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Memorial Rx – Maintenance Generic Savings Program

$4 (30-day supply) / $10 (90-day supply)

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Blood Pressure / Heart
Medication
Strength
Supply
Pricing
Lisinopril

All strengths

30-day supply

$4
Lisinopril

All strengths

90-day supply

$10
Amlodipine

All strengths

30-day supply

$4
Amlodipine

All strengths

90-day supply

$10
Hydrochlorothiazide (tablet only)

All strengths

30-day supply

$4
Hydrochlorothiazide (tablet only)

All strengths

90-day supply

$10
Atenolol

All strengths

30-day supply

$4
Atenolol

All strengths

90-day supply

$10
Metoprolol tartrate only

All strengths

30-day supply

$4
Metoprolol tartrate only

All strengths

90-day supply

$10
Losartan

All strengths

30-day supply

Discounted cash price – ask pharmacist
Losartan

All strengths

90-day supply

Discounted cash price – ask pharmacist
Diabetes
Medication
Strength
Supply
Pricing
Glimepiride

All strengths

90-day supply

$10
Glimepiride

All strengths

30-day supply

$4
Glipizide IR

All strengths

90-day supply

$10
Metformin IR

500 mg

30-day supply

$4
Metformin IR

500 mg

90-day supply

$10
Metformin IR

850 mg

30-day supply

$4
Metformin IR

850 mg

90-day supply

$10
Metformin IR

1000 mg

30-day supply

$4
Metformin IR

1000 mg

90-day supply

$10
Glipizide IR

All strengths

30-day supply

$4
Mental Health
Medication
Strength
Supply
Pricing
Quetiapine

Selected strengths

90-day supply

Discounted cash price – ask pharmacist
Quetiapine

Selected strengths

30-day supply

Discounted cash price – ask pharmacist
Venlafaxine IR

Selected strengths

90-day supply

Discounted cash price – ask pharmacist
Venlafaxine IR

Selected strengths

30-day supply

Discounted cash price – ask pharmacist
Bupropion SR

Selected strengths

90-day supply

Discounted cash price – ask pharmacist
Bupropion SR

Selected strengths

30-day supply

Discounted cash price – ask pharmacist
Duloxetine (capsules only)

Selected strengths

90-day supply

Discounted cash price – ask pharmacist
Duloxetine (capsules only)

Selected strengths

30-day supply

Discounted cash price – ask pharmacist
Amitriptyline

All strengths

90-day supply

$10
Trazodone

All strengths

30-day supply

$4
Trazodone

All strengths

90-day supply

$10
Sertraline

All strengths

30-day supply

$4
Sertraline

All strengths

90-day supply

$10
Fluoxetine

All strengths

30-day supply

$4
Fluoxetine

All strengths

90-day supply

$10
Citalopram

All strengths

30-day supply

$4
Citalopram

All strengths

90-day supply

$10
Amitriptyline

All strengths

30-day supply

$4
Cholesterol
Medication
Strength
Supply
Pricing
Simvastatin

All strengths

90-day supply

$10
Simvastatin

All strengths

30-day supply

$4
Atorvastatin

20 mg only

90-day supply

$10
Atorvastatin

20 mg only

30-day supply

$4
Atorvastatin

10 mg only

30-day supply

$4
Atorvastatin

10 mg only

90-day supply

$10
GI / Acid Reduction
Medication
Strength
Supply
Pricing
Famotidine

All strengths

90-day supply
$10
Famotidine

All strengths

30-day supply
$4
Pantoprazole

All strengths

90-day supply
$10
Pantoprazole

All strengths

30-day supply
$4
Omeprazole

All strengths

90-day supply
$10
Omeprazole

All strengths

30-day supply
$4
Thyroid
Medication
Strength
Supply
Pricing
Levothyroxine

Most strengths

30-day supply

$4
Levothyroxine

Most strengths

90-day supply

$10

Pricing applies to select strengths and approved manufacturers only. Maintenance medications only. Prices are subject to change without notice. This list is reviewed monthly and adjusted as needed. Final pricing is confirmed by the pharmacist at the time of dispensing.

The Memorial Rx – Maintenance Generic Savings Program list represents medications available at posted pricing for select strengths and approved manufacturers. This is not an all-inclusive list. Products not represented on this list may be available at different pricing. Pricing applies to maintenance medications only and is subject to change without notice. This list is reviewed monthly and adjusted as needed.
 

Void where prohibited by law. Your prescription benefit plan design may apply restrictions, regardless of the drug's appearance in this document. For coverage and copay information, log into www.MemorialRX.com or call Customer Care using the toll-free number on your prescription benefit ID card.
 

Final pricing is confirmed by the pharmacist at the time of dispensing. Memorial Rx Pharmacy may receive rebates, discounts, and service fees from pharmaceutical manufacturers for certain listed products.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.
 

Copyright 2026 Memorial Rx Pharmacy. All rights reserved. This document contains confidential and proprietary information of Memorial Rx Pharmacy and cannot be reproduced, distributed, or printed without written permission from Memorial Rx Pharmacy.

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