Page 86 - APPENDICES for Vic Bosiger

An official website of the United States government
Here's how you know
Because aspirin 81mg is an over-the-counter
drug, it is not covered by Part D.
Menu

Alprazolam 0.5mg tablet Quantity Frequency
generic 30 Every month

Amlodipine 5mg tablet Quantity Frequency
generic 30 Every month

Carvedilol 25mg tablet Quantity Frequency
generic 60 Every month

Farxiga 10mg tablet Quantity Frequency
30 Every month

Furosemide 40mg tablet Quantity Frequency
generic 30 Every month

Glipizide 10mg tablet Quantity Frequency
generic 60 Every month

Isosorbide mononitrate 30mg Quantity Frequency
tablet extended release 24 30 Every month
hour
generic

Lisinopril 20mg tablet Quantity Frequency
generic 90 Every month

Metformin hydrochloride Quantity Frequency
1000mg tablet 60 Every month
generic
or as needed

Nitroglycerin 0.4mg tablet Quantity Frequency
sublingual 50 Every month
generic

Omeprazole 20mg capsule Quantity Frequency
delayed release 30 Every month
generic
generic version of
Effient
Prasugrel 10mg tablet Quantity Frequency
generic 30 Every month