Blink Health Rate Sheet - 04.21

Page 1

eRx: Blink Pharmacy Plus U.S. Date: April 1, 2021 Contact: Victoria Kratzat victoria.kratzat@blinkhealth.com | (949) 615-1048

Medication Name

Phone: 1-844-963-0320 Fax: 1-866-347-7092

Covered by

Not Covered by

Commercial Insurance

Commercial Insurance

Manufacturer

Quantity

First Fill

Refill

First Fill

Refill

Cash Price

Lexette 100g

Mayne

100g

$0

$0

--

--

$125

Lexette 50g

Mayne

50g

$0

$65

$65

$65

$65

Sorilux 120g

Mayne

120g

$0

$0

--

--

--

Sorilux 60g

Mayne

60g

$0

$65

$65

$65

$65

Fabior 100g

Mayne

100g

$0

$0

--

--

--

Fabior 50g

Mayne

50g

$0

$65

$65

$65

$65

Doxycycline 50mg

Mayne

0-30 days

$0

$45

--

--

--

Doxycycline 50mg

Mayne

31-60 days

$0

$45

--

--

--

Doxycycline 50mg

Mayne

60 days

--

--

$0

--

$45

Doxycycline 50mg

Mayne

61-90 days

$0

$0

$25

$25

--

Doxycycline 50mg

Mayne

91-120 days

$0

$0

$25

$25

--

Doxycycline 100mg

Mayne

60 days

$0

$45

$45

$45

$45

Doxycycline 100mg

Mayne

30 days

$0

--

$0

$0

$45

Doxycycline 100mg

Mayne

31-60 days

$0

--

$45

$45

$45

Doxycycline DR 150mg

Mayne

30 days

$0

$0

--

--

--

Doxycycline 200mg

Mayne

30 days

$0

$0

$0

$0

--

Doxycycline 200mg

Mayne

60 days

$0

$45

--

--

$45

Doryx MPC 120mg

Mayne

0-30 days

$0

$0

--

--

$65

Doryx MPC 120mg

Mayne

30 days

$0

$65

--

--

$65

Doryx MPC 120mg

Mayne

60 days

$0

--

$65

$65

--

Doryx 200mg

Mayne

30 days

$0

$0

--

--

--

Doryx 50mg

Mayne

0-30 days

$0

$0

--

--

--

Doryx 50mg

Mayne

31-60 days

$0

$0

--

--

--

Doryx 50mg

Mayne

61-90 days

$0

$0

--

--

--

Doryx 50mg

Mayne

91-120 days

$0

$0

--

--

--

Fluorouracil 5% Cream 40g

Mayne

Per Unit

$0

$0

$0

$45

$45

EpiCeram

Primus

Per Unit

$0

$0

$20

$20

$20

Impoyz

Primus

Per Unit

$0

$0

$49

$49

$49

Sernivo

Primus

Per Unit

$0

$0

$49

$49

$49

Vasculera

Primus

30 tablets

$0

$0

$49

$49

$49


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