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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
ALLERGY RELF TAB 10MG - 30 TAB
ALLERGY RELI TAB 50MG - 24 TAB
BANOPHEN CAP 25MG - 14 CAP
CARBINOXAMIN LIQ 4MG/5ML - 4 ML
CHLORPHENIR CAP 12MG ER - 30 CAP
CHLORPHENIR CAP 12MG TR - 60 CAP
CHLORPHENIR CAP 8MG ER - 60 CAP
COMP ALLERGY CAP 25MG - 30 CAP
COMP ALLERGY ELX 12.5/5ML - 118 ML
DIPHEDRYL CAP 25MG - 16 CAP
DIPHEDRYL ELX 12.5/5ML - 118 ML
DIPHEN AF SYP 12.5/5ML - 4 ML
DIPHENHIST CAP 25MG - 2 CAP
DIPHENHIST ELX 12.5/5ML - 480 ML
DIPHENHYDRAM CAP 25MG - 30 CAP
DIPHENHYDRAM CAP 50MG - 30 CAP
DIPHENHYDRAM ELX 12.5/5ML - 20 ML
DIPHENHYDRAM INJ 50MG/ML - 1 ML
DYTUSS SYP 12.5/5ML - 240 ML
GENAHIST CAP 25MG - 28 CAP
HYDRAMINE ELX 12.5/5ML - 120 ML
PHENERGAN INJ 25MG/ML - 3 ML
PROMETHAZINE INJ 50MG/ML - 1 ML
SM ALLERGY TAB 4MG - 24 TAB
SM VALU-DRYL CAP 25MG - 30 CAP
VALU-DRYL ELX 12.5/5ML - 120 ML

Formulary $20 List
Drug Name      
BENADRYL INJ 50MG/ML - 10 ML
BIDHIST TAB - 60 TAB
BPM TAB 6MG - 60 TAB
DEXCHLORPHEN TAB 4MG CR - 60 TAB
FEXOFENADINE TAB 30MG - 30 TAB
LODRANE 24 CAP - 20 CAP
LOHIST-12 TAB 12 HOUR - 60 TAB
NOHIST-EXT TAB 8-2.5MG - 30 TAB
PALGIC TAB 4MG - 30 TAB
PHENADOZ SUP 12.5MG - 12 MG
PHENADOZ SUP 25MG - 12 MG
PHENERGAN SUP 25MG - 12 MG
PHENERGAN SUP 50MG - 3 MG
PHENERGAN TAB 25MG - 20 TAB
PROMETHAZINE INJ 25MG/ML - 5 ML
PROMETHAZINE SUP 12.5MG - 12 MG
PROMETHAZINE SUP 25MG - 12 MG
PROMETHAZINE SYP 6.25/5ML - 240 ML
PROMETHAZINE TAB 12.5MG - 30 TAB
PROMETHAZINE TAB 25MG - 30 TAB
PROMETHAZINE TAB 50MG - 30 TAB
PROMETHEGAN SUP 12.5MG - 12 MG
PROMETHEGAN SUP 25MG - 12 MG
RYNEZE TAB 8-2.5MG - 20 TAB
UNI-TANN CHW 25MG - 15 TAB