OptumRx Vigilant Drug Program

Non-essential medications strategy

Thousands of medications are available today with even more entering the market — sometimes at a higher cost without additional value. OptumRx can help ensure that your pharmacy benefit dollars cover only the most clinically appropriate and affordable medications.

Non-essential medications strategy* — Excludes select products that are available in the market but may not be approved by the U.S. Food and Drug Administration (FDA) or are deemed non-essential by the OptumRx Pharmacy & Therapeutics (P&T) Committee. These high-dollar products offer little clinical value versus other well-tested, FDA-approved agents.

*Programs are also available for clients who prefer prior authorization rather than an exclusion strategy. Effective January 1, 2020 Drug Name Drug Name 1ST MEDX-PATCH/ LIDOCAINE EXTERNAL ALBA-DERM PATCH 4-0.0375-5-20 % alcohol injection 7T LIDO ALCORTIN A ACACIA SUBCUTANEOUS ALDER ACCUCAINE ALEVAMAX ACREMONIUM ALEVICYN ANTIPRURITIC ACTICOAT 7 2"X2" ALEVICYN ANTIPRURITIC SG EXTERNAL ACTICOAT 7 4"X5" GEL ACTICOAT ABSORBENT 4"X5" alevicyn dermal spray ACTICOAT ANTIMICROBIAL 2"X2" ALMOND (DIAGNOSTIC) ACTICOAT ANTIMICROBIAL 4"X4" ALPAWASH ACTICOAT FLEX 3 4"X4" altacaine ACTIVE FE ALTADERM ACTIVE INJECTION BLM-1 altafluor ACTIVE INJECTION BM ALTERNARIA ACTIVE INJECTION D ALZAIR ALLERGY NASAL SPRAY ACTIVE INJECTION DL AMELUZ ACTIVE INJECTION DLM AMERICAN BEECH ACTIVE INJECTION KET-L AMERICAN COCKROACH ACTIVE INJECTION KETMARC-L AMERICAN ELM ACTIVE INJECTION KIT L AMERICAN SYCAMORE ACTIVE INJECTION KL-3 aminoamrms ACTIVE INJECTION KM aminobenzoate potassium oral packet ACTIVE INJECTION LM-2 aminoreliefrms ACTIVE INJECTION LM-DEP-1 AMMONIA N 13 ACTIVE INJECTION LM-DEP-2 AMYTAL SODIUM ACTIVE INJECTION M-1 ANACAINE ACUICYN ana-lex ACUNOL ANALPRAM HC ADRENALIN NASAL ANALPRAM HC SINGLES ADVANCED ALLERGY COLLECTION ANDEXXA ADVANCED BASE PLUS ANIMI-3 ADYPHREN ANIMI-3/VITAMIN D ADYPHREN AMP anodyne lpt ADYPHREN AMP II anucort-hc ADYPHREN II anusol-hc rectal suppository agoneaze APPLE (DIAGNOSTIC) AKOVAZ APRIZIO PAK ALA-QUIN AQUORAL MOUTH/THROAT SOLUTION

2 Drug Name Drug Name ARESTIN BALD CYPRESS argatroban in sodium chloride intravenous BANANA (DIAGNOSTIC) solution 50 mg/50ml BASE W301 argatroban intravenous solution 125 mg/125ml BAYBERRY (WAX MYRTLE) ARIZONA CYPRESS BEEF (DIAGNOSTIC) arzol silver nit applicators belladonna alkaloids-opium ASCOR BENSAL HP ascorbic acid injection BENZAC AC WASH EXTERNAL LIQUID ASCORBIC ACID INTRAVENOUS benzepro creamy wash ASTERO BENZEPRO EXTERNAL ATOPADERM BENZEPRO EXTERNAL FOAM 5.2 %, 9.7 % ATOPICLAIR benzepro external foam 5.3 % ATRAPRO CP BENZEPRO EXTERNAL LIQUID ATRAPRO HYDROGEL benzepro foaming cloths atropine sulfate injection solution 0.4 mg/ml, 1 benzepro short contact mg/ml, 8 mg/20ml BENZIQ atropine sulfate injection solution prefilled syringe 0.5 mg/5ml, 1 mg/10ml BENZIQ LS ATROPINE SULFATE OPHTHALMIC BENZIQ WASH EMULSION BENZODOX AUREOBASIDIUM benzoin compound AUSTRALIAN PINE benzoin external tincture AUXIPRO VANISHING BENZOYL PEROX-HYDROCORTISONE avar cleanser benzoyl peroxide external foam 9.8 % AVAR EXTERNAL PAD BENZOYL PEROXIDE EXTERNAL GEL 6.5 AVAR LS %, 8 % AVAR LS CLEANSER BENZOYL PEROXIDE FORTE- HC avar-e emollient BERMUDA GRASS avar-e green BESER EXTERNAL KIT AVAR-E LS BETA 1 KIT AVENOVA BETALIDO AVIDOXY DK BETALOAN SUIK AVOCADO (DIAGNOSTIC) BETAMETHASONE COMBO AXIFOL BETAMETHASONE SOD PHOS & ACET AZEDRA DOSIMETRIC BETAMETHASONE SODIUM PHOSPHATE INJECTION AZEDRA THERAPEUTIC BEVACIZUMAB B-12 COMPLIANCE INJECTION BHI URI-CONTROL BACMIN bio glo BAHIA BIOFREQUENCY INSOLES BAL-CARE DHA

3 Drug Name Drug Name bio-statin oral powder CATTLE EPITHELIUM BIVALIRUDIN-SODIUM CHLORIDE CEDAR ELM BLACK WALNUT POLLEN CEFUROXIME SODIUM-NACL BLACK WILLOW CELA BASE BOCASAL celacyn gel external BOTRYTIS CELACYN GEL EXTERNAL BOX ELDER CELLPAD bp 10-1 cem-urea BP CLEANSING WASH CENTANY AT bp foam CERACADE bp wash external liquid 2.5 %, 7 % ceramax external cream bpo CERAMAX EXTERNAL LOTION BRIDION cerovel external lotion BRIMONIDINE-DORZOLAMIDE cervical specimen collection BROME CETACAINE EXTERNAL AEROSOL BROMPHENIRAMINE MALEATE CETACAINE EXTERNAL LIQUID INTRAMUSCULAR CHEW-HESIVE BUPIVACAINE HCL INJECTION SOLUTION CHICKEN MEAT (DIAGNOSTIC) 312.5 MG/10ML choline-mag trisalicylate BUPIVILOG CHONDROITIN SULFATE OPHTHALMIC CADIRAMD CHRYSADERM DAY CAFFEINE-SODIUM BENZOATE CHRYSADERM NIGHT calcium chloride cicatrace pad CALCIUM GLUCONATE SOLUTION 10 % INTRAVENOUS ciclopirox treatment calcium gluconate solution 10 % intravenous CIFEREX CALCIUM GLUCONATE-NACL CIFRAZOL INTRAVENOUS SOLUTION 2-0.675 CITRANATAL 90 DHA ORAL 90-1 & 300 MG GM/100ML-% CITRANATAL ASSURE ORAL 35-1 & 300 MG CALCIUM-FOLIC ACID PLUS D CITRANATAL B-CALM CALIFORNIA PEPPER TREE CITRANATAL DHA CANDIDA ALBICANS EXTRACT CITRANATAL HARMONY ORAL CAPSULE CANTALOUPE (DIAGNOSTIC) 27-1-260 MG CANTHARIDIN EXTERNAL CITRANATAL MEDLEY CAPHOSOL MOUTH/THROAT SOLUTION CITRANATAL RX CAPSFENAC PAK CLADOSPORIUM CLADOSPORIOIDES CARDIOVID PLUS CLADOSPORIUM SPHAEROSPERMUM CARRASYN HYDROGEL WOUND DRESS CLINDACIN ETZ EXTERNAL KIT CASEIN (DIAGNOSTIC) CLINDACIN PAC CAT HAIR EXTRACT CLINIMIX N9G20E

4 Drug Name Drug Name clinpro 5000 dermacinrx prizopak CLODAN EXTERNAL KIT DERMACINRX PUREFOLIX cocaine hcl external solution 4 % DERMACINRX SURGICAL COMBOPAK COCAINE HCL NASAL DERMACINRX SURGICAL PHARMAPAK COCKLEBUR DERMACINRX THERAZOLE PAK COCOA BEAN (DIAGNOSTIC) DERMACINRX TICANASE PAK COLCIGEL DERMACINRX TOPICAL BASE COLLATYL DERMACINRX ZRM COMPACT SPACE CHAMBER/SM MASK dermazene CONTRAST ALLERGY PREMED PACK DEXAMETHASONE ACE & SOD PHOS CONVENIENCE PAK DEXAMETHASONE SOD PHOS-BUPIV COPASIL EXTERNAL DEXAMETHASONE-MOXIFLOXACIN CORN POLLEN DEXAMETH-MOXIFLOX-KETOROLAC CORTANE-B EXTERNAL DEXERYL covaryx DEXLIDO covaryx hs DEXLIDO-M CRAB (DIAGNOSTIC) DEXOPIN CREAM BASE DEXTENZA CREAM BASE NIOSOMES dextrose intravenous solution 50 % CREAM CONCENTRATE DFS DR/MS/MENTH/CAP PAK CREAM-HEAVY BASE NIOSOMES DFS/MS/MENTH/CAP PAK CURVULARIA DIAB EXTERNAL GEL CUTIS PLUS DIAB F.D.G. FREEZE-DRIED cyclobenzaprine hcl oral tablet 10 mg DIALYVITE SUPREME D CYCLOSPORINE IN KLARITY diclofenac sodium transdermal gel 3 % CYSTADANE diclofex dc combination therapy pack 1.5- cytra k crystals 0.025 % DEBACTEROL DICLOFONO DEFITELIO diclopak dehydrated alcohol injection DICLOPR DELUO diclosaicin DERMACINRX ANALGESIC COMBOPAK DICLOVIX DERMACINRX AZENASE PAK DICLOZOR DERMACINRX CLORHEXACIN DMT SUIK DERMACINRX DUOPATCH PHARMAPAK DOG EPITHELIUM dermacinrx empricaine DOG FENNEL DERMACINRX LEXITRAL PHARMAPAK DONNATAL DERMACINRX NEUROTRAL PHARMAPAK DOUBLEDEX DERMACINRX PHN DRECHSLERA

5 Drug Name Drug Name DRITHO-CREME HP EPINEPHRINESNAP-EMS DSUVIA EPINEPHRINESNAP-V DUET DHA 400 EPISNAP DUET DHA BALANCED ORAL 25-1 & 267 MG EQUAPAX/ATORVASTATIN/COQ10 DURACHOL EQUAPAX/IBUPROFEN/MINREX DUST MITE MIXED ALLERGEN EXT ERGOCAL DYNABAC 5.0 ESCAVITE D DYURAL-40 escavite lq oral liquid DYURAL-80 ESKATA DYURAL-L ESOMEP-EZS DYURAL-LM est estrogens-methyltest EASTERN COTTONWOOD est estrogens-methyltest ds ECZEMOL est estrogens-methyltest hs eemt EXYDERM eemt hs E-Z-DISK EGG WHITE (DIAGNOSTIC) E-Z-HD EHA E-Z-PAQUE ELCYS E-Z-PASTE ELETONE FAGRON LS PLUS ELETONE TWINPACK FAGRON NATURAL ELLZIA PAK FAGRON SUPREME EMOLIVAN FALESSA ORAL KIT 20-1-0.1 MCG-MG EMOLLIENT BASE FEM PH EMULSION SB FENTANYL CITRATE INTRAVENOUS ENBRACE HR SOLUTION PREFILLED SYRINGE 100 MCG/2ML ENGLISH PLANTAIN FENTANYL CITRATE-NACL EPIDURAL ENGYSTOL INJECTION FENTANYL CITRATE-NACL INTRAVENOUS ENLYTE SOLUTION 5-0.9 MG/250ML-% ENTERO VU ORAL SUSPENSION 24 % FENTANYL CIT-ROPIVACAINE-NACL ENTTY SPRAY EMULSION EPIDURAL SOLUTION 0.2-0.15-0.9 ENZADYNE MG/100ML-%, 0.4-0.2-0.9 MG/200ML-% ENZOCLEAR FENTANYL-BUPIVACAINE-NACL EPIDURAL SOLUTION 0.6-0.125-0.9 MG/200ML-% ephedrine sulfate injection FERIVAFA EPICERAM FIRE ANT EPICOCCUM FITALITE EPICYN FLEXIN epinephrine injection solution 30 mg/30ml FLEXIPAK epinephrine pf FLEXIZOL COMBIPAK EPINEPHRINE PROFESSIONAL

6 Drug Name Drug Name FLORIVA ORAL LIQUID grafco silver nit applicator FLORIVA ORAL TABLET CHEWABLE 0.5 GRAFIX CORE 1.5CM X 2CM MG, 1 MG GRAFIX CORE 16MM flucaine GRAFIX CORE 2CM X 3CM FLUOVIX GRAFIX CORE 3CM X 4CM FOLET DHA GRAFIX CORE 5CM X 5CM FOLET ONE GRAFIX PRIME 1.5CM X 2CM FOLI-D GRAFIX PRIME 16MM FOLIKA-D GRAFIX PRIME 2CM X 3CM FOLITE GRAFIX PRIME 3CM X 4CM FOLVITE-D GRAFIX PRIME 5CM X 5CM formaldehyde external solution 10 % GRAFIX XC 7.5CM X 15CM FREEDOM ADAPTADERM EXTERNAL green glo lissamine green FREEDOM DERMA SERUM HACKBERRY FREEDOM DERMA-D HEMATOGEN FA FREEDOM DERMA-N HEMETAB FUL-GLO OPHTHALMIC STRIP 0.6 MG hemmorex-hc rectal suppository 25 mg ful-glo ophthalmic strip 1 mg HEPMED FUNGIMEZ HONEY BEE VENOM PROTEIN FUSARIUM HONEY BEE VENOM SUBCUTANEOUS FUSION SPRINKLES HORMONE CR HEAVY BASE NIOSOMES GATIFLOXACIN-DEXAMETHASONE HORMONE CREAM BASE NIOSOMES GELCLAIR HORSE EPITHELIUM GELFILM OPHTHALMIC HPR GEL-FLOW HPR PLUS GELFOAM-JMI POWDER HPR PLUS HYDROGEL GELFOAM-JMI SPONGE HPR PLUS-MB HYDROGEL GENADUR HYCLODEX GENICIN VITA-D HYDRO 35 GENICIN VITA-Q HYDRO 40 GENICIN VITA-S hydrocortisone ace-pramoxine cream 2.5-1 % GERMAN COCKROACH external GHRP2-GHRP6-SERMORELIN hydrocortisone ace-pramoxine cream 2.5-1 % GHRP2-SERMORELIN rectal GIAPREZA hydrocortisone ace-pramoxine rectal cream 2.5-1 % glycolic acid solution hydrocortisone acetate rectal GLYTACTIN RTD 10 hydrocortisone-iodoquinol external cream 1-1 GOLDENROD % GOPRELTO HYDROGEL

7 Drug Name Drug Name HYDROMORPHONE HCL INJECTION KCL (IN NACL 0.9%) INTRAVENOUS SOLUTION 1 MG/ML SOLUTION 40 MEQ/500ML hydromorphone hcl injection solution 2 mg/ml KEDRAB INJECTION hydromorphone hcl rectal KELARX HYDROMORPHONE HCL-NACL KENDALL AMORPHOUS WOUND INTRAVENOUS SOLUTION 10-0.9 KERAGEL MG/100ML-%, 25-0.9 MG/50ML-%, 5-0.9 MG/50ML-%, 50-0.9 MG/50ML-%, 6-0.9 KERAGELT MG/30ML-% KERALAC EXTERNAL CREAM 47 % hydroquinone external cream KERALYT EXTERNAL GEL 6 % HYLATOPIC PLUS KERALYT SCALP HYLIRA KETOROCAINE-L hyophen KETOROCAINE-LM hyoscyamine sulfate er oral tablet extended KETOROLAC-BUPIV-KETAMINE release 12 hour KETOROLAC-ROPIV-KETAMINE HYPERLYTE-CR KIVIK HYPERRAB S/D INJECTION SOLUTION 300 KLARITY-A UNIT/2ML KLARITY-B HYPOCYN KLARITY-L IFE-BIMIX 30/1 klor-con/ef IFE-PG20 KOCHIA ILUVIEN INTRAVITREAL K-PHOS inflammacin K-PHOS NO 2 INFLAMMATION REDUCTION PACK K-PHOS-NEUTRAL INFLATHERM COMBINATION THERAPY PACK KYBELLA INOVA LAMBS QUARTERS INOVA 4/1 ACNE CONTROL THERAPY LATANOPROST-TIMOLOL MALEATE INOVA 8/2 ACNE CONTROL THERAPY LATRIX XM IODOQUIMEZ-HC LAVARE WOUND WASH iodoquinol-hc-aloe polysacch l-cysteine hcl intravenous iodoquinol-hydrocortisone-aloe LDO PLUS IONSYS lecithin oral granules IPAMORELIN ACETATE LENSCALE IROSPAN 24/6 LEU TECHNELITE isoxsuprine hcl oral LEVATIO JOHNSON GRASS LEVBID JTT PHYSICIANS LEVICYN JUNE GRASS POLLEN STANDARDIZED levicyn dermal spray KAMDOY LEVSIN INJECTION KAPOK LEVSIN ORAL TABLET

8 Drug Name Drug Name LEVSIN/SL LIQUIVIDA HYDRATION lido bdk livixil pak lidocaine external ointment LMA MAD NASAL lidocaine hcl external cream 3 % LMR PLUS LIDOCAINE HCL EXTERNAL CREAM 4.12 % LOPROX EXTERNAL KIT lidocaine hcl external lotion LORID LIDOCAINE-EPINEPHRINE INTRAOCULAR LOUTREX LIDOCAINE-HYDROCORTISONE ACE LOYON EXTERNAL CREAM 1-1 % LT INJECTION KIT lidocaine-hydrocortisone ace rectal lugols external LIDOCAINE-PHENYLEPHRINE LUMASON LIDOCAINE-PHENYLEPHRINE-BSS LUTATHERA lidocaine-prilocaine external kit LUXAMEND LIDOCIDEX I LYMPHOMYOSOT X LIDOCILONE I MACI LIDO-EPINEPHRINE-TETRACAINE manganese sulfate intravenous lidolog MARBETA-25 LIDOPAC MARBETA-L lidopin external cream 3 % MARDEX-25 LIDOPIN EXTERNAL CREAM 3.25 % marlido lidopril external kit MARLIDO-25 lidopril xr MARNATAL-F lido-prilo caine pack MARVONA SUIK LIDOPURE PATCH MAS CARE-PAK LIDORX MB HYDROGEL LIDO-SORB me/naphos/mb/hyo1 LIDOTHOL MEADOW FESCUE GRASS POLLEN LIDOTRAL MEDIDERM LIDOTREX MEDI-DERM/L-RX LIDOZION MEDI-DERM-RX LIOPEN ABSORPTION ENHANCING MEDI-PATCH RX LIPO CREAM BASE MEDROLOAN II SUIK LIPOFOAM RX MEDROLOAN SUIK LIPOPEN ULTRA BASE MELALEUCA LIPOSOMAL HEAVY MESQUITE LIPOSOMAL REGULAR METAXALL CP LIPOZYME METHAVER LIQUID E-Z-PAQUE METHAZEL LIQUID POLIBAR PLUS methenamine mandelate oral

9 Drug Name Drug Name methyl salicylate external liquid MOXIFLOXACIN HCL INTRAOCULAR methylene blue injection SOLUTION 5 MG/ML METHYLPREDNISOLONE ACE-LIDO MOXIFLOXACIN HCL INTRAOCULAR SOLUTION PREFILLED SYRINGE MICROCYN EXTERNAL GEL MOXIFLOXACIN HCL-BSS MICROCYN SKIN AND WOUND MUCOR MIDAZOLAM HCL-NACL MUCOSITISRX MIDAZOLAM HCL-SODIUM CHLORIDE INTRAVENOUS SOLUTION 100-0.9 MUGARD MG/100ML-% MUGWORT MIDAZOLAM-KETAMINE-ONDANSETRON MULTIBASE MIGRAINE PACK MULTI-SPECIALTY MIGRANOW MULTITRACE-4 MIMYX multitrace-4 concentrate MIRODERM BIOLOGIC MATRIX FENES MULTITRACE-4 NEONATAL MIRODERM BIOLOGIC WOUND MATRIX MULTITRACE-4 PEDIATRIC MITE (D. FARINAE) MULTITRACE-5 MITE (D. PTERONYSSINUS) multitrace-5 concentrate MITOMYCIN INTRAVESICAL multivitamin/fluoride oral solution MIXED ASPERGILLUS MY MDI FINGER PULSE OXIMETER MIXED FEATHERS MY MDI PORTABLE NEBULISER MIXED RAGWEED myferon 150 forte MIXED VESPID VENOM PROTEIN mynephrocaps INJECTION SOLUTION RECONSTITUTED NALTREXONE SUBCUTANEOUS MIXED VESPID VENOM PROTEIN NANDROLONE-TESTOSTERONE CYP SUBCUTANEOUS NATACHEW ORAL TABLET CHEWABLE 28- MKO MELT DOSE PACK 1 MG mlk f1 NATELLE ONE ORAL CAPSULE 28-1-250 mlk f2 MG mlk f3 NEOCERA MLK F4 NEOSALUS MONSELS FERRIC SUBSULFATE NEOSALUS CP EXTERNAL NEO-SYNALAR EXTERNAL KIT MORCIN NEPHPLEX RX MORGIDOX COMBINATION NESTABS DHA morphine sulfate intravenous solution 1 mg/ml, NETSPOT 25 mg/ml, 50 mg/ml NEUAC EXTERNAL KIT morphine sulfate rectal NEURALGO-RHEUM MOSQUITO (DIAGNOSTIC) NEUT MOUNTAIN CEDAR NEUTRASAL MOUSE EPITHELIUM NIACIN

10 Drug Name Drug Name NIPRIDE RTU INTRAVENOUS SOLUTION OMEGA-3 RX COMPLETE 20-0.9 MG/100ML-%, 50-0.9 MG/100ML-% OMEGA-3/D-3 WELLNESS PACK nitroglycerin er oral capsule extended release OMEGAVEN 2.5 mg opium nitro-time ORACIT NIVATOPIC PLUS ORAFATE NOURILITE ORANGE (DIAGNOSTIC) NOURIVAN ANTIOX BASE ORCHARD GRASS POLLEN NOVACORT EXTERNAL GEL 1-2 % ORMECA NUCARACLINPAK ORTHO DF NUCARARXPAK oscimin sr NUCORT OTIPRIO NUDERMRXPAK 120 OVACE PLUS NUDERMRXPAK 60 OVACE PLUS WASH nudiclo solupak OVACE WASH nudiclo tabpak PAINGO KFT NUDROXIPAK papaverine hcl injection NUDROXIPAK DSDR-50 PAPAVERINE-PHENTOLAMINE NUDROXIPAK DSDR-75 PAPAV-PHENTOLAMINE-ALPROSTADIL NUDROXIPAK E-400 paregoric NUDROXIPAK I-800 P-CARE 100MX NUDROXIPAK M-15 P-CARE D40 NUDROXIPAK N-500 P-CARE D40G NUMOISYN P-CARE D40MX NUSURGEPAK SURGICAL PREP/CARE P-CARE D80 NUTRASEB P-CARE D80G COMBINATION NUTRIARX CREAMPAK P-CARE D80MX NUTRIDOX P-CARE K40 NUVAIL P-CARE K40G NUVAKAAN P-CARE K40MX NUVAZIL P-CARE K80 OASIS ULTRA MATRIX FENESTRATED EXTERNAL SHEET 3X7CM P-CARE K80G OASIS ULTRA TRI-LAYER MATRIX P-CARE K80MX EXTERNAL SHEET 7X10CM P-CARE M OASIS WOUND MATRIX FENESTRATED P-CARE MG EXTERNAL SHEET 3X7CM P-CARE X OAT GRAIN (DIAGNOSTIC) PCCA ALADERM BASE OCUVEL ORAL CAPSULE 0.5 MG PCCA ANHYDROUS LIPODERM BASE OLIVE TREE PCCA BIOPEPTIDE BASE

11 Drug Name Drug Name PCCA LIPODERM BASE PLEXION PCCA MVC BASE PLEXION CLEANSER EXTERNAL LIQUID PCCA NATACREAM PLEXION CLEANSING CLOTH EXTERNAL PCCA POLYPEG BASE PAD PCCA VANISHING CREAM BASE pnv folic acid + iron PCCA VANISHING CREAM LIGHT pnv-dha PCCA VANPEN BASE pnv-select PCP 100 POD-CARE 100C PEANUT (DIAGNOSTIC) POD-CARE 100CG PECAN NUT (DIAGNOSTIC) POD-CARE 100CMX PECAN POLLEN POD-CARE 100K PENCREAM POD-CARE 100KG PENDERM POD-CARE 100KMX PENICILLIUM NOTATUM podocon PENLEN POINT OF CARE KM PENTAPHENE BASE POINT OF CARE L.2 PERENNIAL RYE GRASS POLLEN POINT OF CARE L.5 PHARMABASE COSMETIC POINT OF CARE LM DEP 2 PHARMABASE HEAVY POINT OF CARE LM-2.2 phenazopyridine hcl oral tablet 200 mg POINT OF CARE LM-2.5 phenobarbital sodium injection POLIDOCANOL phenobarbital-belladonna alk POLYOXYL 40 STEARATE PELLET phenohytro PORK (DIAGNOSTIC) PHENYLBUTAZONE POTABA ORAL CAPSULE PHENYLEPHRINE HCL-NACL potassium bicarbonate oral INTRAVENOUS SOLUTION 50-0.9 POTASSIUM CHLORIDE IN D5W MG/500ML-% INTRAVENOUS SOLUTION 20 MEQ/250ML PHLAG SPRAY potassium chloride oral packet PHOMA EXIGUA potassium citrate-citric acid oral solution phospha 250 neutral potassium phosphates phosphasal PR BENZOYL PEROXIDE phospho-trin 250 neutral pr benzoyl peroxide wash PHYSICIANS EZ USE B-12 PR CREAM PHYSICIANS EZ USE JOINT/TUNNEL pr natal 400 PHYSICIANS EZ USE M-PRED pr natal 400 ec PHYSOSTIGMINE SALICYLATE INJECTION pr natal 430 PHYTOBASE PRAMOSONE EXTERNAL CREAM 1-2.5 % PICO WOUND THERAPY SYSTEM PRAMOSONE EXTERNAL OINTMENT PISTACHIO NUT (DIAGNOSTIC) pramox

12 Drug Name Drug Name PRASTERA PRILOVIX LITE PRAXBIND prilovix plus PRE & POST SX POUCH prilovix ultralite PREDNISOL ACE-MOXIFLOX-BROMFEN priloxx lp prednisolone acetate p-f PRIMACARE ORAL CAPSULE PREDNISOLONE ACETATE-NEPAFENAC PRIVET PREDNISOLONE ACET-MOXIFLOXACIN PRIZOTRAL PREDNISOLONE-BROMFENAC PRO-C-DURE 5 PREDNISOLONE-GATIFLOXACIN PRO-C-DURE 6 PREDNISOLONE-MOXIFLOXACIN PROCORT PREDNISOLON-GATIFLOX-BROMFENAC PROCTOCORT RECTAL SUPPOSITORY PREDNISOLON-MOXIFLOX-BROMFENAC PRODIGEN OPHTHALMIC SOLUTION 1-0.5-0.075 % PROMACTIN AA PLUS 20PE PREDNISOLON-MOXIFLOX-NEPAFENAC PROMISEB premium lidocaine PROPEL PREMIUM SCAR PROPEL MINI PRENAISSANCE PROTHELIAL PRENAISSANCE PLUS PROTYL AG prenatal 19 oral tablet chewable 29-1 mg PROVAD prenatal oral tablet 27-1 mg PRUCLAIR prenatal vitamin plus low iron PRUMYX PRENATE P-SILOXAN DS PRENATE AM PSORIZIDE FORTE PRENATE DHA ORAL CAPSULE 18-0.6-0.4- PSORIZIDE ULTRA 300 MG PYRIDIUM PRENATE ELITE ORAL TABLET 20-0.6-0.4 MG QUEEN PALM PRENATE ENHANCE QUFLORA FE PEDIATRIC PRENATE ESSENTIAL ORAL CAPSULE 18- QUFLORA GUMMIES 0.6-0.4-300 MG quflora pediatric oral solution 0.5 mg/ml PRENATE MINI ORAL CAPSULE 18-0.6-0.4- quflora pediatric oral tablet chewable 0.25 mg 350 MG QUINIXIL PRENATE PIXIE QUINJA PRENATE RESTORE QUTENZA PRESERA QUTENZA (2 PATCH) PREVELEAK SURGICAL SEALANT RABBIT EPITHELIUM PREVIDOLRX ANALGESIC RADIAGEL previdolrx plus analgesic RADIAPLEXRX prilolid RAPID GEL RX prilovix READYSHARP ANESTH + BETAMETH

13 Drug Name Drug Name READYSHARP ANESTH + DEXAMETH ROUGH MARSH ELDER READYSHARP ANESTH + KETOROLAC ROUGH PIGWEED READYSHARP ANESTH + METHYLPRED RUSSIAN THISTLE READYSHARP BETAMETHASONE SA3 DERM READYSHARP DEXAMETHASONE SACCHAROMYCES CEREVISIAE READYSHARP KETOROLAC SAGEBRUSH READYSHARP LIDOCAINE SALEX EXTERNAL SHAMPOO READYSHARP-A salicylic acid er RECK salicylic acid external cream RECURA salicylic acid external foam RED BIRCH salicylic acid external gel RED CEDAR salicylic acid external liquid 27.5 % RED MAPLE salicylic acid external lotion RED MULBERRY salicylic acid external shampoo RED TOP GRASS POLLEN salicylic acid external solution 26 % relador pak external kit salicylic acid wart remover relador pak plus salicylic acid-cleanser RELIZORB salimez REMIGEN SALIMEZ FORTE RENOVO saline bacteriostatic RESET FOR ANDROID APP SALIVAMAX RESET FOR IOS APP salsalate oral RESET-O FOR ANDROID APP SALT DURABLE CREAM RESET-O FOR IOS APP SALT STABLE LS ADVANCED RESORCINOL-SULFUR SALTSTABLE LO RETISERT INTRAVITREAL SALVAX REVESTA SALVAX DUO PLUS REXAPHENAC SANADERMRX SKIN REPAIR REXASIL PATCH & VITAMIN E LIQ SANARE SCAR THERAPY RHIZOPUS SCALACORT DK RICE (DIAGNOSTIC) SCARCARE GEL-PAD KIT/LARGE ROPIDEX SCARCIN EXTERNAL GEL ROPIVACAINE HCL INJECTION SOLUTION SCARCIN EXTERNAL LIQUID 33.4 MG/ML SCARSILK EXTERNAL ROPIVACAINE HCL INJECTION SOLUTION SCARZEN SKIN REPAIR PREFILLED SYRINGE SEBUDERM ROPIVACAINE HCL-NACL INJECTION SOLUTION 0.2-0.9 % SEDANARE ROPIV-CLONIDINE-KETOROLAC SELECT-OB ROSADAN EXTERNAL KIT SELECT-OB+DHA 14 Drug Name Drug Name SELENIOUS ACID INTRAVENOUS STEMPHYLIUM SELENIUM INTRAVENOUS sterile water for injection injection selenium sulfide external shampoo STRAWBERRY (DIAGNOSTIC) SELRX STROVITE FORTE ORAL TABLET SERAQUA STROVITE ONE SESAME SEED (DIAGNOSTIC) sulfacetamide sodium external gel SHAGBARK HICKORY sulfacetamide sodium external liquid SHEEP SORREL sulfacetamide sodium-sulfur external cream SHORT RAGWEED POLLEN EXT sulfacetamide sodium-sulfur external emulsion SHRIMP (DIAGNOSTIC) sulfacetamide sodium-sulfur external liquid SILIPAC sulfacetamide sodium-sulfur external lotion SILPROTEX PLUS sulfacetamide sodium-sulfur external pad 10-4 SILTREX % silver nitrate external solution sulfacetamide sodium-sulfur external suspension sod citrate-citric acid sulfacetamide sod-sulfur wash external kit sodium acetate intravenous solution 4 meq/ml sulfacetamide-sulfur in urea external emulsion sodium bicarbonate intravenous solution 4.2 %, 8.4 % sulfacleanse 8/4 sodium chloride injection solution 0.9 % sulfamez wash sodium chloride intravenous solution 4 meq/ml SUMADAN SODIUM CITRATE-GENTAMICIN SULF SUMADAN WASH sodium hyaluronate external gel SUMADAN XLT sodium phosphates intravenous solution 15 SUMAXIN mmole/5ml, 45 mmole/15ml SUMAXIN CP sodium sulfacetamide external shampoo SUMAXIN WASH sodium sulfacetamide wash liquid 10 % sure result dss premium pack external SURE RESULT O3D3 SYSTEM SODIUM SULFACETAMIDE WASH LIQUID SUVICORT 10 % EXTERNAL SWEET CORN (DIAGNOSTIC) SOLYDRA SWEET GUM SOOTHEE EXTERNAL PATCH 0.5-0.0375-5- 2 % SWEET VERNAL GRASS POLLEN SORREL/DOCK MIX SX1 MEDICATED POST-OPERATIVE SOYBEAN (DIAGNOSTIC) SYMAX DUOTAB SPASCUPREEL INJECTION symax-sl SPEEDGEL RX symax-sr SPINY PIGWEED SYNALAR (CREAM) SSKI SYNALAR (OINTMENT) sss 10-5 external cream SYNALAR TS SSS 10-5 EXTERNAL FOAM SYNERDERM

15 Drug Name Drug Name SYNVEXIA TC TRIAMCINOLONE DIACETATE PF TALL RAGWEED INJECTION SUSPENSION 80 MG/2ML taron-crystals TRIAMCINOLONE-MOXIFLOXACIN TECHNELITE TRIAMSIL COMBIPAK EXTERNAL THERAPY PACK TESTONE CIK TRIAMSIL MULTIPAK TESTOSTERONE CYPIONATE & PROP TRI-CHLOR TESTOSTERONE CYPIONATE INJECTION TRICHOPHYTON SUBCUTANEOUS TESTOSTERONE CYPIONATE INTRAMUSCULAR SOLUTION 200 MG/ML tricitrates TESTOSTERONE ENANTHATE INJECTION TRILOAN II SUIK TESTOSTERONE IMPLANT PELLET 100 TRILOAN SUIK MG, 200 MG, 25 MG, 50 MG TRI-MIX TESTOSTERONE PROPIONATE INJECTION TRIMO-SAN VAGINAL GEL 0.025-0.01 % tetracaine hcl injection TRINAZ tetravisc TROPICAMIDE-CYCLOPENTOLATE-PE tetravisc forte TROPICAMIDE-PHENYLEPHRINE TETRIX EXTERNAL CREAM TROPIC-PROPARACA-PE-KETOROLAC TEXAVITE LQ TRUSKIN THERAHONEY EXTERNAL GEL tryptophan oral THRIVACIN 30 turpentine external THRIVACIN DETOX ULTRADERM TIGHTENING BASE ULTRASAL-ER TIMOLOL-BRIMON-DORZOL-LATANOPR umecta mousse TIMOLOL-BRIMONIDINE-DORZOLAMID URAMAXIN EXTERNAL GEL TIMOLOL-DORZOLAMID-LATANOPROST urea external cream 39 %, 40 %, 41 %, 45 %, TIMOTHY GRASS POLLEN ALLERGEN 47 % TOMATO (DIAGNOSTIC) UREA EXTERNAL FOAM TOPIDEX urea external lotion 40 % TORONOVA II SUIK urea external suspension 40 % TORONOVA SUIK urea hydrating TRACE ELEMENTS 4/PEDIATRIC urea in zn undecyl-lactic acid TRANZGEL urea nail external gel 45 % TRAUMEEL EXTERNAL OINTMENT urea-c40 TRAUMEEL INJECTION uredeb TRAUMEEL ORAL TABLET urelle TRIAMCINOLONE ACETONIDE INJECTION uremez-40 SUSPENSION 40 MG/ML, 50 MG/ML URESOL TRIAMCINOLONE DIACETATE INJECTION uribel SUSPENSION 40 MG/ML URIMAR-T uro-458 16 Drug Name Drug Name UROGESIC-BLUE VITA-RX DIABETIC VITAMIN uro-mp VIZAMYL uryl VOLUMEN ustell VP DERMABASE uticap VSL#3 DS utira-c VYTONE UTOPIC WASP VENOM PROTEIN INJECTION VANISHING SOLUTION RECONSTITUTED 1300 MCG, 550 MCG VANISHING CREAM BOTANICAL BASE WASP VENOM PROTEIN SUBCUTANEOUS VANISH-PEN WESTERN JUNIPER VANOXIDE-HC wheat germ oil oral oil VARIBAR HONEY WHITE ASH VARIBAR NECTAR WHITE BIRCH VARIBAR PUDDING WHITE FACED HORNET VENOM VARIBAR THIN HONEY WHITE MULBERRY VARIBAR THIN LIQUID WHITE OAK VAROPHEN WHITE PINE VASCUDERM HYDROGEL WHITE-FACED HORNET VENOM VENOMIL HONEY BEE VENOM WHOLE EGG (DIAGNOSTIC) VENOMIL MIXED VESPID VENOM WPR PLUS WOUND HEALING SYSTEM VENOMIL WASP VENOM XALIX VENOMIL WHITE FACED HORNET XAQUIL XR VENOMIL YELLOW HORNET VENOM XEMATOP BASE VENOMIL YELLOW JACKET VENOM XERALUX VERSAPRO EXTERNAL CREAM XEROSTOMIA RELIEF SPRAY VEXASYN XOLEGEL COREPAK vexatrol XOLEGEL DUO/HEAD & SHOULDERS vilamit mb XOLEGEL DUO/XOLEX vilevev mb XRYLIX VIRASAL YELLOW DOCK VIRGINIA LIVE OAK YELLOW HORNET VENOM PROTEIN VITAFOL ORAL TABLET INJECTION SOLUTION RECONSTITUTED VITAFOL ULTRA 550 MCG VITAFOL-NANO YELLOW HORNET VENOM PROTEIN vitafol-ob SUBCUTANEOUS VITAFOL-OB+DHA YELLOW JACKET VENOM PROTEIN INJECTION SOLUTION RECONSTITUTED VITAFOL-ONE 1300 MCG, 550 MCG vitamin b-complex 100 YELLOW JACKET VENOM PROTEIN VITAMIN DEFICIENCY SYSTEM-B12 SUBCUTANEOUS

17 Drug Name YUTIQ ZACARE ZACLIR CLEANSING EXTERNAL LOTION 8 % ZANABIN HYDROGEL ZEEL INJECTION ZELAC ZENEVIX zeruvia ZILACAINE PATCH ZINC SULFATE INTRAVENOUS ZITHRANOL ZOE SCRIPTS IDEALBASE

18 About OptumRx OptumRx is a pharmacy care services company helping clients and more than 65 million members achieve better health outcomes and lower overall costs through innovative prescription drug benefit services, including network claims processing, clinical programs, formulary management and specialty pharmacy care. OptumRx is part of Optum®, a leading information and technology-enabled health services business dedicated to making the health system work better for everyone. For more information, visit optum.com/optumrx.

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