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Express Scripts Specialty Distribution Services, Inc.
PO Box 66536
Saint Louis, MO 63166-6536
1-800-769-3880
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Rx Outreach Medication List

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ALL A B C D E F G H I J K L M N O P Q R S T U V W Z

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DiseaseRx Outreach Medication ListBrand or Generic EquivalentAvailable strengths offered through Rx OutreachPrice per 90 day supplyPrice per 180 day supply
Muscle SpasmsCyclobenzaprine tabletFlexeril®10mg$25n/a
Muscle SpasmsTizanidine HCL tabletZanaflex®2mg, 4mg$30n/a
NauseaMeclizine HCL tabletAntivert®12.5mg, 25mg $30$55
NauseaOndansetron ODT tabletZofran ODT®4mg, 8mg$50$95
NauseaOndansetron tabletZofran ®4mg, 8mg$50$95
Nausea / PsychosisProchlorperazine tabletN/A5mg, 10mgn/a$20
Nausea / StomachMetoclopramide HCL tabletReglan®5mg, 10mg$20 (limit 1 with no refills)n/a
Oral ContraceptivesPrevifem(tm) tabletOrtho-Cyclen®28's$35 (limit 3)$65 (limit 6)
Oral ContraceptivesTri-Previfem(tm) tablet Ortho-Tri-cyclen®28's$35 (limit 3)$65 (limit 6)
OsteoporosisAlendronate tabletFosamax®70mg (Once a week dosage)$25 (limit 12) $45 (limit 24)
PainTramadol tablet (CS)Ultram®50mg$35n/a
Parkinson'sBenztropine tabletN/A0.5mg, 1mg, 2mgn/a$20
Parkinson'sCarbidopa / Levodopa SR tabletSinemet CR®25/100mg, 50/200mg$45$85
Parkinson'sCarbidopa / Levodopa tabletSinemet CR®10/100mg, 25/100mg, 25/250mg$45$85
Blood Pressure/HeartCarvedilol tablet Coreg®3.125mg, 6.25mg, 12.5mg, 25mgn/a$20
ProstateFinasteride tabletProscar®5mg$50$95
PsychosisHaloperidol tabletN/A0.5mg, 1mg, 2mg, 5mg$25n/a
SeizuresCarbamazepine tabletTegretol®200mgn/a$20
SeizuresGabapentin capsuleNeurontin®100mg, 300mg, 400mg$35$65
SeizuresPhenytoin Sodium capsuleDilantin®100mg$45$85
Seizures / Anxiety / InsomniaClonazepam tablet (CS)Klonopin®0.5mg, 1mg, 2mg$35n/a
Seizures / PainGabapentin tabletNeurontin®600mg, 800mg$35$65
ThyroidLevothyroxine tabletLevoxyl® or Synthroid®25mcg, 50mcg, 75mcg, 88mcg, 100mcg, 112mcg, 125mcg, 137mcg, 150mcg, 175mcg, 200mcg, 300mcgn/a$20
TuberculosisIsoniazid tabletIsoniazid/INH®300mgn/a$20
Viral InfectionAcyclovir capsuleZovirax®200mgn/a$20
Viral InfectionAcyclovir tabletZovirax®400mg, 800mg n/a$20
SeizuresDivalproex NA DR tabletDepakote®125mg, 250mg, 500mg$45$85
Blood Pressure / HeartRamipril capsuleAltace®1.25mg, 2.5mg, 5mg, 10mg$25$45
Sleep/insomniaZaleplon capsule (CS)Sonata®5mg, 10mg $35n/a
Cancer /Sickle Cell / PsoriasisHydroxyurea capsuleHydrea®500mg (180 capsules)$45n/a
Cancer /Sickle Cell / PsoriasisHydroxyurea capsuleHydrea®500mg (270 capsules)$65n/a
Cancer / Sickle Cell / PsoriasisHydroxyurea capsuleHydrea®500mg (369 capsules)$85n/a
Cancer /Sickle Cell / PsoriasisHydroxyurea capsuleHydrea®500mg (450 capsules)$105n/a
Cancer / Sickle Cell / PsoriasisHydroxyurea capsuleHydrea®500mg (540 capsules)$120n/a
Cancer / Sickle Cell / PsoriasisHydroxyurea capsuleHydrea®500mg (630 capsules)$135n/a
Blood / heartPotassium Chloride ER tabletKlor-Con 10MEq750mg (10MEQ)n/a$20
Blood / heartPotassium Chloride ER tabletK-Dur 20/Klor-Con M201500mg (20MEQ)$30$55
DepressionVenlafaxine tabletEffexor®25mg, 37.5mg, 50mg, 75mg, 100mg$45n/a
ProstateBicalutamideCasodex®50mg$35$65
DepressionBupropion HCL XLWellbutrin XL®150mg, 300mg$65n/a
SeizuresLamotrigineLamictal®25mg, 100mg, 150mg, 200mg$40$75
SeizuresLevetiracetamKeppra®250mg, 500mg 750mg$50$95
PsychosisRisperidoneRisperdal®0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg$45n/a
Parkinson’sRopinirole HCLRequip®0.25mg, 0.5mg, 1mg, 2mg$45$85
MigrainesSumatriptan SuccImitrex®25mg, 50mg, 100mg$35n/a
SeizuresTopiramateTopamax®25mg, 50mg, 100mg, 200mg$35$65
Cholesterol / TriglyceridesFibricor™Fenofibric Acid105mg$15n/a
AllergyFexofenadine HCL tablet Allegra®30mg, 60mg, 180mg$50$95
AllergyFluticasone nasal spray Flonase®50mcg $35 (limit 4)$65 (limit 8)
Angina / Chest PainNitroglycerin SA capsuleN/A2.5mg, 6.5mg, 9mg$45$85
Angina / Chest PainNitroglycerin tablet sublingual Nitroquick®0.4mgn/a$20 (limit 6)
Angina / HeartIsosorbide Mononitrate ER tablet Imdur®30mg, 60mg 120mgn/a$20
Angina / HeartIsosorbide Mononitrate tabletISMO® or Monoket®10mg, 20mgn/a$20
Anti-infectiveClindamycin HCL capsuleCleocin®150mg$45$85
Anti-infectiveMinocycline capsuleMinocin / Dynacin®50mg, 75mg, 100mg$45$85
Anti-infectiveMinocycline HCL tabletDynacin®50mg, 75mg$45$85
Anti-infectiveSulfamethoxazole/Trimethoprim DSBactrim® DS or Septra® DS800mg/160mgn/a$20
Anti-thyroidPropylthiouracil tabletN/A50mg$35$65
AnxietyAlprazolam tablet (CS)Xanax®0.25mg, 0.5mg, 1mg, 2 mg$35n/a
AnxietyBuspirone tabletBuSpar®5mg, 10mg, 15mg, 30mg$20n/a
AnxietyLorazepam tablet (CS)Ativan®0.5mg, 1mg, 2mg$35n/a
Anxiety / SeizuresDiazepam tablet (CS)Valium®2mg, 5mg, 10mg$35n/a
ArthritisIbuprofen tabletMotrin®400mg, 600mg, 800mg$20n/a
ArthritisNaproxen tabletNaprosyn®250mg, 375mg, 500mg$20n/a
Arthritis / MalariaHydroxychloroquine tabletPlaquenil®200mg$25$45
Arthritis / PainDiclofenac EC tabletVoltaren®25mg, 50mg, 75mg$25n/a
Arthritis / PainDiclofenac ER tabletVoltaren XR®100mg$40n/a
Arthritis / PainEtodolac capsuleLodine®200mg, 300mg$30n/a
Arthritis / PainEtodolac tabletLodine®400mg, 500mg$30n/a
Arthritis / PainMeloxicam tabletMobic®7.5mg, 15mg$20n/a
Arthritis / PainNabumetone tabletN/A500mg, 750mg$35n/a
Arthritis / PainNaproxen Sodium tabletAnaprox® DS550mg$25n/a
Arthritis / PainPiroxicam capsuleFeldene®10mg, 20mg$15n/a
Arthritis/PainOxaprozin TabletDayPro®600mg$50n/a
AsthmaTheophylline ER tabletN/A100mg, 200mg, 300mg$30$55
Bipolar DisorderLithium Carbonate capsuleN/A300mg$25n/a
BladderOxybutynin tabletDitropan®5mgn/a$20
BloodCilostazol tabletPletal®50mg, 100mg$30$55
BloodPentoxifylline ER tabletTrental®400mg$30$55
Blood / HeartFolic Acid tabletN/A1mgn/a$20
Blood / HeartTiclopidine tabletTiclid®250mg$35$65
Blood / HeartWarfarin tabletsCoumadin®1mg, 2mg, 2.5mg, 3mg, 4mg, 5mg, 6mg, 7.5mg, 10mg$25n/a
Blood Pressure / HeartAfeditab CR tablet (Nifedipine CR)Adalat CC® / Nifediac CC®30mg, 60mg$50$95
Blood Pressure / HeartAmlodipine tabletNorvasc®2.5mg, 5mg, 10mg$25$45
Blood Pressure / HeartAtenolol tabletTenormin®25mg, 50mg, 100mgn/a$20
Blood Pressure / HeartAtenolol/Chlorthalidone tabletTenoretic®50/25mg, 100/25mgn/a$20
Blood Pressure / HeartBenazepril tabletLotensin®5mg, 10mg, 20mg, 40mgn/a$20
Blood Pressure / HeartBenazepril/HCTZ tabletLotensin HCT®5/6.25mg, 10/12.5mg, 20/12.5mg, 20/25mg$25$45
Blood Pressure / HeartBisoprolol/HCTZ tabletZiac®2.5/6.25mg, 5/6.25mg, 10/6.25mgn/a$20
Blood Pressure / HeartBumetanide tabletBumex®0.5mg, 1mg, 2mgn/a$20
Blood Pressure / HeartCaptopril tabletCapoten®12.5mg, 25mg, 50mg, 100mgn/a$20
Blood Pressure / HeartChlorthalidone tabletN/A25mg, 50mgn/a$20
Blood Pressure / HeartClonidine HCL tabletCatapres®0.1mg, 0.2mg, 0.3mgn/a$20
Blood Pressure / HeartDiltiazem ER capsule (24hr) (Dilt-XR)Dilacor XR®120mg, 180mg, 240mg$40$75
Blood Pressure / HeartDiltiazem ER capsule (Dilt-CD)Cardizem CD®120mg, 180mg, 240mg, 300mg$40$75
Blood Pressure / HeartDoxazosin Mesylate tabletCardura®1mg, 2mg, 4mg, 8mgn/a$20
Blood Pressure / HeartEnalapril Maleate tabletVasotec®2.5mg, 5mg, 10mg, 20mgn/a$20
Blood Pressure / HeartEnalapril/HCTZ tabletVaseretic®5/12.5mg, 10/25mgn/a$20
Blood Pressure / HeartFurosemide tabletLasix®20mg, 40mg, 80mgn/a$20
Blood Pressure / HeartHydralazine tabletN/A10mg, 25mg, 50mg$25$45
Blood Pressure / HeartHydrochlorothiazide capsuleMicrozide®12.5mgn/a$20
Blood Pressure / HeartHydrochlorothiazide tabletN/A25mg, 50mgn/a$20
Blood Pressure / HeartIndapamide tabletN/A1.25mg, 2.5mgn/a$20
Blood Pressure / HeartLabetalol HCL tabletTrandate®100mg, 200mg, 300mg$30$55
Blood Pressure / HeartLisinopril tabletZestril® or Prinivil®2.5mg, 5mg, 10mg, 20mg, 30mg, 40mgn/a$20
Blood Pressure / HeartLisinopril/HCTZ tabletZestoretic® or Prinzide®10/12.5mg, 20/12.5mg, 20/25mgn/a$20
Blood Pressure / HeartMetolazone tabletZaroxolyn®2.5mg, 5mg$35$65
Blood Pressure / HeartMetoprolol Succ ER tabletToprol XL®25mg, 50mg, 100mg, 200mg$50$95
Blood Pressure / HeartMetoprolol Tartrate tabletLopressor®25mg, 50mg, 100mgn/a$20
Blood Pressure / HeartNadolol tabletCorgard®20mg, 40mg, 80mgn/a$20
Blood Pressure / HeartPrazosin capsuleN/A1mg, 2mg, 5mgn/a$20
Blood Pressure / HeartPropranolol tabletInderal®10mg, 20mg, 40mg, 80mgn/a$20
Blood Pressure / HeartQuinapril tabletAccupril®5mg, 10mg, 20mg, 40mg$30$55
Blood Pressure / HeartSpironolactone tabletAldactone®25mgn/a$20
Blood Pressure / HeartTerazosin capsuleHytrin®1mg, 2mg, 5mg, 10mgn/a$20
Blood Pressure / HeartTrandolapril tabletMavik®1mg, 2mg, 4mg$30$55
Blood Pressure / HeartTriamterene/HCTZ capsuleDyazide®37.5/25mgn/a$20
Blood Pressure / HeartTriamterene/HCTZ tabletMaxzide®37.5/25mg, 75/50mgn/a$20
Blood Pressure / HeartVerapamil SR tabletCalan-SR® or Isoptin-SR®120mg, 180mg, 240mg$35$65
Blood Pressure / HeartVerapamil tabletCalan®40mg, 80mg, 120mgn/a$20
CancerTamoxifen Citrate tabletN/A10mg, 20mg$25$45
Cancer / Rheumatoid ArthritisMethotrexate tabletN/A2.5mg$25n/a
Cholesterol / TriglyceridesGemfibrozil tabletLopid®600mg$30$55
Cholesterol / TriglyceridesLovastatin tabletMevacor®10mg, 20mg, 40mgn/a$20
Cholesterol / TriglyceridesPravastatin tabletPravachol®10mg, 20mg, 40mgn/a$20
Cholesterol / TriglyceridesSimvastatin tabletZocor®5mg, 10mg, 20mg, 40mg, 80mg$25$45
DepressionAmitriptyline tabletN/A10mg, 25mg, 50mg, 75mg, 100mg, 150mg$20n/a
DepressionBupropion HCL tabletWellbutrin®75mg, 100mg$30n/a
DepressionCitalopram tabletCelexa®10mg, 20mg, 40mg$20n/a
DepressionDoxepin capsuleN/A10mg, 25mg, 50mg, 75mg, 100mg$15n/a
DepressionFluoxetine capsuleProzac®10mg, 20mg, 40mg$15n/a
DepressionMirtazapine tabletRemeron®15mg, 30mg, 45mg$30n/a
DepressionNortriptyline HCL capsulePamelor®10mg, 25mg, 50mg, 75mg$20n/a
DepressionParoxetine HCL tabletPaxil® (HCL)10mg, 20mg, 30mg, 40mg$20n/a
DepressionSertraline tabletZoloft®25mg, 50mg, 100mg$35n/a
Depression / AnxietyTrazodone tabletDesyrel®50mg, 100mg, 150mg$20n/a
DiabetesGlimepiride tabletAmaryl®1mg, 2mg, 4mgn/a$20
DiabetesGlipizide ER tabletGlucotrol XL®2.5mg, 5mg, 10mg$35$65
DiabetesGlipizide tabletGlucotrol®5mg, 10mgn/a$20
DiabetesGlyburide tabletMicronase®1.25mg, 2.5mg, 5mgn/a$20
DiabetesGlyburide, micronized tabletGlynase® PresTab®1.5mg, 3mg, 6mgn/a$20
DiabetesGlyburide/Metformin tabletGlucovance®1.25/250mg, 2.5/500mg, 5/500mg$30$55
DiabetesMetformin HCL ER tabletGlucophage XR®500mg, 750mgn/a$20
DiabetesMetformin HCL tabletGlucophage®500mg, 850mg, 1000mgn/a$20
DiarrheaDiphenoxylate/Atropine tablet (CS)Lomotil® or Lonox®2.5/0.025mg$35n/a
GoutAllopurinol tabletZyloprim®100mg, 300mgn/a$20
Immune DeficiencyStavudine capsuleZerit®20mg$50n/a
HeartAmiodarone tabletCordarone®200mg$30$55
HeartDigoxin tabletLanoxin®0.125mg, 0.25mgn/a$20
HeartPropafenone HCL tabletRythmol®150mg, 225mg, 300mg$40$75
Heartburn / Acid Reflux / UlcersFamotidine tabletPepcid®20mg, 40mgn/a$20
Heartburn / Acid Reflux / UlcersOmeprazole capsulePrilosec®10mg, 20mg, 40mg$35$65
Heartburn / Acid Reflux / UlcersRanitidine tabletZantac®150mg, 300mgn/a$20
HormonesEstradiol tabletEstrace®0.5mg, 1mg, 2 mgn/a$20
HormonesEstropipate tabletOgen®0.625(0.75mg), 1.25(1.5mg)n/a$20
HormonesMedroxyprogesterone tabletProvera®2.5mg, 5mg, 10mg$15n/a
HormonesPrednisone tabletN/A1mg, 2.5mg, 5mg, 10mg, 20mg, 50mg$20n/a
InsomniaTemazepam capsule (CS)Restoril®15mg, 30mg$35n/a
InsomniaZolpidem Tartrate (CS)Ambien®5mg, 10mg$35n/a
Irritable Bowl SyndromeBelladonna Alkaloids/Phenobarbital tabletN/AN/A$20n/a
Irritable Bowl SyndromeDicyclomine capsuleBentyl®10mgn/a$20
Irritable Bowl SyndromeDicyclomine tabletBentyl®20mgn/a$20
Muscle RelaxerBaclofen tabletLioresal®10mg, 20mg$15n/a
Blood Pressure/HeartTorsemide tabletDemadex®5mg$20n/a
 
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