Drug Price Examples
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The three tiered pricing structure includes:


Tier I
  • Preferred brand and generic drugs available for $10 or less for the scheduled quantity and dose
Amoxicillin250mgqty 20
Doxepin10mgqty 20
Hydralazine Tab50mgqty 90
Niacin Capsule Sa250mgqty 58
Naproxen250mgqty 30
Penicillin VKTab250mgqty 40
Piroxicam20mgqty 30
Tetracycline250mgqty 60

Tier II
  • Preferred brand and generic drugs available for $20 or less for the scheduled quantity and dose
Amoxapine25mgqty 20
Ampicillin500mgqty 30
Cefaclor Cap250mgqty 29
Amoxicillin Susp400mg/5mlqty 200
Dapsone100mgqty 60
Glucotrol XL2.5mgqty 36
Glyburide2.5mgqty 60
Ketoprofen75mgqty 60

Tier III
  • Preferred brand and generic drugs available for $40 or less for the scheduled quantity or dose
Allegra-DTab60-120ERqty 30
Cipro Tab250mgqty 10
Cleocin Cap75mgqty 30
Coumadinp7.5mgqty 30
Cytomel Tab50mcgqty 30
Dilantin100mgqty 100
Etodolac300mgqty 60
Lorazepam2mgqty 60

Payment must be made at the time of service in order to receive a discount.


THIS IS NOT INSURANCE, NOR IS IT INTENDED TO REPLACE INSURANCE
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