PREFERRED GENERIC DRUG LIST

These discount programs are NOT health insurance policies and are not intended as a substitute for insurance. The programs do not qualify as a minimum creditable coverage under Massachusetts law or where prohibited by law. The programs only provide for discounts on health services from participating pharmacies, and the range of the discounts will vary depending on the health services received. The programs do not make payments to pharmacies of health care services. Members are required to pay for all health care services, but will receive a discount from the contracted pharmacies. Except in the states of California, Utah, and Washington, these are custom-branded programs, provided and administered by Medical Security Card Company, LLC, (MSC), 4911 E. Broadway Rd., Ste. 100, Tucson, AZ 85711, 1-866435-7958, www.scriptsave.com and marketed by Kmart. These programs are not available in all states and the terms of each program may vary from state to state. Each program is governed by the applicable terms of the membership agreement provided upon activation and made available at www.KmartPrescriptionSavingsClub.com. MSC is not responsible for providing or guaranteeing pharmacy services or for the quality of such rendered services. Participating pharmacies are subject to change without notice and are not available in all areas. The program contracts are not protected by any state guaranty fund.2 An annual fee of $10 is payable at the time of initial enrollment and enrollment renewal. The program, as well as the prices and the list of covered drugs, can be modied at any time without notice.
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Notwithstanding the above, the programs, as described above and available in the states of California, Utah, and Washington, are custom-branded and operated directly by Kmart. The applicable terms relating to any such Kmart custom-branded and operated program shall also be available at www. KmartPrescriptionSavingsClub.com. MSC may participate or assist in the administration of such programs. For questions, please call 1-866-435-7958, log on to www.KmartPrescriptionSavingsClub.com or see the pharmacist for further details.

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DRUG CLASSIFICATION/DRUG NAME

REVISED DECEMBER 20, 2013

30-day Supply* $5 or $10 a

90-day Supply* $10, $15 b, $20c or $30d

Preferred generic drugs

*The day supply is based upon the average dispensing patterns for the specic drug and strength. 30-day supply price starts at $5. 90-day supply price starts at $10. drugs for a 30-Day Supply are priced at $10; bSelect drugs for a 90-Day Supply are priced at $15; cSelect drugs for a 90-Day Supply are priced at $20; dSelect drugs for a 90-Day Supply are priced at $30. Select Womens and Mens Health prescription medications are available in up to a 30-day supply for $12.00 each or in up to a 90-day supply for $36.00 each (see last page).
aSelect

ALLERGIES & COLD AND FLU BENZONATATE 100 MG CAP CETIRIZINE HCL 5 MG TAB CHLORPHENIRAMINE MALEATE 4 MG TAB CLEMASTINE FUMARATE 1.34 MG TAB CYPROHEPTADINE HCL 4 MG TAB DIPHENHYDRAMINE HCL 50 MG CAP D-METHORPHAN HB/PROMETH HCL 15-6.25/5 SYRUP 14 30 100 30 30a 90 120 42 90 300 90b 90d 270b 360

30-day supply* for $5 or $10 90-day supply* for $10, $15, $20 or $30

PREFERRED GENERIC DRUG LIST

90-day Supply* $10, $15 b, $20c or $30d 540b 90 36 36 60b 540b 90-day Supply* $10, $15 b, $20c or $30d 42 60b 45b 90b 90b 300b 60 84b 60b

DRUG CLASSIFICATION/DRUG NAME

30-day Supply* $5 or $10 a 180 30 12 12 20 180

DRUG CLASSIFICATION/DRUG NAME

30-day Supply* $5 or $10 a 14 20 15 30 30 100 20 28 20

GUAIFENESIN/DEXTROMETHORPHAN 100-10MG/5 LIQUID LORATADINE 10 MG TAB PROMETHAZINE HCL 12.5 MG TAB PROMETHAZINE HCL 25 MG TAB PROMETHAZINE HCL 50 MG TAB PROMETHAZINE HCL 6.25MG/5ML SYRUP ANTIBIOTIC & ANTI-INFECTIVE TREATMENTS ACYCLOVIR 200 MG CAP AMOXICILLIN 250 MG CAP AMOXICILLIN 500 MG CAP AMOXICILLIN 125 MG/5ML SUSP AMOXICILLIN 200 MG/5ML SUSP AMOXICILLIN 250 MG/5ML SUSP AMOXICILLIN 400 MG/5ML SUSP AMOXICILLIN 125 MG TAB AMPICILLIN TRIHYDRATE 250 MG CAP AMPICILLIN TRIHYDRATE 500 MG CAP BACITRACIN ZINC 500 UNIT/G OINT BACITRACIN ZINC 500 UNIT/G PACKET CEPHALEXIN 250 MG CAP CEPHALEXIN 500 MG CAP

CIPROFLOXACIN HCL 250 MG TAB CIPROFLOXACIN HCL 500 MG TAB ECONAZOLE NITRATE 1 % CRM ISONIAZID 300 MG TAB PENICILLIN V POTASSIUM 250 MG TAB PENICILLIN V POTASSIUM 250 MG/5ML SOLN PENICILLIN V POTASSIUM 500 MG TAB

30 30 30 150 100 150 100 20 28 28 30 30 28 30

90b 90b 90 450b 300b 450b 300 60b 84b 84b 90b 90b 84b 90b

SMZ/TMP 400MG-80MG TAB SMZ/TMP 800-160 MG TAB ARTHRITIS & PAIN ASPIRIN 81 MG TAB BACLOFEN 10 MG TAB BACLOFEN 20 MG TAB CYCLOBENZAPRINE HCL 5 MG TAB CYCLOBENZAPRINE HCL 10 MG TAB DIBUCAINE 1 % OINT IBUPROFEN 400 MG TAB IBUPROFEN 600 MG TAB IBUPROFEN 800 MG TAB MELOXICAM 7.5 MG TAB MELOXICAM 15 MG TAB

120 30 30 30 30 30 90 60 30 30 30

360b 90 90 90 90 90b 270b 180b 90b 90 90

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PREFERRED GENERIC DRUG LIST

90-day Supply* $10, $15 b, $20c or $30d 180b 180b 180b 90b 360d 90-day Supply* $10, $15 b, $20c or $30d 180d 180d 270d 180b 180 180 180

DRUG CLASSIFICATION/DRUG NAME

30-day Supply* $5 or $10 a 60 60 60 30 120a

DRUG CLASSIFICATION/DRUG NAME

30-day Supply* $5 or $10 a 60a 60a 90a 60 60 60 60

NAPROXEN 250 MG TAB NAPROXEN 375 MG TAB NAPROXEN 500 MG TAB NAPROXEN SODIUM 275 MG TAB TRAMADOL HCL 50 MG TAB ASTHMA ALBUTEROL SULFATE 2 MG/5 ML SYRUP ALBUTEROL SULFATE 2.5 MG/3ML VIAL-NEB IPRATROPIUM BROMIDE 0.2 MG/ML SOLN DIABETES GLIMEPIRIDE 1 MG TAB GLIMEPIRIDE 2 MG TAB GLIMEPIRIDE 4 MG TAB GLIPIZIDE 5 MG TAB GLIPIZIDE 10 MG TAB GLYBURIDE 1.25 MG TAB GLYBURIDE 2.5 MG TAB GLYBURIDE 5 MG TAB GLYBURIDE, MICRONIZED 1.5 MG TAB GLYBURIDE, MICRONIZED 3 MG TAB GLYBURIDE,MICRONIZED 6 MG TAB

GLYBURIDE/METFORMIN HCL 1.25-250MG TAB GLYBURIDE/METFORMIN HCL 2.5-500 MG TAB GLYBURIDE/METFORMIN HCL 5 MG-500MG TAB METFORMIN HCL 500 MG TAB METFORMIN HCL 850 MG TAB METFORMIN HCL 1000 MG TAB

120 75 75

360b 225b 225b

METFORMIN HCL ER 500 MG TAB FUNGAL INFECTIONS FLUCONAZOLE 150 MG TAB GASTROINTESTINAL HEALTH

3b

30 30 30 30 60 30 30a 30a 30 30 30

90 90 90 90 180 90b 90c 90c 90 90 90

CIMETIDINE 300 MG TAB CIMETIDINE 400 MG TAB DICYCLOMINE HCL 10 MG CAP DICYCLOMINE HCL 20 MG TAB DOCUSATE CALCIUM 240 MG CAP DOCUSATE SODIUM 100 MG CAP FAMOTIDINE 20 MG TAB FAMOTIDINE 40 MG TAB LACTULOSE 10 G/15 ML SOLN LACTULOSE 20 G/30 ML SOLN METOCLOPRAMIDE HCL 5 MG/5 ML SOLN

30 30 90 60 30 100 60 30a 237 237 60

90 90 270b 180b 90 300b 180 90c 711b 711b 180

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PREFERRED GENERIC DRUG LIST

90-day Supply* $10, $15 b, $20c or $30d 180 180b 180 90d 120b 90 300b 180 90 90-day Supply* $10, $15 b, $20c or $30d 90 90b 90b 90b 90b 90b 90b 90b 90b 90b 180 180 180 180b 90 90 90d 90d 180 180 180b

DRUG CLASSIFICATION/DRUG NAME

30-day Supply* $5 or $10 a 60 60 60 30a 40 30 100 60 30

DRUG CLASSIFICATION/DRUG NAME

30-day Supply* $5 or $10 a 30 30 30 30 30 30 30 30 30 30 60 60 60 60 30 30 30a 30a 60 60 60

METOCLOPRAMIDE HCL 10 MG/10ML SOLN METOCLOPRAMIDE HCL 5 MG TAB METOCLOPRAMIDE HCL 10 MG TAB OMEPRAZOLE 20 MG CAP PROCHLORPERAZINE MALEATE 5 MG TAB PROCHLORPERAZINE MALEATE 10 MG TAB RANITIDINE HCL 15 MG/ML SYRUP RANITIDINE HCL 150 MG TAB RANITIDINE HCL 300 MG TAB GLAUCOMA & EYE CARE DICLOFENAC SODIUM 0.1 % DROPS FLURBIPROFEN SODIUM 0.03 % DROPS NAPHAZOLINE HCL 0.1 % DROPS TIMOLOL MALEATE 0.25 % DROPS TIMOLOL MALEATE 0.5 % DROPS HEART HEALTH & BLOOD PRESSURE AMLODIPINE BESYLATE 2.5 MG TAB AMLODIPINE BESYLATE 5 MG TAB AMLODIPINE BESYLATE 10 MG TAB ATENOLOL 25 MG TAB ATENOLOL 50 MG TAB

ATENOLOL 100 MG TAB ATENOLOL/CHLORTHALIDONE 50 MG-25MG TAB BENAZEPRIL HCL 5 MG TAB BENAZEPRIL HCL 10 MG TAB BENAZEPRIL HCL 20 MG TAB BENAZEPRIL HCL 40 MG TAB BISOPROLOL FUMARATE/HCTZ 2.5-6.25MG TAB BISOPROLOL FUMARATE/HCTZ 5-6.25MG TAB BUMETANIDE 0.5 MG TAB BUMETANIDE 1 MG TAB

2.5 2.5 15 5 5

7.5b 7.5b 45b 15 15b

CARVEDILOL 3.125 MG TAB CARVEDILOL 6.25 MG TAB CARVEDILOL 12.5 MG TAB CARVEDILOL 25 MG TAB CLONIDINE HCL 0.1 MG TAB CLONIDINE HCL 0.2 MG TAB

30 30 30 30 30

90 90 90 90 90

DIGOXIN 125 MCG TAB DIGOXIN 250 MCG TAB DILTIAZEM HCL 30 MG TAB DILTIAZEM HCL 60 MG TAB DILTIAZEM HCL 90 MG TAB

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PREFERRED GENERIC DRUG LIST

90-day Supply* $10, $15 b, $20c or $30d 90 90b 90b 90b 90b 90b 90d 90d 90 90 90 180d 90 90b 90b 90 90 90 90 90 90 90-day Supply* $10, $15 b, $20c or $30d 90 90 90 90c 90 90 90 90 90 90c 180 180 180b 90b 180 180 180 180b 90b 90c 90

DRUG CLASSIFICATION/DRUG NAME

30-day Supply* $5 or $10 a 30 30 30 30 30 30 30a 30a 30 30 30 60a 30 30 30 30 30 30 30 30 30

DRUG CLASSIFICATION/DRUG NAME

30-day Supply* $5 or $10 a 30 30 30 30a 30 30 30 30 30 30a 60 60 60 30 60 60 60 60 30 30a 30

DILTIAZEM HCL 120 MG TAB ENALAPRIL MALEATE 2.5 MG TAB ENALAPRIL MALEATE 5 MG TAB ENALAPRIL MALEATE 10 MG TAB ENALAPRIL MALEATE 20 MG TAB ENALAPRIL-HCTZ 10-25 MG TAB FOSINOPRIL SODIUM 20 MG TAB FOSINOPRIL SODIUM 40 MG TAB FUROSEMIDE 20 MG TAB FUROSEMIDE 40 MG TAB FUROSEMIDE 80 MG TAB GEMFIBROZIL 600 MG TAB GUANFACINE HCL 1 MG TAB GUANFACINE HCL 2 MG TAB HYDRALAZINE HCL 25 MG TAB HYDROCHLOROTHIAZIDE 12.5 MG CAP HYDROCHLOROTHIAZIDE 25 MG TAB HYDROCHLOROTHIAZIDE 50 MG TAB INDAPAMIDE 1.25 MG TAB INDAPAMIDE 2.5 MG TAB LISINOPRIL 2.5 MG TAB

LISINOPRIL 5 MG TAB LISINOPRIL 10 MG TAB LISINOPRIL 20 MG TAB LISINOPRIL 40 MG TAB LISINOPRIL-HCTZ 10-12.5 MG TAB LISINOPRIL-HCTZ 20-12.5 MG TAB LISINOPRIL-HCTZ 20-25 MG TAB LOVASTATIN 10 MG TAB LOVASTATIN 20 MG TAB LOVASTATIN 40 MG TAB METOPROLOL TARTRATE 25 MG TAB METOPROLOL TARTRATE 50 MG TAB METOPROLOL TARTRATE 100 MG TAB PRAZOSIN HCL 1 MG CAP PROPRANOLOL HCL 10 MG TAB PROPRANOLOL HCL 20 MG TAB PROPRANOLOL HCL 40 MG TAB PROPRANOLOL HCL 80 MG TAB QUINAPRIL HCL 5 MG TAB SIMVASTATIN 10 MG TAB SIMVASTATIN 20 MG TAB

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PREFERRED GENERIC DRUG LIST

90-day Supply* $10, $15 b, $20c or $30d 90 90b 90 90 90 90 90 90b 90 90 90 90 90 90 90 90 90 90 90 90-day Supply* $10, $15 b, $20c or $30d 90 90 90 90 90b 180 180b 180 180 90 90 90b 90 90 90 90 90 270d 90 90 90b

DRUG CLASSIFICATION/DRUG NAME

30-day Supply* $5 or $10 a 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30

DRUG CLASSIFICATION/DRUG NAME

30-day Supply* $5 or $10 a 30 30 30 30 30 60 60 60 60 30 30 30 30 30 30 30 30 90a 30 30 30

SIMVASTATIN 40 MG TAB SOTALOL HCL 80 MG TAB SPIRONOLACTONE 25 MG TAB TERAZOSIN HCL 1 MG CAP TERAZOSIN HCL 2 MG CAP TERAZOSIN HCL 5 MG CAP TERAZOSIN HCL 10 MG CAP TORSEMIDE 10 MG TAB VERAPAMIL HCL 80 MG TAB VERAPAMIL HCL 120 MG TAB WARFARIN SODIUM 1 MG TAB WARFARIN SODIUM 2 MG TAB WARFARIN SODIUM 2.5 MG TAB WARFARIN SODIUM 3 MG TAB WARFARIN SODIUM 4 MG TAB WARFARIN SODIUM 5 MG TAB WARFARIN SODIUM 6 MG TAB WARFARIN SODIUM 7.5 MG TAB WARFARIN SODIUM 10 MG TAB MENTAL & NEURO HEALTH AMITRIPTYLINE HCL 10 MG TAB

AMITRIPTYLINE HCL 25 MG TAB AMITRIPTYLINE HCL 50 MG TAB AMITRIPTYLINE HCL 75 MG TAB AMITRIPTYLINE HCL 100 MG TAB AMITRIPTYLINE HCL 150 MG TAB BUSPIRONE HCL 5 MG TAB BUSPIRONE HCL 10 MG TAB CARBAMAZEPINE 100 MG TAB CARBAMAZEPINE 200 MG TAB CITALOPRAM HBR 20 MG TAB CITALOPRAM HBR 40 MG TAB DOXEPIN HCL 10 MG CAP FLUOXETINE HCL 10 MG CAP FLUOXETINE HCL 20 MG CAP FLUOXETINE HCL 10 MG TAB FLUPHENAZINE HCL 1 MG TAB FLUPHENAZINE HCL 2.5 MG TAB GABAPENTIN 300 MG CAP HALOPERIDOL 0.5 MG TAB HALOPERIDOL 1 MG TAB

30

90

HALOPERIDOL 2 MG TAB

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PREFERRED GENERIC DRUG LIST

90-day Supply* $10, $15 b, $20c or $30d 270b 270b 90 90 90b 90b 90b 90c 90c 90c 90 90 90b 90b 90b 90-day Supply* $10, $15 b, $20c or $30d 18b 300b 18 90 360b 90 90 90 90

DRUG CLASSIFICATION/DRUG NAME

30-day Supply* $5 or $10 a 90 90 30 30 30 30 30 30a 30a 30a 30 30 30 30 30

DRUG CLASSIFICATION/DRUG NAME

30-day Supply* $5 or $10 a 6 100 6 30 120 30 30 30 30

LITHIUM CARBONATE 150 MG CAP LITHIUM CARBONATE 300 MG CAP MIRTAZAPINE 15 MG TAB NORTRIPTYLINE HCL 10 MG CAP NORTRIPTYLINE HCL 25 MG CAP PAROXETINE HCL 10 MG TAB PAROXETINE HCL 20 MG TAB SERTRALINE HCL 25 MG TAB SERTRALINE HCL 50 MG TAB SERTRALINE HCL 100 MG TAB TRAZODONE HCL 50 MG TAB TRAZODONE HCL 100 MG TAB TRAZODONE HCL 150 MG TAB ZONISAMIDE 25 MG CAP ZONISAMIDE 50 MG CAP OTHER MEDICAL CONDITIONS ALLOPURINOL 100 MG TAB ALLOPURINOL 300 MG TAB CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH DEXAMETHASONE 0.5 MG TAB DEXAMETHASONE 0.75 MG TAB

DEXAMETHASONE 4 MG TAB LIDOCAINE HCL 20 MG/ML SOLN PHENAZOPYRIDINE HCL 100 MG TAB PHENAZOPYRIDINE HCL 200 MG TAB PREDNISOLONE 15 MG/5 ML SOLN PREDNISONE 2.5 MG TAB PREDNISONE 5 MG TAB PREDNISONE 10 MG TAB PREDNISONE 20 MG TAB SKIN CONDITIONS HYDROCORTISONE 1 % CRM HYDROCORTISONE 1 % PACKET HYDROCORTISONE 2.5 % CRM HYDROCORTISONE 2.5 % OINT HYDROCORTISONE/ALOE VERA 1 % CRM MOMETASONE FUROATE 0.1 % OINT

30 30 30 28.35 30 15 15

90b 90b 90b 85.05b 90b 45b 45b

30 30 473 30 12

90 90 1419 90b 36b

TRIAMCINOLONE ACETONIDE 0.025 % OINT THYROID CONDITIONS LEVOTHYROXINE 25 MCG TAB LEVOTHYROXINE 50 MCG TAB LEVOTHYROXINE 75 MCG TAB

30 30 30

90b 90b 90b

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PREFERRED GENERIC DRUG LIST

30-day Supply* $5 or $10 a 30 30 30 30 30 90-day Supply* $10, $15 b, $20c or $30d 90b 90b 90b 90b 90 30-day Supply* $5 or $10 a 30 30 180 30 30 30 180 90 90 90 30 30 30 30 90-day Supply* $10, $15 b, $20c or $30d 90b 90b 540b 90b 90b 90b 540b 270b 270b 270b 90b 90b 90b 90b

DRUG CLASSIFICATION/DRUG NAME

DRUG CLASSIFICATION/DRUG NAME

LEVOTHYROXINE 88 MCG TAB LEVOTHYROXINE 100 MCG TAB LEVOTHYROXINE 112 MCG TAB LEVOTHYROXINE 150 MCG TAB METHIMAZOLE 5 MG TAB VITAMINS & NUTRITIONAL HEALTH AMINO ACIDS/MULTIVITS-MIN CAP BETA-CAROTENE(A) W-C & E/MIN CAP BETA-CAROTENE(A) W-C & E/SE CAP CALCIUM CARBONATE/VITAMIN D3 600 MG-200 TAB CALCIUM CARBONATE/VITAMIN D3 600 MG-400 TAB CITRIC ACID/SODIUM CITRATE 334-500MG SOLN CO-NATAL FA TAB ERGOCALCIFEROL (VITAMIN D2) 50000 UNIT CAP FOLIC ACID 1 MG TAB FOLIC ACID/VITAMIN B COMP W-C 1 MG-100MG TAB MAGNESIUM CHLORIDE 64 MG TAB MAGNESIUM OXIDE 400 MG TAB MULTIVIT/FOLIC ACID/ZINC/VIT C 400-50-500 CAP MULTIVITAMIN WITH MINERALS CAP MULTIVITAMINS WITH MIN NO.7/FA 1 MG CAP

MULTIVITAMINS,THER W-MINERALS CAP MULTIVITS-MINERALS/FA/LYCOPENE 0.4MG-600 CAP POTASSIUM CITRATE/CITRIC ACID 1100-334/5 SOLN PRENATABS RX TAB PRENATAL LOW IRON TAB PRENATAL PLUS TAB

30 30 30 60 60 180 30 4 30 30 60 30 30 30 30

90b 90b 90b 180b 180b 540 90b 12 90 90b 180b 90b 90b 90b 90b

SOD/POT/K CIT/SOD CIT/CIT ACID 500-550/5 SOLN SODIUM FLUORIDE 0.25 (0.55) TAB SODIUM FLUORIDE 0.5 (1.1)MG TAB SODIUM FLUORIDE 1MG (2.2MG) TAB VIT B CMPLX 3/FA/VIT C/BIOTIN 1MG-60MG TAB VIT B COMPLEX & C NO.19/FA/D3 800-2000 TAB VIT C/VIT E AC/LUT/MINERAL 1 60-30-6 CAP VITAMIN A/VIT C/VIT E/SELENIUM CAP WOMENS HEALTH ALENDRONATE SODIUM 5 MG TAB ALENDRONATE SODIUM 70 MG TAB ESTRADIOL 0.5 MG TAB ESTRADIOL 1 MG TAB ESTRADIOL 2 MG TAB MEDROXYPROGESTERONE 2.5 MG TAB

30 4 30 30 30 30

90b 12b 90 90 90 90

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PREFERRED GENERIC DRUG LIST

30-day Supply* $5 or $10 a 30 10 30 90-day Supply* $10, $15 b, $20c or $30d 90 30 90b

Select Womens and Mens Health prescription medications are available in up to a 30-day supply* for $12.00 each or up to a 90-day supply* for $36.00 each.
WOMENS HEALTH ALENDRONATE SODIUM 10 MG TAB ALENDRONATE SODIUM 35 MG TAB TAMOXIFEN CITRATE 10 MG TAB TAMOXIFEN CITRATE 20 MG TAB TRI-PREVIFEM TAB MENS HEALTH FINASTERIDE 5 MG TAB 30-day Supply 30 4 60 30 28 30-day Supply 30 90-day Supply 90 12 180 90 84 90-day Supply 90

DRUG CLASSIFICATION/DRUG NAME

MEDROXYPROGESTERONE 5 MG TAB MEDROXYPROGESTERONE 10 MG TAB MEGESTROL ACETATE 20 MG TAB

A0158_KMART_CLASS_DL_121913

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