Vantage Health Plan Formulary

VHP674

Current as of December 31, 2012 2013 Vantage Catamaran Advantage Formulary Benefit designs may vary and formulary changes can occur at any time

Effective January 1, 2013

Introduction

The Vantage Catamaran Advantage Formulary was developed to serve as a guide for physicians, pharmacists, health care professionals and members in the selection of cost-effective drug therapy. Catamaran recognizes that drug therapy is an integral part of effective health management. The vast availability of medication options, however, warrants a reasonable program for drug selection and use. Catamaran continually reviews new and existing medications to ensure the Formulary remains responsive to the needs of our members and health professionals. Criteria used to evaluate drug selection for the formulary includes, but is not limited, to: safety, efficacy and cost-effectiveness data, as well as comparison of relevant benefits of similar prescription or over-the counter (OTC) agents while minimizing potential duplications. The formulary is a continually reviewed and modified document that represents the prevailing clinical opinion of Catamaran and Vantage Health Plan. This dynamic process does not allow this document to be completely accurate at all times. To accommodate regular changes, an updated electronic version of this formulary is available online at www.vhpla.com. Vantage and Catamaran welcomes your input and feedback on the information provided in this document.

How to Read the Formulary

All drugs are listed by their generic names and most common proprietary (branded) name. Specific drug listings may be accessed by using the index, either by generic (in lowercase) or proprietary name (in uppercase) and by therapeutic drug category. The brand names listed are for reference use only, and do not denote coverage, unless specifically noted. Any drug not found in this Formulary listing, or any Formulary updates published by Catamaran, shall be considered a non-formulary drug.

Sample Listing:

Tier Generic Name – Reference Name Generic Preferred Alternatives/ Status Comments ANTI-INFECTIVES PENICILLINS 1 amoxicillin – AMOXIL, TRIMOX generic 1 amoxicillin/clavulanate – AUGMENTIN, AUGMENTIN ES generic 1 amoxicillin/clavulanate er – AUGMENTIN XR generic 1 ampicillin – PRINCIPEN generic 1 dicloxacillin – DYNAPEN generic 1 penicillin v potassium – VEETIDS generic AUGMENTIN SUSPENSION 2 amoxicillin/clavulanate – 125/31.25 2 penicillin g benzathine – BICILLIN LA penicillin g 2 benzathine/penicillin g – BICILLIN CR procaine amoxicillin, 3 amoxicillin er – MOXATAG amoxicillin/clavulanate, penicillin v potassium

1

Once the category or product is located, the following items can be viewed.

Tier: This section identifies if the product is a Tier 1 product (i.e. typically generic), Tier 2 product (i.e. typically preferred brand), Tier 3 product (i.e. typically non-preferred brand or non-formulary), or Tier 4 (Specialty or high-cost drug) on the Vantage Catamaran 2013 Advantage Formulary. Generic products are considered to be Tier 1.

Generic Name: This lists the generic name for the product (lowercase). Products are listed within the product index by both generic and brand name.

Reference Name: This lists the brand name or common reference name for the product (UPPERCASE). Products are listed within the product index by both generic and brand name.

Generic Status: If the word “generic” is listed, the product is available as a generic and the tier listing provided refers to the generic version. The generic listed within the Drug Name section is considered to be a Tier 1 product and the brand listed will cost significantly more and, depending on the plan design, may require a significantly higher or 100% member copayment or co-insurance.

Preferred Alternatives/Comments: This field includes considerations for preferred Formulary alternatives for non-preferred products or may include comments regarding preferred options or OTC product availability. For certain agents within the Formulary, a recommended prescribing guideline may apply. Please refer to your specific benefit design for details.

Benefit Coverage and Limitations This printed Formulary does not define benefit coverage and limitations. Many members have specific benefit inclusions, exclusions, copayments, or a lack of coverage, which are not reflected in the Vantage Catamaran Advantage Formulary. Members should contact their Plan Sponsor or the Vantage Member Services Department at 1-866-823-1910 if they have questions regarding their coverage. Please note that the formulary process is evolutionary and changes can occur throughout the year. The following topics may or may not be applicable to individual members depending on member-specific benefit parameter.

Tier Description The amount that plan participants pay when purchasing medications and the tier status of certain medications may vary depending on plan design and program. Four-tiered plan designs provide coverage of prescription drugs at different levels or tiers. Generally, generic drugs are available to plan participants at the lowest copayment (Tier 1). Brand-name drugs that are considered preferred (Tier 2) will cost plan participants more than generics, but less than non-preferred brands. Brand-name drugs that are considered non-preferred or non-formulary (Tier 3) will cost more than preferred brands and Specialty and high-cost drugs are the highest copayment tier (Tier 4).

Prescribing Guidelines Prescribing guidelines may apply to select drugs on the Vantage Catamaran Advantage Formulary. Prescribing guidelines may vary by benefit design but may include:

Prior Authorization: Requires specific physician request process. Quantity Limit: Coverage may be limited to specific quantities Step Therapy: Coverage may depend on previous use or trial of another preferred drug. Age Edit: Coverage may depend on patient age. Gender Edit: Coverage may depend on patient gender. Prior authorization review of prescribing guidelines will be evaluated utilizing the established drug review criteria approved by Vantage Health Plan and Catamaran. If the request does not meet the approved criteria, the request will not be approved and alternative therapy may be recommended along with the proper course of alternative action. A list of edits recommended by Vantage and Catamaran is available upon request or by going to www.vhpla.com. Members should contact their Plan Sponsor or the Vantage Member Services Department at 1-866-823-1910 if they have questions regarding their specific coverage.

2

Non-Formulary Agents Drugs not found on the Catamaran Advantage Formulary, or any Advantage Formulary updates published by Catamaran, shall be considered a non-formulary drug. Requests for coverage of non-formulary agents may be requested by the health professional depending on specific coverage parameters. Review for non- formulary drug requests will require documentation of medical necessity. Generally, the following basic medical necessity guidelines are used in conducting a review:

ƒ The patient has failed an appropriate trial of formulary or preferred agents. ƒ The use of preferred or formulary agent is contraindicated in the patient. ƒ The formulary drug or preferred agents are not suited for the present patient care need, and the drug selected is required for patient safety.

If the request does not meet the established guidelines request, it will not be approved and alternative therapy may be recommended along with the proper course of alternative action. Common Drug Exclusions Due to benefit design parameters, some plan sponsors may choose to exclude certain drug classes. Prior authorization is generally not available for drugs that are specifically excluded by benefit design. Common excluded coverages may include, but are not limited to:

ƒ OTC medications or their equivalents unless otherwise specified in the Formulary listing. ƒ Smoking Cessation products (i.e. transdermal nicotine, nicotine gum, nicotine inhaler) ƒ Drug products used for cosmetic purposes ƒ Experimental drug products, or any drug product used in an experimental manner ƒ Replacement of lost or stolen medication ƒ Foreign drugs or drugs not approved by the United States Food & Drug Administration (FDA)

Mandated Generic Substitution Catamaran advocates the use of cost-effective generic drugs where FDA-labeled brand equivalent drugs are available. Generic products are listed in the Formulary and noted as “generic” wherever an FDA-approved generic drug product is available. If a member or physician requests a brand-name product in lieu of an approved generic, the member, based upon their coverage, will typically be required to pay the difference in cost between the brand and the generic drug. A physician can request coverage through the medication request process if he or she determines there is a documented medical need for the brand-drug equivalent.

Select drug products are excluded from generic substitution due to unique dosage form, complex pharmacokinetics and pharmacodynamics (what the body does to the drugs and what a drug does to the body, respectively), narrow therapeutic efficacy and/or where the critical maintenance of the drug blood level is crucial to its efficacy and prevention of adverse effects. This mandated generic substitution process is not intended to supersede any federal, state or local statues or regulations of the dispensing or generic substitution of any prescription agents. The drug list below is continuously reviewed to reflect current clinical standards and practices.

Products excluded for exclusion from the generic mandate are: ƒ Coumadin ƒ Dilantin ƒ Lanoxin ƒ Synthroid ƒ Tegretol/ XR ƒ Uniphyl ƒ Zarontin

3

2013 Catamaran Advantage Formulary Benefit designs may vary and formulary changes can occur at any time Generic Preferred Alternatives / Tier Generic Name - Reference Name Status Comments ANTI-INFECTIVES PENICILLINS 1 amoxicillin – AMOXIL, TRIMOX generic 1 amoxicillin/clavulanate – AUGMENTIN, AUGMENTIN ES generic 1 amoxicillin/clavulanate er – AUGMENTIN XR generic 1 ampicillin – PRINCIPEN generic 1 dicloxacillin – DYNAPEN generic 1 penicillin v potassium – VEETIDS generic AUGMENTIN SUSPENSION 2 amoxicillin/clavulanate – 125/31.25 2 penicillin g benzathine – BICILLIN LA penicillin g 2 benzathine/penicillin g – BICILLIN CR procaine amoxicillin, 3 amoxicillin er – MOXATAG amoxicillin/clavulanate, penicillin v potassium CEPHALOSPORINS 1 cefaclor – CECLOR generic 1 cefadroxil – DURICEF generic 1 cefdinir – OMNICEF generic 1 cefpodoxime – VANTIN generic 1 cefprozil – CEFZIL generic 1 cefuroxime axetil – CEFTIN generic 1 cephalexin – KEFLEX, KEFTAB generic cefaclor, cefprozil, cefuroxime 3 cefaclor er – CECLOR CD axetil 3 cefditoren – SPECTRACEF cefdinir, cefpodoxime 3 cefixime – SUPRAX cefdinir, cefpodoxime 3 ceftibuten – CEDAX cefdinir, cefpodoxime MACROLIDES 1 azithromycin – ZITHROMAX generic 1 clarithromycin – BIAXIN generic 1 clarithromycin er – BIAXIN XL generic erythromycin 1 – E.E.S 400 generic ethylsuccinate 2 erythromycin base – ERYTHROMYCIN FILMTAB erythromycin 2 – E.E.S GRANULES, ERYPED ethylsuccinate 2 erythromycin stearate – ERYTHROCIN 3 azithromycin – ZMAX azithromycin, clarithromycin erythromycin base, erythromycin erythromycin base, delayed 3 – ERY-TAB, PCE ethylsuccinate, erythromycin release stearate SULFONAMIDES & COMBINATIONS

1 erythromycin/sulfisoxazole – PEDIAZOLE generic 1 sulfadiazine – SULFADIAZINE generic 4

sulfamethoxazole/trimethop 1 – BACTRIM DS, SEPTRA DS generic rim 1 sulfisoxazole – GANTRISIN generic erythromycin/sulfisoxazole, 3 sulfisoxazole – GANTRISIN PEDIATRIC sulfamethoxazole/trimethoprim TETRACYCLINES 1 demeclocycline – DECLOMYCIN generic 1 doxycycline hyclate – VIBRA-TABS, VIBRAMYCIN generic 1 doxycycline hyclate – PERIOSTAT generic 1 doxycycline monohydrate – ADOXA generic 1 doxycycline monohydrate – MONODOX generic 1 minocycline – DYNACIN, MINOCIN generic 1 tetracycline – ACHROMYCIN, SUMYCIN generic ADOXA 75mg, 150mg 2 doxycycline monohydrate – CAPSULES 3 doxycycline monohydrate – ORACEA doxycycline 3 doxycycline hyclate – ORAXYL doxycycline 3 doxycycline monohydrate – VIBRAMYCIN SUSPENSION doxycycline 3 minocycline – SOLODYN minocycline 3 minocycline powder – ARESTIN doxycycline, minocycline MISCELLANEOUS ANTI-BACTERIALS & ANTI-MYCOBACTERIALS 1 chlorhexidine – PERIDEX, PERIOGARD generic 1 clindamycin hcl – CLEOCIN generic 1 clindamycin palmitate – CLEOCIN PEDIATRIC generic 1 metronidazole – FLAGYL generic 1 metronidazole er – FLAGYL ER generic 1 neomycin – NEOMYCIN generic 1 paromomycin – HUMATIN generic 1 vancomycin – VANCOCIN INJECTION generic 2 dapsone – DAPSONE 4 linezolid – ZYVOX 4 tobramycin – TOBI 2 vancomycin – VANCOCIN CAPSULES 2 ceftaroline – TEFLARO 2 rifaximin – XIFAXAN 3 aztreonam – CAYSTON 3 fidaxomicin – DIFICID metronidazole, Vancocin azithromycin, cefprozil, 3 telithromycin – KETEK cefuroxime axetil URINARY ANTI-INFECTIVES 1 methenamine hippurate – HIPREX generic nitrofurantoin 1 – MACRODANTIN generic macrocrystals

nitrofurantoin 1 – MACROBID 50mg, 100mg generic monohydrate/macrocrystals 1 trimethoprim – PROLOPRIM, TRIMPEX generic 1 nitrofurantoin – FURADANTIN SUSPENSION generic ciprofloxacin, ciprofloxaxin er, 3 fosfomycin – MONUROL sulfamethoxazole/trimethoprim 3 nitrofurantoin – MACRODANTIN 25mg nitrofurantoin macrocrystals ciprofloxacin, ciprofloxaxin er, 3 trimethoprim – PRIMSOL sulfamethoxazole/trimethoprim, trimethoprim

5

QUINOLONES 1 ciprofloxacin – CIPRO generic 1 ciprofloxacin er – CIPRO XR generic 1 ofloxacin – FLOXIN generic 1 levofloxacin – LEVAQUIN generic 2 ciprofloxacin – CIPRO SUSPENSION ciprofloxacin, ciprofloxaxin er, 3 ciprofloxacin – PROQUIN XR ofloxacin, levofloxacin ciprofloxacin, ciprofloxaxin er, 3 gemifloxacin – FACTIVE ofloxacin, levofloxacin ciprofloxacin, ciprofloxaxin er, 3 moxifloxacin – AVELOX ofloxacin, levofloxacin ciprofloxacin, ciprofloxaxin er, 3 norfloxacin – NOROXIN ofloxacin, levofloxacin ORAL ANTIFUNGAL AGENTS 1 clotrimazole – MYCELEX TROCHE generic 1 fluconazole – DIFLUCAN generic griseofulvin microsize 1 – GRIFULVIN V SUSPENSION generic suspension 1 itraconazole – SPORANOX generic 1 ketoconazole – NIZORAL TABLETS generic 1 nystatin – NILSTAT, MYCOSTATIN generic 1 terbinafine – LAMISIL generic 1 voriconazole – VFEND TABLETS generic 2 flucytosine – ANCOBON 2 itraconazole – SPORANOX SOLUTION 2 posaconazole – NOXAFIL SUSPENSION 2 terbinafine – LAMISIL ORAL GRANULES 2 voriconazole – VFEND SUSPENSION griseofulvin microsize, 3 griseofulvin – GRIFULVIN itraconzaole, terbinafine griseofulvin microsize, 3 griseofulvin ultramicrosize – GRIS-PEG itraconzaole, terbinafine 3 nystatin – BIO-STATIN nystatin ANTIVIRAL AGENTS ORAL ANTIVIRAL AGENTS - ANTI-INFLUENZA 1 amantadine – SYMMETREL CAPSULES generic 1 rimantadine – FLUMADINE generic 2 oseltamivir – TAMIFLU 2 zanamivir – RELENZA 3 amantadine – SYMMETREL TABLETS amantadine capsules ANTIVIRAL AGENTS - HEPATITIS COPEGUS, REBETOL, 4 ribavirin – generic RIBASPHERE 4 adefovir – HEPSERA 4 entecavir – BARACLUDE 4 telaprevir – INCIVEK 4 peginterferon alpha-2a – PEGASYS 4 peginterferon alpha-2b – PEG INTRON 4 ribavirin oral solution – REBETOL ORAL SOLUTION 4 ribavirin inhalation – VIRAZOLE 4 interferon alfacon-1 – INFERGEN 4 telbivudine – TYZEKA 4 boceprevir – VICTRELIS Pegasys, Peg Intron 6

ANTIVIRAL AGENTS - HERPES 1 acyclovir – ZOVIRAX generic 1 famciclovir – FAMVIR generic 1 valacyclovir – VALTREX generic ANTIVIRAL AGENTS - OTHER 4 valganciclovir – VALCYTE 4 ganciclovir – CYTOVENE Valcyte 4 tesamorelin – EGRIFTA ANTIRETROVIRAL AGENTS - COMBINATION PRODUCTS 4 abacavir/lamivudine – EPZICOM abacavir/lamivudine/zidovu 4 – TRIZIVIR dine efavirenz/emtricitabine/teno 4 – ATRIPLA fovir 4 emtricitabine/tenofovir – TRUVADA 4 lamivudine/zidovudine – COMBIVIR 4 lopinavir/ritonavor – KALETRA ANTIRETROVIRAL AGENTS - OTHER PRODUCTS 4 enfuvirtide – FUZEON 4 maroviroc – SELZENTRY 4 raltegravir – ISENTRESS ANTIRETROVIRAL AGENTS - PROTEASE INHIBITORS 4 atazanavir – REYATAZ 4 darunavir – PREZISTA 4 fosamprenavir – LEXIVA 3 indinavir – CRIXIVAN 3 nelfinavir – VIRACEPT 4 ritonavir – NORVIR 4 saquinavir – INVIRASE 4 tipranavir – APTIVUS ANTIRETROVIRAL AGENTS - REVERSE TRANSCRIPTASE INHIBITORS 1 didanosine – VIDEX EC generic 1 stavudine – ZERIT generic 1 zidovudine – RETROVIR generic 4 abacavir sulfate – ZIAGEN 4 delavirdine mesylate – RESCRIPTOR 4 didanosine – VIDEX SOLUTION 4 efavirenz – SUSTIVA 4 emtricitabine – EMTRIVA 4 etravirine – INTELENCE 4 lamivudine – EPIVIR/HBV 4 nevirapine – VIRAMUNE 4 nevirapine sr – VIRAMUNE XR 4 tenofovir – VIREAD Intelence, Rescriptor, Sustiva, 4 rilpivirine hcl – EDURANT Viramune, Viramune XR ANTI-MALARIAL AGENTS 1 chloroquine phosphate – ARALEN generic 1 hydroxychloroquine – PLAQUENIL generic 1 mefloquine – LARIAM generic 1 atovaquone/progaunil – MALARONE generic 2 artemether/lumefantrine – COARTEM 2 primaquine – PRIMAQUINE 2 pyrimethamine – DARAPRIM 7

2 quinine sulfate – QUALAQUIN ANTI-AMEBIC, ANTI-HELMINTHIC & ANTI-PROTOZOAL AGENTS 1 mebendazole – VERMOX generic 2 albendazole – ALBENZA 2 atovaquone – MEPRON 2 diiodohydroxyquin – YODOXIN 2 ivermectin – STROMECTOL 2 nitazoxanide – ALINIA 2 pentamidine – NEBUPENT 2 praziquantel – BILTRICIDE 2 tinidazole – TINDAMAX ANTI-TUBERCULOSIS 1 ethambutol – MYAMBUTOL generic 1 isoniazid – NIAZID, NYDRAZID generic 1 pyrazinamide – PYRAZINAMIDE generic 1 rifampin – RIFADIN, RIMACTANE generic 2 cycloserine – SEROMYCIN 2 ethionamide – TRECATOR 2 rifabutin – MYCOBUTIN

2 rifampin/inh/pyrazinamide – RIFATER 2 rifampin/isoniazid – RIFAMATE 3 aminosalicylic acid – PASER 3 rifapentine – PRIFTIN rifampin, Rifamate, Rifater IMMUNOSUPPRESSANT AGENTS 1 azathioprine – IMURAN generic 1 cyclosporine – NEORAL, SANDIMMUNE generic 1 leflunomide – ARAVA generic 1 methotrexate – RHEUMATREX 2.5mg generic 1 mycophenolate mofetil – CELLCEPT CAPSULES generic 1 tacrolimus – PROGRAF generic 2 auranofin – RIDAURA 2 cyclosporine – SANDIMMUNE 2 methotrexate – TREXALL 2 mycophenolate mofetil – CELLCEPT SUSPENSION

2 penicillamine – CUPRIMINE, DEPEN TITRATABS 3 sirolimus – RAPAMUNE 3 mycophenolate sodium – MYFORTIC mycophenolate mofetil ANTI-NEOPLASTIC AGENTS 1 anagrelide – AGRYLIN generic 1 anastrozole – ARIMIDEX generic 1 exemestane – AROMASIN generic 1 bicalutamide – CASODEX generic 1 etoposide – VEPESID INJECTION generic 1 flutamide – EULEXIN generic 1 letrozole – FEMARA generic 1 hydroxyurea – HYDREA 500mg generic 1 leucovorin – LEUCOVORIN generic 4 leuprolide – LUPRON generic 1 megestrol – MEGACE generic 1 mercaptopurine – PURINETHOL generic 1 mesna – MESNEX INJECTION generic 4 mitoxantrone – NOVANTRONE generic

8

4 octreotide – SANDOSTATIN generic 1 tamoxifen – NOLVADEX generic 4 tretinoin – VESANOID generic 1 vinorelbine – NAVELBINE generic 4 aldesleukin – PROLEUKIN 4 altretamine – HEXALEN 4 azacitidine – VIDAZA 4 bendamustine – TREANDA 4 bevacizumab – AVASTIN 4 bortezomib – VELCADE 4 busulfan – MYLERAN 4 capecitabine – XELODA 4 eribulin mesylate – HALAVEN 4 cetuximab – ERBITUX 4 chlorambucil – LEUKERAN 4 cyclophosphamide – CYTOXAN 4 dasatinib – SPRYCEL 4 degarelix – DEGARELIX 4 erlotinib – TARCEVA 4 erlotinib – TASIGNA 4 estramustine – EMCYT 4 etoposide – VEPESID CAPSULES 4 everolimus – AFINITOR 4 goserelin – ZOLADEX 4 histrelin –SUPPRELINLA,VANTAS 4 hydroxyurea – DROXIA 4 imatinib – GLEEVEC 4 interferon alpha-2b – INTRON A 4 peginterferon alfa-2b – SYLATRON 4 ixabepilone – IXEMPRA 4 lapatinib – TYKERB 4 lenalidomide – REVLIMID

4 leuprolide – LUPRON DEPOT/PED, ELIGARD 4 lomustine – CEENU 4 melphalan – ALKERAN 4 mesna – MESNEX B 4 methoxsalen – OXSORALEN-ULTRA, 8-MOP 4 mitotane – LYSODREN 4 octreotide – SANDOSTATIN LAR DEPOT 4 procarbazine – MATULANE 4 rituximab – RITUXAN 4 belimumab – BENLYSTA 4 sorafenib – NEXAVAR 4 fludarabine phosphate – OFORTA 4 sunitinib malate – SUTENT 4 temozolomide – TEMODAR 4 temsirolimus – TORISEL 4 thalidomide – THALOMID 4 thioguanine – TABLOID 4 topotecan – HYCAMTIN 4 trastuzumab – HERCEPTIN 4 denosumab – XGEVA 4 vandetanib – VANDETANIB

9

4 ipilimumab – YERVOY 4 abiraterone – ZYTIGA 4 bexarotene – TARGRETIN 4 gefitinib – IRESSA 3 megestrol – MEGACE ES megestrol 4 nilutamide – NILANDRON 4 pazopanib – VOTRIENT 4 tamoxifen – SOLTAMOX tamoxifen 4 toremifene – FARESTON 4 zoledronic acid ZOMETA 4 vorinostat – ZOLINZA 4 everolimis – ZORTRESS 4 crizotinib XALKORI HEMATOPOETIC GROWTH FACTORS 4 filgrastim – NEUPOGEN 4 oprelvekin – NEUMEGA 4 pegfilgrastim – NEULASTA 4 sargramostim – LEUKINE ANTIPSORIASIS AGENTS 2 acitretin – SORIATANE CK KIT CARDIOVASCULAR MEDICATIONS CARDIAC GLYCOSIDES 1 digoxin – LANOXIN generic 3 digoxin – LANOXIN CALCIUM ANTAGONISTS 1 amlodipine – NORVASC generic 1 diltiazem – CARDIZEM generic 1 diltiazem er – CARDIZEM CD, CARTIA XT generic 1 diltiazem er – CARDIZEM LA generic 1 diltiazem er – DILACOR XR generic 1 diltiazem er – DILTZAC, TAZTIA XT, TIAZAC generic 1 felodipine – PLENDIL generic 1 isradipine – DYNACIRC generic 1 nicardipine – CARDENE generic 1 nifedipine – PROCARDIA generic 1 nifedipine er – ADALAT CC generic 1 nifedipine er – PROCARDIA XL generic 1 nimodipine – NIMOTOP generic CALCIUM ANTAGONISTS (cont.) 1 nisoldipine er – SULAR generic 1 verapamil – CALAN, ISOPTIN generic 1 verapamil er – CALAN SR, ISOPTIN SR generic 1 verapamil er – VERELAN PM generic amlodipine, felodipine, isradipine, 3 isradipine er – DYNACIRC CR nifedipine er amlodipine, felodipine, 3 nicardipine er – CARDENE SR nicardipine, nifedipine er 3 verapamil er – COVERA-HS verapamil er DIURETICS 1 acetazolamide – DIAMOX generic 1 amiloride – MIDAMOR generic amiloride/hydrochlorothiazi 1 – MODURETIC generic de 1 bumetanide – BUMEX generic 10

1 chlorothiazide – DIURIL generic 1 chlorthalidone – HYGROTON generic 1 eplerenone – INSPRA generic 1 furosemide – LASIX generic 1 hydrochlorothiazide – ESIDRIX, HYDRODIURIL generic 1 indapamide – LOZOL generic 1 methyclothiazide – AQUATENSEN, ENDURON generic 1 metolazone – ZAROXOLYN generic 1 spironolactone – ALDACTONE generic spironolactone/hydrochlorot 1 – ALDACTAZIDE generic hiazide 1 torsemide – DEMADEX generic triamterene/hydrochlorothia DYAZIDE, MAXZIDE, MAXZIDE- 1 – generic zide 25 3 ethacrynate – EDECRIN BETA-ADRENERGIC ANTAGONIST AGENTS & COMBINATIONS 1 acebutolol – SECTRAL generic 1 atenolol – TENORMIN generic 1 atenololchlorthalidone – TENORETIC generic 1 betaxolol – KERLONE generic 1 bisoprolol – ZEBETA generic bisoprolol/hydrochlorothiazi 1 – ZIAC generic de 1 carvedilol – COREG generic 1 labetalol – NORMODYNE, TRANDATE generic 1 metoprolol succinate – TOPROL XL generic 1 metoprolol tartrate – LOPRESSOR generic metoprolol/hydrochlorothiaz 1 – LOPRESSOR HCT 100/25 generic ide 1 nadolol – CORGARD generic nadolol/bendroflumethiazid 1 – CORZIDE generic e 1 pindolol – VISKEN generic 1 propranolol – INDERAL generic 1 propranolol er – INDERAL LA generic propranolol/hydrochlorothia 1 – INDERIDE 40/25 generic zide 2 nebivolol – BYSTOLIC 2 carvedilol – COREG CR 2 propranolol – PROPANOLOL SOLUTION metoprolol/hydrochlorothiaz 3 – LOPRESSOR HCT 100/50 metoprolol/hydrochlorothiazide ide 3 penbutolol – LEVATOL nadalol, pindolol 3 propranolol er – INNOPRAN XL propranolol er propranolol/hydrochlorothia 3 – INDERIDE 80/25 propranolol/hydrochlorothiazide zide 3 timolol – BLOCADREN nadalol, pindolol ACE INHIBITORS & COMINATIONS 1 benazepril – LOTENSIN generic benazepril/amlodipine 1 – LOTREL generic besylate benazepril/hydrochlorothiaz 1 – LOTENSIN HCT generic ide 1 captopril – CAPOTEN generic

11

captopril/hydrochlorothiazid 1 – CAPOZIDE generic e 1 enalapril – VASOTEC generic enalapril/hydrochlorothiazid 1 – VASERETIC generic e 1 fosinopril – MONOPRIL generic fosinopril/hydrochlorothiazi 1 – MONOPRIL HCT generic de 1 lisinopril – PRINIVIL generic 1 lisinopril – ZESTRIL generic lisinopril/hydrochlorothiazid 1 – PRINZIDE generic e lisinopril/hydrochlorothiazid 1 – ZESTORETIC generic e 1 moexipril – UNIVASC generic moexipril/hydrochlorothiazi 1 – UNIRETIC generic de 1 quinapril – ACCUPRIL generic quinapril/hydrochlorothiazid 1 – ACCURETIC generic e 1 perindopril – ACEON generic 1 ramipril – ALTACE CAPSULES generic 1 trandolapril – MAVIK generic

benazepril/amlodipine besylate, 3 trandolapril/verapamil – TARKA enalapril, felodipine, Lotrel 3 ramipril – ALTACE TABLETS ramipril capsules

benazepril/amlodipine besylate, 3 enalapril maleate/felodipine – LEXXEL enalapril, felodipine, Lotrel ANGIOTENSIN II RECEPTOR ANTAGONISTS & COMBINATION 1 losartan – COZAAR generic losartan/hydrochlorothiazid 1 – HYZAAR generic e amlodipine 2 – AZOR besylate/olmesartan 1 valsartan – DIOVAN generic 2 valsartan/amlodipine – EXFORGE valsartan/amlodipine/ 2 – EXFORGE HCT hydrochlorothiazide valsartan/hydrochlorothiazi 1 – DIOVAN HCT generic de 2 telmisartan – MICARDIS telmisartan/hydrochlorothia 2 – MICARDIS HCT zide 3 aliskiren/amlodipine – TEKAMLO olmesartan/amlodipine/hydr 2 – TRIBENZOR ochlorothiazide 2 telmisartan/amlodipine – TWYNSTA 3 candesartan – ATACAND Cozaar, Diovan, Micardis candesartan/hydrochlorothi 3 – ATACAND HCT Diovan HCT, Micardis HCT azide 1 irbesartan – AVAPRO generic

12

irbesartan/hydrochlorothiazi 1 – AVALIDE generic de 3 olmesartan – BENICAR Cozaar, Diovan, Micardis olmesartan/hydrochlorothia 3 – BENICAR HCT Diovan HCT, Micardis HCT zide 3 azilsartan medoxomil – EDARBI Cozaar, Diovan, Micardis 3 eprosartan – TEVETEN Cozaar, Diovan, Micardis eprosartan/hydrochlorothia 3 – TEVETEN HCT Diovan HCT, Micardis HCT zide OTHER ANTIHYPERTENSIVES 1 clonidine – CATAPRES generic 1 clonidine transdermal – CATAPRES TTS generic 1 clonidine/chlorthalidone – CLORPRES generic 1 doxazosin – CARDURA generic 1 guanfacine – TENEX generic 1 hydralazine – APRESOLINE generic hydralazine/hydrochlorothia 1 – APRESAZIDE generic zide 1 methyldopa–ALDOMET generic methyldopa/hydrochlorothia 1 – ALDORIL generic zide 1 midodrine – PROAMATINE generic 1 minoxidil – LONITEN generic 1 prazosin – MINIPRESS generic 1 terazosin – HYTRIN generic aliskiren-amlodipine- 3 – AMTURNIDE hydrochlorothiazide 3 aliskiren – TEKTURNA aliskiren/hydrochlorothiazid 3 – TEKTURNA HCT e 2 reserpine – RESERPINE clonidine, guanfacine, 3 guanabenz – WYTENSIN methyldopa PHEOCHROMOCYTOMA AGENTS 4metyrosine–DEMSER 3 phenoxybenzamine – DIBENZYLINE VASODILATING AGENTS 1 isosorbide dinitrate – ISORDIL, SORBITRATE generic 1 isosorbide dinitrate er – ISOCHRON generic 1 isosorbide mononitrate – IMDUR, MONOKET generic 1 nitroglycerin er – NITRO-BID CAPSULES generic 1 nitroglycerin sublingual – NITROSTAT generic

1 nitroglycerin transdermal – MINITRAN, NITREK, NITRO-DUR generic 2 isosorbide dinitrate – DILATRATE-SR isosorbide 2 dinitrate/hydrochlorothiazid – BIDIL e 2 nitroglycerin ointment – NITRO-BID OINTMENT 3 nitroglycerin spray – NITROLINGUAL PUMP SPRAY 2 ranolazine er – RANEXA isosorbide dinitrate, isosorbide 3 isosorbide dinitrate er – ISORDIL TITRADOSE 40mg mononitrate

13

nitroglycerin transdermal, 3 nitroglycerin aerosol – NITROMIST nitroglycerin er nitroglycerin transdermal, 3 nitroglycerin transdermal – NITRO-DUR 0.3mg, 0.8mg nitroglycerin er ANTIDYSRHYTHMIC AGENTS CORDARONE, PACERONE 1 amiodarone – generic 200mg, 400mg 1 mexiletine – MEXITIL generic 1 disopyramide – NORPACE generic 1 flecainide – TAMBOCOR generic 1 propafenone – RYTHMOL generic 1 propafenone er RYTHMOL SR generic 1 quinidine gluconate – QUINAGLUTE DURA-TAB generic 1 quinidine sulfate – QUINIDINE generic 1 sotalol – BETAPACE, BETAPACE AF generic 2 amiodarone – PACERONE 100mg,300mg 2 dofetilide – TIKOSYN 2 moricizine – ETHMOZINE 3 disopyramide er – NORPACE CR 3 dronedarone – MULTAQ 3 quinidine sulfate er – QUINIDEX ANTILIPEMIC AGENTS HMG-COA REDUCTASE INHIBITORS 1 lovastatin – MEVACOR generic 1 pravastatin – PRAVACHOL generic 1 simvastatin – ZOCOR generic 1 atorvastatin calcium – LIPITOR generic 2 lovastatin er – ALTOPREV 2 rosuvastatin – CRESTOR 2 simvastatin/ezetimibe – VYTORIN 3 lovastatin/niacin – ADVICOR niacin, lovastatin lovastatin, pravastatin, 3 fluvastatin – LESCOL simvastatin, atorvastatin, Altoprev, Crestor, Vytorin lovastatin, pravastatin, 3 fluvastatin er LESCOL XL simvastatin, atorvastatin, Altoprev, Crestor, Vytorin lovastatin, pravastatin, 3 pitavastatin – LIVALO simvastatin, atorvastatin, Altoprev, Crestor, Vytorin ANTILIPEMIC AGENTS - OTHER

1 cholestyramine/aspartame – QUESTRAN LIGHT generic 1 cholestyramine/sucrose – QUESTRAN generic 1 colestipol – COLESTID generic 1 fenofibrate micronized – LOFIBRA generic 1 gemfibrozil – LOPID generic 1 niacin – NIACOR generic 2 colesevelam – WELCHOL 2 ezetimibe – ZETIA 2 niacin er – NIASPAN 2 fenofibrate – LIPOFEN

2 omega-3-acid ethyl esters – LOVAZA

14

2 simvastatin/niacin – SIMCOR

3 fenofibrate micronized – ANTARA fenofibrate micronized , Lipofen 3 amlodipine/atorvastatin – CADUET amlodipine, Lipitor

3 fenofibrate – FENOGLIDE fenofibrate micronized, Lipofen

3 fenofibric acid – FIBRICOR fenofibrate micronized, Lipofen

3 fenofibrate – TRICOR fenofibrate micronized, Lipofen

3 fenofibrate – TRIGLIDE fenofibrate micronized, Lipofen

3 choline fenofibrate – TRILIPIX fenofibrate micronized, Lipofen AUTONOMIC & CNS MEDICATIONS ANALGESICS 1 fentanyl citrate lozenzes – ACTIQ generic 1 fentanyl patch – DURAGESIC generic 1 hydromorphone – DILAUDID generic

1 meperidine – DEMEROL INJECTION, TABLETS generic 1 methadone – DOLOPHINE generic 1 methadone METHADONE SOLUTION generic 1 morphine – MSIR generic 1 oxymorphone – OPANA generic 1 morphine – ROXANOL generic 1 morphine er – MS CONTIN generic OXYIR, ROXICODONE 5mg, 1 oxycodone – generic 15mg,30mg 1 tramadol – ULTRAM generic 1 tramadol er – ULTRAM ER generic 1 buprenorphine – SUBUTEX generic 2 codeine sulfate – CODEINE 2 hydromorphone – DILAUDID LIQUID 2 meperidine – DEMEROL SOLUTION DOLOPHINE 5mg/5ml, 10mg/5ml 2 methadone – SOLUTION 2 morphine – MORPHINE SOLUTION 2 morphine – MORPHINE SUPPOSITORIES 2 morphine er – AVINZA 2 oxycodone er – OXYCONTIN fentanyl citrate lozenges, 3 fentanyl citrate sublingual ABSTRAL morphine, oxycodone fentanyl citrate lozenges, 3 fentanyl citrate effervescent – FENTORA morphine, oxycodone hydromorphone, methadone, 3 levorphanol – LEVO-DROMORAN morphine, oxycodone 3 morphine er/naltrexone – EMBEDA morphine er 3 morphine er – KADIAN morphine er, Avinza 3 morphine er – ORAMORPH morphine er, Avinza hydromorphone, methadone, 3 hydromorphone hcl EXALGO morphine 3 oxycodone – DAZIDOX 10mg,20mg oxycodone 3 tapentadol – NUCYNTA

15

3 tapentadol sr – NUCYNTA ER

hydromorphone, methadone, 3 oxymorphone er – OPANA ER morphine er, Avinza, OxyContin 3 tramadol er – RYZOLT, ULTRAM ER tramadol ANALGESIC COMBINATIONS 1 codeine/acetaminophen – TYLENOL/CODEINE generic 1 codeine/aspirin – EMPIRIN/CODEINE generic hydrocodone/acetaminoph 1 – LORTAB, VICODIN, VICODIN ES generic en 1 hydrocodone/ibuprofen – VICOPROFEN generic

1 oxycodone/acetaminophen – PERCOCET generic 1 oxycodone/aspirin – PERCODAN generic 1 oxycodone/ibuprofen – COMBUNOX generic pentazocine/acetaminophe 1 – TALACEN generic n 1 tramadol/acetaminophen – ULTRACET generic ANALGESIC COMBINATIONS (CONT.) dihydrocodeine/aspirin/caff 3 – SYNALGOS DC eine 3 meprobamate/aspirin – EQUAGESIC

3 opium/belladonna alkaloids – B&O NARCOTIC PARTIAL AGONISTS / ANTAGONISTS 1 pentazocine/naloxone – TALWIN NX generic

3 buprenorphine/naloxone – SUBOXONE, SUBOXONE FILM NARCOTIC ANTAGONISTS 1 naltrexone – REVIA generic 3 naltrexone – VIVITROL naltrexone AGENTS TO PREVENT & TREAT HEADACHES

1 butalbital/acetaminophen – PHRENILIN, PHRENILIN FORTE generic butalbital/acetaminophen/c 1 – ESGIC/PLUS, FIORICET generic affeine 1 butalbital/aspirin/caffeine – FIORINAL generic butalbital/codeine/acetamin 1 – FIORICET/CODEINE generic ophen butalbital/codeine/aspirin/c 1 – FIORINAL/CODEINE generic affeine 1 butorphanol – STADOL NS generic 1 dihydroergotamine – DHE-45 generic 1 ergotamine/caffeine – CAFERGOT generic ergotamine/caffeine 1 – MIGERGOT generic suppositories

isometheptene/dichlorophe 1 – MIDRIN generic nazone/ acetaminophen 2 divalproex – DEPAKOTE ER 2 ergotamine tartrate – ERGOMAR naratriptan, sumatriptan, Maxalt, 3 dihydroergotamine – MIGRANAL Relpax TRIPTAN AGENTS

16

1 naratriptan – AMERGE generic 1 sumatriptan tablets – IMITREX TABLETS generic IMITREX INJECTION 6mg/0.5ml 1 sumatriptan vial – generic VIAL

IMITREX INJECTION 4mg/0.5ml, 1 sumatriptan injection – generic INJECTION KIT, NASAL SPRAY 2 eletriptan – RELPAX 2 sumatriptan nasal spray –IMITREX 2 rizatriptan – MAXALT, MAXALT MLT naratriptan, sumatriptan, Maxalt, 3 almotriptan – AXERT Relpax naratriptan, sumatriptan, Maxalt, 3 frovatriptan – FROVA Relpax naratriptan, sumatriptan, Maxalt, 3 sumatriptan succinate – SUMAVEL DOSEPRO Relpax naproxen, naratriptan, 3 sumatriptan/naproxen – TREXIMET sumatriptan, Maxalt, Relpax naratriptan, sumatriptan, Maxalt, 3 zolmitriptan – ZOMIG, ZOMIG ZMT Relpax ANXIOLYTICS 1 alprazolam – XANAX generic 1 alprazolam er – XANAX XR generic 1 alprazolam odt – NIRAVAM generic

1 buspirone – BUSPAR 5mg, 10mg, 15mg, 30mg generic 1 chlordiazepoxide – LIBRIUM generic 1 clorazepate – TRANXENE generic 1 diazepam – VALIUM generic 1 lorazepam – ATIVAN generic 1 midazolam – VERSED generic 1 oxazepam – SERAX generic 3 buspirone – BUSPAR 7.5mg buspirone 3 clorazepate – TRANXENE SD clorazepate DIAZEPAM 1mg/ml, 5mg/ml 3 diazepam – diazepam, lorazepam SOLUTION SEDATIVE / HYPNOTIC AGENTS 1 estazolam – PROSOM generic 1 flurazepam – DALMANE generic 1 temazepam – RESTORIL generic 1 triazolam – HALCION generic 1 zaleplon – SONATA generic 1 zolpidem – AMBIEN generic 1 zolpidem er – AMBIEN CR 6.25mg,12.5mg generic

3 butabarbital – BUTISOL temazepam, zaleplon, zolpidem

3 chloral hydrate – SOMNOTE temazepam, zaleplon, zolpidem

3 eszopiclone – LUNESTA temazepam, zaleplon, zolpidem

3 pentobarbital – NEMBUTAL INJECTION temazepam, zaleplon, zolpidem

3 ramelteon – ROZEREM temazepam, zaleplon, zolpidem

17

3 secobarbital – SECONAL temazepam, zaleplon, zolpidem 3 zolpidem spray –ZOLPIMST Zolpidem 3 zolpidem sl – EDLUAR zolpidem ANTI-MANIA AGENTS 1 lithium carbonate – LITHONATE, ESKALITH generic 1 lithium carbonate er – LITHOBID generic 1 lithium citrate – LITHIUM CITRATE SYRUP generic LITHIUM CARBONATE 300mg 3 lithium carbonate – lithium carbonate, lithium citrate TABLETS ANTICONVULSANT AGENTS 1 felbamate – FELBATOL generic 1 carbamazepine – TEGRETOL generic 1 carbamazepine er – TEGRETOL XR 200mg,400mg generic 1 clonazepam – KLONOPIN generic 1 divalproex – DEPAKOTE generic 1 divalproex er – DEPAKOTE ER generic 4 ezogabine POTIGA 1 ethosuximide – ZARONTIN generic ANTICONVULSANT AGENTS (cont.) 1 gabapentin – NEURONTIN generic 1 gabapentin – NEURONTIN SOLUTION generic LAMICTAL CHEWABLE 1 lamotrigine – generic DISPERSABLE 5mg,25mg 1 lamotrigine – LAMICTAL generic 1 levetiracetam – KEPPRA generic 1 levetiracetam er – KEPPRA XR generic 1 mephobarbital – MEBARAL generic 1 oxcarbazepine – TRILEPTAL generic 1 phenobarbital – PHENOBARBITAL generic 1 phenytoin – DILANTIN generic 1 phenytoin – PHENYTEK generic 1 primidone – MYSOLINE generic 1 topiramate – TOPAMAX generic 1 valproic acid – DEPAKENE generic 1 zonisamide – ZONEGRAN generic 1 carbamazepine – CARBATROL generic 2 carbamazepine – TEGRETOL 3 carbamazepine er – TEGRETOL XR 2 diazepam – DIASTAT 3 ethosuximide – ZARONTIN 2 ethotoin – PEGANONE LAMICTAL CHEWABLE 2 lamotrigine – DISPERSABLE 2mg 2 lamotrigine er – LAMICTAL XR 2 lamotrigineodt – LAMICTALODT 2 methsuximide – CELONTIN 2 phenacemide – PHENURONE 3 phenytoin – DILANTIN 3 phenytoin chewable – DILANTIN INFATABS 2 pregabalin – LYRICA 2 rufinamide – BANZEL 2 tiagabine – GABITRIL 2 lacosamide – VIMPAT

18

3 carbamazepine er – EQUETRO carbamazepine er

3 divalproex – DEPAKOTE SPRINKLES divalproex tablets, valproic acid 3 gabapentin – GABARONE gabapentin 3 gabapentin enacarbil – HORIZANT gabapentin 3 lamotrigine sr – LAMICTAL XR 300MG TABLET lamotrigine 3 oxcarbazepine – TRILEPTAL SUSPENSION oxcarbazepine tablets divalproex, divalproex er, valproic 3 valproic acid er – STAVZOR acid 3 vigabatrin – SABRIL TRICYCLIC ANTIDEPRESSANTS 1 amitriptyline – ELAVIL generic amitriptyline/chlordiazepoxi 1 – LIMBITROL 12.5mg/5mg generic de 1 clomipramine – ANAFRANIL generic 1 desipramine – NORPRAMIN generic 1 doxepin – SINEQUAN generic 1 imipramine – TOFRANIL generic 1 imipramine – TOFRANIL PM generic 1 nortriptyline – AVENTYL, PAMELOR generic 1 protriptyline – VIVACTIL generic 1 trazodone – DESYREL generic 2 amoxapine – ASENDIN 2 trimipramine – SURMONTIL amitriptyline/chlordiazepoxi 3 – LIMBITROL 25mg/10mg amitriptyline/chlordiazepoxide de ETRAFON, ETRAFON FORTE, 3 amitriptyline/perphenazine – amitriptyline, perphenazine TRIAVIL 3 trazodone hcl – OLEPTRO trazodone SSRI ANTIDEPRESSANTS 1 citalopram – CELEXA generic 1 fluoxetine capsules – PROZAC generic 1 fluoxetine er – PROZAC ONCE WEEKLY generic 1 fluvoxamine – LUVOX generic 1 paroxetine hydrochloride – PAXIL generic

1 paroxetine hydrochloride er – PAXIL CR generic 1 sertraline – ZOLOFT generic 1 escitalopram – LEXAPRO generic citalopram, fluoxetine, 3 fluoxetine tablets – SARAFEM paroxetine, sertraline 3 fluvoxamine – LUVOX CR fluvoxamine citalopram, fluoxetine, 3 paroxetine hydrochloride – PAXIL CR 37.5mg paroxetine, sertraline citalopram, fluoxetine, 3 paroxetine mesylate – PEXEVA paroxetine, sertraline citalopram, fluoxetine, 3 vilazodone hcl – VIIBRYD paroxetine, sertraline OTHER ANTIDEPRESSANTS 1 venlafaxine er – EFFEXOR XR generic 1 bupropion – WELLBUTRIN generic 1 bupropion er – WELLBUTRIN SR generic 1 bupropion er – WELLBUTRIN XL generic 1 mirtazapine – REMERON generic

19

1 mirtazapine – REMERON SOLTAB generic 1 venlafaxine – VENLAFAXINE generic 1 venlafaxine – EFFEXOR generic OTHER ANTIDEPRESSANTS (cont.) 2 desvenlafaxine – PRISTIQ 2 duloxetine – CYMBALTA 3 bupropion er – APLENZIN bupropion er 3 nefazodone – SERZONE MAO INHIBITORS 1 tranylcypromine – PARNATE generic 1 phenelzine – NARDIL generic 3 isocarboxazid – MARPLAN phenelzine, tranylcypromine 3 selegiline transdermal – EMSAM phenelzine, tranylcypromine ANTIVERTIGO & ANTIEMETIC AGENTS 1 dronabinol – MARINOL generic 1 granisetron – KYTRIL generic

1 meclizine – ANTIVERT 12.5mg, 25mg, 32mg generic 1 ondansetron – ZOFRAN generic 1 prochlorperazine – COMPAZINE generic 1 promethazine – PHENERGAN generic 1 trimethobenzamide – TIGAN generic 2 aprepitant – EMEND 2 dolasetron – ANZEMET 2 granisetron transdermal – SANCUSO 2 scopolamine transdermal – TRANSDERM SCOP meclizine, prochlorperazine, 3 meclizine ANTIVERT 50mg promethazine 3 nabilone – CESAMET dronabinol 3 ondansetron – ZUPLENZ ondansetron ANTIPARKINSON AGENTS 1 benztropine – COGENTIN generic 1 pramipexole – MIRAPEX generic 1 bromocriptine mesylate – PARLODEL generic 1 carbidopa/levodopa–PARCOPA generic 1 carbidopa/levodopa–SINEMET/CR generic 1 ropinirole – REQUIP generic 1 selegiline – ELDEPRYL CAPSULES generic 1 trihexyphenidyl–ARTANE generic 2 apomorphine – APOKYN 2 carbidopa–LODOSYN pramipexole 2 – MIRAPEX ER dihydrochloride 3 entacapone – COMTAN 2 rasagiline mesylate – AZILECT 2 ropinirole er – REQUIP XL carbidopa/levodopa/entaca 3 – STALEVO carbidopa/levodopa, Comtan pone 3 levodopa–LARODOPA carbidopa/levodopa 3 selegiline – ELDEPRYL TABLETS selegiline capsules 3 selegiline odt – ZELAPAR selegiline capsules 3 tolcapone – TASMAR Comtan ANTIPYCHOTICS 1 chlorpromazine – THORAZINE generic 20

1 clozapine – CLOZARIL 25mg, 50mg, 100mg generic 1 fluphenazine – PERMITIL generic 1 haloperidol – HALDOL generic 1 loxapine – LOXITANE generic 1 perphenazine – TRILAFON generic 1 risperidone – RISPERDAL generic RISPERDAL M-TAB 0.5mg, 2mg, 1 risperidone – generic 3mg,4mg 1 thioridazine – MELLARIL, MELLARIL-S generic NAVANE 1mg, 2mg, 5mg, 10mg 1 thiothixene – generic CAPSULES 1 trifluoperazine – STELAZINE generic 1 olanzapine – ZYPREXA generic 2 molindone – MOBAN 2 olanzapine odt – ZYPREXA ZYDIS 2 pimozide – ORAP 1 quetiapine – SEROQUEL generic 1 quetiapine er – SEROQUEL XR generic 1 ziprasidone – GEODON generic risperidone, 3 aripirazole – ABILIFY, ABILIFY DISCMELT olanzapine,ziprasidone, quetiapine risperidone, 3 iloperidone – FANAPT olanzapine,ziprasidone, quetiapine risperidone, 3 asenapine – SAPHRIS olanzapine,ziprasidone, quetiapine 3 clozapine – FAZACLO clozapine 3 olanzapine/fluoxetine – SYMBYAX olanzapine AND fluoxetine 3 paliperidone – INVEGA risperidone 3 risperidone – RISPERDAL CONSTA risperidone 3 risperidone – RISPERDAL M-TAB 1mg risperidone 3 risperidone odt – RISPERDAL 0.25mg ODT risperidone 3 thiothixene – NAVANE 20mg CAPSULES thiothixene 3 olanzapine pamoate – ZYPREXA RELP INJ Zyprexa 3 lurasidone – LATUDA CNS STIMULANTS FOR ATTENTION DEFICIT HYPERACTIVITY DISORDER amphetamine/dextroamphe 1 – ADDERALL generic tamine 1 methamphetamine – DESOXYN generic DEXEDRINE, DEXTROSTAT 5mg 1 dextroamphetamine – generic TABLET 1 dexmethylphenidate – FOCALIN generic 1 methylphenidate – METHYLIN, RITALIN generic 1 methylphenidate er – METADATE ER generic 2 guanfacine er – INTUNIV 2 atomoxetine – STRATTERA 2 lisdexamfetamine – VYVANSE 2 methylphenidate – CONCERTA 2 methylphenidate er – METADATE CD methylphenidate 2 – DAYTRANA transdermal

21

amphetamine/dextroamphetamin amphetamine/dextroamphe 3 – ADDERALL XR e, methylphenidate ER, tamine er Concerta, Metadate CD, Vyvanse

amphetamine/dextroamphetamin 3 dexmethylphenidate – FOCALIN XR e, methylphenidate ER, Concerta, Metadate CD, Vyvanse 3 dextroamphetamine – DEXEDRINE 10mg TABLET dextroamphetamine 3 dextroamphetamine – PROCENTRA dextroamphetamine METHYLIN 2.5mg, 5mg, 10mg, 3 methylphenidate – CHEWABLE TABLETS, methylphenidate SOLUTION methylphenidate er, Metadate 3 methylphenidate er – RITALIN LA CD AGENTS TO TREAT ALZHEIMER'S DISEASE 1 donepezil – ARICEPT 5mg,10mg generic 1 donepezil – ARICEPT ODT generic 1 rivastigmine tartrate – EXELON generic 1 galantamine – RAZADYNE generic 1 galantamine er – RAZADYNE ER generic 2 donepezil – ARICEPT 2 memantine – NAMENDA AGENTS TO TREAT MULTIPLE SCLEROSIS 4 dalfampridine – AMPYRA 4 interferon beta-1a – AVONEX 4 glatiramer – COPAXONE 4 interferon beta-1b – EXTAVIA 4 fingolimod – GILENYA 4 interferon beta-1a – REBIF 4 interferon beta-1b – BETASERON 4 natalizumab – TYSABRI OTHER CNS / AUTONOMIC AGENTS 1 pyridostigmine – MESTINON generic 2 modafinil – PROVIGIL 2 neostigmine bromide – PROSTIGMIN 2 pyridostigmine – MESTINON SYRUP 2 pyridostigmine er – MESTINON TIMESPAN 4 sodium oxybate – XYREM 4 tetrabenazine – XENAZINE 3 ambenonium chloride – MYTELASE 3 armodafinil – NUVIGIL 3 milnacipran – SAVELLA gabapentin, Cymbalta, Lyrica BIOTECHNOLOGY AGENTS interferon gamma-1b, 4 – ACTIMMUNE recombinant 4 rilonacept – ARCALYST 4 alefacept–AMEVIVE 4 interferon alfa-n3 – ALFERON A DERMATOLOGICAL AGENTS TOPICAL ANESTHETICS 1 lidocaine – XYLOCAINE generic 1 lidocaine/prilocaine – EMLA generic 2 lidocaine patch – LIDODERM 22

3 lidocaine/prilocaine – EMLA with TEGADERM lidocaine/prilocaine 3 lidocaine/tetracaine – SYNERA lidocaine/prilocaine

ANTI-ACNE AGENTS 1 erythromycin solution – A/T/S generic AMNESTEEM, CLARAVIS, 1 isotretinoin – generic SOTRET 1 tretinoin – AVITA generic 1 benzoyl peroxide gel – BENZAC, BREVOXYL generic clindamycin 1 phosphate/benzoyl – BENZACLIN generic peroxide erythromycin/benzoyl 1 – BENZAMYCIN generic peroxide 1 benzoyl peroxide wash – BENZIQ, DESQUAM generic BENZOYL PEROXIDE WASH 1 benzoyl peroxide wash – generic 2.5%

CLENIA, PLEXION, ROSAC 1 sulfacetamide/sulfur – generic WASH, ROSULA, SULFACET-R 1 clindamycin phosphate – CLEOCIN T, CLINDA-DERM generic 1 adapalene – DIFFERIN 0.1% GEL generic 1 adapalene – DIFFERIN CREAM generic 1 erythromycin gel – EMGEL, ERYGEL generic 1 erythromycin pledgets – ERY PADS generic 1 clindamycin – EVOCLIN FOAM generic 1 tretinoin – RETIN-A generic 1 isotretinoin – SOTRET generic 1 benzoyl peroxide lotion – TRIAZ generic 1 benzoyl peroxide pad – TRIAZ generic benzoyl peroxide foaming 1 – TRIAZ generic cloth ZODERM CLEANSER, GEL, 1 benzoyl peroxide/urea – generic PADS clindaymycin 2 phosphate/benzoyl – ACANYA GEL peroxide 2 azelaid acid – AZELEX benzoyl 2 – DUAC peroxide/clindamycin adapalene/benzoly 2 EPIDUO peroxide 2 benzoyl peroxide/urea – ZODERM 4.5% CREAM 2 sulfacetamide/sulfur – ROSULA 2 sulfacetamide/sulfur – ROSULA NS 3 benzoyl peroxide cream – BENZASHAVE 5% benzoyl peroxide 3 benzoyl peroxide gel – CLINAC BPO 7% benzoyl peroxide gel adapalene, clindamycin 3 adapalene DIFFERIN GEL 0.3% phosphate, erythromycin adapalene, clindamycin 3 adapalene – DIFFERIN LOTION phosphate, erythromycin 3 tretinoin – RETIN-A MICRO tretinoin 3 tretinoin – TRETIN-X tretinoin

23

benzoyl 3 – VANOXIDE-HC benzoyl peroxide, hydrocortisone peroxide/hydrocortisone clindamycin 3 – ZIANA clindaymcin phosphate, tretinoin phosphate/tretinoin erythromycin gel, erythromycin 3 erythromycin ointment – A/T/S solution TOPICAL ANTIBACTERIAL AGENTS 1 bacitracin – BACITRACIN generic 1 gentamicin – GARAMYCIN generic 1 mupirocin – BACTROBAN OINTMENT generic 1 nystatin – MYCOSTATIN generic 1 silver sulfadiazine – SILVADENE generic 3 mafenide – SULFAMYLON silver sulfadiazine BACTROBAN CREAM, NASAL, 3 mupirocin – mupirocin ointment CENTANY 3 retapamulin – ALTABAX mupirocin ointment TOPICAL ANTIFUNGAL AGENTS LOPROX CREAM, GEL, LOTION, 1 ciclopirox – generic SUSPENSION 1 clotrimazole – LOTRIMIN, MYCELEX generic 1 econazole nitrate – SPECTAZOLE generic 1 ketoconazole – EXTINA generic 1 ketoconazole – NIZORAL CREAM, SHAMPOO generic 1 miconazole – MONISTAT-DERM generic 1 ketocon plus XOLEGEL KIT COREPAK generic 2 butenafine – MENTAX 3 sertaconazole – ERTACZO 3 ciclopirox – PENLAC itraconazole, terbinafine 3 ciclopirox – LOPROX SHAMPOO ketoconazole shampoo ciclopirox, econazole, 3 ketoconazole – XOLEGEL ketoconazole cream ciclopirox, econazole, 3 naftifine – NAFTIN ketoconazole cream ciclopirox, econazole, 3 oxiconazole – OXISTAT ketoconazole cream ciclopirox, econazole, 3 sulfoconazole – EXELDERM ketoconazole cream TOPICAL ANTIFUNGAL & CORTICOSTEROID COMBINATIONS clotrimazole/betamethason 1 – LOTRISONE generic e 1 nystatin/triamcinolone – MYCOLOG generic TOPICAL ANTIVIRAL AGENTS 2 acyclovir – ZOVIRAX CREAM, OINTMENT 3 penciclovir – DENAVIR acyclovir KERATOLYTIC AGENTS 1 podofilox – CONDYLOX SOLUTION generic 2 podofilox – CONDYLOX GEL TOPICAL ANTIPSORIASIS & ANTI-ECZEMA AGENTS 1 sulfacetamide sodium CARMOL SCALP generic 1 calcipotriene – DOVONEX SOLUTION generic 1 sulfacetamide sodium – KLARON generic 2 anthralin – DRITHO-SCALP, PRORIATEC 2 calcipotriene – DOVONEX CREAM 2 sulfacetamide sodium – SEB-PREV 24

2 tazarotene – TAZORAC 2 urea – KERALAC 2 calcitriol – VECTICAL calcipotriene/betamethason betamethasone, calcipotriene, 3 – TACLONEX edipropionate Dovonex 3 sulfacetamide sodium – OVACE sulfacetamide sodium

TOPICAL IMMUNOMODULATORS 2 tacrolimus – PROTOPIC 2 pimecrolimus – ELIDEL TOPICAL CORTICOSTEROID AGENTS

1 aclometasone – ACLOVATE OINTMENT, CREAM generic 1 amcinonide – CYCLOCORT CREAM generic betamethasone 1 – DIPROSONE, MAXIVATE generic dipropionate betamethasone 1 – DIPROLENE, DIPROLENE AF generic dipropionate augmented 1 betamethasone valerate – VALISONE generic 1 clobetasol – TEMOVATE generic 1 desonide – DESOWEN, TRIDESILON generic 1 desoximetasone – TOPICORT, TOPICORT LP generic FLORONE, FLORONE E, 1 diflorasone – generic PSORCON E 1 fluocinolone acetonide – SYNALAR generic 1 fluocinonide – LIDEX, LIDEX E generic 1 fluticasone propionate – CUTIVATE generic 1 halobetasol – ULTRAVATE generic 1 hydrocortisone – HYTONE generic 1 hydrocortisone butyrate – LOCOID generic 1 hydrocortisone valerate – WESTCORT generic ELOCON OINTMENT, CREAM, 1 mometasone – generic LOTION 1 prednicarbate – DERMATOP generic 1 triamcinolone acetonide – KENALOG generic 2 clobetasol – CLOBEX 2 fluocinolone – CAPEX SHAMPOO 2 hydrocortisone butyrate – LOCOID LIPOCREAM amcinonide cream,

CYCLOCORT LOTION, betamethasone dipropionate 3 amcinonide – OINTMENT augmented, diflorasone, fluocinonide amcinonide cream,

betamethasone dipropionate 3 betamethasone valerate – LUXIQ augmented, diflorasone, fluocinonide betamethasone dipropionate 3 clobetasol propionate – OLUX-E augmented, clobetasol, diflorasone, halobetasol betamethasone dipropionate,

desoximetasone, fluocinolone 3 clocortolone – CLODERM acetonide, triamcinolone acetonide

25

aclometasone, fluocinolone 3 desonide – DESONATE acetonide, hydrocortisone aclometasone, fluocinolone 3 desonide – VERDESO acetonide, hydrocortisone betamethasone dipropionate,

DERMA-SMOOTHE, DERMA- desoximetasone, fluocinolone 3 fluocinolone acetonide – SMOOTHE FS acetonide, triamcinolone acetonide amcinonide cream,

betamethasone dipropionate 3 fluocinonide – VANOS augmented, diflorasone, fluocinonide betamethasone dipropionate,

desoximetasone, fluocinolone 3 flurandrenolide – CORDRAN acetonide, triamcinolone acetonide amcinonide cream,

betamethasone dipropionate 3 halcinonide – HALOG, HALOG E augmented, diflorasone, fluocinonide betamethasone dipropionate,

desoximetasone, fluocinolone 3 hydrocortisone probutate – PANDEL acetonide, triamcinolone acetonide betamethasone dipropionate,

desoximetasone, fluocinolone 3 triamcinolone acetonide – KENALOG AEROSOL acetonide, triamcinolone acetonide TOPICAL CORTICOSTEROID COMBINATION AGENTS 1hydro-iodoquinol 2-1 – ALCORTIN A generic 1 clioquinol/hydrocortisone – HYSONE generic hydrocortisone 1 – CARMOL HC, U-CORT generic acetate/urea hydrocortisone 1 – PRAMOSONE 2.5% OINTMENT generic acetate/pramoxone hcl

1 pramoxine/hydrocortisone – PRAMOSONE 1-1% CREAM generic

1 iodoquinol/hydrocortisone – VYTONE generic

2 pramoxine/hydrocortisone – EPIFOAM, PRAMOSONE iodoquinol/hydrocortisone/a 3 – ALCORTIN iodoquinol/hydrocortisone loe TOPICAL OB/GYN ANTI-INFECTIVES 1 clindamycin phosphate – CLEOCIN VAGINAL CREAM generic 1 metronidazole – METROGEL-VAGINAL generic 2 clindamycin phosphate – CLINDESSE 2 metronidazole – VANDAZOLE 2 sulfanilamide – AVC CLEOCIN VAGINAL clindamycin phosphate vaginal 3 clindamycin phosphate – SUPPOSITORY cream, Clindesse TOPICAL VAGINAL ANTIFUNGALS 1 terconazole – TERAZOL 3 SUPP generic

26

1 terconazole – TERAZOL 3, TERAZOL 7 CREAM generic 2 buconazole nitrate – GYNAZOLE-1 2 nystatin – NYSTATIN VAGINAL TABLETS

3 miconazole nitrate – MICONAZOLE-3 miconazole nitrate, terconazole TOPICAL RECTAL AGENTS 1 hydrocortisone – ANUSOL-HC generic PROCTOCORT HC, 1 hydrocortisone – generic CORTENEMA

1 hydrocortisone/pramoxine – ANALPRAM-HC generic 2 hydrocortisone – ANUSOL-HC 2 hydrocortisone – CORTIFOAM ANAMANTLE HC, ANAMANTLE 2 hydrocortisone/lidocaine – HC FORTE

2 hydrocortisone/pramoxine – ANALPRAM-HC

2 hydrocortisone/pramoxine – PROCTOFOAM-HC TOPICAL NON-STERIODAL ANTI-INFLAMMATORY AGENTS 3 diclofenac gel – SOLARAZE GEL 3% 3 diclofenac gel – VOLTAREN GEL 1% 3 diclofenac patch – FLECTOR PATCH OTHER DEMATOLOGICAL AGENTS 1 imiquimod – ALDARA generic aluminum chloride 1 – DRYSOL generic hexahydrate 1 ammonium lactate – LAC-HYDRIN generic 1 doxepin – ZONALON generic 1 fluorouracil – EFUDEX generic 1 hyaluronate sodium – HYLIRA generic 1 hydroquinone – ELDOQUIN FORTE generic 1 lactic acid – LACTINOL generic 1 lactic acid/vitamin e – LACTINOL-E generic 1 lindane – KWELL generic 1 metronidazole – METROCREAM generic 1 metronidazole – METROLOTION generic 1 permethrin – ELIMITE generic trypsin/balsam peru/castor 1 – GRANULEX generic oil 1 urea – CARMOL, UMECTA generic 1 malathion – OVIDE generic 2 alitretinoin – PANRETIN 2 azelaic acid – FINACEA 2 azelaic acid – FINACEA PLUS 2 benzyl alcohol – ULESFIA 2 crotamiton – EURAX 2 fluorouracil – CARAC, FLUOROPLEX 2 metronidazole – METROGEL 3 aluminum chloride – XERAC AC 3 collagenase – COLLAGENASE SANTYL 3 emollient cream – MIMYX 3 mequinol/tretinoin – SOLAGE

27

metronidazole cream, 3 metronidazole – NORITATE metronidazole lotion 4 becaplermin – REGRANEX 3 urea-hyaluronate sodium – UMECTA PD miconazole/zinc 3 – VUSION oxide/white petrolatum 3 sinecatechins – VEREGEN EAR, NOSE & THROAT AGENTS NASAL CORTICOSTEROIDS 1 triamcinolone – NASACORT AQ generic 1 flunisolide – NASAREL generic 1 fluticasone propionate – FLONASE generic 2 mometasone – NASONEX flunisolide, fluticasone 3 beclomethasone – BECONASE AQ propionate, triamcinolone, Nasonex flunisolide, fluticasone 3 ciclesonide – OMNARIS propionate, triamcinolone, Nasonex flunisolide, fluticasone 3 budesonide – RHINOCORT AQUA propionate, triamcinolone, Nasonex flunisolide, fluticasone 3 fluticasone furoate – VERAMYST propionate, triamcinolone, Nasonex AGENTS AFFECTING THE EAR acetic acid/aluminum BOROFAIR OTIC, OTIC 1 – generic acetate DOMEBORO

acetic 1 – AURALGAN generic acid/antipyrine/benzocaine

1 acetic acid/hydrocortisone – VOSOL HC generic hydrocortisone/pramoxine/c 1 – CORTANE-B generic hloroxylenol neomycin 1 sulfate/polymyxin/hydrocort – CORTISPORIN generic isone neomycin 1 sulfate/polymyxin/hydrocort – PEDIOTIC generic isone 1 ofloxacin – FLOXIN OTIC generic acetic acid/polycosanol/ 2 trolamine polypeptide – CERUMENEX oleate ciprofloxacin/dexamethaso 2 – CIPRODEX ne

ciprofloxacin/hydrocortison neomycin 3 – CIPRO HC e sulfate/polymyxin/hydrocortisone

hydrocortisone/neomycin neomycin 3 – COLY-MYCIN S sulfate sulfate/polymyxin/hydrocortisone

28

neomycin/colistin/hydrocorti neomycin 3 – CORTISPORIN TC sone/thonzonium sulfate/polymyxin/hydrocortisone AGENTS AFFECTING THE NOSE 1 ipratropium – ATROVENT generic 1 azelastine – ASTELIN generic 2 azelastine – ASTEPRO

3 olopatadine – PATANASE azelastine, ipratropium, Astepro AGENTS AFFECTING THE MOUTH ] pilocarpine – SALAGEN generic

1 triamcinolone dental paste – KENALOG IN ORABASE generic 2 cevimeline – EVOXAC 3 amlexanox – APHTHASOL ENDOCRINE MEDICATIONS ANTIDIABETIC AGENTS - BIGUANIDES 1 metformin – GLUCOPHAGE generic 1 metformin er – GLUCOPHAGE XR generic 1 metformin – FORTAMET generic 3metformin–GLUMETZA metformin, metformin er 3metformin–RIOMET metformin, metformin er ANTIDIABETIC AGENTS - SULFONYLUREAS 1 chlorpropamide – DIABENESE generic 1 glimepiride – AMARYL generic 1 glipizide – GLUCOTROL generic 1 glipizide er – GLUCOTROL XL generic DIABETA, GLYNASE, 1 glyburide – generic MICRONASE glimepiride, glipizide, glipizide er, 3 glyburide – GLYCRON 4.5mg glyburide

3 tolazamide – TOLINASE glimepiride, glipizide, glipizide er

3 tolbutamide – ORINASE glimepiride, glipizide, glipizide er ANTIDIABETIC AGENTS - THIAZOLIDINEDIONES 1 pioglitazone – ACTOS generic 3 rosiglitazone – AVANDIA REMS program only

ANTIDIABETIC AGENTS - DPP-IV INHIBITORS 2 sitagliptin – JANUVIA 2 saxagliptin – ONGLYZA 3 linagliptin – TRADJENTA Januvia, Onglyza ANTIDIABETIC AGENTS - COMBINATIONS 1 glipizide/metformin – METAGLIP generic 1 glyburide/metformin – GLUCOVANCE generic 2 pioglitazone/glimepiride – DUETACT 2 pioglitazone/metformin ACTOPLUS MET/ XR 2 sitagliptin/metformin – JANUMET 2 saxagliptin/metformin – KOMBIGLYZE XR 3 repaglinide/metformin – PRANDIMET 3 rosiglitazone/metformin – AVANDAMET REMS program only ANTIDIABETIC AGENTS - OTHER 1 acarbose – PRECOSE generic 29

1 nateglinide – STARLIX generic 2 exenatide – BYETTA 2 exenatide BYDEURON 2 pramlintide – SYMLIN 2 repaglinide – PRANDIN 3 miglitol – GLYSET 3 liraglutide – VICTOZA DIABETIC AGENTS - OTHER 2glucagon–GLUCAGON INSULIN 2 insulin glulisine – APIDRA 2 insulin, glargine – LANTUS 2 insulin, human – NOVOLIN

2 insulin, human aspart – NOVOLOG, NOVOLOG PENFILL insulin, human aspart & NOVOLOG MIX, NOVOLOG MIX 2 – protamine PENFILL 3 insulin, human lispro – HUMALOG, HUMALOG PEN insulin, human lispro & HUMALOG MIX, HUMALOG MIX 3 – protamine PEN 3 insulin, human – HUMULIN, HUMULIN PEN 3 insulin detemir – LEVEMIR BISPHOSPHATES & RELATED AGENTS 1 alendronate – FOSAMAX generic calcitonin-salmon nasal 1 – FORTICAL, MIACALCIN generic spray 1 etidronate – DIDRONEL generic 2 alendronate – FOSAMAX plus D 2 alendronate – FOSAMAX SOLUTION 1 ibandronate – BONIVA generic 2 raloxifene – EVISTA 4 teriparatide – FORTEO 3 risedronate – ATELVIA alendronate, ibandronate 4 ibandronate – BONIVA INJECTION alendronate, ibandronate 3 risedronate – ACTONEL alendronate, ibandronate 3 risedronate – ACTONEL with CALCIUM alendronate, ibandronate 3 calcitonin injection – MIACALCIN INJECTION 3 tiludronate – SKELID alendronate, ibandronate 4 denosumab – PROLIA alendronate, ibandronate 4 zoledronic acid – RECLAST alendronate, ibandronate ADRENAL CORTICOSTEROID AGENTS 1 cortisone – CORTISONE generic DECADRON ELIXIR, 0.5mg, 1 dexamethasone – 0.75mg, 1.5mg, 4mg, 6mg generic TABLETS 1 fludrocortisone – FLORINEF generic 1 hydrocortisone – CORTEF generic 1 methylprednisolone – MEDROL generic 1 prednisolone – PRELONE SYRUP generic prednisolone sodium 1 – ORAPRED, PEDIAPRED generic phosphate DELTASONE 1mg, 2.5mg, 5mg, 1 prednisone – generic 10mg,20mg

30

DELTASONE CONCENTRATE, 2 prednisone – SOLUTION, 50mg TABLETS dexamethasone elixir, 3 betamethasone – CELESTONE SOLUTION dexamethasone tablets DECADRON SOLUTION, 1mg, dexamethasone elixir, 3 dexamethasone – 2mg TABLETS dexamethasone tablets 3 dexamethasone – DEXPAK dexamethasone tablets

3 dexamethasone drops – DEXAMETHASONE INTENSOL dexamethasone elixir prednisolone, prednisolone 3 prednisolone – MILLIPRED sodium phosphate prednisolone, prednisolone 3 prednisolone – VERIPRED sodium phosphate prednisolone sodium prednisolone, prednisolone 3 – ORAPRED ODT phosphate sodium phosphate THYROID AGENTS 1 levothyroxine – LEVOTHROID, LEVOXYL generic ARMOUR THYROID, 1 thyroid – WESTHROID 32.5mg, 65mg, generic 130mg, 195mg ARMOUR THYROID 30mg, 60mg, 1 thyroid – generic 90mg 1 levothyroxine – UNITHROID generic THYROID AGENTS (cont.) 3 levothyroxine – SYNTHROID ARMOUR THYROID, NATURE

THYROID 15mg, 16.25mg, 2 thyroid – 97.5mg, 120mg, 180mg, 240mg, 260mg, 300mg, 325mg 3liothyronine– CYTOMEL levothyroxine 3liotrix– THYROLAR levothyroxine 3 levothyroxine sodium TIROSINT levothyroxine 3thyroid,pork– BIO-THROID levothyroxine

ANTI-THYROID AGENTS 1 methimazole – TAPAZOLE generic 1 propylthiouracil – PTU generic OTHER ENDOCRINE AGENTS / ENZYME REPLACEMENT 4 cabergoline – DOSTINEX generic 4 desmopressin – DDAVP generic 4 carglumic acid – CARBAGLU 4 agalsidase beta – FABRAZYME 4 alglucosidase alfa – MYOZYME 3 cinacalcet – SENSIPAR 4 galsulfase – NAGLAZYME 4 idursulfase – ELAPRASE 4 imiglucerase – CEREZYME 4 laronidase – ALDURAZYME 4 sapropterin – KUVAN 4 tolvaptan – SAMSCA 4 sacrosidase – SUCRAID 4 miglustat – ZAVESCA GROWTH HORMONES

31

4 pegvisomet – SOMAVERT GENOTROPIN, GENOTROPIN 4 somatropin – MINIQUICK 4 somatropin – HUMATROPE 4 somatropin – NORDITROPIN Genotropin, Humatrope, 4 mecasermin – INCRELEX Norditropin Genotropin, Humatrope, 4 somatropin NUTROPIN/AQ/AQ NUSPIN Norditropin Genotropin, Humatrope, 4 somatropin – OMNITROPE Norditropin Genotropin, Humatrope, 4 somatropin – SAIZEN Norditropin Genotropin, Humatrope, 4 somatropin – SEROSTIM Norditropin Genotropin, Humatrope, 4 somatropin – TEV-TROPIN Norditropin Genotropin, Humatrope, 4 somatropin – ZORBITIVE Norditropin GASTROINTESTINAL MEDICATIONS ANTISPASMODICS / AGENTS AFFECTING GI MOTILITY belladonna 1 – DONNATAL generic alkaloids/phenobarbital

1 clidinium/chlordiazepoxide – LIBRAX generic 1 dicyclomine – BENTYL generic diphenoxylate/atropine 1 – LOMOTIL generic sulfate 1 glycopyrrolate – ROBINUL, ROBINUL FORTE generic ANASPAZ, LEVSIN, LEVSIN SL, 1 hyoscyamine – generic NULEV 1 hyoscyamine er – LEVBID generic 1 hyoscyamine er – LEVSINEX generic 1 loperamide – IMODIUM generic 1 methscopolamine – PAMINE, PAMINE FORTE generic 1 metoclopramide – REGLAN generic 1 opium – PAREGORIC generic 2 alosetron – LOTRONEX 2 lubiprostone – AMITIZA 2 methscopolamine – PAMINE, PAMINE FORTE 2 methylnaltrexone – RELISTOR 2 propantheline – PRO-BANTHINE 3 hyoscyamine – LEVSIN, LEVSIN SL hyoscyamine, hyoscyamine er 3 hyoscyamine – NULEV hyoscyamine, hyoscyamine er 3 atropine sulfate – SAL-TROPINE hyoscyamine, hyoscyamine er belladonna belladonna 3 – DONNATAL EXTENTAB alkaloids/phenobarbital, alkaloids/phenobarbital dycyclomine diphenoxylate/atropine sulfate, 3 difenoxin – MOTOFEN loperamide 3 homatropine – HOMAPINE hyoscyamine, hyoscyamine er 3 mepenzolate – CANTIL 3 opium tincture – OPIUM TINCTURE H-2 ANTAGONIST AGENTS

32

1 cimetidine – TAGAMET generic 1 famotidine – PEPCID generic 1 famotidine – PEPCID SUSPENSION generic 1 nizatidine – AXID generic 1 ranitidine–ZANTAC generic cimetidine, famotidine tablets, 3 nizatidine – AXID ORAL SOLUTION nizatidine, ranitidine cimetidine, famotidine tablets, 3 ranitidine – ZANTAC EFFERDOSE nizatidine, ranitidine PROTON PUMP INHIBITORS PREVACID, PREVACID 1 lansoprazole – generic SUSPENSION 1 omeprazole – PRILOSEC generic 1 pantoprazole sodium PROTONIX generic omeprazole/sodium 1 – ZEGERID generic bicarbonate 2 esomeprazole – NEXIUM, NEXIUM GRANULES omeprazole, lansoprazole, 3 dexlansoprazole – DEXILANT pantoprazole omeprazole, lansoprazole, 3 lansoprazole – PREVACID SOLUTABS pantoprazole PRILOSEC SUSPENSION omeprazole, lansoprazole, 3 omeprazole – PACKETS pantoprazole omeprazole, lansoprazole, 3 rabeprazole sodium – ACIPHEX pantoprazole BOWL PREPARATION AGENTS polyethylene 1 – COLYTE, GOLYTELY, NULYTELY generic glycol/electrolyte solution bisacodyl/polyethylene 2 – HALFLYTELY glycol/electrolyte solution polyethylene polyethylene glycol/electrolyte 3 – MOVIPREP glycol/electrolyte solution solution polyethylene polyethylene glycol/electrolyte 3 – TRILYTE glycol/electrolyte solution solution sodium phosphate

monobasic polyethylene glycol/electrolyte 3 – OSMOPREP monohydrate/sodium solution phosphate dibasic sodium phosphate

monobasic polyethylene glycol/electrolyte 3 – VISICOL monohydrate/sodium solution phosphate dibasic

DIGESTIVE ENZYMES 2 amylase/lipase/protease – CREON, ZENPEP

2 pancrelipase(lip-prot-amyl) – PANCREAZE AGENTS TO TREAT CROHN'S DISEASE & ULCERATIVE COLITIS 1 balsalazide – COLAZAL generic 1 mesalamine enema – ROWASA generic 1 sulfasalazine – AZULFIDINE generic 1 budesonide – ENTOCORT EC generic 2 mesalamine capsules er – PENTASA

33

2 mesalamine suppositories – CANASA 2 mesalamine tablets er – ASACOL 3 mesalamine tablets er – LIALDA 3 mesalamine capsules er – APRISO Asacol, Lialda, Pentasa 3 olsalazine – DIPENTUM Asacol, Lialda, Pentasa OTHER GASTROINTESTINAL AGENTS 1 lactulose – CEPHULAC generic 1 misoprostol – CYTOTEC generic 1 sucralfate – CARAFATE TABLETS generic

1 ursodiol – ACTIGALL, URSO, URSO FORTE generic 2 lactulose – KRISTALOSE bismuth/metronidazole/tetr 2 – PYLERA acycline 2 cromolyn sodium – GASTROCROM 2 sucralfate – CARAFATE SUSPENSION bismuth/metronidazole/tetr 3 – HELIDAC acycline IMMUNOLOGICALS 4 abatacept – ORENCIA 4 adalimumab – HUMIRA 4 etanercept – ENBREL 4 infliximab – REMICADE 4 tocilizumab ACTEMRA Enbrel, Humira 4 certolizumab – CIMZIA Enbrel, Humira 4 anakinra – KINERET Enbrel, Humira 4 golimumab – SIMPONI Enbrel, Humira MUSCULOSKELETAL MEDICATION SALICYLATES & RELATED AGENTS choline/magnesium 1 – TRILISATE generic salicylate 1 diflunisal – DOLOBID generic 1 salsalate – DISALCID, SALFLEX generic NON-STERIODAL ANTI-INFLAMMATORY AGENTS 1 diclofenac potassium – CATAFLAM generic 1 diclofenac sodium – VOLTAREN 50mg,75mg generic 1 diclofenac sodium er – VOLTAREN XR generic 1 etodolac – LODINE generic 1 etodolac er – LODINE XL generic 1 fenoprofen – NALFON 600MG generic 1 flurbiprofen – ANSAID generic 1 ibuprofen – MOTRIN generic 1 indomethacin – INDOCIN generic 1 indomethacin er – INDOCIN SR generic 1 ketoprofen – ORUDIS generic 1 ketorolac – TORADOL generic 1 meloxicam – MOBIC generic 1 nabumetone – RELAFEN generic 1 naproxen – NAPROSYN generic 1 naproxen er – EC-NAPROSYN generic 1 naproxen sodium – ANAPROX, ANAPROX DS generic 1 oxaprozin – DAYPRO generic 1 piroxicam – FELDENE generic 34

1 sulindac – CLINORIL generic 1 tolmetin – TOLECTIN 400mg generic 1 mefenamic acid – PONSTEL generic 2 celecoxib – CELEBREX 3 diclofenac potassium – ZIPSOR diclofenac potassium 3 diclofenac sodium – VOLTAREN 25mg diclofenac sodium diclofenac 3 – ARTHROTEC diclofenac sodium, misoprostol sodium/misoprostol

3 fenoprofen – NALFON 200, 400mg fenoprofen, ibuprofen, naproxen INDOCIN SUPPOSITORIES, 3 indomethacin – indomethacin, indomethacin er SUSPENSION

3 ketoprofen er – ORUVAIL ketoprofen, ibuprofen, naproxen

3 meclofenamate – MECLOMEN ibuprofen, meloxicam, naproxen 3 meloxicam – MOBIC SUSPENSION meloxicam tablets 3 naproxen er – NAPRELAN naproxen er 3 ketorolac tromethamine – SPRIX ketorolac 3 tolmetin – TOLECTIN 200mg,600mg ibuprofen, naproxen, tolmetin

naproxen and 3 – VIMOVO ibuprofen, meloxicam, naproxen esomeprazole magnesium ARTHRITIS AGENTS - OTHER 1 gold sodium thiomalate – MYOCHRYSINE generic 4 hyaluronic acid – SYNVISC EUFLEXXA, HYALGAN, 4 hyaluronic acid – Synvisc ORTHOVISC, SUPARTZ GOUT AGENTS 1 allopurinol – ZYLOPRIM generic 1 colchicine & probenecid – COL-BENEMID generic 1 probenecid – BENEMID generic 2 colchicine – COLCRYS 2 pegloticase – KRYSTEXXA 3 febuxostat – ULORIC allopurinol

SKELETAL MUSCLE AGENTS 1 cyclobenzaprine er – AMRIX generic 1 cyclobenzaprine – FEXMID generic 1 baclofen – LIORESAL generic 1 metaxalone – SKELAXIN generic 1 carisoprodol – SOMA generic 1 carisoprodol/aspirin – SOMA COMPOUND generic 1 chlorzoxazone – PARAFON FORTE DSC generic 1 cyclobenzaprine – FLEXERIL generic 1 dantrolene – DANTRIUM generic 1 methocarbamol – ROBAXIN generic 1 orphenadrine – NORFLEX generic orphenadrine/aspirin/caffei 1 – NORGESIC generic ne 1 tizanidine – ZANAFLEX TABLETS generic 4 riluzole – RILUTEK baclofen, carisoprodol, 3 carisoprodol – SOMA 250mg cyclobenzaprine

35

3 tizanidine – ZANAFLEX CAPSULES tizanidine tablets NUTRITION & ELECTROLYTE AGENTS VITAMINS, MINERALS & RELATED AGENTS 1 calcitriol – ROCALTROL generic 1 cyanocobalamin injection – VITAMIN B-12 generic 1 ergocalciferol – DRISDOL generic sodium ferric gluconate 1 – FERRLECIT generic complex 1 folic acid – FOLVITE generic 1 levocarnitine – CARNITOR generic 1 multivitamins w/fluoride – POLY-VI-FLOR generic multivitamins w/fluoride & 1 – POLY-VI-FLOR with IRON generic iron

1 polysaccaride iron complex – NIFEREX generic 1 triple vitamins w/fluoride – TRI-VI-FLOR generic triple vitamins w/fluoride & 1 – TRI-VI-FLOR with IRON generic iron 2 doxercalciferol – HECTOROL 2 iron dextran – DEXFERRUM, INFED iron/vitamins b12 & c 2 – REPLIVA 21/7 w/folic acid 2 paricalcitrol – ZEMPLAR 2 phytonadione – MEPHYTON cyanocobalamin nasal 3 – CALOMIST, NASCOBAL cyanocobalamin injection spray 3 iron sucrose – VENOFER 3 zinc acetate – GALZIN FLUORIDE PRODUCTS 1 sodium fluoride – KARDIUM, LURIDE generic 1 sodium fluoride – PHOS-FLUR generic 3 stannous fluoride – GEL-KAM sodium fluoride POTASSIUM SUPPLEMENTS potassium 1 – K-LYTE generic bicarbonate/citric acid 1 potassium chloride liquid – KAY CIEL generic

1 potassium chloride powder – K-LOR, KLOR-CON generic

1 potassium chloride tablets – K-TAB, SLOW-K generic potassium chloride 1 – MICRO-K generic capsules potassium 2 – EFFER-K bicarbonate/citric acid

potassium 3 – TRI-K potassium bicarbonate/citric acid acetate/bicarbonate/citrate potassium 3 bicarbonate/potassium – K-LYTE CL 50 potassium bicarbonate/citric acid chloride/citric acid potassium 3 bicarbonate/potassium – K-LYTE DS potassium bicarbonate/citric acid citrate/citric acid

36

potassium chloride powder, 3 potassium chloride powder – KLOR-CON/25 tablets, liquid potassium chloride powder, 3 potassium gluconate – KAON tablets, liquid POTASSIUM - REMOVING RESINS sodium polystyrene 1 – KAYEXELATE generic sulfonate PHOSPHATE BINDERS 1 calcium acetate – ELIPHOS generic 1 calcium acetate – PHOSLO generic 2 calcium acetate – PHOSLO 2 lathanum carbonate – FOSRENOL 3 sevelamer – RENAGEL 2 sevelamer carbonate – RENVELA URINARY ALKINALYZERS 1 phosphorus – K PHOS NEUTRAL generic 1 sodium citrate/citric acid – BICITRA, CYTRA-2 generic 3 phosphorus – K PHOS MF 3 phosphorus – URO-KP-NEUTRAL 3 sodium citrate/citric acid – CYTRA-3 sodium citrate/citric acid 3 sodium citrate/citric acid – ORACIT sodium citrate/citric acid 3 sodium citrate/citric acid – TRICITRATES SOLUTION sodium citrate/citric acid BLOOD MODIFIERS ANTIPLATELET AGENTS 1 cilostazol – PLETAL generic 1 dipyridamole – PERSANTINE generic 1 pentoxifylline – TRENTAL generic 1 ticlopidine – TICLID generic 2 aspirin/dipyridamole – AGGRENOX 1 clopidogrel – PLAVIX generic 2 prasugrel – EFFIENT ANTICOAGULANTS & RELATED AGENTS 4 fondaparinux – ARIXTRA generic 1 warfarin sodium – COUMADIN generic 1 heparin – HEPARIN generic 4 enoxaparin – LOVENOX generic 4 dalteparin – FRAGMIN 2 desirudin – IPRIVASK 2 dabigatran – PRADAXA 3 warfarin sodium – COUMADIN enoxaparin, fondaparinux, 4 tinzaparin – INNOHEP Fragmin 10mg dose: enoxaparin, 3 rivaroxaban – XARELTO fondaparinux, Fragmin 15-20mg dose: Pradaxa HEMATOPOIETIC AGENTS 4 darbepoetin – ARANESP 4 erythropoietin – PROCRIT 4 erythropoietin – EPOGEN Aranesp, Procrit HEMOSTATICS 1 aminocaproic acid – AMICAR 500mg TABLETS generic 2 aminocaproic acid – AMICAR 1000mg TABLETS

37

antihemophilic factor/von 4 – ALPHANATE, HUMATE-P willenbrand factor complex

4 coagulation factor VIIa – NOVOSEVEN, NOVOSEVEN RT 4 eltrombopag – PROMACTA 4 romiplostim – NPLATE 4 factor XIII – CORIFACT

ADVATE, COGENATE, HEMOFIL M, HELIXATE, KOATE-DVI, 4 antihemophilic factor VIII – MONOCLATE-P, RECOMBINATE, REFACTO, XYNTHA anti-inhibitor coagulant 4 – FEIBA complex 4 coagulation factor IX – ALPHANINE, MONONINE OBSTETRICAL & GYNECOLOGICAL MEDICATIONS PRENATAL VITAMINS All Prenatal Vitamins are on the – Formulary ANDROGEN AGENTS 1 danazol – DANAZOL generic 1 oxandrolone – OXANDRIN generic DELATESTRYL, DEPO- 1 testosterone cypionate – generic TESTOSTERONE 2 testosterone – ANDROGEL 3 testosterone – ANDRODERM testosterone 3 methyltestosterone – ANDROID testosterone 3 testosterone transdermal – AXIRON testosterone 3 methyltestosterone – METHITEST testosterone 3 methyltestosterone – TESTRED testosterone 3 oxymetholone – ANADROL testosterone 3 testosterone buccal – STRIANT testosterone 3 testosterone – TESTIM testosterone 3 testosterone gel – FORTESTA testosterone 3 testosterone transdermal – FORTESTA testosterone ORAL ESTROGEN AGENTS 1 estradiol – ESTRACE generic 1 estropipate – OGEN, ORTHO-EST generic 2 estrogens, conjugated – PREMARIN estrogens, conjugated 2 – CENESTIN synthetic, a estrogens, conjugated 2 – ENJUVIA synthetic, b estradiol, estropipate, Enjuvia, 3 esterified estrogens – MENEST Menest, Premarin 3 estradiol – FEMTRACE estradiol 3 estradiol – GYNODIOL 1.5mg estradiol TRANSDERMAL ESTROGEN AGENTS 1 estradiol transdermal – CLIMARA generic ESTRADIOL TRANSDERMAL 1 estradiol transdermal – generic SYSTEM 2 estradiol transdermal – ESTRADERM 2 estradiol transdermal – VIVELLE-DOT

38

estradiol trandermal, Estraderm, 3 estradiol transdermal – ALORA Vivelle-Dot estradiol trandermal, Estraderm, 3 estradiol transdermal – MENOSTAR Vivelle-Dot TOPICAL ESTROGEN PRODUCTS 3 estradiol gel – DIVIGEL 2 estradiol spray – EVAMIST 2 estradiol cream – ESTRACE VAGINAL CREAM 2 estradiol vaginal ring – ESTRING 2 estradiol vaginal tablets – VAGIFEM estrogens, conjugated 3 – PREMARIN VAGINAL CREAM Divigel, Evamist vaginal cream 3 estradiol emulsion – ESTRASORB Divigel, Evamist 3 estradiol gel – ELESTRIN, ESTROGEL Divigel, Evamist 3 estradiol vaginal ring –FEMRING Estring ESTROGEN / PROGESTIN COMBINATION AGENTS 1 estradiol/norethindrone – ACTIVELLA generic ethinyl 1 – FEMHRT generic estradiol/norethindrone norethindrone-ethinyl 1 – JINTEL I generic estradiol conjugated 2 estrogen/medroxyprogester – PREMPHASE one conjugated 2 estrogen/medroxyprogester – PREMPRO one 2 estradiol/norethindrone – COMBIPATCH estradiol/norethindrone, 3 estradiol/drospirenone – ANGELIQ Premphase, Prempro estradiol/norethindrone, 3 estradiol/levonorgestrel – CLIMARA PRO Premphase, Prempro estradiol/norethindrone, 3 estradiol/norgestimate – PREFEST Premphase, Prempro PROGESTIN AGENTS 1 medroxyprogesterone – PROVERA generic 1 norethindrone – AYGESTIN generic 2 progesterone – PROMETRIUM 2 progesterone vaginal gel – CRINONE, PROCHIEVE

3 progesterone vaginal insert – ENDOMETRIN Crinone, Prochieve, Prometrium CONTRACEPTIVE AGENTS ethinyl estradiol/ 1 norethindrone/ferrous – LOESTRIN, LOESTRIN FE generic fumarate ethinyl 1 – MIRCETTE generic estradiol/desogestrel ethinyl 1 – CYCLESSA generic estradiol/desogestrel ethinyl 1 – LO/OVRAL generic estradiol/desogestrel ethinyl 1 – ORTHO-CEPT, DESOGEN generic estradiol/desogestrel

39

ethinyl estradiol/ethynodiol 1 – DEMULEN 1/35, ZOVIA 1/35 generic diacetate ethinyl 1 – LEVLEN, NORDETTE generic estradiol/levonorgestrel ethinyl 1 – SEASONALE generic estradiol/levonorgestrel ethinyl TRI-LEVLEN, TRIPHASIL, 1 – generic estradiol/levonorgestrel TRIVORA ethinyl 1 – ALESSE, LEVLITE generic estradiol/levonorgestrel ethinyl 1 – LYBREL generic estradiol/levonorgestrel ethinyl 1 – AMETHYST generic estradiol/levonorgestrel 1 inyl-estradiol/levonorgestrel – SEASONIQUE generic 1 onorgestrel- ethinyl estradiol – CAMRESE generic 1 onorgestrel- ethinyl estradiol –AMETHIA generic ethinyl 1 – BREVICON, MODICON generic estradiol/norethindrone ethinyl 1 – TRI-NORINYL generic estradiol/norethindrone ethinyl 1 – OVCON 35 generic estradiol/norethindrone ethinyl 1 estradiol/norethindrone/ferr – ESTROSTEP, ESTROSTEP FE generic ous fumarate ethinyl 1 estradiol/norethindrone – FEMCON FE generic chewable ethinyl 1 – ORTHO CYCLEN generic estradiol/norgestimate ethinyl 1 – ORTHO TRI-CYCLEN generic estradiol/norgestimate medroxyprogesterone 1 – DEPO-PROVERA generic acetate 1 mestranol/norethindrone – ORTHO NOVUM, NORINYL generic 1 norethindrone – MICRONOR, NOR Q.D. generic levonorgestrel & ethinyl 1 INTROVALE generic estradiol levonorgestrel & ethinyl 1 QUASENSE generic estradiol ethinyl 1 – YASMIN generic estradiol/drospirenone ethinyl 1 – YAZ generic estradiol/drospirenone levonorgestrel & ethinyl 1 – JOLESSA generic estradiol 2 ulipristal – ELLA ethinyl 2 – NUVARING estradiol/etonogestrel medroxyprogesterone 2 – DEPO-PROVERA acetate

40

ethinyl estradiol/ethynodiol ethinyl estradiol/ethynodiol 3 – ZOVIA 1/50 diacetate diacetate ethinyl 3 – LOSEASONIQUE ethinyl estradiol/levonorgestrel estradiol/levonorgestrel ethinyl 3 – ORTHO-EVRA Jolessa, Lybrel, Yaz estradiol/norelgestromin ethinyl 3 – ORTHO TRI-CYCLEN LO ethinyl estradiol/norgestimate estradiol/norgestimate ethinyl 3 – OVCON 50 ethinyl estradiol/norethindrone estradiol/norethindrone ethinyl 3 estradiol/norethindrone – LOESTRIN 24 FE Jolessa, Yaz acetate/ferrous fumarate

3 ethinyl estradiol/norgestrel – OGESTREL ethinyl estradiol/desogestrel medroxyprogesterone 3 – DEPO-SUBQ PROVERA medroxyprogesterone acetate acetate 3 mestranol/norethindrone – NECON 10/11

3 estradiol valerate/dienogest – NATAZIA drospirenone-ethinyl 3 – SAFYRAL estradiol-levomefolate MISCELLANEOUS OB/GYN AGENTS 1 methylergonovine – METHERGINE generic 4 nafarelin – SYNAREL OPHTHALMIC MEDICATION OPHTHALMIC TOPICAL ANTI-INFECTIVE AGENTS 1 bacitracin/polymyxin b – POLYSPORIN generic 1 chloramphenicol – CHLOROMYCETIN generic 1 ciprofloxacin – CILOXAN SOLUTION generic 1 erythromycin – ILOTYCIN generic gentamicin ophthalmic 1 – GARAMYCIN, GENOPTIC generic solution neomycin/bacitracin/polymy 1 – NEOSPORIN generic xin b neomycin/polymyxin 1 – AK-SPORE generic b/gramicidin 1 ofloxacin – OCUFLOX generic 1 sulfacetamide sodium – BLEPH-10 generic 1 tobramycin – TOBREX SOLUTION generic 1 trifluridine – VIROPTIC generic bacitracin ophthalmic BACITRACIN OPHTHALMIC 2 – ointment OINTMENT 2 ciprofloxacin – CILOXAN OINTMENT 2 gatifloxacin – ZYMAR 2 gatifloxacin – ZYMAXID gentamicin ophthalmic GARAMYCIN OPHTHALMIC 2 – ointment OINTMENT 2 moxifloxacin – VIGAMOX 2 natamycin – NATACYN 2 tobramycin – TOBREX OINTMENT ciprofloxacin, erythromycin, 3 azithromycin – AZASITE ofloxacin

41

ciprofloxacin, erythromycin, 3 besifloxacin – BESIVANCE ofloxacin ciprofloxacin, erythromycin, 3 levofloxacin – IQUIX ofloxacin ciprofloxacin, erythromycin, 3 levofloxacin – QUIXIN ofloxacin OPHTHALMIC CORTICOSTERIOD AGENTS dexamethasone sodium 1 – DECADRON generic phosphate 1 fluorometholone – FML generic ECONOPRED PLUS, PRED 1 prednisolone acetate – generic FORTE 2 fluocinolone acetonide – RETISERT 2 loteprednol – LOTEMAX 2 loteprednol – ALREX 2 prednisolone acetate – PRED MILD dexamethasone sodium 3 dexamethasone – MAXIDEX phosphate, prednisolone acetate dexamethasone sodium 3 difluprednate – DUREZOL phosphate, prednisolone acetate dexamethasone sodium 3 fluorometholone – FLAREX phosphate, prednisolone acetate dexamethasone sodium 3 fluorometholone – FML FORTE, FML OINTMENT phosphate, prednisolone acetate dexamethasone sodium prednisolone sodium 3 – INFLAMASE FORTE phosphate, phosphate prednisolone acetate dexamethasone sodium 3 rimexolone – VEXOL phosphate, prednisolone acetate OPHTHALMIC ANTI-INFECTIVE / CORICOSTEROID AGENTS neomycin/bacitracin/polymy 1 – CORTISPORIN generic xin/hydrocortisone neomycin/polymyxin/dexam 1 – MAXITROL generic ethasone 1 polymyxin b/trimethoprim – POLYTRIM generic sulfacetamide/prednisolone 1 – VASOCIDIN generic sodium phosphate tobramycin/dexamethason 1 – TOBRADEX generic e 2 tobramycin/loteprednol – ZYLET sulfacetamide/prednisolone sulfacetamide/prednisolone 3 – BLEPHAMIDE acetate sodium phosphate tobramycin/dexamethasone, 3 gentamicin/prednisolone – PRED–G Zylet neomycin/polymyxin/predni neomycin/polymyxin/dexamethas 3 – POLY-PRED solone one OPHTHALMIC ANTIHISTIMIES 1 epinastine – ELESTAT generic 1 ketotifen fumarate – ZADITOR generic

42

1 azelastine – OPTIVAR generic 2 olopatadine – PATADAY 2 olopatadine – PATANOL ketotifen fumarate, azelastine, 3 bepotastine – BEPREVE Pataday,Patanol ketotifen fumarate, azelastine, 3 emedastine – EMADINE Pataday,Patanol ketotifen fumarate, azelastine, 3 alcaftadine – LASTACAFT Pataday,Patanol OPHTHALMIC MAST CELL STABILIZERS 1 cromolyn–CROLOM generic 3 pemirolast – ALAMAST 3 lodoxamide – ALOMIDE 3 nedocromil – ALOCRIL cromolyn OPHTHALMIC NON-STERIODAL ANTI-INFLAMMATORY AGENTS 1 diclofenac – VOLTAREN generic 1 flurbiprofen – OCUFEN generic 1 bromfenac – XIBROM generic ACULAR, ACULAR LS, ACULAR 3 ketorolac – diclofenac, flubiprofen PF 3 ketorolac – ACUVAIL diclofenac, flubiprofen 3 nepafenac – NEVANAC diclofenac, flubiprofen GLAUCOMA AGENTS 1 acetazolamide – DIAMOX generic 1 acetazolamide er – DIAMOX SEQUELS generic 1 betaxolol – BETOPTIC generic 1 brimonidine – ALPHAGAN generic 1 brimonidine – ALPHAGAN P 0.15% generic 1 carteolol – OCUPRESS generic 1 dipivefrin – PROPINE generic 1 dorzolamide – TRUSOPT generic 1 dorzolamide/timolol – COSOPT generic 1 homatropine – ISOPTO HOMATROPINE generic 1 levobunolol – BETAGAN generic 1 metipranolol – OPTIPRANOLOL generic 1 pilocarpine – PILOCAR generic 1 timolol – TIMOPTIC, TIMOPTIC XE generic 1 latanoprost – XALATAN generic 2 betaxolol – BETOPTIC S 2 brimonidine – ALPHAGAN P 0.1% 2 brinzolamide – AZOPT 2 carbachol – ISOPTO CARBACHOL 2 echothiophate iodide – PHOSPHOLINE IODIDE 2 pilocarpine – PILOPINE H.S. 2 travoprost – TRAVATAN, TRAVATAN Z betaxolol, carteolol, levobunolol, 3 timolol hemihydrate – BETIMOL timolol 3 apraclonidine – IOPIDINE

3 brimonidine/timolol maleate – COMBIGAN brimonidine, timolol betaxolol, carteolol, levobunolol, 3 timolol maleate – ISTALOL timolol

3 bimatoprost – LUMIGAN latanoprost, Travatan, Travatan Z

43

3 tafluprost ZIOPTAN latanoprost, Travatan, Travatan Z OPHTHALMIC AGENTS - OTHER 1 atropine sulfate – ISOPTO ATROPINE generic 1 cyclopentolate – CYCLOGYL 1% generic 1 naphazoline – AK-CON generic 1 phenylephrine – AK-DILATE, MYDFRIN generic 1 tetracaine – TETCAINE generic 1 tropicamide – MYDRIACYL generic 2 cyclopentolate – CYCLOGYL 0.5%, 2% 2 cyclosporine – RESTASIS 2 hydroxypropylcellulose – LACRISERT 2 ranibizumab – LUCENTIS 3 pegaptanib MACUGEN Lucentis 3 ganciclovir – ZIRGAN RESPIRATORY AGENTS BRONCHODILATORS - BETA AGONISTS 1 albuterol solution – ACCUNEB generic 1 albuterol tablets – PROVENTIL generic 1 albuterol tablets er – VOSPIRE ER generic 1 levalbuterol – XOPENEX generic 1 metaproterenol – ALUPENT 2 albuterol inhaler – PROAIR HFA 2formoterol–FORADIL 2formoterol– PERFOROMIST 3 pirbuterol – MAXAIR AUTOHALER 2 salmeterol – SEREVENT DISKUS Foradil, Perforomist, Serevent 3 indacaterol maleate – ARCAPTA NEOHALER Diskus PROVENTIL HFA, VENTOLIN 3 albuterol inhaler – ProAir HFA HFA 3 arformoterol – BROVANA Perforomist 3 levalbuterol – XOPENEX, XOPENEX HFA BRONCHODILATORS - COMBINATIONS ipratropium/albuterol 1 – DUONEB generic solution 2 budesonide/formorterol – SYMBICORT 2fluticasone/salmeterol–ADVAIR ipratropium/albuterol 2 – COMBIVENT inhaler mometasone furoate and 2 – DULERA formoterol fumarate PULMONARY AGENTS - OTHER 1 acetylcysteine – MUCOMYST generic 1 cromolyn–INTAL generic 1 ipratropium aerosol – ATROVENT generic 1 terbutaline sulfate – BRETHINE generic 1 theophylline er – THEO-24, THEOCHRON generic 2 aminophylline – AMINOPHYLLINE 4 c1 inhibitor, human – CINRYZE 4 deoxyribonuclease – PULMOZYME 2 ephedrine sulfate – EPHEDRINE SULFATE 2 epinephrine – EPIPEN, EPIPEN JR 2 ipratropium – ATROVENT HFA 44

4 palivizumab – SYNAGIS 2 theophylline – ELIXOPHYLLIN ELIXIR 2 tiotropium – SPIRIVA HANDIHALER 3 epinephrine ADRENACLICK EPIPEN 3 epinephrine –TWINJECT EPIPEN 3 dyphylline – LUFYLLIN aminophylline, theophylline er 4 omalizumab – XOLAIR 3 theophylline er – THEO-24 theophylline er 3 theophylline er – UNIPHYL theophylline er theophylline/pseudoephedri 3 – BRONCOMAR-1 ne/guaifenesin PULMONARY CORTICOSTEROIDS 1 budesonide – PULMICORT RESPULES generic 2 beclomethasone – QVAR 2 budesonide – PULMICORT FLEXHALER 3 fluticasone – FLOVENT 2 mometasone – ASMANEX Asmanex, Flovent, Pulmicort, 3 ciclesonide – ALVESCO Qvar Asmanex, Flovent, Pulmicort, 3 flunisolide – AEROBID, AEROBID-M Qvar Asmanex, Flovent, Pulmicort, 3 triamcinolone – AZMACORT Qvar Asmanex, Flovent, Pulmicort, 3 roflumilast – DALIRESP Qvar LEUKOTRIENE MODIFIERS 1 zafirlukast – ACCOLATE generic 1 montelukast – SINGULAIR generic 3 zileuton – ZYFLO montelukast 3zileutoner– ZYFLO CR montelukast COUGH & COLD THERAPY ANTITUSSIVE COMBINATIONS 1 benzonatate – TESSALON PERLE generic dextromethorphan/ 1 pseudoephedrine/bromphe – BROMFED DM generic niramine 1 guaifenesin/codeine – ROBTIUSSIN AC generic 1 guaifenesin/codeine – TUSSI-ORGANIDIN/S NR generic

hydrocodone polistirex and 1 – TUSSIONEX ER generic chlirpheniramine polustirex guaifenesin/dextromethorp 1 – DURATUSS/GP generic han

1 hydrocodone/homatropine – HYCODAN generic phenylephrine/bromphenira 1 – BROMFED/PD generic mine hydrocodone/chlorphenira 2 – TUSSICAPS mine hydrocodone/chlorphenira 2 – TUSSIONEX mine EXPECTORANT COMBINATIONS 1 guaifenesin – LIQUIBID generic

45

1 guaifenesin/phenylephrine – SINUVENT PE generic guaifenesin/pseudoephedri 1 – MAXIFED-G generic ne ANTIHISTAMINE DECONGESTANT COMBINATIONS brompheniramine/pseudoe 1 – BROMFED generic phedrine brompheniramine/pseudoe 1 – BROMFED PD generic phedrine er carbetapentaine/pseudoep 1 – RESPI-TANN generic hrine chlorpheniramine/pseudoe 1 – HISTEX LIQUID generic phedrine chlorpheniramine/pseudoe 2 – HISTEX generic phedrine

1 cetirizine/psedoephedrine – ZYRTEC-D generic loratadine/pseudoephedrin 1 – CLARITIN-D generic e chlorpheniramine/pseudoe 2 – HISTEX SR phedrine er ANTIHISTAMINES 1 hydroxyzine hcl – ATARAX generic 1 hydroxyzine pamoate – VISTARIL generic 1 loratadine – CLARITIN OTC generic 1 cetirizine – ZYRTEC OTC generic PULMONARY ARTERIAL HYPERTENSION AGENTS 4 epoprostenol injection – FLOLAN generic 4ambrisentan–LETAIRIS 4 bosentan – TRACLEER 4 iloprost – VENTAVIS 4 sildenafil – REVATIO 4 treprostinil – REMODULIN, TYVASO 4 tadalafil – ADCIRCA Revatio UROLOGICAL AGENTS OVERACTIVE BLADDER AGENTS 1 flavoxate – URISPAS generic 1 oxybutynin – DITROPAN generic 1 oxybutynin er – DITROPAN XL generic 1 trospium – SANCTURA generic 2 darifenacin ENABLEX 2 oxybutynin transdermal – OXYTROL 2 solifenacin – VESICARE 1 tolterodine – DETROL generic 2 tolterodine er – DETROL LA 2 trospium er – SANCTURA XR oxybutynin er, trospium, Detrol, 3 fesoterodine – TOVIAZ Detrol LA, Enablex, Sanctura XR, Vesciare oxybutynin er, trospium, Detrol, 3 oxybutynin gel – GELNIQUE Detrol LA, Enablex, Sanctura XR, Vesciare BENIGN PROSTATIC HYPERTROPHY AGENTS 1 doxazosin – CARDURA generic 46

1 tamsulosin – FLOMAX generic 1 finasteride – PROSCAR generic 1 terazosin – HYTRIN generic 1 alfuzosin – UROXATRAL generic 2 dutasteride – AVODART

2 dutasteride and tamulosin – JALYN alfuzosin, doxazosin, tamsulosin, 3 doxazosin er – CARDURA XL terazosin, Avodart alfuzosin, doxazosin, tamsulosin, 3 sildosin – RAPAFLO terazosin, Avodart OTHER GENITOURINARY AGENTS 1 bethanechol – URECHOLINE generic

1 citric acid/potassium citrate – CYTRA-K, POLYCITRA-K generic

dibasic sodium phosphate monobasic potassium 1 – K-PHOS NEUTRAL generic phosphate monobasic sodium phosphate methenamine/methylene

blue/hyoscamine/ phenyl 1 – UTIRA-C generic salicylate/sodium phosphate 1 phenazopyridine – PYRIDIUM generic 1 potassium citrate – UROCIT-K generic sodium citrate/citric acid 1 – BICITRA generic solution 2 betaine – CYSTADANE citric acid/potassium 2 – CYTRA-3 sodium citrates 2 cysteamine – CYSTAGON pentosan polysulfate 2 – ELMIRON sodium 3 gluconic acid/citric acid – RENACIDIN potassium acid 3 phosphate/sodium acid – K-PHOS M.F., K-PHOS NO. 2 phosphate DIABETIC SUPPLIES GLUCOSE MONITORS

2 blood glucose monitor – ACCU-CHEK ACTIVE SYSTEMS ACCU-CHEK ADVANTAGE 2 blood glucose monitor – SYSTEMS 2 blood glucose monitor – ACCU-CHEK AVIA SYSTEMS ACCU-CHEK COMPACT 2 blood glucose monitor – SYSTEMS ACCU-CHEK COMPLETE 2 blood glucose monitor – SYSTEMS 2 blood glucose monitor – ONETOUCH ULTRA SYSTEMS ONETOUCH ULTRAMINI 2 blood glucose monitor – SYSTEMS ONETOUCH ULTRASMART 2 blood glucose monitor – SYSTEMS

47

Accu-Chek Systems, 3 blood glucose monitor – PRECISION SYSTEMS OneTouch Accu-Chek Systems, OneTouch 3 blood glucose monitor – ASCENSIA BREEZE SYSTEMS Systems Accu-Chek Systems, OneTouch 3 blood glucose monitor – ASCENSIA CONTOUR SYSTEMS Systems

GLUCOSE TEST STRIPS 2 blood glucose test strip – ACCU-CHEK ACTIVE STRIPS ACCU-CHEK ADVANTAGE 2 blood glucose test strip – STRIPS 2 blood glucose test strip – ACCU-CHEK AVIA STRIPS ACCU-CHEK COMFORT CURVE 2 blood glucose test strip – STRIPS

2 blood glucose test strip – ACCU-CHEK COMPACT STRIPS

2 blood glucose test strip – ACCU-CHEK INSTANT STRIPS

2 blood glucose test strip – ACCU-CHEK SIMPLICITY STRIPS 2 blood glucose test strip – CHEMSTRIP BG STRIPS 2 blood glucose test strip –CHEMSTRIPK 2 blood glucose test strip – ONETOUCH BASIC STRIPS

2 blood glucose test strip – ONETOUCH FASTTAKE STRIPS 2 blood glucose test strip – ONETOUCH PROFILE STRIPS

2 blood glucose test strip – ONETOUCH SURESTEP STRIPS 2 blood glucose test strip – ONETOUCH ULTRA STRIPS Accu-Chek Strips, OneTouch 3 blood glucose test strip – ASCENSIA ELITE STRIPS Strips Accu-Chek Strips, OneTouch 3 blood glucose test strip – ASCENSIA AUTODISC STRIPS Strips Accu-Chek Strips, OneTouch 3 blood glucose test strip – ASCENSIA BREEZE STRIPS Strips Accu-Chek Strips, OneTouch 3 blood glucose test strip – ASCENSIA CONTOUR STRIPS Strips Accu-Chek Strips, OneTouch 3 blood glucose test strip – PRECISION STRIPS Strips MISCELLANEOUS DIABETIC SUPPLIES

2 blood testing alcohol swab – BD ALCOHOL SWABS 2 blood testing lancet – ACCU-CHEK LANCETS

BD LANCETS, BD PEN 2 blood testing lancet – NEEDLES, BD LANCET DEVICE

BD MICROFINE, BD MICROFINE 2 diabetic syringes – ULTRAFINESYRINGES 2 diabetic syringes – NOVOFINE 2 blood testing lancet – ONE TOUCH LANCETS MISCELLANEOUS AGENTS MISCELLANEOUS AGENTS

48

1 disulfiram – ANTABUSE generic 4antithrombin ATRYN 4c1esteraseinhibitor–BERINERT

4 alpha 1 proteinase inhibitor – PROLASTIN 4 vismodegib ERIVEDGE 4 asparaginase Erwinia ERWINAZE 4 deferasirox – EXJADE 4 aflibercept EYLEA 4deferiprone FERRIPROX 4axitinib INLYTA 4 ruxolitinib JAKAFI 4 ivacaftor KALYDECO 4eculizumab–SOLIRIS 4nitisinone–ORFADIN 4 pegademase bovine – ADAGEN 4 tositumomab BEXXAR 4 phenylbutyrate sodium – BUPHENYL 4 riluzole – RILUTEK 2succimer–CHEMET 3 acamprosate – CAMPRAL

4 alpha 1 proteinase inhibitor – ZEMAIRA Prolastin

4 alpha 1-proteinase inhibitor – ARALAST Prolastin

49