FRESENIUS TOTAL HEALTH (PPO SNP)

Transcription

1 FRESENIUS TOTAL HEALTH (PPO SNP) 07 Formulary List of Covered Drugs PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN H9 7444, V This formulary was updated on 07/0/07. For more recent information or other questions, please contact Fresenius Total Health Member Services at TTY Hours: February 5 - September 0, 8 am - pm ET, Monday - Friday. October - February 4, 8 am to pm ET, 7 days a week. Or visit H9_Formulary_0 Accepted 08/08/06 Version 7

2 Note to existing members: This formulary has changed since last year. Please review this document to make sure that it still contains the drugs you take. When this drug list (formulary) refers to we, us, or our, it means Fresenius Health Plans. When it refers to plan or our plan, it means Fresenius Total Health (PPO SNP) This document includes list of the drugs (formulary) for our plan which is current as of 07/0/07. For an updated formulary, please contact us. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. You must generally use network pharmacies to use your prescription drug benefit. Benefits, formulary, pharmacy network, and/or copayments/coinsurance may change on January, 08, and from time to time during the year. What is the Fresenius Total Health Formulary? A formulary is a list of covered drugs selected by Fresenius Total Health in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Fresenius Total Health will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Fresenius Total Health network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage. Can the Formulary (drug list) change? Generally, if you are taking a drug on our 07 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 07 coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released. Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same cost-sharing for those members taking it for the remainder of the coverage year. We feel it is important that you have continued access for the remainder of the coverage year to the formulary drugs that were available when you chose our plan, except for cases in which you can save additional money or we can ensure your safety. If we remove drugs from our formulary, add prior authorization, quantity limits and/or step therapy restrictions on a drug, or move a drug to a higher cost-sharing tier, we must notify affected members of the change at least 60 days before the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60 day supply of the drug. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug. The enclosed formulary is current as of 07/0/07. To get updated information about the drugs covered by Fresenius Total Health, please contact us. Our contact information appears on the front and back cover pages. Every month, we update our printed formulary with a monthly addendum. Please visit our website at or contact Member Services for more information. ii

3 How do I use the Formulary? There are two ways to find your drug within the formulary: Medical Condition The formulary begins on page. The drugs in this formulary are grouped into categories depending on the type of medical conditions that they are used to treat. For example, drugs used to treat a heart condition are listed under the category, Cardiovascular Agents. If you know what your drug is used for, look for the category name in the list that begins on page. Then look under the category name for your drug. Alphabetical Listing If you are not sure what category to look under, you should look for your drug in the Index that begins on page 08. The Index provides an alphabetical list of all of the drugs included in this document. Both brand name drugs and generic drugs are listed in the Index. Look in the Index and find your drug. Next to your drug, you will see the page number where you can find coverage information. Turn to the page listed in the Index and find the name of your drug in the first column of the list. What are generic drugs? Fresenius Total Health covers both brand name drugs and generic drugs. A generic drug is approved by the FDA as having the same active ingredient as the brand name drug. Generally, generic drugs cost less than brand name drugs. Are there any restrictions on my coverage? Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include: Prior Authorization: Fresenius Total Health requires you or your physician to get prior authorization for certain drugs. This means that you will need to get approval from Fresenius Total Health before you fill your prescriptions. If you don t get approval, Fresenius Total Health may not cover the drug. Quantity Limits: For certain drugs, Fresenius Total Health limits the amount of the drug that Fresenius Total Health will cover. For example, Fresenius Total Health provides 0 tablets per prescription for Digoxin. This may be in addition to a standard one-month or three-month supply. Step Therapy: In some cases, Fresenius Total Health requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition Fresenius Total Health may not cover Drug B unless you try Drug A first. If Drug A does not work for you, Fresenius Total Health will then cover Drug B. You can find out if your drug has any additional requirements or limits by looking in the formulary that begins on page. You can also get more information about the restrictions applied to specific covered drugs by visiting our website. We have posted on line documents that explain our prior authorization and step therapy restrictions. You may also ask us to send you a copy. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. You can ask Fresenius Total Health to make an exception to these restrictions or limits or for a list of other, similar drugs that may treat your health condition. See the section, How do I request an exception to Fresenius Total Health s formulary? on page iv for information about how to request an exception. iii

4 What if my drug is not on the Formulary? If your drug is not included in this formulary (list of covered drugs), you should first contact Member Services and ask if your drug is covered. If you learn that Fresenius Total Health does not cover your drug, you have two options: You can ask Member Services for a list of similar drugs that are covered by Fresenius Total Health. When you receive the list, show it to your doctor and ask him or her to prescribe a similar drug that is covered by Fresenius Total Health You can ask Fresenius Total Health to make an exception and cover your drug. See below for information about how to request an exception. How do I request an exception to Fresenius Total Health s Formulary? You can ask Fresenius Total Health to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make. You can ask us to cover a drug even if it is not on our formulary. If approved, this drug will be covered at a pre-determined cost-sharing level, and you would not be able to ask us to provide the drug at a lower cost-sharing level. You can ask us to cover a formulary drug at a lower cost-sharing level. If approved this would lower the amount you must pay for your drug. You can ask us to waive coverage restrictions or limits on your drug. For example, for certain drugs, Fresenius Total Health limits the amount of the drug that we will cover. If your drug has a quantity limit, you can ask us to waive the limit and cover a greater amount. Generally, Fresenius Total Health will only approve your request for an exception if the alternative drugs included on the plan s formulary, the lower cost-sharing drug or additional utilization restrictions would not be as effective in treating your condition and/or would cause you to have adverse medical effects. You should contact us to ask us for an initial coverage decision for a formulary, tier, or utilization restriction exception. When you request a formulary, tier, or utilization restriction exception you should submit a statement from your prescriber or physician supporting your request. Generally, we must make our decision within 7 hours of getting your prescriber s supporting statement. You can request an expedited (fast) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 7 hours for a decision. If your request to expedite is granted, we must give you a decision no later than 4 hours after we get a supporting statement from your doctor or other prescriber. iv

5 What do I do before I can talk to my doctor about changing my drugs or requesting an exception? As a new or continuing member in our plan you may be taking drugs that are not on our formulary. Or, you may be taking a drug that is on our formulary but your ability to get it is limited. For example, you may need a prior authorization from us before you can fill your prescription. You should talk to your doctor to decide if you should switch to an appropriate drug that we cover or request a formulary exception so that we will cover the drug you take. While you talk to your doctor to determine the right course of action for you, we may cover your drug in certain cases during the first 90 days you are a member of our plan. For each of your drugs that is not on our formulary or if your ability to get your drugs is limited, we will cover a temporary 0 day supply (unless you have a prescription written for fewer days) when you go to a network pharmacy. After your first 0 day supply, we will not pay for these drugs, even if you have been a member of the plan less than 90 days. If you are a resident of a long-term care facility, we will allow you to refill your prescription until we have provided you with up to a 98 day transition supply, consistent with dispensing increment, (unless you have a prescription written for fewer days). We will cover more than one refill of these drugs for the first 90 days you are a member of our plan. If you need a drug that is not on our formulary or if your ability to get your drugs is limited, but you are past the first 90 days of membership in our plan, we will cover a day emergency supply of that drug (unless you have a prescription for fewer days) while you pursue a formulary exception. Members who have a change in level of care (setting) will be allowed up to a one-time 0 day transition supply per drug. For example, members who: Enter long-term care (LTC) facilities from hospitals are sometimes accompanied by a discharge list of medications from the hospital formulary, with very short term planning taken into account (often under 8 hours). Are discharged from a hospital to a home. End their skilled nursing facility Medicare Part A stay (where payments include all pharmacy charges) and who need to revert to their Part D plan formulary. End a long-term care facility stay and return to the community. If a member has more than one change in level of care in a month, the pharmacy will have to call our Plan to request an extension of the transition policy. For more information For more detailed information about your Fresenius Health Plans prescription drug coverage, please review your Evidence of Coverage and other plan materials. If you have questions about Fresenius Health Plans please contact us. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. If you have general questions about Medicare prescription drug coverage, please call Medicare at -800-MEDICARE ( ) 4 hours a day/7 days a week. TTY users should call Or, visit v

6 Fresenius Total Health s Formulary The formulary that begins on page provides coverage information about the drugs covered by Fresenius Total Health. If you have trouble finding your drug in the list, turn to the Index that begins on page 08. The first column of the chart lists the drug name. Brand name drugs are capitalized (e.g., COUMADIN) and generic drugs are listed in lower-case italics (e.g., <warfarin>). The information in the Requirements/Limits column tells you if Fresenius Total Health has any special requirements for coverage of your drug. List of Abbreviations B/D: QL: ST: PA: This prescription drug has a Part B versus D administrative prior authorization requirement. This drug may be covered under Medicare Part B or D depending upon the circumstances. Information may need to be submitted describing the use and setting of the drug to make the determination. Quantity Limit. For certain drugs, Fresenius Total Health limits the amount of the drug that Fresenius Total Health will cover. For example, Fresenius Total Health provides twelve tablets per prescription for Sumatriptan Succinate. This may be in addition to a standard one month or three month supply. Step Therapy. In some cases, Fresenius Total Health requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, Fresenius Total Health may not cover drug B unless you try Drug A first. If Drug A does not work for you, Fresenius Total Health will then cover Drug B. Prior Authorization. Fresenius Total Health requires you or your physician to get prior authorization for certain drugs. This means that you will need to get approval from Fresenius Total Health before you fill your prescriptions. If you don t get approval, Fresenius Total Health may not cover the drug. Standard Retail Cost-Sharing TIER ONE-MONTH SUPPLY THREE-MONTH SUPPLY Tier (Preferred Generic) $0 $0 Tier (Generic) 5% of the cost 5% of the cost Tier (Preferred Brand) 5% of the cost 5% of the cost Tier 4 (Non-Preferred Brand) 5% of the cost 5% of the cost Tier 5 (Specialty Tier) 5% of the cost Not Offered vi

7 Drug Table This information could change Analgesics Analgesics acetaminophen-codeine oral solution 0 mg- mg /5 ml (5 ml), 0- mg/5 ml, 00 mg-0 mg /.5 ml acetaminophen-codeine oral tablet 00-5 mg, 00-0 mg, mg ascomp with codeine oral capsule mg butalbital compound w/codeine oral capsule mg butalbital-acetaminop-caf-cod oral capsule mg carisoprodol-asa-codeine oral tablet mg PA PA PA PA carisoprodol-aspirin oral tablet 00-5 mg PA codeine-butalbital-asa-caff oral capsule mg endocet oral tablet 0-5 mg, 5-5 mg, mg hydrocodone-acetaminophen oral tablet 0-5 mg,.5-5 mg, 5-5 mg, mg hydrocodone-ibuprofen oral tablet 0-00 mg, 5-00 mg, mg oxycodone-acetaminophen oral tablet 0-5 mg,.5-5 mg, 5-5 mg, mg oxycodone-aspirin oral tablet mg PA pentazocine-naloxone oral tablet mg PA tramadol-acetaminophen oral tablet mg Nonsteroidal Anti-Inflammatory Drugs

8 celecoxib oral capsule 00 mg, 00 mg, 400 mg, 50 mg comfort pac-ibuprofen kit 800 mg comfort pac-meloxicam kit 5 mg comfort pac-naproxen kit 500 mg diclofenac potassium oral tablet 50 mg diclofenac sodium oral tablet extended release 4 hr 00 mg diclofenac sodium oral tablet,delayed release (dr/ec) 5 mg, 50 mg, 75 mg diclofenac sodium topical gel % diclofenac sodium topical gel % 5 diflunisal oral tablet 500 mg etodolac oral capsule 00 mg, 00 mg etodolac oral tablet 400 mg, 500 mg flurbiprofen oral tablet 00 mg, 50 mg ibuprofen oral suspension 00 mg/5 ml ibuprofen oral tablet 400 mg, 600 mg, 800 mg ibuprofen-oxycodone oral tablet mg indomethacin oral capsule 5 mg, 50 mg PA indomethacin oral capsule, extended release 75 mg ketoprofen oral capsule 50 mg, 75 mg PA ketorolac injection cartridge 0 mg/ml PA ketorolac injection solution 5 mg/ml, 0 mg/ml, 0 mg/ml ( ml) PA ketorolac intramuscular solution 60 mg/ ml PA ketorolac oral tablet 0 mg PA meclofenamate oral capsule 00 mg, 50 mg meloxicam oral suspension 7.5 mg/5 ml meloxicam oral tablet 5 mg, 7.5 mg nabumetone oral tablet 500 mg, 750 mg

9 NAPRELAN CR ORAL TABLET, ER MULTIPHASE 4 HR 750 MG naproxen oral suspension 5 mg/5 ml naproxen oral tablet 50 mg, 75 mg, 500 mg naproxen oral tablet,delayed release (dr/ec) 75 mg, 500 mg naproxen sodium oral tablet 75 mg, 550 mg piroxicam oral capsule 0 mg, 0 mg sulindac oral tablet 50 mg, 00 mg tolmetin oral capsule 400 mg tolmetin oral tablet 00 mg VOLTAREN TOPICAL GEL % 4 ZORVOLEX ORAL CAPSULE 8 MG, 5 MG ST Opioid Analgesics, Long-Acting duramorph (pf) injection solution 0.5 mg/ml, mg/ml fentanyl citrate buccal lozenge on a handle,00 mcg,,600 mcg, 00 mcg, 400 mcg, 600 mcg, 800 mcg fentanyl transdermal patch 7 hour 00 mcg/hr, mcg/hr, 5 mcg/hr, 7.5 mcg/hour, 50 mcg/hr, 6.5 mcg/hour, 75 mcg/hr, 87.5 mcg/hour methadone oral solution 0 mg/5 ml, 5 mg/5 ml methadone oral tablet 0 mg, 5 mg 4 B/D PA; QL (0 EA per 0 days) QL (0 EA per 0 days) morphine oral tablet 5 mg, 0 mg QL (80 EA per 0 days) morphine oral tablet extended release 00 mg, 5 mg, 00 mg, 0 mg, 60 mg oxycodone oral tablet,oral only,ext.rel. hr 0 mg, 5 mg, 0 mg, 0 mg, 40 mg, 60 mg, 80 mg OXYCONTIN ORAL TABLET,ORAL ONLY,EXT.REL. HR 5 MG, 0 MG OXYCONTIN ORAL TABLET,ORAL ONLY,EXT.REL. HR 60 MG Opioid Analgesics, Short-Acting QL (60 EA per 0 days) PA; QL (60 EA per 0 days) 4 PA; QL (60 EA per 0 days) ; QL (60 EA per 0 days)

10 butorphanol tartrate injection solution mg/ml, mg/ml butorphanol tartrate nasal spray,non-aerosol 0 mg/ml hydromorphone (pf) injection solution 0 (mg/ml) (5 ml), 0 mg/ml hydromorphone injection solution mg/ml, mg/ml, 4 mg/ml hydromorphone injection syringe mg/ml B/D hydromorphone oral tablet mg, 4 mg, 8 mg QL (80 EA per 0 days) LAZANDA NASAL SPRAY,NON-AEROSOL 00 MCG/SPRAY LAZANDA NASAL SPRAY,NON-AEROSOL 00 MCG/SPRAY, 400 MCG/SPRAY PA; QL (600 EA per 0 days) PA; QL (50 EA per 0 days) meperidine oral solution 50 mg/5 ml PA; QL (600 ML per 0 days) meperidine oral tablet 00 mg, 50 mg PA; QL (40 EA per 0 days) nalbuphine injection solution 0 mg/ml, 0 mg/ml B/D oxycodone oral solution 5 mg/5 ml QL (5400 ML per 0 days) oxycodone oral tablet 0 mg, 5 mg, 0 mg, 0 mg, 5 mg QL (80 EA per 0 days) tramadol oral tablet 50 mg QL (40 EA per 0 days) Anesthetics Local Anesthetics dermacinrx empricaine topical kit.5-.5 % B/D lidocaine (pf) injection solution 0 mg/ml ( %), 5 mg/ml (0.5 %) lidocaine hcl injection solution 5 mg/ml (0.5 %) lidocaine hcl laryngotracheal solution 4 % lidocaine hcl mucous membrane jelly % lidocaine hcl mucous membrane jelly in applicator % lidocaine hcl mucous membrane solution 4 % (40 mg/ml) lidocaine hcl urethral gel % 4

11 lidocaine topical adhesive patch,medicated 5 % PA; QL (90 EA per 0 days) lidocaine topical ointment 5 % lidocaine-prilocaine topical cream.5-.5 % B/D lidocaine-prilocaine topical kit.5-.5 % B/D LIDOPAC TOPICAL KIT 5 % lidopril topical kit.5-.5 % B/D lidopril xr topical kit.5-.5 % B/D lido-prilo caine pack topical kit.5-.5 % B/D liprozonepak topical kit.5-.5 % B/D livixil pak topical kit.5-.5 % B/D lp lite pak topical kit.5-.5 % B/D prilolid topical kit.5-.5 % B/D Anti-Addiction/ Substance Abuse Treatment Agents Alcohol Deterrents/ Anti-Craving acamprosate oral tablet,delayed release (dr/ec) mg disulfiram oral tablet 50 mg, 500 mg naltrexone oral tablet 50 mg Opioid Dependence Treatments buprenorphine hcl sublingual tablet mg, 8 mg buprenorphine-naloxone sublingual tablet -0.5 mg, 8- mg ZUBSOLV SUBLINGUAL TABLET MG, MG,.4-.9 MG, MG, MG, MG Opioid Reversal Agents naloxone injection solution 0.4 mg/ml naloxone injection syringe mg/ml Smoking Cessation Agents CHANTIX CONTINUING MONTH BOX ORAL TABLET MG PA QL (6 EA per 68 days) CHANTIX ORAL TABLET 0.5 MG, MG QL (6 EA per 68 days) 5

12 CHANTIX STARTING MONTH BOX ORAL TABLETS,DOSE PACK 0.5 MG ()- MG (4) NICOTROL INHALATION CARTRIDGE 0 MG NICOTROL NS NASAL SPRAY,NON- AEROSOL 0 MG/ML Antibacterials Aminoglycosides amikacin injection solution,000 mg/4 ml, 500 mg/ ml gentak ophthalmic ointment 0. % ( mg/gram) gentamicin injection solution 0 mg/ ml gentamicin ophthalmic drops 0. % gentamicin ophthalmic ointment 0. % ( mg/gram) gentamicin sulfate (ped) (pf) injection solution 0 mg/ ml gentamicin sulfate (pf) intravenous solution 00 mg/0 ml, 60 mg/6 ml, 80 mg/8 ml gentamicin topical cream 0. % gentamicin topical ointment 0. % neomycin oral tablet 500 mg neomycin-polymyxin b gu irrigation solution 40 mg-00,000 unit/ml paromomycin oral capsule 50 mg streptomycin intramuscular recon soln gram TOBRADEX OPHTHALMIC OINTMENT % tobramycin in 0.5 % nacl inhalation solution for nebulization 00 mg/5 ml tobramycin ophthalmic drops 0. % tobramycin sulfate injection recon soln. gram tobramycin sulfate injection solution 0 mg/ml, 40 mg/ml QL (6 EA per 68 days) 4 4 6

13 tobramycin with nebulizer inhalation solution for nebulization 00 mg/5 ml Antibacterials, Other acetic acid otic solution % acetic acid-aluminum acetate otic drops % alcohol pads topical pads, medicated bacitracin ophthalmic ointment 500 unit/gram BACTROBAN NASAL NASAL OINTMENT % chloramphenicol sod succinate intravenous recon soln gram clindamycin hcl oral capsule 50 mg, 00 mg, 75 mg clindamycin in 5 % dextrose intravenous piggyback 00 mg/50 ml, 600 mg/50 ml, 900 mg/50 ml clindamycin palmitate hcl oral recon soln 75 mg/5 ml clindamycin pediatric oral recon soln 75 mg/5 ml clindamycin phosphate injection solution 50 (mg/ml) (6 ml), 50 mg/ml clindamycin phosphate intravenous solution 00 mg/ ml, 600 mg/4 ml, 900 mg/6 ml clindamycin phosphate topical gel % clindamycin phosphate topical lotion % clindamycin phosphate topical solution % clindamycin phosphate topical swab % clindamycin phosphate vaginal cream % colistin (colistimethate na) injection recon soln 50 mg CUBICIN INTRAVENOUS RECON SOLN 500 MG CUBICIN RF INTRAVENOUS RECON SOLN 500 MG 4 daptomycin intravenous recon soln 500 mg 7

14 lincomycin injection solution 00 mg/ml linezolid intravenous parenteral solution 600 mg/00 ml linezolid oral suspension for reconstitution 00 mg/5 ml linezolid oral tablet 600 mg linezolid-0.9% sodium chloride intravenous parenteral solution 600 mg/00 ml methenamine hippurate oral tablet gram metro i.v. intravenous piggyback 500 mg/00 ml metronidazole in nacl (iso-os) intravenous piggyback 500 mg/00 ml metronidazole oral capsule 75 mg metronidazole oral tablet 50 mg, 500 mg metronidazole topical cream 0.75 % metronidazole topical gel 0.75 %, % metronidazole topical gel with pump % metronidazole topical lotion 0.75 % metronidazole vaginal gel 0.75 % mupirocin topical ointment % nitrofurantoin macrocrystal oral capsule 00 mg, 5 mg, 50 mg nitrofurantoin monohyd/m-cryst oral capsule 00 mg, 00 mg (75/5) polymyxin b sulfate injection recon soln 500,000 unit SYNERCID INTRAVENOUS RECON SOLN 500 MG trimethoprim oral tablet 00 mg vancomycin in 0.9% sodium cl intravenous piggyback gram/00 ml, 500 mg/00 ml, 750 mg/50 ml vancomycin in 0.9% sodium cl intravenous solution.5 gram/50 ml, 750 mg/50 ml PA; QL (60 EA per 65 days) PA; QL (60 EA per 65 days) B/D B/D 8

15 vancomycin in dextrose 5 % intravenous piggyback gram/00 ml, 500 mg/00 ml, 750 mg/50 ml vancomycin intravenous recon soln,000 mg, 0 gram, 5 gram, 500 mg, 750 mg VANCOMYCIN ORAL CAPSULE 5 MG, 50 MG Beta-Lactam, Cephalosporins cefaclor oral capsule 50 mg, 500 mg cefaclor oral tablet extended release hr 500 mg cefadroxil oral capsule 500 mg cefadroxil oral suspension for reconstitution 50 mg/5 ml, 500 mg/5 ml cefadroxil oral tablet gram cefazolin in dextrose (iso-os) intravenous piggyback gram/50 ml cefazolin injection recon soln gram cefazolin intravenous recon soln gram cefdinir oral capsule 00 mg cefdinir oral suspension for reconstitution 5 mg/5 ml, 50 mg/5 ml cefepime in dextrose 5 % intravenous piggyback gram/50 ml, gram/50 ml cefepime in dextrose,iso-osm intravenous piggyback gram/50 ml, gram/00 ml cefepime injection recon soln gram, gram cefotaxime injection recon soln gram, gram, 500 mg cefoxitin in dextrose, iso-osm intravenous piggyback gram/50 ml, gram/50 ml cefoxitin intravenous recon soln gram, 0 gram, gram cefpodoxime oral suspension for reconstitution 00 mg/5 ml, 50 mg/5 ml cefpodoxime oral tablet 00 mg, 00 mg B/D B/D 4 PA 9

16 cefprozil oral suspension for reconstitution 5 mg/5 ml, 50 mg/5 ml cefprozil oral tablet 50 mg, 500 mg CEFTIN ORAL SUSPENSION FOR RECONSTITUTION 50 MG/5 ML ceftriaxone in dextrose,iso-os intravenous piggyback gram/50 ml, gram/50 ml ceftriaxone injection recon soln gram, gram, 500 mg ceftriaxone intravenous recon soln gram, gram cefuroxime axetil oral tablet 50 mg, 500 mg cefuroxime sodium injection recon soln.5 gram cefuroxime sodium intravenous recon soln.5 gram cephalexin oral capsule 50 mg, 500 mg cephalexin oral suspension for reconstitution 5 mg/5 ml, 50 mg/5 ml cephalexin oral tablet 50 mg, 500 mg SUPRAX ORAL CAPSULE 400 MG 4 TEFLARO INTRAVENOUS RECON SOLN 400 MG, 600 MG Beta-Lactam, Other aztreonam injection recon soln gram, gram DORIBAX INTRAVENOUS RECON SOLN 500 MG 4 4 PA 4 PA doripenem intravenous recon soln 50 mg, 500 mg PA imipenem-cilastatin intravenous recon soln 50 mg, 500 mg PA INVANZ INJECTION RECON SOLN GRAM 4 PA INVANZ INTRAVENOUS RECON SOLN GRAM meropenem intravenous recon soln gram, 500 mg meropenem-0.9% sodium chloride intravenous piggyback gram/50 ml, 500 mg/50 ml 4 PA 0

17 Beta-Lactam, Penicillins amoxicillin oral capsule 50 mg, 500 mg amoxicillin oral suspension for reconstitution 5 mg/5 ml, 00 mg/5 ml, 50 mg/5 ml, 400 mg/5 ml amoxicillin oral tablet 500 mg, 875 mg amoxicillin oral tablet,chewable 5 mg, 50 mg amoxicillin-pot clavulanate oral suspension for reconstitution mg/5 ml, mg/5 ml, mg/5 ml, mg/5 ml amoxicillin-pot clavulanate oral tablet 50-5 mg, mg, mg amoxicillin-pot clavulanate oral tablet extended release hr, mg amoxicillin-pot clavulanate oral tablet,chewable mg, mg ampicillin oral capsule 50 mg, 500 mg ampicillin oral suspension for reconstitution 5 mg/5 ml, 50 mg/5 ml ampicillin sodium injection recon soln gram, 0 gram, 5 mg, gram, 50 mg, 500 mg ampicillin sodium intravenous recon soln gram ampicillin-sulbactam injection recon soln.5 gram, 5 gram, gram ampicillin-sulbactam intravenous recon soln.5 gram, gram BICILLIN L-A INTRAMUSCULAR SYRINGE,00,000 UNIT/ ML,,400,000 UNIT/4 ML, 600,000 UNIT/ML dicloxacillin oral capsule 50 mg, 500 mg nafcillin in dextrose iso-osm intravenous piggyback gram/50 ml, gram/00 ml nafcillin injection recon soln gram, gram nafcillin intravenous recon soln gram, gram penicillin g procaine intramuscular syringe. million unit/ ml 4

18 penicillin g sodium injection recon soln 5 million unit penicillin v potassium oral recon soln 5 mg/5 ml, 50 mg/5 ml penicillin v potassium oral tablet 50 mg, 500 mg piperacillin-tazobactam intravenous recon soln.5 gram,.5 gram,.75 gram, 4.5 gram, 40.5 gram Macrolides azithromycin intravenous recon soln 500 mg, 500 mg ( mg/ml) azithromycin oral packet gram azithromycin oral suspension for reconstitution 00 mg/5 ml, 00 mg/5 ml azithromycin oral tablet 50 mg, 50 mg (6 pack), 500 mg, 500 mg ( pack), 600 mg clarithromycin oral suspension for reconstitution 5 mg/5 ml, 50 mg/5 ml clarithromycin oral tablet 50 mg, 500 mg clarithromycin oral tablet extended release 4 hr 500 mg E.E.S. GRANULES ORAL SUSPENSION FOR RECONSTITUTION 00 MG/5 ML ery pads topical swab % ERYPED 00 ORAL SUSPENSION FOR RECONSTITUTION 00 MG/5 ML erythrocin (as stearate) oral tablet 50 mg ERYTHROCIN INTRAVENOUS RECON SOLN 500 MG erythromycin ethylsuccinate oral suspension for reconstitution 00 mg/5 ml erythromycin ethylsuccinate oral tablet 400 mg erythromycin ophthalmic ointment 5 mg/gram (0.5 %) erythromycin oral tablet 50 mg, 500 mg 4 4 4

19 erythromycin with ethanol topical gel % erythromycin with ethanol topical solution % KETEK ORAL TABLET 00 MG, 400 MG 4 PA; QL (0 EA per 0 days) Quinolones AVELOX IN NACL (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK 400 MG/50 ML ciprofloxacin (mixture) oral tablet, er multiphase 4 hr,000 mg, 500 mg ciprofloxacin hcl ophthalmic drops 0. % ciprofloxacin hcl oral tablet 00 mg ciprofloxacin hcl oral tablet 50 mg, 500 mg, 750 mg ciprofloxacin lactate intravenous solution 00 mg/0 ml, 400 mg/40 ml levofloxacin oral solution 50 mg/0 ml levofloxacin oral tablet 50 mg, 500 mg, 750 mg MOXEZA OPHTHALMIC DROPS, VISCOUS 0.5 % moxifloxacin oral tablet 400 mg moxifloxacin-sod.ace,sul-water intravenous piggyback 400 mg/50 ml ofloxacin ophthalmic drops 0. % ofloxacin oral tablet 00 mg, 400 mg ofloxacin otic drops 0. % VIGAMOX OPHTHALMIC DROPS 0.5 % Sulfonamides silver sulfadiazine topical cream % ssd topical cream % sulfacetamide sodium (acne) topical suspension 0 % sulfacetamide sodium ophthalmic drops 0 % sulfacetamide sodium ophthalmic ointment 0 % sulfadiazine oral tablet 500 mg 4

20 sulfamethoxazole-trimethoprim intravenous solution mg/5 ml sulfamethoxazole-trimethoprim oral suspension mg/5 ml sulfamethoxazole-trimethoprim oral tablet mg, mg Tetracyclines demeclocycline oral tablet 50 mg, 00 mg doxy-00 intravenous recon soln 00 mg doxycycline hyclate intravenous recon soln 00 mg doxycycline hyclate oral capsule 00 mg, 50 mg doxycycline hyclate oral tablet 00 mg, 0 mg doxycycline monohydrate oral capsule 00 mg, 50 mg doxycycline monohydrate oral tablet 00 mg, 50 mg, 50 mg, 75 mg minocycline oral capsule 00 mg, 50 mg, 75 mg minocycline oral tablet 00 mg, 50 mg, 75 mg morgidox oral capsule 50 mg Anticonvulsants Anticonvulsants, Other BRIVIACT INTRAVENOUS SOLUTION 50 MG/5 ML BRIVIACT ORAL SOLUTION 0 MG/ML BRIVIACT ORAL TABLET 0 MG, 00 MG, 5 MG, 50 MG, 75 MG levetiracetam in nacl (iso-os) intravenous piggyback,000 mg/00 ml,,500 mg/00 ml, 500 mg/00 ml levetiracetam intravenous solution 500 mg/5 ml levetiracetam oral solution 00 mg/ml, 500 mg/5 ml (5 ml) levetiracetam oral tablet,000 mg, 50 mg, 500 mg, 750 mg 4

21 levetiracetam oral tablet extended release 4 hr 500 mg, 750 mg POTIGA ORAL TABLET 00 MG, 00 MG, 400 MG, 50 MG roweepra oral tablet,000 mg, 500 mg, 750 mg SPRITAM ORAL TABLET FOR SUSPENSION,000 MG, 50 MG, 500 MG SPRITAM ORAL TABLET FOR SUSPENSION 750 MG Calcium Channel Modifying Agents CELONTIN ORAL CAPSULE 00 MG 4 ethosuximide oral capsule 50 mg ethosuximide oral solution 50 mg/5 ml zonisamide oral capsule 00 mg, 5 mg, 50 mg Gamma-Aminobutyric Acid (Gaba) Augmenting Agents 4 ST; QL (90 EA per 0 days) 4 ST; QL (60 EA per 0 days) 5 ST; QL (0 EA per 0 days) clonazepam oral tablet 0.5 mg, mg PA; QL (90 EA per 0 days) clonazepam oral tablet mg PA; QL (00 EA per 0 days) clonazepam oral tablet,disintegrating 0.5 mg, 0.5 mg, 0.5 mg, mg PA; QL (90 EA per 0 days) clonazepam oral tablet,disintegrating mg PA; QL (00 EA per 0 days) diazepam rectal kit mg PA; QL (40 EA per 0 days) diazepam rectal kit.5 mg PA; QL (5 EA per 0 days) diazepam rectal kit mg PA; QL (0 EA per 0 days) divalproex oral capsule, delayed rel sprinkle 5 mg divalproex oral tablet extended release 4 hr 50 mg, 500 mg divalproex oral tablet,delayed release (dr/ec) 5 mg, 50 mg, 500 mg gabapentin oral capsule 00 mg, 00 mg, 400 mg gabapentin oral solution 50 mg/5 ml, 50 mg/5 ml (5 ml), 00 mg/6 ml (6 ml) gabapentin oral tablet 600 mg, 800 mg GABITRIL ORAL TABLET MG, 6 MG 4 5

22 ONFI ORAL SUSPENSION.5 MG/ML 4 PA; QL (480 ML per 0 days) ONFI ORAL TABLET 0 MG, 0 MG 4 PA; QL (60 EA per 0 days) phenobarbital oral elixir 0 mg/5 ml (4 mg/ml) PA phenobarbital oral tablet 00 mg, 5 mg, 6. mg, 0 mg,.4 mg, 60 mg, 64.8 mg, 97. mg primidone oral tablet 50 mg, 50 mg PA SABRIL ORAL POWDER IN PACKET 500 MG 4 PA SABRIL ORAL TABLET 500 MG 4 PA; QL (80 EA per 0 days) tiagabine oral tablet mg, 4 mg valproate sodium intravenous solution 500 mg/5 ml (00 mg/ml) valproic acid (as sodium salt) oral solution 50 mg/5 ml, 50 mg/5 ml (5 ml), 500 mg/0 ml (0 ml) valproic acid oral capsule 50 mg Glutamate Reducing Agents felbamate oral suspension 600 mg/5 ml felbamate oral tablet 400 mg, 600 mg FYCOMPA ORAL SUSPENSION 0.5 MG/ML 4 ST FYCOMPA ORAL TABLET 0 MG, MG, MG, 4 MG, 6 MG, 8 MG FYCOMPA ORAL TABLETS,DOSE PACK MG (7)- 4 MG (7) lamotrigine oral tablet 00 mg, 50 mg, 00 mg, 5 mg lamotrigine oral tablet extended release 4hr 00 mg, 00 mg, 5 mg, 50 mg, 00 mg, 50 mg lamotrigine oral tablet, chewable dispersible 5 mg, 5 mg topiramate oral capsule, sprinkle 5 mg, 5 mg topiramate oral tablet 00 mg, 00 mg, 5 mg, 50 mg Sodium Channel Agents 4 ST; QL (0 EA per 0 days) APTIOM ORAL TABLET 00 MG 4 ST; QL (0 EA per 0 days) 4 6

23 APTIOM ORAL TABLET 400 MG, 800 MG 5 ST; QL (0 EA per 0 days) APTIOM ORAL TABLET 600 MG 4 ST; QL (60 EA per 0 days) BANZEL ORAL SUSPENSION 40 MG/ML ; QL (400 ML per 0 days) BANZEL ORAL TABLET 00 MG 4 PA; QL (40 EA per 0 days) BANZEL ORAL TABLET 400 MG ; QL (40 EA per 0 days) carbamazepine oral suspension 00 mg/5 ml carbamazepine oral tablet 00 mg carbamazepine oral tablet extended release hr 00 mg, 00 mg, 400 mg carbamazepine oral tablet,chewable 00 mg DILANTIN ORAL CAPSULE 0 MG 4 epitol oral tablet 00 mg EQUETRO ORAL CAPSULE, ER MULTIPHASE HR 00 MG, 00 MG, 00 MG fosphenytoin injection solution 00 mg pe/ ml, 500 mg pe/0 ml oxcarbazepine oral suspension 00 mg/5 ml (60 mg/ml) oxcarbazepine oral tablet 50 mg, 00 mg, 600 mg PEGANONE ORAL TABLET 50 MG 4 phenytoin oral suspension 00 mg/4 ml, 5 mg/5 ml phenytoin oral tablet,chewable 50 mg phenytoin sodium extended oral capsule 00 mg, 00 mg, 00 mg phenytoin sodium intravenous solution 50 mg/ml VIMPAT INTRAVENOUS SOLUTION 00 MG/0 ML VIMPAT ORAL SOLUTION 0 MG/ML 5 ST; QL (00 ML per 0 days) VIMPAT ORAL TABLET 00 MG, 50 MG, 00 MG, 50 MG Antidementia Agents Antidementia Agents, Other ST; QL (60 EA per 0 days) 7

24 ergoloid oral tablet mg PA Cholinesterase Inhibitors donepezil oral tablet 0 mg, mg, 5 mg donepezil oral tablet,disintegrating 0 mg, 5 mg rivastigmine tartrate oral capsule.5 mg, mg, 4.5 mg, 6 mg rivastigmine transdermal patch 4 hour. mg/4 hour, 4.6 mg/4 hr, 9.5 mg/4 hr N-Methyl-D-Aspartate (Nmda) Receptor Antagonist memantine oral tablet 0 mg, 5 mg memantine oral tablets,dose pack 5-0 mg NAMENDA XR ORAL CAP,SPRINKLE,ER 4HR DOSE PACK MG NAMENDA XR ORAL CAPSULE,SPRINKLE,ER 4HR 4 MG, MG, 8 MG, 7 MG Antidepressants Antidepressants, Other APLENZIN ORAL TABLET EXTENDED RELEASE 4 HR 74 MG, 48 MG, 5 MG buproban oral tablet extended release hr 50 mg bupropion hcl (smoking deter) oral tablet extended release hr 50 mg bupropion hcl oral tablet 00 mg, 75 mg bupropion hcl oral tablet extended release hr 00 mg, 50 mg, 00 mg bupropion hcl oral tablet extended release 4 hr 50 mg, 00 mg FORFIVO XL ORAL TABLET EXTENDED RELEASE 4 HR 450 MG maprotiline oral tablet 5 mg, 50 mg, 75 mg mirtazapine oral tablet 5 mg, 0 mg, 45 mg, 7.5 mg 4 ST 4 ST; QL (0 EA per 0 days) 4 4 8

25 mirtazapine oral tablet,disintegrating 5 mg, 0 mg, 45 mg nefazodone oral tablet 00 mg, 50 mg, 00 mg, 50 mg, 50 mg perphenazine-amitriptyline oral tablet -0 mg, - 5 mg, 4-0 mg, 4-5 mg, 4-50 mg quetiapine oral tablet extended release 4 hr 50 mg, 00 mg quetiapine oral tablet extended release 4 hr 00 mg, 400 mg, 50 mg trazodone oral tablet 00 mg, 50 mg, 00 mg, 50 mg Monoamine Oxidase Inhibitors EMSAM TRANSDERMAL PATCH 4 HOUR MG/4 HR, 6 MG/4 HR, 9 MG/4 HR MARPLAN ORAL TABLET 0 MG 4 phenelzine oral tablet 5 mg tranylcypromine oral tablet 0 mg Ssris/ Snris citalopram oral solution 0 mg/5 ml citalopram oral tablet 0 mg, 0 mg, 40 mg desvenlafaxine fumarate oral tablet extended release 4hr 00 mg, 50 mg desvenlafaxine oral tablet extended release 4 hr 00 mg, 50 mg desvenlafaxine oral tablet extended release 4hr 00 mg, 50 mg desvenlafaxine succinate oral tablet extended release 4 hr 00 mg, 5 mg, 50 mg duloxetine oral capsule,delayed release(dr/ec) 0 mg, 0 mg, 60 mg escitalopram oxalate oral solution 5 mg/5 ml escitalopram oxalate oral tablet 0 mg, 0 mg, 5 mg PA QL (0 EA per 0 days) QL (60 EA per 0 days) 4 9

26 FETZIMA ORAL CAPSULE,EXT REL 4HR DOSE PACK 0 MG ()- 40 MG (6) FETZIMA ORAL CAPSULE,EXTENDED RELEASE 4 HR 0 MG, 0 MG, 40 MG, 80 MG fluoxetine oral capsule 0 mg, 0 mg, 40 mg fluoxetine oral capsule,delayed release(dr/ec) 90 mg fluoxetine oral solution 0 mg/5 ml (4 mg/ml) fluoxetine oral tablet 0 mg fluoxetine oral tablet 0 mg fluvoxamine oral tablet 00 mg, 5 mg, 50 mg paroxetine hcl oral tablet 0 mg, 0 mg, 0 mg, 40 mg paroxetine hcl oral tablet extended release 4 hr.5 mg, 5 mg PAXIL ORAL SUSPENSION 0 MG/5 ML 4 PRISTIQ ORAL TABLET EXTENDED RELEASE 4 HR 00 MG, 5 MG, 50 MG sertraline oral concentrate 0 mg/ml sertraline oral tablet 00 mg, 5 mg, 50 mg TRINTELLIX ORAL TABLET 0 MG, 0 MG, 5 MG venlafaxine oral capsule,extended release 4hr 50 mg, 7.5 mg, 75 mg venlafaxine oral tablet 00 mg, 5 mg, 7.5 mg, 50 mg, 75 mg venlafaxine oral tablet extended release 4hr 50 mg, 5 mg, 7.5 mg, 75 mg VIIBRYD ORAL TABLET 0 MG, 0 MG, 40 MG VIIBRYD ORAL TABLETS,DOSE PACK 0 MG (7)- 0 MG () Tricyclics 4 ST 4 ST 4 ST 4 ST 4 ST 0

27 amitriptyline oral tablet 0 mg, 00 mg, 50 mg, 5 mg, 50 mg, 75 mg amoxapine oral tablet 00 mg, 50 mg, 5 mg, 50 mg PA clomipramine oral capsule 5 mg, 50 mg, 75 mg PA desipramine oral tablet 0 mg, 00 mg, 50 mg, 5 mg, 50 mg, 75 mg doxepin oral capsule 0 mg, 00 mg, 50 mg, 5 mg, 50 mg, 75 mg PA doxepin oral concentrate 0 mg/ml PA imipramine hcl oral tablet 0 mg, 5 mg, 50 mg PA imipramine pamoate oral capsule 00 mg, 5 mg, 50 mg, 75 mg nortriptyline oral capsule 0 mg, 5 mg, 50 mg, 75 mg nortriptyline oral solution 0 mg/5 ml protriptyline oral tablet 0 mg, 5 mg PA trimipramine oral capsule 00 mg, 5 mg, 50 mg PA Antiemetics Antiemetics, Other chlorpromazine injection solution 5 mg/ml chlorpromazine oral tablet 0 mg, 00 mg, 00 mg, 5 mg, 50 mg compro rectal suppository 5 mg diphenhydramine hcl injection solution 50 mg/ml PA hydroxyzine hcl oral solution 0 mg/5 ml PA hydroxyzine hcl oral tablet 0 mg, 5 mg, 50 mg PA hydroxyzine pamoate oral capsule 00 mg, 5 mg, 50 mg meclizine oral tablet.5 mg, 5 mg metoclopramide hcl injection solution 5 mg/ml metoclopramide hcl oral solution 5 mg/5 ml metoclopramide hcl oral tablet 0 mg, 5 mg PA

28 perphenazine oral tablet 6 mg, mg, 4 mg, 8 mg phenadoz rectal suppository.5 mg PA prochlorperazine edisylate injection solution 0 mg/ ml (5 mg/ml), 5 mg/ml prochlorperazine maleate oral tablet 0 mg, 5 mg prochlorperazine rectal suppository 5 mg promethazine oral syrup 6.5 mg/5 ml PA promethazine oral tablet.5 mg, 5 mg, 50 mg PA promethazine rectal suppository.5 mg, 5 mg PA promethegan rectal suppository 5 mg, 50 mg PA TRANSDERM-SCOP TRANSDERMAL PATCH DAY.5 MG ( MG OVER DAYS) trimethobenzamide oral capsule 00 mg PA Emetogenic Therapy Adjuncts aprepitant oral capsule 5 mg, 40 mg, 80 mg B/D aprepitant oral capsule,dose pack 5 mg ()- 80 mg () 4 B/D dronabinol oral capsule 0 mg,.5 mg, 5 mg B/D EMEND ORAL CAPSULE 5 MG, 40 MG, 80 MG EMEND ORAL CAPSULE,DOSE PACK 5 MG ()- 80 MG () EMEND ORAL SUSPENSION FOR RECONSTITUTION 5 MG (5 MG/ ML FINAL CONC.) granisetron (pf) intravenous solution mg/ml ( ml), 00 mcg/ml granisetron hcl intravenous solution mg/ml, mg/ml ( ml) 4 B/D 4 B/D 4 B/D PA PA granisetron hcl oral tablet mg PA ondansetron hcl (pf) injection solution 4 mg/ ml ondansetron hcl (pf) injection syringe 4 mg/ ml ondansetron hcl intravenous solution mg/ml ondansetron hcl oral solution 4 mg/5 ml B/D

29 ondansetron hcl oral tablet 4 mg B/D; QL (5 EA per 0 days) ondansetron hcl oral tablet 4 mg, 8 mg B/D ondansetron oral tablet,disintegrating 4 mg, 8 mg B/D Antifungals Antifungals abelcet intravenous suspension 5 mg/ml B/D AMBISOME INTRAVENOUS SUSPENSION FOR RECONSTITUTION 50 MG 4 B/D amphotericin b injection recon soln 50 mg B/D CANCIDAS INTRAVENOUS RECON SOLN 50 MG, 70 MG ciclopirox topical cream 0.77 % ciclopirox topical solution 8 % ciclopirox topical suspension 0.77 % ciclopirox-ure-camph-menth-euc topical solution 8 % clotrimazole mucous membrane troche 0 mg clotrimazole topical cream % clotrimazole topical solution % econazole topical cream % ERAXIS(WATER DILUENT) INTRAVENOUS RECON SOLN 00 MG, 50 MG fluconazole in dextrose(iso-o) intravenous piggyback 00 mg/00 ml, 400 mg/00 ml fluconazole in nacl (iso-osm) intravenous piggyback 00 mg/50 ml, 00 mg/00 ml, 400 mg/00 ml fluconazole oral suspension for reconstitution 0 mg/ml, 40 mg/ml fluconazole oral tablet 00 mg, 50 mg, 00 mg, 50 mg flucytosine oral capsule 50 mg, 500 mg griseofulvin microsize oral suspension 5 mg/5 ml 4 PA

30 itraconazole oral capsule 00 mg ketoconazole oral tablet 00 mg ketoconazole topical cream % ketoconazole topical shampoo % LAMISIL ORAL GRANULES IN PACKET 5 MG, 87.5 MG MENTAX TOPICAL CREAM % 4 MYCAMINE INTRAVENOUS RECON SOLN 00 MG MYCAMINE INTRAVENOUS RECON SOLN 50 MG NOXAFIL ORAL SUSPENSION 00 MG/5 ML (40 MG/ML) NOXAFIL ORAL TABLET,DELAYED RELEASE (DR/EC) 00 MG nyamyc topical powder 00,000 unit/gram nyata topical powder 00,000 unit/gram nystatin oral suspension 00,000 unit/ml nystatin oral tablet 500,000 unit nystatin topical cream 00,000 unit/gram nystatin topical ointment 00,000 unit/gram nystatin topical powder 00,000 unit/gram nystop topical powder 00,000 unit/gram terbinafine hcl oral tablet 50 mg terconazole vaginal cream 0.4 %, 0.8 % terconazole vaginal suppository 80 mg voriconazole intravenous solution 00 mg voriconazole oral suspension for reconstitution 00 mg/5 ml (40 mg/ml) voriconazole oral tablet 00 mg 5 voriconazole oral tablet 50 mg Antigout Agents Antigout Agents 4 PA 4 PA

31 allopurinol oral tablet 00 mg, 00 mg colchicine oral tablet 0.6 mg probenecid oral tablet 500 mg probenecid-colchicine oral tablet mg ULORIC ORAL TABLET 40 MG, 80 MG ST Anti-Inflammatory Agents Glucocorticoids a-hydrocort injection recon soln 00 mg betamethasone dipropionate topical cream 0.05 % betamethasone dipropionate topical lotion 0.05 % betamethasone dipropionate topical ointment 0.05 % betamethasone valerate topical cream 0. % betamethasone valerate topical lotion 0. % betamethasone valerate topical ointment 0. % betamethasone, augmented topical cream 0.05 % betamethasone, augmented topical gel 0.05 % betamethasone, augmented topical lotion 0.05 % betamethasone, augmented topical ointment 0.05 % cortisone oral tablet 5 mg dexamethasone intensol oral drops mg/ml dexamethasone oral elixir 0.5 mg/5 ml dexamethasone oral solution 0.5 mg/5 ml dexamethasone oral tablet 0.5 mg, 0.75 mg, mg,.5 mg, mg, 4 mg, 6 mg dexamethasone sodium phos (pf) injection solution 0 mg/ml dexamethasone sodium phosphate injection solution 0 mg/ml, 4 mg/ml dexamethasone sodium phosphate injection syringe 4 mg/ml hydrocortisone oral tablet 0 mg, 5 mg 5

32 methylprednisolone acetate injection suspension 40 mg/ml, 80 mg/ml methylprednisolone oral tablet 6 mg, mg, 4 mg, 8 mg methylprednisolone oral tablets,dose pack 4 mg methylprednisolone sodium succ injection recon soln 5 mg, 40 mg methylprednisolone sodium succ intravenous recon soln,000 mg prednisolone acetate ophthalmic drops,suspension % prednisolone oral solution 5 mg/5 ml prednisolone sodium phosphate oral solution 5 mg/5 ml ( mg/ml), 5 mg/5 ml (5 mg/ml), 5 mg base/5 ml (6.7 mg/5 ml) prednisone oral solution 5 mg/5 ml prednisone oral tablet mg, 0 mg,.5 mg, 0 mg, 5 mg, 50 mg prednisone oral tablets,dose pack 0 mg, 0 mg (48 pack), 5 mg, 5 mg (48 pack) RAYOS ORAL TABLET,DELAYED RELEASE (DR/EC) MG, MG, 5 MG Antimigraine Agents Ergot Alkaloids dihydroergotamine injection solution mg/ml PA dihydroergotamine nasal spray,non-aerosol 0.5 mg/pump act. (4 mg/ml) 4 PA; QL (8 ML per 0 days) ERGOMAR SUBLINGUAL TABLET MG 4 PA; QL (0 EA per 0 days) Serotonin (5-Ht) B/D Receptor Agonists naratriptan oral tablet mg,.5 mg QL ( EA per 0 days) sumatriptan nasal spray,non-aerosol 0 mg/actuation, 5 mg/actuation sumatriptan succinate oral tablet 00 mg, 5 mg, 50 mg QL ( EA per 0 days) QL ( EA per 0 days) 6

33 sumatriptan succinate subcutaneous cartridge 4 mg/0.5 ml, 6 mg/0.5 ml sumatriptan succinate subcutaneous pen injector 4 mg/0.5 ml, 6 mg/0.5 ml, 6 mg/0.5 ml (autoinjector) sumatriptan succinate subcutaneous solution 6 mg/0.5 ml sumatriptan succinate subcutaneous syringe 6 mg/0.5 ml SUMAVEL DOSEPRO SUBCUTANEOUS NEEDLE-FREE INJECTOR 4 MG/0.5 ML, 6 MG/0.5 ML TREXIMET ORAL TABLET 0-60 MG, MG Antimyasthenic Agents Parasympathomimetics guanidine oral tablet 5 mg pyridostigmine bromide oral tablet 60 mg Antimycobacterials Antimycobacterials, Other dapsone oral tablet 00 mg, 5 mg rifabutin oral capsule 50 mg Antituberculars CAPASTAT INJECTION RECON SOLN GRAM ethambutol oral tablet 00 mg, 400 mg isoniazid injection solution 00 mg/ml isoniazid oral tablet 00 mg, 00 mg PASER ORAL GRANULES DR FOR SUSP IN PACKET 4 GRAM PRIFTIN ORAL TABLET 50 MG 4 pyrazinamide oral tablet 500 mg rifampin intravenous recon soln 600 mg rifampin oral capsule 50 mg, 00 mg QL (4 ML per 0 days) QL (4 ML per 0 days) QL (4 ML per 0 days) QL (4 ML per 0 days) 4 QL (4 ML per 0 days) 4 4 7

34 RIFATER ORAL TABLET MG 4 SIRTURO ORAL TABLET 00 MG TRECATOR ORAL TABLET 50 MG 4 Antineoplastics Alkylating Agents BUSULFAN INTRAVENOUS SOLUTION 60 MG/0 ML BUSULFEX INTRAVENOUS SOLUTION 60 MG/0 ML carboplatin intravenous solution 0 mg/ml B/D cisplatin intravenous solution mg/ml B/D cyclophosphamide oral capsule 5 mg, 50 mg B/D GLEOSTINE ORAL CAPSULE 0 MG, 00 MG, 40 MG, 5 MG 4 PA HEXALEN ORAL CAPSULE 50 MG 4 PA LEUKERAN ORAL TABLET MG MATULANE ORAL CAPSULE 50 MG 4 melphalan hcl intravenous recon soln 50 mg oxaliplatin intravenous solution 00 mg/0 ml B/D thiotepa injection recon soln 5 mg 5 B/D VALCHLOR TOPICAL GEL 0.06 % 4 Antiandrogens bicalutamide oral tablet 50 mg flutamide oral capsule 5 mg NILANDRON ORAL TABLET 50 MG 4 nilutamide oral tablet 50 mg XTANDI ORAL CAPSULE 40 MG ZYTIGA ORAL TABLET 50 MG, 500 MG Antiangiogenic Agents POMALYST ORAL CAPSULE MG, MG, MG, 4 MG 8

35 REVLIMID ORAL CAPSULE 0 MG, 5 MG, 5 MG, 5 MG THALOMID ORAL CAPSULE 00 MG, 50 MG, 00 MG, 50 MG Antiestrogens/Modifiers ; LA EMCYT ORAL CAPSULE 40 MG 4 PA FARESTON ORAL TABLET 60 MG 4 PA SOLTAMOX ORAL SOLUTION 0 MG/5 ML 4 tamoxifen oral tablet 0 mg, 0 mg Antimetabolites DROXIA ORAL CAPSULE 00 MG, 00 MG, 400 MG fludarabine intravenous recon soln 50 mg 4 PA gemcitabine intravenous recon soln gram, gram, 00 mg gemcitabine intravenous solution gram/6. ml (8 mg/ml), gram/5.6 ml (8 mg/ml), 00 mg/5.6 ml (8 mg/ml) hydroxyurea oral capsule 500 mg PURIXAN ORAL SUSPENSION 0 MG/ML TABLOID ORAL TABLET 40 MG 4 PA Antineoplastics adriamycin intravenous solution 0 mg/0 ml B/D AVASTIN INTRAVENOUS SOLUTION 5 MG/ML (6 ML) docetaxel intravenous solution 0 mg/ml, 80 mg/4 ml (0 mg/ml), 80 mg/8 ml (0 mg/ml) doxorubicin, peg-liposomal intravenous suspension mg/ml 4 B/D PA epirubicin intravenous solution 00 mg/00 ml 4 B/D irinotecan intravenous solution 00 mg/5 ml 4 B/D levoleucovorin intravenous solution 0 mg/ml B/D mitomycin intravenous recon soln 0 mg, 40 mg, 5 mg B/D 9

36 paclitaxel intravenous concentrate 6 mg/ml B/D Antineoplastics, Other ABRAXANE INTRAVENOUS SUSPENSION FOR RECONSTITUTION 00 MG amifostine crystalline intravenous recon soln 500 mg COTELLIC ORAL TABLET 0 MG fludarabine intravenous solution 50 mg/ ml 4 PA FUSILEV INTRAVENOUS RECON SOLN 50 MG ISTODAX INTRAVENOUS RECON SOLN 0 MG/ ML KISQALI ORAL TABLET 00 MG/DAY (00 MG X ), 400 MG/DAY (00 MG X ), 600 MG/DAY (00 MG X ) KYPROLIS INTRAVENOUS RECON SOLN 0 MG, 60 MG leucovorin calcium injection recon soln 00 mg, 00 mg, 50 mg, 500 mg leucovorin calcium oral tablet 0 mg, 5 mg, 5 mg, 5 mg B/D levoleucovorin intravenous recon soln 75 mg B/D levoleucovorin intravenous recon soln 50 mg PA LONSURF ORAL TABLET MG, MG LYNPARZA ORAL CAPSULE 50 MG mesna intravenous solution 00 mg/ml B/D MESNEX ORAL TABLET 400 MG 4 mitoxantrone intravenous concentrate mg/ml NINLARO ORAL CAPSULE. MG, MG, 4 MG ODOMZO ORAL CAPSULE 00 MG REVLIMID ORAL CAPSULE.5 MG, 0 MG ; LA RUBRACA ORAL TABLET 00 MG, 00 MG 0

37 SYLATRON 4-PACK SUBCUTANEOUS KIT 00 MCG, 00 MCG, 600 MCG SYLATRON SUBCUTANEOUS KIT 00 MCG, 00 MCG, 600 MCG SYNRIBO SUBCUTANEOUS RECON SOLN.5 MG TICE BCG INTRAVESICAL SUSPENSION FOR RECONSTITUTION 50 MG VELCADE INJECTION RECON SOLN.5 MG VENCLEXTA ORAL TABLET 0 MG, 50 MG 4 PA VENCLEXTA ORAL TABLET 00 MG VENCLEXTA STARTING PACK ORAL TABLETS,DOSE PACK 0 MG-50 MG- 00 MG YONDELIS INTRAVENOUS RECON SOLN MG ZALTRAP INTRAVENOUS SOLUTION 00 MG/4 ML (5 MG/ML), 00 MG/8 ML (5 MG/ML) ZOLINZA ORAL CAPSULE 00 MG Aromatase Inhibitors, Rd Generation anastrozole oral tablet mg exemestane oral tablet 5 mg letrozole oral tablet.5 mg Enzyme Inhibitors ETOPOPHOS INTRAVENOUS RECON SOLN 00 MG 4 PA etoposide intravenous solution 0 mg/ml B/D FARYDAK ORAL CAPSULE 0 MG, 5 MG, 0 MG IBRANCE ORAL CAPSULE 00 MG, 5 MG, 75 MG toposar intravenous solution 0 mg/ml B/D topotecan intravenous recon soln 4 mg topotecan intravenous solution 4 mg/4 ml ( mg/ml)

38 ZYDELIG ORAL TABLET 00 MG, 50 MG Molecular Target Inhibitors AFINITOR DISPERZ ORAL TABLET FOR SUSPENSION MG, MG, 5 MG AFINITOR ORAL TABLET 0 MG,.5 MG, 5 MG, 7.5 MG ALECENSA ORAL CAPSULE 50 MG BOSULIF ORAL TABLET 00 MG, 500 MG CABOMETYX ORAL TABLET 0 MG, 40 MG, 60 MG CAPRELSA ORAL TABLET 00 MG, 00 MG COMETRIQ ORAL CAPSULE 00 MG/DAY(80 MG X-0 MG X), 40 MG/DAY(80 MG X-0 MG X), 60 MG/DAY (0 MG X /DAY) ERIVEDGE ORAL CAPSULE 50 MG GILOTRIF ORAL TABLET 0 MG, 0 MG, 40 MG ICLUSIG ORAL TABLET 5 MG, 45 MG imatinib oral tablet 00 mg, 400 mg PA IMBRUVICA ORAL CAPSULE 40 MG INLYTA ORAL TABLET MG, 5 MG IRESSA ORAL TABLET 50 MG JAKAFI ORAL TABLET 0 MG, 5 MG, 0 MG, 5 MG, 5 MG LENVIMA ORAL CAPSULE 0 MG/DAY (0 MG X /DAY), 4 MG/DAY(0 MG X -4 MG X ), 8 MG/DAY (0 MG X -4 MG X), 0 MG/DAY (0 MG X ), 4 MG/DAY(0 MG X -4 MG X ), 8 MG/DAY (4 MG X ) MEKINIST ORAL TABLET 0.5 MG, MG NEXAVAR ORAL TABLET 00 MG OFEV ORAL CAPSULE 00 MG, 50 MG SPRYCEL ORAL TABLET 00 MG, 40 MG, 0 MG, 50 MG, 70 MG, 80 MG STIVARGA ORAL TABLET 40 MG

39 SUTENT ORAL CAPSULE.5 MG, 5 MG, 7.5 MG, 50 MG TAFINLAR ORAL CAPSULE 50 MG, 75 MG TAGRISSO ORAL TABLET 40 MG, 80 MG TARCEVA ORAL TABLET 00 MG, 50 MG, 5 MG TASIGNA ORAL CAPSULE 50 MG, 00 MG TYKERB ORAL TABLET 50 MG VOTRIENT ORAL TABLET 00 MG XALKORI ORAL CAPSULE 00 MG, 50 MG ZELBORAF ORAL TABLET 40 MG ZYKADIA ORAL CAPSULE 50 MG Monoclonal Antibodies BAVENCIO INTRAVENOUS SOLUTION 0 MG/ML CYRAMZA INTRAVENOUS SOLUTION 0 MG/ML, 0 MG/ML (50 ML) DARZALEX INTRAVENOUS SOLUTION 0 MG/ML EMPLICITI INTRAVENOUS RECON SOLN 00 MG, 400 MG HERCEPTIN INTRAVENOUS RECON SOLN 50 MG, 440 MG KEYTRUDA INTRAVENOUS RECON SOLN 50 MG KEYTRUDA INTRAVENOUS SOLUTION 00 MG/4 ML (5 MG/ML) LARTRUVO INTRAVENOUS SOLUTION 0 MG/ML OPDIVO INTRAVENOUS SOLUTION 00 MG/0 ML, 40 MG/4 ML RITUXAN INTRAVENOUS CONCENTRATE 0 MG/ML TECENTRIQ INTRAVENOUS SOLUTION,00 MG/0 ML (60 MG/ML)

40 YERVOY INTRAVENOUS SOLUTION 50 MG/0 ML (5 MG/ML) Retinoids bexarotene oral capsule 75 mg 5 PANRETIN TOPICAL GEL 0. % PA TARGRETIN TOPICAL GEL % PA tretinoin (chemotherapy) oral capsule 0 mg 5 Antiparasitics Anthelmintics ALBENZA ORAL TABLET 00 MG 4 BILTRICIDE ORAL TABLET 600 MG Antiprotozoals ALINIA ORAL SUSPENSION FOR RECONSTITUTION 00 MG/5 ML ALINIA ORAL TABLET 500 MG 4 atovaquone oral suspension 750 mg/5 ml 5 atovaquone-proguanil oral tablet mg chloroquine phosphate oral tablet 50 mg, 500 mg COARTEM ORAL TABLET 0-0 MG 4 DARAPRIM ORAL TABLET 5 MG 4 hydroxychloroquine oral tablet 00 mg MALARONE ORAL TABLET MG 4 mefloquine oral tablet 50 mg NEBUPENT INHALATION RECON SOLN 00 MG 4 4 B/D PENTAM INJECTION RECON SOLN 00 MG 4 PA PRIMAQUINE ORAL TABLET 6. MG 4 quinine sulfate oral capsule 4 mg Pediculicides/ Scabicides lindane topical shampoo % malathion topical lotion 0.5 % 4

41 permethrin topical cream 5 % Antiparkinson Agents Anticholinergics benztropine oral tablet 0.5 mg, mg, mg PA Antiparkinson Agents, Other amantadine hcl oral capsule 00 mg amantadine hcl oral solution 50 mg/5 ml amantadine hcl oral tablet 00 mg APOKYN SUBCUTANEOUS CARTRIDGE 0 MG/ML entacapone oral tablet 00 mg rasagiline oral tablet 0.5 mg tolcapone oral tablet 00 mg trihexyphenidyl oral elixir 0.4 mg/ml PA trihexyphenidyl oral tablet mg, 5 mg PA Dopamine Agonists bromocriptine oral capsule 5 mg bromocriptine oral tablet.5 mg NEUPRO TRANSDERMAL PATCH 4 HOUR MG/4 HOUR, MG/4 HOUR, MG/4 HOUR, 4 MG/4 HOUR, 6 MG/4 HOUR, 8 MG/4 HOUR pramipexole oral tablet 0.5 mg, 0.5 mg, 0.5 mg, 0.75 mg, mg,.5 mg pramipexole oral tablet extended release 4 hr 0.75 mg, 0.75 mg,.5 mg,.5 mg, mg,.75 mg, 4.5 mg ropinirole oral tablet 0.5 mg, 0.5 mg, mg, mg, mg, 4 mg, 5 mg 4 PA Dopamine Precursors/ L-Amino Acid Decarboxylase Inhibitors carbidopa-levodopa oral tablet 0-00 mg, 5-00 mg, 5-50 mg carbidopa-levodopa oral tablet extended release 5-00 mg, mg 5

42 Monoamine Oxidase B (Mao-B) Inhibitors AZILECT ORAL TABLET MG 4 rasagiline oral tablet 0.5 mg, mg selegiline hcl oral capsule 5 mg selegiline hcl oral tablet 5 mg Antipsychotics St Generation/ Typical fluphenazine decanoate injection solution 5 mg/ml fluphenazine hcl injection solution.5 mg/ml fluphenazine hcl oral concentrate 5 mg/ml fluphenazine hcl oral elixir.5 mg/5 ml fluphenazine hcl oral tablet mg, 0 mg,.5 mg, 5 mg haloperidol decanoate intramuscular solution 00 mg/ml, 50 mg/ml haloperidol lactate injection solution 5 mg/ml haloperidol lactate oral concentrate mg/ml haloperidol oral tablet 0.5 mg, mg, 5 mg QL (90 EA per 0 days) haloperidol oral tablet mg QL (70 EA per 0 days) haloperidol oral tablet 0 mg, 0 mg QL (50 EA per 0 days) loxapine succinate oral capsule 0 mg QL (0 EA per 0 days) loxapine succinate oral capsule 5 mg, 5 mg QL (90 EA per 0 days) loxapine succinate oral capsule 50 mg molindone oral tablet 0 mg, 5 mg QL (0 EA per 0 days) molindone oral tablet 5 mg QL (70 EA per 0 days) pimozide oral tablet mg, mg thioridazine oral tablet 0 mg, 00 mg, 5 mg, 50 mg thiothixene oral capsule mg, 0 mg, mg, 5 mg trifluoperazine oral tablet mg, 0 mg, mg, 5 mg PA 6

43 Nd Generation/ Atypical abilify maintena intramuscular suspension,extended rel recon 00 mg ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON 400 MG abilify maintena intramuscular suspension,extended rel syring 00 mg, 400 mg ; QL ( EA per 8 days) ; QL ( EA per 8 days) ; QL ( EA per 8 days) aripiprazole oral solution mg/ml 5 QL (900 ML per 0 days) aripiprazole oral tablet 0 mg, 5 mg, mg, 0 mg, 0 mg, 5 mg aripiprazole oral tablet,disintegrating 0 mg, 5 mg ARISTADA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING 44 MG/.6 ML ARISTADA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING 66 MG/.4 ML ARISTADA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING 88 MG/. ML QL (0 EA per 0 days) 5 QL (60 EA per 0 days) ; QL (.6 ML per 8 days) ; QL (.4 ML per 8 days) ; QL (. ML per 8 days) FANAPT ORAL TABLET MG, MG 4 ST; QL (60 EA per 0 days) FANAPT ORAL TABLET 0 MG, MG, 4 MG, 6 MG, 8 MG FANAPT ORAL TABLETS,DOSE PACK MG()-MG()- 4MG()-6MG() GEODON INTRAMUSCULAR RECON SOLN 0 MG/ML (FINAL CONC.) INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 7 MG/0.75 ML INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 56 MG/ML INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 4 MG/.5 ML INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 9 MG/0.5 ML 5 ST; QL (60 EA per 0 days) 4 ST 4 PA; QL ( EA per 0 days) ; QL (0.75 ML per 8 days) ; QL ( ML per 8 days) ; QL (.5 ML per 8 days) 4 PA; QL (0.5 ML per 8 days) 7

44 INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 78 MG/0.5 ML INVEGA TRINZA INTRAMUSCULAR SYRINGE 7 MG/0.875 ML INVEGA TRINZA INTRAMUSCULAR SYRINGE 40 MG/.5 ML INVEGA TRINZA INTRAMUSCULAR SYRINGE 546 MG/.75 ML INVEGA TRINZA INTRAMUSCULAR SYRINGE 89 MG/.65 ML LATUDA ORAL TABLET 0 MG, 0 MG, 40 MG, 60 MG, 80 MG ; QL (0.5 ML per 8 days) ; QL (0.875 ML per 84 days) ; QL (.5 ML per 84 days) ; QL (.75 ML per 84 days) ; QL (.65 ML per 84 days) 5 ST; QL (0 EA per 0 days) NUPLAZID ORAL TABLET 7 MG ; QL (60 EA per 0 days) olanzapine intramuscular recon soln 0 mg QL (90 EA per 0 days) olanzapine oral tablet 0 mg, 5 mg,.5 mg, 0 mg, 5 mg, 7.5 mg olanzapine oral tablet,disintegrating 0 mg, 5 mg, 0 mg, 5 mg paliperidone oral tablet extended release 4hr.5 mg, mg, 9 mg paliperidone oral tablet extended release 4hr 6 mg quetiapine oral tablet 00 mg, 00 mg, 00 mg, 400 mg QL (0 EA per 0 days) QL (0 EA per 0 days) PA; QL (0 EA per 0 days) PA; QL (60 EA per 0 days) QL (60 EA per 0 days) quetiapine oral tablet 5 mg, 50 mg QL (90 EA per 0 days) quetiapine oral tablet extended release 4 hr 50 mg, 00 mg quetiapine oral tablet extended release 4 hr 00 mg, 400 mg, 50 mg REXULTI ORAL TABLET 0.5 MG, 0.5 MG, MG, MG, MG, 4 MG RISPERDAL CONSTA INTRAMUSCULAR SYRINGE.5 MG/ ML, 5 MG/ ML RISPERDAL CONSTA INTRAMUSCULAR SYRINGE 7.5 MG/ ML, 50 MG/ ML QL (0 EA per 0 days) QL (60 EA per 0 days) ; QL (0 EA per 0 days) 4 PA; QL ( EA per 8 days) ; QL ( EA per 8 days) risperidone oral solution mg/ml QL (40 ML per 0 days) 8

45 risperidone oral tablet 0.5 mg, 0.5 mg, mg, mg, mg, 4 mg risperidone oral tablet,disintegrating 0.5 mg, 0.5 mg, mg, mg, mg, 4 mg SAPHRIS (BLACK CHERRY) SUBLINGUAL TABLET 0 MG,.5 MG, 5 MG SEROQUEL XR ORAL TABLET EXTENDED RELEASE 4 HR 50 MG, 00 MG SEROQUEL XR ORAL TABLET EXTENDED RELEASE 4 HR 00 MG, 400 MG, 50 MG VRAYLAR ORAL CAPSULE.5 MG, MG, 4.5 MG, 6 MG VRAYLAR ORAL CAPSULE,DOSE PACK.5 MG ()- MG (6) ziprasidone hcl oral capsule 0 mg, 40 mg, 60 mg, 80 mg ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 0 MG ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 00 MG, 405 MG Treatment-Resistant QL (60 EA per 0 days) QL (60 EA per 0 days) QL (60 EA per 0 days) 4 QL (0 EA per 0 days) 4 QL (60 EA per 0 days) 5 ST; QL (0 EA per 0 days) 4 ST; QL (8 EA per 8 days) QL (60 EA per 0 days) 4 PA clozapine oral tablet 00 mg QL (70 EA per 0 days) clozapine oral tablet 00 mg QL (0 EA per 0 days) clozapine oral tablet 5 mg, 50 mg QL (90 EA per 0 days) clozapine oral tablet,disintegrating.5 mg, 5 mg clozapine oral tablet,disintegrating 50 mg QL (80 EA per 0 days) clozapine oral tablet,disintegrating 00 mg QL (0 EA per 0 days) VERSACLOZ ORAL SUSPENSION 50 MG/ML 5 QL (540 ML per 0 days) Antispasticity Agents Antispasticity Agents baclofen oral tablet 0 mg, 0 mg comfort pac-tizanidine kit 4 mg 9

46 dantrolene oral capsule 00 mg, 5 mg, 50 mg tizanidine oral tablet mg, 4 mg Antivirals Anti-Cytomegalovirus (Cmv) Agents cidofovir intravenous solution 75 mg/ml ganciclovir sodium intravenous recon soln 500 mg B/D VALCYTE ORAL RECON SOLN 50 MG/ML 5 valganciclovir oral recon soln 50 mg/ml 4 valganciclovir oral tablet 450 mg 5 ZIRGAN OPHTHALMIC GEL 0.5 % 4 ST Anti-Hepatitis B (Hbv) Agents ADEFOVIR ORAL TABLET 0 MG 4 PA BARACLUDE ORAL SOLUTION 0.05 MG/ML entecavir oral tablet 0.5 mg, mg 5 EPIVIR HBV ORAL SOLUTION 5 MG/5 ML (5 MG/ML) INTRON A INJECTION RECON SOLN 0 MILLION UNIT ( ML) INTRON A INJECTION SOLUTION 0 MILLION UNIT/ML INTRON A INJECTION SOLUTION 6 MILLION UNIT/ML lamivudine oral solution 0 mg/ml lamivudine oral tablet 00 mg, 50 mg, 00 mg TYZEKA ORAL TABLET 600 MG 4 VEMLIDY ORAL TABLET 5 MG 5 VIREAD ORAL POWDER 40 MG/SCOOP (40 MG/GRAM) VIREAD ORAL TABLET 50 MG, 00 MG, 50 MG, 00 MG Anti-Hepatitis C (Hcv) Agents 4 4 PA 4 PA EPCLUSA ORAL TABLET MG

47 HARVONI ORAL TABLET MG MODERIBA DOSE PACK ORAL TABLETS,DOSE PACK 400 MG (7)- 400 MG (7), 600 MG (7)- 600 MG (7) moderiba oral tablet 00 mg PA PEGASYS PROCLICK SUBCUTANEOUS PEN INJECTOR 5 MCG/0.5 ML, 80 MCG/0.5 ML PEGASYS SUBCUTANEOUS SOLUTION 80 MCG/ML PEGASYS SUBCUTANEOUS SYRINGE 80 MCG/0.5 ML PEGINTRON REDIPEN SUBCUTANEOUS PEN INJECTOR KIT 0 MCG/0.5 ML, 50 MCG/0.5 ML, 50 MCG/0.5 ML, 80 MCG/0.5 ML PEGINTRON SUBCUTANEOUS KIT 0 MCG/0.5 ML, 50 MCG/0.5 ML, 50 MCG/0.5 ML, 80 MCG/0.5 ML REBETOL ORAL SOLUTION 40 MG/ML 4 PA ribasphere oral capsule 00 mg PA ribasphere oral tablet 00 mg PA RIBASPHERE ORAL TABLET 400 MG 4 PA RIBASPHERE ORAL TABLET 600 MG ribasphere ribapak oral tablets,dose pack 00 mg (8)- 400 mg (8), 00 mg (7)- 400 mg (7) RIBASPHERE RIBAPAK ORAL TABLETS,DOSE PACK 400 MG (7)- 400 MG (7), MG (8)-MG (8), 600 MG (7)- 400 MG (7), 600 MG (7)- 600 MG (7), MG (8)-MG (8), MG (8)-MG (8) RIBATAB DOSE PACK ORAL TABLETS,DOSE PACK MG (8)-MG (8) ribavirin oral capsule 00 mg PA ribavirin oral tablet 00 mg PA SOVALDI ORAL TABLET 400 MG ZEPATIER ORAL TABLET MG 4

48 Antiherpetic Agents acyclovir oral capsule 00 mg acyclovir oral suspension 00 mg/5 ml acyclovir oral tablet 400 mg, 800 mg acyclovir sodium intravenous recon soln,000 mg, 500 mg B/D acyclovir sodium intravenous solution 50 mg/ml B/D acyclovir topical ointment 5 % DENAVIR TOPICAL CREAM % 5 famciclovir oral tablet 5 mg, 50 mg, 500 mg trifluridine ophthalmic drops % valacyclovir oral tablet gram, 500 mg ZOVIRAX TOPICAL CREAM 5 % 5 Anti-Hiv Agents, Integrase Inhibitors (Insti) GENVOYA ORAL TABLET MG ISENTRESS ORAL POWDER IN PACKET 00 MG 5 QL (0 EA per 0 days) ISENTRESS ORAL TABLET 400 MG 5 QL (0 EA per 0 days) ISENTRESS ORAL TABLET,CHEWABLE 00 MG, 5 MG STRIBILD ORAL TABLET MG QL (80 EA per 0 days) 5 QL (0 EA per 0 days) TIVICAY ORAL TABLET 0 MG 4 QL (00 EA per 0 days) TIVICAY ORAL TABLET 5 MG 5 QL (0 EA per 0 days) TIVICAY ORAL TABLET 50 MG 5 QL (60 EA per 0 days) VITEKTA ORAL TABLET 50 MG, 85 MG 5 QL (0 EA per 0 days) Anti-Hiv Agents, Non-Nucleoside Reverse Transcriptase Inhibitors (Nnrti) COMPLERA ORAL TABLET MG 5 QL (0 EA per 0 days) EDURANT ORAL TABLET 5 MG 5 QL (0 EA per 0 days) INTELENCE ORAL TABLET 00 MG, 5 MG 4 QL (0 EA per 0 days) INTELENCE ORAL TABLET 00 MG 5 QL (60 EA per 0 days) 4

49 nevirapine oral suspension 50 mg/5 ml nevirapine oral tablet 00 mg QL (60 EA per 0 days) nevirapine oral tablet extended release 4 hr 00 mg nevirapine oral tablet extended release 4 hr 400 mg QL (0 EA per 0 days) QL (0 EA per 0 days) RESCRIPTOR ORAL TABLET 00 MG 4 QL (80 EA per 0 days) RESCRIPTOR ORAL TABLET, DISPERSIBLE 00 MG 4 QL (60 EA per 0 days) SUSTIVA ORAL CAPSULE 00 MG QL (0 EA per 0 days) SUSTIVA ORAL CAPSULE 50 MG QL (60 EA per 0 days) SUSTIVA ORAL TABLET 600 MG 5 QL (0 EA per 0 days) Anti-Hiv Agents, Nucleoside And Nucleotide Reverse Transcriptase Inhibitors (Nrti) abacavir oral tablet 00 mg QL (60 EA per 0 days) abacavir-lamivudine oral tablet mg 5 QL (0 EA per 0 days) abacavir-lamivudine-zidovudine oral tablet mg QL (60 EA per 0 days) ATRIPLA ORAL TABLET MG 5 QL (0 EA per 0 days) DESCOVY ORAL TABLET 00-5 MG 5 QL (0 EA per 0 days) didanosine oral capsule,delayed release(dr/ec) 5 mg didanosine oral capsule,delayed release(dr/ec) 00 mg didanosine oral capsule,delayed release(dr/ec) 50 mg, 400 mg QL (90 EA per 0 days) QL (60 EA per 0 days) QL (0 EA per 0 days) EMTRIVA ORAL CAPSULE 00 MG QL (0 EA per 0 days) EMTRIVA ORAL SOLUTION 0 MG/ML EPZICOM ORAL TABLET MG 5 QL (0 EA per 0 days) lamivudine-zidovudine oral tablet mg QL (60 EA per 0 days) RETROVIR INTRAVENOUS SOLUTION 0 MG/ML stavudine oral capsule 5 mg, 0 mg QL (0 EA per 0 days) stavudine oral capsule 0 mg, 40 mg QL (60 EA per 0 days) 4

50 TRUVADA ORAL TABLET MG, - 00 MG, MG, MG VIDEX GRAM PEDIATRIC ORAL RECON SOLN 0 MG/ML (FINAL) VIDEX 4 GRAM PEDIATRIC ORAL RECON SOLN 0 MG/ML (FINAL) zerit oral recon soln mg/ml 4 ZIAGEN ORAL SOLUTION 0 MG/ML 4 5 QL (0 EA per 0 days) zidovudine oral capsule 00 mg QL (80 EA per 0 days) zidovudine oral syrup 0 mg/ml zidovudine oral tablet 00 mg QL (60 EA per 0 days) Anti-Hiv Agents, Other FUZEON SUBCUTANEOUS RECON SOLN 90 MG ODEFSEY ORAL TABLET MG 5 QL (0 EA per 0 days) SELZENTRY ORAL TABLET 50 MG 5 QL (60 EA per 0 days) SELZENTRY ORAL TABLET 5 MG 4 QL (0 EA per 0 days) SELZENTRY ORAL TABLET 00 MG 5 QL (0 EA per 0 days) SELZENTRY ORAL TABLET 75 MG 4 QL (60 EA per 0 days) TRIUMEQ ORAL TABLET MG 5 QL (0 EA per 0 days) TYBOST ORAL TABLET 50 MG QL (0 EA per 0 days) Anti-Hiv Agents, Protease Inhibitors APTIVUS ORAL CAPSULE 50 MG QL (0 EA per 0 days) APTIVUS ORAL SOLUTION 00 MG/ML CRIXIVAN ORAL CAPSULE 00 MG QL (60 EA per 0 days) CRIXIVAN ORAL CAPSULE 400 MG QL (80 EA per 0 days) EVOTAZ ORAL TABLET MG 5 QL (0 EA per 0 days) INVIRASE ORAL CAPSULE 00 MG QL (00 EA per 0 days) INVIRASE ORAL TABLET 500 MG 5 QL (0 EA per 0 days) KALETRA ORAL SOLUTION MG/5 ML KALETRA ORAL TABLET 00-5 MG QL (40 EA per 0 days)

51 KALETRA ORAL TABLET MG 5 QL (0 EA per 0 days) LEXIVA ORAL SUSPENSION 50 MG/ML 4 LEXIVA ORAL TABLET 700 MG 5 QL (0 EA per 0 days) NORVIR ORAL CAPSULE 00 MG 4 QL (60 EA per 0 days) NORVIR ORAL SOLUTION 80 MG/ML 4 NORVIR ORAL TABLET 00 MG 4 QL (60 EA per 0 days) PREZCOBIX ORAL TABLET MG-MG 5 QL (0 EA per 0 days) PREZISTA ORAL SUSPENSION 00 MG/ML PREZISTA ORAL TABLET 50 MG 5 QL (80 EA per 0 days) PREZISTA ORAL TABLET 600 MG 5 QL (60 EA per 0 days) PREZISTA ORAL TABLET 75 MG 5 QL (00 EA per 0 days) PREZISTA ORAL TABLET 800 MG 5 QL (0 EA per 0 days) REYATAZ ORAL CAPSULE 50 MG, 00 MG 5 QL (0 EA per 0 days) REYATAZ ORAL CAPSULE 00 MG 5 QL (60 EA per 0 days) REYATAZ ORAL POWDER IN PACKET 50 MG VIRACEPT ORAL TABLET 50 MG 4 QL (00 EA per 0 days) VIRACEPT ORAL TABLET 65 MG 5 QL (0 EA per 0 days) Anti-Hiv-Specific Agents, Protease Inhibitor lopinavir-ritonavir oral solution mg/5 ml Anti-Influenza Agents oseltamivir oral capsule 0 mg QL (84 EA per 80 days) oseltamivir oral capsule 45 mg QL (4 EA per 80 days) oseltamivir oral capsule 75 mg QL (8 EA per 80 days) RELENZA DISKHALER INHALATION BLISTER WITH DEVICE 5 MG/ACTUATION rimantadine oral tablet 00 mg 5 4 QL (60 EA per 80 days) TAMIFLU ORAL CAPSULE 0 MG 4 QL (84 EA per 80 days) TAMIFLU ORAL CAPSULE 45 MG 4 QL (4 EA per 80 days) TAMIFLU ORAL CAPSULE 75 MG 4 QL (8 EA per 80 days) TAMIFLU ORAL SUSPENSION FOR RECONSTITUTION 6 MG/ML 4 QL (540 ML per 80 days) 45

52 Anxiolytics Anxiolytics, Other buspirone oral tablet 0 mg, 5 mg, 0 mg, 5 mg, 7.5 mg meprobamate oral tablet 00 mg, 400 mg PA Benzodiazepines alprazolam oral tablet 0.5 mg, 0.5 mg, mg QL (0 EA per 0 days) alprazolam oral tablet mg QL (50 EA per 0 days) clorazepate dipotassium oral tablet 5 mg PA; QL (80 EA per 0 days) clorazepate dipotassium oral tablet.75 mg, 7.5 mg PA; QL (90 EA per 0 days) diazepam intensol oral concentrate 5 mg/ml PA; QL (40 ML per 0 days) diazepam oral concentrate 5 mg/ml PA; QL (40 ML per 0 days) diazepam oral solution 5 mg/5 ml ( mg/ml), 5 mg/5 ml ( mg/ml, 5 ml) PA; QL (00 ML per 0 days) diazepam oral tablet 0 mg, mg, 5 mg PA; QL (0 EA per 0 days) lorazepam intensol oral concentrate mg/ml QL (50 ML per 0 days) lorazepam oral concentrate mg/ml QL (50 ML per 0 days) lorazepam oral tablet 0.5 mg, mg QL (90 EA per 0 days) lorazepam oral tablet mg QL (50 EA per 0 days) Bipolar Agents Mood Stabilizers carbamazepine oral capsule, er multiphase hr 00 mg, 00 mg, 00 mg lithium carbonate oral capsule 50 mg, 00 mg, 600 mg lithium carbonate oral tablet 00 mg lithium carbonate oral tablet extended release 00 mg, 450 mg lithium citrate oral solution 8 meq/5 ml Blood Glucose Regulators Antidiabetic Agents 46

53 acarbose oral tablet 00 mg, 5 mg, 50 mg ST AVANDIA ORAL TABLET MG 4 ST; QL (0 EA per 0 days) AVANDIA ORAL TABLET 4 MG 4 ST; QL (60 EA per 0 days) glimepiride oral tablet mg QL (40 EA per 0 days) glimepiride oral tablet mg QL (0 EA per 0 days) glimepiride oral tablet 4 mg QL (60 EA per 0 days) glipizide oral tablet 0 mg QL (0 EA per 0 days) glipizide oral tablet 5 mg QL (40 EA per 0 days) glipizide oral tablet extended release 4hr 0 mg QL (60 EA per 0 days) glipizide oral tablet extended release 4hr.5 mg QL (40 EA per 0 days) glipizide oral tablet extended release 4hr 5 mg QL (0 EA per 0 days) glipizide-metformin oral tablet.5-50 mg QL (40 EA per 0 days) glipizide-metformin oral tablet mg, mg QL (0 EA per 0 days) glyburide micronized oral tablet.5 mg PA; QL (40 EA per 0 days) glyburide micronized oral tablet mg PA; QL (0 EA per 0 days) glyburide micronized oral tablet 6 mg PA; QL (60 EA per 0 days) glyburide oral tablet.5 mg PA; QL (480 EA per 0 days) glyburide oral tablet.5 mg PA; QL (40 EA per 0 days) glyburide oral tablet 5 mg PA; QL (0 EA per 0 days) glyburide-metformin oral tablet.5-50 mg PA; QL (40 EA per 0 days) glyburide-metformin oral tablet mg, mg PA; QL (0 EA per 0 days) GLYXAMBI ORAL TABLET 0-5 MG ST; QL (0 EA per 0 days) GLYXAMBI ORAL TABLET 5-5 MG ST; QL (60 EA per 0 days) INVOKAMET ORAL TABLET 50-,000 MG, MG, 50-,000 MG ST; QL (60 EA per 0 days) INVOKAMET ORAL TABLET MG ST; QL (0 EA per 0 days) INVOKAMET XR ORAL TABLET, IR - ER, BIPHASIC 4HR 50-,000 MG, MG, 50-,000 MG, MG ST; QL (60 EA per 0 days) INVOKANA ORAL TABLET 00 MG ST; QL (90 EA per 0 days) INVOKANA ORAL TABLET 00 MG ST; QL (0 EA per 0 days) 47

54 JANUMET ORAL TABLET 50-,000 MG, MG JANUMET XR ORAL TABLET, ER MULTIPHASE 4 HR 00-,000 MG JANUMET XR ORAL TABLET, ER MULTIPHASE 4 HR 50-,000 MG, MG ST; QL (60 EA per 0 days) ST; QL (0 EA per 0 days) ST; QL (60 EA per 0 days) JANUVIA ORAL TABLET 00 MG ST; QL (0 EA per 0 days) JANUVIA ORAL TABLET 5 MG ST; QL (0 EA per 0 days) JANUVIA ORAL TABLET 50 MG ST; QL (60 EA per 0 days) JARDIANCE ORAL TABLET 0 MG, 5 MG ST; QL (0 EA per 0 days) JENTADUETO ORAL TABLET.5-,000 MG, MG, MG JENTADUETO XR ORAL TABLET, IR - ER, BIPHASIC 4HR.5-,000 MG, 5-,000 MG ST; QL (60 EA per 0 days) ST; QL (60 EA per 0 days) metformin oral tablet,000 mg QL (75 EA per 0 days) metformin oral tablet 500 mg QL (50 EA per 0 days) metformin oral tablet 850 mg QL (90 EA per 0 days) metformin oral tablet extended release 4 hr 500 mg metformin oral tablet extended release 4 hr 750 mg nateglinide oral tablet 0 mg, 60 mg ST QL (0 EA per 0 days) QL (75 EA per 0 days) pioglitazone oral tablet 5 mg QL (90 EA per 0 days) pioglitazone oral tablet 0 mg QL (45 EA per 0 days) pioglitazone oral tablet 45 mg QL (0 EA per 0 days) pioglitazone-metformin oral tablet mg, mg repaglinide oral tablet 0.5 mg, mg, mg ST SYMLINPEN 0 SUBCUTANEOUS PEN INJECTOR,700 MCG/.7 ML SYMLINPEN 60 SUBCUTANEOUS PEN INJECTOR,500 MCG/.5 ML SYNJARDY ORAL TABLET.5-,000 MG, MG, 5-,000 MG, MG QL (90 EA per 0 days) 4 PA 4 PA ST; QL (60 EA per 0 days) tolazamide oral tablet 50 mg QL (0 EA per 0 days) 48

55 tolazamide oral tablet 500 mg QL (60 EA per 0 days) tolbutamide oral tablet 500 mg QL (80 EA per 0 days) TRADJENTA ORAL TABLET 5 MG ST; QL (0 EA per 0 days) TRULICITY SUBCUTANEOUS PEN INJECTOR 0.75 MG/0.5 ML,.5 MG/0.5 ML VICTOZA -PAK SUBCUTANEOUS PEN INJECTOR 0.6 MG/0. ML (8 MG/ ML) VICTOZA -PAK SUBCUTANEOUS PEN INJECTOR 0.6 MG/0. ML (8 MG/ ML) Glycemic Agents GLUCAGEN DIAGNOSTIC KIT INJECTION RECON SOLN MG/ML GLUCAGEN HYPOKIT INJECTION RECON SOLN MG GLUCAGON EMERGENCY KIT (HUMAN) INJECTION KIT MG GLUCAGON HCL INJECTION RECON SOLN MG KORLYM ORAL TABLET 00 MG PROGLYCEM ORAL SUSPENSION 50 MG/ML 4 Insulins APIDRA SOLOSTAR SUBCUTANEOUS INSULIN PEN 00 UNIT/ML APIDRA SUBCUTANEOUS SOLUTION 00 UNIT/ML HUMALOG KWIKPEN SUBCUTANEOUS INSULIN PEN 00 UNIT/ML, 00 UNIT/ML ( ML) HUMALOG MIX KWIKPEN SUBCUTANEOUS INSULIN PEN 00 UNIT/ML (50-50) HUMALOG MIX SUBCUTANEOUS SUSPENSION 00 UNIT/ML (50-50) HUMALOG MIX 75-5 KWIKPEN SUBCUTANEOUS INSULIN PEN 00 UNIT/ML (75-5) QL (4 EA per 0 days) QL (4 EA per 0 days) QL ( EA per 0 days) QL ( EA per 0 days) 49

56 HUMALOG MIX 75-5 SUBCUTANEOUS SUSPENSION 00 UNIT/ML (75-5) HUMALOG SUBCUTANEOUS CARTRIDGE 00 UNIT/ML HUMALOG SUBCUTANEOUS SOLUTION 00 UNIT/ML, 00 UNIT/ML (PREFILLED SYRINGE) HUMULIN 70/0 KWIKPEN SUBCUTANEOUS INSULIN PEN 00 UNIT/ML (70-0) HUMULIN 70/0 SUBCUTANEOUS SUSPENSION 00 UNIT/ML (70-0) HUMULIN N KWIKPEN SUBCUTANEOUS INSULIN PEN 00 UNIT/ML ( ML) HUMULIN N SUBCUTANEOUS SUSPENSION 00 UNIT/ML HUMULIN R U-00 INJECTION SOLUTION 00 UNIT/ML HUMULIN R U-500 (CONC) KWIKPEN SUBCUTANEOUS INSULIN PEN 500 UNIT/ML ( ML) HUMULIN R U-500 (CONCENTRATED) SUBCUTANEOUS SOLUTION 500 UNIT/ML LANTUS SOLOSTAR SUBCUTANEOUS INSULIN PEN 00 UNIT/ML ( ML) LANTUS SUBCUTANEOUS SOLUTION 00 UNIT/ML LEVEMIR FLEXTOUCH SUBCUTANEOUS INSULIN PEN 00 UNIT/ML ( ML) LEVEMIR SUBCUTANEOUS SOLUTION 00 UNIT/ML NOVOLIN 70/0 SUBCUTANEOUS SUSPENSION 00 UNIT/ML (70-0) NOVOLIN N SUBCUTANEOUS SUSPENSION 00 UNIT/ML NOVOLIN R INJECTION SOLUTION 00 UNIT/ML 50

57 NOVOLOG FLEXPEN SUBCUTANEOUS INSULIN PEN 00 UNIT/ML NOVOLOG MIX 70-0 FLEXPEN SUBCUTANEOUS INSULIN PEN 00 UNIT/ML (70-0) NOVOLOG MIX 70-0 SUBCUTANEOUS SOLUTION 00 UNIT/ML (70-0) NOVOLOG PENFILL SUBCUTANEOUS CARTRIDGE 00 UNIT/ML NOVOLOG SUBCUTANEOUS SOLUTION 00 UNIT/ML Blood Products/ Modifiers/ Volume Expanders Anticoagulants argatroban in 0.9 % sod chlor intravenous parenteral solution 50 mg/50 ml ( mg/ml) argatroban in 0.9 % sod chlor intravenous solution mg/ml argatroban in nacl (iso-os) intravenous solution 50 mg/50 ml ( mg/ml) B/D B/D B/D argatroban intravenous solution 00 mg/ml 5 B/D COUMADIN ORAL TABLET MG, 0 MG, MG,.5 MG, MG, 4 MG, 5 MG, 6 MG, 7.5 MG ELIQUIS ORAL TABLET.5 MG, 5 MG enoxaparin subcutaneous solution 00 mg/ ml enoxaparin subcutaneous syringe 00 mg/ml, 0 mg/0.8 ml, 0 mg/0. ml, 40 mg/0.4 ml, 60 mg/0.6 ml, 80 mg/0.8 ml enoxaparin subcutaneous syringe 50 mg/ml 5 fondaparinux subcutaneous syringe 0 mg/0.8 ml, 7.5 mg/0.6 ml fondaparinux subcutaneous syringe.5 mg/0.5 ml, 5 mg/0.4 ml FRAGMIN SUBCUTANEOUS SOLUTION 5,000 ANTI-XA UNIT/ML

58 FRAGMIN SUBCUTANEOUS SYRINGE 0,000 ANTI-XA UNIT/ML,,500 ANTI-XA UNIT/0.5 ML, 5,000 ANTI-XA UNIT/0.6 ML, 8,000 ANTI-XA UNIT/0.7 ML, 7,500 ANTI-XA UNIT/0. ML FRAGMIN SUBCUTANEOUS SYRINGE,500 ANTI-XA UNIT/0. ML, 5,000 ANTI-XA UNIT/0. ML heparin (porcine) in 5 % dex intravenous parenteral solution 0,000 unit/500 ml (40 unit/ml) heparin (porcine) injection cartridge 5,000 unit/ml ( ml) heparin (porcine) injection solution,000 unit/ml, 0,000 unit/ml, 5,000 unit/ml heparin, porcine (pf) injection solution,000 unit/ml, 5,000 unit/0.5 ml jantoven oral tablet mg, 0 mg, mg,.5 mg, mg, 4 mg, 5 mg, 6 mg, 7.5 mg PRADAXA ORAL CAPSULE 0 MG, 50 MG, 75 MG warfarin oral tablet mg, 0 mg, mg,.5 mg, mg, 4 mg, 5 mg, 6 mg, 7.5 mg XARELTO ORAL TABLET 0 MG, 5 MG, 0 MG XARELTO ORAL TABLETS,DOSE PACK 5 MG (4)- 0 MG (9) Blood Formation Modifiers anagrelide oral capsule 0.5 mg, mg ARANESP (IN POLYSORBATE) INJECTION SOLUTION 00 MCG/ML, 50 MCG/0.75 ML, 00 MCG/ML, 00 MCG/ML ARANESP (IN POLYSORBATE) INJECTION SOLUTION 5 MCG/ML, 40 MCG/ML, 60 MCG/ML ARANESP (IN POLYSORBATE) INJECTION SYRINGE 0 MCG/0.4 ML, 5 MCG/0.4 ML, 40 MCG/0.4 ML, 60 MCG/0. ML PA 4 PA 5

59 ARANESP (IN POLYSORBATE) INJECTION SYRINGE 00 MCG/0.5 ML, 50 MCG/0. ML, 00 MCG/0.4 ML, 00 MCG/0.6 ML, 500 MCG/ML EPOGEN INJECTION SOLUTION 0,000 UNIT/ML,,000 UNIT/ML, 0,000 UNIT/ ML,,000 UNIT/ML, 4,000 UNIT/ML EPOGEN INJECTION SOLUTION 0,000 UNIT/ML GRANIX SUBCUTANEOUS SYRINGE 00 MCG/0.5 ML, 480 MCG/0.8 ML 4 PA LEUKINE INJECTION RECON SOLN 50 MCG MOZOBIL SUBCUTANEOUS SOLUTION 4 MG/. ML (0 MG/ML) NEULASTA SUBCUTANEOUS SYRINGE 6 MG/0.6ML NEULASTA SUBCUTANEOUS SYRINGE, W/ WEARABLE INJECTOR 6 MG/0.6 ML NEUPOGEN INJECTION SOLUTION 00 MCG/ML, 480 MCG/.6 ML NEUPOGEN INJECTION SYRINGE 00 MCG/0.5 ML, 480 MCG/0.8 ML PROCRIT INJECTION SOLUTION 0,000 UNIT/ML,,000 UNIT/ML, 0,000 UNIT/ ML,,000 UNIT/ML, 4,000 UNIT/ML PROCRIT INJECTION SOLUTION 0,000 UNIT/ML PROCRIT INJECTION SOLUTION 40,000 UNIT/ML PROMACTA ORAL TABLET.5 MG, 5 MG, 50 MG, 75 MG ZARXIO INJECTION SYRINGE 00 MCG/0.5 ML, 480 MCG/0.8 ML Coagulants tranexamic acid intravenous solution,000 mg/0 ml (00 mg/ml) tranexamic acid oral tablet 650 mg PA 4 PA 5 QL (0 EA per 0 days) 5

60 Platelet Modifying Agents aspirin-dipyridamole oral capsule, er multiphase hr 5-00 mg BRILINTA ORAL TABLET 60 MG, 90 MG 4 cilostazol oral tablet 00 mg, 50 mg clopidogrel oral tablet 00 mg clopidogrel oral tablet 75 mg dipyridamole oral tablet 5 mg, 50 mg, 75 mg PA EFFIENT ORAL TABLET 0 MG, 5 MG Cardiovascular Agents Alpha-Adrenergic Agonists clonidine hcl oral tablet 0. mg, 0. mg, 0. mg clonidine transdermal patch weekly 0. mg/4 hr, 0. mg/4 hr, 0. mg/4 hr guanfacine oral tablet mg, mg PA methyldopa oral tablet 50 mg, 500 mg PA methyldopate intravenous solution 50 mg/5 ml PA midodrine oral tablet 0 mg,.5 mg, 5 mg NORTHERA ORAL CAPSULE 00 MG, 00 MG, 00 MG Alpha-Adrenergic Blocking Agents doxazosin oral tablet mg, mg, 4 mg, 8 mg prazosin oral capsule mg, mg, 5 mg terazosin oral capsule mg, 0 mg, mg, 5 mg Angiotensin Ii Receptor Antagonists amlodipine-olmesartan oral tablet 0-0 mg, 0-40 mg, 5-0 mg, 5-40 mg BENICAR ORAL TABLET 0 MG, 40 MG, 5 MG irbesartan oral tablet 50 mg, 00 mg, 75 mg losartan oral tablet 00 mg, 5 mg, 50 mg 4 ST olmesartan oral tablet 0 mg, 40 mg, 5 mg ST 54

61 olmesartan-amlodipin-hcthiazid oral tablet mg, mg, mg, mg, mg valsartan oral tablet 60 mg, 0 mg, 40 mg, 80 mg Angiotensin-Converting Enzyme (Ace) Inhibitors benazepril oral tablet 0 mg, 0 mg, 40 mg, 5 mg captopril oral tablet 00 mg,.5 mg, 5 mg, 50 mg enalapril maleate oral tablet 0 mg,.5 mg, 0 mg, 5 mg fosinopril oral tablet 0 mg, 0 mg, 40 mg lisinopril oral tablet 0 mg,.5 mg, 0 mg, 0 mg, 40 mg, 5 mg moexipril oral tablet 5 mg, 7.5 mg quinapril oral tablet 0 mg, 0 mg, 40 mg, 5 mg ramipril oral capsule.5 mg, 0 mg,.5 mg, 5 mg trandolapril oral tablet mg, mg, 4 mg Antiarrhythmics amiodarone oral tablet 00 mg, 00 mg, 400 mg disopyramide phosphate oral capsule 00 mg, 50 mg dofetilide oral capsule 5 mcg, 50 mcg, 500 mcg flecainide oral tablet 00 mg, 50 mg, 50 mg mexiletine oral capsule 50 mg, 00 mg, 50 mg MULTAQ ORAL TABLET 400 MG 4 NORPACE CR ORAL CAPSULE, EXTENDED RELEASE 00 MG, 50 MG propafenone oral tablet 50 mg, 5 mg, 00 mg quinidine gluconate oral tablet extended release 4 mg quinidine sulfate oral tablet 00 mg, 00 mg sorine oral tablet 0 mg, 60 mg, 40 mg, 80 mg PA 4 PA 55

62 sotalol af oral tablet 0 mg, 60 mg, 80 mg sotalol oral tablet 0 mg, 60 mg, 40 mg, 80 mg Beta-Adrenergic Blocking Agents acebutolol oral capsule 00 mg, 400 mg atenolol oral tablet 00 mg, 5 mg, 50 mg bisoprolol fumarate oral tablet 0 mg, 5 mg carvedilol oral tablet.5 mg, 5 mg,.5 mg, 6.5 mg labetalol oral tablet 00 mg, 00 mg, 00 mg metoprolol succinate oral tablet extended release 4 hr 00 mg, 00 mg, 5 mg, 50 mg metoprolol tartrate oral tablet 00 mg, 5 mg, 7.5 mg, 50 mg, 75 mg nadolol oral tablet 0 mg, 40 mg, 80 mg propranolol oral capsule,extended release 4 hr 0 mg, 60 mg, 60 mg, 80 mg propranolol oral solution 0 mg/5 ml (4 mg/ml), 40 mg/5 ml (8 mg/ml) propranolol oral tablet 0 mg, 0 mg, 40 mg, 60 mg, 80 mg Calcium Channel Blocking Agents afeditab cr oral tablet extended release 0 mg, 60 mg amlodipine oral tablet 0 mg,.5 mg, 5 mg cartia xt oral capsule,extended release 4hr 0 mg, 80 mg, 40 mg, 00 mg diltiazem hcl intravenous recon soln 00 mg diltiazem hcl intravenous solution 5 mg/ml diltiazem hcl oral capsule, extended release 0 mg, 80 mg, 40 mg, 00 mg, 60 mg, 40 mg diltiazem hcl oral capsule,ext release degradable 0 mg, 80 mg, 40 mg diltiazem hcl oral capsule,extended release hr 0 mg, 60 mg, 90 mg 56

63 diltiazem hcl oral capsule,extended release 4hr 0 mg, 80 mg, 40 mg, 00 mg, 60 mg diltiazem hcl oral tablet 0 mg, 0 mg, 60 mg, 90 mg dilt-xr oral capsule,ext release degradable 0 mg, 80 mg, 40 mg felodipine oral tablet extended release 4 hr 0 mg,.5 mg, 5 mg isradipine oral capsule.5 mg, 5 mg nifedical xl oral tablet extended release 4hr 0 mg, 60 mg nifedipine oral capsule 0 mg, 0 mg PA nifedipine oral tablet extended release 4hr 0 mg, 60 mg, 90 mg nifedipine oral tablet extended release 0 mg, 60 mg, 90 mg nimodipine oral capsule 0 mg taztia xt oral capsule, extended release 0 mg, 80 mg, 40 mg, 00 mg, 60 mg verapamil oral capsule,ext rel. pellets 4 hr 0 mg, 80 mg, 40 mg, 60 mg verapamil oral tablet 0 mg, 40 mg, 80 mg verapamil oral tablet extended release 0 mg, 0 mg (4 hours), 80 mg, 40 mg Cardiovascular Agents ALDACTAZIDE ORAL TABLET MG 4 amiloride-hydrochlorothiazide oral tablet 5-50 mg amlodipine-benazepril oral capsule 0-0 mg, 0-40 mg,.5-0 mg, 5-0 mg, 5-0 mg, 5-40 mg amlodipine-olmesartan oral tablet 0-0 mg, 0-40 mg, 5-0 mg, 5-40 mg amlodipine-valsartan oral tablet 0-60 mg, 0-0 mg, 5-60 mg, 5-0 mg amlodipine-valsartan-hcthiazid oral tablet mg, mg, mg, mg, mg 57

64 atenolol-chlorthalidone oral tablet 00-5 mg, 50-5 mg benazepril-hydrochlorothiazide oral tablet 0-.5 mg, 0-.5 mg, 0-5 mg, mg BENICAR HCT ORAL TABLET 0-.5 MG, MG, 40-5 MG bisoprolol-hydrochlorothiazide oral tablet mg, mg, mg captopril-hydrochlorothiazide oral tablet 5-5 mg, 5-5 mg, 50-5 mg, 50-5 mg ST DEMSER ORAL CAPSULE 50 MG 4 PA enalapril-hydrochlorothiazide oral tablet 0-5 mg, 5-.5 mg ENTRESTO ORAL TABLET 4-6 MG, 49-5 MG, 97-0 MG ezetimibe-simvastatin oral tablet 0-0 mg, 0-0 mg, 0-40 mg, 0-80 mg fosinopril-hydrochlorothiazide oral tablet 0-.5 mg, 0-.5 mg irbesartan-hydrochlorothiazide oral tablet mg, mg lisinopril-hydrochlorothiazide oral tablet 0-.5 mg, 0-.5 mg, 0-5 mg losartan-hydrochlorothiazide oral tablet mg, 00-5 mg, mg methyldopa-hydrochlorothiazide oral tablet 50-5 mg, 50-5 mg moexipril-hydrochlorothiazide oral tablet 5-.5 mg, 5-5 mg, mg olmesartan-amlodipin-hcthiazid oral tablet mg, mg, mg, mg, mg olmesartan-hydrochlorothiazide oral tablet 0-.5 mg, mg, 40-5 mg quinapril-hydrochlorothiazide oral tablet 0-.5 mg, 0-.5 mg, 0-5 mg 4 PA ST reserpine oral tablet 0. mg, 0.5 mg PA 58

65 spironolacton-hydrochlorothiaz oral tablet 5-5 mg TEKTURNA HCT ORAL TABLET MG, 50-5 MG, MG, 00-5 MG triamterene-hydrochlorothiazid oral capsule mg, 50-5 mg triamterene-hydrochlorothiazid oral tablet mg, mg TRIBENZOR ORAL TABLET MG, MG, MG, MG, MG valsartan-hydrochlorothiazide oral tablet mg, 60-5 mg, 0-.5 mg, 0-5 mg, mg VYTORIN 0-0 ORAL TABLET 0-0 MG VYTORIN 0-0 ORAL TABLET 0-0 MG VYTORIN 0-40 ORAL TABLET 0-40 MG VYTORIN 0-80 ORAL TABLET 0-80 MG Cardiovascular Agents, Other digitek oral tablet 5 mcg QL (0 EA per 0 days) digitek oral tablet 50 mcg PA digox oral tablet 5 mcg QL (0 EA per 0 days) digox oral tablet 50 mcg PA digoxin oral solution 50 mcg/ml PA digoxin oral tablet 5 mcg QL (0 EA per 0 days) digoxin oral tablet 50 mcg PA pentoxifylline oral tablet extended release 400 mg RANEXA ORAL TABLET EXTENDED RELEASE HR,000 MG, 500 MG TEKTURNA ORAL TABLET 50 MG, 00 MG Diuretics, Carbonic Anhydrase Inhibitors acetazolamide oral capsule, extended release 500 mg acetazolamide oral tablet 5 mg, 50 mg 4 PA 59

66 KEVEYIS ORAL TABLET 50 MG Diuretics, Loop bumetanide oral tablet 0.5 mg, mg, mg furosemide injection solution 0 mg/ml furosemide injection syringe 0 mg/ml furosemide oral solution 0 mg/ml, 40 mg/5 ml (8 mg/ml) furosemide oral tablet 0 mg, 40 mg, 80 mg torsemide oral tablet 0 mg, 00 mg, 0 mg, 5 mg Diuretics, Potassium-Sparing amiloride oral tablet 5 mg eplerenone oral tablet 5 mg, 50 mg spironolactone oral tablet 00 mg, 5 mg, 50 mg Diuretics, Thiazide chlorothiazide oral tablet 50 mg, 500 mg chlorthalidone oral tablet 5 mg, 50 mg hydrochlorothiazide oral capsule.5 mg hydrochlorothiazide oral tablet.5 mg, 5 mg, 50 mg indapamide oral tablet.5 mg,.5 mg methyclothiazide oral tablet 5 mg metolazone oral tablet 0 mg,.5 mg, 5 mg Dyslipidemics, Fibric Acid Derivatives fenofibrate micronized oral capsule 4 mg, 00 mg, 67 mg fenofibrate nanocrystallized oral tablet 45 mg, 48 mg fenofibrate oral tablet 60 mg, 54 mg fenofibric acid (choline) oral capsule,delayed release(dr/ec) 5 mg, 45 mg gemfibrozil oral tablet 600 mg Dyslipidemics, Hmg Coa Reductase Inhibitors 60

67 atorvastatin oral tablet 0 mg, 0 mg, 40 mg, 80 mg LIVALO ORAL TABLET MG, MG, 4 MG lovastatin oral tablet 0 mg, 0 mg, 40 mg pravastatin oral tablet 0 mg, 0 mg, 40 mg, 80 mg rosuvastatin oral tablet 0 mg, 0 mg, 40 mg, 5 mg simvastatin oral tablet 0 mg, 0 mg, 40 mg, 5 mg, 80 mg Dyslipidemics, Other cholestyramine (with sugar) oral powder 4 gram cholestyramine (with sugar) oral powder in packet 4 gram cholestyramine light oral powder 4 gram cholestyramine light oral powder in packet 4 gram colestipol oral granules 5 gram colestipol oral packet 5 gram colestipol oral tablet gram ezetimibe oral tablet 0 mg JUXTAPID ORAL CAPSULE 0 MG, 0 MG, 0 MG, 40 MG, 5 MG, 60 MG KYNAMRO SUBCUTANEOUS SYRINGE 00 MG/ML niacin oral tablet extended release 4 hr,000 mg, 500 mg, 750 mg omega- acid ethyl esters oral capsule gram prevalite oral powder 4 gram prevalite oral powder in packet 4 gram REPATHA PUSHTRONEX SUBCUTANEOUS WEARABLE INJECTOR 40 MG/.5 ML REPATHA SURECLICK SUBCUTANEOUS PEN INJECTOR 40 MG/ML 6

68 REPATHA SYRINGE SUBCUTANEOUS SYRINGE 40 MG/ML WELCHOL ORAL POWDER IN PACKET.75 GRAM WELCHOL ORAL TABLET 65 MG ZETIA ORAL TABLET 0 MG Vasodilators, Direct-Acting Arterial hydralazine oral tablet 0 mg, 00 mg, 5 mg, 50 mg minoxidil oral tablet 0 mg,.5 mg Vasodilators, Direct-Acting Arterial/ Venous isosorbide dinitrate oral tablet 0 mg, 0 mg, 0 mg, 5 mg isosorbide dinitrate oral tablet extended release 40 mg isosorbide mononitrate oral tablet 0 mg, 0 mg isosorbide mononitrate oral tablet extended release 4 hr 0 mg, 0 mg, 60 mg NITRO-BID TRANSDERMAL OINTMENT % 4 NITRO-DUR TRANSDERMAL PATCH 4 HOUR 0. MG/HR, 0.8 MG/HR nitroglycerin sublingual tablet 0. mg, 0.4 mg, 0.6 mg nitroglycerin transdermal patch 4 hour 0. mg/hr, 0. mg/hr, 0.4 mg/hr, 0.6 mg/hr nitroglycerin translingual aerosol,spray 400 mcg/spray nitroglycerin translingual spray,non-aerosol 400 mcg/spray NITROSTAT SUBLINGUAL TABLET 0. MG, 0.4 MG, 0.6 MG RECTIV RECTAL OINTMENT 0.4 % (W/W) 4 Central Nervous System Agents Attention Deficit Hyperactivity Disorder Agents, Amphetamines 4 4 6

69 dextroamphetamine oral capsule, extended release 0 mg dextroamphetamine oral capsule, extended release 5 mg dextroamphetamine oral capsule, extended release 5 mg PA; QL (50 EA per 0 days) PA; QL (0 EA per 0 days) PA; QL (90 EA per 0 days) dextroamphetamine oral tablet 0 mg PA; QL (80 EA per 0 days) dextroamphetamine oral tablet 5 mg PA; QL (60 EA per 0 days) dextroamphetamine-amphetamine oral capsule,extended release 4hr 0 mg, 5 mg, 0 mg, 5 mg, 0 mg, 5 mg dextroamphetamine-amphetamine oral tablet 0 mg, 0 mg, 0 mg, 5 mg, 7.5 mg dextroamphetamine-amphetamine oral tablet.5 mg dextroamphetamine-amphetamine oral tablet 5 mg Attention Deficit Hyperactivity Disorder Agents, Non-Amphetamines clonidine hcl oral tablet extended release hr 0. mg dexmethylphenidate oral capsule,er biphasic mg, 5 mg, 0 mg, 5 mg, 0 mg, 5 mg, 40 mg, 5 mg dexmethylphenidate oral tablet 0 mg,.5 mg, 5 mg FOCALIN XR ORAL CAPSULE,ER BIPHASIC MG, 5 MG PA; QL (0 EA per 0 days) PA; QL (60 EA per 0 days) PA; QL (0 EA per 0 days) PA; QL (90 EA per 0 days) QL (0 EA per 0 days) PA PA 4 PA methylphenidate oral tablet 0 mg, 0 mg, 5 mg PA methylphenidate oral tablet extended release 0 mg methylphenidate oral tablet extended release 4hr 8 mg methylphenidate oral tablet extended release 4hr 7 mg methylphenidate oral tablet extended release 4hr 6 mg PA; QL (90 EA per 0 days) PA; QL (0 EA per 0 days) PA; QL (90 EA per 0 days) PA; QL (60 EA per 0 days) 6

70 methylphenidate oral tablet extended release 4hr 54 mg STRATTERA ORAL CAPSULE 0 MG, 00 MG, 8 MG, 5 MG, 40 MG, 60 MG, 80 MG Central Nervous System, Other EXONDYS 5 INTRAVENOUS SOLUTION 50 MG/ML, 50 MG/ML (0 ML) HORIZANT ORAL TABLET EXTENDED RELEASE 00 MG, 600 MG NUEDEXTA ORAL CAPSULE 0-0 MG 4 riluzole oral tablet 50 mg tetrabenazine oral tablet.5 mg, 5 mg 5 Fibromyalgia Agents LYRICA ORAL CAPSULE 00 MG, 50 MG, 00 MG, 5 MG, 5 MG, 00 MG, 50 MG, 75 MG LYRICA ORAL SOLUTION 0 MG/ML SAVELLA ORAL TABLET 00 MG,.5 MG, 5 MG, 50 MG SAVELLA ORAL TABLETS,DOSE PACK.5 MG (5)-5 MG(8)-50 MG(4) Multiple Sclerosis Agents AMPYRA ORAL TABLET EXTENDED RELEASE HR 0 MG PA; QL (0 EA per 0 days) AUBAGIO ORAL TABLET 4 MG, 7 MG BETASERON SUBCUTANEOUS KIT 0. MG BETASERON SUBCUTANEOUS RECON SOLN 0. MG COPAXONE SUBCUTANEOUS SYRINGE 0 MG/ML, 40 MG/ML EXTAVIA SUBCUTANEOUS KIT 0. MG EXTAVIA SUBCUTANEOUS RECON SOLN 0. MG GILENYA ORAL CAPSULE 0.5 MG 64

71 REBIF (WITH ALBUMIN) SUBCUTANEOUS SYRINGE MCG/0.5 ML, 44 MCG/0.5 ML REBIF REBIDOSE SUBCUTANEOUS PEN INJECTOR MCG/0.5 ML, 44 MCG/0.5 ML, 8.8MCG/0.ML- MCG/0.5ML (6) REBIF TITRATION PACK SUBCUTANEOUS SYRINGE 8.8MCG/0.ML- MCG/0.5ML (6) TECFIDERA ORAL CAPSULE,DELAYED RELEASE(DR/EC) 0 MG, 0 MG (4)- 40 MG (46), 40 MG TYSABRI INTRAVENOUS SOLUTION 00 MG/5 ML Dental And Oral Agents Dental And Oral Agents cevimeline oral capsule 0 mg chlorhexidine gluconate mucous membrane mouthwash 0. % CUVPOSA ORAL SOLUTION MG/5 ML (0. MG/ML) glycopyrrolate oral tablet mg, mg periogard mucous membrane mouthwash 0. % pilocarpine hcl oral tablet 5 mg, 7.5 mg triamcinolone acetonide dental paste 0. % Dermatological Agents Dermatological Agents ; LA 8-MOP ORAL CAPSULE 0 MG 4 PA acitretin oral capsule 0 mg, 7.5 mg, 5 mg ammonium lactate topical cream % ammonium lactate topical lotion % calcipotriene scalp solution % calcipotriene topical cream % calcipotriene topical ointment % claravis oral capsule 0 mg, 0 mg, 0 mg, 40 mg 4 65

72 clindamycin-benzoyl peroxide topical gel. %( % base) -5 % clotrimazole-betamethasone topical cream % clotrimazole-betamethasone topical lotion % cormax scalp solution 0.05 % doxepin topical cream 5 % ELIDEL TOPICAL CREAM % 4 ST erythromycin-benzoyl peroxide topical gel -5 % fluorouracil intravenous solution gram/0 ml,.5 gram/50 ml, 5 gram/00 ml, 500 mg/0 ml fluorouracil topical cream 0.5 %, 5 % fluorouracil topical solution %, 5 % fluticasone topical cream 0.05 % fluticasone topical lotion 0.05 % fluticasone topical ointment % imiquimod topical cream in packet 5 % methoxsalen oral capsule,liqd-filled,rapid rel 0 mg myorisan oral capsule 0 mg, 0 mg, 0 mg, 40 mg nystatin-triamcinolone topical cream 00, unit/g-% nystatin-triamcinolone topical ointment 00, unit/gram-% podofilox topical solution 0.5 % prednicarbate topical cream 0. % prednicarbate topical ointment 0. % B/D PA PRUDOXIN TOPICAL CREAM 5 % 4 PA REGRANEX TOPICAL GEL 0.0 % 4 PA; QL (5 GM per 0 days) SANTYL TOPICAL OINTMENT 50 UNIT/GRAM selenium sulfide topical lotion.5 % 66

73 STELARA INTRAVENOUS SOLUTION 0 MG/6 ML STELARA SUBCUTANEOUS SYRINGE 45 MG/0.5 ML, 90 MG/ML tacrolimus topical ointment 0.0 %, 0. % ST tazarotene topical cream 0. % TAZORAC TOPICAL CREAM 0.05 %, 0. % 4 TAZORAC TOPICAL GEL 0.05 %, 0. % 4 tretinoin (emollient) topical cream 0.05 % tretinoin topical cream 0.05 %, 0.05 %, 0. % tretinoin topical gel 0.0 %, 0.05 % UVADEX INJECTION SOLUTION 0 MCG/ML 4 B/D VEREGEN TOPICAL OINTMENT 5 % 4 zenatane oral capsule 0 mg ZYCLARA TOPICAL CREAM IN METERED- DOSE PUMP.5 %,.75 % ZYCLARA TOPICAL CREAM IN PACKET.75 % Diabetic Supplies Diabetic Supplies assure id insulin safety syringe ml 9 gauge x /" gauze pad topical bandage x " insulin syringe-needle u-00 syringe 0. ml 9 gauge, ml 9 gauge x /", / ml 8 gauge pen needle, diabetic needle 9 gauge x /" Enzyme Replacement/ Modifiers Enzyme Replacement/ Modifiers ADAGEN INTRAMUSCULAR SOLUTION 50 UNIT/ML ALDURAZYME INTRAVENOUS SOLUTION.9 MG/5 ML allopurinol sodium intravenous recon soln 500 mg 4 B/D 67

74 CEREZYME INTRAVENOUS RECON SOLN 400 UNIT CHOLBAM ORAL CAPSULE 50 MG, 50 MG CREON ORAL CAPSULE,DELAYED RELEASE(DR/EC),000-8,000-60,000 UNIT, 4,000-76,000-0,000 UNIT,,000-9,500-5,000 UNIT, 6,000-4,000-80,000 UNIT, 6,000-9,000-0,000 UNIT CYSTADANE ORAL POWDER GRAM/.7 ML CYSTAGON ORAL CAPSULE 50 MG, 50 MG 4 PA ELAPRASE INTRAVENOUS SOLUTION 6 MG/ ML ELELYSO INTRAVENOUS RECON SOLN 00 UNIT ELITEK INTRAVENOUS RECON SOLN.5 MG ELITEK INTRAVENOUS RECON SOLN 7.5 MG FABRAZYME INTRAVENOUS RECON SOLN 5 MG, 5 MG KUVAN ORAL POWDER IN PACKET 00 MG, 500 MG 4 4 PA KUVAN ORAL TABLET,SOLUBLE 00 MG NAGLAZYME INTRAVENOUS SOLUTION 5 MG/5 ML ORFADIN ORAL CAPSULE 0 MG, MG, 0 MG, 5 MG ORFADIN ORAL SUSPENSION 4 MG/ML RAVICTI ORAL LIQUID. GRAM/ML STRENSIQ SUBCUTANEOUS SOLUTION 00 MG/ML, 40 MG/ML SUCRAID ORAL SOLUTION 8,500 UNIT/ML 4 PA VPRIV INTRAVENOUS RECON SOLN 400 UNIT 5 B/D ZAVESCA ORAL CAPSULE 00 MG 4 PA 68

75 ZENPEP ORAL CAPSULE,DELAYED RELEASE(DR/EC) 0,000-4,000-55,000 UNIT, 5,000-5,000-8,000 UNIT, 0,000-68,000-09,000 UNIT, 5,000-85,000-6,000 UNIT,,000-0,000-6,000 UNIT, 40,000-6,000-8,000 UNIT, 5,000-7,000-7,000 UNIT Gastrointestinal Agents Antispasmodics, Gastrointestinal dicyclomine oral capsule 0 mg dicyclomine oral solution 0 mg/5 ml dicyclomine oral tablet 0 mg Gastrointestinal Agents, Other diphenoxylate-atropine oral liquid mg/5 ml diphenoxylate-atropine oral tablet mg GATTEX 0-VIAL SUBCUTANEOUS KIT 5 MG GATTEX ONE-VIAL SUBCUTANEOUS KIT 5 MG loperamide oral capsule mg OCALIVA ORAL TABLET 0 MG, 5 MG proctozone-hc topical cream with perineal applicator.5 % RELISTOR ORAL TABLET 50 MG 4 PA RELISTOR SUBCUTANEOUS SOLUTION MG/0.6 ML RELISTOR SUBCUTANEOUS SYRINGE MG/0.6 ML, 8 MG/0.4 ML ursodiol oral capsule 00 mg ursodiol oral tablet 50 mg, 500 mg 4 PA 4 PA XERMELO ORAL TABLET 50 MG Histamine (H) Receptor Antagonists cimetidine hcl oral solution 00 mg/5 ml 69

76 cimetidine oral tablet 00 mg, 00 mg, 400 mg, 800 mg famotidine (pf) intravenous solution 0 mg/ ml famotidine intravenous solution 0 mg/ml famotidine oral tablet 0 mg, 40 mg nizatidine oral capsule 50 mg, 00 mg ranitidine hcl oral syrup 5 mg/ml ranitidine hcl oral tablet 50 mg, 00 mg Irritable Bowel Syndrome Agents alosetron oral tablet 0.5 mg, mg AMITIZA ORAL CAPSULE 4 MCG, 8 MCG budesonide oral capsule,delayed,extend.release mg LINZESS ORAL CAPSULE 45 MCG, 90 MCG, 7 MCG Laxatives constulose oral solution 0 gram/5 ml enulose oral solution 0 gram/5 ml gavilyte-c oral recon soln gram gavilyte-g oral recon soln gram gavilyte-n oral recon soln 40 gram generlac oral solution 0 gram/5 ml KRISTALOSE ORAL PACKET 0 GRAM, 0 GRAM lactulose oral solution 0 gram/5 ml, 0 gram/5 ml (5 ml), 0 gram/0 ml peg-50 with flavor packs oral recon soln 40 gram peg-electrolyte soln oral recon soln 40 gram polyethylene glycol 50 oral powder 7 gram/dose 4 PA 70

77 polyethylene glycol 50 oral powder in packet 7 gram trilyte with flavor packets oral recon soln 40 gram Protectants misoprostol oral tablet 00 mcg, 00 mcg sucralfate oral tablet gram Proton Pump Inhibitors esomeprazole magnesium oral capsule,delayed release(dr/ec) 0 mg, 40 mg lansoprazole oral capsule,delayed release(dr/ec) 5 mg, 0 mg omeprazole oral capsule,delayed release(dr/ec) 0 mg, 0 mg, 40 mg pantoprazole intravenous recon soln 40 mg pantoprazole oral tablet,delayed release (dr/ec) 0 mg, 40 mg protonix intravenous recon soln 40 mg Genitourinary Agents Antispasmodics, Urinary darifenacin oral tablet extended release 4 hr 5 mg, 7.5 mg flavoxate oral tablet 00 mg MYRBETRIQ ORAL TABLET EXTENDED RELEASE 4 HR 5 MG, 50 MG oxybutynin chloride oral syrup 5 mg/5 ml oxybutynin chloride oral tablet 5 mg oxybutynin chloride oral tablet extended release 4hr 0 mg, 5 mg, 5 mg tolterodine oral capsule,extended release 4hr mg, 4 mg ST 4 ST; QL (0 EA per 0 days) ST tolterodine oral tablet mg, mg ST TOVIAZ ORAL TABLET EXTENDED RELEASE 4 HR 4 MG, 8 MG 7

78 Benign Prostatic Hypertrophy Agents alfuzosin oral tablet extended release 4 hr 0 mg dutasteride oral capsule 0.5 mg dutasteride-tamsulosin oral capsule, er multiphase 4 hr mg finasteride oral tablet 5 mg tamsulosin oral capsule,extended release 4hr 0.4 mg Genitourinary Agents, Other bethanechol chloride oral tablet 0 mg, 5 mg, 5 mg, 50 mg DEPEN TITRATABS ORAL TABLET 50 MG 4 PA ELMIRON ORAL CAPSULE 00 MG 4 potassium citrate oral tablet extended release 0 meq (,080 mg), 5 meq, 5 meq (540 mg) sodium phenylbutyrate oral powder 0.94 gram/gram Phosphate Binders calcium acetate oral capsule 667 mg calcium acetate oral tablet 667 mg FOSRENOL ORAL POWDER IN PACKET,000 MG, 750 MG FOSRENOL ORAL TABLET,CHEWABLE,000 MG, 500 MG, 750 MG PHOSLYRA ORAL SOLUTION 667 MG (69 MG CALCIUM)/5 ML RENAGEL ORAL TABLET 400 MG, 800 MG 4 RENVELA ORAL POWDER IN PACKET 0.8 GRAM,.4 GRAM RENVELA ORAL TABLET 800 MG VELPHORO ORAL TABLET,CHEWABLE 500 MG Hormonal Agents, Stimulant/ Replacement/ Modifying (Adrenal) Hormonal Agents, Stimulant/ Replacement/ Modifying (Adrenal) 7

79 ala-cort topical cream %,.5 % alclometasone topical cream 0.05 % alclometasone topical ointment 0.05 % clobetasol scalp solution 0.05 % clobetasol topical cream 0.05 % clobetasol topical gel 0.05 % ST clobetasol topical ointment 0.05 % ST clobetasol-emollient topical cream 0.05 % desonide topical cream 0.05 % desonide topical lotion 0.05 % desonide topical ointment 0.05 % desoximetasone topical cream 0.05 %, 0.5 % desoximetasone topical gel 0.05 % desoximetasone topical ointment 0.05 %, 0.5 % diflorasone topical cream 0.05 % fludrocortisone oral tablet 0. mg fluocinolone topical cream 0.0 %, 0.05 % fluocinolone topical ointment 0.05 % fluocinolone topical solution 0.0 % fluocinonide topical cream 0.05 % fluocinonide topical gel 0.05 % fluocinonide topical ointment 0.05 % fluocinonide topical solution 0.05 % fluocinonide-e topical cream 0.05 % halobetasol propionate topical cream 0.05 % halobetasol propionate topical ointment 0.05 % hydrocortisone butyrate topical cream 0. % hydrocortisone butyrate topical ointment 0. % hydrocortisone butyrate topical solution 0. % hydrocortisone butyr-emollient topical cream 0. % 7

80 hydrocortisone oral tablet 0 mg hydrocortisone topical cream %,.5 % hydrocortisone topical lotion.5 % hydrocortisone topical ointment %,.5 % hydrocortisone valerate topical cream 0. % hydrocortisone valerate topical ointment 0. % hydrocortisone-min oil-wht pet topical ointment % mometasone topical cream 0. % mometasone topical ointment 0. % mometasone topical solution 0. % procto-pak topical cream with perineal applicator % triamcinolone acetonide topical cream 0.05 %, 0. %, 0.5 % triamcinolone acetonide topical lotion 0.05 %, 0. % triamcinolone acetonide topical ointment 0.05 %, 0. %, 0.5 % triderm topical cream 0. % Hormonal Agents, Stimulant/ Replacement/ Modifying (Pituitary) Hormonal Agents, Stimulant/ Replacement/ Modifying (Pituitary) chorionic gonadotropin, human intramuscular recon soln 0,000 unit desmopressin injection solution 4 mcg/ml desmopressin nasal aerosol,spray 0 mcg/spray (0. ml) desmopressin nasal solution 0. mg/ml (refrigerate) desmopressin nasal spray,non-aerosol 0 mcg/spray (0. ml) desmopressin oral tablet 0. mg, 0. mg EGRIFTA SUBCUTANEOUS RECON SOLN MG, MG PA 74

81 GENOTROPIN MINIQUICK SUBCUTANEOUS SYRINGE 0. MG/0.5 ML GENOTROPIN MINIQUICK SUBCUTANEOUS SYRINGE 0.4 MG/0.5 ML, 0.6 MG/0.5 ML, 0.8 MG/0.5 ML, MG/0.5 ML,. MG/0.5 ML,.4 MG/0.5 ML,.6 MG/0.5 ML,.8 MG/0.5 ML, MG/0.5 ML GENOTROPIN SUBCUTANEOUS CARTRIDGE MG/ML (6 UNIT/ML), 5 MG/ML (5 UNIT/ML) HUMATROPE INJECTION CARTRIDGE MG (6 UNIT), 4 MG (7 UNIT), 6 MG (8 UNIT) HUMATROPE INJECTION RECON SOLN 5 (5 UNIT) MG INCRELEX SUBCUTANEOUS SOLUTION 0 MG/ML NORDITROPIN FLEXPRO SUBCUTANEOUS PEN INJECTOR 0 MG/.5 ML (6.7 MG/ML), 5 MG/.5 ML (0 MG/ML), 0 MG/ ML (0 MG/ML), 5 MG/.5 ML (. MG/ML) NORDITROPIN NORDIFLEX SUBCUTANEOUS PEN INJECTOR 0 MG/ ML (0 MG/ML) NUTROPIN AQ NUSPIN SUBCUTANEOUS PEN INJECTOR 0 MG/ ML (5 MG/ML), 0 MG/ ML (0 MG/ML), 5 MG/ ML (.5 MG/ML) NUTROPIN AQ SUBCUTANEOUS CARTRIDGE 0 MG/ ML (0 MG/ML) OMNITROPE SUBCUTANEOUS CARTRIDGE 0 MG/.5 ML (6.7 MG/ML) OMNITROPE SUBCUTANEOUS CARTRIDGE 5 MG/.5 ML (. MG/ML) OMNITROPE SUBCUTANEOUS RECON SOLN 5.8 MG SEROSTIM SUBCUTANEOUS RECON SOLN 4 MG, 5 MG, 6 MG 4 PA 4 PA Hormonal Agents, Stimulant/ Replacement/ Modifying (Sex Hormones/ Modifiers) 75

82 Anabolic Steroids ANADROL-50 ORAL TABLET 50 MG oxandrolone oral tablet 0 mg,.5 mg Androgens ANDROGEL TRANSDERMAL GEL IN PACKET.6 % (0.5 MG/.5 GRAM),.6 % (40.5 MG/.5 GRAM) androxy oral tablet 0 mg danazol oral capsule 00 mg, 00 mg, 50 mg 4 4 ST methyltestosterone oral capsule 0 mg TESTIM TRANSDERMAL GEL 50 MG/5 GRAM ( %) testosterone cypionate intramuscular oil 00 mg/ml, 00 mg/ml testosterone transdermal gel 50 mg/5 gram ( %) testosterone transdermal gel in metered-dose pump.5 mg/.5 gram ( %) testosterone transdermal gel in packet % (5 mg/.5gram), % (50 mg/5 gram) Estrogens DIVIGEL TRANSDERMAL GEL IN PACKET 0.5 MG/0.5 GRAM (0. %), 0.5 MG/0.5 GRAM (0. %), MG/GRAM (0. %) DUAVEE ORAL TABLET MG ESTRACE VAGINAL CREAM 0.0 % (0. MG/GRAM) estradiol oral tablet 0.5 mg, mg, mg estradiol transdermal patch semiweekly 0.05 mg/4 hr, 0.05 mg/4 hr, mg/4 hr, 0. mg/4 hr estradiol transdermal patch weekly 0.05 mg/4 hr, mg/4 hr, 0.05 mg/4 hr, 0.06 mg/4 hr, mg/4 hr, 0. mg/4 hr estradiol valerate intramuscular oil 0 mg/ml, 40 mg/ml 4 ST

83 ESTRING VAGINAL RING MG (7.5 MCG /4 HOUR) estropipate oral tablet 0.75 mg,.5 mg, mg PA marlissa oral tablet mg MENEST ORAL TABLET 0. MG, 0.65 MG,.5 MG,.5 MG MENOSTAR TRANSDERMAL PATCH WEEKLY 4 MCG/4 HR PREMARIN INJECTION RECON SOLN 5 MG PREMARIN ORAL TABLET 0. MG, 0.45 MG, 0.65 MG, 0.9 MG,.5 MG PREMARIN VAGINAL CREAM 0.65 MG/GRAM VAGIFEM VAGINAL TABLET 0 MCG 4 yuvafem vaginal tablet 0 mcg 4 4 PA Hormonal Agents, Stimulant/ Replacement/ Modifying (Sex Hormones/ Modifiers) alyacen /5 (8) oral tablet -5 mg-mcg amabelz oral tablet mg, -0.5 mg apri oral tablet mg aranelle (8) oral tablet 0.5//0.5-5 mg-mcg aubra oral tablet 0.-0 mg-mcg aviane oral tablet 0.-0 mg-mcg balziva (8) oral tablet mg-mcg bekyree (8) oral tablet mgx /0.0 mg x 5 blisovi fe.5/0 (8) oral tablet.5 mg-0 mcg ()/75 mg (7) blisovi fe /0 (8) oral tablet mg-0 mcg ()/75 mg (7) briellyn oral tablet mg-mcg caziant (8) oral tablet 0./.5/.5-5 mg-mcg CLIMARA PRO TRANSDERMAL PATCH WEEKLY MG/4 HR 77

84 COMBIPATCH TRANSDERMAL PATCH SEMIWEEKLY MG/4 HR, MG/4 HR cryselle (8) oral tablet 0.-0 mg-mcg cyclafem /5 (8) oral tablet -5 mg-mcg cyclafem 7/7/7 (8) oral tablet 0.5/0.75/ mg- 5 mcg deblitane oral tablet 0.5 mg delyla (8) oral tablet 0.-0 mg-mcg desog-e.estradiol/e.estradiol oral tablet mgx /0.0 mg x 5 drospirenone-ethinyl estradiol oral tablet -0.0 mg emoquette oral tablet mg enpresse oral tablet 50-0 (6)/75-40 (5)/5-0(0) estradiol-norethindrone acet oral tablet -0.5 mg ethynodiol diac-eth estradiol oral tablet -50 mgmcg falmina (8) oral tablet 0.-0 mg-mcg femynor oral tablet mg-mcg fyavolv oral tablet -5 mg-mcg gildagia oral tablet mg-mcg gildess.5/0 () oral tablet.5-0 mg-mcg introvale oral tablets,dose pack, month 0.5 mg- 0 mcg jinteli oral tablet -5 mg-mcg juleber oral tablet mg junel.5/0 () oral tablet.5-0 mg-mcg junel /0 () oral tablet -0 mg-mcg junel fe.5/0 (8) oral tablet.5 mg-0 mcg ()/75 mg (7) junel fe /0 (8) oral tablet mg-0 mcg ()/75 mg (7) 78

85 kariva (8) oral tablet mgx /0.0 mg x 5 kelnor /5 (8) oral tablet -5 mg-mcg kimidess (8) oral tablet mgx /0.0 mg x 5 larin.5/0 () oral tablet.5-0 mg-mcg larin /0 () oral tablet -0 mg-mcg larin fe.5/0 (8) oral tablet.5 mg-0 mcg ()/75 mg (7) larin fe /0 (8) oral tablet mg-0 mcg ()/75 mg (7) larissia oral tablet 0.-0 mg-mcg leena 8 oral tablet 0.5//0.5-5 mg-mcg lessina oral tablet 0.-0 mg-mcg levonest (8) oral tablet 50-0 (6)/75-40 (5)/5-0(0) levonorgestrel-ethinyl estrad oral tablet 0.-0 mg-mcg levonorgestrel-ethinyl estrad oral tablets,dose pack, month 0.5 mg-0 mcg levonorg-eth estrad triphasic oral tablet 50-0 (6)/75-40 (5)/5-0(0) levora-8 oral tablet mg lopreeza oral tablet mg, -0.5 mg low-ogestrel (8) oral tablet 0.-0 mg-mcg lutera (8) oral tablet 0.-0 mg-mcg microgestin.5/0 () oral tablet.5-0 mg-mcg microgestin /0 () oral tablet -0 mg-mcg microgestin fe.5/0 (8) oral tablet.5 mg-0 mcg ()/75 mg (7) microgestin fe /0 (8) oral tablet mg-0 mcg ()/75 mg (7) mimvey lo oral tablet mg mononessa (8) oral tablet mg-mcg 79

86 necon 0.5/5 (8) oral tablet mg-mcg necon /5 (8) oral tablet -5 mg-mcg necon 0/ (8) oral tablet 0.5-5/-5 mgmcg/mg-mcg necon 7/7/7 (8) oral tablet 0.5/0.75/ mg- 5 mcg nora-be oral tablet 0.5 mg norethindrone ac-eth estradiol oral tablet -0 mg-mcg, -5 mg-mcg norgestimate-ethinyl estradiol oral tablet 0.8/0.5/0.5 mg-5 mcg (8), mg-mcg norlyroc oral tablet 0.5 mg nortrel 0.5/5 (8) oral tablet mg-mcg nortrel /5 () oral tablet -5 mg-mcg nortrel /5 (8) oral tablet -5 mg-mcg nortrel 7/7/7 (8) oral tablet 0.5/0.75/ mg- 5 mcg NUVARING VAGINAL RING MG/4 HR ocella oral tablet -0.0 mg orsythia oral tablet 0.-0 mg-mcg pimtrea (8) oral tablet mgx /0.0 mg x 5 pirmella oral tablet -5 mg-mcg portia oral tablet mg PREFEST ORAL TABLET MG (5)/ MG MG (5) PREMPHASE ORAL TABLET 0.65 MG (4)/ 0.65MG-5MG(4) PREMPRO ORAL TABLET MG, MG, MG, MG previfem oral tablet mg-mcg quasense oral tablets,dose pack, month 0.5 mg- 0 mcg reclipsen (8) oral tablet mg 4 80

87 setlakin oral tablets,dose pack, month 0.5 mg-0 mcg sharobel oral tablet 0.5 mg sprintec (8) oral tablet mg-mcg sronyx oral tablet 0.-0 mg-mcg tarina fe /0 (8) oral tablet mg-0 mcg ()/75 mg (7) TRI FEMYNOR ORAL TABLET 0.8/0.5/0.5 MG-5 MCG (8) tri-legest fe oral tablet -0(5)/-0(7) /mg- 5mcg (9) trinessa (8) oral tablet 0.8/0.5/0.5 mg-5 mcg (8) tri-previfem (8) oral tablet 0.8/0.5/0.5 mg-5 mcg (8) tri-sprintec (8) oral tablet 0.8/0.5/0.5 mg-5 mcg (8) trivora (8) oral tablet 50-0 (6)/75-40 (5)/5-0(0) velivet triphasic regimen (8) oral tablet 0./.5/.5-5 mg-mcg vienva oral tablet 0.-0 mg-mcg vyfemla (8) oral tablet mg-mcg xulane transdermal patch weekly 50-5 mcg/4 hr yuvafem vaginal tablet 0 mcg zarah oral tablet -0.0 mg zenchent (8) oral tablet mg-mcg zovia /5e (8) oral tablet -5 mg-mcg zovia /50e (8) oral tablet -50 mg-mcg Progestins camila oral tablet 0.5 mg DEPO-PROVERA INTRAMUSCULAR SOLUTION 400 MG/ML 4 PA 8

88 DEPO-SUBQ PROVERA 04 SUBCUTANEOUS SYRINGE 04 MG/0.65 ML errin oral tablet 0.5 mg jolivette oral tablet 0.5 mg lyza oral tablet 0.5 mg medroxyprogesterone intramuscular suspension 50 mg/ml medroxyprogesterone oral tablet 0 mg,.5 mg, 5 mg megestrol oral suspension 400 mg/0 ml (0 ml), 400 mg/0 ml (40 mg/ml), 65 mg/5 ml 4 PA megestrol oral tablet 0 mg, 40 mg PA norethindrone (contraceptive) oral tablet 0.5 mg norethindrone acetate oral tablet 5 mg progesterone micronized oral capsule 00 mg, 00 mg Selective Estrogen Receptor Modifying Agents raloxifene oral tablet 60 mg Hormonal Agents, Stimulant/ Replacement/ Modifying (Thyroid) Hormonal Agents, Stimulant/ Replacement/ Modifying (Thyroid) levothyroxine intravenous recon soln 00 mcg levothyroxine oral tablet 00 mcg, mcg, 5 mcg, 7 mcg, 50 mcg, 75 mcg, 00 mcg, 5 mcg, 00 mcg, 50 mcg, 75 mcg, 88 mcg levoxyl oral tablet 00 mcg, mcg, 5 mcg, 7 mcg, 50 mcg, 75 mcg, 00 mcg, 5 mcg, 50 mcg, 75 mcg, 88 mcg liothyronine intravenous solution 0 mcg/ml liothyronine oral tablet 5 mcg, 5 mcg, 50 mcg SYNTHROID ORAL TABLET 00 MCG, MCG, 5 MCG, 7 MCG, 50 MCG, 75 MCG, 00 MCG, 5 MCG, 00 MCG, 50 MCG, 75 MCG, 88 MCG 4 8

89 UNITHROID ORAL TABLET 00 MCG, MCG, 5 MCG, 50 MCG, 75 MCG, 00 MCG, 5 MCG, 00 MCG, 50 MCG, 75 MCG, 88 MCG unithroid oral tablet 7 mcg Hormonal Agents, Suppressant (Adrenal) Hormonal Agents, Suppressant (Adrenal) LYSODREN ORAL TABLET 500 MG Hormonal Agents, Suppressant (Parathyroid) Hormonal Agents, Suppressant (Parathyroid) SENSIPAR ORAL TABLET 0 MG QL (60 EA per 0 days) SENSIPAR ORAL TABLET 60 MG 5 QL (60 EA per 0 days) SENSIPAR ORAL TABLET 90 MG 5 QL (0 EA per 0 days) Hormonal Agents, Suppressant (Pituitary) Hormonal Agents, Suppressant (Pituitary) cabergoline oral tablet 0.5 mg ELIGARD ( MONTH) SUBCUTANEOUS SYRINGE.5 MG ELIGARD (4 MONTH) SUBCUTANEOUS SYRINGE 0 MG ELIGARD (6 MONTH) SUBCUTANEOUS SYRINGE 45 MG ELIGARD SUBCUTANEOUS SYRINGE 7.5 MG ( MONTH) FIRMAGON KIT W DILUENT SYRINGE SUBCUTANEOUS RECON SOLN 0 MG FIRMAGON KIT W DILUENT SYRINGE SUBCUTANEOUS RECON SOLN 80 MG FIRMAGON SUBCUTANEOUS RECON SOLN 0 MG FIRMAGON SUBCUTANEOUS RECON SOLN 80 MG leuprolide subcutaneous kit mg/0. ml leuprolide subcutaneous solution mg/0. ml 4 4 PA 4 PA 4 PA 4 PA 4 PA 4 PA 8

90 LUPRON DEPOT ( MONTH) INTRAMUSCULAR SYRINGE KIT.5 MG,.5 MG LUPRON DEPOT (4 MONTH) INTRAMUSCULAR SYRINGE KIT 0 MG LUPRON DEPOT (6 MONTH) INTRAMUSCULAR SYRINGE KIT 45 MG LUPRON DEPOT INTRAMUSCULAR SYRINGE KIT.75 MG, 7.5 MG LUPRON DEPOT-PED ( MONTH) INTRAMUSCULAR SYRINGE KIT.5 MG LUPRON DEPOT-PED ( MONTH) INTRAMUSCULAR SYRINGE KIT 0 MG LUPRON DEPOT-PED INTRAMUSCULAR KIT.5 MG, 5 MG LUPRON DEPOT-PED INTRAMUSCULAR KIT 7.5 MG (PED) octreotide acetate injection solution,000 mcg/ml, 500 mcg/ml octreotide acetate injection solution 00 mcg/ml, 00 mcg/ml, 50 mcg/ml SANDOSTATIN LAR DEPOT INTRAMUSCULAR KIT 0 MG, 0 MG, 0 MG SANDOSTATIN LAR DEPOT INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON 0 MG, 0 MG, 0 MG SIGNIFOR SUBCUTANEOUS SOLUTION 0. MG/ML ( ML), 0.6 MG/ML ( ML), 0.9 MG/ML ( ML) SOMATULINE DEPOT SUBCUTANEOUS SYRINGE 0 MG/0.5 ML, 60 MG/0. ML, 90 MG/0. ML SOMAVERT SUBCUTANEOUS RECON SOLN 0 MG, 5 MG, 0 MG, 5 MG, 0 MG SYNAREL NASAL SPRAY,NON-AEROSOL MG/ML 4 PA 4 PA 4 PA 4 PA 84

91 TRELSTAR INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION.5 MG TRELSTAR INTRAMUSCULAR SYRINGE.5 MG/ ML,.75 MG/ ML TRELSTAR INTRAMUSCULAR SYRINGE.5 MG/ ML Hormonal Agents, Suppressant (Thyroid) Antithyroid Agents methimazole oral tablet 0 mg, 5 mg propylthiouracil oral tablet 50 mg Immunological Agents Angioedema (Hae) Agents CINRYZE INTRAVENOUS RECON SOLN 500 UNIT (5 ML) FIRAZYR SUBCUTANEOUS SYRINGE 0 MG/ ML Immune Suppressants ASTAGRAF XL ORAL CAPSULE,EXTENDED RELEASE 4HR 0.5 MG, MG, 5 MG ATGAM INTRAVENOUS SOLUTION 50 MG/ML 4 PA 4 B/D 5 B/D AZASAN ORAL TABLET 00 MG, 75 MG 4 PA azathioprine oral tablet 50 mg B/D azathioprine sodium injection recon soln 00 mg B/D BENLYSTA INTRAVENOUS RECON SOLN 0 MG, 400 MG CELLCEPT INTRAVENOUS INTRAVENOUS RECON SOLN 500 MG CIMZIA POWDER FOR RECONST SUBCUTANEOUS KIT 400 MG (00 MG X VIALS) CIMZIA STARTER KIT SUBCUTANEOUS SYRINGE KIT 400 MG/ ML (00 MG/ML X ) CIMZIA SUBCUTANEOUS SYRINGE KIT 400 MG/ ML (00 MG/ML X ) 4 PA 85

92 cyclosporine intravenous solution 50 mg/5 ml B/D cyclosporine modified oral capsule 00 mg, 5 mg, 50 mg B/D cyclosporine modified oral solution 00 mg/ml B/D cyclosporine oral capsule 00 mg, 5 mg B/D ENBREL SUBCUTANEOUS RECON SOLN 5 MG ( ML) ENBREL SUBCUTANEOUS SYRINGE 5 MG/0.5ML (0.5), 50 MG/ML (0.98 ML) ENBREL SURECLICK SUBCUTANEOUS PEN INJECTOR 50 MG/ML (0.98 ML) ENVARSUS XR ORAL TABLET EXTENDED RELEASE 4 HR 0.75 MG, MG, 4 MG B/D gengraf oral capsule 00 mg, 5 mg, 50 mg B/D gengraf oral solution 00 mg/ml B/D HUMIRA PEDIATRIC CROHN'S START SUBCUTANEOUS SYRINGE KIT 40 MG/0.8 ML, 40 MG/0.8 ML (6 PACK) HUMIRA PEN CROHN'S-UC-HS START SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.8 ML HUMIRA PEN PSORIASIS-UVEITIS SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.8 ML HUMIRA PEN SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.8 ML HUMIRA SUBCUTANEOUS SYRINGE KIT 0 MG/0. ML, 0 MG/0.4 ML, 40 MG/0.8 ML INFLECTRA INTRAVENOUS RECON SOLN 00 MG KINERET SUBCUTANEOUS SYRINGE 00 MG/0.67 ML mercaptopurine oral tablet 50 mg methotrexate sodium (pf) injection recon soln gram 86

93 methotrexate sodium (pf) injection solution 5 mg/ml methotrexate sodium injection solution 5 mg/ml methotrexate sodium oral tablet.5 mg mycophenolate mofetil hcl intravenous recon soln 500 mg PA mycophenolate mofetil oral capsule 50 mg B/D mycophenolate mofetil oral suspension for reconstitution 00 mg/ml B/D mycophenolate mofetil oral tablet 500 mg B/D mycophenolate sodium oral tablet,delayed release (dr/ec) 80 mg, 60 mg NULOJIX INTRAVENOUS RECON SOLN 50 MG ORENCIA (WITH MALTOSE) INTRAVENOUS RECON SOLN 50 MG ORENCIA CLICKJECT SUBCUTANEOUS AUTO-INJECTOR 5 MG/ML ORENCIA SUBCUTANEOUS SYRINGE 5 MG/ML, 50 MG/0.4 ML, 87.5 MG/0.7 ML B/D 5 B/D OTEZLA ORAL TABLET 0 MG OTEZLA STARTER ORAL TABLETS,DOSE PACK 0 MG (4)-0 MG (4)-0 MG (47), 0 MG (4)-0 MG (4)-0 MG(9) PROGRAF INTRAVENOUS SOLUTION 5 MG/ML 4 PA RAPAMUNE ORAL SOLUTION MG/ML 4 B/D REMICADE INTRAVENOUS RECON SOLN 00 MG SANDIMMUNE ORAL SOLUTION 00 MG/ML B/D SIMPONI ARIA INTRAVENOUS SOLUTION.5 MG/ML SIMPONI SUBCUTANEOUS PEN INJECTOR 00 MG/ML, 50 MG/0.5 ML SIMPONI SUBCUTANEOUS SYRINGE 50 MG/0.5 ML 87

94 SIMULECT INTRAVENOUS RECON SOLN 0 MG, 0 MG sirolimus oral tablet 0.5 mg, mg, mg B/D tacrolimus oral capsule 0.5 mg, mg, 5 mg B/D TORISEL INTRAVENOUS RECON SOLN 0 MG/ ML (0 MG/ML) (FIRST) TREXALL ORAL TABLET 0 MG, 5 MG, 5 MG, 7.5 MG 4 PA ZORTRESS ORAL TABLET 0.5 MG 4 B/D ZORTRESS ORAL TABLET 0.5 MG, 0.75 MG 5 B/D Immunizing Agents, Passive BIVIGAM INTRAVENOUS SOLUTION 0 % 5 B/D CARIMUNE NF NANOFILTERED INTRAVENOUS RECON SOLN GRAM, 6 GRAM carimune nf nanofiltered intravenous recon soln gram FLEBOGAMMA DIF INTRAVENOUS SOLUTION 0 % GAMASTAN S/D INTRAMUSCULAR SOLUTION 5-8 % RANGE, 5-8 % RANGE (0 ML), 5-8 % RANGE ( ML) GAMMAGARD LIQUID INJECTION SOLUTION 0 % GAMMAGARD S-D (IGA < MCG/ML) INTRAVENOUS RECON SOLN 0 GRAM, 5 GRAM GAMMAKED INJECTION SOLUTION GRAM/0 ML (0 %), 0 GRAM/00 ML (0 %),.5 GRAM/5 ML (0 %), 0 GRAM/00 ML (0 %), 5 GRAM/50 ML (0 %) GAMMAPLEX (WITH SORBITOL) INTRAVENOUS SOLUTION 5 % GAMMAPLEX INTRAVENOUS SOLUTION 0 % 5 B/D 5 B/D B/D 5 B/D 5 B/D 4 B/D 5 B/D 5 B/D 88

95 GAMUNEX-C INJECTION SOLUTION GRAM/0 ML (0 %), 0 GRAM/00 ML (0 %),.5 GRAM/5 ML (0 %), 0 GRAM/00 ML (0 %), 40 GRAM/400 ML (0 %), 5 GRAM/50 ML (0 %) HYPERRAB S/D (PF) INTRAMUSCULAR SOLUTION 50 UNIT/ML, 50 UNIT/ML (0 ML) 4 B/D PRIVIGEN INTRAVENOUS SOLUTION 0 % 5 B/D SYNAGIS INTRAMUSCULAR SOLUTION 00 MG/ML, 50 MG/0.5 ML THYMOGLOBULIN INTRAVENOUS RECON SOLN 5 MG Immunomodulators ACTEMRA INTRAVENOUS SOLUTION 00 MG/0 ML (0 MG/ML), 400 MG/0 ML (0 MG/ML), 80 MG/4 ML (0 MG/ML) ACTEMRA SUBCUTANEOUS SYRINGE 6 MG/0.9 ML ACTIMMUNE SUBCUTANEOUS SOLUTION 00 MCG/0.5 ML ARCALYST SUBCUTANEOUS RECON SOLN 0 MG ILARIS (PF) SUBCUTANEOUS RECON SOLN 80 MG/. ML (50 MG/ML) ILARIS (PF) SUBCUTANEOUS SOLUTION 50 MG/ML leflunomide oral tablet 0 mg, 0 mg SIMPONI SUBCUTANEOUS SYRINGE 00 MG/ML Vaccines ACTHIB (PF) INTRAMUSCULAR RECON SOLN 0 MCG/0.5 ML ADACEL(TDAP ADOLESN/ADULT)(PF) INTRAMUSCULAR SUSPENSION LF-( MCG)-5LF/0.5 ML 4 PA 5 B/D 89

96 ADACEL(TDAP ADOLESN/ADULT)(PF) INTRAMUSCULAR SYRINGE LF-( MCG)-5LF/0.5 ML BCG VACCINE, LIVE (PF) PERCUTANEOUS SUSPENSION FOR RECONSTITUTION 50 MG BEXSERO INTRAMUSCULAR SYRINGE MCG/0.5 ML BOOSTRIX TDAP INTRAMUSCULAR SUSPENSION LF-MCG-LF/0.5ML BOOSTRIX TDAP INTRAMUSCULAR SYRINGE LF-MCG-LF/0.5ML DAPTACEL (DTAP PEDIATRIC) (PF) INTRAMUSCULAR SUSPENSION LF- MCG-LF/0.5ML ENGERIX-B (PF) INTRAMUSCULAR SUSPENSION 0 MCG/ML ENGERIX-B (PF) INTRAMUSCULAR SYRINGE 0 MCG/ML ENGERIX-B PEDIATRIC (PF) INTRAMUSCULAR SUSPENSION 0 MCG/0.5 ML ENGERIX-B PEDIATRIC (PF) INTRAMUSCULAR SYRINGE 0 MCG/0.5 ML GARDASIL (PF) INTRAMUSCULAR SUSPENSION MCG/0.5 ML GARDASIL (PF) INTRAMUSCULAR SYRINGE MCG/0.5 ML GARDASIL 9 (PF) INTRAMUSCULAR SUSPENSION 0.5 ML GARDASIL 9 (PF) INTRAMUSCULAR SYRINGE 0.5 ML HAVRIX (PF) INTRAMUSCULAR SUSPENSION,440 ELISA UNIT/ML, 70 ELISA UNIT/0.5 ML HAVRIX (PF) INTRAMUSCULAR SYRINGE,440 ELISA UNIT/ML, 70 ELISA UNIT/0.5 ML B/D B/D B/D B/D 90

97 HIBERIX (PF) INTRAMUSCULAR RECON SOLN 0 MCG/0.5 ML IMOVAX RABIES VACCINE (PF) INTRAMUSCULAR RECON SOLN.5 UNIT INFANRIX (DTAP) (PF) INTRAMUSCULAR SUSPENSION LF-MCG-LF/0.5ML INFANRIX (DTAP) (PF) INTRAMUSCULAR SYRINGE LF-MCG-LF/0.5ML IPOL INJECTION SUSPENSION UNIT/0.5 ML IXIARO (PF) INTRAMUSCULAR SYRINGE 6 MCG/0.5 ML KINRIX (PF) INTRAMUSCULAR SUSPENSION 5 LF-58 MCG-0 LF/0.5 ML KINRIX (PF) INTRAMUSCULAR SYRINGE 5 LF-58 MCG-0 LF/0.5 ML MENACTRA (PF) INTRAMUSCULAR SOLUTION 4 MCG/0.5 ML MENHIBRIX (PF) INTRAMUSCULAR RECON SOLN 5-.5 MCG/0.5 ML MENOMUNE - A/C/Y/W-5 (PF) SUBCUTANEOUS RECON SOLN 50 MCG MENOMUNE - A/C/Y/W-5 SUBCUTANEOUS RECON SOLN 50 MCG MENVEO A-C-Y-W-5-DIP (PF) INTRAMUSCULAR KIT 0-5 MCG/0.5 ML M-M-R II (PF) SUBCUTANEOUS RECON SOLN,000-,500 TCID50/0.5 ML PEDIARIX (PF) INTRAMUSCULAR SYRINGE 0 MCG-5LF-5 MCG-0LF/0.5 ML PEDVAX HIB (PF) INTRAMUSCULAR SOLUTION 7.5 MCG/0.5 ML PROQUAD (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION 0EXP TCID50/0.5 9

98 QUADRACEL (PF) INTRAMUSCULAR SUSPENSION 5 LF-48 MCG- 5 LF UNIT/0.5ML RABAVERT (PF) INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION.5 UNIT RECOMBIVAX HB (PF) INTRAMUSCULAR SUSPENSION 0 MCG/ML, 40 MCG/ML, 5 MCG/0.5 ML RECOMBIVAX HB (PF) INTRAMUSCULAR SYRINGE 0 MCG/ML, 5 MCG/0.5 ML ROTARIX ORAL SUSPENSION FOR RECONSTITUTION 0EXP6 CCID50/ML ROTATEQ VACCINE ORAL SOLUTION ML TENIVAC (PF) INTRAMUSCULAR SUSPENSION 5 LF UNIT- LF UNIT/0.5ML TENIVAC (PF) INTRAMUSCULAR SYRINGE 5- LF UNIT/0.5 ML tetanus,diphtheria tox ped(pf) intramuscular suspension 5-5 lf unit/0.5 ml tetanus-diphtheria toxoids-td intramuscular suspension - lf unit/0.5 ml TRUMENBA INTRAMUSCULAR SYRINGE 0 MCG/0.5 ML TWINRIX (PF) INTRAMUSCULAR SUSPENSION 70 ELISA UNIT -0 MCG/ML TWINRIX (PF) INTRAMUSCULAR SYRINGE 70 ELISA UNIT -0 MCG/ML TYPHIM VI INTRAMUSCULAR SOLUTION 5 MCG/0.5 ML TYPHIM VI INTRAMUSCULAR SYRINGE 5 MCG/0.5 ML VAQTA (PF) INTRAMUSCULAR SUSPENSION 5 UNIT/0.5 ML, 50 UNIT/ML VAQTA (PF) INTRAMUSCULAR SYRINGE 5 UNIT/0.5 ML, 50 UNIT/ML B/D B/D B/D B/D 9

99 VARIVAX (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION,50 UNIT/0.5 ML VARIZIG INTRAMUSCULAR RECON SOLN 5 UNIT VARIZIG INTRAMUSCULAR SOLUTION 5 UNIT/. ML YF-VAX (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION 0 EXP4.74 UNIT/0.5 ML ZOSTAVAX (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION 9,400 UNIT/0.65 ML Inflammatory Bowel Disease Agents Aminosalicylates balsalazide oral capsule 750 mg CANASA RECTAL SUPPOSITORY,000 MG DELZICOL ORAL CAPSULE (WITH DEL REL TABLETS) 400 MG DELZICOL ORAL CAPSULE,DELAYED RELEASE(DR/EC) 400 MG DIPENTUM ORAL CAPSULE 50 MG 4 LIALDA ORAL TABLET,DELAYED RELEASE (DR/EC). GRAM mesalamine rectal enema 4 gram/60 ml mesalamine with cleansing wipe rectal enema kit 4 gram/60 ml PENTASA ORAL CAPSULE, EXTENDED RELEASE 50 MG, 500 MG Glucocorticoids colocort rectal enema 00 mg/60 ml hydrocortisone rectal enema 00 mg/60 ml hydrocortisone topical cream with perineal applicator.5 % prednisone intensol oral concentrate 5 mg/ml 9

100 procto-med hc topical cream with perineal applicator.5 % proctosol hc rectal cream with applicator.5 % proctosol hc topical cream with perineal applicator.5 % Sulfonamides sulfasalazine oral tablet 500 mg sulfasalazine oral tablet,delayed release (dr/ec) 500 mg Metabolic Bone Disease Agents Metabolic Bone Disease Agents alendronate oral tablet 0 mg, 5 mg, 40 mg, 5 mg, 70 mg calcitonin (salmon) nasal spray,non-aerosol 00 unit/actuation calcitriol oral capsule 0.5 mcg, 0.5 mcg calcitriol oral solution mcg/ml doxercalciferol intravenous solution 4 mcg/ ml doxercalciferol oral capsule 0.5 mcg, mcg,.5 mcg etidronate disodium oral tablet 00 mg, 400 mg FORTEO SUBCUTANEOUS PEN INJECTOR 0 MCG/DOSE MCG/.4 ML ibandronate intravenous solution mg/ ml PA MIACALCIN INJECTION SOLUTION 00 UNIT/ML NATPARA SUBCUTANEOUS CARTRIDGE 00 MCG/DOSE, 5 MCG/DOSE, 50 MCG/DOSE, 75 MCG/DOSE pamidronate intravenous recon soln 0 mg, 90 mg pamidronate intravenous solution 0 mg/0 ml ( mg/ml), 60 mg/0 ml (6 mg/ml), 90 mg/0 ml (9 mg/ml) paricalcitol oral capsule mcg, mcg, 4 mcg 4 B/D 94

101 PROLIA SUBCUTANEOUS SYRINGE 60 MG/ML risedronate oral tablet 50 mg, 0 mg, 5 mg, 5 mg ( pack), 5 mg (4 pack), 5 mg XGEVA SUBCUTANEOUS SOLUTION 0 MG/.7 ML (70 MG/ML) 4 PA zoledronic acid intravenous recon soln 4 mg PA zoledronic acid intravenous solution 4 mg/5 ml PA zoledronic acid-mannitol-water intravenous piggyback 5 mg/00 ml ZOMETA INTRAVENOUS PIGGYBACK 4 MG/00 ML Ophthalmic Agents Ophthalmic Agents ak-poly-bac ophthalmic ointment 500-0,000 unit/gram bacitracin-polymyxin b ophthalmic ointment 500-0,000 unit/gram neomycin-bacitracin-poly-hc ophthalmic ointment ,000 mg-unit/g-% neomycin-bacitracin-polymyxin ophthalmic ointment ,000 mg-unit-unit/g neomycin-polymyxin b-dexameth ophthalmic drops,suspension.5mg/ml-0,000 unit/ml-0. % neomycin-polymyxin b-dexameth ophthalmic ointment.5 mg/g-0,000 unit/g-0. % neomycin-polymyxin-gramicidin ophthalmic drops.75 mg-0,000 unit-0.05mg/ml neomycin-polymyxin-hc ophthalmic drops,suspension.5-0,000-0 mg-unit-mg/ml polymyxin b sulf-trimethoprim ophthalmic drops 0,000 unit- mg/ml tobramycin-dexamethasone ophthalmic drops,suspension % Ophthalmic Agents, Other PA 95

102 CYSTARAN OPHTHALMIC DROPS 0.44 % 5 naphazoline ophthalmic drops 0. % proparacaine ophthalmic drops 0.5 % RESTASIS MULTIDOSE OPHTHALMIC DROPS 0.05 % RESTASIS OPHTHALMIC DROPPERETTE 0.05 % QL ( ML per 0 days) QL (60 EA per 0 days) XIIDRA OPHTHALMIC DROPPERETTE 5 % QL (60 EA per 0 days) Ophthalmic Anti-Allergy Agents azelastine ophthalmic drops 0.05 % ST cromolyn ophthalmic drops 4 % epinastine ophthalmic drops 0.05 % ST olopatadine ophthalmic drops 0. % Ophthalmic Antiglaucoma Agents ALPHAGAN P OPHTHALMIC DROPS 0. % AZOPT OPHTHALMIC DROPS,SUSPENSION % brimonidine ophthalmic drops 0.5 % brimonidine ophthalmic drops 0. % carteolol ophthalmic drops % COMBIGAN OPHTHALMIC DROPS % dorzolamide ophthalmic drops % dorzolamide-timolol ophthalmic drops.-6.8 mg/ml levobunolol ophthalmic drops 0.5 % methazolamide oral tablet 5 mg, 50 mg metipranolol ophthalmic drops 0. % PHOSPHOLINE IODIDE OPHTHALMIC DROPS 0.5 % SIMBRINZA OPHTHALMIC DROPS,SUSPENSION -0. % timolol maleate ophthalmic drops 0.5 %, 0.5 % ST 96

103 timolol maleate ophthalmic gel forming solution 0.5 %, 0.5 % TIMOPTIC OCUDOSE (PF) OPHTHALMIC DROPPERETTE 0.5 %, 0.5 % TIMOPTIC OPHTHALMIC DROPS 0.5 %, 0.5 % Ophthalmic Anti-Inflammatories dexamethasone sodium phosphate ophthalmic drops 0. % diclofenac sodium ophthalmic drops 0. % DUREZOL OPHTHALMIC DROPS 0.05 % fluorometholone ophthalmic drops,suspension 0. % flurbiprofen sodium ophthalmic drops 0.0 % FML FORTE OPHTHALMIC DROPS,SUSPENSION 0.5 % ketorolac ophthalmic drops 0.4 %, 0.5 % prednisolone sodium phosphate ophthalmic drops % sulfacetamide-prednisolone ophthalmic drops 0 %-0. % (0.5 %) Ophthalmic Prostaglandin And Prostamide Analogs latanoprost ophthalmic drops % LUMIGAN OPHTHALMIC DROPS 0.0 % TRAVATAN Z OPHTHALMIC DROPS % Otic Agents Otic Agents CIPRODEX OTIC DROPS,SUSPENSION % hydrocortisone-acetic acid otic drops - % neomycin-polymyxin-hc otic drops,suspension.5-0,000- mg/ml-unit/ml-% neomycin-polymyxin-hc otic solution.5-0,000- mg/ml-unit/ml-%

104 Respiratory Tract Agents Respiratory Tract Agents, Other acetylcysteine solution 00 mg/ml (0 %), 00 mg/ml (0 %) ARALAST NP INTRAVENOUS RECON SOLN,000 MG, 500 MG GLASSIA INTRAVENOUS SOLUTION GRAM/50 ML ( %) LUMIZYME INTRAVENOUS RECON SOLN 50 MG PROLASTIN-C INTRAVENOUS RECON SOLN,000 MG ZEMAIRA INTRAVENOUS RECON SOLN,000 MG Respiratory Tract/ Pulmonary Agents Antihistamines azelastine nasal aerosol,spray 7 mcg (0. %) azelastine nasal spray,non-aerosol 0.5 % (05.5 mcg) B/D 4 PA 4 PA 4 PA 4 PA clemastine oral tablet.68 mg PA cyproheptadine oral syrup mg/5 ml PA cyproheptadine oral tablet 4 mg PA levocetirizine oral solution.5 mg/5 ml levocetirizine oral tablet 5 mg Anti-Inflammatories, Inhaled Corticosteroids ADVAIR DISKUS INHALATION BLISTER WITH DEVICE MCG/DOSE, MCG/DOSE, MCG/DOSE ADVAIR HFA INHALATION HFA AEROSOL INHALER 5- MCG/ACTUATION, 0- MCG/ACTUATION, 45- MCG/ACTUATION budesonide inhalation suspension for nebulization 0.5 mg/ ml, 0.5 mg/ ml, mg/ ml B/D 98

105 FLOVENT DISKUS INHALATION BLISTER WITH DEVICE 00 MCG/ACTUATION, 50 MCG/ACTUATION, 50 MCG/ACTUATION FLOVENT HFA INHALATION HFA AEROSOL INHALER 0 MCG/ACTUATION, 0 MCG/ACTUATION, 44 MCG/ACTUATION flunisolide nasal spray,non-aerosol 5 mcg (0.05 %) fluticasone nasal spray,suspension 50 mcg/actuation mometasone nasal spray,non-aerosol 50 mcg/actuation NASONEX NASAL SPRAY,NON-AEROSOL 50 MCG/ACTUATION QVAR INHALATION AEROSOL 40 MCG/ACTUATION, 80 MCG/ACTUATION Antileukotrienes montelukast oral granules in packet 4 mg montelukast oral tablet 0 mg montelukast oral tablet,chewable 4 mg, 5 mg zafirlukast oral tablet 0 mg, 0 mg PA zileuton oral tablet, er multiphase hr 600 mg PA ZYFLO CR ORAL TABLET, ER MULTIPHASE HR 600 MG 4 ZYFLO ORAL TABLET 600 MG Bronchodilators, Anticholinergic ipratropium bromide inhalation solution 0.0 % B/D ipratropium bromide nasal spray,non-aerosol 0.0 %, 0.06 % SPIRIVA RESPIMAT INHALATION MIST.5 MCG/ACTUATION,.5 MCG/ACTUATION SPIRIVA WITH HANDIHALER INHALATION CAPSULE, W/INHALATION DEVICE 8 MCG 99

106 TUDORZA PRESSAIR INHALATION AEROSOL POWDR BREATH ACTIVATED 400 MCG/ACTUATION, 400 MCG/ACTUATION (0 ACTUAT) Bronchodilators, Sympathomimetic albuterol sulfate inhalation solution for nebulization 0.6 mg/ ml,.5 mg/ ml,.5 mg / ml (0.08 %),.5 mg/0.5 ml, 5 mg/ml albuterol sulfate oral syrup mg/5 ml albuterol sulfate oral tablet mg, 4 mg albuterol sulfate oral tablet extended release hr 4 mg, 8 mg B/D aprepitant oral capsule 5 mg B/D epinephrine injection auto-injector 0.5 mg/0.5 ml, 0.5 mg/0. ml, 0. mg/0. ml EPIPEN -PAK INJECTION AUTO-INJECTOR 0. MG/0. ML EPIPEN INJECTION AUTO-INJECTOR 0. MG/0. ML EPIPEN JR -PAK INJECTION AUTO- INJECTOR 0.5 MG/0. ML metaproterenol oral syrup 0 mg/5 ml metaproterenol oral tablet 0 mg, 0 mg PROVENTIL HFA INHALATION HFA AEROSOL INHALER 90 MCG/ACTUATION SEREVENT DISKUS INHALATION BLISTER WITH DEVICE 50 MCG/DOSE terbutaline oral tablet.5 mg, 5 mg terbutaline subcutaneous solution mg/ml VENTOLIN HFA INHALATION HFA AEROSOL INHALER 90 MCG/ACTUATION Cystic Fibrosis Agents BETHKIS INHALATION SOLUTION FOR NEBULIZATION 00 MG/4 ML KALYDECO ORAL GRANULES IN PACKET 50 MG, 75 MG QL ( EA per 0 days) 4 QL ( EA per 0 days) 4 QL ( EA per 0 days) 4 QL ( EA per 0 days) ; QL (4 ML per 8 days) 00

107 KALYDECO ORAL TABLET 50 MG ORKAMBI ORAL TABLET 00-5 MG, 00-5 MG PULMOZYME INHALATION SOLUTION MG/ML Mast Cell Stabilizers cromolyn inhalation solution for nebulization 0 mg/ ml Phosphodiesterase Inhibitors, Airways Disease aminophylline intravenous solution 50 mg/0 ml, 500 mg/0 ml DALIRESP ORAL TABLET 500 MCG 4 ELIXOPHYLLIN ORAL ELIXIR 80 MG/5 ML 4 theophylline oral tablet extended release hr 00 mg, 00 mg, 00 mg, 450 mg theophylline oral tablet extended release 4 hr 400 mg, 600 mg theophylline oral tablet extended release 400 mg, 600 mg Pulmonary Antihypertensives ADEMPAS ORAL TABLET 0.5 MG, MG,.5 MG, MG,.5 MG B/D LETAIRIS ORAL TABLET 0 MG, 5 MG REMODULIN INJECTION SOLUTION MG/ML, 0 MG/ML,.5 MG/ML, 5 MG/ML REVATIO ORAL SUSPENSION FOR RECONSTITUTION 0 MG/ML sildenafil intravenous solution 0 mg/.5 ml sildenafil oral tablet 0 mg PA TRACLEER ORAL TABLET 5 MG, 6.5 MG ; LA VENTAVIS INHALATION SOLUTION FOR NEBULIZATION 0 MCG/ML, 0 MCG/ML Respiratory Tract/ Pulmonary Agents 0

108 ANORO ELLIPTA INHALATION BLISTER WITH DEVICE MCG/ACTUATION ARNUITY ELLIPTA INHALATION BLISTER WITH DEVICE 00 MCG/ACTUATION, 00 MCG/ACTUATION BREO ELLIPTA INHALATION BLISTER WITH DEVICE 00-5 MCG/DOSE, 00-5 MCG/DOSE COMBIVENT RESPIMAT INHALATION MIST 0-00 MCG/ACTUATION 4 ST ESBRIET ORAL CAPSULE 67 MG ESBRIET ORAL TABLET 67 MG, 80 MG INCRUSE ELLIPTA INHALATION BLISTER WITH DEVICE 6.5 MCG/ACTUATION ipratropium-albuterol inhalation solution for nebulization 0.5 mg- mg(.5 mg base)/ ml B/D promethazine vc oral syrup mg/5 ml PA promethazine-phenylephrine oral syrup mg/5 ml STIOLTO RESPIMAT INHALATION MIST.5-.5 MCG/ACTUATION SYMBICORT INHALATION HFA AEROSOL INHALER MCG/ACTUATION, MCG/ACTUATION XOLAIR SUBCUTANEOUS RECON SOLN 50 MG Skeletal Muscle Relaxants Skeletal Muscle Relaxants PA carisoprodol oral tablet 50 mg, 50 mg PA chlorzoxazone oral tablet 500 mg PA comfort pac-cyclobenzaprine kit 0 mg PA cyclobenzaprine oral tablet 0 mg, 5 mg PA methocarbamol oral tablet 500 mg, 750 mg PA orphenadrine citrate oral tablet extended release 00 mg PA 0

109 Sleep Disorder Agents Gaba Receptor Modulators zaleplon oral capsule 0 mg, 5 mg QL (90 EA per 65 days) zolpidem oral tablet 0 mg, 5 mg QL (90 EA per 65 days) Sleep Disorders, Other HETLIOZ ORAL CAPSULE 0 MG MODAFINIL ORAL TABLET 00 MG, 00 MG PA ROZEREM ORAL TABLET 8 MG 4 QL (0 EA per 0 days) XYREM ORAL SOLUTION 500 MG/ML 4 LA Therapeutic Nutrients/ Minerals/ Electrolytes Electrolyte/ Mineral Modifiers AMINOSYN 7 % WITH ELECTROLYTES INTRAVENOUS PARENTERAL SOLUTION 7 % AMINOSYN-RF 5. % INTRAVENOUS PARENTERAL SOLUTION 5. % EXJADE ORAL TABLET, DISPERSIBLE 5 MG, 50 MG, 500 MG 4 B/D 4 B/D FERRIPROX ORAL TABLET 500 MG kionex (with sorbitol) oral suspension 5-9. gram/60 ml kionex oral powder SAMSCA ORAL TABLET 5 MG, 0 MG 5 sodium polystyrene (sorb free) oral suspension 5 gram/60 ml sodium polystyrene sulfonate oral powder sodium polystyrene sulfonate oral suspension 5 gram/60 ml sodium polystyrene sulfonate rectal enema 0 gram/0 ml, 50 gram/00 ml sps (with sorbitol) oral suspension 5-0 gram/60 ml sps (with sorbitol) rectal enema 0-40 gram/0 ml 0

110 SYPRINE ORAL CAPSULE 50 MG 4 PA Electrolyte/ Mineral Replacement CARBAGLU ORAL TABLET, DISPERSIBLE 00 MG klor-con 0 oral tablet extended release 0 meq klor-con 8 oral tablet extended release 8 meq klor-con m0 oral tablet,er particles/crystals 0 meq klor-con m5 oral tablet,er particles/crystals 5 meq klor-con m0 oral tablet,er particles/crystals 0 meq klor-con sprinkle oral capsule, extended release 0 meq, 8 meq k-sol oral liquid 0 meq/5 ml, 40 meq/5 ml magnesium sulfate injection solution 4 meq/ml (50 %) normosol-r intravenous parenteral solution normosol-r ph 7.4 intravenous parenteral solution potassium chloride intravenous piggyback 0 meq/50 ml, 40 meq/00 ml potassium chloride oral capsule, extended release 0 meq, 8 meq potassium chloride oral liquid 0 meq/5 ml, 40 meq/5 ml potassium chloride oral tablet extended release 0 meq, 0 meq, 8 meq potassium chloride oral tablet,er particles/crystals 0 meq, 0 meq sodium chlor 0.9% bacteriostat injection solution 0.9 % sodium chloride 0.9 % injection solution 0.9 % sodium chloride 0.9 % intravenous parenteral solution 0.9 % 04

111 sodium chloride 0.9 % intravenous piggyback 0.9 % sodium chloride % intravenous parenteral solution % sodium chloride intravenous parenteral solution.5 meq/ml sodium chloride irrigation solution 0.9 % SODIUM FLUORIDE ORAL TABLET MG FLUORIDE (. MG) Therapeutic Nutrients/ Minerals/ Electrolytes amino acids 5 % intravenous parenteral solution 5 % aminosyn 8.5 %-electrolytes intravenous parenteral solution 8.5 % AMINOSYN II 0 % INTRAVENOUS PARENTERAL SOLUTION 0 % AMINOSYN II 5 % INTRAVENOUS PARENTERAL SOLUTION 5 % AMINOSYN II 7 % INTRAVENOUS PARENTERAL SOLUTION 7 % AMINOSYN II 8.5 % INTRAVENOUS PARENTERAL SOLUTION 8.5 % aminosyn ii 8.5 %-electrolytes intravenous parenteral solution 8.5 % AMINOSYN M.5 % INTRAVENOUS PARENTERAL SOLUTION.5 % AMINOSYN-HBC 7% INTRAVENOUS PARENTERAL SOLUTION 7 % AMINOSYN-PF 0 % INTRAVENOUS PARENTERAL SOLUTION 0 % AMINOSYN-PF 7 % (SULFITE-FREE) INTRAVENOUS PARENTERAL SOLUTION 7 % clinimix 4.5%/d0w sulf free intravenous parenteral solution 4.5 % clinimix 4.5%-d0w sulf-free intravenous parenteral solution 4.5 % B/D 4 B/D B/D 4 B/D 4 B/D 4 B/D 4 B/D B/D 4 B/D 4 B/D 4 B/D 4 B/D B/D B/D 05

112 clinimix 4.5%-d5w sulf-free intravenous parenteral solution 4.5 % clinisol sf 5 % intravenous parenteral solution 5 % d0 %-0.45 % sodium chloride intravenous parenteral solution d.5 %-0.45 % sodium chloride intravenous parenteral solution d5 % and 0.9 % sodium chloride intravenous parenteral solution d5 %-0.45 % sodium chloride intravenous parenteral solution dextrose 0 % and 0. % nacl intravenous parenteral solution dextrose 0 % in water (d0w) intravenous parenteral solution 0 % dextrose 5 % in water (d5w) intravenous parenteral solution dextrose 5 % in water (d5w) intravenous piggyback 5 % dextrose 5 %-lactated ringers intravenous parenteral solution dextrose 5%-0. % sod chloride intravenous parenteral solution dextrose 5%-0. % sod.chloride intravenous parenteral solution B/D B/D intralipid intravenous emulsion 0 % B/D lactated ringers intravenous parenteral solution levocarnitine (with sugar) oral solution 00 mg/ml levocarnitine oral tablet 0 mg potassium chlorid-d5-0.45%nacl intravenous parenteral solution 0 meq/l potassium chloride in lr-d5 intravenous parenteral solution 40 meq/l PRENATAL VITAMIN PLUS LOW IRON ORAL TABLET 7 MG IRON- MG 4 06

113 water for irrigation, sterile irrigation solution 07

114 Index 8 8-MOP A abacavir... 4 abacavir-lamivudine... 4 abacavir-lamivudinezidovudine... 4 abelcet... abilify maintena... 6 ABILIFY MAINTENA... 6 ABRAXANE... 9 acamprosate... 5 acarbose acebutolol acetaminophen-codeine... acetazolamide acetic acid... 7 acetic acid-aluminum acetate. 7 acetylcysteine acitretin ACTEMRA ACTHIB (PF) ACTIMMUNE acyclovir... 4 acyclovir sodium... 4 ADACEL(TDAP ADOLESN/ADULT)(PF) 89 ADAGEN ADEFOVIR ADEMPAS adriamycin... 9 ADVAIR DISKUS ADVAIR HFA afeditab cr AFINITOR... AFINITOR DISPERZ... a-hydrocort... 5 ak-poly-bac ala-cort... 7 ALBENZA... 4 albuterol sulfate alclometasone... 7 alcohol pads... 7 ALDACTAZIDE ALDURAZYME ALECENSA... alendronate... 9 alfuzosin... 7 ALINIA... 4 allopurinol... 4 allopurinol sodium alosetron ALPHAGAN P alprazolam alyacen /5 (8) amabelz amantadine hcl... 4, 5 AMBISOME... amifostine crystalline... 9 amikacin... 6 amiloride amiloride-hydrochlorothiazide amino acids 5 % aminophylline AMINOSYN 7 % WITH ELECTROLYTES... 0 aminosyn 8.5 %-electrolytes AMINOSYN II 0 % AMINOSYN II 5 % AMINOSYN II 7 % AMINOSYN II 8.5 % aminosyn ii 8.5 %-electrolytes AMINOSYN M.5 % AMINOSYN-HBC 7% AMINOSYN-PF 0 % AMINOSYN-PF 7 % (SULFITE-FREE) AMINOSYN-RF 5. %... 0 amiodarone AMITIZA amitriptyline... 0 amlodipine amlodipine-benazepril amlodipine-olmesartan... 54, 57 amlodipine-valsartan amlodipine-valsartan-hcthiazid ammonium lactate amoxapine... 0 amoxicillin... amoxicillin-pot clavulanate.. amphotericin b... ampicillin... ampicillin sodium... ampicillin-sulbactam... AMPYRA ANADROL anagrelide... 5 anastrozole... ANDROGEL androxy ANORO ELLIPTA APIDRA APIDRA SOLOSTAR APLENZIN... 8 APOKYN... 5 aprepitant..., 99 apri APTIOM... 6 APTIVUS ARALAST NP aranelle (8) ARANESP (IN POLYSORBATE)... 5 ARCALYST argatroban... 5 argatroban in 0.9 % sod chlor... 5 argatroban in nacl (iso-os)... 5 aripiprazole... 6, 7 ARISTADA... 7 ARNUITY ELLIPTA ascomp with codeine... aspirin-dipyridamole... 5 assure id insulin safety ASTAGRAF XL atenolol atenolol-chlorthalidone ATGAM atorvastatin atovaquone... 4 atovaquone-proguanil... 4 ATRIPLA... 4 AUBAGIO aubra

115 AVANDIA AVASTIN... 9 AVELOX IN NACL (ISO- OSMOTIC)... aviane AZASAN azathioprine azathioprine sodium azelastine... 95, 97 AZILECT... 5 azithromycin... AZOPT aztreonam... 0 B bacitracin... 7 bacitracin-polymyxin b baclofen... 9 BACTROBAN NASAL... 7 balsalazide... 9 balziva (8) BANZEL... 7 BARACLUDE BAVENCIO... BCG VACCINE, LIVE (PF) 89 bekyree (8) benazepril benazepril-hydrochlorothiazide BENICAR BENICAR HCT BENLYSTA benztropine... 4 betamethasone dipropionate. 5 betamethasone valerate... 5 betamethasone, augmented... 5 BETASERON bethanechol chloride... 7 BETHKIS bexarotene... BEXSERO bicalutamide... 8 BICILLIN L-A... BILTRICIDE... 4 bisoprolol fumarate bisoprolol-hydrochlorothiazide BIVIGAM blisovi fe.5/0 (8) blisovi fe /0 (8) BOOSTRIX TDAP BOSULIF... BREO ELLIPTA... 0 briellyn BRILINTA... 5 brimonidine BRIVIACT... 4 bromocriptine... 5 budesonide... 69, 97 bumetanide buprenorphine hcl... 5 buprenorphine-naloxone... 5 buproban... 8 bupropion hcl... 8 bupropion hcl (smoking deter)... 8 buspirone BUSULFAN... 8 BUSULFEX... 8 butalbital compound w/codeine... butalbital-acetaminop-caf-cod butorphanol tartrate... 4 C cabergoline... 8 CABOMETYX... calcipotriene calcitonin (salmon)... 9 calcitriol... 9 calcium acetate... 7 camila... 8 CANASA... 9 CANCIDAS... CAPASTAT... 7 CAPRELSA... captopril captopril-hydrochlorothiazide CARBAGLU... 0 carbamazepine... 7, 46 carbidopa-levodopa... 5 carboplatin... 8 carimune nf nanofiltered CARIMUNE NF NANOFILTERED carisoprodol... 0 carisoprodol-asa-codeine... carisoprodol-aspirin... carteolol cartia xt carvedilol caziant (8) cefaclor... 9 cefadroxil... 9 cefazolin... 9 cefazolin in dextrose (iso-os).. 9 cefdinir... 9 cefepime... 9 cefepime in dextrose 5 %... 9 cefepime in dextrose,iso-osm. 9 cefotaxime... 9 cefoxitin... 9 cefoxitin in dextrose, iso-osm. 9 cefpodoxime... 9 cefprozil... 0 CEFTIN... 0 ceftriaxone... 0 ceftriaxone in dextrose,iso-os... 0 cefuroxime axetil... 0 cefuroxime sodium... 0 celecoxib... CELLCEPT INTRAVENOUS CELONTIN... 5 cephalexin... 0 CEREZYME cevimeline CHANTIX... 5 CHANTIX CONTINUING MONTH BOX... 5 CHANTIX STARTING MONTH BOX... 6 chloramphenicol sod succinate... 7 chlorhexidine gluconate chloroquine phosphate... 4 chlorothiazide chlorpromazine... chlorthalidone chlorzoxazone... 0 CHOLBAM cholestyramine (with sugar). 60 cholestyramine light

116 chorionic gonadotropin, human ciclopirox... ciclopirox-ure-camph-mentheuc... cidofovir... 9 cilostazol... 5 cimetidine cimetidine hcl CIMZIA CIMZIA POWDER FOR RECONST CIMZIA STARTER KIT CINRYZE CIPRODEX ciprofloxacin (mixture)... ciprofloxacin hcl... ciprofloxacin lactate... cisplatin... 8 citalopram... 9 claravis clarithromycin... clemastine CLIMARA PRO clindamycin hcl... 7 clindamycin in 5 % dextrose.. 7 clindamycin palmitate hcl... 7 clindamycin pediatric... 7 clindamycin phosphate... 7 clindamycin-benzoyl peroxide clinimix 4.5%/d0w sulf free clinimix 4.5%-d0w sulf-free clinimix 4.5%-d5w sulf-free clinisol sf 5 % clobetasol... 7 clobetasol-emollient... 7 clomipramine... clonazepam... 5 clonidine clonidine hcl... 5, 6 clopidogrel... 5 clorazepate dipotassium. 45, 46 clotrimazole... clotrimazole-betamethasone. 65 clozapine... 9 COARTEM... 4 codeine-butalbital-asa-caff... colchicine... 4 colestipol... 6 colistin (colistimethate na)... 7 colocort... 9 COMBIGAN COMBIPATCH COMBIVENT RESPIMAT 0 COMETRIQ... comfort pac-cyclobenzaprine... 0 comfort pac-ibuprofen... comfort pac-meloxicam... comfort pac-naproxen... comfort pac-tizanidine... 9 COMPLERA... 4 compro... constulose COPAXONE cormax cortisone... 5 COTELLIC... 9 COUMADIN... 5 CREON CRIXIVAN cromolyn... 95, 00 cryselle (8) CUBICIN... 7 CUBICIN RF... 7 CUVPOSA cyclafem /5 (8) cyclafem 7/7/7 (8) cyclobenzaprine... 0 cyclophosphamide... 8 cyclosporine cyclosporine modified cyproheptadine CYRAMZA... CYSTADANE CYSTAGON CYSTARAN D d0 %-0.45 % sodium chloride d.5 %-0.45 % sodium chloride d5 % and 0.9 % sodium chloride d5 %-0.45 % sodium chloride DALIRESP danazol dantrolene... 9 dapsone... 7 DAPTACEL (DTAP PEDIATRIC) (PF) daptomycin... 7 DARAPRIM... 4 darifenacin DARZALEX... deblitane delyla (8) DELZICOL... 9 demeclocycline... 4 DEMSER DENAVIR... 4 DEPEN TITRATABS... 7 DEPO-PROVERA... 8 DEPO-SUBQ PROVERA dermacinrx empricaine... 4 DESCOVY... 4 desipramine... desmopressin desog-e.estradiol/e.estradiol. 77 desonide... 7 desoximetasone... 7 desvenlafaxine... 9 desvenlafaxine fumarate... 9 desvenlafaxine succinate... 9 dexamethasone... 5 dexamethasone intensol... 5 dexamethasone sodium phos (pf)... 5 dexamethasone sodium phosphate... 5, 96 dexmethylphenidate... 6 dextroamphetamine... 6 dextroamphetamineamphetamine... 6 dextrose 0 % and 0. % nacl dextrose 0 % in water (d0w)

117 dextrose 5 % in water (d5w) dextrose 5 %-lactated ringers dextrose 5%-0. % sod chloride dextrose 5%-0. % sod.chloride diazepam... 5, 46 diazepam intensol diclofenac potassium... diclofenac sodium..., 96 dicloxacillin... dicyclomine didanosine... 4 diflorasone... 7 diflunisal... digitek digox digoxin dihydroergotamine... 6 DILANTIN... 7 diltiazem hcl dilt-xr DIPENTUM... 9 diphenhydramine hcl... diphenoxylate-atropine dipyridamole... 5 disopyramide phosphate disulfiram... 5 divalproex... 5 DIVIGEL docetaxel... 9 dofetilide donepezil... 8 DORIBAX... 0 doripenem... 0 dorzolamide dorzolamide-timolol doxazosin doxepin..., 65 doxercalciferol... 9 doxorubicin, peg-liposomal.. 9 doxy doxycycline hyclate... 4 doxycycline monohydrate... 4 dronabinol... drospirenone-ethinyl estradiol DROXIA... 9 DUAVEE duloxetine... 9 duramorph (pf)... DUREZOL dutasteride... 7 dutasteride-tamsulosin... 7 E E.E.S. GRANULES... econazole... EDURANT... 4 EFFIENT... 5 EGRIFTA ELAPRASE ELELYSO ELIDEL ELIGARD... 8 ELIGARD ( MONTH)... 8 ELIGARD (4 MONTH)... 8 ELIGARD (6 MONTH)... 8 ELIQUIS... 5 ELITEK ELIXOPHYLLIN ELMIRON... 7 EMCYT... 8 EMEND... emoquette EMPLICITI... EMSAM... 9 EMTRIVA... 4 enalapril maleate enalapril-hydrochlorothiazide ENBREL ENBREL SURECLICK endocet... ENGERIX-B (PF) ENGERIX-B PEDIATRIC (PF) enoxaparin... 5 enpresse entacapone... 5 entecavir ENTRESTO enulose ENVARSUS XR EPCLUSA epinastine epinephrine EPIPEN EPIPEN -PAK EPIPEN JR -PAK epirubicin... 9 epitol... 7 EPIVIR HBV eplerenone EPOGEN... 5 EPZICOM... 4 EQUETRO... 7 ERAXIS(WATER DILUENT)... ergoloid... 7 ERGOMAR... 6 ERIVEDGE... errin... 8 ery pads... ERYPED ERYTHROCIN... erythrocin (as stearate)... erythromycin... erythromycin ethylsuccinate. erythromycin with ethanol..., erythromycin-benzoyl peroxide ESBRIET... 0 escitalopram oxalate... 9 esomeprazole magnesium ESTRACE estradiol estradiol valerate estradiol-norethindrone acet. 77 ESTRING estropipate ethambutol... 7 ethosuximide... 5 ethynodiol diac-eth estradiol 77 etidronate disodium... 9 etodolac... ETOPOPHOS... etoposide... EVOTAZ exemestane... EXJADE... 0

118 EXONDYS EXTAVIA ezetimibe... 6 ezetimibe-simvastatin F FABRAZYME falmina (8) famciclovir... 4 famotidine famotidine (pf) FANAPT... 7 FARESTON... 8 FARYDAK... felbamate... 6 felodipine femynor fenofibrate fenofibrate micronized fenofibrate nanocrystallized. 60 fenofibric acid (choline) fentanyl... fentanyl citrate... FERRIPROX... 0 FETZIMA... 9, 0 finasteride... 7 FIRAZYR FIRMAGON... 8 FIRMAGON KIT W DILUENT SYRINGE 8, 8 flavoxate... 7 FLEBOGAMMA DIF flecainide FLOVENT DISKUS FLOVENT HFA fluconazole... fluconazole in dextrose(iso-o)... fluconazole in nacl (iso-osm) flucytosine... fludarabine... 9, 0 fludrocortisone... 7 flunisolide fluocinolone... 7 fluocinonide... 7, 7 fluocinonide-e... 7 fluorometholone fluorouracil fluoxetine... 0 fluphenazine decanoate... 6 fluphenazine hcl... 6 flurbiprofen... flurbiprofen sodium flutamide... 8 fluticasone... 65, 98 fluvoxamine... 0 FML FORTE FOCALIN XR... 6 fondaparinux... 5 FORFIVO XL... 8 FORTEO... 9 fosinopril fosinopril-hydrochlorothiazide fosphenytoin... 7 FOSRENOL... 7, 7 FRAGMIN... 5 furosemide FUSILEV... 0 FUZEON fyavolv FYCOMPA... 6 G gabapentin... 5 GABITRIL... 5 GAMASTAN S/D GAMMAGARD LIQUID GAMMAGARD S-D (IGA < MCG/ML) GAMMAKED GAMMAPLEX GAMMAPLEX (WITH SORBITOL) GAMUNEX-C ganciclovir sodium... 9 GARDASIL (PF) GARDASIL 9 (PF) GATTEX 0-VIAL GATTEX ONE-VIAL gauze pad gavilyte-c gavilyte-g gavilyte-n gemcitabine... 9 gemfibrozil generlac gengraf GENOTROPIN GENOTROPIN MINIQUICK gentak... 6 gentamicin... 6 gentamicin sulfate (ped) (pf).. 6 gentamicin sulfate (pf)... 6 GENVOYA... 4 GEODON... 7 gildagia gildess.5/0 () GILENYA GILOTRIF... GLASSIA GLEOSTINE... 8 glimepiride glipizide... 46, 47 glipizide-metformin GLUCAGEN DIAGNOSTIC KIT GLUCAGEN HYPOKIT GLUCAGON EMERGENCY KIT (HUMAN) GLUCAGON HCL glyburide glyburide micronized glyburide-metformin glycopyrrolate GLYXAMBI granisetron (pf)... granisetron hcl... GRANIX... 5 griseofulvin microsize... guanfacine guanidine... 7 H halobetasol propionate... 7 haloperidol... 6 haloperidol decanoate... 6 haloperidol lactate... 6 HARVONI HAVRIX (PF)... 89, 90 heparin (porcine)... 5 heparin (porcine) in 5 % dex 5 heparin, porcine (pf)... 5 HERCEPTIN... HETLIOZ... 0 HEXALEN... 8

119 HIBERIX (PF) HORIZANT... 6 HUMALOG HUMALOG KWIKPEN HUMALOG MIX HUMALOG MIX KWIKPEN HUMALOG MIX HUMALOG MIX 75-5 KWIKPEN HUMATROPE HUMIRA HUMIRA PEDIATRIC CROHN'S START HUMIRA PEN HUMIRA PEN CROHN'S- UC-HS START HUMIRA PEN PSORIASIS- UVEITIS HUMULIN 70/ HUMULIN 70/0 KWIKPEN HUMULIN N HUMULIN N KWIKPEN HUMULIN R U HUMULIN R U-500 (CONC) KWIKPEN HUMULIN R U-500 (CONCENTRATED) hydralazine... 6 hydrochlorothiazide hydrocodone-acetaminophen. hydrocodone-ibuprofen... hydrocortisone... 5, 7, 9 hydrocortisone butyrate... 7 hydrocortisone butyr-emollient... 7 hydrocortisone valerate... 7 hydrocortisone-acetic acid hydrocortisone-min oil-wht pet... 7 hydromorphone... 4 hydromorphone (pf)... 4 hydroxychloroquine... 4 hydroxyurea... 9 hydroxyzine hcl... hydroxyzine pamoate... HYPERRAB S/D (PF) I ibandronate... 9 IBRANCE... ibuprofen... ibuprofen-oxycodone... ICLUSIG... ILARIS (PF) imatinib... IMBRUVICA... imipenem-cilastatin... 0 imipramine hcl... imipramine pamoate... imiquimod IMOVAX RABIES VACCINE (PF) INCRELEX INCRUSE ELLIPTA... 0 indapamide indomethacin... INFANRIX (DTAP) (PF) INFLECTRA INLYTA... insulin syringe-needle u INTELENCE... 4 intralipid INTRON A introvale INVANZ... 0 INVEGA SUSTENNA... 7 INVEGA TRINZA... 7 INVIRASE INVOKAMET INVOKAMET XR INVOKANA IPOL ipratropium bromide ipratropium-albuterol... 0 irbesartan irbesartan-hydrochlorothiazide IRESSA... irinotecan... 9 ISENTRESS... 4 isoniazid... 7 isosorbide dinitrate... 6 isosorbide mononitrate... 6 isradipine ISTODAX... 0 itraconazole... IXIARO (PF) J JAKAFI... jantoven... 5 JANUMET JANUMET XR JANUVIA JARDIANCE JENTADUETO JENTADUETO XR jinteli jolivette... 8 juleber junel.5/0 () junel /0 () junel fe.5/0 (8) junel fe /0 (8) JUXTAPID... 6 K KALETRA KALYDECO kariva (8) kelnor /5 (8) KETEK... ketoconazole... ketoprofen... ketorolac..., 96 KEVEYIS KEYTRUDA... kimidess (8) KINERET KINRIX (PF) kionex... 0 kionex (with sorbitol)... 0 KISQALI... 0 klor-con klor-con klor-con m klor-con m klor-con m klor-con sprinkle... 0 KORLYM KRISTALOSE k-sol... 0 KUVAN KYNAMRO... 6 KYPROLIS... 0

120 L labetalol lactated ringers lactulose LAMISIL... 4 lamivudine lamivudine-zidovudine... 4 lamotrigine... 6 lansoprazole LANTUS LANTUS SOLOSTAR larin.5/0 () larin /0 () larin fe.5/0 (8) larin fe /0 (8) larissia LARTRUVO... latanoprost LATUDA... 8 LAZANDA... 4 leena leflunomide LENVIMA... lessina LETAIRIS letrozole... leucovorin calcium... 0 LEUKERAN... 8 LEUKINE... 5 leuprolide... 8 LEVEMIR LEVEMIR FLEXTOUCH levetiracetam... 4 levetiracetam in nacl (iso-os) 4 levobunolol levocarnitine levocarnitine (with sugar) levocetirizine levofloxacin... levoleucovorin... 9, 0 levonest (8) levonorgestrel-ethinyl estrad 78 levonorg-eth estrad triphasic 78 levora levothyroxine... 8 levoxyl... 8 LEXIVA LIALDA... 9 lidocaine... 5 lidocaine (pf)... 4 lidocaine hcl... 4 lidocaine-prilocaine... 5 LIDOPAC... 5 lidopril... 5 lidopril xr... 5 lido-prilo caine pack... 5 lincomycin... 8 lindane... 4 linezolid... 8 linezolid-0.9% sodium chloride... 8 LINZESS liothyronine... 8 liprozonepak... 5 lisinopril lisinopril-hydrochlorothiazide lithium carbonate lithium citrate LIVALO livixil pak... 5 LONSURF... 0 loperamide lopinavir-ritonavir lopreeza lorazepam lorazepam intensol losartan losartan-hydrochlorothiazide 58 lovastatin low-ogestrel (8) loxapine succinate... 6 lp lite pak... 5 LUMIGAN LUMIZYME LUPRON DEPOT... 8 LUPRON DEPOT ( MONTH)... 8 LUPRON DEPOT (4 MONTH)... 8 LUPRON DEPOT (6 MONTH)... 8 LUPRON DEPOT-PED... 8 LUPRON DEPOT-PED ( MONTH)... 8 lutera (8) LYNPARZA... 0 LYRICA... 6 LYSODREN... 8 lyza... 8 M magnesium sulfate... 0 MALARONE... 4 malathion... 4 maprotiline... 8 marlissa MARPLAN... 9 MATULANE... 8 meclizine... meclofenamate... medroxyprogesterone... 8 mefloquine... 4 megestrol... 8 MEKINIST... meloxicam... melphalan hcl... 8 memantine... 8 MENACTRA (PF) MENEST MENHIBRIX (PF) MENOMUNE - A/C/Y/W MENOMUNE - A/C/Y/W-5 (PF) MENOSTAR MENTAX... 4 MENVEO A-C-Y-W-5-DIP (PF) meperidine... 4 meprobamate mercaptopurine meropenem... 0 meropenem-0.9% sodium chloride... 0 mesalamine... 9 mesalamine with cleansing wipe... 9 mesna... 0 MESNEX... 0 metaproterenol metformin methadone... methazolamide methenamine hippurate

121 methimazole methocarbamol... 0 methotrexate sodium methotrexate sodium (pf) methoxsalen methyclothiazide methyldopa methyldopahydrochlorothiazide methyldopate methylphenidate... 6 methylprednisolone... 5 methylprednisolone acetate.. 5 methylprednisolone sodium succ... 6 methyltestosterone metipranolol metoclopramide hcl... metolazone metoprolol succinate metoprolol tartrate metro i.v metronidazole... 8 metronidazole in nacl (iso-os) 8 mexiletine MIACALCIN... 9 microgestin.5/0 () microgestin /0 () microgestin fe.5/0 (8) microgestin fe /0 (8) midodrine mimvey lo minocycline... 4 minoxidil... 6 mirtazapine... 8 misoprostol mitomycin... 9 mitoxantrone... 0 M-M-R II (PF) MODAFINIL... 0 moderiba MODERIBA DOSE PACK. 40 moexipril moexipril-hydrochlorothiazide molindone... 6 mometasone... 7, 98 mononessa (8) montelukast morgidox... 4 morphine... MOXEZA... moxifloxacin... moxifloxacin-sod.ace,sul-water... MOZOBIL... 5 MULTAQ mupirocin... 8 MYCAMINE... 4 mycophenolate mofetil mycophenolate mofetil hcl mycophenolate sodium myorisan MYRBETRIQ... 7 N nabumetone... nadolol nafcillin... nafcillin in dextrose iso-osm NAGLAZYME nalbuphine... 4 naloxone... 5 naltrexone... 5 NAMENDA XR... 8 naphazoline NAPRELAN CR... naproxen... naproxen sodium... naratriptan... 6 NASONEX nateglinide NATPARA... 9 NEBUPENT... 4 necon 0.5/5 (8) necon /5 (8) necon 0/ (8) necon 7/7/7 (8) nefazodone... 9 neomycin... 6 neomycin-bacitracin-poly-hc 94 neomycin-bacitracinpolymyxin neomycin-polymyxin b gu... 6 neomycin-polymyxin b- dexameth neomycin-polymyxingramicidin neomycin-polymyxin-hc. 94, 96 NEULASTA... 5 NEUPOGEN... 5 NEUPRO... 5 nevirapine... 4 NEXAVAR... niacin... 6 NICOTROL... 6 NICOTROL NS... 6 nifedical xl nifedipine... 56, 57 NILANDRON... 8 nilutamide... 8 nimodipine NINLARO... 0 NITRO-BID... 6 NITRO-DUR... 6 nitrofurantoin macrocrystal... 8 nitrofurantoin monohyd/mcryst... 8 nitroglycerin... 6 NITROSTAT... 6 nizatidine nora-be NORDITROPIN FLEXPRO 74 NORDITROPIN NORDIFLEX norethindrone (contraceptive)... 8 norethindrone acetate... 8 norethindrone ac-eth estradiol norgestimate-ethinyl estradiol norlyroc normosol-r... 0 normosol-r ph NORPACE CR NORTHERA nortrel 0.5/5 (8) nortrel /5 () nortrel /5 (8) nortrel 7/7/7 (8) nortriptyline... NORVIR NOVOLIN 70/

122 NOVOLIN N NOVOLIN R NOVOLOG NOVOLOG FLEXPEN NOVOLOG MIX NOVOLOG MIX 70-0 FLEXPEN NOVOLOG PENFILL NOXAFIL... 4 NUEDEXTA... 6 NULOJIX NUPLAZID... 8 NUTROPIN AQ NUTROPIN AQ NUSPIN NUVARING nyamyc... 4 nyata... 4 nystatin... 4 nystatin-triamcinolone nystop... 4 O OCALIVA ocella octreotide acetate... 8 ODEFSEY ODOMZO... 0 OFEV... ofloxacin... olanzapine... 8 olmesartan olmesartan-amlodipinhcthiazid... 54, 58 olmesartanhydrochlorothiazide olopatadine omega- acid ethyl esters... 6 omeprazole OMNITROPE ondansetron... ondansetron hcl... ondansetron hcl (pf)... ONFI... 5 OPDIVO... ORENCIA ORENCIA (WITH MALTOSE) ORENCIA CLICKJECT ORFADIN ORKAMBI orphenadrine citrate... 0 orsythia oseltamivir OTEZLA OTEZLA STARTER oxaliplatin... 8 oxandrolone oxcarbazepine... 7 oxybutynin chloride... 7 oxycodone..., 4 oxycodone-acetaminophen... oxycodone-aspirin... OXYCONTIN... P paclitaxel... 9 paliperidone... 8 pamidronate... 9 PANRETIN... pantoprazole paricalcitol... 9 paromomycin... 6 paroxetine hcl... 0 PASER... 7 PAXIL... 0 PEDIARIX (PF) PEDVAX HIB (PF) peg-50 with flavor packs.. 70 PEGANONE... 7 PEGASYS... 40, 4 PEGASYS PROCLICK peg-electrolyte soln PEGINTRON... 4 PEGINTRON REDIPEN... 4 pen needle, diabetic penicillin g procaine... penicillin g sodium... penicillin v potassium... PENTAM... 4 PENTASA... 9 pentazocine-naloxone... pentoxifylline periogard permethrin... 4 perphenazine... perphenazine-amitriptyline... 9 phenadoz... phenelzine... 9 phenobarbital... 6 phenytoin... 7 phenytoin sodium... 7 phenytoin sodium extended.. 7 PHOSLYRA... 7 PHOSPHOLINE IODIDE pilocarpine hcl pimozide... 6 pimtrea (8) pioglitazone pioglitazone-metformin piperacillin-tazobactam... pirmella piroxicam... podofilox polyethylene glycol polymyxin b sulfate... 8 polymyxin b sulf-trimethoprim POMALYST... 8 portia potassium chlorid-d5-0.45%nacl potassium chloride... 0 potassium chloride in lr-d5. 05 potassium citrate... 7 POTIGA... 5 PRADAXA... 5 pramipexole... 5 pravastatin prazosin prednicarbate prednisolone... 6 prednisolone acetate... 6 prednisolone sodium phosphate... 6, 96 prednisone... 6 prednisone intensol... 9 PREFEST PREMARIN PREMPHASE PREMPRO PRENATAL VITAMIN PLUS LOW IRON prevalite... 6 previfem PREZCOBIX PREZISTA... 44, 45 6

123 PRIFTIN... 7 prilolid... 5 PRIMAQUINE... 4 primidone... 6 PRISTIQ... 0 PRIVIGEN probenecid... 4 probenecid-colchicine... 4 prochlorperazine... prochlorperazine edisylate... prochlorperazine maleate... PROCRIT... 5 procto-med hc... 9 procto-pak... 7 proctosol hc... 9 proctozone-hc progesterone micronized... 8 PROGLYCEM PROGRAF PROLASTIN-C PROLIA PROMACTA... 5 promethazine... promethazine vc... 0 promethazine-phenylephrine... 0 promethegan... propafenone proparacaine propranolol propylthiouracil PROQUAD (PF) protonix protriptyline... PROVENTIL HFA PRUDOXIN PULMOZYME PURIXAN... 9 pyrazinamide... 7 pyridostigmine bromide... 7 Q QUADRACEL (PF)... 9 quasense quetiapine... 9, 8 quinapril quinapril-hydrochlorothiazide quinidine gluconate quinidine sulfate quinine sulfate... 4 QVAR R RABAVERT (PF)... 9 raloxifene... 8 ramipril RANEXA ranitidine hcl RAPAMUNE rasagiline... 5 RAVICTI RAYOS... 6 REBETOL... 4 REBIF (WITH ALBUMIN). 64 REBIF REBIDOSE REBIF TITRATION PACK. 64 reclipsen (8) RECOMBIVAX HB (PF)... 9 RECTIV... 6 REGRANEX RELENZA DISKHALER RELISTOR REMICADE REMODULIN RENAGEL... 7 RENVELA... 7 repaglinide REPATHA PUSHTRONEX 6 REPATHA SURECLICK... 6 REPATHA SYRINGE... 6 RESCRIPTOR... 4 reserpine RESTASIS RESTASIS MULTIDOSE RETROVIR... 4 REVATIO REVLIMID... 8, 0 REXULTI... 8 REYATAZ ribasphere... 4 RIBASPHERE... 4 ribasphere ribapak... 4 RIBASPHERE RIBAPAK... 4 RIBATAB DOSE PACK... 4 ribavirin... 4 rifabutin... 7 rifampin... 7 RIFATER... 7 riluzole... 6 rimantadine risedronate RISPERDAL CONSTA... 8 risperidone... 8 RITUXAN... rivastigmine... 8 rivastigmine tartrate... 8 ropinirole... 5 rosuvastatin ROTARIX... 9 ROTATEQ VACCINE... 9 roweepra... 5 ROZEREM... 0 RUBRACA... 0 S SABRIL... 6 SAMSCA... 0 SANDIMMUNE SANDOSTATIN LAR DEPOT... 8 SANTYL SAPHRIS (BLACK CHERRY)... 8 SAVELLA selegiline hcl... 5 selenium sulfide SELZENTRY SENSIPAR... 8 SEREVENT DISKUS SEROQUEL XR... 8 SEROSTIM sertraline... 0 setlakin sharobel SIGNIFOR... 8 sildenafil silver sulfadiazine... SIMBRINZA SIMPONI... 87, 88 SIMPONI ARIA SIMULECT simvastatin sirolimus SIRTURO... 7 sodium chlor 0.9% bacteriostat

124 sodium chloride... 0, 04 sodium chloride 0.9 %... 0 sodium chloride %... 0 SODIUM FLUORIDE sodium phenylbutyrate... 7 sodium polystyrene (sorb free)... 0 sodium polystyrene sulfonate... 0 SOLTAMOX... 9 SOMATULINE DEPOT SOMAVERT sorine sotalol sotalol af SOVALDI... 4 SPIRIVA RESPIMAT SPIRIVA WITH HANDIHALER spironolactone spironolacton-hydrochlorothiaz sprintec (8) SPRITAM... 5 SPRYCEL... sps (with sorbitol)... 0 sronyx ssd... stavudine... 4 STELARA STIOLTO RESPIMAT... 0 STIVARGA... STRATTERA... 6 STRENSIQ streptomycin... 6 STRIBILD... 4 SUCRAID sucralfate sulfacetamide sodium... sulfacetamide sodium (acne) sulfacetamide-prednisolone.. 96 sulfadiazine... sulfamethoxazole-trimethoprim..., 4 sulfasalazine... 9 sulindac... sumatriptan... 6 sumatriptan succinate... 6, 7 SUMAVEL DOSEPRO... 7 SUPRAX... 0 SUSTIVA... 4 SUTENT... SYLATRON... 0 SYLATRON 4-PACK... 0 SYMBICORT... 0 SYMLINPEN SYMLINPEN SYNAGIS SYNAREL SYNERCID... 8 SYNJARDY SYNRIBO... 0 SYNTHROID... 8 SYPRINE... 0 T TABLOID... 9 tacrolimus... 66, 87 TAFINLAR... TAGRISSO... TAMIFLU tamoxifen... 9 tamsulosin... 7 TARCEVA... TARGRETIN... tarina fe /0 (8) TASIGNA... tazarotene TAZORAC taztia xt TECENTRIQ... TECFIDERA TEFLARO... 0 TEKTURNA TEKTURNA HCT TENIVAC (PF)... 9 terazosin terbinafine hcl... 4 terbutaline terconazole... 4 TESTIM testosterone testosterone cypionate tetanus,diphtheria tox ped(pf)... 9 tetanus-diphtheria toxoids-td 9 tetrabenazine... 6 THALOMID... 8 theophylline thioridazine... 6 thiotepa... 8 thiothixene... 6 THYMOGLOBULIN tiagabine... 6 TICE BCG... 0 timolol maleate TIMOPTIC TIMOPTIC OCUDOSE (PF) TIVICAY... 4 tizanidine... 9 TOBRADEX... 6 tobramycin... 6 tobramycin in 0.5 % nacl... 6 tobramycin sulfate... 6 tobramycin with nebulizer... 7 tobramycin-dexamethasone.. 94 tolazamide tolbutamide tolcapone... 5 tolmetin... tolterodine... 7 topiramate... 6 toposar... topotecan... TORISEL torsemide TOVIAZ... 7 TRACLEER TRADJENTA tramadol... 4 tramadol-acetaminophen... trandolapril tranexamic acid... 5 TRANSDERM-SCOP... tranylcypromine... 9 TRAVATAN Z trazodone... 9 TRECATOR... 7 TRELSTAR tretinoin tretinoin (chemotherapy)... tretinoin (emollient) TREXALL TREXIMET

125 TRI FEMYNOR triamcinolone acetonide. 65, 7 triamterene-hydrochlorothiazid TRIBENZOR triderm... 7 trifluoperazine... 6 trifluridine... 4 trihexyphenidyl... 5 tri-legest fe trilyte with flavor packets trimethobenzamide... trimethoprim... 8 trimipramine... trinessa (8) TRINTELLIX... 0 tri-previfem (8) tri-sprintec (8) TRIUMEQ trivora (8) TRULICITY TRUMENBA... 9 TRUVADA... 4 TUDORZA PRESSAIR TWINRIX (PF)... 9 TYBOST TYKERB... TYPHIM VI... 9 TYSABRI TYZEKA U ULORIC... 5 unithroid... 8 UNITHROID... 8 ursodiol UVADEX V VAGIFEM valacyclovir... 4 VALCHLOR... 8 VALCYTE... 9 valganciclovir... 9, 40 valproate sodium... 6 valproic acid... 6 valproic acid (as sodium salt)... 6 valsartan valsartan-hydrochlorothiazide vancomycin... 9 VANCOMYCIN... 9 vancomycin in 0.9% sodium cl... 8 vancomycin in dextrose 5 %.. 9 VAQTA (PF)... 9 VARIVAX (PF)... 9 VARIZIG... 9 VELCADE... velivet triphasic regimen (8) VELPHORO... 7 VEMLIDY VENCLEXTA... VENCLEXTA STARTING PACK... venlafaxine... 0 VENTAVIS VENTOLIN HFA verapamil VEREGEN VERSACLOZ... 9 VICTOZA -PAK VICTOZA -PAK VIDEX GRAM PEDIATRIC... 4 VIDEX 4 GRAM PEDIATRIC... 4 vienva VIGAMOX... VIIBRYD... 0 VIMPAT... 7 VIRACEPT VIREAD VITEKTA... 4 VOLTAREN... voriconazole... 4 VOTRIENT... VPRIV VRAYLAR... 9 vyfemla (8) VYTORIN VYTORIN VYTORIN VYTORIN W warfarin... 5 water for irrigation, sterile.. 05 WELCHOL... 6 X XALKORI... XARELTO... 5 XERMELO XGEVA XIIDRA XOLAIR... 0 XTANDI... 8 xulane XYREM... 0 Y YERVOY... YF-VAX (PF)... 9 YONDELIS... yuvafem... 76, 8 Z zafirlukast zaleplon... 0 ZALTRAP... zarah... 8 ZARXIO... 5 ZAVESCA ZELBORAF... ZEMAIRA zenatane zenchent (8)... 8 ZENPEP ZEPATIER... 4 zerit... 4 ZETIA... 6 ZIAGEN... 4 zidovudine... 4, 44 zileuton ziprasidone hcl... 9 ZIRGAN zoledronic acid zoledronic acid-mannitol-water ZOLINZA... zolpidem... 0 ZOMETA zonisamide... 5 ZORTRESS ZORVOLEX... 9

126 ZOSTAVAX (PF)... 9 zovia /5e (8)... 8 zovia /50e (8)... 8 ZOVIRAX... 4 ZUBSOLV... 5 ZYCLARA ZYDELIG... ZYFLO ZYFLO CR ZYKADIA... ZYPREXA RELPREVV... 9 ZYTIGA

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