A0158_kmart_class_dl_121913.indd

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 your home for family health
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, 1-866-435-7958, 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 modifi ed at any time without notice.
2Notwithstanding 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 your home for family health
DRUG CLASSIFICATION/DRUG NAME
$10, $15b,
$5 or $10a
Preferred generic drugs
ALLERGIES & COLD AND FLU
• 90-day supply* for $10, $15, $20 or $30 • *The day supply is based upon the average dispensing patterns for the specifi c drug and strength. 30-day supply price starts at $5. 90-day supply price starts at $10.
aSelect 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; d Select drugs for a 90-Day Supply are priced at $30.
D-METHORPHAN HB/PROMETH HCL 15-6.25/5 SYRUP Select Women’s and Men’s 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).
PREFERRED GENERIC DRUG LIST
DRUG CLASSIFICATION/DRUG NAME
$10, $15b,
DRUG CLASSIFICATION/DRUG NAME
$10, $15b,
$5 or $10a
$5 or $10a
GUAIFENESIN/DEXTROMETHORPHAN 100-10MG/5 LIQUID ANTIBIOTIC & ANTI-INFECTIVE TREATMENTS
ARTHRITIS & PAIN
your home for family health
PREFERRED GENERIC DRUG LIST
DRUG CLASSIFICATION/DRUG NAME
$10, $15b,
DRUG CLASSIFICATION/DRUG NAME
$10, $15b,
$5 or $10a
$5 or $10a
FUNGAL INFECTIONS
DIABETES
GASTROINTESTINAL HEALTH
your home for family health
PREFERRED GENERIC DRUG LIST
DRUG CLASSIFICATION/DRUG NAME
$10, $15b,
DRUG CLASSIFICATION/DRUG NAME
$10, $15b,
$5 or $10a
$5 or $10a
GLAUCOMA & EYE CARE
HEART HEALTH & BLOOD PRESSURE
your home for family health
PREFERRED GENERIC DRUG LIST
DRUG CLASSIFICATION/DRUG NAME
$10, $15b,
DRUG CLASSIFICATION/DRUG NAME
$10, $15b,
$5 or $10a
$5 or $10a
your home for family health
PREFERRED GENERIC DRUG LIST
DRUG CLASSIFICATION/DRUG NAME
$10, $15b,
DRUG CLASSIFICATION/DRUG NAME
$10, $15b,
$5 or $10a
$5 or $10a
MENTAL & NEURO HEALTH
your home for family health
PREFERRED GENERIC DRUG LIST
DRUG CLASSIFICATION/DRUG NAME
$10, $15b,
DRUG CLASSIFICATION/DRUG NAME
$10, $15b,
$5 or $10a
$5 or $10a
SKIN CONDITIONS
OTHER MEDICAL CONDITIONS
THYROID CONDITIONS
your home for family health
PREFERRED GENERIC DRUG LIST
DRUG CLASSIFICATION/DRUG NAME
$10, $15b,
DRUG CLASSIFICATION/DRUG NAME
$10, $15b,
$5 or $10a
$5 or $10a
MULTIVITS-MINERALS/FA/LYCOPENE 0.4MG-600 CAP POTASSIUM CITRATE/CITRIC ACID 1100-334/5 SOLN VITAMINS & NUTRITIONAL HEALTH
SOD/POT/K CIT/SOD CIT/CIT ACID 500-550/5 SOLN CALCIUM CARBONATE/VITAMIN D3 600 MG-200 TAB CALCIUM CARBONATE/VITAMIN D3 600 MG-400 TAB VIT B CMPLX 3/FA/VIT C/BIOTIN 1MG-60MG TAB CITRIC ACID/SODIUM CITRATE 334-500MG SOLN VIT B COMPLEX & C NO.19/FA/D3 800-2000 TAB ERGOCALCIFEROL (VITAMIN D2) 50000 UNIT CAP WOMEN’S HEALTH
FOLIC ACID/VITAMIN B COMP W-C 1 MG-100MG TAB MULTIVIT/FOLIC ACID/ZINC/VIT C 400-50-500 CAP your home for family health
PREFERRED GENERIC DRUG LIST
Select Women’s and Men’s 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. DRUG CLASSIFICATION/DRUG NAME
$10, $15b,
$5 or $10a
WOMEN’S HEALTH
MEN’S HEALTH
your home for family health

Source: https://pharmacy.kmart.com/shc/Mygofer/pdf/DrugList.pdf