HD Select Formulary

2017 National Formulary Effective 04/01/2017

The Formulary List is a guide providing common preferred brand medicines within select therapeutic categories. The Formulary List does not include all drugs covered by your prescription drug benefit. Generic medicines are available within many of the therapeutic categories listed, in addition to categories not listed, and should be considered as the first line of prescribing.

For benefit coverage or restrictions please check your benefit plan document(s).

This listing is revised periodically as new drugs and new prescribing information becomes available. It is recommended that you bring this list of medications when you or a covered family member sees a physician or other healthcare provider.

Tier Definitions 1 Generics 2 Preferred Brands 3 Non-Preferred Brands

(ST) Step Therapy

Non-Preferred and Excluded* Drugs with Preferred Alternatives

The following is a list of non-preferred and excluded* brand-name medications with covered preferred alternatives that are on the formulary.  Column 1 lists the Drug Class.  Column 2 lists non-preferred and excluded* brand-name medications. o Note: Drugs marked with * are excluded for 4 Tier benefit plans and are considered non-preferred for 3 Tier benefit plans.  Column 3 lists covered preferred alternatives.

Additional covered alternatives may be available. Costs for covered alternatives may vary. Other prescription benefit considerations may apply. Drug Class Non-Preferred or Excluded* Preferred Alternatives

AUTONOMIC & CENTAL NERVOUS SYSTEM

Antidepressants Pexeva*, Sarafem*, Viibryd* Generic SSRIs, trazodone

Antipsychotics Fanapt, Invega Rexulti, Saphris aripiprazole, olanzapine, quetiapine, Latuda, Seroquel XR

Narcotic Analgesics Abstral*, Fentora* Kadian ER, Fentanyl lozenge, fentanyl oxycodone ER Zohydro ER transdermal patch, morphine sulfate ER, Embeda, Hysingla ER, Nucynta ER, Oxycontin

Narcotic Antagonists Suboxone, Vivitrol Buprenorphine-naloxone, Zubsolv

Sleep Agents Intermezzo, Zolpimist ezsopiclone, zaleplon, zolpidem/ER, Belsomra, Rozerem

CARDIOVASCULAR

Angiotensin II Receptor Antagonists + Benicar (HCT), Edarbi, Edarbyclor, candesartanHCT, irbesartanHCT, Diuretic Combinations Teveten HCT losartanHCT, valsartanHCT

Statins Livalo atorvastatin, rosuvastatin, simvastatin, Vytorin

DERMATOLOGICAL

Oral Agents For Rosacea Doxycycline 40 mg capsules Oracea

Topical Agents for Acne/Rosacea Atralin, Avage, Azelex, BenzaClin Adapalene, clindamycin/benzoyl Gel Pump, Veltin* peroxide, clindamycin PLUS tretinoin, topical erythromycin, topical metronidazole, tretinoin, Acanya, Epiduo, Finacea, Tazorac

Topical Agents for Actinic Keratosis Aldara, flurouracil 0.5% cream*, Flurouracil, imiquimod 5% cream, Zyclara* Picato

DIABETES Advocate*, Bayer* (Breeze, Abbott (Freestyle), Contour), Nipro* (TRUEtrack, Blood Glucose Meters & Strips LifeScan (OneTouch) TRUEtest), Omnis Health* (Embrace, Victory), Prodigy*, 2

Drug Class Non-Preferred or Excluded* Preferred Alternatives

Roche* (Accu-Chek), UniStrip*

DPP-4 Inhibitors & Combos Alogliptin*, Kazano*,Kombiglyze*, Janumet (XR), Januvia, Tradjenta, Nesina*, Onglyza*, Oseni* Jentadueto (XR)

Incretin Mimetics (GLP-1 Agonists) Byetta*, Bydureon*, Tanzeum* Trulicity, Victoza

Insulins Humulin*, Relion* Novolin

Apidra*, Afrezza*, Humalog* NovoLog

SGLT-2s Farxiga*, Xigduo XR* Ivokana, Invokamet, Jardiance, S;ynjardy

Other Glumetza*, Riomet metformin

EAR/NOSE Nasonex, Beconase AQ*, flunisolide, fluticasone propionate, Omnaris*, Veramyst*, Zetonna* triamcinolone acetonide, Dymista, Nasal Steroids QNASL

Otic Fluoroquinolone Antibiotics Cetraxal* ciprofloxacin otic solution, Ciprodex

ENDOCRINE (OTHER) Genotropin*, Humatrope*, Norditropin Nutropin AQ*, Omnitrope*, Growth Hormone Saizen*, Zomacton*, Zorbtive*

Estrogen Products Divigel*, Enjuvia*, Estring* estradiol, Premarin

Topical Testosterone Products Fortesta*, Natesto*, Striant*, AndroGel, Axiron Testim*, Vogelxo*

GASTROINTESTINAL Duexis*, Vimovo* famotidine PLUS ibuprofen, omeprazole PLUS naproxen Anti-Inflammatory / Anti-Ulcer Agents

Inflammatory Bowel Agents Asacol HD*, Delzicol*, Dipentum, Amitiza, Apriso, balsalazide Lialda*, Linzess* disodium, Pentasa

Pancreatic Enzymes Pancreaze, Pertzye, Ultresa Pancrelipase, Creon, Viokace, Zenpep

Proton Pump Inhibitors Dexilant, Nexium DR, Zegerid Rx esomeprazole magnesium, lansoprazole, omeparazole, pantoprazole

HEMATOLOGICAL Aranesp*, Epogen*, Mircera* Procrit

Erythropoiesis-Stimulating Agents

Anticoagulants Pradaxa* Clopidogrel, Eliquis, Xarelto

HEPATITIS Rebetrol, RibaPak* ribavirin capsules, ribavirin tablets, Moderiba Antivirals

Hepatitis C (genotype 1, 4) Daklinza*, Epclusa*, Harvoni*, Zepatier

Drug Class Non-Preferred or Excluded* Preferred Alternatives

Sovaldi*, Technivie*, Viekira*

INFLAMMATORY CONDITIONS Actemra, Cimzia, Cosentyx, Enbrel, Humira Orencia*, Otezla*, Remicade*, Tumor Necrosis Factor Antagonists and SImponi*, Stelara, Talz*, Xeljanz* Other Drugs for Inflammatory Conditions

OBSTETRICAL & GYNECOLOGICAL Ganirelix*, Pregnyl Cetrotide, Novarel

Gonadotropin-Releasing Hormone (GnRH) antagonists (for infertility)

Ovulatory Stimulants (for infertility) Bravelle*, Follistim AQ* Clomiphene, Gonal F, Menopur, Repronex

Vaginal Progesterones Endometrin Crinone 8% Gel

OPHTHALMIC Azopt, Rescula, Simbrinza, Zioptan* Betaxolol, dorzolamide, latanoprost, levobunol, timolol, Antiglaucoma Drugs Alphagan P 0.1%, Combigan, Cosopt PF, Travatan Z

Ophthalmic Non-Steroidal Anti- Acuvail* Bromfenac drops, diclofenac Inflammatory Drugs (NSAIDS) drops, ketorolac drops, Ilevro, Nevanac, Prolensa

OSTEOARTHRITIS Euflexxa*, Gel-One*, Gel-Syn*, Synvisc, Synvisc One Hyalgan*, Monovisc*, Orthovisc*, Hyaluronic Acid Derivatives Supartz*

RESPIRATORY Arcapta Neohaler*, Foradil, Proair HFA/ RespiClick, Serevent Perforomist*, Proventil HFA*, Diskus, Ventolin HFA Inhaled Beta Agonists Xopenex HFA*

Inhaled Corticosteroids Alvesco*, Pulmicort Flexhaler*, Advair Diskus/HFA, Arnuity Ellipta, QVAR*, Symbicort* Asmanex HFA Twisthaler, Breo Ellipta, Dulera, Flovent Diskus/HFA

Other (COPD) Daliresp*, Tudorza Respimat* Anoro Ellipta, Incruse Ellipta, Spiriva, Stiolto Respimat

UROLOGICAL Levitra*, Staxyn*, Stendra* Cialis, Viagra

Erectile Dysfunction Oral Agents

Antispasmotics Enablex, Gelnique*, Toviaz* oxybutynin, tolterodine, Myrbetriq, Vesicare

2017 National Drug Formulary Effective 04/01/2017

Drug Name Tier Notes 1st choice lancets super thin 2 1st choice lancets thin 2 1st choice lancets ultra thin 2 1st tier unifine pentips 3 1st tier unilet comfortouch 2 abacavir sulfate oral tablet 1 abacavir-lamivudine-zidovudine oral tablet 1 ABILIFY ORAL TABLET 3 ABSORICA ORAL CAPSULE 2 ABSTRAL SUBLINGUAL TABLET SUBLINGUAL 3 ACANYA EXTERNAL GEL 2 acarbose oral tablet 1 ACCOLATE ORAL TABLET 3 ACCUCAINE COMBINATION KIT 3 ACCU-CHEK AVIVA CONNECT KIT 3 ACCU-CHEK AVIVA IN VITRO STRIP 3 ACCU-CHEK AVIVA PLUS IN VITRO STRIP 3 ACCU-CHEK AVIVA PLUS KIT 3 ACCU-CHEK COMPACT PLUS IN VITRO STRIP 3 ACCU-CHEK COMPACT TEST DRUM IN VITRO 3 STRIP ACCU-CHEK FASTCLIX LANCETS 3 ACCU-CHEK MULTICLIX LANCETS 3 ACCU-CHEK NANO SMARTVIEW KIT 3 ACCU-CHEK SAFE-T PRO LANCETS 3 ACCU-CHEK SMARTVIEW IN VITRO STRIP 3 ACCU-CHEK SOFT TOUCH LANCETS 2 ACCU-CHEK SOFTCLIX LANCETS 3 ACCU-CHEK VOICEMATE KIT 3 ACCURETIC ORAL TABLET 3

Drug Name Tier Notes ACCUTREND GLUCOSE IN VITRO STRIP 3 acebutolol hcl oral capsule 1 acetaminophen-codeine #3 oral tablet 1 acetaminophen-codeine oral solution 1 acetaminophen-codeine oral tablet 1 acetasol hc otic solution 1 acetazolamide oral tablet 1 acetic acid otic solution 1 ACIPHEX ORAL TABLET DELAYED RELEASE 3 acitretin oral capsule 1 ACTEMRA SUBCUTANEOUS SOLUTION PREFILLED 3 ST SYRINGE ACTIGALL ORAL CAPSULE 3 acti-lance 28g 1 acti-lance lite lancets 28g 1 acti-lance special lancets 17g 1 acti-lance universal 23g 1 ACTIMMUNE SUBCUTANEOUS SOLUTION 2 ACTIQ BUCCAL LOZENGE ON A HANDLE 3 ACTIVE 1ST BLOOD LANCETS 30G 2 ACTIVELLA ORAL TABLET 3 ACTONEL ORAL TABLET 3 ACTOPLUS MET ORAL TABLET 3 ACTOS ORAL TABLET 3 ACULAR OPHTHALMIC SOLUTION 3 ACUVAIL OPHTHALMIC SOLUTION 3 acyclovir external ointment 1 acyclovir oral capsule 1 acyclovir oral suspension 1 acyclovir oral tablet 1 ACZONE EXTERNAL GEL 3 ADALAT CC ORAL TABLET EXTENDED RELEASE 24 3 HOUR adapalene external gel 1 adapalene external lotion 3 ADCIRCA ORAL TABLET 2 ADDERALL ORAL TABLET 3

Drug Name Tier Notes ADDERALL XR ORAL CAPSULE EXTENDED RELEASE 3 24 HOUR ADDYI ORAL TABLET 3 ADEMPAS ORAL TABLET 2 ADLYXIN STARTER PACK SUBCUTANEOUS PEN- 3 INJECTOR KIT ADLYXIN SUBCUTANEOUS SOLUTION PEN- 3 INJECTOR ADOXA ORAL CAPSULE 3 ADRENACLICK INJECTION SOLUTION AUTO- 3 INJECTOR ADVAIR DISKUS INHALATION AEROSOL POWDER 2 BREATH ACTIVATED ADVAIR HFA INHALATION AEROSOL 2 ADVATE INTRAVENOUS SOLUTION 2 RECONSTITUTED ADVICOR ORAL TABLET EXTENDED RELEASE 24 3 HOUR ADVOCATE BLOOD GLUCOSE SYSTEM KIT 3 ADVOCATE INSULIN PEN NEEDLES 2 ADVOCATE LANCETS 2 ADVOCATE LANCETS 30G 2 ADVOCATE REDI-CODE IN VITRO STRIP 3 ADVOCATE REDI-CODE KIT 3 ADVOCATE REDI-CODE+ TEST IN VITRO STRIP 3 ADVOCATE SAFETY LANCETS 2 ADVOCATE SAFETY LANCETS 26G 2 ADVOCATE TEST IN VITRO STRIP 3 adynovate intravenous solution reconstituted 3 ADZENYS XR-ODT ORAL TABLET EXTENDED 3 RELEASE DISPERSIBLE AEROCHAMBER MINI CHAMBER DEVICE 2 AEROCHAMBER MV 2 AEROCHAMBER PLUS FLO-VU 2 AEROCHAMBER PLUS FLO-VU LARGE 2 AEROCHAMBER PLUS FLO-VU MEDIUM 2 AEROCHAMBER PLUS FLO-VU SMALL 2 AEROCHAMBER PLUS FLO-VU W/MASK 2

Drug Name Tier Notes AEROCHAMBER PLUS FLOW VU 2 AEROCHAMBER W/FLOWSIGNAL 2 AEROCHAMBER Z-STAT PLUS 2 AEROCHAMBER Z-STAT PLUS CHAMBR 2 AEROCHAMBER Z-STAT PLUS/LARGE 2 AEROCHAMBER Z-STAT PLUS/MEDIUM 2 AEROCHAMBER Z-STAT PLUS/SMALL 2 AEROVENT PLUS DEVICE 2 afeditab cr oral tablet extended release 24 hour 1 AFINITOR DISPERZ ORAL TABLET SOLUBLE 2 AFINITOR ORAL TABLET 2 AGAMATRIX AMP TEST IN VITRO STRIP 3 AGAMATRIX JAZZ TEST IN VITRO STRIP 3 AGAMATRIX JAZZ WIRELESS 2 KIT 3 AGAMATRIX PRESTO KIT 3 AGAMATRIX PRESTO TEST IN VITRO STRIP 3 AGAMATRIX ULTRA-THIN LANCETS 2 AGGRENOX ORAL CAPSULE EXTENDED RELEASE 3 12 HOUR ak-poly-bac ophthalmic ointment 1 ala-cort external cream 1 ALBENZA ORAL TABLET 2 albuterol sulfate inhalation nebulization solution 1 albuterol sulfate oral syrup 1 albuterol sulfate oral tablet 1 ALCAINE OPHTHALMIC SOLUTION 3 alclometasone dipropionate external cream 1 alclometasone dipropionate external ointment 1 ALCORTIN A EXTERNAL GEL 3 ALDACTAZIDE ORAL TABLET 3 ALDACTONE ORAL TABLET 3 ALDARA EXTERNAL CREAM 3 ALECENSA ORAL CAPSULE 3 alendronate sodium oral solution 1 alendronate sodium oral tablet 1 ALFERON N INJECTION SOLUTION 2

Drug Name Tier Notes alfuzosin hcl er oral tablet extended release 24 1 hour ALINIA ORAL SUSPENSION RECONSTITUTED 2 ALINIA ORAL TABLET 2 allopurinol oral tablet 1 almotriptan malate oral tablet 1 ALOCRIL OPHTHALMIC SOLUTION 3 alogliptin benzoate oral tablet 3 alogliptin-metformin hcl oral tablet 3 alogliptin-pioglitazone oral tablet 3 ALORA TRANSDERMAL PATCH TWICE WEEKLY 3 alosetron hcl oral tablet 1 ALPHAGAN P OPHTHALMIC SOLUTION 2 ALPHANATE INTRAVENOUS SOLUTION 2 RECONSTITUTED ALPHANATE/VWF COMPLEX/HUMAN 2 INTRAVENOUS SOLUTION RECONSTITUTED ALPHANINE SD INTRAVENOUS SOLUTION 2 RECONSTITUTED alprazolam er oral tablet extended release 24 1 hour alprazolam intensol oral concentrate 1 alprazolam oral tablet 1 alprazolam oral tablet dispersible 1 alprazolam xr oral tablet extended release 24 1 hour ALPROLIX INTRAVENOUS SOLUTION 2 RECONSTITUTED ALREX OPHTHALMIC SUSPENSION 2 ALSUMA SUBCUTANEOUS SOLUTION AUTO- 3 INJECTOR ALTABAX EXTERNAL OINTMENT 3 altacaine ophthalmic solution 1 ALTACE ORAL CAPSULE 3 altafluor ophthalmic solution 1 altavera oral tablet 1 ALTOPREV ORAL TABLET EXTENDED RELEASE 24 3 HOUR ALVESCO INHALATION AEROSOL SOLUTION 3 9

Drug Name Tier Notes alyacen 1/35 oral tablet 1 alyacen 7/7/7 oral tablet 1 amantadine hcl oral capsule 1 amantadine hcl oral syrup 1 AMARYL ORAL TABLET 3 AMBIEN CR ORAL TABLET EXTENDED RELEASE 3 AMBIEN ORAL TABLET 3 amcinonide external cream 1 amcinonide external lotion 1 amcinonide external ointment 1 AMERGE ORAL TABLET 3 amethia oral tablet 1 amethyst oral tablet 1 AMICAR ORAL TABLET 2 amiloride hcl oral tablet 1 amiloride-hydrochlorothiazide oral tablet 1 amiodarone hcl oral tablet 1 AMITIZA ORAL CAPSULE 2 amitriptyline hcl oral tablet 1 amlodipine besy-benazepril hcl oral capsule 1 amlodipine besylate oral tablet 1 amlodipine besylate-valsartan oral tablet 1 amlodipine-atorvastatin oral tablet 1 amlodipine-valsartan-hctz oral tablet 1 amnesteem oral capsule 1 amoxapine oral tablet 1 amoxicill-clarithro-lansopraz oral 1 amoxicillin oral suspension reconstituted 1 amoxicillin oral tablet 1 amoxicillin-pot clavulanate er oral tablet 1 extended release 12 hour amoxicillin-pot clavulanate oral suspension 1 reconstituted amoxicillin-pot clavulanate oral tablet 1 amphetamine-dextroamphet er oral capsule 1 extended release 24 hour amphetamine-dextroamphetamine oral tablet 1

Drug Name Tier Notes ampicillin oral capsule 1 ampicillin oral suspension reconstituted 1 ampicillin sodium injection solution reconstituted 1 AMPYRA ORAL TABLET EXTENDED RELEASE 12 2 HOUR AMRIX ORAL CAPSULE EXTENDED RELEASE 24 3 HOUR ANAFRANIL ORAL CAPSULE 3 ANALPRAM E RECTAL KIT 3 ANAPROX ORAL TABLET 3 anaspaz oral tablet dispersible 1 anastrozole oral tablet 1 ANCOBON ORAL CAPSULE 3 ANDRODERM TRANSDERMAL PATCH 24 HOUR 3 ANDROGEL PUMP TRANSDERMAL GEL 2 ANDROGEL TRANSDERMAL GEL 2 ANDROID ORAL CAPSULE 3 androxy oral tablet 1 ANGELIQ ORAL TABLET 3 ANORO ELLIPTA INHALATION AEROSOL POWDER 2 BREATH ACTIVATED ANTABUSE ORAL TABLET 3 ANTARA ORAL CAPSULE 3 anucort-hc rectal suppository 1 ANUSOL-HC RECTAL SUPPOSITORY 3 ANZEMET ORAL TABLET 3 apexicon e external cream 1 APIDRA INJECTION SOLUTION 3 APIDRA SOLOSTAR SUBCUTANEOUS SOLUTION 3 PEN-INJECTOR APLENZIN ORAL TABLET EXTENDED RELEASE 24 3 HOUR apraclonidine hcl ophthalmic solution 1 aprepitant oral capsule 1 apri oral tablet 1 APRISO ORAL CAPSULE EXTENDED RELEASE 24 2 HOUR APTIVUS ORAL CAPSULE 2

Drug Name Tier Notes APTIVUS ORAL SOLUTION 2 aranelle oral tablet 1 ARANESP (ALBUMIN FREE) INJECTION SOLUTION 3 ARANESP (ALBUMIN FREE) INJECTION SOLUTION 3 PREFILLED SYRINGE ARAVA ORAL TABLET 3 arbinoxa oral solution 1 arbinoxa oral tablet 1 ARCAPTA NEOHALER INHALATION CAPSULE 3 ARIMIDEX ORAL TABLET 3 aripiprazole oral tablet 1 aripiprazole oral tablet dispersible 1 ARIXTRA SUBCUTANEOUS SOLUTION 3 armodafinil oral tablet 1 ARMOUR THYROID ORAL TABLET 2 ARNUITY ELLIPTA INHALATION AEROSOL 2 POWDER BREATH ACTIVATED AROMASIN ORAL TABLET 3 ARTHROTEC ORAL TABLET DELAYED RELEASE 3 ASACOL HD ORAL TABLET DELAYED RELEASE 3 ascomp-codeine oral capsule 1 ashlyna oral tablet 1 ASMANEX 120 METERED DOSES INHALATION 2 AEROSOL POWDER BREATH ACTIVATED ASMANEX 14 METERED DOSES INHALATION 2 AEROSOL POWDER BREATH ACTIVATED ASMANEX 30 METERED DOSES INHALATION 2 AEROSOL POWDER BREATH ACTIVATED ASMANEX 60 METERED DOSES INHALATION 2 AEROSOL POWDER BREATH ACTIVATED aspirin-dipyridamole er oral capsule extended 1 release 12 hour ASSURE 4 TEST IN VITRO STRIP 3 assure comfort lancets 28g 2 assure comfort lancets 30g 2 ASSURE HAEMOLANCE PLUS HIGH 2 ASSURE HAEMOLANCE PLUS LOW 2 ASSURE HAEMOLANCE PLUS MICRO 2

Drug Name Tier Notes ASSURE HAEMOLANCE PLUS NORMAL 2 ASSURE HAEMOLANCE PLUS PED 2 ASSURE LANCE LANCETS 2 ASSURE LANCE LANCETS 21G 2 ASSURE LANCE PLUS SAFETY 25G 2 ASSURE LANCE PLUS SAFETY 30G 2 ASSURE PLATINUM IN VITRO STRIP 3 ASSURE PRISM MULTI TEST IN VITRO STRIP 3 ASTAGRAF XL ORAL CAPSULE EXTENDED RELEASE 3 24 HOUR ATACAND HCT ORAL TABLET 3 ATACAND ORAL TABLET 3 ATELVIA ORAL TABLET DELAYED RELEASE 3 atenolol oral tablet 1 atenolol-chlorthalidone oral tablet 1 ATIVAN ORAL TABLET 3 atorvastatin calcium oral tablet 1 atovaquone oral suspension 1 atovaquone-proguanil hcl oral tablet 1 ATRALIN EXTERNAL GEL 3 ATRIPLA ORAL TABLET 2 atropine sulfate ophthalmic solution 1 ATROVENT HFA INHALATION AEROSOL 2 SOLUTION ATROVENT NASAL SOLUTION 3 AUBAGIO ORAL TABLET 2 aubra oral tablet 1 AUGMENTIN ORAL TABLET 3 AUGMENTIN XR ORAL TABLET EXTENDED 3 RELEASE 12 HOUR AVAGE EXTERNAL CREAM 3 AVALIDE ORAL TABLET 3 AVAPRO ORAL TABLET 3 AVAR EXTERNAL PAD 3 AVC VAGINAL VAGINAL CREAM 3 aviane oral tablet 1

Drug Name Tier Notes AVINZA ORAL CAPSULE EXTENDED RELEASE 24 3 HOUR avita external cream 1 AVITA EXTERNAL GEL 3 AVODART ORAL CAPSULE 3 AVONEX INTRAMUSCULAR KIT 3 AXERT ORAL TABLET 3 AXIRON TRANSDERMAL SOLUTION 2 azacitidine injection suspension reconstituted 1 AZASAN ORAL TABLET 2 AZASITE OPHTHALMIC SOLUTION 2 azathioprine oral tablet 1 azelastine hcl nasal solution 1 azelastine hcl ophthalmic solution 1 AZELEX EXTERNAL CREAM 3 AZILECT ORAL TABLET 2 azithromycin oral suspension reconstituted 1 azithromycin oral tablet 1 AZOPT OPHTHALMIC SUSPENSION 3 AZOR ORAL TABLET 2 AZULFIDINE EN-TABS ORAL TABLET DELAYED 3 RELEASE AZULFIDINE ORAL TABLET 3 azurette oral tablet 1 bacitracin ophthalmic ointment 1 bacitracin-polymyxin b ophthalmic ointment 1 bacitra-neomycin-polymyxin-hc ophthalmic 1 ointment baclofen oral tablet 1 BACTRIM ORAL TABLET 3 BACTROBAN EXTERNAL OINTMENT 3 balsalazide disodium oral capsule 1 balziva oral tablet 1 BANZEL ORAL TABLET 2 BARACLUDE ORAL TABLET 3 BASAGLAR KWIKPEN SUBCUTANEOUS SOLUTION 3 PEN-INJECTOR

Drug Name Tier Notes BAYER BREEZE 2 TEST IN VITRO DISK 3 BAYER CONTOUR LINK MONITOR KIT 3 BAYER CONTOUR MONITOR KIT 3 BAYER CONTOUR NEXT EZ KIT 3 BAYER CONTOUR NEXT LINK KIT 3 BAYER CONTOUR NEXT MONITOR KIT 3 BAYER CONTOUR NEXT TEST IN VITRO STRIP 3 BAYER CONTOUR NEXT USB MONITOR KIT 3 BAYER CONTOUR TEST IN VITRO STRIP 3 BAYER MICROLET LANCETS 2 BD DISP NEEDLES 2 BD INSULIN SYRINGE 2 BD INSULIN SYRINGE MICROFINE 2 BD LANCET ULTRAFINE 30G 2 BD LANCET ULTRAFINE 33G 2 BD MICROTAINER LANCETS 2 BD PEN NEEDLE MINI U/F 3 BEBULIN INTRAVENOUS SOLUTION 2 RECONSTITUTED BEBULIN VH INTRAVENOUS SOLUTION 2 RECONSTITUTED BECONASE AQ NASAL SUSPENSION 3 bekyree oral tablet 1 belladonna tincture 2 BELSOMRA ORAL TABLET 2 benazepril hcl oral tablet 1 benazepril-hydrochlorothiazide oral tablet 1 BENEFIX INTRAVENOUS KIT 2 BENEFIX INTRAVENOUS SOLUTION 2 RECONSTITUTED BENICAR HCT ORAL TABLET 3 BENICAR ORAL TABLET 3 BENTYL ORAL CAPSULE 3 BENZACLIN EXTERNAL GEL 3 BENZACLIN WITH PUMP EXTERNAL GEL 3 BENZAMYCIN EXTERNAL GEL 3 BENZEFOAM EXTERNAL FOAM 3

Drug Name Tier Notes BENZEPRO CREAMY WASH EXTERNAL LIQUID 3 benzonatate oral capsule 1 benzoyl peroxide external foam 1 benzoyl peroxide-erythromycin external gel 1 benztropine mesylate oral tablet 1 BEPREVE OPHTHALMIC SOLUTION 2 BERINERT INTRAVENOUS KIT 2 BESIVANCE OPHTHALMIC SUSPENSION 3 BETAGAN OPHTHALMIC SOLUTION 3 betamethasone dipropionate aug external cream 1 betamethasone dipropionate external lotion 1 betamethasone dipropionate external ointment 1 betamethasone valerate external cream 1 betamethasone valerate external lotion 1 betamethasone valerate external ointment 1 BETAPACE AF ORAL TABLET 3 BETAPACE ORAL TABLET 3 BETASERON SUBCUTANEOUS KIT 2 betaxolol hcl ophthalmic solution 1 betaxolol hcl oral tablet 1 bethanechol chloride oral tablet 1 BETIMOL OPHTHALMIC SOLUTION 3 BETOPTIC-S OPHTHALMIC SUSPENSION 3 BEYAZ ORAL TABLET 2 BG STAR TEST IN VITRO STRIP 3 BIAXIN ORAL TABLET 3 bicalutamide oral tablet 1 BIDIL ORAL TABLET 3 BILTRICIDE ORAL TABLET 2 bimatoprost external solution 1 bimatoprost ophthalmic solution 1 BINOSTO ORAL TABLET EFFERVESCENT 3 BIONECT EXTERNAL CREAM 3 BIONECT EXTERNAL GEL 3 bisoprolol fumarate oral tablet 1 bisoprolol-hydrochlorothiazide oral tablet 1

Drug Name Tier Notes BIVIGAM INTRAVENOUS SOLUTION 3 BLEPH-10 OPHTHALMIC SOLUTION 3 BLEPHAMIDE OPHTHALMIC SUSPENSION 3 BLEPHAMIDE S.O.P. OPHTHALMIC OINTMENT 3 blisovi 24 fe oral tablet 1 blisovi fe 1.5/30 oral tablet 1 blood glucose monitor system kit 3 blood glucose test in vitro strip 3 BONIVA ORAL TABLET 3 BOOSTRIX INTRAMUSCULAR SUSPENSION 2 BOSULIF ORAL TABLET 2 bp cleansing wash external emulsion 1 BRAVELLE INJECTION SOLUTION RECONSTITUTED 3 BREATHERITE 2 BREATHERITE COLL SPACER ADULT 2 BREATHERITE COLL SPACER CHILD 2 BREATHERITE COLL SPACER INFANT 2 BREATHERITE RIGID SPACER/MASK 2 BREATHERITE SPACER NEONATE 2 BREATHERITE SPACER SMALL CHILD 2 BREATHERITE/LARGE MASK 2 BREATHERITE/MEDIUM MASK 2 BREATHERITE/SMALL MASK 2 BREO ELLIPTA INHALATION AEROSOL POWDER 2 BREATH ACTIVATED BREVICON (28) ORAL TABLET 3 briellyn oral tablet 1 BRILINTA ORAL TABLET 2 brimonidine tartrate ophthalmic solution 1 BRINTELLIX ORAL TABLET 2 BRISDELLE ORAL CAPSULE 3 BROMFED DM ORAL SYRUP 3 bromfenac sodium ophthalmic solution 1 bromocriptine mesylate oral tablet 1 budesonide inhalation suspension 1 budesonide oral capsule delayed release particles 1 bullseye mini safety lancets 2

Drug Name Tier Notes bumetanide oral tablet 1 BUPHENYL ORAL POWDER 3 BUPHENYL ORAL TABLET 3 buprenorphine hcl sublingual tablet sublingual 1 buprenorphine hcl-naloxone hcl sublingual tablet 1 sublingual buproban oral tablet extended release 12 hour 1 bupropion hcl er (smoking det) oral tablet 1 extended release 12 hour bupropion hcl er (xl) oral tablet extended release 1 24 hour bupropion hcl oral tablet 1 buspirone hcl oral tablet 1 butalbital-apap-caff-cod oral capsule 1 butalbital-apap-caffeine oral tablet 1 butalbital-asa-caff-codeine oral capsule 1 butalbital-aspirin-caffeine oral capsule 1 BUTISOL SODIUM ORAL TABLET 3 BUTRANS TRANSDERMAL PATCH WEEKLY 2 BYDUREON SUBCUTANEOUS PEN-INJECTOR 3 BYDUREON SUBCUTANEOUS SUSPENSION 3 RECONSTITUTED ER BYETTA 5 MCG PEN SUBCUTANEOUS SOLUTION 3 PEN-INJECTOR BYSTOLIC ORAL TABLET 2 cabergoline oral tablet 1 CADUET ORAL TABLET 3 CAFERGOT ORAL TABLET 3 CALAN ORAL TABLET 3 calcipotriene external cream 1 calcipotriene external ointment 1 calcipotriene external solution 1 calcitonin (salmon) nasal solution 1 calcitrene external ointment 1 calcitriol oral capsule 1 calcium acetate (phos binder) oral capsule 1 calcium acetate oral capsule 1 camila oral tablet 1 18

Drug Name Tier Notes camrese oral tablet 1 CANASA RECTAL SUPPOSITORY 2 candesartan cilexetil oral tablet 1 candesartan cilexetil-hctz oral tablet 1 CANTIL ORAL TABLET 3 CAPEX EXTERNAL SHAMPOO 3 CAPITAL/CODEINE ORAL SUSPENSION 3 CAPRELSA ORAL TABLET 2 captopril oral tablet 1 captopril-hydrochlorothiazide oral tablet 1 CARAC EXTERNAL CREAM 2 carafate oral suspension 1 CARAFATE ORAL TABLET 3 CARBAGLU ORAL TABLET 2 carbamazepine er oral tablet extended release 1 12 hour carbamazepine oral suspension 1 carbamazepine oral tablet 1 carbidopa-levodopa er oral tablet extended 1 release carbidopa-levodopa oral tablet 1 carbidopa-levodopa oral tablet dispersible 1 carbidopa-levodopa-entacapone oral tablet 1 carbinoxamine maleate oral solution 1 carbinoxamine maleate oral tablet 1 CARDIZEM CD ORAL CAPSULE EXTENDED 3 RELEASE 24 HOUR CARDIZEM ORAL TABLET 3 CARDURA ORAL TABLET 3 CARDURA XL ORAL TABLET EXTENDED RELEASE 3 24 HOUR CAREONE BLOOD GLUCOSE SYSTEM KIT 3 CAREONE BLOOD GLUCOSE TEST IN VITRO STRIP 3 careone lancet thin 23g 2 careone lancet ultra thin 28g 2 careone unifine pentips 3 careone unifine pentips plus 2

Drug Name Tier Notes CARESENS N GLUCOSE TEST IN VITRO STRIP 3 CARIMUNE NF INTRAVENOUS SOLUTION 3 RECONSTITUTED carisoprodol oral tablet 1 carisoprodol-aspirin oral tablet 1 carisoprodol-aspirin-codeine oral tablet 1 carteolol hcl ophthalmic solution 1 cartia xt oral capsule extended release 24 hour 1 carvedilol oral tablet 1 CASODEX ORAL TABLET 3 CATAPRES ORAL TABLET 3 caziant oral tablet 1 CEDAX ORAL CAPSULE 3 CEDAX ORAL SUSPENSION RECONSTITUTED 3 cefaclor oral capsule 1 cefaclor oral suspension reconstituted 1 cefadroxil oral capsule 1 cefadroxil oral suspension reconstituted 1 cefazolin sodium injection solution reconstituted 1 cefdinir oral capsule 1 cefdinir oral suspension reconstituted 1 cefditoren pivoxil oral tablet 1 cefixime oral suspension reconstituted 1 cefprozil oral suspension reconstituted 1 cefprozil oral tablet 1 ceftibuten oral capsule 1 ceftibuten oral suspension reconstituted 1 CEFTIN ORAL SUSPENSION RECONSTITUTED 3 CEFTIN ORAL TABLET 3 cefuroxime axetil oral tablet 1 CELEBREX ORAL CAPSULE 3 celecoxib oral capsule 1 CELEXA ORAL TABLET 3 CELLCEPT ORAL CAPSULE 3 CELLCEPT ORAL SUSPENSION RECONSTITUTED 3 CENTANY EXTERNAL OINTMENT 3 cephalexin oral suspension reconstituted 1

Drug Name Tier Notes cephalexin oral tablet 1 CEREBYX INJECTION SOLUTION 3 CERVARIX INTRAMUSCULAR SUSPENSION 2 cetirizine hcl oral solution 1 cetirizine hcl oral syrup 1 CETRAXAL OTIC SOLUTION 3 CETROTIDE SUBCUTANEOUS KIT 2 cevimeline hcl oral capsule 1 CHANTIX CONTINUING MONTH PAK ORAL 2 TABLET CHANTIX ORAL TABLET 2 chateal oral tablet 1 CHENODAL ORAL TABLET 2 cheratussin ac oral syrup 1 chlordiazepoxide hcl oral capsule 1 chlordiazepoxide-amitriptyline oral tablet 1 chlordiazepoxide-clidinium oral capsule 1 chloroquine phosphate oral tablet 1 chlorothiazide oral tablet 1 chlorpromazine hcl oral tablet 1 chlorzoxazone oral tablet 1 cholestyramine light oral packet 1 cholestyramine oral packet 1 chorionic gonadotropin intramuscular solution 1 reconstituted CIALIS ORAL TABLET 2 ciclopirox external gel 1 ciclopirox external shampoo 1 ciclopirox olamine external suspension 1 cilostazol oral tablet 1 CILOXAN OPHTHALMIC OINTMENT 3 CILOXAN OPHTHALMIC SOLUTION 3 cimetidine hcl oral solution 1 cimetidine oral tablet 1 CIMZIA STARTER KIT SUBCUTANEOUS KIT 3 ST CIMZIA SUBCUTANEOUS KIT 3 ST

Drug Name Tier Notes CINRYZE INTRAVENOUS SOLUTION 2 RECONSTITUTED CIPRO HC OTIC SUSPENSION 3 CIPRO ORAL TABLET 3 CIPRO XR ORAL TABLET EXTENDED RELEASE 24 3 HOUR CIPRODEX OTIC SUSPENSION 2 ciprofloxacin hcl ophthalmic solution 1 ciprofloxacin hcl oral tablet 1 ciprofloxacin hcl otic solution 1 ciprofloxacin-ciproflox hcl er oral tablet extended 1 release 24 hour citalopram hydrobromide oral solution 1 citalopram hydrobromide oral tablet 1 claravis oral capsule 1 CLARIFOAM EF EXTERNAL FOAM 3 CLARINEX ORAL TABLET 3 clarithromycin er oral tablet extended release 24 1 hour clarithromycin oral suspension reconstituted 1 clarithromycin oral tablet 1 clemastine fumarate oral tablet 1 CLEOCIN ORAL CAPSULE 3 CLEOCIN ORAL SOLUTION RECONSTITUTED 3 CLEOCIN VAGINAL CREAM 3 CLEOCIN-T EXTERNAL GEL 3 CLEOCIN-T EXTERNAL LOTION 3 CLEOCIN-T EXTERNAL SOLUTION 3 CLEOCIN-T EXTERNAL SWAB 3 CLEVER CHEK AUTO-CODE TEST IN VITRO STRIP 3 CLEVER CHEK AUTO-CODE VOICE IN VITRO STRIP 3 CLEVER CHEK LANCETS 2 CLEVER CHEK SYSTEM KIT 3 CLEVER CHEK TEST IN VITRO STRIP 3 CLEVER CHOICE AUTO-CODE TEST IN VITRO STRIP 3 CLEVER CHOICE MICRO SYSTEM KIT 3 CLEVER CHOICE MICRO TEST IN VITRO STRIP 3

Drug Name Tier Notes CLIMARA PRO TRANSDERMAL PATCH WEEKLY 3 CLIMARA TRANSDERMAL PATCH WEEKLY 3 clindacin etz external swab 1 clindacin-p external swab 1 CLINDAGEL EXTERNAL GEL 3 clindamycin hcl oral capsule 1 clindamycin palmitate hcl oral solution 1 reconstituted clindamycin phos-benzoyl perox external gel 1 clindamycin phosphate external foam 1 clindamycin phosphate external gel 1 clindamycin phosphate external lotion 1 clindamycin phosphate external solution 1 clindamycin phosphate external swab 1 clindamycin phosphate vaginal cream 1 clindamycin-tretinoin external gel 1 clobetasol propionate e external cream 1 clobetasol propionate external liquid 1 clobetasol propionate external ointment 1 clobetasol propionate external shampoo 1 clobetasol propionate external solution 1 CLOBEX EXTERNAL SHAMPOO 3 CLOBEX SPRAY EXTERNAL LIQUID 3 clocortolone pivalate external cream 3 clocortolone pivalate pump external cream 3 clodan external shampoo 1 CLODERM EXTERNAL CREAM 3 CLODERM PUMP EXTERNAL CREAM 3 clomiphene citrate oral tablet 1 clomipramine hcl oral capsule 1 clonazepam oral tablet 1 clonazepam oral tablet dispersible 1 clonidine hcl oral tablet 1 clopidogrel bisulfate oral tablet 1 clorazepate dipotassium oral tablet 1 clorpres oral tablet 1 clotrimazole external cream 1

Drug Name Tier Notes clotrimazole external solution 1 clotrimazole mouth/throat lozenge 1 clotrimazole mouth/throat troche 1 clotrimazole-betamethasone external cream 1 clotrimazole-betamethasone external lotion 1 clozapine oral tablet 1 clozapine oral tablet dispersible 100 mg 1 clozapine oral tablet dispersible 150 mg 3 CLOZARIL ORAL TABLET 3 COAGADEX INTRAVENOUS SOLUTION 2 RECONSTITUTED COAGUCHEK LANCETS 2 COARTEM ORAL TABLET 2 codeine sulfate oral tablet 1 COLAZAL ORAL CAPSULE 3 colchicine oral capsule 1 colchicine oral tablet 1 colchicine-probenecid oral tablet 1 COLCRYS ORAL TABLET 2 COLESTID ORAL TABLET 3 colestipol hcl oral tablet 1 colocort rectal enema 1 COLY-MYCIN S OTIC SUSPENSION 3 COMBIGAN OPHTHALMIC SOLUTION 2 COMBIPATCH TRANSDERMAL PATCH TWICE 2 WEEKLY COMBIVENT RESPIMAT INHALATION AEROSOL 2 SOLUTION COMBIVIR ORAL TABLET 3 COMETRIQ (140 MG DAILY DOSE) ORAL KIT 3 comfort assured lancets 28g 2 comfort assured lancets 33g 2 COMFORT EZ INSULIN SYRINGE 2 COMFORT EZ PEN NEEDLES 2 comfort lancets 2 COMPACT SPACE CHAMBER DEVICE 2 COMPACT SPACE CHAMBER/LG MASK DEVICE 2

Drug Name Tier Notes COMPACT SPACE CHAMBER/MED MASK DEVICE 2 COMPACT SPACE CHAMBER/SM MASK DEVICE 2 COMPAZINE ORAL TABLET 3 COMPLERA ORAL TABLET 2 COMTAN ORAL TABLET 3 CONDYLOX EXTERNAL SOLUTION 3 constulose oral solution 1 CONTROL AST IN VITRO STRIP 3 CONTROL BLOOD GLUCOSE SYSTEM KIT 3 CONTROL TEST IN VITRO STRIP 3 CONZIP ORAL CAPSULE EXTENDED RELEASE 24 3 HOUR COOL BLOOD GLUCOSE TEST STRIPS IN VITRO 3 STRIP COOL MONITOR KIT KIT 3 COPAXONE SUBCUTANEOUS SOLUTION 2 PREFILLED SYRINGE COPEGUS ORAL TABLET 3 CORDARONE ORAL TABLET 3 CORDRAN EXTERNAL CREAM 3 COREG CR ORAL CAPSULE EXTENDED RELEASE 24 2 HOUR COREG ORAL TABLET 3 CORGARD ORAL TABLET 3 CORIFACT INTRAVENOUS KIT 2 cormax scalp application external solution 1 CORTEF ORAL TABLET 3 CORTENEMA RECTAL ENEMA 3 CORTIFOAM RECTAL FOAM 2 CORTISPORIN-TC OTIC SUSPENSION 3 CORZIDE ORAL TABLET 3 COSENTYX 300 DOSE SUBCUTANEOUS SOLUTION 3 ST PREFILLED SYRINGE COSENTYX SENSOREADY 300 DOSE 3 ST SUBCUTANEOUS SOLUTION AUTO-INJECTOR COSOPT OPHTHALMIC SOLUTION 3 COSOPT PF OPHTHALMIC SOLUTION 2 COUMADIN ORAL TABLET 2

Drug Name Tier Notes covaryx hs oral tablet 1 COZAAR ORAL TABLET 3 CREON ORAL CAPSULE DELAYED RELEASE 2 PARTICLES CRESTOR ORAL TABLET 3 CRIXIVAN ORAL CAPSULE 2 cromolyn sodium ophthalmic solution 1 cryselle-28 oral tablet 1 CUTIVATE EXTERNAL CREAM 3 CUTIVATE EXTERNAL LOTION 3 CUVITRU SUBCUTANEOUS SOLUTION 3 CUVPOSA ORAL SOLUTION 3 CVS ADVANCED GLUCOSE TEST IN VITRO STRIP 3 CVS BLOOD GLUCOSE METER KIT 3 cvs lancets 21g 2 cvs lancets micro thin 33g 2 cvs lancets thin 26g 2 cvs lancets ultra thin 30g 2 cvs ultra thin lancets 2 cyclafem 1/35 oral tablet 1 cyclafem 7/7/7 oral tablet 1 CYCLESSA ORAL TABLET 3 cyclobenzaprine hcl oral tablet 1 CYCLOGYL OPHTHALMIC SOLUTION 3 CYCLOMYDRIL OPHTHALMIC SOLUTION 3 cyclopentolate hcl ophthalmic solution 1 cycloserine oral capsule 3 CYCLOSET ORAL TABLET 3 cyclosporine modified oral capsule 1 cyclosporine modified oral solution 1 cyclosporine oral capsule 1 CYMBALTA ORAL CAPSULE DELAYED RELEASE 3 PARTICLES cyproheptadine hcl oral syrup 1 cyproheptadine hcl oral tablet 1 cyred oral tablet 1 CYSTADANE ORAL POWDER 2

Drug Name Tier Notes CYSTARAN OPHTHALMIC SOLUTION 2 cytarabine (pf) injection solution 1 CYTOGAM INTRAVENOUS INJECTABLE 2 CYTOMEL ORAL TABLET 3 DAKLINZA ORAL TABLET 3 DALIRESP ORAL TABLET 3 danazol oral capsule 1 DANTRIUM ORAL CAPSULE 3 dantrolene sodium oral capsule 1 dapsone oral tablet 1 DARAPRIM ORAL TABLET 2 darifenacin hydrobromide er oral tablet 1 extended release 24 hour DARZALEX INTRAVENOUS SOLUTION 2 dasetta 1/35 oral tablet 1 dasetta 7/7/7 oral tablet 1 DAYPRO ORAL TABLET 3 daysee oral tablet 1 DAYTRANA TRANSDERMAL PATCH 2 DDAVP ORAL TABLET 3 deblitane oral tablet 1 delyla oral tablet 1 DELZICOL ORAL CAPSULE DELAYED RELEASE 3 DEMADEX ORAL TABLET 3 demeclocycline hcl oral tablet 1 DENAVIR EXTERNAL CREAM 3 DEPAKENE ORAL CAPSULE 3 DEPAKENE ORAL SYRUP 3 DEPAKOTE ER ORAL TABLET EXTENDED RELEASE 3 24 HOUR DEPAKOTE ORAL TABLET DELAYED RELEASE 3 DEPO-MEDROL INJECTION SUSPENSION 3 DEPO-TESTOSTERONE INTRAMUSCULAR 3 SOLUTION DERMATOP EXTERNAL OINTMENT 3 desipramine hcl oral tablet 1 desloratadine oral tablet 1

Drug Name Tier Notes desmopressin ace spray refrig nasal solution 1 desmopressin acetate oral tablet 1 DESOGEN ORAL TABLET 3 desogestrel-ethinyl estradiol oral tablet 1 DESONATE EXTERNAL GEL 3 desonide external lotion 1 desonide external ointment 1 DESOWEN EXTERNAL LOTION 3 desoximetasone external cream 1 desoximetasone external gel 1 desoximetasone external ointment 1 desvenlafaxine er oral tablet extended release 24 3 hour DETROL LA ORAL CAPSULE EXTENDED RELEASE 3 24 HOUR DETROL ORAL TABLET 3 dexamethasone oral tablet 1 dexamethasone sodium phosphate ophthalmic 1 solution DEXCOM G4 PLAT PED RCV/SHARE KIT 2 DEXCOM G4 PLAT PED RECEIVER KIT 2 DEXCOM G4 PLATINUM RCV/SHARE KIT 2 DEXCOM G4 PLATINUM RECEIVER KIT 2 DEXCOM G4 PLATINUM TRANSMITTER KIT 2 DEXCOM G5 MOB/G4 PLAT SENSOR KIT 2 DEXCOM G5 MOBILE RECEIVER KIT 2 DEXCOM G5 MOBILE TRANSMITTER KIT 2 dexedrine oral tablet 1 DEXILANT ORAL CAPSULE DELAYED RELEASE 3 dexmethylphenidate hcl er oral capsule extended 1 release 24 hour dexmethylphenidate hcl oral tablet 1 dextroamphetamine sulfate oral solution 1 dextroamphetamine sulfate oral tablet 1 DIABETA ORAL TABLET 3 dialyvite oral tablet 1 DIASTAT PEDIATRIC RECTAL GEL 3

Drug Name Tier Notes diatrue plus test in vitro strip 3 diazepam intensol oral concentrate 1 diazepam oral concentrate 1 diazepam oral tablet 1 diazepam rectal gel 1 diclofenac potassium oral tablet 1 diclofenac sodium er oral tablet extended release 1 24 hour diclofenac sodium ophthalmic solution 1 diclofenac sodium transdermal gel 1 diclofenac-misoprostol oral tablet delayed 1 release dicloxacillin sodium oral capsule 1 dicyclomine hcl oral capsule 1 didanosine oral capsule delayed release 1 DIFFERIN EXTERNAL GEL 3 DIFFERIN EXTERNAL LOTION 3 DIFICID ORAL TABLET 2 diflorasone diacetate external cream 1 DIFLUCAN ORAL SUSPENSION RECONSTITUTED 3 DIFLUCAN ORAL TABLET 3 diflunisal oral tablet 1 digitek oral tablet 1 digox oral tablet 1 digoxin oral solution 1 digoxin oral tablet 1 dihydroergotamine mesylate nasal solution 1 DILANTIN ORAL CAPSULE 3 DILANTIN ORAL SUSPENSION 3 DILATRATE-SR ORAL CAPSULE EXTENDED 2 RELEASE DILAUDID ORAL TABLET 3 diltiazem cd oral capsule extended release 24 1 hour diltiazem hcl er beads oral capsule extended 1 release 24 hour diltiazem hcl er coated beads oral capsule 1 extended release 24 hour

Drug Name Tier Notes diltiazem hcl oral tablet 1 DIOVAN HCT ORAL TABLET 3 DIOVAN ORAL TABLET 3 DIPENTUM ORAL CAPSULE 3 diphenhydramine hcl oral elixir 1 diphenoxylate-atropine oral liquid 1 diphenoxylate-atropine oral tablet 1 DIPROLENE AF EXTERNAL CREAM 3 dipyridamole oral tablet 1 DISALCID ORAL TABLET 3 disopyramide phosphate oral capsule 1 disulfiram oral tablet 1 DITROPAN XL ORAL TABLET EXTENDED RELEASE 3 24 HOUR divalproex sodium er oral tablet extended 1 release 24 hour divalproex sodium oral tablet delayed release 1 DIVIGEL TRANSDERMAL GEL 3 dofetilide oral capsule 1 DORAL ORAL TABLET 3 DORYX ORAL TABLET DELAYED RELEASE 3 dorzolamide hcl ophthalmic solution 1 dorzolamide hcl-timolol mal ophthalmic solution 1 DOVONEX EXTERNAL CREAM 3 doxazosin mesylate oral tablet 1 doxepin hcl oral capsule 1 doxepin hcl oral concentrate 1 doxycycline hyclate oral capsule 1 doxycycline hyclate oral tablet 1 doxycycline hyclate oral tablet delayed release 1 doxycycline monohydrate oral capsule 1 doxycycline oral capsule delayed release 3 dritho-creme hp external cream 1 dronabinol oral capsule 1 DROPLET LANCETS ULTRA THIN 30G 2 DROPLET PEN NEEDLES 2 drospirenone-ethinyl estradiol oral tablet 1

Drug Name Tier Notes DROXIA ORAL CAPSULE 2 drug mart lancets thin 26g 2 drug mart lancets ultra thin 2 DRUG MART ON-THE-GO LANCET 30G 2 drug mart unifine pentips 3 DRUG MART UNILET LANCETS 28G 2 DRUG MART UNILET LANCETS 30G 2 duane reade lancet altern site 2 duane reade lancet super thin 2 duane reade lancet ultra thin 2 DUAVEE ORAL TABLET 2 DUETACT ORAL TABLET 3 DUEXIS ORAL TABLET 3 DULERA INHALATION AEROSOL 2 duloxetine hcl oral capsule delayed release 1 particles DUREZOL OPHTHALMIC EMULSION 3 dutasteride oral capsule 1 dutasteride-tamsulosin hcl oral capsule 1 DYMISTA NASAL SUSPENSION 2 DYRENIUM ORAL CAPSULE 3 e.e.s. 400 oral tablet 1 EASIVENT 2 EASIVENT MASK LARGE 2 EASIVENT MASK MEDIUM 2 EASIVENT MASK SMALL 2 easy comfort lancets 2 easy comfort pen needles 2 easy plus ii glucose test in vitro strip 3 EASY STEP GLUCOSE MONITOR KIT 3 EASY STEP TEST IN VITRO STRIP 3 easy talk blood glucose system kit 3 easy talk blood glucose test in vitro strip 3 EASY TOUCH FLIPLOCK NEEDLES 3 EASY TOUCH GLUCOSE SYSTEM KIT 2 EASY TOUCH HEALTHPRO SYSTEM KIT 3 EASY TOUCH HEALTHPRO TEST IN VITRO STRIP 3

Drug Name Tier Notes EASY TOUCH HYPODERMIC NEEDLE 3 EASY TOUCH INSULIN SYRINGE 2 EASY TOUCH LANCETS 21G 2 EASY TOUCH LANCETS 23G 2 EASY TOUCH LANCETS 26G 2 EASY TOUCH LANCETS 26G/TWIST 2 EASY TOUCH LANCETS 28G 2 EASY TOUCH LANCETS 28G/TWIST 2 EASY TOUCH LANCETS 30G 2 EASY TOUCH LANCETS 30G/TWIST 2 EASY TOUCH LANCETS 32G 2 EASY TOUCH LANCETS 32G/TWIST 2 EASY TOUCH LANCETS 33G/TWIST 2 EASY TOUCH PEN NEEDLES 3 EASY TOUCH SAFETY LANCETS 21G 2 EASY TOUCH SAFETY LANCETS 23G 2 EASY TOUCH SAFETY LANCETS 26G 2 EASY TOUCH SAFETY LANCETS 28G 2 EASY TOUCH TEST IN VITRO STRIP 2 easy trak blood glucose system kit 3 easy trak blood glucose test in vitro strip 3 EASY TWIST & CAP LANCETS 2 EASYGLUCO IN VITRO STRIP 3 EASYGLUCO PLUS IN VITRO STRIP 3 EASYGLUCO PLUS KIT 3 EASYGLUCO PLUS STARTER KIT 3 EASYMAX 15 TEST IN VITRO STRIP 3 EASYMAX NG BLOOD GLUCOSE KIT 3 EASYMAX TEST IN VITRO STRIP 3 econazole nitrate external cream 1 ECOZA EXTERNAL FOAM 3 EDARBI ORAL TABLET 3 EDARBYCLOR ORAL TABLET 3 ed-spaz oral tablet dispersible 1 EDURANT ORAL TABLET 2 eemt hs oral tablet 1

Drug Name Tier Notes EFFEXOR XR ORAL CAPSULE EXTENDED RELEASE 3 24 HOUR EFFIENT ORAL TABLET 2 EFUDEX EXTERNAL CREAM 3 EGRIFTA SUBCUTANEOUS SOLUTION 2 RECONSTITUTED element compact test in vitro strip 3 ELEMENT TEST IN VITRO STRIP 3 ELESTAT OPHTHALMIC SOLUTION 3 ELIDEL EXTERNAL CREAM 2 ELIGARD SUBCUTANEOUS KIT 2 ELIMITE EXTERNAL CREAM 3 elinest oral tablet 1 ELIQUIS ORAL TABLET 2 elite-ob oral tablet 1 ELOCON EXTERNAL LOTION 3 ELOCON EXTERNAL OINTMENT 3 ELOCTATE INTRAVENOUS SOLUTION 2 RECONSTITUTED EMADINE OPHTHALMIC SOLUTION 3 EMBEDA ORAL CAPSULE EXTENDED RELEASE 2 EMBRACE BLOOD GLUCOSE TEST IN VITRO STRIP 3 EMBRACE EVO BLOOD GLUCOSE TEST IN VITRO 3 STRIP EMBRACE EVO GLUCOSE MONITORING KIT 3 EMBRACE LANCETS ULTRA THIN 30G 2 EMBRACE PRO GLUCOSE TEST IN VITRO STRIP 3 EMCYT ORAL CAPSULE 2 EMEND ORAL CAPSULE 2 EMLA EXTERNAL CREAM 3 emoquette oral tablet 1 EMSAM TRANSDERMAL PATCH 24 HOUR 3 EMTRIVA ORAL CAPSULE 2 EMTRIVA ORAL SOLUTION 2 ENABLEX ORAL TABLET EXTENDED RELEASE 24 3 HOUR enalapril maleate oral tablet 1

Drug Name Tier Notes ENBREL SURECLICK SUBCUTANEOUS SOLUTION 2 AUTO-INJECTOR endocet oral tablet 1 ENGERIX-B INJECTION SUSPENSION 2 ENJUVIA ORAL TABLET 3 enoxaparin sodium subcutaneous solution 1 enpresse-28 oral tablet 1 enskyce oral tablet 1 entacapone oral tablet 1 entecavir oral tablet 1 ENTEREG ORAL CAPSULE 3 ENTOCORT EC ORAL CAPSULE DELAYED RELEASE 3 PARTICLES ENTRESTO ORAL TABLET 2 EPCLUSA ORAL TABLET 3 EPIDUO EXTERNAL GEL 2 EPIFOAM EXTERNAL FOAM 3 epinastine hcl ophthalmic solution 1 epinephrine hcl injection solution 1 epinephrine injection solution auto-injector 1 EPIPEN 2-PAK INJECTION SOLUTION AUTO- 2 INJECTOR EPIPEN JR 2-PAK INJECTION SOLUTION AUTO- 2 INJECTOR epitol oral tablet 1 EPIVIR HBV ORAL SOLUTION 2 EPIVIR HBV ORAL TABLET 3 EPIVIR ORAL SOLUTION 3 eplerenone oral tablet 1 EPOGEN INJECTION SOLUTION 3 eprosartan mesylate oral tablet 1 EPZICOM ORAL TABLET 2 eq blood glucose test in vitro strip 3 eql color lancets 21g 2 eql color lancets micro 33g 2 eql super thin lancets 30g 2 eql thin lancets 26g 2

Drug Name Tier Notes EQUETRO ORAL CAPSULE EXTENDED RELEASE 12 3 HOUR ERGOMAR SUBLINGUAL TABLET SUBLINGUAL 3 errin oral tablet 1 ERTACZO EXTERNAL CREAM 3 erygel external gel 1 ery-tab oral tablet delayed release 1 erythromycin base oral tablet 1 erythromycin ethylsuccinate oral tablet 1 erythromycin external gel 1 erythromycin external solution 1 erythromycin ophthalmic ointment 1 escitalopram oxalate oral solution 1 escitalopram oxalate oral tablet 1 ESGIC ORAL TABLET 3 esomeprazole magnesium oral capsule delayed 1 release est estrogens-methyltest hs oral tablet 1 estarylla oral tablet 1 estazolam oral tablet 1 estradiol transdermal patch twice weekly 1 estradiol transdermal patch weekly 1 estradiol-norethindrone acet oral tablet 1 ESTRING VAGINAL RING 3 ESTROGEL TRANSDERMAL GEL 3 ESTROSTEP FE ORAL TABLET 3 eszopiclone oral tablet 1 ethambutol hcl oral tablet 1 ethosuximide oral capsule 1 ethosuximide oral solution 1 etidronate disodium oral tablet 1 etodolac oral tablet 1 EUFLEXXA INTRA-ARTICULAR SOLUTION 3 PREFILLED SYRINGE EURAX EXTERNAL CREAM 3 EVENCARE G2 TEST IN VITRO STRIP 3 EVENCARE G3 TEST IN VITRO STRIP 3

Drug Name Tier Notes EVENCARE MINI GLUCOSE TEST IN VITRO STRIP 3 EVOCLIN EXTERNAL FOAM 3 EVOLUTION AUTOCODE IN VITRO STRIP 3 EVOXAC ORAL CAPSULE 3 EXEL COMFORT POINT INSULIN SYR 2 EXELDERM EXTERNAL SOLUTION 3 EXELON ORAL CAPSULE 3 EXELON TRANSDERMAL PATCH 24 HOUR 3 exemestane oral tablet 1 EXFORGE HCT ORAL TABLET 3 EXFORGE ORAL TABLET 3 EXJADE ORAL TABLET SOLUBLE 2 EXODERM EXTERNAL LOTION 3 EXTAVIA SUBCUTANEOUS KIT 3 e-z ject lancet micro-thin 33g 1 e-z ject lancet super thin 30g 1 e-z ject lancets 1 e-z ject lancets 21g 1 E-Z JECT LANCETS THIN 26G 2 EZ SMART BLOOD GLUCOSE LANCETS 2 EZ SMART BLOOD GLUCOSE TEST IN VITRO STRIP 3 EZ SMART PLUS GLUCOSE TEST IN VITRO STRIP 3 E-Z SPACER DEVICE 2 ezetimibe oral tablet 1 FABIOR EXTERNAL FOAM 3 FACTIVE ORAL TABLET 3 falmina oral tablet 1 famciclovir oral tablet 1 famotidine oral suspension reconstituted 1 famotidine oral tablet 1 FAMVIR ORAL TABLET 3 FANAPT ORAL TABLET 3 FARESTON ORAL TABLET 2 FARXIGA ORAL TABLET 3 FAZACLO ORAL TABLET DISPERSIBLE 3 felbamate oral suspension 1

Drug Name Tier Notes felbamate oral tablet 1 FELBATOL ORAL SUSPENSION 3 FELBATOL ORAL TABLET 3 FELDENE ORAL CAPSULE 3 felodipine er oral tablet extended release 24 1 hour FEMARA ORAL TABLET 3 FEMCON FE ORAL TABLET CHEWABLE 3 FEMHRT LOW DOSE ORAL TABLET 3 fenofibrate oral capsule 3 fenofibrate oral tablet 1 fenofibric acid oral capsule delayed release 1 FENOGLIDE ORAL TABLET 3 fenoprofen calcium oral capsule 3 fenoprofen calcium oral tablet 1 FENORTHO ORAL CAPSULE 3 fentanyl citrate buccal lozenge on a handle 1 FENTORA BUCCAL TABLET 3 FETZIMA TITRATION ORAL CAPSULE ER 24 HOUR 2 THERAPY PACK FIFTY50 GLUCOSE METER 2.0 KIT 3 FIFTY50 GLUCOSE TEST 2.0 IN VITRO STRIP 3 FIFTY50 PEN NEEDLES 2 FIFTY50 SAFETY SEAL LANCETS 2 FIFTY50 UNILET LANCETS 33G 2 FINACEA EXTERNAL GEL 2 finasteride oral tablet 1 FINE 30 2 FINGERSTIX LANCETS 2 FIORINAL ORAL CAPSULE 3 FIORINAL/CODEINE #3 ORAL CAPSULE 3 FLAGYL ER ORAL TABLET EXTENDED RELEASE 24 3 HOUR FLAGYL ORAL TABLET 3 FLAREX OPHTHALMIC SUSPENSION 3 flavoxate hcl oral tablet 1 FLEBOGAMMA DIF INTRAVENOUS SOLUTION 3

Drug Name Tier Notes FLEBOGAMMA INTRAVENOUS SOLUTION 3 flecainide acetate oral tablet 1 FLECTOR TRANSDERMAL PATCH 2 FLEXICHAMBER DEVICE 2 FLOLAN INTRAVENOUS SOLUTION 2 RECONSTITUTED FLOMAX ORAL CAPSULE 3 FLOVENT DISKUS INHALATION AEROSOL 2 POWDER BREATH ACTIVATED FLOVENT HFA INHALATION AEROSOL 2 flucaine ophthalmic solution 1 fluconazole oral suspension reconstituted 1 fluconazole oral tablet 1 flucytosine oral capsule 1 fludrocortisone acetate oral tablet 1 FLUMADINE ORAL TABLET 3 flunisolide nasal solution 1 fluocinolone acetonide external cream 1 fluocinolone acetonide external solution 1 fluocinonide external cream 1 fluocinonide external gel 1 fluocinonide external ointment 1 fluocinonide-e external cream 1 fluorescein-benoxinate ophthalmic solution 1 fluoritab oral tablet chewable 1 fluorometholone ophthalmic suspension 1 fluorouracil external cream 0.5 % 3 fluorouracil external cream 5 % 1 fluorouracil external solution 1 fluoxetine hcl oral capsule 1 fluoxetine hcl oral solution 1 fluphenazine hcl oral concentrate 1 fluphenazine hcl oral tablet 1 flurandrenolide external cream 1 flurazepam hcl oral capsule 1 flurbiprofen oral tablet 1 flurbiprofen sodium ophthalmic solution 1

Drug Name Tier Notes flurox ophthalmic solution 1 flutamide oral capsule 1 fluticasone propionate external cream 1 fluticasone propionate external lotion 1 fluticasone propionate nasal suspension 3 fluvastatin sodium er oral tablet extended 1 release 24 hour fluvastatin sodium oral capsule 1 fluvoxamine maleate oral tablet 1 FML FORTE OPHTHALMIC SUSPENSION 3 FML LIQUIFILM OPHTHALMIC SUSPENSION 3 FOCALIN ORAL TABLET 3 FOCALIN XR ORAL CAPSULE EXTENDED RELEASE 3 24 HOUR folic acid oral tablet 1 FOLLISTIM AQ INJECTION SOLUTION 3 FOLLISTIM AQ SUBCUTANEOUS SOLUTION 3 fondaparinux sodium subcutaneous solution 1 FORA D10 BLOOD GLUCOSE TEST IN VITRO STRIP 3 FORA D15G BLOOD GLUCOSE TEST IN VITRO 3 STRIP FORA D20 BLOOD GLUCOSE TEST IN VITRO STRIP 3 FORA D40/G31 BLOOD GLUCOSE IN VITRO STRIP 3 FORA G20 BLOOD GLUCOSE SYSTEM KIT 3 FORA G20 BLOOD GLUCOSE TEST IN VITRO STRIP 3 FORA G30A BLOOD GLUCOSE TEST IN VITRO 3 STRIP FORA GD20 TEST IN VITRO STRIP 3 FORA GD50 BLOOD GLUCOSE TEST IN VITRO 3 STRIP FORA LANCETS 2 FORA TN'G VOICE KIT 3 FORA TN'G/TN'G VOICE IN VITRO STRIP 3 FORA V10 BLOOD GLUCOSE TEST IN VITRO STRIP 3 FORA V12 BLOOD GLUCOSE TEST IN VITRO STRIP 3 FORA V20 BLOOD GLUCOSE TEST IN VITRO STRIP 3 FORA V30A BLOOD GLUCOSE SYSTEM KIT 3

Drug Name Tier Notes FORA V30A BLOOD GLUCOSE TEST IN VITRO 3 STRIP FORACARE GD40 TEST IN VITRO STRIP 3 FORACARE PREMIUM V10 TEST IN VITRO STRIP 3 FORACARE TEST N GO TEST IN VITRO STRIP 3 FORADIL AEROLIZER INHALATION CAPSULE 3 FORFIVO XL ORAL TABLET EXTENDED RELEASE 24 3 HOUR FORTEO SUBCUTANEOUS SOLUTION 2 FORTESTA TRANSDERMAL GEL 3 fortical nasal solution 1 FORTISCARE GLUCOSE SYSTEM KIT 3 FORTISCARE TEST IN VITRO STRIP 3 FOSAMAX PLUS D ORAL TABLET 3 fosinopril sodium oral tablet 1 fosinopril sodium-hctz oral tablet 1 fosphenytoin sodium injection solution 1 FOSRENOL ORAL TABLET CHEWABLE 2 FRAGMIN SUBCUTANEOUS SOLUTION 2 freds pharmacy unifine pentip+ 2 freds pharmacy unilet lanc 28g 2 freds pharmacy unilet lanc 30g 2 FREESTYLE FREEDOM KIT 2 FREESTYLE FREEDOM LITE KIT 2 FREESTYLE INSULINX SYSTEM KIT 2 FREESTYLE INSULINX TEST IN VITRO STRIP 2 FREESTYLE LANCETS 2 FREESTYLE LITE TEST IN VITRO STRIP 2 FREESTYLE PRECISION NEO SYSTEM KIT 2 FREESTYLE PRECISION NEO TEST IN VITRO STRIP 2 FREESTYLE SIDEKICK II KIT 2 FREESTYLE TEST IN VITRO STRIP 2 FREESTYLE UNISTICK II LANCETS 2 FROVA ORAL TABLET 3 frovatriptan succinate oral tablet 1 FULYZAQ ORAL TABLET DELAYED RELEASE 3 furosemide oral solution 1

Drug Name Tier Notes fyavolv oral tablet 1 FYCOMPA ORAL TABLET 2 gabapentin oral capsule 1 gabapentin oral tablet 1 GABITRIL ORAL TABLET 2 galantamine hydrobromide er oral capsule 1 extended release 24 hour GAMMAGARD INJECTION SOLUTION 2 GAMMAGARD S/D LESS IGA INTRAVENOUS 2 SOLUTION RECONSTITUTED ganirelix acetate subcutaneous solution 3 GARDASIL INTRAMUSCULAR SUSPENSION 2 gatifloxacin ophthalmic solution 1 gavilyte-g oral solution reconstituted 1 ge100 blood glucose system kit 3 ge100 blood glucose test in vitro strip 3 GELNIQUE TRANSDERMAL GEL 3 GEL-ONE INTRA-ARTICULAR PREFILLED SYRINGE 3 GELSYN-3 INTRA-ARTICULAR SOLUTION 2 PREFILLED SYRINGE gemfibrozil oral tablet 1 GENERESS FE ORAL TABLET CHEWABLE 3 gengraf oral capsule 1 gengraf oral solution 1 GENOTROPIN SUBCUTANEOUS SOLUTION 3 RECONSTITUTED GENSTRIP 50 IN VITRO STRIP 3 gentak ophthalmic ointment 1 gentamicin sulfate ophthalmic ointment 1 gentamicin sulfate ophthalmic solution 1 GENVISC 850 INTRA-ARTICULAR SOLUTION 3 PREFILLED SYRINGE GEODON ORAL CAPSULE 3 ght blood glucose monitor kit 3 ght test in vitro strip 3 gianvi oral tablet 1 GIAZO ORAL TABLET 3 gildagia oral tablet 1 41

Drug Name Tier Notes gildess 1.5/30 oral tablet 1 gildess 1/20 oral tablet 1 gildess 24 fe oral tablet 1 gildess fe 1.5/30 oral tablet 1 GILENYA ORAL CAPSULE 2 GILOTRIF ORAL TABLET 2 glatopa subcutaneous solution prefilled syringe 1 GLEEVEC ORAL TABLET 3 GLEOSTINE ORAL CAPSULE 2 glimepiride oral tablet 1 glipizide er oral tablet extended release 24 hour 1 glipizide oral tablet 1 glipizide xl oral tablet extended release 24 hour 1 glipizide-metformin hcl oral tablet 1 global ease inject pen needles 2 global inject ease insulin syr 2 global inject ease lancets 28g 2 global inject ease lancets 30g 2 global insulin syringes 2 GLUCAGEN HYPOKIT INJECTION SOLUTION 2 RECONSTITUTED GLUCAGON EMERGENCY INJECTION KIT 2 GLUCOCARD 01 BLOOD GLUCOSE KIT 3 GLUCOCARD 01 SENSOR PLUS IN VITRO STRIP 3 GLUCOCARD EXPRESSION MONITOR KIT 3 GLUCOCARD EXPRESSION TEST IN VITRO STRIP 3 GLUCOCARD SHINE KIT 3 GLUCOCARD SHINE TEST IN VITRO STRIP 3 GLUCOCARD VITAL MONITOR KIT 3 GLUCOCARD VITAL TEST IN VITRO STRIP 3 GLUCOCOM LANCETS 28G 2 GLUCOCOM LANCETS 30G 2 GLUCOCOM LANCETS 33G 2 GLUCOCOM MONITOR KIT 3 GLUCOCOM TEST IN VITRO STRIP 3 GLUCONAVII BLOOD GLUCOSE SYS KIT 3

Drug Name Tier Notes GLUCONAVII BLOOD GLUCOSE TEST IN VITRO 3 STRIP GLUCOPHAGE ORAL TABLET 3 GLUCOPHAGE XR ORAL TABLET EXTENDED 3 RELEASE 24 HOUR glucose meter test in vitro strip 3 GLUCOTROL ORAL TABLET 3 GLUCOTROL XL ORAL TABLET EXTENDED RELEASE 3 24 HOUR GLUMETZA ORAL TABLET EXTENDED RELEASE 24 3 HOUR glyburide micronized oral tablet 1 glyburide oral tablet 1 glyburide-metformin oral tablet 1 glycopyrrolate oral tablet 1 GLYNASE ORAL TABLET 3 GLYSET ORAL TABLET 3 GLYXAMBI ORAL TABLET 2 GMATE BLOOD GLUCOSE TEST IN VITRO STRIP 3 GMATE LANCETS 30G 2 GMATE SMART STARTER KIT 3 gnp easy touch glucose test in vitro strip 3 gnp insulin syringe 2 gnp lancets 2 gnp lancets 21g 2 gnp lancets micro thin 33g 2 gnp lancets super thin 30g 2 gnp lancets thin 2 gnp lancets thin 26g 2 gnp micro thin lancets 33g 2 gnp super thin lancets 30g 2 gnp ultra com insulin syringe 2 GOLYTELY ORAL SOLUTION RECONSTITUTED 3 GONAL-F INJECTION SOLUTION RECONSTITUTED 2 granisetron hcl oral tablet 1 GRIFULVIN V ORAL TABLET 3 griseofulvin microsize oral suspension 1

Drug Name Tier Notes griseofulvin microsize oral tablet 1 griseofulvin ultramicrosize oral tablet 1 GRIS-PEG ORAL TABLET 3 guaiatussin ac oral syrup 1 guaifenesin ac oral syrup 1 guaifenesin-codeine oral solution 3 guanfacine hcl er oral tablet extended release 24 1 hour guanfacine hcl oral tablet 1 guanidine hcl oral tablet 1 GUARDIAN REAL-TIME STARTER KIT 3 GUARDIAN REAL-TIME SYSTEM PED KIT 3 GYNAZOLE-1 VAGINAL CREAM 3 HALDOL DECANOATE INTRAMUSCULAR 3 SOLUTION halobetasol propionate external ointment 1 HALOG EXTERNAL CREAM 3 HALOG EXTERNAL OINTMENT 3 haloperidol decanoate intramuscular solution 1 haloperidol lactate oral concentrate 1 haloperidol oral tablet 1 HARVONI ORAL TABLET 3 HAVRIX INTRAMUSCULAR SUSPENSION 2 healthy accents unifine pentip 2 healthy accents unilet lancets 2 heather oral tablet 1 h-e-b incontrol lancets 28g 2 h-e-b incontrol lancets 30g 2 h-e-b incontrol lancets 33g 2 h-e-b incontrol pen needles 2 HELIXATE FS INTRAVENOUS KIT 2 hemmorex-hc rectal suppository 1 HEMOFIL M INTRAVENOUS SOLUTION 2 RECONSTITUTED heparin sodium (porcine) injection solution 1 HIPREX ORAL TABLET 3 homatropaire ophthalmic solution 1

Drug Name Tier Notes homatropine hbr ophthalmic solution 1 HORIZANT ORAL TABLET EXTENDED RELEASE 3 HP ACTHAR INJECTION GEL 2 HUMALOG MIX 50/50 SUBCUTANEOUS 3 SUSPENSION HUMALOG MIX 75/25 SUBCUTANEOUS 3 SUSPENSION HUMALOG SUBCUTANEOUS SOLUTION 3 HUMATE-P INTRAVENOUS SOLUTION 2 RECONSTITUTED HUMATROPE INJECTION SOLUTION 3 RECONSTITUTED HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT 2 HUMIRA PEN-CROHNS STARTER SUBCUTANEOUS 2 PEN-INJECTOR KIT HUMIRA PEN-PSORIASIS STARTER 2 SUBCUTANEOUS PEN-INJECTOR KIT HUMULIN 70/30 SUBCUTANEOUS SUSPENSION 3 HUMULIN N SUBCUTANEOUS SUSPENSION 3 HUMULIN R INJECTION SOLUTION 3 HYALGAN INTRA-ARTICULAR SOLUTION 3 PREFILLED SYRINGE HYCAMTIN ORAL CAPSULE 2 HYCET ORAL SOLUTION 3 hydralazine hcl oral tablet 1 HYDREA ORAL CAPSULE 3 hydrochlorothiazide oral tablet 1 hydrocod polst-cpm polst er oral suspension 1 extended release hydrocodone-acetaminophen oral solution 2.5- 1 108 mg/5ml hydrocodone-acetaminophen oral solution 5-217 3 mg/10ml, 7.5-325 mg/15ml hydrocodone-acetaminophen oral tablet 1 hydrocodone-homatropine oral tablet 1 hydrocodone-ibuprofen oral tablet 1 hydrocortisone ace-pramoxine rectal kit 1 hydrocortisone acetate rectal suppository 1 hydrocortisone butyrate external cream 1

Drug Name Tier Notes hydrocortisone butyrate external solution 1 hydrocortisone external cream 1 hydrocortisone oral tablet 1 hydrocortisone rectal enema 1 hydrocortisone-acetic acid otic solution 1 hydromorphone hcl oral tablet 1 hydroxychloroquine sulfate oral tablet 1 hydroxyurea oral capsule 1 hydroxyzine hcl oral syrup 1 hydroxyzine hcl oral tablet 1 hydroxyzine pamoate oral capsule 1 HYMOVIS INTRA-ARTICULAR SOLUTION 3 PREFILLED SYRINGE hyoscyamine sulfate oral solution 1 hyoscyamine sulfate oral tablet dispersible 1 hyosyne oral solution 1 hypodermic needle 2 HYSINGLA ER ORAL TABLET ER 24 HOUR ABUSE- 2 DETERRENT HYZAAR ORAL TABLET 3 ibandronate sodium oral tablet 1 ICLUSIG ORAL TABLET 2 ILEVRO OPHTHALMIC SUSPENSION 2 ILOTYCIN OPHTHALMIC OINTMENT 3 imatinib mesylate oral tablet 1 IMBRUVICA ORAL CAPSULE 2 imipramine hcl oral tablet 1 imipramine pamoate oral capsule 1 imiquimod external cream 1 IMITREX NASAL SOLUTION 3 IMITREX ORAL TABLET 3 IMITREX STATDOSE SYSTEM SUBCUTANEOUS 3 SOLUTION AUTO-INJECTOR IMURAN ORAL TABLET 3 INCRUSE ELLIPTA INHALATION AEROSOL 2 POWDER BREATH ACTIVATED indapamide oral tablet 1

Drug Name Tier Notes INDOCIN RECTAL SUPPOSITORY 3 indomethacin oral capsule 1 INFANRIX INTRAMUSCULAR SUSPENSION 2 INFINITY BLOOD GLUCOSE SYSTEM KIT 3 INFINITY BLOOD GLUCOSE TEST IN VITRO STRIP 3 INLYTA ORAL TABLET 2 INOVA EXTERNAL KIT 3 INSPIRACHAMBER/LARGE DEVICE 2 INSPIRACHAMBER/MEDIUM DEVICE 2 INSPIRACHAMBER/MOUTHPIECE DEVICE 2 INSPIRACHAMBER/SMALL DEVICE 2 INSPRA ORAL TABLET 3 insulin syringe 2 insulin syringe/needle 2 INTELENCE ORAL TABLET 2 INTERMEZZO SUBLINGUAL TABLET SUBLINGUAL 3 INTRON A INJECTION SOLUTION RECONSTITUTED 2 introvale oral tablet 1 INTUNIV ORAL TABLET EXTENDED RELEASE 24 3 HOUR INVEGA ORAL TABLET EXTENDED RELEASE 24 3 HOUR INVIRASE ORAL TABLET 2 INVOKAMET ORAL TABLET 2 INVOKAMET XR ORAL TABLET EXTENDED 2 RELEASE 24 HOUR INVOKANA ORAL TABLET 2 iophen c-nr oral liquid 1 IOPIDINE OPHTHALMIC SOLUTION 3 ipratropium bromide inhalation solution 1 ipratropium bromide nasal solution 1 ipratropium-albuterol inhalation solution 1 irbesartan oral tablet 1 irbesartan-hydrochlorothiazide oral tablet 1 ISENTRESS ORAL TABLET 2 isometheptene-dichloral-apap oral capsule 1 isoniazid oral tablet 1

Drug Name Tier Notes ISOPTO ATROPINE OPHTHALMIC SOLUTION 3 ISOPTO CARPINE OPHTHALMIC SOLUTION 3 ISORDIL TITRADOSE ORAL TABLET 3 isosorbide dinitrate oral tablet 1 isosorbide mononitrate oral tablet 1 isradipine oral capsule 1 ISTALOL OPHTHALMIC SOLUTION 3 itraconazole oral capsule 1 ivermectin oral tablet 1 IXINITY INTRAVENOUS SOLUTION 2 RECONSTITUTED JAKAFI ORAL TABLET 2 JALYN ORAL CAPSULE 3 jantoven oral tablet 1 JANUMET ORAL TABLET 2 JANUMET XR ORAL TABLET EXTENDED RELEASE 2 24 HOUR JANUVIA ORAL TABLET 2 JARDIANCE ORAL TABLET 2 jencycla oral tablet 1 JENTADUETO ORAL TABLET 2 JENTADUETO XR ORAL TABLET EXTENDED 2 RELEASE 24 HOUR jevantique lo oral tablet 1 jinteli oral tablet 1 jolessa oral tablet 1 jolivette oral tablet 1 juleber oral tablet 1 junel 1.5/30 oral tablet 1 junel 1/20 oral tablet 1 junel fe 1.5/30 oral tablet 1 junel fe 24 oral tablet 1 JUXTAPID ORAL CAPSULE 2 KADIAN ORAL CAPSULE EXTENDED RELEASE 24 3 HOUR kaitlib fe oral tablet chewable 1 KALETRA ORAL SOLUTION 2

Drug Name Tier Notes KALETRA ORAL TABLET 2 KALYDECO ORAL TABLET 2 kariva oral tablet 1 KAZANO ORAL TABLET 3 kelnor 1/35 oral tablet 1 KENALOG EXTERNAL AEROSOL SOLUTION 3 KEPPRA ORAL SOLUTION 3 KEPPRA ORAL TABLET 3 ketoconazole external cream 1 ketoconazole external shampoo 1 ketoconazole oral tablet 1 ketoprofen oral capsule 1 ketorolac tromethamine ophthalmic solution 1 ketorolac tromethamine oral tablet 1 KHEDEZLA ORAL TABLET EXTENDED RELEASE 24 3 HOUR kimidess oral tablet 1 KINERET SUBCUTANEOUS SOLUTION PREFILLED 3 ST SYRINGE KINEVAC INJECTION SOLUTION RECONSTITUTED 2 kinney lancets 2 kinney thin lancets 2 KISQALI 200 DOSE ORAL TABLET 2 KLONOPIN ORAL TABLET 3 klor-con 10 oral tablet extended release 1 klor-con oral packet 1 KOATE-DVI INTRAVENOUS SOLUTION 2 RECONSTITUTED KOGENATE FS BIO-SET INTRAVENOUS KIT 2 KOGENATE FS INTRAVENOUS KIT 2 KOMBIGLYZE XR ORAL TABLET EXTENDED 3 RELEASE 24 HOUR KOVALTRY INTRAVENOUS SOLUTION 3 RECONSTITUTED KRISTALOSE ORAL PACKET 3 kroger blood glucose test in vitro strip 3 kroger lancets 21g 2 kroger lancets micro thin 33g 2 49

Drug Name Tier Notes kroger lancets thin 26g 2 kroger lancets ultrathin 30g 2 kroger premium blood glucose kit 3 kroger premium glucose test in vitro strip 3 kroger test in vitro strip 3 KRYSTEXXA INTRAVENOUS SOLUTION 2 k-sol oral solution 1 K-TAB ORAL TABLET EXTENDED RELEASE 3 kurvelo oral tablet 1 KYLEENA INTRAUTERINE INTRAUTERINE DEVICE 3 labetalol hcl oral tablet 1 lactulose oral solution 1 LAMICTAL ODT ORAL TABLET DISPERSIBLE 3 LAMICTAL ORAL TABLET 3 LAMICTAL XR ORAL KIT 2 LAMISIL ORAL PACKET 2 LAMISIL ORAL TABLET 3 lamivudine oral solution 1 lamivudine oral tablet 1 lamivudine-zidovudine oral tablet 1 lamotrigine oral tablet 1 lamotrigine oral tablet dispersible 1 lancets 2 lancets 28g 2 lancets 30g 2 lancets micro thin 33g 2 lancets super thin 28g 2 lancets thin 2 LANCETS ULTRA FINE 2 LANCETS ULTRA THIN 2 lancets ultra thin 30g 2 LANOXIN ORAL TABLET 3 lansoprazole oral capsule delayed release 1 LANTUS SOLOSTAR SUBCUTANEOUS SOLUTION 2 PEN-INJECTOR LANTUS SUBCUTANEOUS SOLUTION 2 larin 1.5/30 oral tablet 1

Drug Name Tier Notes larin 1/20 oral tablet 1 larin 24 fe oral tablet 1 larin fe 1.5/30 oral tablet 1 larissia oral tablet 1 LASTACAFT OPHTHALMIC SOLUTION 3 latanoprost ophthalmic solution 1 LATUDA ORAL TABLET 2 layolis fe oral tablet chewable 1 leader insulin syringe 2 LEADER UNIFINE PENTIPS 2 LEADER UNIFINE PENTIPS PLUS 2 leena oral tablet 1 leflunomide oral tablet 1 LESCOL ORAL CAPSULE 3 LESCOL XL ORAL TABLET EXTENDED RELEASE 24 3 HOUR lessina oral tablet 1 LETAIRIS ORAL TABLET 2 letrozole oral tablet 1 leucovorin calcium oral tablet 1 LEUKERAN ORAL TABLET 2 levalbuterol hcl inhalation nebulization solution 1 LEVAQUIN ORAL TABLET 3 LEVATOL ORAL TABLET 3 LEVEMIR SUBCUTANEOUS SOLUTION 2 levetiracetam oral solution 1 levetiracetam oral tablet 1 LEVITRA ORAL TABLET 3 levobunolol hcl ophthalmic solution 1 levocetirizine dihydrochloride oral tablet 1 levofloxacin ophthalmic solution 1 levofloxacin oral solution 3 levofloxacin oral tablet 1 levonest oral tablet 1 levonorgest-eth estrad 91-day oral tablet 1 levonorgestrel-ethinyl estrad oral tablet 1 levonorg-eth estrad triphasic oral tablet 1

Drug Name Tier Notes levora 0.15/30 (28) oral tablet 1 LEVO-T ORAL TABLET 2 levothyroxine sodium oral tablet 1 levoxyl oral tablet 1 LEXAPRO ORAL SOLUTION 3 LEXAPRO ORAL TABLET 3 LEXIVA ORAL SUSPENSION 2 LEXIVA ORAL TABLET 2 LIALDA ORAL TABLET DELAYED RELEASE 3 liberty test in vitro strip 3 LIBRAX ORAL CAPSULE 3 lidocaine external ointment 1 lidocaine pak external ointment 1 lidocaine-hydrocortisone ace rectal cream 1 lidocaine-prilocaine external cream 1 lidocaine-tetracaine external cream 3 lindane external shampoo 1 linezolid oral tablet 1 LINZESS ORAL CAPSULE 3 liothyronine sodium oral tablet 1 LIPITOR ORAL TABLET 3 LIPOFEN ORAL CAPSULE 2 lisinopril oral tablet 1 lisinopril-hydrochlorothiazide oral tablet 1 lite touch lancets 2 LITE TOUCH PEN NEEDLES 2 LITEAIRE DEVICE 2 LITETOUCH INSULIN SYRINGE 2 LITETOUCH LANCETS 2 lithium carbonate er oral tablet extended release 1 lithium carbonate oral capsule 1 lithium oral solution 1 LIVALO ORAL TABLET 3 live better lancet super thin 2 live better lancet ultra thin 2 LO LOESTRIN FE ORAL TABLET 2

Drug Name Tier Notes LOCOID EXTERNAL CREAM 3 LOCOID EXTERNAL LOTION 3 LOCOID EXTERNAL SOLUTION 3 LOESTRIN 1.5/30 (21) ORAL TABLET 3 LOESTRIN 1/20 (21) ORAL TABLET 3 LOESTRIN FE 1.5/30 ORAL TABLET 3 LOFIBRA ORAL TABLET 3 lomedia 24 fe oral tablet 1 LOMOTIL ORAL TABLET 3 longs lancets standard 2 longs lancets thin 2 longs lancets ultra thin 2 loperamide hcl oral capsule 1 LOPID ORAL TABLET 3 lopreeza oral tablet 1 LOPRESSOR ORAL TABLET 3 LOPROX EXTERNAL SHAMPOO 3 lorazepam intensol oral concentrate 1 lorazepam oral concentrate 1 lorazepam oral tablet 1 lorcet oral tablet 1 lortab oral tablet 1 loryna oral tablet 1 LORZONE ORAL TABLET 3 losartan potassium oral tablet 1 losartan potassium-hctz oral tablet 1 LOTEMAX OPHTHALMIC SUSPENSION 2 LOTENSIN ORAL TABLET 3 LOTREL ORAL CAPSULE 3 LOTRISONE EXTERNAL CREAM 3 LOTRONEX ORAL TABLET 3 lovastatin oral tablet 1 LOVAZA ORAL CAPSULE 3 LOVENOX SUBCUTANEOUS SOLUTION 3 low-ogestrel oral tablet 1 loxapine succinate oral capsule 1

Drug Name Tier Notes ludent oral tablet chewable 1 LUMIGAN OPHTHALMIC SOLUTION 2 LUNESTA ORAL TABLET 3 lutera oral tablet 1 LYRICA ORAL CAPSULE 2 LYSODREN ORAL TABLET 2 lyza oral tablet 1 MACROBID ORAL CAPSULE 3 MACRODANTIN ORAL CAPSULE 3 MALARONE ORAL TABLET 3 malathion external lotion 1 maprotiline hcl oral tablet 1 MARINOL ORAL CAPSULE 3 marlissa oral tablet 1 MARPLAN ORAL TABLET 3 MATULANE ORAL CAPSULE 2 MAVIK ORAL TABLET 3 MAXALT ORAL TABLET 3 MAXI-COMFORT INSULIN SYRINGE 2 MAXIDEX OPHTHALMIC SUSPENSION 3 MAXITROL OPHTHALMIC OINTMENT 3 MAXITROL OPHTHALMIC SUSPENSION 3 MAXZIDE-25 ORAL TABLET 3 meclizine hcl oral tablet 1 meclofenamate sodium oral capsule 1 medicine shoppe lancets 2 medicine shoppe lancets thin 2 MEDISENSE THIN LANCETS 2 medlance lite 25g 1 MEDLANCE PLUS EXTRA 21G 2 medlance plus lancets 1 MEDLANCE PLUS LITE 25G 2 MEDLANCE PLUS SPECIAL 0.8MM 2 MEDLANCE PLUS SUPERLITE 30G 2 MEDLANCE PLUS UNIVERSAL 21G 2 medlance universal 21g 1

Drug Name Tier Notes MEDROL ORAL TABLET THERAPY PACK 3 mefenamic acid oral capsule 1 mefloquine hcl oral tablet 1 MEGACE ES ORAL SUSPENSION 3 MEGACE ORAL ORAL SUSPENSION 3 megestrol acetate oral suspension 1 megestrol acetate oral tablet 1 meijer blood glucose kit 3 meijer blood glucose test in vitro strip 3 MEIJER LANCETS 2 MEIJER LANCETS THIN 2 MEIJER LANCETS UNIVERSAL 33G 2 meijer premium blood glucose kit 3 meijer premium glucose test in vitro strip 3 MEIJER SUPER THIN LANCETS 2 MEKINIST ORAL TABLET 2 meloxicam oral suspension 1 meloxicam oral tablet 1 memantine hcl oral solution 1 MENOPUR SUBCUTANEOUS SOLUTION 2 RECONSTITUTED MENTAX EXTERNAL CREAM 3 meperidine hcl oral solution 1 MEPHYTON ORAL TABLET 2 meprobamate oral tablet 1 MEPRON ORAL SUSPENSION 3 mercaptopurine oral tablet 1 mesalamine oral tablet delayed release 3 mesalamine rectal enema 1 MESNEX ORAL TABLET 2 METADATE CD ORAL CAPSULE EXTENDED 3 RELEASE metaproterenol sulfate oral syrup 1 metaproterenol sulfate oral tablet 1 metaxall oral tablet 1 metaxalone oral tablet 1

Drug Name Tier Notes metformin hcl er (mod) oral tablet extended 1 release 24 hour metformin hcl er oral tablet extended release 24 1 hour metformin hcl oral tablet 1 methadone hcl oral solution 1 methadone hcl oral tablet soluble 1 methadose oral tablet soluble 1 methazolamide oral tablet 1 methenamine hippurate oral tablet 1 methenamine mandelate oral tablet 1 methimazole oral tablet 1 methocarbamol oral tablet 1 methotrexate oral tablet 1 methscopolamine bromide oral tablet 1 methyclothiazide oral tablet 1 methyldopa oral tablet 1 methyldopa-hydrochlorothiazide oral tablet 1 METHYLIN ORAL SOLUTION 3 methylphenidate hcl er (cd) oral capsule 1 extended release methylphenidate hcl er (la) oral capsule extended 1 release 24 hour methylphenidate hcl oral solution 1 methylphenidate hcl oral tablet 1 methylprednisolone acetate injection suspension 1 methylprednisolone oral tablet therapy pack 1 methyltestosterone oral capsule 1 metipranolol ophthalmic solution 1 metoclopramide hcl oral solution 1 metoclopramide hcl oral tablet 1 metoclopramide hcl oral tablet dispersible 1 metolazone oral tablet 1 metoprolol tartrate oral tablet 1 METOZOLV ODT ORAL TABLET DISPERSIBLE 3 METROCREAM EXTERNAL CREAM 3 METROGEL-VAGINAL VAGINAL GEL 3

Drug Name Tier Notes METROLOTION EXTERNAL LOTION 3 metronidazole external cream 1 metronidazole external gel 1 metronidazole external lotion 1 metronidazole oral tablet 1 metronidazole vaginal gel 1 mexiletine hcl oral capsule 1 MIACALCIN NASAL SOLUTION 3 MICARDIS HCT ORAL TABLET 3 MICARDIS ORAL TABLET 3 miconazole 3 vaginal suppository 1 MICROCHAMBER 2 MICRODOT BLOOD GLUCOSE SYSTEM KIT 3 MICRODOT TEST IN VITRO STRIP 3 microgestin 1.5/30 oral tablet 1 microgestin 1/20 oral tablet 1 MICROGESTIN 24 FE ORAL TABLET 3 microgestin fe 1.5/30 oral tablet 1 MICROLET LANCETS 2 MICROSPACER 2 midazolam hcl oral syrup 1 midodrine hcl oral tablet 1 miglitol oral tablet 1 MIGRANAL NASAL SOLUTION 3 mimvey oral tablet 1 MINIPRESS ORAL CAPSULE 3 MINITRAN TRANSDERMAL PATCH 24 HOUR 3 MINIVELLE TRANSDERMAL PATCH TWICE 3 WEEKLY MINOCIN ORAL CAPSULE 3 minocycline hcl oral capsule 1 minoxidil oral tablet 1 MIRAPEX ER ORAL TABLET EXTENDED RELEASE 3 24 HOUR MIRCERA INJECTION SOLUTION PREFILLED 3 SYRINGE MIRCETTE ORAL TABLET 3

Drug Name Tier Notes mirtazapine oral tablet 1 MIRVASO EXTERNAL GEL 2 MITIGARE ORAL CAPSULE 3 MITOSOL OPHTHALMIC KIT 3 MOBIC ORAL SUSPENSION 3 MOBIC ORAL TABLET 3 modafinil oral tablet 1 moderiba 800 dose pack oral tablet 1 moderiba oral tablet 1 MODICON (28) ORAL TABLET 3 moexipril hcl oral tablet 1 moexipril-hydrochlorothiazide oral tablet 1 mometasone furoate external ointment 1 mometasone furoate external solution 1 mometasone furoate nasal suspension 1 MONOCLATE-P INTRAVENOUS KIT 2 MONOJECT HYPODERMIC NEEDLE 2 MONOJECT INSULIN SYRINGE 2 MONOJECT ULTRA COMFORT SYRINGE 2 MONOLET LANCETS 2 mono-linyah oral tablet 1 mononessa oral tablet 1 MONONINE INTRAVENOUS SOLUTION 2 RECONSTITUTED MONOVISC INTRA-ARTICULAR SOLUTION 3 PREFILLED SYRINGE montelukast sodium oral packet 1 montelukast sodium oral tablet 1 MONUROL ORAL PACKET 3 morgidox oral capsule 1 morphine sulfate er oral capsule extended 1 release 24 hour morphine sulfate er oral tablet extended release 1 morphine sulfate rectal suppository 1 MOVANTIK ORAL TABLET 3 MOVIPREP ORAL SOLUTION RECONSTITUTED 3 MOXEZA OPHTHALMIC SOLUTION 2

Drug Name Tier Notes MS CONTIN ORAL TABLET EXTENDED RELEASE 3 MULTAQ ORAL TABLET 3 mupirocin external ointment 1 MUSE URETHRAL PELLET 2 M-VIT ORAL TABLET 3 MYAMBUTOL ORAL TABLET 3 mycophenolate mofetil oral capsule 1 mycophenolate mofetil oral suspension 1 reconstituted MYDRIACYL OPHTHALMIC SOLUTION 3 MYGLUCOHEALTH BLOOD GLUCOSE KIT 3 MYGLUCOHEALTH LANCETS 30G 2 MYGLUCOHEALTH TEST IN VITRO STRIP 3 myorisan oral capsule 1 MYRBETRIQ ORAL TABLET EXTENDED RELEASE 24 2 HOUR MYSOLINE ORAL TABLET 3 myzilra oral tablet 1 nabumetone oral tablet 1 nadolol oral tablet 1 nadolol-bendroflumethiazide oral tablet 1 naftifine hcl external cream 1 NAFTIN EXTERNAL CREAM 3 NAFTIN EXTERNAL GEL 3 NALFON ORAL CAPSULE 3 naltrexone hcl oral tablet 1 NAMENDA ORAL SOLUTION 3 NAMENDA XR ORAL CAPSULE EXTENDED 2 RELEASE 24 HOUR naproxen oral tablet 1 naproxen sodium oral tablet 1 naratriptan hcl oral tablet 1 NARCAN NASAL LIQUID 2 NARDIL ORAL TABLET 3 NASCOBAL NASAL SOLUTION 2 NASONEX NASAL SUSPENSION 3 NATACYN OPHTHALMIC SUSPENSION 2

Drug Name Tier Notes NATAZIA ORAL TABLET 2 nateglinide oral tablet 1 NATESTO NASAL GEL 3 nature-throid oral tablet 1 necon 0.5/35 (28) oral tablet 1 necon 1/35 (28) oral tablet 1 necon 1/50 (28) oral tablet 1 necon 7/7/7 oral tablet 1 nefazodone hcl oral tablet 1 neomycin-bacitracin zn-polymyx ophthalmic 1 ointment neomycin-polymyxin-dexameth ophthalmic 1 ointment neomycin-polymyxin-dexameth ophthalmic 1 suspension neomycin-polymyxin-gramicidin ophthalmic 1 solution neomycin-polymyxin-hc ophthalmic suspension 1 neomycin-polymyxin-hc otic solution 1 neo-polycin hc ophthalmic ointment 1 neo-polycin ophthalmic ointment 1 NEORAL ORAL CAPSULE 2 NEORAL ORAL SOLUTION 2 NEOSPORIN OPHTHALMIC SOLUTION 3 nephro-vite rx oral tablet 1 NEPTAZANE ORAL TABLET 3 NESINA ORAL TABLET 3 NEULASTA SUBCUTANEOUS SOLUTION 2 PREFILLED SYRINGE NEUPOGEN INJECTION SOLUTION PREFILLED 2 SYRINGE NEUPRO TRANSDERMAL PATCH 24 HOUR 3 NEURONTIN ORAL CAPSULE 3 NEURONTIN ORAL TABLET 3 NEUTEK 2TEK TEST IN VITRO STRIP 3 NEVANAC OPHTHALMIC SUSPENSION 2 nevirapine oral suspension 1 nevirapine oral tablet 1

Drug Name Tier Notes NEXAVAR ORAL TABLET 2 NEXIUM ORAL CAPSULE DELAYED RELEASE 3 NEXIUM ORAL PACKET 2 niacin er (antihyperlipidemic) oral tablet 1 extended release NIACOR ORAL TABLET 3 NIASPAN ORAL TABLET EXTENDED RELEASE 3 nifedipine er oral tablet extended release 24 1 hour nifedipine oral capsule 1 nikki oral tablet 1 nimodipine oral capsule 1 nisoldipine er oral tablet extended release 24 1 hour nitro-bid transdermal ointment 1 NITRO-DUR TRANSDERMAL PATCH 24 HOUR 3 nitrofurantoin macrocrystal oral capsule 1 nitrofurantoin monohyd macro oral capsule 1 nitroglycerin transdermal patch 24 hour 1 nitroglycerin translingual aerosol solution 1 NITROMIST TRANSLINGUAL AEROSOL SOLUTION 3 NITROSTAT SUBLINGUAL TABLET SUBLINGUAL 2 NIVA-PLUS ORAL TABLET 3 nizatidine oral capsule 1 nizatidine oral solution 1 NIZORAL EXTERNAL SHAMPOO 3 nodolor oral capsule 1 nora-be oral tablet 1 NORCO ORAL TABLET 3 NORDITROPIN FLEXPRO SUBCUTANEOUS 2 SOLUTION norethin ace-eth estrad-fe oral tablet 1 norethindrone acet-ethinyl est oral tablet 1 norethindrone oral tablet 1 norethindrone-eth estradiol oral tablet 1 norethin-eth estradiol-fe oral tablet chewable 1 norgestimate-eth estradiol oral tablet 1

Drug Name Tier Notes norgestim-eth estrad triphasic oral tablet 1 NORINYL 1+35 (28) ORAL TABLET 3 NORINYL 1+50 (28) ORAL TABLET 3 NORITATE EXTERNAL CREAM 3 norlyroc oral tablet 1 NORPACE CR ORAL CAPSULE EXTENDED RELEASE 3 12 HOUR NORPACE ORAL CAPSULE 3 NORPRAMIN ORAL TABLET 3 NOR-QD ORAL TABLET 3 nortrel 0.5/35 (28) oral tablet 1 nortrel 1/35 (21) oral tablet 1 nortrel 1/35 (28) oral tablet 1 nortrel 7/7/7 oral tablet 1 nortriptyline hcl oral capsule 1 nortriptyline hcl oral solution 1 NORVASC ORAL TABLET 3 NORVIR ORAL SOLUTION 2 NORVIR ORAL TABLET 2 NOVA MAX BLOOD GLUCOSE SYSTEM KIT 3 NOVA MAX GLUCOSE TEST IN VITRO STRIP 3 NOVA SAFETY LANCETS 23G 2 NOVA SAFETY LANCETS 28G 2 NOVA SUREFLEX LANCETS 2 NOVACORT EXTERNAL GEL 3 novarel intramuscular solution reconstituted 1 NOVOEIGHT INTRAVENOUS SOLUTION 3 RECONSTITUTED NOVOFINE 2 NOVOFINE PLUS 2 NOVOLIN 70/30 RELION SUBCUTANEOUS 2 SUSPENSION NOVOLIN 70/30 SUBCUTANEOUS SUSPENSION 2 NOVOLIN N RELION SUBCUTANEOUS 2 SUSPENSION NOVOLIN N SUBCUTANEOUS SUSPENSION 2 NOVOLIN R INJECTION SOLUTION 2

Drug Name Tier Notes NOVOLIN R RELION INJECTION SOLUTION 2 NOVOLOG FLEXPEN SUBCUTANEOUS SOLUTION 2 PEN-INJECTOR NOVOLOG MIX 70/30 SUBCUTANEOUS 2 SUSPENSION NOVOLOG PENFILL SUBCUTANEOUS SOLUTION 2 CARTRIDGE NOVOSEVEN RT INTRAVENOUS SOLUTION 2 RECONSTITUTED NOXAFIL ORAL SUSPENSION 2 NUCYNTA ER ORAL TABLET EXTENDED RELEASE 2 12 HOUR NUCYNTA ORAL TABLET 2 NUEDEXTA ORAL CAPSULE 2 NULEV ORAL TABLET DISPERSIBLE 3 NUOX EXTERNAL GEL 3 NUTROPIN AQ NUSPIN 10 SUBCUTANEOUS 3 SOLUTION NUTROPIN AQ PEN SUBCUTANEOUS SOLUTION 3 NUVARING VAGINAL RING 2 NUVIGIL ORAL TABLET 3 NUWIQ INTRAVENOUS KIT 3 NUWIQ INTRAVENOUS SOLUTION 3 RECONSTITUTED nystatin external ointment 1 nystatin mouth/throat suspension 1 nystatin oral tablet 1 nystatin-triamcinolone external cream 1 OB COMPLETE ORAL TABLET 3 obizur intravenous solution reconstituted 2 O-CAL FA ORAL TABLET 3 ocella oral tablet 1 OCTAGAM INTRAVENOUS SOLUTION 3 OCUFEN OPHTHALMIC SOLUTION 3 OCUFLOX OPHTHALMIC SOLUTION 3 ofloxacin ophthalmic solution 1 ogestrel oral tablet 1 olanzapine oral tablet 1

Drug Name Tier Notes olanzapine oral tablet dispersible 1 olanzapine-fluoxetine hcl oral capsule 1 OLEPTRO ORAL TABLET EXTENDED RELEASE 24 3 HOUR olopatadine hcl nasal solution 1 olopatadine hcl ophthalmic solution 1 OLYSIO ORAL CAPSULE 3 omega-3-acid ethyl esters oral capsule 1 omeprazole oral capsule delayed release 1 omeprazole-sodium bicarbonate oral capsule 1 OMNARIS NASAL SUSPENSION 3 OMNIPRED OPHTHALMIC SUSPENSION 3 OMNITROPE SUBCUTANEOUS SOLUTION 3 ON CALL EXPRESS BLOOD GLUCOSE IN VITRO 3 STRIP ON CALL EXPRESS MONITORING SYS KIT 3 ON CALL LANCETS 2 ON CALL PLUS BLOOD GLUCOSE IN VITRO STRIP 3 ON CALL PLUS LANCETS 2 ON CALL PLUS METER KIT 3 ON CALL PLUS MONITORING SYSTEM KIT 3 ON CALL VIVID BLOOD GLUCOSE IN VITRO STRIP 3 ON CALL VIVID METER KIT 3 ON CALL VIVID MONITORING KIT 3 ON CALL VIVID PAL METER KIT 3 ondansetron hcl oral solution 1 ondansetron hcl oral tablet 1 ondansetron oral tablet dispersible 1 ONETOUCH DELICA LANCETS 33G 2 ONETOUCH DELICA LANCETS FINE 2 ONETOUCH ULTRA 2 KIT 2 ONETOUCH ULTRA BLUE IN VITRO STRIP 2 ONETOUCH ULTRA MINI KIT 2 ONETOUCH ULTRASOFT LANCETS 2 ONETOUCH VERIO FLEX SYSTEM KIT 2 ONETOUCH VERIO IN VITRO STRIP 2 ONETOUCH VERIO IQ SYSTEM KIT 2

Drug Name Tier Notes ONETOUCH VERIO KIT 2 ONETOUCH VERIO SYNC SYSTEM KIT 2 ONFI ORAL SUSPENSION 2 ONGLYZA ORAL TABLET 3 ONMEL ORAL TABLET 3 OPANA ER ORAL TABLET ER 12 HOUR ABUSE- 2 DETERRENT OPANA ORAL TABLET 3 OPTICHAMBER DIAMOND 2 OPTICHAMBER DIAMOND-LG MASK DEVICE 2 OPTICHAMBER DIAMOND-MD MASK 2 OPTICHAMBER DIAMOND-SM MASK 2 OPTIUM TEST IN VITRO STRIP 3 OPTIUMEZ TEST IN VITRO STRIP 3 OPTUMRX BLOOD GLUCOSE METER KIT 3 OPTUMRX BLOOD GLUCOSE SYSTEM KIT 3 OPTUMRX BLOOD GLUCOSE TEST IN VITRO STRIP 3 ORACEA ORAL CAPSULE DELAYED RELEASE 2 ORAP ORAL TABLET 3 ORAPRED ODT ORAL TABLET DISPERSIBLE 3 ORENCIA CLICKJECT SUBCUTANEOUS SOLUTION 3 AUTO-INJECTOR ORENCIA SUBCUTANEOUS SOLUTION PREFILLED 3 SYRINGE orphenadrine citrate er oral tablet extended 1 release 12 hour orsythia oral tablet 1 ORTHO MICRONOR ORAL TABLET 3 ORTHO TRI-CYCLEN (28) ORAL TABLET 3 ORTHO TRI-CYCLEN LO ORAL TABLET 3 ORTHO-CYCLEN (28) ORAL TABLET 3 ORTHO-NOVUM 1/35 (28) ORAL TABLET 3 ORTHO-NOVUM 7/7/7 (28) ORAL TABLET 3 ORTHOVISC INTRA-ARTICULAR SOLUTION 3 PREFILLED SYRINGE oscimin oral tablet dispersible 1 oseltamivir phosphate oral capsule 1 OSENI ORAL TABLET 3 65

Drug Name Tier Notes OSMOPREP ORAL TABLET 3 OTEZLA ORAL TABLET 3 OTREXUP SUBCUTANEOUS SOLUTION AUTO- 2 INJECTOR OVACE PLUS EXTERNAL SHAMPOO 3 OVACE PLUS WASH EXTERNAL LIQUID 3 OVACE WASH EXTERNAL LIQUID 3 OVCON-35 (28) ORAL TABLET 3 OVIDE EXTERNAL LOTION 3 OXANDRIN ORAL TABLET 3 oxandrolone oral tablet 1 oxaprozin oral tablet 1 OXAYDO ORAL TABLET ABUSE-DETERRENT 3 oxcarbazepine oral suspension 1 oxcarbazepine oral tablet 1 oxiconazole nitrate external cream 1 OXISTAT EXTERNAL CREAM 3 OXISTAT EXTERNAL LOTION 3 OXTELLAR XR ORAL TABLET EXTENDED RELEASE 3 24 HOUR oxybutynin chloride er oral tablet extended 1 release 24 hour oxybutynin chloride oral syrup 1 oxybutynin chloride oral tablet 1 oxycodone hcl er oral tablet er 12 hour abuse- 3 deterrent oxycodone hcl oral solution 1 oxycodone-acetaminophen oral tablet 1 oxycodone-aspirin oral tablet 1 oxycodone-ibuprofen oral tablet 1 OXYCONTIN ORAL TABLET ER 12 HOUR ABUSE- 2 DETERRENT oxymorphone hcl er oral tablet extended release 1 12 hour oxymorphone hcl oral tablet 1 OXYTROL TRANSDERMAL PATCH TWICE WEEKLY 3 pacerone oral tablet 1 PACNEX WASH EXTERNAL LIQUID† 3

Drug Name Tier Notes paliperidone er oral tablet extended release 24 1 hour PAMELOR ORAL CAPSULE 3 PANCREAZE ORAL CAPSULE DELAYED RELEASE 3 PARTICLES PANDEL EXTERNAL CREAM 3 pantoprazole sodium oral tablet delayed release 1 PARAFON FORTE DSC ORAL TABLET 3 PAREMYD OPHTHALMIC SOLUTION 3 PARLODEL ORAL TABLET 3 PARNATE ORAL TABLET 3 paromomycin sulfate oral capsule 1 paroxetine hcl oral tablet 1 PASER ORAL PACKET 3 PATADAY OPHTHALMIC SOLUTION 2 PATANASE NASAL SOLUTION 3 PATANOL OPHTHALMIC SOLUTION 3 PAXIL ORAL TABLET 3 pc lancets super thin 30g 2 pc unifine pentips 2 PCE ORAL TABLET DELAYED RELEASE 3 PEDIADERM HC EXTERNAL KIT 3 peg-3350/electrolytes oral solution reconstituted 1 PEGANONE ORAL TABLET 2 PEG-INTRON REDIPEN PAK 4 SUBCUTANEOUS KIT 3 PEG-INTRON REDIPEN SUBCUTANEOUS KIT 3 PEGINTRON SUBCUTANEOUS KIT 3 pen needles 3/16" 2 penicillin v potassium oral solution reconstituted 1 penicillin v potassium oral tablet 1 PENTASA ORAL CAPSULE EXTENDED RELEASE 2 PENTIPS 2 pentoxifylline er oral tablet extended release 1 PEPCID ORAL SUSPENSION RECONSTITUTED 3 PEPCID ORAL TABLET 3 PERCOCET ORAL TABLET 3

Drug Name Tier Notes PERFOROMIST INHALATION NEBULIZATION 3 SOLUTION perindopril erbumine oral tablet 1 permethrin external cream 1 perphenazine oral tablet 1 perphenazine-amitriptyline oral tablet 1 PERSANTINE ORAL TABLET 3 PERTZYE ORAL CAPSULE DELAYED RELEASE 3 PARTICLES PEXEVA ORAL TABLET 3 PHARMACIST CHOICE AUTOCODE IN VITRO STRIP 3 PHARMACIST CHOICE AUTOCODE SYS KIT 3 PHARMACIST CHOICE LANCETS 2 pharmacist choice no coding in vitro strip 3 phenelzine sulfate oral tablet 1 phenobarbital oral elixir 1 phenobarbital oral solution 1 phenobarbital oral tablet 1 phenyleph-promethazine-cod oral syrup 1 phenytoin oral suspension 1 phenytoin sodium extended oral capsule 1 philith oral tablet 1 PICATO EXTERNAL GEL 2 pilocarpine hcl ophthalmic solution 1 pimozide oral tablet 1 pimtrea oral tablet 1 pindolol oral tablet 1 pioglitazone hcl oral tablet 1 pioglitazone hcl-glimepiride oral tablet 1 pioglitazone hcl-metformin hcl oral tablet 1 pirmella 1/35 oral tablet 1 pirmella 7/7/7 oral tablet 1 piroxicam oral capsule 1 PLAN B ONE-STEP ORAL TABLET 3 PLAQUENIL ORAL TABLET 3 PLAVIX ORAL TABLET 3 PLETAL ORAL TABLET 3

Drug Name Tier Notes PLIAGLIS EXTERNAL CREAM 3 PNEUMOVAX 23 INJECTION INJECTABLE 2 pnv prenatal plus multivitamin oral tablet 1 pnv tabs 29-1 oral tablet 1 POCKET CHAMBER DEVICE 2 podofilox external solution 1 poly hub needle 2 polycin ophthalmic ointment 1 polymyxin b-trimethoprim ophthalmic solution 1 POLYTRIM OPHTHALMIC SOLUTION 3 POMALYST ORAL CAPSULE 2 PONSTEL ORAL CAPSULE 3 portia-28 oral tablet 1 potassium chloride er oral tablet extended 1 release potassium chloride oral packet 1 potassium chloride oral solution 1 POTIGA ORAL TABLET 2 PR BENZOYL PEROXIDE WASH EXTERNAL LIQUID 3 PRADAXA ORAL CAPSULE 3 PRALUENT SUBCUTANEOUS SOLUTION PEN- 2 INJECTOR PRALUENT SUBCUTANEOUS SOLUTION 2 PREFILLED SYRINGE pramipexole dihydrochloride er oral tablet 1 extended release 24 hour PRAMOSONE E EXTERNAL CREAM 3 PRAMOSONE EXTERNAL CREAM 3 PRAMOSONE EXTERNAL LOTION 3 PRAMOSONE EXTERNAL OINTMENT 3 PRANDIN ORAL TABLET 3 pravastatin sodium oral tablet 1 prazosin hcl oral capsule 1 PRECISION PCX IN VITRO STRIP 3 PRECISION PCX PLUS TEST IN VITRO STRIP 3 PRECISION POINT OF CARE TEST IN VITRO STRIP 3 PRECISION QID TEST IN VITRO STRIP 3

Drug Name Tier Notes PRECISION XTRA BLOOD GLUCOSE IN VITRO 2 STRIP PRECOSE ORAL TABLET 3 PRED FORTE OPHTHALMIC SUSPENSION 3 PRED MILD OPHTHALMIC SUSPENSION 2 PRED-G S.O.P. OPHTHALMIC OINTMENT 3 prednicarbate external ointment 1 prednisolone acetate ophthalmic suspension 1 prednisolone oral solution 1 prednisolone oral syrup 1 prednisolone sodium phosphate oral tablet 1 dispersible prednisone oral tablet 1 preferred plus insulin syringe 2 preferred plus lancets colored 2 preferred plus lancets thin 2 preferred plus unifine pentips 2 PREFEST ORAL TABLET 3 PREGNYL INTRAMUSCULAR SOLUTION 3 RECONSTITUTED PREMARIN ORAL TABLET 2 PREMARIN VAGINAL CREAM 2 premium blood glucose test in vitro strip 3 PREMPHASE ORAL TABLET 2 PREMPRO ORAL TABLET 2 prenatabs rx oral tablet 1 prenatal low iron oral tablet 1 prenatal oral tablet 1 prenatal plus iron oral tablet 1 prenatal plus oral tablet 1 prenatal vitamin plus low iron oral tablet 1 preplus oral tablet 1 PREVACID ORAL CAPSULE DELAYED RELEASE 3 prevalite oral packet 1 previfem oral tablet 1 PREVNAR 13 INTRAMUSCULAR SUSPENSION 2 PREVPAC ORAL 3

Drug Name Tier Notes PREZISTA ORAL SUSPENSION 2 PREZISTA ORAL TABLET 2 primaquine phosphate oral tablet 2 primidone oral tablet 1 PRIMLEV ORAL TABLET 3 PRIMSOL ORAL SOLUTION 3 PRISTIQ ORAL TABLET EXTENDED RELEASE 24 2 HOUR PRIVIGEN INTRAVENOUS SOLUTION 2 PROAIR HFA INHALATION AEROSOL SOLUTION 2 probenecid oral tablet 1 procainamide hcl injection solution 1 PROCARDIA ORAL CAPSULE 3 procentra oral solution 1 prochlorperazine maleate oral tablet 1 PROCRIT INJECTION SOLUTION 2 PRODIGY AUTOCODE BLOOD GLUCOSE KIT 3 PRODIGY INSULIN SYRINGE 2 PRODIGY LANCETS 28G 2 PRODIGY NO CODING BLOOD GLUC IN VITRO 3 STRIP PRODIGY POCKET BLOOD GLUCOSE KIT 3 PRODIGY SAFETY LANCETS 26G 2 PRODIGY TWIST TOP LANCETS 28G 2 PRODIGY VOICE BLOOD GLUCOSE KIT 3 PROFILNINE INTRAVENOUS SOLUTION 2 RECONSTITUTED PROFILNINE SD INTRAVENOUS SOLUTION 2 RECONSTITUTED progesterone micronized oral capsule 1 PROGRAF ORAL CAPSULE 3 PROLENSA OPHTHALMIC SOLUTION 2 PROLIA SUBCUTANEOUS SOLUTION 3 promethazine hcl oral tablet 1 promethazine hcl rectal suppository 1 promethazine vc plain oral syrup 1 promethazine vc/codeine oral syrup 1

Drug Name Tier Notes promethazine-dm oral syrup 1 promethazine-phenylephrine oral syrup 1 PROMETRIUM ORAL CAPSULE 3 propafenone hcl oral tablet 1 proparacaine hcl ophthalmic solution 1 propranolol hcl oral solution 1 propranolol hcl oral tablet 1 propranolol-hctz oral tablet 1 PROSCAR ORAL TABLET 3 PROTONIX ORAL TABLET DELAYED RELEASE 3 PROTOPIC EXTERNAL OINTMENT 3 protriptyline hcl oral tablet 1 PROVENTIL HFA INHALATION AEROSOL 3 SOLUTION PROVIGIL ORAL TABLET 3 PROZAC ORAL CAPSULE 3 pseudoeph-bromphen-dm oral syrup 1 psorcon external cream 3 PULMICORT FLEXHALER INHALATION AEROSOL 3 POWDER BREATH ACTIVATED PULMICORT INHALATION SUSPENSION 3 PULMOZYME INHALATION SOLUTION 2 px lancets ultra thin 2 px mini pen needles 2 PYLERA ORAL CAPSULE 2 pyrazinamide oral tablet 1 qc lancets super thin 30g 2 qc unilet lancets 28g 2 qc unilet lancets micro thin 2 QNASL NASAL AEROSOL SOLUTION 2 QSYMIA ORAL CAPSULE EXTENDED RELEASE 24 3 HOUR QUALAQUIN ORAL CAPSULE 3 QUARTETTE ORAL TABLET 3 quasense oral tablet 1 quazepam oral tablet 1 QUESTRAN ORAL PACKET 3

Drug Name Tier Notes quetiapine fumarate oral tablet 1 QUILLICHEW ER ORAL TABLET CHEWABLE 2 EXTENDED RELEASE QUILLIVANT XR ORAL SUSPENSION 2 RECONSTITUTED quinapril-hydrochlorothiazide oral tablet 1 quinidine gluconate injection solution 1 quinidine sulfate er oral tablet extended release 1 quinine sulfate oral capsule 1 QUINTET AC BLOOD GLUCOSE TEST IN VITRO 3 STRIP QVAR INHALATION AEROSOL SOLUTION 3 ra e-zject lancets 28g 1 ra e-zject lancets thin 26g 1 ra e-zject lancets thin 28g 1 ra e-zject lancets ultra thin 1 ra lancets alternate site 1 ra lancets thin 2 ra lancets ultra thin 1 ra pen needles 2 RA TRUETEST TEST IN VITRO STRIP 3 rabeprazole sodium oral tablet delayed release 1 ramipril oral capsule 1 RANEXA ORAL TABLET EXTENDED RELEASE 12 2 HOUR ranitidine hcl oral syrup 1 ranitidine hcl oral tablet 1 RAPAFLO ORAL CAPSULE 2 RAPAMUNE ORAL SOLUTION 2 RAPAMUNE ORAL TABLET 3 RAYOS ORAL TABLET DELAYED RELEASE 3 RAZADYNE ER ORAL CAPSULE EXTENDED 3 RELEASE 24 HOUR REBETOL ORAL CAPSULE 3 REBETOL ORAL SOLUTION 3 REBIF SUBCUTANEOUS SOLUTION PREFILLED 3 SYRINGE reclipsen oral tablet 1

Drug Name Tier Notes RECOMBINATE INTRAVENOUS SOLUTION 2 RECONSTITUTED RECOMBIVAX HB INJECTION SUSPENSION 2 REFUAH PLUS BLOOD GLUCOSE TEST IN VITRO 3 STRIP REFUAH PLUS MONITORING SYSTEM KIT 3 REGLAN ORAL TABLET 3 REGRANEX EXTERNAL GEL 2 RELION CONFIRM GLUCOSE MONITOR KIT 3 RELION CONFIRM/MICRO TEST IN VITRO STRIP 3 RELION LANCETS THIN 26G 2 RELION LANCETS ULTRA-THIN 30G 2 RELION MICRO KIT 3 RELION PRIME TEST IN VITRO STRIP 3 RELION ULTIMA GLUCOSE SYSTEM KIT 3 RELION ULTIMA TEST IN VITRO STRIP 3 RELION ULTRA THIN LANCETS 30G 2 RELION ULTRA THIN PLUS LANCETS 2 RELISTOR SUBCUTANEOUS SOLUTION 2 RELPAX ORAL TABLET 2 REMERON ORAL TABLET 3 RENAGEL ORAL TABLET 3 rena-vite rx oral tablet 1 RENVELA ORAL PACKET 2 repaglinide oral tablet 1 REPATHA SUBCUTANEOUS SOLUTION PREFILLED 2 SYRINGE REPATHA SURECLICK SUBCUTANEOUS SOLUTION 2 AUTO-INJECTOR REQUIP ORAL TABLET 3 RESCRIPTOR ORAL TABLET 2 RESCULA OPHTHALMIC SOLUTION 3 reserpine oral tablet 1 RESTASIS OPHTHALMIC EMULSION 2 RESTORIL ORAL CAPSULE 3 RETIN-A EXTERNAL CREAM 3 RETIN-A EXTERNAL GEL 3

Drug Name Tier Notes RETIN-A MICRO EXTERNAL GEL 3 RETIN-A MICRO PUMP EXTERNAL GEL 3 RETROVIR ORAL CAPSULE 3 RETROVIR ORAL SYRUP 3 REVATIO ORAL TABLET 3 REVEAL BLOOD GLUCOSE MONITOR KIT 3 REVEAL BLOOD GLUCOSE TEST IN VITRO STRIP 3 REVIA ORAL TABLET 3 REVLIMID ORAL CAPSULE 2 REXALL BLOOD GLUCOSE SYSTEM KIT 3 REXALL BLOOD GLUCOSE TEST IN VITRO STRIP 3 REXALL LANCETS ULTRA THIN 30G 2 REYATAZ ORAL CAPSULE 2 RHEUMATREX ORAL TABLET 3 RHOFADE EXTERNAL CREAM 3 ribasphere oral capsule 1 ribasphere oral tablet 1 RIBASPHERE RIBAPAK ORAL TABLET 3 RIBATAB ORAL TABLET 3 ribavirin oral capsule 1 ribavirin oral tablet 1 RIFADIN ORAL CAPSULE 3 rifampin oral capsule 1 RIFATER ORAL TABLET 3 RIGHTEST GL300 LANCETS 2 RIGHTEST GM100 BLOOD GLUCOSE KIT 3 RIGHTEST GM300 BLOOD GLUCOSE KIT 3 RIGHTEST GM550 BLOOD GLUCOSE KIT 3 RIGHTEST GS100 BLOOD GLUCOSE IN VITRO 3 STRIP RIGHTEST GS300 BLOOD GLUCOSE IN VITRO 3 STRIP RIGHTEST GS550 BLOOD GLUCOSE IN VITRO 3 STRIP RILUTEK ORAL TABLET 3 riluzole oral tablet 1 rimantadine hcl oral tablet 1

Drug Name Tier Notes RIOMET ORAL SOLUTION 3 risedronate sodium oral tablet 1 risedronate sodium oral tablet delayed release 1 RISPERDAL CONSTA INTRAMUSCULAR 2 SUSPENSION RECONSTITUTED RISPERDAL ORAL TABLET 3 risperidone oral tablet 1 risperidone oral tablet dispersible 1 RITALIN LA ORAL CAPSULE EXTENDED RELEASE 3 24 HOUR RITALIN ORAL TABLET 3 RITEFLO DEVICE 2 rivastigmine tartrate oral capsule 1 rivastigmine transdermal patch 24 hour 1 rixubis intravenous solution reconstituted 3 rizatriptan benzoate oral tablet 1 ROBAXIN ORAL TABLET 3 ROBINUL ORAL TABLET 3 ROCALTROL ORAL CAPSULE 3 ropinirole hcl oral tablet 1 rosadan external cream 1 rosadan external gel 1 rosuvastatin calcium oral tablet 1 ROTATEQ ORAL SOLUTION 2 ROZEREM ORAL TABLET 2 RYTHMOL ORAL TABLET 3 SABRIL ORAL TABLET 2 SAFESNAP INSULIN SYRINGE 2 safety lancet 21g/pressure act 2 safety lancet 28g/pressure act 2 SAFETY LANCETS 2 SAFETY LANCETS 21G 2 safety lancets 28g 2 SAFETY LET LANCETS 2 SAFETY SEAL LANCETS 2 SAFYRAL ORAL TABLET 2

Drug Name Tier Notes SAIZEN CLICK.EASY INJECTION SOLUTION 3 RECONSTITUTED SAIZEN INJECTION SOLUTION RECONSTITUTED 3 salsalate oral tablet 1 SANCUSO TRANSDERMAL PATCH 2 SANDIMMUNE ORAL CAPSULE 2 SANDIMMUNE ORAL SOLUTION 2 SANTYL EXTERNAL OINTMENT 2 sapscare twist top lancets 2 SARAFEM ORAL TABLET 3 SAVELLA ORAL TABLET 3 SEASONIQUE ORAL TABLET 3 seb-prev wash external liquid 1 SECTRAL ORAL CAPSULE 3 selegiline hcl oral tablet 1 selenium sulfide external lotion 1 selenium sulfide external shampoo 1 selenium sulf-pyrithione-urea external shampoo 1 SELZENTRY ORAL TABLET 2 SEMPREX-D ORAL CAPSULE 3 SEREVENT DISKUS INHALATION AEROSOL 2 POWDER BREATH ACTIVATED serophene oral tablet 1 SEROQUEL ORAL TABLET 3 SEROQUEL XR ORAL TABLET EXTENDED RELEASE 2 24 HOUR SEROSTIM SUBCUTANEOUS SOLUTION 3 RECONSTITUTED sertraline hcl oral concentrate 1 sertraline hcl oral tablet 1 setlakin oral tablet 1 sharobel oral tablet 1 SHOPKO ON-THE-GO LANCETS 30G 2 SHOPKO UNIFINE PENTIPS 2 SHOPKO UNIFINE PENTIPS PLUS 2 SHOPKO UNILET LANCETS 28G 2 SHOPKO UNILET LANCETS 30G 2

Drug Name Tier Notes sildenafil citrate oral tablet 1 SILVADENE EXTERNAL CREAM 3 silver sulfadiazine external cream 1 SIMBRINZA OPHTHALMIC SUSPENSION 3 SIMCOR ORAL TABLET EXTENDED RELEASE 24 2 HOUR SIMPONI SUBCUTANEOUS SOLUTION AUTO- 3 INJECTOR simvastatin oral tablet 1 SINEMET CR ORAL TABLET EXTENDED RELEASE 3 SINEMET ORAL TABLET 3 SINGLE-LET 2 SINGULAIR ORAL PACKET 3 SINGULAIR ORAL TABLET 3 sirolimus oral tablet 1 SIRTURO ORAL TABLET 2 SIVEXTRO ORAL TABLET 2 SKELAXIN ORAL TABLET 3 SKYLA INTRAUTERINE INTRAUTERINE DEVICE 3 sm glucose test in vitro strip 3 sm insulin syringe 2 sm lancets 21g 2 sm lancets 33g 2 sm super thin lancets 30g 2 sm thin lancets 26g 2 SMART SENSE COLOR LANCETS 33G 2 SMART SENSE PREMIUM SYSTEM KIT 3 SMART SENSE PREMIUM TEST IN VITRO STRIP 3 SMART SENSE STANDARD LANCETS 2 SMART SENSE SUPER THIN LANCETS 2 SMART SENSE THIN LANCETS 26G 2 SMART SENSE VALUE GLUCOSE SYS KIT 3 SMART SENSE VALUE TEST IN VITRO STRIP 3 SMARTEST BLOOD GLUCOSE TEST IN VITRO STRIP 3 SMARTEST EJECT STARTER KIT 3 SMARTEST LANCETS 28G 2 SMARTEST PERSONA STARTER KIT 3

Drug Name Tier Notes SMARTEST PRONTO STARTER KIT 3 SMARTEST PROTEGE STARTER KIT 3 sodium fluoride oral tablet chewable 1 sodium sulfacetamide external shampoo 1 SOLIQUA SUBCUTANEOUS SOLUTION PEN- 2 INJECTOR SOLODYN ORAL TABLET EXTENDED RELEASE 24 2 HOUR SOLTAMOX ORAL SOLUTION 3 SOLU-CORTEF INJECTION SOLUTION 2 RECONSTITUTED SOLUS V2 BLOOD GLUCOSE SYSTEM KIT 3 SOLUS V2 LANCETS 28G 2 SOLUS V2 TEST IN VITRO STRIP 3 SOLUS V2 TWIST LANCETS 30G 2 SOMA ORAL TABLET 3 SORIATANE ORAL CAPSULE 3 SORILUX EXTERNAL FOAM 3 sorine oral tablet 1 sotalol hcl (af) oral tablet 1 sotalol hcl oral tablet 1 SOVALDI ORAL TABLET 3 SPIRIVA HANDIHALER INHALATION CAPSULE 2 SPIRIVA RESPIMAT INHALATION AEROSOL 2 SOLUTION spironolactone oral tablet 1 spironolactone-hctz oral tablet 1 SPORANOX ORAL CAPSULE 3 SPORANOX ORAL SOLUTION 2 SPORANOX PULSEPAK ORAL CAPSULE 3 sprintec 28 oral tablet 1 SPRIX NASAL SOLUTION 3 SPRYCEL ORAL TABLET 2 sronyx oral tablet 1 ssd external cream 1 SSKI ORAL SOLUTION 3 sss 10-5 external foam 1

Drug Name Tier Notes STALEVO 75 ORAL TABLET 3 STARLIX ORAL TABLET 3 stavudine oral capsule 1 stavudine oral solution reconstituted 1 STAXYN ORAL TABLET DISPERSIBLE 3 STELARA INTRAVENOUS SOLUTION 3 ST STELARA SUBCUTANEOUS SOLUTION PREFILLED 3 ST SYRINGE STENDRA ORAL TABLET 3 STERILANCE TL 2 STIOLTO RESPIMAT INHALATION AEROSOL 2 SOLUTION STIVARGA ORAL TABLET 2 STRATTERA ORAL CAPSULE 2 STRIANT BUCCAL 3 STRIBILD ORAL TABLET 2 STROMECTOL ORAL TABLET 3 SUBOXONE SUBLINGUAL FILM 3 SUBSYS SUBLINGUAL LIQUID 3 SUCRAID ORAL SOLUTION 2 sucralfate oral tablet 1 SULAR ORAL TABLET EXTENDED RELEASE 24 3 HOUR sulfacetamide sodium external liquid 1 sulfacetamide sodium ophthalmic solution 1 sulfacetamide sodium-sulfur external foam 1 sulfacetamide sodium-sulfur external lotion 1 sulfacetamide-prednisolone ophthalmic solution 1 sulfacetamide-sulfur in urea external emulsion 1 sulfadiazine oral tablet 1 sulfamethoxazole-trimethoprim oral suspension 1 sulfamethoxazole-trimethoprim oral tablet 1 SULFAMYLON EXTERNAL CREAM 2 sulfasalazine oral tablet 1 sulfasalazine oral tablet delayed release 1 sulfatrim pediatric oral suspension 1 sulindac oral tablet 1

Drug Name Tier Notes sumatriptan nasal solution 1 sumatriptan succinate oral tablet 1 sumatriptan succinate subcutaneous solution 1 auto-injector SUPARTZ FX INTRA-ARTICULAR SOLUTION 2 PREFILLED SYRINGE SUPARTZ INTRA-ARTICULAR SOLUTION 2 PREFILLED SYRINGE SUPRAX ORAL SUSPENSION RECONSTITUTED 3 SUPREP BOWEL PREP ORAL SOLUTION 2 sure comfort insulin syringe 2 sure comfort lancets 28g 2 sure comfort lancets 30g 2 sure comfort pen needles 2 SURE-FINE PEN NEEDLES 2 SURE-JECT INSULIN SYRINGE 2 SURE-LANCE FLAT LANCETS 2 SURE-LANCE THIN LANCETS 28G 2 SURE-LANCE ULTRA THIN LANCETS 2 SURE-TEST EASYPLUS MINI TEST IN VITRO STRIP 3 SURE-TOUCH LANCETS UNIVERSAL 2 SUSTIVA ORAL CAPSULE 2 SUTENT ORAL CAPSULE 2 syeda oral tablet 1 SYLATRON SUBCUTANEOUS KIT 2 symax fastabs oral tablet dispersible 1 SYMBICORT INHALATION AEROSOL 3 SYMBYAX ORAL CAPSULE 3 SYMLINPEN 120 SUBCUTANEOUS SOLUTION PEN- 2 INJECTOR SYNALAR (CREAM) EXTERNAL KIT 3 SYNALAR EXTERNAL SOLUTION 3 SYNJARDY ORAL TABLET 2 SYNTHROID ORAL TABLET 2 SYNVISC INTRA-ARTICULAR SOLUTION PREFILLED 2 SYRINGE SYNVISC ONE INTRA-ARTICULAR SOLUTION 2 PREFILLED SYRINGE

Drug Name Tier Notes TABLOID ORAL TABLET 2 TACLONEX EXTERNAL SUSPENSION 2 tacrolimus external ointment 1 tacrolimus oral capsule 1 TAFINLAR ORAL CAPSULE 2 TAMIFLU ORAL CAPSULE 2 TAMIFLU ORAL SUSPENSION RECONSTITUTED 2 tamoxifen citrate oral tablet 1 tamsulosin hcl oral capsule 1 TANZEUM SUBCUTANEOUS PEN-INJECTOR 3 TAPAZOLE ORAL TABLET 3 TARCEVA ORAL TABLET 2 TARKA ORAL TABLET EXTENDED RELEASE 3 TASIGNA ORAL CAPSULE 2 TASMAR ORAL TABLET 3 TAZORAC EXTERNAL CREAM 2 TAZORAC EXTERNAL GEL 2 taztia xt oral capsule extended release 24 hour 1 TECFIDERA ORAL CAPSULE DELAYED RELEASE 3 TECHLITE LANCETS 2 TECHLITE LANCETS 30G 2 TECHLITE PEN NEEDLES 2 TECHNIVIE ORAL TABLET 3 TEGRETOL ORAL SUSPENSION 3 TEGRETOL ORAL TABLET 3 TEGRETOL-XR ORAL TABLET EXTENDED RELEASE 3 12 HOUR TEKAMLO ORAL TABLET 2 TEKTURNA HCT ORAL TABLET 2 TEKTURNA ORAL TABLET 2 TELCARE BLOOD GLUCOSE SYSTEM KIT 3 TELCARE BLOOD GLUCOSE TEST IN VITRO STRIP 3 telmisartan oral tablet 1 telmisartan-amlodipine oral tablet 1 telmisartan-hctz oral tablet 1 temazepam oral capsule 1 TEMODAR ORAL CAPSULE 3

Drug Name Tier Notes TEMOVATE EXTERNAL OINTMENT 3 temozolomide oral capsule 1 TENEX ORAL TABLET 3 TENORETIC 50 ORAL TABLET 3 TENORMIN ORAL TABLET 3 TERAZOL 7 VAGINAL CREAM 3 terbinafine hcl oral tablet 1 terbutaline sulfate oral tablet 1 terconazole vaginal cream 1 terconazole vaginal suppository 1 TERSI EXTERNAL FOAM 3 TERUMO INSULIN SYRINGE 2 TERUMO SURGUARD2 SAFETY NEEDLE 2 TESSALON PERLES ORAL CAPSULE 3 TESTIM TRANSDERMAL GEL 3 TESTOPEL IMPLANT PELLET 3 testosterone cypionate intramuscular solution 1 testosterone transdermal gel 3 TESTRED ORAL CAPSULE 3 tetcaine ophthalmic solution 1 tetrabenazine oral tablet 1 tetracaine hcl ophthalmic solution 1 TETRAVISC FORTE OPHTHALMIC SOLUTION 3 TETRAVISC OPHTHALMIC SOLUTION 3 TEXACORT EXTERNAL SOLUTION 3 tgt blood glucose monitoring kit 3 tgt blood glucose test in vitro strip 3 tgt lancet alternate site 2 tgt lancet micro thin 33g 2 tgt lancet super thin 30g 2 tgt lancet thin 23g 2 tgt lancet thin 26g 2 tgt lancet ultra thin 28g 2 tgt lancet ultra thin 30g 2 THALOMID ORAL CAPSULE 2 theochron oral tablet extended release 12 hour 1

Drug Name Tier Notes theophylline er oral tablet extended release 12 1 hour theophylline oral solution 1 thermazene external cream 1 thin lancets 2 THINPRO INSULIN SYRINGE 2 thioridazine hcl oral tablet 1 thiothixene oral capsule 1 thrivite rx oral tablet 3 THYROLAR-1/4 ORAL TABLET 3 tiagabine hcl oral tablet 1 TIAZAC ORAL CAPSULE EXTENDED RELEASE 24 3 HOUR ticlopidine hcl oral tablet 1 TIGAN ORAL CAPSULE 3 TIKOSYN ORAL CAPSULE 3 tilia fe oral tablet 1 timolol maleate ophthalmic solution 1 timolol maleate oral tablet 1 TIMOPTIC OCUDOSE OPHTHALMIC SOLUTION 3 TIMOPTIC OPHTHALMIC SOLUTION 3 TINDAMAX ORAL TABLET 3 tinidazole oral tablet 1 TIROSINT ORAL CAPSULE 3 TIVICAY ORAL TABLET 2 tizanidine hcl oral tablet 1 TOBI PODHALER INHALATION CAPSULE 2 TOBRADEX OPHTHALMIC OINTMENT 2 TOBRADEX OPHTHALMIC SUSPENSION 3 TOBRADEX ST OPHTHALMIC SUSPENSION 2 tobramycin ophthalmic solution 1 tobramycin-dexamethasone ophthalmic 1 suspension TOBREX OPHTHALMIC OINTMENT 3 TOBREX OPHTHALMIC SOLUTION 3 todays health thin lancets 28g 2 todays health thin lancets 30g 2

Drug Name Tier Notes TOFRANIL ORAL TABLET 3 tolcapone oral tablet 1 tolmetin sodium oral capsule 1 tolterodine tartrate er oral capsule extended 1 release 24 hour tolterodine tartrate oral tablet 1 TOPAMAX ORAL TABLET 3 TOPICORT EXTERNAL CREAM 3 TOPICORT EXTERNAL GEL 3 TOPICORT EXTERNAL OINTMENT 3 TOPICORT SPRAY EXTERNAL LIQUID 3 topiramate oral tablet 1 torsemide oral tablet 1 TOUJEO SOLOSTAR SUBCUTANEOUS SOLUTION 2 PEN-INJECTOR TOVIAZ ORAL TABLET EXTENDED RELEASE 24 2 HOUR TRACLEER ORAL TABLET 2 TRADJENTA ORAL TABLET 2 tramadol hcl er oral capsule extended release 24 3 hour tramadol hcl er oral tablet extended release 24 1 hour tramadol hcl oral tablet 1 tramadol-acetaminophen oral tablet 1 trandolapril oral tablet 1 trandolapril-verapamil hcl er oral tablet extended 1 release TRANSDERM-SCOP (1.5 MG) TRANSDERMAL 2 PATCH 72 HOUR TRANXENE-T ORAL TABLET 3 tranylcypromine sulfate oral tablet 1 TRAVATAN Z OPHTHALMIC SOLUTION 2 travel lancets 2 trazodone hcl oral tablet 1 TRECATOR ORAL TABLET 3 TRESIBA FLEXTOUCH SUBCUTANEOUS SOLUTION 2 PEN-INJECTOR

Drug Name Tier Notes tretinoin external cream 1 tretinoin external gel 1 tretinoin microsphere external gel 1 tretinoin microsphere pump external gel 1 TRETTEN INTRAVENOUS SOLUTION 2 RECONSTITUTED TREXALL ORAL TABLET 2 TREXIMET ORAL TABLET 3 triamcinolone acetonide external aerosol 1 solution triamcinolone acetonide external cream 1 triamcinolone acetonide external lotion 1 triamcinolone acetonide nasal aerosol 3 triamterene-hctz oral tablet 1 trianex external ointment 1 TRIBENZOR ORAL TABLET 2 TRICARE ORAL TABLET 3 TRICOR ORAL TABLET 3 triderm external cream 1 tri-estarylla oral tablet 1 trifluoperazine hcl oral tablet 1 trifluridine ophthalmic solution 1 TRIGLIDE ORAL TABLET 3 trihexyphenidyl hcl oral elixir 1 trihexyphenidyl hcl oral tablet 1 tri-legest fe oral tablet 1 TRILEPTAL ORAL SUSPENSION 3 TRILEPTAL ORAL TABLET 3 tri-linyah oral tablet 1 TRILIPIX ORAL CAPSULE DELAYED RELEASE 3 tri-lo-estarylla oral tablet 1 tri-lo-marzia oral tablet 1 tri-lo-sprintec oral tablet 1 trimethobenzamide hcl oral capsule 1 trimethoprim oral tablet 1 trinessa (28) oral tablet 1 trinessa lo oral tablet 1

Drug Name Tier Notes TRI-NORINYL (28) ORAL TABLET 3 TRINTELLIX ORAL TABLET 2 tri-previfem oral tablet 1 tri-sprintec oral tablet 1 trivora (28) oral tablet 1 TRIZIVIR ORAL TABLET 3 TROKENDI XR ORAL CAPSULE EXTENDED RELEASE 3 24 HOUR tropicamide ophthalmic solution 1 trospium chloride oral tablet 1 TRUE METRIX AIR GLUCOSE METER KIT 3 TRUE METRIX BLOOD GLUCOSE TEST IN VITRO 3 STRIP TRUE METRIX METER KIT 3 TRUE2GO BLOOD GLUCOSE MONITOR KIT 3 TRUEPLUS INSULIN SYRINGE 2 TRUEPLUS LANCETS 26G 2 TRUEPLUS LANCETS 28G 2 TRUEPLUS LANCETS 30G 2 TRUEPLUS LANCETS 33G 2 TRUEPLUS SAFETY LANCETS 28G 2 TRUERESULT BLOOD GLUCOSE KIT 3 TRUETEST TEST IN VITRO STRIP 3 TRUETRACK BLOOD GLUCOSE KIT 3 TRUETRACK SMART SYSTEM KIT 3 TRUETRACK TEST IN VITRO STRIP 3 TRULICITY SUBCUTANEOUS SOLUTION PEN- 2 INJECTOR TRUSOPT OPHTHALMIC SOLUTION 3 TRUVADA ORAL TABLET 2 TUDORZA PRESSAIR INHALATION AEROSOL 3 POWDER BREATH ACTIVATED TUSSICAPS ORAL CAPSULE EXTENDED RELEASE 2 12 HOUR tussigon oral tablet 1 TUSSIONEX PENNKINETIC ER ORAL SUSPENSION 3 EXTENDED RELEASE TWINRIX INTRAMUSCULAR SUSPENSION 2

Drug Name Tier Notes TWYNSTA ORAL TABLET 3 TYKERB ORAL TABLET 2 TYLENOL WITH CODEINE #3 ORAL TABLET 3 TYSABRI INTRAVENOUS CONCENTRATE 2 TYZEKA ORAL TABLET 2 ULORIC ORAL TABLET 2 ULTICARE INSULIN SYRINGE 2 ULTILET BASIC LANCETS 30G 2 ULTILET CLASSIC LANCETS 2 ULTILET LANCETS 2 ULTILET SAFETY LANCETS 23G 2 ULTIMA TEST IN VITRO STRIP 3 ultra thin lancets 28g 2 ultra thin lancets 30g 2 ULTRA TRAK PRO BLOOD GLUCOSE KIT 3 ULTRACET ORAL TABLET 3 ultra-comfort insulin syringe 2 ULTRAM ER ORAL TABLET EXTENDED RELEASE 24 3 HOUR ULTRAM ORAL TABLET 3 ULTRA-THIN II AUTO LANCET 2 ULTRA-THIN II LANCETS 2 ULTRA-THIN II MINI PEN NEEDLE 2 ULTRATRAK PRO TEST IN VITRO STRIP 3 ULTRATRAK ULTIMATE TEST IN VITRO STRIP 3 ULTRAVATE EXTERNAL OINTMENT 3 ULTRESA ORAL CAPSULE DELAYED RELEASE 3 PARTICLES UNIFINE PENTIPS 2 unifine pentips plus 2 UNILET COMFORTOUCH LANCET 2 UNILET EXCELITE 2 UNILET EXCELITE II 2 UNILET G.P. SUPERLITE LANCET 2 UNILET GP 28 ULTRA THIN 2 UNILET MICRO-THIN 33G 2 UNILET SUPER-THIN 30G 2

Drug Name Tier Notes UNILET ULTRA-THIN 28G 2 UNISTIK 3 GENTLE 2 UNISTIK SAFETY LANCETS 28G 2 UNISTIK SAFETY LANCETS 30G 2 UNISTIK TOUCH SAFETY LANC 21G 2 UNISTIK TOUCH SAFETY LANC 23G 2 UNISTIK TOUCH SAFETY LANC 28G 2 UNISTIK TOUCH SAFETY LANC 30G 2 UNISTRIP1 GENERIC IN VITRO STRIP 3 unithroid oral tablet 1 UNIVERSAL 1 LANCETS THIN 26G 2 UNIVERSAL 1 LANCETS ULTRA THIN 2 URECHOLINE ORAL TABLET 3 UROXATRAL ORAL TABLET EXTENDED RELEASE 24 3 HOUR ursodiol oral capsule 1 VAGIFEM VAGINAL TABLET 3 valacyclovir hcl oral tablet 1 VALCYTE ORAL SOLUTION RECONSTITUTED 2 VALCYTE ORAL TABLET 3 valganciclovir hcl oral tablet 1 VALIUM ORAL TABLET 3 valproate sodium oral syrup 1 valproic acid oral capsule 1 valproic acid oral solution 1 valsartan oral tablet 1 valsartan-hydrochlorothiazide oral tablet 1 VALTREX ORAL TABLET 3 value plus lancet standard 21g 2 valumark lancet super thin 30g 2 valumark lancet ultra thin 28g 2 valved holding chamber device 2 VANCOCIN HCL ORAL CAPSULE 3 vancomycin hcl oral capsule 1 vandazole vaginal gel 1 VASCEPA ORAL CAPSULE 2 VASOTEC ORAL TABLET 3

Drug Name Tier Notes VECAMYL ORAL TABLET 3 velivet oral tablet 1 VELTIN EXTERNAL GEL 3 VEMLIDY ORAL TABLET 2 venlafaxine hcl er oral capsule extended release 1 24 hour venlafaxine hcl oral tablet 1 VENTOLIN HFA INHALATION AEROSOL SOLUTION 2 VERAMYST NASAL SUSPENSION 3 verapamil hcl er oral capsule extended release 24 1 hour verapamil hcl oral tablet 1 VERDESO EXTERNAL FOAM 3 VERELAN PM ORAL CAPSULE EXTENDED RELEASE 3 24 HOUR VERSACLOZ ORAL SUSPENSION 3 VESICARE ORAL TABLET 2 vestura oral tablet 1 VEXOL OPHTHALMIC SUSPENSION 3 VFEND ORAL SUSPENSION RECONSTITUTED 3 VFEND ORAL TABLET 3 VIAGRA ORAL TABLET 2 VIBRAMYCIN ORAL CAPSULE 3 VIBRAMYCIN ORAL SYRUP 3 VICTOZA SUBCUTANEOUS SOLUTION PEN- 2 INJECTOR VIDA MIA UNILET LANCETS 28G 2 VIDA MIA UNILET LANCETS 30G 2 VIDAZA INJECTION SUSPENSION RECONSTITUTED 3 VIDEX EC ORAL CAPSULE DELAYED RELEASE 3 VIDEX ORAL SOLUTION RECONSTITUTED 2 VIEKIRA PAK ORAL TABLET THERAPY PACK 3 vienva oral tablet 1 VIIBRYD ORAL TABLET 3 VIMOVO ORAL TABLET DELAYED RELEASE 3 VIMPAT ORAL SOLUTION 2 VIMPAT ORAL TABLET 2

Drug Name Tier Notes VIOKACE ORAL TABLET 2 viorele oral tablet 1 VIRACEPT ORAL TABLET 2 VIRAMUNE ORAL SUSPENSION 3 VIRAMUNE ORAL TABLET 3 VIREAD ORAL TABLET 2 VIROPTIC OPHTHALMIC SOLUTION 3 virtussin a/c oral solution 1 VISTARIL ORAL CAPSULE 3 VITAMEDMD ONE RX/QUATREFOLIC ORAL 3 CAPSULE VIVELLE-DOT TRANSDERMAL PATCH TWICE 3 WEEKLY VIVITROL INTRAMUSCULAR SUSPENSION 3 RECONSTITUTED VOGELXO PUMP TRANSDERMAL GEL 3 VOGELXO TRANSDERMAL GEL 3 vol-care rx oral tablet 1 vol-plus oral tablet 1 vol-tab rx oral tablet 1 VOLTAREN TRANSDERMAL GEL 3 VOLTAREN-XR ORAL TABLET EXTENDED RELEASE 3 24 HOUR voriconazole oral suspension reconstituted 1 voriconazole oral tablet 1 VORTEX VALVED HOLDING CHAMBER DEVICE 2 VOTRIENT ORAL TABLET 2 vp-vite rx oral tablet 1 vyfemla oral tablet 1 VYTORIN ORAL TABLET 2 VYVANSE ORAL CAPSULE 2 VYVANSE ORAL TABLET CHEWABLE 2 walgreens adv travel lancets 2 WALGREENS LANCETS 2 walgreens lancets micro thin 2 walgreens lancets super thin 2 WALGREENS THIN LANCETS 2

Drug Name Tier Notes WALGREENS ULTRA THIN LANCETS 2 warfarin sodium oral tablet 1 WAVESENSE AMP KIT 3 WAVESENSE PRESTO IN VITRO STRIP 3 wegmans unifine pentips plus 2 WELCHOL ORAL PACKET 2 WELCHOL ORAL TABLET 2 WELLBUTRIN ORAL TABLET 3 WELLBUTRIN XL ORAL TABLET EXTENDED 3 RELEASE 24 HOUR wera oral tablet 1 WILATE INTRAVENOUS KIT 2 WP THYROID ORAL TABLET 3 wymzya fe oral tablet chewable 1 XALATAN OPHTHALMIC SOLUTION 3 XALKORI ORAL CAPSULE 2 XANAX ORAL TABLET 3 XANAX XR ORAL TABLET EXTENDED RELEASE 24 3 HOUR XARELTO ORAL TABLET 2 XELJANZ ORAL TABLET 2 ST XELJANZ XR ORAL TABLET EXTENDED RELEASE 24 2 HOUR XENAZINE ORAL TABLET 3 XERESE EXTERNAL CREAM 3 XIFAXAN ORAL TABLET 2 XIGDUO XR ORAL TABLET EXTENDED RELEASE 24 3 HOUR XIIDRA OPHTHALMIC SOLUTION 3 XOLAIR SUBCUTANEOUS SOLUTION 2 RECONSTITUTED XOPENEX HFA INHALATION AEROSOL 3 XOPENEX INHALATION NEBULIZATION SOLUTION 3 XTANDI ORAL CAPSULE 3 xulane transdermal patch weekly 1 XULTOPHY SUBCUTANEOUS SOLUTION PEN- 3 INJECTOR XYNTHA INTRAVENOUS KIT 2

Drug Name Tier Notes XYNTHA SOLOFUSE INTRAVENOUS KIT 2 XYZAL ORAL TABLET 3 YASMIN 28 ORAL TABLET 3 YAZ ORAL TABLET 3 zafirlukast oral tablet 1 zaleplon oral capsule 1 ZANTAC ORAL TABLET 3 zarah oral tablet 1 ZARONTIN ORAL CAPSULE 3 ZARONTIN ORAL SOLUTION 3 ZARXIO INJECTION SOLUTION PREFILLED SYRINGE 2 ZEGERID ORAL CAPSULE 3 ZELAPAR ORAL TABLET DISPERSIBLE 3 ZELBORAF ORAL TABLET 2 zenatane oral capsule 1 zenchent fe oral tablet chewable 1 zenchent oral tablet 1 ZENPEP ORAL CAPSULE DELAYED RELEASE 2 PARTICLES zenzedi oral tablet 1 zeosa oral tablet chewable 1 ZEPATIER ORAL TABLET 2 ZERIT ORAL CAPSULE 3 ZERIT ORAL SOLUTION RECONSTITUTED 3 ZESTORETIC ORAL TABLET 3 ZESTRIL ORAL TABLET 3 ZETIA ORAL TABLET 3 ZETONNA NASAL AEROSOL SOLUTION 3 ZIAC ORAL TABLET 3 ZIAGEN ORAL SOLUTION 2 ZIAGEN ORAL TABLET 3 ZIANA EXTERNAL GEL 2 zidovudine oral capsule 1 zidovudine oral syrup 1 zidovudine oral tablet 1 ZIOPTAN OPHTHALMIC SOLUTION 3 ziprasidone hcl oral capsule 1

Drug Name Tier Notes ZIPSOR ORAL CAPSULE 3 ZIRGAN OPHTHALMIC GEL 3 ZITHRANOL-RR EXTERNAL CREAM 3 ZITHROMAX ORAL SUSPENSION RECONSTITUTED 3 ZITHROMAX ORAL TABLET 3 ZITHROMAX Z-PAK ORAL TABLET 3 ZOCOR ORAL TABLET 3 ZODRYL AC 35 ORAL SUSPENSION 3 ZOFRAN ODT ORAL TABLET DISPERSIBLE 3 ZOFRAN ORAL SOLUTION 3 ZOFRAN ORAL TABLET 3 ZOLINZA ORAL CAPSULE 2 zolmitriptan oral tablet 1 zolmitriptan oral tablet dispersible 1 ZOLOFT ORAL CONCENTRATE 3 ZOLOFT ORAL TABLET 3 zolpidem tartrate er oral tablet extended release 1 zolpidem tartrate oral tablet 1 zolpidem tartrate sublingual tablet sublingual 1 ZOLPIMIST ORAL SOLUTION 3 ZOMACTON SUBCUTANEOUS SOLUTION 3 RECONSTITUTED ZOMIG NASAL SOLUTION 2 ZOMIG ORAL TABLET 3 ZOMIG ZMT ORAL TABLET DISPERSIBLE 3 ZONEGRAN ORAL CAPSULE 3 zonisamide oral capsule 1 ZORBTIVE SUBCUTANEOUS SOLUTION 3 RECONSTITUTED ZORTRESS ORAL TABLET 2 ZORVOLEX ORAL CAPSULE 2 ZOSTAVAX SUBCUTANEOUS SOLUTION 2 RECONSTITUTED zovia 1/35e (28) oral tablet 1 ZOVIRAX EXTERNAL OINTMENT 3 ZOVIRAX ORAL CAPSULE 3 ZOVIRAX ORAL SUSPENSION 3

Drug Name Tier Notes ZOVIRAX ORAL TABLET 3 ZUBSOLV SUBLINGUAL TABLET SUBLINGUAL 2 ZUPLENZ ORAL FILM 3 ZYBAN ORAL TABLET EXTENDED RELEASE 12 3 HOUR ZYCLARA EXTERNAL CREAM 3 ZYCLARA PUMP EXTERNAL CREAM 3 ZYFLO ORAL TABLET 3 ZYLET OPHTHALMIC SUSPENSION 2 ZYLOPRIM ORAL TABLET 3 ZYMAXID OPHTHALMIC SOLUTION 3 ZYPREXA ORAL TABLET 3 ZYPREXA ZYDIS ORAL TABLET DISPERSIBLE 3 ZYTIGA ORAL TABLET 2 ZYVOX ORAL TABLET 3

Index

1st choice lancets super thin ...... 1 ACTIVE 1ST BLOOD LANCETS AEROCHAMBER PLUS FLO-VU 1st choice lancets thin ...... 1 30G ...... 2 W/MASK ...... 3 1st choice lancets ultra thin ...... 1 ACTIVELLA ...... 2 AEROCHAMBER PLUS FLOW VU...4 1st tier unifine pentips ...... 1 ACTONEL ...... 2 AEROCHAMBER 1st tier unilet comfortouch ...... 1 ACTOPLUS MET ...... 2 W/FLOWSIGNAL ...... 4 abacavir sulfate ...... 1 ACTOS ...... 2 AEROCHAMBER Z-STAT PLUS ...... 4 abacavir-lamivudine-zidovudine.. 1 ACULAR ...... 2 AEROCHAMBER Z-STAT PLUS ABILIFY ...... 1 ACUVAIL ...... 2 CHAMBR ...... 4 ABSORICA ...... 1 acyclovir ...... 2 AEROCHAMBER Z-STAT ABSTRAL ...... 1 ACZONE ...... 2 PLUS/LARGE ...... 4 ACANYA ...... 1 ADALAT CC ...... 2 AEROCHAMBER Z-STAT acarbose ...... 1 adapalene ...... 2 PLUS/MEDIUM ...... 4 ACCOLATE ...... 1 ADCIRCA ...... 2 AEROCHAMBER Z-STAT ACCUCAINE ...... 1 ADDERALL ...... 2 PLUS/SMALL ...... 4 ACCU-CHEK AVIVA ...... 1 ADDERALL XR ...... 3 AEROVENT PLUS ...... 4 ACCU-CHEK AVIVA CONNECT ...... 1 ADDYI ...... 3 afeditab cr ...... 4 ACCU-CHEK AVIVA PLUS ...... 1 ADEMPAS ...... 3 AFINITOR ...... 4 ACCU-CHEK COMPACT PLUS ...... 1 ADLYXIN ...... 3 AFINITOR DISPERZ ...... 4 ACCU-CHEK COMPACT TEST ADLYXIN STARTER PACK ...... 3 AGAMATRIX AMP TEST ...... 4 DRUM ...... 1 ADOXA ...... 3 AGAMATRIX JAZZ TEST ...... 4 ACCU-CHEK FASTCLIX LANCETS .... 1 ADRENACLICK ...... 3 AGAMATRIX JAZZ WIRELESS 2 ...... 4 ACCU-CHEK MULTICLIX LANCETS. 1 ADVAIR DISKUS ...... 3 AGAMATRIX PRESTO ...... 4 ACCU-CHEK NANO SMARTVIEW...1 ADVAIR HFA ...... 3 AGAMATRIX PRESTO TEST...... 4 ACCU-CHEK SAFE-T PRO LANCETS ADVATE ...... 3 AGAMATRIX ULTRA-THIN 1 ADVICOR ...... 3 LANCETS ...... 4 ACCU-CHEK SMARTVIEW ...... 1 ADVOCATE BLOOD GLUCOSE AGGRENOX ...... 4 ACCU-CHEK SOFT TOUCH SYSTEM ...... 3 ak-poly-bac ...... 4 LANCETS ...... 1 ADVOCATE INSULIN PEN ala-cort ...... 4 ACCU-CHEK SOFTCLIX LANCETS ... 1 NEEDLES ...... 3 ALBENZA ...... 4 ACCU-CHEK VOICEMATE ...... 1 ADVOCATE LANCETS ...... 3 albuterol sulfate ...... 4 ACCURETIC ...... 1 ADVOCATE LANCETS 30G ...... 3 ALCAINE ...... 4 ACCUTREND GLUCOSE ...... 2 ADVOCATE REDI-CODE ...... 3 alclometasone dipropionate ...... 4 acebutolol hcl ...... 2 ADVOCATE REDI-CODE+ TEST ...... 3 ALCORTIN A ...... 4 acetaminophen-codeine ...... 2 ADVOCATE SAFETY LANCETS ...... 3 ALDACTAZIDE ...... 4 acetaminophen-codeine #3 ...... 2 ADVOCATE SAFETY LANCETS ALDACTONE ...... 4 acetasol hc ...... 2 26G ...... 3 ALDARA...... 4 acetazolamide ...... 2 ADVOCATE TEST ...... 3 ALECENSA ...... 4 acetic acid ...... 2 adynovate ...... 3 alendronate sodium ...... 4 ACIPHEX ...... 2 ADZENYS XR-ODT ...... 3 ALFERON N ...... 4 acitretin ...... 2 AEROCHAMBER MINI CHAMBER..3 alfuzosin hcl er ...... 5 ACTEMRA ...... 2 AEROCHAMBER MV ...... 3 ALINIA ...... 5 ACTIGALL ...... 2 AEROCHAMBER PLUS FLO-VU ...... 3 allopurinol ...... 5 acti-lance 28g ...... 2 AEROCHAMBER PLUS FLO-VU almotriptan malate ...... 5 acti-lance lite lancets 28g ...... 2 LARGE ...... 3 ALOCRIL ...... 5 acti-lance special lancets 17g ...... 2 AEROCHAMBER PLUS FLO-VU alogliptin benzoate ...... 5 acti-lance universal 23g ...... 2 MEDIUM ...... 3 alogliptin-metformin hcl ...... 5 ACTIMMUNE ...... 2 AEROCHAMBER PLUS FLO-VU alogliptin-pioglitazone...... 5 ACTIQ ...... 2 SMALL ...... 3 ALORA ...... 5 97 alosetron hcl ...... 5 amphetamine- ASMANEX 120 METERED DOSES.. 8 ALPHAGAN P ...... 5 dextroamphetamine ...... 6 ASMANEX 14 METERED DOSES .... 8 ALPHANATE ...... 5 ampicillin ...... 7 ASMANEX 30 METERED DOSES .... 8 ALPHANATE/VWF ampicillin sodium ...... 7 ASMANEX 60 METERED DOSES .... 8 COMPLEX/HUMAN ...... 5 AMPYRA ...... 7 aspirin-dipyridamole er ...... 8 ALPHANINE SD ...... 5 AMRIX ...... 7 ASSURE 4 TEST ...... 8 alprazolam ...... 5 ANAFRANIL ...... 7 assure comfort lancets 28g ...... 8 alprazolam er ...... 5 ANALPRAM E ...... 7 assure comfort lancets 30g ...... 8 alprazolam intensol ...... 5 ANAPROX ...... 7 ASSURE HAEMOLANCE PLUS alprazolam xr ...... 5 anaspaz ...... 7 HIGH ...... 8 ALPROLIX ...... 5 anastrozole ...... 7 ASSURE HAEMOLANCE PLUS ALREX ...... 5 ANCOBON ...... 7 LOW ...... 8 ALSUMA ...... 5 ANDRODERM ...... 7 ASSURE HAEMOLANCE PLUS ALTABAX ...... 5 ANDROGEL ...... 7 MICRO ...... 8 altacaine ...... 5 ANDROGEL PUMP ...... 7 ASSURE HAEMOLANCE PLUS ALTACE ...... 5 ANDROID ...... 7 NORMAL ...... 9 altafluor ...... 5 androxy ...... 7 ASSURE HAEMOLANCE PLUS altavera ...... 5 ANGELIQ...... 7 PED ...... 9 ALTOPREV ...... 5 ANORO ELLIPTA ...... 7 ASSURE LANCE LANCETS ...... 9 ALVESCO ...... 5 ANTABUSE ...... 7 ASSURE LANCE LANCETS 21G ...... 9 alyacen 1/35 ...... 6 ANTARA ...... 7 ASSURE LANCE PLUS SAFETY alyacen 7/7/7 ...... 6 anucort-hc ...... 7 25G ...... 9 amantadine hcl ...... 6 ANUSOL-HC ...... 7 ASSURE LANCE PLUS SAFETY AMARYL ...... 6 ANZEMET ...... 7 30G ...... 9 AMBIEN ...... 6 apexicon e ...... 7 ASSURE PLATINUM ...... 9 AMBIEN CR ...... 6 APIDRA ...... 7 ASSURE PRISM MULTI TEST ...... 9 amcinonide ...... 6 APIDRA SOLOSTAR ...... 7 ASTAGRAF XL ...... 9 AMERGE...... 6 APLENZIN ...... 7 ATACAND ...... 9 amethia ...... 6 apraclonidine hcl...... 7 ATACAND HCT ...... 9 amethyst ...... 6 aprepitant ...... 7 ATELVIA ...... 9 AMICAR ...... 6 apri ...... 7 atenolol ...... 9 amiloride hcl ...... 6 APRISO ...... 7 atenolol-chlorthalidone ...... 9 amiloride-hydrochlorothiazide .... 6 APTIVUS...... 7, 8 ATIVAN ...... 9 amiodarone hcl ...... 6 aranelle ...... 8 atorvastatin calcium ...... 9 AMITIZA ...... 6 ARANESP (ALBUMIN FREE) ...... 8 atovaquone ...... 9 amitriptyline hcl ...... 6 ARAVA ...... 8 atovaquone-proguanil hcl ...... 9 amlodipine besy-benazepril hcl ... 6 arbinoxa ...... 8 ATRALIN ...... 9 amlodipine besylate ...... 6 ARCAPTA NEOHALER ...... 8 ATRIPLA ...... 9 amlodipine besylate-valsartan ..... 6 ARIMIDEX ...... 8 atropine sulfate ...... 9 amlodipine-atorvastatin ...... 6 aripiprazole ...... 8 ATROVENT ...... 9 amlodipine-valsartan-hctz...... 6 ARIXTRA ...... 8 ATROVENT HFA ...... 9 amnesteem ...... 6 armodafinil ...... 8 AUBAGIO ...... 9 amoxapine ...... 6 ARMOUR THYROID ...... 8 aubra ...... 9 amoxicill-clarithro-lansopraz ...... 6 ARNUITY ELLIPTA ...... 8 AUGMENTIN ...... 9 amoxicillin...... 6 AROMASIN ...... 8 AUGMENTIN XR ...... 9 amoxicillin-pot clavulanate ...... 6 ARTHROTEC ...... 8 AVAGE ...... 9 amoxicillin-pot clavulanate er ...... 6 ASACOL HD ...... 8 AVALIDE ...... 9 amphetamine-dextroamphet er.. 6 ascomp-codeine ...... 8 AVAPRO ...... 9 ashlyna ...... 8 AVAR ...... 9

AVC VAGINAL...... 9 BD INSULIN SYRINGE BINOSTO ...... 12 aviane ...... 9 MICROFINE...... 11 BIONECT ...... 12 AVINZA ...... 10 BD LANCET ULTRAFINE 30G ...... 11 bisoprolol fumarate ...... 12 avita ...... 10 BD LANCET ULTRAFINE 33G ...... 11 bisoprolol-hydrochlorothiazide..12 AVITA ...... 10 BD MICROTAINER LANCETS ...... 11 BIVIGAM ...... 13 AVODART ...... 10 BD PEN NEEDLE MINI U/F ...... 11 BLEPH-10 ...... 13 AVONEX ...... 10 BEBULIN ...... 11 BLEPHAMIDE ...... 13 AXERT ...... 10 BEBULIN VH ...... 11 BLEPHAMIDE S.O.P...... 13 AXIRON ...... 10 BECONASE AQ ...... 11 blisovi 24 fe ...... 13 azacitidine ...... 10 bekyree ...... 11 blisovi fe 1.5/30 ...... 13 AZASAN ...... 10 belladonna ...... 11 blood glucose monitor system... 13 AZASITE ...... 10 BELSOMRA ...... 11 blood glucose test ...... 13 azathioprine ...... 10 benazepril hcl ...... 11 BONIVA ...... 13 azelastine hcl ...... 10 benazepril-hydrochlorothiazide. 11 BOOSTRIX ...... 13 AZELEX ...... 10 BENEFIX ...... 11 BOSULIF ...... 13 AZILECT ...... 10 BENICAR ...... 11 bp cleansing wash ...... 13 azithromycin ...... 10 BENICAR HCT ...... 11 BRAVELLE ...... 13 AZOPT ...... 10 BENTYL ...... 11 BREATHERITE ...... 13 AZOR ...... 10 BENZACLIN ...... 11 BREATHERITE COLL SPACER AZULFIDINE ...... 10 BENZACLIN WITH PUMP ...... 11 ADULT ...... 13 AZULFIDINE EN-TABS ...... 10 BENZAMYCIN ...... 11 BREATHERITE COLL SPACER azurette ...... 10 BENZEFOAM...... 11 CHILD ...... 13 bacitracin ...... 10 BENZEPRO CREAMY WASH ...... 12 BREATHERITE COLL SPACER bacitracin-polymyxin b ...... 10 benzonatate ...... 12 INFANT ...... 13 bacitra-neomycin-polymyxin-hc.10 benzoyl peroxide ...... 12 BREATHERITE RIGID baclofen ...... 10 benzoyl peroxide-erythromycin. 12 SPACER/MASK ...... 13 BACTRIM ...... 10 benztropine mesylate ...... 12 BREATHERITE SPACER NEONATE 13 BACTROBAN ...... 10 BEPREVE ...... 12 BREATHERITE SPACER SMALL balsalazide disodium ...... 10 BERINERT ...... 12 CHILD ...... 13 balziva ...... 10 BESIVANCE ...... 12 BREATHERITE/LARGE MASK ...... 13 BANZEL ...... 10 BETAGAN ...... 12 BREATHERITE/MEDIUM MASK... 13 BARACLUDE ...... 10 betamethasone dipropionate ..... 12 BREATHERITE/SMALL MASK ...... 13 BASAGLAR KWIKPEN ...... 10 betamethasone dipropionate BREO ELLIPTA ...... 13 BAYER BREEZE 2 TEST ...... 11 aug ...... 12 BREVICON (28) ...... 13 BAYER CONTOUR LINK betamethasone valerate ...... 12 briellyn ...... 13 MONITOR ...... 11 BETAPACE ...... 12 BRILINTA ...... 13 BAYER CONTOUR MONITOR ...... 11 BETAPACE AF ...... 12 brimonidine tartrate ...... 13 BAYER CONTOUR NEXT EZ ...... 11 BETASERON ...... 12 BRINTELLIX ...... 13 BAYER CONTOUR NEXT LINK ...... 11 betaxolol hcl...... 12 BRISDELLE ...... 13 BAYER CONTOUR NEXT bethanechol chloride ...... 12 BROMFED DM ...... 13 MONITOR ...... 11 BETIMOL ...... 12 bromfenac sodium ...... 13 BAYER CONTOUR NEXT TEST ...... 11 BETOPTIC-S ...... 12 bromocriptine mesylate ...... 13 BAYER CONTOUR NEXT USB BEYAZ ...... 12 budesonide ...... 13 MONITOR ...... 11 BG STAR TEST ...... 12 bullseye mini safety lancets ...... 13 BAYER CONTOUR TEST ...... 11 BIAXIN ...... 12 bumetanide ...... 14 BAYER MICROLET LANCETS ...... 11 bicalutamide ...... 12 BUPHENYL ...... 14 BD DISP NEEDLES ...... 11 BIDIL ...... 12 buprenorphine hcl ...... 14 BD INSULIN SYRINGE ...... 11 BILTRICIDE ...... 12 buprenorphine hcl-naloxone hcl 14 bimatoprost ...... 12 buproban ...... 14

99 bupropion hcl ...... 14 CAREONE BLOOD GLUCOSE chlordiazepoxide-amitriptyline.. 17 bupropion hcl er (smoking det)..14 SYSTEM ...... 15 chlordiazepoxide-clidinium ...... 17 bupropion hcl er (xl) ...... 14 CAREONE BLOOD GLUCOSE chloroquine phosphate ...... 17 buspirone hcl ...... 14 TEST ...... 15 chlorothiazide ...... 17 butalbital-apap-caff-cod ...... 14 careone lancet thin 23g ...... 15 chlorpromazine hcl ...... 17 butalbital-apap-caffeine ...... 14 careone lancet ultra thin 28g ..... 15 chlorzoxazone ...... 17 butalbital-asa-caff-codeine ...... 14 careone unifine pentips ...... 15 cholestyramine ...... 17 butalbital-aspirin-caffeine ...... 14 careone unifine pentips plus ...... 15 cholestyramine light ...... 17 BUTISOL SODIUM ...... 14 CARESENS N GLUCOSE TEST ...... 16 chorionic gonadotropin ...... 17 BUTRANS ...... 14 CARIMUNE NF ...... 16 CIALIS ...... 17 BYDUREON ...... 14 carisoprodol ...... 16 ciclopirox ...... 17 BYETTA 5 MCG PEN ...... 14 carisoprodol-aspirin ...... 16 ciclopirox olamine ...... 17 BYSTOLIC ...... 14 carisoprodol-aspirin-codeine ...... 16 cilostazol ...... 17 cabergoline ...... 14 carteolol hcl ...... 16 CILOXAN ...... 17 CADUET ...... 14 cartia xt ...... 16 cimetidine ...... 17 CAFERGOT ...... 14 carvedilol...... 16 cimetidine hcl ...... 17 CALAN ...... 14 CASODEX ...... 16 CIMZIA ...... 17 calcipotriene ...... 14 CATAPRES...... 16 CIMZIA STARTER KIT ...... 17 calcitonin (salmon) ...... 14 caziant ...... 16 CINRYZE ...... 18 calcitrene ...... 14 CEDAX ...... 16 CIPRO ...... 18 calcitriol ...... 14 cefaclor ...... 16 CIPRO HC ...... 18 calcium acetate ...... 14 cefadroxil ...... 16 CIPRO XR ...... 18 calcium acetate (phos binder) .... 14 cefazolin sodium ...... 16 CIPRODEX ...... 18 camila ...... 14 cefdinir ...... 16 ciprofloxacin hcl ...... 18 camrese ...... 15 cefditoren pivoxil ...... 16 ciprofloxacin-ciproflox hcl er ...... 18 CANASA ...... 15 cefixime ...... 16 citalopram hydrobromide ...... 18 candesartan cilexetil ...... 15 cefprozil ...... 16 claravis ...... 18 candesartan cilexetil-hctz ...... 15 ceftibuten ...... 16 CLARIFOAM EF...... 18 CANTIL ...... 15 CEFTIN ...... 16 CLARINEX ...... 18 CAPEX ...... 15 cefuroxime axetil ...... 16 clarithromycin ...... 18 CAPITAL/CODEINE ...... 15 CELEBREX ...... 16 clarithromycin er ...... 18 CAPRELSA ...... 15 celecoxib ...... 16 clemastine fumarate ...... 18 captopril ...... 15 CELEXA ...... 16 CLEOCIN ...... 18 captopril-hydrochlorothiazide ... 15 CELLCEPT ...... 16 CLEOCIN-T ...... 18 CARAC ...... 15 CENTANY ...... 16 CLEVER CHEK AUTO-CODE TEST. 18 carafate ...... 15 cephalexin...... 16, 17 CLEVER CHEK AUTO-CODE CARAFATE ...... 15 CEREBYX ...... 17 VOICE ...... 18 CARBAGLU ...... 15 CERVARIX ...... 17 CLEVER CHEK LANCETS ...... 18 carbamazepine ...... 15 cetirizine hcl ...... 17 CLEVER CHEK SYSTEM ...... 18 carbamazepine er ...... 15 CETRAXAL ...... 17 CLEVER CHEK TEST ...... 18 carbidopa-levodopa ...... 15 CETROTIDE ...... 17 CLEVER CHOICE AUTO-CODE carbidopa-levodopa er ...... 15 cevimeline hcl ...... 17 TEST ...... 18 carbidopa-levodopa- CHANTIX ...... 17 CLEVER CHOICE MICRO SYSTEM 18 entacapone ...... 15 CHANTIX CONTINUING MONTH CLEVER CHOICE MICRO TEST ..... 18 carbinoxamine maleate ...... 15 PAK ...... 17 CLIMARA ...... 19 CARDIZEM...... 15 chateal ...... 17 CLIMARA PRO ...... 19 CARDIZEM CD ...... 15 CHENODAL ...... 17 clindacin etz ...... 19 CARDURA ...... 15 cheratussin ac ...... 17 clindacin-p ...... 19 CARDURA XL ...... 15 chlordiazepoxide hcl ...... 17 CLINDAGEL ...... 19

100 clindamycin hcl ...... 19 COMPACT SPACE CHAMBER/LG CVS ADVANCED GLUCOSE TEST..22 clindamycin palmitate hcl ...... 19 MASK ...... 20 CVS BLOOD GLUCOSE METER .... 22 clindamycin phos-benzoyl perox 19 COMPACT SPACE cvs lancets 21g ...... 22 clindamycin phosphate ...... 19 CHAMBER/MED MASK ...... 21 cvs lancets micro thin 33g ...... 22 clindamycin-tretinoin ...... 19 COMPACT SPACE CHAMBER/SM cvs lancets thin 26g ...... 22 clobetasol propionate ...... 19 MASK ...... 21 cvs lancets ultra thin 30g...... 22 clobetasol propionate e ...... 19 COMPAZINE ...... 21 cvs ultra thin lancets ...... 22 CLOBEX ...... 19 COMPLERA ...... 21 cyclafem 1/35 ...... 22 CLOBEX SPRAY ...... 19 COMTAN ...... 21 cyclafem 7/7/7 ...... 22 clocortolone pivalate ...... 19 CONDYLOX ...... 21 CYCLESSA ...... 22 clocortolone pivalate pump ...... 19 constulose ...... 21 cyclobenzaprine hcl ...... 22 clodan ...... 19 CONTROL AST ...... 21 CYCLOGYL ...... 22 CLODERM ...... 19 CONTROL BLOOD GLUCOSE CYCLOMYDRIL...... 22 CLODERM PUMP ...... 19 SYSTEM ...... 21 cyclopentolate hcl ...... 22 clomiphene citrate ...... 19 CONTROL TEST ...... 21 cycloserine ...... 22 clomipramine hcl ...... 19 CONZIP ...... 21 CYCLOSET ...... 22 clonazepam ...... 19 COOL BLOOD GLUCOSE TEST cyclosporine ...... 22 clonidine hcl ...... 19 STRIPS ...... 21 cyclosporine modified ...... 22 clopidogrel bisulfate ...... 19 COOL MONITOR KIT ...... 21 CYMBALTA ...... 22 clorazepate dipotassium ...... 19 COPAXONE ...... 21 cyproheptadine hcl ...... 22 clorpres ...... 19 COPEGUS ...... 21 cyred ...... 22 clotrimazole...... 19, 20 CORDARONE ...... 21 CYSTADANE ...... 22 clotrimazole-betamethasone ..... 20 CORDRAN ...... 21 CYSTARAN...... 23 clozapine...... 20 COREG ...... 21 cytarabine (pf) ...... 23 CLOZARIL ...... 20 COREG CR ...... 21 CYTOGAM ...... 23 COAGADEX ...... 20 CORGARD ...... 21 CYTOMEL ...... 23 COAGUCHEK LANCETS ...... 20 CORIFACT ...... 21 DAKLINZA ...... 23 COARTEM ...... 20 cormax scalp application ...... 21 DALIRESP ...... 23 codeine sulfate ...... 20 CORTEF ...... 21 danazol ...... 23 COLAZAL ...... 20 CORTENEMA ...... 21 DANTRIUM ...... 23 colchicine ...... 20 CORTIFOAM ...... 21 dantrolene sodium ...... 23 colchicine-probenecid ...... 20 CORTISPORIN-TC ...... 21 dapsone ...... 23 COLCRYS ...... 20 CORZIDE ...... 21 DARAPRIM ...... 23 COLESTID ...... 20 COSENTYX 300 DOSE ...... 21 darifenacin hydrobromide er ..... 23 colestipol hcl ...... 20 COSENTYX SENSOREADY 300 DARZALEX ...... 23 colocort ...... 20 DOSE ...... 21 dasetta 1/35 ...... 23 COLY-MYCIN S ...... 20 COSOPT ...... 21 dasetta 7/7/7...... 23 COMBIGAN ...... 20 COSOPT PF ...... 21 DAYPRO ...... 23 COMBIPATCH ...... 20 COUMADIN ...... 21 daysee ...... 23 COMBIVENT RESPIMAT ...... 20 covaryx hs ...... 22 DAYTRANA ...... 23 COMBIVIR ...... 20 COZAAR ...... 22 DDAVP ...... 23 COMETRIQ (140 MG DAILY CREON ...... 22 deblitane ...... 23 DOSE) ...... 20 CRESTOR ...... 22 delyla ...... 23 comfort assured lancets 28g ...... 20 CRIXIVAN ...... 22 DELZICOL ...... 23 comfort assured lancets 33g ...... 20 cromolyn sodium ...... 22 DEMADEX ...... 23 COMFORT EZ INSULIN SYRINGE. 20 cryselle-28 ...... 22 demeclocycline hcl ...... 23 COMFORT EZ PEN NEEDLES ...... 20 CUTIVATE ...... 22 DENAVIR ...... 23 comfort lancets ...... 20 CUVITRU ...... 22 DEPAKENE ...... 23 COMPACT SPACE CHAMBER ...... 20 CUVPOSA ...... 22 DEPAKOTE ...... 23

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DEPAKOTE ER ...... 23 diclofenac-misoprostol ...... 25 DROPLET PEN NEEDLES ...... 26 DEPO-MEDROL ...... 23 dicloxacillin sodium ...... 25 drospirenone-ethinyl estradiol...26 DEPO-TESTOSTERONE ...... 23 dicyclomine hcl ...... 25 DROXIA ...... 27 DERMATOP ...... 23 didanosine ...... 25 drug mart lancets thin 26g ...... 27 desipramine hcl ...... 23 DIFFERIN ...... 25 drug mart lancets ultra thin ...... 27 desloratadine ...... 23 DIFICID ...... 25 DRUG MART ON-THE-GO desmopressin ace spray refrig... 24 diflorasone diacetate ...... 25 LANCET 30G ...... 27 desmopressin acetate ...... 24 DIFLUCAN ...... 25 drug mart unifine pentips ...... 27 DESOGEN ...... 24 diflunisal ...... 25 DRUG MART UNILET LANCETS desogestrel-ethinyl estradiol ..... 24 digitek ...... 25 28G ...... 27 DESONATE ...... 24 digox...... 25 DRUG MART UNILET LANCETS desonide ...... 24 digoxin...... 25 30G ...... 27 DESOWEN ...... 24 dihydroergotamine mesylate ..... 25 duane reade lancet altern site... 27 desoximetasone ...... 24 DILANTIN ...... 25 duane reade lancet super thin... 27 desvenlafaxine er ...... 24 DILATRATE-SR ...... 25 duane reade lancet ultra thin .... 27 DETROL ...... 24 DILAUDID ...... 25 DUAVEE ...... 27 DETROL LA ...... 24 diltiazem cd ...... 25 DUETACT ...... 27 dexamethasone ...... 24 diltiazem hcl ...... 26 DUEXIS ...... 27 dexamethasone sodium diltiazem hcl er beads ...... 25 DULERA ...... 27 phosphate...... 24 diltiazem hcl er coated beads ..... 25 duloxetine hcl ...... 27 DEXCOM G4 PLAT PED DIOVAN ...... 26 DUREZOL ...... 27 RCV/SHARE ...... 24 DIOVAN HCT...... 26 dutasteride ...... 27 DEXCOM G4 PLAT PED DIPENTUM ...... 26 dutasteride-tamsulosin hcl ...... 27 RECEIVER ...... 24 diphenhydramine hcl ...... 26 DYMISTA ...... 27 DEXCOM G4 PLATINUM diphenoxylate-atropine ...... 26 DYRENIUM ...... 27 RCV/SHARE ...... 24 DIPROLENE AF ...... 26 e.e.s. 400 ...... 27 DEXCOM G4 PLATINUM dipyridamole ...... 26 EASIVENT ...... 27 RECEIVER ...... 24 DISALCID ...... 26 EASIVENT MASK LARGE ...... 27 DEXCOM G4 PLATINUM disopyramide phosphate ...... 26 EASIVENT MASK MEDIUM ...... 27 TRANSMITTER...... 24 disulfiram ...... 26 EASIVENT MASK SMALL ...... 27 DEXCOM G5 MOB/G4 PLAT DITROPAN XL ...... 26 easy comfort lancets ...... 27 SENSOR ...... 24 divalproex sodium ...... 26 easy comfort pen needles ...... 27 DEXCOM G5 MOBILE RECEIVER..24 divalproex sodium er ...... 26 easy plus ii glucose test ...... 27 DEXCOM G5 MOBILE DIVIGEL ...... 26 EASY STEP GLUCOSE MONITOR..27 TRANSMITTER...... 24 dofetilide ...... 26 EASY STEP TEST ...... 27 dexedrine...... 24 DORAL ...... 26 easy talk blood glucose system.. 27 DEXILANT ...... 24 DORYX ...... 26 easy talk blood glucose test ...... 27 dexmethylphenidate hcl ...... 24 dorzolamide hcl ...... 26 EASY TOUCH FLIPLOCK NEEDLES 27 dexmethylphenidate hcl er ...... 24 dorzolamide hcl-timolol mal ...... 26 EASY TOUCH GLUCOSE SYSTEM. 27 dextroamphetamine sulfate ...... 24 DOVONEX ...... 26 EASY TOUCH HEALTHPRO DIABETA ...... 24 doxazosin mesylate...... 26 SYSTEM ...... 27 dialyvite ...... 24 doxepin hcl ...... 26 EASY TOUCH HEALTHPRO TEST.. 27 DIASTAT PEDIATRIC ...... 24 doxycycline ...... 26 EASY TOUCH HYPODERMIC diatrue plus test ...... 25 doxycycline hyclate ...... 26 NEEDLE ...... 28 diazepam ...... 25 doxycycline monohydrate ...... 26 EASY TOUCH INSULIN SYRINGE.. 28 diazepam intensol ...... 25 dritho-creme hp ...... 26 EASY TOUCH LANCETS 21G ...... 28 diclofenac potassium ...... 25 dronabinol...... 26 EASY TOUCH LANCETS 23G ...... 28 diclofenac sodium ...... 25 DROPLET LANCETS ULTRA THIN EASY TOUCH LANCETS 26G ...... 28 diclofenac sodium er ...... 25 30G ...... 26

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EASY TOUCH LANCETS elinest ...... 29 eprosartan mesylate ...... 30 26G/TWIST ...... 28 ELIQUIS...... 29 EPZICOM ...... 30 EASY TOUCH LANCETS 28G ...... 28 elite-ob ...... 29 eq blood glucose test ...... 30 EASY TOUCH LANCETS ELOCON ...... 29 eql color lancets 21g ...... 30 28G/TWIST ...... 28 ELOCTATE ...... 29 eql color lancets micro 33g ...... 30 EASY TOUCH LANCETS 30G ...... 28 EMADINE ...... 29 eql super thin lancets 30g ...... 30 EASY TOUCH LANCETS EMBEDA ...... 29 eql thin lancets 26g ...... 30 30G/TWIST ...... 28 EMBRACE BLOOD GLUCOSE EQUETRO ...... 31 EASY TOUCH LANCETS 32G ...... 28 TEST ...... 29 ERGOMAR ...... 31 EASY TOUCH LANCETS EMBRACE EVO BLOOD GLUCOSE errin ...... 31 32G/TWIST ...... 28 TEST ...... 29 ERTACZO ...... 31 EASY TOUCH LANCETS EMBRACE EVO GLUCOSE erygel ...... 31 33G/TWIST ...... 28 MONITORING ...... 29 ery-tab ...... 31 EASY TOUCH PEN NEEDLES ...... 28 EMBRACE LANCETS ULTRA THIN erythromycin ...... 31 EASY TOUCH SAFETY LANCETS 30G ...... 29 erythromycin base ...... 31 21G ...... 28 EMBRACE PRO GLUCOSE TEST... 29 erythromycin ethylsuccinate...... 31 EASY TOUCH SAFETY LANCETS EMCYT ...... 29 escitalopram oxalate ...... 31 23G ...... 28 EMEND ...... 29 ESGIC ...... 31 EASY TOUCH SAFETY LANCETS EMLA ...... 29 esomeprazole magnesium ...... 31 26G ...... 28 emoquette ...... 29 est estrogens-methyltest hs ...... 31 EASY TOUCH SAFETY LANCETS EMSAM ...... 29 estarylla ...... 31 28G ...... 28 EMTRIVA ...... 29 estazolam ...... 31 EASY TOUCH TEST ...... 28 ENABLEX ...... 29 estradiol...... 31 easy trak blood glucose system..28 enalapril maleate ...... 29 estradiol-norethindrone acet ..... 31 easy trak blood glucose test ...... 28 ENBREL SURECLICK ...... 30 ESTRING ...... 31 EASY TWIST & CAP LANCETS ...... 28 endocet ...... 30 ESTROGEL ...... 31 EASYGLUCO ...... 28 ENGERIX-B ...... 30 ESTROSTEP FE ...... 31 EASYGLUCO PLUS ...... 28 ENJUVIA ...... 30 eszopiclone ...... 31 EASYGLUCO PLUS STARTER ...... 28 enoxaparin sodium ...... 30 ethambutol hcl ...... 31 EASYMAX 15 TEST ...... 28 enpresse-28 ...... 30 ethosuximide ...... 31 EASYMAX NG BLOOD GLUCOSE. 28 enskyce ...... 30 etidronate disodium ...... 31 EASYMAX TEST ...... 28 entacapone ...... 30 etodolac ...... 31 econazole nitrate...... 28 entecavir ...... 30 EUFLEXXA ...... 31 ECOZA ...... 28 ENTEREG ...... 30 EURAX ...... 31 EDARBI ...... 28 ENTOCORT EC ...... 30 EVENCARE G2 TEST ...... 31 EDARBYCLOR ...... 28 ENTRESTO ...... 30 EVENCARE G3 TEST ...... 31 ed-spaz ...... 28 EPCLUSA ...... 30 EVENCARE MINI GLUCOSE TEST. 32 EDURANT ...... 28 EPIDUO ...... 30 EVOCLIN ...... 32 eemt hs ...... 28 EPIFOAM ...... 30 EVOLUTION AUTOCODE ...... 32 EFFEXOR XR ...... 29 epinastine hcl ...... 30 EVOXAC ...... 32 EFFIENT ...... 29 epinephrine ...... 30 EXEL COMFORT POINT INSULIN EFUDEX ...... 29 epinephrine hcl ...... 30 SYR ...... 32 EGRIFTA ...... 29 EPIPEN 2-PAK ...... 30 EXELDERM ...... 32 element compact test ...... 29 EPIPEN JR 2-PAK ...... 30 EXELON ...... 32 ELEMENT TEST ...... 29 epitol ...... 30 exemestane ...... 32 ELESTAT ...... 29 EPIVIR ...... 30 EXFORGE ...... 32 ELIDEL ...... 29 EPIVIR HBV ...... 30 EXFORGE HCT ...... 32 ELIGARD ...... 29 eplerenone ...... 30 EXJADE ...... 32 ELIMITE ...... 29 EPOGEN ...... 30 EXODERM ...... 32

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EXTAVIA ...... 32 FLAGYL ...... 33 FORA D20 BLOOD GLUCOSE e-z ject lancet micro-thin 33g ..... 32 FLAGYL ER ...... 33 TEST ...... 35 e-z ject lancet super thin 30g ..... 32 FLAREX ...... 33 FORA D40/G31 BLOOD e-z ject lancets ...... 32 flavoxate hcl ...... 33 GLUCOSE ...... 35 e-z ject lancets 21g ...... 32 FLEBOGAMMA ...... 34 FORA G20 BLOOD GLUCOSE E-Z JECT LANCETS THIN 26G ...... 32 FLEBOGAMMA DIF ...... 33 SYSTEM ...... 35 EZ SMART BLOOD GLUCOSE flecainide acetate ...... 34 FORA G20 BLOOD GLUCOSE LANCETS ...... 32 FLECTOR ...... 34 TEST ...... 35 EZ SMART BLOOD GLUCOSE FLEXICHAMBER ...... 34 FORA G30A BLOOD GLUCOSE TEST ...... 32 FLOLAN...... 34 TEST ...... 35 EZ SMART PLUS GLUCOSE TEST..32 FLOMAX ...... 34 FORA GD20 TEST ...... 35 E-Z SPACER ...... 32 FLOVENT DISKUS ...... 34 FORA GD50 BLOOD GLUCOSE ezetimibe ...... 32 FLOVENT HFA ...... 34 TEST ...... 35 FABIOR ...... 32 flucaine ...... 34 FORA LANCETS ...... 35 FACTIVE ...... 32 fluconazole ...... 34 FORA TN'G VOICE ...... 35 falmina ...... 32 flucytosine...... 34 FORA TN'G/TN'G VOICE ...... 35 famciclovir ...... 32 fludrocortisone acetate ...... 34 FORA V10 BLOOD GLUCOSE famotidine ...... 32 FLUMADINE ...... 34 TEST ...... 35 FAMVIR ...... 32 flunisolide ...... 34 FORA V12 BLOOD GLUCOSE FANAPT ...... 32 fluocinolone acetonide ...... 34 TEST ...... 35 FARESTON ...... 32 fluocinonide ...... 34 FORA V20 BLOOD GLUCOSE FARXIGA ...... 32 fluocinonide-e ...... 34 TEST ...... 35 FAZACLO ...... 32 fluorescein-benoxinate ...... 34 FORA V30A BLOOD GLUCOSE felbamate...... 32, 33 fluoritab ...... 34 SYSTEM ...... 35 FELBATOL ...... 33 fluorometholone ...... 34 FORA V30A BLOOD GLUCOSE FELDENE ...... 33 fluorouracil ...... 34 TEST ...... 36 felodipine er ...... 33 fluoxetine hcl ...... 34 FORACARE GD40 TEST ...... 36 FEMARA ...... 33 fluphenazine hcl ...... 34 FORACARE PREMIUM V10 TEST. 36 FEMCON FE ...... 33 flurandrenolide ...... 34 FORACARE TEST N GO TEST ...... 36 FEMHRT LOW DOSE ...... 33 flurazepam hcl ...... 34 FORADIL AEROLIZER ...... 36 fenofibrate...... 33 flurbiprofen ...... 34 FORFIVO XL ...... 36 fenofibric acid ...... 33 flurbiprofen sodium ...... 34 FORTEO ...... 36 FENOGLIDE ...... 33 flurox ...... 35 FORTESTA ...... 36 fenoprofen calcium ...... 33 flutamide ...... 35 fortical ...... 36 FENORTHO ...... 33 fluticasone propionate ...... 35 FORTISCARE GLUCOSE SYSTEM.. 36 fentanyl citrate ...... 33 fluvastatin sodium ...... 35 FORTISCARE TEST ...... 36 FENTORA ...... 33 fluvastatin sodium er ...... 35 FOSAMAX PLUS D ...... 36 FETZIMA TITRATION ...... 33 fluvoxamine maleate ...... 35 fosinopril sodium...... 36 FIFTY50 GLUCOSE METER 2.0 ..... 33 FML FORTE ...... 35 fosinopril sodium-hctz ...... 36 FIFTY50 GLUCOSE TEST 2.0 ...... 33 FML LIQUIFILM...... 35 fosphenytoin sodium ...... 36 FIFTY50 PEN NEEDLES ...... 33 FOCALIN ...... 35 FOSRENOL ...... 36 FIFTY50 SAFETY SEAL LANCETS...33 FOCALIN XR ...... 35 FRAGMIN ...... 36 FIFTY50 UNILET LANCETS 33G .... 33 folic acid ...... 35 freds pharmacy unifine pentip+. 36 FINACEA ...... 33 FOLLISTIM AQ ...... 35 freds pharmacy unilet lanc 28g.. 36 finasteride ...... 33 fondaparinux sodium ...... 35 freds pharmacy unilet lanc 30g.. 36 FINE 30 ...... 33 FORA D10 BLOOD GLUCOSE FREESTYLE FREEDOM ...... 36 FINGERSTIX LANCETS...... 33 TEST ...... 35 FREESTYLE FREEDOM LITE ...... 36 FIORINAL ...... 33 FORA D15G BLOOD GLUCOSE FREESTYLE INSULINX SYSTEM .... 36 FIORINAL/CODEINE #3 ...... 33 TEST ...... 35 FREESTYLE INSULINX TEST ...... 36

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FREESTYLE LANCETS ...... 36 GLEEVEC ...... 38 gnp easy touch glucose test ...... 39 FREESTYLE LITE TEST ...... 36 GLEOSTINE ...... 38 gnp insulin syringe ...... 39 FREESTYLE PRECISION NEO glimepiride ...... 38 gnp lancets ...... 39 SYSTEM ...... 36 glipizide ...... 38 gnp lancets 21g ...... 39 FREESTYLE PRECISION NEO TEST 36 glipizide er ...... 38 gnp lancets micro thin 33g ...... 39 FREESTYLE SIDEKICK II ...... 36 glipizide xl ...... 38 gnp lancets super thin 30g ...... 39 FREESTYLE TEST ...... 36 glipizide-metformin hcl ...... 38 gnp lancets thin ...... 39 FREESTYLE UNISTICK II LANCETS 36 global ease inject pen needles... 38 gnp lancets thin 26g ...... 39 FROVA ...... 36 global inject ease insulin syr ...... 38 gnp micro thin lancets 33g ...... 39 frovatriptan succinate ...... 36 global inject ease lancets 28g ..... 38 gnp super thin lancets 30g ...... 39 FULYZAQ ...... 36 global inject ease lancets 30g ..... 38 gnp ultra com insulin syringe ..... 39 furosemide ...... 36 global insulin syringes ...... 38 GOLYTELY ...... 39 fyavolv ...... 37 GLUCAGEN HYPOKIT ...... 38 GONAL-F ...... 39 FYCOMPA ...... 37 GLUCAGON EMERGENCY ...... 38 granisetron hcl ...... 39 gabapentin ...... 37 GLUCOCARD 01 BLOOD GRIFULVIN V ...... 39 GABITRIL ...... 37 GLUCOSE ...... 38 griseofulvin microsize...... 39, 40 galantamine hydrobromide er... 37 GLUCOCARD 01 SENSOR PLUS... 38 griseofulvin ultramicrosize ...... 40 GAMMAGARD ...... 37 GLUCOCARD EXPRESSION GRIS-PEG ...... 40 GAMMAGARD S/D LESS IGA ...... 37 MONITOR ...... 38 guaiatussin ac ...... 40 ganirelix acetate ...... 37 GLUCOCARD EXPRESSION TEST..38 guaifenesin ac ...... 40 GARDASIL...... 37 GLUCOCARD SHINE ...... 38 guaifenesin-codeine ...... 40 gatifloxacin ...... 37 GLUCOCARD SHINE TEST ...... 38 guanfacine hcl ...... 40 gavilyte-g ...... 37 GLUCOCARD VITAL MONITOR .... 38 guanfacine hcl er ...... 40 ge100 blood glucose system ...... 37 GLUCOCARD VITAL TEST ...... 38 guanidine hcl ...... 40 ge100 blood glucose test ...... 37 GLUCOCOM LANCETS 28G ...... 38 GUARDIAN REAL-TIME STARTER 40 GELNIQUE ...... 37 GLUCOCOM LANCETS 30G ...... 38 GUARDIAN REAL-TIME SYSTEM GEL-ONE ...... 37 GLUCOCOM LANCETS 33G ...... 38 PED ...... 40 GELSYN-3 ...... 37 GLUCOCOM MONITOR ...... 38 GYNAZOLE-1 ...... 40 gemfibrozil ...... 37 GLUCOCOM TEST ...... 38 HALDOL DECANOATE ...... 40 GENERESS FE ...... 37 GLUCONAVII BLOOD GLUCOSE halobetasol propionate ...... 40 gengraf ...... 37 SYS ...... 38 HALOG ...... 40 GENOTROPIN ...... 37 GLUCONAVII BLOOD GLUCOSE haloperidol ...... 40 GENSTRIP 50 ...... 37 TEST ...... 39 haloperidol decanoate ...... 40 gentak ...... 37 GLUCOPHAGE ...... 39 haloperidol lactate ...... 40 gentamicin sulfate ...... 37 GLUCOPHAGE XR ...... 39 HARVONI ...... 40 GENVISC 850 ...... 37 glucose meter test ...... 39 HAVRIX ...... 40 GEODON ...... 37 GLUCOTROL ...... 39 healthy accents unifine pentip... 40 ght blood glucose monitor ...... 37 GLUCOTROL XL ...... 39 healthy accents unilet lancets .... 40 ght test ...... 37 GLUMETZA ...... 39 heather ...... 40 gianvi ...... 37 glyburide ...... 39 h-e-b incontrol lancets 28g ...... 40 GIAZO ...... 37 glyburide micronized ...... 39 h-e-b incontrol lancets 30g ...... 40 gildagia ...... 37 glyburide-metformin ...... 39 h-e-b incontrol lancets 33g ...... 40 gildess 1.5/30 ...... 38 glycopyrrolate ...... 39 h-e-b incontrol pen needles ...... 40 gildess 1/20 ...... 38 GLYNASE ...... 39 HELIXATE FS ...... 40 gildess 24 fe ...... 38 GLYSET ...... 39 hemmorex-hc ...... 40 gildess fe 1.5/30 ...... 38 GLYXAMBI ...... 39 HEMOFIL M ...... 40 GILENYA ...... 38 GMATE BLOOD GLUCOSE TEST.. 39 heparin sodium (porcine) ...... 40 GILOTRIF ...... 38 GMATE LANCETS 30G ...... 39 HIPREX ...... 40 glatopa ...... 38 GMATE SMART STARTER ...... 39 homatropaire ...... 40

105 homatropine hbr ...... 41 imiquimod ...... 42 ivermectin ...... 44 HORIZANT ...... 41 IMITREX ...... 42 IXINITY ...... 44 HP ACTHAR ...... 41 IMITREX STATDOSE SYSTEM ...... 42 JAKAFI ...... 44 HUMALOG ...... 41 IMURAN ...... 42 JALYN ...... 44 HUMALOG MIX 50/50 ...... 41 INCRUSE ELLIPTA ...... 42 jantoven ...... 44 HUMALOG MIX 75/25 ...... 41 indapamide ...... 42 JANUMET ...... 44 HUMATE-P ...... 41 INDOCIN ...... 43 JANUMET XR ...... 44 HUMATROPE ...... 41 indomethacin ...... 43 JANUVIA ...... 44 HUMIRA PEN ...... 41 INFANRIX ...... 43 JARDIANCE ...... 44 HUMIRA PEN-CROHNS STARTER 41 INFINITY BLOOD GLUCOSE jencycla ...... 44 HUMIRA PEN-PSORIASIS SYSTEM ...... 43 JENTADUETO ...... 44 STARTER ...... 41 INFINITY BLOOD GLUCOSE TEST.43 JENTADUETO XR ...... 44 HUMULIN 70/30 ...... 41 INLYTA ...... 43 jevantique lo ...... 44 HUMULIN N ...... 41 INOVA ...... 43 jinteli ...... 44 HUMULIN R ...... 41 INSPIRACHAMBER/LARGE ...... 43 jolessa ...... 44 HYALGAN ...... 41 INSPIRACHAMBER/MEDIUM ...... 43 jolivette ...... 44 HYCAMTIN ...... 41 INSPIRACHAMBER/MOUTHPIEC juleber ...... 44 HYCET ...... 41 E ...... 43 junel 1.5/30 ...... 44 hydralazine hcl ...... 41 INSPIRACHAMBER/SMALL ...... 43 junel 1/20 ...... 44 HYDREA ...... 41 INSPRA ...... 43 junel fe 1.5/30 ...... 44 hydrochlorothiazide ...... 41 insulin syringe ...... 43 junel fe 24 ...... 44 hydrocod polst-cpm polst er ...... 41 insulin syringe/needle ...... 43 JUXTAPID ...... 44 hydrocodone-acetaminophen.... 41 INTELENCE ...... 43 KADIAN ...... 44 hydrocodone-homatropine ...... 41 INTERMEZZO ...... 43 kaitlib fe ...... 44 hydrocodone-ibuprofen ...... 41 INTRON A ...... 43 KALETRA...... 44, 45 hydrocortisone ...... 42 introvale ...... 43 KALYDECO...... 45 hydrocortisone ace-pramoxine.. 41 INTUNIV ...... 43 kariva ...... 45 hydrocortisone acetate ...... 41 INVEGA ...... 43 KAZANO ...... 45 hydrocortisone butyrate...... 41, 42 INVIRASE ...... 43 kelnor 1/35 ...... 45 hydrocortisone-acetic acid ...... 42 INVOKAMET ...... 43 KENALOG ...... 45 hydromorphone hcl ...... 42 INVOKAMET XR ...... 43 KEPPRA ...... 45 hydroxychloroquine sulfate ...... 42 INVOKANA ...... 43 ketoconazole ...... 45 hydroxyurea ...... 42 iophen c-nr ...... 43 ketoprofen ...... 45 hydroxyzine hcl ...... 42 IOPIDINE ...... 43 ketorolac tromethamine ...... 45 hydroxyzine pamoate ...... 42 ipratropium bromide ...... 43 KHEDEZLA ...... 45 HYMOVIS ...... 42 ipratropium-albuterol ...... 43 kimidess ...... 45 hyoscyamine sulfate ...... 42 irbesartan ...... 43 KINERET ...... 45 hyosyne ...... 42 irbesartan-hydrochlorothiazide. 43 KINEVAC ...... 45 hypodermic needle ...... 42 ISENTRESS ...... 43 kinney lancets ...... 45 HYSINGLA ER ...... 42 isometheptene-dichloral-apap...43 kinney thin lancets ...... 45 HYZAAR ...... 42 isoniazid ...... 43 KISQALI 200 DOSE ...... 45 ibandronate sodium ...... 42 ISOPTO ATROPINE...... 44 KLONOPIN ...... 45 ICLUSIG ...... 42 ISOPTO CARPINE ...... 44 klor-con ...... 45 ILEVRO ...... 42 ISORDIL TITRADOSE ...... 44 klor-con 10 ...... 45 ILOTYCIN ...... 42 isosorbide dinitrate ...... 44 KOATE-DVI ...... 45 imatinib mesylate ...... 42 isosorbide mononitrate ...... 44 KOGENATE FS ...... 45 IMBRUVICA ...... 42 isradipine ...... 44 KOGENATE FS BIO-SET ...... 45 imipramine hcl ...... 42 ISTALOL ...... 44 KOMBIGLYZE XR ...... 45 imipramine pamoate ...... 42 itraconazole ...... 44 KOVALTRY ...... 45

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KRISTALOSE ...... 45 leflunomide ...... 47 lithium carbonate ...... 48 kroger blood glucose test ...... 45 LESCOL ...... 47 lithium carbonate er...... 48 kroger lancets 21g ...... 45 LESCOL XL ...... 47 LIVALO ...... 48 kroger lancets micro thin 33g .... 45 lessina ...... 47 live better lancet super thin ...... 48 kroger lancets thin 26g ...... 46 LETAIRIS ...... 47 live better lancet ultra thin ...... 48 kroger lancets ultrathin 30g ...... 46 letrozole ...... 47 LO LOESTRIN FE ...... 48 kroger premium blood glucose.. 46 leucovorin calcium ...... 47 LOCOID ...... 49 kroger premium glucose test ..... 46 LEUKERAN ...... 47 LOESTRIN 1.5/30 (21) ...... 49 kroger test ...... 46 levalbuterol hcl ...... 47 LOESTRIN 1/20 (21) ...... 49 KRYSTEXXA ...... 46 LEVAQUIN ...... 47 LOESTRIN FE 1.5/30 ...... 49 k-sol ...... 46 LEVATOL ...... 47 LOFIBRA ...... 49 K-TAB ...... 46 LEVEMIR ...... 47 lomedia 24 fe...... 49 kurvelo ...... 46 levetiracetam ...... 47 LOMOTIL ...... 49 KYLEENA ...... 46 LEVITRA ...... 47 longs lancets standard ...... 49 labetalol hcl ...... 46 levobunolol hcl ...... 47 longs lancets thin ...... 49 lactulose ...... 46 levocetirizine dihydrochloride .... 47 longs lancets ultra thin ...... 49 LAMICTAL ...... 46 levofloxacin ...... 47 loperamide hcl...... 49 LAMICTAL ODT ...... 46 levonest ...... 47 LOPID ...... 49 LAMICTAL XR ...... 46 levonorgest-eth estrad 91-day... 47 lopreeza ...... 49 LAMISIL ...... 46 levonorgestrel-ethinyl estrad ..... 47 LOPRESSOR ...... 49 lamivudine ...... 46 levonorg-eth estrad triphasic ..... 47 LOPROX ...... 49 lamivudine-zidovudine ...... 46 levora 0.15/30 (28) ...... 48 lorazepam ...... 49 lamotrigine ...... 46 LEVO-T ...... 48 lorazepam intensol ...... 49 lancets ...... 46 levothyroxine sodium ...... 48 lorcet ...... 49 lancets 28g ...... 46 levoxyl ...... 48 lortab ...... 49 lancets 30g ...... 46 LEXAPRO ...... 48 loryna...... 49 lancets micro thin 33g ...... 46 LEXIVA ...... 48 LORZONE ...... 49 lancets super thin 28g ...... 46 LIALDA ...... 48 losartan potassium ...... 49 lancets thin ...... 46 liberty test ...... 48 losartan potassium-hctz ...... 49 LANCETS ULTRA FINE...... 46 LIBRAX ...... 48 LOTEMAX ...... 49 LANCETS ULTRA THIN ...... 46 lidocaine ...... 48 LOTENSIN...... 49 lancets ultra thin 30g ...... 46 lidocaine pak ...... 48 LOTREL ...... 49 LANOXIN ...... 46 lidocaine-hydrocortisone ace ..... 48 LOTRISONE ...... 49 lansoprazole ...... 46 lidocaine-prilocaine ...... 48 LOTRONEX ...... 49 LANTUS ...... 46 lidocaine-tetracaine ...... 48 lovastatin ...... 49 LANTUS SOLOSTAR ...... 46 lindane ...... 48 LOVAZA ...... 49 larin 1.5/30 ...... 46 linezolid ...... 48 LOVENOX ...... 49 larin 1/20 ...... 47 LINZESS...... 48 low-ogestrel ...... 49 larin 24 fe...... 47 liothyronine sodium ...... 48 loxapine succinate ...... 49 larin fe 1.5/30 ...... 47 LIPITOR ...... 48 ludent ...... 50 larissia ...... 47 LIPOFEN...... 48 LUMIGAN ...... 50 LASTACAFT...... 47 lisinopril ...... 48 LUNESTA ...... 50 latanoprost ...... 47 lisinopril-hydrochlorothiazide .... 48 lutera ...... 50 LATUDA ...... 47 lite touch lancets ...... 48 LYRICA...... 50 layolis fe ...... 47 LITE TOUCH PEN NEEDLES ...... 48 LYSODREN ...... 50 leader insulin syringe ...... 47 LITEAIRE ...... 48 lyza...... 50 LEADER UNIFINE PENTIPS ...... 47 LITETOUCH INSULIN SYRINGE ..... 48 MACROBID ...... 50 LEADER UNIFINE PENTIPS PLUS..47 LITETOUCH LANCETS ...... 48 MACRODANTIN ...... 50 leena ...... 47 lithium ...... 48 MALARONE ...... 50

107 malathion ...... 50 meperidine hcl ...... 51 MICRODOT BLOOD GLUCOSE maprotiline hcl ...... 50 MEPHYTON ...... 51 SYSTEM ...... 53 MARINOL ...... 50 meprobamate ...... 51 MICRODOT TEST ...... 53 marlissa ...... 50 MEPRON ...... 51 microgestin 1.5/30 ...... 53 MARPLAN ...... 50 mercaptopurine ...... 51 microgestin 1/20 ...... 53 MATULANE ...... 50 mesalamine ...... 51 MICROGESTIN 24 FE ...... 53 MAVIK ...... 50 MESNEX ...... 51 microgestin fe 1.5/30 ...... 53 MAXALT ...... 50 METADATE CD ...... 51 MICROLET LANCETS ...... 53 MAXI-COMFORT INSULIN metaproterenol sulfate ...... 51 MICROSPACER ...... 53 SYRINGE ...... 50 metaxall ...... 51 midazolam hcl ...... 53 MAXIDEX...... 50 metaxalone ...... 51 midodrine hcl ...... 53 MAXITROL ...... 50 metformin hcl ...... 52 miglitol ...... 53 MAXZIDE-25 ...... 50 metformin hcl er ...... 52 MIGRANAL ...... 53 meclizine hcl ...... 50 metformin hcl er (mod) ...... 52 mimvey ...... 53 meclofenamate sodium ...... 50 methadone hcl ...... 52 MINIPRESS ...... 53 medicine shoppe lancets ...... 50 methadose ...... 52 MINITRAN ...... 53 medicine shoppe lancets thin .... 50 methazolamide ...... 52 MINIVELLE ...... 53 MEDISENSE THIN LANCETS ...... 50 methenamine hippurate ...... 52 MINOCIN ...... 53 medlance lite 25g ...... 50 methenamine mandelate ...... 52 minocycline hcl ...... 53 MEDLANCE PLUS EXTRA 21G ..... 50 methimazole ...... 52 minoxidil ...... 53 medlance plus lancets ...... 50 methocarbamol ...... 52 MIRAPEX ER ...... 53 MEDLANCE PLUS LITE 25G ...... 50 methotrexate ...... 52 MIRCERA ...... 53 MEDLANCE PLUS SPECIAL methscopolamine bromide ...... 52 MIRCETTE ...... 53 0.8MM ...... 50 methyclothiazide ...... 52 mirtazapine ...... 54 MEDLANCE PLUS SUPERLITE methyldopa ...... 52 MIRVASO ...... 54 30G ...... 50 methyldopa- MITIGARE ...... 54 MEDLANCE PLUS UNIVERSAL hydrochlorothiazide ...... 52 MITOSOL ...... 54 21G ...... 50 METHYLIN ...... 52 MOBIC ...... 54 medlance universal 21g ...... 50 methylphenidate hcl ...... 52 modafinil ...... 54 MEDROL...... 51 methylphenidate hcl er (cd) ...... 52 moderiba ...... 54 mefenamic acid ...... 51 methylphenidate hcl er (la) ...... 52 moderiba 800 dose pack ...... 54 mefloquine hcl ...... 51 methylprednisolone...... 52 MODICON (28) ...... 54 MEGACE ES ...... 51 methylprednisolone acetate ...... 52 moexipril hcl ...... 54 MEGACE ORAL ...... 51 methyltestosterone ...... 52 moexipril-hydrochlorothiazide...54 megestrol acetate ...... 51 metipranolol ...... 52 mometasone furoate ...... 54 meijer blood glucose ...... 51 metoclopramide hcl ...... 52 MONOCLATE-P ...... 54 meijer blood glucose test ...... 51 metolazone ...... 52 MONOJECT HYPODERMIC MEIJER LANCETS ...... 51 metoprolol tartrate ...... 52 NEEDLE ...... 54 MEIJER LANCETS THIN ...... 51 METOZOLV ODT ...... 52 MONOJECT INSULIN SYRINGE .... 54 MEIJER LANCETS UNIVERSAL METROCREAM ...... 52 MONOJECT ULTRA COMFORT 33G ...... 51 METROGEL-VAGINAL ...... 52 SYRINGE ...... 54 meijer premium blood glucose.. 51 METROLOTION ...... 53 MONOLET LANCETS...... 54 meijer premium glucose test ..... 51 metronidazole ...... 53 mono-linyah ...... 54 MEIJER SUPER THIN LANCETS .... 51 mexiletine hcl ...... 53 mononessa ...... 54 MEKINIST ...... 51 MIACALCIN ...... 53 MONONINE ...... 54 meloxicam ...... 51 MICARDIS ...... 53 MONOVISC ...... 54 memantine hcl ...... 51 MICARDIS HCT ...... 53 montelukast sodium ...... 54 MENOPUR ...... 51 miconazole 3 ...... 53 MONUROL ...... 54 MENTAX ...... 51 MICROCHAMBER ...... 53 morgidox ...... 54

108 morphine sulfate ...... 54 neomycin-polymyxin-gramicidin 56 NORITATE ...... 58 morphine sulfate er ...... 54 neomycin-polymyxin-hc ...... 56 norlyroc ...... 58 MOVANTIK ...... 54 neo-polycin ...... 56 NORPACE ...... 58 MOVIPREP ...... 54 neo-polycin hc...... 56 NORPACE CR ...... 58 MOXEZA ...... 54 NEORAL ...... 56 NORPRAMIN ...... 58 MS CONTIN ...... 55 NEOSPORIN ...... 56 NOR-QD ...... 58 MULTAQ ...... 55 nephro-vite rx ...... 56 nortrel 0.5/35 (28) ...... 58 mupirocin ...... 55 NEPTAZANE ...... 56 nortrel 1/35 (21) ...... 58 MUSE ...... 55 NESINA ...... 56 nortrel 1/35 (28) ...... 58 M-VIT ...... 55 NEULASTA ...... 56 nortrel 7/7/7 ...... 58 MYAMBUTOL ...... 55 NEUPOGEN ...... 56 nortriptyline hcl ...... 58 mycophenolate mofetil ...... 55 NEUPRO ...... 56 NORVASC ...... 58 MYDRIACYL ...... 55 NEURONTIN ...... 56 NORVIR ...... 58 MYGLUCOHEALTH BLOOD NEUTEK 2TEK TEST ...... 56 NOVA MAX BLOOD GLUCOSE GLUCOSE ...... 55 NEVANAC ...... 56 SYSTEM ...... 58 MYGLUCOHEALTH LANCETS 30G55 nevirapine ...... 56 NOVA MAX GLUCOSE TEST ...... 58 MYGLUCOHEALTH TEST ...... 55 NEXAVAR ...... 57 NOVA SAFETY LANCETS 23G ...... 58 myorisan ...... 55 NEXIUM ...... 57 NOVA SAFETY LANCETS 28G ...... 58 MYRBETRIQ ...... 55 niacin er (antihyperlipidemic) ..... 57 NOVA SUREFLEX LANCETS ...... 58 MYSOLINE ...... 55 NIACOR ...... 57 NOVACORT ...... 58 myzilra ...... 55 NIASPAN ...... 57 novarel...... 58 nabumetone ...... 55 nifedipine ...... 57 NOVOEIGHT ...... 58 nadolol ...... 55 nifedipine er ...... 57 NOVOFINE ...... 58 nadolol-bendroflumethiazide .... 55 nikki ...... 57 NOVOFINE PLUS ...... 58 naftifine hcl ...... 55 nimodipine ...... 57 NOVOLIN 70/30 ...... 58 NAFTIN ...... 55 nisoldipine er ...... 57 NOVOLIN 70/30 RELION ...... 58 NALFON ...... 55 nitro-bid ...... 57 NOVOLIN N ...... 58 naltrexone hcl ...... 55 NITRO-DUR ...... 57 NOVOLIN N RELION ...... 58 NAMENDA ...... 55 nitrofurantoin macrocrystal ...... 57 NOVOLIN R ...... 58 NAMENDA XR ...... 55 nitrofurantoin monohyd macro. 57 NOVOLIN R RELION ...... 59 naproxen ...... 55 nitroglycerin ...... 57 NOVOLOG FLEXPEN ...... 59 naproxen sodium ...... 55 NITROMIST ...... 57 NOVOLOG MIX 70/30 ...... 59 naratriptan hcl ...... 55 NITROSTAT ...... 57 NOVOLOG PENFILL ...... 59 NARCAN ...... 55 NIVA-PLUS ...... 57 NOVOSEVEN RT ...... 59 NARDIL ...... 55 nizatidine ...... 57 NOXAFIL ...... 59 NASCOBAL ...... 55 NIZORAL ...... 57 NUCYNTA ...... 59 NASONEX ...... 55 nodolor ...... 57 NUCYNTA ER ...... 59 NATACYN ...... 55 nora-be ...... 57 NUEDEXTA ...... 59 NATAZIA ...... 56 NORCO ...... 57 NULEV ...... 59 nateglinide ...... 56 NORDITROPIN FLEXPRO ...... 57 NUOX ...... 59 NATESTO ...... 56 norethin ace-eth estrad-fe ...... 57 NUTROPIN AQ NUSPIN 10 ...... 59 nature-throid ...... 56 norethindrone...... 57 NUTROPIN AQ PEN ...... 59 necon 0.5/35 (28) ...... 56 norethindrone acet-ethinyl est.. 57 NUVARING ...... 59 necon 1/35 (28) ...... 56 norethindrone-eth estradiol ...... 57 NUVIGIL ...... 59 necon 1/50 (28) ...... 56 norethin-eth estradiol-fe ...... 57 NUWIQ ...... 59 necon 7/7/7 ...... 56 norgestimate-eth estradiol ...... 57 nystatin ...... 59 nefazodone hcl ...... 56 norgestim-eth estrad triphasic...58 nystatin-triamcinolone ...... 59 neomycin-bacitracin zn-polymyx56 NORINYL 1+35 (28) ...... 58 OB COMPLETE ...... 59 neomycin-polymyxin-dexameth.56 NORINYL 1+50 (28) ...... 58 obizur ...... 59

109

O-CAL FA ...... 59 ONFI ...... 61 oxcarbazepine ...... 62 ocella ...... 59 ONGLYZA ...... 61 oxiconazole nitrate ...... 62 OCTAGAM...... 59 ONMEL ...... 61 OXISTAT ...... 62 OCUFEN ...... 59 OPANA ...... 61 OXTELLAR XR ...... 62 OCUFLOX ...... 59 OPANA ER ...... 61 oxybutynin chloride...... 62 ofloxacin ...... 59 OPTICHAMBER DIAMOND ...... 61 oxybutynin chloride er ...... 62 ogestrel ...... 59 OPTICHAMBER DIAMOND-LG oxycodone hcl ...... 62 olanzapine...... 59, 60 MASK ...... 61 oxycodone hcl er ...... 62 olanzapine-fluoxetine hcl ...... 60 OPTICHAMBER DIAMOND-MD oxycodone-acetaminophen ...... 62 OLEPTRO ...... 60 MASK ...... 61 oxycodone-aspirin ...... 62 olopatadine hcl ...... 60 OPTICHAMBER DIAMOND-SM oxycodone-ibuprofen ...... 62 OLYSIO ...... 60 MASK ...... 61 OXYCONTIN ...... 62 omega-3-acid ethyl esters ...... 60 OPTIUM TEST ...... 61 oxymorphone hcl ...... 62 omeprazole...... 60 OPTIUMEZ TEST ...... 61 oxymorphone hcl er ...... 62 omeprazole-sodium OPTUMRX BLOOD GLUCOSE OXYTROL ...... 62 bicarbonate ...... 60 METER ...... 61 pacerone ...... 62 OMNARIS ...... 60 OPTUMRX BLOOD GLUCOSE PACNEX WASH...... 62 OMNIPRED...... 60 SYSTEM ...... 61 paliperidone er ...... 63 OMNITROPE ...... 60 OPTUMRX BLOOD GLUCOSE PAMELOR...... 63 ON CALL EXPRESS BLOOD TEST ...... 61 PANCREAZE ...... 63 GLUCOSE ...... 60 ORACEA ...... 61 PANDEL ...... 63 ON CALL EXPRESS MONITORING ORAP ...... 61 pantoprazole sodium ...... 63 SYS ...... 60 ORAPRED ODT...... 61 PARAFON FORTE DSC ...... 63 ON CALL LANCETS...... 60 ORENCIA ...... 61 PAREMYD ...... 63 ON CALL PLUS BLOOD GLUCOSE 60 ORENCIA CLICKJECT ...... 61 PARLODEL ...... 63 ON CALL PLUS LANCETS ...... 60 orphenadrine citrate er ...... 61 PARNATE ...... 63 ON CALL PLUS METER ...... 60 orsythia ...... 61 paromomycin sulfate ...... 63 ON CALL PLUS MONITORING ORTHO MICRONOR ...... 61 paroxetine hcl ...... 63 SYSTEM ...... 60 ORTHO TRI-CYCLEN (28) ...... 61 PASER ...... 63 ON CALL VIVID BLOOD GLUCOSE60 ORTHO TRI-CYCLEN LO ...... 61 PATADAY ...... 63 ON CALL VIVID METER ...... 60 ORTHO-CYCLEN (28) ...... 61 PATANASE ...... 63 ON CALL VIVID MONITORING..... 60 ORTHO-NOVUM 1/35 (28) ...... 61 PATANOL ...... 63 ON CALL VIVID PAL METER ...... 60 ORTHO-NOVUM 7/7/7 (28) ...... 61 PAXIL ...... 63 ondansetron ...... 60 ORTHOVISC ...... 61 pc lancets super thin 30g ...... 63 ondansetron hcl ...... 60 oscimin ...... 61 pc unifine pentips ...... 63 ONETOUCH DELICA LANCETS oseltamivir phosphate ...... 61 PCE ...... 63 33G ...... 60 OSENI ...... 61 PEDIADERM HC ...... 63 ONETOUCH DELICA LANCETS OSMOPREP ...... 62 peg-3350/electrolytes ...... 63 FINE ...... 60 OTEZLA ...... 62 PEGANONE ...... 63 ONETOUCH ULTRA 2 ...... 60 OTREXUP ...... 62 PEGINTRON ...... 63 ONETOUCH ULTRA BLUE ...... 60 OVACE PLUS ...... 62 PEG-INTRON REDIPEN ...... 63 ONETOUCH ULTRA MINI ...... 60 OVACE PLUS WASH ...... 62 PEG-INTRON REDIPEN PAK 4 ...... 63 ONETOUCH ULTRASOFT LANCETS OVACE WASH ...... 62 pen needles 3/16" ...... 63 60 OVCON-35 (28) ...... 62 penicillin v potassium ...... 63 ONETOUCH VERIO...... 60, 61 OVIDE ...... 62 PENTASA ...... 63 ONETOUCH VERIO FLEX SYSTEM 60 OXANDRIN ...... 62 PENTIPS ...... 63 ONETOUCH VERIO IQ SYSTEM 60 oxandrolone ...... 62 pentoxifylline er ...... 63 ONETOUCH VERIO SYNC oxaprozin ...... 62 PEPCID ...... 63 SYSTEM ...... 61 OXAYDO ...... 62 PERCOCET ...... 63

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PERFOROMIST ...... 64 potassium chloride er ...... 65 primaquine phosphate ...... 67 perindopril erbumine ...... 64 POTIGA ...... 65 primidone ...... 67 permethrin ...... 64 PR BENZOYL PEROXIDE WASH .... 65 PRIMLEV ...... 67 perphenazine ...... 64 PRADAXA ...... 65 PRIMSOL ...... 67 perphenazine-amitriptyline ...... 64 PRALUENT ...... 65 PRISTIQ ...... 67 PERSANTINE ...... 64 pramipexole dihydrochloride er.65 PRIVIGEN ...... 67 PERTZYE ...... 64 PRAMOSONE ...... 65 PROAIR HFA ...... 67 PEXEVA ...... 64 PRAMOSONE E ...... 65 probenecid ...... 67 PHARMACIST CHOICE PRANDIN ...... 65 procainamide hcl ...... 67 AUTOCODE ...... 64 pravastatin sodium ...... 65 PROCARDIA ...... 67 PHARMACIST CHOICE prazosin hcl ...... 65 procentra ...... 67 AUTOCODE SYS ...... 64 PRECISION PCX ...... 65 prochlorperazine maleate ...... 67 PHARMACIST CHOICE LANCETS..64 PRECISION PCX PLUS TEST ...... 65 PROCRIT ...... 67 pharmacist choice no coding...... 64 PRECISION POINT OF CARE TEST 65 PRODIGY AUTOCODE BLOOD phenelzine sulfate ...... 64 PRECISION QID TEST ...... 65 GLUCOSE ...... 67 phenobarbital ...... 64 PRECISION XTRA BLOOD PRODIGY INSULIN SYRINGE ...... 67 phenyleph-promethazine-cod.... 64 GLUCOSE ...... 66 PRODIGY LANCETS 28G ...... 67 phenytoin ...... 64 PRECOSE...... 66 PRODIGY NO CODING BLOOD phenytoin sodium extended ...... 64 PRED FORTE ...... 66 GLUC ...... 67 philith ...... 64 PRED MILD ...... 66 PRODIGY POCKET BLOOD PICATO ...... 64 PRED-G S.O.P...... 66 GLUCOSE ...... 67 pilocarpine hcl ...... 64 prednicarbate ...... 66 PRODIGY SAFETY LANCETS 26G..67 pimozide ...... 64 prednisolone ...... 66 PRODIGY TWIST TOP LANCETS pimtrea ...... 64 prednisolone acetate ...... 66 28G ...... 67 pindolol ...... 64 prednisolone sodium phosphate66 PRODIGY VOICE BLOOD pioglitazone hcl ...... 64 prednisone ...... 66 GLUCOSE ...... 67 pioglitazone hcl-glimepiride ...... 64 preferred plus insulin syringe ..... 66 PROFILNINE ...... 67 pioglitazone hcl-metformin hcl.. 64 preferred plus lancets colored... 66 PROFILNINE SD ...... 67 pirmella 1/35 ...... 64 preferred plus lancets thin ...... 66 progesterone micronized ...... 67 pirmella 7/7/7 ...... 64 preferred plus unifine pentips .... 66 PROGRAF ...... 67 piroxicam ...... 64 PREFEST...... 66 PROLENSA...... 67 PLAN B ONE-STEP ...... 64 PREGNYL ...... 66 PROLIA ...... 67 PLAQUENIL ...... 64 PREMARIN ...... 66 promethazine hcl ...... 67 PLAVIX ...... 64 premium blood glucose test ...... 66 promethazine vc plain ...... 67 PLETAL ...... 64 PREMPHASE ...... 66 promethazine vc/codeine ...... 67 PLIAGLIS ...... 65 PREMPRO ...... 66 promethazine-dm ...... 68 PNEUMOVAX 23 ...... 65 prenatabs rx ...... 66 promethazine-phenylephrine .... 68 pnv prenatal plus multivitamin.. 65 prenatal ...... 66 PROMETRIUM ...... 68 pnv tabs 29-1 ...... 65 prenatal low iron ...... 66 propafenone hcl ...... 68 POCKET CHAMBER ...... 65 prenatal plus ...... 66 proparacaine hcl ...... 68 podofilox...... 65 prenatal plus iron ...... 66 propranolol hcl ...... 68 poly hub needle ...... 65 prenatal vitamin plus low iron... 66 propranolol-hctz ...... 68 polycin ...... 65 preplus ...... 66 PROSCAR ...... 68 polymyxin b-trimethoprim ...... 65 PREVACID ...... 66 PROTONIX ...... 68 POLYTRIM ...... 65 prevalite ...... 66 PROTOPIC ...... 68 POMALYST ...... 65 previfem ...... 66 protriptyline hcl ...... 68 PONSTEL ...... 65 PREVNAR 13 ...... 66 PROVENTIL HFA ...... 68 portia-28 ...... 65 PREVPAC ...... 66 PROVIGIL ...... 68 potassium chloride ...... 65 PREZISTA ...... 67 PROZAC ...... 68

111 pseudoeph-bromphen-dm ...... 68 RECOMBINATE ...... 70 REXALL BLOOD GLUCOSE psorcon ...... 68 RECOMBIVAX HB...... 70 SYSTEM ...... 71 PULMICORT ...... 68 REFUAH PLUS BLOOD GLUCOSE REXALL BLOOD GLUCOSE TEST...71 PULMICORT FLEXHALER ...... 68 TEST ...... 70 REXALL LANCETS ULTRA THIN PULMOZYME ...... 68 REFUAH PLUS MONITORING 30G ...... 71 px lancets ultra thin ...... 68 SYSTEM ...... 70 REYATAZ ...... 71 px mini pen needles ...... 68 REGLAN ...... 70 RHEUMATREX ...... 71 PYLERA ...... 68 REGRANEX...... 70 RHOFADE ...... 71 pyrazinamide ...... 68 RELION CONFIRM GLUCOSE ribasphere ...... 71 qc lancets super thin 30g ...... 68 MONITOR ...... 70 RIBASPHERE RIBAPAK ...... 71 qc unilet lancets 28g...... 68 RELION CONFIRM/MICRO TEST..70 RIBATAB ...... 71 qc unilet lancets micro thin ...... 68 RELION LANCETS THIN 26G ...... 70 ribavirin ...... 71 QNASL ...... 68 RELION LANCETS ULTRA-THIN RIFADIN ...... 71 QSYMIA ...... 68 30G ...... 70 rifampin ...... 71 QUALAQUIN ...... 68 RELION MICRO ...... 70 RIFATER ...... 71 QUARTETTE ...... 68 RELION PRIME TEST ...... 70 RIGHTEST GL300 LANCETS ...... 71 quasense...... 68 RELION ULTIMA GLUCOSE RIGHTEST GM100 BLOOD quazepam ...... 68 SYSTEM ...... 70 GLUCOSE ...... 71 QUESTRAN ...... 68 RELION ULTIMA TEST ...... 70 RIGHTEST GM300 BLOOD quetiapine fumarate ...... 69 RELION ULTRA THIN LANCETS GLUCOSE ...... 71 QUILLICHEW ER ...... 69 30G ...... 70 RIGHTEST GM550 BLOOD QUILLIVANT XR ...... 69 RELION ULTRA THIN PLUS GLUCOSE ...... 71 quinapril-hydrochlorothiazide ... 69 LANCETS ...... 70 RIGHTEST GS100 BLOOD quinidine gluconate ...... 69 RELISTOR ...... 70 GLUCOSE ...... 71 quinidine sulfate er ...... 69 RELPAX ...... 70 RIGHTEST GS300 BLOOD quinine sulfate ...... 69 REMERON ...... 70 GLUCOSE ...... 71 QUINTET AC BLOOD GLUCOSE RENAGEL ...... 70 RIGHTEST GS550 BLOOD TEST ...... 69 rena-vite rx ...... 70 GLUCOSE ...... 71 QVAR ...... 69 RENVELA ...... 70 RILUTEK ...... 71 ra e-zject lancets 28g ...... 69 repaglinide ...... 70 riluzole ...... 71 ra e-zject lancets thin 26g ...... 69 REPATHA ...... 70 rimantadine hcl ...... 71 ra e-zject lancets thin 28g ...... 69 REPATHA SURECLICK ...... 70 RIOMET ...... 72 ra e-zject lancets ultra thin...... 69 REQUIP ...... 70 risedronate sodium ...... 72 ra lancets alternate site ...... 69 RESCRIPTOR ...... 70 RISPERDAL ...... 72 ra lancets thin ...... 69 RESCULA ...... 70 RISPERDAL CONSTA ...... 72 ra lancets ultra thin ...... 69 reserpine ...... 70 risperidone ...... 72 ra pen needles ...... 69 RESTASIS ...... 70 RITALIN ...... 72 RA TRUETEST TEST...... 69 RESTORIL ...... 70 RITALIN LA ...... 72 rabeprazole sodium...... 69 RETIN-A ...... 70 RITEFLO...... 72 ramipril ...... 69 RETIN-A MICRO ...... 71 rivastigmine ...... 72 RANEXA ...... 69 RETIN-A MICRO PUMP ...... 71 rivastigmine tartrate ...... 72 ranitidine hcl...... 69 RETROVIR ...... 71 rixubis ...... 72 RAPAFLO ...... 69 REVATIO ...... 71 rizatriptan benzoate ...... 72 RAPAMUNE ...... 69 REVEAL BLOOD GLUCOSE ROBAXIN ...... 72 RAYOS ...... 69 MONITOR ...... 71 ROBINUL ...... 72 RAZADYNE ER ...... 69 REVEAL BLOOD GLUCOSE TEST.. 71 ROCALTROL ...... 72 REBETOL ...... 69 REVIA ...... 71 ropinirole hcl ...... 72 REBIF ...... 69 REVLIMID ...... 71 rosadan ...... 72 reclipsen ...... 69 rosuvastatin calcium ...... 72

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ROTATEQ ...... 72 SIMPONI ...... 74 SOMA...... 75 ROZEREM ...... 72 simvastatin ...... 74 SORIATANE ...... 75 RYTHMOL...... 72 SINEMET ...... 74 SORILUX ...... 75 SABRIL ...... 72 SINEMET CR ...... 74 sorine ...... 75 SAFESNAP INSULIN SYRINGE 72 SINGLE-LET ...... 74 sotalol hcl ...... 75 safety lancet 21g/pressure act... 72 SINGULAIR ...... 74 sotalol hcl (af) ...... 75 safety lancet 28g/pressure act... 72 sirolimus ...... 74 SOVALDI...... 75 SAFETY LANCETS ...... 72 SIRTURO ...... 74 SPIRIVA HANDIHALER ...... 75 SAFETY LANCETS 21G ...... 72 SIVEXTRO ...... 74 SPIRIVA RESPIMAT ...... 75 safety lancets 28g ...... 72 SKELAXIN ...... 74 spironolactone ...... 75 SAFETY LET LANCETS ...... 72 SKYLA ...... 74 spironolactone-hctz ...... 75 SAFETY SEAL LANCETS ...... 72 sm glucose test ...... 74 SPORANOX ...... 75 SAFYRAL ...... 72 sm insulin syringe ...... 74 SPORANOX PULSEPAK ...... 75 SAIZEN ...... 73 sm lancets 21g ...... 74 sprintec 28 ...... 75 SAIZEN CLICK.EASY ...... 73 sm lancets 33g ...... 74 SPRIX ...... 75 salsalate ...... 73 sm super thin lancets 30g ...... 74 SPRYCEL ...... 75 SANCUSO ...... 73 sm thin lancets 26g ...... 74 sronyx ...... 75 SANDIMMUNE ...... 73 SMART SENSE COLOR LANCETS ssd...... 75 SANTYL...... 73 33G ...... 74 SSKI ...... 75 sapscare twist top lancets 73 SMART SENSE PREMIUM sss 10-5 ...... 75 SARAFEM ...... 73 SYSTEM ...... 74 STALEVO 75 ...... 76 SAVELLA ...... 73 SMART SENSE PREMIUM TEST... 74 STARLIX ...... 76 SEASONIQUE ...... 73 SMART SENSE STANDARD stavudine ...... 76 seb-prev wash ...... 73 LANCETS ...... 74 STAXYN ...... 76 SECTRAL ...... 73 SMART SENSE SUPER THIN STELARA...... 76 selegiline hcl ...... 73 LANCETS ...... 74 STENDRA ...... 76 selenium sulfide ...... 73 SMART SENSE THIN LANCETS STERILANCE TL ...... 76 selenium sulf-pyrithione-urea 73 26G ...... 74 STIOLTO RESPIMAT ...... 76 SELZENTRY ...... 73 SMART SENSE VALUE GLUCOSE STIVARGA ...... 76 SEMPREX-D ...... 73 SYS ...... 74 STRATTERA ...... 76 SEREVENT DISKUS ...... 73 SMART SENSE VALUE TEST ...... 74 STRIANT ...... 76 serophene ...... 73 SMARTEST BLOOD GLUCOSE STRIBILD ...... 76 SEROQUEL ...... 73 TEST ...... 74 STROMECTOL ...... 76 SEROQUEL XR ...... 73 SMARTEST EJECT STARTER ...... 74 SUBOXONE ...... 76 SEROSTIM ...... 73 SMARTEST LANCETS 28G ...... 74 SUBSYS ...... 76 sertraline hcl ...... 73 SMARTEST PERSONA STARTER...74 SUCRAID ...... 76 setlakin ...... 73 SMARTEST PRONTO STARTER ..... 75 sucralfate ...... 76 sharobel ...... 73 SMARTEST PROTEGE STARTER... 75 SULAR ...... 76 SHOPKO ON-THE-GO LANCETS sodium fluoride ...... 75 sulfacetamide sodium ...... 76 30G ...... 73 sodium sulfacetamide...... 75 sulfacetamide sodium-sulfur ..... 76 SHOPKO UNIFINE PENTIPS 73 SOLIQUA...... 75 sulfacetamide-prednisolone ...... 76 SHOPKO UNIFINE PENTIPS PLUS 73 SOLODYN ...... 75 sulfacetamide-sulfur in urea ...... 76 SHOPKO UNILET LANCETS 28G...73 SOLTAMOX ...... 75 sulfadiazine...... 76 SHOPKO UNILET LANCETS 30G...73 SOLU-CORTEF ...... 75 sulfamethoxazole-trimethoprim 76 sildenafil citrate ...... 74 SOLUS V2 BLOOD GLUCOSE SULFAMYLON ...... 76 SILVADENE ...... 74 SYSTEM ...... 75 sulfasalazine ...... 76 silver sulfadiazine ...... 74 SOLUS V2 LANCETS 28G ...... 75 sulfatrim pediatric ...... 76 SIMBRINZA ...... 74 SOLUS V2 TEST ...... 75 sulindac ...... 76 SIMCOR ...... 74 SOLUS V2 TWIST LANCETS 30G.. 75 sumatriptan ...... 77

113 sumatriptan succinate ...... 77 TECHLITE LANCETS 30G ...... 78 tgt lancet ultra thin 30g ...... 79 SUPARTZ ...... 77 TECHLITE PEN NEEDLES ...... 78 THALOMID ...... 79 SUPARTZ FX ...... 77 TECHNIVIE ...... 78 theochron ...... 79 SUPRAX ...... 77 TEGRETOL ...... 78 theophylline ...... 80 SUPREP BOWEL PREP ...... 77 TEGRETOL-XR ...... 78 theophylline er ...... 80 sure comfort insulin syringe ...... 77 TEKAMLO ...... 78 thermazene ...... 80 sure comfort lancets 28g ...... 77 TEKTURNA ...... 78 thin lancets ...... 80 sure comfort lancets 30g ...... 77 TEKTURNA HCT ...... 78 THINPRO INSULIN SYRINGE ...... 80 sure comfort pen needles ...... 77 TELCARE BLOOD GLUCOSE thioridazine hcl ...... 80 SURE-FINE PEN NEEDLES ...... 77 SYSTEM ...... 78 thiothixene ...... 80 SURE-JECT INSULIN SYRINGE ...... 77 TELCARE BLOOD GLUCOSE TEST 78 thrivite rx ...... 80 SURE-LANCE FLAT LANCETS ...... 77 telmisartan ...... 78 THYROLAR-1/4 ...... 80 SURE-LANCE THIN LANCETS 28G 77 telmisartan-amlodipine ...... 78 tiagabine hcl ...... 80 SURE-LANCE ULTRA THIN telmisartan-hctz ...... 78 TIAZAC ...... 80 LANCETS ...... 77 temazepam ...... 78 ticlopidine hcl ...... 80 SURE-TEST EASYPLUS MINI TEST 77 TEMODAR ...... 78 TIGAN ...... 80 SURE-TOUCH LANCETS TEMOVATE ...... 79 TIKOSYN ...... 80 UNIVERSAL ...... 77 temozolomide ...... 79 tilia fe ...... 80 SUSTIVA ...... 77 TENEX ...... 79 timolol maleate ...... 80 SUTENT ...... 77 TENORETIC 50 ...... 79 TIMOPTIC ...... 80 syeda ...... 77 TENORMIN ...... 79 TIMOPTIC OCUDOSE ...... 80 SYLATRON ...... 77 TERAZOL 7 ...... 79 TINDAMAX ...... 80 symax fastabs ...... 77 terbinafine hcl ...... 79 tinidazole ...... 80 SYMBICORT ...... 77 terbutaline sulfate ...... 79 TIROSINT ...... 80 SYMBYAX ...... 77 terconazole ...... 79 TIVICAY ...... 80 SYMLINPEN 120 ...... 77 TERSI ...... 79 tizanidine hcl ...... 80 SYNALAR ...... 77 TERUMO INSULIN SYRINGE ...... 79 TOBI PODHALER ...... 80 SYNALAR (CREAM) ...... 77 TERUMO SURGUARD2 SAFETY TOBRADEX ...... 80 SYNJARDY ...... 77 NEEDLE ...... 79 TOBRADEX ST ...... 80 SYNTHROID ...... 77 TESSALON PERLES ...... 79 tobramycin ...... 80 SYNVISC ...... 77 TESTIM ...... 79 tobramycin-dexamethasone ...... 80 SYNVISC ONE ...... 77 TESTOPEL ...... 79 TOBREX ...... 80 TABLOID ...... 78 testosterone ...... 79 todays health thin lancets 28g... 80 TACLONEX...... 78 testosterone cypionate ...... 79 todays health thin lancets 30g... 80 tacrolimus ...... 78 TESTRED ...... 79 TOFRANIL ...... 81 TAFINLAR ...... 78 tetcaine ...... 79 tolcapone ...... 81 TAMIFLU ...... 78 tetrabenazine ...... 79 tolmetin sodium ...... 81 tamoxifen citrate ...... 78 tetracaine hcl ...... 79 tolterodine tartrate ...... 81 tamsulosin hcl ...... 78 TETRAVISC ...... 79 tolterodine tartrate er ...... 81 TANZEUM ...... 78 TETRAVISC FORTE ...... 79 TOPAMAX ...... 81 TAPAZOLE ...... 78 TEXACORT ...... 79 TOPICORT ...... 81 TARCEVA ...... 78 tgt blood glucose monitoring ..... 79 TOPICORT SPRAY ...... 81 TARKA ...... 78 tgt blood glucose test ...... 79 topiramate...... 81 TASIGNA ...... 78 tgt lancet alternate site ...... 79 torsemide ...... 81 TASMAR ...... 78 tgt lancet micro thin 33g ...... 79 TOUJEO SOLOSTAR ...... 81 TAZORAC ...... 78 tgt lancet super thin 30g ...... 79 TOVIAZ ...... 81 taztia xt ...... 78 tgt lancet thin 23g ...... 79 TRACLEER ...... 81 TECFIDERA ...... 78 tgt lancet thin 26g ...... 79 TRADJENTA ...... 81 TECHLITE LANCETS ...... 78 tgt lancet ultra thin 28g ...... 79 tramadol hcl ...... 81

114 tramadol hcl er ...... 81 trospium chloride ...... 83 ULTRA-THIN II MINI PEN NEEDLE84 tramadol-acetaminophen ...... 81 TRUE METRIX AIR GLUCOSE ULTRATRAK PRO TEST ...... 84 trandolapril ...... 81 METER ...... 83 ULTRATRAK ULTIMATE TEST ...... 84 trandolapril-verapamil hcl er ..... 81 TRUE METRIX BLOOD GLUCOSE ULTRAVATE ...... 84 TRANSDERM-SCOP (1.5 MG) ...... 81 TEST ...... 83 ULTRESA ...... 84 TRANXENE-T ...... 81 TRUE METRIX METER ...... 83 UNIFINE PENTIPS ...... 84 tranylcypromine sulfate ...... 81 TRUE2GO BLOOD GLUCOSE unifine pentips plus ...... 84 TRAVATAN Z ...... 81 MONITOR ...... 83 UNILET COMFORTOUCH LANCET84 travel lancets ...... 81 TRUEPLUS INSULIN SYRINGE ...... 83 UNILET EXCELITE ...... 84 trazodone hcl ...... 81 TRUEPLUS LANCETS 26G ...... 83 UNILET EXCELITE II ...... 84 TRECATOR ...... 81 TRUEPLUS LANCETS 28G ...... 83 UNILET G.P. SUPERLITE LANCET. 84 TRESIBA FLEXTOUCH ...... 81 TRUEPLUS LANCETS 30G ...... 83 UNILET GP 28 ULTRA THIN ...... 84 tretinoin ...... 82 TRUEPLUS LANCETS 33G ...... 83 UNILET MICRO-THIN 33G ...... 84 tretinoin microsphere ...... 82 TRUEPLUS SAFETY LANCETS 28G 83 UNILET SUPER-THIN 30G ...... 84 tretinoin microsphere pump ...... 82 TRUERESULT BLOOD GLUCOSE.. 83 UNILET ULTRA-THIN 28G ...... 85 TRETTEN ...... 82 TRUETEST TEST ...... 83 UNISTIK 3 GENTLE ...... 85 TREXALL ...... 82 TRUETRACK BLOOD GLUCOSE .... 83 UNISTIK SAFETY LANCETS 28G... 85 TREXIMET ...... 82 TRUETRACK SMART SYSTEM ...... 83 UNISTIK SAFETY LANCETS 30G... 85 triamcinolone acetonide ...... 82 TRUETRACK TEST ...... 83 UNISTIK TOUCH SAFETY LANC triamterene-hctz ...... 82 TRULICITY ...... 83 21G ...... 85 trianex ...... 82 TRUSOPT ...... 83 UNISTIK TOUCH SAFETY LANC TRIBENZOR ...... 82 TRUVADA ...... 83 23G ...... 85 TRICARE ...... 82 TUDORZA PRESSAIR ...... 83 UNISTIK TOUCH SAFETY LANC TRICOR ...... 82 TUSSICAPS ...... 83 28G ...... 85 triderm...... 82 tussigon ...... 83 UNISTIK TOUCH SAFETY LANC tri-estarylla ...... 82 TUSSIONEX PENNKINETIC ER ...... 83 30G ...... 85 trifluoperazine hcl ...... 82 TWINRIX ...... 83 UNISTRIP1 GENERIC ...... 85 trifluridine...... 82 TWYNSTA ...... 84 unithroid ...... 85 TRIGLIDE ...... 82 TYKERB ...... 84 UNIVERSAL 1 LANCETS THIN trihexyphenidyl hcl ...... 82 TYLENOL WITH CODEINE #3 ...... 84 26G ...... 85 tri-legest fe ...... 82 TYSABRI ...... 84 UNIVERSAL 1 LANCETS ULTRA TRILEPTAL ...... 82 TYZEKA ...... 84 THIN ...... 85 tri-linyah ...... 82 ULORIC ...... 84 URECHOLINE ...... 85 TRILIPIX ...... 82 ULTICARE INSULIN SYRINGE ...... 84 UROXATRAL ...... 85 tri-lo-estarylla ...... 82 ULTILET BASIC LANCETS 30G ...... 84 ursodiol ...... 85 tri-lo-marzia ...... 82 ULTILET CLASSIC LANCETS ...... 84 VAGIFEM ...... 85 tri-lo-sprintec ...... 82 ULTILET LANCETS ...... 84 valacyclovir hcl ...... 85 trimethobenzamide hcl ...... 82 ULTILET SAFETY LANCETS 23G .... 84 VALCYTE...... 85 trimethoprim ...... 82 ULTIMA TEST ...... 84 valganciclovir hcl ...... 85 trinessa (28) ...... 82 ultra thin lancets 28g ...... 84 VALIUM ...... 85 trinessa lo ...... 82 ultra thin lancets 30g ...... 84 valproate sodium ...... 85 TRI-NORINYL (28) ...... 83 ULTRA TRAK PRO BLOOD valproic acid ...... 85 TRINTELLIX ...... 83 GLUCOSE ...... 84 valsartan ...... 85 tri-previfem ...... 83 ULTRACET ...... 84 valsartan-hydrochlorothiazide... 85 tri-sprintec ...... 83 ultra-comfort insulin syringe ...... 84 VALTREX ...... 85 trivora (28) ...... 83 ULTRAM ...... 84 value plus lancet standard 21g...85 TRIZIVIR ...... 83 ULTRAM ER ...... 84 valumark lancet super thin 30g..85 TROKENDI XR ...... 83 ULTRA-THIN II AUTO LANCET...... 84 valumark lancet ultra thin 28g... 85 tropicamide ...... 83 ULTRA-THIN II LANCETS ...... 84 valved holding chamber ...... 85

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VANCOCIN HCL ...... 85 vol-care rx ...... 87 XYNTHA ...... 88 vancomycin hcl ...... 85 vol-plus...... 87 XYNTHA SOLOFUSE ...... 89 vandazole ...... 85 vol-tab rx ...... 87 XYZAL ...... 89 VASCEPA ...... 85 VOLTAREN ...... 87 YASMIN 28 ...... 89 VASOTEC ...... 85 VOLTAREN-XR ...... 87 YAZ ...... 89 VECAMYL ...... 86 voriconazole ...... 87 zafirlukast ...... 89 velivet ...... 86 VORTEX VALVED HOLDING zaleplon ...... 89 VELTIN ...... 86 CHAMBER ...... 87 ZANTAC ...... 89 VEMLIDY ...... 86 VOTRIENT ...... 87 zarah ...... 89 venlafaxine hcl ...... 86 vp-vite rx ...... 87 ZARONTIN ...... 89 venlafaxine hcl er ...... 86 vyfemla ...... 87 ZARXIO ...... 89 VENTOLIN HFA ...... 86 VYTORIN ...... 87 ZEGERID ...... 89 VERAMYST ...... 86 VYVANSE ...... 87 ZELAPAR ...... 89 verapamil hcl ...... 86 walgreens adv travel lancets ...... 87 ZELBORAF ...... 89 verapamil hcl er ...... 86 WALGREENS LANCETS ...... 87 zenatane ...... 89 VERDESO ...... 86 walgreens lancets micro thin ...... 87 zenchent ...... 89 VERELAN PM...... 86 walgreens lancets super thin ...... 87 zenchent fe ...... 89 VERSACLOZ ...... 86 WALGREENS THIN LANCETS ...... 87 ZENPEP ...... 89 VESICARE ...... 86 WALGREENS ULTRA THIN zenzedi ...... 89 vestura ...... 86 LANCETS ...... 88 zeosa ...... 89 VEXOL ...... 86 warfarin sodium ...... 88 ZEPATIER ...... 89 VFEND ...... 86 WAVESENSE AMP ...... 88 ZERIT ...... 89 VIAGRA ...... 86 WAVESENSE PRESTO ...... 88 ZESTORETIC ...... 89 VIBRAMYCIN ...... 86 wegmans unifine pentips plus .... 88 ZESTRIL ...... 89 VICTOZA ...... 86 WELCHOL ...... 88 ZETIA ...... 89 VIDA MIA UNILET LANCETS 28G.86 WELLBUTRIN ...... 88 ZETONNA ...... 89 VIDA MIA UNILET LANCETS 30G.86 WELLBUTRIN XL ...... 88 ZIAC ...... 89 VIDAZA ...... 86 wera ...... 88 ZIAGEN...... 89 VIDEX ...... 86 WILATE ...... 88 ZIANA ...... 89 VIDEX EC ...... 86 WP THYROID ...... 88 zidovudine ...... 89 VIEKIRA PAK ...... 86 wymzya fe ...... 88 ZIOPTAN ...... 89 vienva ...... 86 XALATAN ...... 88 ziprasidone hcl ...... 89 VIIBRYD ...... 86 XALKORI ...... 88 ZIPSOR ...... 90 VIMOVO ...... 86 XANAX ...... 88 ZIRGAN ...... 90 VIMPAT ...... 86 XANAX XR ...... 88 ZITHRANOL-RR ...... 90 VIOKACE ...... 87 XARELTO ...... 88 ZITHROMAX ...... 90 viorele ...... 87 XELJANZ...... 88 ZITHROMAX Z-PAK ...... 90 VIRACEPT ...... 87 XELJANZ XR ...... 88 ZOCOR ...... 90 VIRAMUNE ...... 87 XENAZINE ...... 88 ZODRYL AC 35 ...... 90 VIREAD ...... 87 XERESE ...... 88 ZOFRAN ...... 90 VIROPTIC ...... 87 XIFAXAN ...... 88 ZOFRAN ODT ...... 90 virtussin a/c ...... 87 XIGDUO XR ...... 88 ZOLINZA ...... 90 VISTARIL ...... 87 XIIDRA ...... 88 zolmitriptan ...... 90 VITAMEDMD ONE XOLAIR ...... 88 ZOLOFT ...... 90 RX/QUATREFOLIC ...... 87 XOPENEX ...... 88 zolpidem tartrate ...... 90 VIVELLE-DOT ...... 87 XOPENEX HFA ...... 88 zolpidem tartrate er ...... 90 VIVITROL ...... 87 XTANDI ...... 88 ZOLPIMIST ...... 90 VOGELXO ...... 87 xulane...... 88 ZOMACTON ...... 90 VOGELXO PUMP ...... 87 XULTOPHY ...... 88 ZOMIG ...... 90

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ZOMIG ZMT ...... 90 ZONEGRAN ...... 90 zonisamide ...... 90 ZORBTIVE ...... 90 ZORTRESS ...... 90 ZORVOLEX ...... 90 ZOSTAVAX ...... 90 zovia 1/35e (28) ...... 90 ZOVIRAX...... 90, 91 ZUBSOLV ...... 91 ZUPLENZ ...... 91 ZYBAN ...... 91 ZYCLARA ...... 91 ZYCLARA PUMP ...... 91 ZYFLO ...... 91 ZYLET ...... 91 ZYLOPRIM ...... 91 ZYMAXID ...... 91 ZYPREXA ...... 91 ZYPREXA ZYDIS ...... 91 ZYTIGA ...... 91 ZYVOX ...... 91

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