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

Transcription

1 AETNA BETTER HEALTH Formulary Guide Aetna Better Health of West Virginia Formulary Guide June 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: 06/01/2017 P ag 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: 06/01/2017 P ag e 3

4 Aetna Better Health West Virginia Table of Contents *ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS*...3 *ANALGESICS - ANTI-INFLAMMATORY*... 3 *ANALGESICS - NONNARCOTIC*...3 *ANDROGENS-ANABOLIC*... 4 *ANORECTAL AGENTS*...5 *ANTACIDS*...5 *ANTHELMINTICS*... 5 *ANTIANGINAL AGENTS*... 6 *ANTIANXIETY AGENTS*...6 *ANTIARRHYTHMICS*... 7 *ANTIASTHMATIC AND BRONCHODILATOR AGENTS*... 7 *ANTICOAGULANTS*... 7 *ANTIDEPRESSANTS*...8 *ANTIDIABETICS*... 8 *ANTIDIARRHEALS*...9 *ANTIDOTES*... 9 *ANTIEMETICS*... 9 *ANTIHISTAMINES*... 9 *ANTIHYPERTENSIVES* *ANTI-INFECTIVE AGENTS - MISC.* *ANTIMALARIALS*...12 *ANTIMYASTHENIC AGENTS* *ANTIMYASTHENIC/CHOLINERGIC AGENTS* *ANTIMYCOBACTERIAL AGENTS* *ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES*...12 *ANTIPSYCHOTICS/ANTIMANIC AGENTS* *ASSORTED CLASSES* *CARDIOTONICS* *CHEMICALS*...16 *CONTRACEPTIVES*...16 *CORTICOSTEROIDS* *COUGH/COLD/ALLERGY*...22 *DERMATOLOGICALS* *DIAGNOSTIC PRODUCTS*...26 *DIURETICS*...26 *ENDOCRINE AND METABOLIC AGENTS - MISC.*...27 *ESTROGENS*...28 *GASTROINTESTINAL AGENTS - MISC.*...28 *GENITOURINARY AGENTS - MISCELLANEOUS* *HEMATOLOGICAL AGENTS - MISC.* *HEMATOPOIETIC AGENTS*...29 *LAXATIVES* *MEDICAL DEVICES*...31 *MIGRAINE PRODUCTS*

5 *MINERALS & ELECTROLYTES*...43 *MOUTH/THROAT/DENTAL AGENTS*...45 *MULTIVITAMINS*...46 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *OPHTHALMIC AGENTS*...52 *OTIC AGENTS*...52 *OXYTOCICS*...52 *PASSIVE IMMUNIZING AGENTS*...52 *PENICILLINS*...53 *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*...61 *VASOPRESSORS* *VITAMINS*

6 Aetna Better Health West Virginia CURRENT AS OF 6/1/2017 Formulary Drug Name Reference Restrictions *ADHD/ANTI- NARCOLEPSY/ANTI- OBESITY/ANOREXIANTS* *Analeptics*** caffeine citrate oral solution *ANALGESICS - ANTI- INFLAMMATORY* *Pyrimidine Synthesis Inhibitors*** leflunomide oral tablet Arava *ANALGESICS - NONNARCOTIC* *Analgesics Other*** acetaminophen extra strength oral liquid Chloraseptic Sore Throat acetaminophen oral liquid Little Remedies for Fever acetaminophen oral solution 160 mg/5ml PediaCare Infant Fever/Pain acetaminophen oral tablet 500 mg Mapap Extra Strength acetaminophen oral tablet chewable 80 mg Childrens Medi-Tabs acetaminophen rectal suppository 120 mg Acephen childrens acetaminophen oral suspension 160 mg/5ml Mapap Childrens childrens acetaminophen oral tablet dispersible Mapap Childrens childrens apap oral tablet chewable Childrens Medi-Tabs childrens aspirin free oral elixir Medi-Tabs Childrens infants pain reliever oral suspension CHLORASEPTIC SORE THROAT ORAL Acetaminophen Extra Strength LIQUID PEDIACARE INFANTS ORAL SUSPENSION Pain Relief Childrens 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 Esgic mg butalbital-asa-caffeine oral capsule Fiorinal butalbital-aspirin-caffeine oral capsule Fiorinal marten-tab oral tablet Tencon CAPACET ORAL CAPSULE Butalbital-APAP-Caffeine ESGIC ORAL CAPSULE Butalbital-APAP-Caffeine TENCON ORAL TABLET MG Butalbital-Acetaminophen ZEBUTAL ORAL CAPSULE MG Butalbital-APAP-Caffeine *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 Advanced Aspirin Reg St aspirin oral tablet chewable Bayer Low Dose aspirin oral tablet delayed release 325 mg Ecotrin aspirin oral tablet delayed release 81 mg Aspir-Low aspirtab oral tablet delayed release Ecotrin salsalate oral tablet Disalcid BAYER ADVANCED ASPIRIN REG ST ORAL TABLET CVS Aspirin BAYER ASPIRIN EC LOW DOSE ORAL TABLET DELAYED RELEASE BAYER ASPIRIN REGIMEN ORAL TABLET DELAYED RELEASE ECOTRIN LOW STRENGTH ORAL TABLET DELAYED RELEASE ECOTRIN ORAL TABLET DELAYED RELEASE *ANDROGENS-ANABOLIC* *Androgens*** danazol oral capsule EQ Adult Aspirin Low Strength SB Aspirin EC EQ Adult Aspirin Low Strength SB Aspirin EC 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 Colocort 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 Hydrocortisone PROCTO-PAK RECTAL CREAM Hydrocortisone PROCTOSOL HC RECTAL CREAM Hydrocortisone PROCTOZONE-HC RECTAL CREAM Hydrocortisone *ANTACIDS* *Antacids - Bicarbonate*** sodium bicarbonate oral powder *Antacids - Calcium Salts*** antacid oral tablet chewable 500 mg Tums Lasting Effects calcium carbonate antacid oral tablet chewable 500 mg Tums Lasting Effects TUMS FRESHERS ORAL TABLET CHEWABLE HM Calcium Antacid *Antacids - Magnesium Salts*** magnesium oxide oral tablet 400 mg *ANTHELMINTICS* *Anthelmintics*** ivermectin oral tablet Stromectol reeses pinworm medicine oral suspension reeses pinworm medicine oral tablet 5

9 *ANTIANGINAL AGENTS* *Nitrates*** isosorbide dinitrate er oral tablet extended release isosorbide dinitrate oral tablet Isordil Titradose isosorbide mononitrate er oral tablet extended release 24 hour isosorbide mononitrate oral tablet nitroglycerin er oral capsule extended release Nitro-Time 2.5 mg, 6.5 mg nitroglycerin transdermal patch 24 hour Nitro-Dur MINITRAN TRANSDERMAL PATCH 24 HOUR Nitroglycerin NITRO-BID TRANSDERMAL OINTMENT NITRO-TIME ORAL CAPSULE EXTENDED RELEASE 2.5 MG, 6.5 MG Nitroglycerin ER *ANTIANXIETY AGENTS* *Antianxiety Agents - Misc.*** buspirone hcl oral tablet 10 mg, 15 mg, 5 mg, 7.5 mg buspirone hcl oral tablet 30 mg PA hydroxyzine hcl oral syrup hydroxyzine hcl oral tablet hydroxyzine pamoate oral capsule Vistaril *Benzodiazepines*** alprazolam er oral tablet extended release 24 hour Xanax XR alprazolam oral tablet Xanax alprazolam oral tablet dispersible alprazolam xr oral tablet extended release 24 hour Xanax XR chlordiazepoxide hcl oral capsule clorazepate dipotassium oral tablet diazepam oral solution 1 mg/ml lorazepam oral concentrate LORazepam Intensol lorazepam oral tablet Ativan oxazepam oral capsule ALPRAZOLAM INTENSOL ORAL CONCENTRATE 6

10 LORAZEPAM INTENSOL ORAL CONCENTRATE *ANTIARRHYTHMICS* *Antiarrhythmics Type I-A*** disopyramide phosphate oral capsule quinidine gluconate er oral tablet extended release quinidine sulfate oral tablet *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, 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 LORazepam Norpace Pacerone Amiodarone HCl Theochron Theophylline ER 7

11 *ANTIDEPRESSANTS* *Antidepressants - Misc.*** maprotiline hcl oral tablet *Tricyclic Agents*** amitriptyline hcl oral tablet amoxapine oral tablet clomipramine hcl oral capsule desipramine hcl oral tablet doxepin hcl oral capsule doxepin hcl oral concentrate nortriptyline hcl oral capsule protriptyline hcl oral tablet *ANTIDIABETICS* *Alpha-Glucosidase Inhibitors*** acarbose oral tablet *Diabetic Other*** GLUCAGEN HYPOKIT INJECTION SOLUTION RECONSTITUTED GLUCAGON EMERGENCY INJECTION KIT *Sulfonylurea-Biguanide Combinations*** glipizide-metformin hcl oral tablet glyburide-metformin oral tablet *Sulfonylureas*** chlorpropamide oral tablet glimepiride oral tablet glipizide er oral tablet extended release 24 hour glipizide oral tablet glipizide xl oral tablet extended release 24 hour glyburide micronized oral tablet glyburide oral tablet tolazamide oral tablet tolbutamide oral tablet Anafranil Norpramin Pamelor Precose Amaryl Glucotrol XL Glucotrol Glucotrol XL Glynase QLL (2 EA per 30 days) QLL (2 EA per 30 days) 8

12 *ANTIDIARRHEALS* *Antiperistaltic Agents*** anti-diarrheal oral capsule Imodium A-D diphenoxylate-atropine oral liquid diphenoxylate-atropine oral tablet Lomotil lofene oral tablet Lomotil loperamide hcl oral capsule Imodium A-D paregoric oral tincture *ANTIDOTES* *Antidotes - Chelating Agents*** CHEMET ORAL CAPSULE *Opioid Antagonists*** naltrexone hcl oral tablet *ANTIEMETICS* *5-Ht3 Receptor Antagonists*** ondansetron hcl oral tablet 24 mg QLL (2 EA per 30 days) *Antiemetics - Anticholinergic*** meclizine hcl oral tablet meclizine hcl oral tablet chewable motion sickness relief oral tablet chewable trimethobenzamide hcl oral capsule Tigan DRAMAMINE LESS DROWSY ORAL TABLET GNP Motion Sickness Relief *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** allergy childrens oral liquid Total Allergy Medicine allergy relief childrens oral liquid Total Allergy Medicine allergy relief oral capsule Benadryl Dye-Free Allergy allerhist-1 oral tablet Dayhist Allergy 12 Hour Relief clemastine fumarate oral tablet 1.34 mg Dayhist Allergy 12 Hour Relief clemastine fumarate oral tablet 2.68 mg complete allergy medicine oral capsule Benadryl Dye-Free Allergy diphenhist oral capsule Benadryl Dye-Free Allergy diphenhydramine hcl oral capsule Benadryl Dye-Free Allergy diphenhydramine hcl oral elixir silphen cough oral syrup 9

13 DAYHIST ALLERGY 12 HOUR RELIEF ORAL TABLET Clemastine Fumarate *Antihistamines - Non-Sedating*** all day allergy childrens oral tablet chewable 10 mg Wal-Zyr Childrens ; QLL (1 UNIT per 1 day) all day allergy oral tablet ZyrTEC Allergy ; QLL (1 UNIT per 1 day) allergy relief child oral syrup Claritin ; QLL (300 ML per 30 days) allergy relief childrens oral tablet chewable Wal-Zyr Childrens ; QLL (1 UNIT per 1 day) cetirizine hcl allergy child oral solution ZyrTEC Childrens Allergy QLL (300 ML per 30 days) cetirizine hcl childrens oral solution 5 mg/5ml ZyrTEC Childrens Allergy ; QLL (300 ML per 30 days) cetirizine hcl hives relief oral solution ZyrTEC Childrens Allergy ; QLL (300 ML per 30 days) cetirizine hcl oral tablet ; QLL (1 UNIT per 1 day) cetirizine hcl oral tablet chewable Wal-Zyr Childrens ; QLL (1 UNIT per 1 day) loratadine allergy relief oral tablet dispersible Wal-vert ; QLL (1 UNIT per 1 day) loratadine hives relief oral solution Claritin ; QLL (300 ML per 30 days) loratadine oral tablet KLS AllerClear ; QLL (1 UNIT per 1 day) ALAVERT ORAL TABLET RA Loratadine ; QLL (1 UNIT per 1 day) ALAVERT ORAL TABLET DISPERSIBLE Meijer Allergy Relief ; QLL (1 UNIT per 1 day) CLARITIN ALLERGY CHILDRENS Loratadine Childrens ORAL SYRUP TRIAMINIC ALLERCHEWS ORAL Meijer Allergy Relief TABLET DISPERSIBLE *Antihistamines - Phenothiazines*** promethazine hcl oral solution promethazine hcl oral syrup promethazine hcl oral tablet promethazine hcl rectal suppository Phenergan 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 ; QLL (300 ML per 30 days) ; QLL (1 UNIT per 1 day) 10

14 *ANTIHYPERTENSIVES* *Ace Inhibitors*** captopril oral tablet 12.5 mg, 25 mg, 50 mg QLL (90 EA per 30 days) *Adrenolytics-Central & Thiazide/Thiazide-Like Comb*** methyldopa-hydrochlorothiazide oral tablet *Antiadrenergics - Centrally Acting*** methyldopa oral tablet *Antiadrenergics - Peripherally Acting*** prazosin hcl oral capsule Minipress *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 Sulfatrim Pediatric suspension mg/5ml sulfamethoxazole-trimethoprim oral tablet Bactrim SULFATRIM PEDIATRIC ORAL Sulfamethoxazole- SUSPENSION Trimethoprim *Leprostatics*** dapsone oral tablet *Lincosamides*** clindamycin hcl oral capsule Cleocin clindamycin palmitate hcl oral solution Cleocin reconstituted *Oxazolidinones*** linezolid in sodium chloride intravenous PA solution linezolid intravenous solution 600 mg/300ml Zyvox PA 11

15 linezolid oral suspension reconstituted Zyvox PA linezolid oral tablet Zyvox PA ZYVOX INTRAVENOUS SOLUTION 200 MG/100ML PA ZYVOX INTRAVENOUS SOLUTION 600 Linezolid MG/300ML PA ZYVOX ORAL SUSPENSION RECONSTITUTED Linezolid PA ZYVOX ORAL TABLET Linezolid PA *ANTIMALARIALS* *Antimalarials*** hydroxychloroquine sulfate oral tablet Plaquenil mefloquine hcl oral tablet *ANTIMYASTHENIC AGENTS* *Antimyasthenic Agents*** pyridostigmine bromide oral tablet Mestinon *Antimyasthenic/Cholinergic Agents*** pyridostigmine bromide oral tablet Mestinon *ANTIMYASTHENIC/CHOLINER GIC AGENTS* pyridostigmine bromide oral tablet Mestinon *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 12

16 *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 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 *Antineoplastics Misc.*** hydroxyurea oral capsule Hydrea INTRON A INJECTION SOLUTION PA 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 13

17 *Lhrh Analogs*** LUPRON DEPOT (1-MONTH) INTRAMUSCULAR KIT LUPRON DEPOT (3-MONTH) INTRAMUSCULAR KIT LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT *Mitotic Inhibitors*** etoposide oral capsule *Nitrogen Mustards*** ALKERAN ORAL TABLET LEUKERAN ORAL TABLET *Nitrosoureas*** GLEOSTINE ORAL CAPSULE 10 MG *Progestins-Antineoplastic*** hydroxyprogesterone caproate intramuscular solution *Retinoids*** tretinoin oral capsule *Selective Retinoid X Receptor Agonists*** bexarotene oral capsule Targretin *Urinary Tract Protective Agents*** MESNEX ORAL TABLET *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 PA PA PA PA 14

18 *Dibenzoxazepines*** loxapine succinate oral capsule *Phenothiazines*** chlorpromazine hcl oral tablet fluphenazine hcl oral concentrate fluphenazine hcl oral elixir fluphenazine hcl oral tablet perphenazine oral tablet prochlorperazine maleate oral tablet 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 PA; QLL (112 EA per 28 days) THALOMID ORAL CAPSULE 150 MG, 200 MG PA; QLL (56 EA per 28 days) THALOMID ORAL CAPSULE 50 MG PA; QLL (224 EA per 28 days) *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 Kionex KIONEX ORAL POWDER Sodium Polystyrene Sulfonate KIONEX ORAL SUSPENSION Sodium Polystyrene Sulfonate SPS ORAL SUSPENSION Sodium Polystyrene Sulfonate *CARDIOTONICS* *Cardiac Glycosides*** digoxin oral solution digoxin oral tablet Digitek DIGITEK ORAL TABLET Digoxin DIGOX ORAL TABLET Digoxin 15

19 *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 *CONTRACEPTIVES* *Biphasic Contraceptives - Oral*** desogestrel-ethinyl estradiol oral tablet /0.01 mg (21/5) Kimidess viorele oral tablet Kimidess AZURETTE ORAL TABLET Desogestrel-Ethinyl Estradiol BEKYREE ORAL TABLET Desogestrel-Ethinyl Estradiol KARIVA ORAL TABLET Desogestrel-Ethinyl Estradiol 16

20 KIMIDESS ORAL TABLET Desogestrel-Ethinyl Estradiol NECON 10/11 (28) ORAL TABLET PIMTREA ORAL TABLET Desogestrel-Ethinyl Estradiol *Combination Contraceptives - Oral*** alyacen 1/35 oral tablet Dasetta 1/35 briellyn oral tablet Philith drospirenone-ethinyl estradiol oral tablet mg Yasmin 28 levonorgestrel-ethinyl estrad oral tablet mg-mcg Aubra levonorgestrel-ethinyl estrad oral tablet mg-mcg Altavera marlissa oral tablet Altavera norethin ace-eth estrad-fe oral tablet 1-20 mgmcg Blisovi FE 1/20 norethindrone acet-ethinyl est oral tablet Larin 1/20 norgestimate-eth estradiol oral tablet mg-mcg MonoNessa ALTAVERA ORAL TABLET Levonorgestrel-Ethinyl Estrad APRI ORAL TABLET 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 Levonorgestrel-Ethinyl Estrad CRYSELLE-28 ORAL TABLET CYCLAFEM 1/35 ORAL TABLET Alyacen 1/35 CYRED ORAL TABLET DASETTA 1/35 ORAL TABLET Alyacen 1/35 DELYLA ORAL TABLET Levonorgestrel-Ethinyl Estrad ELINEST ORAL TABLET EMOQUETTE ORAL TABLET ENSKYCE ORAL TABLET ESTARYLLA ORAL TABLET Norgestimate-Eth Estradiol FALMINA ORAL TABLET Levonorgestrel-Ethinyl Estrad GILDAGIA ORAL TABLET Briellyn GILDESS FE 1.5/30 ORAL TABLET 17

21 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 Norethin Ace-Eth Estrad-FE Norethindrone Acet-Ethinyl Est Norethin Ace-Eth Estrad-FE Levonorgestrel-Ethinyl Estrad Norethindrone Acet-Ethinyl Est Norethin Ace-Eth Estrad-FE Levonorgestrel-Ethinyl Estrad Levonorgestrel-Ethinyl Estrad Levonorgestrel-Ethinyl Estrad Levonorgestrel-Ethinyl Estrad MICROGESTIN 1/20 ORAL TABLET Norethindrone Acet-Ethinyl 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 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 Levonorgestrel-Ethinyl Estrad 18

22 PREVIFEM ORAL TABLET Norgestimate-Eth Estradiol RECLIPSEN ORAL TABLET 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 Take Action AFTERA ORAL TABLET Levonorgestrel ECONTRA EZ ORAL TABLET Levonorgestrel FALLBACK SOLO ORAL TABLET Levonorgestrel 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 19

23 *Progestin Contraceptives - Injectable*** medroxyprogesterone acetate intramuscular Depo-Provera suspension *Progestin Contraceptives - Iud*** KYLEENA INTRAUTERINE INTRAUTERINE DEVICE LILETTA (52 MG) INTRAUTERINE INTRAUTERINE DEVICE MIRENA (52 MG) INTRAUTERINE INTRAUTERINE DEVICE SKYLA INTRAUTERINE INTRAUTERINE DEVICE *Progestin Contraceptives - Oral*** norethindrone oral tablet Deblitane 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 Pirmella 7/7/7 levonorg-eth estrad triphasic oral tablet Myzilra norgestim-eth estrad triphasic oral tablet Tri-Estarylla 0.18/0.215/0.25 mg-35 mcg ARANELLE ORAL TABLET CAZIANT ORAL TABLET CYCLAFEM 7/7/7 ORAL TABLET Alyacen 7/7/7 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 QLL (1 EA per 999 days) QLL (1 EA per 999 days) QLL (1 EA per 999 days) QLL (1 EA per 999 days) 20

24 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 TRI-LEGEST FE ORAL TABLET TRI-LINYAH ORAL TABLET TRINESSA (28) ORAL TABLET TRI-PREVIFEM ORAL TABLET TRI-SPRINTEC ORAL TABLET TRIVORA (28) ORAL TABLET VELIVET ORAL TABLET *CORTICOSTEROIDS* *Glucocorticosteroids*** cortisone acetate oral tablet dexamethasone oral elixir dexamethasone oral solution dexamethasone oral tablet 0.5 mg, 0.75 mg, 1.5 mg, 2 mg, 4 mg, 6 mg hydrocortisone oral tablet methylprednisolone oral tablet methylprednisolone oral tablet therapy pack prednisolone oral solution prednisolone oral syrup 15 mg/5ml prednisolone sodium phosphate oral solution 15 mg/5ml prednisolone sodium phosphate oral solution 6.7 (5 base) mg/5ml prednisone oral solution prednisone oral tablet prednisone oral tablet therapy pack DELTASONE ORAL TABLET DEXPAK 10 DAY ORAL TABLET THERAPY PACK DEXPAK 6 DAY ORAL TABLET THERAPY PACK Norgestim-Eth Estrad Triphasic Norgestim-Eth Estrad Triphasic Norgestim-Eth Estrad Triphasic Norgestim-Eth Estrad Triphasic Norgestim-Eth Estrad Triphasic Levonorg-Eth Estrad Triphasic Cortef Medrol Medrol Pediapred PredniSONE QLL (21 EA per 21 days) 21

25 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 *Antitussive - Opioid*** hydrocodone-homatropine oral syrup hydromet oral syrup *Antitussive-Expectorant*** cheratussin ac oral syrup childrens mucus relief cough oral liquid Delsym Cough/Chest Congest DM dextromethorphan-guaifenesin oral solution Tolu-Sed DM dextromethorphan-guaifenesin oral syrup Robitussin Peak Cold DM diabetic siltussin-dm max st oral liquid Diabetic Tussin Max St diabetic siltussin-dm oral liquid Tolu-Sed DM guaiatussin ac oral syrup guaifenesin-codeine oral solution guaifenesin-dm oral syrup Robitussin Peak Cold DM intense cough reliever oral liquid mg/5ml m-clear wc oral solution medi-tussin dm double strength oral liquid mucus relief cough childrens oral liquid Delsym Cough/Chest Congest DM neotuss oral liquid relcof c oral solution trymine cg oral liquid Mar-Cof CG Expectorant DELSYM CGH/CHEST CONG DM CHILD ORAL LIQUID DELSYM COUGH/CHEST CONGEST DM ORAL LIQUID DIABETIC TUSSIN DM ORAL LIQUID DIABETIC TUSSIN FOR CHILDREN ORAL LIQUID SM Mucus Relief Cough Children SM Mucus Relief Cough Children Dextromethorphan- Guaifenesin Dextromethorphan- Guaifenesin 22

26 DIABETIC TUSSIN MAX ST ORAL LIQUID MUCINEX COUGH CHILDRENS ORAL LIQUID ROBITUSSIN COLD COUGH+ CHEST ORAL LIQUID ROBITUSSIN COUGH+CHEST CONG DM ORAL LIQUID MG/5ML 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*** Tussin DM Max SM Mucus Relief Cough Children Dextromethorphan- Guaifenesin SM Mucus Relief Cough Children Dextromethorphan- Guaifenesin Wal-itin D 24 Hour Wal-itin D 24 Hour Claritin-D 12 Hour Wal-itin D 24 Hour CVS Allergy Relief-D12 eq tussin oral liquid Diabetic Tussin guaifenesin oral liquid Diabetic Tussin guaifenesin oral solution Diabetic Tussin guaifenesin oral syrup Diabetic Tussin EX guaifenesin oral tablet 200 mg organ-i nr oral tablet refenesen oral tablet scot-tussin expectorant oral liquid Diabetic Tussin BUCKLEYS CHEST CONGESTION ORAL LIQUID CVS Chest Congestion Childrens ; 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 RA Tussin MUCINEX CHEST CONGESTION CHILD ORAL LIQUID ROBITUSSIN MUCUS+CHEST CONGEST ORAL LIQUID *Misc. Respiratory Inhalants*** sodium chloride inhalation nebulization solution 0.9 %, 10 % CVS Chest Congestion Childrens CVS Chest Congestion Childrens 23

27 sodium chloride inhalation nebulization solution 3 % Nebusal sodium chloride inhalation nebulization solution 7 % HyperSal NEBUSAL INHALATION NEBULIZATION SOLUTION 3 % Sodium Chloride PULMOSAL INHALATION NEBULIZATION SOLUTION Sodium Chloride *Mucolytics*** acetylcysteine inhalation solution *Non-Narc Antitussive- Antihistamine*** promethazine-dm oral syrup *Opioid Antitussive- Antihistamine*** promethazine-codeine oral syrup QLL (120 UNITS per 1 RX) *Opioid Antitussive-Decongestant- Antihistamine*** promethazine vc/codeine oral syrup QLL (120 UNITS per 1 RX) *DERMATOLOGICALS* *Acne Products*** CLARAVIS ORAL CAPSULE ST MYORISAN ORAL CAPSULE ST ZENATANE ORAL CAPSULE ST *Antibiotic Mixtures Topical*** bacitracin-neomycin-polymyxin external ointment Lanabiotic triple antibiotic external ointment , Lanabiotic *Antifungals - Topical*** antifungal external cream 1 % Tinactin Jock Itch tolnaftate external cream Tinactin Jock Itch *Antineoplastic Antimetabolites - Topical*** fluorouracil external solution *Antiseborrheic Combinations*** selenium sulfide external shampoo selenium sulf-pyrithione-urea external shampoo 24

28 *Antiseborrheic Products*** selenium sulfide external lotion *Burn Products*** silver sulfadiazine external cream Silvadene SSD EXTERNAL CREAM Silver Sulfadiazine *Emollients*** ammonium lactate external cream Lac-Hydrin ammonium lactate external lotion Lac-Hydrin glycerin external liquid ra gentle skin external cream Albolene ALBOLENE EXTERNAL CREAM Beta Care AMLACTIN EXTERNAL LOTION CVS Hydrating Skin Treatment AVEENO INTENSE RELIEF HAND EXTERNAL CREAM Beta Care CERAVE EXTERNAL CREAM Beta Care CETAPHIL EXTERNAL CREAM Beta Care CETAPHIL MOISTURIZING EXTERNAL CREAM Beta Care EUCERIN PLUS INTENSIVE REPAIR EXTERNAL CREAM Beta Care GERI-HYDROLAC 12 EXTERNAL CREAM Ammonium Lactate GOLD BOND ULTIMATE HEALING EXTERNAL CREAM Beta Care NEUTROGENA HAND EXTERNAL CREAM Beta Care NEUTROGENA HEALTHY SKIN EXTERNAL CREAM Beta Care NIVEA EXTERNAL CREAM Beta Care NUTRADERM EXTERNAL CREAM Beta Care *Imidazole-Related Antifungals - Topical*** clotrimazole af external cream Lotrimin AF Jock Itch clotrimazole anti-fungal external cream Lotrimin AF Jock Itch clotrimazole external cream Lotrimin AF Jock Itch clotrimazole external solution FungiCure Intensive/NailGuard DESENEX EXTERNAL CREAM Pro-Ex Antifungal DESENEX EXTERNAL POWDER Miconazorb AF 25

29 FUNGICURE INTENSIVE/NAILGUARD EXTERNAL SOLUTION Clotrimazole LOTRIMIN AF EXTERNAL POWDER Miconazorb AF ZEASORB-AF EXTERNAL POWDER Miconazorb AF *Keratolytic/Antimitotic Agents*** salicylic acid external cream Salacyn salicylic acid external foam Salvax salicylic acid external lotion Salacyn salicylic acid external shampoo Salex 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 *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 26 Liberty Test Liberty Test Diamox Sequels Neptazane Aldactazide Dyazide ; QLL (150 EA per 30 days) ; QLL (150 EA per 30 days)

30 triamterene-hctz oral tablet *Loop Diuretics*** bumetanide oral tablet Maxzide-25 Bumex furosemide oral solution 10 mg/ml, 8 mg/ml furosemide oral tablet Lasix torsemide oral tablet *Potassium Sparing Diuretics*** amiloride hcl oral tablet spironolactone oral tablet Aldactone *Thiazides And Thiazide-Like Diuretics*** chlorothiazide oral tablet chlorthalidone oral tablet 25 mg, 50 mg hydrochlorothiazide oral capsule Microzide 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 Carnitor SF levocarnitine oral tablet Carnitor *Hyperparathyroid Treatment - Vitamin D Analogs*** calcitriol oral capsule Rocaltrol calcitriol oral solution Rocaltrol *Somatostatic Agents*** 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 QLL (2 UNITS per 1 day) PA PA 27

31 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 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 generlac oral solution lactulose encephalopathy oral solution *GENITOURINARY AGENTS - MISCELLANEOUS* *Citrates*** cytra k crystals oral packet Taron-Crystals potassium citrate er oral tablet extended release 10 meq (1080 mg) Urocit-K 10 potassium citrate er oral tablet extended release 5 meq (0 mg) Urocit-K 5 28

32 potassium citrate-citric acid oral packet Taron-Crystals 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 Potassium Citrate-Citric Acid *Urinary Analgesics*** phenazopyridine hcl oral tablet 100 mg, 200 mg Pyridium PHENAZO ORAL TABLET 200 MG Phenazopyridine HCl *HEMATOLOGICAL AGENTS - MISC.* *Phosphodiesterase Iii Inhibitors*** cilostazol oral tablet *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 Icar-C Plus iron 100 plus oral tablet Icar-C Plus myferon 150 forte oral capsule iferex 150 Forte poly-iron 150 forte oral capsule iferex 150 Forte polysaccharide iron forte oral capsule iferex 150 Forte tl-hem 150 oral tablet Hematron-AF 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 29

33 INTEGRA F ORAL CAPSULE *Iron*** fe tabs oral tablet delayed release ferretts oral tablet 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 ferrous sulfate oral tablet delayed release 325 (65 fe) mg ferrousul oral tablet iron high-potency oral tablet iron oral tablet 325 (65 fe) mg myferon 150 oral capsule Nu-Iron px iron oral tablet 200 (65 fe) mg Feosol wee care oral suspension Icar EZFE 200 ORAL CAPSULE FEROSUL ORAL ELIXIR Ferrous Sulfate IFEREX 150 ORAL CAPSULE Ferric x-150 NU-IRON ORAL CAPSULE Ferric x-150 POLY-IRON 150 ORAL CAPSULE Ferric x-150 *LAXATIVES* *Laxatives - Miscellaneous*** constulose oral solution lactulose oral solution sorbitol oral solution *Stimulant Laxatives*** castor oil stimulant laxative oral oil geri-kot oral tablet Senokot senna oral tablet 8.6 mg Senokot senna-lax oral tablet Senokot DR EDWARDS OLIVE LAXATIVE ORAL TABLET Geri-kot SENNACON ORAL TABLET Geri-kot *Surfactant Laxatives*** docqlace oral capsule Phillips Stool Softener 30

34 docusate sodium oral capsule 100 mg Phillips Stool Softener stool softener oral capsule 100 mg Phillips Stool Softener CORRECTOL EXTRA GENTLE ORAL CAPSULE DSS DOCUSIL ORAL CAPSULE DSS DOK ORAL CAPSULE 100 MG DSS PHILLIPS STOOL SOFTENER ORAL CAPSULE DSS SOF-LAX ORAL CAPSULE DSS *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 GlucoCom Control diatrue control level 1 in vitro solution FortisCare Control diatrue control level 2 in vitro solution GlucoCom Control diatrue control level 3 in vitro solution Prodigy Control Solution easy plus ii control in vitro solution Prodigy Control Solution easy talk control in vitro solution Prodigy Control Solution easy trak control in vitro solution Prodigy Control Solution element compact control 2 in vitro solution Accu-Chek Compact Plus Control element compact control 3 in vitro solution Accu-Chek Compact Plus Control ge100 control in vitro solution GlucoCom Control 31

35 glucose control in vitro solution Accu-Chek Compact Plus Control lancets Fingerstix Lancets select-lite device/lancets kit Autolet Lite Starter Pack supreme ii high/low control in vitro liquid Accu-Chek Compact Plus Control ACCU-CHEK AVIVA IN VITRO SOLUTION ACCU-CHEK COMPACT PLUS CONTROL IN VITRO SOLUTION 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 ACCU-CHEK SOFTCLIX LANCET DEV KIT Select-Lite Device/Lancets ACCUTREND GLUCOSE CONTROL IN VITRO SOLUTION ADVANCE INTUITION CONTROL IN VITRO LIQUID Easy Talk Control ADVANCE MICRO-DRAW CONTROL IN VITRO LIQUID ADVANCE MICRO-DRAW NORMAL IN VITRO LIQUID ADVOCATE CONTROL SOLUTION IN VITRO LIQUID DiaTrue Control Level 3 ADVOCATE REDI-CODE+ CONTROL IN VITRO SOLUTION DiaTrue Control Level 3 AGAMATRIX CONTROL IN VITRO SOLUTION ASSURE 3 CONTROL IN VITRO LIQUID ASSURE 4 CONTROL LEVEL 1 & 2 IN VITRO LIQUID ASSURE DOSE CONTROL IN VITRO SOLUTION Easy Talk Control ASSURE DOSE NORM/HIGH CONTROL IN VITRO SOLUTION ASSURE II CONTROL IN VITRO LIQUID ASSURE II CONTROL LEVEL 1 & 2 IN VITRO LIQUID 32

36 ASSURE PRISM CONTROL LEVEL 1&2 IN VITRO SOLUTION ASSURE PRO CONTROL LEVEL 1 & 2 IN VITRO LIQUID AT LAST CONTROL IN VITRO SOLUTION 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 DiaTrue Control Level 3 LIQUID BAYER CONTOUR IN VITRO LIQUID DiaTrue Control Level 3 BAYER CONTOUR NEXT CONTROL IN Easy Talk Control VITRO SOLUTION CARESENS CONTROL A IN VITRO SOLUTION CLEVER CHOICE GLUCOSE CONTROL IN VITRO LIQUID DiaTrue Control Level 3 COOL CONTROL A IN VITRO SOLUTION COOL CONTROL B IN VITRO SOLUTION DUO-CARE CONTROL SOLUTION IN VITRO LIQUID EASY STEP CONTROL IN VITRO SOLUTION DiaTrue Control Level 3 EASY TOUCH CONTROL HIGH & LOW IN VITRO SOLUTION EASY TOUCH HEALTHPRO CONTROL IN VITRO SOLUTION EASYGLUCO CONTROL IN VITRO SOLUTION DiaTrue Control Level 3 EASYGLUCO PLUS LEVEL 1 IN VITRO SOLUTION EASYMAX 15 LEVEL 1 CONTROL IN VITRO SOLUTION EASYMAX 15 LEVEL 2 CONTROL IN VITRO SOLUTION EASYMAX CONTROL IN VITRO SOLUTION DiaTrue Control Level 3 ELEMENT CONTROL IN VITRO LIQUID DiaTrue Control Level 3 33

37 EMBRACE CONTROL IN VITRO SOLUTION DiaTrue Control Level 1 EMBRACE EVO CONTROL LEVEL 1 IN DiaTrue Control Level 1 VITRO LIQUID EMBRACE EVO CONTROL LEVEL 2 IN Easy Talk Control VITRO LIQUID EMBRACE GLUCOSE CONTROL IN VITRO LIQUID DiaTrue Control Level 3 EMBRACE PRO GLUCOSE CONTROL IN VITRO LIQUID EVENCARE CONTROL LOW/HIGH IN VITRO LIQUID EVENCARE G2 LOW/HIGH CONTROL IN VITRO SOLUTION EVENCARE G3 LOW/HIGH CONTROL IN VITRO SOLUTION EVENCARE MINI CONTROL IN VITRO Easy Talk Control SOLUTION EVOLUTION CONTROL IN VITRO SOLUTION Easy Talk Control FORA CONTROL IN VITRO SOLUTION DiaTrue Control Level 3 FORACARE GDH CONTROL IN VITRO SOLUTION DiaTrue Control Level 3 FORTISCARE CONTROL IN VITRO SOLUTION DiaTrue Control Level 3 FREESTYLE CONTROL SOLUTION IN VITRO LIQUID GLUCOCARD 01 CONTROL IN VITRO LIQUID GLUCOCARD 01 CONTROL IN VITRO SOLUTION Easy Talk Control GLUCOCARD EXPRESSION CONTROL IN VITRO SOLUTION GLUCOCARD SHINE CONTROL IN VITRO SOLUTION GLUCOCARD X-SENSOR CONTROL IN Easy Talk Control VITRO SOLUTION GLUCOCOM CONTROL IN VITRO LIQUID DiaTrue Control Level 3 GMATE CONTROL LEVEL 2 IN VITRO SOLUTION GNP EASY TOUCH CONT HIGH/LOW IN VITRO SOLUTION 34

38 HYPOLANCE AST LANCING KIT Select-Lite Device/Lancets IN TOUCH GLUCOSE CONTROL IN VITRO SOLUTION INFINITY CONTROL IN VITRO SOLUTION DiaTrue Control Level 3 LIBERTY GLUCOSE CONTROL IN VITRO LIQUID Easy Talk Control LIBERTY GLUCOSE CONTROL IN VITRO SOLUTION LIBERTY GLUCOSE CONTROL MID IN VITRO SOLUTION MEDISENSE GLUCOSE KETONE CONTR IN VITRO LIQUID MEDISENSE HI/MID/LOW CONTROL IN VITRO LIQUID MEDISENSE HIGH/LOW CONTROL IN VITRO LIQUID MEDISENSE MID CONTROL IN VITRO LIQUID MICRODOT CONTROL HIGH/LOW IN VITRO SOLUTION MULTI-LANCET DEVICE 2 KIT Select-Lite Device/Lancets MYGLUCOHEALTH CONTROL IN VITRO SOLUTION NEUTEK 2TEK CONTROL IN VITRO SOLUTION NEXGEN CONTROL IN VITRO LIQUID Easy Talk Control NOVA MAX PLUS GLU/KET CONTROL IN VITRO LIQUID ON CALL EXPRESS GLUCOSE CONTR IN VITRO SOLUTION ON CALL PLUS GLUCOSE CONTROL IN VITRO SOLUTION ON CALL VIVID GLUCOSE CONTROL IN VITRO SOLUTION ONETOUCH ULTRA 2 KIT GE100 Blood Glucose System ONETOUCH ULTRA CONTROL IN VITRO SOLUTION ONETOUCH ULTRA MINI KIT GE100 Blood Glucose System ONETOUCH ULTRALINK KIT GE100 Blood Glucose System ONETOUCH VERIO IN VITRO SOLUTION ONETOUCH VERIO IQ SYSTEM KIT GE100 Blood Glucose System 35

39 ONETOUCH VERIO KIT GE100 Blood Glucose System ONETOUCH VERIO SYNC SYSTEM KIT GE100 Blood Glucose System OPTUMRX GLUCOSE CONTROL IN VITRO SOLUTION PENLET II BLOOD SAMPLER KIT Select-Lite Device/Lancets POCKETCHEM EZ CONTROL IN VITRO SOLUTION PRECISION GLUCOSE CONTROL IN VITRO LIQUID PRECISION GLUCOSE CONTROL SOLN IN VITRO SOLUTION PRECISION GLUCOSE KETONE CONTR IN VITRO LIQUID PRECISION GLUCOSE/KETONE CONTR IN VITRO LIQUID PRODIGY CONTROL SOLUTION IN VITRO SOLUTION DiaTrue Control Level 3 QUICKTEK CONTROL SOLUTION IN VITRO LIQUID QUINTET CONTROL HIGH/NORMAL IN VITRO SOLUTION REFUAH PLUS GLUCOSE CONTROL IN VITRO SOLUTION RELION LANCING DEVICE KIT Select-Lite Device/Lancets RIGHTEST GC300 CONTROL IN VITRO DiaTrue Control Level 3 LIQUID SMARTEST CONTROL MEDIUM IN VITRO SOLUTION SOLARTEK GLUCOSE CONTROL IN VITRO LIQUID SOLUS V2 CONTROL IN VITRO SOLUTION DiaTrue Control Level 3 SURESTEP GLUCOSE CONTROL IN VITRO SOLUTION SURESTEP PRO HIGH GLUCOSE IN VITRO LIQUID DiaTrue Control Level 3 SURESTEP PRO LOW GLUCOSE IN VITRO LIQUID DiaTrue Control Level 1 SURESTEP PRO NORMAL GLUCOSE IN VITRO LIQUID Easy Talk Control TAI DOC CONTROL IN VITRO SOLUTION Easy Talk Control 36

40 TELCARE GLUCOSE CONTROL IN VITRO SOLUTION TRUE METRIX LEVEL 1 IN VITRO SOLUTION DiaTrue Control Level 1 TRUE METRIX LEVEL 2 IN VITRO SOLUTION Easy Talk Control TRUE METRIX LEVEL 3 IN VITRO SOLUTION DiaTrue Control Level 3 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 DiaTrue Control Level 3 VICTORY CONTROL LEVEL 1/2 IN VITRO SOLUTION *Misc. Devices*** folding paddle walker Precision Specimen Container ; QLL (1 UNIT per 1 day) *Needles & Syringes*** elite-thin insulin syringe 31g x 5/16" 0.5 ml Ultra-Thin II Ins Syr Short global inject ease insulin syr 29g x 1/2" 0.3 ml BD Insulin Syringe Ultrafine global inject ease insulin syr 30g x 5/16" 0.3 ml Ultilet Insulin Syringe Short insulin syringe 29g x 1" 0.3 ml insulin syringe 29g x 1/2" 0.3 ml, 29g x 1/2" 1 BD Insulin Syringe Ultrafine ml insulin syringe 30g x 5/16" 0.3 ml Ultilet Insulin Syringe Short insulin syringe 30g x 5/16" 1 ml Comfort Assist Insulin Syringe insulin syringe 31g x 5/16" 0.3 ml TRUEplus Insulin Syringe insulin syringe 31g x 5/16" 0.5 ml Ultra-Thin II Ins Syr Short insulin syringe 31g x 5/16" 1 ml Fifty50 Superior Comfort Syr insulin syringe/needle Easy Touch Insulin Syringe 37

41 kmart valu insulin syringe 29g kmart valu insulin syringe 30g leader insulin syringe 29g x 1/2" 0.3 ml BD Insulin Syringe Ultrafine leader insulin syringe 30g x 5/16" 0.3 ml Ultilet Insulin Syringe Short medic insulin syringe 30g x 5/16" 0.3 ml Ultilet Insulin Syringe Short preferred plus insulin syringe 29g x 1/2" 0.3 ml BD Insulin Syringe Ultrafine preferred plus insulin syringe 30g x 5/16" 0.3 ml Ultilet Insulin Syringe Short sure comfort insulin syringe 29g x 1/2" 0.3 ml BD Insulin Syringe Ultrafine sure comfort insulin syringe 30g x 1/2" 0.3 ml UltiCare Insulin Syringe sure comfort insulin syringe 30g x 5/16" 0.3 ml Ultilet Insulin Syringe Short topco insulin syringe 28g x 1/2" 1 ml UltiCare Insulin Syringe topco insulin syringe 29g x 1/2" 0.3 ml BD Insulin Syringe Ultrafine ultra comfort insulin syringe 30g x 5/16" 0.3 ml Ultilet Insulin Syringe Short ultra-comfort insulin syringe 29g x 1/2" 0.3 ml BD Insulin Syringe Ultrafine ultra-comfort insulin syringe 30g x 5/16" 0.3 ml Ultilet Insulin Syringe Short ADVOCATE INSULIN SYRINGE 29G X 1/2" 0.3 ML Insulin Syringe BD INSULIN SYR ULTRAFINE II EQL Insulin Syringe BD INSULIN SYRINGE 25G X 1" 1 ML, 25G X 5/8" 1 ML, 26G X 1/2" 1 ML BD INSULIN SYRINGE 27G X 1/2" 1 ML Safety Insulin Syringes BD INSULIN SYRINGE 30G X 1/2" 0.5 ML Insulin Syringe BD INSULIN SYRINGE 31G X 5/16" 0.3 ML Elite-Thin Insulin Syringe BD INSULIN SYRINGE HALF-UNIT Elite-Thin Insulin Syringe BD INSULIN SYRINGE MICROFINE 27G X 5/8" 1 ML BD INSULIN SYRINGE MICROFINE 28G X 1/2" 0.5 ML Insulin Syringe/Needle BD INSULIN SYRINGE MICROFINE 28G X 1/2" 1 ML Insulin Syringe BD INSULIN SYRINGE U ML Kmart Valu Insulin Syringe 30G BD INSULIN SYRINGE ULTRAFINE Insulin Syringe COMFORT ASSIST INSULIN SYRINGE 29G X 1/2" 0.3 ML Insulin Syringe 38

42 COMFORT EZ INSULIN SYRINGE 29G X 1/2" 0.3 ML Insulin Syringe EASY TOUCH INSULIN SYRINGE 27G X Insulin Syringe 1/2" 0.5 ML, 30G X 5/16" 0.3 ML EASY TOUCH INSULIN SYRINGE 27G X Safety Insulin Syringes 1/2" 1 ML EXEL COMFORT POINT INSULIN SYR 29G X 1/2" 0.3 ML Insulin Syringe LITETOUCH INSULIN SYRINGE 29G X 1/2" 0.3 ML, 30G X 5/16" 0.3 ML Insulin Syringe MAGELLAN INSULIN SAFETY SYR 29G Insulin Syringe X 1/2" 0.3 ML MONOJECT INSULIN SYRINGE 25G X 5/8" 1 ML MONOJECT INSULIN SYRINGE 27G X 1/2" 1 ML Safety Insulin Syringes MONOJECT INSULIN SYRINGE 29G X 1/2" 0.3 ML, 30G X 5/16" 0.3 ML Insulin Syringe MONOJECT INSULIN SYRINGE 29G X 1/2" 1 ML EQL Insulin Syringe MONOJECT INSULIN SYRINGE 30G X 5/16" 1 ML Elite-Thin Insulin Syringe MONOJECT INSULIN SYRINGE U ML MONOJECT ULTRA COMFORT SYRINGE 29G X 1/2" 0.3 ML MONOJECT ULTRA COMFORT SYRINGE 30G X 5/16" 0.3 ML PRECISION SUREDOSE PLUS SYR 29G X 1/2" 0.3 ML PRECISION SURE-DOSE SYRINGE 30G X 3/8" 0.5 ML PRECISION SURE-DOSE SYRINGE 30G X 5/16" 0.3 ML RELI-ON INSULIN SYRINGE 29G 0.3 ML, 29G 0.5 ML RELION INSULIN SYRINGE 29G X 1/2" 0.3 ML, 30G X 5/16" 0.3 ML Kmart Valu Insulin Syringe 30G Insulin Syringe Insulin Syringe Insulin Syringe Insulin Syringe Insulin Syringe SAFETY-GLIDE SYRINGE Insulin Syringe SURE-JECT INSULIN SYRINGE 29G X 1/2" 0.3 ML, 30G X 5/16" 0.3 ML Insulin Syringe TRUEPLUS INSULIN SYRINGE 29G X 1/2" 0.3 ML Insulin Syringe 39