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2021 YAMHILL COMMUNITY CARE Updates

October, 2020

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 10/23/2020 ULTOMIRIS ravulizumab-cwvz REMOVE FROM Non-Formulary FORMULARY 10/23/2020 EPCLUSA sofosbuvir/velpatasvir REMOVE FROM Non-Formulary FORMULARY 10/23/2020 ULTOMIRIS ravulizumab-cwvz REMOVE FROM Non-Formulary FORMULARY 10/30/2020 CLINIMIX E 8 % comb REMOVE FROM Non-Formulary no.3/d10w/parenteral FORMULARY electrolytes no.37 10/30/2020 CLINIMIX E amino acid 8 % comb REMOVE FROM Non-Formulary no.3/d10w/parenteral FORMULARY electrolytes no.37 10/30/2020 CLINIMIX amino acids 8 % in dextrose REMOVE FROM Non-Formulary 14% water FORMULARY 10/30/2020 CLINIMIX amino acids 8 % in dextrose REMOVE FROM Non-Formulary 14% water FORMULARY 10/30/2020 CLINIMIX E amino acid 8 % comb REMOVE FROM Non-Formulary no.3/d14w/parenteral FORMULARY electrolytes no.37 10/30/2020 CLINIMIX E amino acid 8 % comb REMOVE FROM Non-Formulary no.3/d14w/parenteral FORMULARY electrolytes no.37 10/30/2020 CLINIMIX amino acid 6 % in dextrose REMOVE FROM Non-Formulary 5 % water FORMULARY 10/30/2020 CLINIMIX amino acids 8 % in dextrose REMOVE FROM Non-Formulary 10% water FORMULARY 10/30/2020 CLINIMIX amino acids 8 % in dextrose REMOVE FROM Non-Formulary 10% water FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 1 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 10/30/2020 LIDOMARK 1-5 lidocaine hcl/preservative REMOVE FROM Non-Formulary free/adhesive bandage FORMULARY 10/30/2020 sofia2 flu-sars covid-19, influenza a, REMOVE FROM Non-Formulary antigen fia influenza b antigen FORMULARY immunoassay test

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 2 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

November, 2020

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 11/06/2020 IBUPAK /glycerin REMOVE FROM Non-Formulary FORMULARY 11/06/2020 rufinamide rufinamide ADD TO FORMULARY Covered 11/06/2020 icosapent ethyl icosapent ethyl ADD TO FORMULARY Covered 11/13/2020 timolol maleate timolol maleate/pf REMOVE FROM Non-Formulary FORMULARY 11/13/2020 gemmily norethindrone acetate- REMOVE FROM Non-Formulary ethinyl /ferrous FORMULARY fumarate 11/13/2020 gemmily norethindrone acetate- REMOVE FROM Non-Formulary ethinyl estradiol/ferrous FORMULARY fumarate 11/20/2020 levothyroxine levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY 11/20/2020 levothyroxine levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY 11/20/2020 levothyroxine levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY 11/20/2020 levothyroxine levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY 11/20/2020 levothyroxine levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY 11/20/2020 levothyroxine levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY 11/20/2020 levothyroxine levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY 11/20/2020 levothyroxine levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 3 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 11/20/2020 levothyroxine levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY 11/20/2020 levothyroxine levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY 11/20/2020 levothyroxine levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY 11/20/2020 levothyroxine levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY 11/20/2020 lyllana estradiol ADD TO FORMULARY Covered 11/20/2020 lyllana estradiol ADD TO FORMULARY Covered 11/20/2020 lyllana estradiol ADD TO FORMULARY Covered 11/20/2020 lyllana estradiol ADD TO FORMULARY Covered 11/20/2020 lyllana estradiol ADD TO FORMULARY Covered 11/20/2020 zovia 1-35 ethynodiol diacetate-ethinyl ADD TO FORMULARY Covered estradiol 11/27/2020 RETACRIT epoetin alfa-epbx ADD TO FORMULARY Covered 11/27/2020 RETACRIT epoetin alfa-epbx ADD TO FORMULARY Covered 11/27/2020 RETACRIT epoetin alfa-epbx ADD TO FORMULARY Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 4 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

December, 2020

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 12/04/2020 RETACRIT epoetin alfa-epbx ADD TO FORMULARY Covered 12/04/2020 RETACRIT epoetin alfa-epbx ADD TO FORMULARY Covered 12/04/2020 RETACRIT epoetin alfa-epbx ADD TO FORMULARY Covered 12/04/2020 alvimopan alvimopan REMOVE FROM Non-Formulary FORMULARY 12/04/2020 ivermectin ivermectin REMOVE FROM Non-Formulary FORMULARY 12/04/2020 XARACOLL bupivacaine hcl REMOVE FROM Non-Formulary FORMULARY 12/04/2020 XARACOLL bupivacaine hcl REMOVE FROM Non-Formulary FORMULARY 12/04/2020 NYVEPRIA pegfilgrastim-apgf ADD TO FORMULARY Covered 12/11/2020 rufinamide rufinamide ADD TO FORMULARY Covered 12/11/2020 swabs alcohol antiseptic pads REMOVE FROM Non-Formulary FORMULARY 12/11/2020 nymyo norgestimate-ethinyl ADD TO FORMULARY Covered estradiol 12/11/2020 CERIANNA fluoroestradiol f-18 REMOVE FROM Non-Formulary FORMULARY 12/11/2020 nitazoxanide nitazoxanide REMOVE FROM Non-Formulary FORMULARY 12/11/2020 nitazoxanide nitazoxanide REMOVE FROM Non-Formulary FORMULARY 12/11/2020 VAXELIS diphtheria,pertus(acell),tetan REMOVE FROM Non-Formulary us/hepb/polio/hib conj- FORMULARY meng/pf

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 5 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 12/11/2020 VAXELIS diphtheria,pertus(acell),tetan REMOVE FROM Non-Formulary us/hepb/polio/hib conj- FORMULARY meng/pf 12/11/2020 VAXELIS diphtheria,pertus(acell),tetan REMOVE FROM Non-Formulary us/hepb/polio/hib conj- FORMULARY meng/pf 12/11/2020 VAXELIS diphtheria,pertus(acell),tetan REMOVE FROM Non-Formulary us/hepb/polio/hib conj- FORMULARY meng/pf 12/18/2020 ACZONE dapsone REMOVE FROM Non-Formulary FORMULARY 12/18/2020 ACZONE dapsone REMOVE FROM Non-Formulary FORMULARY 12/18/2020 bimatoprost bimatoprost REMOVE FROM Non-Formulary FORMULARY 12/18/2020 bimatoprost bimatoprost REMOVE FROM Non-Formulary FORMULARY 12/18/2020 docetaxel docetaxel REMOVE FROM Non-Formulary FORMULARY 12/18/2020 docetaxel docetaxel REMOVE FROM Non-Formulary FORMULARY 12/18/2020 acetaminophen acetaminophen REMOVE FROM Non-Formulary FORMULARY 12/18/2020 finasteride finasteride REMOVE FROM Non-Formulary FORMULARY 12/18/2020 finasteride finasteride REMOVE FROM Non-Formulary FORMULARY 12/18/2020 finasteride finasteride REMOVE FROM Non-Formulary FORMULARY 12/18/2020 sorbitan sorbitan monooleate REMOVE FROM Non-Formulary monooleate FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 6 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 12/18/2020 norepinephrine norepinephrine bitartrate in REMOVE FROM Non-Formulary bitar-0.9% nacl 0.9 % sodium chloride FORMULARY 12/18/2020 docetaxel docetaxel REMOVE FROM Non-Formulary FORMULARY 12/18/2020 fluocinolone fluocinolone acetonide, REMOVE FROM Non-Formulary acetonide micro micronized FORMULARY 12/18/2020 fluocinolone fluocinolone acetonide, REMOVE FROM Non-Formulary acetonide micro micronized FORMULARY 12/18/2020 prednisolone- prednisolone REMOVE FROM Non-Formulary bromfenac acetate/bromfenac sodium FORMULARY 12/18/2020 t:slim x2 control- subcutaneous pump REMOVE FROM Non-Formulary iq FORMULARY 12/18/2020 bremelanotide bremelanotide acetate REMOVE FROM Non-Formulary acetate FORMULARY 12/18/2020 oxytocin acetate oxytocin acetate REMOVE FROM Non-Formulary FORMULARY 12/18/2020 neuriva de-stress coffee REMOVE FROM Non-Formulary extract/theanine/superoxide FORMULARY dismutase 12/18/2020 perme8 gel base no.243 REMOVE FROM Non-Formulary anhydrous gel FORMULARY 12/18/2020 PRELIEF calcium glycerophosphate REMOVE FROM Non-Formulary FORMULARY 12/18/2020 MUCINEX guaifenesin/dextromethorph REMOVE FROM Non-Formulary JUNIOR an hbr/phenylephrine FORMULARY COUGH- CONGEST 12/18/2020 carboxymethylcel carboxymethylcellulose REMOVE FROM Non-Formulary lulose sodium sodium FORMULARY 12/18/2020 children's motrin ibuprofen REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 7 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 12/18/2020 mycozyl ap miconazole nitrate REMOVE FROM Non-Formulary FORMULARY 12/18/2020 adult multivitamin multivitamin with REMOVE FROM Non-Formulary gummies minerals/folic acid FORMULARY 12/18/2020 pen needle pen needle, diabetic REMOVE FROM Non-Formulary FORMULARY 12/18/2020 asenapine asenapine maleate REMOVE FROM Non-Formulary maleate FORMULARY 12/18/2020 asenapine asenapine maleate REMOVE FROM Non-Formulary maleate FORMULARY 12/18/2020 asenapine asenapine maleate REMOVE FROM Non-Formulary maleate FORMULARY 12/18/2020 asenapine asenapine maleate REMOVE FROM Non-Formulary maleate FORMULARY 12/18/2020 asenapine asenapine maleate REMOVE FROM Non-Formulary maleate FORMULARY 12/18/2020 asenapine asenapine maleate REMOVE FROM Non-Formulary maleate FORMULARY 12/18/2020 asenapine asenapine maleate REMOVE FROM Non-Formulary maleate FORMULARY 12/18/2020 asenapine asenapine maleate REMOVE FROM Non-Formulary maleate FORMULARY 12/18/2020 asenapine asenapine maleate REMOVE FROM Non-Formulary maleate FORMULARY 12/18/2020 asenapine asenapine maleate REMOVE FROM Non-Formulary maleate FORMULARY 12/18/2020 asenapine asenapine maleate REMOVE FROM Non-Formulary maleate FORMULARY 12/18/2020 iclevia levonorgestrel/ethinyl ADD TO FORMULARY Covered estradiol

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 8 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 12/18/2020 abiraterone ADD TO FORMULARY Covered acetate 12/18/2020 meloxicam meloxicam, submicronized REMOVE FROM Non-Formulary FORMULARY 12/18/2020 meloxicam meloxicam, submicronized REMOVE FROM Non-Formulary FORMULARY 12/25/2020 skyaderm-lp lidocaine/prilocaine REMOVE FROM Non-Formulary FORMULARY 12/25/2020 famotidine famotidine REMOVE FROM Non-Formulary FORMULARY 12/25/2020 ACTIDOSE activated charcoal/sorbitol REMOVE FROM Non-Formulary solution FORMULARY 12/25/2020 ACTIDOSE activated charcoal/sorbitol REMOVE FROM Non-Formulary solution FORMULARY 12/25/2020 PRELIEF calcium glycerophosphate REMOVE FROM Non-Formulary FORMULARY 12/25/2020 PRELIEF calcium glycerophosphate REMOVE FROM Non-Formulary FORMULARY 12/25/2020 diclofenac diclofenac sodium REMOVE FROM Non-Formulary sodium FORMULARY 12/25/2020 vardenafil hcl vardenafil hcl REMOVE FROM Non-Formulary FORMULARY 12/25/2020 BOOST lactose-reduced food REMOVE FROM Non-Formulary FORMULARY 12/25/2020 CERTAVITE multivitamin with REMOVE FROM Non-Formulary SENIOR minerals/folic FORMULARY acid/lycopene/lutein 12/25/2020 ZEMBRACE sumatriptan succinate REMOVE FROM Non-Formulary SYMTOUCH FORMULARY 12/25/2020 ZEMBRACE sumatriptan succinate REMOVE FROM Non-Formulary SYMTOUCH FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 9 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 12/25/2020 t:slim x2 control- subcutaneous insulin pump REMOVE FROM Non-Formulary iq FORMULARY 12/25/2020 AIRBORNE multivit-minerals/vit REMOVE FROM Non-Formulary c//lysine hcl/herbal FORMULARY no.124 12/25/2020 AIRBORNE multivit-minerals/vit REMOVE FROM Non-Formulary c/glutamine/lysine hcl/herbal FORMULARY no.124 12/25/2020 BOOST PLUS lactose-reduced food REMOVE FROM Non-Formulary FORMULARY 12/25/2020 DIGESTIVE bacillus coagulans REMOVE FROM Non-Formulary ADVANTAGE FORMULARY PROBIO-PRE 12/25/2020 AZO vit b1/b3/b6/vit REMOVE FROM Non-Formulary HORMONAL e/calcium/ FORMULARY HEALTH CYCLE oxide/chastetree extr CARE 12/25/2020 DIGESTIVE bacillus coagulans REMOVE FROM Non-Formulary ADVANTAGE FORMULARY KID PROBIO 12/25/2020 MEGARED omega-3 fatty REMOVE FROM Non-Formulary ADVANCED 6X acids/docosahexaenoic FORMULARY ABSORPTION acid/epa/fish oil 12/25/2020 MEGARED omega-3 fatty REMOVE FROM Non-Formulary ADVANCED 6X acids/docosahexaenoic FORMULARY ABSORPTION acid/epa/fish oil 12/25/2020 activated activated charcoal REMOVE FROM Non-Formulary charcoal FORMULARY 12/25/2020 fergon ferrous gluconate REMOVE FROM Non-Formulary FORMULARY 12/25/2020 hcl- ketamine hcl in 0.9 % REMOVE FROM Non-Formulary 0.9% nacl sodium chloride FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 10 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 12/25/2020 dextrose 5%- dextrose 5 % and 0.45 % REMOVE FROM Non-Formulary 0.45% nacl sodium chloride FORMULARY 12/25/2020 potassium potassium chloride ADD TO FORMULARY Covered chloride 12/25/2020 merzee norethindrone acetate- REMOVE FROM Non-Formulary ethinyl estradiol/ferrous FORMULARY fumarate 12/25/2020 RIABNI rituximab-arrx REMOVE FROM Non-Formulary FORMULARY 12/25/2020 RIABNI rituximab-arrx REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 11 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

January, 2021

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 01/01/2021 acneclear benzoyl peroxide ADD TO FORMULARY Non-Formulary Covered 01/01/2021 acne treatment benzoyl peroxide ADD TO FORMULARY Covered 01/01/2021 bp benzoyl peroxide ADD TO FORMULARY Non-Formulary Covered 01/01/2021 daylogic acne benzoyl peroxide ADD TO FORMULARY Non-Formulary Covered treatment 01/01/2021 zovia 1-35 ethynodiol diacetate-ethinyl ADD TO FORMULARY Covered estradiol 01/01/2021 ZOMACTON somatropin ADD TO FORMULARY Non-Formulary Covered 01/01/2021 ZOMACTON somatropin REMOVE UM: SPECIALTY Specialty Drug 01/01/2021 BIVIGAM immune CHANGE UM: MED Medical Drug globulin,gamm(igg)//i ga greater than 50 mcg/ml 01/01/2021 mebendazole,ver mebendazole CHANGE TIER Covered mox,emverm 01/01/2021 OCTAGAM immune CHANGE UM: MED Medical Drug globulin,gamm(igg)/maltose/ iga greater than 50 mcg/ml

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 12 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 01/01/2021 acetaminophen,n acetaminophen CHANGE TIER Covered on- aspirin,children's non- aspirin,children's acetaminophen,c hild's medi- tabs,apra,dorcol,t ylenol,child's pain relief,antic,genap ap,children's genapap,apap,ap anol,no- aspirin,anacin- 3,pain relief w/o aspirin,uni- ace,myapap,biop hen,liquiprin,child ren's lopap,pain reliever,ty- pap,mapap,aspiri n free child's,albatemp, aspirin free,bayapap,chil dren's pain relief,non-aspirin pain relief,panadol children's,mardol, aspirin- free,aspirin-free children's elixir,st. joseph,children's apap,childrens elixir,apap- elixir,pain reliever child,non aspirin pain

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 13 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value reliever,ridenol,d olono,acetanol,ex - prin,apapedyn,chi ldren's pain reliever,komaphe n,child pain relief,non aspirin,pain relieving,child's pain reliever w/o asa,pain reliever w/o asa 01/01/2021 BYFAVO remimazolam besylate REMOVE FROM Non-Formulary FORMULARY 01/05/2021 accu-chek blood sugar diagnostic, REMOVE FROM Covered Non-Formulary compact plus drum-type FORMULARY strips 01/07/2021 EPCLUSA sofosbuvir/velpatasvir ADD UM: SPECIALTY Specialty Drug 01/08/2021 icosapent ethyl icosapent ethyl ADD UM: CUSTOM ELIGIBLE FOR 90 DAY SUPPLY 01/08/2021 venngel one diclofenac sodium REMOVE FROM Non-Formulary FORMULARY 01/08/2021 aminocaproic aminocaproic acid REMOVE FROM Non-Formulary acid FORMULARY 01/08/2021 isoproterenol hcl isoproterenol hcl REMOVE FROM Non-Formulary FORMULARY 01/08/2021 isoproterenol hcl isoproterenol hcl REMOVE FROM Non-Formulary FORMULARY 01/08/2021 fluticasone- fluticasone ADD TO FORMULARY Covered salmeterol propionate/salmeterol xinafoate

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 14 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 01/08/2021 dextrose 5%- potassium chloride in REMOVE FROM Non-Formulary 1/2ns-kcl dextrose 5 %-0.45 % FORMULARY sodium chloride 01/08/2021 MONISTAT 7 miconazole nitrate REMOVE FROM Non-Formulary FORMULARY 01/08/2021 melatonin REMOVE FROM Non-Formulary FORMULARY 01/08/2021 succinylcholine succinylcholine chloride REMOVE FROM Non-Formulary chloride FORMULARY 01/08/2021 nitrofurantoin nitrofurantoin REMOVE FROM Non-Formulary FORMULARY 01/08/2021 thiamine hcl thiamine hcl REMOVE FROM Non-Formulary FORMULARY 01/08/2021 hydrocortisone- hydrocortisone REMOVE FROM Non-Formulary pramoxine acetate/pramoxine hcl FORMULARY 01/08/2021 piperacillin- piperacillin REMOVE FROM Non-Formulary tazobactam sodium/tazobactam sodium FORMULARY 01/08/2021 meclizine hcl meclizine hcl ADD TO FORMULARY Covered 01/08/2021 meclizine hcl meclizine hcl ADD TO FORMULARY Covered 01/08/2021 oralyte electrolytes/dextrose ADD TO FORMULARY Covered 01/08/2021 fluticasone- fluticasone ADD TO FORMULARY Covered salmeterol propionate/salmeterol xinafoate 01/08/2021 migraine relief aspirin/acetaminophen/caffei REMOVE FROM Non-Formulary ne FORMULARY 01/08/2021 dextrose in water dextrose 10 % in water REMOVE FROM Non-Formulary FORMULARY 01/08/2021 decitabine decitabine REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 15 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 01/08/2021 decitabine decitabine REMOVE FROM Non-Formulary FORMULARY 01/08/2021 monobenzone monobenzone REMOVE FROM Non-Formulary FORMULARY 01/08/2021 monobenzone monobenzone REMOVE FROM Non-Formulary FORMULARY 01/08/2021 monobenzone monobenzone REMOVE FROM Non-Formulary FORMULARY 01/08/2021 TRAVATAN Z travoprost REMOVE FROM Non-Formulary FORMULARY 01/08/2021 irinotecan hcl irinotecan hcl REMOVE FROM Non-Formulary FORMULARY 01/08/2021 irinotecan hcl irinotecan hcl REMOVE FROM Non-Formulary FORMULARY 01/08/2021 melatonin melatonin REMOVE FROM Non-Formulary FORMULARY 01/08/2021 hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 01/08/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 01/08/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 01/08/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 01/08/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 01/08/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 01/08/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 16 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 01/08/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 01/08/2021 blood pressure blood pressure test kit- REMOVE FROM Non-Formulary monitor medium FORMULARY 01/08/2021 hcl doxepin hcl REMOVE FROM Non-Formulary FORMULARY 01/08/2021 doxepin hcl doxepin hcl REMOVE FROM Non-Formulary FORMULARY 01/08/2021 children's acetaminophen REMOVE FROM Non-Formulary acetaminophen FORMULARY 01/08/2021 irinotecan hcl irinotecan hcl REMOVE FROM Non-Formulary FORMULARY 01/08/2021 SYLVANT siltuximab REMOVE FROM Non-Formulary FORMULARY 01/08/2021 SYLVANT siltuximab REMOVE FROM Non-Formulary FORMULARY 01/08/2021 tavaborole tavaborole REMOVE FROM Non-Formulary FORMULARY 01/08/2021 acetaminophen acetaminophen REMOVE FROM Non-Formulary FORMULARY 01/08/2021 lubricant eye propylene glycol REMOVE FROM Non-Formulary drop FORMULARY 01/08/2021 l-theanine theanine REMOVE FROM Non-Formulary FORMULARY 01/08/2021 MUCINEX FAST- diphenhydramine/phenyleph REMOVE FROM Non-Formulary MAX DAY-NITE rin/dextromethorph/acetamin FORMULARY COLD ophen/gg 01/08/2021 BOROLEUM menthol/camphor/white REMOVE FROM Non-Formulary petrolatum FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 17 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 01/08/2021 mucinex fast-max phenylephrine REMOVE FROM Non-Formulary cold-flu hcl/ FORMULARY hbr/acetaminophen/guaifen 01/08/2021 MUCINEX triprolidine REMOVE FROM Non-Formulary NIGHTSHIFT hcl/phenylephrine/dextromet FORMULARY SINUS horphn/acetaminophen 01/08/2021 AJOVY fremanezumab-vfrm REMOVE FROM Non-Formulary AUTOINJECTOR FORMULARY 01/08/2021 MUCINEX triprolidine/phenylephrine/de REMOVE FROM Non-Formulary SINUS-MAX xtromethorph/acetamin/guaif FORMULARY NIGHTSHIFT enes 01/08/2021 vitamin d3 cholecalciferol (vitamin d3) REMOVE FROM Non-Formulary FORMULARY 01/08/2021 AIRBORNE multivitamin-minerals/vit REMOVE FROM Non-Formulary GUMMY c/herbal no.124 FORMULARY 01/08/2021 AIRBORNE multivitamin-minerals/vit REMOVE FROM Non-Formulary GUMMY c/herbal no.124 FORMULARY 01/08/2021 AIRBORNE multivitamin-minerals/vit REMOVE FROM Non-Formulary GUMMY c/herbal no.124 FORMULARY 01/08/2021 AIRBORNE multivitamin-minerals/vit REMOVE FROM Non-Formulary GUMMY c/herbal no.124 FORMULARY 01/08/2021 MUCINEX triprolidine REMOVE FROM Non-Formulary NIGHTSHFT hcl/phenylephrine/dextromet FORMULARY SEVR CLD-FLU horphn/acetaminophen 01/08/2021 REFRESH carboxymethylcellulose REMOVE FROM Non-Formulary RELIEVA PF sodium/glycerin/pf FORMULARY 01/08/2021 PATADAY ONCE olopatadine hcl REMOVE FROM Non-Formulary DAILY RELIEF FORMULARY 01/08/2021 hydralyte electrolytes/dextrose REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 18 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 01/08/2021 hydralyte electrolytes/dextrose REMOVE FROM Non-Formulary FORMULARY 01/08/2021 hydralyte electrolytes/dextrose REMOVE FROM Non-Formulary FORMULARY 01/08/2021 children's cold-flu dextromethorphan/phenylep REMOVE FROM Non-Formulary hrine/acetaminophen/chlorp FORMULARY heniramin 01/08/2021 PRILO PATCH II lidocaine/prilocaine REMOVE FROM Non-Formulary FORMULARY 01/08/2021 tri-nymyo norgestimate-ethinyl ADD TO FORMULARY Covered estradiol 01/08/2021 nylia norethindrone-ethinyl ADD TO FORMULARY Covered estradiol 01/08/2021 VITREXYL multivitamin with minerals REMOVE FROM Non-Formulary no.86/folic acid FORMULARY 01/11/2021 effaclar adapalene ADD TO FORMULARY Non-Formulary Covered adapalene 01/12/2021 nitazoxanide nitazoxanide ADD UM: QUANTITY 6 / 30 days 01/15/2021 aprepitant aprepitant REMOVE FROM Non-Formulary FORMULARY 01/15/2021 aprepitant aprepitant REMOVE FROM Non-Formulary FORMULARY 01/15/2021 westab plus prenatal vits with calcium ADD TO FORMULARY Covered no.72/ferrous fumarate/folic acid 01/15/2021 eptifibatide eptifibatide REMOVE FROM Non-Formulary FORMULARY 01/15/2021 desmopressin desmopressin acetate REMOVE FROM Non-Formulary acetate FORMULARY 01/15/2021 desmopressin desmopressin acetate REMOVE FROM Non-Formulary acetate FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 19 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 01/15/2021 atropine sulfate atropine sulfate REMOVE FROM Non-Formulary FORMULARY 01/15/2021 daunorubicin hcl daunorubicin hcl REMOVE FROM Non-Formulary FORMULARY 01/15/2021 sodium sodium bicarbonate REMOVE FROM Non-Formulary bicarbonate FORMULARY 01/15/2021 aspirin ec aspirin REMOVE FROM Non-Formulary FORMULARY 01/15/2021 eptifibatide eptifibatide REMOVE FROM Non-Formulary FORMULARY 01/15/2021 dexrazoxane dexrazoxane hcl REMOVE FROM Non-Formulary FORMULARY 01/15/2021 hydrocortisone- hydrocortisone/iodoquinol REMOVE FROM Non-Formulary iodoquinol FORMULARY 01/15/2021 dexamethasone dexamethasone sodium REMOVE FROM Non-Formulary sodium phosphate FORMULARY phosphate 01/15/2021 non-aspirin pm acetaminophen/diphenhydra REMOVE FROM Non-Formulary mine hcl FORMULARY 01/15/2021 senna-s sennosides/docusate REMOVE FROM Non-Formulary sodium FORMULARY 01/15/2021 meclizine hcl meclizine hcl REMOVE FROM Non-Formulary FORMULARY 01/15/2021 pen needle pen needle, diabetic REMOVE FROM Non-Formulary FORMULARY 01/15/2021 hydromorphone hydromorphone hcl REMOVE FROM Non-Formulary hcl FORMULARY 01/15/2021 aprepitant aprepitant REMOVE FROM Non-Formulary FORMULARY 01/15/2021 aprepitant aprepitant REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 20 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 01/15/2021 aprepitant aprepitant REMOVE FROM Non-Formulary FORMULARY 01/15/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 01/15/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 01/15/2021 pen needle pen needle, diabetic REMOVE FROM Non-Formulary FORMULARY 01/15/2021 DOTAREM gadoterate meglumine REMOVE FROM Non-Formulary FORMULARY 01/15/2021 DOTAREM gadoterate meglumine REMOVE FROM Non-Formulary FORMULARY 01/15/2021 sulfate morphine sulfate REMOVE FROM Non-Formulary FORMULARY 01/15/2021 tavaborole tavaborole REMOVE FROM Non-Formulary FORMULARY 01/15/2021 ALLZITAL butalbital/acetaminophen REMOVE FROM Non-Formulary FORMULARY 01/15/2021 cyclopentolate- cyclopentolate REMOVE FROM Non-Formulary tropicamide-pe hcl/tropicamide/phenylephrin FORMULARY e hcl in water 01/15/2021 cyclopentolate- cyclopentolate REMOVE FROM Non-Formulary tropicamide-pe hcl/tropicamide/phenylephrin FORMULARY e hcl in water 01/15/2021 acidophilus lactobacillus acidophilus REMOVE FROM Non-Formulary probiotic FORMULARY 01/15/2021 INTRAROSA (dhea) REMOVE FROM Non-Formulary FORMULARY 01/15/2021 atropine sulfate atropine sulfate REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 21 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 01/15/2021 atropine sulfate atropine sulfate REMOVE FROM Non-Formulary FORMULARY 01/15/2021 PATADAY ONCE olopatadine hcl REMOVE FROM Non-Formulary DAILY RELIEF FORMULARY 01/15/2021 L.E.T. (LIDO- lidocaine hcl/epinephrine REMOVE FROM Non-Formulary EPINEPH- bitartrate/tetracaine hcl FORMULARY TETRA) 01/15/2021 GLYTACTIN nutritional therapy for pku REMOVE FROM Non-Formulary BUILD 20-20 no.64 FORMULARY 01/15/2021 GLYTACTIN nutritional therapy for pku REMOVE FROM Non-Formulary BUILD 20-20 no.64 FORMULARY 01/15/2021 GLYTACTIN nutritional therapy for pku REMOVE FROM Non-Formulary BUILD 20-20 no.64 FORMULARY 01/15/2021 GLYTACTIN nutritional therapy for pku REMOVE FROM Non-Formulary BUILD 20-20 no.64 FORMULARY 01/15/2021 NEURIVA PLUS b6/folic REMOVE FROM Non-Formulary acid/cyanocobalamin/coffee FORMULARY ext/phosphatidyl 01/15/2021 pediatric poly- pediatric multivitamin REMOVE FROM Non-Formulary vitamin-iron no.194/ferrous sulfate FORMULARY 01/15/2021 5-mthf methyltetrahydrofolate REMOVE FROM Non-Formulary glucosamine FORMULARY 01/15/2021 5-htp 5-hydroxytryptophan (5-htp) REMOVE FROM Non-Formulary FORMULARY 01/15/2021 ENCALA nutritional therapy for REMOVE FROM Non-Formulary impaired digestive function FORMULARY 01/15/2021 ENCALA nutritional therapy for REMOVE FROM Non-Formulary impaired digestive function FORMULARY 01/15/2021 carepoint luer syringe, disposable, 3 ml REMOVE FROM Non-Formulary lock FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 22 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 01/15/2021 securesafe pen pen needle, diabetic, safety REMOVE FROM Non-Formulary needle FORMULARY 01/15/2021 securesafe pen pen needle, diabetic, safety REMOVE FROM Non-Formulary needle FORMULARY 01/15/2021 neuriva original coffee extract/phosphatidyl REMOVE FROM Non-Formulary serine FORMULARY 01/15/2021 quickvue sars covid-19 antigen REMOVE FROM Non-Formulary antigen immunoassay test FORMULARY 01/15/2021 series 600 bp blood pressure test kit-large REMOVE FROM Non-Formulary monitor FORMULARY 01/15/2021 GEMTESA vibegron REMOVE FROM Non-Formulary FORMULARY 01/15/2021 DOTAREM gadoterate meglumine REMOVE FROM Non-Formulary FORMULARY 01/15/2021 DOTAREM gadoterate meglumine REMOVE FROM Non-Formulary FORMULARY 01/15/2021 VITREXYL PLUS multivitamin with minerals REMOVE FROM Non-Formulary IRON no.86/ferrous fumarate/folic FORMULARY acid 01/15/2021 lyleq norethindrone ADD TO FORMULARY Covered 01/15/2021 lyleq norethindrone ADD TO FORMULARY Covered 01/15/2021 lyleq norethindrone ADD TO FORMULARY Covered 01/22/2021 midazolam hcl midazolam in sodium REMOVE FROM Non-Formulary chloride, iso-osmotic/pf FORMULARY 01/22/2021 cisatracurium cisatracurium besylate REMOVE FROM Non-Formulary besylate FORMULARY 01/22/2021 ropivacaine hcl ropivacaine hcl/pf REMOVE FROM Non-Formulary FORMULARY 01/22/2021 ropivacaine hcl ropivacaine hcl/pf REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 23 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 01/22/2021 dibucaine dibucaine REMOVE FROM Non-Formulary FORMULARY 01/22/2021 doxorubicin hcl doxorubicin hcl REMOVE FROM Non-Formulary FORMULARY 01/22/2021 triamcinolone triamcinolone acetonide REMOVE FROM Non-Formulary acetonide FORMULARY 01/22/2021 triamcinolone triamcinolone acetonide REMOVE FROM Non-Formulary acetonide FORMULARY 01/22/2021 triamcinolone triamcinolone acetonide REMOVE FROM Non-Formulary acetonide FORMULARY 01/22/2021 epinephrine epinephrine ADD TO FORMULARY Covered 01/22/2021 TYLENOL acetaminophen REMOVE FROM Non-Formulary EXTRA FORMULARY STRENGTH 01/22/2021 oxytocin oxytocin REMOVE FROM Non-Formulary FORMULARY 01/22/2021 oxytocin oxytocin REMOVE FROM Non-Formulary FORMULARY 01/22/2021 solifenacin solifenacin succinate REMOVE FROM Non-Formulary succinate FORMULARY 01/22/2021 solifenacin solifenacin succinate REMOVE FROM Non-Formulary succinate FORMULARY 01/22/2021 CERAVE ceramides 1,3,6-ii REMOVE FROM Non-Formulary MOISTURIZING FORMULARY 01/22/2021 ropivacaine hcl ropivacaine hcl/pf REMOVE FROM Non-Formulary FORMULARY 01/22/2021 ropivacaine hcl ropivacaine hcl/pf REMOVE FROM Non-Formulary FORMULARY 01/22/2021 RHOFADE oxymetazoline hcl REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 24 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 01/22/2021 8hr muscle acetaminophen REMOVE FROM Non-Formulary aches-pain FORMULARY 01/22/2021 levorphanol tartrate REMOVE FROM Non-Formulary tartrate FORMULARY 01/22/2021 women's diaper,brief,adult, REMOVE FROM Non-Formulary underwear disposable FORMULARY 01/22/2021 losartan losartan potassium REMOVE FROM Non-Formulary potassium FORMULARY 01/22/2021 clever choice diaper,brief,adult, REMOVE FROM Non-Formulary comfort protect disposable FORMULARY 01/22/2021 clever choice diaper,brief,adult, REMOVE FROM Non-Formulary comfort protect disposable FORMULARY 01/22/2021 clever choice diaper,brief,adult, REMOVE FROM Non-Formulary comfort protect disposable FORMULARY 01/22/2021 CHILDREN'S acetaminophen REMOVE FROM Non-Formulary TYLENOL FORMULARY 01/22/2021 CHILDREN'S acetaminophen REMOVE FROM Non-Formulary TYLENOL FORMULARY 01/22/2021 MUCINEX FAST- triprolidine/phenylephrine/de REMOVE FROM Non-Formulary MAX COLD- xtromethorph/acetamin/guaif FORMULARY NGHTSHFT enes 01/22/2021 docosanol docosanol REMOVE FROM Non-Formulary FORMULARY 01/22/2021 olopatadine hcl olopatadine hcl REMOVE FROM Non-Formulary FORMULARY 01/22/2021 olopatadine hcl olopatadine hcl REMOVE FROM Non-Formulary FORMULARY 01/22/2021 5-mthf es methyltetrahydrofolate REMOVE FROM Non-Formulary glucosamine FORMULARY 01/22/2021 multivitamin multivitamin with REMOVE FROM Non-Formulary gummies minerals/folic acid FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 25 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 01/22/2021 ulticare pen pen needle, diabetic REMOVE FROM Non-Formulary needle FORMULARY 01/22/2021 comfort touch pen needle, diabetic REMOVE FROM Non-Formulary pen needle FORMULARY 01/22/2021 comfort touch pen needle, diabetic REMOVE FROM Non-Formulary pen needle FORMULARY 01/22/2021 comfort touch pen needle, diabetic REMOVE FROM Non-Formulary pen needle FORMULARY 01/22/2021 naproxen naproxen REMOVE FROM Non-Formulary FORMULARY 01/22/2021 naproxen naproxen REMOVE FROM Non-Formulary FORMULARY 01/22/2021 blood pressure blood pressure test kit-large REMOVE FROM Non-Formulary cuff monitor FORMULARY 01/22/2021 naproxen sodium naproxen sodium REMOVE FROM Non-Formulary cr FORMULARY 01/22/2021 emtricitabine- emtricitabine/tenofovir ADD TO FORMULARY Covered tenofovir disop disoproxil fumarate 01/22/2021 emtricitabine- emtricitabine/tenofovir ADD TO FORMULARY Covered tenofovir disop disoproxil fumarate 01/22/2021 emtricitabine- emtricitabine/tenofovir ADD TO FORMULARY Covered tenofovir disop disoproxil fumarate 01/22/2021 ICLUSIG ponatinib hcl ADD TO FORMULARY Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 26 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 01/29/2021 januvia,trulicity,mi sitagliptin CHANGE UM: CUSTOM ELIGIBLE FOR cronase,precose, phosphate,,glybu 90 DAY SUPPLY humalog,humalo ride,acarbose,insulin g mix 75- lispro, 25,humalog mix protamine and insulin 50-50,humulin lispro,insulin regular, r,humulin human,insulin nph human n,humulin r u- isophane,insulin nph human 500,humulin 70- isophane/insulin regular, 30,humalog mix human,insulin lispro 75-25 protamine & insulin kwikpen,humalog lispro,glyburide,micronized,g mix 50-50 lucagon,miglitol,rosiglitazon kwikpen,humalog e kwikpen u- maleate/glimepiride,rosiglita 100,glynase,gluc zone maleate/metformin agon emergency hcl,saxagliptin kit,glyset,avandar hcl,saxagliptin hcl/metformin yl,avandamet,ong hcl,sitagliptin lyza,kombiglyze phosphate/metformin xr,janumet hcl,sitagliptin xr,janumet,juvisy phosphate/simvastatin,glime nc,diabeta,amaryl piride,glipizide, ,glucotrol maleate,insulin xl,glucotrol,acarb glargine,human recombinant ose,avandia,lantu analog,, s human recombinant solostar,lantus,ap analog,insulin idra,apidra glulisine,nateglinide,metform solostar,starlix,gl in hcl,glyburide/metformin ucophage,glucop hcl, hage hcl,glipizide/metformin xr,glucovance,gli hcl,pioglitazone mepiride,glyburid hcl/metformin hcl,insulin e aspart, micronized,glybur protamine human/insulin ide,metformin aspart,insulin hcl,metformin hcl detemir,repaglinide,glucago er,pioglitazone n,human

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 27 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value hcl,glyburide- recombinant,,repa metformin glinide/metformin hcl,glipizide- hcl,dextrose/dextrin/maltose, metformin,pioglita chlorpropamide,tolbutamide, zone- tolazamide,dextrose,diazoxi metformin,novolin de,linagliptin,linagliptin/metf r,novolin ormin hcl,pioglitazone n,novolin 70- hcl/glimepiride,dextrose/chol 30,novolog,novol ecalciferol (vitamin og mix 70- d3), 30,levemir,novolo acetate,canagliflozin,nph, g mix 70-30 human insulin flexpen,novolog isophane,,nph, flexpen,levemir human insulin flexpen,prandin,gl isophane/insulin regular, ipizide,glucagen, human,alogliptin victoza 2- benzoate,alogliptin pak,victoza 3- benzoate/metformin pak,prandimet,gli hcl,alogliptin pizide er,insta- benzoate/pioglitazone glucose,chlorprop hcl,exenatide ,tolbutamid microspheres,bromocriptine e,tolazamide,rep mesylate,metformin/ aglinide,nateglini /amino acids#7/herbal de,metformin er comb#125/choline osmotic,glutose- bit,metformin/amino acids 15,glutose- comb. #7/herbal 45,proglycem,tra comb.#125/choline,mifeprist djenta,jentadueto one,dapagliflozin ,pioglitazone- propanediol,,emp glimepiride,gluco agliflozin,canagliflozin/metfo se,riomet,glucose rmin hcl,dapagliflozin gel,gluco propanediol/metformin shot,glumetza,tru hcl,empagliflozin/linagliptin,e eplus mpagliflozin/metformin glucose,actos,sy hcl,dextrose/maltodextrin,ins mlinpen ulin degludec,insulin 60,symlinpen degludec/liraglutide,lixisenati 120,symlin,actopl de,insulin glargine,human

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 28 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value us met,dex4 recombinant glucose,dex4 analog/,metformi glucose n hcl/blood sugar bits,glucose diagnostic,insulin aspart bits,ultilet,invokan (niacinamide),dapagliflozin a,fortamet,glutos propanediol/saxagliptin e,glucagon,byetta hcl,,ertugliflozin ,glipizide pidolate,ertugliflozin xl,duetact,actoplu pidolate/sitagliptin s met phosphate,ertugliflozin xr,nesina,kazano, pidolate/metformin oseni,bydureon,c hcl,insulin regular, human in ycloset,appformin 0.9 % sodium ,appformin- chloride,glucagon d,relion,korlym,gl hcl,empagliflozin/linagliptin/ uco burst,humulin metformin hcl,insulin lispro- 50- aabc 50,metaglip,novol in n innolet,novolin 70-30 innolet,diabinese, humulin 70/30 kwikpen,humulin n kwikpen,farxiga,l evemir flextouch,tanzeu m,bydureon pen,jardiance,inv okamet,xigduo xr,afrezza,glyxam bi,toujeo solostar,humalog kwikpen u- 200,synjardy,gluc ose powder packets,tresiba flextouch u-

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 29 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 200,tresiba flextouch u- 100,repaglinide- metformin hcl,metformin er gastric,humulin r u-500 kwikpen,alogliptin ,alogliptin- metformin,aloglipt in- pioglitazone,migli tol,jentadueto xr,invokamet xr,xultophy 100- 3.6,basaglar kwikpen u- 100,adlyxin,soliq ua 100- 33,synjardy xr,dm2,humalog junior kwikpen,fiasp,fias p flextouch,bydureo n bcise,qtern,ozem pic,admelog,adm elog solostar,steglatro, steglujan,segluro met,toujeo max solostar,novolin 70-30 flexpen,sugarup,t resiba,insulin lispro,insulin lispro kwikpen u- 100,glutose-

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 30 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 5,microdot glucose gel,baqsimi,myxr edlin,gvoke hypopen 1- pack,gvoke hypopen 2- pack,gvoke pfs 1- pack syringe,gvoke pfs 2-pack syringe,fiasp penfill,rybelsus,in sulin aspart,insulin aspart penfill,insulin aspart flexpen,insulin aspart prot mix 70-30,novolin r flexpen,novolin n flexpen,riomet er,trijardy xr,,insuli n lispro junior kwikpen,insulin lispro protamine mix,lyumjev,lyumj ev kwikpen u- 100,lyumjev kwikpen u- 200,semglee,sem glee pen,sweet cheeks 01/29/2021 WILZIN acetate REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 31 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 01/29/2021 iron ferrous sulfate REMOVE FROM Non-Formulary FORMULARY 01/29/2021 naproxen sodium naproxen sodium REMOVE FROM Non-Formulary FORMULARY 01/29/2021 naproxen sodium naproxen sodium REMOVE FROM Non-Formulary FORMULARY 01/29/2021 naproxen sodium naproxen sodium REMOVE FROM Non-Formulary FORMULARY 01/29/2021 naproxen sodium naproxen sodium REMOVE FROM Non-Formulary FORMULARY 01/29/2021 glucose dextrose REMOVE FROM Non-Formulary FORMULARY 01/29/2021 infants' gas relief simethicone REMOVE FROM Non-Formulary FORMULARY 01/29/2021 ibuprofen ibuprofen REMOVE FROM Non-Formulary FORMULARY 01/29/2021 TYLENOL acetaminophen REMOVE FROM Non-Formulary FORMULARY 01/29/2021 DERMACINRX prenatal vitamins REMOVE FROM Non-Formulary PRENATRIX no.170/ferrous fumarate/folic FORMULARY acid 01/29/2021 phenylephrine hcl phenylephrine hcl REMOVE FROM Non-Formulary FORMULARY 01/29/2021 phenylephrine hcl phenylephrine hcl REMOVE FROM Non-Formulary FORMULARY 01/29/2021 mycophenolate mycophenolate mofetil hcl REMOVE FROM Non-Formulary mofetil FORMULARY 01/29/2021 dexamethasone dexamethasone sodium REMOVE FROM Non-Formulary sodium phosphate/pf FORMULARY phosphate

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 32 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 01/29/2021 hydrocodone hydrocodone bitartrate REMOVE FROM Non-Formulary bitartrate FORMULARY 01/29/2021 fulvestrant REMOVE FROM Non-Formulary FORMULARY 01/29/2021 nasal spray oxymetazoline hcl REMOVE FROM Non-Formulary FORMULARY 01/29/2021 ACTIDOSE- activated charcoal REMOVE FROM Non-Formulary AQUA FORMULARY 01/29/2021 pain relief extra acetaminophen REMOVE FROM Non-Formulary strength FORMULARY 01/29/2021 pain relief extra acetaminophen REMOVE FROM Non-Formulary strength FORMULARY 01/29/2021 nasal phenylephrine hcl REMOVE FROM Non-Formulary decongestant pe FORMULARY 01/29/2021 oxaliplatin oxaliplatin REMOVE FROM Non-Formulary FORMULARY 01/29/2021 oxaliplatin oxaliplatin REMOVE FROM Non-Formulary FORMULARY 01/29/2021 sodium fluoride fluoride (sodium) REMOVE FROM Non-Formulary 5000 dry mouth FORMULARY 01/29/2021 metformin er metformin hcl REMOVE FROM Non-Formulary gastric FORMULARY 01/29/2021 metformin er metformin hcl REMOVE FROM Non-Formulary gastric FORMULARY 01/29/2021 levetiracetam levetiracetam REMOVE FROM Non-Formulary FORMULARY 01/29/2021 diclofenac diclofenac sodium REMOVE FROM Non-Formulary sodium FORMULARY 01/29/2021 cefazolin sodium- cefazolin sodium/water for REMOVE FROM Non-Formulary sterile water injection,sterile FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 33 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 01/29/2021 sumatriptan succ- sumatriptan REMOVE FROM Non-Formulary naproxen sod succinate/naproxen sodium FORMULARY 01/29/2021 STALEVO 75 carbidopa/levodopa/entacap REMOVE FROM Non-Formulary one FORMULARY 01/29/2021 STALEVO 125 carbidopa/levodopa/entacap REMOVE FROM Non-Formulary one FORMULARY 01/29/2021 norepinephrine norepinephrine bitartrate in REMOVE FROM Non-Formulary bitar-0.9% nacl 0.9 % sodium chloride FORMULARY 01/29/2021 blood pressure blood pressure test kit-wrist REMOVE FROM Non-Formulary monitor FORMULARY 01/29/2021 VIBATIV telavancin hcl REMOVE FROM Non-Formulary FORMULARY 01/29/2021 epoprostenol epoprostenol sodium REMOVE FROM Non-Formulary sodium FORMULARY 01/29/2021 mucinex fast-max guaifenesin/dextromethorph REMOVE FROM Non-Formulary dm max an hbr FORMULARY 01/29/2021 epoprostenol epoprostenol sodium REMOVE FROM Non-Formulary sodium FORMULARY 01/29/2021 wymzya fe norethindrone-ethinyl REMOVE FROM Non-Formulary estradiol/ferrous fumarate FORMULARY 01/29/2021 dexmedetomidine dexmedetomidine hcl in 0.9 REMOVE FROM Non-Formulary -0.9% nacl % sodium chloride FORMULARY 01/29/2021 dexmedetomidine dexmedetomidine hcl in 0.9 REMOVE FROM Non-Formulary -0.9% nacl % sodium chloride FORMULARY 01/29/2021 ephedrine sulfate ephedrine sulfate REMOVE FROM Non-Formulary FORMULARY 01/29/2021 ephedrine sulfate ephedrine sulfate REMOVE FROM Non-Formulary FORMULARY 01/29/2021 MUCINEX FAST- diphenhydramine/phenyleph REMOVE FROM Non-Formulary MAX DAY-NITE rin/dextromethorph/acetamin FORMULARY CONG ophen/gg

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 34 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 01/29/2021 t:slim x2 with subcutaneous insulin pump REMOVE FROM Non-Formulary basal-iq FORMULARY 01/29/2021 t:slim x2 with subcutaneous insulin pump REMOVE FROM Non-Formulary basal-iq FORMULARY 01/29/2021 minimed mio infusion set for insulin pump REMOVE FROM Non-Formulary advance FORMULARY 01/29/2021 minimed mio infusion set for insulin pump REMOVE FROM Non-Formulary advance FORMULARY 01/29/2021 minimed mio infusion set for insulin pump REMOVE FROM Non-Formulary advance FORMULARY 01/29/2021 mya joy breast breast pump REMOVE FROM Non-Formulary pump FORMULARY 01/29/2021 nuvazil ii silicone adhesive REMOVE FROM Non-Formulary FORMULARY 01/29/2021 troche base sf - troche base no.235 REMOVE FROM Non-Formulary bitter-bloc FORMULARY 01/29/2021 troche base sf - troche base no.235 REMOVE FROM Non-Formulary bitter-bloc FORMULARY 01/29/2021 troche base sf - troche base no.235 REMOVE FROM Non-Formulary bitter-bloc FORMULARY 01/29/2021 troche base sf - troche base no.235 REMOVE FROM Non-Formulary bitter-bloc FORMULARY 01/29/2021 siladerm silicone adhesive REMOVE FROM Non-Formulary FORMULARY 01/29/2021 ALL DAY cetirizine hcl REMOVE FROM Non-Formulary ALLERGY FORMULARY RELIEF 01/29/2021 URINOZINC vitamin b REMOVE FROM Non-Formulary PROSTATE complex/minerals/saw FORMULARY COMPLX CLSC palmetto/pygeum africanum

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 35 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 01/29/2021 URINOZINC vitamin b REMOVE FROM Non-Formulary PROSTATE complex/minerals/saw FORMULARY COMPLX CLSC palmetto/pygeum africanum 01/29/2021 GENADEK pediatric multivitamin REMOVE FROM Non-Formulary no.196/vitamin d3/vit k1 FORMULARY 01/29/2021 FLORAJEN lactobacillus REMOVE FROM Non-Formulary WOMEN acidophilus/lactobacillus FORMULARY rhamnosus gg 01/29/2021 allergy relief levocetirizine REMOVE FROM Non-Formulary dihydrochloride FORMULARY 01/29/2021 5-mthf plus b12 methyltetrahydrofolate REMOVE FROM Non-Formulary glucosamine/mecobalamin FORMULARY 01/29/2021 eye multivitamin beta-carotene/ascorbic REMOVE FROM Non-Formulary acid/vite ac/zinc oxide/cupric FORMULARY oxide 01/29/2021 mucinex fast-max guaifenesin REMOVE FROM Non-Formulary chest-congest FORMULARY 01/29/2021 LUCEMYRA lofexidine hcl REMOVE FROM Non-Formulary FORMULARY 01/29/2021 LUCEMYRA lofexidine hcl REMOVE FROM Non-Formulary FORMULARY 01/29/2021 salonpas lidocaine REMOVE FROM Non-Formulary FORMULARY 01/29/2021 MUCINEX phenylephrine REMOVE FROM Non-Formulary SINUS-MAX hcl/dextromethorphan FORMULARY PRESSURE- hbr/acetaminophen/guaifen CGH 01/29/2021 8 hour pain relief acetaminophen REMOVE FROM Non-Formulary FORMULARY 01/29/2021 vitamin d3 cholecalciferol (vitamin d3) REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 36 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 01/29/2021 accutane isotretinoin ADD TO FORMULARY Covered 01/29/2021 accutane isotretinoin ADD TO FORMULARY Covered 01/29/2021 accutane isotretinoin ADD TO FORMULARY Covered 01/29/2021 accutane isotretinoin ADD TO FORMULARY Covered 01/29/2021 zolmitriptan zolmitriptan ADD TO FORMULARY Covered 01/29/2021 zolmitriptan zolmitriptan ADD TO FORMULARY Covered 01/29/2021 imiquimod imiquimod REMOVE FROM Non-Formulary FORMULARY 01/29/2021 ICLUSIG ponatinib hcl ADD TO FORMULARY Covered 01/29/2021 CYCLOPAK cyclobenzaprine/lidocaine/pr REMOVE FROM Non-Formulary ilocaine/glycerin FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 37 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

February, 2021

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/01/2021 darifenacin er darifenacin hydrobromide ADD TO FORMULARY Covered 02/01/2021 darifenacin er darifenacin hydrobromide ADD TO FORMULARY Covered 02/01/2021 tolvaptan tolvaptan REMOVE FROM Covered Non-Formulary FORMULARY 02/01/2021 GIVLAARI givosiran sodium ADD UM: SPECIALTY Specialty Drug 02/01/2021 MONJUVI tafasitamab-cxix ADD UM: MED Medical Drug 02/01/2021 MEPRON atovaquone REMOVE UM: SPECIALTY Specialty Drug 02/01/2021 VEREGEN sinecatechins REMOVE UM: SPECIALTY Specialty Drug 02/01/2021 dimethyl dimethyl fumarate REMOVE UM: Limited Access fumarate LIMITEDACCESS 02/01/2021 alinia,nitazoxanid nitazoxanide CHANGE UM: QUANTITY 2 / 1 days e 02/01/2021 INQOVI decitabine/cedazuridine ADD TO FORMULARY Covered 02/01/2021 GAVRETO pralsetinib ADD TO FORMULARY Covered 02/01/2021 heparin sodium,porcine/pf REMOVE FROM Covered Non-Formulary flush,heparin lock FORMULARY flush 02/01/2021 heparin heparin sodium,porcine/pf ADD UM: MED Medical Drug flush,heparin lock flush 02/01/2021 heparin sodium heparin sodium,porcine REMOVE FROM Covered Non-Formulary FORMULARY 02/01/2021 heparin sodium heparin sodium,porcine ADD UM: MED Medical Drug 02/01/2021 NEXIUM esomeprazole magnesium ADD TO FORMULARY Non-Formulary Covered 02/01/2021 NEXIUM esomeprazole magnesium ADD TO FORMULARY Non-Formulary Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 38 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/01/2021 NOXAFIL posaconazole REMOVE UM: SPECIALTY Specialty Drug 02/01/2021 NOXAFIL posaconazole REMOVE UM: SPECIALTY Specialty Drug 02/01/2021 BROVANA arformoterol tartrate REMOVE UM: SPECIALTY Specialty Drug 02/01/2021 DIFICID fidaxomicin REMOVE UM: SPECIALTY Specialty Drug 02/01/2021 dimethyl dimethyl fumarate REMOVE UM: Limited Access fumarate LIMITEDACCESS 02/01/2021 dimethyl dimethyl fumarate REMOVE UM: Limited Access fumarate LIMITEDACCESS 02/01/2021 NEXIUM esomeprazole magnesium REMOVE FROM Covered Non-Formulary FORMULARY 02/01/2021 NEXIUM esomeprazole magnesium REMOVE FROM Covered Non-Formulary FORMULARY 02/01/2021 tolvaptan tolvaptan ADD UM: SPECIALTY Specialty Drug 02/01/2021 iclevia levonorgestrel/ethinyl ADD TO FORMULARY Covered estradiol 02/01/2021 abiraterone abiraterone acetate ADD TO FORMULARY Covered acetate 02/01/2021 abiraterone abiraterone acetate ADD UM: LIMITEDACCESS Limited Access acetate 02/01/2021 MYCAPSSA octreotide acetate CHANGE UM: QUANTITY 120 / 30 days 4 / 1 days 02/01/2021 EPCLUSA sofosbuvir/velpatasvir ADD TO FORMULARY Non-Formulary Covered 02/01/2021 EPCLUSA sofosbuvir/velpatasvir REMOVE UM: SPECIALTY Specialty Drug 02/01/2021 CLINIMIX amino acid 6 % in dextrose ADD UM: MED Medical Drug 5 % water 02/01/2021 CLINIMIX E amino acid 8 % comb ADD UM: MED Medical Drug no.3/d10w/parenteral electrolytes no.37

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 39 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/01/2021 CLINIMIX E amino acid 8 % comb ADD UM: MED Medical Drug no.3/d14w/parenteral electrolytes no.37 02/01/2021 CLINIMIX amino acids 8 % in dextrose ADD UM: MED Medical Drug 10% water 02/01/2021 CLINIMIX amino acids 8 % in dextrose ADD UM: MED Medical Drug 14% water 02/02/2021 RIABNI rituximab-arrx ADD UM: MED Medical Drug 02/02/2021 BYFAVO remimazolam besylate ADD UM: MED Medical Drug 02/04/2021 ICLUSIG ponatinib hcl ADD UM: LIMITEDACCESS Limited Access 02/05/2021 fentanyl citrate- fentanyl citrate in 0.9 % REMOVE FROM Non-Formulary 0.9% nacl sodium chloride/pf FORMULARY 02/05/2021 metyrosine metyrosine REMOVE FROM Non-Formulary FORMULARY 02/05/2021 PHENEX-2 nutritional therapy for REMOVE FROM Non-Formulary phenylketonuria (pku) with FORMULARY iron no.1 02/05/2021 PHENEX-2 nutritional therapy for REMOVE FROM Non-Formulary phenylketonuria (pku) with FORMULARY iron no.1 02/05/2021 acetaminophen acetaminophen REMOVE FROM Non-Formulary FORMULARY 02/05/2021 acetaminophen acetaminophen REMOVE FROM Non-Formulary FORMULARY 02/05/2021 diphenhydramine diphenhydramine hcl REMOVE FROM Non-Formulary hcl FORMULARY 02/05/2021 diphenhydramine diphenhydramine hcl REMOVE FROM Non-Formulary hcl FORMULARY 02/05/2021 ammonium ammonium lactate REMOVE FROM Non-Formulary lactate FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 40 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/05/2021 ammonium ammonium lactate REMOVE FROM Non-Formulary lactate FORMULARY 02/05/2021 nicotine gum nicotine polacrilex REMOVE FROM Non-Formulary FORMULARY 02/05/2021 simethicone simethicone REMOVE FROM Non-Formulary FORMULARY 02/05/2021 dibucaine dibucaine REMOVE FROM Non-Formulary FORMULARY 02/05/2021 NABI-HB hepatitis b immune globulin REMOVE FROM Non-Formulary FORMULARY 02/05/2021 milk of magnesia magnesium hydroxide REMOVE FROM Non-Formulary FORMULARY 02/05/2021 docusate calcium docusate calcium REMOVE FROM Non-Formulary FORMULARY 02/05/2021 sulfamethoxazole sulfamethoxazole REMOVE FROM Non-Formulary FORMULARY 02/05/2021 sulfamethoxazole sulfamethoxazole REMOVE FROM Non-Formulary FORMULARY 02/05/2021 succinylcholine succinylcholine chloride REMOVE FROM Non-Formulary chloride FORMULARY 02/05/2021 zinc oxide zinc oxide REMOVE FROM Non-Formulary FORMULARY 02/05/2021 acetaminophen acetaminophen REMOVE FROM Non-Formulary FORMULARY 02/05/2021 acetaminophen acetaminophen REMOVE FROM Non-Formulary FORMULARY 02/05/2021 miconazole 1 miconazole nitrate REMOVE FROM Non-Formulary FORMULARY 02/05/2021 sucralfate sucralfate REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 41 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/05/2021 sucralfate sucralfate REMOVE FROM Non-Formulary FORMULARY 02/05/2021 sucralfate sucralfate REMOVE FROM Non-Formulary FORMULARY 02/05/2021 sucralfate sucralfate REMOVE FROM Non-Formulary FORMULARY 02/05/2021 sucralfate sucralfate REMOVE FROM Non-Formulary FORMULARY 02/05/2021 diphenhydramine diphenhydramine hcl REMOVE FROM Non-Formulary hcl FORMULARY 02/05/2021 diphenhydramine diphenhydramine hcl REMOVE FROM Non-Formulary hcl FORMULARY 02/05/2021 hydrocortisone hydrocortisone REMOVE FROM Non-Formulary FORMULARY 02/05/2021 epinephrine epinephrine REMOVE FROM Non-Formulary FORMULARY 02/05/2021 senna laxative sennosides REMOVE FROM Non-Formulary FORMULARY 02/05/2021 senna laxative sennosides REMOVE FROM Non-Formulary FORMULARY 02/05/2021 docusate sodium docusate sodium REMOVE FROM Non-Formulary FORMULARY 02/05/2021 docusate sodium docusate sodium REMOVE FROM Non-Formulary FORMULARY 02/05/2021 folic acid folic acid ADD TO FORMULARY Covered 02/05/2021 folic acid folic acid ADD TO FORMULARY Covered 02/05/2021 ammonium ammonium lactate REMOVE FROM Non-Formulary lactate FORMULARY 02/05/2021 PROPIMEX-2 nutritional therapy for REMOVE FROM Non-Formulary propionic acidemia with iron FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 42 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/05/2021 paclitaxel paclitaxel REMOVE FROM Non-Formulary FORMULARY 02/05/2021 tranexamic acid tranexamic acid REMOVE FROM Non-Formulary FORMULARY 02/05/2021 tranexamic acid tranexamic acid REMOVE FROM Non-Formulary FORMULARY 02/05/2021 tranexamic acid tranexamic acid REMOVE FROM Non-Formulary FORMULARY 02/05/2021 tranexamic acid tranexamic acid REMOVE FROM Non-Formulary FORMULARY 02/05/2021 tranexamic acid tranexamic acid REMOVE FROM Non-Formulary FORMULARY 02/05/2021 hydromorphone hydromorphone hcl REMOVE FROM Non-Formulary hcl FORMULARY 02/05/2021 calcium citrate calcium citrate REMOVE FROM Non-Formulary FORMULARY 02/05/2021 omeprazole omeprazole magnesium REMOVE FROM Non-Formulary magnesium FORMULARY 02/05/2021 omeprazole omeprazole magnesium REMOVE FROM Non-Formulary magnesium FORMULARY 02/05/2021 omeprazole omeprazole magnesium REMOVE FROM Non-Formulary magnesium FORMULARY 02/05/2021 NABI-HB hepatitis b immune globulin REMOVE FROM Non-Formulary FORMULARY 02/05/2021 diclofenac diclofenac sodium REMOVE FROM Non-Formulary sodium FORMULARY 02/05/2021 tadalafil tadalafil REMOVE FROM Non-Formulary FORMULARY 02/05/2021 allergy relief-d cetirizine REMOVE FROM Non-Formulary hcl/pseudoephedrine hcl FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 43 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/05/2021 bimatoprost bimatoprost REMOVE FROM Non-Formulary FORMULARY 02/05/2021 bimatoprost bimatoprost REMOVE FROM Non-Formulary FORMULARY 02/05/2021 sodium sulfacetamide sodium/sulfur REMOVE FROM Non-Formulary sulfacetamide- FORMULARY sulfur 02/05/2021 succinylcholine succinylcholine chloride REMOVE FROM Non-Formulary chloride FORMULARY 02/05/2021 gemcitabine hcl gemcitabine hcl REMOVE FROM Non-Formulary FORMULARY 02/05/2021 allergy relief fexofenadine hcl REMOVE FROM Non-Formulary FORMULARY 02/05/2021 ferrous gluconate ferrous gluconate REMOVE FROM Non-Formulary FORMULARY 02/05/2021 chlorzoxazone chlorzoxazone REMOVE FROM Non-Formulary FORMULARY 02/05/2021 potassium cl- potassium chloride/lidocaine REMOVE FROM Non-Formulary lidocaine-ns hcl in 0.9 % sodium chloride FORMULARY 02/05/2021 dexmedetomidine dexmedetomidine hcl in 0.9 REMOVE FROM Non-Formulary -0.9% nacl % sodium chloride FORMULARY 02/05/2021 dexmedetomidine dexmedetomidine hcl in 0.9 REMOVE FROM Non-Formulary -0.9% nacl % sodium chloride FORMULARY 02/05/2021 cidofovir cidofovir REMOVE FROM Non-Formulary FORMULARY 02/05/2021 cidofovir cidofovir REMOVE FROM Non-Formulary FORMULARY 02/05/2021 BOOST lactose-reduced food REMOVE FROM Non-Formulary FORMULARY 02/05/2021 BOOST lactose-reduced food REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 44 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/05/2021 LUMASON sulfur hexafluoride REMOVE FROM Non-Formulary microspheres FORMULARY 02/05/2021 mynephron vitamin b complex and REMOVE FROM Non-Formulary vitamin c no.20/folic acid FORMULARY 02/05/2021 nicotine lozenge nicotine polacrilex REMOVE FROM Non-Formulary FORMULARY 02/05/2021 nicotine lozenge nicotine polacrilex REMOVE FROM Non-Formulary FORMULARY 02/05/2021 allergy relief levocetirizine REMOVE FROM Non-Formulary dihydrochloride FORMULARY 02/05/2021 first aid kit first aid kit REMOVE FROM Non-Formulary FORMULARY 02/05/2021 compressor nebulizer and compressor REMOVE FROM Non-Formulary nebulizer FORMULARY 02/05/2021 true metrix blood sugar diagnostic REMOVE FROM Non-Formulary glucose test strip FORMULARY 02/05/2021 true metrix blood sugar diagnostic REMOVE FROM Non-Formulary glucose test strip FORMULARY 02/05/2021 true metrix air blood-glucose meter REMOVE FROM Non-Formulary glucose meter FORMULARY 02/05/2021 pediatric bear nebulizer and compressor REMOVE FROM Non-Formulary nebulizer FORMULARY 02/05/2021 neodot infrared thermometer, infrared, non- REMOVE FROM Non-Formulary thermometer contact FORMULARY 02/05/2021 comfort touch bp blood pressure test kit-large REMOVE FROM Non-Formulary monitor FORMULARY 02/05/2021 comfort touch incontinence pad,liner,disp REMOVE FROM Non-Formulary underpad FORMULARY 02/05/2021 VANQUISH aspirin/acetaminophen/caffei REMOVE FROM Non-Formulary ne FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 45 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/05/2021 ELDERTONIC vitamin b complex/zinc REMOVE FROM Non-Formulary sulfate/manganese sulfate FORMULARY 02/05/2021 ALIVE WOMEN'S multivit with REMOVE FROM Non-Formulary 50 PLUS minerals/folic/lutein/herbal FORMULARY complex no. 293 02/05/2021 WOMEN'S multivitamin with REMOVE FROM Non-Formulary MULTIVITAMIN minerals/folic acid/collagen, FORMULARY COLLAGEN hydrolyzed 02/05/2021 airshield multivitamin- REMOVE FROM Non-Formulary minerals/ascorbic FORMULARY acid/herbal no.124 02/05/2021 airshield multivitamin- REMOVE FROM Non-Formulary minerals/ascorbic FORMULARY acid/herbal no.124 02/05/2021 OMEGA-V omega-3 fatty REMOVE FROM Non-Formulary BENEFITS acids/dha/epa/dpa FORMULARY 02/05/2021 infants' simethicone REMOVE FROM Non-Formulary simethicone FORMULARY 02/05/2021 dextromethorpha dextromethorphan hbr REMOVE FROM Non-Formulary n hbr FORMULARY 02/05/2021 urinary pain relief phenazopyridine hcl REMOVE FROM Non-Formulary FORMULARY 02/05/2021 pediatric d-vite cholecalciferol (vitamin d3) REMOVE FROM Non-Formulary FORMULARY 02/05/2021 pediatric fe-vite ferrous sulfate REMOVE FROM Non-Formulary FORMULARY 02/05/2021 asperflex lidocaine REMOVE FROM Non-Formulary FORMULARY 02/05/2021 calypxo hp methyl salicylate/menthol REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 46 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/05/2021 vision health vit c/vit e acetate/zinc REMOVE FROM Non-Formulary oxid/cupric FORMULARY oxide/lutein/zeaxanthin 02/05/2021 tadalafil tadalafil REMOVE FROM Non-Formulary FORMULARY 02/05/2021 morphine sulfate morphine sulfate REMOVE FROM Non-Formulary FORMULARY 02/05/2021 ulticare pen pen needle, diabetic REMOVE FROM Non-Formulary needle FORMULARY 02/05/2021 ulticare safety pen needle, diabetic, safety REMOVE FROM Non-Formulary pen needle FORMULARY 02/05/2021 ulticare safety pen needle, diabetic, safety REMOVE FROM Non-Formulary pen needle FORMULARY 02/05/2021 foscarnet sodium foscarnet sodium REMOVE FROM Non-Formulary FORMULARY 02/10/2021 ZOMACTON somatropin REMOVE FROM Covered Non-Formulary FORMULARY 02/10/2021 ZOMACTON somatropin ADD UM: SPECIALTY Specialty Drug 02/10/2021 NUTROPIN somatropin REMOVE FROM Covered Non-Formulary FORMULARY 02/10/2021 NUTROPIN somatropin ADD UM: SPECIALTY Specialty Drug 02/10/2021 NORDITROPIN somatropin REMOVE FROM Covered Non-Formulary FORMULARY 02/12/2021 lubiprostone lubiprostone ADD TO FORMULARY Covered 02/12/2021 lubiprostone lubiprostone ADD TO FORMULARY Covered 02/13/2021 CALAN SR verapamil hcl REMOVE FROM Non-Formulary FORMULARY 02/13/2021 DERMACINRX multivitamin with minerals REMOVE FROM Non-Formulary VITRANOL no.86/folic acid FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 47 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/13/2021 DERMACINRX multivitamin with minerals REMOVE FROM Non-Formulary VITREXATE no.86/folic acid FORMULARY 02/13/2021 DERMACINRX multivitamin with minerals REMOVE FROM Non-Formulary VITREXATE FE no.86/ferrous fumarate/folic FORMULARY acid 02/13/2021 sodium fluoride sodium fluoride/potassium REMOVE FROM Non-Formulary enamel protect nitrate FORMULARY 02/13/2021 phenylephrine phenylephrine hcl in 0.9 % REMOVE FROM Non-Formulary hcl-0.9% nacl sodium chloride FORMULARY 02/13/2021 epinephrine epinephrine REMOVE FROM Non-Formulary convenience kit FORMULARY 02/13/2021 kapzin dc diclofenac sodium/capsicum REMOVE FROM Non-Formulary oleoresin FORMULARY 02/13/2021 mylanta magnesium REMOVE FROM Non-Formulary maximum hydroxide/aluminum FORMULARY strength hydroxide/simethicone 02/13/2021 mylanta magnesium REMOVE FROM Non-Formulary maximum hydroxide/aluminum FORMULARY strength hydroxide/simethicone 02/13/2021 lidocaine pain lidocaine REMOVE FROM Non-Formulary relief FORMULARY 02/13/2021 glucagon glucagon REMOVE FROM Non-Formulary emergency kit FORMULARY 02/13/2021 nicotine gum nicotine polacrilex REMOVE FROM Non-Formulary FORMULARY 02/13/2021 nicotine gum nicotine polacrilex REMOVE FROM Non-Formulary FORMULARY 02/13/2021 nicotine gum nicotine polacrilex REMOVE FROM Non-Formulary FORMULARY 02/13/2021 multivitamin with pediatric multivitamin REMOVE FROM Non-Formulary fluoride no.16/sodium fluoride FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 48 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/13/2021 - phenobarbital/hyoscyamine REMOVE FROM Non-Formulary belladonna sulf/atropine FORMULARY sulf/scopolamine hb 02/13/2021 phenobarbital- phenobarbital/hyoscyamine REMOVE FROM Non-Formulary belladonna sulf/atropine FORMULARY sulf/scopolamine hb 02/13/2021 TYLENOL acetaminophen REMOVE FROM Non-Formulary ARTHRITIS FORMULARY 02/13/2021 nitrofurantoin nitrofurantoin REMOVE FROM Non-Formulary FORMULARY 02/13/2021 melphalan hcl melphalan hcl REMOVE FROM Non-Formulary FORMULARY 02/13/2021 thiamine hcl thiamine hcl REMOVE FROM Non-Formulary FORMULARY 02/13/2021 ciclopirox ciclopirox olamine REMOVE FROM Non-Formulary olamine FORMULARY 02/13/2021 nicotine gum nicotine polacrilex REMOVE FROM Non-Formulary FORMULARY 02/13/2021 nicotine gum nicotine polacrilex REMOVE FROM Non-Formulary FORMULARY 02/13/2021 olopatadine hcl olopatadine hcl REMOVE FROM Non-Formulary FORMULARY 02/13/2021 dexmedetomidine dexmedetomidine hcl REMOVE FROM Non-Formulary hcl FORMULARY 02/13/2021 mupirocin calcium REMOVE FROM Non-Formulary FORMULARY 02/13/2021 mupirocin mupirocin calcium REMOVE FROM Non-Formulary FORMULARY 02/13/2021 CETAPHIL glycerin/dimethicone/petrolat REMOVE FROM Non-Formulary um,white/water FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 49 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/13/2021 alcohol swabs alcohol antiseptic pads REMOVE FROM Non-Formulary FORMULARY 02/13/2021 fentanyl citrate fentanyl citrate/pf REMOVE FROM Non-Formulary FORMULARY 02/13/2021 omeprazole omeprazole magnesium REMOVE FROM Non-Formulary magnesium FORMULARY 02/13/2021 capsaicin capsaicin REMOVE FROM Non-Formulary FORMULARY 02/13/2021 olopatadine hcl olopatadine hcl REMOVE FROM Non-Formulary FORMULARY 02/13/2021 phentermine hcl phentermine hcl REMOVE FROM Non-Formulary FORMULARY 02/13/2021 phentermine hcl phentermine hcl REMOVE FROM Non-Formulary FORMULARY 02/13/2021 magnesium magnesium sulfate in 0.9 % REMOVE FROM Non-Formulary sulfate-0.9% nacl sodium chloride FORMULARY 02/13/2021 eye itch relief ketotifen fumarate REMOVE FROM Non-Formulary FORMULARY 02/13/2021 ephedrine ephedrine sulfate in 0.9 % REMOVE FROM Non-Formulary sulfate-0.9% nacl sodium chloride/pf FORMULARY 02/13/2021 neostigmine neostigmine methylsulfate REMOVE FROM Non-Formulary methylsulfate FORMULARY 02/13/2021 REMOVE FROM Non-Formulary enanthate FORMULARY 02/13/2021 testosterone testosterone enanthate REMOVE FROM Non-Formulary enanthate FORMULARY 02/13/2021 testosterone testosterone enanthate REMOVE FROM Non-Formulary enanthate FORMULARY 02/13/2021 sodium hyaluronate sodium REMOVE FROM Non-Formulary hyaluronate FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 50 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/13/2021 sodium hyaluronate sodium REMOVE FROM Non-Formulary hyaluronate FORMULARY 02/13/2021 diethylpropion hcl diethylpropion hcl REMOVE FROM Non-Formulary FORMULARY 02/13/2021 HYDROPHOR petrolatum,white REMOVE FROM Non-Formulary FORMULARY 02/13/2021 HYDROPHOR petrolatum,white REMOVE FROM Non-Formulary FORMULARY 02/13/2021 tavaborole tavaborole REMOVE FROM Non-Formulary FORMULARY 02/13/2021 tavaborole tavaborole REMOVE FROM Non-Formulary FORMULARY 02/13/2021 tavaborole tavaborole REMOVE FROM Non-Formulary FORMULARY 02/13/2021 EVEKEO sulfate REMOVE FROM Non-Formulary FORMULARY 02/13/2021 EVEKEO amphetamine sulfate REMOVE FROM Non-Formulary FORMULARY 02/13/2021 cefazolin sodium- cefazolin sodium in 0.9 % REMOVE FROM Non-Formulary 0.9% nacl sodium chloride FORMULARY 02/13/2021 SYNDROS dronabinol REMOVE FROM Non-Formulary FORMULARY 02/13/2021 multivitamin with pediatric multivitamin no.82 REMOVE FROM Non-Formulary fluoride with sodium fluoride FORMULARY 02/13/2021 incontrol blood blood pressure test kit-large REMOVE FROM Non-Formulary pressure mntr FORMULARY 02/13/2021 incontrol blood blood pressure test kit-large REMOVE FROM Non-Formulary pressure mntr FORMULARY 02/13/2021 incontrol blood blood pressure test kit-large REMOVE FROM Non-Formulary pressure mntr FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 51 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/13/2021 incontrol blood blood pressure test kit-wrist REMOVE FROM Non-Formulary pressure mntr FORMULARY 02/13/2021 incontrol blood blood pressure test kit-wrist REMOVE FROM Non-Formulary pressure mntr FORMULARY 02/13/2021 mycophenolate mycophenolate mofetil REMOVE FROM Non-Formulary mofetil FORMULARY 02/13/2021 calcium citrate- calcium REMOVE FROM Non-Formulary vitamin d3 citrate/cholecalciferol FORMULARY (vitamin d3) 02/13/2021 dermacinrx lactobacillus REMOVE FROM Non-Formulary promerol acidophilus/bifidobacterium FORMULARY animalis 02/13/2021 dermacinrx lactobacillus REMOVE FROM Non-Formulary probitrol acidophilus/bifidobacterium FORMULARY animalis 02/13/2021 niavasc REMOVE FROM Non-Formulary FORMULARY 02/13/2021 GLYRX-PF glycopyrrolate/pf REMOVE FROM Non-Formulary FORMULARY 02/13/2021 hydromorphone hydromorphone hcl in 0.9 % REMOVE FROM Non-Formulary hcl-0.9% nacl sodium chloride/pf FORMULARY 02/13/2021 hydromorphone hydromorphone hcl in 0.9 % REMOVE FROM Non-Formulary hcl-0.9% nacl sodium chloride/pf FORMULARY 02/13/2021 vasopressin- vasopressin in 0.9 % sodium REMOVE FROM Non-Formulary 0.9% nacl chloride FORMULARY 02/13/2021 vitamin d3 cholecalciferol (vitamin d3) ADD TO FORMULARY Covered 02/19/2021 CLOFENAX diclofenac REMOVE FROM Non-Formulary sodium/kinesiology tape FORMULARY 02/19/2021 DERMACINRX prenatal vitamins REMOVE FROM Non-Formulary PRENATRYL no.170/ferrous fumarate/folic FORMULARY acid

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 52 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/19/2021 fentanyl citrate- fentanyl citrate in 0.9 % REMOVE FROM Non-Formulary 0.9% nacl sodium chloride/pf FORMULARY 02/19/2021 CYCLOPHOSPH cyclophosphamide REMOVE FROM Non-Formulary AMIDE FORMULARY 02/19/2021 b and c balsam peru/castor oil REMOVE FROM Non-Formulary FORMULARY 02/19/2021 dermelle dimethicone REMOVE FROM Non-Formulary FORMULARY 02/19/2021 sodium sodium bicarbonate REMOVE FROM Non-Formulary bicarbonate FORMULARY 02/19/2021 vitamin b-12 cyanocobalamin (vitamin b- REMOVE FROM Non-Formulary 12) FORMULARY 02/19/2021 l-citrulline citrulline REMOVE FROM Non-Formulary FORMULARY 02/19/2021 oralyte electrolytes/dextrose REMOVE FROM Non-Formulary FORMULARY 02/19/2021 oralyte electrolytes/dextrose REMOVE FROM Non-Formulary FORMULARY 02/19/2021 alcohol prep pads alcohol antiseptic pads REMOVE FROM Non-Formulary FORMULARY 02/19/2021 leuprolide acetate leuprolide acetate REMOVE FROM Non-Formulary FORMULARY 02/19/2021 sorbitol sorbitol solution ADD TO FORMULARY Covered 02/19/2021 hcl papaverine hcl REMOVE FROM Non-Formulary FORMULARY 02/19/2021 papaverine hcl papaverine hcl REMOVE FROM Non-Formulary FORMULARY 02/19/2021 meclizine hcl meclizine hcl ADD TO FORMULARY Covered 02/19/2021 oxytocin oxytocin REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 53 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/19/2021 oxytocin oxytocin REMOVE FROM Non-Formulary FORMULARY 02/19/2021 lansoprazole lansoprazole REMOVE FROM Non-Formulary FORMULARY 02/19/2021 lansoprazole lansoprazole REMOVE FROM Non-Formulary FORMULARY 02/19/2021 acidophilus- lactobacillus REMOVE FROM Non-Formulary pectin acidophilus/pectin, citrus FORMULARY 02/19/2021 allergy plus-sinus diphenhydramine REMOVE FROM Non-Formulary headache hcl/phenylephrine FORMULARY hcl/acetaminophen 02/19/2021 lubricant eye carboxymethylcellulose REMOVE FROM Non-Formulary drops sodium FORMULARY 02/19/2021 stool softener- sennosides/docusate REMOVE FROM Non-Formulary stimulant lax sodium FORMULARY 02/19/2021 magnesium magnesium sulfate/dextrose REMOVE FROM Non-Formulary sulfate-d5w 5 % in water FORMULARY 02/19/2021 magnesium magnesium sulfate in sterile REMOVE FROM Non-Formulary sulfate water FORMULARY 02/19/2021 magnesium magnesium sulfate in sterile REMOVE FROM Non-Formulary sulfate water FORMULARY 02/19/2021 magnesium magnesium sulfate in sterile REMOVE FROM Non-Formulary sulfate water FORMULARY 02/19/2021 irinotecan hcl irinotecan hcl REMOVE FROM Non-Formulary FORMULARY 02/19/2021 irinotecan hcl irinotecan hcl REMOVE FROM Non-Formulary FORMULARY 02/19/2021 vitamin a and d vitamins a and d/white REMOVE FROM Non-Formulary petrolatum/lanolin FORMULARY 02/19/2021 tacrolimus tacrolimus REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 54 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/19/2021 chorionic chorionic gonadotropin, REMOVE FROM Non-Formulary gonadotropin human FORMULARY 02/19/2021 GRALISE gabapentin REMOVE FROM Non-Formulary FORMULARY 02/19/2021 GRALISE gabapentin REMOVE FROM Non-Formulary FORMULARY 02/19/2021 antacid-antigas magnesium REMOVE FROM Non-Formulary hydroxide/aluminum FORMULARY hydroxide/simethicone 02/19/2021 BOOST VHC nutritional therapy, lactose- REMOVE FROM Non-Formulary reduced, with iron FORMULARY 02/19/2021 double bacitracin zinc/polymyxin b REMOVE FROM Non-Formulary sulfate FORMULARY 02/19/2021 calcipotriene calcipotriene REMOVE FROM Non-Formulary FORMULARY 02/19/2021 testosterone testosterone REMOVE FROM Non-Formulary FORMULARY 02/19/2021 testosterone testosterone REMOVE FROM Non-Formulary FORMULARY 02/19/2021 vapro plus urinary bag/catheter REMOVE FROM Non-Formulary intermitt catheter FORMULARY 02/19/2021 GAMIFANT emapalumab-lzsg REMOVE FROM Non-Formulary FORMULARY 02/19/2021 high potency multivits with calcium and REMOVE FROM Non-Formulary multivitamin minerals/iron fumarate/folic FORMULARY acid 02/19/2021 AIRBORNE ascorbic acid/vitamin REMOVE FROM Non-Formulary ELDERBERRY d3/vitamin e/zinc FORMULARY GUMMY gluconate/elderberry

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 55 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/19/2021 DIGESTIVE bacillus coagulans/lactase REMOVE FROM Non-Formulary ADVANTAGE FORMULARY LACTOS SUP 02/19/2021 DELSYM triprolidine REMOVE FROM Non-Formulary NIGHTTIME hcl/dextromethorphan FORMULARY COUGH hbr/acetaminophen 02/19/2021 K1-1000 phytonadione (vit k1) REMOVE FROM Non-Formulary FORMULARY 02/19/2021 headache relief aspirin/acetaminophen/caffei REMOVE FROM Non-Formulary ne FORMULARY 02/19/2021 lidocaine-menthol lidocaine/menthol REMOVE FROM Non-Formulary FORMULARY 02/19/2021 antibacterial- methenamine/sodium REMOVE FROM Non-Formulary urinary pain rlf salicylate FORMULARY 02/19/2021 KERALYT salicylic acid REMOVE FROM Non-Formulary SCALP FORMULARY 02/19/2021 testosterone testosterone REMOVE FROM Non-Formulary FORMULARY 02/19/2021 testosterone testosterone REMOVE FROM Non-Formulary FORMULARY 02/19/2021 fentanyl citrate fentanyl citrate/pf REMOVE FROM Non-Formulary FORMULARY 02/19/2021 arsenic trioxide arsenic trioxide REMOVE FROM Non-Formulary FORMULARY 02/19/2021 loteprednol loteprednol etabonate ADD TO FORMULARY Covered etabonate 02/24/2021 sotret isotretinoin ADD TO FORMULARY Covered 02/24/2021 sotret isotretinoin ADD TO FORMULARY Covered 02/24/2021 sotret isotretinoin ADD TO FORMULARY Covered 02/24/2021 sotret isotretinoin ADD TO FORMULARY Non-Formulary Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 56 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/24/2021 zomig,zolmitripta zolmitriptan CHANGE UM: QUANTITY 6 / 30 days n 02/24/2021 ICLUSIG ponatinib hcl ADD UM: LIMITEDACCESS Limited Access 02/26/2021 glucagon glucagon ADD TO FORMULARY Non-Formulary Covered emergency kit 02/26/2021 AQUASOL A vitamin a palmitate REMOVE FROM Non-Formulary FORMULARY 02/26/2021 pnv tabs 20-1 prenatal vitamins REMOVE FROM Non-Formulary no.163/iron bis- FORMULARY glycinate/folate no.10 02/26/2021 vc- promethazine/phenylephrine ADD TO FORMULARY Covered hcl/codeine 02/26/2021 promethazine vc phenylephrine ADD TO FORMULARY Covered hcl/promethazine hcl 02/26/2021 morphine sulfate- morphine sulfate in 0.9 % REMOVE FROM Non-Formulary nacl sodium chloride/pf FORMULARY 02/26/2021 derpixa dimethicone REMOVE FROM Non-Formulary FORMULARY 02/26/2021 fexofenadine hcl fexofenadine hcl REMOVE FROM Non-Formulary FORMULARY 02/26/2021 stool softener docusate sodium REMOVE FROM Non-Formulary FORMULARY 02/26/2021 stool softener docusate sodium REMOVE FROM Non-Formulary FORMULARY 02/26/2021 sodium sulfacetamide sodium/sulfur REMOVE FROM Non-Formulary sulfacetamide- FORMULARY sulfur 02/26/2021 sodium sulfacetamide sodium/sulfur REMOVE FROM Non-Formulary sulfacetamide- FORMULARY sulfur

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 57 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/26/2021 adenosine adenosine REMOVE FROM Non-Formulary FORMULARY 02/26/2021 adenosine adenosine REMOVE FROM Non-Formulary FORMULARY 02/26/2021 fexofenadine hcl fexofenadine hcl REMOVE FROM Non-Formulary FORMULARY 02/26/2021 fexofenadine hcl fexofenadine hcl REMOVE FROM Non-Formulary FORMULARY 02/26/2021 senna sennosides REMOVE FROM Non-Formulary FORMULARY 02/26/2021 stool softener docusate calcium REMOVE FROM Non-Formulary FORMULARY 02/26/2021 atropine sulfate atropine sulfate REMOVE FROM Non-Formulary FORMULARY 02/26/2021 aspirin aspirin ADD TO FORMULARY Covered 02/26/2021 phenylephrine hcl phenylephrine hcl REMOVE FROM Non-Formulary FORMULARY 02/26/2021 stomach relief bismuth subsalicylate REMOVE FROM Non-Formulary FORMULARY 02/26/2021 gas relief simethicone REMOVE FROM Non-Formulary FORMULARY 02/26/2021 ibuprofen ib ibuprofen REMOVE FROM Non-Formulary FORMULARY 02/26/2021 clofarabine clofarabine REMOVE FROM Non-Formulary FORMULARY 02/26/2021 lutein lutein REMOVE FROM Non-Formulary FORMULARY 02/26/2021 PEPCID AC famotidine REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 58 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/26/2021 all day allergy cetirizine hcl REMOVE FROM Non-Formulary FORMULARY 02/26/2021 all day allergy cetirizine hcl REMOVE FROM Non-Formulary FORMULARY 02/26/2021 allergy relief cetirizine hcl REMOVE FROM Non-Formulary FORMULARY 02/26/2021 milrinone in 5% milrinone lactate/dextrose 5 REMOVE FROM Non-Formulary dextrose % in water FORMULARY 02/26/2021 milrinone in 5% milrinone lactate/dextrose 5 REMOVE FROM Non-Formulary dextrose % in water FORMULARY 02/26/2021 bpo benzoyl peroxide REMOVE FROM Non-Formulary FORMULARY 02/26/2021 allergy relief fexofenadine hcl REMOVE FROM Non-Formulary FORMULARY 02/26/2021 allergy relief fexofenadine hcl REMOVE FROM Non-Formulary FORMULARY 02/26/2021 allergy relief fexofenadine hcl REMOVE FROM Non-Formulary FORMULARY 02/26/2021 allergy relief fexofenadine hcl REMOVE FROM Non-Formulary FORMULARY 02/26/2021 epinephrine epinephrine REMOVE FROM Non-Formulary convenience kit FORMULARY 02/26/2021 sodium sulfacetamide sodium/sulfur REMOVE FROM Non-Formulary sulfacetamide- FORMULARY sulfur 02/26/2021 azelastine- azelastine hcl/fluticasone REMOVE FROM Non-Formulary fluticasone propionate FORMULARY 02/26/2021 one daily multivitamin with folic acid REMOVE FROM Non-Formulary multivitamin FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 59 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/26/2021 sodium sulfacetamide sodium/sulfur REMOVE FROM Non-Formulary sulfacetamide- FORMULARY sulfur 02/26/2021 ranger ready icaridin REMOVE FROM Non-Formulary repellent FORMULARY 02/26/2021 ranger ready icaridin REMOVE FROM Non-Formulary repellent FORMULARY 02/26/2021 MOVE FREE calcium fructoborate REMOVE FROM Non-Formulary ULTRA FASTER FORMULARY COMFORT 02/26/2021 PROVIMIN nutritional supplement REMOVE FROM Non-Formulary FORMULARY 02/26/2021 OMEGA-3 2100 omega-3 fatty REMOVE FROM Non-Formulary acids/dha/epa/dpa/fish oil FORMULARY 02/26/2021 OMEGA-3 2100 omega-3 fatty REMOVE FROM Non-Formulary acids/dha/epa/dpa/fish oil FORMULARY 02/26/2021 skarlite gel-matrix pad dressing, REMOVE FROM Non-Formulary silicone FORMULARY 02/26/2021 ulticare low dead syringe with REMOVE FROM Non-Formulary space syring needle,disposable, 3 ml FORMULARY 02/26/2021 bisoprolol bisoprolol fumarate REMOVE FROM Non-Formulary fumarate FORMULARY 02/26/2021 bisoprolol bisoprolol fumarate REMOVE FROM Non-Formulary fumarate FORMULARY 02/26/2021 bisoprolol bisoprolol fumarate REMOVE FROM Non-Formulary fumarate FORMULARY 02/26/2021 bisoprolol bisoprolol fumarate REMOVE FROM Non-Formulary fumarate FORMULARY 02/26/2021 bisoprolol bisoprolol fumarate REMOVE FROM Non-Formulary fumarate FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 60 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/26/2021 URINOZINC multivitamin-mineral/herbal REMOVE FROM Non-Formulary PROSTATE complex no.208/beta- FORMULARY FORMULA PLS sitosterol 02/26/2021 PRIMATENE ephedrine hcl REMOVE FROM Non-Formulary FORMULARY 02/26/2021 PRIMATENE ephedrine hcl REMOVE FROM Non-Formulary FORMULARY 02/26/2021 CAPASIL methyl salicylate/menthol REMOVE FROM Non-Formulary FORMULARY 02/26/2021 BOOST lactose-reduced food REMOVE FROM Non-Formulary MOBILITY FORMULARY 02/26/2021 GENTEAL propylene REMOVE FROM Non-Formulary TEARS SEVERE glycol/polyethylene glycol FORMULARY 400 02/26/2021 LIDAFLEX lidocaine hcl REMOVE FROM Non-Formulary FORMULARY 02/26/2021 melatonin melatonin REMOVE FROM Non-Formulary FORMULARY 02/26/2021 glucosamine- glucosamine/msm/chondroiti REMOVE FROM Non-Formulary chondroitin adv n sa na/herbal FORMULARY 149/hyaluronic acid 02/26/2021 nutrisure plus lactose-reduced food REMOVE FROM Non-Formulary FORMULARY 02/26/2021 nutrisure plus lactose-reduced food REMOVE FROM Non-Formulary FORMULARY 02/26/2021 nutrisure original lactose-reduced food REMOVE FROM Non-Formulary FORMULARY 02/26/2021 nutrisure original lactose-reduced food REMOVE FROM Non-Formulary FORMULARY 02/26/2021 pediatric tri-vite vitamin a palmitate/ascorbic REMOVE FROM Non-Formulary acid/cholecalciferol (vit d3) FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 61 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/26/2021 soothing saline- sodium chloride/aloe vera REMOVE FROM Non-Formulary aloe FORMULARY 02/26/2021 medicated relief methyl REMOVE FROM Non-Formulary salicylate/menthol/camphor FORMULARY 02/26/2021 aquaphor itch hydrocortisone REMOVE FROM Non-Formulary relief FORMULARY 02/26/2021 hydromorphone hydromorphone hcl in REMOVE FROM Non-Formulary hcl-nacl sodium chloride, iso- FORMULARY osmotic/pf 02/26/2021 loteprednol loteprednol etabonate ADD TO FORMULARY Covered etabonate 02/26/2021 droxidopa droxidopa REMOVE FROM Non-Formulary FORMULARY 02/26/2021 droxidopa droxidopa REMOVE FROM Non-Formulary FORMULARY 02/26/2021 droxidopa droxidopa REMOVE FROM Non-Formulary FORMULARY 02/26/2021 droxidopa droxidopa REMOVE FROM Non-Formulary FORMULARY 02/26/2021 droxidopa droxidopa REMOVE FROM Non-Formulary FORMULARY 02/26/2021 droxidopa droxidopa REMOVE FROM Non-Formulary FORMULARY 02/26/2021 droxidopa droxidopa REMOVE FROM Non-Formulary FORMULARY 02/26/2021 droxidopa droxidopa REMOVE FROM Non-Formulary FORMULARY 02/26/2021 droxidopa droxidopa REMOVE FROM Non-Formulary FORMULARY 02/26/2021 droxidopa droxidopa REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 62 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/26/2021 droxidopa droxidopa REMOVE FROM Non-Formulary FORMULARY 02/26/2021 droxidopa droxidopa REMOVE FROM Non-Formulary FORMULARY 02/26/2021 droxidopa droxidopa REMOVE FROM Non-Formulary FORMULARY 02/26/2021 droxidopa droxidopa REMOVE FROM Non-Formulary FORMULARY 02/26/2021 droxidopa droxidopa REMOVE FROM Non-Formulary FORMULARY 02/26/2021 droxidopa droxidopa REMOVE FROM Non-Formulary FORMULARY 02/26/2021 droxidopa droxidopa REMOVE FROM Non-Formulary FORMULARY 02/26/2021 droxidopa droxidopa REMOVE FROM Non-Formulary FORMULARY 02/26/2021 droxidopa droxidopa REMOVE FROM Non-Formulary FORMULARY 02/26/2021 droxidopa droxidopa REMOVE FROM Non-Formulary FORMULARY 02/26/2021 droxidopa droxidopa REMOVE FROM Non-Formulary FORMULARY 02/26/2021 droxidopa droxidopa REMOVE FROM Non-Formulary FORMULARY 02/26/2021 droxidopa droxidopa REMOVE FROM Non-Formulary FORMULARY 02/26/2021 droxidopa droxidopa REMOVE FROM Non-Formulary FORMULARY 02/26/2021 droxidopa droxidopa REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 63 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 02/26/2021 GAMIFANT emapalumab-lzsg REMOVE FROM Non-Formulary FORMULARY 02/26/2021 OZEMPIC semaglutide ADD TO FORMULARY Covered 02/26/2021 TRIAMAZOLE econazole REMOVE FROM Non-Formulary nitrate/triamcinolone FORMULARY acetonide

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 64 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

March, 2021

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 03/01/2021 zolmitriptan zolmitriptan ADD TO FORMULARY Covered 03/01/2021 zomig,zolmitripta zolmitriptan CHANGE UM: QUANTITY 6 / 30 days n 03/01/2021 multivitamin with pediatric multivitamins no.17 CHANGE TIER Covered fluoride,multivita with sodium mins with fluoride,pediatric fluoride,multi multivitamin no.16/sodium vitamins with fluoride,pediatric fluoride,multivita multivitamins combination mins w/fluoride no.12/sodium fluoride,multivitamins with fluoride 03/02/2021 morphine sulfate- morphine sulfate in 0.9 % ADD UM: Total cumulative 0.9% sodium chloride/pf QUANTITYCUSTOM opioid dose nacl,morphine limited to 90 sulfate-nacl morphine milligram equivalent (MME) per day 03/03/2021 hydromorphone hydromorphone hcl in ADD UM: Total cumulative hcl-nacl sodium chloride, iso- QUANTITYCUSTOM opioid dose osmotic/pf limited to 90 morphine milligram equivalent (MME) per day 03/05/2021 zomig,zolmitripta zolmitriptan ADD UM: QUANTITY 12 / 30 days n 03/05/2021 solifenacin solifenacin succinate CHANGE TIER Covered succinate

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 65 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 03/05/2021 HUMIRA(CF) adalimumab ADD TO FORMULARY Covered PEN PEDIATRIC UC 03/05/2021 TRAZIMERA trastuzumab-qyyp REMOVE FROM Non-Formulary FORMULARY 03/05/2021 hydrocodone hydrocodone bitartrate REMOVE FROM Non-Formulary bitartrate er FORMULARY 03/05/2021 hydrocodone hydrocodone bitartrate REMOVE FROM Non-Formulary bitartrate er FORMULARY 03/05/2021 hydrocodone hydrocodone bitartrate REMOVE FROM Non-Formulary bitartrate er FORMULARY 03/05/2021 hydrocodone hydrocodone bitartrate REMOVE FROM Non-Formulary bitartrate er FORMULARY 03/05/2021 hydrocodone hydrocodone bitartrate REMOVE FROM Non-Formulary bitartrate er FORMULARY 03/05/2021 hydrocodone hydrocodone bitartrate REMOVE FROM Non-Formulary bitartrate er FORMULARY 03/05/2021 XTANDI enzalutamide ADD TO FORMULARY Covered 03/05/2021 XTANDI enzalutamide ADD TO FORMULARY Covered 03/05/2021 HETLIOZ LQ REMOVE FROM Non-Formulary FORMULARY 03/05/2021 HETLIOZ LQ tasimelteon REMOVE FROM Non-Formulary FORMULARY 03/08/2021 ORLADEYO berotralstat hydrochloride ADD UM: QUANTITY 1 / 1 days 03/08/2021 ORLADEYO berotralstat hydrochloride ADD TO FORMULARY Covered 03/08/2021 ORLADEYO berotralstat hydrochloride REMOVE UM: SPECIALTY Specialty Drug 03/08/2021 ORLADEYO berotralstat hydrochloride ADD TO FORMULARY Covered 03/08/2021 ORLADEYO berotralstat hydrochloride REMOVE UM: SPECIALTY Specialty Drug 03/08/2021 ORLADEYO berotralstat hydrochloride ADD UM: QUANTITY 1 / 1 days

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 66 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 03/12/2021 CINRYZE c1 esterase inhibitor REMOVE FROM Non-Formulary FORMULARY 03/12/2021 cetirizine- cetirizine REMOVE FROM Non-Formulary pseudoephedrine hcl/pseudoephedrine hcl FORMULARY er 03/12/2021 cetirizine- cetirizine REMOVE FROM Non-Formulary pseudoephedrine hcl/pseudoephedrine hcl FORMULARY er 03/12/2021 ivermectin ivermectin REMOVE FROM Non-Formulary FORMULARY 03/12/2021 - ,esterified/methylt REMOVE FROM Non-Formulary methyltestosteron estosterone FORMULARY e 03/12/2021 allergy relief chlorpheniramine maleate REMOVE FROM Non-Formulary FORMULARY 03/12/2021 diapers diaper/brief,infant-toddler, REMOVE FROM Non-Formulary disposable FORMULARY 03/12/2021 vancomycin hcl vancomycin hcl REMOVE FROM Non-Formulary FORMULARY 03/12/2021 methylprednisolo methylprednisolone acetate REMOVE FROM Non-Formulary ne acetate FORMULARY 03/12/2021 methylprednisolo methylprednisolone acetate REMOVE FROM Non-Formulary ne acetate FORMULARY 03/12/2021 methylprednisolo methylprednisolone acetate REMOVE FROM Non-Formulary ne acetate FORMULARY 03/12/2021 diapers diaper/brief,infant-toddler, REMOVE FROM Non-Formulary disposable FORMULARY 03/12/2021 diapers diaper/brief,infant-toddler, REMOVE FROM Non-Formulary disposable FORMULARY 03/12/2021 methylprednisolo methylprednisolone acetate REMOVE FROM Non-Formulary ne acetate FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 67 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 03/12/2021 methylprednisolo methylprednisolone acetate REMOVE FROM Non-Formulary ne acetate FORMULARY 03/12/2021 methylprednisolo methylprednisolone acetate REMOVE FROM Non-Formulary ne acetate FORMULARY 03/12/2021 methylprednisolo methylprednisolone acetate REMOVE FROM Non-Formulary ne acetate FORMULARY 03/12/2021 ferrous sulfate ferrous sulfate REMOVE FROM Non-Formulary FORMULARY 03/12/2021 ALA-SCALP hydrocortisone REMOVE FROM Non-Formulary FORMULARY 03/12/2021 naproxen sodium naproxen sodium REMOVE FROM Non-Formulary FORMULARY 03/12/2021 estrogen- estrogens,esterified/methylt REMOVE FROM Non-Formulary methyltestosteron estosterone FORMULARY e 03/12/2021 sodium chloride 0.9 % sodium chloride REMOVE FROM Non-Formulary FORMULARY 03/12/2021 sodium chloride 0.9 % sodium chloride REMOVE FROM Non-Formulary FORMULARY 03/12/2021 sodium chloride 0.9 % sodium chloride REMOVE FROM Non-Formulary FORMULARY 03/12/2021 sodium chloride 0.9 % sodium chloride REMOVE FROM Non-Formulary FORMULARY 03/12/2021 sodium chloride 0.9 % sodium chloride REMOVE FROM Non-Formulary FORMULARY 03/12/2021 sodium chloride 0.9 % sodium chloride REMOVE FROM Non-Formulary FORMULARY 03/12/2021 sodium chloride 0.9 % sodium chloride REMOVE FROM Non-Formulary FORMULARY 03/12/2021 sodium chloride 0.9 % sodium chloride REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 68 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 03/12/2021 sodium chloride 0.9 % sodium chloride REMOVE FROM Non-Formulary FORMULARY 03/12/2021 sodium chloride 0.9 % sodium chloride REMOVE FROM Non-Formulary FORMULARY 03/12/2021 diapers diaper/brief,infant-toddler, REMOVE FROM Non-Formulary disposable FORMULARY 03/12/2021 diapers diaper/brief,infant-toddler, REMOVE FROM Non-Formulary disposable FORMULARY 03/12/2021 diapers diaper/brief,infant-toddler, REMOVE FROM Non-Formulary disposable FORMULARY 03/12/2021 nac REMOVE FROM Non-Formulary FORMULARY 03/12/2021 anticoagulant sodium citrate REMOVE FROM Non-Formulary sodium citrate FORMULARY 03/12/2021 TWOCAL HN nut.supplement,special REMOVE FROM Non-Formulary formula,lactose-free with FORMULARY iron/fos 03/12/2021 TWOCAL HN nut.supplement,special REMOVE FROM Non-Formulary formula,lactose-free with FORMULARY iron/fos 03/12/2021 wild cherry flavor wild cherry flavor REMOVE FROM Non-Formulary FORMULARY 03/12/2021 advanced healing petrolatum,white REMOVE FROM Non-Formulary FORMULARY 03/12/2021 advanced healing petrolatum,white REMOVE FROM Non-Formulary FORMULARY 03/12/2021 ZENZEDI dextroamphetamine sulfate REMOVE FROM Non-Formulary FORMULARY 03/12/2021 ZENZEDI dextroamphetamine sulfate REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 69 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 03/12/2021 iodoquinol- hydrocortisone REMOVE FROM Non-Formulary hydrocortisone- acetate/iodoquinol/aloe FORMULARY aloe polysaccharides no.2 03/12/2021 ZENZEDI dextroamphetamine sulfate REMOVE FROM Non-Formulary FORMULARY 03/12/2021 ZENZEDI dextroamphetamine sulfate REMOVE FROM Non-Formulary FORMULARY 03/12/2021 ZENZEDI dextroamphetamine sulfate REMOVE FROM Non-Formulary FORMULARY 03/12/2021 geri-dryl diphenhydramine hcl REMOVE FROM Non-Formulary FORMULARY 03/12/2021 MUCINEX FAST- diphenhydramine/phenyleph REMOVE FROM Non-Formulary MAX DAY-NITE rin/dextromethorph/acetamin FORMULARY COLD ophen/gg 03/12/2021 MUCINEX FAST- diphenhydramine/phenyleph REMOVE FROM Non-Formulary MAX DAY-NITE rin/dextromethorph/acetamin FORMULARY COLD ophen/gg 03/12/2021 estroven cmplt rhubarb root extract REMOVE FROM Non-Formulary menopause rlf FORMULARY 03/12/2021 pure comfort lancets REMOVE FROM Non-Formulary lancets FORMULARY 03/12/2021 CERAVE petrolatum,white REMOVE FROM Non-Formulary HEALING FORMULARY 03/12/2021 CERAVE petrolatum,white REMOVE FROM Non-Formulary HEALING FORMULARY 03/12/2021 rightest gs700 blood sugar diagnostic REMOVE FROM Non-Formulary test strip FORMULARY 03/12/2021 SYSTANE propylene REMOVE FROM Non-Formulary HYDRATION PF glycol/polyethylene glycol FORMULARY 400/pf

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 70 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 03/12/2021 blood pressure blood pressure test kit REMOVE FROM Non-Formulary monitor manual FORMULARY 03/12/2021 series 800 bp blood pressure test kit-large REMOVE FROM Non-Formulary monitor FORMULARY 03/12/2021 series 600w bp blood pressure test kit-wrist REMOVE FROM Non-Formulary monitor FORMULARY 03/12/2021 marshmallow marshmallow flavor REMOVE FROM Non-Formulary flavor FORMULARY 03/12/2021 marshmallow marshmallow flavor REMOVE FROM Non-Formulary flavor FORMULARY 03/12/2021 peanut butter peanut butter flavor REMOVE FROM Non-Formulary flavor FORMULARY 03/12/2021 ultiguard syringe-needle,insulin,0.5 REMOVE FROM Non-Formulary safepack-insulin ml/container,empty FORMULARY syr 03/12/2021 biotel care bgm-4 blood-glucose meter REMOVE FROM Non-Formulary FORMULARY 03/12/2021 rightest gc700 lev blood glucose calibration REMOVE FROM Non-Formulary 2 ctrl soln control solution, normal FORMULARY 03/12/2021 pip pen needle pen needle, diabetic REMOVE FROM Non-Formulary FORMULARY 03/12/2021 pip pen needle pen needle, diabetic REMOVE FROM Non-Formulary FORMULARY 03/12/2021 surelife thintemp thermometer, infrared, non- REMOVE FROM Non-Formulary thermometer contact FORMULARY 03/12/2021 easy touch thermometer, infrared, non- REMOVE FROM Non-Formulary infrared thermom contact FORMULARY 03/12/2021 fora tn'g advan blood sugar diagnostic REMOVE FROM Non-Formulary pro test strip FORMULARY 03/12/2021 fora tn'g advan blood sugar diagnostic REMOVE FROM Non-Formulary pro test strip FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 71 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 03/12/2021 ge333 blood blood sugar diagnostic REMOVE FROM Non-Formulary glucose test strip FORMULARY 03/12/2021 ge333 blood blood sugar diagnostic REMOVE FROM Non-Formulary glucose test strip FORMULARY 03/12/2021 ge333 blood blood-glucose meter REMOVE FROM Non-Formulary glucose system FORMULARY 03/12/2021 ge333 control blood glucose calibration REMOVE FROM Non-Formulary solution normal control solution, normal FORMULARY 03/12/2021 droplet genteel lancing device REMOVE FROM Non-Formulary lancing device FORMULARY 03/12/2021 lidocaine lidocaine REMOVE FROM Non-Formulary FORMULARY 03/12/2021 allergy- fexofenadine REMOVE FROM Non-Formulary congestion er hcl/pseudoephedrine hcl FORMULARY 03/12/2021 OMEGAPURE omega-3 fatty REMOVE FROM Non-Formulary 900 EC acids/docosahexaenoic FORMULARY acid/epa/fish oil 03/12/2021 DEKAS PLUS multivit with minerals REMOVE FROM Non-Formulary no.53/folic acid/vit FORMULARY k1/ubidecarenone 03/12/2021 1.0 nutritional supplement/fiber REMOVE FROM Non-Formulary FORMULARY 03/12/2021 PEPTIDE 1.0 nutritional supplement/fiber REMOVE FROM Non-Formulary FORMULARY 03/12/2021 CHILD honey/marshmallow root REMOVE FROM Non-Formulary SOOTHING extract FORMULARY THROAT 03/12/2021 PEDIATRIC pediatric multivitamin REMOVE FROM Non-Formulary POLY-VITE no.197/ferrous sulfate FORMULARY WITH IRON

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 72 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 03/12/2021 OSTEOBLOX CF cholecalciferol (vit REMOVE FROM Non-Formulary d3)/vitamin k2/olive leaf FORMULARY extract 03/12/2021 PEDIATRIC pediatric multivitamin no.197 REMOVE FROM Non-Formulary POLY-VITE FORMULARY 03/12/2021 CHILDREN'S honey/english ivy REMOVE FROM Non-Formulary COUGH-MUCUS extract/grapefruit seed FORMULARY extract/vit c/zinc 03/12/2021 CHILDREN'S honey/english ivy REMOVE FROM Non-Formulary COUGH-MUCUS extract/grapefruit seed FORMULARY extract/vit c/zinc 03/12/2021 OMEGA omega-3 fatty REMOVE FROM Non-Formulary MONOPURE acids/docosahexaenoic FORMULARY DHA EC acid/epa/fish oil 03/12/2021 CHILDREN'S honey/grapefruit seed REMOVE FROM Non-Formulary COUGH extract/vitamin c/zinc FORMULARY gluconate 03/12/2021 CHILDREN'S honey/grapefruit seed REMOVE FROM Non-Formulary COUGH extract/vitamin c/zinc FORMULARY gluconate 03/12/2021 CHILD honey/grapefruit seed REMOVE FROM Non-Formulary COMPLETE xt/elderberry flower xt/vit FORMULARY COUGH- c/d3/zinc IMMUNE 03/12/2021 MUCINEX guaifenesin/dextromethorph REMOVE FROM Non-Formulary FREEFROM SEV an hbr/phenylephrine FORMULARY CONG-COUG 03/12/2021 glucosamine- glucosamine/msm/chondro REMOVE FROM Non-Formulary chondroitin-vit d3 su a/vitamin d3/boswellia FORMULARY serrata 03/12/2021 niavasc niacin REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 73 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 03/12/2021 dermacinrx lactobacillus REMOVE FROM Non-Formulary lacterol acidophilus/bifidobacterium FORMULARY animalis 03/12/2021 pepcix polaprezinc (zinc carnosine) REMOVE FROM Non-Formulary FORMULARY 03/12/2021 children's sleep melatonin REMOVE FROM Non-Formulary FORMULARY 03/12/2021 sodium chloride sodium chloride 0.45 % REMOVE FROM Non-Formulary FORMULARY 03/12/2021 milrinone lactate milrinone lactate REMOVE FROM Non-Formulary FORMULARY 03/12/2021 heparin sodium- heparin sodium,porcine in REMOVE FROM Non-Formulary 0.9% nacl 0.9 % sodium chloride/pf FORMULARY 03/12/2021 CARDENE I.V. nicardipine in sodium REMOVE FROM Non-Formulary chloride, iso-osmotic FORMULARY 03/12/2021 series 200 bp blood pressure test kit-large REMOVE FROM Non-Formulary monitor FORMULARY 03/12/2021 series 200w bp blood pressure test kit-wrist REMOVE FROM Non-Formulary monitor FORMULARY 03/12/2021 ALBUTEIN albumin human REMOVE FROM Non-Formulary FORMULARY 03/12/2021 ALBUTEIN albumin human REMOVE FROM Non-Formulary FORMULARY 03/12/2021 zafemy norelgestromin/ethinyl ADD TO FORMULARY Covered estradiol 03/12/2021 brinzolamide brinzolamide ADD TO FORMULARY Covered 03/12/2021 brinzolamide brinzolamide ADD TO FORMULARY Covered 03/12/2021 brinzolamide brinzolamide ADD TO FORMULARY Covered 03/12/2021 brinzolamide brinzolamide ADD TO FORMULARY Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 74 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 03/17/2021 XELJANZ tofacitinib citrate ADD TO FORMULARY Covered 03/17/2021 XELJANZ tofacitinib citrate ADD UM: QUANTITY 10 / 1 days 03/17/2021 loteprednol loteprednol etabonate ADD TO FORMULARY Covered etabonate 03/19/2021 magnesium magnesium sulfate REMOVE FROM Non-Formulary sulfate FORMULARY 03/19/2021 miconazole 7 miconazole nitrate REMOVE FROM Non-Formulary FORMULARY 03/19/2021 zinc oxide zinc oxide REMOVE FROM Non-Formulary FORMULARY 03/19/2021 zinc zinc sulfate REMOVE FROM Non-Formulary FORMULARY 03/19/2021 morphine sulfate morphine sulfate REMOVE FROM Non-Formulary FORMULARY 03/19/2021 pain relief pm acetaminophen/diphenhydra REMOVE FROM Non-Formulary mine hcl FORMULARY 03/19/2021 diapers diaper/brief,infant-toddler, REMOVE FROM Non-Formulary disposable FORMULARY 03/19/2021 thymol iodide thymol iodide REMOVE FROM Non-Formulary FORMULARY 03/19/2021 gentle laxative bisacodyl REMOVE FROM Non-Formulary FORMULARY 03/19/2021 tioconazole-1 tioconazole REMOVE FROM Non-Formulary FORMULARY 03/19/2021 sports tape adhesive tape REMOVE FROM Non-Formulary FORMULARY 03/19/2021 olanzapine olanzapine REMOVE FROM Non-Formulary FORMULARY 03/19/2021 children's allergy diphenhydramine hcl REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 75 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 03/19/2021 oxymetholone REMOVE FROM Non-Formulary FORMULARY 03/19/2021 oxymetholone oxymetholone REMOVE FROM Non-Formulary FORMULARY 03/19/2021 oxymetholone oxymetholone REMOVE FROM Non-Formulary FORMULARY 03/19/2021 oxymetholone oxymetholone REMOVE FROM Non-Formulary FORMULARY 03/19/2021 oxymetholone oxymetholone REMOVE FROM Non-Formulary FORMULARY 03/19/2021 bubble gum bubblegum flavor REMOVE FROM Non-Formulary flavor FORMULARY 03/19/2021 bubble gum bubblegum flavor REMOVE FROM Non-Formulary flavor FORMULARY 03/19/2021 OXYCODONE oxycodone hcl REMOVE FROM Non-Formulary HCL ER FORMULARY 03/19/2021 OXYCODONE oxycodone hcl REMOVE FROM Non-Formulary HCL ER FORMULARY 03/19/2021 OXYCODONE oxycodone hcl REMOVE FROM Non-Formulary HCL ER FORMULARY 03/19/2021 ASPERCREME lidocaine hcl REMOVE FROM Non-Formulary LIDOCAINE FORMULARY 03/19/2021 ASPERCREME lidocaine hcl REMOVE FROM Non-Formulary LIDOCAINE FORMULARY 03/19/2021 meloxicam meloxicam, submicronized REMOVE FROM Non-Formulary FORMULARY 03/19/2021 meloxicam meloxicam, submicronized REMOVE FROM Non-Formulary FORMULARY 03/19/2021 skarlite gel-matrix pad dressing, REMOVE FROM Non-Formulary silicone FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 76 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 03/19/2021 N.O.MAX ER oxoglurate REMOVE FROM Non-Formulary FORMULARY 03/19/2021 CHILDREN'S melatonin REMOVE FROM Non-Formulary SLEEP FORMULARY 03/19/2021 CHILDREN'S melatonin REMOVE FROM Non-Formulary SLEEP FORMULARY 03/19/2021 NEUROPHX pyridoxal REMOVE FROM Non-Formulary DPN phos/methyltetrahydrofolate FORMULARY gluc/mecobalamin/ala 03/19/2021 MOOD FOOD ES gaba/5- REMOVE FROM Non-Formulary htp/theanine/taurine/multivit FORMULARY amin with minerals 03/19/2021 CHEST RUB eucalyptus oil/lavender REMOVE FROM Non-Formulary oil/pine needle oil/beeswax FORMULARY 03/19/2021 OMEGA eicosapentaenoic acid REMOVE FROM Non-Formulary MONOPURE (epa)/fish oil FORMULARY EPA EC 03/19/2021 OSSOPAN 1100 hydroxyapatite REMOVE FROM Non-Formulary FORMULARY 03/19/2021 CHILD ALL IN honey/english ivy REMOVE FROM Non-Formulary ONE COUGH extract/turmeric/marshmallo FORMULARY PLUS w/vit c/zinc 03/19/2021 nuva iii silicone adhesive REMOVE FROM Non-Formulary FORMULARY 03/19/2021 oncoplex broccoli seed extract REMOVE FROM Non-Formulary FORMULARY 03/19/2021 oncoplex es broccoli seed extract REMOVE FROM Non-Formulary FORMULARY 03/19/2021 true comfort pen pen needle, diabetic REMOVE FROM Non-Formulary needle FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 77 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 03/19/2021 pogo automatic blood-glucose meter REMOVE FROM Non-Formulary blood gluc sys FORMULARY 03/19/2021 peppermint burst flavoring agent REMOVE FROM Non-Formulary flavor FORMULARY 03/19/2021 lemon-lime flavor flavoring agent REMOVE FROM Non-Formulary FORMULARY 03/19/2021 creme flavor flavoring agent REMOVE FROM Non-Formulary FORMULARY 03/19/2021 very berry flavor flavoring agent REMOVE FROM Non-Formulary FORMULARY 03/19/2021 mango passion flavoring agent REMOVE FROM Non-Formulary fruit flavor FORMULARY 03/19/2021 tropical fusion flavoring agent REMOVE FROM Non-Formulary flavor FORMULARY 03/19/2021 tropical fusion flavoring agent REMOVE FROM Non-Formulary flavor FORMULARY 03/19/2021 true comfort pen pen needle, diabetic REMOVE FROM Non-Formulary needle FORMULARY 03/19/2021 hydroxocobalami hydroxocobalamin hcl REMOVE FROM Non-Formulary n hcl FORMULARY 03/19/2021 adjustable diaper,brief,adult, REMOVE FROM Non-Formulary underwear disposable FORMULARY 03/19/2021 vanilla flavor flavoring agent REMOVE FROM Non-Formulary FORMULARY 03/19/2021 caramel flavor caramel flavor REMOVE FROM Non-Formulary FORMULARY 03/19/2021 green apple apple flavor REMOVE FROM Non-Formulary flavor FORMULARY 03/19/2021 blood orange orange flavor REMOVE FROM Non-Formulary flavor FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 78 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 03/19/2021 strawberry flavor strawberry flavor REMOVE FROM Non-Formulary FORMULARY 03/19/2021 grape flavor grape flavor REMOVE FROM Non-Formulary FORMULARY 03/19/2021 dairy relief lactase REMOVE FROM Non-Formulary FORMULARY 03/19/2021 arthritis trolamine salicylate REMOVE FROM Non-Formulary FORMULARY 03/19/2021 baby vitamin d3 cholecalciferol (vitamin d3) REMOVE FROM Non-Formulary FORMULARY 03/19/2021 child delsym guaifenesin/dextromethorph REMOVE FROM Non-Formulary cough-chest dm an hbr FORMULARY 03/19/2021 psyllium fiber psyllium husk REMOVE FROM Non-Formulary FORMULARY 03/19/2021 sinus relief phenylephrine hcl REMOVE FROM Non-Formulary FORMULARY 03/19/2021 artificial tears carboxymethylcellulose REMOVE FROM Non-Formulary sodium FORMULARY 03/19/2021 selsun blue 2-in-1 selenium sulfide REMOVE FROM Non-Formulary FORMULARY 03/19/2021 FOSCAVIR foscarnet sodium REMOVE FROM Non-Formulary FORMULARY 03/19/2021 GLYRX-PF glycopyrrolate/pf REMOVE FROM Non-Formulary FORMULARY 03/19/2021 eptifibatide eptifibatide REMOVE FROM Non-Formulary FORMULARY 03/19/2021 eptifibatide eptifibatide REMOVE FROM Non-Formulary FORMULARY 03/19/2021 heparin sodium- heparin sodium,porcine in REMOVE FROM Non-Formulary 0.9% nacl 0.9 % sodium chloride/pf FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 79 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 03/19/2021 vestura ethinyl ADD TO FORMULARY Covered estradiol/drospirenone 03/19/2021 SAROCLADIUM allergenic extract- REMOVE FROM Non-Formulary STRICTUM acremonium strictum FORMULARY 03/19/2021 ZYVANA pyridoxine/ascorbic REMOVE FROM Non-Formulary acid/vitamin FORMULARY d3/zinc/selenium yeast 03/23/2021 OXYCODONE oxycodone hcl ADD UM: Total culmulative HCL ER QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 03/23/2021 OXYCODONE oxycodone hcl ADD UM: Total culmulative HCL ER QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 03/23/2021 OXYCONTIN,OX oxycodone hcl CHANGE UM: Total culmulative YCODONE HCL QUANTITYCUSTOM opioid dose ER limited to 90 morphine milligram equivalent (MME) per day 03/25/2021 HUMIRA(CF) adalimumab ADD UM: QUANTITY 3 / 28 days PEN PEDIATRIC UC 03/26/2021 DERMACINRX multivitamin with minerals REMOVE FROM Non-Formulary VENEXA no.86/folic acid FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 80 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 03/26/2021 DERMACINRX multivitamin with minerals REMOVE FROM Non-Formulary VITRANOL FE no.86/ferrous fumarate/folic FORMULARY acid 03/26/2021 melatonin melatonin REMOVE FROM Non-Formulary FORMULARY 03/26/2021 melatonin melatonin REMOVE FROM Non-Formulary FORMULARY 03/26/2021 melatonin melatonin REMOVE FROM Non-Formulary FORMULARY 03/26/2021 melatonin melatonin REMOVE FROM Non-Formulary FORMULARY 03/26/2021 melatonin melatonin REMOVE FROM Non-Formulary FORMULARY 03/26/2021 docosanol docosanol REMOVE FROM Non-Formulary FORMULARY 03/26/2021 estrogen- estrogens,esterified/methylt REMOVE FROM Non-Formulary methyltestosteron estosterone FORMULARY e 03/26/2021 famotidine famotidine REMOVE FROM Non-Formulary FORMULARY 03/26/2021 aspirin aspirin REMOVE FROM Non-Formulary FORMULARY 03/26/2021 aspirin aspirin REMOVE FROM Non-Formulary FORMULARY 03/26/2021 itraconazole itraconazole REMOVE FROM Non-Formulary FORMULARY 03/26/2021 fexofenadine hcl fexofenadine hcl REMOVE FROM Non-Formulary FORMULARY 03/26/2021 vancomycin hcl vancomycin hcl REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 81 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 03/26/2021 -nacl fluconazole in sodium REMOVE FROM Non-Formulary chloride, iso-osmotic FORMULARY 03/26/2021 famotidine famotidine REMOVE FROM Non-Formulary FORMULARY 03/26/2021 lice treatment permethrin REMOVE FROM Non-Formulary FORMULARY 03/26/2021 gas relief simethicone REMOVE FROM Non-Formulary FORMULARY 03/26/2021 estrogen- estrogens,esterified/methylt REMOVE FROM Non-Formulary methyltestosteron estosterone FORMULARY e 03/26/2021 ibuprofen ibuprofen REMOVE FROM Non-Formulary FORMULARY 03/26/2021 gentle laxative bisacodyl REMOVE FROM Non-Formulary FORMULARY 03/26/2021 stomach relief bismuth subsalicylate REMOVE FROM Non-Formulary FORMULARY 03/26/2021 anti-nausea phosphorated carbohydrate REMOVE FROM Non-Formulary (dextrose and fructose) FORMULARY 03/26/2021 pain reliever pm acetaminophen/diphenhydra REMOVE FROM Non-Formulary mine hcl FORMULARY 03/26/2021 MUCINEX guaifenesin REMOVE FROM Non-Formulary FORMULARY 03/26/2021 pain reliever acetaminophen REMOVE FROM Non-Formulary FORMULARY 03/26/2021 ACTIDOSE activated charcoal/sorbitol REMOVE FROM Non-Formulary solution FORMULARY 03/26/2021 ACTIDOSE activated charcoal/sorbitol REMOVE FROM Non-Formulary solution FORMULARY 03/26/2021 MUCINEX DM guaifenesin/dextromethorph REMOVE FROM Non-Formulary an hbr FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 82 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 03/26/2021 children's allergy diphenhydramine hcl REMOVE FROM Non-Formulary FORMULARY 03/26/2021 calcium calcium carbonate REMOVE FROM Non-Formulary carbonate FORMULARY 03/26/2021 nasal phenylephrine hcl REMOVE FROM Non-Formulary decongestant pe FORMULARY 03/26/2021 MUCINEX guaifenesin REMOVE FROM Non-Formulary FORMULARY 03/26/2021 diclofenac diclofenac sodium REMOVE FROM Non-Formulary sodium FORMULARY 03/26/2021 ARCALYST rilonacept REMOVE FROM Non-Formulary FORMULARY 03/26/2021 sodium sulfacetamide sodium REMOVE FROM Non-Formulary sulfacetamide FORMULARY 03/26/2021 ANTISEPTIC chlorhexidine gluconate REMOVE FROM Non-Formulary SKIN FORMULARY CLEANSER 03/26/2021 GLUCERNA nutritional therapy, glucose REMOVE FROM Non-Formulary HUNGER intolerance,lactose-free,soy FORMULARY SMART 03/26/2021 GLUCERNA nutritional therapy, glucose REMOVE FROM Non-Formulary HUNGER intolerance,lactose-free,soy FORMULARY SMART 03/26/2021 raspberry raspberry flavor REMOVE FROM Non-Formulary concentrate FORMULARY flavor 03/26/2021 PFD TODDLER infant formula, special REMOVE FROM Non-Formulary metabolic with iron FORMULARY 03/26/2021 children's acetaminophen REMOVE FROM Non-Formulary acetaminophen FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 83 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 03/26/2021 daptomycin daptomycin REMOVE FROM Non-Formulary FORMULARY 03/26/2021 tropicamide- phenylephrine REMOVE FROM Non-Formulary phenylephrine hcl/tropicamide in sterile FORMULARY water 03/26/2021 MEGARED omega-3 fatty REMOVE FROM Non-Formulary ADVANCED 4- acids/dha/epa/fish oil/krill oil FORMULARY IN-1 03/26/2021 skarlite gel-matrix pad dressing, REMOVE FROM Non-Formulary silicone FORMULARY 03/26/2021 neuriva original coffee extract/phosphatidyl REMOVE FROM Non-Formulary serine FORMULARY 03/26/2021 neuriva original coffee extract/phosphatidyl REMOVE FROM Non-Formulary serine FORMULARY 03/26/2021 ulticare low dead syringe with REMOVE FROM Non-Formulary space syring needle,disposable, 1 ml FORMULARY 03/26/2021 lovastatin lovastatin REMOVE FROM Non-Formulary FORMULARY 03/26/2021 carepoint luer syringe with REMOVE FROM Non-Formulary lock needle,disposable, 3 ml FORMULARY 03/26/2021 carepoint luer syringe with REMOVE FROM Non-Formulary lock needle,disposable, 3 ml FORMULARY 03/26/2021 carepoint luer syringe with REMOVE FROM Non-Formulary lock needle,disposable, 3 ml FORMULARY 03/26/2021 carepoint luer syringe with REMOVE FROM Non-Formulary lock needle,disposable, 3 ml FORMULARY 03/26/2021 carepoint luer syringe with REMOVE FROM Non-Formulary lock needle,disposable, 3 ml FORMULARY 03/26/2021 carepoint luer syringe with REMOVE FROM Non-Formulary lock needle,disposable, 3 ml FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 84 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 03/26/2021 carepoint luer syringe with REMOVE FROM Non-Formulary lock needle,disposable, 3 ml FORMULARY 03/26/2021 oraxinol herbal complex no.319 REMOVE FROM Non-Formulary FORMULARY 03/26/2021 nrf2 activator turmeric xt/green REMOVE FROM Non-Formulary xt/pterostilbene/broccoli FORMULARY seed xt 03/26/2021 spearmint flavor flavoring agent REMOVE FROM Non-Formulary FORMULARY 03/26/2021 DIGESTIVE bacillus coagulans/digestive REMOVE FROM Non-Formulary ADVANTAGE combo no.10 FORMULARY PROBIO-GAS 03/26/2021 FIRST AID povidone-iodine REMOVE FROM Non-Formulary ANTISEPTIC FORMULARY 03/26/2021 BABY eucalyptus oil/lavender REMOVE FROM Non-Formulary SOOTHING oil/beeswax FORMULARY CHEST 03/26/2021 OMEGAPURE omega-3 fatty REMOVE FROM Non-Formulary 600 EC acids/docosahexaenoic FORMULARY acid/epa/fish oil 03/26/2021 OMEGAPURE omega-3 fatty REMOVE FROM Non-Formulary 780 EC acids/docosahexaenoic FORMULARY acid/epa/fish oil 03/26/2021 CULTURELLE fucosyllactose/lacto-n- REMOVE FROM Non-Formulary IBS COMPLETE neotetraose FORMULARY SUPPRT 03/26/2021 OMEGA omega-3 fatty REMOVE FROM Non-Formulary MONOPURE acids/dha/epa/fish FORMULARY CURCUMIN EC oil/turmeric root extract 03/26/2021 AZO DUAL l.crispatus/l.gasseri/l.jensenii REMOVE FROM Non-Formulary PROTECTION /l.rhamnosus/bacteriophage FORMULARY s

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 85 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 03/26/2021 first aid antiseptic lidocaine hcl/benzalkonium REMOVE FROM Non-Formulary chloride FORMULARY 03/26/2021 lidocaine hcl lidocaine hcl REMOVE FROM Non-Formulary FORMULARY 03/26/2021 mucus-er max guaifenesin REMOVE FROM Non-Formulary FORMULARY 03/26/2021 acidophilus lactobacillus acidophilus REMOVE FROM Non-Formulary probiotic FORMULARY 03/26/2021 arthritis pain diclofenac sodium REMOVE FROM Non-Formulary FORMULARY 03/26/2021 up4 probiotics- bacillus coagulans/bacillus REMOVE FROM Non-Formulary mind and body subtilis FORMULARY 03/26/2021 NORMOSOL-M electrolyte-m REMOVE FROM Non-Formulary AND DEXTROSE solution/dextrose 5 % in FORMULARY water 03/26/2021 atropine sulfate atropine sulfate REMOVE FROM Non-Formulary FORMULARY 03/26/2021 dactinomycin dactinomycin REMOVE FROM Non-Formulary FORMULARY 03/26/2021 mycophenolate mycophenolate mofetil hcl REMOVE FROM Non-Formulary mofetil FORMULARY 03/26/2021 dextrose in water dextrose 5 % in water REMOVE FROM Non-Formulary FORMULARY 03/26/2021 palonosetron hcl palonosetron hcl REMOVE FROM Non-Formulary FORMULARY 03/26/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 03/26/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 03/26/2021 phenylephrine phenylephrine hcl in 0.9 % REMOVE FROM Non-Formulary hcl-0.9% nacl sodium chloride FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 86 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 03/26/2021 tazarotene tazarotene REMOVE FROM Non-Formulary FORMULARY 03/26/2021 ABILIFY MYCITE aripiprazole REMOVE FROM Non-Formulary FORMULARY 03/26/2021 ABILIFY MYCITE aripiprazole REMOVE FROM Non-Formulary FORMULARY 03/26/2021 ABILIFY MYCITE aripiprazole REMOVE FROM Non-Formulary FORMULARY 03/26/2021 ABILIFY MYCITE aripiprazole REMOVE FROM Non-Formulary FORMULARY 03/26/2021 ABILIFY MYCITE aripiprazole REMOVE FROM Non-Formulary FORMULARY 03/26/2021 ABILIFY MYCITE aripiprazole REMOVE FROM Non-Formulary FORMULARY 03/26/2021 ABILIFY MYCITE aripiprazole REMOVE FROM Non-Formulary FORMULARY 03/26/2021 ABILIFY MYCITE aripiprazole REMOVE FROM Non-Formulary FORMULARY 03/26/2021 ABILIFY MYCITE aripiprazole REMOVE FROM Non-Formulary FORMULARY 03/26/2021 ABILIFY MYCITE aripiprazole REMOVE FROM Non-Formulary FORMULARY 03/26/2021 ABILIFY MYCITE aripiprazole REMOVE FROM Non-Formulary FORMULARY 03/26/2021 ABILIFY MYCITE aripiprazole REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 87 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

April, 2021

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/01/2021 XERESE acyclovir/hydrocortisone ADD UM: QUANTITY 10 / 365 days 04/01/2021 zovirax,acyclovir acyclovir ADD UM: QUANTITY 10 / 365 days 04/01/2021 DENAVIR penciclovir ADD UM: QUANTITY 10 / 365 days 04/01/2021 SITAVIG acyclovir CHANGE UM: QUANTITY 1 / 30 days 2 / 365 days 04/01/2021 zovirax,acyclovir acyclovir ADD UM: QUANTITY 30 / 365 days 04/01/2021 lyrica,pregabalin pregabalin REMOVE UM: QUANTITY 3 / 1 DAY 04/01/2021 lyrica,pregabalin pregabalin REMOVE UM: QUANTITY 3 / 1 DAY 04/01/2021 lyrica,pregabalin pregabalin REMOVE UM: QUANTITY 3 / 1 DAY 04/01/2021 lyrica,pregabalin pregabalin REMOVE UM: QUANTITY 3 / 1 DAY 04/01/2021 lyrica,pregabalin pregabalin REMOVE UM: QUANTITY 3 / 1 DAY 04/01/2021 lyrica,pregabalin pregabalin REMOVE UM: QUANTITY 3 / 1 DAY 04/01/2021 lyrica,pregabalin pregabalin REMOVE UM: QUANTITY 2 / 1 DAY 04/01/2021 lyrica,pregabalin pregabalin REMOVE UM: QUANTITY 2 / 1 DAY 04/01/2021 zocor,simvastatin simvastatin REMOVE UM: QUANTITY 1 / 1 DAY 04/01/2021 lipitor,atorvastatin atorvastatin calcium REMOVE UM: QUANTITY 1 / 1 DAY calcium 04/01/2021 lipitor,atorvastatin atorvastatin calcium REMOVE UM: QUANTITY 1 / 1 DAY calcium 04/01/2021 lipitor,atorvastatin atorvastatin calcium REMOVE UM: QUANTITY 1.5 / 1 DAY calcium 04/01/2021 OMEGAVEN fatty acids combo. no.6/fish ADD UM: MED Medical Drug oil/glycerin/phospholipids, egg 04/01/2021 LUMOXITI moxetumomab pasudotox- CHANGE UM: MED Medical Drug tdfk

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 88 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/01/2021 solifenacin solifenacin succinate CHANGE TIER Covered succinate 04/01/2021 DANYELZA naxitamab-gqgk ADD UM: MED Medical Drug 04/01/2021 COSENTYX (2 secukinumab CHANGE UM: QUANTITY 2 / 28 days 4 / 56 days SYRINGES) 04/01/2021 COSENTYX PEN secukinumab ADD TO FORMULARY Non-Formulary Covered 04/01/2021 COSENTYX PEN secukinumab ADD TO FORMULARY Non-Formulary Covered (2 PENS) 04/01/2021 XYWAV sodium oxybate/calcium ADD UM: QUANTITY 540 / 30 days oxybate/magnesium oxybate/pot oxybate 04/01/2021 XYWAV sodium oxybate/calcium ADD TO FORMULARY Covered oxybate/magnesium oxybate/pot oxybate 04/01/2021 QDOLO hcl ADD UM: QUANTITY 80 / 1 days 04/01/2021 OXLUMO lumasiran sodium ADD UM: MED Medical Drug 04/01/2021 BRAFTOVI encorafenib REMOVE FROM Covered Non-Formulary FORMULARY 04/01/2021 DIFICID fidaxomicin ADD TO FORMULARY Covered 04/01/2021 ORLADEYO berotralstat hydrochloride ADD TO FORMULARY Covered 04/01/2021 ORLADEYO berotralstat hydrochloride REMOVE UM: SPECIALTY Specialty Drug 04/01/2021 ORLADEYO berotralstat hydrochloride ADD TO FORMULARY Covered 04/01/2021 ORLADEYO berotralstat hydrochloride REMOVE UM: SPECIALTY Specialty Drug 04/01/2021 ONGENTYS opicapone ADD TO FORMULARY Covered 04/01/2021 ONGENTYS opicapone ADD TO FORMULARY Covered 04/01/2021 REMDESIVIR remdesivir ADD UM: MED Medical Drug (EUA),VEKLURY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 89 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/01/2021 SUTAB sodium sulfate/potassium ADD TO FORMULARY Covered chloride/magnesium sulfate 04/01/2021 LENVIMA lenvatinib mesylate ADD UM: SPECIALTY Specialty Drug 04/01/2021 moxifloxacin moxifloxacin hcl ADD TO FORMULARY Non-Formulary Covered 04/01/2021 alinia,nitazoxanid nitazoxanide CHANGE UM: QUANTITY 6 / 30 days e 04/01/2021 ULTOMIRIS ravulizumab-cwvz ADD UM: MED Medical Drug 04/01/2021 CLINOLIPID fat emulsions/olive ADD UM: MED Medical Drug oil/soybean oil/phospholipids,egg 04/01/2021 ZYTIGA abiraterone acetate REMOVE UM: Limited Access LIMITEDACCESS 04/01/2021 abiraterone abiraterone acetate REMOVE UM: Limited Access acetate LIMITEDACCESS 04/01/2021 ZYTIGA abiraterone acetate ADD UM: SPECIALTY Specialty Drug 04/01/2021 ORGOVYX relugolix ADD TO FORMULARY Covered 04/01/2021 bupropion hcl bupropion hcl REMOVE FROM Non-Formulary sr,bupropion hcl FORMULARY er 04/01/2021 acetaminophen,a acetaminophen CHANGE TIER Covered pap,ty-tab,non- aspirin 04/01/2021 mylanta,mylanta magnesium CHANGE TIER Covered maximum hydroxide/aluminum strength,mylanta hydroxide/simethicone double-strength 04/01/2021 sk- diphenhydramine hcl CHANGE TIER Covered diphenhydramine hcl,diphenhydram ine hcl,diphenhist

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 90 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/01/2021 docusate docusate sodium CHANGE TIER Covered sodium,doss- 100,stool softener 04/01/2021 stool softener,hm docusate sodium CHANGE TIER Covered stool softener 04/01/2021 nicotine nicotine polacrilex CHANGE TIER Covered gum,equate nicotine gum 04/01/2021 simethicone simethicone CHANGE TIER Covered 04/01/2021 gas relief simethicone CHANGE TIER Covered 04/01/2021 docusate docusate calcium CHANGE TIER Covered calcium,sulfolax 04/01/2021 stool softener docusate calcium ADD TO FORMULARY Non-Formulary Covered 04/01/2021 milk of magnesium hydroxide CHANGE TIER Covered magnesia,hm milk of magnesia 04/01/2021 senna sennosides CHANGE TIER Covered 04/01/2021 acetaminophen,a acetaminophen CHANGE TIER Covered cetaminophen es,apap,pain reliever,ty- tab,non-aspirin 04/01/2021 aspirin aspirin CHANGE TIER Covered ec,aspirin,coat-a- prin,aspirin enteric coated,ecaspirin 04/01/2021 nicotine nicotine polacrilex CHANGE TIER Covered gum,equate nicotine gum

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 91 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/01/2021 diphenhydramine diphenhydramine hcl CHANGE TIER Covered hcl,diphedryl,diph en 04/01/2021 ferrous ferrous sulfate CHANGE TIER Covered sulfate,iron,hm iron 04/01/2021 naproxen sodium naproxen sodium CHANGE TIER Covered 04/01/2021 infants simethicone ADD TO FORMULARY Non-Formulary Covered simethicone,infan ts' simethicone 04/01/2021 infants' gas simethicone CHANGE TIER Covered relief,infant gas relief,v-r gas relief infant 04/01/2021 ibuprofen,menad ibuprofen CHANGE TIER Covered ol,ibu-profen 04/01/2021 senna laxative sennosides CHANGE TIER Covered 04/01/2021 oralyte electrolytes/dextrose CHANGE TIER Covered 04/01/2021 hydralyte electrolytes/dextrose ADD TO FORMULARY Non-Formulary Covered 04/01/2021 senna s,senna- sennosides/docusate CHANGE TIER Covered s,senna-s sodium laxative 04/01/2021 stool softener- sennosides/docusate CHANGE TIER Covered stimulant lax sodium 04/01/2021 non-aspirin acetaminophen/diphenhydra CHANGE TIER Covered pm,non-aspirin mine hcl p.m. 04/01/2021 calcium citrate calcium citrate CHANGE TIER Covered 04/01/2021 sleep aid succinate REMOVE FROM Non-Formulary FORMULARY 04/01/2021 ibuprofen ib ibuprofen CHANGE TIER Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 92 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/01/2021 motrin,children's ibuprofen ADD TO FORMULARY Non-Formulary Covered motrin 04/01/2021 pain relief extra acetaminophen CHANGE TIER Covered strength,pain relief 04/01/2021 8 hour pain acetaminophen CHANGE TIER Covered relief,8 hour pain reliever,8 hour acetaminophen,8 hr arthritis pain,8hr arthritis pain relief 04/01/2021 8hr muscle acetaminophen CHANGE TIER Covered aches-pain 04/01/2021 all day allergy cetirizine hcl CHANGE TIER Covered 04/01/2021 allergy cetirizine hcl CHANGE TIER Covered relief,allergy 04/01/2021 vitamin a and vitamins a and d/white CHANGE TIER Covered d,vitamin a & d petrolatum/lanolin,vitamins a & d/white petrolatum/lanolin 04/01/2021 children's acetaminophen CHANGE TIER Covered acetaminophen,c hild suspension,childr ens suspension 04/01/2021 ferrous gluconate ferrous gluconate CHANGE TIER Covered 04/01/2021 antacid-antigas magnesium CHANGE TIER Covered hydroxide/aluminum hydroxide/simethicone 04/01/2021 one daily multivitamin with folic acid CHANGE TIER Covered multivitamin

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 93 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/01/2021 lubricant eye propylene glycol CHANGE TIER Covered drop 04/01/2021 nicotine lozenge nicotine polacrilex CHANGE TIER Covered 04/01/2021 LUCEMYRA lofexidine hcl CHANGE TIER Covered 04/01/2021 meclizine meclizine hcl CHANGE TIER Covered hcl,meclizine hcl chewable 04/01/2021 methylphenidate hcl CHANGE UM: QUANTITY 1 / 1 days er,concerta 04/01/2021 methylphenidate methylphenidate hcl CHANGE UM: QUANTITY 1 / 1 days er,concerta 04/01/2021 methylphenidate methylphenidate hcl CHANGE UM: QUANTITY 2 / 1 days er,concerta 04/01/2021 methylphenidate methylphenidate hcl CHANGE UM: QUANTITY 1 / 1 days er,concerta 04/01/2021 emend,aprepitant aprepitant CHANGE UM: QUANTITY 4 / 30 days 04/01/2021 cialis,tadalafil tadalafil CHANGE UM: QUANTITY 30 / 30 days 04/01/2021 treximet,sumatrip sumatriptan CHANGE UM: QUANTITY 9 / 30 days tan succ- succinate/naproxen sodium naproxen sod 04/01/2021 venlafaxine hcl er venlafaxine hcl CHANGE UM: QUANTITY 1 / 1 days 04/01/2021 venlafaxine hcl er venlafaxine hcl CHANGE UM: CUSTOM COVERED BY OMAP 04/01/2021 silenor,doxepin doxepin hcl CHANGE UM: QUANTITY 0.5 / 1 days hcl 04/01/2021 silenor,doxepin doxepin hcl CHANGE UM: QUANTITY 0.5 / 1 days hcl

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 94 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/01/2021 answer,contour blood sugar diagnostic CHANGE UM: QUANTITY 5 / 1 days test strip,contour next test strip,relion confirm-micro,bg- star,advance test strips,assure pro,assure platinum,assure 4,glucocard expression,pocke tchem ez,relion prime test strips,micro,gluco card 01 sensor plus,glucocard x- sensor,glucocard vital,glucocard vital sensor,evencare g2,evencare,eve ncare g3,blood glucose test strip,easygluco test strips,easy gluco g2,control ast test strip,control,g- 4,maxima,infinity test strips,acura test strips,easygluco plus,easy pro plus,prodigy,prodi gy eject,prodigy no coding,prodigy autocode,prodigy voice,easy touch test

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 95 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value strip,eclipse,envis ion,evolution test strips,element test strips,smartdiabet es xpres,element plus,element compact,glucolab ,smartest test,glucocom glucose,rightest gs300 test strip,rightest gs100 test strip,rightest gs550 test strip,ge100 blood glucose test strip,nova max glucose test strips,keynote,wa vesense jazz,wavesense presto,agamatrix amp,liberty test strips,ultratrak,ult ratrak ultimate,solus v2 test strips,caresens n,smart caresens n,reveal test strip,glucose test strip,truetest test strips,truetrack test strip,premium blood glucose test,foracare

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 96 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value gd20,fora v10,choicedm g20,fora g20,fora test strip,fora g71a,foracare gd40,premium v10,test n'go,fora v12,refuah plus,surechek test strips,sure edge test strips,vocal point,ultratrak pro,truetrack smart system,easymax, easymax 15,easyplus,td gold test strip,myglucoheal th,accu-chek comfort curve,accu-chek active,microdot,m icrodot xtra,ez smart,ez smart plus,one touch verio,fast take,surestep,on e touch test strips,onetouch ultra test strip,onetouch verio test strip,onetouch ultra test strips,surestep pro,glucostix,test strips,test

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 97 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value strip,prestige test strips,prestige smart system,precision pcx plus,precision point of care,optium ez,precision q-i- d,precision pcx,optium,precis ion xtra,neutek 2tek test strips,telcare,sure -test easyplus mini,accu-chek aviva,accutrend glucose,accu- chek aviva plus,accu-chek smartview,ultima, on call plus test strip,optumrx,on call vivid test strip,gmate test strips,gluco navii,choicedm clarus test strips,quintet,quin tet ac,easy step,easy plus,easy trak,easy talk,easy plus ii,easy check test strip,diatrue plus,fifty50 test strip,embrace,vict ory,advocate test

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 98 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value strip,advocate redi- code,advocate redi-code+,clever choice test strips,clever choice voice+ tst strip,clever choice pro,pharmacist choice,clever choice micro test strip,clever choice talk,fora v10-v12-d10- d20,fora d15c,fora d15z,fora v20,fora v22,fora g30-premium v10 test strp,fora d15g,fora d20,fora g90,fora v30a,freestyle test strips,freestyle lite test strip,freestyle lite strips,freestyle insulinx test strips,freestyle insulinx,rightest gs260 test strip,glucometer elite,ascensia elite,pts panels,bioscanne r glucose test,at- last test

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 99 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value strips,assure ii,quicktek,assure 3,supreme test strips,smart sense test strips,nexgen,eas ypro,duo- care,accu-chek instant plus,accu- chek instant,one touch ultra test strips,accu-chek advantage,life medical test strip,diabetic.com test strip,sentry test strip,precision sof- tact,exactech,exa ctech rsg,rightest gs250s test strip,glucometer encore,glucofilm, glucostix reagent,visidex ii,seralyzer glucose,dextrosti x reagent,glucomet er dex,glucose test strips,duet,expres s view glucose test strp,glucoprotein, quick-check one,quick-check ii,quick-check

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 100 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value film,excel ge,excel g,uni- check,bd test strips,checkmate, checkmate plus,select gt,assure,senova, glucoleader,valus trip test strips,kyodex reagent,longs blood glucose strip,biotel hi- value v,biotel hi- value 3,truetrack,diasca n,diascan test strips,diascan dual pad test strips,diascan dual pad strips,ultra standard strips,ultra +,ultra,swiftcheck ,blood glucose test,tt strips,accu- chek,accu-chek simplicity,chemstr ip bg,tracer bg,blood glucose 3 test,reagent,gluc oscan test strips,glucoscan/ gm test strips,one touch,trendstrips, diascan first choice,trackease,

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 101 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value relief plus,companion 2,medisense 2 test strips,sof- tact,supreme confidence strips,ga test strips,one touch ii test strips,first choice,glucose alert,genstrip,unis trip1,onetouch verio,embrace evo,embrace pro test strip,on call express test strip,healthpro glucose test strips,advanced glucose test strips,true metrix glucose test strip,fora gd50 test strips,fora test n'go test strips,fortiscare glucose test strips,assure prism multi,glucocard shine,genultimate test strip,evencare mini glucose test str,fora tn'g voice test strips,freestyle precision neo,fora d40-g31

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 102 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value test strips,cool glucose test strip,accu-chek guide test strip,dario blood glucose test strip,iglucose test strip,infinity voice test strip,premier test strip,caretouch test strip,verasens test strip,goodlife ac-302 test strip,true metrix pro test strip,harmony glucose test strip,evencare proview test strip,pro voice v8- v9 test strip,fora 6 connect glucose strip,advanced glucose test strip,embrace talk test strip,fora gtel glucose test strip,vivaguard ino test strip,assure platinum test strip,gojji blood glucose test strip,agamatrix presto,easy trak ii test strip,rightest

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 103 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value gt333 test strip,rightest gs700 test strip,rightest max test strip 04/01/2021 stress multivitamin,stress CHANGE TIER Covered formula,stress formula,vitamin b formula complex/minerals,multivits,st w/iron,stress ress formula formula,iron/multivits,stress w/zinc,stress formula,multivits,stress formula 600 formula/zinc,iron/vitamin b complex,vitamin b complex 04/01/2021 promethazine hcl promethazine hcl REMOVE FROM Non-Formulary FORMULARY 04/01/2021 heparin heparin sodium,porcine/pf REMOVE FROM Non-Formulary flush,heparin lock FORMULARY flush 04/01/2021 NOVOLIN 70-30 insulin nph human REMOVE FROM Non-Formulary FLEXPEN isophane/insulin regular, FORMULARY human 04/01/2021 TAB-A-VITE multivitamin/ferrous CHANGE TIER Covered MULTIVIT WITH sulfate/folic acid IRON 04/01/2021 COSENTYX PEN secukinumab REMOVE UM: SPECIALTY Specialty Drug (2 PENS) 04/01/2021 COSENTYX PEN secukinumab REMOVE UM: SPECIALTY Specialty Drug 04/01/2021 OTEZLA apremilast REMOVE FROM Covered Non-Formulary FORMULARY 04/01/2021 OTEZLA apremilast ADD UM: SPECIALTY Specialty Drug 04/01/2021 OTEZLA apremilast REMOVE FROM Covered Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 104 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/01/2021 OTEZLA apremilast ADD UM: SPECIALTY Specialty Drug 04/01/2021 OTEZLA apremilast REMOVE FROM Covered Non-Formulary FORMULARY 04/01/2021 OTEZLA apremilast ADD UM: SPECIALTY Specialty Drug 04/01/2021 epoprostenol epoprostenol sodium REMOVE UM: Limited Access sodium (glycine) LIMITEDACCESS 04/01/2021 epoprostenol epoprostenol sodium REMOVE UM: Limited Access sodium (glycine) LIMITEDACCESS 04/01/2021 irbesartan irbesartan ADD TO FORMULARY Covered 04/01/2021 irbesartan irbesartan ADD TO FORMULARY Covered 04/02/2021 clariscan gadoterate meglumine REMOVE FROM Non-Formulary FORMULARY 04/02/2021 desmopressin desmopressin acetate REMOVE FROM Non-Formulary acetate FORMULARY 04/02/2021 desmopressin desmopressin acetate REMOVE FROM Non-Formulary acetate FORMULARY 04/02/2021 succinylcholine succinylcholine chloride REMOVE FROM Non-Formulary chloride FORMULARY 04/02/2021 succinylcholine succinylcholine chloride REMOVE FROM Non-Formulary chloride FORMULARY 04/02/2021 cisatracurium cisatracurium besylate REMOVE FROM Non-Formulary besylate FORMULARY 04/02/2021 salsalate salsalate REMOVE FROM Non-Formulary FORMULARY 04/02/2021 voriconazole voriconazole REMOVE FROM Non-Formulary FORMULARY 04/02/2021 allergy relief-d12 loratadine/pseudoephedrine REMOVE FROM Non-Formulary sulfate FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 105 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/02/2021 metformin er metformin hcl REMOVE FROM Non-Formulary gastric FORMULARY 04/02/2021 metformin er metformin hcl REMOVE FROM Non-Formulary gastric FORMULARY 04/02/2021 grape flavor grape flavor REMOVE FROM Non-Formulary FORMULARY 04/02/2021 grape flavor grape flavor REMOVE FROM Non-Formulary FORMULARY 04/02/2021 grape flavor grape flavor REMOVE FROM Non-Formulary FORMULARY 04/02/2021 strawberry flavor strawberry flavor REMOVE FROM Non-Formulary FORMULARY 04/02/2021 strawberry flavor strawberry flavor REMOVE FROM Non-Formulary FORMULARY 04/02/2021 strawberry flavor strawberry flavor REMOVE FROM Non-Formulary FORMULARY 04/02/2021 rifaximin rifaximin REMOVE FROM Non-Formulary FORMULARY 04/02/2021 rifaximin rifaximin REMOVE FROM Non-Formulary FORMULARY 04/02/2021 rifaximin rifaximin REMOVE FROM Non-Formulary FORMULARY 04/02/2021 marshmallow marshmallow flavor REMOVE FROM Non-Formulary flavor FORMULARY 04/02/2021 marshmallow marshmallow flavor REMOVE FROM Non-Formulary flavor FORMULARY 04/02/2021 marshmallow marshmallow flavor REMOVE FROM Non-Formulary flavor FORMULARY 04/02/2021 marshmallow marshmallow flavor REMOVE FROM Non-Formulary flavor FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 106 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/02/2021 marshmallow marshmallow flavor REMOVE FROM Non-Formulary flavor FORMULARY 04/02/2021 marshmallow marshmallow flavor REMOVE FROM Non-Formulary flavor FORMULARY 04/02/2021 peanut butter peanut butter flavor REMOVE FROM Non-Formulary flavor FORMULARY 04/02/2021 peanut butter peanut butter flavor REMOVE FROM Non-Formulary flavor FORMULARY 04/02/2021 caramel flavor caramel flavor REMOVE FROM Non-Formulary FORMULARY 04/02/2021 caramel flavor caramel flavor REMOVE FROM Non-Formulary FORMULARY 04/02/2021 caramel flavor caramel flavor REMOVE FROM Non-Formulary FORMULARY 04/02/2021 green apple apple flavor REMOVE FROM Non-Formulary flavor FORMULARY 04/02/2021 wild cherry flavor wild cherry flavor REMOVE FROM Non-Formulary FORMULARY 04/02/2021 green apple apple flavor REMOVE FROM Non-Formulary flavor FORMULARY 04/02/2021 wild cherry flavor wild cherry flavor REMOVE FROM Non-Formulary FORMULARY 04/02/2021 wild cherry flavor wild cherry flavor REMOVE FROM Non-Formulary FORMULARY 04/02/2021 green apple apple flavor REMOVE FROM Non-Formulary flavor FORMULARY 04/02/2021 blood orange orange flavor REMOVE FROM Non-Formulary flavor FORMULARY 04/02/2021 blood orange orange flavor REMOVE FROM Non-Formulary flavor FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 107 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/02/2021 blood orange orange flavor REMOVE FROM Non-Formulary flavor FORMULARY 04/02/2021 raspberry raspberry flavor REMOVE FROM Non-Formulary concentrate FORMULARY flavor 04/02/2021 raspberry raspberry flavor REMOVE FROM Non-Formulary concentrate FORMULARY flavor 04/02/2021 bubble gum bubblegum flavor REMOVE FROM Non-Formulary flavor FORMULARY 04/02/2021 raspberry raspberry flavor REMOVE FROM Non-Formulary concentrate FORMULARY flavor 04/02/2021 bubble gum bubblegum flavor REMOVE FROM Non-Formulary flavor FORMULARY 04/02/2021 bubble gum bubblegum flavor REMOVE FROM Non-Formulary flavor FORMULARY 04/02/2021 bubble gum bubblegum flavor REMOVE FROM Non-Formulary flavor FORMULARY 04/02/2021 bubble gum bubblegum flavor REMOVE FROM Non-Formulary flavor FORMULARY 04/02/2021 bubble gum bubblegum flavor REMOVE FROM Non-Formulary flavor FORMULARY 04/02/2021 vanilla flavor flavoring agent REMOVE FROM Non-Formulary FORMULARY 04/02/2021 vanilla flavor flavoring agent REMOVE FROM Non-Formulary FORMULARY 04/02/2021 vanilla flavor flavoring agent REMOVE FROM Non-Formulary FORMULARY 04/02/2021 tadalafil tadalafil REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 108 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/02/2021 bard lubricath catheter REMOVE FROM Non-Formulary foley catheter FORMULARY 04/02/2021 FLORATUMMYS lactobacillus REMOVE FROM Non-Formulary QUICK reuteri/bifidobacterium FORMULARY DISSOLVE infantis/fos 04/02/2021 embrace lancing lancing device REMOVE FROM Non-Formulary device FORMULARY 04/02/2021 AZO D- d-mannose REMOVE FROM Non-Formulary MANNOSE FORMULARY 04/02/2021 SUDANYL PE phenylephrine hcl REMOVE FROM Non-Formulary FORMULARY 04/02/2021 REMEDY menthol/zinc oxide REMOVE FROM Non-Formulary CALAZIME FORMULARY INTENSIVE SKIN 04/02/2021 nicotine patch nicotine REMOVE FROM Non-Formulary FORMULARY 04/02/2021 nicotine patch nicotine REMOVE FROM Non-Formulary FORMULARY 04/02/2021 melatonin-vitamin melatonin/pyridoxine hcl (vit REMOVE FROM Non-Formulary b6 cr b6) FORMULARY 04/02/2021 melatonin melatonin REMOVE FROM Non-Formulary FORMULARY 04/02/2021 urinary pain relief phenazopyridine hcl REMOVE FROM Non-Formulary FORMULARY 04/02/2021 keralyt salicylic acid REMOVE FROM Non-Formulary FORMULARY 04/02/2021 FLUORESCEIN- benoxinate hcl/fluorescein REMOVE FROM Non-Formulary BENOXINATE sodium FORMULARY 04/02/2021 ULTRA HIS RX a-carnit/arginine/coq10/a- REMOVE FROM Non-Formulary cyst/lycopene/pine/g.tea/pun FORMULARY cture

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 109 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/02/2021 ULTRA HIS RX a-carnit/arginine/coq10/a- REMOVE FROM Non-Formulary cyst/lycopene/pine/g.tea/pun FORMULARY cture 04/02/2021 QUTENZA capsaicin/skin cleanser REMOVE FROM Non-Formulary FORMULARY 04/02/2021 neostigmine neostigmine methylsulfate REMOVE FROM Non-Formulary methylsulfate FORMULARY 04/02/2021 amikacin sulfate amikacin sulfate REMOVE FROM Non-Formulary FORMULARY 04/02/2021 amikacin sulfate amikacin sulfate REMOVE FROM Non-Formulary FORMULARY 04/02/2021 gemcitabine hcl gemcitabine hcl REMOVE FROM Non-Formulary FORMULARY 04/02/2021 gemcitabine hcl gemcitabine hcl REMOVE FROM Non-Formulary FORMULARY 04/02/2021 gemcitabine hcl gemcitabine hcl REMOVE FROM Non-Formulary FORMULARY 04/02/2021 CERETEC kit for prep tc- REMOVE FROM Non-Formulary 99m/exametazime FORMULARY 04/02/2021 fiber powder psyllium husk (with sugar) REMOVE FROM Non-Formulary FORMULARY 04/02/2021 BARHEMSYS amisulpride REMOVE FROM Non-Formulary FORMULARY 04/09/2021 hydrocodone hydrocodone bitartrate ADD UM: Total cumulative bitartrate er QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 110 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/09/2021 hydrocodone hydrocodone bitartrate ADD UM: Total cumulative bitartrate er QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 04/09/2021 hydrocodone hydrocodone bitartrate ADD UM: Total cumulative bitartrate er QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 04/09/2021 hydrocodone hydrocodone bitartrate ADD UM: Total cumulative bitartrate er QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 04/09/2021 hydrocodone hydrocodone bitartrate ADD UM: Total cumulative bitartrate er QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 04/09/2021 hydrocodone hydrocodone bitartrate ADD UM: Total cumulative bitartrate er QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 111 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/09/2021 hydrocodone hydrocodone bitartrate ADD UM: Total cumulative bitartrate er QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 04/09/2021 TRAZIMERA trastuzumab-qyyp ADD UM: MED Medical Drug 04/09/2021 gas relief simethicone REMOVE FROM Non-Formulary FORMULARY 04/09/2021 gentle laxative bisacodyl REMOVE FROM Non-Formulary FORMULARY 04/09/2021 lansoprazole lansoprazole REMOVE FROM Non-Formulary FORMULARY 04/09/2021 butorphanol butorphanol tartrate REMOVE FROM Non-Formulary tartrate FORMULARY 04/09/2021 butorphanol butorphanol tartrate REMOVE FROM Non-Formulary tartrate FORMULARY 04/09/2021 medicated heat capsaicin REMOVE FROM Non-Formulary patch FORMULARY 04/09/2021 CULTURELLE lactobacillus rhamnosus gg REMOVE FROM Non-Formulary KIDS PURELY FORMULARY PROB 04/09/2021 MODERNA covid-19 vaccine, mrna- REMOVE FROM Non-Formulary COVID-19 1273, lnp-s (moderna)/pf FORMULARY VACCINE (EUA) 04/09/2021 MODERNA covid-19 vaccine, mrna- REMOVE FROM Non-Formulary COVID-19 1273, lnp-s (moderna)/pf FORMULARY VACCINE (EUA) 04/09/2021 LIQUACEL amino acids/protein REMOVE FROM Non-Formulary hydrolysate FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 112 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/09/2021 pen needle pen needle, diabetic REMOVE FROM Non-Formulary FORMULARY 04/09/2021 comfort touch ult lancets REMOVE FROM Non-Formulary thin lancet FORMULARY 04/09/2021 comfort touch lancets REMOVE FROM Non-Formulary plus safety lanc FORMULARY 04/09/2021 contour next blood-glucose meter REMOVE FROM Non-Formulary glucose meter FORMULARY 04/09/2021 KERALYT salicylic acid REMOVE FROM Non-Formulary FORMULARY 04/09/2021 NATTOKINASE soybean, fermented REMOVE FROM Non-Formulary FORMULARY 04/09/2021 laxative sennosides REMOVE FROM Non-Formulary FORMULARY 04/09/2021 boil relief benzocaine REMOVE FROM Non-Formulary FORMULARY 04/09/2021 liquid bandage nitrocellulose REMOVE FROM Non-Formulary FORMULARY 04/09/2021 DERMACINRX multivitamin with minerals REMOVE FROM Non-Formulary FOLITIN-Z no.89/ferrous fumarate/folic FORMULARY acid 04/09/2021 miconazole 7 miconazole nitrate REMOVE FROM Non-Formulary FORMULARY 04/09/2021 succinylcholine succinylcholine chloride REMOVE FROM Non-Formulary chloride FORMULARY 04/09/2021 verapamil hcl verapamil hcl REMOVE FROM Non-Formulary FORMULARY 04/09/2021 verapamil hcl verapamil hcl REMOVE FROM Non-Formulary FORMULARY 04/09/2021 labetalol hcl labetalol hcl REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 113 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/09/2021 labetalol hcl labetalol hcl REMOVE FROM Non-Formulary FORMULARY 04/09/2021 labetalol hcl labetalol hcl REMOVE FROM Non-Formulary FORMULARY 04/09/2021 diazepam diazepam REMOVE FROM Non-Formulary FORMULARY 04/09/2021 magnesium magnesium sulfate in sterile REMOVE FROM Non-Formulary sulfate water FORMULARY 04/09/2021 magnesium magnesium sulfate in sterile REMOVE FROM Non-Formulary sulfate water FORMULARY 04/09/2021 diclofenac diclofenac sodium REMOVE FROM Non-Formulary sodium FORMULARY 04/09/2021 docetaxel docetaxel REMOVE FROM Non-Formulary FORMULARY 04/09/2021 docetaxel docetaxel REMOVE FROM Non-Formulary FORMULARY 04/09/2021 neostigmine neostigmine methylsulfate REMOVE FROM Non-Formulary methylsulfate FORMULARY 04/09/2021 SIVEXTRO tedizolid phosphate REMOVE FROM Non-Formulary FORMULARY 04/09/2021 CYCLOPHOSPH cyclophosphamide REMOVE FROM Non-Formulary AMIDE FORMULARY 04/12/2021 XTANDI enzalutamide ADD UM: LIMITEDACCESS Limited Access 04/12/2021 XTANDI enzalutamide ADD UM: LIMITEDACCESS Limited Access 04/12/2021 HETLIOZ LQ tasimelteon ADD UM: QUANTITY 5 / 1 days 04/12/2021 HETLIOZ LQ tasimelteon ADD UM: SPECIALTY Specialty Drug 04/12/2021 HETLIOZ LQ tasimelteon ADD UM: LIMITEDACCESS Limited Access 04/14/2021 BARHEMSYS amisulpride ADD UM: MED Medical Drug

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 114 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/14/2021 SAROCLADIUM allergenic extract- ADD UM: MED Medical Drug STRICTUM acremonium strictum

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 115 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/14/2021 xanax,xanax alprazolam,olanzapine,olanz CHANGE UM: CUSTOM Covered by xr,zyprexa,zyprex apine OMAP a zydis,zyprexa pamoate,diazepam,lorazepa relprevv,alprazola m,thiothixene,ziprasidone m mesylate,ziprasidone intensol,diazepa hcl,asenapine m,lorazepam maleate,risperidone,quetiapi intensol,navane,g ne fumarate, eodon,saphris,ris lactate,clozapine,iloperidone peridone,quetiapi ,buspirone hcl, ne hcl,oxazepam,clorazepate fumarate,haloperi dipotassium,thioridazine dol hcl, lactate,niravam,cl hcl,haloperidol,loxapine ozaril,fanapt,busp succinate,droperidol,chlordia irone zepoxide hcl,lorazepam,alp hcl,,meprobam razolam ate, er,clozapine hcl,haloperidol odt,clozapine,ola decanoate,aripiprazole,palip nzapine,olanzapi eridone,risperidone ne microspheres,paliperidone odt,valium,fluphe palmitate,fluphenazine nazine decanoate,,molindo hcl,oxazepam,alp ne hcl,lurasidone razolam,alprazola hcl,alprazolam/dietary m supplement,misc combo odt,clorazepate no.17,loxapine,brexpiprazol dipotassium,sero e,aripiprazole quel,seroquel lauroxil,cariprazine xr,thioridazine hcl,pimavanserin hcl,trifluoperazine tartrate,aripiprazole lauroxil, hcl,haloperidol,thi submicronized,asenapine,lu othixene,risperido mateperone tosylate ne odt,loxapine,drop eridol,chlordiazep oxide hcl,perphenazine,

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 116 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value ,chl orpromazine hcl,,ziprasi done hcl,haloperidol decanoate 100,vanspar,risp erdal,abilify,ativa n,fazaclo,invega, alprazolam xr,haldol decanoate 50,haldol decanoate 100,haldol,risper dal consta,risperdal m-tab,invega sustenna,loxitane ,fluphenazine decanoate,orap,a bilify maintena,abilify discmelt,moban,l atuda,tranxene t- tab,gabazolamine ,buspar,librium,ve rsacloz,inapsine,t ranxene sd,adasuve,aripip razole,invega trinza,rexulti,palip eridone er,pimozide,aripip razole odt,aristada,molin done hcl,vraylar,nuplaz

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 117 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value id,quetiapine fumarate er,aristada initio,perseris,abil ify mycite,secuado,c aplyta,ziprasidon e mesylate,asenapi ne maleate

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 118 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/14/2021 cymbalta,effexor, duloxetine hcl,venlafaxine CHANGE UM: CUSTOM Covered by symbyax,prozac hcl,olanzapine/ OMAP weekly,effexor hcl,fluoxetine xr,pristiq,aplenzin hcl,desvenlafaxine ,parnate,strattera, succinate,bupropion lithium carbonate hbr,tranylcypromine er,lithium sulfate, carbonate,lithium, hcl,lithium carbonate,lithium paxil citrate,paroxetine cr,paxil,zoloft,cital hcl, hcl, opram hydrobromide,protriptyline hbr,protriptyline hcl, hcl,imipramine pamoate,,desipr pamoate,remeron hcl,phenelzine ,norpramin,nardil, sulfate, olanzapine- maleate, fluoxetine oxalate,nortriptyline hcl,fluvoxamine hcl, maleate,fluoxetin hcl,doxepin hcl,bupropion e hcl,nefazodone hcl,escitalopram hcl,trazodone hcl,maprotiline oxalate,paroxetin hcl,perphenazine/amitriptylin e e hcl, hcl,selfemra,nortr hcl,amitriptyline iptyline hcl/chlordiazepoxide,modafi hcl,clomipramine nil,imipramine hcl,doxepin hcl,vilazodone hcl,mirtazapine,v hcl,amoxapine,st. john's enlafaxine wort,clonidine hcl,venlafaxine hcl,armodafinil,carbamazepi hcl er,bupropion ne,isocarboxazid,,t hcl,budeprion rimipramine xl,budeprion maleate,desvenlafaxine,gua sr,nefazodone nfacine hcl,vortioxetine hcl,sertraline hydrobromide,trazodone hcl,bupropion hcl hcl/dietary sr,bupropion supplement,misc.combo8,flu xl,wellbutrin oxetine hcl/dietary sr,wellbutrin,trazo supplement,misc

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 119 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value done comb17,fluoxetine hcl,wellbutrin hcl/dietary xl,maprotiline supplement,misc.combo8,bu hcl,perphenazine propion hcl/dietary - supplement,misc amitriptyline,paro comb15,bupropion xetine hcl/dietary supplement,misc er,amitriptyline comb16,paroxetine hcl,chlordiazepox mesylate, ide- hcl,desvenlafaxine amitriptyline,mod fumarate, afinil,anafranil,pa hcl,brexanolone, melor,tofranil,tofr hcl anil- pm,sarafem,lexa pro,celexa,viibryd ,fluoxetine dr,amoxapine,pro zac,imipramine hcl,desipramine hcl,st. john's wort,fluvoxamine maleate er,clonidine hcl er,provigil,nuvigil, paroxetine cr,equetro,marpla n,emsam,phenelz ine sulfate,trimiprami ne maleate,khedezla ,forfivo xl,tranylcypromin e sulfate,surmontil, vivactil,intuniv,am itriptyline- perphenazine,ka

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 120 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value pvay,desvenlafax ine er,brintellix,lithiu m citrate,trazamine, gaboxetine,sentr oxatine,appbuta mone- d,appbutamone,l uvox cr,lithobid,pexeva ,oleptro er,limbitrol,fetzim a,amitriptyline- chlordiazepoxide, citalopram,duloxe tine hcl,limbitrol ds,desyrel,rapiflu x,desvenlafaxine fumarate er,guanfacine hcl er,irenka,trintellix, elavil,armodafinil, bupropion hcl er,desvenlafaxine succinate er,atomoxetine hcl,spravato,zulre sso,sunosi,drizal ma sprinkle

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 121 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/14/2021 ,lamict lamotrigine CHANGE UM: CUSTOM Covered by al,lamictal OMAP (orange),lamictal (blue),lamictal xr,lamictal xr (blue),lamictal xr (green),lamictal xr (orange),lamictal odt,lamictal odt (orange),lamictal odt (blue),lamictal odt (green),lamictal (green),lamotrigin e er,lamotrigine odt,lamotrigine odt (blue),lamotrigine odt (green),lamotrigin e odt (orange),lamotrigi ne (orange),lamotrigi ne (green),lamotrigin e (blue),subvenite,s ubvenite (orange),subvenit e (blue),subvenite (green) 04/14/2021 depakene,valproi valproic acid CHANGE UM: CUSTOM Covered by c OMAP acid,stavzor,depr oic,dalpro

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 122 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/15/2021 gabapentin gabapentin ADD TO FORMULARY Covered 04/15/2021 disulfiram disulfiram CHANGE TIER Covered 04/16/2021 HOMACTIN AA nutritional therapy, REMOVE FROM Non-Formulary PLUS 15 PE metabolic disorder, FORMULARY -free 04/16/2021 acetaminophen acetaminophen REMOVE FROM Non-Formulary FORMULARY 04/16/2021 acetaminophen acetaminophen REMOVE FROM Non-Formulary FORMULARY 04/16/2021 acetaminophen acetaminophen REMOVE FROM Non-Formulary FORMULARY 04/16/2021 loratadine loratadine REMOVE FROM Non-Formulary FORMULARY 04/16/2021 magnesium magnesium citrate REMOVE FROM Non-Formulary citrate FORMULARY 04/16/2021 klor-con-ef potassium bicarbonate/citric REMOVE FROM Non-Formulary acid FORMULARY 04/16/2021 one step pregnancy test kit REMOVE FROM Non-Formulary pregnancy test FORMULARY 04/16/2021 children's ibuprofen REMOVE FROM Non-Formulary ibuprofen FORMULARY 04/16/2021 timolol maleate timolol maleate/pf REMOVE FROM Non-Formulary FORMULARY 04/16/2021 omeprazole omeprazole magnesium REMOVE FROM Non-Formulary magnesium FORMULARY 04/16/2021 omeprazole omeprazole magnesium REMOVE FROM Non-Formulary magnesium FORMULARY 04/16/2021 lutein lutein REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 123 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/16/2021 eye pad eye patch REMOVE FROM Non-Formulary FORMULARY 04/16/2021 antacid extra calcium carbonate REMOVE FROM Non-Formulary strength FORMULARY 04/16/2021 men's one daily multivitamin with REMOVE FROM Non-Formulary minerals/folic acid/vitamin FORMULARY k1/lycopene 04/16/2021 prenatal vitamin prenatal vits with calcium REMOVE FROM Non-Formulary plus low iron no.72/ferrous fumarate/folic FORMULARY acid 04/16/2021 KETOVIE 4:1 nutritional tx, REMOVE FROM Non-Formulary ketogenic,whey FORMULARY 04/16/2021 nextol sf candy lollipop base no.232 REMOVE FROM Non-Formulary base FORMULARY 04/16/2021 nextol sf candy lollipop base no.232 REMOVE FROM Non-Formulary base FORMULARY 04/16/2021 krystal sf candy lollipop base no.233 REMOVE FROM Non-Formulary base FORMULARY 04/16/2021 krystal sf candy lollipop base no.233 REMOVE FROM Non-Formulary base FORMULARY 04/16/2021 carepoint luer syringe with REMOVE FROM Non-Formulary lock needle,disposable, 3 ml FORMULARY 04/16/2021 carepoint luer slip syringe with REMOVE FROM Non-Formulary syring-ndl needle,disposable, 1 ml FORMULARY 04/16/2021 saloxicin willow bark ext/boswellia REMOVE FROM Non-Formulary serrata ext/herbal complex FORMULARY no. 322 04/16/2021 nuvagel silicone adhesive REMOVE FROM Non-Formulary FORMULARY 04/16/2021 pogo automatic lancets with blood glucose REMOVE FROM Non-Formulary test cartridge test strips FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 124 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/16/2021 medcaps herbal complex no.321 REMOVE FROM Non-Formulary menopause FORMULARY 04/16/2021 NEUROACTIVES a-carnitine/a- REMOVE FROM Non-Formulary BRAINSUSTAIN cyst/ala/coq10/phos FORMULARY serine/broccoli seed ext 04/16/2021 MEDCAPS GI glutamine/inulin/vitamin REMOVE FROM Non-Formulary b5/zinc glycinate/aloe vera FORMULARY extract 04/16/2021 MEDCAPS DPO pyridoxal REMOVE FROM Non-Formulary phos/methyltetrahydrofolate/ FORMULARY mecobalamin/herb 320 04/16/2021 niacin niacin (inositol niacinate) REMOVE FROM Non-Formulary FORMULARY 04/16/2021 st. john's wort st. john's wort REMOVE FROM Non-Formulary FORMULARY 04/16/2021 cold-flu severe phenylephrine REMOVE FROM Non-Formulary hcl/dextromethorphan FORMULARY hbr/acetaminophen/guaifen 04/16/2021 melatonin melatonin REMOVE FROM Non-Formulary FORMULARY 04/16/2021 sinus pressure- phenylephrine REMOVE FROM Non-Formulary pain hcl/acetaminophen FORMULARY 04/16/2021 s-acetyl s-acetylglutathione REMOVE FROM Non-Formulary FORMULARY 04/16/2021 skin protectant petrolatum,white REMOVE FROM Non-Formulary FORMULARY 04/16/2021 cough gels dextromethorphan hbr REMOVE FROM Non-Formulary FORMULARY 04/16/2021 succinylcholine succinylcholine chloride REMOVE FROM Non-Formulary chloride FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 125 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/16/2021 hydralazine hcl hydralazine hcl REMOVE FROM Non-Formulary FORMULARY 04/16/2021 PHOXILLUM phosphate hemodialysis REMOVE FROM Non-Formulary solution no.2 without FORMULARY dextrose 04/16/2021 ultra flo insulin syringe with REMOVE FROM Non-Formulary syringe needle,insulin,0.3 ml FORMULARY 04/16/2021 ultra flo insulin syringe with REMOVE FROM Non-Formulary syringe needle,insulin,0.5 ml FORMULARY 04/16/2021 ultra flo pen pen needle, diabetic REMOVE FROM Non-Formulary needle FORMULARY 04/16/2021 OXIATAR tretinoin/hyaluronate REMOVE FROM Non-Formulary sodium/niacinamide FORMULARY 04/16/2021 OXIAVARRY tretinoin/hyaluronate REMOVE FROM Non-Formulary sodium/niacinamide FORMULARY 04/16/2021 ONZDEOXIA benzoyl REMOVE FROM Non-Formulary peroxide/clindamycin FORMULARY phosphate/niacinamide 04/16/2021 ROAOXIA diclofenac REMOVE FROM Non-Formulary sodium/hyaluronate FORMULARY sodium/niacinamide 04/16/2021 GUANENDRUX salicylic REMOVE FROM Non-Formulary acid/cimetidine/lidocaine FORMULARY 04/16/2021 pregabalin er pregabalin REMOVE FROM Non-Formulary FORMULARY 04/16/2021 pregabalin er pregabalin REMOVE FROM Non-Formulary FORMULARY 04/16/2021 pregabalin er pregabalin REMOVE FROM Non-Formulary FORMULARY 04/16/2021 pregabalin er pregabalin REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 126 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/16/2021 pregabalin er pregabalin REMOVE FROM Non-Formulary FORMULARY 04/16/2021 pregabalin er pregabalin REMOVE FROM Non-Formulary FORMULARY 04/16/2021 pregabalin er pregabalin REMOVE FROM Non-Formulary FORMULARY 04/16/2021 pregabalin er pregabalin REMOVE FROM Non-Formulary FORMULARY 04/16/2021 pregabalin er pregabalin REMOVE FROM Non-Formulary FORMULARY 04/19/2021 lansoprazole lansoprazole ADD TO FORMULARY Covered 04/20/2021 XERMELO telotristat etiprate CHANGE UM: SPECIALTY Specialty Drug 04/20/2021 XERMELO telotristat etiprate CHANGE UM: Limited Access LIMITEDACCESS 04/21/2021 ARCALYST rilonacept CHANGE UM: SPECIALTY Specialty Drug 04/21/2021 ARCALYST rilonacept CHANGE UM: Limited Access LIMITEDACCESS 04/21/2021 ARCALYST rilonacept CHANGE UM: MED Medical Drug 04/21/2021 CINRYZE c1 esterase inhibitor ADD UM: SPECIALTY Specialty Drug 04/21/2021 CINRYZE c1 esterase inhibitor CHANGE UM: Limited Access LIMITEDACCESS 04/21/2021 CINRYZE c1 esterase inhibitor CHANGE UM: MED Medical Drug 04/21/2021 strattera,atomoxe atomoxetine hcl REMOVE UM: QUANTITY tine hcl 04/21/2021 strattera,atomoxe atomoxetine hcl REMOVE UM: QUANTITY tine hcl 04/21/2021 strattera,atomoxe atomoxetine hcl REMOVE UM: QUANTITY tine hcl

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 127 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/21/2021 rightest gs700 blood sugar diagnostic ADD UM: QUANTITY 5 / 1 days test strip 04/21/2021 QUTENZA capsaicin/skin cleanser ADD UM: SPECIALTY Specialty Drug 04/21/2021 QUTENZA capsaicin/skin cleanser ADD UM: MED Medical Drug 04/21/2021 proventil albuterol sulfate ADD UM: 2 INHALERS hfa,ventolin QUANTITYCUSTOM PER 30 DAYS hfa,proair hfa,albuterol sulfate hfa 04/21/2021 proventil albuterol sulfate REMOVE UM: QUANTITY hfa,ventolin hfa,proair hfa,albuterol sulfate hfa 04/21/2021 proventil hfa albuterol sulfate CHANGE UM: CUSTOM ELIGIBLE FOR 90 DAY SUPPLY 04/22/2021 OZEMPIC semaglutide ADD UM: QUANTITY 3 / 28 days 04/22/2021 OZEMPIC semaglutide ADD UM: CUSTOM ELIGIBLE FOR 90 DAY SUPPLY 04/23/2021 FINAPOD minoxidil/finasteride REMOVE FROM Non-Formulary FORMULARY 04/23/2021 OXIANUJO tacrolimus/niacinamide REMOVE FROM Non-Formulary FORMULARY 04/23/2021 OXIANUJO tacrolimus/hyaluronate REMOVE FROM Non-Formulary sodium/niacinamide FORMULARY 04/23/2021 ACIOXIAY azelaic acid/niacinamide REMOVE FROM Non-Formulary FORMULARY 04/23/2021 caffeine caffeine REMOVE FROM Non-Formulary FORMULARY 04/23/2021 stool softener docusate sodium REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 128 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/23/2021 athlete's foot tolnaftate REMOVE FROM Non-Formulary FORMULARY 04/23/2021 infants' gas relief simethicone REMOVE FROM Non-Formulary FORMULARY 04/23/2021 loratadine loratadine REMOVE FROM Non-Formulary FORMULARY 04/23/2021 ertapenem ertapenem sodium REMOVE FROM Non-Formulary FORMULARY 04/23/2021 ertapenem ertapenem sodium REMOVE FROM Non-Formulary FORMULARY 04/23/2021 elastic bandage elastic bandage REMOVE FROM Non-Formulary FORMULARY 04/23/2021 lutein lutein REMOVE FROM Non-Formulary FORMULARY 04/23/2021 red yeast rice red yeast rice REMOVE FROM Non-Formulary FORMULARY 04/23/2021 PROMISEB emollient combination no.43 REMOVE FROM Non-Formulary FORMULARY 04/23/2021 sore muscle rub menthol REMOVE FROM Non-Formulary FORMULARY 04/23/2021 revonto dantrolene sodium REMOVE FROM Non-Formulary FORMULARY 04/23/2021 magnesium magnesium oxide REMOVE FROM Non-Formulary FORMULARY 04/23/2021 ENFAMIL infant formula with REMOVE FROM Non-Formulary NEURO iron/docosahexaenoic FORMULARY ENFACARE acid/arachidonic ac NON-GMO

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 129 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/23/2021 ENFAMIL infant formula with REMOVE FROM Non-Formulary NEURO iron/docosahexaenoic FORMULARY ENFACARE acid/arachidonic ac NON-GMO 04/23/2021 ultra flo insulin syringe with needle,insulin REMOVE FROM Non-Formulary syringe 0.3 ml (half unit mark) FORMULARY 04/23/2021 aquacel-ag silver/hydrocolloid dressing REMOVE FROM Non-Formulary advantage FORMULARY 04/23/2021 ultra flo insulin syringe with needle,insulin REMOVE FROM Non-Formulary syringe 0.3 ml (half unit mark) FORMULARY 04/23/2021 ultra flo insulin syringe with needle,insulin REMOVE FROM Non-Formulary syringe 0.3 ml (half unit mark) FORMULARY 04/23/2021 gentle wrap elastic bandage REMOVE FROM Non-Formulary FORMULARY 04/23/2021 gentle wrap elastic bandage REMOVE FROM Non-Formulary FORMULARY 04/23/2021 menofem herbal complex no.323 REMOVE FROM Non-Formulary FORMULARY 04/23/2021 KONSYL DAILY psyllium husk/sweetleaf REMOVE FROM Non-Formulary FIBER FORMULARY 04/23/2021 SYNOVX glycosaminoglycans,mixed/a REMOVE FROM Non-Formulary METABOLIC scorbic acid FORMULARY 04/23/2021 SYNOVX collagen/hyaluronic REMOVE FROM Non-Formulary PERFORMANCE acid/hesperidin/hops extract FORMULARY 04/23/2021 LITHOLYTE potassium REMOVE FROM Non-Formulary citrate/magnesium FORMULARY citrate/sodium bicarbonate 04/23/2021 MEDCAPS T3 vit a palm/vit d3/vit REMOVE FROM Non-Formulary e/iodine/zinc/selenomethioni FORMULARY ne/herbs

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 130 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/23/2021 diphenhydramine diphenhydramine hcl REMOVE FROM Non-Formulary hcl FORMULARY 04/23/2021 sinus severe guaifenesin/phenylephrine REMOVE FROM Non-Formulary hcl/acetaminophen FORMULARY 04/23/2021 melatonin melatonin REMOVE FROM Non-Formulary FORMULARY 04/23/2021 MUCOR allergenic extract-mucor REMOVE FROM Non-Formulary PLUMBEUS plumbeus FORMULARY 04/23/2021 GEAMETDRAY salicylic REMOVE FROM Non-Formulary acid/ibuprofen/cimetidine FORMULARY 04/23/2021 OXOPOD minoxidil/betamethasone REMOVE FROM Non-Formulary dipropionate FORMULARY 04/23/2021 succinylcholine succinylcholine chloride REMOVE FROM Non-Formulary chloride FORMULARY 04/23/2021 DEMEROL meperidine hcl/pf REMOVE FROM Non-Formulary FORMULARY 04/23/2021 DEMEROL meperidine hcl/pf REMOVE FROM Non-Formulary FORMULARY 04/23/2021 temsirolimus temsirolimus REMOVE FROM Non-Formulary FORMULARY 04/23/2021 dolishale levonorgestrel/ethinyl ADD TO FORMULARY Covered estradiol 04/23/2021 dolishale levonorgestrel/ethinyl ADD TO FORMULARY Covered estradiol 04/23/2021 LABETALOL labetalol hcl in sodium REMOVE FROM Non-Formulary HCL-NACL chloride, iso-osmotic FORMULARY 04/23/2021 LABETALOL labetalol hcl in sodium REMOVE FROM Non-Formulary HCL-NACL chloride, iso-osmotic FORMULARY 04/23/2021 LABETALOL labetalol hcl in sodium REMOVE FROM Non-Formulary HCL-NACL chloride, iso-osmotic FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 131 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/23/2021 LABETALOL labetalol hcl in dextrose, iso- REMOVE FROM Non-Formulary HCL-DEXTROSE osmotic FORMULARY 04/23/2021 DERMALID lidocaine/elastic bandage REMOVE FROM Non-Formulary FORMULARY 04/26/2021 MAYZENT siponimod ADD TO FORMULARY Covered 04/30/2021 woundgelha hyaluronate REMOVE FROM Non-Formulary matrix sodium/hydroxyethylcellulos FORMULARY e/polyethylene glycol 04/30/2021 woundgelha hyaluronate REMOVE FROM Non-Formulary matrix sodium/hydroxyethylcellulos FORMULARY e/polyethylene glycol 04/30/2021 chlordiazepoxide- chlordiazepoxide/clidinium REMOVE FROM Non-Formulary clidinium bromide FORMULARY 04/30/2021 norepinephrine norepinephrine bitartrate REMOVE FROM Non-Formulary bitartrate FORMULARY 04/30/2021 galactose galactose REMOVE FROM Non-Formulary FORMULARY 04/30/2021 ultra flo pen pen needle, diabetic REMOVE FROM Non-Formulary needle FORMULARY 04/30/2021 ultra flo pen pen needle, diabetic REMOVE FROM Non-Formulary needle FORMULARY 04/30/2021 quickvue at-home covid-19 antigen REMOVE FROM Non-Formulary covid-19 test immunoassay test FORMULARY 04/30/2021 quickvue at-home covid-19 antigen REMOVE FROM Non-Formulary covid-19 test immunoassay test FORMULARY 04/30/2021 TYLENOL acetaminophen REMOVE FROM Non-Formulary EXTRA FORMULARY STRENGTH

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 132 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/30/2021 SYNOVX DJD glucosamin/chondroitin/msm REMOVE FROM Non-Formulary /vit FORMULARY c/manganese/hyaluronic/mu ssel 04/30/2021 VISTA MEIBO eyelid cleanser combination REMOVE FROM Non-Formulary EYELID no.11 FORMULARY CLEANSING 04/30/2021 MEMORALL b6/mfolate/b12/acetylcarnitin REMOVE FROM Non-Formulary e/acetylcysteine/ginko/herbs FORMULARY 04/30/2021 MUCINEX guaifenesin/phenylephrine REMOVE FROM Non-Formulary FREEFROM hcl/acetaminophen FORMULARY COLD-FLU- CONG 04/30/2021 dairy relief lactase REMOVE FROM Non-Formulary FORMULARY 04/30/2021 pain relieving methyl REMOVE FROM Non-Formulary salicylate/menthol/camphor FORMULARY 04/30/2021 cold therapy menthol REMOVE FROM Non-Formulary FORMULARY 04/30/2021 vista meibo tears propylene glycol REMOVE FROM Non-Formulary FORMULARY 04/30/2021 vista gel hypromellose REMOVE FROM Non-Formulary FORMULARY 04/30/2021 vista tears propylene REMOVE FROM Non-Formulary glycol/polyethylene glycol FORMULARY 400 04/30/2021 gas relief simethicone ADD TO FORMULARY Covered 04/30/2021 mucinex fast-max phenylephrine REMOVE FROM Non-Formulary cold-flu hcl/dextromethorphan FORMULARY hbr/acetaminophen/guaifen 04/30/2021 sodium chloride sodium chloride 0.9 % REMOVE FROM Non-Formulary (flush) FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 133 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 04/30/2021 diltiazem hcl- diltiazem hcl in 0.9 % REMOVE FROM Non-Formulary 0.7% nacl sodium chloride FORMULARY 04/30/2021 ADAINZOXIA adapalene/benzoyl REMOVE FROM Non-Formulary peroxide/niacinamide FORMULARY 04/30/2021 ADAINZDE adapalene/benzoyl REMOVE FROM Non-Formulary peroxide/clindamycin FORMULARY phosphate 04/30/2021 QUIHOXVAR imiquimod/tretinoin/levocetiri REMOVE FROM Non-Formulary zine dihydrochloride FORMULARY 04/30/2021 PODPROG minoxidil/ REMOVE FROM Non-Formulary FORMULARY 04/30/2021 OXIAZAR tretinoin/hyaluronate REMOVE FROM Non-Formulary sodium/niacinamide FORMULARY 04/30/2021 DIOCHLOY clobetasol REMOVE FROM Non-Formulary propionate/calcipotriene FORMULARY 04/30/2021 HAXCHLO ciclopirox olamine/clobetasol REMOVE FROM Non-Formulary propionate FORMULARY 04/30/2021 XPOVIO selinexor ADD TO FORMULARY Covered 04/30/2021 XPOVIO selinexor ADD TO FORMULARY Covered 04/30/2021 XPOVIO selinexor ADD TO FORMULARY Covered 04/30/2021 XPOVIO selinexor ADD TO FORMULARY Covered 04/30/2021 ALTERNARIA allergenic extract-alternaria REMOVE FROM Non-Formulary ALTERNATA alternata FORMULARY 04/30/2021 AUREOBASIDIU allergenic extract- REMOVE FROM Non-Formulary M PULLULANS aureobasidium pullulans FORMULARY 04/30/2021 EPICOCCUM allergenic extract-epicoccum REMOVE FROM Non-Formulary NIGRUM nigrum FORMULARY 04/30/2021 HIXDEFRIMA ciclopirox REMOVE FROM Non-Formulary olamine/fluconazole/terbinafi FORMULARY ne hcl

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 134 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

May, 2021

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/01/2021 SEMGLEE insulin glargine,human ADD TO FORMULARY Covered recombinant analog 05/01/2021 SEMGLEE PEN insulin glargine,human ADD TO FORMULARY Covered recombinant analog 05/01/2021 progesterone in progesterone ADD TO FORMULARY Non-Formulary Covered oil,progesterone 05/01/2021 progesterone in progesterone ADD UM: MED Medical Drug oil,progesterone 05/01/2021 progesterone in progesterone REMOVE UM: MED Medical Drug oil,progesterone 05/01/2021 ketoconazole ketoconazole ADD TO FORMULARY Covered 05/01/2021 baclofen baclofen ADD TO FORMULARY Covered 05/01/2021 sulfadiazine sulfadiazine ADD TO FORMULARY Covered 05/01/2021 hydroxyzine hydroxyzine pamoate ADD TO FORMULARY Covered pamoate 05/01/2021 azathioprine azathioprine ADD TO FORMULARY Covered 05/01/2021 imipramine hcl imipramine hcl ADD TO FORMULARY Covered 05/01/2021 atenolol atenolol ADD TO FORMULARY Covered 05/01/2021 sulfasalazine sulfasalazine ADD TO FORMULARY Covered 05/01/2021 topiramate ADD TO FORMULARY Covered 05/01/2021 amitriptyline hcl amitriptyline hcl ADD TO FORMULARY Covered 05/01/2021 sulindac sulindac ADD TO FORMULARY Covered 05/01/2021 sodium sodium phenylbutyrate ADD TO FORMULARY Covered phenylbutyrate 05/01/2021 mefenamic acid mefenamic acid ADD TO FORMULARY Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 135 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/01/2021 terbutaline sulfate terbutaline sulfate ADD TO FORMULARY Covered 05/01/2021 glyburide glyburide ADD TO FORMULARY Non-Formulary Covered 05/01/2021 levothyroxine levothyroxine sodium ADD TO FORMULARY Covered sodium 05/01/2021 hcl methadone hcl ADD TO FORMULARY Covered 05/01/2021 sodium valproic acid (as sodium ADD TO FORMULARY Covered valproate,valproa salt) (valproate te sodium sodium),valproate sodium 05/01/2021 glipizide glipizide ADD TO FORMULARY Covered 05/01/2021 heparin sodium heparin sodium,porcine ADD TO FORMULARY Covered 05/01/2021 mitotane mitotane ADD TO FORMULARY Covered 05/01/2021 zolmitriptan zolmitriptan ADD TO FORMULARY Covered 05/01/2021 ivermectin ivermectin ADD TO FORMULARY Covered 05/01/2021 potassium potassium chloride ADD TO FORMULARY Covered chloride 05/01/2021 procarbazine hcl procarbazine hcl ADD TO FORMULARY Covered 05/01/2021 leucovorin leucovorin calcium ADD TO FORMULARY Covered calcium,calcium folinate 05/01/2021 azithromycin azithromycin ADD TO FORMULARY Covered 05/01/2021 erythromycin erythromycin base ADD TO FORMULARY Covered 05/01/2021 ciprofloxacin hcl ciprofloxacin hcl ADD TO FORMULARY Covered 05/01/2021 tropicamide tropicamide ADD TO FORMULARY Covered 05/01/2021 podofilox podofilox ADD TO FORMULARY Covered 05/01/2021 buprenorphine buprenorphine hcl ADD TO FORMULARY Covered hcl,buprenorphin e hydrochloride 05/01/2021 trimethoprim trimethoprim ADD TO FORMULARY Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 136 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/01/2021 triamterene triamterene ADD TO FORMULARY Covered 05/01/2021 budesonide budesonide, micronized ADD TO FORMULARY Covered micronized,budes onide 05/01/2021 trazodone hcl trazodone hcl ADD TO FORMULARY Covered 05/01/2021 mechlorethamine mechlorethamine hcl ADD TO FORMULARY Covered hcl 05/01/2021 estradiol valerate ADD TO FORMULARY Covered 05/01/2021 cromolyn sodium cromolyn sodium ADD TO FORMULARY Covered 05/01/2021 spironolactone ADD TO FORMULARY Covered 05/01/2021 pyrimethamine pyrimethamine ADD TO FORMULARY Covered 05/01/2021 zonisamide zonisamide ADD TO FORMULARY Covered 05/01/2021 quinine sulfate quinine sulfate ADD TO FORMULARY Covered 05/01/2021 cycloserine ADD TO FORMULARY Covered 05/01/2021 econazole nitrate econazole nitrate ADD TO FORMULARY Covered 05/01/2021 clindamycin hcl clindamycin hcl ADD TO FORMULARY Covered 05/01/2021 ergocalciferol ergocalciferol (vitamin d2) ADD TO FORMULARY Covered 05/01/2021 erythromycin erythromycin ethylsuccinate ADD TO FORMULARY Covered ethylsuccinate 05/01/2021 pyridostigmine pyridostigmine bromide ADD TO FORMULARY Covered bromide 05/01/2021 doxycycline doxycycline hyclate ADD TO FORMULARY Covered hyclate 05/01/2021 colchicine colchicine ADD TO FORMULARY Covered 05/01/2021 warfarin sodium warfarin sodium ADD TO FORMULARY Covered 05/01/2021 lamotrigine lamotrigine ADD TO FORMULARY Covered 05/01/2021 diltiazem hcl diltiazem hcl ADD TO FORMULARY Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 137 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/01/2021 labetalol hcl labetalol hcl ADD TO FORMULARY Covered 05/01/2021 ketoprofen ketoprofen ADD TO FORMULARY Covered 05/01/2021 ketoprofen ketoprofen, micronized ADD TO FORMULARY Covered micronized 05/01/2021 lidocaine hcl lidocaine hcl ADD TO FORMULARY Covered 05/01/2021 sirolimus sirolimus ADD TO FORMULARY Non-Formulary Covered 05/01/2021 azelaic acid azelaic acid ADD TO FORMULARY Non-Formulary Covered 05/01/2021 estradiol ADD TO FORMULARY Covered cypionate 05/01/2021 ipratropium ipratropium bromide ADD TO FORMULARY Covered bromide 05/01/2021 buspirone hcl buspirone hcl ADD TO FORMULARY Covered 05/01/2021 doxepin hcl doxepin hcl ADD TO FORMULARY Covered 05/01/2021 ondansetron hcl ondansetron hcl ADD TO FORMULARY Covered 05/01/2021 liothyronine liothyronine sodium ADD TO FORMULARY Covered sodium 05/01/2021 gemfibrozil ADD TO FORMULARY Covered 05/01/2021 furosemide ADD TO FORMULARY Covered 05/01/2021 phenoxybenzami phenoxybenzamine hcl ADD TO FORMULARY Covered ne hcl 05/01/2021 flurbiprofen flurbiprofen ADD TO FORMULARY Non-Formulary Covered 05/01/2021 dantrolene dantrolene sodium ADD TO FORMULARY Covered sodium 05/01/2021 cyclophosphamid cyclophosphamide ADD TO FORMULARY Covered e,cyclophospham ide monohydrate 05/01/2021 pentoxifylline pentoxifylline ADD TO FORMULARY Covered 05/01/2021 apomorphine hcl apomorphine hcl ADD TO FORMULARY Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 138 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/01/2021 indomethacin indomethacin ADD TO FORMULARY Covered 05/01/2021 flunisolide flunisolide ADD TO FORMULARY Covered 05/01/2021 tinidazole tinidazole ADD TO FORMULARY Covered 05/01/2021 primidone primidone ADD TO FORMULARY Covered 05/01/2021 pentosan pentosan polysulfate sodium ADD TO FORMULARY Covered polysulfate sodium 05/01/2021 tacrolimus tacrolimus ADD TO FORMULARY Covered 05/01/2021 celecoxib celecoxib ADD TO FORMULARY Covered 05/01/2021 succimer succimer ADD TO FORMULARY Covered dmsa,dmsa,2,3- dimercaptosuccin ic acid 05/01/2021 nicotine nicotine polacrilex ADD TO FORMULARY Covered polacrilex 05/01/2021 l-dopa,levodopa levodopa ADD TO FORMULARY Covered 05/01/2021 haloperidol haloperidol decanoate ADD TO FORMULARY Covered decanoate 05/01/2021 simvastatin simvastatin ADD TO FORMULARY Covered 05/01/2021 dihydroergotamin dihydroergotamine mesylate ADD TO FORMULARY Covered e mesylate,dhe 05/01/2021 clomipramine hcl clomipramine hcl ADD TO FORMULARY Covered 05/01/2021 anastrozole anastrozole ADD TO FORMULARY Covered 05/01/2021 enalapril maleate enalapril maleate ADD TO FORMULARY Covered 05/01/2021 estradiol estradiol,estradiol ADD TO FORMULARY Covered hemihydrate, micronized,estradiol micronized 05/01/2021 proparacaine hcl proparacaine hcl ADD TO FORMULARY Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 139 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/01/2021 clotrimazole clotrimazole ADD TO FORMULARY Covered 05/01/2021 lidocaine,lidocain lidocaine ADD TO FORMULARY Covered e base 05/01/2021 prednisolone,pani prednisolone ADD TO FORMULARY Covered solone,prednisolo ne anhydrous,predni solone u.s.p. 05/01/2021 brimonidine brimonidine tartrate ADD TO FORMULARY Covered tartrate 05/01/2021 cortisone cortisone acetate ADD TO FORMULARY Covered acetate,cortisone 05/01/2021 diazoxide diazoxide ADD TO FORMULARY Covered 05/01/2021 desipramine hcl desipramine hcl ADD TO FORMULARY Covered 05/01/2021 oxycodone oxycodone hcl ADD TO FORMULARY Covered hydrochloride 05/01/2021 norethindrone norethindrone ADD TO FORMULARY Covered 05/01/2021 meloxicam meloxicam ADD TO FORMULARY Covered 05/01/2021 ergoloid ergoloid mesylates ADD TO FORMULARY Covered mesylates 05/01/2021 sulfacetamide sulfacetamide sodium ADD TO FORMULARY Covered sodium,sodium sulfacetamide 05/01/2021 adrenocorticotrop corticotropin ADD TO FORMULARY Covered hic hormone,corticotr ophin,corticotropi n 05/01/2021 diclofenac diclofenac sodium ADD TO FORMULARY Covered sodium 05/01/2021 propylthiouracil propylthiouracil ADD TO FORMULARY Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 140 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/01/2021 propantheline propantheline bromide ADD TO FORMULARY Covered bromide 05/01/2021 nicotine nicotine polacrilex ADD TO FORMULARY Non-Formulary Covered polacrilex 05/01/2021 lithium carbonate lithium carbonate ADD TO FORMULARY Covered 05/01/2021 hcl naloxone hcl ADD TO FORMULARY Covered 05/01/2021 thioguanine thioguanine ADD TO FORMULARY Covered 05/01/2021 ketorolac ketorolac tromethamine ADD TO FORMULARY Covered tromethamine 05/01/2021 azelastine hcl azelastine hcl ADD TO FORMULARY Non-Formulary Covered 05/01/2021 valacyclovir hcl valacyclovir hcl ADD TO FORMULARY Covered 05/01/2021 fluticasone fluticasone propionate, ADD TO FORMULARY Covered propionate micro micronized 05/01/2021 tiopronin tiopronin ADD TO FORMULARY Covered 05/01/2021 sertraline hcl sertraline hcl ADD TO FORMULARY Covered 05/01/2021 prazosin hcl prazosin hcl ADD TO FORMULARY Non-Formulary Covered 05/01/2021 isotretinoin isotretinoin ADD TO FORMULARY Non-Formulary Covered 05/01/2021 prednisolone prednisolone sodium ADD TO FORMULARY Covered sodium phosphate,prednisolone sod phosphate,predni phosphate solone sodium 05/01/2021 butorphanol butorphanol tartrate ADD TO FORMULARY Covered tartrate 05/01/2021 metronidazole metronidazole ADD TO FORMULARY Covered 05/01/2021 paromomycin paromomycin sulfate ADD TO FORMULARY Covered sulfate 05/01/2021 cyclosporine cyclosporine ADD TO FORMULARY Covered 05/01/2021 phenobarbital phenobarbital ADD TO FORMULARY Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 141 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/01/2021 fentanyl citrate fentanyl citrate ADD TO FORMULARY Covered 05/01/2021 dicyclomine hcl dicyclomine hcl ADD TO FORMULARY Covered 05/01/2021 mexiletine hcl mexiletine hcl ADD TO FORMULARY Covered 05/01/2021 selegiline hcl selegiline hcl ADD TO FORMULARY Covered 05/01/2021 hydromorphone hydromorphone hcl ADD TO FORMULARY Covered hcl,dilaudid 05/01/2021 isoniazid isoniazid ADD TO FORMULARY Covered 05/01/2021 silver silver sulfadiazine ADD TO FORMULARY Covered sulfadiazine,silver sulphadiazine 05/01/2021 hydroxyzine hcl hydroxyzine hcl ADD TO FORMULARY Covered 05/01/2021 thioridazine thioridazine hcl ADD TO FORMULARY Covered hydrochloride 05/01/2021 amlodipine amlodipine besylate ADD TO FORMULARY Covered besilate,amlodipi ne besylate 05/01/2021 alprazolam alprazolam ADD TO FORMULARY Covered 05/01/2021 lorazepam lorazepam ADD TO FORMULARY Covered 05/01/2021 methyltestosteron ADD TO FORMULARY Covered e 05/01/2021 tranexamic acid tranexamic acid ADD TO FORMULARY Covered 05/01/2021 acebutolol hcl acebutolol hcl ADD TO FORMULARY Covered 05/01/2021 gatifloxacin gatifloxacin ADD TO FORMULARY Covered sesquihydrate 05/01/2021 perphenazine perphenazine ADD TO FORMULARY Covered 05/01/2021 trifluridine trifluridine ADD TO FORMULARY Covered 05/01/2021 hydroxyurea hydroxyurea ADD TO FORMULARY Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 142 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/01/2021 5-aminosalicylic mesalamine ADD TO FORMULARY Covered acid,mesalamine 05/01/2021 captopril captopril ADD TO FORMULARY Covered 05/01/2021 acetazolamide acetazolamide ADD TO FORMULARY Covered 05/01/2021 testosterone testosterone enanthate ADD TO FORMULARY Covered enanthate 05/01/2021 fluticasone fluticasone propionate ADD TO FORMULARY Covered propionate 05/01/2021 betamethasone betamethasone sodium ADD TO FORMULARY Covered sodium phosphate phosphate 05/01/2021 aminosalicylic aminosalicylic acid ADD TO FORMULARY Covered acid 05/01/2021 calcipotriene,calci calcipotriene ADD TO FORMULARY Covered potriol 05/01/2021 ergotamine ergotamine tartrate ADD TO FORMULARY Covered tartrate 05/01/2021 estradiol estradiol ADD TO FORMULARY Covered micronized,estrad micronized,estradiol iol hemihydrate, micronized,estradiol 05/01/2021 aluminum aluminum chloride ADD TO FORMULARY Covered chloride 05/01/2021 estriol micronized ADD TO FORMULARY Covered micronized,estriol 05/01/2021 bromfenac bromfenac sodium ADD TO FORMULARY Covered sodium 05/01/2021 disulfiram disulfiram ADD TO FORMULARY Covered 05/01/2021 calcitriol calcitriol ADD TO FORMULARY Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 143 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/01/2021 desmopressin desmopressin acetate ADD TO FORMULARY Covered acetate 05/01/2021 methocarbamol, methocarbamol,methyltesto ADD TO FORMULARY Covered methyltestosteron sterone e 05/01/2021 dipyridamole dipyridamole ADD TO FORMULARY Covered 05/01/2021 diaminopyridine amifampridine ADD TO FORMULARY Covered 05/01/2021 hcl amantadine hcl ADD TO FORMULARY Covered 05/01/2021 cyclobenzaprine cyclobenzaprine hcl ADD TO FORMULARY Non-Formulary Covered hcl,cyclobenzapri nehcl 05/01/2021 metformin metformin hcl ADD TO FORMULARY Covered hcl,metformin hydrochloride 05/01/2021 danazol ADD TO FORMULARY Covered 05/01/2021 benazepril hcl benazepril hcl ADD TO FORMULARY Covered 05/01/2021 bromocriptine bromocriptine mesylate ADD TO FORMULARY Covered mesylate 05/01/2021 cyanocobalamin cyanocobalamin (vitamin b- ADD TO FORMULARY Covered 12) 05/01/2021 clobetasol clobetasol propionate ADD TO FORMULARY Covered propionate micro,clobetasol propionate,clobet asol 17- propionate,clobet asol 17 propionate 05/01/2021 hydralazine hcl hydralazine hcl ADD TO FORMULARY Non-Formulary Covered 05/01/2021 lisinopril lisinopril ADD TO FORMULARY Covered 05/01/2021 phenytoin ADD TO FORMULARY Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 144 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/01/2021 phenelzine phenelzine sulfate ADD TO FORMULARY Covered sulfate 05/01/2021 methscopolamine methscopolamine bromide ADD TO FORMULARY Covered bromide,scopola mine methylbromide 05/01/2021 cysteamine hcl cysteamine hcl ADD TO FORMULARY Covered 05/01/2021 ciclopirox ciclopirox olamine ADD TO FORMULARY Covered olamine 05/01/2021 hydrocortisone,le hydrocortisone ADD TO FORMULARY Covered xocort,panhydros one 05/01/2021 chlorpromazine chlorpromazine hcl ADD TO FORMULARY Covered hcl 05/01/2021 rasagiline rasagiline mesylate ADD TO FORMULARY Covered mesylate 05/01/2021 etoposide etoposide ADD TO FORMULARY Covered 05/01/2021 bupropion hcl bupropion hcl ADD TO FORMULARY Covered 05/01/2021 formoterol formoterol fumarate ADD TO FORMULARY Covered fumarate 05/01/2021 cimetidine cimetidine ADD TO FORMULARY Covered 05/01/2021 clemastine fumarate ADD TO FORMULARY Covered fumarate 05/01/2021 itraconazole itraconazole ADD TO FORMULARY Covered 05/01/2021 bimatoprost bimatoprost ADD TO FORMULARY Non-Formulary Covered 05/01/2021 clonidine hcl clonidine hcl ADD TO FORMULARY Covered 05/01/2021 duloxetine hcl duloxetine hcl ADD TO FORMULARY Non-Formulary Covered 05/01/2021 fluorouracil fluorouracil ADD TO FORMULARY Covered 05/01/2021 clonazepam clonazepam ADD TO FORMULARY Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 145 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/01/2021 clopidogrel clopidogrel bisulfate ADD TO FORMULARY Covered bisulfate 05/01/2021 mometasone mometasone furoate ADD TO FORMULARY Covered furoate 05/01/2021 sulfate neomycin sulfate ADD TO FORMULARY Covered 05/01/2021 misoprostol misoprostol ADD TO FORMULARY Covered hpmc,misoprostol 05/01/2021 acetyl salicylic aspirin ADD TO FORMULARY Covered acid,aspirin 05/01/2021 praziquantel praziquantel ADD TO FORMULARY Covered 05/01/2021 cyproheptadine cyproheptadine hcl ADD TO FORMULARY Covered hcl 05/01/2021 carbidopa carbidopa ADD TO FORMULARY Covered 05/01/2021 carisoprodol ADD TO FORMULARY Covered 05/01/2021 imiquimod imiquimod ADD TO FORMULARY Covered 05/01/2021 nitrofurantoin nitrofurantoin macrocrystal ADD TO FORMULARY Covered 05/01/2021 mercaptopurine mercaptopurine ADD TO FORMULARY Covered 05/01/2021 prochlorperazine prochlorperazine maleate ADD TO FORMULARY Covered maleate 05/01/2021 betamethasone betamethasone valerate ADD TO FORMULARY Covered valerate 05/01/2021 betamethasone betamethasone dipropionate ADD TO FORMULARY Covered dipropionate 05/01/2021 clindamycin clindamycin phosphate ADD TO FORMULARY Covered phosphate 05/01/2021 oxandrolone oxandrolone ADD TO FORMULARY Covered 05/01/2021 meperidine hcl meperidine hcl ADD TO FORMULARY Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 146 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/01/2021 amoxicillin amoxicillin ADD TO FORMULARY Covered trihydrate 05/01/2021 vitamin d3 cholecalciferol (vitamin d3) ADD TO FORMULARY Non-Formulary Covered 05/01/2021 calcium acetate calcium acetate ADD TO FORMULARY Covered 05/01/2021 metoprolol metoprolol tartrate ADD TO FORMULARY Covered tartrate 05/01/2021 fluocinolone fluocinolone acetonide ADD TO FORMULARY Covered acetonide 05/01/2021 tizanidine hcl tizanidine hcl ADD TO FORMULARY Covered 05/01/2021 cholestyramine cholestyramine ADD TO FORMULARY Covered resin 05/01/2021 timolol maleate timolol maleate ADD TO FORMULARY Covered 05/01/2021 naproxen naproxen ADD TO FORMULARY Covered 05/01/2021 methylphenidate methylphenidate hcl ADD TO FORMULARY Covered hcl 05/01/2021 carbamazepine carbamazepine ADD TO FORMULARY Covered 05/01/2021 citrate tamoxifen citrate ADD TO FORMULARY Covered 05/01/2021 sulfate quinidine sulfate ADD TO FORMULARY Covered 05/01/2021 allopurinol allopurinol ADD TO FORMULARY Covered 05/01/2021 haloperidol haloperidol ADD TO FORMULARY Covered 05/01/2021 dexamethasone dexamethasone sodium ADD TO FORMULARY Covered sodium phosphate,dexamethasone phosphate sod phosphate 05/01/2021 epinephrine epinephrine ADD TO FORMULARY Covered 05/01/2021 meclofenamate meclofenamate sodium ADD TO FORMULARY Covered sodium

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 147 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/01/2021 4- dalfampridine ADD TO FORMULARY Covered aminopyridine,dal fampridine 05/01/2021 methoxsalen methoxsalen ADD TO FORMULARY Covered 05/01/2021 methimazole methimazole ADD TO FORMULARY Covered 05/01/2021 methazolamide methazolamide ADD TO FORMULARY Covered 05/01/2021 naltrexone hcl naltrexone hcl ADD TO FORMULARY Covered 05/01/2021 thyroid thyroid,pork ADD TO FORMULARY Covered 05/01/2021 chlorambucil chlorambucil ADD TO FORMULARY Covered 05/01/2021 levocetirizine levocetirizine ADD TO FORMULARY Covered dihydrochloride dihydrochloride 05/01/2021 gentamicin gentamicin sulfate ADD TO FORMULARY Covered sulfate 05/01/2021 hcl propranolol hcl ADD TO FORMULARY Covered 05/01/2021 hcl memantine hcl ADD TO FORMULARY Covered 05/01/2021 pyrazinamide pyrazinamide ADD TO FORMULARY Covered 05/01/2021 sucralfate sucralfate ADD TO FORMULARY Covered 05/01/2021 pilocarpine hcl pilocarpine hcl ADD TO FORMULARY Covered 05/01/2021 clarithromycin clarithromycin ADD TO FORMULARY Covered 05/01/2021 penicillamine(d- penicillamine ADD TO FORMULARY Covered ),penicillamine 05/01/2021 ibuprofen ibuprofen ADD TO FORMULARY Covered 05/01/2021 orphenadrine citrate ADD TO FORMULARY Covered citrate 05/01/2021 bethanechol bethanechol chloride ADD TO FORMULARY Covered chloride 05/01/2021 promethazine hcl promethazine hcl ADD TO FORMULARY Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 148 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/01/2021 acetylcysteine,n- acetylcysteine ADD TO FORMULARY Covered acetyl-l-cysteine 05/01/2021 diazepam diazepam ADD TO FORMULARY Covered 05/01/2021 mupirocin mupirocin ADD TO FORMULARY Covered 05/01/2021 metoclopramide metoclopramide hcl ADD TO FORMULARY Covered hcl,metocloprami de hydrochloride 05/01/2021 nortriptyline hcl nortriptyline hcl ADD TO FORMULARY Covered 05/01/2021 mebendazole mebendazole ADD TO FORMULARY Covered 05/01/2021 norethindrone norethindrone acetate ADD TO FORMULARY Covered acetate 05/01/2021 tazarotene tazarotene ADD TO FORMULARY Covered 05/01/2021 niacin,nicotinic niacin ADD TO FORMULARY Covered acid 05/01/2021 naproxen sodium naproxen sodium ADD TO FORMULARY Covered 05/01/2021 nadolol nadolol ADD TO FORMULARY Covered 05/01/2021 ethosuximide ethosuximide ADD TO FORMULARY Covered 05/01/2021 digoxin digoxin ADD TO FORMULARY Non-Formulary Covered 05/01/2021 collagenase collagenase clostridium ADD TO FORMULARY Covered histolyticum 05/01/2021 fludrocortisone fludrocortisone acetate ADD TO FORMULARY Covered acetate 05/01/2021 omeprazole omeprazole magnesium REMOVE FROM Non-Formulary magnesium FORMULARY 05/05/2021 dextrose 5%- dextrose 5 % and 0.9 % ADD UM: MED Medical Drug 0.9% sodium chloride nacl,dextrose with sodium chloride

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 149 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/05/2021 dextrose 5%- dextrose 5 % and 0.2 % ADD UM: MED Medical Drug 0.2% sodium chloride nacl,dextrose 5%-0.225% nacl,dextrose with sodium chloride 05/05/2021 dextrose 2.5%- dextrose 2.5 % and 0.45 % ADD UM: MED Medical Drug 0.45% sodium chloride nacl,dextrose with sodium chloride 05/05/2021 dextrose 5%- dextrose 5 % and 0.45 % ADD UM: MED Medical Drug 0.45% sodium chloride nacl,dextrose with sodium chloride 05/05/2021 dextrose 5%- dextrose 5 % and 0.3 % ADD UM: MED Medical Drug 0.33% sodium chloride nacl,dextrose 5%-0.3% nacl,dextrose with sodium chloride 05/05/2021 norepinephrine norepinephrine bitartrate ADD UM: MED Medical Drug bitartrate 05/05/2021 LEVOPHED norepinephrine bitartrate ADD UM: MED Medical Drug BITARTATE,LEV OPHED BITARTRATE,LE VOPHED 05/05/2021 normal saline sodium chloride 0.9 % ADD UM: MED Medical Drug flush,sodium (flush),0.9 % sodium chloride chloride

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 150 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/05/2021 sodium sodium chloride 0.9 % ADD UM: MED Medical Drug chloride,vasceze (flush),bacteriostatic sodium (vafd),normal chloride,0.9 % sodium saline chloride 05/05/2021 monoject prefill sodium chloride 0.9 % ADD UM: MED Medical Drug advanced (flush),0.9 % sodium chloride 05/05/2021 monoject 0.9% sodium chloride 0.9 % ADD UM: MED Medical Drug sodium (flush) chloride,monoject sodium chloride flush 05/05/2021 clearshield sodium chloride 0.9 % ADD UM: MED Medical Drug sodium chlor (flush) flush 05/05/2021 morphine sulfate- morphine sulfate in 0.9 % ADD UM: Total cumulative 0.9% nacl sodium chloride/pf QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 05/05/2021 morphine sulfate- morphine sulfate in 0.9 % ADD UM: MED Medical Drug 0.9% nacl sodium chloride/pf 05/05/2021 morphine sulfate- morphine sulfate in 0.9 % ADD UM: MED Medical Drug 0.9% nacl sodium chloride/pf 05/05/2021 morphine sulfate- morphine sulfate in 0.9 % ADD UM: MED Medical Drug 0.9% nacl sodium chloride/pf 05/05/2021 morphine sulfate- morphine sulfate in 0.9 % ADD UM: MED Medical Drug 0.9% nacl sodium chloride/pf 05/05/2021 morphine sulfate- morphine sulfate in 0.9 % ADD UM: MED Medical Drug 0.9% nacl sodium chloride/pf

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 151 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/05/2021 morphine sulfate- morphine sulfate in 0.9 % ADD UM: MED Medical Drug 0.9% nacl sodium chloride 05/05/2021 morphine sulfate- morphine sulfate in 0.9 % ADD UM: MED Medical Drug 0.9% nacl sodium chloride 05/05/2021 morphine sulfate- morphine sulfate in 0.9 % ADD UM: MED Medical Drug 0.9% nacl sodium chloride 05/05/2021 morphine sulfate- morphine sulfate in 0.9 % ADD UM: MED Medical Drug 0.9% nacl sodium chloride 05/05/2021 morphine sulfate- morphine sulfate in 0.9 % ADD UM: MED Medical Drug 0.9% nacl sodium chloride 05/05/2021 morphine sulfate- morphine sulfate in 0.9 % ADD UM: MED Medical Drug 0.9% nacl sodium chloride 05/05/2021 morphine sulfate- morphine sulfate in 0.9 % ADD UM: MED Medical Drug 0.9% sodium chloride/pf nacl,morphine sulfate-nacl 05/05/2021 morphine sulfate- morphine sulfate in 0.9 % ADD UM: MED Medical Drug 0.9% nacl sodium chloride/pf 05/07/2021 desrx desonide REMOVE FROM Non-Formulary FORMULARY 05/07/2021 pure-comfort gloves REMOVE FROM Non-Formulary vinyl gloves FORMULARY 05/07/2021 pure-comfort gloves REMOVE FROM Non-Formulary vinyl gloves FORMULARY 05/07/2021 pure-comfort gloves REMOVE FROM Non-Formulary vinyl gloves FORMULARY 05/07/2021 pure-comfort gloves REMOVE FROM Non-Formulary vinyl gloves FORMULARY 05/07/2021 sure comfort pen needle, diabetic, safety REMOVE FROM Non-Formulary safety pen needle FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 152 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/07/2021 polyblend rx suppository base no.246 REMOVE FROM Non-Formulary suppository base FORMULARY 05/07/2021 GOLD BOND emollient combination REMOVE FROM Non-Formulary ULTIMATE no.116 FORMULARY DIABETIC 05/07/2021 guaifenesin- guaifenesin/pseudoephedrin ADD TO FORMULARY Covered pseudoephedrine e hcl er 05/07/2021 fluticasone fluticasone propionate ADD TO FORMULARY Covered propionate 05/07/2021 fluticasone fluticasone propionate ADD TO FORMULARY Covered propionate 05/07/2021 nasal four phenylephrine hcl REMOVE FROM Non-Formulary FORMULARY 05/07/2021 allergy relief diphenhydramine hcl ADD TO FORMULARY Covered 05/07/2021 saccharomycin df saccharomyces boulardii REMOVE FROM Non-Formulary FORMULARY 05/07/2021 allergy relief diphenhydramine hcl ADD TO FORMULARY Covered 05/07/2021 allergy multi- phenylephrine REMOVE FROM Non-Formulary symptom hcl/acetaminophen/chlorphe FORMULARY niramine 05/07/2021 sinus-headache phenylephrine REMOVE FROM Non-Formulary hcl/acetaminophen FORMULARY 05/07/2021 cold head dextromethorphan/phenylep REMOVE FROM Non-Formulary congestion hrine/acetaminophen/chlorp FORMULARY nighttime heniramin 05/07/2021 cold-sinus relief ibuprofen/pseudoephedrine REMOVE FROM Non-Formulary hcl FORMULARY 05/07/2021 cold head guaifenesin/phenylephrine REMOVE FROM Non-Formulary congest severe hcl/acetaminophen FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 153 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/07/2021 mucus rlf cold-flu- phenylephrine REMOVE FROM Non-Formulary sore throat hcl/dextromethorphan FORMULARY hbr/acetaminophen/guaifen 05/07/2021 limetcam lidocaine/methyl REMOVE FROM Non-Formulary salicylate/camphor FORMULARY 05/07/2021 cold max severe phenylephrine REMOVE FROM Non-Formulary day hcl/dextromethorphan FORMULARY hbr/acetaminophen/guaifen 05/07/2021 cold max daytime dextromethorphan REMOVE FROM Non-Formulary hbr/phenylephrine FORMULARY hcl/acetaminophen 05/07/2021 cold max day- dextromethorphan/phenylep REMOVE FROM Non-Formulary night hrine/acetaminophen/chlorp FORMULARY heniramin 05/07/2021 sinus-headache phenylephrine REMOVE FROM Non-Formulary hcl/acetaminophen/chlorphe FORMULARY niramine 05/07/2021 zantac-360 famotidine ADD TO FORMULARY Covered (famotidine) 05/07/2021 zantac-360 famotidine ADD TO FORMULARY Covered (famotidine) 05/07/2021 zantac-360 famotidine ADD TO FORMULARY Covered (famotidine) 05/07/2021 zantac-360 famotidine ADD TO FORMULARY Covered (famotidine) 05/07/2021 zantac-360 famotidine ADD TO FORMULARY Covered (famotidine) 05/07/2021 zantac-360 famotidine ADD TO FORMULARY Covered (famotidine) 05/07/2021 lidocaine pain lidocaine REMOVE FROM Non-Formulary relief FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 154 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/07/2021 BLOXIVERZ neostigmine methylsulfate REMOVE FROM Non-Formulary FORMULARY 05/07/2021 isotretinoin isotretinoin REMOVE FROM Non-Formulary FORMULARY 05/07/2021 isotretinoin isotretinoin REMOVE FROM Non-Formulary FORMULARY 05/07/2021 isotretinoin isotretinoin REMOVE FROM Non-Formulary FORMULARY 05/07/2021 isotretinoin isotretinoin REMOVE FROM Non-Formulary FORMULARY 05/07/2021 tritocin triamcinolone acetonide ADD TO FORMULARY Covered 05/07/2021 INGREZZA valbenazine tosylate REMOVE FROM Non-Formulary FORMULARY 05/07/2021 ENZNONUTY lidocaine/tetracaine/benzoca REMOVE FROM Non-Formulary ine FORMULARY 05/07/2021 estradiol estradiol REMOVE FROM Non-Formulary FORMULARY 05/07/2021 estradiol estradiol REMOVE FROM Non-Formulary FORMULARY 05/07/2021 estradiol estradiol REMOVE FROM Non-Formulary FORMULARY 05/07/2021 estradiol estradiol REMOVE FROM Non-Formulary FORMULARY 05/07/2021 estradiol estradiol REMOVE FROM Non-Formulary FORMULARY 05/07/2021 estradiol estradiol REMOVE FROM Non-Formulary FORMULARY 05/10/2021 acetaminophen,a acetaminophen CHANGE TIER Covered pap,ty-tab,non- aspirin

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 155 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/10/2021 nicotine nicotine CHANGE TIER Covered patch,nicotine 05/10/2021 loratadine,childre loratadine CHANGE TIER Covered n's loratadine,loratad ine hives relief,loratadine allergy 05/10/2021 famotidine,pepcid famotidine CHANGE TIER Covered ac 05/10/2021 stool softener docusate sodium ADD TO FORMULARY Non-Formulary Covered 05/10/2021 a.s.a.,aspirin,lite aspirin CHANGE TIER Covered coat aspirin,coated aspirin,aspirin lite coat 05/10/2021 miconazole miconazole nitrate CHANGE TIER Covered nitrate,miconazol e-7,miconazole 7 05/10/2021 allergy chlorpheniramine maleate CHANGE TIER Covered relief,allergy 05/10/2021 famotidine famotidine CHANGE TIER Covered 05/10/2021 pain relief acetaminophen/diphenhydra CHANGE TIER Covered pm,pain relief mine hcl 05/10/2021 gas relief simethicone CHANGE TIER Covered 05/10/2021 lice treatment permethrin CHANGE TIER Covered 05/10/2021 hydrocortisone,hy hydrocortisone CHANGE TIER Covered drocort 05/10/2021 ferrous ferrous sulfate CHANGE TIER Covered sulfate,iron,hm iron

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 156 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/10/2021 gentle laxative bisacodyl ADD TO FORMULARY Non-Formulary Covered 05/10/2021 athlete's foot tolnaftate CHANGE TIER Covered cream,athletes foot,athlete's foot 05/10/2021 nicotine nicotine CHANGE TIER Covered patch,nicotine 05/10/2021 infants' gas simethicone CHANGE TIER Covered relief,infant gas relief,v-r gas relief infant 05/10/2021 lansoprazole lansoprazole CHANGE TIER Covered 05/10/2021 gas relief simethicone CHANGE TIER Covered 05/10/2021 magnesium magnesium citrate CHANGE TIER Covered citrate,citrate of magnesia 05/10/2021 loratadine loratadine CHANGE TIER Covered 05/10/2021 ibuprofen ibuprofen CHANGE TIER Covered 05/10/2021 gentle laxative bisacodyl CHANGE TIER Covered 05/10/2021 pain reliever acetaminophen/diphenhydra CHANGE TIER Covered pm,pain reliever mine hcl pm ex-strength 05/10/2021 children's ibuprofen CHANGE TIER Covered ibuprofen,ibuprof en child 05/10/2021 tioconazole tioconazole CHANGE TIER Covered 1,tioconazole-1 05/10/2021 tadalafil tadalafil REMOVE FROM Non-Formulary FORMULARY 05/10/2021 pain reliever acetaminophen CHANGE TIER Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 157 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/10/2021 children's diphenhydramine hcl CHANGE TIER Covered allergy,children's allergy relief,children's allergy medicine 05/10/2021 calcium calcium carbonate CHANGE TIER Covered carbonate 05/10/2021 antacid extra calcium carbonate CHANGE TIER Covered strength,antacid 05/10/2021 heparin flush heparin sodium,porcine/pf REMOVE FROM Non-Formulary FORMULARY 05/10/2021 children's acetaminophen CHANGE TIER Covered acetaminophen 05/10/2021 geri-dryl diphenhydramine hcl CHANGE TIER Covered 05/10/2021 nicorette,nicotine nicotine polacrilex CHANGE UM: QUANTITY 3600 / 365 days lozenge 05/10/2021 nicotine lozenge nicotine polacrilex CHANGE TIER Covered 05/10/2021 tussin dm max guaifenesin/dextromethorph REMOVE FROM Non-Formulary an hbr FORMULARY 05/10/2021 SUBSYS fentanyl CHANGE UM: QUANTITY 4 / 1 days 05/10/2021 SUBSYS fentanyl CHANGE UM: Total cumulative QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 05/10/2021 SUBSYS fentanyl CHANGE UM: QUANTITY 4 / 1 days

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 158 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/10/2021 SUBSYS fentanyl CHANGE UM: Total cumulative QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 05/11/2021 RELISTOR methylnaltrexone bromide REMOVE UM: MED Medical Drug 05/11/2021 RELISTOR methylnaltrexone bromide REMOVE UM: MED Medical Drug 05/11/2021 RELISTOR methylnaltrexone bromide REMOVE UM: MED Medical Drug 05/11/2021 NULYTELY sodium chloride/sodium REMOVE FROM Covered Non-Formulary WITH FLAVOR bicarbonate/potassium FORMULARY PACKS chloride/peg 05/14/2021 sodium fluoride fluoride (sodium) REMOVE FROM Non-Formulary FORMULARY 05/14/2021 LOVAZA omega-3 acid ethyl esters REMOVE FROM Non-Formulary FORMULARY 05/14/2021 anti-diarrheal hcl REMOVE FROM Non-Formulary FORMULARY 05/14/2021 piperacillin- piperacillin REMOVE FROM Non-Formulary tazobactam sodium/tazobactam sodium FORMULARY 05/14/2021 piperacillin- piperacillin REMOVE FROM Non-Formulary tazobactam sodium/tazobactam sodium FORMULARY 05/14/2021 famotidine famotidine REMOVE FROM Non-Formulary FORMULARY 05/14/2021 aminocaproic aminocaproic acid REMOVE FROM Non-Formulary acid FORMULARY 05/14/2021 acetaminophen acetaminophen REMOVE FROM Non-Formulary er FORMULARY 05/14/2021 bacitracin zinc bacitracin zinc REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 159 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/14/2021 guaifenesin- guaifenesin/pseudoephedrin REMOVE FROM Non-Formulary pseudoephedrine e hcl FORMULARY er 05/14/2021 guaifenesin- guaifenesin/pseudoephedrin REMOVE FROM Non-Formulary pseudoephedrine e hcl FORMULARY er 05/14/2021 laxative sennosides REMOVE FROM Non-Formulary FORMULARY 05/14/2021 antacid ultra calcium carbonate REMOVE FROM Non-Formulary strength FORMULARY 05/14/2021 diclofenac diclofenac potassium ADD TO FORMULARY Covered potassium 05/14/2021 dextrose in water dextrose 40 % in water REMOVE FROM Non-Formulary FORMULARY 05/14/2021 estradiol valerate estradiol valerate REMOVE FROM Non-Formulary FORMULARY 05/14/2021 dextrose 5%- dextrose 5 % and 0.3 % REMOVE FROM Non-Formulary 0.3% nacl sodium chloride FORMULARY 05/14/2021 DERMOPLAST benzocaine/menthol REMOVE FROM Non-Formulary FORMULARY 05/14/2021 gentle laxative bisacodyl REMOVE FROM Non-Formulary FORMULARY 05/14/2021 migraine relief aspirin/acetaminophen/caffei REMOVE FROM Non-Formulary ne FORMULARY 05/14/2021 dextrose in water dextrose 10 % in water REMOVE FROM Non-Formulary FORMULARY 05/14/2021 day time cold-flu dextromethorphan REMOVE FROM Non-Formulary relief hbr/phenylephrine FORMULARY hcl/acetaminophen 05/14/2021 dapsone dapsone REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 160 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/14/2021 dapsone dapsone REMOVE FROM Non-Formulary FORMULARY 05/14/2021 children's cold- brompheniramine REMOVE FROM Non-Formulary allergy maleate/phenylephrine hcl FORMULARY 05/14/2021 RESOURCE 2.0 nutritional supplement REMOVE FROM Non-Formulary FORMULARY 05/14/2021 LIQUID E-Z barium sulfate REMOVE FROM Non-Formulary PAQUE FORMULARY 05/14/2021 ENSURE lactose-reduced food REMOVE FROM Non-Formulary ORIGINAL FORMULARY 05/14/2021 ENSURE lactose-reduced food REMOVE FROM Non-Formulary ORIGINAL FORMULARY 05/14/2021 sleep aid diphenhydramine hcl REMOVE FROM Non-Formulary FORMULARY 05/14/2021 redness relief naphazoline hcl/glycerin REMOVE FROM Non-Formulary FORMULARY 05/14/2021 antacid-antigas magnesium REMOVE FROM Non-Formulary hydroxide/aluminum FORMULARY hydroxide/simethicone 05/14/2021 series 800 bp blood pressure test kit-large REMOVE FROM Non-Formulary monitor FORMULARY 05/14/2021 itch relief diphenhydramine hcl/zinc REMOVE FROM Non-Formulary acetate FORMULARY 05/14/2021 eye itch relief ketotifen fumarate REMOVE FROM Non-Formulary FORMULARY 05/14/2021 allergy relief cetirizine hcl REMOVE FROM Non-Formulary FORMULARY 05/14/2021 allergy relief cetirizine hcl REMOVE FROM Non-Formulary FORMULARY 05/14/2021 allergy relief cetirizine hcl REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 161 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/14/2021 lubricant eye propylene glycol REMOVE FROM Non-Formulary drop FORMULARY 05/14/2021 lubricant eye propylene glycol REMOVE FROM Non-Formulary drop FORMULARY 05/14/2021 vitamin b-12 cyanocobalamin (vitamin b- REMOVE FROM Non-Formulary 12) FORMULARY 05/14/2021 ropivacaine hcl- ropivacaine hcl in 0.9 % REMOVE FROM Non-Formulary 0.9% nacl sodium chloride/pf FORMULARY 05/14/2021 easypoint needle needles, safety REMOVE FROM Non-Formulary FORMULARY 05/14/2021 easypoint needle needles, safety REMOVE FROM Non-Formulary FORMULARY 05/14/2021 tropical fusion flavoring agent REMOVE FROM Non-Formulary flavor FORMULARY 05/14/2021 tropical fusion flavoring agent REMOVE FROM Non-Formulary flavor FORMULARY 05/14/2021 tropical fusion flavoring agent REMOVE FROM Non-Formulary flavor FORMULARY 05/14/2021 medium chain caprylic/capric triglyceride REMOVE FROM Non-Formulary triglycerides FORMULARY 05/14/2021 easypoint needle needles, safety REMOVE FROM Non-Formulary FORMULARY 05/14/2021 easypoint needle needles, safety REMOVE FROM Non-Formulary FORMULARY 05/14/2021 azo uti test strip urinary tract infection (uti) REMOVE FROM Non-Formulary test FORMULARY 05/14/2021 fora ketone blood-ketone control, normal REMOVE FROM Non-Formulary control solution FORMULARY 05/14/2021 techna 10 sf troche base no.245 REMOVE FROM Non-Formulary troche base FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 162 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/14/2021 bitter-bloc pure bitter mask flavoring REMOVE FROM Non-Formulary FORMULARY 05/14/2021 candicidal turmeric/ginger/olive/oregan REMOVE FROM Non-Formulary o/sodium caprylate FORMULARY 05/14/2021 fos-a fixed oil almond REMOVE FROM Non-Formulary susp vehicle oil/silicon,colloidal/butylated FORMULARY hydroxytoluene 05/14/2021 fora tn'g advance blood ketone and glucose REMOVE FROM Non-Formulary pro monitor monitor FORMULARY 05/14/2021 MUCINEX triprolidine REMOVE FROM Non-Formulary NIGHTSHIFT hcl/dextromethorphan FORMULARY COLD-FLU hbr/acetaminophen 05/14/2021 ALAMAX CR alpha lipoic acid/biotin REMOVE FROM Non-Formulary FORMULARY 05/14/2021 VISTA vitamin e REMOVE FROM Non-Formulary ADVANCED mixed/dha/lutein/zeaxanthin/ FORMULARY CAROTENOID astaxan/bilberry 05/14/2021 BIO C 1:1 ascorbic acid/bioflavonoids REMOVE FROM Non-Formulary FORMULARY 05/14/2021 ALLERDHQ vitamin REMOVE FROM Non-Formulary c/acetylcysteine/rutin/querce FORMULARY tin/bromelains/nettle 05/14/2021 lidocaine lidocaine REMOVE FROM Non-Formulary FORMULARY 05/14/2021 advanced l.acidophilus/l.casei/l.lactis/l. REMOVE FROM Non-Formulary probiotic rhamnosus/b.lactis/b.longum FORMULARY 05/14/2021 arthritis pain diclofenac sodium REMOVE FROM Non-Formulary FORMULARY 05/14/2021 benfotiamine benfotiamine REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 163 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/14/2021 medistay 240 benzalkonium chloride REMOVE FROM Non-Formulary FORMULARY 05/14/2021 doxycycline doxycycline hyclate REMOVE FROM Non-Formulary hyclate FORMULARY 05/14/2021 unifine pen pen needle, diabetic REMOVE FROM Non-Formulary needle FORMULARY 05/14/2021 ultra flo insulin syringe with REMOVE FROM Non-Formulary syringe needle,insulin,0.3 ml FORMULARY 05/14/2021 CLOBETEX clobetasol REMOVE FROM Non-Formulary propionate/desloratadine FORMULARY 05/14/2021 phenol REMOVE FROM Non-Formulary FORMULARY 05/14/2021 SKYRIZI risankizumab-rzaa REMOVE FROM Non-Formulary FORMULARY 05/14/2021 SKYRIZI PEN risankizumab-rzaa REMOVE FROM Non-Formulary FORMULARY 05/17/2021 ENVARSUS XR tacrolimus REMOVE UM: MED Medical Drug 05/17/2021 ENVARSUS XR tacrolimus REMOVE UM: MED Medical Drug 05/17/2021 ENVARSUS XR tacrolimus REMOVE UM: MED Medical Drug 05/18/2021 SKYRIZI risankizumab-rzaa ADD UM: QUANTITY 1 / 84 days 05/18/2021 SKYRIZI risankizumab-rzaa ADD UM: SPECIALTY Specialty Drug 05/18/2021 SKYRIZI PEN risankizumab-rzaa ADD UM: QUANTITY 1 / 84 days 05/18/2021 SKYRIZI PEN risankizumab-rzaa ADD UM: SPECIALTY Specialty Drug 05/21/2021 INGREZZA valbenazine tosylate ADD UM: QUANTITY 1 / 1 days 05/21/2021 INGREZZA valbenazine tosylate ADD UM: SPECIALTY Specialty Drug 05/21/2021 estradiol estradiol ADD UM: MED Medical Drug 05/21/2021 estradiol estradiol ADD UM: MED Medical Drug 05/21/2021 estradiol estradiol ADD UM: MED Medical Drug

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 164 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/21/2021 estradiol estradiol ADD UM: MED Medical Drug 05/21/2021 estradiol estradiol ADD UM: MED Medical Drug 05/21/2021 estradiol estradiol ADD UM: MED Medical Drug 05/21/2021 EPICOCCUM allergenic extract-epicoccum ADD UM: MED Medical Drug NIGRUM nigrum 05/21/2021 ALTERNARIA allergenic extract-alternaria ADD UM: MED Medical Drug ALTERNATA alternata 05/21/2021 AUREOBASIDIU allergenic extract- ADD UM: MED Medical Drug M PULLULANS aureobasidium pullulans 05/21/2021 ferrous sulfate ferrous sulfate REMOVE FROM Non-Formulary FORMULARY 05/21/2021 senna sennosides ADD TO FORMULARY Covered 05/21/2021 one daily multivit with minerals/folic REMOVE FROM Non-Formulary women's 50 plus acid/calcium carbonate/vit FORMULARY adv k1 05/21/2021 miconazole 7 miconazole nitrate ADD TO FORMULARY Covered 05/21/2021 DERMACINRX multivitamin with minerals REMOVE FROM Non-Formulary VENEXA FE no.86/ferrous fumarate/folic FORMULARY acid 05/21/2021 midazolam hcl- midazolam hcl in 0.9 % REMOVE FROM Non-Formulary nacl sodium chloride FORMULARY 05/21/2021 furosemide furosemide REMOVE FROM Non-Formulary FORMULARY 05/21/2021 furosemide furosemide REMOVE FROM Non-Formulary FORMULARY 05/21/2021 furosemide furosemide REMOVE FROM Non-Formulary FORMULARY 05/21/2021 CLENIA PLUS sulfacetamide sodium/sulfur REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 165 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/21/2021 gabapentin gabapentin REMOVE FROM Non-Formulary FORMULARY 05/21/2021 techna 20 troche base no.248 REMOVE FROM Non-Formulary unsweet troche FORMULARY base 05/21/2021 techna nat sf troche base no.252 REMOVE FROM Non-Formulary troche base g2 FORMULARY 05/21/2021 LOTRIMIN AF clotrimazole REMOVE FROM Non-Formulary FORMULARY 05/21/2021 CAPHOSOL saliva substitute combo no.2 REMOVE FROM Non-Formulary FORMULARY 05/21/2021 clindamycin clindamycin ADD TO FORMULARY Covered phos-benzoyl phosphate/benzoyl peroxide perox 05/21/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 05/21/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 05/21/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 05/21/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 05/21/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 05/21/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 05/21/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 05/21/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 166 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/21/2021 series 600 bp blood pressure test kit-large REMOVE FROM Non-Formulary monitor FORMULARY 05/21/2021 series 400w bp blood pressure test kit-wrist REMOVE FROM Non-Formulary monitor FORMULARY 05/21/2021 succinylcholine succinylcholine chloride REMOVE FROM Non-Formulary chloride FORMULARY 05/21/2021 neostigmine neostigmine methylsulfate REMOVE FROM Non-Formulary methylsulfate FORMULARY 05/21/2021 neostigmine neostigmine methylsulfate REMOVE FROM Non-Formulary methylsulfate FORMULARY 05/21/2021 BOOST lactose-reduced food REMOVE FROM Non-Formulary FORMULARY 05/21/2021 bevacizumab bevacizumab REMOVE FROM Non-Formulary FORMULARY 05/21/2021 CULTURELLE lactobacillus rhamnosus REMOVE FROM Non-Formulary ULTIMATE gg/inulin FORMULARY 05/21/2021 series 600w bp blood pressure test kit-wrist REMOVE FROM Non-Formulary monitor FORMULARY 05/21/2021 pure-comfort gloves REMOVE FROM Non-Formulary nitrile gloves FORMULARY 05/21/2021 pure-comfort gloves REMOVE FROM Non-Formulary nitrile gloves FORMULARY 05/21/2021 pure-comfort gloves REMOVE FROM Non-Formulary nitrile gloves FORMULARY 05/21/2021 pure-comfort gloves REMOVE FROM Non-Formulary nitrile gloves FORMULARY 05/21/2021 bitter-bloc ws bitter mask flavor REMOVE FROM Non-Formulary powder conc combination no.3 FORMULARY 05/21/2021 HAND SOAP chlorhexidine gluconate REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 167 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/21/2021 PANXYME PH lipase/protease/amylase REMOVE FROM Non-Formulary FORMULARY 05/21/2021 MYLANTA calcium REMOVE FROM Non-Formulary COAT-COOL carbonate/magnesium FORMULARY hydroxide/simethicone 05/21/2021 BRAINSTRONG ginkgo biloba leaf REMOVE FROM Non-Formulary MEMORY extract/choline bitartrate FORMULARY SUPPORT 05/21/2021 DULCOLAX magnesium hydroxide REMOVE FROM Non-Formulary FORMULARY 05/21/2021 ALAMAX alpha lipoic REMOVE FROM Non-Formulary PROTECT acid/biotin/berberine FORMULARY chloride 05/21/2021 CHELEX acetylcysteine/alpha lipoic REMOVE FROM Non-Formulary acid/edetate FORMULARY calc/garlic/herbs 05/21/2021 series 100 bp blood pressure test kit-large REMOVE FROM Non-Formulary monitor FORMULARY 05/21/2021 clemastine clemastine fumarate REMOVE FROM Non-Formulary fumarate FORMULARY 05/21/2021 calcitonin-salmon calcitonin,salmon,synthetic REMOVE FROM Non-Formulary FORMULARY 05/21/2021 tiopronin tiopronin REMOVE FROM Non-Formulary FORMULARY 05/21/2021 ZYNRELEF bupivacaine/meloxicam REMOVE FROM Non-Formulary FORMULARY 05/21/2021 ZYNRELEF bupivacaine/meloxicam REMOVE FROM Non-Formulary FORMULARY 05/21/2021 NEURACEQ florbetaben f-18 REMOVE FROM Non-Formulary FORMULARY 05/24/2021 INGREZZA valbenazine tosylate ADD UM: LIMITEDACCESS Limited Access

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 168 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/24/2021 fulvestrant fulvestrant CHANGE UM: MED Medical Drug 05/25/2021 tiopronin tiopronin ADD UM: SPECIALTY Specialty Drug 05/27/2021 ZEPOSIA ozanimod hydrochloride REMOVE UM: Limited Access LIMITEDACCESS 05/27/2021 ZEPOSIA ozanimod hydrochloride REMOVE UM: Limited Access LIMITEDACCESS 05/27/2021 ZEPOSIA ozanimod hydrochloride REMOVE UM: Limited Access LIMITEDACCESS 05/28/2021 heatwraps activated REMOVE FROM Non-Formulary charcoal/iron/sodium/water FORMULARY 05/28/2021 wrist blood blood pressure test kit-wrist REMOVE FROM Non-Formulary pressure monitor FORMULARY 05/28/2021 sure comfort pen needle, diabetic, safety REMOVE FROM Non-Formulary safety pen needle FORMULARY 05/28/2021 techna nat unswt troche base no.247 REMOVE FROM Non-Formulary troche baseg2 FORMULARY 05/28/2021 bitter-bloc ws-os bitter mask flavoring REMOVE FROM Non-Formulary liquid conc FORMULARY 05/28/2021 ginkgo biloba ginkgo biloba leaf REMOVE FROM Non-Formulary plus extract/bacopa leaf extract FORMULARY 05/28/2021 ARTIFICIAL carboxymethylcellulose ADD TO FORMULARY Covered TEARS sodium 05/28/2021 BOOST MAX nutritional supplement REMOVE FROM Non-Formulary MEN FORMULARY 05/28/2021 BOOST MAX nutritional supplement REMOVE FROM Non-Formulary MEN FORMULARY 05/28/2021 VISTA MEIBO eyelid cleanser combination REMOVE FROM Non-Formulary EYELID no.12 FORMULARY CLEANSE

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 169 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 05/28/2021 capsaicin heat capsaicin REMOVE FROM Non-Formulary patch FORMULARY 05/28/2021 visine tetrahydrozoline hcl REMOVE FROM Non-Formulary FORMULARY 05/28/2021 vitamin c with ascorbic acid REMOVE FROM Non-Formulary rose hips FORMULARY 05/28/2021 duragel callus salicylic acid REMOVE FROM Non-Formulary removers FORMULARY 05/28/2021 resistance saccharomyces boulardii REMOVE FROM Non-Formulary formula probiotic FORMULARY 05/28/2021 BOOST MAX nutritional supplement REMOVE FROM Non-Formulary FORMULARY 05/28/2021 BOOST MAX nutritional supplement REMOVE FROM Non-Formulary FORMULARY 05/28/2021 BOOST MAX nutritional supplement REMOVE FROM Non-Formulary FORMULARY 05/28/2021 BOOST MAX nutritional supplement REMOVE FROM Non-Formulary FORMULARY 05/28/2021 CALAN SR verapamil hcl REMOVE FROM Non-Formulary FORMULARY 05/28/2021 HUMATIN paromomycin sulfate REMOVE FROM Non-Formulary FORMULARY 05/28/2021 clariscan gadoterate meglumine REMOVE FROM Non-Formulary FORMULARY 05/28/2021 PROPOFOL- propofol in lipid emulsion REMOVE FROM Non-Formulary LIPURO mct/lct (1:1)/pf FORMULARY 05/28/2021 KIMYRSA oritavancin diphosphate REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 170 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

June, 2021

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/01/2021 cataflam diclofenac potassium ADD TO FORMULARY Covered 06/01/2021 foscarnet foscarnet sodium ADD UM: MED Medical Drug sodium,foscavir 06/01/2021 COMBIVENT ipratropium CHANGE UM: QUANTITY 4 / 30 days 8 / 30 days RESPIMAT bromide/albuterol sulfate 06/01/2021 droxidopa droxidopa ADD UM: SPECIALTY Specialty Drug 06/01/2021 droxidopa droxidopa ADD UM: LIMITEDACCESS Limited Access 06/01/2021 droxidopa droxidopa ADD UM: SPECIALTY Specialty Drug 06/01/2021 droxidopa droxidopa ADD UM: LIMITEDACCESS Limited Access 06/01/2021 droxidopa droxidopa ADD UM: SPECIALTY Specialty Drug 06/01/2021 droxidopa droxidopa ADD UM: LIMITEDACCESS Limited Access 06/01/2021 virazole,ribavirin ribavirin ADD UM: MED Medical Drug 06/01/2021 OLINVYK oliceridine fumarate ADD UM: MED Medical Drug 06/01/2021 OLINVYK oliceridine fumarate ADD UM: MED Medical Drug 06/01/2021 GAMIFANT emapalumab-lzsg ADD UM: MED Medical Drug 06/01/2021 ZOKINVY lonafarnib ADD UM: SPECIALTY Specialty Drug 06/01/2021 GEMTESA vibegron ADD TO FORMULARY Non-Formulary Covered 06/01/2021 PALYNZIQ pegvaliase-pqpz CHANGE UM: QUANTITY 2 / 1 DAY 3 / 1 days 06/01/2021 omnipod insulin pump cartridge ADD UM: MED Medical Drug 06/01/2021 BREYANZI lisocabtagene maraleucel ADD UM: MED Medical Drug 06/01/2021 OZEMPIC semaglutide ADD TO FORMULARY Covered 06/01/2021 OZEMPIC semaglutide ADD UM: QUANTITY 3 / 28 days 06/01/2021 droxidopa droxidopa REMOVE UM: Limited Access LIMITEDACCESS

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 171 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/01/2021 droxidopa droxidopa REMOVE UM: Limited Access LIMITEDACCESS 06/01/2021 droxidopa droxidopa REMOVE UM: Limited Access LIMITEDACCESS 06/01/2021 SIGNIFOR LAR pasireotide pamoate ADD UM: SPECIALTY Specialty Drug 06/01/2021 SIGNIFOR LAR pasireotide pamoate ADD UM: MED Medical Drug 06/01/2021 SIGNIFOR LAR pasireotide pamoate ADD UM: SPECIALTY Specialty Drug 06/01/2021 SIGNIFOR LAR pasireotide pamoate ADD UM: MED Medical Drug 06/01/2021 SIGNIFOR LAR pasireotide pamoate ADD UM: SPECIALTY Specialty Drug 06/01/2021 SIGNIFOR LAR pasireotide pamoate ADD UM: MED Medical Drug 06/01/2021 SIGNIFOR LAR pasireotide pamoate ADD UM: SPECIALTY Specialty Drug 06/01/2021 SIGNIFOR LAR pasireotide pamoate ADD UM: MED Medical Drug 06/01/2021 SIGNIFOR LAR pasireotide pamoate ADD UM: SPECIALTY Specialty Drug 06/01/2021 SIGNIFOR LAR pasireotide pamoate ADD UM: MED Medical Drug 06/01/2021 midodrine hcl midodrine hcl ADD TO FORMULARY Covered 06/01/2021 millipred dp prednisolone REMOVE FROM Covered Non-Formulary FORMULARY 06/01/2021 WINLEVI clascoterone ADD UM: QUANTITY 60 / 30 days 06/01/2021 CABENUVA cabotegravir/rilpivirine ADD UM: MED Medical Drug 06/01/2021 IMCIVREE setmelanotide acetate ADD TO FORMULARY Covered 06/01/2021 sapropterin sapropterin dihydrochloride CHANGE UM: SPECIALTY Specialty Drug dihydrochloride 06/01/2021 ZOKINVY lonafarnib ADD UM: SPECIALTY Specialty Drug 06/01/2021 tiopronin tiopronin ADD UM: SPECIALTY Specialty Drug 06/01/2021 ZYNRELEF bupivacaine/meloxicam ADD UM: MED Medical Drug 06/01/2021 ZYNRELEF bupivacaine/meloxicam ADD UM: MED Medical Drug

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 172 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/01/2021 NEURACEQ florbetaben f-18 ADD UM: MED Medical Drug 06/01/2021 FORTEO ADD TO FORMULARY Covered 06/01/2021 FORTEO teriparatide REMOVE UM: SPECIALTY Specialty Drug 06/01/2021 sulfamethoxazole sulfamethoxazole/trimethopr ADD TO FORMULARY Non-Formulary Covered /trimethoprim,sulf im amethoxazole- trimethoprim,beth aprim 06/01/2021 high potency multivitamin/ferrous ADD TO FORMULARY Non-Formulary Covered multivitamin fumarate/folic acid 06/01/2021 selsun blue 2-in-1 selenium sulfide ADD TO FORMULARY Non-Formulary Covered 06/01/2021 dolishale levonorgestrel/ethinyl ADD TO FORMULARY Covered estradiol 06/01/2021 mycozyl ap miconazole nitrate ADD TO FORMULARY Non-Formulary Covered 06/01/2021 vista tears propylene ADD TO FORMULARY Non-Formulary Covered glycol/polyethylene glycol 400 06/01/2021 vista meibo tears propylene glycol ADD TO FORMULARY Non-Formulary Covered 06/03/2021 lubricant eye propylene glycol CHANGE TIER Covered drop 06/03/2021 fentanyl citrate- fentanyl citrate in 0.9 % CHANGE UM: Total cumulative 0.9% sodium chloride/pf QUANTITYCUSTOM opioid dose nacl,fentanyl limited to citrate/ns 90 morphine milligram equivalent (MME) per day 06/03/2021 fentanyl citrate- fentanyl citrate in 0.9 % ADD UM: MED Medical Drug ns,fentanyl sodium chloride/pf citrate-0.9% nacl

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 173 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/03/2021 fentanyl citrate- fentanyl citrate in 0.9 % ADD UM: MED Medical Drug ns,fentanyl sodium chloride/pf citrate-0.9% nacl 06/03/2021 fentanyl citrate- fentanyl citrate in 0.9 % ADD UM: MED Medical Drug 0.9% nacl sodium chloride/pf 06/03/2021 fentanyl citrate- fentanyl citrate in 0.9 % ADD UM: Total cumulative ns,fentanyl sodium chloride/pf QUANTITYCUSTOM opioid dose citrate-0.9% nacl limited to 90 morphine milligram equivalent (MME) per day 06/03/2021 fentanyl citrate- fentanyl citrate in 0.9 % ADD UM: Total cumulative ns,fentanyl sodium chloride/pf QUANTITYCUSTOM opioid dose citrate-0.9% nacl limited to 90 morphine milligram equivalent (MME) per day 06/03/2021 fentanyl citrate- fentanyl citrate in 0.9 % ADD UM: Total cumulative 0.9% nacl sodium chloride/pf QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 06/04/2021 pregabalin er pregabalin ADD UM: QUANTITY 1 / 1 days 06/04/2021 pregabalin er pregabalin ADD UM: QUANTITY 1 / 1 days 06/04/2021 pregabalin er pregabalin ADD UM: QUANTITY 1 / 1 days 06/04/2021 LABETALOL labetalol hcl in dextrose, iso- ADD UM: MED Medical Drug HCL-DEXTROSE osmotic 06/04/2021 LABETALOL labetalol hcl in sodium ADD UM: MED Medical Drug HCL-NACL chloride, iso-osmotic

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 174 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/04/2021 ultiguard syringe with needle, REMOVE FROM Non-Formulary safepack-insulin insulin,1 ml and sharps FORMULARY syr container 06/04/2021 ultiguard syringe with needle,insulin REMOVE FROM Non-Formulary safepack-insulin disposable,0.3 ml/empty FORMULARY syr containr 06/04/2021 ultiguard syringe-needle,insulin,0.5 REMOVE FROM Non-Formulary safepack-insulin ml/container,empty FORMULARY syr 06/04/2021 ultiguard syringe with needle, REMOVE FROM Non-Formulary safepack-insulin insulin,1 ml and sharps FORMULARY syr container 06/04/2021 ultiguard syringe with needle,insulin REMOVE FROM Non-Formulary safepack-insulin disposable,0.3 ml/empty FORMULARY syr containr 06/04/2021 easy touch blu blood-glucose meter REMOVE FROM Non-Formulary link gluc syst FORMULARY 06/04/2021 easy touch blu blood sugar diagnostic REMOVE FROM Non-Formulary link test strip FORMULARY 06/04/2021 truclear stevia sweetleaf (stevia REMOVE FROM Non-Formulary plus rebaudiana, extract) FORMULARY 06/04/2021 CULTURELLE lactobacillus REMOVE FROM Non-Formulary - rhamnosus/bifido FORMULARY WT MGMT animalis/vit b6/vit b12 06/04/2021 ASPERCREME lidocaine REMOVE FROM Non-Formulary LIDOCAINE FORMULARY 06/04/2021 co q-10 ubidecarenone REMOVE FROM Non-Formulary FORMULARY 06/04/2021 athlete's foot tolnaftate REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 175 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/04/2021 calcium- calcium REMOVE FROM Non-Formulary magnesium-zinc carbonate/magnesium FORMULARY oxide/zinc sulfate 06/04/2021 acetaminophen acetaminophen REMOVE FROM Non-Formulary FORMULARY 06/04/2021 lidocaine-menthol lidocaine/menthol REMOVE FROM Non-Formulary FORMULARY 06/04/2021 lidocaine lidocaine REMOVE FROM Non-Formulary FORMULARY 06/04/2021 spectravite multivitamin- REMOVE FROM Non-Formulary women 50 plus minerals/ferrous FORMULARY fumarate/folic acid/lutein 06/04/2021 orapenn sd liquid base no.249 REMOVE FROM Non-Formulary sweetened FORMULARY 06/04/2021 cytotine creatine monohydrate REMOVE FROM Non-Formulary FORMULARY 06/04/2021 acetaminophen acetaminophen ADD TO FORMULARY Covered 06/04/2021 cisatracurium cisatracurium besylate REMOVE FROM Non-Formulary besylate FORMULARY 06/04/2021 cisatracurium cisatracurium besylate REMOVE FROM Non-Formulary besylate FORMULARY 06/04/2021 cisatracurium cisatracurium besylate REMOVE FROM Non-Formulary besylate FORMULARY 06/04/2021 antacid-antigas magnesium ADD TO FORMULARY Covered hydroxide/aluminum hydroxide/simethicone 06/04/2021 zinc oxide zinc oxide REMOVE FROM Non-Formulary FORMULARY 06/04/2021 docu liquid docusate sodium ADD TO FORMULARY Covered 06/04/2021 glucose dextrose REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 176 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/04/2021 papaverine hcl papaverine hcl REMOVE FROM Non-Formulary FORMULARY 06/04/2021 stomach relief bismuth subsalicylate ADD TO FORMULARY Covered 06/04/2021 spectravite men's multivits with calcium and REMOVE FROM Non-Formulary minerals/iron/folic FORMULARY acid/lycopene 06/04/2021 amphetamine amphetamine sulfate REMOVE FROM Non-Formulary sulfate FORMULARY 06/04/2021 amphetamine amphetamine sulfate REMOVE FROM Non-Formulary sulfate FORMULARY 06/04/2021 MACI autologous cultured REMOVE FROM Non-Formulary chondrocytes/collagen, FORMULARY porcine 06/04/2021 MACI autologous cultured REMOVE FROM Non-Formulary chondrocytes/collagen, FORMULARY porcine 06/04/2021 econtra one-step levonorgestrel ADD TO FORMULARY Covered 06/04/2021 vancomycin hcl vancomycin hcl REMOVE FROM Non-Formulary FORMULARY 06/04/2021 GAMIFANT emapalumab-lzsg REMOVE FROM Non-Formulary FORMULARY 06/04/2021 ultiguard pen needle, diabetic, REMOVE FROM Non-Formulary safepack-pen remover and disposal unit FORMULARY needle 06/04/2021 ultiguard pen needle, diabetic, REMOVE FROM Non-Formulary safepack-pen remover and disposal unit FORMULARY needle 06/04/2021 ESSENTIAL nut.tx.impaired digest REMOVE FROM Non-Formulary CARE JR fxn/fiber FORMULARY 06/04/2021 ESSENTIAL nut.tx.impaired digest REMOVE FROM Non-Formulary CARE JR fxn/fiber FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 177 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/04/2021 ESSENTIAL nut.tx.impaired digest REMOVE FROM Non-Formulary CARE JR fxn/fiber FORMULARY 06/04/2021 ESSENTIAL nut.tx.impaired digest REMOVE FROM Non-Formulary CARE JR fxn/fiber FORMULARY 06/04/2021 ESSENTIAL nut.tx.impaired digest REMOVE FROM Non-Formulary CARE JR fxn/fiber FORMULARY 06/04/2021 ESSENTIAL nut.tx.impaired digest REMOVE FROM Non-Formulary CARE JR fxn/fiber FORMULARY 06/04/2021 ESSENTIAL nut.tx.impaired digest REMOVE FROM Non-Formulary CARE JR fxn/fiber FORMULARY 06/04/2021 ESSENTIAL nut.tx.impaired digest REMOVE FROM Non-Formulary CARE JR fxn/fiber FORMULARY 06/04/2021 phenylephrine phenylephrine hcl in 0.9 % REMOVE FROM Non-Formulary hcl-0.9% nacl sodium chloride FORMULARY 06/04/2021 easy touch safety pen needle, diabetic, safety REMOVE FROM Non-Formulary pen needle FORMULARY 06/04/2021 easy touch safety pen needle, diabetic, safety REMOVE FROM Non-Formulary pen needle FORMULARY 06/04/2021 acetaminophen acetaminophen ADD TO FORMULARY Non-Formulary Covered 06/04/2021 spectravite multivitamin- ADD TO FORMULARY Non-Formulary Covered women 50 plus minerals/ferrous fumarate/folic acid/lutein 06/04/2021 hydromorphone hydromorphone hcl in sterile REMOVE FROM Non-Formulary hcl-water water/pf FORMULARY 06/04/2021 arformoterol arformoterol tartrate REMOVE FROM Non-Formulary tartrate FORMULARY 06/04/2021 arformoterol arformoterol tartrate REMOVE FROM Non-Formulary tartrate FORMULARY 06/04/2021 rufinamide rufinamide ADD TO FORMULARY Covered 06/04/2021 rufinamide rufinamide ADD TO FORMULARY Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 178 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/04/2021 rufinamide rufinamide ADD TO FORMULARY Covered 06/04/2021 rufinamide rufinamide ADD TO FORMULARY Covered 06/07/2021 alinia,nitazoxanid nitazoxanide CHANGE UM: QUANTITY 6 / 30 days e 06/07/2021 venlafaxine hcl er venlafaxine hcl CHANGE UM: QUANTITY 1 / 1 days 06/07/2021 anti- loperamide hcl CHANGE TIER Covered diarrheal,antidiarr heal,hm anti- diarrheal,anti diarrheal 06/07/2021 famotidine,pepcid famotidine CHANGE TIER Covered ac 06/07/2021 guaifenesin guaifenesin/pseudoephedrin CHANGE TIER Covered w/pseudoephedri e hcl ne,guaifenesin- pseudoephedrine ,guaifenesin- pseudoephedrine er 06/07/2021 naproxen naproxen ADD TO FORMULARY Covered 06/07/2021 bacitracin bacitracin zinc CHANGE TIER Covered zinc,bacitracin 06/07/2021 acetaminophen acetaminophen CHANGE TIER Covered er,acetaminophe n 8 hour,acetaminop hen 06/07/2021 antacid ultra calcium carbonate CHANGE TIER Covered strength,antacid ultra 06/07/2021 calcipotriene calcipotriene CHANGE TIER Covered 06/07/2021 gentle laxative bisacodyl CHANGE TIER Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 179 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/07/2021 allergy cetirizine hcl CHANGE TIER Covered relief,allergy 06/07/2021 itch relief diphenhydramine hcl/zinc CHANGE TIER Covered acetate 06/07/2021 antacid-antigas magnesium CHANGE TIER Covered hydroxide/aluminum hydroxide/simethicone 06/08/2021 NIMBEX cisatracurium besylate ADD UM: MED Medical Drug 06/08/2021 cisatracurium cisatracurium besylate ADD UM: MED Medical Drug besylate 06/08/2021 papaverine hcl papaverine hcl ADD UM: MED Medical Drug 06/08/2021 GAMIFANT emapalumab-lzsg CHANGE UM: MED Medical Drug 06/08/2021 easy touch blu blood sugar diagnostic ADD UM: QUANTITY 5 / 1 days link test strip 06/08/2021 VIVITROL naltrexone microspheres ADD UM: MED Medical Drug 06/11/2021 venlafaxine hcl er venlafaxine hcl CHANGE UM: CUSTOM Covered by OMAP 06/11/2021 labetalol hcl labetalol hcl ADD UM: MED Medical Drug 06/11/2021 hydromorphone hydromorphone hcl in sterile ADD UM: MED Medical Drug hcl-water water/pf 06/11/2021 hydromorphone hydromorphone hcl in sterile ADD UM: Total cumulative hcl-water water/pf QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 06/11/2021 ganciclovir ganciclovir sodium REMOVE FROM Non-Formulary sodium FORMULARY 06/11/2021 magnesium magnesium chloride REMOVE FROM Non-Formulary chloride FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 180 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/11/2021 fentanyl citrate fentanyl citrate ADD TO FORMULARY Covered 06/11/2021 meprobamate meprobamate REMOVE FROM Non-Formulary FORMULARY 06/11/2021 vitamin a and d vitamins a and d ADD TO FORMULARY Covered 06/11/2021 OMNIPAQUE iohexol REMOVE FROM Non-Formulary FORMULARY 06/11/2021 OMNIPAQUE iohexol REMOVE FROM Non-Formulary FORMULARY 06/11/2021 morphine sulfate morphine sulfate REMOVE FROM Non-Formulary FORMULARY 06/11/2021 hydromorphone hydromorphone hcl ADD TO FORMULARY Covered hcl 06/11/2021 hydromorphone hydromorphone hcl ADD TO FORMULARY Covered hcl 06/11/2021 headache relief aspirin/acetaminophen/caffei REMOVE FROM Non-Formulary ne FORMULARY 06/11/2021 OMNIPAQUE iohexol REMOVE FROM Non-Formulary FORMULARY 06/11/2021 clotrimazole clotrimazole ADD TO FORMULARY Covered 06/11/2021 olive oil olive oil REMOVE FROM Non-Formulary FORMULARY 06/11/2021 sodium nitroprusside sodium REMOVE FROM Non-Formulary nitroprusside FORMULARY 06/11/2021 meprobamate meprobamate REMOVE FROM Non-Formulary FORMULARY 06/11/2021 labetalol hcl labetalol hcl REMOVE FROM Non-Formulary FORMULARY 06/11/2021 norepinephrine norepinephrine bitartrate REMOVE FROM Non-Formulary bitartrate FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 181 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/11/2021 esomeprazole esomeprazole magnesium REMOVE FROM Non-Formulary magnesium FORMULARY 06/11/2021 esomeprazole esomeprazole magnesium REMOVE FROM Non-Formulary magnesium FORMULARY 06/11/2021 esomeprazole esomeprazole magnesium REMOVE FROM Non-Formulary magnesium FORMULARY 06/11/2021 sufentanil citrate sufentanil citrate REMOVE FROM Non-Formulary FORMULARY 06/11/2021 STALEVO 50 carbidopa/levodopa/entacap REMOVE FROM Non-Formulary one FORMULARY 06/11/2021 daptomycin daptomycin REMOVE FROM Non-Formulary FORMULARY 06/11/2021 azacitidine azacitidine REMOVE FROM Non-Formulary FORMULARY 06/11/2021 oxaliplatin oxaliplatin REMOVE FROM Non-Formulary FORMULARY 06/11/2021 oxaliplatin oxaliplatin REMOVE FROM Non-Formulary FORMULARY 06/11/2021 reusable hot-cold cold-hot pack REMOVE FROM Non-Formulary compress FORMULARY 06/11/2021 metformin er metformin hcl REMOVE FROM Non-Formulary gastric FORMULARY 06/11/2021 metformin er metformin hcl REMOVE FROM Non-Formulary gastric FORMULARY 06/11/2021 chest congestion guaifenesin/phenylephrine REMOVE FROM Non-Formulary relief pe hcl FORMULARY 06/11/2021 sodium sulfacetamide sodium REMOVE FROM Non-Formulary sulfacetamide FORMULARY 06/11/2021 sodium sulfacetamide sodium REMOVE FROM Non-Formulary sulfacetamide FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 182 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/11/2021 clopidogrel clopidogrel bisulfate REMOVE FROM Non-Formulary FORMULARY 06/11/2021 sinus wash sodium chloride/sodium REMOVE FROM Non-Formulary bicarbonate FORMULARY 06/11/2021 VARIBAR barium sulfate REMOVE FROM Non-Formulary NECTAR FORMULARY 06/11/2021 caprylic-capric caprylic/capric triglyceride REMOVE FROM Non-Formulary triglyceride FORMULARY 06/11/2021 azelastine hcl azelastine hcl ADD TO FORMULARY Covered 06/11/2021 easy touch syringe with REMOVE FROM Non-Formulary insulin syringe needle,disposable,insulin 1 FORMULARY ml 06/11/2021 easy touch syringe with REMOVE FROM Non-Formulary insulin syringe needle,insulin,0.5 ml FORMULARY 06/11/2021 easy touch syringe with REMOVE FROM Non-Formulary insulin syringe needle,disposable,insulin 1 FORMULARY ml 06/11/2021 easy touch syringe with REMOVE FROM Non-Formulary insulin syringe needle,insulin,0.5 ml FORMULARY 06/11/2021 easy touch syringe with REMOVE FROM Non-Formulary insulin syringe needle,disposable,insulin 1 FORMULARY ml 06/11/2021 elastic bandage elastic bandage REMOVE FROM Non-Formulary FORMULARY 06/11/2021 easy touch syringe with REMOVE FROM Non-Formulary insulin syringe needle,insulin,0.5 ml FORMULARY 06/11/2021 reusable pain cold-hot pack REMOVE FROM Non-Formulary relief cold pack FORMULARY 06/11/2021 ultiguard pen needle, diabetic, REMOVE FROM Non-Formulary safepack-pen remover and disposal unit FORMULARY needle

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 183 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/11/2021 capsoral capsule compounding base REMOVE FROM Non-Formulary no.250 FORMULARY 06/11/2021 orapenn sd liquid base no.251 REMOVE FROM Non-Formulary unsweetened FORMULARY 06/11/2021 ellume covid-19 covid-19 antigen REMOVE FROM Non-Formulary home test immunoassay test FORMULARY 06/11/2021 easy touch blu blood glucose calibration REMOVE FROM Non-Formulary link ctrl soln control high and low FORMULARY 06/11/2021 NEURIVA PLUS b6/folic REMOVE FROM Non-Formulary BRAIN acid/cyanocobalamin/coffee FORMULARY PERFORMANCE ext/phosphatidyl serine 06/11/2021 NEURIVA PLUS b6/folic REMOVE FROM Non-Formulary BRAIN acid/cyanocobalamin/coffee FORMULARY PERFORMANCE ext/phosphatidyl serine 06/11/2021 clariscan gadoterate meglumine REMOVE FROM Non-Formulary FORMULARY 06/11/2021 procaine hcl procaine hcl REMOVE FROM Non-Formulary FORMULARY 06/11/2021 VAZCULEP phenylephrine hcl REMOVE FROM Non-Formulary FORMULARY 06/11/2021 SYNOGESIC ascorbic acid/cholecalciferol REMOVE FROM Non-Formulary (vit d3)/herbal complex FORMULARY no.313 06/11/2021 CULTURELLE l. rhamnosus gg/ascorbic REMOVE FROM Non-Formulary KIDS IMMUNE acid/zinc oxide/elderberry FORMULARY DEFENSE fruit 06/11/2021 CULTURELLE lactobacillus REMOVE FROM Non-Formulary KIDS GROW- rhamnosus/bifidobac FORMULARY THRIVE animalis/fucosyllactose/d3 06/11/2021 anti-diarrheal- loperamide hcl/simethicone REMOVE FROM Non-Formulary anti-gas FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 184 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/11/2021 chest rub eucalyptus REMOVE FROM Non-Formulary oil/menthol/camphor FORMULARY 06/11/2021 diclofenac diclofenac sodium REMOVE FROM Non-Formulary sodium FORMULARY 06/11/2021 diclofenac diclofenac sodium REMOVE FROM Non-Formulary sodium FORMULARY 06/11/2021 diclofenac diclofenac sodium REMOVE FROM Non-Formulary sodium FORMULARY 06/11/2021 antibiotic and neomycin sulfate/polymyxin REMOVE FROM Non-Formulary pain relief b sulfate/pramoxine FORMULARY 06/11/2021 spectravite adult multivitamin/ferrous ADD TO FORMULARY Covered fumarate/folic acid 06/11/2021 methyl salicylate methyl salicylate REMOVE FROM Non-Formulary FORMULARY 06/11/2021 spectravite men multivitamin with ADD TO FORMULARY Covered 50 plus minerals/folic acid/lycopene/lutein 06/11/2021 lidocaine-menthol lidocaine/menthol REMOVE FROM Non-Formulary FORMULARY 06/11/2021 lubricating tears dextran 70/hypromellose REMOVE FROM Non-Formulary FORMULARY 06/11/2021 eye allergy itch- olopatadine hcl REMOVE FROM Non-Formulary redness rlf FORMULARY 06/11/2021 artificial eye mineral oil/petrolatum,white ADD TO FORMULARY Covered lubricant 06/11/2021 carboprost carboprost tromethamine REMOVE FROM Non-Formulary tromethamine FORMULARY 06/11/2021 lopinavir-ritonavir lopinavir/ritonavir ADD TO FORMULARY Covered 06/11/2021 lopinavir-ritonavir lopinavir/ritonavir ADD TO FORMULARY Covered 06/11/2021 rufinamide rufinamide ADD TO FORMULARY Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 185 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/11/2021 rufinamide rufinamide ADD TO FORMULARY Covered 06/11/2021 rufinamide rufinamide ADD TO FORMULARY Covered 06/11/2021 rufinamide rufinamide ADD TO FORMULARY Covered 06/11/2021 fentanyl citrate- fentanyl citrate in 0.9 % REMOVE FROM Non-Formulary 0.9% nacl sodium chloride/pf FORMULARY 06/11/2021 fentanyl citrate- fentanyl citrate in 0.9 % REMOVE FROM Non-Formulary 0.9% nacl sodium chloride/pf FORMULARY 06/11/2021 WEGOVY semaglutide REMOVE FROM Non-Formulary FORMULARY 06/11/2021 WEGOVY semaglutide REMOVE FROM Non-Formulary FORMULARY 06/11/2021 WEGOVY semaglutide REMOVE FROM Non-Formulary FORMULARY 06/11/2021 WEGOVY semaglutide REMOVE FROM Non-Formulary FORMULARY 06/11/2021 WEGOVY semaglutide REMOVE FROM Non-Formulary FORMULARY 06/14/2021 ganciclovir ganciclovir sodium ADD UM: MED Medical Drug sodium 06/14/2021 CYTOVENE ganciclovir sodium ADD UM: MED Medical Drug 06/14/2021 meprobamate meprobamate CHANGE UM: CUSTOM Covered by OMAP 06/14/2021 OMNIPAQUE iohexol ADD UM: MED Medical Drug 06/14/2021 OMNIPAQUE iohexol ADD UM: MED Medical Drug 06/14/2021 nitroprusside nitroprusside sodium ADD UM: CUSTOM Eligible for 90 sodium,sodium day supply nitroprusside

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 186 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/14/2021 nitroprusside nitroprusside sodium ADD UM: MED Medical Drug sodium,sodium nitroprusside 06/14/2021 NITROPRESS nitroprusside sodium ADD UM: MED Medical Drug 06/14/2021 meprobamate meprobamate CHANGE UM: CUSTOM Covered by OMAP 06/14/2021 labetalol hcl labetalol hcl CHANGE UM: CUSTOM Eligible for 90 day supply 06/14/2021 daptomycin daptomycin ADD UM: MED Medical Drug 06/14/2021 CUBICIN daptomycin ADD UM: MED Medical Drug 06/14/2021 CUBICIN RF daptomycin ADD UM: MED Medical Drug 06/14/2021 azacitidine azacitidine CHANGE UM: MED Medical Drug 06/14/2021 phenylephrine hcl phenylephrine hcl ADD UM: MED Medical Drug 06/14/2021 VAZCULEP phenylephrine hcl ADD UM: MED Medical Drug 06/14/2021 easy touch blu blood glucose calibration ADD UM: MED Medical Drug link ctrl soln control high and low 06/17/2021 KYNMOBI apomorphine hcl REMOVE UM: Limited Access LIMITEDACCESS 06/17/2021 KYNMOBI apomorphine hcl REMOVE UM: Limited Access LIMITEDACCESS 06/17/2021 KYNMOBI apomorphine hcl REMOVE UM: Limited Access LIMITEDACCESS 06/17/2021 KYNMOBI apomorphine hcl REMOVE UM: Limited Access LIMITEDACCESS 06/17/2021 KYNMOBI apomorphine hcl REMOVE UM: Limited Access LIMITEDACCESS 06/18/2021 arformoterol arformoterol tartrate ADD UM: CUSTOM ELIGIBLE FOR tartrate 90 DAY SUPPLY 06/18/2021 naproxen naproxen ADD TO FORMULARY Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 187 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/18/2021 naproxen naproxen ADD TO FORMULARY Covered 06/18/2021 potassium potassium chloride in water REMOVE FROM Non-Formulary chloride for injection, sterile FORMULARY 06/18/2021 potassium potassium chloride in water REMOVE FROM Non-Formulary chloride for injection, sterile FORMULARY 06/18/2021 potassium potassium chloride in water REMOVE FROM Non-Formulary chloride for injection, sterile FORMULARY 06/18/2021 potassium potassium chloride in water REMOVE FROM Non-Formulary chloride for injection, sterile FORMULARY 06/18/2021 potassium potassium chloride in water REMOVE FROM Non-Formulary chloride for injection, sterile FORMULARY 06/18/2021 ivermectin ivermectin REMOVE FROM Non-Formulary FORMULARY 06/18/2021 metoprolol metoprolol tartrate ADD TO FORMULARY Covered tartrate 06/18/2021 metoprolol metoprolol tartrate ADD TO FORMULARY Covered tartrate 06/18/2021 easypoint needle needles, disposable REMOVE FROM Non-Formulary FORMULARY 06/18/2021 easypoint needle needles, disposable REMOVE FROM Non-Formulary FORMULARY 06/18/2021 easy touch luer syringe, disposable, 20 ml REMOVE FROM Non-Formulary lock syringe FORMULARY 06/18/2021 easy touch luer syringe, disposable, 60 ml REMOVE FROM Non-Formulary lock syringe FORMULARY 06/18/2021 echinacea echinacea purpurea aerial REMOVE FROM Non-Formulary parts extract FORMULARY 06/18/2021 pcca custom troche base no.253 REMOVE FROM Non-Formulary troche base FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 188 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/18/2021 PROBIOTIC lactobacillus REMOVE FROM Non-Formulary PEARLS acidophilus/bifidobacterium FORMULARY ACIDOPHILUS longum 06/18/2021 OPTIFAST multivitamin,calcium,mineral REMOVE FROM Non-Formulary s/folic acid/phytonadione(vit FORMULARY k) 06/18/2021 calcium d- calcium glucarate REMOVE FROM Non-Formulary glucarate FORMULARY 06/18/2021 nasal mist 0.9 % sodium chloride REMOVE FROM Non-Formulary FORMULARY 06/18/2021 lice-bedbug-mite permethrin REMOVE FROM Non-Formulary bedding FORMULARY 06/18/2021 eye allergy itch olopatadine hcl REMOVE FROM Non-Formulary relief FORMULARY 06/18/2021 arctic relief menthol REMOVE FROM Non-Formulary FORMULARY 06/18/2021 arctic relief menthol REMOVE FROM Non-Formulary FORMULARY 06/18/2021 ESTROVEN multivitamin, min/folic REMOVE FROM Non-Formulary MENOPAUSE acid/black FORMULARY cohosh/isoflavones/jujube 06/18/2021 NOVOLOG insulin aspart REMOVE FROM Non-Formulary FORMULARY 06/18/2021 NOVOLOG MIX insulin aspart protamine REMOVE FROM Non-Formulary 70-30 FLEXPEN human/insulin aspart FORMULARY 06/18/2021 NOVOLOG MIX insulin aspart protamine REMOVE FROM Non-Formulary 70-30 human/insulin aspart FORMULARY 06/18/2021 NOVOLOG insulin aspart REMOVE FROM Non-Formulary FLEXPEN FORMULARY 06/18/2021 sodium chloride sodium chloride REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 189 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/18/2021 CERAVE BABY petrolatum,white REMOVE FROM Non-Formulary HEALING FORMULARY 06/18/2021 MULTI FOR HIM multivitamin with REMOVE FROM Non-Formulary minerals/folic FORMULARY acid/phytonadione 06/18/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 06/18/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 06/18/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 06/18/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 06/18/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 06/18/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 06/18/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 06/18/2021 venlafaxine hcl er venlafaxine hcl REMOVE FROM Non-Formulary FORMULARY 06/18/2021 nicardipine hcl nicardipine hcl REMOVE FROM Non-Formulary FORMULARY 06/18/2021 nicardipine hcl nicardipine hcl REMOVE FROM Non-Formulary FORMULARY 06/18/2021 hydromorphone hydromorphone hcl REMOVE FROM Non-Formulary hcl FORMULARY 06/18/2021 sodium chloride sodium chloride REMOVE FROM Non-Formulary FORMULARY 06/18/2021 sodium chloride sodium chloride REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 190 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/18/2021 etravirine etravirine ADD TO FORMULARY Covered 06/18/2021 etravirine etravirine ADD TO FORMULARY Covered 06/18/2021 TRIKAFTA elexacaftor/tezacaftor/ivacaft ADD TO FORMULARY Covered or 06/18/2021 PANCREAZE lipase/protease/amylase REMOVE FROM Non-Formulary FORMULARY 06/22/2021 potassium potassium chloride in water ADD UM: MED Medical Drug chloride for injection, sterile,potassium chloride 06/22/2021 hydromorphone hydromorphone hcl ADD UM: MED Medical Drug hcl,hydromorpho ne hcl injection,hydromo rphone hydrochloride 06/22/2021 potassium potassium chloride in water ADD UM: MED Medical Drug chloride,potassiu for injection, m chloride-water sterile,potassium chloride 06/22/2021 potassium potassium chloride in water ADD UM: MED Medical Drug chloride for injection, sterile,potassium chloride 06/22/2021 sodium chloride sodium chloride ADD UM: MED Medical Drug 06/22/2021 venlafaxine hcl er venlafaxine hcl CHANGE UM: CUSTOM COVERED BY OMAP 06/22/2021 deferiprone deferiprone CHANGE UM: SPECIALTY Specialty Drug 06/22/2021 deferiprone deferiprone CHANGE UM: Limited Access LIMITEDACCESS 06/22/2021 soolantra,ivermec ivermectin CHANGE UM: QUANTITY 45 / 30 days tin 06/22/2021 HEMABATE carboprost tromethamine ADD UM: MED Medical Drug

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 191 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/22/2021 carboprost carboprost tromethamine ADD UM: MED Medical Drug tromethamine 06/22/2021 KIMYRSA oritavancin diphosphate ADD UM: MED Medical Drug 06/23/2021 labetalol hcl labetalol hcl CHANGE UM: MED Medical Drug 06/25/2021 DERMACINRX multivitamin with minerals REMOVE FROM Non-Formulary VENTRIXYL no.86/folic acid FORMULARY 06/25/2021 doxorubicin hcl doxorubicin hcl pegylated REMOVE FROM Non-Formulary liposome liposomal FORMULARY 06/25/2021 doxorubicin hcl doxorubicin hcl pegylated REMOVE FROM Non-Formulary liposome liposomal FORMULARY 06/25/2021 PANRETIN alitretinoin REMOVE FROM Non-Formulary FORMULARY 06/25/2021 tobramycin tobramycin sulfate REMOVE FROM Non-Formulary sulfate FORMULARY 06/25/2021 cyanocobalamin cyanocobalamin (vitamin b- REMOVE FROM Non-Formulary 12) FORMULARY 06/25/2021 easy touch safety pen needle, diabetic, safety REMOVE FROM Non-Formulary pen needle FORMULARY 06/25/2021 OPTIFIBER glucomannan REMOVE FROM Non-Formulary LEAN FORMULARY 06/25/2021 OLIVDEFENSE leaf REMOVE FROM Non-Formulary extract/theanine/elderberry FORMULARY fruit/olive xtrac 06/25/2021 APPE-CURB 5- REMOVE FROM Non-Formulary hydroxytryptophan// FORMULARY glutamin/phenylal/b6/c/chro mium 06/25/2021 MUCINEX FAST- triprolidine/phenylephrine/de REMOVE FROM Non-Formulary MAX CONG- xtromethorph/acetamin/guaif FORMULARY NGHTSHFT enes

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 192 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/25/2021 headache relief aspirin/acetaminophen/caffei REMOVE FROM Non-Formulary ne FORMULARY 06/25/2021 headache relief aspirin/acetaminophen/caffei REMOVE FROM Non-Formulary ne FORMULARY 06/25/2021 headache relief aspirin/acetaminophen/caffei REMOVE FROM Non-Formulary ne FORMULARY 06/25/2021 headache relief aspirin/acetaminophen/caffei REMOVE FROM Non-Formulary ne FORMULARY 06/25/2021 omeprazole omeprazole magnesium REMOVE FROM Non-Formulary magnesium FORMULARY 06/25/2021 nighttime sleep diphenhydramine hcl REMOVE FROM Non-Formulary aid FORMULARY 06/25/2021 callus removers salicylic acid REMOVE FROM Non-Formulary FORMULARY 06/25/2021 cold-sinus relief ibuprofen/pseudoephedrine REMOVE FROM Non-Formulary hcl FORMULARY 06/25/2021 cold and hot pain methyl salicylate/menthol REMOVE FROM Non-Formulary relief FORMULARY 06/25/2021 antacid-antigas calcium REMOVE FROM Non-Formulary carbonate/simethicone FORMULARY 06/25/2021 iron bisglycinate ferrous bis-glycinate chelate REMOVE FROM Non-Formulary FORMULARY 06/25/2021 doxorubicin hcl doxorubicin hcl REMOVE FROM Non-Formulary FORMULARY 06/25/2021 doxorubicin hcl doxorubicin hcl REMOVE FROM Non-Formulary FORMULARY 06/25/2021 doxorubicin hcl doxorubicin hcl REMOVE FROM Non-Formulary FORMULARY 06/25/2021 doxorubicin hcl doxorubicin hcl REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 193 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/25/2021 doxorubicin hcl doxorubicin hcl REMOVE FROM Non-Formulary FORMULARY 06/25/2021 doxorubicin hcl doxorubicin hcl REMOVE FROM Non-Formulary FORMULARY 06/25/2021 AKOVAZ ephedrine sulfate REMOVE FROM Non-Formulary FORMULARY 06/25/2021 formoterol formoterol fumarate REMOVE FROM Non-Formulary fumarate FORMULARY 06/25/2021 formoterol formoterol fumarate REMOVE FROM Non-Formulary fumarate FORMULARY 06/25/2021 formoterol formoterol fumarate REMOVE FROM Non-Formulary fumarate FORMULARY 06/25/2021 formoterol formoterol fumarate REMOVE FROM Non-Formulary fumarate FORMULARY 06/25/2021 DUPIXENT PEN dupilumab REMOVE FROM Non-Formulary FORMULARY 06/25/2021 AYVAKIT avapritinib REMOVE FROM Non-Formulary FORMULARY 06/25/2021 AYVAKIT avapritinib REMOVE FROM Non-Formulary FORMULARY 06/29/2021 venlafaxine hcl er venlafaxine hcl CHANGE UM: CUSTOM COVERED BY OMAP 06/29/2021 venlafaxine hcl er venlafaxine hcl REMOVE UM: QUANTITY 06/29/2021 doxorubicin hcl doxorubicin hcl pegylated ADD UM: MED Medical Drug liposome liposomal 06/29/2021 lipodox doxorubicin hcl pegylated ADD UM: MED Medical Drug liposomal 06/29/2021 DOXIL doxorubicin hcl pegylated ADD UM: MED Medical Drug liposomal

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 194 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/29/2021 lipodox 50 doxorubicin hcl pegylated ADD UM: MED Medical Drug liposomal 06/29/2021 PANRETIN alitretinoin CHANGE UM: SPECIALTY Specialty Drug 06/29/2021 venlafaxine hcl er venlafaxine hcl CHANGE UM: CUSTOM COVERED BY Covered by OMAP OMAP 06/29/2021 venlafaxine hcl er venlafaxine hcl CHANGE UM: CUSTOM Covered by OMAP 06/29/2021 venlafaxine hcl er venlafaxine hcl CHANGE UM: CUSTOM Covered by OMAP 06/29/2021 venlafaxine hcl er venlafaxine hcl CHANGE UM: CUSTOM Covered by OMAP 06/30/2021 BICNU carmustine ADD UM: MED Medical Drug 06/30/2021 carmustine carmustine ADD UM: MED Medical Drug 06/30/2021 doxorubicin hcl doxorubicin hcl ADD UM: MED Medical Drug 06/30/2021 adriamycin doxorubicin hcl ADD UM: MED Medical Drug 06/30/2021 adriamycin doxorubicin hcl ADD UM: MED Medical Drug 06/30/2021 doxorubicin hcl doxorubicin hcl ADD UM: MED Medical Drug 06/30/2021 tobramycin tobramycin sulfate ADD UM: MED Medical Drug sulfate 06/30/2021 arformoterol arformoterol tartrate CHANGE UM: CUSTOM Eligible for 90 tartrate day supply 06/30/2021 doxorubicin hcl doxorubicin hcl ADD UM: MED Medical Drug 06/30/2021 doxorubicin hcl doxorubicin hcl ADD UM: MED Medical Drug 06/30/2021 adriamycin doxorubicin hcl ADD UM: MED Medical Drug 06/30/2021 adriamycin doxorubicin hcl ADD UM: MED Medical Drug 06/30/2021 doxorubicin hcl doxorubicin hcl ADD UM: MED Medical Drug 06/30/2021 adriamycin doxorubicin hcl ADD UM: MED Medical Drug

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 195 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 06/30/2021 SUBSYS fentanyl CHANGE UM: QUANTITY 4 / 1 days 06/30/2021 SUBSYS fentanyl CHANGE UM: Total cumulative QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 06/30/2021 ephedrine sulfate ephedrine sulfate ADD UM: MED Medical Drug 06/30/2021 AKOVAZ ephedrine sulfate ADD UM: MED Medical Drug 06/30/2021 LUMASON sulfur hexafluoride ADD UM: MED Medical Drug microspheres 06/30/2021 VYLEESI bremelanotide acetate CHANGE UM: Limited Access LIMITEDACCESS 06/30/2021 VYLEESI bremelanotide acetate CHANGE UM: QUANTITY 4 / 30 days

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 196 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

July, 2021

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 07/01/2021 cefixime cefixime ADD TO FORMULARY Non-Formulary Covered 07/01/2021 cefixime cefixime ADD TO FORMULARY Non-Formulary Covered 07/01/2021 cefixime cefixime ADD TO FORMULARY Non-Formulary Covered 07/02/2021 formoterol formoterol fumarate ADD UM: CUSTOM Eligible for 90 fumarate Day Supply 07/02/2021 TRIKAFTA elexacaftor/tezacaftor/ivacaft ADD UM: QUANTITY 3 / 1 days or 07/02/2021 DUPIXENT PEN dupilumab ADD UM: QUANTITY 2.28 / 28 days 07/02/2021 DUPIXENT PEN dupilumab ADD UM: SPECIALTY Specialty Drug 07/02/2021 AYVAKIT avapritinib ADD UM: SPECIALTY Specialty Drug 07/02/2021 AYVAKIT avapritinib ADD UM: SPECIALTY Specialty Drug 07/02/2021 AYVAKIT avapritinib ADD UM: LIMITEDACCESS Limited Access 07/02/2021 AYVAKIT avapritinib ADD UM: LIMITEDACCESS Limited Access 07/02/2021 dextrose in water dextrose 5 % in water REMOVE FROM Non-Formulary FORMULARY 07/02/2021 dextrose in water dextrose 10 % in water REMOVE FROM Non-Formulary FORMULARY 07/02/2021 dextrose in water dextrose 10 % in water REMOVE FROM Non-Formulary FORMULARY 07/02/2021 dextrose in water dextrose 10 % in water REMOVE FROM Non-Formulary FORMULARY 07/02/2021 PANZYGA immune REMOVE FROM Non-Formulary globulin,gamma(igg)-ifas FORMULARY human/glycine

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 197 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 07/02/2021 PANZYGA immune REMOVE FROM Non-Formulary globulin,gamma(igg)-ifas FORMULARY human/glycine 07/02/2021 PANZYGA immune REMOVE FROM Non-Formulary globulin,gamma(igg)-ifas FORMULARY human/glycine 07/02/2021 PANZYGA immune REMOVE FROM Non-Formulary globulin,gamma(igg)-ifas FORMULARY human/glycine 07/02/2021 PANZYGA immune REMOVE FROM Non-Formulary globulin,gamma(igg)-ifas FORMULARY human/glycine 07/02/2021 PANZYGA immune REMOVE FROM Non-Formulary globulin,gamma(igg)-ifas FORMULARY human/glycine 07/02/2021 micro thin lancet lancets REMOVE FROM Non-Formulary FORMULARY 07/02/2021 excell-rdt sf base tablet rapid dissolve REMOVE FROM Non-Formulary compounding base no.254 FORMULARY 07/02/2021 ACTIVICE menthol REMOVE FROM Non-Formulary FORMULARY 07/02/2021 CULTURELLE l. rhamnosus gg/ascorbic REMOVE FROM Non-Formulary IMMUNE acid/zinc oxide/elderberry FORMULARY DEFENSE fruit 07/02/2021 NIX ULTRA mineral oil/dimethicone REMOVE FROM Non-Formulary FORMULARY 07/02/2021 MUCINEX FAST- triprolidine/phenylephrine/de REMOVE FROM Non-Formulary MAX COLD- xtromethorph/acetamin/guaif FORMULARY NGHTSHFT enes 07/02/2021 MUCINEX FAST- triprolidine/phenylephrine/de REMOVE FROM Non-Formulary MAX COLD- xtromethorph/acetamin/guaif FORMULARY NGHTSHFT enes

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 198 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 07/02/2021 MUCINEX FAST- triprolidine/phenylephrine/de REMOVE FROM Non-Formulary MAX COLD- xtromethorph/acetamin/guaif FORMULARY NGHTSHFT enes 07/02/2021 one daily men's multivitamin,calcium,mineral REMOVE FROM Non-Formulary health s/folic acid/vitamin FORMULARY k1/lycopene 07/02/2021 b-12 with folic cyanocobalamin/folic acid REMOVE FROM Non-Formulary acid FORMULARY 07/02/2021 alpha lipoic acid - alpha lipoic acid/biotin REMOVE FROM Non-Formulary biotin FORMULARY 07/02/2021 ERWINASE asparaginase (erwinia REMOVE FROM Non-Formulary chrysanthemi) FORMULARY 07/02/2021 DAYAVITE multivitamin with minerals REMOVE FROM Non-Formulary no.90/folic acid/ala/coq10 FORMULARY 07/02/2021 water water for injection,sterile REMOVE FROM Non-Formulary FORMULARY 07/02/2021 children's ibuprofen ADD TO FORMULARY Covered ibuprofen 07/02/2021 children's ibuprofen ADD TO FORMULARY Covered ibuprofen 07/02/2021 NYMALIZE nimodipine REMOVE FROM Non-Formulary FORMULARY 07/06/2021 dextrose in dextrose 5 % in water ADD UM: MED Medical Drug water,glucose in water 07/06/2021 dextrose in water dextrose 10 % in water ADD UM: MED Medical Drug 07/06/2021 docetaxel docetaxel CHANGE UM: MED Medical Drug 07/06/2021 docetaxel docetaxel CHANGE UM: MED Medical Drug 07/06/2021 suppository shell, suppository mold ADD UM: MED Medical Drug small

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 199 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 07/06/2021 PANZYGA immune CHANGE UM: SPECIALTY Specialty Drug globulin,gamma(igg)-ifas human/glycine 07/06/2021 PANZYGA immune CHANGE UM: MED Medical Drug globulin,gamma(igg)-ifas human/glycine 07/06/2021 ketamine hcl- ketamine hcl in sterile water ADD UM: MED Medical Drug water 07/06/2021 ERWINAZE asparaginase (erwinia ADD UM: MED Medical Drug chrysanthemi) 07/06/2021 ERWINASE asparaginase (erwinia ADD UM: LIMITEDACCESS Limited Access chrysanthemi) 07/06/2021 ERWINASE asparaginase (erwinia ADD UM: MED Medical Drug chrysanthemi) 07/06/2021 l-methylfolate levomefolate calcium CHANGE UM: CUSTOM Eligible for 90 calcium Day Supply 07/06/2021 fenofibrate CHANGE UM: CUSTOM Eligible for 90 Day Supply 07/08/2021 bupropion hcl bupropion hcl REMOVE FROM Non-Formulary sr,bupropion hcl FORMULARY er 07/08/2021 bupropion hcl bupropion hcl CHANGE UM: CUSTOM Covered by sr,bupropion hcl OMAP er 07/08/2021 diclofenac diclofenac sodium CHANGE TIER Covered sodium 07/08/2021 omeprazole omeprazole magnesium CHANGE TIER Covered magnesium 07/08/2021 SUBSYS fentanyl CHANGE UM: QUANTITY 4 / 1 days

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 200 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 07/08/2021 SUBSYS fentanyl ADD UM: CUSTOM Total cumulative opioid dose limited to 90 morphine milligram equivalent (MME) per day 07/08/2021 DEMEROL meperidine hcl ADD TO FORMULARY Non-Formulary Covered 07/09/2021 KLOXXADO naloxone hcl ADD TO FORMULARY Covered 07/09/2021 FLUAD QUAD influenza vaccine REMOVE FROM Non-Formulary 2021-2022 quadrivalent 2021-22 (65 yr FORMULARY up)/mf59c.1/pf 07/09/2021 fortiscare g1 test blood sugar diagnostic REMOVE FROM Non-Formulary strip FORMULARY 07/09/2021 SENOKOT- senna leaf/herbal complex REMOVE FROM Non-Formulary CHAMOMILE no.324 FORMULARY 07/09/2021 pain relief lidocaine REMOVE FROM Non-Formulary FORMULARY 07/09/2021 dermacinrx lactobacillus REMOVE FROM Non-Formulary probitran acidophilus/bifidobacterium FORMULARY animalis 07/09/2021 AFLURIA QUAD influenza virus vaccine REMOVE FROM Non-Formulary 2021-22 (6- quadrival 2021-22 (6 mos- FORMULARY 35MO) 35 mos)/pf 07/09/2021 AFLURIA QUAD influenza virus vaccine REMOVE FROM Non-Formulary 2021-22 (3YR quadrivalent 2021-22 (36 FORMULARY UP) mos up)/pf 07/09/2021 AFLURIA QUAD influenza virus vaccine REMOVE FROM Non-Formulary 2021-2022 quadrivalent 2021-22 (6 mos FORMULARY and up)

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 201 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 07/09/2021 FLUCELVAX flu vaccine quad 2021- REMOVE FROM Non-Formulary QUAD 2021- 2022(2 years and older)cell FORMULARY 2022 derived/pf 07/09/2021 FLUCELVAX flu vaccine quadriv 2021- REMOVE FROM Non-Formulary QUAD 2021- 2022(2 years and older)cell FORMULARY 2022 derived 07/09/2021 READI-CAT 2 barium sulfate REMOVE FROM Non-Formulary FORMULARY 07/09/2021 READI-CAT 2 barium sulfate REMOVE FROM Non-Formulary FORMULARY 07/09/2021 READI-CAT 2 barium sulfate REMOVE FROM Non-Formulary FORMULARY 07/09/2021 foscarnet sodium foscarnet sodium REMOVE FROM Non-Formulary FORMULARY 07/09/2021 penicillamine penicillamine REMOVE FROM Non-Formulary FORMULARY 07/09/2021 sodium chloride sodium chloride 0.45 % REMOVE FROM Non-Formulary FORMULARY 07/09/2021 sodium chloride sodium chloride 0.45 % REMOVE FROM Non-Formulary FORMULARY 07/09/2021 sodium chloride sodium chloride 0.45 % REMOVE FROM Non-Formulary FORMULARY 07/09/2021 sodium chloride sodium chloride 0.45 % REMOVE FROM Non-Formulary FORMULARY 07/09/2021 loperamide loperamide hcl ADD TO FORMULARY Covered 07/09/2021 lactated ringers ringer's solution,lactated REMOVE FROM Non-Formulary FORMULARY 07/09/2021 lactated ringers ringer's solution,lactated REMOVE FROM Non-Formulary FORMULARY 07/09/2021 lactated ringers ringer's solution,lactated REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 202 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 07/09/2021 zinc oxide zinc oxide REMOVE FROM Non-Formulary FORMULARY 07/09/2021 potassium potassium chloride ADD TO FORMULARY Covered chloride 07/09/2021 nitrofurantoin nitrofurantoin REMOVE FROM Non-Formulary FORMULARY 07/09/2021 nitrofurantoin nitrofurantoin REMOVE FROM Non-Formulary FORMULARY 07/09/2021 nitrofurantoin nitrofurantoin REMOVE FROM Non-Formulary FORMULARY 07/09/2021 carmustine carmustine REMOVE FROM Non-Formulary FORMULARY 07/09/2021 chlorambucil chlorambucil ADD TO FORMULARY Covered 07/09/2021 chlorambucil chlorambucil ADD TO FORMULARY Covered 07/09/2021 potassium potassium chloride ADD TO FORMULARY Covered chloride 07/09/2021 furosemide furosemide ADD TO FORMULARY Covered 07/09/2021 ANTIVERT meclizine hcl REMOVE FROM Non-Formulary FORMULARY 07/09/2021 fluorouracil fluorouracil ADD TO FORMULARY Covered 07/09/2021 fluorouracil fluorouracil ADD TO FORMULARY Covered 07/09/2021 pyrimethamine pyrimethamine ADD TO FORMULARY Covered 07/09/2021 diclofenac diclofenac potassium ADD TO FORMULARY Covered potassium 07/09/2021 oralyte electrolytes/dextrose REMOVE FROM Non-Formulary FORMULARY 07/09/2021 daptomycin daptomycin REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 203 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 07/09/2021 benzocaine benzocaine REMOVE FROM Non-Formulary FORMULARY 07/09/2021 urimar-t methenamine/methylene REMOVE FROM Non-Formulary blue/salicylate/sodium FORMULARY phos/hyoscyamin 07/09/2021 cyclophosphamid cyclophosphamide ADD TO FORMULARY Covered e 07/09/2021 ketoconazole ketoconazole REMOVE FROM Non-Formulary FORMULARY 07/09/2021 ketoconazole ketoconazole REMOVE FROM Non-Formulary FORMULARY 07/09/2021 topiramate topiramate ADD TO FORMULARY Covered 07/09/2021 topiramate topiramate ADD TO FORMULARY Covered 07/09/2021 itch relief diphenhydramine hcl/zinc ADD TO FORMULARY Covered acetate 07/09/2021 testosterone testosterone REMOVE FROM Non-Formulary FORMULARY 07/09/2021 ARGINAID whey protein REMOVE FROM Non-Formulary EXTRA isolate/arginine/c/e/zinc FORMULARY sulfate 07/09/2021 SIMILAC PRO- infant formula with REMOVE FROM Non-Formulary SENSITIVE iron/docosahexaenoic FORMULARY NON-GMO acid/arachidonic ac 07/09/2021 SIMILAC PRO- infant formula with REMOVE FROM Non-Formulary SENSITIVE iron/docosahexaenoic FORMULARY NON-GMO acid/arachidonic ac 07/09/2021 SIMILAC PRO- infant formula with REMOVE FROM Non-Formulary ADVANCE NON- iron/docosahexaenoic FORMULARY GMO acid/arachidonic ac

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 204 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 07/09/2021 SIMILAC PRO- infant formula with REMOVE FROM Non-Formulary ADVANCE NON- iron/docosahexaenoic FORMULARY GMO acid/arachidonic ac 07/09/2021 KETOCAL 3:1 nutritional therapy, REMOVE FROM Non-Formulary ketogenic, milk based with FORMULARY soy 07/09/2021 SIMILAC PRO- infant formula with REMOVE FROM Non-Formulary TOTAL CMFT iron/docosahexaenoic FORMULARY NON-GMO acid/arachidonic ac 07/09/2021 SIMILAC PRO- infant formula with REMOVE FROM Non-Formulary TOTAL CMFT iron/docosahexaenoic FORMULARY NON-GMO acid/arachidonic ac 07/09/2021 hydrophilic catheter REMOVE FROM Non-Formulary catheter FORMULARY 07/09/2021 true comfort pro alcohol antiseptic pads REMOVE FROM Non-Formulary alcohol pads FORMULARY 07/09/2021 fortiscare t1 blood-glucose meter REMOVE FROM Non-Formulary blood gluc sys FORMULARY 07/09/2021 EFFIENT prasugrel hcl REMOVE FROM Non-Formulary FORMULARY 07/09/2021 EFFIENT prasugrel hcl REMOVE FROM Non-Formulary FORMULARY 07/09/2021 fentanyl citrate fentanyl citrate/pf REMOVE FROM Non-Formulary FORMULARY 07/09/2021 pain reliever plus aspirin/acetaminophen/caffei REMOVE FROM Non-Formulary ne FORMULARY 07/09/2021 docetaxel docetaxel REMOVE FROM Non-Formulary FORMULARY 07/09/2021 docetaxel docetaxel REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 205 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 07/09/2021 argatroban-0.9% argatroban in 0.9 % sodium REMOVE FROM Non-Formulary nacl chloride FORMULARY 07/09/2021 docetaxel docetaxel REMOVE FROM Non-Formulary FORMULARY 07/09/2021 sildenafil citrate sildenafil citrate ADD TO FORMULARY Covered 07/09/2021 PEPTIDE 1.5 nutritional supplement/fiber REMOVE FROM Non-Formulary FORMULARY 07/09/2021 fish oil omega-3 omega-3 fatty REMOVE FROM Non-Formulary acids/docosahexaenoic FORMULARY acid/epa/fish oil 07/09/2021 STANDARD 1.4 nutritional supplement/fiber REMOVE FROM Non-Formulary FORMULARY 07/09/2021 ALFAMINO nutritional therapy for REMOVE FROM Non-Formulary JUNIOR impaired digestive function FORMULARY 07/13/2021 TRIKAFTA elexacaftor/tezacaftor/ivacaft ADD UM: LIMITEDACCESS Limited Access or 07/14/2021 arthritis diclofenac sodium ADD TO FORMULARY Non-Formulary Covered pain,arthritis pain reliever 07/14/2021 fortiscare g1 test blood sugar diagnostic ADD UM: QUANTITY 5 / 1 days strip 07/14/2021 penicillamine penicillamine CHANGE UM: SPECIALTY Specialty Drug 07/14/2021 fish oil omega-3 fatty CHANGE UM: CUSTOM ELIGIBLE FOR acids/docosahexaenoic 90 DAY SUPPLY acid/epa/fish oil,omega-3 fatty acids/fish oil,omega-3 fatty acids/docosahexanoic acid/epa/fish oil

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 206 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 07/14/2021 fish oil omega-3 fatty CHANGE UM: CUSTOM ELIGIBLE FOR acids/docosahexaenoic 90 DAY SUPPLY acid/epa/fish oil,omega-3 fatty acids/docosahexanoic acid/epa/fish oil,omega-3 fatty acids/dha/epa/other omega-3s/fish oil 07/14/2021 fish oil omega-3 fatty ADD UM: CUSTOM ELIGIBLE FOR acids/docosahexanoic 90 DAY SUPPLY acid/epa/fish oil,omega-3 fatty acids/docosahexaenoic acid/epa/fish oil 07/14/2021 ultra omega-3 omega-3 fatty ADD UM: CUSTOM ELIGIBLE FOR acids/docosahexaenoic 90 DAY SUPPLY acid/epa/fish oil 07/14/2021 fish oil omega-3 fatty ADD UM: CUSTOM ELIGIBLE FOR acids/docosahexaenoic 90 DAY SUPPLY acid/epa/fish oil 07/14/2021 OMEGAPURE omega-3 fatty ADD UM: CUSTOM ELIGIBLE FOR 600 EC acids/docosahexaenoic 90 DAY SUPPLY acid/epa/fish oil 07/14/2021 OMEGAPURE omega-3 fatty ADD UM: CUSTOM ELIGIBLE FOR 780 EC acids/docosahexaenoic 90 DAY SUPPLY acid/epa/fish oil 07/14/2021 fish oil omega-3 fatty ADD UM: CUSTOM ELIGIBLE FOR acids/docosahexaenoic 90 DAY SUPPLY acid/epa/fish oil 07/14/2021 fish oil omega-3 fatty ADD UM: CUSTOM ELIGIBLE FOR acids/docosahexaenoic 90 DAY SUPPLY acid/epa/fish oil 07/14/2021 fish oil omega-3 omega-3 fatty ADD UM: CUSTOM ELIGIBLE FOR acids/docosahexaenoic 90 DAY SUPPLY acid/epa/fish oil

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 207 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 07/14/2021 hydrophilic catheter ADD UM: MED Medical Drug catheter 07/14/2021 fentanyl citrate fentanyl citrate/pf ADD UM: MED Medical Drug 07/14/2021 fentanyl citrate fentanyl citrate/pf CHANGE UM: Total cumulative QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 07/14/2021 foscarnet sodium foscarnet sodium CHANGE UM: MED Medical Drug 07/14/2021 sodium chloride sodium chloride 0.45 % ADD UM: MED Medical Drug 07/14/2021 carmustine carmustine CHANGE UM: MED Medical Drug 07/14/2021 lactated ringers ringer's ADD UM: MED Medical Drug solution,lactated,ringers solution,lactated 07/14/2021 docetaxel docetaxel CHANGE UM: MED Medical Drug 07/14/2021 docetaxel docetaxel CHANGE UM: MED Medical Drug 07/14/2021 argatroban-0.9% argatroban in 0.9 % sodium CHANGE UM: MED Medical Drug nacl chloride 07/16/2021 micafungin micafungin sodium REMOVE FROM Non-Formulary FORMULARY 07/16/2021 sodium acetate sodium acetate REMOVE FROM Non-Formulary FORMULARY 07/16/2021 sodium acetate sodium acetate REMOVE FROM Non-Formulary FORMULARY 07/16/2021 papaverine hcl papaverine hcl REMOVE FROM Non-Formulary FORMULARY 07/16/2021 dextrose in water dextrose 50 % in water REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 208 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 07/16/2021 micafungin micafungin sodium REMOVE FROM Non-Formulary FORMULARY 07/16/2021 azelastine hcl azelastine hcl REMOVE FROM Non-Formulary FORMULARY 07/16/2021 tranexamic acid tranexamic acid REMOVE FROM Non-Formulary FORMULARY 07/16/2021 SUBSYS fentanyl REMOVE FROM Non-Formulary FORMULARY 07/16/2021 SUBSYS fentanyl REMOVE FROM Non-Formulary FORMULARY 07/16/2021 one daily multivitamin with REMOVE FROM Non-Formulary essential minerals/folic acid FORMULARY 07/16/2021 GERBER GS multivitamin with minerals ADD TO FORMULARY Covered PRENATAL no.92/folic acid/dha NOURISH PLS 07/16/2021 loperamide- loperamide hcl/simethicone REMOVE FROM Non-Formulary simethicone FORMULARY 07/16/2021 children's plus m- dextromethorphan/phenylep REMOVE FROM Non-Formulary s cold hrine/acetaminophen/chlorp FORMULARY heniramin 07/16/2021 NEONATAL prenatal vitamins REMOVE FROM Non-Formulary PLUS no.154/ferrous fumarate/folic FORMULARY acid 07/16/2021 NEONATAL FE iron,carbonyl/ascorbic REMOVE FROM Non-Formulary acid/cyanocobalamin/folic FORMULARY acid 07/16/2021 norepinephrine norepinephrine bitartrate in REMOVE FROM Non-Formulary bitar-0.9% nacl 0.9 % sodium chloride FORMULARY 07/16/2021 sodium sulfacetamide sodium/sulfur REMOVE FROM Non-Formulary sulfacetamide- FORMULARY sulfur

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 209 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 07/16/2021 realheal-i lidocaine/prilocaine REMOVE FROM Non-Formulary FORMULARY 07/16/2021 varenicline varenicline tartrate ADD TO FORMULARY Covered tartrate 07/16/2021 varenicline varenicline tartrate ADD TO FORMULARY Covered tartrate 07/16/2021 ferumoxytol ferumoxytol REMOVE FROM Non-Formulary FORMULARY 07/19/2021 SUBSYS fentanyl CHANGE UM: QUANTITY 4 / 1 days 07/19/2021 SUBSYS fentanyl CHANGE UM: Total cumulative QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 07/19/2021 SUBSYS fentanyl CHANGE UM: QUANTITY 4 / 1 days 07/19/2021 SUBSYS fentanyl CHANGE UM: Total cumulative QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 07/20/2021 dextrose in water dextrose 50 % in water ADD UM: MED Medical Drug 07/20/2021 micafungin micafungin sodium CHANGE UM: MED Medical Drug 07/20/2021 MYCAMINE micafungin sodium ADD UM: MED Medical Drug 07/20/2021 sodium acetate sodium acetate ADD UM: MED Medical Drug 07/20/2021 papaverine hcl papaverine hcl CHANGE UM: MED Medical Drug 07/20/2021 micafungin micafungin sodium ADD UM: MED Medical Drug 07/20/2021 MYCAMINE micafungin sodium ADD UM: MED Medical Drug

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 210 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 07/20/2021 norepinephrine norepinephrine bitartrate in ADD UM: MED Medical Drug bitar-0.9% nacl 0.9 % sodium chloride 07/20/2021 lamotrigine odt lamotrigine CHANGE UM: CUSTOM Covered by OMAP 07/20/2021 lamotrigine odt lamotrigine CHANGE UM: CUSTOM Covered by OMAP 07/20/2021 lamotrigine odt lamotrigine CHANGE UM: CUSTOM Covered by OMAP 07/20/2021 lamotrigine odt lamotrigine CHANGE UM: CUSTOM Covered by OMAP 07/27/2021 XOFLUZA baloxavir marboxil REMOVE FROM Non-Formulary FORMULARY 07/27/2021 sodium sulfacetamide sodium/sulfur REMOVE FROM Non-Formulary sulfacetamide- FORMULARY sulfur 07/27/2021 NAC acetylcysteine REMOVE FROM Non-Formulary FORMULARY 07/27/2021 premier lock n roll ostomy supply REMOVE FROM Non-Formulary FORMULARY 07/27/2021 premier classic blood-glucose meter REMOVE FROM Non-Formulary glucose meter FORMULARY 07/27/2021 fexofenadine-pse fexofenadine REMOVE FROM Non-Formulary er hcl/pseudoephedrine hcl FORMULARY 07/27/2021 menthol-zinc menthol/zinc oxide REMOVE FROM Non-Formulary oxide FORMULARY 07/27/2021 zinc-vitamin c ascorbic acid/zinc oxide REMOVE FROM Non-Formulary FORMULARY 07/27/2021 TIROSINT-SOL levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY 07/27/2021 TIROSINT-SOL levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 211 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 07/27/2021 TIROSINT-SOL levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY 07/27/2021 XOFLUZA baloxavir marboxil REMOVE FROM Non-Formulary FORMULARY 07/27/2021 SILATRIX sucralfate malate, REMOVE FROM Non-Formulary polymerized FORMULARY 07/27/2021 NEONATAL prenatal vitamins REMOVE FROM Non-Formulary COMPLETE no.175/ferrous fumarate/folic FORMULARY acid 07/27/2021 purelan lanolin REMOVE FROM Non-Formulary FORMULARY 07/30/2021 dicloheal-60 diclofenac sodium/capsaicin REMOVE FROM Non-Formulary FORMULARY 07/30/2021 azelastine hcl azelastine hcl REMOVE FROM Non-Formulary FORMULARY 07/30/2021 VAZALORE aspirin ADD TO FORMULARY Covered 07/30/2021 VAZALORE aspirin ADD TO FORMULARY Covered 07/30/2021 olopatadine hcl olopatadine hcl REMOVE FROM Non-Formulary FORMULARY 07/30/2021 allergy relief cetirizine REMOVE FROM Non-Formulary nasal decongest hcl/pseudoephedrine hcl FORMULARY 07/30/2021 mycozyl al tolnaftate REMOVE FROM Non-Formulary FORMULARY 07/30/2021 tylenol cold-flu dextromethorphan REMOVE FROM Non-Formulary multi-act day hbr/pseudoephedrine FORMULARY hcl/acetaminophen 07/30/2021 FLUMIST QUAD influenza vaccine REMOVE FROM Non-Formulary 2021-2022 quadrivalent live 2021-2022 FORMULARY (2 yrs-49 yrs) 07/30/2021 milrinone lactate milrinone lactate REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 212 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 07/30/2021 norepinephrine norepinephrine bitartrate REMOVE FROM Non-Formulary bitartrate FORMULARY 07/30/2021 azacitidine azacitidine REMOVE FROM Non-Formulary FORMULARY 07/30/2021 argatroban-0.9% argatroban in 0.9 % sodium REMOVE FROM Non-Formulary nacl chloride FORMULARY 07/30/2021 caretouch pen pen needle, diabetic REMOVE FROM Non-Formulary needle FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 213 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

August, 2021

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/01/2021 BASAGLAR insulin glargine,human REMOVE FROM Covered Non-Formulary KWIKPEN U-100 recombinant analog FORMULARY 08/01/2021 LOTEMAX loteprednol etabonate REMOVE FROM Covered Non-Formulary FORMULARY 08/01/2021 LOTEMAX SM loteprednol etabonate REMOVE FROM Covered Non-Formulary FORMULARY 08/01/2021 loteprednol loteprednol etabonate REMOVE FROM Covered Non-Formulary etabonate FORMULARY 08/01/2021 loteprednol loteprednol etabonate REMOVE FROM Covered Non-Formulary etabonate FORMULARY 08/01/2021 chorionic chorionic gonadotropin, ADD UM: SPECIALTY Specialty Drug gonadotropin human 08/01/2021 chorionic chorionic gonadotropin, ADD UM: MED Medical Drug gonadotropin human 08/01/2021 chorionic chorionic gonadotropin, ADD UM: SPECIALTY Specialty Drug gonadotropin human 08/01/2021 chorionic chorionic gonadotropin, ADD UM: MED Medical Drug gonadotropin human 08/01/2021 FOLLISTIM AQ follitropin beta,recombinant ADD UM: MED Medical Drug 08/01/2021 FOLLISTIM AQ follitropin beta,recombinant ADD UM: MED Medical Drug 08/01/2021 FOLLISTIM AQ follitropin beta,recombinant ADD UM: MED Medical Drug 08/01/2021 GONAL-F follitropin alfa, recombinant ADD UM: MED Medical Drug 08/01/2021 GONAL-F follitropin alfa, recombinant ADD UM: MED Medical Drug 08/01/2021 GONAL-F RFF follitropin alfa, recombinant ADD UM: MED Medical Drug 08/01/2021 GONAL-F RFF follitropin alfa, recombinant ADD UM: MED Medical Drug REDI-JECT

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 214 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/01/2021 GONAL-F RFF follitropin alfa, recombinant ADD UM: MED Medical Drug REDI-JECT 08/01/2021 GONAL-F RFF follitropin alfa, recombinant ADD UM: MED Medical Drug REDI-JECT 08/01/2021 OVIDREL choriogonadotropin alfa ADD UM: MED Medical Drug 08/01/2021 NOVAREL chorionic gonadotropin, ADD UM: MED Medical Drug human 08/01/2021 MENOPUR menotropins ADD UM: MED Medical Drug 08/01/2021 NOVAREL chorionic gonadotropin, ADD UM: MED Medical Drug human 08/01/2021 REYVOW lasmiditan succinate CHANGE UM: QUANTITY 4 / 30 days 8 / 30 days 08/01/2021 ganirelix acetate ganirelix acetate ADD UM: SPECIALTY Specialty Drug 08/01/2021 ganirelix acetate ganirelix acetate ADD UM: MED Medical Drug 08/01/2021 EVKEEZA evinacumab-dgnb ADD UM: MED Medical Drug 08/01/2021 DOTAREM gadoterate meglumine ADD UM: MED Medical Drug 08/01/2021 clariscan gadoterate meglumine ADD UM: MED Medical Drug 08/01/2021 LUPKYNIS voclosporin ADD TO FORMULARY Covered 08/01/2021 UKONIQ umbralisib tosylate ADD TO FORMULARY Covered 08/01/2021 NUCYNTA ER hcl ADD UM: QUANTITY 2 / 1 days 08/01/2021 NUCYNTA ER tapentadol hcl ADD UM: QUANTITY 2 / 1 days 08/01/2021 NUCYNTA ER tapentadol hcl ADD UM: QUANTITY 2 / 1 days 08/01/2021 NUCYNTA ER tapentadol hcl ADD UM: QUANTITY 2 / 1 days 08/01/2021 NUCYNTA ER tapentadol hcl ADD UM: QUANTITY 2 / 1 days 08/01/2021 TEPMETKO tepotinib hcl ADD TO FORMULARY Covered 08/01/2021 epoprostenol epoprostenol sodium ADD UM: MED Medical Drug sodium

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 215 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/01/2021 epoprostenol epoprostenol sodium ADD UM: MED Medical Drug sodium 08/01/2021 ABECMA idecabtagene vicleucel ADD UM: MED Medical Drug 08/01/2021 AMONDYS-45 casimersen ADD UM: MED Medical Drug 08/01/2021 COSELA trilaciclib dihydrochloride ADD UM: MED Medical Drug 08/01/2021 GAMASTAN immune ADD UM: SPECIALTY Specialty Drug globulin,gamma(igg),immun e globulin,gamma(igg)/glycine 08/01/2021 GAMASTAN immune ADD UM: SPECIALTY Specialty Drug S/D,GAMASTAN globulin,gamma(igg),immun S-D e globulin,gamma(igg)/glycine 08/01/2021 BYNFEZIA octreotide acetate ADD UM: SPECIALTY Specialty Drug 08/01/2021 cyclophosphamid cyclophosphamide ADD TO FORMULARY Non-Formulary Covered e 08/01/2021 cyclophosphamid cyclophosphamide ADD TO FORMULARY Covered e 08/01/2021 FOTIVDA tivozanib hcl ADD TO FORMULARY Covered 08/01/2021 FOTIVDA tivozanib hcl ADD TO FORMULARY Covered 08/01/2021 MARGENZA margetuximab-cmkb ADD UM: MED Medical Drug 08/01/2021 NUCYNTA tapentadol hcl ADD UM: QUANTITY 6 / 1 days 08/01/2021 NUCYNTA tapentadol hcl ADD UM: QUANTITY 6 / 1 days 08/01/2021 NUCYNTA tapentadol hcl ADD UM: QUANTITY 6 / 1 days 08/01/2021 NULIBRY fosdenopterin hydrobromide ADD UM: SPECIALTY Specialty Drug 08/01/2021 NULIBRY fosdenopterin hydrobromide ADD UM: MED Medical Drug 08/01/2021 PEPAXTO melphalan flufenamide ADD UM: MED Medical Drug hydrochloride

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 216 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/01/2021 PROLATE oxycodone ADD UM: Total cumulative hcl/acetaminophen QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 08/01/2021 ROXYBOND oxycodone hcl REMOVE UM: Total cumulative QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 08/01/2021 ROXYBOND oxycodone hcl REMOVE UM: Total cumulative QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 08/01/2021 tramadol hcl tramadol hcl ADD UM: QUANTITY 2 / 1 days er,ryzolt 08/01/2021 tramadol hcl tramadol hcl ADD UM: QUANTITY 2 / 1 days er,ultram er 08/01/2021 tramadol hcl tramadol hcl ADD UM: QUANTITY 1 / 1 days er,ryzolt 08/01/2021 tramadol hcl tramadol hcl ADD UM: QUANTITY 1 / 1 days er,ryzolt 08/01/2021 SOMATULINE lanreotide acetate ADD UM: MED Medical Drug DEPOT 08/01/2021 SOMATULINE lanreotide acetate ADD UM: MED Medical Drug DEPOT

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 217 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/01/2021 SOMATULINE lanreotide acetate ADD UM: MED Medical Drug DEPOT 08/01/2021 calcipotriene- calcipotriene/betamethason ADD TO FORMULARY Non-Formulary Covered betamethasone e dipropionate 08/01/2021 tramadol hcl- tramadol hcl/acetaminophen ADD UM: QUANTITY 10 / 1 days acetaminophen,ul tracet 08/01/2021 tramadol tramadol hcl ADD UM: QUANTITY 8 / 1 days hcl,ultram 08/01/2021 tramadol hcl tramadol hcl ADD UM: QUANTITY 1 / 1 days er,ultram er 08/01/2021 tramadol hcl tramadol hcl ADD UM: QUANTITY 1 / 1 days er,ultram er 08/01/2021 VYZULTA latanoprostene bunod ADD UM: QUANTITY 2.5 / 25 days 08/01/2021 ZIOPTAN tafluprost/pf ADD UM: QUANTITY 1 / 1 days 08/01/2021 PREGNYL chorionic gonadotropin, ADD UM: MED Medical Drug human 08/01/2021 chorionic chorionic gonadotropin, ADD UM: MED Medical Drug gonadotropin human 08/01/2021 tramadol hcl tramadol hcl REMOVE UM: QUANTITY 2 / 1 days er,ultram er 08/01/2021 tramadol hcl tramadol hcl REMOVE UM: QUANTITY 1 / 1 days er,ultram er 08/01/2021 tramadol hcl tramadol hcl REMOVE UM: QUANTITY 2 / 1 days er,ryzolt 08/01/2021 tramadol hcl tramadol hcl REMOVE UM: QUANTITY 1 / 1 days er,ryzolt 08/01/2021 tramadol hcl tramadol hcl REMOVE UM: QUANTITY 1 / 1 days er,ryzolt

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 218 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/01/2021 tramadol hcl- tramadol hcl/acetaminophen REMOVE UM: QUANTITY 10 / 1 days acetaminophen,ul tracet 08/01/2021 tramadol tramadol hcl REMOVE UM: QUANTITY 8 / 1 days hcl,ultram 08/01/2021 tramadol hcl tramadol hcl REMOVE UM: QUANTITY 1 / 1 days er,ultram er 08/01/2021 ROXYBOND oxycodone hcl REMOVE UM: Total cumulative QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 08/01/2021 dihydroergotamin dihydroergotamine mesylate CHANGE UM: QUANTITY 24 / 48 days 24 / 28 days e mesylate,d.h.e.45 08/01/2021 SUBSYS fentanyl CHANGE UM: Total cumulative QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 08/01/2021 SUBSYS fentanyl REMOVE UM: CUSTOM Total cumulative opioid dose limited to 90 morphine milligram equivalent (MME) per day 08/01/2021 docetaxel docetaxel CHANGE UM: MED Medical Drug 08/01/2021 tramadol hcl tramadol hcl ADD UM: QUANTITY 1 / 1 days er,ultram er

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 219 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/01/2021 tramadol hcl tramadol hcl ADD UM: QUANTITY 1 / 1 days er,ryzolt 08/01/2021 tramadol hcl tramadol hcl REMOVE UM: QUANTITY 1 / 1 days er,ultram er 08/01/2021 tramadol hcl tramadol hcl REMOVE UM: QUANTITY 1 / 1 days er,ryzolt 08/01/2021 NUCYNTA tapentadol hcl REMOVE UM: QUANTITY 6 / 1 days 08/01/2021 NUCYNTA tapentadol hcl REMOVE UM: QUANTITY 6 / 1 days 08/01/2021 NUCYNTA tapentadol hcl REMOVE UM: QUANTITY 6 / 1 days 08/01/2021 NUCYNTA ER tapentadol hcl REMOVE UM: QUANTITY 2 / 1 days 08/01/2021 NUCYNTA ER tapentadol hcl REMOVE UM: QUANTITY 2 / 1 days 08/01/2021 NUCYNTA ER tapentadol hcl REMOVE UM: QUANTITY 2 / 1 days 08/01/2021 NUCYNTA ER tapentadol hcl REMOVE UM: QUANTITY 2 / 1 days 08/01/2021 NUCYNTA ER tapentadol hcl REMOVE UM: QUANTITY 2 / 1 days 08/01/2021 acetaminophen acetaminophen REMOVE FROM Covered Non-Formulary FORMULARY 08/01/2021 BIDIL isosorbide CHANGE UM: CUSTOM ELIGIBLE FOR dinitrate/hydralazine hcl 90 DAY SUPPLY 08/01/2021 BUPHENYL sodium phenylbutyrate ADD UM: SPECIALTY Specialty Drug 08/01/2021 ferumoxytol ferumoxytol ADD UM: MED Medical Drug 08/01/2021 FERAHEME ferumoxytol ADD UM: MED Medical Drug 08/01/2021 metformin er metformin hcl CHANGE UM: CUSTOM ELIGIBLE FOR gastric 90 DAY SUPPLY 08/01/2021 metformin er metformin hcl CHANGE UM: CUSTOM ELIGIBLE FOR gastric 90 DAY SUPPLY 08/01/2021 HUMIRA(CF) adalimumab REMOVE UM: Limited Access PEDIATRIC LIMITEDACCESS CROHN'S

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 220 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/01/2021 PRESTALIA perindopril CHANGE UM: CUSTOM ELIGIBLE FOR arginine/amlodipine besylate 90 DAY SUPPLY 08/01/2021 PRESTALIA perindopril CHANGE UM: CUSTOM ELIGIBLE FOR arginine/amlodipine besylate 90 DAY SUPPLY 08/01/2021 PRESTALIA perindopril CHANGE UM: CUSTOM ELIGIBLE FOR arginine/amlodipine besylate 90 DAY SUPPLY 08/01/2021 SYLVANT siltuximab CHANGE UM: MED Medical Drug 08/01/2021 SYLVANT siltuximab CHANGE UM: MED Medical Drug 08/01/2021 trientine hcl trientine hcl CHANGE UM: SPECIALTY Specialty Drug 08/04/2021 ENBREL etanercept CHANGE UM: QUANTITY 2 / 28 days 8 / 28 days 08/04/2021 azacitidine azacitidine CHANGE UM: MED Medical Drug 08/04/2021 CYTOGAM cytomegalovirus immune ADD UM: MED Medical Drug globulin (human),cytomegalovirus immune glob 08/04/2021 XOFLUZA baloxavir marboxil ADD UM: QUANTITY 1 / 30 days 08/06/2021 potassium potassium chloride ADD TO FORMULARY Covered chloride 08/06/2021 potassium potassium chloride ADD TO FORMULARY Covered chloride 08/06/2021 ziclopro diclofenac sodium/capsicum REMOVE FROM Non-Formulary oleoresin FORMULARY 08/06/2021 corti-sav hydrocortisone/iodoquinol REMOVE FROM Non-Formulary FORMULARY 08/06/2021 meropenem meropenem REMOVE FROM Non-Formulary FORMULARY 08/06/2021 meropenem meropenem REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 221 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/06/2021 dandlelion kisses sucrose REMOVE FROM Non-Formulary FORMULARY 08/06/2021 dandlelion kisses sucrose REMOVE FROM Non-Formulary FORMULARY 08/06/2021 dandlelion kisses sucrose REMOVE FROM Non-Formulary FORMULARY 08/06/2021 dandlelion kisses sucrose REMOVE FROM Non-Formulary FORMULARY 08/06/2021 turmeric turmeric root extract/ginger REMOVE FROM Non-Formulary curcumin-ginger root extract FORMULARY 08/06/2021 bardex i.c. foley catheter REMOVE FROM Non-Formulary catheter FORMULARY 08/06/2021 RENA STEP nutritional therapy, impaired REMOVE FROM Non-Formulary renal function FORMULARY 08/06/2021 JUST 4 KIDZ pediatric multivitamin REMOVE FROM Non-Formulary MULTIVIT- no.200/bacillus coagulans FORMULARY PROBIOTIC 08/06/2021 VAZALORE aspirin REMOVE FROM Non-Formulary FORMULARY 08/06/2021 chest congestion guaifenesin/dextromethorph REMOVE FROM Non-Formulary relief dm an hbr FORMULARY 08/06/2021 sore throat benzocaine/menthol REMOVE FROM Non-Formulary lozenge FORMULARY 08/06/2021 lidocaine-menthol lidocaine/menthol REMOVE FROM Non-Formulary FORMULARY 08/06/2021 lutein-zeaxanthin- lutein/zeaxanthin/bilberry REMOVE FROM Non-Formulary bilberry fruit extract FORMULARY 08/06/2021 HYDROCORTIS hydrocortisone REMOVE FROM Non-Formulary ONE- acetate/pramoxine hcl FORMULARY PRAMOXINE

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 222 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/06/2021 adenosine adenosine REMOVE FROM Non-Formulary FORMULARY 08/06/2021 adenosine adenosine REMOVE FROM Non-Formulary FORMULARY 08/06/2021 tetracaine hcl tetracaine hcl/pf REMOVE FROM Non-Formulary FORMULARY 08/06/2021 TROPHAMINE amino acids 10 % REMOVE FROM Non-Formulary FORMULARY 08/06/2021 fluorouracil fluorouracil REMOVE FROM Non-Formulary FORMULARY 08/06/2021 fluorouracil fluorouracil REMOVE FROM Non-Formulary FORMULARY 08/06/2021 fluorouracil fluorouracil REMOVE FROM Non-Formulary FORMULARY 08/06/2021 fluorouracil fluorouracil REMOVE FROM Non-Formulary FORMULARY 08/06/2021 norepinephrine norepinephrine bitartrate in REMOVE FROM Non-Formulary bitartrate-d5w 5 % dextrose in water FORMULARY 08/06/2021 norepinephrine norepinephrine bitartrate in REMOVE FROM Non-Formulary bitartrate-d5w 5 % dextrose in water FORMULARY 08/06/2021 ibuprofen- ibuprofen/famotidine REMOVE FROM Non-Formulary famotidine FORMULARY 08/06/2021 MYRBETRIQ mirabegron ADD TO FORMULARY Covered 08/13/2021 ADYNOVATE antihemophilic factor (fviii) ADD UM: MED Medical Drug recombinant, full length, peg 08/13/2021 ADYNOVATE antihemophilic factor (fviii) ADD UM: MED Medical Drug recombinant, full length, peg 08/13/2021 ADYNOVATE antihemophilic factor (fviii) ADD UM: MED Medical Drug recombinant, full length, peg

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 223 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/13/2021 ADYNOVATE antihemophilic factor (fviii) ADD UM: MED Medical Drug recombinant, full length, peg 08/13/2021 ADYNOVATE antihemophilic factor (fviii) ADD UM: MED Medical Drug recombinant, full length, peg 08/13/2021 ADYNOVATE antihemophilic factor (fviii) ADD UM: MED Medical Drug recombinant, full length, peg 08/13/2021 AFSTYLA antihemophilic factor viii ADD UM: MED Medical Drug recomb,single-chn,b-dom truncated 08/13/2021 AFSTYLA antihemophilic factor viii ADD UM: MED Medical Drug recomb,single-chn,b-dom truncated 08/13/2021 AFSTYLA antihemophilic factor viii ADD UM: MED Medical Drug recomb,single-chn,b-dom truncated 08/13/2021 AFSTYLA antihemophilic factor viii ADD UM: MED Medical Drug recomb,single-chn,b-dom truncated 08/13/2021 AFSTYLA antihemophilic factor viii ADD UM: MED Medical Drug recomb,single-chn,b-dom truncated 08/13/2021 AFSTYLA antihemophilic factor viii ADD UM: MED Medical Drug recomb,single-chn,b-dom truncated 08/13/2021 AFSTYLA antihemophilic factor viii ADD UM: MED Medical Drug recomb,single-chn,b-dom truncated 08/13/2021 ADYNOVATE antihemophilic factor (fviii) ADD UM: MED Medical Drug recombinant, full length, peg 08/13/2021 ALPHANATE antihemophilic factor, ADD UM: MED Medical Drug human/von willebrand factor,human

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 224 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/13/2021 ALPHANATE antihemophilic factor, ADD UM: MED Medical Drug human/von willebrand factor,human 08/13/2021 ALPHANATE antihemophilic factor, ADD UM: MED Medical Drug human/von willebrand factor,human 08/13/2021 ALPHANATE antihemophilic factor, ADD UM: MED Medical Drug human/von willebrand factor,human 08/13/2021 ALPHANATE antihemophilic factor, ADD UM: MED Medical Drug human/von willebrand factor,human 08/13/2021 ALPHANINE SD factor ix ADD UM: MED Medical Drug 08/13/2021 ALPHANINE SD factor ix ADD UM: MED Medical Drug 08/13/2021 ALPHANINE SD factor ix ADD UM: MED Medical Drug 08/13/2021 BAFIERTAM monomethyl fumarate ADD UM: LIMITEDACCESS Limited Access 08/13/2021 BRONCHITOL mannitol ADD UM: LIMITEDACCESS Limited Access 08/13/2021 COAGADEX coagulation factor x ADD UM: MED Medical Drug 08/13/2021 COAGADEX coagulation factor x ADD UM: MED Medical Drug 08/13/2021 DOJOLVI triheptanoin ADD UM: LIMITEDACCESS Limited Access 08/13/2021 DUOPA carbidopa/levodopa ADD UM: MED Medical Drug 08/13/2021 ENDARI glutamine ADD UM: SPECIALTY Specialty Drug 08/13/2021 EVRYSDI risdiplam ADD UM: LIMITEDACCESS Limited Access 08/13/2021 FENSOLVI leuprolide acetate ADD UM: LIMITEDACCESS Limited Access 08/13/2021 FINTEPLA fenfluramine hcl ADD UM: LIMITEDACCESS Limited Access 08/13/2021 FOTIVDA tivozanib hcl ADD UM: LIMITEDACCESS Limited Access 08/13/2021 FOTIVDA tivozanib hcl ADD UM: LIMITEDACCESS Limited Access 08/13/2021 GAVRETO pralsetinib ADD UM: LIMITEDACCESS Limited Access

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 225 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/13/2021 GAZYVA obinutuzumab ADD UM: MED Medical Drug 08/13/2021 HELIXATE FS antihemophilic factor viii, ADD UM: MED Medical Drug human recombinant,antihemophilic factor (fviii) recombinant,full length 08/13/2021 IMCIVREE setmelanotide acetate ADD UM: LIMITEDACCESS Limited Access 08/13/2021 INQOVI decitabine/cedazuridine ADD UM: LIMITEDACCESS Limited Access 08/13/2021 LUPKYNIS voclosporin ADD UM: LIMITEDACCESS Limited Access 08/13/2021 MONONINE factor ix ADD UM: MED Medical Drug 08/13/2021 MYCAPSSA octreotide acetate ADD UM: LIMITEDACCESS Limited Access 08/13/2021 ORGOVYX relugolix ADD UM: LIMITEDACCESS Limited Access 08/13/2021 ORLADEYO berotralstat hydrochloride ADD UM: LIMITEDACCESS Limited Access 08/13/2021 ORLADEYO berotralstat hydrochloride ADD UM: LIMITEDACCESS Limited Access 08/13/2021 QINLOCK ripretinib ADD UM: LIMITEDACCESS Limited Access 08/13/2021 RETEVMO selpercatinib ADD UM: LIMITEDACCESS Limited Access 08/13/2021 RETEVMO selpercatinib ADD UM: LIMITEDACCESS Limited Access 08/13/2021 RIASTAP fibrinogen ADD UM: MED Medical Drug 08/13/2021 SIGNIFOR LAR pasireotide pamoate ADD UM: LIMITEDACCESS Limited Access 08/13/2021 SIGNIFOR LAR pasireotide pamoate ADD UM: LIMITEDACCESS Limited Access 08/13/2021 SIGNIFOR LAR pasireotide pamoate ADD UM: LIMITEDACCESS Limited Access 08/13/2021 SIGNIFOR LAR pasireotide pamoate ADD UM: LIMITEDACCESS Limited Access 08/13/2021 SIGNIFOR LAR pasireotide pamoate ADD UM: LIMITEDACCESS Limited Access 08/13/2021 SYNAGIS palivizumab ADD UM: MED Medical Drug 08/13/2021 SYNAGIS palivizumab ADD UM: MED Medical Drug 08/13/2021 TEPMETKO tepotinib hcl ADD UM: LIMITEDACCESS Limited Access

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 226 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/13/2021 UKONIQ umbralisib tosylate ADD UM: LIMITEDACCESS Limited Access 08/13/2021 UPLIZNA inebilizumab-cdon ADD UM: LIMITEDACCESS Limited Access 08/13/2021 VISUDYNE verteporfin ADD UM: MED Medical Drug 08/13/2021 VONVENDI von willebrand factor ADD UM: MED Medical Drug (recombinant) 08/13/2021 VONVENDI von willebrand factor ADD UM: MED Medical Drug (recombinant) 08/13/2021 XYWAV sodium oxybate/calcium ADD UM: LIMITEDACCESS Limited Access oxybate/magnesium oxybate/pot oxybate 08/13/2021 ZOKINVY lonafarnib ADD UM: LIMITEDACCESS Limited Access 08/13/2021 ZOKINVY lonafarnib ADD UM: LIMITEDACCESS Limited Access 08/13/2021 DIBENZYLINE phenoxybenzamine hcl CHANGE UM: CUSTOM Eligible for 90 Day Supply 08/13/2021 DIBENZYLINE phenoxybenzamine hcl CHANGE UM: SPECIALTY Specialty Drug 08/13/2021 etoposide,toposa etoposide ADD UM: MED Medical Drug r 08/13/2021 JADENU deferasirox ADD UM: SPECIALTY Specialty Drug SPRINKLE 08/13/2021 JADENU deferasirox ADD UM: SPECIALTY Specialty Drug SPRINKLE 08/13/2021 JADENU deferasirox ADD UM: SPECIALTY Specialty Drug SPRINKLE 08/13/2021 MARQIBO vincristine sulfate liposomal CHANGE UM: SPECIALTY Specialty Drug 08/13/2021 MARQIBO vincristine sulfate liposomal ADD UM: MED Medical Drug 08/13/2021 SIMPONI ARIA golimumab ADD UM: SPECIALTY Specialty Drug 08/13/2021 SIVEXTRO tedizolid phosphate CHANGE UM: MED Medical Drug 08/13/2021 SYNVISC hylan g-f 20 ADD UM: MED Medical Drug

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 227 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/13/2021 SYNVISC-ONE hylan g-f 20 ADD UM: MED Medical Drug 08/13/2021 cialis,tadalafil tadalafil CHANGE UM: QUANTITY 30 / 30 days 08/13/2021 DERMACINRX cholecalciferol (vit d3)/folic REMOVE FROM Non-Formulary PUREFOLTIN acid FORMULARY 08/13/2021 DERMACINRX multivitamin with minerals REMOVE FROM Non-Formulary RIBOTIN-E no.89/ferrous fumarate/folic FORMULARY acid 08/13/2021 DERMACINRX multivitamin with minerals REMOVE FROM Non-Formulary ZINTREXYL-C no.89/ferrous fumarate/folic FORMULARY acid 08/13/2021 DERMACINRX prenatal vitamins REMOVE FROM Non-Formulary PRETRATE no.170/ferrous fumarate/folic FORMULARY acid 08/13/2021 ketamine hcl- ketamine hcl REMOVE FROM Non-Formulary water FORMULARY 08/13/2021 taysofy norethindrone acetate- REMOVE FROM Non-Formulary ethinyl estradiol/ferrous FORMULARY fumarate 08/13/2021 daptomycin daptomycin REMOVE FROM Non-Formulary FORMULARY 08/13/2021 micafungin micafungin sodium REMOVE FROM Non-Formulary FORMULARY 08/13/2021 children's cold- brompheniramine REMOVE FROM Non-Formulary allergy maleate/phenylephrine hcl FORMULARY 08/13/2021 daptomycin daptomycin REMOVE FROM Non-Formulary FORMULARY 08/13/2021 cloth tape adhesive tape REMOVE FROM Non-Formulary FORMULARY 08/13/2021 isoproterenol hcl isoproterenol hcl REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 228 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/13/2021 isoproterenol hcl isoproterenol hcl REMOVE FROM Non-Formulary FORMULARY 08/13/2021 atropine sulfate atropine sulfate REMOVE FROM Non-Formulary FORMULARY 08/13/2021 atropine sulfate atropine sulfate REMOVE FROM Non-Formulary FORMULARY 08/13/2021 CARDENE I.V. nicardipine in sodium REMOVE FROM Non-Formulary chloride, iso-osmotic FORMULARY 08/13/2021 CARDENE I.V. nicardipine in sodium REMOVE FROM Non-Formulary chloride, iso-osmotic FORMULARY 08/13/2021 CARDENE I.V. nicardipine in sodium REMOVE FROM Non-Formulary chloride, iso-osmotic FORMULARY 08/13/2021 CARDENE I.V. nicardipine in sodium REMOVE FROM Non-Formulary chloride, iso-osmotic FORMULARY 08/13/2021 docetaxel docetaxel REMOVE FROM Non-Formulary FORMULARY 08/13/2021 docetaxel docetaxel REMOVE FROM Non-Formulary FORMULARY 08/13/2021 docetaxel docetaxel REMOVE FROM Non-Formulary FORMULARY 08/13/2021 bevacizumab bevacizumab REMOVE FROM Non-Formulary FORMULARY 08/13/2021 TYLENOL dextromethorphan/pseudoe REMOVE FROM Non-Formulary COLD-FLU phedrine/acetaminophen/chl FORMULARY MULTI-ACT D-N orpheniram 08/13/2021 diaper rash zinc oxide REMOVE FROM Non-Formulary ointment FORMULARY 08/13/2021 sodium chloride sodium chloride REMOVE FROM Non-Formulary FORMULARY 08/13/2021 headache relief aspirin/acetaminophen/caffei REMOVE FROM Non-Formulary ne FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 229 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/13/2021 immune support multivit-minerals/vit REMOVE FROM Non-Formulary c/glutamine/lysine hcl/herbal FORMULARY no.124 08/13/2021 control menstrual menthol REMOVE FROM Non-Formulary cramp FORMULARY 08/13/2021 mucinex hexylresorcinol REMOVE FROM Non-Formulary instasoothe FORMULARY comfort 08/13/2021 mucinex hexylresorcinol REMOVE FROM Non-Formulary instasoothe FORMULARY comfort 08/13/2021 after pill levonorgestrel ADD TO FORMULARY Covered 08/13/2021 dermacinrx atrix salicylic acid REMOVE FROM Non-Formulary FORMULARY 08/13/2021 krt heat menthol REMOVE FROM Non-Formulary FORMULARY 08/13/2021 HEXATRIONE triamcinolone hexacetonide REMOVE FROM Non-Formulary FORMULARY 08/16/2021 oralyte electrolytes/dextrose CHANGE TIER Covered 08/16/2021 first aid antibiotic neomycin sulfate/bacitracin CHANGE TIER Covered zinc/polymyxin b 08/16/2021 ambien tartrate CHANGE UM: QUANTITY 0.5 / 1 days cr,zolpidem tartrate er 08/16/2021 ambien zolpidem tartrate CHANGE UM: QUANTITY 0.5 / 1 days cr,zolpidem tartrate er 08/16/2021 premier test strip blood sugar diagnostic ADD UM: QUANTITY 5 / 1 days 08/20/2021 sajazir acetate ADD TO FORMULARY Covered 08/20/2021 sajazir icatibant acetate ADD TO FORMULARY Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 230 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/20/2021 ondansetron hcl ondansetron hcl REMOVE FROM Non-Formulary FORMULARY 08/20/2021 piperacillin- piperacillin REMOVE FROM Non-Formulary tazobactam sodium/tazobactam sodium FORMULARY 08/20/2021 guanfacine hcl guanfacine hcl ADD TO FORMULARY Covered 08/20/2021 zinc zinc gluconate REMOVE FROM Non-Formulary FORMULARY 08/20/2021 diflorasone diflorasone diacetate REMOVE FROM Non-Formulary diacetate FORMULARY 08/20/2021 CLARINEX desloratadine REMOVE FROM Non-Formulary FORMULARY 08/20/2021 isoproterenol hcl isoproterenol hcl REMOVE FROM Non-Formulary FORMULARY 08/20/2021 ertapenem ertapenem sodium REMOVE FROM Non-Formulary FORMULARY 08/20/2021 CHILDREN'S ibuprofen REMOVE FROM Non-Formulary MOTRIN FORMULARY 08/20/2021 carvedilol er carvedilol phosphate ADD TO FORMULARY Covered 08/20/2021 carvedilol er carvedilol phosphate ADD TO FORMULARY Covered 08/20/2021 carvedilol er carvedilol phosphate ADD TO FORMULARY Covered 08/20/2021 carvedilol er carvedilol phosphate ADD TO FORMULARY Covered 08/20/2021 NEXPLANON etonogestrel REMOVE FROM Non-Formulary FORMULARY 08/20/2021 tranexamic acid tranexamic acid REMOVE FROM Non-Formulary FORMULARY 08/20/2021 esomeprazole esomeprazole magnesium REMOVE FROM Non-Formulary magnesium FORMULARY 08/20/2021 esomeprazole esomeprazole magnesium REMOVE FROM Non-Formulary magnesium FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 231 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/20/2021 esomeprazole esomeprazole magnesium REMOVE FROM Non-Formulary magnesium FORMULARY 08/20/2021 VOLTAREN diclofenac sodium REMOVE FROM Non-Formulary ARTHRITIS PAIN FORMULARY 08/20/2021 comfort touch pen needle, diabetic REMOVE FROM Non-Formulary pen needle FORMULARY 08/20/2021 comfort touch pen needle, diabetic REMOVE FROM Non-Formulary pen needle FORMULARY 08/20/2021 comfort touch pen needle, diabetic REMOVE FROM Non-Formulary pen needle FORMULARY 08/20/2021 comfort touch pen needle, diabetic REMOVE FROM Non-Formulary pen needle FORMULARY 08/20/2021 comfort touch pen needle, diabetic REMOVE FROM Non-Formulary pen needle FORMULARY 08/20/2021 comfort touch pen needle, diabetic REMOVE FROM Non-Formulary pen needle FORMULARY 08/20/2021 comfort touch pen needle, diabetic REMOVE FROM Non-Formulary pen needle FORMULARY 08/20/2021 VISTA vit c/vit REMOVE FROM Non-Formulary ADVANCED e/zinc/copper/selen/lutein/ze FORMULARY AREDS2 axanthin/glutathione 08/20/2021 VISTA omega 3,6/borage oil/fish REMOVE FROM Non-Formulary ADVANCED DRY oil/vit c/vit FORMULARY EYE d3/lutein/zeax/herbs 08/20/2021 DERMEND ANTI- pramoxine hcl REMOVE FROM Non-Formulary ITCH FORMULARY 08/20/2021 MUCINEX hexylresorcinol REMOVE FROM Non-Formulary INSTASOOTHE FORMULARY PAIN RLF

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 232 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/20/2021 MUCINEX hexylresorcinol REMOVE FROM Non-Formulary INSTASOOTHE FORMULARY PAIN RLF 08/20/2021 MUCINEX dextromethorphan REMOVE FROM Non-Formulary INSTASOOTHE hbr/hexylresorcinol FORMULARY COUGH 08/20/2021 NEURACIN methyl REMOVE FROM Non-Formulary salicylate/menthol/camphor FORMULARY 08/20/2021 vapor steam camphor/eucalyptus/mentho REMOVE FROM Non-Formulary l FORMULARY 08/20/2021 sore throat benzocaine/menthol REMOVE FROM Non-Formulary lozenge FORMULARY 08/20/2021 cold and hot pain lidocaine/menthol REMOVE FROM Non-Formulary relief FORMULARY 08/20/2021 children's allergy diphenhydramine hcl REMOVE FROM Non-Formulary relief FORMULARY 08/20/2021 zinc zinc citrate REMOVE FROM Non-Formulary FORMULARY 08/20/2021 children's omega- omega-3 fatty REMOVE FROM Non-Formulary 3 gummy fish acids/docosahexaenoic FORMULARY acid/epa/fish oil 08/20/2021 omega-3 krill oil krill oil/omega-3 fatty REMOVE FROM Non-Formulary acids/dha/epa/phospholipids FORMULARY /astaxan 08/20/2021 sunitinib malate sunitinib malate ADD TO FORMULARY Covered 08/20/2021 sunitinib malate sunitinib malate ADD TO FORMULARY Covered 08/20/2021 sunitinib malate sunitinib malate ADD TO FORMULARY Covered 08/20/2021 sunitinib malate sunitinib malate ADD TO FORMULARY Covered 08/20/2021 dextroamphetami dextroamphetamine sulfate REMOVE FROM Non-Formulary ne sulfate FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 233 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/20/2021 dextroamphetami dextroamphetamine sulfate REMOVE FROM Non-Formulary ne sulfate FORMULARY 08/20/2021 dextroamphetami dextroamphetamine sulfate REMOVE FROM Non-Formulary ne sulfate FORMULARY 08/20/2021 buprenorphine buprenorphine hcl REMOVE FROM Non-Formulary hcl FORMULARY 08/20/2021 buprenorphine buprenorphine hcl REMOVE FROM Non-Formulary hcl FORMULARY 08/20/2021 buprenorphine buprenorphine hcl REMOVE FROM Non-Formulary hcl FORMULARY 08/20/2021 buprenorphine buprenorphine hcl REMOVE FROM Non-Formulary hcl FORMULARY 08/20/2021 buprenorphine buprenorphine hcl REMOVE FROM Non-Formulary hcl FORMULARY 08/20/2021 buprenorphine buprenorphine hcl REMOVE FROM Non-Formulary hcl FORMULARY 08/20/2021 buprenorphine buprenorphine hcl REMOVE FROM Non-Formulary hcl FORMULARY 08/20/2021 enalapril maleate enalapril maleate ADD TO FORMULARY Covered 08/20/2021 UPTRAVI selexipag REMOVE FROM Non-Formulary FORMULARY 08/20/2021 PLENITY carboxymethylcellulose/citric REMOVE FROM Non-Formulary acid FORMULARY 08/20/2021 PLENITY carboxymethylcellulose/citric REMOVE FROM Non-Formulary acid FORMULARY 08/20/2021 CLINDAVIX clindamycin REMOVE FROM Non-Formulary phosphate/dimethicone/zinc FORMULARY oxide 08/23/2021 ZOSYN piperacillin ADD UM: MED Medical Drug sodium/tazobactam sodium

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 234 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/23/2021 piperacillin- piperacillin ADD UM: MED Medical Drug tazobactam sodium/tazobactam sodium 08/23/2021 INVANZ ertapenem sodium ADD UM: MED Medical Drug 08/23/2021 ertapenem ertapenem sodium ADD UM: MED Medical Drug 08/23/2021 ISUPREL isoproterenol hcl ADD UM: MED Medical Drug 08/23/2021 isoproterenol hcl isoproterenol hcl ADD UM: MED Medical Drug 08/23/2021 docetaxel docetaxel CHANGE UM: MED Medical Drug 08/23/2021 docetaxel docetaxel CHANGE UM: MED Medical Drug 08/23/2021 docetaxel docetaxel CHANGE UM: MED Medical Drug 08/23/2021 NEXPLANON etonogestrel CHANGE UM: Limited Access LIMITEDACCESS 08/23/2021 NEXPLANON etonogestrel ADD UM: MED Medical Drug 08/25/2021 firazyr,icatibant,s icatibant acetate CHANGE UM: QUANTITY 9 / 30 days ajazir 08/27/2021 LUMAKRAS sotorasib ADD UM: LIMITEDACCESS Limited Access 08/27/2021 BIVIGAM immune REMOVE FROM Non-Formulary globulin,gamm(igg)/glycine/i FORMULARY ga greater than 50 mcg/ml 08/27/2021 metoprolol metoprolol tartrate ADD TO FORMULARY Covered tartrate 08/27/2021 true comfort pro syringe with REMOVE FROM Non-Formulary ins syringe needle,disposable,insulin 1 FORMULARY ml 08/27/2021 true comfort pro syringe with REMOVE FROM Non-Formulary ins syringe needle,disposable,insulin 1 FORMULARY ml 08/27/2021 true comfort pro syringe with REMOVE FROM Non-Formulary ins syringe needle,insulin,0.5 ml FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 235 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/27/2021 true comfort pro syringe with REMOVE FROM Non-Formulary ins syringe needle,insulin,0.5 ml FORMULARY 08/27/2021 true comfort pro syringe with REMOVE FROM Non-Formulary ins syringe needle,disposable,insulin 1 FORMULARY ml 08/27/2021 true comfort pro syringe with REMOVE FROM Non-Formulary ins syringe needle,disposable,insulin 1 FORMULARY ml 08/27/2021 bpm 2 advanced blood pressure test kit-large REMOVE FROM Non-Formulary bp monitor FORMULARY 08/27/2021 simplythick xanthan gum REMOVE FROM Non-Formulary FORMULARY 08/27/2021 comfort touch pen needle, diabetic REMOVE FROM Non-Formulary pen needle FORMULARY 08/27/2021 veritor sars-cov-2 covid-19, influenza a, REMOVE FROM Non-Formulary and flu a-b influenza b antigen FORMULARY immunoassay test 08/27/2021 MUCINEX benzocaine/menthol REMOVE FROM Non-Formulary INSTASOOTHE FORMULARY PAIN RLF 08/27/2021 WOMEN'S lactobacillus REMOVE FROM Non-Formulary PROBIOTIC no.76/bifidobacterium FORMULARY animalis,breve/fos/larch 08/27/2021 ELDERBERRY ascorbic acid/zinc REMOVE FROM Non-Formulary ZINC gluconate/herbal complex FORMULARY no.325 08/27/2021 BIOMEPRO lactobacillus REMOVE FROM Non-Formulary acidophilus/lactobacillus FORMULARY casei/l. rhamnosus 08/27/2021 BIOMEPRO lactobacillus REMOVE FROM Non-Formulary acidophilus/lactobacillus FORMULARY casei/l. rhamnosus

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 236 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/27/2021 BIOMEPRO lactobacillus REMOVE FROM Non-Formulary acidophilus/lactobacillus FORMULARY casei/l. rhamnosus 08/27/2021 mylanta gas simethicone REMOVE FROM Non-Formulary minis FORMULARY 08/27/2021 beauty 360 daily dimethicone/colloidal REMOVE FROM Non-Formulary moisturizing oatmeal FORMULARY 08/27/2021 throat relief pops pectin REMOVE FROM Non-Formulary FORMULARY 08/27/2021 daily fiber psyllium husk/aspartame ADD TO FORMULARY Covered 08/27/2021 zylotrol lidocaine/menthol REMOVE FROM Non-Formulary FORMULARY 08/27/2021 exigence lidocaine/menthol REMOVE FROM Non-Formulary FORMULARY 08/27/2021 norepinephrine norepinephrine bitartrate REMOVE FROM Non-Formulary bitartrate FORMULARY 08/27/2021 baclofen baclofen REMOVE FROM Non-Formulary FORMULARY 08/27/2021 baclofen baclofen REMOVE FROM Non-Formulary FORMULARY 08/27/2021 baclofen baclofen REMOVE FROM Non-Formulary FORMULARY 08/27/2021 midazolam hcl- midazolam hcl in 0.9 % REMOVE FROM Non-Formulary 0.9% nacl sodium chloride/pf FORMULARY 08/27/2021 midazolam hcl- midazolam hcl in 0.9 % REMOVE FROM Non-Formulary 0.9% nacl sodium chloride/pf FORMULARY 08/27/2021 baclofen baclofen REMOVE FROM Non-Formulary FORMULARY 08/27/2021 ursodiol ursodiol REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 237 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/27/2021 ursodiol ursodiol REMOVE FROM Non-Formulary FORMULARY 08/27/2021 EB-P1 DR mecobalamin/levomefolate REMOVE FROM Non-Formulary calcium FORMULARY 08/27/2021 EB-P2 DR cholecalciferol (vit REMOVE FROM Non-Formulary d3)/levomefolate calcium FORMULARY 08/27/2021 EB-C3 DR pyridoxal REMOVE FROM Non-Formulary phosphate/levomefolate/me FORMULARY cobalamin/acetylcysteine 08/27/2021 EB-N6 DR pyridoxal/levomefolate/meco REMOVE FROM Non-Formulary balamin/lipoic FORMULARY acid/benfotiamine 08/27/2021 EB-L1 biotin/collagen/keratin/levom REMOVE FROM Non-Formulary efolate calcium/silicon FORMULARY 08/27/2021 EB-N3 DR riboflavin/pyridoxal REMOVE FROM Non-Formulary phosphate/levomefolate FORMULARY calc/mecobalamin 08/27/2021 EB-N5 DR pyridoxal/levomefolate/meco REMOVE FROM Non-Formulary balamin/vit d3/alpha lipoic FORMULARY acid 08/31/2021 NOVOLIN 70-30 insulin nph human ADD TO FORMULARY Non-Formulary Covered isophane/insulin regular, human 08/31/2021 NOVOLIN 70-30 insulin nph human ADD UM: CUSTOM ELIGIBLE FOR isophane/insulin regular, 90 DAY SUPPLY human 08/31/2021 NOVOLIN N insulin nph human isophane ADD TO FORMULARY Non-Formulary Covered 08/31/2021 NOVOLIN N insulin nph human isophane ADD UM: CUSTOM ELIGIBLE FOR 90 DAY SUPPLY 08/31/2021 NOVOLIN R insulin regular, human ADD TO FORMULARY Non-Formulary Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 238 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/31/2021 NOVOLIN R insulin regular, human ADD UM: CUSTOM ELIGIBLE FOR 90 DAY SUPPLY 08/31/2021 NOVOLOG MIX insulin aspart protamine CHANGE UM: CUSTOM ELIGIBLE FOR 70-30 human/insulin aspart 90 DAY SUPPLY 08/31/2021 NOVOLOG insulin aspart CHANGE UM: CUSTOM ELIGIBLE FOR 90 DAY SUPPLY 08/31/2021 novolin 70- insulin nph human ADD UM: CUSTOM ELIGIBLE FOR 30,relion novolin isophane/insulin regular, 90 DAY SUPPLY 70/30,novolin human,nph, human insulin 70/30 isophane/insulin regular, human 08/31/2021 novolin n,relion insulin nph human ADD UM: CUSTOM ELIGIBLE FOR novolin n isophane,nph, human insulin 90 DAY SUPPLY isophane 08/31/2021 novolin r,relion insulin reg human semi- ADD UM: CUSTOM ELIGIBLE FOR novolin r syn,insulin regular, human 90 DAY SUPPLY 08/31/2021 venlafaxine hcl er venlafaxine hcl CHANGE UM: CUSTOM Covered by OMAP 08/31/2021 venlafaxine hcl er venlafaxine hcl CHANGE UM: CUSTOM Covered by OMAP 08/31/2021 venlafaxine hcl er venlafaxine hcl CHANGE UM: CUSTOM Covered by OMAP 08/31/2021 venlafaxine hcl er venlafaxine hcl CHANGE UM: CUSTOM Covered by OMAP 08/31/2021 BIVIGAM immune CHANGE UM: SPECIALTY Specialty Drug globulin,gamm(igg)/glycine/i ga greater than 50 mcg/ml 08/31/2021 BIVIGAM immune CHANGE UM: MED Medical Drug globulin,gamm(igg)/glycine/i ga greater than 50 mcg/ml 08/31/2021 REMERON mirtazapine CHANGE UM: CUSTOM Covered by OMAP

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 239 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 08/31/2021 AEMCOLO rifamycin sodium CHANGE UM: QUANTITY 12 / 28 days 08/31/2021 bpm 2 advanced blood pressure test kit-large ADD UM: MED Medical Drug bp monitor 08/31/2021 norepinephrine norepinephrine bitartrate CHANGE UM: MED Medical Drug bitartrate

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 240 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

September, 2021

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 09/01/2021 tramadol hcl tramadol hcl ADD UM: QUANTITY 2 / 1 days er,ryzolt 09/01/2021 tramadol hcl tramadol hcl ADD UM: QUANTITY 2 / 1 days er,ultram er 09/01/2021 tramadol hcl tramadol hcl ADD UM: QUANTITY 1 / 1 days er,ryzolt 09/01/2021 tramadol hcl tramadol hcl ADD UM: QUANTITY 1 / 1 days er,ryzolt 09/01/2021 tramadol hcl- tramadol hcl/acetaminophen ADD UM: QUANTITY 10 / 1 days acetaminophen,ul tracet 09/01/2021 tramadol tramadol hcl ADD UM: QUANTITY 8 / 1 days hcl,ultram 09/01/2021 tramadol hcl tramadol hcl ADD UM: QUANTITY 1 / 1 days er,ultram er 09/01/2021 tramadol hcl tramadol hcl ADD UM: QUANTITY 2 / 1 days er,ultram er 09/01/2021 tramadol hcl tramadol hcl ADD UM: QUANTITY 2 / 1 days er,ryzolt 09/01/2021 NUCYNTA tapentadol hcl ADD UM: QUANTITY 6 / 1 days 09/01/2021 NUCYNTA tapentadol hcl ADD UM: QUANTITY 6 / 1 days 09/01/2021 NUCYNTA tapentadol hcl ADD UM: QUANTITY 6 / 1 days 09/01/2021 NUCYNTA ER tapentadol hcl ADD UM: QUANTITY 2 / 1 days 09/01/2021 NUCYNTA ER tapentadol hcl ADD UM: QUANTITY 2 / 1 days 09/01/2021 NUCYNTA ER tapentadol hcl ADD UM: QUANTITY 2 / 1 days 09/01/2021 NUCYNTA ER tapentadol hcl ADD UM: QUANTITY 2 / 1 days

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 241 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 09/01/2021 NUCYNTA ER tapentadol hcl ADD UM: QUANTITY 2 / 1 days 09/01/2021 tramadol hcl tramadol hcl ADD UM: QUANTITY 1 / 1 days er,ultram er 09/01/2021 LUMAKRAS sotorasib ADD TO FORMULARY Covered 09/01/2021 TRUSELTIQ infigratinib phosphate ADD TO FORMULARY Covered 09/01/2021 TRUSELTIQ infigratinib phosphate ADD TO FORMULARY Covered 09/01/2021 TRUSELTIQ infigratinib phosphate ADD TO FORMULARY Covered 09/01/2021 TRUSELTIQ infigratinib phosphate ADD TO FORMULARY Covered 09/01/2021 klor-con m15 potassium chloride REMOVE FROM Covered Non-Formulary FORMULARY 09/01/2021 chlorpromazine chlorpromazine hcl ADD UM: CUSTOM COVERED BY hcl OMAP 09/01/2021 chlorpromazine chlorpromazine hcl ADD UM: CUSTOM COVERED BY hcl OMAP 09/01/2021 tetracaine hcl tetracaine hcl/pf ADD UM: MED Medical Drug 09/01/2021 trophamine amino acids 10 % ADD UM: MED Medical Drug 09/01/2021 daptomycin daptomycin CHANGE UM: MED Medical Drug 09/01/2021 micafungin micafungin sodium CHANGE UM: MED Medical Drug 09/01/2021 docetaxel docetaxel CHANGE UM: MED Medical Drug 09/01/2021 docetaxel docetaxel CHANGE UM: MED Medical Drug 09/01/2021 docetaxel docetaxel CHANGE UM: MED Medical Drug 09/01/2021 daptomycin daptomycin ADD UM: MED Medical Drug 09/01/2021 nicardipine hcl- nicardipine in sodium ADD UM: CUSTOM ELIGIBLE FOR 0.9% nacl chloride, iso-osmotic 90 DAY SUPPLY 09/01/2021 nicardipine hcl- nicardipine in sodium ADD UM: MED Medical Drug 0.9% nacl chloride, iso-osmotic

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 242 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 09/01/2021 nicardipine hcl- nicardipine in sodium ADD UM: CUSTOM ELIGIBLE FOR 0.9% nacl chloride, iso-osmotic 90 DAY SUPPLY 09/01/2021 nicardipine hcl- nicardipine in sodium ADD UM: MED Medical Drug 0.9% nacl chloride, iso-osmotic 09/01/2021 CARDENE I.V. nicardipine in sodium CHANGE UM: CUSTOM ELIGIBLE FOR chloride, iso-osmotic 90 DAY SUPPLY 09/01/2021 CARDENE I.V. nicardipine in sodium ADD UM: MED Medical Drug chloride, iso-osmotic 09/01/2021 CARDENE I.V. nicardipine in sodium CHANGE UM: CUSTOM ELIGIBLE FOR chloride, iso-osmotic 90 DAY SUPPLY 09/01/2021 CARDENE I.V. nicardipine in sodium ADD UM: MED Medical Drug chloride, iso-osmotic 09/01/2021 HEXATRIONE triamcinolone hexacetonide ADD UM: MED Medical Drug 09/02/2021 baclofen baclofen ADD UM: MED Medical Drug 09/02/2021 GABLOFEN baclofen ADD UM: MED Medical Drug 09/03/2021 clozapine odt clozapine REMOVE FROM Non-Formulary FORMULARY 09/03/2021 cyclophosphamid cyclophosphamide REMOVE FROM Non-Formulary e FORMULARY 09/03/2021 cyclophosphamid cyclophosphamide REMOVE FROM Non-Formulary e FORMULARY 09/03/2021 hydrocortisone hydrocortisone acetate REMOVE FROM Non-Formulary acetate FORMULARY 09/03/2021 hydrocortisone hydrocortisone acetate REMOVE FROM Non-Formulary acetate FORMULARY 09/03/2021 dibucaine dibucaine REMOVE FROM Non-Formulary FORMULARY 09/03/2021 etomidate etomidate REMOVE FROM Non-Formulary FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 243 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 09/03/2021 etomidate etomidate REMOVE FROM Non-Formulary FORMULARY 09/03/2021 contour next ez blood-glucose meter REMOVE FROM Non-Formulary FORMULARY 09/03/2021 THERA-GESIC methyl salicylate/menthol REMOVE FROM Non-Formulary FORMULARY 09/03/2021 THERA-GESIC methyl salicylate/menthol REMOVE FROM Non-Formulary FORMULARY 09/03/2021 midazolam hcl- midazolam hcl in 0.9 % REMOVE FROM Non-Formulary 0.9% nacl sodium chloride/pf FORMULARY 09/03/2021 midazolam hcl- midazolam hcl in 0.9 % REMOVE FROM Non-Formulary 0.9% nacl sodium chloride/pf FORMULARY 09/03/2021 OSMOLEX ER amantadine hcl REMOVE FROM Non-Formulary FORMULARY 09/03/2021 unispend compound vehicle REMOVE FROM Non-Formulary anhydrous sweet suspension sugar-free no.24 FORMULARY 09/03/2021 children's l. acidophilus/l. REMOVE FROM Non-Formulary chewable rhamnosus/b. breve/s. FORMULARY probiotic thermophilus 09/03/2021 gripe water ginger root extract/fennel REMOVE FROM Non-Formulary seed extract FORMULARY 09/03/2021 SIMILAC infant formula with REMOVE FROM Non-Formulary NEOSURE iron/docosahexaenoic FORMULARY acid/arachidonic ac 09/03/2021 SIMILAC infant formula with REMOVE FROM Non-Formulary NEOSURE iron/docosahexaenoic FORMULARY acid/arachidonic ac 09/03/2021 DERMACINRX lidocaine hcl REMOVE FROM Non-Formulary LIDOGEL FORMULARY 09/03/2021 FERRIPROX (3 deferiprone REMOVE FROM Non-Formulary TIMES A DAY) FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 244 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 09/03/2021 carisoprodol carisoprodol ADD TO FORMULARY Covered 09/03/2021 true comfort pro syringe with REMOVE FROM Non-Formulary ins syringe needle,insulin,0.5 ml FORMULARY 09/03/2021 true comfort pro syringe with REMOVE FROM Non-Formulary ins syringe needle,insulin,0.5 ml FORMULARY 09/03/2021 EB-A7 DR s- REMOVE FROM Non-Formulary adenosylmeth/collagen/hyal FORMULARY uronic/boswellia/turmeric/pe pper 09/07/2021 belbuca,buprenor buprenorphine hcl CHANGE UM: QUANTITY 2 / 1 days phine hcl 09/07/2021 belbuca,buprenor buprenorphine hcl CHANGE UM: Total cumulative phine hcl QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 09/07/2021 belbuca,buprenor buprenorphine hcl CHANGE UM: QUANTITY 2 / 1 days phine hcl 09/07/2021 belbuca,buprenor buprenorphine hcl CHANGE UM: Total cumulative phine hcl QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 09/07/2021 belbuca,buprenor buprenorphine hcl CHANGE UM: QUANTITY 2 / 1 days phine hcl

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 245 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 09/07/2021 belbuca,buprenor buprenorphine hcl CHANGE UM: Total cumulative phine hcl QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day

09/07/2021 belbuca,buprenor buprenorphine hcl CHANGE UM: QUANTITY 2 / 1 days phine hcl 09/07/2021 belbuca,buprenor buprenorphine hcl CHANGE UM: Total cumulative phine hcl QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 09/07/2021 belbuca,buprenor buprenorphine hcl CHANGE UM: QUANTITY 2 / 1 days phine hcl 09/07/2021 belbuca,buprenor buprenorphine hcl CHANGE UM: Total cumulative phine hcl QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 09/07/2021 belbuca,buprenor buprenorphine hcl CHANGE UM: QUANTITY 2 / 1 days phine hcl 09/07/2021 belbuca,buprenor buprenorphine hcl CHANGE UM: Total cumulative phine hcl QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 246 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 09/07/2021 belbuca,buprenor buprenorphine hcl CHANGE UM: QUANTITY 2 / 1 days phine hcl 09/07/2021 belbuca,buprenor buprenorphine hcl CHANGE UM: Total cumulative phine hcl QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 09/07/2021 UPTRAVI selexipag ADD UM: MED Medical Drug 09/09/2021 SUTENT sunitinib malate ADD UM: SPECIALTY Specialty Drug 09/09/2021 SUTENT sunitinib malate ADD UM: SPECIALTY Specialty Drug 09/09/2021 SUTENT sunitinib malate ADD UM: SPECIALTY Specialty Drug 09/09/2021 SUTENT sunitinib malate ADD UM: SPECIALTY Specialty Drug 09/09/2021 JADENU deferasirox ADD UM: SPECIALTY Specialty Drug 09/09/2021 JADENU deferasirox ADD UM: SPECIALTY Specialty Drug 09/09/2021 JADENU deferasirox ADD UM: SPECIALTY Specialty Drug 09/10/2021 HAPRODERM emollient combination REMOVE FROM Non-Formulary no.56/hyaluronic acid FORMULARY 09/10/2021 DERMACINRX multivitamin with minerals REMOVE FROM Non-Formulary VENTRIXYL FE no.86/ferrous fumarate/folic FORMULARY acid 09/10/2021 cranberry urinary cranberry fruit REMOVE FROM Non-Formulary tract health concentrate/ascorbic FORMULARY acid/bacillus coagulans 09/10/2021 smartmask baby nebulizer accessories REMOVE FROM Non-Formulary with elbow FORMULARY 09/10/2021 apogee plus catheter REMOVE FROM Non-Formulary intermittent FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 247 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 09/10/2021 ENFAGROW pediatric nutrition,milk REMOVE FROM Non-Formulary TODDLER NON- based,iron/docosahexaenoic FORMULARY GMO acid 09/10/2021 PRESERVISION vit c/vit e acetate/zinc REMOVE FROM Non-Formulary AREDS 2 oxid/cupric FORMULARY oxide/lutein/zeaxanthin 09/10/2021 ENFAGROW pediatric nutrition,milk REMOVE FROM Non-Formulary TODDLER NON- based,iron/docosahexaenoic FORMULARY GMO acid 09/10/2021 migraine relief aspirin/acetaminophen/caffei REMOVE FROM Non-Formulary ne FORMULARY 09/10/2021 children's cold- brompheniramine REMOVE FROM Non-Formulary cough maleate/phenylephrine FORMULARY hcl/dextromethorphan 09/10/2021 krt athletic trolamine salicylate REMOVE FROM Non-Formulary muscle FORMULARY 09/10/2021 mycozyl ac clotrimazole REMOVE FROM Non-Formulary FORMULARY 09/16/2021 FERRIPROX deferiprone CHANGE UM: SPECIALTY Specialty Drug 09/16/2021 FERRIPROX deferiprone CHANGE UM: Limited Access LIMITEDACCESS 09/16/2021 FERRIPROX,FE deferiprone ADD UM: SPECIALTY Specialty Drug RRIPROX (3 TIMES A DAY) 09/16/2021 FERRIPROX,FE deferiprone CHANGE UM: Limited Access RRIPROX (3 LIMITEDACCESS TIMES A DAY) 09/16/2021 FERRIPROX deferiprone CHANGE UM: SPECIALTY Specialty Drug 09/16/2021 FERRIPROX deferiprone CHANGE UM: Limited Access LIMITEDACCESS 09/17/2021 REZUROCK belumosudil mesylate ADD TO FORMULARY Covered

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 248 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 09/17/2021 REZUROCK belumosudil mesylate ADD UM: QUANTITY 1 / 1 days 09/17/2021 triheal-80 triamcinolone REMOVE FROM Non-Formulary acetonide/dimethicone/silico FORMULARY ne, adhesive 09/17/2021 aspercreme trolamine salicylate REMOVE FROM Non-Formulary FORMULARY 09/17/2021 fosfomycin fosfomycin tromethamine ADD TO FORMULARY Covered tromethamine 09/17/2021 potass cit-sod cit- sodium/potassium/potassiu REMOVE FROM Non-Formulary citric acid m citrate/sodium citrate/cit FORMULARY ac 09/17/2021 meclizine hcl meclizine hcl REMOVE FROM Non-Formulary FORMULARY 09/17/2021 potassium citrate- potassium citrate/citric acid REMOVE FROM Non-Formulary citric acid FORMULARY 09/17/2021 vitamin b-12 cyanocobalamin (vitamin b- REMOVE FROM Non-Formulary 12) FORMULARY 09/17/2021 sodium citrate- citric acid/sodium citrate REMOVE FROM Non-Formulary citric acid FORMULARY 09/17/2021 arsenic trioxide arsenic trioxide REMOVE FROM Non-Formulary FORMULARY 09/17/2021 ketamine hcl-nacl ketamine hcl in sodium REMOVE FROM Non-Formulary chloride, iso-osmotic FORMULARY 09/17/2021 glycopyrrolate glycopyrrolate in sterile REMOVE FROM Non-Formulary water/pf FORMULARY 09/17/2021 MUCINEX FAST- phenylephrine REMOVE FROM Non-Formulary MAX COLD-FLU hcl/dextromethorphan FORMULARY hbr/acetaminophen/guaifen 09/17/2021 ALGAE BASED calcium/vitamin REMOVE FROM Non-Formulary CALCIUM d3/magnesium/vitamin FORMULARY k2/minerals/herb 326

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 249 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 09/17/2021 ENU PRO3 nutritional supplement REMOVE FROM Non-Formulary PLUS FORMULARY 09/17/2021 MUCINEX triprolidine REMOVE FROM Non-Formulary NIGHTSHIFT hcl/phenylephrine/dextromet FORMULARY SINUS horphn/acetaminophen 09/17/2021 MUCINEX triprolidine/phenylephrine/de REMOVE FROM Non-Formulary SINUS-MAX xtromethorph/acetamin/guaif FORMULARY DAY-NIGHT enes 09/17/2021 MUCINEX triprolidine/phenylephrine/de REMOVE FROM Non-Formulary SINUS-MAX xtromethorph/acetamin/guaif FORMULARY DAY-NIGHT enes 09/17/2021 MUCINEX triprolidine/phenylephrine/de REMOVE FROM Non-Formulary SINUS-MAX xtromethorph/acetamin/guaif FORMULARY DAY-NIGHT enes 09/17/2021 EB-S4 calcium citrate/vitamin REMOVE FROM Non-Formulary d3/magnesium FORMULARY glycinate/zinc gly 09/17/2021 ONE-DAILY multivitamin-minerals/folic REMOVE FROM Non-Formulary MULTI acid/co q10/lycopene/lutein FORMULARY 09/17/2021 olopatadine hcl olopatadine hcl REMOVE FROM Non-Formulary FORMULARY 09/17/2021 mucus relief guaifenesin REMOVE FROM Non-Formulary FORMULARY 09/17/2021 hair regrowth minoxidil REMOVE FROM Non-Formulary treatment FORMULARY 09/17/2021 hair regrowth minoxidil REMOVE FROM Non-Formulary treatment FORMULARY 09/17/2021 lidoreal-30 lidocaine REMOVE FROM Non-Formulary FORMULARY 09/17/2021 westussin dm dexchlorpheniramine REMOVE FROM Non-Formulary maleate/phenylephrine/dextr FORMULARY omethorphan

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 250 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 09/17/2021 prochlorperazine prochlorperazine edisylate REMOVE FROM Non-Formulary edisylate FORMULARY 09/17/2021 acetaminophen acetaminophen REMOVE FROM Non-Formulary FORMULARY 09/24/2021 triadime-80 triamcinolone REMOVE FROM Non-Formulary acetonide/dimethicone/silico FORMULARY ne, adhesive 09/24/2021 pennsaicin diclofenac sodium/capsaicin REMOVE FROM Non-Formulary FORMULARY 09/24/2021 onetouch delica lancets REMOVE FROM Non-Formulary safety lancet FORMULARY 09/24/2021 DIMETAPP brompheniramine REMOVE FROM Non-Formulary COLD-COUGH maleate/phenylephrine FORMULARY hcl/dextromethorphan 09/24/2021 THERA-GESIC methyl salicylate/menthol REMOVE FROM Non-Formulary PLUS FORMULARY 09/24/2021 KETOGEN nutritional therapy, REMOVE FROM Non-Formulary ketogenic, milk FORMULARY 09/24/2021 lidoheal-90 lidocaine/transparent REMOVE FROM Non-Formulary dressing FORMULARY 09/24/2021 AMINOSYN II parenteral amino acid 15 % REMOVE FROM Non-Formulary combination no.2 FORMULARY 09/24/2021 acetaminophen acetaminophen REMOVE FROM Non-Formulary FORMULARY 09/24/2021 carmustine carmustine REMOVE FROM Non-Formulary FORMULARY 09/24/2021 melphalan hcl melphalan hcl REMOVE FROM Non-Formulary FORMULARY 09/24/2021 sodium nitroprusside sodium REMOVE FROM Non-Formulary nitroprusside FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 251 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 09/24/2021 ganirelix acetate ganirelix acetate REMOVE FROM Non-Formulary FORMULARY 09/24/2021 decitabine decitabine REMOVE FROM Non-Formulary FORMULARY 09/24/2021 RENFLEXIS infliximab-abda REMOVE FROM Non-Formulary FORMULARY 09/24/2021 ONTRUZANT trastuzumab-dttb REMOVE FROM Non-Formulary FORMULARY 09/24/2021 ONTRUZANT trastuzumab-dttb REMOVE FROM Non-Formulary FORMULARY 09/28/2021 ONTRUZANT trastuzumab-dttb CHANGE UM: MED Medical Drug 09/28/2021 ONTRUZANT trastuzumab-dttb CHANGE UM: MED Medical Drug 09/30/2021 emend,aprepitant aprepitant CHANGE UM: QUANTITY 2 / 30 days

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 252 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

October, 2021

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 10/01/2021 JEMPERLI dostarlimab-gxly ADD UM: MED Medical Drug 10/01/2021 ZYNLONTA loncastuximab tesirine-lpyl ADD UM: MED Medical Drug 10/01/2021 BELSOMRA CHANGE UM: QUANTITY 0.5 / 1 days 1 / 1 days 10/01/2021 BELSOMRA suvorexant CHANGE UM: QUANTITY 0.5 / 1 days 1 / 1 days 10/01/2021 BELSOMRA suvorexant CHANGE UM: QUANTITY 0.5 / 1 days 1 / 1 days 10/01/2021 BELSOMRA suvorexant CHANGE UM: QUANTITY 0.5 / 1 days 1 / 1 days 10/01/2021 DAYVIGO CHANGE UM: QUANTITY 0.5 / 1 days 1 / 1 days 10/01/2021 DAYVIGO lemborexant CHANGE UM: QUANTITY 0.5 / 1 days 1 / 1 days 10/01/2021 lunesta,eszopiclo CHANGE UM: QUANTITY 0.5 / 1 days 2 / 1 days ne 10/01/2021 lunesta,eszopiclo eszopiclone CHANGE UM: QUANTITY 0.5 / 1 days 1 / 1 days ne 10/01/2021 lunesta,eszopiclo eszopiclone CHANGE UM: QUANTITY 0.5 / 1 days 1 / 1 days ne 10/01/2021 flurazepam flurazepam hcl CHANGE UM: QUANTITY 0.5 / 1 days 1 / 1 days hcl,dalmane 10/01/2021 flurazepam flurazepam hcl CHANGE UM: QUANTITY 0.5 / 1 days 1 / 1 days hcl,dalmane 10/01/2021 intermezzo,zolpid zolpidem tartrate CHANGE UM: QUANTITY 0.5 / 1 days 1 / 1 days em tartrate 10/01/2021 intermezzo,zolpid zolpidem tartrate CHANGE UM: QUANTITY 0.5 / 1 days 1 / 1 days em tartrate 10/01/2021 rozerem,ramelteo CHANGE UM: QUANTITY 0.5 / 1 days 1 / 1 days n 10/01/2021 silenor,doxepin doxepin hcl CHANGE UM: QUANTITY 0.5 / 1 days 1 / 1 days hcl

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 253 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 10/01/2021 silenor,doxepin doxepin hcl CHANGE UM: QUANTITY 0.5 / 1 days 1 / 1 days hcl 10/01/2021 temazepam,resto temazepam CHANGE UM: QUANTITY 0.5 / 1 days 1 / 1 days ril 10/01/2021 temazepam,resto temazepam CHANGE UM: QUANTITY 0.5 / 1 days 1 / 1 days ril 10/01/2021 temazepam,resto temazepam CHANGE UM: QUANTITY 0.5 / 1 days 1 / 1 days ril 10/01/2021 temazepam,resto temazepam CHANGE UM: QUANTITY 0.5 / 1 days 1 / 1 days ril 10/01/2021 halcion,triazolam triazolam CHANGE UM: QUANTITY 0.5 / 1 days 2 / 1 days 10/01/2021 halcion,triazolam triazolam CHANGE UM: QUANTITY 0.5 / 1 days 1 / 1 days 10/01/2021 sonata, zaleplon CHANGE UM: QUANTITY 0.5 / 1 days 2 / 1 days 10/01/2021 sonata,zaleplon zaleplon CHANGE UM: QUANTITY 0.5 / 1 days 2 / 1 days 10/01/2021 ambien zolpidem tartrate CHANGE UM: QUANTITY 0.5 / 1 days 2 / 1 days pak,ambien,zolpi dem tartrate 10/01/2021 ambien zolpidem tartrate CHANGE UM: QUANTITY 0.5 / 1 days 1 / 1 days pak,ambien,zolpi dem tartrate 10/01/2021 PONVORY ponesimod ADD UM: SPECIALTY Specialty Drug 10/01/2021 PONVORY ponesimod ADD UM: SPECIALTY Specialty Drug 10/01/2021 XYWAV sodium oxybate/calcium REMOVE FROM Covered Non-Formulary oxybate/magnesium FORMULARY oxybate/pot oxybate 10/01/2021 XYREM sodium oxybate REMOVE FROM Covered Non-Formulary FORMULARY 10/01/2021 JORNAY PM methylphenidate hcl ADD UM: QUANTITY 1 / 1 days 10/01/2021 JORNAY PM methylphenidate hcl ADD UM: QUANTITY 1 / 1 days

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 254 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 10/01/2021 JORNAY PM methylphenidate hcl ADD UM: QUANTITY 1 / 1 days 10/01/2021 JORNAY PM methylphenidate hcl ADD UM: QUANTITY 1 / 1 days 10/01/2021 JORNAY PM methylphenidate hcl ADD UM: QUANTITY 1 / 1 days 10/01/2021 INBRIJA levodopa ADD UM: QUANTITY 10 / 1 days 10/01/2021 CYKLOKAPRON tranexamic acid ADD UM: MED Medical Drug 10/01/2021 tranexamic acid tranexamic acid ADD UM: MED Medical Drug 10/01/2021 SILVADENE silver sulfadiazine ADD TO FORMULARY Non-Formulary Covered 10/01/2021 ssd silver sulfadiazine ADD TO FORMULARY Non-Formulary Covered 10/01/2021 EVRYSDI risdiplam ADD UM: QUANTITY 7 / 1 days 10/01/2021 RYBREVANT amivantamab-vmjw ADD UM: MED Medical Drug 10/01/2021 OSMOLEX ER amantadine hcl REMOVE FROM Covered Non-Formulary FORMULARY 10/01/2021 OSMOLEX ER amantadine hcl REMOVE FROM Covered Non-Formulary FORMULARY 10/01/2021 OSMOLEX ER amantadine hcl REMOVE FROM Covered Non-Formulary FORMULARY 10/01/2021 OSMOLEX ER amantadine hcl REMOVE FROM Covered Non-Formulary FORMULARY 10/01/2021 deferasirox deferasirox REMOVE UM: Limited Access LIMITEDACCESS 10/01/2021 deferasirox deferasirox REMOVE UM: Limited Access LIMITEDACCESS 10/01/2021 deferasirox deferasirox REMOVE UM: Limited Access LIMITEDACCESS 10/01/2021 JADENU deferasirox ADD UM: SPECIALTY Specialty Drug 10/01/2021 JADENU deferasirox ADD UM: SPECIALTY Specialty Drug 10/01/2021 JADENU deferasirox ADD UM: SPECIALTY Specialty Drug

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 255 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 10/01/2021 CRINONE progesterone, ADD UM: SPECIALTY Specialty Drug micronized,progesterone,mi cronized 10/01/2021 CRINONE progesterone, ADD UM: SPECIALTY Specialty Drug micronized,progesterone,mi cronized 10/01/2021 PROLIA denosumab ADD UM: SPECIALTY Specialty Drug 10/01/2021 PROLIA denosumab ADD UM: MED Medical Drug 10/01/2021 SPRAVATO esketamine hcl ADD UM: MED Medical Drug 10/01/2021 SPRAVATO esketamine hcl ADD UM: MED Medical Drug 10/01/2021 TEMODAR temozolomide REMOVE UM: MED Medical Drug 10/01/2021 THROMBATE III antithrombin iii (hum ADD UM: MED Medical Drug plas),antithrombin iii (human plasma derived) 10/01/2021 tobramycin tobramycin ADD UM: CUSTOM J7862 10/01/2021 tobramycin tobramycin sulfate/sodium ADD UM: MED Medical Drug sulfate in ns chloride 10/01/2021 tobramycin tobramycin sulfate ADD UM: MED Medical Drug sulfate 10/01/2021 tobramycin tobramycin sulfate ADD UM: MED Medical Drug sulfate 10/01/2021 TRETTEN factor xiii a-subunit, ADD UM: MED Medical Drug recombinant 10/01/2021 XGEVA denosumab ADD UM: SPECIALTY Specialty Drug 10/01/2021 XGEVA denosumab ADD UM: MED Medical Drug 10/01/2021 ZORTRESS everolimus ADD UM: SPECIALTY Specialty Drug 10/01/2021 SPRAVATO esketamine hcl ADD UM: SPECIALTY Specialty Drug 10/01/2021 SPRAVATO esketamine hcl ADD UM: SPECIALTY Specialty Drug

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 256 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 10/01/2021 VUMERITY diroximel fumarate ADD UM: SPECIALTY Specialty Drug 10/01/2021 ambien zolpidem tartrate CHANGE UM: QUANTITY 0.5 / 1 days 1 / 1 days cr,zolpidem tartrate er 10/01/2021 ambien zolpidem tartrate CHANGE UM: QUANTITY 0.5 / 1 days 1 / 1 days cr,zolpidem tartrate er 10/01/2021 exalgo,hydromor hydromorphone hcl CHANGE UM: Total cumulative phone er QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 10/01/2021 exalgo,hydromor hydromorphone hcl CHANGE UM: Total cumulative phone er QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 10/01/2021 exalgo,hydromor hydromorphone hcl CHANGE UM: Total cumulative phone er QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 10/01/2021 exalgo,hydromor hydromorphone hcl CHANGE UM: Total cumulative phone er QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 257 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 10/01/2021 DELESTROGEN estradiol valerate ADD UM: MED Medical Drug 10/01/2021 estradiol valerate estradiol valerate ADD UM: MED Medical Drug 10/01/2021 XYREM sodium oxybate ADD UM: SPECIALTY Specialty Drug 10/01/2021 XYWAV sodium oxybate/calcium ADD UM: SPECIALTY Specialty Drug oxybate/magnesium oxybate/pot oxybate

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 258 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 10/01/2021 child mucus relief guaifenesin/dextromethorph ADD TO FORMULARY Non-Formulary Covered cough,mucus an hbr relief dm max,children's cough,mucus relief cough,recofen d,childrens cough,dm max,child chest congestion + cough,children's mucinex cough,mucinex fast-max dm max,children's mucinex,benylin, ameritussin dm,child delsym cough+chest dm,delsym cough+chest congest dm,cough-chest congestion dm,adult dm maximum,robitus sin cough-chest- cong dm,chld robitussin cough- chest dm,child cough-chest congest dm,child chest congestion- cough,cough- chest congest dm,tussin dm,child mucus- cough

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 259 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value relief,tussin dm max,child mucinex freefrom day cgh,child delsym cough- chest dm 10/01/2021 double bacitracin zinc/polymyxin b ADD TO FORMULARY Covered antibiotic,polyspo sulfate rin,wal- sporin,poly bacitracin,bacitra cin- polymyxin,betadi ne 10/01/2021 aprepitant aprepitant ADD TO FORMULARY Non-Formulary Covered 10/01/2021 aprepitant aprepitant ADD TO FORMULARY Non-Formulary Covered 10/01/2021 therapeutic lanolin alcohols/mineral ADD TO FORMULARY Non-Formulary Covered moisturizing oil/petrolatum,white/ceresin 10/01/2021 GERBER GS multivitamin with minerals REMOVE FROM Covered Non-Formulary PRENATAL no.92/folic acid/dha FORMULARY NOURISH PLS 10/01/2021 mylanta gas simethicone ADD TO FORMULARY Non-Formulary Covered maximum strength,mylanta gas minis 10/01/2021 FERRIPROX (2 deferiprone ADD UM: SPECIALTY Specialty Drug TIMES A DAY)

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 260 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

November, 2021

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 11/01/2021 avinza,morphine morphine sulfate ADD UM: QUANTITY 1 / 1 days sulfate er 11/01/2021 avinza,morphine morphine sulfate ADD UM: QUANTITY 1 / 1 days sulfate er 11/01/2021 avinza,morphine morphine sulfate ADD UM: QUANTITY 1 / 1 days sulfate er 11/01/2021 avinza,morphine morphine sulfate ADD UM: QUANTITY 1 / 1 days sulfate er 11/01/2021 avinza,morphine morphine sulfate ADD UM: QUANTITY 1 / 1 days sulfate er 11/01/2021 avinza,morphine morphine sulfate ADD UM: QUANTITY 1 / 1 days sulfate er 11/01/2021 EMBEDA morphine sulfate/naltrexone ADD UM: Total cumulative hcl QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 11/01/2021 EMBEDA morphine sulfate/naltrexone ADD UM: Total cumulative hcl QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 261 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 11/01/2021 EMBEDA morphine sulfate/naltrexone ADD UM: Total cumulative hcl QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 11/01/2021 EMBEDA morphine sulfate/naltrexone ADD UM: Total cumulative hcl QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 11/01/2021 EMBEDA morphine sulfate/naltrexone ADD UM: Total cumulative hcl QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 11/01/2021 EMBEDA morphine sulfate/naltrexone ADD UM: Total cumulative hcl QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 11/01/2021 exalgo,hydromor hydromorphone hcl ADD UM: QUANTITY 1 / 1 days phone er

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 262 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 11/01/2021 exalgo,hydromor hydromorphone hcl CHANGE UM: Total cumulative phone er QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 11/01/2021 exalgo,hydromor hydromorphone hcl ADD UM: QUANTITY 1 / 1 days phone er 11/01/2021 exalgo,hydromor hydromorphone hcl CHANGE UM: Total cumulative phone er QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 11/01/2021 exalgo,hydromor hydromorphone hcl ADD UM: QUANTITY 1 / 1 days phone er 11/01/2021 exalgo,hydromor hydromorphone hcl CHANGE UM: Total cumulative phone er QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 11/01/2021 exalgo,hydromor hydromorphone hcl ADD UM: QUANTITY 1 / 1 days phone er 11/01/2021 exalgo,hydromor hydromorphone hcl CHANGE UM: Total cumulative phone er QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 263 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 11/01/2021 hysingla hydrocodone bitartrate ADD UM: QUANTITY 1 / 1 days er,hydrocodone bitartrate er 11/01/2021 hysingla hydrocodone bitartrate ADD UM: QUANTITY 1 / 1 days er,hydrocodone bitartrate er 11/01/2021 hysingla hydrocodone bitartrate ADD UM: QUANTITY 1 / 1 days er,hydrocodone bitartrate er 11/01/2021 hysingla hydrocodone bitartrate ADD UM: QUANTITY 1 / 1 days er,hydrocodone bitartrate er 11/01/2021 hysingla hydrocodone bitartrate ADD UM: QUANTITY 1 / 1 days er,hydrocodone bitartrate er 11/01/2021 hysingla hydrocodone bitartrate ADD UM: QUANTITY 1 / 1 days er,hydrocodone bitartrate er 11/01/2021 hysingla hydrocodone bitartrate ADD UM: QUANTITY 1 / 1 days er,hydrocodone bitartrate er 11/01/2021 MORPHABOND morphine sulfate ADD UM: QUANTITY 3 / 1 days ER 11/01/2021 MORPHABOND morphine sulfate ADD UM: QUANTITY 3 / 1 days ER 11/01/2021 MORPHABOND morphine sulfate ADD UM: QUANTITY 3 / 1 days ER 11/01/2021 MORPHABOND morphine sulfate ADD UM: QUANTITY 3 / 1 days ER 11/01/2021 oxymorphone hcl oxymorphone hcl ADD UM: QUANTITY 2 / 1 days er,opana er

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 264 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 11/01/2021 oxymorphone hcl oxymorphone hcl ADD UM: QUANTITY 2 / 1 days er,opana er 11/01/2021 oxymorphone hcl oxymorphone hcl ADD UM: QUANTITY 2 / 1 days er,opana er 11/01/2021 oxymorphone hcl oxymorphone hcl ADD UM: QUANTITY 2 / 1 days er,opana er 11/01/2021 oxymorphone hcl oxymorphone hcl ADD UM: QUANTITY 2 / 1 days er,opana er 11/01/2021 oxymorphone hcl oxymorphone hcl ADD UM: QUANTITY 2 / 1 days er,opana er 11/01/2021 oxymorphone hcl oxymorphone hcl ADD UM: QUANTITY 2 / 1 days er,opana er 11/01/2021 oxycontin,oxycod oxycodone hcl ADD UM: QUANTITY 3 / 1 days one hcl er 11/01/2021 oxycontin,oxycod oxycodone hcl CHANGE UM: Total cumulative one hcl er QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 11/01/2021 OXYCONTIN,OX oxycodone hcl ADD UM: QUANTITY 3 / 1 days YCODONE HCL ER 11/01/2021 oxycontin,oxycod oxycodone hcl ADD UM: QUANTITY 3 / 1 days one hcl er 11/01/2021 oxycontin,oxycod oxycodone hcl CHANGE UM: Total cumulative one hcl er QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 265 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 11/01/2021 OXYCONTIN,OX oxycodone hcl ADD UM: QUANTITY 3 / 1 days YCODONE HCL ER 11/01/2021 OXYCONTIN,OX oxycodone hcl ADD UM: QUANTITY 3 / 1 days YCODONE HCL ER 11/01/2021 oxycontin,oxycod oxycodone hcl ADD UM: QUANTITY 3 / 1 days one hcl er 11/01/2021 OXYCONTIN,OX oxycodone hcl ADD UM: QUANTITY 3 / 1 days YCODONE HCL ER 11/01/2021 XTAMPZA ER oxycodone myristate ADD UM: QUANTITY 2 / 1 days 11/01/2021 XTAMPZA ER oxycodone myristate ADD UM: QUANTITY 2 / 1 days 11/01/2021 XTAMPZA ER oxycodone myristate ADD UM: QUANTITY 2 / 1 days 11/01/2021 XTAMPZA ER oxycodone myristate ADD UM: QUANTITY 2 / 1 days 11/01/2021 XTAMPZA ER oxycodone myristate ADD UM: QUANTITY 2 / 1 days 11/01/2021 meperidine meperidine hcl REMOVE FROM Covered Non-Formulary hcl,meperitab FORMULARY 11/01/2021 meperidine meperidine hcl REMOVE UM: Total cumulative hcl,meperitab QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 11/01/2021 meperidine meperidine hcl REMOVE FROM Covered Non-Formulary hcl,meperitab FORMULARY

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 266 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 11/01/2021 meperidine meperidine hcl REMOVE UM: Total cumulative hcl,meperitab QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 11/01/2021 meperidine meperidine hcl ADD UM: Total cumulative hcl,meperitab QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 11/01/2021 meperidine meperidine hcl ADD UM: Total cumulative hcl,meperitab QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day 11/01/2021 DEMEROL meperidine hcl ADD UM: Total cumulative QUANTITYCUSTOM opioid dose limited to 90 morphine milligram equivalent (MME) per day

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 267 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates

January, 2022

Effective Date Brand Name Generic Name Type of Change Previous Value New Value 01/01/2022 VYLEESI bremelanotide acetate CHANGE UM: Limited Access LIMITEDACCESS

BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 268 UPDATED 10/2021