Effective January 1, 2020 *Available As Brand Only 1 of 13 THERAPEUTIC AREA DRUG CLASS GENERIC NAME BRAND NAME ANAPHYLAXIS THERA

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MedImpact Safe Harbor Preventative Drug List This list includes medications identified as those most likely to qualify as “preventive” based on the U.S. Department of Treasury Department/IRS guidance. This list may not include all medications considered preventive or every health condition for which a preventive drug may be prescribed. At this time, neither MedImpact nor your health plan can guarantee which medications will satisfy U.S. Treasury Department definition for preventative safe harbor medications. Please also note: --- Utilization management (ie. prior authorization, step therapy, and quantity limits) may apply to listed medications based on benefit design --- Use of generics may be required depending on plan design --- Some strengths or dosage forms may not be included --- Certain products or therapeutic categories may not be covered --- Brand and generic status may not be current due to the changes and drug availability in the market --- This list is subject to change without prior notice --- Regardless of their appearance in this document, please contact member services at the number on your prescription benefits card should you have any questions regarding coverage THERAPEUTIC AREA DRUG CLASS GENERIC NAME BRAND NAME ANAPHYLAXIS ANAPHYLAXIS THERAPY EPINEPHRINE EPINEPHRINE, EPIPEN*, THERAPY AGENTS EPIPEN JR*, SYMJEPI* ANTICOAGULANTS/A ANTICOAGULANTS,COU WARFARIN SODIUM COUMADIN, WARFARIN SODIUM, NTIPLATELET MARIN TYPE JANTOVEN DIRECT FACTOR XA APIXABAN ELIQUIS* INHIBITORS RIVAROXABAN XARELTO* BETRIXABAN MALEATE BEVYXXA* EDOXABAN TOSYLATE SAVAYSA* HEPARIN AND RELATED DALTEPARIN FRAGMIN* PREPARATIONS SODIUM,PORCINE ENOXAPARIN SODIUM LOVENOX, ENOXAPARIN SODIUM FONDAPARINUX SODIUM ARIXTRA, FONDAPARINUX SODIUM

PLATELET AGGREGATION ASPIRIN/ DIPYRIDAMOLE AGGRENOX, ASPIRIN- INHIBITORS DIPYRIDAMOLE ER

CILOSTAZOL CILOSTAZOL CLOPIDOGREL BISULFATE PLAVIX, CLOPIDOGREL

DIPYRIDAMOLE DIPYRIDAMOLE PRASUGREL HCL EFFIENT, PRASUGREL HCL TICAGRELOR BRILINTA* VORAPAXAR SULFATE ZONTIVITY* SICKLE CELL ANEMIA HYDROXYUREA DROXIA*, SIKLOS* AGENTS

Effective January 1, 2020 *Available as Brand Only 1 of 13 THERAPEUTIC AREA DRUG CLASS GENERIC NAME BRAND NAME

ASTHMA AND COPD ANTICHOLINERGICS, TIOTROPIUM BROMIDE SPIRIVA*, SPIRIVA RESPIMAT* ORALLY INHALED LONG ACTING UMECLIDINIUM BROMIDE INCRUSE ELLIPTA*

GLYCOPYRROLATE/NEB.AC LONHALA MAGNAIR REFILL* CESSORIES GLYCOPYRROL/NEBULIZER LONHALA MAGNAIR STARTER* /ACCESSOR

REVEFENACIN YUPELRI* BETA-ADRENERGIC ALBUTEROL SULFATE ALBUTEROL SULFATE, PROAIR AGENTS, INHALED, RESPICLICK*, ALBUTEROL SULFATE SHORT ACTING HFA, PROAIR DIGIHALER*, PROAIR HFA, VENTOLIN HFA

LEVALBUTEROL HCL XOPENEX, XOPENEX CONCENTRATE, LEVALBUTEROL CONCENTRATE, LEVALBUTEROL HCL

BETA-ADRENERGIC FORMOTEROL FUMARATE PERFOROMIST* AGENTS, ORALLY INHALED,LONG ACTING SALMETEROL XINAFOATE SEREVENT DISKUS* ARFORMOTEROL BROVANA* TARTRATE BETA-ADRENERGIC AND BUDESONIDE/FORMOTER SYMBICORT* GLUCOCORTICOID OL FUMARATE COMBINATIONS FLUTICASONE/VILANTERO BREO ELLIPTA* L MOMETASONE/FORMOTE DULERA* ROL FLUTICASONE ADVAIR HFA*, ADVAIR DISKUS, PROPION/SALMETEROL FLUTICASONE-SALMETEROL, WIXELA INHUB

Effective January 1, 2020 *Available as Brand Only 2 of 13 THERAPEUTIC AREA DRUG CLASS GENERIC NAME BRAND NAME GLUCOCORTICOIDS, BECLOMETHASONE QVAR REDIHALER* ORALLY INHALED DIPROPIONATE BUDESONIDE BUDESONIDE, PULMICORT, PULMICORT FLEXHALER* FLUTICASONE FUROATE ARNUITY ELLIPTA* FLUTICASONE FLOVENT DISKUS*, FLOVENT HFA* PROPIONATE

MOMETASONE FUROATE ASMANEX*, ASMANEX HFA* LEUKOTRIENE RECEPTOR MONTELUKAST SODIUM SINGULAIR, MONTELUKAST ANTAGONISTS SODIUM

ZAFIRLUKAST ACCOLATE, ZAFIRLUKAST MAST CELL STABILIZERS, CROMOLYN SODIUM CROMOLYN SODIUM, ORALLY INHALED GASTROCROM, CROMOLYN SODIUM ANTICHOLINERGIC, IPRATROPIUM BROMIDE ATROVENT HFA*, IPRATROPIUM ORALLY INHALED SHORT BROMIDE ACTING BETA-ADRENERGIC INDACATEROL MALEATE ARCAPTA NEOHALER* AGENTS, INHALED, ULTRA-LONG ACTING OLODATEROL HCL STRIVERDI RESPIMAT* BETA-ADRENERGIC AND UMECLIDINIUM ANORO ELLIPTA* ANTICHOLINERGIC BRM/VILANTEROL TR COMBINATIONS GLYCOPYRROLATE/FORM BEVESPI AEROSPHERE* OTEROL FUM IPRATROPIUM/ALBUTERO COMBIVENT RESPIMAT*, L SULFATE IPRATROPIUM-ALBUTEROL

TIOTROPIUM STIOLTO RESPIMAT* BR/OLODATEROL HCL

BETA-ADRENERGIC- FLUTICASONE/UMECLIDIN TRELEGY ELLIPTA* ANTICHOLINERGIC- /VILANTER GLUCOCORT, INHALED PHOSPHODIESTERASE-4 ROFLUMILAST DALIRESP* (PDE4) INHIBITORS

Effective January 1, 2020 *Available as Brand Only 3 of 13 THERAPEUTIC AREA DRUG CLASS GENERIC NAME BRAND NAME GLUCOCORTICOIDS PREDNISONE PREDNISONE, PREDNISONE INTENSOL*, RAYOS* BEHAVIORAL HEALTH SELECTIVE SEROTONIN CITALOPRAM CELEXA, CITALOPRAM HBR - ANTIDEPRESSANTS REUPTAKE INHIBITOR HYDROBROMIDE (SSRIS) ESCITALOPRAM OXALATE LEXAPRO, ESCITALOPRAM OXALATE

FLUVOXAMINE MALEATE FLUVOXAMINE MALEATE, FLUVOXAMINE MALEATE ER PAROXETINE HCL PAXIL CR, PAROXETINE ER, PAXIL, PAROXETINE HCL, PAROXETINE CR

SERTRALINE HCL ZOLOFT, SERTRALINE HCL FLUOXETINE HCL FLUOXETINE HCL, PROZAC, SARAFEM, FLUOXETINE DR ST. JOHN'S WORT ST. JOHN'S WORT PAROXETINE MESYLATE PAROXETINE MESYLATE SSRI & 5HT1A PARTIAL VILAZODONE VIIBRYD* AGONIST HYDROCHLORIDE ANTIDEPRESSANT SSRI & SEROTONIN VORTIOXETINE TRINTELLIX* RECEPTOR MODULATOR HYDROBROMIDE ANTIDEPRESSANT

CANCER ANTINEOPLASTIC ANASTROZOLE ARIMIDEX, ANASTROZOLE PREVENTION AROMATASE INHIBITORS

EXEMESTANE AROMASIN, EXEMESTANE CARDIOVASCULAR ACE INHIBITOR/CALCIUM AMLODIPINE BESYLATE/ LOTREL, AMLODIPINE BESYLATE- DISEASE CHANNEL BLOCKER BENAZEPRIL BENAZEPRIL COMBINATION

TRANDOLAPRIL/ TARKA, TRANDOLAPRIL-VERAPAMIL VERAPAMIL HCL ER PERINDOPRIL PRESTALIA* ARG/AMLODIPINE BES ACE INHIBITOR/THIAZIDE BENAZEPRIL/ LOTENSIN HCT, BENAZEPRIL- & THIAZIDE-LIKE HYDROCHLOROTHIAZIDE HYDROCHLOROTHIAZIDE DIURETIC

CAPTOPRIL/ CAPTOPRIL- HYDROCHLOROTHIAZIDE HYDROCHLOROTHIAZIDE

Effective January 1, 2020 *Available as Brand Only 4 of 13 THERAPEUTIC AREA DRUG CLASS GENERIC NAME BRAND NAME ENALAPRIL/ VASERETIC, ENALAPRIL- HYDROCHLOROTHIAZIDE HYDROCHLOROTHIAZIDE FOSINOPRIL/ FOSINOPRIL- HYDROCHLOROTHIAZIDE HYDROCHLOROTHIAZIDE LISINOPRIL/ ZESTORETIC, LISINOPRIL- HYDROCHLOROTHIAZIDE HYDROCHLOROTHIAZIDE QUINAPRIL/ ACCURETIC, QUINAPRIL- HYDROCHLOROTHIAZIDE HYDROCHLOROTHIAZIDE ALPHA/BETA- CARVEDILOL COREG, CARVEDILOL ADRENERGIC BLOCKING AGENTS CARVEDILOL PHOSPHATE COREG CR, CARVEDILOL ER LABETALOL HCL LABETALOL HCL ANGIOTEN.RECEPTR AMLODIPINE/ EXFORGE HCT, AMLODIPINE- ANTAG./CAL.CHANL VALSARTAN/ HCTHIAZID VALSARTAN-HCTZ BLKR/THIAZIDE CB OLMESARTAN/ TRIBENZOR, OLMESARTAN- AMLODIPIN/ HCTHIAZID AMLODIPINE-HCTZ ANGIOTENSIN RECEPTOR AZILSARTAN MED/ EDARBYCLOR* ANTAG./THIAZIDE CHLORTHALIDONE DIURETIC COMB

CANDESARTAN/ ATACAND HCT, CANDESARTAN- HYDROCHLOROTHIAZID HYDROCHLOROTHIAZID IRBESARTAN/ AVALIDE, IRBESARTAN- HYDROCHLOROTHIAZIDE HYDROCHLOROTHIAZIDE LOSARTAN/ HYZAAR, HYZAAR*, LOSARTAN- HYDROCHLOROTHIAZIDE HYDROCHLOROTHIAZIDE OLMESARTAN/ BENICAR HCT, OLMESARTAN- HYDROCHLOROTHIAZIDE HYDROCHLOROTHIAZIDE TELMISARTAN/ MICARDIS HCT, TELMISARTAN- HYDROCHLOROTHIAZID HYDROCHLOROTHIAZID VALSARTAN/ DIOVAN HCT, VALSARTAN- HYDROCHLOROTHIAZIDE HYDROCHLOROTHIAZIDE ANGIOTENSIN RECEPTOR AMLODIPINE BES/ AZOR, AMLODIPINE-OLMESARTAN ANTGNST & OLMESARTAN MED CALC.CHANNEL BLOCKR

AMLODIPINE BESYLATE/ EXFORGE, AMLODIPINE- VALSARTAN VALSARTAN TELMISARTAN/ TWYNSTA, TELMISARTAN- AMLODIPINE AMLODIPINE

Effective January 1, 2020 *Available as Brand Only 5 of 13 THERAPEUTIC AREA DRUG CLASS GENERIC NAME BRAND NAME ANTIHYPERTENSIVES, BENAZEPRIL HCL LOTENSIN, BENAZEPRIL HCL ACE INHIBITORS CAPTOPRIL CAPTOPRIL ENALAPRIL MALEATE VASOTEC, ENALAPRIL MALEATE, EPANED* FOSINOPRIL SODIUM FOSINOPRIL SODIUM LISINOPRIL PRINIVIL, ZESTRIL, LISINOPRIL, QBRELIS* MOEXIPRIL HCL MOEXIPRIL HCL PERINDOPRIL ERBUMINE PERINDOPRIL ERBUMINE QUINAPRIL HCL ACCUPRIL, QUINAPRIL HCL RAMIPRIL ALTACE, RAMIPRIL TRANDOLAPRIL TRANDOLAPRIL ANTIHYPERTENSIVES, AZILSARTAN MEDOXOMIL EDARBI* ANGIOTENSIN RECEPTOR ANTAGONIST

CANDESARTAN CILEXETIL ATACAND, CANDESARTAN CILEXETIL EPROSARTAN MESYLATE EPROSARTAN MESYLATE IRBESARTAN AVAPRO, IRBESARTAN LOSARTAN POTASSIUM COZAAR, LOSARTAN POTASSIUM OLMESARTAN BENICAR, OLMESARTAN MEDOXOMIL MEDOXOMIL TELMISARTAN MICARDIS, TELMISARTAN VALSARTAN DIOVAN, VALSARTAN BETA-ADRENERGIC ACEBUTOLOL HCL ACEBUTOLOL HCL BLOCKING AGENTS ATENOLOL TENORMIN, ATENOLOL BETAXOLOL HCL BETAXOLOL HCL BISOPROLOL FUMARATE BISOPROLOL FUMARATE METOPROLOL SUCCINATE TOPROL XL, KAPSPARGO SPRINKLE*, METOPROLOL SUCCINATE METOPROLOL TARTRATE LOPRESSOR, METOPROLOL TARTRATE NADOLOL CORGARD, NADOLOL NEBIVOLOL HCL BYSTOLIC* PINDOLOL PINDOLOL PROPRANOLOL HCL INDERAL LA, HEMANGEOL*, PROPRANOLOL HCL, PROPRANOLOL HCL ER

Effective January 1, 2020 *Available as Brand Only 6 of 13 THERAPEUTIC AREA DRUG CLASS GENERIC NAME BRAND NAME SOTALOL HCL BETAPACE, BETAPACE AF, SORINE, SOTALOL, SOTALOL AF, SOTYLIZE* TIMOLOL MALEATE TIMOLOL MALEATE PENBUTOLOL SULFATE LEVATOL* BETA-ADRENERGIC ATENOLOL/ TENORETIC 100, TENORETIC 50, BLOCKING CHLORTHALIDONE ATENOLOL-CHLORTHALIDONE AGENTS/THIAZIDE & RELATED BISOPROLOL/ ZIAC, BISOPROLOL- HYDROCHLOROTHIAZIDE HYDROCHLOROTHIAZIDE

METOPROLOL/ LOPRESSOR HCT, METOPROLOL- HYDROCHLOROTHIAZIDE HYDROCHLOROTHIAZIDE NADOLOL/ NADOLOL-BENDROFLUMETHIAZIDE BENDROFLUMETHIAZIDE PROPRANOLOL/ PROPRANOLOL- HYDROCHLOROTHIAZID HYDROCHLOROTHIAZID CALCIUM CHANNEL AMLODIPINE BESYLATE NORVASC, AMLODIPINE BESYLATE BLOCKING AGENTS DILTIAZEM HCL CARDIZEM CD, TIAZAC, CARDIZEM, CARDIZEM LA*, CARDIZEM LA, CARTIA XT, DILTIAZEM 12HR ER, DILTIAZEM 24HR ER, DILTIAZEM 24HR ER (CD), DILTIAZEM 24HR ER (LA), DILTIAZEM HCL, DILT-XR, MATZIM LA, TAZTIA XT, TIADYLT ER

FELODIPINE FELODIPINE ER ISRADIPINE ISRADIPINE NICARDIPINE HCL NICARDIPINE HCL NIFEDIPINE ADALAT CC, PROCARDIA, PROCARDIA XL, NIFEDIPINE, NIFEDIPINE ER NISOLDIPINE SULAR, NISOLDIPINE VERAPAMIL HCL CALAN SR, VERELAN, VERELAN PM, CALAN, VERAPAMIL ER, VERAPAMIL ER PM, VERAPAMIL HCL, VERAPAMIL SR AMLODIPINE BENZOATE KATERZIA* DIGITALIS GLYCOSIDES DIGOXIN DIGOXIN, DIGOXIN*, DIGITEK, DIGOX, LANOXIN*, LANOXIN PEDIATRIC*

Effective January 1, 2020 *Available as Brand Only 7 of 13 THERAPEUTIC AREA DRUG CLASS GENERIC NAME BRAND NAME LOOP DIURETICS BUMETANIDE BUMETANIDE ETHACRYNIC ACID EDECRIN, ETHACRYNIC ACID FUROSEMIDE LASIX, FUROSEMIDE TORSEMIDE TORSEMIDE POTASSIUM SPARING AMILORIDE HCL AMILORIDE HCL DIURETICS EPLERENONE INSPRA, EPLERENONE SPIRONOLACTONE ALDACTONE, SPIRONOLACTONE TRIAMTERENE DYRENIUM, TRIAMTERENE POTASSIUM SPARING AMILORIDE/ AMILORIDE- DIURETICS IN HYDROCHLOROTHIAZIDE HYDROCHLOROTHIAZIDE COMBINATION SPIRONOLACT/ ALDACTAZIDE, ALDACTAZIDE*, HYDROCHLOROTHIAZID SPIRONOLACTONE-HCTZ TRIAMTERENE/ DYAZIDE, MAXZIDE, MAXZIDE-25 HYDROCHLOROTHIAZID MG, TRIAMTERENE- HYDROCHLOROTHIAZID THIAZIDE AND RELATED CHLOROTHIAZIDE CHLOROTHIAZIDE, DIURIL* DIURETICS CHLORTHALIDONE CHLORTHALIDONE HYDROCHLOROTHIAZIDE HYDROCHLOROTHIAZIDE INDAPAMIDE INDAPAMIDE METOLAZONE METOLAZONE VASODILATORS,CORONA NITROGLYCERIN NITROGLYCERIN, NITROLINGUAL, RY NITROSTAT, NITRO-TIME, NITROMIST* ANGIOTENSIN RECEPT- SACUBITRIL/VALSARTAN ENTRESTO* NEPRILYSIN INHIBITOR COMB(ARNI) ANTIANGINAL, HEART IVABRADINE HCL CORLANOR* RATE REDUCING, I(F) INHIBITOR ANTIARRHYTHMICS AMIODARONE HCL AMIODARONE HCL, PACERONE DOFETILIDE DOFETILIDE, TIKOSYN FLECAINIDE ACETATE FLECAINIDE ACETATE DRONEDARONE HCL MULTAQ* PROPAFENONE HCL PROPAFENONE HCL, PROPAFENONE HCL ER, RYTHMOL SR DIABETES ANTIHYPERGLY, (DPP-4) LINAGLIPTIN/ JENTADUETO*, JENTADUETO XR* INHIBITOR & BIGUANIDE METFORMIN HCL COMB.

Effective January 1, 2020 *Available as Brand Only 8 of 13 THERAPEUTIC AREA DRUG CLASS GENERIC NAME BRAND NAME SITAGLIPTIN PHOS/ JANUMET*, JANUMET XR* METFORMIN HCL ALOGLIPTIN ALOGLIPTIN-METFORMIN BENZ/METFORMIN HCL

ANTIHYPERGLY,INCRETIN DULAGLUTIDE TRULICITY* MIMETIC(GLP-1 RECEP.AGONIST) LIRAGLUTIDE VICTOZA 2-PAK*, VICTOZA 3-PAK*

EXENATIDE BYDUREON BCISE*, BYDUREON MICROSPHERES PEN* EXENATIDE BYETTA* SEMAGLUTIDE RYBELSUS* ANTIHYPERGLYCEMC- SOD/GLUC COTRANSPORT2(SGLT2)I NHIB EMPAGLIFLOZIN JARDIANCE* DAPAGLIFLOZIN FARXIGA* PROPANEDIOL

ANTIHYPERGLYCEMIC, LINAGLIPTIN TRADJENTA* DPP-4 INHIBITORS SITAGLIPTIN PHOSPHATE JANUVIA* ALOGLIPTIN BENZOATE ALOGLIPTIN

ANTIHYPERGLYCEMIC, GLIMEPIRIDE AMARYL, GLIMEPIRIDE INSULIN-RELEASE STIMULANT TYPE GLIPIZIDE GLUCOTROL, GLUCOTROL XL, GLIPIZIDE, GLIPIZIDE ER, GLIPIZIDE XL GLYBURIDE GLYBURIDE GLYBURIDE,MICRONIZED GLYNASE, GLYBURIDE MICRONIZED

NATEGLINIDE STARLIX, NATEGLINIDE REPAGLINIDE PRANDIN, REPAGLINIDE ANTIHYPERGLYCEMIC, PIOGLITAZONE HCL ACTOS, PIOGLITAZONE HCL INSULIN-RESPONSE ENHANCER (N-S)

Effective January 1, 2020 *Available as Brand Only 9 of 13 THERAPEUTIC AREA DRUG CLASS GENERIC NAME BRAND NAME ROSIGLITAZONE MALEATE AVANDIA*

ANTIHYPERGLYCEMIC,BI METFORMIN HCL FORTAMET, GLUCOPHAGE, GUANIDE TYPE(NON- GLUCOPHAGE XR, RIOMET*, SULFONYLUREA) METFORMIN ER GASTRIC, METFORMIN ER OSMOTIC, METFORMIN HCL, METFORMIN HCL ER ANTIHYPERGLYCEMIC,IN GLIPIZIDE/ METFORMIN GLIPIZIDE-METFORMIN SULIN-REL STIM.& HCL BIGUANIDE CMB GLYBURIDE/ METFORMIN GLYBURIDE-METFORMIN HCL HCL REPAGLINIDE/ REPAGLINIDE-METFORMIN HCL METFORMIN HCL ANTIHYPERGLYCEMIC,IN PIOGLITAZONE HCL/ DUETACT, PIOGLITAZONE- SULIN-RESPONSE & GLIMEPIRIDE GLIMEPIRIDE RELEASE COMB. ANTIHYPERGLYCEMIC- SGLT2 INHIBITOR & BIGUANIDE COMB EMPAGLIFLOZIN/ SYNJARDY*, SYNJARDY XR* METFORMIN HCL

DAPAGLIFLOZIN/METFOR XIGDUO XR* MIN HCL ANTIHYPERGLYCM,INSUL-PIOGLITAZONE HCL/ ACTOPLUS MET, ACTOPLUS MET RESP.ENHANCER & METFORMIN HCL XR*, PIOGLITAZONE-METFORMIN BIGUANIDE CMB INSULINS INSULIN LANTUS SOLOSTAR*, TOUJEO GLARGINE,HUM.REC.ANLO SOLOSTAR*, TOUJEO MAX G SOLOSTAR* INSULIN LISPRO HUMALOG JUNIOR KWIKPEN*, HUMALOG KWIKPEN U-200*, HUMALOG*, HUMALOG KWIKPEN U-100, INSULIN LISPRO KWIKPEN U-100

INSULIN LISPRO HUMALOG MIX 50-50 KWIKPEN*, PROTAMIN/ LISPRO HUMALOG MIX 75-25 KWIKPEN* INSULIN NPH HUM/ REG HUMULIN 70/30 KWIKPEN* INSULIN HM

Effective January 1, 2020 *Available as Brand Only 10 of 13 THERAPEUTIC AREA DRUG CLASS GENERIC NAME BRAND NAME INSULIN NPH HUMAN HUMULIN N KWIKPEN* ISOPHANE INSULIN REGULAR, HUMULIN R U-500 KWIKPEN*, HUMAN AFREZZA*

INSULIN ASPART FIASP FLEXTOUCH*, FIASP PENFILL* (NIACINAMIDE) INSULIN DETEMIR LEVEMIR FLEXTOUCH*

INSULIN DEGLUDEC TRESIBA FLEXTOUCH U-100*, TRESIBA FLEXTOUCH U-200* ANTIHYPERGLYCEMIC,IN INSULIN XULTOPHY 100-3.6* SULIN & GLP-1 DEGLUDEC/LIRAGLUTIDE RECEPTOR AGONIST INSULIN SOLIQUA 100-33* GLARGINE/LIXISENATIDE ANTIHYPERGLY,DPP-4 ALOGLIPTIN ALOGLIPTIN-PIOGLITAZONE ENZYME INHIB BENZ/PIOGLITAZONE &THIAZOLIDINEDIONE ANTIHYPERGLYCEMIC, EMPAGLIFLOZIN/LINAGLIP GLYXAMBI* SGLT-2 & DPP-4 TIN INHIBITOR COMB.

HYPERGLYCEMICS DEXTROSE DEX4 GLUCOSE, DEX4 GLUCOSE BITS, GLUCO BURST, GLUCO SHOT, GLUCOSE, GLUCOSE BITS, GLUCOSE GEL, GLUTOSE-15, GLUTOSE-45, GLUTOSE-5, MICRODOT GLUCOSE GEL, SUGARUP*, TRUEPLUS GLUCOSE DIABETIC SUPPLIES BLOOD-GLUCOSE METER HIV PROPHYLAXIS HIV PROPHYLAXIS EMTRICITABINE/TENOFOV TRUVADA IR (TDF) HYPERLIPIDEMIA ANTIHYPERLIPIDEMIC - ATORVASTATIN CALCIUM LIPITOR, ATORVASTATIN CALCIUM HMG COA REDUCTASE INHIBITORS FLUVASTATIN SODIUM LESCOL, LESCOL XL, FLUVASTATIN ER, FLUVASTATIN SODIUM

Effective January 1, 2020 *Available as Brand Only 11 of 13 THERAPEUTIC AREA DRUG CLASS GENERIC NAME BRAND NAME LOVASTATIN ALTOPREV*, LOVASTATIN PITAVASTATIN CALCIUM LIVALO* PRAVASTATIN SODIUM PRAVACHOL, PRAVASTATIN SODIUM ROSUVASTATIN CALCIUM CRESTOR, EZALLOR SPRINKLE*, ROSUVASTATIN CALCIUM SIMVASTATIN ZOCOR, FLOLIPID*, SIMVASTATIN PITAVASTATIN ZYPITAMAG* MAGNESIUM BILE SALT CHOLESTYRAMINE (WITH QUESTRAN, CHOLESTYRAMINE SEQUESTRANTS SUGAR) CHOLESTYRAMINE/ QUESTRAN LIGHT, ASPARTAME CHOLESTYRAMINE LIGHT, PREVALITE COLESEVELAM HCL COLESEVELAM HCL, WELCHOL COLESTIPOL HCL COLESTID, COLESTID*, COLESTIPOL HCL LIPOTROPICS EZETIMIBE ZETIA, EZETIMIBE FENOFIBRATE FENOGLIDE, LIPOFEN, FENOFIBRATE

FENOFIBRATE TRICOR, TRIGLIDE*, FENOFIBRATE NANOCRYSTALLIZED FENOFIBRATE,MICRONIZE FENOFIBRATE D FENOFIBRIC ACID FIBRICOR, FENOFIBRIC ACID FENOFIBRIC ACID TRILIPIX, FENOFIBRIC ACID (CHOLINE) GEMFIBROZIL LOPID, GEMFIBROZIL ICOSAPENT ETHYL VASCEPA* NIACIN NIACOR, NIASPAN, NIACIN, NIACIN ER OMEGA-3 ACID ETHYL LOVAZA, OMEGA-3 ACID ETHYL ESTERS ESTERS, TRIKLO ANTIHYPERLIP.HMG COA EZETIMIBE/SIMVASTATIN VYTORIN, EZETIMIBE-SIMVASTATIN REDUCT INHIB&CHOLEST.AB.INHI B NIACIN PREPARATIONS NIACIN NIACIN, ENDUR-ACIN, PLAIN NIACIN, SLO-NIACIN NIACINAMIDE NIACIN, ENDUR-AMIDE, ENDUR- AMIDE*, NIACINAMIDE NIACIN/PANTETHINE ENDUR-THINE*

Effective January 1, 2020 *Available as Brand Only 12 of 13 THERAPEUTIC AREA DRUG CLASS GENERIC NAME BRAND NAME NIACIN (INOSITOL NIACIN, NIACIN*, NIACIN FLUSH NIACINATE) FREE, NIACIN FLUSH FREE*, NIACIN FLUSH-FREE, NIACIN INOSITOL, NO FLUSH NIACIN OSTEOPOROSIS BONE RESORPTION ALENDRONATE SODIUM/ FOSAMAX PLUS D* INHIBITOR & VITAMIN D VITAMIN D3 COMBINATIONS BONE RESORPTION ALENDRONATE SODIUM FOSAMAX, INHIBITORS ALENDRONATE SODIUM, IBANDRONATE SODIUM BONIVA,B IBANDRONATE SODIUM RALOXIFENE HCL EVISTA, RALOXIFENE HCL RISEDRONATE SODIUM ACTONEL, ATELVIA, RISEDRONATE SODIUM, RISEDRONATE SODIUM DR DENOSUMAB PROLIA* VITAMIN AND/OR PRENATAL VITAMIN VARIOUS PRENATAL MINERAL DEFICIENCY PREPARATIONS VITAMINS

PEDIATRIC VITAMINS VARIOUS PEDIATRIC VITAMINS

Effective January 1, 2020 *Available as Brand Only 13 of 13