MVP HEALTH CARE 2015 COMPREHENSIVE MEDICARE PART D FORMULARY

Transcription

1 MVP HEALTH CARE 2015 COMPREHENSIVE MEDICARE PART D FORMULARY (List of Covered Drugs) PLEASE READ: This document contains information about the drugs we cover in this plan. This Formulary was updated in August For more recent information or other questions, please contact MVP s Medicare Customer Care Center Monday Friday, 8 am 8 pm Eastern Time at: From Oct. 1 Feb. 14 call seven days a week from 8 am 8 pm. Or visit for the most up-to-date Formulary listing. TTY: 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 and to see if they have changed tiers since last year. When this drug list (Formulary) refers to we, us, or our it means MVP. When it refers to plan or our plan it means GoldValue HMO-POS, Preferred Gold HMO-POS, Gold PPO, BasiCare PPO, GoldAnywhere PPO, USA Care PPO or MVP RxCare PDP. This document includes a list of the drugs (Formulary) for our plans which is current as of August 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 access your prescription drug benefit. Benefits, formulary, pharmacy network, and/or copayments/coinsurance may change on January 1, 2016, and from time to time during the year. Y0051_2315 Approved 08/13/2014 Formulary ID15217, Version 8

2 PLEASE NOTE: Some of the abbreviations listed here have changed. Please review this list before looking up your drug. Abbreviations and Definitions of Formulary Terms You may find one or more of the following abbreviations in the Formulary under the Requirements/Limits column next to a drug name. Not Available at Mail Order (NM) Certain drugs are not allowed through the mail order pharmacy program. These prescriptions can only be filled at a retail pharmacy. Prior Authorization (PA) MVP Health Care requires you or your doctor to get prior authorization for certain drugs. This means that you will need to get approval from MVP before you fill your prescriptions. If you don t get approval first, MVP may not cover the drug. Quantity Limits (QL) For certain drugs, MVP Health Care limits the amount of the drug that we will cover. For example, MVP provides one tablet per day for ZETIA. This limit may be applied to a standard one-month or three-month supply. Step Therapy (ST) In some cases, MVP Health Care requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, MVP may not cover Drug B unless you try Drug A first. If Drug A does not work for you, MVP will then cover Drug B. Dispensing Limits (DL) Certain drugs are limited to a 30-day supply through a retail pharmacy and are not available through the mail order program. Limited Access (LA) Some drugs are available only through a designated Specialty Pharmacy because of manufacturer limited distribution. Part B versus Part D drug coverage (B/D) Some drugs could be covered under the Part B or Part D benefit, depending on certain criteria. This means that you or your doctor will need to submit a request to MVP Health Care so we can determine, based on Medicare guidelines, if your drug will be covered as Part B or Part D. Your cost sharing will be based on this determination. MVP RxCare PDP Members: because your MVP plan is Part D prescription drug coverage only, any drugs deemed Part B will not be covered. You will need to seek coverage from Original Medicare for Part B drugs. NOTE: Tier 1 and Tier 6 drugs are covered at the same copay ($0 or no more than $3) through all benefit stages all year long the Initial Coverage stage, the Coverage Gap stage, and the Catastrophic Coverage stage.

3 ATTENTION! Not all MVP Medicare Advantage plans are offered in all counties throughout New York and Vermont. Prescription drug copays may also vary by county. Please refer to the chart on the following pages that applies to you: Chart #1: If you live in Erie, Genesee, Livingston, Monroe, Niagara, Ontario, Orleans, Seneca, Steuben, Wayne, Wyoming, or Yates counties in New York. Chart #2: If you live in Albany, Broome, Cayuga, Chenango, Columbia, Cortland, Dutchess, Essex, Fulton, Greene, Montgomery, Orange, Putnam, Rensselaer, Saratoga, Schenectady, Schoharie, Tioga, Tompkins, Ulster, Warren, Washington, or Westchester counties in New York. Chart #3: If you live in Herkimer, Madison, Oneida, Onondaga, Oswego, or Otsego counties in New York; or Addison, Bennington, Chittenden, Lamoille, Rutland, or Washington counties in Vermont. ATTENTION! The costs in the charts that follow may be different for you if: 1. Your coverage is through an employer group. 2. You qualify for low income subsidy (Extra Help). If your coverage is through your former employer, or if you qualify for low income subsidy, the following information may not apply. Please check with your former employer, or read your Evidence of Coverage (your contract) and other plan materials for details. a

4 Chart #1 Refer to the list of counties at the beginning of this booklet to make sure you are looking at the right chart for the prescription drug copays and plans available to you based on where you live. The costs in the chart below show what you will pay for prescription drugs. Your costs may be different if your coverage is through a former employer or if you qualify for low income subsidy (Extra Help). Please read your Evidence of Coverage (your contract) and other plan materials for details. Coverage Level Stage 1: Yearly Deductible Stage Tier (Drug Cost-Sharing Level) GoldValue HMO-POS with Part D Because there is no deductible for the plan, this payment stage does not apply to you. Retail Pharmacy 30-day Supply Mail Order Pharmacy 90-day Supply Stage 2: Initial Coverage Stage During this stage, you pay your Tier copay or coinsurance for covered prescription drugs. Tier 1 Preferred Generic Drugs $0 $0 Tier 2 Non-Preferred Generic Drugs $10 $20 Tier 3 Preferred Brand Drugs $35 $70 Tier 4 Non-Preferred Brand Drugs $90 $180 Tier 5 Specialty Drugs 33% 33% Tier 6 Select Vaccines $0 $0 Stage 3: Coverage Gap Stage Once your total drug costs* reach $2,960, what you pay for your prescription drugs changes. Stage 4: Catastrophic Coverage Stage Once your out-of-pocket costs** (your payments) reach $4,700 the plan pays most of the cost for your covered drugs. Generic Drugs 65% Brand Name Drugs 45% Tier 1 Preferred Generic Drugs $0 Tier 6 Select Vaccines $0 Generic Drugs The greater of 5% or $2.65 Brand Name Drugs The greater of 5% or $6.60 Tier 1 Preferred Generic Drugs $0 Tier 6 Select Vaccines $0 *Total drug costs = your out-of-pocket costs for covered drugs (what you pay) plus what the plan pays for your covered drugs. **Out-of-pocket costs = your out-of-pocket costs for covered drugs (what you pay only - not what the plan pays). b

5 Chart #1, continued If you receive more than a 30-day supply at a retail pharmacy, you will pay more than the amounts listed above. Some drugs are limited to only a 30-day supply. If your doctor prescribes less than a full month s supply of a drug, you will only pay for the amount of the drug you receive. Some drugs are available by mail order you can receive a 90-day supply of your prescription for two copays (for example, if your Tier 2 copay is $10, you will receive a 90-day supply by mail for $20). Certain drugs are not allowed through the mail order pharmacy program. Gold PPO with Part D BasiCare PPO with Part D Because there is no deductible for the plan, this payment stage does not apply to you. $320 deductible. You will pay 100% of the cost of your drugs until you spend $320. Retail Pharmacy 30-day Supply Mail Order Pharmacy 90-day Supply $0 $0 25% $10 $20 25% $35 $70 25% $90 $180 25% 33% 33% 25% $0 $0 25% 65% 65% 45% 45% $0 $0 Generic Drugs: 65% Brand Name Drugs: 45% The greater of 5% or $2.65 The greater of 5% or $2.65 The greater of 5% or $6.60 The greater of 5% or $6.60 $0 Generic Drugs: The greater of 5% or $2.65 Brand Name Drugs: The greater of 5% or $6.60 $0 c

6 Chart #2 Refer to the list of counties at the beginning of this booklet to make sure you are looking at the right chart for the prescription drug copays and plans available to you based on where you live. The costs in the chart below show what you will pay for prescription drugs. Your costs may be different if your coverage is through a former employer or if you qualify for low income subsidy (Extra Help). Please read your Evidence of Coverage (your contract) and other plan materials for details. Gold PPO with Part D and BasiCare PPO with Part D are not available in Columbia, Dutchess, Greene, Orange, Putnam, Ulster and Westchester counties. Coverage Level Stage 1: Yearly Deductible Stage Tier (Drug Cost-Sharing Level) GoldValue HMO-POS with Part D Because there is no deductible for the plan, this payment stage does not apply to you. Retail Pharmacy 30-day Supply Mail Order Pharmacy 90-day Supply Stage 2: Initial Coverage Stage During this stage, you pay your Tier copay or coinsurance for covered prescription drugs. Tier 1 Preferred Generic Drugs $3 $6 Tier 2 Non-Preferred Generic Drugs $15 $30 Tier 3 Preferred Brand Drugs $45 $90 Tier 4 Non-Preferred Brand Drugs $95 $190 Tier 5 Specialty Drugs 33% 33% Stage 3: Coverage Gap Stage Once your total drug costs* reach $2,960, what you pay for your prescription drugs changes. Stage 4: Catastrophic Coverage Stage Once your out-of-pocket costs** (your payments) reach $4,700 the plan pays most of the cost for your covered drugs. Tier 6 Select Vaccines $0 $0 Generic Drugs 65% Brand Name Drugs 45% Tier 1 Preferred Generic Drugs $3 Tier 6 Select Vaccines $0 Generic Drugs The greater of 5% or $2.65 Brand Name Drugs The greater of 5% or $6.60 Tier 1 Preferred Generic Drugs $3 Tier 6 Select Vaccines $0 *Total drug costs = your out-of-pocket costs for covered drugs (what you pay) plus what the plan pays for your covered drugs. d

7 Chart #2, continued If you receive more than a 30-day supply at a retail pharmacy, you will pay more than the amounts listed above. Some drugs are limited to only a 30-day supply. If your doctor prescribes less than a full month s supply of a drug, you will only pay for the amount of the drug you receive. Some drugs are available by mail order you can receive a 90-day supply of your prescription for two copays (for example, if your Tier 2 copay is $10, you will receive a 90-day supply by mail for $20). Certain drugs are not allowed through the mail order pharmacy program. Gold PPO with Part D and BasiCare PPO with Part D are not available in Columbia, Dutchess, Greene, Orange, Putnam, Ulster and Westchester counties. Preferred Gold HMO-POS with Part D Because there is no deductible for the plan, this payment stage does not apply to you. Gold PPO with Part D Because there is no deductible for the plan, this payment stage does not apply to you. BasiCare PPO with Part D $320 deductible. You will pay 100% of the cost of your drugs until you spend $320. Retail Pharmacy 30-day Supply Mail Order Pharmacy 90-day Supply Retail Pharmacy 30-day Supply Mail Order Pharmacy 90-day Supply $0 $0 $0 $0 25% $10 $20 $10 $20 25% $35 $70 $35 $70 25% $90 $180 $90 $180 25% 33% 33% 33% 33% 25% $0 $0 $0 $0 25% 65% 65% 65% 45% 45% 45% $0 $0 $0 $0 Generic Drugs: 65% Brand Name Drugs: 45% The greater of 5% or $2.65 The greater of 5% or $2.65 The greater of 5% or $2.65 The greater of 5% or $6.60 The greater of 5% or $2.65 The greater of 5% or $6.60 $0 $0 $0 $0 Generic Drugs: The greater of 5% or $2.65 Brand Name Drugs: The greater of 5% or $6.60 **Out-of-pocket costs = your out-of-pocket costs for covered drugs (what you pay only - not what the plan pays). e

8 Chart #3 Refer to the list of counties at the beginning of this booklet to make sure you are looking at the right chart for the prescription drug copays and plans available to you based on where you live. The costs in the chart below show what you will pay for prescription drugs. Your costs may be different if your coverage is through a former employer or if you qualify for low income subsidy (Extra Help). Please read your Evidence of Coverage (your contract) and other plan materials for details. Coverage Level Stage 1: Yearly Deductible Stage Tier (Drug Cost-Sharing Level) GoldValue HMO-POS with Part D Because there is no deductible for the plan, this payment stage does not apply to you. Retail Pharmacy 30-day Supply Mail Order Pharmacy 90-day Supply Stage 2: Initial Coverage Stage During this stage, you pay your Tier copay or coinsurance for covered prescription drugs. Tier 1 Preferred Generic Drugs $3 $6 Tier 2 Non-Preferred Generic Drugs $15 $30 Tier 3 Preferred Brand Drugs $45 $90 Tier 4 Non-Preferred Brand Drugs $95 $190 Tier 5 Specialty Drugs 33% 33% Tier 6 Select Vaccines $0 $0 Stage 3: Coverage Gap Stage Once your total drug costs* reach $2,960, what you pay for your prescription drugs changes. Stage 4: Catastrophic Coverage Stage Once your out-of-pocket costs** (your payments) reach $4,700 the plan pays most of the cost for your covered drugs. Generic Drugs 65% Brand Name Drugs 45% Tier 1 Preferred Generic Drugs $3 Tier 6 Select Vaccines $0 Generic Drugs The greater of 5% or $2.65 Brand Name Drugs The greater of 5% or $6.60 Tier 1 Preferred Generic Drugs $3 Tier 6 Select Vaccines $0 *Total drug costs = your out-of-pocket costs for covered drugs (what you pay) plus what the plan pays for your covered drugs. **Out-of-pocket costs = your out-of-pocket costs for covered drugs (what you pay only - not what the plan pays). f

9 Chart #3, continued If you receive more than a 30-day supply at a retail pharmacy, you will pay more than the amounts listed above. Some drugs are limited to only a 30-day supply. If your doctor prescribes less than a full month s supply of a drug, you will only pay for the amount of the drug you receive. Some drugs are available by mail order you can receive a 90-day supply of your prescription for two copays (for example, if your Tier 2 copay is $10, you will receive a 90-day supply by mail for $20). Certain drugs are not allowed through the mail order pharmacy program. Gold PPO with Part D BasiCare PPO with Part D Because there is no deductible for the plan, this payment stage does not apply to you. $320 deductible. You will pay 100% of the cost of your drugs until you spend $320. Retail Pharmacy 30-day Supply Mail Order Pharmacy 90-day Supply $0 $0 25% $10 $20 25% $35 $70 25% $90 $180 25% 33% 33% 25% $0 $0 25% 65% 65% 45% 45% $0 $0 Generic Drugs: 65% Brand Name Drugs: 45% The greater of 5% or $2.65 The greater of 5% or $2.65 The greater of 5% or $6.60 The greater of 5% or $6.60 $0 Generic Drugs: The greater of 5% or $2.65 Brand Name Drugs: The greater of 5% or $6.60 $0 g

10 Table of Contents What is the MVP Health Care Comprehensive Medicare Part D Formulary?... i Can the Formulary change?...i MVP Health Care s Medicare Part D Formulary and Tiers...i How do I use the Formulary?...j What are generic drugs?... What programs are in place to promote cost savings and safety?... What if my drug is not on the Formulary?... How do I request an exception to MVP s Medicare Part D Formulary?...l What do I do before I talk to my doctor about changing my drugs or requesting an exception?... l For more information...m MVP s list of covered drugs by category...1 Alphabetical index of covered drugs k k k

11 What is the MVP Health Care Comprehensive Medicare Part D Formulary? A Formulary is a list of Medicare covered drugs selected by MVP Health Care 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. MVP Health Care will generally cover the drugs listed in our Formulary as long as the drug is medically necessary, the prescription is filled at an MVP Health Care network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage (your contract). Can the Formulary change? Generally, if you are taking a drug on our 2015 Formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 2015 coverage year except when a new, less expensive generic drug becomes available or when information about concerns with 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 amount 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 need to make a change to ensure your safety. If we remove drugs from our Formulary, move a drug to a higher cost-sharing tier, or add prior authorization, quantity limits and/or step therapy restrictions on a drug, 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 Drug Administration deems a drug on our Formulary to be unsafe or a 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 August To get updated information about the drugs covered by MVP Health Care, please visit our website at www. mvphealthcare.com or contact us. Our contact information appears on the front and back cover pages. In the event of a change or changes to the Formulary during the year, the changes also will be posted on the MVP website: (This updated version of the Formulary will be posted on the MVP website on a monthly basis as needed.) To view the list of changes, start at our home page and: Click on Medicare Members. Click on the county you live in or the Employer Group Retirees Part D Coverage link at the top of the page. Under the Part D (Prescription Drug Coverage) heading click on Covered Formulary Drug List and Updates at the top of the list. Click on 2015 Formulary Changes. Or you may request an errata sheet (a copy of the 2015 Formulary changes) by calling MVP s Medicare Customer Care Center at the phone numbers on the back of your Member ID card. MVP Health Care s Medicare Part D Formulary and Tiers The Comprehensive Formulary that begins on page 1 provides coverage information about most of the drugs covered by MVP Health Care. To look for your drug, turn to the Index that begins on page 52. The first column of the Formulary chart lists the drug name. Brand-name drugs are capitalized (e.g., ZETIA) and generic drugs are listed in lower-case italics (e.g., allopurinol). The information in the Requirements/Limits column tells you if MVP Health Care has any special requirements for coverage of your drug. See inside front cover for abbreviations and definitions of Formulary terms. The 2015 Formulary is divided into six tiers (or cost groups) that correspond to the drug copays in your Evidence of Coverage (your contract) or prescription drug Rider. Copays may vary if you are in the Medicare Part D coverage gap, if you are in catastrophic coverage or if you have qualified for Extra Help. Refer to your Evidence of Coverage for more details about the different levels of coverage. i

12 Note for members with BasiCare PPO or the employer group Basic Prescription Drug Coverage Rider: the drug tiers in this Formulary do not apply to you. You will pay 25% for each medication you receive in the initial coverage phase of your benefit (after you meet your deductible) regardless of the tier on the Formulary. Here are the six tiers for 2015: Tier 1 Preferred Generic Drugs - $0 cost* *NOTE: GoldValue with Part D members who live in the counties listed for charts #2 and #3 at the front of this booklet pay a $3 copay for Tier 1 drugs. Tier 1 includes select drugs for diabetes, blood pressure control, glaucoma, gout, bone health, heartburn and ulcers, mental health conditions, pain management, cholesterol control, and thyroid conditions. Think about using a Tier 1 generic drug if you and your doctor decide it is right for you. Tier 2 Non-Preferred Generic Drugs Tier 2 includes non-preferred generic drugs. (Note: Not all generic drugs will be a Tier 2 drug.) Generic drugs have the same active ingredients, strength, and effectiveness as the brand-name versions, but generally at a much lower cost. Tier 3 - Preferred Brand Name Drugs Tier 3 includes preferred brand drugs that have the lowest cost sharing for brand name drugs. If you and your doctor decide that a brand name drug is right for you, try using a Tier 3 brand name drug to save money. Tier 4 - Non-Preferred Brand Drugs Tier 4 non-preferred brand name and non-preferred generic drugs are available at a higher cost. In addition, Part D drugs excluded from our Formulary must go through an exception process in order for MVP to cover them. If they are approved, they will be covered in Tier 4. Tier 5 Specialty Drugs Tier 5 includes drugs (brand name and generic) that cost $600 or more for a 30-day supply. Most drugs in this tier are restricted to a 30-day supply at retail, and are excluded from the mail order program and tier exception process. j Tier 6 Vaccines $0 cost The drugs in Tier 6 are provided at no cost to you! Tier 6 includes the most common Part D vaccines: the shingles vaccine (Zostavax), tetanus vaccines, and combination tetanus / diphtheria / pertussis vaccines (such as Tenivac, Adacel and Boostrix). Some of these vaccines can be given by a pharmacist. You will pay $0 if you receive your vaccination at the pharmacy. If you get your vaccine at a doctor s office, ask the doctor to process your vaccine claim through a service called TransactRx. If your doctor does not process your claim using TransactRx, you will have to pay out-of-pocket for your vaccine and submit the claim to CVS/caremark for reimbursement. MVP will reimburse vaccine claims up to MVP s allowed amount. If your doctor chooses to charge more than the allowed amount, you are responsible for paying the difference. Not all providers use the TransactRx service. Check with your doctor before getting your vaccine. NOTE: Tier 1 and Tier 6 drugs are available at $0 or no more than $3 through all benefit stages all year long in the Initial Coverage Stage, the Coverage Gap Stage, and the Catastrophic Coverage Stage. Refer to the drug copay charts at the front of this booklet to find the correct payment for your plan. How do I use the Formulary? There are two ways to find your covered drug within the Formulary: By Alphabetical Listing Look for your covered drug in the Index that begins on page 52. The Index provides an alphabetical list of all of the drugs included in this document. Both brand name drugs and generic drugs are listed in the Index. 1. Look in the Index and find your drug. 2. Next to your drug, you will see the page number where you can find coverage information. 3. Turn to the page listed in the Index and find the name of your drug in the column of the list. By Medical Condition The drugs in this Formulary are grouped into categories depending on the type of medical condition that they are used to treat. For example, drugs used to treat high blood pressure are listed under the category, Ace Inhibitors. If you know the category of what your drug is used for, look in the list that begins on page 1.

13 What are generic drugs? MVP Health Care 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. MVP Health Care covers select generic drugs for $0 or $3* through all benefit stages all year long in the Initial Coverage stage, the Coverage Gap stage, and the Catastrophic Coverage stage. Tier 1 includes select drugs for diabetes, blood pressure control, glaucoma, gout, bone health, heartburn and ulcers, mental health conditions, pain management, cholesterol control, and thyroid conditions. *NOTE: GoldValue with Part D members who live in the counties listed in Charts #2 and #3 at the front of this booklet pay a $3 copay for Tier 1 drugs. BasiCare PPO members and employer group members with the Basic Prescription Drug Coverage Rider pay 25% for all drugs after you meet your deductible. Refer to your Evidence of Coverage (your contract) and plan Riders for more information. What programs are in place to promote cost savings and safety? For safety reasons and/or cost savings, some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include: Prior Authorization: MVP Health Care requires you or your doctor to get prior authorization for certain drugs. For example, some compound prescriptions require Prior Authorization. This means that you will need to get approval from MVP before you fill your prescriptions. If you don t get approval first, MVP may not cover the drug. Quantity Limits: For certain drugs, MVP Health Care limits the amount of the drug that we will cover. For example, MVP provides one tablet per day for ZETIA. This limit may be applied to a standard one-month or three-month supply. Step Therapy: In some cases, MVP Health Care requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, MVP may not cover Drug B unless you try Drug A first. If Drug A does not work for you, MVP will then cover Drug B. You can find out if your drug has any additional requirements or limits by looking in the Requirements/ Limits column of the Formulary that begins on page 1. You also can get more information about the restrictions applied to specific covered drugs by visiting our website at We have posted online 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 MVP Health Care to make an exception to these restrictions or limits. See the section, How do I request an exception to the MVP Health Care Formulary? on page L for information about how to request an exception. What if my drug is not on the Formulary? To find out if your drug is covered but is not listed in this Formulary (drug list), you should first contact MVP s Customer Care Center and ask if your drug is covered. If you learn that MVP Health Care does not cover your drug, you have two options: You can ask MVP s Medicare Customer Care Center for a list of similar drugs that are covered by MVP Health Care. When you receive the list, show it to your doctor and ask him or her to prescribe a similar drug that is covered by MVP. You can ask MVP Health Care to make an exception and cover your drug. On this page is information about how to request an exception. Your drug may be available as a generic. Many popular brand name drugs have recently become available as generics. If you don t see your brand name medication on the formulary, a generic version may be available. If you have questions about the coverage of your brand name drug, please call MVP s Medicare Customer Care Center at the phone number on the back of your member ID card. Your drug may be a Part B drug, which means that the drug is not covered under your Medicare Part D pharmacy benefit, but under your medical benefit. If it is a Part B drug, you may be responsible to pay a coinsurance (a percentage). These drugs must still be obtained through an MVP network pharmacy. The following are examples of Part B drugs and supplies: k

14 Temodar (temozolomide) Xeloda (capecitabine) Vepesid (etoposide) Inhalation spacers Diabetic testing supplies like lancets, test strips* Insulin pump supplies *You pay a 10% coinsurance for OneTouch, FreeStyle and Precision test strips. You pay a 20% coinsurance for all other test strips. MVP RxCare PDP Members: Because your MVP plan is Part D prescription drug coverage only, any drugs deemed Part B will not be covered. You will need to seek coverage from Original Medicare for Part B drugs. How do I request an exception to MVP s Medicare Part D Formulary? You can ask MVP Health Care to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make. Formulary Exception: You can ask us to cover certain drugs even if they are not on our Formulary. If approved, these drugs will be covered at a Tier 4 copay and you would not be able to ask us to provide these drugs at a lower cost-sharing level. Generally, MVP Health Care will only approve your request for an exception if the alternative drugs included on the plan s Formulary, the lower costsharing drug or additional utilization restrictions, would not be as effective in treating your condition and/or would cause you to have negative 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 doctor supporting your request. Generally, we must make our decision within 72 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 72 hours for a decision. If your request to expedite is granted, we must give you a decision no later than 24 hours after we get a supporting statement from your doctor or other prescriber. Please note that MVP can not approve a formulary exception request for a Medicare excluded drug. If you or your doctor believes it meets the definition of a covered Part D drug, you may request a coverage determination. Examples of Medicare excluded drugs include drugs used for weight loss, cough and colds, and erectile dysfunction. Also excluded are drugs not approved by the Food and Drug Administration and most vitamins. Tier Exception: You can ask us to cover a Formulary drug at a lower cost-sharing level. If approved, this would lower the amount you must pay for your drug. NOTE: You may not ask us to cover a Tier 5 (Specialty Tier) Formulary drug at a lower cost-sharing level. NOTE: Because BasiCare PPO members and employer group members with the Basic Prescription Drug Coverage Rider pay 25% for all drugs, Tier Exceptions do not apply. Quantity Limit Exception: You can ask us to waive coverage restrictions or limits on your drug. For example, for certain drugs, MVP Health Care 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. What do I do before I 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 that you are a member of our plan. l

15 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 30-day transition supply (unless you have a prescription written for fewer days) when you go to a network pharmacy. After your first 30-day supply, we will not pay for these drugs even if you have been a member of the plan less than 90 days unless your doctor submits a request for your drug and it is approved by the plan. 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 a 93-day transition supply, consistent with the 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 31-day emergency supply of that drug (unless you have a prescription for fewer days) while you pursue a Formulary exception. Members who are changing levels of care may be eligible for a transition supply of medication outside of their initial 90-day enrollment transition period. Level of care changes may include: entering or leaving a long-term care facility, discharge from hospital to home, and ending a skilled nursing facility stay and reverting to Part D Formulary coverage under your plan. For more information For more detailed information about your MVP Health Care Medicare Advantage prescription drug coverage, please review your Evidence of Coverage (your contract) and other plan materials. If you have questions about MVP Health Care, please contact us. Our contact information, along with the date we last updated the Formulary, appears on the front and back cover pages. Or, visit our website at for more information about Medicare Part D drug coverage. If you have general questions about Medicare prescription drug coverage, please call Medicare at MEDICARE ( ) 24 hours a day/7 days a week. TTY users should call Or, visit m

16 5-HT3 RECEPTOR ANTAGONISTS ALOXI INJ 0.25MG/5 4 PA; DL ANZEMET INJ 20MG/ML 4 PA; DL ANZEMET TAB 50MG 4 B/D, QL (14 tabs / 30 days); DL ANZEMET TAB 100MG 4 B/D, QL (7 tabs / 30 days); DL granisetron inj 0.1mg/ml, 1mg/ml 2 PA; DL granisetron tab 1mg 2 B/D, QL (30 tabs / 30 days); DL GRANISOL SOL 2MG/10ML 2 B/D, QL (150 ml / 30 days); DL ondansetron inj 4mg/2ml 2 PA; DL ondansetron sol 4mg/5ml 2 B/D, QL (450 ml / 30 days); DL ondansetron tab 4mg, 4mg odt, 8mg, 8mg odt 2 B/D, QL (45 tabs / 30 days); DL ondansetron tab 24mg 2 B/D, QL (7 tabs / 30 days); DL SANCUSO DIS 3.1MG 4 ACE INHIBITORS benazepril tab 5mg, 10mg, 20mg, 40 mg 1 captopril tab 12.5mg, 25mg, 50 mg, 100mg 1 enalapril tab 2.5mg, 5mg, 10mb, 20mg 1 fosinopril tab 10mg, 20mg, 40mg 1 lisinopril tab 2.5mg, 5mg, 10mg, 20mg, 30mg, 40mg 1 moexipril tab 7.5mg, 15 mg 2 perindopril tab 2mg, 4mg, 8mg 2 quinapril tab 5mg, 10mg, 20mg, 40mg 1 ramipril cap 1.25mg, 2.5mg, 5mg 1 trandolapril tab 1mg, 2mg, 4mg 2 ACNE PRODUCTS ACANYA GEL % 4 adapalene 2 adapalene cre 0.1% 2 adapalene gel 0.1% 2 AKNE-MYCIN OIN 2% 4 amnesteem 2 AZELEX CRE 20% 4 claravis 2 clindamy/ben gel 1-5% 2 clindamycin aer 1% 2 clindamycin gel 1% 2 clindamycin lot 1% 2 clindamycin pad 1% 2 clindamycin sol 1% 2 DIFFERIN LOT 0.1% 4 ery 2 erythromycin gel 2% 2 erythromycin gel /benzoyl 2 erythromycin sol 2% 2 myorisan 2 sulfacetamid sus 10% 2 tretinoin cre 0.1%, 0.05%, 0.025% 2 PA; DL tretinoin gel 0.01%, 0.025% 2 PA; DL AGENTS FOR CHEMICAL DEPENDENCY acampro cal tab 333mg 2 CAMPRAL TAB 333MG 4 1

17 disulfiram tab 250mg, 500mg 2 AGENTS FOR EXTERNAL GENITAL AND PERIANAL WARTS VEREGEN OIN 15% 4 AGENTS FOR GAUCHER DISEASE CEREZYME INJ 400UNIT 5 NM, PA; DL VPRIV INJ 400UNIT 5 NM, PA; DL ZAVESCA CAP 100MG 5 NM, LA, PA; DL AGENTS FOR PHEOCHROMOCYTOMA DEMSER 5 DIBENZYLINE CAP 10MG 3 AGENTS FOR SICKLE CELL ANEMIA DROXIA CAP 200MG, 300MG, 400MG 3 ALKALINIZERS pot citrate tab 540mg, 1080mg 2 ALKYLATING AGENTS BICNU INJ 100MG 4 B/D; DL BUSULFEX INJ 6MG/ML 4 B/D; DL carboplatin inj 150/15ml 2 B/D; DL cisplatin inj 100mg 2 B/D; DL cyclophosphamide tab 25mg, 50mg 2 B/D; DL CYCLOPHOSPHAMIDE CAPS 3 B/D HEXALEN CAP 50MG 5 IFEX INJ 1GM 4 B/D; DL ifosfamide inj 1gm 2 B/D; DL LEUKERAN TAB 2MG 3 lomustine cap 10mg, 40mg, 100mg 4 melphalan inj 50mg 2 B/D; DL MUSTARGEN INJ 10MG 4 B/D; DL oxaliplatin inj 100mg 4 B/D; DL TREANDA INJ 100MG 5 B/D, NM; DL ZANOSAR INJ 1GM 4 B/D; DL ALPHA-2 RECEPTOR ANTAGONISTS (TETRACYCLICS) mirtazapine tab 7.5mg, 15mg, 30mg, 45mg 2 mirtazapine tab 15mg odt, 30mg odt, 45mg odt 2 ALPHA-BETA BLOCKERS carvedilol tab 3.125mg, 6.25mg, 12.5mg, 25mg 1 COREG CR CAP 10MG, 20MG, 40MG, 80MG 4 labetalol inj 5mg/ml 2 labetalol tab 100mg, 200mg, 300mg 2 ALPHA-GLUCOSIDASE INHIBITORS acarbose tab 25mg, 50mg, 100mg 2 GLYSET TAB 25MG, 50MG, 100MG 4 ALPHA-PROTEINASE INHIBITOR (HUMAN) ARALAST NP INJ 400MG 5 NM, LA, PA; DL GLASSIA INJ 5 NM, LA, PA; DL PROLASTIN-C INJ 1000MG 5 NM, LA, PA; DL ZEMAIRA INJ 1000MG 5 NM, LA, PA; DL ALS AGENTS riluzole tab 50mg 4 AMINOGLYCOSIDES 2

18 amikacin inj 500/2ml 2 GENTAMACIN/NACL INJ 0.9MG/ML, 1.4MG/ML 2 gentamacin/nacl inj 60mg, 80mg, 100mg 2 gentamicin inj 10mg/ml, 40mg/ml 2 neomycin tab 500mg 2 paromomycin cap 250mg 2 streptomycin inj 1gm 4 TOBI NEB 300/5ML 5 B/D, NM; DL TOBI PODHALR CAP 28MG 4 NM, PA; DL TOBRAMYCIN/NACL INJ 80/0.9 2 tobramycin inj 10mg/ml, 80mg/2ml 2 B/D; DL tobramycin neb 300/5ml 2 B/D, NM AMINOPENICILLINS amoxicillin cap 250mg, 500mg 2 amoxicillin chw 125mg, 250mg 2 amoxicillin sus 125/5ml, 200/5ml, 250/5ml, 400/ml 2 amoxicillin tab 500mg, 875mg 2 ampicillin cap 250mg, 500mg 2 ampicillin inj 1gm, 10gm, 125mg 2 ampicillin sus 125/5ml, 250/5ml 2 MOXATAG TAB 775MG 4 AMPA GLUTAMATE RECEPTOR ANTAGONISTS FYCOMPA TAB 2MG, 4MG, 6MG, 8MG, 10MG, 12MG 4 PA; DL AMPHETAMINES amphetamine cap 5mg er, 10mg er, 15mg er, 20mg er, 25mg er, 30mg 2 er amphetamine tab 5mg, 7.5mg, 10mg, 12.5mg, 15mg, 20mg, 30mg 2 dextroamphetamine cap 5mg er, 10mg er, 15mg er 4 dextroamphetamine tab 5mg, 10mg 2 methamphetamine tab 5mg 2 VYVANSE CAP 20MG, 30MG, 40MG, 50MG, 60MG, 70MG 4 ANALGESIC COMBINATIONS butalbital/apap/caf cap 2 QL (24 caps / 30 days) butalbital/apap/caf tab 2 QL (24 tabs / 30 days) butalbital/asa/caff cap 2 QL (24 caps / 30 days) butalbital/apap tab mg 2 QL (24 tabs / 30 days) ANAPHYLAXIS THERAPY AGENTS ADRENALIN INJ 1MG/ML 2 DL EPIPEN 2-PAK INJ 0.3MG 3 QL (1 / 30 days) EPIPEN-JR INJ 2-PAK 3 QL (1 / 30 days) ANDROGENS ANDRODERM DIS 2MG/24HR, 4MG/24HR 4 QL (30 patches / 30 days) ANDROGEL GEL 1%(50MG) 3 ANDROGEL GEL 1.62% 3 ANDROXY TAB 10MG 2 danazol cap 50mg, 100mg, 200mg 2 METHITEST TAB 10MG 4 oxandrolone TABS 2.5mg 2 QL (120 tabs / 30 days); DL oxandrolone TABS 10mg 4 DL testosterone cyp inj 100mg/ml, 200mg/ml 2 testosterone enan inj 200mg/ml 2 3

19 ANESTHETICS TOPICAL ORAL lidocaine sol 2% visc 2 ANGIOTENSIN II RECEPTOR ANTAGONISTS BENICAR TAB 5MG, 20MG, 40MG 4 candesartan tab 4mg, 8mg, 16mg, 32mg 2 DIOVAN TAB 40MG, 80MG, 160MG, 320MG 4 EDARBI TAB 40MG 4 EDARBI TAB 80MG 4 eprosartan mes tab 600mg 2 irbesartan tab 75mg, 150mg, 300mg 2 losartan pot tab 25mg, 50mg, 100mg 1 telmisartan tab 20mg, 40mg, 80mg 2 ANTI TB COMBINATIONS rifamate 4 RIFATER TAB 4 ANTI-CATAPLECTIC AGENTS XYREM SOL 500MG/ML 5 QL (540 ml / 30 days), LA, PA; DL ANTI-INFECTIVE AGENTS - MISC. AZACTAM/DEX INJ 1GM, 2GM 4 aztreonam inj 1gm 2 baci-im 2 BACITRACIN INJ 50000UNT 2 colistimethate inj 150mg 4 FLAGYL ER TAB 750MG 4 metronidazole/nacl inj 500mg 2 metronidazole cap 375mg 2 metronidazole tab 250mg, 500mg 2 NEBUPENT INH 300MG 4 B/D; DL PENTAM 300 INJ 300MG 4 DL PRIMSOL SOL 50MG/5ML 4 TEFLARO 4 tinidazole tab 250mg, 500mg 2 trimethoprim tab 100mg 2 vancomycin cap 125mg, 250mg 5 vancomycin inj 10gm, 500mg, 1000mg 2 XIFAXAN TAB 200MG 4 QL (9 tabs / 30 days), PA; DL XIFAXAN TAB 550MG 4 ANTI-INFECTIVE MISC. - COMBINATIONS smz-tmp inj /5 2 smz-tmp sus /5 2 smz-tmp tab mg 2 smz/tmp ds tab ANTI-INFECTIVES - THROAT clotrimazole tro 10mg 2 nystatin sus ANTI-INFLAMMATORY AGENTS cromolyn sod neb 20mg/2ml 2 B/D ANTI-INFLAMMATORY AGENTS - TOPICAL diclofenac sodium 1.5% (topical) 2 VOLTAREN GEL 1% 4 4

20 ANTI-TNF-ALPHA - MONOCLONAL ANTIBODIES HUMIRA KIT 20MG/0.4, 40MG/0.8 5 NM, PA; DL HUMIRA PEN KIT CROHNS 5 NM, PA; DL SIMPONI 5 NM, PA; DL SIMPONI ARIA SOL 50MG/4ML 5 NM, PA; DL SIMPONI INJ 50MG 5 NM, PA; DL ANTIADRENERGIC ANTIHYPERTENSIVES clonidine dis 0.1/24hr, 0.2/24hr, 0.3/24hr 2 clonidine tab 0.1mg, 0.2mg, 0.3mg 2 doxazosin tab 1mg, 2mg, 4mg, 8mg 2 methyldopa tab 250mg, 500mg 4 prazosin hcl cap 1mg, 2mg, 5mg 2 reserpine tab 0.1mg, 0.25mg 2 terazosin cap 1mg, 2mg, 5mg, 10mg 2 ANTIANGINALS-OTHER RANEXA TAB 500MG, 1000MG 4 ANTIANXIETY AGENTS - MISC. buspirone tab 5mg, 7.5mg, 10mg, 15mg, 30mg 1 ANTIARRHYTHMICS TYPE I-A disopyramide cap 100mg, 150mg 2 NORPACE CAP 100MG CR, 150MG CR 4 procainamide inj 100mg/ml 2 PROCAINAMIDE INJ 500MG/ML 2 QUINIDINE GL INJ 80MG/ML 2 quinidine gl tab 324mg cr 2 quinidine su tab 200mg, 300mg, 300mg er 2 ANTIARRHYTHMICS TYPE I-B mexiletine cap 150mg, 200mg, 250mg 2 ANTIARRHYTHMICS TYPE I-C flecainide tab 50mg, 100mg, 150mg 2 propafenone cap 225mg er, 325mg er, 425mg er 3 propafenone tab 150mg, 225mg, 300mg 2 ANTIARRHYTHMICS TYPE III amiodarone inj 50mg/ml 2 amiodarone tab 200mg, 400mg 2 MULTAQ TAB 400MG 4 pacerone 2 TIKOSYN CAP 125MCG, 250MCG, 500MCG 4 NM ANTIASTHMATIC - MONOCLONAL ANTIBODIES XOLAIR SOL 150MG 5 NM, LA; DL ANTIBIOTICS - TOPICAL ALTABAX OIN 1% 4 CORTISPORIN CRE 0.5% 4 CORTISPORIN OIN 1% 4 gentamicin cre 0.1% 2 gentamicin oin 0.1% 2 mupirocin cre 2% 2 mupirocin oin 2% 2 ANTICOAGULANTS COUMADIN INJ 5 MG 4 5

21 ANTICONVULSANTS - BENZODIAZEPINES clonazepam odt tab 0.5mg, 0.25, 0.125, 1mg, 2mg 2 clonazepam tab 0.5mg, 1mg, 2mg 2 diazepam gel (anticonvulsant) 3 ONFI SUS 2.5MG/ML 4 DL ONFI TAB 10MG, 20MG 4 DL ANTICONVULSANTS - MISC. APTIOM 4 PA BANZEL SUS 40MG/ML 5 BANZEL TAB 200MG 4 BANZEL TAB 400MG 5 carbamazepine cap 100mg er, 200mg er, 300mg er 2 carbamazepine chw 100mg 2 carbamazepine sus 100/5ml 2 carbamazepine tab 200mg, 200mg er, 400mg er 2 epitol 2 gabapentin cap 100mg, 300mg, 400mg 2 gabapentin sol 250/5ml 2 gabapentin tab 600mg, 800mg 2 lamotrigine chw 5mg, 25mg 2 lamotrigine tab 25mg 2 lamotrigine tab 25mg er, 50mg er 4 lamotrigine tab 100mg 2 lamotrigine tab 100mg er 4 lamotrigine tab 150mg, 200 mg 2 lamotrigine tab 200mg er, 250mg er, 300mg er 4 levetiracetam sol 100mg/ml 2 levetiracetam tab 250mg, 500mg, 500mg er, 750mg, 750mg er, mg levetiracetam inj 500/5ml 2 LYRICA CAP 25MG, 50MG, 75MG, 100MG, 150MG, 200MG, 225MG, 4 QL (90 caps / 30 days) 300MG LYRICA SOL 20MG/ML 4 PA; DL oxcarbazepine sus 300mg/5m 2 oxcarbazepine tab 150mg, 300mg, 600mg 2 POTIGA TAB 50MG, 200MG, 300MG, 400MG 4 primidone tab 50mg, 250mg 2 TEGRETOL-XR TAB 100MG 3 topiramate cap 15mg, 25mg 2 topiramate tab 25mg, 50mg, 100mg, 200mg 2 TRILEPTAL SUS 300MG/5M 4 VIMPAT INJ 200MG/20 4 VIMPAT SOL 10MG/ML 4 VIMPAT TAB 50MG, 100MG, 150MG, 200MG 4 zonisamide cap 25mg, 50mg, 100mg 2 ANTIDEMENTIA AGENTS donepezil tab 5mg, 5mg odt, 10mg, 10mg odt 2 donepezil tab hcl 23mg 2 EXELON DIS 4.6MG/24, 9.5MG/24, 13.3/24 4 galantamine cap 8mg er, 16mg er, 24mg er 2 galantamine sol 4mg/ml 2 galantamine tab 4mg, 8mg, 12mg 2 6

22 NAMENDA SOL 10MG/5ML 3 NAMENDA XR CAP 7MG, 14MG, 21MG, 28MG 3 NAMENDA XR CAP TITRATIO 3 rivastigmine cap 1.5mg, 3mg, 4.5mg, 6mg 2 ANTIDEPRESSANTS - MISC. APLENZIN TAB 174MG, 348MG, 522MG 4 bupropion tab 75mg, 100mg, 100mg sr, 150mg sr, 200mg sr 2 bupropion hcl tab 150mg xl, 300mg xl 2 maprotiline tab 25mg, 50mg, 75mg 2 ANTIDIABETIC - AMYLIN ANALOGS SYMLINPEN 60 INJ 1000MCG 4 SYMLNPEN 120 INJ 1000MCG 4 ANTIDIABETIC COMBINATIONS AVANDAMET TAB 2-500MG, 1000MG 4 AVANDAMET TAB 4-500MG, 1000MG 4 AVANDARYL TAB 4-1MG, 2MG, 4MG 4 AVANDARYL TAB 8-2MG, 4MG 4 glipizide/metform tab m, 500m 2 glipizide/metform tab 5-500mg 2 glyburide-metformin 4 PA JANUMET TAB MG, 100MG 3 JANUMET XR TAB MG, 1000MG 3 JANUMET XR TAB JENTADUETO 3 pioglitazone/glimepiride tab 30-2mg, 4mg 2 pioglitazone/metformin tab mg, 850mg 2 ANTIDOTES fomepizole inj 1gm/ml 2 ANTIDOTES - CHELATING AGENTS CHEMET CAP 100MG 4 EXJADE TAB 125MG 4 NM, LA; DL EXJADE TAB 250MG, 500MG 5 NM, LA; DL ANTIEMETICS - ANTICHOLINERGIC meclizine tab 12.5mg, 25mg 2 TRANSDERM-SCOP 4 ANTIEMETICS - MISCELLANEOUS CESAMET CAP 1MG 4 dronabinol cap 2.5mg, 5mg, 10mg 2 QL (60 caps / 30 days) ANTIFUNGAL - GLUCAN SYNTHESIS INHIBITORS (ECHINOCANDINS) ALBENZA TAB 200MG 4 BILTRICIDE TAB 600MG 3 CANCIDAS INJ 50MG, 70MG 5 DL ERAXIS INJ 100MG 4 STROMECTOL TAB 3MG 4 ANTIFUNGALS ABELCET INJ 5MG/ML 5 B/D; DL amphotericin inj 50mg 2 B/D; DL flucytosine cap 250mg, 500mg 2 GRIS-PEG TAB 125MG, 250MG 4 griseofulvin sus 125/5ml 2 7

23 griseofulvin tab micr griseofulvin tab ultr griseofulvin tab ultr nystatin tab terbinafine tab 250mg 2 QL (84 tabs/ 365 days) ANTIFUNGALS - TOPICAL ciclopirox cre 0.77% 2 ciclopirox gel 0.77% 2 ciclopirox sha 1% 2 ciclopirox sol 8% 2 PA; DL ciclopirox sus 0.77% 2 clotrim/beta cre diprop 2 clotrim/beta lot diprop 2 econazole cre 1% 2 EXELDERM CRE 1% 4 EXELDERM SOL 1% 4 ketoconazole cre 2% 2 ketoconazole sha 2% 2 KETODAN KIT 2% 2 NAFTIN CRE 1% 4 NAFTIN GEL 1%, 2% 4 nyamyc 2 nystat/triam cre 2 nystat/triam oin 2 nystatin cre nystatin oin nystatin pow nystop 2 OXISTAT CRE 1% 4 OXISTAT LOT 1% 4 pedi-dri 2 ANTIHISTAMINES - ETHANOLAMINES carbinoxamine sol 4mg/5ml 2 carbinoxamine tab 4mg 2 clemastine syp 0.5/5ml 2 clemastine tab 2.68mg 2 PALGIC TAB 4MG 2 ANTIHISTAMINES - NON-SEDATING CLARINEX SYP 0.5MG/ML 4 desloratadine tab 2.5 odt 2 desloratadine tab 5mg, 5mg odt 2 levocetirizine sol 2.5/5ml 2 levocetirizine tab 5mg 2 ANTIHISTAMINES - PHENOTHIAZINES phenadoz 2 promethazine inj 25mg/ml, 50mg/ml 2 promethazine sup 12.5mg, 25mg 2 promethazine syp 6.25/5ml 2 promethazine tab 12.5mg, 25mg, 50mg 2 promethegan 2 ANTIHYPERLIPIDEMICS - COMBINATIONS 8

24 LIPTRUZET 3 VYTORIN TAB 10-10MG, 20MG, 40MG, 80MG 4 ANTIHYPERLIPIDEMICS - MISC. KYNAMRO INJ 200MG/ML 5 NM, PA; DL omega-3-acid ethyl esters 2 ANTIHYPERTENSIVE COMBINATIONS amlodipine/benazapril cap mg 2 amlodipine/benazapril cap 5-10mg, 20mg, 40mg 2 amlodipine/benazapril cap 10-20mg, 40mg 2 atenol/chlor tab 50-25mg 1 atenol/chlor tab mg 1 AZOR TAB 5-20MG, 40MG 4 AZOR TAB 10-20MG, 40MG 4 benazepril/hctz tab benazepril/hctz tab benazepril/hctz tab , 25mg 1 BENICAR HCT TAB BENICAR HCT TAB MG, 25MG 4 bisoprolol/hctz tab 2.5/ bisoprolol/hctz tab mg 1 bisoprolol/hctz tab 10/ candesartan/hctz tab candesartan/hctz tab , 25mg 2 captopril/hctz tab 25-15mg, 25mg 1 captopril/hctz tab 50-15mg, 25mg 1 EDARBYCLOR TAB MG, 25MG 4 enalapril/hctz tab mg 1 enalapril/hctz tab 10-25mg 1 EXFORGE TAB 5-160MG, 320MG 4 EXFORGE TAB MG, 320MG 4 EXFORGE HCT/ , EXFORGE HCT/ , , fosinopril/hctz tab 10/ fosinopril/hctz tab 20/ irbesartan/hctz tab , lisinopril/hctz tab lisinopril/hctz tab lisinopril/hctz tab 20-25mg 1 losartan/hct tab losartan/hct tab , methyldopa/hctz tab 250/15, 250/25 4 metoprolol/hctz tab 50-25mg, mg 1 metoprl/hctz tab mg 1 moexipril/hctz tab , , 15-25mg 2 nadolol/bend tab 40-5mg, 80-5mg 2 propranolol/hctz tab 40/25, 80/25 1 quinapril/hctz tab quinapril/hctz tab , 20-25mg 1 TEKTURNA HCT TAB MG, 25MG 4 TEKTURNA HCT TAB MG, 25MG 4 telmisartan/amlodipine tab 40-5mg, 10mg 2 telmisartan/amlodipine tab 80-5mg, 10mg 2 9

25 telmisartan/hctz tab telmisartan/hctz tab mg, 25mg 2 TRIBENZOR20- TAB MG 4 TRIBENZOR40- TAB MG, 5-25MG 4 TRIBENZOR40- TAB MG, 10-25MG 4 valsartan/hctz tab valsartan/hctz tab mg, mg 2 valsartan/hctz tab mg, mg 2 ANTIMALARIAL COMBINATIONS atovaq/progu tab DL COARTEM TAB MG 4 DL ANTIMALARIALS chloroquine tab 250mg, 500mg 2 DL DARAPRIM TAB 25MG 4 DL hydroxychloroquine tab 200mg 2 mefloquine tab 250mg 2 DL PRIMAQUINE TAB 26.3MG 4 DL QUALAQUIN CAP 324MG 4 DL quinine sulf cap 324mg 2 DL ANTIMANIC AGENTS lithium carb cap 150mg, 300mg, 600mg 2 lithium carb tab 300mg 2 lithium carb tab 300mg er, 450mg er 2 LITHIUM CITR SOL 8MEQ/5ML 2 ANTIMETABOLITES ALIMTA INJ 500MG 5 B/D; DL ARRANON INJ 5MG/ML 5 B/D; DL azacitidine inj 100mg 5 B/D, NM; DL cladribine inj 1mg/ml 4 B/D; DL cytarabine inj 20mg/ml, 100mg/ml 2 B/D; DL decitabine inj 50mg 5 B/D, NM; DL fludarabine inj 50mg 2 B/D; DL fluorouracil inj 2.5g/50m 2 B/D; DL gemcitabine inj 1gm 2 B/D; DL mercaptopur tab 50mg 2 methotrexate inj 1gm 2 B/D; DL methotrexate inj 1gm/40ml 2 methotrexate tab 2.5mg 2 TABLOID TAB 40MG 4 TREXALL TAB 5MG, 7.5MG, 10MG, 15MG 4 VIDAZA INJ 100MG 5 B/D, NM; DL ANTIMYASTHENIC/CHOLINERGIC AGENTS GUANIDINE HCL 2 MESTINON SYP 60MG/5ML 4 MESTINON TAB TIMESPAN 4 pyridostigmine tab 60mg 2 ANTIMYCOBACTERIAL AGENTS CAPASTAT SUL INJ 1GM 4 ethambutol tab 100mg, 400mg 2 isoniazid inj 100mg/ml 2 isoniazid syp 50mg/5ml 2 10

26 isoniazid tab 100mg, 300mg 2 MYCOBUTIN CAP 150MG 4 PASER GRA 4GM 4 PRIFTIN TAB 150MG 4 pyrazinamide tab 500mg 2 rifabutin 2 rifampin cap 150mg, 300mg 2 rifampin inj 600 mg 2 SIRTURO TAB 100MG 5 LA, PA; DL TRECATOR TAB 250MG 4 ANTINEOPLASTIC - ANGIOGENESIS INHIBITORS AVASTIN INJ 5 B/D, NM; DL ZALTRAP INJ 100/4ML 5 NM, PA; DL ANTINEOPLASTIC - ANTIBODIES ARZERRA CON 100/5ML 5 B/D, NM; DL ERBITUX INJ 100MG 5 B/D, NM; DL HERCEPTIN INJ 440MG 5 B/D, NM; DL KADCYLA INJ 100MG 5 NM, PA; DL PERJETA INJ 420/14ML 5 NM, PA; DL RITUXAN INJ 500MG 5 NM; DL VECTIBIX INJ 100MG 5 B/D, NM; DL YERVOY INJ 50MG 5 NM, PA; DL ANTINEOPLASTIC - HEDGEHOG PATHWAY INHIBITORS ERIVEDGE CAP 150MG 5 NM, LA, PA; DL ANTINEOPLASTIC - HORMONAL AND RELATED AGENTS anastrozole tab 1mg 2 bicalutamide tab 50mg 2 DEPO-PROVERA INJ 400/ML 4 ELIGARD INJ 7.5MG, 22.5MG, 30MG, 45MG 4 B/D, NM; DL EMCYT CAP 140MG 3 exemestane tab 25mg 2 FARESTON TAB 60MG 3 FASLODEX INJ 250MG 5 B/D; DL FIRMAGON INJ 80MG 4 B/D, QL (4 / 28 days), NM; DL FIRMAGON INJ 120MG 5 B/D, NM; DL flutamide cap 125mg 2 letrozole tab 2.5mg 2 leuprolide inj 1mg/0.2 2 NM LUPRON DEPOT INJ 3.75MG 4 QL (1 box / 30 days), NM; DL LUPRON DEPOT INJ 7.5MG, 1125MG, 22.5MG, 30MG, 45MG 5 NM; DL LYSODREN TAB 500MG 3 megestrol ac sus 40mg/ml 2 PA; DL megestrol ac tab 20mg, 40mg 2 PA; DL NILANDRON TAB 150MG 3 SOLTAMOX SOL 10MG/5ML 4 tamoxifen tab 10mg, 20mg 2 TRELSTAR DEP INJ 3.75MG 4 NM; DL TRELSTAR LA INJ 11.25MG 4 NM; DL TRELSTAR MIX INJ 22.5MG 5 NM; DL XTANDI CAP 40MG 5 NM, LA, PA; DL ZYTIGA TAB 250MG 5 NM, PA; DL ANTINEOPLASTIC - IMMUNOMODULATORS 11

27 POMALYST CAP 1MG, 2MG, 3MG, 4MG 5 QL (30 caps / 30 days), NM, LA, PA; DL ANTINEOPLASTIC ANTIBIOTICS bleomycin inj 30unit 2 B/D; DL daunorubicin inj 5mg/ml 2 B/D; DL DOXIL INJ 2MG/ML 4 B/D; DL doxorubicin inj 50mg 2 B/D; DL ELLENCE INJ 2MG/ML 5 B/D; DL epirubicin inj 50/25ml 4 B/D; DL idarubicin inj 10/10ml 2 B/D; DL mitomycin inj 20mg 2 B/D; DL mitoxantron inj 2mg/ml 2 B/D, NM; DL ANTINEOPLASTIC ENZYME INHIBITORS AFINITOR DIS TAB 2MG, 3MG, 5MG 5 NM; DL AFINITOR TAB 2.5MG, 5MG, 7.5MG, 10MG 5 NM; DL BOSULIF TAB 100MG, 500MG 5 NM, PA; DL CAPRELSA TAB 100MG, 300MG 5 QL (60 tabs / 30 days), NM, LA, PA; DL COMETRIQ KIT 60MG, 100MG, 140MG 5 NM, PA; DL GILOTRIF TAB 20MG, 30MG, 40MG 5 NM, PA; DL GLEEVEC TAB 100MG, 400MG 5 NM; DL IMBRUVICA CAP 140MG 5 NM, PA; DL INLYTA TAB 1MG, 5MG 5 NM, LA, PA; DL ISTODAX INJ 10MG 5 B/D, NM; DL JAKAFI TAB 5MG, 10MG, 15MG, 20MG, 25MG 5 QL (60 tabs / 30 days), NM, LA, PA; DL MEKINIST TAB 0.5MG, 2MG 5 NM, PA; DL NEXAVAR TAB 200MG 5 NM, LA; DL SPRYCEL TAB 20MG, 50MG, 70MG, 80MG, 100MG, 140MG 5 NM; DL STIVARGA TAB 40MG 5 NM, LA, PA; DL SUTENT CAP 12.5MG, 25MG, 50MG 5 NM; DL TAFINLAR CAP 50MG, 75MG 5 NM, PA; DL TARCEVA TAB 25MG, 100MG, 150MG 5 NM; DL TASIGNA CAP 150MG, 200MG 5 NM; DL TORISEL SOL 25MG/ML 5 B/D, NM; DL TYKERB TAB 250MG 5 NM, LA VELCADE INJ 3.5MG 5 B/D, NM; DL VOTRIENT TAB 200MG 5 NM XALKORI CAP 200MG, 250MG 5 NM, LA, PA; DL ZELBORAF TAB 240MG 5 NM, LA, PA; DL ZOLINZA CAP 100MG 5 NM; DL ZYKADIA 5 NM, PA ANTINEOPLASTIC ENZYMES ERWINAZE INJ 10000UNT 5 NM; DL ONCASPAR INJ 750/ML 5 NM; DL ANTINEOPLASTIC OR PREMALIGNANT LESION AGENTS - TOPICAL CARAC CRE 0.5% 4 diclofenac gel 3% 2 fluorouracil cre 5% 2 fluorouracil sol 2%, 5% 2 PANRETIN GEL 0.1% 3 SOLARAZE GEL 3% W/W 4 TARGRETIN GEL 1% 5 NM ANTINEOPLASTICS MISC. 12

28 ACTIMMUNE INJ 2MU/0.5 5 NM, LA, PA; DL dacarbazine inj 200mg 2 B/D; DL hydroxyurea cap 500mg 2 INTRON-A INJ 10MU 5 NM; DL INTRON-A INJ 18MU 4 NM; DL MATULANE CAP 50MG 5 DL NIPENT INJ 10MG 5 B/D; DL PROLEUKIN INJ 22MU 5 NM; DL SYLATRON KIT 296MCG, 444MCG, 888MCG 5 QL (4 boxes / 28 days), NM, PA; DL SYNRIBO INJ 3.5MG 5 NM, PA; DL TARGRETIN CAP 75MG 5 NM; DL tretinoin cap 10mg 5 DL TRISENOX SOL 10MG/10M 4 B/D; DL UVADEX INJ 20MCG/ML 4 ANTIPARKINSON ADJUVANTS carbidopa TABS 2 ANTIPARKINSON ANTICHOLINERGICS benztropine inj 1mg/ml 2 benztropine tab 0.5mg, 1mg, 2mg 2 trihexyphenidyl elx 0.4mg/ml 2 trihexyphenidyl tab 2mg, 5mg 2 ANTIPARKINSON COMT INHIBITORS entacapone tab 200mg 2 TASMAR TAB 100MG 4 ANTIPARKINSON DOPAMINERGICS amantadine cap 100mg 2 amantadine syp 50mg/5ml 2 amantadine tab 100mg 2 APOKYN INJ 10MG/ML 5 NM, LA; DL bromocriptine cap 5mg 2 bromocriptine tab 2.5mg 2 carb/levo er tab mg, mg 2 carb/levo tab mg 2 carb/levo tab mg, mg 2 CARBIDOPA-LEVODOPA-ENTACAPONE 2 NEUPRO DIS 1MG/24HR, 2MG/24HR, 3MG/24HR, 6MG/24H, 4 8MG/24H pramipexole tab 0.5mg, 0.25mg, 0.75mg, 0.125mg, 1.5mg, 1mg 2 ropinirole tab 0.5mg 2 ropinirole tab 0.25mg, 1mg, 2mg, 2mg er, 3mg, 4mg, 4mg er, 5mg, 6mg 2 er, 8mg er, 12mg er ANTIPARKINSON MONOAMINE OXIDASE INHIBITORS AZILECT TAB 0.5MG, 1MG 4 selegiline cap 5mg 2 selegiline tab 5mg 2 ZELAPAR TAB 1.25MG 4 ANTIPERISTALTIC AGENTS diphen/atrop liq 2.5/5 2 diphen/atrop tab 2.5mg 2 loperamide cap 2mg 2 ANTIPROTOZOAL AGENTS 13

29 ALINIA SUS 100/5ML 4 DL ALINIA TAB 500MG 4 DL atovaquone 4 PA; DL ANTIPRURITICS - TOPICAL prudoxin 2 ANTIPSORIATICS 8-MOP 3 DL acitretin cap 10mg, 17.5mg, 25mg 5 DL calcipotrien cre 0.005% 4 calcipotrien oin 0.005% 4 calcipotrien sol 0.005% 4 CALCITRIOL (TOPICAL) 3 methoxsalen rapid 2 DL OXSORALEN-UL CAP 10MG 5 STELARA INJ 45MG/0.5 5 NM, PA; DL STELARA INJ 90MG/ML 5 NM, PA; DL TAZORAC CRE 0.1%, 0.05% 4 PA ANTIPSYCHOTICS - MISC. EQUETRO CAP 100MG, 200MG, 300MG 4 GEODON INJ 20MG 4 DL LATUDA TAB 20MG, 40MG, 60MG, 80MG, 120MG 4 ziprasidone cap 20mg, 40mg, 60mg, 80mg 2 ANTIRETROVIRALS abacav/lamiv /zidovud tab 4 abacavir tab 300mg 2 APTIVUS CAP 250MG 5 APTIVUS SOL 5 ATRIPLA TAB 5 COMPLERA TAB 5 CRIXIVAN CAP 200MG, 400MG 3 didanosine cap 125mg, 200mg, 250mg, 400mg 2 EDURANT TAB 25MG 5 EMTRIVA CAP 200MG 3 EMTRIVA SOL 10MG/ML 3 EPIVIR SOL 10MG/ML 3 EPZICOM TAB FUZEON INJ 90MG 5 NM INTELENCE TAB 25MG 4 INTELENCE TAB 100MG, 200MG 5 INVIRASE CAP 200MG 3 INVIRASE TAB 500MG 3 ISENTRESS POW 100MG 4 ISENTRESS CHW 25MG 3 ISENTRESS CHW 100MG 5 ISENTRESS TAB 400MG 5 KALETRA SOL 3 KALETRA TAB MG, MG 3 lamivud/zido tab lamivudine tab 100mg, 150mg, 300mg 2 LEXIVA SUS 50MG/ML 4 LEXIVA TAB 700MG 5 NEVIRAPINE SUSP 2 14

30 nevirapine tab 400mg er 4 nevirapine tab 200mg 2 NORVIR CAP 100MG 3 NORVIR SOL 80MG/ML 3 NORVIR TAB 100MG 3 PREZISTA SUS 100MG/ML 4 PREZISTA TAB 75MG, 150MG 4 PREZISTA TAB 600MG, 800MG 5 RESCRIPTOR TAB 100 MG, 200MG 3 RETROVIR INJ 10MG/ML 4 REYATAZ CAP 150MG, 200MG, 300MG 5 SELZENTRY TAB 150MG, 300MG 5 stavudine cap 15mg, 20mg, 30mg, 40mg 2 stavudine sol 1mg/ml 2 STRIBILD TAB 5 SUSTIVA CAP 50MG, 200MG 3 SUSTIVA TAB 600MG 3 TIVICAY TAB 50MG 5 TRIZIVIR TAB 5 TRUVADA TAB VIDEX SOL 2GM 4 VIRACEPT TAB 250MG, 625MG 3 VIREAD POW 40MG/GM 3 VIREAD TAB 150MG, 200MG, 250MG, 300MG 3 ZERIT SOL 1MG/ML 4 ZIAGEN SOL 20MG/ML 3 ZIAGEN TAB 300MG 3 zidovudine cap 100mg 2 zidovudine syp 50mg/5ml 2 zidovudine tab 300mg 2 ANTIRHEUMATIC - ENZYME INHIBITORS XELJANZ TAB 5MG 5 NM, PA; DL ANTIRHEUMATIC ANTIMETABOLITES RHEUMATREX TAB 2.5MG 4 ANTISEBORRHEIC PRODUCTS selenium sul lot 2.5% 2 ANTISEPTICS - MOUTH/THROAT chlorhex glu sol 0.12% 2 periogard 2 ANTISPASMODICS atropine sul inj 0.1mg/ml 2 atropine sul inj 0.05mg/1 2 CANTIL TAB 25MG 4 dicyclomine cap 10mg 2 dicyclomine sol 10mg/5ml 2 dicyclomine tab 20mg 2 glycopyrrolate inj 0.2mg/ml 2 glycopyrrolate tab 1mg, 2mg 2 methscopolamine tab 2.5mg, 5mg 2 propantheline tab 15mg 2 ANTITHYROID AGENTS 15

31 methimazole tab 5mg, 10mg 2 propylthiouracil tab 50mg 2 ANTIVIRALS - TOPICAL acyclovir oin 5% 2 DENAVIR CRE 1% 4 ZOVIRAX CRE 5% 4 ARTIFICIAL TEARS AND LUBRICANTS LACRISERT MIS 5MG OP 4 ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) AGENTS INTUNIV 4 QL (30 tabs / 30 days) KAPVAY TAB 0.1 MG 4 STRATTERA CAP 10MG, 18MG, 25MG, 40MG, 60MG, 80MG, 100MG 4 AZITHROMYCIN azithromycin inj 500mg 2 azithromycin sus 100/5ml, 200/5ml 2 azithromycin tab 250mg, 500mg, 600mg 2 ZMAX SUS 2GM 4 Anti-Infectives AMBISOME 5 B/D ketoconazole TABS 4 BACTERIAL VACCINES ACTHIB INJ 6 BCG VACCINE INJ 4 B/D; DL MENACTRA INJ 4 MENOMUNE INJ A/C/Y/W 4 MENVEO INJ 4 PEDVAX HIB INJ 4 TYPHIM VI INJ 4 BANDAGES-DRESSINGS-TAPE GAUZE PADS 2" X 2" 4 BARBITURATE HYPNOTICS phenobarbital elx 20mg/5ml 2 phenobarbital tab 15mg, 16.2mg, 30mg, 32.4mg, 60mg, 64.8mg, mg, 100mg seconal sodium 4 QL (30 caps / 30 days), PA BENZISOXAZOLES FANAPT PAK 4 FANAPT TAB 1MG, 2MG, 4MG, 6MG, 8MG, 10MG, 12MG 4 INVEGA SUST INJ 39/ QL (1 / 28 days); DL INVEGA SUST INJ 78/0.5ML 4 QL (1 / 28 days); DL INVEGA SUST INJ 117/ QL (1 / 28 days); DL INVEGA SUST INJ 156MG/ML 5 QL (1 / 28 days); DL INVEGA SUST INJ 234/1.5 5 QL (1 / 28 days); DL INVEGA TAB 1.5MG, 3MG, 6MG, 9MG 4 RISPERDAL INJ 12.5MG, 12MG, 37.5MG, 50MG 4 risperidone sol 1mg/ml 2 risperidone tab 0.5mg, 0.5mg od, 0.25mg odt, 0.25mg, 1mg, 1mg odt, 2mg, 2mg odt, 3mg, 3mg odt, 4mg, 4mg odt 2 BENZODIAZEPINES ALPRAZOLAM CON 1 MG/ML 2 DL 16

32 alprazolam tab 0.5mg, 0.5mg er, 0.5mg od, 0.25mg odt, 0.25mg, 1mg, 2 DL 1mg er, 1mg odt, 2mg, 2mg er, 2mg odt, 3mg er chlordiazepoxide cap 5mg, 10mg, 25mg 2 DL clorazepate dipot tab 3.75mg, 7.5mg, 15mg 2 DL DIAZEPAM CON 5MG/ML 2 DL diazepam sol 1mg/ml 2 DL diazepam tab 2mg, 5mg, 10mg 2 DL lorazepam con 2mg/ml 2 DL lorazepam tab 0.5mg, 1mg, 2mg, 10mg, 15mg, 30mg 2 DL BETA BLOCKERS CARDIO-SELECTIVE acebutolol cap 200mg, 400mg 2 atenolol tab 25mg, 50mg, 100mg 1 betaxolol tab 10mg, 20mg 2 bisoprolol fum tab 5mg, 10mg 1 BYSTOLIC TAB 2.5MG, 5MG, 10MG, 20MG 4 metoprolol tartrate tab 25mg, 50mg, 100mg 1 metoprolol inj 1mg/ml 2 metoprolol tab 25mg er, 50mg er, 100mg er, 200mg er 2 BETA BLOCKERS NON-SELECTIVE INNOPRAN XL CAP 80MG, 120MG 4 nadolol tab 20mg, 40mg, 80mg 1 pindolol tab 5mg, 10mg 2 propranolol cap 60mg er, 80mg er, 120mg er, 160mg er 2 propranolol inj 1mg/ml 2 propranolol sol 20mg/5ml, 40mg/5ml 2 propranolol tab 10mg, 20mg, 40mg, 60mg, 80mg 1 sorine 2 sotalol af tab 120mg 2 sotalol hcl tab 80mg, 160mg, 240mg 2 timolol mal tab 5mg, 10mg, 20mg 2 BETA-BLOCKERS - OPHTHALMIC betaxolol sol 0.5% op 2 BETIMOL.5% 4 BETOPTIC-S SUS 0.25% OP 4 carteolol sol 1% op 2 COMBIGAN SOL 0.2/0.5% 4 dorzol/timol sol 2-0.5%op 2 ISTALOL SOL 0.5% OP 4 levobunolol sol 0.5% op 2 metipranolol sol 0.3% oph 2 timolol gel sol 0.5% op, 0.25% op 2 timolol mal sol 0.5% op, 0.25% op 1 BICARBONATES SOD LACTATE INJ 5MEQ/ML 2 BIGUANIDES GLUMETZA TAB 500MG, 1000MG 4 metformin er tab 1000mg 2 metformin tab 500mg, 500mg er, 750mg er, 850mg, 1000mg 1 RIOMET SOL 4 BILE ACID SEQUESTRANTS cholestyram pow 4gm lite 2 17

33 colestipol gra 5gm 2 colestipol tab 1gm 2 prevalite 2 WELCHOL PAK 3.75GM 4 WELCHOL TAB 625MG 4 BIOLOGICALS MISC ADAGEN INJ 250/ML 5 NM, LA, PA; DL BONE DENSITY REGULATORS alendronate sol 70/75ml 1 alendronate tab 5mg, 10mg 2 alendronate tab 35mg 1 alendronate tab 40mg 2 alendronate tab 70mg 1 ATELVIA TAB 4 calcitonin spr 200/act 2 etidronate disd tab 200mg, 400mg 2 FORTEO SOL 600/2.4 5 NM, PA; DL FORTICAL SPR 200/ACT 2 ibandronate sodium inj 4 DL ibandronate tab 150mg 2 MIACALCIN INJ 200/ML 4 PAMIDRONATE INJ 6MG/ML 4 DL pamidronate inj 30/10ml, 90/10ml 4 DL PROLIA SOL 60MG/ML 4 NM; DL risedronate sodium 2 XGEVA INJ 5 NM; DL zoledronic inj 4mg/5ml 4 NM; DL zoledronic inj 5/100ml 4 NM; DL BRADYKININ B2 RECEPTOR ANTAGONISTS FIRAZYR INJ 30MG/3ML 5 NM, PA; DL BRONCHODILATORS - ANTICHOLINERGICS ATROVENT HFA AER 17MCG 3 ipratropium sol 0.02%inh 2 B/D SPIRIVA CAP HANDIHLR 3 TUDORZA PRES AER 400/ACT 4 BURN PRODUCTS mafenide ace pak 5% 2 silver sulfa cre 1% 2 ssd 2 SULFAMYLON CRE 85MG/GM 3 SULFAMYLON PAK 5% 3 BUTYROPHENONES haloper dec inj 50mg/ml, 100mg/ml 2 haloper lac inj 5mg/ml 2 haloperidol con 2mg/ml 2 haloperidol tab 0.5mg, 1mg, 2mg, 5mg, 10mg, 20mg 2 CALCIUM CHANNEL BLOCKERS afeditab cr 2 amlodipine tab 2.5mg, 5mg, 10mg 2 CARDIZEM CD CAP 360MG/24 4 CARDIZEM LA TAB 120MG 4 18

34 cartia xt 2 dilt xr 2 diltiazem cap 60mg er, 90mg er, 120mg cd, 120mg er, 180mg/24, 2 240mg cd, 300mg er, 360mg/24, 420mg/24 diltiazem cap 90mg er 2 diltiazem inj 50/10ml 2 DILTIAZEM INJ 100MG 2 diltiazem tab 30mg, 60mg, 90mg, 120mg 2 felodipine tab 2.5mg er 2 felodipine tab 5mg er, 10mg er 2 isradipine cap 2.5mg, 5mg 2 matzim la 2 nicardipine cap 20mg, 30mg 2 nifedical 2 nifedipine tab 30mg er, 60mg er, 90mg er 2 nimodipine cap 30mg 4 nisoldipine tab 8.5mg er, 17mg er, 20mg, 25.5mg, 30mg, 34mg er, 4 40mg taztiaxt 2 verapamil cap 100mg er, 120mg er, 180mg er, 200mg er, 240mg er, 2 300mg er, 360mg er verapamil inj 2.5mg/ml 2 verapamil tab 40mg, 80mg, 120mg, 120mg er, 180mg er, 240mg er 2 CARBAMATES felbamate sus 600/5ml 2 felbamate tab 400mg, 600mg 2 CARBAPENEMS DORIBAX INJ 500MG 4 imipenem/cil inj 250mg, 500mg 2 INVANZ INJ 1GM 4 meropenem inj 500mg 2 PRIMAXIN IV INJ 500MG 4 CARBOHYDRATES dextrose inj 5%, 10% 2 CARBONIC ANHYDRASE INHIBITORS acetazolamide cap 500mg er 2 acetazolamide inj 500mg 2 acetazolamide tab 125mg, 250mg 2 methazolamide tab 25mg, 50mg 2 CARDIAC GLYCOSIDES digoxin inj 0.25mg/1 2 digoxin sol 50mcg/ml 2 digoxin tab 0.25mg, 0.125mg 2 LANOXIN TAB 0.25MG, 0.125MG, MG, MG 4 CARDIOVASCULAR AGENTS MISC. - COMBINATIONS amlodipine/atorvastatin tab mg, 20mg, 40mg 2 amlodipine/atorvastatin tab 5-10mg, 20mg, 40mg 2 amlodipine/atorvastatin tab 5-80mg 2 amlodipine/atorvastatin tab 10-10mg, 20mg, 40mg, 80mg 2 CENTRAL MUSCLE RELAXANTS baclofen tab 10mg, 20mg 2 19

35 cyclobenzaprine hcl tabs 5mg, 10mg 3 QL (90 tabs / 30 days) tizanidine cap 2mg, 4mg, 6mg 2 tizanidine tab 2mg, 4mg 2 CEPHALOSPORINS - 1ST GENERATION cefadroxil cap 500mg 2 cefadroxil sus 250/5ml, 500/5ml 2 cefadroxil tab 1gm 2 cefazolin inj 1gm 2 CEFAZOLIN INJ 1GM/50ML 2 cefazolin inj 10gm 4 cefazolin inj 500mg 2 cephalexin cap 250mg, 500mg 2 cephalexin sus 125/5ml, 250/5ml 2 cephalexin tab 250mg, 500mg 2 CEPHALOSPORINS - 2ND GENERATION cefaclor cap 250mg, 500mg 2 CEFACLOR ER TAB 500MG 2 CEFOTETAN INJ 1GM/10ML 2 CEFOTETAN INJ 2GM/20ML 2 CEFOTETAN INJ 10G 2 CEFOXITIN INJ 1GM 2 cefoxitin inj 1gm 1gm 2 CEFOXITIN INJ 2GM 2 cefoxitin inj 2gm 2gm 2 cefoxitin inj 10gm 2 cefprozil sus 125/5ml, 250/5ml 2 cefprozil tab 250mg, 500mg 2 cefuroxime inj 1.5gm, 7.5gm, 750mg 2 cefuroxime tab 250mg, 500mg 2 CEPHALOSPORINS - 3RD GENERATION CEDAX CAP 400MG 4 cefdinir cap 300mg 2 cefdinir sus 125/5ml, 250/5ml 2 CEFDITOREN PIVOXIL 200mg 2 cefotaxime inj 1gm, 2gm, 10gm, 500gm 2 cefpodo prox sus 50mg/5ml, 100/5ml 2 cefpodoxime tab 100mg, 200mg 2 ceftazidime inj 1gm, 2gm, 6gm 2 CEFTAZIDIME/ SOL D5W 1GM, 2GM 4 ceftriaxone inj 1gm, 2gm, 10gm, 250gm, 500gm 2 CLAFORAN INJ 1GM, 2GM 4 FORTAZ INJ 1GM, 2GM, 6GM 4 SUPRAX CAP 400MG 4 SUPRAX SUS 100/5ML, 200/5ML, 500/5ML 4 SUPRAX TAB 400MG 4 CEPHALOSPORINS - 4TH GENERATION cefepime inj 1gm, 2gm 2 CHELATING AGENTS DEPEN TITRA TAB 250MG 4 SYPRINE CAP 250MG 4 CHEMOTHERAPY ADJUNCTS 20

36 ELITEK INJ 1.5MG 5 B/D; DL CHEMOTHERAPY RESCUE/ANTIDOTE AGENTS amifostine inj 500mg 5 B/D; DL dexrazoxane inj 250mg 4 B/D; DL leucovorin ca inj 100mg, 350mg 2 B/D; DL leucovorin ca tab 5mg, 10mg, 15mg 2 leucovorin ca tab 25mg 4 mesna inj 1gm 2 B/D; DL MESNEX TAB 400MG 3 ZINECARD INJ 250MG 4 B/D; DL CHLORAMPHENICOLS chloramphenicol inj 1gm 2 CHLORIDE AMMONIUM CHL INJ 5MEQ/ML 4 CLARITHROMYCIN BIAXIN XL TAB PAC clarithromycin sus 125/5ml, 250/5ml 2 clarithromycin tab 250mg, 500mg, 500mg er 2 CMV AGENTS cidofovir inj 75mg/ml 2 ganciclovir inj 500mg 2 B/D; DL VALCYTE SOL 50MG/ML 5 DL VALCYTE TAB 450MG 5 DL VISTIDE INJ 75MG/ML 4 COMBINATION CONTRACEPTIVES - ORAL amethia 91 day 2 amethyst 28 day 2 apri 28 day 2 aranelle 28 2 aviane 28 2 balziva 28 day 2 briellyn 28 day 2 cryselle 28 2 cyclafem 1/35 28 day 2 cyclafem 7/7/7 28 day 2 drospir/ethi tab mg 2 emoquette 2 enpresse 28 day 2 gildagia 2 introvale 91 day 2 junel 1.5/30 21 day 2 junel 1/20 21 day 2 junel fe 1.5/30 28 day 2 junel fe 1/20 28 day 2 kariva 28 day 2 kelnor 1/35 28 day 2 larin 1/20 2 larin fe 1.5/30 2 larin fe 1/20 2 leena 28 day 2 lessina 28 day 2 21

37 levonest 28 day 2 levonor/ethi tab estradio 2 levora 0.15/30 28 day 2 LO LOESTRIN TAB 4 loryna 28 day 2 low-ogestrel 28 day 2 lutera 28 day 2 marlissa 28 day 2 microgestin 1.5/30 21 day 2 microgestin 1/20 21 day 2 microgestin fe 1.5/30 28 day 2 microgestin fe 1/20 28 day 2 mononessa 28 day 2 necon 0.5/35 28 day 2 necon 1/35 28 day 2 necon 7/7/7 28 day 2 NECON TAB 10/ nortrel 0.5/35 28 day 2 nortrel 1/35 21 day 2 nortrel 1/35 28 day 2 nortrel 7/7/7 28 day 2 ogestrel 28 day 2 orsythia 28 day 2 ORTHO TRI- TAB CYCLN LO 3 pimtrea pack 2 pirmella 1/35 28 day 2 portia 28 day 2 previfem 28 day 2 quasense 91 day 2 reclipsen 28 day 2 sprintec 28 day 2 sronyx 28 day 2 tri-legest 28 day 2 tri-previfem 28 day 2 tri-sprintec 28 day 2 trinessa 28 day 2 trivora 28 day 2 velivet 28 day 2 vestura 2 vyfemia 28 day 2 zenchent 28 day 2 zenchent fe 28 day 2 zovia 1/35e 28 day 2 zovia 1/50e 28 day 2 COMBINATION CONTRACEPTIVES - TRANSDERMAL ORTHO EVRA DIS WEEK 3 COMBINATION CONTRACEPTIVES - VAGINAL NUVARING MIS 3 COMBINATION PSYCHOTHERAPEUTICS olanza/fluox cap 3-25mg, 6-25mg, 6-50mg, 12-25mg, 12-50mg 4 perphen/amit tab 2-10mg, 2-25mg, 4-10mg, 4-25mg, 4-50mg 2 CORTICOSTEROIDS - TOPICAL 22

38 alclometason cre 0.05% 2 alclometason oin 0.05% 2 amcinonide cre 0.1% 2 amcinonide lot 0.1% 2 AMCINONIDE OIN 0.1% 2 aug betamet cre 0.05% 2 aug betamet gel 0.05% 2 aug betamet lot 0.05% 2 aug betamet oin 0.05% 2 betameth dip cre 0.05% 2 betamethasone dip lot 0.05% 2 betamethasone dip oin 0.05% 2 betamethasone val aer 0.12% 2 betamethasone val cre 0.1% 2 betamethasone val lot 0.1% 2 betamethasone val oin 0.1% 2 calcipotriene-betamethasone dipropionate 4 CAPEX SHA 0.01% 4 clobetasol aer 0.05% 4 clobetasol e cre 0.05% 2 clobetasol gel 0.05% 2 clobetasol lot 0.05% 4 clobetasol oin 0.05% 2 clobetasol sha 0.05% 2 clobetasol sol 0.05% 2 CORDRAN 80X3 TAP 4MCG/CM 4 desonide cre 0.05% 2 desonide lot 0.05% 2 desonide oin 0.05% 2 desoximetasone cre 0.05%, 0.25% 2 desoximetasone gel 0.05% 2 desoximetasone oin 0.05% 2 desoximetasone oin 0.25% 2 diflorasone cre 0.05% 2 diflorasone oin 0.05% 2 fluocinolone acet cre 0.01% 2 fluocinolone acet cre 0.025% 2 fluocinolone acet oil body 2 fluocinolone acet oin 0.025% 2 fluocinolone acet sol 0.01% 2 fluocinonide cre 0.1% 2 fluocinonide cre -e 0.05% 2 fluocinonide gel 0.05% 2 fluocinonide oin 0.05% 2 fluocinonide sol 0.05% 2 fluticasone cre 0.05% 2 fluticasone lot 0.05% 2 fluticasone oin 0.005% 2 halobetasol cre 0.05% 2 halobetasol oin 0.05% 2 HALOG CRE 0.1% 4 HALOG OIN 0.1% 4 hc butyrate cre 0.1% 2 23

39 he butyrate oin 0. 7% 2 he butyrate sol 0. 7% 2 he valerate ere 0.2% 2 he valerate oin 0.2% 2 hydrocortisone ere 2.5% 2 hydrocortisone lot 2. 5% 2 hydrocortisone oin 2.5% 2 KENALOG AER SPRAY 4 mometasone ere 0. 7% 2 mometasone oin 0. 7% 2 mometasone sol 0. 7% 2 prednicarbat oin 0. 7% 2 prednicarbate 2 TACLONEX SUS 4 triamcinolone ere 0. 7%, 0.5%, 0.025% 2 triamcinolone lot 0. 7%, 0.025% 2 triamcinolone oin 0. 7%, 0.5% 2 triamcinolon oin 0.025% 2 triderm 2 u-cort 4 CORTICOTROPIN ACTHAR HP INJ 80UNIT 5 NM, PA COUGH/COLD/ALLERGY COMBINATIONS CLARINEX-D TAB promethazine vc syp plain 2 COUMARIN ANTICOAGULANTS COUMADIN TAB 1MG, 2.5MG, 2MG, 3MG, 4MG, 5MG, 6MG, 7.5MG, 4 10MG antoven 2 warfarin tab 7 mq, 2. 5mq, 2mq, Jmq, 4mq, 5mq, 6mq, 7. 5mq, 7 Omq 2 CYCLIC LIPOPEPTIDES CUBICIN SOL 500MG 5 CYSTIC FIBROSIS AGENTS KAL YDECO TAB 150MG PULMOZYME SOL 1 MG/ML CYSTINOSIS AGENTS CYSTAGON CAP 50MG, 150MG Central Nervous System COPAXONE KIT 20MG/ML DIABETIC OTHER GLUCAGEN INJ HYPOKIT GLUCAGON KIT 1 MG PROGL YCEM SUS 50MG/ML DIBENZAPINES clozapine tab 25mq, 50mq, 700mq, 200mq 2 FAZACLO 4 loxapine cap 5mq, 70mq, 25mq, 50mq 2 olanzapine inj 7 Omq 2 olanzapine tab 2.5mg, 5mg, 5mg odt, 7.5mg, 70mg, 70mg odt, 75mg, 2 75mg odt, 20mg, 20mg odt, 25mg, 50mg, 700mg, 200mg, 300mg, 400m quetiapine tab 25mg, 50mg, 100mg, 200mg, 300mg, 400mg QL (60 tabs I 30 days), NM, PA; DL BID, NM; DL NM NM; DL 24

40 SAPHRIS SUB 5MG, 10MG 4 SEROQUEL XR TAB 50MG, 150MG, 200MG, 300MG, 400MG 4 VERSACLOZ 4 PA; DL DIGESTIVE ENZYMES CREON CAP 3000UNIT, 6000UNIT, 12000UNIT, 24000UNIT, UNIT SUCRAID SOL 8500/ML 5 ZENPEP CAP 3000UNIT, 10000UNIT, 15000UNIT, 20000UNIT, UNIT DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITORS JANUVIA TAB 25MG, 50MG, 100MG 3 TRADJENTA TAB 5MG 3 DIRECT FACTOR XA INHIBITORS ELIQUIS TAB 2.5MG, 5MG 4 XARELTO TAB 10MG, 15MG, 20MG 4 DIRECT MUSCLE RELAXANTS dantrolene cap 25mg, 50mg, 100mg 2 DIRECT RENIN INHIBITORS TEKTURNA TAB 150MG, 300MG 4 DIURETIC COMBINATIONS ALDACTAZIDE TAB 50/50 4 amiloride/hctz tab spironolactone/hctz tab 25/25 1 triamterene/hctz cap triamterene/hctz cap 50-25mg 1 triamterene/hctz tab triamterene/hctz tab 75-50mg 1 ELECTROLYTE MIXTURES d2.5w/nacl inj 0.45% 2 d5w/lr inj 2 d5w/nacl inj 0.2%, 0.9%, 0.33%, 0.45%, 0.225% 2 D10W/NACL INJ 0.2% 2 d10w/nacl inj 0.45% 2 IONOSOL-B/ INJ D5W 4 DL IONOSOL-MB INJ /D5W 4 DL ISOLYTE-P INJ /D5W 4 DL ISOLYTE-S INJ 4 DL kcl in nacl inj 2 kcl/d5w inj 0.3%, 0.15% 2 KCL/D5W/LR INJ 0.15% 2 KCL/D5W/NACL INJ 0.3/0.9% 2 kcl/d5w/nacl inj 0.3/ kcl/d5w/nacl inj 0.15/0.2 2 KCL/D5W/NACL INJ 0.15/0.2 2 kcl/d5w/nacl inj 0.15/0.9 2 kcl/d5w/nacl inj.15/.33% 2 kcl/d5w/nacl inj.15/.45% 2 kcl/d5w/nacl inj.22/.45 2 kcl/d5w/nacl inj.075/.45 2 kcl/nacl inj kcl/nacl inj

41 lactated rin inj 2 NORMOSOL -R INJ /D5W 4 NORMOSOL-R INJ PH DL PLASMA-LYTE INJ 56/D5W 4 DL PLASMA-LYTE INJ DL PLASMA-LYTE INJ -A 4 DL ringers inj 2 ENDOCRINE AND METABOLIC ELLA 3 ENZYMES - TOPICAL SANTYL OIN 250/GM 3 ERYTHROMYCINS e.e.s. 2 ERY-TAB TAB 250MG EC, 333MG EC 2 ERY-TAB TAB 500MG EC 3 ERYPED SUS 200/5ML 4 ERYPED SUS 400/5ML 4 ERYTHROCIN INJ 500MG 4 erythrocin stearate 2 erythrom eth tab 400mg 2 erythromycin tab 250mg bs, 500mg bs 2 PCE TAB 333MG EC, 500MG EC 4 ESTROGEN COMBINATIONS estra/noreth tab estra/noreth tab 1-0.5mg 2 PREMPRO TAB , , , ESTROGENS ALORA DIS 0.1MG, 0.05MG, 0.025MG, 0.075MG 4 estrad val inj 20mg/ml 3 estradiol dis 0.1mg, 0.05mg, 0.06mg, 0.025mg, 0.075mg, mg 3 estradiol tab 0.5mg, 1mg, 2mg 3 estropipate tab 0.75mg, 1.5mg, 3mg 2 EVAMIST SPR 1.53MG 4 MENEST TAB 0.3MG, 0.625MG, 1.25MG, 2.5MG 4 PREMARIN INJ 25MG 4 PREMARIN TAB 0.3MG, 0.9MG, 0.45MG, 0.625MG, 1.25MG 4 FIBRIC ACID DERIVATIVES FENOFIBRATE 2 fenofibrate cap 43mg, 67mg, 130mg, 134mg, 200mg 2 fenofibrate tab 48mg, 54mg, 145mg, 160mg 2 fenofibric cap 45mg dr, 135mg dr 2 gemfibrozil tab 600mg 2 FIBROMYALGIA AGENTS SAVELLA MIS TITR PAK 3 SAVELLA TAB 12.5MG, 25MG, 50MG, 100MG 3 FIDAXOMICIN DIFICID TAB 200MG 5 PA; DL FLUOROQUINOLONES AVELOX INJ 4 PA; DL CIPRO (5%) SUS 250MG/5 4 26

42 CIPRO (10%) SUS 500MG/5 4 ciprofloxacin SUSR 2 ciprofloxacin inj 200mg, 400mg 2 PA; DL ciprofloxacin tab 100mg, 250mg, 500mg, 750mg 2 FACTIVE 4 levoflox/d5w inj 500/100m 2 PA; DL levofloxacin inj 25mg/ml 2 PA; DL levofloxacin sol 25mg/ml 2 levofloxacin tab 250mg, 500mg, 750mg 2 moxifloxacin hcl 2 ofloxacin tab 200mg, 300mg, 400mg 2 GABA MODULATORS GABITRIL TAB 2MG, 4MG, 12MG, 16MG 4 SABRIL POW 500MG 5 NM, LA SABRIL TAB 500MG 5 NM, LA tiagabine tab 2mg, 4mg 2 GALLSTONE SOLUBILIZING AGENTS chenodal 5 ursodiol cap 300mg 2 ursodiol tab 250mg, 500mg 2 GASTROINTESTINAL ANTIALLERGY AGENTS cromolyn sod con 100/5ml 2 GASTROINTESTINAL CHLORIDE CHANNEL ACTIVATORS AMITIZA CAP 8MCG, 24MCG 3 DL GASTROINTESTINAL STIMULANTS metoclopramide inj 5mg/ml 2 metoclopramide sol 5mg/5ml 2 metoclopramide tab 5mg, 10mg 2 GENITOURINARY IRRIGANTS neo/poly gu sol 40/ml ir 2 sodium chlor sol 0.9% irr 2 GLUCOCORTICOSTEROIDS a-hydrocort 2 budesonide cap 3mg/24hr 2 cortisone ac tab 25mg 2 DEPO-MEDROL INJ 20MG/ML, 40MG/ML, 80MG/ML 4 dexameth pho inj 10mg/ml 2 dexameth pho inj 120mg/30 2 DEXAMETHASON CON 1MG/ML 2 dexamethasone elx 0.5/5ml 2 dexamethasone tab 0.5mg, 0.75mg, 1.5mg, 1mg, 2mg, 4mg, 6mg 2 hydrocortisone tab 5mg, 10mg, 20mg 2 methylprednisolone ace inj 40mg/ml, 80mg/ml 2 methylprednisolone ss inj 40mg, 125mg 2 methylprednisolone pak 4mg 2 methylprednisolone tab 4mg, 8mg, 16mg, 32mg 2 MILLIPRED SOL 10MG/5ML 4 MILLIPRED TAB 5MG 2 pred sod pho sol 5mg/5ml 2 prednisolone sol 15mg/5ml, 25mg/5ml 2 PREDNISONE CON 5MG/ML 2 27

43 prednisone sol 5mg/5ml 2 prednisone tab 1mg, 2.5mg, 5mg, 10mg, 20mg, 50mg 2 SOLU-CORTEF INJ 100MG, 250MG 4 SOLU-MEDROL INJ 2GM, 40MG, 500MG 4 VERIPRED 20 SOL 20MG/5ML 2 GLYCYLCYCLINES TYGACIL INJ 50MG 4 DL GOLD COMPOUNDS RIDAURA CAP 3MG 3 GOUT AGENT COMBINATIONS proben/colch tab GOUT AGENTS allopurinol tab 100mg, 300mg 1 ALOPRIM INJ 500MG 2 COLCRYS TAB 0.6MG 4 ULORIC TAB 40MG, 80MG 4 QL (30 tabs / 30 days), PA; DL GROWTH HORMONE RECEPTOR ANTAGONISTS SOMAVERT INJ 10MG, 15MG, 20MG 5 NM, LA; DL GROWTH HORMONES GENOTROPIN INJ 0.2MG, 0.4MG, 0.6MG, 0.8MG, 1.2MG, 1.4MG, 4 NM, PA; DL 1.6MG, 1.8MG, 1MG, 2MG GENOTROPIN INJ 5MG, 12MG 5 NM, PA; DL HUMATROPE INJ 5MG 5 NM, PA; DL HUMATROPE INJ 6MG 4 NM, PA; DL HUMATROPE INJ 12MG, 24MG 5 NM, PA; DL NORDITROPIN INJ 5/1.5ML, 10/1.5ML, 15/1.5ML, 30/3ML 5 NM, PA; DL OMNITROPE INJ 5.8MG 5 NM, PA; DL OMNITROPE INJ 10/1.5ML 4 NM, PA; DL SAIZEN INJ 5MG, 8.8MG 5 NM, PA; DL TEV-TROPIN INJ 5MG 4 NM, PA; DL ZORBTIVE INJ 8.8MG 5 NM, PA; DL H-2 ANTAGONISTS cimetidine sol 300/5ml 2 cimetidine tab 200mg, 300mg, 400mg, 800mg 2 famotidine inj 10mg/ml, 20mg/50ml 2 famotidine sus 40mg/5ml 2 famotidine tab 20mg, 40mg 1 nizatidine cap 150mg, 300mg 2 nizatidine sol 15mg/ml 2 ranitidine cap 150mg, 300mg 1 ranitidine inj 150/6ml 2 PA; DL ranitidine syp 15mg/ml 2 ranitidine tab 150mg, 300mg 1 HEMATOPOIETIC GROWTH FACTORS ARANESP INJ 25MCG 25mcg/0.42ml 4 QL (1 / 30 days), NM, PA; DL ARANESP INJ 25MCG 25mcg/ml 4 QL (2 / 30 days), NM, PA; DL ARANESP INJ 40MCG 40mcg/0.4ml 4 QL (1 / 30 days), NM, PA; DL ARANESP INJ 40MCG 40mcg/ml 4 QL (2 / 30 days), NM, PA; DL ARANESP INJ 60MCG 60mcg/0.3ml 4 QL (2.4 / 30 days), NM, PA; DL ARANESP INJ 60MCG 60mcg/ml 4 QL (8 / 30 days), NM, PA; DL ARANESP INJ 100MCG 100mcg/0.5ml 5 NM, PA; DL 28

44 ARANESP INJ 100MCG 100mcg/ml 4 QL (2 / 30 days), NM, PA; DL ARANESP INJ 150MCG, 200MCG, 300MCG, 500MCG 5 NM, PA; DL EPOGEN INJ 2000/ML, 3000/ML, 4000/ML 3 QL (12 / 30 days), NM, PA; DL EPOGEN INJ 10000/ML 4 QL (12 / 30 days), NM, PA; DL EPOGEN INJ 20000/ML 4 NM, PA; DL LEUKINE INJ 250MCG 5 NM; DL NEULASTA INJ 6MG/0.6M 5 NM; DL NEUMEGA INJ 5MG 5 NM; DL NEUPOGEN INJ 300/0.5, 480/0.8, 480MCG 5 NM; DL PROCRIT INJ 2000/ML, 3000/ML, 4000/ML 3 QL (12 / 30 days), NM, PA; DL PROCRIT INJ 10000/ML 4 QL (12 / 30 days), NM, PA; DL PROCRIT INJ 20000/ML, 40000/ML 5 NM, PA; DL PROMACTA TAB 12.5MG, 25MG, 50MG, 75MG 5 NM, LA, PA; DL HEMATORHEOLOGIC AGENTS pentoxifylline tab 400mg er 2 HEMOSTATICS - SYSTEMIC tranexamic acid inj 100mg/ml 2 DL tranexamic acid tab 650mg 2 HEPARINS AND HEPARINOID-LIKE AGENTS enoxaparin inj 30/0.3ml, 40/0.4, 60/0.6, 80/0.8, 100mg/ml, 120/0.8, 4 DL 150mg/ml, 300/3ml fondaparinux sol 2.5/0.5 4 DL fondaparinux sol 5.0/0.4, 7.5/0.6, 10/0.8 5 DL FRAGMIN INJ 2500/0.2, 5000/0.2 4 DL FRAGMIN INJ 7500/0.3, 10000/ML, 12500UNT, 15000UNT, 18000UNT 5 L FRAGMIN INJ 25000/ML 4 DL hep sod/d5w inj 20000unt 2 HEP SOD/D5W INJ 25000UNT 2 hep sod/nacl inj 1000unit 2 heparin sod inj 1000/ml 2 heparin sod inj 5000/ml, 10000/ml, 20000/ml 2 HEPATITIS AGENTS adefov dipiv tab 10mg 2 BARACLUDE SOL.05MG/ML 4 BARACLUDE TAB 0.5MG, 1MG 4 HEPSERA TAB 10MG 5 INCIVEK TAB 375MG 5 NM, PA; DL moderiba TABS 4 NM, PA; DL MODERIBA PAK 800/DAY, 1200/DAY 5 NM, PA; DL OLYSIO CAP 150MG 5 NM, PA; DL PEG-INTRON 5 NM, PA; DL PEG-INTRON KIT 50MCG, 50MCG RP, 80MCG RP, 120RP, 150RP 5 NM, PA; DL PEGASYS INJ 5 NM, PA; DL PEGASYS INJ 180MCG/M 5 NM, PA; DL PEGASYS INJ PROCLICK 5 NM, PA; DL REBETOL SOL 40MG/ML 3 QL (900 ml / 30 days), NM, PA; DL RIBAPAK PAK 800/DAY, 1000/DAY, 1200/DAY 5 NM, PA; DL ribasphere CAPS 4 NM, PA; DL ribasphere TABS 200mg, 400mg 4 NM, PA; DL ribasphere TABS 600mg 5 NM, PA; DL ribavirin cap 200mg 4 NM, PA; DL ribavirin tab 200mg 4 NM, PA; DL 29

45 SOVALDI TAB 400MG 5 NM, PA; DL TYZEKA TAB 600MG 4 VICTRELIS CAP 200MG 5 NM, PA; DL HERPES AGENTS acyclovir cap 200mg 1 acyclovir na inj 500mg 2 B/D; DL acyclovir sus 200/5ml 2 acyclovir tab 400mg, 800mg 2 famciclovir tab 125mg, 250mg, 500mg 2 valacyclovir tab 1gm, 500mg 2 HMG COA REDUCTASE INHIBITORS ADVICOR TAB MG, MG, MG, MG 4 ALTOPREV TAB 20MG ER, 40MG ER, 60MG ER 4 atorvastatin tab 10mg, 20mg, 40mg, 80mg 2 CRESTOR TAB 5MG, 10MG, 20MG, 40MG 3 fluvastatin cap 20mg, 40mg 2 LESCOL XL TAB 80MG 4 LIVALO TAB 1MG, 2MG, 4MG 4 lovastatin tab 10mg, 20mg, 40mg 1 pravastatin tab 10mg, 20mg, 40mg, 80mg 1 SIMCOR TAB MG, 40MG 4 SIMCOR TAB MG 4 SIMCOR TAB , simvastatin tab 5mg, 10mg, 20mg, 40mg, 80mg 1 HORMONE RECEPTOR MODULATORS raloxifene hcl 2 HYDANTOINS DILANTIN CAP 30MG, 100MG 4 DILANTIN CHW 50MG 4 DILANTIN-125 SUS 125/5ML 4 fosphenytoin inj 100/2ml 2 PEGANONE TAB 250MG 3 phenytoin chw 50mg 2 phenytoin ex cap 100mg, 200mg, 300mg 2 phenytoin inj 50mg/ml 2 phenytoin sus 125/5ml 2 HYPNOTICS - TRICYCLIC AGENTS SILENOR TAB 3MG, 6MG 4 QL (30 tabs / 30 days) IMIDAZOLE-RELATED ANTIFUNGALS fluconazole sus 10mg/ml, 40mg/ml 2 fluconazole tab 50mg, 100mg, 150mg, 200mg 2 fluconazole/ inj dex itraconazole cap 100mg 4 PA; DL NOXAFIL SUS 40MG/ML 5 VFEND IV INJ 200MG 4 voriconazole inj 200mg 4 DL voriconazole sus 40mg/ml 5 DL voriconazole tab 50mg 4 DL voriconazole tab 200mg 5 DL IMMUNE SERUMS BIVIGAM 10gm/100ml 5 NM, PA; DL 30

46 CARIMUNE NF INJ 3GM 5 NM, PA; DL GAMASTAN S/D INJ 4 NM, PA; DL GAMMAGARD INJ 2.5GM/25 5 NM, PA; DL GAMMAPLEX INJ 10GM 5 NM, PA; DL GAMUNEX-C INJ 1GM/10ML 5 NM, PA; DL PRIVIGEN INJ 20GRAMS 5 NM, PA; DL IMMUNOMODULATING AGENTS - TOPICAL imiquimod cre 5% 3 ZYCLARA CRE 3.75% 4 ZYCLARA PUMP CRE 2.5% 4 IMMUNOMODULATORS REVLIMID CAP 2.5MG, 5MG, 10MG, 15MG, 20MG, 25MG 5 NM, LA; DL THALOMID CAP 50MG, 100MG, 150MG, 200MG 5 NM; DL IMMUNOSUPPRESSIVE AGENTS ASTAGRAF XL CAP 0.5MG, 1MG, 5MG 4 B/D ATGAM INJ 250MG 5 DL AZASAN TAB 75MG, 100MG 4 B/D azathioprine tab 50mg 2 B/D CELLCEPT IV INJ 500MG 4 B/D; DL CELLCEPT SUS 200MG/ML 3 B/D cyclosporine cap 25mg, 25mg mod, 50mg mod, 100mg, 100mg md 2 B/D cyclosporine inj 50mg/ml 2 B/D; DL cyclosporine sol modified 2 B/D gengraf 2 B/D mycophenolate cap 250mg 2 B/D mycophenolate tab 500mg 2 B/D mycophenolic tab 180mg dr, 360mg dr 2 B/D NEORAL CAP 25MG, 100MG 4 B/D NEORAL SOL 100MG/ML 4 B/D NULOJIX INJ 250MG 5 B/D; DL PROGRAF INJ 5MG/ML 4 B/D; DL RAPAMUNE SOL 1MG/ML 4 B/D RAPAMUNE TAB 0.5MG, 1MG, 2MG 4 B/D SANDIMMUNE CAP 25MG, 100MG 3 B/D SANDIMMUNE INJ 50MG/ML 4 B/D; DL SANDIMMUNE SOL 100MG/ML 3 B/D SIMULECT INJ 20MG 4 B/D; DL sirolimus tab 0.5mg 2 B/D tacrolimus cap 0.5mg 2 B/D tacrolimus cap 1mg, 5mg 2 B/D THYMOGLOBULN INJ 25MG 3 B/D; DL ZORTRESS TAB 0.5MG 5 B/D; DL ZORTRESS TAB 0.25MG 4 B/D, QL (60 tabs / 30 days); DL ZORTRESS TAB 0.75MG 5 B/D; DL IMMUNOSUPPRESSIVE AGENTS - TOPICAL ELIDEL CRE 1% 4 PROTOPIC 4 IMPOTENCE AGENTS CIALIS TAB 2.5MG, 5MG 4 QL (30 tabs / 30 days), PA; DL INCRETIN MIMETIC AGENTS (GLP-1 RECEPTOR AGONISTS) BYETTA INJ 5MCG 4 31

47 BYETTA INJ 10MCG 4 VICTOZA INJ 18MG/3ML 3 INFLAMMATORY BOWEL AGENTS APRISO CAP 0.375GM 4 ASACOL HD TAB 800MG 4 balsalazide cap 750mg 2 CANASA SUP 1000MG 4 CIMZIA KIT 5 NM, PA; DL CIMZIA PREFL KIT 200MG/ML 5 NM, PA; DL DELZICOL CAP 400MG 4 DIPENTUM CAP 250MG 4 LIALDA TAB 1.2GM 4 mesalamine kit 4gm 2 PENTASA CAP 250MG CR, 500MG CR 4 REMICADE INJ 100MG 5 NM, PA; DL sulfasalazine tab 500mg 2 sulfazine ec tab 500mg 2 INFLUENZA AGENTS RELENZA MIS DISKHALE 4 QL (3 inhalers / 180 days) rimantadine tab 100mg 2 TAMIFLU CAP 30MG 4 QL (56 caps / 180 days) TAMIFLU CAP 45MG, 75MG 4 QL (28 caps / 180 days) TAMIFLU SUS 6MG/ML 4 QL (360 ml / 180 days) INSULIN APIDRA INJ SOLOSTAR 4 ST APIDRA INJ U ST HUMALOG INJ 100/ML 3 HUMALOG MIX INJ 50/50, 50/50KWP, 75/25KWP 3 HUMALOG MIX SUS 75/25 3 HUMULIN INJ 70/30 3 HUMULIN N INJ U HUMULIN N PN INJ U HUMULIN PEN INJ 70/30 3 HUMULIN R INJ U HUMULIN R INJ U LANTUS INJ 100/ML 3 LANTUS INJ SOLOSTAR 3 LEVEMIR INJ 3 LEVEMIR INJ FLEXPEN 3 NOVOLIN INJ 70/30 4 ST NOVOLIN N INJ U ST NOVOLIN R INJ U ST NOVOLOG INJ 100/ML 4 ST NOVOLOG INJ PENFILL 4 ST NOVOLOG MIX INJ 70/30 4 ST NOVOLOG MIX INJ FLEXPEN 4 ST INSULIN SENSITIZING AGENTS AVANDIA TAB 2MG, 4MG, 8Mg 4 pioglitazone tab 15mg, 30mg, 45mg 2 INSULIN-LIKE GROWTH FACTORS (SOMATOMEDINS) INCRELEX INJ 40MG/4ML 5 NM, LA; DL 32

48 INTERLEUKIN-1 BLOCKERS ARCALYST INJ 220MG 5 NM, PA; DL ILARIS 5 NM, PA; DL INTERLEUKIN-6 RECEPTOR INHIBITORS ACTEMRA INJ 162/0.9 5 NM, PA; DL ACTEMRA INJ 200/10ML 5 NM, PA; DL INTERSTITIAL CYSTITIS AGENTS ELMIRON CAP 100MG 3 INTESTINAL ACIDIFIERS enulose 2 generlac 2 INTESTINAL CHOLESTEROL ABSORPTION INHIBITORS ZETIA TAB 10MG 4 INTRARECTAL STEROIDS colocort 2 CORTIFOAM AER 90MG 3 hydrocortisone enema 100mg 2 IRRIGATION SOLUTIONS lactated rin sol irrigat 2 ringers irr sol 2 steril water sol irrig 2 IRRITABLE BOWEL SYNDROME (IBS) AGENTS LINZESS CAP 145MCG, 290MCG 4 DL LOTRONEX TAB 0.5MG, 1MG 5 DL Immunologic Agents KINERET 5 NM, PA; DL KERATOLYTIC/ANTIMITOTIC AGENTS CONDYLOX GEL 0.5% 3 podofilox sol 0.5% 2 KETOLIDES KETEK TAB 300MG, 400MG 4 LAXATIVE COMBINATIONS gavilytee-g 2 gavilyte-c 2 gavilyte-n 2 GOLYTELY SOL 4 MOVIPREP SOL 4 SUPREP BOWEL SOL PREP 4 trilyte 2 LAXATIVES - MISCELLANEOUS constulose 2 KRISTALOSE PAK 10GM, 20GM 3 lactulose sol 10gm/15 2 polyethylene glycol 3350 POWD 2 LEPROSTATICS dapsone tab 25mg 3 dapsone tab 100mg 3 LEUKOTRIENE MODULATORS montelukast chw 4mg, 5mg 2 33

49 montelukast gra 4mg 2 montelukast tab 10mg 2 zafirlukast tab 10mg, 20mg 2 ZYFLO CR TAB 600MG 4 ZYFLO TAB 600MG 4 LHRH/GNRH AGONIST ANALOG PITUITARY SUPPRESSANTS LUPR DEP-PED INJ 11.25MG, 15MG 5 NM; DL SYNAREL SOL 2MG/ML 3 LINCOSAMIDES CLEOCIN CAP 75MG 4 CLEOCIN/D5W INJ 900MG 4 clindamycin cap 75mg, 150mg, 300mg 2 clindamycin inj 150mg/ml, 300mg, 600mg, 900mg 2 clindamycin sol 75mg/5ml 2 LINCOCIN 3 LIPIDS intralipid 2 B/D; DL INTRALIPID INJ 30% 4 B/D; DL LIPOSYN III INJ 10%, 20% 2 B/D; DL LOCAL ANESTHETICS - AMIDES lidocaine hcl (local anesth.) 2 lidocaine inj 0.5%, 1% 2 LOCAL ANESTHETICS - TOPICAL lido/prilocn cre % 2 lidocaine gel 2% jelly 2 lidocaine oin 5% 2 lidocaine pad 5% 2 PA lidocaine sol 4% 2 lidoderm 2 PA LOOP DIURETICS bumetanide inj 0.25/ml 2 bumetanide tab 0.5mg, 1mg, 2mg 2 EDECRIN TAB 25MG 4 furosemide inj 10mg/ml 2 FUROSEMIDE SOL 8MG/ML 2 furosemide sol 10mg/ml 2 furosemide tab 20mg, 40mg, 80mg 1 TORSEMIDE INJ 20MG/2ML 2 torsemide tab 5mg, 10mg, 20mg, 100mg 2 MAGNESIUM magnesium su inj 50% 2 MEGLITINIDE ANALOGUES nateglinide tab 60mg, 120mg, 0.5mg 2 repaglinide tab 1mg 2 repaglinide tab 2mg 2 METABOLIC MODIFIERS ALDURAZYME INJ 2.9MG/5M 5 NM, LA, PA; DL calcitriol cap 0.5mcg,0.25mcg 2 calcitriol inj 1mcg/ml 2 calcitriol sol 1mcg/ml 2 34

50 CYSTADANE POW 4 NM; DL doxercalciferol cap 0.5mcg, 1mcg, 2.5mcg 4 FABRAZYME INJ 35MG 5 NM, PA; DL KUVAN TAB 100MG 5 NM, LA, PA; DL levocarnitine inj 200mg/ml 4 levocarnitine sol 1gm/10ml 2 levocarnitine tab 330mg 2 MYOZYME INJ 50MG 5 NM, PA; DL NAGLAZYME INJ 1MG/ML 5 NM, LA, PA; DL ORFADIN 5 NM paricalcitol cap 1 mcg, 2 mcg, 4 mcg 4 SENSIPAR TAB 30MG, 60MG, 90MG 3 NM; DL ZEMPLAR CAP 1MCG, 2MCG, 4MCG 4 ZEMPLAR INJ 2MCG/ML, 5MCG/ML 4 B/D; DL MICROSOMAL TRIGLYCERIDE TRANSFER PROTEIN (MTP) INHIBITORS JUXTAPID CAP 5MG, 10MG, 20MG 5 NM, PA; DL MIGRAINE COMBINATIONS TREXIMET TAB MG 4 QL (9 tabs / 30 days) MIGRAINE PRODUCTS cafergot 4 QL (43 tabs / 30 days) dihydroergot inj 1mg/ml 2 QL (26 / 30 days) MIGRANAL 4 MINERALOCORTICOIDS fludrocort tab 0.1mg 2 MIOTICS PHOSPHOLINE SOL 0.125%OP 3 MISC. ANTI-ULCER CARAFATE SUS 1GM/10ML 2 sucralfate tab 1gm 2 MITOTIC INHIBITORS ABRAXANE INJ 100MG 5 B/D; DL DOCEFREZ INJ 20MG, 80MG 4 DL docetaxel inj 80mg/4ml 2 B/D; DL DOCETAXEL INJ 80MG/8ML 2 B/D; DL ETOPOPHOS INJ 100MG 4 B/D; DL etoposide inj 500/25ml 2 B/D; DL HALAVEN INJ 1MG/2ML 5 B/D, NM; DL IXEMPRA KIT INJ 45MG 5 B/D, NM; DL JEVTANA INJ 60/1.5ML 5 B/D, NM; DL paclitaxel inj 300/50ml 2 B/D; DL VINBLASTINE INJ 1MG/ML 2 B/D; DL vincasar 2 B/D; DL vincristine inj 1mg/ml 2 B/D; DL vinorelbine inj 10mg/ml 4 B/D; DL MIXED VACCINE COMBINATIONS COMVAX INJ 4 MODIFIED CYCLICS BRINTELLIX TAB 5MG, 10MG, 20MG 4 PA nefazodone tab 50mg, 100mg, 150mg, 200mg, 250mg 2 trazodone tab 50mg, 100mg, 150mg, 300mg 2 35

51 VIIBRYD KIT 4 VIIBRYD TAB 10MG, 20MG, 40MG 4 MONOAMINE OXIDASE INHIBITORS (MAOIS) EMSAM DIS 6MG/24HR, 9MG/24HR, 12MG/24HR 4 MARPLAN TAB 10MG 4 phenelzine tab 15mg 2 tranylcypromine tab 10mg 2 MONOCLONAL ANTIBODIES SYNAGIS INJ 50MG 5 NM; DL MOVEMENT DISORDER DRUG THERAPY XENAZINE TAB 12.5MG 5 NM, LA, PA; DL XENAZINE TAB 25MG 5 NM, LA, PA; DL MUCOLYTICS acetylcyst sol 10%, 20% 2 B/D; DL MULTIPLE SCLEROSIS AGENTS AMPYRA TAB 10MG 5 QL (60 tabs / 30 days), NM, LA, PA; DL AUBAGIO TAB 7MG, 14MG 5 QL (30 tabs / 30 days), NM; DL AVONEX KIT 30MCG 5 NM; DL AVONEX PREFL KIT 30MCG 5 NM; DL BETASERON INJ 0.3MG 5 NM; DL COPAXONE INJ 40MG/ML 5 NM; DL EXTAVIA INJ 0.3MG 5 NM; DL GILENYA CAP 0.5MG 5 QL (30 caps / 30 days), NM; DL REBIF INJ 22/0.5, 44/0.5 5 NM; DL REBIF TITRTN SOL PACK 5 NM; DL TECFIDERA CAP 120MG, 240MG 5 NM; DL TECFIDERA MIS STARTER 5 NM; DL TYSABRI INJ 300/15ML 5 NM, LA, PA; DL NASAL ANTI-INFECTIVES BACTROBAN OIN NASAL 2% 4 NASAL ANTIALLERGY azelastine spr 0.15%, 0.1% 2 PATANASE SPR 0.6% 4 NASAL ANTICHOLINERGICS ipratropium spr 0.03%, 0.06% 2 NASAL STEROIDS BECONASE AQ SUS 0.042% 4 budesonide (nasal) 2 flunisolide spr 0.025% 2 fluticasone spr 50mcg 2 OMNARIS SPR 4 triamcinolone spr 55mcg/ac 2 VERAMYST SPR 27.5MCG 4 NATURAL PENICILLINS BICILLIN L-A INJ , , PEN G PROC INJ pen g sod inj PENICILL GK/ INJ DEX 2MU, 3MU 4 penicilln gk inj 5mu 2 penicilln vk sol 125/5ml, 250/5ml 2 36

52 penicilln vk tab 250mg, 500mg 2 pfizerpen 2 NICOTINIC ACID DERIVATIVES niacin er tab 500mg, 750mg, 1000mg 2 niacor 3 NITRATES ISORDIL TAB 40MG 4 isosorb din tab 5mg, 10mg, 20mg, 40mg er 2 isosorb mono tab 10mg, 20mg, 30mg er, 60mg er, 120mg er 2 NITRO-BID OIN 2% 2 NITRO-DUR DIS 0.1MG/HR, 0.2MG/HR, 0.3MG/HR, 0.4MG/HR, 4 0.6MG/HR, 0.8MG/HR nitroglycerin dis 0.1mg/hr, 0.2mg/hr, 0/4mg/hr 2 NITROGLYCERIN INJ 5MG/ML 2 nitroglycerin dis 0.6mg/hr 2 Nitroglycerin spray 0.4mg 2 NITROSTAT SUB 0.3MG, 0.4MG, 0.6MG 4 NON-BARBITURATE HYPNOTICS zaleplon 4 QL (90 caps / 320 days) zolpidem tab 5mg, 10mg 2 QL (90 tabs / 320 days) NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS) CELEBREX CAP 50MG, 100MG, 200MG, 400MG 4 diclo/misopr tab mg, mg 2 diclofenac pot tab 50mg 2 diclofenac tab 25mg dr, 50mg dr, 75mg dr, 100mg er 2 DUEXIS 4 etodolac cap 200mg, 300mg 2 etodolac tab 400mg, 500mg 2 fenoprofen tab 600mg 2 flurbiprofen tab 50mg, 100mg 2 ibuprofen tab 400mg, 600mg, 800mg 1 ketoprofen cap 50mg, 75mg, 200mg er 2 meclofenamate sod cap 50mg, 100mg 2 mefenam acid cap 250mg 2 meloxicam SUSP 2 meloxicam tab 7.5mg, 15mg 1 nabumetone tab 500mg, 750mg 2 naproxen dr tab 375mg, 500mg 1 naproxen sod tab 275mg, 550mg 1 naproxen sus 125/5ml 1 naproxen tab 250mg, 375mg, 500mg 1 oxaprozin tab 600mg 2 piroxicam cap 10mg, 20mg 2 sulindac tab 150mg, 200mg 2 tolmetin sod cap 400mg, 600mg 3 OPHTHALMIC ADRENERGIC AGENTS ALPHAGAN P SOL 0.1% 3 apraclonidin sol 0.5% op 2 brimonidine sol 0.2% op, 0.15% 2 IOPIDINE SOL 1% OP 4 SIMBRINZA SUS 1-0.2% 4 37

53 OPHTHALMIC ANTI-INFECTIVES AZASITE SOL 1% 4 bacit/polymy oin op 2 bacitracin oin op 2 BESIVANCE SUS 0.6% 4 BLEPH-10 SOL 10% OP 4 CILOXAN OIN 0.3% OP 4 ciprofloxacn sol 0.3% op 2 erythromycin oin op 2 gatifloxacin sol 0.5% 2 gentak 2 gentamicin oin 0.3% op 2 gentamicin sol 0.3% op 2 levofloxacin sol 0.5% 2 NATACYN SUS 5% OP 3 neo/bac/poly oin op 2 neo/poly/gra sol op 2 ofloxacin dro 0.3% op 2 polymyxin b/ sol trimethp 2 sod sulfacet sol 10% op 2 sulfacet sod oin 10% op 2 tobramycin sol 0.3% op 2 TOBREX OIN 0.3% OP 4 trifluridine sol 1% op 2 VIGAMOX DRO 0.5% 3 ZIRGAN GEL 0.15% 4 ZYMAXID SOL 0.5% 4 OPHTHALMIC DECONGESTANTS naphazoline sol 0.1% op 2 OPHTHALMIC IMMUNOMODULATORS RESTASIS EMU 0.05% 4 OPHTHALMIC LOCAL ANESTHETICS proparacaine sol 0.5% op 2 OPHTHALMIC STEROIDS BLEPHAMIDE OIN S.O.P. 4 BLEPHAMIDE SUS OP 4 dexameth pho sol 0.1% op 2 DUREZOL EMU 0.05% 4 FLAREX SUS 0.1% OP 4 FML FORTE SUS 0.25% OP 4 FML OIN 0.1% OP 4 LOTEMAX GEL 0.5% 3 LOTEMAX OIN 0.5% 3 MAXIDEX SUS 0.1% OP 3 neo/poly/bac oin /hc 1%op 2 neo/poly/dex oin 0.1% op 2 neo/poly/dex sus 0.1% op 2 neo/poly/hc sus op 2 PRED MILD SUS 0.12% OP 4 PRED SOD PHO SOL 1% OP 2 PRED-G S.O.P OIN OP 4 PRED-G SUS OP 4 38

54 prednisolone acetate (ophth) 2 sulf/pred na sol op 2 tobra/dexame sus % 2 TOBRADEX OIN % 3 VEXOL SUS 1% OP 4 OPHTHALMICS - MISC. ACUVAIL SOL 0.45% 4 ALOCRIL SOL 2% 4 ALOMIDE SOL 0.1% OP 4 azelastine dro 0.05% 2 AZOPT SUS 1% OP 4 bromfenac sol 0.09% 2 cromolyn sod sol 4% op 2 CYSTARAN SOL 0.44% 5 NM, PA; DL diclofenac sol 0.1% op 2 dorzolamide sol 2% op 2 EMADINE SOL 0.05% OP 4 epinastine dro 0.05% 2 flurbiprofen sol 0.03% op 2 ketorolac sol 0.4% 2 ketorolac sol 0.5% 2 NEVANAC SUS 0.1% 4 PATADAY SOL 0.2% 4 PATANOL SOL 0.1% OP 3 PILOCARPINE HCL SOLN 2 OPIOID AGONISTS codeine sulf tab 15mg 2 codeine sulf tab 30mg, 60mg 2 DILAUDID LIQ 1MG/ML 4 duramorph 2 fentanyl dis 12mcg/hr, 25mcg/hr, 50mcg/hr, 75mcg/hr, 100mcg/hr 2 QL (20 patches / 30 days) fentanyl ot loz 200mcg 4 QL (120 lpop / 30 days), PA; DL fentanyl ot loz 400mcg, 600mcg, 800mcg, 1200mcg, 1600mcg 5 QL (120 lpop / 30 days), PA; DL FENTORA TAB 100MCG, 200MCG, 400MCG, 600MCG, 800MCG 5 QL (120 tabs / 30 days), PA; DL hydromorphon inj 500/50ml 2 hydromorphon tab 2mg, 4mg, 8mg 2 QL (250 tabs / 30 days) hydromorphone hcl LIQD 2 LAZANDA 5 QL (24 bottles / 30 days), PA; DL levorphanol tab 2mg 2 QL (160 tabs / 30 days) METHADONE INJ 10MG/ML 2 methadone sol 5mg/5ml 2 methadone sol 10mg/5ml 2 methadone tab 5mg, 10mg 2 morphine sul bead cap 30mg er, 60mg er 4 QL (90 caps / 90 days) morphine sul cap 10mg er, 20mg er 3 QL (90 caps / 30 days) morphine sul cap 30mg er, 45mg er, 50mg er 4 QL (90 caps / 30 days) morphine sul cap 60mg er 4 QL (60 caps / 30 days) morphine sul cap 75mg er 4 QL (90 caps / 90 days) morphine sul cap 80mg er 4 QL (60 caps / 30 days) morphine sul cap 90mg er 4 QL (90 caps / 90 days) morphine sul cap 100mg er 4 QL (60 caps / 30 days) morphine sul cap 120mg er 4 QL (90 caps / 90 days) 39

55 morphine sul sol 10mg/5ml, 20mg/5ml, 20mg/ml 2 morphine sul tab 15mg, 30mg 2 QL (300 tabs / 30 days) morphine sul tab 15mg er, 30mg er 2 QL (90 tabs / 30 days) morphine sul tab 60mg er, 100mg er, 200mg er 2 QL (60 tabs / 30 days) MORPHINE SULFATE SOLN 2mg/ml, 4mg/ml 2 OPANA ER TAB 5MG, 7.5MG, 10MG, 15MG, 20MG 4 QL (90 tabs / 30 days) OPANA ER TAB 30MG, 40MG 4 QL (60 tabs / 30 days) oxycodone cap 5mg 2 QL (240 caps / 30 days) oxycodone con 100/5ml 2 QL (120 ml / 30 days) oxycodone sol 5mg/5ml 2 oxycodone tab 5mg, 10mg 2 QL (240 tabs / 30 days) oxycodone tab 15mg, 20mg, 30mg 2 QL (200 tabs / 30 days) OXYCONTIN TAB 10MG CR, 15MG CR, 20MG CR, 30MG CR 4 QL (90 tabs / 30 days) OXYCONTIN TAB 40MG CR, 60MG CR, 80MG CR 4 QL (60 tabs / 30 days) oxymorphone tab 5mg er 2 QL (90 tabs / 30 days) oxymorphone tab 7.5mg er, 10mg er 2 QL (90 tabs / 30 days) oxymorphone tab 15mg er, 20mg er 4 QL (90 tabs / 30 days) oxymorphone tab 30mg er, 40mg er 4 QL (60 tabs / 30 days) oxymorphone tab hcl 5mg 3 QL (240 tabs / 30 days) oxymorphone tab hcl 10mg 3 QL (200 tabs / 30 days) tramadol hcl tab 50mg 2 tramadol hcl tab 100mg er, 200mg er, 300mg er 3 ZOHYDRO ER CAP 10MG, 15MG, 20MG, 30MG, 40MG, 50MG 4 QL (60 caps / 30 days), PA OPIOID ANTAGONISTS naloxone inj 1mg/ml 2 naltrexone tab 50mg 2 VIVITROL INJ 380MG 5 NM; DL OPIOID COMBINATIONS apap/codeine sol /5 2 apap/codeine tab mg, mg, mg 2 QL (360 tabs / 30 days) ascomp 2 but/apap/caf cap codeine 2 endocet 2 QL (360 tabs / 30 days) hydrocodone/apap sol hydrocodone/apap tab 5-300mg, 5-325mg 2 QL (360 tabs / 30 days) hydrocodone/apap tab , mg 2 QL (360 tabs / 30 days) hydrocodone/apap tab mg, mg 2 QL (360 tabs / 30 days) hydrocodone/ibu tab QL (150 tabs / 30 days) lorcet 3 QL (360 tabs / 30 days) lortab TABS 3 QL (360 tabs / 30 days) oxycodone/apap tab , 5-325mg, mg, mg 2 QL (360 tabs / 30 days) oxycodone/asa tab 2 QL (360 tabs / 30 days) oxycodone/ibu tab 5-400mg 2 QL (28 tabs / 30 days) reprexain 2 QL (150 tabs / 30 days) REPREXAIN TAB , 5-200MG 2 QL (150 tabs / 30 days) Tramadol/apap tab vicodin 2 QL (360 tabs / 30 days) ZAMICET SOL MG 2 OPIOID PARTIAL AGONISTS bupren/nalox sub 2-0.5mg 4 QL (90 tabs / 30 days) bupren/nalox sub 8-2mg 4 QL (90 tabs / 30 days) BUPRENEX INJ 0.3MG/ML 4 40

56 buprenorphine inj 0.3mg/ml 2 buprenorphine sub 2mg, 8mg 2 butorphanol inj 1mg/ml, 2mg/ml 2 butorphanol sol 10mg/ml 2 QL (4 vials / per 30 days) nalbuphine inj 10mg/ml, 20mg/ml 2 SUBOXONE MIS 2-0.5MG, 4-1MG, 8-2MG, 12-3MG 4 QL (90 tabs / 30 days) OTIC AGENTS - MISCELLANEOUS acetic acid sol 2% otic 2 OTIC ANTI-INFECTIVES ofloxacin dro 0.3%otic 2 OTIC COMBINATIONS CIPRO HC SUS OTIC 4 CIPRODEX SUS % 3 COLY-MYCIN S SUS OTIC 4 CORTISPORIN SUS -TC OTIC 4 neo/poly/hc sol 1% otic 2 neo/poly/hc sus 1% otic 2 OTIC STEROIDS acetasol hc 2 fluocinolone acet oil 0.01% 2 hc/acetic acid sol otic 2 OXAZOLIDINONES ZYVOX SOL 2MG/ML 5 PA; DL ZYVOX SUS 100MG/5M 5 QL (1680 ml / 180 days); DL ZYVOX TAB 600MG 5 QL (56 tabs / 180 days); DL OXYTOCICS methylergon tab 0.2mg 2 PARENTERAL THERAPY SUPPLIES INSULIN PEN NEEDLE 3 INSULIN SAFETY NEEDLES 3 INSULIN SYRINGE 3 PENICILLIN COMBINATIONS amox-pot cla tab er 2 amox/k clav chw 200mg, 400mg 2 amox/k clav sus 200/5ml, 250/5ml, 400/5ml, 600/5ml 2 amox/k clav tab 250mg, 500mg, 875mg 2 amp-sulbacta inj 3gm, 15mg 2 BICILLIN C-R INJ 900/300 4 BICILLIN C-R INJ piper/tazoba inj g, 4-0.5gm 2 TIMENTIN INJ 3.1GM 4 ZOSYN SOL GM, G 4 PENICILLINASE-RESISTANT PENICILLINS BACTOCILL INJ DEX 1GM, 2GM 2 dicloxacill cap 250mg, 500mg 2 nafcillin inj 1gm 2 nafcillin inj 10gm 2 NALLPEN/DEX INJ 1GM/50ML 2 oxacillin inj 2gm, 10mg 2 PERIPHERAL OPIOID RECEPTOR ANTAGONISTS 41

57 RELISTOR KIT 12/0.6ML 4 PHENOTHIAZINES CHLORPROMAZINE INJ 25MG/ML 2 chlorpromazine tab 10mg, 25mg, 50mg, 100mg, 200mg 2 compro 2 fluphenaz de inj 25mg/ml 2 fluphenazine con 5mg/ml 2 fluphenazine elx 2.5/5ml 2 fluphenazine inj 2.5mg/ml 2 fluphenazine tab 1mg, 2.5mg, 5mg, 10mg 2 perphenazine tab 2mg, 4mg, 8mg, 16mg 2 prochlorperazine inj 5mg/ml 2 prochlorperazine sup 25mg 2 prochlorperazine tab 5mg, 10mg 2 thioridazine tab 10mg 4 thioridazine tab 25mg, 50mg, 100mg 4 trifluoperazine tab 1mg, 2mg, 5mg, 10mg 2 PHOSPHATE BINDER AGENTS calc acetate cap 667mg 2 ELIPHOS TAB 667MG 2 FOSRENOL CHW 500MG, 750MG, 1000MG 4 RENAGEL TAB 400MG, 800MG 4 PIGMENTING-DEPIGMENTING AGENTS OXSORALEN LOT 1% 4 PLATELET AGGREGATION INHIBITORS AGGRENOX CAP MG 4 anagrelide cap 0.5mg, 1mg 2 BRILINTA TAB 90MG 4 cilostazol tab 50mg, 100mg 2 clopidogrel tab 75mg, 300mg 2 EFFIENT TAB 5MG, 10MG 4 POLYMYXINS polymyxin b inj POSTERIOR PITUITARY HORMONES desmopressin inj 4mcg/ml 2 desmopressin spr 0.01% 2 desmopressin tab 0.1mg, 0.2mg 2 STIMATE SOL 1.5MG/ML 4 NM POTASSIUM K-TAB 4 K-TAB TAB 10MEQ CR 4 klor-con 2 KLOR-CON M15 TAB 2 pot chloride cap 8meq er, 10meq er 2 pot chloride inj 2meq/ml 2 pot chloride inj 10meq, 20meq, 40meq 2 pot cl micro tab 10meq er, 20meq er 2 POTASSIUM REMOVING RESINS kionex 2 sod poly sul sus 15gm/60 2 POTASSIUM SPARING DIURETICS 42

58 amiloride tab 5mg 1 DYRENIUM CAP 50MG, 100MG 4 spironolactone tab 25mg, 50mg, 100mg 1 PRENATAL VITAMINS PRENATAL VITAMIN/FOLIC ACID > 0.8 MG (GENERIC) 2 PROGESTIN CONTRACEPTIVES - INJECTABLE DEPO-SQ PROV INJ medroxyprogesterone ac inj 150mg/ml 2 PROGESTIN CONTRACEPTIVES - ORAL camila 28 day 2 errin 28 day 2 jolivette 28 day 2 lyza 2 nora-be 28 day 2 norethindron tab 0.35mg 2 PROGESTINS medroxyprogesterone acetate tab 2.5mg, 5mg, 10mg 2 MEGACE ES SUS 625/5ML 4 PA; DL norethin ace tab 5mg 2 progesterone cap 100mg, 200mg 2 PROLACTIN INHIBITORS cabergoline tab 0.5mg 2 PROSTAGLANDIN VASODILATORS TYVASO SOL 0.6MG/ML 5 NM, PA; DL VENTAVIS SOL 10MCG/ML, 20MCG/ML 5 NM, PA; DL PROSTAGLANDINS - OPHTHALMIC latanoprost sol 0.005% 1 LUMIGAN SOL 0.01% 4 TRAVATAN Z DRO 0.004% 4 travoprost dro 0.004% 2 PROSTATIC HYPERTROPHY AGENTS alfuzosin tab 10mg 2 AVODART CAP 0.5MG 3 finasteride tab 5mg 2 JALYN CAP 3 RAPAFLO CAP 4MG, 8MG 4 tamsulosin cap 0.4mg 2 PROTEINS AMINOSYN II INJ 7%, 8.5%, 10% 4 B/D; DL AMINOSYN II INJ 15% 2 B/D; DL AMINOSYN M INJ 3.5% 4 B/D; DL AMINOSYN-HBC INJ 7% 4 B/D; DL AMINOSYN-PF INJ 7%, 10% 4 B/D; DL CLINIMIX E INJ 2.75/D5W, 2.75/D10 4 CLINIMIX E INJ 4.25/D5W, 4.25/D5W 4 B/D; DL CLINIMIX E INJ 5%/D15W, 5%/D20W, 5%/D25W 4 B/D; DL CLINIMIX INJ 2.75/D5W 4 B/D; DL CLINIMIX INJ 4.25/D5W 4 B/D CLINIMIX INJ 4.25/D10, 4.25/D20 4 B/D; DL CLINIMIX INJ 5%/D15W, 5%/D20W, 5%/D25W 4 B/D; DL 43

59 hepatamine 8 4 B/D; DL hepatasol 8 4 B/D; DL NEPHRAMINE INJ 5.4% 4 B/D; DL premasol 4 B/D; DL PREMASOL SOL 10% 2 B/D; DL PROCALAMINE INJ 3% 4 B/D; DL PROSOL INJ 20% 4 B/D; DL TRAVASOL INJ 10% 2 B/D; DL TROPHAMINE INJ 6%, 10% 4 B/D; DL PROTON PUMP INHIBITORS DEXILANT CAP 30MG DR, 60MG DR 4 QL (90 caps / 90 days) esomeprazole inj 20mg 4 PA; DL esomeprazole inj 40mg 4 PA; DL lansoprazole cap 15mg dr, 30mg dr 2 QL (180 caps / 90 days) NEXIUM CAP 20MG, 40MG 4 QL (90 caps / 90 days) NEXIUM GRA 2.5MG DR, 5MG DR, 10MG DR, 40MG DR 4 QL (90 / 90 days) omeprazole cap 10mg, 20mg, 40mg 2 QL (60 caps / 30 days) OMEPRAZOLE-SODIUM BICARBONATE 3 QL (30 caps / 30 days) pantoprazole tab 20mg, 40mg 2 QL (180 tabs / 90 days) rabeprazole tab 20mg 2 QL (30 tabs / 30 days) PSEUDOBULBAR AFFECT (PBA) AGENTS NUEDEXTA CAP 20-10MG 4 PA; DL PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. ergoloid mesylates TABS 2 ORAP TAB 1MG, 2MG 4 PULMONARY HYPERTENSION - ENDOTHELIN RECEPTOR ANTAGONISTS LETAIRIS TAB 5MG, 10MG 5 NM, LA, PA; DL OPSUMIT TAB 10MG 5 NM, PA; DL TRACLEER TAB 62.5MG, 125MG 5 NM, LA, PA; DL PULMONARY HYPERTENSION - PHOSPHODIESTERASE INHIBITORS ADCIRCA TAB 20MG 5 NM, PA; DL sildenafil tab 20mg 2 QL (90 tabs / 30 days), NM, PA; DL PULMONARY HYPERTENSION - SOL GUANYLATE CYCLASE STIMULATOR ADEMPAS TAB 0.5MG, 1.5MG, 1MG, 2.5MG, 2MG 5 QL (90 tabs / 30 days), NM, PA; DL PYRIMIDINE SYNTHESIS INHIBITORS leflunomide tab 10mg, 20mg 2 QUINOLINONE DERIVATIVES ABILIFY DISC TAB 10MG, 15MG 4 ABILIFY INJ 9.75MG 4 ABILIFY MAIN INJ 300MG 5 QL (1 / 28 days); DL ABILIFY SOL 1MG/ML 4 ABILIFY TAB 2MG, 5MG, 10MG, 15MG, 20MG, 30MG 4 RECTAL STEROIDS procto-pak 2 proctozone hc 2 RESPIRATORY cetirizine hcl SYRP 1mg/ml 2 CLARINEX-D TAB 5-240MG 4 SEMPREX-D 4 RESPIRATORY SYNCYTIAL VIRUS (RSV) AGENTS 44

60 VIRAZOLE INH 6GM 5 RESTLESS LEG SYNDROME (RLS) AGENTS HORIZANT TAB 300MG, 600MG 3 ROSACEA AGENTS FINACEA GEL 15% 4 METROGEL GEL 1% 4 metronidazol cre 0.75% 2 metronidazol gel 0.75% 2 metronidazol gel 1% 3 metronidazol lot 0.75% 2 Respiratory diphenhydramine hcl INJ 2 SALICYLATES diflunisal tab 500mg 2 SALINE LAXATIVES OSMOPREP TAB 1.5GM 3 SCABICIDES PEDICULICIDES EURAX CRE 10% 4 EURAX LOT 10% 4 lindane lot 1% 2 lindane sha 1% 2 malathion lot 0.5% 2 permethrin cre 5% 2 spinosad sus 0.9% 2 ULESFIA LOT 5% 4 SELECTIVE ALDOSTERONE RECEPTOR ANTAGONISTS (SARAS) eplerenone tab 25mg 2 eplerenone tab 50mg 2 SELECTIVE COSTIMULATION MODULATORS ORENCIA INJ 125MG/ML 5 QL (4 / 28 days), NM, PA; DL SELECTIVE MELATONIN RECEPTOR AGONISTS HETLIOZ 5 QL (30 caps / 30 days), NM, PA ROZEREM TAB 8MG 3 QL (30 tabs / 30 days) SELECTIVE PHOSPHODIESTERASE 4 (PDE4) INHIBITORS DALIRESP TAB 500MCG 4 DL SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) citalopram sol 10mg/5ml 1 citalopram tab 10mg, 20mg, 40mg 1 escitalopram sol 5mg/5ml 2 escitalopram tab 5mg, 10mg, 20mg 2 fluoxetine cap 10mg, 20mg, 40mg 1 fluoxetine cap 90mg dr 3 fluoxetine sol 20mg/5ml 1 fluoxetine tab 10mg, 20mg 1 FLUOXETINE TAB 60MG 4 fluvoxamine cap 100mg er, 150mg er 2 fluvoxamine tab 25mg, 50mg, 100mg 2 paroxetin er tab 12.5mg, 37.5mg 2 paroxetine tab 10mg, 20mg 1 paroxetine tab 25mg er 2 45

61 paroxetine tab 30mg, 40mg 1 PAXIL SUS 10MG/5ML 4 sertraline con 20mg/ml 1 sertraline tab 25mg, 50mg, 100mg 1 SEROTONIN AGONISTS AXERT TAB 6.25MG 4 QL (12 tabs / 30 days) AXERT TAB 12.5MG 4 QL (8 tabs / 30 days) FROVA TAB 2.5MG 4 QL (12 tabs / 30 days) naratriptan tab 1mg 2 QL (18 tabs / 30 days) naratriptan tab 2.5mg 2 QL (9 tabs / 30 days) RELPAX TAB 20MG 3 QL (12 tabs / 30 days) RELPAX TAB 40MG 3 QL (8 tabs / 30 days) rizatriptan tab 5mg, 5mg odt, 10mg, 10mg odt 2 QL (12 tabs / 30 days) SUMATRIPTAN SOLN 3 QL (12 units / 30 days) sumatriptan inj 6mg/0.5 4 QL (4 / 30 days) sumatriptan tab 25mg, 50mg 2 QL (18 tabs / 30 days) sumatriptan tab 100mg 2 QL (9 tabs / 30 days) zolmitriptan tab 2.5 mg odt, 2.5mg 2 QL (36 tabs / 90 days) zolmitriptan tab 5mg, 5mg odt 2 QL (24 tabs / 90 days) SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS) DESVENLAFAX TAB 50MG ER 2 DESVENLAFAXINE TAB 100MG ER 2 duloxetine cap 20mg, 30mg, 60mg 2 FETZIMA CAP 20MG, 40MG, 80MG, 120MG 4 PA FETZIMA CAP TITRATIO 4 PA PRISTIQ TAB 50MG, 100MG 4 venlafaxine cap 37.5 er, 75mg er, 150mg er 2 venlafaxine tab 25mg, 37.5mg er, 37.5mg, 50mg, 75mg, 75mg er, 2 100mg, 150mg er VENLAFAXINE TAB 225MG ER 4 SHORT BOWEL SYNDROME (SBS) AGENTS GATTEX KIT 5MG 5 NM, LA; DL SMOKING DETERRENTS buproban 2 CHANTIX PAK 0.5& 1MG 4 CHANTIX TAB 0.5MG, 1MG 4 NICOTROL INH 4 NICOTROL NS SPR 10MG/ML 4 SODIUM sod chloride inj 0.9%, 0.45% 2 sod chloride inj 2.5/ml 2 sod chloride inj 3%, 5% 2 SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITORS FARXIGA 4 INVOKANA TAB 100MG, 300MG 4 SOLUBLE TUMOR NECROSIS FACTOR RECEPTOR AGENTS ENBREL INJ 25/0.5ML 5 NM, PA; DL ENBREL INJ 25MG 5 NM, PA; DL ENBREL INJ 50MG/ML 5 NM, PA; DL SOMATOSTATIC AGENTS octreotide inj 50mcg/ml 4 NM; DL 46

62 octreotide inj 100mcg, 200mcg 4 NM; DL octreotide inj 500mcg, 1000mcg 5 NM; DL SANDOSTATIN KIT LAR 10MG, 20MG, 30MG 5 NM; DL SOMATULINE INJ 60/0.2ML, 90/0.3ML, 120/.5ML 5 NM; DL STEM CELL MOBILIZERS MOZOBIL INJ 5 NM, PA; DL STEROID INHALANTS ALVESCO AER 80MCG, 160MCG 4 ASMANEX 30 AER 110MCG, 220MCG 3 ASMANEX 60 AER 220MCG 3 ASMANEX 120 AER 220MCG 3 budesonide sus 0.5mg/2, 0.25mg/2 2 B/D FLOVENT DISK AER 50MCG, 100MCG, 250MCG 3 FLOVENT HFA AER 44MCG, 110MCG, 220MCG 3 PULMICORT INH 90MCG, 180MCG 3 PULMICORT SUS 1MG/2ML 4 B/D QVAR AER 40MCG, 80MCG 3 STEROIDS - MOUTH/THROAT triamcin/ora pst 0.1% 2 STIMULANTS - MISC. DAYTRANA DIS 10MG/9HR, 15MG/9HR, 20MG/9HR, 30MG/9HR 4 dexmethylphenidate cap 15mg er, 30mg er, 40mg er 2 dexmethylphenidate tab 2.5mg, 5mg, 10mg 2 metadate 2 METHYLIN CHW 2.5MG, 5MG, 10MG 4 methylphenidate cap 10mg, 20mg er, 30mg er, 40mg er, 50mg, 60mg 4 methylphenidate sol 5mg/5ml, 10mg/5ml 2 methylphenidate tab 5mg, 10mg 2 methylphenidate tab 18mg er 4 methylphenidate tab 20mg 2 methylphenidate tab 20mg er, 27mg er, 36mg er, 54mg er 4 modafinil tab 100mg, 200mg 4 QL (30 tabs / 30 days), PA STREPTOGRAMINS SYNERCID INJ 500MG 5 DL SUBSTANCE P/NEUROKININ 1 (NK1) RECEPTOR ANTAGONISTS EMEND CAP 40MG 3 B/D, QL (1 caps / 30 days); DL EMEND CAP 80MG 3 B/D, QL (8 caps / 30 days); DL EMEND CAP 125MG 3 B/D, QL (2 caps / 30 days); DL EMEND PAK 80 & B/D, QL (6 caps / 30 days); DL SUCCINIMIDES CELONTIN CAP 300MG 3 ethosuximide cap 250mg 2 ethosuximide sol 250/5ml 2 SULFONAMIDES SULFADIAZINE TAB 500MG 2 SULFONYLUREAS glimepiride tab 1mg, 2mg, 4mg 1 glipizide er tab 2.5mg, 5mg, 10mg 1 glipizide tab 5mg, 10mg 1 tolazamide tab 250mg, 500mg 2 47

63 tolbutamide tab 500mg 2 SYMPATHOMIMETIC DECONGESTANTS TYZINE PED DRO 0.05% 3 SYMPATHOMIMETICS ADVAIR DISKU AER 100/50, 250/50, 500/50 3 ADVAIR HFA AER 45/21, 115/21, 230/21 3 albuterol neb 0.5% 2 B/D albuterol neb 0.63mg/3 2 B/D albuterol neb 0.083% 2 B/D albuterol neb 1.25mg/3 2 B/D albuterol syp 2mg/5ml 2 albuterol tab 2mg, 4mg, 4mg er, 8mg er 2 BREO ELLIPTA INH BROVANA NEB 15MCG 4 B/D; DL COMBIVENT AER RESPIMAT 3 DULERA AER 100-5MCG, 200-5MCG 3 FORADIL CAP AEROLIZE 3 ipratropium/ sol albuter 2 B/D levalbuterol neb 0.31mg, 0.63mg 2 B/D levalbuterol neb 1.25/0.5 2 B/D metaproteren syp 10mg/5ml 2 metaproteren tab 10mg, 20mg 2 PERFOROMIST NEB 20MCG 4 B/D; DL PROAIR HFA AER 3 SEREVENT DIS AER 50MCG 3 SYMBICORT AER , terbutaline inj 1mg/ml 2 terbutaline tab 2.5mg 2 terbutaline tab 5mg 2 VENTOLIN HFA AER 3 TETRACYCLINES demeclocycl tab 150mg, 300mg 2 doxycyc mono tab 50mg 2 doxycyc mono tab 75mg, 150mg 4 doxycycl hyc cap 50mg, 100mg 2 doxycycl hyc tab 75mg dr, 100mg 2 doxycycl hyc tab 100mg dr, 150mg dr 4 doxycycline cap 75mg 2 doxycycline hyclate SOLR 2 doxycycline sus 25mg/5ml 2 doxycycline tab 20mg 2 minocycline cap 50mg, 75mg, 100mg 2 minocycline tab 45mg er 4 minocycline tab 50mg, 75mg 2 minocycline tab 90mg er 4 minocycline tab 100mg 2 minocycline tab 135mg er 4 VIBRAMYCIN SYP 50MG/5ML 4 THIAZIDES AND THIAZIDE-LIKE DIURETICS chlorothiazide tab 250mg, 500mg 1 chlorthalidone tab 25mg, 50mg 1 hydrochlorothiazide cap 12.5mg 1 48

64 hydrochlorothiazide tab 12.5mg, 25mg, 50mg 1 indapamide tab 1.25mg, 2.5mg 1 methyclothia tab 5mg 2 metolazone tab 2.5mg, 5mg, 10mg 2 THIOXANTHENES thiothixene cap 1mg, 2mg, 5mg, 10mg 2 THROAT PRODUCTS - MISC. cevimeline cap 30mg 2 pilocarpine tab 5mg, 7.5mg 2 THROMBIN INHIBITORS ARGATROBAN INJ 125/125 5 B/D PRADAXA CAP 75MG, 150MG 4 THYROID HORMONES levothyroxin tab 25mcg, 50mcg, 75mcg, 88mcg, 100mcg, 112 mcg, 1 125mcg, 137mcg, 150mcg, 175mcg, 200mcg, 300mcg levoxyl 2 liothyronine inj 10mcg/ml 2 liothyronine tab 5mcg 2 liothyronine tab 25mcg 2 liothyronine tab 50mcg 2 SYNTHROID TAB 25MCG, 5MCG, 75MCG, 88MCG, 100MCG, 4 112MCG, 125MCG, 137MCG, 150MCG, 175MCG, 200MCG, 300MCG THYROLAR-1 TAB 60MG 4 THYROLAR-1/2 TAB 30MG 4 THYROLAR-1/4 TAB 15MG 4 THYROLAR-2 TAB 120MG 4 THYROLAR-3 TAB 180MG 4 TIROSINT CAP 13MCG, 25MCG, 50MCG, 75MCG, 88MCG, 100MCG, 4 112MCG, 125MCG, 137MCG, 150MCG unithroid 2 TOPOISOMERASE I INHIBITORS irinotecan inj 100/5ml 4 B/D; DL topotecan inj 4mg 5 B/D; DL TOXOID COMBINATIONS ADACEL INJ 6 BOOSTRIX INJ 6 DAPTACEL INJ 6 DIPHTHERIA/TETANUS TOXOID 6 INFANRIX INJ 6 TET/DIP TOX INJ 2-2 LF 6 TOXOIDS TETANUS TOX INJ 5LF ADS 6 TRICYCLIC AGENTS amitriptyline tab 10mg, 25mg, 50mg, 75mg, 100mg, 150mg 2 amoxapine tab 25mg, 50mg, 100mg, 150mg 2 clomipramine cap 25mg, 50mg, 75mg 3 desipramine tab 10mg, 25mg, 50mg 75mg, 100mg, 150mg 2 doxepin hcl cap 10mg, 25mg, 50mg, 75mg, 100mg, 150mg 2 doxepin hcl con 10mg/ml 2 imipramine hcl tab 10mg, 25mg, 50mg 2 imipramine pam cap 75mg, 100mg, 125mg, 150mg 4 49

65 nortriptyline cap 10mg, 25mg, 50mg, 75mg 2 nortriptyline sol 10mg/5ml 2 protriptyline tab 5mg 2 protriptylin tab 10mg 2 SURMONTIL CAP 25MG, 50MG, 100MG 4 ULCER DRUGS - PROSTAGLANDINS misoprostol tab 100mcg, 200mcg 2 ULCER THERAPY COMBINATIONS lansopr/amox mis /clarith 2 OMECLAMOX-PAK 4 PREVPAC MIS 4 PYLERA CAP 4 URICOSURICS probenecid tab 500mg 2 URINARY ANTI-INFECTIVES MACRODANTIN CAP 25MG 4 methenam hip tab 1gm 2 MONUROL PAK GRANULES 4 nitrofur mac cap 50mg 4 nitrofurantoin cap 100mg 4 nitrofurantoin sus 25mg/5ml 4 URINARY ANTISPASMODIC - ANTIMUSCARINICS (ANTICHOLINERGIC) oxybutynin syp 5mg/5ml 2 oxybutynin tab 5mg, 5mg er, 10mg er, 15mg er 2 tolterodine cap 2mg er, 4mb er 2 tolterodine tab 1mg, 2mg 2 TOVIAZ TAB 4MG, 8MG 4 trospium chl cap 60mg er 2 trospium cl tab 20mg 2 VESICARE TAB 5MG, 10MG 4 URINARY ANTISPASMODICS - BETA-3 ADRENERGIC AGONISTS MYRBETRIQ TAB 25MG, 50MG 4 URINARY ANTISPASMODICS - CHOLINERGIC AGONISTS bethanechol tab 5mg, 10mg, 25mg, 50mg 2 URINARY ANTISPASMODICS - DIRECT MUSCLE RELAXANTS flavoxate tab 100mg 2 VAGINAL ANTI-INFECTIVES CLEOCIN SUP 100MG 4 clindamycin cre 2% vag 2 gynazole-1 4 metronidazol gel 0.75%vag 2 terconazole cre 0.4%, 0.8% 2 terconazole sup 80mg 2 vandazole 2 zazole 2 VAGINAL ESTROGENS ESTRACE VAG CRE 0.1MG/GM 4 ESTRING MIS 2MG 3 FEMRING MIS 0.1MG/24 4 FEMRING MIS 0.05/24H 4 50

66 PREMARIN VAG CRE 0.625MG 4 VAGIFEM TAB 10MCG 3 VALPROIC ACID divalproex cap 125mg 2 divalproex tab 125mg dr, 250mg dr, 250mg er, 500mg dr, 500mg er 2 valproate inj 100mg/ml 2 valproic acd cap 250mg 2 valproic acd syp 250/5ml 2 VASODILATORS hydralazine inj 20mg/ml 2 hydralazine tab 10mg, 25mg, 50mg, 100mg 2 minoxidil tab 2.5mg, 10mg 2 VASOPRESSIN RECEPTOR ANTAGONISTS SAMSCA TAB 15MG, 30MG 5 NM, PA; DL VASOPRESSORS midodrine tab 2.5mg, 5mg, 10mg 2 VIRAL VACCINES CERVARIX INJ 4 ENGERIX-B INJ 10/0.5ML 4 B/D ENGERIX-B INJ 20MCG/ML 4 B/D GARDASIL INJ 4 HAVRIX INJ 720UNIT, 1440UNIT 4 IMOVAX RABIE INJ 2.5/ML 3 DL IPOL INJ INACTIVE 4 IXIARO INJ 4 M-M-R II INJ LIVE 4 PROQUAD INJ 4 RABAVERT INJ 3 DL RECOMBIVA HB INJ 10MCG/ML, 40MCG/ML 4 B/D ROTARIX 4 ROTATEQ SOL 4 TWINRIX INJ 4 VAQTA INJ 25/0.5ML 4 VARIVAX INJ 4 YF-VAX INJ 4 ZOSTAVAX INJ 6 WOUND CARE PRODUCTS REGRANEX GEL 0.01% 4 XANTHINES aminophyllin inj 25mg/ml 2 ELIXOPHYLLIN ELX 80/15ML 3 LUFYLLIN TAB 200MG, 400MG 4 theophylline tab 100mg cr, 200mg cr, 300mg er, 400mg er, 450mg er, 2 600mg er 51

67 Index 8 8-MOP 14 A abacav/lamiv /zidovud tab 14 abacavir tab 300mg 14 ABELCET INJ 5MG/ML 7 ABILIFY DISC TAB 10MG, 15MG 44 ABILIFY INJ 9.75MG 44 ABILIFY MAIN INJ 300MG 44 ABILIFY SOL 1MG/ML 44 ABILIFY TAB 2MG, 5MG, 10MG, 15MG, 20MG, 30MG 44 ABRAXANE INJ 100MG 35 acampro cal tab 333mg 1 ACANYA GEL % 1 acarbose tab 25mg, 50mg, 100mg 2 acebutolol cap 200mg, 400mg 17 acetasol hc 41 acetazolamide cap 500mg er 19 acetazolamide inj 500mg 19 acetazolamide tab 125mg, 250mg 19 acetic acid sol 2% otic 41 acetylcyst sol 10%, 20% 36 acitretin cap 10mg, 17.5mg, 25mg 14 ACTEMRA INJ 162/ ACTEMRA INJ 200/10ML 33 ACTHAR HP INJ 80UNIT 24 ACTHIB INJ 16 ACTIMMUNE INJ 2MU/ ACUVAIL SOL 0.45% 39 acyclovir cap 200mg 30 acyclovir na inj 500mg 30 acyclovir oin 5% 16 acyclovir sus 200/5ml 30 acyclovir tab 400mg, 800mg 30 ADACEL INJ 49 ADAGEN INJ 250/ML 18 adapalene 1 adapalene cre 0.1% 1 adapalene gel 0.1% 1 ADCIRCA TAB 20MG 44 adefov dipiv tab 10mg 29 ADEMPAS TAB 0.5MG, 1.5MG, 1MG, 2.5MG, 2MG 44 ADRENALIN INJ 1MG/ML 3 ADVAIR DISKU AER 100/50, 250/50, 500/50 48 ADVAIR HFA AER 45/21, 115/21, 230/21 48 ADVICOR TAB MG, MG, MG, MG 30 afeditab cr 18 AFINITOR DIS TAB 2MG, 3MG, 5MG 12 AFINITOR TAB 2.5MG, 5MG, 7.5MG, 10MG 12 AGGRENOX CAP MG 42 a-hydrocort 27 AKNE-MYCIN OIN 2% 1 ALBENZA TAB 200MG 7 albuterol neb 0.083% 48 albuterol neb 0.5% 48 albuterol neb 0.63mg/3 48 albuterol neb 1.25mg/3 48 albuterol syp 2mg/5ml 48 albuterol tab 2mg, 4mg, 4mg er, 8mg er 48 alclometason cre 0.05% 23 alclometason oin 0.05% 23 ALDACTAZIDE TAB 50/50 25 ALDURAZYME INJ 2.9MG/5M 34 alendronate sol 70/75ml 18 alendronate tab 35mg 18 alendronate tab 40mg 18 alendronate tab 5mg, 10mg 18 alendronate tab 70mg 18 alfuzosin tab 10mg 43 ALIMTA INJ 500MG 10 ALINIA SUS 100/5ML 14 allopurinol tab 100mg, 300mg 28 ALOCRIL SOL 2% 39 ALOMIDE SOL 0.1% OP 39 ALOPRIM INJ 500MG 28 ALORA DIS 0.1MG, 0.05MG, 0.025MG, 0.075MG 26 ALOXI INJ 0.25MG/5 1 ALPHAGAN P SOL 0.1% 37 alprazolam tab 0.5mg, 0.5mg er, 0.5mg od, 0.25mg odt, 0.25mg, 1mg, 1mg er, 1mg odt, 2mg, 2mg er, 2mg odt, 3mg er 17 ALTABAX OIN 1% 5 ALTOPREV TAB 20MG ER, 40MG ER, 60MG ER 30 ALVESCO AER 80MCG, 160MCG 47 amantadine cap 100mg 13 amantadine syp 50mg/5ml 13 amantadine tab 100mg 13 AMBISOME 16 amcinonide cre 0.1% 23 amcinonide lot 0.1% 23 AMCINONIDE OIN 0.1% 23 amethia 91 day 21 amethyst 28 day 21 amifostine inj 500mg 21 amikacin inj 500/2ml 3 amiloride tab 5mg 43 amiloride/hctz tab aminophyllin inj 25mg/ml 51 AMINOSYN II INJ 15% 43 AMINOSYN II INJ 7%, 8.5%, 10% 43 AMINOSYN M INJ 3.5% 43 AMINOSYN-HBC INJ 7% 43 AMINOSYN-PF INJ 7%, 10% 43 amiodarone inj 50mg/ml 5 amiodarone tab 200mg, 400mg 5 52

68 AMITIZA CAP 8MCG, 24MCG 27 amitriptyline tab 10mg, 25mg, 50mg, 75mg, 100mg, 150mg 49 amlodipine tab 2.5mg, 5mg, 10mg 18 amlodipine/atorvastatin tab 10-10mg, 20mg, 40mg, 80mg 19 amlodipine/atorvastatin tab mg, 20mg, 40mg 19 amlodipine/atorvastatin tab 5-10mg, 20mg, 40mg 19 amlodipine/atorvastatin tab 5-80mg 19 amlodipine/benazapril cap 10-20mg, 40mg 9 amlodipine/benazapril cap mg 9 amlodipine/benazapril cap 5-10mg, 20mg, 40mg 9 AMMONIUM CHL INJ 5MEQ/ML 21 amnesteem 1 amox/k clav chw 200mg, 400mg 41 amox/k clav sus 200/5ml, 250/5ml, 400/5ml, 600/5ml 41 amox/k clav tab 250mg, 500mg, 875mg 41 amoxapine tab 25mg, 50mg, 100mg, 150mg 49 amoxicillin cap 250mg, 500mg 3 amoxicillin chw 125mg, 250mg 3 amoxicillin sus 125/5ml, 200/5ml, 250/5ml, 400/ml 3 amoxicillin tab 500mg, 875mg 3 amox-pot cla tab er 41 amphetamine cap 5mg er, 10mg er, 15mg er, 20mg er, 25mg er, 30mg er 3 amphetamine tab 5mg, 7.5mg, 10mg, 12.5mg, 15mg, 20mg, 30mg 3 amphotericin inj 50mg 7 ampicillin cap 250mg, 500mg 3 ampicillin inj 1gm, 10gm, 125mg 3 ampicillin sus 125/5ml, 250/5ml 3 amp-sulbacta inj 3gm, 15mg 41 AMPYRA TAB 10MG 36 anagrelide cap 0.5mg, 1mg 42 anastrozole tab 1mg 11 ANDRODERM DIS 2MG/24HR, 4MG/24HR 3 ANDROGEL GEL 1%(50MG) 3 ANDROGEL GEL 1.62% 3 ANDROXY TAB 10MG 3 ANZEMET INJ 20MG/ML 1 ANZEMET TAB 100MG 1 ANZEMET TAB 50MG 1 apap/codeine sol /5 40 apap/codeine tab mg, mg, mg 40 APIDRA INJ SOLOSTAR 32 APIDRA INJ U APLENZIN TAB 174MG, 348MG, 522MG 7 APOKYN INJ 10MG/ML 13 apraclonidin sol 0.5% op 37 apri 28 day 21 APRISO CAP 0.375GM 32 APTIOM 6 APTIVUS CAP 250MG 14 APTIVUS SOL 14 ARALAST NP INJ 400MG 2 aranelle ARANESP INJ 100MCG 100mcg/0.5ml 28 ARANESP INJ 100MCG 100mcg/ml 29 ARANESP INJ 150MCG, 200MCG, 300MCG, 500MCG 29 ARANESP INJ 25MCG 25mcg/0.42ml 28 ARANESP INJ 25MCG 25mcg/ml 28 ARANESP INJ 40MCG 40mcg/0.4ml 28 ARANESP INJ 40MCG 40mcg/ml 28 ARANESP INJ 60MCG 60mcg/0.3ml 28 ARANESP INJ 60MCG 60mcg/ml 28 ARCALYST INJ 220MG 33 ARGATROBAN INJ 125/ ARRANON INJ 5MG/ML 10 ARZERRA CON 100/5ML 11 ASACOL HD TAB 800MG 32 ascomp 40 ASMANEX 120 AER 220MCG 47 ASMANEX 30 AER 110MCG, 220MCG 47 ASMANEX 60 AER 220MCG 47 ASTAGRAF XL CAP 0.5MG, 1MG, 5MG 31 ATELVIA TAB 18 atenol/chlor tab mg 9 atenol/chlor tab 50-25mg 9 atenolol tab 25mg, 50mg, 100mg 17 ATGAM INJ 250MG 31 atorvastatin tab 10mg, 20mg, 40mg, 80mg 30 atovaq/progu tab atovaquone 14 ATRIPLA TAB 14 atropine sul inj 0.05mg/1 15 atropine sul inj 0.1mg/ml 15 ATROVENT HFA AER 17MCG 18 AUBAGIO TAB 7MG, 14MG 36 aug betamet cre 0.05% 23 aug betamet gel 0.05% 23 aug betamet lot 0.05% 23 aug betamet oin 0.05% 23 AVANDAMET TAB 2-500MG, 1000MG 7 AVANDAMET TAB 4-500MG, 1000MG 7 AVANDARYL TAB 4-1MG, 2MG, 4MG 7 AVANDARYL TAB 8-2MG, 4MG 7 AVANDIA TAB 2MG, 4MG, 8Mg 32 AVASTIN INJ 11 AVELOX INJ 26 aviane AVODART CAP 0.5MG 43 AVONEX KIT 30MCG 36 AVONEX PREFL KIT 30MCG 36 AXERT TAB 12.5MG 46 AXERT TAB 6.25MG 46 azacitidine inj 100mg 10 AZACTAM/DEX INJ 1GM, 2GM 4 AZASAN TAB 75MG, 100MG 31 AZASITE SOL 1% 38 azathioprine tab 50mg 31 azelastine dro 0.05% 39 azelastine spr 0.15%, 0.1% 36 53

69 AZELEX CRE 20% 1 AZILECT TAB 0.5MG, 1MG 13 azithromycin inj 500mg 16 azithromycin sus 100/5ml, 200/5ml 16 azithromycin tab 250mg, 500mg, 600mg 16 AZOPT SUS 1% OP 39 AZOR TAB 10-20MG, 40MG 9 AZOR TAB 5-20MG, 40MG 9 aztreonam inj 1gm 4 B baci-im 4 bacit/polymy oin op 38 BACITRACIN INJ 50000UNT 4 bacitracin oin op 38 baclofen tab 10mg, 20mg 19 BACTOCILL INJ DEX 1GM, 2GM 41 BACTROBAN OIN NASAL 2% 36 balsalazide cap 750mg 32 balziva 28 day 21 BANZEL SUS 40MG/ML 6 BANZEL TAB 200MG 6 BANZEL TAB 400MG 6 BARACLUDE SOL.05MG/ML 29 BARACLUDE TAB 0.5MG, 1MG 29 BCG VACCINE INJ 16 BECONASE AQ SUS 0.042% 36 benazepril tab 5mg, 10mg, 20mg, 40 mg 1 benazepril/hctz tab benazepril/hctz tab , 25mg 9 benazepril/hctz tab BENICAR HCT TAB BENICAR HCT TAB MG, 25MG 9 BENICAR TAB 5MG, 20MG, 40MG 4 benztropine inj 1mg/ml 13 benztropine tab 0.5mg, 1mg, 2mg 13 BESIVANCE SUS 0.6% 38 betameth dip cre 0.05% 23 betamethasone dip lot 0.05% 23 betamethasone dip oin 0.05% 23 betamethasone val aer 0.12% 23 betamethasone val cre 0.1% 23 betamethasone val lot 0.1% 23 betamethasone val oin 0.1% 23 BETASERON INJ 0.3MG 36 betaxolol sol 0.5% op 17 betaxolol tab 10mg, 20mg 17 bethanechol tab 5mg, 10mg, 25mg, 50mg 50 BETIMOL.5% 17 BETOPTIC-S SUS 0.25% OP 17 BIAXIN XL TAB PAC bicalutamide tab 50mg 11 BICILLIN C-R INJ BICILLIN C-R INJ 900/ BICILLIN L-A INJ , , BICNU INJ 100MG 2 BILTRICIDE TAB 600MG 7 bisoprolol fum tab 5mg, 10mg 17 bisoprolol/hctz tab 10/ bisoprolol/hctz tab 2.5/ bisoprolol/hctz tab mg 9 BIVIGAM 10gm/100ml 30 bleomycin inj 30unit 12 BLEPH-10 SOL 10% OP 38 BLEPHAMIDE OIN S.O.P. 38 BLEPHAMIDE SUS OP 38 BOOSTRIX INJ 49 BOSULIF TAB 100MG, 500MG 12 BREO ELLIPTA INH briellyn 28 day 21 BRILINTA TAB 90MG 42 brimonidine sol 0.2% op, 0.15% 37 BRINTELLIX TAB 5MG, 10MG, 20MG 35 bromfenac sol 0.09% 39 bromocriptine cap 5mg 13 bromocriptine tab 2.5mg 13 BROVANA NEB 15MCG 48 budesonide (nasal) 36 budesonide cap 3mg/24hr 27 budesonide sus 0.5mg/2, 0.25mg/2 47 bumetanide inj 0.25/ml 34 bumetanide tab 0.5mg, 1mg, 2mg 34 bupren/nalox sub 2-0.5mg 40 bupren/nalox sub 8-2mg 40 BUPRENEX INJ 0.3MG/ML 40 buprenorphine inj 0.3mg/ml 41 buprenorphine sub 2mg, 8mg 41 buproban 46 bupropion hcl tab 150mg xl, 300mg xl 7 bupropion tab 75mg, 100mg, 100mg sr, 150mg sr, 200mg sr 7 buspirone tab 5mg, 7.5mg, 10mg, 15mg, 30mg 5 BUSULFEX INJ 6MG/ML 2 but/apap/caf cap codeine 40 butalbital/apap tab mg 3 butalbital/apap/caf cap 3 butalbital/apap/caf tab 3 butalbital/asa/caff cap 3 butorphanol inj 1mg/ml, 2mg/ml 41 butorphanol sol 10mg/ml 41 BYETTA INJ 10MCG 32 BYETTA INJ 5MCG 31 BYSTOLIC TAB 2.5MG, 5MG, 10MG, 20MG 17 C cabergoline tab 0.5mg 43 cafergot 35 calc acetate cap 667mg 42 calcipotrien cre 0.005% 14 calcipotrien oin 0.005% 14 calcipotrien sol 0.005% 14 calcipotriene-betamethasone dipropionate 23 calcitonin spr 200/act 18 54

70 CALCITRIOL (TOPICAL) 14 calcitriol cap 0.5mcg,0.25mcg 34 calcitriol inj 1mcg/ml 34 calcitriol sol 1mcg/ml 34 camila 28 day 43 CAMPRAL TAB 333MG 1 CANASA SUP 1000MG 32 CANCIDAS INJ 50MG, 70MG 7 candesartan tab 4mg, 8mg, 16mg, 32mg 4 candesartan/hctz tab candesartan/hctz tab , 25mg 9 CANTIL TAB 25MG 15 CAPASTAT SUL INJ 1GM 10 CAPEX SHA 0.01% 23 CAPRELSA TAB 100MG, 300MG 12 captopril tab 12.5mg, 25mg, 50 mg, 100mg 1 captopril/hctz tab 25-15mg, 25mg 9 captopril/hctz tab 50-15mg, 25mg 9 CARAC CRE 0.5% 12 CARAFATE SUS 1GM/10ML 35 carb/levo er tab mg, mg 13 carb/levo tab mg 13 carb/levo tab mg, mg 13 carbamazepine cap 100mg er, 200mg er, 300mg er 6 carbamazepine chw 100mg 6 carbamazepine sus 100/5ml 6 carbamazepine tab 200mg, 200mg er, 400mg er 6 carbidopa TABS 13 CARBIDOPA-LEVODOPA-ENTACAPONE 13 carbinoxamine sol 4mg/5ml 8 carbinoxamine tab 4mg 8 carboplatin inj 150/15ml 2 CARDIZEM CD CAP 360MG/24 18 CARDIZEM LA TAB 120MG 18 CARIMUNE NF INJ 3GM 31 carteolol sol 1% op 17 cartia xt 19 carvedilol tab 3.125mg, 6.25mg, 12.5mg, 25mg 2 CEDAX CAP 400MG 20 cefaclor cap 250mg, 500mg 20 CEFACLOR ER TAB 500MG 20 cefadroxil cap 500mg 20 cefadroxil sus 250/5ml, 500/5ml 20 cefadroxil tab 1gm 20 cefazolin inj 10gm 20 cefazolin inj 1gm 20 CEFAZOLIN INJ 1GM/50ML 20 cefazolin inj 500mg 20 cefdinir cap 300mg 20 cefdinir sus 125/5ml, 250/5ml 20 CEFDITOREN PIVOXIL 200mg 20 cefepime inj 1gm, 2gm 20 cefotaxime inj 1gm, 2gm, 10gm, 500gm 20 CEFOTETAN INJ 10G 20 CEFOTETAN INJ 1GM/10ML 20 CEFOTETAN INJ 2GM/20ML 20 cefoxitin inj 10gm 20 CEFOXITIN INJ 1GM 20 cefoxitin inj 1gm 1gm 20 CEFOXITIN INJ 2GM 20 cefoxitin inj 2gm 2gm 20 cefpodo prox sus 50mg/5ml, 100/5ml 20 cefpodoxime tab 100mg, 200mg 20 cefprozil sus 125/5ml, 250/5ml 20 cefprozil tab 250mg, 500mg 20 ceftazidime inj 1gm, 2gm, 6gm 20 CEFTAZIDIME/ SOL D5W 1GM, 2GM 20 ceftriaxone inj 1gm, 2gm, 10gm, 250gm, 500gm 20 cefuroxime inj 1.5gm, 7.5gm, 750mg 20 cefuroxime tab 250mg, 500mg 20 CELEBREX CAP 50MG, 100MG, 200MG, 400MG 37 CELLCEPT IV INJ 500MG 31 CELLCEPT SUS 200MG/ML 31 CELONTIN CAP 300MG 47 cephalexin cap 250mg, 500mg 20 cephalexin sus 125/5ml, 250/5ml 20 cephalexin tab 250mg, 500mg 20 CEREZYME INJ 400UNIT 2 CERVARIX INJ 51 CESAMET CAP 1MG 7 cetirizine hcl SYRP 1mg/ml 44 cevimeline cap 30mg 49 CHANTIX PAK 0.5& 1MG 46 CHANTIX TAB 0.5MG, 1MG 46 CHEMET CAP 100MG 7 chenodal 27 chloramphenicol inj 1gm 21 chlordiazepoxide cap 5mg, 10mg, 25mg 17 chlorhex glu sol 0.12% 15 chloroquine tab 250mg, 500mg 10 chlorothiazide tab 250mg, 500mg 48 CHLORPROMAZINE INJ 25MG/ML 42 chlorpromazine tab 10mg, 25mg, 50mg, 100mg, 200mg 42 chlorthalidone tab 25mg, 50mg 48 cholestyram pow 4gm lite 17 CIALIS TAB 2.5MG, 5MG 31 ciclopirox cre 0.77% 8 ciclopirox gel 0.77% 8 ciclopirox sha 1% 8 ciclopirox sol 8% 8 ciclopirox sus 0.77% 8 cidofovir inj 75mg/ml 21 cilostazol tab 50mg, 100mg 42 CILOXAN OIN 0.3% OP 38 cimetidine sol 300/5ml 28 cimetidine tab 200mg, 300mg, 400mg, 800mg 28 CIMZIA KIT 32 CIMZIA PREFL KIT 200MG/ML 32 CIPRO (10%) SUS 500MG/5 27 CIPRO (5%) SUS 250MG/

71 CIPRO HC SUS OTIC 41 CIPRODEX SUS % 41 ciprofloxacin SUSR 27 ciprofloxacin inj 200mg, 400mg 27 ciprofloxacin tab 100mg, 250mg, 500mg, 750mg 27 ciprofloxacn sol 0.3% op 38 cisplatin inj 100mg 2 citalopram sol 10mg/5ml 45 citalopram tab 10mg, 20mg, 40mg 45 cladribine inj 1mg/ml 10 CLAFORAN INJ 1GM, 2GM 20 claravis 1 CLARINEX SYP 0.5MG/ML 8 CLARINEX-D TAB CLARINEX-D TAB 5-240MG 44 clarithromycin sus 125/5ml, 250/5ml 21 clarithromycin tab 250mg, 500mg, 500mg er 21 clemastine syp 0.5/5ml 8 clemastine tab 2.68mg 8 CLEOCIN CAP 75MG 34 CLEOCIN SUP 100MG 50 CLEOCIN/D5W INJ 900MG 34 clindamy/ben gel 1-5% 1 clindamycin aer 1% 1 clindamycin cap 75mg, 150mg, 300mg 34 clindamycin cre 2% vag 50 clindamycin gel 1% 1 clindamycin inj 150mg/ml, 300mg, 600mg, 900mg 34 clindamycin lot 1% 1 clindamycin pad 1% 1 clindamycin sol 1% 1 clindamycin sol 75mg/5ml 34 CLINIMIX E INJ 2.75/D5W, 2.75/D10 43 CLINIMIX E INJ 4.25/D5W, 4.25/D5W 43 CLINIMIX E INJ 5%/D15W, 5%/D20W, 5%/D25W 43 CLINIMIX INJ 2.75/D5W 43 CLINIMIX INJ 4.25/D10, 4.25/D20 43 CLINIMIX INJ 4.25/D5W 43 CLINIMIX INJ 5%/D15W, 5%/D20W, 5%/D25W 43 clobetasol aer 0.05% 23 clobetasol e cre 0.05% 23 clobetasol gel 0.05% 23 clobetasol lot 0.05% 23 clobetasol oin 0.05% 23 clobetasol sha 0.05% 23 clobetasol sol 0.05% 23 clomipramine cap 25mg, 50mg, 75mg 49 clonazepam odt tab 0.5mg, 0.25, 0.125, 1mg, 2mg 6 clonazepam tab 0.5mg, 1mg, 2mg 6 clonidine dis 0.1/24hr, 0.2/24hr, 0.3/24hr 5 clonidine tab 0.1mg, 0.2mg, 0.3mg 5 clopidogrel tab 75mg, 300mg 42 clorazepate dipot tab 3.75mg, 7.5mg, 15mg 17 clotrim/beta cre diprop 8 clotrim/beta lot diprop 8 clotrimazole tro 10mg 4 clozapine tab 25mg, 50mg, 100mg, 200mg 24 COARTEM TAB MG 10 codeine sulf tab 15mg 39 codeine sulf tab 30mg, 60mg 39 COLCRYS TAB 0.6MG 28 colestipol gra 5gm 18 colestipol tab 1gm 18 colistimethate inj 150mg 4 colocort 33 COLY-MYCIN S SUS OTIC 41 COMBIGAN SOL 0.2/0.5% 17 COMBIVENT AER RESPIMAT 48 COMETRIQ KIT 60MG, 100MG, 140MG 12 COMPLERA TAB 14 compro 42 COMVAX INJ 35 CONDYLOX GEL 0.5% 33 constulose 33 COPAXONE INJ 40MG/ML 36 COPAXONE KIT 20MG/ML 24 CORDRAN 80X3 TAP 4MCG/CM 23 COREG CR CAP 10MG, 20MG, 40MG, 80MG 2 CORTIFOAM AER 90MG 33 cortisone ac tab 25mg 27 CORTISPORIN CRE 0.5% 5 CORTISPORIN OIN 1% 5 CORTISPORIN SUS -TC OTIC 41 COUMADIN INJ 5 MG 5 COUMADIN TAB 1MG, 2.5MG, 2MG, 3MG, 4MG, 5MG, 6MG, 7.5MG, 10MG 24 CREON CAP 3000UNIT, 6000UNIT, 12000UNIT, 24000UNIT, 36000UNIT 25 CRESTOR TAB 5MG, 10MG, 20MG, 40MG 30 CRIXIVAN CAP 200MG, 400MG 14 cromolyn sod con 100/5ml 27 cromolyn sod neb 20mg/2ml 4 cromolyn sod sol 4% op 39 cryselle CUBICIN SOL 500MG 24 cyclafem 1/35 28 day 21 cyclafem 7/7/7 28 day 21 cyclobenzaprine hcl tabs 5mg, 10mg 20 CYCLOPHOSPHAMIDE CAPS 2 cyclophosphamide tab 25mg, 50mg 2 cyclosporine cap 25mg, 25mg mod, 50mg mod, 100mg, 100mg md 31 cyclosporine inj 50mg/ml 31 cyclosporine sol modified 31 CYSTADANE POW 35 CYSTAGON CAP 50MG, 150MG 24 CYSTARAN SOL 0.44% 39 cytarabine inj 20mg/ml, 100mg/ml 10 D D10W/NACL INJ 0.2% 25 56

72 d10w/nacl inj 0.45% 25 d2.5w/nacl inj 0.45% 25 d5w/lr inj 25 d5w/nacl inj 0.2%, 0.9%, 0.33%, 0.45%, 0.225% 25 dacarbazine inj 200mg 13 DALIRESP TAB 500MCG 45 danazol cap 50mg, 100mg, 200mg 3 dantrolene cap 25mg, 50mg, 100mg 25 dapsone tab 100mg 33 dapsone tab 25mg 33 DAPTACEL INJ 49 DARAPRIM TAB 25MG 10 daunorubicin inj 5mg/ml 12 DAYTRANA DIS 10MG/9HR, 15MG/9HR, 20MG/9HR, 30MG/9HR 47 decitabine inj 50mg 10 DELZICOL CAP 400MG 32 demeclocycl tab 150mg, 300mg 48 DEMSER 2 DENAVIR CRE 1% 16 DEPEN TITRA TAB 250MG 20 DEPO-MEDROL INJ 20MG/ML, 40MG/ML, 80MG/ML 27 DEPO-PROVERA INJ 400/ML 11 DEPO-SQ PROV INJ desipramine tab 10mg, 25mg, 50mg 75mg, 100mg, 150mg 49 desloratadine tab 2.5 odt 8 desloratadine tab 5mg, 5mg odt 8 desmopressin inj 4mcg/ml 42 desmopressin spr 0.01% 42 desmopressin tab 0.1mg, 0.2mg 42 desonide cre 0.05% 23 desonide lot 0.05% 23 desonide oin 0.05% 23 desoximetasone cre 0.05%, 0.25% 23 desoximetasone gel 0.05% 23 desoximetasone oin 0.05% 23 desoximetasone oin 0.25% 23 DESVENLAFAX TAB 50MG ER 46 DESVENLAFAXINE TAB 100MG ER 46 dexameth pho inj 10mg/ml 27 dexameth pho inj 120mg/30 27 dexameth pho sol 0.1% op 38 DEXAMETHASON CON 1MG/ML 27 dexamethasone elx 0.5/5ml 27 dexamethasone tab 0.5mg, 0.75mg, 1.5mg, 1mg, 2mg, 4mg, 6mg 27 DEXILANT CAP 30MG DR, 60MG DR 44 dexmethylphenidate cap 15mg er, 30mg er, 40mg er 47 dexmethylphenidate tab 2.5mg, 5mg, 10mg 47 dexrazoxane inj 250mg 21 dextroamphetamine cap 5mg er, 10mg er, 15mg er 3 dextroamphetamine tab 5mg, 10mg 3 dextrose inj 5%, 10% 19 DIAZEPAM CON 5MG/ML 17 diazepam gel (anticonvulsant) 6 diazepam sol 1mg/ml 17 diazepam tab 2mg, 5mg, 10mg 17 DIBENZYLINE CAP 10MG 2 diclo/misopr tab mg, mg 37 diclofenac gel 3% 12 diclofenac pot tab 50mg 37 diclofenac sodium 1.5% (topical) 4 diclofenac sol 0.1% op 39 diclofenac tab 25mg dr, 50mg dr, 75mg dr, 100mg er 37 dicloxacill cap 250mg, 500mg 41 dicyclomine cap 10mg 15 dicyclomine sol 10mg/5ml 15 dicyclomine tab 20mg 15 DIFFERIN LOT 0.1% 1 DIFICID TAB 200MG 26 diflorasone cre 0.05% 23 diflorasone oin 0.05% 23 diflunisal tab 500mg 45 digoxin inj 0.25mg/1 19 digoxin sol 50mcg/ml 19 digoxin tab 0.25mg, 0.125mg 19 dihydroergot inj 1mg/ml 35 DILANTIN CAP 30MG, 100MG 30 DILANTIN CHW 50MG 30 DILANTIN-125 SUS 125/5ML 30 DILAUDID LIQ 1MG/ML 39 dilt xr 19 diltiazem cap 60mg er, 90mg er, 120mg cd, 120mg er, 180mg/24, 240mg cd, 300mg er, 360mg/24, 420mg/24 19 diltiazem cap 90mg er 19 DILTIAZEM INJ 100MG 19 diltiazem inj 50/10ml 19 diltiazem tab 30mg, 60mg, 90mg, 120mg 19 DIOVAN TAB 40MG, 80MG, 160MG, 320MG 4 DIPENTUM CAP 250MG 32 diphen/atrop liq 2.5/5 13 diphen/atrop tab 2.5mg 13 diphenhydramine hcl INJ 45 DIPHTHERIA/TETANUS TOXOID 49 disopyramide cap 100mg, 150mg 5 disulfiram tab 250mg, 500mg 2 divalproex cap 125mg 51 divalproex tab 125mg dr, 250mg dr, 250mg er, 500mg dr, 500mg er 51 DOCEFREZ INJ 20MG, 80MG 35 docetaxel inj 80mg/4ml 35 DOCETAXEL INJ 80MG/8ML 35 donepezil tab 5mg, 5mg odt, 10mg, 10mg odt 6 donepezil tab hcl 23mg 6 DORIBAX INJ 500MG 19 dorzol/timol sol 2-0.5%op 17 dorzolamide sol 2% op 39 doxazosin tab 1mg, 2mg, 4mg, 8mg 5 doxepin hcl cap 10mg, 25mg, 50mg, 75mg, 100mg, 150mg 49 doxepin hcl con 10mg/ml 49 57

73 doxercalciferol cap 0.5mcg, 1mcg, 2.5mcg 35 DOXIL INJ 2MG/ML 12 doxorubicin inj 50mg 12 doxycyc mono tab 50mg 48 doxycyc mono tab 75mg, 150mg 48 doxycycl hyc cap 50mg, 100mg 48 doxycycl hyc tab 100mg dr, 150mg dr 48 doxycycl hyc tab 75mg dr, 100mg 48 doxycycline cap 75mg 48 doxycycline hyclate SOLR 48 doxycycline sus 25mg/5ml 48 doxycycline tab 20mg 48 dronabinol cap 2.5mg, 5mg, 10mg 7 drospir/ethi tab mg 21 DROXIA CAP 200MG, 300MG, 400MG 2 DUEXIS 37 DULERA AER 100-5MCG, 200-5MCG 48 duloxetine cap 20mg, 30mg, 60mg 46 duramorph 39 DUREZOL EMU 0.05% 38 DYRENIUM CAP 50MG, 100MG 43 E e.e.s. 26 econazole cre 1% 8 EDARBI TAB 40MG 4 EDARBI TAB 80MG 4 EDARBYCLOR TAB MG, 25MG 9 EDECRIN TAB 25MG 34 EDURANT TAB 25MG 14 EFFIENT TAB 5MG, 10MG 42 ELIDEL CRE 1% 31 ELIGARD INJ 7.5MG, 22.5MG, 30MG, 45MG 11 ELIPHOS TAB 667MG 42 ELIQUIS TAB 2.5MG, 5MG 25 ELITEK INJ 1.5MG 21 ELIXOPHYLLIN ELX 80/15ML 51 ELLA 26 ELLENCE INJ 2MG/ML 12 ELMIRON CAP 100MG 33 EMADINE SOL 0.05% OP 39 EMCYT CAP 140MG 11 EMEND CAP 125MG 47 EMEND CAP 40MG 47 EMEND CAP 80MG 47 EMEND PAK 80 & emoquette 21 EMSAM DIS 6MG/24HR, 9MG/24HR, 12MG/24HR 36 EMTRIVA CAP 200MG 14 EMTRIVA SOL 10MG/ML 14 enalapril tab 2.5mg, 5mg, 10mb, 20mg 1 enalapril/hctz tab 10-25mg 9 enalapril/hctz tab mg 9 ENBREL INJ 25/0.5ML 46 ENBREL INJ 25MG 46 ENBREL INJ 50MG/ML 46 endocet 40 ENGERIX-B INJ 10/0.5ML 51 ENGERIX-B INJ 20MCG/ML 51 enicilln vk sol 125/5ml, 250/5ml 36 enoxaparin inj 30/0.3ml, 40/0.4, 60/0.6, 80/0.8, 100mg/ml, 120/0.8, 150mg/ml, 300/3ml 29 enpresse 28 day 21 entacapone tab 200mg 13 enulose 33 epinastine dro 0.05% 39 EPIPEN 2-PAK INJ 0.3MG 3 EPIPEN-JR INJ 2-PAK 3 epirubicin inj 50/25ml 12 epitol 6 EPIVIR SOL 10MG/ML 14 eplerenone tab 25mg 45 eplerenone tab 50mg 45 EPOGEN INJ 10000/ML 29 EPOGEN INJ 2000/ML, 3000/ML, 4000/ML 29 EPOGEN INJ 20000/ML 29 eprosartan mes tab 600mg 4 EPZICOM TAB EQUETRO CAP 100MG, 200MG, 300MG 14 ERAXIS INJ 100MG 7 ERBITUX INJ 100MG 11 ergoloid mesylates TABS 44 ERIVEDGE CAP 150MG 11 errin 28 day 43 ERWINAZE INJ 10000UNT 12 ery 1 ERYPED SUS 200/5ML 26 ERYPED SUS 400/5ML 26 ERY-TAB TAB 250MG EC, 333MG EC 26 ERY-TAB TAB 500MG EC 26 ERYTHROCIN INJ 500MG 26 erythrocin stearate 26 erythrom eth tab 400mg 26 erythromycin gel /benzoyl 1 erythromycin gel 2% 1 erythromycin oin op 38 erythromycin sol 2% 1 erythromycin tab 250mg bs, 500mg bs 26 escitalopram sol 5mg/5ml 45 escitalopram tab 5mg, 10mg, 20mg 45 esomeprazole inj 20mg 44 esomeprazole inj 40mg 44 estra/noreth tab estra/noreth tab 1-0.5mg 26 ESTRACE VAG CRE 0.1MG/GM 50 estrad val inj 20mg/ml 26 estradiol dis 0.1mg, 0.05mg, 0.06mg, 0.025mg, 0.075mg, mg 26 estradiol tab 0.5mg, 1mg, 2mg 26 ESTRING MIS 2MG 50 estropipate tab 0.75mg, 1.5mg, 3mg 26 58

74 ethambutol tab 100mg, 400mg 10 ethosuximide cap 250mg 47 ethosuximide sol 250/5ml 47 etidronate disd tab 200mg, 400mg 18 etodolac cap 200mg, 300mg 37 etodolac tab 400mg, 500mg 37 ETOPOPHOS INJ 100MG 35 etoposide inj 500/25ml 35 EURAX CRE 10% 45 EURAX LOT 10% 45 EVAMIST SPR 1.53MG 26 EXELDERM CRE 1% 8 EXELDERM SOL 1% 8 EXELON DIS 4.6MG/24, 9.5MG/24, 13.3/24 6 exemestane tab 25mg 11 EXFORGE HCT/ , , EXFORGE HCT/ , EXFORGE TAB MG, 320MG 9 EXFORGE TAB 5-160MG, 320MG 9 EXJADE TAB 125MG 7 EXJADE TAB 250MG, 500MG 7 EXTAVIA INJ 0.3MG 36 F FABRAZYME INJ 35MG 35 FACTIVE 27 famciclovir tab 125mg, 250mg, 500mg 30 famotidine inj 10mg/ml, 20mg/50ml 28 famotidine sus 40mg/5ml 28 famotidine tab 20mg, 40mg 28 FANAPT PAK 16 FANAPT TAB 1MG, 2MG, 4MG, 6MG, 8MG, 10MG, 12MG 16 FARESTON TAB 60MG 11 FARXIGA 46 FASLODEX INJ 250MG 11 FAZACLO 24 felbamate sus 600/5ml 19 felbamate tab 400mg, 600mg 19 felodipine tab 2.5mg er 19 felodipine tab 5mg er, 10mg er 19 FEMRING MIS 0.05/24H 50 FEMRING MIS 0.1MG/24 50 FENOFIBRATE 26 fenofibrate cap 43mg, 67mg, 130mg, 134mg, 200mg 26 fenofibrate tab 48mg, 54mg, 145mg, 160mg 26 fenofibric cap 45mg dr, 135mg dr 26 fenoprofen tab 600mg 37 fentanyl dis 12mcg/hr, 25mcg/hr, 50mcg/hr, 75mcg/hr, 100mcg/hr 39 fentanyl ot loz 200mcg 39 fentanyl ot loz 400mcg, 600mcg, 800mcg, 1200mcg, 1600mcg 39 FENTORA TAB 100MCG, 200MCG, 400MCG, 600MCG, 800MCG 39 FETZIMA CAP 20MG, 40MG, 80MG, 120MG 46 FETZIMA CAP TITRATIO 46 FINACEA GEL 15% 45 finasteride tab 5mg 43 FIRAZYR INJ 30MG/3ML 18 FIRMAGON INJ 120MG 11 FIRMAGON INJ 80MG 11 FLAGYL ER TAB 750MG 4 FLAREX SUS 0.1% OP 38 flavoxate tab 100mg 50 flecainide tab 50mg, 100mg, 150mg 5 FLOVENT DISK AER 50MCG, 100MCG, 250MCG 47 FLOVENT HFA AER 44MCG, 110MCG, 220MCG 47 fluconazole sus 10mg/ml, 40mg/ml 30 fluconazole tab 50mg, 100mg, 150mg, 200mg 30 fluconazole/ inj dex flucytosine cap 250mg, 500mg 7 fludarabine inj 50mg 10 fludrocort tab 0.1mg 35 flunisolide spr 0.025% 36 fluocinolone acet cre 0.01% 23 fluocinolone acet cre 0.025% 23 fluocinolone acet oil 0.01% 41 fluocinolone acet oil body 23 fluocinolone acet oin 0.025% 23 fluocinolone acet sol 0.01% 23 fluocinonide cre 0.1% 23 fluocinonide cre -e 0.05% 23 fluocinonide gel 0.05% 23 fluocinonide oin 0.05% 23 fluocinonide sol 0.05% 23 fluorouracil cre 5% 12 fluorouracil inj 2.5g/50m 10 fluoxetine cap 10mg, 20mg, 40mg 45 fluoxetine cap 90mg dr 45 fluoxetine sol 20mg/5ml 45 fluoxetine tab 10mg, 20mg 45 FLUOXETINE TAB 60MG 45 fluphenaz de inj 25mg/ml 42 fluphenazine con 5mg/ml 42 fluphenazine elx 2.5/5ml 42 fluphenazine inj 2.5mg/ml 42 fluphenazine tab 1mg, 2.5mg, 5mg, 10mg 42 flurbiprofen sol 0.03% op 39 flurbiprofen tab 50mg, 100mg 37 flutamide cap 125mg 11 fluticasone cre 0.05% 23 fluticasone lot 0.05% 23 fluticasone oin 0.005% 23 fluticasone spr 50mcg 36 fluvastatin cap 20mg, 40mg 30 fluvoxamine cap 100mg er, 150mg er 45 fluvoxamine tab 25mg, 50mg, 100mg 45 FML FORTE SUS 0.25% OP 38 FML OIN 0.1% OP 38 fomepizole inj 1gm/ml 7 fondaparinux sol 2.5/

75 fondaparinux sol 5.0/0.4, 7.5/0.6, 10/ FORADIL CAP AEROLIZE 48 FORTAZ INJ 1GM, 2GM, 6GM 20 FORTEO SOL 600/ FORTICAL SPR 200/ACT 18 fosinopril tab 10mg, 20mg, 40mg 1 fosinopril/hctz tab 10/ fosinopril/hctz tab 20/ fosphenytoin inj 100/2ml 30 FOSRENOL CHW 500MG, 750MG, 1000MG 42 FRAGMIN INJ 2500/0.2, 5000/ FRAGMIN INJ 25000/ML 29 FRAGMIN INJ 7500/0.3, 10000/ML, 12500UNT, 15000UNT, 18000UNT 29 FROVA TAB 2.5MG 46 furosemide inj 10mg/ml 34 furosemide sol 10mg/ml 34 FUROSEMIDE SOL 8MG/ML 34 furosemide tab 20mg, 40mg, 80mg 34 FUZEON INJ 90MG 14 FYCOMPA TAB 2MG, 4MG, 6MG, 8MG, 10MG, 12MG 3 G gabapentin cap 100mg, 300mg, 400mg 6 gabapentin sol 250/5ml 6 gabapentin tab 600mg, 800mg 6 GABITRIL TAB 2MG, 4MG, 12MG, 16MG 27 galantamine cap 8mg er, 16mg er, 24mg er 6 galantamine sol 4mg/ml 6 galantamine tab 4mg, 8mg, 12mg 6 GAMASTAN S/D INJ 31 GAMMAGARD INJ 2.5GM/25 31 GAMMAPLEX INJ 10GM 31 GAMUNEX-C INJ 1GM/10ML 31 ganciclovir inj 500mg 21 GARDASIL INJ 51 gatifloxacin sol 0.5% 38 GATTEX KIT 5MG 46 GAUZE PADS 2" X 2" 16 gavilyte-c 33 gavilytee-g 33 gavilyte-n 33 gemcitabine inj 1gm 10 gemfibrozil tab 600mg 26 generlac 33 gengraf 31 GENOTROPIN INJ 0.2MG, 0.4MG, 0.6MG, 0.8MG, 1.2MG, 1.4MG, 1.6MG, 1.8MG, 1MG, 2MG 28 GENOTROPIN INJ 5MG, 12MG 28 gentak 38 GENTAMACIN/NACL INJ 0.9MG/ML, 1.4MG/ML 3 gentamacin/nacl inj 60mg, 80mg, 100mg 3 gentamicin cre 0.1% 5 gentamicin inj 10mg/ml, 40mg/ml 3 gentamicin oin 0.1% 5 gentamicin oin 0.3% op 38 gentamicin sol 0.3% op 38 GEODON INJ 20MG 14 gildagia 21 GILENYA CAP 0.5MG 36 GILOTRIF TAB 20MG, 30MG, 40MG 12 GLASSIA INJ 2 GLEEVEC TAB 100MG, 400MG 12 glimepiride tab 1mg, 2mg, 4mg 47 glipizide er tab 2.5mg, 5mg, 10mg 47 glipizide tab 5mg, 10mg 47 glipizide/metform tab m, 500m 7 glipizide/metform tab 5-500mg 7 GLUCAGEN INJ HYPOKIT 24 GLUCAGON KIT 1MG 24 GLUMETZA TAB 500MG, 1000MG 17 glyburide-metformin 7 glycopyrrolate inj 0.2mg/ml 15 glycopyrrolate tab 1mg, 2mg 15 GLYSET TAB 25MG, 50MG, 100MG 2 GOLYTELY SOL 33 granisetron inj 0.1mg/ml, 1mg/ml 1 granisetron tab 1mg 1 GRANISOL SOL 2MG/10ML 1 griseofulvin sus 125/5ml 7 griseofulvin tab micr griseofulvin tab ultr griseofulvin tab ultr GRIS-PEG TAB 125MG, 250MG 7 GUANIDINE HCL 10 gynazole-1 50 H HALAVEN INJ 1MG/2ML 35 halobetasol cre 0.05% 23 halobetasol oin 0.05% 23 HALOG CRE 0.1% 23 HALOG OIN 0.1% 23 haloper dec inj 50mg/ml, 100mg/ml 18 haloper lac inj 5mg/ml 18 haloperidol con 2mg/ml 18 haloperidol tab 0.5mg, 1mg, 2mg, 5mg, 10mg, 20mg 18 HAVRIX INJ 720UNIT, 1440UNIT 51 hc butyrate cre 0.1% 23 hc butyrate oin 0.1% 24 hc butyrate sol 0.1% 24 hc valerate cre 0.2% 24 hc valerate oin 0.2% 24 hc/acetic acid sol otic 41 hep sod/d5w inj 20000unt 29 HEP SOD/D5W INJ 25000UNT 29 hep sod/nacl inj 1000unit 29 heparin sod inj 1000/ml 29 heparin sod inj 5000/ml, 10000/ml, 20000/ml 29 hepatamine 8 44 hepatasol 8 44 HEPSERA TAB 10MG 29 60

76 HERCEPTIN INJ 440MG 11 HETLIOZ 45 HEXALEN CAP 50MG 2 HORIZANT TAB 300MG, 600MG 45 HUMALOG INJ 100/ML 32 HUMALOG MIX INJ 50/50, 50/50KWP, 75/25KWP 32 HUMALOG MIX SUS 75/25 32 HUMATROPE INJ 12MG, 24MG 28 HUMATROPE INJ 5MG 28 HUMATROPE INJ 6MG 28 HUMIRA KIT 20MG/0.4, 40MG/0.8 5 HUMIRA PEN KIT CROHNS 5 HUMULIN INJ 70/30 32 HUMULIN N INJ U HUMULIN N PN INJ U HUMULIN PEN INJ 70/30 32 HUMULIN R INJ U HUMULIN R INJ U hydralazine inj 20mg/ml 51 hydralazine tab 10mg, 25mg, 50mg, 100mg 51 hydrochlorothiazide cap 12.5mg 48 hydrochlorothiazide tab 12.5mg, 25mg, 50mg 49 hydrocodone/apap sol hydrocodone/apap tab mg, mg 40 hydrocodone/apap tab 5-300mg, 5-325mg 40 hydrocodone/apap tab , mg 40 hydrocodone/ibu tab hydrocortisone cre 2.5% 24 hydrocortisone enema 100mg 33 hydrocortisone lot 2.5% 24 hydrocortisone oin 2.5% 24 hydrocortisone tab 5mg, 10mg, 20mg 27 hydromorphon inj 500/50ml 39 hydromorphon tab 2mg, 4mg, 8mg 39 hydromorphone hcl LIQD 39 hydroxychloroquine tab 200mg 10 hydroxyurea cap 500mg 13 I ibandronate sodium inj 18 ibandronate tab 150mg 18 ibuprofen tab 400mg, 600mg, 800mg 37 idarubicin inj 10/10ml 12 IFEX INJ 1GM 2 ifosfamide inj 1gm 2 ILARIS 33 IMBRUVICA CAP 140MG 12 imipenem/cil inj 250mg, 500mg 19 imipramine hcl tab 10mg, 25mg, 50mg 49 imipramine pam cap 75mg, 100mg, 125mg, 150mg 49 imiquimod cre 5% 31 IMOVAX RABIE INJ 2.5/ML 51 INCIVEK TAB 375MG 29 INCRELEX INJ 40MG/4ML 32 indapamide tab 1.25mg, 2.5mg 49 INFANRIX INJ 49 INLYTA TAB 1MG, 5MG 12 INNOPRAN XL CAP 80MG, 120MG 17 INSULIN PEN NEEDLE 41 INSULIN SAFETY NEEDLES 41 INSULIN SYRINGE 41 INTELENCE TAB 100MG, 200MG 14 INTELENCE TAB 25MG 14 intralipid 34 INTRALIPID INJ 30% 34 INTRON-A INJ 10MU 13 INTRON-A INJ 18MU 13 introvale 91 day 21 INTUNIV 16 INVANZ INJ 1GM 19 INVEGA SUST INJ 117/ INVEGA SUST INJ 156MG/ML 16 INVEGA SUST INJ 234/ INVEGA SUST INJ 39/ INVEGA SUST INJ 78/0.5ML 16 INVEGA TAB 1.5MG, 3MG, 6MG, 9MG 16 INVIRASE CAP 200MG 14 INVIRASE TAB 500MG 14 INVOKANA TAB 100MG, 300MG 46 IONOSOL-B/ INJ D5W 25 IONOSOL-MB INJ /D5W 25 IOPIDINE SOL 1% OP 37 IPOL INJ INACTIVE 51 ipratropium sol 0.02%inh 18 ipratropium spr 0.03%, 0.06% 36 ipratropium/ sol albuter 48 irbesartan tab 75mg, 150mg, 300mg 4 irbesartan/hctz tab , irinotecan inj 100/5ml 49 ISENTRESS CHW 100MG 14 ISENTRESS CHW 25MG 14 ISENTRESS POW 100MG 14 ISENTRESS TAB 400MG 14 ISOLYTE-P INJ /D5W 25 ISOLYTE-S INJ 25 isoniazid inj 100mg/ml 10 isoniazid syp 50mg/5ml 10 isoniazid tab 100mg, 300mg 11 ISORDIL TAB 40MG 37 isosorb din tab 5mg, 10mg, 20mg, 40mg er 37 isosorb mono tab 10mg, 20mg, 30mg er, 60mg er, 120mg er 37 isradipine cap 2.5mg, 5mg 19 ISTALOL SOL 0.5% OP 17 ISTODAX INJ 10MG 12 itraconazole cap 100mg 30 IXEMPRA KIT INJ 45MG 35 IXIARO INJ 51 J JAKAFI TAB 5MG, 10MG, 15MG, 20MG, 25MG 12 JALYN CAP 43 jantoven 24 61

77 JANUMET TAB MG, 100MG 7 JANUMET XR TAB JANUMET XR TAB MG, 1000MG 7 JANUVIA TAB 25MG, 50MG, 100MG 25 JENTADUETO 7 JEVTANA INJ 60/1.5ML 35 jolivette 28 day 43 junel 1.5/30 21 day 21 junel 1/20 21 day 21 junel fe 1.5/30 28 day 21 junel fe 1/20 28 day 21 JUXTAPID CAP 5MG, 10MG, 20MG 35 K KADCYLA INJ 100MG 11 KALETRA SOL 14 KALETRA TAB MG, MG 14 KALYDECO TAB 150MG 24 KAPVAY TAB 0.1 MG 16 kariva 28 day 21 kcl in nacl inj 25 kcl/d5w inj 0.3%, 0.15% 25 KCL/D5W/LR INJ 0.15% 25 kcl/d5w/nacl inj.075/ kcl/d5w/nacl inj.15/.33% 25 kcl/d5w/nacl inj.15/.45% 25 kcl/d5w/nacl inj.22/ kcl/d5w/nacl inj 0.15/ KCL/D5W/NACL INJ 0.15/ kcl/d5w/nacl inj 0.15/ kcl/d5w/nacl inj 0.3/ KCL/D5W/NACL INJ 0.3/0.9% 25 kcl/nacl inj kcl/nacl inj kelnor 1/35 28 day 21 KENALOG AER SPRAY 24 KETEK TAB 300MG, 400MG 33 ketoconazole TABS 16 ketoconazole cre 2% 8 ketoconazole sha 2% 8 KETODAN KIT 2% 8 ketoprofen cap 50mg, 75mg, 200mg er 37 ketorolac sol 0.4% 39 ketorolac sol 0.5% 39 KINERET 33 kionex 42 klor-con 42 KLOR-CON M15 TAB 42 KRISTALOSE PAK 10GM, 20GM 33 K-TAB 42 K-TAB TAB 10MEQ CR 42 KUVAN TAB 100MG 35 KYNAMRO INJ 200MG/ML 9 L labetalol inj 5mg/ml 2 labetalol tab 100mg, 200mg, 300mg 2 LACRISERT MIS 5MG OP 16 lactated rin inj 26 lactated rin sol irrigat 33 lactulose sol 10gm/15 33 lamivud/zido tab lamivudine tab 100mg, 150mg, 300mg 14 lamotrigine chw 5mg, 25mg 6 lamotrigine tab 100mg 6 lamotrigine tab 100mg er 6 lamotrigine tab 150mg, 200 mg 6 lamotrigine tab 200mg er, 250mg er, 300mg er 6 lamotrigine tab 25mg 6 lamotrigine tab 25mg er, 50mg er 6 LANOXIN TAB 0.25MG, 0.125MG, MG, MG 19 lansopr/amox mis /clarith 50 lansoprazole cap 15mg dr, 30mg dr 44 LANTUS INJ 100/ML 32 LANTUS INJ SOLOSTAR 32 larin 1/20 21 larin fe 1.5/30 21 larin fe 1/20 21 latanoprost sol 0.005% 43 LATUDA TAB 20MG, 40MG, 60MG, 80MG, 120MG 14 LAZANDA 39 leena 28 day 21 leflunomide tab 10mg, 20mg 44 LESCOL XL TAB 80MG 30 lessina 28 day 21 LETAIRIS TAB 5MG, 10MG 44 letrozole tab 2.5mg 11 leucovorin ca inj 100mg, 350mg 21 leucovorin ca tab 25mg 21 leucovorin ca tab 5mg, 10mg, 15mg 21 LEUKERAN TAB 2MG 2 LEUKINE INJ 250MCG 29 leuprolide inj 1mg/ levalbuterol neb 0.31mg, 0.63mg 48 levalbuterol neb 1.25/ LEVEMIR INJ 32 LEVEMIR INJ FLEXPEN 32 levetiracetam inj 500/5ml 6 levetiracetam sol 100mg/ml 6 levetiracetam tab 250mg, 500mg, 500mg er, 750mg, 750mg er, 1000mg 6 levobunolol sol 0.5% op 17 levocarnitine inj 200mg/ml 35 levocarnitine sol 1gm/10ml 35 levocarnitine tab 330mg 35 levocetirizine sol 2.5/5ml 8 levocetirizine tab 5mg 8 levoflox/d5w inj 500/100m 27 levofloxacin inj 25mg/ml 27 levofloxacin sol 0.5% 38 levofloxacin sol 25mg/ml 27 levofloxacin tab 250mg, 500mg, 750mg 27 62

78 levonest 28 day 22 levonor/ethi tab estradio 22 levora 0.15/30 28 day 22 levorphanol tab 2mg 39 levothyroxin tab 25mcg, 50mcg, 75mcg, 88mcg, 100mcg, 112 mcg, 125mcg, 137mcg, 150mcg, 175mcg, 200mcg, 300mcg 49 levoxyl 49 LEXIVA SUS 50MG/ML 14 LEXIVA TAB 700MG 14 LIALDA TAB 1.2GM 32 lido/prilocn cre % 34 lidocaine gel 2% jelly 34 lidocaine hcl (local anesth.) 34 lidocaine inj 0.5%, 1% 34 lidocaine oin 5% 34 lidocaine pad 5% 34 lidocaine sol 2% visc 4 lidocaine sol 4% 34 lidoderm 34 LINCOCIN 34 lindane lot 1% 45 lindane sha 1% 45 LINZESS CAP 145MCG, 290MCG 33 liothyronine inj 10mcg/ml 49 liothyronine tab 25mcg 49 liothyronine tab 50mcg 49 liothyronine tab 5mcg 49 LIPOSYN III INJ 10%, 20% 34 LIPTRUZET 9 lisinopril tab 2.5mg, 5mg, 10mg, 20mg, 30mg, 40mg 1 lisinopril/hctz tab lisinopril/hctz tab lisinopril/hctz tab 20-25mg 9 lithium carb cap 150mg, 300mg, 600mg 10 lithium carb tab 300mg 10 lithium carb tab 300mg er, 450mg er 10 LITHIUM CITR SOL 8MEQ/5ML 10 LIVALO TAB 1MG, 2MG, 4MG 30 LO LOESTRIN TAB 22 lomustine cap 10mg, 40mg, 100mg 2 loperamide cap 2mg 13 lorazepam con 2mg/ml 17 lorazepam tab 0.5mg, 1mg, 2mg, 10mg, 15mg, 30mg 17 lorcet 40 lortab TABS 40 loryna 28 day 22 losartan pot tab 25mg, 50mg, 100mg 4 losartan/hct tab , losartan/hct tab LOTEMAX GEL 0.5% 38 LOTEMAX OIN 0.5% 38 LOTRONEX TAB 0.5MG, 1MG 33 lovastatin tab 10mg, 20mg, 40mg 30 low-ogestrel 28 day 22 loxapine cap 5mg, 10mg, 25mg, 50mg 24 LUFYLLIN TAB 200MG, 400MG 51 LUMIGAN SOL 0.01% 43 LUPR DEP-PED INJ 11.25MG, 15MG 34 LUPRON DEPOT INJ 3.75MG 11 LUPRON DEPOT INJ 7.5MG, 1125MG, 22.5MG, 30MG, 45MG 11 lutera 28 day 22 LYRICA CAP 25MG, 50MG, 75MG, 100MG, 150MG, 200MG, 225MG, 300MG 6 LYRICA SOL 20MG/ML 6 LYSODREN TAB 500MG 11 lyza 43 M MACRODANTIN CAP 25MG 50 mafenide ace pak 5% 18 magnesium su inj 50% 34 malathion lot 0.5% 45 maprotiline tab 25mg, 50mg, 75mg 7 marlissa 28 day 22 MARPLAN TAB 10MG 36 MATULANE CAP 50MG 13 matzim la 19 MAXIDEX SUS 0.1% OP 38 meclizine tab 12.5mg, 25mg 7 meclofenamate sod cap 50mg, 100mg 37 medroxyprogesterone ac inj 150mg/ml 43 medroxyprogesterone acetate tab 2.5mg, 5mg, 10mg 43 mefenam acid cap 250mg 37 mefloquine tab 250mg 10 MEGACE ES SUS 625/5ML 43 megestrol ac sus 40mg/ml 11 megestrol ac tab 20mg, 40mg 11 MEKINIST TAB 0.5MG, 2MG 12 meloxicam SUSP 37 meloxicam tab 7.5mg, 15mg 37 melphalan inj 50mg 2 MENACTRA INJ 16 MENEST TAB 0.3MG, 0.625MG, 1.25MG, 2.5MG 26 MENOMUNE INJ A/C/Y/W 16 MENVEO INJ 16 mercaptopur tab 50mg 10 meropenem inj 500mg 19 mesalamine kit 4gm 32 mesna inj 1gm 21 MESNEX TAB 400MG 21 MESTINON SYP 60MG/5ML 10 MESTINON TAB TIMESPAN 10 metadate 47 metaproteren syp 10mg/5ml 48 metaproteren tab 10mg, 20mg 48 metformin er tab 1000mg 17 metformin tab 500mg, 500mg er, 750mg er, 850mg, 1000mg 17 METHADONE INJ 10MG/ML 39 methadone sol 10mg/5ml 39 methadone sol 5mg/5ml 39 63

79 methadone tab 5mg, 10mg 39 methamphetamine tab 5mg 3 methazolamide tab 25mg, 50mg 19 methenam hip tab 1gm 50 methimazole tab 5mg, 10mg 16 METHITEST TAB 10MG 3 methotrexate inj 1gm 10 methotrexate inj 1gm/40ml 10 methotrexate tab 2.5mg 10 methoxsalen rapid 14 methscopolamine tab 2.5mg, 5mg 15 methyclothia tab 5mg 49 methyldopa tab 250mg, 500mg 5 methyldopa/hctz tab 250/15, 250/25 9 methylergon tab 0.2mg 41 METHYLIN CHW 2.5MG, 5MG, 10MG 47 methylphenidate cap 10mg, 20mg er, 30mg er, 40mg er, 50mg, 60mg 47 methylphenidate sol 5mg/5ml, 10mg/5ml 47 methylphenidate tab 18mg er 47 methylphenidate tab 20mg 47 methylphenidate tab 20mg er, 27mg er, 36mg er, 54mg er 47 methylphenidate tab 5mg, 10mg 47 methylprednisolone ace inj 40mg/ml, 80mg/ml 27 methylprednisolone pak 4mg 27 methylprednisolone ss inj 40mg, 125mg 27 methylprednisolone tab 4mg, 8mg, 16mg, 32mg 27 metipranolol sol 0.3% oph 17 metoclopramide inj 5mg/ml 27 metoclopramide sol 5mg/5ml 27 metoclopramide tab 5mg, 10mg 27 metolazone tab 2.5mg, 5mg, 10mg 49 metoprl/hctz tab mg 9 metoprolol inj 1mg/ml 17 metoprolol tab 25mg er, 50mg er, 100mg er, 200mg er 17 metoprolol tartrate tab 25mg, 50mg, 100mg 17 metoprolol/hctz tab 50-25mg, mg 9 METROGEL GEL 1% 45 metronidazol cre 0.75% 45 metronidazol gel 0.75% 45 metronidazol gel 0.75%vag 50 metronidazol gel 1% 45 metronidazol lot 0.75% 45 metronidazole cap 375mg 4 metronidazole tab 250mg, 500mg 4 metronidazole/nacl inj 500mg 4 mexiletine cap 150mg, 200mg, 250mg 5 MIACALCIN INJ 200/ML 18 microgestin 1.5/30 21 day 22 microgestin 1/20 21 day 22 microgestin fe 1.5/30 28 day 22 microgestin fe 1/20 28 day 22 midodrine tab 2.5mg, 5mg, 10mg 51 MIGRANAL 35 MILLIPRED SOL 10MG/5ML 27 MILLIPRED TAB 5MG 27 minocycline cap 50mg, 75mg, 100mg 48 minocycline tab 100mg 48 minocycline tab 135mg er 48 minocycline tab 45mg er 48 minocycline tab 50mg, 75mg 48 minocycline tab 90mg er 48 minoxidil tab 2.5mg, 10mg 51 mirtazapine tab 15mg odt, 30mg odt, 45mg odt 2 mirtazapine tab 7.5mg, 15mg, 30mg, 45mg 2 misoprostol tab 100mcg, 200mcg 50 mitomycin inj 20mg 12 mitoxantron inj 2mg/ml 12 M-M-R II INJ LIVE 51 modafinil tab 100mg, 200mg 47 moderiba TABS 29 MODERIBA PAK 800/DAY, 1200/DAY 29 moexipril tab 7.5mg, 15 mg 1 moexipril/hctz tab , , 15-25mg 9 mometasone cre 0.1% 24 mometasone oin 0.1% 24 mometasone sol 0.1% 24 mononessa 28 day 22 montelukast chw 4mg, 5mg 33 montelukast gra 4mg 34 montelukast tab 10mg 34 MONUROL PAK GRANULES 50 morphine sul bead cap 30mg er, 60mg er 39 morphine sul cap 100mg er 39 morphine sul cap 10mg er, 20mg er 39 morphine sul cap 120mg er 39 morphine sul cap 30mg er, 45mg er, 50mg er 39 morphine sul cap 60mg er 39 morphine sul cap 75mg er 39 morphine sul cap 80mg er 39 morphine sul cap 90mg er 39 morphine sul sol 10mg/5ml, 20mg/5ml, 20mg/ml 40 morphine sul tab 15mg er, 30mg er 40 morphine sul tab 15mg, 30mg 40 morphine sul tab 60mg er, 100mg er, 200mg er 40 MORPHINE SULFATE SOLN 2mg/ml, 4mg/ml 40 MOVIPREP SOL 33 MOXATAG TAB 775MG 3 moxifloxacin hcl 27 MOZOBIL INJ 47 MULTAQ TAB 400MG 5 mupirocin cre 2% 5 mupirocin oin 2% 5 MUSTARGEN INJ 10MG 2 MYCOBUTIN CAP 150MG 11 mycophenolate cap 250mg 31 mycophenolate tab 500mg 31 mycophenolic tab 180mg dr, 360mg dr 31 myorisan 1 MYOZYME INJ 50MG 35 64

80 MYRBETRIQ TAB 25MG, 50MG 50 N nabumetone tab 500mg, 750mg 37 nadolol tab 20mg, 40mg, 80mg 17 nadolol/bend tab 40-5mg, 80-5mg 9 nafcillin inj 10gm 41 nafcillin inj 1gm 41 NAFTIN CRE 1% 8 NAFTIN GEL 1%, 2% 8 NAGLAZYME INJ 1MG/ML 35 nalbuphine inj 10mg/ml, 20mg/ml 41 NALLPEN/DEX INJ 1GM/50ML 41 naloxone inj 1mg/ml 40 naltrexone tab 50mg 40 NAMENDA SOL 10MG/5ML 7 NAMENDA XR CAP 7MG, 14MG, 21MG, 28MG 7 NAMENDA XR CAP TITRATIO 7 naphazoline sol 0.1% op 38 naproxen dr tab 375mg, 500mg 37 naproxen sod tab 275mg, 550mg 37 naproxen sus 125/5ml 37 naproxen tab 250mg, 375mg, 500mg 37 naratriptan tab 1mg 46 naratriptan tab 2.5mg 46 NATACYN SUS 5% OP 38 nateglinide tab 60mg, 120mg, 0.5mg 34 NEBUPENT INH 300MG 4 necon 0.5/35 28 day 22 necon 1/35 28 day 22 necon 7/7/7 28 day 22 NECON TAB 10/ nefazodone tab 50mg, 100mg, 150mg, 200mg, 250mg 35 neo/bac/poly oin op 38 neo/poly gu sol 40/ml ir 27 neo/poly/bac oin /hc 1%op 38 neo/poly/dex oin 0.1% op 38 neo/poly/dex sus 0.1% op 38 neo/poly/gra sol op 38 neo/poly/hc sol 1% otic 41 neo/poly/hc sus 1% otic 41 neo/poly/hc sus op 38 neomycin tab 500mg 3 NEORAL CAP 25MG, 100MG 31 NEORAL SOL 100MG/ML 31 NEPHRAMINE INJ 5.4% 44 NEULASTA INJ 6MG/0.6M 29 NEUMEGA INJ 5MG 29 NEUPOGEN INJ 300/0.5, 480/0.8, 480MCG 29 NEUPRO DIS 1MG/24HR, 2MG/24HR, 3MG/24HR, 6MG/24H, 8MG/24H 13 NEVANAC SUS 0.1% 39 NEVIRAPINE SUSP 14 nevirapine tab 400mg er 15 nevirapine tab 200mg 15 NEXAVAR TAB 200MG 12 NEXIUM CAP 20MG, 40MG 44 NEXIUM GRA 2.5MG DR, 5MG DR, 10MG DR, 40MG DR 44 niacin er tab 500mg, 750mg, 1000mg 37 nicardipine cap 20mg, 30mg 19 NICOTROL INH 46 NICOTROL NS SPR 10MG/ML 46 nifedical 19 nifedipine tab 30mg er, 60mg er, 90mg er 19 NILANDRON TAB 150MG 11 nimodipine cap 30mg 19 NIPENT INJ 10MG 13 nisoldipine tab 8.5mg er, 17mg er, 20mg, 25.5mg, 30mg, 34mg er, 40mg 19 NITRO-BID OIN 2% 37 NITRO-DUR DIS 0.1MG/HR, 0.2MG/HR, 0.3MG/HR, 0.4MG/HR, 0.6MG/HR, 0.8MG/HR 37 nitrofur mac cap 50mg 50 nitrofurantoin cap 100mg 50 nitrofurantoin sus 25mg/5ml 50 nitroglycerin dis 0.1mg/hr, 0.2mg/hr, 0/4mg/hr 37 nitroglycerin dis 0.6mg/hr 37 NITROGLYCERIN INJ 5MG/ML 37 Nitroglycerin spray 0.4mg 37 NITROSTAT SUB 0.3MG, 0.4MG, 0.6MG 37 nizatidine cap 150mg, 300mg 28 nizatidine sol 15mg/ml 28 nora-be 28 day 43 NORDITROPIN INJ 5/1.5ML, 10/1.5ML, 15/1.5ML, 30/3ML 28 norethin ace tab 5mg 43 norethindron tab 0.35mg 43 NORMOSOL -R INJ /D5W 26 NORMOSOL-R INJ PH NORPACE CAP 100MG CR, 150MG CR 5 nortrel 0.5/35 28 day 22 nortrel 1/35 21 day 22 nortrel 1/35 28 day 22 nortrel 7/7/7 28 day 22 nortriptyline cap 10mg, 25mg, 50mg, 75mg 50 nortriptyline sol 10mg/5ml 50 NORVIR CAP 100MG 15 NORVIR SOL 80MG/ML 15 NORVIR TAB 100MG 15 NOVOLIN INJ 70/30 32 NOVOLIN N INJ U NOVOLIN R INJ U NOVOLOG INJ 100/ML 32 NOVOLOG INJ PENFILL 32 NOVOLOG MIX INJ 70/30 32 NOVOLOG MIX INJ FLEXPEN 32 NOXAFIL SUS 40MG/ML 30 NUEDEXTA CAP 20-10MG 44 NULOJIX INJ 250MG 31 NUVARING MIS 22 nyamyc 8 nystat/triam cre 8 65

81 nystat/triam oin 8 nystatin cre nystatin oin nystatin pow nystatin sus nystatin tab nystop 8 O octreotide inj 100mcg, 200mcg 47 octreotide inj 500mcg, 1000mcg 47 octreotide inj 50mcg/ml 46 ofloxacin dro 0.3% op 38 ofloxacin dro 0.3%otic 41 ofloxacin tab 200mg, 300mg, 400mg 27 ogestrel 28 day 22 olanza/fluox cap 3-25mg, 6-25mg, 6-50mg, 12-25mg, 12-50mg 22 olanzapine inj 10mg 24 olanzapine tab 2.5mg, 5mg, 5mg odt, 7.5mg, 10mg, 10mg odt, 15mg, 15mg odt, 20mg, 20mg odt, 25mg, 50mg, 100mg, 200mg, 300mg, 400mg 24 OLYSIO CAP 150MG 29 OMECLAMOX-PAK 50 omega-3-acid ethyl esters 9 omeprazole cap 10mg, 20mg, 40mg 44 OMEPRAZOLE-SODIUM BICARBONATE 44 OMNARIS SPR 36 OMNITROPE INJ 10/1.5ML 28 OMNITROPE INJ 5.8MG 28 ONCASPAR INJ 750/ML 12 ondansetron inj 4mg/2ml 1 ondansetron sol 4mg/5ml 1 ondansetron tab 24mg 1 ondansetron tab 4mg, 4mg odt, 8mg, 8mg odt 1 ONFI SUS 2.5MG/ML 6 ONFI TAB 10MG, 20MG 6 OPANA ER TAB 30MG, 40MG 40 OPANA ER TAB 5MG, 7.5MG, 10MG, 15MG, 20MG 40 OPSUMIT TAB 10MG 44 ORAP TAB 1MG, 2MG 44 ORENCIA INJ 125MG/ML 45 ORFADIN 35 orsythia 28 day 22 ORTHO EVRA DIS WEEK 22 ORTHO TRI- TAB CYCLN LO 22 OSMOPREP TAB 1.5GM 45 oxacillin inj 2gm, 10mg 41 oxaliplatin inj 100mg 2 oxandrolone TABS 10mg 3 oxandrolone TABS 2.5mg 3 oxaprozin tab 600mg 37 oxcarbazepine sus 300mg/5m 6 oxcarbazepine tab 150mg, 300mg, 600mg 6 OXISTAT CRE 1% 8 OXISTAT LOT 1% 8 OXSORALEN LOT 1% 42 OXSORALEN-UL CAP 10MG 14 oxybutynin syp 5mg/5ml 50 oxybutynin tab 5mg, 5mg er, 10mg er, 15mg er 50 oxycodone cap 5mg 40 oxycodone con 100/5ml 40 oxycodone sol 5mg/5ml 40 oxycodone tab 15mg, 20mg, 30mg 40 oxycodone tab 5mg, 10mg 40 oxycodone/apap tab , 5-325mg, mg, mg 40 oxycodone/asa tab 40 oxycodone/ibu tab 5-400mg 40 OXYCONTIN TAB 10MG CR, 15MG CR, 20MG CR, 30MG CR 40 OXYCONTIN TAB 40MG CR, 60MG CR, 80MG CR 40 oxymorphone tab 15mg er, 20mg er 40 oxymorphone tab 30mg er, 40mg er 40 oxymorphone tab 5mg er 40 oxymorphone tab 7.5mg er, 10mg er 40 oxymorphone tab hcl 10mg 40 oxymorphone tab hcl 5mg 40 P pacerone 5 paclitaxel inj 300/50ml 35 PALGIC TAB 4MG 8 pamidronate inj 30/10ml, 90/10ml 18 PAMIDRONATE INJ 6MG/ML 18 PANRETIN GEL 0.1% 12 pantoprazole tab 20mg, 40mg 44 paricalcitol cap 1 mcg, 2 mcg, 4 mcg 35 paromomycin cap 250mg 3 paroxetin er tab 12.5mg, 37.5mg 45 paroxetine tab 10mg, 20mg 45 paroxetine tab 25mg er 45 paroxetine tab 30mg, 40mg 46 PASER GRA 4GM 11 PATADAY SOL 0.2% 39 PATANASE SPR 0.6% 36 PATANOL SOL 0.1% OP 39 PAXIL SUS 10MG/5ML 46 PCE TAB 333MG EC, 500MG EC 26 pedi-dri 8 PEDVAX HIB INJ 16 PEGANONE TAB 250MG 30 PEGASYS INJ 29 PEGASYS INJ 180MCG/M 29 PEGASYS INJ PROCLICK 29 PEG-INTRON 29 PEG-INTRON KIT 50MCG, 50MCG RP, 80MCG RP, 120RP, 150RP 29 PEN G PROC INJ pen g sod inj PENICILL GK/ INJ DEX 2MU, 3MU 36 penicilln gk inj 5mu 36 66

82 penicilln vk tab 250mg, 500mg 37 PENTAM 300 INJ 300MG 4 PENTASA CAP 250MG CR, 500MG CR 32 pentoxifylline tab 400mg er 29 PERFOROMIST NEB 20MCG 48 perindopril tab 2mg, 4mg, 8mg 1 periogard 15 PERJETA INJ 420/14ML 11 permethrin cre 5% 45 perphen/amit tab 2-10mg, 2-25mg, 4-10mg, 4-25mg, 4-50mg 22 perphenazine tab 2mg, 4mg, 8mg, 16mg 42 pfizerpen 37 phenadoz 8 phenelzine tab 15mg 36 phenobarbital elx 20mg/5ml 16 phenobarbital tab 15mg, 16.2mg, 30mg, 32.4mg, 60mg, 64.8mg, 97.2mg, 100mg 16 phenytoin chw 50mg 30 phenytoin ex cap 100mg, 200mg, 300mg 30 phenytoin inj 50mg/ml 30 phenytoin sus 125/5ml 30 PHOSPHOLINE SOL 0.125%OP 35 PILOCARPINE HCL SOLN 39 pilocarpine tab 5mg, 7.5mg 49 pimtrea pack 22 pindolol tab 5mg, 10mg 17 pioglitazone tab 15mg, 30mg, 45mg 32 pioglitazone/glimepiride tab 30-2mg, 4mg 7 pioglitazone/metformin tab mg, 850mg 7 piper/tazoba inj g, 4-0.5gm 41 pirmella 1/35 28 day 22 piroxicam cap 10mg, 20mg 37 PLASMA-LYTE INJ PLASMA-LYTE INJ 56/D5W 26 PLASMA-LYTE INJ -A 26 podofilox sol 0.5% 33 polyethylene glycol 3350 POWD 33 polymyxin b inj polymyxin b/ sol trimethp 38 POMALYST CAP 1MG, 2MG, 3MG, 4MG 12 portia 28 day 22 pot chloride cap 8meq er, 10meq er 42 pot chloride inj 10meq, 20meq, 40meq 42 pot chloride inj 2meq/ml 42 pot citrate tab 540mg, 1080mg 2 pot cl micro tab 10meq er, 20meq er 42 POTIGA TAB 50MG, 200MG, 300MG, 400MG 6 PRADAXA CAP 75MG, 150MG 49 pramipexole tab 0.5mg, 0.25mg, 0.75mg, 0.125mg, 1.5mg, 1mg 13 pravastatin tab 10mg, 20mg, 40mg, 80mg 30 prazosin hcl cap 1mg, 2mg, 5mg 5 PRED MILD SUS 0.12% OP 38 PRED SOD PHO SOL 1% OP 38 pred sod pho sol 5mg/5ml 27 PRED-G S.O.P OIN OP 38 PRED-G SUS OP 38 prednicarbat oin 0.1% 24 prednicarbate 24 prednisolone acetate (ophth) 39 prednisolone sol 15mg/5ml, 25mg/5ml 27 PREDNISONE CON 5MG/ML 27 prednisone sol 5mg/5ml 28 prednisone tab 1mg, 2.5mg, 5mg, 10mg, 20mg, 50mg 28 PREMARIN INJ 25MG 26 PREMARIN TAB 0.3MG, 0.9MG, 0.45MG, 0.625MG, 1.25MG 26 PREMARIN VAG CRE 0.625MG 51 premasol 44 PREMASOL SOL 10% 44 PREMPRO TAB , , , PRENATAL VITAMIN/FOLIC ACID > 0.8 MG (GENERIC) 43 prevalite 18 previfem 28 day 22 PREVPAC MIS 50 PREZISTA SUS 100MG/ML 15 PREZISTA TAB 600MG, 800MG 15 PREZISTA TAB 75MG, 150MG 15 PRIFTIN TAB 150MG 11 PRIMAQUINE TAB 26.3MG 10 PRIMAXIN IV INJ 500MG 19 primidone tab 50mg, 250mg 6 PRIMSOL SOL 50MG/5ML 4 PRISTIQ TAB 50MG, 100MG 46 PRIVIGEN INJ 20GRAMS 31 PROAIR HFA AER 48 proben/colch tab probenecid tab 500mg 50 procainamide inj 100mg/ml 5 PROCAINAMIDE INJ 500MG/ML 5 PROCALAMINE INJ 3% 44 prochlorperazine inj 5mg/ml 42 prochlorperazine sup 25mg 42 prochlorperazine tab 5mg, 10mg 42 PROCRIT INJ 10000/ML 29 PROCRIT INJ 2000/ML, 3000/ML, 4000/ML 29 PROCRIT INJ 20000/ML, 40000/ML 29 procto-pak 44 proctozone hc 44 progesterone cap 100mg, 200mg 43 PROGLYCEM SUS 50MG/ML 24 PROGRAF INJ 5MG/ML 31 PROLASTIN-C INJ 1000MG 2 PROLEUKIN INJ 22MU 13 PROLIA SOL 60MG/ML 18 PROMACTA TAB 12.5MG, 25MG, 50MG, 75MG 29 promethazine inj 25mg/ml, 50mg/ml 8 promethazine sup 12.5mg, 25mg 8 promethazine syp 6.25/5ml 8 promethazine tab 12.5mg, 25mg, 50mg 8 67

83 promethazine vc syp plain 24 promethegan 8 propafenone cap 225mg er, 325mg er, 425mg er 5 propafenone tab 150mg, 225mg, 300mg 5 propantheline tab 15mg 15 proparacaine sol 0.5% op 38 propranolol cap 60mg er, 80mg er, 120mg er, 160mg er 17 propranolol inj 1mg/ml 17 propranolol sol 20mg/5ml, 40mg/5ml 17 propranolol tab 10mg, 20mg, 40mg, 60mg, 80mg 17 propranolol/hctz tab 40/25, 80/25 9 propylthiouracil tab 50mg 16 PROQUAD INJ 51 PROSOL INJ 20% 44 PROTOPIC 31 protriptylin tab 10mg 50 protriptyline tab 5mg 50 prudoxin 14 PULMICORT INH 90MCG, 180MCG 47 PULMICORT SUS 1MG/2ML 47 PULMOZYME SOL 1MG/ML 24 PYLERA CAP 50 pyrazinamide tab 500mg 11 pyridostigmine tab 60mg 10 Q QUALAQUIN CAP 324MG 10 quasense 91 day 22 quinapril tab 5mg, 10mg, 20mg, 40mg 1 quinapril/hctz tab quinapril/hctz tab , 20-25mg 9 QUINIDINE GL INJ 80MG/ML 5 quinidine gl tab 324mg cr 5 quinidine su tab 200mg, 300mg, 300mg er 5 quinine sulf cap 324mg 10 QVAR AER 40MCG, 80MCG 47 R RABAVERT INJ 51 rabeprazole tab 20mg 44 raloxifene hcl 30 ramipril cap 1.25mg, 2.5mg, 5mg 1 RANEXA TAB 500MG, 1000MG 5 ranitidine cap 150mg, 300mg 28 ranitidine inj 150/6ml 28 ranitidine syp 15mg/ml 28 ranitidine tab 150mg, 300mg 28 RAPAFLO CAP 4MG, 8MG 43 RAPAMUNE SOL 1MG/ML 31 RAPAMUNE TAB 0.5MG, 1MG, 2MG 31 REBETOL SOL 40MG/ML 29 REBIF INJ 22/0.5, 44/ REBIF TITRTN SOL PACK 36 reclipsen 28 day 22 RECOMBIVA HB INJ 10MCG/ML, 40MCG/ML 51 REGRANEX GEL 0.01% 51 RELENZA MIS DISKHALE 32 RELISTOR KIT 12/0.6ML 42 RELPAX TAB 20MG 46 RELPAX TAB 40MG 46 REMICADE INJ 100MG 32 RENAGEL TAB 400MG, 800MG 42 repaglinide tab 1mg 34 repaglinide tab 2mg 34 reprexain 40 REPREXAIN TAB , 5-200MG 40 RESCRIPTOR TAB 100 MG, 200MG 15 reserpine tab 0.1mg, 0.25mg 5 RESTASIS EMU 0.05% 38 RETROVIR INJ 10MG/ML 15 REVLIMID CAP 2.5MG, 5MG, 10MG, 15MG, 20MG, 25MG 31 REYATAZ CAP 150MG, 200MG, 300MG 15 RHEUMATREX TAB 2.5MG 15 RIBAPAK PAK 800/DAY, 1000/DAY, 1200/DAY 29 ribasphere CAPS 29 ribasphere TABS 200mg, 400mg 29 ribasphere TABS 600mg 29 ribavirin cap 200mg 29 ribavirin tab 200mg 29 RIDAURA CAP 3MG 28 rifabutin 11 rifamate 4 rifampin cap 150mg, 300mg 11 rifampin inj 600 mg 11 RIFATER TAB 4 riluzole tab 50mg 2 rimantadine tab 100mg 32 ringers inj 26 ringers irr sol 33 RIOMET SOL 17 risedronate sodium 18 RISPERDAL INJ 12.5MG, 12MG, 37.5MG, 50MG 16 risperidone sol 1mg/ml 16 risperidone tab 0.5mg, 0.5mg od, 0.25mg odt, 0.25mg, 1mg, 1mg odt, 2mg, 2mg odt, 3mg, 3mg odt, 4mg, 4mg odt 16 RITUXAN INJ 500MG 11 rivastigmine cap 1.5mg, 3mg, 4.5mg, 6mg 7 rizatriptan tab 5mg, 5mg odt, 10mg, 10mg odt 46 ropinirole tab 0.5mg 13 ROTARIX 51 ROTATEQ SOL 51 ROZEREM TAB 8MG 45 S SABRIL POW 500MG 27 SABRIL TAB 500MG 27 SAIZEN INJ 5MG, 8.8MG 28 SAMSCA TAB 15MG, 30MG 51 SANCUSO DIS 3.1MG 1 SANDIMMUNE CAP 25MG, 100MG 31 SANDIMMUNE INJ 50MG/ML 31 SANDIMMUNE SOL 100MG/ML 31 SANDOSTATIN KIT LAR 10MG, 20MG, 30MG 47 68

84 SANTYL OIN 250/GM 26 SAPHRIS SUB 5MG, 10MG 25 SAVELLA MIS TITR PAK 26 SAVELLA TAB 12.5MG, 25MG, 50MG, 100MG 26 seconal sodium 16 selegiline cap 5mg 13 selegiline tab 5mg 13 selenium sul lot 2.5% 15 SELZENTRY TAB 150MG, 300MG 15 SEMPREX-D 44 SENSIPAR TAB 30MG, 60MG, 90MG 35 SEREVENT DIS AER 50MCG 48 SEROQUEL XR TAB 50MG, 150MG, 200MG, 300MG, 400MG 25 sertraline con 20mg/ml 46 sertraline tab 25mg, 50mg, 100mg 46 sildenafil tab 20mg 44 SILENOR TAB 3MG, 6MG 30 silver sulfa cre 1% 18 SIMBRINZA SUS 1-0.2% 37 SIMCOR TAB , SIMCOR TAB MG, 40MG 30 SIMCOR TAB MG 30 SIMPONI 5 SIMPONI ARIA SOL 50MG/4ML 5 SIMPONI INJ 50MG 5 SIMULECT INJ 20MG 31 simvastatin tab 5mg, 10mg, 20mg, 40mg, 80mg 30 sirolimus tab 0.5mg 31 SIRTURO TAB 100MG 11 smz/tmp ds tab smz-tmp inj /5 4 smz-tmp sus /5 4 smz-tmp tab mg 4 sod chloride inj 0.9%, 0.45% 46 sod chloride inj 2.5/ml 46 sod chloride inj 3%, 5% 46 SOD LACTATE INJ 5MEQ/ML 17 sod poly sul sus 15gm/60 42 sod sulfacet sol 10% op 38 sodium chlor sol 0.9% irr 27 SOLARAZE GEL 3% W/W 12 SOLTAMOX SOL 10MG/5ML 11 SOLU-CORTEF INJ 100MG, 250MG 28 SOLU-MEDROL INJ 2GM, 40MG, 500MG 28 SOMATULINE INJ 60/0.2ML, 90/0.3ML, 120/.5ML 47 SOMAVERT INJ 10MG, 15MG, 20MG 28 sorine 17 sotalol af tab 120mg 17 sotalol hcl tab 80mg, 160mg, 240mg 17 SOVALDI TAB 400MG 30 spinosad sus 0.9% 45 SPIRIVA CAP HANDIHLR 18 spironolactone tab 25mg, 50mg, 100mg 43 spironolactone/hctz tab 25/25 25 sprintec 28 day 22 SPRYCEL TAB 20MG, 50MG, 70MG, 80MG, 100MG, 140MG 12 sronyx 28 day 22 ssd 18 stavudine cap 15mg, 20mg, 30mg, 40mg 15 stavudine sol 1mg/ml 15 STELARA INJ 45MG/ STELARA INJ 90MG/ML 14 steril water sol irrig 33 STIMATE SOL 1.5MG/ML 42 STIVARGA TAB 40MG 12 STRATTERA CAP 10MG, 18MG, 25MG, 40MG, 60MG, 80MG, 100MG 16 streptomycin inj 1gm 3 STRIBILD TAB 15 STROMECTOL TAB 3MG 7 SUBOXONE MIS 2-0.5MG, 4-1MG, 8-2MG, 12-3MG 41 SUCRAID SOL 8500/ML 25 sucralfate tab 1gm 35 sulf/pred na sol op 39 sulfacet sod oin 10% op 38 sulfacetamid sus 10% 1 SULFADIAZINE TAB 500MG 47 SULFAMYLON CRE 85MG/GM 18 SULFAMYLON PAK 5% 18 sulfasalazine tab 500mg 32 sulfazine ec tab 500mg 32 sulindac tab 150mg, 200mg 37 SUMATRIPTAN SOLN 46 sumatriptan inj 6mg/ sumatriptan tab 100mg 46 sumatriptan tab 25mg, 50mg 46 SUPRAX CAP 400MG 20 SUPRAX SUS 100/5ML, 200/5ML, 500/5ML 20 SUPRAX TAB 400MG 20 SUPREP BOWEL SOL PREP 33 SURMONTIL CAP 25MG, 50MG, 100MG 50 SUSTIVA CAP 50MG, 200MG 15 SUSTIVA TAB 600MG 15 SUTENT CAP 12.5MG, 25MG, 50MG 12 SYLATRON KIT 296MCG, 444MCG, 888MCG 13 SYMBICORT AER , SYMLINPEN 60 INJ 1000MCG 7 SYMLNPEN 120 INJ 1000MCG 7 SYNAGIS INJ 50MG 36 SYNAREL SOL 2MG/ML 34 SYNERCID INJ 500MG 47 SYNRIBO INJ 3.5MG 13 SYNTHROID TAB 25MCG, 5MCG, 75MCG, 88MCG, 100MCG, 112MCG, 125MCG, 137MCG, 150MCG, 175MCG, 200MCG, 300MCG 49 SYPRINE CAP 250MG 20 T TABLOID TAB 40MG 10 69

85 TACLONEX SUS 24 tacrolimus cap 0.5mg 31 tacrolimus cap 1mg, 5mg 31 TAFINLAR CAP 50MG, 75MG 12 TAMIFLU CAP 30MG 32 TAMIFLU CAP 45MG, 75MG 32 TAMIFLU SUS 6MG/ML 32 tamoxifen tab 10mg, 20mg 11 tamsulosin cap 0.4mg 43 TARCEVA TAB 25MG, 100MG, 150MG 12 TARGRETIN CAP 75MG 13 TARGRETIN GEL 1% 12 TASIGNA CAP 150MG, 200MG 12 TASMAR TAB 100MG 13 TAZORAC CRE 0.1%, 0.05% 14 taztiaxt 19 TECFIDERA CAP 120MG, 240MG 36 TECFIDERA MIS STARTER 36 TEFLARO 4 TEGRETOL-XR TAB 100MG 6 TEKTURNA HCT TAB MG, 25MG 9 TEKTURNA HCT TAB MG, 25MG 9 TEKTURNA TAB 150MG, 300MG 25 telmisartan tab 20mg, 40mg, 80mg 4 telmisartan/amlodipine tab 40-5mg, 10mg 9 telmisartan/amlodipine tab 80-5mg, 10mg 9 telmisartan/hctz tab telmisartan/hctz tab mg, 25mg 10 terazosin cap 1mg, 2mg, 5mg, 10mg 5 terbinafine tab 250mg 8 terbutaline inj 1mg/ml 48 terbutaline tab 2.5mg 48 terbutaline tab 5mg 48 terconazole cre 0.4%, 0.8% 50 terconazole sup 80mg 50 testosterone cyp inj 100mg/ml, 200mg/ml 3 testosterone enan inj 200mg/ml 3 TET/DIP TOX INJ 2-2 LF 49 TETANUS TOX INJ 5LF ADS 49 TEV-TROPIN INJ 5MG 28 THALOMID CAP 50MG, 100MG, 150MG, 200MG 31 theophylline tab 100mg cr, 200mg cr, 300mg er, 400mg er, 450mg er, 600mg er 51 thioridazine tab 10mg 42 thioridazine tab 25mg, 50mg, 100mg 42 thiothixene cap 1mg, 2mg, 5mg, 10mg 49 THYMOGLOBULN INJ 25MG 31 THYROLAR-1 TAB 60MG 49 THYROLAR-1/2 TAB 30MG 49 THYROLAR-1/4 TAB 15MG 49 THYROLAR-2 TAB 120MG 49 THYROLAR-3 TAB 180MG 49 tiagabine tab 2mg, 4mg 27 TIKOSYN CAP 125MCG, 250MCG, 500MCG 5 TIMENTIN INJ 3.1GM 41 timolol gel sol 0.5% op, 0.25% op 17 timolol mal sol 0.5% op, 0.25% op 17 timolol mal tab 5mg, 10mg, 20mg 17 tinidazole tab 250mg, 500mg 4 TIROSINT CAP 13MCG, 25MCG, 50MCG, 75MCG, 88MCG, 100MCG, 112MCG, 125MCG, 137MCG, 150MCG 49 TIVICAY TAB 50MG 15 tizanidine cap 2mg, 4mg, 6mg 20 tizanidine tab 2mg, 4mg 20 TOBI NEB 300/5ML 3 TOBI PODHALR CAP 28MG 3 tobra/dexame sus % 39 TOBRADEX OIN % 39 tobramycin inj 10mg/ml, 80mg/2ml 3 tobramycin neb 300/5ml 3 tobramycin sol 0.3% op 38 TOBRAMYCIN/NACL INJ 80/0.9 3 TOBREX OIN 0.3% OP 38 tolazamide tab 250mg, 500mg 47 tolbutamide tab 500mg 48 tolmetin sod cap 400mg, 600mg 37 tolterodine cap 2mg er, 4mb er 50 tolterodine tab 1mg, 2mg 50 topiramate cap 15mg, 25mg 6 topiramate tab 25mg, 50mg, 100mg, 200mg 6 topotecan inj 4mg 49 TORISEL SOL 25MG/ML 12 TORSEMIDE INJ 20MG/2ML 34 torsemide tab 5mg, 10mg, 20mg, 100mg 34 TOVIAZ TAB 4MG, 8MG 50 TRACLEER TAB 62.5MG, 125MG 44 TRADJENTA TAB 5MG 25 tramadol hcl tab 100mg er, 200mg er, 300mg er 40 tramadol hcl tab 50mg 40 Tramadol/apap tab trandolapril tab 1mg, 2mg, 4mg 1 tranexamic acid inj 100mg/ml 29 tranexamic acid tab 650mg 29 TRANSDERM-SCOP 7 tranylcypromine tab 10mg 36 TRAVASOL INJ 10% 44 TRAVATAN Z DRO 0.004% 43 travoprost dro 0.004% 43 trazodone tab 50mg, 100mg, 150mg, 300mg 35 TREANDA INJ 100MG 2 TRECATOR TAB 250MG 11 TRELSTAR DEP INJ 3.75MG 11 TRELSTAR LA INJ 11.25MG 11 TRELSTAR MIX INJ 22.5MG 11 tretinoin cap 10mg 13 tretinoin cre 0.1%, 0.05%, 0.025% 1 tretinoin gel 0.01%, 0.025% 1 TREXALL TAB 5MG, 7.5MG, 10MG, 15MG 10 TREXIMET TAB MG 35 triamcin/ora pst 0.1% 47 70

86 triamcinolon oin 0.025% 24 triamcinolone cre 0.1%, 0.5%, 0.025% 24 triamcinolone lot 0.1%, 0.025% 24 triamcinolone oin 0.1%, 0.5% 24 triamcinolone spr 55mcg/ac 36 triamterene/hctz cap triamterene/hctz cap 50-25mg 25 triamterene/hctz tab triamterene/hctz tab 75-50mg 25 TRIBENZOR20- TAB MG 10 TRIBENZOR40- TAB MG, 10-25MG 10 TRIBENZOR40- TAB MG, 5-25MG 10 triderm 24 trifluoperazine tab 1mg, 2mg, 5mg, 10mg 42 trifluridine sol 1% op 38 trihexyphenidyl elx 0.4mg/ml 13 trihexyphenidyl tab 2mg, 5mg 13 tri-legest 28 day 22 TRILEPTAL SUS 300MG/5M 6 trilyte 33 trimethoprim tab 100mg 4 trinessa 28 day 22 tri-previfem 28 day 22 TRISENOX SOL 10MG/10M 13 tri-sprintec 28 day 22 trivora 28 day 22 TRIZIVIR TAB 15 TROPHAMINE INJ 6%, 10% 44 trospium chl cap 60mg er 50 trospium cl tab 20mg 50 TRUVADA TAB TUDORZA PRES AER 400/ACT 18 TWINRIX INJ 51 TYGACIL INJ 50MG 28 TYKERB TAB 250MG 12 TYPHIM VI INJ 16 TYSABRI INJ 300/15ML 36 TYVASO SOL 0.6MG/ML 43 TYZEKA TAB 600MG 30 TYZINE PED DRO 0.05% 48 U u-cort 24 ULESFIA LOT 5% 45 ULORIC TAB 40MG, 80MG 28 unithroid 49 ursodiol cap 300mg 27 ursodiol tab 250mg, 500mg 27 UVADEX INJ 20MCG/ML 13 V VAGIFEM TAB 10MCG 51 valacyclovir tab 1gm, 500mg 30 VALCYTE SOL 50MG/ML 21 VALCYTE TAB 450MG 21 valproate inj 100mg/ml 51 valproic acd cap 250mg 51 valproic acd syp 250/5ml 51 valsartan/hctz tab mg, mg 10 valsartan/hctz tab mg, mg 10 valsartan/hctz tab vancomycin cap 125mg, 250mg 4 vancomycin inj 10gm, 500mg, 1000mg 4 vandazole 50 VAQTA INJ 25/0.5ML 51 VARIVAX INJ 51 VECTIBIX INJ 100MG 11 VELCADE INJ 3.5MG 12 velivet 28 day 22 venlafaxine cap 37.5 er, 75mg er, 150mg er 46 VENLAFAXINE TAB 225MG ER 46 venlafaxine tab 25mg, 37.5mg er, 37.5mg, 50mg, 75mg, 75mg er, 100mg, 150mg er 46 VENTAVIS SOL 10MCG/ML, 20MCG/ML 43 VENTOLIN HFA AER 48 VERAMYST SPR 27.5MCG 36 verapamil cap 100mg er, 120mg er, 180mg er, 200mg er, 240mg er, 300mg er, 360mg er 19 verapamil inj 2.5mg/ml 19 verapamil tab 40mg, 80mg, 120mg, 120mg er, 180mg er, 240mg er 19 VEREGEN OIN 15% 2 VERIPRED 20 SOL 20MG/5ML 28 VERSACLOZ 25 VESICARE TAB 5MG, 10MG 50 vestura 22 VEXOL SUS 1% OP 39 VFEND IV INJ 200MG 30 VIBRAMYCIN SYP 50MG/5ML 48 vicodin 40 VICTOZA INJ 18MG/3ML 32 VICTRELIS CAP 200MG 30 VIDAZA INJ 100MG 10 VIDEX SOL 2GM 15 VIGAMOX DRO 0.5% 38 VIIBRYD KIT 36 VIIBRYD TAB 10MG, 20MG, 40MG 36 VIMPAT INJ 200MG/20 6 VIMPAT SOL 10MG/ML 6 VIMPAT TAB 50MG, 100MG, 150MG, 200MG 6 VINBLASTINE INJ 1MG/ML 35 vincasar 35 vincristine inj 1mg/ml 35 vinorelbine inj 10mg/ml 35 VIRACEPT TAB 250MG, 625MG 15 VIRAZOLE INH 6GM 45 VIREAD POW 40MG/GM 15 VIREAD TAB 150MG, 200MG, 250MG, 300MG 15 VISTIDE INJ 75MG/ML 21 VIVITROL INJ 380MG 40 VOLTAREN GEL 1% 4 voriconazole inj 200mg 30 71

87 voriconazole sus 40mg/ml 30 voriconazole tab 200mg 30 voriconazole tab 50mg 30 VOTRIENT TAB 200MG 12 VPRIV INJ 400UNIT 2 vyfemia 28 day 22 VYTORIN TAB 10-10MG, 20MG, 40MG, 80MG 9 VYVANSE CAP 20MG, 30MG, 40MG, 50MG, 60MG, 70MG 3 W warfarin tab 1mg, 2.5mg, 2mg, 3mg, 4mg, 5mg, 6mg, 7.5mg, 10mg 24 WELCHOL PAK 3.75GM 18 WELCHOL TAB 625MG 18 X XALKORI CAP 200MG, 250MG 12 XARELTO TAB 10MG, 15MG, 20MG 25 XELJANZ TAB 5MG 15 XENAZINE TAB 12.5MG 36 XENAZINE TAB 25MG 36 XGEVA INJ 18 XIFAXAN TAB 200MG 4 XIFAXAN TAB 550MG 4 XOLAIR SOL 150MG 5 XTANDI CAP 40MG 11 XYREM SOL 500MG/ML 4 Y YERVOY INJ 50MG 11 YF-VAX INJ 51 Z zafirlukast tab 10mg, 20mg 34 zaleplon 37 ZALTRAP INJ 100/4ML 11 ZAMICET SOL MG 40 ZANOSAR INJ 1GM 2 ZAVESCA CAP 100MG 2 zazole 50 ZELAPAR TAB 1.25MG 13 ZELBORAF TAB 240MG 12 ZEMAIRA INJ 1000MG 2 ZEMPLAR CAP 1MCG, 2MCG, 4MCG 35 ZEMPLAR INJ 2MCG/ML, 5MCG/ML 35 zenchent 28 day 22 zenchent fe 28 day 22 ZENPEP CAP 3000UNIT, 10000UNIT, 15000UNIT, 20000UNIT, 25000UNIT 25 ZERIT SOL 1MG/ML 15 ZETIA TAB 10MG 33 ZIAGEN SOL 20MG/ML 15 ZIAGEN TAB 300MG 15 zidovudine cap 100mg 15 zidovudine syp 50mg/5ml 15 zidovudine tab 300mg 15 ZINECARD INJ 250MG 21 ziprasidone cap 20mg, 40mg, 60mg, 80mg 14 ZIRGAN GEL 0.15% 38 ZMAX SUS 2GM 16 ZOHYDRO ER CAP 10MG, 15MG, 20MG, 30MG, 40MG, 50MG 40 zoledronic inj 4mg/5ml 18 zoledronic inj 5/100ml 18 ZOLINZA CAP 100MG 12 zolmitriptan tab 2.5 mg odt, 2.5mg 46 zolmitriptan tab 5mg, 5mg odt 46 zolpidem tab 5mg, 10mg 37 zonisamide cap 25mg, 50mg, 100mg 6 ZORBTIVE INJ 8.8MG 28 ZORTRESS TAB 0.25MG 31 ZORTRESS TAB 0.5MG 31 ZORTRESS TAB 0.75MG 31 ZOSTAVAX INJ 51 ZOSYN SOL GM, G 41 zovia 1/35e 28 day 22 zovia 1/50e 28 day 22 ZOVIRAX CRE 5% 16 ZYCLARA CRE 3.75% 31 ZYCLARA PUMP CRE 2.5% 31 ZYFLO CR TAB 600MG 34 ZYFLO TAB 600MG 34 ZYKADIA 12 ZYMAXID SOL 0.5% 38 ZYTIGA TAB 250MG 11 ZYVOX SOL 2MG/ML 41 ZYVOX SUS 100MG/5M 41 ZYVOX TAB 600MG 41 72

88 This Formulary was updated in August For more recent information or other questions, please contact MVP s Medicare Customer Care Center Monday Friday, 8 am 8 pm Eastern Time at: From Oct. 1 Feb. 14 call seven days a week from 8 am 8 pm. TTY: Or, visit our website at for more information on Medicare Part D drug coverage. Gold PPO with Part D and BasiCare PPO with Part D are not available in Columbia, Dutchess, Greene, Orange, Putnam, Ulster and Westchester counites. Preferred Gold with Part D is not available to members who pay directly for their MVP health plan in Erie, Genesee, Herkimer, Livingston, Madison, Monroe, Niagara, Oneida, Onondaga, Ontario, Orleans, Oswego, Otsego, Seneca, Steuben, Wayne, Wyoming, and Yates counties in New York and Addison, Bennington, Chittenden, Lamoille, Rutland, and Washington counties in Vermont. MVP Health Plan, Inc. is an HMO-POS/PPO organization with a Medicare contract. Enrollment in MVP Health Plan, Inc. depends on contract renewal. Beneficiaries must use network pharmacies to access their prescription drug benefit. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or copayments/ coinsurance may change on January 1 of each year. Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next. 15MVPFRMPDR 11627