**THIS IS A DRUG LOOKUP TOOL FOR MAIL-ORDER MEDICATIONS ONLY** Members should refer to the Acute Medications List for the drugs covered at $0.00 cost when filling prescriptions at the pharmacy.

Disclaimer: The prices generated through this tool are estimates only and are not guaranteed. Actual costs may vary at time of purchase and are subject to change without notice.

Members should refer to the Acute Medications List for the drugs covered at $0.00 cost when filling prescriptions at the pharmacy.

All pricing displayed is an ESTIMATE ONLY and should NOT be considered a guarantee of final cost. Actual prices may vary due to factors including, but not limited to, program formulary, whether a deductible applies, other program terms and conditions, pharmacy specific pricing, and state or federal dispensing guidelines. Other factors such as your doctor’s instructions, medication packaging, and quantity or days’ supply dispensed may also affect pricing. Additionally, pricing estimates are contingent upon the accuracy of the information entered by the user into the tool. For precise pricing details, please consult your pharmacy at the time the prescription is processed. Program formulary is subject to change without notice.