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These drugs are within the same therapeutic class and may provide you a choice of other medications that could be prescribed by your doctor to save you money.  Prices are subject to change and quantities may vary. Your medication may or may not be in the tier shown.

 

Formulary $10 List

Drug Name
AMITRIPTYLIN TAB 100MG - 30 TAB
AMITRIPTYLIN TAB 10MG - 30 TAB
AMITRIPTYLIN TAB 150MG - 30 TAB
AMITRIPTYLIN TAB 25MG - 30 TAB
AMITRIPTYLIN TAB 50MG - 30 TAB
DESYREL TAB 50MG - 30 TAB
DOXEPIN HCL CAP 10MG - 30 CAP
DOXEPIN HCL CAP 25MG - 30 CAP
DOXEPIN HCL CAP 75MG - 30 CAP
ELAVIL TAB 25MG - 30 TAB
ELAVIL TAB 75MG - 30 TAB
FLUOXETINE CAP 20MG - 30 CAP
IMIPRAM HCL TAB 10MG - 30 TAB
NORTRIPTYLIN CAP 10MG - 30 CAP
NORTRIPTYLIN CAP 25MG - 30 CAP
NORTRIPTYLIN CAP 50MG - 30 CAP
NORTRIPTYLIN CAP 75MG - 30 CAP
PAMELOR CAP 10MG - 30 CAP
PAMELOR CAP 75MG - 30 CAP
PROZAC CAP 20MG - 30 CAP
SARAFEM CAP 20MG - 28 CAP

Formulary $20 List
Drug Name      
ANAFRANIL CAP 25MG - 30 CAP
CELEXA TAB 10MG - 30 TAB
CELEXA TAB 20MG - 30 TAB
CELEXA TAB 40MG - 30 TAB
CITALOPRAM TAB 10MG - 30 TAB
CITALOPRAM TAB 20MG - 30 TAB
CITALOPRAM TAB 40MG - 30 TAB
CLOMIPRAMINE CAP 25MG - 30 CAP
DESIPRAMINE TAB 10MG - 30 TAB
DESIPRAMINE TAB 25MG - 30 TAB
DESIPRAMINE TAB 50MG - 30 TAB
DOXEPIN HCL CAP 100MG - 30 CAP
DOXEPIN HCL CAP 50MG - 30 CAP
FLUOXETINE CAP 10MG - 30 CAP
FLUOXETINE TAB 10MG - 30 TAB
IMIPRAM HCL TAB 25MG - 30 TAB
IMIPRAM HCL TAB 50MG - 30 TAB
MAPROTILINE TAB 25MG - 30 TAB
NORTRIPTYLIN SOL 10MG/5ML - 150 ML
PAMELOR CAP 25MG - 90 CAP
PROZAC CAP 10MG - 31 CAP
SARAFEM CAP 10MG - 28 CAP
SINEQUAN CAP 25MG - 100 CAP
SINEQUAN CAP 50MG - 100 CAP
TRAZODONE TAB 100MG - 30 TAB
TRAZODONE TAB 150MG - 30 TAB
TRAZODONE TAB 50MG - 30 TAB