Eye & Ear
*Due to state laws, these drugs are not covered under the 30-day program in MN and WI; however, they have been competitively priced. Please ask your pharmacist for specific pricing in these states.
†Due to state laws, these drugs are not covered under the 90-day program in MN and WI; however, they have been competitively priced. Please ask your pharmacist for specific pricing in these states.
$4 prescriptions are for up to a 30-day supply at commonly prescribed dosages. List subject to change.
| GENERIC NAME | BRAND NAME | QTY | FORM |
| ANTIPYRINE / BENZOCAINE | AURALGAN® | 10 | OTIC SOLUTION |
| ATROPINE SULFATE 1% | ISOPTO ATROPINE® | 5 | OPHTHALMIC SOLUTION |
| BACITRACIN | BACIGUENT® | 4 | OPHTHALMIC OINTMENT |
| GENTAMICIN 0.30% | GARAMYCIN® | 5 | OPHTHALMIC SOLUTION |
| LEVOBUNOLOL 0.50% | BETAGAN® | 5 | OPHTHALMIC SOLUTION |
| NEOMYCIN / POLYMYXIN / DEXAMETHASONE 0.10% | MAXITROL® | 4 | OPHTHALMIC OINTMENT |
| NEOMYCIN/POLYMYXIN / DEXAMETHASONE 0.10% | MAXITROL® | 5 | OPHTHALMIC SUSPENSION |
| PILOCARPINE 1% | ISOPTO CARPINE® | 15 | OPHTHALMIC SOLUTION |
| PILOCARPINE 2% | ISOPTO CARPINE® | 15 | OPHTHALMIC SOLUTION |
| POLYMIXIN/TMP | POLYTRIM® | 10 | SOLUTION |
| SULFACETAMIDE SODIUM 10% | SODIUM SULAMYD® | 15 | OPHTHALMIC SOLUTION |
| TIMOLOL MALEATE 0.25% | TIMOPTIC® | 5 | OPHTHALMIC DROP |
| TIMOLOL MALEATE 0.50% | TIMOPTIC® | 5 | OPHTHALMIC DROP |
| TOBRAMYCIN 0.30% | TOBREX® | 5 | OPHTHALMIC SOLUTION |
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