New Jersey Department of Human Services State Upper Limit (SUL) List - PROPOSED Effective

Transcription

1 New Jersey Department of Human Services State Upper Limit () List - PROPOSED Effective New ABACAVIR FATE ORAL TABLET 300 MG ABACAVIR FATE/LAMIVUDINE ORAL TABLET MG ABACAVIR FATE/LAMIVUDINE/ZIDOVUDINE ORAL TABLET MG ACETAZOLAMIDE ORAL TABLET 250 MG ACYCLOVIR TOPICAL OINTMENT (GRAM) 5 % ADAPALENE TOPICAL GEL (GRAM) 0.1 % ADAPALENE/BENZOYL PEROXIDE TOPICAL GEL WITH PUMP (GRAM) 0.1 %-2.5% ALBUTEROL FATE INHALATION VIAL, NEBULIZER (ML) 1.25MG/3ML ALENDRONATE SODIUM ORAL TABLET 35 MG ALENDRONATE SODIUM ORAL TABLET 70 MG ALFUZOSIN HCL ORAL TABLET, EXTENDED RELEASE 24 HR 10 MG ALLOPURINOL ORAL TABLET 100 MG ALLOPURINOL ORAL TABLET 300 MG ALOGLIPTIN BENZOATE ORAL TABLET 25 MG ALOGLIPTIN BENZOATE/METFORMIN HCL ORAL TABLET ALOGLIPTIN BENZOATE/METFORMIN HCL ORAL TABLET MG AMITRIPTYLINE HCL ORAL TABLET 100 MG AMITRIPTYLINE HCL ORAL TABLET 25 MG AMLODIPINE BESYLATE/ATORVASTATIN CALCIUM ORAL TABLET 10 MG-40MG AMLODIPINE BESYLATE/ATORVASTATIN CALCIUM ORAL TABLET 5 MG-20 MG AMLODIPINE BESYLATE/BENAZEPRIL HCL ORAL CAPE 2.5MG-10MG AMLODIPINE BESYLATE/BENAZEPRIL HCL ORAL CAPE 5 MG-20 MG AMLODIPINE BESYLATE/OLMESARTAN MEDOXOMIL ORAL TABLET 5 MG-20 MG AMLODIPINE BESYLATE/OLMESARTAN MEDOXOMIL ORAL TABLET 5 MG-40 MG AMLODIPINE BESYLATE/VALSARTAN/HYDROCHLOROTHIAZIDE ORAL TABLET AMLODIPINE BESYLATE/VALSARTAN/HYDROCHLOROTHIAZIDE ORAL TABLET AMOXICILLIN/POTASSIUM CLAVULANATE ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) MG/5 AMOXICILLIN/POTASSIUM CLAVULANATE ORAL TABLET MG AMOXICILLIN/POTASSIUM CLAVULANATE ORAL TABLET MG ARIPIPRAZOLE ORAL SOLUTION, ORAL 1 MG/ML ARIPIPRAZOLE ORAL TABLET 10 MG ARIPIPRAZOLE ORAL TABLET 15 MG ARIPIPRAZOLE ORAL TABLET 2 MG Page 1 of 12

2 New ARIPIPRAZOLE ORAL TABLET 20 MG ARIPIPRAZOLE ORAL TABLET 30 MG ARIPIPRAZOLE ORAL TABLET 5 MG ARMODAFINIL ORAL TABLET 250 MG ATOMOXETINE HCL ORAL CAPE 10 MG ATOMOXETINE HCL ORAL CAPE 100 MG ATOMOXETINE HCL ORAL CAPE 60 MG ATORVASTATIN CALCIUM ORAL TABLET 20 MG ATORVASTATIN CALCIUM ORAL TABLET 80 MG AZELASTINE HCL NASAL AEROSOL, SPRAY WITH PUMP (ML) 137 MCG AZELASTINE HCL NASAL AEROSOL, SPRAY WITH PUMP (ML) MCG AZELASTINE HCL OPHTHALMIC DROPS 0.05 % BACLOFEN ORAL TABLET 10 MG BACLOFEN ORAL TABLET 20 MG BETAMETHASONE DIPROPIONATE/PROPYLENE GLYCOL TOPICAL LOTION (ML) 0.05 % BETHANECHOL CHLORIDE ORAL TABLET 25 MG BROMPHENIRAMINE MALEATE/PHENYLEPHRINE HCL/DEXTROMETHORPHAN ORAL SOLUTION, ORAL /5 BROMPHENIRAMINE MALEATE/PSEUDOEPHEDRINE HCL/DEXTROMETHORPHAN ORAL SYRUP /5 BUDESONIDE INHALATION AMPUL FOR NEBULIZATION (ML) 0.25MG/2ML BUDESONIDE INHALATION AMPUL FOR NEBULIZATION (ML) 0.5 MG/2ML BUPRENORPHINE HCL SUBLINGUAL TABLET, SUBLINGUAL 2 MG BUPRENORPHINE HCL/NALOXONE HCL SUBLINGUAL TABLET, SUBLINGUAL 8 MG-2 MG BUPRENORPHINE TRANSDERMAL PATCH, TRANSDERMAL WEEKLY 10 MCG/HR BUPROPION HCL ORAL TABLET, EXTENDED RELEASE 12 HR 200 MG BUPROPION HCL ORAL TABLET, EXTENDED RELEASE 24 HR 300 MG BUTALBITAL/ACETAMINOPHEN/CAFFEINE ORAL TABLET CABERGOLINE ORAL TABLET 0.5 MG CALCIPOTRIENE TOPICAL CREAM (GRAM) % CALCITRIOL ORAL CAPE 0.25 MCG CALCIUM ACETATE ORAL CAPE 667 MG CAPECITABINE ORAL TABLET 500 MG CARBAMAZEPINE ORAL TABLET, EXTENDED RELEASE 12 HR 100 MG CARBAMAZEPINE ORAL TABLET, EXTENDED RELEASE 12 HR 200 MG CARBAMAZEPINE ORAL TABLET, EXTENDED RELEASE 12 HR 400 MG CARBIDOPA/LEVODOPA/ENTACAPONE ORAL TABLET CARISOPRODOL ORAL TABLET 250 MG Page 2 of 12

3 CARVEDILOL PHOSPHATE ORAL CAPE,EXTENDED RELEASE MULTIPHASE 24HR 20 MG CARVEDILOL PHOSPHATE ORAL CAPE,EXTENDED RELEASE MULTIPHASE 24HR 80 MG New CEFADROXIL ORAL CAPE 500 MG CEFDINIR ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 125 MG/5ML CEFDINIR ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 250 MG/5ML CEFTRIAXONE SODIUM INJECTION VIAL (EA) 250 MG CEFUROXIME AXETIL ORAL TABLET 500 MG CELECOXIB ORAL CAPE 100 MG CELECOXIB ORAL CAPE 200 MG CEPHALEXIN ORAL CAPE 250 MG CEPHALEXIN ORAL CAPE 500 MG CEPHALEXIN ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 250 MG/5ML CHLORPROMAZINE HCL ORAL TABLET 25 MG CHLORTHALIDONE ORAL TABLET 25 MG CHOLESTYRAMINE (WITH SUGAR) ORAL POWDER IN PACKET (EA) 4 G CHOLESTYRAMINE/ASPARTAME ORAL POWDER IN PACKET (EA) 4 G CICLOPIROX TOPICAL SHAMPOO 1 % CILOSTAZOL ORAL TABLET 100 MG CLARITHROMYCIN ORAL TABLET, EXTENDED RELEASE 24 HR 500 MG CLINDAMYCIN PHOSPHATE TOPICAL LOTION (ML) 1 % CLINDAMYCIN PHOSPHATE TOPICAL SOLUTION, NON-ORAL 1 % CLINDAMYCIN PHOSPHATE TOPICAL SWAB, MEDICATED 1 % CLINDAMYCIN PHOSPHATE/BENZOYL PEROXIDE TOPICAL GEL WITH PUMP (GRAM) 1 %-5 % CLINDAMYCIN PHOSPHATE/TRETINOIN TOPICAL GEL (GRAM) % CLOBETASOL PROPIONATE TOPICAL OINTMENT (GRAM) 0.05 % CLOMIPHENE CITRATE ORAL TABLET 50 MG CLONAZEPAM ORAL TABLET,DISINTEGRATING MG CLONIDINE TRANSDERMAL PATCH, TRANSDERMAL WEEKLY 0.1MG/24HR CLONIDINE TRANSDERMAL PATCH, TRANSDERMAL WEEKLY 0.3MG/24HR CLOTRIMAZOLE MUCOUS MEMBRANE TROCHE 10 MG CLOZAPINE ORAL TABLET 100 MG CLOZAPINE ORAL TABLET,DISINTEGRATING 200 MG CYCLOPENTOLATE HCL OPHTHALMIC DROPS 2 % CYPROHEPTADINE HCL ORAL TABLET 4 MG DANTROLENE SODIUM ORAL CAPE 100 MG DANTROLENE SODIUM ORAL CAPE 50 MG Page 3 of 12

4 New DAPSONE ORAL TABLET 100 MG DARIFENACIN HYDROBROMIDE ORAL TABLET, EXTENDED RELEASE 24 HR 15 MG DESIPRAMINE HCL ORAL TABLET 25 MG DESLORATADINE ORAL TABLET 5 MG DESMOPRESSIN ACETATE ORAL TABLET 0.2 MG DEXAMETHASONE ORAL TABLET 2 MG DEXTROAMPHETAMINE F-SACCHARATE/AMPHETAMINE F-ASPARTATE ORAL CAPE, EXT RELEASE 24 HR 10 MG DEXTROAMPHETAMINE F-SACCHARATE/AMPHETAMINE F-ASPARTATE ORAL CAPE, EXT RELEASE 24 HR 20 MG DEXTROAMPHETAMINE F-SACCHARATE/AMPHETAMINE F-ASPARTATE ORAL CAPE, EXT RELEASE 24 HR 30 MG DEXTROAMPHETAMINE F-SACCHARATE/AMPHETAMINE F-ASPARTATE ORAL CAPE, EXT RELEASE 24 HR 5 MG DEXTROAMPHETAMINE F-SACCHARATE/AMPHETAMINE F-ASPARTATE ORAL TABLET 10 MG DEXTROAMPHETAMINE F-SACCHARATE/AMPHETAMINE F-ASPARTATE ORAL TABLET 30 MG DEXTROAMPHETAMINE F-SACCHARATE/AMPHETAMINE F-ASPARTATE ORAL TABLET 5 MG DICLOFENAC SODIUM ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 75 MG DICLOFENAC SODIUM TOPICAL GEL (GRAM) 1 % DICLOFENAC SODIUM TOPICAL GEL (GRAM) 3 % DICLOFENAC SODIUM/MISOPROSTOL ORAL TABLET,IMMEDIATE,DELAY RELEASE,BIPHASE 75 MG-200 DIGOXIN ORAL TABLET 250 MCG DILTIAZEM HCL ORAL CAPE, EXT RELEASE 24 HR 240 MG DILTIAZEM HCL ORAL CAPE, EXTENDED RELEASE 24HR 360 MG DIVALPROEX SODIUM ORAL CAPE, DELAYED RELEASE SPRINKLE 125 MG DIVALPROEX SODIUM ORAL TABLET, EXTENDED RELEASE 24 HR 250 MG DIVALPROEX SODIUM ORAL TABLET, EXTENDED RELEASE 24 HR 500 MG DONEPEZIL HCL ORAL TABLET 23 MG DOXEPIN HCL ORAL CAPE 50 MG DOXYCYCLINE HYCLATE ORAL TABLET 100 MG DOXYCYCLINE MONOHYDRATE ORAL CAPE 100 MG DOXYCYCLINE MONOHYDRATE ORAL CAPE,IMMEDIATE, DELAY RELEASE,BIPHASE 40 MG DROSPIRENONE/ETHINYL ESTRADIOL/LEVOMEFOLATE CALCIUM ORAL TABLET (24) DULOXETINE HCL ORAL CAPE,DELAYED RELEASE (ENTERIC COATED) 20 MG DULOXETINE HCL ORAL CAPE,DELAYED RELEASE (ENTERIC COATED) 30 MG DUTASTERIDE ORAL CAPE 0.5 MG ECONAZOLE NITRATE TOPICAL CREAM (GRAM) 1 % EFAVIRENZ ORAL TABLET 600 MG ELETRIPTAN HYDROBROMIDE ORAL TABLET 40 MG ENALAPRIL MALEATE ORAL TABLET 10 MG Page 4 of 12

5 New ENALAPRIL MALEATE ORAL TABLET 2.5 MG ENOXAPARIN SODIUM SUBCUTANEOUS SYRINGE (ML) 150 MG/ML ENTACAPONE ORAL TABLET 200 MG ENTECAVIR ORAL TABLET 1 MG EPLERENONE ORAL TABLET 25 MG ESCITALOPRAM OXALATE ORAL TABLET 20 MG ESOMEPRAZOLE MAGNESIUM ORAL CAPE,DELAYED RELEASE (ENTERIC COATED) 20 MG ESOMEPRAZOLE MAGNESIUM ORAL CAPE,DELAYED RELEASE (ENTERIC COATED) 40 MG ESTRADIOL TRANSDERMAL PATCH, TRANSDERMAL SEMIWEEKLY 0.1MG/24HR ESTRADIOL VAGINAL CREAM WITH APPLICATOR 0.01 % ETHINYL ESTRADIOL/DROSPIRENONE ORAL TABLET 0.03MG-3MG EXEMESTANE ORAL TABLET 25 MG EZETIMIBE ORAL TABLET 10 MG FELODIPINE ORAL TABLET, EXTENDED RELEASE 24 HR 2.5 MG FENOFIBRATE NANOCRYSTALLIZED ORAL TABLET 145MG FENOFIBRATE NANOCRYSTALLIZED ORAL TABLET 48 MG FENOFIBRATE ORAL TABLET 160 MG FENOFIBRATE,MICRONIZED ORAL CAPE 130 MG FENOFIBRATE,MICRONIZED ORAL CAPE 134 MG FENOFIBRATE,MICRONIZED ORAL CAPE 200 MG FENOFIBRIC ACID (CHOLINE) ORAL CAPE,DELAYED RELEASE (ENTERIC COATED) 135 MG FENOPROFEN CALCIUM ORAL CAPE 400 MG FENTANYL TRANSDERMAL PATCH, TRANSDERMAL 72 HOURS 100 MCG/HR FENTANYL TRANSDERMAL PATCH, TRANSDERMAL 72 HOURS 12 MCG/HR FEXOFENADINE HCL ORAL TABLET 180 MG FLUCONAZOLE ORAL TABLET 100 MG FLUDROCORTISONE ACETATE ORAL TABLET 0.1 MG FLUOCINOLONE ACETONIDE TOPICAL OIL (ML) 0.01 % FLUOCINONIDE TOPICAL OINTMENT (GRAM) 0.05 % FLUOROURACIL TOPICAL CREAM (GRAM) 5 % FLUVASTATIN SODIUM ORAL CAPE 20 MG FLUVOXAMINE MALEATE ORAL TABLET 100 MG FONDAPARINUX SODIUM SUBCUTANEOUS SYRINGE (ML) 2.5 MG/0.5 FROVATRIPTAN SUCCINATE ORAL TABLET 2.5 MG FUROSEMIDE INJECTION VIAL (ML) 10 MG/ML GABAPENTIN ORAL TABLET 800 MG Page 5 of 12

6 New GALANTAMINE HBR ORAL CAPE, EXTENDED RELEASE PELLETS 24 HR 8 MG GLIMEPIRIDE ORAL TABLET 2 MG GLIPIZIDE ORAL TABLET, EXTENDED RELEASE 24 HR 10 MG GLIPIZIDE ORAL TABLET, EXTENDED RELEASE 24 HR 2.5 MG GLIPIZIDE/METFORMIN HCL ORAL TABLET 5 MG-500MG GUANFACINE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 2 MG GUANFACINE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 3 MG GUANFACINE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 4 MG HALOPERIDOL ORAL TABLET 10 MG HALOPERIDOL ORAL TABLET 20 MG HYDROCODONE BITARTRATE/ACETAMINOPHEN ORAL TABLET 10MG-300MG HYDROCODONE BITARTRATE/ACETAMINOPHEN ORAL TABLET 5 MG-300MG HYDROCODONE BITARTRATE/ACETAMINOPHEN ORAL TABLET MG HYDROCORTISONE ORAL TABLET 10 MG HYDROCORTISONE ORAL TABLET 5 MG HYDROCORTISONE TOPICAL CREAM WITH PERINEAL APPLICATOR 2.5 % HYDROMORPHONE HCL ORAL TABLET 8 MG HYDROQUINONE TOPICAL CREAM (GRAM) 4 % HYDROXYCHLOROQUINE FATE ORAL TABLET 200 MG HYDROXYZINE HCL ORAL TABLET 50 MG IBANDRONATE SODIUM ORAL TABLET 150 MG ISOSORBIDE MONONITRATE ORAL TABLET, EXTENDED RELEASE 24 HR 30 MG ISOTRETINOIN ORAL CAPE 20 MG ISOTRETINOIN ORAL CAPE 40 MG KETOTIFEN FUMARATE OPHTHALMIC DROPS % LABETALOL HCL ORAL TABLET 200 MG LAMIVUDINE ORAL SOLUTION, ORAL 10 MG/ML LAMIVUDINE/ZIDOVUDINE ORAL TABLET MG LAMOTRIGINE ORAL TABLET, EXTENDED RELEASE 24 HR 250 MG LANTHANUM CARBONATE ORAL TABLET, CHEWABLE 500 MG LEVALBUTEROL HCL INHALATION VIAL, NEBULIZER (ML) 0.63MG/3ML LEVETIRACETAM ORAL TABLET 750 MG LEVOFLOXACIN ORAL TABLET 500 MG LEVOTHYROXINE SODIUM ORAL TABLET 100 MCG LEVOTHYROXINE SODIUM ORAL TABLET 125 MCG LEVOTHYROXINE SODIUM ORAL TABLET 150 MCG Page 6 of 12

7 New LEVOTHYROXINE SODIUM ORAL TABLET 75 MCG LEVOTHYROXINE SODIUM ORAL TABLET 88 MCG LITHIUM CARBONATE ORAL CAPE 150 MG LORAZEPAM ORAL TABLET 2 MG LOSARTAN POTASSIUM/HYDROCHLOROTHIAZIDE ORAL TABLET MG LOSARTAN POTASSIUM/HYDROCHLOROTHIAZIDE ORAL TABLET 100MG-25MG MECLIZINE HCL ORAL TABLET 25 MG MEDROXYPROGESTERONE ACETATE INTRAMUSCULAR SYRINGE (ML) 150 MG/ML MEDROXYPROGESTERONE ACETATE INTRAMUSCULAR VIAL (ML) 150 MG/ML MEMANTINE HCL ORAL CAPE SPRINKLE, EXTENDED RELEASE 24 HR 14 MG MEMANTINE HCL ORAL CAPE SPRINKLE, EXTENDED RELEASE 24 HR 21 MG MEMANTINE HCL ORAL CAPE SPRINKLE, EXTENDED RELEASE 24 HR 28 MG MEMANTINE HCL ORAL CAPE SPRINKLE, EXTENDED RELEASE 24 HR 7 MG MEMANTINE HCL ORAL TABLET 5 MG MESALAMINE ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 1.2 G METFORMIN HCL ORAL TABLET, ER GASTRIC RETENTION 24 HR 1000 MG METFORMIN HCL ORAL TABLET, EXTENDED RELEASE 24 HR 1000 MG METFORMIN HCL ORAL TABLET, EXTENDED RELEASE 24 HR 500 MG METHOCARBAMOL ORAL TABLET 500 MG METHOTREXATE SODIUM ORAL TABLET 2.5 MG METHYLPHENIDATE HCL ORAL TABLET 10 MG METHYLPHENIDATE HCL ORAL TABLET 20 MG METHYLPHENIDATE HCL ORAL TABLET 5 MG METHYLPHENIDATE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 27 MG METHYLPREDNISOLONE ORAL TABLET, DOSE PACK 4 MG METOLAZONE ORAL TABLET 2.5 MG METOPROLOL SUCCINATE ORAL TABLET, EXTENDED RELEASE 24 HR 100 MG METOPROLOL SUCCINATE ORAL TABLET, EXTENDED RELEASE 24 HR 25 MG METOPROLOL SUCCINATE ORAL TABLET, EXTENDED RELEASE 24 HR 50 MG METOPROLOL TARTRATE/HYDROCHLOROTHIAZIDE ORAL TABLET 50 MG-25MG METRONIDAZOLE TOPICAL CREAM (GRAM) 0.75 % MIDODRINE HCL ORAL TABLET 5 MG MIRTAZAPINE ORAL TABLET 7.5 MG MODAFINIL ORAL TABLET 200 MG MOMETASONE FUROATE TOPICAL OINTMENT (GRAM) 0.1 % MONTELUKAST SODIUM ORAL TABLET 10 MG Page 7 of 12

8 New MORPHINE FATE ORAL TABLET, EXTENDED RELEASE 15 MG MORPHINE FATE ORAL TABLET, EXTENDED RELEASE 60 MG MUPIROCIN TOPICAL OINTMENT (GRAM) 2 % MYCOPHENOLATE MOFETIL ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 200 MG/ML MYCOPHENOLATE MOFETIL ORAL TABLET 500 MG NABUMETONE ORAL TABLET 500 MG NABUMETONE ORAL TABLET 750 MG NALTREXONE HCL ORAL TABLET 50 MG NAPROXEN ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 500 MG NAPROXEN SODIUM ORAL TABLET,EXTENDED RELEASE MULTIPHASE 24 HR 375 MG NAPROXEN SODIUM ORAL TABLET,EXTENDED RELEASE MULTIPHASE 24 HR 500 MG NATEGLINIDE ORAL TABLET 120 MG NEOMYCIN/POLYMYXIN B FATE/DEXAMETHASONE OPHTHALMIC OINTMENT (GRAM) K-.1 NEOMYCIN/POLYMYXIN B FATE/DEXAMETHASONE OPHTHALMIC SUSPENSION, DROPS(FINAL DOSAGE FORM) (ML) 0.1 % NIACIN ORAL TABLET, EXTENDED RELEASE 24 HR 500 MG NIACINAMIDE/AZELAIC ACID/ZINC OXIDE/VIT B6/COPPER/FA ORAL TABLET NIFEDIPINE ORAL TABLET, EXTENDED RELEASE 24 HR 30 MG NIFEDIPINE ORAL TABLET, EXTENDED RELEASE 24 HR 60 MG NILUTAMIDE ORAL TABLET 150 MG NITROFURANTOIN MACROCRYSTAL ORAL CAPE 50 MG NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS ORAL CAPE 100 MG NITROGLYCERIN TRANSDERMAL PATCH, TRANSDERMAL 24 HOURS 0.4MG/HR NORETHINDRONE ACETATE ORAL TABLET 5 MG NORGESTIMATE-ETHINYL ESTRADIOL ORAL TABLET NORGESTREL-ETHINYL ESTRADIOL ORAL TABLET MG NYSTATIN TOPICAL OINTMENT (GRAM) /G NYSTATIN TOPICAL POWDER (GRAM) /G NYSTATIN/TRIAMCINOLONE ACETONIDE TOPICAL CREAM (GRAM) OFLOXACIN OPHTHALMIC DROPS 0.3 % OLANZAPINE ORAL TABLET 10 MG OLANZAPINE ORAL TABLET 15 MG OLANZAPINE ORAL TABLET 20 MG OLANZAPINE ORAL TABLET,DISINTEGRATING 10 MG OLANZAPINE ORAL TABLET,DISINTEGRATING 5 MG OLMESARTAN MEDOXOMIL ORAL TABLET 20 MG OLMESARTAN MEDOXOMIL ORAL TABLET 40 MG Page 8 of 12

9 New OLMESARTAN MEDOXOMIL/AMLODIPINE BESYLATE/HYDROCHLOROTHIAZIDE ORAL TABLET MG OLMESARTAN MEDOXOMIL/HYDROCHLOROTHIAZIDE ORAL TABLET 40 MG-25MG OLMESARTAN MEDOXOMIL/HYDROCHLOROTHIAZIDE ORAL TABLET MG OLOPATADINE HCL OPHTHALMIC DROPS 0.1 % OLOPATADINE HCL OPHTHALMIC DROPS 0.2 % OMEGA-3 ACID ETHYL ESTERS ORAL CAPE 1 G OMEPRAZOLE ORAL CAPE,DELAYED RELEASE (ENTERIC COATED) 10 MG OMEPRAZOLE/SODIUM BICARBONATE ORAL CAPE 40MG-1.1G ONDANSETRON HCL ORAL SOLUTION, ORAL 4 MG/5 ML ONDANSETRON HCL ORAL TABLET 8 MG OSELTAMIVIR PHOSPHATE ORAL CAPE 45 MG OSELTAMIVIR PHOSPHATE ORAL CAPE 75 MG OSELTAMIVIR PHOSPHATE ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 6 MG/ML OXCARBAZEPINE ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 300 MG/5ML OXCARBAZEPINE ORAL TABLET 150 MG OXCARBAZEPINE ORAL TABLET 600 MG OXYBUTYNIN CHLORIDE ORAL TABLET 5 MG OXYBUTYNIN CHLORIDE ORAL TABLET, EXTENDED RELEASE 24 HR 10 MG OXYBUTYNIN CHLORIDE ORAL TABLET, EXTENDED RELEASE 24 HR 15 MG OXYCODONE HCL ORAL CONCENTRATE, ORAL 20 MG/ML OXYCODONE HCL ORAL TABLET 10 MG OXYCODONE HCL/ACETAMINOPHEN ORAL TABLET 10MG-325MG OXYCODONE HCL/ACETAMINOPHEN ORAL TABLET MG OXYMORPHONE HCL ORAL TABLET 10 MG PALIPERIDONE ORAL TABLET, EXTENDED RELEASE 24 HR 3 MG PALIPERIDONE ORAL TABLET, EXTENDED RELEASE 24 HR 9 MG PARICALCITOL ORAL CAPE 1 MCG PAROXETINE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 12.5 MG PAROXETINE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 25 MG PAROXETINE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 37.5 MG PEDIATRIC MULTIVITAMINS NO.17 WITH SODIUM FLUORIDE ORAL TABLET, CHEWABLE 0.5 MG PERPHENAZINE ORAL TABLET 4 MG PHENOBARBITAL ORAL TABLET 64.8 MG PHENOBARBITAL ORAL TABLET 97.2MG PHENTERMINE HCL ORAL CAPE 15 MG PHENTERMINE HCL ORAL TABLET 37.5 MG Page 9 of 12

10 New PHENYTOIN SODIUM EXTENDED ORAL CAPE 100 MG PILOCARPINE HCL OPHTHALMIC DROPS 2 % PIOGLITAZONE HCL ORAL TABLET 15 MG PIOGLITAZONE HCL ORAL TABLET 45 MG POLYVINYL ALCOHOL OPHTHALMIC DROPS 1.4 % PRAVASTATIN SODIUM ORAL TABLET 10 MG PRAVASTATIN SODIUM ORAL TABLET 20 MG PRAVASTATIN SODIUM ORAL TABLET 80 MG PRAZOSIN HCL ORAL CAPE 1 MG PREDNISONE ORAL TABLET 10 MG PROBENECID ORAL TABLET 500 MG PROGESTERONE INTRAMUSCULAR VIAL (ML) 50 MG/ML PROGESTERONE, MICRONIZED ORAL CAPE 100 MG PROPRANOLOL HCL ORAL TABLET 10 MG PYRIDOSTIGMINE BROMIDE ORAL TABLET 60 MG QUETIAPINE FUMARATE ORAL TABLET 100 MG QUETIAPINE FUMARATE ORAL TABLET, EXTENDED RELEASE 24 HR 150 MG QUETIAPINE FUMARATE ORAL TABLET, EXTENDED RELEASE 24 HR 200 MG QUETIAPINE FUMARATE ORAL TABLET, EXTENDED RELEASE 24 HR 400 MG QUETIAPINE FUMARATE ORAL TABLET, EXTENDED RELEASE 24 HR 50 MG QUININE FATE ORAL CAPE 324 MG RABEPRAZOLE SODIUM ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 20 MG RAMIPRIL ORAL CAPE 5 MG RASAGILINE MESYLATE ORAL TABLET 0.5 MG RASAGILINE MESYLATE ORAL TABLET 1 MG REPAGLINIDE ORAL TABLET 0.5 MG REPAGLINIDE ORAL TABLET 1 MG REPAGLINIDE ORAL TABLET 2 MG RILUZOLE ORAL TABLET 50 MG RISEDRONATE SODIUM ORAL TABLET 35 MG RISEDRONATE SODIUM ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 35 MG RISPERIDONE ORAL TABLET 4 MG RITONAVIR ORAL TABLET 100 MG RIVASTIGMINE TARTRATE ORAL CAPE 3 MG RIVASTIGMINE TRANSDERMAL PATCH, TRANSDERMAL 24 HOURS 9.5MG/24HR RIZATRIPTAN BENZOATE ORAL TABLET 10 MG Page 10 of 12

11 New RIZATRIPTAN BENZOATE ORAL TABLET,DISINTEGRATING 10 MG ROPINIROLE HCL ORAL TABLET 3 MG ROSUVASTATIN CALCIUM ORAL TABLET 10 MG ROSUVASTATIN CALCIUM ORAL TABLET 20 MG ROSUVASTATIN CALCIUM ORAL TABLET 5 MG SEVELAMER CARBONATE ORAL POWDER IN PACKET (EA) 0.8 G SILDENAFIL CITRATE ORAL TABLET 100 MG SILDENAFIL CITRATE ORAL TABLET 20 MG SIMETHICONE ORAL CAPE 125 MG SPIRONOLACTONE ORAL TABLET 50 MG FACETAMIDE SODIUM OPHTHALMIC DROPS 10 % FAMETHOXAZOLE/TRIMETHOPRIM ORAL TABLET MG INDAC ORAL TABLET 150 MG TACROLIMUS ORAL CAPE 1 MG TAMOSIN HCL ORAL CAPE, EXT RELEASE 24 HR 0.4 MG TELMISARTAN/HYDROCHLOROTHIAZIDE ORAL TABLET MG TEMOZOLOMIDE ORAL CAPE 100 MG TENOFOVIR DISOPROXIL FUMARATE ORAL TABLET 300 MG THYROID,PORK ORAL TABLET 60 MG TIZANIDINE HCL ORAL CAPE 4 MG TIZANIDINE HCL ORAL TABLET 4 MG TOLTERODINE TARTRATE ORAL CAPE, EXT RELEASE 24 HR 2 MG TOLTERODINE TARTRATE ORAL CAPE, EXT RELEASE 24 HR 4 MG TORSEMIDE ORAL TABLET 10 MG TORSEMIDE ORAL TABLET 100 MG TRAZODONE HCL ORAL TABLET 100 MG TRAZODONE HCL ORAL TABLET 300 MG TRIAMCINOLONE ACETONIDE DENTAL PASTE (GRAM) 0.1 % TRIFLUOPERAZINE HCL ORAL TABLET 2 MG VALSARTAN ORAL TABLET 160 MG VALSARTAN ORAL TABLET 320 MG VALSARTAN ORAL TABLET 80 MG VALSARTAN/HYDROCHLOROTHIAZIDE ORAL TABLET MG VALSARTAN/HYDROCHLOROTHIAZIDE ORAL TABLET 320MG-25MG VANCOMYCIN HCL ORAL CAPE 125 MG VENLAFAXINE HCL ORAL CAPE, EXT RELEASE 24 HR 75 MG Page 11 of 12

12 New VORICONAZOLE ORAL TABLET 200 MG WARFARIN SODIUM ORAL TABLET 2.5 MG WARFARIN SODIUM ORAL TABLET 7.5 MG ZIPRASIDONE HCL ORAL CAPE 20 MG ZIPRASIDONE HCL ORAL CAPE 40 MG ZIPRASIDONE HCL ORAL CAPE 60 MG ZOLPIDEM TARTRATE ORAL TABLET, EXTENDED RELEASE MULTIPHASE 12.5 MG Page 12 of 12