Texas Medicaid Drug Utilization Board Decisions July 27, 2018

Transcription

1 ALZHEIMER'S AGENTS ARICEPT (ORAL) NPD NPD NPD For this therapeutic drug class, the Board believed that all of the drugs ARICEPT 23 MG (ORAL) NPD NPD NPD being recommended as preferred demonstrated the greatest safety, DONEPEZIL 23 MG (ORAL) NPD NPD NPD efficacy, and value and provided clinicians with the greatest number of DONEPEZIL ODT (ORAL) PDL PDL PDL DONEPEZIL TABLET (ORAL) PDL PDL PDL EXELON (TRANSDERM.) NPD NPD NPD X GALANTAMINE ER (ORAL) NPD NPD NPD GALANTAMINE SOLUTION (ORAL) NPD NPD NPD GALANTAMINE TABLET (ORAL) NPD NPD NPD MEMANTINE ER (ORAL) NPD NPD NPD MEMANTINE SOLUTION (ORAL) NPD NPD NPD MEMANTINE TABLET (AG) (ORAL) PDL PDL PDL MEMANTINE TABLET (ORAL) PDL PDL PDL MEMANTINE TABLET DOSE PACK (AG) (ORAL) NPD NPD NPD NAMENDA TABLET (ORAL) NPD NPD NPD NAMENDA TABLET DOSE PACK (ORAL) NPD NPD NPD NAMENDA XR (ORAL) NPD NPD NPD NAMZARIC (ORAL) NPD NPD NPD NAMZARIC DOSE PACK (ORAL) NPD NPD NPD RIVASTIGMINE (AG) (TRANSDERM.) PDL PDL PDL RIVASTIGMINE (TRANSDERM.) PDL PDL PDL RIVASTIGMINE CAPSULES (ORAL) NPD NPD NPD ANTIHISTAMINES, MINIMALLY SEDATING ALLEGRA ALLERGY OTC (ORAL) NPD NPD NPD For this therapeutic drug class, the Board believed that all of the drugs ALLEGRA ALLERGY SUSPENSION OTC (ORAL) NPD NPD NPD being recommended as preferred demonstrated the greatest safety, ALLEGRA-D 12 HOUR OTC (ORAL) NPD NPD NPD efficacy, and value and provided clinicians with the greatest number of ALLEGRA-D 24 HOUR OTC (ORAL) NPD NPD NPD CETIRIZINE CAPSULE OTC (ORAL) NPD NPD NPD CETIRIZINE CHEWABLE OTC (ORAL) NPD NPD NPD CETIRIZINE SOLUTION (ORAL) PDL PDL PDL CETIRIZINE SOLUTION 5MG/5ML OTC (ORAL) NPD NPD NPD CETIRIZINE SOLUTION OTC (ORAL) PDL PDL PDL CETIRIZINE TABLETS OTC (ORAL) PDL PDL PDL CETIRIZINE-D OTC (ORAL) NPD NPD NPD CLARINEX SYRUP (ORAL) NPD NPD NPD CLARINEX TABLET (ORAL) NPD NPD NPD CLARINEX-D 12 HOUR (ORAL) NPD NPD NPD CLARITIN CAPSULE OTC (ORAL) NPD NPD NPD CLARITIN CHEW OTC (ORAL) NPD NPD NPD CLARITIN ODT OTC (ORAL) NPD NPD NPD CLARITIN SOLUTION OTC (ORAL) NPD NPD NPD CLARITIN TABLET OTC (ORAL) NPD NPD NPD CLARITIN-D 12 HOUR OTC (ORAL) NPD NPD NPD CLARITIN-D 24 HOUR OTC (ORAL) NPD NPD NPD DESLORATADINE (ORAL) NPD NPD NPD DESLORATADINE ODT (ORAL) NPD NPD NPD FEXOFENADINE 60, 180 MG OTC (ORAL) NPD NPD NPD FEXOFENADINE ODT OTC (ORAL) NPD NPD NPD FEXOFENADINE SUSPENSION OTC (ORAL) NPD NPD NPD FEXOFENADINE-D 12-HOUR OTC (ORAL) NPD NPD NPD LEVOCETIRIZINE SOLUTION (ORAL) NPD NPD NPD LEVOCETIRIZINE TABLETS (ORAL) NPD NPD NPD LORATADINE CAPSULE OTC (ORAL) NPD NPD NPD LORATADINE ODT OTC (ORAL) PDL NPD NPD Financial LORATADINE SOLUTION OTC (ORAL) PDL PDL PDL LORATADINE TABLETS OTC (ORAL) PDL PDL PDL Page 1 of 16

2 ANTIHISTAMINES, MINIMALLY SEDATING (Continued) LORATADINE-D OTC (ORAL) PDL NPD NPD Financial SEMPREX-D (ORAL) NPD NPD NPD XYZAL SOLUTION OTC (ORAL) NPD NPD NPD XYZAL TABLET OTC (ORAL) NPD NPD NPD ZYRTEC ODT OTC (ORAL) NPD NPD NPD ZYRTEC OTC (ORAL) NPD NPD NPD ZYRTEC SOLUTION OTC (ORAL) NPD NPD NPD ZYRTEC-D OTC (ORAL) NPD NPD NPD ANTIHYPERTENSIVES, SYMPATHOLYTICS CATAPRES (ORAL) NPD NPD NPD For this, the Board believed that all of the drugs CATAPRES-TTS (TRANSDERM) PDL PDL PDL being recommended as preferred meet the fiscal requirements of the CLONIDINE (ORAL) PDL PDL PDL state and are the most safe and efficacious. CLONIDINE (TRANSDERM) NPD NPD NPD GUANFACINE (ORAL) PDL PDL PDL METHYLDOPA (ORAL) PDL PDL PDL METHYLDOPA/HYDROCHLOROTHIAZIDE (ORAL) NPD NPD NPD METHYLDOPATE HCL (INTRAVEN) NPD NPD NPD CALCIUM CHANNEL BLOCKERS ADALAT CC (ORAL) NPD NPD NPD For this therapeutic drug class, the Board believed that all of the drugs AMLODIPINE (ORAL) PDL PDL PDL being recommended as preferred demonstrated the greatest safety, CALAN SR (ORAL) NPD NPD NPD efficacy, and value and provided clinicians with the greatest number of CARDIZEM (ORAL) NPD NPD NPD CARDIZEM CD (ORAL) NPD NPD NPD CARDIZEM CD 360 MG (ORAL) NPD NPD NPD CARDIZEM LA (ORAL) NPD NPD NPD DILTIAZEM CAPSULE ER (ORAL) PDL PDL PDL DILTIAZEM LA (AG) (ORAL) NPD NPD NPD DILTIAZEM TABLET (ORAL) PDL PDL PDL FELODIPINE ER (ORAL) PDL PDL PDL ISRADIPINE (ORAL) NPD NPD NPD MATZIM LA (ORAL) NPD NPD NPD NICARDIPINE (ORAL) NPD NPD NPD NIFEDIPINE ER (ORAL) PDL PDL PDL NIFEDIPINE IR (ORAL) NPD NPD NPD NIMODIPINE (ORAL) NPD NPD NPD NISOLDIPINE (ORAL) NPD NPD NPD NORVASC (ORAL) NPD NPD NPD NYMALIZE (ORAL) NPD NPD NPD PROCARDIA (ORAL) NPD NPD NPD PROCARDIA XL (ORAL) NPD NPD NPD TIAZAC (ORAL) NPD NPD NPD TIAZAC 420 MG (ORAL) NPD NPD NPD VERAPAMIL 360 MG CAPSULE (ORAL) NPD NPD NPD VERAPAMIL CAPSULE ER (ORAL) PDL PDL PDL VERAPAMIL ER PM (ORAL) NPD NPD NPD VERAPAMIL TABLET (ORAL) PDL PDL PDL VERAPAMIL TABLET ER (ORAL) PDL PDL PDL VERELAN PM (ORAL) NPD NPD NPD CEPHALOSPORINS AND RELATED ANTIBIOTICS AMOXICILLIN/CLAV CHEW TABLET (ORAL) NPD NPD NPD For this therapeutic drug class, the Board believed that all of the drugs AMOXICILLIN/CLAV SUSPENSION (ORAL) PDL PDL PDL being recommended as preferred demonstrated the greatest safety, AMOXICILLIN/CLAV TABLET (ORAL) PDL PDL PDL efficacy, and value and provided clinicians with the greatest number of AMOXICILLIN/CLAV XR (ORAL) PDL PDL PDL AUGMENTIN 125 SUSPENSION (ORAL) NPD NPD NPD AUGMENTIN 250 SUSPENSION (ORAL) NPD NPD NPD CEFACLOR CAPSULE (ORAL) NPD NPD NPD Page 2 of 16

3 CEPHALOSPORINS AND RELATED ANTIBIOTICS (Continued) CEFACLOR SUSPENSION (ORAL) NPD NPD NPD CEFACLOR TABLET ER (ORAL) NPD NPD NPD CEFADROXIL CAPSULE (ORAL) PDL PDL PDL CEFADROXIL SUSPENSION (ORAL) PDL PDL PDL CEFADROXIL TABLET (ORAL) NPD NPD NPD CEFDINIR CAPSULE (ORAL) PDL PDL PDL CEFDINIR SUSPENSION (ORAL) PDL PDL PDL CEFIXIME SUSPENSION (ORAL) NPD NPD NPD CEFPODOXIME SUSPENSION (ORAL) NPD NPD NPD CEFPODOXIME TABLET (ORAL) NPD NPD NPD CEFPROZIL SUSPENSION (ORAL) PDL PDL PDL CEFPROZIL TABLET (ORAL) NPD NPD NPD CEFTIN SUSPENSION (ORAL) NPD NPD NPD CEFUROXIME TABLET (ORAL) PDL PDL PDL CEPHALEXIN CAPSULE (ORAL) PDL PDL PDL CEPHALEXIN SUSPENSION (ORAL) PDL PDL PDL CEPHALEXIN TABLET (ORAL) NPD NPD NPD DAXBIA (ORAL) NPD NPD NPD KEFLEX (ORAL) NPD NPD NPD SUPRAX CAPSULE (ORAL) NPD NPD NPD X SUPRAX SUSPENSION (ORAL) NPD NPD NPD SUPRAX TAB CHEW (ORAL) NPD NPD NPD FLUOROQUINOLONES, ORAL AVELOX (ORAL) NPD NPD NPD For this, the Board believed that all of the drugs BAXDELA (ORAL) NR NPD NPD Financial being recommended as preferred meet the fiscal requirements of the CIPRO SUSPENSION (ORAL) PDL NPD NPD Financial state and are the most safe and efficacious. The board discussed CIPRO TABLET (ORAL) NPD NPD NPD pharmacy notification of Cipro suspension to non-preferred and access CIPROFLOXACIN ER (ORAL) NPD NPD NPD to Baxdela for treatment of MRSA. CIPROFLOXACIN SUSPENSION (ORAL) NPD PDL PDL Financial CIPROFLOXACIN TABLET (ORAL) PDL PDL PDL LEVAQUIN TABLET (ORAL) NPD NPD NPD LEVOFLOXACIN SOLUTION (ORAL) NPD NPD NPD LEVOFLOXACIN TABLET (ORAL) PDL PDL PDL MOXIFLOXACIN (AG) (ORAL) NPD NPD NPD MOXIFLOXACIN (ORAL) NPD NPD NPD OFLOXACIN (ORAL) NPD NPD NPD GLUCOCORTICOIDS, ORAL BUDESONIDE EC (ORAL) PDL PDL PDL For this therapeutic drug class, the Board believed that all of the drugs CORTEF (ORAL) NPD NPD NPD being recommended as preferred demonstrated the greatest safety, CORTISONE (ORAL) NPD NPD NPD efficacy, and value and provided clinicians with the greatest number of DEXAMETHASONE ELIXIR (ORAL) PDL PDL PDL DEXAMETHASONE INTENSOL (ORAL) NPD NPD NPD DEXAMETHASONE SOLUTION (ORAL) PDL PDL PDL DEXAMETHASONE TAB DS PK (ORAL) NPD NPD NPD DEXAMETHASONE TABLET (ORAL) PDL PDL PDL DEXPAK (ORAL) NPD NPD NPD EMFLAZA SUSPENSION (ORAL) NPD NPD NPD EMFLAZA TABLET (ORAL) NPD NPD NPD ENTOCORT EC (ORAL) NPD NPD NPD HYDROCORTISONE (ORAL) PDL PDL PDL MEDROL TAB DS PK (ORAL) NPD NPD NPD MEDROL TABLET (ORAL) NPD NPD NPD METHYLPREDNISOLONE 16 MG TABLET (ORAL) NPD NPD NPD METHYLPREDNISOLONE 32 MG TABLET (ORAL) NPD NPD NPD METHYLPREDNISOLONE 4 MG TABLET (ORAL) NPD NPD NPD METHYLPREDNISOLONE 8 MG TABLET (ORAL) NPD NPD NPD Page 3 of 16

4 GLUCOCORTICOIDS, ORAL (Continued) METHYLPREDNISOLONE TAB DS PK (ORAL) PDL PDL PDL MILLIPRED DP TAB DS PK (ORAL) NPD NPD NPD MILLIPRED SOLUTION (ORAL) NPD NPD NPD MILLIPRED TABLET (ORAL) NPD NPD NPD ORAPRED ODT (ORAL) NPD NPD NPD PREDNISOLONE SODIUM PHOSPHATE (ORAL) PDL PDL PDL PREDNISOLONE SODIUM PHOSPHATE ODT (AG) (ORAL) NPD NPD NPD PREDNISOLONE SODIUM PHOSPHATE ODT (ORAL) NPD NPD NPD PREDNISOLONE SODIUM PHOSPHATE SOLUTION (MILLIPRED) (ORAL) NPD NPD NPD PREDNISOLONE SODIUM PHOSPHATE SOLUTION (VERIPRED) (ORAL) NPD NPD NPD PREDNISOLONE SOLUTION (ORAL) PDL PDL PDL PREDNISONE INTENSOL (ORAL) NPD NPD NPD PREDNISONE SOLUTION (ORAL) PDL PDL PDL PREDNISONE TAB DS PK (ORAL) NPD NPD NPD PREDNISONE TABLET (ORAL) PDL PDL PDL RAYOS TABLET DR (ORAL) NPD NPD NPD TAPERDEX (ORAL) NR NPD NPD Financial VERIPRED 20 (ORAL) NPD NPD NPD ZODEX (ORAL) NPD NPD NPD IMMUNOSUPPRESSIVES, ORAL ASTAGRAF XL (ORAL) NPD NPD NPD For this therapeutic drug class, the Board believed that all of the drugs AZASAN (ORAL) NPD NPD NPD being recommended as preferred demonstrated the greatest safety, AZATHIOPRINE (ORAL) PDL PDL PDL efficacy, and value and provided clinicians with the greatest number of CELLCEPT CAPSULE (ORAL) NPD NPD NPD CELLCEPT SUSPENSION (ORAL) NPD NPD NPD CELLCEPT TABLET (ORAL) NPD NPD NPD CYCLOSPORINE CAPSULE (ORAL) NPD NPD NPD CYCLOSPORINE SOFTGEL (ORAL) NPD NPD NPD CYCLOSPORINE, MODIFIED CAPSULE (ORAL) PDL PDL PDL CYCLOSPORINE, MODIFIED SOLUTION (ORAL) PDL PDL PDL ENVARSUS XR (ORAL) NPD NPD NPD IMURAN (ORAL) NPD NPD NPD MYCOPHENOLATE MOFETIL CAPSULE (ORAL) PDL PDL PDL MYCOPHENOLATE MOFETIL SUSPENSION (ORAL) NPD NPD NPD MYCOPHENOLATE MOFETIL TABLET (ORAL) PDL PDL PDL MYCOPHENOLIC ACID (ORAL) NPD NPD NPD MYFORTIC (ORAL) NPD NPD NPD NEORAL CAPSULE (ORAL) PDL PDL PDL NEORAL SOLUTION (ORAL) NPD NPD NPD PROGRAF (ORAL) NPD NPD NPD RAPAMUNE SOLUTION (ORAL) PDL PDL PDL RAPAMUNE TABLET (ORAL) NPD NPD NPD SANDIMMUNE CAPSULE (ORAL) NPD NPD NPD SANDIMMUNE SOLUTION (ORAL) NPD NPD NPD SIROLIMUS (AG) (ORAL) PDL PDL PDL SIROLIMUS (ORAL) PDL PDL PDL TACROLIMUS (ORAL) PDL PDL PDL ZORTRESS (ORAL) NPD NPD NPD IRON, ORAL ACTIVE FE TABLET (ORAL) NPD NPD NPD For this therapeutic drug class, the Board believed that all of the drugs CITRANATAL BLOOM (ORAL) NR NPD NPD Financial being recommended as preferred demonstrated the greatest safety, CORVITE 150 TABLET (ORAL) NPD NPD NPD efficacy, and value and provided clinicians with the greatest number of CORVITE FE TABLET (ORAL) NPD NPD NPD The board EZFE 200 CAPSULE OTC (ORAL) NR PDL PDL Financial discussed ensuring a broad selection of various iron salts and product FEOSOL TABLET OTC (ORAL) NR NPD NPD Financial tolerability, as well as having a product with folic acid available for FERGON TABLET OTC (ORAL) NR NPD NPD Financial Page 4 of 16

5 pregnant patients. IRON, ORAL (Continued) FER-IN-SOL DROPS OTC (ORAL) NR NPD NPD Financial FERIVA 21-7 (ORAL) NPD NPD NPD FERIVA FA CAPSULE (ORAL) NPD NPD NPD FERRALET 90 DUAL-IRON TABLET (ORAL) PDL PDL PDL X FERRAPLUS 90 TABLET (ORAL) NPD NPD NPD FERREX 150 FORTE PLUS CAPSULE (ORAL) NR NPD NPD Financial FERREX 28 TABLET (ORAL) NR NPD NPD Financial FERRIMIN 150 TABLET OTC (ORAL) NR NPD NPD Financial FERROUS FUMARATE TABLET OTC (ORAL) NR PDL PDL Financial FERROUS FUMARATE/FA/MULTIVITAMIN & MINERALS CAPSULE (ORAL) PDL PDL PDL FERROUS FUMARATE/IRON POLYSACCHARIDES/FA/MULTIVITAMIN CAPSULE (ORAL) PDL PDL PDL FERROUS GLUCONATE TABLET OTC (ORAL) PDL PDL PDL FERROUS SULFATE DROPS OTC (ORAL) NR PDL PDL Financial FERROUS SULFATE SOLUTION OTC (ORAL) NR PDL PDL Financial FERROUS SULFATE TABLET ER OTC (ORAL) PDL PDL PDL FERROUS SULFATE TABLET OTC (ORAL) NR PDL PDL Financial FERROUS SULFATE, DRIED TABLET ER OTC (ORAL) NR PDL PDL Financial FERROUS SULFATE/ASCORBIC ACID/FA TABLET ER OTC (ORAL) NR NPD NPD Financial FOLIVANE-F CAPSULE (ORAL) NR NPD NPD Financial FUSION OTC (ORAL) NPD NPD NPD FUSION PLUS CAPSULE (ORAL) NPD NPD NPD HEMOCYTE PLUS CAPSULE (ORAL) PDL PDL PDL X HEMOCYTE TABLET OTC (ORAL) NR NPD NPD Financial HEMOCYTE-F TABLET (ORAL) PDL PDL PDL X ICAR SUSPENSION OTC (ORAL) NR NPD NPD Financial ICAR-C TABLET OTC (ORAL) NR NPD NPD Financial INTEGRA CAPSULE OTC (ORAL) PDL PDL PDL INTEGRA F CAPSULE (ORAL) PDL PDL PDL X INTEGRA PLUS CAPSULE (ORAL) PDL PDL PDL X IRON CARBONYL SUSPENSION OTC (ORAL) NR NPD NPD Financial IRON CARBONYL/ASCORBIC ACID TABLET OTC (ORAL) NR PDL PDL Financial IRON CARBONYL/IRON GLUCONATE/FA/B12/ASCORBIC ACID/DOCUSATE TABLET (ORAL) NPD NPD NPD IRON POLYSACCHARIDES CAPSULE OTC (ORAL) NR PDL PDL Financial IRON POLYSACCHARIDES/B12/FA CAPSULE (ORAL) PDL PDL PDL IROSPAN TABLET (ORAL) NPD NPD NPD NEPHRON FA TABLET (ORAL) PDL PDL PDL NOVAFERRUM 125 LIQUID OTC (ORAL) NPD NPD NPD NOVAFERRUM 50 CAPSULE OTC (ORAL) NPD NPD NPD NOVAFERRUM DROPS OTC (ORAL) NPD NPD NPD NU-IRON 150 CAPSULE OTC (ORAL) NR NPD NPD Financial SLOW FE TABLET ER OTC (ORAL) NR NPD NPD Financial TANDEM DUAL ACTION CAPSULE OTC (ORAL) PDL PDL PDL TANDEM PLUS CAPSULE (ORAL) PDL PDL PDL X TARON FORTE CAPSULE (ORAL) NPD NPD NPD TL-HEM 150 TABLET ER 24H (ORAL) NR NPD NPD Financial LEUKOTRIENE MODIFIERS ACCOLATE (ORAL) NPD NPD NPD For this, the Board believed that all of the drugs MONTELUKAST CHEWABLE TABLET (ORAL) PDL PDL PDL being recommended as preferred meet the fiscal requirements of the MONTELUKAST GRANULES (ORAL) NPD NPD NPD state and are the most safe and efficacious. MONTELUKAST TABLET (ORAL) PDL PDL PDL SINGULAIR CHEWABLE TABLET (ORAL) NPD NPD NPD SINGULAIR GRANULES (ORAL) NPD NPD NPD SINGULAIR TABLET (ORAL) NPD NPD NPD ZAFIRLUKAST (ORAL) NPD NPD NPD ZILEUTON ER (ORAL) NPD NPD NPD ZYFLO (ORAL) NPD NPD NPD Page 5 of 16

6 ZYFLO CR (ORAL) NPD NPD NPD Page 6 of 16

7 NSAIDS ADVIL MIGRAINE CAPSULE OTC (ORAL) NPD NPD NPD For this therapeutic drug class, the Board believed that all of the drugs being recommended as preferred demonstrated the greatest safety, efficacy, and value and provided clinicians with the greatest number of ADVIL OTC (ORAL) NPD NPD NPD ADVIL TAB CHEW OTC (ORAL) NPD NPD NPD ALEVE TABLET OTC (ORAL) NPD NPD NPD ANAPROX (ORAL) NPD NPD NPD ARTHROTEC (ORAL) NPD NPD NPD CELEBREX (ORAL) NPD NPD NPD CELECOXIB (AG) (ORAL) NPD NPD NPD CELECOXIB (ORAL) NPD NPD NPD CHILDREN'S MOTRIN ORAL SUSP OTC (ORAL) NPD NPD NPD DERMACINRX LEXITRAL (TOPICAL) NPD NPD NPD DICLOFENAC GEL (TOPICAL) NPD NPD NPD DICLOFENAC POTASSIUM (ORAL) NPD NPD NPD DICLOFENAC SODIUM (ORAL) NPD NPD NPD DICLOFENAC SODIUM/MISOPROSTOL (ORAL) NPD NPD NPD DICLOFENAC SOLUTION (TOPICAL) NPD NPD NPD DICLOFENAC SR (ORAL) NPD NPD NPD DICLOFENAC/CAPSICUM OLEORESIN KIT (MISCELL.) NPD NPD NPD DIFLUNISAL (ORAL) NPD NPD NPD DUEXIS (ORAL) NPD NPD NPD ETODOLAC (ORAL) NPD NPD NPD ETODOLAC TAB SR (ORAL) NPD NPD NPD FELDENE (ORAL) NPD NPD NPD FENOPROFEN (AG) (ORAL) NPD NPD NPD FENOPROFEN (ORAL) NPD NPD NPD FLECTOR (TOPICAL) NPD NPD NPD X FLURBIPROFEN (ORAL) NPD NPD NPD IBUPROFEN CAPSULE OTC (ORAL) PDL PDL PDL IBUPROFEN DROPS SUSPENSION OTC (ORAL) PDL PDL PDL IBUPROFEN SUSPENSION (ORAL) PDL PDL PDL IBUPROFEN SUSPENSION OTC (ORAL) PDL PDL PDL IBUPROFEN TAB CHEW OTC (ORAL) PDL PDL PDL IBUPROFEN TABLET (ORAL) PDL PDL PDL IBUPROFEN TABLET OTC (ORAL) PDL PDL PDL INDOCIN SUSPENSION (ORAL) NPD NPD NPD INDOMETHACIN CAPSULE (ORAL) PDL PDL PDL INDOMETHACIN CAPSULE ER (ORAL) NPD NPD NPD INFANT'S MOTRIN DROPS SUSP OTC (ORAL) NPD NPD NPD KETOPROFEN (ORAL) NPD NPD NPD KETOPROFEN ER (ORAL) NPD NPD NPD KETOROLAC (ORAL) PDL NPD NPD Financial MECLOFENAMATE (ORAL) NPD NPD NPD MEFENAMIC ACID (ORAL) NPD NPD NPD MELOXICAM SUSPENSION (ORAL) NPD NPD NPD MELOXICAM TABLET (ORAL) PDL PDL PDL MOBIC TABLET (ORAL) NPD NPD NPD NABUMETONE (ORAL) NPD NPD NPD NALFON (ORAL) NPD NPD NPD NAPRELAN (ORAL) NPD NPD NPD NAPROXEN CR (AG) (ORAL) NPD NPD NPD NAPROXEN CR (ORAL) NPD NPD NPD NAPROXEN EC (ORAL) NPD NPD NPD NAPROXEN SODIUM (ORAL) NPD NPD NPD NAPROXEN SODIUM OTC (ORAL) PDL PDL PDL NAPROXEN SUSPENSION (ORAL) NPD NPD NPD NAPROXEN TABLET (ORAL) PDL PDL PDL Page 7 of 16

8 NSAIDS (Continued) OXAPROZIN (ORAL) NPD NPD NPD PENNSAID PUMP (TOPICAL) NPD NPD NPD PIROXICAM (ORAL) NPD NPD NPD SPRIX (NASAL) NPD NPD NPD SULINDAC (ORAL) NPD NPD NPD TIVORBEX (ORAL) NPD NPD NPD TOLMETIN SODIUM CAPSULE (ORAL) NPD NPD NPD TOLMETIN SODIUM TABLET (ORAL) NPD NPD NPD VIMOVO (ORAL) NPD NPD NPD VIVLODEX (ORAL) NPD NPD NPD VOLTAREN (TOPICAL) NPD PDL PDL Financial VOPAC MDS (TOPICAL) NPD NPD NPD XRYLIX KIT (TOPICAL) NPD NPD NPD ZIPSOR (ORAL) NPD NPD NPD ZORVOLEX (ORAL) NPD NPD NPD OPHTHALMIC ANTIBIOTICS AZASITE (OPHTHALMIC) NPD NPD NPD For this therapeutic drug class, the Board believed that all of the drugs BACITRACIN (OPHTHALMIC) NPD NPD NPD being recommended as preferred demonstrated the greatest safety, BACITRACIN/POLYMYXIN B SULFATE OINT. (OPHTHALMIC) PDL PDL PDL efficacy, and value and provided clinicians with the greatest number of BESIVANCE (OPHTHALMIC) NPD NPD NPD BLEPH-10 (OPHTHALMIC) NPD NPD NPD CILOXAN DROPS (OPHTHALMIC) NPD NPD NPD CILOXAN OINTMENT (OPHTHALMIC) NPD NPD NPD CIPROFLOXACIN SOLUTION (OPHTHALMIC) PDL PDL PDL ERYTHROMYCIN (OPHTHALMIC) PDL PDL PDL GATIFLOXACIN (OPHTHALMIC) NPD NPD NPD GENTAMICIN DROPS (OPHTHALMIC) PDL PDL PDL GENTAMICIN OINT. (OPHTHALMIC) PDL PDL PDL LEVOFLOXACIN (OPHTHALMIC) NPD NPD NPD MOXEZA (OPHTHALMIC) PDL PDL PDL X MOXIFLOXACIN (AG) (VIGAMOX) (OPHTHALMIC) NPD NPD NPD MOXIFLOXACIN (VIGAMOX) (OPHTHALMIC) NPD NPD NPD NATACYN (OPHTHALMIC) NPD NPD NPD NEOMYCIN/BACITRACIN/POLYMYXIN OINT (OPHTHALMIC) NPD NPD NPD NEOMYCIN-POLYMYXIN-GRAMICIDIN (OPHTHALMIC) NPD NPD NPD OCUFLOX (OPHTHALMIC) NPD NPD NPD OFLOXACIN (OPHTHALMIC) NPD NPD NPD POLYMYXIN/TRIMETHOPRIM (OPHTHALMIC) PDL PDL PDL POLYTRIM (OPHTHALMIC) NPD NPD NPD SULFACETAMIDE OINTMENT (OPHTHALMIC) NPD NPD NPD SULFACETAMIDE SOLUTION (OPHTHALMIC) NPD NPD NPD TOBRAMYCIN (OPHTHALMIC) PDL PDL PDL TOBREX DROPS (OPHTHALMIC) NPD NPD NPD TOBREX OINTMENT (OPHTHALMIC) PDL PDL PDL VIGAMOX (OPHTHALMIC) PDL NPD NPD Clinical and Financial ZYMAXID (OPHTHALMIC) NPD NPD NPD OPHTHALMIC ANTIBIOTIC-STEROID COMBINATIONS BLEPHAMIDE (OPHTHALMIC) PDL PDL PDL For this, the Board believed that all of the drugs BLEPHAMIDE S.O.P. (OPHTHALMIC) NPD NPD NPD being recommended as preferred meet the fiscal requirements of the MAXITROL DROPS SUSP (OPHTHALMIC) NPD NPD NPD state and are the most safe and efficacious. MAXITROL OINT. (OPHTHALMIC) NPD NPD NPD NEOMYCIN/BACITRACIN/POLY/HC (OPHTHALMIC) NPD NPD NPD NEOMYCIN/POLYMYXIN/DEXAMETHASONE (OPHTHALMIC) PDL PDL PDL NEOMYCIN/POLYMYXIN/HC (OPHTHALMIC) NPD NPD NPD PRED-G DROPS SUSP (OPHTHALMIC) NPD NPD NPD PRED-G OINT. (OPHTHALMIC) NPD NPD NPD Page 8 of 16

9 OPHTHALMIC ANTIBIOTIC-STEROID COMBINATIONS SULFACETAMIDE / PREDNISOLONE (OPHTHALMIC) PDL PDL PDL TOBRADEX OINTMENT (OPHTHALMIC) PDL PDL PDL TOBRADEX ST (OPHTHALMIC) NPD NPD NPD TOBRADEX SUSPENSION (OPHTHALMIC) NPD NPD NPD TOBRAMYCIN / DEXAMETHASONE SUSPENSION (AG) (OPHTHALMIC) NPD NPD NPD TOBRAMYCIN / DEXAMETHASONE SUSPENSION (OPHTHALMIC) NPD NPD NPD ZYLET (OPHTHALMIC) NPD NPD NPD OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS ALOCRIL (OPHTHALMIC) NPD NPD NPD For this, the Board believed that all of the drugs ALOMIDE (OPHTHALMIC) NPD NPD NPD being recommended as preferred meet the fiscal requirements of the ALREX (OPHTHALMIC) NPD NPD NPD state and are the most safe and efficacious. AZELASTINE (OPHTHALMIC) NPD NPD NPD BEPREVE (OPHTHALMIC) NPD NPD NPD CROMOLYN SODIUM (OPHTHALMIC) PDL PDL PDL EMADINE (OPHTHALMIC) NPD NPD NPD EPINASTINE (OPHTHALMIC) NPD NPD NPD KETOTIFEN OTC (OPHTHALMIC) NPD NPD NPD LASTACAFT (OPHTHALMIC) NPD NPD NPD OLOPATADINE (PATANOL) (AG) (OPHTHALMIC) NPD NPD NPD OLOPATADINE (PATANOL) (OPHTHALMIC) NPD NPD NPD OLOPATADINE DROPS (PATADAY) (AG) (OPHTHALMIC) NPD NPD NPD OLOPATADINE DROPS (PATADAY) (OPHTHALMIC) NPD NPD NPD PATADAY (OPHTHALMIC) NPD NPD NPD PATANOL (OPHTHALMIC) NPD NPD NPD PAZEO (OPHTHALMIC) PDL PDL PDL X ZADITOR OTC (OPHTHALMIC) NPD NPD NPD OPHTHALMICS, ANTI-INFLAMMATORIES ACULAR (OPHTHALMIC) NPD NPD NPD For this therapeutic drug class, the Board believed that all of the drugs ACULAR LS (OPHTHALMIC) NPD NPD NPD being recommended as preferred demonstrated the greatest safety, ACUVAIL (OPHTHALMIC) NPD NPD NPD efficacy, and value and provided clinicians with the greatest number of BROMFENAC (OPHTHALMIC) NPD NPD NPD BROMSITE (OPHTHALMIC) NPD NPD NPD DEXAMETHASONE (OPHTHALMIC) NPD NPD NPD DICLOFENAC (OPHTHALMIC) PDL PDL PDL DUREZOL (OPHTHALMIC) PDL PDL PDL FLAREX (OPHTHALMIC) NPD NPD NPD FLUOROMETHOLONE (OPHTHALMIC) NPD NPD NPD FLURBIPROFEN (OPHTHALMIC) PDL PDL PDL FML (OPHTHALMIC) NPD NPD NPD FML FORTE (OPHTHALMIC) NPD NPD NPD FML S.O.P. (OPHTHALMIC) NPD NPD NPD ILEVRO (OPHTHALMIC) NPD NPD NPD KETOROLAC (OPHTHALMIC) PDL PDL PDL KETOROLAC LS (OPHTHALMIC) NPD NPD NPD LOTEMAX DROPS (OPHTHALMIC) PDL PDL PDL LOTEMAX GEL (OPHTHALMIC) NPD NPD NPD LOTEMAX OINTMENT (OPHTHALMIC) NPD NPD NPD MAXIDEX (OPHTHALMIC) NPD NPD NPD NEVANAC (OPHTHALMIC) PDL PDL PDL PRED FORTE (OPHTHALMIC) NPD NPD NPD PRED MILD (OPHTHALMIC) NPD NPD NPD PREDNISOLONE ACETATE (OPHTHALMIC) PDL PDL PDL PREDNISOLONE SOD PHOSPHATE (OPHTHALMIC) NPD NPD NPD PROLENSA (OPHTHALMIC) NPD NPD NPD OPHTHALMICS, GLAUCOMA AGENTS ALPHAGAN P 0.1% (OPHTHALMIC) NPD PEND PEND Page 9 of 16

10 For this, the Board elected to postpone review until October in order to gather more information. OPHTHALMICS, GLAUCOMA AGENTS (Continued) ALPHAGAN P 0.15% (OPHTHALMIC) NPD PEND PEND APRACLONIDINE (OPHTHALMIC) NPD PEND PEND AZOPT (OPHTHALMIC) PDL PEND PEND BETAXOLOL (OPHTHALMIC) NPD PEND PEND BETIMOL (OPHTHALMIC) NPD PEND PEND BETOPTIC S (OPHTHALMIC) NPD PEND PEND BIMATOPROST 2.5ML (OPHTHALMIC) NPD PEND PEND BIMATOPROST 5ML (OPHTHALMIC) NPD PEND PEND BIMATOPROST 7.5ML (OPHTHALMIC) NPD PEND PEND BRIMONIDINE (OPHTHALMIC) PDL PEND PEND BRIMONIDINE P 0.15% (OPHTHALMIC) NPD PEND PEND CARTEOLOL (OPHTHALMIC) PDL PEND PEND COMBIGAN (OPHTHALMIC) PDL PEND PEND COSOPT (OPHTHALMIC) NPD PEND PEND COSOPT PF (OPHTHALMIC) NPD PEND PEND DORZOLAMIDE (OPHTHALMIC) PDL PEND PEND DORZOLAMIDE / TIMOLOL (OPHTHALMIC) PDL PEND PEND IOPIDINE (OPHTHALMIC) NPD PEND PEND ISTALOL (OPHTHALMIC) NPD PEND PEND LATANOPROST 2.5 ML (OPHTHALMIC) PDL PEND PEND LEVOBUNOLOL (OPHTHALMIC) PDL PEND PEND LUMIGAN 2.5ML (OPHTHALMIC) NPD PEND PEND LUMIGAN 5ML (OPHTHALMIC) NPD PEND PEND LUMIGAN 7.5ML (OPHTHALMIC) NPD PEND PEND PHOSPHOLINE IODIDE (OPHTHALMIC) NPD PEND PEND PILOCARPINE (OPHTHALMIC) PDL PEND PEND RHOPRESSA (OPHTHALMIC) NR PEND PEND X SIMBRINZA (OPHTHALMIC) PDL PEND PEND X TIMOLOL (ISTALOL) (OPHTHALMIC) NPD PEND PEND TIMOLOL (OPHTHALMIC) PDL PEND PEND TIMOPTIC OCUDOSE (OPHTHALMIC) NPD PEND PEND TRAVATAN Z 2.5 ML (OPHTHALMIC) PDL PEND PEND TRAVATAN Z 5 ML (OPHTHALMIC) PDL PEND PEND TRUSOPT (OPHTHALMIC) NPD PEND PEND VYZULTA (OPHTHALMIC) NPD PEND PEND XALATAN 2.5 ML (OPHTHALMIC) NPD PEND PEND ZIOPTAN (OPHTHALMIC) NPD PEND PEND OTIC ANTIBIOTICS CIPRO HC (OTIC) NPD NPD NPD For this, the Board believed that all of the drugs CIPRODEX (OTIC) PDL PDL PDL X being recommended as preferred meet the fiscal requirements of the CIPROFLOXACIN (OTIC) PDL PDL PDL state and are the most safe and efficacious. COLY-MYCIN S (OTIC) NPD NPD NPD NEOMYCIN/POLYMYXIN/HC SOLN/SUSP (OTIC) PDL PDL PDL OFLOXACIN (OTIC) NPD NPD NPD OTIPRIO (OTIC) NPD NPD NPD OTOVEL (OTIC) NPD NPD NPD OTIC ANTI-INFECTIVES & ANESTHETICS ACETIC ACID (OTIC) PDL PDL PDL For this, the Board believed that all of the drugs being recommended as preferred meet the fiscal requirements of the state and are the most safe and efficacious. ACETIC ACID HC (OTIC) NPD NPD NPD PRENATAL VITAMINS CITRANATAL 90 DHA (ORAL) PDL PDL PDL X For this therapeutic drug class, the Board believed that all of the drugs CITRANATAL ASSURE (ORAL) PDL PDL PDL X Page 10 of 16

11 being recommended as preferred demonstrated the greatest safety, efficacy, and value and provided clinicians with the greatest number of PRENATAL VITAMINS (Continued) CITRANATAL B-CALM (ORAL) NPD PDL PDL X Financial CITRANATAL DHA (ORAL) NPD PDL PDL X Financial CITRANATAL HARMONY (ORAL) PDL PDL PDL X CITRANATAL RX (ORAL) NPD PDL PDL X Financial COMPLETENATE CHEW TABLET (ORAL) NPD NPD NPD CONCEPT DHA (ORAL) NPD NPD NPD CONCEPT OB (ORAL) NPD NPD NPD EXTRA-VIRT PLUS DHA (ORAL) NPD NPD NPD FE C/FA (ORAL) NPD NPD NPD FOCALGIN 90 DHA (ORAL) NPD NPD NPD ICAR-C PLUS (ORAL) NPD NPD NPD NESTABS (ORAL) NPD NPD NPD NESTABS ABC (ORAL) NPD NPD NPD NESTABS DHA (ORAL) NPD NPD NPD OB COMPLETE ONE (ORAL) NPD NPD NPD OB COMPLETE PETITE (ORAL) NPD NPD NPD OB COMPLETE PREMIER (ORAL) NPD NPD NPD OB COMPLETE TABLET (ORAL) NPD NPD NPD PNV #19/IRON PS&HEME/FOLIC/DHA (ORAL) NPD NPD NPD PNV 11-IRON FUM-FOLIC ACID-OM3 (ORAL) NPD NPD NPD PNV COMBO #22/IRON/FA/OM3/DHA (ORAL) NPD NPD NPD PNV COMBO#47/IRON/FA #1/DHA (ORAL) NPD NPD NPD PNV NO.118/IRON FUMARATE/FA CHEW TABLET (ORAL) NPD NPD NPD PNV NO.15/IRON FUM & PS CMP/FA (ORAL) NPD NPD NPD PNV W-CA NO.40/IRON FUM/FA CMB NO.1 (ORAL) NPD NPD NPD PNV WITH CA NO.68/IRON/FA NO.1/DHA (ORAL) NPD NPD NPD PNV WITH CA,NO.72/IRON/FA (ORAL) NPD NPD NPD PNV#16/IRON FUM & PS/FA/OM-3 (ORAL) NPD NPD NPD PNV#21/IRON PS& HEME POLYP/FA (ORAL) NPD NPD NPD PNV/FA/B6/CALCIUM PHOS/GINGER (ORAL) NPD NPD NPD PNV119/IRON FUMARATE/FA/DSS TABLET (ORAL) NPD NPD NPD PNV2/IRON B-G SUC-P/FA/OMEGA-3 (ORAL) NPD NPD NPD PNV53/IRON B-G HCL-P/FA/OMEGA3 (ORAL) NPD NPD NPD PNV66/IRON FUMARATE/FA/DSS/DHA (ORAL) NPD NPD NPD PNV73/IRON,CARB&GLU/FA/DSS/DHA (ORAL) NPD NPD NPD PNV80/IRON FUMARATE/FA/DSS/DHA (ORAL) NPD NPD NPD PREFERA OB (ORAL) NPD NPD NPD PREFERA-OB ONE (ORAL) NPD NPD NPD PREFERA-OB PLUS DHA (ORAL) NPD NPD NPD PRENATAL VIT #76/IRON,CARB/FA (ORAL) NPD NPD NPD PRENATAL VIT 15/IRON CB/FA/DSS (ORAL) NPD NPD NPD PRENATAL VIT 16/IRON CB/FA/DSS (ORAL) NPD NPD NPD PRENATAL VIT NO.73/IRON/FA (ORAL) NPD NPD NPD PRENATAL VIT27&CALCIUM/IRON/FA (ORAL) NPD NPD NPD PRENATE AM (ORAL) NPD NPD NPD PRENATE CHEWABLE TABLET (ORAL) NPD NPD NPD PRENATE DHA (ORAL) NPD NPD NPD PRENATE ELITE (ORAL) NPD NPD NPD PRENATE ENHANCE (ORAL) NPD NPD NPD PRENATE ESSENTIAL (ORAL) NPD NPD NPD PRENATE MINI (ORAL) NPD NPD NPD PRENATE PIXIE (ORAL) NPD NPD NPD PRENATE RESTORE (ORAL) NPD NPD NPD PRENATE STAR (ORAL) NPD NPD NPD PROVIDA DHA (ORAL) NPD NPD NPD PROVIDA OB (ORAL) PDL PDL PDL X Page 11 of 16

12 PRENATAL VITAMINS (Continued) PV W-O VIT A/FE FUMARATE/FA TAB CHEW (ORAL) NPD NPD NPD SELECT-OB + DHA (ORAL) PDL PDL PDL X SELECT-OB TAB CHEW (ORAL) NPD NPD NPD X TRICARE (ORAL) PDL PDL PDL X TRICARE DHA (ORAL) NPD NPD NPD TRINATAL RX 1 (ORAL) PDL PDL PDL TRISTART DHA (ORAL) NPD NPD NPD VITAFOL NANO (ORAL) PDL PDL PDL X VITAFOL ULTRA (ORAL) PDL PDL PDL X VITAFOL-OB (ORAL) NPD NPD NPD X VITAFOL-OB+DHA (ORAL) PDL PDL PDL X VITAFOL-ONE (ORAL) PDL PDL PDL X VOL-PLUS (ORAL) PDL PDL PDL VP-CH-PNV (ORAL) NPD NPD NPD VP-PNV-DHA (ORAL) NPD NPD NPD SKELETAL MUSCLE RELAXANTS AMRIX (ORAL) NPD NPD NPD For this therapeutic drug class, the Board believed that all of the drugs BACLOFEN (ORAL) PDL PDL PDL being recommended as preferred demonstrated the greatest safety, CARISOPRODOL (ORAL) PDL PDL PDL efficacy, and value and provided clinicians with the greatest number of CARISOPRODOL 250 MG (ORAL) NPD NPD NPD CARISOPRODOL COMPOUND (ORAL) NPD NPD NPD CHLORZOXAZONE (ORAL) PDL NPD NPD Financial CYCLOBENZAPRINE (ORAL) PDL PDL PDL DANTRIUM (ORAL) NPD NPD NPD DANTROLENE SODIUM (AG) (ORAL) NPD NPD NPD DANTROLENE SODIUM (ORAL) NPD NPD NPD LORZONE (ORAL) NPD NPD NPD METAXALONE (ORAL) NPD NPD NPD METHOCARBAMOL (ORAL) PDL PDL PDL ORPHENADRINE ER (ORAL) NPD NPD NPD ROBAXIN (ORAL) NPD NPD NPD SKELAXIN (ORAL) NPD NPD NPD SOMA (ORAL) NPD NPD NPD TIZANIDINE CAPSULES (ORAL) NPD NPD NPD TIZANIDINE TABLETS (ORAL) PDL PDL PDL ZANAFLEX CAPSULE (ORAL) NPD NPD NPD ZANAFLEX TABLET (ORAL) NPD NPD NPD STEROIDS, TOPICAL HIGH AMCINONIDE CREAM (TOPICAL) NPD NPD NPD For this therapeutic drug class, the Board believed that all of the drugs AMCINONIDE LOTION (TOPICAL) NPD NPD NPD being recommended as preferred demonstrated the greatest safety, BETAMET DIPROP / PROP GLY CREAM (TOPICAL) PDL PDL PDL efficacy, and value and provided clinicians with the greatest number of BETAMET DIPROP / PROP GLY LOTION (TOPICAL) NPD NPD NPD BETAMET DIPROP / PROP GLY OINTMENT (TOPICAL) NPD NPD NPD BETAMETHASONE DIPROPIONATE CREAM (TOPICAL) NPD NPD NPD BETAMETHASONE DIPROPIONATE GEL (TOPICAL) NPD NPD NPD BETAMETHASONE DIPROPIONATE LOTION (TOPICAL) PDL PDL PDL BETAMETHASONE DIPROPIONATE OINTMENT (TOPICAL) NPD NPD NPD BETAMETHASONE VALERATE CREAM (TOPICAL) PDL PDL PDL BETAMETHASONE VALERATE LOTION (TOPICAL) NPD NPD NPD BETAMETHASONE VALERATE OINTMENT (TOPICAL) NPD NPD NPD DERMACINRX SILAPAK (TOPICAL) NPD NPD NPD DERMACINRX SILAZONE (TOPICAL) NPD NPD NPD DERMASORB TA (TOPICAL) NPD NPD NPD DESOXIMETASONE CREAM (TOPICAL) NPD NPD NPD DESOXIMETASONE GEL (TOPICAL) NPD NPD NPD DESOXIMETASONE OINTMENT (TOPICAL) NPD NPD NPD Page 12 of 16

13 STEROIDS, TOPICAL HIGH DIFLORASONE DIACETATE CREAM (TOPICAL) NPD NPD NPD DIFLORASONE DIACETATE OINTMENT (TOPICAL) NPD NPD NPD DIPROLENE OINTMENT (TOPICAL) NPD NPD NPD ELLZIA PAK (TOPICAL) NPD NPD NPD FLUOCINONIDE CREAM (TOPICAL) NPD NPD NPD FLUOCINONIDE EMOLLIENT (TOPICAL) NPD NPD NPD FLUOCINONIDE GEL (TOPICAL) NPD NPD NPD FLUOCINONIDE OINTMENT (TOPICAL) NPD NPD NPD FLUOCINONIDE SOLUTION (TOPICAL) NPD NPD NPD HALOG CREAM (TOPICAL) NPD NPD NPD HALOG OINTMENT (TOPICAL) NPD NPD NPD KENALOG AEROSOL (TOPICAL) NPD NPD NPD SERNIVO SPRAY (TOPICAL) NPD NPD NPD SILAZONE-II (TOPICAL) NPD NPD NPD TOPICORT CREAM (TOPICAL) NPD NPD NPD TOPICORT OINTMENT (TOPICAL) NPD NPD NPD TOPICORT SPRAY (TOPICAL) NPD NPD NPD TRIAMCINOLONE ACETONIDE AEROSOL (TOPICAL) NPD NPD NPD TRIAMCINOLONE ACETONIDE CREAM (TOPICAL) PDL PDL PDL TRIAMCINOLONE ACETONIDE LOTION (TOPICAL) NPD NPD NPD TRIAMCINOLONE ACETONIDE OINTMENT (TOPICAL) PDL PDL PDL TRIAMCINOLONE ACETONIDE/DIMETHICONE (TOPICAL) NPD NPD NPD TRIANEX OINTMENT (TOPICAL) NPD NPD NPD STEROIDS, TOPICAL LOW ALA-CORT CREAM (TOPICAL) NPD NPD NPD For this therapeutic drug class, the Board believed that all of the drugs ALA-SCALP HP (TOPICAL) NPD NPD NPD being recommended as preferred demonstrated the greatest safety, ALCLOMETASONE DIPROPIONATE CREAM (TOPICAL) NPD NPD NPD efficacy, and value and provided clinicians with the greatest number of ALCLOMETASONE DIPROPIONATE OINTMENT (TOPICAL) NPD NPD NPD AQUA GLYCOLIC HC (TOPICAL) NPD NPD NPD CAPEX SHAMPOO (TOPICAL) NPD NPD NPD DERMA-SMOOTHE-FS (TOPICAL) NPD PDL PDL X Financial DERMASORB HC (TOPICAL) NPD NPD NPD DESONATE GEL (TOPICAL) NPD NPD NPD DESONIDE CREAM (TOPICAL) NPD NPD NPD DESONIDE LOTION (TOPICAL) NPD NPD NPD DESONIDE OINTMENT (TOPICAL) NPD NPD NPD FLUOCINOLONE 0.01% OIL (TOPICAL) PDL NPD NPD Financial HYDROCORTISONE / MIN OIL / PET OINTMENT (TOPICAL) NPD NPD NPD HYDROCORTISONE ACETATE CREAM OTC (TOPICAL) PDL PDL PDL HYDROCORTISONE ACETATE OINTMENT OTC (TOPICAL) PDL PDL PDL HYDROCORTISONE CREAM (TOPICAL) PDL PDL PDL HYDROCORTISONE CREAM OTC (TOPICAL) PDL PDL PDL HYDROCORTISONE LOTION (TOPICAL) NPD NPD NPD HYDROCORTISONE LOTION OTC (TOPICAL) PDL PDL PDL HYDROCORTISONE OINTMENT (TOPICAL) PDL PDL PDL HYDROCORTISONE OINTMENT OTC (TOPICAL) PDL PDL PDL HYDROCORTISONE SOLUTION OTC (TOPICAL) NPD NPD NPD HYDROCORTISONE-ALOE CREAM OTC (TOPICAL) PDL PDL PDL MICORT-HC (TOPICAL) NPD NPD NPD SCALPICIN OTC (TOPICAL) NPD NPD NPD TEXACORT (TOPICAL) NPD NPD NPD X STEROIDS, TOPICAL MEDIUM BETAMETHASONE VALERATE FOAM (TOPICAL) NPD NPD NPD For this therapeutic drug class, the Board believed that all of the drugs CLOCORTOLONE CREAM (AG) (TOPICAL) NPD NPD NPD being recommended as preferred demonstrated the greatest safety, CLODERM (TOPICAL) NPD NPD NPD efficacy, and value and provided clinicians with the greatest number of CORDRAN TAPE (TOPICAL) NPD NPD NPD Page 13 of 16

14 STEROIDS, TOPICAL MEDIUM CUTIVATE LOTION (TOPICAL) NPD NPD NPD ELOCON CREAM (TOPICAL) NPD NPD NPD ELOCON OINTMENT (TOPICAL) NPD NPD NPD FLUOCINOLONE ACETONIDE CREAM (TOPICAL) NPD NPD NPD FLUOCINOLONE ACETONIDE OINTMENT (TOPICAL) NPD NPD NPD FLUOCINOLONE ACETONIDE SOLUTION (TOPICAL) NPD NPD NPD FLURANDRENOLIDE CREAM (TOPICAL) NPD NPD NPD FLURANDRENOLIDE LOTION (AG) (TOPICAL) NPD NPD NPD FLURANDRENOLIDE LOTION (TOPICAL) NPD NPD NPD FLURANDRENOLIDE OINTMENT (TOPICAL) NPD NPD NPD FLUTICASONE PROPIONATE CREAM (TOPICAL) PDL PDL PDL FLUTICASONE PROPIONATE LOTION (TOPICAL) NPD NPD NPD FLUTICASONE PROPIONATE OINTMENT (TOPICAL) PDL PDL PDL HYDROCORTISONE BUTYRATE CREAM (AG) (TOPICAL) NPD NPD NPD HYDROCORTISONE BUTYRATE CREAM (TOPICAL) NPD NPD NPD HYDROCORTISONE BUTYRATE LOTION (TOPICAL) NPD NPD NPD HYDROCORTISONE BUTYRATE OINTMENT (AG) (TOPICAL) NPD NPD NPD HYDROCORTISONE BUTYRATE OINTMENT (TOPICAL) NPD NPD NPD HYDROCORTISONE BUTYRATE SOLUTION (AG) (TOPICAL) NPD NPD NPD HYDROCORTISONE BUTYRATE SOLUTION (TOPICAL) NPD NPD NPD HYDROCORTISONE BUTYRATE/EMOLLIENT (AG) (TOPICAL) NPD NPD NPD HYDROCORTISONE BUTYRATE/EMOLLIENT (TOPICAL) NPD NPD NPD HYDROCORTISONE VALERATE CREAM (TOPICAL) NPD NPD NPD HYDROCORTISONE VALERATE OINTMENT (TOPICAL) NPD NPD NPD LUXIQ (TOPICAL) NPD NPD NPD MOMETASONE FUROATE CREAM (TOPICAL) PDL PDL PDL MOMETASONE FUROATE OINTMENT (TOPICAL) PDL PDL PDL MOMETASONE FUROATE SOLUTION (TOPICAL) PDL PDL PDL PANDEL (TOPICAL) NPD NPD NPD PREDNICARBATE CREAM (TOPICAL) NPD NPD NPD PREDNICARBATE OINTMENT (TOPICAL) NPD NPD NPD SYNALAR CREAM KIT (TOPICAL) NPD NPD NPD SYNALAR OINTMENT (TOPICAL) NPD NPD NPD SYNALAR OINTMENT KIT (TOPICAL) NPD NPD NPD SYNALAR SOLUTION (TOPICAL) NPD NPD NPD SYNALAR TS KIT (TOPICAL) NPD NPD NPD STEROIDS, TOPICAL VERY HIGH APEXICON E (TOPICAL) NPD NPD NPD For this therapeutic drug class, the Board believed that all of the drugs CLOBETASOL EMOLLIENT (TOPICAL) PDL PDL PDL being recommended as preferred demonstrated the greatest safety, CLOBETASOL LOTION (TOPICAL) NPD NPD NPD efficacy, and value and provided clinicians with the greatest number of CLOBETASOL PROPIONATE CREAM (TOPICAL) PDL PDL PDL CLOBETASOL PROPIONATE FOAM (TOPICAL) NPD NPD NPD CLOBETASOL PROPIONATE GEL (TOPICAL) PDL PDL PDL CLOBETASOL PROPIONATE OINTMENT (TOPICAL) NPD NPD NPD CLOBETASOL PROPIONATE SOLUTION (TOPICAL) PDL PDL PDL CLOBETASOL PROPIONATE SPRAY (AG) (TOPICAL) NPD NPD NPD CLOBETASOL PROPIONATE SPRAY (TOPICAL) NPD NPD NPD CLOBETASOL SHAMPOO (TOPICAL) NPD NPD NPD CLOBEX LOTION (TOPICAL) NPD NPD NPD CLOBEX SHAMPOO (TOPICAL) NPD NPD NPD CLOBEX SPRAY (TOPICAL) NPD NPD NPD CLODAN KIT (TOPICAL) NPD NPD NPD HALOBETASOL PROPIONATE CREAM (TOPICAL) PDL PDL PDL HALOBETASOL PROPIONATE OINTMENT (TOPICAL) PDL PDL PDL OLUX (TOPICAL) NPD NPD NPD TEMOVATE CREAM (TOPICAL) NPD NPD NPD Page 14 of 16

15 ULTRAVATE LOTION (TOPICAL) NPD NPD NPD ULTRAVATE OINTMENT (TOPICAL) NPD NPD NPD ULTRAVATE X PAC CREAM (TOPICAL) NPD NPD NPD ULTRAVATE X PAC OINTMENT (TOPICAL) NPD NPD NPD Page 15 of 16

16 ULCERATIVE COLITIS AGENTS APRISO (ORAL) NPD NPD NPD For this therapeutic drug class, the Board believed that all of the drugs ASACOL HD (ORAL) NPD NPD NPD being recommended as preferred demonstrated the greatest safety, efficacy, and value and provided clinicians with the greatest number of AZULFIDINE TABLET (ORAL) NPD NPD NPD AZULFIDINE TABLET DR (ORAL) NPD NPD NPD BALSALAZIDE (ORAL) NPD NPD NPD CANASA (RECTAL) PDL PDL PDL DELZICOL (ORAL) PDL PDL PDL DIPENTUM (ORAL) NPD NPD NPD GIAZO (ORAL) NPD NPD NPD LIALDA (ORAL) PDL PDL PDL X MESALAMINE (ASACOL HD) (AG) (ORAL) NPD NPD NPD MESALAMINE (LIALDA) (AG) (ORAL) NPD NPD NPD MESALAMINE (LIALDA) (ORAL) NPD NPD NPD MESALAMINE (RECTAL) NPD NPD NPD MESALAMINE KIT (RECTAL) NPD NPD NPD PENTASA (ORAL) NPD NPD NPD ROWASA (RECTAL) NPD NPD NPD SULFASALAZINE (ORAL) PDL PDL PDL SULFASALAZINE DR (ORAL) PDL PDL PDL UCERIS (ORAL) NPD NPD NPD UCERIS (RECTAL) NPD NPD NPD For these products, the Board believed that Eliquis Dose Pack and Makena Auto Injector met the clinical and fiscal requirements of the state. ANTICOAGULANTS ELIQUIS DOSE PACK (ORAL) NR PDL PDL X Financial and clinical ANTIEMETIC/ANTIVERTIGO AGENTS BONJESTA (ORAL) NR NPD NPD Financial COPD AGENTS LONHALA MAGNAIR (INHALATION) NR NPD NPD Financial HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS STEGLUJAN (ORAL) NR NPD NPD Financial HYPOGLYCEMICS, INSULIN AND RELATED AGENTS TOUJEO MAX SOLOSTAR PEN (SUBCUTANEOUS) NR NPD NPD Financial HYPOGLYCEMICS, SGLT2 SEGLUROMET (ORAL) NR NPD NPD Financial LIPOTROPICS, STATINS ZYPITAMAG (ORAL) NR NPD NPD Financial PROGESTATIONAL AGENTS MAKENA AUTO INJECTOR (SUBCUTANEOUS) PDL PDL PDL X Page 16 of 16