FORMULARY November 2015

Transcription

1 FORUAR ovember 2015

2 July 2011 was the last printed publication of the ova Scotia Formulary onthly updates of the ova Scotia Formulary are published online and can be accessed at: Copyright 1996 ova Scotia Department of Health. All rights reserved. o part of this publication may be reproduced, photocopied, stored on a retrieval system, or transmitted without the express written consent of the publisher.

3 TAB OF COTTS ITRODUCTIO How to Use the Formulary egend ATC CASSIFICATIO OF DRUGS A - Alimentary Tract and etabolism 1-23 B - Blood and Blood Forming Organs C - Cardiovascular System D - Dermatologicals G - Genito-Urinary System & Sex Hormones H - Systemic Hormonal reparations, xcluding Sex Hormones J - General Antiinfectives, Systemic Antineoplastics and Immunomodulating Agents usculo-skeletal System ervous System Antiparasitic roducts, Insecticides and Repellents R - Respiratory System S - Sensory Organs V - Various ISCAOUS Diabetic Supplies Benefit ist Ostomy Supplies Benefit ist Compounds ADICS Appendix I - Abbreviations Appendix II - Abbreviations of anufacturers' ames Appendix III - Criteria for Coverage of xception Status Drugs RODUCT IDX

4

5 ITRODUCTIO The ova Scotia Formulary details which drugs and supplies are benefits under the ova Scotia Seniors' harmacare rogram, Family harmacare rogram, Diabetes Assistance rogram, Community Services harmacare rograms and Drug Assistance for Cancer atients. The Formulary is provided on our website at in DF. The ATC Classification System All medications are classified according to the Anatomical Therapeutic Chemical (ATC) Classification System which is used by the World Health Organization for pharmacoepidemiological purposes and by the atented edicine rices Review Board for pricing purposes. The ATC Classification System groups chemically similar products according to their site of action and facilitates the comparison of new medicines with previously available medicines. There are fourteen main groups in the ATC system: A B C D G H J R S V Alimentary tract and metabolism Blood and blood forming organs Cardiovascular system Dermatologicals Genito-urinary system and sex hormones Systemic hormonal preparations, excluding sex hormones General antiinfectives, systemic Antineoplastic and immunomodulating agents usculo-skeletal system ervous system Antiparasitic products, insecticides and repellents Respiratory system Sensory organs Various ach group is subdivided into anatomical, therapeutic and chemical subgroups as shown in the egend. A drug may be given more than one ATC code. If it is available in two or more strengths or formulations with clearly different therapeutic uses, the drug would appear in various categories depending on its different forms. If a drug has more than one clinical indication, the main indication is chosen for the listing of the various brands and strengths of this drug. ovember 2015 age i

6 Interchangeability, aximum Reimbursable rice (R) and harmacare Reimbursement rice (R) The Formulary indicates those products which have been deemed interchangeable by the Drugs and Therapeutics Committee of the ova Scotia Department of Health and Wellness (see the egend). For generic products that meet the criteria for interchangeability a aximum Reimbursable rice (R) may be applied. R is the maximum price established by the harmacare rograms for an interchangeable generic drug. R is applied to those drugs which are harmacare benefits, and have been deemed interchangeable (e.g., brand name drugs and their generic equivalents) The R is the maximum amount that the harmacare rograms will reimburse providers for one unit (tablet, capsule, millilitre, etc.) of a drug. For each interchangeable, generic drug category, a maximum reimbursable price per unit (e.g., tablet, capsule, millilitre) is determined by calculating a percentage of the cost of the equivalent brand name drug. The percentage of the R is reimbursed at 25% of the cost of the manufacturer list price of the equivalent brand drug. Some generic drugs may have exceptions to the R formula, and their R will also be included in the Reimbursement ist. xemptions to the R are available for beneficiaries who have experienced a severe or life threatening reaction with lower cost alternatives. A request must be received from the prescriber detailing the reaction. roviders shall not charge any cost difference between the R of the drug and amount reimbursed by the harmacare rograms unless the beneficiary requests the higher priced drug. If the beneficiary requests the higher priced drug the extra cost is not counted toward their annual maximum copayment or annual maximum deductible. In addition, a harmacare Reimbursement rice (R) is the maximum cost assigned to: - certain groups of drugs that are similar in effect; - specific services for which coverage is established; - certain unit dose and special delivery formats that are also available in less expensive bulk formats; and - certain supplies that are used for the same function. The R is the maximum amount the harmacare rogram reimburses providers for one unit of a drug (tablet, capsule, millilitre, etc.) supply or service. roviders may charge the beneficiary the portion of their AAC that exceeds the R. The extra cost is not counted toward the beneficiary's annual maximum copayment or annual maximum deductible. In all pricing categories, except AAC, the harmacare rograms will reimburse pharmacies the lesser of the amount submitted, or as applicable,, R, or R. All anufacturer ist rices (s) will be updated on a quarterly basis unless otherwise notified directly by the manufacturer. rescriber The Formulary provides prescriber codes (see egend) associated with each benefit under the harmacare rograms. These codes indicate which benefits will be reimbursed when prescribed by a specific prescriber. ovember 2015 age ii

7 The ova Scotia Government harmacare rograms 1. Seniors' harmacare rogram - available to all ova Scotia seniors 65 years or older who have a valid ova Scotia Health Card, and do not have private drug coverage. 2. Community Services harmacare rograms - The Department of Community Services provides drug benefits as part of the Income Assistance rograms (including Special eeds harmacare and Transitional harmacare), the ow Income harmacare rogram for Children, Services for ersons with Disabilities and the Children in Care rograms. ligibility is determined by the Department of Community Services. 3. Drug Assistance for Cancer atients, an income based assistance program covering medication for the treatment of cancer. 4. Diabetes Assistance rogram, an income based assistance program covering medication and supplies needed for diabetes treatment. 5. Under 65-ong Term Care (TC) harmacare, provides drug coverage for long term care residents under 65 years of age who have no drug insurance. 6. Family harmacare rogram, an income based program available to all ova Scotians with a valid ova Scotia Health Card who are not currently receiving drug benefits through Seniors', Community Services, Diabetes Assistance or the Under 65-ong Term Care harmacare rograms. The benefit status of medications reimbursed under these programs are indicated, in the fourth column of the ATC classification, by the letters S (Seniors' harmacare), F (Community Services harmacare / Under 65-ong Term Care harmacare / Family harmacare), C (Drug Assistance for Cancer atients), D (Diabetes Assistance) or (xception Status Drug - see Appendix III). If this column is blank, the product is not a benefit under any of these programs. ovember 2015 age iii

8 iscellaneous Section Diabetes and ostomy supplies are listed in this section. These products are benefits under the Seniors' and Community Services harmacare rograms and are cross-referenced in the appropriate ATC classification. Diabetes supplies are also benefits under the Diabetes Assistance rogram. egend 1. Therapeutic ain Group 2. Therapeutic Subgroup 3. Chemical/Therapeutic Subgroup 4. Subgroup for Chemical Substance 5. Brand or anufacturer's ame of the Drug, including dosage form and/or route and strength 6. Interchangeable roduct Heading 7. rescriber Codes: D - hysician / Dentist - urse ractitioner - harmacist - idwife O - rescribing Optometrist 8. Unit rice 9. = aximum Reimbursement rice = harmacare Reimbursement rice = anufacturer's ist rice 10. Benefit Status (plans for which the product is a benefit): S - Seniors' harmacare F - Community Services harmacare - Under 65-ong Term Care harmacare - Family harmacare C - Drug Assistance for Cancer atients D - Diabetes Assistance rogram - xception status applies (see Appendix III) 11. Drug Identification umber (DI) 12. Abbreviation of anufacturer (see Appendix II) 13. Interchangeable roduct Indicator ovember 2015 age iv

9 CC A A01 A01A A01AB Alimentary Tract and etabolism STOATOOGICAS, OUTH RARATIOS STOATOOGICAS, OUTH RARATIOS ATIIFCTIVS FOR OCA ORA TRATT A01AB03 CHORHXIDI chlorhexidine 0.12% oral rinse erichlor 0.12% Oral Rinse S eridex 0.12% Oral Rinse ZIA A01AB22 DOXCCI eriostat 20mg Cap D A01AC CORTICOSTROIDS FOR OCA ORA TRATT A01AC01 TRIACIOO triamcinolone acetonide 0.1% oral paste Oracort 0.1% Oral aste TAR Kenalog 0.1% in Orabase (discontinued) BRI A01AD OTHR DRUGS FOR OCA ORA TRATT A01AD02 BZDAI benzydamine 0.15% oral rinse harixia 1.5mg/m Oral Rinse D Tantum Oral Rinse (discontinued) DS A02 A02A A02AB DRUGS FOR ACID RATD DISORDRS ATACIDS AUIIU COOUDS A02AB01 AUIIU HDROXID Basaljel 500mg Cap AUR A02AD COB OF AUIIU,CACIU AD AGSIU COOUDS A02AD01 ATACIDS, ORDIAR SAT COBIATIOS Diovol Regular O/ CHU A02AF ATACIDS WITH ATIFATUTS A02AF02 ATACIDS, ORDIAR SAT COBIATIOS AD ATIFATUTS Diovol lus O/ CHU Diovol lus Tab CHU ylanta Double St Tab JJ A02B A02BA DRUGS FOR TIC UCR AD GASTROSOHAGA RFUX DI(GRD) H2-RCTOR ATAGOISTS A02BA01 CITIDI cimetidine 200mg tab Apo-Cimetidine 200mg Tab ovember

10 A Alimentary Tract and etabolism Tagamet 200mg Tab (discontinued) SKR cimetidine 300mg tab Apo-Cimetidine 300mg Tab A-Cimetidine 300mg Tab Tagamet 300mg Tab (discontinued) GSK cimetidine 400mg tab Apo-Cimetidine 400mg Tab A-Cimetidine 400mg Tab Tagamet 400mg Tab (discontinued) GSK cimetidine 600mg tab Apo-Cimetidine 600mg Tab A-Cimetidine 600mg Tab Tagamet 600mg Tab (discontinued) GSK A02BA02 RAITIDI ranitidine 15mg/m o/l Apo-Ranitidine 15mg/m O/ ovo-ranitidine 15mg/m O/ C TV Zantac 15mg/m O/ (discontinued) GSK ranitidine 25mg/m inj Ranitidine 25mg/m Inj C Zantac 25mg/m Inj C GSK ranitidine 75mg tab Apo-Ranitidine 75mg Tab Zantac 75mg Tab (discontinued) JJ ranitidine 150mg tab Apo-Ranitidine 150mg Tab C CO Ranitidine 150mg Tab C yl-ranitidine 150mg Tab (discontinued) A-Ranitidine 150mg Tab C ovo-ranidine 150mg Tab C TV pms-ranitidine 150mg Tab C S RA-Ranitidine 150mg Tab C RA Ranitidine 150mg Tab C Ranitidine-150mg Tab C SIV Sandoz Ranitidine 150mg Tab C Zantac 150mg Tab C GSK ranitidine 300mg tab Apo-Ranitidine 300mg Tab C CO Ranitidine 300mg Tab C yl-ranitidine 300mg Tab (discontinued) A-Ranitidine 300mg Tab C ovo-ranidine 300mg Tab C TV pms-ranitidine 300mg Tab C S RA-Ranitidine 300mg Tab C RA Ranitidine 300mg Tab C Ranitidine-300mg Tab C SIV ovember

11 A Alimentary Tract and etabolism Sandoz Ranitidine 300mg Tab C Zantac 300mg Tab C GSK A02BA03 FAOTIDI famotidine 10mg/m inj Famotidine Omega 10mg/m Inj OG epcid 10mg/m Inj (discontinued) FRS famotidine 10mg/m inj (pf) Famotidine Omega (F) 10mg/m Inj OG epcid (F) 10mg/m Inj (discontinued) FRS famotidine 20mg tab Apo-Famotidine 20mg Tab Famotidine 20mg Tab A-Famotidine 20mg Tab ovo-famotidine 20mg Tab TV epcid 20mg Tab (discontinued) FRS famotidine 40mg tab Apo-Famotidine 40mg Tab Famotidine 40mg Tab A-Famotidine 40mg Tab ovo-famotidine 40mg Tab TV epcid 40mg Tab (discontinued) FRS A02BA04 IZATIDI nizatidine 150mg cap Apo-izatidine 150mg Cap (discontinued) Axid 150mg Cap D nizatidine 300mg cap Apo-izatidine 300mg Cap (discontinued) Axid 300mg Cap (discontinued) D A02BB ROSTAGADIS A02BB01 ISOROSTO misoprostol 100mcg tab isoprostol 100mcg Tab AA Cytotec 100mcg Tab (discontinued) misoprostol 200mcg tab isoprostol 200mcg Tab AA Cytotec 200mcg Tab (discontinued) A02BC ROTO U IHIBITORS A02BC01 ORAZO omeprazole 10mg cap A-Omeprazole 10mg Cap C* Sandoz Omeprazole 10mg Cap C* osec 10mg Cap (discontinued) AZ *exception status when daily dose exceeds once daily ovember

12 A Alimentary Tract and etabolism omeprazole 10mg cap/tab A-Omeprazole 10mg Cap C* Teva-Omeprazole 10mg Tab C* TV osec 10mg Tab C* AZ *exception status when daily dose exceeds once daily. omeprazole 20mg cap Apo-Omeprazole 20mg Cap C* A-Omeprazole 20mg Cap C* Omeprazole 20mg Cap C* Omeprazole-20mg Cap C* SIV pms-omeprazole 20mg Cap C* S RA-Omeprazole 20mg Cap C* RA Sandoz Omeprazole 20mg Cap C* osec 20mg Cap C* AZ *exception status when daily dose exceeds once daily. omeprazole 20mg cap/tab Apo-Omeprazole 20mg Cap C* Jamp-Omeprazole DR 20mg Tab C* JC A-Omeprazole 20mg Cap C* ovo-omeprazole Delayed-Release 20mg Tab C* TV Omeprazole 20mg Cap C* Omeprazole DR 20mg Tab C* AHI pms-omeprazole DR 20mg Tab C* S RA-Omeprazole 20mg tab C* RA osec 20mg Tab C* AZ *exception status when daily dose exceeds once daily. A02BC02 ATORAZO pantoprazole 20mg C tab Apo-antoprazole 20mg DR Tab C* Jamp-antoprazole 20mg Tab C* JC antoprazole-20mg Tab C* SIV pms-antoprazole 20mg DR Tab S RA-antoprazole 20mg Tab C* RA Sandoz antoprazole 20mg DR Tab C* Teva-antoprazole 20mg DR Tab C* TV antoloc 20mg Tab C* TAK *exception status when daily dose exceeds once daily. pantoprazole 40mg C tab Abbott-antoprazole 40mg Tab C* ABB Apo-antoprazole 40mg DR Tab C* CO antoprazole 40mg DR Tab C* Jamp-antoprazole 40mg Tab C* JC ar-antoprazole 40mg DR Tab C* AR IT-antoprazole 40mg DR Tab C* T A-antoprazole 40mg DR Tab C* antoprazole 40mg DR Tab C* S antoprazole 40mg Tab C* antoprazole-40mg Tab C* SIV ovember

13 A Alimentary Tract and etabolism pms-antoprazole 40mg DR Tab C* S RA-antoprazole 40mg Tab C* RA Sandoz antoprazole 40mg DR Tab C* Teva-antoprazole 40mg DR Tab C* TV antoloc 40mg Tab C* TAK *exception status when daily dose exceeds once daily. Tecta 40mg Tab TAK A02BC03 ASORAZO lansoprazole 15mg cap Apo-ansoprazole 15mg DR Cap ansoprazole 15mg Cap S ansoprazole 15mg Cap SIV ansoprazole 15mg DR Cap A-ansoprazole 15mg DR Cap ovo-ansoprazole 15mg DR Cap TV pms-ansoprazole 15mg Cap (discontinued) S RA-ansoprazole 15mg Cap RA Sandoz ansoprazole 15mg DR Cap revacid 15mg Cap ABB revacid FasTab 15mg Tab ABB lansoprazole 30mg cap Apo-ansoprazole 30mg DR Cap ansoprazole 30mg Cap S ansoprazole 30mg DR Cap ansoprazole-30mg Cap SIV A-ansoprazole 30mg DR Cap ovo-ansoprazole 30mg DR Cap TV pms-ansoprazole 30mg DR Cap (discontinued) S RA-ansoprazole 30mg Cap RA Sandoz ansoprazole 30mg DR Cap revacid 30mg Cap ABB revacid FasTab 30mg Tab ABB A02BC04 RABRAZO rabeprazole 10mg C tab Abbott-Rabeprazole 10mg DR Tab C ABB Apo-Rabeprazole 10mg C Tab C A-Rabeprazole 10mg Tab C pms-rabeprazole 10mg C Tab C S Rabeprazole C 10mg Tab C Rabeprazole-10mg Tab C SIV RA-Rabeprazole 10mg Tab C RA Sandoz Rabeprazole 10mg C Tab C Teva-Rabeprazole-C 10mg Tab C TV ariet 10mg Tab C JA rabeprazole 20mg C tab Abbott-Rabeprazole 20mg DR Tab C ABB ovember

14 A Alimentary Tract and etabolism Apo-Rabeprazole 20mg C Tab C A-Rabeprazole 20mg Tab C pms-rabeprazole 20mg C Tab C S Rabeprazole C 20mg Tab C Rabeprazole-20mg Tab C SIV RA-Rabeprazole 20mg Tab C RA Sandoz Rabeprazole 20mg C Tab C Teva-Rabeprazole-C 20mg Tab C TV ariet 20mg Tab C JA A02BC05 SORAZO esomeprazole 20mg tab Apo-someprazole 20mg DR Tab A-someprazole 20mg DR Tab RA-someprazole 20mg Tab RA exium 20mg Tab AZ esomeprazole 40mg cap/tab Apo-someprazole 40mg DR Tab someprazole 40mg DR Tab A-someprazole 40mg DR Tab pms-someprazole DR 40mg Cap S RA-someprazole 40mg Tab RA exium 40mg Tab AZ A02BD COBIATIOS FOR RADICATIO OF HICOBACTR ORI A02BD07 ASORAZO, CARITHROCI AD AOXICII Hp-AC * ABB *quantity limit of one pack per year A02BX DRUGS FOR TIC UCR AD GASTROSOHAGA RFUX DI(GRD) A02BX02 SUCRAFAT sucralfate 1g tab Apo-Sucralfate 1g Tab ovo-sucralate 1g Tab TV Sulcrate 1g Tab AXC Sulcrate 1g/5m lus Susp AXC A03 A03A A03AA DRUGS FOR FUCTIOA GASTROITSTIA DISORDRS DRUGS FOR FUCTIOA BOW DISORDRS ST ATICHOI STRS WITH TRTIAR AIO GROU A03AA05 TRIBUTI Trimebutine 100mg Tab C AA trimebutine 200mg tab Trimebutine 200mg Tab C AA odulon 200mg Tab C AXC A03AA07 DICCOVRI (DICCOI) ovember

15 A Alimentary Tract and etabolism Jamp-Dicyclomine 10mg Tab C JC Bentylol 10mg Tab C AXC Dicyclomine 10mg/m Inj Bentylol 10mg/5m Syr C AXC Jamp-Dicyclomine 20mg Tab C JC Bentylol 20mg Tab C AXC A03AB ST ATICHOIRGICS,STRS,QUATR AOIU CO A03AB02 GCORROAT (GCORROIU) Glycopyrrolate 0.2mg/m Inj C A03AD AAVRI AD DRIVATIVS A03AD01 AAVRI apaverine HCl 32.5mg/m Inj A03AX OTHR DRUGS FOR FUCTIOA BOW DISORDRS A03AX04 IAVRIU Dicetel 50mg Tab C ABB Dicetel 100mg Tab C ABB A03AX13 SIICOS Ovol 80 (80mg) Tab CHU A03B A03BA BADOA AD DRIVATIVS, AI BADOA AKAOIDS, TRTIAR AIS A03BA01 ATROI Atropine Sulfate 0.4mg/m Inj C Atropine Sulfate 0.6mg/m Inj C A03BA03 HOSCAI evsin 0.125mg S Tab C AXS A03C A03CA ATISASODICS I COBIATIO WITH SCHOTICS STHTICS,SCHOTICS COBIATIOS A03CA02 CIDIIU AD SCHOTICS chlordiazepoxide HCl 5mg & clidinium Br 2.5mg cap Apo-Chlorax 5/2.5mg Cap D C AA ibrax Cap D C V A03 A03D ATISASODICS,ATICHOIRGICS WITH AAGSICS ATISASODICS I COBIATIO WITH OTHR DRUGS A03D99 ATISASODICS, COBIATIOS Bellergal Spacetabs D C A ovember

16 A Alimentary Tract and etabolism A03F A03FA ROUSIVS ROUSIVS A03FA01 TOCORAID metoclopramide HCl 1mg o/l etonia 1mg/m iq C D axeran 1mg/m O/ (discontinued) RD metoclopramide HCl 5mg tab etonia 5mg Tab C D axeran 5mg Tab (discontinued) RR etoclopramide 5mg/m Inj C metoclopramide HCl 10mg tab etonia 10mg Tab C D axeran 10mg Tab (discontinued) RR A03FA03 DORIDO domperidone maleate 10mg tab Apo-Domperidone 10mg Tab C Domperidone 10mg Tab C Domperidone-10mg Tab C SIV Jamp-Domperidone 10mg Tab C JC ar-domperidone 10mg Tab C AR A-Domperidone 10mg Tab (discontinued) pms-domperidone 10mg Tab C S RA-Domperidone 10mg Tab C RA ratio-domperidone 10mg Tab C TV Teva-Domperidone 10mg Tab C TV otilium 10mg Tab (discontinued) JA A04 A04A A04AA ATITICS AD ATIAUSATS ATITICS AD ATIAUSATS SROTOI (5HT3) ATAGOISTS A04AA01 ODASTRO ondansetron 4mg tab Apo-Ondansetron 4mg Tab CO Ondansetron 4mg Tab Jamp-Ondansetron 4mg Tab JC ar-ondansetron 4mg Tab AR IT-Ondansetron 4mg Tab T A-Ondansetron 4mg Tab AT-Ondansetron 4mg Tab AT ovo-ondansetron 4mg Tab TV Ondansetron 4mg Tab Ondansetron-Odan 4mg Tab OD pms-ondansetron 4mg Tab S RA-Ondansetron 4mg Tab RA ratio-ondansetron 4mg Tab (discontinued) TV ovember

17 A Alimentary Tract and etabolism Sandoz Ondansetron 4mg Tab Septa-Ondansetron 4mg Tab ST Zofran 4mg Tab VR ondansetron 4mg/5m o/l Ondansetron 4mg/5m O/ AA Zofran 4mg/5m O/ VR ondansetron OD 4mg tab/film Ondissolve ODF 4mg Film TAK Zofran 4mg ODT Tab VR ondansetron 8mg tab Apo-Ondansetron 8mg Tab CO Ondansetron 8mg Tab Jamp-Ondansetron 8mg Tab JC ar-ondansetron 8mg Tab AR IT-Ondansetron 8mg Tab T A-Ondansetron 8mg Tab AT-Ondansetron 8mg Tab AT Ondansetron 8mg Tab pms-ondansetron 8mg Tab S RA-Ondansetron 8mg Tab RA ratio-ondansetron 8mg Tab (discontinued) TV Sandoz Ondansetron 8mg Tab Septa-Ondansetron 8mg Tab ST Teva-Ondansetron 8mg Tab TV Zofran 8mg Tab VR ondansetron OD 8mg tab/film Ondissolve ODF 8mg Film TAK Zofran 8mg ODT Tab VR A04AA02 GRAISTRO granisetron 1mg tab Granisetron 1mg Tab AA Kytril 1mg Tab (discontinued) HR A04AA05 AOOSTRO Aloxi 0.25/5m Inj IS Aloxi 0.5mg Cap IS A04AD OTHR ATITICS A04AD01 SCOOAI Scopolamine 0.4mg/m Inj C HOS Scopolamine 0.6mg/m Inj C HOS Transderm-V 1.5mg atch VR Buscopan 10mg Tab BO hyoscine butylbromide 20mg/m inj Hyoscine Butylbromide 20mg/m Inj Buscopan 20mg/m Inj (discontinued) BO ovember

18 A Alimentary Tract and etabolism A04AD11 ABIO (CAABIOID (THC) DRIVATIVS) nabilone 0.25mg cap RA-abilone 0.25mg Cap D RA Teva-abilone 0.25mg Cap D TV Cesamet 0.25mg Cap D V nabilone 0.5mg cap CO abilone 0.5mg Cap D pms-abilone 0.5mg Cap D S RA-abilone 0.5mg Cap D RA Teva-abilone 0.5mg Cap D TV Cesamet 0.5mg Cap D V nabilone 1mg cap CO abilone 1mg Cap D pms-abilone 1mg Cap D S RA-abilone 1mg Cap D RA Teva-abilone 1mg Cap D TV Cesamet 1mg Cap D V A04AD12 ARITAT mend Tri-ack Cap FRS mend 80mg Cap FRS mend 125mg Cap FRS A04AD99 DIHDRIAT dimenhydrinate 10mg/m IV inj Dimenhydrinate 10mg/m IV Amp Gravol 10mg/m IV Amp (discontinued) CHU Gravol 15mg/5m O/ CHU Gravol 25mg Supp CHU dimenhydrinate 50mg/m I inj Dimenhydrinate 50mg/m I Inj C Gravol l 50mg/m I Inj C CHU Dimenhydrinate 50mg Supp Gravol 50mg Tab CHU Dimenhydrinate 100mg (Adult) Supp Gravol 100mg Supp CHU A05 A05A A05AA BI AD IVR THRA BI THRA BI ACID RARATIOS A05AA02 URSODIO (URSODOXCHOIC ACID) ursodiol 250mg tab pms-ursodiol C 250mg Tab D S Urso 250mg Tab D AXC ovember

19 A Alimentary Tract and etabolism ursodiol 500mg tab pms-ursodiol C 500mg Tab D S Urso DS 500mg Tab D AXC A05AA99 DHDROCHOIC ACID Dycholium 300mg Tab D C A06 A06A A06AA AXATIVS AXATIVS SOFTRS, OITS A06AA02 DOCUSAT SODIU pms-docusate Sodium 4mg/m Syr C S pms-docusate Sodium 10mg Drp C S Colace 10mg/m Drp C WS Colace 20mg/5m Syrup C WS ratio-docusate Sodium 20mg/5m Syr C TV Selax 20mg/5m US Syr C OD docusate sodium 100mg cap Docusate Sodium 100mg Cap C pms-docusate Sodium 100mg Cap C S Docusate Sodium 100mg Cap C TAR Jamp-Docusate Sodium 100mg Cap C JC ovo-docusate 100mg Cap TV ratio-docusate Sodium 100mg Cap C TV Colace 100mg Cap C WS Selax 100mg Cap C OD A06AB COTACT AXATIVS A06AB02 BISACOD Apo-Bisacodyl 5mg Tab C Jamp-Bisacodyl 5mg Tab C JC Bisacodyl-ODA 5mg Tab C OD Dulcolax CT 5mg Tab C BO Jamp-Bisacodyl 5mg Supp C JC pms-bisacodyl 10mg Supp C S Dulcolax 10mg Supp C BO Jamp-Bisacodyl 10mg Supp C JC A06AB06 SA GCOSIDS Senokot 1.7mg/m Syr C FR Jamp-Sennosides 8.6mg Tab C JC Senokot 8.6mg Tab C FR A06AB56 SA GCOSIDS, COBIATIOS Senokot S 8.6mg/50mg Tab C FR ovember

20 A Alimentary Tract and etabolism A06AD OSOTICA ACTIG AXATIVS A06AD10 IRA SATS I COBIATIO Coyte owder for Solution C D eglyte owder for Solution C D A06AD11 ACTUOS lactulose 667mg/m o/l Apo-actulose 667mg/m O/ Jamp-actulose 667mg/m O/ JC ratio-actulose 667mg/m O/ TV Teva-actulose 667mg/m O/ TV Chronulac 667mg/m O/ (discontinued) R lactulose 667mg/m syrup actulose 667mg/5m Syr pms-actulose 667mg/m Syr S A06AD15 ACROGO G 3350 wd Sol SC A06AD19 AGSIU CITRAT Citro ag 50mg/m O/ C ROG Citrodan 50mg/m O/ C OD A06AH RIHRA OIOID RCTOR ATAGOISTS A06AH01 THATRXO BROID Relistor 20mg/m Inj A06AX OTHR DRUGS FOR COSTIATIO A06AX05 RUCAORID Resotran 1mg Tab JA Resotran 2mg Tab JA A07 A07A A07AA ATIDIARRHAS, ITSTIA ATIIFAATOR/ATIIFCTIV AGTS ITSTIA ATIIFCTIVS ATIBIOTICS A07AA02 STATI nystatin 100,000iu o/l ratio-ystatin 100,000iu/m Oral Drops C TV ycostatin 100,000iu/m Oral Susp (discontinued) BRI pms-ystatin 100,000iu/m Oral Susp C S A07AA06 AROOCI Humatin 250mg Cap RF A07B A07BB ITSTIA ADSORBTS BISUTH RARATIOS ovember

21 A Alimentary Tract and etabolism A07BB99 BISUTH SUBSAICAT eptobismol 17.6mg/m O/ GA A07D A07DA ATIROUSIVS ATIROUSIVS A07DA01 DIHOXAT omotil 2.5mg Tab D C A07DA02 OIU Sandoz Opium & Belladonna 65mg/15mg Supp D C A07DA03 ORAID loperamide HCl 0.2mg/m o/l pms-operamide 0.2mg/m O/ C S Imodium 0.2mg/m O/ (discontinued) JJ loperamide 2mg caplet Apo-operamide 2mg Caplet C ovo-operamide 2mg Caplet C TV pms-operamide 2mg Caplet C S Diarr-eze 2mg Caplet (discontinued) D Imodium 2mg Caplet (discontinued) JJ Jamp-operamide 2mg Tab C JC A07 A07A ITSTIA ATIIFAATOR AGTS CORTICOSTROIDS ACTIG OCA A07A02 HDROCORTISO Cortifoam A Cortenema 100mg/60m Susp AXC A07A04 BTATHASO Betnesol 5mg/100m Retention nema A A07A06 BUDSOID ntocort 0.02mg/m nema AZ ntocort 3mg Cap AZ A07B ATIARGIC AGTS, XC CORTICOSTROIDS A07B01 CROOGCAT SODIU alcrom 100mg Cap SAV A07C AIOSAICIC ACID AD SIIAR AGTS A07C01 SUFASAAZI pms-sulfasalazine 500mg Tab S pms-sulfasalazine C 500mg Tab S Salazopyrin 500mg ntabs ovember

22 A Alimentary Tract and etabolism Salazopyrin 500mg Tab A07C02 5-AIOSAICIC ACID (SAAI) entasa 1g Supp FI Salofalk 1g Supp AXC entasa 1g/100m Rectal Susp FI ezavant 1.2g Tab SHI Salofalk 2g/60g Rectal Susp AXC Salofalk 4g/60g Rectal Susp AXC entasa 4g/100m Rectal Susp FI 5-aminosalicylic acid 400mg tab ovo-5-asa 400mg C Tab TV Asacol 400mg Tab esasal 500mg Tab GSK entasa 500mg Tab FI Salofalk 500mg Supp AXC Salofalk 500mg Tab AXC Asacol 800 (800mg) Tab A07C03 OSAAZI (5-ASA) Dipentum 250mg Cap S A07F A07FA ATIDIARRHOA ICROORGAISS ATIDIARRHOA ICROORGAISS A07FA01 ACTIC ACID RODUCIG ORGAISS Bacid Cap RF A08 A08A A08AB ATIOBSIT RARATIOS, XC DIT RODUCTS ATIOBSIT RARATIOS, XC DIT RODUCTS RIHRA ACTIG ATIOBSIT RODUCTS A08AB01 ORISTAT Xenical 120mg Cap HR A09 A09A A09AA DIGSTIVS, IC ZS DIGSTIVS, IC ZS Z RARATIOS A09AA02 UTIZS (IAS, ROTAS, TC) Cotazym Cap FRS Ultrase T20 Cap AXC Viokase Tab AXC Cotazym CS 4 Cap (discontinued) SCH ancrease T 4 Cap JA ovember

23 A Alimentary Tract and etabolism Ultrase S4 Cap AXC Creon 6 inimicrospheres ABB Cotazym CS 8 Cap SCH Creon 10 inimicrospheres ABB ancrease T 10 Cap JA Ultrase T12 Cap AXC ancrease T 16 Cap JA Viokase 16 Tab AXC Cotazym CS 20 Cap SCH Creon 25 inimicrospheres ABB Cotazym-65B Cap (discontinued) SCH A09AA03 SI Fermentol 100mg/30m iq CHU A10 A10A A10AB DRUGS USD I DIABTS ISUIS AD AAOGUS ISUIS & AAOGUS FOR IJCTIO, FAST-ACTIG A10AB01 ISUI (HUA) Humulin R Cartridges D I Humulin R Insulin D I ovolin G Toronto Insulin D O ovolin G Toronto enfill D O A10AB04 ISUI ISRO Humalog Cartridges * I Humalog Insulin * I Humalog Kwiken * I *full benefit for children 18 years and younger. A10AB05 ISUI ASART ovoix 30 enfill O ovorapid 100iu/m enfill Ins * O ovorapid 100iu/m Vial Ins * O *full benefit for children 18 years and younger. A10AB06 ISUI GUISI Apidra 3m Cartridges * SAV Apidra 3m refilled en * SAV Apidra 10m Vial * SAV *full benefit for children 18 years and younger. A10AC ISUIS & AAOGUS FOR IJCTIO, ITRDIAT-ACTIG A10AC01 ISUI (HUA) ovember

24 A Alimentary Tract and etabolism Humulin Cartridges D I Humulin Insulin D I Humulin Kwiken D I ovolin G H Insulin D O ovolin G H enfill D O A10AD ISUIS & AAOGUS FOR IJC. ITRDIAT-ACTIG + FAST-ACTIG A10AD01 ISUI (HUA) Humulin 30/70 Cartridges D I Humulin 30/70 Insulin D I ovolin G 30/70 Insulin D O ovolin G 30/70 enfill D O ovolin G 40/60 enfill D O ovolin G 50/50 enfill D O A10AD04 ISUI ISRO Humalog ix25 Cartridges I Humalog ix25 Kwiken I Humalog ix25 Vial I Humalog ix50 Cartridges I Humalog ix50 Kwiken I A10A ISUIS & AAOGUS, FOR IJCTIO OG-ACTIG A10A04 ISUI GARGI antus 100iu/m Cartridge SAV antus 100iu/m Solostar re-filled en SAV antus 100iu/m Vial SAV A10A05 ISUI DTIR evemir 100iu/m enfill O evemir FlexTouch 100iu/m re-filled en O A10B A10BA BOOD GUCOS OWRIG DRUGS, XC. ISUIS BIGUAIDS A10BA02 TFORI metformin HCl 500mg tab Apo-etformin 500mg Tab D CO etformin 500mg Tab D Jamp-etformin 500mg Tab D JC Jamp-etformin Blackberry 500mg Tab D JC ar-etformin 500mg Tab D AR etformin 500mg Tab (AR) D AR etformin 500mg Tab () D etformin FC 500mg Tab D SIV IT-etformin 500mg Tab D T A-etformin 500mg Tab D pms-etformin 500mg Tab D S ovember

25 A Alimentary Tract and etabolism RA-etformin 500mg Tab Tab D RA ratio-etformin 500mg Tab D TV Sandoz etformin FC 500mg Tab D Septa-etformin 500mg Tab D ST Teva-etformin 500mg Tab D TV Glucophage 500mg Tab D SAV metformin HCl 850mg tab Apo-etformin 850mg Tab D CO etformin 850mg Tab D Jamp-etformin 850mg Tab D JC Jamp-etformin Blackberry 850mg Tab D JC ar-etformin 850mg Tab D AR etformin 850mg Tab (AR) D AR etformin 850mg Tab () D etformin FC 850mg Tab D SIV IT-etformin 850mg Tab D T A-etformin 850mg Tab D pms-etformin 850mg Tab D S RA-etformin 850mg Tab D RA ratio-etformin 850mg Tab D TV Sandoz etformin FC 850mg Tab D Septa-etformin 850mg Tab D ST Teva-etformin 850mg Tab D TV Glucophage 850mg Tab D SAV A10BB SUFOAIDS, URA DRIVATIVS A10BB01 GBURID (GIBCAID) glyburide 2.5mg tab Apo-Glyburide 2.5mg Tab D Glyburide 2.5mg Tab D A-Glybe 2.5mg Tab (discontinued) Sandoz Glyburide 2.5mg Tab D Teva-Glyburide 2.5mg Tab D TV Diabeta 2.5mg Tab D SAV uglucon 2.5mg Tab (discontinued) S glyburide 5mg tab Apo-Glyburide 5mg Tab D Glyburide 5mg Tab D A-Glybe 5mg Tab (discontinued) pms-glyburide 5mg Tab D S Sandoz Glyburide 5mg Tab D Teva-Glyburide 5mg Tab D TV Diabeta 5mg Tab D SAV uglucon 5mg Tab (discontinued) S A10BB02 CHORROAID Apo-Chlorpropamide 100mg Tab chlorpropamide 250mg tab ovember

26 A Alimentary Tract and etabolism Apo-Chlorpropamide 250mg Tab Diabinese 250mg Tab (discontinued) A10BB03 TOBUTAID tolbutamide 500mg tab Tolbutamide 500mg Tab D AA obenol 500mg Tab (discontinued) HOR A10BB09 GICAZID gliclazide 30mg R tab ACT Gliclazide R 30mg Tab D Apo-Gliclazide R 30mg Tab D AO IT-Gliclazide R 30mg Tab D T Diamicron R 30mg Tab D SV gliclazide 60mg R tab Apo-Gliclazide R 60mg Tab D Diamicron R 60mg Tab D SV gliclazide 80mg tab Apo-Gliclazide 80mg Tab D Gliclazide 80mg Tab D A-Gliclazide 80mg Tab D ovo-gliclazide 80mg Tab D TV Diamicron 80mg Tab D SV A10BB12 GIIRID glimepiride 1mg tab Apo-Glimepiride 1mg Tab ovo-glimepiride 1mg Tab (discontinued) TV ratio-glimepiride 1mg Tab TV Sandoz Glimepiride 1mg Tab Amaryl 1mg Tab SAV glimepiride 2mg tab Apo-Glimepiride 2mg Tab ovo-glimepiride 2mg Tab (discontinued) TV ratio-glimepiride 2mg Tab TV Sandoz Glimepiride 2mg Tab Amaryl 2mg Tab SAV glimepiride 4mg tab Apo-Glimepiride 4mg Tab ovo-glimepiride 4mg Tab (discontinued) TV ratio-glimepiride 4mg Tab TV Sandoz Glimepiride 4mg Tab Amaryl 4mg Tab SAV A10BD COBIATIOS OF ORA BOOD GUCOS OWRIG DRUGS A10BD03 TFORI AD ROSIGITAZO Avandamet 2/500mg Tab GSK Avandamet 2/1000mg Tab GSK ovember

27 A Alimentary Tract and etabolism Avandamet 4/500mg Tab GSK Avandamet 4/1000mg Tab GSK A10BD07 TFORI AD SITAGITI Janumet 50/500mg Tab FRS Janumet 50/850mg Tab FRS Janumet 50/1000mg Tab FRS Janumet 50/1000mg XR Tab FRS A10BD10 TFORI AD SAXAGITI Komboglyze 2.5mg/500mg Tab AZ Komboglyze 2.5mg/850mg Tab AZ Komboglyze 2.5mg/1000mg Tab AZ A10BD13 TFORI AD AOGITI Kazano 500/12.5mg Tab TAK Kazano 850/12.5mg Tab TAK Kazano 1000/12.5mg Tab TAK A10BF AHA GUCOSIDAS IHIBITORS A10BF01 ACARBOS Glucobay 50mg Tab D BA Glucobay 100mg Tab D BA A10BG THIAZOIDIOS A10BG02 ROSIGITAZO Avandia 2mg Tab GSK Avandia 4mg Tab GSK Avandia 8mg Tab GSK A10BG03 IOGITAZO pioglitazone 15mg tab Accel ioglitazone 15mg Tab ACC Apo-ioglitazone 15mg Tab Auro-ioglitiazone 15mg Tab ARO CO ioglitazone 15mg Tab Jamp-ioglitazone 15mg Tab JC IT-ioglitazone 15mg Tab T A-ioglitazone 15mg Tab ovo-ioglitazone 15mg Tab TV ioglitazone 15mg Tab AHI pms-ioglitazone 15mg Tab S RA-ioglitazone 15mg Tab RA Sandoz ioglitazone 15mg Tab Actos 15mg Tab TAK ovember

28 A Alimentary Tract and etabolism pioglitazone 30mg tab Accel ioglitazone 30mg Tab ACC Apo-ioglitazone 30mg Tab Auro-ioglitazone 30mg Tab ARO CO ioglitazone 30mg Tab Jamp-ioglitazone 30mg Tab JC IT-ioglitazone 30mg Tab T A-ioglitazone 30mg Tab ovo-ioglitazone 30mg Tab TV ioglitazone 30mg Tab AHI pms-ioglitazone 30mg Tab S RA-ioglitazone 30mg Tab RA Sandoz ioglitazone 30mg Tab Actos 30mg Tab TAK pioglitazone 45mg tab Accel ioglitazone 45mg Tab ACC Apo-ioglitazone 45mg Tab Auro-ioglitazone 45mg Tab ARO CO ioglitazone 45mg Tab Jamp-ioglitazone 45mg Tab JC IT-ioglitazone 45mg Tab T A-ioglitazone 45mg Tab ovo-ioglitazone 45mg Tab TV ioglitazone 45mg Tab AHI pms-ioglitazone 45mg Tab S RA-ioglitazone 45mg Tab RA Sandoz ioglitazone 45mg Tab Actos 45mg Tab TAK A10BH DITID TIDAS 4 (D-4) IHIBITORS A10BH01 SITAGITI Januvia 25mg Tab FRS Januvia 50mg Tab FRS Januvia 100mg Tab FRS A10BH03 SAXAGITI Onglyza 2.5mg Tab AZ Onglyza 5mg Tab AZ A10BH04 AOGITI esina 6.25mg Tab TAK esina 12.5mg Tab TAK esina 25mg Tab TAK A10BH05 IAGITI Trajenta 5mg Tab BO A10BX OTHR BOOD GUCOS OWRIG DRUGS, XC ISUIS ovember

29 A Alimentary Tract and etabolism A10BX02 RAGIID repaglinide 0.5mg tab Apo-Repaglinide 0.5mg Tab Auro-Repaglinide 0.5mg Tab ARO CO Repaglinide 0.5mg Tab pms-repaglinide 0.5mg Tab S Sandoz Repaglinide 0.5mg Tab Glucoorm 0.5mg Tab O repaglinide 1mg tab Apo-Repaglinide 1mg Tab Auro-Repaglinide 1mg Tab ARO CO Repaglinide 1mg Tab pms-repaglinide 1mg Tab S Sandoz Repaglinide 1mg Tab Glucoorm 1mg Tab O repaglinide 2mg tab Apo-Repaglinide 2mg Tab CO Repaglinide 2mg Tab pms-repaglinide 2mg Tab S Sandoz Repaglinide 2mg Tab Glucoorm 2mg Tab O A10BX03 ATGIID Starlix 60mg Tab (discontinued) VR Starlix 120mg Tab (discontinued) VR A10BX04 XATID Byetta 1.2m refilled en AZ Byetta 2.4m refilled en AZ A10BX07 IRAGUTID Victoza 6mg/m Inj O A10BX11 CAAGIFOZI Invokana 100mg Tab JA Invokana 300mg Tab JA A11 A11C A11CC VITAIS VIT A AD D, IC COBIATIOS OF TH TWO VITAI D AD AAOGUS A11CC01 RGOCACIFRO rdol 8,288iu/m Sol OD A11CC03 AFACACIDO One-Alpha 0.25mcg Cap O One-Alpha 1mcg Cap O ovember

30 A Alimentary Tract and etabolism One-Alpha 2mcg O/ O A11CC04 CACITRIO Rocaltrol 0.25mcg Cap HR Rocaltrol 0.5mcg Cap HR A11D A11DA VIT B1,AI AD I COB WITH VITAI B6 AD B12 THIAI (VIT B1), AI A11DA01 THIAI (VIT B1) thiamine (vit B1) 100mg/m inj Thiamine 100mg/m Inj CI Vitamin B1 100mg/m Inj Betaxin 100mg/m Inj (discontinued) HOS Thiamiject 100mg/m Inj (Omega) OG A12 A12B A12BA IRA SUTS OTASSIU OTASSIU A12BA01 OTASSIU CHORID potassium chloride 1.33mq/m o/l pms-otassium Chloride 20mq/15m C S K-10 Sol 20mq/15m C GSK Apo-K 8mq Tab C icro-k 8mq xtencap C A Slow-K 8mq Tab C VR Jamp-K8 600mg Tab C JC Jamp-K mg SR Tab C JC Odan-K mg SR Tab C OD A12BA02 OTASSIU CITRAT K-yte 25mq ff Tab C WS A12C A12CC OTHR IRA SUTS AGSIU A12CC99 AGSIU GUCOHTOAT Jamp-agnesium 5mg/m O/ JC agnesium-odan 5mg/m O/ OD Rougier-agnesium 5mg/m O/ ROG A12CX VARIOUS IRA RODUCTS A12CX99 SODIU HOSHAT hosphate-ovartis 500mg ff Tab VR A16 OTHR AITAR TRACT AD TABOIS RODUCTS ovember

31 A Alimentary Tract and etabolism A16A A16AA OTHR AITAR TRACT AD TABOIS RODUCTS AIO ACIDS AD DRIVATIVS A16AA01 VOCARITI Carnitor 1g/5m Inj QGT Carnitor 100mg/m O/ QGT Carnitor 330mg Tab QGT A16AA06 BTAI A16AB ZS Cystadane 1g owder for Oral Sol OR A16AB05 AROIDAS Aldurazyme 0.58mg/m Inj GZ A16AB07 AGUCOSIDAS AFA yozyme 50mg dr for Inj GZ A16AB09 IDURSUFAS A16AX laprase 2mg/m Inj VARIOUS AITAR TRACT & TABOIS RODUCTS A A16AX06 IGUSTAT Zavesca 100mg Cap ACT ovember

32 B B01 B01A B01AA Blood and Blood Forming Organs ATICOAGUATS ATICOAGUATS VITAI K ATAGOISTS B01AA03 WARFARI warfarin 1mg tab Apo-Warfarin 1mg Tab C A-Warfarin 1mg Tab C Taro-Warfarin 1mg Tab C TAR Coumadin 1mg Tab C BRI warfarin 2mg tab Apo-Warfarin 2mg Tab C A-Warfarin 2mg Tab C ovo-warfarin 2mg Tab (discontinued) TV Taro-Warfarin 2mg Tab C TAR Coumadin 2mg Tab C BRI warfarin 2.5mg tab Apo-Warfarin 2.5mg Tab C A-Warfarin 2.5mg Tab C ovo-warfarin 2.5mg Tab (discontinued) TV Taro-Warfarin 2.5mg Tab C TAR Coumadin 2.5mg Tab C BRI warfarin 3mg tab Apo-Warfarin 3mg Tab C A-Warfarin 3mg Tab C Taro-Warfarin 3mg Tab C TAR Coumadin 3mg Tab C BRI warfarin 4mg tab Apo-Warfarin 4mg Tab C A-Warfarin 4mg Tab C Taro-Warfarin 4mg Tab C TAR Coumadin 4mg Tab C BRI warfarin 5mg tab Apo-Warfarin 5mg Tab C A-Warfarin 5mg Tab C ovo-warfarin 5mg Tab (discontinued) TV Taro-Warfarin 5mg Tab C TAR Coumadin 5mg Tab C BRI warfarin 6mg tab A-Warfarin 6mg Tab C Taro-Warfarin 6mg Tab TAR Coumadin 6mg Tab C BRI warfarin 7.5mg tab A-Warfarin 7.5 Tab C Taro-Warfarin 7.5mg Tab C TAR warfarin 10mg tab Apo-Warfarin 10mg Tab C ovember

33 B Blood and Blood Forming Organs A-Warfarin 10mg Tab C Taro-Warfarin 10mg Tab C TAR Coumadin 10mg Tab C BRI B01AA07 ACOCOUARO Sintrom 1mg Tab C A Sintrom 4mg Tab C A B01AB HARI GROU B01AB01 HARI Heparin 100iu/m Inj C O Heparin 1,000iu/m Inj C O Heparin 10,000iu/m Inj (discontinued) O B01AB04 DATARI Fragmin 2,500iu [anti-xa] 0.2/m Syringe Inj C Fragmin 5,000iu [anti-xa] 0.2/m Syringe Inj C Fragmin 7,500iu [anti-xa] 0.3/m Syringe Inj C Fragmin 10,000iu [anti-xa]/m Amp Inj C Fragmin 10,000iu [anti-xa] 0.4/m Syringe Inj C Fragmin 12,500iu [anti-xa] 0.5/m Syringe Inj C Fragmin 15,000iu [anti-xa] 0.6/m Syringe Inj C Fragmin 18,000iu [anti-xa] 0.72/m Syringe Inj C Fragmin 25,000iu [anti-xa]/m Vial Inj C B01AB05 OXAARI ovenox 30mg/0.3m Syringe Inj C SAV ovenox 40mg/0.4m Syringe Inj C SAV ovenox 60mg/0.6m Syringe Inj C SAV ovenox 80mg/0.8m Syringe Inj C SAV ovenox 100mg/m refilled Syringe Inj C SAV ovenox 100mg/m Vial Inj C SAV ovenox 120mg/0.8m Syringe Inj C SAV ovenox H 150mg/m Syringe Inj C SAV B01AB10 TIZAARI Innohep 2,500iu/0.25m Inj C O Innohep 3,500iu/0.35m Inj C O Innohep 4,500iu/0.45m Inj C O Innohep 8,000iu/0.4m Inj C O Innohep 10,000iu/0.5m Inj C O Innohep 10,000iu/m Inj C O ovember

34 B Blood and Blood Forming Organs Innohep 12,000iu/0.6m Inj C O Innohep 14,000iu/0.7m Inj C O Innohep 16,000iu/0.8m Inj C O Innohep 18,000iu/0.9m Inj C O Innohep 20,000iu/m Inj C O B01AC ATT AGGRGATIO IHIBITORS XC. HARI B01AC04 COIDOGR clopidogrel 75mg tab Abbott-Clopidogrel 75mg Tab ABB Apo-Clopidogrel 75mg Tab Auro-Clopidogrel 75mg Tab ARO Clopidogrel 75mg Tab Clopidogrel-75mg Tab SIV CO Clopidogrel 75mg Tab Jamp-Clopidogrel 75mg Tab JC ar-clopidogrel 75mg Tab AR IT-Clopidogrel 75mg Tab T A-Clopidogrel 75mg Tab pms-clopidogrel 75mg Tab S RA-Clopidogrel 75mg Tab RA Sandoz Clopidogrel 75mg Tab Teva-Clopidogrel 75mg Tab TV lavix 75mg Tab SAV clopidogrel 300mg tab Apo-Clopidogrel 300mg Tab Teva-Clopidogrel 300mg Tab TV lavix 300mg Tab SAV B01AC05 TICOIDI ticlopidine 250mg tab Apo-Ticlopidine 250mg Tab Teva-Ticlopidine 250mg Tab TV Ticlid 250mg Tab (discontinued) S B01AC07 DIRIDAO dipyridamole 25mg tab Apo-Dipyridamole-FC 25mg Tab ersantine 25mg Tab (discontinued) BO dipyridamole 50mg tab Apo-Dipyridamole-FC 50mg Tab ersantine 50mg Tab (discontinued) BO dipyridamole 75mg tab Apo-Dipyridamole-FC 75mg Tab ersantine 75mg Tab (discontinued) BO B01AC21 TRROSTII ovember

35 B Blood and Blood Forming Organs Remodulin 1mg/m Inj UTC Remodulin 2.5mg/m Inj UTC Remodulin 5mg/m Inj UTC Remodulin 10mg/m Inj UTC B01AC22 RASUGR ffient 10mg Tab I B01AC24 TICAGROR Brilinta 90mg Tab AZ B01AC30 ATT AGGRGATIO IHIBITORS, COBIATIOS Aggrenox 200/25mg Cap BO B01A DIRCT THROBI IHIBITORS B01A07 DABIGATRA TXIAT radaxa 75mg Cap BO radaxa 110mg Cap BO radaxa 150mg Cap BO B01AF DIRCT FACTOR XA IHIBITORS B01AF01 RIVAROXABA Xarelto 10mg Tab BA B01AF02 AIXABA liquis 2.5mg Tab BRI liquis 5mg Tab BRI B01AX OTHR ATITHROBOTIC AGTS B01AX05 FODAARIUX fondaparinux sodium 2.5mg/0.5m Inj Fondaparinux Sodium 2.5mg/0.5m Inj RCH Arixtra 2.5mg/0.5m Inj AR fondapariunux sodium 12.5mg/m Inj Fondaparinux Sodium 12.5mg/m Inj RCH Arixtra 12.5mg/m AR B01AX06 RIVAROXABA Xarelto 15mg Tab BA Xarelto 20mg Tab BA B02 B02A B02AA ATIHAORRHAGICS ATIFIBRIOTICS AIO ACIDS B02AA02 TRAXAIC ACID ovember

36 B Blood and Blood Forming Organs tranexamic acid 100mg/m inj Tranexamic Acid 100mg/m Inj Cyklokapron 100mg/m Inj tranexamic acid 500mg tab GD-Tranexamic Acid 500mg Tab GD Tranexamic Acid 500mg Tab STR Cyklokapron 500mg Tab B02B B02BA VITAI K AD OTHR HOSTATICS VITAI K B02BA01 HTOADIO Vitamin K1 10mg/m Inj Vitamin K1 2mg/m Inj B02BX OTHR SSTIC HAOSTATICS B02BX04 ROIOSTI plate 250mcg/0.5m Inj AGA plate 500mcg/m Inj AGA B02BX05 TROBOAG Revolade 25mg Tab GSK Revolade 50mg Tab GSK B03 B03A B03AA ATIAAIC RARATIOS IRO RARATIOS IRO BIVAT, ORA RARATIOS B03AA02 FRROUS FUARAT alafer 300mg Cap V alafer 300mg/5m Susp V B03AA03 FRROUS GUCOAT ferrous gluconate 300mg tab AC-Ferrous Gluconate 300mg Tab Apo-Ferrous Gluconate 300mg Tab ovo-ferrogluc 300mg Tab TV B03AA07 FRROUS SUFAT Ferodan 75mg/m Infant Drops OD pms-ferrous Sulfate 75mg/0.6m Drops S Ferodan 150mg5/m Syrup OD B03AC IRO TRIVAT, ARTRA RARATIOS B03AC01 DXTRIFRRO (IRO DXTRA) DexIron 50mg/m Inj BHC ovember

37 B Blood and Blood Forming Organs B03AC02 SACCHARATD IRO OXID Venofer 20mg/m Inj BHC B03AC07 FRRIC SODIU GUCOAT COX Ferrlecit 12.5mg/m Inj SAV B03AC99 FRUOXTO Feraheme 30mg/m Inj TAK B03A IRO I OTHR COBIATIOS B03A02 IRO, UTIVITAIS AD FOIC ACID alafer CF Cap V B03A04 IRO, UTIVITAIS AD IRAS regvit Tab DUI B03B B03BA VITAI B12 AD FOIC ACID VITAI B12 (CAOCOBAAI AD DRIVATIVS) B03BA01 CAOCOBAAI cyanocobalamin 100mcg/m inj Vitamin B12 100mcg/m Inj Vitamin B12 100mcg/m Inj (discontinued) HOS Vitamin B12 250mcg Tab SWS Vitamin B12 500mcg Tab S V cyancocobalamin 1000mcg/m inj Cyanocobalamin 1,000mcg/m Inj Cyanocobalamin 1,000mcg/m Inj CI Vitamin B12 1,000mcg/m Inj Vitamin B12 1,000mcg Tab S V B03BA51 CAOCOBAAI, COBIATIOS Vitamin B12 1,000mcg Tab w Folic Acid S V B03BB FOIC ACID AD DRIVATIVS B03BB01 FOIC ACID Folic Acid 1mg Tab WA Apo-Folic Acid 5mg Tab C uro-folic Acid 5mg Tab C UR Folic Acid 5mg/m Inj C Jamp-Folic Acide 5mg Tab C JC B03X B03XA OTHR ATIAIC RARATIOS OTHR ATIAIC RARATIOS B03XA01 RTHROOITI ovember

38 B Blood and Blood Forming Organs prex 1,000iu/0.5m Syringe Inj JA prex 2,000iu/0.5m Syringe Inj JA prex 3,000iu/0.3m Syringe Inj JA prex 4,000iu/0.4m Syringe Inj JA prex 5,000iu/0.5m Syringe Inj JA prex 6,000iu/0.6m Syringe Inj JA prex 8,000iu/0.8m Syringe Inj JA prex 10,000iu/m Syringe Inj JA prex 20,000iu/0.5m Syringe Inj JA prex 30,000iu/0.75m Syringe Inj JA prex 30,000iu/0.75m Syringe Inj JA prex 40,000iu/m Syringe Inj JA B03XA02 DARBOTI Aranesp 10mcg/0.4m Syringe Inj AGA Aranesp 20mcg/0.5m Syringe Inj AGA Aranesp 40mcg/m Syringe Inj (discontinued) AGA Aranesp 100mcg/m Syringe Inj (discontinued) AGA Aranesp 30mcg/0.3m Syringe Inj AGA Aranesp 40mcg/0.4m Syringe Inj AGA Aranesp 50mcg/0.5m Syringe Inj AGA Aranesp 100mcg/0.5m Syringe Inj AGA Aranesp 130mcg/0.65m Syringe Inj AGA Aranesp 200mcg/m Syringe Inj (discontinued) AGA Aranesp 60mcg/0.3m Syringe Inj AGA Aranesp 80mcg/0.4m Syringe Inj AGA Aranesp 150mcg/0.3m Syringe Inj AGA Aranesp 200mcg/0.4m Syringe Inj AGA Aranesp 300mcg/0.6m Syringe Inj AGA Aranesp 500mcg/m Syringe Inj AGA B05 B05B B05BA BOOD SUBSTITUTS AD RFUSIO SOUTIOS I.V. SOUTIOS SOUTIOS FOR ARTRA UTRITIO B05BA03 CARBOHDRATS Dextrose 50% Inj HOS B05C B05CA IRRIGATIG SOUTIOS ATIIFCTIVS B05CA10 ATIIFCTIVS, COBIATIOS eosporin Irrigating Sol (discontinued) GSK B05CB SAT SOUTIOS ovember

39 B Blood and Blood Forming Organs B05CB01 SODIU CHORID Sodium Chloride Irr Sol BAX B05X B05XA I.V. SOUTIO ADDITIVS CTROT SOUTIOS B05XA03 SODIU CHORID Sodium Chloride 9mg/m Inj HOS Sodium Chloride 146mg/m Inj HOS ovember

40 C C01 C01A C01AA Cardiovascular System CARDIAC THRA CARDIAC GCOSIDS DIGITAIS GCOSIDS C01AA05 DIGOXI digoxin 0.05mg/m inj Digoxin 0.05mg/m Inj anoxin 0.05mg/m Inj (discontinued) GA Toloxin 0.05mg/m Sol D digoxin mg tab Toloxin mg Tab D anoxin mg Tab (discontinued) S digoxin 0.125mg tab Toloxin 0.125mg Tab D anoxin 0.125mg Tab (discontinued) S digoxin 0.25mg tab Toloxin 0.25mg Tab D anoxin 0.25mg Tab (discontinued) S digoxin 0.25mg/m inj Digoxin 0.25mg/m Inj anoxin 0.25mg/m Inj (discontinued) VCO C01B C01BA ATIARRHTHICS, CASS I AD III ATIARRHTHICS, CASS IA C01BA02 ROCAIAID procainamide 100mg/m inj rocainamide 100mg/m Inj ronestyl 100mg/m Inj (discontinued) SQU rocan SR 250mg Tab RF rocan SR 500mg Tab (discontinued) RF rocan SR 750mg Tab (discontinued) RF C01BA03 DISORAID Rythmodan 100mg Cap SAV Rythmodan 150mg Cap (discontinued) SAV Rythmodan-A 250mg Tab (discontinued) SAV C01BB ATIARRHTHICS, CASS IB C01BB02 XITI mexiletine 100mg cap ovo-exiletine 100mg Cap TV exitil 100mg Cap (discontinued) BO mexiletine 200mg cap ovo-exiletine 200mg Cap TV ovember

41 C Cardiovascular System exitil 200mg Cap (discontinued) BO C01BC ATIARRHTHICS, CASS IC C01BC03 ROAFO propafenone 150mg tab Apo-ropafenone 150mg Tab A-ropafenone 150mg Tab pms-ropafenone 150mg Tab S ropafenone 150mg Tab Rythmol 150mg Tab BG propafenone 300mg tab Apo-ropafenone 300mg Tab A-ropafenone 300mg Tab pms-ropafenone 300mg Tab S ropafenone 300mg Tab Rythmol 300mg Tab BG C01BC04 FCAIID flecainide 50mg tab Flecainide 50mg Tab AA Tambocor 50mg Tab (discontinued) GW flecainide 100mg tab Flecainide 100mg Tab AA Tambocor 100mg Tab (discontinued) GW C01BD ATIARRHTHICS, CASS III C01BD01 AIODARO amiodarone HCl 50mg/m inj Amiodarone 50mg/m Inj Cordarone 50mg/m Inj (discontinued) WA pms-amiodarone 100mg Tab S amiodarone 200mg tab Amiodarone 200mg Tab Amiodarone-200mg Tab SIV Apo-Amiodarone 200mg Tab A-Amiodarone 200mg Tab pms-amiodarone 200mg Tab S Sandoz Amiodarone 200mg Tab Teva-Amiodarone 200mg Tab TV Cordarone 200mg Tab C01BD02 BRTIU TOSAT bretylium tosylate 50mg/m inj Bretylate 50mg/m Inj (discontinued) GA Bretylium Tosylate 50mg/m Inj C01BD07 DRODARO ultaq 400mg Tab SAV ovember

42 C Cardiovascular System C01C C01CA CARDIAC STIUATS XC.CARDIAC GCOSIDS ADRRGIC AD DOAIRGIC AGTS C01CA03 ORIHRI norepinephrine 1mg/m inj orepinephrine Bitartrate 1mg/m Inj evophed 1mg/m Inj HOS C01CA06 HHRI phenylephrine 10mg/m inj henylephrine 10mg/m Inj eo-synephrine 10mg/m Inj HOS C01CA07 DOBUTAI dobutamine 12.5mg/m inj Dobutamine 12.5mg/m Inj Dobutrex 12.5mg/m Inj (discontinued) C C01CA17 IDODRI midodrine 2.5mg tab idodrine 2.5mg Tab AA Amatine 2.5mg Tab (discontinued) SHI midodrine 5mg tab idodrine 5mg Tab AA Amatine 5mg Tab (discontinued) SHI C01CA24 IHRI Allerject 0.15mg/0.15ml Inj * SAV Twinject 0.15mg Auto-Injector * A Allerject 0.3mg/0.3ml Inj * SAV Twinject 0.3mg Auto-Injector * A pinephrine 1:1000 Inj HOS pipen 1:1000 (0.3mg/dose) Inj * KG pipen Jr. 1:2000 (0.15mg/dose) Inj * KG *quantity limit of two injections per fiscal year. The prescriber can submit a request for consideration should beneficiaries C01C require more than two injections per fiscal year. HOSHODISTRAS IHIBITORS C01C99 TADAAFI Adcirca 20mg Tab I C01D C01DA VASODIATORS USD I CARDIAC DIS ORGAIC ITRATS C01DA02 ITROGCRI (GCR TRIITRAT) ovember

43 C Cardiovascular System nitroglycerin 0.2mg/hr patch A-itro 0.2mg/hr atch itro-dur 0.2mg/hr atch FRS initran 0.2mg/hr atch V Transderm-itro 0.2mg/hr atch VR Trinipatch 0.2mg/hr atch A itrostat 0.3mg Tab nitroglycerin 0.4mg/dose pumpspray Apo-itroglycerin umpspray 0.4mg/dose Rho-itro umpspray 0.4mg/dose itrolingual umpspray 0.4mg/dose SAV nitroglycerin 0.4mg/hr patch A-itro 0.4mg/hr atch itro-dur 0.4mg/hr atch FRS A-itro 0.4mg/dose S Spray initran 0.4mg/hr atch V Transderm-itro 0.4mg/hr atch VR Trinipatch 0.4mg/hr atch A nitroglycerin 0.6mg/hr patch A-itro 0.6mg/hr atch itro-dur 0.6mg/hr atch FRS initran 0.6mg/hr atch V itrostat 0.6mg Tab Transderm-itro 0.6mg/hr atch VR Trinipatch 0.6mg/hr atch A nitroglycerin 0.8mg/hr patch A-itro 0.8mg/hr atch itro-dur 0.8mg/hr atch FRS itrol 2% Oint A itroglycerin 5mg/m Inj C01DA08 ISOSORBID DIITRAT isosorbide dinitrate 5mg S tab ISD 5mg Tab AA Isordil Sublingual 5mg Tab (discontinued) WA isosorbide dinitrate 10mg tab ISD 10mg Tab AA Isordil 10mg Tab (discontinued) WA isosorbide dinitrate 30mg tab ISD 30mg Tab AA Isordil 30mg Tab (discontinued) WA C01DA14 ISOSORBID OOITRAT isosorbide mononitrate 60mg SR tab Apo-IS 60mg Tab pms-is 60mg SR Tab S ovember

44 C Cardiovascular System Imdur 60mg R Tab AZ C02 C02A C02AB ATIHRTSIVS ATIADRRGIC AGTS, CTRA ACTIG THDOA C02AB02 THDOA (RACIC) methyldopa 125mg tab ethyldopa 125mg Tab AA Aldomet 125mg Tab (discontinued) IH methyldopa 250mg tab ethyldopa 250mg Tab AA Aldomet 250mg Tab (discontinued) IH methyldopa 500mg tab ethyldopa 500mg Tab AA Aldomet 500mg Tab (discontinued) IH C02AC COIDI AD AAOGUS C02AC01 COIDI clonidine HCl 0.025mg tab ovo-clonidine 0.025mg Tab TV Dixarit 0.025mg Tab BO clonidine HCl 0.1mg tab ovo-clonidine 0.1mg Tab TV Catapres 0.1mg Tab (discontinued) BO clonidine HCl 0.2mg tab ovo-clonidine 0.2mg Tab TV Catapres 0.2mg Tab (discontinued) BO C02C C02CA ATIADRRGIC AGTS, RIHRA ACTIG AHA-ADROCTOR BOCKIG AGTS C02CA01 RAZOSI prazosin HCl 1mg tab Apo-razo 1mg Tab ovo-razin 1mg Tab TV inipres 1mg Tab (discontinued) prazosin HCl 2mg tab Apo-razo 2mg Tab ovo-razin 2mg Tab TV inipres 2mg Tab (discontinued) prazosin HCl 5mg tab Apo-razo 5mg Tab ovo-razin 5mg Tab TV inipres 5mg Tab (discontinued) C02CA04 DOXAZOSI ovember

45 C Cardiovascular System doxazosin 1mg tab Apo-Doxazosin 1mg Tab A-Doxazosin 1mg Tab (discontinued) ovo-doxazosin 1mg Tab TV pms-doxazosin 1mg Tab S Cardura-1 1mg Tab doxazosin 2mg tab Apo-Doxazosin 2mg Tab A-Doxazosin 2mg Tab (discontinued) ovo-doxazosin 2mg Tab TV pms-doxazosin 2mg Tab S Cardura-2 2mg Tab doxazosin 4mg tab Apo-Doxazosin 4mg Tab A-Doxazosin 4mg Tab (discontinued) ovo-doxazosin 4mg Tab TV pms-doxazosin 4mg Tab S Cardura-4 4mg Tab C02D C02DB ARTRIOAR SOOTH USC, AGTS ACTIG O HDRAZIOHTHAAZI DRIVATIVS C02DB02 HDRAAZI hydralazine HCl 10mg tab Hydralazine 10mg Tab AA Apresoline 10mg Tab (discontinued) STR Apresoline 20mg/m Inj STR hydralazine HCl 25mg tab Hydralazine 25mg Tab AA Apresoline 25mg Tab (discontinued) STR hydralazine HCl 50mg tab Hydralazine 50mg Tab AA Apresoline 50mg Tab (discontinued) STR C02DC RIIDI DRIVATIVS C02DC01 IOXIDI oniten 2.5mg Tab oniten 10mg Tab C02K C02KX OTHR ATIHRTSIVS OTHR ATIHRTSIVS C02KX01 BOSTA bosentan 62.5mg tab CO Bosentan 62.5mg Tab A-Bosentan 62.5mg Tab pms-bosentan 62.5mg Tab S ovember

46 C Cardiovascular System Sandoz Bosentan 62.5mg Tab Teva-Bosentan 62.5mg Tab (discontinued) TV Tracleer 62.5mg Tab ACT bosentan 125mg tab CO Bosentan 125mg Tab A-Bosentan 125mg Tab pms-bosentan 125mg Tab S Sandoz Bosentan 125mg Tab Teva-Bosentan 125mg Tab (discontinued) TV Tracleer 125mg Tab ACT C02KX02 ABRISTA Volibris 5mg Tab GSK Volibris 10mg Tab GSK C02KX05 RIOCIGUAT Adempas 0.5mg Tab BA Adempas 1mg Tab BA Adempas 1.5mg Tab BA Adempas 2mg Tab BA Adempas 2.5mg Tab BA C02KX99 SIDAFI sildenafil 20mg tab Apo-Sildenafil R 20mg Tab pms-sildenafil-r 20mg Tab S ratio-sildenafil-r 20mg Tab TV Revatio 20mg Tab C03 C03A C03AA DIURTICS OW-CIIG DIURTICS, THIAZIDS THIAZIDS, AI C03AA03 HDROCHOROTHIAZID hydrochlorothiazide 12.5mg tab Apo-Hydro 12.5mg Tab pms-hydrochlorothiazide 12.5mg Tab S hydrochlorothiazide 25mg tab Apo-Hydro 25mg Tab Hydrochlorothiazide 25mg Tab pms-hydrochlorothiazide 25mg Tab S Teva-Hydrochlorothiazide 25mg Tab TV Hydrodiuril 25mg Tab (discontinued) FRS hydrochlorothiazide 50mg tab Apo-Hydro 50mg Tab Hydrochlorothiazide 50mg Tab ovember

47 C Cardiovascular System ovo-hydrazide 50mg Tab TV pms-hydrochlorothiazide 50mg Tab S Hydrodiuril 50mg Tab (discontinued) SD hydrochlorothiazide 100mg tab Apo-Hydro 100mg Tab Hydrodiuril 100mg Tab (discontinued) IH C03B C03BA OW-CIIG DIURTICS, XC THIAZIDS SUFOAIDS, AI C03BA04 CHORTHAIDO Chlorthalidone 50mg Tab AA C03BA08 TOAZO Zaroxolyn 2.5mg Tab SAV C03BA11 IDAAID indapamide 1.25mg tab Apo-Indapamide 1.25mg Tab Jamp-Indapamide 1.25mg Tab JC A-Indapamide 1.25mg Tab pms-indapamide 1.25mg Tab S ozide 1.25mg Tab SV indapamide 2.5mg tab Apo-Indapamide 2.5mg Tab Jamp-Indapamide 2.5mg Tab JC A-Indapamide 2.5mg Tab ovo-indapamide 2.5mg Tab TV pms-indapamide 2.5mg Tab S ozide 2.5mg Tab SV C03C C03CA HIGH-CIIG DIURTICS SUFOAIDS, AI C03CA01 FUROSID Furosemide 10mg/m Inj Furosemide 10mg/m Inj asix 10mg/m Sol SAV furosemide 20mg tab Apo-Furosemide 20mg Tab Furosemide 20mg Tab ovo-semide 20mg Tab TV asix 20mg Tab (discontinued) SAV furosemide 40mg tab Apo-Furosemide 40mg Tab Furosemide 40mg Tab ovo-semide 40mg Tab TV asix 40mg Tab (discontinued) SAV ovember

48 C Cardiovascular System furosemide 80mg tab Apo-Furosemide 80mg Tab Furosemide 80mg Tab ovo-semide 80mg Tab TV asix 80mg Tab (discontinued) SAV asix Special 500mg Tab SAV C03CA02 BUTAID Burinex 1mg Tab O Burinex 5mg Tab O C03D C03DA OTASSIU-SARIG DRUGS ADOSTRO ATAGOISTS C03DA01 SIROOACTO spironolactone 25mg tab ovo-spiroton 25mg Tab TV Aldactone 25mg Tab spironolactone 100mg tab ovo-spiroton 100mg Tab TV Aldactone 100mg Tab C03DA04 RO Inspra 25mg Tab Inspra 50mg Tab C03DB OTHR OTASSIU-SARIG DRUGS C03DB01 AIORID amiloride 5mg tab idamor 5mg Tab AA idamor 5mg Tab (discontinued) ORB C03 C03A DIURTICS AD OTASSIU-SARIG DRUGS I COBIATIO OW-CIIG DIURTICS AD OTASSIU-SARIG DRUGS C03A01 HDROCHOROTHIAZID AD OTASSIU-SARIG AGTS hydrochlorothiazide 25mg & spironolactone 25mg tab ovo-spirozine 25mg Tab TV Aldactazide 25mg Tab hydrochlorothiazide 25mg & triamterene 50mg tab Apo-Triazide Tab ovo-triamzide 50/25 Tab TV Dyazide 50/25 Tab (discontinued) SKR hydrochlorothiazide 50mg & amiloride HCl 5mg tab Apo-Amilzide 5-50 Tab ovamilor 5/50 Tab TV oduret 5/50 Tab (discontinued) R ovember

49 C Cardiovascular System hydrochlorothiazide 50mg & spironolactone 50mg tab ovo-spirozine 50mg Tab TV Aldactazide 50mg Tab C03X C03XA OTHR DIURTICS VASORSSI ATAGOISTS C03XA01 TOVATA Samsca 15mg Tab OTS Samsca 30mg Tab OTS C04 C04A C04AB RIHRA VASODIATORS RIHRA VASODIATORS IIDAZOI DRIVATIVS C04AB01 HTOAI hentolamine esylate 5mg/m Inj C04AD URI DRIVATIVS C04AD03 TOXIFI pentoxifylline 400mg tab entoxifylline SR 400mg Tab AA Trental 400mg Tab (discontinued) SAV C04A RGOT AKAOIDS C04A01 RGOOID SATS Hydergine 1mg Tab STR C05 C05A C05AA VASOROTCTIVS AGTS FOR TRATT OF HORRHOIDS & AA FISSURS / TOICA US CORTICOSTROIDS C05AA01 HDROCORTISO hydrocortisone, framycetin sulfate & cinchocaine HCl oint roctol Oint OD ratio-roctosone Oint TV Sandoz roctomyxin HC Oint roctosedyl Oint AXC hydrocortisone, framycetin sulfate & cinchocaine HCl supp roctol Supp OD ratio-roctosone Supp TV Sandoz roctomyxin HC Supp roctosedyl Supp AXC hydrocortisone, pramoxine oint roctodan-hc Oint OD Anugesic-HC Oint JJ ovember

50 C Cardiovascular System hydrocortisone, pramoxine supp roctodan-hc Supp OD Sandoz Anuzinc HC lus Supp Anugesic-HC Supp JJ ratio-hemcort HC Oint TV ratio-hemcort HC Supp TV roctofoam HC Aer DUI hydrocortisone 0.5% oint Anodan-HC Oint OD Sandoz Anuzinc HC Oint Anusol-HC Oint JJ hydrocortisone 10mg supp Anodan-HC Supp OD Sandoz Anuzinc HC Supp Anusol-HC Supp JJ C05B C05BA ATIVARICOS THRA HARIS OR HARIOIDS FOR TOICA US C05BA04 TOSA OSUFAT SODIU lmiron 100mg Cap JA C07 C07A C07AA BTA BOCKIG AGTS BTA BOCKIG AGTS, AI BTA BOCKIG AGTS, AI, O-SCTIV C07AA03 IDOO pindolol 5mg tab Apo-indol 5mg Tab ovo-indol 5mg Tab TV pms-indolol 5mg Tab (discontinued) S Visken 5mg Tab TRB pindolol 10mg tab Apo-indol 10mg Tab ovo-indol 10mg Tab TV pms-indolol 10mg Tab (discontinued) S Visken 10mg Tab TRB pindolol 15mg tab Apo-indol 15mg Tab ovo-indol 15mg Tab TV pms-indolol 15mg Tab (discontinued) S Sandoz indolol 15mg Tab Visken 15mg Tab TRB C07AA05 RORAOO ropranolol HC 1mg/m Inj propranolol 10mg tab ovember

51 C Cardiovascular System ovo-ranol 10mg Tab TV Inderal 10mg Tab (discontinued) WA propranolol 20mg tab ovo-ranol 20mg Tab TV Inderal 20mg Tab (discontinued) WA propranolol 40mg tab ovo-ranol 40mg Tab TV Inderal 40mg Tab (discontinued) WA Inderal-A 60mg Cap propranolol 80mg tab ovo-ranol 80mg Tab TV Inderal 80mg Tab (discontinued) WA Inderal-A 80mg Cap propranolol 120mg tab Apo-ropranolol 120mg Tab (discontinued) Inderal 120mg Tab (discontinued) WA Inderal-A 120mg Cap Inderal-A 160mg Cap C07AA06 TIOO timolol maleate 5mg tab Apo-Timol 5mg Tab Blocadren 5mg Tab (discontinued) IH timolol maleate 10mg tab Apo-Timol 10mg Tab ovo-timol 10mg Tab (discontinued) TV Blocadren 10mg Tab (discontinued) FRS timolol maleate 20mg tab Apo-Timol 20mg Tab ovo-timol 20mg Tab (discontinued) TV Blocadren 20mg Tab (discontinued) FRS C07AA07 SOTAO sotalol 80mg tab Apo-Sotalol 80mg Tab Jamp-Sotalol 80mg Tab JC A-Sotalol 80mg Tab (discontinued) ovo-sotalol 80mg Tab (discontinued) TV pms-sotalol 80mg Tab S ratio-sotalol 80mg Tab TV Sandoz Sotalol 80mg Tab Sotalol-80mg Tab SIV Sotacor 80mg Tab (discontinued) BRI sotalol 160mg tab Apo-Sotalol 160mg Tab Jamp-Sotalol 160mg Tab JC ovember

52 C Cardiovascular System A-Sotalol 160mg Tab (discontinued) ovo-sotalol 160mg Tab (discontinued) TV pms-sotalol 160mg Tab S ratio-sotalol 160mg Tab TV Sandoz Sotalol 160mg Tab Sotalol-160mg Tab SIV Sotacor 160mg Tab (discontinued) BRI C07AA12 ADOO nadolol 40mg tab Apo-adol 40mg Tab AA Corgard 40mg Tab (discontinued) BRI nadolol 80mg tab Apo-adol 80mg Tab AA Corgard 80mg Tab (discontinued) BRI nadolol 160mg tab Apo-adol 160mg Tab AA Corgard 160mg Tab (discontinued) BRI C07AB BTA BOCKIG AGTS, AI, SCTIV C07AB02 TOROO Apo-etoprolol 25mg Tab A-etoprolol (Type ) 25mg Tab pms-etoprolol- 25mg Tab S metoprolol tartrate 50mg tab Apo-etoprolol 50mg Tab Apo-etoprolol- 50mg Tab Jamp-etoprolol- 50mg Tab JC etoprolol Film-Coated 50mg Tab A-etoprolol (Type ) 50mg Tab pms-etoprolol- 50mg Tab S Sandoz etoprolol (Type ) 50mg Tab Teva-etoprol 50mg Tab (pink) TV Betaloc 50mg Tab (discontinued) AZ opresor 50mg Tab VR Teva-etoprol 50mg Tab (white) TV metoprolol tartrate 100mg SR tab Apo-etoprolol SR 100mg Tab Sandoz etoprolol SR 100mg Tab opresor SR 100mg Tab VR metoprolol tartrate 100mg tab Apo-etoprolol 100mg Tab Apo-etoprolol- 100mg Tab Jamp-etoprolol- 100mg Tab JC etoprolol Film-Coated 100mg Tab A-etoprolol (Type ) 100mg Tab pms-etoprolol- 100mg Tab S ovember

53 C Cardiovascular System Sandoz etoprolol (Type ) 100mg Tab Teva-etoprol 100mg Tab (blue) TV Betaloc 100mg Tab (discontinued) AZ opresor 100mg Tab VR Teva-etoprol 100mg Tab (white) TV metoprolol tartrate 200mg SR tab Apo-etoprolol SR 200mg Tab Sandoz etoprolol SR 200mg Tab opresor SR 200mg Tab VR Betaloc Durules 200mg Tab (discontinued) AZ C07AB03 ATOO atenolol 25mg tab Atenolol-25mg Tab SIV pms-atenolol 25mg Tab S Jamp-Atenolol 25mg Tab JC ar-atenolol 25mg Tab AR IT-Atenol 25mg Tab T A-Atenolol 25mg Tab RA-Atenolol 25mg Tab RA Teva-Atenolol 25mg Tab TV atenolol 50mg tab Apo-Atenol 50mg Tab Atenolol-50mg Tab SIV CO Atenolol 50mg Tab Jamp-Atenolol 50mg Tab JC ar-atenolol 50mg Tab AR IT-Atenol 50mg tab T A-Atenolol 50mg Tab pms-atenolol 50mg Tab S RA-Atenolol 50mg Tab RA ratio-atenolol 50mg Tab TV Septa-Atenolol 50mg Tab ST Tenormin 50mg Tab AZ atenolol 100mg tab Apo-Atenol 100mg Tab Atenolol-100mg Tab SIV CO Atenolol 100mg Tab Jamp-Atenolol 100mg Tab JC ar-atenolol 100mg Tab AR IT-Atenol 100mg tab T A-Atenolol 100mg Tab pms-atenolol 100mg Tab S RA-Atenolol 100mg Tab RA ratio-atenolol 100mg Tab TV Septa-Atenolol 100mg Tab ST Teva-Atenolol 100mg Tab (discontinued) TV Tenormin 100mg Tab AZ ovember

54 C Cardiovascular System C07AB04 ACBUTOO acebutolol HCl 100mg tab Acebutolol 100mg Tab Apo-Acebutolol 100mg Tab A-Acebutolol (Type S) 100mg Tab A-Acebutolol 100mg Tab ovo-acebutolol 100mg Tab TV onitan 100mg Tab (discontinued) WA Sectral 100mg Tab SAV acebutolol HCl 200mg tab Acebutolol 200mg Tab Apo-Acebutolol 200mg Tab A-Acebutolol (Type S) 200mg Tab A-Acebutolol 200mg Tab ovo-acebutolol 200mg Tab TV onitan 200mg Tab (discontinued) WA Sectral 200mg Tab SAV acebutolol HCl 400mg tab Acebutolol 400mg Apo-Acebutolol 400mg Tab A-Acebutolol (Type S) 400mg Tab A-Acebutolol 400mg Tab ovo-acebutolol 400mg Tab TV onitan 400mg Tab (discontinued) WA Rhotral 400mg Tab (discontinued) Sectral 400mg Tab SAV C07AB07 BISOROO bisoprolol 5mg tab Apo-Bisoprolol 5mg Tab Bisoprolol 5mg Tab Bisoprolol-5mg Tab SIV A-Bisoprolol 5mg Tab ovo-bisoprolol 5mg Tab TV pms-bisoprolol 5mg Tab S Sandoz Bisoprolol 5mg Tab onocor 5mg Tab (discontinued) BV bisoprolol 10mg tab Apo-Bisoprolol 10mg Tab Bisoprolol 10mg Tab Bisoprolol-10mg Tab SIV A-Bisoprolol 10mg Tab ovo-bisoprolol 10mg Tab TV pms-bisoprolol 10mg Tab S Sandoz Bisoprolol 10mg Tab onocor 10mg Tab (discontinued) BV C07AB12 BIVOO ovember

55 C Cardiovascular System Bystolic 2.5mg Tab FC Bystolic 5mg Tab FC Bystolic 10mg Tab FC Bystolic 20mg Tab FC C07AG AHA AD BTA BOCKIG AGTS C07AG01 ABTAO labetalol 5mg/m inj abetalol 5mg/m Inj Trandate 5mg/m Inj (discontinued) SHI Trandate 100mg Tab A Trandate 200mg Tab A C07AG02 CARVDIO carvedilol 3.125mg tab Apo-Carvedilol 3.125mg Tab Carvedilol 3.125mg Tab Carvedilol-3.125mg Tab SIV Jamp-Carvedilol 3.125mg Tab JC A-Carvedilol 3.125mg Tab pms-carvedilol 3.125mg Tab S RA-Carvedilol 3.125mg Tab RA ratio-carvedilol 3.125mg Tab TV Coreg 3.125mg Tab (discontinued) GSK carvedilol 6.25mg tab Apo-Carvedilol 6.25mg Tab Carvedilol 6.25mg Tab Carvedilol-6.25mg Tab SIV Jamp-Carvedilol 6.25mg Tab JC A-Carvedilol 6.25mg Tab pms-carvedilol 6.25mg Tab S RA-Carvedilol 6.25mg Tab RA ratio-carvedilol 6.25mg Tab TV Coreg 6.25mg Tab (discontinued) GSK carvedilol 12.5mg tab Apo-Carvedilol 12.5mg Tab Carvedilol 12.5mg Tab Carvedilol-12.5mg Tab SIV Jamp-Carvedilol 12.5mg Tab JC A-Carvedilol 12.5mg Tab pms-carvedilol 12.5mg Tab S RA-Carvedilol 12.5mg Tab RA ratio-carvedilol 12.5mg Tab TV Coreg 12.5mg Tab (discontinued) GSK carvedilol 25mg tab Apo-Carvedilol 25mg Tab Carvedilol 25mg Tab ovember

56 C Cardiovascular System Carvedilol-25mg Tab SIV Jamp-Carvedilol 25mg Tab JC A-Carvedilol 25mg Tab pms-carvedilol 25mg Tab S RA-Carvedilol 25mg Tab RA ratio-carvedilol 25mg Tab TV Coreg 25mg Tab (discontinued) GSK C07C C07CA BTA BOCKIG AGTS AD OTHR DIURTICS BTA BOCKIG AGTS,O-SCTIV,OTHR DIURTICS C07CA03 IDOO AD OTHR DIURTICS Viskazide 10/25 Tab TRB Viskazide 10/50 Tab TRB C07CB BTA BOCKIG AGTS,SCTIV,AD OTHR DIURTICS C07CB03 ATOO AD OTHR DIURTICS atenolol 50mg & chlorthalidone 25mg tab Apo-Atenidone 50/25 Tab Teva-Atenolol/Chlorthalidone 50/25mg Tab TV Tenoretic 50/25 Tab AZ atenolol 100mg & chlorthalidone 25mg tab Apo-Atenidone 100/25 Tab Teva-Atenolol/Chlorthalidone 100/25mg Tab TV Tenoretic 100/25 Tab AZ C08 C08C C08CA CACIU CHA BOCKRS SCTIV CACIU CHA BOCKRS WITH AI VASCUAR FFCTS DIHDRORIDI DRIVATIVS C08CA01 AODII ACT-Amlodipine 2.5mg Tab pms-amlodipine 2.5mg Tab S amlodipine 5mg tab Amlodipine 5mg Tab Amlodipine 5mg Tab JC Amlodipine-5mg Tab SIV Amlodipine-ODA 5mg Tab (discontinued) OD Apo-Amlodipine 5mg Tab Auro-Amlodipine 5mg Tab ARO CO Amlodipine 5mg Tab GD-Amlodipine 5mg Tab GD Jamp-Amlodipine 5mg Tab (discontinued) JC ar-amlodipine 5mg Tab AR IT-Amlodipine 5mg Tab T A-Amlodipine 5mg Tab pms-amlodipine 5mg Tab S RA-Amlodipine 5mg Tab RA ovember

57 C Cardiovascular System ratio-amlodipine 5mg Tab (discontinued) TV Sandoz Amlodipine 5mg Tab Septa-Amlodipine 5mg Tab ST Teva-Amlodipine 5mg Tab TV orvasc 5mg Tab amlodipine 10mg tab Amlodipine 10mg Tab JC Amlodipine 10mg Tab Amlodipine-10mg Tab SIV Amlodipine-ODA 10mg Tab (discontinued) OD Apo-Amlodipine 10mg Tab Auro-Amlodipine 10mg Tab ARO CO Amlodipine 10mg Tab GD-Amlodipine 10mg Tab GD Jamp-Amlodipine 10mg Tab (discontinued) JC ar-amlodipine 10mg Tab AR IT-Amlodipine 10mg Tab T A-Amlodipine 10mg Tab pms-amlodipine 10mg Tab S RA-Amlodipine 10mg Tab RA ratio-amlodipine 10mg Tab (discontinued) TV Sandoz Amlodipine 10mg Tab Septa-Amlodipine 10mg Tab ST Teva-Amlodipine 10mg Tab TV orvasc 10mg Tab C08CA02 FODII lendil 2.5mg R Tab AZ felodipine 5mg tab (lendil) Sandoz Felodipine 5mg Tab lendil 5mg Tab AZ felodipine 5mg tab (Renedil) Sandoz Felodipine 5mg Tab Renedil 5mg Tab (discontinued) SAV felodipine 10mg tab (lendil) Sandoz Felodipine 10mg Tab lendil 10mg Tab AZ felodipine 10mg tab (Renedil) Sandoz Felodipine 10mg Tab Renedil 10mg Tab (discontinued) SAV C08CA05 IFDII nifedipine 5mg cap ifedipine 5mg Cap AA Adalat 5mg Cap (discontinued) I nifedipine 10mg cap ifedipine 10mg Cap AA Adalat 10mg Cap (discontinued) I ovember

58 C Cardiovascular System Adalat X 20mg Tab TV nifedipine 30mg R tab A-ifedipine R 30mg Tab Adalat X 30mg Tab TV nifedipine 60mg R tab A-ifedipine R 60mg Tab Adalat X 60mg Tab TV C08CA06 IODII imotop 30mg Tab BA C08D C08DA SCTIV CACIU CHA BOCKRS WITH DIRCT CARDIAC FFCTS HAKAI DRIVATIVS C08DA01 VRAAI verapamil 2.5mg/m inj Verapamil 2.5mg/m Inj Isoptin IV 2.5mg/m Inj (discontinued) ABB verapamil HCl 80mg tab Apo-Verap 80mg Tab A-Verapamil 80mg Tab Isoptin 80mg Tab (discontinued) ABB verapamil 120mg SR tab Apo-Verap SR 120mg Tab A-Verapamil SR 120mg Tab Isoptin SR 120mg Tab BG verapamil HCl 120mg tab Apo-Verap 120mg Tab A-Verapamil 120mg Tab Isoptin 120mg Tab (discontinued) ABB verapamil 180mg SR tab Apo-Verap SR 180mg Tab A-Verapamil SR 180mg Tab Isoptin SR 180mg Tab BG verapamil 240mg SR tab Apo-Verap SR 240mg Tab A-Verapamil SR 240mg Tab pms-verapamil SR 240mg Tab S Isoptin SR 240mg Tab BG C08DB BZOTHIAZI DRIVATIVS C08DB01 DITIAZ diltiazem 5mg/m inj Diltiazem Hydrochloride 5mg/m Inj Cardizem 5mg/m Inj (discontinued) BV diltiazem HCl 30mg tab ovember

59 C Cardiovascular System Apo-Diltiaz 30mg Tab ovo-diltazem 30mg Tab TV Cardizem 30mg Tab (discontinued) BV diltiazem HCl 60mg tab Apo-Diltiaz 60mg Tab ovo-diltazem 60mg Tab TV Cardizem 60mg Tab (discontinued) BV diltiazem 120mg CD cap Apo-Diltiaz CD 120mg Cap CO Diltiazem CD 120mg Cap Diltiazem CD 120mg Cap ovo-diltazem CD 120mg Cap TV pms-diltiazem CD 120mg Cap S Sandoz Diltiazem CD 120mg Cap Cardizem CD 120mg Cap V diltiazem 120mg R cap Apo-Diltiaz TZ 120mg Cap (discontinued) CO Diltiazem T 120mg Cap ovo-diltazem R 120mg Cap TV Sandoz Diltiazem T 120mg Cap Tiazac R 120mg Cap V Tiazac XC 120mg Tab V diltiazem 180mg CD cap Apo-Diltiaz CD 180mg Cap CO Diltiazem CD 180mg Cap Diltiazem CD 180mg Cap ovo-diltazem CD 180mg Cap TV pms-diltiazem CD 180mg Cap S Sandoz Diltiazem CD 180mg Cap Cardizem CD 180mg Cap V diltiazem 180mg R cap Apo-Diltiaz TZ 180mg Cap (discontinued) CO Diltiazem T 180mg Cap ovo-diltazem R 180mg Cap TV Sandoz Diltiazem T 180mg Cap Tiazac R 180mg Cap V Tiazac XC 180mg Tab V diltiazem 240mg CD cap Apo-Diltiaz CD 240mg Cap CO Diltiazem CD 240mg Cap Diltiazem CD 240mg Cap ovo-diltazem CD 240mg Cap TV pms-diltiazem CD 240mg Cap S Sandoz Diltiazem CD 240mg Cap Cardizem CD 240mg Cap V diltiazem 240mg R cap Apo-Diltiaz TZ 240mg Cap (discontinued) ovember

60 C Cardiovascular System CO Diltiazem T 240mg Cap ovo-diltazem R 240mg Cap TV Sandoz Diltiazem T 240mg Cap Tiazac R 240mg Cap V Tiazac XC 240mg Tab V diltiazem 300mg CD cap Apo-Diltiaz CD 300mg Cap CO Diltiazem CD 300mg Cap Diltiazem CD 300mg Cap ovo-diltazem CD 300mg Cap TV pms-diltiazem CD 300mg Cap S Sandoz Diltiazem CD 300mg Cap Cardizem CD 300mg Cap V diltiazem 300mg R cap Apo-Diltiaz TZ 300mg Cap (discontinued) CO Diltiazem T 300mg Cap ovo-diltazem R 300mg Cap TV Sandoz Diltiazem T 300mg Cap Tiazac R 300mg Cap V Tiazac XC 300mg Tab V diltiazem 360mg R cap Apo-Diltiaz TZ 360mg Cap (discontinued) CO Diltiazem T 360mg Cap ovo-diltazem R 360mg Cap TV Sandoz Diltiazem T 360mg Cap Tiazac R 360mg Cap V Tiazac XC 360mg Tab V C09 C09A C09AA AGTS ACTIG O TH RI-AGIOTSI SST AC-IHIBITORS, AI AC-IHIBITORS, AI C09AA01 CATORI Apo-Capto 6.25mg Tab captopril 12.5mg tab Apo-Capto 12.5mg Tab ovo-captoril 12.5mg Tab TV Capoten 12.5mg Tab (discontinued) BRI captopril 25mg tab Apo-Capto 25mg Tab A-Captopril 25mg Tab (discontinued) ovo-captoril 25mg Tab TV Capoten 25mg Tab (discontinued) BRI captopril 50mg tab Apo-Capto 50mg Tab ovo-captoril 50mg Tab TV ovember

61 C Cardiovascular System Capoten 50mg Tab (discontinued) BRI captopril 100mg tab Apo-Capto 100mg Tab ovo-captoril 100mg Tab TV Capoten 100mg Tab (discontinued) BRI C09AA02 AARI enalapril 2.5mg tab Apo-nalapril 2.5mg Tab CO nalapril 2.5mg Tab nalapril 2.5mg Tab A-nalapril 2.5mg Tab ovo-nalapril 2.5mg Tab (discontinued) TV pms-nalapril 2.5mg Tab S RA-nalapril 2.5mg Tab RA Sandoz nalapril 2.5mg Tab Vasotec 2.5mg Tab FRS enalapril 5mg tab Apo-nalapril 5mg Tab CO nalapril 5mg Tab nalapril 5mg Tab A-nalapril 5mg Tab ovo-nalapril 5mg Tab TV pms-nalapril 5mg Tab S RA-nalapril 5mg Tab RA Sandoz nalapril 5mg Tab Vasotec 5mg Tab FRS enalapril 10mg tab Apo-nalapril 10mg Tab CO nalapril 10mg Tab nalapril 10mg Tab A-nalapril 10mg Tab ovo-nalapril 10mg Tab TV pms-nalapril 10mg Tab S RA-nalapril 10mg Tab RA Sandoz nalapril 10mg Tab Vasotec 10mg Tab FRS enalapril 20mg tab Apo-nalapril 20mg Tab CO nalapril 20mg Tab nalapril 20mg Tab A-nalapril 20mg Tab ovo-nalapril 20mg Tab TV pms-nalapril 20mg Tab S RA-nalapril 20mg Tab RA Sandoz nalapril 20mg Tab Vasotec 20mg Tab FRS C09AA03 ISIORI ovember

62 C Cardiovascular System lisinopril 5mg tab Apo-isinopril 5mg Tab Auro-isinopril 5mg Tab ARO CO isinopril 5mg Tab Jamp-isinopril 5mg Tab JC isinopril-5mg Tab SIV A-isinopril 5mg Tab ovo-isinopril 5mg Tab TV ovo-isinopril Z 5mg Tab TV pms-isinopril 5mg Tab S RA-isinopril 5mg Tab RA Sandoz isinopril 5mg Tab rinivil 5mg Tab FRS Zestril 5mg Tab AZ lisinopril 10mg tab Apo-isinopril 10mg Tab Auro-isinopril 10mg Tab ARO CO isinopril 10mg Tab Jamp-isinopril 10mg Tab JC isinopril-10mg Tab SIV A-isinopril 10mg Tab ovo-isinopril Z 10mg Tab TV pms-isinopril 10mg Tab S RA-isinopril 10mg Tab RA Sandoz isinopril 10mg Tab Teva-isinopril (Type ) 10mg Tab TV rinivil 10mg Tab FRS Zestril 10mg Tab AZ lisinopril 20mg tab Apo-isinopril 20mg Tab Auro-isinopril 20mg Tab ARO CO isinopril 20mg Tab Jamp-isinopril 20mg Tab JC isinopril-20mg Tab SIV A-isinopril 20mg Tab ovo-isinopril Z 20mg Tab TV pms-isinopril 20mg Tab S RA-isinopril 20mg Tab RA Sandoz isinopril 20mg Tab Teva-isinopril (Type ) 20mg Tab TV rinivil 20mg Tab FRS Zestril 20mg Tab AZ C09AA04 RIDORI Coversyl 2mg Tab SV Coversyl 4mg Tab SV Coversyl 8mg Tab SV C09AA05 RAIRI ovember

63 C Cardiovascular System ramipril 1.25mg cap/tab Apo-Ramipril 1.25mg Cap Auro-Ramipril 1.25mg Cap ARO CO Ramipril 1.25mg Cap Jamp-Ramipril 1.25mg Cap JC ar-ramipril 1.25mg Cap AR A-Ramipril 1.25mg Cap pms-ramipril 1.25mg Cap S RA-Ramipril 1.25mg Cap RA Sandoz Ramipril 1.25mg Tab Altace 1.25mg Cap SAV ramipril 2.5mg cap/tab Apo-Ramipril 2.5mg Cap Auro-Ramipril 2.5mg Cap ARO CO Ramipril 2.5mg Cap Jamp-Ramipril 2.5mg Cap JC ar-ramipril 2.5mg Cap AR IT-Ramipril 2.5mg Cap T A-Ramipril 2.5mg Cap pms-ramipril 2.5mg Cap S Ramipril 2.5mg Cap Ramipril-2.5mg Cap SIV RA-Ramipril 2.5mg Cap RA Sandoz Ramipril 2.5mg Tab Teva-Ramipril 2.5mg Cap TV Altace 2.5mg Cap SAV ramipril 5mg cap/tab Apo-Ramipril 5mg Cap Auro-Ramipril 5mg Cap ARO CO Ramipril 5mg Cap Jamp-Ramipril 5mg Cap JC ar-ramipril 5mg Cap AR IT-Ramipril 5mg Cap T A-Ramipril 5mg Cap pms-ramipril 5mg Cap S Ramipril 5mg Cap Ramipril-5mg Cap SIV RA-Ramipril 5mg Cap RA Sandoz Ramipril 5mg Tab Teva-Ramipril 5mg Cap TV Altace 5mg Cap SAV ramipril 10mg cap/tab Apo-Ramipril 10mg Cap Auro-Ramipril 10mg Cap ARO CO Ramipril 10mg Cap Jamp-Ramipril 10mg Cap JC ar-ramipril 10mg Cap AR IT-Ramipril 10mg Cap T A-Ramipril 10mg Cap ovember

64 C Cardiovascular System pms-ramipril 10mg Cap S Ramipril 10mg Cap Ramipril-10mg Cap SIV RA-Ramipril 10mg Cap RA Sandoz Ramipril 10mg Tab Teva-Ramipril 10mg Cap TV Altace 10mg Cap SAV ramipril 15mg cap Apo-Ramipril 15mg Cap ar-ramipril 15mg Cap AR IT-Ramipril 15mg Cap T RA-Ramipril 15mg Cap RA Altace 15mg Cap SAV C09AA06 QUIARI quinapril 5mg tab Apo-Quinapril 5mg Tab Accupril 5mg Tab quinapril 10mg tab Apo-Quinapril 10mg Tab Accupril 10mg Tab quinapril 20mg tab Apo-Quinapril 20mg Tab Accupril 20mg Tab quinapril 40mg tab Apo-Quinapril 40mg Tab Accupril 40mg Tab C09AA07 BAZRI benazepril 5mg tab Benazepril 5mg Tab AA otensin 5mg Tab VR benazepril 10mg tab Benazepril 10mg Tab AA otensin 10mg Tab (discontinued) VR benazepril 20mg tab Benazepril 20mg Tab AA otensin 20mg Tab VR C09AA08 CIAZARI cilazapril 1mg tab Apo-Cilazapril 1mg Tab A-Cilazapril 1mg Tab ovo-cilazapril 1mg Tab TV pms-cilazapril 1mg Tab S Inhibace 1mg Tab (discontinued) HR cilazapril 2.5mg tab ovember

65 C Cardiovascular System Apo-Cilazapril 2.5mg Tab Cilazapril 2.5mg Tab A-Cilazapril 2.5mg Tab ovo-cilazapril 2.5mg Tab TV pms-cilazapril 2.5mg Tab S Inhibace 2.5mg Tab HR cilazapril 5mg tab Apo-Cilazapril 5mg Tab A-Cilazapril 5mg Tab ovo-cilazapril 5mg Tab (discontinued) TV pms-cilazapril 5mg Tab S Inhibace 5mg Tab HR C09AA09 FOSIORI fosinopril 10mg tab Apo-Fosinopril 10mg Tab Jamp-Fosinopril 10mg Tab JC A-Fosinopril 10mg Tab Teva-Fosinopril 10mg Tab TV onopril 10mg Tab (discontinued) BRI fosinopril 20mg tab Apo-Fosinopril 20mg Tab Jamp-Fosinopril 20mg Tab JC A-Fosinopril 20mg Tab Teva-Fosinopril 20mg Tab TV onopril 20mg Tab (discontinued) BRI C09AA10 TRADOARI avik 0.5mg Cap BG avik 1mg Cap BG avik 2mg Cap BG avik 4mg Cap BG C09B C09BA AC-IHIBITORS, COBIATIOS AC-IHIBITORS AD DIURTICS C09BA02 AARI AD DIURTICS enalapril 5mg & hydrochlorothiazide 12.5mg tab Apo-nalapril aleate/hctz 5/12.5mg Tab Vaseretic 5/12.5mg Tab (discontinued) FRS enalapril 10mg & hydrochlorothiazide 25mg tab Apo-nalapril aleate/hctz 10/25mg Tab Vaseretic 10/25mg Tab FRS C09BA03 ISIORI AD DIURTICS lisinopril 10mg & hydrochlorothiazide 12.5mg tab Apo-isinopril/HCTZ 10/12.5mg Tab (discontinued) ovember

66 C Cardiovascular System isinopril/hctz 10mg/12.5mg Tab (Type Z) A-isinopril/HCTZ 10/12.5mg Tab (discontinued) ovo-isinopril/hctz 10/12.5mg Tab (Type ) TV ovo-isinopril/hctz 10/12.5mg Tab (Type Z) TV Sandoz isinopril 10/12.5mg Tab rinzide 10/12.5mg Tab (discontinued) FRS Zestoretic 10/12.5mg Tab AZ lisinopril 20mg & hydrochlorothiazide 12.5mg tab Apo-isinopril/HCTZ 20/12.5mg Tab (discontinued) isinopril/hctz 20mg/12.5mg Tab (Type Z) A-isinopril/HCTZ 20/12.5mg Tab (discontinued) ovo-isinopril/hctz 20/12.5mg Tab (Type ) TV Sandoz isinopril 20/12.5mg Tab Teva-isinopril/HCTZ (Type Z) 20/12.5mg Tab TV Zestoretic 20/12.5mg Tab AZ lisinopril 20mg & hydrochlorothiazide 25mg tab Apo-isinopril/HCTZ 20/25mg Tab (discontinued) isinopril/hctz 20mg/25mg Tab (Type Z) A-isinopril/HCTZ 20/25mg Tab (discontinued) ovo-isinopril/hctz 20/25mg Tab (Type ) TV ovo-isinopril/hctz 20/25mg Tab (Type Z) TV Sandoz isinopril 20/25mg Tab rinzide 20/25mg Tab (discontinued) FRS Zestoretic 20/25mg Tab AZ C09BA04 RIDORI AD DIURTICS Coversyl lus D 2/0.625mg Tab SV Coversyl lus 4/1.25mg Tab SV Coversyl lus HD 8/2.5mg Tab SV C09BA05 RAIRI AD DIURTICS ramipril 2.5mg & hydrochlorothiazide 12.5mg tab pms-ramipril-hctz 2.5/12.5mg Tab S Teva-Ramipril/HCTZ 2.5/5mg Tab (discontinued) TV Altace HCT 2.5/12.5mg Tab SAV ramipril 5mg & hydrochlorothiazide 12.5mg tab pms-ramipril-hctz 5/12.5mg Tab S Ramipril-HCTZ 5mg/12.5mg Tab Teva-Ramipril/HCTZ 5/12.5mg Tab (discontinued) TV Altace HCT 5/12.5mg Tab SAV ramipril 5mg & hydrochlorothiazide 25mg tab pms-ramipril-hctz 5/25mg Tab S Ramipril-HCTZ 5mg/25mg Tab Teva-Ramipril/HCTZ 5/25mg Tab (discontinued) TV Altace HCT 5/25mg Tab SAV ramipril 10mg & hydrochlorothiazide 12.5mg tab pms-ramipril-hctz 10/12.5mg Tab S ovember

67 C Cardiovascular System Ramipril-HCTZ 10mg/12.5mg Tab Teva-Ramipril/HCTZ 10/12.5mg Tab (discontinued) TV Altace HCT 10/12.5mg Tab SAV ramipril 10mg & hydrochlorothiazide 25mg tab pms-ramipril-hctz 10/25mg Tab S Ramipril-HCTZ 10mg/25mg Tab Teva-Ramipril/HCTZ 10/25mg Tab (discontinued) TV Altace HCT 10/25mg Tab SAV C09BA06 QUIARI AD DIURTICS quinapril 10mg & hydrochlorothiazide 12.5mg tab Apo-Quinapril/HCTZ 10/12.5mg Tab Accuretic 10/12.5mg Tab quinapril 20mg & hydrochlorothiazide 12.5mg tab Apo-Quinapril/HCTZ 20/12.5mg Tab Accuretic 20/12.5mg Tab quinapril 20mg & hydrochlorothiazide 25mg tab Apo-Quinapril/HCTZ 20/25mg Tab Accuretic 20/25mg Tab C09BA08 CIAZARI AD DIURTICS cilazapril 5mg & hydrochlorothiazide 12.5mg tab Apo-Cilazapril/HCTZ 5/12.5mg Tab ovo-cilazapril/hctz 5mg/12.5mg Tab TV Inhibace lus 5/12.5mg Tab HR C09BB AC-IHIBITORS AD CACIU CHA BOCKRS C09BB10 TRADOARI AD VRAAI Tarka 2/240mg Tab BG Tarka 4/240mg Tab BG C09C C09CA AGIOTSI II ATAGOISTS AGIOTSI II ATAGOISTS, AI C09CA01 OSARTA losartan 25mg tab Apo-osartan 25mg Tab Auro-osartan 25mg Tab ARO CO osartan 25mg Tab Jamp-osartan 25mg Tab JC osartan 25mg Tab osartan-25mg Tab SIV IT-osartan 25mg Tab T A-osartan 25mg Tab pms-osartan 25mg Tab S RA-osartan 25mg Tab (discontinued) RA Sandoz osartan 25mg Tab Septa-osartan 25mg Tab ST ovember

68 C Cardiovascular System Teva-osartan 25mg Tab TV Cozaar 25mg Tab FRS losartan 50mg tab Apo-osartan 50mg Tab Auro-osartan 50mg Tab ARO CO osartan 50mg Tab Jamp-osartan 50mg Tab JC osartan 50mg Tab osartan-50mg Tab SIV IT-osartan 50mg Tab T A-osartan 50mg Tab pms-osartan 50mg Tab S RA-osartan 50mg Tab (discontinued) RA Sandoz osartan 50mg Tab Septa-osartan 50mg Tab ST Teva-osartan 50mg Tab TV Cozaar 50mg Tab FRS losartan 100mg tab Apo-osartan 100mg Tab Auro-osartan 100mg Tab ARO CO osartan 100mg Tab Jamp-osartan 100mg Tab JC osartan 100mg Tab osartan-100mg Tab SIV IT-osartan 100mg Tab T A-osartan 100mg Tab pms-osartan 100mg Tab S RA-osartan 100mg Tab (discontinued) RA Sandoz osartan 100mg Tab Septa-osartan 100mg Tab ST Teva-osartan 100mg Tab TV Cozaar 100mg Tab FRS C09CA02 ROSARTA Teveten 400mg Tab BG Teveten 600mg Tab BG C09CA03 VASARTA valsartan 40mg tab Apo-Valsartan 40mg Tab Auro-Valsartan 40mg Tab ARO CO Valsartan 40mg Tab A-Valsartan 40mg Tab pms-valsartan 40mg Tab S RA-Valsartan 40mg Tab RA Sandoz Valsartan 40mg Tab Teva-Valsartan 40mg Tab TV Valsartan 40mg Tab Valsartan-40mg Tab SIV ovember

69 C Cardiovascular System Diovan 40mg Tab VR valsartan 80mg tab ACT Valsartan 80mg Tab Apo-Valsartan 80mg Tab Auro-Valsartan 80mg Tab ARO A-Valsartan 80mg Tab pms-valsartan 80mg Tab S RA-Valsartan 80mg Tab RA Sandoz Valsartan 80mg Tab Teva-Valsartan 80mg Tab TV Valsartan 80mg Tab Valsartan-80mg Tab SIV Diovan 80mg Tab VR valsartan 160mg tab ACT Valsartan 160mg Tab Apo-Valsartan 160mg Tab Auro-Valsartan 160mg Tab ARO A-Valsartan 160mg Tab pms-valsartan 160mg Tab S RA-Valsartan 160mg Tab RA Sandoz Valsartan 160mg Tab Teva-Valsartan 160mg Tab TV Valsartan 160mg Tab Valsartan-160mg Tab SIV Diovan 160mg Tab VR valsartan 320mg tab ACT Valsartan 320mg Tab Apo-Valsartan 320mg Tab A-Valsartan 320mg Tab pms-valsartan 320mg Tab S Sandoz Valsartan 320mg Tab Teva-Valsartan 320mg Tab TV Valsartan 320mg Tab Valsartan-320mg Tab SIV Diovan 320mg Tab VR C09CA04 IRBSARTA irbesartan 75mg tab Apo-Irbesartan 75mg Tab Auro-Irbesartan 75mg Tab ARO CO Irbesartan 75mg Tab Irbesartan 75mg Tab Irbesartan-75mg Tab SIV Jamp-Irbesartan 75mg Tab JC A-Irbesartan 75mg Tab pms-irbesartan 75mg Tab S RA-Irbesartan 75mg Tab RA ratio-irbesartan 75mg Tab TV Sandoz Irbesartan 75mg ovember

70 C Cardiovascular System Avapro 75mg Tab SAV irbesartan 150mg tab Apo-Irbesartan 150mg Tab Auro-Irbesartan 150mg Tab ARO CO Irbesartan 150mg Tab Irbesartan 150mg Tab Irbesartan-150mg Tab SIV Jamp-Irbesartan 150mg Tab JC A-Irbesartan 150mg Tab pms-irbesartan 150mg Tab S RA-Irbesartan 150mg Tab RA ratio-irbesartan 150mg Tab TV Sandoz Irbesartan 150mg Teva-Irbesartan 150mg Tab TV Avapro 150mg Tab SAV irbesartan 300mg tab Apo-Irebsartan 300mg Tab Auro-Irbesartan 300mg Tab ARO CO Irbesartan 300mg Tab Irbesartan 300mg Tab Irbesartan-300mg Tab SIV Jamp-Irbesartan 300mg Tab JC A-Irbesartan 300mg Tab pms-irbesartan 300mg Tab S RA-Irbesartan 300mg Tab RA ratio-irbesartan 300mg Tab TV Sandoz Irbesartan 300mg Avapro 300mg Tab SAV C09CA06 CADSARTA candesartan 4mg tab Apo-Candesartan 4mg Tab Candesartan 4mg Tab Candesartan Cilexetil 4mg Tab AHI Candesartan-4mg Tab SIV CO Candesartan 4mg Tab Jamp-Candesartan 4mg Tab JC A-Candesartan 4mg Tab pms-candesartan 4mg Tab S RA-Candesartan 4mg Tab RA Sandoz Candesartan 4mg Tab Atacand 4mg Tab AZ candesartan 8mg tab Apo-Candesartan 8mg Tab Candesartan 8mg Tab Candesartan Cilexetil 8mg Tab AHI Candesartan-8mg Tab SIV CO Candesartan 8mg Tab Jamp-Candesartan 8mg Tab JC ovember

71 C Cardiovascular System A-Candesartan 8mg Tab pms-candesartan 8mg Tab S RA-Candesartan 8mg Tab RA Sandoz Candesartan 8mg Tab Teva-Candesartan 8mg Tab TV Atacand 8mg Tab AZ candesartan 16mg tab Apo-Candesartan 16mg Tab Cabdesartan-16mg Tab SIV Candesartan 16mg Tab Candesartan Cilexetil 16mg Tab AHI CO Candesartan 16mg Tab Jamp-Candesartan 16mg Tab JC A-Candesartan 16mg Tab pms-candesartan 16mg Tab S RA-Candesartan 16mg Tab RA Sandoz Candesartan 16mg Tab Teva-Candesartan 16mg Tab TV Atacand 16mg Tab AZ candesartan 32mg tab Apo-Candesartan 32mg Tab Candesartan 32mg Tab Candesartan Cilexetil 32mg Tab AHI CO Candesartan 32mg Tab Jamp-Candesartan 32mg Tab JC A-Candesartan 32mg Tab pms-candesartan 32mg Tab S RA-Candesartan 32mg Tab RA Sandoz Candesartan 32mg Tab Sandoz-Candesartan 32mg Tab Teva-Candesartan 32mg Tab TV Atacand 32mg Tab AZ C09CA07 TISARTA telmisartan 40mg tab Apo-Telmisartan 40mg Tab CO Telmisartan 40mg Tab A-Telmisartan 40mg Tab pms-telmisartan 40mg Tab (discontinued) S Sandoz Telmisartan 40mg Tab Telmisartan 40mg Tab AHI Telmisartan 40mg Tab S Telmisartan 40mg Tab Telmisartan-40mg Tab SIV Teva-Telmisartan 40mg Tab TV icardis 40mg Tab BO telmisartan 80mg tab Apo-Telmisartan 80mg Tab CO Telmisartan 80mg Tab ovember

72 C Cardiovascular System A-Telmisartan 80mg Tab pms-telmisartan 80mg Tab (discontinued) S Sandoz Telmisartan 80mg Tab Telmisartan 80mg Tab S Telmisartan 80mg Tab Telmisartan 80mg Tab AHI Telmisartan-80mg Tab SIV Teva-Telmisartan 80mg Tab TV icardis 80mg Tab BO C09CA08 OSARTA DOXOI Olmetec 20mg Tab FRS Olmetec 40mg Tab FRS C09CA09 ASISARTA DOXOI darbi 40mg Tab V darbi 80mg Tab V C09D C09DA AGIOTSI II ATAGOISTS, COBIATIOS AGIOTSI II ATAGOISTS AD DIURTICS C09DA01 OSARTA AD DIURTICS losartan 50mg & hydrochlorothiazide 12.5mg tab Apo-osartan/HCTZ 50/12.5mg Tab CO osartan/hct 50/12.5mg Tab Jamp-osartan HCTZ 50/12.5mg Tab JC osartan/hct mg Tab SIV osartan/hctz 50mg/12.5mg Tab IT-osartan/HCTZ 50/12.5mg Tab T A-osartan HCTZ 50/12.5mg Tab pms-osartan-hctz 50/12.5mg Tab S Sandoz osartan HCT 50/12.5mg Tab Teva-osartan/HCTZ 50/12.5mg Tab TV Hyzaar 50/12.5mg Tab FRS losartan 100mg & hydrochlorothiazide 12.5mg tab Apo-osartan/HCTZ 100/12.5mg Tab CO osartan/hct 100/12.5mg Tab osartan/hct-100/12.5mg Tab SIV osartan/hctz 100mg/12.5mg Tab IT-osartan/HCTZ 100/12.5mg Tab T A-osartan HCTZ 100/12.5mg Tab pms-osartan-hctz 100/12.5mg Tab S Sandoz osartan HCT 100/12.5mg Tab Teva-osartan/HCTZ 100/12.5mg Tab TV Hyzaar 100/12.5mg Tab FRS losartan 100mg & hydrochlorothiazide 25mg tab Apo-osartan/HCTZ 100/25mg Tab CO osartan/hct 100/25mg Tab ovember

73 C Cardiovascular System Jamp-osartan HCTZ 100/25mg Tab JC osartan/hct-100/25mg Tab SIV osartan/hctz 100mg/25mg Tab IT-osartan/HCTZ DS 100/25mg Tab T A-osartan HCTZ 100/25mg Tab pms-osartan-hctz 100/25mg Tab S Sandoz osartan HCT DS 100/25mg Tab Teva-osartan/HCTZ 100/25mg Tab TV Hyzaar DS 100/25mg Tab FRS C09DA02 ROSARTA AD DIURTICS Teveten lus 600mg/12.5mg Tab BG C09DA03 VASARTA AD DIURTICS valsartan 80mg & hydrochlorothiazide 12.5mg tab Apo-Valsartan/HCTZ 80/12.5mg Tab Auro-Valsartan HCT 80/12.5mg Tab ARO A-Valsartan HCTZ 80/12.5mg Tab Sandoz Valsartan/HCT 80/12.5mg Tab Teva-Valsartan/HCTZ 80/12.5mg Tab TV Valsartan HCT 80/12.5mg Tab Valsartan HCT-80mg/12.5mg Tab SIV Diovan-HCT 80/12.5mg Tab VR valsartan 160mg & hydrochlorothiazide 12.5mg tab Apo-Valsartan/HCTZ 160/12.5mg Tab Auro-Valsartan HCT 160/12.6mg Tab ARO A-Valsartan HCTZ 160/12.5mg Tab Sandoz Valsartan/HCT 160/12.5mg Tab Teva-Valsartan/HCTZ 160/12.5mg Tab TV Valsartan HCT 160/12.5mg Tab Valsartan HCT-160mg/12.5mg Tab SIV Diovan-HCT 160/12.5mg Tab VR valsartan 160mg & hydrochlorothiazide 25mg tab Apo-Valsartan/HCTZ 160/25mg Tab Auro-Valsartan HCT 160/25mg Tab ARO A-Valsartan HCTZ 160/25mg Tab Sandoz Valsartan/HCT 160/25mg Tab Teva-Valsartan/HCTZ 160/25mg Tab TV Valsartan HCT 160/25mg Tab Valsartan HCT-160mg/25mg Tab SIV Diovan-HCT 160/25mg Tab VR valsartan 320mg & hydrochlorothiazide 12.5mg tab Apo-Valsartan/HCTZ 320/12.5mg Tab Auro-Valsartan HCT 230/12.5mg Tab ARO A-Valsartan HCTZ 320/12.5mg Tab Sandoz Valsartan/HCT 320/12.5mg Tab Teva-Valsartan/HCTZ 320/12.5mg Tab TV Valsartan HCT 320/12.5mg Tab Diovan-HCT 320/12.5mg Tab VR ovember

74 C Cardiovascular System valsartan 320mg & hydrochlorothiazide 25mg tab Apo-Valsartan/HCTZ 320/25mg Tab Auro-Valsartan HCT 320/25mg Tab ARO A-Valsartan HCTZ 320/25mg Tab Sandoz Valsartan/HCT 320/25mg Tab Teva-Valsartan/HCTZ 320/25mg Tab TV Valsartan HCT 320/25mg Tab Diovan-HCT 320/25mg Tab VR C09DA04 IRBSARTA AD DIURTICS irbesartan 150mg & hydrochlorothiazide 12.5mg tab Apo-Irbesartan/HCTZ 150/12.5mg Tab CO Irbesartan/HCT 150/12.5mg Tab Irbesartan HCT-150/12.5mg Tab SIV Irbesartan/HCTZ 150/12.5mg Tab Jamp-Irbesartan/Hydrochlorothiazide 150/12.5mg Tab JC IT-Irbesartan/HCTZ 150/12.5mg Tab T pms-irbesartan-hctz 150/12.5 mg Tab S RA-Irbesartan HCTZ 150/12.5mg Tab RA ratio-irbesartan HCTZ 150/12.5 mg Tab TV Sandoz Irbesartan HCT 150/12.5mg Tab Teva-Irbesartan/HCTZ 150/12.5mg Tab TV Avalide 150/12.5mg Tab SAV irbesartan 300mg & hydrochlorothiazide 12.5mg tab Apo-Irbesartan/HCTZ 300/12.5mg Tab CO Irbesartan/HCT 300/12.5mg Tab Irbesartan HCT-300/12.5mg Tab SIV Irbesartan/HCTZ 300/12.5mg Tab Jamp-Irbesartan/Hydrochlorothiazide 300/12.5mg Tab JC IT-Irbesartan/HCTZ 300/12.5mg Tab T pms-irbesartan-hctz 300/12.5 mg Tab S RA-Irbesartan HCTZ 300/12.5mg Tab RA ratio-irbesartan HCTZ 300/12.5 mg Tab TV Sandoz Irbesartan HCT 300/12.5mg Tab Teva-Irbesartan/HCTZ 300/12.5mg Tab TV Avalide 300/12.5mg Tab SAV irbesartan 300mg & hydrochlorothiazide 25mg tab Apo-Irbesartan/HCTZ 300/25mg Tab CO Irbesartan/HCT 300/25mg Tab Irbesartan HCT-300/25mg Tab SIV Irbesartan/HCTZ 300/25mg Tab Jamp-Irbesartan/Hydrochlorothiazide 300/25mg Tab JC IT-Irbesartan/HCTZ 300/25mg Tab T pms-irbesartan-hctz 300/25 mg Tab S RA-Irbesartan HCTZ 300/25mg Tab RA ratio-irbesartan HCTZ 300/25 mg Tab TV Sandoz Irbesartan HCT 300/25mg Tab Teva-Irbesartan/HCTZ 300/25mg Tab TV Avalide 300/25mg Tab (discontinued) BRI ovember

75 C Cardiovascular System C09DA06 CADRSARTA AD DIURTICS candesartan 16mg & hydrochlorothiazide 12.5mg tab Apo-Candesartan/HCTZ 16/12.5mg Tab Candesartan HCT-16/12.5mg Tab SIV Candesartan/HCTZ 16/12.5mg Tab CO Candesartan/HCTZ 16/12.5mg Tab A-Candesartan/HCTZ 16/12.5mg Tab pms-candesartan HCTZ 16/12.5mg Tab S Sandoz Candesartan lus 16/12.5mg Tab Teva-Candesartan/HCTZ 16/12.5mg Tab TV Atacand lus 16/12.5mg Tab AZ candesartan 32mg & hydrochlorothiazide 12.5mg tab Apo-Candesartan/HCTZ 32/12.5mg Tab Sandoz Candesartan lus 32/12.5mg Tab Teva-Candesartan/HCTZ 32/12.5mg TV Atacand lus 32/12.5mg Tab AZ candesartan 32mg & hydrochlorothiazide 25mg tab Apo-Candesartan/HCTZ 32/25mg Tab Sandoz Candesartan lus 32/25mg Tab Atacand lus 32/25mg Tab AZ C09DA07 TISARTA AD DIURTICS telmisartan 80mg & hydrochlorothiazide 12.5mg tab CO Telmisartan/HCT 80/12.5mg Tab A-Telmisartan HCTZ 80/12.5mg Tab pms-telmisartan-hctz 80/12.5mg Tab (discontinued) S Sandoz Telmisartan HCT 80/12.5mg Tab Telmisartan HCTZ-80mg/12.5mg Tab SIV Telmisartan-HCTZ 80mg/12.5mg Tab S Telmisartan/HCTZ 80/12.5mg Tab Teva-Telmisartan HCTZ 80/12.5mg tab TV icardis lus 80/12.5mg Tab BO telmisartan 80mg & hydrochlorothiazide 25mg tab CO Telmisartan/HCT 80/25mg Tab A-Telmisartan HCTZ 80/25mg Tab pms-telmisartan-hctz 80/25mg Tab S Sandoz Telmisartan HCT 80/25mg Tab Telmisartan HCTZ-80mg/25mg Tab SIV Telmisartan/HCTZ 80/25mg Tab Teva-Telmisartan HCTZ 80/25mg tab TV icardis lus 80/25mg Tab BO C09DA08 OSARTA DOXOI AD DIURTICS Olmetec lus 20mg/12.5mg Tab FRS Olmetec lus 40mg/12.5mg Tab FRS Olmetec lus 40mg/25mg Tab FRS C09DA99 ASISARTA DOXOI AD CHORTHAIDO ovember

76 C Cardiovascular System darbyclor 40/12.5mg Tab TAK darbyclor 40/25mg Tab TAK darbyclor 80/12.5mg Tab TAK C09DB AGIOTSI II ATAGOISTS AD CACIU CHA BOCKRS C09DB04 TISARTA AD AODII Twynsta 40/5mg Tab BO Twynsta 40/10mg Tab BO Twynsta 80/5mg Tab BO Twynsta 80/10mg Tab BO C09X C09XA OTHR AGTS ACTIG O TH RI-AGIOTSI SST RI IHIBITORS C09XA02 AISKIR Rasilez 150mg Tab VR Rasilez 300mg Tab VR C10 C10A C10AA IID ODIFIG AGTS IID ODIFIG AGTS, AI HG COA RDUCTAS IHIBITORS C10AA01 SIVASTATI simvastatin 5mg tab Apo-Simvastatin 5mg Tab Auro-Simvastatin 5mg Tab ARO CO Simvastatin 5mg Tab Jamp-Simvastatin 5mg Tab JC ar-simvastatin 5mg Tab AR IT-Simvastatin 5mg Tab T A-Simvastatin 5mg Tab pms-simvastatin 5mg Tab S RA-Simvastatin 5mg Tab RA Simvastatin 5mg Tab Simvastatin-5mg Tab SIV Simvastatin-ODA 5mg Tab (discontinued) OD Teva-Simvastatin 5mg Tab TV Zocor 5mg Tab FRS simvastatin 10mg tab Apo-Simvastatin 10mg Tab Auro-Simvastatin 10mg Tab ARO CO Simvastatin 10mg Tab Jamp-Simvastatin 10mg Tab JC ar-simvastatin 10mg Tab AR IT-Simvastatin 10mg Tab T A-Simvastatin 10mg Tab ovember

77 C Cardiovascular System ovo-simvastatin 10mg Tab TV pms-simvastatin 10mg Tab S RA-Simvastatin 10mg Tab RA Sandoz Simvastatin 10mg Tab Simvastatin 10mg Tab Simvastatin-10mg Tab SIV Simvastatin-ODA 10mg Tab (discontinued) OD Zocor 10mg Tab FRS simvastatin 20mg tab Apo-Simvastatin 20mg Tab Auro-Simvastatin 20mg Tab ARO CO Simvastatin 20mg Tab Jamp-Simvastatin 20mg Tab JC ar-simvastatin 20mg Tab AR IT-Simvastatin 20mg Tab T A-Simvastatin 20mg Tab ovo-simvastatin 20mg Tab TV pms-simvastatin 20mg Tab S RA-Simvastatin 20mg Tab RA Sandoz Simvastatin 20mg Tab Simvastatin 20mg Tab Simvastatin-20mg Tab SIV Simvastatin-ODA 20mg Tab (discontinued) OD Zocor 20mg Tab FRS simvastatin 40mg tab Apo-Simvastatin 40mg Tab Auro-Simvastatin 40mg Tab ARO CO Simvastatin 40mg Tab Jamp-Simvastatin 40mg Tab JC ar-simvastatin 40mg Tab AR IT-Simvastatin 40mg Tab T A-Simvastatin 40mg Tab pms-simvastatin 40mg Tab S RA-Simvastatin 40mg Tab RA Sandoz Simvastatin 40mg Tab Simvastatin 40mg Tab Simvastatin-40mg Tab SIV Simvastatin-ODA 40mg Tab (discontinued) OD Teva-Simvastatin 40mg Tab TV Zocor 40mg Tab FRS simvastatin 80mg tab Apo-Simvastatin 80mg Tab Auro-Simvastatin 80mg Tab ARO CO Simvastatin 80mg Tab Jamp-Simvastatin 80mg Tab JC ar-simvastatin 80mg Tab AR IT-Simvastatin 80mg Tab T A-Simvastatin 80mg Tab pms-simvastatin 80mg Tab S ovember

78 C Cardiovascular System RA-Simvastatin 80mg Tab RA Sandoz Simvastatin 80mg Tab Simvastatin 80mg Tab Simvastatin-80mg Tab SIV Simvastatin-ODA 80mg Tab (discontinued) OD Teva-Simvastatin 80mg Tab TV Zocor 80mg Tab (discontinued) FRS C10AA02 OVASTATI lovastatin 20mg tab Apo-ovastatin 20mg Tab CO ovastatin 20mg Tab ovastatin 20mg Tab A-ovastatin 20mg Tab ovo-ovastatin 20mg Tab TV pms-ovastatin 20mg Tab S evacor 20mg Tab (discontinued) FRS lovastatin 40mg tab Apo-ovastatin 40mg Tab CO ovastatin 40mg Tab ovastatin 40mg Tab A-ovastatin 40mg Tab ovo-ovastatin 40mg Tab TV pms-ovastatin 40mg Tab S evacor 40mg Tab (discontinued) FRS C10AA03 RAVASTATI pravastatin 10mg tab Apo-ravastatin 10mg Tab CO ravastatin 10mg Tab Jamp-ravastatin 10mg Tab JC IT-ravastatin 10mg Tab T A-ravastatin 10mg Tab pms-ravastatin 10mg Tab S ravastatin 10mg Tab () ravastatin-10mg SIV RA-ravastatin 10mg Tab RA Sandoz ravastatin 10mg Tab (discontinued) Teva-ravastatin 10mg Tab TV ravachol 10mg Tab (discontinued) BRI pravastatin 20mg tab Apo-ravastatin 20mg Tab CO ravastatin 20mg Tab Jamp-ravastatin 20mg Tab JC IT-ravastatin 20mg Tab T A-ravastatin 20mg Tab pms-ravastatin 20mg Tab S ravastatin 20mg Tab () ravastatin-20mg Tab SIV ovember

79 C Cardiovascular System RA-ravastatin 20mg Tab RA Sandoz ravastatin 20mg Tab (discontinued) Teva-ravastatin 20mg Tab TV ravachol 20mg Tab BRI pravastatin 40mg tab Apo-ravastatin 40mg Tab CO ravastatin 40mg Tab Jamp-ravastatin 40mg Tab JC IT-ravastatin 40mg Tab T A-ravastatin 40mg Tab pms-ravastatin 40mg Tab S ravastatin 40mg Tab () ravastatin-40mg Tab SIV RA-ravastatin 40mg Tab RA Sandoz ravastatin 40mg Tab Teva-ravastatin 40mg Tab TV ravachol 40mg Tab BRI C10AA04 FUVASTATI fluvastatin 20mg cap Sandoz Fluvastatin 20mg Cap Teva-Fluvastatin 20mg Cap TV escol 20mg Cap VR fluvastatin 40mg cap Sandoz Fluvastatin 40mg Cap Teva-Fluvastatin 40mg Cap TV escol 40mg Cap VR escol X 80mg Cap VR C10AA05 ATORVASTATI atorvastatin 10mg tab Apo-Atorvastatin 10mg Tab Atorvastatin 10mg Tab () Atorvastatin-10mg Tab SIV CO Atorvastatin 10mg Tab GD-Atorvastatin 10mg Tab GD Jamp-Atorvastatin 10mg Tab JC A-Atorvastatin 10mg Tab A-Atorvastin 10mg Tab (discontinued) ovo-atorvastatin 10mg Tab (discontinued) TV pms-atorvastatin 10mg Tab S RA-Atorvastatin 10mg Tab RA ratio-atorvastatin 10mg Tab TV Reddy-Atorvastatin 10mg Tab RCH Sandoz Atorvastatin 10mg Tab ipitor 10mg Tab atorvastatin 20mg tab Apo-Atorvastatin 20mg Tab ovember

80 C Cardiovascular System Atorvastatin 20mg Tab () Atorvastatin-20mg Tab SIV CO Atorvastatin 20mg Tab GD-Atorvastatin 20mg Tab GD Jamp-Atorvastatin 20mg Tab JC A-Atorvastatin 20mg Tab A-Atorvastin 20mg Tab (discontinued) ovo-atorvastatin 20mg Tab (discontinued) TV pms-atorvastatin 20mg Tab S RA-Atorvastatin 20mg Tab RA ratio-atorvastatin 20mg Tab TV Reddy-Atorvastatin 20mg Tab RCH Sandoz Atorvastatin 20mg Tab ipitor 20mg Tab atorvastatin 40mg tab Apo-Atorvastatin 40mg Tab Atorvastatin 40mg Tab () Atorvastatin-40mg Tab SIV CO Atorvastatin 40mg Tab GD-Atorvastatin 40mg Tab GD Jamp-Atorvastatin 40mg Tab JC A-Atorvastatin 40mg Tab A-Atorvastin 40mg Tab (discontinued) ovo-atorvastatin 40mg Tab (discontinued) TV pms-atorvastatin 40mg Tab S RA-Atorvastatin 40mg Tab RA ratio-atorvastatin 40mg Tab TV Reddy-Atorvastatin 40mg Tab RCH Sandoz Atorvastatin 40mg Tab ipitor 40mg Tab atorvastatin 80mg tab Apo-Atorvastatin 80mg Tab Atorvastatin 80mg Tab () Atorvastatin-80mg Tab SIV CO Atorvastatin 80mg Tab GD-Atorvastatin 80mg Tab GD Jamp-Atorvastatin 80mg Tab JC A-Atorvastatin 80mg Tab A-Atorvastin 80mg Tab (discontinued) ovo-atorvastatin 80mg Tab (discontinued) TV pms-atorvastatin 80mg Tab S RA-Atorvastatin 80mg Tab RA ratio-atorvastatin 80mg Tab TV Reddy-Atorvastatin 80mg Tab RCH Sandoz Atorvastatin 80mg Tab ipitor 80mg Tab C10AA07 ROSUVASTATI rosuvastatin 5mg tab ovember

81 C Cardiovascular System Apo-Rosuvastatin 5mg Tab CO Rosuvastatin 5mg Tab Jamp-Rosuvastatin 5mg Tab JC ar-rosuvastatin 5mg Tab AR IT-Rosuvastatin 5mg Tab T A-Rosuvastatin 5mg Tab pms-rosuvastatin 5mg Tab S RA-Rosuvastatin 5mg Tab RA Rosuvastatin 5mg Tab Rosuvastatin-5mg Tab SIV Sandoz Rosuvastatin 5mg Tab Teva-Rosuvastatin 5mg Tab TV Crestor 5mg Tab AZ rosuvastatin 10mg tab Apo-Rosuvastatin 10mg Tab CO Rosuvastatin 10mg Tab Jamp-Rosuvastatin 10mg Tab JC ar-rosuvastatin 10mg Tab AR IT-Rosuvastatin 10mg Tab T A-Rosuvastatin 10mg Tab pms-rosuvastatin 10mg Tab S RA-Rosuvastatin 10mg Tab RA Rosuvastatin 10mg Tab Rosuvastatin-10mg Tab SIV Sandoz Rosuvastatin 10mg Tab Teva-Rosuvastatin 10mg Tab TV Crestor 10mg Tab AZ rosuvastatin 20mg tab Apo-Rosuvastatin 20mg Tab CO Rosuvastatin 20mg Tab Jamp-Rosuvastatin 20mg Tab JC ar-rosuvastatin 20mg Tab AR IT-Rosuvastatin 20mg Tab T A-Rosuvastatin 20mg Tab pms-rosuvastatin 20mg Tab S RA-Rosuvastatin 20mg Tab RA Rosuvastatin 20mg Tab Rosuvastatin-20mg Tab SIV Sandoz Rosuvastatin 20mg Tab Teva-Rosuvastatin 20mg Tab TV Crestor 20mg Tab AZ rosuvastatin 40mg tab Apo-Rosuvastatin 40mg Tab CO Rosuvastatin 40mg Tab Jamp-Rosuvastatin 40mg Tab JC ar-rosuvastatin 40mg Tab AR IT-Rosuvastatin 40mg Tab T A-Rosuvastatin 40mg Tab pms-rosuvastatin 40mg Tab S ovember

82 C Cardiovascular System RA-Rosuvastatin 40mg Tab RA Rosuvastatin 40mg Tab Rosuvastatin-40mg Tab SIV Sandoz Rosuvastatin 40mg Tab Teva-Rosuvastatin 40mg Tab TV Crestor 40mg Tab AZ C10AB FIBRATS C10AB02 BZAFIBRAT Bezalip 400mg SR Tab TRB C10AB04 GFIBROZI gemfibrozil 300mg cap Apo-Gemfibrozil 300mg Cap ovo-gemfibrozil 300mg Cap TV opid 300mg Cap (discontinued) gemfibrozil 600mg tab Apo-Gemfibrozil 600mg Tab A-Gemfibrozil 600mg Tab ovo-gemfibrozil 600mg Tab TV pms-gemfibrozil 600mg Tab (discontinued) S opid 600mg Tab (discontinued) C10AB05 FOFIBRAT fenofibrate 48mg tab Sandoz Fenofibrate 48mg Tab ipidil Z 48mg Tab BG fenofibrate 67mg cap Apo-Feno-icro 67mg Cap ipidil icro 67mg Cap (discontinued) FOU fenofibrate 100mg tab Apo-Feno-Super 100mg Tab Fenofibrate-S 100mg Tab ovo-fenofibrate-s 100mg Tab TV Sandoz Fenofibrate S 100mg Tab ipidil Supra 100mg Tab (discontinued) ABB Apo-Fenofibrate 100mg Cap fenofibrate 145mg tab Sandoz Fenofibrate 145mg tab ipidil Z 145mg Tab BG fenofibrate 160mg tab Apo-Feno-Super 160mg Tab Fenofibrate-S 160mg Tab ovo-fenofibrate-s 160mg Tab (discontinued) TV Sandoz Fenofibrate S 160mg Tab ipidil Supra 160mg Tab ABB fenofibrate 200mg cap ovember

83 C Cardiovascular System Apo-Feno-icro 200mg Cap Fenofibrate icro 200mg Cap (discontinued) A-Fenofibrate icro 200mg Cap ovo-fenofibrate icronized 200mg Cap (discontinued) TV ratio-fenofibrate C 200mg Cap TV ipidil icro 200mg Cap (discontinued) ABB C10AC BI ACID SQUSTRATS C10AC01 CHOSTRAI cholestyramine powder pouches Olestyr ight 4g/9g dr (Sugar Reduced) D Olestyr Regular 4g/9g dr D Questran ight dr 4g/dose (discontinued) BRI Questran dr4g/dose (discontinued) BRI C10AC02 COSTIO Colestid 1g Tab Colestid Granules 5g/pack Colestid Orange Gran 5g/pack C10AC04 COSVA odalis 625mg Tab V C10AD ICOTIIC ACID AD DRIVATIVS C10AD02 ICOTIIC ACID i-oda 500mg R Tab OD iaspan 500mg Tab SV iaspan FCT 500mg R Tab SV iaspan FCT 750mg R Tab SV iaspan 1,000mg Tab SV iaspan FCT 1000mg R Tab SV C10AX OTHR IID ODIFIG AGTS C10AX09 ZTIIB ezetimibe 10mg tab ACH-zetimibe 10mg Tab AHI ACT zetimibe 10mg Tab Apo-zetimibe 10mg Tab zetimibe 10mg Tab zetimibe 10mg Tab SIV Jamp-zetimibe 10mg Tab JC ar-zetimibe 10mg Tab AR IT-zetimibe 10mg Tab T A-zetimibe 10mg Tab pms-zetimibe 10mg Tab S RA-zetimibe 10mg Tab RA Sandoz zetimibe 10mg Tab Teva-zetimibe 10mg Tab TV ovember

84 C Cardiovascular System zetrol 10mg Tab FRS C10B C10BX IID ODIFIG AGTS, COBIATIOS HG COA RDUCTAS IHIBITORS, OTHR COBIATIOS C10BX03 ATORVASTATI AD AODII amlodipine 5mg & atorvastatin 10mg tab Apo-Amlodipine/Atorvastatin 5/10mg Tab GD-Amlodipine/Atorvastatin 5/10mg Tab GD pms-amlodipine-atorvastatin 5/10mg Tab S Caduet 5/10mg Tab amlodipine 5mg & atorvastatin 20mg tab Apo-Amlodipine/Atorvastatin 5/20mg Tab GD-Amlodipine/Atorvastatin 5/20mg Tab GD pms-amlodipine-atorvastatin 5/20mg Tab S Caduet 5/20mg Tab amlodipine 5mg & atorvastatin 40mg tab Apo-Amlodipine/Atorvastatin 5/40mg Tab GD-Amlodipine/Atorvastatin 5/40mg Tab GD Caduet 5/40mg Tab amlodipine 5mg & atorvastatin 80mg tab Apo-Amlodipine/Atorvastatin 5/80mg Tab GD-Amlodipine/Atorvastatin 5/80mg Tab GD Caduet 5/80mg Tab amlodipine 10mg & atorvastatin 10mg tab Apo-Amlodipine/Atorvastatin 10/10mg Tab GD-Amlodipine/Atorvastatin 10/10mg Tab GD pms-amlodipine-atorvastatin 10/10mg Tab S Caduet 10/10mg Tab amlodipine 10mg & atorvastatin 20mg tab Apo-Amlodipine/Atorvastatin 10/20mg Tab GD-Amlodipine/Atorvastatin 10/20mg Tab GD pms-amlodipine-atorvastatin 10/20mg Tab S Caduet 10/20mg Tab amlodipine 10mg & atorvastatin 40mg tab Apo-Amlodipine/Atorvastatin 10/40mg Tab GD-Amlodipine/Atorvastatin 10/40mg Tab GD Caduet 10/40mg Tab amlodipine 10mg & atorvastatin 80mg tab Apo-Amlodipine/Atorvastatin 10/80mg Tab GD-Amlodipine/Atorvastatin 10/80mg Tab GD Caduet 10/80mg Tab ovember

85 D D01 D01A D01AA Dermatologicals ATIFUGAS, DRATOOGICA ATIFUGAS, TOICA RARATIOS ATIBIOTICS D01AA01 STATI ratio-ystatin 100,000 iu/g Cr C TV ratio-ystatin 100,000 iu/g Oint C TV ycostatin 100,000 iu/g dr (discontinued) CO yaderm 100,000 iu/g Cr C TAR D01AC IIDAZO AD TRIAZO DRIVATIVS D01AC01 COTRIAZO clotrimazole 1% cr Clotrimaderm 1% Cr C TAR Canesten 1% Cr C O D01AC02 ICOAZO icatin 2% Cr C WS onistat 2% Derm Cr C JJ D01AC08 KTOCOAZO ketoconazole 2% cr Ketoderm 2% Cr C TH izoral 2% Cr (discontinued) JJ D01AC20 IIDAZO DRIVATIVS, COBIATIOS otriderm Cr C FRS D01A OTHR TOICA ATIFUGAS D01A13 SIU SUFID Versel 2.5% ot VA D01A14 CICOIROX oprox 1% Cr C V oprox 1% ot C V Stieprox 1.5% Shampoo STI ciclopirox 8% w/w top sol Apo-Ciclopirox 8% w/w Top Sol Ciclopirox 8% w/w Top Sol STR pms-ciclopirox 8% w/w Top Sol S Taro-Ciclopirox 8% w/w Top Sol TAR enlac 8% w/w Top Sol V D01A15 TRBIAFI amisil 1% Cr C VR amisil 1% Top Spray C VR D01A18 TOAFTAT ovember

86 D Dermatologicals Tinactin 10mg/g Cr SCH D01B D01BA ATIFUGAS, SSTIC RARATIOS ATIFUGAS FOR SSTIC US D01BA02 TRBIAFI terbinafine 250mg tab Apo-Terbinafine 250mg Tab Auro-Terbinafine 250mg Tab ARO CO Terbinafine 250mg Tab Jamp-Terbinafine 250mg Tab JC A-Terbinafine 250mg Tab (discontinued) ovo-terbinafine 250mg Tab TV pms-terbinafine 250mg Tab S Sandoz Terbinafine 250mg Tab (discontinued) Terbinafine 250mg Tab Terbinafine-250mg Tab SIV amisil 250mg Tab VR D03 D03B D03BA RARATIOS FOR TRATT OF WOUDS AD UCRS ZS ROTOTIC ZS D03BA02 COAGAS (COSTRIDIOITIDAS) Santyl 250u/g Oint TI D04 D04A D04AB ATIRURITICS,IC ATIHIST,AASTHT,TC. ATIRURITICS,IC ATIHIST,AASTHT,TC. AASTHTICS, TOICA D04AB01 IDOCAI idodan 2% Viscous iq C OD pms-idocaine 2% Viscous iq C S Xylocaine 2% Jelly C AZ Xylocaine 2% Viscous iq C AZ Xylocaine 4% Topical iq (discontinued) AZ lidocaine 5% oint idodan 5% Oint C OD Xylocaine 5% Oint C AZ Xylocaine 12mg/dose ndotracheal Spray AZ D05 D05A D05AD ATISORIATICS ATISORIATICS FOR TOICA US SORAS FOR TOICA US D05AD02 THOXSA ovember

87 D Dermatologicals Oxsoralen 1% ot (discontinued) V D05AX OTHR ATISORIATICS FOR TOICA US D05AX02 CACIOTRIO Dovonex 50mcg/g Cr O Dovonex 50mcg/g Oint O Dovonex 50mcg/m Scalp Sol O D05AX03 CACITRIO Silkis 3ug/G oint GAC D05AX05 TAZAROT Tazorac 0.05% Gel A Tazorac 0.1% Gel A D05AX52 CACIOTRIO, COBIATIOS Dovobet 0.5mg/g/50mcg/g Gel O Dovobet 50mcg/0.5mg/g Oint O D05B D05BB ATISORIATICS FOR SSTIC US RTIOIDS FOR TRATT OF SORIASIS D05BB02 ACITRTI Soriatane 10mg Cap TRB Soriatane 25mg Cap TRB D06 D06A D06AX ATIBIOTICS AD CHOTHRAUTICS, DRATOOGICAS ATIBIOTICS, TOICA RARATIOS VARIOUS TOICA ATIBIOTICS D06AX01 FUSIDIC ACID Fucidin 2% Cr O Fucidin 2% Oint O D06AX04 OCI eosporin Oint GSK D06AX05 BACITRACI Bacitracin 50,000iu dr/vial D06AX09 UIROCI mupirocin 2% oint Taro-upirocin 2% Oint TAR Bactroban 2% Oint GCH Bactroban 2% Cr GCH D06AX30 ATIBIOTICS, COBIATIOS ovember

88 D Dermatologicals Soframycin Oint RF D06B D06BA CHOTHRAUTICS, TOICA RARATIOS SUFOAIDS D06BA01 SIVR SUFADIAZI Flamazine 1% Cr C S D06BB ATIVIRAS D06BB03 ACCOVIR Zovirax 5% Oint V D06BB04 ODOHOTOXI Condyline 0.5% Top Sol SAV Wartec 0.5% Top Sol (discontinued) A odofilm 250mg/m iq A D06BB10 IIQUIOD imiquimod 5% cr Apo-Imiquimod 5% Cr Aldara 5% Cr V D06BX OTHR CHOTHRAUTICS D06BX01 TROIDAZO etrocream 0.75% Cr C GAC etrootion 0.75% ot C GAC etrogel 1% Gel C GAC oritate 1% Cr C V D07 D07A D07AA CORTICOSTROIDS, DRATOOGICA RARATIOS CORTICOSTROIDS, AI CORTICOSTROIDS, WAK (GROU I) D07AA02 HDROCORTISO hydrocortisone valerate 0.2% cr Hydroval 0.2% Cr TH Westcort 0.2% Cr (discontinued) WSQ Hydroval 0.2% Oint TH Cortoderm 1% Oint TAR mo-cort 1% Cr (discontinued) STI mo-cort 1% ot (discontinued) STI Hyderm 1% Cr TAR revex HC 1% Cr (discontinued) GSK Sarna HC 1% ot (discontinued) STI mo-cort 2.5% Cr GSK mo-cort 2.5% ot GSK ovember

89 D Dermatologicals D07AB CORTICOSTROIDS, ODRAT OTT (GROU II) D07AB01 COBTASO Spectro czemacare edicated Cream GCH D07AB08 DSOID desonide 0.05% cr pms-desonide 0.05% Cr S Tridesilon 0.05% Cr (discontinued) S desonide 0.05% oint pms-desonide 0.05% Oint S Tridesilon 0.05% Oint (discontinued) S D07AB09 TRIACIOO Triaderm 0.1% Cr TAR Aristocort R 0.1% Cr V Aristocort R 0.1% Oint V Aristocort C 0.5% Cr V D07AC CORTICOSTROIDS, OTT (GROU III) D07AC01 BTATHASO betamethasone 17 valerate 0.05% cr Betaderm 0.05% Cr TAR Celestoderm-V/2 0.05% Cr V Celestoderm-V/2 0.05% Cr (discontinued) SCH betamethasone dipropionate 0.05% cr Taro-Sone 0.05% Cr TAR Diprosone 0.05% Cr FRS betamethasone dipropionate 0.05% glycol cr ratio-topilene 0.05% Glycol Cr TV Diprolene 0.05% Glycol Cr FRS betamethasone dipropionate 0.05% glycol lot ratio-topilene 0.05% Glycol ot TV Diprolene 0.05% Glycol ot FRS betamethasone dipropionate 0.05% glycol oint ratio-topilene 0.05% Glycol Oint TV Diprolene 0.05% Glycol Oint FRS betamethasone dipropionate 0.05% lot ratio-topisone 0.05% ot TV Diprosone 0.05% ot FRS betamethasone dipropionate 0.05% oint ratio-topisone 0.05% Oint TV Diprosone 0.05% Oint FRS Betaderm 0.05% Oint TAR ratio-ctosone 0.05% Cr TV ratio-ctosone 0.05% ot TV ratio-topisone 0.05% Cr TV ovember

90 D Dermatologicals Celestoderm-V/2 0.05% Oint V betamethasone 17 valerate 0.1% cr Betaderm 0.1% Cr TAR Celestoderm-V 0.1% Cr V Celestoderm-V 0.1% Cr (discontinued) SCH Betaderm 0.1% Oint TAR Betaderm 0.1% Scalp ot TAR ratio-ctosone 0.1% Cr TV ratio-ctosone 0.1% Scalp ot TV Celestoderm-V 0.1% Oint V revex B 0.1% Cr GSK Valisone 0.1% Scalp otion V ratio-ctosone 1% ot TV D07AC03 DSOXITASO Topicort 0.05% Gel V Topicort ild 0.05% Cr V Topicort 0.25% Cr V Topicort 0.25% Oint V D07AC04 FUOCIOO ACTOID Derma-Smoothe FS 0.01% Top Oil HZ D07AC06 DIFUCORTOO erisone 0.1% Oily Cr STI erisone 0.1% Oint (discontinued) GSK D07AC08 FUOCIOID fluocinonide 0.05% cr yderm 0.05% Cr TH idex 0.05% Cr V fluocinonide 0.05% gel yderm 0.05% Gel TH idex 0.05% Gel V fluocinonide 0.05% oint yderm 0.05% Oint TH idex 0.05% Oint V idemol 0.05% Cr V Tiamol 0.05% Cr TH D07AC11 ACIOID amcinonide 0.1% cr ratio-amcinonide 0.1% Cr TV Taro-Amcinonide 0.1% Cr TAR Cyclocort 0.1% Cr STI amcinonide 0.1% lot ratio-amcinonide 0.1% ot TV ovember

91 D Dermatologicals Cyclocort 0.1% ot STI amcinonide 0.1% oint ratio-amcinonide 0.1% Oint TV Cyclocort 0.1% Oint STI D07AC13 OTASO mometasone 0.1% cr Taro-ometasone 0.1% Cr TAR locom 0.1% Cr FRS mometasone 0.1% lot Taro-ometasone 0.1% ot TAR locom 0.1% ot FRS mometasone 0.1% oint ratio-ometasone 0.1% Oint TV Taro-ometasone 0.1% Oint TAR locom 0.1% Oint FRS D07AD CORTICOSTROIDS, VR OTT (GROU IV) D07AD01 COBTASO clobetasol 17-propionate 0.05% cr A-Clobetasol 0.05% Cr ovo-clobetasol 0.05% Cr TV pms-clobetasol 0.05% Cr S ratio-clobetasol 0.05% Cr TV Taro-Clobetasol 0.05% Cr TAR Dermovate 0.05% Cr TH clobetasol 17-propionate 0.05% oint A-Clobetasol 0.05% Oint ovo-clobetasol 0.05% Oint TV pms-clobetasol 0.05% Oint S ratio-clobetasol 0.05% Oint TV Taro-Clobetasol 0.05% Oint TAR Dermovate 0.05% Oint TH clobetasol 17-propionate 0.05% scalp lot A-Clobetasol 0.05% Scalp ot pms-clobetasol 0.05% Scalp ot S ratio-clobetasol 0.05% Scalp ot TV Taro-Clobetasol 0.05% Scalp ot TAR Dermovate 0.05% Scalp ot TH D07C D07CA CORTICOSTROIDS, COB WITH ATIBIOTICS CORTICOSTROIDS, WAK, COB WITH ATIBIOTICS D07CA01 HDROCORTISO AD ATIBIOTICS Cortisporin Oint (discontinued) GSK Vioform HC Cr A Fucidin H 1% Cr O ovember

92 D Dermatologicals D07CB CORTICOSTROIDS, ODRAT. OTT, COB W/ATIBIOT. D07CB01 TRIACIOO AD ATIBIOTICS triamcinolone 0.1%, nystatin, neomycin & gramicidin cr Viaderm KC Cr TAR Kenacomb Cr (discontinued) WSQ triamcinolone 0.1%, nystatin, neomycin & gramicidin oint Viaderm KC Oint TAR Kenacomb Oint (discontinued) WSQ D07CB05 FUTASO AD ATIBIOTICS ocacorten Vioform Cr A D07CC CORTICOSTROIDS, OTT, COB WITH ATIBIOTICS D07CC01 BTATHASO AD ATIBIOTICS Valisone G Cream V Valisone G Oint V D07X D07XA CORTICOSTROIDS, OTHR COBIATIOS CORTICOSTROIDS, WAK, OTHR COBIATIOS D07XA01 HDROCORTISO ramox HC 1% Cr DT ramox HC 1% ot DT D07XC CORTICOSTROIDS, OTT, OTHR COBIATIOS D07XC01 BTATHASO Diprosalic Oint FRS bethamethasone dipropionate 0.05% & salicylic acid 2% lot ratio-topisalic ot TV Diprosalic ot FRS D08 D08A D08A ATISTICS AD DISIFCTATS ATISTICS AD DISIFCTATS HO AD DRIVATIVS D08A01 HXACHOROH phisohex 3% iq (discontinued) SAV D08AJ QUATRAR AOIU COOUDS D08AJ58 BZTHOIU CHORID, COBIATIOS Buro-Sol 2.36g/ack dr TCD D09 D09A D09AA DICATD DRSSIGS DICATD DRSSIGS OITT DRSSIGS WITH ATIIFCTIVS ovember

93 D Dermatologicals D09AA01 FRACTI Sofra-Tulle 1% 10cm x 10cm RF Sofra-Tulle 1% 10cm x 30cm RF D10 D10A D10AA ATI-AC RARATIOS ATI-AC RARATIOS CORTICOSTROIDS, COBIATIOS FOR AC D10AA02 THRDISOO eo-edrol Acne ot F D10AB RARATIOS COTAIIG SUHUR D10AB02 SUHUR Sulfacet-R ot F V D10AD RTIOIDS FOR TOICA US I AC D10AD01 TRTIOI Stieva-A 0.01% Cr F* STI Retin-A 0.025% Gel F* V Stieva-A 0.025% Cr F* STI Retin-A 0.05% Cr F* V Stieva-A 0.05% Cr F* STI Vitamin A Acid 0.05% Gel F* V Stieva-A 0.1% Forte Cr F* STI D10A ROXIDS *full benefit for beneficiaries 30 years and under D10A01 BZO ROXID Solugel 8% Gel STI D10AF ATIIFCTIVS FOR TRATT OF AC D10AF01 CIDACI clindamycin 1% top sol Taro-Clindamycin 1% Sol F TAR Dalacin T 1% Sol F D10AF51 CIDACI, COBIATIOS BenzaClin Gel V Clindoxyl Gel STI D10AF52 RTHROCI, COBIATIOS Stievamycin Forte Gel (discontinued) STI Stievamycin ild Gel F STI Stievamycin Regular Gel F STI D10AX OTHR ATI AC RARATIOS FOR TOICA US ovember

94 D Dermatologicals D10AX03 AZAIC ACID Finacea 15% Gel C BA D10B D10BA ATI AC RARATIOS FOR SSTIC US RTIOIDS FOR TRATT OF AC D10BA01 ISOTRTIOI isotretinoin 10mg cap Clarus 10mg Cap F Accutane 10mg Cap F HR puris 10mg Tab F CI puris 20mg Tab F CI puris 30mg Tab F CI isotretinoin 40mg cap Clarus 40mg Cap F Accutane 40mg Cap F HR puris 40mg Tab F CI D11 D11A D11AH OTHR DRATOOGICA RARATIOS OTHR DRATOOGICA RARATIOS AGTS FOR DRATITIS, XCUDIG CORTICOSTROIDS D11AH01 TACROIUS rotopic 0.03% Oint AS rotopic 0.1% Oint AS D11AH02 ICROIUS lidel 1% Cr V D11AH04 AITRTIOI Toctino 10mg Cap GSK Toctino 30mg Cap GSK D11AX OTHR DRATOOGICAS D11AX01 IOXIDI minoxidil 20mg/m top sol Apo-Gain 20mg/m Top Sol Rogaine 20mg/m Top Sol (discontinued) JJ D11AX10 FIASTRID finasteride 1mg tab A-Finasteride HG 1mg tab pms-finasteride 1mg Tab S Sandoz Finasteride A 1mg Tab ropecia 1mg Tab FRS ovember

95 D Dermatologicals D11AX99 AIOBZOAT OTASSIU, SSTIC otaba 500mg Cap (discontinued) G ovember

96 G G01 G01A G01AA Genito-Urinary System & Sex Hormones GCOOGICA ATIIFCTIVS AD ATISTICS ATIIFCTIVS/ATIST.,XC COB WITH CORTICOST. ATIBIOTICS G01AA01 STATI yaderm 100,000iu/dose Vag Cr C TAR ratio-ystatin 500,000iu/dose Vag Cr C TV G01AA10 CIDACI Dalacin 100mg/dose Vag Cr FC A G01AA51 STATI, COBIATIOS Flagystatin Vag Cr C SAV Flagystatin Vag Ovules C SAV G01AF IIDAZO DRIVATIVS G01AF01 TROIDAZO idagel 0.75% Vag Gel C V Flagyl 10% Vag Cr C SAV G01AF02 COTRIAZO clotrimazole 1% vag cr Clotrimaderm 1% Vag Cr C TAR Canesten 6 Vag Cr (6 day) C O Canesten 1 Comfortab Combi-ak (1 day) C O Canesten 1 Vag Cr C O Canesten 1 Vag Cr Combi-ak C O clotrimazole 2% vag cr Clotrimaderm 2% Vag Cr C TAR Canesten 3 Vag Cr (3 day) C O Canesten 3 Comfortab Combi-ak (3 day) C O G01AF04 ICOAZO miconazole 2% vag cr icozole 2% Vag Cr C TAR onistat 7 (2%) Vag Cr C JJ onistat 3 (400mg) Vag Ovules C JJ onistat 3 Dual-ak C JJ onistat 7 Dual-ak C JJ G02 G02A G02AD OTHR GACOOGICAS OXTOCICS ROSTAGADIS G02AD02 DIOROSTO rostin 2 0.5mg Tab A ovember

97 G Genito-Urinary System & Sex Hormones G02B G02BA TOICA COTRACTIVS ITRAUTRI COTRACTIVS G02BA03 ASTIC IUD WITH ROGSTOG Jaydess IUD 13.5mg/insert F BA irena IUD 52mg/insert F BA G02BB ITRAVAGIA COTRACTIVS G02BB01 THI STRADIO AD TOOGSTR uvaring F FRS G02C G02CB OTHR GACOOGICAS ROACTI IHIBITORS G02CB01 BROOCRITI bromocriptine mesylate 2.5mg tab Bromocriptine 2.5mg Tab C AA arlodel 2.5mg Tab (discontinued) VR bromocriptine mesylate 5mg cap Bromocriptine 5mg Cap C AA arlodel 5mg Cap (discontinued) VR G02CB03 CABRGOI cabergoline 0.5mg tab CO Cabergoline 0.5mg Tab Dostinex 0.5mg Tab A G02CB04 QUIAGOID orprolac 0.025mg Tab FI orprolac 0.05mg Tab FI orprolac 0.075mg Tab FI orprolac 0.15mg Tab FI G03 G03A G03AA SX HOROS AD ODUATORS OF TH GITA SST HOROA COTRACTIVS, SSTIC ROGSTOGS AD STROGS, FIXD COBIATIOS G03AA01 THODIO AD STROG Demulen 30 Tab 21 Day F Demulen 30 Tab 28 Day F G03AA05 ORTHIDRO AD STROG Brevicon 1/35 Tab 28 Day F Brevicon 0.5/35 Tab 21 Day F Brevicon 0.5/35 Tab 28 Day F Ortho 0.5/35 Tab 21 Day F JA ovember

98 G Genito-Urinary System & Sex Hormones Ortho 0.5/35 Tab 28 Day F JA instrin 1/20 Tab 21 Day F TV instrin 1/20 Tab 28 Day F TV Brevicon 1/35 Tab 21 Day F Ortho 1/35 Tab 21 Day F JA Ortho 1/35 Tab 28 Day F JA Select 1/35 Tab 21 Day F Select 1/35 Tab 28 Day F ostrin 1.5/30 Tab 21 Day F TV ostrin 1.5/30 Tab 28 Day F TV G03AA07 VOORGSTR AD STROG Seasonale Tab (91 Day) WC levonorgestrel 0.10mg & ethinyl estradiol 0.02mg tab (21) Alysena Tab 21 Day F Aviane Tab 21 Day F TV S Tab 21 Day F utera Tab 21 Day F COB Alesse Tab 21 Day F levonorgestrel 0.10mg & ethinyl estradiol 0.02mg tab (28) Alysena Tab 28 Day F Aviane Tab 28 Day F TV S Tab 28 Day F utera Tab 28 Day F COB Alesse Tab 28 Day F levonorgestrel 0.15mg & ethinyl estradiol 0.03mg tab (21) Ovima Tab 21 Day F ortia Tab 21 Day F TV in-ovral Tab 21 Day F levonorgestrel 0.15mg & ethinyl estradiol 0.03mg tab (28) Ovima Tab 28 Day F ortia Tab 28 Day F TV in-ovral Tab 28 Day F G03AA09 DSOGSTR AD STROG inessa Tab 21 Day F AR inessa Tab 28 Day F AR Orthocept Tab 28 Day (discontinued) JA desogestrel 150mcg and ethiny estradiol 30mcg tab (21) Apri Tab 21 Day F TV Freya Tab 21 Day irvala Tab 21 Day F Reclipsen Tab 21 Day arvelon Tab 21 Day F FRS desogestrel 150mcg and ethiny estradiol 30mcg tab (28) Apri Tab 28 Day F TV Freya Tab 28 Day ovember

99 G Genito-Urinary System & Sex Hormones irvala Tab 28 Day F Reclipsen Tab 28 Day arvelon Tab 28 Day F FRS G03AA11 ORGSTIAT AD STROG Cyclen Tab 21 Day F JA Cyclen Tab 28 Day F JA G03AA12 DROSIRO AD STROG drospirenone 3mg & ethinyl estradiol 0.03mg tab (21) Zamine Tab 21 Day F Zarah Tab 21 Day asmin Tab 21 Day F BA drospirenone 3mg & ethinyl estradiol 0.03mg tab (28) Zamine Tab 28 Day Zarah Tab 28 Day F asmin Tab 28 Day F BA drospirenone 3mg & ethinyl estradiol 0.02mg tab (28) A 3mg/0.02mg Tab az 3mg/0.02mg Tab BA G03AA13 ORGSTROI AD STROG vra 0.6/6mg atch JA G03AB ROGSTOGS AD STROGS,SQUTIA RARATIOS G03AB03 VOORGSTR AD STROG Triquilar Tab 21 Day F BA Triquilar Tab 28 Day F BA G03AB04 ORTHIDRO AD STROG Ortho 7/7/7 Tab 21 Day F JA Ortho 7/7/7 Tab 28 Day F JA Synphasic Tab 21 Day F Synphasic Tab 28 Day F G03AB11 ORGSTIAT AD STROG norgestimate & ethinylestradiol 3 phase tab (21) Tricira o (21 Day) F Tri-Cyclen o Tab 21 Day F JA norgestimate & ethinylestradiol 3 phase tab (28) Tricira o (28 Day) F Tri-Cyclen o Tab 28 Day F JA Tri-Cyclen Tab 21 Day F JA Tri-Cyclen Tab 28 Day F JA G03AC ROGSTOGS G03AC01 ORTHIDRO norethindrone 0.35mg tab (28) ovember

100 G Genito-Urinary System & Sex Hormones ovisse Tab 28 Day icronor Tab 28 Day JA G03AC06 DROXROGSTRO Depo-rovera 50mg/m Inj C medroxyprogesterone acetate 150mg/m inj edroxyprogesterone Acetate 150mg/m Inj C Depo-rovera 150mg/m Inj C G03AD03 VOORGSTR levonorgestrel 0.75mg tab ext Choice 0.75mg Tab F lan B 0.75mg Tab F A G03B G03BA ADROGS AD COBIATIOS, XC G03 3-OXOADROST (4) DRIVATIVS G03BA03 TSTOSTRO Testim 1% Top Gel D A Androgel 2.5g/pkt Top Gel D BG Androderm 2.5mg (12.2mg)/24 hr atch D AS Androgel 5g/pkt Top Gel D BG Androderm 5mg (24.3mg)/24 hr atch D AS testosterone undercanoate 40mg cap pms-testosterone 40mg Cap D C S Taro-Testosterone 40mg Cap D C TAR Andriol 40mg Cap D C FRS testosterone cypionate 100mg/m inj Testosterone Cypionate 100mg/m Inj D C Depo-Testosterone 100mg/m Inj D C Delatestryl 200mg/m Inj D C V G03C G03CA STROGS AD COBIATIOS, XC G03,G03F,G03HB ATURA AD SISTHTIC STROGS, AI G03CA03 STRADIO strogel 0.06% Top Gel FRS strace 0.5mg Tab C T strace 1mg Tab C T strace 2mg Tab C T string 7.5mcg/24 hr Vag Ring C A Vagifem 10mcg Vag Tab C O stradot atch (25mcg/day) VR Climara 25 (25mcg/day, 2mg/patch) BA ovember

101 G Genito-Urinary System & Sex Hormones Oesclim (25mcg/day, 5mg/patch) A stradot atch (37.5mcg/day) VR estradiol 50mcg/day patch (stradot) Sandoz stradiol Derm 50 (50mcg/day patch) stradot atch (50mcg/day) VR estradiol 50mcg/day patch (Vivelle) Sandoz stradiol Derm 50 (50mcg/day patch) Vivelle atch (50mcg/day) (discontinued) VR Climara 50 (50mcg/day, 3.9mg/patch) BA Oesclim (50mcg/day, 10mg/patch) A estradiol 75mcg/day patch (stradot) Sandoz stradiol Derm 75 (75mcg/day patch) stradot atch (75mcg/day) VR estradiol 75mcg/day patch (Vivelle) Sandoz stradiol Derm 75 (75mcg/day patch) Vivelle atch (75mcg/day) (discontinued) VR Climara 75 (75mcg/day, 5.7mg/patch) BA estradiol 100mcg/day patch (stradot) Sandoz stradiol Derm 100 (100mcg/day patch) stradot atch (100mcg/day) VR estradiol 100mcg/day patch (Vivelle) Sandoz stradiol Derm 100 (100mcg/day patch) Vivelle atch (100mcg/day) (discontinued) VR Climara 100 (100mcg/day, 7.8mg/patch) BA G03CA07 STRO stragyn Vag Cr C A G03CA57 COJUGATD STROGS remarin 0.3mg Tab C remarin 0.625mg Tab C remarin 0.625mg/g Vag Cr C remarin 1.25mg Tab C remarin 25mg/vial Inj C G03D G03DA ROGSTOGS AD COBIATIOS, XC G03 AD G03F RG (4) DRIVATIVS G03DA02 DROXROGSTRO medroxyprogesterone acetate 2.5mg tab Apo-edroxy 2.5mg Tab C ovo-edrone 2.5mg Tab C TV rovera 2.5mg Tab C medroxyprogesterone acetate 5mg tab ovember

102 G Genito-Urinary System & Sex Hormones Apo-edroxy 5mg Tab C ovo-edrone 5mg Tab C TV rovera 5mg Tab C medroxyprogesterone acetate 10mg tab Apo-edroxy 10mg Tab C ovo-edrone 10mg Tab C TV rovera 10mg Tab C medroxyprogesterone acetate 100mg tab Apo-edroxy 100mg Tab C rovera 100mg Tab (discontinued) G03DA04 ROGSTRO progesterone 100mg cap Teva-rogesterone 100mg Cap TV rometrium 100mg Cap FRS G03DB RGADI DRIVATIVS G03DB08 DIOGST Visanne 2mg tab BA G03F G03FA ROGSTOGS AD STROGS I COBIATIO ROGSTROGS AD STROGS COBIATIOS G03FA01 ORTHIDRO AD STROG stalis 140/50mcg Transdermal atch VR stalis 250/50mcg Transdermal atch VR G03G G03GB GOADOTROHIS AD OTHR OVUATIO STIUATS OVUATIO STIUATS, STHTICS G03GB02 COIF Clomid 50mg Tab SAV Serophene 50mg Tab D G03H G03HA ATIADROGS AD COBIATIOS ATIADROGS, AI RARATIOS G03HA01 CROTRO cyproterone 50mg tab Cyproterone 50mg Tab C AA D-Cyproterone 50mg Tab C G Androcur 50mg Tab C S G03HB ATIADROGS AD STROGS G03HB01 CROTRO AD STROG cyproterone acetate 2mg & ethinyl estradiol 0.035mg tab Cyestra-35 Tab A ovember

103 G Genito-Urinary System & Sex Hormones ovo-cyproterone/thinyl stradiol 2mg/0.035mg Tab TV RA-Cyproterone/thinyl stradiol 2mg/0.035mg Tab RA Diane-35 Tab BA G03X G03XA OTHR SX HOROS ATIGOADOTROHIS G03XA01 DAAZO Cyclomen 50mg Cap SAV Cyclomen 100mg Cap SAV Cyclomen 200mg Cap SAV G03XC SCTIV STROG RCTOR ODUATORS G03XC01 RAOXIF raloxifene 60mg tab Apo-Raloxifene 60mg Tab CO Raloxifene 60mg Tab ovo-raloxifene 60mg Tab TV pms-raloxifene 60mg Tab S vista 60mg Tab I G04 G04B G04BD UROOGICAS OTHR UROOGICAS, IC ATISASODICS URIAR ATISASODICS B04BD12 IRABGRO yrbetriq 25mg R Tab AS yrbetriq 50mg R Tab AS G04BD04 OXBUTI oxybutynin 1mg/m o/l pms-oxybutynin 1mg/m O/ S Ditropan 1mg/m O/ (discontinued) JA Oxytrol atch (3.9mg/day 36mg/patch) AS oxybutynin 5mg tab Apo-Oxybutynin 5mg Tab A-Oxybutynin 5mg Tab ovo-oxybutynin 5mg Tab TV Oxybutynin 5mg Tab pms-oxybutynin 5mg Tab S Ditropan 5mg Tab (discontinued) JA Ditropan X 5mg Tab JA Ditropan X 10mg Tab JA Gelnique 100mg/g Gel AS G04BD07 TOTRODI ovember

104 G Genito-Urinary System & Sex Hormones Detrol 1mg Tab Detrol 2mg Tab Detrol A 2mg Cap Detrol A 4mg Cap G04BD08 SOIFACI solifenacin 5mg tab ACT-Solifenacin 5mg Tab Sandoz Solifenacin 5mg Tab Teva-Solifenacin 5mg Tab TV Vesicare 5mg Tab AS solifenacin 10mg tab ACT-Solifenacin 10mg Tab Sandoz Solifenacin 10mg Tab Teva-Solifenacin 10mg Tab TV Vesicare 10mg Tab AS G04BD09 TROSIU Trosec 20mg Tab SV G04BD10 DARIFACI nablex 7.5mg Tab RS nablex 15mg Tab RS G04BD11 FSOTRODI Toviaz 4mg Tab Toviaz 8mg Tab G04B DRUGS USD I RCTI DUCTIO G04B03 SIDAFI sildenafil 25mg tab Apo-Sildenafil 25mg Tab CO Sildenafil 25mg Tab Jamp-Sildenafil 25mg Tab JC IT-Sildenafil 25mg Tab T yl-sildenafil 25mg Tab ovo-sildenafil 25mg Tab TV pms-sildenafil 25mg Tab S RA-Sildenafil 25mg Tab RA Sandoz Sildenafil 25mg Tab Sildenafil 25mg Tab S Viagra 25mg Tab sildenafil 50mg tab Apo-Sildenafil 50mg Tab CO Sildenafil 50mg Tab Jamp-Sildenafil 50mg Tab JC IT-Sildenafil 50mg Tab T ovember

105 G Genito-Urinary System & Sex Hormones yl-sildenafil 50mg Tab ovo-sildenafil 50mg Tab TV pms-sildenafil 50mg Tab S RA-Sildenafil 50mg Tab RA Sandoz Sildenafil 50mg Tab Sildenafil 50mg Tab Sildenafil 50mg Tab S Viagra 50mg Tab sildenafil 100mg tab Apo-Sildenafil 100mg Tab CO Sildenafil 100mg Tab Jamp-Sildenafil 100mg Tab JC IT-Sildenafil 100mg Tab T yl-sildenafil 100mg Tab ovo-sildenafil 100mg Tab TV pms-sildenafil 100mg Tab S RA-Sildenafil 100mg Tab RA Sandoz Sildenafil 100mg Tab Sildenafil 100mg Tab Sildenafil 100mg Tab S Viagra 100mg Tab G04BX OTHR UROOGICA G04BX01 AGSIU HDROXID Urologic G Irr Sol HOS G04BX13 DITH SUFOXID Rimso-50 (50%) Irr Sol BCH G04C G04CA DRUGS USD I BIG ROSTATIC HRTROH AHA-ADRORCTOR ATAGOISTS G04AC04 SIDOSI Rapaflo 4mg Cap AS Rapaflo 8mg Cap AS G04CA01 AFUZOSI alfuzosin 10mg extended release tab Apo-Alfuzosin 10mg Tab Sandoz Alfuzosin 10mg Tab Xatral 10mg Tab SAV G04CA02 TASUOSI tamsulosin 0.4mg sustained release cap A-Tamsulosin 0.4mg Cap ovo-tamsulosin 0.4mg Cap TV ratio-tamsulosin 0.4mg Cap TV Sandoz Tamsulosin 0.4mg Cap ovember

106 G Genito-Urinary System & Sex Hormones Flomax 0.4mg Cap (discontinued) BO tamsulosin 0.4mg sustained release cap/tab Apo-Tamsulosin CR 0.4mg Tab Sandoz Tamsulosin CR 0.4mg Tab Tamsulosin CR 0.4mg Tab SIV Tamsulosin CR 0.4mg Tab Teva-Tamsulosin CR 0.4mg Tab TV Flomax 0.4mg CR Tab BO G04CA03 TRAZOSI terazosin 1mg tab Apo-Terazosin 1mg Tab A-Terazosin 1mg Tab (discontinued) pms-terazosin 1mg Tab S Terazosin 1mg Tab Teva-Terazosin 1mg Tab TV Hytrin 1mg Tab BG terazosin 2mg tab Apo-Terazosin 2mg Tab A-Terazosin 2mg Tab (discontinued) pms-terazosin 2mg Tab S Terazosin 2mg Tab Teva-Terazosin 2mg Tab TV Hytrin 2mg Tab BG terazosin 5mg tab Apo-Terazosin 5mg Tab A-Terazosin 5mg Tab (discontinued) pms-terazosin 5mg Tab S Terazosin 5mg Tab Teva-Terazosin 5mg Tab TV Hytrin 5mg Tab BG terazosin 10mg tab Apo-Terazosin 10mg Tab A-Terazosin 10mg Tab (discontinued) pms-terazosin 10mg Tab S Terazosin 10mg Tab Teva-Terazosin 10mg Tab TV Hytrin 10mg Tab BG G04CB TSTOSTRO-5-AHA RDUCTAS IHIBITORS G04CB01 FIASTRID finasteride 5mg tab Apo-Finasteride 5mg Tab Auro-Finasteride 5mg Tab ARO CO Finasteride 5mg Tab Finasteride 5mg Tab AHI Jamp-Finasteride 5mg Tab JC IT-Finasteride 5mg Tab T ovember

107 G Genito-Urinary System & Sex Hormones A-Finasteride 5mg Tab ovo-finasteride 5mg Tab TV pms-finasteride 5mg Tab S RA-Finasteride 5mg Tab RA Sandoz Finasteride 5mg Tab roscar 5mg Tab FRS G04CB02 DUTASTRID dutasteride 0.5mg cap ACT Dutasteride 0.5mg Cap Apo-Dutasteride 0.5mg Cap Dutasteride 0.5mg Cap SIV Dutasteride 0.5mg Cap D-Dutasteride 0.5mg Cap G IT-Dutasteride 0.5mg Tab T pms-dutasteride 0.5mg Cap S Sandoz Dutasteride 0.5mg Cap Teva-Dutasteride 0.5mg Cap TV Avodart 0.5mg Cap GSK ovember

108 H H01 H01A H01AC Systemic Hormonal reparations, xcluding Sex Hormones ITUITAR AD HOTHAAIC HOROS ATRIOR ITUITAR OB HOROS SOATROI AD SOATROI AGOISTS H01AC01 SOATROI utropin AQ en Cartridge HR Genotropin iniquick 0.6mg/syr Genotropin iniquick 0.8mg/syr Genotropin iniquick 1mg/syr Humatrope 1mg/m Inj I Genotropin iniquick 1.2mg/syr Genotropin iniquick 1.4mg/syr Genotropin iniquick 1.6mg/syr Genotropin iniquick 1.8mg/syr Genotropin iniquick 2mg/syr Saizen 3.33mg/vial Inj D Saizen 5mg/vial Inj D Omnitrope 5mg/1.5m Genotropin GoQuick 5.3mg/pen Omnitrope 5.8mg/vial Humatrope 6mg/vial Inj I Saizen 6mg Cart D Saizen 8.8mg/vial Inj D Omnitrope 10mg/1.5m Genotropin GoQuick 12mg/pen Humatrope 12mg/vial Inj I Saizen 12mg Cart D Saizen 20mg Cart D Humatrope 24mg/vial Inj I H01AX OTHR ATRIOR ITUITAR HOROS AD AAOGUS H01AX01 GVISOAT Somavert 10mg/vial Inj Somavert 15mg/vial Inj Somavert 20mg/vial Inj H01B H01BA OSTRIOR ITUITAR OB HOROS VASORSSI AD AAOGUS H01BA01 VASORSSI vasopressin 20units/m usp inj Vasopressin 20units/m US Inj ovember

109 H Systemic Hormonal reparations, xcluding Sex Hormones ressyn 20units/m US Inj (discontinued) FI ressyn AR 20units/m US Inj FI H01BA02 DSORSSI desmopressin 0.1mg tab Apo-Desmopressin 0.1mg Tab F* ovo-desmopressin 0.1mg Tab F* TV pms-desmopressin 0.1mg Tab F* S DDAV 0.1mg Tab F* FI *full benefit for children 16 years and under. inirin 0.1mg Tab (discontinued) FI desmopressin 0.2mg tab Apo-Desmopressin 0.2mg Tab F* ovo-desmopressin 0.2mg Tab F* TV pms-desmopressin 0.2mg Tab F* S DDAV 0.2mg Tab F* FI *full benefit for children 16 years and under. Octostim 1.5mg/m asal Spray FI DDAV 4mcg/m Inj FI desmopressin 10mcg/dose nasal sp Desmopressin 10mcg/dose asal Sp AA DDAV 10mcg/dose asal Sp FI Octostim 15mcg/m Inj FI DDAV T 60mcg Tab F* FI DDAV 100mcg/m Rhinyle Drops FI DDAV T 120mcg Tab F* FI DDAV T 240mcg Tab F* FI *full benefit for children 16 years and under. H01C H01CA HOTHAAIC HOROS GOADOTROI-RASIG HOROS H01CA02 AFARI Synarel 2mg/m Sol C H01CA03 HISTRI Vantas 50mg/vial Inj A H01CB SOATOSTATI AD AAOGUS H01CB02 OCTROTID Sandostatin AR 10mg/vial Inj C VR Sandostatin AR 20mg/vial Inj C VR Sandostatin AR 30mg/vial Inj C VR octreotide 50mcg/m inj ovember

110 H Systemic Hormonal reparations, xcluding Sex Hormones Ocphyl 50mcg/m Inj C D Octreotide Acetate Omega 50mcg/m Inj C OG Sandostatin 50mcg/m Inj C VR octreotide 100mcg/m inj Ocphyl 100mcg/m Inj C D Octreotide Acetate Omega 100mcg/m Inj C OG Sandostatin 100mcg/m Inj C VR octreotide 200mcg/m inj Octreotide Acetate Omega 200mcg/m Inj C OG Sandostatin 200mcg/m Inj C VR octreotide 500mcg/m inj Ocphyl 500mcg/m Inj C D Octreotide Acetate Omega 500mcg/m Inj C OG Sandostatin 500mcg/m Inj C VR H01CB03 AROTID Somatuline Autogel 60mg/0.3m Syringe Inj C D Somatuline Autogel 90mg/0.3m Syringe Inj C D Somatuline Autogel 120mg/0.5m Syringe Inj C D H02 H02A H02AA SSTIC CORTICOSTROIDS SSTIC CORTICOSTROIDS, AI IRAOCORTICOIDS H02AA02 FUDROCORTISO Florinef 0.1mg Tab C A H02AB GUCOCORTICOIDS H02AB01 BTATHASO betamethasone 6mg/m inj Betaject 6mg/m Inj C Celestone 6mg/m Soluspan Inj C FRS H02AB02 DXATHASO dexamethasone 0.5mg tab Apo-Dexamethasone 0.5mg Tab C pms-dexamethasone 0.5mg Tab C S Decadron 0.5mg Tab (discontinued) FRS dexamethasone 0.75mg tab pms-dexamethasone 0.75mg Tab C S Decadron 0.75mg Tab (discontinued) FRS pms-dexamethasone 2mg Tab C S dexamethasone 4mg tab Apo-Dexamethasone 4mg Tab C pms-dexamethasone 4mg Tab C S Decadron 4mg Tab (discontinued) FRS ovember

111 H Systemic Hormonal reparations, xcluding Sex Hormones Dexasone 4mg Tab C V dexamethasone 4mg/m inj Dexamethasone 4mg/m Inj C Dexamethasone 4mg/m Inj C CI Decadron 4mg/m Inj (discontinued) FRS Dexamethasone 10mg/m Inj C Dexamethasone 10mg/m Inj C OG pms-dexamethasone 10mg/m Inj C S H02AB04 THRDISOO methylprednisolone sodium succinate 1g/vial inj ethylprednisolone Sod. Succ. 1g/vial Inj C TV Solu-edrol 1g/vial Inj C edrol 4mg Tab C edrol 16mg Tab C Depo-edrol 20mg/m Aq ultidose Inj C methylprednisolone acetate 40mg/vial inj ethylprednisolone Acetate 40mg/vial Inj C Depo-edrol 40mg/m Aq ultidose Inj C methylprednisolone acetate 40mg/vial inj (pf) ethylprednisolone Acetate 40mg/vial Inj (F) C Depo-edrol 40mg/m Aq ultidose Inj (F) C methylprednisolone sodium succinate 40mg/vial inj ethylprednisolone Sod. Succ. 40mg/vial Inj C TV Solu-edrol 40mg/vial Inj (discontinued) methylprednisolone acetate 80mg/vial inj Depo-edrol 80mg/m Aq ultidose Inj C ethylprednisolone Acetate 80mg/vial Inj C methylprednisolone acetate 80mg/vial inj (pf) ethylprednisolone Acetate 80mg/vial Inj (F) C Depo-edrol 80mg/m Aq ultidose Inj (F) C methylprednisolone sodium succinate 125mg/vial inj ethylprednisolone Sod. Succ. 125mg/vial Inj C TV Solu-edrol 125mg/vial Inj (discontinued) methylprednisolone sodium succinate 500mg/vial inj ethylprednisolone Sod. Succ. 500mg/vial Inj C TV Solu-edrol 500mg/vial Inj C H02AB06 RDISOO prednisolone sodium phosphare 1mg/m o/l pms-rednisolone 1mg/m O/ C S ediapred 1mg/m O/ C SAV H02AB07 RDISO Winpred 1mg Tab C AA ovember

112 H Systemic Hormonal reparations, xcluding Sex Hormones prednisone 5mg tab Apo-rednisone 5mg Tab C ovo-rednisone 5mg Tab C TV Deltasone 5mg Tab (discontinued) U prednisone 50mg tab Apo-rednisone 50mg Tab C ovo-rednisone 50mg Tab C TV Deltasone 50mg Tab (discontinued) U H02AB08 TRIACIOO triamcinolone 10mg/m inj Triamcinolone 10mg/m Inj C Kenalog-10 (10mg/m) Inj C WSQ triamcinolone 40mg/m inj Triamcinolone 40mg/m Inj C CI Kenalog-40 (40mg/m) Inj C WSQ H02AB09 HDROCORTISO Solu-Cortef 1g/vial Inj C Cortef 10mg Tab C Cortef 20mg Tab C Solu-Cortef 100mg/vial Inj C Solu-Cortef 250mg/vial Inj C Solu-Cortef 500mg/vial Inj C H02AB10 CORTISO Cortisone Acetate 25mg Tab C V H02B H02BX SSTIC CORTICOSTROIDS, COBIATIOS SSTIC CORTICOSTROIDS, COBIATIOS H02BX01 THRDISOO, COBIATIOS Depo-edrol 40mg/m w idocaine Inj C H03 H03A H03AA THROID THRA THROID RARATIOS THROID HOROS H03AA01 VOTHROXI SODIU Synthroid 0.025mg Tab BG Synthroid 0.05mg Tab BG Synthroid 0.075mg Tab BG Synthroid 0.088mg Tab BG Synthroid 0.1mg Tab BG Synthroid 0.112mg Tab BG ovember

113 H Systemic Hormonal reparations, xcluding Sex Hormones Synthroid 0.125mg Tab BG Synthroid 0.137mg Tab BG Synthroid 0.15mg Tab BG Synthroid 0.175mg Tab BG Synthroid 0.2mg Tab BG Synthroid 0.3mg Tab BG ltroxin 50mcg Tab AR ltroxin 100mcg Tab AR ltroxin 150mcg Tab AR ltroxin 200mcg Tab AR ltroxin 300mcg Tab AR H03AA02 IOTHROI SODIU Cytomel 5mcg Tab Cytomel 25mcg Tab H03AA05 THROID GAD RARATIOS Thyroid 30mg Tab RF Thyroid 60mg Tab RF Thyroid 125mg Tab RF H03B H03BA ATITHROID RARATIOS THIOURACIS H03BA02 ROTHIOURACI ropyl-thyracil 50mg Tab A ropyl-thyracil 100mg Tab A H03BB SUHUR-COTAIIG IIDAZO DRIVATIVS H03BB02 THIAZO (THIAAZO) Tapazole 5mg Tab A Tapazole 10mg Tab A H04 H04A H04AA ACRATIC HOROS GCOGOTIC HOROS GCOGOTIC HOROS H04AA01 GUCAGO GlucaGen 1mg/vial D A GlucaGen Hypokit 1mg/vial D A Glucagon 1mg/vial Inj D I H05 CACIU HOOSTASIS ovember

114 H Systemic Hormonal reparations, xcluding Sex Hormones H05B H05BA ATI-ARATHROID AGTS CACITOI RARATIOS H05BA01 CACITOI (SAO STHTIC) H05BX Calcimar 200iu/m Inj OTHR ATI-ARATHROID AGTS C SAV H05BX01 CIACAT Sensipar 30mg Tab AGA Sensipar 60mg Tab AGA Sensipar 90mg Tab AGA ovember

115 J J01 J01A J01AA General Antiinfectives, Systemic ATIBACTRIAS FOR SSTIC US TTRACCIS TTRACCIS J01AA02 DOXCCI Apprilon XR 40mg Cap GAC doxycycline 100mg cap Apo-Doxy 100mg Cap C Doxycycline 100mg Cap C ovo-doxylin 100mg Cap C TV Vibramycin 100mg Cap C doxycycline 100mg tab (Vibra-tabs) Apo-Doxy 100mg Tab C Doxycycline 100mg Tab C ovo-doxylin 100mg Tab C TV Vibra-Tabs C-ak (discontinued) Doxycin 100mg Cap RIV Doxycin 100mg Tab C RIV J01AA07 TTRACCI tetracycline 250mg cap Tetra 250mg Cap C AA Tetracyn 250mg Cap (discontinued) J01AA08 IOCCI minocycline HCl 50mg cap Apo-inocycline 50mg Cap C inocycline 50mg Cap C A-inocycline 50mg Cap C ovo-inocycline 50mg Cap C TV pms-inocycline 50mg Cap C S Sandoz inocycline 50mg Cap C inocin 50mg Cap (discontinued) GSK minocycline HCl 100mg cap Apo-inocycline 100mg Cap C inocycline 100mg Cap C A-inocycline 100mg Cap C ovo-inocycline 100mg Cap C TV pms-inocycline 100mg Cap C S Sandoz inocycline 100mg Cap C inocin 100mg Cap (discontinued) GSK J01AA12 TIGCCI tigecycline 50mg/vial inj Tigecycline 50mg/vial ws IV Tygacil 50mg/vial ws IV J01B AHICOS ovember

116 J General Antiinfectives, Systemic J01BA AHICOS J01BA01 CHORAHICO Chloromycetin Succinate 1g/vial Inj C RF J01C J01CA BTA ACTA ATIBACTRIAS,ICIIS ICII WITH XTDD SCTRUS J01CA01 AICII ampicillin 250mg cap ovo-ampicillin 250mg Cap C TV enbritin 250mg Cap (discontinued) WA ampicillin 500mg cap ovo-ampicillin 500mg Cap C TV enbritin 500mg Cap (discontinued) WA J01CA04 AOXICII amoxicillin 25mg/m o/l Amoxicillin 125mg Susp C Amoxicillin Sugar Reduced 25mg/m O/ C Apo-Amoxi 125mg Susp C Apo-Amoxi Sugar Free 125mg Susp C ovamoxin 125mg Susp C TV ovamoxin Sugar Reduced 25mg/m O/ C TV pms-amoxicillin 25mg/m Susp C S Amoxil 25mg/m Susp (discontinued) WA amoxicillin 50mg/m o/l Amoxicillin 250mg Susp C Amoxicillin Sugar Reduced 50mg/m O/ C Amoxicillin Sugar-Reduced 250mg/5m Susp C SIV Amoxicillin-250mg/5m Susp C SIV Apo-Amoxi 250mg Susp C Apo-Amoxi Sugar Free 250mg Susp C ovamoxin 250mg Susp C TV ovamoxin Sugar Reduced 50mg/m O/ C TV pms-amoxicillin 50mg/m Susp C S Amoxil 50mg/m Susp (discontinued) WA amoxicillin 250mg cap Amoxicillin 250mg Cap C Amoxicillin-250mg Cap C SIV Apo-Amoxi 250mg Cap C Auro-Amoxicillin 250mg Cap C ARO A-Amoxicillin 250mg Cap C ovamoxin 250mg Cap C TV pms-amoxicillin 250mg Cap C S Amoxil 250mg Cap (discontinued) WA amoxicillin 250mg chewable tab ovamoxin 250mg Chew Tab C TV ovember

117 J General Antiinfectives, Systemic Amoxil 250mg Chew Tab (discontinued) WA amoxicillin 500mg cap Amoxicillin 500mg Cap C Amoxicillin-500mg Cap C SIV Apo-Amoxi 500mg Cap C Auro-Amoxicillin 500mg Cap C ARO A-Amoxicillin 500mg Cap C ovamoxin 500mg Cap C TV pms-amoxicillin 500mg Cap C S Amoxil 500mg Cap (discontinued) WA J01C BTA-ACTAAS SSITIV ICIIS J01C02 HOXTHICII (ICII V) Apo-en VK 125mg/5m Susp C en-vee 180mg/5m Susp (discontinued) D penicillin V potassium 300mg tab Apo-en VK 300mg Tab C AA VF K 300mg Tab (discontinued) FRS penicillin V potassium 60mg/m o/l Apo-en VK 300mg/5m Susp C VF 500 (300mg/5m) Susp (discontinued) FRS J01CF BTA-ACTAAS RSISTAT ICIIS\ J01CF02 COXACII cloxacillin 25mg/m o/l ovo-cloxin 125mg/5m Susp C TV Orbenin 125mg/5m Susp (discontinued) WA cloxacillin 250mg cap ovo-cloxin 250mg Cap C TV Orbenin 250mg Cap (discontinued) WA cloxacillin 500mg cap ovo-cloxin 500mg Cap C TV Orbenin 500mg Cap (discontinued) WA J01CR COBIATIOS ICIIS IC BTA ACTAAS IHIB J01CR02 AOXICII AD Z IHIBITOR amoxicillin & enzyme inhibitor 125mg/5m susp Apo-Amoxi Clav 125mg/5m Susp C ratio-aclavulanate 125mg/5m Susp (discontinued) TV Clavulin-125F (125mg/5m) Susp C GSK Clavulin-200 (200mg/5m) Susp C GSK amoxicillin & enzyme inhibitor 250mg tab Apo-Amoxi Clav 250mg Tab C Clavulin-250 (250mg) Tab (discontinued) GSK amoxicillin & enzyme inhibitor 250mg/5m susp Apo-Amoxi Clav 250mg/5m Susp ovember

118 J General Antiinfectives, Systemic ratio-aclavulanate 250mg/5m Susp (discontinued) TV Clavulin-250F (250mg/5m) Susp C GSK amoxicillin & enzyme inhibitor 400mg/5m susp Apo-Amoxi Clav 400mg/5m Susp C Clavulin-400 (400mg/5m) Susp C GSK amoxicillin & enzyme inhibitor 500mg tab Apo-Amoxi Clav 500mg Tab C ratio-aclavulanate 500mg Tab C TV Clavulin-500F (500mg) Tab C GSK amoxicillin & enzyme inhibitor 875mg tab Apo-Amoxi Clav 875mg Tab C ovo-clavamoxin 875 (875mg) Tab (discontinued) TV ratio-aclavulanate 875mg Tab C TV Clavulin-875 (875mg) Tab C GSK J01CR05 IRACII AD Z IHIBITOR piperacillin sodium & enzyme inhibitor 2g/vial inj iperacillin & Tazobactam 2g/vial Inj (Apotex) Tazocin 2g/vial Inj (discontinued) piperacillin sodium & enzyme inhibitor 3g/vial inj iperacillin/tazobactam 3g/0.375g Vial Teva-iperacillin/Tazobactam 3g/0.375g Vial TV iperacillin & Tazobactam 3g/vial Inj (Apotex) Tazocin 3g/vial Inj (discontinued) piperacillin sodium & enzyme inhibitor 4g/vial inj iperacillin/tazobactam 4g/0.5g Vial Teva-iperacillin/Tazobactam 4g/0.5g Vial TV iperacillin & Tazobactam 4g/vial Inj (Apotex) Tazocin 4g/vial Inj (discontinued) J01D J01DB OTHR BTA ACTA ATIBACTRIAS FIRST GRATIO CHAOSORIS J01DB01 CHAXI cephalexin monohydrate 25mg o/l ovo-exin 125mg/5m Susp C TV Keflex 125mg/5m Susp (discontinued) D cephalexin monohydrate 250mg tab Apo-Cephalex 250mg Tab C ovo-exin 250mg Tab C TV Keflex 250mg Tab (discontinued) D ovo-exin 250mg Cap C TV cephalexin monohydrate 50mg o/l ovo-exin 250mg/5m Susp C TV Keflex 250mg/5m Susp (discontinued) D cephalexin monohydrate 500mg tab ovember

119 J General Antiinfectives, Systemic Apo-Cephalex 500mg Tab C ovo-exin 500mg Tab C TV Keflex 500mg Tab (discontinued) D ovo-exin 500mg Cap C TV J01DB04 CFAZOI cefazolin sodium 1g/vial inj Cefazolin Sodium 1g/vial Inj C TV Cefazolin Sodium 1g/vial Inj C Cefazolin Sodium 1g/vial Inj C cefazolin sodium 10g/vial inj Cefazolin Sodium 10g/vial Inj TV Cefazolin Sodium 10g/vial Inj cefazolin sodium 500mg/vial inj Cefazolin Sodium 500mg/vial Inj C TV Cefazolin Sodium 500mg/vial Inj C J01DB05 CFADROXI cefadroxil 500mg cap Apo-Cefadroxil 500mg Cap C ovo-cefadroxil 500mg Cap C TV Duricef 500mg Cap (discontinued) BRI J01DC SCOD GRATIO CHAOSORIS J01DC02 CFUROXI Ceftin 125mg/5m O/ C GSK cefuroxime axetil 250mg tab Apo-Cefuroxime 250mg Tab C Auro-Cefuroxime 250mg Tab C ARO ratio-cefuroxime 250mg Tab C TV Ceftin 250mg Tab C GSK cefuroxime axetil 500mg tab Apo-Cefuroxime 500mg Tab C Auro-Cefuroxime 500mg Tab C ARO ratio-cefuroxime 500mg Tab C TV Ceftin 500mg Tab C GSK J01DC04 CFACOR Ceclor 125mg/5m Susp C D Ceclor 250mg Cap C D Ceclor 250mg/5m Susp C D Ceclor 500mg Cap C D J01DC10 CFROZI cefprozil 25mg/m o/l RA-Cefprozil 125mg/5m O/ C RA Cefzil 125mg/5m O/ C BRI ovember

120 J General Antiinfectives, Systemic cefprozil 250mg tab Apo-Cefprozil 250mg Tab C Auro-Cefprozil 250mg Tab C ARO RA-Cefprozil 250mg Tab C RA Sandoz Cefprozil 250mg Tab C Cefzil 250mg Tab C BRI cefprozil 50mg/m o/l RA-Cefprozil 250mg/5m O/ C RA Cefzil 250mg/5m O/ C BRI cefprozil 500mg tab Apo-Cefprozil 500mg Tab C Auro-Cefprozil 500mg Tab C ARO RA-Cefprozil 500mg Tab C RA Sandoz-Cefprozil 500mg Tab C Cefzil 500mg Tab C BRI J01DD THIRD GRATIO CHAOSORIS J01DD01 CFOTAXI cefotaxime 1g/vial inj Cefotaxime Sodium 1g/vial Inj C STR Claforan 1g/vial Inj C SAV cefotaxime 2g/vial inj Cefotaxime Sodium 2g/vial Inj STR Claforan 2g/vial Inj SAV J01DD02 CFTAZIDI Fortaz 1g/vial Inj C GSK Fortaz 2g/vial Inj C GSK Fortaz 6g/vial Inj C GSK J01DD04 CFTRIAXO ceftriaxone 0.25g/vial inj Ceftriaxone 0.25g/vial Inj C Ceftriaxone Sodium 0.25g/vial Inj C STR Rocephin 0.25g/vial Inj (discontinued) HR ceftriaxone 1g/vial inj Ceftriaxone 1g/vial Inj C Ceftriaxone 1g/vial Inj C Ceftriaxone 1g/vial Inj C TV Ceftroaxone Sodium 1g/vial Inj C STR Rocephin 1g/vial Inj (discontinued) HR ceftriaxone 2g/vial inj Ceftriaxone 2g/vial Inj C Ceftriaxone 2g/vial Inj C Ceftriaxone Sodium 2g/vial Inj C STR Rocephin 2g/vial Inj (discontinued) HR ceftriaxone 10g/vial inj ovember

121 J General Antiinfectives, Systemic Ceftriaxone 10g/vial Inj Ceftriaxone Sodium 10g/vial Inj STR Rocephin 10g/vial Inj (discontinued) HR J01DD08 CFIXI Suprax 100mg/5m Susp C SAV cefixime 400mg tab Auro-Cefixime 400mg Tab C ARO Suprax 400mg Tab C SAV J01D FOURTH GRATIO AD OTHR CHAOSORIS J01D01 CFI (HDROCHORID) cefepime 2g/vial inj Cefepime for injection 2g/vial Inj axipime 2g/vial Inj (discontinued) BRI J01DF OOBACTAS J01DF01 AZTROA Cayston 75mg vial dr for Sol GI J01DH CARBAS J01DH51 II AD Z IHIBITOR rimaxin 500mg/vial Inj C FRS J01 J01A SUFOAIDS AD TRITHORI TRITHORI RARATIOS J01A01 TRITHORI trimethoprim 100mg tab Trimethoprim 100mg Tab C AA roloprim 100mg Tab (discontinued) GSK trimethoprim 200mg tab Trimethoprim 200mg Tab C AA roloprim 200mg Tab (discontinued) GSK J01 COBIATIOS SUFOAIDS,TRITHORI DRIV J0101 SUFATHOXAZO AD TRITHORI sulfamethoxazole 40mg & trimethoprim 8mg/m o/l ovo-trimel 40/8mg Susp C TV Septra 40/8mg Susp (discontinued) GSK Apo-Sulfatrim 100/20mg Tab C sulfamethoxazole 400mg & trimethoprim 80mg tab Apo-Sulfatrim 400/80mg Tab C ovo-trimel 400/80mg Tab C TV Septra 400/80mg Tab (discontinued) GSK sulfamethoxazole 800mg & trimethoprim 160mg tab ovember

122 J General Antiinfectives, Systemic Apo-Sulfatrim DS 800/160mg Tab C ovo-trimel 800/160mg Tab C TV Septra 800/160mg Tab (discontinued) GSK J01F J01FA ACROIDS,ICOSAIDS & STRTOGRAIS ACROIDS J01FA01 RTHROCI erythromycin ethylsuccinate 40mg/m o/l ovo-rythro S 200mg/5m Susp (discontinued) TV S-200 (200mg/5m) Granules (discontinued) AD erythromycin base 250mg cap rythro-c 250mg Cap (discontinued) AA RC 250mg Cap C Apo-rythro Base 250mg Tab C AA rythro-s 250mg Tab C AA ovo-rythro ST 250mg/5m Susp C TV erythromycin base 333mg cap rythro-c 333mg Cap (discontinued) AA RC 333mg Cap C erythromycin ethylsuccinate 80mg/m o/l ovo-rythro S 400mg/5m Susp (discontinued) TV S-400 (400mg/5m) Granules (discontinued) AD rythro-s 500mg Tab C AA erythromycin ethylsuccinate 600mg tab rythro-s 600mg Tab C AA S-600 (600mg) Tab (discontinued) AD J01FA02 SIRACI Rovamycine 250mg Cap C OD Rovamycine 500mg Cap C OD J01FA09 CARITHROCI clarithromycin 25mg/m o/l Accel-Clarithromycin 125mg/5m O/ C ACC Clarithromycin 125mg/5m O/ C Biaxin 125mg/5m O/ C ABB clarithromycin 250mg tab Apo-Clarithromycin 250mg Tab C A-Clarithromycin 250mg Tab C pms-clarithromycin 250mg Tab C S RA-Clarithromycin 250mg Tab C RA Sandoz Clarithromycin 250mg Tab C Teva-Clarithromycin 250mg Tab C TV Biaxin BID 250mg Tab C ABB clarithromycin 50mg/m o/l ovember

123 J General Antiinfectives, Systemic Accel-Clarithromycin 250mg/5m O/ C ACC Clarithromycin 250mg/5m O/ C Biaxin 250mg/5m O/ C ABB clarithromycin 500mg X tab ACT-Clarithromycin X 500mg Tab C Apo-Clarithromycin X 500mg Tab C Biaxin X 500mg Tab C ABB clarithromycin 500mg tab Apo-Clarithromycin 500mg Tab C A-Clarithromycin 500mg Tab C pms-clarithromycin 500mg Tab C S RA-Carithromycin 500mg Tab C RA Sandoz Clarithromycin 500mg Tab C Teva-Clarithromycin 500mg Tab C TV Biaxin BID 500mg Tab C ABB J01FA10 AZITHROCI azithromycin pos 20mg/m susp Azithromycin OS 100mg/5m Susp Azithromycin OS 100mg/5m Susp S GD-Azithromycine 100mg/5m Susp GD ovo-azithromycin OS 100mg/5m Susp TV pms-azithromycin 100mg/5m Susp S Zithromax OS 100mg/5m Susp azithromycin pos 40mg/m susp Azithromycin OS 200mg/5m Susp S Azithromycin OS 200mg/5m Susp GD-Azithromycine 200mg/5m Susp GD ovo-azithromycin OS 200mg/5m Susp TV pms-azithromycin 200mg/5m Susp S Zithromax OS 200mg/5m Susp azithromycin 250mg tab Apo-Azithromycin Z 250mg Tab Azithromycin 250mg Tab CO Azithromycin 250mg Tab GD-Azithromycin 250mg Tab GD A-Azithromycin 250mg Tab ovo-azithromycin 250mg Tab TV pms-azithromycin 250mg Tab S ratio-azithromycin 250mg Tab (discontinued) TV Sandoz Azithromycin 250mg Tab Zithromax 250mg Tab Zithromax 500mg/vial Inj azithromycin 600mg tab CO Azithromycin 600mg Tab pms-azithromycin 600mg Tab S Zithromax 600mg Tab (discontinued) J01FF ICOSAIDS ovember

124 J General Antiinfectives, Systemic J01FF01 CIDACI Dalacin C 75mg/5m Granules C clindamycin 150mg cap Apo-Clindamycin 150mg Cap C Clindamycin 150mg Cap C A-Clindamycin 150mg Cap C Teva-Clindamycin 150mg Cap C TV Dalacin C 150mg Cap C clindamycin 150mg/m (bulk) inj Clindamycin 150mg/m Inj C Dalacin C hos 150mg/m Inj C clindamycin 150mg/m inj Clindamycin 150mg/m Inj C Dalacin C hos 150mg/m Inj C clindamycin 300mg cap Apo-Clindamycin 300mg Cap C Clindamycin 300mg Cap C A-Clindamycin 300mg Cap C ovo-clindamycin 300mg Cap C TV Dalacin C 300mg Cap C J01FF02 ICOCI incocin 300mg/m Inj J01G J01GB AIOGCOSID ATIBACTRIAS OTHR AIOGCOSIDS J01GB01 TOBRACI tobramycin 10mg/m inj Tobramycin 10mg/m Inj ebcin 10mg/m Inj (discontinued) I TOBI odhaler 28mg Cap VR tobramycin 40mg/m inj Jamp-Tobramycin 40mg/m Inj C JC Tobramycin 40mg/m Inj C Tobramycin 40mg/m Inj () C ebcin 40mg/m Inj (discontinued) I tobramycin 40mg/m inj (pf) Tobramycin 40mg/m Inj (F) C ebcin 40mg/m Inj (discontinued) I TOBI 300mg/5m Sol VR J01GB03 GTAICI gentamicin 40mg/m inj Gentamicin 40mg/m Inj C Garamycin 40mg/m Inj (discontinued) SCH ovember

125 J General Antiinfectives, Systemic J01GB06 AIKACI amikacin 250mg/m inj Amikacin 250mg/m Inj Amikin 250mg/m Inj (discontinued) BRI J01 J01A QUIOO ATIBACTRIAS FOUROQUIOOS J01A01 OFOXACI ofloxacin 200mg tab Ofloxacin 200mg Tab (discontinued) AA Floxin 200mg Tab (discontinued) JA ofloxacin 300mg tab Ofloxacin 300mg Tab (discontinued) AA Floxin 300mg Tab (discontinued) JA ofloxacin 400mg tab Ofloxacin 400mg Tab (discontinued) AA Floxin 400mg Tab (discontinued) JA J01A02 CIROFOXACI Cipro 100mg/m O/ BA ciprofloxacin 250mg tab Apo-Ciproflox 250mg Tab Auro-Ciprofloxacin 250mg Tab ARO Ciprofloxacin 250mg Tab Ciprofloxacin-250mg Tab SIV CO Ciprofloxacin 250mg Tab Jamp-Ciprofloxacin 250mg Tab JC ar-ciprofloxacin 250mg Tab AR IT-Ciprofloxacin 250mg Tab T A-Ciprofloxacin 250mg Tab ovo-ciprofloxacin 250mg Tab TV pms-ciprofloxacin 250mg Tab S RA-Ciproflox 250mg Tab RA Sandoz Ciprofloxacin 250mg Tab Septa-Ciprofloxacin 250mg Tab ST Cipro 250mg Tab BA ciprofloxacin 500mg tab Apo-Ciproflox 500mg Tab Auro-Ciprofloxacin 500mg Tab ARO Ciprofloxacin 500mg Tab Ciprofloxacin-500mg Tab SIV CO Ciprofloxacin 500mg Tab Jamp-Ciprofloxcin 500mg Tab JC ar-ciprofloxacin 500mg Tab AR IT-Ciproflox 500mg Tab T IT-Ciprofloxacin 500mg Tab T A-Ciprofloxacin 500mg Tab ovember

126 J General Antiinfectives, Systemic ovo-ciprofloxacin 500mg Tab TV pms-ciprofloxacin 500mg Tab S RA-Ciproflox 500mg Tab RA Sandoz Ciprofloxacin 500mg Tab Septa-Ciprofloxacin 500mg Tab ST Cipro 500mg Tab BA ciprofloxacin X 500mg tab pms-ciprofloxacin X 500mg Tab S Cipro X 500mg Tab BA ciprofloxacin 750mg tab Apo-Ciproflox 750mg Tab Auro-Ciprofloxacin 750mg Tab ARO Ciprofloxacin 750mg Tab CO Ciprofloxacin 750mg Tab Jamp-Ciprofloxacin 750mg Tab JC ar-ciprofloxacin 750mg Tab AR IT-Ciprofloxacin 750mg Tab T A-Ciprofloxacin 750mg Tab ovo-ciprofloxacin 750mg Tab TV pms-ciprofloxacin 750mg Tab S RA-Ciproflox 750mg Tab RA Sandoz Ciprofloxacin 750mg Tab Septa-Ciprofloxacin 750mg Tab ST Cipro 750mg Tab BA Cipro X 1,000mg Tab BA J01A06 ORFOXACI norfloxacin 400mg tab Apo-orflox 400mg Tab CO orfloxacin 400mg Tab ovo-orfloxacin 400mg Tab TV oroxin 400mg Tab (discontinued) FRS J01A12 VOFOXACI levofloxacin 250mg tab Apo-evofloxacin 250mg Tab CO evofloxacin 250mg Tab A-evofloxacin 250mg Tab ovo-evofloxacin 250mg Tab TV pms-evofloxacin 250mg Tab S Sandoz evofloxacin 250mg Tab evaquin 250mg Tab (discontinued) JA levofloxacin 500mg tab Apo-evofloxacin 500mg Tab CO evofloxacin 500mg Tab A-evofloxacin 500mg Tab ovo-evofloxacin 500mg Tab TV pms-evofloxacin 500mg Tab S ovember

127 J General Antiinfectives, Systemic Sandoz evofloxacin 500mg Tab evaquin 500mg Tab (discontinued) JA levofloxacin 750mg tab Apo-evofloxacin 750mg Tab CO evofloxacin 750mg Tab ovo-evaquin 750mg Tab TV pms-evofloxacin 750mg Tab S Sandoz evofloxacin 750mg Tab evaquin 750mg Tab (discontinued) JA J01A14 OXIFOXACI Avelox 400mg Tab BA J01X J01XA OTHR ATIBACTRIAS GCOTID ATIBACTRIAS J01XA01 VACOCI vancomycin 125mg cap Jamp-Vancomycin 125mg Cap JC Vancomycin HCl 125mg Cap FKB Vancocin 125mg Cap RS vancomycin 250mg cap Jamp-Vancomycin 250mg Cap JC Vancomycin HCl 250mg Cap FKB Vancocin 250mg Cap RS vancomycin 500mg vial inj Vancomycin HCl 500mg/Vial Inj Vancomycin 500mg/Vial Inj FKB vancomycin 500mg/vial inj pms-vancomycin 500mg/vial Inj (discontinued) S Vancocin C 500mg/vial Inj (discontinued) I vancomycin HCl 500mg/vial inj Val-Vancomycin 500mg/vial Inj C V Vancomycin HCl 500mg/vial Inj STR Sterile Vancomycin HCl 500mg/vial Inj C HOS vancomycin 1g vial inj Vancomycin HCl 1g/Vial Inj Vancomycin 1g/Vial Inj FKB vancomycin 1g/vial inj pms-vancomycin 1g/vial Inj (discontinued) S Vancocin C 1g/vial Inj (discontinued) FKB vancomycin HCl 1g/vial inj Val-Vancomycin 1000mg/vial Inj C V Vancomycin HCl 1g/vial Inj STR Sterile Vancomycin HCl 1g/vial Inj C HOS J01XD IIDAZO DRIVATIVS ovember

128 J General Antiinfectives, Systemic J01XD01 TROIDAZO metronidazole 250mg tab etronidazole 250mg Tab C AA Flagyl 250mg Tab (discontinued) RR metronidazole 500mg cap etronidazole 500mg Cap AA pms-etronidazole 500mg Cap S Flagyl 500mg Cap SAV J01X ITROFURA DRIVATIVS J01X01 ITROFURATOI nitrofurantoin 50mg cap ovo-furantoin 50mg Cap C TV acrodantin 50mg Cap (discontinued) GA itrofurantoin 50mg Tab C AA nitrofurantoin 100mg cap ovo-furantoin 100mg Cap TV acrodantin 100mg Cap (discontinued) GA itrofurantoin 100mg Tab AA acrobid 100mg Cap C J01XX OTHR ATIBACTRIAS J01XX01 FOOCI onurol 3g Sachet AR J01XX05 THAI andelamine 500mg Tab C RF J01XX08 IZOID linezolid 600mg tab Apo-inezolid 600mg Tab Sandoz inezolid 600mg Tab Zyvoxam 600mg Tab J01XX09 DATOCI Cubicin 500mg Vial SV J02 J02A J02AA SSTIC ATICOTICS SSTIC ATICOTICS ATIBIOTICS J02AA01 AHOTRICI Fungizone 50mg/vial Inj C BRI J02AB IIDAZO DRIVATIVS J02AB02 KTOCOAZO ovember

129 J General Antiinfectives, Systemic ketoconazole 200mg tab Apo-Ketoconazole 200mg Tab C ovo-ketoconazole 200mg Tab C TV izoral 200mg Tab (discontinued) JJ J02AC TRIAZO DRIVATIVS J02AC01 FUCOAZO fluconazole 2mg/m inj Fluconazole 2mg/m Inj Fluconazole 2mg/m Vial Inj Diflucan 2mg/m Inj Diflucan OS 10mg/m fluconazole 50mg tab Apo-Fluconazole 50mg Tab C CO Fluconazole 50mg Tab C A-Fluconazole 50mg Tab C ovo-fluconazole 50mg Tab C TV pms-fluconazole 50mg Tab C S Diflucan 50mg Tab (discontinued) fluconazole 100mg tab Apo-Fluconazole 100mg Tab C CO Fluconazole 100mg Tab C A-Fluconazole 100mg Tab C ovo-fluconazole 100mg Tab C TV pms-fluconazole 100mg Tab C S Diflucan 100mg Tab (discontinued) fluconazole 150mg cap Apo-Fluconazole 150mg Cap C pms-fluconazole 150mg Cap C S Diflucan 150mg Cap (discontinued) fluconazole 150mg cap (otc) Jamp-Fluconazole 150mg Cap C JC Diflucan One 150mg Cap J02AC02 ITRACOAZO Sporanox 100mg Cap JA J02AC03 VORICOAZO voriconazole 50mg tab Apo-Voriconazole 50mg Tab Sandoz Voriconazole 50mg Tab Teva-Voriconazole 50mg Tab TV Vfend 50mg Tab voriconazole 200mg tab Apo-Voriconazole 200mg Tab Sandoz Voriconazole 200mg Tab Teva-Voriconazole 200mg Tab TV ovember

130 J General Antiinfectives, Systemic Vfend 200mg Tab J02AC04 OSACOAZO osanol 40mg/m Susp FRS J04 J04A J04AB ATICOBACTRIAS DRUGS FOR TRATT OF TUBRCUOSIS ATIBIOTICS J04AB02 RIFAI (RIFAICI) rifampin 150mg cap Rifadin 150mg Cap C SAV Rofact 150mg Cap C V rifampin 300mg cap Rifadin 300mg Cap C SAV Rofact 300mg Cap C V J04AB04 RIFABUTI ycobutin 150mg Cap C J04AC HDRAZIDS J04AC01 ISOIAZID pms-isoniazid 300mg Tab C S J04AK OTHR DRUGS FOR TRATT OF TUBRCUOSIS J04AK02 THABUTO tibi 100mg Tab C V tibi 400mg Tab C V J04A COB. OF DRUGS FOR TRATT OF TUBRCUOSIS J04A02 RIFAI AD ISOIAZID Rifater Tab SAV J04B J04BA DRUGS FOR TRATT OF RA DRUGS FOR TRATT OF RA J04BA02 DASO Dapsone 100mg Tab C JCB J05 J05A J05AB SSTIC ATIVIRAS DIRCT ACTIG ATIVIRAS UCOSIDS AD UCOTIDS XC.RVRS TRASCRITAS IHIBITORS J05AB01 ACCOVIR acyclovir 200mg tab Apo-Acyclovir 200mg Tab C ovember

131 J General Antiinfectives, Systemic A-Acyclovir 200mg Tab C ovo-acyclovir 200mg Tab C TV ratio-acyclovir 200mg Tab C TV Zovirax 200mg Tab C GSK Zovirax 200mg/5m O/ C GSK acyclovir 400mg tab Acyclovir 400mg Tab C Apo-Acyclovir 400mg Tab C A-Acyclovir 400mg Tab C ovo-acyclovir 400mg Tab C TV Zovirax 400mg Tab (discontinued) GSK acyclovir 800mg tab Apo-Acyclovir 800mg Tab C A-Acyclovir 800mg Tab C ovo-acyclovir 800mg Tab C TV Zovirax Zostab 800mg Tab (discontinued) GSK J05AB06 GACICOVIR Cytovene 500mg/vial Inj HR J05AB09 FACICOVIR famciclovir 125mg tab Apo-Famciclovir 125mg Tab C CO Famciclovir 125mg Tab C pms-famciclovir 125mg Tab C S Sandoz Famciclovir 125mg Tab C Famvir 125mg Tab C VR famciclovir 250mg tab Apo-Famciclovir 250mg Tab C CO Famciclovir 250mg Tab C pms-famciclovir 250mg Tab C S Sandoz Famciclovir 250mg Tab C Famvir 250mg Tab C VR famciclovir 500mg tab Apo-Famciclovir 500mg Tab C CO Famciclovir 500mg Tab C pms-famciclovir 500mg Tab C S Sandoz Famciclovir 500mg Tab C Famvir 500mg Tab C VR J05AB11 VAACCOVIR valacyclovir 500mg tab Apo-Valacyclovir 500mg Tab C CO Valacyclovir 500mg Tab C Jamp-Valacyclovir 500mg Tab C JC ar-valacyclovir 500mg Tab C AR A-Valacyclovir 500mg Tab C pms-valacyclovir 500mg Tab C S ovember

132 J General Antiinfectives, Systemic Sandoz Valacyclovir 500mg Tab C Teva-Valacyclovir 500mg Tab C TV Valtrex 500mg Tab C GSK valacyclovir 1000mg tab Apo-Valacyclovir 1000mg Tab pms-valacyclovir 1000mg Tab S Valtrex 1000mg Tab GSK J05AB14 VAGACICOVIR valganciclovir 450mg tab Apo-Valganciclovir 450mg Tab Auro-Valganciclovir 450mg Tab ARO Teva-Valganciclovir 450mg Tab TV Valcyte 450mg Tab HR J05A ROTAS IHIBITORS J05A01 SAQUIAVIR Invirase 200mg Cap HR Invirase 500mg Tab HR J05A02 IDIAVIR Crixivan 400mg Cap FRS J05A03 RITOAVIR orvir 80mg/m O/ ABV orvir FCT 100mg Tab ABV J05A04 FIAVIR Viracept 625mg Tab VIV J05A07 FOSARAVIR Telzir 50mg/m Susp VIV Telzir 700mg Tab VIV J05A08 ATAZAAVIR Reyataz 150mg Cap BRI Reyataz 200mg Cap BRI Reyataz 300mg Cap BRI J05A09 TIRAAVIR Aptivus 250mg Cap BO J05A10 DARUAVIR rezista 75mg Tab JA rezista 400mg Tab (discontinued) JA J05A11 TARVIR ovember

133 J General Antiinfectives, Systemic Incivek 375mg Tab (discontinued) VTX Incivek 375mg Tab* (discontinued) VTX *use when drug cost in excess of ChA maximum J05A12 BOCRVIR Victrelis 200mg Cap (discontinued) FRS J05A14 SIRVIR Galexos 150mg Cap JA J05A30 ROTAS IHIBITORS, COBIATIOS Keletra 100/25mg ediatric Tab ABV Kaletra 200/50mg Tab ABV J05AF UCOSID AD UCOTID RVRS TRASCRITAS IHIBITORS J05AF01 ZIDOVUDI zidovudine 100mg cap Apo-Zidovudine 100mg Cap Retrovir 100mg Cap VIV J05AF04 STAVUDI Zerit 15mg Cap BRI Zerit 20mg Cap BRI Zerit 30mg Cap BRI Zerit 40mg Cap BRI J05AF05 AIVUDI 3TC 10mg/m O/ VIV lamivudine 100mg tab Apo-amivudine HBV 100mg Tab Heptovir 100mg Tab GSK lamivudine 150mg tab Apo-amivudine 150mg Tab TC 150mg Tab VIV lamivudine 300mg tab Apo-amivudine 300mg Tab TC 300mg Tab VIV J05AF07 TOFOVIR DISOROXI Viread 300mg Tab GI J05AF08 ADFOVIR DIIVOXI adefovir 10mg tab Apo-Adefovir 10mg Tab Hepsera 10mg Tab GI J05AF10 TCAVIR ovember

134 J General Antiinfectives, Systemic entecavir 0.5mg tab Apo-ntecavir 0.5mg Tab pms-ntecavir 0.5mg Tab S Baraclude 0.5mg Tab BRI J05AF11 TBIVUDI Sebivo 600mg Tab VR J05AG O-UCOSIDS RVRS TRASCRITAS IHIBITORS J05AG01 VIRAI nevirapine 200mg tab Auro-evirapine 200mg Tab ARO A-evirapine 200mg Tab pms-evirapine 200mg Tab S Teva-evirapine 200mg Tab TV Viramune 200mg Tab BO J05AG03 FAVIRZ efavirenz 600mg tab Auro-favirenz 600mg Tab ARO A-favirenz 600mg Tab Teva-favirenz 600mg Tab TV Sustiva 600mg Tab BRI J05AG04 TRAVIRI Intelence 100mg Tab JA J05AG05 RIIVIRI durant 25mg Tab JA J05AH URAIIDAS IHIBITORS J05AH01 ZAAIVIR Relenza 5mg dr for Inhalation GSK J05AH02 OSTAIVIR Tamiflu 6mg/m Susp HR Tamiflu 30mg Cap HR Tamiflu 45mg Cap HR Tamiflu 75mg Cap HR J05AR ATIVIRAS FOR TRATT OF HIV IFCTIOS, COBIATIOS J05AR01 ZIDOVUDI AD AIVUDI lamivudine 150mg & zidovudine 300mg tab Apo-amivudine-Zidovudine 150/300mg Tab Auro-amivudine/Zidovudine 150/300mg Tab ARO Teva-amivudine/Zidovudine 150/300mg Tab TV Combivir 150/300mg Tab VIV ovember

135 J General Antiinfectives, Systemic J05AR02 AIVUDI AD ABACAVIR Kivexa Tab VIV J05AR03 TOFOVIR DISOROXI AD TRICITABI Truvada Tab GI J05AR06 TRICITABI, TOFOVIR DISOROXI AD FAVIRZ Atripla Tab GI J05AR08 TRICITABI, TOFOVIR DISOROXI AD RIIVIRI Complera 200/25/300mg Tab GI J05AR09 TRICITABI, TOFOVIR DISOROXI, VITGRAVIR AD COBICISTAT Stribild 150mg/150mg/200mg/300mg Tab GI J05AR13 DUOTGRAVIR, ABACAVIR, AIVUDI Triumeq 50mg/600mg/300mg Tab VIV J05AX OTHR ATIVIRAS J05AB04 RIBAVIRI oderiba 200mg Tab ABV Ibavyr 400mg Tab D oderiba 400mg Tab ABV Ibavyr 600mg Tab D oderiba 600mg Tab ABV J05AX07 FUVIRTID Fuzeon 108mg/vial Inj HR J05AX08 RATGRAVIR Isentress 400mg Tab FRS J05AX09 ARAVIROC Celsentri 150mg Tab VIV Celsentri 300mg Tab VIV J05AX12 DOUTGRAVIR Tivicay 50mg Tab VIV J05AX15 SOFOSBUVIR Sovaldi 400mg Tab GI Sovaldi 400mg Tab* GI Sovaldi 400mg Tab* GI *use when drug cost in excess of ChA maximum J05AX65 DIASVIR AD SOFOSBUVIR Harvoni 90/400mg Tab GI Harvoni 90/400mg Tab* GI ovember

136 J General Antiinfectives, Systemic Harvoni 90/400mg Tab* GI *use when drug cost in excess of ChA maximum J05AX66 DASABUVIR, OBITASVIR, ARITARVIR AD RITOAVIR Holkira ak Tab ABV Holkira ak Tab* ABV Holkira ak Tab* ABV *use when drug cost in excess of ChA maximum ovember

137 01 01A 01AA Antineoplastics and Immunomodulating Agents ATIOASTIC AGTS AKATIG AGTS ITROG USTARD AAOGUS 01AA01 CCOHOSHAID rocytox 25mg Tab C BAX rocytox 50mg Tab C BAX 01AA02 CHORABUCI eukeran 2mg Tab C AR 01AA03 HAA Alkeran 2mg Tab C AR 01AB AK SUHOATS 01AB01 BUSUFA yleran 2mg Tab C AR 01AD ITROSOURAS 01AD02 OUSTI CeeU 10mg Cap C BRI CeeU 40mg Cap C BRI CeeU 100mg Cap C BRI 01AX OTHR AKATIG AGTS 01AX03 TOZOOID Temodal 5mg Cap FRS temozolomide 20mg cap CO Temozolomide 20mg Cap COB Temodal 20mg Cap FRS temozolomide 100mg cap CO Temozolomide 100mg Cap COB Temodal 100mg Cap FRS temozolomide 140mg cap CO Temozolomide 140mg Cap COB Temodal 140mg Cap FRS temozolomide 250mg cap CO Temozolomide 250mg Cap COB Temodal 250mg Cap FRS 01B 01BA ATITABOITS FOIC ACID AAOGUS 01BA01 THOTRXAT methotrexate 2.5mg tab Apo-ethotrexate 2.5mg Tab C ovember

138 Antineoplastics and Immunomodulating Agents ratio-ethotrexate Sodium 2.5mg Tab C TV ethotrexate 2.5mg Tab C ethotrexate 10mg Tab C HOS ethotrexate 10mg/m Inj C HOS methotrexate 25mg/m inj ethotrexate 25mg/m Inj C ethotrexate 25mg/m Inj C HOS methotrexate 25mg/m inj (pf) Jamp-ethotrexate 25mg/m Inj (F) (2m) C JC ethotrexate 25mg/m Inj (F) (2m) C ethotrexate 25mg/m Inj (F) C HOS ethotrexate 25mg/m Inj C TV ethotrexate 25mg/m Inj (F) C HOS 01BB URI AAOGUS 01BB02 RCATOURI mercaptopurine 50mg tab ercaptopurine 50mg Tab C STR urinethol 50mg Tab C TV 01BB03 THIOGUAI anvis 40mg Tab C AR 01BB05 FUDARABI Fludara 10mg Tab SAV 01BC RIIDI AAOGUS 01BC02 FUOROURACI fudex 5% Cr C V Fluorouracil 50mg/vial Inj C BC05 GCITABI gemcitabine hydrochloride 1g/vial inj Gemcitabine 38mg/m Inj (1g Vial) HOS Gemcitabine 1g/vial Inj AHI Gemzar 1g/vial Inj (discontinued) I gemcitabine hydrochloride 200mg/vial inj Gemcitabine 38mg/m Inj (200mg Vial) HOS Gemzar 200mg/vial Inj (discontinued) I 01BC06 CACITABI capecitabine 150mg tab ACH-Capecitabine 150mg Tab AHI Sandoz Capecitabine 150mg Tab Teva-Capecitabine 150mg Tab TV Xeloda 150mg Tab HR capecitabine 500mg tab ovember

139 Antineoplastics and Immunomodulating Agents ACH-Capecitabine 500mg Tab AHI Sandoz Capecitabine 500mg Tab Teva-Capecitabine 500mg Tab TV Xeloda 500mg Tab HR 01C 01CB AT AKAOIDS AD OTHR ATURA RODUCTS ODOHOTOXI DRIVATIVS 01CB01 TOOSID Vepesid 50mg Cap C BRI 01CD TAXAS 01CD01 ACITAX paclitaxel 6mg/m inj aclitaxel 6mg/m Inj AHI Taxol 6mg/m Inj (discontinued) BRI 01CD02 DOCTAX docetaxel 10mg/m (2m) Docetaxel 10mg/m Inj (2m) HOS Docetaxel 20mg/vial Inj TV Taxotere 20mg/vial Inj SAV docetaxel 10mg/m (8m) Docetaxel 10mg/m Inj (8m) HOS Docetaxel 80mg/vial Inj TV Taxotere 80mg/vial Inj SAV 01D 01DB CTOTOXIC ATIBIOTICS AD RATD SUBSTACS ATHRACCIS AD RATD SUBSTACS 01DB03 IRUBICI harmorubicin FS 2mg/m inj X 01XA OTHR ATIOASTIC AGTS ATIU COOUDS 01XA01 CISATI cisplatin 1mg/m inj Cisplatin 1mg/m AHI Teva-Cisplatin 1mg/m Inj TV Cisplatin 1mg/m HOS 01XB THHDRAZIS 01XB01 ROCARBAZI atulane 50mg Cap C QGT 01XC OOCOA ATIBODIS 01XC02 RITUXIAB ovember

140 Antineoplastics and Immunomodulating Agents Rituxan 10mg/m Inj HR Rituxan 10mg/m Inj* HR *use when drug cost in excess of ChA maximum 01X ROTI KIAS IHIBITORS 01X01 IATIIB imatinib 100mg tab Apo-Imatinib 100mg Tab CO Imatinib 100mg Tab pms-imatinib 100mg Tab S Teva-Imatinib 100mg Tab TV Gleevec 100mg Tab VR imatinib 400mg tab Apo-Imatinib 400mg Tab CO Imatinib 400mg Tab pms-imatinib 400mg Tab S Teva-Imatinib 400mg Tab TV Gleevec 400mg Tab VR 01X02 GFITIIB Iressa 250mg Tab AZ 01X03 ROTIIB erlotinib 25mg tab Teva-rlotinib 25mg Tab TV Tarceva 25mg Tab HR erlotinib 100mg tab Teva-rlotinib 100mg Tab TV Tarceva 100mg Tab HR erlotinib 150mg tab Teva-rlotinib 150mg Tab TV Tarceva 150mg Tab HR 01X04 SUITIIB Sutent 12.5mg Cap Sutent 25mg Cap Sutent 50mg Cap Sutent 50mg Cap* *use when drug cost in excess of ChA maximum 01X05 SORAFIB exavar 200mg Tab BA 01X06 DASATIIB Sprycel 20mg Cap BRI Sprycel 50mg Cap BRI Sprycel 70mg Cap BRI ovember

141 Antineoplastics and Immunomodulating Agents Sprycel 100mg Cap BRI Sprycel 100mg Cap* BRI *use when drug cost in excess of ChA maximum 01X07 AATIIB Tykerb 250mg Tab GSK 01X08 IOTIIB Tasigna 150mg Cap VR Tasigna 150mg Cap* VR *use when drug cost in excess of ChA maximum Tasigna 200mg Cap VR 01X11 AZOAIB Votrient 200mg tab GSK 01X13 AFATIIB Giotrif 20mg Tab BO Giotrif 30mg Tab BO Giotrif 40mg Tab BO 01X15 VURAFIB Zelboraf 240mg Tab HR Zelboraf 240mg Tab* HR *use when drug cost in excess of ChA maximum 01X16 CRIZOTIIB Xalkori 200mg Cap Xalkori 250mg Cap X17 AXITIIB Inlyta 1mg Tab Inlyta 5mg Tab X18 RUXOITIIB Jakavi 5mg Tab VR Jakavi 5mg Tab* VR *use when drug cost in excess of ChA maximum Jakavi 15mg Tab VR Jakavi 15mg Tab* VR Jakavi 20mg Tab VR 01X21 RGORAFIB Stivarga 40mg Tab BA 01X27 IBRUTIIB Imbruvica 140mg Cap JA ovember

142 Antineoplastics and Immunomodulating Agents 01XX OTHR ATIOASTIC AGTS 01XX05 HDROXURA (HDROXCARBAID) hydroxyurea 500mg cap A-Hydroxyurea 500mg Cap C Hydrea 500mg Cap C BRI 01XX11 STRAUSTI mcyt 140mg Tab C XX17 TOOTCA topotecan 1mg/m inj Topotecan 1mg/m Inj (4m Vial) AHI Topotecan HCl 1mg/m Inj (4m Vial) HOS Topotecan WS 4mg/vial Inj AHI Hycamtin 4mg/Vial Inj GSK 01XX35 AAGRID anagrelide 0.5mg cap A-Anagrelide 0.5mg Cap (discontinued) Sandoz Anagrelide 0.5mg Cap Agrylin 0.5mg Cap SHI 01XX43 VISODGIB rivedge 150mg Cap HR 02 02A 02AB DOCRI THRA HOROS AD RATD AGTS ROGSTOGS 02AB01 GSTRO megestrol 40mg tab egestrol 40mg Tab C AA egace 40mg Tab (discontinued) BRI egace OS 40mg/m O/ C BRI megestrol 160mg tab egestrol 160mg Tab C AA egace 160mg Tab (discontinued) BRI 02A GOADOTROHI RH AAOGUS 02A01 BUSRI Suprefact 1mg/m asal Sol C SAV Suprefact Depot 6.3mg (2 month) Implant C SAV Suprefact Depot 9.45mg (3 month) Implant C SAV 02A02 UROID (URORI) upron Depot 3.75mg (monthly) Inj Kit ABV ovember

143 Antineoplastics and Immunomodulating Agents upron 5mg/m Inj C ABV upron Depot 7.5mg (monthly) Inj Kit C ABV upron Depot 11.25mg (3 month) SR Inj Kit ABV ligard 22.5mg (3 month) Inj Kit C SAV upron Depot 22.5mg (3 month) SR Inj Kit C ABV upron Depot 30mg (4 month) SR Inj Kit C ABV ligard 45mg (6 month) Inj Kit C SAV 02A03 GOSRI Zoladex Depot 3.6mg/syringe Inj C AZ Zoladex A 10.8mg/syringe (3 month) Inj C AZ 02A04 TRITORI Trelstar Depot 3.75mg/vial Inj C AS Trelstar A 11.25mg/vial Inj C AS Trelstar 22.5mg/vial Inj C AS 02B 02BA HORO ATAGOISTS AD RATD AGTS ATI-STROGS 02BA01 TAOXIF tamoxifen citrate 10mg tab Apo-Tamox 10mg Tab C A-Tamoxifen 10mg Tab C ovo-tamoxifen 10mg Tab C TV olvadex 10mg Tab (discontinued) AZ Tamofen 10mg Tab (discontinued) SAV tamoxifen citrate 20mg tab Apo-Tamox 20mg Tab C A-Tamoxifen 20mg Tab C ovo-tamoxifen 20mg Tab C TV olvadex-d 20mg Tab C AZ Tamofen 20mg Tab (discontinued) SAV 02BB ATI-ADROGS 02BB01 FUTAID flutamide 250mg tab Apo-Flutamide 250mg Tab C ovo-flutamide 250mg Tab (discontinued) TV pms-flutamide 250mg Tab C S uflex 250mg Tab (discontinued) FRS 02BB02 IUTAID Anandron 50mg Tab C SAV 02BB03 BICAUTAID ovember

144 Antineoplastics and Immunomodulating Agents bicalutamide 50mg tab Apo-Bicalutamide 50mg Tab C Bicalutamide 50mg Tab C AHI Bicalutamide-50mg Tab C SIV CO Bicalutamide 50mg Tab C Jamp-Bicalutamide 50mg Tab C JC A-Bicalutamide 50mg Tab (discontinued) ovo-bicalutamide 50mg Tab C TV pms-bicalutamide 50mg Tab C S RA-Bicalutamide 50mg Tab C RA Sandoz Bicalutamide 50mg Tab C Casodex 50mg Tab C AZ 02BB04 ZAUTAID Xtandi 40mg Cap AS 02BG AROATAS IHIBITORS 02BG03 AASTROZO anastrozole 1mg tab Anastrozole 1mg Tab C AHI Apo-Anastrozole 1mg Tab C Auro-Anastrozole 1mg Tab C ARO CO Anastrozole 1mg Tab C Jamp-Anastrozole 1mg Tab C JC ar-anastrozole 1mg Tab C AR D-Anastrozole 1mg Tab C G IT-Anastrozole 1mg Tab C T A-Anastrozole 1mg Tab C AT-Anastrozole 1mg Tab C AT pms-anastrozole 1mg Tab C S RA-Anastrozole 1mg Tab C RA Sandoz Anastrozole 1mg Tab C Taro-Anastrozole 1mg Tab C TAR Teva-Anastrozole 1mg Tab (discontinued) TV Zinda-Anastrozole 1mg Tab C CK Arimidex 1mg Tab C AZ 02BG04 TROZO letrozole 2.5mg tab Apo-etrozole 2.5mg Tab C Auro-etrozole 2.5mg Tab C ARO Jamp-etrozole 2.5mg Tab C JC etrozole 2.5mg Tab C AHI etrozole 2.5mg Tab C ar-etrozole 2.5mg Tab C AR D-etrozole 2.5mg Tab C G AT-etrozole 2.5mg Tab C AT pms-etrozole 2.5mg Tab C S RA-etrozole 2.5mg Tab C RA ovember

145 Antineoplastics and Immunomodulating Agents Sandoz etrozole 2.5mg Tab C Teva-etrozole 2.5mg Tab C TV Zinda-etrozole 2.5mg Tab C CK Femara 2.5mg Tab C VR 02BG06 XSTA exemestane 25mg tab Apo-xemestane 25mg Tab C CO xemestane 25mg Tab C D-xemestane 25mg Tab C G Teva-xemestane 25mg Tab C TV Aromasin 25mg Tab C BX OTHR HORO ATAGOISTS AD RATD AGTS 02BX02 DGARIX Firmagon 80mg/vial Inj C FI Firmagon 120mg/vial Inj C FI 02BX03 ABIRATRO Zytiga 250mg tab JA 03 03A 03AA IUOODUATORS/-STIUATS IUOSTIUATS COO STIUATIG FACTORS 03AA02 FIGRASTI eupogen 300mcg/m Inj AGA 03AA13 GFIGRASTI eulasta 10mg/m Inj AGA 03AB ITRFROS 03AB05 ITRFRO AHA-2B Intron A 6,000,000iu/m Inj (albumin free) SCH Intron A 10,000,000iu/m Inj (albumin free) SCH Intron A 10,000,000iu/vial Inj SCH Intron A 15,000,000iu ultidose en SCH Intron A 25,000,000iu ultidose en FRS Intron A 50,000,000iu ultidose en SCH 03AB07 ITRFRO BTA-1A Rebif 22mcg ultidose Cartridges D Rebif 22mcg/0.5m Inj D Avonex S 30mcg/0.5m Inj BIG Rebif 44mcg ulitdose Cartridges D ovember

146 Antineoplastics and Immunomodulating Agents Rebif 44mcg/0.5m Inj D 03AB08 ITRFRO BTA-1B Betaseron Initiation ack BA Betaseron 0.3mg/vial Inj BA xtavia 0.3mg/vial Inj VR 03AB11 GITRFRO AFA-2A egasys 180mcg/0.5m Syr Inj HR egasys roclick Autoinjector 180mcg/0.5m Syr Inj HR 03AB60 GITRFRO AFA-2B, COBIATIOS egetron 50mcg/m Inj/200mg Cap (discontinued) SCH egetron Clearclick 80mcg/0.5m Inj/200mg Cap FRS Victrelis Triple 80mcg Inj/200mg/200mg Cap (discontinued) FRS egetron Clearclick 100mcg/0.5m Inj/200mg Cap FRS Victrelis Triple 100mcg Inj/200mg/200mg Cap (discontinued) FRS egetron Clearclick 120mcg/0.5m Inj/200mg Cap FRS Victrelis Triple 120mcg Inj/200mg/200mg Cap (discontinued) FRS Victrelis Triple 120mcg Inj/200mg/200mg Cap* (discontinued) FRS *use when drug cost in excess of ChA maximum egetron Clearclick 150mcg/0.5m Inj/200mg Cap FRS Victrelis Triple 150mcg Inj/200mg/200mg Cap (discontinued) FRS 03AB61 GITRFRO AFA-2A, COBIATIOS egasys RBV 180mcg/0.5m Inj/200mg Tab (1 Kit) HR egasys RBV 180mcg/0.5m Inj/200mg Tab (4 Kit) HR egasys RBV roclick 180mcg/0.5m Inj/200mg Tab HR 03AX OTHR IUOSTIUATS 03AX03 BCG VACCI ImmuCyst BCG Therapeutic 3.5CFU/vial Inj C AV 03AX13 GATIRAR ACTAT Copaxone 20mg/m Syr Inj T 03AX16 RIXAFOR ozobil 24mg/1.2m (20mg/m) Single Use Vial SAV ozobil 24mg/1.2m (20mg/m) Single Use Vial* SAV ozobil 24mg/1.2m (20mg/m) Single Use Vial* SAV *use when drug cost in excess of ChA maximum 04 04A 04AA IUOSURSSATS IUOSURSSATS SCTIV IUOSURSSATS ovember

147 Antineoplastics and Immunomodulating Agents 04AA06 COHOIC ACID mycophenolic acid 180mg tab Apo-ycophenolic Acid 180mg Tab yfortic 180mg Tab VR mycophenolic acid 250mg cap Apo-ycophenolate 250mg Cap Jamp-ycophenolate 250mg Cap JC A-ycophenolate 250mg Cap ovo-ycophenolate 250mg Cap TV Sandoz ycophenolate ofetil 250mg Cap Cellcept 250mg Cap HR mycophenolic acid 360mg tab Apo-ycophenolic Acid 360mg Tab yfortic 360mg Tab VR mycophenolic acid 500mg tab Apo-ycophenolate 500mg Tab Jamp-ycophenolate ofetil 500mg Tab JC A-ycophenolate 500mg Tab ovo-ycophenolate 500mg Tab TV Sandoz ycophenolate ofetil 500mg Tab Cellcept 500mg Tab HR 04AA13 FUOID leflunomide 10mg tab Apo-eflunomide 10mg Tab eflunomide 10mg Tab A-eflunomide 10mg Tab ovo-eflunomide 10mg Tab TV pms-eflunomide 10mg Tab S Sandoz eflunomide 10mg Tab Arava 10mg Tab SAV leflunomide 20mg tab Apo-eflunomide 20mg Tab eflunomide 20mg Tab A-eflunomide 20mg Tab ovo-eflunomide 20mg Tab TV pms-eflunomide 20mg Tab S Sandoz eflunomide 20mg Tab Arava 20mg Tab SAV 04AA18 VROIUS Afinitor 2.5mg Tab VR Afinitor 2.5mg Tab* VR Afinitor 5mg Tab VR Afinitor 5mg Tab* VR Afinitor 10mg Tab VR Afinitor 10mg Tab* VR ovember

148 Antineoplastics and Immunomodulating Agents *use when drug cost in excess of ChA maximum 04AA23 ATAIZUAB Tysabri 300mg/15m Vial Inj BIG 04AA24 ABATACT Orencia 250mg/vial Inj BRI 04AA26 BIUAB Benlysta 120mg/vial GSK Benlysta 400mg/vial GSK 04AA27 FIGOIOD Gilenya 0.5mg Cap VR 04AA31 TRIFUOID Aubagio 14mg Tab GZ 04AB TUOR CROSIS FACTOR AHA (TF-AHA) IHIBITORS 04AB01 TARCT nbrel 25mg dr for Inj AGA nbrel 50mg/m Inj AGA nbrel 50mg/m Inj* AGA nbrel Sureclick 50mg/m Autoinject (I ) AGA *use when drug cost in excess of ChA maximum 04AB02 IFIXIAB Remicade 100mg dr for Inj JA Remicade 100mg dr for Inj* JA *Use for Drug Cost in xcess of ChA aximum 04AB04 ADAIUAB *use when drug cost in excess of ChA maximum Humira 40mg/0.8m en (I ) ABV Humira 40mg/0.8m Syringe Inj (I ) ABV Humira 40mg/0.8m Syringe Inj* ABV 04AB05 CRTOIZUAB GO Cimzia 200mg/m SC Inj UCB 04AB06 GOIUAB Simponi 50mg/0.5m Autoinjector JA Simponi 50mg/0.5m re-filled Syringe JA 04AC ITRUKI IHIBITORS 04AC03 AAKIRA Kineret 100mg/syringe Inj BVT 04AC05 USTKIUAB ovember

149 Antineoplastics and Immunomodulating Agents Stelara 45mg/0.5m Syringe Inj* JA Stelara 45mg/0.5m Syringe Inj** JA Stelara 90mg/1.0m Syringe Inj* JA Stelara 90mg/1.0m Syringe Inj** JA **use when drug cost in excess of ChA maximum *rice listed is per m 04AC07 TOCIIZUAB Actemra 80mg/4m Inj HR Actemra 200mg/10m Inj HR Actemra 400mg/20m Inj HR 04AC08 CAAKIUAB Ilaris 150mg/vial Inj VR 04AD CACIURI IHIBITORS 04AD01 CCOSORI eoral 10mg Cap VR cyclosporine 25mg cap Sandoz Cyclosporine 25mg Cap eoral 25mg Cap VR cyclosporine 50mg cap Sandoz Cyclosporine 50mg Cap eoral 50mg Cap VR cyclosporine 100mg cap Sandoz Cyclosporine 100mg Cap eoral 100mg Cap VR cyclosporine 100mg/m o/l Apo-Cyclosporine 100mg/m O/ eoral 100mg/m O/ VR 04AD02 TACROIUS tacrolimus 0.5mg cap Sandoz Tacrolimus 0.5mg Cap rograf 0.5mg Cap AS Advagraf 0.5mg R Cap AS tacrolimus 1mg cap Sandoz Tacrolimus 1mg Cap rograf 1mg Cap AS Advagraf 1mg R Cap AS Advagraf 3mg Cap AS tacrolimus 5mg cap Sandoz Tacrolimus 5mg Cap rograf 5mg Cap AS Advagraf 5mg R Cap AS ovember

150 Antineoplastics and Immunomodulating Agents 04AX OTHR IUOSURSSATS 04AX01 AZATHIORI azathioprine 50mg tab Apo-Azathioprine 50mg Tab C Azathioprine 50mg Tab C A-Azathioprine 50mg Tab C Teva-Azathioprine 50mg Tab C TV Imuran 50mg Tab C AR 04AX04 AIDOID Revlimid 5mg Cap C Revlimid 5mg Cap* C Revlimid 10mg Cap C Revlimid 10mg Cap* C Revlimid 10mg Cap* C Revlimid 15mg Cap C Revlimid 15mg Cap* C Revlimid 25mg Cap C Revlimid 25mg Cap* C Revlimid 25mg Cap* C *use when drug cost in excess of ChA maximum 04AX05 IRFIDO sbriet 267mg Cap IT 04AX06 OAIDOID omalyst 1mg Cap C omalyst 1mg Cap* C omalyst 2mg Cap C omalyst 2mg Cap* C omalyst 3mg Cap C omalyst 3mg Cap* C omalyst 4mg Cap C omalyst 4mg Cap* C *use when drug cost in excess of ChA maximum ovember

151 01 01A 01AB usculo-skeletal System ATIIFAATOR AD ATIRHUATIC RODUCTS ATIIFAATOR/ATIRHUATIC ROD.,O-STROIDS ACTIC ACID AD ACTAID DRIVATIVS 01AB01 IDOTHACI indomethacin 25mg cap ovo-ethacin 25mg Cap C TV Indocid 25mg Cap (discontinued) FRS indomethacin 50mg cap ovo-ethacin 50mg Cap C TV Indocid 50mg Cap (discontinued) IH indomethacin 50mg supp Sandoz Indomethacin 50mg Supp C Indocid 50mg Supp (discontinued) FRS indomethacin 100mg supp ratio-indomethacin 100mg Supp C TV Sandoz Indomethacin 100mg Supp C Indocid 100mg Supp (discontinued) FRS 01AB02 SUIDAC sulindac 150mg tab ovo-sundac 150mg Tab TV Clinoril 150mg Tab (discontinued) IH sulindac 200mg tab ovo-sundac 200mg Tab TV Clinoril 200mg Tab (discontinued) IH 01AB05 DICOFAC diclofenac sodium 25mg C tab Apo-Diclo 25mg Tab ovo-difenac 25mg Tab TV pms-diclofenac 25mg Tab S Sandoz Diclofenac 25mg Tab Voltaren 25mg Tab (discontinued) VR diclofenac potassium 50mg tab Apo-Diclo Rapide 50mg Tab Diclofenac otassium 50mg Tab pms-diclofenac-k 50mg Tab S Sandoz Diclofenac Rapide 50mg Tab Teva-Diclofenac-K 50mg Tab TV Voltaren Rapide 50mg Tab VR diclofenac sodium 50mg C tab Apo-Diclo 50mg Tab Diclofenac Sodium 50mg Tab ovo-difenac 50mg Tab TV pms-diclofenac 50mg Tab S Sandoz Diclofenac 50mg Tab Voltaren 50mg Tab VR ovember

152 usculo-skeletal System diclofenac sodium 50mg supp pms-diclofenac 50mg Supp S Sandoz Diclofenac 50mg Supp Voltaren 50mg Supp VR diclofenac sodium 75mg SR tab Apo-Diclo SR 75mg Tab Diclofenac Sodium SR 75mg Tab ovo-difenac SR 75mg Tab TV pms-diclofenac SR 75mg Tab S Sandoz Diclofenac SR 75mg Tab Voltaren SR 75mg Tab VR diclofenac sodium 100mg SR tab Apo-Diclo SR 100mg Tab ovo-difenac SR 100mg Tab TV pms-diclofenac SR 100mg Tab S Sandoz Diclofenac SR 100mg Tab Voltaren SR 100mg Tab VR diclofenac sodium 100mg supp pms-diclofenac 100mg Supp S Sandoz Diclofenac 100mg Supp Voltaren 100mg Supp VR 01AB08 TODOAC etodolac 200mg cap todolac 200mg Cap AA Ultradol 200mg Cap (discontinued) GA etodolac 300mg cap todolac 300mg Cap AA Ultradol 300mg Cap (discontinued) GA 01AB15 KTOROAC ketorolac 10mg tab Apo-Ketorolac 10mg Tab AA Toradol 10mg Tab HR Toradol 10mg/m Inj HR ketorolac 30mg/m inj Ketorolac 30mg/m Inj Toradol 30mg/m Inj (discontinued) HR 01AB55 DICOFAC, COBIATIOS diclofenac 50mg & misoprostol 200mcg tab CO Diclo-iso 50mg Tab GD-Diclofenac/isoprostol 50mg Tab GD Arthrotec 50mg Tab diclofenac 75mg & misoprostol 200mcg tab CO Diclo-iso 75mg Tab GD-Diclofenac/isoprostol 75mg Tab GD ovember

153 usculo-skeletal System Arthrotec 75mg Tab AC OXICAS 01AC01 IROXICA piroxicam 10mg cap Apo-iroxicam 10mg Cap ovo-irocam 10mg Cap TV Feldene 10mg Cap (discontinued) piroxicam 20mg cap Apo-iroxicam 20mg Cap ovo-irocam 20mg Cap TV Feldene 20mg Cap (discontinued) AC02 TOXICA tenoxicam 20mg tab Tenoxicam 20mg Tab AA obiflex 20mg Tab (discontinued) HR 01AC06 OXICA meloxicam 7.5mg tab Apo-eloxicam 7.5mg Tab Auro-eloxicam 7.5mg Tab ARO CO eloxicam 7.5mg Tab eloxicam 7.5mg Tab A-eloxicam 7.5mg Tab ovo-eloxicam 7.5mg Tab TV pms-eloxicam 7.5mg Tab S obicox 7.5mg Tab BO meloxicam 15mg tab Apo-eloxicam 15mg Tab Auro-eloxicam 15mg Tab ARO CO eloxicam 15mg Tab eloxicam 15mg Tab A-eloxicam 15mg Tab pms-eloxicam 15mg Tab S Teva-eloxicam 15mg Tab TV obicox 15mg Tab BO 01A ROIOIC ACID DRIVATIVS 01A01 IBUROF Apo-Ibuprofen 200mg Tab ibuprofen 300mg tab Apo-Ibuprofen 300mg Tab C otrin IB 300mg Tab C JJ ibuprofen 400mg tab Apo-Ibuprofen 400mg Tab Jamp-Ibuprofen 400mg Tab C JC ovo-rofen 400mg Tab C TV ovember

154 usculo-skeletal System otrin IB 400mg Tab C JJ ibuprofen 600mg tab Apo-Ibuprofen 600mg Tab C ovo-rofen 600mg Tab C TV otrin 600mg Tab (discontinued) JJ 01A02 AROX naproxen 125mg tab Apo-aproxen 125mg Tab C aprosyn 125mg Tab (discontinued) HR naproxen 250mg C tab Apo-aproxen 250mg C Tab C aproxen 250mg C Tab C ovo-aprox 250mg C Tab C TV aprosyn- 250mg C Tab (discontinued) HR naproxen 250mg tab Apo-aproxen 250mg Tab C aproxen 250mg Tab C Teva-aproxen 250mg Tab C TV aprosyn 250mg Tab (discontinued) HR naproxen sodium 275mg tab Apo-apro-a 275mg Tab aproxen Sodium 275mg Tab Teva-aprox Sodium 275mg Tab TV Anaprox 275mg Tab HR naproxen 375mg C tab Apo-aproxen 375mg C Tab C A-aproxen 375mg C Tab C aproxen 375mg C Tab C pms-aproxen 375mg C Tab C S Teva-aproxen C 375mg Tab C TV aprosyn- 375mg C Tab C HR naproxen 375mg tab Apo-aproxen 375mg Tab C aproxen 375mg Tab C Teva-aproxen 375mg Tab C TV aprosyn 375mg Tab (discontinued) HR naproxen 500mg C tab Apo-aproxen 500mg C Tab C A-aproxen 500mg C Tab C aproxen 500mg C Tab C ovo-aprox 500mg C Tab C TV pms-aproxen 500mg C Tab C S aprosyn- 500mg C Tab C HR naproxen 500mg supp pms-aproxen 500mg Supp C S aprosyn 500mg Supp (discontinued) HR ovember

155 usculo-skeletal System naproxen 500mg tab Apo-aproxen 500mg Tab C aproxen 500mg Tab C Teva-aproxen 500mg Tab C TV aprosyn 500mg Tab (discontinued) HR naproxen sodium 550mg tab Apo-apro-a DS 550mg Tab aproxen Sodium DS 550mg Tab Teva-aprox Sodium DS 550mg Tab TV Anaprox DS 550mg Tab HR aprosyn SR 750mg Tab C HR 01A03 KTOROF ketoprofen 50mg C tab Apo-Keto- 50mg Tab C AA Orudis- 50mg Tab (discontinued) SAV ketoprofen 50mg cap Apo-Keto 50mg Cap C AA Orudis 50mg Cap (discontinued) SAV ketoprofen 100mg C tab Apo-Keto- 100mg Tab C AA Orudis- 100mg Tab (discontinued) SAV pms-ketoprofen 100mg supp C S ketoprofen 200mg SR tab Ketoprofen SR 200mg Tab C AA Orudis-SR 200mg Tab (discontinued) SAV 01A09 FURBIROF flurbiprofen 50mg tab Apo-Flurbiprofen 50mg Tab ovo-flurprofen 50mg Tab TV Ansaid 50mg Tab (discontinued) flurbiprofen 100mg tab Apo-Flurbiprofen 100mg Tab ovo-flurprofen 100mg Tab TV Ansaid 100mg Tab (discontinued) A11 TIAROFIC ACID tiaprofenic acid 200mg tab ovo-tiaprofenic 200mg Tab TV Surgam 200mg Tab (discontinued) SAV tiaprofenic acid 300mg tab ovo-tiaprofenic 300mg Tab TV Surgam 300mg Tab (discontinued) SAV 01A12 OXAROZI oxaprozin 600mg tab ovember

156 usculo-skeletal System Apo-Oxaprozin 600mg Tab Daypro 600mg Tab (discontinued) AG FATS 01AG01 FAIC ACID mefenamic acid 250mg cap Apo-efenamic 250mg Cap F AA onstan 250mg Cap F RF 01AH COXIBS 01AH01 CCOXIB celecoxib 100mg cap Apo-Celecoxib 100mg Cap Celecoxib 100mg Cap SIV Celecoxib 100mg Cap CO Celecoxib 100mg Cap GD-Celecoxib 100mg Cap GD Jamp-Celecoxib 100mg Cap JC ar-celecoxib 100mg Cap AR IT-Celecoxib 100mg Cap T A-Celecoxib 100mg Cap pms-celecoxib 100mg Cap S RA-Celecoxib 100mg Cap RA Sandoz Celecoxib 100mg Cap Teva-Celecoxib 100mg Cap TV Celebrex 100mg Cap celecoxib 200mg cap Apo-Celecoxib 200mg Cap Celecoxib 200mg Cap SIV Celecoxib 200mg Cap CO Celecoxib 200mg Cap GD-Celecoxib 200mg Cap GD Jamp-Celecoxib 200mg Cap JC ar-celecoxib 200mg Cap AR IT-Celecoxib 200mg Cap T A-Celecoxib 200mg Cap pms-celecoxib 200mg Cap S RA-Celecoxib 200mg Cap RA Sandoz Celecoxib 200mg Cap Teva-Celecoxib 200mg Cap TV Celebrex 200mg Cap AX OTHR ATIIFAATOR/ATIRHUATICS,O-STROIDS 01AX01 ABUTO nabumetone 500mg tab Apo-abumetone 500mg Tab abumetone 500mg Tab ovo-abumetone 500mg Tab TV ovember

157 usculo-skeletal System Relafen 500mg Tab (discontinued) GSK nabumetone 750mg tab ovo-abumetone 750mg Tab TV Relafen 750mg Tab (discontinued) GSK 01C 01CB SCIFIC ATIRHUATIC AGTS GOD RARATIOS 01CB01 SODIU AUROTHIOAAT sodium aurothiomalate 10mg/m inj Sodium Aurothiomalate 10mg/m Inj yochrysine 10mg/m Inj SAV sodium aurothiomalate 25mg/m inj Sodium Aurothiomalate 25mg/m Inj yochrysine 25mg/m Inj (discontinued) SAV yochrysine 50mg/m Inj SAV 01CB03 AURAOFI Ridaura 3mg Cap XI 01CC ICIAI AD SIIAR AGTS 01CC01 ICIAI Cuprimine 250mg Cap V 02 02A 02AA TOICA RODUCTS FOR JOIT AD USCUAR AI TOICA RODUCTS FOR JOIT AD USCUAR AI ATIIFAATOR RS,O-STROIDS TOICA US 02AA15 DICOFAC diclofenac 1.5% w/w top sol pms-diclofenac 1.5% Top Sol S Taro-Diclofenac 1.5% Top Sol TAR ennsaid 1.5% Top Sol A 03 03A 03AX USC RAXATS RIHRA ACTIG AGTS,USC RAXATS OTHR USC RAXATS,RIHRA ACTIG 03AX01 ICOBOTUIUTOXI-A Xeomin 50iu/vial inj RZ Xeomin 100iu/vial Inj RZ 03AX01 OABOTUIUTOXI-A Botox 50iu/vial Inj A Botox 100iu/vial Inj A Botox 200iu/vial Inj A ovember

158 usculo-skeletal System 03B 03BA CTRA ACTIG AGTS CARBAIC ACID STRS 03BA03 THOCARBAO Robaxin 500mg Tab WCH Robaxin 750mg Tab WCH 03BA53 THOCARBAO, COBIATIOS XCUDIG SCHOTICS ethoxacet Caplet ROG ethoxacet-c1/8 Caplet ROG ethoxisal-c1/2 Caplet ROG ethoxisal-c1/4 Caplet ROG ethoxisal-c1/8 Caplet ROG Robaxacet Caplet WCH Robaxacet-8 Tab WCH Robaxisal C1/2 Tab WCH Robaxisal C1/4 Tab WCH 03BC THRS, CHICA COS TO ATIHISTAIS 03BC01 ORHADRI (CITRAT) orphenadrine 100mg tab Sandoz Orphenadrine 100mg Tab orflex 100mg Tab (discontinued) GW Orfenace 100mg Tab STR 03BX OTHR CTRA ACTIG AGTS 03BX01 BACOF ioresal Intrathecal 0.05mg/m VR ioresal Intrathecal 0.5mg/m VR ioresal Intrathecal 2mg/m VR baclofen 10mg tab Apo-Baclofen 10mg Tab Baclofen 10mg Tab A-Baclofen 10mg Tab pms-baclofen 10mg Tab S ratio-baclofen 10mg Tab TV ioresal 10mg Tab VR baclofen 20mg tab Apo-Baclofen 20mg Tab Baclofen 20mg Tab A-Baclofen 20mg Tab pms-baclofen 20mg Tab S ratio-baclofen 20mg Tab TV ioresal DS 20mg Tab VR 03BX02 TIZAIDI tizanidine 4mg tab ovember

159 usculo-skeletal System Apo-Tizanidine 4mg Tab Zanaflex 4mg Tab A 03BX08 CCOBZARI cyclobenzaprine HCl 10mg tab Apo-Cyclobenzaprine 10mg Tab Auro-Cyclobenzaprine 10mg Tab ARO Cyclobenzaprine 10mg Tab SIV Cyclobenzaprine 10mg Tab Jamp-Cyclobenzaprine 10mg Tab JC A-Cyclobenzaprine 10mgTab ovo-cycloprine 10mg Tab TV pms-cyclobenzaprine 10mg Tab S Flexeril 10mg Tab (discontinued) JA 03C 03CA DIRCT ACTIG AGTS DATRO AD DRIVATIVS 03CA01 DATRO Dantrium 25mg Cap T Dantrium 100mg Cap T 04 04A 04AA ATIGOUT RARATIOS ATIGOUT RARATIOS RARATIOS IHIBITIG URIC ACID RODUCTIO 04AA01 AOURIO allopurinol 100mg tab Apo-Allopurinol 100mg Tab C ar-allopurinol 100mg Tab C AR Zyloprim 100mg Tab C AA Zyloprim 100mg Tab (discontinued) GSK allopurinol 200mg tab Apo-Allopurinol 200mg Tab C ar-allopurinol 200mg Tab C AR Zyloprim 200mg Tab C AA Zyloprim 200mg Tab (discontinued) GSK allopurinol 300mg tab Apo-Allopurinol 300mg Tab C ar-allopurinol 300mg Tab C AR Zyloprim 300mg Tab C AA Zyloprim 300mg Tab (discontinued) GSK 04AA03 FBUXOSTAT Uloric 80mg Tab TAK 04AB RARATIOS ICRASIG URIC ACID XCRTIO 04AB02 SUFIRAZO ovember

160 usculo-skeletal System sulfinpyrazone 200mg tab Sulfinpyrazone 200mg Tab C AA Anturan 200mg Tab (discontinued) VR 04AC RARATIO WITH O FFCT O URIC ACID TABOIS 04AC01 COCHICI colchicine 0.6mg tab Colchicine 0.6mg Tab OD uro-colchicine 0.6mg Tab UR pms-colchicine 0.6mg Tab S Colchicine 0.6mg Tab (discontinued) ABB Jamp-Colchicine 0.6mg Tab JC 05 05B 05BA DRUGS FOR TRATT OF BO DIS DRUGS AFFCTIG BO STRUCTUR AD IRAIZATIO BISHOSHOATS 05BA01 TIDROIC ACID (TIDROAT) etidronate 200mg tab CO tidronate 200mg Tab A-tidronate 200mg Tab Didronel 200mg Tab (discontinued) GA 05BA02 CODROIC ACID (CODROAT) Bonefos 60mg/m Inj BA Bonefos 400mg Cap C BA 05BA03 AIDROIC ACID (AIDROAT) pamidronate disodium 30mg/vial inj amidronate Disodium Omega 30mg/vial Inj OG Aredia 30mg/vial Inj VR pamidronate disodium 90mg/vial inj amidronate Disodium Omega 90mg/m Inj OG Aredia 90mg/vial Inj VR 05BA04 ADROIC ACID (ADROAT) alendronate 5mg tab Alendronate Sodium 5mg Tab AHI Apo-Alendronate 5mg Tab RA-Alendronate 5mg Tab RA Sandoz Alendronate 5mg Tab Fosamax 5mg Tab (discontinued) FRS alendronate 10mg tab Alendronate Sodium 10mg Tab C AHI Apo-Alendronate 10mg Tab C Auro-Alendronate 10mg Tab C ARO IT-Alendronate 10mg Tab C T ovember

161 usculo-skeletal System A-Alendronate 10mg Tab (discontinued) RA-Alendronate 10mg Tab C RA Sandoz Alendronate 10mg Tab C Teva-Alendronate 10mg Tab C TV Fosamax 10mg Tab (discontinued) FRS alendronate 40mg tab CO Alendronate 40mg Tab Fosamax 40mg Tab (discontinued) FRS alendronate 70mg tab Alendronate 70mg Tab C Alendronate Sodium 70mg Tab C AHI Alendronate-FC 70mg Tab C SIV Apo-Alendronate 70mg Tab C Auro-Alendronate 70mg Tab C ARO CO Alendronate 70mg Tab C Jamp-Alendronate 70mg Tab C JC IT-Alendronate 70mg Tab C T A-Alendronate 70mg Tab C pms-alendronate-fc 70mg Tab C S RA-Alendronate 70mg Tab C RA Sandoz Alendronate 70mg Tab C Teva-Alendronate 70mg Tab C TV Fosamax 70mg Tab C FRS 05BA07 RISDROIC ACID (RISDROAT) risedronate 5mg tab Teva-Risedronate 5mg Tab C TV Actonel 5mg Tab C risedronate 30mg tab Teva-Risedronate 30mg Tab TV Actonel 30mg Tab risedronate 35mg tab Apo-Risedronate 35mg Tab C Auro-Risedronate 35mg Tab C ARO Jamp-Risedronate 35mg Tab C JC A-Risedronate 35mg Tab C pms-risedronate 35mg Tab C S ratio-risedronate 35mg Tab (discontinued) TV Risedronate 35mg Tab C Risedronate-35mg Tab C SIV Sandoz Risedronate 35mg Tab C Teva-Risedronate 35mg Tab C TV Actonel 35mg Tab C WC risedronate 150mg tab Apo-Risedronate 150mg Tab A-Risedronate 150mg Tab pms-risedronate 150mg Tab S Teva-Risedronate 150mg Tab TV ovember

162 usculo-skeletal System Actonel 150mg Tab WC 05BA08 ZODROIC ACID zoledronic acid 4mg inj pms-zoledronic Acid 4mg/5m Inj S Taro-Zoledronic Acid 4mg/5m Inj TAR Teva-Zoledronic Acid 4mg/5m Inj TV Zoledronic Acid 4mg/5m Inj OG Zoledronic Acid 4mg/5m Inj RCH Zoledronic Acid Z 4mg/5m Inj Zometa 4mg/vial Inj VR zoledronic acid 5mg inj Taro-Zoledronic Acid 5mg/100m Inj TAR Teva-Zoledronic Acid 5mg/100m Inj TV Zoledronic Acid 5mg/100m Inj RCH Aclasta 5mg/100m Inj VR 05BB BISHOSHOATS, COBIATIOS 05BB01 TIDROIC ACID AD CACIU, SQUTIA etidronic disodium 400mg & calcium carbonate 500mg tab, sequential kit CO tidrocal Kit tidrocal Kit (discontinued) Didrocal Kit (discontinued) WC 05BB03 ADROIC ACID AD CHOCACIFRO alendronic acid 70mg & cholecalciferol 2800 IU tab Alendronate/Cholecalciferol 70mg/2800 IU Tab TV Fosavance 70mg/2800 IU Tab FRS alendronic acid 70mg & cholecalciferol 5600 IU tab Alendronate/Cholecalciferol 70mg/5600 IU Tab C TV Sandoz Alendronate/Cholecalciferol 70mg/140mcg Tab C Fosavance 70mg/5600 IU Tab C FRS 05BX OTHR DRUGS AFFCTIG IRAIZATIO 05BX04 DOSUAB rolia 60mg/m Inj AGA Xgeva 120mg/1.7m Sol AGA ovember

163 01 01A 01AH ervous System AASTHTICS AASTHTICS, GRA OIOID ASTHTICS 01AH01 FTA fentanyl citrate 50mcg/m inj Fentanyl Citrate 50mcg/m Inj Fentanyl Citrate 50mcg/m Inj HOS 01AH02 AFTAI alfentanil 500mcg/m inj Alfentanil 500mcg/m Inj (discontinued) Alfenta 500mcg/m Inj (discontinued) JA 01AH03 SUFTAI sufentanil citrate 50mcg/m inj Sufentanil Citrate 50mcg/m Inj D C Sufenta 50mcg/m Inj (discontinued) JA 01AX VARIOUS GRA AASTHTICS 01AX03 KTAI ketamine 10mg/m inj Ketamine 10mg/m Inj Ketalar 10mg/m Inj RF ketamine 50mg/m inj Ketamine 50mg/m Inj Ketalar 50mg/m Inj RF 01B 01BB OCA AASTHTICS, XC DRATOOGICAS AIDS 01BB01 BUIVACAI arcaine 0.25% Inj C HOS Sensorcaine 0.25% Inj C AZ arcaine 0.5% Inj C HOS Sensorcaine 0.5% Inj C AZ 01BB02 IDOCAI Xylocaine 1% (with perservative) C AZ Xylocaine 1% Inj C AZ Xylocaine 2% (with perservative) C AZ Xylocaine 2% Inj C AZ Xylocaine 2% Jelly Inj C AZ idodan ndotracheal 10mg/ACT iq OD 01BB52 IDOCAI, COBIATIOS Xylocaine 2% W pine Inj C AZ ovember

164 02 02A 02AA ervous System AAGSICS OIOIDS ATURA OIU AKAOIDS 02AA01 ORHI orphine pidural 0.5mg/m Inj orphine pidural 1mg/m Inj ratio-orphine 1mg/m Syr D C TV Statex 1mg/m Syr D C A orphine Sulfate 2mg/m Inj D C orphine Sulfate 2mg/m Inj D C ratio-orphine 5mg/m Syr D C TV OS Sulphate 5mg Tab D C V S-IR 5mg Tab D C FR Statex 5mg Tab D C A Statex 5mg/m Syr D C A morphine sulfate 10mg/m inj orphine Sulfate 10mg/m Inj D C orphine Sulfate 10mg/m Inj (ABB) (discontinued) ABB ratio-orphine 10mg/m Syr D C TV Kadian 10mg Cap D C ABB -slon R 10mg Cap D C SAV OS Sulphate 10mg Tab D C V S-IR 10mg Tab D C FR Statex 10mg Supp D C A Statex 10mg Tab D C A morphine sulfate 15mg SR tab orphine SR 15mg Tab D C ovo-orphine SR 15mg Tab D C TV Sandoz orphine SR 15mg Tab D C S Contin 15mg Tab D C FR morphine sulfate 15mg/m inj orphine Sulfate 15mg/m Inj D C orphine Sulfate 15mg/m Inj (ABB - discontinued) ABB -slon R 15mg Cap D C SAV Kadian 20mg Cap D C ABB S-IR 20mg Tab D C FR Statex 20mg Supp D C A Statex 20mg/m Drops D C A orphine H 25mg/m Inj D C OS Sulphate 25mg Tab D C V Statex 25mg Tab D C A morphine sulfate 30mg SR tab orphine SR 30mg Tab D C ovo-orphine SR 30mg Tab D C TV Sandoz orphine SR 30mg Tab D C ovember

165 ervous System S Contin 30mg Tab D C FR -slon R 30mg Cap D C SAV OS-SR 30mg Tab D C V S-IR 30mg Tab D C FR Statex 30mg Supp D C A orphine H 50mg/m Inj D C Kadian 50mg Cap D C ABB OS Sulphate 50mg Tab D C V Statex 50mg Tab D C A Statex 50mg/m Drops D C A morphine sulfate 60mg SR tab orphine SR 60mg Tab D C ovo-orphine SR 60mg Tab D C TV Sandoz orphine SR 60mg Tab D C S Contin 60mg Tab D C FR -slon R 60mg Cap D C SAV OS-SR 60mg Tab (discontinued) V morphine sulfate 100mg SR tab ovo-orphine SR 100mg Tab D C TV S Contin 100mg Tab D C FR Kadian 100mg Cap D C ABB -slon R 100mg Cap D C SAV morphine sulfate 200mg SR tab ovo-orphine SR 200mg Tab D C TV S Contin 200mg Tab D C FR -slon R 200mg Cap D C SAV 02AA03 HDROORHO hydromorphone 1mg/m oral sol pms-hydromorphone 1mg/m Oral Sol D C S Dilaudid 1mg/m Oral Sol D C FR hydromorphone HCl 1mg tab Apo-Hydromorphone 1mg Tab D C pms-hydromorphone 1mg Tab D C S Teva-Hydromorphone 1mg Tab D C TV Dilaudid 1mg Tab D C FR hydromorphone 2mg/m inj Hydromorphone 2mg/m Inj D C Dilaudid 2mg/m Inj D C FR hydromorphone HCl 2mg tab Apo-Hydromorphone 2mg Tab D C pms-hydromorphone 2mg Tab D C S Teva-Hydromorphone 2mg Tab D C TV Dilaudid 2mg Tab D C FR Hydromorph Contin 3mg Cap D C FR ovember

166 ervous System hydromorphone HCl 4mg tab Apo-Hydromorphone 4mg Tab D C pms-hydromorphone 4mg Tab D C S Teva-Hydromorphone 4mg Tab D C TV Dilaudid 4mg Tab D C FR Jurnista 4mg Tab JA Hydromorph Contin 4.5mg Cap D C FR Hydromorph Contin 6mg Cap D C FR hydromorphone HCl 8mg tab Apo-Hydromorphone 8mg Tab D C pms-hydromorphone 8mg Tab D C S Teva-Hydromorphone 8mg Tab D C TV Dilaudid 8mg Tab D C FR Junista 8mg Tab JA Hydromoprh Contin 9mg Cap D C FR hydromorphone 10mg/m inj Hydromorphone H 10mg/m Inj D C Dilaudid H 10mg/m Inj D C FR Hydromorph Contin 12mg Cap D C FR Junista 16mg Tab JA Hydromorph Contin 18mg Cap D C FR hydromorphone 20mg/m inj Hydromorphone H 20mg/m Inj D C Dilaudid H lus 20mg/m Inj (discontinued) FR Hydromorph Contin 24mg Cap D C FR Hydromorph Contin 30mg Cap D C FR Junista 32mg Tab JA hydromorphone 50mg/m inj Hydromorphone H 50mg/m Inj D C Dilaudid X 50mg/m Inj (discontinued) FR 02AA05 OXCODO Targin 2.5/5mg Tab FR oxycodone 5mg tab (Oxy-IR) pms-oxycodone 5mg Tab D C S Oxy-IR 5mg Tab D C FR oxycodone 5mg tab (Supeudol) pms-oxycodone 5mg Tab D C S Supeudol 5mg Tab D C Targin 5/10mg Tab FR oxycodone 10mg tab (Oxy-IR) pms-oxycodone 10mg Tab D C S Oxy-IR 10mg Tab D C FR ovember

167 ervous System oxycodone 10mg tab (Supeudol) pms-oxycodone 10mg Tab D C S Supeudol 10mg Tab D C Oxyeo 10mg Tab FR Supeudol 10mg Supp D C Targin 10/20mg Tab FR Oxyeo 15mg Tab FR oxycodone 20mg tab (Oxy-IR) pms-oxycodone 20mg Tab D C S Oxy-IR 20mg Tab D C FR oxycodone 20mg tab (Supeudol) pms-oxycodone 20mg Tab D C S Supeudol 20mg Tab Oxyeo 20mg Tab FR Supeudol 20mg Supp D C Targin 20/40mg Tab FR Oxyeo 30mg Tab FR Oxyeo 40mg Tab FR Oxyeo 60mg Tab FR Oxyeo 80mg Tab FR 02AA59 CODI, COBIATIOS XC. SCHOTICS ratio-mtec Tab D C TV ratio-enoltec #3 Tab D C TV ratio-enoltec #4 Tab D C TV 292 Tab D C D Atasol 30 Tab D C CHU Tylenol #3 Tab D C JA Tylenol #4 Tab D C JA 02AB HIRIDI DRIVATIVS 02AB02 THIDI (RIDI) pethidine 50mg/m inj eperidine 50mg/m Inj D C Demerol 50mg/m Inj (discontinued) SAV Demerol 50mg Tab SAV pethidine 75mg/m inj eperidine 75mg/m Inj D C Demerol 75mg/m Inj (discontinued) SAV pethidine 100mg/m inj eperidine 100mg/m Inj D C Demerol 100mg/m Inj (discontinued) HOS 02AB03 FTA fentanyl 12mcg/hr patch ovember

168 ervous System CO Fentanyl 12mcg/hr atch D COB A-Fentanyl atrix 12mcg/hr atch D pms-fentanyl TX 12mcg/hr atch D S RA-Fentanyl TX 12mcg/hr atch D RA Sandoz Fentanyl 12mcg/hr atch D Teva-Fentanyl 12mcg/hr atch D TV Duragesic 12mcg/hr atch (discontinued) JA fentanyl 25mcg/hr patch Apo-Fentanyl 25mcg/hr atch D CO Fentanyl 25mcg/hr atch D COB A-Fentanyl atrix 25mcg/hr atch D pms-fentanyl TX 25mcg/hr atch D S RA-Fentanyl TX 25mcg/hr atch D RA Sandoz Fentanyl 25mcg/hr atch D Teva-Fentanyl 25mcg/hr atch D TV Duragesic 25mcg/hr atch (discontinued) JA Duragesic AT 25mcg/hr atch D JA fentanyl 50mcg/hr patch Apo-Fentanyl 50mcg/hr atch D CO Fentanyl 50mcg/hr atch D COB A-Fentanyl atrix 50mcg/hr atch D pms-fentanyl 50mcg/hr atch D S RA-Fentanyl TX 50mcg/hr atch D RA Sandoz Fentanyl 50mcg/hr atch D Teva-Fentanyl 50mcg/hr atch D TV Duragesic 50mcg/hr atch (discontinued) JA Duragesic AT 50mcg/hr atch D JA fentanyl 75mcg/hr patch Apo-Fentanyl 75mcg/hr atch D CO Fentanyl 75mcg/hr atch D COB A-Fentanyl atrix 75mcg/hr atch D pms-fentanyl 75mcg/hr atch D S RA-Fentanyl TX 75mcg/hr atch D RA Sandoz Fentanyl 75mcg/hr atch D Teva-Fentanyl 75mcg/hr atch D TV Duragesic 75mcg/hr atch (discontinued) JA Duragesic AT 75mcg/hr atch D JA fentanyl 100mcg/hr patch Apo-Fentanyl 100mcg/hr atch D CO Fentanyl 100mcg/hr atch D COB A-Fentanyl atrix 100mcg/hr atch D pms-fentanyl 100mcg/hr atch D S RA-Fentanyl TX 100mcg/hr atch D RA Sandoz Fentanyl 100mcg/hr atch D Teva-Fentanyl 100mcg/hr atch D TV Duragesic 100mcg/hr atch (discontinued) JA Duragesic AT 100mcg/hr atch D JA Abstral 100mcg S Tab A ovember

169 ervous System Abstral 200mcg S Tab A Abstral 300mcg S Tab A Abstral 400mcg S Tab A Abstral 600mcg S Tab A 02AD BZOORHA DRIVATIVS 02AD01 DXTROROOXH Talwin 30mg/m Inj HOS Talwin 50mg Tab SAV 02A ORIAVI DRIVATIVS 02A01 BURORHI Butrans-5 5mcg/hr atch FR Butrans-10 10mcg/hr atch FR Butrans-20 20mcg/hr atch FR 02AF ORHIA DRIVATIVS 02AF01 BUTORHAO butorphanol 10mg/m nasal sp Apo-Butorphanol asal Sp D AA Stadol S 10mg/m asal Sp (discontinued) B 02AX OTHR OIOIDS 02AX02 TRAADO tramadol 50mg Tab Apo-Tramadol 50mg Tab Ultram 50mg Tab JA Ralivia 100mg Tab V Zytram X 150mg Tab FR Ralivia 200mg Tab V Zytram X 200mg Tab FR Ralivia 300mg Tab V Zytram X 300mg Tab FR Zytram X 400mg Tab FR 02AX52 TRAADO, COBIATIOS tramadol 37.5mg & acetaminophen 325mg tab Apo-Tramadol/Acet 37.5/325mg Tab CO Tramadol/Acet 37.5/325mg Tab Jamp-Acet-Tramadol 325/37.5mg Tab JC ar-tramadol/acet 37.5/325mg Tab AR IT-Tramadol/Acet 37.5/325mg Tab T A-Tramadol/Acet 37.5/325mg Tab pms-tramadol/acet 37.5/325mg Tab S RA-Tramadol/Acet 37.5/325mg Tab RA ovember

170 ervous System Teva-Tramadol/Acetaminophen 37.5/325mg Tab TV Tramadol/Acet 37.5/325mg Tab SIV Tramadol/Acet 37.5/325mg Tab Tramacet 37.5/325mg Tab JA 02B 02BA OTHR AAGSICS AD ATIRTICS SAICIC ACID AD DRIVATIVS 02BA01 ACTSAICIC ACID ASATAB 80mg Chewable Tab OD acetylsalicylic acid 325mg C tab ntrophen 325mg Tab D ovasen 325mg Tab TV pms-asa C 325mg Tab S ASATAB C 325mg Tab OD nteric Coated ASA 325mg Tab JC acetylsalicylic acid 650mg C tab ovasen 650mg Tab C TV ntrophen 650mg Tab (discontinued) D nteric Coated ASA 650mg Tab C JC 02BA11 DIFUISA diflunisal 250mg tab Apo-Diflunisal 250mg Tab (discontinued) AA ovo-diflunisal 250mg Tab C TV Dolobid 250mg Tab (discontinued) IH diflunisal 500mg tab Apo-Diflunisal 500mg Tab (discontinued) Dolobid 500mg Tab (discontinued) IH 02BA51 ACTSAICIC ACID (ASA) COBIATIOS XC. SCHOTICS ratio-oxycodan Tab D C TV 02BA71 ACTSAICIC ACID (ASA) COBIATIOS WITH SCHOTICS ratio-tecnal Tab D C TV acetylsalicylic acid 330mg, butalbital 50mg, caffeine 40mg & codeine phosphate 15mg cap ratio-tecnal C1/4 Cap D C TV Fiorinal C1/4 Cap D C VR acetylsalicylic acid 330mg, butalbital 50mg, caffeine 40mg & codeine phosphate 30mg cap ratio-tecnal C1/2 Cap D C TV Fiorinal C1/2 Cap D C VR acetylsalicylic acid 330mg, butalbital 50mg & caffeine 40mg cap ratio-tecnal Cap D C TV Fiorinal Cap D C VR 02B AIIDS ovember

171 ervous System 02B01 ACTAIOH (ARACTAO) Assorted Generic Brands Tylenol 325mg Caplets JJ Tylenol 325mg Tab JJ Tylenol 500mg Caplets JJ Tylenol 500mg Tab JJ 02B51 ACTAIOH, COB. XC. SCHOTICS pms-acetaminophen W Codeine lx D C S ratio-enoltec #2 Tab D C TV Atasol 15 Tab D C CHU ercocet Demi Tab D C BRI Tylenol #2 Tab D C JA acetaminophen 325mg & oxycodone 5mg tab Apo-Oxycodone/Acet 5/325mg Tab D C Oxycodone/Acet 5/325mg Tab D C ratio-oxycocet Tab D C TV Sandoz Oxycodone Acet 5/325mg Tab D C ndocet Tab D C BRI ercocet Tab D C BRI 02BG OTHRS,AAGSICS AD ATIRTICS 02BG04 FOCTAFI floctafenine 200mg tab Floctafenine 200mg Tab C AA Idarac 200mg Tab (discontinued) SAV floctafenine 400mg tab Floctafenine 400mg Tab C AA Idarac 400mg Tab (discontinued) SAV 02BG99 CAABIOID DRIVATIVS, COBIATIOS Sativex Spray BA 02C 02CA ATIIGRAI RARATIOS RGOT AKAOIDS 02CA01 DIHDRORGOTAI Dihydroergotamine 1mg/m Inj STR igranal 4mg/m asal Spray STR 02CC SCTIV 5HT1-RCTOR AGOISTS 02CC01 SUATRITA Imitrex 5mg asal Spray GSK sumatriptan 12mg/m inj Sumatriptan SU 6mg/0.5m Inj TAR Imitrex 6mg/0.5m Inj GSK ovember

172 ervous System Imitrex Stat Dose Kit With Case Inj 12mg/m iq GSK Imitrex Unit Dose Inj 12mg/m iq GSK Imitrex 20mg asal Spray GSK sumatriptan 25mg tab CO Sumatriptan 25mg Tab A-Sumatriptan 25mg Tab ovo-sumatriptan DF 25mg Tab TV pms-sumatriptan 25mg Tab S Imitrex DF 25mg Tab (discontinued) GSK sumatriptan 50mg tab Apo-Sumatriptan 50mg Tab CO Sumatriptan 50mg Tab A-Sumatriptan 50mg Tab ovo-sumatriptan DF 50mg Tab TV pms-sumatriptan 50mg Tab S Sandoz Sumatriptan 50mg Tab Sumatriptan 50mg Tab Sumatriptan DF-50mg Tab SIV Imitrex DF 50mg Tab GSK sumatriptan 100mg tab Apo-Sumatriptan 100mg Tab CO Sumatriptan 100mg Tab A-Sumatriptan 100mg Tab ovo-sumatriptan 100mg Tab TV ovo-sumatriptan DF 100mg Tab TV pms-sumatriptan 100mg Tab S Sandoz Sumatriptan 100mg Tab Sumatriptan 100mg Tab Sumatriptan DF-100mg Tab SIV Imitrex DF 100mg Tab GSK 02CC02 ARATRITA naratriptan 1mg tab ovo-aratriptan 1mg Tab TV Amerge 1mg Tab GSK naratriptan 2.5mg tab ovo-aratriptan 2.5mg Tab TV Sandoz-aratriptan 2.5mg Tab Amerge 2.5mg Tab GSK 02CC03 ZOITRITA zolmitriptan 2.5mg tab Jamp-Zolmitriptan 2.5mg Tab JC ar-zolmitriptan 2.5mg Tab AR IT-Zolmitriptan 2.5mg Tab T A-Zolmitriptan 2.5mg Tab pms-zolmitriptan 2.5mg Tab S Sandoz Zolmitriptan 2.5mg Tab ovember

173 ervous System Teva-Zolmitriptan 2.5mg Tab TV Zomig 2.5mg Tab AZ zolmitriptan ODT 2.5mg tab Jamp-Zolmitriptan ODT 2.5mg Tab JC IT-Zolmitriptan ODT 2.5mg Tab T A-Zolmitriptan ODT 2.5mg Tab pms-zolmitriptan ODT 2.5mg Tab S Sandoz Zolmitriptan ODT 2.5mg Tab Septa-Zolmitriptan ODT 2.5mg Tab ST Teva-Zolmitriptan OD 2.5mg Tab TV Zomig Rapimelt 2.5mg Tab AZ Zomig 2.5mg asal Spray AZ Zomig 5mg asal Spray AZ 02CC04 RIZATRITA rizatriptan 5mg tab Apo-Rizatriptan 5mg Tab Jamp-Rizatriptan 5mg Tab JC axalt 5mg Tab (discontinued) FRS rizatriptan ODT 5mg tab Apo-Rizatriptan RD 5mg Tab CO Rizatriptan ODT 5mg Tab IT-Rizatriptan ODT 5mg Tab T A-Rizatriptan ODT 5mg Tab AT-Rizatriptan ODT 5mg Tab AT pms-rizatriptan RDT 5mg Tab S Sandoz Rizatriptan ODT 5mg Tab Teva-Rizatriptn ODT 5mg Tab TV axalt RD 5mg Wafers FRS rizatriptan 10mg tab Apo-Rizatriptan 10mg Tab CO Rizatriptan 10mg Tab Jamp-Rizatriptan 10mg Tab JC ar-rizatriptan 10mg Tab AR axalt 10mg Tab FRS rizatriptan ODT 10mg tab Apo-Rizatriptan RD 10mg Tab CO Rizatriptan ODT 10mg Tab IT-Rizatriptan ODT 10mg Tab T A-Rizatriptan ODT 10mg Tab AT-Rizatriptan ODT 10mg Tab AT pms-rizatriptan RDT 10mg Tab S Sandoz Rizatriptan ODT 10mg Tab Teva-Rizatriptan ODT 10mg Tab TV axalt RD 10mg Wafers FRS 02CC05 AOTRITA almotriptan 6.25mg tab ovember

174 ervous System Apo-Almotriptan 6.25mg Tab A-Almotriptan 6.25mg Tab Axert 6.25mg Tab JJ almotriptan 12.5mg tab Apo-Almotriptan 12.5mg Tab A-Almotriptan 12.5mg Tab Sandoz Almotriptan 12.5mg Tab Axert 12.5mg Tab JJ 02CC06 TRITA eletriptan 20mg tab Apo-letriptan 20mg Tab GD-letriptan 20mg Tab GD pms-letriptan 20mg Tab S Teva-letriptan 20mg Tab TV Relpax 20mg Tab eletriptan 40mg tab Apo-letriptan 40mg Tab GD-letriptan 40mg Tab GD pms-letriptan 40mg Tab S Teva-letriptan 40mg Tab TV Relpax 40mg Tab CC07 FROVATRITA frovatriptan 2.5mg tab Apo-Frovatriptan 2.5mg Tab Teva-Frovatriptan 2.5mg Tab TV Frova 2.5mg Tab T 02CX VARIOUS ATIIGRAI RARATIOS 02CX01 IZOTIF Sandomigran 0.5mg Tab A Sandomigran DS 1mg Tab A 03 03A 03AA ATIITICS ATIITICS BARBITURATS AD DRIVATIVS 03AA02 HOBARBITA henobarb 5mg/m lixir D C D henobarb 15mg Tab D C D henobarb 30mg Tab D C D henobarb 60mg Tab D C D henobarb 100mg Tab D C D 03AA03 RIIDO ovember

175 ervous System primidone 125mg tab rimidone 125mg Tab D AA ysoline 125mg Tab (discontinued) DRH primidone 250mg tab rimidone 250mg Tab D AA ysoline 250mg Tab (discontinued) DRH 03AB HDATOI DRIVATIVS 03AB02 HTOI Dilantin-30 (6mg/m) Susp C phenytoin 25mg/m susp Taro-henytoin 25mg/m Susp C TAR Dilantin-125 (25mg/m) Susp C Dilantin 30mg Cap C Dilantin 50mg Infatabs C Dilantin 100mg Cap C AD SUCCIIID DRIVATIVS 03AD01 THOSUXIID Zarontin 250mg Cap RF Zarontin 250mg/5m Syr RF 03AD03 THSUXIID (SUXIID) Celontin 300mg Cap (discontinued) RF 03A BZODIAZI DRIVATIVS AS ATIITICS 03A01 COAZA pms-clonazepam 0.25mg Tab D S clonazepam 0.5mg tab Apo-Clonazepam 0.5mg Tab D A-Clonazepam 0.5mg Tab D ovo-clonazepam 0.5mg Tab D TV pms-clonazepam 0.5mg Tab D S pms-clonazepam-r 0.5mg Tab D S Sandoz Clonazepam 0.5mg Tab (discontinued) Rivotril 0.5mg Tab D HR pms-clonazepam 1mg Tab D S Sandoz Clonazepam 1mg Tab D clonazepam 2mg tab Apo-Clonazepam 2mg Tab D CO Clonazepam 2mg Tab (discontinued) A-Clonazepam 2mg Tab D ovo-clonazepam 2mg Tab D TV pms-clonazepam 2mg Tab D S Sandoz Clonazepam 2mg Tab (discontinued) Rivotril 2mg Tab D HR ovember

176 ervous System 03AF CARBOXAID DRIVATIVS 03AF01 CARBAAZI carbamazepine 100mg chewable tab pms-carbamazepine 100mg Chewtab C S Sandoz Carbamazepine 100mg Chewtab (discontinued) Taro-Carbamazepine 100mg Chewtab C TAR Tegretol 100mg Chewtab C VR carbamazepine 20mg/m o/l Taro-Carbamazepine 100mg/5m O/ TAR Tegretol 100mg/5m O/ VR carbamazepine 200mg CR tab A-Carbamazepine CR 200mg Tab (discontinued) pms-carbamazepine CR 200mg Tab C S Sandoz Carbamazepine CR 200mg Tab C Tegretol CR 200mg Tab C VR carbamazepine 200mg chewable tab pms-carbamazepine 200mg Chewtab C S Sandoz Carbamazepine 200mg Chewtab (discontinued) Taro-Carbamazepine 200mg Chewtab TAR Tegretol 200mg Chewtab C VR carbamazepine 200mg tab Taro-Carbamazepine 200mg Tab C TAR Teva-Carbamazepine 200mg Tab C TV Tegretol 200mg Tab C VR carbamazepine 400mg CR tab A-Carbamazepine CR 400mg Tab (discontinued) pms-carbamazepine CR 400mg Tab C S Sandoz Carbamazepine CR 400mg Tab C Tegretol CR 400mg Tab C VR 03AF02 OXCARBAZI Trileptal 60mg/m O/ VR oxcarbazepine 150mg tab Apo-Oxcarbazepine 150mg Tab Trileptal 150mg Tab VR oxcarbazepine 300mg tab Apo-Oxcarbazepine 300mg Tab Trileptal 300mg Tab VR oxcarbazepine 600mg tab Apo-Oxcarbazepine 600mg Tab Trileptal 600mg Tab VR 03AF03 RUFIAID Banzel 100mg Tab IS Banzel 200mg Tab IS Banzel 400mg Tab IS ovember

177 ervous System 03AG FATT ACID DRIVATIVS 03AG01 VAROIC ACID (DIVAROX SODIU) valproic acid 50mg/m syr Apo-Valproic 50mg/m Syr pms-valproic 50mg/m Syr S Depakene 50mg/m Syr BG divalproex sodium 125mg tab Apo-Divalproex 125mg Tab Divalproex 125mg Tab ovo-divalproex 125mg Tab TV pival 125mg Tab BG divalproex sodium 250mg tab Apo-Divalproex 250mg Tab Divalproex 250mg Tab ovo-divalproex 250mg Tab TV pival 250mg Tab BG valproic acid 250mg cap Apo-Valproic 250mg Cap ovo-valproic 250mg Cap (discontinued) TV pms-valproic 250mg Cap S Depakene 250mg Cap BG divalproex sodium 500mg tab Apo-Divalproex 500mg Tab Divalproex 500mg Tab ovo-divalproex 500mg Tab TV pival 500mg Tab BG valproic acid 500mg C cap pms-valproic C 500mg Cap S Depakene 500mg Cap (discontinued) ABB 03AG04 VIGABATRI Sabril 0.5g Sachets BK Sabril 500mg Tab BK 03AX VARIOUS ATIITICS 03AX09 AOTRIGI amictal 5mg Chewable Tab GSK lamotrigine 25mg tab Apo-amotrigine 25mg Tab Auro-amotrigine 25mg Tab ARO amotrigine 25mg Tab SIV amotrigine 25mg Tab A-amotrigine 25mg Tab ovo-amotrigine 25mg Tab TV pms-amotrigine 25mg Tab S amictal 25mg Tab GSK ovember

178 ervous System lamotrigine 100mg tab Apo-amotrigine 100mg Tab Auro-amotrigine 100mg Tab ARO amotrigine 100mg Tab SIV amotrigine 100mg Tab A-amotrigine 100mg Tab ovo-amotrigine 100mg Tab TV pms-amotrigine 100mg Tab S amictal 100mg Tab GSK lamotrigine 150mg tab Apo-amotrigine 150mg Tab Auro-amotrigine 150mg Tab ARO amotrigine 150mg Tab SIV amotrigine 150mg Tab A-amotrigine 150mg Tab ovo-amotrigine 150mg Tab TV pms-amotrigine 150mg Tab S amictal 150mg Tab GSK 03AX11 TOIRAAT Topamax 15mg Sprinkle Cap JA topiramate 25mg tab Abbott-Topiramate 25mg Tab ABB Apo-Topiramate 25mg Tab Auro-Topiramate 25mg Tab ARO CO Topiramate 25mg Tab IT-Topiramate 25mg Tab T A-Topiramate 25mg Tab ovo-topiramate 25mg Tab TV pms-topiramate 25mg Tab S RA-Topiramate 25mg Tab RA Sandoz Topiramate 25mg Tab Sandoz Topiramate 25mg Tab (discontinued) Topiramate 25mg Tab AHI Topiramate 25mg Tab Topiramate-25mg Tab SIV Topamax 25mg Tab JA Topamax 25mg Sprinkle Cap JA pms-topiramate 50mg Tab S topiramate 100mg tab Abbott-Topiramate 100mg Tab ABB Apo-Topiramate 100mg Tab Auro-Topiramate 100mg Tab ARO CO Topiramate 100mg Tab IT-Topiramate 100mg Tab T A-Topiramate 100mg Tab ovo-topiramate 100mg Tab TV pms-topiramate 100mg Tab S ovember

179 ervous System RA-Topiramate 100mg Tab RA Sandoz Topiramate 100mg Tab Sandoz Topiramate 100mg Tab (discontinued) Topiramate 100mg Tab Topiramate 100mg Tab AHI Topiramate-100mg Tab SIV Topamax 100mg Tab JA topiramate 200mg tab Abbott-Topiramate 200mg Tab ABB Apo-Topiramate 200mg Tab Auro-Topiramate 200mg Tab ARO CO Topiramate 200mg Tab IT-Topiramate 200mg Tab T A-Topiramate 200mg Tab ovo-topiramate 200mg Tab TV pms-topiramate 200mg Tab S RA-Topiramate 200mg Tab RA Sandoz Topiramate 200mg Tab Sandoz Topiramate 200mg Tab (discontinued) Topiramate 200mg Tab Topiramate 200mg Tab AHI Topamax 200mg Tab JA 03AX12 GABATI gabapentin 100mg cap Apo-Gabapentin 100mg Cap Auro-Gabapentin 100mg Cap ARO CO Gabapentin 100mg Cap Gabapentin 100mg Cap () Gabapentin-100mg Cap SIV GD-Gabapentin 100mg Cap GD Jamp-Gabapentin 100mg Cap JC ar-gabapentin 100mg Cap AR A-Gabapentin 100mg Cap pms-gabapentin 100mg Cap S RA-Gabapentin 100mg Cap RA Teva-Gabapentin 100mg Cap TV eurontin 100mg Cap gabapentin 300mg cap Apo-Gabapentin 300mg Cap Auro-Gabapentin 300mg Cap ARO CO Gabapentin 300mg Cap Gabapentin 300mg Cap () Gabapentin-300mg Cap SIV GD-Gabapentin 300mg Cap GD Jamp-Gabapentin 300mg Cap JC ar-gabapentin 300mg Cap AR A-Gabapentin 300mg Cap pms-gabapentin 300mg Cap S ovember

180 ervous System RA-Gabapentin 300mg Cap RA Teva-Gabapentin 300mg Cap TV eurontin 300mg Cap gabapentin 400mg cap Apo-Gabapentin 400mg Cap Auro-Gabapentin 400mg Cap ARO CO Gabapentin 400mg Cap Gabapentin 400mg Cap () Gabapentin-400mg Cap SIV GD-Gabapentin 400mg Cap GD Jamp-Gabapentin 400mg Cap JC ar-gabapentin 400mg Cap AR A-Gabapentin 400mg Cap pms-gabapentin 400mg Cap S RA-Gabapentin 400mg Cap RA Teva-Gabapentin 400mg Cap TV eurontin 400mg Cap gabapentin 600mg tab Apo-Gabapentin 600mg Tab Gabapentin 600mg Tab AHI Gabapentin 600mg Tab Gabapentin-600mg Tab SIV GD-Gabapentin 600mg Tab GD Jamp-Gabapentin 600mg Tab JC A-Gabapentin 600mg Tab pms-gabapentin 600mg Tab S Teva-Gabapentin 600mg Tab TV eurontin 600mg Tab gabapentin 800mg tab Apo-Gabapentin 800mg Tab Gabapentin 800mg Tab Gabapentin 800mg Tab AHI Gabapentin-800mg Tab SIV GD-Gabapentin 800mg Tab GD Jamp-Gabapentin 800mg Tab JC A-Gabapentin 800mg Tab pms-gabapentin 800mg Tab S Teva-Gabapentin 800mg Tab TV eurontin 800mg Tab AX14 VTIRACTA levetiracetam 250mg tab Abbott-evetiracetam 250mg Tab ABB Apo-evetiracetam 250mg Tab Auro-evetiracetam 250mg tab ARO CO evetiracetam 250mg Tab Jamp-evetiracetam 250mg Tab JC evetiracetam 250mg Tab evetiracetam 250mg Tab AHI ovember

181 ervous System pms-evetiracetam 250mg Tab S RA-evetiracetam 250mg Tab RA Keppra 250mg Tab UCB levetiracetam 500mg tab Abbott-evetiracetam 500mg Tab ABB Apo-evetiracetam 500mg Tab Auro-evetiracetam 500mg tab ARO CO evetiracetam 500mg Tab Jamp-evetiracetam 500mg Tab JC evetiracetam 500mg Tab evetiracetam 500mg Tab AHI pms-evetiracetam 500mg Tab S RA-evetiracetam 500mg Tab RA Keppra 500mg Tab UCB levetiracetam 750mg tab Abbott-evetiracetam 750mg Tab ABB Apo-evetiracetam 750mg Tab Auro-evetiracetam 750mg tab ARO CO evetiracetam 750mg Tab Jamp-evetiracetam 750mg Tab JC evetiracetam 750mg Tab pms-evetiracetam 750mg Tab S RA-evetiracetam 750mg Tab RA Keppra 750mg Tab UCB evetiracetam 750mg Tab AHI 03AX16 RGABAI pregabalin 25mg cap Apo-regabalin 25mg Cap Auro-regabalin 25mg Cap ARO CO regabalin 25mg Cap GD-regabalin 25mg Cap (discontinued) GD ar-regabalin 25mg Cap AR IT-regabalin 25mg Cap T yl-regabalin 25mg Cap pms-regabalin 25mg Cap S regabalin 25mg Cap regabalin 25mg Cap SIV regabalin-25mg Cap SIV RA-regabalin 25mg Cap RA Sandoz regabalin 25mg Cap Teva-regabalin 25mg Cap TV yrica 25mg Cap pregabalin 50mg cap Apo-regabalin 50mg Cap Auro-regablain 50mg Cap ARO CO regabalin 50mg Cap GD-regabalin 50mg Cap (discontinued) GD ovember

182 ervous System ar-regabalin 50mg Cap AR IT-regabalin 50mg Cap T yl-regabalin 50mg Cap pms-regabalin 50mg Cap S regabalin 50mg Cap regabalin 50mg Cap SIV regabalin-50mg Cap SIV RA-regabalin 50mg Cap RA Sandoz regabalin 50mg Cap Teva-regablin 50mg Cap TV yrica 50mg Cap pregabalin 75mg cap Apo-regabalin 75mg Cap CO regabalin 75mg Cap GD-regabalin 75mg Cap (discontinued) GD ar-regabalin 75mg Cap AR IT-regabalin 75mg Cap T yl-regabalin 75mg Cap pms-regablin 75mg Cap S regabalin 75mg Cap SIV regabalin 75mg Cap regabalin-75mg Cap SIV RA-regabalin 75mg Cap RA Sandoz regabalin 75mg Cap Teva-regabalin 75mg Cap TV yrica 75mg Cap pregabalin 150mg cap Apo-regabalin 150mg Cap Auro-regabalin 150mg Cap ARO CO regabalin 150mg Cap GD-regabalin 150mg Cap (discontinued) GD ar-regabalin 150mg Cap AR IT-regabalin 150mg Cap T yl-regabalin 150mg Cap pms-regabalin 150mg Cap S regabalin 150mg Cap regabalin 150mg Cap SIV regabalin-150mg Cap SIV RA-regabalin 150mg Cap RA Sandoz regabalin 150mg Cap Teva-regabalin 150mg Cap TV yrica 150mg Cap pregabalin 225mg cap Apo-regabalin 225mg Cap CO regabalin 225mg Cap GD-regabalin 225mg Cap (discontinued) GD pms-regabalin 225mg Cap S RA-regabalin 225mg Cap RA Teva-regabalin 225mg Cap TV ovember

183 ervous System yrica 225mg Cap pregabalin 300mg cap Apo-regabalin 300mg Cap CO regabalin 300mg Cap GD-regabalin 300mg Cap (discontinued) GD yl-regabalin 300mg Cap pms-regabalin 300mg Cap S regabalin 300mg Cap regabalin 300mg Cap SIV RA-regabalin 300mg Cap RA Sandoz regabalin 300mg Cap Teva-regabalin 300mg Cap TV yrica 300mg Cap AX18 ACOSAID Vimpat 50mg Tab UCB Vimpat 100mg Tab UCB Vimpat 150mg Tab UCB Vimpat 200mg Tab UCB 03AX22 RAA Fycompa 2mg Tab IS Fycompa 4mg Tab IS Fycompa 6mg Tab IS Fycompa 8mg Tab IS Fycompa 10mg Tab IS Fycompa 12mg Tab IS 04 04A 04AA ATI-ARKISO DRUGS ATI-CHOIRGIC AGTS TRTIAR AIS WITH CARBO CHAI 04AA01 TRIHXHID Trihexyphenidyl 2mg Tab AA Trihexyphenidyl 5mg Tab AA 04AA04 ROCCIDI procyclidine HCl 0.5mg/m o/l pms-rocyclidine 0.5mg/m lx S Kemadrin 0.5mg/m O/ (discontinued) GSK procyclidine HCl 5mg tab pms-rocyclidine 5mg Tab S Kemadrin 5mg Tab (discontinued) GSK 04AA05 THOROAZI (ROFAI) ovember

184 ervous System arsitan 50mg Tab RF 04AC THRS OF TROI OR TROI DRIVATIVS 04AC01 BZTROI pms-benztropine 1mg Tab S benztropine mesylate 2mg tab Benztropine 2mg Tab S Cogentin 2mg Tab (discontinued) FRS 04B 04BA DOAIRGIC AGTS DOA AD DOA DRIVATIVS 04BA02 VODOA AD DCARBOXAS IHIBITOR rolopa Cap HR rolopa Cap HR rolopa Cap HR Duodopa 5mg/20mg/m Inj ABV levodopa 100mg & carbidopa 10mg tab Apo-evocarb 100/10 Tab ovo-evocarbidopa 100/10 Tab TV Sinemet 100/10 Tab FRS levodopa 100mg & carbidopa 25mg CR tab Apo-evocarb CR 100/25mg Tab pms-evocarb CR 100mg/25mg Tab S Sinemet CR 100/25mg Tab FRS levodopa 100mg & carbidopa 25mg tab Apo-evocarb 100/25 Tab ovo-evocarbidopa 100/25 Tab TV Sinemet 100/25 Tab FRS levodopa 200mg & carbidopa 50mg CR tab Apo-evocarb CR 200/50 Tab pms-evocarb CR 200mg/50mg Tab S Sinemet CR 200/50mg Tab FRS levodopa 250mg & carbidopa 25mg tab Apo-evocarb 250/25 Tab ovo-evocarbidopa 250/25 Tab TV Sinemet 250/25 Tab FRS 04BA03 VODOA, DCARBOXAS IHIBITOR AD COT IHIBITOR Stalevo 50mg Tab VR Stalevo 75mg Tab VR Stalevo 100mg Tab VR Stalevo 125mg Tab VR Stalevo 150mg Tab VR 04BB ADAATI DRIVATIVS ovember

185 ervous System 04BB01 AATADI amantadine HCl 10mg/m o/l pms-amantadine 10mg/m Syr D Symmetrel 10mg/m Syr (discontinued) BRI amantadine HCl 100mg cap pms-amantadine 100mg Cap D ndantadine 100mg Cap (discontinued) BRI Symmetrel 100mg Cap (discontinued) BRI 04BC DOAI AGOISTS 04BC04 ROIIRO ropinirole 0.25mg tab CO Ropinirole 0.25mg Tab Jamp-Ropinirole 0.25mg Tab JC pms-ropinirole 0.25mg Tab S RA-Ropinirole 0.25mg Tab RA Ropinirole 0.25mg Tab ReQuip 0.25mg Tab GSK ropinirole 1mg tab CO Ropinirole 1mg Tab Jamp-Ropinirole 1mg Tab JC pms-ropinirole 1mg Tab S RA-Ropinirole 1mg Tab RA Ropinirole 1mg Tab ReQuip 1mg Tab GSK ropinirole 2mg tab CO Ropinirole 2mg Tab Jamp-Ropinirole 2mg Tab JC pms-ropinirole 2mg Tab S RA-Ropinirole 2mg Tab RA ReQuip 2mg Tab GSK ropinirole 5mg tab CO Ropinirole 5mg Tab Jamp-Ropinirole 5mg Tab JC pms-ropinirole 5mg Tab S RA-Ropinirole 5mg Tab RA Ropinirole 5mg Tab ReQuip 5mg Tab GSK 04BC05 RAIXO pramipexole 0.25mg tab ACT ramipexole 0.25mg Tab Apo-ramipexole 0.25mg Tab A-ramipexole 0.25mg Tab ovo-ramipexole 0.25mg Tab TV pms-ramipexole 0.25mg Tab S ramipexole 0.25mg Tab ramipexole-0.25mg Tab SIV ovember

186 ervous System Sandoz ramipexole 0.25mg Tab irapex 0.25mg Tab BO pramipexole 0.5mg tab ACT ramipexole 0.5mg Tab Apo-ramipexole 0.5mg Tab A-ramipexole 0.5mg Tab ovo-ramipexole 0.5mg Tab TV pms-ramipexole 0.5mg Tab S ramipexole 0.5mg Tab ramipexole-0.5mg Tab SIV Sandoz ramipexole 0.5mg Tab irapex 0.5mg Tab BO pramipexole 1mg tab ACT ramipexole 1mg Tab Apo-ramipexole 1mg Tab A-ramipexole 1mg Tab ovo-ramipexole 1mg Tab TV pms-ramipexole 1mg Tab S ramipexole 1mg Tab ramipexole-1mg Tab SIV Sandoz ramipexole 1mg Tab irapex 1mg Tab BO pramipexole 1.5mg tab ACT ramipexole 1.5mg Tab Apo-ramipexole 1.5mg Tab A-ramipexole 1.5mg Tab ovo-ramipexole 1.5mg Tab TV pms-ramipexole 1.5mg Tab S ramipexole-1.5mg Tab SIV Sandoz ramipexole 1.5mg Tab irapex 1.5mg Tab BO 04BD OOAI OXIDAS T B IHIBITORS 04BD01 SGII selegiline 5mg tab Apo-Selegiline 5mg Tab A-Selegiline 5mg Tab ovo-selegiline 5mg Tab TV ldepryl 5mg Tab (discontinued) DRH 04BD02 RASAGII Azilect 0.5mg Tab T Azilect 1mg Tab T 04BX OTHR DOAIRGIC AGTS 04BX02 TACAO entacapone 200mg tab A-ntacapone 200mg Tab ovember

187 ervous System Sandoz ntacapone 200mg Tab Teva-ntacapone 200mg Tab TV Comtan 200mg Tab VR 05 05A 05AA SCHOTICS ATISCHOTICS HOTHIAZI WITH AIHATIC SID CHAI 05AA01 CHORROAZI chlorpromazine 25mg/m inj Chlorpromazine 25mg/m Inj argactil 25mg/5m Inj (discontinued) SAV Teva-Chlorpromazine 25mg Tab C TV Teva-Chlorpromazine 50mg Tab C TV Teva-Chlorpromazine 100mg Tab C TV 05AA02 THOTRIRAZI (VOROAZI) methotrimeprazine 2mg tab ethoprazine 2mg Tab C AA ozinan 2mg Tab (discontinued) SAV methotrimeprazine 5mg tab ethoprazine 5mg Tab C AA ozinan 5mg Tab (discontinued) SAV methotrimeprazine 25mg tab ethoprazine 25mg Tab C AA ozinan 25mg Tab (discontinued) SAV ozinan 25mg/m Inj C SAV methotrimeprazine 50mg tab ethoprazine 50mg Tab C AA ozinan 50mg Tab (discontinued) SAV 05AB HOTHIAZI WITH IRAZI STRUCTUR 05AB02 FUHAZI Fluphenazine 1mg Tab C AA Fluphenazine 2mg Tab C AA Fluphenazine 5mg Tab C AA pms-fluphenazine 5mg Tab C S odecate Concentrate 100mg/m Inj C BRI 05AB03 RHAZI erphenazine 2mg Tab C AA perphenazine 4mg tab erphenazine 4mg Tab C AA Trilafon 4mg Tab (discontinued) SCH erphenazine 8mg Tab C AA ovember

188 ervous System erphenazine 16mg Tab C AA 05AB04 ROCHORRAZI prochlorperazine 5mg tab rochlorazine 5mg Tab C AA Stemetil 5mg Tab (discontinued) RO prochlorperazine 5mg/m inj rochlorperazine 5mg/m Inj C Stemetil 5mg/m Inj (discontinued) RO prochlorperazine 10mg tab rochlorazine 10mg Tab C AA Stemetil 10mg Tab (discontinued) RO rochlorperazine 10mg Supp C AB06 TRIFUORAZI trifluoperazine 1mg tab Trifluoperazine 1mg Tab C AA Stelazine 1mg Tab (discontinued) GSK trifluoperazine 2mg tab Trifluoperazine 2mg Tab C AA Stelazine 2mg Tab (discontinued) GSK trifluoperazine 5mg tab Trifluoperazine 5mg Tab C AA Stelazine 5mg Tab (discontinued) GSK trifluoperazine 10mg tab Trifluoperazine 10mg Tab C AA Stelazine 10mg Tab (discontinued) GSK Trifluoperazine 20mg Tab C AA 05AB08 THIORORAZI ajeptil 10mg Tab C RF 05AC HOTHIAZI WITH IRIDI STRUCTUR 05AC01 RICAZI (RORICAZI) euleptil 5mg Cap RF euleptil 10mg Cap RF euleptil 10mg/m Oral Drops RF euleptil 20mg Cap RF 05AD BUTROHO DRIVATIVS 05AD01 HAORIDO haloperidol 0.5mg tab ovo-eridol 0.5mg Tab C TV Haldol 0.5mg Tab (discontinued) OC haloperidol 1mg tab ovo-eridol 1mg Tab C TV ovember

189 ervous System Haldol 1mg Tab (discontinued) OC haloperidol 2mg tab ovo-eridol 2mg Tab C TV Haldol 2mg Tab (discontinued) OC haloperidol 5mg tab ovo-eridol 5mg Tab C TV Haldol 5mg Tab (discontinued) OC Haloperidol 5mg/m Inj C haloperidol 10mg tab ovo-eridol 10mg Tab C TV Haldol 10mg Tab (discontinued) OC haloperidol 20mg tab ovo-eridol 20mg Tab TV Haldol 20mg Tab (discontinued) OC haloperidol A 50mg/m inj Haloperidol A 50mg/m Inj C Haldol A 50mg/m Inj (discontinued) JA haloperidol A 100mg/m inj Haloperidol A 100mg/m Inj C Haldol A 100mg/m Inj (discontinued) JA 05AD08 DRORIDO Droperidol 2.5mg/m Inj A IDO DRIVATIVS 05A04 ZIRASIDO Zeldox 20mg Cap Zeldox 40mg Cap Zeldox 60mg Cap Zeldox 80mg Cap A05 URASIDO atuda 20mg Tab SV atuda 40mg Tab SV atuda 60mg Tab SV atuda 80mg Tab SV atuda 120mg Tab SV 05AF THIOXATH DRIVATIVS 05AF01 FUTHIXO Fluanxol 0.5mg Tab C VH Fluanxol Depot 2% Inj C VH Fluanxol 3mg Tab C VH ovember

190 ervous System Fluanxol Depot 10% Inj C VH 05AF04 THIOTHIX avane 2mg Cap (discontinued) RF avane 5mg Cap C RF avane 10mg Cap (discontinued) RF 05AF05 ZUCOTHIXO Clopixol 10mg Tab VH Clopixol 25mg Tab VH Clopixol-Acuphase 50mg/m Inj VH Clopixol-Depot 200mg/m Inj VH 05AG DIHBUTIRIDI DRIVATIVS 05AG02 IOZID pimozide 2mg tab Apo-imozide 2mg Tab C AA Orap 2mg Tab C S pimozide 4mg tab Apo-imozide 4mg Tab C AA Orap 4mg Tab C S 05AH DIAZIS, OXAZIS, THIAZIS AD OXIS 05AH01 OXAI Xylac 2.5mg Tab C D loxapine 5mg tab Xylac 5mg Tab C D oxapac 5mg Tab (discontinued) WA loxapine 10mg tab Xylac10mg Tab C D oxapac 10mg Tab (discontinued) WA loxapine 25mg tab Xylac 25mg Tab C D oxapac 25mg Tab (discontinued) WA loxapine 50mg tab Xylac 50mg Tab C D oxapac 50mg Tab (discontinued) WA oxapac 50mg/m I Inj C AH02 COZAI clozapine 25mg tab Apo-Clozapine 25mg Tab Gen-Clozapine 25mg Tab Clozaril 25mg Tab VR Gen-Clozapine 50mg Tab ovember

191 ervous System clozapine 100mg tab Apo-Clozapine 100mg Tab Gen-Clozapine 100mg Tab Clozaril 100mg Tab VR Gen-Clozapine 200mg Tab AH03 OAZAI olanzapine 2.5mg tab Apo-Olanzapine 2.5mg Tab CO Olanzapine 2.5mg Tab ar-olanzapine 2.5mg Tab AR A-Olanzapine 2.5mg Tab Olanzapine 2.5mg Tab Olanzapine-2.5mg Tab SIV pms-olanzapine 2.5mg Tab S RA-Olanzapine 2.5mg Tab RA Sandoz Olanzapine 2.5mg Tab Teva-Olanzapine 2.5mg Tab TV Zyprexa 2.5mg Tab I olanzapine 5mg tab Apo-Olanzapine 5mg Tab CO Olanzapine 5mg Tab ar-olanzapine 5mg Tab AR A-Olanzapine 5mg Tab Olanzapine 5mg Tab Olanzapine-5mg Tab SIV pms-olanzapine 5mg Tab S RA-Olanzapine 5mg Tab RA Sandoz Olanzapine 5mg Tab Teva-Olanzapine 5mg Tab TV Zyprexa 5mg Tab I olanzapine ODT 5mg tab Apo-Olanzapine ODT 5mg Tab CO Olanzapine ODT 5mg Tab Jamp-Olanzapine ODT 5mg Tab JC ar-olanzapine ODT 5mg Tab AR A-Olanzapine ODT 5mg Tab ovo-olanzapine OD 5mg Tab TV Olanzapine ODT 5mg Tab Olanzapine-ODT 5mg Tab SIV pms-olanzapine ODT 5mg Tab S RA-Olanzapine ODT 5mg Tab RA Sandoz Olanzapine ODT 5mg Tab Zyprexa Zydis 5mg Tab I olanzapine 7.5mg tab Apo-Olanzapine 7.5mg Tab CO Olanzapine 7.5mg Tab ar-olanzapine 7.5mg Tab AR ovember

192 ervous System A-Olanzapine 7.5mg Tab Olanzapine 7.5mg Tab Olanzapine-7.5mg Tab SIV pms-olanzapine 7.5mg Tab S RA-Olanzapine 7.5mg Tab RA Sandoz Olanzapine 7.5mg Tab Teva-Olanzapine 7.5mg Tab TV Zyprexa 7.5mg Tab I olanzapine 10mg tab Apo-Olanzapine 10mg Tab CO Olanzapine 10mg Tab ar-olanzapine 10mg Tab AR A-Olanzapine 10mg Tab Olanzapine 10mg Tab Olanzapine-10mg Tab SIV pms-olanzapine 10mg Tab S RA-Olanzapine 10mg Tab RA Sandoz Olanzapine 10mg Tab Teva-Olanzapine 10mg Tab TV Zyprexa 10mg Tab I olanzapine ODT 10mg tab Apo-Olanzapine ODT 10mg Tab CO Olanzapine ODT 10mg Tab Jamp-Olanzapine ODT 10mg Tab JC ar-olanzapine ODT 10mg Tab AR A-Olanzapine ODT 10mg Tab ovo-olanzapine OD 10mg Tab TV Olanzapine ODT 10mg Tab Olanzapine-ODT 10mg Tab SIV pms-olanzapine ODT 10mg Tab S RA-Olanzapine ODT 10mg Tab RA Sandoz Olanzapine ODT 10mg Tab Zyprexa Zydis 10mg Tab I Zyprexa 10mg/vial Inj I olanzapine 15mg tab Apo-Olanzapine 15mg Tab CO Olanzapine 15mg Tab ar-olanzapine 15mg Tab AR A-Olanzapine 15mg Tab Olanzapine 15mg Tab Olanzapine-15mg Tab SIV pms-olanzapine 15mg Tab S RA-Olanzapine 15mg Tab RA Sandoz Olanzapine 15mg Tab Teva-Olanzapine 15mg Tab TV Zyprexa 15mg Tab I olanzapine ODT 15mg tab Apo-Olanzapine ODT 15mg Tab ovember

193 ervous System CO Olanzapine ODT 15mg Tab Jamp-Olanzapine ODT 15mg Tab JC ar-olanzapine ODT 15mg Tab AR A-Olanzapine ODT 15mg Tab ovo-olanzapine OD 15mg Tab TV Olanzapine ODT 15mg Tab Olanzapine-ODT 15mg Tab SIV pms-olanzapine ODT 15mg Tab S RA-Olanzapine ODT 15mg Tab RA Sandoz Olanzapine ODT 15mg Tab Zyprexa Zydis 15mg Tab I olanzapine 20mg tab Apo-Olanzapine 20mg Tab CO Olanzapine 20mg Tab pms-olanzapine 20mg Tab S Teva-Olanzapine 20mg TV Zyprexa 20mg Tab I olanzapine ODT 20mg tab Apo-Olanzapine ODT 20mg Tab CO Olanzapine ODT 20mg Tab Jamp-Olanzapine ODT 20mg Tab JC ar-olanzapine ODT 20mg Tab AR A-Olanzapine ODT 20mg Tab ovo-olanzapine OD 20mg Tab TV Olanzapine-ODT 20mg Tab SIV pms-olanzapine ODT 20mg Tab S RA-Olanzapine ODT 20mg Tab RA Sandoz Olanzapine ODT 20mg Tab Zyprexa Zydis 20mg Tab I 05AH04 QUTIAI quetiapine 25mg tab Abbott-Quetiapine 25mg Tab ABB Apo-Quetiapine 25mg Tab Auro-Quetiapine 25mg Tab ARO CO Quetiapine 25mg Tab Jamp-Quetiapine 25mg Tab JC ar-quetiapine 25mg Tab AR A-Quetiapine 25mg Tab ovo-quetiapine 25mg Tab TV pms-quetiapine 25mg Tab S Quetiapine 25mg Tab Quetiapine-25mg Tab SIV Quetiapine-25mg Tab AHI RA-Quetiapine 25mg Tab RA Sandoz Quetiapine 25mg Tab Seroquel 25mg Tab AZ quetiapine 50mg R tab Sandoz Quetiapine XRT 50mg Tab ovember

194 ervous System Teva-Quetiapine XR 50mg Tab TV Seroquel XR 50mg Tab AZ pms-quetiapine 50mg Tab S quetiapine 100mg tab Abbott-Quetiapine 100mg Tab ABB Apo-Quetiapine 100mg Tab Auro-Quetiapine 100mg Tab ARO CO Quetiapine 100mg Tab Jamp-Quetiapine 100mg Tab JC ar-quetiapine 100mg Tab AR A-Quetiapine 100mg Tab ovo-quetiapine 100mg Tab TV pms-quetiapine 100mg Tab S Quetiapine 100mg Tab Quetiapine-100mg Tab SIV Quetiapine-100mg Tab AHI RA-Quetiapine 100mg Tab RA Sandoz Quetiapine 100mg Tab Seroquel 100mg Tab AZ quetiapine 150mg R tab Sandoz Quetiapine XRT 150mg Tab Teva-Quetiapine XR 150mg Tab TV Seroquel XR 150mg Tab AZ quetiapine 150mg tab ovo-quetiapine 150mg Tab TV Seroquel 150mg Tab (discontinued) AZ quetiapine 200mg R tab Sandoz Quetiapine XRT 200mg Tab Teva-Quetiapine XR 200mg Tab TV Seroquel XR 200mg Tab AZ quetiapine 200mg tab Abbott-Quetiapine 200mg Tab ABB Apo-Quetiapine 200mg Tab Auro-Quetiapine 200mg Tab ARO CO Quetiapine 200mg Tab Jamp-Quetiapine 200mg Tab JC ar-quetiapine 200mg Tab AR A-Quetiapine 200mg Tab ovo-quetiapine 200mg Tab TV pms-quetiapine 200mg Tab S Quetiapine 200mg Tab Quetiapine-200mg Tab AHI Quetiapine-200mg Tab SIV RA-Quetiapine 200mg Tab RA Sandoz Quetiapine 200mg Tab Seroquel 200mg Tab AZ quetiapine 300mg R tab ovember

195 ervous System Sandoz Quetiapine XRT 300mg Tab Teva-Quetiapine XR 300mg Tab TV Seroquel XR 300mg Tab AZ quetiapine 300mg tab Abbott-Quetiapine 300mg Tab ABB Apo-Quetiapine 300mg Tab Auro-Quetiapine 300mg Tab ARO CO Quetiapine 300mg Tab Jamp-Quetiapine 300mg Tab JC ar-quetiapine 300mg Tab AR A-Quetiapine 300mg Tab ovo-quetiapine 300mg Tab TV pms-quetiapine 300mg Tab S Quetiapine 300mg Tab Quetiapine-300mg Tab AHI Quetiapine-300mg Tab SIV RA-Quetiapine 300mg Tab RA Sandoz Quetiapine 300mg Tab Seroquel 300mg Tab AZ quetiapine 400mg R tab Sandoz Quetiapine XRT 400mg Tab Teva-Quetiapine XR 400mg Tab TV Seroquel XR 400mg Tab AZ 05AH05 ASAI Saphris 5mg S Tab FRS Saphris 10mg S Tab FRS 05A ITHIU 05A01 ITHIU lithium 150mg cap (Carbolith) Apo-ithium Carbonate 150mg Cap C pms-ithium Carbonate 150mg Cap C S Carbolith 150mg Cap C V lithium 150mg cap (ithane) Apo-ithium Carbonate 150mg Cap C ithane 150mg Cap C RF lithium 300mg SR tab ithmax SR 300mg Tab C AA Duralith 300mg Tab (discontinued) JA lithium 300mg cap (Carbolith) Apo-ithium Carbonate 300mg Cap C pms-ithium Carbonate 300mg Cap C S Carbolith 300mg Cap C V lithium 300mg cap (ithane) Apo-ithium Carbonate 300mg Cap C ithane 300mg Cap C RF ovember

196 ervous System lithium 600mg cap pms-ithium Carbonate 600mg Cap C S Carbolith 600mg Cap C V 05AX OTHR UROTICS 05AX08 RISRIDO risperidone 0.25mg tab Apo-Risperidone 0.25mg Tab CO Risperidone 0.25mg Tab Jamp-Risperidone 0.25mg Tab JC ar-risperidone 0.25mg Tab AR IT-Risperidon 0.25mg Tab T A-Risperidone 0.25mg Tab ovo-risperidone 0.25mg Tab TV pms-risperidone 0.25mg Tab S RA-Risperidone 0.25mg Tab RA Risperidone 0.25mg Tab Sandoz Risperidone 0.25mg Tab Risperdal 0.25mg Tab JA risperidone 0.5mg tab Apo-Risperidone 0.5mg Tab CO Risperidone 0.5mg Tab Jamp-Risperidone 0.5mg Tab JC ar-risperidone 0.5mg Tab AR IT-Risperidon 0.5mg Tab T A-Risperidone 0.5mg Tab ovo-risperidone 0.5mg Tab TV pms-risperidone 0.5mg Tab S RA-Risperidone 0.5mg Tab RA Risperidone 0.5mg Tab Sandoz Risperidone 0.5mg Tab Risperdal 0.5mg Tab JA risperidone ODT 0.5mg tab A-Risperidone ODT 0.5mg Risperdal -Tab (0.5mg) JA risperidone 1mg tab Apo-Risperidone 1mg Tab CO Risperidone 1mg Tab Jamp-Risperidone 1mg Tab JC ar-risperidone 1mg Tab AR IT-Risperidon 1mg Tab T A-Risperidone 1mg Tab ovo-risperidone 1mg Tab TV pms-risperidone 1mg Tab S RA-Risperidone 1mg Tab RA Risperidone 1mg Tab Sandoz Risperidone 1mg Tab Risperdal 1mg Tab JA ovember

197 ervous System risperidone 1mg/m o/l Apo-Risperidone 1mg/m O/ pms-risperidone 1mg/m O/ S Risperdal 1mg/m O/ JA risperidone ODT 1mg tab A-Risperidone ODT 1mg Tab pms-risperidone ODT 1mg Tab S Risperdal -Tab (1mg) JA risperidone 2mg tab Apo-Risperidone 2mg Tab CO Risperidone 2mg Tab Jamp-Risperidone 2mg Tab JC ar-risperidone 2mg Tab AR IT-Risperidon 2mg Tab T A-Risperidone 2mg Tab ovo-risperidone 2mg Tab TV pms-risperidone 2mg Tab S RA-Risperidone 2mg Tab RA Risperidone 2mg Tab Sandoz Risperidone 2mg Tab Risperdal 2mg Tab JA risperidone ODT 2mg tab A-Risperidone ODT 2mg Tab pms-risperidone ODT 2mg Tab S Risperdal -Tab (2mg) JA risperidone 3mg tab Apo-Risperidone 3mg Tab CO Risperidone 3mg Tab Jamp-Risperidone 3mg Tab JC ar-risperidone 3mg Tab AR IT-Risperidon 3mg Tab T A-Risperidone 3mg Tab ovo-risperidone 3mg Tab TV pms-risperidone 3mg Tab S RA-Risperidone 3mg Tab RA Risperidone 3mg Tab Sandoz Risperidone 3mg Tab Risperdal 3mg Tab JA risperidone ODT 3mg tab A-Risperidone ODT 3mg Tab pms-risperidone ODT 3mg Tab S Risperdal -Tab (3mg) JA risperidone 4mg tab Apo-Risperidone 4mg Tab CO Risperidone 4mg Tab Jamp-Risperidone 4mg Tab JC ar-risperidone 4mg Tab AR IT-Risperidon 4mg Tab T ovember

198 ervous System A-Risperidone 4mg Tab ovo-risperidone 4mg Tab TV pms-risperidone 4mg Tab S RA-Risperidone 4mg Tab RA Risperidone 4mg Tab Sandoz Risperidone 4mg Tab Risperdal 4mg Tab JA risperidone ODT 4mg tab A-Risperidone ODT 4mg Tab pms-risperidone ODT 4mg Tab S Risperdal -Tab (4mg) JA Risperdal Consta 12.5mg/2m Inj JA Risperdal Consta 25mg/2m Inj JA Risperdal Consta 37.5mg/2m Inj JA Risperdal Consta 50mg/2m Inj JA 05AX12 ARIIRAZO Abilify 2mg Tab BRI Abilify 5mg Tab BRI Abilify 10mg Tab BRI Abilify 15mg Tab BRI Abilify 20mg Tab BRI Abilify 30mg Tab BRI Abilify aintena 300mg/Vial Inj BRI Abilify aintena 400mg/Vial Inj BRI 05AX13 AIRIDO Invega Sustenna 50mg/0.5m Kit JA Invega Sustenna 75mg/0.75m Kit JA Invega Sustenna 100mg/1m Kit JA Invega Sustenna 150mg/1.5m Kit JA 05B 05BA AXIOTICS BZODIAZI DRIVATIVS 05BA01 DIAZA pms-diazepam 1mg/m O/ D C S Apo-Diazepam 2mg Tab D C pms-diazepam 2mg Tab D C S diazepam 5mg tab Apo-Diazepam 5mg Tab D C Valium 5mg Tab D C HR Vivol 5mg Tab (discontinued) AXS ovember

199 ervous System diazepam 5mg/m inj Diazepam 5mg/m Inj D C Valium 5mg/m Inj (discontinued) HR pms-diazepam 5mg Tab D C S Diastat 5mg/m Rectal Gel V Diazemuls 5mg/m Inj D C diazepam 10mg tab Apo-Diazepam 10mg Tab D C Valium 10mg Tab (discontinued) HR Vivol 10mg Tab (discontinued) AXS pms-diazepam 10mg Tab D C S 05BA02 CHORDIAZOXID Chlordiazepoxide 5mg Cap D C AA Chlordiazepoxide 10mg Cap D C AA Chlordiazepoxide 25mg Cap D C AA 05BA04 OXAZA oxazepam 10mg tab Apo-Oxazepam 10mg Tab D C Serax 10mg Tab (discontinued) WA oxazepam 15mg tab Apo-Oxazepam 15mg Tab D C Serax 15mg Tab (discontinued) WA oxazepam 30mg tab Apo-Oxazepam 30mg Tab D C Serax 30mg Tab (discontinued) WA 05BA05 CORAZAT DIOTASSIU clorazepate dipotassium 3.75mg cap Clorazepate 3.75mg Cap D C AA Tranxene 3.75mg Cap (discontinued) ABB clorazepate dipotassium 7.5mg cap Clorazepate 7.5mg Cap D C AA Tranxene 7.5mg Cap (discontinued) ABB clorazepate dipotassium 15mg cap Clorazepate 15mg Cap D C AA Tranxene 15mg Cap (discontinued) ABB 05BA06 ORAZA lorazepam 0.5mg S tab Apo-orazepam 0.5mg S Tab Ativan 0.5mg S Tab lorazepam 0.5mg tab Apo-orazepam 0.5mg Tab D C orazepam 0.5mg Tab D C ovember

200 ervous System ovo-orazem 0.5mg Tab D C TV pms-orazepam 0.5mg Tab D C S Ativan 0.5mg Tab D C lorazepam 1mg S tab Apo-orazepam 1mg S Tab Ativan 1mg S Tab lorazepam 1mg tab Apo-orazepam 1mg Tab D C orazepam 1mg Tab D C ovo-orazem 1mg Tab D C TV pms-orazepam 1mg Tab D C S Ativan 1mg Tab D C lorazepam 2mg S tab Apo-orazepam 2mg S Tab Ativan 2mg S Tab lorazepam 2mg tab Apo-orazepam 2mg Tab D C orazepam 2mg Tab D C ovo-orazem 2mg Tab D C TV pms-orazepam 2mg Tab D C S Ativan 2mg Tab D C lorazepam 4mg/m inj orazepam 4mg/m Inj D C Ativan 4mg/m Inj (discontinued) WA 05BA08 BROAZA bromazepam 1.5mg tab Apo-Bromazepam 1.5mg Tab D C ectopam 1.5mg Tab (discontinued) HR bromazepam 3mg tab Apo-Bromazepam 3mg Tab D C ovo-bromazepam 3mg Tab D C TV ectopam 3mg Tab D C HR bromazepam 6mg tab Apo-Bromazepam 6mg Tab D C ovo-bromazepam 6mg Tab D C TV ectopam 6mg Tab D C HR 05BA09 COBAZA clobazam 10mg tab Apo-Clobazam 10mg Tab D ovo-clobazam 10mg Tab D TV pms-clobazam 10mg Tab (discontinued) S Frisium 10mg Tab D BK 05BA12 ARAZOA alprazolam 0.25mg tab ovember

201 ervous System Alprazolam 0.25mg Tab D C Apo-Alpraz 0.25mg Tab D C Jamp-Alprazolam 0.25mg Tab D C JC A-Alprazolam 0.25mg Tab D C AT-Alprazolam 0.25mg Tab D C AT Teva-Alprazolam 0.25mg Tab D C TV Xanax 0.25mg Tab D C alprazolam 0.5mg tab Alprazolam 0.5mg Tab D C Apo-Alpraz 0.5mg Tab D C A-Alprazolam 0.5mg Tab D C AT-Alprazolam 0.5mg Tab D C AT Teva-Alprazolam 0.5mg Tab D C TV Jamp-Alprazolam 0.5mg Tab D C JC Xanax 0.5mg Tab D C alprazolam 1mg tab Apo-Alpraz 1mg Tab Jamp-Alprazolam 1mg Tab JC A-Alprazolam 1mg Tab AT-Alprazolam 1mg Tab AT Xanax 1mg Tab alprazolam 2mg tab Apo-Alpraz 2mg Tab A-Alprazolam 2mg Tab Xanax 2mg Tab BB DIHTHA DRIVATIVS 05BB01 HDROXZI Atarax 2mg/m Syr RF hydroxyzine HCl 10mg cap Apo-Hydroxyzine 10mg Cap ovo-hydroxyzin 10mg Cap TV Atarax 10mg Cap (discontinued) RF hydroxyzine HCl 25mg cap Apo-Hydroxyzine 25mg Cap ovo-hydroxyzin 25mg Cap TV Atarax 25mg Cap (discontinued) RF hydroxyzine 50mg/m inj Hydroxyzine 50mg/m Inj Atarax 50mg/m Inj (discontinued) RF hydroxyzine HCl 50mg cap Apo-Hydroxyzine 50mg Cap ovo-hydroxyzin 50mg Cap TV Atarax 50mg Cap (discontinued) RF 05B AZASIRODCADIO DRIVATIVS 05B01 BUSIRO ovember

202 ervous System buspirone HCl 10mg tab Apo-Buspirone 10mg Tab C ovo-buspirone 10mg Tab C TV pms-buspirone 10mg Tab C S Buspar 10mg Tab (discontinued) BRI 05C 05CC HOTICS AD SDATIVS ADHDS AD DRIVATIVS 05CC01 CHORA HDRAT Chloral Hydrate-ODA 100mg/m Syr C OD pms-chloral Hydrate 100mg/m Syr C S 05CD BZODIAZI DRIVATIVS 05CD01 FURAZA flurazepam 15mg cap Apo-Flurazepam 15mg Cap AA Dalmane 15mg Cap (discontinued) V flurazepam 30mg cap Apo-Flurazepam 30mg Cap AA Dalmane 30mg Cap (discontinued) V 05CD02 ITRAZA nitrazepam 5mg tab ogadon 5mg Tab AA itrazadon 5mg Tab (discontinued) V nitrazepam 10mg tab ogadon 10mg Tab AA itrazadon 10mg Tab (discontinued) V 05CD05 TRIAZOA Triazolam 0.125mg Tab (discontinued) AA Triazolam 0.25mg Tab D C AA 05CD07 TAZA temazepam 15mg cap Apo-Temazepam 15mg Cap D C CO Temazepam 15mg Cap (discontinued) ovo-temazepam 15mg Cap D C TV Restoril 15mg Cap D C SV temazepam 30mg cap Apo-Temazepam 30mg Cap D C CO Temazepam 30mg Cap (discontinued) ovo-temazepam 30mg Cap D C TV Restoril 30mg Cap D C SV 05CD08 IDAZOA midazolam 1mg/m inj ovember

203 ervous System idazolam 1mg/m Inj D idazolam 1mg/m Inj D Versed 1mg/m Inj (discontinued) HR midazolam 5mg/m inj idazolam 5mg/m Inj D idazolam 5mg/m Inj D Versed 5mg/m Inj (discontinued) HR 05CF BZODIAZI RATD DRUGS 05CF01 ZOICO zopiclone 5mg tab Apo-Zopiclone 5mg Tab C CO Zopiclone 5mg Tab C Jamp-Zopiclone 5mg Tab C JC ar-zopiclone 5mg Tab C AR IT-Zopiclone 5mg Tab C T A-Zopiclone 5mg Tab C ovo-zopiclone 5mg Tab (discontinued) TV pms-zopiclone 5mg Tab C S RA-Zopiclone 5mg Tab C RA ratio-zopiclone 5mg Tab C TV Sandoz Zopiclone 5mg Tab C Septa-Zopiclone 5mg Tab C ST Zopiclone 5mg Tab C Zopiclone-5mg Tab C SIV Imovane 5mg Tab C SAV zopiclone 7.5mg tab Apo-Zopiclone 7.5mg Tab CO Zopiclone 7.5mg Tab Jamp-Zopiclone 7.5mg Tab JC Jamp-Zopiclone 7.5mg Tab JC ar-zopiclone 7.5mg Tab AR IT-Zopiclone 7.5mg Tab T A-Zopiclone 7.5mg Tab ovo-zopiclone 7.5mg Tab (discontinued) TV pms-zopiclone 7.5mg Tab S RA-Zopiclone 7.5mg Tab RA ratio-zopiclone 7.5mg Tab TV Sandoz Zopiclone 7.5mg Tab Septa-Zopiclone 7.5mg Tab ST Zopiclone 7.5mg Tab Zopiclone-7.5mg Tab SIV Imovane 7.5mg Tab SAV Rhovane 7.5mg Tab CF02 ZOID zolpidem ODT 5mg tab Apo-Zolpidem ODT 5mg Tab Sublinox 5mg S Tab V ovember

204 ervous System zolpidem ODT 10mg tab Apo-Zolpidem ODT 10mg Tab Sublinox 10mg S Tab V 06 06A 06AA SCHOAATICS ATIDRSSATS TRICCIC DRIVATIVS 06AA01 DSIRAI desipramine 10mg tab Desipramine 10mg Tab C AA orpramin 10mg Tab (discontinued) SAV desipramine 25mg tab Desipramine 25mg Tab C AA orpramin 25mg Tab (discontinued) SAV desipramine 50mg tab Desipramine 50mg Tab C AA orpramin 50mg Tab (discontinued) SAV desipramine 75mg tab Desipramine 75mg Tab C AA orpramin 75mg Tab (discontinued) SAV desipramine 100mg tab Desipramine 100mg Tab C AA orpramin 100mg Tab (discontinued) SAV 06AA02 IIRAI imipramine 10mg tab Imipramine 10mg Tab C AA Tofranil 10mg Tab (discontinued) VR imipramine 25mg tab Imipramine 25mg Tab C AA Tofranil 25mg Tab (discontinued) VR imipramine 50mg tab Imipramine 50mg Tab C AA Tofranil 50mg Tab (discontinued) VR Imipramine 75mg Tab C AA 06AA04 COIRAI clomipramine 10mg tab Apo-Clomipramine 10mg Tab (discontinued) CO Clomipramine 10mg Tab (discontinued) Anafranil 10mg Tab C AR clomipramine 25mg tab Apo-Clomipramine 25mg Tab (discontinued) CO Clomipramine 25mg Tab C Anafranil 25mg Tab C AR ovember

205 ervous System clomipramine 50mg tab Apo-Clomipramine 50mg Tab (discontinued) CO Clomipramine 50mg Tab C Anafranil 50mg Tab C AR 06AA06 TRIIRAI trimipramine 12.5mg tab Trimipramine 12.5mg Tab C AA Surmontil 12.5mg Tab (discontinued) SAV trimipramine 25mg tab Trimipramine 25mg Tab C AA Surmontil 25mg Tab (discontinued) SAV trimipramine 50mg tab Trimipramine 50mg Tab C AA Surmontil 50mg Tab (discontinued) SAV trimipramine 75mg cap Trimipramine 75mg Cap C AA Surmontil 75mg Cap (discontinued) SAV trimipramine 100mg tab Trimipramine 100mg Tab C AA Surmontil 100mg Tab (discontinued) SAV 06AA09 AITRITI amitriptyline 10mg tab Apo-Amitriptyline 10mg Tab C lavil 10mg Tab AA ar-amitriptyline 10mg Tab C AR pms-amitriptyline 10mg Tab C S Teva-Amitriptyline 10mg Tab C TV lavil 10mg Tab (discontinued) FRS amitriptyline 25mg tab Apo-Amitritpyline 25mg Tab C lavil 25mg Tab AA ar-amitriptyline 25mg Tab C AR pms-amitriptyline 25mg Tab C S Teva-Amitriptyline 25mg Tab C TV lavil 25mg Tab (discontinued) FRS amitriptyline 50mg tab Apo-Amitriptyline 50mg Tab C lavil 50mg Tab AA ar-amitriptyline 50mg Tab C AR pms-amitriptyline 50mg Tab C S Teva-Amitriptyline 50mg Tab C TV lavil 50mg Tab (discontinued) FRS amitriptyline 75mg tab Apo-Amitriptyline 75mg Tab C lavil 75mg Tab AA ovember

206 ervous System ar-amitriptyline 75mg Tab C AR lavil 75mg Tab (discontinued) FRS 06AA10 ORTRITI Aventyl 10mg Cap C AA Aventyl 25mg Cap C AA 06AA12 DOXI doxepin HCl 10mg cap Apo-Doxepin 10mg Cap C Sinequan 10mg Cap C RF doxepin HCl 25mg cap Apo-Doxepin 25mg Cap C Sinequan 25mg Cap C RF doxepin HCl 50mg cap Apo-Doxepin 50mg Cap C Sinequan 50mg Cap C RF doxepin HCl 75mg cap Apo-Doxepin 75mg Cap C Sinequan 75mg Cap (discontinued) RF doxepin HCl 100mg cap Apo-Doxepin 100mg Cap C Sinequan 100mg Cap (discontinued) RF 06AA21 AROTII maprotiline 25mg tab ovo-aprotiline 25mg Tab C TV udiomil 25mg Tab (discontinued) VR maprotiline 50mg tab ovo-aprotiline 50mg Tab C TV udiomil 50mg Tab (discontinued) VR maprotiline 75mg tab ovo-aprotiline 75mg Tab C TV udiomil 75mg Tab (discontinued) S 06AB SCTIV SROTOI RUTAK IHIBITORS (SSRI'S) 06AB03 FUOXTI fluoxetine 10mg cap Apo-Fluoxetine 10mg Cap C Auro-Fluoxetine 10mg Cap C ARO CO Fluoxetine 10mg Cap C Fluoxetine 10mg Cap C Fluoxetine B 10mg Cap C AHI Fluoxetine-10mg Cap C SIV Jamp-Fluoxetine 10mg Cap C JC ar-fluoxetine 10mg Cap C AR IT-Fluoxetine 10mg Cap C T ovember

207 ervous System A-Fluoxetine 10mg Cap C pms-fluoxetine 10mg Cap C S RA-Fluoxetine 10mg Cap C RA Sandoz Fluoxetine 10mg Cap C Teva-Fluoxetine 10mg Cap C TV rozac 10mg Cap C I fluoxetine 20mg cap Apo-Fluoxetine 20mg Cap C Auro-Fluoxetine 20mg Cap C ARO CO Fluoxetine 20mg Cap C Fluoxetin-20mg Cap C SIV Fluoxetine 20mg Cap C Fluoxetine B 20mg Cap C AHI Jamp-Fluoxetine 20mg Cap C JC ar-fluoxetine 20mg Cap C AR IT-Fluoxetine 20mg Cap C T A-Fluoxetine 20mg Cap C pms-fluoxetine 20mg Cap C S RA-Fluoxetine 20mg Cap C RA Sandoz Fluoxetine 20mg Cap C Teva-Fluoxetine 20mg Cap C TV rozac 20mg Cap C I fluoxetine 4mg/m syr Apo-Fluoxetine 20mg/5m Syr AA rozac 20mg/5m Syr (discontinued) I 06AB04 CITAORA Abbott Citalopram 10mg Tab C ABB IT-Citalopram 10mg tab C T AT-Citalopram 10mg Tab C AT pms-citalopram 10mg Tab C S citalopram 20mg tab Abbott Citalopram 20mg Tab C ABB Apo-Citalopram 20mg Tab C Auro-Citalopram 20mg Tab C ARO Citalopram 20mg Tab C Citalopram 20mg Tab C JC Citalopram-20mg Tab C SIV Citalopram-Odan 20mg Tab C OD CO Citalopram 20mg Tab C Jamp-Citalopram 20mg Tab C JC ar-citalopram 20mg Tab C AR IT-Citalopram 20mg Tab C T A-Citalopram 20mg Tab C AT-Citalopram 20mg Tab C AT ovo-citalopram 20mg Tab C TV pms-citalopram 20mg Tab C S RA-Citalo 20mg Tab C RA Sandoz Citalopram 20mg Tab C ovember

208 ervous System Septa-Citalopram 20mg Tab C ST Celexa 20mg Tab C VH CT30 (30mg) Tab C SV citalopram 40mg tab Abbott Citalopram 40mg Tab C ABB Apo-Citalopram 40mg Tab C Auro-Citalopram 40mg Tab C ARO Citalopram 40mg Tab C JC Citalopram 40mg Tab C Citalopram-40mg Tab C SIV Citalopram-Odan 40mg Tab C OD CO Citalopram 40mg Tab C Jamp-Citalopram 40mg Tab C JC ar-citalopram 40mg Tab C AR IT-Citalopram 40mg Tab C T A-Citalopram 40mg Tab C AT-Citalopram 40mg Tab C AT ovo-citalopram 40mg Tab C TV pms-citalopram 40mg Tab C S RA-Citalo 40mg Tab C RA Sandoz Citalopram 40mg Tab C Septa-Citalopram 40mg Tab C ST Celexa 40mg Tab C VH 06AB05 AROXTI paroxetine 10mg tab Apo-aroxetine 10mg Tab CO aroxetine 10mg Tab Jamp-aroxetine 10mg Tab JC ar-aroxetine 10mg Tab AR IT-aroxetine 10mg Tab T A-aroxetine 10mg Tab aroxetine 10mg Tab aroxetine-10mg Tab SIV pms-aroxetine 10mg Tab S Sandoz aroxetine 10mg Tab Sandoz aroxetine 10mg Tab (discontinued) Teva-aroxetine 10mg Tab TV axil 10mg Tab GSK paroxetine 20mg tab Apo-aroxetine 20mg Tab C Auro-aroxetine 20mg Tab C ARO CO aroxetine 20mg Tab C Jamp-aroxetine 20mg Tab C JC ar-aroxetine 20mg Tab C AR IT-aroxetine 20mg Tab C T A-aroxetine 20mg Tab C aroxetine 20mg Tab () C aroxetine-20mg Tab C SIV ovember

209 ervous System pms-aroxetine 20mg Tab C S Sandoz aroxetine 20mg Tab C Teva-aroxetine 20mg Tab C TV axil 20mg Tab C GSK paroxetine 30mg tab Apo-aroxetine 30mg Tab C Auro-aroxetine 30mg Tab C ARO CO aroxetine 30mg Tab C Jamp-aroxetine 30mg Tab C JC ar-aroxetine 30mg Tab C AR IT-aroxetine 30mg Tab C T A-aroxetine 30mg Tab C aroxetine 30mg Tab () C aroxetine-30mg Tab C SIV pms-aroxetine 30mg Tab C S Sandoz aroxetine 30mg Tab C Sandoz aroxetine 30mg Tab (discontinued) Teva-aroxetine 30mg Tab C TV axil 30mg Tab C GSK pms-aroxetine 40mg Tab S 06AB06 SRTRAI sertraline 25mg cap Apo-Sertraline 25mg Cap C Auro-Sertraline 25mg Cap C ARO CO Sertraline 25mg Cap C GD-Sertraline 25mg Cap GD Jamp-Sertaline 25mg Cap C JC ar-sertraline 25mg Cap C AR IT-Sertraline 25mg Cap C T A-Sertraline 25mg Cap C ovo-sertraline 25mg Cap C TV pms-sertraline 25mg Cap C S RA-Sertraline 25mg cap C RA Sandoz Sertraline 25mg Cap C Sertraline 25mg Cap C Sertraline-25mg Cap C SIV Zoloft 25mg Cap C sertraline 50mg cap Apo-Sertraline 50mg Cap C Auro-Sertraline 50mg Cap C ARO CO Sertraline 50mg Cap C GD-Sertraline 50mg Cap C GD Jamp-Sertaline 50mg Cap C JC ar-sertraline 50mg Cap C AR IT-Sertraline 50mg Cap C T A-Sertraline 50mg Cap C ovo-sertraline 50mg Cap C TV pms-sertraline 50mg Cap C S ovember

210 ervous System RA-Sertraline 50mg cap C RA Sandoz Sertraline 50mg Cap C Sertraline 50mg Cap C Sertraline-50mg Cap C SIV Zoloft 50mg Cap C sertraline 100mg cap Apo-Sertraline 100mg Cap C Auro-Sertraline 100mg Cap C ARO CO Sertraline 100mg Cap C GD-Sertraline 100mg Cap GD Jamp-Sertraline 100mg Cap C JC ar-sertraline 100mg Cap C AR IT-Sertraline 100mg Cap C T A-Sertraline 100mg Cap C pms-sertraline 100mg Cap C S RA-Sertraline 100mg cap C RA Sandoz Sertraline 100mg Cap C Sertraline 100mg Cap C Sertraline-100mg Cap C SIV Teva-Sertraline 100mg Cap C TV Zoloft 100mg Cap C AB08 FUVOXAI fluvoxamine 50mg tab Apo-Fluvoxamine 50mg Tab C CO Fluvoxamine 50mg Tab C ovo-fluvoxamine 50mg Tab C TV ratio-fluvoxamine 50mg Tab C TV uvox 50mg Tab C BG fluvoxamine 100mg tab Apo-Fluvoxamine 100mg Tab C CO Fluvoxamine 100mg Tab C ovo-fluvoxamine 100mg Tab C TV uvox 100mg Tab C BG 06AB10 SCITAORA escitalopram 10mg tab Apo-scitalopram 10mg Tab Auro-scitalopram 10mg Tab ARO CO scitalopram 10mg Tab scitalopram 10mg Tab SIV scitalopram 10mg Tab Jamp-scitalopram 10mg Tab JC ar-scitalopram 10mg Tab AR ylan-scitalopram 10mg Tab pms-scitalopram 10mg Tab S RA-scitalopram 10mg Tab RA Sandoz scitalopram 10mg Tab Teva-scitalopram 10mg Tab TV ovember

211 ervous System Cipralex 10mg Tab VH escitalopram 20mg tab Apo-scitalopram 20mg Tab Auro-scitalopram 20mg Tab ARO CO scitalopram 20mg Tab scitalopram 20mg Tab scitalopram 20mg Tab SIV Jamp-scitalopram 20mg Tab JC ar-scitalopram 20mg Tab AR ylan-scitalopram 20mg Tab RA-scitalopram 20mg Tab RA Sandoz scitalopram 20mg Tab Teva-scitalopram 20mg Tab TV Cipralex 20mg Tab VH pms-scitalopram 20mg Tab S 06AF OOAI OXIDAS IHIBITORS,O-SCTIV 06AF03 HZI ardil 15mg Tab C RF 06AF04 TRACROI arnate 10mg Tab C GSK 06AG OOAI OXIDAS T A IHIBITORS 06AG02 OCOBID moclobemide 100mg tab Apo-oclobemide 100mg Tab C ovo-oclobemide 100mg Tab C TV anerix 100mg Tab (discontinued) HR moclobemide 150mg tab Apo-oclobemide 150mg Tab C ovo-oclobemide 150mg Tab C TV anerix 150mg Tab C V moclobemide 300mg tab Apo-oclobemide 300mg Tab C ovo-oclobemide 300mg Tab C TV anerix 300mg Tab C V 06AX OTHR ATIDRSSATS 06AX02 TRTOHA tryptophan 1g tab Apo-Tryptophan 1g Tab ratio-tryptophan 1g Tab TV Tryptan 1g Tab V Tryptan 250mg Tab V tryptophan 500mg cap Apo-Tryptophan 500mg Cap ovember

212 ervous System ratio-tryptophan 500mg Cap TV Tryptan 500mg Cap V tryptophan 500mg tab Apo-Tryptophan 500mg Tab ratio-tryptophan 500mg Tab TV Tryptan 500mg Tab V Tryptan 750mg Tab V 06AX05 TRAZODO trazodone 50mg tab Apo-Trazodone 50mg Tab C A-Trazodone 50mg Tab (discontinued) pms-trazodone 50mg Tab C S Teva-Trazodone 50mg Tab C TV Trazodone 50mg Tab C Desyrel 50mg Tab (discontinued) BRI pms-trazodone 75mg Tab C S trazodone 100mg tab Apo-Trazodone 100mg Tab C pms-trazodone 100mg Tab C S Teva-Trazodone 100mg Tab C TV Trazodone 100mg Tab C Desyrel 100mg Tab (discontinued) BRI trazodone 150mg tab Apo-Trazodone 150mg Tab Teva-Trazodone 150mg Tab C TV Trazodone 150mg Tab C Desyrel 150mg Tab (discontinued) BRI 06AX11 IRTAZAI mirtazapine 15mg RD tab Auro-irtazapine OD 15mg Tab C ARO ovo-irtazapine OD 15mg Tab C TV Remeron RD 15mg Tab C FRS pms-irtazapine 15mg Tab C S Sandoz irtazapine 15mg Tab C mirtazapine 30mg RD tab Auro-irtazapine OD 30mg Tab C ARO ovo-irtazapine OD 30mg Tab C TV Remeron RD 30mg Tab C FRS mirtazapine 30mg tab Apo-irtazapine 30mg Tab C Auro-irtazapine 30mg Tab C ARO irtazapine 30mg Tab () C A-irtazapine 30mg Tab C ovo-irtazapine 30mg Tab C TV pms-irtazapine 30mg Tab C S ovember

213 ervous System Sandoz irtazapine 30mg Tab C Remeron 30mg Tab C FRS mirtazapine 45mg RD tab Auro-irtazapine OD 45mg Tab C ARO ovo-irtazapine OD 45mg Tab C TV Remeron RD 45mg Tab C FRS 06AX12 BUROIO bupropion 100mg SR tab Bupropion SR 100mg Tab C pms-bupropion SR 100mg Tab C S ratio-bupropion SR 100mg Tab C TV Sandoz Bupropion SR 100mg Tab C Wellbutrin SR 100mg Tab (discontinued) BV bupropion 150mg SR tab Bupropion SR 150mg Tab C pms-bupropion SR 150mg Tab C S ratio-bupropion SR 150mg Tab C TV Sandoz Bupropion SR 150mg Tab C Wellbutrin SR 150mg Tab C V bupropion 150mg X tab A-Bupropion X 150mg Tab C Wellbutrin X 150mg Tab C V bupropion 300mg X tab A-Bupropion X 300mg Tab C Wellbutrin X 300mg Tab C V 06AX16 VAFAXI venlafaxine 37.5mg R cap Apo-Venlafaxine XR 37.5mg Cap C CO Venlafaxine XR 37.5mg Cap C GD-Venlafaxine XR 37.5mg Cap C GD A-Venlafaxine XR 37.5mg Cap C pms-venlafaxine XR 37.5mg Cap C S RA-Venlafaxine XR 37.5mg Cap C RA Sandoz Venlafaxine XR 37.5mg Cap C Teva-Venlafaxine XR 37.5mg Cap C TV Venlafaxine XR 37.5mg Cap C Venlafaxine-XR 37.5mg Cap C SIV ffexor XR 37.5mg Cap C venlafaxine 75mg R cap Apo-Venlafaxine XR 75mg Cap C CO Venlafaxine XR 75mg Cap C GD-Venlafaxine XR 75mg Cap C GD A-Venlafaxine XR 75mg Cap C ovo-venlafaxine XR 75mg Cap C TV pms-venlafaxine XR 75mg Cap C S RA-Venlafaxine XR 75mg Cap C RA ovember

214 ervous System Sandoz Venlafaxine XR 75mg Cap C Venlafaxine XR 75mg Cap C Venlafaxine-XR 75mg Cap C SIV ffexor XR 75mg Cap C venlafaxine 150mg R cap Apo-Venlafaxine XR 150mg Cap C CO Venlafaxine XR 150mg Cap C GD-Venlafaxine XR 150mg Cap C GD A-Venlafaxine XR 150mg Cap C pms-venlafaxine XR 150mg Cap C S RA-Venlafaxine XR 150mg Cap C RA Sandoz Venlafaxine XR 150mg Cap C Teva-Venlafaxine XR 150mg Cap C TV Venlafaxine XR 150mg Cap C Venlafaxine-XR 150mg Cap C SIV ffexor XR 150mg Cap C AX21 DUOXTI Cymbalta 30mg Cap I Cymbalta 60mg Cap I 06AX23 DSVAFAXI ristiq 50mg R Tab ristiq 100mg R Tab B 06BA SCHOSTIUATS, AGTS USD FOR ADHD AD OOTROICS CTRA ACTIG SATHOITICS 06BA01 AHTAIS Adderall XR 5mg Cap SHI Adderall XR 10mg Cap SHI Adderall XR 15mg Cap SHI Adderall XR 20mg Cap SHI Adderall XR 25mg Cap SHI Adderall XR 30mg Cap SHI 06BA02 DXAHTAI dextroamphetamine 5mg tab Apo-Dextroamphetamine 5mg Tab D C Dexedrine 5mg Tab D C A Dexedrine Spansule 10mg Cap D C A Dexedrine Spansule 15mg Cap D C A 06BA04 THHIDAT Apo-ethylphenidate 5mg Tab D C pms-ethylphenidate 5mg Tab D C S ovember

215 ervous System methylphenidate 10mg tab Apo-ethylphenidate 10mg Tab D C pms-ethylphenidate 10mg Tab D C S Ritalin 10mg Tab D C VR Biphentin 10mg Cap D FR Biphentin 15mg Cap D FR methylphenidate 18mg R tab ovo-ethylphenidate R-C 18mg Tab D TV pms-ethylphenidate R 18mg Tab D S Concerta 18mg Tab D JA methylphenidate 20mg SR tab Apo-ethylphenidate SR 20mg Tab D C Sandoz ethylphenidate SR 20mg Tab D C Ritalin SR 20mg Tab D C VR methylphenidate 20mg tab Apo-ethylphenidate 20mg Tab D C pms-ethylphenidate 20mg Tab D C S Ritalin 20mg Tab D C VR Biphentin 20mg Cap D FR methylphenidate 27mg R tab ovo-ethylphenidate R-C 27mg Tab D TV pms-ethylphenidate R 27mg Tab D S Concerta 27mg Tab D JA Biphentin 30mg Cap D FR methylphenidate 36mg R tab ovo-ethylphenidate R-C 36mg Tab D TV pms-ethylphenidate R 36mg Tab D S Concerta 36mg Tab D JA Biphentin 40mg Cap D FR Biphentin 50mg Cap D FR methylphenidate 54mg R tab ovo-ethylphenidate R-C 54mg Tab D TV pms-ethylphenidate R 54mg Tab D S Concerta 54mg Tab D JA Biphentin 60mg Cap D FR Biphentin 80mg Cap D FR 06BA07 ODAFII modafinil 100mg tab Auro-odafinil 100mg Tab ARO ar-odafinil 100mg Tab AR odafinil 100mg Tab Teva-odafinil 100mg Tab TV Alertec 100mg Tab SHI 06BA09 ATOOXTI ovember

216 ervous System atomoxetine 10mg cap Apo-Atomoxetine 10mg Cap ovo-atomoxetine 10mg Cap TV pms-atomoxetine 10mg Cap S Sandoz Atomoxetine 10mg Cap Strattera 10mg Cap I atomoxetine 18mg cap Apo-Atomoxetine 18mg Cap A-Atomoxetine 18mg cap ovo-atomoxetine 18mg Cap TV pms-atomoxetine 18mg Cap S Sandoz Atomoxetine 18mg Cap Strattera 18mg Cap I atomoxetine 25mg cap Apo-Atomoxetine 25mg Cap A-Atomoxetine 25mg cap ovo-atomoxetine 25mg Cap TV pms-atomoxetine 25mg Cap S Sandoz Atomoxetine 25mg Cap Strattera 25mg Cap I atomoxetine 40mg cap Apo-Atomoxetine 40mg Cap A-Atomoxetine 40mg cap ovo-atomoxetine 40mg Cap TV pms-atomoxetine 40mg Cap S Sandoz Atomoxetine 40mg Cap Strattera 40mg Cap I atomoxetine 60mg cap Apo-Atomoxetine 60mg Cap A-Atomoxetine 60mg cap ovo-atomoxetine 60mg Cap TV pms-atomoxetine 60mg Cap S Sandoz Atomoxetine 60mg Cap Strattera 60mg Cap I atomoxetine 80mg cap Apo-Atomoxetine 80mg Cap A-Atomoxetine 80mg Cap Sandoz Atomoxetine 80mg Cap Teva-Atomoxetine 80mg Cap TV Strattera 80mg Cap I atomoxetine 100mg cap Apo-Atomoxetine 100mg Cap A-Atomoxetine 100mg Cap Sandoz Atomoxetine 100mg Cap Teva-Atomoxetine 100mg Cap TV Strattera 100mg Cap I 06BA12 ISDXAFTAI ovember

217 ervous System Vyvanse 10mg Cap SHI Vyvanse 20mg Cap SHI Vyvanse 30mg Cap SHI Vyvanse 40mg Cap SHI Vyvanse 50mg Cap SHI Vyvanse 60mg Cap SHI 06D 06DA ATI-DTIA DRUGS ATICHOISTRASS 06DA02 DOZI donepezil 5mg tab Apo-Donepezil 5mg Tab Auro-Donepezil 5mg Tab ARO CO Donepezil 5mg Tab Donepezil HCl 5mg Tab AHI Donepezil-5mg Tab SIV Jamp-Donepezil 5mg Tab JC Jamp-Donepezil 5mg Tab JC ar-donepezil 5mg Tab AR ylan-donepezil 5mg Tab pms-donepezil 5mg Tab S RA-Donepezil 5mg Tab RA Sandoz Donepezil 5mg Tab Septa-Donepezil 5mg Tab ST Teva-Donepezil 5mg Tab TV Aricept 5mg Tab donepezil OD 5mg tab CO Donepezil ODT 5mg Tab Sandoz Donepezil 5mg Tab Aricept RDT 5mg Tab donepezil 10mg tab Apo-Donepezil 10mg Tab Auro-Donepezil 10mg Tab ARO CO Donepezil 10mg Tab Donepezil HCl 10mg Tab AHI Donepezil-10mg Tab SIV Jamp-Donepezil 10mg Tab JC Jamp-Donepezil 10mg tab JC ar-donepezil 10mg Tab AR ylan-donepezil 10mg Tab pms-donepezil 10mg Tab S RA-Donepezil 10mg Tab RA Sandoz Donepezil 10mg Tab Septa-Donepezil 10mg tab ST Teva-Donepezil 10mg Tab TV Aricept 10mg Tab ovember

218 ervous System donepezil OD 10mg tab CO Donepezil ODT 10mg Tab Sandoz Donepezil 10mg Tab Aricept RDT 10mg Tab DA03 RIVASTIGI rivastigmine 1.5mg cap Apo-Rivastigmine 1.5mg Cap D-Rivastigmine 1.5mg Cap G IT-Rivastigmine 1.5mg Cap T ovo-rivastigmine 1.5mg Cap TV pms-rivastigmine 1.5mg Cap S ratio-rivastigmine 1.5mg Cap TV Sandoz Rivastigmine 1.5mg Cap xelon 1.5mg Cap VR xelon 2mg/m O/ VR rivastigmine 3mg cap Apo-Rivastigmine 3mg Cap D-Rivastigmine 3mg Cap G IT-Rivastigmine 3mg Cap T ovo-rivastigmine 3mg Cap TV pms-rivastigmine 3mg Cap S ratio-rivastigmine 3mg Cap TV Sandoz Rivastigmine 3mg Cap xelon 3mg Cap VR rivastigmine 4.5mg cap Apo-Rivastigmine 4.5mg Cap D-Rivastigmine 4.5mg Cap G IT-Rivastigmine 4.5mg Cap T ovo-rivastigmine 4.5mg Cap TV pms-rivastigmine 4.5mg Cap S ratio-rivastigmine 4.5mg Cap TV Sandoz Rivastigmine 4.5mg Cap xelon 4.5mg Cap VR xelon atch 5 (4.6mg/24hr) VR rivastigmine 6mg cap Apo-Rivastigmine 6mg Cap D-Rivastigmine 6mg Cap G IT-Rivastigmine 6mg Cap T ovo-rivastigmine 6mg Cap TV ratio-rivastigmine 6mg Cap TV Sandoz Rivastigmine 6mg Cap xelon 6mg Cap VR xelon atch 10 (9.5mg/24hr) VR 06DA04 GAATAI galantamine 8mg R cap ar-galantamine R 8mg Cap AR ovember

219 ervous System A-Galantamine R 8mg Cap AT-Galantamine R 8mg Cap H pms-galantamine R 8mg Cap S Reminyl R 8mg Cap JA galantamine 16mg R cap ar-galantamine R 16mg Cap AR A-Galantamine R 16mg Cap AT-Galantamine R 16mg Cap H pms-galantamine R 16mg Cap S Reminyl R 16mg Cap JA galantamine 24mg R cap ar-galantamine R 24mg Cap AR A-Galantamine R 24mg Cap AT-Galantamine R 24mg Cap H pms-glanatamine R 24mg Cap S Reminyl R 24mg Cap JA 06DX OTHR ATI-DTIA DRUGS 06DX01 ATI memantine 10mg tab Apo-emantine 10mg Tab CO emantine 10mg Tab D-emantine 10mg Tab G A-emantine 10mg Tab pms-emantine 10mg Tab S RA-emantine 10mg Tab RA ratio-emantine 10mg Tab TV Sandoz emantine 10mg Tab Sandoz emantine FCT 10mg Tab bixa 10mg Tab VH 07 07A 07AA OTHR RVOUS SST DRUGS ARASATHOITICS ATICHOISTRASS 07AA01 OSTIGI eostigmine ethylsulfate 0.5mg/m Inj eostigmine ethylsulfate 1mg/m Inj eostigmine ethylsulfate 2.5mg/m Inj rostigmin 15mg Tab V 07AA02 RIDOSTIGI estinon 60mg Tab V estinon 180mg SR Tab V 07AB CHOI STRS 07AB02 BTHACHO ovember

220 ervous System Duvoid 10mg Tab A bethanechol chloride 25mg tab Urecholine 25mg Tab (discontinued) FRS Duvoid 25mg Tab A Duvoid 50mg Tab A 07AX OTHR ARASATHOITICS 07AX01 IOCARI pilocarpine 5mg tab ilocarpine 5mg Tab (discontinued) STR Salagen 5mg Tab B 07BA DRUGS USD I ADDICTIV DISORDRS DRUGS USD I ICOTI DDC 07BA02 BUROIO Zyban 150mg Tab V 07BB DRUGS USD I ACOHO DDC 07BB03 ACAROSAT Campral 333mg Tab BB04 ATRXO ReVia 50mg Tab TV 07BC DRUGS USD I OIOID DDC 07BC02 THADO ethadone dr (o/l compound) D VAR etadol 1mg Tab D A etadol 1mg/m O/ A etadol 5mg Tab D A etadol 10mg Tab D A etadol 10mg/m O/ A etadol 25mg Tab D A 07BC51 BURORHI, COBIATIOS buprenorphine 2mg & naloxone 0.5mg tab A-Buprenorphine/aloxone 2mg/0.5mg Tab D Teva-Buprenorphine/aloxone 2mg/0.5mg Tab D TV Suboxone 2mg/0.5mg S Tab D IC buprenorphine 8mg & naloxone 2mg tab A-Buprenorphine/aloxone 8mg/2mg Tab D Teva-Buprenorphine/aloxone 8mg/2mg Tab D TV Suboxone 8mg/2mg S Tab D IC 07C ATIVRTIGO RARATIOS ovember

221 ervous System 07CA ATIVRTIGO RARATIOS 07CA01 BTAHISTI betahistine 16mg tab CO Betahistine 16mg Tab ovo-betahistine 16mg Tab TV pms-betahistine 16mg Tab S Serc 16mg Tab BG betahistine 24mg tab CO Betahistine 24mg Tab ovo-betahistine 24mg Tab TV pms-betahistine 24mg Tab S Serc 24mg Tab BG 07CA03 FUARIZI flunarizine 5mg cap Flunarizine 5mg Cap AA Sibelium 5mg Cap (discontinued) S 07X 07XX OTHR RVOUS SST DRUGS OTHR RVOUS SST DRUGS 07XX02 RIUZO riluzole 50mg tab Apo-Riluzole 50mg Tab A-Riluzole 50mg Tab Rilutek 50mg Tab SAV 07XX06 TTRABAZI tetrabenazine 25mg tab Apo-Tetrabenazine 25mg Tab pms-tetrabenazine 25mg Tab S Tetrabenazine 25mg Tab STR itoman 25mg Tab V 07XX07 FARIDI Fampyra 10mg SR Tab BIG 07XX09 DITH FUARAT Tecfidera 120mg DR Cap BIG Tecfidera 240mg DR Cap BIG ovember

222 01 01A 01AX Antiparasitic roducts, Insecticides and Repellents ATIROTOZOAS AGTS VS.AOBIASIS & OTHR ROTOZOA DIS OTHR AGTS VS AOBIASIS & OTHR ROTOZOA DIS. 01AX06 ATOVAQUO epron 150mg/m Oral Susp GSK 01B 01BA ATIAARIAS AIOQUIOIS 01BA01 CHOROQUI chloroquine phosphate 250mg tab ovo-chloroquine 250mg Tab TV Aralen 250mg Tab (discontinued) SAV 01BA02 HDROXCHOROQUI hydroxychloroquine 200mg tab Apo-Hydroxyquine 200mg Tab IT-Hydroxychloroquine 200mg Tab T A-Hydroxychloroquine 200mg Tab laquenil 200mg Tab SAV 01BA03 RIAQUI rimaquine 15mg Tab SAV 01BB51 ROGUAI, COBIATIOS atovaquone 250mg & proguanil HCl 100mg tab Atovaquone roguanil 250/100mg Tab ylan-atovaquone/roguanil 250mg/100mg Tab Teva-Atovaquone roguanil 250/100mg Tab TV alarone 250/100mg Tab GSK 01BC THAOQUIOIS 01BC01 QUII quinine sulfate 200mg cap ovo-quinine 200mg Cap TV Quinine 200mg Cap (discontinued) DA Apo-Quinine 200mg Cap Quinine-Odan 200mg Cap OD quinine sulfate 300mg cap ovo-quinine 300mg Cap TV Quinine 300mg Cap (discontinued) DA Apo-Quinine 300mg Cap Quinine-Odan 300mg Cap OD Quinine-Odan 300mg Tab OD 01BC02 FOQUI mefloquine 250mg tab ovember

223 Antiparasitic roducts, Insecticides and Repellents efloquine 250mg Tab AA arium 250mg Tab (discontinued) HR 02 02C 02CA ATHITICS ATIATODA AGTS BZIIDAZO AGTS 02CA01 BDAZO Vermox 100mg Tab JA 03 03A 03AX CTOARASITICIDS,IC SCABICIDS,ISCT.&RA CTOARASITICIDS, IC SCABICIDS OTHR CTOARACITICIDS, IC SCABICIDS 03AX99 ISORO RISTAT Resultz 50% Top Sol DF ovember

224 R R01 R01A R01AB Respiratory System ASA RARATIOS DCOGSTATS & OTHR ASA RS,TOICA US SATHOITICS,COBIATIOS XC CORTICOSTROIDS R01AB01 HHRI Soframycin asal Spray RF R01AC ATIARGIC AGTS, XC CORTICOSTROIDS R01AC01 CROOGCAT SODIU cromoglycate sodium 2% nasal sol Rhinaris-CS Anti-Allergic asal ist S Rynacrom 2% asal Sol (discontinued) RR R01AC02 VOCABASTI ivostin 0.5mg/m asal Spray JA R01AD CORTICOSTROIDS R01AD01 BCOTHASO beclomethasone dipropionate 50mcg/dose aqueous nasal spray Apo-Beclo 50mcg/dose Acq asal Sp C A-Beclo 50mcg/dose Acq asal Spray C Beconase 50mcg/dose Acq asal Sp (discontinued) GA R01AD05 BUDSOID budesonide 64mcg/dose aqueous nasal spray A-Budesonide AQ 64mcg/dose asal Spray Rhinocort 64mcg/dose Aqua asal Spray AZ A-Budesonide AQ 100mcg/dose asal Spray Rhinocort 100mcg/dose Turbuhaler AZ R01AD08 FUTICASO fluticasone 50mcg/dose nasal spray Apo-Fluticasone 50mcg/dose asal Spray ratio-fluticasone 50mcg/dose asal Spray TV Flonase 50mcg/dose asal Spray GSK R01AD09 OTASO mometasone 50mcg/m nasal spray Apo-ometasone 0.05% asal Spray F* asonex 0.05% asal Spray F* FRS *full benefit for children aged 3 to 11 years. R01AD11 TRIACIOO asacort AQ 55mcg/dose asal Spray SAV R01AX OTHR ASA RARATIOS R01AX03 IRATROIU BROID ipratropium bromide 0.3% nasal spray (21mcg/dose) ovember

225 R Respiratory System pms-ipratropium 21mcg/dose asal Spray S Atrovent 21mcg/dose asal Spray BO ipratropium bromide 0.6% nasal spray (42mcg/dose) Apo-Ipravent 42mcg/dose asal Spray AA Atrovent 42mcg/dose asal Spray BO R01AX10 VARIOUS ASA RARATIOS Dey-ak Sodium Chloride Inhalation Sol 0.9% DU R03 R03A R03AC DRUGS FOR OBSTRUCTIV AIRWA DIS ADRRGICS, IHAATS SCTIV BTA-2-ADROCTOR AGOISTS R03AC02 SABUTAO salbutamol 0.5mg/m unit dose inh sol pms-salbutamol 0.5mg/m olynebs S ratio-salbutamol 0.5mg/m ebules TV Ventolin 0.5mg/m ebules (discontinued) GSK salbutamol 1mg/m unit dose inh sol pms-salbutamol 1mg/m olynebs S ratio-salbutamol 1mg/m ebules TV Ventolin 1mg/m ebules GSK salbutamol 2mg/m unit dose inh sol pms-salbutamol 2mg/m olynebs S ratio-salbutamol 2mg/m ebules (discontinued) TV Ventolin 2mg/m ebules GSK salbutamol 5mg/m inh sol pms-salbutamol 5mg/m Resp Sol (discontinued) S ratio-salbutamol 5mg/m Resp Sol TV Sandoz Salbutamol 5mg/m Resp Sol Ventolin 5mg/m Resp Sol GSK salbutamol 100mcg/dose oral inh Apo-Salvent 100mcg/dose CFC Free Inh C ovo-salbutamol HFC 100mcg/act Inh C TV Salbutamol HFA 100mcg/dose Inh C Airomir 100mcg/act Inh C V Ventolin HFA 100mcg/dose Inh C GSK Ventolin 200mcg/dose Diskus C GSK R03AC03 TRBUTAI Bricanyl 0.5mg/dose Turbuhaler AZ R03AC12 SATRO Serevent 50mcg/dose Diskhaler GSK Serevent 50mcg/dose Diskus GSK R03AC13 FOROTRO ovember

226 R Respiratory System Oxeze 6mcg/dose Turbuhaler AZ Foradil 12mcg Cap for Inhalation VR Oxeze 12mcg/dose Turbuhaler AZ R03AC18 IDACATRO Onbrez 75mcg icronized wd for Inhilation VR R03AK ADRRGICS AD OTHR DRUGS FOR OBSTRUCTIV AIRWA DIS R03AK03 FOTRO AD OTHR DRUGS FOR OBSTRUCTIV AIRWA DIS Duovent UDV Inh Sol BO R03AK04 SABUTAO AD OTHR DRUGS FOR OBSTRUCTIV AIRWA DIS ipratropium bromide 200mcg/m & salbutamol 1mg/m unit dose inh sol Teva-Combo Sterinebs TV Combivent UDV Inh Sol BO R03AK06 SATRO AD OTHR DRUGS FOR OBSTRUCTIV AIRWA DIS Advair HFA 25/125mcg/dose Inh GSK Advair HFA 25/250mcg/dose Inh GSK Advair 50/100mcg Diskus GSK Advair 50/250mcg Diskus GSK Advair 50/500mcg Diskus GSK R03AK07 FOROTRO AD OTHR DRUGS FOR OBSTRUCTIV AIRWA DIS Zenhale 5/50mcg Inh (discontinued) FRS Zenhale 5/100mcg Inh FRS Zenhale 5/200mcg Inh FRS Symbicort 100/6mcg Turbuhaler AZ Symbicort 200/6mcg Turbuhaler AZ R03AK10 VIATRO AD FUTICASO FUROAT Breo llipta 100mcg/25mcg wd for Inh GSK R03A ADRRGICS I COBIATIO WITH ATICHOIRGICS R03A02 SABUTAO AD IATRORIU BROID Combivent 100/20mcg Respimat C BO R03A03 VIATRO AD UCIDIIU BROID Anoro llipta 62.5/25mcg wd for Inh GSK R03A04 IDACATRO AD GCORROIU BROID Ultibro Breezhaler 110/50mcg Cap for Inh VR R03B R03BA OTHR DRUGS FOR OBSTRUCTIV AIRWA DIS, IHAATS GUCOCORTICOIDS, ATI-ASTHATICS, IHAD ovember

227 R Respiratory System R03BA01 BCOTHASO QVAR 50mcg/dose Inh C V QVAR 100mcg/dose Inh C V R03BA02 BUDSOID ulmicort 0.125mg/m ebuamps AZ ulmicort 0.25mg/m ebuamps AZ ulmicort 0.5mg/m ebuamps AZ ulmicort 100mcg/dose Turbuhaler AZ ulmicort 200mcg/dose Turbuhaler AZ ulmicort 400mcg/dose Turbuhaler AZ R03BA05 FUTICASO Flovent Diskus 50mcg GSK Flovent HFA 50mcg/act Inh GSK Flovent Diskus 100mcg GSK Flovent HFA 125mcg/act Inh GSK Flovent Diskus 250mcg GSK Flovent HFA 250mcg/act Inh GSK Flovent Diskus 500mcg GSK R03BA07 OTASO Asmanex 200mcg/act Twisthaler FRS Asmanex 400mcg/act Twisthaler FRS R03BA08 CICSOID Omnaris 50mcg/dose asal Spray TAK Alvesco 100mcg/dose Inh C Alvesco 200mcg/dose Inh C R03BB ATICHOIRGICS R03BB01 IRATROIU BROID Atrovent HFA 20mcg/dose Inhaler C BO ipratropium bromide 125mcg/m unit dose inh sol (2m) pms-ipratropium 125mcg/m olynebs S Atrovent 125mcg/m UDV (discontinued) BO ipratropium bromide 250mcg/m inh sol (20m) Apo-Ipravent 250mcg/m Inh Sol A-Ipratropium 250mcg/m Inh Sol ovo-ipramide 250mcg/m Inh Sol (discontinued) TV pms-ipratropium 250mcg/m Inh Sol S Atrovent 250mcg/m Inh Sol (discontinued) BO ipratropium bromide 250mcg/m unit dose inh sol (1m) pms-ipratropium 250mcg/m olynebs S ovember

228 R Respiratory System ratio-ipratropium 250mcg/m ebules TV Teva-Ipratropium 250mcg/m Sterinebs TV Atrovent 250mcg/m UDV (discontinued) BO ipratropium bromide 250mcg/m unit dose inh sol (2m) pms-ipratropium 250mcg/m olynebs S ratio-ipratropium 250mcg/m ebules TV Atrovent 250mcg/m UDV (discontinued) BO R03BB04 TIOTROIU BROID Spiriva 18mcg Cap for Inh BO R03BB05 ACIDIIU BROID Tudorza Genuair 400mcg wd for Inh A R03BB06 GCORROIU BROID Seebri 50mcg Cap for Inh VR R03BC ATIARGIC AGTS, XC CORTICOSTROIDS R03BC01 CROOGCAT SODIU cromoglycate sodium 1% unit dose inh sol pms-sodium Cromoglycate 1% eb Sol S Intal 1% eb Sol (discontinued) SAV R03C R03CB ADRRGICS, SSTIC RARATIOS O-SCTIV BTA-ADROCTOR AGOISTS R03CB03 ORCIRAI orciprenaline 2mg/m syr Apo-Orciprenaline 2mg/m Syr AA Alupent 2mg/m Syr (discontinued) BO R03CC SCTIV BTA-2-ADROCTOR AGOISTS R03CC02 SABUTAO salbutamol 2mg tab Apo-Salvent 2mg Tab C Ventolin 2mg Tab (discontinued) GA salbutamol 4mg tab Apo-Salvent 4mg Tab C Ventolin 4mg Tab (discontinued) GA R03D R03DA OTHR SSTIC DRUGS FOR OBSTRUCTIV AIRWA DIS XATIS R03DA02 OXTRIHI (CHOI THOHIAT) Choledyl 20mg/m lx RF R03DA04 THOHI Theolair 80mg/15m iq V ovember

229 R Respiratory System Apo-Theo A 100mg Tab ovo-theophyl SR 100mg Tab TV theophylline 200mg SR tab ovo-theophyl SR 200mg Tab TV Theo-DUR 200mg Tab (discontinued) AZ Apo-Theo A 200mg Tab theophylline 300mg SR tab ovo-theophyl SR 300mg Tab TV Theo-DUR 300mg Tab (discontinued) AZ Apo-Theo A 300mg Tab theophylline 400mg R tab Theo R 400mg Tab AA Uniphyl 400mg Tab FR theophylline 600mg R tab Theo R 600mg Tab AA Uniphyl 600mg Tab FR R03DA54 THOHI, COBIATIOS XCUDIG SCHOTICS Choledyl xpectorant RF R03DC UKOTRI RCTOR ATAGOISTS R03DC01 ZAFIRUKAST Accolate 20mg Tab AZ R03DC03 OTUKAST montelukast 4mg chewtab Apo-ontelukast 4mg Chewtab Auro-ontelukast 4mg Chewtab ARO ar-ontelukast 4mg Chewtab AR IT-ontelukast 4mg Chewtab T ontelukast 4mg Chewtab ontelukast-4mg Chewtab SIV A-ontelukast 4mg Chewtab pms-ontelukast 4mg Chewtab S RA-ontelukast 4mg Chewtab RA Sandoz ontelukast 4mg Chewtab Teva-ontelukast 4mg Chewtab TV Singulair 4mg Chewtab FRS montelukast 4mg granules Sandoz ontelukast 4mg Granules Singulair 4mg/pkt Granules FRS montelukast 5mg chewtab Apo-ontelukast 5mg Chewtab Auro-ontelukast 5mg Chewtab ARO ar-ontelukast 5mg Chewtab AR IT-ontelukast 5mg Chewtab T ontelukast 5mg Chewtab SIV ovember

230 R Respiratory System ontelukast 5mg Chewtab A-ontelukast 5mg Chewtab pms-ontelukast 5mg Chewtab S RA-ontelukast 5mg Chewtab RA Sandoz ontelukast 5mg Chewtab Teva-ontelukast 5mg Chewtab TV Singulair 5mg Chewtab FRS montelukast 10mg tab Apo-ontelukast 10mg Tab Auro-ontelukast 10mg Tab ARO Jamp-ontelukast 10mg Tab JC ar-ontelukast 10mg Tab AR IT-ontelukast 10mg Tab T ontelukast 10mg Tab SIV ontelukast 10mg Tab (AHI) AHI ontelukast 10mg Tab () A-ontelukast 10mg Tab pms-ontelukast FC 10mg Tab S RA-ontelukast 10mg Tab RA Sandoz ontelukast 10mg Tab Teva-ontelukast 10mg Tab TV Singulair 10mg Tab FRS R03DX OHTR SSTIC DRUGS FOR OBSTRUCTIV AIRWA DIS R03DX05 OAIZUAB Xolair 150mg/vial Inj VR R03DX07 ROFUIAST Daxas 500mcg Tab TAK R05 R05C R05CA COUGH AD COD RARATIOS XCTORATS,XC COBIATIOS WITH ATITUSSIVS XCTORATS R05CA03 GUAIFSI Robitussin 20mg/m O/ WCH R05CB UCOTICS R05CB01 ACTCSTI acetylcysteine 200mg/m inj Acetylcysteine 200mg/m Inj ucomyst 20% Inj WS R05D R05DA ATITUSSIVS, XC COBIATIOS WITH XCTORATS OIU AKAOIDS AD DRIVATIVS R05DA04 CODI inctus Codeine Blanc 0.2% iq D C AT ovember

231 R Respiratory System Codeine hosphate 4.7mg/m Syr D C AT ratio-codeine 15mg Tab D C TV Codeine hosphate 30mg/m Inj ratio-codeine 30mg Tab D C TV Codeine Contin 50mg Tab D FR Codeine Contin 100mg Tab D FR Codeine Contin 150mg Tab D FR Codeine Contin 200mg Tab D FR R06 R06A R06AA SSTIC ATIHISTAIS SSTIC ATIHISTAIS AIOAK THRS R06AA02 DIHHDRAI Benadryl 12.5mg/5m lx JJ Benadryl 25mg Caplets JJ Diphenhydramine 50mg/m Inj R06AA09 DOXAI Diclectin Tab C DUI R06A IRAZI DRIVATIVS R06A07 CTIRIZI Reactine 5mg Tab JJ cetirizine 10mg tab Apo-Cetirizine 10mg Tab xtra Strength Allergy Relief 10mg Tab D Reactine 10mg Tab JJ cetirizine 20mg tab pms-cetirizine 20mg Tab S Reactine 20mg Tab JJ R06AX VARIOUS SSTIC ATIHISTAIS R06AX13 ORATADI loratadine 10mg tab AC-oratadine 10mg Tab Apo-oratadine 10mg Tab Claritin 10mg Tab SCH R06AX17 KTOTIF Zaditen 1mg Tab TV ketotifen fumarate 1mg/5m syr ovo-ketotifen 1mg/5m Syr (discontinued) TV Zaditen 1mg/5m Syr TV ovember

232 R Respiratory System R06AX26 FXOFADI Allegra 60mg Tab SAV Allegra 120mg Tab SAV R06AX27 DSORATADI desloratadine 5mg tab Desloratadine Allergy Control 5mg Tab D Aerius 5mg Tab SCH R07 R07A R07AX OTHR RSIRATOR SST RODUCTS OTHR RSIRATOR SST RODUCTS OTHR RSIRATOR SST RODUCTS R07AX01 OTHR RSIRATOR SST RODUCTS AC Boyz Chamber FC TI AC Girlz Chamber FC TI AeroChamber ax ediatric with ask FC TI AeroChamber lus Flow-Vu with ask (g) C TI AeroChamber lus Flow-Vu with ask (ed) C TI AeroChamber lus Flow-Vu with ask (Sm) FC TI AeroChamber lus Flow-Vu with outhpiece C TI AreoChamber AC-Boyz FC TI AreoChamber AC-Girlz FC TI R07AX02 IVACAFTOR Kalydeco 150mg Tab VTX Kalydeco 150mg Tab* VTX Kalydeco 150mg Tab* VTX *use when drug cost in excess of ChA maximum ovember

233 S S01 S01A S01AA Sensory Organs OHTHAOOGICAS ATIIFCTIVS ATIBIOTICS(OHTHAOOGICAS) S01AA07 FRACTI Soframycin 0.5% Oph Sol O RF S01AA12 TOBRACI tobramycin 0.3% oph sol Sandoz Tobramycin 0.3% Oph Sol O Tobrex 0.3% Oph Sol O AC Tobrex 0.3% Oph Oint O AC S01AA13 FUSIDIC ACID Fucithalmic 1% Oph Sol O S01AA17 RTHROCI pms-rythromycin 0.5% Oph Oint O S rythromycin 5mg/g Oph Oint O SGQ S01AA30 ATIBIOTICS (OHTHAIC), COBIATIOS polymyxin B 10,000u/m & trimethoprim 1mg/m oph sol Sandozy olytrimethoprim Oph Sol olytrim Oph Sol A S01AB SUFOAIDS S01AB04 SUFACTAID Sodium Sulamyd 10% Oph Sol (discontinued) S01AD ATIVIRAS S01AD02 TRIFURIDI Viroptic 1% Oph Sol O V S01A FUOROQUIOOS S01A01 OFOXACI ofloxacin 0.3% oph sol Apo-Ofloxacin 0.3% Oph Sol O Sandoz Ofloxacin 0.3% Oph Sol (discontinued) Ocuflox 0.3% Oph Sol O A S01A03 CIROFOXACI ciprofloxacin 0.3% oph sol Apo-Ciproflox 0.3% Oph Sol Sandoz Ciprofloxacin 0.3% Oph Sol O Ciloxan 0.3% Oph Sol O AC Ciloxan 0.3% Oph Oint O AC S01A06 GATIFOXACI ovember

234 S Sensory Organs Zymar 0.3% Oph Sol A S01A07 OXIFOXACI Vigamox 0.5% Oph Sol AC S01B S01BA ATIIFAATOR AGTS CORTICOSTROIDS, AI S01BA01 DXATHASO axidex 0.1% Oph Oint O AC axidex 0.1% Oph Susp O AC Ozurdex 0.7mg Intravitreal Implant A S01BA04 RDISOO prednisolone acetate 0.12% oph susp Sandoz rednisolone 0.12% Oph Susp (discontinued) red ild 0.12% Oph Susp O A prednisolone acetate 1% oph susp ratio-rednisolone 1% Oph Susp O TV Sandoz rednisolone 1% Oph Susp O red Forte 1% Oph Susp O A S01BA07 FUOROTHOO fluorometholone 0.1% oph susp Sandoz Fluorometholone 0.1% Oph Susp O F 0.1% iquifilm Oph Susp O A Flarex 0.1% Oph Sol O AC F Forte 0.25% Oph Sol O A S01BA14 OTRDO otemax 0.5% Oph Susp BSH S01BC ATIIFAATOR AGTS,O STROIDS S01BC03 DICOFAC diclofenac 0.1% oph sol Apo-Diclofenac 0.1% Oph Sol O Voltaren 0.1% Oph Sol O AC S01BC05 KTOROAC Acuvail 0.45% Oph Sol O A ketorolac 0.5% oph sol Apo-Ketorolac 0.5% Oph Sol O AA Acular 0.5% Oph Sol O A S01C S01CA ATIIFAATOR AGTS & ATIIFCTIVS I COB. CORTICOSTROIDS AD ATIIFCTIVS I COBIATIO S01CA01 DXATHASO AD ATIIFCTIVS ovember

235 S Sensory Organs axitrol Oph Oint O AC axitrol Oph Susp O AC Tobradex Oph Oint O AC Tobradex Oph Sol O AC S01CA02 RDISOO AD ATIIFCTIVS Blephamide Oph Oint O A Blephamide Oph Sol O A S01 S01A ATIGAUCOA RARATIOS AD IOTICS SATHOITICS I GAUCOA THRA S01A03 ARACOIDI Iopidine 0.5% Oph Sol AC S01A05 BRIOIDI brimonidine 0.15% oph sol Apo-Brimonidine 0.15% Oph Sol AA Alphagan 0.15% Oph Sol A brimonidine 0.2% oph sol Apo-Brimonidine 0.2% Oph Sol pms-brimonidine 0.2% Oph Sol S ratio-brimonidine 0.2% Oph Sol (discontinued) TV Sandoz Brimonidine 0.2% Oph Sol Alphagan 0.2% Oph Sol A S01B ARASATHOITICS S01B01 IOCARI Isopto Carpine 1% Oph Sol AC Isopto Carpine 2% Oph Sol AC Isopto Carpine 4% Oph Sol AC S01C CARBOIC AHDRAS IHIBITORS S01C01 ACTAZOAID acetazolamide 250mg tab Acetazolamide 250mg Tab AA Diamox 250mg Tab (discontinued) WA S01C03 DORZOAID dorzolamide HCI 2% oph sol Sandoz Dorzolamide 2% Oph Sol Trusopt 2% Oph Sol FRS Trusopt 2% (F) Oph Sol FRS S01C04 BRIZOAID Azopt 1% Oph Sol AC S01C05 THAZOAID ovember

236 S Sensory Organs ethazolamide 50mg Tab AA S01D BTA BOCKIG AGTS S01D01 TIOO timolol maleate 0.25% oph gel Timolol aleate-x 0.25% Oph Gel Timoptic-X 0.25% Oph Gel FRS timolol maleate 0.25% oph sol Apo-Timop 0.25% Oph Sol pms-timolol 0.25% Oph Sol (discontinued) S Sandoz Timolol 0.25% Oph Sol Timoptic 0.25% Oph Sol (discontinued) FRS timolol maleate 0.5% oph gel Timolol aleate-x 0.5% Oph Gel Timoptic-X 0.5% Oph Gel FRS timolol maleate 0.5% oph sol Apo-Timop 0.5% Oph Sol pms-timolol 0.5% Oph Sol S Sandoz Timolol 0.5% Oph Sol Timoptic 0.5% Oph Sol FRS Apo-Timop 0.5% Oph Gel S01D02 BTAXOO Betoptic-S 0.25% Oph Susp AC S01D03 VOBUOO levobunolol HCl 0.25% oph sol ratio-evobunolol 0.25% Oph Sol (discontinued) TV Betagan 0.25% Oph Sol (discontinued) A levobunolol HCl 0.5% oph sol pms-evobunolol 0.5% Oph Sol (discontinued) S ratio-evobunolol 0.5% Oph Sol (discontinued) TV Sandoz evobunolol 0.5% Oph Sol (discontinued) Betagan 0.5% Oph Sol A S01D51 TIOO, COBIATIOS Azarga Oph Susp AC Combigan Oph Sol A Cosopt (F) Oph Sol FRS Duo Trav Oph Sol AC dorzolamide HCI 2% & timolol maleate 0.5% oph sol Apo-Dorzo-Timop 2%/0.5% Oph Sol CO DorzoTimolol 2%/0.5% Oph Sol Sandoz Dorzolamide/Timolol 2/0.5% Oph Sol Teva-Dorzotimol 2%/0.5% Oph Sol TV Cosopt Oph Sol FRS latanoprost 50mcg/m & timolol maleate 5mg/m oph sol ovember

237 S Sensory Organs ACT-atanoprost/Timolol 50mcg/5mg/m Oph Sol Apo-atanoprost/Timolol 50mcg/5mg/m Oph Sol GD-atanoprost/Timolol 50mcg/5mg/m Oph Sol GD Sandoz atanoprost/timolol 50mcg/5mg/m Oph Sol Xalacom Oph Sol S01 ROSTAGADI AAOGUS S0101 ATAOROST latanoprost 50mcg/m oph sol Apo-atanoprost 0.005% Oph Sol CO atanoprost 0.005% Oph Sol GD-atanoprost 0.005% Oph Sol GD pms-atanoprost 0.005% Oph Sol S Xalatan 0.005% Oph Sol S0103 BIATOROST umigan RC 0.01% Oph Sol A S0104 TRAVOROST travoprost 0.004% oph sol Apo-Travoprost Z 0.004% Oph Sol Sandoz Travoprost 0.004% Oph Sol Teva-Travoprost Z 0.004% Ops Sol TV Travatan Z 0.004% Oph Sol AC S01F S01FA DRIATICS AD CCOGICS ATICHOIRGICS S01FA01 ATROI Isopto Atropine 1% Oph Sol O AC S01FA04 CCOTOAT Cyclogyl 1.0% Oph Sol O AC S01FA05 HOATROI Isopto Homatropine 2% Sol O AC Isopto Homatropine 5% Sol O AC S01FA06 TROICAID ydriacyl 0.5% Oph Sol O AC ydriacyl 1% Oph Sol O AC S01G S01GA DCOGSTATS AD ATIARGICS SATHOITICS USD AS DCOGSTATS S01GA05 HHRI ydfrin 2.5% Oph Sol O AC S01GX OTHR ATIARGICS ovember

238 S Sensory Organs S01GX01 CROOGCAT SODIU cromoglycate sodium 2% oph sol Cromolyn 2% Oph Sol O D Opticrom 2% Oph Sol O A S01GX08 KTOTIF ketotifen 0.25% oph sol Ketotifen 0.25% Oph Sol STR Zaditor 0.25% Oph Sol O VO S01GX09 OOATADI olopatadine 0.1% oph sol Apo-Olopatadine 0.1% Oph Sol CO Olopatadine 0.1% Oph Sol COB IT-Olopatadine 0.1% Oph Sol T Sandoz Olopatadine 0.1% Oph Sol atanol 0.1% Oph Sol O AC olopatadine 0.2% oph sol ACT Olopatadine 0.2% Oph Sol Apo-Olopatadine 0.2% Oph Sol Sandoz Olopatadine 0.2% Oph Sol ataday 0.2% Oph Sol O AC S01H S01HA OCA ASTHTICS OCA ASTHTICS S01HA04 ROXTACAI Alcaine 0.5% Drops O AC S01 S01A OCUAR VASCUAR DISORDR AGTS ATIOVASCUARISATIO AGTS S01A01 VRTORFI Visudyne 15mg/vial Inj V S01A03 GATAIB acugen 0.3mg/90mcl re-filled Syringe (discontinued) S01X S01XA OTHR OHTHAOOGICAS OTHR OHTHAOOGICAS S01XA03 SODIU CHORID, HRTOIC ODA-Sodium Chloride 5% Oph Oint O OD uro 128 (5%) Oph Oint O BSH ODA-Sodium Chloride 5% Oph sol O OD uro 128 (5%) Oph Sol O BSH S01XA18 CICOSORI ovember

239 S Sensory Organs Restasis 0.05% Oph Sol A S01XA20 ARTIFICIA TARS AD OTHR IDIFFRT RARATIOS Bion Tears Oph Sol AC Duolube Oph Oint O BSH GenTeal 3mg/g Oph Sol O AC Hypotears Oph Oint (discontinued) AC Refresh acri-ube Oph Oint A TearGel Oph Oint O VO Tears aturale Free Oph Sol O AC Tears aturale II Oph Sol O AC Tears aturale Oph Sol AC Tears aturale.. Oph Oint AC Hylashield 0.15%/0.4% Allets ID GenTeal 0.3% Oph Gel O AC artificial tears 0.5% oph sol Sandoz yelube 0.5% Oph Sol Isopto Tears 0.5% Oph Sol AC Refresh lus 0.5% Oph Sol O A Refresh Tears 0.5% Oph Sol O A artificial tears 1% oph sol Sandoz yelube 1% Oph Sol Isopto Tears 1% Oph Sol AC Refresh 1% iquigel A Refresh Celluvisc 1% iq O A Artificial Tears 1.4% Oph Sol D Refresh 1.4% Oph Sol O A Tears lus 1.4% Oph Sol A S01XA22 OCRIASI Jetrea 2.5mg/m Inj AC S02 S02C S02CA OTOOGICAS CORTICOSTROIDS AD ATIIFCTIVS I COBIATIO CORTICOSTROIDS AD ATIIFCTIVS I COBIATIO S02CA02 FUTASO AD ATIIFCTIVS ocacorten Vioform Otic Sol A S02CA06 DXATHASO AD ATIIFCTIVS Ciprodex Otic Susp AC S03 S03B S03BA OHTHAOOGICA AD OTOOGICA RARATIOS CORTICOSTROIDS CORTICOSTROIDS, AI S03BA01 DXATHASO ovember

240 S Sensory Organs dexamethasone 0.1% oph/otic sol Sandoz Dexamethasone 0.1% Oph/Otic Sol O Decadron 0.1% Oph/Otic Sol (discontinued) FRS S03C S03CA CORTICOSTROIDS AD ATIIFCTIVS I COBIATIO CORTICOSTROIDS AD ATIIFCTIVS I COBIATIO S03CA01 DXATHASO AD ATIIFCTIVS Sofracort Oph/Otic Sol O SAV ovember

241 V V01 V01A V01AA Various ARGS ARGS ARG XTRACTS V01AA02 GRASS O ollinex-r Inj C Oralair 100iu IR S/ Tab STA Oralair 300iu IR S/ Tab STA V01AA20 VARIOUS Allergy Serum VAR V03 V03A V03AB A OTHR THRAUTIC RODUCTS A OTHR THRAUTIC RODUCTS ATIDOTS V03AB15 AOXO naloxone 0.4mg/m inj aloxone 0.4mg/m Inj arcan 0.4mg/m Inj (discontinued) BRI naloxone 1mg/m inj aloxone 1mg/m Inj arcan 1mg/m Inj (discontinued) BRI V03AB25 FUAZI flumazenil 0.1mg/m inj Flumazenil 0.1mg/m Inj Anexate 0.1mg/m Inj (discontinued) HR V03AC IRO CHATIG AGTS V03AC01 DFROXAI Desferal 2g/vial Inj VR deferoxamine 500mg/vial inj Desferrioxamine 500mg/vial Inj HOS Desferal 500mg/vial Inj VR V03AC03 DFRASIROX xjade 125mg Tab for Susp VR xjade 250mg Tab for Susp VR xjade 500mg Tab for Susp VR V03A FOR TRATT OF HRKAIA AD HRHOSHATIA V03A01 OSTR SUFOAT pms-sodium olystyrene Sulfonate d S Solystat Oral D Kayexalate owder SAV ovember

242 V Various V03A02 SVAR Renagel 800mg Tab SAV V03A03 ATHAU CARBOAT Fosrenol 250mg Tab SHI Fosrenol 500mg Tab SHI Fosrenol 750mg Tab SHI Fosrenol 1,000mg Tab SHI V03A99 CACIU ACTAT hoslo 667mg Tab (discontinued) FR V03AF DTOXIFIG AGTS FOR CTOSTATIC TRATT V03AF03 CACIU FOIAT ederle eucovorin 5mg Tab C V03AH DRUGS FOR TRATT OF HOGCIA V03AH01 DIAZOXID roglycem 100mg Cap FRS V04 V04C V04CA DIAGOSTIC AGTS OTHR DIAGOSTIC AGTS TSTS FOR DIABTS V04CA02 GUCOS *Diabetic Supplies Benefit ist (Testing Strips) D V04CJ TSTS FOR THROIDA FUCTIO V04CJ01 THROTROI Thyrogen 0.9mg/m Inj GZ V07 V07A V07AB A OTHR O-THRAUTIC RODUCTS A OTHR O-THRAUTIC RODUCTS SOVTS AD DIUTIG AGTS,IC IRRIGAT SOUT V07AB99 STRI WATR Bacteriostatic Water for Inj HOS Sterile Water for Inj (W) HOS V07AS STOI QUIT V07AS01 STOI QUIT *Ostomy Supplies Benefit ist C V07A VARIOUS O-THRAUTIC AUXIIAR RODUCTS V07A03 ISCAOUS DVICS ovember

243 V Various CADD ump Cassette C VAR V07A04 ISUI SRIGS *Diabetic Supplies Benefit ist D V07A05 ISUI DS *Diabetic Supplies Benefit ist D V07A06 DIABTIC ACTS *Diabetic Supplies Benefit ist D V07A90 ACBO lacebo Tab C OD ovember

244 Diabetic Supplies Benefit ist ISUI DS I RODUCT DSCRITIO KG SIZ BD Ultra-Fine II en eedles, 12.7mm, 29g BD Ultra-Fine III ini en eedles, 5mm, 31g BD Ultra-Fine III Short en eedles. 8mm, 31g BD Ultra-Fine ano en eedles 32g x 4mm Global ase en Inject eedle 29g x 9mm Global ase en Inject eedle 31g x 5mm Global ase en Inject eedle 31g x 8mm Insupen, 29g x 12mm Insupen, 30g x 8mm Insupen, 31g x 6mm Insupen, 31g x 8mm Insupen, 32g x 6mm Insupen, 32g x 8mm ontkiddy en eedles,4mm, 32g, Blue ontkiddy en eedles,4mm, 32g, Green ontkiddy en eedles,4mm, 32g, ink ontkiddy en eedles,4mm, 32g, ellow ontméd en eedles, 4mm, 32g ontméd en eedles, 5mm, 31g ontméd en eedles, 6mm, 32g ontméd en eedles, 6mm, 32g ontméd en eedles, 8mm, 31g ontméd en eedles, 8mm, 32g ovofine TW en eedles 32g ovofine en eedles 28g X 12mm ovofine en eedles 30g X 6mm ovofine en eedles 30g X 8mm ovofine lus 32g x 4mm ovotwist 30g (8mm) Tip eedles ovotwist 32g (5mm) Tip eedles SUR-FI en eedles (icro 29g 12.7mm) SUR-FI en eedles (icro 31g 5mm) SUR-FI en eedles (XTRA 31g 8mm) Ulticare en eedles 31g x 6mm Ulticare en eedles 31g x 8mm Ulticare en eedles 32g x 4mm Unifine en eedles 29g x 12mm Unifine en eedles 31g x 6mm Unifine en eedles 31g x 8mm 100 ISUI SRIGS I RODUCT DSCRITIO KG SIZ BD Ultra-Fine II Short Half-Unit Syringes, 0.3cc, 31g BD Ultra-Fine II Syringes, 0.3cc, 30g BD Ultra-Fine II Syringes, 0.3cc, 31g BD Ultra-Fine II Syringes, 0.5cc. 30g BD Ultra-Fine II Syringes, 1cc, 30g BD Ultra-Fine Syringes, 0.3cc, 29g BD Ultra-Fine Syringes, 0.5cc, 29g 100 RODUCT # OA3529 OA3590 OA3530 RODUCT # FR BTD BTD BTD BTD C C C DO DO DO DO DO DO TD TD TD TD TD TD TD TD TD TD O O O O O O O S S S DRX DRX DRX AUT AUT AUT FR BTD BTD BTD BTD BTD BTD BTD RIC RIC T T ovember

245 Diabetic Supplies Benefit ist ISUI SRIGS I RODUCT DSCRITIO BD Ultra-Fine Syringes, 0.5cc, 31g BD Ultra-Fine Syringes, 1.0cc, 31g BD Ultra-Fine Syringes, 1cc, 29g onoject Syringes 0.3cc, 29 x 1/2" onoject Syringes 0.3cc, 30g x 5/16" onoject Syringes 0.5cc, 25g x 5/8" onoject Syringes 0.5cc, 28g x 1/2" onoject Syringes 0.5cc, 29g x 1/2" onoject Syringes 0.5cc, 30g x 5/16" onoject Syringes 1cc, 27g x 1/2" onoject Syringes 1cc, 28g x 1/2" onoject Syringes 1cc, 28g x 1/2" onoject Syringes 1cc, 29g x 1/2" onoject Syringes 1cc, 30g x 5/16" ontméd Syringes 0.3cc, 31g ontméd Syringes 0.5cc, 31g ontméd Syringes 1cc, 31g UltiCare Syringes 0.3cc, 29g UltiCare Syringes 0.3cc, 30g UltiCare Syringes 0.5cc, 29g UltiCare Syringes 0.5cc, 30g UltiCare Syringes 1cc, 29g UltiCare Syringes 1cc, 30g ACTS I RODUCT DSCRITIO Abbott Thin 28g ancets Abbott Thin 28g ancets Accu-Chek Fastclix ancets Accu-Chek Fastclix ancets Accu-Chek ulticlix ancets Accu-Chek ulticlix ancets Accu-Chek Softclix ancets Accu-Chek Softclix ancets Accu-Chek Softclix ro ancets Ascensia icrolet ancets Ascensia icrolet ancets BD Ultra-Fine ancets BD Ultra-Fine ancets BGStar anets Z Health ancets Finger Stix ancets FORA TD-Thin ancet FreeStyle ancets itest ancets 28g itest ancets 33g edi+sure Soft 30G Twist ancet (urple) edi+sure Soft 33G Twist ancet (Beige) edlance lus ite ancets 25g KG SIZ KG SIZ RODUCT # UC09239 UC09339 UC09259 UC09359 UC09219 UC09319 RODUCT # BA 6550C GH TD IT31005 IT31003 DG030 DG FR BTD BTD BTD TC TC TC TC TC TC TC TC TC TC TC TD TD TD AUT AUT AUT AUT AUT AUT FR ID ID BO BO BO BO BO BO BO BDD BDD BTD BTD SAV THI BDD FRA ID AUT AUT SR SR D RIC RIC T T ovember

246 Diabetic Supplies Benefit ist ACTS I RODUCT DSCRITIO edlance lus Universal ancets 21g D Thin ancets D Ultra Thin ancets OneTouch Delica ancet 33G OneTouch Delica ancets 30G OneTouch SureSoft ancets 21g OneTouch UltraSoft Safe-T-ro ancets Ultilet Classic ancets 20g TSTIG STRIS I RODUCT DSCRITIO Accu-Chek Advantage Glucose Test Strips Accu-Chek Advantage Glucose Test Strips Accu-Chek AVIVA Test Strips Accu-Chek AVIVA Test Strips Accu-Chek Compact Test Strips Accu-Chek Compact Test Strips Accu-Chek obile BG Test Strip Cassette Accu-Chek obile BG Test Strip Cassette Acetest Albustix Ascensia Breeze 2 Test Strip Disc Ascensia Breeze 2 Test Strip Disc Ascensia Contour Test Strip Ascensia Contour Test Strip BGStar Test Strips Chemstrip ugk Glucose and Ketone Strips Chemstrip Chemstrip-BG (Accu-Chek) Chemstrip-BG Glucose Strips (Visual Testing) Chemstrip-G Clinitest Contour XT Blood Glucose Test Strips Contour XT Blood Glucose Test Strips Diastix Z Oracle Test Strips FORA Test n' Go BG Strip FreeStyle Blood Glucose Test Strips FreeStyle Blood Glucose Test Strips FreeStyle ite Test Strips FreeStyle ite Test Strips Freestyle recision Strips Freestyle recisions Strips G200 Glucose Test Strip G200 Glucose Test Strip Hemastix itest Blood Glucose Test Strips Keto-Diastix KG SIZ KG SIZ RODUCT # / / RODUCT # / U B 7081B GH-B1S100 TD A IT U FR D D D FS FS FS FS BO B FR BO BO BO BO BO BO BO BO BDD BDD BDD BDD BDD BDD SAV BO BO BO BO BO BDD BDD BDD BDD THI FRA ID ID ID ID ID ID B B BDD AUT BDD RIC RIC T T ovember

247 Diabetic Supplies Benefit ist TSTIG STRIS I RODUCT DSCRITIO Ketostix abstix edi+sure BG Test Strip ultistix yglucohealth Glucose Test Strips ovaax Test Strips ovaax Test Strips On-Call lus Test Strips On-Call lus Test Strips On-Call lus Test Strips One-Touch FastTake Blood Glucose Test Strips One-Touch FastTake Blood Glucose Test Strips One-Touch Test Strips One-Touch Test Strips One-Touch Ultra Test Strips One-Touch Ultra Test Strips One-Touch Verio Test Strips One-Touch Verio Test Strips Rapid Response Blood Glucose Test Strips Rightest GS100 Test Strips Rightest GS100 Test Strips Sidekick Blood Glucose Testing System Suretest Blood Glucose Test Strips TRUtest Blood Glucose Test Strips TRUtest Blood Glucose Test Strips TrueTrack Blood Glucose Test Strip TrueTrack Blood Glucose Test Strip Uristix KG SIZ RODUCT # 2880U 2810A DG001S 2820A CA-GH-TS GU K /D i i20-80 A A U FR BDD BDD SR BDD HS B B ACO ACO ACO FS FS FS FS FS FS FS FS BTX B B HO SK HO HO HO HO BDD RIC T ovember

248 Ostomy Supplies Benefit ist ISCAOUS I RODUCT DSCRITIO RODUCT # Assura Irrigation Sleeve Assura Irrigation Sleeve Assura Irrigation Sleeve Assura Irrigation Sleeve Centerointock Irrig Sleeve Centerointock Irrig Sleeve Centerointock Irrig Sleeve Centerointock Irrig Sleeve Centerointock Irrig Sleeve Cone Irrigator Kit Confidence Comfort Dr ouch DT Confidence Comfort Dr ouch DT ConvaTec ouch Closure Dermacol Stoma Collar DC Dermacol Stoma Collar DC Dermacol Stoma Collar DC Dermacol Stoma Collar DC Dermacol Stoma Collar DC Dermacol Stoma Collar DC Dermacol Stoma Collar DC Dermacol Stoma Collar DC Drainable ouch Clamp Drainable ouch Clamp Duoock ouch Closure Irrigator Sleeve w Closure Irrigator Sleeve w Closure ew Image Irrigation Sleeve ew Image Irrigation Sleeve ew Image Irrigation Sleeve Sur-Fit Autoock Convex Insrt Sur-Fit Autoock Convex Insrt Sur-Fit atura Convex Inserts Sur-Fit atura Convex Inserts Sur-Fit atura Convex Inserts Sur-Fit atura Convex Inserts Sur-Fit atura Convex Inserts Sur-Fit atura Convex Inserts Sur-Fit atura Convex Inserts Sur-Fit atura Convex Inserts Sur-Fit atura Irrig Closure Sur-Fit atura Irrig Sleeve Sur-Fit atura Irrig Sleeve Sur-Fit atura Irrig Sleeve Sur-Fit atura Irrig Sleeve O-IC SSTS I RODUCT DSCRITIO RODUCT # Active ife Closed-nd Active ife Closed-nd FR CO CO CO CO HO HO HO HO HO HO ARG ARG CO ARG ARG ARG ARG ARG ARG ARG ARG CO HO CO HO HO HO HO HO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO FR CO CO ovember

249 Ostomy Supplies Benefit ist O-IC SSTS I RODUCT DSCRITIO RODUCT # Active ife Dr Durahesive Active ife Dr Durahesive Active ife Dr Durahesive Active ife Dr Durahesive Active ife Dr Durahesive Active ife Dr Durahesive Active ife Dr Durahesive Active ife Dr Durahesive Active ife Dr Durahesive Active ife Dr Durahesive Active ife Dr Durahesive Active ife Dr Durahesive Active ife Dr Durahesive Active ife Dr Durahesive Active ife Dr Durahesive Active ife Dr Durahesive Active ife Dr Durahesive Active ife Dr Durahesive Active ife Dr Durahesive Active ife Dr Durahesive Active ife Dr Durahesive Active ife Dr Durahesive Active ife Drainable Active ife Drainable Active ife Drainable Active ife Drainable Active ife Drainable Active ife Drainable Active ife Drainable Active ife Drainable Active ife Drainable Active ife Drainable Active ife Drainable Active ife Drainable Active ife Drainable Active ife Drainable Active ife Drainable Active ife Drainable Active ife Drainable Active ife Drainable Active ife Drainable Active ife Drainable Active ife Drainable Active ife Drainable Active ife Durahesive Active ife Durahesive Active ife Durahesive Active ife Durahesive FR CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO ovember

250 Ostomy Supplies Benefit ist O-IC SSTS I RODUCT DSCRITIO RODUCT # Active ife ittle Ones Active ife ittle Ones Active ife re-cut Closed Active ife re-cut Closed Active ife re-cut Closed Active ife re-cut Closed Active ife re-cut Closed Active ife re-cut Closed Active ife re-cut Closed Active ife re-cut Closed Active ife re-cut Closed Active ife re-cut Closed Active ife Stoma Cap Active ife Uros Durahesive Active ife Uros Durahesive Active ife Uros Durahesive Assura Drainable Assura Drainable Assura Drainable Assura Drainable Assura Drainable Assura Drainable Assura Drainable Assura Drainable Assura Drainable w asiclose Assura Drainable w asiclose Assura Drainable w asiclose Assura Drainable w asiclose Assura Drainable w asiclose Assura Drainable w asiclose Assura Drainable w asiclose Assura Drainable w asiclose Assura - Wear Drainable Assura - Wear Drainable Assura - Wear Drainable Assura - Wear Drainable Assura - Wear Urostomy Assura - Wear Urostomy Assura ediatric Closed Assura ediatric Drainable Assura ediatric Urostomy Assura Std Wear Closed Assura Std Wear Closed Assura Std Wear Closed Assura Std Wear Closed Assura Std Wear Closed Assura Std Wear Closed Assura Std Wear Closed FR CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO ovember

251 Ostomy Supplies Benefit ist O-IC SSTS I RODUCT DSCRITIO RODUCT # Assura Std Wear Closed Assura Std Wear Closed Assura Std Wear Closed Assura Std Wear Closed Assura Std Wear Closed Assura Std Wear Closed Assura Std Wear Closed Assura Std Wear Closed Assura Std Wear Closed Assura Std Wear Closed Assura Std Wear Closed Assura Std Wear Closed Assura Std Wear Closed Assura Std Wear Closed Assura Std Wear Dr asiclose Assura Std Wear Dr asiclose Assura Std Wear Dr asiclose Assura Std Wear Dr asiclose Assura Std Wear Dr asiclose Assura Std Wear Dr asiclose Assura Std Wear Dr asiclose Assura Std Wear Dr asiclose Assura Std Wear Dr asiclose Assura Std Wear Dr asiclose Assura Std Wear Dr asiclose Assura Std Wear Dr asiclose Assura Std Wear Dr asiclose Assura Std Wear Dr asiclose Assura Std Wear Drainable Assura Std Wear Drainable Assura Std Wear Drainable Assura Std Wear Drainable Assura Std Wear Urostomy Assura Std Wear Urostomy Assura Std Wear Urostomy Assura Std Wear Urostomy Assura Std Wear Urostomy Assura Std Wear Urostomy Assura Std Wear Urostomy Assura Std Wear Urostomy Assura Std Wear Urostomy Assura Std Wear Urostomy Assura Std Wear Urostomy Assura Stoma Cap Assura Stoma Cap Assura Stoma Cap Confidence Convex Supersoft CUSS Confidence Convex Supersoft CUSS1338 FR CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO ARG ARG ovember

252 Ostomy Supplies Benefit ist O-IC SSTS I RODUCT DSCRITIO RODUCT # Confidence Convex Supersoft CUSS Confidence Convex Supersoft CUSS Confidence Convex Supersoft CUSS Confidence Convex Supersoft CUSS Confidence Convex Supersoft CUSS Confidence Convex Supersoft CCSS Confidence Convex Supersoft CCSS Confidence Convex Supersoft CCSS Confidence Convex Supersoft CCSS Confidence Convex Supersoft CCSS Confidence Convex Supersoft CCSS Confidence Convex Supersoft CCSS Confidence Convex Supersoft CCSS Confidence Convex Supersoft CCSS Confidence Convex Supersoft CCSS Confidence Convex Supersoft CCSS Confidence Convex Supersoft CCSS Confidence Convex Supersoft CCSS Confidence Convex Supersoft CDSS Confidence Convex Supersoft CDSS Confidence Convex Supersoft CDSS Confidence Convex Supersoft CDSS Confidence Convex Supersoft CDSS Confidence Convex Supersoft CDSS Confidence Convex Supersoft CDSS Confidence Convex Supersoft CDSS Confidence Convex Supersoft CDSS Confidence Convex Supersoft CDSS Confidence Convex Supersoft CDSS Confidence Convex Supersoft CDSS Confidence Convex Supersoft CDSS Confidence Convex Supersoft CDSSS Confidence Convex Supersoft CDSSS Confidence Convex Supersoft CDSSS Confidence Convex Supersoft CUSS Confidence Convex Supersoft CUSS Confidence atural Confidence atural Confidence atural Confidence atural Confidence atural Confidence atural Confidence atural Confidence atural Confidence atural T Confidence atural Confidence atural T Confidence atural D13 FR ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ovember

253 Ostomy Supplies Benefit ist O-IC SSTS I RODUCT DSCRITIO RODUCT # Confidence atural D Confidence atural D Confidence atural D Confidence atural D Confidence atural D Confidence atural DT Confidence atural DS Confidence atural DT Confidence atural U Confidence atural U Confidence atural U Confidence atural U Confidence atural U Confidence atural US Contour Stoma Cap steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch FR ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG HO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO ovember

254 Ostomy Supplies Benefit ist O-IC SSTS I RODUCT DSCRITIO RODUCT # steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Closed ouch steem + Drainable ouch steem + Drainable ouch steem + Drainable ouch steem + Drainable ouch steem + Drainable ouch steem + Drainable ouch steem + Drainable ouch steem + Drainable ouch First Choice Closed First Choice Closed First Choice Closed First Choice Closed First Choice Closed First Choice Closed First Choice Closed First Choice Closed First Choice Closed First Choice Closed First Choice Closed First Choice Closed First Choice Closed First Choice Closed First Choice Closed First Choice Closed First Choice Closed First Choice Closed First Choice Closed First Choice Closed First Choice Closed First Choice Closed First Choice Closed First Choice Drainable First Choice Drainable First Choice Drainable First Choice Drainable First Choice Drainable First Choice Drainable First Choice Drainable First Choice Drainable First Choice Drainable 3616 FR CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO ovember

255 Ostomy Supplies Benefit ist O-IC SSTS I RODUCT DSCRITIO RODUCT # First Choice Drainable First Choice Drainable First Choice Drainable First Choice Drainable First Choice Drainable First Choice Drainable First Choice Drainable First Choice Drainable First Choice Drainable First Choice Drainable First Choice Drainable First Choice Drainable First Choice Drainable First Choice Drainable First Choice Drainable First Choice Urostomy First Choice Urostomy First Choice Urostomy First Choice Urostomy First Choice Urostomy First Choice Urostomy First Choice Urostomy First Choice Urostomy First Choice Urostomy First Choice Urostomy First Choice Urostomy First Choice Urostomy First Choice Urostomy First Choice Urostomy Hollister Closed Hollister Closed Hollister Closed Hollister Closed Hollister Closed Hollister Closed o-rofile Urostomy o-rofile Urostomy o-rofile Urostomy o-rofile Urostomy o-rofile Urostomy ouchkins ediatric ouchkins ediatric ouchkins ediatric ouchkins ediatric ouchkins ediatric ouchkins ediatric ouchkins ediatric ouchkins ediatric 9766 FR HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO ovember

256 Ostomy Supplies Benefit ist O-IC SSTS I RODUCT DSCRITIO RODUCT # remier Closed remier Closed remier Closed remier Closed remier Closed remier Closed remier Closed remier Closed remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable remier Drainable ock'n Roll remier Drainable ock'n Roll remier Drainable ock'n Roll remier Drainable ock'n Roll remier Drainable ock'n Roll remier Drainable ock'n Roll remier Drainable ock'n Roll remier Drainable ock'n Roll FR HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO ovember

257 Ostomy Supplies Benefit ist O-IC SSTS I RODUCT DSCRITIO RODUCT # remier Drainable ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier ock'n Roll remier Soft Convexity remier Soft Convexity remier Soft Convexity remier Soft Convexity remier Soft Convexity remier Soft Convexity remier Urostomy remier Urostomy remier Urostomy remier Urostomy 8488 FR HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO ovember

258 Ostomy Supplies Benefit ist O-IC SSTS I RODUCT DSCRITIO RODUCT # remier Urostomy remier Urostomy remier Urostomy remier Urostomy remier Urostomy remier Urostomy remier Urostomy remier Urostomy remier Urostomy remier Urostomy remier Urostomy remier Urostomy remier Urostomy remier Urostomy remier Urostomy remier Urostomy remium Closed remium Closed remium Closed remium Closed remium Closed remium Closed remium Closed remium Drainable remium Drainable remium Drainable remium Drainable remium Drainable remium Drainable remium Drainable remium Drainable remium Drainable remium Drainable remium Drainable remium Drainable Sensura asiclose Sensura axi Sensura axi Sensura axi Sensura axi Sensura axi Sensura axi Sensura axi Sensura axi Sensura axi Sensura axi Sensura axi Sensura axi FR HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO CO CO CO CO CO CO CO CO CO CO CO CO CO ovember

259 Ostomy Supplies Benefit ist O-IC SSTS I RODUCT DSCRITIO RODUCT # Sensura axi Sensura axi Sensura axi Sensura axi Sensura axi Closed Sensura axi Closed Sensura axi Closed Sensura axi Closed Sensura axi Closed Sensura axi Closed Sensura axi Closed Sensura axi Closed Sensura axi Closed Sensura axi Closed Sensura axi Closed Sensura axi Closed Sensura idi Sensura idi Sensura idi Sensura idi Sensura idi Closed Sensura idi Closed Sensura idi Closed Sensura idi Closed Sensura idi Closed Sensura idi Closed Sensura idi Closed Sensura idi Closed Sensura io axi Sensura io axi Sensura io axi Sensura io axi Sensura io axi Sensura io axi Sensura io axi Sensura io axi Sensura io axi Sensura io axi Sensura io axi Sensura io axi Sensura io axi Sensura io idi Stoma Cap Stoma Cap 3186 OUCHS (O-COSD) (2 IC) I RODUCT DSCRITIO RODUCT # Assura asiclose Drainable Assura asiclose Drainable FR CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO HO HO FR CO CO ovember

260 Ostomy Supplies Benefit ist OUCHS (O-COSD) (2 IC) I RODUCT DSCRITIO RODUCT # Assura asiclose Drainable Assura asiclose Drainable Assura asiclose Drainable Assura asiclose Drainable Assura asiclose Drainable Assura asiclose Drainable Assura asiclose Drainable Assura asiclose Drainable Assura asiclose Drainable Assura asiclose Drainable Assura asiclose Drainable Assura asiclose Drainable Assura asiclose Drainable Assura ediatric Drainable Assura ediatric Drainable Assura ediatric Urostomy Assura Two-iece Closed Assura Two-iece Closed Assura Two-iece Closed Assura Two-iece Closed Assura Two-iece Closed Assura Two-iece Closed Assura Two-iece Closed Assura Two-iece Closed Assura Two-iece Closed Assura Two-iece Closed Assura Two-iece Closed Assura Two-iece Closed Assura Two-iece Drainable Assura Two-iece Drainable Assura Two-iece Drainable Assura Urostomy Assura Urostomy Assura Urostomy Assura Urostomy Assura Urostomy Assura Urostomy Assura Urostomy ight Bag Centerointock Closed Centerointock Closed Centerointock Closed Centerointock Closed Centerointock Drainable Centerointock Drainable Centerointock Drainable Centerointock Drainable Centerointock Drainable Centerointock Drainable 3804 FR CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO HO HO HO HO HO HO HO HO HO HO ovember

261 Ostomy Supplies Benefit ist OUCHS (O-COSD) (2 IC) I RODUCT DSCRITIO RODUCT # Centerointock Drainable Centerointock Drainable Centerointock Drainable Centerointock Drainable Centerointock Drainable Centerointock Drainable Centerointock Drainable Centerointock Drainable Centerointock Drainable Centerointock Drainable Centerointock Drainable Centerointock Drainable Centerointock Drainable Centerointock Drainable Centerointock Drainable Centerointock Drainable Centerointock Drainable Centerointock Drainable Centerointock remier Centerointock remier Centerointock remier Centerointock remier Centerointock remier Centerointock remier Centerointock remier Centerointock remier Centerointock remier Centerointock remier Centerointock remier Centerointock remier Centerointock remier Centerointock remier Centerointock remier Centerointock remier Centerointock remier Centerointock Stoma Cap Centerointock Stoma Cap Centerointock Stoma Cap Centerointock Stoma Cap Centerointock Urostomy Centerointock Urostomy Centerointock Urostomy Centerointock Urostomy asiflex Closed asiflex Closed asiflex Closed asiflex Closed asiflex Closed FR HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO CO CO CO CO CO ovember

262 Ostomy Supplies Benefit ist OUCHS (O-COSD) (2 IC) I RODUCT DSCRITIO RODUCT # asiflex Closed asiflex Closed asiflex Closed asiflex Closed asiflex Closed asiflex Drainable w asiclose asiflex Drainable w asiclose asiflex Drainable w asiclose asiflex Drainable w asiclose asiflex Drainable w asiclose asiflex Drainable w asiclose asiflex Drainable w asiclose asiflex Drainable w asiclose asiflex Drainable w asiclose asiflex Drainable w asiclose asiflex Drainable w asiclose asiflex Drainable w asiclose asiflex Drainable w asiclose asiflex Drainable w asiclose asiflex Drainable w asiclose asiflex Drainable w asiclose asiflex Drainable w asiclose steem Synergy Closed steem Synergy Closed steem Synergy Closed steem Synergy Closed steem Synergy Closed steem Synergy Closed steem Synergy Closed steem Synergy Drainable steem Synergy Drainable steem Synergy Drainable steem Synergy Drainable steem Synergy Drainable steem Synergy Drainable steem Synergy Drainable steem Synergy Drainable steem Synergy Drainable steem Synergy Drainable steem Synergy Drainable steem Synergy Drainable steem Synergy Drainable steem Synergy Drainable steem Synergy Drainable steem Synergy Drainable steem Synergy Invisiclose steem Synergy Invisiclose steem Synergy Invisiclose FR CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO ovember

263 Ostomy Supplies Benefit ist OUCHS (O-COSD) (2 IC) I RODUCT DSCRITIO RODUCT # steem Synergy Invisiclose steem Synergy Invisiclose steem Synergy Invisiclose steem Synergy Invisiclose steem Synergy Invisiclose steem Synergy Urostomy steem Synergy Urostomy steem Synergy Urostomy steem Synergy Urostomy steem Synergy Urostomy steem Synergy Urostomy steem Synergy Urostomy steem Synergy Urostomy steem Synergy Urostomy atura + Drainable ouch atura + Drainable ouch atura + Drainable ouch atura + Drainable ouch atura + Drainable ouch atura + Drainable ouch atura + Drainable ouch atura + Drainable ouch atura + Drainable ouch atura + Drainable ouch atura + Drainable ouch atura + Drainable ouch atura + Drainable ouch atura + Drainable ouch atura + Drainable ouch atura + Drainable ouch atura + Drainable ouch atura + Drainable ouch atura + Drainable ouch atura + Drainable ouch atura + Drainable ouch atura + Drainable ouch atura + Drainable ouch atura + Drainable ouch atura + Drainable ouch ew Image Closed ew Image Closed ew Image Closed ew Image Closed ew Image Closed ew Image Closed ew Image Closed ew Image Closed ew Image Closed FR CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO HO HO HO HO HO HO HO HO HO ovember

264 Ostomy Supplies Benefit ist OUCHS (O-COSD) (2 IC) I RODUCT DSCRITIO RODUCT # ew Image Closed ini ew Image Closed ini ew Image Closed ini ew Image Dr ock'n Roll ew Image Dr ock'n Roll ew Image Dr ock'n Roll ew Image Dr ock'n Roll ew Image Dr ock'n Roll ew Image Dr ock'n Roll ew Image Drainable ew Image Drainable ew Image Drainable ew Image Drainable ew Image Drainable ew Image Drainable ew Image Drainable ew Image Drainable ew Image Drainable ew Image Drainable ew Image Drainable ew Image Drainable ew Image Drainable ew Image Drainable ew Image Irrigator Drain ew Image Irrigator Drain ew Image Irrigator Drain ew Image ock'n Roll ew Image ock'n Roll ew Image ock'n Roll ew Image ock'n Roll ew Image ock'n Roll ew Image ock'n Roll ew Image ock'n Roll ew Image ock'n Roll ew Image ock'n Roll ew Image ock'n Roll ew Image ock'n Roll ew Image ock'n Roll ew Image ock'n Roll ew Image ock'n Roll ew Image ock'n Roll ew Image ock'n Roll ew Image ock'n Roll ew Image ini ew Image ini ew Image ini ew Image Urostomy ew Image Urostomy FR HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO ovember

265 Ostomy Supplies Benefit ist OUCHS (O-COSD) (2 IC) I RODUCT DSCRITIO RODUCT # ew Image Urostomy ew Image Urostomy ew Image Urostomy ew Image Urostomy ew Image Urostomy ew Image Urostomy Overnight Drainage Bag ouchkins ediatric Drainable ouchkins ediatric Urostomy Sensura Closed Sensura Closed Sensura Closed Sensura Closed Sensura Closed Sensura Closed Sensura Closed Sensura Closed Sensura Closed Sensura Closed Sensura Closed Sensura asiclose Sensura asiclose Sensura asiclose Sensura asiclose Sensura asiclose Sensura asiclose Sensura asiclose Sensura asiclose Sensura asiclose Sensura asiclose Sensura asiclose Sensura asiclose Sensura Flex Dr ouch Sensura Flex Dr ouch Sensura Flex Dr ouch Sensura Flex Dr ouch Sensura Flex Dr ouch Sensura io Click axi Sensura io Click axi Sensura io Click axi Sensura io Click axi Sensura io Click axi Sensura io Click axi Sensura io Click axi Sensura io Click axi Sensura io Click idi Sensura io Click idi Sensura io Closed FR HO HO HO HO HO HO HO HO HO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO ovember

266 Ostomy Supplies Benefit ist OUCHS (O-COSD) (2 IC) I RODUCT DSCRITIO RODUCT # Sensura io Closed Sensura io Closed Sensura io Closed Sensura io Closed Sensura io Closed Sensura io Closed Sensura io Closed Sensura io Closed Sensura io Closed Sensura io Closed Sensura io Flex axi Sensura io Flex axi Sensura io Flex axi Sensura io Flex axi Sensura io Flex idi Sensura Urostomy ouch Sensura Urostomy ouch Sensura Urostomy ouch Sensura Urostomy ouch Sensura Urostomy ouch Sensura Urostomy ouch Sur-Fit Autoock Accuseal Sur-Fit Autoock Accuseal Sur-Fit Autoock Accuseal Sur-Fit Autoock Accuseal Sur-Fit Autoock Accuseal Sur-Fit Autoock Accuseal Sur-Fit Autoock Accuseal Sur-Fit Autoock Accuseal Sur-Fit Autoock Closed Sur-Fit Autoock Closed Sur-Fit Autoock Closed Sur-Fit Autoock Closed Sur-Fit Autoock Drainable Sur-Fit Autoock Drainable Sur-Fit Autoock Drainable Sur-Fit Autoock Drainable Sur-Fit Autoock Drainable Sur-Fit Autoock Drainable Sur-Fit Autoock Drainable Sur-Fit Autoock Drainable Sur-Fit Autoock Drainable Sur-Fit atura Accuseal Sur-Fit atura Accuseal Sur-Fit atura Accuseal Sur-Fit atura Accuseal Sur-Fit atura Accuseal Sur-Fit atura Accuseal FR CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO ovember

267 Ostomy Supplies Benefit ist OUCHS (O-COSD) (2 IC) I RODUCT DSCRITIO RODUCT # Sur-Fit atura Accuseal Sur-Fit atura Accuseal Sur-Fit atura Accuseal Sur-Fit atura Accuseal Sur-Fit atura Accuseal Sur-Fit atura Accuseal Sur-Fit atura Accuseal Sur-Fit atura Accuseal Sur-Fit atura Bendable Sur-Fit atura Bendable Sur-Fit atura Bendable Sur-Fit atura Bendable Sur-Fit atura Bendable Sur-Fit atura Bendable Sur-Fit atura Bendable Sur-Fit atura Bendable Sur-Fit atura Bendable Sur-Fit atura Closed Sur-Fit atura Closed Sur-Fit atura Closed Sur-Fit atura Closed Sur-Fit atura Closed Sur-Fit atura Closed Sur-Fit atura Closed Sur-Fit atura Closed Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable FR CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO ovember

268 Ostomy Supplies Benefit ist OUCHS (O-COSD) (2 IC) I RODUCT DSCRITIO RODUCT # Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Drainable Sur-Fit atura Flange Cap Sur-Fit atura Flange Cap Sur-Fit atura Flange Cap Sur-Fit atura Invisiclose Sur-Fit atura Invisiclose Sur-Fit atura Invisiclose Sur-Fit atura Invisiclose Sur-Fit atura Invisiclose Sur-Fit atura Invisiclose Sur-Fit atura Invisiclose Sur-Fit atura Invisiclose Sur-Fit atura Invisiclose Sur-Fit atura Invisiclose Sur-Fit atura Invisiclose Sur-Fit atura Invisiclose Sur-Fit atura Invisiclose Sur-Fit atura Invisiclose Sur-Fit atura Invisiclose Sur-Fit atura Invisiclose Sur-Fit atura ittle Ones Sur-Fit atura ittle Ones Sur-Fit atura ittle Ones Sur-Fit atura ittle Ones Sur-Fit atura ini Sur-Fit atura ini FR CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO ovember

269 Ostomy Supplies Benefit ist OUCHS (O-COSD) (2 IC) I RODUCT DSCRITIO RODUCT # Sur-Fit atura ini Sur-Fit atura ini SKI BARRIR / ADHSIVS I RODUCT DSCRITIO RODUCT # Adapt Barrier Strips Adapt Convex Barrier Rings Adapt Convex Barrier Rings Adapt Convex Barrier Rings Adapt Convex Barrier Rings Adapt Convex Barrier Rings Adapt Convex Barrier Rings Adapt aste Adapt aste Adapt Skin Barrier Rings Adapt Skin Barrier Rings Adapt Skin Barrier Rings Adapt Skin Barrier Rings Allkare rotective Barrier Wipe Allkare rotective Barrier Wipe Ceralus Skin Barrier Ceralus Skin Barrier Ceralus Skin Barrier Ceralus Skin Barrier Ceralus Skin Barrier Ceralus Skin Barrier Ceralus Skin Barrier Ceralus Skin Barrier Ceralus Skin Barrier Ceralus Skin Barrier Coloplast Ostomy aste Coloplast Ostomy Strip aste Coloplast rep Barrier Coloplast rep Barrier Wipe Coloplast Skin Barrier Coloplast Skin Barrier Coloplast Skin Barrier Coloplast Skin Barrier Rings Coloplast Skin Barrier Rings Coloplast Skin Barrier Rings Coloplast Skin Barrier Rings Coloplast Skin Barrier Rings akin Cohesive Seals akin Cohesive Seals akin Cohesive Seals - Slim akin Cohesive Skin Barrier akin Cohesive Skin Barrier Flextend xt Wear Skin Barrier Flextend xt Wear Skin Barrier 8801 FR CO CO FR HO HO HO HO HO HO HO HO HO HO HO HO HO CO CO HO HO HO HO HO HO HO HO HO HO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO HO HO ovember

270 Ostomy Supplies Benefit ist SKI BARRIR / ADHSIVS I RODUCT DSCRITIO RODUCT # FormaFlex Shape-to-Fit Skin Barrier FormaFlex Shape-to-Fit Skin Barrier FormaFlex Shape-to-Fit Skin Barrier Hollihesive Skin Barrier Hollihesive Skin Barrier edical Adhesive ouldable Rings (3.0mm) ouldable Rings (4.2mm) ight Drainage Bag Z ight Drainage Bag Adapter DA remium owder remium Skin Barrier remium Skin Barrier rotective Wipes W rotective Wipes W Seculast Hydro Stips Aloe SHA Seculast Hydro Strips SH Seculast ouldable Seals SST Seculast ouldable Seals SSS Seculast ouldable Seals SS Sensi-Care rotective Barrier Wipe Skin Gel rotective Wipes Skin-rep rotective Barrier Skin-rep rotective Barrier Stoma aste S Stomahesive aste Tube Stomahesive rotective dr Stomahesive Skin Barrier Stomahesive Skin Barrier Urihesive Strips SKI BARRIRS OR WAFRS W FAG (2 IC) I RODUCT DSCRITIO RODUCT # Harmony Duo HD Harmony Duo HD Harmony Duo HD Harmony Duo Flexible HDF Harmony Duo Flexible HDF Harmony Duo Flexible HDF Harmony Duo Flexible w Aloe FHDF Harmony Duo Flexible w Aloe FHDF Harmony Duo Flexible w Aloe FHDF Harmony Duo Flexible w Aloe FHDF Harmony Duo Flexible w Aloe FHDF Harmony Duo Flexible w Aloe FHDF Harmony Duo Flexible w Aloe FHDF Harmony Duo Flexible w Aloe FHDF Harmony Duo Flexible w Aloe FHDF Harmony Duo ouch HDC1370 FR HO HO HO HO HO HO CO CO ARG ARG HO HO HO ARG ARG ARG ARG ARG ARG ARG CO HO S S ARG CO CO CO CO CO FR ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ovember

271 Ostomy Supplies Benefit ist SKI BARRIRS OR WAFRS W FAG (2 IC) I RODUCT DSCRITIO RODUCT # Harmony Duo ouch HDC Harmony Duo ouch HDC Harmony Duo ouch HDC Harmony Duo ouch HDD Harmony Duo ouch HDD Harmony Duo ouch HDD Harmony Duo ouch HDD Harmony Duo ouch HDD Harmony Duo ouch HDD Harmony Duo ouch HDDT Harmony Duo ouch HDDT Harmony Duo ouch HDDT Harmony Duo ouch HDDS Harmony Duo ouch HDDS Harmony Duo ouch HDC Harmony Duo ouch HDC Harmony Duo w Aloe FHD Harmony Duo w Aloe FHD Harmony Duo w Aloe FHD Harmony Duo w Aloe FHD Harmony Duo w Aloe FHD Harmony Duo w Aloe FHD Harmony Duo w Aloe FHD Harmony Duo w Aloe FHD Harmony Duo w Aloe FHD Sensura io Click Sensura io Click Sensura io Click Sensura io Click Sensura io Click Sensura io Click Sensura io Click Sensura io Click Sensura io Flex Sensura io Flex Sensura io Flex Sensura io Flex Sensura io Flex Sensura io Flex Sur-Fit atura Dura old Sur-Fit atura Dura old Sur-Fit atura Dura old Sur-Fit atura Dura old Sur-Fit atura Dura old Acc Sur-Fit atura Dura old Acc Sur-Fit atura Dura old Acc Sur-Fit atura Stoma old Sur-Fit atura Stoma old FR ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG ARG CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO ovember

272 Ostomy Supplies Benefit ist SKI BARRIRS OR WAFRS W FAG (2 IC) I RODUCT DSCRITIO RODUCT # Sur-Fit atura Stoma old Sur-Fit atura Stoma old Sur-Fit atura Stoma old Acc Sur-Fit atura Stoma old Acc Sur-Fit atura Stoma old Acc SKI BARRIRS or WAFRS w FAG (2 IC) I RODUCT DSCRITIO RODUCT # Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura - Wear Assura ediatric Assura Std Wear Assura Std Wear Assura Std Wear Assura Std Wear Assura Std Wear Assura Std Wear Assura Std Wear Assura Std Wear Assura Std Wear FR CO CO CO CO CO FR CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO ovember

273 Ostomy Supplies Benefit ist SKI BARRIRS or WAFRS w FAG (2 IC) I RODUCT DSCRITIO RODUCT # Assura Std Wear Assura Std Wear Assura Std Wear Assura Std Wear Assura Std Wear Assura Std Wear Assura Std Wear Assura Std Wear Assura Std Wear Assura Std Wear Assura Std Wear Assura Std Wear Assura Std Wear Assura Std Wear Assura Std Wear Assura Std Wear Assura Std Wear Assura Std Wear Assura Std Wear Assura Std Wear Assura Std Wear Assura Std Wear Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating 3738 FR CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO ovember

274 Ostomy Supplies Benefit ist SKI BARRIRS or WAFRS w FAG (2 IC) I RODUCT DSCRITIO RODUCT # Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating Centerointock Floating Centerointock remier Flex Centerointock remier Flex Centerointock remier Flex Centerointock remier Flex Centerointock remier Flex Centerointock remier Flex Centerointock remier Flex Centerointock remier Flex Centerointock remier Flex Centerointock remier Flex Centerointock remier Flex Centerointock remier Flex Centerointock remier Flex Centerointock remier Flex Centerointock remier Flex Centerointock remier Flex Centerointock remier Flex Centerointock remier Flex Centerointock remier Flex Centerointock remier Flex Centerointock remier Flex Centerointock remier Flex Centerointock remier Flex Centerointock remier Flex Centerointock remier Flex asiflex - Wear asiflex - Wear asiflex - Wear asiflex - Wear asiflex - Wear asiflex - Wear asiflex Std Wear asiflex Std Wear asiflex Std Wear asiflex Std Wear asiflex Std Wear steem Synergy Dura old steem Synergy Dura old steem Synergy Dura old steem Synergy Stomahesive steem Synergy Stomahesive steem Synergy Stomahesive FR HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO ovember

275 Ostomy Supplies Benefit ist SKI BARRIRS or WAFRS w FAG (2 IC) I RODUCT DSCRITIO RODUCT # steem Synergy Stomahesive steem Synergy Stomahesive steem Synergy Stomahesive steem Synergy Stomahesive steem Synergy Stomahesive steem Synergy Stomahesive steem Synergy Stomahesive steem Synergy Stomahesive steem Synergy Stomahesive steem Synergy Stomahesive steem Synergy Stomahesive steem Synergy Stomahesive steem Synergy Stomahesive steem Synergy Stomahesive steem Synergy Stomahesive First Choice Drainable ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Flat w Tape ew Image Flat w Tape ew Image Flat w Tape ew Image Flat w Tape ew Image Flat w Tape ew Image Flat w Tape ew Image Flat w Tape ew Image Flat w Tape ew Image Flat w Tape ew Image Flat w Tape ew Image Flat w Tape ew Image Flat w Tape ew Image Flat w Tape ew Image Flat w Tape ew Image Flat w Tape ew Image Flat w Tape ew Image Flat w Tape ew Image Flat w Tape ew Image Flat w/o Tape ew Image Flat w/o Tape ew Image Flat w/o Tape ew Image Flat w/o Tape ew Image Flat w/o Tape ew Image Flat w/o Tape ew Image Flat w/o Tape FR CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO ovember

276 Ostomy Supplies Benefit ist SKI BARRIRS or WAFRS w FAG (2 IC) I RODUCT DSCRITIO RODUCT # ew Image Flat w/o Tape ew Image Flat w/o Tape ew Image Flat w/o Tape ew Image Flat w/o Tape ew Image Flat w/o Tape ew Image Flat w/o Tape ew Image Flat w/o Tape ew Image Flat w/o Tape ew Image Flat w/o Tape ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating ew Image Floating FR HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO ovember

277 Ostomy Supplies Benefit ist SKI BARRIRS or WAFRS w FAG (2 IC) I RODUCT DSCRITIO RODUCT # ew Image Floating ew Image Stationary ew Image Stationary ew Image Stationary ew Image Stationary ew Image Stationary ew Image Stationary ew Image Stationary ew Image Stationary ew Image Stationary ew Image Stationary ew Image Stationary ew Image Stationary ew Image Stationary ew Image Stationary ew Image Stationary ew Image Stationary ouchkins ediatric Sensura Flex Skin Sensura Flex Skin Sensura Flex Skin Sensura Flex Skin Sensura Flex Skin Sensura Flex Skin Sensura Flex Skin Sensura Flex Skin Sensura Flex Skin Sensura Flex Skin Sensura Flex Skin Sensura Flex Skin Sensura Flex Skin Sensura Flex Skin Sensura Flex Skin Sensura Flex Skin Sensura Flex Skin Sensura Flex Skin Sensura Std Wear Sensura Std Wear Sensura Std Wear Sensura Std Wear Sensura Std Wear Sensura Std Wear Sensura Std Wear Sensura Std Wear Sensura Std Wear Sensura Std Wear Sensura Std Wear Sensura Std Wear FR HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO HO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO ovember

278 Ostomy Supplies Benefit ist SKI BARRIRS or WAFRS w FAG (2 IC) I RODUCT DSCRITIO RODUCT # Sensura Std Wear Sensura Std Wear Sensura Std Wear Sensura Std Wear Sur-Fit Autoock Dura Flex Sur-Fit Autoock Dura Flex Sur-Fit Autoock Dura Flex Sur-Fit Autoock Dura Flex Sur-Fit Autoock Dura Flex Sur-Fit Autoock Dura Flex Sur-Fit Autoock Dura Flex Sur-Fit Autoock Dura Flex Sur-Fit Autoock Dura Flex Sur-Fit atura Dura Flex Sur-Fit atura Dura Flex Sur-Fit atura Dura Flex Sur-Fit atura Dura Flex Sur-Fit atura Dura Flex Sur-Fit atura Dura Flex Sur-Fit atura Dura Flex Sur-Fit atura Dura Flex Sur-Fit atura Dura Flex Sur-Fit atura Dura Flex Sur-Fit atura Dura Flex Sur-Fit atura Dura Flex Sur-Fit atura Dura Flex Sur-Fit atura Dura Flex Sur-Fit atura Dura Flex Sur-Fit atura Dura Flex Sur-Fit atura Dura ow rof Sur-Fit atura Dura ow rof Sur-Fit atura Dura ow rof Sur-Fit atura Dura ow rof Sur-Fit atura Dura ow rof Sur-Fit atura Dura ow rof Sur-Fit atura Dura ow rof Sur-Fit atura Dura ow rof Sur-Fit atura Dura ow rof Sur-Fit atura Dura ow rof Sur-Fit atura Dura ow rof Sur-Fit atura Dura ow rof Sur-Fit atura Dura old Sur-Fit atura Dura old Sur-Fit atura Dura old Sur-Fit atura Dura old Sur-Fit atura Dura old Sur-Fit atura Dura old Sur-Fit atura Dura old FR CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO ovember

279 Ostomy Supplies Benefit ist SKI BARRIRS or WAFRS w FAG (2 IC) I RODUCT DSCRITIO RODUCT # Sur-Fit atura ittle Ones Sur-Fit atura Stoma Flex Sur-Fit atura Stoma Flex Sur-Fit atura Stoma Flex Sur-Fit atura Stoma Flex Sur-Fit atura Stoma Flex Sur-Fit atura Stoma Flex Sur-Fit atura Stoma Flex Sur-Fit atura Stoma Flex Sur-Fit atura Stoma Flex Sur-Fit atura Stoma Flex Sur-Fit atura Stoma Flex Sur-Fit atura Stoma Flex Sur-Fit atura Stoma Flex Sur-Fit atura Stoma Flex Sur-Fit atura Stoma Flex Sur-Fit atura Stoma Flex Sur-Fit atura Stoma Flex Sur-Fit atura Stoma Flex Sur-Fit atura Stoma Flex Sur-Fit atura Stoma Flex Sur-Fit atura Stoma Flex Sur-Fit atura Stoma old Sur-Fit atura Stoma old Sur-Fit atura Stoma old Sur-Fit atura Stoma old Sur-Fit atura Stomahesive Sur-Fit atura Stomahesive Sur-Fit atura Stomahesive Sur-Fit atura Stomahesive Sur-Fit atura Stomahesive Sur-Fit atura Stomahesive FR CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO ovember

280 Compounds *For compound formulations please see the ova Scotia harmacists' Guide All Beneficiaries RODUCT DSCRITIO DI ROVT BSTAT Anthralin 0.4% Oint Anthralin Soft 0.05% aste Anthralin Soft 0.1% aste Anthralin Soft 0.2% aste Anthralin Weak 0.2% Oint Disulfiram 250mg Cap Hydrocortisone dr 1-2.5% in Clotrimazole Cr CD (coal tar) reparations CD(20%) reparations agic outhwash O/ C ethadone dr (o/l compound) D lacebo C robenecid 250mg Cap (Compound) robenecid 500mg Cap (Compound) Salicylic Acid Oint Tar omade Children 12 ears and Under RODUCT DSCRITIO DI ROVT BSTAT Acetazolamide Oral Suspension F Allopurinol Oral Suspension FC Amiodarone Oral Suspension F Amlodipine Oral Suspension F Atenolol Oral Syrup F Azathioprine Oral Suspension FC Baclofen Oral Suspension F Carvedilol Oral Suspension F Clonazepam Oral Suspension D F Clonidine Oral Suspension F Clotrimazole Oral Suspension FC Dexamethasone Oral Suspension FC Domperidone Oral Suspension FC nalapril Oral Suspension F Hydralazine Oral Suspension F Hydrochlorothiazide Oral Suspension F Hydrocortisone Oral Suspension FC Indomethacin Oral Suspension FC abetalol Oral Suspension F amotrigine Oral Suspension F ansoprazole Oral Suspension FC isinopril Oral Suspension F ethimazole Oral Suspension F etolazone Oral Suspension F etoprolol Oral Suspension F etronidazole Oral Suspension FC adolol Oral Syrup F aproxen Oral Suspension FC ovember

281 Children 12 ears and Under Compounds *For compound formulations please see the ova Scotia harmacists' Guide RODUCT DSCRITIO DI ROVT BSTAT itrazepam Oral Suspension D F itrofurantoin Oral Suspension FC ropranolol Oral Suspension F yrazinamide Oral Suspension FC Sotalol Oral Suspension F Spironolactone Oral Suspension F Sulfasalazine Oral Suspension F ovember

282 roduct Index 5-AIOSAICIC ACID (SAAI) ABATACT ABIRATRO ACAROSAT ACARBOS ACBUTOO ACOCOUARO ACTAIOH (ARACTAO) ACTAIOH, COB. XC. SCHOTICS ACTAZOAID ACTCSTI ACTSAICIC ACID ACTSAICIC ACID (ASA) COBIATIOS XC. SCHOTICS ACTSAICIC ACID (ASA) COBIATIOS WITH SCHOTICS ACITRTI ACIDIIU BROID ACCOVIR ADAIUAB ADFOVIR DIIVOXI AFATIIB ADROIC ACID (ADROAT) ADROIC ACID AD CHOCACIFRO AFACACIDO AFTAI AFUZOSI AGUCOSIDAS AFA AISKIR AITRTIOI AOURIO AOTRITA AOGITI ARAZOA AUIIU HDROXID AATADI ABRISTA ACIOID

283 roduct Index AIKACI AIORID AIOBZOAT OTASSIU, SSTIC AIODARO AITRITI AODII AOXICII AOXICII AD Z IHIBITOR AHTAIS AHOTRICI AICII AAGRID AAKIRA AASTROZO ATACIDS, ORDIAR SAT COBIATIOS ATACIDS, ORDIAR SAT COBIATIOS AD ATIFATUTS ATIBIOTICS (OHTHAIC), COBIATIOS ATIBIOTICS, COBIATIOS ATIIFCTIVS, COBIATIOS ATISASODICS, COBIATIOS AIXABA ARACOIDI ARITAT ARIIRAZO ARTIFICIA TARS AD OTHR IDIFFRT RARATIOS ASAI ASISARTA DOXOI ASISARTA DOXOI AD CHORTHAIDO ATAZAAVIR ATOO ATOO AD OTHR DIURTICS ATOOXTI ATORVASTATI ATORVASTATI AD AODII ATOVAQUO ATROI

284 roduct Index AURAOFI AXITIIB AZATHIORI AZAIC ACID AZITHROCI AZTROA BACITRACI BACOF BCG VACCI BCOTHASO BIUAB BAZRI BZTHOIU CHORID, COBIATIOS BZO ROXID BZTROI BZDAI BTAHISTI BTAI BTATHASO BTATHASO AD ATIBIOTICS BTAXOO BTHACHO BZAFIBRAT BICAUTAID BIATOROST BISACOD BISUTH SUBSAICAT BISOROO BOCRVIR BOSTA BRTIU TOSAT BRIOIDI BRIZOAID BROAZA BROOCRITI BUDSOID

285 roduct Index BUTAID BUIVACAI BURORHI BURORHI, COBIATIOS BUROIO BUSRI BUSIRO BUSUFA BUTORHAO CABRGOI CACIOTRIO CACIOTRIO, COBIATIOS CACITOI (SAO STHTIC) CACITRIO CACIU ACTAT CACIU FOIAT CAAGIFOZI CAAKIUAB CADRSARTA AD DIURTICS CADSARTA CAABIOID DRIVATIVS, COBIATIOS CACITABI CATORI CARBAAZI CARBOHDRATS CARVDIO CFACOR CFADROXI CFAZOI CFI (HDROCHORID) CFIXI CFOTAXI CFROZI CFTAZIDI CFTRIAXO CFUROXI

286 roduct Index CCOXIB CHAXI CRTOIZUAB GO CTIRIZI CHORA HDRAT CHORABUCI CHORAHICO CHORDIAZOXID CHORHXIDI CHOROQUI CHORROAZI CHORROAID CHORTHAIDO CHOSTRAI CICSOID CICOIROX CICOSORI CIAZARI CIAZARI AD DIURTICS CITIDI CIACAT CIROFOXACI CISATI CITAORA CARITHROCI CIDIIU AD SCHOTICS CIDACI CIDACI, COBIATIOS COBAZA COBTASO COBTASO CODROIC ACID (CODROAT) COIF COIRAI COAZA COIDI

287 roduct Index COIDOGR CORAZAT DIOTASSIU COTRIAZO COXACII COZAI CODI CODI, COBIATIOS XC. SCHOTICS COCHICI COSVA COSTIO COAGAS (COSTRIDIOITIDAS) COJUGATD STROGS CORTISO CRIZOTIIB CROOGCAT SODIU CAOCOBAAI CAOCOBAAI, COBIATIOS CCOBZARI CCOTOAT CCOHOSHAID CCOSORI CROTRO CROTRO AD STROG DABIGATRA TXIAT DATARI DAAZO DATRO DASO DATOCI DARBOTI DARIFACI DARUAVIR DASABUVIR, OBITASVIR, ARITARVIR AD RITOAVIR DASATIIB DFRASIROX DFROXAI

288 roduct Index DGARIX DHDROCHOIC ACID DOSUAB DSIRAI DSORATADI DSORSSI DSOGSTR AD STROG DSOID DSOXITASO DSVAFAXI DXATHASO DXATHASO AD ATIIFCTIVS DXAHTAI DXTRIFRRO (IRO DXTRA) DXTROROOXH DIABTIC ACTS DIAZA DIAZOXID DICOFAC DICOFAC, COBIATIOS DICCOVRI (DICCOI) DIOGST DIFUCORTOO DIFUISA DIGOXI DIHDRORGOTAI DITIAZ DIHDRIAT DITH FUARAT DITH SUFOXID DIOROSTO DIHHDRAI DIHOXAT DIRIDAO DISORAID DOBUTAI

289 roduct Index DOCTAX DOCUSAT SODIU DOUTGRAVIR DORIDO DOZI DORZOAID DOXAZOSI DOXI DOXCCI DOXAI DRODARO DRORIDO DROSIRO AD STROG DUOTGRAVIR, ABACAVIR, AIVUDI DUOXTI DUTASTRID FAVIRZ TRITA TROBOAG TRICITABI, TOFOVIR DISOROXI AD FAVIRZ TRICITABI, TOFOVIR DISOROXI AD RIIVIRI TRICITABI, TOFOVIR DISOROXI, VITGRAVIR AD COBICISTAT AARI AARI AD DIURTICS FUVIRTID OXAARI TACAO TCAVIR ZAUTAID IHRI IRUBICI RO ROSARTA ROSARTA AD DIURTICS RGOCACIFRO RGOOID SATS

290 roduct Index ROTIIB RTHROCI RTHROCI, COBIATIOS RTHROOITI SCITAORA SORAZO STRADIO STRAUSTI STRO TARCT THABUTO THI STRADIO AD TOOGSTR THOROAZI (ROFAI) THOSUXIID THODIO AD STROG TIDROIC ACID (TIDROAT) TIDROIC ACID AD CACIU, SQUTIA TODOAC TOOSID TRAVIRI VROIUS XSTA XATID ZTIIB FACICOVIR FAOTIDI FARIDI FBUXOSTAT FODII FOFIBRAT FOTRO AD OTHR DRUGS FOR OBSTRUCTIV AIRWA DIS FTA FRRIC SODIU GUCOAT COX FRROUS FUARAT FRROUS GUCOAT FRROUS SUFAT

291 roduct Index FRUOXTO FSOTRODI FXOFADI FIGRASTI FIASTRID FIGOIOD FCAIID FOCTAFI FUCOAZO FUDARABI FUDROCORTISO FUAZI FUTASO AD ATIBIOTICS FUTASO AD ATIIFCTIVS FUARIZI FUOCIOO ACTOID FUOCIOID FUOROTHOO FUOROURACI FUOXTI FUTHIXO FUHAZI FURAZA FURBIROF FUTAID FUTICASO FUVASTATI FUVOXAI FOIC ACID FODAARIUX FOROTRO FOROTRO AD OTHR DRUGS FOR OBSTRUCTIV AIRWA DIS FOSARAVIR FOOCI FOSIORI FRACTI

292 roduct Index FROVATRITA FUROSID FUSIDIC ACID GABATI GAATAI GACICOVIR GATIFOXACI GFITIIB GCITABI GFIBROZI GTAICI GATIRAR ACTAT GICAZID GIIRID GUCAGO GUCOS GBURID (GIBCAID) GCORROAT (GCORROIU) GCORROIU BROID GOIUAB GOSRI GRAISTRO GRASS O GUAIFSI HAORIDO HARI HXACHOROH HISTRI HOATROI HDRAAZI HDROCHOROTHIAZID HDROCHOROTHIAZID AD OTASSIU-SARIG AGTS HDROCORTISO HDROCORTISO AD ATIBIOTICS HDROORHO HDROXCHOROQUI

293 roduct Index HDROXURA (HDROXCARBAID) HDROXZI HOSCAI IBRUTIIB IBUROF IDURSUFAS IATIIB IIDAZO DRIVATIVS, COBIATIOS II AD Z IHIBITOR IIRAI IIQUIOD ICOBOTUIUTOXI-A IDACATRO IDACATRO AD GCORROIU BROID IDAAID IDIAVIR IDOTHACI IFIXIAB ISUI (HUA) ISUI ASART ISUI DTIR ISUI GARGI ISUI GUISI ISUI ISRO ISUI DS ISUI SRIGS ITRFRO AHA-2B ITRFRO BTA-1A ITRFRO BTA-1B IRATROIU BROID IRBSARTA IRBSARTA AD DIURTICS IRO, UTIVITAIS AD FOIC ACID IRO, UTIVITAIS AD IRAS ISOIAZID ISORO RISTAT

294 roduct Index ISOSORBID DIITRAT ISOSORBID OOITRAT ISOTRTIOI ITRACOAZO IVACAFTOR KTAI KTOCOAZO KTOROF KTOROAC KTOTIF ABTAO ACOSAID ACTIC ACID RODUCIG ORGAISS ACTUOS AIVUDI AIVUDI AD ABACAVIR AOTRIGI AROTID ASORAZO ASORAZO, CARITHROCI AD AOXICII ATHAU CARBOAT AATIIB AROIDAS ATAOROST DIASVIR AD SOFOSBUVIR FUOID AIDOID TROZO UROID (URORI) VTIRACTA VOBUOO VOCABASTI VOCARITI VODOA AD DCARBOXAS IHIBITOR VODOA, DCARBOXAS IHIBITOR AD COT IHIBITOR VOFOXACI

295 roduct Index VOORGSTR VOORGSTR AD STROG VOTHROXI SODIU IDOCAI IDOCAI, COBIATIOS IAGITI ICOCI IZOID IOTHROI SODIU IRAGUTID ISDXAFTAI ISIORI ISIORI AD DIURTICS ITHIU OUSTI ORAID ORATADI ORAZA OSARTA OSARTA AD DIURTICS OTRDO OVASTATI OXAI URASIDO ACROGO AGSIU CITRAT AGSIU GUCOHTOAT AGSIU HDROXID AROTII ARAVIROC BDAZO DROXROGSTRO FAIC ACID FOQUI GSTRO OXICA

296 roduct Index HAA ATI RCATOURI TFORI TFORI AD AOGITI TFORI AD ROSIGITAZO TFORI AD SAXAGITI TFORI AD SITAGITI THADO THAZOAID THAI THIAZO (THIAAZO) THOCARBAO THOCARBAO, COBIATIOS XCUDIG SCHOTICS THOTRXAT THOTRIRAZI (VOROAZI) THOXSA THSUXIID (SUXIID) THDOA (RACIC) THATRXO BROID THHIDAT THRDISOO THRDISOO, COBIATIOS TOCORAID TOAZO TOROO TROIDAZO XITI ICOAZO IDAZOA IDODRI IGUSTAT IRA SATS I COBIATIO IOCCI IOXIDI IRABGRO

297 roduct Index IRTAZAI ISCAOUS DVICS ISOROSTO OCOBID ODAFII OTASO OTUKAST ORHI OXIFOXACI UTIZS (IAS, ROTAS, TC) UIROCI COHOIC ACID ABIO (CAABIOID (THC) DRIVATIVS) ABUTO ADOO AFARI AOXO ATRXO AROX ARATRITA ATAIZUAB ATGIID BIVOO FIAVIR OCI OSTIGI VIRAI ICOTIIC ACID IFDII IOTIIB IUTAID IODII ITRAZA ITROFURATOI ITROGCRI (GCR TRIITRAT) IZATIDI

298 roduct Index ORGSTROI AD STROG ORIHRI ORTHIDRO ORTHIDRO AD STROG ORFOXACI ORGSTIAT AD STROG ORTRITI STATI STATI, COBIATIOS OCRIASI OCTROTID OFOXACI OAZAI OSARTA DOXOI OSARTA DOXOI AD DIURTICS OOATADI OSAAZI (5-ASA) OAIZUAB ORAZO OABOTUIUTOXI-A ODASTRO OIU ORCIRAI ORISTAT ORHADRI (CITRAT) OSTAIVIR OTHR RSIRATOR SST RODUCTS OXAROZI OXAZA OXCARBAZI OXTRIHI (CHOI THOHIAT) OXBUTI OXCODO ACITAX AIRIDO AOOSTRO

299 roduct Index AIDROIC ACID (AIDROAT) ATORAZO AAVRI AROOCI AROXTI AZOAIB GATAIB GFIGRASTI GITRFRO AFA-2A GITRFRO AFA-2A, COBIATIOS GITRFRO AFA-2B, COBIATIOS GVISOAT ICIAI TOSA OSUFAT SODIU TOXIFI SI RAA RICAZI (RORICAZI) RIDORI RIDORI AD DIURTICS RHAZI THIDI (RIDI) HZI HOBARBITA HOXTHICII (ICII V) HTOAI HHRI HTOI HTOADIO IOCARI ICROIUS IOZID IAVRIU IDOO IDOO AD OTHR DIURTICS IOGITAZO

300 roduct Index IRACII AD Z IHIBITOR IRFIDO IROXICA IZOTIF ACBO ASTIC IUD WITH ROGSTOG ATT AGGRGATIO IHIBITORS, COBIATIOS RIXAFOR ODOHOTOXI OSTR SUFOAT OAIDOID OSACOAZO OTASSIU CHORID OTASSIU CITRAT RAIXO RASUGR RAVASTATI RAZOSI RDISOO RDISOO AD ATIIFCTIVS RDISO RGABAI RIAQUI RIIDO ROCAIAID ROCARBAZI ROCHORRAZI ROCCIDI ROGSTRO ROGUAI, COBIATIOS ROAFO RORAOO ROTHIOURACI ROTAS IHIBITORS, COBIATIOS ROXTACAI RUCAORID

301 roduct Index RIDOSTIGI QUTIAI QUIAGOID QUIARI QUIARI AD DIURTICS QUII RABRAZO RAOXIF RATGRAVIR RAIRI RAIRI AD DIURTICS RAITIDI RASAGII RGORAFIB RAGIID RIBAVIRI RIFABUTI RIFAI (RIFAICI) RIFAI AD ISOIAZID RIIVIRI RIUZO RIOCIGUAT RISDROIC ACID (RISDROAT) RISRIDO RITOAVIR RITUXIAB RIVAROXABA RIVASTIGI RIZATRITA ROFUIAST ROIOSTI ROIIRO ROSIGITAZO ROSUVASTATI RUFIAID RUXOITIIB

302 roduct Index SACCHARATD IRO OXID SABUTAO SABUTAO AD IATRORIU BROID SABUTAO AD OTHR DRUGS FOR OBSTRUCTIV AIRWA DIS SATRO SATRO AD OTHR DRUGS FOR OBSTRUCTIV AIRWA DIS SAQUIAVIR SAXAGITI SCOOAI SGII SIU SUFID SA GCOSIDS SA GCOSIDS, COBIATIOS SRTRAI SVAR SIDAFI SIDOSI SIICOS SIVR SUFADIAZI SIRVIR SIVASTATI SITAGITI SODIU AUROTHIOAAT SODIU CHORID SODIU CHORID, HRTOIC SODIU HOSHAT SOFOSBUVIR SOIFACI SOATROI SORAFIB SOTAO SIRACI SIROOACTO STAVUDI STRI WATR STOI QUIT

303 roduct Index SUCRAFAT SUFTAI SUFACTAID SUFATHOXAZO AD TRITHORI SUFASAAZI SUFIRAZO SUIDAC SUHUR SUATRITA SUITIIB TACROIUS TADAAFI TAOXIF TASUOSI TAZAROT TARVIR TBIVUDI TISARTA TISARTA AD AODII TISARTA AD DIURTICS TAZA TOZOOID TOFOVIR DISOROXI TOFOVIR DISOROXI AD TRICITABI TOXICA TRAZOSI TRBIAFI TRBUTAI TRIFUOID TSTOSTRO TTRABAZI TTRACCI THOHI THOHI, COBIATIOS XCUDIG SCHOTICS THIAI (VIT B1) THIOGUAI

304 roduct Index THIORORAZI THIOTHIX THROID GAD RARATIOS THROTROI TIAROFIC ACID TICAGROR TICOIDI TIGCCI TIOO TIOO, COBIATIOS TIZAARI TIOTROIU BROID TIRAAVIR TIZAIDI TOBRACI TOCIIZUAB TOBUTAID TOAFTAT TOTRODI TOVATA TOIRAAT TOOTCA TRAADO TRAADO, COBIATIOS TRADOARI TRADOARI AD VRAAI TRAXAIC ACID TRACROI TRAVOROST TRAZODO TRROSTII TRTIOI TRIACIOO TRIACIOO AD ATIBIOTICS TRIAZOA TRIFUORAZI

305 roduct Index TRIFURIDI TRIHXHID TRIBUTI TRITHORI TRIIRAI TRITORI TROICAID TROSIU TRTOHA URSODIO (URSODOXCHOIC ACID) USTKIUAB VAACCOVIR VAGACICOVIR VAROIC ACID (DIVAROX SODIU) VASARTA VASARTA AD DIURTICS VACOCI VARIOUS VARIOUS ASA RARATIOS VASORSSI VURAFIB VAFAXI VRAAI VRTORFI VIGABATRI VIATRO AD FUTICASO FUROAT VIATRO AD UCIDIIU BROID VISODGIB VORICOAZO WARFARI ZAFIRUKAST ZAAIVIR ZIDOVUDI ZIDOVUDI AD AIVUDI ZIRASIDO ZODROIC ACID

306 roduct Index ZOITRITA ZOID ZOICO ZUCOTHIXO

307 Appendix I Abbreviations Aer Aerosol R odified Release Amp Ampoule as asal Cap Capsule eb ebules CFU Colony Forming Units OD Orally Disintegrating Chewtab Chewable Tablet O/ Oral iquid Cr Cream Oint Ointment CD Controlled Distribution Oph Ophthalmic CR Controlled Release Otic ar DR Delayed Release ck ackage Drp Drops dr owder C nteric Coated F reservative Free ff ffervescent pkt acket lx lixir l. Ampule lastic Ampule R xtended Release OS owder for Oral Solution FC Film Coated Resp Respirator g Gram RD Rapid Dissolving Gran Granules RD Rapid Disintegrating I Intramuscular S Sublingual Inh Inhaler Sod Chl Sodium Chloride Inj Injection Sol Solution Ins Insulin Sp Spray IR Immediate Release SR Slow Release Irr Irrigation Supp Suppository iu International Unit Susp Suspension IV Intravenous Syr Syrup A ong Acting Tab Tablet iq iquid TCT Tincture ot otion UDV Unit Dose Vial mcg icrogram US United States harmacopeia mcl icroliter Vag Vaginal mq illi-equivalent w/w By Weight mg illigram X xtended Release m illiliter ovember 2015 Appendix I

308 Appendix II Abbreviations of anufacturers ames AA ABB ABV ACC ACO ACT AGA AHI AK AC A A ARG ARO AS AT AUR AUT AVD AV AXC AXS AZ BAX BA BCH BDD BG BHC BIG B B BO BO BRI BSH BTD BTX BV BVT CDX C CHU CI C COB CO CO CD CI DT DRX DUI HS IS D RF AA harma Inc. Abbott aboratories td. AbbVie Corporation Accel harma Inc. agnum harmaceutics Actelion harmaceuticals Canada Inc. Amgen Canada Inc. Accord Healthcare Inc. Dioptic aboratories Alcon Canada Inc. Allergan Inc. Almirall Canada td. Apotex Inc. Argyle edical Distributors Inc Auro harma Inc Astellas harma Canada Inc. aboratoire Atlas Inc. Actavis harma Company Aurium harma Inc. Auto Control edical Inc. Alveda harma Sanofi asteur imited Aptalis harma Canada Inc. Axxess harma Inc. AstraZeneca Canada Inc. Baxter Corporation Bayer Inc. Bioniche Inc. Bayer HealthCare, Diabetes Care Division BG harma Inc Bellco Healthcare Inc. Biogen Idec Canada Inc. Boca edical roducts Bionime USA Corp Boehringer Ingelheim (Canada) td. Roche Diagnostics, Div.of Hoffmann-aRoche Bristol-yers Squibb Canada Inc. Bausch & omb Canada Inc. Becton Dickinson Canada BTX Inc Biovail harmaceuticals Canada Biovitrum Canderm harmaca Inc. Celgene Church and Dwight Canada Corp. Cipher harmaceuticals Inc. Canadian edical artners Cobalt harmaceuticals Company Coloplast Canada ConvaTec Canada td manually compounded Cytex harmaceuticals Inc. Dermtek harmaceuticals td. Domrex harma Inc. Duchesnay Inc. ntra Health Systems Inc isai imited D Serono Canada Inc. RFA Canada Inc. FI FKB FC FRS GAC GCH GI G GD G GSK GZ HR HZ HO HO HOS HT IC ID IRO IT JA JCB JJ JC KG BK O FS I AR CK DS D GI ID JO T T O D RS SC TD V AT B O G C O VO VR C OD OG Ferring Inc. Fresenius Kabi Canada Forest aboratories Canada Inc. erck Canada td. Galderma Canada Inc. GlaxoSmithKline Consumer Healthcare Inc. Gilead Sciences Inc. Glenwood aboratories Canada td. Gened, A Division of fizer Canada Inc. Generic edical artners Inc. GlaxoSmithKline Inc. Genzyme Canada Inc. Hoffmann-aRoche imited Hill Dermaceuticals, Inc. Hollister imited Home Diagnostics Inc. Hospira Healthcare Corporation Healthpoint Canada UC Indivior Canada imited I-ed harma Inc. Iroko International Intermune Canada Janssen-Ortho Inc. Jacobus harmaceutical Company Inc. Johnson & Johnson Inc. Jamp harma Corporation King harma Canada td. undbeck Inc. eo harma Inc. ifescan Canada td. li illy Canada Inc. arcan harmaceuticals Inc Zinda harma td. edicis Canada td. edican Technologies Inc. ediapharm Inc. GI harma Inc. Abbott Diabetes Care / edisense ead Johnson (Canada) Inc Therapeutics Inc. int harmaceuticals Inc. olnlycke Health Care Inc. edical lastic Devices Inc. erus abs Inc. edisca harmaceutique Inc. ontmed Inc. ylan harmaceuticals UC. eda Valeant harma Canada atco harma (Canada) Inc. ova Biomedical eolab Inc. ext Generation harma Inc. ovartis Consumer Health Canada Inc. ovo ordisk Canada Inc. ovartis Ophthalmics ovartis harmaceuticals Canada Inc. ycomed Canada Inc. Odan aboratories td. Omega aboratories td. ovember 2015 Appendix II

309 Appendix II Abbreviations of anufacturers ames ORB ORG OR OTS A D R FR H S B C H QGT RA RBH RCH RIV ROG SAV SCH S SV SHI SIV SK S SV ST STA STI Orbus harma Inc. Organon Canada td. Orphan edical Inc. Otsuka Canada harmaceuticals aladin abs Inc. endoharm, Division of harmascience Inc. errigo International fizer Canada Inc. urdue harma harmel Inc. harmascience Inc. roval harma Division of Servier Canada Inc. harmaceutical artners of Canada Inc. atriot harmaceuticals C. Sigma-Tau harmaceuticals Inc. Ranbaxy harmaceuticals Canada Inc. Reckitt Benckiser Healthcare td. Dr. Reddy's aboratories Inc. Riva aboratoire Inc. Rougier harma, Division of ratiopharm Inc. Sanis Health Inc Sanofi-Aventis Canada Inc. Schering-lough (Canada) Inc. Sandoz Canada Incorporated Sunovion harmaceuticals Canada Inc. Servier Canada Inc. Shire Canada Inc. Sivem harmaceuticals Skyed edical roducts Smith & ephew Inc. Sunovion harmaceuticals Canada Inc. Septa harmaceuticals Inc. Stallergene Canada Inc. Stiefel Canada Inc. STR SWS TAK TAR TR TV THI THR TI T T TH TRB TRI TC UCB UTC VA VAR VCO VIV VH V VTX WA WCH WC WS WSQ WTS XI O ZIA Z Steriax Inc. Swiss Herbal Remedies td. Takeda Canada Inc. Taro harmaceuticals Inc. Tercica Inc. Teva Canada td. Tremblay Harrison Inc. Theramed Corporation Trudell edical International Trimel harmaceutical Corporation Teva euroscience Canada Taroharma, Div. of Taro harmaceuticals Inc. Tribute harma Canada Inc Triton harma Inc. Tyco Healthcare UCB harma Canada Inc. United Therapeutics Corporation Valeo harma Inc. various manufacturers Virco harmaceuticals (Canada) Inc. ViiV Health Care Inc. undbeck Canada Inc. Valeant Canada imited Vertex harmaceuticals Wampole Brands Inc. Wyeth Consumer HealthCare Inc. Warner Chilcott Canada Co Wellspring harmaceutical Canada Corp. Westwood Squibb, Div.of Bristol-yers Squibb Watson harma Company Xediton harmaceuticals Inc. Bayer Inc., Consumer Care Division Zila harmaceuticals Inc. Zymcan harmaceuticals Inc. ovember 2015 Appendix II

310 Appendix III Criteria for Coverage of xception Status Drugs Coverage of exception status drugs will be approved according to the following criteria upon review of a prescriber's written request. Included with the ova Scotia Formulary are forms for xception Status Drug requests, which may be used to facilitate the approval process. As an alternative to sending a written request to the harmacare office, certain exception status drugs have been assigned criteria codes. To allow for on-line payment of these drugs, the criteria code may be provided by the prescriber on the prescription or confirmed by the pharmacist. The use of these codes offers the prescriber and the pharmacist access to immediate coverage for patients who clearly meet the exception status criteria. The criteria codes are indicated within the following exception criteria. ABATACT (Orencia 250mg/vial Injection) - for patients with a diagnosis of active rheumatoid arthritis (RA) who: have not responded or who have had intolerable toxicity to an adequate trial 1 of combination therapy of at least two traditional DARDs 2 or if combination therapy is not an option, an adequate trial 1 of at least three traditional DARDs 2 in sequence as monotherapy and patients must have had an adequate trial 1 of leflunomide. xceptions can be considered in cases where leflunomide is contraindicated or not tolerated - therapy must include methotrexate alone or in combination unless contraindicated or not tolerated - written request of a rheumatologist or prescriber with a specialty in rheumatology - coverage will be approved initially for 16 weeks. Can be reassessed for yearly coverage dependent on patient achieving an improvement in symptoms of at least 20% 1 An adequate trial is 5 months for I gold, 6 months for penicillamine, 4 months for hydroxychloroquine and 3 months for all other traditional DARDs as well as leflunomide, infliximab and etanercept. 2 Traditional agents include methotrexate, I gold, sulfasalazine, hydroxychloroquine, azathioprine, chloroquine, penicillamine and cyclosporine. *ABIRATRO ACTAT (Zytiga 250mg Tablet) Asymptomatic or ildly Symptomatic atients: - in combination with prednisone for asymptomatic or mildly symptomatic metastatic CRC patients after failure of androgen deprivation therapy (including an HRH agonist/antagonist or orchiectomy) who have not received prior chemotherapy for metastatic CRC and have COG S 0 or 1. - abiraterone would be an alternative to enzalutamide and not sequential therapy in this asymptomatic or mildly symptomatic patient population. Symptomatic (post-docetaxel chemotherapy) atients: - in combination with prednisone for metastatic CRC patients with COG S of 0-2 and progression after previous treatment with docetaxel. - abiraterone would be an alternative to enzalutamide and not sequential therapy in this symptomatic post docetaxel chemotherapy setting. Retreatment: - Use of abiraterone in the post-docetaxel setting is not permitted if previously used in the pre-chemotherapy setting. ACAROSAT (Campral 333mg Tablet) - for treatment in patients who have been abstinent from alcohol for at least four days and who have contraindications to naltrexone (i.e., acute hepatitis, liver failure or currently receiving opioids) ACIDIIU BROID (Tudorza Genuair 400mcg powder for inhalation) - for the treatment of moderate to severe chronic obstructive pulmonary disease (COD) as defined by spirometry. OR - for the treatment of COD in patients with an inadequate response to short acting bronchodilators. - combination therapy with a long- acting beta-2 agonist /inhaled corticosteroid (ABA/ICS) and a long acting anticholinergic (AAC) inhaler will be considered in patients with: moderate to severe COD, as defined by spirometry, a history of COD exacerbation(s) and an inadequate response to ABA/ICS or AAC. ote: Coverage for ABA and AAC as two separate inhalers will not be considered. OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

311 Clinical otes: 1. oderate to severe COD is defined by spirometry as a post bronchodilator FV1 < 60% predicted and FV1/FVC ratio of < Spirometry reports from any point in time will be accepted. If spirometry cannot be obtained, reasons must be clearly explained and other evidence of COD severity provided, i.e., edical Research Council (RC) Dyspnea Scale Score of at least Grade 3. RC Grade 3 is described as: walks slower than people of same age on the level because of shortness of breath from COD or has to stop for breath when walking at own pace on the level. 2. Inadequate response to short acting bronchodilators is defined as persistent symptoms, i.e., RC of at least Grade 3, after at least 2 months of short acting bronchodilator at the following doses*: 8 puffs per day of short acting beta-2 agonist or 12 puffs per day of ipratropium or 6 puffs per day of ipratropium plus salbutamol combination inhaler * Inadequate response to ABA/ICS or AAC is defined as persistent symptoms after at least 2 months of therapy. 3. COD exacerbation is defined as an increase in symptoms requiring treatment with antibiotics and/or systemic (oral or intravenous) corticosteroids. Treatment of COD lease note that inhaled corticosteroids in combination with long-acting beta 2 agonists (ABA/ICS) have been associated with an increased risk of pneumonia in patients with COD. Guidelines recommend their use in moderate to severe COD patients who are experiencing frequent exacerbations, not controlled by long-acting bronchodilators. For patients with moderate to severe COD who are not experiencing frequent exacerbations, long-acting beta 2 agonists or long-acting anticholinergics are recommended. Global strategy for the diagnosis, management and prevention of COD ote: Inhalers which combine a ABA/AAC are also available as SD benefits. These products have their own criteria which are listed in the S Formulary. ADAIUAB (Humira 40mg/vial Injection) - See Anti-Tumor ecrosis Factor (TF) Agents ADFOVIR DIIVOXI (Hepsera 10mg Tablet) - in combination with lamivudine in patients who: have developed failure to lamivudine (increase in HBV DA of 1 log 10 iu/m over the nadir measured on two separate occasions within an interval of at least one month, after the first 3 months of lamivudine therapy) AD when failure to lamivudine is not due to poor adherence to therapy - coverage approved for 1 year *AFATIIB DIAAT (Giotrif 20mg, 30mg, 40mg Tablet) - for first line treatment of patients with GFR mutation positive advanced or metastatic adenocarcinoma of the lung and with an COG performance status 0 or 1 ADROAT (Fosamax 40mg Tablet and generic brands) - for the treatment of aget s disease of bone (6 month limit) - other requests reviewed on a case by case basis AGUCOSIDAS AFA (yozyme 50mg owder for Injection) - for the treatment of infantile onset ompe disease in patients who have had the onset of symptoms and confirmed cardiomyopathy before the age of 12 months AD - participation in the long-term evaluation of the efficacy of treatment by periodic medical assessment as outlined in the monitoring of therapy guidelines - initial approval is for 6 months. Continued coverage will be based on evaluation of the efficacy of treatment by regular medical assessment as outlined in the monitoring and discontinuation of therapy guidelines (available from the harmacare Office upon request). OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

312 ARG IUOTHRA (Allergy Serum, ollinex-r Injection) - for immunotherapy with specific, standardized allergenic material, administered in high-dose schedules for carefully selected patients with a diagnosis of: Ig mediated anaphylactic reactions to insect stings or severe, seasonal (lasting two or more years) or perennial Ig dependent allergic rhinoconjunctivitis when optimal drug therapy and allergen avoidance have not been sufficiently effective in controlling symptoms or Ig mediated allergic asthma, specifically where there is a clear temporal association between exposure and signs and symptoms of asthma and when optimal drug therapy and avoidance measures have not been sufficiently effective in controlling symptoms ote: The allergy serum must be dispensed from a pharmacy on prescription from a prescriber. Initial authorization is for two years, and can be continued for up to five years if improvement is noted. AOTRITA (Axert 6.25mg, 12.5mg Tablet) - See Selective 5HT 1 - Receptor Agonists *ATRTAI (Hexalen 50mg Capsule) - written request from an oncologist or prescriber with a specialty in oncology - for the treatment of ovarian carcinoma ABRISTA (Volibris 5mg, 10mg Tablet) - for the treatment of patients with at least Class III pulmonary arterial hypertension (AH), either idiopathic or associated with connective tissue disease who have failed therapy with sildenafil or who have contraindications to sildenafil. - diagnosis must be confirmed by right heart catheterization - request must be from a AH specialist AAGRID (Agrylin 0.5mg Capsule and generic brands) ova Scotia Seniors' harmacare rogram: - for the treatment of essential thrombocythemia (T) in patients who have: failed hydroxyurea therapy (does not provide sufficient platelet reduction) or intolerable side effects from hydroxyurea therapy Community Services harmacare rograms: - for the treatment of essential thrombocythemia (T) as an alternative to hydroxyurea ATI-TUOR CROSIS FACTOR (TF) AGTS (Adalimumab, Certolizumab egol, tanercept, Golimumab, Infliximab) Ankylosing Spondylitis (Adalimumab, tanercept, Golimumab, Infliximab) - for the treatment of patients with moderate to severe ankylosing spondylitis (e.g., Bath AS Disease Activity Index (BASDAI) score 4 on 10 point scale) who: have axial symptoms** and who have failed to respond to the sequential use of at least 2 SAIDs at the optimum dose for a minimum period of 3 months observation, or in whom SAIDs are contraindicated OR have peripheral symptoms and who have failed to respond to, or have contraindications to, the sequential use of at least 2 SAIDs at the optimum dose for a minimum period of 3 months observation and have had an inadequate response to an optimal dose or maximal tolerated dose of a DARD must be prescribed by a rheumatologist or prescriber with a specialty in rheumatology requests for renewal must include information showing the beneficial effects of the treatment, specifically: - a decrease of at least 2 points on the BASDAI scale, compared with the pre-treatment score; OR - patient and expert opinion of an adequate clinical response as indicated by a significant functional improvement (measured by outcomes such as HAQ or "ability to return to work") ** atients with recurrent uveitis (2 or more episodes within 12 months) as a complication of axial disease, do not require a trial of 2 SAIDs. OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

313 Initial Coverage Duration and aximum Dosage approved: Adalimumab - initial period 6 months, maximum dose of 40mg every two weeks and not in combination with other anti-tf agents tanercept - initial period 6 months, maximum dose of 50mg per week and not in combination with other anti-tf agents Golimumab - initial period 16 weeks, maximum dose 50mg per month and not in combination with other anti-tf agents Infliximab - initial coverage period 6 months, maximum dose 5mg/kg at 0, 2, and 6 weeks then every 6-8 weeks thereafter and not in combination with other anti-tf agents Crohn's Disease (Adalimumab) - for patients with moderate to severely active Crohn s disease and are: refractory or have contraindications to an adequate course of 5-aminosalicylic acid and corticosteroids and other immunosuppressive therapy initial reimbursement is restricted to an induction dose of 160mg followed by 80mg clinical response to be assessed twelve weeks after the first induction dose and maintenance therapy approved in responders only at a dose not exceeding 40mg every two weeks Crohn's Disease (Infliximab) - for treatment of Crohn s disease in adults, when prescribed by a gastroenterologist or physician with a specialty in gastroenterology: in patients with moderate to severe active disease refractory to 5-ASA products AD glucocorticoids (e.g., prednisone) AD immunosuppressive therapy (azathioprine or 6-mercaptopurine or methotrexate)**. Initial approval of infliximab will be for a single infusion of 5mg/kg/dose. A second infusion may be warranted in patients not responding to the first infusion or in patients responding initially but then worsening before maintenance therapy is effective. Request for approval beyond induction therapy will be considered on a case by case basis in patients with fistulizing disease who have actively draining perianal or enterocutaneous fistula(e) that have recurred or persisted despite a course of appropriate antibiotic therapy (e.g., metronidazole +/-ciprofloxacin for a minimum of 3 weeks) AD immunosuppressive therapy (azathioprine or 6-mercaptopurine or methotrexate)**. Initial approval is for three infusions of infliximab of 5mg/kg/dose at 0, 2 and 6 week intervals ** atients who are very ill and not candidates for surgery may qualify for infliximab therapy without a trial of AZA, 6- or TX, as they may require a more rapid onset of response. Juvenile Rheumatoid Arthritis (tanercept) - for the treatment of moderate to severely active, polyarticular juvenile rheumatoid arthritis in children (age 4-17) who have not responded to adequate treatment with one or more DARDs for at least 3 months or have intolerance to DARDs, and do not have a contraindication to etanercept olyarticular Juvenile Idiopathic Arthritis (Adalimumab) - for the treatment of polyarticular juvenile idiopathic arthritis (pjia)with the following criteria: for patients aged 4-17 years with moderately or severe pjia who have had a inadequate response to one or more disease-modifying anti-rheumatic drugs (DARDs); and - treatment must be initiated by a rheumatologist who is familiar with the use of DARDs and/or biologic DARDs in children. soriasis (Adalimumab, tanercept, Infliximab) - for patients with severe, debilitating chronic plaque psoriasis (so) who meet all of the following criteria: Body Surface Area (BSA) involvement of >10% and/or significant involvement of the face, hands, feet or genital region failure to respond to, contraindications to or intolerant of methotrexate and cyclosporine failure to respond to, intolerant of or unable to access phototherapy - written request of a dermatologist or prescriber with a specialty in dermatology - continued coverage is dependent on evidence of improvement, specifically: 75% reduction in the soriasis Area and Severity Index (ASI) score, or 50% reduction in ASI with a 5 point improvement in DQI (Dermatology ife Quality Index), or significant reduction in BSA involved, with consideration of important regions such as the face, hands, feet or genitals - concurrent use of biologics not approved OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

314 Initial duration and maximum dosage approved: Adalimumab - initial approval for a maximum of 16 weeks - maximum dosage for ongoing coverage is 40mg every two weeks tanercept - initial approval for a maximum of 12 weeks - maximum dosage approved: 50mg biweekly for the initial 12 weeks then 50mg weekly thereafter Infliximab - initial approval for a maximum of 12 weeks - dosage restricted to infliximab 5mg/kg 0, 2 and 6 weeks then every 8 weeks soriatic Arthritis (Adalimumab, Golimumab) - for patients with active psoriatic arthritis who meet all of the following: have at least three active and tender joints have not responded to an adequate trial with two DARDs or have an intolerance or contraindication to DARDs not used in combination with other TF antagonists - written request of a rheumatologist or prescriber with a specialty in rheumatology - after initial coverage period, can be reassessed for yearly coverage dependent on patient achieving an improvement in symptoms of at least 20% Initial Coverage Duration and aximum Dosage approved: Adalimumab - initial period 3 months, maximum dose of 40mg every two weeks Golimumab - initial period 3 months, maximum dose 50mg per month soriatic Arthritis (tanercept) - for the treatment of active psoriatic arthritis in patients who have not responded to an adequate trial with two DARDs or who have an intolerance or contraindication to DARDs - written request of a rheumatologist or prescriber with a specialty in rheumatology - coverage will be approved initially for 3 months. Can be reassessed for yearly coverage dependent on patient achieving an improvement in symptoms of at least 20% Rheumatoid Arthritis (Adalimumab, Certolizumab egol, tanercept, Golimumab, Infliximab) - for patients with a diagnosis of active rheumatoid arthritis (RA) who: have not responded or who have had intolerable toxicity to an adequate trial 1 of combination therapy of at least two traditional DARDs 2 or if combination therapy is not an option, an adequate trial 1 of at least three traditional DARDs 2 in sequence as monotherapy and patients must have had an adequate trial 1 of leflunomide. xceptions can be considered in cases where leflunomide is contraindicated or not tolerated - therapy must include methotrexate alone or in combination unless contraindicated or not tolerated - written request of a rheumatologist or prescriber with a specialty in rheumatology - after initial coverage period, can be reassessed for yearly coverage dependent on patient achieving an improvement in symptoms of at least 20% Initial Coverage Duration and aximum Dosage approved: Adalimumab - initial coverage period 6 months, maximum dose of 40mg every two weeks Certolizumab egol - initial coverage period 12 weeks, maximum dose 400mg at weeks 0, 2 and 4, then 200mg every 2 weeks (or 400mg every 4 weeks) tanercept - initial coverage period 6 months Golimumab - initial coverage period 16 weeks, maximum dose 50mg per month Infliximab - initial coverage period 6 months 1 An adequate trial is 5 months for I gold, 6 months for penicillamine, 4 months for hydroxychloroquine and 3 months for all other traditional DARDs as well as leflunomide, infliximab and etanercept. 2 Traditional agents include methotrexate, I gold, sulfasalazine, hydroxychloroquine, azathioprine, chloroquine, penicillamine and cyclosporine. *lease note that the concurrent use of anti-tf agents will not be approved. OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

315 AIXABA (liquis, 2.5mg, 5mg Tablet) Total Knee/Hip Replacement (liquis 2.5mg Tablet): - for the prophylaxis of venous thromboembolism following total knee replacement surgery for up to 14 days, as an alternative to low molecular weight heparins. [Criteria Code 14] - for the prophylaxis of venous thromboembolism following total hip replacement surgery for up to 35 days, as an alternative to low molecular weight heparins. [Criteria Code 35] otes: - The total duration of therapy includes the period during which doses are administered post-operatively in an acute care (hospital) setting, and the approval period is for the balance of the total duration after discharge. - The first dose is typically administered 12 to 24 hours after surgery, assuming adequate hemostasis has been achieved. - The ADVAC clinical trial program did not evaluate the efficacy or safety of sequential use of molecular weight heparin followed by apixaban for the prophylaxis of VT. Due to the current lack of evidence for sequential use, coverage is not intended for this practice. - Clinical judgment is warranted to assess the increased risk for VT and/or adverse effects in patients with a history of previous VT, myocardial infarction, transient ischemic attack or ischemic stroke; a history of intraocular or intracerebral bleeding; a history of gastrointestinal disease with gastrointestinal bleeding; moderate or severe renal insufficiency (estimated creatinine clearance <30 m/min); severe liver disease; concurrent use of other anticoagulants; or age greater than 75 years. - Apixaban has not been studied in clinical trials in patients undergoing hip fracture surgery, and is not recommended in these patients. on-valvular Atrial Fibrillation (AF) (liquis 2.5mg, 5mg Tablet): - Inclusion Criteria: At-risk patients with non-valvular atrial fibrillation (AF) who require apixaban for the prevention of stroke and systemic embolism AD in whom: anticoagulation is inadequate following at least a 2-month trial on warfarin; OR anticoagulation with warfarin is contraindicated or not possible due to inability to regularly monitor via International ormalized Ratio (IR) testing (i.e. no access to IR testing services at a laboratory, clinic, pharmacy, and at home) - xclusion Criteria: atients with impaired renal function (creatinine clearance or estimated glomerular filtration rate < 25 m/min) OR > 75 years of age and without documented stable renal function OR hemodynamically significant rheumatic valvular heart disease, especially mitral stenosis; OR prosthetic heart valves otes: - At risk patients with non valvular atrial fibrillation are defined as those with a CHADS2 score of 1. rescribers may consider an antiplatelet regimen or oral anticoagulation for patients with CHADS2 score of 1. - Inadequate anticoagulation is defined as IR testing results that are outside the desired IR range for at least 35% of the tests during the monitoring period (i.e. adequate anticoagulation is defined as IR test results that are within the desired IR range for at least 65% of the tests during the monitoring period). - Documented stable renal function is defined as creatinine or estimated glomerular filtration rate maintained for at least 3 months. - Dosing: the usual recommended dose is 5mg twice daily; a reduced dose of apixaban 2.5mg twice daily is recommended for patients with at least two [2] of the following: age > 80 years, body weight < 60kg, or serum creatinine >133 micromole/litre. - Since renal impairment can increase bleeding risk, renal function should be regularly monitored. Other factors that increase bleeding risk should also be assessed and monitored (see apixaban roduct onograph). - atients starting apixaban should have ready access to appropriate medical services to manage a major bleeding event. - There is currently no data to support that apixaban provides adequate anticoagulation in patients with rheumatic valvular disease or those with prosthetic heart valves. As a result, apixaban is not recommended for these patient populations. OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

316 *ARITAT (mend 80mg, 125mg Capsule and Tri-ack Capsule) - in combination with a 5-HT 3 antagonist and dexamethasone in adult cancer patients treated with chemotherapy that includes cisplatin as a single day therapy greater than or equal to ( ) 70mg/m 2 to prevent acute and delayed nausea and vomiting. aprepitant will only be used with single day cisplatin-based therapy 70mg/m 2 (and not multiple day cisplatin chemotherapy) aprepitant will not be used in patients receiving moderately emetogenic cancer chemotherapy or radiotherapy the 5-HT 3 antagonist should only be used on the first day of cisplatin therapy with aprepitant continuing on Day 2 and Day 3 ARIIRAZO (Abilify 2mg, 5mg, 10mg, 15mg, 20mg and 30mg Tablet) - for the treatment of schizophrenia and schizoaffective disorders in patients who have a contraindication to quetiapine and risperidone, or have failed a trial of quetiapine and risperidone due to intolerance or lack of response ARIIRAZO (Abilify aintena 300mg and 400mg rolonged Release Injectable Suspension) - for the maintenance treatment of schizophrenia in adult patients who are stabilized on oral aripiprazole, and who have: problems with compliance with oral treatments or inadequate control or significant side-effects (e.g. S or TD) from one or more conventional depot antipsychotic agents ARTIFICIA TARS, RSRVATIV FR (Celluvisc, Refresh, Refresh lus, Refresh Tears, Tears aturale Free) - for patients with a diagnosis of dry eye requiring frequent daily doses of artificial tears, to prevent sensitivity to preservatives or in patients in whom preservative sensitivity is suspected - written request from an ophthalmologist or optometrist confirming the diagnosis will be required to initiate coverage ASAI (Saphris 5mg and 10mg S Tab) - for the acute treatment of manic or mixed episodes associated with bipolar I disorder as either: monotherapy, after a trial of lithium or divalproex sodium has failed, and trials of less expensive atypical antipsychotic agents have failed due to intolerance or lack of response co-therapy with lithium or divalproex sodium, after trials of less expensive atypical antipsychotic agents have failed due to intolerance or lack of response *AXITIIB (Inlyta 1mg and 5mg Tablet) - as a single second line agent for the treatment of patients (COG S 0 or 1) with advanced or metastatic clear cell renal cell carcinoma (RCC) who are unable to tolerate ongoing use of an effective dose of everolimus or who have a contraindication to everolimus - sequential use of axitinib and everolimus is not permitted except in the case of intolerability or contraindication *AZITHROCI (Zithromax OS 100mg/5m, 200mg/5m and 250mg, 600mg Tablet and generic brands) - the treatment of infections requiring a macrolide antibiotic when the patient has a documented intolerance to clarithromycin [Criteria Code 02] - the treatment of chlamydia trachomatis as a single dose of 1g [Criteria Code 05] - the treatment and prevention of mycobacterium avium complex (AC) [Criteria Code 06] - the treatment of infections requiring a macrolide antibiotic when the patient is taking medications that would significantly interact with erythromycin/clarithromycin [Criteria Code 07] *BZDAI HC (Tantum 0.15% Oral Rinse and generic brands) - for oncology patients only BTAHISTI (Serc 16mg, 24mg Tablet and generic brands) - for the symptomatic treatment of recurrent episodes of vertigo associated with eniere's disease BTATHASO, CACIOTRIO (Dovobet 0.5mg/g/50mcg/g Gel) - for the treatment of body and scalp psoriasis after failure of a topical steroid and a vitamin D analogue as single agents OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

317 BOCRVIR (Victrelis 200mg Capsule) BOCRVIR/RIBAVIRI GITRFRO AFA-2B (Victrelis Triple Injection/Capsule) - for the treatment of chronic hepatitis C genotype 1 infection in combination with peginterferon alpha/ribavirin (egifα/rbv), if the following criteria are met: detectable levels of hepatitis C virus (HCV) RA prior to treatment fibrosis stage of F2, F3, or F4 as determined by a biopsy/fibroscan where available OR recommendation of a hepatologist or a prescriber with a specialty in hepatitis one course of treatment only (up to 44 weeks duration) BOSTA (Tracleer 62.5mg, 125mg Tablet and generic brands) - written initial request from a pulmonary arterial hypertension (AH) specialist only - diagnosis of AH should be confirmed by right heart catheterization - IAH (functional class III and IV) for the treatment of patients with World Health Organization (WHO) functional class III and IV idiopathic pulmonary arterial hypertension (IAH) who do not demonstrate vasoreactivity on testing or who do demonstrate vasoreactivity on testing but fail a trial of calcium channel blockers (CCB) or are intolerant to CCB - AH secondary to scleroderma, congenital heart disease or HIV (functional class III and IV) for the treatment of patients with World Health Organization (WHO) functional class III and IV pulmonary arterial hypertension (AH) associated with scleroderma, congenital heart disease or HIV who do not respond to conventional therapy *BUDSOID (ulmicort ebuamps 0.125mg/m, 0.25mg/m, 0.5mg/m Suspension) - See Wet ebulization Solutions BURORHI AD AOXO (Suboxone 2mg/0.5mg, 8mg/2mg Sublingual Tablet) - for the treatment of opioid dependence for patients in whom methadone is contraindicated (e.g., patients at high risk of, or with, QT prolongation, or hypersensitivity to methadone) - for the treatment of opioid dependence for appropriate patients ages years - must be prescribed by a physician licensed to prescribe methadone for opioid dependence or by a physician registered to prescribe buprenorphine/naloxone for opioid dependence with the College of hysicians and Surgeons of ova Scotia (CSS). ote: CSS requires physicians wishing to expand their scope of practice to include the use of buprenorphine/naloxone in the treatment for opioid dependence to complete the online CAH Buprenorphine-Assisted Treatment of Opioid Dependence course. Information regarding the course can be found at the following link: BUTORHAO (10mg/m asal Spray and generic brands) - for the treatment of migraine, upon the request of a neurologist, prescriber with a specialty in neurology or a specialist in pain management, when conventional forms of therapy are ineffective or inappropriate CABRGOI (Dostinex 0.5mg Tablet and generic brands) - for the treatment of micro- or macro-adenoma of the pituitary after failure of bromocriptine (as determined by prolactin levels) or if bromocriptine is not tolerated CACIOTRIO (Dovonex 50mcg/g Ointment, Cream and 50mcg/m Scalp Solution) - for the treatment of psoriasis when conventional therapies have been ineffective or inappropriate OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

318 CAAGIFOZI (Invokana 100mg and 300mg Tablet) - for the treatment of Type II diabetes for patients with: inadequate glycemic control on metformin and a sulfonylurea; and for whom insulin is not an option ote: 200mg is not a recognized dose; as such a dose of two 100mg tablets will not be funded. *CACITABI (Xeloda 150mg and 500mg Tablet) - requests must be from an oncologist or a prescriber with a specialty in oncology eo-adjuvant and Adjuvant Colon and Rectal Cancer - neo-adjuvant treatment of stage II or stage III rectal cancer as a single agent prior to radiotherapy and/or concurrent with radiotherapy - adjuvant treatment of stage II or stage III rectal cancer as a single agent and/or concurrent with radiotherapy - adjuvant treatment of stage III colon cancer as a single agent - adjuvant treatment of stage III colon or rectal cancer as part of the XOX (CAOX) regimen as an alternative to infusional 5-FU in the FOFOX regimen - coverage approved for 6 months, to be renewed as required etastatic Colorectal Cancer - first line single agent as an alternative to combination chemotherapy - alternative to the infusional 5-FU in the FOFOX regimen as part of the XOX (CAOX) regimen - coverage approved for 3 months, to be renewed as required Advanced or etastatic Breast Cancer (BC) - as a single agent or in combination with HR2 directed therapy (e.g. lapatinib or trastuzumab) as one line of therapy in patients with advanced or metastatic breast cancer (BC) who have an COG performance status of 0-2. For any one patient, a capecitabine-based regimen may only be used as one line of therapy for the treatment of BC - coverage approved for 3 months, to be renewed as required CARVDIO (Coreg 3.125mg, 6.25mg, 12.5mg, 25mg Tablet and generic brands) - for the treatment of stable symptomatic heart failure with systolic dysfunction (i.e., left ventricular ejection fraction (VF) less than or equal to 40%) CRTOIZUAB GO (Cimzia 200mg/m SC Injection) - See Anti-Tumor ecrosis Factor (TF) Agents CTIRIZI (Reactine 5mg, 10mg Tablet and generic brands) - for chronic urticaria, defined as the presence of hives or lesions for longer than six weeks, which has responded to treatment with cetirizine CHOISTRAS IHIBITORS (ChI) (Donepezil, Galantamine, Rivastigmine) - for the treatment of mild to moderate probable Alzheimer s disease or possible Alzheimer s disease with vascular component, with ewy bodies who meet the following criteria: a ini-ental State xamination (S) score of 10 to 30 AD a Functional Assessment Staging Test (FAST) score of 4 to 5 - initial requests for reimbursement will be considered for a maximum 4 month approval; subsequent requests may be considered for a maximum 12 month approval. Requests to switch from one agent in the class to another will not be considered beyond the initial 4 month approval CIACACT (Sensipar 30mg, 60mg and 90mg Tablets) - for the treatment of patients with chronic kidney disease on dialysis with severe secondary hyperparathyroidism who: are not responding to optimal doses of Vitamin D analogues or phosphate binders (calcium or non-calcium based) AD are either not a surgical candidate due to surgical or anesthetic risk OR awaiting kidney transplant in addition laboratory findings must confirm serum phosphate >1.8mmol/, serum calcium 2.2mmol/ and ith >88pmol/ on more than one occasion at least 6 weeks apart OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

319 ongoing laboratory investigations must include serum calcium, albumin, phosphorous weekly for three weeks and ith every 6 weeks - coverage for cinacalcet will be renewed if there is a greater than 30% decrease in ith after at least 3 months with escalating dose, indicating the patient is responding - approval period 12 months, provided there has been a greater than 30% decrease in ith as stated above CIROFOXACI, OHTHAIC (Ciloxan 0.3% Ophthalmic Solution and generic brands and Ointment) - See Fluoroquinolones, Ophthalmic *CIROFOXACI, ORA (Cipro 100mg/m Oral iquid and 250mg, 500mg, 750mg Tablet and generic brands) - See Fluoroquinolones, Oral *CIROFOXACI X, ORA (Cipro X 1000mg Tablet) - for the oral treatment of gram-negative infections in complicated urinary tract infections, for which other oral agents are not effective or available [Criteria Code 10] - for the oral treatment of acute uncomplicated pyelonephritis [Criteria Code 11] CIROFOXACI & DXATHASO, OTIC (Ciprodex Otic Suspension) - for the treatment of patients with acute otitis media with otorrhea through tympanostomy tubes [Criteria Code 01] - for the treatment of patients with acute otitis externa in the presence of a tympanostomy tube or known perforation of the tympanic membrane [Criteria Code 02] COIDOGR (lavix 75mg Tablet and generic brands) - for the secondary prevention of the following vascular ischemic events in patients with a history of symptomatic atherosclerotic disease, including: ischemic stroke/ transient ischemic attack (TIA) in patients with a documented severe allergy to ASA or who experience a recurrent thrombotic event (stroke, symptoms of TIA) while taking ASA or a GI hemorrhage while on ASA, myocardial infarction (I) in patients with a documented severe allergy to ASA or who experience a GI hemorrhage while on ASA, peripheral vascular disease (VD) in patients with a documented severe allergy to ASA or who experience a GI hemorrhage while on ASA, unstable angina in patients with a documented severe allergy to ASA or who experience a GI hemorrhage while on ASA - in patients with intravascular stent implantation, the coverage period following insertion is: Bare etal Stent(s) (BS) - 30 days Drug luting Stent(s) (DS) - 12 months ote: The [Criteria Code 30] may be used for the initial 30 days coverage period for all types of intravascular stent implantation. For coverage beyond the initial 30 day online approval a written request from the prescriber is required. - for patients with non-st-segment elevation acute coronary syndrome (ACS) (i.e., unstable angina or non-st-segment elevation myocardial infarction), in combination with ASA, for a coverage period of 3 months coverage. Coverage for 12 months is available for high risk patients: with a second ACS within 12 months, or with complex or extensive coronary artery disease (CAD) e.g., diffuse 3 vessel CAD not amenable to revascularization, or who have had a previous stroke, TIA or have symptomatic VD - other requests on a case by case basis OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

320 *CODI, SUSTAID RAS (Codeine Contin 50mg, 100mg, 150mg and 200mg Tablet) - for the treatment of mild to moderate chronic pain syndrome, if pain has been controlled by doses less than 200mg q12h - patients may be considered candidates if they are achieving good pain control from immediate-release plain codeine preparations but prefer the convenience of a long-acting preparation, or if they are achieving good pain control from acetaminophen or ASA plus codeine preparations but are limited by the acetaminophen content to no greater than 12 tablets per day - not insured for the treatment of acute pain (e.g., post-operative pain) CROOGCAT SODIU (pms-sodium Cromoglycate1% ebulizer Solution) - See Wet ebulization Solutions *CAOCOBAAI, IJCTIO (Cyanocobalamin, Vitamin B mcg/m and 1000mcg/m Injection) - for the treatment of documented cyanocobalamin deficiency, when the oral route is inappropriate or contraindicated (criteria applies to all rograms) *CAOCOBAAI, ORA (Vitamin B mcg and 1,000mcg Tablet) - for the treatment of documented cyanocobalamin deficiency in recipients of the Community Services harmacare rogram, Family harmacare rogram and Drug Assistance for Cancer atients; oral cyanocobalamin is fully insured for Seniors' harmacare rogram *CAOCOBAAI, ORA I COBIATIO (Vitamin B mcg S Tablet with Folic Acid) - for the treatment of documented cyanocobalamin deficiency in recipients of the Community Services harmacare rogram, Family harmacare rogram and Drug Assistance for Cancer atients; oral cyanocobalamin is fully insured for Seniors' harmacare rogram CCOSORI (eoral 10mg, 25mg, 50mg, 100mg Capsule and 100mg/m Oral iquid and generic brands) - for the treatment of severe psoriasis - for the treatment of severe rheumatoid arthritis DABIGATRA (radaxa 110mg and 150mg Capsule) - Inclusion Criteria: At-risk 1 patients with non-valvular atrial fibrillation (AF) who require dabigatran for the prevention of stroke and systemic embolism AD in whom: anticoagulation is inadequate 2 following a reasonable trial 3 on warfarin; OR anticoagulation with warfarin is contraindicated or not possible due to inability to regularly monitor via International ormalized Ratio (IR) testing (i.e. no access to IR testing services at a laboratory, clinic, pharmacy, and at home) - xclusion Criteria: atients with impaired renal function 4 (creatinine clearance or estimated glomerular filtration rate < 30m/min) OR 75 years of age and without documented stable renal function 5 OR hemodynamically significant rheumatic valvular heart disease 6, especially mitral stenosis; OR prosthetic heart valves. * lease ote: atients starting dabigatran should have ready access to appropriate medical services to manage a major bleeding event. 1 At risk patients with non valvular atrial fibrillation are defined as those with a CHADS 2 score of 1. 2 Inadequate anticoagulation is defined as IR testing results that are outside the desired IR range for at least 35% of the tests during the monitoring period (i.e. adequate anticoagulation is defined as IR test results that are within the desired IR range for at least 65% of the tests during the monitoring period). 3 A reasonable trial on warfarin is defined as at least two months of therapy. 4 Since renal impairment can increase bleeding risk, renal function should be regularly monitored. Other factors that increase bleeding risk should also be assessed and monitored (see radaxa (dabigatran) roduct onograph). 5 Documented stable renal function is defined as creatinine clearance or estimated glomerular filtration rate that is maintained for at least three months (i.e m/min for 110mg twice daily dosing or 50 m/min for 150 mg twice daily dosing). 6 There is currently no data to support that dabigatran provides adequate anticoagulation in patients with rheumatic valvular disease or those with prosthetic heart valves, so dabigatran is not recommended in these populations. OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

321 *DARBOTI (Aranesp Syringe Injection) - for the treatment of transfusion dependent patients with hematologic malignancies who have a baseline anemia of 90g/ and whose transfusion requirements are 2 units of packed red blood cells per month over 3 months - initial approval for 12 weeks with the documentation of dose, hemoglobin and therapeutic outcome (number of transfusions) - approval of further 12 week cycles are dependent on evidence of satisfactory clinical response or reduced treatment requirement to less than 2 units of RBC monthly ote: Specialized request forms are used to request coverage for darbepoetin. DARIFACI (nablex 7.5mg, 15mg Tablet) - for the treatment of over-active bladder (not stress incontinence) for patients who cannot tolerate or have insufficient response to an adequate trial of immediate relase oxybutynin (e.g. 3 months) - a three month trial will be approved initially with assessment of the effectiveness of this therapy required if further coverage is considered *DASATIIB (Sprycel 20mg, 50mg, 70mg Tablet) - as a single agent for the treatment of adults with chronic, accelerated or blast phase chronic myelogenous leukemia (C) and hiladelphia chromosome acute lymphoblastic leukemia (h A) with resistance or intolerance to prior therapy including imatinib - coverage approved for 6 months DFRASIROX (xjade 125mg, 250mg, 500mg Tablet for Suspension) - for the treatment of patients who require iron chelation and deferoxamine is contraindicated *DOSUAB (rolia 60mg/m re-filled syringe) - for women with postmenopausal osteoporosis for whom bisphosphonates are contraindicated due to hypersensitivity or abnormalities of the esophagus (e.g., esophageal stricture or achalasia) and have at least two of the following: age >75 years a prior fragility fracture a bone mineral density (BD) T-score -2.5 *DOSUAB (Xgeva 120mg/1.7m Solution) - as a single agent for the prevention of skeletal related events (SRs) for metastatic castrate resistant prostate cancer (CRC) patients with one or more documented bone metastases and COG performance status (S) 0-2 DIOGST (Visanne 2mg Tablet) - for the management of pelvic pain associated with endometriosis in patients for whom one or more less costly hormonal options are either ineffective or cannot be used DITH FUARAT (Tecfidera 120mg and 240mg DR Capsule) - for the treatment of patients with relapsing remitting multiple sclerosis (RRS) who meet all of the following criteria: requested and followed by a neurologist experienced in the management of RRS, and recent expanded disability status scale (DSS) score of 5.5 or less (i.e. patients must be able to ambulate at least 100 metres without assistance.) xclusion: - not funded in combination with other disease modifying therapies - not funded in patients with an DSS > not funded in patients < 18 years of age Renewals: - DSS score < 5.5 (i.e. patients must be able to ambulate at least 100 metres without assistance). Date and details of the most recent neurological examination and DSS score must be provided (exam must have occurred within the last 90 days), and - patients must be stable or have experienced no more than 1 disabling attack/relapse in the past year OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

322 DIRIDAO & ASA (Aggrenox 200/25mg Capsule) - for the secondary prevention of ischemic stroke/transient ischemic attack (TIA) in patients who have experienced a recurrent thrombotic event (stroke, symptoms of TIA) while taking ASA DOZI (Aricept 5mg, 10mg Tablet) - See Cholinesterase Inhibitors (ChI) DUOXTI (Cymbalta 30mg, 60mg Capsule) - for the treatment of neuropathic pain in diabetic patients who are unresponsive to adequate courses of two alternative agents, such as tricyclic antidepressants and anticonvulsants - dose limited to a maximum of 60mg per day TACAO (Comtan 200mg Tablet) - for the treatment of arkinson's disease as adjunctive therapy in patients who are not well controlled and are experiencing significant "wearing off" symptoms despite optimal therapy with a levodopa and a decarboxylase inhibitor TCAVIR (Baraclude 0.5mg Tablet) - for the treatment of chronic hepatitis B infection in patients with: documented cirrhosis on radiologic or histologic grounds AD a HBV DA concentration above 2000iu/m ZAUTAID (Xtandi 40mg Capsule) Asymptomatic or ildly Symptomatic atients: - as a single agent treatment for asymptomatic or mildly symptomatic metastatic CRC patients after failure of androgen deprivation therapy (including an HRH agonist/antagonist or orchiectomy) who have not received prior chemotherapy for metastatic CRC, COG S 0-1 and no risk for seizures. - enzalutamide would be an alternative to abiraterone and not sequential therapy in this asymptomatic or mildly symptomatic patient population. Symptomatic (post-docetaxel chemotherapy) atients: - as a single agent treatment for metastatic CRC patients with COG S 0-2, no risk for seizures and progression after previous treatment with docetaxel. - enzalutamide would be an alternative to abiraterone and not sequential therapy in this symptomatic post docetaxel chemotherapy setting. Retreatment: - use of enzalutamide in the post docetaxel setting is not permitted if previously used in the pre-chemotherapy setting. IHRI (pipen 1:1000, pipen Jr. 1:2000 Injection and Twinject 0.15mg, 0.3mg Auto-Injector) - for the emergency treatment of anaphylactic reactions, when out of reach of immediate medical attention ote: Regular benefit, but with a quantity limit of two injections per fiscal year. Additional units require an exception status request. RO (Inspra 25mg and 50mg Tablet) - for patients >55 years with mild to moderate HF on standard HF treatments with F 30% (or 35% if QRS duration >130ms) and recent (6 months) hospitalization for CV disease or with elevated B or T-proB levels. otes: - Requests will be considered from practitioners with a specialty in cardiology. - atients must be on optimal therapy with an angiotensin-converting enzyme (AC) inhibitor, an angiotensin-receptor blocker (ARB), or both and a beta-blocker (unless contraindicated) at the recommended dose or maximal tolerated dose. OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

323 *ROTIIB (Tarceva 100mg, 150mg Tablet) - as monotherapy for the treatment of patients with locally advanced or metastatic on-small Cell ung Cancer (SCC) after failure of at least one prior chemotherapy regimen and whose GFR expression status is positive or unknown - coverage approved for 6 months *RTHROOITI (prex ultidose Vial and Syringe Injection) - for the treatment of transfusion dependent patients with hematologic malignancies who have a baseline anemia of 90g/ and whose transfusion requirements are 2 units of packed red blood cells per month over 3 months - initial approval for 12 weeks with the documentation of dose, hemoglobin and therapeutic outcome (number of transfusions) - approval of further 12 week cycles are dependent on evidence of satisfactory clinical response or reduced treatment requirement to less than 2 units of RBC monthly - if transfusion requirements increase to 2 units/ month (over a 3 month period), one dose increase may be attempted (maximum dose 60,000iu per week) ote: Specialized request forms are used to request coverage for erythropoietin. *STRADIO (Climara, straderm, stradot Transdermal atch, strogel Topical Gel and generic brands) *STRADIO/ORTHIDRO ACTAT (stalis Transdermal atch) - for the treatment of menopausal symptoms in women who cannot tolerate the oral forms of hormone replacement therapy TARCT (nbrel 25mg owder For Injection and 50mg/l Injection) - See Anti-Tumor ecrosis Factor (TF) Agents *TIDROAT (200mg Tablet, generic brands) *TIDROAT AD CACIU (Didrocal Kit and generic brands) - for the treatment of osteoporosis associated with documented fragility fracture when alendronate, risedronate and raloxifene are not tolerated or are contraindicated - for the treatment of osteoporosis without documented fragility fracture when the patient is at a high 10 year fracture risk (>20% major osteoporotic fracture over 10 years) as indicated by the radiologist on a BD report, and alendronate, risedronate and raloxifene are not tolerated or are contraindicated - other requests reviewed on a case by case basis *VROIUS (Afinitor 2.5mg, 5mg, and 10mg Tablet) - as a single agent for metastatic renal cell carcinoma (RCC) patients with documented clear cell histology who have a Karnofsky performance status 70% or higher after progression or intolerance to the VGF multi-targeted tyrosine kinase inhibitors (TKIs), (e.g., sunitinib, pazopanib and/or sorafenib) - in combination with exemestane for postmenopausal patients (COG S 2) with documented hormone receptor positive, HR2 negative-advanced breast cancer after recurrence or progression following a non-steroidal aromatase inhibitor (SAI) ote: It may be clinically reasonable to use the combination in patients with treated and stable brain metastasis. - for the treatment of patients with progressive, unresectable, well or moderately differentiated, locally advanced or metastatic pancreatic neuroendocrine tumors (pt) with good performance status (COG 0-2), until disease progression ote: atients whose disease progresses on sunitinib are not eligible for funded treatment with everolimus for pt ZTIIB (zetrol 10mg Tablet) - for the treatment of hypercholesterolemia, as adjunctive therapy with statins, in patients who have not reached treatment goals on maximum tolerated statin therapy alone - for the treatment of hypercholesterolemia, as monotherapy, in patients who are intolerant to statins and, when appropriate, fibrates OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

324 FBUXOSTAT (Uloric 80mg Tablet) - for the treatment of symptomatic gout in patients who have documented hypersensitivity to allopurinol FOTRO (Berotec 1mg/m Solution) - See Wet ebulization Solutions *FTA (Fentanyl 12mcg/hr, 25mcg/hr, 50mcg/hr, 75mcg/hr, 100mcg/hr Transdermal System and generic brands) - for the treatment of malignant or chronic non-malignant pain in adult patients who were previously receiving continuous opioid administration (i.e., not opioid naive), or who are unable to take oral therapy FRUOXTO (Feraheme 30mg/m Injection) - for the treatment of iron deficiency anemia in home hemodialysis, peritoneal dialysis and predialysis chronic kidney disease patients. coverage must be requested by a practitioner with a specialty in nephrology. coverage will only be considered if the dose required is ferumoxytol 510mg to avoid wastage and unnecessary costs. otes: - Given the safety concerns with IV iron, patients should be closely monitored for signs and symptoms of hypersensitivity reactions including monitoring of blood pressure and pulse during and for at least 30 minutes following each infusion of Feraheme. IV iron product monographs recommend IV irons should only be administered when personnel and therapies are immediately available for the treatment of anaphylaxis and other hypersensitivity reactions. - Ferumoxytol is contraindicated in some patients, including those with hypersensitivities to this product, any allergies to other parenteral iron products, and in individuals with any known drug allergy. - Ferumoxytol may affect the diagnostic ability of RI for up to 3 months. FSOTRODI FUARAT (Toviaz 4mg and 8mg Tablets) - for the treatment of over-active bladder (not stress incontinence) for patients who cannot tolerate immediate release oxybutynin after an adequate trial (e.g. 3 months) - a three month trial will be approved initially with assessment of the effectiveness of this therapy required if further coverage is considered FIGOIOD (Gilenya 0.5mg Capsule) For the treatment of patients with relapsing remitting multiple sclerosis (RRS) who meet all of the following criteria: - have failed to respond to a full and adequate course of at least one disease modifying therapy (DT) publicly insured in ova Scotia as an initial therapy, or has contraindications/intolerance to at least two initial therapies. - one or more clinically disabling relapses in the previous year. - significant increase in T2 lesion load compared with that from a previous RI scan (i.e. 3 or more new lesions) or at least one gadolinium-enhancing lesion. - requested and followed by a neurologist experienced in the management of RRS - recent expanded disability status scale (DSS) score of 5.5 or less (i.e. patients must be able to ambulate at least 100 meters without assistance). Dosage: 0.5mg daily Approval period: 1 year xclusions: - not funded in combination with other disease modifying therapies - not funded in patients with an DSS>5.5 - not funded in patients who have had a heart attack or stroke in the last six months of funding request, patients with a history of sick sinus syndrome, atrioventricular block, significant QT prolongations, bradycardia, ischemic heart disease, or congestive heart failure - not funded in patients <18 years of age - not funded due to needle phobia or preference for oral therapy over injection in patients without clinical contraindications to interferon or glatiramer therapy - ote: skin reactions at the site of injection do not qualify as contraindications to interferon or glatiramer therapy OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

325 Renewal: - DSS score 5.5 (i.e. patients must be able to ambulate at least 100 meters without assistance). Date and details of the most recent neurological examination and DSS scores must be provided (exam must have occurred within that last 90 days) AD - atients must be stable or have experienced no more than 1 disabling attack/relapse in the past year Of ote: *Failure to respond to full and adequate courses: defined as a trial of at least 6 months of interferon or glatiramer therapy AD experienced at least one disabling relapse (attack) while on interferon or glatiramer therapy **Intolerance is defined as: documented serious adverse effects or contraindications that are incompatible with further use of that class of drug *FUCOAZO (Diflucan OS 10mg/m) - for the treatment of oropharyngeal candidiasis when nystatin has failed, or for systemic infections when oral tablets are not an option *FUDARABI (Fludara 10mg Tablet) - for the treatment of chronic lymphocytic leukemia (C), in patients with an COG performance status of 0-2, when: the patient has failed to respond or relapsed during or after previous therapy with an alkylating agent, and intravenous administration is not desirable FUOROQUIOOS, OHTHAIC (Ciprofloxacin, Ofloxacin) - for the treatment of eye infections upon the order of an ophthalmologist, ophthalmology resident, prescribing optometrist or other prescriber who has a specialty in ophthalmology [Criteria Code 01] *FUOROQUIOOS, ORA (Ciprofloxacin, orfloxacin, Ofloxacin) - for the treatment of patients intolerant or allergic (hypersensitivity reaction) to all other effective oral agents [Criteria Code 01] - for the treatment of aerobic, gram-negative infections which are resistant to other suitable oral agents [Criteria Code 02] - for the oral treatment of multi-resistant, aerobic, gram-negative infections traditionally requiring parenteral therapy (e.g., osteomyelitis, complicated urinary tract infections, bacterial pneumonia in cystic fibrosis, prostatitis) for which other oral agents are not effective or available [Criteria Code 03] - for infections due to seudomonas aeruginosa (ciprofloxacin is the preferred agent) [Criteria Code 04] - for the treatment of necrotizing (malignant) otitis externa [Criteria Code 05] - for the prevention of endophthalmitis in patients who have had cataract surgery involving an unplanned vitrectomy (ciprofloxacin) [Criteria Code 06] *FUOROQUIOOS, RSIRATOR (evofloxacin, oxifloxacin) - for the completion of therapy instituted in the hospital setting for the treatment of nosocomial pneumonia, community acquired pneumonia (CA) or acute exacerbation of chronic bronchitis (ACB) [Criteria Code 01] - for the treatment of severe pneumonia in nursing home patients [Criteria Code 02] - for the treatment 1 of CA in patients with comorbidity 2 upon radiographic confirmation of pneumonia, or who have failed first line therapies (macrolide, doxycycline, amoxicillin-clavulanate) [Criteria Code 03] - for the treatment 1 of ACB in complicated patients 3 who have failed treatment with one of the following: amoxicillin, doxycycline, T-SX, cefuroxime, macrolide, ketolide or amoxicillin-clavulanate [Criteria Code 04] 1 If treated with an antibiotic within the past 3 months choose an antibiotic from a different class. 2 Comorbidity includes chronic lung disease, malignancy, diabetes, liver failure, renal failure, congestive heart failure, use of antibiotics or steroids in the past 3 months, suspected macroaspiration, hospitalization within last 3 months, HIV/AIDS, smoking, malnutrition or acute weight loss. 3 Complicated ACB defined as increased cough and sputum, sputum purulence and increased dyspnea and FV1 < 50% predicted or FV1 50% - 65% and one of the following: 4 exacerbations per year, ischemic heart disease, chronic oral steroid use or antibiotic use in past 3 months OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

326 FUTICASO FUROAT AD VIATRO (AS TRIFATAT) (Breo llipta 100mcg/25mg dry powder for inhalation) - for the treatment of moderate to severe chronic obstructive pulmonary disease (COD) as defined by spirometry. OR - for the treatment of COD in patients with an inadequate response to short acting bronchodilators. - combination therapy with a long- acting beta-2 agonist /inhaled corticosteroid (ABA/ICS) and a long acting anticholinergic (AAC) inhaler will be considered in patients with: moderate to severe COD, as defined by spirometry, a history of COD exacerbation(s) and an inadequate response to ABA/ICS or AAC. ote: Coverage for ABA and AAC as two separate inhalers will not be considered. Clinical otes: 1. oderate to severe COD is defined by spirometry as a post bronchodilator FV1 < 60% predicted and FV1/FVC ratio of < Spirometry reports from any point in time will be accepted. If spirometry cannot be obtained, reasons must be clearly explained and other evidence of COD severity provided, i.e., edical Research Council (RC) Dyspnea Scale Score of at least Grade 3. RC Grade 3 is described as: walks slower than people of same age on the level because of shortness of breath from COD or has to stop for breath when walking at own pace on the level. 2. Inadequate response to short acting bronchodilators is defined as persistent symptoms, i.e., RC of at least Grade 3, after at least 2 months of short acting bronchodilator at the following doses*: 8 puffs per day of short acting beta-2 agonist or 12 puffs per day of ipratropium or 6 puffs per day of ipratropium plus salbutamol combination inhaler * Inadequate response to ABA/ICS or AAC is defined as persistent symptoms after at least 2 months of therapy. 3. COD exacerbation is defined as an increase in symptoms requiring treatment with antibiotics and/or systemic (oral or intravenous) corticosteroids. Treatment of COD lease note that inhaled corticosteroids in combination with long-acting beta 2 agonists (ABA/ICS) have been associated with an increased risk of pneumonia in patients with COD. Guidelines recommend their use in moderate to severe COD patients who are experiencing frequent exacerbations, not controlled by long-acting bronchodilators. For patients with moderate to severe COD who are not experiencing frequent exacerbations, long-acting beta 2 agonists or long-acting anticholinergics are recommended. Global strategy for the diagnosis, management and prevention of COD ote: Inhalers which combine a ABA/AAC are also available as SD benefits. These products have their own criteria which are listed in the S Formulary. FOROTRO (Foradil 12ug Capsule For Inhalation, Oxeze 6mcg/Dose, 12mcg/Dose Turbuhaler, Zenhale 50/5mcg, 100/5mcg, 200/5mcg Inh) - See ong-acting Beta 2 -Agonists FOROTRO, I COBIATIO (Symbicort 100/6mcg, 200/6mcg Turbuhaler) - See ong-acting Beta 2 -Agonists/Inhaled Corticosteroids FOOCI TROTHAI (onurol 3g/sachet) - for the treatment of uncomplicated urinary tract infections in adult female patients where: the infecting organism is resistant to other oral agents [Criteria Code 01] OR other less costly treatments are not tolerated [Criteria Code 02] *GABATI (100mg, 300mg, 400mg, 600mg and 800mg Capsule and Tablet and generic brands) - for the treatment of neuropathic pain (e.g. diabetic neuropathy, postherpetic neuropathy) in patients who have failed a trial of a tricylic antidepressant (e.g. amitriptyline, desipramine, imipramine, nortriptyline). GAATAI (Reminyl r 8mg, 16mg, 24mg Capsule and generic brands) - See Cholinesterase Inhibitors (ChI) OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

327 GCORROIU BROID (Seebri 50mcg Capsule for Inhalation) - for the treatment of moderate to severe chronic obstructive pulmonary disease (COD) as defined by spirometry. OR - for the treatment of COD in patients with an inadequate response to short acting bronchodilators. - combination therapy with a long- acting beta-2 agonist /inhaled corticosteroid (ABA/ICS) and a long acting anticholinergic (AAC) inhaler will be considered in patients with: moderate to severe COD, as defined by spirometry, a history of COD exacerbation(s) and an inadequate response to ABA/ICS or AAC. ote: Coverage for ABA and AAC as two separate inhalers will not be considered. Clinical otes: 1. oderate to severe COD is defined by spirometry as a post bronchodilator FV1 < 60% predicted and FV1/FVC ratio of < Spirometry reports from any point in time will be accepted. If spirometry cannot be obtained, reasons must be clearly explained and other evidence of COD severity provided, i.e., edical Research Council (RC) Dyspnea Scale Score of at least Grade 3. RC Grade 3 is described as: walks slower than people of same age on the level because of shortness of breath from COD or has to stop for breath when walking at own pace on the level. 2. Inadequate response to short acting bronchodilators is defined as persistent symptoms, i.e., RC of at least Grade 3, after at least 2 months of short acting bronchodilator at the following doses*: 8 puffs per day of short acting beta-2 agonist or 12 puffs per day of ipratropium or 6 puffs per day of ipratropium plus salbutamol combination inhaler * Inadequate response to ABA/ICS or AAC is defined as persistent symptoms after at least 2 months of therapy. 3. COD exacerbation is defined as an increase in symptoms requiring treatment with antibiotics and/or systemic (oral or intravenous) corticosteroids. Treatment of COD lease note that inhaled corticosteroids in combination with long-acting beta 2 agonists (ABA/ICS) have been associated with an increased risk of pneumonia in patients with COD. Guidelines recommend their use in moderate to severe COD patients who are experiencing frequent exacerbations, not controlled by long-acting bronchodilators. For patients with moderate to severe COD who are not experiencing frequent exacerbations, long-acting beta 2 agonists or long-acting anticholinergics are recommended. Global strategy for the diagnosis, management and prevention of COD ote: Inhalers which combine a ABA/AAC are also available as SD benefits. These products have their own criteria which are listed in the S Formulary. GOIUAB (Simponi 50mg/0.5ml Autoinjector and re-filled Syringe) - See Anti-Tumor ecrosis Factor (TF) Agents *GRAISTRO (Kytril 1mg Tablet and generic brands) - See Serotonin (5-HT 3 ) Antagonists ote: Recommended dose is 2mg orally 1 hour pre-chemotherapy or 1mg 1 hour pre-chemotherapy and 1mg 12 hours post-chemotherapy. OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

328 GRASS O ARG XTRACT (Oralair 100 and 300 Unit IR S/ Tablet) - For the seasonal treatment of grass pollen allergic rhinitis in patients that have not adequately responded to, or tolerated, conventional pharmacotherapy. otes: - Treatment with 5-GA must be prescribed and initiated by physicians with adequate training and experience in the treatment of respiratory allergic diseases. - Treatment should be initiated four (4) months before onset of pollen season and should only be continued until the end of the season. - Treatment should not be taken for more than three (3) consecutive years. HDROXZI (10mg, 25mg, 50mg Capsule, generic brands and Atarax Syrup) - for chronic urticaria, defined as the presence of hives or lesions for longer than six weeks, which has responded to treatment with hydroxyzine *IBRUTIIB (Imbruvica 140mg Cap) As a treatment option for patients with relapsed and/or refractory chronic lymphocytic leukemia (C) or small lymphocytic leukemia (S) who have received at least one prior therapy and are considered inappropriate for treatment or retreatment with a fludarabine-based regimen, including : - atients who received prior fludarabine-based treatment and had a progression free interval of less than three years - atients who received prior fludarabine-based treatment and had a progression free interval of greater than three years, but are now considered unfit for fludarabine-based retreatment due to age 70, or age 65 and the presence of comorbidities (Cumulative Illness Rating Scale [CIRS] 6 or creatinine clearance <70ml/min) - atients who did not receive prior fludarabine-based treatment because they were considered unfit, and who relapsed after at least two cycles of alkylator-based therapy, regardless of the progression free interval after that therapy *IATIIB (Gleevec 100mg Capsule and 100mg, 400mg Tablet) - as a single agent for adult patients with a histological diagnosis of localized primary Gastrointestinal Stromal Tumors (GIST) (KIT (CD-117)-positive) following surgical complete resection and at a high risk of recurrence risk of recurrence is dependent on location, size and mitotic rate. Specific parameters for considering adjuvant therapy after resection of GIST along the gastrointestinal tract may include but are not limited to: gastric: any tumor >3cm where the mitotic rate is >5/50 high powered fields (HFs). Adjuvant treatment could be considered where the mitotic rate is <5HFs and tumor >10cm duodenal, small bowel, peritoneal, colorectal: any tumor where the mitotic rate is >5HFs; any tumor >5cm in size coverage duration: 36 months - for the treatment of chronic myelogenous leukemia (C), as a single agent, in patients who have documented evidence of hiladelphia chromosome positive C, with an COG performance status of 0-2 and who: are in blast crisis, accelerated phase, or chronic phase OR as a secondary treatment in patients who demonstrate a hematologic relapse or cytogenetic progression after interferon-alpha (IF-a) therapy coverage duration: 1 year - requests for other indications will be reviewed on a case by case basis - written request of an oncologist required *IIQUIOD (Aldara 5% Cream) - for the treatment of external genital and perianal warts and condyloma acuminata in adults - for the treatment of actinic keratosis on the head and neck in patients who have failed treatment with 5FU and cryotherapy - for the treatment of biopsy-confirmed primary superficial basal cell carcinoma: with a tumor diameter of 2cm AD located on the trunk, neck or extremities (excluding hands and feet) AD where surgery or eradication therapy is not medically indicated recurrent lesions in previously irradiated area OR multiple lesions, too numerous to irradiate or remove surgically OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

329 approval period: 6 weeks ote: Surgical management should be considered first-line for superficial basal cell carcinoma in most patients, especially for isolated lesions ICOBOTUIUTOXI A (Xeomin 50u/vial and 100iu/vial) - for the treatment of blepharospasm or cervical dystonia (spasmodic torticollis) IDACATRO (Onbrez 75mcg icronized powder for inhalation) See ong-acting Beta 2 -Agonists IDACATRO AD GCORROIU (Ultibro Breezhaler 110mcg/50mcg Capsule) - for the treatment of moderate to severe chronic obstructive pulmonary disease (COD), as defined by spirometry, in patients with an inadequate response to a long-acting beta-2 agonist (ABA) or long-acting anticholinergic (AAC) ote: - oderate to severe COD is defined by spirometry (post-bronchodilator) FV1 < 60% predicted and FV1/FVC ratio of < Spirometry reports from any point in time will be accepted. If spirometry cannot be obtained, reasons must be clearly explained and other evidence regarding COD severity must be provided for consideration (i.e. edical Research Council (RC) Dyspnea Scale score of at least Grade 3). RC Grade 3 is described as: walks slower than people of same age on the level because of shortness of breath (SOB) from COD or has to stop for breath when walking at own pace on the level. - Inadequate response is defined as persistent symptoms after at least 2 months of long-acting beta-agonist (ABA) or long-acting anticholinergic therapy (AAC). IFIXIAB (Remicade 100mg owder For Injection) - See Anti-Tumor ecrosis Factor (TF) Agents ISUI ASART (ovorapid 100iu/l enfill and Vial) ISUI GUISI (Apidra 3ml re-filled en, 10ml Vial And Cartridges) ISUI ISRO (Humalog Insulin, Cartridges and Kwikpen) - regular benefit for children 18 years and younger, under Community Services, Family harmacare and Diabetes Assistance rograms - for the management of Type I and Type II diabetes mellitus in patients 19 years of age and older, who are: undergoing intensive therapy, i.e., administering three or more injections of insulin per day including basal insulin, and testing blood glucose levels 4-6 times per day ISUI DTIR (evemir 100iu/m enfill and FlexTouch re-filled en) ISUI GARGI (antus 100iu/m vial, cartridge, and Solostar re-filled pen) - for the treatment of patients who have been diagnosed with Type 1 or Type 2 diabetes requiring insulin and have previously taken H and/or premix insulin daily at optimal dosing AD have experienced unexplained nocturnal hypoglycemia at least once a month despite optimal management OR have documented severe or continuing systemic or local allergic reaction to existing insulin(s) *ITRFRO AHA-2B (Intron-A Injection and ultidose en) - written request of an oncologist only - for hairy cell leukemia - for AIDS-related Kaposi's sarcoma - for chronic hepatitis B or C - for chronic myelogenous leukemia (C) - for thrombocytosis associated with C - for malignant melanoma - for basal cell carcinoma OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

330 *IRATROIU BROID (250mcg/m Inhaled Solutions - See Formulary istings For roduct ames) - See Wet ebulization Solutions *IRATROIU BROID, I COBIATIO (Combivent Inhaled Solution and generic brands) - See Wet ebulization Solutions *IRO DXTRA (DexIron 50mg/ml Injection) - for the treatment of iron deficiency anemia in patients intolerant to oral iron replacement products OR - for patients who have not responded to adequate therapy with oral iron. otes: - Given the safety concerns associated with IV iron, it is expected that the patients will be carefully screened and will have tried various oral iron options before being eligible for IV iron. - Details regarding oral iron tried, length of therapy, and outcome must be provided. *ITRACOAZO (Sporanox 100mg Capsule) - for the treatment of severe systemic fungal infections - for the treatment of severe or resistant fungal infections in immunocompromised patients - for the treatment of severe onychomycosis caused by dermatophyte fungi as diagnosed by a dermatologist, attending physician or prescriber with a specialty in dermatology IVACAFTOR (Kalydeco 150mg Tablet) For the treatment of cystic fibrosis in patients who meet the following criteria: - age 6 years and older; AD - patient has documented G551D mutation in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene. Initial renewal criteria 1 : Renewals will be considered in patients with documented response to treatment (after at least 6 months of therapy), as evidenced by the following: In cases where the patient s sweat chloride levels prior to commencing therapy were above 60 mmol/litre: - the patient s sweat chloride level fell below 60 mmol/litre; OR - the patient s sweat chloride level is 30% lower than the level reported in a previous test; In cases where the patient s sweat chloride levels prior to commencing therapy were below 60 mmol/litre: - the patient s sweat chloride level is 30% lower than the level reported in a previous test; OR - the patient demonstrates a sustained absolute improvement in FV1 of at least 5% when compared to the FV1 test conducted prior to the commencement of therapy. Subsequent renewal criteria after the patient has met the initial renewal criteria: The patient is continuing to benefit from therapy with Kalydeco. 1 It should be noted that, while baseline sweat chloride levels and FV1 are not required to meet initial approval criteria for ivacaftor, these parameters may be used to evaluate the effect of ivacaftor upon renewal of the request. It is important that the physician measures baseline sweat chloride levels and FV1 and provides this information upon renewal to avoid delays in the assessment of the renewal funding decision as these measurements may be required to evaluate renewal requests. ACOSAID (Vimpat 50mg, 100mg, 150mg, 200mg Tablet) - as adjunctive treatment for patients with refractory partial-onset seizures who meet all of the following criteria: are under the care of a physician experienced in the treatment of epilepsy, and are currently receiving two or more antiepileptic drugs, and in whom all other antiepileptic drugs are ineffective or not appropriate *ACTUOS (667mg/m Oral iquid, generic brands) - for portal systemic encephalopathy - for pneumatosis cystoides intestinalis OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

331 AIVUDI (Heptovir 100mg Tablet and generic brands) - for the treatment of hepatitis B, upon written request of a specialist - therapy is approved for one year, with reassessment required at that time *ASORAZO (revacid FasTab 15mg, 30mg Tablet) - for patients who require the use of a proton pump inhibitor and require administration through a feeding tube. *ASORAZO (revacid 15mg, 30mg Capsule and generic brands) - See roton ump Inhibitors ATHAU CARBOAT (Fosrenol 250mg, 500mg, 750mg, 1000mg Tablet) - upon the written request of a nephrologist or other prescriber within the rovincial Dialysis rogram - for the treatment of hyperphosphatemia (>1.8mmol/) and calciphylaxis (calcific arteriolopathy) or hypercalcemia after failure on a calcium-based binder ote: The initial coverage will be for a three-month period. Renewals will be at six month intervals when there has been a significant reduction in phosphate levels (a decrease of more than 0.7mmol of phosphate). *AATIIB (Tykerb 250mg Tablet) - in combination with capecitabine as a treatment option in patients with human epidermal growth factor receptor 2 (HR2) positive advanced or etastic Breast Cancer (BC) with trastuzumab refractory disease (previously treated with trastuzumab alone or in combination with chemotherapy such as taxane and/or vinorelbine) who have an COG performance status of 0 to 2 and choose to receive systemic chemotherapy. atients with previous exposure to capecitabine are not considered eligible DIASVIR AD SOFOSBUVIR (Harvoni 90mg/400mg Tab) - For treatment-naïve and treatment-experienced adult patients with chronic hepatitis C genotype 1 infection, with compensated liver disease, (including compensated cirrhosis) 1 according to the following criteria: rescribed by a hepatologist or other specialist with expertise in the treatment of hepatitis C ab-confirmed hepatitis C genotype 1 atient has a quantitative HCV RA value within the last 6 months Fibrosis stage F2 or greater (etavir scale or equivalent) Duration of therapy reimbursed: Genotype 1 atient opulation Treatment naïve, non-cirrhotic, viral load < 6 IU/m Treatment naïve, non-cirrhotic, viral load 6 IU/m OR Treatment naïve, cirrhotic OR Treatment-experienced 2, non-cirrhotic Treatment-experienced 2, cirrhotic Duration of therapy 8* weeks 12 weeks 24 weeks xclusion criteria: - atients currently being treated with another HCV antiviral agent - atients who have received a previous trial of ledipasvir/sofosbuvir (Re-treatment requests will not be considered) otes: 1. Compensated cirrhosis is defined as cirrhosis with a Child ugh Score =A (5-6). 2. Treatment experienced is defined as those who failed prior therapy with an interferon-based regimen, including regimens containing an HCV protease inhibitor. 3. HIV-HCV co-infected patients with Genotype 1 may be considered as per criteria listed above. 4. Treatment of decompensated HCV may be considered for coverage on an exceptional case by case basis. * For this population cohort, evidence has shown that the SVR rates with the 8-week and 12-week treatment regimens are similar. Treatment regimens of up to 12 weeks are recognized as a Health Canada approved treatment option. atients may be considered for 12 weeks of coverage if they have borderline or severe fibrosis (F3-4) or if they are co-infected with HIV. OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

332 *AIDOID (Revlimid 5mg, 10mg, 15mg, 25mg Capsule) - in combination with dexamethasone in adult patients with progressive myeloma () after at least one previous treatment, not resistant to dexamethasone, documented measurable disease and COG performance status of as a single agent in adult myelodysplastic syndrome (DS) patients with transfusion dependent anemia due to low or intermediate-1 risk DS associated with a deletion 5q cytogenetic abnormality with or without additional cytogenic abnormalities ewly Diagnosed ultiple yeloma ost-autologous Stem Cell Transplant (D post-asct) For the maintenance treatment of patients with newly diagnosed multiple myeloma, following autologous stem-cell transplantation (ASCT): - in patients with stable disease or better, with no evidence of disease progression; - treat until progression or development of unacceptable toxicity requiring discontinuation of lenalidomide; - initial dose 10 mg lenalidomide O daily, AD - dose adjustments (5-15 mg) may be necessary based on individual patient characteristics/responses ote: - Celgene will ensure that the roduct will be prescribed and dispensed only by physicians and pharmacists, respectively, who are registered with and agree in writing to adhere to the guidelines of the Company s RevAid rogram, details of which rogram are available at UKOTRI RCTOR ATAGOISTS (ontelukast, Zafirlukast) - for the treatment of moderate to severe asthma in adults and children who: despite compliance are not adequately controlled with a moderate or high dose inhaled corticosteroid and require additional symptom control (e.g., cough, awakening at night, missing activities such as school, work or social activities because of asthma symptoms) and require increasing amounts of short-acting beta 2 -agonists, indicative of poor control VTIRACTA (Keppra 250mg, 500mg, 750mg Tablet and generic brands) - as adjunctive therapy in the management of patients with epilepsy who are not satisfactorily controlled by conventional therapy VOCARITI (Carnitor 1g/5m Injection, 100mg/m Oral iquid and 300mg Tablet) - for the treatment of primary systemic carnitine deficiency VODOA AD CARBIDOA AD TACAO (Stalevo 50mg, 75mg, 100mg, 125mg, 150mg Tablet) - for the treatment of arkinson s disease as adjunctive therapy in patients who: are not well controlled and are experiencing significant wearing off symptoms despite optimal therapy with levodopa/carbidopa were not well controlled and experienced significant wearing off symptoms despite optimal therapy with levodopa/carbidopa and are currently using levodopa/carbidopa and entacapone separately *VOFOXACI (evaquin 250mg, 500mg Tablet and generic brands) - See Fluoroquinolones, Respiratory IZOID (Zyvoxam 600mg Tablet) - written request from an infectious disease specialist or prescriber with a specialty in infectious diseases - for the treatment of proven vancomycin-resistant enterococci (VR) infections - for the treatment of proven methicillin-resistant staphylococcus aureus or epidermidis (RSA/RS) infections in those patients who are unresponsive to, or intolerant of vancomycin IAGITI (Trajenta 5mg Tab) - for the treatment of Type II diabetes for patients with: inadequate glycemic control on metformin and a sulfonylurea; and for whom insulin is not an option OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

333 ISDXAFTAI DISAT (Vyvanse 10mg, 20mg, 30mg, 40mg, 50mg, and 60mg Capsule) - for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in patients age 6 to 25 years who: demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning; and have been tried on methylphenidate (immediate release or long-acting formulation) or dexamphetamine with unsatisfactory results. otes: - Requests will be considered from specialists in pediatric psychiatry, pediatricians or general practitioners with expertise in ADHD. - The maximum dose reimbursed is 60mg daily. OG-ACTIG BTA 2 -AGOISTS (Formoterol, Indacaterol, Salmeterol) OG-ACTIG BTA 2 -AGOISTS/IHAD CORTICOSTROIDS (Formoterol, In Combination; Salmeterol, In Combination) Asthma - for the treatment of moderate to severe asthma in patients who: are compliant with inhaled corticosteroids at optimal doses; and require additional symptom control, (e.g., cough, awakening at night, missing activities such as school, work or social activities because of asthma symptoms); and require increasing amounts of short-acting beta 2 -agonists, indicative of poor control Chronic Obstructive ulmonary Disease - for the treatment of moderate to severe chronic obstructive pulmonary disease (COD) as defined by spirometry. OR - for the treatment of COD in patients with an inadequate response to short acting bronchodilators. - combination therapy with a long- acting beta-2 agonist /inhaled corticosteroid (ABA/ICS) and a long acting anticholinergic (AAC) inhaler will be considered in patients with: moderate to severe COD, as defined by spirometry, a history of COD exacerbation(s) and an inadequate response to ABA/ICS or AAC. ote: Coverage for ABA and AAC as two separate inhalers will not be considered. Clinical otes: 1. oderate to severe COD is defined by spirometry as a post bronchodilator FV1 < 60% predicted and FV1/FVC ratio of < Spirometry reports from any point in time will be accepted. If spirometry cannot be obtained, reasons must be clearly explained and other evidence of COD severity provided, i.e., edical Research Council (RC) Dyspnea Scale Score of at least Grade 3. RC Grade 3 is described as: walks slower than people of same age on the level because of shortness of breath from COD or has to stop for breath when walking at own pace on the level. 2. Inadequate response to short acting bronchodilators is defined as persistent symptoms, i.e., RC of at least Grade 3, after at least 2 months of short acting bronchodilator at the following doses*: 8 puffs per day of short acting beta-2 agonist or 12 puffs per day of ipratropium or 6 puffs per day of ipratropium plus salbutamol combination inhaler * Inadequate response to ABA/ICS or AAC is defined as persistent symptoms after at least 2 months of therapy. 3. COD exacerbation is defined as an increase in symptoms requiring treatment with antibiotics and/or systemic (oral or intravenous) corticosteroids. Treatment of COD lease note that inhaled corticosteroids in combination with long-acting beta 2 agonists (ABA/ICS) have been associated with an increased risk of pneumonia in patients with COD. Guidelines recommend their use in moderate to severe COD patients who are experiencing frequent exacerbations, not controlled by long-acting bronchodilators. For patients with moderate to severe COD who are not experiencing frequent exacerbations, long-acting beta 2 agonists or long-acting anticholinergics are recommended. Global strategy for the diagnosis, management and prevention of COD OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

334 ote: Inhalers which combine a ABA/AAC are also available as SD benefits. These products have their own criteria which are listed in the S Formulary. ORATADI (Claritin 10mg Tablet and generic brands) - for chronic urticaria, defined as the presence of hives or lesions for longer than six weeks, which has responded to treatment with loratadine URASIDO (atuda 20mg, 40mg, 60mg, 80mg, 120mg Tablet) - for the treatment of schizophrenia or schizoaffective disorder in patients who have a contraindication to quetiapine and risperidone, or have failed a trial of quetiapine and risperidone due to intolerance or lack of response. AGSIU GUCOHTOAT (5mg/m Solution and generic brands) - for the treatment of hypomagnesemia *THADO (etadol 1mg, 5mg, 10mg, 25mg Tablet) - for the management of severe chronic or malignant pain as an alternative to other opiates - written request of a physician authorized to prescribe methadone *THADO, ORA IQUID (ethadone o/l Compound) - for the management of severe chronic or malignant pain as an alternative to other opiates - for the management of patients undergoing therapy for drug dependence - written request of a physician authorized to prescribe methadone THHIDAT (Biphentin 10mg, 15mg, 20mg 30mg, 40mg, 50mg, 60mg and 80mg Capsule) THHIDAT R (ovo-ethylphenidate R-C 18mg, 27mg, 36mg, and 54mg Tablets) - for patients 6-25 years of age diagnosed with attention deficit hyperactivity disorder (ADHD) who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning AD prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics, general practitioners or other prescribers with expertise in ADHD AD have been tried on immediate release or slow release methylphenidate with unsatisfactory results *IDAZOA (1mg/m, 5mg/m Injection and generic brands) - for adjunctive therapy of pain management in palliative care patients outside the hospital setting [Criteria Code 01] IRABGRO (yrbetriq 25mg R and 50mg R Tablet) - for the treatment of overactive bladder (OAB) with symptoms of urgency, urgency incontinence, and urinary frequency if the patient has had an intolerance or inadequate response to an adequate trial of an anticholinergic therapy - not to be used in combination with other pharmacological treatments of OAB - a three month trial will be approved initially with assessment of the effectiveness of this therapy required if further coverage is considered ODAFII (Alertec 100mg Tablet and generic brands) - for the treatment of narcolepsy confirmed by sleep study OTUKAST (Singulair 4mg, 5mg Chewtabs, 4mg/pkt Granules and 10mg Tablets and generic brands) - See eukotriene Receptor Antagonists *OXIFOXACI (Avelox 400mg Tablet) - See Fluoroquinolones, Respiratory *ABIO (Cesamet 0.25mg, 0.5mg and 1mg Capsule) - for the management of severe nausea and vomiting associated with cancer chemotherapy OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

335 ATRXO (Revia 50mg Tablet) - for the treatment of alcohol dependence, as an adjunct to a comprehensive psychotherapeutic or psychological alcoholism counseling program to support abstinence, and reduce the risk of relapse - eligibility is initially restricted to a three month period with reassessment at that time for further coverage ARATRITA (Amerge 1mg, 2.5mg Tablet and generic brands) - See Selective 5HT 1 - Receptor Agonists ATAIZUAB (Tysabri 300mg/15m Vial) Initial Request: For the treatment of Relapsing-Remitting ultiple Sclerosis (RRS) who meet all the following criteria: - the patient s physician is a neurologist experienced in the management of relapsing-remitting multiple sclerosis (RRS); AD - the patient; has a current DSS less than or equal to 5.0; AD has failed to respond to a full and adequate course* (at least six months) of at least O disease modifying therapy OR has contraindications/intolerance to at least TWO disease modifying therapies; AD has had O of the following types of relapses in the past year: the occurrence of one relapse with partial recovery during the past year AD has at least O gadoliniumenhancing lesion on brain RI, OR significant increase in T2 lesion load compared to a previous RI; OR the occurrence of two or more relapses with partial recovery during the past year; OR the occurrence of two or more relapses with complete recovery during the past year AD has at least O gadolinium-enhancing lesion on brain RI, OR significant increase in T2 lesion load compared to a previous RI. - approval period: 1 year Requirements for Initial Requests: - the patient s physician provides documentation setting out the details of the patient s most recent neurological examination within ninety (90) days of the submitted request. This must include a description of any recent attacks, the dates, and the neurological findings. - RI reports do OT need to be submitted with the initial request Renewal: - date and details of the most recent neurological examination and DSS scores must be provided (exam must have occurred within the last 90 days) AD - patients must be stable or have experienced no more than 1 disabling attack/relapse in the past year; AD - recent xpanded Disability Status Scale (DSS) score less than or equal to 5.0. * Failure to respond to a full and adequate course is defined as a trial of at least one approved first line therapy for a minimum of 6 months AD experienced at least one disabling relapse (attack) while on this therapy. *IOTIIB (Tasigna 150mg & 200mg Capsule) First ine: - as a single first line agent for the treatment of adults with chronic phase C Second ine: - as a single second line agent for the treatment of adults with chronic or accelerated phase C with resistance or intolerance to prior therapy These second line criteria include: atients with C in chronic phase who are intolerant to oral tyrosine kinase inhibitors (TKIs) (i.e. imatinib or dasatinib or both) atients with C in chronic phase who are resistant to imatinib atients with C that have progressed to accelerated phase while on imatinib therapy - In any one patient, only two of the TKIs will be funded within these criteria during their lifetime OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

336 - If a patient develops grade 3 or 4 toxicity to one of the TKIs used within 3 months of initiating therapy, access to a third agent will be funded - Sequential use of nilotinib and dasatinib is not permitted except in the circumstance described above (i.e. grade 3 or 4 toxicity) *ORFOXACI (400mg Tablet, generic brands) - See Fluoroquinolones, Oral OCRIASI (Jetrea 2.5mg/m Injection) For the treatment of symptomatic vitreomacular adhesion (VA) if the following clinical criteria and conditions are met: - diagnosis of VA should be confirmed through optical coherence tomography - patient does not have any of the following: large diameter macular holes (> 400 micrometre), high myopia (> 8 dioptre spherical correction or axial length > 28 millimetre), aphakia, history of retinal detachment, lens zonule instability, recent ocular surgery or intraocular injection (including laser therapy), proliferative diabetic retinopathy, ischemic retinopathies, retinal vein occlusions, exudative age-related macular degeneration, or vitreous hemorrhage Conditions: - Ocriplasmin should be administered by a retinal specialist or by a qualified ophthalmologist experienced in intravitreal injections - Treatment with ocriplasmin should be limited to a single injection per eye (i.e., retreatments are not covered) OFOXACI, OHTHAIC (Ocuflox 0.3% Ophthalmic Solution and generic brands) - See Fluoroquinolones, Ophthalmic *OFOXACI, ORA (300mg and 400mg Tablet and generic brands) - See Fluoroquinolones, Oral OAZAI (Zyprexa 2.5mg, 5mg, 7.5mg, 10mg, 15mg Tablet and generic brands) OAZAI, ORA DISITGRATIG (Zyprexa Zydis 5mg, 10mg, 15mg, 20mg Tablet and generic brands) - for the treatment of schizophrenia and related psychotic disorders upon the written request of a psychiatrist, either first line or upon failure of other antipsychotic agents - for the acute treatment of manic or mixed episodes in bipolar I disorder in patients with intolerance or a history of failure to one other atypical antipsychotic - for maintenance therapy in patients with bipolar disease who are currently stabilized on olanzapine OBITASVIR/ARITARVIR/RITOAVIR AD DASABUVIR (Holkira ak 12.5/75/50mg and 250mg Tablet) - for treatment-naïve and treatment-experienced adult patients with chronic hepatitis C genotype 1 infection, with compensated liver disease, (including compensated cirrhosis) 1 according to the following criteria: prescribed by a hepatologist or other specialist with expertise in the treatment of hepatitis C; lab-confirmed hepatitis C genotype 1, sub-type 1a and 1b required; patient has a quantitative HCV RA value within the last 6 months; fibrosis stage F2 or greater (etavir scale or equivalent); Duration of therapy reimbursed: Genotype 1 atient opulation Treatment naïve and experienced Genotype 1b, non-cirrhotic** Treatment naïve and experienced Genotype 1a, non-cirrhotic Treatment naïve and experienced Genotype 1b, cirrhotic Duration of Therapy 12 Weeks 12 Weeks in combination with ribavirin (oderiba) 12 Weeks in combination with ribavirin (oderiba) OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

337 Genotype 1 atient opulation Duration of Therapy Treatment naïve and experienced (prior 12 Weeks in combination relapsers and prior partial responders) with ribavirin (oderiba) Genotype 1a, cirrhotic Treatment experienced genotype 1a, with 24 Weeks in combination cirrhosis AD who have had a previous with ribavirin (oderiba) null response to egif and RBV **Holkira ak with ribavirin is recommended in patients with an unknown genotype 1 subtype or with mixed genotype 1 infection. xclusion criteria: - patients currently being treated with another HCV antiviral agent - patients who have received a previous trial of Holkira ak (Re-treatment requests will OT be considered) - decompensated patients - no funding for other genotypes except as noted in the above funding criteria for genotype 1 - patients who have received previous S3/4A protease inhibitor-based regimens (boceprevir, telaprevir, and simeprevirbased regimens) - patients who have received previous sofosbuvir-based regimens (including ledispavir/sofosbuvir) otes: 1. Compensated cirrhosis is defined as cirrhosis with a Child ugh Score =A (5-6) 2. Treatment experienced patients are defined as those who have previously been treated with egif/rbv and did OT receive adequate response. 3. HIV-HCV co-infected patients with genotype 1 may be considered as per criteria listed above *ORAZO (osec 10mg, 20mg Capsule/Tablet and generic brands) - See roton ump Inhibitors ote: Omeprazole is available as a full benefit if the dose does not exceed the standard dose of 20mg per day (maximum of 425 tablets/capsules per year). If the dosage is greater than 20mg per day then the criteria for coverage must be met. OABOTUIUTOXI-A (Botox 50iu/vial and 100iu/vial Injection) - for the treatment of the following Health Canada approved indications: focal spasticity following stroke in adults equinus foot deformity in cerebral palsy patients 2 years of age and older cervical dystonia blepharospasm, hemifacial spasm (VII nerve disorder) or strabismus in patients 12 years of age and older OABOTUIUTOXI-A (Botox 200iu/vial Injection) - for the treatment of urinary incontinence due to neurogenic detrusor overactivity resulting from neurogenic bladder associated with multiple sclerosis (S) or subcervical spinal cord injury (SCI) in patients who have failed to respond to behavioural modification and anticholinergics and/or are intolerant to anticholinergics subsequent treatments are provided at intervals no less than every 36 weeks *ODASTRO (Zofran 4mg, 8mg Tablet, 4mg/5m Oral iquid, ODT Tablet and generic brands) - See Serotonin (5-HT 3 ) Antagonists ote: Only requests for the oral dosage forms are eligible for consideration. Although the dose may vary, usually a single oral 8mg dose pre-chemotherapy is sufficient to control symptoms. As well, some patients may require additional therapy up to 48 hours after the last dose of chemotherapy or last radiation treatment. Benefit beyond 48 hours has not been established and is therefore, not insured. OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

338 *OSTAIVIR (Tamiflu 30mg, 45mg, 75mg Capsule, 12mg/m Oral Suspension) - for the treatment of long-term care residents with clinically suspected or lab confirmed influenza A or B. A clinically suspected case is one in which the patient meets the criteria of influenza-like illness and there is confirmation of influenza A or B circulating within the facility or surrounding community - for the prophylaxis of influenza A or B in long-term care residents where the facility has an outbreak - a protocol has been developed by ublic Health for the treatment of patients in long-term care facilities. The facility must contact the edical Officer of Health or local ublic Health Office, who will notify the harmacare office (or dispensing pharmacy after office hours) if coverage is required OXCARBAZI (Trileptal 60mg/m Oral iquid and 150mg, 300mg, 600mg Tablet and generic brands) - for the treatment of epileptic seizures in patients who have had an inadequate response to or are intolerant of at least three other formulary agents (prior or current use) including carbamazepine OXBUTI X (Ditropan X and Uromax 5mg, 10mg Tablet) - for the treatment of over-active bladder (not stress incontinence) for patients who cannot tolerate immediate relase oxybutinin after an adequate trial (e.g. 3 months) - a three month trial will be approved initially with assessment of the effectiveness of this therapy required if further coverage is considered AIRIDO (Invega Sustenna 50mg/0.5m, 75mg/0.75m, 100mg/m, 150mg/1.5m) - for patients having problems with compliance on an oral antipsychotic or - for patients who are currently receiving a conventional depot antipsychotic and are experiencing significant side effects (S or TD) or lack of efficacy *ATORAZO AGSIU (Tecta 40mg Tablet) - See roton ump Inhibitors *ATORAZO SODIU (antoloc 20mg, 40mg C Tablet and generic brands) - See roton ump Inhibitors *AZOAIB (Votrient 200mg Tablet) - as a single agent first-line treatment option for patients with documented evidence of histologically confirmed advanced or metastatic clear cell renal cell carcinoma (RCC) who have an COG S of 0 or 1. In any one patient, all the following conditions must be met: pazopanib may be a first line option. pazopanib may not be used after another VGF tyrosine kinase inhibitor as sequential therapy. In the event of significant toxicity, a switch to another VGF tyrosine kinase inhibitor may be allowed. GITRFRO AFA-2A (egasys 180mcg Injection) - for the treatment of hepatitis C in patients who are treatment naive, upon the written request of a hepatologist or prescriber with a specialty in hepatitis - a 24 week period will be initially approved at which time a further request will be required documenting the patient s response. If a positive response occurs, coverage can be continued for an additional 24 weeks (48 weeks total) - for the treatment of HBeAg negative Chronic Hepatitis B (CHB) patients with compensated liver disease, liver inflammation and evidence of viral replication with demonstrated intolerance to or failure of lamivudine therapy, upon written request of a hepatologist or prescriber with a specialty in hepatitis. aximum duration of coverage is 48 weeks OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

339 GITRFRO AFA-2A AD RIBAVIRI (egasys RBV Injection/Tablet) GITRFRO AFA-2B AD RIBAVIRI (egetron and egetron Redipen Injection/Capsule) - for the treatment of hepatitis C in patients who are treatment naive, upon the written request of a hepatologist or prescriber with a specialty in hepatitis - a 24 week period will initially be approved at which time a further request will be required documenting the patient s response. If a positive response occurs, coverage can be continued for an additional 24 weeks (48 weeks total) - as combination therapy with new protease inhibitors (i.e., boceprevir or telaprevir); futility rules being enforced. atients should stop all therapy (both protease inhibitor and egifα/rbv) if hepatitis C virus levels are: with boceprevir, 100 IU/m at 12 weeks or detectable at 24 weeks with telaprevir, 1,000 IU/m at 4 weeks or 12 weeks, or detectable at 24 weeks TOXIFI (Trental 400mg Tablet and generic brands) - for the treatment of patients with ulcers due to ischemia of critical limbs RAA (Fycompa 2mg, 4mg, 6mg, 8mg, 10mg and 12mg Tablet) - as an adjunctive therapy in the management of partial-onset seizures, in adult patients with epilepsy who are not satisfactorily controlled with conventional therapy who meet all of the following criteria: are under the care of a physician experienced in the treatment of epilepsy; are currently receiving two or more antiepileptic drugs; and in whom all other antiepileptic drugs are ineffective or not appropriate. *IOCARI, ORA (Salagen 5mg Tablet) - for oncology patients only - for the treatment of the symptoms of xerostomia due to salivary gland hypofunction caused by radiotherapy for cancer of the head and neck IOGITAZO (Actos 15mg, 30mg, 45mg Tablet and generic brands) - for treatment of Type II diabetes in patients who have: inadequate glycemic control on optimal doses of sulfonylurea and metformin; or demonstrated intolerance or contraindication to metformin and are on optimal doses of sulfonylurea; or demonstrated intolerance or contraindication to sulfonylurea and are on optimal does of metformin - patients must have a recent A1C of < 10% unless insulin therapy is inappropriate for the patient. Duration of intial approval will be 6 months; further coverage will require demonstrated evidence of efficacy (a reduction of A1C of 0.7 observed to continue coverage) IRFIDO (sbriet 267mg Capsule) Initial approval criteria: - adult patients who have a diagnosis of mild to moderate idiopathic pulmonary fibrosis (IF) 1 confirmed by a respirologist and a high-resolution CT scan within the previous 24 months. - initial approval period: 7 months (allow 4 weeks for repeat pulmonary function tests) Initial renewal criteria: - patients must OT demonstrate progression of disease defined as an absolute decline in percent predicted FVC of 10% from initiation of therapy until renewal (initial 6 month treatment period). If a patient has experienced progression as defined above, then the results should be validated with a confirmatory pulmonary function test conducted 4 weeks later. - approval period: 6 months Second renewal criteria (12 months after initiation of therapy): - patients must OT demonstrate progression of disease defined as an absolute decline in percent predicted FVC of 10% since initiation of therapy (baseline). If a patient has experienced progression as defined above, then the results should be validated with a confirmatory pulmonary function test conducted 4 weeks later - approval period: 12 months 1 ild-moderate IF is defined as: a FVC between 50-80% predicted, and a ercent Carbon onoxide Diffusing Capacity (%DCO) between 30-90% predicted. OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

340 RIXAFOR (ozobil 24mg/1.2m (20mg/m) Single Use Vial) - for use in combination with filgrastim to mobilize hematopoietic stem cells for subsequent autologous transplantation in patients with on-hodgkin s lymphoma (H) or multiple myeloma () if one of the following criteria are met: a BCD34+ count of < 10cells/u after 4 days of filgrastim; OR less than 50% of the target CD34 yield is achieved on the 1st day of apheresis (after being mobilized with filgrastim alone or following chemotherapy); OR if a patient has failed a previous stem cell mobilization with filgrastim alone or following chemotherapy. ote: Reimbursement is limited to a maximum of 4 doses (0.24mg/kg given daily) for a single mobilization attempt and to prescriptions written by an oncologist or hematologist. *OAIDOID (omalyst 1mg, 2mg, 3mg, and 4mg Capsule) - for patients with relapsed and/or refractory multiple myeloma who have previously failed at least two treatments, including both bortezomib and lenalidomide and demonstrated disease progression on the last treatment. - omalidomide may be an option in rare instances where bortezomib is not tolerated or contraindicated but in all cases, patients should have failed lenalidomide. ote: omalidomide must be prescribed and dispensed only by physicians and pharmacists who are registered with and agree in writing to adhere to the guidelines of the Company s RevAid rogram. Details are available at RASUGR HDROCHORID (ffient 10mg Tablet) - in combination with ASA for patients with: ST-elevated myocardial infarction (STI) undergoing primary percutaneous coronary intervention (CI) who have not received antiplatelet therapy prior to arrival in the catheterization lab. treatment must be initiated in hospital. approval period 12 months (up to 3 months for patients with bare metal stents). otes: - Criteria Code 30 may be used for the initial 30 day coverage period, however a written request submitted to the harmacare office is required to allow coverage for the remaining duration of treatment. - As per the product monograph, prasugrel is contraindicated in patients with a known history of transient ischemic attack or stroke; those with active pathological bleeding such as gastrointestinal bleeding or intracranial hemorrhage; and those with severe hepatic impairment (Child-ugh Class C). - As per the product monograph, prasugrel is not recommended in patients 75 years of age because of the increase risk of fatal and intracranial bleeding; or those with body weight < 60kg because of increased risk of major bleeding due to an increase in exposure to the active metabolite of prasugrel. *RGABAI (yrica 25mg, 50mg, 75mg, 150mg, 225mg, 300mg Capsule and generic brands) - for the treatment of neuropathic pain (e.g. diabetic neuropathy, postherpetic neuropathy) in patients who have failed a trial of a tricylic antidepressant (e.g. amitriptyline, desipramine, imipramine, nortriptyline) *ROTO U IHIBITORS (Is) Omeprazole - Standard dose: full benefit at usual daily dose (e.g. 20mg per day). aximum 425 tabs/caps per year. - Double dose: requires special authorization and must have failed standard daily doses of all full benefit I s omeprazole, rabeprazole and pantoprazole sodium. Coverage duration: 8 week trial, followed by up to one year of coverage. Use beyond the 8 week trial will be considered if step down to standard dose is not successful. antoprazole Sodium - Standard dose: full benefit at usual daily dose (e.g. 40mg per day). aximum 425 tabs/caps per year. - Double dose: requires special authorization and must have failed standard daily doses of all full benefit I s omeprazole, rabeprazole and pantoprazole sodium. Coverage duration: 8 week trial, followed by up to one year of coverage. Use beyond the 8 week trial will be considered if step down to standard dose is not successful OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

341 antoprazole agnesium and ansoprazole - Standard dose: failure of a trial of all open benefit Is (omeprazole, rabeprazole and pantoprazole sodium). aximum 425 tabs/caps per year. - Double dose: failure of standard dose of requested agent and double doses of rabeprazole. Coverage duration: 8 week trial, followed by up to one year of coverage. Use beyond an 8 week trial will be considered if step down to standard dose is not successful. *QUIAGOID (orprolac 0.025mg, 0.05mg, 0.075mg, 0.15mg Tablet) - for the treatment of hyperprolactinemia (idiopathic or originating from a prolactin secreting micro or macro-adenoma of the pituitary) after failure of bromocriptine (as determined by prolactin levels) or if bromocriptine is not tolerated RAOXIF (vista 60mg Tablet and generic brands) - for the treatment of postmenopausal osteoporosis associated with documented fragility fracture when bisphosphonates are not tolerated or are contraindicated - for the treatment of postmenopausal osteoporosis without documented fractures when patient is at high 10 year fracture risk (using fracture risk tables) and bisphosphonates are not tolerated or are contraindicated - other requests reviewed on a case by case basis *RGORAFIB (Stivarga 40mg tablet) - for patients with metastatic and/or unresectable gastrointestinal stromal tumors (GIST) who have had disease progression on, or intolerance to, imatinib and sunitinib; AD has COG 1 RIBAVIRI (Ibavyr 400mg and 600mg tablet) - for use within a combination therapy regimen for the treatment of chronic hepatitis C, in accordance with the specific eligibility criteria for approved agents. RIBAVIRI (oderiba 200mg, 400mg and 600mg Tablet) - for use in chronic hepatitis C patients, genotype 1, who have been approved for coverage of Holkira ak RIUZO (Rilutek 50mg Tablet and generic brands) - for the treatment of amyotrophic lateral sclerosis (AS) or ou Gehrig s Disease, when initiated by a neurologist with expertise in the management of AS, when the patient has: probable or definite diagnosis of AS AS symptoms for less than five years FVC >60% predicted upon initiation of therapy no tracheostomy for invasive ventilation - coverage to be reviewed every six months - coverage cannot be renewed once the patient has a tracheostomy for the purpose of invasive ventilation or mechanical ventilation RIOCIGUAT (Adempas 0.5mg, 1.0mg, 1.5mg, 2.0mg, 2.5mg Tablet) - for the treatment of inoperable chronic thromboembolic pulmonary hypertension (CTH, World Health Organization [WHO] Group 4) or persistent or recurrent CTH after surgical treatment in adult patients ( 18 years of age) with WHO Functional Class (FC) II or III pulmonary hypertension (H). - Adempas should be prescribed by a clinician with experience in the diagnosis and treatment of CTH. RISDROAT (Actonel 30mg Tablet and generic brands) - aget s disease of bone (2 month limit, one re-treatment course may be considered) - other requests reviewed on a case by case basis OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

342 RISRIDO (Risperdal Consta 12.5mg/2m 25mg/2m, 37.5mg/2m, 50mg/2m Injection) - for patients having problems with compliance on an oral antipsychotic or - for patients who are currently receiving a conventional depot antipsychotic and are experiencing significant side effects (S or TD) or lack of efficacy RITUXIAB (Rituxan 10mg/m Injection) - for the treatment of adult patients with severe active rheumatoid arthritis who have failed to respond to an adequate trial with an anti-tf agent - cannot be used concomitantly with anti-tf agents - written request from a rheumatologist or prescriber with a specialty in rheumatology - approval for re-treatment with rituximab will only be considered for patients who have achieved a response, followed by a subsequent loss of effect and, after an interval of no less than six months from the previous dose - for the induction of remission in patients with severely active granulomatosis with polyangitis (GA) or microscopic polyangitis (A) who have severe intolerance or other contraindication to cyclophosphamide, or who have failed an adequate trial of cyclophosphamide RIVAROXABA (Xarelto 10mg Tablet) - for the prophylaxis of venous thromboembolism following total knee replacement surgery for up to 14 days, as an alternative to low molecular weight heparins [Criteria Code 14] - for the prophylaxis of venous thromboembolism following total hip replacement surgery for up to 35 days, as an alternative to low molecular weight heparins [Criteria Code 35] RIVAROXABA (Xarelto 15mg and 20mg Tablet) Deep Vein Thrombosis/ulmonary mbolism: - Inclusion Criteria: For the treatment of deep vein thrombosis (DVT) or pulmonary embolism () Approval eriod: Up to six (6) months Criteria Code 42 will be used to allow the 15mg strength to pay (max 42 tablets), which will allow patients to start therapy while awaiting SD approval for the six months of therapy otes: - The recommended dose of rivaroxaban for patients initiating DVT or treatment is 15mg twice daily for 3 weeks, followed by 20mg once daily. - Drug plan coverage for rivaroxaban is an alternative to heparin/warfarin for up to six months. When used for greater than 6 months, rivaroxaban is more costly than heparin/warfarin. As such, patients with an intended duration of therapy greater than 6 months should be considered for initiation on heparain/warfarin. - Since renal impairment can increase bleeding risk, it is important to monitor renal function regularly. Other factors that increase bleeding risks should also be assessed and monitored (see rivaroxaban product monograph) on-valvular Atrial Fibrillation: - Inclusion Criteria: - At-risk 1 patients with non-valvular atrial fibrillation (AF) who require rivaroxaban for the prevention of stroke and systemic embolism AD in whom: Anticoagulation is inadequate 2 following a reasonable trial 3 on warfarin; OR Anticoagulation with warfarin is contraindicated or not possible due to inability to regularly monitor via International ormalized Ratio (IR) testing (i.e. no access to IR testing services at a laboratory, clinic, pharmacy, and at home) 1 At-risk patients with non-valvular atrial fibrillation are defined as those with a CHADS 2 score of 1. Although the ROCKT-AF trial included patients with higher CHADS 2 scores ( 2), other landmark studies with the other newer oral anticoagulants demonstrated a therapeutic benefit in patients with a CHADS 2 score of 1. rescribers may consider an antiplatelet regimen or oral anticoagulation for patients with a CHADS 2 score of 1. 2 Inadequate anticoagulation is defined as IR testing results that are outside the desired IR range for at least 35% of the tests during the monitoring period (i.e. adequate anticoagulation is defined as IR test results that are within the desired IR range for at least 65% of the tests during the monitoring period). 3 A reasonable trial on warfarin is defined as at least two months of therapy. OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

343 xclusion Criteria: - atients with impaired renal function 4 (creatinine clearance or estimated glomerular filtration rate < 30 m/min) OR 75 years of age and without documented stable renal function 5 OR hemodynamically significant rheumatic valvular heart disease 6, especially mitral stenosis; OR prosthetic heart valves * lease ote: atients starting rivaroxaban should have ready access to appropriate medical services to manage a major bleeding event. 4 Since renal impairment can increase bleeding risk, renal function should be regularly monitored. Other factors that increase bleeding risk should also be assessed and monitored (see Xarelto (rivaroxaban) roduct onograph). 5 Documented stable renal function is defined as creatinine clearance or estimated glomerular filtration rate of m/min for 15mg once daily dosing or 50 m/min for 20mg once daily dosing that is maintained for at least 3 months. 6 There is currently no data to support that rivaroxaban provides adequate anticoagulation in patients with rheumatic valvular disease or those with prosthetic heart valves, so rivaroxaban is not recommended in these populations. RIVASTIGI (xelon 2mg/m Oral iquid and 1.5mg, 3mg, 4.5mg, 6mg Capsule and generic brands) - See Cholinesterase Inhibitors (ChI) RUFIAID (Banzel 100mg, 200mg and 400mg Tablet) - for the adjunctive treatment of seizures associated with ennox-gastaut syndrome for patients who meet all of the following criteria: are under the care of a physician experienced in treating ennox-gastaut syndrome-associated seizures, AD are currently receiving two or more antiepileptic drugs, AD in whom less costly antiepileptic drugs are ineffective or not appropriate *RUXOITIIB (Jakavi 5mg, 15mg and 20mg Tablet) - as a single agent in patients with intermediate or high risk symptomatic myelofibrosis (using the Dynamic International rognostic Scoring System (DISS) lus or symptomatic splenomegaly) with an COG performance status (S) 3 as first line therapy or refractory to other treatments. Ongoing monitoring and follow up of therapy will be required. *SACCHARATD IRO OXID (Venofer 20mg/m Injection) - for the treatment of iron deficiency anemia in patients intolerant to oral iron replacement products OR - for patients who have not responded to adequate therapy with oral iron. otes: - Given the safety concerns associated with IV iron, it is expected that the patients will be carefully screened and will have tried various oral iron options before being eligible for IV iron. - Details regarding oral iron tried, length of therapy, and outcome must be provided. *SABUTAO (0.5mg/m, 1mg/m, 2mg/m Unit Dose Inhaled Solution And 5mg/m Inhaled Solution - See Formulary istings For roduct ames) - See Wet ebulization Solutions *SABUTAO, I COBIATIO (Combivent Inhaled Solution and generic brands) - See Wet ebulization Solutions SATRO (Serevent 50mcg/dose Diskhaler and 50mcg/dose Diskus) - See ong-acting Beta 2 -Agonists SATRO I COBIATIO (Advair 50/100mcg, 50/250mcg, 50/500mcg Diskus and HFA 25/125 mcg/dose, HFA 25/250 mcg/dose Inhaler) - See ong-acting Beta 2 -Agonists/Inhaled Corticosteroids SAXAGITI (Onglyza 2.5mg and 5mg Tablet) - for the treatment of Type II diabetes for patients with: inadequate glycemic control on metformin and a sulfonylurea; and for whom insulin is not an option. OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

344 SAXAGITI AD TFORI (Komboglyze 2.5mg/500mg, 2.5mg/850mg, 2.5mg/1000mg Tab) - for the treatment of Type II diabetes for patients: who are already stabilized on therapy with metformin, a sulfonylurea and saxagliptin to replace the individual components of saxagliptin and metformin; and for whom insulin is not an option. SCTIV 5HT 1 - RCTOR AGOISTS (Almotriptan Tablet, aratriptan Tablet, Sumatriptan asal Spray) Sumatriptan 50mg & 100mg Tablet, aratriptan Tablet - for the treatment of migraine 1 headache when: migraines are moderate 2 in severity and other therapies (e.g. SAIDs, acetaminophen, DH spray) are not effective, or migraine attacks are severe 2 or ultra severe 2 1 As diagnosed based on current Canadian guidelines. 2 Definitions: oderate pain is distracting causing need to slow down and limit activities; Severe pain affects ability to concentrate and very difficult to continue with daily activities; Ultra severe unable to speak or think clearly; not able to function; likely lying down or sleeping. Almotriptan Tablet, Sumatriptan asal Spray - for the treatment of migraine 1 headache of moderate 2 intensity when: other therapies (e.g. SAIDs, acetaminophen, DH spray) are not effective AD patients have not responded to oral sumatriptan, zolmitriptan, rizatriptan and naratriptan. for the treatment of migraine 1 headache of severe 2 or ultra severe2 intensity when patients have not responded to oral sumatriptan, zolmitriptan, rizatriptan, and/or naratriptan. Sumatriptan 6mg/Syringe Injection - for the treatment of migraine 1 headache of moderate 2 intensity when: other therapies (e.g. SAIDs, acetaminophen, DH spray) are not effective AD oral and nasal triptans are not appropriate. for the treatment of migraine 1 headache of severe 2 or ultra severe 2 intensity when oral and nasal triptans are not appropriate. ote: Coverage limited to 18 doses/3 months 1 patients with >3 migraines/month on average despite prophylactic therapy may be considered for up to a maximum of 12 doses/30 day 1 Reimbursement will be available for a maximum quantity of 18 triptan doses per quarter (e.g., Jan to ar) regardless of the agent(s) used within the 90 day period. *SROTOI (5-HT 3 ) ATAGOISTS (Granisetron, Ondansetron) - for the treatment of emesis in patients who are: receiving moderately or severely emetogenic chemotherapy [Criteria Code 01] or receiving intravenous chemotherapy or radiotherapy and who have not experienced adequate control with other available antiemetics [Criteria Code 02] or receiving intravenous chemotherapy or radiotherapy and who are experiencing intolerable side effects to other antiemetics, including steroids and anti-dopaminergic agents [Criteria Code 03] ote: - Use of criteria codes is limited to appropriate doses pre and post chemotherapy or radiation. Criteria codes must not be used for claims related to other causes of nausea and vomiting or for long term, daily management of nausea and vomiting. SVAR (Renagel 800mg Tablet) - upon the written request of a nephrologist or other prescriber within the rovincial Dialysis rogram - for the treatment of hyperphosphatemia (>1.8 mmol/) and calciphylaxis (calcific arteriolopathy) or hypercalcemia after failure on a calcium-based binder OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

345 ote: The initial coverage will be for a three-month period. Renewals will be at six month intervals when there has been a significant reduction in phosphate levels (a decrease of more than 0.7mmol of phosphate). SIDAFI (Revatio 20mg Tablet and generic brands) - written request from a pulmonary arterial hypertension (AH) specialist only - diagnosis of AH should be confirmed by right heart catheterization - dose of sildenafil will be limited to 20mg tid - IAH (functional class III) for the treatment of patients with World Health Organization (WHO) functional class III idiopathic pulmonary arterial hypertension (IAH) who do not demonstrate vasoreactivity on testing, or who do demonstrate vasoreactivity on testing but fail a trial of calcium channel blockers (CCB), or are intolerant to CCB - AH secondary to connective tissue disease (functional class III) for the treatment of patients with World Health Organization (WHO) functional class III pulmonary hypertension associated with connective tissue disease who do not respond to conventional therapy SIRVIR (Galexos 150mg Capsule) In combination with peginterferon alfa and ribavirin, for the treatment of chronic hepatitis C genotype 1 infection in adults with compensated liver disease if the following clinical criteria and conditions are met: - detectable levels of hepatitis C virus (HCV) RA in the last six months; AD - a fibrosis stage of F2, F3, or F4 Conditions: - patients should have their HCV strain tested for S3 Q80K polymorphism Dosage: 150 mg once daily for 12 weeks in combination with peginterferon alfa and ribavirin. Response-guided therapy (RGT) for treatment naïve patients or treatment experienced patients as per roduct onograph Treatment Futility Rule as per roduct onograph Renewals are not considered. xclusion Criteria: - patients with the S3 Q80K polymorphism - patients who have received a prior treatment with boceprevir or telaprevir in combination with pegif/rbv and did OT receive an adequate response - patients not genotype 1 - fibrosis stage less than F2 (etavir scale or equivalent) - decompensated liver disease - patients less than 18 years old - simeprevir monotherapy - simeprevir in combination with sofosbuvir SITAGITI (Januvia 25mg, 50mg, 100mg Tablet) - for treatment of Type II diabetes in patients who have: inadequate glycemic control on optimal doses of sulfonylurea and metformin; or demonstrated intolerance or contraindication to metformin and are on optimal doses of sulfonylurea; or demonstrated intolerance or contraindication to sulfonylurea and are on optimal doses of metformin; patients must have a recent A1C of <10% unless insulin therapy is inappropriate for the patient. Duration of initial approval will be 6 months; further coverage will require demonstrated evidence of efficacy (a reduction of A1C of 0.7 observed to continue coverage) SITAGITI AD TFORI (Janumet 50/500mg, 50/850mg, 50/1000mg and 50/1000 XR Tablet) - for combination treatment of type 2 diabetes mellitus for patients already stabilized on combination treatment with the individual components of metformin and sitagliptin OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

346 SODIU FRRIC GUCOAT (Ferrlecit 12.5mg/ml Injection) - for the treatment of iron deficiency anemia in patients intolerant to oral iron replacement products OR - for patients who have not responded to adequate therapy with oral iron. otes: - Given the safety concerns associated with IV iron, it is expected that the patients will be carefully screened and will have tried various oral iron options before being eligible for IV iron. - Details regarding oral iron tried, length of therapy, and outcome must be provided. SOFOSBUVIR (Sovaldi 400mg tablet) - For the treatment of adult patients with chronic hepatitis C infection with compensated liver disease, (including compensated cirrhosis) 1 as follows: Genotype 1 [for 12 weeks in combination with egylated interferon (egif)/ribavirin (RBV)]: - Treatment-naive patients OR Genotype 2 (for 12 weeks in combination with RBV): - Treatment-naïve patients in whom interferon (IF) is medically contraindicated 2 OR - egif/rbv treatment-experienced 3 patients OR Genotype 3 (for 24 weeks in combination with RBV): - Treatment-naïve patients in whom interferon (IF) is medically contraindicated 2 OR - egif/rbv treatment-experienced 3 patients AD Who meet A of the following: - rescribed by a hepatologist or other specialist with expertise in the treatment of hepatitis C. - ab-confirmed hepatitis C genotype 1, 2, or, 3 - atient has a quantitative HCV RA value within the last 6 months - Fibrosis stage F2 or greater (etavir scale or equivalent) xclusion criteria: - atients currently being treated with another HCV antiviral agent; - atients who have previously received a treatment course of sofosbuvir (Re-treatment requests will not be considered). otes: 1. Compensated cirrhosis is defined as cirrhosis with a Child ugh Score = A (5-6) 2. edical contraindication to IF is defined as hypersensitivity to peginterferon or interferon alfa-2a or 2b, polyethylene glycol or any component of the formulation resulting in discontinuation of therapy; OR presence of significant clinical comorbidities which are deemed to have a high risk of worsening with IF treatment. Details are required regarding patient s contraindications and/or risk of worsening significant comorbidities. 3. Treatment-experienced patients (with Genotype 2 or 3) are defined as patients who have previously been treated with egif/rbv and did OT receive adequate response. 4. HIV-HCV co-infected patients may be considered as per criteria listed above. 5. Treatment of decompensated HCV may be considered for coverage on an exceptional case by case basis. SOIFACI (Vesicare 5mg, 10mg Tablet) - for the treatment of over-active bladder (not stress incontinence) for patients who cannot tolerate or have insufficient response to an adequate trial of immediate release oxybutynin (e.g. 3 months) - a three month trial will be approved initially with assessment of the effectiveness of this therapy required if further coverage is considered OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

347 SOATROI (Humatrope, Genotropin GoQuick and iniquick, utropin, utropin Aq, Saizen Injection and Cartridge) - for treatment of growth hormone deficiency in patients with Turner Syndrome, upon the request of an endocrinologist or prescriber with a specialty in endocrinology ote: The larger 8.8mg/vial format can be approved when suitable for dosing requirements, if it does not result in drug wastage. *SORAFIB (exavar 200mg Tablet) - as a single agent first line systemic therapy option in adult patients with a diagnosis of hepatocellular carcinoma (HCC) with Child-ugh Class A liver dysfunction (mild hepatic impairment) with COG performance status 0-1; and who have either progression of disease, or who are not candidates for curative intent treatments (transplantation, hepatic resection), or other well established palliative interventions (ablation, transcatheter arterial chemo-embolization (TAC), internal radiation) - as a single agent for second line treatment of patients with documented evidence of histologically confirmed advanced or metastatic clear cell renal cell carcinoma, considered to be intermediate or low risk (according to emorial Sloan- Kettering (SKCC) prognostic score), have an COG performance status of 0 or 1 and progressed after prior cytokine therapy (or intolerance) within the previous 8 months. In any one patient all of the following conditions must be met: sorafenib may be a second line option only after cytokine therapy sorafenib may not be used after another tyrosine kinase inhibitor (i.e., sunitinib) as sequential therapy In the event of severe toxicity within the first 8 weeks of therapy, a switch to another tyrosine kinase inhibitor (i.e., sunitinib) may be allowed - coverage approved for 5 months with reassessment SUATRITA (Imitrex 50mg, 100mg Tablet and generic brands) - See Selective 5HT 1 - Receptor Agonists SUATRITA (Imitrex 6mg/Syringe Injection) - See Selective 5HT 1 - Receptor Agonists *SUITIIB (Sutent 12.5mg, 25mg, 50mg Capsule) - as a single agent first line treatment in patients with documented evidence of histologically confirmed advanced or metastatic clear cell renal cell carcinoma who have an COG performance status of 0 or 1. In any one patient all of the following conditions must be met: sunitinib may be a first line option sunitinib may not be used after another tyrosine kinase inhibitor (i.e., sorafenib, or pazopanib) as sequential therapy in the event of significant toxicity, a switch to another tyrosine kinase inhibitor (i.e., sorafenib or pazopanib) may be allowed - as a single agent for the treatment of advanced gastrointestinal stromal tumor (GIST) patients after failure of imatinib due to intolerance or resistance - coverage approved for 9 months with reassessment - for the treatment of patients with progressive, unresectable, well or moderately differentiated, locally advanced or metastatic pancreatic neuroendocrine tumors (pt) with good performance status (COG 0-2), until disease progression TACROIUS (rotopic 0.03%, 0.1% Ointment) - for children greater than 2 years of age with refractory atopic dermatitis. Coverage will be renewed yearly - for the intermittent use for moderate to severe atopic dermatitis in adults who have: failed or are intolerant to a site appropriate strength of corticosteroid therapy (i.e., low potency on face versus intermediate to high potency for trunk and extremities) TAZAROT (Tazorac 0.05%, 0.1% Gel) - for use in psoriasis therapy when conventional therapies have been ineffective or inappropriate OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

348 *TOZOOID (Temodal 5mg, 20mg, 100mg, 200mg Capsule and generic brands) - in combination with radiotherapy (concomitant therapy) and as adjuvant therapy (post radiation for 6 cycles) for newly diagnosed high grade glioma patients with a good performance status (S) (Karnofsky 60) and who choose to receive first line systemic chemotherapy - use as a single agent may be considered for patients with recurrent high grade glioma and a good S (Karnofsky 60) who have not previously been treated with first line combination (temozolomide and radiation) therapy - use as a single agent may be considered for patients with high grade glioma who have recurrent disease occurring during their initial adjuvant therapy. Other systemic treatment options such as etoposide, nitrosourea based therapy or a clinical trial should be considered for patients who recur immediately following temozolomide therapy. Rechallenge with temozolomide could be considered for patients with a temozolomide free interval of six months TOFOVIR DISOROXI (Viread 300mg Tablet) - for the treatment of chronic hepatitis B infection in patients with: documented cirrhosis on radiologic or histologic grounds AD a HBV DA concentration above 2000iu/m TRBIAFI (amisil 250mg Tablet and generic brands) - for the treatment of severe onychomycosis caused by dermatophyte fungi. (Suggested treatment periods: 6 weeks for fingernails and 12 weeks for toenails. onger periods of time will be considered on a case by case basis) - for the treatment of dermatophyte infection unresponsive to other treatments or unlikely to respond to other treatments due to the site or severity of the infection TRIFUOID (Aubagio 14mg Tablet) For the treatment of patients with relapsing remitting multiple sclerosis (RRS) who meet all of the following criteria: - requested and followed by a neurologist experienced in the management of RRS, and - recent expanded disability status scale (DSS) score of 5.5 or less (i.e. patients must be able to ambulate at least 100 metres without assistance) xclusions: - not funded in combination with other disease modifying therapies - not funded in patients with an DSS > not funded in patients < 18 years of age Renewals: - DSS score < 5.5 (i.e. patients must be able to ambulate at least 100 metres without assistance). Date and details of the most recent neurological examination and DSS score must be provided (exam must have occurred within the last 90 days), and - atients must be stable or have experienced no more than 1 disabling attack/relapse in the past year *TSTOSTRO, TOICA (Androderm atch, Androgel Gel acket & Testim Gel) - for the treatment of congenital and acquired primary or secondary hypogonadism in males with a specific diagnosis of: rimary: cryptorchidism, Klinefelter's, orchidectomy, and other established causes Secondary: pituitary-hypothalamic injury due to tumors, trauma, radiation deficiency should be clearly demonstrated by clinical features and confirmed by two separate biochemical tests before initiating any therapy ote: aximum dose approved is 5g per day or a 5mg patch per day. This will be adjudicated by limiting the quantity payable each quarter (e.g. Jan-ar) to: 120 Androderm atches (2.5mg or 5mg atch); 300g of Androgel 2.5g gel (packet); 600g of Androgel 5g gel (packet); or 600g of Testim Gel lease be reminded that topical gels are to be billed per gram (not per packet) OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

349 *THROTROI (Thyrogen 0.9mg/m Injection) - to monitor for recurrence and metastatic disease, in patients who have documented evidence of thyroid cancer and who have undergone appropriate surgical and/or medical management. This includes: primary use in patients with inability to raise an endogenous TSH level ( 25 mu/) with thyroid hormone withdrawal primary use in cases of documented morbidity in patients for whom severe hypothyroidism could be life-threatening secondary use in patients with previous thyroid hormone withdrawal resulting in a documented life-threatening event - as a single agent for the preparation of radioiodine remnant ablation in patients with papillary or follicular thyroid cancer who have undergone thyroidectomy as treatment for thyroid cancer thyrotropin is a reasonable alternate to thyroid hormone withdrawal in patients who are unable to tolerate the prolonged hypothyroid state or who cannot achieve satisfactory elevation of endogenous TSH thyrotropin may be used in new patients or patients with previously incomplete remnant ablation or who have a recurrence of thyroid cancer and require therapeutic remnant ablation TICOIDI (Ticlid 250mg Tablet and generic brands) - for the secondary prevention of ischemic stroke or transient ischemic attack (TIA) in patients with a documented severe allergy to ASA or who experience a recurrent thrombotic event (stroke, symptoms of TIA) while taking ASA [Criteria Code 01] - for the prevention of thrombosis in patients post intracoronary stent implantation for a period of up to 30 days following insertion [Criteria Code 02] - other requests on a case by case basis TICAGROR (Brilinta 90mg Tablet) - to be taken in combination with ASA 75 mg -150mg daily 1 for patients with acute coronary syndrome (i.e. ST elevation myocardial infarction (STI), non-st elevation myocardial infarction (STI), or unstable angina (UA), as follows: STI 2,3 STI patients undergoing primary percutaneous coronary intervention (CI) STI or UA 2,3 presence of high risk features irrespective of intent to perform revascularization: high GRAC risk score (>140) high TII risk score (5-7) second ACS within 12 months complex or extensive coronary artery disease e.g. diffuse three vessel disease definite documented cerebrovascular or peripheral vascular disease previous CABG OR undergoing CI + high risk angiographic anatomy 4 - coverage duration 12 months ote: Criteria Code 30 may be used for the initial 30 day coverage period, however a written request submitted to the harmacare office is required to allow coverage for the remaining duration of treatment. 1 Co-administration of ticagrelor with high maintenance dose ASA (>150 mg daily) is not recommended. 2 In the ATO study more patients on ticagrelor experienced non CABG related major bleeding than patients on clopidogrel, however, there was no difference between the rate of overall major bleeding, between patients treated with ticagrelor and those treated with clopidogrel. As with all other antiplatelet treatments the benefit/risk ratio of antithrombotic effect vs. bleeding complications should be evaluated. 3 Ticagrelor is contraindicated in patients with active pathological bleeding, in those with a history of intracranial hemorrhage and moderate to severe hepatic impairment. 4 High risk angiographic anatomy is defined as any of the following: left main stenting, high risk bifurcation stenting (i.e., two-stent techniques), long stents 38 mm or overlapping stents, small stents 2.5 mm in patients with diabetes. OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

350 TIOTROIU BROID (Spiriva 18mcg Cap for Inhalation) - for the treatment of moderate to severe chronic obstructive pulmonary disease (COD) as defined by spirometry. OR - for the treatment of COD in patients with an inadequate response to short acting bronchodilators. - combination therapy with a long- acting beta-2 agonist /inhaled corticosteroid (ABA/ICS) and a long acting anticholinergic (AAC) inhaler will be considered in patients with: moderate to severe COD, as defined by spirometry, a history of COD exacerbation(s) and an inadequate response to ABA/ICS or AAC. ote: Coverage for ABA and AAC as two separate inhalers will not be considered. Clinical otes: 1. oderate to severe COD is defined by spirometry as a post bronchodilator FV1 < 60% predicted and FV1/FVC ratio of < Spirometry reports from any point in time will be accepted. If spirometry cannot be obtained, reasons must be clearly explained and other evidence of COD severity provided, i.e., edical Research Council (RC) Dyspnea Scale Score of at least Grade 3. RC Grade 3 is described as: walks slower than people of same age on the level because of shortness of breath from COD or has to stop for breath when walking at own pace on the level. 2. Inadequate response to short acting bronchodilators is defined as persistent symptoms, i.e., RC of at least Grade 3, after at least 2 months of short acting bronchodilator at the following doses*: 8 puffs per day of short acting beta-2 agonist or 12 puffs per day of ipratropium or 6 puffs per day of ipratropium plus salbutamol combination inhaler * Inadequate response to ABA/ICS or AAC is defined as persistent symptoms after at least 2 months of therapy. 3. COD exacerbation is defined as an increase in symptoms requiring treatment with antibiotics and/or systemic (oral or intravenous) corticosteroids. Treatment of COD lease note that inhaled corticosteroids in combination with long-acting beta 2 agonists (ABA/ICS) have been associated with an increased risk of pneumonia in patients with COD. Guidelines recommend their use in moderate to severe COD patients who are experiencing frequent exacerbations, not controlled by long-acting bronchodilators. For patients with moderate to severe COD who are not experiencing frequent exacerbations, long-acting beta 2 agonists or long-acting anticholinergics are recommended. Global strategy for the diagnosis, management and prevention of COD ote: Inhalers which combine a ABA/AAC are also available as SD benefits. These products have their own criteria which are listed in the S Formulary. TIZAIDI (Zanaflex 4mg Tablet and generic brands) - for the treatment of spasticity resulting from traumatic brain injury, multiple sclerosis (S), spinal cord injury (SCI) or cerebral vascular accident (CVA) in patients for whom baclofen is not indicated, ineffective or not tolerated TOCIIZUAB (Actemra 80mg/4m, 200mg/10m, 400mg/20m Injection) Rheumatoid Arthritis (RA) - for patients with a diagnosis of moderate-to-severely active RA who have failed to resond to an adequate trial of both disease-modifying antirheumatic drugs (DARDs) and a tumour necrosis factor (TF)-alpha inhibitor - therapy must include methotrexate unless contraindicated or not tolerated - written request of rheumatologist or prescriber with a specialty in rheumatology - intial coverage for 16 weeks at dose of 4mg/kg, yearly coverage dependent on patient achieving an improvement in symptoms of at least 20% - maximum dose: 800 mg every 4 weeks Systemic Juvenile Idiopathic Arthritis (sjia) - for the treatment of active systemic juvenile idiopathic arthritis (sjia) in patients two years of age and older who have responded inadequately to non-steroidal anti-inflammatory drugs (SAIDs) and systemic corticosteroids (with or without methotrexate), due to intolerance or lack of efficacy OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

351 - written request of a pediatric rheumatologist - initial coverage for 16 weeks at dose of 12 mg/kg for those < 30kg or 8 mg/kg for those 30 kg to a maximum of 800mg, administered by IV every 2 weeks - continued coverage beyond 16 weeks dependent on a positive patient response as determined by a pediatric rheumatology specialist - yearly coverage dependent on a continued positive patient response as determined by a pediatric rheumatology specialist TOTRODI (Detrol 1mg, 2mg and Detrol A 2mg, 4mg Tablet) - for the treatment of over-active bladder (not stress incontinence) for patients who cannot tolerate immediate release oxybutynin after an adequate trial (e.g. 3 months) - a three month trial will be approved initially with assessment of the effectiveness of this therapy required if further coverage is considered TOIRAAT (Topamax 25mg, 100mg, 200mg Tablet and generic brands and Topamax 15mg, 25mg Sprinkle Capsule) - for adjunctive management of epilepsy not satisfactorily controlled by conventional therapy - for management of migraine headaches in adult patients who have failed an adequate trial of, or have contraindications to, beta blockers, AD tricyclic antidepressants for prophylaxis TRTIOI (Vitamin A Acid Topical reparations) - regular benefit for beneficiaries 30 years and under - for treatment of actinic keratosis in beneficiaries over the age of 30 TROSIU (Trosec 20mg Tablet) - for the treatment of over-active bladder (not stress incontinence) for patients who cannot tolerate immediate release oxybutynin after an adequate trial (e.g. 3 months) - a three month trial will be approved initially with assessment of the effectiveness of this therapy required if further coverage is considered TRTOHA (Tryptan 500mg Capsule and 500mg, 750mg, 1g Tablet and generic brands) - as an adjunct for the treatment of depression in the management of patients suffering from bipolar affective disorders UCIDIIU (AS BROID) AD VIATRO (AS TRIFATAT) (Anoro llipta 62.5mcg/25mcg dry powder for oral inhalation) - for the treatment of moderate to severe chronic obstructive pulmonary disease (COD), as defined by spirometry, in patients with an inadequate response to a long-acting beta-2 agonist (ABA) or long-acting anticholinergic (AAC). otes: - oderate to severe COD is defined by spirometry (post-bronchodilator) FV1 < 60% predicted and FV1/FVC ratio of < Spirometry reports from any point in time will be accepted. If spirometry cannot be obtained, reasons must be clearly explained and other evidence regarding COD severity must be provided for consideration (i.e. edical Research Council (RC) Dyspnea Scale score of at least Grade 3). RC Grade 3 is described as: walks slower than people of same age on the level because of shortness of breath (SOB) from COD or has to stop for breath when walking at own pace on the level. - Inadequate response is defined as persistent symptoms after at least 2 months of long-acting beta agonist (ABA) or long-acting anticholinergic therapy (AAC). URSODIO (Urso 250mg, DS 500mg Tablet) - for dissolution of radiolucent, noncalcified gallstones of less than 20mm size for patients who cannot undergo a cholecystectomy - for management of cholestatic liver disease such as primary biliary cirrhosis OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

352 USTKIUAB (Stelara 45mg/0.5m Injection) - for patients with severe, debilitating chronic plaque psoriasis (so) who meet all of the following criteria: Body Surface Area (BSA) involvement of >10% and/or significant involvement of the face, hands, feet or genitals failure to respond to, contraindication to or intolerant of methotrexate and cyclosporine failure to respond to, intolerant of or unable to access phototherapy - written request of a dermatologist or prescriber with a specialty in dermatology - continued coverage is dependent on evidence of improvement, specifically: 75% reduction in the soriasis Area and Severity Index (ASI) score, or 50% reduction in ASI with a 5 point improvement in DQI (Dermatology ife Quality Index), or significant reduction in BSA involved, with consideration of important regions such as the face, hands, feet or genitals - concurrent use of biologics not approved - initial approval for a maximum of 16 weeks - dosage restricted to 45mg at 0, 4 and 16 weeks, response must be assessed prior to fourth dose - maintenance dosing every 12 weeks VAGACICOVIR (Valcyte 450mg Tablet) - for the treatment of cytomegalovirus (CV) retinitis in HIV-positive patients, upon the request of an infectious disease specialist or prescriber with a specialty in infectious disease - for the prevention of CV disease post solid organ transplantation in patients at high-risk (D+ / R-) (i.e., donor positive/recipient negative). Coverage will be for a maximum of 90 days - for the treatment of patients with CV infection who have received a solid organ transplant. *VACOCI (Vancocin 125mg, 250mg Capsule and generic brands) - for the treatment of pseudomembranous colitis (C) when patients have not responded to initial therapy with metronidazole, or for initial treatment of severe C, or when drug interactions or intolerance, prevent the use of metronidazole [Criteria Code 01] VURAFIB (Zelboraf 240mg Tablet) - as a first line, single agent for the treatment of BRAF V600 mutation positive unresectable or metastatic melanoma in patients with an COG performance status (S) of 1 - for BRAF V600 mutation positive patients who have progressed after first line treatment prior to vemurafenib availability, funding of vemurafenib as a second line agent may be considered VRTORFI (Visudyne 15mg/vial Injection) - for the treatment of wet age-related macular degeneration (AD) as prescribed by an authorized ophthalmologist [Criteria Code 01] VIGABATRI (Sabril 0.5g Sachet and 500mg Tablet) - for adjunctive management of epilepsy not satisfactorily controlled by conventional therapy *VISODGIB (rivedge 150mg Capsule) - as a single agent for the treatment of measurable metastatic BCC, OR - for the treatment of locally advanced BCC (including basal cell nevus syndrome i.e. Gorlin syndrome who are 18 years of age and older) in patients who are inappropriate for surgery and radiotherapy based on a discussion/evaluation with other members of the multi-disciplinary team. - patient has COG 2 *VITAI B 12, IJCTIO - See Cyanocobalamin, Injection *VITAI B 12, ORA - See Cyanocobalamin, Oral OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III

353 VORICOAZO (Vfend 50mg, 200mg Tablet) - for the treatment of patients with invasive aspergillosis - for the treatment of invasive candidiasis (proven on culture) with documented resistance to fluconazole *WT BUIZATIO SOUTIOS (Budesonide, Cromoglycate Sodium, Fenoterol, Ipratropium Bromide, Salbutamol) - for adult patients with a vital capacity of 900m or less - for adult patients with a respiratory rate greater than 25 breaths/minute - for patients who have demonstrated they cannot follow instructions, cannot hold the spacer device or cannot hold the device long enough to actuate it - other requests reviewed on a case by case basis *XAKORI (Crizotinib 200mg, 250mg Capsule) - As a second-line therapy for patients with AK-positive advanced non-small cell lung cancer with COG performance status 2. ZAFIRUKAST (Accolate 20mg Tablet) - See eukotriene Receptor Antagonists *ZAAIVIR (Relenza 5mg owder For Inhalation) - for the treatment of long-term care residents with clinically suspected or lab confirmed influenza A or B, when there is documented resistance to oseltamivir or when oseltamivir is contraindicated. A clinically suspected case is one in which the patient meets the criteria of influenza-like illness and there is confirmation of influenza A or B circulating within the facility or surrounding community - for the prophylaxis of influenza A or B in long term care residents where the facility has an outbreak, when there is documented resistance to oseltamivir or when oseltamivir is contraindicated. - a protocol has been developed by ublic Health for the treatment of patients in long-term care facilities. The facility must contact the edical Officer of Health or local ublic Health Office, who will notify the harmacare office (or dispensing pharmacy after office hours) if coverage is required ZIRASIDO (Zeldox 20mg, 40mg, 60mg, 80mg Capsule) - for the treatment of schizophrenia and schizoaffective disorder *ZODROIC ACID (Aclasta 5mg/100ml Injection) - for the treatment of aget s disease - for women with postmenopausal osteoporosis for whom oral bisphosphonates are contraindicated due to abnormalities of the esophagus (e.g. esophageal stricture or achalasia) and have at least two of the following: age > 75 years a prior fragility fracture a bone mineral density (BD) T-score -2.5 OT: xception status drugs for Drug Assistance for Cancer atients are indicated by an asterisk (*). ovember 2015 Appendix III