ORDER NO. 31180
BIDS FOR PHARMACEUTICAL PROVIDERS FOR KERR COUNTY INDIGENT
HEALTH PROGRAM
Came to be heard this the 9th day of February, 2009, with a motion made by
Commissioner Williams, seconded by Commissioner Letz, the Court unanimously
approved by a vote of 4-0-0 to:
Open and accept bids for pharmaceutical providers for the Kerr County Indigent Health
Program for the balance of fiscal year 2009 and fiscal year 2010, and refer to Indigent
Health Department for evaluation:
1. The Medicine Stop
2. Ackman Pharmacy
3. HEB, San Antonio
~ 3J1 ~~
~~
COMMISSIONERS' COURT AGENDA REQUEST
PLEASE FURNISH ONE ORIGINAL AND NINE COPIES OF THIS
REQUEST AND DOCUMENTS TO BE REVIEWED BY,THE COURT.
MADE BY: Dawn Lantz & Rosa Lavender OFFICE: Indigent Health
MEETING DATE: Feb. 9, 2009 TIME PREFERRED: 9:00 (timed item)
SUBJECT: Open bids from pharmaceutical providers for the Kerr County Indigent Health
program for the balance of the 2009 fiscal year and FY 2010 and refer bids to Indigent
Health Department for evaluation.
EXECUTIVE SESSION REQUESTED: (PLEASE STATE REASON)
NAME OF PERSON ADDRESSING THE COURT: None
ESTIMATED LENGTH OF PRESENTATION: None
IF PERSONNEL MATTER -NAME OF EMPLOYEE:
Time for submitting this request for Court to assure that the matter is posted in accordance
with Title 5, Chapter 551 and 552, Government Code, is as follows:
Meeting scheduled for Mondays: 5:00 P.M. previous Tuesday.
THIS REQUEST RECEIV~D BY:
THIS REQUEST RECEIVED ON:

All Agenda Requests will be screened by the County Judge's Office to determine if adequate
information has been prepared for the Court's formal consideration and action at time of Court
Meetings. Your cooperation will be appreciated and contribute towards you request being
addressed at the earliest opportunity. See Agenda Request Rules Adopted by Commissioners'
Court.
..~,~:_;,~ KERR COUI\ITY II`IDIGEhIT HEALTH
''~ ~~ r CARE PROCRAM
~ ,>
~~~ ' ~,,
~,~s r'~ .. ..
~: <~^~:r:.r'~~ 700 Main Street BA-108 e• Kerrville, Texas 78028 (830) 792-2239
`~,~_~~; ` ` ~" Fax (830) 257-8194
January 12, 2009
To: Prospective Bidders for the Kerr County Indigent Health Program
Pharmaceuticals
Enclosed are:
i. Copy of Notice to Bidder published in the Kerrville Daily Times (Notice that the
deadline_fi~r bid suhntission is F'eb. 6 at 4:30 p.m.~
2. Copy of Testis Department of State Health Services guidelines for prescription
Drugs.
3. ON CD:
a. Copy of Kerr County Indigent Health Care Policy adopted in December 2008
b. Copy of list of prescription drugs dispensed to indigent health clients from
September i to December 31, 2008 with NCR codes with dosage information
c. Copy of Top 20 NDC Usage reports for Kerr County IHC for September,
October and November, 2008 (December is not available yet} We suggest you
make copies of this information because of the format it was scanned into.
#. Additional information that may be of interest to you in your bid decision.
5. Form to he returned with bid package and your bid letter.
Please feel free to give us a call if you have any questions about this bid package.
~ ~~
~~~~.i~"s~ i „r,ti,~~•}. ;,~,
Dawn Lantz
1HC Coordinator
792-2239
Rosa Lavender
IHC Supervisor
792-2297
Notice to Bidder:
Kerr County is accepting proposals from qualified pharmaceutical providers to provide
prescriptions for persons approved for the Kerr County Indigent Health program for the
balance of the 2008-2009 fiscal year plus FY 2010. Bid packages will be available in the
Kerr County Indigent Health Care office in the lower level of the courthouse annex
beginning January 12. Proposals are to be submitted as unit pricing based on a list of
commonly prescribed medications that will be provided with the bid package. The
county's method of payment will be based on monthly billing from the provider. No bond
will be required from the bidder. Proposals are to be submitted as one original complete
Proposal set (marked "original") and three copies of the Proposal (marked "copy"). All
proposals must be returned in a sealed envelope with the Firm's name, address, Proposal
name, and the wording "SEALED BID" clearly marked on the outside of the envelope.
Sealed proposals may be hand-delivered or mailed to the Kerr County Clerk, 700 Main
St., #122, Kerrville, TX 78028. The proposals must be received in the County Clerk's
Office on or before February 6, at 4:30 p.m. The bids will be opened on February 9 at 9
a.m. in the Kerr County Commissioners' Court.
~~-
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SECTION FOUR
SERVICE DELIVERY
Page 12
Basic Health Care Services (continued)
Prescription This service includes up to three prescription drugs per month. New and
Drugs refilled prescriptions count equally toward this three prescription drugs per
month total. Drugs must be prescribed by a physician or other practitioner
within the scope of practice under law.
The quantity of each prescription depends on the prescribing practice of
the physician and the needs of the patient.
Payment Standard. Use the following information and formula.
• Use the drug's 11-digit National Drug Code (NDC) number and the
quantity dispensed to select the average wholesale price (AWP} in the
Red BookC~. In addition to the annual Red Book®, the monthly Red
Booker Update may be used. Red Book® products may be obtained
by contacting Thomson Healthcare at 1-800-678-5689.
• Net Cost is:
o Red BookO AWP minus 40% for generic prescription drugs
o Red Books AWP minus 13% for name brand prescription drugs
• The drug dispensing fee is $5.60.
• The formula for computing the TDSHS Payable is:
Net Cost plus drug dispensing fee =TDSHS Payable
Example: Red Booker AWP for 25 tablets is $100.00.
1. $100.00 divided by 25 = $4.00 per tablet
2. $4.00 per tablet x 34 tablets (prescribed quantity) _ $136.00
3. $136.00 - $54.40 (40% for generic) _ $81.60
4. $81.60 + $5.60 (dispensing fee) _ $87.20 TDSHS Payable
• A payment amount may be negotiated with the provider for:
o Prescription compound drugs,
o Prescription drugs not listed in the Red Book, or
o Prescription drugs that do not have an NDC number.
Rural Health RHC services must be provided in a freestanding or - sed rural
Clinic (RHC) health cl' d provided by a physicia physician assistant, an
Services advanced practice e (includin rse practitioner, a clinical nurse
specialist, and a certified n Idwife), or a visiting nurse.
Pa ment St da d: Use the Rate Per Visl he "Medicare-Approved
Rural Healt Clinic Rates" included in Section Four, rvice Delivery.
CIHCP 05-5
September 2005
KERR COUNTY INDIGENT HEALTH PROGRAM
PRESCRIPTION DRUGS
March 1, 2009 to August 31, 2010
Return this form with the Bid proposal attached.
• NET COST to be computed in accordance with
Department of State Health Services, County
Indigent Health Care Program Handbook,
Payment Standard for Prescription Drugs. (Page
12 excerpted from current DHS Handbook
attached -Handbook was scheduled to be updated
in January 2009.)
ADDITIONAL DISCOUNT TO BE APPLIED
TO THE NET COST OF GENERIC PRESCRIPTION
DRUGS
ADDITIONAL DISCOUNT TO BE APPLIED
TO THE NET COST OF NAME BRAND
PRESCRIPTION DRUGS
ADDITIONAL INFORMATION:
CVS Pharmacy has been the county's indigent health pharmaceuticals provider for
the past several years. From January 1, 2008 to December 31, 2008 Kerr County
paid out $86,609 to CVS Pharmacy. State law requires that any county expenditure
exceeding $25,000 annually must be put up for bid at least every three years.
Ackman Pharmacy provided the pharmaceuticals for the Kerr County Jail during
that same period, but this budget year the county contracted with a company to
provide the prescriptions for the prisoners as part of a comprehensive health care
contract for inmates.
2008-2009
KERR COUNTY INDIGENT HEALTH CARE POLICY
(This policy, adopted by Kerr County Commissioners' Court at the regular meeting in
December, 2008, shall become effective January 31, 2009, and remain in effect
until August 31, 2009)
The Kerr County Indigent Health Program is established with an application,
documentation, and verification process based on Texas Department of State Health
Services (TDSHS) guidelines established Chapter 61 of the Health and Safety Code.
Chapter 61, the Indigent Health Care and Treatment Act was passed in 1986 by the 69r"
Texas Legislature.
The Kerr County Indigent Health Program will be referred to as KCIHP in the remainder
of this policy document.
KCIHP is a county-based program providing basic services according to the TDSHS
guidelines and does not offer any optional services.
KCIHP has a maximum county liability per client for each state fiscal year (September 1
to August 31) for health services provided by all assistance providers, including hospital
and skilled nursing facility.
Eligibility must (by law) be determined within 14 days of application completion date.
KCIHP will consider four eligibility criteria for determination of eligibility:
Residence, Household, Income and Resources.
KCIHP Residency Requirements (may include but are not limited to):
• Mail addressed and delivered to the applicant's physical address. No post office
box addresses are acceptable.
• Texas driver's license or other official identification showing current Kerr
County address.
• Rent or mortgage payment showing applicant's name and address of property and
date signed.
• Kerr County property tax receipt for the most recent tax year
• Kerr County voter registration card showing current address
• School enrollment records
KCIHP Household Requirements (may include but are not limited to):
A KCIHP household may be a person living alone or two or more persons living
together where legal responsibility for support exists, excluding disqualified
persons. Verification of household is required.
Legal responsibility for support exists between persons who are legally married,
a legal parent and a minor child, or a managing conservator and a minor child.
KCIHP Income Requirements
• A household must pursue and accept all income to which the household is legally
entitled.
• The income of all household members is considered in determining eligibility.
• Monthly Income Standards will be based on the annual Federal Poverty
Guidelines
• Verification of income may include but is not limited to requests for paycheck
stubs, statements from employers, W-2 forms, verification of cash contributions,
business records, award letters, court orders or public decrees, sales records,
income tax returns or statements completed, signed and dated by the self-
employed person.
KCIHP Resources Requirements
• A household must pursue all resources to which the household is legally entitled
unless it is unreasonable to pursue the resource. Indigent health care should be
considered the source of last resort.
• The resources of all household members are considered. Proof of resources may
be required.
KCIHP Policies
• All applicants for KCIHP will be required to visit the county's indigent health
office in the basement of the Kerr County Courthouse annex for an interview. If
the applicant misses the interview appointment the application will be denied and
applicant will have to reapply. If approved, a photo identification card will be
generated for the applicant.
• Persons already on the program will be photographed and an identification card
generated when they are reviewed. Reviews must be done every 6 months but
can be required at any interval of time less than the 6 months, as determined by
KCIHP.
• Beginning Feb. 1, 2009, persons covered under the Kerr County Indigent Health
Program will be asked to share in the costs of their health care. $50 co-pay per
hospital visit, $25 co-pay per doctor visit and $5 co-pay per prescription will be
requested. Program participants will be encouraged to seek information on other
low-cost prescription plans that are available through their providers.
• Persons on KCIHP or new applicants will have 14 days to report changes in
address, in income or resources, people living in the household, or any
application for or receipt of Medicaid, TANF, or SSI to our office. Failure to do
so will jeopardize eligibility and could lead to criminal charges.
• Applicants will be required to sign an affidavit swearing to the accuracy of
information provided in the application process and the affidavit will be notarized
at no cost to the applicant. A person who provides false information will be
banned from re-applying for indigent health care in Kerr County for a period of
two years. Giving false information on an application could lead to criminal
charges.
• Applicants will be subject to background checks to include screening under
www.yourte~asbenefits.com and http://best.ssa.800
• The filing of an application for Kerr County IHP or the receipt of services
constitutes an assignment of the applicant's or recipient's right of recovery from
personal insurance, other sources, or another person for personal injury caused by
another person's negligence or wrong doing. An applicant or recipient shall
inform the county at the time of application or any time during eligibility, of any
unsettled tort claim that may affect medical needs and of any private accident or
sickness insurance coverage that is or may become available. Notice must be
given to KCIHP within 10 days of the date the person learns of the insurance
coverage, tort claim or potential cause of action.
• If an applicant is denied coverage, the person will have 90 days to file a written
appeal with KCIHP. A form will be provided. An appeals committee will review
the application and written appeal and set up a hearing with the applicant. The
review committee will be made up of the IHC Coordinator (non-voting) and two
unbiased members.
• Kerr County may, by state law, designate providers for indigent health care
recipients. Out-of-county care will require prior approval and a referral in writing
from a Kerr County physician or meet one of three criteria (an emergency
situation, when medical care is not available in Kerr County, or when care in
Kerr County would be medically inappropriate).
• KCIHP requires dispensing of generic prescriptions, if there is a generic
available. A physician can request the name-brand as part of the prescription but
the IHC recipient cannot make the choice. Medications that are available in an
over-the-counter form will not be covered. Prescriptions are limited to a total of
three per month for each IHC recipient. If a physician writes the prescription for
a 90 day supply then the prescription will count as one of the three for each of the
three months. Dosage verification will be required for all prescriptions.
Persons on KCIHP may be required to register with the Workforce Solutions
Alamo for job eligibility or training. They may also be advised to seek services
from the Texas Rehabilitation Commission or ask Social Security to determine
whether they are eligible for Social Security Disability Insurance/Medicare.
• For claim payments to be considered, a claim must be received in the KCIHP
office no later than 95 days from (1) the date of service, for services provided
after the date of approval, or (2) the date of approval, for services provided
before the household was approved.
First Update January 12, 2009
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Ackman Pharmacy
200 Wesley Dr.
Kerrville, TX 78028
(830) 257-4121
FAX (830) 257-3485
02/06/2008
Kerr County Clerk
700 Main St., # 122
Kerrville, TX 78028
Attn: Kerr County Commissioners' Court
Please accept our BID to be the prescription drug provider for the Kerr
County Indigent Health Program.
Thank you for your consideration.
Sincerely,
~.-.- ,~
Steve Ackman
_,
..,
f - C~
~; ~
.~
KERR COUNTY INDIGENT HEALTH PROGRAM
PRESCRIPTION DRUGS
March 1, 2009 to August 31, 2010
Return this fof m with the Bid proposal attached.
• NET COST to be computed in accordance with
Department of State Health Services, County
Indigent Health Care Program Handbook,
Payment Standard for Prescription Drugs. (Page
12 excerpted from current DHS Handbook
attached -Handbook was scheduled to be updated
in January 2009.)
ADDITIONAL DISCOUNT TO BE APPLIED
TO THE NET COST OF GENERIC PRESCRIPTION
DRUGS
ADDITIONAL DISCOUNT TO BE APPLIED
TO THE NET COST OF NAME BRAND
PRESCRIPTION DRUGS
dll char; es must be included in the bid r2ce.
No other charges may be added to the bid price when invoiced unlg,~s noted as an
ea . ~~ion in the bid form. "'
.f}. d~
~'I
JI ~ ~ /G' ~ L1 ~.
KERR COUNTY INDIGENT HEALTI-I PROGRA
PRESCRIPTION DRUGS
March 1, 2009 to August 31, 2010
Return this form with the Bid proposal attached.
• NET COST to be computed in accordance vt~ith
Department of State Health Services, County
Indigent Health Care Program Handbook,
Payment Standard far Frescription Drugs. (Page
12 excerpted from current DHS Handbook
attached -Handbook was scheduled to be updated
in January 2009.)
ADDITIONAL DISCOUNT TO BE APPLIED
TO THE NET COST OF GENERIC PRESCRIPTION
DRUGS
ADDITIONAL DISCOUNT TO B.E APPLIED
TO THE NET COST OF NAME BRAND
PRESCRIPTION DRUGS
--/~!_t _~~~
Q
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~,
Co ~
KERR COUNTY INDIGENT HEALTH PROGRAM
PRESCRIPTION DRUGS
March 1, 2009 to August 31, 2010
Return this form with the Bid proposal attached.
• NET COST to be computed in accordance with
Department of State Health Services, County
Indigent Health Care Program Handbook,
Payment Standard for Prescription Drugs. (Page
12 excerpted from current DHS Handbook
attached -Handbook was scheduled to be updated
in January 2009.)
ADDITIONAL DISCOUNT TO BE APPLIED
TO THE NET ~'OS"T OF GENERIC PRESCRIPTION
DRUGS
P~
~'1'~ C~Spe.r1S2 ~~ ®Yl 50 ~ten~i:. i 5f
ADDITIONAL DISCOUNT TO BE APPLIED
TO THE NET COST OF NAME BRAND
PRESCRIPTION DRUGS
SECTION FOUR
SERVICE DELIVERY
Page 12
Basic Health Care Services (continued)
Prescription This service includes up to three prescription drugs per month. New and
Drugs refilled prescriptions count equally toward this three prescription drugs per
month total. Drugs must be prescribed by a physician or other practitioner
within the scope of practice under faw.
The quantity of each prescription depends on the prescribing practice of
the physician and the needs of the patient.
Payment Standard. Use the #ollowing information and formula.
• Use the drug's 11-digit National Drug Code (NDC) number and the
quantity dispensed to select the average wholesale price (AWP) in the
Red Book4. In addition to the annual Red Book®, the monthly Red
Booker Update may be used. Red Book® products may be obtained
by contacting Thomson Healthcare at 1-800-678-5689.
• Net Cost is:
o Red Book® AWP minus 40% for generic prescription drugs
o Red Book® AWP minus 13% for name brand prescription drugs
• The drug dispensing fee is $5.60.
• The formula for computing the TDSHS Payable is:
Net Cost plus drug dispensing fee =TDSHS Payable
Example: Red Bookt~ AWP for 25 tablets is $100.00.
1. $100.00 divided by 25 = $4.00 per tablet
2. $4.00 per tablet x 34 tablets (prescribed quantity) _ $136.00
3. $136.00 - $54.40 (40% for generic) _ $81.60
4. $81.60 + $5.60 (dispensing fee) _ $87.20 TDSHS Payable
• A payment amount may be negotiated with the provider for:
o Prescription compound drugs,
o Prescription drugs not listed in the Red Book®, or
o Prescription drugs that do not have an NDC number.
Rural Health RHC services must be provided in a freestanding or - sed rural
Clinic (RHC) health cl' d provided by a physicia physician assistant, an
Services advanced practice a (includin rse practitioner, a clinical nurse
specialist, and a certified n idwife}, or a visiting nurse.
Pa ment St ard: Use the Rate Per Visi ~ he "Medicare-Approved
Rural Healt Clinic Rates" included in Section Four, rvice Delivery.
CIHCP 05-5
September 2005
2008-2009
KERB COUNTY INDIGENT HEALTH CARE POLICY
(This policy, adopted by Kerr County Commissioners' Court at the regular meeting in
December, 2008, shall become effective January 31, 2009, and remain in effect
until August 31, 2009)
The Kerr County Indigent Health Program is established with an application,
documentation, and verification process based on Texas Department of State Health
Services (TDSHS) guidelines established Chapter 61 of the Health and Safety Code.
Chapter 61, the Indigent Health Care and Treatment Act was passed in 1986 by the 69t1i
Texas Legislature.
The Kerr County Indigent Health Program will be referred to as KCIHP in the remainder
of this policy document.
KCIHP is a county-based program providing basic services according to the TDSHS
guidelines and does not offer any optional services.
KCIHP has a maximum county liability per client for each state fiscal year (September 1
to August 31) for health services provided by all assistance providers, including hospital
and skilled nursing facility.
Eligibility must (by law) be determined within 14 days of application completion date.
KCIHP will consider four eligibility criteria for determination of eligibility:
Residence, Household, Income and Resources.
KCIHP Residency Requirements (may include but are not limited to):
• Mail addressed and delivered to the applicant's physical address. No post office
box addresses are acceptable.
• Texas driver's license or other official identification showing current Kerr
County address.
• Rent or mortgage payment showing applicant's name and address of property and
date signed.
• Kerr County property tax receipt for the most recent tax year
• Kerr County .voter registration card showing current address
• School enrollment records
KCIHP Household Requirements (may include but are not limited to):
• A KCIHP household may be a person living alone or two or more persons living
together where legal responsibility for support exists, excluding disqualified
persons. Verification of household is required.
• Legal responsibility for support exists between persons who are legally married,
a legal parent and a minor child, or a managing conservator and a minor child.
KCIHP Income Requirements
• A household must pursue and accept all income to which the household is legally
entitled.
• The income of all household members is considered in determining eligibility.
• Monthly Income Standards will be based on the annual Federal Poverty
Guidelines
• Verification of income may include but is not limited to requests for paycheck
stubs, statements from employers, W-2 forms, verification of cash contributions,
business records, award letters, court orders or public decrees, sales records,
income tax returns or statements completed, signed and dated by the self-
employed person.
KCIHP Resources Requirements
A household must pursue all resources to which the household is legally entitled
unless it is unreasonable to pursue the resource. Indigent health care should be
considered the source of last resort.
The resources of all household members are considered. Proof of resources may
be required.
KCIHP Policies
• All applicants for KCIHP will be required to visit the county's indigent health
office in the basement of the Kerr County Courthouse annex for an interview. If
the applicant misses the interview appointment the application will be denied and
applicant will have to reapply. If approved, a photo identification card will be
generated for the applicant.
• Persons already on the program will be photographed and an identification card
generated when they are reviewed. Reviews must be done every 6 months but
can be required at any interval of time less than the 6 months, as determined by
KCIHP.
• Beginning Feb. 1, 2009, persons covered under the Kerr County Indigent Health
Program will be asked to share in the costs of their health care. $50 co-pay per
hospital visit, $25 co-pay per doctor visit and $5 co-pay per prescription will be
requested. Program participants will be encouraged to seek information on other
low-cost prescription plans that are available through their providers.
• Persons on KCIHP or new applicants will have 14 days to report changes in
address, in income or resources, people living in the household, or any
application for or receipt of Medicaid, TANF, or SSI to our office. Failure to do
so will jeopardize eligibility and could lead to criminal charges.
• Applicants will be required to sign an affidavit swearing to the accuracy of
information provided in the application process and the affidavit will be notarized
at no cost to the applicant. A person who provides false information will be
banned from re-applying for indigent health care in Kerr County for a period of
two years. Giving false information on an application could lead to criminal
charges.
• Applicants will be subject to background checks to include screening under
www.yourtexasbenefits.com and http://best.ssa.800
• The filing of an application for Kerr County IHP or the receipt of services
constitutes an assignment of the applicant's or recipient's right of recovery from
personal insurance, other sources, or another person for personal injury caused by
another person's negligence or wrong doing. An applicant or recipient shall
inform the county at the time of application or any time during eligibility, of any
unsettled tort claim that may affect medical needs and of any private accident or
sickness insurance coverage that is or may become available. Notice must be
given to KCIHP within 10 days of the date the person learns of the insurance
coverage, tort claim or potential cause of action.
• If an applicant is denied coverage, the person will have 90 days to file a written
appeal with KCIHP. A form will be provided. An appeals committee will review
the application and written appeal and set up a hearing with the applicant. The
review committee will be made up of the IHC Coordinator (non-voting) and two
unbiased members.
• Kerr County may, by state law, designate providers for indigent health care
recipients. Out-of-county care will require prior approval and a referral in writing
from a Kerr County physician or meet one of three criteria (an emergency
situation, when medical care is not available in Kerr County, or when care in
Kerr County would be medically inappropriate).
• KCIHP requires dispensing of generic prescriptions, if there is a generic
available. A physician can request the name-brand as part of the prescription but
the IHC recipient cannot make the choice. Medications that are available in an
over-the-counter form will not be covered. Prescriptions are limited to a total of
three per month for each IHC recipient. If a physician writes the prescription for
a 90 day supply then the prescription will count as one of the three for each of the
three months. Dosage verification will be required for all prescriptions.
• Persons on KCIHP maybe required to register with the Workforce Solutions
Alamo for job eligibility or training. They may also be advised to seek services
from the Texas Rehabilitation Commission or ask Social Security to determine
whether they are eligible for Social Security Disability Insurance/Medicare.
• For claim payments to be considered, a claim must be received in the KCIHP
office no later than 95 days from (1) the date of service, for services provided
after the date of approval, or (2) the date of approval, for services provided
before the household was approved.
First Update January 12, 2009
K~RR Ci0U1`IT~ II\IDIC~ItiIT HEALTH
GARS PROGRAM
700 Main Street BA-108 ti• Kerrville, Texas 78028 d• (830) 792-2239 r•
Fax (830) 257-8194
January 12, 2009
To: Prospective Bidders for the Kerr County Indigent Health Program
Pharmaceuticals
Enclosed are:
1. Copy of Notice to Bidder published in the Kerrville Daily Times (Notice that the
deadline for bid submission is Feb. 6 at 4:30 p.m.)
2. Copy of Tegas Department of State Health Services guidelines for prescription
Drugs.
3. ON CD:
a. Copy of Kerr County Indigent Health Care Policy adopted in December 2008
b. Copy of list of prescription drugs dispensed to indigent health clients from
September 1 to December 31, 2008 with NCR codes with dosage information
c. Copy of Top 20 NDC Usage reports for Kerr County IHC for September,
October and November, 2008 (December is not available yet) We suggest you
make copies of this information because of the fo~nat it was scanned into.
4. Additional information that may be of interest to you in your bid decision.
S. Form to be returned with bid package and your bid letter.
Please feel free to give us a call if you have any questions about this bid package.
~S r i
Dawn Lantz
IHC Coordinator
792-2239
Rosa Lavender
IHC Supervisor
792-2297
Notice to Bidder:
Kerr County is accepting proposals from qualified pharmaceutical providers to provide
prescriptions for persons approved for the Kerr County Indigent Health program for the
balance of the 2008-2009 fiscal year plus FY ZO10. Bid packages will be available in the
Kerr County Indigent Health Care office in the lower level of the courthouse annex
beginning January 12. Proposals are to be submitted as unit pricing based on a list of
commonly prescribed medications that will be provided with the bid package. The
county's method of payment will be based on monthly billing from the provider. No bond
will be required from the bidder. Proposals are to be submitted as one original complete
Proposal set (marked "original") and three copies of the Proposal (marked "copy"). All
proposals must be returned in a sealed envelope with the Firm's name, address, Proposal
name, and the wording "SEALED BID" clearly marked on the outside of the envelope.
Sealed proposals may be hand-delivered or mailed to the Kerr County Clerk, 700 Main
St., #122, Kerrville, TX 78028. The proposals must be received in the County Clerk's
Office on or before February 6, at 4:30 p.m. The bids will be opened on February 9 at 9
a. m. in the Kerr County Commissioners' Court.
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February 4, 2009
H-E-B Pharmacy
646 S. Main Avenue
San Antonio, TX 78204
c/o Sandra Barsenas
210-938-7423
Kerr County Prescription Drug Bid
Indigent Health Care Pharmaceuticals
Due Date: February 6, 2009
Opening Date: February 9, 2009
* Generics (must be at least 40% discount) Minimum of 40% off of AWP with access
to the list of 500 generics for $5 each. Plus a dispensing fee of $5.00 per prescription.
There is no dispense fee for prescriptions on the 500 generic list).
* Brands Minimum of 13% off AWP. Plus a dispensing fee of $5.00 per prescription.
Please note, that the 500 generic list covers a wide variety of medications which includes
medications for both acute and maintenance conditions. Such medications include but
are not limited to:
• Cardiac,
• Asthma,
• Penicillins,
• Ulcer,
• Allergy, Cough, and Cold,
• Anxiety,
• Seizures,
• Hormone,
• Cholesterol,
• Antibiotics,
• Antidepressants,
• Diabetes,
• Contraceptives,
• Thyroid,
• and Gastrointestinal
• Plus others as noted on the attached list
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Helping Texans
save money
and live better!
Dear County Administrator:
You want the best for your clients, and so do we at your H-E-B Pharmacy.
That's why H-E-B introduced the My H-E-B Rxtra Advantage Community Choice program. This program
offers an option for community based organizations to take advantage of prescription savings.
With the uninsured and underinsured population on the rise, this program will help people afford
life-saving medications and save your county money that can then be used to help more citizens every
day. Enclosed you will find a list of 500 drugs that are currently available from the H-E-B Pharmacy for
$5 each fora 30 day supply and a map showing H-E-B Pharmacy locations. These 500 generic medica-
tions cover a wide range of conditions and diagnosis groups.
Administration of The My H-E-B Rxtra Advantage Community Choice program includes
the following benefits:
• Personalized County web site for enrollment and termination
• Participant welcome letter and ID card
•Administration of 3 prescriptions per month per participant
•Administration of diabetic supplies does not count toward the three scripts available per month
•Access to 500 generic medications for $5 each (30 day supply)
• 90-day supply for only $9.99 is also available
• Diabetic patients receive a coupon for a FREE H-E-B InControl Diabetic Starter Kit.
• System modifications to block non-covered prescriptions with the ability to override in approved
circumstances
•Access to designated H-E-B Pharmacies
• Monthly invoicing with detailed billing information
• Account Manager to help with day to day issues
Clients also have access to cash discounts on the 500 for $5 list and the 90 Days for $9.99 Platinum
pricing once they have exhausted their three monthly prescriptions.
Thank you for allowing us to share this valuable information with you.
Pha acy
A ~{~' for you from the
o.
o
Better Value. Better Service. Better Care.
We make it all better.'M
Dear
Thank you for choosing H-E-B Pharmacy to fill your prescription needs and becoming a member of H-E-B
Rxtra Advantage. As a welcome to our program and to assist in your therapy, we would like to offer you
an H-E-B inControl Plus Complete Diabetes Monitoring Kit at no charge. Simply return this letter to your
H-E-B Pharmacy and you will be on your way to better management of your diabetes.
---~ ~.
J
iL'o~itr'bl
Benefits of the H-E-B inControl Plus Monitor include: r ~ ~ . ;;
PI Ir DiaLrtis Mon~lorin~ KiI
• Small blood sample -Only 1 microliter "~`--~"~~~'~°° °°~
j Starter
• Ease of Use - 2 simple steps h'r
• Results in only 10 seconds "W •~~~ '`~'
• Forearm and fingertip testing approved -.
• 365 test memory ~~
Plus, by using the H-E-B inControl Plus Monitor you will be saving over $500 a year on
diabetic testing supplies versus other blood glucose monitoring systems.*
At H-E-B we care about your health and want to provide you the tools for maintaining your health at
valuable savings. Stop by your H-E-B Pharmacy today and take advantage of this great offer.
Visit www.heb.com
for pharmacy locations.
* Source -Home Diagnostics Inc. -When compared to
National Brands and testing three times per day.
R9032 RV1799
' IN-AD COUPON GOOD TNRU 12/31/08 '
' Cnmplrtr, D:ahclcr, MonilorinF h~~. ~ '
); 5tartcr e e
~ ~ ~
~ •,..~ H-E-B ~
~' ~.
~ ~~ inControl Plus ~
~ ~ ; Starter Kit ~
R9032
1 ..,,..~..~..,,. .., '
Only At Items may not be available at all H-E-B Sores. ,
~ Limit one coupon per purchase of product indicated
Phai~B'18Cy • Coupon may not be mechanically reproduced, 5 412 2 0 6 0 6 01 1 '
doubled or combined with any other offer
~. . ~ ~ ~ . . . . . . . . . . . . . . . J
..---
1k pays to go
.Y~~ PLATINUM.
1~-~ -sign up and save!
~; .
Discounts on ALL BRAND NAME
and GENERIC medications
~~ a • FREE health screenings*
• 500 generic medications for $5
(for up to a 30-day supply)*
• 500 generic medications for'9~
(fora 90~day supply)*
"~ • Discounts on ALL immunizations
• Discounts on ALL pet medications
• FREE prenatal vitamins*
;.
One time enrollment fee of ~5 for the entire family!
Visit your H-E-B Pharmacy for details.
/s1~I~~;ZHI~-Y:'[d~l~~lel~l~73	>A~=~~i~	FLURBIPROFEN TAB 100MG	60	CICLOPIROX CRE 0.77°k	30	TIMOLOL MAL SOL 0.5°k OP	15
BENZONATATE CAP 100MG	30	IBUPROFEN SUS 100/5ML	120	CICLOPIROX SUS 0.77%	30	TOBRAMYCIN SOL 0.3°k OP	5
CERON SYP	240	IBUPROFEN TAB 400MG	90	CLOTRIMAZOLE CRE 1°~	15		
CLEMASTINE SYP 0.5/5ML	120	IBUPROFEN TAB 600MG	60	CLOTRIMAZOLE LOZ lOMG	70		
COLDAMINE TAB 8-90-2.5	60	IBUPROFEN TAB 800MG	30	ECONAZOLE CRE 1%	15	ACEBUiOLOI CAP 200MG	30
DEHISTINE SYP	240	INDOMETHACIN CAP 25MG	60	FLUCONAZOLE 100MG TABLETS	30	AMILOR/HCTZ TAB 5-50	30
DEX PC SYP	120	KETOPROFEN CAP 75MG	60	FLUCONAZOLE 150MG TABLETS	1	AMLODIPINE TAB 2.5MG	30
DURADRYL SR TAB	30	KETOPROFEN CAP 200MG ER	30	FLUCONAZOLE 200MG TABLETS	2	ATENOL/CHLOR TAB 50-25MG	30
FLUNISOLIDE SPR 0.025°~	25	MELOXICAM TAB 7.5MG	30	KETOCONAZOLE CRE 2~°	15	ATENOL/CHLOR TAB 100-25MG	30
GANI-TUBS DM LIQ 100-10/5	240	MELOXICAM TAB 15MG	30	NYSTAT/TRIAM CRE	15	ATENOLOL TAB 25MG	30
IPRATROPIUM SPR 0.03%	30	METHOCARBAM TAB 500MG	60	NYSTAT/TRIAM CRE	30	ATENOLOL TAB 50MG	30
IPRATROPIUM SPR 0.06%	15	MST 600 TAB	60	NYSTAT/TRIAM CRE	60	ATENOLOL TAB 100MG	30
PROMETHAZINE SYP 6.25/5ML	120	NAPROXEN TAB 250MG	60	NYSTAT/TRIAM OIN	15	BENAZEP/HCTZ TAB 5-6.25	30
PROMEFHAZINE SYP DM	120	NAPROXEN TAB 375MG	60	NYSTAT/TRIAM OIN	30	BENAZEPRIL TAB 5MG	30
PROMETHAZINE TAB 25MG	30	NAPROXEN TAB 500MG	60	NYSTATIN CRE 100000	30	BENAZEPRIL TAB 10MG	30
PSE/DM/GG SYP 40-15-10	120	ORPHEN CPD TAB DS	30	NYSTATIN OIN 100000	15	BENAZEPRIL TAB 20MG	30
		PIROXICAM CAP 20MG	30	NYSTATIN OIN 100000	30	BENAZEPRIL TAB 40MG	30
'	'	SALSALATE TAB 500MG	60	NYSTATIN SUS 100000	60	BISOPRL/HCTZ TAB 2.5/6.25	30
AMOX/K CLAV CHW 200MG	20	SALSALATE TAB 750MG	60	NYSTATIN TAB 500000	60	BISOPRL/HCTZ TAB 5/6.25	30
AMOX/K CLAV SUS 200/5ML	50	TRAMADOL HCLTAB 50MG	60	TERBINAFINE TAB 250MG	30	BISOPRL/HCTZ TAB 10/6.25	30
AMOXICILLIN CAP 250MG	30					BISOPROL FUM TAB IOMG	30
AMOXICILLIN CAP 500MG	30		~	' ~	~	BUMETANIDE TAB 0.5MG	30
AMOXICIWN SUS 125/5ML	80	ALBUTEROL NEB 0.083°~	75	BELLA ALK/PB TAB 16.2MG	60	BUMETANIDE TAB iMG	30
AMOXICILLIN SUS 125/5ML	100	ALBUTEROL NEB 0.5°~	20	CIMEfiDINE TAB 300MG	60	BUMETANIDE TAB 2MG	30
AMOXICILLIN SUS 125/5ML	150	ALBUTEROL SYP 2MG/5ML	120	CIMETIDINE TAB 400MG	60	CAPTOPR/HCTZ TAB 25-15MG	60
AMOXICILLIN SUS 200/5ML	50	ALBUTEROLTAB 2MG	60	CIMETIDINE TAB 800MG	30	CAPiOPRIL TAB 12.5MG	60
AMOXICILLIN SUS 250/5ML	80	ALBUTEROLTAB 4MG	60	CYTRA-2 SOL	473	CAPTOPRIL TAB 25MG	60
AMOXICILLIN SUS 250/5ML	100	IPRATROPIUM SOL INHAL	63	DICYCLOMINE CAP lOMG	90	CAPfOPRII TAB 50MG	60
AMOXICILLIN SUS 250/5ML	150	THEOPHYLLINE TAB 100MG CR	30	DICYCLOMINE TAB 20MG	30	CAPTOPRIL TAB 100MG	60
AMOXICILLIN SUS 400/5ML	50	THEOPHYLUNE TAB 200MG CR	30	DIPHEN/ATROP TAB 2.5MG	30	CARVEDILOL TAB 3.125MG	60
AMOXICILLIN SUS 400/5ML	75	THEOPHYLLINE TAB 200MG ER	60	FAMOTIDINE TAB 20MG	60	CARVEDILOL TAB 6.25MG	60
AMOXICILLIN SUS 400/5ML	100	THEOPHYLLINE TAB 300MG ER	60	FAMOTIDINE TAB 40MG	30	CARVEDILOL TAB 12.5MG	60
CEFPROZIL SUS 125/5ML	50			HYOSYNE DRO 0.125/ML	15	CARVEDILOL TAB 25MG	60
CEFUROXIME TAB 250MG	20	~ ''	~	LACTULOSE SOL lOGM/15	946	CHLORTHALID TAB 25MG	30
CEFUROXIME TAB 500MG	20	CHOLESTYRAM POW 4GM	378	LOPERAMIDE CAP 2MG	30	CHLORTHALID TAB 50MG	30
CEPHALEXIN CAP 250MG.	40	CHOLESIYRAM POW 4GM LITE	210	METOCLOPRAM SOL 5MG/5ML	60	CLONIDINE TAB O.1MG	60
CEPHALEXIN CAP 500MG	30	LOVASTATIN TAB 10MG	30	METOCLOPRAM TAB lOMG	120	CLONIDINE TAB 0.2MG	60
CEPHALEXIN SUS 125/5ML	100	LOVASTATIN TAB 20MG	30	MISOPROSTOL TAB 200MCG	60	DIGOXIN TAB 0.125MG	30
CIPROROXACN TAB 250MG	14	PRAVASTATIN TAB IOMG	30	OMEPRAZOLE CAP IOMG	30	DIGOXIN TAB 0.25MG	30
CIPROFLOXACN TAB 500MG	20	PRAVASTATIN TAB 20MG	30	ONDANSETRON TAB 4MG ODT	10	DILTIAZEM TAB 30MG	60
CIARITHROMYC SUS 125/5ML	50	PRAVASTATIN TAB 40MG	30	RANITIDINE TAB 150MG	60	DILTIAZEM TAB 60MG	60
DOXYCYCL HYC CAP 50MG	30	SIMVASTATIN TAB 5MG	30	RANITIDINE TAB 300MG	30	DILTIAZEM TAB 90MG	60
DOXYCYCL HYC CAP 100MG	20	SIMVASTATIN TAB IOMG	30	SUCRALFATE TAB 1GM	60	DILTIAZEM CAP 120MG ER	30
DOXYCYCL HYC TAB 100MG	20					DILTIAZEM TAB 120MG	30
ERYTHROCIN TAB 250MG	40	~ ~	~	~	~	DIPYRIDAMOLE TAB 50MG	60
ERYTHROMYCIN CAP 250MG EC	40	CHLORPROPAM TAB 100MG	30	ATROPINE SUL OIN i°k OP	4	DOXAZOSIN TAB iMG	30
METRONIDAZOLTAB 250MG	28	CHLORPROPAM TAB 250MG	30	ATROPINE SUL SOL 1°~ OP	15	DOXAZOSIN TAB 2MG	30
METRONIDAZOLTAB 500MG	14	GLIMEPIRIDE TAB 1MG	30	BACff/POLYMY OIN OP	4	DOXAZOSIN TAB 4MG	30
PENICILLN VK SOL 125/5ML	100	GLIMEPIRIDE TAB 2MG	30	BACffRACiN OIN OP	4	DOXAZOSIN TAB 8MG	30
PENICILLN VK SOL 250/5ML	100	GUPIZIDE TAB 5MG	60	CYCLOPENTOL SOl 1% OP	2	ENALAPR/HCTZ TAB 5-12.5MG	30
PENICILLN VK SOL 250/5ML	200	GLIPIZIDE TAB 10MG	60	CYCLOPENTOL SOL 1°~ OP	15	ENALAPRIL TAB 2.5MG	30
PENICILLN VK TAB 250MG	30	GLYB/METFORM TAB 1.25-250	60	DEXAMETH PHO SOL 0.1% OP	5	ENALAPRIL TAB 5MG	30
SMZ/TMP DS TAB 800-160	20	GLYBURID MCR TAB 3MG	60	ERYTHROMYCIN OIN OP	4	ENALAPRIL TAB IOMG	30
SMZ-TMP SUS 200-40/5	100	GLYBURID MCR TAB 6MG	60	GENTAK OIN 0.3% OP	4	ENALAPRIL TAB 20MG	30
SMZTMP TAB 400-80MG	30	GLYBURIDE TAB 1.25MG	30	GENTAMICIN SOL 0.3% OP	5	FUROSEMIDE SOL 10MG/ML	60
TETRACYCLINE CAP 250MG	60	GLYBURIDE TAB 2.5MG	30	LEVOBUNOLOL SOL 0.5°~ OP	5	fUROSEMIDE TAB 20MG	30
TETRACYCLINE CAP 500MG	60	GLYBURIDE TAB 5MG (BLUE)	60	NEO/POLY/DEX OIN 0.1°~ OP	4	FUROSEMIDE TAB 40MG	30
TRIMETHOPRIM TAB 100MG	60	GLYBURIDE TAB 5MG (GREEN)	60	NEO/POLY/DEX SUS 0.1% OP	5	FUROSEMIDE TAB 80MG	30
		METFORMIN TAB 1000MG	60	OFLOXACIN OPTH SOL 0.3%	5	GUANFACINE TAB 1MG	30
	~	METFORMIN TAB 500MG	60	PILOCARPINE SOL 1°~ OP	15	GUANFACINE TAB 2MG	30
ALLOPURINOL TAB 100MG	30	METFORMIN TAB 500MG ER	60	PILOCARPINE SOL 2% OP	15	HCTZ TAB 25MG	30
ALLOPURINOL TAB 300MG	30	METFORMIN TAB 850MG	60	PILOCARPINE SOL 4°h OP	15	HCTZ TAB 50MG	30
BACLOFEN TAB lOMG	90			POLYMYXIN BTRIMETHOPRIM OS	10	HYDRALAZINE TAB lOMG	60
CHLORZOXAZON TAB 500MG	120		~	PRED SOD PHO SOL 1°~ OP	15	HYDRALAZINE TAB 25MG	60
COLCHICINE TAB 0:6MG	30	ANTIPY/BENZO SOL OTIC	10	PREDNISOLONE SUS 1% OP	5	HYDROCHLOROT CAP 12.5MG	30
CYCLOBENZAPR TAB 5MG	30	EAR-GESIC DRO OTIC	15	PREDNISOLONE SUS 1°~ OP	10	INDAPAMIDE TAB 1.25MG	30
CYCLOBENZAPR TAB 10MG	30	OTICAINE SOL 20% OTIC	15	SULFACET SOD SOL 10% OP	15	INDAPAMIDE TAB 2.5MG	30
DICLOFENAC TAB 50MG EC	60			TIMOLOL MAL SOL 0.25% OP	5	ISOSORB DIN TAB 40MG ER	60
DICLOFENAC TAB 75MG DR	60	'	'	TIMOLOL MAL SOL 0.5% OP	5	ISOSORB MONO TAB 30MG ER	30
EfODOLAC CAP 300MG	60	CICLOPIROX CRE 0.77%	15	TIMOLOL MAL SOL 0.5% OP	10	ISOSORB MONO TAB 60MG ER	30
							
ISOSORB MONO TAB 120MG ER 30
LABETALOL TAB 100MG	60
LISINOP/HCTZ TAB 10-12.5	30
LISINOP/HCTZ TAB 20-12.5	30
LISINOP/HCTZ TAB 20-25MG	30
LISINOPRIL TAB 2.5MG	30
LISINOPRIL TAB 5MG	30
LISINOPRIL TAB IOMG	30
LISINOPRIL TAB 20MG	30
LISINOPRIL TAB 30MG	30
MEfHYLDOPA TAB 250MG	60
MEfHYLDOPA TAB 500MG	60
METOPROLOLTAR25MGTAB	60
METOPROLOLTAR 50MGTA6	60
METOPROLOLTAR 100MGTA6	60
MINOXIDIL TAB 2.5MG	30
NADOLOL TAB 20MG	30
NADOLOL TAB 40MG	30
NIFEDIPINE CAP IOMG	90
NfiROGLYCER CAP 2.5MG ER	60
NITROGLYCER CAP 6.5MG CR	60
NfiROGLYCER CAP 6.5MG ER	60
NffROGLYCERI DIS 0.6MG/HR	30
NITROQUICK SUB 0.3MG	100
NITROQUICK SUB 0.4MG	100
PINDOLOL TAB 5MG	30
PINDOLOL TAB IOMG	30
PRAZOSIN HCL CAP iMG	60
PRAZOSIN HCL CAP 2MG	30
PRAZOSIN HCL CAP 5MG	30
PROPRANOLOL TAB IOMG	60
PROPRANOLOL TAB 20MG	60
PROPRANOLOL TAB 40MG	60
PROPRANOLOL TAB 60MG	60
PROPRANOLOL TAB 80MG	60
QNAPRIL/HCTZ TAB 20-25MG	30
QUINAPRIL TAB 5MG	30
QUINAPRIL TAB lOMG	30
SOTALOL HCL TAB 80MG	60
SOTALOL HCL TAB 120MG	60
SPIRONOLACT TAB 25MG	30
TERAZOSIN CAP 1MG	30
TERAZOSIN CAP 2MG	30
TERAZOSIN CAP 5MG	30
TERAZOSIN CAP 10MG	30
TICLOPIDINE TAB 250MG	60
TORSEMIDE TAB IOMG	30
TRIAM/HCTZ CAP 37.5-25	30
TRIAM/HCTZ TAB 37.5-25	30
TRIAM/HCTZ TAB 75-50	30
VERAPAMIL TAB SOMG	90
VERAPAMIL TAB 120MG	30
WARFARIN TAB 1MG	30
WARFARIN TAB 2MG	30
WARFARIN TAB 2.5MG	30
WARFARIN TAB 3MG	30
WARFARIN TAB 4MG	30
WARFARIN TAB 5MG	30
WARFARIN TAB 6MG	30
WARFARIN TAB 7.5MG	30
WARFARIN TAB 10MG	30
	
AMffRIPTYLiN TAB lOMG	30
AMITRIPTYUN TAB 25MG	30
AMRRIPTYLIN TAB 50MG	30
AMIiRIPTYLIN TAB 75MG	30
AMRRIPIYLIN TAB 100MG	30
BENZIROPINE TAB 1MG	30
BENZfROPINE TAB 2MG	30
BUSPIRONE TAB 5MG
BUSPIRONE TAB IOMG
CARBAMAZEPIN TAB 200MG
CiTALOPRAM TAB IOMG
CITALOPRAM TAB 20MG
CITALOPRAM TAB 40MG
CLOMIPRAMINE CAP 25MG
DESIPRAMINE TAB 50MG
DOXEPIN HCL CAP IOMG
DOXEPIN HCL CAP 25MG
DOXEPIN HCL CAP 50MG
DOXEPIN HCL CAP 75MG
DOXEPIN HCL CAP 100MG
FLUOXETINE CAP 10MG
FLUOXEiINE CAP 20MG
FLUOXETINE CAP 40MG
FLUOXEfINE TAB lOMG
FLUOXETINE TAB 20MG
FLUPHENAZINE TAB 1MG
HALOPERIDOL TAB 0.5MG
HALOPERIDOL TAB 1MG
HALOPERIDOL TAB 2MG
HALOPERIDOL TAB 5MG
HYDROXYZ HCL SYP IOMG/5ML
HYDROXYZ PAM CAP 25MG
HYDROXYZ PAM CAP 50MG
IMIPRAM HCL TAB lOMG
LITHIUM CARB CAP 300MG
MIRTAZAPINE TAB 45MG
NEFAZODONE TAB 100MG
NEFAZODONE TAB 150MG
NEFAZODONE TAB 200MG
NORTRIPIYLIN CAP lOMG
NORTRIPTYLIN CAP 25MG
NORTRIPTYLIN CAP 50MG
NORTRIPTYLIN CAP 75MG
PAROXETINE TAB IOMG
PAROXETINE TAB 20MG
PERPHENAZINE TAB 4MG
PROCHLORPER TAB lOMG
THIORIDAZINE TAB 25MG
THIORIDAZINE TAB 50MG
THIOTHIXENE CAP 2MG
TRAZODONE TAB 50MG
TRAZODONE TAB 100MG
TRAZODONE TAB 150MG
TRIHEXYPHEN TAB 2MG
TRIHEXYPHEN TAB 5MG
VALPROIC ACD SYP 250/5ML
AMANTADINE SYP 50MG/5ML
ANUCORT-HC SUP 25MG
BETHANECHOL TAB 25MG
CARB/LEVO TAB 10-100MG
CHLORHEX GLU SOL 0.12%
DEXAMETHASON ELX 0.5/5ML
DEXAMETHASON TAB 0.5MG
DEXAMETHASON TAB 0.75MG
DEXAMETHASON TAB 4MG
DIVALPROEX TAB 125MG EC
HEMORRHOIDAL SUP -HC 25MG
HYDROCORT TAB 20MG
HYDROCORTAC SUP25MG
ISONIAZID TAB 300MG
l1DOCAINE GEL 2% JELLY
LIDOCAINE OIN 5%
l1DOCAINE SOL 2% VISC
MEGESTROLACTAB 20MG
METHYLPRED TAB 4MG
60
60
60
30
30
30
30
60
30
30
30
30
30
30
30
30
30
30
30
30
30
30
30
120
30
30
30
90
30
30
30
60
30
30
30
30
30
30
30
30
60
60
120
30
30
30
60
60
473
100
12
90
30
473
240
30
10
10
60
12
45
12
30
30
35
100
30
30
METHYLPRED PAK 4MG	21	LEVOTHYROXIN TAB 75MCG	30
OXYBUTYNIN TAB 5MG	60	LEVOTHYROXIN TAB 88MCG	30
PHENAZOPYRID TAB 100MG	6	LEVOTHYROXIN TAB SOOMCG	30
PHENAZOPYRID TAB 200MG	30	LEVOTHYROXIN TAB 112MCG	30
PREDNISONE TAB 2.5MG	30	LEVOTHYROXIN TAB 125MCG	30
PREDNISONE TAB 5MG	30	LEVOTHYROXIN TAB 137MCG	30
PREDNISONE PAK 5MG	21	LEVOTHYROXIN TAB 150MCG	30
PREDNISONETAB 10MG	30	LEVOTHYROXIN TAB 175MCG	30
PREDNISONE PAK 10MG	48	LEVOTHYROXIN TAB 200MCG	30
PREDNISONE TAB 20MG	30	THYROID TAB 32.5MG	30
		THYROID TAB 65MG	30
ALCLOMETASON CRE 0.05%
ALCLOMETASON CRE 0.05°k
AMMONIUM LAC LOT 12°~
AUG BETAMET CRE 0.05°~
AUG BETAMET OIN 0.05°k
AUG BETAMET GEL 0.05%
BE~AMETH DIP CRE 0.05°~
BETAMETH DIP CRE 0.05%
BETAMETH VAL CRE 0.1%
BETAMETH VAL CRE 0.1%
BETAMETH VAL OIN 0.1°k
BETAMEiH VAL OIN 0.1°~
CLINDAMYCIN SOL 1%
CLINDAMYCIN SOL 1%
CLOBETASOL CRE 0.05°~
CLOBETASOL CRE 0.05°~
CLOBETASOL OIN 0.05°~
CLOBETASOL OIN 0.05°~
CLOBETASOL E CRE 0.05°k
DESONIDE CRE 0.05°~
ERYTHROMYCIN GEL 2%
ERYTHROMYCIN SOL 2°~
FLUOCIN ACET CRE 0.025%
FLUOCIN ACET SOL 0.01%
FLUOCINONIDE CRE 0.05°k
FLUOCINONIDE CRE 0.05%
FLUOCINONIDE CRE 0.05%
FLUOCINONIDE OIN 0.05%
FLUOCINONIDE OIN 0.05%
FLUOCINONIDE OIN 0.05%
FLUOCINONIDE SOL 0.05%
GENTAMICIN CRE 0.1%
GENTAMICIN OIN 0.1%
HALOBETASOL CRE 0.05%
HALOBETASOL OIN 0.05°,6
HC VALERATE OIN 0.2°~
HYDROCORT CRE 1%
HYDROCORT CRE 2.5°~
HYDROCORT LOT 1%
LAVOCLEN-4 LIQ CREM WSH
METRONIDAZOL LOT 0.75°k
MOMETASONE OIN 0.1°~
SELENIUM SUL SHA 2.5%
SILVER SULFA CRE 1°~
SSD CRE 1°k
TRIAMCINOLON CRE 0.025%
TRIAMCINOLON CRE 0.1%
TRIAMCINOLON CRE 0.1%
TRIAMCINOLON CRE 0.5°~
TRIAMCINOLON OIN 0.025%
TRIAMCINOLON OIN 0.1°k
15
45
400
15
15
50
15
45
15
45
30
45
30
60
15
30
30
45
30
15
60
60
15
60
15
30
60
15
30
60
60
15
15
15
15
15
28
28
118
170
59
15
118
400
85
15
30
80
15
80
454
ACYCLOVIR CAP 200MG 60
~~ ~ ~ ~ ~ ~
LEVOTHROID TAB 50MCG 30
LEVOTHROID TAB 125MCG 30
LEVOTHROID TAB 150MCG 30
LEVOTHYROXIN TAB 25MCG 30
LEVOTHYROXIN TAB 50MCG 30
~	~
CYANOCOBALAM INJ 1000MCG	30
ETHEDENT CHW 0.25MG	30
ETHEDENT CHW 0.5MG	30
FER-IRON DRO 15/0.6ML	50
FERROUS GLUC TAB 246MG	30
FERROUS SULF TAB 325MG	60
FOLIC ACID TAB 1MG	30
HEMATINIC PL TAB VIT/MIN	30
KLOR-CON MiOTAB lOMEQ ER	30
KLOR-CON 10 TAB lOMEQ ER	30
KLOR-CON 8 TAB 8MEQ ER	30
KLOR-CON/EF TAB 25MEQ FR	30
MAG64 TAB 64MG	60
MULTI VIT/FL CHW 025MG	30
MULTI-VIT/FL CHW 1MG	30
POLY-VIT/FE DRO /FL 0.25	50
POLY-VIT/FL DRO 0.25MG	50
POT CHLORIDE LIQ 10%	473
POT CHLORIDE LIQ 20°k	473
ESTRADIOL DIS 0.025MG
ESTRADIOL DIS 0.0375MG
ESTRADIOLTAB 0.5MG
ESTRADIOLTAB 1MG
ESTRADIOLTAB 2MG
ESTROPIPATE TAB 0.75MG
ESTROPIPATE TAB 1.5MG
LEENA TAB
MEDROXYPR AC TAB 2.5MG
MEDROXYPR AC TAB 5MG
MEDROXYPR AC TAB 10MG
NATACAPS CAP
NATATAB RXTAB 29-1MG
SRONYXTAB
VELIVET PAK
ZOVIA 1/50E TAB
~ .~-
Influenza (Flu)
Pneumococcal (Pneumonia)
Zostavax (Vaccine for Shingles)
Gardasii (Vaccine for Cervical Cancer)"
Tetanus /Diptheria / Pertussis
Tetanus /Diptheria
Hepatitus A and B
Meningococcal (Meningitis)
~~
Foltabs
Vinate GT
Prenatal Plus
........ ..
Flrequently Asked Questions
1. Is there a minimum age requirement for enrollment? Yes. Customers must be 18 years or older to enroll.
2. Is there a limit to the number of family members on one card? No. If customers need extra fields to include the entire
family, they can add on the back of the form.
3. Can college age students enroll separately from their parents? Yes. Anyone age 18 and older can enroll in the program
individually.
4. Is the My H-E-B Rx Rewards Platinum program a substitute for prescription insurance? No. This program is not an insur-
ance policy and does not provide insurance coverage.
5. Can I use My H-E-B Rx Rewards Platinum card along with my prescription coverage plan? No. H-E-B Rx Rewards Platinum
members choose to either purchase their prescription drugs through the My H-E-B Rx Rewards Platinum program OR pay the
applicable cost-sharing amount under their insurance or other third party payer program. No claims will be submitted to a third
party payer for prescriptions processed using the H-E-B Rx Rewards Platinum card.
6. Does a prescription purchased through the My H-E-B Rx Rewards Platinum program count towards my insurance
deductible? Customers should consult their prescription coverage plans to determine if their purchases using the My H-E-B Rx
Rewards Platinum program count toward the customer's total drug spend for calculating deductibles or other patient payment
responsibilities. Savings under the My H-E-B Rx Rewards Platinum program will NOT be used to discount or waive any co-pay,
coinsurance or deductible amounts.
7. How will 1 know if my drug is available on the 500 for $5 list? Customers can visit www.heb.com/pharmacy to determine
individual pricing on specific medications. Or, customers can call 1-866-286-8098 for assistance. The pharmacy staff and
selected store partners will be available to answer questions too.
8. What if 1 am an existing Rx Rewards member? You can upgrade to the preferred My H-E-B Rx Rewards Platinum program by
paying the one time $5.00 enrollment fee. There is no need for membership in both programs as the Platinum program includes
the Rx Rewards benefits plus so much more! If you are interested in upgrading to the My H-E-B Rx Rewards Platinum program,
you will need to fill out a new enrollment form. You will be provided a new card to use for this new program.
9. Can I add my pet to the My H-E-B Rx Reward Platinum program at a later date than when I sign myself up? Yes, you can
add a pet at any time by calling 1-866-286-8098.
10. What discounted prescriptions are available for pets? Most veterinarians use a combination of human, veterinary-only, and
compounded medications for your pet's medical condition. More than 600 drugs used to treat pets are human drugs and can be
purchased at your local H-E-B Pharmacy with a prescription from your veterinarian. H-E-B does not stock or provide discounts on
veterinary-only medication used for the treatment of fleas, ticks, heartworms or other medical conditions.
11. What quantity is included in the $5.00 price? The $5.00 price is for commonly prescribed dosages up to a 30 day supply.*
12. What quantity is included in the $9.99 price? The $9.99 price is for commonly prescribed dosages at a 90 day supply.*
13. Is there a fee for the Platinum program? Yes, there is a one time $5.00 enrollment fee.
14. How does the Prenatal Vitamin program work? Participating Prenatal vitamins are available at no cost for 30-day supply
(up to 12 refills).*
15. What discounts on immunizations are available on the My H-E-B RX Rewards Platinum program?
Visit www.heb.com, call 866-286-8098, or visit your H-E-B Pharmacist for more information.
16. How do I find out the cost of medicines that are not on the 500 for $5 list?
Visit www.heb.com, call 866-286-8098, or visit your H-E-B Pharmacist for more information.
Full terms and conditions available on enrollment form.

*The day supply is based upon the average dispensing patterns for the specific drug and strength. The program, as well as, the prices and the list
of covered drugs can be modified by H-E-B Pharmacy at any time without notice and at H-E-B Pharmacy's discretion.
**See your H-E-B Pharmacy for more details.
DISCOUNT ONLY • NOT INSURANCE Discounts are available exclusively through participating pharmacies. You may cancel your registration
under the My H-E-B Rx Rewards Platinum Program at any time by contacting 1-866.286-8098.