FORMULARY November 2015

FORUAR ovember 2015

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: www.nspharmacare.ca 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.

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 24-31 C - Cardiovascular System 32-76 D - Dermatologicals 77-87 G - Genito-Urinary System & Sex Hormones 88-99 H - Systemic Hormonal reparations, xcluding Sex Hormones 100-106 J - General Antiinfectives, Systemic 107-128 - Antineoplastics and Immunomodulating Agents 129-142 - usculo-skeletal System 143-154 - ervous System 155-214 - Antiparasitic roducts, Insecticides and Repellents 214-216 R - Respiratory System 216-225 S - Sensory Organs 225-233 V - Various 233-236 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

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 www.nspharmacare.ca 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

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

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

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

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 02240433 S eridex 0.12% Oral Rinse 02237452 ZIA A01AB22 DOXCCI eriostat 20mg Cap 02247104 D A01AC CORTICOSTROIDS FOR OCA ORA TRATT A01AC01 TRIACIOO triamcinolone acetonide 0.1% oral paste Oracort 0.1% Oral aste 0.9267 01964054 TAR Kenalog 0.1% in Orabase (discontinued) 01999788 BRI A01AD OTHR DRUGS FOR OCA ORA TRATT A01AD02 BZDAI benzydamine 0.15% oral rinse harixia 1.5mg/m Oral Rinse 0.0618 02229777 D Tantum Oral Rinse (discontinued) 01966065 DS A02 A02A A02AB DRUGS FOR ACID RATD DISORDRS ATACIDS AUIIU COOUDS A02AB01 AUIIU HDROXID Basaljel 500mg Cap 0.1500 02135620 AUR A02AD COB OF AUIIU,CACIU AD AGSIU COOUDS A02AD01 ATACIDS, ORDIAR SAT COBIATIOS Diovol Regular O/ 01966529 CHU A02AF ATACIDS WITH ATIFATUTS A02AF02 ATACIDS, ORDIAR SAT COBIATIOS AD ATIFATUTS Diovol lus O/ 00116815 CHU Diovol lus Tab 00116882 CHU ylanta Double St Tab 02019787 JJ A02B A02BA DRUGS FOR TIC UCR AD GASTROSOHAGA RFUX DI(GRD) H2-RCTOR ATAGOISTS A02BA01 CITIDI cimetidine 200mg tab Apo-Cimetidine 200mg Tab 0.3284 00584215 ovember 2015 1

A Alimentary Tract and etabolism Tagamet 200mg Tab (discontinued) 01916793 SKR cimetidine 300mg tab Apo-Cimetidine 300mg Tab 0.1791 00487872 A-Cimetidine 300mg Tab 0.1791 02227444 Tagamet 300mg Tab (discontinued) 01916815 GSK cimetidine 400mg tab Apo-Cimetidine 400mg Tab 0.2930 00600059 A-Cimetidine 400mg Tab 0.2930 02227452 Tagamet 400mg Tab (discontinued) 01916785 GSK cimetidine 600mg tab Apo-Cimetidine 600mg Tab 0.3405 00600067 A-Cimetidine 600mg Tab 0.3405 02227460 Tagamet 600mg Tab (discontinued) 01916777 GSK A02BA02 RAITIDI ranitidine 15mg/m o/l Apo-Ranitidine 15mg/m O/ 02280833 ovo-ranitidine 15mg/m O/ 0.0932 C 02242940 TV Zantac 15mg/m O/ (discontinued) 02212374 GSK ranitidine 25mg/m inj Ranitidine 25mg/m Inj 1.3976 C 02256711 Zantac 25mg/m Inj 1.3976 C 02212366 GSK ranitidine 75mg tab Apo-Ranitidine 75mg Tab 02230507 Zantac 75mg Tab (discontinued) 02230287 JJ ranitidine 150mg tab Apo-Ranitidine 150mg Tab 0.1800 C 00733059 CO Ranitidine 150mg Tab 0.1800 C 02248570 yl-ranitidine 150mg Tab (discontinued) 02367378 A-Ranitidine 150mg Tab 0.1800 C 02207761 ovo-ranidine 150mg Tab 0.1800 C 00828564 TV pms-ranitidine 150mg Tab 0.1800 C 02242453 S RA-Ranitidine 150mg Tab 0.1800 C 02336480 RA Ranitidine 150mg Tab 0.1800 C 02353016 Ranitidine-150mg Tab 0.1800 C 02385953 SIV Sandoz Ranitidine 150mg Tab 0.1800 C 02243229 Zantac 150mg Tab 0.1800 C 02212331 GSK ranitidine 300mg tab Apo-Ranitidine 300mg Tab 0.3600 C 00733067 CO Ranitidine 300mg Tab 0.3600 C 02248571 yl-ranitidine 300mg Tab (discontinued) 02367386 A-Ranitidine 300mg Tab 0.3600 C 02207788 ovo-ranidine 300mg Tab 0.3600 C 00828556 TV pms-ranitidine 300mg Tab 0.3600 C 02242454 S RA-Ranitidine 300mg Tab 0.3600 C 02336502 RA Ranitidine 300mg Tab 0.3600 C 02353024 Ranitidine-300mg Tab 0.3600 C 02385961 SIV ovember 2015 2

A Alimentary Tract and etabolism Sandoz Ranitidine 300mg Tab 0.3600 C 02243230 Zantac 300mg Tab 0.3600 C 02212358 GSK A02BA03 FAOTIDI famotidine 10mg/m inj Famotidine Omega 10mg/m Inj 1.9850 02247745 OG epcid 10mg/m Inj (discontinued) 00728128 FRS famotidine 10mg/m inj (pf) Famotidine Omega (F) 10mg/m Inj 1.9850 02247735 OG epcid (F) 10mg/m Inj (discontinued) 00728128 FRS famotidine 20mg tab Apo-Famotidine 20mg Tab 0.1800 01953842 Famotidine 20mg Tab 0.1800 02351102 A-Famotidine 20mg Tab 0.1800 02196018 ovo-famotidine 20mg Tab 0.1800 02022133 TV epcid 20mg Tab (discontinued) 00710121 FRS famotidine 40mg tab Apo-Famotidine 40mg Tab 0.3600 01953834 Famotidine 40mg Tab 0.3600 02351110 A-Famotidine 40mg Tab 0.3600 02196026 ovo-famotidine 40mg Tab 0.3600 02022141 TV epcid 40mg Tab (discontinued) 00710113 FRS A02BA04 IZATIDI nizatidine 150mg cap Apo-izatidine 150mg Cap (discontinued) 02220156 Axid 150mg Cap 0.1800 00778338 D nizatidine 300mg cap Apo-izatidine 300mg Cap (discontinued) 02220164 Axid 300mg Cap (discontinued) 00778346 D A02BB ROSTAGADIS A02BB01 ISOROSTO misoprostol 100mcg tab isoprostol 100mcg Tab 0.2804 02244022 AA Cytotec 100mcg Tab (discontinued) 00813966 misoprostol 200mcg tab isoprostol 200mcg Tab 0.4669 02244023 AA Cytotec 200mcg Tab (discontinued) 00632600 A02BC ROTO U IHIBITORS A02BC01 ORAZO omeprazole 10mg cap A-Omeprazole 10mg Cap 0.2059 C* 02329425 Sandoz Omeprazole 10mg Cap 0.2059 C* 02296438 osec 10mg Cap (discontinued) 02119579 AZ *exception status when daily dose exceeds once daily ovember 2015 3

A Alimentary Tract and etabolism omeprazole 10mg cap/tab A-Omeprazole 10mg Cap 0.2059 C* 02329425 Teva-Omeprazole 10mg Tab 0.2059 C* 02295407 TV osec 10mg Tab 0.2059 C* 02230737 AZ *exception status when daily dose exceeds once daily. omeprazole 20mg cap Apo-Omeprazole 20mg Cap 0.4117 C* 02245058 A-Omeprazole 20mg Cap 0.4117 C* 02329433 Omeprazole 20mg Cap 0.4117 C* 02348691 Omeprazole-20mg Cap 0.4117 C* 02411857 SIV pms-omeprazole 20mg Cap 0.4117 C* 02320851 S RA-Omeprazole 20mg Cap 0.4117 C* 02403617 RA Sandoz Omeprazole 20mg Cap 0.4117 C* 02296446 osec 20mg Cap 0.4117 C* 00846503 AZ *exception status when daily dose exceeds once daily. omeprazole 20mg cap/tab Apo-Omeprazole 20mg Cap 0.4117 C* 02245058 Jamp-Omeprazole DR 20mg Tab 0.4117 C* 02420198 JC A-Omeprazole 20mg Cap 0.4117 C* 02329433 ovo-omeprazole Delayed-Release 20mg Tab 0.4117 C* 02295415 TV Omeprazole 20mg Cap 0.4117 C* 02348691 Omeprazole DR 20mg Tab 0.4117 C* 02416549 AHI pms-omeprazole DR 20mg Tab 0.4117 C* 02310260 S RA-Omeprazole 20mg tab 0.4117 C* 02374870 RA osec 20mg Tab 0.4117 C* 02190915 AZ *exception status when daily dose exceeds once daily. A02BC02 ATORAZO pantoprazole 20mg C tab Apo-antoprazole 20mg DR Tab 0.3246 C* 02292912 Jamp-antoprazole 20mg Tab 0.3246 C* 02408414 JC antoprazole-20mg Tab 0.3246 C* 02385740 SIV pms-antoprazole 20mg DR Tab 02307863 S RA-antoprazole 20mg Tab 0.3246 C* 02305038 RA Sandoz antoprazole 20mg DR Tab 0.3246 C* 02301075 Teva-antoprazole 20mg DR Tab 0.3246 C* 02285479 TV antoloc 20mg Tab 0.3246 C* 02241804 TAK *exception status when daily dose exceeds once daily. pantoprazole 40mg C tab Abbott-antoprazole 40mg Tab 0.3628 C* 02412969 ABB Apo-antoprazole 40mg DR Tab 0.3628 C* 02292920 CO antoprazole 40mg DR Tab 0.3628 C* 02300486 Jamp-antoprazole 40mg Tab 0.3628 C* 02357054 JC ar-antoprazole 40mg DR Tab 0.3628 C* 02416565 AR IT-antoprazole 40mg DR Tab 0.3628 C* 02417448 T A-antoprazole 40mg DR Tab 0.3628 C* 02299585 antoprazole 40mg DR Tab 0.3628 C* 02437945 S antoprazole 40mg Tab 0.3628 C* 02370808 antoprazole-40mg Tab 0.3628 C* 02385759 SIV ovember 2015 4

A Alimentary Tract and etabolism pms-antoprazole 40mg DR Tab 0.3628 C* 02307871 S RA-antoprazole 40mg Tab 0.3628 C* 02305046 RA Sandoz antoprazole 40mg DR Tab 0.3628 C* 02301083 Teva-antoprazole 40mg DR Tab 0.3628 C* 02285487 TV antoloc 40mg Tab 0.3628 C* 02229453 TAK *exception status when daily dose exceeds once daily. Tecta 40mg Tab 0.7500 02267233 TAK A02BC03 ASORAZO lansoprazole 15mg cap Apo-ansoprazole 15mg DR Cap 0.2500 02293811 ansoprazole 15mg Cap 0.2500 02433001 S ansoprazole 15mg Cap 0.2500 02385767 SIV ansoprazole 15mg DR Cap 0.2500 02357682 A-ansoprazole 15mg DR Cap 0.2500 02353830 ovo-ansoprazole 15mg DR Cap 0.2500 02280515 TV pms-ansoprazole 15mg Cap (discontinued) 02395258 S RA-ansoprazole 15mg Cap 0.2500 02402610 RA Sandoz ansoprazole 15mg DR Cap 0.2500 02385643 revacid 15mg Cap 0.2500 02165503 ABB revacid FasTab 15mg Tab 2.0000 02249464 ABB lansoprazole 30mg cap Apo-ansoprazole 30mg DR Cap 0.5000 02293838 ansoprazole 30mg Cap 0.5000 02433028 S ansoprazole 30mg DR Cap 0.5000 02357690 ansoprazole-30mg Cap 0.5000 02410389 SIV A-ansoprazole 30mg DR Cap 0.5000 02353849 ovo-ansoprazole 30mg DR Cap 0.5000 02280523 TV pms-ansoprazole 30mg DR Cap (discontinued) 02395266 S RA-ansoprazole 30mg Cap 0.5000 02402629 RA Sandoz ansoprazole 30mg DR Cap 0.5000 02385651 revacid 30mg Cap 0.5000 02165511 ABB revacid FasTab 30mg Tab 2.0000 02249472 ABB A02BC04 RABRAZO rabeprazole 10mg C tab Abbott-Rabeprazole 10mg DR Tab 0.1204 C 02422638 ABB Apo-Rabeprazole 10mg C Tab 0.1204 C 02345579 A-Rabeprazole 10mg Tab 0.1204 C 02408392 pms-rabeprazole 10mg C Tab 0.1204 C 02310805 S Rabeprazole C 10mg Tab 0.1204 C 02356511 Rabeprazole-10mg Tab 0.1204 C 02385449 SIV RA-Rabeprazole 10mg Tab 0.1204 C 02298074 RA Sandoz Rabeprazole 10mg C Tab 0.1204 C 02314177 Teva-Rabeprazole-C 10mg Tab 0.1204 C 02296632 TV ariet 10mg Tab 0.1204 C 02243796 JA rabeprazole 20mg C tab Abbott-Rabeprazole 20mg DR Tab 0.2408 C 02422646 ABB ovember 2015 5

A Alimentary Tract and etabolism Apo-Rabeprazole 20mg C Tab 0.2408 C 02345587 A-Rabeprazole 20mg Tab 0.2408 C 02408406 pms-rabeprazole 20mg C Tab 0.2408 C 02310813 S Rabeprazole C 20mg Tab 0.2408 C 02356538 Rabeprazole-20mg Tab 0.2408 C 02385457 SIV RA-Rabeprazole 20mg Tab 0.2408 C 02298082 RA Sandoz Rabeprazole 20mg C Tab 0.2408 C 02314185 Teva-Rabeprazole-C 20mg Tab 0.2408 C 02296640 TV ariet 20mg Tab 0.2408 C 02243797 JA A02BC05 SORAZO esomeprazole 20mg tab Apo-someprazole 20mg DR Tab 02339099 A-someprazole 20mg DR Tab 02383039 RA-someprazole 20mg Tab 02423979 RA exium 20mg Tab 02244521 AZ esomeprazole 40mg cap/tab Apo-someprazole 40mg DR Tab 02339102 someprazole 40mg DR Tab 02431173 A-someprazole 40mg DR Tab 02383047 pms-someprazole DR 40mg Cap 02379171 S RA-someprazole 40mg Tab 02423987 RA exium 40mg Tab 02244522 AZ A02BD COBIATIOS FOR RADICATIO OF HICOBACTR ORI A02BD07 ASORAZO, CARITHROCI AD AOXICII Hp-AC 86.6500 * 02238525 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 0.1924 02125250 ovo-sucralate 1g Tab 0.1924 02045702 TV Sulcrate 1g Tab 0.1924 02100622 AXC Sulcrate 1g/5m lus Susp 0.1122 02103567 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 0.2690 C 02245663 AA trimebutine 200mg tab Trimebutine 200mg Tab 0.5680 C 02245664 AA odulon 200mg Tab 0.5680 C 00803499 AXC A03AA07 DICCOVRI (DICCOI) ovember 2015 6

A Alimentary Tract and etabolism Jamp-Dicyclomine 10mg Tab 0.1128 C 02391619 JC Bentylol 10mg Tab 0.1265 C 02103087 AXC Dicyclomine 10mg/m Inj 00392812 Bentylol 10mg/5m Syr 0.0677 C 02102978 AXC Jamp-Dicyclomine 20mg Tab 0.2207 C 02366088 JC Bentylol 20mg Tab 0.2388 C 02103095 AXC A03AB ST ATICHOIRGICS,STRS,QUATR AOIU CO A03AB02 GCORROAT (GCORROIU) Glycopyrrolate 0.2mg/m Inj 3.9775 C 02039508 A03AD AAVRI AD DRIVATIVS A03AD01 AAVRI apaverine HCl 32.5mg/m Inj 00009881 A03AX OTHR DRUGS FOR FUCTIOA BOW DISORDRS A03AX04 IAVRIU Dicetel 50mg Tab 0.3533 C 01950592 ABB Dicetel 100mg Tab 0.6160 C 02230684 ABB A03AX13 SIICOS Ovol 80 (80mg) Tab 00292990 CHU A03B A03BA BADOA AD DRIVATIVS, AI BADOA AKAOIDS, TRTIAR AIS A03BA01 ATROI Atropine Sulfate 0.4mg/m Inj 2.2880 C 00392782 Atropine Sulfate 0.6mg/m Inj 2.4880 C 00392693 A03BA03 HOSCAI evsin 0.125mg S Tab 0.4935 C 00125857 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 0.2330 C 00618454 AA ibrax Cap D 0.2330 C 00115630 V A03 A03D ATISASODICS,ATICHOIRGICS WITH AAGSICS ATISASODICS I COBIATIO WITH OTHR DRUGS A03D99 ATISASODICS, COBIATIOS Bellergal Spacetabs D 1.4919 C 00176141 A ovember 2015 7

A Alimentary Tract and etabolism A03F A03FA ROUSIVS ROUSIVS A03FA01 TOCORAID metoclopramide HCl 1mg o/l etonia 1mg/m iq 0.0475 C 02230433 D axeran 1mg/m O/ (discontinued) 00314714 RD metoclopramide HCl 5mg tab etonia 5mg Tab 0.0590 C 02230431 D axeran 5mg Tab (discontinued) 02099195 RR etoclopramide 5mg/m Inj 2.9500 C 02185431 metoclopramide HCl 10mg tab etonia 10mg Tab 0.0618 C 02230432 D axeran 10mg Tab (discontinued) 02099209 RR A03FA03 DORIDO domperidone maleate 10mg tab Apo-Domperidone 10mg Tab 0.0594 C 02103613 Domperidone 10mg Tab 0.0594 C 02350440 Domperidone-10mg Tab 0.0594 C 02238341 SIV Jamp-Domperidone 10mg Tab 0.0594 C 02369206 JC ar-domperidone 10mg Tab 0.0594 C 02403870 AR A-Domperidone 10mg Tab (discontinued) 02278669 pms-domperidone 10mg Tab 0.0594 C 02236466 S RA-Domperidone 10mg Tab 0.0594 C 02268078 RA ratio-domperidone 10mg Tab 0.0594 C 01912070 TV Teva-Domperidone 10mg Tab 0.0594 C 02157195 TV otilium 10mg Tab (discontinued) 00855820 JA A04 A04A A04AA ATITICS AD ATIAUSATS ATITICS AD ATIAUSATS SROTOI (5HT3) ATAGOISTS A04AA01 ODASTRO ondansetron 4mg tab Apo-Ondansetron 4mg Tab 2.5556 02288184 CO Ondansetron 4mg Tab 2.5556 02296349 Jamp-Ondansetron 4mg Tab 2.5556 02313685 JC ar-ondansetron 4mg Tab 2.5556 02371731 AR IT-Ondansetron 4mg Tab 2.5556 02305259 T A-Ondansetron 4mg Tab 2.5556 02297868 AT-Ondansetron 4mg Tab 2.5556 02417839 AT ovo-ondansetron 4mg Tab 2.5556 02264056 TV Ondansetron 4mg Tab 2.5556 02421402 Ondansetron-Odan 4mg Tab 2.5556 02306212 OD pms-ondansetron 4mg Tab 2.5556 02258188 S RA-Ondansetron 4mg Tab 2.5556 02312247 RA ratio-ondansetron 4mg Tab (discontinued) 02278529 TV ovember 2015 8

A Alimentary Tract and etabolism Sandoz Ondansetron 4mg Tab 2.5556 02274310 Septa-Ondansetron 4mg Tab 2.5556 02376091 ST Zofran 4mg Tab 2.5556 02213567 VR ondansetron 4mg/5m o/l Ondansetron 4mg/5m O/ 1.5856 02291967 AA Zofran 4mg/5m O/ 1.5856 02229639 VR ondansetron OD 4mg tab/film Ondissolve ODF 4mg Film 2.5556 02389983 TAK Zofran 4mg ODT Tab 2.5556 02239372 VR ondansetron 8mg tab Apo-Ondansetron 8mg Tab 5.1111 02288192 CO Ondansetron 8mg Tab 5.1111 02296357 Jamp-Ondansetron 8mg Tab 5.1111 02313693 JC ar-ondansetron 8mg Tab 5.1111 02371758 AR IT-Ondansetron 8mg Tab 5.1111 02305267 T A-Ondansetron 8mg Tab 5.1111 02297876 AT-Ondansetron 8mg Tab 5.1111 02417847 AT Ondansetron 8mg Tab 5.1111 02421410 pms-ondansetron 8mg Tab 5.1111 02258196 S RA-Ondansetron 8mg Tab 5.1111 02312255 RA ratio-ondansetron 8mg Tab (discontinued) 02278537 TV Sandoz Ondansetron 8mg Tab 5.1111 02274329 Septa-Ondansetron 8mg Tab 5.1111 02376105 ST Teva-Ondansetron 8mg Tab 5.1111 02264064 TV Zofran 8mg Tab 5.1111 02213575 VR ondansetron OD 8mg tab/film Ondissolve ODF 8mg Film 5.1111 02389991 TAK Zofran 8mg ODT Tab 5.1111 02239373 VR A04AA02 GRAISTRO granisetron 1mg tab Granisetron 1mg Tab 14.6475 02308894 AA Kytril 1mg Tab (discontinued) 02185881 HR A04AA05 AOOSTRO Aloxi 0.25/5m Inj 02381710 IS Aloxi 0.5mg Cap 02381729 IS A04AD OTHR ATITICS A04AD01 SCOOAI Scopolamine 0.4mg/m Inj 4.8900 C 00541869 HOS Scopolamine 0.6mg/m Inj 5.3600 C 00541877 HOS Transderm-V 1.5mg atch 80024336 VR Buscopan 10mg Tab 0.3383 00363812 BO hyoscine butylbromide 20mg/m inj Hyoscine Butylbromide 20mg/m Inj 4.5150 02229868 Buscopan 20mg/m Inj (discontinued) 00363839 BO ovember 2015 9

A Alimentary Tract and etabolism A04AD11 ABIO (CAABIOID (THC) DRIVATIVS) nabilone 0.25mg cap RA-abilone 0.25mg Cap D 1.0471 02358077 RA Teva-abilone 0.25mg Cap D 1.0471 02392925 TV Cesamet 0.25mg Cap D 1.0471 02312263 V nabilone 0.5mg cap CO abilone 0.5mg Cap D 0.7756 02393581 pms-abilone 0.5mg Cap D 0.7756 02380900 S RA-abilone 0.5mg Cap D 0.7756 02358085 RA Teva-abilone 0.5mg Cap D 0.7756 02384884 TV Cesamet 0.5mg Cap D 0.7756 02256193 V nabilone 1mg cap CO abilone 1mg Cap D 1.5513 02393603 pms-abilone 1mg Cap D 1.5513 02380919 S RA-abilone 1mg Cap D 1.5513 02358093 RA Teva-abilone 1mg Cap D 1.5513 02384892 TV Cesamet 1mg Cap D 1.5513 00548375 V A04AD12 ARITAT mend Tri-ack Cap 31.8633 02298813 FRS mend 80mg Cap 31.8600 02298791 FRS mend 125mg Cap 31.8617 02298805 FRS A04AD99 DIHDRIAT dimenhydrinate 10mg/m IV inj Dimenhydrinate 10mg/m IV Amp 00392731 Gravol 10mg/m IV Amp (discontinued) 00013560 CHU Gravol 15mg/5m O/ 00230197 CHU Gravol 25mg Supp 00783595 CHU dimenhydrinate 50mg/m I inj Dimenhydrinate 50mg/m I Inj 1.3800 C 00392537 Gravol l 50mg/m I Inj 1.3800 C 00013579 CHU Dimenhydrinate 50mg Supp 00392553 Gravol 50mg Tab 00013803 CHU Dimenhydrinate 100mg (Adult) Supp 00392545 Gravol 100mg Supp 00013609 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 1.0736 02273497 S Urso 250mg Tab D 1.0736 02238984 AXC ovember 2015 10

A Alimentary Tract and etabolism ursodiol 500mg tab pms-ursodiol C 500mg Tab D 2.0363 02273500 S Urso DS 500mg Tab D 2.0363 02245894 AXC A05AA99 DHDROCHOIC ACID Dycholium 300mg Tab D 0.3905 02162148 C A06 A06A A06AA AXATIVS AXATIVS SOFTRS, OITS A06AA02 DOCUSAT SODIU pms-docusate Sodium 4mg/m Syr 0.0254 C 00703508 S pms-docusate Sodium 10mg Drp 0.1996 C 00880140 S Colace 10mg/m Drp 0.1770 C 02090163 WS Colace 20mg/5m Syrup 0.0232 C 02086018 WS ratio-docusate Sodium 20mg/5m Syr 0.0523 C 00870226 TV Selax 20mg/5m US Syr 0.0220 C 00695033 OD docusate sodium 100mg cap Docusate Sodium 100mg Cap 0.0378 C 02426838 pms-docusate Sodium 100mg Cap 0.0378 C 00703494 S Docusate Sodium 100mg Cap 0.0383 C 00716731 TAR Jamp-Docusate Sodium 100mg Cap 0.0250 C 02245946 JC ovo-docusate 100mg Cap 02020084 TV ratio-docusate Sodium 100mg Cap 0.0258 C 00870196 TV Colace 100mg Cap 0.1567 C 02106256 WS Selax 100mg Cap 0.0383 C 00514888 OD A06AB COTACT AXATIVS A06AB02 BISACOD Apo-Bisacodyl 5mg Tab 0.0450 C 00545023 Jamp-Bisacodyl 5mg Tab 0.0405 C 02246039 JC Bisacodyl-ODA 5mg Tab 0.0550 C 02273411 OD Dulcolax CT 5mg Tab 0.1950 C 00254142 BO Jamp-Bisacodyl 5mg Supp 0.4500 C 02410893 JC pms-bisacodyl 10mg Supp 0.5014 C 00582883 S Dulcolax 10mg Supp 1.1667 C 00003875 BO Jamp-Bisacodyl 10mg Supp 0.5014 C 02361450 JC A06AB06 SA GCOSIDS Senokot 1.7mg/m Syr 0.0477 C 00367729 FR Jamp-Sennosides 8.6mg Tab 0.0488 C 80009595 JC Senokot 8.6mg Tab 0.1740 C 00026158 FR A06AB56 SA GCOSIDS, COBIATIOS Senokot S 8.6mg/50mg Tab 0.1910 C 00026123 FR ovember 2015 11

A Alimentary Tract and etabolism A06AD OSOTICA ACTIG AXATIVS A06AD10 IRA SATS I COBIATIO Coyte owder for Solution 0.0048 C 00677442 D eglyte owder for Solution 0.0048 C 00777838 D A06AD11 ACTUOS lactulose 667mg/m o/l Apo-actulose 667mg/m O/ 0.0145 02242814 Jamp-actulose 667mg/m O/ 0.0145 02295881 JC ratio-actulose 667mg/m O/ 0.0145 00854409 TV Teva-actulose 667mg/m O/ 02331551 TV Chronulac 667mg/m O/ (discontinued) 00534528 R lactulose 667mg/m syrup actulose 667mg/5m Syr 0.0145 02412268 pms-actulose 667mg/m Syr 0.0145 00703486 S A06AD15 ACROGO G 3350 wd Sol 02358034 SC A06AD19 AGSIU CITRAT Citro ag 50mg/m O/ 0.0134 C 00262609 ROG Citrodan 50mg/m O/ 0.0133 C 80001809 OD A06AH RIHRA OIOID RCTOR ATAGOISTS A06AH01 THATRXO BROID Relistor 20mg/m Inj 02308215 A06AX OTHR DRUGS FOR COSTIATIO A06AX05 RUCAORID Resotran 1mg Tab 02377012 JA Resotran 2mg Tab 02377020 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 0.0740 C 02194201 TV ycostatin 100,000iu/m Oral Susp (discontinued) 00248169 BRI pms-ystatin 100,000iu/m Oral Susp 0.0592 C 00792667 S A07AA06 AROOCI Humatin 250mg Cap 02078759 RF A07B A07BB ITSTIA ADSORBTS BISUTH RARATIOS ovember 2015 12

A Alimentary Tract and etabolism A07BB99 BISUTH SUBSAICAT eptobismol 17.6mg/m O/ 02097079 GA A07D A07DA ATIROUSIVS ATIROUSIVS A07DA01 DIHOXAT omotil 2.5mg Tab D 0.4607 C 00036323 A07DA02 OIU Sandoz Opium & Belladonna 65mg/15mg Supp D 4.3467 C 01901869 A07DA03 ORAID loperamide HCl 0.2mg/m o/l pms-operamide 0.2mg/m O/ 0.1137 C 02016095 S Imodium 0.2mg/m O/ (discontinued) 02183323 JJ loperamide 2mg caplet Apo-operamide 2mg Caplet 0.0953 C 02212005 ovo-operamide 2mg Caplet 0.0953 C 02132591 TV pms-operamide 2mg Caplet 0.0953 C 02228351 S Diarr-eze 2mg Caplet (discontinued) 02229552 D Imodium 2mg Caplet (discontinued) 02183862 JJ Jamp-operamide 2mg Tab 0.2508 C 02256452 JC A07 A07A ITSTIA ATIIFAATOR AGTS CORTICOSTROIDS ACTIG OCA A07A02 HDROCORTISO Cortifoam 6.6740 00579335 A Cortenema 100mg/60m Susp 0.1212 02112736 AXC A07A04 BTATHASO Betnesol 5mg/100m Retention nema 0.1035 02060884 A A07A06 BUDSOID ntocort 0.02mg/m nema 8.6800 02052431 AZ ntocort 3mg Cap 1.6671 02229293 AZ A07B ATIARGIC AGTS, XC CORTICOSTROIDS A07B01 CROOGCAT SODIU alcrom 100mg Cap 1.4824 00500895 SAV A07C AIOSAICIC ACID AD SIIAR AGTS A07C01 SUFASAAZI pms-sulfasalazine 500mg Tab 0.2322 00598461 S pms-sulfasalazine C 500mg Tab 0.3536 00598488 S Salazopyrin 500mg ntabs 0.4038 02064472 ovember 2015 13

A Alimentary Tract and etabolism Salazopyrin 500mg Tab 0.2647 02064480 A07C02 5-AIOSAICIC ACID (SAAI) entasa 1g Supp 1.6480 02153564 FI Salofalk 1g Supp 1.8887 02242146 AXC entasa 1g/100m Rectal Susp 0.0381 02153521 FI ezavant 1.2g Tab 1.6253 02297558 SHI Salofalk 2g/60g Rectal Susp 0.0690 02112795 AXC Salofalk 4g/60g Rectal Susp 0.1173 02112809 AXC entasa 4g/100m Rectal Susp 0.0459 02153556 FI 5-aminosalicylic acid 400mg tab ovo-5-asa 400mg C Tab 0.4666 02171929 TV Asacol 400mg Tab 0.4666 01997580 esasal 500mg Tab 0.6368 01914030 GSK entasa 500mg Tab 0.5716 02099683 FI Salofalk 500mg Supp 1.2857 02112760 AXC Salofalk 500mg Tab 0.5817 02112787 AXC Asacol 800 (800mg) Tab 1.0938 02267217 A07C03 OSAAZI (5-ASA) Dipentum 250mg Cap 0.5585 02063808 S A07F A07FA ATIDIARRHOA ICROORGAISS ATIDIARRHOA ICROORGAISS A07FA01 ACTIC ACID RODUCIG ORGAISS Bacid Cap 0.9600 80017987 RF A08 A08A A08AB ATIOBSIT RARATIOS, XC DIT RODUCTS ATIOBSIT RARATIOS, XC DIT RODUCTS RIHRA ACTIG ATIOBSIT RODUCTS A08AB01 ORISTAT Xenical 120mg Cap 02240325 HR A09 A09A A09AA DIGSTIVS, IC ZS DIGSTIVS, IC ZS Z RARATIOS A09AA02 UTIZS (IAS, ROTAS, TC) Cotazym Cap 0.2079 00263818 FRS Ultrase T20 Cap 0.8067 02045869 AXC Viokase Tab 0.2431 02230019 AXC Cotazym CS 4 Cap (discontinued) 02181215 SCH ancrease T 4 Cap 0.5985 00789445 JA ovember 2015 14

A Alimentary Tract and etabolism Ultrase S4 Cap 0.2334 02203324 AXC Creon 6 inimicrospheres 0.1703 02415194 ABB Cotazym CS 8 Cap 0.3751 00502790 SCH Creon 10 inimicrospheres 0.2723 02200104 ABB ancrease T 10 Cap 1.4963 00789437 JA Ultrase T12 Cap 0.4656 02045834 AXC ancrease T 16 Cap 2.3940 00789429 JA Viokase 16 Tab 0.3731 02241933 AXC Cotazym CS 20 Cap 0.9837 00821373 SCH Creon 25 inimicrospheres 0.8507 01985205 ABB Cotazym-65B Cap (discontinued) 00456233 SCH A09AA03 SI Fermentol 100mg/30m iq 0.0130 00378739 CHU A10 A10A A10AB DRUGS USD I DIABTS ISUIS AD AAOGUS ISUIS & AAOGUS FOR IJCTIO, FAST-ACTIG A10AB01 ISUI (HUA) Humulin R Cartridges 3.0080 D 01959220 I Humulin R Insulin 2.2990 D 00586714 I ovolin G Toronto Insulin 2.1640 D 02024233 O ovolin G Toronto enfill 2.8313 D 02024284 O A10AB04 ISUI ISRO Humalog Cartridges 3.7587 * 02229705 I Humalog Insulin 2.8020 * 02229704 I Humalog Kwiken 3.6847 * 02403412 I *full benefit for children 18 years and younger. A10AB05 ISUI ASART ovoix 30 enfill 02265435 O ovorapid 100iu/m enfill Ins 3.9207 * 02244353 O ovorapid 100iu/m Vial Ins 2.9000 * 02245397 O *full benefit for children 18 years and younger. A10AB06 ISUI GUISI Apidra 3m Cartridges 3.3333 * 02279479 SAV Apidra 3m refilled en 3.3567 * 02294346 SAV Apidra 10m Vial 2.5230 * 02279460 SAV *full benefit for children 18 years and younger. A10AC ISUIS & AAOGUS FOR IJCTIO, ITRDIAT-ACTIG A10AC01 ISUI (HUA) ovember 2015 15

A Alimentary Tract and etabolism Humulin Cartridges 3.0080 D 01959239 I Humulin Insulin 2.2990 D 00587737 I Humulin Kwiken 3.0080 D 02403447 I ovolin G H Insulin 2.2130 D 02024225 O ovolin G H enfill 2.8993 D 02024268 O A10AD ISUIS & AAOGUS FOR IJC. ITRDIAT-ACTIG + FAST-ACTIG A10AD01 ISUI (HUA) Humulin 30/70 Cartridges 3.0080 D 01959212 I Humulin 30/70 Insulin 2.2990 D 00795879 I ovolin G 30/70 Insulin 2.2240 D 02024217 O ovolin G 30/70 enfill 2.8660 D 02025248 O ovolin G 40/60 enfill 2.8867 D 02024314 O ovolin G 50/50 enfill 2.8867 D 02024322 O A10AD04 ISUI ISRO Humalog ix25 Cartridges 02240294 I Humalog ix25 Kwiken 02403420 I Humalog ix25 Vial 02240296 I Humalog ix50 Cartridges 02240297 I Humalog ix50 Kwiken 02403439 I A10A ISUIS & AAOGUS, FOR IJCTIO OG-ACTIG A10A04 ISUI GARGI antus 100iu/m Cartridge 6.1900 02251930 SAV antus 100iu/m Solostar re-filled en 6.1900 02294338 SAV antus 100iu/m Vial 6.1690 02245689 SAV A10A05 ISUI DTIR evemir 100iu/m enfill 6.9140 02271842 O evemir FlexTouch 100iu/m re-filled en 7.1527 02412829 O A10B A10BA BOOD GUCOS OWRIG DRUGS, XC. ISUIS BIGUAIDS A10BA02 TFORI metformin HCl 500mg tab Apo-etformin 500mg Tab 0.0444 D 02167786 CO etformin 500mg Tab 0.0444 D 02257726 Jamp-etformin 500mg Tab 0.0444 D 02380196 JC Jamp-etformin Blackberry 500mg Tab 0.0444 D 02380722 JC ar-etformin 500mg Tab 0.0444 D 02378620 AR etformin 500mg Tab (AR) 0.0444 D 02378841 AR etformin 500mg Tab () 0.0444 D 02353377 etformin FC 500mg Tab 0.0444 D 02385341 SIV IT-etformin 500mg Tab 0.0444 D 02388766 T A-etformin 500mg Tab 0.0444 D 02148765 pms-etformin 500mg Tab 0.0444 D 02223562 S ovember 2015 16

A Alimentary Tract and etabolism RA-etformin 500mg Tab Tab 0.0444 D 02269031 RA ratio-etformin 500mg Tab 0.0444 D 02242974 TV Sandoz etformin FC 500mg Tab 0.0444 D 02246820 Septa-etformin 500mg Tab 0.0444 D 02379767 ST Teva-etformin 500mg Tab 0.0444 D 02045710 TV Glucophage 500mg Tab 0.0444 D 02099233 SAV metformin HCl 850mg tab Apo-etformin 850mg Tab 0.0610 D 02229785 CO etformin 850mg Tab 0.0610 D 02257734 Jamp-etformin 850mg Tab 0.0610 D 02380218 JC Jamp-etformin Blackberry 850mg Tab 0.0610 D 02380730 JC ar-etformin 850mg Tab 0.0610 D 02378639 AR etformin 850mg Tab (AR) 0.0610 D 02378868 AR etformin 850mg Tab () 0.0610 D 02353385 etformin FC 850mg Tab 0.0610 D 02385368 SIV IT-etformin 850mg Tab 0.0610 D 02388774 T A-etformin 850mg Tab 0.0610 D 02229656 pms-etformin 850mg Tab 0.0610 D 02242589 S RA-etformin 850mg Tab 0.0610 D 02269058 RA ratio-etformin 850mg Tab 0.0610 D 02242931 TV Sandoz etformin FC 850mg Tab 0.0610 D 02246821 Septa-etformin 850mg Tab 0.0610 D 02379775 ST Teva-etformin 850mg Tab 0.0610 D 02230475 TV Glucophage 850mg Tab 0.0610 D 02162849 SAV A10BB SUFOAIDS, URA DRIVATIVS A10BB01 GBURID (GIBCAID) glyburide 2.5mg tab Apo-Glyburide 2.5mg Tab 0.0321 D 01913654 Glyburide 2.5mg Tab 0.0321 D 02350459 A-Glybe 2.5mg Tab (discontinued) 00808733 Sandoz Glyburide 2.5mg Tab 0.0321 D 02248008 Teva-Glyburide 2.5mg Tab 0.0321 D 01913670 TV Diabeta 2.5mg Tab 0.0321 D 02224550 SAV uglucon 2.5mg Tab (discontinued) 00720933 S glyburide 5mg tab Apo-Glyburide 5mg Tab 0.0573 D 01913662 Glyburide 5mg Tab 0.0573 D 02350467 A-Glybe 5mg Tab (discontinued) 00808741 pms-glyburide 5mg Tab 0.0573 D 02236734 S Sandoz Glyburide 5mg Tab 0.0573 D 02248009 Teva-Glyburide 5mg Tab 0.0573 D 01913689 TV Diabeta 5mg Tab 0.0573 D 02224569 SAV uglucon 5mg Tab (discontinued) 00720941 S A10BB02 CHORROAID Apo-Chlorpropamide 100mg Tab 00399302 chlorpropamide 250mg tab ovember 2015 17

A Alimentary Tract and etabolism Apo-Chlorpropamide 250mg Tab 00312711 Diabinese 250mg Tab (discontinued) 00024716 A10BB03 TOBUTAID tolbutamide 500mg tab Tolbutamide 500mg Tab 0.1182 D 00312762 AA obenol 500mg Tab (discontinued) 00013889 HOR A10BB09 GICAZID gliclazide 30mg R tab ACT Gliclazide R 30mg Tab 0.0931 D 02429764 Apo-Gliclazide R 30mg Tab 0.0931 D 02297795 AO IT-Gliclazide R 30mg Tab 0.0931 D 02423286 T Diamicron R 30mg Tab 0.0931 D 02242987 SV gliclazide 60mg R tab Apo-Gliclazide R 60mg Tab 0.2150 D 02407124 Diamicron R 60mg Tab 0.2150 D 02356422 SV gliclazide 80mg tab Apo-Gliclazide 80mg Tab 0.0931 D 02245247 Gliclazide 80mg Tab 0.0931 D 02287072 A-Gliclazide 80mg Tab 0.0931 D 02229519 ovo-gliclazide 80mg Tab 0.0931 D 02238103 TV Diamicron 80mg Tab 0.0931 D 00765996 SV A10BB12 GIIRID glimepiride 1mg tab Apo-Glimepiride 1mg Tab 02295377 ovo-glimepiride 1mg Tab (discontinued) 02273756 TV ratio-glimepiride 1mg Tab 02273101 TV Sandoz Glimepiride 1mg Tab 02269589 Amaryl 1mg Tab 02245272 SAV glimepiride 2mg tab Apo-Glimepiride 2mg Tab 02295385 ovo-glimepiride 2mg Tab (discontinued) 02273764 TV ratio-glimepiride 2mg Tab 02273128 TV Sandoz Glimepiride 2mg Tab 02269597 Amaryl 2mg Tab 02245273 SAV glimepiride 4mg tab Apo-Glimepiride 4mg Tab 02295393 ovo-glimepiride 4mg Tab (discontinued) 02273772 TV ratio-glimepiride 4mg Tab 02273136 TV Sandoz Glimepiride 4mg Tab 02269619 Amaryl 4mg Tab 02245274 SAV A10BD COBIATIOS OF ORA BOOD GUCOS OWRIG DRUGS A10BD03 TFORI AD ROSIGITAZO Avandamet 2/500mg Tab 02247086 GSK Avandamet 2/1000mg Tab 02248440 GSK ovember 2015 18

A Alimentary Tract and etabolism Avandamet 4/500mg Tab 02247087 GSK Avandamet 4/1000mg Tab 02248441 GSK A10BD07 TFORI AD SITAGITI Janumet 50/500mg Tab 1.6158 02333856 FRS Janumet 50/850mg Tab 1.6158 02333864 FRS Janumet 50/1000mg Tab 1.6158 02333872 FRS Janumet 50/1000mg XR Tab 1.6158 02416794 FRS A10BD10 TFORI AD SAXAGITI Komboglyze 2.5mg/500mg Tab 1.2700 02389169 AZ Komboglyze 2.5mg/850mg Tab 1.2700 02389177 AZ Komboglyze 2.5mg/1000mg Tab 1.2700 02389185 AZ A10BD13 TFORI AD AOGITI Kazano 500/12.5mg Tab 02417219 TAK Kazano 850/12.5mg Tab 02417227 TAK Kazano 1000/12.5mg Tab 02417235 TAK A10BF AHA GUCOSIDAS IHIBITORS A10BF01 ACARBOS Glucobay 50mg Tab 0.2695 D 02190885 BA Glucobay 100mg Tab 0.3733 D 02190893 BA A10BG THIAZOIDIOS A10BG02 ROSIGITAZO Avandia 2mg Tab 02241112 GSK Avandia 4mg Tab 02241113 GSK Avandia 8mg Tab 02241114 GSK A10BG03 IOGITAZO pioglitazone 15mg tab Accel ioglitazone 15mg Tab 02303442 ACC Apo-ioglitazone 15mg Tab 0.5946 02302942 Auro-ioglitiazone 15mg Tab 0.5946 02384906 ARO CO ioglitazone 15mg Tab 0.5946 02302861 Jamp-ioglitazone 15mg Tab 0.5946 02397307 JC IT-ioglitazone 15mg Tab 0.5946 02326477 T A-ioglitazone 15mg Tab 0.5946 02298279 ovo-ioglitazone 15mg Tab 0.5946 02274914 TV ioglitazone 15mg Tab 0.5946 02391600 AHI pms-ioglitazone 15mg Tab 0.5946 02303124 S RA-ioglitazone 15mg Tab 0.5946 02375850 RA Sandoz ioglitazone 15mg Tab 0.5946 02297906 Actos 15mg Tab 0.5946 02242572 TAK ovember 2015 19

A Alimentary Tract and etabolism pioglitazone 30mg tab Accel ioglitazone 30mg Tab 02303450 ACC Apo-ioglitazone 30mg Tab 0.8330 02302950 Auro-ioglitazone 30mg Tab 0.8330 02384914 ARO CO ioglitazone 30mg Tab 0.8330 02302888 Jamp-ioglitazone 30mg Tab 0.8330 02365529 JC IT-ioglitazone 30mg Tab 0.8330 02326485 T A-ioglitazone 30mg Tab 0.8330 02298287 ovo-ioglitazone 30mg Tab 0.8330 02274922 TV ioglitazone 30mg Tab 0.8330 02339587 AHI pms-ioglitazone 30mg Tab 0.8330 02303132 S RA-ioglitazone 30mg Tab 0.8330 02375869 RA Sandoz ioglitazone 30mg Tab 0.8330 02297914 Actos 30mg Tab 0.8330 02242573 TAK pioglitazone 45mg tab Accel ioglitazone 45mg Tab 02303469 ACC Apo-ioglitazone 45mg Tab 1.2525 02302977 Auro-ioglitazone 45mg Tab 1.2525 02384922 ARO CO ioglitazone 45mg Tab 1.2525 02302896 Jamp-ioglitazone 45mg Tab 1.2525 02365537 JC IT-ioglitazone 45mg Tab 1.2525 02326493 T A-ioglitazone 45mg Tab 1.2525 02298295 ovo-ioglitazone 45mg Tab 1.2525 02274930 TV ioglitazone 45mg Tab 1.2525 02339595 AHI pms-ioglitazone 45mg Tab 1.2525 02303140 S RA-ioglitazone 45mg Tab 1.2525 02375877 RA Sandoz ioglitazone 45mg Tab 1.2525 02297922 Actos 45mg Tab 1.2525 02242574 TAK A10BH DITID TIDAS 4 (D-4) IHIBITORS A10BH01 SITAGITI Januvia 25mg Tab 2.9790 02388839 FRS Januvia 50mg Tab 2.9790 02388847 FRS Januvia 100mg Tab 2.9790 02303922 FRS A10BH03 SAXAGITI Onglyza 2.5mg Tab 2.3997 02375842 AZ Onglyza 5mg Tab 2.8640 02333554 AZ A10BH04 AOGITI esina 6.25mg Tab 02417189 TAK esina 12.5mg Tab 02417197 TAK esina 25mg Tab 02417200 TAK A10BH05 IAGITI Trajenta 5mg Tab 2.2500 02370921 BO A10BX OTHR BOOD GUCOS OWRIG DRUGS, XC ISUIS ovember 2015 20

A Alimentary Tract and etabolism A10BX02 RAGIID repaglinide 0.5mg tab Apo-Repaglinide 0.5mg Tab 02355663 Auro-Repaglinide 0.5mg Tab 02424258 ARO CO Repaglinide 0.5mg Tab 02321475 pms-repaglinide 0.5mg Tab 02354926 S Sandoz Repaglinide 0.5mg Tab 02357453 Glucoorm 0.5mg Tab 02239924 O repaglinide 1mg tab Apo-Repaglinide 1mg Tab 02355671 Auro-Repaglinide 1mg Tab 02424266 ARO CO Repaglinide 1mg Tab 02321483 pms-repaglinide 1mg Tab 02354934 S Sandoz Repaglinide 1mg Tab 02357461 Glucoorm 1mg Tab 02239925 O repaglinide 2mg tab Apo-Repaglinide 2mg Tab 02355698 CO Repaglinide 2mg Tab 02321491 pms-repaglinide 2mg Tab 02354942 S Sandoz Repaglinide 2mg Tab 02357488 Glucoorm 2mg Tab 02239926 O A10BX03 ATGIID Starlix 60mg Tab (discontinued) 02245438 VR Starlix 120mg Tab (discontinued) 02245439 VR A10BX04 XATID Byetta 1.2m refilled en 02361809 AZ Byetta 2.4m refilled en 02361817 AZ A10BX07 IRAGUTID Victoza 6mg/m Inj 02351064 O A10BX11 CAAGIFOZI Invokana 100mg Tab 2.6177 02425483 JA Invokana 300mg Tab 2.6177 02425491 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 0.3917 80003615 OD A11CC03 AFACACIDO One-Alpha 0.25mcg Cap 0.4890 00474517 O One-Alpha 1mcg Cap 1.4637 00474525 O ovember 2015 21

A Alimentary Tract and etabolism One-Alpha 2mcg O/ 5.5920 02240329 O A11CC04 CACITRIO Rocaltrol 0.25mcg Cap 0.9364 00481823 HR Rocaltrol 0.5mcg Cap 1.4891 00481815 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 1.1880 02243525 CI Vitamin B1 100mg/m Inj 00816078 Betaxin 100mg/m Inj (discontinued) 02241983 HOS Thiamiject 100mg/m Inj (Omega) 1.1880 02193221 OG A12 A12B A12BA IRA SUTS OTASSIU OTASSIU A12BA01 OTASSIU CHORID potassium chloride 1.33mq/m o/l pms-otassium Chloride 20mq/15m 0.0158 C 02238604 S K-10 Sol 20mq/15m 0.0158 C 80024360 GSK Apo-K 8mq Tab 0.0899 C 00602884 icro-k 8mq xtencap 0.0930 C 02042304 A Slow-K 8mq Tab 0.1803 C 80040226 VR Jamp-K8 600mg Tab 0.0899 C 80013005 JC Jamp-K20 1500mg SR Tab 0.1995 C 80013007 JC Odan-K20 1500mg SR Tab 0.2050 C 80004415 OD A12BA02 OTASSIU CITRAT K-yte 25mq ff Tab 0.5717 C 02085992 WS A12C A12CC OTHR IRA SUTS AGSIU A12CC99 AGSIU GUCOHTOAT Jamp-agnesium 5mg/m O/ 0.0200 80009357 JC agnesium-odan 5mg/m O/ 0.0200 80004109 OD Rougier-agnesium 5mg/m O/ 0.0200 00026697 ROG A12CX VARIOUS IRA RODUCTS A12CX99 SODIU HOSHAT hosphate-ovartis 500mg ff Tab 0.8240 80027202 VR A16 OTHR AITAR TRACT AD TABOIS RODUCTS ovember 2015 22

A Alimentary Tract and etabolism A16A A16AA OTHR AITAR TRACT AD TABOIS RODUCTS AIO ACIDS AD DRIVATIVS A16AA01 VOCARITI Carnitor 1g/5m Inj 12.5220 02144344 QGT Carnitor 100mg/m O/ 0.3961 02144336 QGT Carnitor 330mg Tab 1.3078 02144328 QGT A16AA06 BTAI A16AB ZS Cystadane 1g owder for Oral Sol 02238526 OR A16AB05 AROIDAS Aldurazyme 0.58mg/m Inj 02254506 GZ A16AB07 AGUCOSIDAS AFA yozyme 50mg dr for Inj 840.3100 02284863 GZ A16AB09 IDURSUFAS A16AX laprase 2mg/m Inj VARIOUS AITAR TRACT & TABOIS RODUCTS 02296314 A A16AX06 IGUSTAT Zavesca 100mg Cap 02250519 ACT ovember 2015 23

B B01 B01A B01AA Blood and Blood Forming Organs ATICOAGUATS ATICOAGUATS VITAI K ATAGOISTS B01AA03 WARFARI warfarin 1mg tab Apo-Warfarin 1mg Tab 0.0796 C 02242924 A-Warfarin 1mg Tab 0.0796 C 02244462 Taro-Warfarin 1mg Tab 0.0796 C 02242680 TAR Coumadin 1mg Tab 0.0796 C 01918311 BRI warfarin 2mg tab Apo-Warfarin 2mg Tab 0.0841 C 02242925 A-Warfarin 2mg Tab 0.0841 C 02244463 ovo-warfarin 2mg Tab (discontinued) 02265281 TV Taro-Warfarin 2mg Tab 0.0841 C 02242681 TAR Coumadin 2mg Tab 0.0841 C 01918338 BRI warfarin 2.5mg tab Apo-Warfarin 2.5mg Tab 0.0674 C 02242926 A-Warfarin 2.5mg Tab 0.0674 C 02244464 ovo-warfarin 2.5mg Tab (discontinued) 02265303 TV Taro-Warfarin 2.5mg Tab 0.0674 C 02242682 TAR Coumadin 2.5mg Tab 0.0674 C 01918346 BRI warfarin 3mg tab Apo-Warfarin 3mg Tab 0.1043 C 02245618 A-Warfarin 3mg Tab 0.1043 C 02287498 Taro-Warfarin 3mg Tab 0.1043 C 02242683 TAR Coumadin 3mg Tab 0.1043 C 02240205 BRI warfarin 4mg tab Apo-Warfarin 4mg Tab 0.1043 C 02242927 A-Warfarin 4mg Tab 0.1043 C 02244465 Taro-Warfarin 4mg Tab 0.1043 C 02242684 TAR Coumadin 4mg Tab 0.1043 C 02007959 BRI warfarin 5mg tab Apo-Warfarin 5mg Tab 0.0675 C 02242928 A-Warfarin 5mg Tab 0.0675 C 02244466 ovo-warfarin 5mg Tab (discontinued) 02265346 TV Taro-Warfarin 5mg Tab 0.0675 C 02242685 TAR Coumadin 5mg Tab 0.0675 C 01918354 BRI warfarin 6mg tab A-Warfarin 6mg Tab 0.1753 C 02287501 Taro-Warfarin 6mg Tab 02242686 TAR Coumadin 6mg Tab 0.1753 C 02240206 BRI warfarin 7.5mg tab A-Warfarin 7.5 Tab 0.3014 C 02287528 Taro-Warfarin 7.5mg Tab 0.3014 C 02242697 TAR warfarin 10mg tab Apo-Warfarin 10mg Tab 0.1211 C 02242929 ovember 2015 24

B Blood and Blood Forming Organs A-Warfarin 10mg Tab 0.1211 C 02244467 Taro-Warfarin 10mg Tab 0.1211 C 02242687 TAR Coumadin 10mg Tab 0.1211 C 01918362 BRI B01AA07 ACOCOUARO Sintrom 1mg Tab 0.5578 C 00010383 A Sintrom 4mg Tab 1.7399 C 00010391 A B01AB HARI GROU B01AB01 HARI Heparin 100iu/m Inj 0.4794 C 00727520 O Heparin 1,000iu/m Inj 0.5637 C 00453811 O Heparin 10,000iu/m Inj (discontinued) 00579718 O B01AB04 DATARI Fragmin 2,500iu [anti-xa] 0.2/m Syringe Inj 26.1100 C 02132621 Fragmin 5,000iu [anti-xa] 0.2/m Syringe Inj 52.2200 C 02132648 Fragmin 7,500iu [anti-xa] 0.3/m Syringe Inj 52.2200 C 02352648 Fragmin 10,000iu [anti-xa]/m Amp Inj 16.4920 C 02132664 Fragmin 10,000iu [anti-xa] 0.4/m Syringe Inj 52.2200 C 02352656 Fragmin 12,500iu [anti-xa] 0.5/m Syringe Inj 52.2200 C 02352664 Fragmin 15,000iu [anti-xa] 0.6/m Syringe Inj 52.2233 C 02352672 Fragmin 18,000iu [anti-xa] 0.72/m Syringe Inj 52.2194 C 02352680 Fragmin 25,000iu [anti-xa]/m Vial Inj 41.2289 C 02231171 B01AB05 OXAARI ovenox 30mg/0.3m Syringe Inj 21.6233 C 02012472 SAV ovenox 40mg/0.4m Syringe Inj 21.6225 C 02236883 SAV ovenox 60mg/0.6m Syringe Inj 21.6233 C 02378426 SAV ovenox 80mg/0.8m Syringe Inj 21.6238 C 02378434 SAV ovenox 100mg/m refilled Syringe Inj 21.6240 C 02378442 SAV ovenox 100mg/m Vial Inj 21.6233 C 02236564 SAV ovenox 120mg/0.8m Syringe Inj 32.4350 C 02242692 SAV ovenox H 150mg/m Syringe Inj 32.4360 C 02378469 SAV B01AB10 TIZAARI Innohep 2,500iu/0.25m Inj 19.6560 C 02229755 O Innohep 3,500iu/0.35m Inj 19.6343 C 02358158 O Innohep 4,500iu/0.45m Inj 19.6400 C 02358166 O Innohep 8,000iu/0.4m Inj 40.1225 C 02429462 O Innohep 10,000iu/0.5m Inj 40.0860 C 02231478 O Innohep 10,000iu/m Inj 19.4765 C 02167840 O ovember 2015 25

B Blood and Blood Forming Organs Innohep 12,000iu/0.6m Inj 40.1233 C 02429470 O Innohep 14,000iu/0.7m Inj 40.1229 C 02358174 O Innohep 16,000iu/0.8m Inj 40.1238 C 02429489 O Innohep 18,000iu/0.9m Inj 40.1189 C 02358182 O Innohep 20,000iu/m Inj 39.5650 C 02229515 O B01AC ATT AGGRGATIO IHIBITORS XC. HARI B01AC04 COIDOGR clopidogrel 75mg tab Abbott-Clopidogrel 75mg Tab 0.4735 02412942 ABB Apo-Clopidogrel 75mg Tab 0.4735 02252767 Auro-Clopidogrel 75mg Tab 0.4735 02416387 ARO Clopidogrel 75mg Tab 0.4735 02400553 Clopidogrel-75mg Tab 0.4735 02385813 SIV CO Clopidogrel 75mg Tab 0.4735 02303027 Jamp-Clopidogrel 75mg Tab 0.4735 02415550 JC ar-clopidogrel 75mg Tab 0.4735 02422255 AR IT-Clopidogrel 75mg Tab 0.4735 02408910 T A-Clopidogrel 75mg Tab 0.4735 02351536 pms-clopidogrel 75mg Tab 0.4735 02348004 S RA-Clopidogrel 75mg Tab 0.4735 02379813 RA Sandoz Clopidogrel 75mg Tab 0.4735 02359316 Teva-Clopidogrel 75mg Tab 0.4735 02293161 TV lavix 75mg Tab 0.4735 02238682 SAV clopidogrel 300mg tab Apo-Clopidogrel 300mg Tab 02398591 Teva-Clopidogrel 300mg Tab 02388065 TV lavix 300mg Tab 02330555 SAV B01AC05 TICOIDI ticlopidine 250mg tab Apo-Ticlopidine 250mg Tab 0.4398 02237701 Teva-Ticlopidine 250mg Tab 0.4398 02236848 TV Ticlid 250mg Tab (discontinued) 02162776 S B01AC07 DIRIDAO dipyridamole 25mg tab Apo-Dipyridamole-FC 25mg Tab 0.2633 00895644 ersantine 25mg Tab (discontinued) 00067385 BO dipyridamole 50mg tab Apo-Dipyridamole-FC 50mg Tab 0.3685 00895652 ersantine 50mg Tab (discontinued) 00067393 BO dipyridamole 75mg tab Apo-Dipyridamole-FC 75mg Tab 0.4963 00895660 ersantine 75mg Tab (discontinued) 00452092 BO B01AC21 TRROSTII ovember 2015 26

B Blood and Blood Forming Organs Remodulin 1mg/m Inj 02246552 UTC Remodulin 2.5mg/m Inj 02246553 UTC Remodulin 5mg/m Inj 02246554 UTC Remodulin 10mg/m Inj 02246555 UTC B01AC22 RASUGR ffient 10mg Tab 2.7377 02349124 I B01AC24 TICAGROR Brilinta 90mg Tab 1.4992 02368544 AZ B01AC30 ATT AGGRGATIO IHIBITORS, COBIATIOS Aggrenox 200/25mg Cap 0.8492 02242119 BO B01A DIRCT THROBI IHIBITORS B01A07 DABIGATRA TXIAT radaxa 75mg Cap 02312433 BO radaxa 110mg Cap 1.6000 02312441 BO radaxa 150mg Cap 1.6000 02358808 BO B01AF DIRCT FACTOR XA IHIBITORS B01AF01 RIVAROXABA Xarelto 10mg Tab 2.8400 02316986 BA B01AF02 AIXABA liquis 2.5mg Tab 1.6000 02377233 BRI liquis 5mg Tab 1.6000 02397714 BRI B01AX OTHR ATITHROBOTIC AGTS B01AX05 FODAARIUX fondaparinux sodium 2.5mg/0.5m Inj Fondaparinux Sodium 2.5mg/0.5m Inj 02406853 RCH Arixtra 2.5mg/0.5m Inj 02245531 AR fondapariunux sodium 12.5mg/m Inj Fondaparinux Sodium 12.5mg/m Inj 02406896 RCH Arixtra 12.5mg/m 02258056 AR B01AX06 RIVAROXABA Xarelto 15mg Tab 2.8400 02378604 BA Xarelto 20mg Tab 2.8400 02378612 BA B02 B02A B02AA ATIHAORRHAGICS ATIFIBRIOTICS AIO ACIDS B02AA02 TRAXAIC ACID ovember 2015 27

B Blood and Blood Forming Organs tranexamic acid 100mg/m inj Tranexamic Acid 100mg/m Inj 02246365 Cyklokapron 100mg/m Inj 02064413 tranexamic acid 500mg tab GD-Tranexamic Acid 500mg Tab 0.5934 02409097 GD Tranexamic Acid 500mg Tab 0.5934 02401231 STR Cyklokapron 500mg Tab 0.5934 02064405 B02B B02BA VITAI K AD OTHR HOSTATICS VITAI K B02BA01 HTOADIO Vitamin K1 10mg/m Inj 3.7490 00804312 Vitamin K1 2mg/m Inj 9.2600 00781878 B02BX OTHR SSTIC HAOSTATICS B02BX04 ROIOSTI plate 250mcg/0.5m Inj 02322854 AGA plate 500mcg/m Inj 02322862 AGA B02BX05 TROBOAG Revolade 25mg Tab 02361825 GSK Revolade 50mg Tab 02361833 GSK B03 B03A B03AA ATIAAIC RARATIOS IRO RARATIOS IRO BIVAT, ORA RARATIOS B03AA02 FRROUS FUARAT alafer 300mg Cap 01923420 V alafer 300mg/5m Susp 01923439 V B03AA03 FRROUS GUCOAT ferrous gluconate 300mg tab AC-Ferrous Gluconate 300mg Tab 00545031 Apo-Ferrous Gluconate 300mg Tab 00545031 ovo-ferrogluc 300mg Tab 80000435 TV B03AA07 FRROUS SUFAT Ferodan 75mg/m Infant Drops 02237385 OD pms-ferrous Sulfate 75mg/0.6m Drops 02222574 S Ferodan 150mg5/m Syrup 00758469 OD B03AC IRO TRIVAT, ARTRA RARATIOS B03AC01 DXTRIFRRO (IRO DXTRA) DexIron 50mg/m Inj 13.7500 02205963 BHC ovember 2015 28