Call Toll Free: 1-866-699-8239

Monday-Friday 9:00 AM - 5:00 PM EST

Patient Assistance Program


Generic medications have not always been available through Patient Assistance Programs. Xubex now offers assistance to individuals for generic medications through its innovative program. Our goal is to offer patients who qualify access to prescriptions, ensuring low-cost, predictable pharmaceutical services.

With our Patient Assistance Programs, a licensed pharmacist in the United States fills all prescriptions with the same medications available from your local pharmacy. With no cost to join and no monthly fees, we pride ourselves on providing exceptional service to all who qualify. In order to comply with HIPAA confidentiality regulations, all medications are shipped discreetly to your home, office or trusted family member.



You can apply online using the short entry form or download a pdf copy of the application.The pharmacy can accept only original prescription drug orders from patients, and that faxed prescriptions can be accepted only from the prescribing practitioners. You can also have us contact your current pharmacy for a prescription transfer.
HyperLink
Following are a list of generic medications available through our Patient Assistance Program.Click on medication name for medication monographs.

Please Note: This service is not currently available in Montana.
Skip Navigation Links
All
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
Generic Name / StrengthBrand NameTreatmentMax QtyPrice
ACEBUTOLOL HCL ( 200MG ) Sectral®Hypertension180$30
ACYCLOVIR ( 200MG, 400MG, 800MG ) Zovirax®Anti-Viral90$30
ALBUTEROL SULFATE ( 0.83MG/ML ) Ventolin® Proventil®Anti-asthma - Beta-2 Agonist180/60$20
ALBUTEROL SULFATE ( 2MG, 4MG ) Ventolin® Proventil®Anti-asthma - Beta-2 Agonist360$20
ALBUTEROL/IPRATROPIUM ( NOT AVAILABLE ) DuoNeb®COPD,Emphysema60x3ml$30
ALENDRONATE SODIUM ( 5MG, 10MG, 35MG, 70MG ) Fosamax®Osteoporosis12$20
ALFUZOSIN HCL (10MG ) Uroxatral®Prostate90$45
ALLOPURINOL ( 100MG, 300MG ) Zyloprim®Anti-inflammatory agent, Anti-gout agent180$20
ALPRAZOLAM ( 0.25MG, 0.5MG, 1MG ) Xanax®Anxiety360$30
ALPRAZOLAM (2MG ) Xanax®Anxiety100$20
AMILORIDE HCL/HCTZ ( 5-50MG ) Moduretic®Diuretics90$20
AMINOPHYLLINE ( 100MG, 200MG ) AminophyllineBroncho Dilator360$20
AMIODARONE HCL ( 200MG ) Cordaron®Heart Condition180$30
AMITRIPTYLINE HCL ( 10MG, 25MG, 50MG, 75MG, 100MG ) Elavil®Anti-depressants360$20
AMLODIPINE BESYLATE ( 2.5MG, 5MG, 10MG ) Norvasc®Hypertension180$20
ANASTROZOLE (1MG ) Arimidex ® 90$45
ANUCORT-HC ( 25MG ) Anusol-HC SuppHemorrhoids36$30
ATENOLOL ( 25MG, 50MG, 100MG ) Tenormin®Beta-2 Antagonist270$20
ATENOLOL/CHLORTHALIDONE ( 50-25MG, 100-25MG ) Tenoretic®Beta-2 Antagonist/Diuretic90$20
ATORVASTATIN (10MG, 20MG, 40MG, 80MG ) Lipitor®cholesterol30$90
ATROPINE (1% ) Isopto-Atropine 5 ML$20
AZATHIOPRINE (50MG ) Imuran® 180$30
BACLOFEN ( 10MG, 20MG ) Lioresal®Muscle Relaxer360$30
BENAZEPRIL ( 5MG, 10MG, 20MG, 40MG ) Lotensin®Antihypertensive180$20
BENAZEPRIL/HCTZ ( 5-6.25MG, 10-12.5MG, 20-12.5MG, 20-25MG ) Lotensin-HCT®Antihypertensive180$20
BENZTROPINE MESYLATE ( 0.5MG, 1MG, 2MG ) Cogentin®Antipsychotic180$20
BICALUTAMIDE ( 50MG ) Casodex®Prostate Cancer90$65
BISOPROLOL/HCTZ ( 2.5-6.25MG, 5-6.25MG, 10-6.25MG ) Ziac®Beta-2 Antagonist/Diuretic180$20
BUMETANIDE ( 0.5MG, 1MG, 2MG ) Bumex®Diuretics180$30
BUPROPION ( 75MG, 100MG,150MG ) Wellbutrin®Depression100$45
BUPROPION XL ( 300MG ) Wellbutrin XL®  Depression90$65
BUPROPION XL ( 150MG ) Wellbutrin XL®  Depression90$65
BUSPIRONE HCL ( 5MG, 10MG, 15MG ) BuSpar®Anxiolytics, Sedatives, Hypnotics270$20
CAPTOPRIL ( 12.5MG, 25MG, 50MG, 100MG ) Capoten®ACE Inhibitors360$20
CAPTOPRIL/HCTZ ( 25-15MG, 25-25MG ) Capozide®ACE Inhibitors/Diuretic180$20
CAPTOPRIL/HCTZ (50-15MG, 50-25MG ) Capozide®ACE Inhibitors/Diuretic360$20
CARBAMAZEPINE ( 100MG, 200MG ) Tegretol®Anticonvulsant360$20
CARISOPRODOL ( 350MG ) Soma®Muscle Relaxer270$30
CARVEDILOL ( 3.125MG, 6.25MG, 12.5MG, 25MG ) Coreg®Heart Failure180$20
CETIRIZINE ( 10MG ) Zyrtec®Allergy90$20
CHLORDIAZEPOXIDE HCL ( 5MG, 10MG, 25MG ) Librium®Anxiety360$30
CHLORPROPAMIDE ( 100MG ) Diabinese®Treat High Sugar270$30
CHLORTHALIDONE ( 25MG, 50MG ) Thalitone®Diuretic180$20
CHLORZOXAZONE ( 500MG ) Parafon-Forte®Skeletal Muscle Relaxants360$20
CILOSTAZOL ( 50MG, 100MG ) Pletal®Circulation180$40
CIMETIDINE ( 300MG, 400MG, 800MG ) Tegamet®Histamine-2 Antagonist360$20
CITALOPRAM HYDROBROMIDE ( 10MG, 20MG, 40MG ) Celexa®Selective Seratonin Receptor Inhibitor180$20
CLOMIPRAMINE HCL ( 25MG, 50MG, 75MG ) AnafranilO.C.D.180$30
CLONAZEPAM ( 0.5MG, 1MG, 2MG ) Klonopin®Seizure Disorder270$30
CLONIDINE HCL ( 0.1MG, 0.2MG, 0.3MG ) Catapres®Centrally Acting Anti-adrenergics270$20
CLORAZEPATE DIPOTASSIUM ( 3.75MG, 7.5MG, 15MG ) TranxeneAnxiety180$30
CROMOLYN SODIUM ( 4% ) Crolom®Allergy30$30
CYCLOBENZAPRINE HCL ( 5MG, 10MG ) Flexeril®Muscle Relaxer360$30
CYCLOSPORINE (25MG ) Neoral®Transplant60$45
DIAZEPAM ( 2MG, 5MG, 10MG ) Valium®Anxiety360$30
DICYCLOMINE HCL ( 10MG, 20MG ) Bentyl®I.B.S.360$20
DIGOXIN ( 0.125MG, 0.25MG ) Lanoxin®Cardiac Glycosides180$20
DILTIAZEM HCL ( 180MG ) Cardizem-CD®, Tiazac®, Diltia-XR®Hypertension90$40
DILTIAZEM HCL ( 240MG ) Cardizem-CD®, Tiazac®, Diltia-XR®Hypertension90$60
DILTIAZEM HCL ( 30MG, 60MG ) Cardizem®Calcium Channel Blockers360$20
DILTIAZEM HCL (90MG, 120MG ) Cardizem®Calcium Channel Blockers180$30
DILTIAZEM HCL CD ( 120MG ) Cardizem-CD®, Tiazac®, Diltia-XR®Hypertension90$40
DIPHENOXYLATE/ATROPINE ( 2.5-0.025MG ) Lomotil ®Diarrhea270$30
DIVALPROEX SODIUM ( 125MG, 250MG, 500MG ) Depakote®Biploar/Epilepsy180$30
DIVALPROEX SODIUM ER (250MG, 500MG ) Depakote® ERBiploar/Epilepsy180$65
DONEPEZIL HCL (5MG, 10MG ) Aricept 90$30
DOXAZOSIN MESYLATE ( 1MG, 2MG, 4MG, 8MG ) Cardura®Benign Prostatic Hyperplasia (BPH)180$20
DOXEPIN HCL ( 10MG, 25MG, 50MG ) Sinequan®Anti-depressant180$20
DOXYCYCLINE HYCLATE ( 50MG, 100MG ) Vibramycin®Antibiotic270$20
ENALAPRIL MALEATE ( 2.5MG, 5MG, 10MG, 20MG ) Vasotec®ACE Inhibitors270$20
ENALAPRIL MALEATE/HCTZ ( 5-12.5MG, 10-25MG ) Vaseretic® ACE Inhibitors180$20
ESTRADIOL ( 0.5MG, 1MG, 2MG ) Estrace®Hormones, Estrogens180$20
ESTROPIPATE ( 0.75MG, 1.5MG ) Ogen®Hormones, Estrogens90$20
ETODOLAC ( 200MG, 300MG ) Lodine®NSAID Arthritis180$30
FAMOTIDINE ( 20MG, 40MG ) Pepcid®Histamine-2 Antagonist180$20
FEXOFENADINE 24H (180MG ) Allegra®Allergy90$40
FLUCONAZOLE ( 100MG, 150MG, 200MG ) Diflucan®Anti-fungal90$30
FLUOCINOLONE ACETONIDE ( 0.01% ) Synalar®Eczema/dermatitis240$20
FLUOXETINE HCL ( 10MG, 20MG ) Prozac®Selective Seratonin Receptor Inhibitor270$20
FLUPHENAZINE HCL (1MG, 2.5MG, 5MG, 10MG ) Prolixin®Anti-psychotics180$30
FLURAZEPAM HCL ( 15MG, 30MG ) Dalmane®Insomnia90$30
FLURBIPROFEN ( 50MG, 100MG ) Ansaid®NSAID Arthiritis180$20
FOLIC ACID ( 1MG ) FolviteVitamins270$20
FOSINOPRIL SODIUM ( 10MG, 20MG, 40MG ) Monopril®Hypertension90$30
FUROSEMIDE ( 20MG, 40MG, 80MG ) Lasix®Diuretics360$20
GABAPENTIN ( 100MG, 300MG, 400MG ) Neurontin®Seizure/Pain270$30
GEMFIBROZIL ( 600MG ) Lopid®Cholestrol180$30
GLIMEPIRIDE ( 1MG, 2MG, 4MG ) Amaryl ®Antidiabeticagent180$20
GLIPIZIDE ( 5MG, 10MG ) Glucotrol®Anti-diabetic Agent-Sulfonylureas360$20
GLIPIZIDE ER ( 2.5MG, 5MG, 10MG ) Glucotrol XL® Diabetes180$40
GLYBURIDE MICRONIZED ( 1.5MG, 3MG, 6MG ) Glynase®Anti-diabetic Agent Sulfonylureas360$20
GLYBURIDE/METFORMIN ( 1.25-250MG, 2.5-500MG, 5-500MG ) GlucovanceDiabetes180$30
GUAIFENESIN ( 200MG ) Bidex/LiquibidExpectorant270$30
GUAIFENESIN ( 400MG ) Bidex/LiquibidExpectorant360$30
GUAIFENESIN ( 200MG ) Bidex/Liquibid 400mgExpectorant270$30
GUANFACINE HCL ( 1MG, 2MG ) Tenex®Hypertension180$30
HALOPERIDOL ( 0.5MG, 1MG, 2MG, 5MG ) Haldol®Schizophrenia180$20
HYDRALAZINE HCL ( 10MG, 25MG, 50MG ) Apresoline®Hypertension100$20
HYDROCHLOROTHIAZIDE ( 12.5MG, 25MG, 50MG ) Esidrix®, HydroDiuril®Diuretics180$20
HYDROXYCHLOROQUINE SULFATE ( 200MG ) Plaquenil®Rheumatoid Arthritis180$30
HYDROXYZINE PAMOATE ( 25MG, 50MG ) Vistaril®Sedative360$20
IBUPROFEN ( 400MG, 600MG, 800MG ) Motrin®Anti-inflammatory Agent360$20
INDAPAMIDE ( 1.25MG, 2.5MG ) Lozol®Diuretics180$20
IPRATROPIUM BROMIDE ( 0.2MG/ML ) Atrovent®Anti-cholionergic, Respiratory Agent180/60$20
ISONIAZID ( 300MG ) Isoniazid®Tuberculosis270$20
ISOSORBIDE DINITRATE ( 5MG, 10MG, 20MG ) Isordil®Anti-anginal, Nitrates360$20
ISOSORBIDE MONONITRATE ( 20MG, 30MG, 60MG ) Imdur®Anti-anginal, Nitrates90$30
JANTOVEN ( 1MG, 2MG, 2.5MG, 3MG, 4MG, 5MG, 6MG, 7.5MG, 10MG ) Coumadin®, Jantoven ®Blood Thinner180$30
KETOCONAZOLE ( 2% ) Nizoral® CreamAnti-Fungal120$30
KETOCONAZOLE ( 200MG ) Nizoral®Anti-Fungal90$30
KETOPROFEN ( 50MG, 75MG ) Orudis®NSAID Arthritis270$30
LABETALOL HCL ( 100MG, 200MG, 300MG ) Trandate®Hypertension180$30
LAMOTRIGINE ( 25MG, 100MG, 150MG, 200MG ) Lamictal®Epilepsy180$30
LATANOPROST (0.005% ) Xalatan®Eye Condition7.50$30
LEFLUNOMIDE ( 10MG, 20MG ) Arava® R.A.90$65
LETROZOLE (2.5MG ) FemaraBreast Cancer90$60
LEVETIRACETAM ( 250MG, 500MG, 750MG ) Keppra®    Seizures180$60
LEVOBUNOLOL HCL ( 0.25%, 0.5% ) Betagan®Glaucoma15$20
LEVOCETIRIZINE DIHYDROCHLORIDE (5MG ) Xyzal®Glaucoma90$45
LEVOTHYROXINE SODIUM ( 25MCG, 50MCG, 75MCG, 88MCG, 100MCG, 112MCG, 125MCG, 137MCG, 150MCG, 175MCG, 200MCG, 300MCG ) Synthroid®Thyroid Hormones90$20
LISINOPRIL ( 2.5MG, 5MG, 10MG, 20MG, 30MG, 40MG ) Prinivil® , Zestril®ACE Inhibitors270$20
LISINOPRIL/HCTZ ( 10-12.5MG, 20-12.5MG, 20-25MG ) Zestoretic®ACE Inhibitors270$20
LITHIUM CAPSULES (300MG ) Esklith®Manic Depression360$30
LITHIUM CARBONATE (150MG, 300MG ) EskalithManic Depression360$30
LITHIUM CARBONATE ( 300MG ) Lithobid®Manic Depression180$40
LORATADINE ( 10MG ) ClaritinAlergy100$20
LORAZEPAM ( 0.5MG, 1MG, 2MG ) Ativan®Anxiety360$30
LOSARTAN (25MG, 50MG, 100MG ) Cozaar®High Blood Pressure90$30
LOSARTAN/HCTZ (50/12.5MG, 100/12.5MG, 100/25MG ) Hyzaar®High Blood Pressure90$30
LOVASTATIN ( 10MG, 20MG, 40MG ) Mevacor®Cholestrol90$30
MECLIZINE HCL ( 12.5MG, 25MG ) AntivertDizziness270$20
MEDROXYPROGESTERONE ACETATE ( 2.5MG, 5MG, 10MG ) Amen®, Provera®Hormones, Progestins180$20
MELOXICAM ( 7.5MG, 15MG ) Mobic®NSAID Arthiritis180$20
MERCAPTOPURINE (50MG ) Purinethol® 60$75
METFORMIN HCL ( 500MG, 850MG, 1000MG ) Glucophage®Anti-diabetes Agent360$30
METFORMIN HCL ER ( 500MG, 750MG ) Glucophage-XR®Anti-diabetic Agent180$30
METHOCARBAMOL ( 500MG, 750MG ) Robaxin ®Muscle Relaxant360$30
METHOTREXATE ( 2.5MG ) Rheumatrex®Neoplastic Diseases/RA96$20
METHYLDOPA ( 250MG ) AldometHypertension270$30
METOCLOPRAMIDE HCL ( 5MG, 10MG ) Reglan®Heartburn360$20
METOPROLOL TARTRATE ( 25MG, 50MG, 100MG ) Lopressor®Beta-2 Antagonist270$20
MIRTAZAPINE ( 15MG, 30MG, 45MG ) Remeron®Depression90$30
MYCOPHENOLATE MOFETIL ( 250MG ) Cellcept®Immune System120$60
NADOLOL ( 20MG, 40MG ) Corgard®Beta-2 Antagonist180$20
NAPROXEN ( 250MG, 375MG, 500MG ) Naprosyn®Anti-inflammatory Agent180$20
NAPROXEN SODIUM ( 275MG, 550MG ) AnaproxAnti-inflammatory Agent180$20
NAPROXEN SODIUM ( 275MG, 550MG ) Anaprox-DSAnti-inflammatory Agent180$20
NIACIN TD ( 500MG ) NIACINCholestrol360$20
NICARDIPINE HCL ( 20MG, 30MG ) Cardene®Hypertension180$30
NORTRIPTYLINE HCL ( 10MG, 25MG, 50MG, 75MG ) Pamelor®Anti-depressants100$20
OMEPRAZOLE ( 20MG, 40MG ) Prilosec®GERD90$30
ONDANSETRON HCL ( 4MG, 8MG ) Zofran®Nausea30$30
OXYBUTYNIN CHLORIDE (5MG ) Ditropan®Anti-choligneric, Genitourinary Agent270$20
PANTOPRAZOLE (20MG, 40MG ) Protonix®GERD90$30
PAROXETINE HCL ( 10MG, 20MG, 30MG, 40MG ) Paxil®Depression90$30
PENTOXIFYLLINE (400MG ) Trental®Circulation270$40
PHENOBARBITAL ( 16.2MG, 32.4MG, 64.8MG, 97.2MG, 100MG ) PhenobarbitalSeizure360$30
PRAMIPEXOLE DI-HCL (0.125MG, 0.25MG, 0.5MG, 1MG, 1.5MG ) Mirapex®Parkinson's disease 180$30
PRAVASTATIN SODIUM ( 10MG, 20MG, 40MG ) Pravachol®Cholestrol90$30
PREDNISONE ( 5MG, 10MG, 20MG ) Deltasone®Corticosteroid360$20
PRIMIDONE (50MG, 250MG ) Mysoline®Seizure180$30
PROCHLORPERAZINE ( 5MG ) Compazine®nausea and vomiting270$30
PROCHLORPERAZINE MALEATE ( 10MG ) Compazine®nausea and vomiting270$30
PROPAFENONE HCL ( 150MG ) Rythmol ®Heart180$40
PROPRANOLOL HCL ( 10MG, 20MG, 40MG, 80MG ) Inderal®Beta-2 Antagonist360$20
QUINAPRIL HCL ( 5MG, 10MG, 20MG, 40MG ) Accupril®ACE Inhibitors180$30
RAMIPRIL ( 1.25MG, 2.5MG, 5MG, 10MG ) Altace®Blood Pressure90$20
RANITIDINE HCL ( 150MG, 300MG ) Zantac®Histamine-2 Antagonist180$20
RISPERIDONE ( 0.25MG, 0.5MG, 1MG, 2MG, 3MG, 4MG ) RisperdalSchizophrenia180$60
ROPINIROLE ( 0.25MG, 0.5MG, 1MG, 2MG, 3MG, 4MG, 5MG ) Requip®Parkinsons, RLS90$40
SERTRALINE HCL ( 25MG, 50MG, 100MG ) Zoloft®Depression180$30
SIMVASTATIN ( 5MG, 20MG, 40MG, 80MG ) Zocor®Cholestrol90$20
SIMVASTATIN (5MG, 10MG, 20MG, 40MG, 80MG ) Zocor®Cholestrol90$20
SOTALOL AF ( 80MG, 120MG, 160MG ) Betapace®-AF®Heart180$40
SOTALOL HCL ( 80MG, 120MG, 160MG ) Betapace®Heart180$30
SPIRONOLACTONE ( 25MG ) Aldactone®Diuretic180$30
SPIRONOLACTONE ( 50MG ) Aldactone®Diuretic90$30
SUCRALFATE ( 1GM ) CarafateUlcer270$45
SULFAMETHOXAZOLE/TRIMETHOPRIM ( 400-80MG, 800-160MG ) Septra-DS/Bactrim-DS®Antibiotic180$20
SULFASALAZINE ( 500MG ) Azulfidine®Ulcerative Colitis360$30
SULFAZINE EC ( 500MG ) Azulfidine® Entab ECUlcerative Colitis/Crohn`s180$40
SULINDAC ( 150MG, 200MG ) Clinoril®Arthiritis180$30
SUMATRIPTAN SUCCINATE ( 25MG, 50MG, 100MG ) Imitrex® Migraines18$35
TEMAZEPAM ( 15MG, 30MG ) Restoril®Insomnia90$30
TERAZOSIN HCL ( 1MG, 2MG, 5MG, 10MG ) Hytrin®Prostate180$20
TERBINAFINE HCL ( 250MG ) Lamisil®Anti-Fungal90$30
THEOPHYLLINE ANHYDROUS ( 100MG, 200MG, 300MG ) Theo-Dur ®COPD/Asthma180$30
TIMOLOL MALEATE ( 0.25%, 0.5% ) Timoptic®Glaucoma30$20
TIMOLOL MALEATE ( 5MG ) Timoptic®Glaucoma180$30
TIZANIDINE HCL ( 2MG, 4MG ) Zanaflex®Muscle Relaxer360$30
TOPIRAMATE ( 25MG, 50MG, 100MG, 200MG ) Topamax®Migraine180$30
TORSEMIDE ( 10MG, 20MG ) Demadex®Diuretics180$30
TORSEMIDE ( 100MG ) Demadex®Diuretics90$30
TRAMADOL HCL ( 50MG ) Ultram®Pain360$30
TRANDOLAPRIL ( 1MG, 2MG, 4MG ) Mavik®Hypertension90$30
TRAZODONE HCL ( 50MG, 100MG ) Desyrel®Anti-depressants360$20
TRIAMTERENE/HCTZ ( 37.5-25MG, 75-50MG ) Dyazide®, Maxzide®Diuretics180$20
TRIAZOLAM ( 0.125MG, 0.25MG ) Halcion® Insomnia90$30
TRIHEXYPHENIDYL HCL ( 2MG ) Artane®Antipsychotic180$20
VENLAFAXINE ER Capsule (37.5MG, 75MG, 150MG ) Effexor-XR 90$75
VERAPAMIL HCL (120MG, 180MG, 240MG ) Calan/Isoptin SR®Hypertension90$30
VERAPAMIL HCL ( 80MG ) Calan®, Isoptin®Hypertension360$20
VERAPAMIL HCL ER ( 180MG ) Calan/Isoptin SR®Hypertension90$30
WARFARIN SODIUM ( 1MG, 2MG, 2.5MG, 4MG, 5MG, 6MG, 7.5MG, 10MG ) Coumadin®, Jantoven ®Blood Thinner180$30
ZALEPLON ( 5MG, 10MG ) Sonata®Insomnia90$30
ZOLPIDEM TARTRATE ( 5MG, 10MG ) Ambien®Insomnia90$30
ZONISAMIDE ( 25MG, 50MG ) Zonegran®Anticonvulsants180$30
All quantities are for Maximum 90 day supply
* Quantity Limitation Applies.
**** All creams have quantity limitation
! Medicare eligibility required. Administrative fee applies.
Medications beyond therapeutic dosages according to the manufacturer will be dispensed based on established therapeutic guidelines.

This service is not currently available in Montana.