Comprehensive Dual Preferred Drug List (List of Covered Drugs)

Transcription

1 Comprehensive Dual referred Drug List (List of Covered Drugs) WellCare of New Jersey 00 9 lease read: This document contains information about the drugs we cover in this plan. Last updated (04/01/2014) 2014

2 WellCare of New Jersey Dual Eligible Medicaid Cough & Cold Drug List Non-referred Drugs ANTITUSSIVES,NON-NARCOTIC Benzonatate TESSALON 200 CASULE BENZONATATE 100 CASULE BENZONATATE 200 CASULE Dextromethorphan olistirex DELSYM 30 /5 ML EXTENDED-RELEASE SUSENSION Dextromethorphan HBr ROBITUSSIN EDIATRIC COUGH SY Dextromethorphan HBr/Menthol DELSYM COUGH RELIEF LUS LOZENGE NON-NARC ANTITUSS-1ST GEN. ANTIHISTAMINE-DECONGEST Brompheniramine/Dextromethorphan HBr/seudoephedrine HCl ALLANHIST DX DROS BROMHIST DX DROS BROTA DM LIQUID Q-TA DM ELIXIR BROMFED DM SYRU ENDACOF-D DROS Brophenaramine/Dextromethorphan HBr/henylephrine HCl COLD/COUGH CHILDRENS ELIXIR RYNEX DM DIMAHEN DM ELIXIR Chlorpheniramine/Dextromethorphan HBr/henylephrine HCl C-HEN DM RONDEX-DM SYRU DE-CHLOR DM LIQUID NOHIST-DM D-COF SYRU SILDEC E-DM SYRU CORFEN DM TRI-DEX E Chlorpheniramine/Dextromethorphan HBr/seudoephedrine HCl EDIATRIC COUGH-COLD LIQUID MESEHIST DM KIDKARE COUGH/COLD Dexchlorpheniramine/seudoephedrine HCl/Chlophedianol HCl VANACOF LIQUID Chlorpheniramine/Dextromethorphan HBr DIMETA LONG-ACTING COUGH LIQ ROBITUSSIN LONG ACTING LIQUID romethazine HCl/Dextromethorphan HBr ROMETHAZINE-DM SYRU Dextromethorphan HBr/Acetaminophen/Doxylamine DELSYM NIGHTTIME MULTI-SYMTOM EXECTORANTS DECONGESTANT-EXECTORANT COMBINATIONS referred Drugs NON-NARC ANTITUSS-1ST GEN. ANTIHIST-ANALGESIC COMBINATION Guaifenesin/henylephrine HCl DONATUSSIN DROS E-GUAI DROS DESEC LIQUID RESCON-GG LIQUID Last updated 04/01/14 age 1 of 2

3 WellCare of New Jersey Dual Eligible Medicaid Cough & Cold Drug List Non-referred Drugs referred Drugs NON-NARCOTIC DECONGESTANT-EXECTORANT-ANTITUSSIVE Guaifenesin/Dextromethorphan HBr/henylephreine ROBAFEN CF SYRU Dextromethorphan HBr/Guaifenesin DURATUSS DM ELIXIR SU-TUSS DM ELIXIR MUCUS RELIEF COUGH LIQUID DIABETIC TUSSIN DM LIQUID SIMUC-DM ELIXIR GUAIFENESIN DM SYRU Q-TUSSIN-DM SYRU EXTRA ACTION COUGH SILTUSSIN DM COUGH SYRU REFENESEN DM SILTUSSIN DM DAS COUGH SYRU MUCOSA DM ROBITUSSIN COUGH CHEST CONGESTION DM LIQUID Chlorpheniramine/Hydrocodone olistirex TUSSIONEX ENNKINETIC SUS TUSSICAS (min. age 6 years old) HYDROCODONE-CHLORHENIRAMINE SUSENSION (min. age 6 years old) Codeine hosphate/romethazine HCl Dexbrompheniramine/Hydrocodone Bit/henylephrine HCl Codeine/henylephrine HCl/romethazine CYTUSS-HC NR SYRU HC/E/DBROM SYRU ROMETH VC W/COD SYRU ROMETHAZINE VC/COD SYRU HC 2.5-E 5-DBROM 1 SYRU seudoephedrine HCl/Codeine/Chlorpheniramine HENYLHISTINE DH HYDROMET SYRU NON-NARCOTIC ANTITUSSIVE AND EXECTORANT COMB. NARCOTIC ANTITUSSIVE-1ST GENERATION ANTIHISTAMINE ROMETHAZINE-CODEINE SYRU (min. age 6 years old) NARCOTIC ANTITUSSIVE-1ST GEN. ANTIHISTAMINE-DECONGESTANT NARCOTIC ANTITUSSIVE-ANTICHOLINERGIC COMBINATION Hydrocodone Bit/Homatropine HYDROCODONE-HOMATROINE NARCOTIC ANTITUSSIVE-EXECTORANT COMBINATION Guaifenesin/Hydrocodone Bit Codeine hosphate/guaifenesin HYDROCODONE-GUAIFENESIN SYRU CHERATUSSIN AC SYRU NARCOF SYRU TUSSICLEAR DH SYRU GUAIFENESIN-CODEINE SYRU IOHEN C-NR NARCOTIC ANTITUSSIVE-DECONGESTANT-EXECTORANT COMBINATIONS Codeine hosphate/guaifenesin/seudoephedrine HCl CHERATUSSIN DAC SYRU Last updated 04/01/14 age 2 of 2

4 UERCASE = Brand name drugs italics = Generic drugs reference Details = referred Dagger ( ) = N/A Asterisk (*) = N/A Asterisk (**) = N/A Asterisk (***) = N/A XX = N/A Coverage Details A = rior Authorization ST = Step Therapy QL = Quantity Limit AL = Age Limit Notes = Notes OTC = OTC- Covered w/rx Drug Name reference Details Coverage Details *Analgesics - Anti-Inflammatory* *Nonsteroidal Anti-Inflammatory Agents (Nsaids)** *Nonsteroidal Anti-Inflammatory Agents (Nsaids)*** Childrens Ibuprofen ORAL SUSENSION 40 /ML Ibuprofen ORAL SUSENSION 100 /5ML Ibuprofen ORAL TABLET 200 *Analgesics - Nonnarcotic* *Analgesics Other** *Analgesics Other*** Acetaminophen ORAL SOLUTION 160 /5ML Acetaminophen ORAL TABLET 325 Acetaminophen ORAL TABLET 500 Childrens Non-ASA ain Relief ORAL TABLET CHEWABLE 80 Childrens Non-Aspirin ORAL TABLET CHEWABLE 80 Childrens Non-Aspirin ain ORAL TABLET CHEWABLE 80 Childrens ain Reliever ORAL TABLET CHEWABLE 80 OTC; QL (279 EA per 31 days) OTC; QL (186 EA per 31 days) 1

5 Drug Name reference Details Coverage Details Childrens Silapap ORAL LIQUID 160 /5ML Childrens Tactinal ORAL TABLET CHEWABLE 80 Ed-AA ORAL LIQUID 160 /5ML Infants Silapap ORAL SOLUTION 100 /ML Mapap ORAL CASULE 500 OTC; QL (186 EA per 31 days) Mapap ORAL LIQUID 160 /5ML Mapap ORAL TABLET 325 Mapap ORAL TABLET 500 OTC; QL (279 EA per 31 days) OTC; QL (186 EA per 31 days) Mapap ORAL TABLET CHEWABLE 80 Mapap Arthritis ain ORAL TABLET EXTENDEDRELEASE* 650 MAA CHILDRENS ORAL SUSENSION 160 /5ML Maxapap Maximum Strength ORAL TABLET 500 Maxapap Regular Strength ORAL TABLET 325 Non-Aspirin ORAL TABLET 325 Non-Aspirin Extra Strength ORAL TABLET 500 Nortemp Infants ORAL SUSENSION 80 /0.8ML ain & Fever Childrens ORAL SOLUTION 160 /5ML ain Relief ORAL TABLET 500 HARBETOL ORAL TABLET 325 HARBETOL EXTRA STRENGTH ORAL TABLET 500 Q-A ORAL TABLET 325 Tactinal ORAL TABLET 325 Tactinal Extra Strength ORAL TABLET 500 *Salicylates** *Salicylate Combinations*** 2 OTC; QL (93 EA per 31 days) OTC; QL (186 EA per 31 days) OTC; QL (279 EA per 31 days) OTC; QL (279 EA per 31 days) OTC; QL (186 EA per 31 days) OTC; QL (186 EA per 31 days) OTC; QL (279 EA per 31 days) OTC; QL (186 EA per 31 days) OTC; QL (279 EA per 31 days) OTC; QL (279 EA per 31 days) OTC; QL (186 EA per 31 days)

6 Drug Name reference Details Coverage Details Tri-Buffered Aspirin ORAL TABLET 325 *Salicylates*** Aspirin ORAL TABLET 325, 81 Aspirin ORAL TABLET CHEWABLE 81 Aspirin ORAL TABLET DELAYED RELEASE 81 Aspirin RE SUOSITORY 300, 600 Aspirin Childrens ORAL TABLET CHEWABLE 81 Aspirin EC ORAL TABLET DELAYED RELEASE 325, 81 Aspirin EC Low Dose ORAL TABLET DELAYED RELEASE 81 Aspirin Low Dose ORAL TABLET 81 ECIRIN ORAL TABLET DELAYED RELEASE 325 *Antacids* *Antacid Combinations** *Antacid & Simethicone*** Alamag lus ORAL TABLET CHEWABLE ALMACONE ORAL SUSENSION /5ML Antacid ORAL SUSENSION /5ML Antacid Anti-Gas ORAL SUSENSION /5ML Antacid Anti-Gas Max Strength ORAL SUSENSION /5ML Antacid Extra Strength ORAL SUSENSION /5ML Antacid I ORAL SUSENSION /5ML Antacid III ORAL SUSENSION /5ML Geri-Lanta ORAL SUSENSION /5ML MAALOX ADVANCED ORAL SUSENSION /5ML MAALOX ADVANCED MAX ST ORAL SUSENSION /5ML 3

7 Drug Name reference Details Coverage Details MAALOX MAX ORAL SUSENSION /5ML MAALOX MULTI SYMTOM MAX ST ORAL SUSENSION /5ML MAALOX REGULAR STRENGTH ORAL SUSENSION /5ML Milantex ORAL SUSENSION /5ML Milantex Extra Strength ORAL SUSENSION /5ML MINTOX LUS ORAL TABLET CHEWABLE *Antacid Combinations*** ACID GONE ORAL TABLET CHEWABLE , MI-ACID ORAL TABLET CHEWABLE *Antacids - Aluminum Salts** *Antacids - Aluminum Salts*** Aluminum Hydroxide Gel ORAL SUSENSION 320 /5ML *Antacids - Bicarbonate** *Antacids - Bicarbonate*** Sodium Bicarbonate ORAL TABLET 325, 650 *Antacids - Calcium Salts** *Antacids - Calcium Salts*** Alcalak ORAL TABLET CHEWABLE 420 Antacid ORAL TABLET CHEWABLE 420, 500 CAL-GEST ANTACID ORAL TABLET CHEWABLE 500 Calcium Antacid ORAL TABLET CHEWABLE 500 Calcium Antacid Extra Strength ORAL TABLET CHEWABLE 750 Calcium Carbonate Antacid ORAL TABLET 648 Calcium Carbonate Antacid ORAL TABLET CHEWABLE 500 MAALOX ORAL TABLET CHEWABLE 600 4

8 Drug Name reference Details Coverage Details TITRALAC ORAL TABLET CHEWABLE 420 *Antacids - Magnesium Salts** *Antacids - Magnesium Salts*** Magnesium Oxide ORAL TABLET 250, 400, 420 *Anthelmintics* *Anthelmintics** *Anthelmintics*** Reeses inworm Medicine ORAL SUSENSION 144 /ML *Antidiabetics* *Diabetic Other** *Diabetic Other*** BD GLUCOSE ORAL TABLET CHEWABLE 5 GM Glucose ORAL TABLET CHEWABLE 4 GM Ultilet Glucose ORAL TABLET CHEWABLE 4 GM *Antidiarrheals* *Antidiarrheal Agents - Misc.** *Antidiarrheal Agents - Misc.*** Bismatrol ORAL SUSENSION 262 /15ML Bismatrol ORAL TABLET CHEWABLE 262 Bismuth ORAL TABLET CHEWABLE 262 Diotame ORAL TABLET CHEWABLE 262 Kao-Tin ORAL SUSENSION 262 /15ML KAOECTATE ORAL SUSENSION 262 /15ML KAOECTATE EXTRA STRENGTH ORAL SUSENSION 525 /15ML ink Bismuth ORAL SUSENSION 262 /15ML ink Bismuth ORAL TABLET CHEWABLE 262 Stomach Relief ORAL SUSENSION 262 /15ML, 527 /30ML Stomach Relief ORAL TABLET CHEWABLE 262 Stomach Relief lus ORAL SUSENSION 525 /15ML 5

9 Drug Name reference Details Coverage Details *Antiperistaltic Agents** *Antiperistaltic Agents*** Anti-Diarrheal ORAL LIQUID 1 /5ML LOERAMIDE A-D ORAL TABLET 2 Loperamide HCl ORAL LIQUID 1 /5ML *Antidotes* *Antidotes** *Antidotes*** Ipecac ORAL SYRU *Antiemetics* *Antiemetics - Anticholinergic** *Antiemetics - Anticholinergic*** Meclizine HCl ORAL TABLET 12.5, 25 Travel Sickness ORAL TABLET CHEWABLE 25 *Antihistamines* *Antihistamines - Alkylamines** *Antihistamines - Alkylamines*** Aller-Chlor ORAL SYRU 2 /5ML Aller-Chlor ORAL TABLET 4 Allergy ORAL TABLET 4 Allergy Relief ORAL TABLET 4 ChlorHist ORAL TABLET 4 Chlorphen ORAL TABLET 4 DIABETIC TUSSIN ALLERGY ORAL SYRU 2 /5ML *Antihistamines - Ethanolamines** *Antihistamines - Ethanolamines*** Aler-Cap ORAL CASULE 25 Aler-Dryl ORAL TABLET 50 AlerTab ORAL TABLET 25 Allergy Relief Childrens ORAL LIQUID 12.5 /5ML Altaryl ORAL ELIXIR 12.5 /5ML Altaryl ORAL SYRU 12.5 /5ML Anti-Hist ORAL CASULE 25 Anti-Hist Allergy ORAL TABLET 25 BANOHEN ORAL CASULE 25 BANOHEN ORAL LIQUID 12.5 /5ML 6

10 Drug Name reference Details Coverage Details BANOHEN ORAL TABLET 25 BENADRYL ALLERGY CHILDRENS ORAL LIQUID 12.5 /5ML Complete Allergy Medication ORAL TABLET 25 Complete Allergy Relief ORAL TABLET 25 Diphenhist ORAL CASULE 25 Diphenhist ORAL LIQUID 12.5 /5ML Diphenhist ORAL TABLET 25 DiphenhydrAMINE HCl ORAL CASULE 25, 50 DiphenhydrAMINE HCl ORAL TABLET 25 DORMIN ORAL CASULE 25 Genahist ORAL CASULE 25 harbedryl ORAL CASULE 25, 50 Q-Dryl ORAL CASULE 25 Q-Dryl ORAL LIQUID 12.5 /5ML Quenalin ORAL SYRU 12.5 /5ML SCOT-TUSSIN ALLERGY RELIEF ORAL LIQUID 12.5 /5ML Siladryl Allergy ORAL LIQUID 12.5 /5ML Silphen Cough ORAL SYRU 12.5 /5ML SIMLY ALLERGY ORAL TABLET 25 Total Allergy ORAL TABLET 25 TOTAL ALLERGY MEDICINE ORAL LIQUID 12.5 /5ML *Antihistamines - Non-Sedating** *Antihistamines - Non-Sedating*** ALLEGRA ALLERGY CHILDRENS ORAL TABLET 30 Allergy ORAL TABLET DISERSIBLE 10 Cetirizine HCl ORAL SYRU 5 /5ML Notes (OTC- Covered w/rx); OTC; QL (300 ML per 31 days) Cetirizine HCl ORAL TABLET 10, 5 Cetirizine HCl Childrens ORAL SOLUTION 1 /ML Cetirizine HCl Childrens Alrgy ORAL SYRU 1 /ML Childrens Loratadine ORAL SYRU 5 /5ML OTC; QL (300 ML per 31 days) OTC; QL (300 ML per 31 days) Notes (OTC- Covered w/rx); OTC; QL (300 ML per 31 days) 7

11 Drug Name reference Details Coverage Details Fexofenadine HCl ORAL TABLET 180, 60 Loratadine ORAL TABLET 10 Loratadine Hives Relief ORAL SOLUTION 5 /5ML *Antiseptics & Disinfectants* *Chlorine Antiseptics** *Chlorine Antiseptics*** Chlorhexidine Gluconate EXTERNAL LIQUID 4 % *Iodine Antiseptics** *Iodine Antiseptics*** OERAND OVIDONE-IODINE EXTERNAL SOLUTION 10 % OTC; QL (300 ML per 31 days) Notes (OTC- Covered w/rx); OTC; QL (480 ML per 31 days) ovidone-iodine EXTERNAL SOLUTION 10 % *Cough/Cold/Allergy* *Cough/Cold/Allergy Combinations** *Decongestant & Antihistamine*** ALAVERT ALLERGY/SINUS ORAL TABLET EXTENDED RELEASE 12 HR* ALLEGRA-D ALLERGY & CONGESTION ORAL TABLET EXTENDED RELEASE 12 HR* Allergy Relief/Nasal Decongest ORAL TABLET EXTENDED RELEASE 24 HR* Antihistamine Decongestant ORAL TABLET BROTA ORAL LIQUID 1-15 /5ML Cetirizine-seudoephedrine ER ORAL TABLET EXTENDED RELEASE 12 HR* Fexofenadine-seudoephed ER ORAL TABLET EXTENDED RELEASE 24 HR* Q-TA ORAL ELIXIR 1-15 /5ML *Expectorants** *Expectorants*** Chest Congestion Relief ORAL TABLET 400 Mucus Relief ORAL TABLET 400 Refenesen ORAL TABLET 200 Refenesen 400 ORAL TABLET 400 Robafen ORAL SYRU 100 /5ML *Misc. Respiratory Inhalants** 8

12 Drug Name reference Details Coverage Details *Misc. Respiratory Inhalants*** BRONCHO SALINE INHALATION AEROSOL, SOLUTION 0.9 % Sodium Chloride INHALATION NEBULIZATION SOLUTION 0.9 % *Dermatologicals* *Acne roducts** *Acne roducts*** Acne Medication 5 EXTERNAL LOTION 5 % Benzoyl eroxide EXTERNAL GEL 10 %, 5 % *Antibiotics - Topical** *Antibiotic Mixtures Topical*** Bacitracin-Neomycin-olymyxin EXTERNAL OINTMENT Double Antibiotic EXTERNAL OINTMENT UNIT/GM Triple Antibiotic EXTERNAL OINTMENT , *Antibiotics - Topical*** Bacitracin EXTERNAL OINTMENT 500 UNIT/GM Bacitracin Zinc EXTERNAL OINTMENT 500 UNIT/GM *Antifungals - Topical** *Antifungals - Topical*** Terbinafine HCl EXTERNAL CREAM 1 % *Imidazole-Related Antifungals - Topical*** Baza Antifungal EXTERNAL CREAM 2 % Clotrimazole EXTERNAL CREAM 1 % Clotrimazole EXTERNAL SOLUTION 1 % *Antihistamines-Topical** *Antihistamines - Topical*** Allergy EXTERNAL CREAM 2 % Anti-Itch Maximum Strength EXTERNAL CREAM 2 % BENADRYL ITCH STOING EXTERNAL GEL 2 % Itch Relief EXTERNAL CREAM 2 % *Corticosteroids - Topical** *Corticosteroids - Topical*** 9

13 Drug Name reference Details Coverage Details AVEENO ANTI-ITCH MAX ST EXTERNAL CREAM 1 % Hydrocortisone EXTERNAL CREAM 0.5 %, 1 % Hydrocortisone EXTERNAL LOTION 1 % Hydrocortisone EXTERNAL OINTMENT 0.5 %, 1 % Hydrocortisone Max St EXTERNAL CREAM 1 % Hydrocortisone Max St/12 Moist EXTERNAL CREAM 1 % HYDROSKIN EXTERNAL CREAM 1 % K Hydrocortisone EXTERNAL CREAM 1 % REARATION H HYDROCORTISONE EXTERNAL CREAM 1 % TGT Anti-Itch/Aloe/Vit E EXTERNAL CREAM 1 % *Topical Steroid Combinations*** Hydrocortisone-Aloe EXTERNAL CREAM 1 % SM Hydrocortisone lus EXTERNAL CREAM 1 % *Emollients** *Emollients*** AMLACTIN EXTERNAL LOTION 12 % Ammonium Lactate EXTERNAL CREAM 12 % Ammonium Lactate EXTERNAL LOTION 12 % *Keratolytic/Antimitotic Agents** *Keratolytic/Antimitotic Agents*** CLEAR AWAY 1-STE WART REMOVER EXTERNAL AD 40 % Notes (OTC- Covered w/rx); OTC; QL (400 GM per 31 days) Notes (OTC- Covered w/rx); OTC; QL (400 GM per 31 days) Notes (OTC- Covered w/rx); OTC; QL (400 GM per 31 days) COMOUND W EXTERNAL LIQUID 17 % COMOUND W MAXIMUM STRENGTH EXTERNAL GEL 17 % FREEZONE EXTERNAL LIQUID 17.6 % SALACTIC FILM EXTERNAL SOLUTION 17 % *Local Anesthetics - Topical** *Local Anesthetics - Topical*** Capsaicin EXTERNAL CREAM % *Scabicides & ediculicides** 10

14 Drug Name reference Details Coverage Details *Scabicides & ediculicides*** ermethrin EXTERNAL LOTION 1 % *Diagnostic roducts* *Diagnostic Tests** *Diagnostic Tests*** OTC; QL (60 ML per 31 days) regnancy Test IN VITRO DIAGNOSTIC TEST *Gastrointestinal Agents - Misc.* *Antiflatulents** *Antiflatulents*** Mi-Acid Gas Relief ORAL TABLET CHEWABLE 80 Mytab Gas ORAL TABLET CHEWABLE 80 Simethicone ORAL SUSENSION 40 /0.6ML Simethicone ORAL TABLET CHEWABLE 80 *Genitourinary Agents - Miscellaneous* *Alkalinizers** *Citrates*** Sodium Citrate ORAL GRANULES *Hematopoietic Agents* *Cobalamins** *Cobalamins*** Cyanocobalamin INJECTION SOLUTION 1000 MCG/ML Vitamin B-12 ORAL TABLET 1000 MCG, 500 MCG Vitamin B-12 SUBLINGUAL TABLET SUBLINGUAL 1000 MCG Vitamin B-12 ER ORAL TABLET EXTENDEDRELEASE* 1000 MCG *Folic Acid/Folates** *Folic Acid/Folates*** Folic Acid ORAL TABLET 1 Folic Acid ORAL TABLET 400 MCG, 800 MCG *Iron** *Iron*** Ferro-Bob ORAL TABLET 325 (65 Fe) Ferrous Sulfate ORAL ELIXIR 220 (44 Fe) /5ML Ferrous Sulfate ORAL TABLET 325 (65 Fe) 11

15 Drug Name reference Details Coverage Details Ferrous Sulfate ORAL TABLET DELAYED RELEASE 324 (65 Fe), 325 (65 Fe) FerrouSul ORAL TABLET 325 (65 Fe) Iron ORAL TABLET 325 (65 Fe), 90 (18 Fe) OLY-IRON 150 ORAL CASULE 150 Slow Release Iron ORAL TABLET EXTENDEDRELEASE* 160 (50 Fe) *Hypnotics* *Antihistamine Hypnotics** *Antihistamine Hypnotic Combinations*** Acetaminophen M ORAL TABLET Headache M ORAL TABLET Mapap M ORAL TABLET ain Relief M Extra Strength ORAL TABLET ain Reliever M ORAL TABLET *Antihistamine Hypnotics*** OTC; QL (62 EA per 31 Days) OTC; QL (62 EA per 31 days) OTC; QL (62 EA per 31 days) OTC; QL (62 EA per 31 days) OTC; QL (62 EA per 31 days) Compoz ORAL CASULE 50 Compoz ORAL TABLET 50 NYTOL ORAL TABLET 25 SIMLY SLEE ORAL TABLET 25 Sleep Tabs ORAL TABLET 25 Sleep-Tabs ORAL TABLET 25 SOMINEX ORAL TABLET 25 SOMINEX MAXIMUM STRENGTH ORAL TABLET 50 Tetra-Formula Nighttime Sleep ORAL TABLET 50 *Laxatives* *Bulk Laxatives** *Bulk Laxatives*** Fiber ORAL TABLET 625 Fiber Laxative ORAL TABLET 625 Fiber Therapy ORAL OWDER 58.6 % Fiber-Lax ORAL TABLET 625 FIBERGEN ORAL TABLET

16 Drug Name reference Details Coverage Details KONSYL ORAL ACKET 100 % KONSYL FIBER ORAL TABLET 625 METAMUCIL ORAL CASULE 0.52 GM METAMUCIL ORAL OWDER 30.9 % METAMUCIL ORAL WAFER METAMUCIL MULTIHEALTH FIBER ORAL OWDER 58.6 % METAMUCIL SMOOTH TEXTURE ORAL ACKET 28 % METAMUCIL SMOOTH TEXTURE ORAL OWDER 28.3 %, 58.6 % Natural Fiber Therapy ORAL OWDER 30.9 %, % Natural Vegetable Fiber ORAL OWDER % REGULOID ORAL CASULE 0.52 GM *Laxative Combinations** *Laxatives & Dss*** DOC-Q-LAX ORAL TABLET ERI-COLACE ORAL TABLET Senna lus ORAL TABLET Senna S ORAL TABLET Senna-Docusate Sodium ORAL TABLET Senna-S ORAL TABLET Senna-Time S ORAL TABLET SENNALAX-S ORAL TABLET Sennosides-Docusate Sodium ORAL TABLET *Laxatives - Miscellaneous** *Laxatives - Miscellaneous*** Sorbitol ORAL SOLUTION 70 % *Saline Laxatives** *Saline Laxative Mixtures*** Enema RE ENEMA 7-19 GM/118ML hosphate Laxative ORAL SOLUTION GM/5ML *Saline Laxatives*** Citrate of Magnesia ORAL SOLUTION GM/30ML 13

17 Drug Name reference Details Coverage Details CITROMA ORAL SOLUTION GM/30ML DULCOLAX MILK OF MAGNESIA ORAL SUSENSION 400 /5ML Magnesium Citrate ORAL SOLUTION GM/30ML Milk of Magnesia ORAL SUSENSION 400 /5ML, 7.75 % *Stimulant Laxatives** *Stimulant Laxatives*** BISAC-EVAC ORAL TABLET DELAYED RELEASE 5 BISAC-EVAC RE SUOSITORY 10 Biscolax RE SUOSITORY 10 CARTERS LITTLE ILLS ORAL TABLET DELAYED RELEASE 5 Correct ORAL TABLET DELAYED RELEASE 5 CORRECTOL ORAL TABLET DELAYED RELEASE 5 Ducodyl ORAL TABLET DELAYED RELEASE 5 EX-LAX ORAL TABLET CHEWABLE 15 EX-LAX ULTRA ORAL TABLET DELAYED RELEASE 5 FEENAMINT ORAL TABLET DELAYED RELEASE 5 FLEET LAXATIVE ORAL TABLET DELAYED RELEASE 5 Gentle Laxative ORAL TABLET DELAYED RELEASE 5 Laxative RE SUOSITORY 10 Magic Bullets RE SUOSITORY 10 Natural Senna Laxative ORAL TABLET Senexon ORAL LIQUID 8.8 /5ML Senexon ORAL TABLET 8.6 Senna ORAL SYRU 8.8 /5ML Senna ORAL TABLET 15, 8.6 Senna Lax ORAL TABLET 8.6 Senna Laxative ORAL TABLET 8.6 Senna Maximum Strength ORAL TABLET 25 14

18 Drug Name reference Details Coverage Details SENNA SMOOTH ORAL TABLET 15 Senna-Lax ORAL TABLET 8.6 Senna-Tabs ORAL TABLET 8.6 Senna-Time ORAL TABLET 8.6 SENNACON ORAL TABLET 8.6 SENNO ORAL TABLET 8.6 Stimulant Laxative ORAL TABLET DELAYED RELEASE 5 Womens Laxative ORAL TABLET DELAYED RELEASE 5 *Surfactant Laxatives** *Surfactant Laxatives*** CORRECTOL EXTRA GENTLE ORAL CASULE 100 D.O.S. ORAL CASULE 250 Diocto ORAL LIQUID 50 /5ML Diocto ORAL SYRU 60 /15ML DocQLace ORAL CASULE 100 Docu Soft ORAL CASULE 100 Docusate Calcium ORAL CASULE 240 Docusate Sodium ORAL CASULE 250 Docusate Sodium ORAL TABLET 100 DOCUSIL ORAL CASULE 100 DOK ORAL CASULE 100, 250 DOK ORAL TABLET 100 DSS ORAL CASULE 100, 250 DULCOLAX STOOL SOFTENER ORAL CASULE 100 Kao-Tin ORAL CASULE 240 Laxa Basic ORAL CASULE 100, 250 Silace ORAL LIQUID 150 /15ML Silace ORAL SYRU 60 /15ML SOF-LAX ORAL CASULE 100 Stool Softener ORAL CASULE 100, 250 Stool Softener Laxative DC ORAL CASULE 240 Sur-Q-Lax ORAL CASULE 240 SURFAK ORAL CASULE 240 *Medical Devices* 15

19 Drug Name reference Details Coverage Details *Contraceptives** *Condoms - Male*** TROJAN RIBBED XX MISC *Contraceptive Sponge*** TODAY SONGE VAGINAL MISC *Respiratory Therapy Supplies** *eak Flow Meters*** eak Flow Meter XX DEVICE *Respiratory Therapy Supplies*** ACE AEROSOL CLOUD ENHANCER XX MISC IN-CHECK DIAL FLOW TRAINER XX DEVICE Inhaler Companions XX MISC Notes (OTC- Covered w/rx); OTC; QL (2 EA per 365 days) QL (2 EA per 365 days) QL (2 EA per 365 days) OTC; QL (2 EA per 365 days) FLEX XX MISC QL (2 EA per 365 days) THRESHOLD IMT XX MISC QL (2 EA per 365 days) THRESHOLD E XX DEVICE QL (2 EA per 365 days) WINDMILL TRAINER XX MISC QL (2 EA per 365 days) *Spacer/Aerosol-Holding Chambers & Supplies*** AEROCHAMBER MV XX MISC QL (2 EA per 365 days) AEROCHAMBER LUS FLO-VU XX MISC QL (2 EA per 365 days) AEROCHAMBER LUS FLO-VU LARGE XX MISC AEROCHAMBER LUS FLO-VU SMALL XX MISC AEROCHAMBER LUS FLO-VU W/MASK XX MISC QL (2 EA per 365 days) QL (2 EA per 365 days) QL (2 EA per 365 days) AEROCHAMBER W/FLOWSIGNAL XX MISC QL (2 EA per 365 days) AEROCHAMBER Z-STAT LUS XX MISC QL (2 EA per 365 days) AEROCHAMBER Z-STAT LUS CHAMBR XX MISC QL (2 EA per 365 days) EASIVENT XX MISC QL (2 EA per 365 days) MICROCHAMBER XX MISC QL (2 EA per 365 days) MICROSACER XX MISC QL (2 EA per 365 days) OTICHAMBER ADVANTAGE XX MISC QL (2 EA per 365 days) OTICHAMBER FACE MASK-LARGE XX MISC Notes (OTC- Covered w/rx); OTC; QL (2 EA per 365 days) 16

20 Drug Name reference Details Coverage Details OTICHAMBER FACE MASK-MEDIUM XX MISC OTICHAMBER FACE MASK-SMALL XX MISC Notes (OTC- Covered w/rx); OTC; QL (2 EA per 365 days) Notes (OTC- Covered w/rx); OTC; QL (2 EA per 365 days) OTIHALER XX DEVICE QL (2 EA per 365 days) OTIHALER XX MISC QL (2 EA per 365 days) OCKET CHAMBER XX DEVICE QL (2 EA per 365 days) OCKET SACER XX DEVICE QL (2 EA per 365 days) WATCHHALER XX DEVICE QL (2 EA per 365 days) *Minerals & Electrolytes* *Calcium** *Calcium Combinations*** Calcium ORAL TABLET UNIT Calcium + D3 ORAL TABLET UNIT Calcium 600-D ORAL TABLET UNIT Calcium Carbonate-Vitamin D ORAL TABLET UNIT, UNIT Calcium High otency/vitamin D ORAL TABLET UNIT Calcium-Carb D ORAL TABLET UNIT Calcium-Vitamin D ORAL TABLET UNIT, UNIT, UNIT CALTRATE 600+D ORAL TABLET UNIT Liquid Calcium/Vitamin D ORAL CASULE UNIT OYSCO 500+D ORAL TABLET UNIT OYSCO D ORAL TABLET UNIT Oyst-Cal D ORAL TABLET UNIT Oyster Calcium + D ORAL TABLET UNIT Oyster Shell Calcium + D ORAL TABLET UNIT Oyster Shell Calcium D ORAL TABLET UNIT Oyster Shell Calcium/D ORAL TABLET UNIT, UNIT 17

21 Drug Name reference Details Coverage Details Oyster Shell Calcium/Vitamin D ORAL TABLET UNIT Oyster Shell/Vitamin D ORAL TABLET UNIT *Calcium*** CAL-CARB FORTE ORAL TABLET 1250 Cal-Lac ORAL CASULE 500 Calcarb 600 ORAL TABLET 1500 CALCI-CHEW ORAL TABLET CHEWABLE 1250 Calcium 600 ORAL TABLET 600 Calcium Carbonate ORAL SUSENSION 1250 /5ML Calcium Carbonate ORAL TABLET 1250, 1500, 600 Calcium High otency ORAL TABLET 600 Calcium Lactate ORAL TABLET 648 Calcium Oyster Shell ORAL TABLET 1250 Calcium-Carb 600 ORAL TABLET 600 CALTRATE 600 ORAL TABLET 1500 OYSCO 500 ORAL TABLET 500 OYSTERCAL ORAL TABLET 500 *Electrolyte Mixtures** *Electrolytes Oral*** ORALYTE ORAL SOLUTION ORALYTE FREEZER OS ORAL SOLUTION *Magnesium** *Magnesium*** Mag-Delay ORAL TABLET EXTENDEDRELEASE* 535 (64 Mg) Mag-SR ORAL TABLET EXTENDEDRELEASE* 535 (64 Mg) MAG-TAB SR ORAL TABLET EXTENDEDRELEASE* 84 (7MEQ) MAG64 ORAL TABLET EXTENDEDRELEASE* 535 (64 ) Notes (OTC- Covered w/rx); OTC; QL (4000 ML per 31 days) Notes (OTC- Covered w/rx); OTC; QL (4000 ML per 31 days) Magnacaps ORAL CASULE 100 Magnesium ORAL TABLET

22 Drug Name reference Details Coverage Details Magnesium Oxide ORAL TABLET 400 (240 Mg) MAGNESIUM-OXIDE ORAL TABLET 400 (241.3 ) *Zinc** *Zinc*** ORAZINC ORAL CASULE 220 Zinc Sulfate ORAL CASULE 220 Zinc Sulfate ORAL TABLET 220 (50 Zn) Zinc-220 ORAL CASULE 220 *Multivitamins* *B-Complex W/ C** *B-Complex W/ C*** Vitamin B Complex-C ORAL CASULE *B-Complex W/ Folic Acid** *B-Complex W/ C & Folic Acid*** NEHRONEX ORAL TABLET Rena-Vite Rx ORAL TABLET 1 RENAL ORAL CASULE 1 Reno Caps ORAL CASULE 1 *Multiple Vitamins W/ Minerals** *Multiple Vitamins W/ Minerals*** Centamin ORAL LIQUID CentaVite ORAL LIQUID Centavite A-Z Complete-Mineral ORAL TABLET CEROVITE ADVANCED FORMULA ORAL TABLET CERTAVITE/ANTIOXIDANTS ORAL LIQUID Formula Twenty-One ORAL TABLET Gerivite Complete ORAL TABLET Golden Age Vitamin/Minerals ORAL LIQUID Multivitamin & Mineral ORAL LIQUID SUER NU-THERA ORAL TABLET Thera Vital M ORAL TABLET Thera-M ORAL TABLET Therabasic-M ORAL TABLET Therapeutic Liquid ORAL SOLUTION Therapeutic-M ORAL TABLET 19

23 Drug Name reference Details Coverage Details TOTAL FORMULA 3 ORAL TABLET *Multivitamins** *Multivitamins*** Daily Multiple Vitamins ORAL TABLET Daily Vite ORAL TABLET Daily Vites ORAL TABLET Multi-Day ORAL TABLET Multi-Vitamin ORAL TABLET Multi-Vitamins ORAL TABLET Once Daily ORAL TABLET One-Daily Multi Vitamins ORAL TABLET THERA ORAL TABLET Thera-Tabs ORAL TABLET THERA/BETA-CAROTENE ORAL TABLET Therapeutic ORAL TABLET *ed Mv W/ Fluoride** *ed Mv W/ Fluoride*** Multi-Vit/Fluoride ORAL SOLUTION 0.25 /ML, 0.5 /ML Multi-Vitamin/Fluoride ORAL TABLET CHEWABLE 0.25, 0.5, 1 Multivitamin/Fluoride ORAL TABLET CHEWABLE 0.25, 0.5, 1 Multivitamins/Fluoride ORAL TABLET CHEWABLE 0.25 *ed Mv W/ Iron** *ed Mv W/ Iron*** olyvitamin/iron ORAL SOLUTION 10 /ML *ediatric Multiple Vitamins** *ediatric Multiple Vitamins W/ C*** oly-vitamin ORAL SOLUTION 35 /ML *ediatric Vitamins** *ediatric Vitamins A & D W/ C*** Tri-Vitamin ORAL SOLUTION *renatal Vitamins** *renatal Mv & Min W/Fe-Fa*** renatal Vitamins ORAL TABLET *Specialty Vitamins roducts** *Specialty Vitamins roducts*** 20

24 Drug Name reference Details Coverage Details Vitamins for Hair ORAL TABLET *Nasal Agents - Systemic And Topical* *Nasal Agents - Misc.** *Nasal Agents - Misc.*** Altamist Spray NASAL SOLUTION 0.65 % AYR NASAL SOLUTION 0.65 % Deep Sea Nasal Spray NASAL SOLUTION 0.65 % HUMIST NASAL SOLUTION 0.65 % LITTLE NOSES SALINE NASAL SOLUTION 0.65 % Na-Zone NASAL SOLUTION 0.65 % NASAL MOIST NASAL SOLUTION 0.65 % OCEAN FOR KIDS NASAL SOLUTION 0.65 % Saline Mist Spray NASAL SOLUTION 0.65 % Saline Nasal Spray NASAL SOLUTION 0.65 % Sea Soft Nasal Mist NASAL SOLUTION 0.65 % *Nasal Antiallergy** *Nasal Mast Cell Stabilizers*** Cromolyn Sodium NASAL AEROSOL, SOLUTION 5.2 /ACT *Sympathomimetic Decongestants** *Systemic Decongestants*** seudoephedrine HCl ORAL TABLET 30, 60 *Ophthalmic Agents* *Artificial Tears And Lubricants** *Artificial Tear And Lubricant Combinations*** Artificial Tears OHTHALMIC OINTMENT % HYOTEARS OHTHALMIC SOLUTION 1-1 % *Artificial Tear Ointments*** Tears Again OHTHALMIC OINTMENT ULTRA FRESH M OHTHALMIC OINTMENT *Artificial Tear Solutions*** Tears Again OHTHALMIC SOLUTION *Artificial Tears And Lubricants*** 21

25 Drug Name reference Details Coverage Details Artificial Tears OHTHALMIC SOLUTION 1.4 % Liquitears OHTHALMIC SOLUTION 1.4 % olyvinyl Alcohol OHTHALMIC SOLUTION 1.4 % *Ophthalmics - Misc.** *Ophthalmic Antiallergic*** OTC; QL (15 ML per 31 days) OTC; QL (15 ML per 31 Days) OTC; QL (15 ML per 31 Days) ALAWAY OHTHALMIC SOLUTION % Ketotifen Fumarate OHTHALMIC SOLUTION % *Otic Agents* *Otic Agents - Miscellaneous** *Otic Agents - Miscellaneous*** Auraphene-B OTIC SOLUTION 6.5 % AURO EARDROS OTIC SOLUTION 6.5 % E-R-O EAR DROS OTIC SOLUTION 6.5 % E-R-O EAR WAX REMOVAL SYSTEM OTIC SOLUTION 6.5 % Ear Drops Earwax Aid OTIC SOLUTION 6.5 % Earwax Treatment Drops OTIC SOLUTION 6.5 % MURINE EAR OTIC SOLUTION 6.5 % MURINE EAR WAX REMOVAL SYSTEM OTIC SOLUTION 6.5 % OTIX OTIC SOLUTION 6.5 % Thera-Ear OTIC SOLUTION 6.5 % *sychotherapeutic And Neurological Agents - Misc.* *Smoking Deterrents** *Smoking Deterrents*** Nicotine TRANSDERMAL ATCH 24 HR 14 /24HR, 21 /24HR, 7 /24HR Nicotine olacrilex MOUTH/THROAT GUM 2, 4 *Ulcer Drugs* *H-2 Antagonists** *H-2 Antagonists*** OTC; QL (70 EA per 365 days) Notes (OTC- Covered w/rx); OTC; QL (4032 EA per 31 days) Acid Reducer ORAL TABLET 75 Cimetidine ORAL TABLET 200 Famotidine ORAL TABLET 10 22

26 Drug Name reference Details Coverage Details *roton ump Inhibitors** *roton ump Inhibitors*** Omeprazole ORAL TABLET DELAYED RELEASE 20 *Vaginal roducts* *Spermicides** *Spermicides*** OTIONS CONCETROL VAGINAL GEL 4 % VCF VAGINAL CONTRACETIVE VAGINAL FOAM 12.5 % *Vaginal Anti-Infectives** *Imidazole-Related Antifungals*** GYNE-LOTRIMIN 3 VAGINAL CREAM 2 % Miconazole 3 Combo ack VAGINAL KIT % (9GM) Miconazole Nitrate VAGINAL CREAM 2 % Miconazole Nitrate VAGINAL SUOSITORY 100 MONISTAT 3 VAGINAL CREAM 4 % *Vitamins* *Oil Soluble Vitamins** *Vitamin A*** Vitamin A ORAL CASULE UNIT, 8000 UNIT *Vitamin D*** CALCIFEROL ORAL SOLUTION 8000 UNIT/ML Vitamin D ORAL CASULE 400 UNIT Vitamin D ORAL TABLET 400 UNIT Vitamin D (Ergocalciferol) ORAL CASULE UNIT QL (4 EA per 28 days) Vitamin D-400 ORAL TABLET 400 UNIT Vitamin D3 ORAL CASULE 2000 UNIT Vitamin D3 ORAL TABLET 1000 UNIT, 400 UNIT Vitamin D3 ORAL TABLET CHEWABLE 400 UNIT *Vitamin E*** Vitamin E ORAL CASULE 400 UNIT Vitamin E ORAL TABLET CHEWABLE 400 UNIT 23

27 Drug Name reference Details Coverage Details *Vitamin K*** Vitamin K (hytonadione) ORAL TABLET 100 MCG *Water Soluble Vitamins** *Vitamin B-1*** Vitamin B-1 ORAL TABLET 100, 250, 50 *Vitamin B-2*** Vitamin B-2 ORAL TABLET 100 *Vitamin B-3*** Niacin ORAL TABLET 100, 250, 50, 500 Niacin ER ORAL CASULE EXTENDED RELEASE* 250 Niacin ER ORAL TABLET EXTENDEDRELEASE* 250 *Vitamin B-6*** Vitamin B-6 ORAL TABLET 100, 25, 250, 50, 500 Vitamin B-6 ER ORAL TABLET EXTENDEDRELEASE* 200 *Vitamin C*** Ascorbic Acid ORAL TABLET 1000, 250, 500 Ascorbic Acid ORAL TABLET CHEWABLE 250 C-500 ORAL TABLET CHEWABLE 500 Vitamin C ORAL SYRU 500 /5ML Vitamin C ORAL TABLET 100, 1000, 250, 500 Vitamin C ORAL TABLET CHEWABLE 100,

28 Index ACE AEROSOL CLOUD ENHANCER Acetaminophen... 1 Acetaminophen M ACID GONE... 4 Acid Reducer Acne Medication AEROCHAMBER MV AEROCHAMBER LUS FLO-VU AEROCHAMBER LUS FLO-VU LARGE AEROCHAMBER LUS FLO-VU SMALL AEROCHAMBER LUS FLO-VU W/MASK AEROCHAMBER W/FLOWSIGNAL AEROCHAMBER Z-STAT LUS AEROCHAMBER Z-STAT LUS CHAMBR Alamag lus... 3 ALAVERT ALLERGY/SINUS... 8 ALAWAY Alcalak... 4 Aler-Cap... 6 Aler-Dryl... 6 AlerTab... 6 ALLEGRA ALLERGY CHILDRENS... 7 ALLEGRA-D ALLERGY & CONGESTION... 8 Aller-Chlor... 6 Allergy... 6, 7, 9 Allergy Relief... 6 Allergy Relief Childrens... 6 Allergy Relief/Nasal Decongest... 8 ALMACONE... 3 Altamist Spray Altaryl... 6 Aluminum Hydroxide Gel... 4 AMLACTIN Ammonium Lactate Antacid... 3, 4 Antacid Anti-Gas... 3 Antacid Anti-Gas Max Strength... 3 Antacid Extra Strength... 3 Antacid I... 3 Antacid III... 3 Anti-Diarrheal... 6 Anti-Hist... 6 Anti-Hist Allergy... 6 Antihistamine Decongestant... 8 Anti-Itch Maximum Strength... 9 Artificial Tears... 21, 22 Ascorbic Acid Aspirin... 3 Aspirin Childrens... 3 Aspirin EC... 3 Aspirin EC Low Dose... 3 Aspirin Low Dose... 3 Auraphene-B AURO EARDROS AVEENO ANTI-ITCH MAX ST AYR Bacitracin... 9 Bacitracin Zinc... 9 Bacitracin-Neomycin-olymyxin... 9 BANOHEN... 6, 7 Baza Antifungal... 9 BD GLUCOSE... 5 BENADRYL ALLERGY CHILDRENS... 7 BENADRYL ITCH STOING... 9 Benzoyl eroxide... 9 BISAC-EVAC Biscolax Bismatrol... 5 Bismuth... 5 BRONCHO SALINE... 9 BROTA... 8 C Calcarb CAL-CARB FORTE CALCI-CHEW CALCIFEROL Calcium Calcium + D3 Calcium Calcium 600-D Calcium Antacid... 4 Calcium Antacid Extra Strength... 4 Calcium Carbonate Calcium Carbonate Antacid... 4 Calcium Carbonate-Vitamin D Calcium High otency Calcium High otency/vitamin D Calcium Lactate Calcium Oyster Shell Calcium-Carb Calcium-Carb D Calcium-Vitamin D CAL-GEST ANTACID

29 Cal-Lac CALTRATE CALTRATE 600+D Capsaicin CARTERS LITTLE ILLS Centamin CentaVite Centavite A-Z Complete-Mineral CEROVITE ADVANCED FORMULA CERTAVITE/ANTIOXIDANTS Cetirizine HCl... 7 Cetirizine HCl Childrens... 7 Cetirizine HCl Childrens Alrgy... 7 Cetirizine-seudoephedrine ER... 8 Chest Congestion Relief... 8 Childrens Ibuprofen... 1 Childrens Loratadine... 7 Childrens Non-ASA ain Relief... 1 Childrens Non-Aspirin... 1 Childrens Non-Aspirin ain... 1 Childrens ain Reliever... 1 Childrens Silapap... 2 Childrens Tactinal... 2 Chlorhexidine Gluconate... 8 ChlorHist... 6 Chlorphen... 6 Cimetidine Citrate of Magnesia CITROMA CLEAR AWAY 1-STE WART REMOVER Clotrimazole... 9 Complete Allergy Medication Complete Allergy Relief... 7 COMOUND W COMOUND W MAXIMUM STRENGTH Compoz Correct CORRECTOL CORRECTOL EXTRA GENTLE Cromolyn Sodium Cyanocobalamin D.O.S Daily Multiple Vitamins Daily Vite Daily Vites Deep Sea Nasal Spray DIABETIC TUSSIN ALLERGY... 6 Diocto Diotame... 5 Diphenhist... 7 DiphenhydrAMINE HCl... 7 DocQLace DOC-Q-LAX Docu Soft Docusate Calcium Docusate Sodium DOCUSIL DOK DORMIN... 7 Double Antibiotic... 9 DSS Ducodyl DULCOLAX MILK OF MAGNESIA DULCOLAX STOOL SOFTENER Ear Drops Earwax Aid Earwax Treatment Drops EASIVENT ECIRIN... 3 Ed-AA... 2 Enema E-R-O EAR DROS E-R-O EAR WAX REMOVAL SYSTEM EX-LAX EX-LAX ULTRA Famotidine FEENAMINT Ferro-Bob Ferrous Sulfate... 11, 12 FerrouSul Fexofenadine HCl... 8 Fexofenadine-seudoephed ER... 8 Fiber Fiber Laxative Fiber Therapy FIBERGEN Fiber-Lax FLEET LAXATIVE Folic Acid Formula Twenty-One FREEZONE Genahist... 7 Gentle Laxative Geri-Lanta... 3 Gerivite Complete Glucose... 5 Golden Age Vitamin/Minerals GYNE-LOTRIMIN Headache M HUMIST Hydrocortisone Hydrocortisone Max St Hydrocortisone Max St/12 Moist Hydrocortisone-Aloe... 10

30 HYDROSKIN HYOTEARS Ibuprofen... 1 IN-CHECK DIAL FLOW TRAINER Infants Silapap... 2 Inhaler Companions Ipecac... 6 Iron Itch Relief... 9 KAOECTATE... 5 KAOECTATE EXTRA STRENGTH... 5 Kao-Tin... 5, 15 Ketotifen Fumarate KONSYL KONSYL FIBER K Hydrocortisone Laxa Basic Laxative Liquid Calcium/Vitamin D Liquitears LITTLE NOSES SALINE LOERAMIDE A-D... 6 Loperamide HCl... 6 Loratadine... 8 Loratadine Hives Relief... 8 MAALOX... 4 MAALOX ADVANCED... 3 MAALOX ADVANCED MAX ST... 3 MAALOX MAX... 4 MAALOX MULTI SYMTOM MAX ST... 4 MAALOX REGULAR STRENGTH... 4 MAG Mag-Delay Magic Bullets Magnacaps Magnesium Magnesium Citrate Magnesium Oxide... 5, 19 MAGNESIUM-OXIDE Mag-SR MAG-TAB SR Mapap... 2 Mapap Arthritis ain... 2 MAA CHILDRENS... 2 Mapap M Maxapap Maximum Strength... 2 Maxapap Regular Strength... 2 Meclizine HCl... 6 METAMUCIL METAMUCIL MULTIHEALTH FIBER METAMUCIL SMOOTH TEXTURE MI-ACID... 4 Mi-Acid Gas Relief Miconazole 3 Combo ack Miconazole Nitrate MICROCHAMBER MICROSACER Milantex... 4 Milantex Extra Strength... 4 Milk of Magnesia MINTOX LUS... 4 MONISTAT Mucus Relief... 8 Multi-Day Multi-Vit/Fluoride Multi-Vitamin Multivitamin & Mineral Multivitamin/Fluoride Multi-Vitamin/Fluoride Multi-Vitamins Multivitamins/Fluoride MURINE EAR MURINE EAR WAX REMOVAL SYSTEM Mytab Gas NASAL MOIST Natural Fiber Therapy Natural Senna Laxative Natural Vegetable Fiber Na-Zone NEHRONEX Niacin Niacin ER Nicotine Nicotine olacrilex Non-Aspirin... 2 Non-Aspirin Extra Strength... 2 Nortemp Infants... 2 NYTOL OCEAN FOR KIDS Omeprazole Once Daily One-Daily Multi Vitamins OERAND OVIDONE-IODINE... 8 OTICHAMBER ADVANTAGE OTICHAMBER FACE MASK-LARGE OTICHAMBER FACE MASK-MEDIUM 27

31 OTICHAMBER FACE MASK-SMALL OTIHALER OTIONS CONCETROL ORALYTE ORALYTE FREEZER OS ORAZINC OTIX OYSCO OYSCO 500+D OYSCO D Oyst-Cal D Oyster Calcium + D Oyster Shell Calcium + D Oyster Shell Calcium D Oyster Shell Calcium/D Oyster Shell Calcium/Vitamin D Oyster Shell/Vitamin D OYSTERCAL ain & Fever Childrens... 2 ain Relief... 2 ain Relief M Extra Strength ain Reliever M eak Flow Meter ERI-COLACE ermethrin FLEX harbedryl... 7 HARBETOL... 2 HARBETOL EXTRA STRENGTH... 2 hosphate Laxative ink Bismuth... 5 OCKET CHAMBER OCKET SACER 28 OLY-IRON olyvinyl Alcohol oly-vitamin olyvitamin/iron ovidone-iodine... 8 regnancy Test renatal Vitamins REARATION H HYDROCORTISONE seudoephedrine HCl Q-Dryl... 7 Q-A... 2 Q-TA... 8 Quenalin... 7 Reeses inworm Medicine... 5 Refenesen... 8 Refenesen REGULOID RENAL Rena-Vite Rx Reno Caps Robafen... 8 SALACTIC FILM Saline Mist Spray Saline Nasal Spray SCOT-TUSSIN ALLERGY RELIEF... 7 Sea Soft Nasal Mist Senexon Senna Senna Lax Senna Laxative Senna Maximum Strength Senna lus Senna S SENNA SMOOTH SENNACON Senna-Docusate Sodium Senna-Lax SENNALAX-S Senna-S Senna-Tabs Senna-Time Senna-Time S SENNO Sennosides-Docusate Sodium Silace Siladryl Allergy... 7 Silphen Cough... 7 Simethicone SIMLY ALLERGY... 7 SIMLY SLEE Sleep Tabs Sleep-Tabs Slow Release Iron SM Hydrocortisone lus Sodium Bicarbonate... 4 Sodium Chloride... 9 Sodium Citrate SOF-LAX SOMINEX SOMINEX MAXIMUM STRENGTH Sorbitol Stimulant Laxative Stomach Relief... 5 Stomach Relief lus... 5 Stool Softener Stool Softener Laxative DC SUER NU-THERA SURFAK Sur-Q-Lax Tactinal... 2

32 Tactinal Extra Strength... 2 Tears Again Terbinafine HCl... 9 Tetra-Formula Nighttime Sleep TGT Anti-Itch/Aloe/Vit E THERA Thera Vital M THERA/BETA-CAROTENE Therabasic-M Thera-Ear Thera-M Therapeutic Therapeutic Liquid Therapeutic-M Thera-Tabs THRESHOLD IMT THRESHOLD E TITRALAC... 5 TODAY SONGE Total Allergy... 7 TOTAL ALLERGY MEDICINE... 7 TOTAL FORMULA Travel Sickness... 6 Tri-Buffered Aspirin... 3 Triple Antibiotic... 9 Tri-Vitamin TROJAN RIBBED Ultilet Glucose... 5 ULTRA FRESH M VCF VAGINAL CONTRACETIVE Vitamin A Vitamin B Complex-C Vitamin B Vitamin B Vitamin B-12 ER Vitamin B Vitamin B Vitamin B-6 ER Vitamin C Vitamin D Vitamin D (Ergocalciferol) Vitamin D Vitamin D Vitamin E Vitamin K (hytonadione) Vitamins for Hair WATCHHALER WINDMILL TRAINER Womens Laxative Zinc Sulfate Zinc