November 4, 2014
Program Updates. . . . Effective immediately
NEW MEDICATIONS
Rx Outreach Medication
Brand/Generic
Equivalent
Available Strengths
Administrative Fee
90-Day
180-Day
Budesonide nasal spray
Rhinocort®
8.6g/32mcg
$62 per nasal spray
Candesartan Cilexetil tablet
Atacand®
4mg, 8mg, 16mg
$30 for up to 30 tablets
Candesartan Cilexetil tablet
Atacand®
32mg
$40 for up to 30 tablets
Atacand HCT®
16/12.5mg
$35 for up to 90 tablets
Atacand HCT®
32/12.5mg, 32/25mg
$45 for up to 90 tablets
Candesartan Cilexetil-HCTZ
tablet
Candesartan Cilexetil-HCTZ
tablet
MEDICATION WITH REDUCED FEE
Rx Outreach Medication
Brand/Generic
Equivalent
Available Strengths
Aricept® tablet
Donepezil
5mg, 10mg
Administrative Fee
90-Day
180-Day
$15
N/A
RECENTLY ADDED MEDICATIONS
Rx Outreach Medication
Brand/Generic
Equivalent
Available Strengths
Eszopiclone tablet (CS)
Lunesta®
1mg, 2mg, 3mg
Pravastatin tablet
Pravachol®
80mg
Ziprasidone capsule
Geodon®
20mg, 40mg, 60mg, 80mg
Zonisamide capsule
Zonegran®
25mg, 50mg, 100mg
Administrative Fee
90-Day
180-Day
$40 for up to 90
tablets
N/A
$25 for up to 90 tablets
$65 for up to 90
capsules
N/A
$25 for up to 90 capsules
(CS) Controlled Substance
To see our complete list of medications available, please visit our web-site, www.rxoutreach.org. Our
customer service center can also answer any questions or provide any additional information you may need –
contact us at 1-888-796-1234 - Monday through Friday 7:00 a.m. to 5:30 p.m. Central Time.
Rx Outreach, Inc.-PO Box 66536-Saint Louis, MO-63166-6536 1-888-RXO-1234