AETNA BETTER HEALTH Formulary Guide. Aetna Better Health of West Virginia Formulary Guide March 2017

Transcription

1 AETNA BETTER HEALTH Formulary Guide Aetna Better Health of West Virginia Formulary Guide March 2017

2 AETNA BETTER HEALTH Formulary Guide What is the Aetna Better Health of West Virginia Formulary? This is a drug list created by Aetna Better Health ( plan ). The plan will cover drugs on this list in addition to the West Virginia Bureau of Medical Services Preferred Drug List (located at List.aspx). Some drugs may have coverage rules. If the rules for that drug are met, the plan will cover the drug. Drugs must also be filled at a plan network pharmacy. Can the Plan s Drug List change? The plan may add or remove drugs on the list. Utilizing members and their providers will be notified at least 30 days before a drug is removed from the formulary. All changes to the formulary will be posted on the plan s website. How do I use the Plan s Formulary? Column #1: lists the covered drug. Brand drugs are in upper case letters (e.g., DRUG). Generics are in lower case letters (e.g., drug). Column #2: shows coverage rules for the drug Drugs are also grouped by the type of condition they treat. Drugs used to treat an earache are listed under the section, Ear-Nose-Throat Medications. If you know what your drug is used for, please look for that section name on the drug list. Then look under that section for your drug. What are generic drugs? The plan covers both brand and generic drugs. Generic drugs cost less and are approved by the Food and Drug Administration (FDA). Are Over-The-Counter () drugs covered? The plan will cover drugs on the formulary. Some drugs may have coverage rules. If the rules for that drug are met, the plan will cover the drug. Like other drugs, drugs need a prescription from a doctor if they are to be covered by the plan. Updated: 03/01/2017 Pa g e 2

3 AETNA BETTER HEALTH Formulary Guide Are there Medication Copays? Copays will vary based on the tier level and cost of the drug. The table below shows your out-ofpocket maximums by tier and copay by amount based on total allowed drug cost. Tier Level Out of Pocket Maximum 1 $0 2 $ $ Total Allowed Charge Co-pay Amount $ $5.00 $0.00 $ $10.00 $0.50 $ $25.00 $1.00 $ $50.00 $2.00 $50.01 and above $3.00 What are some types of coverage rules? Prior Approval (PA): This means your doctor will need to get approval from the plan first before the drug can be filled at the pharmacy. If it is not approved, the plan will not cover the drug. Quantity Level Limits (QLL): This means there is a limit on the amount of drug the plan will cover. For example, the plan provides 60 pills in 30 days for some drugs. Step Therapy (ST): This means you may need to try certain drugs first to treat your condition. After the first drug is tried, the plan will then cover the other drug for that same condition. For example, Drug A and Drug B may treat your condition. The plan may not cover Drug B unless you try Drug A first. If Drug A does not work for you, then Drug B will be covered. What if my drug is not on the plan s Formulary? First, please call your doctor and ask if your drug is covered. If the plan does not cover the drug, then: Ask your doctor for a similar drug that is covered. Your doctor can ask the plan to cover your drug through the prior approval process. Updated: 03/01/2017 Pa g e 3

4 Aetna Better Health West Virginia Table of Contents TablfCoents *ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS*...3 *ANALGESICS - ANTI-INFLAMMATORY*... 3 *ANALGESICS - NONNARCOTIC*...3 *ANDROGENS-ANABOLIC*... 4 *ANORECTAL AGENTS*...5 *ANTACIDS*...5 *ANTIANGINAL AGENTS*... 5 *ANTIANXIETY AGENTS*...6 *ANTIARRHYTHMICS*... 6 *ANTIASTHMATIC AND BRONCHODILATOR AGENTS*... 7 *ANTICOAGULANTS*... 7 *ANTIDEPRESSANTS*...7 *ANTIDIABETICS*... 8 *ANTIDIARRHEALS*...8 *ANTIDOTES*... 9 *ANTIEMETICS*... 9 *ANTIHISTAMINES*... 9 *ANTIHYPERTENSIVES* *ANTI-INFECTIVE AGENTS - MISC.* *ANTIMALARIALS*...11 *ANTIMYASTHENIC AGENTS* *ANTIMYASTHENIC/CHOLINERGIC AGENTS* *ANTIMYCOBACTERIAL AGENTS* *ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES*...12 *ANTIPSYCHOTICS/ANTIMANIC AGENTS* *ASSORTED CLASSES* *CARDIOTONICS* *CHEMICALS*...15 *CONTRACEPTIVES*...16 *CORTICOSTEROIDS* *COUGH/COLD/ALLERGY*...21 *DERMATOLOGICALS* *DIAGNOSTIC PRODUCTS*...25 *DIURETICS*...26 *ENDOCRINE AND METABOLIC AGENTS - MISC.*...26 *ESTROGENS*...27 *GASTROINTESTINAL AGENTS - MISC.*...27 *GENITOURINARY AGENTS - MISCELLANEOUS* *HEMATOLOGICAL AGENTS - MISC.* *HEMATOPOIETIC AGENTS*...28 *LAXATIVES* *MEDICAL DEVICES*...30 *MIGRAINE PRODUCTS*...43 *MINERALS & ELECTROLYTES*

5 TablfCoents *MOUTH/THROAT/DENTAL AGENTS*...45 *MULTIVITAMINS*...46 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *OPHTHALMIC AGENTS*...51 *OTIC AGENTS*...52 *OXYTOCICS*...52 *PASSIVE IMMUNIZING AGENTS*...52 *PENICILLINS*...52 *PHARMACEUTICAL ADJUVANTS* *POTASSIUM REMOVING AGENTS***...57 *PROGESTINS*...57 *PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.*...57 *RESPIRATORY AGENTS - MISC.*...58 *SULFONAMIDES*...58 *THYROID AGENTS* *ULCER DRUGS* *URINARY ANTI-INFECTIVES*...60 *URINARY ANTISPASMODICS*...60 *VAGINAL PRODUCTS*...60 *VASOPRESSORS* *VITAMINS*

6 Aetna Better Health West Virginia CURRENT AS OF 03/01/2017 Formulary Drug Name Reference Restrictions *ADHD/ANTI- NARCOLEPSY/ANTI- OBESITY/ANOREXIANTS* *Analeptics*** caffeine citrate oral solution Cafcit *ANALGESICS - ANTI- INFLAMMATORY* *Pyrimidine Synthesis Inhibitors*** leflunomide oral tablet Arava *ANALGESICS - NONNARCOTIC* *Analgesics Other*** acetaminophen extra strength oral liquid Tylenol Sore Throat Daytime acetaminophen oral capsule acetaminophen oral liquid Little Remedies for Fever acetaminophen oral solution 160 mg/5ml Little Fevers Fever-Pain Rel acetaminophen oral tablet 500 mg Medi-Tabs Extra Strength acetaminophen oral tablet chewable 80 mg Childrens Medi-Tabs acetaminophen rectal suppository 120 mg Feverall childrens acetaminophen oral suspension 160 mg/5ml Nortemp childrens acetaminophen oral tablet dispersible Tylenol Childrens Meltaways childrens apap oral tablet chewable Childrens Medi-Tabs childrens aspirin free oral elixir Medi-Tabs Childrens extra strength acetaminophen oral capsule infants pain reliever oral suspension Infants Medi-Tabs CHLORASEPTIC SORE THROAT ORAL CVS Pain Relief Adult LIQUID PEDIACARE INFANTS ORAL SUSPENSION Childrens Pain Reliever TRIAMINIC FEVER REDUCER ORAL SYRUP 3

7 *Analgesics-Sedatives*** butalbital-acetaminophen oral tablet mg Tencon butalbital-apap-caffeine oral capsule mg Esgic butalbital-apap-caffeine oral tablet Fioricet mg butalbital-asa-caffeine oral capsule Fiorinal butalbital-aspirin-caffeine oral capsule Fiorinal marten-tab oral tablet Tencon CAPACET ORAL CAPSULE Margesic ESGIC ORAL CAPSULE Margesic TENCON ORAL TABLET MG Butalbital-Acetaminophen ZEBUTAL ORAL CAPSULE MG Margesic *Salicylate Combinations*** buffered aspirin oral tablet Bufferin choline-mag trisalicylate oral liquid *Salicylates*** aspirin childrens oral tablet chewable Bayer Low Dose aspirin oral tablet 325 mg Bayer Aspirin aspirin oral tablet chewable Bayer Low Dose aspirin oral tablet delayed release 325 mg Bayer Aspirin Regimen aspirin oral tablet delayed release 81 mg Bayer Low Dose aspirtab oral tablet delayed release Bayer Aspirin Regimen salsalate oral tablet Disalcid BAYER ADVANCED ASPIRIN REG ST ORAL TABLET Aspirin BAYER ASPIRIN EC LOW DOSE ORAL TABLET DELAYED RELEASE Aspirin BAYER ASPIRIN REGIMEN ORAL TABLET DELAYED RELEASE Aspirtab ECOTRIN LOW STRENGTH ORAL TABLET DELAYED RELEASE Aspirin ECOTRIN ORAL TABLET DELAYED RELEASE Aspirtab *ANDROGENS-ANABOLIC* *Androgens*** danazol oral capsule methyltestosterone oral capsule Android 4

8 testosterone cypionate intramuscular solution 100 mg/ml, 200 mg/ml Depo-Testosterone PA testosterone enanthate intramuscular solution PA *ANORECTAL AGENTS* *Intrarectal Steroids*** hydrocortisone rectal enema Cortenema COLOCORT RECTAL ENEMA Hydrocortisone *Rectal Anesthetic/Steroids*** hydrocortisone ace-pramoxine rectal cream 1- Analpram-HC 1 % lidocaine-hydrocortisone ace rectal kit %, 3-1 % pramcort rectal cream Analpram-HC PROCTOFOAM HC RECTAL FOAM *Rectal Steroids*** hydrocortisone rectal cream Proctocort PROCTO-MED HC RECTAL CREAM Hemorrhoidal-HC PROCTO-PAK RECTAL CREAM Hydrocortisone PROCTOSOL HC RECTAL CREAM Hemorrhoidal-HC PROCTOZONE-HC RECTAL CREAM Hemorrhoidal-HC *ANTACIDS* *Antacids - Bicarbonate*** sodium bicarbonate oral powder *Antacids - Calcium Salts*** antacid oral tablet chewable 500 mg Tums calcium carbonate antacid oral tablet chewable 500 mg Tums TUMS FRESHERS ORAL TABLET CHEWABLE Calcium Antacid *Antacids - Magnesium Salts*** magnesium oxide oral tablet 400 mg Mag-Oxide *ANTIANGINAL AGENTS* *Nitrates*** isosorbide dinitrate er oral tablet extended release isosorbide dinitrate oral tablet Isordil Titradose isosorbide mononitrate er oral tablet extended Imdur release 24 hour isosorbide mononitrate oral tablet 5

9 nitroglycerin er oral capsule extended release 2.5 mg, 6.5 mg nitroglycerin transdermal patch 24 hour MINITRAN TRANSDERMAL PATCH 24 HOUR NITRO-BID TRANSDERMAL OINTMENT NITRO-TIME ORAL CAPSULE EXTENDED RELEASE 2.5 MG, 6.5 MG *ANTIANXIETY AGENTS* *Antianxiety Agents - Misc.*** buspirone hcl oral tablet 10 mg, 15 mg, 5 mg, 7.5 mg buspirone hcl oral tablet 30 mg hydroxyzine hcl oral syrup hydroxyzine hcl oral tablet hydroxyzine pamoate oral capsule *Benzodiazepines*** alprazolam er oral tablet extended release 24 hour alprazolam oral tablet alprazolam oral tablet dispersible alprazolam xr oral tablet extended release 24 hour chlordiazepoxide hcl oral capsule clorazepate dipotassium oral tablet diazepam oral solution 1 mg/ml lorazepam oral concentrate lorazepam oral tablet oxazepam oral capsule ALPRAZOLAM INTENSOL ORAL CONCENTRATE LORAZEPAM INTENSOL ORAL CONCENTRATE *ANTIARRHYTHMICS* *Antiarrhythmics Type I-A*** disopyramide phosphate oral capsule quinidine gluconate er oral tablet extended release quinidine sulfate oral tablet Nitro-Time Nitro-Dur Nitroglycerin Nitroglycerin ER Vistaril Xanax XR Xanax Niravam Xanax XR Tranxene-T LORazepam Intensol Ativan LORazepam Norpace PA 6

10 *Antiarrhythmics Type I-B*** mexiletine hcl oral capsule *Antiarrhythmics Type I-C*** flecainide acetate oral tablet propafenone hcl oral tablet *Antiarrhythmics Type Iii*** amiodarone hcl oral tablet 200 mg amiodarone hcl oral tablet 400 mg PACERONE ORAL TABLET 200 MG, 400 MG *ANTIASTHMATIC AND BRONCHODILATOR AGENTS* *Anti-Inflammatory Agents*** cromolyn sodium inhalation nebulization solution *Xanthines*** theophylline er oral tablet extended release 12 hour theophylline er oral tablet extended release 24 hour ELIXOPHYLLIN ORAL ELIXIR THEOCHRON ORAL TABLET EXTENDED RELEASE 12 HOUR 100 MG, 200 MG, 300 MG *ANTICOAGULANTS* *Heparins And Heparinoid-Like Agents*** heparin sodium (porcine) injection solution 1000 unit/ml, unit/ml, unit/ml, 5000 unit/ml heparin sodium (porcine) pf injection solution *ANTIDEPRESSANTS* *Antidepressants - Misc.*** maprotiline hcl oral tablet *Tricyclic Agents*** amitriptyline hcl oral tablet amoxapine oral tablet clomipramine hcl oral capsule desipramine hcl oral tablet Tambocor Rythmol Cordarone Pacerone Amiodarone HCl Theochron Theophylline Theophylline ER Anafranil Norpramin 7

11 doxepin hcl oral capsule doxepin hcl oral concentrate nortriptyline hcl oral capsule Pamelor protriptyline hcl oral tablet Vivactil *ANTIDIABETICS* *Alpha-Glucosidase Inhibitors*** acarbose oral tablet Precose *Diabetic Other*** GLUCAGEN HYPOKIT INJECTION SOLUTION RECONSTITUTED QLL (2 EA per 30 days) GLUCAGON EMERGENCY INJECTION KIT QLL (2 EA per 30 days) *Sulfonylurea-Biguanide Combinations*** glipizide-metformin hcl oral tablet Metaglip glyburide-metformin oral tablet Glucovance *Sulfonylureas*** chlorpropamide oral tablet glimepiride oral tablet Amaryl glipizide er oral tablet extended release 24 hour GlipiZIDE XL glipizide oral tablet Glucotrol glipizide xl oral tablet extended release 24 hour GlipiZIDE XL glyburide micronized oral tablet Glynase glyburide oral tablet Diabeta tolazamide oral tablet tolbutamide oral tablet *ANTIDIARRHEALS* *Antiperistaltic Agents*** anti-diarrheal oral capsule Imodium A-D diphenoxylate-atropine oral liquid diphenoxylate-atropine oral tablet Lonox lofene oral tablet Lonox loperamide hcl oral capsule Imodium A-D paregoric oral tincture 8

12 *ANTIDOTES* *Antidotes - Chelating Agents*** CHEMET ORAL CAPSULE *Opioid Antagonists*** naltrexone hcl oral tablet Depade *ANTIEMETICS* *5-Ht3 Receptor Antagonists*** ondansetron hcl oral tablet 24 mg QLL (2 EA per 30 days) *Antiemetics - Anticholinergic*** meclizine hcl oral tablet Antivert meclizine hcl oral tablet chewable motion sickness relief oral tablet chewable trimethobenzamide hcl oral capsule Tigan DRAMAMINE LESS DROWSY ORAL TABLET Motion Sickness Relief II *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** allergy childrens oral liquid Total Allergy Medicine allergy relief childrens oral liquid Total Allergy Medicine allergy relief oral capsule Benadryl allerhist-1 oral tablet Tavist Allergy clemastine fumarate oral tablet 1.34 mg Tavist Allergy clemastine fumarate oral tablet 2.68 mg complete allergy medicine oral capsule Benadryl diphenhist oral capsule Benadryl diphenhydramine hcl oral capsule Benadryl diphenhydramine hcl oral elixir Medi-Phedryl silphen cough oral syrup DAYHIST ALLERGY 12 HOUR RELIEF ORAL TABLET SM Allergy Relief *Antihistamines - Non-Sedating*** all day allergy childrens oral tablet chewable 10 mg ZyrTEC Childrens Allergy ; QLL (1 UNIT per 1 day) all day allergy oral tablet KLS Aller-Tec ; QLL (1 UNIT per 1 day) allergy relief child oral syrup Claritin ; QLL (300 ML per 30 days) allergy relief childrens oral tablet chewable ZyrTEC Childrens Allergy ; QLL (1 UNIT per 1 day) cetirizine hcl allergy child oral solution Wal-Zyr Childrens QLL (300 ML per 30 days) 9

13 cetirizine hcl childrens oral solution 5 mg/5ml Wal-Zyr Childrens ; QLL (300 ML per 30 days) cetirizine hcl hives relief oral solution Wal-Zyr Childrens ; QLL (300 ML per 30 days) cetirizine hcl oral tablet ; QLL (1 UNIT per 1 day) cetirizine hcl oral tablet chewable ZyrTEC Childrens Allergy ; QLL (1 UNIT per 1 day) loratadine allergy relief oral tablet dispersible Wal-itin Aller-Melts ; QLL (1 UNIT per 1 day) loratadine hives relief oral solution Claritin ; QLL (300 ML per 30 days) loratadine oral tablet Claritin ; QLL (1 UNIT per 1 day) ALAVERT ORAL TABLET Loratadine ; QLL (1 UNIT per 1 day) ALAVERT ORAL TABLET DISPERSIBLE Allergy Relief ; QLL (1 UNIT per 1 day) CLARITIN ALLERGY CHILDRENS SM Childrens Loratadine ORAL SYRUP TRIAMINIC ALLERCHEWS ORAL Allergy Relief TABLET DISPERSIBLE *Antihistamines - Phenothiazines*** promethazine hcl oral solution promethazine hcl oral syrup promethazine hcl oral tablet promethazine hcl rectal suppository Phenadoz PHENADOZ RECTAL SUPPOSITORY Promethazine HCl PHENERGAN RECTAL SUPPOSITORY Promethazine HCl PROMETHEGAN RECTAL Promethazine HCl SUPPOSITORY *Antihistamines - Piperidines*** cyproheptadine hcl oral syrup cyproheptadine hcl oral tablet *ANTIHYPERTENSIVES* *Ace Inhibitors*** captopril oral tablet 12.5 mg, 25 mg, 50 mg *Adrenolytics-Central & Thiazide/Thiazide-Like Comb*** methyldopa-hydrochlorothiazide oral tablet *Antiadrenergics - Centrally Acting*** methyldopa oral tablet ; QLL (300 ML per 30 days) ; QLL (1 UNIT per 1 day) QLL (90 EA per 30 days) 10

14 *Antiadrenergics - Peripherally Acting*** prazosin hcl oral capsule *Vasodilators*** hydralazine hcl oral tablet minoxidil oral tablet *ANTI-INFECTIVE AGENTS - MISC.* *Anti-Infective Agents - Misc.*** trimethoprim oral tablet vancomycin hcl intravenous solution reconstituted *Anti-Infective Misc. - Combinations*** sulfamethoxazole-trimethoprim oral suspension mg/5ml sulfamethoxazole-trimethoprim oral tablet SULFATRIM PEDIATRIC ORAL SUSPENSION *Leprostatics*** dapsone oral tablet *Lincosamides*** clindamycin hcl oral capsule clindamycin palmitate hcl oral solution reconstituted *ANTIMALARIALS* *Antimalarials*** hydroxychloroquine sulfate oral tablet mefloquine hcl oral tablet *ANTIMYASTHENIC AGENTS* *Antimyasthenic Agents*** pyridostigmine bromide oral tablet *Antimyasthenic/Cholinergic Agents*** pyridostigmine bromide oral tablet *ANTIMYASTHENIC/CHOLINER GIC AGENTS* pyridostigmine bromide oral tablet Minipress Sulfatrim Pediatric Bactrim Sulfamethoxazole- Trimethoprim Cleocin Cleocin Plaquenil Mestinon Mestinon Mestinon 11

15 *ANTIMYCOBACTERIAL AGENTS* *Antimycobacterial Agents*** ethambutol hcl oral tablet Myambutol isoniazid oral syrup isoniazid oral tablet pyrazinamide oral tablet rifampin oral capsule Rifadin *ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES* *Alkylating Agents*** HEXALEN ORAL CAPSULE MYLERAN ORAL TABLET *Antiadrenals*** LYSODREN ORAL TABLET *Antiandrogens*** bicalutamide oral tablet Casodex flutamide oral capsule nilutamide oral tablet Nilandron *Antiestrogens*** tamoxifen citrate oral tablet FARESTON ORAL TABLET *Antimetabolites*** capecitabine oral tablet Xeloda PA mercaptopurine oral tablet Purinethol methotrexate oral tablet methotrexate sodium (pf) injection solution 1 gm/40ml, 100 mg/4ml, 200 mg/8ml, 250 mg/10ml, 50 mg/2ml methotrexate sodium injection solution 250 mg/10ml, 50 mg/2ml TABLOID ORAL TABLET *Antineoplastic - Tyrosine Kinase Inhibitors*** imatinib mesylate oral tablet Gleevec PA IMBRUVICA ORAL CAPSULE PA; QLL (120 EA per 30 days) TARCEVA ORAL TABLET PA 12

16 *Antineoplastics Misc.*** hydroxyurea oral capsule INTRON A INJECTION SOLUTION Hydrea INTRON A INJECTION SOLUTION RECONSTITUTED PA MATULANE ORAL CAPSULE *Aromatase Inhibitors*** anastrozole oral tablet Arimidex letrozole oral tablet Femara *Estrogens-Antineoplastic*** EMCYT ORAL CAPSULE *Folic Acid Antagonists Rescue Agents*** leucovorin calcium oral tablet *Imidazotetrazines*** temozolomide oral capsule Temodar PA *Lhrh Analogs*** LUPRON DEPOT INTRAMUSCULAR KIT PA *Mitotic Inhibitors*** etoposide oral capsule *Nitrogen Mustards*** ALKERAN ORAL TABLET LEUKERAN ORAL TABLET *Nitrosoureas*** GLEOSTINE ORAL CAPSULE 10 MG Lomustine *Retinoids*** tretinoin oral capsule *Selective Retinoid X Receptor Agonists*** bexarotene oral capsule Targretin *Urinary Tract Protective Agents*** MESNEX ORAL TABLET PA 13

17 *ANTIPSYCHOTICS/ANTIMANIC AGENTS* *Antimanic Agents*** lithium carbonate er oral tablet extended Lithobid release lithium carbonate oral capsule lithium carbonate oral tablet lithium oral solution *Butyrophenones*** haloperidol decanoate intramuscular solution Haldol Decanoate haloperidol oral tablet *Dibenzoxazepines*** loxapine succinate oral capsule Loxitane *Phenothiazines*** chlorpromazine hcl oral tablet fluphenazine hcl oral concentrate fluphenazine hcl oral elixir fluphenazine hcl oral tablet perphenazine oral tablet prochlorperazine maleate oral tablet Compazine prochlorperazine rectal suppository Compro thioridazine hcl oral tablet trifluoperazine hcl oral tablet COMPRO RECTAL SUPPOSITORY Prochlorperazine *Thioxanthenes*** thiothixene oral capsule *ASSORTED CLASSES* *Antileprotics*** THALOMID ORAL CAPSULE 100 MG THALOMID ORAL CAPSULE 150 MG, 200 MG THALOMID ORAL CAPSULE 50 MG *Irrigation Solutions*** sterile water for irrigation irrigation solution Argyle Sterile Water *Potassium Removing Resins*** sodium polystyrene sulfonate oral powder Kayexalate sodium polystyrene sulfonate oral suspension SPS KIONEX ORAL POWDER Kalexate 14 PA; QLL (112 EA per 28 days) PA; QLL (56 EA per 28 days) PA; QLL (224 EA per 28 days)

18 KIONEX ORAL SUSPENSION Sodium Polystyrene Sulfonate SPS ORAL SUSPENSION Sodium Polystyrene Sulfonate *CARDIOTONICS* *Cardiac Glycosides*** digoxin oral solution digoxin oral tablet Lanoxin DIGITEK ORAL TABLET Digoxin DIGOX ORAL TABLET Digoxin *CHEMICALS* *Bulk Chemicals - Et's*** ethyl oleate liquid *Bulk Chemicals - Hy's*** hydroxyprogesterone caproate powder *Bulk Chemicals - Pr's*** propylene glycol liquid *Bulk Chemicals - So's*** sodium bicarbonate powder Nice Pure Baking Soda NICE PURE BAKING SODA POWDER Sodium Bicarbonate *Bulk Chemicals - St's*** stevia extract powder stevia extract powder 90 % *Fixed Oils*** castor oil oil cottonseed oil oil cvs castor oil oil hm castor oil oil olive oil oil qc castor oil oil qc sweet oil oil sesame oil oil sm sweet oil oil sweet oil oil *Liquids*** benzyl benzoate liquid glycerin liquid glycerine liquid glycerol formal liquid 15

19 *CONTRACEPTIVES* *Biphasic Contraceptives - Oral*** desogestrel-ethinyl estradiol oral tablet /0.01 mg (21/5) Kariva viorele oral tablet Kariva AZURETTE ORAL TABLET Viorele BEKYREE ORAL TABLET Viorele KARIVA ORAL TABLET Viorele KIMIDESS ORAL TABLET Viorele NECON 10/11 (28) ORAL TABLET PIMTREA ORAL TABLET Viorele *Combination Contraceptives - Oral*** alyacen 1/35 oral tablet Necon 1/35 (28) briellyn oral tablet Philith desogestrel-ethinyl estradiol oral tablet mg-mcg Reclipsen drospirenone-ethinyl estradiol oral tablet mg Ocella levonorgestrel-ethinyl estrad oral tablet mg-mcg Lessina-28 levonorgestrel-ethinyl estrad oral tablet mg-mcg Kurvelo marlissa oral tablet Kurvelo norethin ace-eth estrad-fe oral tablet 1-20 mgmcg Microgestin FE 1/20 norethindrone acet-ethinyl est oral tablet Gildess 1/20 norgestimate-eth estradiol oral tablet mg-mcg MonoNessa ALTAVERA ORAL TABLET Marlissa APRI ORAL TABLET Desogestrel-Ethinyl Estradiol AUBRA ORAL TABLET Levonorgestrel-Ethinyl Estrad AVIANE ORAL TABLET Levonorgestrel-Ethinyl Estrad BALZIVA ORAL TABLET Briellyn BLISOVI FE 1.5/30 ORAL TABLET BLISOVI FE 1/20 ORAL TABLET Norethin Ace-Eth Estrad-FE CHATEAL ORAL TABLET Marlissa CRYSELLE-28 ORAL TABLET CYCLAFEM 1/35 ORAL TABLET Alyacen 1/35 CYRED ORAL TABLET Desogestrel-Ethinyl Estradiol 16

20 DASETTA 1/35 ORAL TABLET Alyacen 1/35 DELYLA ORAL TABLET ELINEST ORAL TABLET EMOQUETTE ORAL TABLET ENSKYCE ORAL TABLET ESTARYLLA ORAL TABLET FALMINA ORAL TABLET GILDAGIA ORAL TABLET GILDESS FE 1.5/30 ORAL TABLET GILDESS FE 1/20 ORAL TABLET JULEBER ORAL TABLET JUNEL 1.5/30 ORAL TABLET JUNEL 1/20 ORAL TABLET JUNEL FE 1.5/30 ORAL TABLET JUNEL FE 1/20 ORAL TABLET KELNOR 1/35 ORAL TABLET KURVELO ORAL TABLET LARIN 1.5/30 ORAL TABLET LARIN 1/20 ORAL TABLET LARIN FE 1.5/30 ORAL TABLET LARIN FE 1/20 ORAL TABLET LARISSIA ORAL TABLET LESSINA ORAL TABLET LEVORA 0.15/30 (28) ORAL TABLET LOW-OGESTREL ORAL TABLET LUTERA ORAL TABLET MICROGESTIN 1.5/30 ORAL TABLET Levonorgestrel-Ethinyl Estrad Desogestrel-Ethinyl Estradiol Desogestrel-Ethinyl Estradiol Norgestimate-Eth Estradiol Levonorgestrel-Ethinyl Estrad Briellyn Norethin Ace-Eth Estrad-FE Desogestrel-Ethinyl Estradiol Norethindrone Acet-Ethinyl Est Norethin Ace-Eth Estrad-FE Marlissa Norethindrone Acet-Ethinyl Est Norethin Ace-Eth Estrad-FE Levonorgestrel-Ethinyl Estrad Levonorgestrel-Ethinyl Estrad Marlissa Levonorgestrel-Ethinyl Estrad Norethindrone Acet-Ethinyl MICROGESTIN 1/20 ORAL TABLET Est MICROGESTIN FE 1.5/30 ORAL TABLET MICROGESTIN FE 1/20 ORAL TABLET Norethin Ace-Eth Estrad-FE MONO-LINYAH ORAL TABLET Norgestimate-Eth Estradiol MONONESSA ORAL TABLET Norgestimate-Eth Estradiol NECON 0.5/35 (28) ORAL TABLET NECON 1/35 (28) ORAL TABLET Alyacen 1/35 NECON 1/50 (28) ORAL TABLET 17

21 NORTREL 0.5/35 (28) ORAL TABLET NORTREL 1/35 (21) ORAL TABLET Alyacen 1/35 NORTREL 1/35 (28) ORAL TABLET Alyacen 1/35 OCELLA ORAL TABLET Drospirenone-Ethinyl Estradiol OGESTREL ORAL TABLET ORSYTHIA ORAL TABLET Levonorgestrel-Ethinyl Estrad PHILITH ORAL TABLET Briellyn PIRMELLA 1/35 ORAL TABLET Alyacen 1/35 PORTIA-28 ORAL TABLET Marlissa PREVIFEM ORAL TABLET Norgestimate-Eth Estradiol RECLIPSEN ORAL TABLET Desogestrel-Ethinyl Estradiol SPRINTEC 28 ORAL TABLET Norgestimate-Eth Estradiol SRONYX ORAL TABLET Levonorgestrel-Ethinyl Estrad SYEDA ORAL TABLET Drospirenone-Ethinyl Estradiol TARINA FE 1/20 ORAL TABLET Norethin Ace-Eth Estrad-FE VIENVA ORAL TABLET Levonorgestrel-Ethinyl Estrad VYFEMLA ORAL TABLET Briellyn WERA ORAL TABLET ZARAH ORAL TABLET Drospirenone-Ethinyl Estradiol ZENCHENT ORAL TABLET Briellyn ZOVIA 1/35E (28) ORAL TABLET ZOVIA 1/50E (28) ORAL TABLET Ethynodiol Diac-Eth Estradiol *Combination Contraceptives - Vaginal*** NUVARING VAGINAL RING *Copper Contraceptives - Iud*** PARAGARD INTRAUTERINE COPPER INTRAUTERINE INTRAUTERINE QLL (1 EA per 999 days) DEVICE *Copper Contraceptives - Iud*** (New) PARAGARD INTRAUTERINE COPPER INTRAUTERINE INTRAUTERINE QLL (1 EA per 999 days) DEVICE *Emergency Contraceptives*** levonorgestrel oral tablet 1.5 mg Next Choice One Dose AFTERA ORAL TABLET Levonorgestrel ECONTRA EZ ORAL TABLET Levonorgestrel FALLBACK SOLO ORAL TABLET Levonorgestrel 18

22 MY WAY ORAL TABLET Levonorgestrel NEXT CHOICE ONE DOSE ORAL TABLET Levonorgestrel OPCICON ONE-STEP ORAL TABLET Levonorgestrel REACT ORAL TABLET Levonorgestrel TAKE ACTION ORAL TABLET Levonorgestrel *Progestin Contraceptives - Injectable*** medroxyprogesterone acetate intramuscular suspension Depo-Provera *Progestin Contraceptives - Iud*** KYLEENA INTRAUTERINE INTRAUTERINE DEVICE QLL (1 EA per 999 days) LILETTA (52 MG) INTRAUTERINE INTRAUTERINE DEVICE QLL (1 EA per 999 days) MIRENA (52 MG) INTRAUTERINE INTRAUTERINE DEVICE QLL (1 EA per 999 days) SKYLA INTRAUTERINE INTRAUTERINE DEVICE QLL (1 EA per 999 days) *Progestin Contraceptives - Oral*** norethindrone oral tablet Jolivette CAMILA ORAL TABLET Norethindrone DEBLITANE ORAL TABLET Norethindrone ERRIN ORAL TABLET Norethindrone HEATHER ORAL TABLET Norethindrone JENCYCLA ORAL TABLET Norethindrone JOLIVETTE ORAL TABLET Norethindrone LYZA ORAL TABLET Norethindrone NORA-BE ORAL TABLET Norethindrone NORLYROC ORAL TABLET Norethindrone SHAROBEL ORAL TABLET Norethindrone *Triphasic Contraceptives - Oral*** alyacen 7/7/7 oral tablet Nortrel 7/7/7 levonorg-eth estrad triphasic oral tablet Myzilra norgestim-eth estrad triphasic oral tablet 0.18/0.215/0.25 mg-35 mcg Tri-Linyah ARANELLE ORAL TABLET CAZIANT ORAL TABLET CYCLAFEM 7/7/7 ORAL TABLET Alyacen 7/7/7 19

23 DASETTA 7/7/7 ORAL TABLET Alyacen 7/7/7 ENPRESSE-28 ORAL TABLET Levonorg-Eth Estrad Triphasic LEENA ORAL TABLET LEVONEST ORAL TABLET Levonorg-Eth Estrad Triphasic MYZILRA ORAL TABLET Levonorg-Eth Estrad Triphasic NECON 7/7/7 ORAL TABLET Alyacen 7/7/7 NORTREL 7/7/7 ORAL TABLET Alyacen 7/7/7 PIRMELLA 7/7/7 ORAL TABLET Alyacen 7/7/7 TILIA FE ORAL TABLET TRI-ESTARYLLA ORAL TABLET Norgestim-Eth Estrad Triphasic TRI-LEGEST FE ORAL TABLET TRI-LINYAH ORAL TABLET Norgestim-Eth Estrad Triphasic TRINESSA (28) ORAL TABLET Norgestim-Eth Estrad Triphasic TRI-PREVIFEM ORAL TABLET Norgestim-Eth Estrad Triphasic TRI-SPRINTEC ORAL TABLET Norgestim-Eth Estrad Triphasic TRIVORA (28) ORAL TABLET Levonorg-Eth Estrad Triphasic VELIVET ORAL TABLET *CORTICOSTEROIDS* *Glucocorticosteroids*** cortisone acetate oral tablet dexamethasone oral elixir Baycadron dexamethasone oral solution dexamethasone oral tablet 0.5 mg, 0.75 mg, 1.5 mg, 2 mg, 4 mg, 6 mg hydrocortisone oral tablet Cortef methylprednisolone oral tablet Medrol methylprednisolone oral tablet therapy pack Medrol prednisolone oral solution Prelone prednisolone oral syrup 15 mg/5ml Prelone prednisolone sodium phosphate oral solution 15 mg/5ml Orapred prednisolone sodium phosphate oral solution 6.7 (5 base) mg/5ml Pediapred prednisone oral solution prednisone oral tablet 20

24 prednisone oral tablet therapy pack DELTASONE ORAL TABLET PredniSONE DEXPAK 10 DAY ORAL TABLET THERAPY PACK DEXPAK 6 DAY ORAL TABLET THERAPY PACK QLL (21 EA per 21 days) MILLIPRED ORAL TABLET *Mineralocorticoids*** fludrocortisone acetate oral tablet *COUGH/COLD/ALLERGY* *Antitussive - Nonnarcotic*** benzonatate oral capsule 100 mg Tessalon Perles benzonatate oral capsule 200 mg Tessalon *Antitussive - Opioid*** hydrocodone-homatropine oral syrup hydromet oral syrup *Antitussive-Expectorant*** cheratussin ac oral syrup childrens mucus relief cough oral liquid Mucinex Fast-Max DM Max dextromethorphan-guaifenesin oral solution Cheracol Plus dextromethorphan-guaifenesin oral syrup Robitussin DM Sugar Free diabetic siltussin-dm max st oral liquid Wal-Tussin Cough/Chest DM Max diabetic siltussin-dm oral liquid Cheracol Plus guaiatussin ac oral syrup guaifenesin-codeine oral solution guaifenesin-dm oral syrup Robitussin DM Sugar Free intense cough reliever oral liquid mg/5ml m-clear wc oral solution CGU WC medi-tussin dm double strength oral liquid mucus relief cough childrens oral liquid Mucinex Fast-Max DM Max neotuss oral liquid relcof c oral solution CGU WC trymine cg oral liquid Mar-Cof CG Expectorant DELSYM CGH/CHEST CONG DM CHILD ORAL LIQUID DM Max Maximum Strength DELSYM COUGH/CHEST CONGEST DM ORAL LIQUID DM Max Maximum Strength 21

25 DIABETIC TUSSIN DM ORAL LIQUID PX Tussin DM DIABETIC TUSSIN FOR CHILDREN ORAL LIQUID DIABETIC TUSSIN MAX ST ORAL LIQUID MUCINEX COUGH CHILDRENS ORAL LIQUID ROBITUSSIN COLD COUGH+ CHEST ORAL LIQUID ROBITUSSIN COUGH+CHEST CONG DM ORAL LIQUID ROBITUSSIN TO GO CGH/CHEST DM ORAL LIQUID *Decongestant & Antihistamine*** allergy relief d-24 oral tablet extended release 24 hour allergy relief-d oral tablet extended release 24 hour loratadine-d 12hr oral tablet extended release 12 hour loratadine-d 24hr oral tablet extended release 24 hour ALAVERT ALLERGY/SINUS ORAL TABLET EXTENDED RELEASE 12 HOUR *Expectorants*** PX Tussin DM TGT Cough Formula DM Max Adult DM Max Maximum Strength PX Tussin DM DM Max Maximum Strength PX Tussin DM Claritin-D 24 Hour Claritin-D 24 Hour Claritin-D 12 Hour Claritin-D 24 Hour TGT Allergy/Congestion Relief eq tussin oral liquid Robitussin Mucus+Chest Congest guaifenesin oral liquid Robitussin Mucus+Chest Congest guaifenesin oral solution Robitussin Mucus+Chest Congest guaifenesin oral syrup Diabetic Tussin EX guaifenesin oral tablet 200 mg organ-i nr oral tablet refenesen oral tablet scot-tussin expectorant oral liquid Robitussin Mucus+Chest Congest BUCKLEYS CHEST CONGESTION ORAL LIQUID CVS Tussin Adult Chest Congest ; QLL (1 UNIT per 1 day) ; QLL (1 UNIT per 1 day) ; QLL (2 UNITS per 1 day) ; QLL (1 UNIT per 1 day) ; QLL (2 UNITS per 1 day) DIABETIC TUSSIN EX ORAL SYRUP Tussin 22

26 MUCINEX CHEST CONGESTION CHILD ORAL LIQUID ROBITUSSIN MUCUS+CHEST CONGEST ORAL LIQUID *Misc. Respiratory Inhalants*** sodium chloride inhalation nebulization solution 0.9 %, 10 % sodium chloride inhalation nebulization solution 3 % sodium chloride inhalation nebulization solution 7 % NEBUSAL INHALATION NEBULIZATION SOLUTION 3 % PULMOSAL INHALATION NEBULIZATION SOLUTION *Mucolytics*** acetylcysteine inhalation solution *Non-Narc Antitussive- Antihistamine*** promethazine-dm oral syrup *Opioid Antitussive- Antihistamine*** promethazine-codeine oral syrup *Opioid Antitussive-Decongestant- Antihistamine*** phenyleph-promethazine-cod oral syrup promethazine vc/codeine oral syrup *DERMATOLOGICALS* *Acne Products*** CLARAVIS ORAL CAPSULE MYORISAN ORAL CAPSULE ZENATANE ORAL CAPSULE *Antibiotic Mixtures Topical*** bacitracin-neomycin-polymyxin external ointment triple antibiotic external ointment , *Antifungals - Topical*** CVS Tussin Adult Chest Congest CVS Tussin Adult Chest Congest Nebusal HyperSal Sodium Chloride Sodium Chloride Neosporin Original Neosporin Original QLL (120 UNITS per 1 RX) QLL (120 UNITS per 1 RX) QLL (120 UNITS per 1 RX) ST ST ST antifungal external cream 1 % Medi-First Anti-Fungal tolnaftate antifungal external cream Medi-First Anti-Fungal 23

27 tolnaftate external cream Medi-First Anti-Fungal *Antineoplastic Antimetabolites - Topical*** fluorouracil external solution *Antiseborrheic Combinations*** selenium sulfide external shampoo selenium sulf-pyrithione-urea external shampoo *Antiseborrheic Products*** selenium sulfide external lotion Selsun *Burn Products*** silver sulfadiazine external cream Thermazene SSD EXTERNAL CREAM Silver Sulfadiazine *Emollients*** ammonium lactate external cream Lac-Hydrin ammonium lactate external lotion LAClotion glycerin external liquid ra gentle skin external cream Hydro-Lan ALBOLENE EXTERNAL CREAM RA Renewal Moisturizing AMLACTIN EXTERNAL LOTION CVS Skin Treatment AVEENO INTENSE RELIEF HAND EXTERNAL CREAM RA Renewal Moisturizing CERAVE EXTERNAL CREAM RA Renewal Moisturizing CETAPHIL EXTERNAL CREAM RA Renewal Moisturizing CETAPHIL MOISTURIZING EXTERNAL CREAM RA Renewal Moisturizing EUCERIN PLUS INTENSIVE REPAIR EXTERNAL CREAM RA Renewal Moisturizing GERI-HYDROLAC 12 EXTERNAL CREAM Ammonium Lactate GOLD BOND ULTIMATE HEALING EXTERNAL CREAM RA Renewal Moisturizing NEUTROGENA HAND EXTERNAL CREAM RA Renewal Moisturizing NEUTROGENA HEALTHY SKIN EXTERNAL CREAM RA Renewal Moisturizing NIVEA EXTERNAL CREAM RA Renewal Moisturizing NUTRADERM EXTERNAL CREAM RA Renewal Moisturizing 24

28 *Imidazole-Related Antifungals - Topical*** clotrimazole af external cream Desenex clotrimazole anti-fungal external cream Desenex clotrimazole external cream Desenex clotrimazole external solution FungiCure Intensive/NailGuard DESENEX EXTERNAL CREAM CVS Ringworm DESENEX EXTERNAL POWDER CVS Anti-Fungal FUNGICURE INTENSIVE/NAILGUARD EXTERNAL SOLUTION Clotrimazole LOTRIMIN AF EXTERNAL POWDER CVS Anti-Fungal ZEASORB-AF EXTERNAL POWDER CVS Anti-Fungal *Keratolytic/Antimitotic Agents*** salicylic acid external cream Salacyn salicylic acid external foam Salvax salicylic acid external lotion Salacyn salicylic acid external shampoo Aliclen SALACYN EXTERNAL CREAM Salicylic Acid SALACYN EXTERNAL LOTION Salicylic Acid *Local Anesthetics - Topical*** lidocaine hcl external solution Xylocaine *Rosacea Agents*** metronidazole external cream Rosadan metronidazole external lotion MetroLotion ROSADAN EXTERNAL CREAM MetroNIDAZOLE *DIAGNOSTIC PRODUCTS* *Diagnostic Tests*** NOVA MAX PLUS KETONE TEST IN VITRO STRIP ONETOUCH ULTRA BLUE IN VITRO STRIP ONETOUCH VERIO IN VITRO STRIP PRECISION XTRA KETONE IN VITRO STRIP PTS PANELS KETONE TEST IN VITRO STRIP Blood Glucose Test Blood Glucose Test ; QLL (150 EA per 30 days) ; QLL (150 EA per 30 days) 25

29 *DIURETICS* *Carbonic Anhydrase Inhibitors*** acetazolamide er oral capsule extended release 12 hour acetazolamide oral tablet methazolamide oral tablet *Diuretic Combinations*** amiloride-hydrochlorothiazide oral tablet spironolactone-hctz oral tablet triamterene-hctz oral capsule triamterene-hctz oral tablet *Loop Diuretics*** bumetanide oral tablet furosemide oral solution 10 mg/ml, 8 mg/ml furosemide oral tablet torsemide oral tablet *Potassium Sparing Diuretics*** amiloride hcl oral tablet spironolactone oral tablet *Thiazides And Thiazide-Like Diuretics*** chlorothiazide oral tablet chlorthalidone oral tablet 25 mg, 50 mg hydrochlorothiazide oral capsule hydrochlorothiazide oral tablet indapamide oral tablet methyclothiazide oral tablet metolazone oral tablet *ENDOCRINE AND METABOLIC AGENTS - MISC.* *Calcimimetic Agents*** SENSIPAR ORAL TABLET 60 MG *Carnitine Replenisher - Agents*** levocarnitine oral solution levocarnitine oral tablet *Hyperparathyroid Treatment - Vitamin D Analogs*** calcitriol oral capsule 26 Diamox Sequels Neptazane Aldactazide Dyazide Maxzide-25 Bumex Lasix Demadex Aldactone Microzide Zaroxolyn Carnitor SF Carnitor Rocaltrol QLL (2 UNITS per 1 day)

30 calcitriol oral solution *Somatostatic Agents*** Rocaltrol octreotide acetate injection solution 100 mcg/ml, 1000 mcg/ml, 200 mcg/ml, 50 mcg/ml, SandoSTATIN 500 mcg/ml SANDOSTATIN LAR DEPOT INTRAMUSCULAR KIT *Vasopressin*** desmopressin ace rhinal tube nasal solution DDAVP Rhinal Tube desmopressin ace spray refrig nasal solution Minirin desmopressin acetate oral tablet DDAVP desmopressin acetate spray nasal solution DDAVP *ESTROGENS* *Estrogen & Progestin*** estradiol-norethindrone acet oral tablet Activella AMABELZ ORAL TABLET Estradiol-Norethindrone Acet MIMVEY LO ORAL TABLET Estradiol-Norethindrone Acet MIMVEY ORAL TABLET Estradiol-Norethindrone Acet PREMPHASE ORAL TABLET PREMPRO ORAL TABLET *Estrogens*** estradiol oral tablet Estrace estradiol transdermal patch weekly Climara estropipate oral tablet Ortho-Est MENEST ORAL TABLET 0.3 MG, MG, 1.25 MG PREMARIN ORAL TABLET *GASTROINTESTINAL AGENTS - MISC.* *Gallstone Solubilizing Agents*** ursodiol oral capsule Actigall ursodiol oral tablet Urso 250 *Gastrointestinal Stimulants*** metoclopramide hcl oral solution 10 mg/10ml, 5 mg/5ml metoclopramide hcl oral tablet Reglan *Intestinal Acidifiers*** enulose oral solution PA PA 27

31 generlac oral solution lactulose encephalopathy oral solution *GENITOURINARY AGENTS - MISCELLANEOUS* *Citrates*** citric acid-sodium citrate oral solution Shohls Modified cytra k crystals oral packet Polycitra-K potassium citrate er oral tablet extended release 10 meq (1080 mg) Urocit-K 10 potassium citrate er oral tablet extended release 5 meq (540 mg) Urocit-K 5 potassium citrate-citric acid oral packet Polycitra-K potassium citrate-citric acid oral solution tricitrates oral solution virtrate-2 oral solution Shohls Modified virtrate-3 oral solution virtrate-k oral solution TARON-CRYSTALS ORAL PACKET Cytra K Crystals *Urinary Analgesics*** phenazopyridine hcl oral tablet 100 mg, 200 mg Pyridium PHENAZO ORAL TABLET 200 MG Phenazopyridine HCl *HEMATOLOGICAL AGENTS - MISC.* *Quinazoline Agents*** anagrelide hcl oral capsule Agrylin *HEMATOPOIETIC AGENTS* *Cobalamins*** cyanocobalamin injection solution *Cytotoxic Agents*** DROXIA ORAL CAPSULE *Folic Acid/Folates*** folic acid oral tablet 1 mg *Iron Combinations*** fe c tab plus oral tablet FE C Plus iron 100 plus oral tablet FE C Plus myferon 150 forte oral capsule iferex 150 Forte poly-iron 150 forte oral capsule iferex 150 Forte 28

32 polysaccharide iron forte oral capsule tl-hem 150 oral tablet iferex 150 Forte Hemax FOLIVANE-PLUS ORAL CAPSULE ICAR-C PLUS ORAL TABLET Iron 100 Plus IFEREX 150 FORTE ORAL CAPSULE Poly-Iron 150 Forte INTEGRA PLUS ORAL CAPSULE *Iron W/ Folic Acid*** FOLIVANE-F ORAL CAPSULE INTEGRA F ORAL CAPSULE *Iron*** fe tabs oral tablet delayed release ferretts oral tablet Hemocyte ferrex 150 oral capsule Nu-Iron ferric x-150 oral capsule Nu-Iron ferrous fumarate oral tablet 324 (106 fe) mg Hemocyte ferrous sulfate oral elixir FeroSul ferrous sulfate oral liquid ferrous sulfate oral tablet 325 (65 fe) mg Feosol ferrous sulfate oral tablet delayed release 325 (65 fe) mg ferrousul oral tablet Feosol iron high-potency oral tablet Feosol iron oral tablet 325 (65 fe) mg Feosol myferon 150 oral capsule Nu-Iron px iron oral tablet 200 (65 fe) mg Feosol wee care oral suspension Icar EZFE 200 ORAL CAPSULE FEOSOL ORAL TABLET 325 (65 FE) MG Ferrous Sulfate FEROSUL ORAL ELIXIR Ferrous Sulfate IFEREX 150 ORAL CAPSULE Ferrex 150 NU-IRON ORAL CAPSULE Ferrex 150 POLY-IRON 150 ORAL CAPSULE Ferrex 150 *LAXATIVES* *Laxatives - Miscellaneous*** constulose oral solution lactulose oral solution sorbitol oral solution 29

33 *Stimulant Laxatives*** castor oil stimulant laxative oral oil geri-kot oral tablet Evac-U-Gen senna oral tablet 8.6 mg Evac-U-Gen senna-lax oral tablet Evac-U-Gen DR EDWARDS OLIVE LAXATIVE ORAL TABLET Senna SENNACON ORAL TABLET Senna *Surfactant Laxatives*** docqlace oral capsule Colace docusate sodium oral capsule 100 mg Colace stool softener oral capsule 100 mg Colace CORRECTOL EXTRA GENTLE ORAL CAPSULE Stool Softener DOCUSIL ORAL CAPSULE Stool Softener DOK ORAL CAPSULE 100 MG Colace PHILLIPS STOOL SOFTENER ORAL CAPSULE Stool Softener SOF-LAX ORAL CAPSULE Stool Softener *MEDICAL DEVICES* *Diaphragms*** WIDE-SEAL DIAPHRAGM 60 VAGINAL DIAPHRAGM WIDE-SEAL DIAPHRAGM 65 VAGINAL DIAPHRAGM WIDE-SEAL DIAPHRAGM 70 VAGINAL DIAPHRAGM WIDE-SEAL DIAPHRAGM 75 VAGINAL DIAPHRAGM WIDE-SEAL DIAPHRAGM 80 VAGINAL DIAPHRAGM WIDE-SEAL DIAPHRAGM 85 VAGINAL DIAPHRAGM WIDE-SEAL DIAPHRAGM 90 VAGINAL DIAPHRAGM WIDE-SEAL DIAPHRAGM 95 VAGINAL DIAPHRAGM *Glucose Monitoring Test Supplies*** control in vitro solution Xpres Control 30

34 diatrue control level 1 in vitro solution Bayer Contour Next Control diatrue control level 2 in vitro solution Xpres Control diatrue control level 3 in vitro solution Eclipse Control easy plus ii control in vitro solution Eclipse Control easy talk control in vitro solution Eclipse Control easy trak control in vitro solution Eclipse Control element compact control 2 in vitro solution On Call Plus Glucose Control element compact control 3 in vitro solution On Call Plus Glucose Control ge100 control in vitro solution Xpres Control glucose control in vitro solution On Call Plus Glucose Control lancets UltiCare Thin Lancets 30G select-lite device/lancets kit Autolet Lite Starter Pack supreme ii high/low control in vitro liquid On Call Plus Glucose Control ACCU-CHEK AVIVA IN VITRO SOLUTION Supreme II High/Low Control ACCU-CHEK COMPACT PLUS CONTROL IN VITRO SOLUTION Supreme II High/Low Control ACCU-CHEK FASTCLIX LANCET KIT Select-Lite Device/Lancets ACCU-CHEK MULTICLIX LANCET DEV KIT Select-Lite Device/Lancets ACCU-CHEK SMARTVIEW CONTROL IN VITRO LIQUID Supreme II High/Low Control ACCU-CHEK SOFTCLIX LANCET DEV KIT Select-Lite Device/Lancets ACCUTREND GLUCOSE CONTROL IN VITRO SOLUTION Supreme II High/Low Control ACURA CONTROL IN VITRO SOLUTION Easy Check Control ADVANCE INTUITION CONTROL IN VITRO LIQUID Control ADVANCE MICRO-DRAW CONTROL IN VITRO LIQUID Supreme II High/Low Control ADVANCE MICRO-DRAW NORMAL IN Supreme II High/Low Control VITRO LIQUID ADVOCATE CONTROL SOLUTION IN VITRO LIQUID Easy Check Control ADVOCATE REDI-CODE+ CONTROL IN VITRO SOLUTION Easy Check Control AGAMATRIX CONTROL IN VITRO SOLUTION Supreme II High/Low Control ASSURE 3 CONTROL IN VITRO LIQUID Supreme II High/Low Control 31

35 ASSURE 4 CONTROL LEVEL 1 & 2 IN VITRO LIQUID Supreme II High/Low Control ASSURE DOSE CONTROL IN VITRO SOLUTION Control ASSURE DOSE NORM/HIGH CONTROL Supreme II High/Low Control IN VITRO SOLUTION ASSURE II CONTROL IN VITRO LIQUID Supreme II High/Low Control ASSURE II CONTROL LEVEL 1 & 2 IN VITRO LIQUID Supreme II High/Low Control ASSURE PRISM CONTROL LEVEL 1&2 Supreme II High/Low Control IN VITRO SOLUTION ASSURE PRO CONTROL LEVEL 1 & 2 IN VITRO LIQUID Supreme II High/Low Control AT LAST CONTROL IN VITRO SOLUTION Supreme II High/Low Control AUTOLET II CLINISAFE KIT Select-Lite Device/Lancets AUTOLET LITE CLINISAFE KIT Select-Lite Device/Lancets AUTOLET LITE STARTER PACK KIT Select-Lite Device/Lancets BAYER BREEZE 2 CONTROL IN VITRO Easy Check Control LIQUID BAYER CONTOUR IN VITRO LIQUID Easy Check Control BAYER CONTOUR NEXT CONTROL IN Control VITRO SOLUTION CARESENS CONTROL A IN VITRO SOLUTION Supreme II High/Low Control CLEVER CHOICE GLUCOSE CONTROL IN VITRO LIQUID Easy Check Control COOL CONTROL A IN VITRO SOLUTION Supreme II High/Low Control COOL CONTROL B IN VITRO SOLUTION Supreme II High/Low Control DUO-CARE CONTROL SOLUTION IN VITRO LIQUID Supreme II High/Low Control EASY STEP CONTROL IN VITRO SOLUTION Easy Check Control EASY TOUCH CONTROL HIGH & LOW Supreme II High/Low Control IN VITRO SOLUTION EASY TOUCH HEALTHPRO CONTROL Supreme II High/Low Control IN VITRO SOLUTION EASYGLUCO CONTROL IN VITRO SOLUTION Easy Check Control 32

36 EASYGLUCO PLUS LEVEL 1 IN VITRO SOLUTION Supreme II High/Low Control EASYMAX 15 LEVEL 1 CONTROL IN VITRO SOLUTION Supreme II High/Low Control EASYMAX 15 LEVEL 2 CONTROL IN VITRO SOLUTION Supreme II High/Low Control EASYMAX CONTROL IN VITRO SOLUTION Easy Check Control ELEMENT CONTROL IN VITRO LIQUID Easy Check Control EMBRACE CONTROL IN VITRO SOLUTION Easy Check Control EMBRACE EVO CONTROL LEVEL 1 IN Easy Check Control VITRO LIQUID EMBRACE EVO CONTROL LEVEL 2 IN Control VITRO LIQUID EMBRACE GLUCOSE CONTROL IN VITRO LIQUID Easy Check Control EMBRACE PRO GLUCOSE CONTROL IN VITRO LIQUID Supreme II High/Low Control EVENCARE CONTROL LOW/HIGH IN VITRO LIQUID Supreme II High/Low Control EVENCARE G2 LOW/HIGH CONTROL IN VITRO SOLUTION Supreme II High/Low Control EVENCARE G3 LOW/HIGH CONTROL IN VITRO SOLUTION Supreme II High/Low Control EVENCARE MINI CONTROL IN VITRO Control SOLUTION EVOLUTION CONTROL IN VITRO SOLUTION Control FIFTY50 CONTROL 2.0 IN VITRO SOLUTION Supreme II High/Low Control FORA CONTROL IN VITRO SOLUTION Easy Check Control FORACARE GDH CONTROL IN VITRO SOLUTION Easy Check Control FORTISCARE CONTROL IN VITRO SOLUTION Easy Check Control FREESTYLE CONTROL SOLUTION IN VITRO LIQUID Supreme II High/Low Control GLUCOCARD 01 CONTROL IN VITRO LIQUID Supreme II High/Low Control GLUCOCARD 01 CONTROL IN VITRO SOLUTION Control 33

37 GLUCOCARD EXPRESSION CONTROL Supreme II High/Low Control IN VITRO SOLUTION GLUCOCARD SHINE CONTROL IN VITRO SOLUTION Supreme II High/Low Control GLUCOCARD X-SENSOR CONTROL IN Control VITRO SOLUTION GLUCOCOM CONTROL IN VITRO LIQUID Easy Check Control GMATE CONTROL LEVEL 2 IN VITRO SOLUTION Supreme II High/Low Control GNP EASY TOUCH CONT HIGH/LOW IN VITRO SOLUTION Supreme II High/Low Control HYPOLANCE AST LANCING KIT Select-Lite Device/Lancets IN TOUCH GLUCOSE CONTROL IN VITRO SOLUTION Supreme II High/Low Control INFINITY CONTROL IN VITRO SOLUTION Easy Check Control LIBERTY GLUCOSE CONTROL IN VITRO LIQUID Control LIBERTY GLUCOSE CONTROL IN VITRO SOLUTION Supreme II High/Low Control LIBERTY GLUCOSE CONTROL MID IN Supreme II High/Low Control VITRO SOLUTION MAXIMA CONTROL IN VITRO SOLUTION Supreme II High/Low Control MEDISENSE GLUCOSE KETONE CONTR IN VITRO LIQUID Supreme II High/Low Control MEDISENSE HI/MID/LOW CONTROL IN VITRO LIQUID Supreme II High/Low Control MEDISENSE HIGH/LOW CONTROL IN VITRO LIQUID Supreme II High/Low Control MEDISENSE MID CONTROL IN VITRO LIQUID Supreme II High/Low Control MICRODOT CONTROL HIGH/LOW IN VITRO SOLUTION Supreme II High/Low Control MULTI-LANCET DEVICE 2 KIT Select-Lite Device/Lancets MYGLUCOHEALTH CONTROL IN VITRO SOLUTION Supreme II High/Low Control NEUTEK 2TEK CONTROL IN VITRO SOLUTION Supreme II High/Low Control NEXGEN CONTROL IN VITRO LIQUID Control NOVA MAX PLUS GLU/KET CONTROL Supreme II High/Low Control IN VITRO LIQUID 34

38 ON CALL EXPRESS GLUCOSE CONTR IN VITRO SOLUTION Supreme II High/Low Control ON CALL PLUS GLUCOSE CONTROL IN VITRO SOLUTION Supreme II High/Low Control ON CALL VIVID GLUCOSE CONTROL IN VITRO SOLUTION Supreme II High/Low Control ONETOUCH ULTRA 2 KIT Blood Glucose Monitor System ONETOUCH ULTRA CONTROL IN VITRO SOLUTION Supreme II High/Low Control ONETOUCH ULTRA MINI KIT Blood Glucose Monitor System ONETOUCH ULTRALINK KIT Blood Glucose Monitor System ONETOUCH VERIO IN VITRO SOLUTION Supreme II High/Low Control ONETOUCH VERIO IQ SYSTEM KIT Blood Glucose Monitor System ONETOUCH VERIO KIT Blood Glucose Monitor System Blood Glucose Monitor ONETOUCH VERIO SYNC SYSTEM KIT System OPTUMRX GLUCOSE CONTROL IN VITRO SOLUTION Supreme II High/Low Control PENLET II BLOOD SAMPLER KIT Select-Lite Device/Lancets POCKETCHEM EZ CONTROL IN VITRO SOLUTION Supreme II High/Low Control PRECISION GLUCOSE CONTROL IN VITRO LIQUID Supreme II High/Low Control PRECISION GLUCOSE CONTROL SOLN IN VITRO SOLUTION Supreme II High/Low Control PRECISION GLUCOSE KETONE CONTR IN VITRO LIQUID Supreme II High/Low Control PRECISION GLUCOSE/KETONE CONTR IN VITRO LIQUID Supreme II High/Low Control PRODIGY CONTROL SOLUTION IN VITRO SOLUTION Easy Check Control QUICKTEK CONTROL SOLUTION IN VITRO LIQUID Supreme II High/Low Control QUINTET CONTROL HIGH/NORMAL IN VITRO SOLUTION Supreme II High/Low Control REFUAH PLUS GLUCOSE CONTROL IN VITRO SOLUTION Supreme II High/Low Control 35

39 RELION LANCING DEVICE KIT Select-Lite Device/Lancets RIGHTEST GC300 CONTROL IN VITRO LIQUID SMARTEST CONTROL MEDIUM IN VITRO SOLUTION SOLARTEK GLUCOSE CONTROL IN VITRO LIQUID SOLUS V2 CONTROL IN VITRO SOLUTION SURESTEP GLUCOSE CONTROL IN VITRO SOLUTION SURESTEP PRO HIGH GLUCOSE IN VITRO LIQUID SURESTEP PRO LOW GLUCOSE IN VITRO LIQUID SURESTEP PRO NORMAL GLUCOSE IN VITRO LIQUID TAI DOC CONTROL IN VITRO SOLUTION TELCARE GLUCOSE CONTROL IN VITRO SOLUTION TRUE METRIX LEVEL 1 IN VITRO SOLUTION TRUE METRIX LEVEL 2 IN VITRO SOLUTION TRUE METRIX LEVEL 3 IN VITRO SOLUTION TRUECONTROL GLUCOSE CONT LEV 0 IN VITRO LIQUID TRUECONTROL GLUCOSE CONT LEV 1 IN VITRO LIQUID TRUETEST CONTROL LEVEL 1 IN VITRO LIQUID TRUETEST CONTROL LEVEL 2 IN VITRO LIQUID TRUETEST CONTROL LEVEL 3 IN VITRO LIQUID ULTRATRAK PRO CONTROL IN VITRO SOLUTION ULTRATRAK ULTIMATE CONTROL IN VITRO SOLUTION UNISTRIP CONTROL IN VITRO SOLUTION Easy Check Control Supreme II High/Low Control Supreme II High/Low Control Easy Check Control Supreme II High/Low Control Easy Check Control Easy Check Control Control Xpres Control Supreme II High/Low Control Easy Check Control Control Easy Check Control Supreme II High/Low Control Supreme II High/Low Control Supreme II High/Low Control Supreme II High/Low Control Supreme II High/Low Control Supreme II High/Low Control Supreme II High/Low Control Easy Check Control 36

40 VICTORY CONTROL LEVEL 1/2 IN VITRO SOLUTION Supreme II High/Low Control *Misc. Devices*** folding paddle walker Sprague Rappaport Stethoscope ; QLL (1 UNIT per 1 day) *Needles & Syringes*** easy comfort insulin syringe 30g x 5/16" 0.3 ml TRUEplus Insulin Syringe elite-thin insulin syringe 31g x 5/16" 0.5 ml TRUEplus Insulin Syringe global inject ease insulin syr 29g x 1/2" 0.3 ml V-R Mono Insulin Syringe global inject ease insulin syr 30g x 5/16" 0.3 ml TRUEplus Insulin Syringe insulin syringe 29g x 1" 0.3 ml insulin syringe 29g x 1/2" 0.3 ml V-R Mono Insulin Syringe insulin syringe 29g x 1/2" 1 ml BD Insulin Syringe insulin syringe 30g x 5/16" 0.3 ml, 30g x 5/16" 1 ml, 31g x 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, TRUEplus Insulin Syringe 31g x 5/16" 1 ml insulin syringe/needle Easy Touch Insulin Syringe kmart valu insulin syringe 29g kmart valu insulin syringe 30g leader insulin syringe 29g x 1/2" 0.3 ml V-R Mono Insulin Syringe leader insulin syringe 30g x 5/16" 0.3 ml TRUEplus Insulin Syringe medic insulin syringe 30g x 5/16" 0.3 ml TRUEplus Insulin Syringe preferred plus insulin syringe 29g x 1/2" 0.3 ml V-R Mono Insulin Syringe preferred plus insulin syringe 30g x 5/16" 0.3 ml TRUEplus Insulin Syringe sure comfort insulin syringe 29g x 1/2" 0.3 ml V-R Mono Insulin Syringe sure comfort insulin syringe 30g x 1/2" 0.3 ml BD Insulin Syringe Ultrafine sure comfort insulin syringe 30g x 5/16" 0.3 ml TRUEplus Insulin Syringe topco insulin syringe 28g x 1/2" 1 ml TRUEplus Insulin Syringe topco insulin syringe 29g x 1/2" 0.3 ml V-R Mono Insulin Syringe ultra comfort insulin syringe 30g x 5/16" 0.3 ml TRUEplus Insulin Syringe ultra-comfort insulin syringe 29g x 1/2" 0.3 ml V-R Mono Insulin Syringe ultra-comfort insulin syringe 30g x 5/16" 0.3 ml TRUEplus Insulin Syringe ADVOCATE INSULIN SYRINGE 29G X 1/2" 0.3 ML Kroger Insulin Syringe 37