HHSC Preferred Drug List (PDL) Recommendations April 2015 Pharmaceutical and Therapeutic Committee Meeting

Transcription

1 HHSC Preferred Drug List (PDL) ANTI-ALLERGENS, ORAL GRASTEK (SUBLINGUAL) NA NPD X For this Therapeutic Drug Class, the Committee ORALAIR (SUBLINGUAL) NA NPD believed that all of the drugs being recommended as RAGWITEK (SUBLINGUAL) NA NPD X preferred meet the fiscal requirements of the state ANTIBIOTICS, INHALED BETHKIS (INHALATION) PDL PDL X For this Therapeutic Drug Class, the Committee CAYSTON (INHALATION) PDL PDL believed that all of the drugs being recommended as KITABIS PAK (INHALATION) NR PDL X preferred meet the fiscal requirements of the state TOBI (INHALATION) PDL NPD TOBI PODHALER (INHALATION) PDL NPD TOBRAMYCIN SOLUTION (AG) (INHALATION) NPD NPD X TOBRAMYCIN SOLUTION (INHALATION) NPD NPD ANTICOAGULANTS ARIXTRA (SUBCUTANE.) NPD NPD For this Therapeutic Drug Class, the Committee COUMADIN (ORAL) NPD NPD believed that all of the drugs being recommended as ELIQUIS (ORAL) PDL PDL X preferred meet the fiscal requirements of the state ENOXAPARIN SODIUM VIAL (AG) (SUBCUTANEOUS) PDL PDL ENOXAPARIN SODIUM VIAL (SUBCUTANEOUS) PDL PDL ENOXAPARIN SYRINGE (AG) (SUBCUTANE.) PDL PDL ENOXAPARIN SYRINGE (SUBCUTANE.) PDL PDL FONDAPARINUX (SUBCUTANE.) NPD NPD FRAGMIN DISP SYRIN (SUBCUTANE.) PDL PDL LOVENOX SYRINGE (SUBCUTANE.) NPD NPD LOVENOX VIAL (SUBCUTANE.) NPD NPD PRADAXA (ORAL) PDL PDL X SAVAYSA (ORAL) NR NPD WARFARIN (ORAL) PDL PDL XARELTO (ORAL) NPD PDL X XARELTO DOSE PACK (ORAL) NR PDL X ANTIDEPRESSANTS, OTHER APLENZIN (ORAL) NPD NPD For this therapeutic drug class, the Committee BRINTELLIX (ORAL) NPD NPD X believed that all of the drugs being recommended as BUPROPION (ORAL) PDL PDL preferred demonstrated the greatest safety, efficacy, BUPROPION SR (ORAL) PDL PDL and value and provided clinicians with the greatest BUPROPION XL (ORAL) PDL PDL DESVENLAFAXINE ER (KHEDEZLA) (AG) (ORAL) NPD NPD number of first line options to use before requiring DESVENLAFAXINE ER (ORAL) NPD NPD DESVENLAFAXINE FUMARATE ER (ORAL) NPD NPD EFFEXOR XR (ORAL) NPD NPD EMSAM (TRANSDERMAL) NPD NPD FETZIMA (ORAL) NPD NPD X FORFIVO XL (ORAL) NPD NPD Page 1 of 18

2 HHSC Preferred Drug List (PDL) Page 2 of 18 KHEDEZLA (ORAL) NPD NPD MARPLAN (ORAL) PDL PDL MIRTAZAPINE ODT (ORAL) PDL PDL MIRTAZAPINE TABLET (ORAL) PDL PDL NARDIL (ORAL) NPD NPD NEFAZODONE (ORAL) NPD NPD OLEPTRO ER (ORAL) NPD NPD PARNATE (ORAL) NPD NPD PHENELZINE (ORAL) PDL PDL PRISTIQ (ORAL) NPD NPD X REMERON ODT (ORAL) NPD NPD REMERON TABLET (ORAL) NPD NPD TRANYLCYPROMINE SULFATE (ORAL) NPD NPD TRAZODONE (ORAL) PDL PDL VENLAFAXINE (ORAL) NPD NPD VENLAFAXINE ER CAPSULES (ORAL) PDL PDL VENLAFAXINE ER TABLETS (GENERIC) (ORAL) NPD NPD VENLAFAXINE ER TABLETS (SCHWARZ) (AG) (ORAL) NPD NPD VENLAFAXINE ER TABLETS (UPSTATE) (AG) (ORAL) NPD NPD VIIBRYD (ORAL) NPD NPD X VIIBRYD DOSE PACK (ORAL) NPD NPD X WELLBUTRIN (ORAL) NPD NPD WELLBUTRIN SR (ORAL) NPD NPD WELLBUTRIN XL (ORAL) NPD NPD ANTIDEPRESSANTS, SSRIs BRISDELLE (ORAL) NPD NPD For this therapeutic drug class, the Committee CELEXA TABLET (ORAL) NPD NPD believed that all of the drugs being recommended as CITALOPRAM SOLUTION (ORAL) PDL PDL preferred demonstrated the greatest safety, efficacy, CITALOPRAM TABLET (ORAL) PDL PDL and value and provided clinicians with the greatest ESCITALOPRAM SOLUTION (ORAL) NPD NPD ESCITALOPRAM TABLET (ORAL) PDL PDL number of first line options to use before requiring FLUOXETINE 60 MG (ORAL) PDL PDL FLUOXETINE CAPSULE (ORAL) PDL PDL FLUOXETINE CAPSULE DR (ORAL) NPD NPD FLUOXETINE SOLUTION (ORAL) PDL PDL FLUOXETINE TABLET (ORAL) PDL PDL FLUVOXAMINE (ORAL) PDL PDL FLUVOXAMINE ER (ORAL) NPD NPD LEXAPRO SOLUTION (ORAL) NPD NPD LEXAPRO TABLET (ORAL) NPD NPD LUVOX CR (ORAL) NPD NPD PAROXETINE CR (ORAL) NPD NPD PAROXETINE TABLET (ORAL) PDL PDL PAXIL (ORAL) NPD NPD PAXIL CR (ORAL) NPD NPD

3 HHSC Preferred Drug List (PDL) PAXIL SUSPENSION (ORAL) NPD NPD PEXEVA (ORAL) NPD NPD PROZAC CAPSULE (ORAL) NPD NPD PROZAC WEEKLY (ORAL) NPD NPD SARAFEM (ORAL) NPD NPD SERTRALINE CONC (ORAL) PDL PDL SERTRALINE TABLET (ORAL) PDL PDL ZOLOFT CONC (ORAL) NPD NPD ZOLOFT TABLET (ORAL) NPD NPD ANTIHYPERURICEMICS ALLOPURINOL (ORAL) PDL PDL For this Therapeutic Drug Class, the Committee COLCHICINE CAPSULE (AG) (ORAL) NPD NPD believed that all of the drugs being recommended as COLCHICINE TABLET (AG) (ORAL) NPD NPD preferred meet the fiscal requirements of the state COLCRYS (ORAL) NPD NPD PROBENECID (ORAL) PDL PDL PROBENECID / COLCHICINE (ORAL) PDL PDL ULORIC (ORAL) NPD NPD ZYLOPRIM (ORAL) NPD NPD ANTIPARKINSON'S AGENTS AMANTADINE CAPSULE (ORAL) PDL PDL For this therapeutic drug class, the Committee AMANTADINE SYRUP (ORAL) PDL PDL believed that all of the drugs being recommended as AMANTADINE TABLET (ORAL) PDL PDL preferred demonstrated the greatest safety, efficacy, AZILECT (ORAL) NPD NPD and value and provided clinicians with the greatest BENZTROPINE (ORAL) PDL PDL number of first line options to use before requiring BROMOCRIPTINE (ORAL) PDL PDL CARBIDOPA (ORAL) NPD NPD CARBIDOPA / LEVODOPA (ORAL) PDL PDL CARBIDOPA / LEVODOPA ER (ORAL) PDL PDL CARBIDOPA / LEVODOPA ODT (ORAL) NPD NPD CARBIDOPA/LEVODOPA/ENTACAPONE (ORAL) NPD NPD COMTAN (ORAL) NPD NPD ENTACAPONE (ORAL) NPD NPD LODOSYN (ORAL) NPD NPD MIRAPEX (ORAL) NPD NPD MIRAPEX ER (ORAL) NPD NPD NEUPRO (TRANSDERM) NPD NPD PRAMIPEXOLE (ORAL) PDL PDL PRAMIPEXOLE ER (ORAL) NPD NPD REQUIP (ORAL) NPD NPD REQUIP XL (ORAL) NPD NPD ROPINIROLE (ORAL) PDL PDL ROPINIROLE ER (ORAL) NPD NPD Page 3 of 18

4 HHSC Preferred Drug List (PDL) Page 4 of 18 SELEGILINE CAPSULE (ORAL) NPD NPD SELEGILINE TABLET (ORAL) NPD NPD SINEMET (ORAL) NPD NPD SINEMET CR (ORAL) NPD NPD STALEVO (ORAL) PDL PDL X TASMAR (ORAL) NPD NPD TRIHEXYPHENIDYL ELIXIR (ORAL) PDL PDL TRIHEXYPHENIDYL TABLET (ORAL) PDL PDL ZELAPAR (ORAL) NPD NPD BETA-BLOCKERS ACEBUTOLOL (ORAL) NPD PDL For this therapeutic drug class, the Committee ATENOLOL (ORAL) PDL PDL believed that all of the drugs being recommended as ATENOLOL / CHLORTHALIDONE (ORAL) PDL PDL preferred demonstrated the greatest safety, efficacy, BETAPACE / AF (ORAL) NPD NPD and value and provided clinicians with the greatest BETAXOLOL (ORAL) NPD NPD number of first line options to use before requiring BISOPROLOL (ORAL) NPD PDL BISOPROLOL HCTZ (ORAL) PDL PDL BYSTOLIC (ORAL) NPD NPD X CARVEDILOL (ORAL) PDL PDL COREG (ORAL) NPD NPD COREG CR (ORAL) NPD NPD CORGARD (ORAL) NPD NPD CORZIDE (ORAL) NPD NPD DUTOPROL (ORAL) NPD NPD HEMANGEOL (ORAL) NPD NPD INDERAL LA (ORAL) NPD NPD INDERAL XL (ORAL) NPD NPD INNOPRAN XL (ORAL) NPD NPD LABETALOL (ORAL) PDL PDL LEVATOL (ORAL) NPD NPD LOPRESSOR (ORAL) NPD NPD LOPRESSOR HCT (ORAL) NPD NPD METOPROLOL (ORAL) PDL PDL METOPROLOL / HCTZ (ORAL) NPD NPD METOPROLOL XL (ORAL) NPD PDL NADOLOL (ORAL) NPD NPD NADOLOL / BENDROFLUMETHIAZIDE (ORAL) NPD NPD PINDOLOL (ORAL) NPD NPD PROPRANOLOL / HCTZ (ORAL) NPD NPD PROPRANOLOL ER (ORAL) NPD NPD PROPRANOLOL SOLUTION (ORAL) PDL PDL PROPRANOLOL TABLET (ORAL) PDL PDL

5 HHSC Preferred Drug List (PDL) SECTRAL (ORAL) NPD NPD SOTALOL (ORAL) PDL PDL TENORETIC (ORAL) NPD NPD TENORMIN (ORAL) NPD NPD TIMOLOL (ORAL) NPD NPD TOPROL XL (ORAL) PDL NPD ZIAC (ORAL) NPD NPD BILE SALTS ACTIGALL (ORAL) NPD NPD For this Therapeutic Drug Class, the Committee CHENODAL (ORAL) NPD NPD believed that all of the drugs being recommended as URSO/URSO FORTE TABLET (ORAL) NPD NPD preferred meet the fiscal requirements of the state URSODIOL 300 MG CAPSULE (ORAL) PDL PDL URSODIOL TABLET (ORAL) NPD PDL BPH TREATMENTS ALFUZOSIN (ORAL) PDL PDL For this Therapeutic Drug Class, the Committee AVODART (ORAL) NPD NPD believed that all of the drugs being recommended as CARDURA (ORAL) NPD NPD preferred meet the fiscal requirements of the state CARDURA XL (ORAL) NPD NPD DOXAZOSIN (ORAL) PDL PDL FINASTERIDE (ORAL) PDL PDL FLOMAX (ORAL) NPD NPD JALYN (ORAL) NPD NPD PROSCAR (ORAL) NPD NPD RAPAFLO (ORAL) NPD NPD TAMSULOSIN (ORAL) PDL PDL TERAZOSIN (ORAL) PDL PDL UROXATRAL (ORAL) NPD NPD BRONCHODILATORS, BETA AGONIST ALBUTEROL ER (ORAL) NPD NPD For this therapeutic drug class, the Committee ALBUTEROL NEB SOLN 0.63, 1.25 MG (INHALATION) PDL PDL believed that all of the drugs being recommended as ALBUTEROL NEB SOLN 100 MG/20 ML (INHALATION) PDL PDL preferred demonstrated the greatest safety, efficacy, ALBUTEROL NEB SOLN 2.5 MG/0.5 ML (INHALATION) PDL PDL and value and provided clinicians with the greatest ALBUTEROL NEB SOLN 2.5 MG/3 ML (INHALATION) PDL PDL number of first line options to use before requiring ALBUTEROL SYRUP (ORAL) PDL PDL ALBUTEROL TABLET (ORAL) NPD NPD ARCAPTA NEOHALER (INHALATION) NPD NPD BROVANA (INHALATION) NPD NPD FORADIL (INHALATION) NPD NPD LEVALBUTEROL NEB SOLN (INHALATION) NPD NPD LEVALBUTEROL NEB SOLN CONC (INHALATION) NPD NPD Page 5 of 18

6 HHSC Preferred Drug List (PDL) Page 6 of 18 MAXAIR (INHALATION) NPD NPD METAPROTERENOL SYRUP (ORAL) NPD NPD METAPROTERENOL TABLET (ORAL) NPD NPD PERFOROMIST (INHALATION) NPD NPD PROAIR HFA (INHALATION) PDL PDL PROVENTIL HFA (INHALATION) PDL PDL SEREVENT (INHALATION) NPD NPD STRIVERDI RESPIMAT (INHALATION) NPD NPD X TERBUTALINE (ORAL) NPD NPD VENTOLIN HFA (INHALATION) NPD NPD X XOPENEX HFA (INHALATION) NPD NPD XOPENEX NEB SOLN (INHALATION) NPD NPD XOPENEX NEB SOLN CONC (INHALATION) NPD NPD COPD AGENTS ANORO ELLIPTA (INHALATION) NPD NPD X For this Therapeutic Drug Class, the Committee ATROVENT HFA (INHALATION) PDL PDL believed that all of the drugs being recommended as COMBIVENT RESPIMAT (INHALATION) PDL PDL X preferred meet the fiscal requirements of the state DALIRESP (ORAL) NPD NPD INCRUSE ELLIPTA (INHALATION) NR NPD X IPRATROPIUM / ALBUTEROL (INHALATION) NPD NPD IPRATROPIUM NEBULIZER (INHALATION) PDL PDL SPIRIVA (INHALATION) PDL PDL X SPIRIVA RESPIMAT (INHALATION) NPD NPD X TUDORZA PRESSAIR (INHALATION) NPD NPD COUGH AND COLD, COLD ADRENALIN CHLORIDE SOLUTION (NASAL) NPD NPD For this therapeutic drug class, the Committee ADT ROBITUSSIN COUGH-COLD-FLU LIQUID OTC (ORAL) NPD NPD believed that all of the drugs being recommended as ADVIL COLD & SINUS CAPSULE OTC (ORAL) NPD NPD preferred demonstrated the greatest safety, efficacy, ADVIL COLD & SINUS TABLET OTC (ORAL) NPD NPD and value and provided clinicians with the greatest ADVIL CONGESTION RELIEF TABLET OTC (ORAL) NPD NPD number of first line options to use before requiring ALA-HIST IR TABLET OTC (ORAL) PDL PDL X ALA-HIST PE TABLET OTC (ORAL) PDL PDL X ALDEX GS TABLET OTC (ORAL) NPD NPD ALEVE COLD & SINUS TABLET ER 12H OTC (ORAL) NPD NPD ALKA-SELTZER PLUS COLD TABLET EFF OTC (ORAL) NPD NPD BENZEDREX INHALER OTC (NASAL) NPD NPD BROTAPP LIQUID OTC (ORAL) NPD NPD BROVEX PEB LIQUID OTC (ORAL) NPD NPD CHILD DELSYM COUGH+COLD LIQUID OTC (ORAL) PDL PDL X CHILD DELSYM COUGH-COLD NIGHT SOLUTION OTC (ORAL) PDL PDL CHILDREN'S MUCINEX LIQUID OTC (C) (ORAL) PDL PDL X

7 HHSC Preferred Drug List (PDL) Page 7 of 18 CHLORPHENIRAMINE/PHENYLEPHRINE/ASA TABLET EFF OTC (ORA NPD NPD CONEX SOLUTION OTC (ORAL) NPD NPD CONEX TABLET OTC (ORAL) NPD NPD DALLERGY DROPS OTC (ORAL) PDL PDL X DALLERGY LIQUID OTC (ORAL) PDL PDL X DALLERGY TABLET OTC (ORAL) NPD PDL X DECONEX IR TABLET OTC (ORAL) PDL PDL X DELSYM COUGH & COLD LIQUID OTC (C) (ORAL) PDL PDL X DIMETAPP SOLUTION OTC (ORAL) NPD NPD DIPHENHYDRAMINE/PHENYLEPHRINE/APAP POWDER PACK OTC NPD NPD DIPHENHYDRAMINE/PHENYLEPHRINE/APAP TABLET OTC (ORAL) NPD NPD X DIPHENYDRAMINE/PHENYLEPHRINE/APAP LIQUID OTC (ORAL) NPD NPD DRISTAN COLD TABLET OTC (ORAL) NPD NPD DRISTAN MIST OTC (NASAL) NPD NPD DURAVENT PE TABLET OTC (ORAL) NPD NPD ED A-HIST LIQUID OTC (ORAL) PDL PDL X ED A-HIST PSE TABLET OTC (ORAL) PDL PDL X ED A-HIST TABLET OTC (ORAL) PDL PDL X ED BRON GP LIQUID OTC (ORAL) PDL PDL X ED CHLORPED D DROPS OTC (ORAL) PDL PDL X GUAIFENESIN 200 MG TABLET OTC (ORAL) PDL PDL GUAIFENESIN 400 MG TABLET OTC (ORAL) PDL PDL GUAIFENESIN LIQUID OTC (ORAL) PDL PDL GUAIFENESIN TABLET ER OTC (ORAL) NPD NPD GUAIFENESIN/APAP TABLET OTC (ORAL) NPD NPD GUAIFENESIN/PHENYLEPHRINE TABLET OTC (ORAL) NPD NPD GUAIFENESIN/PHENYLEPHRINE/APAP LIQUID OTC (ORAL) NPD NPD GUAIFENESIN/PHENYLEPHRINE/APAP TABLET OTC (ORAL) NPD NPD GUAIFENESIN/PSE TABLETS OTC (ORAL) NPD NPD GUAIFENESIN/PSEUDOEPHEDRNE TABLET OTC (ORAL) NPD NPD HISTEX-PE LIQUID OTC (ORAL) NPD NPD IBUPROFEN/PHENYLEPHRINE TABLET OTC (ORAL) NPD NPD IBUPROFEN/PSE SUSPENSION OTC (ORAL) NPD NPD IBUPROFEN/PSE TABLET OTC (ORAL) NPD NPD J-MAX SYRUP OTC (ORAL) NPD NPD J-TAN D PD DROPS OTC (ORAL) NPD NPD LEVMETAMFETAMINE INHALER OTC (NASAL) NPD NPD LIQUITUSS GG LIQUID OTC (ORAL) NPD NPD LODRANE D CAPSULE OTC (ORAL) NPD NPD LOHIST-D LIQUID OTC (ORAL) NPD NPD LOHIST-PEB LIQUID OTC (ORAL) NPD NPD LORTUSS LQ LIQUID OTC (ORAL) PDL NPD

8 HHSC Preferred Drug List (PDL) Page 8 of 18 MAXIPHEN TABLET OTC (ORAL) NPD NPD MUCAPHED TABLET OTC (ORAL) PDL PDL X MUCINEX COLD & SINUS LIQUID OTC (ORAL) PDL PDL X MUCINEX D TABLET ER 12H OTC (ORAL) PDL PDL X MUCINEX ER TABLET OTC (ORAL) PDL PDL X MUCINEX FAST-MAX COLD-SINUS TABLET OTC (ORAL) PDL PDL X MUCINEX FAST-MAX NITE COLD-FLU LIQUID OTC (ORAL) PDL PDL X MUCINEX GRAN PACK OTC (ORAL) PDL PDL X MUCINEX SINUS-MAX SPRAY OTC (NASAL) NPD NPD X MUCINEX SINUS-MAX DAY-NIGHT TABLET SEQUELS OTC (ORAL) PDL PDL X MUCINEX SINUS-MAX TABLET OTC (ORAL) PDL PDL X MUCINEX SPRAY OTC (NASAL) PDL PDL NAPROXEN/PSE TABLET OTC (ORAL) NPD NPD NASOHIST DROPS OTC (ORAL) NPD NPD NASOPEN LIQUID OTC (ORAL) PDL PDL NASOPEN PE LIQUID OTC (ORAL) PDL PDL X NOHIST-LQ LIQUID OTC (ORAL) NPD NPD NOREL AD TABLET OTC (ORAL) NPD NPD X OXYMETAZOLINE 12 HR NASAL SPRAY OTC (NASAL) PDL PDL OXYMETAZOLINE MIST OTC (NASAL) NPD NPD OXYMETAZOLINE NASAL SPRAY OTC (NASAL) NPD NPD OXYMETOLAZINE MIST OTC (NASAL) NPD NPD PHENYLEPHRINE FOUR SPRAY OTC (NASAL) NPD NPD PHENYLEPHRINE NOSE DROPS OTC (NASAL) NPD PDL PHENYLEPHRINE/APAP CAPSULE OTC (ORAL) NPD NPD PHENYLEPHRINE/APAP TABLET OTC (ORAL) NPD NPD PHENYLEPHRINE/APAP/CHLORPHENIRAMINE TABLET OTC (ORAL) NPD NPD PHENYLEPHRINE/APAP/CHLORPHENIRAMINE TABLET SEQUELS OT NPD NPD PHENYLEPHRINE/BROMPHENIRAMINE SOLUTION OTC (ORAL) PDL PDL PHENYLEPHRINE/BROMPHENIRAMINE TABLET OTC (ORAL) NPD NPD PHENYLEPHRINE/CHLORPHENIRAMINE DROPS (ORAL) NPD NPD PHENYLEPHRINE/CHLORPHENIRAMINE DROPS OTC (ORAL) NPD NPD PHENYLEPHRINE/CHLORPHENIRAMINE TABLET OTC (ORAL) NPD NPD PHENYLEPHRINE/DIPHENHYDRAMINE LIQUID OTC (ORAL) NPD NPD PHENYLEPHRINE/DIPHENHYDRAMINE SOLUTION OTC (ORAL) NPD NPD PHENYLEPHRINE/PYRILAMINE OTC (ORAL) NPD NPD PHENYLEPHRINE/PYRILAMINE TABLET OTC (ORAL) NPD NPD POLY HIST FORTE TABLET OTC (ORAL) NPD PDL X POLY-VENT IR TABLET OTC (ORAL) PDL PDL X PROMETHAZINE VC SYRUP (QUALITEST) (ORAL) PDL NPD PSE/APAP TABLET OTC (ORAL) NPD NPD PSE/BROMPHENIRAMINE LIQUID OTC (ORAL) NPD NPD

9 HHSC Preferred Drug List (PDL) Page 9 of 18 PSE/CHLORPHENIRAMINE SYRUP OTC (ORAL) NPD NPD PSE/CHLORPHENIRAMINE TABLET OTC (ORAL) NPD PDL PSE/TRIPROLIDINE LIQUID OTC (ORAL) NPD NPD PSE/TRIPROLIDINE TABLET OTC (ORAL) PDL PDL RESCON TABLET OTC (ORAL) NPD NPD RESCON-GG LIQUID OTC (ORAL) NPD NPD RESPAIRE-30 CAPSULE OTC (ORAL) PDL PDL X RYMED TABLET OTC (ORAL) PDL PDL X RYNEX PE SOLUTION OTC (ORAL) PDL PDL X RYNEX PSE LIQUID OTC (ORAL) PDL PDL X SCOT-TUSSIN LIQUID OTC (C) (ORAL) NPD NPD STAHIST AD LIQUID OTC (ORAL) NPD NPD STAHIST AD TABLET OTC (ORAL) NPD NPD THERAFLU POWDER PACKET OTC (C) (ORAL) NPD NPD TRIAMINIC COLD & COUGH LIQUID OTC (ORAL) NPD NPD TRYMINE D SYRUP OTC (ORAL) NPD NPD TUSNEL PEDIATRIC DROPS OTC (ORAL) NPD NPD TYLENOL SINUS CONGESTION-PAIN TABLET OTC (ORAL) NPD NPD TYZINE SPRAY (NASAL) NPD NPD VICKS NYQUIL SINEX CAPSULE OTC (ORAL) NPD NPD VICKS QLEARQUIL DAYTIME OTC (ORAL) NPD NPD VICKS QLEARQUIL NIGHTTIME OTC (ORAL) NPD NPD COUGH AND COLD, NARCOTIC BROMPHENIRAMINE/PSE/CODEINE LIQUID OTC (ORAL) NPD NPD For this therapeutic drug class, the Committee CAPCOF LIQUID (ORAL) NPD NPD believed that all of the drugs being recommended as GUAIFENESIN/CODEINE LIQUID (ORAL) PDL PDL preferred demonstrated the greatest safety, efficacy, GUAIFENESIN/CODEINE LIQUID OTC (ORAL) PDL PDL and value and provided clinicians with the greatest GUAIFENESIN/PSE/CODEINE SYRUP OTC (ORAL) NPD NPD number of first line options to use before requiring HYDROCODONE/CHLORPHENIRAMINE SUSPENSION ER 12H (ORA NPD NPD HYDROCODONE/HOMATROPINE SYRUP (ORAL) NPD NPD HYDROCODONE/HOMATROPINE TABLET (ORAL) NPD NPD MAR-COF BP LIQUID (ORAL) NPD NPD M-CLEAR WC LIQUID (ORAL) NPD NPD M-END MAX D LIQUID (ORAL) NPD NPD M-END PE LIQUID (ORAL) NPD NPD NINJACOF-XG LIQUID OTC (ORAL) NPD NPD POLY-TUSSIN AC LIQUID OTC (ORAL) NPD NPD X POLY-TUSSIN D LIQUID OTC (ORAL) NPD NPD POLY-TUSSIN LIQUID OTC (ORAL) NPD NPD PRO-CLEAR AC LIQUID OTC (ORAL) NPD PDL X PROMETHAZINE/CODEINE SYRUP (ORAL) PDL PDL PROMETHAZINE/PHENYLEPHRINE/CODEINE (QUALITEST) SYRUP ( NPD NPD

10 HHSC Preferred Drug List (PDL) Page 10 of 18 PRO-RED AC LIQUID (ORAL) NPD PDL X PSE/CODEINE/CHLORPHENIRAMINE LIQUID OTC (ORAL) NPD NPD PSE/HYDROCODONE/CHLORPHENIRAMINE SOLUTION (ORAL) NPD NPD REZIRA SOLUTION (ORAL) NPD NPD TUSNEL C SYRUP OTC (ORAL) NPD NPD TUSSICAPS CAPSULE ER 12H (ORAL) NPD NPD TUSSIONEX SUSPENSION ER 12H (ORAL) PDL PDL VANACOF CD LIQUID (ORAL) NPD NPD VITUZ SOLUTION (ORAL) NPD NPD Z-TUSS AC OTC (ORAL) NPD NPD ZUTRIPRO SOLUTION (ORAL) NPD NPD COUGH AND COLD, NON-NARCOTIC ALA-HIST DM LIQUID OTC (ORAL) PDL PDL X For this therapeutic drug class, the Committee ALDEX GS DM TABLET OTC (ORAL) NPD NPD believed that all of the drugs being recommended as ALKA-SELTZER PLUS CAPSULE OTC (ORAL) NPD NPD preferred demonstrated the greatest safety, efficacy, ALKA-SELTZER PLUS FLU TABLET EFF OTC (ORAL) NPD NPD and value and provided clinicians with the greatest ALLFEN DM TABLET OTC (ORAL) PDL NPD number of first line options to use before requiring AQUANAZ OTC (ORAL) NPD NPD BALAMINE DM SYRUP OTC (ORAL) NPD NPD BENZONATATE CAPSULE (ORAL) PDL PDL BICLORA LIQUID OTC (ORAL) NPD NPD BICLORA-D LIQUID OTC (ORAL) NPD NPD BICLORA-D TABLET OTC (ORAL) NPD NPD BP 8 COUGH ORAL SUSPENSION OTC (ORAL) NPD NPD BPM/PSE/DM LIQUID OTC (ORAL) NPD NPD BROMFED DM SYRUP (ORAL) PDL PDL X BROMPHENIRAMINE/PHENYLEPHRINE/DM LIQUID OTC (ORAL) PDL PDL BROMPHENIRAMINE/PHENYLEPHRINE/DM SOLUTION OTC (ORAL NPD NPD BROM-PSE-DM SYRUP (ORAL) NPD NPD BROM-PSE-DM SYRUP OTC (ORAL) NPD NPD BROTAPP DM ELIXIR OTC (ORAL) PDL PDL CAPMIST DM TABLET OTC (ORAL) NPD NPD CAPRON DM LIQUID OTC (ORAL) NPD NPD CHILD MUCINEX M-S COLD DAY-NTE LIQUID SEQUELES OTC (ORA NPD PDL CHILD TRIAMINIC COUGH-CONGEST SYRUP OTC (ORAL) NPD NPD CHILDREN'S DIMETAPP COLD-FLU LIQUID OTC (ORAL) NPD NPD CHILDREN'S MUCINEX LIQUID OTC (NN) (ORAL) PDL PDL X CHLO HIST SOLUTION OTC (ORAL) NPD PDL X CHLO TUSS EX LIQUID OTC (ORAL) NPD NPD CHLO TUSS LIQUID OTC (ORAL) NPD PDL X CODITUSS DM LIQUID OTC (ORAL) NPD NPD CORICIDIN HBP SOFTGEL OTC (ORAL) NPD NPD

11 HHSC Preferred Drug List (PDL) Page 11 of 18 CORICIDIN HBP TABLET OTC (ORAL) NPD NPD DECONEX DMX TABLET OTC (ORAL) PDL PDL X DELSYM COUGH & COLD LIQUID OTC (NN) (ORAL) PDL PDL X DELSYM MULTI-SYMPTOM LIQUID OTC (ORAL) NPD NPD DELSYM SUSPENSION ER 12H OTC (ORAL) PDL PDL X DEXTROMETHORPHAN CAPSULE OTC (ORAL) NPD NPD DEXTROMETHORPHAN LIQUID OTC (ORAL) NPD NPD DEXTROMETHORPHAN SUSPENSION ER 12H OTC (ORAL) NPD NPD DEXTROMETHORPHAN SYRUP OTC (ORAL) NPD NPD DIABETIC TUSSIN NIGHTTIME LIQUID OTC (ORAL) NPD NPD DIMETAPP DM SOLUTION OTC (ORAL) NPD NPD DIMETAPP LONG-ACTING LIQUID OTC (ORAL) NPD NPD DM LIQUID GELCAP (ORAL) NPD NPD DM/APAP/CHLORPHENIRAMINE SUSPENSION OTC (ORAL) NPD NPD DM/APAP/CHLORPHENIRAMINE TABLET OTC (ORAL) NPD NPD DM/APAP/DOXYLAMINE CAPSULE OTC (ORAL) NPD NPD DM/APAP/DOXYLAMINE LIQUID OTC (ORAL) NPD NPD DM/CHLORPHENIRAMINE TABLET OTC (ORAL) NPD NPD DM/DOXYLAMINE LIQUID SEQUELS OTC (ORAL) NPD NPD DM/PHENYLEPHRINE/APAP CAPSULE OTC (ORAL) NPD NPD DM/PHENYLEPHRINE/APAP LIQUID OTC (ORAL) NPD NPD DM/PHENYLEPHRINE/APAP POWDER PACK OTC (ORAL) NPD NPD DM/PHENYLEPHRINE/APAP TABLET OTC (ORAL) NPD NPD DM/PHENYLEPHRINE/APAP/CHLORPHENIRAMINE TABLET SEQUE NPD NPD DM/PHENYLEPHRINE/APAP/CHLORPHENIRAMINE SUSPENSION O NPD NPD DM/PHENYLEPHRINE/APAP/CHLORPHENIRAMINE TABLET OTC (O NPD NPD DM/PHENYLEPHRINE/APAP/DOXYLAMINE LIQUID OTC (ORAL) NPD NPD DM/PHENYLEPHRINE/APAP/DOXYLAMINE LIQUID SEQUELS OTC ( NPD NPD DM/PHENYLEPHRINE/CHLORPHENIRAMINE DROPS OTC (ORAL) NPD NPD DM/PHENYLEPHRINE/CHLORPHENIRAMINE SYRUP OTC (ORAL) PDL PDL DM/PSE/APAP CAPSULE OTC (ORAL) NPD NPD DM/PSE/APAP/DOXYLAMINE CAPSULE OTC (ORAL) NPD NPD DM/PSE/APAP/DOXYLAMINE LIQUID OTC (ORAL) NPD NPD DM/PSE/CHLORPHENIRAMINE LIQUID OTC (ORAL) PDL PDL DONATUSSIN LIQUID OTC (ORAL) PDL NPD X DOXYLAMINE/DM SOLUTION OTC (ORAL) NPD NPD DURAFLU TABLET OTC (ORAL) NPD NPD X DURAVENT DM TABLET OTC (ORAL) NPD NPD ED A-HIST DM TABLET OTC (ORAL) NPD NPD X ED-A-HIST DM LIQUID OTC (ORAL) PDL PDL X ENDACON LIQUID OTC (ORAL) NPD NPD GUAIFENESIN/DM CAPSULE OTC (ORAL) NPD NPD

12 HHSC Preferred Drug List (PDL) Page 12 of 18 GUAIFENESIN/DM LIQUID OTC (ORAL) PDL PDL X GUAIFENESIN/DM TABLET ER 12H OTC (ORAL) NPD NPD GUAIFENESIN/DM TABLET OTC (ORAL) PDL PDL GUAIFENESIN/DM/PHENYLEPHRINE LIQUID OTC (ORAL) NPD NPD GUAIFENESIN/DM/PHENYLEPHRINE SYRUP OTC (ORAL) NPD NPD GUAIFENESIN/DM/PHENYLEPHRINE TABLET OTC (ORAL) NPD NPD GUAIFENESIN/DM/PSE LIQUID OTC (ORAL) NPD NPD HISTEX-DM SYRUP OTC (ORAL) NPD NPD LOHIST PEB DM LIQUID OTC (ORAL) NPD NPD LOHIST-DM LIQUID (ORAL) NPD NPD LORTUSS DM LIQUID OTC (ORAL) PDL NPD MAXIPHEN DM TABLET OTC (ORAL) NPD NPD M-END DMX LIQUID OTC (ORAL) NPD PDL X MUCINEX COLD-FLU & SORE THROAT LIQUID OTC (ORAL) PDL PDL X MUCINEX COUGH GRAN PACK OTC (ORAL) PDL PDL X MUCINEX DM TABLET ER 12H OTC (ORAL) PDL PDL X MUCINEX DM TABLET ER 12H OTC (ORAL) PDL PDL X MUCINEX FAST-MAX COLD-FLU TABLET OTC (ORAL) PDL PDL X MUCINEX FAST-MAX CONGEST-COUGH TABLET OTC (ORAL) NPD PDL X MUCINEX FAST-MAX DAY-NITE COLD LIQUID SEQ OTC (ORAL) NR PDL X MUCINEX FAST-MAX DM MAX LIQUID OTC (ORAL) PDL PDL X MUCINEX FAST-MAX SEVERE COLD LIQUID OTC (ORAL) NPD PDL X MUCINEX SEVERE CONGEST-COUGH LIQUID OTC (ORAL) PDL PDL X MUCUS DM MAX TABLET ER 12H OTC (ORAL) NPD NPD NASOHIST DM DROPS OTC (ORAL) NPD NPD NINJACOF LIQUID OTC (ORAL) NPD NPD NINJACOF-A LIQUID OTC (ORAL) NPD NPD NOHIST-DM LIQUID OTC (ORAL) NPD NPD NOREL CS LIQUID OTC (ORAL) NPD NPD PEDIATEX TDM LIQUID OTC (ORAL) NPD NPD PHENYLEPHRINE/DM LIQUID OTC (ORAL) NPD NPD PHENYLEPHRINE/DM/APAP/GUAIFENESIN CAPLET OTC (ORAL) NPD NPD PHENYLEPHRINE/DM/APAP/GUAIFENESIN LIQUID OTC (ORAL) NPD NPD PHENYLEPHRINE/DM/APAP/GUAIFENESIN TABLET OTC (ORAL) NPD NPD POLY-HIST DM LIQUID OTC (ORAL) NPD PDL X POLY-HIST PD DROPS OTC (ORAL) NPD PDL X POLY-VENT DM TABLET OTC (ORAL) PDL PDL X PRO-CHLO LIQUID OTC (ORAL) NPD PDL X PROMETHAZINE/DM SYRUP (ORAL) PDL PDL PSE/DM/APAP TABLET OTC (ORAL) NPD NPD PSE/DM/APAP/DOXYLAMINE LIQUID OTC (ORAL) NPD NPD PSE/DM/BROMPHENIRAMINE ELIXIR OTC (ORAL) NPD NPD

13 HHSC Preferred Drug List (PDL) RESCON-DM LIQUID OTC (ORAL) NPD NPD ROBITUSSIN COUGH & COLD CF LIQUID OTC (ORAL) NPD NPD ROBITUSSIN LONG-ACTING LIQUID OTC (ORAL) NPD NPD ROBITUSSIN NIGHTTIME COUGH DM LIQUID OTC (ORAL) NPD NPD RYNEX DM SOLUTION OTC (ORAL) PDL PDL X SCOT-TUSSIN DM LIQUID OTC (ORAL) NPD NPD SUDAFED PE PRESSURE+PAIN+COLD OTC (ORAL) NPD NPD TESSALON PERLE CAPSULE (ORAL) NPD NPD THERAFLU POWDER PACK OTC (NN) (ORAL) NPD NPD TRYMINE CD LIQUID OTC (ORAL) NPD NPD TUSNEL PEDIATRIC LIQUID (ORAL) NPD NPD TUSNEL PEDIATRIC LIQUID OTC (ORAL) NPD NPD TUSNEL SOLUTION OTC (ORAL) NPD NPD TUSNEL TABLET OTC (ORAL) NPD NPD TUSNEL-DM PEDIATRIC DROPS OTC (ORAL) NPD NPD TYLENOL COLD & FLU SEVERE TABLET OTC (ORAL) NPD NPD TYLENOL COLD MULTI-SYMPTOM LIQUID OTC (ORAL) NPD NPD TYLENOL COLD-FLU SEVERE LIQUID OTC (ORAL) NPD NPD VANACOF APE LIQUID OTC (ORAL) PDL PDL VANACOF DM LIQUID OTC (ORAL) NPD PDL X VANACOF DX LIQUID OTC (ORAL) PDL PDL VANACOF G LIQUID OTC (ORAL) PDL PDL VANACOF GPE LIQUID OTC (ORAL) PDL PDL VANACOF LIQUID OTC (ORAL) PDL PDL X VANACOF-8 LIQUID OTC (ORAL) NPD PDL X VANATABLET DX TABLET OTC (ORAL) PDL PDL VICKS CHILDREN'S NYQUIL LIQUID OTC (ORAL) NPD NPD VICKS DAYQUIL-NYQUIL CAPSULE SEQUELS OTC (ORAL) NPD NPD VICKS DAYQUIL-NYQUIL COLD-FLU LIQUID SEQUELS OTC (ORAL) NPD NPD VICKS NYQUIL COUGH SOLUTION OTC (ORAL) NPD NPD VICKS NYQUIL LIQUID OTC (ORAL) NPD NPD VICKS NYQUIL SEVERE COLD-FLU TABLET OTC (ORAL) NPD NPD Z-COF 12DM LIQUID OTC (ORAL) NPD NPD ZONATUSS CAPSULE (ORAL) NPD NPD ERYTHROPOIESIS STIMULATING PROTEINS ARANESP DISP SYRIN (INJECTION) NPD NPD X For this Therapeutic Drug Class, the Committee ARANESP VIAL (INJECTION) NPD NPD X believed that all of the drugs being recommended as EPOGEN (INJECTION) PDL PDL preferred meet the fiscal requirements of the state PROCRIT (INJECTION) PDL PDL X Page 13 of 18

14 HHSC Preferred Drug List (PDL) GLUCOCORTICOIDS, INHALED ADVAIR DISKUS (INHALATION) PDL PDL For this Therapeutic Drug Class, the Committee ADVAIR HFA (INHALATION) PDL PDL believed that all of the drugs being recommended as AEROSPAN (INHALATION) NPD NPD X preferred meet the fiscal requirements of the state ALVESCO (INHALATION) NPD NPD ARNUITY ELLIPTA (INHALATION) NR NPD ASMANEX (INHALATION) PDL PDL ASMANEX HFA (INHALATION) NR NPD BREO ELLIPTA (INHALATION) NPD NPD X BUDESONIDE 0.25, 0.5 MG RESPULES (INHALATION) NPD NPD DULERA (INHALATION) PDL PDL X FLOVENT DISKUS (INHALATION) PDL PDL X FLOVENT HFA (INHALATION) PDL PDL X PULMICORT 0.25, 0.5 MG RESPULES (INHALATION) NPD NPD PULMICORT 1 MG RESPULES (INHALATION) NPD NPD PULMICORT FLEXHALER (INHALATION) NPD NPD X QVAR (INHALATION) PDL PDL SYMBICORT (INHALATION) PDL PDL X HAE TREATMENTS BERINERT (INTRAVEN) PDL PDL For this Therapeutic Drug Class, the Committee CINRYZE (INTRAVEN) PDL PDL believed that all of the drugs being recommended as FIRAZYR (SUB-Q) PDL PDL preferred meet the fiscal requirements of the state KALBITOR (SUB-Q) PDL PDL X RUCONEST (INTRAVEN) NPD NPD HYPOGLYCEMICS, SGLT2 FARXIGA (ORAL) NPD NPD X For this Therapeutic Drug Class, the Committee INVOKAMET (ORAL) NPD NPD X believed that all of the drugs being recommended as INVOKANA (ORAL) NPD PDL X preferred meet the fiscal requirements of the state JARDIANCE (ORAL) NPD NPD X XIGDUO XR (ORAL) NPD NPD X IMMUNE GLOBULINS CARIMUNE NF NANOFILTERED (INTRAVEN) PDL NPD For this Therapeutic Drug Class, the Committee CYTOGAM (INTRAVEN) PDL PDL believed that all of the drugs being recommended as FLEBOGAMMA DIF (INTRAVEN) NPD NPD preferred meet the fiscal requirements of the state GAMASTAN S-D VIAL (INTRAMUSC) PDL PDL GAMMAGARD LIQUID (INJECTION) PDL PDL GAMMAGARD S-D (INTRAVEN) PDL PDL GAMMAKED (INTRAVEN) NPD NPD GAMMAPLEX (INTRAVEN) NPD NPD GAMUNEX-C (INJECTION) NPD PDL HEPAGAM B (INTRAMUSC) PDL PDL Page 14 of 18

15 HHSC Preferred Drug List (PDL) HIZENTRA (SUBCUT.) PDL PDL HYQVIA (SUBCUT.) NPD NPD OCTAGAM (INTRAVEN) PDL NPD PRIVIGEN (INTRAVEN) NPD NPD VARIZIG (INTRAMUSC.) PDL PDL LINCOSAMIDES/OXAZOLIDINONES/ CLEOCIN CAPSULES (ORAL) NPD NPD STREPTOGRAMINS CLEOCIN PALMITATE (ORAL) NPD NPD For this Therapeutic Drug Class, the Committee CLEOCIN PHOSPHATE PIGGYBACK (INJECTION) NPD NPD believed that all of the drugs being recommended as CLEOCIN PHOSPHATE VIAL (INJECTION) NPD NPD preferred meet the fiscal requirements of the state CLINDAMYCIN CAPSULES (ORAL) PDL PDL CLINDAMYCIN PALMITATE SOLUTION (ORAL) PDL PDL CLINDAMYCIN PHOSPHATE PIGGYBACK (INJECTION) NPD NPD CLINDAMYCIN PHOSPHATE VIAL (INJECTION) NPD NPD LINCOCIN (INJECTION) NPD NPD LINEZOLID (INTRAVEN) NPD NPD SIVEXTRO (INTRAVEN) NPD NPD SIVEXTRO (ORAL) NPD NPD SYNERCID (INJECTION) NPD NPD ZYVOX (INJECTION) NPD NPD ZYVOX SUSPENSION (ORAL) PDL PDL ZYVOX TABLET (ORAL) PDL PDL LIPOTROPICS, OTHER ANTARA (ORAL) NPD NPD For this therapeutic drug class, the Committee CHOLESTYRAMINE/ASPARTAME (ORAL) PDL PDL believed that all of the drugs being recommended as CHOLESTYRAMINE/SUCROSE (ORAL) PDL PDL preferred demonstrated the greatest safety, efficacy, COLESTID GRANULES (ORAL) NPD NPD and value and provided clinicians with the greatest COLESTID TABLET (ORAL) NPD NPD number of first line options to use before requiring COLESTIPOL GRANULES (ORAL) NPD NPD COLESTIPOL TABLET (ORAL) PDL PDL FENOFIBRATE (ANTARA) (AG) (ORAL) NPD NPD FENOFIBRATE (ANTARA) (ORAL) NPD NPD FENOFIBRATE CAPSULE (LIPOFEN) (ORAL) NPD PDL FENOFIBRATE CAPSULE (LOFIBRA) (ORAL) NPD PDL FENOFIBRATE TABLET (AG) (TRICOR) (ORAL) PDL PDL FENOFIBRATE TABLET (LOFIBRA) (ORAL) NPD PDL FENOFIBRATE TABLET (TRICOR) (ORAL) PDL PDL FENOFIBRIC ACID (FIBRICOR) (ORAL) NPD NPD FENOFIBRIC ACID (TRILIPIX) (AG) (ORAL) PDL PDL FENOFIBRIC ACID (TRILIPIX) (ORAL) PDL PDL FENOGLIDE (ORAL) NPD NPD GEMFIBROZIL (ORAL) PDL PDL Page 15 of 18

16 HHSC Preferred Drug List (PDL) Page 16 of 18 JUXTAPID (ORAL) PDL PDL KYNAMRO (SUBCUTANE.) NPD PDL LIPOFEN (ORAL) NPD NPD LOFIBRA TABLET (ORAL) NPD NPD LOPID (ORAL) NPD NPD LOVAZA (ORAL) NPD NPD NIACIN (INOSITOL NIACINATE) OTC (ORAL) PDL PDL NIACIN CAPSULE ER OTC (ORAL) NPD NPD NIACIN ER (ORAL) NPD PDL NIACIN TABLET ER OTC (ORAL) NPD NPD NIACIN TABLET OTC (ORAL) NPD NPD NIACOR (ORAL) PDL PDL NIASPAN (ORAL) PDL NPD OMEGA-3 ACID ETHYL ESTERS (ORAL) NPD NPD OMEGA-3 OTC (ORAL) PDL PDL QUESTRAN (ORAL) NPD NPD QUESTRAN LIGHT (ORAL) NPD NPD SLO-NIACIN OTC (ORAL) NPD NPD TRICOR (ORAL) NPD NPD TRIGLIDE (ORAL) NPD NPD TRILIPIX (ORAL) NPD NPD VASCEPA (ORAL) NPD NPD WELCHOL POWDER PACK (ORAL) NPD NPD X WELCHOL TABLET (ORAL) NPD NPD X ZETIA (ORAL) PDL PDL X LIPOTROPICS, STATINS ADVICOR (ORAL) NPD NPD For this therapeutic drug class, the Committee ALTOPREV (ORAL) NPD NPD believed that all of the drugs being recommended as AMLODIPINE-ATORVASTATIN (ORAL) NPD NPD preferred demonstrated the greatest safety, efficacy, ATORVASTATIN (ORAL) PDL PDL and value and provided clinicians with the greatest CADUET (ORAL) NPD NPD number of first line options to use before requiring CRESTOR (ORAL) NPD NPD FLUVASTATIN (ORAL) NPD NPD LESCOL (ORAL) NPD NPD LESCOL XL (ORAL) NPD NPD LIPITOR (ORAL) NPD NPD LIPTRUZET (ORAL) NPD NPD LIVALO (ORAL) NPD NPD LOVASTATIN (ORAL) NPD PDL PRAVACHOL (ORAL) NPD NPD PRAVASTATIN (ORAL) PDL PDL SIMCOR (ORAL) PDL PDL

17 HHSC Preferred Drug List (PDL) SIMVASTATIN (ORAL) PDL PDL VYTORIN (ORAL) NPD NPD ZOCOR (ORAL) NPD NPD PAH AGENTS, ORAL AND INHALED ADCIRCA (ORAL) PDL PDL X For this Therapeutic Drug Class, the Committee ADEMPAS (ORAL) NPD NPD believed that all of the drugs being recommended as LETAIRIS (ORAL) PDL PDL X preferred meet the fiscal requirements of the state OPSUMIT (ORAL) NPD NPD X ORENITRAM ER (ORAL) NPD NPD X REVATIO SUSPENSION (ORAL) NPD NPD REVATIO TABLET (ORAL) NPD NPD SILDENAFIL (ORAL) PDL PDL TRACLEER (ORAL) PDL PDL X TYVASO (INHALATION) NPD NPD VENTAVIS (INHALATION) NPD NPD PANCREATIC ENZYMES CREON (ORAL) PDL PDL X For this Therapeutic Drug Class, the Committee PANCREAZE (ORAL) NPD NPD believed that all of the drugs being recommended as PANCRELIPASE (AG) (ORAL) PDL PDL preferred meet the fiscal requirements of the state PERTZYE (ORAL) NPD NPD ULTRESA (ORAL) NPD NPD VIOKACE (ORAL) NPD NPD ZENPEP (ORAL) PDL PDL X SEDATIVE HYPNOTICS AMBIEN (ORAL) NPD NPD For this therapeutic drug class, the Committee AMBIEN CR (ORAL) NPD NPD believed that all of the drugs being recommended as BELSOMRA (ORAL) NR NPD X preferred demonstrated the greatest safety, efficacy, EDLUAR (SUBLINGUAL) NPD NPD and value and provided clinicians with the greatest ESTAZOLAM (ORAL) NPD NPD number of first line options to use before requiring ESZOPICLONE (ORAL) NPD NPD FLURAZEPAM (ORAL) PDL PDL HALCION (ORAL) NPD NPD HETLIOZ (ORAL) NPD NPD INTERMEZZO (SUBLINGUAL) NPD NPD LUNESTA (ORAL) NPD NPD RESTORIL (ORAL) NPD NPD RESTORIL 7.5 MG (ORAL) NPD NPD ROZEREM (ORAL) NPD NPD SILENOR (ORAL) NPD NPD SONATA (ORAL) NPD NPD TEMAZEPAM (ORAL) PDL PDL TEMAZEPAM 22.5 MG (ORAL) NPD NPD Page 17 of 18

18 HHSC Preferred Drug List (PDL) TEMAZEPAM 7.5 MG (ORAL) NPD NPD TRIAZOLAM (ORAL) PDL PDL ZALEPLON (ORAL) NPD NPD ZOLPIDEM (ORAL) PDL PDL ZOLPIDEM ER (ORAL) NPD NPD SINGLE PRODUCT REVIEWS For these products, the Committee believed that only NEULASTA KIT met the clinical and fiscal requirements of the state. ACNE AGENTS, TOPICAL ONEXTON W/PUMP (TOPICAL) NR NPD ANALGESICS, NARCOTICS LONG HYSINGLA ER (ORAL) NR NPD COLONY STIMULATING FACTORS NEULASTA KIT (INJECTION) NR PDL HYPOGLYCEMICS, INSULIN AND RELATED AGENTS AFREZZA CARTRIDGE (INHALATION) NR NPD INTRANASAL RHINITIS AGENTS FLONASE OTC (NASAL) NR NPD PHOSPHATE BINDERS AURYXIA (ORAL) NPD NPD ULCERATIVE COLITIS AGENTS UCERIS (RECTAL) NR NPD Page 18 of 18