Rx Outreach Medication List September 2020 Rx Outreach

Rx Outreach Medication* Similar Medication Available Strengths 30-Day Supply 90-Day Supply 180-Day Supply

Acamprosate Calcium DR tablet Campral® 333mg

Acyclovir capsule Zovirax® 200mg $10 $13 $20

Acyclovir tablet Zovirax® 400mg, 800mg $10 $13 $20

Acyclovir 5% Ointment Zovirax® 15g

Acyclovir 5% Ointment Zovirax® 30g

Albuterol Inhalation Solution Proventil® / Ventolin® 0.083%/3mL

Albuterol Sulfate HFA ProAir HFA® / Proventil® HFA / Ventolin® 90mcg (200 inhalations)

Alclometasone Dipropionate Cream Aclovate® 15gm (0.05%)

Alendronate tablet Fosamax® 70mg (once a week dosage) $20 (limit 12) $40 (limit 24)

Alfuzosin ER tablet Uroxatral® 10mg (see Uroxatral®)

Allopurinol tablet Zyloprim® / Aloprim® 100mg, 300mg $10 $13 $20

Alprazolam tablet (CS) Xanax® / Niravam® 0.25mg, 0.5mg, 1mg, 2mg

Alprazolam XR tablet (CS) Xanax XR® / Niravam® 0.5mg, 1mg

Alprazolam XR tablet (CS) Xanax XR® / Niravam® 2mg, 3mg

Amantadine tablet Symmetrel® 100mg $14 $30 n/a

Amitriptyline tablet HCL Elavil® 10mg

Amitriptyline tablet Elavil® 25mg, 50mg

Amitriptyline tablet Elavil® 75mg, 100mg

Amitriptyline tablet Elavil® 150mg

Amlodipine tablet Norvasc® 2.5mg, 5mg, 10mg $11 $20 $40

Amlodipine/Benazepril capsule Lotrel® 5/10mg, 5/20mg, 10/20mg

Amlodipine/Benazepril capsule Lotrel® 10/40mg

Amlodipine/Olmesartan tablet Azor® 5/20mg, 5/40mg, 10/20mg, 10/40mg

Amlodipine/Valsartan tablet Exforge® 5/160mg, 5/320mg, 10/160mg, 10/320mg

Amlodipine/Valsartan/HCTZ tabletExforge HCT®

5/160/12.5mg, 5/160/25mg, 10/160/12.5mg, 10/160/25mg,

10/320/25mg

Amoxapine tablet Asendin® 100mg

Anastrozole tablet Arimidex® 1mg

Aricept® tablet Donepezil 23mg $25

Aripiprazole tablet Abilify® 2mg, 5mg, 10mg, 15mg, 20mg, 30mg

Armodafinil tablet (CS) Nuvigil® 50mg, 150mg, 200mg, 250mg

Artificial Tears 1.4% drops (OTC) N/A 15ml bottle (No prescription required)

Aspirin EC tablet (OTC) Bufferin® / Ecotrin® 325mg (No prescription required)

Aspirin EC tablet (OTC) Ecotrin® 81mg (No prescription required)

Atenolol tablet Tenormin® 25mg, 50mg, 100mg $7 $9 $18

Atenolol/Chlorthalidone tablet Tenoretic® 50/25mg, 100/25mg $10 $13 $20

Atomoxetine HCL capsule Strattera® 10mg, 18mg, 25mg

Atomoxetine HCL capsule Strattera® 40mg, 60mg

Atomoxetine HCL capsule Strattera® 80mg, 100mg

Atorvastatin tablet Lipitor® 10mg, 20mg, 40mg, 80mg $12 $25 $45

Azathioprine tablet Imuran® / Azasan® 50mg

Azelastine nasal spray Astelin® 137mcg

Baclofen tablet Lioresal® 10mg, 20mg $9 $15 n/a

Balsalazide Disodium capsule Colazal® / Giazo® 750mg

Banzel® Rufinamide 200mg, 400mg tablets; 40mg/mL Oral Suspension

Benazepril tablet Lotensin® 5mg, 10mg, 20mg, 40mg $10 $13 $20

Benazepril/HCTZ tablet Lotensin HCT® 5/6.25mg, 10/12.5mg, 20/12.5mg, 20/25mg $12 $25 $45

Benzonatate capsule Tessalon® / Zonatuss® 100mg

Benzonatate capsule Tessalon Perles® 200mg

Benztropine tablet Cogentin® 0.5mg, 1mg, 2mg $20

Betamethasone Dipropionate Cream, Aug Diprolene® AF / Alphatrex®/ Diprosone®/ Del-Beta® 15gm

Bethanechol tablet Urecholine® 5mg, 10mg, 25mg, 50mg $12 $25 n/a

Bicalutamide tablet Casodex® 50mg $12 $35 $65

Bisoprolol/HCTZ tablet Ziac® 2.5/6.25mg, 5/6.25mg, 10/6.25mg $10 $13 $20

Blood Glucose Monitor (Prodigy® Autocode) N/A N/A (No prescription required)

Blood Glucose Monitor Control Sol, Low (Prodigy®) N/A 4ml. Vial (No prescription required)

Blood Glucose Test Strips (Prodigy®) N/A Box of 50 (No prescription required)

Blood Glucose Twist Top Lancets 28G (Prodigy®) N/A Box of 100; min order - 2 boxes (No prescription required)

Brimonidine Tartrate 0.2% Solution N/A 0.2%/10ml dropper

Bromocriptine tablet Parlodel® 2.5mg

Budesonide EC capsule Entocort EC(R)® 3mg

Budesonide Inhalation Solution Pulmicort Respules® 0.25mg/2mL

Budesonide Inhalation Solution Pulmicort Respules® 0.5mg/2mL

Budesonide Nasal Spray OTC Rhinocort® Allergy OTC 8.6g/32mcg (No prescription required)

Bumetanide tablet Bumex® 0.5mg, 1mg, 2mg

Buprenorphine/Naloxone tablet (CS) Zubsolv®/ Suboxone® 2mg/0.5mg (opioid dependence treatment only)

Buprenorphine/Naloxone tablet (CS) Zubsolv®/ Suboxone® 8mg/2mg (opioid dependence treatment only)

Bupropion HCL SR tablet Wellbutrin SR® 100mg, 150mg, 200mg $30 $65 n/a

Bupropion HCL tablet Wellbutrin® 75mg $17 $40 n/a

Bupropion HCL tablet Wellbutrin® 100mg

Bupropion HCL XL tablet Wellbutrin XL® / Zyban® 150mg,

Bupropion HCL XL tablet Wellbutrin XL® / Zyban® 300mg

Buspirone tablet BuSpar® 5mg, 10mg, 15mg $11 $20 n/a

Buspirone tablet BuSpar® 30mg $26 $35 n/a

Buspirone tablet BuSpar® 7.5mg

Calcitonin-Salmon Nasal Spray Miacalcin® 200 units per spray

Calcitriol capsule Rocaltrol® 0.25mcg

Calcitriol capsule Rocaltrol® 0.5mcg

Calcium Acetate capsule PhosLo® Gelcap 667mg

Candesartan Cilexetil-HCTZ tablet Atacand HCT® 16/12.5mg

Candesartan Cilexetil-HCTZ tablet Atacand HCT® 32/12.5mg, 32/25mg

Candesartan Cilexetil tablet Atacand® 16mg, 32mg

Candesartan Cilexetil tablet Atacand® 4mg, 8mg

Capecitabine tablet Xeloda® 150mg

Capecitabine tablet Xeloda® 500mg

Capsaicin Cream, 0.025% (OTC) Zostrix® 60gm (No prescription required)

Captopril tablet Capoten® 100mg

Captopril tablet Capoten® 12.5mg, 25mg, 50mg

Carbamazepine ER tablet Tegretol XR® / Equetro® 200mg, 400mg

Carbamazepine tablet Tegretol® / Epitol® 200mg

Carbidopa / Levodopa SR tablet Sinemet CR® 25/100mg, 50/200mg $22 $55 n/a

Carbidopa / Levodopa tablet Sinemet® / Parcopa® 10/100mg, 25/100mg, 25/250mg $19 $45 $85

Carbidopa/Levodopa/Entacapone tablet Stalevo® 12.5/50/200mg, 18.75/75/200mg, 25/100/200mg,

31.25/125/200mg, 37.5/150/200mg, 50/200/200mg

Carvedilol tablet Coreg® 3.125mg, 6.25mg, 12.5mg, 25mg $10 $13 $20

Celecoxib capsule Celebrex® 400mg

Celecoxib capsule Celebrex® 50mg, 100mg, 200mg

Cetirizine HCL tablet - OTC Zyrtec® OTC / Alleroff® 10mg (no prescription required)

Cevimeline HCL capsule Evoxac® 30mg

Chlordiazepoxide capsule (CS) Librium® 5mg, 10mg, 25mg

$40 per tube

$65 per tube

$35 per inhaler canister

$15 for up to 75 vials

$30 for up to 30 tablets

$9 for up to 90 tablets$16 up to 30 tabs / $35 up to 90 tabs

$21 up to 30 tabs / $50 up to 90 tabs



$15 per tube

$22 up to 30 caps / $45 up to 90 caps


$7 for a bottle of 100



$90 for up to 30 capsules










$30 per nasal spray



Refer to Patient Forms on Website


$25 per tube

One free monitor annually

$5 per vial

$15 per box

Rx Outreach Medication List





$12 per tube







$9 per bottle




$16 up to 30 tabs / $35 up to 90 tabs$20 up to 30 tabs / $50 up to 90 tabs




$5 per box; min order $10








$10 per bottle of 100 tabs (min. 2 bottles)


$15 per dropper


$22 per bottle (min. 2 bottles)



$65 for two (2) bottles




September 2020

Chlorpromazine HCL tablet Thorazine® 10mg, 25mg, 50mg, 100m, 200mg $16 $35 n/a

Chlorthalidone tablet Hygroton® 25mg, 50mg

Chlorzoxazone tablet Parafon Forte® DSC / Lorzone® / Parafon® 500mg

Cilostazol tablet Pletal® 50mg, 100mg $14 $30 $55

Citalopram tablet Celexa® 10mg, 20mg, 40mg $11 $20 n/a

Clindamycin HCL capsule Cleocin® 150mg $19 $45 $85

Clobetasol cream 0.05% Temovate® 30g

Clomiphene Citrate tablet Clomid® / Serophene® 50mg

Clomipramine capsule Anafranil® 25mg, 50mg, 75mg $40

Clonazepam tablet (CS) Klonopin® 0.5mg

Clonazepam tablet (CS) Klonopin® 1mg, 2mg

Clonidine HCL tablet Catapres® 0.1mg, 0.2mg, 0.3mg $10 $13 $20

Clonidine patch Catapres-TTS® -3 0.3mg/day

Clopidogrel tablet Plavix® 75mg

Clotrimazole/Betamethasone Cream Lotrisone® 15g (1%/0.05%)

Colesevelam HCL tablet Welchol® 625mg

Colestipol Micronized tablet Colestid® 1gm

Cyclobenzaprine tablet Flexeril® 5mg, 10mg $12 $25 n/a

Dalfampridine ER tablet Ampyra® 10mg

Darifenacin ER tablet Enablex® 7.5mg, 15mg

Desonide ointment 0.05% Tridesilon® 60gm

Desvenlafaxine Succ ER tablet Pristiq® 25mg, 50mg, 100mg

Dexmethylphenidate HCL tablet (CS) Focalin® 2.5mg

Dexmethylphenidate HCL tablet (CS) Focalin® 5mg

Dexmethylphenidate HCL tablet (CS) Focalin® 10mg

Dextroamphetamine-Amphetamine ER capsule (CS) Dexedrine® 5mg, 10mg, 15mg, 20mg

Dextroamphetamine-Amphetamine ER capsule (CS) Dexedrine® 25mg, 30mg

Dextroamphetamine-Amphetamine tablet (CS) Adderall® XR 5mg, 10mg, 15mg, 20mg, 30mg

Dextroamphetamine sulfate ER capsule (CS) Adderall® XR 5mg, 10mg

Dextroamphetamine sulfate ER capsule (CS) Adderall® 15mg

Diazepam tablet (CS) Valium® 2mg, 5mg, 10mg

Diclofenac Sodium EC tablet Voltaren Gel® 50mg, 75mg $12 $25 n/a

Diclofenac Sodium ER tablet Voltaren® / Zorvolex® 100mg $17 $40 n/a

Diclofenac Sodium 1% gel Voltaren XR® 100g tube

Dicyclomine capsule Bentyl® 10mg $10 $13 $20

Dicyclomine tablet Bentyl® 20mg $10 $13 $20

Digoxin tablet Lanoxin® / Digitek® 0.125mg, 0.25mg

Diltiazem ER capsule (24hr) (Dilt-XR) Dilacor XR®/Cardizem CD®/Cartia XT®/Dilt-XR®/Diltia XT® 120mg, 180mg, 240mg

Diltiazem ER capsule (Dilt-CD) Cardizem CD®/Dilacor XR®/Cartia XT®/Dilt-XR®/Diltia XT® 120mg, 180mg, 240mg, 300mg, 360mg

Diltiazem ER capsule (24hr)(Dilt-CD) Tiazac®/Cardizem CD®/Dilacor XR® 360mg

Diphenoxylate/Atropine tablet (CS) Lomotil®/Lonox® 2.5/0.025mg

Divalproex NA DR tablet Depakote® 125mg, 250mg, 500mg $16 $35 $65

Divalproex SOD ER tablet Depakote ER® 250mg, 500mg

Dofetilide capsule Tikosyn® 125mcg, 250mcg, 500 mcg

DOK™ soft gel (OTC) Docusate Sodium 250mg (No prescription required)

Donepezil tablet Aricept® 5mg, 10mg $15 n/a

Donnatal® elixir (CS) (mint or grape) N/A 16.2/0.1037/0.0194/0.0065mg $0* n/a

Donnatal® tablet (CS) N/A 16.2/0.1037/0.0194/0.0065mg $0* n/a

Dorzolamide HCL 2% Solution Trusopt® 10ml dropper

Doxazosin Mesylate tablet Cardura® 1mg, 2mg, 4mg, 8mg

Doxepin capsule Sinequan® 10mg

Doxepin capsule Sinequan® 25mg, 50mg

Doxepin capsule Sinequan® 75mg, 100mg

Doxycycline Hyclate capsule Vibramycin® 50mg, 100mg $0* n/a

Duloxetine HCL DR capsule Cymbalta® 20mg, 30mg, 60mg $19 $45 n/a

Dutasteride capsule Avodart® 0.5mg

Dutoprol tablet Metoprolol Succinate ER/HCTZ 25/12.5mg, 50/12.5mg, 100/12.5mg $0* n/a

Dyrenium capsule Triamterene 50mg, 100mg $0* n/a

Econazole Nitrate 1% cream Spectazole® 15g tube

Econazole Nitrate 1% cream Spectazole® 30g tube

Eletriptan HBR tablet Relpax® 20mg

Eletriptan HBR tablet Relpax® 40mg

Enalapril Maleate Tablet Vasotec® 2.5mg, 5mg, 10mg, 20mg $10 $13 $20

Enalapril / HCTZ tablet Vaseretic® 5/12.5mg, 10/25mg $10 $13 $20

Entecavir tablet Baraclude® 0.5mg, 1mg

Epinephrine Auto Injector Adrenaclick / Epipen® / Epipen Jr® 0.15mg/0.15mL, 0.3mg/0.3mL

Eplerenone tablet Inspra® 25mg, 50mg $25 $65 n/a

Escitalopram tablet Lexapro® 5mg, 10mg, 20mg $9 $15 n/a

Esomeprazole DR capsule Nexium® 20mg, 40mg

Estradiol 0.01% Cream Estrace® 42.5g / 0.01%

Estradiol tablet Estrace® 0.5mg, 1mg, 2mg $10 $13 $20

Eszopiclone tablet (CS) Lunesta® 1mg, 2mg, 3mg

Etodolac capsule Lodine® 200mg, 300mg

Etodolac tablet Lodine® 400mg

Etodolac tablet Lodine® 500mg

Exemestane tablet Aromasin® 25mg

Ezetimibe tablet Zetia® 10mg

Famciclovir tablet Famvir® 250mg

Famciclovir tablet Famvir® 500mg

Famotidine tablet Pepcid® 20mg, 40mg $10 $13 $20

Febuxostat tablet Uloric® 40mg, 80mg

Felodipine ER tablet Plendil® ER 10mg

Felodipine ER tablet Plendil® ER 2.5mg, 5mg

Fenofibrate, micronized capsule Lofibra® (micronized) 134mg $25 $70 n/a

Fenofibrate tablet Tricor® 145mg

Fenofibrate tablet Tricor® 48mg

Fenofibrate tablet Tricor® / Lipofen® / Lofibra® 54mg, 160mg $22 $55 $95

Fenofibric Acid DR capsule Trilipix® 135mg

Ferrous Sulfate EC tablet Iron 325mg (No prescription required)

Fexofenadine OTC tablet Allegra® OTC 60mg, 180mg (No prescription required)

Finasteride tablet Propecia® 1mg

Finasteride tablet Proscar® 5mg $12 $25 $45

Flecainide Acetate tablet Tambocor® 50mg, 100mg, 150mg

Fluconazole tablet Diflucan® 100mg, 200mg

Fluocinonide topical solution Vanos® 0.05% 60ml

Fluoxetine capsule Prozac® / Sarafem® 10mg, 20mg, 40mg $9 $15 n/a

Fluticasone Nasal Spray Flonase® 50mcg

Fluticasone / Salmeterol diskus Advair Diskus® 100 / 50mcg



Fluticasone / Salmeterol Inhaler Advair®, AirDuo RespiClick® 55/14mcg, 113/14mcg, 232/14mcg (60 inhalations)

Fluvoxamine Maleate tablet Luvox® 100mg

Folic Acid tablet N/A 1mg $10 $13 $20

$35 per tube

$15 per tube

$20 per tube




$6 per bottle 100 tabs (min 2 bottles)

$40 for 100 tablets



$90 per inhaler canister


$15 per nasal spray


$120 per diskus

$150 per diskus










$40 per 6 tablets/up to 30 tablets

$40 per 6 tablets/up to 60 tablets

$50 per tube









$30 for a 2 unit pack



$80 per pack of 4


$15 per tube


$17 up to 30 tabs (30 day supply only)






$15 per bottle






$9 per bottle (100 ct.)


$100 per diskus

$60 up to 30 caps (30 day supply only)

$20 per tube

$65 per tube


$30 per bottle











Furosemide tablet Lasix® 20mg, 40mg, 80mg $7 $9 $18

Gabapentin capsule Neurontin® / Gabarone® 100mg, 300mg, 400mg

Gabapentin tablet Neurontin® / Gabarone® 600mg, 800mg

Galantamine tablet Razadyne ER® 4mg, 8mg, 12mg

Galantamine ER capsule Razadyne ER® 8mg

Galantamine ER capsule Razadyne® 16mg, 24mg

Gemfibrozil tablet Lopid® 600mg $14 $30 $55

Glimepiride tablet Amaryl® 1mg, 2mg, 4mg $10 $13 $20

Glipizide ER tablet Glucotrol XL® 2.5mg, 5mg, 10mg $16 $35 $65

Glipizide tablet Glucotrol® 5mg, 10mg $10 $13 $20

Glyburide tablet Diabeta® / Micronase® 1.25mg, 2.5mg, 5mg $10 $13 $20

Glyburide, micronized tablet Glynase® / PresTab® 1.5mg, 3mg, 6mg $10 $13 $20

Glyburide/Metformin tablet Glucovance® 1.25/250mg, 2.5/500mg, 5/500mg $14 $30 $55

Guanfacine ER tablet Intuniv® / Tenex® 1mg, 2mg, 3mg, 4mg

Halobetasol Prop ointment, 0.05% Ultravate® 15gm

Haloperidol tablet Haldol® 0.5mg, 1mg, 2mg, 5mg $12 $25 n/a

Hydralazine tablet Apresoline® 10mg, 25mg, 50mg, 100mg $12 $25 $45

Hydrochlorothiazide capsule Microzide® 12.5mg $10 $13 $20

Hydrochlorothiazide tablet Hydrodiuril® 25mg, 50mg $10 $13 $20

Hydrocortisone tablet Cortef® 5mg

Hydrocortisone tablet Cortef® 10mg

Hydroxychloroquine tablet Plaquenil® 200mg

Hydroxyurea capsule Hydrea® / Droxia® 500mg

Hydroxyzine HCL tablet Atarax® 10mg, 25mg, 50mg $12 $25 n/a

Hydroxyzine Pamoate capsule Vistaril® 25mg, 50mg $12 $25 n/a

Ibuprofen tablet Advil® / Motrin® 400mg, 600mg, 800mg $11 $20 n/a

Imatinib tablet Gleevec® 100mg

Indapamide tablet Lozol® 1.25mg, 2.5mg $10 $13 $20

Indomethacin capsule Indocin® 25mg

Indomethacin capsule Indocin® 50mg

Indomethacin ER capsule Indocin SR® 75mg

Insulin Syringes (Prodigy®) N/A 28G 12.7mm - 1cc, 31G 8mm - 1/2cc, 31G 8mm - 1/3cc

Ipratropium / Albuterol Inhalation Solution DuoNeb® 0.5-3(2.5)mg / 3mL vial

Irbesartan tablet Avapro® 75mg, 150mg, 300mg $14 $30 $55

Irbesartan / HCTZ tablet Avalide® 150mg/12.5mg, 300mg/12.5mg $14 $30 $55

Isoniazid tablet Isoniazid / INH® / Nydrazid® 300mg $20

Isosorbide Mononitrate ER tablet Imdur® / Monoket® 30mg, 60mg

Isosorbide Mononitrate ER tablet Imdur® / Monoket® 120mg

Isosorbide Mononitrate tablet Monoket® / Imdur® 10mg, 20mg $10 $13 $20

Jantoven® (Warfarin) tablet Coumadin mg: 1, 2, 2.5, 3, 4, 5, 6, 7.5, 10 $12 $25 n/a

Kapvay ER® tablet Clonidine ER 0.1mg

Ketotifen Fumarate OTC Solution Alaway®/Zaditor®/Zyrtec Itchy Eye®/Claritin Eye® 0.025% / 5mL (No prescription required)

Klor-Con packet Potassium Chloride ER 20meq

Labetalol HCL tablet Trandate®/Normodyne® 100mg, 200mg, 300mg

Lactulose Oral Solution Enulose® / Constulose®/ Generlac® 10gm/15mL

Lamotrigine ER tablet Lamictal XR® 25mg

Lamotrigine ER tablet Lamictal XR® 50mg, 100mg

Lamotrigine ER tablet Lamictal XR® 200mg

Lamotrigine tablet Lamictal® 25mg, 100mg, 150mg, 200mg $14 $30 $55

Lancets 28G Twist Top (Prodigy®) OTC N/A Box of 100; min order - 2 boxes (No prescription required)

Lanoxin® tablet Digoxin / Digitek® .0625mg, .125mg, .1875mg, .25mg

Lansoprazole DR capsule Prevacid® 30mg

Latanoprost 0.005% Solution Xalatan® 2.5ml dropper $45 (limit 3) n/a

Leflunomide tablet Arava® 10mg, 20mg

Letrozole tablet Femara® 2.5mg $14 $30 $55

Levalbuterol Solution Xopenex® 1.25mg/3mL

Levetiracetam ER tablet Keppra XR® 500mg, 750mg

Levetiracetam tablet Keppra® 1000mg

Levetiracetam tablet Keppra® 250mg, 500mg, 750mg $21 $50 $95

Levocetirizine tablet Xyzal® 5mg $16 $35 $65

Levothyroxine tablet Levoxyl®/Synthroid® Levothroid®/Unithroid®/Tirosint® mcg: 25, 50, 75, 88, 100, 112, 125, 137, 150, 175, 200, 300 $10 $13 $20

Lidocaine 2% viscous solution Xylocaine® Viscous 2% 100ml

Lidocaine 5% patch Lidoderm® 5% of lidocaine per patch

Liothyronine Sodium tablet Cytomel® 5mcg, 25mcg

Liothyronine Sodium tablet Cytomel® 50mcg

Lisinopril tablet Zestril® / Prinivil® 2.5mg, 5mg, 10mg, 20mg, 30mg, 40mg $7 $9 $18

Lisinopril/HCTZ tablet Zestoretic® / Prinzide® 10/12.5mg, 20/12.5mg, 20/25mg $7 $9 $18

Lithium Carbonate capsule Eskalith® 150mg, 300mg

Lithium Carbonate ER tablet Lithobid ER® / Eskalith® CR 300mg, 450mg $16 $35 n/a

Loperamide capsule Imodium® 2mg

Loratadine OTC tablet Claritin® OTC / Alavert® 10mg (No prescription required)

Lorazepam tablet (CS) Ativan® 0.5mg $12 $25 n/a

Lorazepam tablet (CS) Ativan® 1mg, 2mg $14 $30 n/a

Losartan Potassium tablet Cozaar® 25mg, 50mg, 100mg $11 $20 $40

Losartan/HCTZ tablet Hyzaar® 50/12.5mg, 100/12.5mg, 100/25mg $12 $25 $45

Lovastatin tablet Mevacor® 10mg, 20mg, 40mg $7 $9 $18

Loxapine capsule Loxitane® 5mg, 10mg

Loxapine capsule Loxitane® 25mg, 50mg

Magnesium Oxide tablet (OTC) MaxOx® / Uro-Mag® 400mg (No prescription required)

Meclizine HCL tablet Antivert®/Dramamine II®/Meclicot®/Meni-D®/Bonine® 12.5mg $12 $25 $50

Meclizine HCL tablet Antivert®/Dramamine II®/Meclicot®/Meni-D®/Bonine® 25mg $14 $30 $55

Medroxyprogesterone tablet Provera® 2.5mg, 5mg, 10mg $9 $15 n/a

Melatonin tablet (OTC) N/A 5mg (No prescription required)

Meloxicam tablet Mobic®/Vivlodex® 7.5mg, 15mg $11 $20 n/a

Memantine HCL tablet Namenda® 5mg, 10mg

Meprobamate tablet (CS) Equanil® 200mg, 400mg

Mesalamine DR tablet Lialda® 1.2g

Metformin HCL ER tablet Glucophage XR®/Glumetza®/Fortamet® 500mg, 750mg $10 $13 $20

Metformin HCL tablet Glucophage® 500mg, 850mg, 1000mg $10 $13 $20

Methimazole tablet Northyx® 5mg, 10mg

Methocarbamol tablet Robaxin® 500mg, 750mg

Methotrexate tablet Rheumatrex® / MTX® 2.5mg

Methylphenidate CD capsule (CS) Metadate CD® 10mg

Methylphenidate CD capsule (CS) Metadate CD® 20mg, 30mg

Methylphenidate CD capsule (CS) Metadate CD® 40mg, 50mg, 60mg

Methylphenidate LA capsule (CS) Ritalin® LA 20mg, 30mg, 40mg

Methylphenidate tablet (CS) Ritalin® 5mg, 10mg

Methylphenidate tablet (CS) Ritalin® 20mg

Methylphenidate LA capsule (CS) Ritalin® LA 10mg

Metoclopramide HCL tablet Reglan® 5mg, 10mg (1 Fill Only / No Refills) $11 $20 n/a

Metolazone tablet Zaroxolyn® / Mykrox® 2.5mg, 5mg

Metoprolol Succinate ER tablet Toprol-XL® 25mg, 50mg, 100mg $16 $35 $65

Metoprolol Succinate ER tablet Toprol-XL® 200mg $20 $45 $85

$0* Supported through a partnership

$85 up to 30 capsules (30-day supply only)



$13 per box of 100






$7 per bottle


$5 per box; min order $10


$10 per bottle of 100 tabs (min 2 bottles)


$15 up to 30 tablets (30-day supply only)

$25 up to 30 tablets (30-day supply only)


$13 per 2 bottles (60 ct)







$20 per 12 tablets

$10 per bottle








$99 for box of 30 patches










$9 per dropper







$35 per tube






$18 up to 30 pkts / $40 up to 90 pkts

Metoprolol Tartrate tablet Lopressor® 25mg, 50mg, 100mg $10 $13 $20

Metoprolol Tartrate/HCTZ tablet Lopressor HCT® 50mg/25mg, 10mg/25mg

Midodrine HCL tablet Proamatine® / Orvaten® 2.5mg, 5mg, 10mg

Minocycline capsule Minocin/Dynacin®/Myrac®/Solodyn®/Ximino® 50mg, 75mg, 100mg $19 $45 $85

Mirtazapine tablet Remeron® 15mg, 30mg, 45mg $14 $30 n/a

Modafinil tablet (CS) Provigil® 100mg, 200mg $35 $80 n/a

Mometasone Furoate Cream Elocon® 15gm

Mometasone Furoate Ointment Elocon® 15gm

Montelukast Sodium tablet Singulair® 10mg, 5mg chewable

Mupirocin 2% ointment Bactroban® 22g

Mycophenolate Mofetil capsule CellCept® 250mg

Mycophenolate Mofetil tablet CellCept® 500mg

Mycophenolic Acid DR tablet Myfortic 180mg

Mycophenolic Acid DR tablet Myfortic 360mg

Nabumetone tablet Relafen® 500mg, 750mg $17 $40 n/a

Naltrexone HCL tablet Revia® 50mg

Naproxen Sodium tablet Anaprox® DS/ Aleve /Aflaxen®/Naprelan® 550mg $13 $25 n/a

Naproxen tablet Naprosyn® 250mg, 375mg, 500mg $10 $20 n/a

Niacin ER tablet Niaspan® ER 500mg

Niacin ER tablet Niaspan® ER 1000mg

Niacin SA capsule (OTC) N/A 250mg (No prescription required)

Nifedipine capsule Procardia® / Nifediac ® / Adalat® 10mg

Nifedipine capsule Procardia® / Nifediac® / Adalat® 20mg

Nifedipine ER tablet Procardia® XL/Adalat® CC/Afeditab® CR/Nifediac® CC 30mg, 60mg, 90mg $21 $50 $95

Nilandron® tablet Nilutamide 150mg

Nitroglycerin SA capsule N/A 2.5mg

Nitroglycerin SA capsule N/A 6.5mg, 9mg

Nitroglycerin SL tablet Nitrostat® 0.3mg, 0.4mg, 0.6mg

Norethindrone Acetate tablet Aygestin® 5mg

Norethindrone tablet Ortho Micronor®/Camila®/Errin® 28's (0.35mg) $15 $35 $65

Norethindrone/Ethinyl Estradiol tablet Ovcon® 35/Balziva/Briellyn/Femcon FE 28's (0.4mg/0.035mg) $15 $35 $65

Nortriptyline HCL capsule Pamelor® / Aventyl® 10mg, 25mg, 50mg, 75mg $11 $20 n/a

Nyamyc® Topical Powder Nystatin 100,000U/g (60g bottle)

Nystatin tablet N/A 500,000 units

Nystatin/Triamcinolone ointment Mycolog II® 30gm

Olanzapine tablet Zyprexa® 2.5mg, 5mg, 7.5mg, 10mg

Olanzapine tablet Zyprexa® 15mg, 20mg

Olmesartan Medoxomil tablet Benicar® 20mg

Olmesartan Medoxomil tablet Benicar® 5mg, 40mg

Olopatadine Nasal Spray Patanase® 665mcg

Olmesartan/HCTZ tablet Benicar HCT® 20/12.5mg, 40/12.5mg, 40/25mg

Olopatadine 0.2% solution Patanol®/Pataday®/Pazeo® 0.2% / 2.5ml

Omega-3-acid ethyl esters capsule Lovaza® / Omtryg® 1gm

Omeprazole capsule Prilosec® 10mg, 20mg, 40mg $16 $35 $65

Ondansetron tablet Zofran® 4mg, 8mg

Ondansetron / Ondansetron ODT tablet Zofran ODT® 4mg, 8mg

Oxandrolone tablet (CS) Oxandrin® 2.5mg, 10mg (Requires statement of diagnosis by provider)

Oxcarbazepine tablet Trileptal® 150mg, 300mg, 600mg $15 $30 n/a

Oxybutynin Chloride ER tablet Ditropan XL® 5mg, 10mg, 15mg $19 $45 $85

Oxybutynin tablet Ditropan® 5mg $10 $13 $20

Pacerone® tablet Cordarone® / Amiodarone 100mg, 200mg, 400mg $12 $25 $45

Panretin® gel 0.1% Alitretinoin 60gm

Pantoprazole tablet Protonix® 20mg, 40mg $11 $20 n/a

Paroxetine ER tablet Paxil CR® 12.5mg, 25mg, 37.5mg

Paroxetine HCL tablet Paxil® (HCL) 10mg, 20mg, 30mg, 40mg $11 $20 n/a

Pentoxifylline ER tablet Trental® / Pentoxil® 400mg $15 $30 $55

Perphenazine tablet Trilafon® 2mg, 4mg

Perphenazine tablet Trilafon® 8mg, 16mg

Phenelzine sulfate tablet Nardil 15mg

Phentermine capsule (CS) Adipex-P® 15mg, 30mg

Phenytoin Sodium capsule Dilantin® 100mg

Pioglitazone HCL tablet Actos® 15mg, 30mg, 45mg $12 $25 n/a

Plaquenil® tablet Hydroxychloroquine 200mg (Letter of necessity required)

PNV Prenatal Multivitamin+ Iron & Folic Acid tablet N/A 27mg/1mg

Polystyrene Sulfonate Powder Kalexate®/ Kionex® 454g

Potassium Chloride ER tablet Klor-Con® / K-Dur® / K-tab® 600mg (8mEQ), 750mg (10mEQ), 1500mg (20mEQ)

Potassium Citrate ER tablet Urocit-K® 540mg (5mEQ), 1080mg (10mEQ)

Pramipexole ER tablet Mirapex ER® 0.375mg, 0.75mg, 1.5mg, 3mg, 4.5mg

Pramipexole ER tablet Mirapex ER® 2.25mg

Pramipexole tablet Mirapex® 0.125mg, 0.25mg, 0.5mg, 1mg, 1.5mg

Prasugrel tablet Effient® 5mg, 10mg

Pravastatin tablet Pravachol® 10mg, 20mg, 40mg, 80mg

Prazosin capsule Minipress® 1mg, 2mg

Prazosin capsule Minipress® 5mg

Prednisone tablet Deltasone® 1mg, 2.5mg, 5mg, 10mg, 20mg, 50mg $9 $20 n/a

Pregabalin capsule Lyrica® 50mg, 75mg, 100mg, 150mg, 200mg, 225mg, 300mg

Prevalite® Powder Cholestyramine / Questran® 4g/5.5g dose packet

Prevalite® Powder Cholestyramine / Questran® 4g/5.5g powder can (231g)

Primidone tablet Mysoline® 50mg

Primidone tablet Mysoline® 250mg

Prochlorperazine tablet N/A 5mg, 10mg $10 $13 $20

Progesterone capsule Prometrium® 100mg, 200mg

Propafenone HCL tablet Rythmol® 150mg, 225mg $18 $40 $75

Propafenone HCL tablet Rythmol® 300mg

Propranolol HCL ER capsule Inderal® LA / Inderal®XL / InnoPran® XL 60mg, 80mg, 120mg 160mg

Propranolol tablet Inderal® 10mg




Propylthiouracil tablet N/A 50mg

Pyridostigmine BR tablet Mestinon® 60mg

Quetiapine Fumarate ER tablet Seroquel XR® 50mg

Quetiapine Fumarate ER tablet Seroquel XR® 150mg, 200mg

Quetiapine Fumarate ER tablet Seroquel XR® 300mg, 400mg

Quetiapine Fumarate tablet Seroquel® 25mg, 50mg, 100mg

Quetiapine Fumarate tablet Seroquel® 200mg, 300mg

Quetiapine Fumarate tablet Seroquel® 400mg

Quinapril tablet Accupril® 5mg, 10mg, 20mg, 40mg $15 $30 $55

Quinapril/HCTZ tablet Accuretic® 10/12.5mg, 20/12.5mg, 20/25mg

Rabeprazole Sodium DR tablet Aciphex® 20mg

Raloxifene tablet Evista® 60mg

Ramipril capsule Altace® 1.25mg, 2.5mg, 5mg, 10mg $12 $25 $45

Ranitidine tablet Zantac® / Taladine® 150mg, 300mg


$0* through partnership (90 days)


Currently Unavailable / Products Recalled

$20 per bottle of 100 tabs


$55 per bottle (240 sprays)


$25 per bottle










$13 per tube



$15 per tube

$15 per tube








$0 supported through partnership








$25 per can



$12 for up to 30 packets




$40 per dropper








$40 per can






$0 Supported through partnership


















$20 per tube

Ranolazine ER tablet Ranexa® 1000mg

Ranolazine ER tablet Ranexa® 500mg

Rasagiline Mesylate tablet Azilect® 0.5mg

Rasagiline Mesylate tablet Azilect® 1mg

Repaglinide tablet Prandin® 0.5mg, 1mg, 2mg

Risedronate Sodium tablet Actonel® / Atelvia® 150mg (once a month dosage)

Risedronate Sodium tablet Actonel® / Atelvia® 35mg (once a week dosage)

Risperidone tablet Risperdal® 0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg $20 $45 n/a

Rivastigmine Tartrate capsule Exelon® 1.5mg, 3mg, 4.5mg, 6mg

Rizatriptan tablet Maxalt® / Maxalt-MLT 5mg, 10mg

Ropinirole ER tablet Requip XL® 2mg



Ropinirole ER tablet Requip XL® 8mg,12mg

Ropinirole HCL tablet Requip® 0.25mg, 0.5mg, 1mg, 2mg, 4mg, 5mg $20 $45 $85

Rosuvastatin Calcium tablet Crestor® 5mg, 10mg, 20mg, 40mg

Salagen® tablet Pilocarpine 5mg, 7.5mg

Sertraline tablet Zoloft® 25mg, 50mg, 100mg $13 $25 n/a

Sevelamer Carbonate tablet Renvela® 800mg

Sildenafil Citrate tablet Revatio® 20mg

Sildenafil Citrate tablet Viagra® 25mg, 50mg, 100mg

Silodosin capsule Rapaflo® 4mg, 8mg

Simvastatin tablet Zocor® 5mg, 10mg, 20mg, 40mg, 80mg $10 $20 $35

Solifenacin tablet Vesicare® 5mg, 10mg

Sotalol tablet Sorine® / Betapace 80mg,120mg,160mg, 240mg $10 $20 n/a

Spironolactone tablet Aldactone® 25mg, 50mg, 100mg $11 $20 $30

Spironolactone/HCTZ tablet Aldactazide® 25mg/25mg

Sprintec® tablet Ortho-Cyclen® / Estarylla / Mononessa / Previfem 28's $35 (limit 3) $65 (limit 6)

Sucralfate tablet Carafate® 1gm

Sulfamethoxazole/Trimethoprim DS Bactrim® DS / Septra® DS 800mg/160mg $10 $13 $20

Sulfasalazine tablet Sulfazine® / Azulfidine® 500mg

Sulfasalazine DR tablet Azulfidine EN-tabs / Sulfazine EC® 500mg

Sumatriptan Succ tablet Imitrex® 25mg



Tacrolimus capsule Prograf® / Astagraf XL® 0.5mg, 1mg

Tacrolimus capsule Prograf® / Astagraf XL® 5mg

Tadalafil tablet Cialis® 2.5mg, 5mg

Tadalafil tablet Cialis® 10mg

Tadalafil tablet Adcirca® / Cialis® 20mg

Tamoxifen Citrate tablet Soltamox® 10mg

Tamoxifen Citrate tablet Soltamox® 20mg

Tamsulosin capsule Flomax® 0.4mg $14 $30 $55

Tazarotene 0.1% cream Tazorac® 30g

Telmisartan tablet Micardis® 20mg, 40mg, 80mg $16 $35 $65

Telmesartan HCTZ tablet Micardis HCT® 40/12.5mg, 80/12.5mg, 80/25mg

Temazepam capsule (CS) Restoril® 15mg, 30mg

Tenofovir Disoproxil Fumarate tablet Viread® 300mg

Terazosin capsule Hytrin® 1mg, 2mg, 5mg, 10mg $10 $13 $20

Testosterone Cypionate Solution (CS) Depo® - Testosterone 200mg/ml - 1ml vial

Testosterone Gel packet (CS) Vogelxo® / AndroGel® / Testim® / Fortesta® 50mg (5g of gel per packet)

Testosterone Gel packet (CS) AndroGel® 1.62% (1.25g of gel per packet)

Testosterone Gel pump (CS) Vogelxo® / AndroGel® / Testim® / Fortesta® 88g pump (12.5mg per pump actuation)

Testosterone Gel pump (CS) AndroGel® 1.62% 88g pump 1.62% (20.25mg per pump actuation)

Testosterone Gel tube (CS) Vogelxo® 50mg (5g of gel per tube)

Theophylline ER tablet Theochron 300mg, 450mg

Tizanidine HCL tablet Zanaflex® 2mg, 4mg $17 $40 n/a

Tolterodine ER capsule Detrol LA® 2mg, 4mg

Tolterodine Tartrate tablet Detrol® 1mg, 2mg

Topiramate ER capsule Qudexy XR® / Trokendi XR® 25mg, 50mg, 100mg, 150mg, 200mg $10 $25 $45

Topiramate tablet Topamax® / Topiragen® 25mg, 50mg, 100mg, 200mg $16 $35 $65

Tramadol HCL ER tablet (CS) Ultram® ER/Ryzolt®/ConZip® 100mg, 200mg

Tramadol HCL ER tablet (CS) Ultram® ER/Ryzolt®/ConZip® 300mg

Tramadol tablet (CS) Ultram® 50mg

Tramadol/Acetaminophen tablet (CS) Ultracet® 37.5mg/325mg

Trandolapril tablet Mavik® 1mg, 2mg, 4mg $14 $30 $55

Trazodone tablet Desyrel® 50mg, 100mg, 150mg $7 $10 n/a

Tretinoin 0.025% cream Avita® 20g

Tretinoin 0.05% cream Retin-A® 20g

Tri-Sprintec® tablet Ortho-Tri-Cyclen®/Tri-Estarylla/Tri-Previfem 28's $35 (limit 3) $65 (limit 6)

Triamcinolone cream 0.1% N/A 454gm (0.1%)

Triamcinolone cream Kenalog® 30gm (0.1%)

Triamcinolone ointment 0.1% N/A 454gm (0.1%)

Triamcinolone ointment N/A 80gm (0.10%)

Triamterene/HCTZ capsule Dyazide® 37.5/25mg $10 $13 $20

Triamterene/HCTZ tablet Maxzide® 37.5/25mg, 75/50mg $10 $13 $20

Trospium Chloride tablet Sanctura® 20mg

Uroxatral® tablet Alfuzosin HCL ER 10mg

Ursodiol capsule Actigall® 300mg

Ursodiol tablet Urso 250® 250mg

Ursodiol tablet Urso Forte® 500mg

Valacyclovir HCL tablet Valtrex® 1gm

Valacyclovir HCL tablet Valtrex® 500mg

Valproic acid capsule Depakene® / Stavzor® 250mg $20 $50 $80

Valsartan tablet Diovan® 40mg, 80mg

Valsartan tablet Diovan® 160mg, 320mg

Valsartan/HCTZ tablet Diovan HCT® 80/12.5mg, 160/12.5mg, 160/25mg, 320/12.5mg, 320/25mg $16 $35 $65

Vandazole 0.75% Gel Metronidazole Vaginal 70g tube

Venlafaxine ER capsule Effexor XR® 37.5mg, 75mg, 150mg $19 $45 n/a

Venlafaxine tablet Effexor® 25mg, 37.5mg, 50mg, 75mg, 100mg $19 $45 n/a

Verapamil ER capsule Verelan® 120mg, 180mg, 240mg

Verapamil SR tablet Calan-SR® / Isoptin-SR® 120mg, 180mg, 240mg $12 $25 $40

Verapamil tablet Calan® 40mg, 80mg, 120mg

Vitamin B-6 tablet (OTC) N/A 50mg (No prescription required)

Vitamin B-6 tablet (OTC) N/A 100mg (No prescription required)

Vitamin D3 tablet (OTC) (cholecalciferol) N/A 400IU (No prescription required)

Vitamin D3 capsule (OTC) N/A 50,000IU (No prescription required)

Zafirlukast tablet Accolate® 10mg, 20mg

Zaleplon capsule (CS) Sonata® 5mg, 10mg

Zidovudine tablet AZT / Retrovir® 300mg

Ziprasidone capsule Geodon® 20mg, 40mg, 60mg, 80mg

Zolpidem Tartrate ER tablet (CS) Ambien CR® 6.25mg, 12.5mg

Zolpidem Tartrate tablet (CS) Ambien® 5mg, 10mg $14 $30 n/a




$90 per tube

$25 for a carton of 2 pumps


$20 per vial

$25 for a carton of 30 packets

$25 for a carton of 30 tubes





$75 for up to 15 packets




$50 per pack of 4 tablets









$20 per jar




$80 per dosage











$40 per tube

$50 per tube







$18 per jar








$30 per tube






$15 for 12 capsules




$30 for 60 tablets






$70 per pump


$12 per tube

$20 per tube


Zonegran® capsule Zonisamide 25mg Letter of necessity required $30 n/a

Zonegran® capsule Zonisamide 100mg Letter of necessity required

Zonisamide capsule Zonegran® 50mg, 100mg

(CS) Controlled Substance

Rx Outreach is a fully licensed pharmacy.

Rx Outreach reserves the right to add or delete medicines available, change fees, or discontinue the program at any time

These are the only medications we offer at this time. If a medication is not on this list, it is not currently available from Rx Outreach.

All prescriptions are evaluated by a pharmacist before being filled. For some medications, the quantity may be less because of dose restrictions set by therapeutic guidelines and state regulations.

Rx Outreach, Inc. / P. O. Box 66536 / St. Louis, MO 63166-6536 / 888-RXO-1234 / www.rxoutreach.org



Documents

Rx Outreach Medication List September 2020 Rx Outreach