|
Label Name
|
Copayment
|
| Buproban 150 Mg Tablet |
$5 |
| Bupropion Hcl Sr 150 Mg Tablet |
$5 |
| Chantix 0.5 Mg Tablet |
$50 |
| Chantix 1 Mg Tablet |
$50 |
| Chantix Starting Month Pak |
$50 |
| Chantix Continuing Month Pak |
$50 |
| Commit 2 Mg Lozenge |
$15 |
| Commit 4 Mg Lozenge |
$15 |
| CVS Nicotine 2 Mg Gum |
$5 |
| CVS Nicotine 4 Mg Gum |
$5 |
| Eck Nicotine 2 Mg Chew Gum |
$5 |
| Eck Nicotine 4 Mg Chew Gum |
$5 |
| Eql Nicotine 2 Mg Gum |
$5 |
| Eql Nicotine 4 Mg Gum |
$5 |
| Equate Nicotine 2 Mg Gum |
$5 |
| Equate Nicotine 4 Mg Gum |
$5 |
| GNP Nicotine 2 Mg Gum |
$5 |
| GNP Nicotine 4 Mg Gum |
$5 |
| Ldr Nicotine 2 Mg Chewing Gum |
$5 |
| Ldr Nicotine 4 Mg Chewing Gum |
$5 |
| Nicorelief 2 Mg Gum |
$5 |
| Nicorelief 4 Mg Gum |
$5 |
| Nicorette 2 Mg Chewing Gum |
$5 |
| Nicorette 4 Mg Chewing Gum |
$5 |
| Nicotine 2 Mg Chewing Gum |
$5 |
| Nicotine 2 Mg Gum |
$5 |
| Nicotine 4 Mg Chewing Gum |
$5 |
| Nicotine 4 Mg Gum |
$5 |
| Nicotine Polacrilex 2 Mg Gum |
$5 |
| Nicotine Polacrilex 4 Mg Gum |
$5 |
| Nicotrol Cartridge Inhaler |
$50 |
| Nicotrol Ns 10 Mg/Ml Spray |
$50 |
| Ra Nicotine 2 Mg Gum |
$5 |
| Ra Nicotine 4 Mg Gum |
$5 |
| Sunmark Nicotine 4 Mg Gum |
$5 |
| Zyban 150 Mg Tablet Sa |
$5 + full cost difference
between generic and brand |