Other Available Assistance Programs Angiotensin Receptor Blocker (ARB)
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1 BENICAR 20 MG TABS (olmesartan) Angiotensin Receptor Blocker (ARB) Daiichi Sankyo Open Care Program These are the best alternatives for Benicar in terms of similarity of medication: EDARBI MG TABS (azilsartan) Arbor Pharmaceuticals Patient Assistance Program n/a CANDESARTAN TABS (BRAND: ATACAND) $30-$40 for up to 30 tablets EPROSARTAN TABS (BRAND: TEVETEN) IRBESARTAN TABS (BRAND: AVAPRO) $30 for 90 day $55 for 180 day LOSARTAN TABS (BRAND: COZAAR) $20 for 90 day $40 for 180 day TELMISARTAN TABS (BRAND: MICARDIS) $35 for 90 day $65 for 180 day 1
2 VALSARTAN TABS (BRAND: DIOVAN) $30-$40 for up to 90 tablets 2
3 Angiotensin-Converting Enzyme (ACE) Inhibitors These are a different subclass (ACE Inh instead of ARB) but a good alternative for most patients: MAVIK TABS (trandolapril) AbbVie Patient Assistance Program BENAZEPRIL TABS (BRAND: LOTENSIN) $20 for 180 day n/a CAPTOPRIL TABS (BRAND: CAPOTEN) $40-$55 for up to 90 tablets ENALAPRIL TABS (BRAND: VASOTEC) FOSINOPRIL TABS (BRAND: MONOPRIL) LISINOPRIL TABS (BRAND: ZESTRIL, PRINIVIL) Preferred Clinic Discount Pricing Program $20 for 180 day $9 per 90 day $18 per 180 day Access to Program - Pre-Qualified VA Sites ONLY MOEXIPRIL TABS (BRAND: UNIVASC) PERINDOPRIL TABS (BRAND: ACEON) 3
4 QUINAPRIL TABS (BRAND: ACCUPRIL) $30 for 90 day $55 for 180 day RAMIPRIL TABS (BRAND: ALTACE) $25 for 90 day $45 for 180 day 4
5 BENICAR HCT TABS (olmesartan/hctz) Angiotensin Receptor Blocker (ARB)/Thiazide Combos Daiichi Sankyo Open Care Program These are the best alternatives for Benicar HCT in terms of similarity of medication: EDARBYCLOR TABS (azilsartan/chlorthalidone) Arbor Pharmaceuticals Patient Assistance Program n/a CANDESARTAN/HCTZ TABS (BRAND: ATACAND HCT) $40 for up to 30 tablets IRBESARTAN/HCTZ TABS (BRAND: AVALIDE) $30 for 90 day $55 for 180 day LOSARTAN/HCTZ TABS (BRAND: HYZAAR) VALSARTAN/HCTZ TABS (BRAND: DIOVAN HCT) $25 for 90 day $45 for 180 day $35 for 90 day $65 for 180 day Angiotensin-Converting Enzyme (ACE) Inhibitor/Thiazide Combos These are a different subclass (ACE Inh instead of ARB, plus thiazide) but a good alternative for most patients: 5
6 ACCURETIC TABS (quinapril/hctz) Pfizer RxPathways n/a BENAZEPRIL/HCTZ TABS (BRAND: LOTENSIN-HCT) $25 for 90 day $45 for 180 day CAPTOPRIL/HCTZ TABS (BRAND: CAPOZIDE) $55 for up to 90 tablets (100mg) $40 for up to 90 tablets (12.5mg, 25mg, 50mg) ENALAPRIL/HCTZ TABS (BRAND: VASERETIC) $20 for 180 day FOSINOPRIL/HCTZ TABS (BRAND: MONOPRIL HCT) LISINOPRIL/HCTZ TABS (BRAND: ZESTORETIC) $9 for 90 day $18 for 180 day MOEXIPRIL/HCTZ TABS (BRAND: UNIRETIC) QUINAPRIL/HCTZ TABS (BRAND: ACCURETIC) $30 for up to 90 tablets 6
7 Angiotensin Receptor Blockers (ARBs), Calcium Channel Blockers (CCBs), Dihydropyridine AZOR TABS (amlodipine/olmesartan) Daiichi Sankyo Open Care Program These are the best alternatives for Azor in terms of similarity of medication: AMLODIPINE/VALSARTAN TABS (BRAND: EXFORGE) $25 for up to 30 tablets TELMISARTAN/AMLODIPINE TABS (BRAND: TWYNSTA) Angiotensin-Converting Enzyme (ACE) Inhibitors, Calcium Channel Blockers (CCBs), Dihydropyridine This is a different subclass (ACE Inh instead of ARB, plus CCB) but a good alternative for most patients: AMLODIPINE/BENAZEPRIL CAPS (BRAND: LOTREL) $12 for up to 30 capsules $50 for up to 90 capsules 7
8 Angiotensin Receptor Blockers (ARBs), Calcium Channel Blockers (CCBs), Dihydropyridine, Thiazide TRIBENZOR TABLETS (amlodipine/olmesartan/hctz) Daiichi Sankyo Open Care Program This the best alternative for Tribenzor in terms of similarity of medication: AMLODIPINE/VALSARTAN/HCTZ TABS (BRAND: EXFORGE HCT) $60 for up to 30 tablets Note - for patients on Azor or Tribenzor who also take a statin, patient could possibly be switched to Caduet (amlodpine/atorvastatin)-pfizer RxPathways plus an ARB or ARB/HCTZ med. 8
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1 of 24. See 17 for PATIENT COUNSELING INFORMATION and FDA-approved patient labeling Revised: 08/2015
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Alphabetical Formulary List
Acetaminophen 120mg, 325mg, and 650mg Suppositories 12 $5.00 Antipyrine and Benzocaine Otic Solution 10 $5.00 Acetic Acid/Aluminum Acetate 2% Solution 60 $5.00 Anucort-HC 25mg Suppositories 12 $5.00 Acyclovir
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