Network Health Medicare Advantage Plans. (List of Covered Drugs)

Transcription

1 Network Health Medicare Advantage Plans Network PlatinumPlus Pharmacy (PPO) Network PlatinumPremier Pharmacy (PPO) Network PlatinumSelect (PPO) NetworkCares (PPO SNP) 016 Formulary (List of Covered s) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN HPMS Approved Formulary File Submission ID 16, Version 1 We have made no changes to this formulary since 7/1/016. This formulary was updated on 7/1/016. For more recent information or other questions, please contact Network Health Medicare Advantage plans customer service at or, for TTY users, , hours a day/seven days a week, or visit NetworkHealthMedicare.com. Note to existing members: This formulary has changed since last year. Please review this document to make sure that it still contains the drugs you take. When this drug list (formulary) refers to we, us, or our, it means Network Health Insurance Corporation. When it refers to plan or our plan, it means Network Health Medicare Advantage plans. This document includes a list of the drugs (formulary) for our plan which is current as of 7/1/016. For an updated formulary, please contact us. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. You must generally use network pharmacies to use your prescription drug benefit. Benefits, formulary, pharmacy network, and/or copayments/coinsurance may change on January 1, 017, and from time to time during the year. H1_660r11_0871 Accepted

2 What is the Network Health Medicare Advantage Plans Formulary? A formulary is a list of covered drugs selected by our plan in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Our plan will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Network Health Medicare Advantage plans network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage. Can the Formulary (drug list) change? Generally, if you are taking a drug on our 016 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 016 coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released. Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same cost-sharing for those members taking it for the remainder of the coverage year. We feel it is important that you have continued access for the remainder of the coverage year to the formulary drugs that were available when you chose our plan, except for cases in which you can save additional money or we can ensure your safety. If we remove drugs from our formulary, add prior authorization, quantity limits and/or step therapy restrictions on a drug or move a drug to a higher cost-sharing tier, we must notify affected members of the change at least 60 days before the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug. If the Food and Administration deems a drug on our formulary to be unsafe or the drug s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug. The enclosed formulary is current as of 7/1/016.To get updated information about the drugs covered by our plan, please contact us. Our contact information appears on the front and back cover pages. In limited instances, our plan may make changes to the formulary during the year which would reduce or discontinue coverage of a drug. Examples of this include removing dosage forms from the formulary, changing a preferred drug to a non-preferred drug even though a less expensive generic drug is not available and adding new prior authorization. If this occurs, a corrected formulary page will be mailed to you listing the updated formulary status of the affected drug. How do I use the Formulary? There are two ways to find your drug within the formulary: Medical Condition The formulary begins on page 10. The drugs in this formulary are grouped into categories depending on the type of medical conditions that they are used to treat. For example, drugs used to treat a heart condition are listed under the category, Cardiovascular, Hypertension/Lipids. If you know what your drug is used for, look for the category name in the list that begins on page 10. Then look under the category name for your drug. Alphabetical Listing If you are not sure what category to look under, you should look for your drug in the Index that begins on page 170. The Index provides an alphabetical list of all of the drugs included in this document. Both

3 brand name drugs and generic drugs are listed in the Index. Look in the Index and find your drug. Next to your drug, you will see the page number where you can find coverage information. Turn to the page listed in the Index and find the name of your drug in the first column of the list. What are generic drugs? Network Health Medicare Advantage plans covers both brand name drugs and generic drugs. A generic drug is approved by the FDA as having the same active ingredient as the brand name drug. Generally, generic drugs cost less than brand name drugs. Are there any restrictions on my coverage? Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include: Prior Authorization: Network Health Medicare Advantage plans requires you or your physician to get prior authorization for certain drugs. This means that you will need to get approval from our plan before you fill your prescriptions. If you don t get approval, our plan may not cover the drug. Quantity : For certain drugs, Network Health Medicare Advantage plans limits the amount of the drug that our plan will cover. For example, our plan provides 0 tablets per prescription for Actos. This may be in addition to a standard one-month or three-month supply. Step Therapy: In some cases, Network Health Medicare Advantage plans requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if A and B both treat your medical condition, our plan may not cover B unless you try A first. If A does not work for you, our plan will then cover B. You can find out if your drug has any additional requirements or limits by looking in the formulary that begins on page 10. You can also get more information about the restrictions applied to specific covered drugs by visiting our web site. We have posted on line documents that explain our prior authorization and step therapy restrictions. You may also ask us to send you a copy. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. You can ask Network Health Medicare Advantage plans to make an exception to these restrictions or limits or for a list of other, similar drugs that may treat your health condition. See the section, How do I request an exception to the Network Health Medicare Advantage plan s formulary? on page for information about how to request an exception. What if my drug is not on the Formulary? If your drug is not included in this formulary (list of covered drugs), you should first contact customer service and ask if your drug is covered. If you learn that Network Health Medicare Advantage plans does not cover your drug, you have two options: You can ask customer service for a list of similar drugs that are covered by our plan. When you receive the list, show it to your doctor and ask him or her to prescribe a similar drug that is covered by our plan.

4 You can ask our plan to make an exception and cover your drug. See below for information about how to request an exception. How do I request an exception to the Network Health Medicare Advantage Plan s Formulary? You can ask our plan to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make. You can ask us to cover a drug even if it is not on our formulary. If approved, this drug will be covered at a pre-determined cost-sharing level, and you would not be able to ask us to provide the drug at a lower cost-sharing level. You can ask us to cover a formulary drug at a lower cost-sharing level if this drug is not on the specialty tier. If approved this would lower the amount you must pay for your drug. You can ask us to waive coverage restrictions or limits on your drug. For example, for certain drugs, Network Health Medicare Advantage plans limits the amount of the drug that we will cover. If your drug has a quantity limit, you can ask us to waive the limit and cover a greater amount. Generally, our plan will only approve your request for an exception if the alternative drugs included on the plan s formulary, the lower cost-sharing drug or additional utilization restrictions would not be as effective in treating your condition and/or would cause you to have adverse medical effects. You should contact us to ask us for an initial coverage decision for a formulary, tiering or utilization restriction exception. When you request a formulary, tiering or utilization restriction exception you should submit a statement from your prescriber or physician supporting your request. Generally, we must make our decision within 7 hours of getting your prescriber s supporting statement. You can request an expedited (fast) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 7 hours for a decision. If your request to expedite is granted, we must give you a decision no later than hours after we get a supporting statement from your doctor or other prescriber. What do I do before I can talk to my doctor about changing my drugs or requesting an exception? As a new or continuing member in our plan you may be taking drugs that are not on our formulary. Or, you may be taking a drug that is on our formulary but your ability to get it is limited. For example, you may need a prior authorization from us before you can fill your prescription. You should talk to your doctor to decide if you should switch to an appropriate drug that we cover or request a formulary exception so that we will cover the drug you take. While you talk to your doctor to determine the right course of action for you, we may cover your drug in certain cases during the first 90 days you are a member of our plan. For each of your drugs that is not on our formulary or if your ability to get your drugs is limited, we will cover a temporary 0-day supply (unless you have a prescription written for fewer days) when you go to a

5 network pharmacy. After your first 0-day supply, we will not pay for these drugs, even if you have been a member of the plan less than 90 days. If you are a resident of a long-term care facility, we will allow you to refill your prescription until we have provided you with up to a 98-day transition supply, consistent with dispensing increment, (unless you have a prescription written for fewer days). We will cover more than one refill of these drugs for the first 90 days you are a member of our plan. If you need a drug that is not on our formulary or if your ability to get your drugs is limited, but you are past the first 90 days of membership in our plan, we will cover a 1-day emergency supply of that drug (unless you have a prescription for fewer days) while you pursue a formulary exception. If you experience a level of care change (for example, if you are admitted to or discharged from a hospital or long-term care facility), you may need additional supplies of medications. If this occurs, your pharmacy can get an override for this situation to allow for early refills. We will not limit your access to appropriate and necessary Part D medication refills if you experience a level of care change. For more information For more detailed information about your Network Health Medicare Advantage plans prescription drug coverage, please review your Evidence of Coverage and other plan materials. If you have questions about Network Health Medicare Advantage plans please contact us. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. If you have general questions about Medicare prescription drug coverage, please call Medicare at 1-800MEDICARE ( ) hours a day/7 days a week TTY users should call Or, visit Network Health Medicare Advantage Plan s Formulary The formulary below provides coverage information about the drugs covered by our plan. If you have trouble finding your drug in the list, turn to the Index that begins on page 170. The first column of the chart lists the drug name. Brand name drugs are capitalized (e.g., CRESTOR) and generic drugs are listed in lower-case italics (e.g., warfarin). The information in the column tells you if Network Health Medicare Advantage plans has any special requirements for coverage of your drug.

6 Legend PA STEP QL B/D PA LA Prior Authorization Step Therapy Quantity Limit This drug may be covered under Medicare Part B or D depending upon the circumstances. Information may need to be submitted describing the use and setting of the drug to make the determination. Limited Availability. This prescription may be available only at certain pharmacies. For more information, consult your Pharmacy Directory or call customer service at , hours a day/seven days a week. TTY users should call

7 Network PlatinumPlus Pharmacy and Network PlatinumSelect This table defines the standard copay structure during the initial coverage phase, which is what you pay after your deductible is met.* Depending on your income level, your actual cost-share may be less. For more information, consult your Evidence of Coverage. Initial Coverage Phase PREFERRED PHARMACY STANDARD PHARMACY DRUG TIER One Month Three Months One Month Three Months 1 $ $ $ $10 $8 $0 $1 $ * $ $100 $ $109 * $8 $00 $90 $1 * 8% N/A 8% N/A *During the deductible stage, you pay the full cost of drugs in, and until you have paid $00. Network PlatinumPremier Pharmacy This table defines the standard copay structure during the initial coverage phase. Depending on your income level, your actual cost-share may be less. For more information, consult your Evidence of Coverage. Initial Coverage Phase PREFERRED PHARMACY STANDARD PHARMACY DRUG TIER One Month Three Months One Month Three Months 1 $ $ $ $10 $8 $0 $1 $ $ $100 $ $109 $8 $00 $90 $1 % N/A % N/A 7

8 NetworkCares This table defines the standard copay structure during the initial coverage phase, which is what you pay after your deductible is met.* Depending on your income level, you will pay the following cost-share. For more information, consult your Evidence of Coverage. Initial Coverage Phase PREFERRED PHARMACY STANDARD PHARMACY 1 DRUG TIER One Month Three Months One Month Three Months $0, $1, $1.0, $.9, or 1% $0, $1.0, $.9, $1 or 1% $0, $1.0, $.9, $ or 1% $0, $1.0, $.9, $0 or 1% $0, $1.0, $.9, $ or 1% $0, $1.0, $.9, $18 or 1% $0, $1.0, $.9, $8 or 1% $0, $1.0, $.9, $ or 1% $0, $1.0, $.9, $.60, $7.0, $ or 1% $0, $.60, $7.0, $80 or 1% $0, $1.0, $.9, $.60, $7.0, 1% or 0% $0, $1.0, $.9, $.60, $7.0, $10 or 1% $0, $.60, $7.0, $1 or 1% $0, $1.0, $.9, $.60, $7.0, $ or 1% $0, $.60, $7.0, $86 or 1% N/A $0, $1.0, $.9, $.60, $7.0, 1% or 0% $0, $1.0, $.9, $.60, $7.0, $10 or 1% $0, $.60, $7.0, $ or 1% N/A *During the deductible stage, you pay the full cost of your drugs. You stay in this stage until you have paid $10 for your drugs. Depending on your income level, your actual deductible and cost-share amounts may be less. 8

9 Legend Description 1 Preferred Generics Generics Preferred Brands Non-Preferred Brands Specialty Symbol QL PA STEP LA Description There is a limit on the amount of this drug that is covered per prescription, or within a specific time frame. You (or your physician) are required to get prior authorization before you fill your prescription for this drug. Without prior approval, we may not cover this drug. In some cases, you may be required to first try certain drugs to treat your medical condition before we will cover another drug for that condition. Limited Availability. This prescription may be available only at certain pharmacies. For more information, consult your Pharmacy Directory or call customer service at , hours a day/seven days a week. TTY users should call You can find information on what the symbols and abbreviations on this table mean by going to page. 9

10 Name ANTI - INFECTIVES ANTIFUNGAL AGENTS ABELCET 100 MG/0 ML VIAL AMBISOME 0 MG VIAL amphotericin b 0 mg vial ANCOBON (0 MG CAPSULE, 00 MG CAPSULE) CANCIDAS (IV 0 MG VIAL, IV 70 MG VIAL) clotrimazole 10 mg troche CRESEMBA (186 MG CAPSULE, 7 MG VIAL) DIFLUCAN (10 MG/ML SUSPENSION, 0 MG/ML SUSPENSION, 0 MG, 100 MG, 10 MG, 00 MG ) ERAXIS (WATER DILUENT) (0 MG VIAL, 100 MG VIAL) fluconazole (10 mg/ml susp recon, 0 mg/ml susp recon, 0 mg tablet, 100 mg tablet, 10 mg tablet, 00 mg tablet) B/D PA B/D PA B/D PA B/D PA Name fluconazole in dextrose,iso-os 00mg/0.l piggyback fluconazole in nacl,iso-osm 100mg/0ml piggyback fluconazole in sodium chloride, isoosmotic (00mg/0.1l pggybk btl, 00mg/0.1l piggyback, 00mg/0.l piggyback) flucytosine (0 mg capsule, 00 mg capsule) GRIS-PEG (1 MG, 0 MG ) griseofulvin ultramicrosize (1 mg tablet, 0 mg tablet) griseofulvin, microsize (1 mg/ml oral susp, 00 mg tablet) itraconazole 100 mg capsule ketoconazole 00 mg tablet LAMISIL (1 MG GRANULES PACKET, 187. MG GRANULES PACK, 0 MG ) MYCAMINE (0 MG VIAL, 100 MG VIAL) PA 10

11 Name Name NOXAFIL (0 MG/ML SUSPENSION, DR 100 MG, 00 MG/16.7 ML VIAL) nystatin (0mm unit powder(ea), 10mm unit powder(ea), 00mm unit powder(ea), 00k unit tablet, /ml oral susp) ONMEL 00 MG PA acyclovir (00 mg capsule, 00 mg/ml oral susp, 00 mg tablet, 800 mg tablet) acyclovir sodium (0 mg/ml vial, 00 mg vial, 1000 mg vial) adefovir dipivoxil 10 mg tablet amantadine hcl (0 mg/ ml solution, 100 mg tablet, 100 mg capsule) B/D PA ORAVIG 0 MG BUCCAL SPORANOX (10 MG/ML SOLUTION, 100 MG CAPSULE) terbinafine hcl 0 mg tablet VFEND (0 MG/ML SUSPENSION, 0 MG, 00 MG ) VFEND IV 00 MG VIAL PA APTIVUS (100 MG/ML SOLUTION, 0 MG CAPSULE) ATRIPLA BARACLUDE (0. MG, 1 MG ) BARACLUDE 0.0 MG/ML SOLUTION cidofovir 7 mg/ml vial COMBIVIR B/D PA voriconazole (0 mg tablet, 00 mg tablet, 00 mg/ml susp recon) voriconazole 00 mg vial ANTIVIRALS COMPLERA COPEGUS 00 MG CRIXIVAN (00 MG CAPSULE, 00 MG CAPSULE) abacavir sulfate 00 mg tablet CYTOVENE 00 MG VIAL abacavir/lamivudine/ zidovudine 10-00mg tablet DAKLINZA (0 MG, 60 MG ) PA 11

12 Name Name DESCOVY 00- MG FLUMADINE 100 MG didanosine (1 mg capsule dr, 00 mg capsule dr, 0 mg capsule dr, 00 mg capsule dr) EDURANT MG FUZEON (90 MG VIAL, CONVENIENCE KIT) ganciclovir sodium 00 mg vial GENVOYA EMTRIVA (10 MG/ML SOLUTION, 00 MG CAPSULE) entecavir (0. mg tablet, 1 mg tablet) EPIVIR (10 MG/ML ORAL SOLN, 10 MG, 00 MG ) EPIVIR HBV 100 MG EPIVIR HBV MG/ ML SOLN EPZICOM EVOTAZ 00 MG-10 MG HARVONI MG HEPSERA 10 MG INTELENCE (100 MG, 00 MG ) INTELENCE MG INVIRASE 00 MG CAPSULE INVIRASE 00 MG ISENTRESS (100 MG CHEW, 00 MG ) PA famciclovir 1 mg tablet famciclovir 0 mg tablet famciclovir 00 mg tablet FAMVIR 1 MG FAMVIR 0 MG FAMVIR 00 MG QL (10 PER QL (60 PER 0 QL (0 PER 10 QL (10 PER QL (60 PER 0 QL (0 PER 10 ISENTRESS ( MG CHEW, 100 MG POWDER PACKET) KALETRA (00-0 MG, / ML ORAL SOLU) KALETRA 100- MG lamivudine (10 mg/ml solution, 100 mg tablet, 10 mg tablet, 00 mg tablet) 1

13 Name Name lamivudine/zidovudin e 10-00mg tablet RELENZA MG DISKHALER LEXIVA 0 MG/ML SUSPENSION LEXIVA 700 MG MODERIBA (00-00 MG DOSEPACK, 00 MG, MG DOSEPACK, MG DOSEPACK) MODERIBA MG DOSEPACK nevirapine (0 mg/ ml oral susp, 100 mg tab er h, 00 mg tablet, 00 mg tab er h) NORVIR (80 MG/ML SOLUTION, 100 MG, 100 MG SOFTGEL CAP) ODEFSEY PREZCOBIX 800 MG- 10 MG RESCRIPTOR (100 MG, 00 MG ) RETROVIR (10 MG/ML SYRUP, 100 MG CAPSULE) RETROVIR 00 MG/0 ML VIAL REYATAZ (0 MG POWDER PACKET, 10 MG CAPSULE, 00 MG CAPSULE, 00 MG CAPSULE) RIBASPHERE (00 MG, 00 MG CAPSULE, 00 MG ) RIBASPHERE 600 MG RIBASPHERE RIBAPAK (00-00 MG, MG, MG, MG) PREZISTA (100 MG/ML SUSPENSION, 600 MG, 800 MG ) PREZISTA (7 MG, 10 MG ) RIBATAB MG DOSEPACK ribavirin (00 mg capsule, 00 mg tablet) rimantadine hcl 100 mg tablet RAPIVAB 00 MG/0 ML VIAL REBETOL 00 MG CAPSULE REBETOL 0 MG/ML SOLUTION SELZENTRY (10 MG, 00 MG ) SOVALDI 00 MG PA 1

14 Name Name stavudine (1 mg/ml soln recon, 1 mg capsule, 0 mg capsule, 0 mg capsule, 0 mg capsule) STRIBILD valganciclovir hcl 0 mg tablet VALTREX 1 GM CAPLET VALTREX 00 MG CAPLET QL (0 PER 0) QL (60 PER 0) SUSTIVA (0 MG CAPSULE, 00 MG CAPSULE, 600 MG ) SYNAGIS (0 MG/0. ML VIAL, 100 MG/1 ML VIAL) TAMIFLU (6 MG/ML SUSPENSION, 0 MG CAPSULE, MG CAPSULE, 7 MG CAPSULE) TECHNIVIE DOSE PACK TIVICAY 0 MG TRIUMEQ TRIZIVIR TRUVADA 00 MG- 00 MG TYBOST 10 MG TYZEKA 600 MG valacyclovir hcl 1000 mg tablet valacyclovir hcl 00 mg tablet LA PA QL (0 PER 0) QL (60 PER 0) VIDEX ( GM SOLN, GM SOLN) VIDEX EC (EC 1 MG CAPSULE, EC 00 MG CAPSULE, EC 0 MG CAPSULE, EC 00 MG CAPSULE) VIEKIRA PAK PA VIRACEPT (0 MG, 6 MG ) VIRAMUNE (0 MG/ ML SUSP, 00 MG ) VIRAMUNE XR (100 MG, 00 MG ) VIRAZOLE 6 GM VIAL VIREAD (10 MG, 00 MG, 0 MG, 00 MG, POWDER) VISTIDE 7 MG/ML VIAL VITEKTA (8 MG, 10 MG ) B/D PA VALCYTE (0 MG/ML SOLUTION, 0 MG ) ZEPATIER MG PA 1

15 Name Name ZERIT (1 MG/ML SOLUTION, 1 MG CAPSULE, 0 MG CAPSULE, 0 MG CAPSULE, 0 MG CAPSULE) ZIAGEN (0 MG/ML SOLUTION, 00 MG ) zidovudine (10 mg/ml syrup, 100 mg capsule, 00 mg tablet) ZOVIRAX (00 MG/ ML SUSP, 00 MG CAPSULE, 00 MG, 800 MG ) cefazolin sodium/dextrose, iso-osmotic (sodium/dextrose,iso 1 g/0 ml froz.piggy, sodium/dextrose,iso 1 g/0 ml piggyback, sodium/dextrose,iso g/0 ml piggyback) cefazolin sodium/dextrose,iso g/100 ml froz.piggy cefdinir (1 mg/ml susp recon, 0 mg/ml susp recon, 00 mg capsule) cefepime hcl (1 g vial, g vial) CEPHALOSPORINS AVYCAZ. GRAM VIAL CEDAX (180 MG/ ML SUSPENSION, 00 MG CAPSULE) cefaclor (1 mg/ml susp recon, 0 mg/ml susp recon, 0 mg capsule, 7 mg/ml susp recon, 00 mg tab er 1h, 00 mg capsule) cefadroxil (1 g tablet, 0 mg/ml susp recon, 00 mg capsule, 00 mg/ml susp recon) cefepime hcl/dextrose % in water (hcl/dw g/0 ml piggyback, hcl/dw 1 g/0 ml piggyback) cefepime hcl/dextrose, isoosmotic (hcl/dextrose, 1 g/0 ml froz.piggy, hcl/dextrose, g/100 ml froz.piggy) cefixime (100 mg/ml susp recon, 00 mg/ml susp recon) CEFOTAN (1 GM VIAL, GM VIAL) cefazolin sodium (1 g vial, 1 g vial port, 10 g vial, 0 g vial, 100 g bulkbaginj, 00g bulkbaginj, 00 mg vial) cefotaxime sodium (1 g vial, g vial, 10 g vial, 00 mg vial) cefotetan disodium (1 g vial, g vial, 10 g vial) 1

16 Name Name cefotetan disodium/dextrose, iso-osmotic (disod/dextrose,iso 1 g/0 ml piggyback, disod/dextrose,iso g/0 ml piggyback) cefoxitin sodium (1 g vial, g vial, 10 g vial) cefoxitin sodium/dextrose, isoosmotic (sodium/dextrose,iso 1 g/0 ml piggyback, sodium/dextrose,iso g/0 ml piggyback) cefpodoxime proxetil (0 mg/ ml susp recon, 100 mg tablet, 100 mg/ml susp recon, 00 mg tablet) cefprozil (1 mg/ml susp recon, 0 mg tablet, 0 mg/ml susp recon, 00 mg tablet) ceftazidime (1 g vial, g vial, 6 g vial) ceftazidime in dextrose % and water (1 g/0 ml piggyback, g/0 ml piggyback) ceftibuten (180 mg/ml susp recon, 00 mg capsule) ceftriaxone sodium (1 g vial, 1 g vial port, g vial port, g vial, 10 g vial, 100 g bulkbaginj, 0 mg vial, 00 mg vial) ceftriaxone sodium/dextrose, iso-osmotic (na/dextrose,iso 1 g/0 ml froz.piggy, na/dextrose,iso g/0 ml froz.piggy) cefuroxime axetil (0 mg tablet, 00 mg tablet) cefuroxime sodium (1. g vial, 7. g vial, 7 g bulkbaginj, 70 mg vial) cephalexin (1 mg/ml susp recon, 0 mg tablet, 0 mg capsule, 0 mg/ml susp recon, 00 mg tablet, 00 mg capsule, 70 mg capsule) CLAFORAN (1 GM VIAL, 1 GM ADD- VANTAGE VL, GM ADD-VANTAGE VL, GM VIAL, 10 GM VIAL, 00 MG VIAL) CLAFORAN- DEXTROSE (1 GM/0 ML, GM/0 ML) CEFTIN (1 MG/ ML ORAL SUSP, 0 MG/ ML ORAL SUSP, 0 MG, 00 MG ) 16

17 Name Name FORTAZ (1 GM VIAL, 1 GM ADD- VANTAGE VIAL, 1 GM TWISTVIAL, GM VIAL, GM TWISTVIAL, GM ADD-VANTAGE VIAL, 6 GM VIAL, 00 MG VIAL) ZERBAXA 1. GRAM VIAL ZINACEF (1. GM TWISTVIAL, 1. GRAM/0 ML, 1. GM VIAL, 7. GM VIAL, 70 MG VIAL, 70 MG TWISTVIAL) FORTAZ IN ISO- OSMOTIC DEXTROSE (FORTAZ-ISO- OSMOT GM/0 ML, FORTAZ-ISO- OSMOTIC 1 GM/0 ML) MAXIPIME (1 GRAM VIAL, 1 GM ADD- VANTAGE VL, GRAM VIAL, GM ADD-VANTAGE VL) MEFOXIN (1 GM/0 ML PIGGYBACK, GM/0 ML PIGGYBACK) SUPRAX (100 MG/ ML SUSPENSION, 100 MG CHEWABLE, 00 MG/ ML SUSPENSION, 00 MG CHEWABLE, 00 MG CAPSULE, 00 MG/ ML SUSPENSION) TAZICEF (1 GRAM VIAL, 1 GM ADD- VANTAGE VIAL, GRAM VIAL, GM ADD-VANTAGE, 6 GRAM VIAL) TEFLARO (00 MG VIAL, 600 MG VIAL) ERYTHROMYCINS / OTHER MACROLIDES azithromycin (1 g packet, 100 mg/ml susp recon, 00 mg/ml susp recon, 0 mg tablet, 00 mg vial port, 00 mg tablet, 00 mg vial, 600 mg tablet) BIAXIN (0 MG, 0 MG/ ML SUSPENSION, 00 MG ) clarithromycin (1 mg/ml susp recon, 0 mg/ml susp recon, 0 mg tablet, 00 mg tab er h, 00 mg tablet) DIFICID 00 MG E.E.S. 00 MG/ ML GRANULES E.E.S. 00 FILMTAB ERY-TAB (EC 0 MG, EC MG ) ERY-TAB EC 00 MG ERYPED 00 MG/ ML SUSPENSION PA; QL (0 PER 10 17

18 Name Name ERYPED 00 MG/ ML SUSPENSION ERYTHROCIN 0 MG FILMTAB ERYTHROCIN LACTOBIONATE (00 MG VIAL, 00 MG ADDVNT VL) erythromycin base (0 mg tablet, 0 mg capsule dr, 00 mg tablet) erythromycin ethylsuccinate 00 mg tablet amikacin sulfate (00 mg/ml vial, 1000mg/ml vial) atovaquone 70 mg/ml oral susp atovaquone/proguani l hcl (atovaquone/progua nil 6.- mg tablet, atovaquone/proguani l mg tablet) AZACTAM (1 GM VIAL, GM VIAL) AZACTAM-ISO- OSMOT 1 GM/0 ML PCE ( MG, 00 MG ) ZITHROMAX (1 GM POWDER PACKET, 100 MG/ ML SUSP, 00 MG/ ML SUSP, 0 MG Z-PAK, 0 MG, 00 MG, 600 MG, I.V. 00 MG VIAL) AZACTAM-ISO- OSMOT GM/0 ML aztreonam (1 g vial, g vial) BACIIM 0,000 UNITS VIAL bacitracin 0000 unit vial BETHKIS 00 MG/ ML AMPULE B/D PA; QL ( PER 8) ZITHROMAX TRI- PAK 00 MG TAB BILTRICIDE 600 MG ZMAX G/60 ML ORAL SUSPENSION MISCELLANEOUS ANTIINFECTIVES ALBENZA 00 MG ALINIA (100 MG/ ML SUSPENSION, 00 MG ) CAPASTAT SULFATE 1 GM VIAL CAYSTON 7 MG INHAL SOLUTION chloramphenicol sod succ 1 g vial chloroquine phosphate (0 mg tablet, 00 mg tablet) LA 18

19 Name Name CLEOCIN 7 MG/ ML GRANULES CLEOCIN HCL (7 MG CAPSULE, 10 MG CAPSULE, 00 MG CAPSULE) CLEOCIN PHOSPHATE (PHOS 9 G/60 ML VIAL, 10 MG/ML ADDVN VIAL, PHOS 10 MG/ML VIAL, PHOS 00 MG/ ML VIAL, PHOS 600 MG/ ML VIAL, PHOS 900 MG/6 ML VIAL) CLEOCIN PHOSPHATE IN DW (00, 600, 900) clindamycin phosphate/dextrose % in water (phosphate/dw 00mg/0ml piggyback, phosphate/dw 900mg/0ml piggyback, phosphate/dw 600mg/0ml piggyback) COARTEM S colistin (colistimethate na) 10 mg vial COLY-MYCIN M 10 MG VIAL CLIN SINGLE USE KIT CUBICIN 00 MG VIAL clindamycin hcl (7 mg capsule, 10 mg capsule, 00 mg capsule) clindamycin palmitate hcl 7 mg/ ml soln recon cycloserine 0 mg capsule DALVANCE 00 MG VIAL dapsone ( mg tablet, 100 mg tablet) clindamycin phosphate (10 mg/ml vial, 00 mg/ml vial port, 600 mg/ml vial port, 900mg/6ml vial port) DARAPRIM MG DORIBAX (0 MG VIAL, 00 MG VIAL) EMVERM 100 MG CHEW ethambutol hcl (100 mg tablet, 00 mg tablet) FLAGYL (0 MG, 7 CAPSULE, 00 MG ) 19

20 Name Name gentamicin in nacl, iso-osm 100mg/0ml piggyback gentamicin sulfate (0 mg/ ml vial, 0 mg/ml vial) gentamicin sulfate in sodium chloride, isoosmotic (gentamic60 mg/0ml piggyback, gentamic70 mg/0ml piggyback, gentamic80 mg/0ml piggyback, gentamic80mg/100ml piggyback, gentamic90mg/100ml piggyback, gentamic100mg/0.1l piggyback, gentamic10mg/0.1l piggyback) ivermectin mg tablet KETEK (00 MG, 00 MG ) KITABIS PAK 00 MG/ ML LINCOCIN 00 MG/ML VIAL lincomycin hcl 00 mg/ml vial linezolid (100 mg/ml susp recon, 600mg/00 iv soln, 600 mg tablet) linezolid-0.9% sodium chloride 600mg/00 iv soln gentamicin sulfate/pf (sulfate/pf 0 mg/ ml vial, sulfate/pf 60 mg/6 ml vial port, sulfate/pf 80 mg/8 ml vial port, sulfate/pf 100mg/10ml vial port) hydroxychloroquine sulfate 00 mg tablet imipenem/cilastatin sodium (imipenem/cilastatin 0 mg vial, imipenem/cilastatin 00 mg vial) MALARONE (6.- MG PED TAB, MG ) mefloquine hcl 0 mg tablet MEPRON 70 MG/ ML SUSPENSION meropenem (1 g vial, 00 mg vial) meropenem in 0.9 % sodium chloride (1 g/0 ml piggyback, 00mg/0ml piggyback) INVANZ (1 GM VIAL, 1 GM ADD- VANTAGE VIAL) MERREM (IV 1 GM VIAL, IV 00 MG VIAL) isoniazid (0 mg/ ml solution, 100 mg/ml vial, 100 mg tablet, 00 mg tablet) METRO IV 00 MG/100 ML 0

21 Name metronidazole (0 mg tablet, 7 mg capsule, 00 mg tablet) metronidazole/sodiu m chloride 00mg/0.1l piggyback MYAMBUTOL 00 MG MYCOBUTIN 10 MG CAPSULE NEBUPENT 00 MG INHAL POWDER neomycin sulfate 00 mg tablet ORBACTIV 00 MG VIAL paromomycin sulfate 0 mg capsule PASER GRANULES GM PACKET PENTAM 00 VIAL B/D PA Name QUALAQUIN MG CAPSULE quinine sulfate mg capsule rifabutin 10 mg capsule RIFADIN (10 MG CAPSULE, 00 MG CAPSULE, IV 600 MG VIAL) RIFAMATE CAPSULE rifampin (10 mg capsule, 00 mg capsule, 600 mg vial) RIFATER RIMSO-0 SOLUTION SIRTURO 100 MG SIVEXTRO (00 MG VIAL, 00 MG ) LA PLAQUENIL 00 MG streptomycin sulfate 1 g vial polymyxin b sulfate 00k unit vial STROMECTOL MG PRIFTIN 10 MG SYNERCID 00 MG VIAL primaquine phosphate 6. mg tablet TINDAMAX (0 MG, 00 MG ) PRIMAXIN (0 MG VIAL, 00 MG VIAL) tinidazole (0 mg tablet, 00 mg tablet) pyrazinamide 00 mg tablet TOBI 00 MG/ ML SOLUTION B/D PA; QL (80 PER 8) 1

22 Name Name TOBI PODHALER 8 MG INHALE CAP tobramycin in 0.% nacl 00 mg/ml ampul-neb tobramycin sulfate (1. g vial, 10 mg/ml vial, 0 mg/ml vial) TRECATOR 0 MG TYGACIL 0 MG VIAL XIFAXAN 00 MG XIFAXAN 0 MG ZYVOX (100 MG/ ML SUSPENSION, 00 MG/100 ML IV SOLN, 600 MG/00 ML IV SOLN, 600 MG ) PENICILLINS amoxicillin (1 mg tab chew, 1 mg/ml susp recon, 00 mg/ml susp recon, 0 mg capsule, 0 mg tab chew, 0 mg/ml susp recon, 00 mg/ml susp recon, 00 mg tablet, 00 mg capsule, 87 mg tablet) QL ( PER 8) B/D PA; QL (80 PER 8) QL (9 PER amoxicillin/potassium clavulanate (amoxicillin/potassiu m 00-8.mg tab chew, amoxicillin/potassium 00-8./ susp recon, amoxicillin/potassium 0-6./ susp recon, amoxicillin/potassium 0-1 mg tablet, amoxicillin/potassium 00-7mg tab chew, amoxicillin/potassium 00-7mg/ susp recon, amoxicillin/potassium 00-1 mg tablet, amoxicillin/potassium / susp recon, amoxicillin/potassium 87-1 mg tablet, amoxicillin/potassium tab er 1h) ampicillin sodium (1 g vial, 1 g vial port, g vial port, g vial, 10 g vial, 1 mg vial, 0 mg vial, 00 mg vial) ampicillin sodium/sulbactam sodium (sodium/sulbactam 1. g vial port, sodium/sulbactam 1. g vial, sodium/sulbactam g vial, sodium/sulbactam g vial port, sodium/sulbactam 1 g vial)

23 Name Name ampicillin trihydrate (1 mg/ml susp recon, 0 mg capsule, 0 mg/ml susp recon, 00 mg capsule) AUGMENTIN (1-1. MG/ ML, 0-6. MG/ ML, 87-1 ) AUGMENTIN XR 1, TAB BICILLIN C-R (1. MILLION UNIT, SYRINGE) BICILLIN L-A (600,000 UNIT/ML, 1,00,000 UNITS,,00,000 UNITS) dicloxacillin sodium (0 mg capsule, 00 mg capsule) nafcillin in dextrose, iso-osmotic (1 g/0 ml froz.piggy, g/100 ml froz.piggy) nafcillin sodium (1 g vial port, 1 g vial, g vial port, g vial) nafcillin sodium 10 g vial oxacillin sodium/dextrose,iso g/0 ml froz.piggy penicillin g potassium (g mm vial, g 0mm vial) penicillin g potassium/dextrosewater (pen g pot/dextrose-water 1mm/0ml froz.piggy, pen g pot/dextrose-water mm/0ml froz.piggy, pen g pot/dextrose-water mm/0ml froz.piggy) penicillin g procaine (g 1.mm/ ml syringe, g /ml syringe) penicillin g sodium mm unit vial penicillin v potassium (1 mg/ml soln recon, 0 mg tablet, 0 mg/ml soln recon, 00 mg tablet) PFIZERPEN ( MILLION UNITS VIAL, 0 MILLION UNIT VIAL) oxacillin sodium (1 g vial, 1 g vial port, g vial port, g vial) oxacillin sodium 10 g vial oxacillin sodium/dextrose,iso 1 g/0 ml froz.piggy

24 Name Name piperacillin sodium/tazobactam sodium (sodium/tazobactam. g vial, sodium/tazobactam.7 g vial, sodium/tazobactam.7 g vial port, sodium/tazobactam. g vial, sodium/tazobactam. g vial port, sodium/tazobactam 0. g vial) UNASYN (1. GM VIAL, GM VIAL, 1 GM VIAL) ZOSYN (. GM/0 ML GALAXY BAG,. GRAM VIAL,.7 GRAM VIAL,.7 GM/0 ML GALAXY,. GRAM VIAL,. GM/100 ML GALAXY BAG, 0. GRAM BULK VIAL) QUINOLONES AVELOX 00 MG AVELOX ABC PACK 00 MG TAB AVELOX IV 00 MG/0 ML CIPRO XR (00 MG, 1,000 MG ) ciprofloxacin (0 mg/ml sus mc rec, 00 mg/ml sus mc rec) ciprofloxacin hcl (100 mg tablet, 0 mg tablet, 00 mg tablet, 70 mg tablet) ciprofloxacin lactate (00mg/0ml vial, 00mg/0ml vial) ciprofloxacin lactate/dextrose % in water (lactate/dw 00mg/0.l piggyback, lactate/dw 00mg/0.1l piggyback) ciprofloxacin/ciproflo xacin hcl (ciprofloxacin/ciproflo xa 00 mg tbmp hr, ciprofloxacin/ciproflo xa 1000 mg tbmp hr) LEVAQUIN (0 MG, 00 MG, 70 MG ) CIPRO (% SUSPENSION, 10% SUSPENSION, 0 MG, 00 MG ) CIPRO I.V. 00 MG/00 ML DW levofloxacin ( mg/ml vial, 0mg/10ml solution, 0 mg tablet, 00 mg tablet, 00mg/0ml solution, 70 mg tablet)

25 Name Name levofloxacin/dextrose % in water (levofloxacin/dw 70mg/.1l piggyback, levofloxacin/dw 0mg/0ml piggyback, levofloxacin/dw 00mg/0.1l piggyback) moxifloxacin hcl 00 mg tablet SULFATRIM PEDIATRIC SUSPENSION TETRACYCLINES ADOXA 10 MG CAPSULE demeclocycline hcl (10 mg tablet, 00 mg tablet) DOXY 100 VIAL moxifloxacin/sod.ace, sul/water 00mg/.l piggyback ofloxacin 00 mg tablet SULFA'S / RELATED AGENTS BACTRIM MG BACTRIM DS sulfadiazine 00 mg tablet sulfamethoxazole/tri methoprim (sulfamethoxazole/tri methoprim 80-16mg/ml vial, sulfamethoxazole/tri methoprim 00-0mg/ oral susp, sulfamethoxazole/tri methoprim 00mg- 80mg tablet, sulfamethoxazole/tri methoprim /0 oral susp, sulfamethoxazole/tri methoprim mg tablet) doxycycline hyclate (0 mg tablet, 0 mg capsule, 7 mg tablet dr, 100 mg capsule, 100 mg tablet, 100 mg tablet dr, 100 mg vial, 10 mg tablet dr) doxycycline monohydrate ( mg/ ml susp recon, 0 mg capsule, 0 mg tablet, 7 mg capsule, 7 mg tablet, 100 mg tablet, 100 mg capsule, 10 mg tablet, 10 mg capsule) doxycycline monohydrate 0 mg cap ir dr MINOCIN (0 MG PELLETIZED CAP, 7 MG PELLETIZED CAP, 100 MG VIAL, 100 MG PELLETIZED CAP)

26 Name Name minocycline hcl ( mg tab er h, 0 mg tablet, 0 mg capsule, 7 mg capsule, 7 mg tablet, 90 mg tab er h, 100 mg capsule, 100 mg tablet, 1 mg tab er h) MONDOXYNE NL (NL 0 MG CAPSULE, NL 7 MG CAPSULE, NL 100 MG CAPSULE) MORGIDOX (1X100 MG KIT, X100 MG KIT) MORGIDOX 100 MG CAPSULE ORACEA 0 MG CAPSULE SOLODYN (ER MG, ER 6 MG, ER 80 MG, ER 10 MG, ER 11 MG ) MACRODANTIN ( MG CAPSULE, 0 MG CAPSULE, 100 MG CAPSULE) methenamine hippurate 1 g tablet methenamine mandelate (1 g tablet, 00 mg tablet) MONUROL GM SACHET nitrofurantoin mg/ ml oral susp nitrofurantoin macrocrystal ( mg capsule, 0 mg capsule, 100 mg capsule) nitrofurantoin monohyd/m-cryst 100 mg capsule trimethoprim 100 mg tablet VANCOMYCIN tetracycline hcl (0 mg capsule, 00 mg capsule) VANCOCIN HCL (1 MG CAPSULE, 0 MG CAPSULE) VIBRAMYCIN ( MG/ ML SUSP, 0 MG/ ML SYRUP, 100 MG CAPSULE) URINARY TRACT AGENTS FURADANTIN MG/ ML SUSP vancomycin hcl (1 g vial, 1 g vial port, g vial, 10 g vial, 00 mg vial, 00 mg vial port, 70 mg vial) vancomycin hcl (1 mg capsule, 0 mg capsule) HIPREX 1 GM vancomycin hcl 70 mg vial port MACROBID 100 MG CAPSULE 6

27 Name vancomycin hcl/dextrose % in water ( % 1g/00ml froz.piggy, % 00mg/0.1l froz.piggy) vancomycin in dextrose,iso-osm 70mg/.1l froz.piggy vancomycin/0.9 % sod chloride 1g/00ml froz.piggy ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS ADJUNCTIVE AGENTS amifostine crystalline 00 mg vial dexrazoxane hcl (0 mg vial, 00 mg vial) ELITEK (1. MG VIAL, 7. MG VIAL) FUSILEV I.V. 0 MG VIAL KEPIVANCE 6. MG VIAL leucovorin calcium ( mg tablet, 10 mg/ml vial, 10 mg tablet, 1 mg tablet, mg tablet, 0 mg vial, 100 mg vial, 00 mg vial, 0 mg vial, 00mg/0ml vial, 00 mg vial) levoleucovorin calcium 10 mg/ml vial mesna 100 mg/ml vial Name MESNEX 1 GRAM/10 ML VIAL MESNEX 00 MG XGEVA 10 MG/1.7 ML VIAL ZINECARD (0 MG VIAL, 00 MG VIAL) ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS ABRAXANE 100 MG VIAL ADRUCIL ( GRAM/100 ML VIAL, 00 MG/10 ML VIAL,,00 MG/0 ML VIAL) AFINITOR (. MG, MG, 7. MG, 10 MG ) AFINITOR DISPERZ ( MG, MG, MG ) ALECENSA 10 MG CAPSULE ALIMTA (100 MG VIAL, 00 MG VIAL) ALKERAN MG ALKERAN 0 MG VIAL anastrozole 1 mg tablet ARIMIDEX 1 MG STEP B/D PA 7

28 Name Name AROMASIN MG ARRANON 0 MG VIAL ARZERRA 1,000 MG/0 ML VIAL ASTAGRAF XL (0. MG CAPSULE, 1 MG CAPSULE, MG CAPSULE) AVASTIN (100 MG/ ML VIAL, 00 MG/16 ML VIAL) azacitidine 100 mg vial B/D PA B/D PA BOSULIF (100 MG, 00 MG ) BUSULFEX 60 MG/10 ML VIAL CABOMETYX (0 MG, 0 MG, 60 MG ) CAMPTOSAR (0 MG/ ML VIAL, 100 MG/ ML VIAL, 00 MG/1 ML VIAL) CAPRELSA (100 MG, 00 MG ) LA AZASAN (7 MG, 100 MG ) B/D PA carboplatin (10 mg/ml vial, 10 mg vial) azathioprine 0 mg tablet B/D PA CASODEX 0 MG azathioprine sodium 100 mg vial BELEODAQ 00 MG VIAL BENDEKA 100 MG/ ML VIAL bexarotene 7 mg capsule bicalutamide 0 mg tablet BICNU 100 MG VIAL bleomycin sulfate (1 vial, 0 vial) B/D PA CELLCEPT (00 MG/ML ORAL SUSP, 00 MG ) CELLCEPT (0 MG CAPSULE, 00 MG VIAL) cisplatin 1 mg/ml vial cladribine 10 mg/10ml vial CLOLAR 0 MG/0 ML VIAL COMETRIQ (60 MG PACK, 100 MG PK, 10 MG PK) B/D PA B/D PA BLINCYTO MCG VIAL+STABILIZER B/D PA COSMEGEN 0. MG VIAL 8

29 Name COTELLIC 0 MG cyclophosphamide (1 g vial, g vial, 00 mg vial) cyclophosphamide ( mg capsule, 0 mg capsule) cyclophosphamide ( mg tablet, 0 mg tablet) cyclosporine ( mg capsule, 100 mg capsule, 0 mg/ml vial, 0 mg/ml ampul) cyclosporine, modified ( mg capsule, 0 mg capsule, 100 mg/ml solution, 100 mg capsule) PA; LA B/D PA B/D PA B/D PA B/D PA Name DARZALEX (100 MG/ ML VIAL, 00 MG/0 ML VIAL) daunorubicin hcl ( mg/ml vial, 0 mg vial) decitabine 0 mg vial DEPOCYT 0 MG/ ML VIAL DOCEFREZ 0 MG VIAL docetaxel (0 mg/ ml vial, 0mg/ml(1) vial, 80 mg/8 ml vial, 80 mg/ ml vial, 10 mg/7ml vial, 160 mg/8ml vial, 160mg/16ml vial, 00mg/0ml vial) DOXIL MG/ML VIAL LA CYRAMZA (100 MG/10 ML VIAL, 00 MG/0 ML VIAL) cytarabine 0 mg/ml vial B/D PA doxorubicin hcl ( mg/ml vial, 10 mg vial, 10 mg/ ml vial, 0 mg/10ml vial, 0 mg vial, 0 mg/ml vial) cytarabine/pf (cytarabine/pf 1 g vial, cytarabine/pf g/0 ml vial, cytarabine/pf 0 mg/ml vial, cytarabine/pf 100 mg/ml vial) doxorubicin hcl pegliposomal mg/ml vial DROXIA (00 MG CAPSULE, 00 MG CAPSULE, 00 MG CAPSULE) dacarbazine (100 mg vial, 00 mg vial) DACOGEN 0 MG VIAL 9

30 Name Name ELIGARD (7. MG SYRINGE B, 7. MG SYRINGE KIT,. MG SYRINGE B,. MG SYRINGE KIT, 0 MG SYRINGE B, 0 MG SYRINGE KIT, MG SYRINGE B, MG SYRINGE KIT) FARESTON 60 MG FARYDAK (10 MG CAPSULE, 1 MG CAPSULE, 0 MG CAPSULE) FASLODEX 0 MG/ ML SYRINGE ELLENCE MG/ML VIAL FEMARA. MG EMCYT 10 MG CAPSULE EMPLICITI (00 MG VIAL, 00 MG VIAL) ENVARSUS XR (0.7 MG, 1 MG, MG ) epirubicin hcl (0 mg vial, 0 mg/ml vial, 00 mg vial, 00mg/0.1l vial) ERBITUX (100 MG/0 ML VIAL, 00 MG/100 ML VIAL) B/D PA B/D PA FIRMAGON ( X 10 MG VIALS, X 10 MG KIT, 80 MG VIAL, 80 MG KIT) floxuridine 00 mg vial fludarabine phosphate (0 mg vial, 0 mg/ ml vial) fluorouracil (1 g/0 ml vial,. g/0ml vial, g/100 ml vial, 00mg/10ml vial) flutamide 1 mg capsule ERIVEDGE 10 MG CAPSULE ERWINAZE 10,000 UNITS VIAL ETOPOPHOS 100 MG VIAL etoposide 0 mg/ml vial EVOMELA 0 MG VIAL exemestane mg tablet FOLOTYN (0 MG/ML VIAL, 0 MG/ ML VIAL) GAZYVA 1,000 MG/0 ML VIAL gemcitabine hcl (1 g vial, 1 g/6.ml vial, g vial, g/.6ml vial, 00 mg vial, 00mg/.6 vial) GEMZAR (1 GRAM VIAL, 00 MG VIAL) 0

31 Name Name GENGRAF ( MG CAPSULE, 100 MG/ML SOLUTION, 100 MG CAPSULE) GILOTRIF (0 MG, 0 MG, 0 MG ) B/D PA PA IFEX (1 GM VIAL, GM VIAL) ifosfamide (1 g/0 ml vial, 1 g vial, g/60ml vial, g vial) ifosfamide/mesna 1g-1g kit GLEEVEC (100 MG, 00 MG ) imatinib mesylate (100 mg tablet, 00 mg tablet) GLEOSTINE ( MG CAPSULE, 10 MG CAPSULE, 0 MG CAPSULE, 100 MG CAPSULE) IMBRUVICA 10 MG CAPSULE IMURAN 0 MG B/D PA HALAVEN 1 MG/ ML VIAL HERCEPTIN 0 MG VIAL HEXALEN 0 MG CAPSULE HYCAMTIN MG VIAL INLYTA (1 MG, MG ) IRESSA 0 MG irinotecan hcl (0 mg/ ml vial, 100 mg/ml vial, 00mg/ml vial) HYDREA 00 MG CAPSULE ISTODAX 10 MG VIAL hydroxyurea 00 mg capsule IXEMPRA (1 MG KIT, MG KIT) IBRANCE (7 MG CAPSULE, 100 MG CAPSULE, 1 MG CAPSULE) ICLUSIG (1 MG, MG ) IDAMYCIN PFS 1 MG/ML VIAL idarubicin hcl 1 mg/ml vial JAKAFI ( MG, 10 MG, 1 MG, 0 MG, MG ) JEVTANA 60 MG/1. ML KIT KADCYLA (100 MG VIAL, 160 MG VIAL) 1

32 Name Name KEYTRUDA (0 MG VIAL, 100 MG/ ML VIAL) LENVIMA (10 MG DAILY, 1 MG DAILY, 0 MG DAILY, MG DAILY) letrozole. mg tablet LEUKERAN MG leuprolide acetate (1 mg/0.ml kit, 1 mg/0.ml vial) LIPODOX MG/ML VIAL LIPODOX 0 MG/ML VIAL LONSURF (1 MG- 6.1 MG, 0 MG-8.19 MG ) LUPRON DEPOT (DEPOT.7 MG KIT, DEPOT- MONTH KIT, DEPOT 7. MG KIT, DEPOT 11. MG MO KIT, DEPOT. MG MO KIT, DEPOT MG 6MO KIT) MARQIBO KIT MATULANE 0 MG CAPSULE MEGACE 0 MG/ML ORAL SUSP MEGACE ES 6 MG/ ML SUSP megestrol acetate (0 mg tablet, 0 mg tablet, 00mg/10ml oral susp, 6mg/ml oral susp) MEKINIST (0. MG, MG ) melphalan hcl 0 mg vial mercaptopurine 0 mg tablet methotrexate sodium (. mg tablet, mg/ml vial) methotrexate sodium/pf (sodium/pf 1 g vial, sodium/pf mg/ml vial) mitomycin ( mg vial, 0 mg vial, 0 mg vial) PA B/D PA B/D PA LUPRON DEPOT- PED (7. MG KIT, 11. MG MO, 11. MG KIT, 1 MG KIT, 0 MG MO KIT) mitoxantrone hcl mg/ml vial MUSTARGEN 10 MG VIAL LYNPARZA 0 MG CAPSULE LYSODREN 00 MG mycophenolate mofetil (0 mg capsule, 00 mg tablet) B/D PA

33 Name mycophenolate mofetil 00 mg/ml susp recon mycophenolate sodium (180 mg tablet dr, 60 mg tablet dr) MYFORTIC (180 MG, 60 MG ) NEORAL ( MG GELATIN CAPSULE, 100 MG/ML SOLUTION, 100 MG GELATIN CAPSULE) NEXAVAR 00 MG NILANDRON 10 MG NINLARO (. MG CAPSULE, MG CAPSULE, MG CAPSULE) NIPENT 10 MG VIAL NULOJIX 0 MG VIAL octreotide acetate (0 mcg/ml vial, 0 mcg/ml ampul, 0 mcg/ml syringe, 100 mcg/ml ampul, 100 mcg/ml vial, 100 mcg/ml syringe, 00 mcg/ml vial) octreotide acetate (00 mcg/ml ampul, 00 mcg/ml syringe, 00 mcg/ml vial, 1000mcg/ml vial) B/D PA B/D PA B/D PA B/D PA LA B/D PA Name ONCASPAR 70 UNIT/ML VIAL OPDIVO (0 MG/ ML VIAL, 100 MG/10 ML VIAL) oxaliplatin (0 mg vial, 0 mg/10ml vial, 100 mg vial, 100mg/0ml vial) paclitaxel 6 mg/ml vial PERJETA 0 MG/1 ML VIAL POMALYST (1 MG CAPSULE, MG CAPSULE, MG CAPSULE, MG CAPSULE) PORTRAZZA 800 MG/0 ML VIAL PROGRAF (0. MG CAPSULE, 1 MG CAPSULE, MG/ML AMPULE, MG CAPSULE) PURIXAN 0 MG/ML ORAL SUSP RAPAMUNE (0. MG, 1 MG, 1 MG/ML ORAL SOLN, MG ) REVLIMID (. MG CAPSULE, MG CAPSULE, 10 MG CAPSULE, 1 MG CAPSULE, 0 MG CAPSULE, MG CAPSULE) B/D PA B/D PA B/D PA LA ODOMZO 00 MG CAPSULE LA RHEUMATREX. MG B/D PA

34 Name Name RITUXAN 10 MG/ML VIAL SANDIMMUNE ( MG CAPSULE, 0 MG/ML AMPUL, 100 MG/ML SOLN, 100 MG CAPSULE) SANDOSTATIN (0.0 MG/ML AMPUL, 0. MG/ML AMPUL) SANDOSTATIN (0.1 MG/ML AMPUL, 0. MG/ML VIAL, 1 MG/ML VIAL) SANDOSTATIN LAR (10 MG KIT, 0 MG KIT, 0 MG KIT) SANDOSTATIN LAR DEPOT (10 MG VL, 10 MG KT, 0 MG VL, 0 MG KT, 0 MG KT, 0 MG VL) SIGNIFOR (0. MG/ML, 0.6 MG/ML, 0.9 MG/ML) SIGNIFOR LAR (0 MG VIAL, 0 MG KIT, 0 MG KIT, 0 MG VIAL, 60 MG VIAL, 60 MG KIT) B/D PA SPRYCEL (0 MG, 0 MG, 70 MG, 80 MG, 100 MG, 10 MG ) STIVARGA 0 MG SUPPRELIN LA 0 MG KIT SUTENT (1. MG CAPSULE, MG CAPSULE, 7. MG CAPSULE, 0 MG CAPSULE) SYLVANT (100 MG VIAL, 00 MG VIAL) SYNRIBO. MG/ML VIAL TABLOID 0 MG tacrolimus (0. mg capsule, 1 mg capsule, mg capsule) TAFINLAR (0 MG CAPSULE, 7 MG CAPSULE) B/D PA PA SIMULECT (10 MG VIAL, 0 MG VIAL) sirolimus (0. mg tablet, 1 mg tablet, mg tablet) SOLTAMOX 10 MG/ ML SOLN SOMATULINE DEPOT (60 MG/0. ML, 90 MG/0. ML, 10 MG/0. ML) B/D PA B/D PA TAGRISSO (0 MG, 80 MG ) tamoxifen citrate (10 mg tablet, 0 mg tablet) TARCEVA ( MG, 100 MG, 10 MG ) LA

35 Name Name TARGRETIN (1% GEL, 7 MG SOFTGEL, 7 MG CAPSULE) TASIGNA (10 MG CAPSULE, 00 MG CAPSULE) TRISENOX 10 MG/10 ML AMPULE TYKERB 0 MG UNITUXIN 17. MG/ ML VIAL LA TAXOTERE (0 MG/ML VIAL, 80 MG/ ML VIAL) TEMODAR 100 MG VIAL THALOMID (0 MG CAPSULE, 100 MG CAPSULE, 10 MG CAPSULE, 00 MG CAPSULE) thiotepa 1 mg vial TOPOSAR (100 MG/ ML VIAL, 00 MG/ ML VIAL, 1,000 MG/0 ML VIAL) topotecan hcl ( mg/ ml vial, mg vial) TORISEL MG KIT TREANDA ( MG VIAL, 100 MG VIAL) VALSTAR 0 MG/ML VIAL VANTAS 0 MG KIT VECTIBIX (100 MG/ ML VIAL, 00 MG/0 ML VIAL) VELCADE. MG VIAL VENCLEXTA (10 MG, 0 MG ) VENCLEXTA 100 MG VENCLEXTA STARTING PACK VIDAZA 100 MG VIAL vinblastine sulfate (1 mg/ml vial, 10 mg vial) B/D PA PA; LA PA; LA PA; LA TRELSTAR (.7 MG SYRINGE, 11. MG SYRINGE,. MG VIAL,. MG SYRINGE) tretinoin 10 mg capsule TREXALL ( MG, 7. MG, 10 MG, 1 MG ) B/D PA VINCASAR PFS (1 MG/ML VIAL, MG/ ML VIAL) vincristine sulfate (1 mg/ml vial, mg/ ml vial) vinorelbine tartrate (10 mg/ml vial, 0 mg/ ml vial) VOTRIENT 00 MG

36 Name Name XALKORI (00 MG CAPSULE, 0 MG CAPSULE) PA ANTICONVULSANTS ACTIVE-PAC KIT XTANDI 0 MG CAPSULE YERVOY (0 MG/10 ML VIAL, 00 MG/0 ML VIAL) YONDELIS 1 MG VIAL ZALTRAP (100 MG/ ML VIAL, 00 MG/8 ML VIAL) ZANOSAR 1 GM POWDER VIAL ZELBORAF 0 MG ZOLADEX (.6 MG IMPLANT SYRN, 10.8 MG IMPLANT SYRN) ZOLINZA 100 MG CAPSULE ZORTRESS (0. MG, 0.7 MG ) PA B/D PA APTIOM (00 MG, 00 MG ) APTIOM (600 MG, 800 MG ) BANZEL (0 MG/ML SUSPENSION, 00 MG ) BANZEL 00 MG carbamazepine (100 mg tab er 1h, 100 mg cpmp 1hr, 100 mg/ml oral susp, 100 mg tab chew, 00 mg tablet, 00 mg tab er 1h, 00 mg cpmp 1hr, 00 mg cpmp 1hr, 00 mg tab er 1h) CARBATROL (ER 100 MG CAPSULE, ER 00 MG CAPSULE, ER 00 MG CAPSULE) QL (0 PER 0); STEP QL (60 PER 0); STEP STEP STEP STEP ZORTRESS 0. MG B/D PA CELONTIN 00 MG KAPSEAL STEP ZYDELIG (100 MG, 10 MG ) CEREBYX (100 MG PE/ ML VIAL, 00 MG PE/10 ML VIAL) STEP ZYKADIA 10 MG CAPSULE ZYTIGA 0 MG STEP AUTONOMIC / CNS DRUGS, NEUROLOGY / PSYCH clonazepam (0.1 mg tab rapdis, 0. mg tab rapdis, 0. mg tablet, 0. mg tab rapdis, 1 mg tab rapdis, 1 mg tablet, mg tab rapdis, mg tablet) PA 6

37 Name Name DEPACON 00 MG VIAL DEPAKENE (0 MG CAPSULE, 0 MG/ ML SOLUTION) DEPAKOTE (DR 1 MG, DR 0 MG, DR 00 MG ) DEPAKOTE 1 MG SPRINKLE CAP DEPAKOTE ER (ER 0 MG, ER 00 MG ) STEP STEP STEP STEP STEP EQUETRO (100 MG CAPSULE, 00 MG CAPSULE, 00 MG CAPSULE) ethosuximide (0 mg/ml solution, 0 mg capsule) felbamate (00 mg tablet, 600 mg tablet, 600 mg/ml oral susp) FELBATOL (00 MG, 600 MG, 600 MG/ ML SUSP) STEP STEP DIASTAT. MG PEDI SYSTEM DIASTAT ACUDIAL ( MG KT, MG) diazepam (. mg kit, mg kit, kit) DILANTIN (0 MG CAPSULE, 0 MG INFATAB, 100 MG CAPSULE) DILANTIN 1 MG/ ML SUSP divalproex sodium (1 mg tablet dr, 1 mg cap sprink, 0 mg tab er h, 0 mg tablet dr, 00 mg tablet dr, 00 mg tab er h) EPITOL 00 MG PA PA PA STEP STEP fosphenytoin sodium (100mg pe/ vial, 00 pe/10 vial) FYCOMPA ( MG, MG, 6 MG, 8 MG, 10 MG, 1 MG ) gabapentin (100 mg capsule, 0 mg/ml solution, 00 mg/6ml solution, 00 mg capsule, 00 mg capsule, 600 mg tablet, 800 mg tablet) GABITRIL ( MG, MG, 1 MG, 16 MG ) GRALISE (0-DAY STARTER PACK, ER 00 MG, ER 600 MG ) STEP STEP 7

38 Name Name KEPPRA (100 MG/ML ORAL SOLN, 0 MG, 00 MG/ ML VIAL, 00 MG, 70 MG, 1,000 MG ) STEP LAMICTAL XR ( MG, 0 MG, 100 MG, 00 MG, 0 MG, 00 MG ) STEP KEPPRA XR (00 MG, 70 MG ) KLONOPIN (0. MG, 1 MG, MG ) LAMICTAL ( MG DISPER, MG DISPER, MG, 100 MG, 10 MG, 00 MG ) LAMICTAL ODT (ODT MG, ODT 0 MG, ODT 100 MG, ODT 00 MG ) LAMICTAL ODT START KIT (BLUE) LAMICTAL ODT START KIT (GREEN) STEP PA STEP STEP STEP STEP LAMICTAL XR START KIT (BLUE) LAMICTAL XR START KIT (GREEN) LAMICTAL XR START KIT (ORANGE) lamotrigine ( mg tb chw dsp, tb rd dspk, mg () tab ds pk, (1)-0 tb rd dspk, mg tablet, mg tab er, mg tab rapdis, mg tb chw dsp, 0 mg tab rapdis, 0 mg tab er, 0()-100 tb rd dspk, 100 mg tab er, 100 mg tab rapdis, 100 mg tablet, 10 mg tablet, 00 mg tablet, 00 mg tab er, 00 mg tab rapdis, 0 mg tab er, 00 mg tab er ) STEP STEP STEP LAMICTAL ODT START KT (ORANGE) LAMICTAL TAB START KIT (BLUE) LAMICTAL TAB START KIT (GREEN) STEP STEP STEP levetiracetam (100 mg/ml solution, 0 mg tablet, 00 mg/ml solution, 00 mg tab er h, 00 mg tablet, 00 mg/ml vial, 70 mg tablet, 70 mg tab er h, 1000 mg tablet) LAMICTAL TB START KIT (ORANGE) STEP 8

39 Name Name levetiracetam in sodium chloride, isoosmotic (00mg/0.1l piggyback, 1000mg/100 piggyback, 100mg/100 piggyback) phenobarbital (1 mg tablet, 16. mg tablet, 0 mg/ ml elixir, 0 mg tablet,. mg tablet, 60 mg tablet, 6.8 mg tablet, 97.mg tablet, 100 mg tablet) LYRICA ( MG CAPSULE, 0 MG CAPSULE, 7 MG CAPSULE, 100 MG CAPSULE, 10 MG CAPSULE, 00 MG CAPSULE, MG CAPSULE, 00 MG CAPSULE) LYRICA 0 MG/ML ORAL SOLUTION STEP phenobarbital sodium (6 mg/ml vial, 10mg/ml vial) PHENYTEK (00 MG CAPSULE, 00 MG CAPSULE) phenytoin (0 mg tab chew, 100 mg/ml oral susp, 1 mg/ml oral susp) STEP MYSOLINE (0 MG, 0 MG ) NEURONTIN (100 MG CAPSULE, 0 MG/ ML SOLN, 00 MG CAPSULE, 00 MG CAPSULE, 600 MG, 800 MG ) ONFI (. MG/ML SUSPENSION, 10 MG, 0 MG ) STEP STEP PA phenytoin sodium (0 mg/ml syringe, 0 mg/ml vial, 0 mg/ml ampul) phenytoin sodium extended (100 mg capsule, 00 mg capsule, 00 mg capsule) POTIGA (0 MG, 00 MG, 00 MG, 00 MG ) STEP oxcarbazepine (10 mg tablet, 00 mg tablet, 00 mg/ml oral susp, 600 mg tablet) OXTELLAR XR (10 MG, 00 MG, 600 MG ) PEGANONE 0 MG STEP primidone (0 mg tablet, 0 mg tablet) QUDEXY XR ( MG CAPSULE, 0 MG CAPSULE, 100 MG CAPSULE, 00 MG CAPSULE) QUDEXY XR 10 MG CAPSULE PA PA 9

40 Name ROWEEPRA 00 MG SABRIL (00 MG, 00 MG POWDER PACKET) SMARTRX GABAKIT SPRITAM (0 MG, 00 MG, 70 MG, 1,000 MG ) TEGRETOL (100 MG/ ML SUSP, 00 MG ) TEGRETOL XR (00 MG, 00 MG ) LA STEP STEP STEP Name TRILEPTAL (10 MG, 00 MG/ ML SUSP, 00 MG, 600 MG ) TROKENDI XR ( MG CAPSULE, 0 MG CAPSULE, 100 MG CAPSULE, 00 MG CAPSULE) valproic acid (as sodium salt) (valproate sodium) (0 mg/ml solution, 00 mg/ml vial, 00mg/10ml solution) valproic acid 0 mg capsule STEP PA TEGRETOL XR 100 MG tiagabine hcl ( mg tablet, mg tablet) TOPAMAX (1 MG SPRINKLE CAP, MG, MG SPRINKLE CAP, 0 MG, 100 MG, 00 MG ) topiramate (1 mg cap sprink, mg cap sprink, mg tablet, 0 mg tablet, 100 mg tablet, 00 mg tablet) STEP PA PA VIMPAT (10 MG/ML SOLUTION, 0 MG, 100 MG, 10 MG, 00 MG/0 ML VIAL, 00 MG ) ZARONTIN (0 MG CAPSULE, 0 MG/ ML SOLUTION) ZONEGRAN ( MG CAPSULE, 100 MG CAPSULE) zonisamide ( mg capsule, 0 mg capsule, 100 mg capsule) STEP STEP PA PA topiramate ( mg cap spr, 0 mg cap spr, 100 mg cap spr, 10 mg cap spr, 00 mg cap spr ) PA ANTIPARKINSONISM AGENTS APOKYN 0 MG/ ML CARTRIDGE AZILECT (0. MG, 1 MG ) LA 0