FEP Rx Drug Formulary (607) Standard Option

Effective August 1, 2012

INTRODUCTION...... 4 PREFACE ...... 4 PRIOR APPROVAL ...... 4 QUANTITY ALLOWANCES ...... 4 PHARMACY AND THERAPEUTICS (P&T) COMMITTEE ...... 5 PRODUCT SELECTION CRITERIA...... 5 FORMULARY PRODUCT DESCRIPTIONS ...... 5 GENERIC SUBSTITUTION ...... 6 DRUG EFFICACY STUDY IMPLEMENTATION DRUGS ...... 6 EDITOR ...... 6 NOTICE ...... 7 LEGEND ...... 7 ANALGESICS...... 8 ANALGESICS, OTHER ...... 8 NSAIDs ...... 8 NSAIDs, COMBINATIONS ...... 8 NSAIDs, TOPICAL ...... 8 COX-2 INHIBITORS ...... 8 GOUT ...... 8 OPIOID ANALGESICS ...... 9 OPIOID ANALGESICS, CII ...... 9 NON-OPIOID ANALGESICS ...... 9 VISCOSUPPLEMENTS ...... 9 ANTI-INFECTIVES ...... 10 ANTIBACTERIALS ...... 10 ANTIFUNGALS ...... 11 ANTIMALARIALS ...... 12 ANTIRETROVIRAL AGENTS ...... 12 ANTITUBERCULAR AGENTS ...... 13 ANTIVIRALS...... 13 MISCELLANEOUS ...... 13 ANTINEOPLASTIC AGENTS ...... 14 ALKYLATING AGENTS ...... 14 ANTIMETABOLITES ...... 14 HORMONAL ANTINEOPLASTIC AGENTS ...... 15 IMMUNOMODULATORS ...... 15 KINASE INHIBITORS ...... 15 TOPOISOMERASE INHIBITORS ...... 16 MISCELLANEOUS ...... 16 CARDIOVASCULAR ...... 17 ACE INHIBITORS...... 17 ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS ...... 17 ACE INHIBITOR/DIURETIC COMBINATIONS ...... 17 ADRENOLYTICS, CENTRAL ...... 18 ALDOSTERONE RECEPTOR ANTAGONISTS ...... 18 ALPHA BLOCKERS ...... 18 ANGIOTENSIN II RECEPTOR ANTAGONISTS/DIURETIC COMBINATIONS ...... 18 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER COMBINATIONS ...... 18 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER/DIURETIC COMBINATIONS ...... 18 ANTIARRHYTHMICS ...... 18 ANTILIPEMICS...... 19 BETA-BLOCKERS ...... 19 BETA-BLOCKER/DIURETIC COMBINATIONS ...... 20 CALCIUM CHANNEL BLOCKERS ...... 20 CALCIUM CHANNEL BLOCKER/ANTILIPEMIC COMBINATIONS ...... 20 DIGITALIS GLYCOSIDES ...... 20

1 DIRECT RENIN INHIBITORS/DIURETIC COMBINATIONS ...... 20 DIRECT RENIN INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS ...... 20 DIURETICS ...... 20 NITRATES ...... 21 NITRATE/VASODILATOR COMBINATIONS ...... 21 PULMONARY ARTERIAL HYPERTENSION ...... 21 MISCELLANEOUS ...... 21 CENTRAL NERVOUS SYSTEM ...... 22 ANTIANXIETY ...... 22 ANTICONVULSANTS ...... 22 ANTIDEMENTIA ...... 23 ANTIDEPRESSANTS ...... 23 ANTIPARKINSONIAN AGENTS ...... 24 ANTIPSYCHOTICS ...... 24 ATTENTION DEFICIT HYPERACTIVITY DISORDER ...... 25 FIBROMYALGIA...... 25 HUNTINGTON'S DISEASE AGENTS ...... 25 HYPNOTICS...... 25 MIGRAINE ...... 26 MOOD STABILIZERS ...... 26 MULTIPLE SCLEROSIS ...... 26 MUSCULOSKELETAL THERAPY AGENTS ...... 26 MYASTHENIA GRAVIS ...... 27 NARCOLEPSY/CATAPLEXY ...... 27 PSYCHOTHERAPEUTIC-MISCELLANEOUS ...... 27 MISCELLANEOUS ...... 27 ENDOCRINE AND METABOLIC ...... 27 ANDROGENS ...... 27 ANTIDIABETICS ...... 28 CALCIUM RECEPTOR ANTAGONISTS ...... 29 CALCIUM REGULATORS ...... 29 CONTRACEPTIVES ...... 30 ENDOMETRIOSIS ...... 31 ESTROGENS ...... 32 ESTROGEN/PROGESTINS ...... 32 FERTILITY REGULATORS ...... 32 GLUCOCORTICOIDS ...... 33 GLUCOSE ELEVATING AGENTS ...... 33 HUMAN GROWTH HORMONES ...... 33 HYPERPARATHYROID TREATMENT, VITAMIN D ANALOGS ...... 33 INSULIN-LIKE GROWTH FACTOR-1 AGENTS ...... 33 PHENYLKETONURIA TREATMENT AGENTS ...... 33 PHOSPHATE BINDER AGENTS ...... 33 PROGESTINS ...... 33 SELECTIVE ESTROGEN RECEPTOR MODULATORS ...... 34 THYROID AGENTS ...... 34 VASOPRESSINS ...... 34 MISCELLANEOUS ...... 34 GASTROINTESTINAL ...... 35 ANTIDIARRHEALS ...... 35 ANTIEMETICS ...... 35 ANTISPASMODICS ...... 35 CHOLELITHOLYTICS ...... 35 H2 RECEPTOR ANTAGONISTS ...... 35 INFLAMMATORY BOWEL DISEASE ...... 35 IRRITABLE BOWEL SYNDROME ...... 36 LAXATIVES ...... 36 PANCREATIC ENZYMES ...... 36 PROSTAGLANDINS ...... 36 PROTON PUMP INHIBITORS ...... 36 SALIVA STIMULANTS ...... 36 STEROIDS, RECTAL ...... 36 ULCER THERAPY COMBINATIONS ...... 37 MISCELLANEOUS ...... 37

2 GENITOURINARY ...... 37 BENIGN PROSTATIC HYPERPLASIA ...... 37 URINARY ANTISPASMODICS ...... 37 VAGINAL ANTI-INFECTIVES ...... 37 MISCELLANEOUS ...... 37 HEMATOLOGIC ...... 37 ANTICOAGULANTS ...... 37 HEMATOPOIETIC GROWTH FACTORS ...... 38 HEMOPHILIA, VON WILLEBRAND DISEASE AND RELATED BLEEDING DISORDERS ...... 38 HEREDITARY ANGIOEDEMA AGENTS ...... 39 IDIOPATHIC THROMBOCYTOPENIC PURPURA AGENTS ...... 39 PAROXYSMAL NOCTURNAL HEMOGLOBINURIA (PNH) AGENTS ...... 39 PLATELET AGGREGATION INHIBITORS ...... 39 PLATELET SYNTHESIS INHIBITORS ...... 39 STEM CELL MOBILIZERS ...... 39 MISCELLANEOUS ...... 39 IMMUNOLOGIC AGENTS ...... 39 BIOLOGIC DISEASE-MODIFYING AGENTS ...... 39 DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs) ...... 39 IMMUNE GLOBULINS ...... 40 IMMUNOMODULATORS ...... 40 IMMUNOSUPPRESSANTS ...... 40 NUTRITIONAL/SUPPLEMENTS ...... 41 ELECTROLYTES ...... 41 VITAMINS AND MINERALS ...... 41 RESPIRATORY ...... 41 ANAPHYLAXIS TREATMENT AGENTS ...... 42 ANTICHOLINERGICS ...... 42 ANTICHOLINERGIC/BETA AGONIST COMBINATIONS ...... 42 ANTIHISTAMINES, LOW SEDATING...... 42 ANTIHISTAMINES, NONSEDATING ...... 42 ANTIHISTAMINES, SEDATING ...... 42 ANTIHISTAMINE/DECONGESTANT COMBINATIONS ...... 42 ANTITUSSIVES...... 42 ANTITUSSIVE COMBINATIONS ...... 42 BETA AGONISTS ...... 42 CYSTIC FIBROSIS ...... 43 LEUKOTRIENE RECEPTOR MODIFIERS ...... 43 MAST CELL STABILIZERS ...... 43 NASAL ANTIHISTAMINES ...... 43 NASAL STEROIDS ...... 43 PHOSPHODIESTERASE-4 INHIBITORS ...... 43 STEROID/BETA AGONIST COMBINATIONS ...... 43 STEROID INHALANTS ...... 43 XANTHINES ...... 43 MISCELLANEOUS ...... 44 TOPICAL ...... 44 DERMATOLOGY...... 44 MOUTH/THROAT/DENTAL AGENTS ...... 47 OPHTHALMIC ...... 47 OTIC ...... 49 WEBSITES ...... 51 INDEX ...... 53

INTRODUCTION FEP is pleased to provide the 2012 FEP Rx Drug Formulary as a useful reference for drug product selection. The drugs on the FEP Rx Drug Formulary have been reviewed by the FEP Pharmacy and Therapeutics (P&T) Committee and FEP physicians and pharmacists and found appropriate for preferred status.

All the information in the FEP Rx Drug Formulary is provided as a reference for drug therapy selection. Specific drug selection for an individual patient rests solely with the prescriber.

National guidelines can be found on the National Guideline Clearinghouse site at http://www.guideline.gov, on the websites listed under each therapeutic class and on the sites listed in the WEBSITES section of this publication. PREFACE The formulary is organized by sections, which refer to either a drug class or disease state. Unless exceptions are noted, all dosage forms and strengths of the drug cited are included in the formulary.

The FEP Rx Drug Formulary is an open formulary, but FEP may impose restrictions or not reimburse for specific drug products or types of products. For example, drugs and supplies for weight loss are excluded from the pharmacy benefit. In addition, over-the-counter (OTC) products, with the exception of insulin and diabetes monitoring products, are generally not included in the pharmacy benefit. Some OTC products are listed in the formulary for informational purposes only.

The formulary is separated by Tiers in the following manner:

Tier 1 Tier 2 Tier 3 Tier 4 generic drugs preferred brand non-preferred brand specialty products products products Standard Option 20% coinsurance 30% coinsurance 45% coinsurance 30% coinsurance Retail Pharmacy

Medicare Part B 15% coinsurance Standard Option $15.00 $70.00 $95.00 Mail Pharmacy

Medicare Part B $10.00 Standard Option $80.00 Specialty Pharmacy

Drug products shown in boldface type in Tier 2, Tier 3 and Tier 4 have generic versions. All generic drug products are Tier 1.

All drugs that are preferred are noted in their respective tiers of the drug lists throughout this formulary. Drugs may be reviewed by the FEP P&T Committee and designated non-preferred. These drugs are listed in Tier 3. Also, FEP may designate certain drugs as non-preferred, typically if the cost-effectiveness is less than other similar drugs. Generic versions of non-preferred drugs, whether listed or not, are always in Tier 1. PRIOR APPROVAL Prior approval (PA) is required for certain drugs before FEP will cover them. The prescribing physician may request PA by calling toll-free 1-877-727-3784. The list of prior approval medications is subject to change. For a current list of medications that require prior approval please see our Prior Approval web page. QUANTITY ALLOWANCES Quantity allowances have been established for some of the medications covered by FEP. Requests for quantities greater than allowed can be submitted to the Prior Approval program by the prescribing physician by calling toll-free 1-877-727-3784. The list of medications that have quantity allowances is subject to change. For a current list of medications with quantity allowances please see our Prior Approval web page.

PHARMACY AND THERAPEUTICS (P&T) COMMITTEE The role of the FEP P&T Committee includes evaluating new medications, and making recommendations for the designation of preferred or non-preferred status on the FEP Rx Drug Formulary. The FEP P&T Committee is made up of physicians and pharmacists who are not employees or agents of, nor have financial interest in FEP. PRODUCT SELECTION CRITERIA The FEP P&T Committee will consider U.S. Food and Drug Administration (FDA) approved drugs for preferred status designation. The evaluation includes a literature review; expert opinion may also be sought. Formal reviews are prepared that typically address the following information:

Safety Efficacy Comparison studies Drug interactions Approved indications Formulation and administration Adverse effects Contraindications Pharmacokinetics Patient compliance considerations Medical outcome and pharmacoeconomic studies

When a new drug is considered for preferred status, an attempt will be made to examine the drug relative to similar drugs currently preferred. In addition, entire therapeutic classes are periodically reviewed. The class review process may result in a designation of non-preferred status to drug(s) in a particular therapeutic class, in an effort to continually promote the most clinically useful and cost-effective agents.

Drugs evaluated by the P&T Committee and not classified as preferred receive a non-preferred designation in the FEP Rx Drug Formulary. This designation indicates the P&T Committee's belief that the drug offers no important clinical or cost advantage over comparable preferred drugs, or that there is currently insufficient information to determine its appropriate clinical role, or that questions remain regarding safety and effectiveness. In an open formulary environment, non-preferred drugs are covered under FEP's pharmacy benefit. However, there may be additional costs incurred by the patient to receive a non-preferred medication. Physicians are encouraged to prescribe preferred drugs.

All the information in the FEP Rx Drug Formulary is provided as a reference for drug therapy selection. The final choice of a specific drug selection for an individual patient rests solely with the prescriber. FORMULARY PRODUCT DESCRIPTIONS To assist in understanding which specific strengths and dosage forms are preferred, examples are noted below. The general principles shown in the examples can usually be extended to other entries in the book. Any exceptions are noted.

Preferred products include all strengths and dosage forms of the cited brand-name product.

aripiprazole Abilify Oral tablets, oral disintegrating tablets, solution and all strengths of Abilify would be included in this listing.

When a strength or dosage form is specified, only the specified strength and dosage form is preferred. Other strengths/dosage forms of the reference product are not.

acyclovir caps, susp, tabs Zovirax The capsules, suspension and tablets of Zovirax are preferred. From this entry, the cream and ointment cannot be assumed to be on the list unless there is a specific entry.

Extended-release and delayed-release products require their own entry.

tolterodine Detrol The immediate-release product listing of Detrol alone would not include the extended-release product Detrol LA.

tolterodine ext-rel Detrol LA A separate entry for Detrol LA confirms that the extended-release product is on the formulary.

Dosage forms will be consistent with the category and use where listed.

neomycin/polymyxin B/hydrocortisone Cortisporin Since Cortisporin is listed only in the OTIC section, it is limited to the otic solution and suspension. From this entry, the topical cream cannot be assumed to be on the list unless there is an entry for this product in the DERMATOLOGY section of the formulary. GENERIC SUBSTITUTION Generic substitution is a pharmacy action whereby a generic version is dispensed rather than a prescribed brand-name product. Boldface type indicates generic availability. However, not all strengths or dosage forms of the generic name in boldface type may be generically available. In addition, boldface type may indicate that the brand name cited is a generic. Examples of the latter include Levoxyl and Trivora.

One way to reduce out-of-pocket cost is by requesting a generic drug. Generic drugs are usually priced lower than their brand-name equivalents. Generic drugs are:

Approved by the FDA for safety and effectiveness, and are manufactured under the same strict standards that apply to brand-name drugs. Tested in humans to assure the generic is absorbed into the bloodstream in a similar rate and to the same extent as the brand-name drug. Generics may be different from the brand in size, color, and inactive ingredients, but this does not alter their effectiveness or ability to be absorbed just like the brand-name drug. Manufactured in the same strength and dosage form as the brand-name drugs.

When a generic drug is substituted for a brand-name drug, you can expect the generic to produce the same clinical effect and safety profile as the brand-name drug. DRUG EFFICACY STUDY IMPLEMENTATION DRUGS Drugs first marketed between 1938 and 1962 were approved as safe but required no showing of effectiveness for FDA approval. Since 1962, all new drugs are required to be both safe and effective before they can be marketed. The legislation that resulted in this change also applies retroactively to all drugs approved as safe from 1938-1962. The Drug Efficacy Study Implementation (DESI) program was established by the FDA to review the effectiveness of these pre-1962 drugs for their labeled indications, and a determination of fully effective was made for most of these products and they remain in the marketplace. A few DESI products remain classified as "less than fully effective" while awaiting final administrative disposition. Also classified as DESI are many products listed as identical, similar, or related to actual DESI products. EDITOR Your comments and suggestions regarding this FEP Rx Drug Formulary are encouraged. Your input is vital to this formulary's continued success. All responses will be reviewed and considered. Please send your comments to:

FEP Rx Drug Formulary - MC 145 P.O. Box 52115 Phoenix, AZ 85072-2115

NOTICE The information contained in this FEP Rx Drug Formulary and its appendices is provided by FEP, solely for the convenience of medical providers. FEP does not warrant or assure accuracy of such information nor is it intended to be comprehensive in nature. The FEP Rx Drug Formulary is not a complete list of all covered medications. This FEP Rx Drug Formulary is not intended to be a substitute for the knowledge, expertise, skill and judgment of the medical provider in his or her choice of prescription drugs. FEP assumes no responsibility for the actions or omissions of any medical provider based upon reliance, in whole or in part, on the information contained herein. The medical provider should consult the drug manufacturer's product literature or standard references for more detailed information.

This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with FEP.

If viewing this formulary via Internet, please be advised that the formulary is updated periodically and changes may appear prior to their effective date. LEGEND d DESI drug OTC Over the counter PA Prior Approval boldface Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name delayed-rel Delayed-release (also known as enteric-coated), refer to the reference brand listed for clarification ext-rel Extended-release (also known as sustained-release), refer to the reference brand listed for clarification

ANALGESICS Practice guidelines of pain management are available at: http://www.asahq.org

ANALGESICS, OTHER Treatment recommendations for osteoarthritis are available at: http://www.rheumatology.org

acetaminophen inj OFIRMEV Tier 3

NSAIDs choline magnesium trisalicylate Tier 1 diclofenac sodium delayed-rel Tier 1 diclofenac sodium ext-rel Tier 1 VOLTAREN XR Tier 3 diflunisal Tier 1 etodolac Tier 1 etodolac ext-rel Tier 1 flurbiprofen Tier 1 ibuprofen Tier 1 indomethacin Tier 1 indomethacin ext-rel Tier 1 ketoprofen Tier 1 ketoprofen ext-rel Tier 1 ketorolac Tier 1 PA meloxicam Tier 1 MOBIC Tier 3 nabumetone Tier 1 naproxen Tier 1 NAPROSYN Tier 3 naproxen sodium Tier 1 ANAPROX Tier 3 oxaprozin Tier 1 DAYPRO Tier 3 piroxicam Tier 1 FELDENE Tier 3 sulindac Tier 1 CLINORIL Tier 3 fenoprofen NALFON Tier 2 ibuprofen inj CALDOLOR Tier 2 indomethacin susp INDOCIN susp Tier 2 diclofenac sodium delayed-rel/ ARTHROTEC Tier 3 misoprostol ketorolac tromethamine nasal spray SPRIX Tier 3 naproxen sodium ext-rel NAPRELAN Tier 3

NSAIDs, COMBINATIONS naproxen/esomeprazole delayed-rel VIMOVO Tier 3

NSAIDs, TOPICAL diclofenac sodium gel VOLTAREN GEL Tier 2

COX-2 INHIBITORS PA celecoxib CELEBREX Tier 2

GOUT allopurinol Tier 1 ZYLOPRIM Tier 3 probenecid Tier 1 febuxostat ULORIC Tier 2 colchicine COLCRYS Tier 3 PA pegloticase KRYSTEXXA Tier 4

OPIOID ANALGESICS Practice Guidelines for Cancer Pain Management (includes WHO analgesic ladder) are available at: http://www.asahq.org http://www.nccn.org

Opioid guidelines in the management of chronic non-malignant pain are available at: http://www.asipp.org/Guidelines.htm

butalbital/acetaminophen/caffeine/ Tier 1 FIORICET w/CODEINE Tier 3 codeine butalbital/aspirin/caffeine/codeine Tier 1 FIORINAL w/CODEINE Tier 3 butorphanol nasal spray Tier 1 codeine/acetaminophen Tier 1 TYLENOL w/CODEINE Tier 3 hydrocodone/acetaminophen Tier 1 LORCET Tier 3 hydrocodone/acetaminophen Tier 1 LORTAB Tier 3 hydrocodone/acetaminophen Tier 1 VICODIN Tier 3 tramadol Tier 1 ULTRAM Tier 3 tramadol ext-rel Tier 1 RYZOLT Tier 3 tramadol ext-rel Tier 1 ULTRAM ER Tier 3 codeine/acetaminophen susp CAPITAL w/CODEINE Tier 2 buprenorphine transdermal BUTRANS Tier 3

OPIOID ANALGESICS, CII fentanyl transdermal Tier 1 DURAGESIC Tier 3 PA fentanyl transmucosal Tier 1 ACTIQ Tier 3 hydromorphone Tier 1 DILAUDID Tier 3 morphine Tier 1 morphine ext-rel Tier 1 KADIAN Tier 2 morphine ext-rel Tier 1 MS CONTIN Tier 3 morphine supp Tier 1 oxycodone Tier 1 ROXICODONE Tier 3 oxycodone concentrate 20 mg/mL Tier 1 oxycodone soln Tier 1 oxycodone/acetaminophen 5/325 Tier 1 PERCOCET Tier 3 oxymorphone Tier 1 OPANA Tier 3 PA fentanyl citrate buccal FENTORA Tier 2 hydromorphone ext-rel EXALGO Tier 2 morphine ext-rel AVINZA Tier 2 oxycodone ext-rel OXYCONTIN Tier 2 oxymorphone ext-rel OPANA ER Tier 2 tapentadol NUCYNTA Tier 2 tapentadol ext-rel NUCYNTA ER Tier 2

NON-OPIOID ANALGESICS butalbital/acetaminophen Tier 1 butalbital/acetaminophen/caffeine Tier 1 FIORICET Tier 3 butalbital/aspirin/caffeine Tier 1 FIORINAL Tier 3 butalbital/acetaminophen PHRENILIN FORTE Tier 2 ziconotide PRIALT Tier 4

VISCOSUPPLEMENTS PA high molecular weight hyaluronan ORTHOVISC Tier 4 PA hylan G-F 20 SYNVISC Tier 4 PA hylan G-F 20 SYNVISC-ONE Tier 4 PA sodium hyaluronate EUFLEXXA Tier 4 PA sodium hyaluronate HYALGAN Tier 4 PA sodium hyaluronate SUPARTZ Tier 4

ANTI-INFECTIVES Hepatitis: CDC recommendations on the treatment of hepatitis are available at: http://www.cdc.gov/hepatitis/index.htm

Guidelines for the management of chronic hepatitis by the American Association for the Study of Liver Disease are available at: http://www.aasld.org

HIV/AIDS: Guidelines for the treatment of HIV patients by the U.S. Department of Health and Human Services are available at: http://www.aidsinfo.nih.gov

Infective Endocarditis: American Heart Association recommendations for the prevention of bacterial endocarditis are available at: http://www.americanheart.org

Influenza: Recommendations of the Advisory Committee on Immunization Practices are available at: http://www.cdc.gov/ncidod/diseases/flu/fluvirus.htm

International Travel: CDC recommendations for international travel are available at: http://www.cdc.gov/travel

Sexually Transmitted Diseases: CDC Sexually Transmitted Diseases Guidelines are available at: http://www.cdc.gov/std/treatment/default.htm

Respiratory Tract Infection/Antibiotic Use/Community Acquired Pneumonia/Other: Principles of appropriate antibiotic use for treatment of nonspecific upper respiratory tract infection in adults are available at: http://www.cdc.gov/ncidod/guidelines/guidelines_topic_ar.htm

Practice guidelines and statements developed and endorsed by the Infectious Diseases Society of America are available at: http://www.idsociety.org

ANTIBACTERIALS Cephalosporins First Generation cephalexin Tier 1 KEFLEX Tier 3

Second Generation cefaclor Tier 1 cefoxitin Tier 1 MEFOXIN Tier 3 cefprozil Tier 1 cefuroxime axetil Tier 1 CEFTIN Tier 3

Third Generation cefdinir Tier 1 cefditoren Tier 1 SPECTRACEF Tier 3 cefotaxime Tier 1 CLAFORAN Tier 3 cefpodoxime Tier 1 ceftazidime Tier 1 FORTAZ Tier 3 ceftriaxone Tier 1 ROCEPHIN Tier 3 ceftibuten CEDAX Tier 2

Fourth Generation cefepime Tier 1

Fifth Generation ceftaroline fosamil TEFLARO Tier 2

Erythromycins/Macrolides azithromycin Tier 1 ZITHROMAX Tier 3 clarithromycin Tier 1 BIAXIN Tier 3

clarithromycin ext-rel Tier 1 BIAXIN XL Tier 3 erythromycin delayed-rel Tier 1 erythromycin ethylsuccinate Tier 1 E.E.S. Tier 3 erythromycin stearate Tier 1 erythromycin/sulfisoxazole Tier 1 azithromycin ZMAX Tier 2 erythromycin dispertabs PCE Tier 2 fidaxomicin DIFICID Tier 2 erythromycin delayed-rel ERY-TAB Tier 3

Fluoroquinolones ciprofloxacin ext-rel Tier 1 ciprofloxacin tabs Tier 1 CIPRO tabs Tier 3 levofloxacin Tier 1 LEVAQUIN Tier 3 ofloxacin Tier 1 ciprofloxacin susp CIPRO susp Tier 2 moxifloxacin AVELOX Tier 2 gemifloxacin FACTIVE Tier 3

Ketolides telithromycin KETEK Tier 3

Penicillins amoxicillin, except film-coated tabs Tier 1 amoxicillin/clavulanate Tier 1 AUGMENTIN Tier 3 amoxicillin/clavulanate ext-rel Tier 1 AUGMENTIN XR Tier 3 amoxicillin/clavulanate susp 600 mg Tier 1 ampicillin Tier 1 ampicillin sodium/sulbactam sodium Tier 1 UNASYN Tier 3 dicloxacillin Tier 1 penicillin VK Tier 1 piperacillin/tazobactam Tier 1 ZOSYN Tier 3 amoxicillin ext-rel MOXATAG Tier 3

Tetracyclines doxycycline hyclate Tier 1 VIBRAMYCIN Tier 3 doxycycline monohydrate Tier 1 ADOXA Tier 3 doxycycline monohydrate Tier 1 MONODOX Tier 3 minocycline Tier 1 DYNACIN Tier 3 minocycline Tier 1 MINOCIN Tier 3 minocycline ext-rel Tier 1 SOLODYN Tier 3 tetracycline Tier 1

ANTIFUNGALS clotrimazole troches Tier 1 fluconazole Tier 1 DIFLUCAN Tier 3 PA itraconazole caps Tier 1 SPORANOX caps Tier 3 ketoconazole tabs Tier 1 nystatin Tier 1 PA terbinafine tabs Tier 1 LAMISIL Tier 3 voriconazole Tier 1 VFEND Tier 2 amphotericin B lipid complex ABELCET Tier 2 amphotericin B lipid complex AMPHOTEC Tier 2 anidulafungin ERAXIS Tier 2 griseofulvin microsize GRIFULVIN V Tier 2 griseofulvin ultramicrosize GRIS-PEG Tier 2 itraconazole oral soln SPORANOX oral soln Tier 2

posaconazole NOXAFIL Tier 2 micafungin MYCAMINE Tier 3

ANTIMALARIALS atovaquone/proguanil Tier 1 MALARONE Tier 2 chloroquine Tier 1 ARALEN Tier 3 mefloquine Tier 1 primaquine Tier 2 artemether/lumefantrine COARTEM Tier 2 pyrimethamine DARAPRIM Tier 2

ANTIRETROVIRAL AGENTS Antiretroviral Combinations lamivudine/zidovudine Tier 1 COMBIVIR Tier 4 abacavir/lamivudine EPZICOM Tier 4 abacavir/lamivudine/zidovudine TRIZIVIR Tier 4 efavirenz/emtricitabine/tenofovir ATRIPLA Tier 4 emtricitabine/rilpivirine/tenofovir COMPLERA Tier 4 emtricitabine/tenofovir TRUVADA Tier 4

Chemokine Receptor Antagonists maraviroc SELZENTRY Tier 4

Fusion Inhibitors enfuvirtide FUZEON Tier 4

Integrase Inhibitors raltegravir ISENTRESS Tier 4

Non-nucleoside Reverse Transcriptase Inhibitors nevirapine Tier 1 VIRAMUNE Tier 4 delavirdine RESCRIPTOR Tier 4 efavirenz SUSTIVA Tier 4 etravirine INTELENCE Tier 4 nevirapine ext-rel VIRAMUNE XR Tier 4 rilpivirine EDURANT Tier 4

Nucleoside Reverse Transcriptase Inhibitors didanosine delayed-rel Tier 1 VIDEX EC Tier 4 lamivudine Tier 1 EPIVIR Tier 4 stavudine Tier 1 ZERIT Tier 4 zidovudine Tier 1 RETROVIR Tier 4 abacavir ZIAGEN Tier 4 didanosine soln VIDEX soln Tier 4 emtricitabine EMTRIVA Tier 4

Nucleotide Reverse Transcriptase Inhibitors tenofovir VIREAD Tier 4

Protease Inhibitors atazanavir REYATAZ Tier 4 darunavir PREZISTA Tier 4 fosamprenavir LEXIVA Tier 4 indinavir CRIXIVAN Tier 4 lopinavir/ritonavir KALETRA Tier 4 nelfinavir VIRACEPT Tier 4 ritonavir NORVIR Tier 4

saquinavir mesylate INVIRASE Tier 4 tipranavir APTIVUS Tier 4

ANTITUBERCULAR AGENTS ethambutol Tier 1 MYAMBUTOL Tier 3 isoniazid Tier 1 pyrazinamide Tier 1 rifampin Tier 1 RIFADIN Tier 3 rifabutin MYCOBUTIN Tier 2 rifampin/isoniazid/pyrazinamide RIFATER Tier 2 rifapentine PRIFTIN Tier 2

ANTIVIRALS Cytomegalovirus Agents foscarnet Tier 1 ganciclovir Tier 1 ganciclovir inj Tier 1 CYTOVENE inj Tier 4 cidofovir VISTIDE Tier 2 PA valganciclovir VALCYTE Tier 2 cytomegalovirus immune globulin CYTOGAM Tier 4

Hepatitis Agents Hepatitis B adefovir dipivoxil HEPSERA Tier 4 entecavir BARACLUDE Tier 4 lamivudine EPIVIR-HBV Tier 4 telbivudine TYZEKA Tier 4

Hepatitis C PA ribavirin caps Tier 1 REBETOL Tier 4 PA ribavirin caps - Ribasphere Tier 1 PA ribavirin tabs Tier 1 COPEGUS Tier 4 PA ribavirin tabs - Ribapak Tier 1 PA ribavirin tabs - Ribatab Tier 1 PA boceprevir VICTRELIS Tier 4 PA ribavirin oral soln REBETOL Tier 4 PA telaprevir INCIVEK Tier 4

Herpes Agents acyclovir caps, susp, tabs Tier 1 ZOVIRAX Tier 3 famciclovir Tier 1 FAMVIR Tier 3 valacyclovir Tier 1 VALTREX Tier 3

Influenza Agents amantadine, except tabs Tier 1 rimantadine Tier 1 FLUMADINE Tier 3 oseltamivir TAMIFLU Tier 2 zanamivir RELENZA Tier 2

Respiratory Syncytial Virus Agents palivizumab SYNAGIS Tier 4

MISCELLANEOUS aztreonam Tier 1 AZACTAM Tier 3 clindamycin Tier 1 CLEOCIN Tier 3 dapsone Tier 1 mebendazole Tier 1

meropenem Tier 1 MERREM Tier 3 methenamine hippurate, prophylaxis Tier 1 HIPREX Tier 3 metronidazole tabs Tier 1 FLAGYL Tier 3 nitrofurantoin ext-rel Tier 1 MACROBID Tier 3 nitrofurantoin macrocrystals Tier 1 MACRODANTIN Tier 3 sulfamethoxazole/trimethoprim Tier 1 sulfamethoxazole/trimethoprim DS Tier 1 tinidazole Tier 1 TINDAMAX Tier 3 trimethoprim Tier 1 vancomycin Tier 1 VANCOCIN Tier 3 atovaquone MEPRON Tier 2 daptomycin CUBICIN Tier 2 ertapenem INVANZ Tier 2 imipenem/cilastatin PRIMAXIN Tier 2 linezolid ZYVOX Tier 2 nitazoxanide ALINIA Tier 2 rifaximin XIFAXAN Tier 2 doripenem DORIBAX Tier 3 telavancin VIBATIV Tier 3 tigecycline TYGACIL Tier 3

ANTINEOPLASTIC AGENTS Clinical practice guidelines in oncology are available at: http://www.asco.org http://www.nccn.org

ALKYLATING AGENTS cyclophosphamide Tier 1 ifosfamide/mesna Tier 1 cyclophosphamide inj Tier 4 thiotepa Tier 4 altretamine HEXALEN Tier 2 busulfan MYLERAN Tier 2 chlorambucil LEUKERAN Tier 2 lomustine CEENU Tier 2 bendamustine TREANDA Tier 4 bulsulfan BUSULFEX Tier 4 carmustine BICNU Tier 4 carmustine GLIADEL WAFER Tier 4 mechlorethamine MUSTARGEN Tier 4 melphalan ALKERAN Tier 4 streptozocin ZANOSAR Tier 4 temozolomide TEMODAR Tier 4

ANTIMETABOLITES cladribine Tier 1 cytarabine Tier 1 floxuridine Tier 1 fludarabine Tier 1 FLUDARA Tier 4 gemcitabine Tier 1 GEMZAR Tier 4 mercaptopurine Tier 1 PURINETHOL Tier 3 thioguanine Tier 1 capecitabine XELODA Tier 4 clofarabine CLOLAR Tier 4 cytarabine liposome DEPOCYT Tier 4 pemetrexed ALIMTA Tier 4

pentostatin NIPENT Tier 4 pralatrexate FOLOTYN Tier 4 rasburicase ELITEK Tier 4

HORMONAL ANTINEOPLASTIC AGENTS Antiandrogens bicalutamide Tier 1 CASODEX Tier 3 flutamide Tier 1 nilutamide NILANDRON Tier 2 abiraterone ZYTIGA Tier 4

Antiestrogens tamoxifen Tier 1 toremifene FARESTON Tier 2 fulvestrant FASLODEX Tier 4

Aromatase Inhibitors anastrozole Tier 1 ARIMIDEX Tier 3 exemestane Tier 1 AROMASIN Tier 2 letrozole Tier 1 FEMARA Tier 2

Gonadotropin-Releasing Hormone (GnRH) Antagonists degarelix acetate FIRMAGON Tier 4

Luteinizing Hormone-releasing Hormone (LHRH) Agonists leuprolide acetate Tier 1 goserelin acetate ZOLADEX Tier 4 histrelin acetate VANTAS Tier 4 PA leuprolide acetate ELIGARD Tier 4 PA leuprolide acetate LUPRON DEPOT Tier 4 PA leuprolide acetate LUPRON DEPOT-PED Tier 4 triptorelin pamoate TRELSTAR Tier 4 triptorelin pamoate TRELSTAR DEPOT Tier 4 triptorelin pamoate TRELSTAR LA Tier 4

Progestins megestrol acetate Tier 1 MEGACE Tier 3 megestrol acetate susp MEGACE ES Tier 2

IMMUNOMODULATORS lenalidomide REVLIMID Tier 4 thalidomide THALOMID Tier 4

KINASE INHIBITORS PA vandetanib CAPRELSA Tier 2 axitinib INLYTA Tier 4 PA crizotinib XALKORI Tier 4 dasatinib SPRYCEL Tier 4 erlotinib TARCEVA Tier 4 everolimus AFINITOR Tier 4 imatinib mesylate GLEEVEC Tier 4 lapatinib TYKERB Tier 4 nilotinib TASIGNA Tier 4 pazopanib VOTRIENT Tier 4 PA ruxolitinib JAKAFI Tier 4 sorafenib NEXAVAR Tier 4 sunitinib SUTENT Tier 4

temsirolimus TORISEL Tier 4 PA vemurafenib ZELBORAF Tier 4

TOPOISOMERASE INHIBITORS topotecan inj Tier 1 HYCAMTIN inj Tier 4 topotecan HYCAMTIN Tier 4

MISCELLANEOUS amifostine Tier 1 ETHYOL Tier 4 bleomycin sulfate Tier 1 carboplatin Tier 1 cisplatin Tier 1 dactinomycin Tier 1 COSMEGEN Tier 4 dexrazoxane Tier 1 TOTECT Tier 4 dexrazoxane Tier 1 ZINECARD Tier 4 etoposide Tier 1 hydroxyurea Tier 1 HYDREA Tier 3 irinotecan Tier 1 CAMPTOSAR Tier 4 leucovorin calcium Tier 1 mesna inj Tier 1 MESNEX inj Tier 3 mitomycin Tier 1 mitoxantrone Tier 1 vincristine Tier 1 vinorelbine Tier 1 NAVELBINE Tier 4 epirubicin Tier 4 vinblastine Tier 4 mitotane LYSODREN Tier 2 procarbazine MATULANE Tier 2 PA sipuleucel-T PROVENGE Tier 2 aldesleukin PROLEUKIN Tier 4 PA alemtuzumab CAMPATH Tier 4 arsenic trioxide TRISENOX Tier 4 asparaginase ELSPAR Tier 4 PA asparaginase Erwinia chrysanthemi ERWINAZE Tier 4 azacitidine VIDAZA Tier 4 BCG live vaccine THERACYS Tier 4 BCG live vaccine TICE BCG Tier 4 PA bevacizumab AVASTIN Tier 4 bexarotene caps TARGRETIN caps Tier 4 bortezomib VELCADE Tier 4 PA brentuximab vedotin ADCETRIS Tier 4 cabazitaxel JEVTANA Tier 4 cetuximab ERBITUX Tier 4 daunorubicin CERUBIDINE Tier 4 daunorubicin citrate liposomal DAUNOXOME Tier 4 decitabine DACOGEN Tier 4 denileukin diftitox ONTAK Tier 4 docetaxel TAXOTERE Tier 4 doxorubicin liposomal DOXIL Tier 4 epirubicin ELLENCE Tier 4 eribulin HALAVEN Tier 4 etoposide phosphate ETOPOPHOS Tier 4 PA ipilimumab YERVOY Tier 4 ixabepilone IXEMPRA Tier 4 levoleucovorin calcium FUSILEV Tier 4 mesna tabs 400 mg MESNEX Tier 4 methoxsalen inj UVADEX Tier 4

nelarabine ARRANON Tier 4 PA ofatumumab ARZERRA Tier 4 oxaliplatin ELOXATIN Tier 4 paclitaxel protein-bound particles ABRAXANE Tier 4 panitumumab VECTIBIX Tier 4 pegaspargase ONCASPAR Tier 4 porfimer sodium PHOTOFRIN Tier 4 PA rituximab RITUXAN Tier 4 romidepsin ISTODAX Tier 4 samarium sm 153 lexidronam QUADRAMET Tier 4 teniposide VUMON Tier 4 tositumomab BEXXAR Tier 4 PA trastuzumab HERCEPTIN Tier 4 valrubicin VALSTAR Tier 4 vismodegib ERIVEDGE Tier 4 PA vorinostat ZOLINZA Tier 4

CARDIOVASCULAR The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure is available at: http://www.nhlbi.nih.gov/guidelines/hypertension

Guidelines for the evaluation and management of cardiovascular diseases in adults are available at: http://www.acc.org http://www.americanheart.org http://www.heartfailureguideline.org

ACE INHIBITORS Guidelines for the use of ACE inhibitors are available at: http://professional.diabetes.org http://www.acc.org http://www.americanheart.org http://www.nhlbi.nih.gov/guidelines/hypertension

benazepril Tier 1 LOTENSIN Tier 3 enalapril Tier 1 VASOTEC Tier 3 fosinopril Tier 1 lisinopril Tier 1 PRINIVIL Tier 3 lisinopril Tier 1 ZESTRIL Tier 3 perindopril Tier 1 ACEON Tier 3 quinapril Tier 1 ACCUPRIL Tier 3 ramipril Tier 1 ALTACE Tier 3 trandolapril Tier 1 MAVIK Tier 3

ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS benazepril/amlodipine Tier 1 LOTREL Tier 3 trandolapril/verapamil ext-rel TARKA Tier 3

ACE INHIBITOR/DIURETIC COMBINATIONS benazepril/hydrochlorothiazide Tier 1 LOTENSIN HCT Tier 3 captopril/hydrochlorothiazide Tier 1 enalapril/hydrochlorothiazide Tier 1 VASERETIC Tier 3 fosinopril/hydrochlorothiazide Tier 1 lisinopril/hydrochlorothiazide Tier 1 PRINZIDE Tier 3 lisinopril/hydrochlorothiazide Tier 1 ZESTORETIC Tier 3 quinapril/hydrochlorothiazide Tier 1 ACCURETIC Tier 3

ADRENOLYTICS, CENTRAL clonidine Tier 1 CATAPRES Tier 3 clonidine transdermal Tier 1 CATAPRES-TTS Tier 3

ALDOSTERONE RECEPTOR ANTAGONISTS eplerenone Tier 1 INSPRA Tier 3 spironolactone Tier 1 ALDACTONE Tier 3

ALPHA BLOCKERS Guidelines for the use of alpha blockers in various patient populations are available at: http://www.nhlbi.nih.gov/guidelines/hypertension

doxazosin Tier 1 CARDURA Tier 3 prazosin Tier 1 MINIPRESS Tier 3 terazosin Tier 1

ANGIOTENSIN II RECEPTOR ANTAGONISTS/DIURETIC COMBINATIONS Guidelines for the use of angiotensin II receptor antagonists in various patient populations are available at: http://professional.diabetes.org http://www.nhlbi.nih.gov/guidelines/hypertension

eprosartan Tier 1 TEVETEN Tier 3 irbesartan Tier 1 AVAPRO Tier 3 irbesartan/hydrochlorothiazide Tier 1 AVALIDE Tier 3 losartan Tier 1 COZAAR Tier 3 losartan/hydrochlorothiazide Tier 1 HYZAAR Tier 3 olmesartan BENICAR Tier 2 olmesartan/hydrochlorothiazide BENICAR HCT Tier 2 telmisartan MICARDIS Tier 2 telmisartan/hydrochlorothiazide MICARDIS HCT Tier 2 valsartan DIOVAN Tier 2 valsartan/hydrochlorothiazide DIOVAN HCT Tier 2 azilsartan EDARBI Tier 3 eprosartan/hydrochlorothiazide TEVETEN HCT Tier 3

ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER COMBINATIONS amlodipine/olmesartan AZOR Tier 2 amlodipine/telmisartan TWYNSTA Tier 2 amlodipine/valsartan EXFORGE Tier 2

ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER/DIURETIC COMBINATIONS amlodipine/valsartan/hydrochlorothiazide EXFORGE HCT Tier 2 olmesartan/amlodipine/hydrochlorothiazide TRIBENZOR Tier 3

ANTIARRHYTHMICS Guidelines for the use of antiarrhythmics and cardiac glycosides in various patient populations are available at: http://www.acc.org

amiodarone Tier 1 CORDARONE Tier 3 disopyramide Tier 1 NORPACE Tier 3 flecainide Tier 1 TAMBOCOR Tier 3 mexiletine Tier 1 propafenone ext-rel Tier 1 RYTHMOL SR Tier 3 quinidine gluconate ext-rel Tier 1 quinidine sulfate ext-rel Tier 1 sotalol Tier 1 BETAPACE Tier 3 disopyramide ext-rel NORPACE CR Tier 2

dronedarone MULTAQ Tier 2 dofetilide TIKOSYN Tier 4

ANTILIPEMICS The Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) is available at: http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm

Antilipemic Combinations ezetimibe/simvastatin VYTORIN Tier 3

Bile Acid Resins cholestyramine pkt Tier 1 QUESTRAN/QUESTRAN LIGHT Tier 3 colestipol Tier 1 COLESTID Tier 3 colesevelam WELCHOL Tier 2

Cholesterol Absorption Inhibitors ezetimibe ZETIA Tier 2

Fibrates gemfibrozil Tier 1 LOPID Tier 3 fenofibrate LIPOFEN Tier 2 fenofibrate, micronized ANTARA Tier 2 fenofibrate, micronized TRICOR Tier 2 fenofibric acid TRILIPIX Tier 2

HMG-CoA Reductase Inhibitors atorvastatin Tier 1 LIPITOR Tier 3 fluvastatin Tier 1 LESCOL Tier 3 lovastatin Tier 1 MEVACOR Tier 3 pravastatin Tier 1 PRAVACHOL Tier 3 simvastatin Tier 1 ZOCOR Tier 3 rosuvastatin CRESTOR Tier 2 fluvastatin ext-rel LESCOL XL Tier 3 pitavastatin LIVALO Tier 3

Niacins/Combinations niacin ext-rel NIASPAN Tier 2 niacin ext-rel/lovastatin ADVICOR Tier 2 niacin ext-rel/simvastatin SIMCOR Tier 2

Omega-3 Fatty Acids omega-3 acid ethyl esters LOVAZA Tier 3

BETA-BLOCKERS Guidelines for the use of beta-blockers and beta-blocker combinations in various patient populations are available at: http://www.acc.org http://www.nhlbi.nih.gov/guidelines/hypertension

acebutolol Tier 1 SECTRAL Tier 3 atenolol Tier 1 TENORMIN Tier 3 carvedilol Tier 1 COREG Tier 3 metoprolol Tier 1 LOPRESSOR Tier 3 metoprolol ext-rel Tier 1 TOPROL-XL Tier 3 pindolol Tier 1 propranolol Tier 1 propranolol ext-rel Tier 1 INDERAL LA Tier 3

carvedilol phosphate ext-rel COREG CR Tier 2 esmolol BREVIBLOC Tier 2 nebivolol BYSTOLIC Tier 2 penbutolol LEVATOL Tier 2 propranolol ext-rel INNOPRAN XL Tier 2

BETA-BLOCKER/DIURETIC COMBINATIONS Guidelines for the use of beta-blockers and diuretic combinations in various patient populations are available at: http://www.acc.org http://www.nhlbi.nih.gov/guidelines/hypertension

atenolol/chlorthalidone Tier 1 TENORETIC Tier 3 bisoprolol/hydrochlorothiazide Tier 1 ZIAC Tier 3 metoprolol/hydrochlorothiazide Tier 1 LOPRESSOR HCT Tier 3 metoprolol succinate ext-rel/ DUTOPROL Tier 3 hydrochlorothiazide

CALCIUM CHANNEL BLOCKERS Dihydropyridines amlodipine Tier 1 NORVASC Tier 3 felodipine ext-rel Tier 1 nicardipine Tier 1 nifedipine ext-rel Tier 1 ADALAT CC Tier 3 nifedipine ext-rel Tier 1 PROCARDIA XL Tier 3 nimodipine Tier 1 NIMOTOP Tier 3 nisoldipine ext-rel Tier 1 SULAR Tier 2 isradipine ext-rel DYNACIRC CR Tier 2 nicardipine ext-rel CARDENE SR Tier 3

Nondihydropyridines diltiazem Tier 1 CARDIZEM Tier 3 diltiazem ext-rel Tier 1 DILACOR XR Tier 3 diltiazem ext-rel Tier 1 TIAZAC Tier 3 diltiazem ext-rel 360 mg Tier 1 CARDIZEM CD Tier 2 diltiazem ext-rel, except 360 mg Tier 1 CARDIZEM CD Tier 3 verapamil Tier 1 CALAN Tier 3 verapamil ext-rel Tier 1 CALAN SR Tier 3 verapamil ext-rel COVERA-HS Tier 2

CALCIUM CHANNEL BLOCKER/ANTILIPEMIC COMBINATIONS amlodipine/atorvastatin Tier 1 CADUET Tier 3

DIGITALIS GLYCOSIDES digoxin Tier 1 LANOXIN Tier 2

DIRECT RENIN INHIBITORS/DIURETIC COMBINATIONS aliskiren TEKTURNA Tier 2 aliskiren/hydrochlorothiazide TEKTURNA HCT Tier 2

DIRECT RENIN INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS aliskiren/amlodipine TEKAMLO Tier 3

DIURETICS Carbonic Anhydrase Inhibitors acetazolamide Tier 1 acetazolamide ext-rel Tier 1 DIAMOX SEQUELS Tier 3 methazolamide Tier 1

Loop Diuretics bumetanide Tier 1 furosemide Tier 1 LASIX Tier 3 torsemide Tier 1 DEMADEX Tier 3 ethacrynic acid EDECRIN Tier 3

Potassium-sparing Diuretics amiloride Tier 1

Thiazides and Thiazide-like Diuretics chlorthalidone Tier 1 hydrochlorothiazide Tier 1 indapamide Tier 1 metolazone Tier 1 ZAROXOLYN Tier 3

Diuretic Combinations amiloride/hydrochlorothiazide Tier 1 spironolactone/hydrochlorothiazide Tier 1 ALDACTAZIDE Tier 3 triamterene/hydrochlorothiazide Tier 1 DYAZIDE Tier 3 triamterene/hydrochlorothiazide Tier 1 MAXZIDE Tier 3 triamterene/hydrochlorothiazide 37.5/25 Tier 1 MAXZIDE-25 Tier 3 triamterene/hydrochlorothiazide 50/25 Tier 1

NITRATES Oral isosorbide dinitrate oral Tier 1 ISORDIL Tier 3 isosorbide mononitrate Tier 1 isosorbide mononitrate ext-rel Tier 1 IMDUR Tier 3

Sublingual nitroglycerin sublingual spray Tier 1 NITROLINGUAL Tier 3 nitroglycerin sublingual NITROSTAT Tier 2

Transdermal nitroglycerin transdermal Tier 1 nitroglycerin transdermal Tier 1 NITRO-DUR Tier 3

NITRATE/VASODILATOR COMBINATIONS isosorbide dinitrate/hydralazine BIDIL Tier 2

PULMONARY ARTERIAL HYPERTENSION Endothelin Receptor Antagonists PA ambrisentan LETAIRIS Tier 4 PA bosentan TRACLEER Tier 4

Phosphodiesterase Inhibitors PA sildenafil REVATIO Tier 4 PA tadalafil ADCIRCA Tier 4

Prostaglandin Vasodilators PA epoprostenol sodium FLOLAN Tier 2 PA iloprost VENTAVIS Tier 4 PA treprostinil REMODULIN Tier 4 PA treprostinil TYVASO Tier 4

MISCELLANEOUS hydralazine Tier 1

midodrine Tier 1 minoxidil Tier 1 ranolazine ext-rel RANEXA Tier 2

CENTRAL NERVOUS SYSTEM Practice guidelines for psychiatric disorders are available at: http://www.psych.org

ANTIANXIETY Benzodiazepines alprazolam Tier 1 XANAX Tier 3 alprazolam ext-rel Tier 1 XANAX XR Tier 3 chlordiazepoxide Tier 1 clonazepam tabs Tier 1 KLONOPIN Tier 3 clorazepate Tier 1 TRANXENE T-TAB Tier 3 diazepam Tier 1 VALIUM Tier 3 lorazepam Tier 1 ATIVAN Tier 3 oxazepam Tier 1

Miscellaneous buspirone Tier 1 clomipramine Tier 1 ANAFRANIL Tier 3 fluvoxamine Tier 1 hydroxyzine HCl Tier 1 hydroxyzine pamoate Tier 1 VISTARIL Tier 3 fluvoxamine ext-rel LUVOX CR Tier 2

ANTICONVULSANTS Practice guidelines for the treatment of epilepsy are available at: http://www.aan.com

carbamazepine Tier 1 TEGRETOL Tier 3 carbamazepine ext-rel Tier 1 TEGRETOL-XR Tier 3 diazepam rectal gel Tier 1 DIASTAT Tier 3 divalproex sodium delayed-rel Tier 1 DEPAKOTE Tier 3 ethosuximide Tier 1 ZARONTIN Tier 3 felbamate Tier 1 FELBATOL Tier 3 gabapentin Tier 1 NEURONTIN Tier 3 lamotrigine Tier 1 LAMICTAL Tier 2 levetiracetam Tier 1 KEPPRA Tier 3 levetiracetam ext-rel Tier 1 KEPPRA XR Tier 2 oxcarbazepine Tier 1 TRILEPTAL Tier 3 phenobarbital Tier 1 phenytoin sodium extended Tier 1 DILANTIN Tier 3 primidone Tier 1 MYSOLINE Tier 3 topiramate Tier 1 TOPAMAX Tier 3 valproic acid Tier 1 DEPAKENE Tier 3 zonisamide Tier 1 ZONEGRAN Tier 3 carbamazepine EQUETRO Tier 2 ezogabine POTIGA Tier 2 lacosamide VIMPAT Tier 2 lamotrigine ext-rel LAMICTAL XR Tier 2 lamotrigine orally disintegrating tablets LAMICTAL ODT Tier 2 oxcarbazepine susp TRILEPTAL susp Tier 2 phenytoin DILANTIN INFATABS Tier 2 pregabalin LYRICA Tier 2

rufinamide BANZEL Tier 2 tiagabine GABITRIL Tier 2 valproic acid delayed-rel STAVZOR Tier 2 clobazam ONFI Tier 3 vigabatrin SABRIL Tier 4

ANTIDEMENTIA Practice guidelines for the management of dementia are available at: http://www.aan.com

donepezil Tier 1 ARICEPT (except 23 mg) Tier 3 donepezil orally disintegrating tabs Tier 1 ARICEPT ODT Tier 3 galantamine Tier 1 RAZADYNE Tier 3 galantamine ext-rel Tier 1 RAZADYNE ER Tier 3 rivastigmine Tier 1 EXELON Tier 3 memantine NAMENDA Tier 2 rivastigmine transdermal EXELON PATCH Tier 2 donepezil ARICEPT 23 mg Tier 3

ANTIDEPRESSANTS Although these agents are primarily indicated for depression, some of these are also approved for other indications, including bipolar disorder, obsessive-compulsive disorder, panic disorder, and premenstrual dysphoric disorder.

Guidelines for the evaluation and management of bipolar and depressive disorders are available at: http://www.psych.org

Monoamine Oxidase Inhibitors (MAOIs) phenelzine Tier 1 NARDIL Tier 3 tranylcypromine Tier 1 PARNATE Tier 3 selegiline transdermal EMSAM Tier 2 isocarboxazid MARPLAN Tier 3

Selective Serotonin Reuptake Inhibitors (SSRIs) citalopram Tier 1 CELEXA Tier 3 escitalopram Tier 1 LEXAPRO Tier 3 fluoxetine Tier 1 PROZAC Tier 3 fluoxetine delayed-rel Tier 1 PROZAC WEEKLY Tier 3 paroxetine HCl Tier 1 PAXIL Tier 3 paroxetine HCl ext-rel Tier 1 PAXIL CR Tier 3 sertraline Tier 1 ZOLOFT Tier 3 fluoxetine SARAFEM Tier 3 paroxetine mesylate PEXEVA Tier 3 vilazodone VIIBRYD Tier 3

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)* * Indicates the proposed mechanism of action, based on the American Psychiatric Association Summary of Treatment Recommendations.

venlafaxine Tier 1 venlafaxine ext-rel Tier 1 EFFEXOR XR Tier 3 venlafaxine ext-rel tabs Tier 1 duloxetine delayed-rel CYMBALTA Tier 2 desvenlafaxine ext-rel PRISTIQ Tier 3

Tricyclic Antidepressants (TCAs) amitriptyline Tier 1 desipramine Tier 1 NORPRAMIN Tier 3

doxepin Tier 1 imipramine HCl Tier 1 TOFRANIL Tier 3 imipramine pamoate Tier 1 TOFRANIL-PM Tier 3 nortriptyline Tier 1 PAMELOR Tier 3 protriptyline Tier 1 VIVACTIL Tier 3

Miscellaneous Agents amitriptyline/perphenazine Tier 1 bupropion Tier 1 WELLBUTRIN Tier 3 bupropion ext-rel Tier 1 WELLBUTRIN SR Tier 3 bupropion ext-rel Tier 1 WELLBUTRIN XL Tier 3 mirtazapine Tier 1 REMERON Tier 3 nefazodone Tier 1 trazodone Tier 1 trazodone ext-rel OLEPTRO Tier 2

ANTIPARKINSONIAN AGENTS Practice guidelines for the diagnosis and treatment of Parkinson's disease are available at: http://www.aan.com

amantadine, except tabs Tier 1 benztropine Tier 1 bromocriptine Tier 1 PARLODEL Tier 3 carbidopa/levodopa Tier 1 PARCOPA Tier 3 carbidopa/levodopa Tier 1 SINEMET Tier 3 carbidopa/levodopa ext-rel Tier 1 SINEMET CR Tier 3 carbidopa/levodopa/entacapone Tier 1 STALEVO Tier 3 diphenhydramine Tier 1 pramipexole Tier 1 MIRAPEX Tier 3 ropinirole Tier 1 REQUIP Tier 3 ropinirole ext-rel Tier 1 REQUIP XL Tier 2 selegiline caps Tier 1 ELDEPRYL Tier 3 trihexyphenidyl Tier 1 entacapone COMTAN Tier 2 pramipexole ext-rel MIRAPEX ER Tier 2 rasagiline mesylate AZILECT Tier 2 selegiline orally disintegrating tabs ZELAPAR Tier 2 tolcapone TASMAR Tier 2 apomorphine APOKYN Tier 4

ANTIPSYCHOTICS Atypicals clozapine Tier 1 CLOZARIL Tier 3 olanzapine Tier 1 ZYPREXA/ZYPREXA ZYDIS Tier 2 olanzapine/fluoxetine Tier 1 SYMBYAX Tier 3 quetiapine Tier 1 SEROQUEL Tier 3 risperidone Tier 1 RISPERDAL Tier 3 ziprasidone Tier 1 GEODON Tier 2 aripiprazole ABILIFY Tier 2 clozapine FAZACLO Tier 2 paliperidone palmitate INVEGA SUSTENNA Tier 2 quetiapine ext-rel SEROQUEL XR Tier 2 risperidone long-acting inj RISPERDAL CONSTA Tier 2 asenapine SAPHRIS Tier 3 iloperidone FANAPT Tier 3 lurasidone LATUDA Tier 3 olanzapine pamoate ZYPREXA RELPREVV Tier 3

paliperidone ext-rel INVEGA Tier 3

Miscellaneous fluphenazine Tier 1 haloperidol Tier 1 loxapine Tier 1 LOXITANE Tier 3 perphenazine Tier 1 thioridazine Tier 1 thiothixene Tier 1 NAVANE Tier 3 trifluoperazine Tier 1

ATTENTION DEFICIT HYPERACTIVITY DISORDER Guidelines for the evaluation and management of attention deficit disorder are available at: http://www.aacap.org http://www.aap.org

PA amphetamine/dextroamphetamine Tier 1 ADDERALL Tier 2 mixed salts PA amphetamine/dextroamphetamine Tier 1 ADDERALL XR Tier 2 mixed salts ext-rel PA dexmethylphenidate Tier 1 FOCALIN Tier 3 PA dextroamphetamine Tier 1 PA dextroamphetamine ext-rel Tier 1 DEXEDRINE SPANSULE Tier 3 PA methylphenidate Tier 1 RITALIN Tier 2 PA methylphenidate ext-rel Tier 1 CONCERTA Tier 2 PA methylphenidate ext-rel Tier 1 RITALIN LA Tier 2 PA methylphenidate ext-rel Tier 1 RITALIN-SR Tier 2 atomoxetine STRATTERA Tier 2 PA dexmethylphenidate ext-rel FOCALIN XR Tier 2 guanfacine ext-rel INTUNIV Tier 2 PA lisdexamfetamine VYVANSE Tier 2 PA methylphenidate ext-rel METADATE CD Tier 2 PA methylphenidate transdermal DAYTRANA Tier 2 clonidine ext-rel KAPVAY Tier 3

FIBROMYALGIA milnacipran SAVELLA Tier 3

HUNTINGTON'S DISEASE AGENTS PA tetrabenazine XENAZINE Tier 4

HYPNOTICS Practice parameters for the treatment of sleep disorders and clinical guidelines for the evaluation and management of chronic insomnia in adults are available at: http://www.aasmnet.org

Benzodiazepines estazolam Tier 1 flurazepam Tier 1 temazepam Tier 1 RESTORIL Tier 3 quazepam DORAL Tier 3

Nonbenzodiazepines chloral hydrate Tier 1 zaleplon Tier 1 SONATA Tier 3 zolpidem Tier 1 AMBIEN Tier 3 zolpidem ext-rel Tier 1 AMBIEN CR Tier 3

butabarbital BUTISOL SODIUM Tier 3 chloral hydrate SOMNOTE Tier 3 ramelteon ROZEREM Tier 3 secobarbital SECONAL Tier 3 zolpidem sublingual EDLUAR Tier 3

Tricyclics doxepin SILENOR Tier 3

MIGRAINE Guidelines for prevention and management of migraine headaches are available at: http://www.aan.com

Ergotamine Derivatives dihydroergotamine inj Tier 1 D.H.E. 45 Tier 3 ergotamine/caffeine Tier 1 CAFERGOT Tier 3 ergotamine/caffeine supp MIGERGOT Tier 2

Selective Serotonin Agonists naratriptan Tier 1 AMERGE Tier 3 sumatriptan Tier 1 IMITREX Tier 3 rizatriptan MAXALT/MAXALT-MLT Tier 2 zolmitriptan ZOMIG/ZOMIG-ZMT Tier 2 frovatriptan FROVA Tier 3

Selective Serotonin Agonist/Nonsteroidal Anti-inflammatory Drug (NSAID) Combinations sumatriptan/naproxen sodium TREXIMET Tier 3

Miscellaneous d acetaminophen/dichloralphenazone/ Tier 1 isometheptene

MOOD STABILIZERS lithium carbonate Tier 1 lithium carbonate ext-rel tabs 300 mg Tier 1 LITHOBID Tier 3 lithium carbonate ext-rel tabs 450 mg Tier 1

MULTIPLE SCLEROSIS Practice guidelines for multiple sclerosis are available at: http://www.aan.com

dalfampridine ext-rel AMPYRA Tier 4 PA fingolimod GILENYA Tier 4 glatiramer COPAXONE Tier 4 interferon beta-1a AVONEX Tier 4 interferon beta-1a REBIF Tier 4 interferon beta-1b BETASERON Tier 4 interferon beta-1b EXTAVIA Tier 4 natalizumab TYSABRI Tier 4

MUSCULOSKELETAL THERAPY AGENTS baclofen Tier 1 cyclobenzaprine Tier 1 FLEXERIL Tier 3 cyclobenzaprine ext-rel Tier 1 AMRIX Tier 3 dantrolene Tier 1 DANTRIUM Tier 3 baclofen intrathecal LIORESAL INTRATHECAL Tier 2

MYASTHENIA GRAVIS pyridostigmine tabs 60 mg Tier 1 MESTINON Tier 3 pyridostigmine ext-rel tabs 180 mg MESTINON TIMESPAN Tier 2 pyridostigmine syrup MESTINON syrup Tier 2

NARCOLEPSY/CATAPLEXY PA modafinil Tier 1 PROVIGIL Tier 3 sodium oxybate XYREM Tier 2 PA armodafinil NUVIGIL Tier 3

PSYCHOTHERAPEUTIC-MISCELLANEOUS Alcohol Deterrents disulfiram Tier 1 ANTABUSE Tier 2 naltrexone Tier 1 REVIA Tier 3 acamprosate calcium CAMPRAL Tier 3 naltrexone microspheres VIVITROL Tier 4

Opioid Antagonists naloxone inj Tier 1

Partial Opioid Agonists/Combinations buprenorphine Tier 1 buprenorphine/naloxone SUBOXONE Tier 2

Pseudobulbar Affect dextromethorphan/quinidine NUEDEXTA Tier 2

Smoking Deterrents bupropion ext-rel Tier 1 ZYBAN Tier 3 OTC nicotine transdermal Tier 1 varenicline CHANTIX Tier 2

MISCELLANEOUS Amyotrophic Lateral Sclerosis riluzole RILUTEK Tier 2

Botulinum Toxins PA abobotulinumtoxinA DYSPORT Tier 4 PA incobotulinumtoxinA XEOMIN Tier 4 PA onabotulinumtoxinA BOTOX Tier 4 PA rimabotulinumtoxinB MYOBLOC Tier 4

ENDOCRINE AND METABOLIC ANDROGENS Clinical practice guidelines for the treatment of hypogonadism are available at: http://www.aace.com

testosterone cypionate Tier 1 testosterone enanthate Tier 1 testosterone gel ANDROGEL Tier 2 testosterone transdermal ANDRODERM Tier 2 testosterone gel FORTESTA Tier 3 testosterone soln AXIRON Tier 3

ANTIDIABETICS Guidelines of treatment and management of diabetes are available at: http://professionals.diabetes.org

Alpha-glucosidase Inhibitors acarbose Tier 1 PRECOSE Tier 3 miglitol GLYSET Tier 2

Amylin Analogs pramlintide SYMLINPEN Tier 2

Biguanides metformin Tier 1 GLUCOPHAGE Tier 3 metformin ext-rel Tier 1 FORTAMET Tier 2 metformin ext-rel Tier 1 GLUCOPHAGE XR Tier 3 metformin soln RIOMET Tier 2

Biguanide/Sulfonylurea Combinations glipizide/metformin Tier 1 METAGLIP Tier 3 glyburide/metformin Tier 1 GLUCOVANCE Tier 3

Dipeptidyl Peptidase-4 (DPP-4) Inhibitors saxagliptin ONGLYZA Tier 2 sitagliptin phosphate JANUVIA Tier 2 linagliptin TRADJENTA Tier 3

Dipeptidyl Peptidase-4 (DPP-4) Inhibitor/Biguanide Combinations saxagliptin/metformin ext-rel KOMBIGLYZE XR Tier 2 sitagliptin/metformin JANUMET Tier 2 linagliptin/metformin JENTADUETO Tier 3 sitagliptin/metformin ext-rel JANUMET XR Tier 3

Dipeptidyl Peptidase-4 (DPP-4) Inhibitor/HMG-CoA Reductase Inhibitor Combinations sitagliptin/simvastatin JUVISYNC Tier 3

Incretin Mimetic Agents exenatide BYETTA Tier 2 liraglutide VICTOZA Tier 2

Insulins insulin aspart NOVOLOG Tier 2 insulin aspart protamine 70%/insulin NOVOLOG MIX 70/30 Tier 2 aspart 30% insulin detemir LEVEMIR Tier 2 insulin glargine LANTUS Tier 2 insulin glulisine APIDRA Tier 2 OTC insulin human HUMULIN R Tier 2 OTC insulin human NOVOLIN R Tier 2 OTC insulin isophane human HUMULIN N Tier 2 OTC insulin isophane human NOVOLIN N Tier 2 OTC insulin isophane human 70%/regular 30% HUMULIN 70/30 Tier 2 OTC insulin isophane human 70%/regular 30% NOVOLIN 70/30 Tier 2 insulin lispro HUMALOG Tier 2 insulin lispro protamine/insulin lispro HUMALOG MIX Tier 2

Insulin Sensitizers pioglitazone ACTOS Tier 2

rosiglitazone AVANDIA Tier 2

Insulin Sensitizer/Biguanide Combinations pioglitazone/metformin ACTOPLUS MET Tier 2 pioglitazone/metformin ext-rel ACTOPLUS MET XR Tier 2 rosiglitazone/metformin AVANDAMET Tier 2

Insulin Sensitizer/Sulfonylurea Combinations pioglitazone/glimepiride DUETACT Tier 2 rosiglitazone/glimepiride AVANDARYL Tier 2

Meglitinides nateglinide Tier 1 STARLIX Tier 3 repaglinide PRANDIN Tier 2

Meglitinide/Biguanide Combinations repaglinide/metformin PRANDIMET Tier 2

Sulfonylureas glimepiride Tier 1 AMARYL Tier 3 glipizide Tier 1 GLUCOTROL Tier 3 glipizide ext-rel Tier 1 GLUCOTROL XL Tier 3 glyburide Tier 1 DIABETA Tier 3 glyburide, micronized Tier 1 GLYNASE Tier 3

Supplies OTC blood glucose test strips ACCU-CHEK test strips Tier 2 OTC blood glucose test strips ONETOUCH test strips Tier 2 OTC insulin syringes BD INSULIN SYRINGES Tier 2 OTC lancet device SOFTCLIX LANCET DEVICE Tier 2 OTC lancet device SOFTTOUCH LANCET DEVICE Tier 2 OTC lancets ONETOUCH LANCETS Tier 2 OTC lancets SOFTCLIX LANCETS Tier 2 OTC lancets SOFTTOUCH LANCETS Tier 2 OTC urine test strips CHEMSTRIP K URINE KETONE STRIPS Tier 2 OTC urine test strips CHEMSTRIP UGK URINE GLUCOSE/ Tier 2 KETONE STRIPS OTC urine test strips CHEMSTRIP UG URINE GLUCOSE Tier 2 STRIPS

Miscellaneous bromocriptine CYCLOSET Tier 3

CALCIUM RECEPTOR ANTAGONISTS cinacalcet SENSIPAR Tier 4

CALCIUM REGULATORS Guidelines of treatment and management of osteoporosis are available at: http://www.aace.com http://www.nof.org

Bisphosphonates alendronate Tier 1 FOSAMAX Tier 3 etidronate Tier 1 DIDRONEL Tier 3 ibandronate Tier 1 BONIVA Tier 3 pamidronate Tier 1 alendronate/vitamin D3 FOSAMAX PLUS D Tier 2

ibandronate inj BONIVA inj Tier 2 risedronate ACTONEL Tier 2 tiludronate SKELID Tier 2 zoledronic acid RECLAST Tier 4 zoledronic acid ZOMETA Tier 4

Calcitonins calcitonin-salmon spray Tier 1 MIACALCIN Tier 3 calcitonin-salmon inj MIACALCIN inj Tier 3

Parathyroid Hormones teriparatide FORTEO Tier 4

Miscellaneous denosumab PROLIA Tier 4 denosumab XGEVA Tier 4

CONTRACEPTIVES EE = ethinyl estradiol ME = mestranol

Monophasic 20 mcg Estrogen drospirenone/EE 3/20 - Gianvi Tier 1 YAZ Tier 3 levonorgestrel/EE 0.1/20 Tier 1 norethindrone acetate/EE 1/20 Tier 1 LOESTRIN 1/20 Tier 3 norethindrone acetate/EE 1/20 and iron Tier 1 LOESTRIN FE 1/20 Tier 3 norethindrone acetate/EE 1/20 and iron LOESTRIN 24 FE Tier 2

30 mcg Estrogen desogestrel/EE 0.15/30 Tier 1 DESOGEN Tier 3 desogestrel/EE 0.15/30 Tier 1 ORTHO-CEPT Tier 3 drospirenone/EE 3/30 Tier 1 YASMIN Tier 3 levonorgestrel/EE 0.15/30 Tier 1 NORDETTE Tier 3 levonorgestrel/EE 0.15/30 - Levora Tier 1 norethindrone acetate/EE 1.5/30 Tier 1 LOESTRIN 1.5/30 Tier 3 norethindrone acetate/EE 1.5/30 and Tier 1 LOESTRIN FE 1.5/30 Tier 3 iron norgestrel/EE 0.3/30 Tier 1 LO/OVRAL Tier 3 norgestrel/EE 0.3/30 - Low-Ogestrel Tier 1

35 mcg Estrogen ethynodiol diacetate/EE 1/35 - Tier 1 Zovia 1/35 norethindrone/EE 0.4/35 Tier 1 OVCON 35 Tier 3 norethindrone/EE 0.5/35 Tier 1 BREVICON Tier 3 norethindrone/EE 0.5/35 Tier 1 MODICON Tier 3 norethindrone/EE 1/35 Tier 1 NORINYL 1+35 Tier 3 norethindrone/EE 1/35 Tier 1 ORTHO-NOVUM 1/35 Tier 3 norgestimate/EE 0.25/35 Tier 1 ORTHO-CYCLEN Tier 3

50 mcg Estrogen ethynodiol diacetate/EE 1/50 - Tier 1 Zovia 1/50 norethindrone/ME 1/50 Tier 1 NORINYL 1+50 Tier 3 norgestrel/EE 0.5/50 Tier 1 norethindrone/EE 1/50 OVCON 50 Tier 2

Biphasic desogestrel/EE Tier 1 MIRCETTE Tier 3 norethindrone/EE NECON 10/11 Tier 2

Triphasic desogestrel/EE Tier 1 CYCLESSA Tier 3 levonorgestrel/EE - Trivora Tier 1 norethindrone acetate/EE and iron Tier 1 ESTROSTEP FE Tier 3 norethindrone/EE Tier 1 ORTHO-NOVUM 7/7/7 Tier 3 norethindrone/EE Tier 1 TRI-NORINYL Tier 3 norgestimate/EE Tier 1 ORTHO TRI-CYCLEN Tier 3 norgestimate/EE ORTHO TRI-CYCLEN LO Tier 2

Four Phase estradiol valerate and dienogest/ NATAZIA Tier 2 estradiol valerate

Extended Cycle levonorgestrel/EE 0.1/20 and EE 10 Tier 1 LOSEASONIQUE Tier 3 levonorgestrel/EE 0.15/30 Tier 1 SEASONALE Tier 3 levonorgestrel/EE 0.15/30 and EE 10 Tier 1 SEASONIQUE Tier 2

Continuous levonorgestrel/EE 0.09/20 Tier 1 LYBREL Tier 2

Progestin Only norethindrone Tier 1 NOR-QD Tier 3 norethindrone Tier 1 ORTHO MICRONOR Tier 3

Emergency Contraception levonorgestrel - Next Choice Tier 1 ulipristal ELLA Tier 2

Implant etonogestrel implant IMPLANON Tier 4 etonogestrel implant NEXPLANON Tier 4

Injectable medroxyprogesterone acetate Tier 1 DEPO-PROVERA Tier 3 150 mg/mL

Progestin Intrauterine Device levonorgestrel releasing IUD MIRENA Tier 4

Transdermal norelgestromin/EE ORTHO EVRA Tier 2

Vaginal etonogestrel/EE ring NUVARING Tier 2

ENDOMETRIOSIS danazol Tier 1 PA nafarelin SYNAREL Tier 2

ESTROGENS Guidelines of treatment and management of hormone therapy and menopause are available at: http://www.menopause.org

Injectable estradiol valerate Tier 1 DELESTROGEN Tier 2

Oral estradiol Tier 1 ESTRACE Tier 3 estrogens, Tier 1 esterified/methyltestosterone estropipate Tier 1 estrogens, conjugated PREMARIN Tier 2 estrogens, conjugated, synthetic B ENJUVIA Tier 2

Transdermal estradiol Tier 1 CLIMARA Tier 3 estradiol VIVELLE-DOT Tier 2 estradiol transdermal gel ESTROGEL Tier 2 estradiol transdermal spray EVAMIST Tier 2 estradiol ALORA Tier 3

Vaginal estradiol vaginal crm ESTRACE Tier 2 estradiol vaginal ring FEMRING Tier 2 estradiol vaginal tabs VAGIFEM Tier 2 estrogens, conjugated crm PREMARIN crm Tier 2

ESTROGEN/PROGESTINS Oral EE/norethindrone acetate Tier 1 FEMHRT Tier 2 estradiol/norethindrone acetate Tier 1 ACTIVELLA Tier 3 estradiol/norgestimate PREFEST Tier 2 estrogens, PREMPHASE Tier 2 conjugated/medroxyprogesterone estrogens, PREMPRO Tier 2 conjugated/medroxyprogesterone

Transdermal estradiol/levonorgestrel CLIMARA PRO Tier 2 estradiol/norethindrone acetate COMBIPATCH Tier 3

FERTILITY REGULATORS PA chorionic gonadotropin Tier 1 PA clomiphene Tier 1 CLOMID Tier 3 PA gonadorelin LUTREPULSE Tier 2 PA cetrorelix CETROTIDE Tier 4 PA choriogonadotropin alfa OVIDREL Tier 4 PA follitropin alfa GONAL-F Tier 4 PA follitropin alfa GONAL-F RFF Tier 4 PA follitropin beta FOLLISTIM AQ Tier 4 PA ganirelix acetate GANIRELIX Tier 4 PA menotropins MENOPUR Tier 4 PA menotropins REPRONEX Tier 4 PA urofollitropin BRAVELLE Tier 4

GLUCOCORTICOIDS cortisone acetate Tier 1 dexamethasone Tier 1 fludrocortisone Tier 1 hydrocortisone Tier 1 CORTEF Tier 3 methylprednisolone Tier 1 MEDROL Tier 3 prednisolone Tier 1 prednisolone sodium phosphate Tier 1 ORAPRED Tier 3 prednisolone sodium phosphate Tier 1 PEDIAPRED Tier 3 prednisolone syrup Tier 1 PRELONE Tier 3 prednisone Tier 1 prednisolone sodium phosphate MILLIPRED Tier 2 prednisolone sodium phosphate orally ORAPRED ODT Tier 2 disintegrating tablet

GLUCOSE ELEVATING AGENTS diazoxide PROGLYCEM Tier 2 glucagon, human recombinant GLUCAGON EMERGENCY KIT Tier 2

HUMAN GROWTH HORMONES Guidelines for use of growth hormone are available at: http://www.aace.com

PA somatropin GENOTROPIN Tier 4 PA somatropin HUMATROPE Tier 4 PA somatropin NORDITROPIN Tier 4 PA somatropin NUTROPIN AQ NUSPIN Tier 4 PA somatropin NUTROPIN/NUTROPIN AQ Tier 4 PA somatropin OMNITROPE Tier 4 PA somatropin SAIZEN Tier 4 PA, * somatropin SEROSTIM Tier 4 PA somatropin TEV-TROPIN Tier 4 PA somatropin ZORBTIVE Tier 4

* Indicated for AIDS wasting only

HYPERPARATHYROID TREATMENT, VITAMIN D ANALOGS calcitriol (1,25-D3) Tier 1 ROCALTROL Tier 3 doxercalciferol HECTOROL Tier 2 paricalcitol ZEMPLAR Tier 2

INSULIN-LIKE GROWTH FACTOR-1 AGENTS PA mecasermin INCRELEX Tier 4

PHENYLKETONURIA TREATMENT AGENTS PA sapropterin KUVAN Tier 4

PHOSPHATE BINDER AGENTS calcium acetate Tier 1 PHOSLO Tier 3 lanthanum FOSRENOL Tier 2 sevelamer RENAGEL Tier 2 sevelamer carbonate RENVELA Tier 2

PROGESTINS Injectable hydroxyprogesterone caproate MAKENA Tier 4

Oral medroxyprogesterone acetate Tier 1 PROVERA Tier 3 norethindrone acetate Tier 1 AYGESTIN Tier 3 PA progesterone, micronized Tier 1 PROMETRIUM Tier 3

Vaginal PA progesterone supp ENDOMETRIN Tier 2

SELECTIVE ESTROGEN RECEPTOR MODULATORS raloxifene EVISTA Tier 2

THYROID AGENTS Antithyroid Agents methimazole Tier 1 TAPAZOLE Tier 3 propylthiouracil Tier 1

Thyroid Supplements levothyroxine Tier 1 SYNTHROID Tier 2 levothyroxine - Levoxyl Tier 1 liothyronine Tier 1 CYTOMEL Tier 3 liotrix THYROLAR Tier 3 thyroid ARMOUR THYROID Tier 3

VASOPRESSINS desmopressin Tier 1 DDAVP Tier 3

MISCELLANEOUS levocarnitine Tier 1 CARNITOR Tier 3 methylergonovine Tier 1 METHERGINE Tier 2 octreotide acetate Tier 1 SANDOSTATIN Tier 4 corticotropin powder Tier 4 acetylcysteine ACETADOTE Tier 2 hydroxocobalamin CYANOKIT Tier 2 miglustat ZAVESCA Tier 2 nitisinone ORFADIN Tier 2 pegademase, bovine ADAGEN Tier 2 trientine SYPRINE Tier 2 gallium nitrate GANITE Tier 3 PA agalsidase beta FABRAZYME Tier 4 alglucerase CEREDASE Tier 4 PA alglucosidase alfa LUMIZYME Tier 4 PA alglucosidase alfa MYOZYME Tier 4 PA corticotropin ACTHAR H.P. Tier 4 cysteamine CYSTAGON Tier 4 PA galsulfase NAGLAZYME Tier 4 histrelin acetate SUPPRELIN LA Tier 4 PA idursulfase ELAPRASE Tier 4 PA imiglucerase CEREZYME Tier 4 lanreotide acetate SOMATULINE DEPOT Tier 4 PA laronidase ALDURAZYME Tier 4 octreotide acetate SANDOSTATIN LAR Tier 4 pegvisomant SOMAVERT Tier 4 PA tesamorelin EGRIFTA Tier 4 thyrotropin alfa THYROGEN Tier 4 tolvaptan SAMSCA Tier 4 PA velaglucerase alfa VPRIV Tier 4

GASTROINTESTINAL Guidelines for the treatment and management of various gastrointestinal diseases/conditions are available at: http://www.acg.gi.org http://www.gastro.org

ANTIDIARRHEALS diphenoxylate/atropine Tier 1 LOMOTIL Tier 3 loperamide Tier 1 opium tincture Tier 1

ANTIEMETICS dronabinol Tier 1 MARINOL Tier 3 granisetron Tier 1 meclizine Tier 1 ANTIVERT Tier 3 metoclopramide Tier 1 REGLAN Tier 3 ondansetron Tier 1 ZOFRAN Tier 3 prochlorperazine Tier 1 promethazine Tier 1 trimethobenzamide Tier 1 TIGAN Tier 3 aprepitant EMEND Tier 2 dolasetron ANZEMET Tier 2 granisetron transdermal SANCUSO Tier 2 ondansetron oral soluble film ZUPLENZ Tier 2 palonosetron ALOXI Tier 2 scopolamine transdermal TRANSDERM SCOP Tier 2

ANTISPASMODICS d atropine/hyoscyamine/scopolamine/ Tier 1 DONNATAL Tier 3 phenobarbital dicyclomine Tier 1 BENTYL Tier 3 hyoscyamine sulfate Tier 1 LEVSIN Tier 3 hyoscyamine sulfate ext-rel Tier 1 LEVBID Tier 3 propantheline 15 mg Tier 1

CHOLELITHOLYTICS ursodiol Tier 1 ACTIGALL Tier 3 ursodiol Tier 1 URSO Tier 3 ursodiol Tier 1 URSO FORTE Tier 3

H2 RECEPTOR ANTAGONISTS cimetidine Tier 1 * famotidine Tier 1 PEPCID Tier 3 famotidine susp Tier 1 PEPCID susp Tier 3 nizatidine Tier 1 AXID Tier 3 ranitidine Tier 1 ZANTAC Tier 3

* Except 20 mg

INFLAMMATORY BOWEL DISEASE Oral Agents balsalazide Tier 1 COLAZAL Tier 3 budesonide delayed-rel caps Tier 1 ENTOCORT EC Tier 2 sulfasalazine Tier 1 AZULFIDINE Tier 3 sulfasalazine delayed-rel Tier 1 AZULFIDINE EN-TABS Tier 3 mesalamine delayed-rel tabs ASACOL Tier 2 mesalamine delayed-rel tabs ASACOL HD Tier 2 mesalamine delayed-rel tabs LIALDA Tier 2

mesalamine ext-rel caps APRISO Tier 2 mesalamine ext-rel caps PENTASA Tier 2 olsalazine DIPENTUM Tier 3

Rectal Agents hydrocortisone enema Tier 1 mesalamine rectal susp Tier 1 ROWASA Tier 2 hydrocortisone acetate foam CORTIFOAM Tier 2 mesalamine supp CANASA Tier 2

IRRITABLE BOWEL SYNDROME Irritable Bowel Syndrome with Constipation lubiprostone AMITIZA Tier 3

Irritable Bowel Syndrome with Diarrhea alosetron LOTRONEX Tier 3

LAXATIVES lactulose Tier 1 peg 3350/electrolytes Tier 1 COLYTE Tier 3 peg 3350/electrolytes Tier 1 GOLYTELY Tier 2 peg 3350/electrolytes Tier 1 NULYTELY Tier 3 peg 3350/electrolytes MOVIPREP Tier 2 sodium phosphates OSMOPREP Tier 2 sodium phosphates VISICOL Tier 2 sodium sulfate/potassium sulfate/ SUPREP Tier 2 magnesium sulfate peg 3350/electrolytes + bisacodyl HALFLYTELY Tier 3

PANCREATIC ENZYMES pancrelipase delayed-rel CREON Tier 2 pancrelipase delayed-rel PANCREAZE Tier 2 pancrelipase delayed-rel ZENPEP Tier 2

PROSTAGLANDINS misoprostol Tier 1 CYTOTEC Tier 3

PROTON PUMP INHIBITORS lansoprazole delayed-rel Tier 1 omeprazole delayed-rel Tier 1 PRILOSEC Tier 3 omeprazole/sodium bicarbonate Tier 1 ZEGERID Tier 3 pantoprazole delayed-rel Tier 1 PROTONIX Tier 3 esomeprazole delayed-rel NEXIUM Tier 2 dexlansoprazole delayed-rel DEXILANT Tier 3 rabeprazole delayed-rel ACIPHEX Tier 3

SALIVA STIMULANTS pilocarpine tabs Tier 1 SALAGEN Tier 3 cevimeline EVOXAC Tier 2

STEROIDS, RECTAL hydrocortisone crm Tier 1 ANUSOL-HC 2.5% Tier 3 d hydrocortisone acetate/pramoxine foam EPIFOAM Tier 2 d hydrocortisone acetate/pramoxine foam PROCTOFOAM-HC Tier 2

ULCER THERAPY COMBINATIONS bismuth subsalicylate + metronidazole + PYLERA Tier 2 tetracycline

MISCELLANEOUS cromolyn sodium Tier 1 GASTROCROM Tier 3 sucralfate Tier 1 CARAFATE Tier 3 methylnaltrexone RELISTOR Tier 2 sacrosidase SUCRAID Tier 2 alvimopan ENTEREG Tier 3 glycopyrrolate CUVPOSA Tier 3 nitroglycerin rectal oint 0.4% RECTIV Tier 3 PA palifermin KEPIVANCE Tier 4

GENITOURINARY BENIGN PROSTATIC HYPERPLASIA Guidelines for the management of BPH are available at: http://www.auanet.org/guidelines

alfuzosin ext-rel Tier 1 finasteride Tier 1 PROSCAR Tier 3 tamsulosin Tier 1 FLOMAX Tier 3 dutasteride AVODART Tier 2 dutasteride/tamsulosin JALYN Tier 2 silodosin RAPAFLO Tier 2 PA tadalafil 2.5 mg, 5 mg CIALIS Tier 3

URINARY ANTISPASMODICS oxybutynin Tier 1 oxybutynin ext-rel Tier 1 DITROPAN XL Tier 3 trospium Tier 1 SANCTURA Tier 3 fesoterodine ext-rel TOVIAZ Tier 2 oxybutynin transdermal OXYTROL Tier 2 solifenacin succinate VESICARE Tier 2 tolterodine DETROL Tier 2 tolterodine ext-rel DETROL LA Tier 2 trospium ext-rel SANCTURA XR Tier 2 darifenacin ext-rel ENABLEX Tier 3

VAGINAL ANTI-INFECTIVES metronidazole Tier 1 METROGEL-VAGINAL Tier 3 terconazole Tier 1 TERAZOL 3 Tier 3 terconazole Tier 1 TERAZOL 7 Tier 3 clindamycin supp CLEOCIN vaginal supp Tier 2

MISCELLANEOUS bethanechol Tier 1 URECHOLINE Tier 3 phenazopyridine Tier 1 PYRIDIUM Tier 3 potassium citrate Tier 1 UROCIT-K Tier 3 pentosan polysulfate sodium ELMIRON Tier 2 potassium citrate 15 mEq UROCIT-K 15 mEq Tier 2

HEMATOLOGIC ANTICOAGULANTS Injectable enoxaparin Tier 1 LOVENOX Tier 2

dalteparin FRAGMIN Tier 2 desirudin IPRIVASK Tier 2 tinzaparin INNOHEP Tier 2

Oral warfarin Tier 1 COUMADIN Tier 2 dabigatran etexilate PRADAXA Tier 2 rivaroxaban XARELTO Tier 2

Synthetic Heparinoid-like Agents fondaparinux Tier 1 ARIXTRA Tier 2

Miscellaneous betaine anhydrous CYSTADANE Tier 2

HEMATOPOIETIC GROWTH FACTORS Guidelines for the management of neutropenia are available at: http://www.asco.org

Guidelines for the management of anemia associated with chronic kidney disease are available at: http://www.kidney.org/professionals/kdoqi/guidelines_commentaries.cfm#guidelines

PA darbepoetin alfa ARANESP Tier 4 PA epoetin alfa EPOGEN Tier 4 PA epoetin alfa PROCRIT Tier 4 PA filgrastim NEUPOGEN Tier 4 PA pegfilgrastim NEULASTA Tier 4 romiplostim NPLATE Tier 4 PA sargramostim LEUKINE Tier 4

HEMOPHILIA, VON WILLEBRAND DISEASE AND RELATED BLEEDING DISORDERS Guidelines of treatment and management of hemophilia are available at: http://www.hemophilia.org

factor IX concentrate BEBULIN VH Tier 3 AHF, human/VWF, human HUMATE-P Tier 4 antihemophilic factor ALPHANATE Tier 4 antihemophilic factor HEMOFIL M Tier 4 antihemophilic factor KOATE-DVI Tier 4 antihemophilic factor MONOCLATE-P Tier 4 antihemophilic factor, recombinant ADVATE Tier 4 antihemophilic factor, recombinant HELIXATE FS Tier 4 antihemophilic factor, recombinant KOGENATE FS Tier 4 antihemophilic factor, recombinant RECOMBINATE Tier 4 antihemophilic factor, recombinant REFACTO Tier 4 antihemophilic factor, recombinant XYNTHA Tier 4 anti-inhibitor coagulant complex FEIBA VH IMMUNO Tier 4 coagulation factor VIIa NOVOSEVEN Tier 4 coagulation factor VIIa NOVOSEVEN RT Tier 4 desmopressin spray STIMATE Tier 4 factor IX concentrate ALPHANINE SD Tier 4 factor IX concentrate BEBULIN Tier 4 factor IX concentrate BENEFIX Tier 4 factor IX concentrate MONONINE Tier 4 factor IX concentrate PROFILNINE SD Tier 4 factor XIII concentrate CORIFACT Tier 4 fibrinogen RIASTAP Tier 4

VWF, human/factor VIII complex WILATE Tier 4

HEREDITARY ANGIOEDEMA AGENTS PA ecallantide KALBITOR Tier 2 PA C1 esterase inhibitor BERINERT Tier 4 PA C1 esterase inhibitor CINRYZE Tier 4

IDIOPATHIC THROMBOCYTOPENIC PURPURA AGENTS eltrombopag PROMACTA Tier 4

PAROXYSMAL NOCTURNAL HEMOGLOBINURIA (PNH) AGENTS PA eculizumab SOLIRIS Tier 4

PLATELET AGGREGATION INHIBITORS clopidogrel Tier 1 PLAVIX Tier 3 dipyridamole Tier 1 PERSANTINE Tier 3 ticlopidine Tier 1 dipyridamole ext-rel/aspirin AGGRENOX Tier 2 prasugrel EFFIENT Tier 2 ticagrelor BRILINTA Tier 3

PLATELET SYNTHESIS INHIBITORS anagrelide Tier 1 AGRYLIN Tier 3

STEM CELL MOBILIZERS plerixafor MOZOBIL Tier 4

MISCELLANEOUS cilostazol Tier 1 PLETAL Tier 3 deferoxamine Tier 1 DESFERAL Tier 4 pentoxifylline ext-rel Tier 1 TRENTAL Tier 2 alteplase CATHFLO ACTIVASE Tier 2 PA deferiprone FERRIPROX Tier 2 PA protein C concentrate, human CEPROTIN Tier 2 tranexamic acid CYKLOKAPRON inj Tier 2 tranexamic acid LYSTEDA Tier 2 PA deferasirox EXJADE Tier 4 PA icatibant FIRAZYR Tier 4 oprelvekin NEUMEGA Tier 4

IMMUNOLOGIC AGENTS Guidelines for the management of rheumatic diseases are available at: http://www.rheumatology.org

BIOLOGIC DISEASE-MODIFYING AGENTS PA abatacept ORENCIA Tier 4 adalimumab HUMIRA Tier 4 anakinra KINERET Tier 4 certolizumab pegol CIMZIA Tier 4 etanercept ENBREL Tier 4 golimumab SIMPONI Tier 4 PA infliximab REMICADE Tier 4

DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs) hydroxychloroquine Tier 1 PLAQUENIL Tier 3 leflunomide Tier 1 ARAVA Tier 3 methotrexate Tier 1

methotrexate RHEUMATREX Tier 2 penicillamine CUPRIMINE Tier 2 auranofin RIDAURA Tier 3

IMMUNE GLOBULINS hepatitis B immune globulin HEPAGAM B Tier 4 hepatitis B immune globulin HYPERHEP B S-D Tier 4 PA immune globulin, gamma GAMASTAN S-D Tier 4 PA immune globulin, gamma GAMUNEX-C Tier 4 PA immune globulin, gamma (IGG) GAMMAKED Tier 4 PA immune globulin, gamma (IGG) GAMMAPLEX Tier 4 PA immune globulin, intravenous CARIMUNE NF Tier 4 PA immune globulin, intravenous FLEBOGAMMA Tier 4 PA immune globulin, intravenous GAMMAGARD LIQUID Tier 4 PA immune globulin, intravenous GAMMAGARD S-D Tier 4 PA immune globulin, intravenous GAMUNEX Tier 4 PA immune globulin, intravenous OCTAGAM Tier 4 PA immune globulin, intravenous PRIVIGEN Tier 4 PA immune globulin, subcutaneous HIZENTRA Tier 4 Rho (D) immune globulin HYPERRHO S-D Tier 4 Rho (D) immune globulin MICRHOGAM Tier 4 Rho (D) immune globulin MICRHOGAM PLUS Tier 4 Rho (D) immune globulin RHOGAM Tier 4 Rho (D) immune globulin RHOGAM PLUS Tier 4 Rho (D) immune globulin RHOPHYLAC Tier 4 Rho (D) immune globulin WINRHO SDF Tier 4

IMMUNOMODULATORS CDC recommendations on the treatment of hepatitis are available at: http://www.cdc.gov/hepatitis/index.htm

Guidelines for the management of hepatitis are available at: http://www.aasld.org

Interferons PA interferon alfa-2b INTRON A Tier 4 PA interferon alfacon-1 INFERGEN Tier 4 PA interferon gamma-1b, recombinant ACTIMMUNE Tier 4 PA peginterferon alfa-2a PEGASYS Tier 4 PA peginterferon alfa-2b PEGINTRON Tier 4 PA peginterferon alfa-2b PEGINTRON REDIPEN Tier 4 PA peginterferon alfa-2b SYLATRON Tier 4

Miscellaneous PA canakinumab ILARIS Tier 4 PA rilonacept ARCALYST Tier 4 tocilizumab ACTEMRA Tier 4

IMMUNOSUPPRESSANTS Antimetabolites azathioprine Tier 1 IMURAN Tier 3 mycophenolate mofetil Tier 1 CELLCEPT Tier 4 mycophenolate mofetil CELLCEPT suspension Tier 4 mycophenolate sodium delayed-rel MYFORTIC Tier 4

Calcineurin Inhibitors cyclosporine Tier 1 SANDIMMUNE Tier 4

cyclosporine, modified Tier 1 NEORAL Tier 4 tacrolimus Tier 1 PROGRAF Tier 4

Rapamycin Derivatives everolimus ZORTRESS Tier 4 sirolimus RAPAMUNE Tier 4

Miscellaneous belatacept NULOJIX Tier 4 PA belimumab BENLYSTA Tier 4

NUTRITIONAL/SUPPLEMENTS ELECTROLYTES Potassium potassium chloride ext-rel Tier 1 potassium chloride liquid Tier 1 potassium chloride powder Tier 1

VITAMINS AND MINERALS Folic Acid Agents folic acid Tier 1

Prenatal Vitamins prenatal vitamins/folic acid DUET DHA Tier 2 prenatal vitamins/folic acid PRENATE ELITE Tier 2 prenatal vitamins/docusate/folic acid CITRANATAL RX Tier 3 prenatal vitamins/folic acid VITAFOL-OB Tier 3 prenatal vitamins/folic acid VITAFOL-PN Tier 3

Miscellaneous cyanocobalamin inj Tier 1 ergocalciferol (D2) Tier 1 DRISDOL Tier 3 fluoride drops Tier 1 LURIDE Tier 3 fluoride tabs Tier 1 LURIDE LOZI-TABS Tier 3 multivitamins/fluoride drops, tabs Tier 1 multivitamins/fluoride/iron drops, tabs Tier 1 sodium ferric gluconate inj Tier 1 FERRLECIT Tier 2 sodium fluoride Tier 1 PREVIDENT Tier 3 vitamin ADC/fluoride drops Tier 1 vitamin ADC/fluoride/iron drops Tier 1 cyanocobalamin spray NASCOBAL Tier 2 ferumoxytol inj FERAHEME Tier 2 iron sucrose inj VENOFER Tier 2 phytonadione MEPHYTON Tier 2 zinc acetate GALZIN Tier 2

RESPIRATORY Guidelines to the management, prevention, or treatment of COPD and asthma are available at: http://www.aaaai.org http://www.ginasthma.com http://www.goldcopd.com http://www.nhlbi.nih.gov

The Allergy Report and guidelines for allergy-related conditions are available at: http://www.aaaai.org

ANAPHYLAXIS TREATMENT AGENTS epinephrine EPIPEN Tier 2 epinephrine EPIPEN JR. Tier 2

ANTICHOLINERGICS ipratropium soln Tier 1 tiotropium SPIRIVA Tier 2 ipratropium, CFC-free aerosol ATROVENT HFA Tier 3

ANTICHOLINERGIC/BETA AGONIST COMBINATIONS ipratropium/albuterol soln Tier 1 DUONEB Tier 3 ipratropium/albuterol COMBIVENT Tier 2

ANTIHISTAMINES, LOW SEDATING levocetirizine Tier 1 XYZAL Tier 3

ANTIHISTAMINES, NONSEDATING desloratadine CLARINEX Tier 2

ANTIHISTAMINES, SEDATING cyproheptadine Tier 1 diphenhydramine Tier 1 hydroxyzine HCl Tier 1 hydroxyzine pamoate Tier 1 VISTARIL Tier 3 promethazine Tier 1

ANTIHISTAMINE/DECONGESTANT COMBINATIONS desloratadine/pseudoephedrine ext-rel CLARINEX-D Tier 2

ANTITUSSIVES benzonatate Tier 1 TESSALON Tier 3

ANTITUSSIVE COMBINATIONS Opioid codeine/promethazine Tier 1 codeine/promethazine/phenylephrine Tier 1 hydrocodone/homatropine Tier 1 hydrocodone/chlorpheniramine/ ZUTRIPRO Tier 3 pseudoephedrine hydrocodone/pseudoephedrine REZIRA Tier 3

BETA AGONISTS Inhalants Short Acting albuterol soln Tier 1 ACCUNEB Tier 3 albuterol soln Tier 1 VENTOLIN Tier 3 albuterol sulfate, CFC-free aerosol PROAIR HFA Tier 2 albuterol sulfate, CFC-free aerosol PROVENTIL HFA Tier 2 albuterol sulfate, CFC-free aerosol VENTOLIN HFA Tier 2

Long Acting formoterol inhalation caps FORADIL Tier 2 salmeterol xinafoate SEREVENT DISKUS Tier 2 arformoterol soln BROVANA Tier 3 indacaterol ARCAPTA NEOHALER Tier 3

Oral Agents albuterol Tier 1 albuterol ext-rel Tier 1 VOSPIRE ER Tier 3 metaproterenol Tier 1 terbutaline Tier 1

CYSTIC FIBROSIS aztreonam lysine inhalation soln CAYSTON Tier 3 PA dornase alfa PULMOZYME Tier 4 PA ivacaftor KALYDECO Tier 4 tobramycin inhalation soln TOBI Tier 4

LEUKOTRIENE RECEPTOR MODIFIERS zafirlukast Tier 1 ACCOLATE Tier 3 montelukast SINGULAIR Tier 2 zileuton ext-rel ZYFLO CR Tier 3

MAST CELL STABILIZERS cromolyn soln Tier 1

NASAL ANTIHISTAMINES azelastine spray Tier 1 ASTELIN Tier 3 azelastine spray ASTEPRO Tier 2 olopatadine PATANASE Tier 3

NASAL STEROIDS flunisolide spray Tier 1 fluticasone spray Tier 1 FLONASE Tier 3 triamcinolone acetonide spray Tier 1 NASACORT AQ Tier 3 budesonide spray RHINOCORT AQUA Tier 2 fluticasone furoate spray VERAMYST Tier 2 mometasone spray NASONEX Tier 2 beclomethasone spray BECONASE AQ Tier 3

PHOSPHODIESTERASE-4 INHIBITORS roflumilast DALIRESP Tier 3

STEROID/BETA AGONIST COMBINATIONS budesonide/formoterol SYMBICORT Tier 2 fluticasone/salmeterol ADVAIR Tier 2 fluticasone/salmeterol, CFC-free aerosol ADVAIR HFA Tier 2 mometasone/formoterol DULERA Tier 2

STEROID INHALANTS budesonide inhalation suspension Tier 1 PULMICORT RESPULES Tier 3 beclomethasone, CFC-free aerosol QVAR Tier 2 budesonide PULMICORT FLEXHALER Tier 2 fluticasone FLOVENT Tier 2 fluticasone, CFC-free aerosol FLOVENT HFA Tier 2 mometasone ASMANEX Tier 2 ciclesonide ALVESCO Tier 3

XANTHINES caffeine citrate Tier 1 CAFCIT Tier 3 theophylline ext-rel tabs Tier 1 theophylline ext-rel caps THEO-24 Tier 2 theophylline liquid ELIXOPHYLLIN Tier 2

MISCELLANEOUS ipratropium spray Tier 1 ATROVENT spray Tier 3 alpha-1 proteinase inhibitor ARALAST NP Tier 4 alpha-1 proteinase inhibitor GLASSIA Tier 4 PA omalizumab XOLAIR Tier 4

TOPICAL DERMATOLOGY Acne Guidelines for the care and treatment of acne vulgaris are available at: http://www.aad.org

Oral isotretinoin Tier 1

Topical PA adapalene Tier 1 DIFFERIN Tier 3 benzoyl peroxide Tier 1 BENZAC AC Tier 3 clindamycin gel, lotion, soln Tier 1 CLEOCIN T Tier 3 clindamycin swabs Tier 1 clindamycin/benzoyl peroxide Tier 1 BENZACLIN Tier 3 erythromycin gel 2% Tier 1 erythromycin soln Tier 1 erythromycin/benzoyl peroxide Tier 1 BENZAMYCIN Tier 3 PA tretinoin Tier 1 RETIN-A Tier 3 PA adapalene/benzoyl peroxide EPIDUO Tier 2 benzoyl peroxide microspheres NEOBENZ MICRO Tier 2 clindamycin/benzoyl peroxide DUAC Tier 2 PA clindamycin/tretinoin ZIANA Tier 2 PA tretinoin ATRALIN Tier 2 PA tretinoin gel microsphere RETIN-A MICRO Tier 2 azelaic acid AZELEX Tier 3

Actinic Keratosis fluorouracil Tier 1 EFUDEX Tier 3 diclofenac sodium SOLARAZE Tier 2 fluorouracil FLUOROPLEX Tier 2

Antibiotics gentamicin Tier 1 mupirocin Tier 1 BACTROBAN Tier 3 silver sulfadiazine Tier 1 SILVADENE Tier 3 retapamulin ALTABAX Tier 2

Antifungals ciclopirox Tier 1 LOPROX Tier 3 clotrimazole Tier 1 clotrimazole/betamethasone Tier 1 econazole Tier 1 ketoconazole Tier 1 nystatin Tier 1 ketoconazole 2% XOLEGEL Tier 2 miconazole nitrate/zinc oxide VUSION Tier 2 naftifine NAFTIN Tier 2 oxiconazole OXISTAT Tier 2 sertaconazole ERTACZO Tier 2

sulconazole EXELDERM Tier 2 PA terbinafine LAMISIL Tier 2

Antipsoriatics Guidelines of care for the management and treatment of psoriasis with topical therapies are available at: http://www.aad.org

Injectable ustekinumab STELARA Tier 4

Oral acitretin SORIATANE Tier 2 methoxsalen oral OXSORALEN-ULTRA Tier 2

Topical PA calcipotriene Tier 1 DOVONEX Tier 3 PA calcitriol oint Tier 1 VECTICAL Tier 2 anthralin DRITHOCREME HP Tier 2 betamethasone dipropionate/calcipotriene TACLONEX Tier 2 PA tazarotene TAZORAC Tier 2

Antiseborrheics ketoconazole shampoo 2% Tier 1 NIZORAL SHAMPOO Tier 3 selenium sulfide shampoo 2.5% Tier 1 SELSUN Tier 3

Corticosteroids Low Potency alclometasone crm, oint 0.05% Tier 1 ACLOVATE Tier 3 desonide crm, lotion, oint 0.05% Tier 1 DESOWEN Tier 3 fluocinolone acetonide soln 0.01% Tier 1 hydrocortisone crm 2.5% Tier 1 hydrocortisone lotion 1% Tier 1 desonide foam 0.05% VERDESO Tier 2 desonide gel 0.05% DESONATE Tier 2

Medium Potency betamethasone valerate crm, lotion, Tier 1 oint 0.1% desoximetasone crm, oint 0.05% Tier 1 TOPICORT LP Tier 3 fluocinolone acetonide crm, Tier 1 oint 0.025% fluticasone propionate crm, Tier 1 CUTIVATE Tier 3 lotion 0.05%, oint 0.005% hydrocortisone valerate crm, oint 0.2% Tier 1 WESTCORT Tier 3 mometasone crm, lotion, oint 0.1% Tier 1 ELOCON Tier 3 triamcinolone acetonide crm, Tier 1 lotion 0.025% triamcinolone acetonide crm, lotion, Tier 1 oint 0.1% flurandrenolide crm 0.05% CORDRAN SP Tier 2 flurandrenolide lotion 0.05% CORDRAN Tier 2 flurandrenolide tape CORDRAN Tier 2 hydrocortisone probutate crm 0.1% PANDEL Tier 2 clocortolone pivalate crm 0.1% CLODERM Tier 3

High Potency amcinonide crm, lotion, oint 0.1% Tier 1

betamethasone dipropionate Tier 1 DIPROLENE AF Tier 3 augmented crm 0.05% betamethasone dipropionate Tier 1 DIPROLENE Tier 3 augmented lotion 0.05% betamethasone dipropionate crm, Tier 1 lotion, oint 0.05% desoximetasone crm, oint 0.25%, Tier 1 TOPICORT Tier 3 gel 0.05% diflorasone diacetate crm 0.05% Tier 1 fluocinonide crm, gel, oint, soln 0.05% Tier 1 triamcinolone acetonide crm 0.5% Tier 1 diflorasone diacetate emollient crm 0.05% APEXICON E Tier 2

Very High Potency betamethasone dipropionate Tier 1 DIPROLENE Tier 3 augmented gel, oint 0.05% clobetasol propionate crm, gel, lotion, Tier 1 TEMOVATE Tier 3 oint 0.05% clobetasol propionate lotion, Tier 1 CLOBEX Tier 3 shampoo 0.05% diflorasone diacetate oint 0.05% Tier 1 halobetasol propionate crm, Tier 1 ULTRAVATE Tier 3 oint 0.05% clobetasol propionate spray 0.05% CLOBEX Tier 2 fluocinonide crm 0.1% VANOS Tier 2

Emollients ammonium lactate 12% Tier 1 LAC-HYDRIN Tier 3 emollient crm MIMYX Tier 2 urea URAMAXIN Tier 2 urea 45% URAMAXIN GT Tier 2

Immunomodulators Guidelines for the treatment of atopic dermatitis are available at: http://www.aad.org

pimecrolimus ELIDEL Tier 2 tacrolimus PROTOPIC Tier 2

Local Analgesics lidocaine patch LIDODERM Tier 2 capsaicin 8% patch QUTENZA Tier 3

Local Anesthetics lidocaine Tier 1 XYLOCAINE Tier 3 lidocaine/prilocaine Tier 1

Rosacea metronidazole crm 0.75% Tier 1 METROCREAM Tier 3 metronidazole gel 0.75% Tier 1 metronidazole lotion 0.75% Tier 1 METROLOTION Tier 3 sulfacetamide/sulfur Tier 1 doxycycline monohydrate ORACEA Tier 2 metronidazole gel 1% METROGEL Tier 2 azelaic acid gel FINACEA Tier 3

Scabicides and Pediculicides lindane Tier 1 permethrin 5% Tier 1 benzyl alcohol ULESFIA Tier 2 crotamiton EURAX Tier 2 spinosad NATROBA Tier 2

Miscellaneous Skin and Mucous Membrane imiquimod Tier 1 ALDARA Tier 3 podofilox Tier 1 CONDYLOX Tier 3 acyclovir ZOVIRAX crm, oint Tier 2 alitretinoin PANRETIN Tier 2 becaplermin REGRANEX Tier 2 d hydrocortisone/aloe polysaccharide/ ALCORTIN A Tier 2 iodoquinol imiquimod ZYCLARA Tier 2 absorbable fibrin sealant TACHOSIL Tier 3 doxepin crm ZONALON Tier 3 sinecatechins VEREGEN Tier 3 PA tretinoin emollient RENOVA Tier 3 PA collagenase clostridium histolyticum XIAFLEX Tier 4 PA interferon alfa-n3 ALFERON N Tier 4

MOUTH/THROAT/DENTAL AGENTS Anesthetics - Topical Oral lidocaine viscous Tier 1

Steroids - Mouth/Throat triamcinolone paste Tier 1

OPHTHALMIC Preferred Practice Pattern Guidelines for the treatment of various ophthalmic conditions are available at: http://one.aao.org

Antiallergics cromolyn sodium Tier 1 epinastine Tier 1 ELESTAT Tier 3 phenylephrine Tier 1 lodoxamide ALOMIDE Tier 2 loteprednol 0.2% ALREX Tier 2 olopatadine PATANOL Tier 2 alcaftadine LASTACAFT Tier 3 bepotastine BEPREVE Tier 3

Antifungals natamycin NATACYN Tier 2

Anti-infectives bacitracin Tier 1 ciprofloxacin Tier 1 CILOXAN Tier 3 erythromycin Tier 1 gentamicin Tier 1 levofloxacin Tier 1 neomycin/polymyxin B/gramicidin Tier 1 NEOSPORIN Tier 3 ofloxacin Tier 1 OCUFLOX Tier 3 polymyxin B/bacitracin Tier 1 polymyxin B/trimethoprim Tier 1 POLYTRIM Tier 3

sulfacetamide soln 10% Tier 1 BLEPH-10 Tier 3 tobramycin Tier 1 TOBREX Tier 3 azithromycin AZASITE Tier 2 besifloxacin BESIVANCE Tier 2 moxifloxacin VIGAMOX Tier 2

Anti-infective/Anti-inflammatory Combinations neomycin/dexamethasone Tier 1 neomycin/polymyxin B/ Tier 1 MAXITROL Tier 3 dexamethasone neomycin/polymyxin B/hydrocortisone Tier 1 susp sulfacetamide/prednisolone phosphate Tier 1 10%/0.25% tobramycin/dexamethasone Tier 1 TOBRADEX Tier 3 gentamicin/prednisolone acetate PRED-G Tier 2 sulfacetamide/prednisolone acetate oint BLEPHAMIDE SOP Tier 2 10%/0.2% tobramycin/loteprednol ZYLET Tier 3

Anti-inflammatories Nonsteroidal bromfenac sodium Tier 1 diclofenac sodium Tier 1 VOLTAREN Tier 3 flurbiprofen Tier 1 OCUFEN Tier 3 ketorolac 0.5% Tier 1 ACULAR Tier 3 bromfenac sodium BROMDAY Tier 2 nepafenac NEVANAC Tier 2

Steroidal dexamethasone sodium phosphate Tier 1 fluorometholone Tier 1 FML Tier 3 prednisolone acetate 1% Tier 1 PRED FORTE Tier 3 prednisolone phosphate 1% Tier 1 dexamethasone MAXIDEX Tier 2 dexamethasone OZURDEX Tier 2 fluorometholone acetate FLAREX Tier 2 prednisolone acetate 0.12% PRED MILD Tier 2 rimexolone VEXOL Tier 2 difluprednate DUREZOL Tier 3 loteprednol 0.5% LOTEMAX Tier 3

Antivirals trifluridine Tier 1 VIROPTIC Tier 3 ganciclovir ZIRGAN Tier 2

Beta-blockers Nonselective carteolol Tier 1 levobunolol Tier 1 BETAGAN Tier 3 metipranolol Tier 1 OPTIPRANOLOL Tier 3 timolol maleate Tier 1 TIMOPTIC Tier 3 timolol maleate gel Tier 1 TIMOPTIC-XE Tier 3 timolol hemihydrate BETIMOL Tier 2 timolol maleate ISTALOL Tier 3

Selective betaxolol BETOPTIC S Tier 2

Carbonic Anhydrase Inhibitors Topical dorzolamide Tier 1 TRUSOPT Tier 3 brinzolamide AZOPT Tier 2

Carbonic Anhydrase Inhibitor/Beta-blocker Combinations dorzolamide/timolol maleate Tier 1 COSOPT Tier 3

Immunomodulators cyclosporine, emulsion RESTASIS Tier 2

Parasympathomimetics pilocarpine PILOPINE HS GEL Tier 3

Prostaglandins latanoprost Tier 1 XALATAN Tier 3 bimatoprost LUMIGAN Tier 2 travoprost TRAVATAN Z Tier 2 tafluprost ZIOPTAN Tier 3

Sympathomimetics atropine Tier 1 brimonidine 0.15% Tier 1 ALPHAGAN P 0.15% Tier 3 brimonidine 0.2% Tier 1 cyclopentolate Tier 1 CYCLOGYL Tier 3 homatropine Tier 1 ISOPTO HOMATROPINE Tier 3 brimonidine 0.1% ALPHAGAN P 0.1% Tier 2 scopolamine ISOPTO HYOSCINE Tier 2

Sympathomimetic/Beta-blocker Combinations brimonidine/timolol COMBIGAN Tier 2

Miscellaneous naphazoline Tier 1 aflibercept EYLEA Tier 4 pegaptanib sodium MACUGEN Tier 4 ranibizumab LUCENTIS Tier 4 verteporfin VISUDYNE Tier 4

OTIC Clinical practice guidelines for the treatment of otitis media are available at: http://www.aap.org

Anti-infectives acetic acid Tier 1 acetic acid/aluminum acetate Tier 1 ofloxacin otic Tier 1 ciprofloxacin otic CETRAXAL Tier 2

Anti-infective/Anti-inflammatory Combinations acetic acid/hydrocortisone Tier 1 neomycin/polymyxin B/hydrocortisone Tier 1 CORTISPORIN OTIC Tier 3 ciprofloxacin/dexamethasone CIPRODEX Tier 2 ciprofloxacin/hydrocortisone CIPRO HC OTIC Tier 2

Miscellaneous fluocinolone acetonide Tier 1 DERMOTIC Tier 2 hydrocortisone/neomycin/colistin/ CORTISPORIN-TC OTIC Tier 3 thonzonium hydrocortisone/pramoxine/chloroxylenol CORTANE-B Tier 3

WEBSITES Agency for Healthcare Research and Quality American Congress of Obstetricians and http://www.ahrq.gov Gynecologists http://www.acog.org Alzheimer's Association http://www.alz.org American Diabetes Association http://www.diabetes.org American Academy of Allergy, Asthma and Immunology American Gastroenterological Association http://www.aaaai.org http://www.gastro.org

American Academy of Child & Adolescent Psychiatry American Headache Society Committee for Headache http://www.aacap.org Education http://www.achenet.org American Academy of Dermatology http://www.aad.org American Heart Association http://www.americanheart.org American Academy of Neurology http://www.aan.com American Lung Association http://www.lungusa.org American Academy of Ophthalmology http://www.aao.org American Medical Association http://www.ama-assn.org American Academy of Pediatrics http://www.aap.org American Psychiatric Association http://www.psych.org American Association for the Study of Liver Disease http://www.aasld.org American Society of Anesthesiologists http://www.asahq.org American Association of Clinical Endocrinologists http://www.aace.com American Society of Clinical Oncology http://www.asco.org American Association of Diabetes Educators http://www.diabeteseducator.org American Society of Interventional Pain Physicians http://www.asipp.org American Cancer Society http://www.cancer.org American Urological Association http://www.auanet.org American College of Allergy, Asthma and Immunology http://www.acaai.org Centers for Disease Control and Prevention http://www.cdc.gov American College of Cardiology http://www.acc.org Centers for Disease Control and Prevention Guideline topics: AIDS American College of Chest Physicians http://www.cdc.gov/hiv/resources/guidelines/index.htm http://www.chestnet.org Centers for Disease Control and Prevention American College of Gastroenterology Guideline topics: Sexually Transmitted Diseases http://www.acg.gi.org http://www.cdc.gov/std/treatment/default.htm

American College of Physicians CVS Caremark http://www.acponline.org http://www.caremark.com

American College of Rheumatology The Food and Drug Administration http://www.rheumatology.org http://www.fda.gov

Global Initiative for Asthma National Foundation for Infectious Diseases http://www.ginasthma.com http://www.nfid.org

Infectious Diseases Society of America National Guideline Clearinghouse http://www.idsociety.org http://www.guideline.gov

Institute for Safe Medication Practices National Heart, Lung and Blood Institute http://www.ismp.org http://www.nhlbi.nih.gov

Johns Hopkins AIDS Service National Institutes of Health http://www.hopkins-aids.edu http://www.nih.gov

Juvenile Diabetes Research Foundation International National Kidney Foundation http://www.jdf.org http://www.kidney.org

MedWatch National Osteoporosis Foundation http://www.fda.gov/medwatch http://www.nof.org

National Agricultural Library North American Menopause Society http://www.nal.usda.gov http://www.menopause.org

National Cancer Institute United States Department of Health and Human http://www.cancer.gov/cancerinformation Services http://www.hhs.gov National Comprehensive Cancer Network http://www.nccn.org World Health Organization http://www.who.int

INDEX A AGRYLIN, 39 abacavir, 12 AHF, human/VWF, human, 38 abacavir/lamivudine, 12 albuterol, 43 abacavir/lamivudine/zidovudine, 12 albuterol ext-rel, 43 abatacept, 39 albuterol soln, 42 ABELCET, 11 albuterol sulfate, CFC-free aerosol, 42 ABILIFY, 24 alcaftadine, 47 abiraterone, 15 alclometasone crm, oint 0.05%, 45 abobotulinumtoxinA, 27 ALCORTIN A, 47 ABRAXANE, 17 ALDACTAZIDE, 21 absorbable fibrin sealant, 47 ALDACTONE, 18 acamprosate calcium, 27 ALDARA, 47 acarbose, 28 aldesleukin, 16 ACCOLATE, 43 ALDURAZYME, 34 ACCU-CHEK test strips, 29 alemtuzumab, 16 ACCUNEB, 42 alendronate, 29 ACCUPRIL, 17 alendronate/vitamin D3, 29 ACCURETIC, 17 ALFERON N, 47 acebutolol, 19 alfuzosin ext-rel, 37 ACEON, 17 alglucerase, 34 ACETADOTE, 34 alglucosidase alfa, 34 acetaminophen inj, 8 ALIMTA, 14 acetaminophen/dichloralphenazone/isometheptene, 26 ALINIA, 14 acetazolamide, 20 aliskiren, 20 acetazolamide ext-rel, 20 aliskiren/amlodipine, 20 acetic acid, 49 aliskiren/hydrochlorothiazide, 20 acetic acid/aluminum acetate, 49 alitretinoin, 47 acetic acid/hydrocortisone, 49 ALKERAN, 14 acetylcysteine, 34 allopurinol, 8 ACIPHEX, 36 ALOMIDE, 47 acitretin, 45 ALORA, 32 ACLOVATE, 45 alosetron, 36 ACTEMRA, 40 ALOXI, 35 ACTHAR H.P., 34 alpha-1 proteinase inhibitor, 44 ACTIGALL, 35 ALPHAGAN P 0.1%, 49 ACTIMMUNE, 40 ALPHAGAN P 0.15%, 49 ACTIQ, 9 ALPHANATE, 38 ACTIVELLA, 32 ALPHANINE SD, 38 ACTONEL, 30 alprazolam, 22 ACTOPLUS MET, 29 alprazolam ext-rel, 22 ACTOPLUS MET XR, 29 ALREX, 47 ACTOS, 28 ALTABAX, 44 ACULAR, 48 ALTACE, 17 acyclovir, 47 alteplase, 39 acyclovir caps, susp, tabs, 13 altretamine, 14 ADAGEN, 34 ALVESCO, 43 ADALAT CC, 20 alvimopan, 37 adalimumab, 39 amantadine, except tabs, 13, 24 adapalene, 44 AMARYL, 29 adapalene/benzoyl peroxide, 44 AMBIEN, 25 ADCETRIS, 16 AMBIEN CR, 25 ADCIRCA, 21 ambrisentan, 21 ADDERALL, 25 amcinonide crm, lotion, oint 0.1%, 45 ADDERALL XR, 25 AMERGE, 26 adefovir dipivoxil, 13 amifostine, 16 ADOXA, 11 amiloride, 21 ADVAIR, 43 amiloride/hydrochlorothiazide, 21 ADVAIR HFA, 43 amiodarone, 18 ADVATE, 38 AMITIZA, 36 ADVICOR, 19 amitriptyline, 23 AFINITOR, 15 amitriptyline/perphenazine, 24 aflibercept, 49 amlodipine, 20 agalsidase beta, 34 amlodipine/atorvastatin, 20 AGGRENOX, 39 amlodipine/olmesartan, 18

53 amlodipine/telmisartan, 18 asparaginase, 16 amlodipine/valsartan, 18 asparaginase Erwinia chrysanthemi, 16 amlodipine/valsartan/hydrochlorothiazide, 18 ASTELIN, 43 ammonium lactate 12%, 46 ASTEPRO, 43 amoxicillin ext-rel, 11 atazanavir, 12 amoxicillin, except film-coated tabs, 11 atenolol, 19 amoxicillin/clavulanate, 11 atenolol/chlorthalidone, 20 amoxicillin/clavulanate ext-rel, 11 ATIVAN, 22 amoxicillin/clavulanate susp 600 mg, 11 atomoxetine, 25 amphetamine/dextroamphetamine mixed salts, 25 atorvastatin, 19 amphetamine/dextroamphetamine mixed salts ext-rel, 25 atovaquone, 14 AMPHOTEC, 11 atovaquone/proguanil, 12 amphotericin B lipid complex, 11 ATRALIN, 44 ampicillin, 11 ATRIPLA, 12 ampicillin sodium/sulbactam sodium, 11 atropine, 49 AMPYRA, 26 atropine/hyoscyamine/scopolamine/phenobarbital, 35 AMRIX, 26 ATROVENT HFA, 42 ANAFRANIL, 22 ATROVENT spray, 44 anagrelide, 39 AUGMENTIN, 11 anakinra, 39 AUGMENTIN XR, 11 ANAPROX, 8 auranofin, 40 anastrozole, 15 AVALIDE, 18 ANDRODERM, 27 AVANDAMET, 29 ANDROGEL, 27 AVANDARYL, 29 anidulafungin, 11 AVANDIA, 29 ANTABUSE, 27 AVAPRO, 18 ANTARA, 19 AVASTIN, 16 anthralin, 45 AVELOX, 11 antihemophilic factor, 38 AVINZA, 9 antihemophilic factor, recombinant, 38 AVODART, 37 anti-inhibitor coagulant complex, 38 AVONEX, 26 ANTIVERT, 35 AXID, 35 ANUSOL-HC 2.5%, 36 AXIRON, 27 ANZEMET, 35 axitinib, 15 APEXICON E, 46 AYGESTIN, 34 APIDRA, 28 azacitidine, 16 APOKYN, 24 AZACTAM, 13 apomorphine, 24 AZASITE, 48 aprepitant, 35 azathioprine, 40 APRISO, 36 azelaic acid, 44 APTIVUS, 13 azelaic acid gel, 46 ARALAST NP, 44 azelastine spray, 43 ARALEN, 12 AZELEX, 44 ARANESP, 38 AZILECT, 24 ARAVA, 39 azilsartan, 18 ARCALYST, 40 azithromycin, 10, 11, 48 ARCAPTA NEOHALER, 42 AZOPT, 49 arformoterol soln, 42 AZOR, 18 ARICEPT (except 23 mg), 23 aztreonam, 13 ARICEPT 23 mg, 23 aztreonam lysine inhalation soln, 43 ARICEPT ODT, 23 AZULFIDINE, 35 ARIMIDEX, 15 AZULFIDINE EN-TABS, 35 aripiprazole, 24 B ARIXTRA, 38 bacitracin, 47 armodafinil, 27 baclofen, 26 ARMOUR THYROID, 34 baclofen intrathecal, 26 AROMASIN, 15 BACTROBAN, 44 ARRANON, 17 balsalazide, 35 arsenic trioxide, 16 BANZEL, 23 artemether/lumefantrine, 12 BARACLUDE, 13 ARTHROTEC, 8 BCG live vaccine, 16 ARZERRA, 17 BD INSULIN SYRINGES, 29 ASACOL, 35 BEBULIN, 38 ASACOL HD, 35 BEBULIN VH, 38 asenapine, 24 becaplermin, 47 ASMANEX, 43

54 beclomethasone spray, 43 BRILINTA, 39 beclomethasone, CFC-free aerosol, 43 brimonidine 0.1%, 49 BECONASE AQ, 43 brimonidine 0.15%, 49 belatacept, 41 brimonidine 0.2%, 49 belimumab, 41 brimonidine/timolol, 49 benazepril, 17 brinzolamide, 49 benazepril/amlodipine, 17 BROMDAY, 48 benazepril/hydrochlorothiazide, 17 bromfenac sodium, 48 bendamustine, 14 bromocriptine, 24, 29 BENEFIX, 38 BROVANA, 42 BENICAR, 18 budesonide, 43 BENICAR HCT, 18 budesonide delayed-rel caps, 35 BENLYSTA, 41 budesonide inhalation suspension, 43 BENTYL, 35 budesonide spray, 43 BENZAC AC, 44 budesonide/formoterol, 43 BENZACLIN, 44 bulsulfan, 14 BENZAMYCIN, 44 bumetanide, 21 benzonatate, 42 buprenorphine, 27 benzoyl peroxide, 44 buprenorphine transdermal, 9 benzoyl peroxide microspheres, 44 buprenorphine/naloxone, 27 benztropine, 24 bupropion, 24 benzyl alcohol, 47 bupropion ext-rel, 24, 27 bepotastine, 47 buspirone, 22 BEPREVE, 47 busulfan, 14 BERINERT, 39 BUSULFEX, 14 besifloxacin, 48 butabarbital, 26 BESIVANCE, 48 butalbital/acetaminophen, 9 BETAGAN, 48 butalbital/acetaminophen/caffeine, 9 betaine anhydrous, 38 butalbital/acetaminophen/caffeine/codeine, 9 betamethasone dipropionate augmented crm 0.05%, 46 butalbital/aspirin/caffeine, 9 betamethasone dipropionate augmented gel, oint 0.05%, 46 butalbital/aspirin/caffeine/codeine, 9 betamethasone dipropionate augmented lotion 0.05%, 46 BUTISOL SODIUM, 26 betamethasone dipropionate crm, lotion, oint 0.05%, 46 butorphanol nasal spray, 9 betamethasone dipropionate/calcipotriene, 45 BUTRANS, 9 betamethasone valerate crm, lotion, oint 0.1%, 45 BYETTA, 28 BETAPACE, 18 BYSTOLIC, 20 BETASERON, 26 C betaxolol, 49 C1 esterase inhibitor, 39 bethanechol, 37 cabazitaxel, 16 BETIMOL, 48 CADUET, 20 BETOPTIC S, 49 CAFCIT, 43 bevacizumab, 16 CAFERGOT, 26 bexarotene caps, 16 caffeine citrate, 43 BEXXAR, 17 CALAN, 20 BIAXIN, 10 CALAN SR, 20 BIAXIN XL, 11 calcipotriene, 45 bicalutamide, 15 calcitonin-salmon inj, 30 BICNU, 14 calcitonin-salmon spray, 30 BIDIL, 21 calcitriol (1,25-D3), 33 bimatoprost, 49 calcitriol oint, 45 bismuth subsalicylate + metronidazole + tetracycline, 37 calcium acetate, 33 bisoprolol/hydrochlorothiazide, 20 CALDOLOR, 8 bleomycin sulfate, 16 CAMPATH, 16 BLEPH-10, 48 CAMPRAL, 27 BLEPHAMIDE SOP, 48 CAMPTOSAR, 16 blood glucose test strips, 29 canakinumab, 40 boceprevir, 13 CANASA, 36 BONIVA, 29 capecitabine, 14 BONIVA inj, 30 CAPITAL w/CODEINE, 9 bortezomib, 16 CAPRELSA, 15 bosentan, 21 capsaicin 8% patch, 46 BOTOX, 27 captopril/hydrochlorothiazide, 17 BRAVELLE, 32 CARAFATE, 37 brentuximab vedotin, 16 carbamazepine, 22 BREVIBLOC, 20 carbamazepine ext-rel, 22 BREVICON, 30

55 carbidopa/levodopa, 24 ciclopirox, 44 carbidopa/levodopa ext-rel, 24 cidofovir, 13 carbidopa/levodopa/entacapone, 24 cilostazol, 39 carboplatin, 16 CILOXAN, 47 CARDENE SR, 20 cimetidine, 35 CARDIZEM, 20 CIMZIA, 39 CARDIZEM CD, 20 cinacalcet, 29 CARDURA, 18 CINRYZE, 39 CARIMUNE NF, 40 CIPRO HC OTIC, 49 carmustine, 14 CIPRO susp, 11 CARNITOR, 34 CIPRO tabs, 11 carteolol, 48 CIPRODEX, 49 carvedilol, 19 ciprofloxacin, 47 carvedilol phosphate ext-rel, 20 ciprofloxacin ext-rel, 11 CASODEX, 15 ciprofloxacin otic, 49 CATAPRES, 18 ciprofloxacin susp, 11 CATAPRES-TTS, 18 ciprofloxacin tabs, 11 CATHFLO ACTIVASE, 39 ciprofloxacin/dexamethasone, 49 CAYSTON, 43 ciprofloxacin/hydrocortisone, 49 CEDAX, 10 cisplatin, 16 CEENU, 14 citalopram, 23 cefaclor, 10 CITRANATAL RX, 41 cefdinir, 10 cladribine, 14 cefditoren, 10 CLAFORAN, 10 cefepime, 10 CLARINEX, 42 cefotaxime, 10 CLARINEX-D, 42 cefoxitin, 10 clarithromycin, 10 cefpodoxime, 10 clarithromycin ext-rel, 11 cefprozil, 10 CLEOCIN, 13 ceftaroline fosamil, 10 CLEOCIN T, 44 ceftazidime, 10 CLEOCIN vaginal supp, 37 ceftibuten, 10 CLIMARA, 32 CEFTIN, 10 CLIMARA PRO, 32 ceftriaxone, 10 clindamycin, 13 cefuroxime axetil, 10 clindamycin gel, lotion, soln, 44 CELEBREX, 8 clindamycin supp, 37 celecoxib, 8 clindamycin swabs, 44 CELEXA, 23 clindamycin/benzoyl peroxide, 44 CELLCEPT, 40 clindamycin/tretinoin, 44 CELLCEPT suspension, 40 CLINORIL, 8 cephalexin, 10 clobazam, 23 CEPROTIN, 39 clobetasol propionate crm, gel, lotion, oint 0.05%, 46 CEREDASE, 34 clobetasol propionate lotion, shampoo 0.05%, 46 CEREZYME, 34 clobetasol propionate spray 0.05%, 46 certolizumab pegol, 39 CLOBEX, 46 CERUBIDINE, 16 clocortolone pivalate crm 0.1%, 45 CETRAXAL, 49 CLODERM, 45 cetrorelix, 32 clofarabine, 14 CETROTIDE, 32 CLOLAR, 14 cetuximab, 16 CLOMID, 32 cevimeline, 36 clomiphene, 32 CHANTIX, 27 clomipramine, 22 CHEMSTRIP K URINE KETONE STRIPS, 29 clonazepam tabs, 22 CHEMSTRIP UG URINE GLUCOSE STRIPS, 29 clonidine, 18 CHEMSTRIP UGK URINE GLUCOSE/KETONE STRIPS, 29 clonidine ext-rel, 25 chloral hydrate, 25, 26 clonidine transdermal, 18 chlorambucil, 14 clopidogrel, 39 chlordiazepoxide, 22 clorazepate, 22 chloroquine, 12 clotrimazole, 44 chlorthalidone, 21 clotrimazole troches, 11 cholestyramine pkt, 19 clotrimazole/betamethasone, 44 choline magnesium trisalicylate, 8 clozapine, 24 choriogonadotropin alfa, 32 CLOZARIL, 24 chorionic gonadotropin, 32 coagulation factor VIIa, 38 CIALIS, 37 COARTEM, 12 ciclesonide, 43 codeine/acetaminophen, 9

56 codeine/acetaminophen susp, 9 CYMBALTA, 23 codeine/promethazine, 42 cyproheptadine, 42 codeine/promethazine/phenylephrine, 42 CYSTADANE, 38 COLAZAL, 35 CYSTAGON, 34 colchicine, 8 cysteamine, 34 COLCRYS, 8 cytarabine, 14 colesevelam, 19 cytarabine liposome, 14 COLESTID, 19 CYTOGAM, 13 colestipol, 19 cytomegalovirus immune globulin, 13 collagenase clostridium histolyticum, 47 CYTOMEL, 34 COLYTE, 36 CYTOTEC, 36 COMBIGAN, 49 CYTOVENE inj, 13 COMBIPATCH, 32 D COMBIVENT, 42 D.H.E. 45, 26 COMBIVIR, 12 dabigatran etexilate, 38 COMPLERA, 12 DACOGEN, 16 COMTAN, 24 dactinomycin, 16 CONCERTA, 25 dalfampridine ext-rel, 26 CONDYLOX, 47 DALIRESP, 43 COPAXONE, 26 dalteparin, 38 COPEGUS, 13 danazol, 31 CORDARONE, 18 DANTRIUM, 26 CORDRAN, 45 dantrolene, 26 CORDRAN SP, 45 dapsone, 13 COREG, 19 daptomycin, 14 COREG CR, 20 DARAPRIM, 12 CORIFACT, 38 darbepoetin alfa, 38 CORTANE-B, 50 darifenacin ext-rel, 37 CORTEF, 33 darunavir, 12 corticotropin, 34 dasatinib, 15 corticotropin powder, 34 daunorubicin, 16 CORTIFOAM, 36 daunorubicin citrate liposomal, 16 cortisone acetate, 33 DAUNOXOME, 16 CORTISPORIN OTIC, 49 DAYPRO, 8 CORTISPORIN-TC OTIC, 50 DAYTRANA, 25 COSMEGEN, 16 DDAVP, 34 COSOPT, 49 decitabine, 16 COUMADIN, 38 deferasirox, 39 COVERA-HS, 20 deferiprone, 39 COZAAR, 18 deferoxamine, 39 CREON, 36 degarelix acetate, 15 CRESTOR, 19 delavirdine, 12 CRIXIVAN, 12 DELESTROGEN, 32 crizotinib, 15 DEMADEX, 21 cromolyn sodium, 37, 47 denileukin diftitox, 16 cromolyn soln, 43 denosumab, 30 crotamiton, 47 DEPAKENE, 22 CUBICIN, 14 DEPAKOTE, 22 CUPRIMINE, 40 DEPOCYT, 14 CUTIVATE, 45 DEPO-PROVERA, 31 CUVPOSA, 37 DERMOTIC, 50 cyanocobalamin inj, 41 DESFERAL, 39 cyanocobalamin spray, 41 desipramine, 23 CYANOKIT, 34 desirudin, 38 CYCLESSA, 31 desloratadine, 42 cyclobenzaprine, 26 desloratadine/pseudoephedrine ext-rel, 42 cyclobenzaprine ext-rel, 26 desmopressin, 34 CYCLOGYL, 49 desmopressin spray, 38 cyclopentolate, 49 DESOGEN, 30 cyclophosphamide, 14 desogestrel/EE, 31 cyclophosphamide inj, 14 desogestrel/EE 0.15/30, 30 CYCLOSET, 29 DESONATE, 45 cyclosporine, 40 desonide crm, lotion, oint 0.05%, 45 cyclosporine, emulsion, 49 desonide foam 0.05%, 45 cyclosporine, modified, 41 desonide gel 0.05%, 45 CYKLOKAPRON inj, 39

DESOWEN, 45 dofetilide, 19 desoximetasone crm, oint 0.05%, 45 dolasetron, 35 desoximetasone crm, oint 0.25%, gel 0.05%, 46 donepezil, 23 desvenlafaxine ext-rel, 23 donepezil orally disintegrating tabs, 23 DETROL, 37 DONNATAL, 35 DETROL LA, 37 DORAL, 25 dexamethasone, 33, 48 DORIBAX, 14 dexamethasone sodium phosphate, 48 doripenem, 14 DEXEDRINE SPANSULE, 25 dornase alfa, 43 DEXILANT, 36 dorzolamide, 49 dexlansoprazole delayed-rel, 36 dorzolamide/timolol maleate, 49 dexmethylphenidate, 25 DOVONEX, 45 dexmethylphenidate ext-rel, 25 doxazosin, 18 dexrazoxane, 16 doxepin, 24, 26 dextroamphetamine, 25 doxepin crm, 47 dextroamphetamine ext-rel, 25 doxercalciferol, 33 dextromethorphan/quinidine, 27 DOXIL, 16 DIABETA, 29 doxorubicin liposomal, 16 DIAMOX SEQUELS, 20 doxycycline hyclate, 11 DIASTAT, 22 doxycycline monohydrate, 11, 46 diazepam, 22 DRISDOL, 41 diazepam rectal gel, 22 DRITHOCREME HP, 45 diazoxide, 33 dronabinol, 35 diclofenac sodium, 44, 48 dronedarone, 19 diclofenac sodium delayed-rel, 8 drospirenone/EE 3/20 - Gianvi, 30 diclofenac sodium delayed-rel/misoprostol, 8 drospirenone/EE 3/30, 30 diclofenac sodium ext-rel, 8 DUAC, 44 diclofenac sodium gel, 8 DUET DHA, 41 dicloxacillin, 11 DUETACT, 29 dicyclomine, 35 DULERA, 43 didanosine delayed-rel, 12 duloxetine delayed-rel, 23 didanosine soln, 12 DUONEB, 42 DIDRONEL, 29 DURAGESIC, 9 DIFFERIN, 44 DUREZOL, 48 DIFICID, 11 dutasteride, 37 diflorasone diacetate crm 0.05%, 46 dutasteride/tamsulosin, 37 diflorasone diacetate emollient crm 0.05%, 46 DUTOPROL, 20 diflorasone diacetate oint 0.05%, 46 DYAZIDE, 21 DIFLUCAN, 11 DYNACIN, 11 diflunisal, 8 DYNACIRC CR, 20 difluprednate, 48 DYSPORT, 27 digoxin, 20 E dihydroergotamine inj, 26 E.E.S., 11 DILACOR XR, 20 ecallantide, 39 DILANTIN, 22 econazole, 44 DILANTIN INFATABS, 22 eculizumab, 39 DILAUDID, 9 EDARBI, 18 diltiazem, 20 EDECRIN, 21 diltiazem ext-rel, 20 EDLUAR, 26 diltiazem ext-rel 360 mg, 20 EDURANT, 12 diltiazem ext-rel, except 360 mg, 20 EE/norethindrone acetate, 32 DIOVAN, 18 efavirenz, 12 DIOVAN HCT, 18 efavirenz/emtricitabine/tenofovir, 12 DIPENTUM, 36 EFFEXOR XR, 23 diphenhydramine, 24, 42 EFFIENT, 39 diphenoxylate/atropine, 35 EFUDEX, 44 DIPROLENE, 46 EGRIFTA, 34 DIPROLENE AF, 46 ELAPRASE, 34 dipyridamole, 39 ELDEPRYL, 24 dipyridamole ext-rel/aspirin, 39 ELESTAT, 47 disopyramide, 18 ELIDEL, 46 disopyramide ext-rel, 18 ELIGARD, 15 disulfiram, 27 ELITEK, 15 DITROPAN XL, 37 ELIXOPHYLLIN, 43 divalproex sodium delayed-rel, 22 ELLA, 31 docetaxel, 16

ELLENCE, 16 estazolam, 25 ELMIRON, 37 ESTRACE, 32 ELOCON, 45 estradiol, 32 ELOXATIN, 17 estradiol transdermal gel, 32 ELSPAR, 16 estradiol transdermal spray, 32 eltrombopag, 39 estradiol vaginal crm, 32 EMEND, 35 estradiol vaginal ring, 32 emollient crm, 46 estradiol vaginal tabs, 32 EMSAM, 23 estradiol valerate, 32 emtricitabine, 12 estradiol valerate and dienogest/estradiol valerate, 31 emtricitabine/rilpivirine/tenofovir, 12 estradiol/levonorgestrel, 32 emtricitabine/tenofovir, 12 estradiol/norethindrone acetate, 32 EMTRIVA, 12 estradiol/norgestimate, 32 ENABLEX, 37 ESTROGEL, 32 enalapril, 17 estrogens, conjugated, 32 enalapril/hydrochlorothiazide, 17 estrogens, conjugated crm, 32 ENBREL, 39 estrogens, conjugated, synthetic B, 32 ENDOMETRIN, 34 estrogens, conjugated/medroxyprogesterone, 32 enfuvirtide, 12 estrogens, esterified/methyltestosterone, 32 ENJUVIA, 32 estropipate, 32 enoxaparin, 37 ESTROSTEP FE, 31 entacapone, 24 etanercept, 39 entecavir, 13 ethacrynic acid, 21 ENTEREG, 37 ethambutol, 13 ENTOCORT EC, 35 ethosuximide, 22 EPIDUO, 44 ethynodiol diacetate/EE 1/35 - Zovia 1/35, 30 EPIFOAM, 36 ethynodiol diacetate/EE 1/50 - Zovia 1/50, 30 epinastine, 47 ETHYOL, 16 epinephrine, 42 etidronate, 29 EPIPEN, 42 etodolac, 8 EPIPEN JR., 42 etodolac ext-rel, 8 epirubicin, 16 etonogestrel implant, 31 EPIVIR, 12 etonogestrel/EE ring, 31 EPIVIR-HBV, 13 ETOPOPHOS, 16 eplerenone, 18 etoposide, 16 epoetin alfa, 38 etoposide phosphate, 16 EPOGEN, 38 etravirine, 12 epoprostenol sodium, 21 EUFLEXXA, 9 eprosartan, 18 EURAX, 47 eprosartan/hydrochlorothiazide, 18 EVAMIST, 32 EPZICOM, 12 everolimus, 15, 41 EQUETRO, 22 EVISTA, 34 ERAXIS, 11 EVOXAC, 36 ERBITUX, 16 EXALGO, 9 ergocalciferol (D2), 41 EXELDERM, 45 ergotamine/caffeine, 26 EXELON, 23 ergotamine/caffeine supp, 26 EXELON PATCH, 23 eribulin, 16 exemestane, 15 ERIVEDGE, 17 exenatide, 28 erlotinib, 15 EXFORGE, 18 ERTACZO, 44 EXFORGE HCT, 18 ertapenem, 14 EXJADE, 39 ERWINAZE, 16 EXTAVIA, 26 ERY-TAB, 11 EYLEA, 49 erythromycin, 47 ezetimibe, 19 erythromycin delayed-rel, 11 ezetimibe/simvastatin, 19 erythromycin dispertabs, 11 ezogabine, 22 erythromycin ethylsuccinate, 11 F erythromycin gel 2%, 44 FABRAZYME, 34 erythromycin soln, 44 FACTIVE, 11 erythromycin stearate, 11 factor IX concentrate, 38 erythromycin/benzoyl peroxide, 44 factor XIII concentrate, 38 erythromycin/sulfisoxazole, 11 famciclovir, 13 escitalopram, 23 famotidine, 35 esmolol, 20 famotidine susp, 35 esomeprazole delayed-rel, 36

FAMVIR, 13 fluorouracil, 44 FANAPT, 24 fluoxetine, 23 FARESTON, 15 fluoxetine delayed-rel, 23 FASLODEX, 15 fluphenazine, 25 FAZACLO, 24 flurandrenolide crm 0.05%, 45 febuxostat, 8 flurandrenolide lotion 0.05%, 45 FEIBA VH IMMUNO, 38 flurandrenolide tape, 45 felbamate, 22 flurazepam, 25 FELBATOL, 22 flurbiprofen, 8, 48 FELDENE, 8 flutamide, 15 felodipine ext-rel, 20 fluticasone, 43 FEMARA, 15 fluticasone furoate spray, 43 FEMHRT, 32 fluticasone propionate crm, lotion 0.05%, oint 0.005%, 45 FEMRING, 32 fluticasone spray, 43 fenofibrate, 19 fluticasone, CFC-free aerosol, 43 fenofibrate, micronized, 19 fluticasone/salmeterol, 43 fenofibric acid, 19 fluticasone/salmeterol, CFC-free aerosol, 43 fenoprofen, 8 fluvastatin, 19 fentanyl citrate buccal, 9 fluvastatin ext-rel, 19 fentanyl transdermal, 9 fluvoxamine, 22 fentanyl transmucosal, 9 fluvoxamine ext-rel, 22 FENTORA, 9 FML, 48 FERAHEME, 41 FOCALIN, 25 FERRIPROX, 39 FOCALIN XR, 25 FERRLECIT, 41 folic acid, 41 ferumoxytol inj, 41 FOLLISTIM AQ, 32 fesoterodine ext-rel, 37 follitropin alfa, 32 fibrinogen, 38 follitropin beta, 32 fidaxomicin, 11 FOLOTYN, 15 filgrastim, 38 fondaparinux, 38 FINACEA, 46 FORADIL, 42 finasteride, 37 formoterol inhalation caps, 42 fingolimod, 26 FORTAMET, 28 FIORICET, 9 FORTAZ, 10 FIORICET w/CODEINE, 9 FORTEO, 30 FIORINAL, 9 FORTESTA, 27 FIORINAL w/CODEINE, 9 FOSAMAX, 29 FIRAZYR, 39 FOSAMAX PLUS D, 29 FIRMAGON, 15 fosamprenavir, 12 FLAGYL, 14 foscarnet, 13 FLAREX, 48 fosinopril, 17 FLEBOGAMMA, 40 fosinopril/hydrochlorothiazide, 17 flecainide, 18 FOSRENOL, 33 FLEXERIL, 26 FRAGMIN, 38 FLOLAN, 21 FROVA, 26 FLOMAX, 37 frovatriptan, 26 FLONASE, 43 fulvestrant, 15 FLOVENT, 43 furosemide, 21 FLOVENT HFA, 43 FUSILEV, 16 floxuridine, 14 FUZEON, 12 fluconazole, 11 G FLUDARA, 14 gabapentin, 22 fludarabine, 14 GABITRIL, 23 fludrocortisone, 33 galantamine, 23 FLUMADINE, 13 galantamine ext-rel, 23 flunisolide spray, 43 gallium nitrate, 34 fluocinolone acetonide, 50 galsulfase, 34 fluocinolone acetonide crm, oint 0.025%, 45 GALZIN, 41 fluocinolone acetonide soln 0.01%, 45 GAMASTAN S-D, 40 fluocinonide crm 0.1%, 46 GAMMAGARD LIQUID, 40 fluocinonide crm, gel, oint, soln 0.05%, 46 GAMMAGARD S-D, 40 fluoride drops, 41 GAMMAKED, 40 fluoride tabs, 41 GAMMAPLEX, 40 fluorometholone, 48 GAMUNEX, 40 fluorometholone acetate, 48 GAMUNEX-C, 40 FLUOROPLEX, 44

60 ganciclovir, 13, 48 HIZENTRA, 40 ganciclovir inj, 13 homatropine, 49 GANIRELIX, 32 HUMALOG, 28 ganirelix acetate, 32 HUMALOG MIX, 28 GANITE, 34 HUMATE-P, 38 GASTROCROM, 37 HUMATROPE, 33 gemcitabine, 14 HUMIRA, 39 gemfibrozil, 19 HUMULIN 70/30, 28 gemifloxacin, 11 HUMULIN N, 28 GEMZAR, 14 HUMULIN R, 28 GENOTROPIN, 33 HYALGAN, 9 gentamicin, 44, 47 HYCAMTIN, 16 gentamicin/prednisolone acetate, 48 HYCAMTIN inj, 16 GEODON, 24 hydralazine, 21 GILENYA, 26 HYDREA, 16 GLASSIA, 44 hydrochlorothiazide, 21 glatiramer, 26 hydrocodone/acetaminophen, 9 GLEEVEC, 15 hydrocodone/chlorpheniramine/pseudoephedrine, 42 GLIADEL WAFER, 14 hydrocodone/homatropine, 42 glimepiride, 29 hydrocodone/pseudoephedrine, 42 glipizide, 29 hydrocortisone, 33 glipizide ext-rel, 29 hydrocortisone acetate foam, 36 glipizide/metformin, 28 hydrocortisone acetate/pramoxine foam, 36 GLUCAGON EMERGENCY KIT, 33 hydrocortisone crm, 36 glucagon, human recombinant, 33 hydrocortisone crm 2.5%, 45 GLUCOPHAGE, 28 hydrocortisone enema, 36 GLUCOPHAGE XR, 28 hydrocortisone lotion 1%, 45 GLUCOTROL, 29 hydrocortisone probutate crm 0.1%, 45 GLUCOTROL XL, 29 hydrocortisone valerate crm, oint 0.2%, 45 GLUCOVANCE, 28 hydrocortisone/aloe polysaccharide/iodoquinol, 47 glyburide, 29 hydrocortisone/neomycin/colistin/thonzonium, 50 glyburide, micronized, 29 hydrocortisone/pramoxine/chloroxylenol, 50 glyburide/metformin, 28 hydromorphone, 9 glycopyrrolate, 37 hydromorphone ext-rel, 9 GLYNASE, 29 hydroxocobalamin, 34 GLYSET, 28 hydroxychloroquine, 39 golimumab, 39 hydroxyprogesterone caproate, 33 GOLYTELY, 36 hydroxyurea, 16 gonadorelin, 32 hydroxyzine HCl, 22, 42 GONAL-F, 32 hydroxyzine pamoate, 22, 42 GONAL-F RFF, 32 hylan G-F 20, 9 goserelin acetate, 15 hyoscyamine sulfate, 35 granisetron, 35 hyoscyamine sulfate ext-rel, 35 granisetron transdermal, 35 HYPERHEP B S-D, 40 GRIFULVIN V, 11 HYPERRHO S-D, 40 griseofulvin microsize, 11 HYZAAR, 18 griseofulvin ultramicrosize, 11 I GRIS-PEG, 11 ibandronate, 29 guanfacine ext-rel, 25 ibandronate inj, 30 H ibuprofen, 8 HALAVEN, 16 ibuprofen inj, 8 HALFLYTELY, 36 icatibant, 39 halobetasol propionate crm, oint 0.05%, 46 idursulfase, 34 haloperidol, 25 ifosfamide/mesna, 14 HECTOROL, 33 ILARIS, 40 HELIXATE FS, 38 iloperidone, 24 HEMOFIL M, 38 iloprost, 21 HEPAGAM B, 40 imatinib mesylate, 15 hepatitis B immune globulin, 40 IMDUR, 21 HEPSERA, 13 imiglucerase, 34 HERCEPTIN, 17 imipenem/cilastatin, 14 HEXALEN, 14 imipramine HCl, 24 high molecular weight hyaluronan, 9 imipramine pamoate, 24 HIPREX, 14 imiquimod, 47 histrelin acetate, 15, 34 IMITREX, 26

61 immune globulin, gamma, 40 isosorbide mononitrate, 21 immune globulin, gamma (IGG), 40 isosorbide mononitrate ext-rel, 21 immune globulin, intravenous, 40 isotretinoin, 44 immune globulin, subcutaneous, 40 isradipine ext-rel, 20 IMPLANON, 31 ISTALOL, 48 IMURAN, 40 ISTODAX, 17 INCIVEK, 13 itraconazole caps, 11 incobotulinumtoxinA, 27 itraconazole oral soln, 11 INCRELEX, 33 ivacaftor, 43 indacaterol, 42 ixabepilone, 16 indapamide, 21 IXEMPRA, 16 INDERAL LA, 19 J indinavir, 12 JAKAFI, 15 INDOCIN susp, 8 JALYN, 37 indomethacin, 8 JANUMET, 28 indomethacin ext-rel, 8 JANUMET XR, 28 indomethacin susp, 8 JANUVIA, 28 INFERGEN, 40 JENTADUETO, 28 infliximab, 39 JEVTANA, 16 INLYTA, 15 JUVISYNC, 28 INNOHEP, 38 INNOPRAN XL, 20 K INSPRA, 18 KADIAN, 9 insulin aspart, 28 KALBITOR, 39 insulin aspart protamine 70%/insulin aspart 30%, 28 KALETRA, 12 insulin detemir, 28 KALYDECO, 43 insulin glargine, 28 KAPVAY, 25 insulin glulisine, 28 KEFLEX, 10 insulin human, 28 KEPIVANCE, 37 insulin isophane human, 28 KEPPRA, 22 insulin isophane human 70%/regular 30%, 28 KEPPRA XR, 22 insulin lispro, 28 KETEK, 11 insulin lispro protamine/insulin lispro, 28 ketoconazole, 44 insulin syringes, 29 ketoconazole 2%, 44 INTELENCE, 12 ketoconazole shampoo 2%, 45 interferon alfa-2b, 40 ketoconazole tabs, 11 interferon alfacon-1, 40 ketoprofen, 8 interferon alfa-n3, 47 ketoprofen ext-rel, 8 interferon beta-1a, 26 ketorolac, 8 interferon beta-1b, 26 ketorolac 0.5%, 48 interferon gamma-1b, recombinant, 40 ketorolac tromethamine nasal spray, 8 INTRON A, 40 KINERET, 39 INTUNIV, 25 KLONOPIN, 22 INVANZ, 14 KOATE-DVI, 38 INVEGA, 25 KOGENATE FS, 38 INVEGA SUSTENNA, 24 KOMBIGLYZE XR, 28 INVIRASE, 13 KRYSTEXXA, 8 ipilimumab, 16 KUVAN, 33 ipratropium soln, 42 L ipratropium spray, 44 LAC-HYDRIN, 46 ipratropium, CFC-free aerosol, 42 lacosamide, 22 ipratropium/albuterol, 42 lactulose, 36 ipratropium/albuterol soln, 42 LAMICTAL, 22 IPRIVASK, 38 LAMICTAL ODT, 22 irbesartan, 18 LAMICTAL XR, 22 irbesartan/hydrochlorothiazide, 18 LAMISIL, 11, 45 irinotecan, 16 lamivudine, 12, 13 iron sucrose inj, 41 lamivudine/zidovudine, 12 ISENTRESS, 12 lamotrigine, 22 isocarboxazid, 23 lamotrigine ext-rel, 22 isoniazid, 13 lamotrigine orally disintegrating tablets, 22 ISOPTO HOMATROPINE, 49 lancet device, 29 ISOPTO HYOSCINE, 49 lancets, 29 ISORDIL, 21 LANOXIN, 20 isosorbide dinitrate oral, 21 lanreotide acetate, 34 isosorbide dinitrate/hydralazine, 21

62 lansoprazole delayed-rel, 36 LITHOBID, 26 lanthanum, 33 LIVALO, 19 LANTUS, 28 LO/OVRAL, 30 lapatinib, 15 lodoxamide, 47 laronidase, 34 LOESTRIN 1.5/30, 30 LASIX, 21 LOESTRIN 1/20, 30 LASTACAFT, 47 LOESTRIN 24 FE, 30 latanoprost, 49 LOESTRIN FE 1.5/30, 30 LATUDA, 24 LOESTRIN FE 1/20, 30 leflunomide, 39 LOMOTIL, 35 lenalidomide, 15 lomustine, 14 LESCOL, 19 loperamide, 35 LESCOL XL, 19 LOPID, 19 LETAIRIS, 21 lopinavir/ritonavir, 12 letrozole, 15 LOPRESSOR, 19 leucovorin calcium, 16 LOPRESSOR HCT, 20 LEUKERAN, 14 LOPROX, 44 LEUKINE, 38 lorazepam, 22 leuprolide acetate, 15 LORCET, 9 LEVAQUIN, 11 LORTAB, 9 LEVATOL, 20 losartan, 18 LEVBID, 35 losartan/hydrochlorothiazide, 18 LEVEMIR, 28 LOSEASONIQUE, 31 levetiracetam, 22 LOTEMAX, 48 levetiracetam ext-rel, 22 LOTENSIN, 17 levobunolol, 48 LOTENSIN HCT, 17 levocarnitine, 34 loteprednol 0.2%, 47 levocetirizine, 42 loteprednol 0.5%, 48 levofloxacin, 11, 47 LOTREL, 17 levoleucovorin calcium, 16 LOTRONEX, 36 levonorgestrel - Next Choice, 31 lovastatin, 19 levonorgestrel releasing IUD, 31 LOVAZA, 19 levonorgestrel/EE - Trivora, 31 LOVENOX, 37 levonorgestrel/EE 0.09/20, 31 loxapine, 25 levonorgestrel/EE 0.1/20, 30 LOXITANE, 25 levonorgestrel/EE 0.1/20 and EE 10, 31 lubiprostone, 36 levonorgestrel/EE 0.15/30, 30, 31 LUCENTIS, 49 levonorgestrel/EE 0.15/30 - Levora, 30 LUMIGAN, 49 levonorgestrel/EE 0.15/30 and EE 10, 31 LUMIZYME, 34 levothyroxine, 34 LUPRON DEPOT, 15 levothyroxine - Levoxyl, 34 LUPRON DEPOT-PED, 15 LEVSIN, 35 lurasidone, 24 LEXAPRO, 23 LURIDE, 41 LEXIVA, 12 LURIDE LOZI-TABS, 41 LIALDA, 35 LUTREPULSE, 32 lidocaine, 46 LUVOX CR, 22 lidocaine patch, 46 LYBREL, 31 lidocaine viscous, 47 LYRICA, 22 lidocaine/prilocaine, 46 LYSODREN, 16 LIDODERM, 46 LYSTEDA, 39 linagliptin, 28 M linagliptin/metformin, 28 MACROBID, 14 lindane, 47 MACRODANTIN, 14 linezolid, 14 MACUGEN, 49 LIORESAL INTRATHECAL, 26 MAKENA, 33 liothyronine, 34 MALARONE, 12 liotrix, 34 maraviroc, 12 LIPITOR, 19 MARINOL, 35 LIPOFEN, 19 MARPLAN, 23 liraglutide, 28 MATULANE, 16 lisdexamfetamine, 25 MAVIK, 17 lisinopril, 17 MAXALT/MAXALT-MLT, 26 lisinopril/hydrochlorothiazide, 17 MAXIDEX, 48 lithium carbonate, 26 MAXITROL, 48 lithium carbonate ext-rel tabs 300 mg, 26 MAXZIDE, 21 lithium carbonate ext-rel tabs 450 mg, 26

MAXZIDE-25, 21 metronidazole crm 0.75%, 46 mebendazole, 13 metronidazole gel 0.75%, 46 mecasermin, 33 metronidazole gel 1%, 46 mechlorethamine, 14 metronidazole lotion 0.75%, 46 meclizine, 35 metronidazole tabs, 14 MEDROL, 33 MEVACOR, 19 medroxyprogesterone acetate, 34 mexiletine, 18 medroxyprogesterone acetate 150 mg/mL, 31 MIACALCIN, 30 mefloquine, 12 MIACALCIN inj, 30 MEFOXIN, 10 micafungin, 12 MEGACE, 15 MICARDIS, 18 MEGACE ES, 15 MICARDIS HCT, 18 megestrol acetate, 15 miconazole nitrate/zinc oxide, 44 megestrol acetate susp, 15 MICRHOGAM, 40 meloxicam, 8 MICRHOGAM PLUS, 40 melphalan, 14 midodrine, 22 memantine, 23 MIGERGOT, 26 MENOPUR, 32 miglitol, 28 menotropins, 32 miglustat, 34 MEPHYTON, 41 MILLIPRED, 33 MEPRON, 14 milnacipran, 25 mercaptopurine, 14 MIMYX, 46 meropenem, 14 MINIPRESS, 18 MERREM, 14 MINOCIN, 11 mesalamine delayed-rel tabs, 35 minocycline, 11 mesalamine ext-rel caps, 36 minocycline ext-rel, 11 mesalamine rectal susp, 36 minoxidil, 22 mesalamine supp, 36 MIRAPEX, 24 mesna inj, 16 MIRAPEX ER, 24 mesna tabs 400 mg, 16 MIRCETTE, 31 MESNEX, 16 MIRENA, 31 MESNEX inj, 16 mirtazapine, 24 MESTINON, 27 misoprostol, 36 MESTINON syrup, 27 mitomycin, 16 MESTINON TIMESPAN, 27 mitotane, 16 METADATE CD, 25 mitoxantrone, 16 METAGLIP, 28 MOBIC, 8 metaproterenol, 43 modafinil, 27 metformin, 28 MODICON, 30 metformin ext-rel, 28 mometasone, 43 metformin soln, 28 mometasone crm, lotion, oint 0.1%, 45 methazolamide, 20 mometasone spray, 43 methenamine hippurate, prophylaxis, 14 mometasone/formoterol, 43 METHERGINE, 34 MONOCLATE-P, 38 methimazole, 34 MONODOX, 11 methotrexate, 39, 40 MONONINE, 38 methoxsalen inj, 16 montelukast, 43 methoxsalen oral, 45 morphine, 9 methylergonovine, 34 morphine ext-rel, 9 methylnaltrexone, 37 morphine supp, 9 methylphenidate, 25 MOVIPREP, 36 methylphenidate ext-rel, 25 MOXATAG, 11 methylphenidate transdermal, 25 moxifloxacin, 11, 48 methylprednisolone, 33 MOZOBIL, 39 metipranolol, 48 MS CONTIN, 9 metoclopramide, 35 MULTAQ, 19 metolazone, 21 multivitamins/fluoride drops, tabs, 41 metoprolol, 19 multivitamins/fluoride/iron drops, tabs, 41 metoprolol ext-rel, 19 mupirocin, 44 metoprolol succinate ext-rel/hydrochlorothiazide, 20 MUSTARGEN, 14 metoprolol/hydrochlorothiazide, 20 MYAMBUTOL, 13 METROCREAM, 46 MYCAMINE, 12 METROGEL, 46 MYCOBUTIN, 13 METROGEL-VAGINAL, 37 mycophenolate mofetil, 40 METROLOTION, 46 mycophenolate sodium delayed-rel, 40 metronidazole, 37 MYFORTIC, 40

MYLERAN, 14 nicotine transdermal, 27 MYOBLOC, 27 nifedipine ext-rel, 20 MYOZYME, 34 NILANDRON, 15 MYSOLINE, 22 nilotinib, 15 N nilutamide, 15 nimodipine, 20 nabumetone, 8 NIMOTOP, 20 nafarelin, 31 NIPENT, 15 naftifine, 44 nisoldipine ext-rel, 20 NAFTIN, 44 nitazoxanide, 14 NAGLAZYME, 34 nitisinone, 34 NALFON, 8 NITRO-DUR, 21 naloxone inj, 27 nitrofurantoin ext-rel, 14 naltrexone, 27 nitrofurantoin macrocrystals, 14 naltrexone microspheres, 27 nitroglycerin rectal oint 0.4%, 37 NAMENDA, 23 nitroglycerin sublingual, 21 naphazoline, 49 nitroglycerin sublingual spray, 21 NAPRELAN, 8 nitroglycerin transdermal, 21 NAPROSYN, 8 NITROLINGUAL, 21 naproxen, 8 NITROSTAT, 21 naproxen sodium, 8 nizatidine, 35 naproxen sodium ext-rel, 8 NIZORAL SHAMPOO, 45 naproxen/esomeprazole delayed-rel, 8 NORDETTE, 30 naratriptan, 26 NORDITROPIN, 33 NARDIL, 23 norelgestromin/EE, 31 NASACORT AQ, 43 norethindrone, 31 NASCOBAL, 41 norethindrone acetate, 34 NASONEX, 43 norethindrone acetate/EE 1.5/30, 30 NATACYN, 47 norethindrone acetate/EE 1.5/30 and iron, 30 natalizumab, 26 norethindrone acetate/EE 1/20, 30 natamycin, 47 norethindrone acetate/EE 1/20 and iron, 30 NATAZIA, 31 norethindrone acetate/EE and iron, 31 nateglinide, 29 norethindrone/EE, 31 NATROBA, 47 norethindrone/EE 0.4/35, 30 NAVANE, 25 norethindrone/EE 0.5/35, 30 NAVELBINE, 16 norethindrone/EE 1/35, 30 nebivolol, 20 norethindrone/EE 1/50, 30 NECON 10/11, 31 norethindrone/ME 1/50, 30 nefazodone, 24 norgestimate/EE, 31 nelarabine, 17 norgestimate/EE 0.25/35, 30 nelfinavir, 12 norgestrel/EE 0.3/30, 30 NEOBENZ MICRO, 44 norgestrel/EE 0.3/30 - Low-Ogestrel, 30 neomycin/dexamethasone, 48 norgestrel/EE 0.5/50, 30 neomycin/polymyxin B/dexamethasone, 48 NORINYL 1+35, 30 neomycin/polymyxin B/gramicidin, 47 NORINYL 1+50, 30 neomycin/polymyxin B/hydrocortisone, 49 NORPACE, 18 neomycin/polymyxin B/hydrocortisone susp, 48 NORPACE CR, 18 NEORAL, 41 NORPRAMIN, 23 NEOSPORIN, 47 NOR-QD, 31 nepafenac, 48 nortriptyline, 24 NEULASTA, 38 NORVASC, 20 NEUMEGA, 39 NORVIR, 12 NEUPOGEN, 38 NOVOLIN 70/30, 28 NEURONTIN, 22 NOVOLIN N, 28 NEVANAC, 48 NOVOLIN R, 28 nevirapine, 12 NOVOLOG, 28 nevirapine ext-rel, 12 NOVOLOG MIX 70/30, 28 NEXAVAR, 15 NOVOSEVEN, 38 NEXIUM, 36 NOVOSEVEN RT, 38 NEXPLANON, 31 NOXAFIL, 12 niacin ext-rel, 19 NPLATE, 38 niacin ext-rel/lovastatin, 19 NUCYNTA, 9 niacin ext-rel/simvastatin, 19 NUCYNTA ER, 9 NIASPAN, 19 NUEDEXTA, 27 nicardipine, 20 NULOJIX, 41 nicardipine ext-rel, 20 NULYTELY, 36

NUTROPIN AQ NUSPIN, 33 oxcarbazepine susp, 22 NUTROPIN/NUTROPIN AQ, 33 oxiconazole, 44 NUVARING, 31 OXISTAT, 44 NUVIGIL, 27 OXSORALEN-ULTRA, 45 nystatin, 11, 44 oxybutynin, 37 O oxybutynin ext-rel, 37 oxybutynin transdermal, 37 OCTAGAM, 40 oxycodone, 9 octreotide acetate, 34 oxycodone concentrate 20 mg/mL, 9 OCUFEN, 48 oxycodone ext-rel, 9 OCUFLOX, 47 oxycodone soln, 9 ofatumumab, 17 oxycodone/acetaminophen 5/325, 9 OFIRMEV, 8 OXYCONTIN, 9 ofloxacin, 11, 47 oxymorphone, 9 ofloxacin otic, 49 oxymorphone ext-rel, 9 olanzapine, 24 OXYTROL, 37 olanzapine pamoate, 24 OZURDEX, 48 olanzapine/fluoxetine, 24 OLEPTRO, 24 P olmesartan, 18 paclitaxel protein-bound particles, 17 olmesartan/amlodipine/hydrochlorothiazide, 18 palifermin, 37 olmesartan/hydrochlorothiazide, 18 paliperidone ext-rel, 25 olopatadine, 43, 47 paliperidone palmitate, 24 olsalazine, 36 palivizumab, 13 omalizumab, 44 palonosetron, 35 omega-3 acid ethyl esters, 19 PAMELOR, 24 omeprazole delayed-rel, 36 pamidronate, 29 omeprazole/sodium bicarbonate, 36 PANCREAZE, 36 OMNITROPE, 33 pancrelipase delayed-rel, 36 onabotulinumtoxinA, 27 PANDEL, 45 ONCASPAR, 17 panitumumab, 17 ondansetron, 35 PANRETIN, 47 ondansetron oral soluble film, 35 pantoprazole delayed-rel, 36 ONETOUCH LANCETS, 29 PARCOPA, 24 ONETOUCH test strips, 29 paricalcitol, 33 ONFI, 23 PARLODEL, 24 ONGLYZA, 28 PARNATE, 23 ONTAK, 16 paroxetine HCl, 23 OPANA, 9 paroxetine HCl ext-rel, 23 OPANA ER, 9 paroxetine mesylate, 23 opium tincture, 35 PATANASE, 43 oprelvekin, 39 PATANOL, 47 OPTIPRANOLOL, 48 PAXIL, 23 ORACEA, 46 PAXIL CR, 23 ORAPRED, 33 pazopanib, 15 ORAPRED ODT, 33 PCE, 11 ORENCIA, 39 PEDIAPRED, 33 ORFADIN, 34 peg 3350/electrolytes, 36 ORTHO EVRA, 31 peg 3350/electrolytes + bisacodyl, 36 ORTHO MICRONOR, 31 pegademase, bovine, 34 ORTHO TRI-CYCLEN, 31 pegaptanib sodium, 49 ORTHO TRI-CYCLEN LO, 31 pegaspargase, 17 ORTHO-CEPT, 30 PEGASYS, 40 ORTHO-CYCLEN, 30 pegfilgrastim, 38 ORTHO-NOVUM 1/35, 30 peginterferon alfa-2a, 40 ORTHO-NOVUM 7/7/7, 31 peginterferon alfa-2b, 40 ORTHOVISC, 9 PEGINTRON, 40 oseltamivir, 13 PEGINTRON REDIPEN, 40 OSMOPREP, 36 pegloticase, 8 OVCON 35, 30 pegvisomant, 34 OVCON 50, 30 pemetrexed, 14 OVIDREL, 32 penbutolol, 20 oxaliplatin, 17 penicillamine, 40 oxaprozin, 8 penicillin VK, 11 oxazepam, 22 PENTASA, 36 oxcarbazepine, 22 pentosan polysulfate sodium, 37

66 pentostatin, 15 prednisolone phosphate 1%, 48 pentoxifylline ext-rel, 39 prednisolone sodium phosphate, 33 PEPCID, 35 prednisolone sodium phosphate orally disintegrating tablet, 33 PEPCID susp, 35 prednisolone syrup, 33 PERCOCET, 9 prednisone, 33 perindopril, 17 PREFEST, 32 permethrin 5%, 47 pregabalin, 22 perphenazine, 25 PRELONE, 33 PERSANTINE, 39 PREMARIN, 32 PEXEVA, 23 PREMARIN crm, 32 phenazopyridine, 37 PREMPHASE, 32 phenelzine, 23 PREMPRO, 32 phenobarbital, 22 prenatal vitamins/docusate/folic acid, 41 phenylephrine, 47 prenatal vitamins/folic acid, 41 phenytoin, 22 PRENATE ELITE, 41 phenytoin sodium extended, 22 PREVIDENT, 41 PHOSLO, 33 PREZISTA, 12 PHOTOFRIN, 17 PRIALT, 9 PHRENILIN FORTE, 9 PRIFTIN, 13 phytonadione, 41 PRILOSEC, 36 pilocarpine, 49 primaquine, 12 pilocarpine tabs, 36 PRIMAXIN, 14 PILOPINE HS GEL, 49 primidone, 22 pimecrolimus, 46 PRINIVIL, 17 pindolol, 19 PRINZIDE, 17 pioglitazone, 28 PRISTIQ, 23 pioglitazone/glimepiride, 29 PRIVIGEN, 40 pioglitazone/metformin, 29 PROAIR HFA, 42 pioglitazone/metformin ext-rel, 29 probenecid, 8 piperacillin/tazobactam, 11 procarbazine, 16 piroxicam, 8 PROCARDIA XL, 20 pitavastatin, 19 prochlorperazine, 35 PLAQUENIL, 39 PROCRIT, 38 PLAVIX, 39 PROCTOFOAM-HC, 36 plerixafor, 39 PROFILNINE SD, 38 PLETAL, 39 progesterone supp, 34 podofilox, 47 progesterone, micronized, 34 polymyxin B/bacitracin, 47 PROGLYCEM, 33 polymyxin B/trimethoprim, 47 PROGRAF, 41 POLYTRIM, 47 PROLEUKIN, 16 porfimer sodium, 17 PROLIA, 30 posaconazole, 12 PROMACTA, 39 potassium chloride ext-rel, 41 promethazine, 35, 42 potassium chloride liquid, 41 PROMETRIUM, 34 potassium chloride powder, 41 propafenone ext-rel, 18 potassium citrate, 37 propantheline 15 mg, 35 potassium citrate 15 mEq, 37 propranolol, 19 POTIGA, 22 propranolol ext-rel, 19, 20 PRADAXA, 38 propylthiouracil, 34 pralatrexate, 15 PROSCAR, 37 pramipexole, 24 protein C concentrate, human, 39 pramipexole ext-rel, 24 PROTONIX, 36 pramlintide, 28 PROTOPIC, 46 PRANDIMET, 29 protriptyline, 24 PRANDIN, 29 PROVENGE, 16 prasugrel, 39 PROVENTIL HFA, 42 PRAVACHOL, 19 PROVERA, 34 pravastatin, 19 PROVIGIL, 27 prazosin, 18 PROZAC, 23 PRECOSE, 28 PROZAC WEEKLY, 23 PRED FORTE, 48 PULMICORT FLEXHALER, 43 PRED MILD, 48 PULMICORT RESPULES, 43 PRED-G, 48 PULMOZYME, 43 prednisolone, 33 PURINETHOL, 14 prednisolone acetate 0.12%, 48 PYLERA, 37 prednisolone acetate 1%, 48 pyrazinamide, 13

PYRIDIUM, 37 REZIRA, 42 pyridostigmine ext-rel tabs 180 mg, 27 RHEUMATREX, 40 pyridostigmine syrup, 27 RHINOCORT AQUA, 43 pyridostigmine tabs 60 mg, 27 Rho (D) immune globulin, 40 pyrimethamine, 12 RHOGAM, 40 Q RHOGAM PLUS, 40 RHOPHYLAC, 40 QUADRAMET, 17 RIASTAP, 38 quazepam, 25 ribavirin caps, 13 QUESTRAN/QUESTRAN LIGHT, 19 ribavirin caps - Ribasphere, 13 quetiapine, 24 ribavirin oral soln, 13 quetiapine ext-rel, 24 ribavirin tabs, 13 quinapril, 17 ribavirin tabs - Ribapak, 13 quinapril/hydrochlorothiazide, 17 ribavirin tabs - Ribatab, 13 quinidine gluconate ext-rel, 18 RIDAURA, 40 quinidine sulfate ext-rel, 18 rifabutin, 13 QUTENZA, 46 RIFADIN, 13 QVAR, 43 rifampin, 13 R rifampin/isoniazid/pyrazinamide, 13 rabeprazole delayed-rel, 36 rifapentine, 13 raloxifene, 34 RIFATER, 13 raltegravir, 12 rifaximin, 14 ramelteon, 26 rilonacept, 40 ramipril, 17 rilpivirine, 12 RANEXA, 22 RILUTEK, 27 ranibizumab, 49 riluzole, 27 ranitidine, 35 rimabotulinumtoxinB, 27 ranolazine ext-rel, 22 rimantadine, 13 RAPAFLO, 37 rimexolone, 48 RAPAMUNE, 41 RIOMET, 28 rasagiline mesylate, 24 risedronate, 30 rasburicase, 15 RISPERDAL, 24 RAZADYNE, 23 RISPERDAL CONSTA, 24 RAZADYNE ER, 23 risperidone, 24 REBETOL, 13 risperidone long-acting inj, 24 REBIF, 26 RITALIN, 25 RECLAST, 30 RITALIN LA, 25 RECOMBINATE, 38 RITALIN-SR, 25 RECTIV, 37 ritonavir, 12 REFACTO, 38 RITUXAN, 17 REGLAN, 35 rituximab, 17 REGRANEX, 47 rivaroxaban, 38 RELENZA, 13 rivastigmine, 23 RELISTOR, 37 rivastigmine transdermal, 23 REMERON, 24 rizatriptan, 26 REMICADE, 39 ROCALTROL, 33 REMODULIN, 21 ROCEPHIN, 10 RENAGEL, 33 roflumilast, 43 RENOVA, 47 romidepsin, 17 RENVELA, 33 romiplostim, 38 repaglinide, 29 ropinirole, 24 repaglinide/metformin, 29 ropinirole ext-rel, 24 REPRONEX, 32 rosiglitazone, 29 REQUIP, 24 rosiglitazone/glimepiride, 29 REQUIP XL, 24 rosiglitazone/metformin, 29 RESCRIPTOR, 12 rosuvastatin, 19 RESTASIS, 49 ROWASA, 36 RESTORIL, 25 ROXICODONE, 9 retapamulin, 44 ROZEREM, 26 RETIN-A, 44 rufinamide, 23 RETIN-A MICRO, 44 ruxolitinib, 15 RETROVIR, 12 RYTHMOL SR, 18 REVATIO, 21 RYZOLT, 9 REVIA, 27 S REVLIMID, 15 SABRIL, 23 REYATAZ, 12

68 sacrosidase, 37 sodium sulfate/potassium sulfate/magnesium sulfate, 36 SAIZEN, 33 SOFTCLIX LANCET DEVICE, 29 SALAGEN, 36 SOFTCLIX LANCETS, 29 salmeterol xinafoate, 42 SOFTTOUCH LANCET DEVICE, 29 samarium sm 153 lexidronam, 17 SOFTTOUCH LANCETS, 29 SAMSCA, 34 SOLARAZE, 44 SANCTURA, 37 solifenacin succinate, 37 SANCTURA XR, 37 SOLIRIS, 39 SANCUSO, 35 SOLODYN, 11 SANDIMMUNE, 40 somatropin, 33 SANDOSTATIN, 34 SOMATULINE DEPOT, 34 SANDOSTATIN LAR, 34 SOMAVERT, 34 SAPHRIS, 24 SOMNOTE, 26 sapropterin, 33 SONATA, 25 saquinavir mesylate, 13 sorafenib, 15 SARAFEM, 23 SORIATANE, 45 sargramostim, 38 sotalol, 18 SAVELLA, 25 SPECTRACEF, 10 saxagliptin, 28 spinosad, 47 saxagliptin/metformin ext-rel, 28 SPIRIVA, 42 scopolamine, 49 spironolactone, 18 scopolamine transdermal, 35 spironolactone/hydrochlorothiazide, 21 SEASONALE, 31 SPORANOX caps, 11 SEASONIQUE, 31 SPORANOX oral soln, 11 secobarbital, 26 SPRIX, 8 SECONAL, 26 SPRYCEL, 15 SECTRAL, 19 STALEVO, 24 selegiline caps, 24 STARLIX, 29 selegiline orally disintegrating tabs, 24 stavudine, 12 selegiline transdermal, 23 STAVZOR, 23 selenium sulfide shampoo 2.5%, 45 STELARA, 45 SELSUN, 45 STIMATE, 38 SELZENTRY, 12 STRATTERA, 25 SENSIPAR, 29 streptozocin, 14 SEREVENT DISKUS, 42 SUBOXONE, 27 SEROQUEL, 24 SUCRAID, 37 SEROQUEL XR, 24 sucralfate, 37 SEROSTIM, 33 SULAR, 20 sertaconazole, 44 sulconazole, 45 sertraline, 23 sulfacetamide soln 10%, 48 sevelamer, 33 sulfacetamide/prednisolone acetate oint 10%/0.2%, 48 sevelamer carbonate, 33 sulfacetamide/prednisolone phosphate 10%/0.25%, 48 sildenafil, 21 sulfacetamide/sulfur, 46 SILENOR, 26 sulfamethoxazole/trimethoprim, 14 silodosin, 37 sulfamethoxazole/trimethoprim DS, 14 SILVADENE, 44 sulfasalazine, 35 silver sulfadiazine, 44 sulfasalazine delayed-rel, 35 SIMCOR, 19 sulindac, 8 SIMPONI, 39 sumatriptan, 26 simvastatin, 19 sumatriptan/naproxen sodium, 26 sinecatechins, 47 sunitinib, 15 SINEMET, 24 SUPARTZ, 9 SINEMET CR, 24 SUPPRELIN LA, 34 SINGULAIR, 43 SUPREP, 36 sipuleucel-T, 16 SUSTIVA, 12 sirolimus, 41 SUTENT, 15 sitagliptin phosphate, 28 SYLATRON, 40 sitagliptin/metformin, 28 SYMBICORT, 43 sitagliptin/metformin ext-rel, 28 SYMBYAX, 24 sitagliptin/simvastatin, 28 SYMLINPEN, 28 SKELID, 30 SYNAGIS, 13 sodium ferric gluconate inj, 41 SYNAREL, 31 sodium fluoride, 41 SYNTHROID, 34 sodium hyaluronate, 9 SYNVISC, 9 sodium oxybate, 27 SYNVISC-ONE, 9 sodium phosphates, 36 SYPRINE, 34

T theophylline ext-rel caps, 43 TACHOSIL, 47 theophylline ext-rel tabs, 43 TACLONEX, 45 theophylline liquid, 43 tacrolimus, 41, 46 THERACYS, 16 tadalafil, 21 thioguanine, 14 tadalafil 2.5 mg, 5 mg, 37 thioridazine, 25 tafluprost, 49 thiotepa, 14 TAMBOCOR, 18 thiothixene, 25 TAMIFLU, 13 THYROGEN, 34 tamoxifen, 15 thyroid, 34 tamsulosin, 37 THYROLAR, 34 TAPAZOLE, 34 thyrotropin alfa, 34 tapentadol, 9 tiagabine, 23 tapentadol ext-rel, 9 TIAZAC, 20 TARCEVA, 15 ticagrelor, 39 TARGRETIN caps, 16 TICE BCG, 16 TARKA, 17 ticlopidine, 39 TASIGNA, 15 TIGAN, 35 TASMAR, 24 tigecycline, 14 TAXOTERE, 16 TIKOSYN, 19 tazarotene, 45 tiludronate, 30 TAZORAC, 45 timolol hemihydrate, 48 TEFLARO, 10 timolol maleate, 48 TEGRETOL, 22 timolol maleate gel, 48 TEGRETOL-XR, 22 TIMOPTIC, 48 TEKAMLO, 20 TIMOPTIC-XE, 48 TEKTURNA, 20 TINDAMAX, 14 TEKTURNA HCT, 20 tinidazole, 14 telaprevir, 13 tinzaparin, 38 telavancin, 14 tiotropium, 42 telbivudine, 13 tipranavir, 13 telithromycin, 11 TOBI, 43 telmisartan, 18 TOBRADEX, 48 telmisartan/hydrochlorothiazide, 18 tobramycin, 48 temazepam, 25 tobramycin inhalation soln, 43 TEMODAR, 14 tobramycin/dexamethasone, 48 TEMOVATE, 46 tobramycin/loteprednol, 48 temozolomide, 14 TOBREX, 48 temsirolimus, 16 tocilizumab, 40 teniposide, 17 TOFRANIL, 24 tenofovir, 12 TOFRANIL-PM, 24 TENORETIC, 20 tolcapone, 24 TENORMIN, 19 tolterodine, 37 TERAZOL 3, 37 tolterodine ext-rel, 37 TERAZOL 7, 37 tolvaptan, 34 terazosin, 18 TOPAMAX, 22 terbinafine, 45 TOPICORT, 46 terbinafine tabs, 11 TOPICORT LP, 45 terbutaline, 43 topiramate, 22 terconazole, 37 topotecan, 16 teriparatide, 30 topotecan inj, 16 tesamorelin, 34 TOPROL-XL, 19 TESSALON, 42 toremifene, 15 testosterone cypionate, 27 TORISEL, 16 testosterone enanthate, 27 torsemide, 21 testosterone gel, 27 tositumomab, 17 testosterone soln, 27 TOTECT, 16 testosterone transdermal, 27 TOVIAZ, 37 tetrabenazine, 25 TRACLEER, 21 tetracycline, 11 TRADJENTA, 28 TEVETEN, 18 tramadol, 9 TEVETEN HCT, 18 tramadol ext-rel, 9 TEV-TROPIN, 33 trandolapril, 17 thalidomide, 15 trandolapril/verapamil ext-rel, 17 THALOMID, 15 tranexamic acid, 39 THEO-24, 43 TRANSDERM SCOP, 35

TRANXENE T-TAB, 22 UROCIT-K, 37 tranylcypromine, 23 UROCIT-K 15 mEq, 37 trastuzumab, 17 urofollitropin, 32 TRAVATAN Z, 49 URSO, 35 travoprost, 49 URSO FORTE, 35 trazodone, 24 ursodiol, 35 trazodone ext-rel, 24 ustekinumab, 45 TREANDA, 14 UVADEX, 16 TRELSTAR, 15 V TRELSTAR DEPOT, 15 VAGIFEM, 32 TRELSTAR LA, 15 valacyclovir, 13 TRENTAL, 39 VALCYTE, 13 treprostinil, 21 valganciclovir, 13 tretinoin, 44 VALIUM, 22 tretinoin emollient, 47 valproic acid, 22 tretinoin gel microsphere, 44 valproic acid delayed-rel, 23 TREXIMET, 26 valrubicin, 17 triamcinolone acetonide crm 0.5%, 46 valsartan, 18 triamcinolone acetonide crm, lotion 0.025%, 45 valsartan/hydrochlorothiazide, 18 triamcinolone acetonide crm, lotion, oint 0.1%, 45 VALSTAR, 17 triamcinolone acetonide spray, 43 VALTREX, 13 triamcinolone paste, 47 VANCOCIN, 14 triamterene/hydrochlorothiazide, 21 vancomycin, 14 triamterene/hydrochlorothiazide 37.5/25, 21 vandetanib, 15 triamterene/hydrochlorothiazide 50/25, 21 VANOS, 46 TRIBENZOR, 18 VANTAS, 15 TRICOR, 19 varenicline, 27 trientine, 34 VASERETIC, 17 trifluoperazine, 25 VASOTEC, 17 trifluridine, 48 VECTIBIX, 17 trihexyphenidyl, 24 VECTICAL, 45 TRILEPTAL, 22 velaglucerase alfa, 34 TRILEPTAL susp, 22 VELCADE, 16 TRILIPIX, 19 vemurafenib, 16 trimethobenzamide, 35 venlafaxine, 23 trimethoprim, 14 venlafaxine ext-rel, 23 TRI-NORINYL, 31 venlafaxine ext-rel tabs, 23 triptorelin pamoate, 15 VENOFER, 41 TRISENOX, 16 VENTAVIS, 21 TRIZIVIR, 12 VENTOLIN, 42 trospium, 37 VENTOLIN HFA, 42 trospium ext-rel, 37 VERAMYST, 43 TRUSOPT, 49 verapamil, 20 TRUVADA, 12 verapamil ext-rel, 20 TWYNSTA, 18 VERDESO, 45 TYGACIL, 14 VEREGEN, 47 TYKERB, 15 verteporfin, 49 TYLENOL w/CODEINE, 9 VESICARE, 37 TYSABRI, 26 VEXOL, 48 TYVASO, 21 VFEND, 11 TYZEKA, 13 VIBATIV, 14 U VIBRAMYCIN, 11 ULESFIA, 47 VICODIN, 9 ulipristal, 31 VICTOZA, 28 ULORIC, 8 VICTRELIS, 13 ULTRAM, 9 VIDAZA, 16 ULTRAM ER, 9 VIDEX EC, 12 ULTRAVATE, 46 VIDEX soln, 12 UNASYN, 11 vigabatrin, 23 URAMAXIN, 46 VIGAMOX, 48 URAMAXIN GT, 46 VIIBRYD, 23 urea, 46 vilazodone, 23 urea 45%, 46 VIMOVO, 8 URECHOLINE, 37 VIMPAT, 22 urine test strips, 29 vinblastine, 16

71 vincristine, 16 Z vinorelbine, 16 zafirlukast, 43 VIRACEPT, 12 zaleplon, 25 VIRAMUNE, 12 zanamivir, 13 VIRAMUNE XR, 12 ZANOSAR, 14 VIREAD, 12 ZANTAC, 35 VIROPTIC, 48 ZARONTIN, 22 VISICOL, 36 ZAROXOLYN, 21 vismodegib, 17 ZAVESCA, 34 VISTARIL, 22, 42 ZEGERID, 36 VISTIDE, 13 ZELAPAR, 24 VISUDYNE, 49 ZELBORAF, 16 VITAFOL-OB, 41 ZEMPLAR, 33 VITAFOL-PN, 41 ZENPEP, 36 vitamin ADC/fluoride drops, 41 ZERIT, 12 vitamin ADC/fluoride/iron drops, 41 ZESTORETIC, 17 VIVACTIL, 24 ZESTRIL, 17 VIVELLE-DOT, 32 ZETIA, 19 VIVITROL, 27 ZIAC, 20 VOLTAREN, 48 ZIAGEN, 12 VOLTAREN GEL, 8 ZIANA, 44 VOLTAREN XR, 8 ziconotide, 9 voriconazole, 11 zidovudine, 12 vorinostat, 17 zileuton ext-rel, 43 VOSPIRE ER, 43 zinc acetate, 41 VOTRIENT, 15 ZINECARD, 16 VPRIV, 34 ZIOPTAN, 49 VUMON, 17 ziprasidone, 24 VUSION, 44 ZIRGAN, 48 VWF, human/factor VIII complex, 39 ZITHROMAX, 10 VYTORIN, 19 ZMAX, 11 VYVANSE, 25 ZOCOR, 19 W ZOFRAN, 35 warfarin, 38 ZOLADEX, 15 WELCHOL, 19 zoledronic acid, 30 WELLBUTRIN, 24 ZOLINZA, 17 WELLBUTRIN SR, 24 zolmitriptan, 26 WELLBUTRIN XL, 24 ZOLOFT, 23 WESTCORT, 45 zolpidem, 25 WILATE, 39 zolpidem ext-rel, 25 WINRHO SDF, 40 zolpidem sublingual, 26 ZOMETA, 30 X ZOMIG/ZOMIG-ZMT, 26 XALATAN, 49 ZONALON, 47 XALKORI, 15 ZONEGRAN, 22 XANAX, 22 zonisamide, 22 XANAX XR, 22 ZORBTIVE, 33 XARELTO, 38 ZORTRESS, 41 XELODA, 14 ZOSYN, 11 XENAZINE, 25 ZOVIRAX, 13 XEOMIN, 27 ZOVIRAX crm, oint, 47 XGEVA, 30 ZUPLENZ, 35 XIAFLEX, 47 ZUTRIPRO, 42 XIFAXAN, 14 ZYBAN, 27 XOLAIR, 44 ZYCLARA, 47 XOLEGEL, 44 ZYFLO CR, 43 XYLOCAINE, 46 ZYLET, 48 XYNTHA, 38 ZYLOPRIM, 8 XYREM, 27 ZYPREXA RELPREVV, 24 XYZAL, 42 ZYPREXA/ZYPREXA ZYDIS, 24 Y ZYTIGA, 15 YASMIN, 30 ZYVOX, 14 YAZ, 30 YERVOY, 16