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Department of Human Services Approved PDL for IOWA Medicaid Program Listing Preferred Cough & Cold Drug Products Effective Date: 1/1/2007 Note: Not all 's may be represented and the status of those listed are subject to change without notification. DRUG CATEGORY 12/21/2006 Drug Description Codeine-Guaifenesin Syrup 10-100 MG/5ML PHARMACEUTICAL ASSOCIATES 00121-0683 - 04 GG/CODEINE SYP 100-10/5 RX PHARMACEUTICAL ASSOCIATES 00121-0683 - 05 GG/CODEINE SYP 100-10/5 RX PHARMACEUTICAL ASSOCIATES 00121-0683 - 10 GG/CODEINE SYP 100-10/5 RX PHARMACEUTICAL ASSOCIATES 00121-0683 - 16 GG/CODEINE SYP 100-10/5 RX IVAX PHARMACEUTICALS, INC. 00182-0017 - 37 GUIATUSS AC SYP 10-100/5 OTC IVAX PHARMACEUTICALS, INC. 00182-0017 - 40 GUIATUSS AC SYP 10-100/5 RX ACTAVIS MID ATLANTIC 00472-0012 - 04 GUIATUSS AC SYP 10-100/5 OTC ACTAVIS MID ATLANTIC 00472-0012 - 16 GUIATUSS AC SYP 10-100/5 RX ACTAVIS MID ATLANTIC 00472-0012 - 28 GUIATUSS AC SYP 10-100/5 RX QUALITEST 00603-1075 - 54 CHERATUSSIN SYP AC OTC QUALITEST 00603-1075 - 56 CHERATUSSIN SYP AC RX QUALITEST 00603-1075 - 58 CHERATUSSIN SYP AC RX MAJOR PHARMACEUTICALS 00904-5065 - 00 ROBAFEN AC SYP 100-10/5 RX MAJOR PHARMACEUTICALS 00904-5065 - 16 ROBAFEN AC SYP 100-10/5 RX HI-TECH 50383-0087 - 04 GUAIATUSSIN SYP AC OTC HI-TECH 50383-0087 - 16 GUAIATUSSIN SYP AC RX MORTON GROVE PHARMACEUTICALS 60432-0045 - 04 MYTUSSIN AC SYP 10-100/5 OTC MORTON GROVE PHARMACEUTICALS 60432-0045 - 16 MYTUSSIN AC SYP 10-100/5 RX WYETH CONSUMER HEALTHCARE 00031-8685 - 12 Brand ROBITUSSIN SYP DM OTC WYETH CONSUMER HEALTHCARE 00031-8685 - 18 Brand ROBITUSSIN SYP DM OTC WYETH CONSUMER HEALTHCARE 00031-8685 - 22 Brand ROBITUSSIN SYP DM OTC WYETH CONSUMER HEALTHCARE 00031-8685 - 25 Brand ROBITUSSIN SYP DM OTC WYETH CONSUMER HEALTHCARE 00031-8686 - 12 Brand ROBITUSSIN SYP SUGAR FR OTC PERRIGO 00113-0359 - 26 TUSSIN DM SYP 100-10/5 OTC PERRIGO 00113-0359 - 34 TUSSIN DM SYP 100-10/5 OTC PERRIGO 00113-0515 - 34 TUSSIN DM SYP 100-10/5 OTC PHARMACEUTICAL ASSOCIATES 00121-0638 - 04 GUAIFENESIN SYP DM OTC PHARMACEUTICAL ASSOCIATES 00121-0638 - 05 GUAIFENESIN SYP DM OTC PHARMACEUTICAL ASSOCIATES 00121-0638 - 08 GUAIFENESIN SYP DM OTC PHARMACEUTICAL ASSOCIATES 00121-0638 - 10 GUAIFENESIN SYP DM OTC PHARMACEUTICAL ASSOCIATES 00121-0638 - 16 GUAIFENESIN SYP DM OTC IVAX PHARMACEUTICALS, INC. 00182-2236 - 37 GENATUSS DM SYP 100-10/5 OTC IVAX PHARMACEUTICALS, INC. 00182-6064 - 37 GUIATUSS DM SYP 100-10/5 OTC IVAX PHARMACEUTICALS, INC. 00182-6064 - 40 GUIATUSS DM SYP 100-10/5 OTC Page 1 of 5

Drug Description IVAX PHARMACEUTICALS, INC. 00182-6064 - 41 GUIATUSS DM SYP 100-10/5 OTC ACTAVIS MID ATLANTIC 00472-1031 - 04 GUIATUSS DM SYP 100-10/5 OTC ACTAVIS MID ATLANTIC 00472-1031 - 16 GUIATUSS DM SYP 100-10/5 OTC ACTAVIS MID ATLANTIC 00472-1031 - 28 GUIATUSS DM SYP 100-10/5 OTC ACTAVIS MID ATLANTIC 00472-1031 - 94 GUIATUSS DM SYP 100-10/5 OTC ACTAVIS MID ATLANTIC 00472-1031 - 98 GUIATUSS DM SYP 100-10/5 OTC RUGBY 00536-0970 - 85 GG/DM SYP 100-10/5 OTC RUGBY 00536-0970 - 97 GG/DM SYP 100-10/5 OTC QUALITEST 00603-0855 - 54 Q-TUSSIN SYP DM OTC QUALITEST 00603-0855 - 56 Q-TUSSIN SYP DM OTC QUALITEST 00603-0855 - 58 Q-TUSSIN SYP DM OTC QUALITEST 00603-0855 - 81 Q-TUSSIN SYP DM OTC QUALITEST 00603-0855 - 94 Q-TUSSIN SYP DM OTC MAJOR PHARMACEUTICALS 00904-0053 - 00 ROBAFEN DM SYP 100-10/5 OTC MAJOR PHARMACEUTICALS 00904-0053 - 09 ROBAFEN DM SYP 100-10/5 OTC MAJOR PHARMACEUTICALS 00904-0053 - 16 ROBAFEN DM SYP 100-10/5 OTC MAJOR PHARMACEUTICALS 00904-0053 - 20 ROBAFEN DM SYP 100-10/5 OTC MAJOR PHARMACEUTICALS 00904-0053 - 28 ROBAFEN DM SYP 100-10/5 OTC MAJOR PHARMACEUTICALS 00904-5180 - 20 ROBAFEN DM SYP 100-10/5 OTC SELECT BRAND 15127-0945 - 44 COUGH CONTRO SYP DM OTC SELECT BRAND 15127-0945 - 48 COUGH CONTRO SYP DM OTC BERGEN BRUNSWIG 24385-0359 - 26 TUSSIN DM SYP 100-10/5 OTC BERGEN BRUNSWIG 24385-0359 - 34 TUSSIN DM SYP 100-10/5 OTC BERGEN BRUNSWIG 24385-0578 - 26 TUSSIN DM SYP CLEAR OTC LEADER BRAND PRODUCTS 37205-0970 - 26 TUSSIN DM SYP 100-10/5 OTC LEADER BRAND PRODUCTS 37205-0970 - 34 TUSSIN DM SYP 100-10/5 OTC MCKESSON VALU-RITE 49348-0017 - 34 EXPECTORANT SYP DM OTC MCKESSON VALU-RITE 49348-0017 - 37 EXPECTORANT SYP DM OTC MCKESSON VALU-RITE 49348-0861 - 34 SM TUSSIN SYP DM CLEAR OTC MCKESSON VALU-RITE 49348-0861 - 37 SM TUSSIN SYP DM CLEAR OTC MEDICINE SHOPPE 49614-0311 - 34 MEDI-TUSSIN SYP DM OTC HI-TECH 50383-0098 - 04 GUAIATUSSIN SYP DM OTC HI-TECH 50383-0098 - 28 GUAIATUSSIN SYP DM OTC MCKESSON/HEALTH MART 52569-0866 - 77 TUSSID DM SYP 100-10/5 OTC MCKESSON/HEALTH MART 52569-0866 - 80 TUSSID DM SYP 100-10/5 OTC SILARX 54838-0209 - 40 SILTUSSIN-DM SYP ALC FREE OTC SILARX 54838-0209 - 70 SILTUSSIN-DM SYP ALC FREE OTC SILARX 54838-0209 - 80 SILTUSSIN-DM SYP ALC FREE OTC ALTAIRE 59390-0005 - 05 ALTARUSSIN SYP DM OTC ALTAIRE 59390-0005 - 10 ALTARUSSIN SYP DM OTC ALTAIRE 59390-0005 - 13 ALTARUSSIN SYP DM OTC ALTAIRE 59390-0005 - 35 ALTARUSSIN SYP DM OTC ALTAIRE 59390-0005 - 41 ALTARUSSIN SYP DM OTC ALTAIRE 59390-0005 - 46 ALTARUSSIN SYP DM OTC ALTAIRE 59390-0005 - 47 ALTARUSSIN SYP DM OTC Page 2 of 5

Drug Description AMKAS LABORATORIES 61073-0025 - 04 GUAIFENESIN SYP DM OTC AMKAS LABORATORIES 61073-0025 - 08 GUAIFENESIN SYP DM OTC CHAIN DRUG MARKETING ASSOC 63868-0855 - 54 TUSSIN DM SYP 100-10/5 OTC CHAIN DRUG MARKETING ASSOC 63868-0855 - 56 TUSSIN DM SYP 100-10/5 OTC WALSH DISTRIBUTION, INC. 64899-0508 - 44 HCA TUSSIN SYP DM OTC WALSH DISTRIBUTION, INC. 64899-0508 - 68 HCA TUSSIN SYP DM OTC Hydrocodone-Pot Guaiaco Syrup 3-350 MG/5ML PRO-PHARMA LLC 66594-0222 - 16 Brand PRO-CLEAR SYP RX S-DECONGESTANT Pseudoephedrine w/ DM-GG Syrup 40-15-100 MG/5ML URL 00677-1860 - 33 PSE/DM/GG SYP 40-15-10 RX BRECKENRIDGE 51991-0307 - 16 COLDMIST DM SYP 40-15-10 RX ETHEX 58177-0925 - 07 TRI-VENT DM SYP RX BOCA PHARMACAL 64376-0712 - 16 PSE/DM/GG SYP 40-15-10 RX COUGH/COLD - NARCOTIC ANTITUSSIVE-DECONGESTANT Phenyleph-Hydrocodone Liq 5-2.5 MG/5ML BLANSETT PHARMACAL 51674-0025 - 07 Brand NALEX DH LIQ 5-2.5/5M RX BRECKENRIDGE 51991-0136 - 16 RHINACON DH LIQ RX BOCA PHARMACAL 64376-0035 - 16 PHENYLEPHRIN LIQ HD RX Pseudoephedrine w/ Hydrocodone Soln 60-5 MG/5ML SANOFI PHARMACEUTICALS 00024-0864 - 16 HISTUSSIN D SOL 60-5/5ML RX QUALITEST 00603-1285 - 58 Brand HC TUSSIVE-D SOL 60-5/5ML RX MAJOR PHARMACEUTICALS 00904-0967 - 16 DETUSSIN SOL 60-5/5ML RX COUGH/COLD - NON-NARC ANTITUSSIVE-DECONGESTANT Pseudoephedrine-DM Liqd 15-7.5 MG/5ML WYETH CONSUMER HEALTHCARE 00031-8609 - 12 Brand ROBITUSS PED LIQ CGH/COLD OTC WYETH CONSUMER HEALTHCARE 00031-8609 - 18 Brand ROBITUSS PED LIQ CGH/COLD OTC NOVARTIS 00067-0207 - 04 TRIAMINIC AM LIQ CGH/DEC OTC NOVARTIS 00067-0561 - 04 TRIAMINIC LIQ ALLERGY OTC NOVARTIS 00067-6080 - 04 TRIAMINIC LIQ CGH/NASL OTC PERRIGO 00113-0575 - 26 TUSSIN PED LIQ CGH/COLD OTC BERGEN BRUNSWIG 24385-0575 - 26 TUSSIN CG&CD LIQ PEDIATRI OTC Pseudoephedrine-DM Liqd 20-10 MG/5ML FAMILY PHARMACY 52735-0410 - 41 FORMULA D LIQ OTC Pseudoephedrine-DM Liqd 30-15 MG/5ML PERRIGO 00113-0589 - 26 Brand TUSSIN COUGH LIQ COLD OTC Pseudoephedrine-DM Elixir 20-10 MG/5ML PERRIGO 00113-0391 - 26 COUGH FORMUL ELX RELIEF D OTC P & G HEALTH 37000-0514 - 04 Brand VICKS FORM ELX 44D CGH OTC P & G HEALTH 37000-0514 - 08 Brand VICKS FORM ELX 44D CGH OTC LEADER BRAND PRODUCTS 37205-0879 - 26 DECONGESTANT ELX D OTC Page 3 of 5

Drug Description COUGH/COLD - NON-NARC ANTITUSSIVE-DECONGESTANT Pseudoephedrine-DM Elixir 20-10 MG/5ML ALTAIRE 59390-0017 - 41 DEXATREX D ELX CF-NASAL OTC Pseudoephedrine-DM Syrup 15-7.5 MG/5ML WYETH CONSUMER HEALTHCARE 00031-2289 - 10 Brand DIMETAPP SYP CGH/COLD OTC Pseudoephedrine-DM Syrup 30-15 MG/5ML WYETH CONSUMER HEALTHCARE 00031-8671 - 12 Brand ROBITUSSIN SYP MAX/CGH OTC WYETH CONSUMER HEALTHCARE 00031-8671 - 18 Brand ROBITUSSIN SYP MAX/CGH OTC MCKESSON VALU-RITE 49348-0261 - 34 SM TUSSIN SYP CGH/COLD OTC Pseudoephedrine-DM Soln 7.5-2.5 MG/0.8ML PFIZER CONS HEALTH 00009-7715 - 01 Brand PEDIACARE SOL DCON/CGH OTC WYETH CONSUMER HEALTHCARE 00031-2242 - 01 Brand DIMETAPP SOL DCON/CGH OTC PERRIGO 00113-0487 - 05 PEDIA RELIEF DRO INFANT OTC PFIZER CONS HEALTH 00501-2410 - 05 Brand PEDIACARE DRO DCON/CGH OTC MAJOR PHARMACEUTICALS 00904-5552 - 35 PEDIA RELIEF DRO INFANT OTC MCKESSON VALU-RITE 49348-0290 - 69 PEDIA RELIEF DRO INFANT OTC COUGH/COLD - SYSTEMIC DECONGESTANTS Pseudoephedrine HCl Tab 30 MG ROXANE 00054-4743 - 25 PSEUDOEPHEDR TAB 30MG OTC GOLDLINE 00182-1459 - 16 GENAPHED TAB 30MG OTC IVAX PHARMACEUTICALS, INC. 00182-1459 - 98 GENAPHED TAB 30MG OTC RUGBY 00536-4391 - 01 PSEUDOEPHEDR TAB 30MG OTC RUGBY 00536-4391 - 35 PSEUDOEPHEDR TAB 30MG OTC SANDOZ 00781-1533 - 01 PSEUDOEPHEDR TAB 30MG OTC MAJOR PHARMACEUTICALS 00904-5053 - 24 SUDOGEST TAB 30MG OTC MAJOR PHARMACEUTICALS 00904-5053 - 59 SUDOGEST TAB 30MG OTC BERGEN BRUNSWIG 24385-0432 - 62 SUPHEDRIN TAB 30MG OTC BERGEN BRUNSWIG 24385-0432 - 80 SUPHEDRIN TAB 30MG OTC LEADER BRAND PRODUCTS 37205-0445 - 62 PSEUDOEPHEDR TAB 30MG OTC LEADER BRAND PRODUCTS 37205-0445 - 80 PSEUDOEPHEDR TAB 30MG OTC MCKESSON VALU-RITE 49348-0024 - 04 SM SUPHEDRIN TAB 30MG OTC MCKESSON VALU-RITE 49348-0164 - 34 SM SUPHEDRIN TAB 30MG OTC MCKESSON VALU-RITE 49348-0296 - 08 SUPHEDRINE TAB 30MG OTC TIME-CAP LABS 49483-0016 - 24 PSEUDOEPHEDR TAB 30MG OTC TIME-CAP LABS 49483-0016 - 48 PSEUDOEPHEDR TAB 30MG OTC TIME-CAP LABS 49483-0016 - 96 PSEUDOEPHEDR TAB 30MG OTC MEDICINE SHOPPE 49614-0432 - 52 MEDI-PHEDRIN TAB 30MG OTC MEDICINE SHOPPE 49614-0432 - 62 MEDI-PHEDRIN TAB 30MG OTC MEDICINE SHOPPE 49614-0432 - 80 MEDI-PHEDRIN TAB 30MG OTC MCNEIL CONSUMER 50580-0506 - 24 SIMPLY STUFF TAB 30MG OTC MCNEIL CONSUMER 50580-0506 - 48 SIMPLY STUFF TAB 30MG OTC RICHMOND PHARMACEUTICALS 54738-0125 - 01 PSEUDOEPHEDR TAB 30MG OTC RICHMOND PHARMACEUTICALS 54738-0125 - 14 PSEUDOEPHEDR TAB 30MG OTC PRIME MARKETING 62107-0006 - 01 SUDOPHED TAB 30MG OTC PRIME MARKETING 62107-0006 - 24 SUDOPHED TAB 30MG OTC Page 4 of 5

Drug Description COUGH/COLD - SYSTEMIC DECONGESTANTS Pseudoephedrine HCl Tab 30 MG CHAIN DRUG MARKETING ASSOC 63868-0146 - 24 SUPHEDRINE TAB 30MG OTC CHAIN DRUG MARKETING ASSOC 63868-0146 - 48 SUPHEDRINE TAB 30MG OTC Pseudoephedrine HCl Tab 60 MG ROXANE 00054-4744 - 25 PSEUDOEPHEDR TAB 60MG OTC SANDOZ 00781-1535 - 01 PSEUDOEPHEDR TAB 60MG OTC MAJOR PHARMACEUTICALS 00904-5125 - 46 SUDOGEST TAB 60MG OTC MAJOR PHARMACEUTICALS 00904-5125 - 59 SUDOGEST TAB 60MG OTC INTERPHARM 53746-0221 - 01 PSEUDOEPHEDR TAB 60MG OTC INTERPHARM 53746-0221 - 30 PSEUDOEPHEDR TAB 60MG OTC INTERPHARM 53746-0221 - 50 PSEUDOEPHEDR TAB 60MG OTC RICHMOND PHARMACEUTICALS 54738-0124 - 01 PSEUDOEPHEDR TAB 60MG OTC Pseudoephedrine HCl Syrup 30 MG/5ML PHARMACEUTICAL ASSOCIATES 00121-0421 - 04 PSEUDOEPHEDR SYP 30MG/5ML OTC ALPHARMA 00472-1517 - 04 DECOFED SYP 30MG/5ML OTC ALPHARMA 00472-1517 - 16 DECOFED SYP 30MG/5ML OTC ALPHARMA 00472-1517 - 94 DECOFED SYP 30MG/5ML OTC RUGBY 00536-1850 - 85 PSEUDOEPHEDR SYP 30MG/5ML OTC RUGBY 00536-1850 - 97 PSEUDOEPHEDR SYP 30MG/5ML OTC Page 5 of 5

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