Information for Vermont Prescribers of Prescription Drugs (Long Form)

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1 Information for Vermont Prescribers of Prescription Drugs (Long Form) LONSURF (tipiracil and trifluridine) tablets This list does not imply that the products on this chart are interchangeable or have the same efficacy or safety. Please refer to each product s FDA-approved label and indication for further information. The prices listed below are Average Wholesale s ("AWP") as established and made available to the public by a third party publisher or as calculated from data made available to the public by a third party publisher. The price paid by consumers may be higher or lower than the prices listed below. Information about AWP of these drugs is being provided to Vermont prescribers pursuant to Vermont law, to give you information about the relative prices of marketed drugs and other drugs in the same therapeutic class. The prices listed here do not necessarily reflect price per dosage, price per course of treatment, or the cost effectiveness of all the products listed. For simplicity, only the smallest package sizes available for each product are included. Marketed Product: Product Name Manufacturer NDC Pkg Size LONSURF Oral Tablet Taiho Oncology, Inc $3, $ LONSURF Oral Tablet Taiho Oncology, Inc $4, $ Other Products: Product Name Manufacturer NDC Size Afinitor Disperz Oral Tablet Soluble 2 Afinitor Disperz Oral Tablet Soluble 5 NOVARTIS $ $ NOVARTIS $ $ Afinitor Oral Tablet 2.5 NOVARTIS $ $ Afinitor Oral Tablet 5 NOVARTIS $ $ Afinitor Oral Tablet 7.5 NOVARTIS $ $ Afinitor Oral Tablet 10 NOVARTIS $ $ Alkeran Oral Tablet 2 APO PHARMA $ $13.58 Anastrozole Oral Tablet 1 ACCORD HEALTHCARE $ $13.30 Anastrozole Oral Tablet 1 APOTEX $ $14.88 Anastrozole Oral Tablet 1 BLUE POINT LABORATORIES $ $

2 Anastrozole Oral Tablet 1 BRECKENRIDGE $ $13.35 Anastrozole Oral Tablet 1 Anastrozole Oral Tablet 1 DR.REDDY'S LABORATORIES, INC FRESENIUS KABI $ $ $9.54 $0.32 Anastrozole Oral Tablet 1 KADMON $20.40 $0.68 Anastrozole Oral Tablet 1 MAJOR $ $12.00 Anastrozole Oral Tablet 1 MYLAN $1, $13.48 Anastrozole Oral Tablet 1 RISING $ $13.48 Anastrozole Oral Tablet 1 WEST-WARD $ $13.50 Anastrozole Oral Tablet 1 SANDOZ $ $13.50 Anastrozole Oral Tablet 1 SUN PHARMACEUTICAL $ $13.50 Anastrozole Oral Tablet 1 Anastrozole Oral Tablet 1 Arimidex Oral Tablet 1 ZYDUS () ASTRAZENECA $ $ $ $ $ $19.09 Aromasin Oral Tablet 25 PFIZER U.S $1, $40.25 Bexarotene Oral Capsule 75 MYLAN $26, $ Bicalutamide Oral Tablet 50 ACCORD HEALTHCARE $ $18.35 Bicalutamide Oral Tablet 50 APOTEX $ $18.56 Bicalutamide Oral Tablet 50 AVKARE $ $18.56 Bicalutamide Oral Tablet 50 BRECKENRIDGE $1, $18.56 Bicalutamide Oral Tablet 50 KREMERS URBAN $ $18.35 Bicalutamide Oral Tablet 50 MAJOR $ $16.47 Bicalutamide Oral Tablet 50 MYLAN $ $

3 Bicalutamide Oral Tablet 50 NORTHSTAR RX $ $18.54 Bicalutamide Oral Tablet 50 SANDOZ $ $18.56 Bicalutamide Oral Tablet 50 SUN PHARMACEUTICAL $ $18.53 Bicalutamide Oral Tablet $ $18.56 Bosulif Oral Tablet 100 PFIZER U.S $16, $ Bosulif Oral Tablet 500 PFIZER U.S $16, $ Capecitabine Oral Tablet 150 ACCORD HEALTHCARE $ $11.74 Capecitabine Oral Tablet 150 AVKARE $ $11.74 Capecitabine Oral Tablet 150 MYLAN $ $11.72 Capecitabine Oral Tablet $ $11.74 Capecitabine Oral Tablet 500 ACCORD HEALTHCARE $4, $39.12 Capecitabine Oral Tablet 500 AVKARE $4, $39.08 Capecitabine Oral Tablet 500 MYLAN $4, $39.08 Capecitabine Oral Tablet $4, $39.12 Caprelsa Oral Tablet 100 ASTRAZENECA $7, $ Caprelsa Oral Tablet 300 ASTRAZENECA $15, $ Casodex Oral Tablet 50 ASTRAZENECA $ $21.00 Cyclophosphamide Oral Capsule 25 Cyclophosphamide Oral Capsule 50 Droxia Oral Capsule 200 Droxia Oral Capsule 300 WEST-WARD PHARMA $ $9.36 WEST-WARD PHARMA $1, $17.18 B-M SQUIBB ONCOLOGY/IMMUNOLOGY B-M SQUIBB ONCOLOGY/IMMUNOLOGY $56.76 $ $56.76 $0.95 3

4 Droxia Oral Capsule 400 Emcyt Oral Capsule 140 B-M SQUIBB ONCOLOGY/IMMUNOLOGY PHARMACIA AND UPJOHN COMPANY $58.31 $ $1, $17.58 Erivedge Oral Capsule 150 GENENTECH $12, $ Etoposide Oral Capsule 50 MYLAN $ $ Exemestane Oral Tablet 25 ALVOGEN $ $20.23 Exemestane Oral Tablet 25 GREENSTONE $ $20.23 Exemestane Oral Tablet 25 ROXANE $ $20.23 Fareston Oral Tablet 60 PROSTRAKAN $1, $49.98 Farydak Oral Capsule 10 NOVARTIS $8, $1, Farydak Oral Capsule 15 NOVARTIS $8, $1, Farydak Oral Capsule 20 NOVARTIS $8, $1, Femara Oral Tablet 2.5 NOVARTIS $ $28.08 Flutamide Oral Capsule 125 Flutamide Oral Capsule 125, INC TEVA, INC $ $ $ $4.99 Flutamide Oral Capsule 125 PAR $ $2.09 Gilotrif Oral Tablet 20 BOEHRINGER INGELHEIM $ $ Gilotrif Oral Tablet 30 BOEHRINGER INGELHEIM $ $ Gilotrif Oral Tablet 40 BOEHRINGER INGELHEIM $ $ Gleevec Oral Tablet 100 NOVARTIS $10, $ Gleevec Oral Tablet 400 NOVARTIS $12, $ Gleostine Oral Capsule 10 Gleostine Oral Capsule 100 NEXTSOURCE BIOTECHNOLOGY NEXTSOURCE BIOTECHNOLOGY $ $ $ $

5 Gleostine Oral Capsule 40 NEXTSOURCE BIOTECHNOLOGY $ $ Hexalen Oral Capsule 50 EISAI $1, $19.08 Hycamtin Oral Capsule 0.25 NOVARTIS $1, $ Hycamtin Oral Capsule 1 NOVARTIS $4, $ Hydrea Oral Capsule 500 Hydroxyurea Oral Capsule 500 Hydroxyurea Oral Capsule 500 Hydroxyurea Oral Capsule 500 B-M SQUIBB ONCOLOGY/IMMUNOLOGY $ $1.64 AVKARE $ $1.02 PAR $ $ $ $1.47 Ibrance Oral Capsule 100 PFIZER U.S $13, $ Ibrance Oral Capsule 125 PFIZER U.S $13, $ Ibrance Oral Capsule 75 PFIZER U.S $13, $ Iclusig Oral Tablet 15 ARIAD $19, $ Iclusig Oral Tablet 45 ARIAD $19, $ Imbruvica Oral Capsule 140 PHARMACYCLICS $13, $ Inlyta Oral Tablet 1 PFIZER U.S $16, $91.20 Inlyta Oral Tablet 5 PFIZER U.S $16, $ Iressa Oral Tablet 250 ASTRAZENECA $9, $ Jakafi Oral Tablet 10 INCYTE CORPORATION $13, $ Jakafi Oral Tablet 15 INCYTE CORPORATION $13, $ Jakafi Oral Tablet 20 INCYTE CORPORATION $13, $ Jakafi Oral Tablet 25 INCYTE CORPORATION $13, $ Jakafi Oral Tablet 5 INCYTE CORPORATION $13, $

6 Letrozole Oral Tablet 2.5 ACCORD HEALTHCARE $ $18.05 Letrozole Oral Tablet 2.5 APOTEX $ $18.13 Letrozole Oral Tablet 2.5 AVKARE $1, $18.11 Letrozole Oral Tablet 2.5 BRECKENRIDGE $ $18.11 Letrozole Oral Tablet 2.5 FRESENIUS KABI $60.44 $2.01 Letrozole Oral Tablet 2.5 MYLAN $9, $18.11 Letrozole Oral Tablet 2.5 WEST-WARD PHARMACEUTICAL $ $18.13 Letrozole Oral Tablet 2.5 SUN PHARMACEUTICAL $ $18.11 Letrozole Oral Tablet $ $18.13 Leukeran Oral Tablet 2 PRASCO LABORATORIES $1, $24.32 Lynparza Oral Capsule 50 ASTRAZENECA $3, $33.70 Lysodren Oral Tablet 500 B-M SQUIBB ONCOLOGY/IMMUNOLOGY $ $5.76 Matulane Oral Capsule 50 SIGMA-TAU $ $97.93 Megestrol Acetate Oral Tablet 20 Megestrol Acetate Oral Tablet 20 Megestrol Acetate Oral Tablet 20 Megestrol Acetate Oral Tablet 40 Megestrol Acetate Oral Tablet 40 Megestrol Acetate Oral Tablet 40 Megestrol Acetate Oral Tablet 40 PAR $69.20 $0.69 WEST-WARD PHARMACEUTICAL $65.48 $ $ $1.04 MAJOR $ $1.37 PAR $ $1.23 WEST-WARD PHARMACEUTICAL $ $ $ $1.71 Mercaptopurine Oral Tablet 50 MYLAN $ $4.09 Mercaptopurine Oral Tablet 50 ROXANE $ $8.18 6

7 Methotrexate Oral Tablet 2.5 MYLAN $ $6.24 Methotrexate Oral Tablet 2.5 Methotrexate Oral Tablet 2.5 WEST-WARD PHARMACEUTICAL $ $ $ $4.05 Myleran Oral Tablet 2 PRASCO LABORATORIES $ $28.11 NexAVAR Oral Tablet 200 Nilandron Oral Tablet 150 BAYER HEALTHCARE PHARMA CONCORDIA $19, $ $ $ Odomzo Oral Capsule 200 NOVARTIS $12, $ Pomalyst Oral Capsule 1 CELGENE CORP $18, $ Pomalyst Oral Capsule 2 CELGENE CORP $18, $ Pomalyst Oral Capsule 3 CELGENE CORP $18, $ Pomalyst Oral Capsule 4 CELGENE CORP $18, $ Revlimid Oral Capsule 10 CELGENE CORP $22, $ Revlimid Oral Capsule 15 CELGENE CORP $16, $ Revlimid Oral Capsule 2.5 CELGENE CORP $22, $ Revlimid Oral Capsule 20 CELGENE CORP $16, $ Revlimid Oral Capsule 25 CELGENE CORP $16, $ Revlimid Oral Capsule 5 CELGENE CORP $22, $ Sprycel Oral Tablet 100 Sprycel Oral Tablet 140 Sprycel Oral Tablet 20 Sprycel Oral Tablet 50 Sprycel Oral Tablet $14, $ $14, $ $ $ $16, $ $16, $

8 Sprycel Oral Tablet 80 Stivarga Oral Tablet 40 Stivarga Oral Tablet 40 BAYER HEALTHCARE PHARMA BAYER HEALTHCARE PHARMA $14, $ $17, $ $ $ Sutent Oral Capsule 12.5 PFIZER U.S $5, $ Sutent Oral Capsule 25 PFIZER U.S $11, $ Sutent Oral Capsule 37.5 PFIZER U.S $16, $ Sutent Oral Capsule 50 PFIZER U.S $19, $ Tabloid Oral Tablet 40 PRASCO LABORATORIES $ $30.33 Tafinlar Oral Capsule 50 NOVARTIS $8, $71.39 Tafinlar Oral Capsule 75 NOVARTIS $11, $96.51 Tamoxifen Citrate Oral Tablet 10 Tamoxifen Citrate Oral Tablet 10 Tamoxifen Citrate Oral Tablet 20 Tamoxifen Citrate Oral Tablet $ $1.89 MYLAN $ $1.89 TEVA $ $3.79 MYLAN $ $3.79 Tarceva Oral Tablet 100 GENENTECH $8, $ Tarceva Oral Tablet 150 GENENTECH $9, $ Tarceva Oral Tablet 25 GENENTECH $3, $ Targretin Oral Capsule 75 VALEANT $31, $ Tasigna Oral Capsule 150 NOVARTIS $3, $ Tasigna Oral Capsule 200 NOVARTIS $3, $ Temodar Oral Capsule 100 MERCK SHARP & DOHME $2, $ Temodar Oral Capsule 140 MERCK SHARP & DOHME $ $

9 Temodar Oral Capsule 180 MERCK SHARP & DOHME $ $ Temodar Oral Capsule 20 MERCK SHARP & DOHME $ $99.46 Temodar Oral Capsule 250 MERCK SHARP & DOHME $ $ Temodar Oral Capsule 5 MERCK SHARP & DOHME $ $24.86 Temozolomide Oral Capsule 100 Temozolomide Oral Capsule 100 Temozolomide Oral Capsule 100 Temozolomide Oral Capsule 100 Temozolomide Oral Capsule 140 Temozolomide Oral Capsule 140 Temozolomide Oral Capsule 140 Temozolomide Oral Capsule 140 Temozolomide Oral Capsule 180 Temozolomide Oral Capsule 180 Temozolomide Oral Capsule 180 Temozolomide Oral Capsule 180 Temozolomide Oral Capsule 20 Temozolomide Oral Capsule 20 Temozolomide Oral Capsule 20 Temozolomide Oral Capsule 20 Temozolomide Oral Capsule $1, $ SANDOZ $1, $ SUN PHARMACEUTICAL $1, $ $1, $ $2, $ SANDOZ $1, $ SUN PHARMACEUTICAL $1, $ $1, $ $2, $ SANDOZ $2, $ SUN PHARMACEUTICAL $2, $ $2, $ $ $57.56 SANDOZ $ $50.52 SUN PHARMACEUTICAL $ $ $ $ $3, $

10 Temozolomide Oral Capsule 250 Temozolomide Oral Capsule 250 Temozolomide Oral Capsule 250 Temozolomide Oral Capsule 5 SANDOZ $3, $ SUN PHARMACEUTICAL $3, $ $3, $ $71.43 $14.29 Temozolomide Oral Capsule 5 SANDOZ $62.70 $12.54 Temozolomide Oral Capsule 5 SUN PHARMACEUTICAL $62.60 $12.52 Temozolomide Oral Capsule $60.19 $12.04 Tretinoin Oral Capsule 10 PAR $ $29.88 Tretinoin Oral Capsule $3, $37.35 Trexall Oral Tablet 10 TEVA/WOMENS HEALTH $ $31.92 Trexall Oral Tablet 15 TEVA/WOMENS HEALTH $1, $47.88 Trexall Oral Tablet 5 TEVA/WOMENS HEALTH $ $15.96 Trexall Oral Tablet 7.5 TEVA/WOMENS HEALTH $ $23.94 Xalkori Oral Capsule 200 PFIZER U.S $18, $ Xalkori Oral Capsule 250 PFIZER U.S $18, $ Xeloda Oral Tablet 150 GENENTECH $ $16.27 Xeloda Oral Tablet 500 GENENTECH $6, $54.22 Xtandi Oral Capsule 40 ASTELLAS $12, $ Zelboraf Oral Tablet 240 GENENTECH $6, $54.25 Zolinza Oral Capsule 100 MERCK SHARP & DOHME $16, $ Zydelig Oral Tablet 100 GILEAD SCIENCES $12, $ Zydelig Oral Tablet 150 GILEAD SCIENCES $12, $

11 Zykadia Oral Capsule 150 NOVARTIS $ $ Zytiga Oral Tablet 250 JANSSEN BIOTECH $11, $93.95 Source: Red Book Release date: January 2018 For additional price comparison information see: VERMONT Pricing (Short) FORM 11

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