG TAB 60 180




$5 or $10a


$20c or $30d


DILTIAZEM HCL 90 MG TAB 60 180b


ENALAPRIL MALEATE 2.5 MG TAB 30 90b

ENALAPRIL MALEATE 5 MG TAB 30 90b



ENALAPRIL-HCTZ 10-25 MG TAB 30 90b

FOSINOPRIL SODIUM 20 MG TAB 30a 90d

FOSINOPRIL SODIUM 40 MG TAB 30a 90d

FUROSEMIDE 20 MG TAB 30 90



GEMFIBROZIL 600 MG TAB 60a 180d

GUANFACINE HCL 1 MG TAB 30 90

GUANFACINE HCL 2 MG TAB 30 90b

HYDRALAZINE HCL 25 MG TAB 30 90b

HYDROCHLOROTHIAZIDE 12.5 MG CAP 30 90

HYDROCHLOROTHIAZIDE 25 MG TAB 30 90

HYDROCHLOROTHIAZIDE 50 MG TAB 30 90

INDAPAMIDE 1.25 MG TAB 30 90


$5 or $10a


$20c or $30d

INDAPAMIDE 2.5 MG TAB 30 90

LISINOPRIL 2.5 MG TAB 30 90

LISINOPRIL 5 MG TAB 30 90





LISINOPRIL-HCTZ 10-12.5 MG TAB 30 90

LISINOPRIL-HCTZ 20-12.5 MG TAB 30 90

LISINOPRIL-HCTZ 20-25 MG TAB 30a 90c

LOSARTAN POTASSIUM 50 MG TAB 30a 90d

LOVASTATIN 10 MG TAB 30 90



METOPROLOL TARTRATE 25 MG TAB 60 180

METOPROLOL TARTRATE 50 MG TAB 60 180

METOPROLOL TARTRATE 100 MG TAB 60 180b

PRAZOSIN HCL 1 MG CAP 30 90b

PROPRANOLOL HCL 10 MG TAB 60 180






$5 or $10a


$20c or $30d

PROPRANOLOL HCL 80 MG TAB 60 180b

QUINAPRIL HCL 5 MG TAB 30 90b

SIMVASTATIN 10 MG TAB 30 90




SOTALOL 80 MG TAB 30a 90c

SPIRONOLACTONE 25 MG TAB 30 90

TERAZOSIN HCL 1 MG CAP 30 90




TORSEMIDE 10 MG TAB 30 90b

TRIAMTERENE-HCTZ 37.5-25 MG TB 30a 90c

VERAPAMIL HCL 80 MG TAB 30 90

VERAPAMIL HCL 120 MG TAB 30 90

VERAPAMIL HCL 180 MG TAB 30a 90c

WARFARIN SODIUM 1 MG TAB 30a 90c


WARFARIN SODIUM 2.5 MG TAB 30a 90c



$5 or $10a


$20c or $30d




WARFARIN SODIUM 7.5 MG TAB 30a 90c


MENTAL & NEURO HEALTH

AMITRIPTYLINE HCL 10 MG TAB 30 90b

AMITRIPTYLINE HCL 25 MG TAB 30a 90c

AMITRIPTYLINE HCL 50 MG TAB 30a 90d



BUSPIRONE HCL 5 MG TAB 60 180

BUSPIRONE HCL 10 MG TAB 60 180b

CITALOPRAM HBR 20 MG TAB 30 90

CITALOPRAM HBR 40 MG TAB 30 90

DOXEPIN HCL 10 MG CAP 30a 90c

FLUOXETINE HCL 20 MG CAP 30 90

FLUOXETINE HCL 40 MG CAP 30a 90c

FLUPHENAZINE HCL 1 MG TAB 30 90

FLUPHENAZINE HCL 2.5 MG TAB 30 90

GABAPENTIN 100 MG CAP 90a 270c




$5 or $10a


$20c or $30d

GABAPENTIN 300 MG CAP 90a 270d

GABAPENTIN 400 MG CAP 90a 270d

HALOPERIDOL 0.5 MG TAB 30 90

HALOPERIDOL 1 MG TAB 30 90

HALOPERIDOL 2 MG TAB 30 90b

LITHIUM CARBONATE 150 MG CAP 90 270b

LITHIUM CARBONATE 300 MG CAP 90 270b

MIRTAZAPINE 15 MG TAB 30 90

NORTRIPTYLINE HCL 10 MG CAP 30 90

NORTRIPTYLINE HCL 25 MG CAP 30 90b

PAROXETINE HCL 10 MG TAB 30 90b

PAROXETINE HCL 20 MG TAB 30 90b

PRAMIPEXOLE DI-HCL 0.5 MG TAB 30a 90c

SERTRALINE HCL 25 MG TAB 30 90b



TRAZODONE HCL 50 MG TAB 30 90

TRAZODONE HCL 100 MG TAB 30 90

TRAZODONE HCL 150 MG TAB 30 90b

ZONISAMIDE 25 MG CAP 30 90b

ZONISAMIDE 50 MG CAP 30 90b


$5 or $10a


$20c or $30d

OTHER MEDICAL CONDITIONS

ALLOPURINOL 100 MG TAB 30 90b

ALLOPURINOL 300 MG TAB 30 90b

CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH 473 1419

DEXAMETHASONE 0.5 MG TAB 30 90b

DEXAMETHASONE 0.75 MG TAB 12 36b

DEXAMETHASONE 4 MG TAB 6 18b

LIDOCAINE HCL 20 MG/ML SOLN 100 300b

PHENAZOPYRIDINE HCL 100 MG TAB 6 18

PREDNISOLONE 15 MG/5 ML SOLN 120 360b

PREDNISONE 2.5 MG TAB 30 90

PREDNISONE 5 MG TAB 30 90



SKIN CONDITIONS

HYDROCORTISONE 1 % CRM 30 90b

HYDROCORTISONE 1 % PACKET 30 90b

HYDROCORTISONE 2.5 % CRM 30 90b

HYDROCORTISONE 2.5 % OINT 28 84b

HYDROCORTISONE/ALOE VERA 1 % CRM 30 90b

MOMETASONE FUROATE 0.1 % OINT 15 45b




$5 or $10a


$20c or $30d

TERBINAFINE HCL 250 MG TABLET 30a 90c

TRIAMCINOLONE ACETONIDE 0.025 % OINT 15 45b

THYROID CONDITIONS

LEVOTHYROXINE 25 MCG TAB 30a 90d








METHIMAZOLE 5 MG TAB 30 90

VITAMINS & NUTRITIONAL HEALTH

AMINO ACIDS/MULTIVITS-MIN CAP 30 90b

BETA-CAROTENE(A) W-C & E/MIN CAP 30 90b

BETA-CAROTENE(A) W-C & E/SE CAP 30 90b

CALCIUM CARBONATE/VITAMIN D3 600 MG-200 TAB 60 180b

CALCIUM CARBONATE/VITAMIN D3 600 MG-400 TAB 60 180b

CITRIC ACID/SODIUM CITRATE 334-500MG SOLN 180 540

CO-NATAL FA TAB 30 90b

ERGOCALCIFEROL (VITAMIN D2) 50000 UNIT CAP 4 12


$5 or $10a


$20c or $30d

FOLIC ACID 1 MG TAB 30 90

FOLIC ACID/VITAMIN B COMP W-C 1 MG-100MG TAB 30 90b

MAGNESIUM CHLORIDE 64 MG TAB 60 180b

MAGNESIUM OXIDE 400 MG TAB 30 90b

MULTIVIT/FOLIC ACID/ZINC/VIT C 400-50-500 CAP 30 90b

MULTIVITAMIN WITH MINERALS CAP 30 90b

MULTIVITAMINS WITH MIN NO.7/FA 1 MG CAP 30 90b

MULTIVITAMINS,THER W-MINERALS CAP 30 90b

MULTIVITS-MINERALS/FA/LYCOPENE 0.4MG-600 CAP 30 90b

POTASSIUM CITRATE/CITRIC ACID 1100-334/5 SOLN 180 540b

PRENATABS RX TAB 30 90b

PRENATAL LOW IRON TAB 30 90b

PRENATAL PLUS TAB 30 90b

SOD/POT/K CIT/SOD CIT/CIT ACID 500-550/5 SOLN 180 540b

SODIUM FLUORIDE 0.25 (0.55) TAB 90 270b

SODIUM FLUORIDE 0.5 (1.1)MG TAB 90 270b

SODIUM FLUORIDE 1MG (2.2MG) TAB 90 270b

VIT B CMPLX 3/FA/VIT C/BIOTIN 1MG-60MG TAB 30 90b

VIT B COMPLEX & C NO.19/FA/D3 800-2000 TAB 30 90b

VIT C/VIT E AC/LUT/MINERAL 1 60-30-6 CAP 30 90b

VITAMIN A/VIT C/VIT E/SELENIUM CAP 30 90b



WOMENS HEALTH 30-day Supply

90-day Supply

ALENDRONATE SODIUM 10 MG TAB 30 90



APRI TABLET 28 84

AVIANE-28 TABLET 28 84

GILDESS FE 1-20 TABLET 28 84

PREVIFEM TABLET 28 84

TAMOXIFEN CITRATE 10 MG TAB 60 180

TAMOXIFEN CITRATE 20 MG TAB 30 90

TRI-PREVIFEM TAB 28 84

MENS HEALTH30-day Supply

90-day Supply

FINASTERIDE 5 MG TAB 30 90

Select Womens and Mens Health prescription medications are available in up to a 30-day supply* for $12.00 each or up to a 90-day supply* for $36.00 each.


$5 or $10a


$20c or $30d

WOMENS HEALTH

ALENDRONATE SODIUM 5 MG TAB 30 90b

ESTRADIOL 0.5 MG TAB 30 90

ESTRADIOL 1 MG TAB 30 90

ESTRADIOL 2 MG TAB 30 90

MEDROXYPROGESTERONE 2.5 MG TAB 30 90

MEDROXYPROGESTERONE 5 MG TAB 30 90

MEDROXYPROGESTERONE 10 MG TAB 10 30

MEGESTROL ACETATE 20 MG TAB 30 90b

A0158_KMART_CLASS_DL_092514

drug list

Documents