HHSC Preferred Drug List (PDL) Recommendations April 27, of 17

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1 ANTI-ALLERGENS, ORAL GRASTEK (SUBLINGUAL) NPD NPD NPD For this, the Board believed ORALAIR (SUBLINGUAL) NPD NPD NPD that none of the drugs meet the fiscal requirements of the state and are the most safe and efficacious. RAGWITEK (SUBLINGUAL) NPD NPD NPD ANTIBIOTICS, INHALED BETHKIS (INHALATION) PDL PDL PDL X For this, the Board believed CAYSTON (INHALATION) PDL PDL PDL that all of the drugs being recommended as KITABIS PAK (INHALATION) PDL PDL PDL X preferred meet the fiscal requirements of the state TOBI (INHALATION) NPD NPD NPD TOBI PODHALER (INHALATION) PDL PDL PDL X TOBRAMYCIN PAK (AG) (INHALATION) NPD NPD NPD TOBRAMYCIN SOLUTION (AG) (INHALATION) NPD NPD NPD TOBRAMYCIN SOLUTION (INHALATION) NPD NPD NPD ANTICOAGULANTS ARIXTRA (SUBCUTANE.) NPD NPD NPD For this, the Board believed COUMADIN (ORAL) NPD NPD NPD that all of the drugs being recommended as ELIQUIS (ORAL) PDL PDL PDL X preferred meet the fiscal requirements of the state ENOXAPARIN SODIUM VIAL (AG) (SUBCUTANEOUS) PDL PDL PDL ENOXAPARIN SODIUM VIAL (SUBCUTANEOUS) PDL PDL PDL ENOXAPARIN SYRINGE (AG) (SUBCUTANE.) PDL PDL PDL ENOXAPARIN SYRINGE (SUBCUTANE.) PDL PDL PDL FONDAPARINUX (SUBCUTANE.) NPD NPD NPD FRAGMIN DISP SYRIN (SUBCUTANE.) PDL PDL PDL FRAGMIN VIAL (SUBCUTANE.) NPD NPD NPD LOVENOX SYRINGE (SUBCUTANE.) NPD NPD NPD X LOVENOX VIAL (SUBCUTANE.) NPD NPD NPD X PRADAXA (ORAL) PDL PDL PDL X SAVAYSA (ORAL) NPD NPD NPD WARFARIN (ORAL) PDL PDL PDL XARELTO (ORAL) PDL PDL PDL X XARELTO DOSE PACK (ORAL) PDL PDL PDL X ANTIDEPRESSANTS, OTHER APLENZIN (ORAL) NPD NPD NPD For this therapeutic drug class, the Board believed BUPROPION (ORAL) PDL PDL PDL that all of the drugs being recommended as BUPROPION SR (ORAL) PDL PDL PDL preferred demonstrated the greatest safety, BUPROPION XL (ORAL) PDL PDL PDL 1 of 17

2 p Therapeutic Drug g Class y, efficacy, and value and provided clinicians with the DESVENLAFAXINE ER (KHEDEZLA) (AG) (ORAL) NPD NPD NPD greatest number of first line options to use before DESVENLAFAXINE ER (NO BRAND) (ORAL) NPD NPD NPD requiring Prior Authorization. DESVENLAFAXINE ER (PRISTIQ) (AG) (ORAL) NPD NPD NPD DESVENLAFAXINE ER (PRISTIQ) (ORAL) NPD NPD NPD DESVENLAFAXINE FUMARATE ER (ORAL) NPD NPD NPD EFFEXOR XR (ORAL) NPD NPD NPD EMSAM (TRANSDERMAL) NPD NPD NPD FETZIMA (ORAL) NPD NPD NPD FORFIVO XL (ORAL) NPD NPD NPD KHEDEZLA (ORAL) NPD NPD NPD MARPLAN (ORAL) PDL PDL PDL MIRTAZAPINE ODT (ORAL) PDL PDL PDL MIRTAZAPINE TABLET (ORAL) PDL PDL PDL NARDIL (ORAL) NPD NPD NPD NEFAZODONE (ORAL) NPD NPD NPD PARNATE (ORAL) NPD NPD NPD PHENELZINE (ORAL) PDL PDL PDL PRISTIQ (ORAL) NPD NPD NPD REMERON ODT (ORAL) NPD NPD NPD REMERON TABLET (ORAL) NPD NPD NPD TRANYLCYPROMINE SULFATE (ORAL) NPD NPD NPD TRAZODONE (ORAL) PDL PDL PDL TRINTELLIX (ORAL) NPD NPD NPD VENLAFAXINE (ORAL) NPD NPD NPD VENLAFAXINE ER CAPSULES (ORAL) PDL PDL PDL VENLAFAXINE ER TABLETS (AG) (ORAL) NPD NPD NPD VENLAFAXINE ER TABLETS (ORAL) NPD NPD NPD VIIBRYD (ORAL) NPD NPD NPD VIIBRYD DOSE PACK (ORAL) NPD NPD NPD WELLBUTRIN SR (ORAL) NPD NPD NPD WELLBUTRIN XL (ORAL) NPD NPD NPD ANTIDEPRESSANTS, SSRIs BRISDELLE (ORAL) NPD NPD NPD For this therapeutic drug class, the Board believed CELEXA TABLET (ORAL) NPD NPD NPD that all of the drugs being recommended as CITALOPRAM SOLUTION (ORAL) PDL PDL PDL preferred demonstrated the greatest safety, CITALOPRAM TABLET (ORAL) PDL PDL PDL efficacy, and value and provided clinicians with the ESCITALOPRAM SOLUTION (ORAL) NPD NPD NPD greatest number of first line options to use before ESCITALOPRAM TABLET (ORAL) PDL PDL PDL requiring Prior Authorization. FLUOXETINE 60 MG (ORAL) PDL PDL PDL FLUOXETINE CAPSULE (ORAL) PDL PDL PDL FLUOXETINE CAPSULE DR (ORAL) NPD NPD NPD FLUOXETINE SOLUTION (ORAL) PDL PDL PDL FLUOXETINE TABLET (ORAL) PDL PDL PDL FLUVOXAMINE (ORAL) PDL PDL PDL 2 of 17

3 FLUVOXAMINE ER (ORAL) NPD NPD NPD LEXAPRO SOLUTION (ORAL) NPD NPD NPD LEXAPRO TABLET (ORAL) NPD NPD NPD PAROXETINE (BRISDELLE) (AG) (ORAL) NPD NPD NPD PAROXETINE (BRISDELLE) (ORAL) NPD NPD NPD PAROXETINE CR (ORAL) NPD NPD NPD PAROXETINE TABLET (ORAL) PDL PDL PDL PAXIL (ORAL) NPD NPD NPD PAXIL CR (ORAL) NPD NPD NPD PAXIL SUSPENSION (ORAL) NPD NPD NPD PEXEVA (ORAL) NPD NPD NPD PROZAC CAPSULE (ORAL) NPD NPD NPD SARAFEM (ORAL) NPD NPD NPD SERTRALINE CONC (ORAL) PDL PDL PDL SERTRALINE TABLET (ORAL) PDL PDL PDL ZOLOFT CONC (ORAL) NPD NPD NPD ZOLOFT TABLET (ORAL) NPD NPD NPD ANTIDEPRESSANTS, TRICYCLIC AMITRIPTYLINE (ORAL) PDL PDL PDL For this, the Board believed AMOXAPINE (ORAL) NPD NPD NPD that all of the drugs being recommended as ANAFRANIL (ORAL) NPD NPD NPD preferred meet the fiscal requirements of the state CLOMIPRAMINE (ORAL) NPD NPD NPD DESIPRAMINE (ORAL) NPD NPD NPD DOXEPIN CAPSULE (ORAL) PDL PDL PDL DOXEPIN CONC (ORAL) PDL PDL PDL IMIPRAMINE (ORAL) PDL PDL PDL IMIPRAMINE PAMOATE (ORAL) NPD NPD NPD MAPROTILINE (ORAL) PDL NPD NPD Financial ANTIDEPRESSANTS, TRICYCLIC CONTINUED NORPRAMIN (ORAL) NPD NPD NPD NORTRIPTYLINE CAPSULE (ORAL) PDL PDL PDL NORTRIPTYLINE SOLUTION (ORAL) NPD NPD NPD PAMELOR CAPSULE (ORAL) NPD NPD NPD PROTRIPTYLINE (ORAL) NPD NPD NPD SURMONTIL (ORAL) NPD NPD NPD TRIMIPRAMINE (ORAL) NPD NPD NPD ANTIHYPERURICEMICS ALLOPURINOL (ORAL) PDL PDL PDL For this, the Board believed COLCHICINE CAPSULE (AG) (ORAL) NPD NPD NPD that all of the drugs being recommended as COLCHICINE TABLET (AG) (ORAL) NPD NPD NPD preferred meet the fiscal requirements of the state COLCRYS (ORAL) NPD NPD NPD DUZALLO (ORAL) NR NPD NPD Financial MITIGARE (ORAL) NPD NPD NPD X PROBENECID (ORAL) PDL PDL PDL PROBENECID / COLCHICINE (ORAL) PDL PDL PDL ULORIC (ORAL) NPD NPD NPD 3 of 17

4 ZURAMPIC (ORAL) NPD NPD NPD ZYLOPRIM (ORAL) NPD NPD NPD ANTIPARKINSON'S AGENTS AMANTADINE CAPSULE (ORAL) PDL PDL PDL NPD/PDL/No Changes: For this therapeutic drug AMANTADINE SYRUP (ORAL) PDL PDL PDL class, the Board believed that all of the drugs being AMANTADINE TABLET (ORAL) PDL PDL PDL recommended as preferred demonstrated the AZILECT (ORAL) NPD NPD NPD greatest safety, efficacy, and value and provided BENZTROPINE (ORAL) PDL PDL PDL clinicians with the greatest number of first line BROMOCRIPTINE (ORAL) PDL PDL PDL options to use before requiring Prior Authorization. CARBIDOPA (ORAL) NPD NPD NPD CARBIDOPA / LEVODOPA (ORAL) PDL PDL PDL CARBIDOPA / LEVODOPA ER (ORAL) PDL PDL PDL CARBIDOPA / LEVODOPA ODT (ORAL) NPD NPD NPD CARBIDOPA/LEVODOPA/ENTACAPONE (ORAL) PDL PDL PDL DUOPA (MISCELL) NPD NPD NPD ENTACAPONE (ORAL) NPD NPD NPD GOCOVRI (ORAL) NR NPD NPD Financial LODOSYN (ORAL) NPD NPD NPD MIRAPEX (ORAL) NPD NPD NPD MIRAPEX ER (ORAL) NPD NPD NPD NEUPRO (TRANSDERM) NPD NPD NPD PRAMIPEXOLE (ORAL) PDL PDL PDL PRAMIPEXOLE ER (ORAL) NPD NPD NPD ANTIPARKINSON'S AGENTS CONTINUED RASAGILINE (ORAL) NPD NPD NPD REQUIP (ORAL) NPD NPD NPD REQUIP XL (ORAL) NPD NPD NPD ROPINIROLE (ORAL) PDL PDL PDL ROPINIROLE ER (ORAL) NPD NPD NPD RYTARY (ORAL) NPD NPD NPD SELEGILINE CAPSULE (ORAL) NPD NPD NPD SELEGILINE TABLET (ORAL) NPD NPD NPD SINEMET (ORAL) NPD NPD NPD SINEMET CR (ORAL) NPD NPD NPD STALEVO (ORAL) NPD NPD NPD TASMAR (ORAL) NPD NPD NPD TOLCAPONE (ORAL) NPD NPD NPD TRIHEXYPHENIDYL ELIXIR (ORAL) PDL PDL PDL TRIHEXYPHENIDYL TABLET (ORAL) PDL PDL PDL XADAGO (ORAL) NPD NPD NPD ZELAPAR (ORAL) NPD NPD NPD ANXIOLYTICS ALPRAZOLAM ER (ORAL) NPD NPD NPD For this, the Board believed ALPRAZOLAM INTENSOL (ORAL) NPD NPD NPD that all of the drugs being recommended as ALPRAZOLAM ODT (ORAL) NPD NPD NPD preferred meet the fiscal requirements of the state ALPRAZOLAM TABLET (ORAL) PDL PDL PDL 4 of 17

5 p Therapeutic Drug q Class ATIVAN TABLET (ORAL) NPD NPD NPD BUSPIRONE (ORAL) PDL PDL PDL CHLORDIAZEPOXIDE (ORAL) PDL PDL PDL CLORAZEPATE (ORAL) PDL PDL PDL DIAZEPAM INTENSOL (ORAL) NPD NPD NPD DIAZEPAM SOLUTION (ORAL) PDL PDL PDL DIAZEPAM TABLET (ORAL) PDL PDL PDL LORAZEPAM INTENSOL (ORAL) PDL PDL PDL LORAZEPAM TABLET (ORAL) PDL PDL PDL MEPROBAMATE (ORAL) NPD NPD NPD OXAZEPAM (ORAL) NPD NPD NPD TRANXENE T-TAB (ORAL) NPD NPD NPD VALIUM TABLET (ORAL) NPD NPD NPD XANAX TABLET (ORAL) NPD NPD NPD XANAX XR (ORAL) NPD NPD NPD BETA-BLOCKERS ACEBUTOLOL (ORAL) PDL PDL PDL For this therapeutic drug class, the Board believed ATENOLOL (ORAL) PDL PDL PDL that all of the drugs being recommended as ATENOLOL / CHLORTHALIDONE (ORAL) PDL PDL PDL preferred demonstrated the greatest safety, BETAPACE / AF (ORAL) NPD NPD NPD efficacy, and value and provided clinicians with the BETAXOLOL (ORAL) NPD NPD NPD greatest number of first line options to use before BISOPROLOL (ORAL) PDL PDL PDL requiring Prior Authorization. BISOPROLOL HCTZ (ORAL) PDL PDL PDL BYSTOLIC (ORAL) NPD NPD NPD CARVEDILOL (ORAL) PDL PDL PDL CARVEDILOL ER (ORAL) NPD NPD NPD COREG (ORAL) NPD NPD NPD COREG CR (ORAL) NPD NPD NPD CORGARD (ORAL) NPD NPD NPD DUTOPROL (ORAL) NPD NPD NPD HEMANGEOL (ORAL) NPD NPD NPD X INDERAL LA (ORAL) NPD NPD NPD INDERAL XL (ORAL) NPD NPD NPD INNOPRAN XL (ORAL) NPD NPD NPD LABETALOL (ORAL) PDL PDL PDL LEVATOL (ORAL) NPD NPD NPD LOPRESSOR (ORAL) NPD NPD NPD METOPROLOL (ORAL) PDL PDL PDL METOPROLOL / HCTZ (ORAL) NPD NPD NPD METOPROLOL XL (ORAL) PDL PDL PDL NADOLOL (ORAL) NPD NPD NPD NADOLOL / BENDROFLUMETHIAZIDE (ORAL) NPD NPD NPD PINDOLOL (ORAL) NPD NPD NPD 5 of 17

6 PROPRANOLOL / HCTZ (ORAL) NPD NPD NPD PROPRANOLOL ER (ORAL) NPD NPD NPD PROPRANOLOL SOLUTION (ORAL) PDL PDL PDL PROPRANOLOL TABLET (ORAL) PDL PDL PDL SOTALOL (ORAL) PDL PDL PDL SOTYLIZE (ORAL) NPD NPD NPD TENORETIC (ORAL) NPD NPD NPD TENORMIN (ORAL) NPD NPD NPD TIMOLOL (ORAL) NPD NPD NPD TOPROL XL (ORAL) NPD NPD NPD ZIAC (ORAL) NPD NPD NPD BILE SALTS ACTIGALL (ORAL) NPD NPD NPD CHENODAL (ORAL) NPD NPD NPD For this, the Board believed that all of the drugs being recommended as preferred meet the fiscal requirements of the state CHOLBAM (ORAL) NPD NPD NPD OCALIVA (ORAL) NPD NPD NPD URSO/URSO FORTE TABLET (ORAL) NPD NPD NPD URSODIOL 300 MG CAPSULE (ORAL) NPD NPD NPD URSODIOL TABLET (ORAL) PDL PDL PDL BPH TREATMENTS ALFUZOSIN (ORAL) PDL PDL PDL For this, the Board believed AVODART (ORAL) NPD NPD NPD that all of the drugs being recommended as CARDURA (ORAL) NPD NPD NPD preferred meet the fiscal requirements of the state CARDURA XL (ORAL) NPD NPD NPD DOXAZOSIN (ORAL) PDL PDL PDL DUTASTERIDE (ORAL) NPD NPD NPD DUTASTERIDE/TAMSULOSIN (ORAL) NPD NPD NPD FINASTERIDE (ORAL) PDL PDL PDL FLOMAX (ORAL) NPD NPD NPD JALYN (ORAL) NPD NPD NPD PROSCAR (ORAL) NPD NPD NPD RAPAFLO (ORAL) NPD NPD NPD TAMSULOSIN (ORAL) PDL PDL PDL TERAZOSIN (ORAL) PDL PDL PDL UROXATRAL (ORAL) NPD NPD NPD BRONCHODILATORS, BETA AGONIST ALBUTEROL ER (ORAL) NPD NPD NPD For this, the Board believed ALBUTEROL NEB SOLN 0.63, 1.25 MG (INHALATION) PDL PDL PDL that all of the drugs being recommended as ALBUTEROL NEB SOLN 100 MG/20 ML (INHALATION) PDL PDL PDL preferred meet the fiscal requirements of the state ALBUTEROL NEB SOLN 2.5 MG/0.5 ML (INHALATION) PDL PDL PDL ALBUTEROL NEB SOLN 2.5 MG/3 ML (INHALATION) PDL PDL PDL ALBUTEROL SYRUP (ORAL) PDL PDL PDL ALBUTEROL TABLET (ORAL) NPD NPD NPD ARCAPTA NEOHALER (INHALATION) NPD NPD NPD X 6 of 17

7 BRONCHODILATORS, BETA AGONIST CONTINUED BROVANA (INHALATION) NPD NPD NPD LEVALBUTEROL HFA (AG) (INHALATION) NPD NPD NPD LEVALBUTEROL NEB SOLN (INHALATION) NPD NPD NPD LEVALBUTEROL NEB SOLN CONC (INHALATION) NPD NPD NPD METAPROTERENOL SYRUP (ORAL) NPD NPD NPD METAPROTERENOL TABLET (ORAL) NPD NPD NPD PERFOROMIST (INHALATION) NPD NPD NPD PROAIR HFA (INHALATION) PDL PDL PDL PROAIR RESPICLICK (INHALATION) NPD NPD NPD PROVENTIL HFA (INHALATION) PDL NPD NPD Safety SEREVENT (INHALATION) NPD NPD NPD STRIVERDI RESPIMAT (INHALATION) NPD NPD NPD X TERBUTALINE (ORAL) NPD NPD NPD VENTOLIN HFA (INHALATION) NPD NPD NPD XOPENEX HFA (INHALATION) NPD NPD NPD XOPENEX NEB SOLN (INHALATION) NPD NPD NPD COPD AGENTS ANORO ELLIPTA (INHALATION) NPD NPD NPD X For this, the Board believed ATROVENT HFA (INHALATION) PDL PDL PDL that all of the drugs being recommended as BEVESPI AEROSPHERE (INHALATION) NPD PDL PDL X Clinical and financial preferred meet the fiscal requirements of the state COMBIVENT RESPIMAT (INHALATION) PDL PDL PDL X DALIRESP (ORAL) NPD NPD NPD INCRUSE ELLIPTA (INHALATION) NPD NPD NPD X IPRATROPIUM / ALBUTEROL (INHALATION) PDL PDL PDL IPRATROPIUM NEBULIZER (INHALATION) PDL PDL PDL SEEBRI NEOHALER (INHALATION) PDL NPD NPD X Financial SPIRIVA (INHALATION) PDL PDL PDL SPIRIVA RESPIMAT (INHALATION) NPD NPD NPD X STIOLTO RESPIMAT (INHALATION) PDL PDL PDL X TUDORZA PRESSAIR (INHALATION) NPD NPD NPD UTIBRON NEOHALER (INHALATION) PDL NPD NPD X Financial COUGH AND COLD, COLD AFRIN SPRAY OTC (NASAL) NPD NPD NPD For this therapeutic drug class, the Board believed ALA-HIST IR TABLET OTC (ORAL) NPD PDL PDL X Financial that all of the drugs being recommended as ALA-HIST PE TABLET OTC (ORAL) PDL PDL PDL X preferred demonstrated the greatest safety, BROTAPP LIQUID OTC (ORAL) NPD NPD NPD efficacy, and value and provided clinicians with the CHILD DELSYM COUGH+COLD LIQUID OTC (ORAL) NPD NPD NPD greatest number of first line options to use before CHILDREN'S MUCINEX LIQUID OTC (C) (ORAL) PDL PDL PDL X requiring Prior Authorization. DALLERGY DROPS OTC (ORAL) NPD NPD NPD DALLERGY LIQUID OTC (ORAL) NPD NPD NPD DECONEX IR TABLET OTC (ORAL) PDL PDL PDL X DELSYM COUGH & COLD LIQUID OTC (C) (ORAL) PDL PDL PDL X DIMETAPP SOLUTION OTC (ORAL) NPD NPD NPD 7 of 17

8 Recommendations HHSC Decision DIPHENHYDRAMINE/PHENYLEPHRINE/APAP LIQUID OTC (ORAL) NPD NPD NPD ED A-HIST LIQUID OTC (ORAL) PDL PDL PDL ED A-HIST PSE TABLET OTC (ORAL) NPD NPD NPD COUGH AND COLD, COLD CONTINUED ED A-HIST TABLET OTC (ORAL) PDL PDL PDL ED BRON GP LIQUID OTC (ORAL) PDL PDL PDL ED CHLORPED D DROPS OTC (ORAL) PDL NPD NPD Financial GUAIFENESIN 200 MG TABLET OTC (ORAL) PDL PDL PDL GUAIFENESIN 400 MG TABLET OTC (ORAL) PDL PDL PDL GUAIFENESIN LIQUID OTC (ORAL) PDL PDL PDL GUAIFENESIN TABLET ER OTC (ORAL) PDL PDL PDL GUAIFENESIN/PHENYLEPHRINE LIQUID OTC (ORAL) NPD NPD NPD GUAIFENESIN/PHENYLEPHRINE TABLET OTC (ORAL) NPD NPD NPD GUAIFENESIN/PHENYLEPHRINE/APAP TABLET OTC (ORAL) NPD NPD NPD GUAIFENESIN/PSE TABLET ER OTC (ORAL) PDL PDL PDL HISTEX-PE LIQUID OTC (ORAL) PDL PDL PDL X IBUPROFEN/PSE TABLET OTC (ORAL) NPD NPD NPD LODRANE D CAPSULE OTC (ORAL) PDL NPD NPD Financial LOHIST-D LIQUID OTC (ORAL) PDL NPD NPD Financial MUCINEX COLD & SINUS LIQUID OTC (ORAL) NPD NPD NPD X MUCINEX D TABLET ER 12H OTC (ORAL) PDL PDL PDL X MUCINEX ER TABLET OTC (ORAL) PDL PDL PDL X MUCINEX FAST-MAX COLD-SINUS TABLET OTC (ORAL) PDL PDL PDL MUCINEX FAST-MAX NITE COLD-FLU LIQUID OTC (ORAL) NPD NPD NPD X MUCINEX GRAN PACK OTC (ORAL) PDL PDL PDL X MUCINEX SINUS-MAX LIQUID OTC (ORAL) PDL PDL PDL X MUCINEX SINUS-MAX TABLET OTC (ORAL) PDL PDL PDL X NAPROXEN/PSE TABLET OTC (ORAL) NPD NPD NPD NASOPEN PE LIQUID OTC (ORAL) PDL PDL PDL X NEO-SYNEPHRINE SPRAY OTC (NASAL) NPD NPD NPD NOHIST-LQ LIQUID OTC (ORAL) PDL PDL PDL OXYMETAZOLINE 12 HR NASAL SPRAY OTC (NASAL) PDL PDL PDL OXYMETAZOLINE MIST OTC (NASAL) NPD NPD NPD PHENYLEPHRINE FOUR SPRAY OTC (NASAL) NPD NPD NPD PHENYLEPHRINE NOSE DROPS OTC (NASAL) NPD NPD NPD PHENYLEPHRINE/APAP TABLET OTC (ORAL) NPD NPD NPD PHENYLEPHRINE/BROMPHENIRAMINE SOLUTION OTC (ORAL) PDL PDL PDL PHENYLEPHRINE/BROMPHENIRAMINE TABLET OTC (ORAL) NPD NPD NPD PHENYLEPHRINE/CHLORPHENIRAMINE TABLET OTC (ORAL) NPD NPD NPD PHENYLEPHRINE/PROMETHAZINE SYRUP (ORAL) NPD NPD NPD COUGH AND COLD, COLD CONTINUED PHENYLEPHRINE/PYRILAMINE TABLET OTC (ORAL) NPD NPD NPD 8 of 17

9 POLY HIST FORTE TABLET OTC (ORAL) PDL PDL PDL X POLY-VENT IR TABLET OTC (ORAL) PDL PDL PDL X PROMETHAZINE VC SYRUP (QUALITEST) (ORAL) NPD NPD NPD PSE/CHLORPHENIRAMINE TABLET OTC (ORAL) PDL PDL PDL PSE/TRIPROLIDINE TABLET OTC (ORAL) PDL PDL PDL RESCON-GG LIQUID OTC (ORAL) NPD NPD NPD RESPAIRE-30 CAPSULE OTC (ORAL) NPD NPD NPD RYMED TABLET OTC (ORAL) PDL NPD NPD Financial RYNEX PE SOLUTION OTC (ORAL) PDL PDL PDL RYNEX PSE LIQUID OTC (ORAL) PDL PDL PDL STAHIST AD TABLET OTC (ORAL) NPD NPD NPD VICKS VAPOINHALER OTC (NASAL) NPD NPD NPD COUGH AND COLD, NARCOTIC FLOWTUSS SOLUTION (ORAL) NPD NPD NPD For this, the Board believed GUAIFENESIN/CODEINE LIQUID OTC (ORAL) PDL PDL PDL that all of the drugs being recommended as GUAIFENESIN/PSE/CODEINE SYRUP OTC (ORAL) NPD NPD NPD preferred meet the fiscal requirements of the state HISTEX-AC SYRUP OTC (ORAL) NPD NPD NPD X HYCOFENIX SOLUTION (ORAL) NPD NPD NPD HYDROCODONE/CHLORPHENIRAMINE SUSPENSION ER 12H (ORAL) NPD NPD NPD HYDROCODONE/HOMATROPINE SYRUP (ORAL) NPD NPD NPD HYDROCODONE/HOMATROPINE TABLET (ORAL) NPD NPD NPD M-CLEAR WC LIQUID (ORAL) NPD NPD NPD X M-END PE LIQUID (ORAL) NPD NPD NPD X NINJACOF-XG LIQUID OTC (ORAL) NPD NPD NPD POLY-TUSSIN AC LIQUID OTC (ORAL) NPD NPD NPD X PROMETHAZINE/CODEINE SYRUP (ORAL) PDL PDL PDL PROMETHAZINE/PHENYLEPHRINE/CODEINE (QUALITEST) SYRUP (ORAL) NPD NPD NPD PROMETHAZINE/PHENYLEPHRINE/CODEINE SYRUP (ORAL) NPD NPD NPD PSE/HYDROCODONE/CHLORPHENIRAMINE SOLUTION (ORAL) NPD NPD NPD ROBAFEN AC (ORAL) NPD NPD NPD TUSSICAPS CAPSULE ER 12H (ORAL) NPD NPD NPD TUSSIONEX SUSPENSION ER 12H (ORAL) NPD NPD NPD TUZISTRA XR SUSPENSION (ORAL) NPD NPD NPD COUGH AND COLD, NON-NARCOTIC ALAHIST CF TABLET OTC (ORAL) NPD PDL PDL X Financial For this therapeutic drug class, the Board believed ALA-HIST DM LIQUID OTC (ORAL) PDL PDL PDL X that all of the drugs being recommended as ALKA-SELTZER PLUS DAY & NIGHT CAPSULE OTC (ORAL) NPD NPD NPD preferred demonstrated the greatest safety, BENZONATATE CAPSULE (ORAL) PDL NPD NPD Clinical efficacy, and value and provided clinicians with the BROMFED DM SYRUP (ORAL) NPD NPD NPD 9 of 17

10 y, Therapeutic p Drug Class greatest number of first line options to use before requiring Prior Authorization. COUGH AND COLD, NON-NARCOTIC CONTINUED Recommendations HHSC Decision BROMPHENIRAMINE/PHENYLEPHRINE/DM LIQUID OTC (ORAL) PDL PDL PDL BROMPHENIRAMINE/PHENYLEPHRINE/DM SOLUTION OTC (ORAL) PDL PDL PDL BROM-PSE-DM SYRUP (ORAL) PDL PDL PDL BROTAPP DM ELIXIR OTC (ORAL) PDL PDL PDL CHILD COLD-COUGH DAY-NIGHT SOLUTION SEQUELS OTC (ORAL) NPD NPD NPD CHILD MUCINEX M-S COLD DAY-NTE LIQUID SEQUELES OTC (ORAL) PDL PDL PDL X CHILDREN'S MUCINEX LIQUID OTC (NN) (ORAL) PDL PDL PDL X CHLO HIST SOLUTION OTC (ORAL) PDL PDL PDL X CHLO TUSS LIQUID OTC (ORAL) PDL PDL PDL X CHLORASEPTIC TOTAL LOZENGE OTC (ORAL) NPD NPD NPD CORICIDIN HBP SOFTGEL OTC (ORAL) NPD NPD NPD DECONEX DMX TABLET OTC (ORAL) PDL PDL PDL X DELSYM COUGH & COLD LIQUID OTC (NN) (ORAL) PDL PDL PDL DELSYM SUSPENSION ER 12H OTC (ORAL) PDL PDL PDL X DEXTROMETHORPHAN CAPSULE OTC (ORAL) NPD NPD NPD DEXTROMETHORPHAN LIQUID OTC (ORAL) NPD NPD NPD DEXTROMETHORPHAN SUSPENSION ER 12H OTC (ORAL) PDL PDL PDL DEXTROMETHORPHAN SYRUP OTC (ORAL) NPD NPD NPD DIMETAPP DM SOLUTION OTC (ORAL) NPD NPD NPD DM/APAP/DOXYLAMINE CAPSULE OTC (ORAL) NPD NPD NPD DM/APAP/DOXYLAMINE LIQUID OTC (ORAL) NPD NPD NPD DM/CHLORPHENIRAMINE TABLET OTC (ORAL) NPD NPD NPD DM/PHENYLEPHRINE/APAP CAPSULE OTC (ORAL) NPD NPD NPD DM/PHENYLEPHRINE/APAP LIQUID OTC (ORAL) NPD NPD NPD DM/PHENYLEPHRINE/APAP TABLET OTC (ORAL) NPD NPD NPD DM/PHENYLEPHRINE/APAP/CHLORPHENIRAMINE TABLET OTC (ORAL) NPD NPD NPD DM/PSE/CHLORPHENIRAMINE LIQUID OTC (ORAL) PDL PDL PDL DURAFLU TABLET OTC (ORAL) PDL NPD NPD X Financial ED A-HIST DM TABLET OTC (ORAL) PDL NPD NPD Financial ED-A-HIST DM LIQUID OTC (ORAL) PDL PDL PDL GUAIFENESIN/DM CAPSULE OTC (ORAL) NPD NPD NPD GUAIFENESIN/DM LIQUID OTC (ORAL) PDL PDL PDL GUAIFENESIN/DM TABLET OTC (ORAL) NPD NPD NPD GUAIFENESIN/DM/PHENYLEPHRINE LIQUID OTC (ORAL) NPD NPD NPD GUAIFENESIN/DM/PHENYLEPHRINE SYRUP OTC (ORAL) NPD NPD NPD HISTEX-DM SYRUP OTC (ORAL) PDL PDL PDL X LOHIST-DM LIQUID (ORAL) PDL PDL PDL LORTUSS DM LIQUID OTC (ORAL) PDL NPD NPD Financial M-END DMX LIQUID OTC (ORAL) PDL PDL PDL X 10 of 17

11 Recommendations HHSC Decision MUCINEX COLD-FLU & SORE THROAT LIQUID OTC (ORAL) PDL PDL PDL X MUCINEX COUGH GRAN PACK OTC (ORAL) PDL PDL PDL X MUCINEX DM TABLET ER 12H OTC (ORAL) PDL PDL PDL X MUCINEX DM TABLET ER 12H OTC (ORAL) PDL PDL PDL X MUCINEX FAST-MAX COLD-FLU TABLET OTC (ORAL) PDL PDL PDL MUCINEX FAST-MAX COLD-FLU-THROAT CAPSULE OTC (ORAL) NPD NPD NPD X MUCINEX FAST-MAX COLD-SINUS CAPSULE OTC (ORAL) NPD NPD NPD X MUCINEX FAST-MAX CONGEST-COLD TABLET OTC (ORAL) NPD NPD NPD X MUCINEX FAST-MAX CONGEST-COUGH TABLET OTC (ORAL) PDL PDL PDL X MUCINEX FAST-MAX DAY-NITE COLD LIQUID SEQ OTC (ORAL) NPD PDL PDL X Financial MUCINEX FAST-MAX DAY-NITE COLD-FLU CAPSULE OTC (ORAL) PDL PDL PDL X COUGH AND COLD, NON-NARCOTIC CONTINUED MUCINEX FAST-MAX DAY-NITE CONG LIQUID OTC (ORAL) PDL PDL PDL X MUCINEX FAST-MAX DM MAX LIQUID OTC (ORAL) PDL PDL PDL X MUCINEX FAST-MAX SEVERE COLD LIQUID OTC (ORAL) PDL PDL PDL X MUCINEX SEVERE CONGEST-COUGH LIQUID OTC (ORAL) PDL NPD NPD Financial NINJACOF LIQUID OTC (ORAL) NPD NPD NPD NOHIST-DM LIQUID OTC (ORAL) PDL PDL PDL PHENYLEPHRINE/DM LIQUID OTC (ORAL) NPD NPD NPD PHENYLEPHRINE/DM/APAP/GUAIFENESIN CAPLET OTC (ORAL) NPD NPD NPD PHENYLEPHRINE/DM/APAP/GUAIFENESIN LIQUID OTC (ORAL) NPD NPD NPD POLY-HIST DM LIQUID OTC (ORAL) PDL PDL PDL X POLY-HIST PD DROPS OTC (ORAL) PDL NPD NPD X Financial POLYTUSSIN DM OTC (ORAL) NPD NPD NPD POLY-VENT DM TABLET OTC (ORAL) PDL PDL PDL X PROMETHAZINE/DM SYRUP (ORAL) PDL PDL PDL RESCON-DM LIQUID OTC (ORAL) PDL NPD NPD Financial ROBITUSSIN CAPSULE OTC (ORAL) NPD NPD NPD ROBITUSSIN COUGH & COLD CF LIQUID OTC (ORAL) NPD NPD NPD ROBITUSSIN LONG-ACTING LIQUID OTC (ORAL) NPD NPD NPD RYNEX DM SOLUTION OTC (ORAL) PDL PDL PDL TESSALON PERLE CAPSULE (ORAL) NPD NPD NPD VANACOF AC LIQUID OTC (ORAL) NPD NPD NPD X VANACOF DM LIQUID OTC (ORAL) PDL PDL PDL X VANACOF LIQUID OTC (ORAL) PDL PDL PDL X VANATAB AC TABLET OTC (ORAL) NPD NPD NPD X 11 of 17

12 VANATAB DM TABLET OTC (ORAL) NPD NPD NPD X ERYTHROPOIESIS STIMULATING PROTEINS ARANESP DISP SYRIN (INJECTION) NPD NPD NPD ARANESP VIAL (INJECTION) NPD NPD NPD EPOGEN (INJECTION) PDL PDL PDL For this, the Board believed that all of the drugs being recommended as preferred meet the fiscal requirements of the state PROCRIT (INJECTION) PDL PDL PDL GLUCOCORTICOIDS, INHALED ADVAIR DISKUS (INHALATION) PDL PDL PDL For this, the Board believed ADVAIR HFA (INHALATION) PDL PDL PDL that all of the drugs being recommended as AEROSPAN (INHALATION) NPD NPD NPD preferred meet the fiscal requirements of the state AIRDUO RESPICLICK (INHALATION) NPD NPD NPD ALVESCO (INHALATION) NPD NPD NPD ARMONAIR RESPICLICK (INHALATION) NPD NPD NPD ARNUITY ELLIPTA (INHALATION) NPD NPD NPD X ASMANEX (INHALATION) PDL PDL PDL ASMANEX HFA (INHALATION) NPD NPD NPD BREO ELLIPTA (INHALATION) NPD NPD NPD X BUDESONIDE 0.25, 0.5 MG RESPULES (INHALATION) NPD NPD NPD BUDESONIDE 1 MG RESPULES (INHALATION) NPD NPD NPD DULERA (INHALATION) PDL PDL PDL FLOVENT DISKUS (INHALATION) PDL NPD NPD Financial GLUCOCORTICOIDS, INHALED CONTINUED FLOVENT HFA (INHALATION) PDL PDL PDL FLUTICASONE/SALMETEROL (AIRDUO) (AG) (INHALATION) NPD NPD NPD PULMICORT 0.25, 0.5 MG RESPULES (INHALATION) NPD PDL PDL X Financial PULMICORT 1 MG RESPULES (INHALATION) NPD PDL PDL X Financial PULMICORT FLEXHALER (INHALATION) NPD NPD NPD QVAR (INHALATION) PDL NPD NPD Financial QVAR REDIHALER (INHALATION) NR NPD NPD X Financial SYMBICORT (INHALATION) PDL PDL PDL TRELEGY ELLIPTA (INHALATION) NPD NPD NPD HAE TREATMENTS BERINERT (INTRAVEN) PDL PDL PDL CINRYZE (INTRAVEN) PDL PDL PDL For this, the Board believed FIRAZYR (SUB-Q) PDL PDL PDL that all of the drugs being recommended as HAEGARDA (SUB-Q) NPD NPD NPD preferred meet the fiscal requirements of the state KALBITOR (SUB-Q) PDL PDL PDL RUCONEST (INTRAVEN) NPD NPD NPD X HYPOGLYCEMICS, SGLT2 FARXIGA (ORAL) PDL PEND PEND X For this, the Board elected INVOKAMET (ORAL) NPD PEND PEND X 12 of 17

13 to postpone review until November in order to gather more information. INVOKAMET XR (ORAL) NPD PEND PEND X INVOKANA (ORAL) NPD PEND PEND X JARDIANCE (ORAL) PDL PEND PEND X STEGLATRO (ORAL) NR PEND PEND SYNJARDY (ORAL) PDL PEND PEND X SYNJARDY XR (ORAL) NPD PEND PEND X XIGDUO XR (ORAL) NPD PEND PEND X IMMUNE GLOBULINS BIVIGAM (INTRAVEN) NPD NPD NPD For this, the Board believed CARIMUNE NF NANOFILTERED (INTRAVEN) NPD NPD NPD that all of the drugs being recommended as CUVITRU (SUBCUT.) NPD NPD NPD preferred meet the fiscal requirements of the state CYTOGAM (INTRAVEN) PDL PDL PDL FLEBOGAMMA DIF (INTRAVEN) NPD NPD NPD GAMASTAN S-D VIAL (INTRAMUSC) PDL PDL PDL GAMMAGARD LIQUID (INJECTION) PDL PDL PDL GAMMAGARD S-D (INTRAVEN) PDL PDL PDL GAMMAKED (INTRAVEN) NPD NPD NPD GAMMAPLEX (INTRAVEN) NPD NPD NPD GAMUNEX-C (INJECTION) PDL PDL PDL HEPAGAM B (INTRAMUSC) PDL PDL PDL IMMUNE GLOBULINS CONTINUED HIZENTRA (SUBCUT.) PDL PDL PDL HYQVIA (SUBCUT.) NPD NPD NPD OCTAGAM (INTRAVEN) NPD NPD NPD PRIVIGEN (INTRAVEN) NPD NPD NPD IMMUNOMODULATORS, ATOPIC DERMATITIS DUPIXENT (SUBCUTANE.) NPD NPD NPD For this, the Board believed that all of the drugs being recommended as preferred meet the fiscal requirements of the state ELIDEL (TOPICAL) NPD NPD NPD EUCRISA (TOPICAL) NPD PDL PDL X Clinical PROTOPIC (TOPICAL) NPD NPD NPD TACROLIMUS (AG) (TOPICAL) NPD NPD NPD TACROLIMUS (TOPICAL) NPD NPD NPD LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMI NS CLEOCIN CAPSULES (ORAL) NPD NPD NPD For this, the Board believed CLEOCIN PALMITATE (ORAL) NPD NPD NPD that all of the drugs being recommended as CLEOCIN PHOSPHATE PIGGYBACK (INJECTION) NPD NPD NPD preferred meet the fiscal requirements of the state CLEOCIN PHOSPHATE VIAL (INJECTION) NPD NPD NPD CLINDAMYCIN CAPSULES (ORAL) PDL PDL PDL CLINDAMYCIN IN 0.9 % SODIUM CHLORIDE PIGGYBACK (INTRAVEN.) NPD NPD NPD CLINDAMYCIN PALMITATE SOLUTION (ORAL) PDL PDL PDL CLINDAMYCIN PHOSPHATE PIGGYBACK (INJECTION) NPD NPD NPD CLINDAMYCIN PHOSPHATE VIAL (INJECTION) NPD NPD NPD LINCOCIN (INJECTION) NPD NPD NPD LINCOMYCIN (INJECTION) NPD NPD NPD 13 of 17

14 LINEZOLID (AG) (INTRAVEN) PDL PDL PDL LINEZOLID (INTRAVEN) PDL PDL PDL LINEZOLID SUSPENSION (AG) (ORAL) PDL PDL PDL LINEZOLID SUSPENSION (ORAL) PDL PDL PDL LINEZOLID TABLET (AG) (ORAL) PDL PDL PDL LINEZOLID TABLET (ORAL) PDL PDL PDL SIVEXTRO (INTRAVEN) NPD NPD NPD SIVEXTRO (ORAL) NPD NPD NPD SYNERCID (INJECTION) NPD NPD NPD ZYVOX (INJECTION) NPD NPD NPD ZYVOX SUSPENSION (ORAL) NPD NPD NPD ZYVOX TABLET (ORAL) NPD NPD NPD LIPOTROPICS, OTHER ANTARA (ORAL) NPD NPD NPD For this therapeutic drug class, the Board believed CHOLESTYRAMINE/ASPARTAME (ORAL) PDL PDL PDL that all of the drugs being recommended as CHOLESTYRAMINE/SUCROSE (ORAL) PDL PDL PDL preferred demonstrated the greatest safety, COLESTID GRANULES (ORAL) NPD NPD NPD efficacy, and value and provided clinicians with the COLESTIPOL GRANULES (ORAL) NPD NPD NPD greatest number of first line options to use before COLESTIPOL TABLET (ORAL) PDL PDL PDL requiring Prior Authorization. EZETIMIBE (ORAL) NPD NPD NPD FENOFIBRATE (ANTARA) (AG) (ORAL) NPD NPD NPD FENOFIBRATE (ANTARA) (ORAL) NPD NPD NPD FENOFIBRATE (FENOGLIDE) (AG) (ORAL) NPD NPD NPD FENOFIBRATE (FENOGLIDE) (ORAL) NPD NPD NPD FENOFIBRATE CAPSULE (LIPOFEN) (ORAL) PDL PDL PDL FENOFIBRATE CAPSULE (LOFIBRA) (ORAL) NPD NPD NPD FENOFIBRATE TABLET (AG) (TRICOR) (ORAL) PDL PDL PDL FENOFIBRATE TABLET (LOFIBRA) (ORAL) NPD NPD NPD FENOFIBRATE TABLET (TRICOR) (ORAL) PDL PDL PDL FENOFIBRIC ACID (FIBRICOR) (ORAL) NPD NPD NPD FENOFIBRIC ACID (TRILIPIX) (AG) (ORAL) NPD NPD NPD FENOFIBRIC ACID (TRILIPIX) (ORAL) NPD NPD NPD FENOGLIDE (ORAL) NPD NPD NPD GEMFIBROZIL (ORAL) PDL PDL PDL JUXTAPID (ORAL) PDL NPD NPD Financial KYNAMRO (SUBCUTANE.) PDL NPD NPD Financial LIPOFEN (ORAL) NPD NPD NPD LOPID (ORAL) NPD NPD NPD LOVAZA (ORAL) NPD NPD NPD NIACIN CAPSULE ER OTC (ORAL) PDL PDL PDL NIACIN ER (ORAL) NPD NPD NPD NIACIN TABLET ER OTC (ORAL) PDL PDL PDL NIACIN TABLET OTC (ORAL) PDL PDL PDL 14 of 17

15 NIACOR (ORAL) PDL PDL PDL NIASPAN (ORAL) NPD NPD NPD OMEGA-3 ACID ETHYL ESTERS (ORAL) NPD NPD NPD OMEGA-3 OTC (ORAL) PDL PDL PDL OMERA OTC (ORAL) NPD NPD NPD PRALUENT PEN (SUBCUTANEOUS) NPD NPD NPD REPATHA PUSHTRONEX (SUBCUTANEOUS) NPD NPD NPD X REPATHA SURECLICK (SUBCUTANEOUS) NPD NPD NPD X REPATHA SYRINGE (SUBCUTANEOUS) NPD NPD NPD X RESTORA OTC (ORAL) NPD NPD NPD LIPOTROPICS, OTHER CONTINUED SLO-NIACIN OTC (ORAL) PDL PDL PDL TRICOR (ORAL) NPD NPD NPD TRIGLIDE (ORAL) NPD NPD NPD TRILIPIX (ORAL) NPD NPD NPD VASCEPA (ORAL) NPD NPD NPD WELCHOL POWDER PACK (ORAL) NPD NPD NPD WELCHOL TABLET (ORAL) NPD NPD NPD ZETIA (ORAL) PDL PDL PDL LIPOTROPICS, STATINS ALTOPREV (ORAL) NPD NPD NPD For this, the Board believed AMLODIPINE-ATORVASTATIN (ORAL) NPD NPD NPD that all of the drugs being recommended as ATORVASTATIN (ORAL) PDL PDL PDL preferred meet the fiscal requirements of the state CADUET (ORAL) NPD NPD NPD CRESTOR (ORAL) NPD NPD NPD EZETIMIBE-SIMVASTATIN (ORAL) NPD NPD NPD FLUVASTATIN (ORAL) NPD NPD NPD FLUVASTATIN ER (AG) (ORAL) NPD NPD NPD FLUVASTATIN ER (ORAL) NPD NPD NPD LESCOL XL (ORAL) NPD NPD NPD LIPITOR (ORAL) NPD NPD NPD LIVALO (ORAL) NPD NPD NPD LOVASTATIN (ORAL) PDL PDL PDL PRAVACHOL (ORAL) NPD NPD NPD PRAVASTATIN (ORAL) PDL PDL PDL ROSUVASTATIN (ORAL) NPD NPD NPD SIMVASTATIN (ORAL) PDL PDL PDL VYTORIN (ORAL) NPD NPD NPD ZOCOR (ORAL) NPD NPD NPD PAH AGENTS, ORAL AND INHALED ADCIRCA (ORAL) PDL PDL PDL For this, the Board believed ADEMPAS (ORAL) NPD NPD NPD that all of the drugs being recommended as LETAIRIS (ORAL) PDL PDL PDL X preferred meet the fiscal requirements of the state OPSUMIT (ORAL) NPD NPD NPD X ORENITRAM ER (ORAL) NPD NPD NPD REVATIO SUSPENSION (ORAL) NPD NPD NPD 15 of 17

16 REVATIO TABLET (ORAL) NPD NPD NPD SILDENAFIL (ORAL) PDL PDL PDL TRACLEER SUSPENSION (ORAL) NR NPD NPD Financial TRACLEER TABLET (ORAL) PDL PDL PDL X TYVASO (INHALATION) NPD NPD NPD PAH AGENTS, ORAL AND INHALED CONTINUED UPTRAVI (ORAL) NPD NPD NPD UPTRAVI TABLET DOSE PACK (ORAL) NPD NPD NPD VENTAVIS (INHALATION) NPD NPD NPD PANCREATIC ENZYMES CREON (ORAL) PDL PDL PDL X For this, the Board believed PANCREAZE (ORAL) NPD NPD NPD that all of the drugs being recommended as PERTZYE (ORAL) NPD NPD NPD X preferred meet the fiscal requirements of the state VIOKACE (ORAL) NPD NPD NPD ZENPEP (ORAL) PDL PDL PDL X SEDATIVE HYPNOTICS AMBIEN (ORAL) NPD NPD NPD For this therapeutic drug class, the Board believed AMBIEN CR (ORAL) NPD NPD NPD that all of the drugs being recommended as BELSOMRA (ORAL) NPD NPD NPD preferred demonstrated the greatest safety, EDLUAR (SUBLINGUAL) NPD NPD NPD efficacy, and value and provided clinicians with the ESTAZOLAM (ORAL) NPD NPD NPD greatest number of first line options to use before ESZOPICLONE (ORAL) NPD NPD NPD requiring Prior Authorization. FLURAZEPAM (ORAL) PDL PDL PDL HALCION (ORAL) NPD NPD NPD HETLIOZ (ORAL) NPD NPD NPD INTERMEZZO (SUBLINGUAL) NPD NPD NPD LUNESTA (ORAL) NPD NPD NPD RESTORIL (ORAL) NPD NPD NPD ROZEREM (ORAL) NPD NPD NPD SILENOR (ORAL) NPD NPD NPD TEMAZEPAM (ORAL) PDL PDL PDL TEMAZEPAM 22.5 MG (ORAL) NPD NPD NPD TEMAZEPAM 7.5 MG (ORAL) NPD NPD NPD TRIAZOLAM (ORAL) PDL PDL PDL ZALEPLON (ORAL) NPD NPD NPD ZOLPIDEM (ORAL) PDL PDL PDL ZOLPIDEM (SUBLINGUAL) NPD NPD NPD ZOLPIDEM ER (ORAL) NPD NPD NPD ZOLPIMIST (ORAL) NPD NPD NPD UREA CYCLE DISORDERS, ORAL BUPHENYL POWDER (ORAL) PDL PDL PDL BUPHENYL TABLET (ORAL) PDL PDL PDL For this, the Board believed CARBAGLU (ORAL) PDL PDL PDL that all of the drugs being recommended as RAVICTI (ORAL) NPD NPD NPD preferred meet the fiscal requirements of the state SODIUM PHENYLBUTYRATE POWDER (ORAL) NPD NPD NPD SODIUM PHENYLBUTYRATE TABLET (ORAL) NPD NPD NPD 16 of 17

17 Recommendations HHSC Decision For these products, the Board believed that Enbrel met the clinical and fiscal requirements of the state. CYTOKINE AND CAM ANTAGONISTS ENBREL CARTRIDGE (SUBCUTANE.) NR PDL PDL X Financial HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS BYDUREON BCISE (SUBCUTANE.) NR NPD NPD X Financial HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS OZEMPIC (SUBCUTANE.) NR NPD NPD Financial HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS QTERN (ORAL) NR NPD NPD X Financial HYPOGLYCEMICS, INSULIN AND RELATED AGENTS ADMELOG SOLOSTAR PEN (SUBCUTANE.) NR NPD NPD Financial HYPOGLYCEMICS, INSULIN AND RELATED AGENTS ADMELOG VIAL (SUBCUTANE.) NR NPD NPD Financial NEUROPATHIC PAIN LYRICA CR (ORAL) NR NPD NPD Financial OPHTHALMICS, GLAUCOMA AGENTS VYZULTA (OPHTHALMIC) NR NPD NPD Financial STIMULANTS AND RELATED AGENTS ADZENYS ER SUSPENSION (ORAL) NR NPD NPD Financial TETRACYCLINES XIMINO (ORAL) NR NPD NPD Financial ACNE AGENTS, TOPICAL RETIN-A MICRO 0.06% PUMP (TOPICAL) NR NPD NPD Financial ANTIBIOTICS, GI SOLOSEC (ORAL) NR NPD NPD Financial 17 of 17