The Low Cost Generics Drug List represents a summary of products included in our MemorialRx program. This is not an all-inclusive list. Products that are not represented on this list may be subject to plan-specific copayment. Void where prohibited by law. Your prescription benefit plan design may apply restrictions, regardless of the drugs, appearance in this document. Log into www.MemorialRX.com to check coverage and copay information for a specific medicine. For more details call Customer Care using the toll-free number on the back of your prescription benefit ID card. Copay means that the amount a plan member is required to pay for a prescription in accordance with a Plan.

Certain drugs or dosages may be subject to additional costs or copays. The Low Cost Generics Drug List is based on commonly prescribed doses. This list is subject to change without prior notice. MemorialRx Pharmacy may receive rebates, discounts and service fees from pharmaceutical manufacturers for certain listed products. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with Memorial Rx Pharmacy. Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

Copyright 2015 MemorialRx Pharmacy. All rights reserved. This document contains confidential and proprietary information of MemorialRx Pharmacy and cannot be reproduced, distributed or printed without written permission from MemorialRx Pharmacy.
 

* These drugs may be priced higher upon cost increase by MemorialRx Pharmacy‘s Drug Suppliers.