
	PREFERRED DRUG LIST

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. A mail order option is available for additional savings based upon a three month supply. Mail order tiers will vary due to differing quantities.

Drug pricing is based on the quantity indicated by the retail and mail order columns. 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.

* By law, schedule II drugs are only allowed to be dispensed for a 30 day supply through the mail order pharmacy.
* Pricing is subject to change without notice.

Search Results for Keyword: i

Drug Name Retail Qty Retail Mail Order
(3 x Retail Qty)
Ibuprofen Susp 100 MG/5ML 120 $5.95 $8.71
Ibuprofen Tab 400 MG 30 $3.84 $7.38
Ibuprofen Tab 400 MG 30 $3.84 $20.65
Ibuprofen Tab 600 MG 30 $5.26 $10.45
Ibuprofen Tab 600 MG 30 $5.26 $36.00
Ibuprofen Tab 800 MG 30 $5.38 $13.72
Ibuprofen Tab 800 MG 30 $5.38 $15.42
Imipramine HCl Tab 10 MG 30 $6.77 $15.78
Imipramine HCl Tab 25 MG 30 $7.92 $31.43
Imipramine HCl Tab 50 MG 30 $9.79 $52.65
Indapamide Tab 1.25 MG 30 $6.90 $32.13
Indapamide Tab 2.5 MG 30 $4.74 $39.24
Indomethacin Cap 25 MG 30 $7.81 $19.80
Indomethacin Cap 50 MG 30 $8.16 $27.23
Iodine Solution Strong (Lugol's) 500 $7.43 $57.60
Iron Chew Tab 15 MG 30 $9.42 $10.27
Iron Combination Cap 30 $8.94 $19.85
Iron Combination Cap 30 $7.94 $7.90
Iron Polysacch Complex-Vit B12-FA Cap 150-0.025-1 MG 30 $8.33 $10.46
Iron Polysacch Complex-Vit B12-FA Cap 150-0.025-1 MG 30 $4.37 $2.20
IRON-C LIQ 236 $9.01 $16.85
Iron-Vit C-Vit B12-Folic Acid Tab 100-250-0.025-1 MG 30 $9.93 $11.09
Isoniazid Tab 100 MG 30 $4.59 $3.96
Isoniazid Tab 300 MG 30 $4.77 $12.18
Isosorbide Dinitrate SL Tab 2.5 MG 100 $7.38 $24.78
Isosorbide Dinitrate SL Tab 5 MG 100 $7.40 $24.78
Isosorbide Dinitrate Tab 10 MG 30 $3.84 $8.80
Isosorbide Dinitrate Tab 20 MG 30 $3.87 $10.71
Isosorbide Dinitrate Tab 30 MG 30 $7.21 $26.24
Isosorbide Dinitrate Tab 5 MG 30 $3.68 $7.69
Isosorbide Mononitrate Tab 10 MG 30 $9.30 $18.33
Isosorbide Mononitrate Tab 20 MG 30 $7.15 $14.85
Isoxsuprine HCl Tab 10 MG 30 $7.99 $41.60

Drug Name Retail Qty Retail Mail Order
(3 x Retail Qty)
ICAR-C PLUS CAP SR 30 $19.06 $43.87
ICAR-C PLUS TAB 30 $18.41 $42.11
INDERAL TAB 10MG 30 $16.76 $37.69
Indigotindisulfonate Sodium Inj 8 MG/ML 5 $13.02 $16.03
INFLAM MILD SOL 0.125%OP 5 $18.90 $43.43
INFLAMASE SOL FORTE 1% 5 $18.74 $43.01
INTESTINEX CAP EC 30 $10.58 $21.06
INTROL SOL 75% 120 $16.32 $36.50
Iodoquinol-HC Cream 1% 28 $18.57 $73.68
Ipratropium Bromide Inhal Soln 0.02% 150 $15.87 $126.96
Ipratropium Bromide Nasal Soln 0.03% (21 MCG/SPRAY) 30 $16.10 $62.16
Ipratropium Bromide Nasal Soln 0.06% (42 MCG/SPRAY) 15 $14.37 $53.30
IRCON-FA TAB 30 $14.46 $31.49
IROFOL LIQ 120 $10.58 $21.06
IROFOL TAB 30 $14.50 $31.59
Iron Combination Elixir 480 $13.66 $17.05
IRON DEXTRAN SOL 10% USP 500 $14.72 $32.18
Iron w/ Vitamin Tab 30 $11.02 $12.83
Iron w/ Vitamin Tab 30 $11.47 $13.55
Iron w/ Vitamin Tab CR 30 $10.20 $22.50
Iron w/ Vitamin Tab CR 30 $10.20 $29.70
Iron-Vit C-Vit B12-Folic Acid Cap CR 100-320-0.025-1 MG 30 $12.76 $15.62
IRO-PLEX TAB 30 $14.03 $30.33
ISO ATROPINE SOL 0.5% OP 5 $12.27 $25.60
ISO CARPINE SOL 0.25% OP 15 $15.58 $34.52
ISO CARPINE SOL 0.5% OP 15 $15.58 $34.52
ISO CETAMIDE SOL 15% OP 15 $19.50 $45.05
Isoetharine HCl Soln Nebu 1% 10 $16.69 $21.90
Isoflurane Inhal Soln 100 $13.91 $17.46
ISOPTIN IV INJ 5MG/2ML 2 $14.05 $30.40
ISORDIL TAB 5MG 30 $19.76 $45.76
Isosorbide Mononitrate Tab SR 24HR 120 MG 30 $18.24 $27.39
Isosorbide Mononitrate Tab SR 24HR 30 MG 30 $13.35 $18.59
Isosorbide Mononitrate Tab SR 24HR 60 MG 30 $13.89 $19.56
ISOVUE-300 INJ 61% 10 $13.41 $28.67
ISOVUE-370 INJ 76% 10 $13.94 $30.10

Drug Name Retail Qty Retail Mail Order
(3 x Retail Qty)
IBERET-FOLIC TAB 500 CR 30 $38.80 $96.97
IB-STAT SPR 0.125/ML 30 $41.58 $104.43
IBUDONE TAB 10-200MG 30 $32.60 $80.29 *
ICAR PRENATA MIS SOFTGEL 120 $24.49 $58.48
IFOSFAMIDE INJ 1GM/20ML 20 $46.25 $117.00
ILETIN II INJ LENTE PK 10 $44.49 $112.27
ILETIN II INJ NPH PORK 10 $44.49 $112.27
ILETIN II RG INJ U100PORK 10 $44.49 $112.27
INAPSINE INJ 2.5MG/ML 10 $42.68 $107.41
INDERAL TAB 20MG 30 $22.42 $52.92
INDERAL TAB 40MG 30 $28.30 $68.71
INDERAL TAB 60MG 30 $39.65 $99.25
INDERAL TAB 80MG 30 $41.95 $105.43
INDERIDE TAB 40/25 30 $46.53 $117.76
INDOCIN CAP 25MG 30 $20.23 $47.01
INDOCIN CAP 50MG 30 $31.50 $77.32
Indomethacin Cap CR 75 MG 30 $46.80 $70.08
INTRON-A INJ 3MU/0.5 0 $33.75 $83.37
IODIN GLYC/ SOL COD 250 $20.15 $46.80 *
IODINE SOL STRONG 480 $33.41 $82.48
IODOFLEX GEL PAD 3 $46.10 $116.60
Iodoquinol-HC Cream 1% 42 $26.30 $79.20
ISCAR MALI INJ 7 $48.43 $122.85
ISCAR MALI INJ 100MG/ML 7 $48.43 $122.85
ISCAR MALI INJ 50MG/ML 7 $48.43 $122.85
ISCAR MALI INJ 5MG/ML 7 $48.43 $122.85
ISCAR MALI INJ SERIES I 7 $48.43 $122.85
ISCAR MALI INJ SERIES O 7 $48.43 $122.85
ISCAR MALI INJ SERIESII 7 $48.43 $122.85
ISCAR MALI INJ SPECIAL 7 $48.43 $122.85
ISCAR PINI INJ 0.005MG/ 7 $48.43 $122.85
ISCAR PINI INJ 0.05MG/M 7 $48.43 $122.85
ISCAR PINI INJ 0.5MG/ML 7 $48.43 $122.85
ISCAR PINI INJ 100MG/ML 7 $48.43 $122.85
ISCAR PINI INJ 50MG/ML 7 $48.43 $122.85
ISCAR PINI INJ 5MG/ML 7 $48.43 $122.85
ISCAR PINI INJ SERIES I 7 $48.43 $122.85
ISCAR PINI INJ SERIES O 7 $48.43 $122.85
ISCAR QUERCU INJ 7 $48.43 $122.85
ISCAR QUERCU INJ 100MG/ML 7 $48.43 $122.85
ISCAR QUERCU INJ 25MG/ML 7 $48.43 $122.85
ISCAR QUERCU INJ 50MG/ML 7 $48.43 $122.85
ISCAR QUERCU INJ 5MG/ML 7 $48.43 $122.85
ISCAR QUERCU INJ SERIES I 7 $48.43 $122.85
ISCAR QUERCU INJ SERIES O 7 $48.43 $122.85
ISCAR QUERCU INJ SERIESII 7 $48.43 $122.85
ISMOTIC SOL 100GM 220 $25.84 $62.11
ISO ATROPINE SOL 1% OP 5 $26.84 $64.80
ISO CARBACHO SOL 1.5% OP 15 $46.63 $118.03
ISO CARPINE SOL 10% OP 15 $22.66 $53.54
ISO HOMATROP SOL 2% OP 5 $29.24 $71.24
ISO HOMATROP SOL 5% OP 5 $33.25 $82.04
ISO HYOSCINE SOL 0.25% OP 5 $29.34 $71.52
Isoflurane Inhal Soln 250 $42.14 $62.62
ISOLYTE-S INJ 12000 $36.47 $90.72
ISOLYTE-S INJ /D5W 12000 $40.91 $102.60
ISOLYTE-S INJ PH 7.4 12000 $46.31 $117.00
Isoproterenol HCl Inj 0.2 MG/ML 50 $44.44 $66.30
ISOPTO CARP SOL 1% OP 15 $44.84 $113.21
ISOPTO CARP SOL 2% OP 15 $45.77 $115.70
ISOPTO CARP SOL 3% OP 30 $24.40 $58.22
ISOPTO CARP SOL 4% OP 15 $47.88 $121.39
ISORDIL TAB 40MG 30 $22.48 $53.08
Isosorbide Dinitrate Tab CR 40 MG 30 $21.05 $30.44
Isosorbide Dinitrate Tab CR 40 MG 30 $21.05 $38.64
Isoxsuprine HCl Tab 20 MG 30 $44.93 $67.09
ISRADIPINE CAP 2.5MG 30 $38.37 $95.82

Drug Name Retail Qty Retail Mail Order
(3 x Retail Qty)
IC GREEN INJ 25MG
$556.03
$1488.12

IDAMYCIN PFS INJ 1MG/ML
$430.05
$1149.29

Idarubicin HCl IV Inj 1 MG/ML
$1328.86
$2121.37

Idarubicin HCl IV Inj 1 MG/ML
$666.05
$1060.87

Idarubicin HCl IV Inj 1 MG/ML
$111.00
$172.80

IFEX INJ 1GM
$150.51
$397.43

IFEX INJ 3GM
$446.02
$1192.25

IFEX/MESNEX KIT
$2360.43
$6341.35

IFOSFAMIDE INJ 3GM/60ML
$165.88
$438.75

Ifosfamide & Mesna Inj Kit 1000-1000 MG
$940.50
$1500.00

Ifosfamide For Inj 1 GM
$55.25
$83.59

IMAGER AC KIT 100%
$150.04
$396.16

IMAGER AC SUS 100%
$103.30
$270.41

IMDUR TAB 120MG ER
$93.42
$243.86

IMDUR TAB 30MG ER
$61.35
$157.62

IMDUR TAB 60MG ER
$67.52
$174.21

Imipramine Pamoate Cap 100 MG
$382.30
$606.88

Imipramine Pamoate Cap 125 MG
$382.30
$606.88

Imipramine Pamoate Cap 150 MG
$382.30
$606.88

Imipramine Pamoate Cap 75 MG
$382.30
$606.88

IMITREX KIT 4MG/0.5
$210.30
$558.24

IMITREX KIT 6MG/0.5
$210.30
$558.24

IMITREX KIT RF
$199.34
$528.75

IMITREX SPR 20MG/ACT
$251.41
$668.81

IMITREX SPR 5MG/ACT
$251.41
$668.81

IMITREX TAB 100MG
$243.91
$648.64

IMITREX TAB 25MG
$262.25
$697.97

IMITREX TAB 50MG
$243.91
$648.64

IMOVAX RABIE INJ 2.5/ML
$214.81
$570.38

IMPLANON IMP 68MG
$682.48
$1828.24

IMURAN INJ 100MG
$59.83
$153.53

IMURAN TAB 50MG
$113.25
$297.20

INAMRINONE INJ 5MG/ML
$116.94
$307.13

INDERAL INJ 1MG/ML
$68.00
$175.50

INDERAL LA CAP 120MG
$148.34
$391.58

INDERAL LA CAP 160MG
$193.36
$512.68

INDERAL LA CAP 60MG
$103.24
$270.27

INDERAL LA CAP 80MG
$120.12
$315.68

INDERIDE TAB 80/25
$57.20
$146.46

INDIGO CARMI SOL 8MG/ML
$75.40
$195.39

INDOCIN SUP 50MG
$50.94
$129.61

INDOCIN SUS 25MG/5ML
$198.41
$526.27

INDOCIN IV INJ 1MG
$87.32
$227.47

INDOCIN SR CAP 75MG
$75.40
$195.40

INFASURF SUS 35MG/ML
$377.62
$1008.26

INFERGEN INJ 15MCG
$472.98
$1264.75

INFERGEN INJ 9MCG
$1161.48
$3116.58

INNOHEP INJ 20000/ML
$160.60
$424.57

INNOPRAN XL CAP 120MG
$68.17
$175.94

INNOPRAN XL CAP 80MG
$68.17
$175.94

INOVA PAD 4%
$58.88
$150.98

INOVA PAD 8%
$58.88
$150.98

INOVA 4/1 PAD ACNE CON
$114.86
$301.53

INOVA 8/2 PAD ACNE CON
$114.86
$301.53

INSPRA TAB 25MG
$132.67
$349.43

INSPRA TAB 50MG
$132.66
$349.42

INSTAT PAD 2.5X5.1
$240.80
$640.27

INSTAT PAD 7.6X10.2
$825.60
$2213.17

INTAL NEB 20MG/2ML
$95.70
$250.01

INTAL INH AER 800MCG
$76.69
$198.88

INTEGRILIN INJ 0.75MG/1
$354.76
$946.79

INTEGRILIN INJ 2MG/ML
$115.24
$302.55

INTELENCE TAB 100MG
$201.41
$534.31

INTERCED TC7 PAD 1.5""X2""
$468.89
$1253.75

INTERCED TC7 PAD 3""X4""
$958.24
$2569.93

INTRALIPID INJ 30%
$1158.00
$3107.25

INTRON-A INJ 10MU
$167.28
$442.54

INTRON-A INJ 10MU PEN
$1454.73
$3905.33

INTRON-A INJ 10MU/ML
$106.07
$277.90

INTRON-A INJ 18MU
$298.93
$796.62

INTRON-A INJ 25MU
$311.82
$831.29

INTRON-A INJ 3MU PEN
$538.64
$1441.35

INTRON-A INJ 50MU
$825.55
$2213.04

INTRON-A INJ 5MU
$64.55
$166.23

INTRON-A INJ 5MU PEN
$895.94
$2402.38

INTRON-A KIT 10MU/ML
$888.33
$2381.91

INTRON-A KIT 3MU/0.5
$225.27
$598.50

INTROPASTE PST 70%
$73.05
$189.07

INULIN INJ 100MG/ML
$383.38
$1023.75

INVANZ INJ 1GM
$685.44
$1836.20

INVEGA TAB 3MG
$430.25
$1149.82

INVEGA TAB 6MG
$430.25
$1149.82

INVEGA TAB 9MG
$644.00
$1724.74

INVERSINE TAB 2.5MG
$138.99
$366.44

INVIRASE CAP 200MG
$103.88
$272.00

INVIRASE TAB 500MG
$235.28
$625.43

IODOPEN INJ 100MCG
$274.36
$730.52

Iodoquinol-Hydrocortisone-Aloe Polysaccharide Gel 1-2-1%
$52.73
$79.56

IODOSORB GEL
$54.75
$139.86

IONAMIN-15 CAP 15MG
$69.59
$179.77

IONAMIN-30 CAP 30MG
$79.31
$205.92

IONOSOL-B/ INJ D5W
$58.19
$149.04

IONOSOL-MB INJ /D5W
$52.07
$132.66

IONOSOL-T INJ /D5W
$69.05
$178.38

IOPIDINE SOL 0.5% OP
$93.17
$243.21

IOPIDINE SOL 1% OP
$363.80
$971.09

IPLEX INJ 36/0.6ML
$2743.25
$7371.00

IPOL INJ INACTIVE
$269.86
$718.44

IQUIX SOL 1.5%
$78.88
$204.76

IRESSA TAB 250MG
$1853.54
$4978.00

Iron & B12 w/ Vitamin Inj
$69.83
$106.92

Iron Dextran Inj 50 MG/ML
$171.75
$270.00

Irrigation Solution, Physiological
$229.92
$363.06

ISENTRESS TAB 400MG
$511.12
$1367.35

ISMO TAB 20MG
$52.88
$134.84

ISO CARBACHO SOL 3% OP
$52.94
$134.99

ISOETHARINE NEB 0.2%
$89.19
$232.48

ISOLYTE-E INJ
$234.59
$623.52

ISOLYTE-P INJ /D5W
$529.97
$1418.04

ISONIAZID SYP 50MG/5ML
$59.39
$152.33

Isoniazid & Rifampin Cap 150-300 MG
$56.86
$86.17

Isoniazid Inj 100 MG/ML
$222.62
$351.38

ISOPTIN SR TAB 120MG
$57.02
$145.97

ISOPTIN SR TAB 180MG
$71.54
$185.01

ISOPTIN SR TAB 240MG
$64.96
$167.31

Isotretinoin Cap 10 MG
$372.05
$590.47

Isotretinoin Cap 20 MG
$423.81
$673.29

Isotretinoin Cap 30 MG
$373.16
$592.26

Isotretinoin Cap 40 MG
$358.14
$813.53

ISOVUE-128 INJ 26%
$410.57
$1096.88

ISOVUE-200 INJ 41%
$461.03
$1232.60

ISOVUE-250 INJ 51%
$474.34
$1268.42

ISOVUE-M 200 INJ 41%
$672.08
$1800.26

ISOVUE-M 300 INJ 61%
$892.11
$2392.07

ISRADIPINE CAP 5MG
$54.84
$140.11

ISTALOL SOL 0.5% OP
$133.47
$351.59

ISUPREL INJ 0.2MG/ML
$85.40
$222.30

Itraconazole Cap 100 MG
$212.33
$334.93

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