Drug Cost Estimates — Brands
Note: The retail pharmacy prices displayed below are estimates only. The actual price of your prescription
may be higher or lower and will be calculated by your pharmacy at the time of purchase.
Drug
Estimated Cost for
a 30 Day Supply
Drug
Estimated Cost for
a 30 Day Supply
ABILIFY TAB 10MG
$383.33
AMBIEN TAB 10MG
$128.06
ABILIFY TAB 5MG
$401.78
AMBIEN TAB 5MG
$129.83
ACCU-CHEK TES COMFORT
$95.01
AMBIEN CR
TAB 12.5MG
$97.79
ACIPHEX TAB 20MG
$180.80
$268.27
ACTONEL TAB 35MG
$96.25
ANDROGEL
GEL 1%(50MG)
ACTOS TAB 15MG
$130.47
ARICEPT TAB 10MG
$169.61
ACTOS TAB 30MG
$204.06
ARIMIDEX TAB 1MG
$295.42
ACTOS TAB 45MG
$222.27
$269.93
ADDERALL XR
CAP 10MG
$149.36
ASACOL TAB
400MG DR
ATRIPLA TAB
$1,358.36
ADDERALL XR
CAP 15MG
$122.04
AVANDIA TAB 4MG
$148.81
AVANDIA TAB 8MG
$212.51
ADDERALL XR
CAP 20MG
$152.79
AVONEX KIT
$1,581.00
BD TEST MIS
$171.29
ADDERALL XR
CAP 25MG
$135.02
BENZACLIN GEL 1-5%
$111.95
ADDERALL XR
CAP 30MG
$133.90
BETASERON
INJ 0.3MG
$1,867.85
ADVAIR DISKU
MIS 100/50
$143.98
BONIVA TAB 150MG
$105.18
BYETTA INJ 10MCG
$229.57
ADVAIR DISKU
MIS 250/50
$179.32
CELEBREX
CAP 200MG
$130.42
ADVAIR DISKU
MIS 500/50
$246.40
CELLCEPT CAP 250MG
$517.06
CELLCEPT TAB 500MG
$642.53
ALDARA CRE 5%
$248.04
CHANTIX PAK
$95.00
ALLEGRA-D
TAB 12 HOUR
$89.07
CHANTIX PAK
$95.25
CHANTIX PAK 1MG
$96.01
ALLEGRA-D
TAB 24 HOUR
$103.16
CHANTIX TAB 1MG
$97.51
CIALIS TAB 20MG
$76.19
ALTACE CAP 10MG
$83.98
continued
Note: The retail pharmacy prices displayed below are estimates only. The actual price of your prescription
may be higher or lower and will be calculated by your pharmacy at the time of purchase.
Estimated Cost for
a 30 Day Supply
Drug
Estimated Cost for
a 30 Day Supply
CIPRODEX SUS
0.3-0.1%
$90.11
ENBREL INJ 50MG/ML
$1,845.67
EVISTA TAB 60MG
$119.86
CLARINEX TAB 5MG
$102.25
FEMARA TAB 2.5MG
$273.09
COMBIVENT AER
$103.92
FLOMAX CAP 0.4MG
$87.48
CONCERTA TAB 18MG
$127.39
$111.06
FLOVENT HFA AER
110MCG
$111.23
CONCERTA TAB 27MG
CONCERTA TAB 36MG
$143.45
$178.11
CONCERTA TAB 54MG
$124.66
FLOVENT HFA AER
220MCG
COPAXONE KIT
20MG/ML
$1,737.54
FORTEO SOL 750/3ML
$705.57
FOSAMAX TAB 70MG
$95.70
COREG TAB 25MG
$127.71
FREESTYLE TES
$114.53
COZAAR TAB 100MG
$87.66
$3,209.83
COZAAR TAB 50MG
$71.42
GENOTROPIN
INJ 13.8MG
CRESTOR TAB 10MG
$104.28
GLEEVEC TAB 100MG
$2,963.57
CRESTOR TAB 20MG
$103.53
GLEEVEC TAB 400MG
$4,570.44
CYMBALTA CAP 30MG
$194.54
HUMALOG INJ 100/ML
$169.92
CYMBALTA CAP 60MG
$129.47
HUMIRA KIT 40MG/0.8
$1,907.11
DEPAKOTE TAB
500MG DR
$204.88
HUMIRA PEN KIT
40MG/0.8
$1,747.17
DEPAKOTE ER
TAB 500MG
$166.85
HYZAAR TAB 100-25
$87.85
IMITREX KIT RF
$491.94
DETROL LA CAP 4MG
$114.83
IMITREX TAB 100MG
$227.14
DIFFERIN GEL 0.1%
$120.51
IMITREX TAB 25MG
$257.44
DIOVAN TAB 160MG
$75.32
IMITREX TAB 50MG
$231.94
DIOVAN TAB 320MG
$91.29
KEPPRA TAB 500MG
$295.03
DIOVAN TAB 80MG
$69.59
$40,078.46
DIOVAN HCT
TAB 160/12.5
$86.23
KOGENATE FS KIT
1000/BS
LAMICTAL TAB 100MG
$245.30
DIOVAN HCT
TAB 160/25MG
$90.79
LAMICTAL TAB 150MG
$232.36
LAMICTAL TAB 200MG
$227.55
DUONEB SOL
$152.13
LAMICTAL TAB 25MG
$316.98
EFFEXOR XR
CAP 150MG
$151.48
LAMISIL TAB 250MG
$361.30
EFFEXOR XR
CAP 37.5MG
$137.87
LANTUS INJ 100/ML
$114.22
LANTUS INJ OPTICLIK
$173.27
EFFEXOR XR
CAP 75MG
$178.27
LEVAQUIN TAB 500MG
$105.06
LEVAQUIN TAB 750MG
$153.47
ENBREL INJ 25MG
$1,455.43
LEXAPRO TAB 10MG
$88.69
ENBREL INJ 50MG/ML
$1,747.43
LEXAPRO TAB 20MG
$92.50
Drug
continued
Note: The retail pharmacy prices displayed below are estimates only. The actual price of your prescription
may be higher or lower and will be calculated by your pharmacy at the time of purchase.
Drug
Estimated Cost for
a 30 Day Supply
LIDODERM DIS 5%
$214.25
LIPITOR TAB 10MG
$96.04
LIPITOR TAB 20MG
$131.00
LIPITOR TAB 40MG
$128.99
LIPITOR TAB 80MG
$121.85
LOTREL CAP 10-20MG
$109.84
LOTREL CAP 5-20MG
$105.40
LOVENOX INJ 100/1ML
$905.17
LOVENOX INJ 40/0.4ML
$479.08
LOVENOX INJ 80/0.8ML
$866.95
LUNESTA TAB 2MG
$115.28
LUNESTA TAB 3MG
$115.41
MAXALT TAB 10MG
Drug
Estimated Cost for
a 30 Day Supply
PREMARIN TAB
0.625MG
$48.30
PREVACID CAP
30MG DR
$204.50
PROAIR HFA AER
$35.47
PROGRAF CAP 1MG
$554.32
PROTONIX TAB 40MG
$140.39
PROVIGIL TAB 200MG
$372.82
PULMICORT
SUS 0.25MG/2
$196.51
PULMICORT
SUS 0.5MG/2
$245.05
$215.47
PULMOZYME SOL
1MG/ML
$2,080.99
NASACORT AQ AER
55MCG/AC
$83.83
REBIF INJ 44/0.5
$1,749.96
NASONEX SPR 50MCG/
AC
$80.92
RECOMBINATE
INJ 801-1240
$35,727.06
NEULASTA INJ
6MG/0.6M
$3,211.41
RELPAX TAB 40MG
$169.33
RESTASIS EMU 0.05%
$144.37
NEXIUM CAP 40MG
$180.97
REVLIMID CAP 25MG
$6,941.07
NIASPAN TAB 500MG
ER
$107.83
RISPERDAL TAB 0.5MG
$178.77
RISPERDAL TAB 1MG
$190.12
NOVOLOG INJ 100/ML
$182.01
SEROQUEL TAB 100MG
$182.11
NOVOLOG INJ
FLEXPEN
$189.47
SEROQUEL TAB 200MG
$337.59
SEROQUEL TAB 25MG
$131.80
NUTROPIN AQ INJ
10MG/2ML
$2,825.33
SEROQUEL TAB 300MG
$359.61
SEROQUEL TAB 50MG
$177.36
NUVARING MIS
$76.06
SINGULAIR CHW 4MG
$100.38
OMNICEF CAP 300MG
$94.69
SINGULAIR CHW 5MG
$103.33
OMNICEF SUS 250MG/5 $117.71
SINGULAIR TAB 10MG
$108.11
ONE TOUCH
TES ULTRA
$110.91
SKELAXIN TAB 800MG
$123.08
ORTHO EVRA
DIS WEEK
$78.03
ORTHO TRI-CY TAB LO
$84.51
PATANOL SOL 0.1% OP
$79.76
PAXIL CR TAB 25MG
$116.14
PEGASYS KIT
$1,787.28
PLAVIX TAB 75MG
$142.11
SPIRIVA CAP HANDIHLR $132.25
STRATTERA CAP 25MG
$160.75
STRATTERA CAP 40MG
$171.75
STRATTERA CAP 60MG
$136.52
SYNAGIS INJ 100MG/ML $1,760.46
SYNAGIS INJ 50MG
$1,746.01
TARCEVA TAB 150MG
$3,609.47
TEMODAR CAP 100MG
$2,395.69
continued
Note: The retail pharmacy prices displayed below are estimates only. The actual price of your prescription
may be higher or lower and will be calculated by your pharmacy at the time of purchase.
Drug
Estimated Cost for
a 30 Day Supply
Drug
Estimated Cost for
a 30 Day Supply
THALOMID CAP 50MG
$6,261.77
VYTORIN TAB 10-40MG
$101.92
TOPAMAX TAB 100MG
$282.76
VYTORIN TAB 10-80MG
$99.97
TOPAMAX TAB 25MG
$172.31
$177.37
TOPAMAX TAB 50MG
$251.91
WELLBUTRIN
TAB XL 150MG
TOPROL XL TAB 100MG
$50.11
XALATAN SOL 0.005%
$61.58
TOPROL XL TAB 50MG
$33.36
XELODA TAB 500MG
$1,313.33
TRICOR TAB 145MG
$116.42
XOLAIR SOL 150MG
$1,840.61
TRILEPTAL TAB 300MG
$233.89
$76.80
TRILEPTAL TAB 600MG
$324.17
YASMIN 28
TAB 3-0.03MG
TRUVADA TAB
$875.49
YAZ TAB 3-0.02MG
$77.38
VALTREX TAB 1GM
$177.17
ZETIA TAB 10MG
$101.89
VALTREX TAB 500MG
$146.47
ZETIA TAB10MG
$101.10
VIAGRA TAB 100MG
$67.95
ZOMIG TAB 5MG
$182.55
VIAGRA TAB 50MG
$86.17
ZYRTEC SYP 1MG/ML
$43.79
VIGAMOX DRO 0.5%
$55.62
ZYRTEC TAB 10MG
$72.59
VYTORIN TAB 10-20MG
$99.53
3321 © Prime Therapeutics LLC 06/07