Large Group Tier 4 HMO and PPO Prescription Drug List DMHC Version

Pharmacy | PDL | California

2021 California Advantage Large Group 4-Tier HMO and PPO Prescription Drug List

Please note: This Prescription Drug List (PDL) is accurate as of September 1, 2021 and is subject to change after this date. All previous versions of this PDL are no longer in effect. Your estimated coverage and copay/coinsurance may vary based on the benefit plan you choose and the effective date of the plan.

This PDL can also be accessed online at myuhc.com > Pharmacy Information > Prescription Drug Lists > California plans > Large Group - Advantage. Plan-specific coverage documents may be accessed online at uhc.com/statedruglists > Large Group Plans > California. If you are a UnitedHealthcare member, please register or log on to myuhc.com, or call the toll-free number on your health plan ID card to find pharmacy information specific to your benefit plan. This PDL is applicable to the following health insurance products offered by UnitedHealthcare: • Navigate • Options PPO • Navigate Plus • Non-Differential PPO • Choice • SignatureValue • Choice Plus • SignatureValue Advantage • Select • SignatureValue Alliance • Select Plus • SignatureValue Focus • Core • SignatureValue Harmony • Core Essential • Doctors Plan

Please refer to your ID card for plan type (HMO or PPO).

Updated 7/13/2021

At UnitedHealthcare, we want to help you better understand your medication options...... 3

How do I use my PDL? ...... 4

What are tiers? ...... 5

When does the PDL change? ...... 5

Utilization Management Programs ...... 6

Your Right to Request Access to a Non-formulary Drug ...... 6

Requesting a Prior Authorization or Step Therapy Exception ...... 7

How do I locate and fill a prescription through a retail network pharmacy? ...... 7

How do I locate and fill a prescription through the mail order pharmacy? ...... 7

How do I locate and fill a prescription at a specialty pharmacy? ...... 8

How do I get updated information about my pharmacy benefit? ...... 8

Nondiscrimination notice and access to communication services ...... 9

Prescription Drug List ...... 13

2 At UnitedHealthcare, we want to help you better understand your medication options. Your pharmacy benefit offers flexibility and choice in determining the right medication for you. To help you get the most out of your pharmacy benefit, we’ve included some of the most commonly used terms and their definitions as well as frequently asked questions: Brand-name drug means a Prescription Drug Product (1) which is manufactured and marketed under a trademark or name by a specific drug manufacturer; or (2) that we identify as a brand-name product, based on available data resources. This includes data sources such as Medi-Span, that classify drugs as either brand or generic based on a number of factors. Not all products identified as a “brand-name” by the manufacturer, pharmacy, or your Physician will be classified as brand-name by us. A brand- name drug is listed in this PDL in all CAPITAL letters. Coinsurance means a percentage of the cost of a covered health care benefit that you pay after you have paid the deductible, if a deductible applies to the health care benefit. Copayment means a fixed dollar amount that you pay for a covered health care benefit after you have paid the deductible, if a deductible applies to the health care benefit. Deductible means the amount you pay for covered health care benefits that are subject to the deductible before your health insurer begins to pay. If your health insurance policy has a deductible, it may have either 1 deductible or separate deductibles for medical benefits and prescription drug benefits. After you pay your deductible, you usually pay only a copayment or coinsurance for covered health care benefits. Your insurance company pays the rest. Drug Tier means a group of Prescription Drug Products that correspond to a specified cost sharing tier in your health insurance policy. The drug tier in which a Prescription Drug Product is placed determines your portion of the cost for the drug. Enrollee is a person enrolled in a health plan who is entitled to receive services from the plan. All references to enrollees in this formulary template shall also include subscribers as defined in this section below. Exception request means a request for coverage of a non-formulary drug. If you, your designee, or your prescribing health care provider submits a request for coverage of a non-formulary drug, your insurer must cover the non-formulary drug when it is medically necessary for you to take the drug. Exigent circumstances means when you are suffering from a medical condition that may seriously jeopardize your life, health, or ability to regain maximum function, or when you are undergoing a current course of treatment using a non-formulary drug. Formulary or Prescription Drug List (PDL) means a list that categorizes into tiers medications or products that have been approved by the U.S. Food and Drug Administration (FDA). This list is subject to our periodic review and modification (generally quarterly, but no more than 6 times per calendar year). Generic drug means a Prescription Drug Product: (1) that is chemically equivalent to a brand-name drug; or (2) that we identify as a generic product based on available data resources. This includes data sources such as Medi-Span, that classify drugs as either brand or generic based on a number of factors. Not all products identified as a “generic” by the manufacturer, pharmacy or your Physician will be classified as a generic by us. A generic drug is listed in this PDL in bold and italicized lowercase letters. Non-formulary drug means a Prescription Drug Product that is not listed on this PDL. Out-of-pocket costs means your expenses for health care benefits that aren’t reimbursed by your health insurance. Out-of- pocket costs include deductibles, copayments and coinsurance for covered health care benefits, plus all costs for health care benefits that are not covered. Prescribing provider means a health care provider who can write a prescription for a drug to diagnose, treat, or prevent a medical condition. Prescription means an oral, written, or electronic order from a prescribing provider authorizing a Prescription Drug Product to be provided to a specific individual. Prescription Drug Product means a medication or product that has been approved by the U.S. Food and Drug Administration (FDA) and that can, under federal or state law, be dispensed only according to a Prescription Order or Refill. A Prescription Drug Product includes a medication that, due to its characteristics, is appropriate for self-administration or administration by a non-skilled caregiver. We will provide coverage for a Prescription Drug Product which includes a medication that, due to its characteristics, is appropriate for self-administration or administration by a non-skilled caregiver. This definition includes: Inhalers (with spacers);

3 Insulin; the following diabetic supplies: standard insulin syringes with needles; blood-testing strips - glucose; urine-testing strips - glucose; ketone-testing strips and tablets; lancets and lancet devices; and glucose meters (including continuous glucose monitors [applies to PPO plans only]); disposable devices which are medically necessary for the administration of a covered outpatient Prescription Drug Product. Benefits also include FDA-approved contraceptive drugs, devices and products available over-the-counter when prescribed by a Network provider. Prior Authorization means a process by your health insurer to determine that a health care benefit is medically necessary for you. If a Prescription Drug Product is subject to prior authorization in this PDL, your prescribing provider must request approval from your health insurer to cover the drug. Your health insurer must grant a prior authorization request when it is medically necessary for you to take the drug. Step therapy means a specific sequence in which Prescription Drug Products for a particular medical condition must be tried. If a drug is subject to step therapy in this PDL, you may have to try 1 or more other drugs before your health insurance policy will cover that drug for your medical condition. If your prescribing provider submits a request for an exception to the step therapy requirement, your health insurer must grant the request when it is medically necessary for you to take the drug. Subscriber means the person who is responsible for payment to a plan or whose employment or other status, except for family dependency, is the basis for eligibility for membership in the plan. How do I use my PDL? When choosing a medication, you and your doctor should consult the PDL. It will help you and your doctor choose the most cost-effective prescription drugs. This guide tells you if special programs apply. Bring this list with you when you see your doctor. It is organized by therapeutic category and class. The therapeutic category and class are based on the American Hospital Formulary Service (AHFS) Pharmacologic-Therapeutic Classification. You may also find a drug by its brand or generic name in the alphabetical index. If a generic equivalent for a brand-name drug is not available on the market or is not covered, the drug will not be separately listed by its generic name. This is the way Prescription Drug Products appear in the PDL: 1. A drug is listed alphabetically by its brand and generic names in the therapeutic category and class to which it belongs; 2. The generic name for a brand-name drug is included after the brand-name in parentheses and all lowercase bold and italicized letters; 3. If a generic equivalent for a brand-name drug is both available and covered, the generic drug will be listed separately from the brand-name drug in all lowercase bold and italicized letters; and 4. If a generic drug is marketed under a proprietary, trademark-protected brand-name, the brand-name will be listed after the generic name in parentheses and regular typeface with the first letter of each word capitalized. Example:

Prescription Drug Name Drug Tier Coverage Requirements & Limits AVAPRO ORAL TABLET 150 MG, 300 MG, 75 MG (irbesartan) 4 irbesartan oral tablet 150 mg, 300 mg, 75 mg 1

If your medication is not listed in this document, please visit myuhc.com or call the toll-free member phone number on your health plan ID card. Below is a list of drug tier numbers, abbreviations and designations used in the PDL as well as an explanation for each.

Drug Tier 1 Your lowest cost medications H-N May be part of health care reform preventive when used for appropriate Drug Tier 2 Your mid-range cost medications preventive purposes Drug Tier 3 Your mid-range cost medications SP Specialty medication Drug Tier 4 Your highest cost medications CM Orally administered anti-cancer medication PA Prior authorization required M May be covered under the medical benefit SL Supply Limit with prior authorization for HMO plans ST Step Therapy SMCS Specialty medication cost share may apply (for HMO plans, does not apply to injectables H May be part of health care reform preventive covered under the medical benefit)

4 What are tiers? Tiers are the different cost levels you pay for a medication. Each tier is assigned a cost, which is determined by your employer or health plan. This is how much you will pay when you fill a prescription. Tier 1 medications are your lowest-cost options. If your medication is placed in Tier 2, 3 or 4, look to see if there is a Tier 1 option available. Discuss these options with your doctor. For orally administered anti-cancer medications on any Tier, the total amount of copayments and/or coinsurance shall not exceed $250 for an individual prescription of up to a 30-day supply. For high deductible health plans, the $250 maximum only applies once the deductible has been met. Check your benefit plan documents to find out your specific pharmacy plan costs, including any maximum dollar amount of cost sharing that may apply to a drug. Preferred medications are found in Tier 1, Tier 2 or Tier 3 and may vary depending on the medication and the condition it treats.

$ Drug Tier Includes Helpful Tips Tier 1 Medications that provide the highest Use Tier 1 drugs for the lowest $ Your lowest cost overall value. Mostly generic drugs. Some out-of-pocket costs. brand-name drugs may also be included.

Tier 2 and 3 Medications that provide good Use Tier 2 or Tier 3 drugs instead $$ Your mid-range cost overall value. A mix of brand-name of Tier 4 to help reduce your and generic drugs. out-of-pocket costs.

Tier 4 Medications that provide the lowest Many Tier 4 drugs have lower-cost $$$ Your highest cost overall value. Mostly brand-name drugs, options in Tier 1, 2 or 3. Ask your as well as some generics. doctor if they could work for you.

Please note: If you have a high deductible plan, the tier cost levels may apply once you reach your deductible. Refer to your enrollment and plan materials on myuhc.com, or call the toll-free number on your health plan ID card for more information about your benefit plan. For HMO plans, please reference your Schedule of Benefits for costs associated with medications covered under the medical benefit. For information related to specialty medication cost share, please refer to the Specialty Medication Cost Share (SMCS) section below.

When does the PDL change? This PDL is required to be updated on a monthly basis. • Medications may move to a lower tier at any time. • Medications may move to a higher tier when a generic becomes available. • Medications may move to a higher tier or become non-formulary most often on Jan. 1, May 1, or Sept. 1. • Medications may become subject to new or revised utilization management procedures, such as prior authorization, step therapy or supply limits, at any time but most often upon FDA approval of the medication or its generic, Jan. 1, May 1, or Sept. 1. When a medication changes tiers, you may have to pay a different amount for that medication. The presence of a Prescription Drug Product on the PDL does not guarantee that you will be prescribed that Prescription Drug Product by your provider for a particular medical condition.

5 Utilization Management Programs

Prior authorization required—Your doctor is required to provide additional information to us to determine coverage. For specific prior authorization requirements, please refer to your Evidence of Coverage. Supply limit—Amount of medication covered per copayment or in a specific time period. Step therapy—Requires you to try 1 or more other medications before the medication you are requesting may be covered. For specific step therapy requirements, please refer to your Evidence of Coverage. Health Care Reform Preventive when used for appropriate preventive purposes—This medication is part of a health care reform preventive benefit and may be available at no cost to you when used for appropriate preventive purposes. For more information, please refer to the California Advantage and Essential HMO and PPO Prescription Drug List (PDL) PPACA $0 Cost-Share Preventive Care Medications list. Designated specialty program—For certain Specialty Prescription Drug Products, we may direct you to a Designated Pharmacy with whom we have an arrangement to provide those Prescription Drug Products, which are identified in the Coverage Requirements and Limits column of the Prescription Drug List (PDL). If you choose not to obtain your Prescription Drug Product from the Designated Pharmacy, you may opt-out of the Designated Pharmacy program by contacting us at myuhc.com or the telephone number on your ID card. Specialty Medication Cost Share (SMCS)—Specialty medication cost share may apply. Please refer to the Pharmacy Schedule of Benefits for specific cost share. For HMO plans, does not apply to injectable medications covered under the medical benefit.

To learn more about a pharmacy program or to find out if it applies to you, please visit myuhc.com or call the toll-free member phone number on your health plan ID card. If you are a pre-enrollee and you would like to learn more about your specific pharmacy benefit, please contact your employer. Drugs administered by a health care professional are generally covered under the medical benefit while drugs that are self- administered are covered under the pharmacy benefit. In order to obtain medical benefits for drugs that are administered by a health care professional, your provider may also be required to obtain a prior authorization. The provider may contact UnitedHealthcare for more information or uhcprovider.com. Your Right to Request Access to a Non-formulary Drug This plan must cover all Medically Necessary Prescription Drug Products. When a Prescription Drug Product is not on our PDL, you or your representative may request an exception to gain access to that Prescription Drug Product. To make a request, contact us in writing or call the toll-free number on your ID card. We will notify you of our determination within 72 hours. If approved, we will cover the Prescription Drug Product for the duration of the prescription, including refills.

Urgent Requests If your request requires immediate action and a delay could significantly increase the risk to your health, or the ability to regain maximum function, call us as soon as possible. We will provide a written or electronic determination within 24 hours. If approved, we will cover the Prescription Drug Product for the duration of the exigency.

External Review If you are not satisfied with our determination of your exception request, you may be entitled to request an external review. You or your representative may request an external review by sending a written request to us to the address set out in the determination letter or by calling the toll-free number on your ID card. The Independent Review Organization (IRO) will notify you of its determination within 72 hours.

Expedited External Review If you are not satisfied with our determination of your exception request and it involves an urgent situation, you or your representative may request an expedited external review by calling the toll-free number on your ID card or by sending a written request to the address set out in the determination letter. The IRO will notify you of our determination within 24 hours. If we deny your exception request, you may appeal. Please refer to your Evidence of Coverage for details. The complaint and appeals process, including independent review, is described under Section 6: Questions, Complaints and Appeals. You may also call the telephone number listed on your identification (ID) card.

6 Requesting a Prior Authorization or Step Therapy Exception Before certain Prescription Drug Products are dispensed to you, your prescribing provider or your pharmacist is required to obtain prior authorization or step therapy exception from us. Your prescribing provider can submit a request by phone to OptumRx or electronically by contacting us at uhcprovider.com. The Prior Authorization staff of qualified pharmacists and technicians is available Monday – Friday from 5 a.m. – 10 p.m. PST and Saturday from 6 a.m. – 3 p.m. PST to assist licensed physicians. Most authorizations are completed within 24 hours. The most common reason for delay in the authorization process is insuﬃcient information. Your licensed physician may need to provide information on diagnosis and medication history and/or evidence in the form of documents, records or lab tests which establish that the use of the requested Prescription Drug Product meets plan criteria. You may determine whether a particular Prescription Drug Product is subject to prior authorization or step therapy requirements by going online at myuhc.com or by calling at the toll-free phone number on the back of your health plan ID card. If you are changing policies, we will not require you to repeat step therapy when you are already being treated for a medical condition by a Prescription Drug Product provided the Prescription Drug Product is appropriately prescribed and considered safe and effective for your medical condition. However, we may impose a prior authorization requirement for the continued coverage of a Prescription Drug Product prescribed pursuant to step therapy requirements imposed by the former policy. Your prescribing provider may also prescribe another Prescription Drug Product covered under your policy that is medically appropriate for your medical condition. If you are currently taking a Prescription Drug Product which was approved by UnitedHealthcare for a specific medical condition and that drug is removed from the Prescription Drug List (PDL) and the prescribing provider continues to prescribe the Prescription Drug Product for your medical condition, we will continue to cover the Prescription Drug Product provided that the drug is appropriately prescribed and is considered safe and effective for treating your medical condition. In the case of a standard prior authorization or step therapy exception request, we will notify you, your designee, or your prescribing provider of the Benefit determination no later than 72 hours following receipt of the request. In the case of an expedited prior authorization or step therapy exception request based on exigent circumstances, we will notify you, your designee, or your prescribing provider of the Benefit determination no later than 24 hours following receipt of the request. If we fail to respond to you, your designee, or your prescribing provider within the prescribed time limits, the request is deemed approved and we may not deny the request thereafter. If you disagree with a determination, you can request an appeal. The complaint and appeals process, including independent medical review, is described in the Evidence of Coverage under Section 6: Questions, Complaints and Appeals. You may also call at the telephone number on your ID card.

How do I locate and fill a prescription through a retail network pharmacy? UnitedHealthcare has a well-established network of pharmacies including most major pharmacy and supermarket chains as well as many independent pharmacies. For a listing of network pharmacies, call the toll-free phone number on your health plan ID card to help locate a network pharmacy near you or visit our website at myuhc.com for an up-to-date list.

How do I locate and fill a prescription through the mail order pharmacy? UnitedHealthcare offers a Mail Order Pharmacy Program through OptumRx®. Here’s how to fill prescriptions through the Mail Order Pharmacy Program. 1. Call your prescribing provider to obtain a new prescription for each medication. When you call, ask the Physician to write the prescription for a 90-day supply which represents 3 prescription units with up to 3 additional refills. The doctor will tell you when to pick up the written prescription. (Note: OptumRx must have a new prescription to process any new Mail Order request.)

7 2. After picking up the prescription, complete the Mail Order Form included in your enrollment materials. (To obtain additional forms or for assistance in completing the form, contact UnitedHealthcare’s Customer Service Department by calling the telephone number on the back of your ID card. You can also find the form atoptumrx.com .) 3. Enclose the prescription and appropriate copayment via check, money order, or credit card. Your Pharmacy Schedule of Benefits will have the applicable copayment for the Mail Order Pharmacy Program. Make the check or money order payable to OptumRx. No cash please. Important Tip: If you are starting a new Prescription Drug Product, please request 2 prescriptions from your physician. Have 1 filled immediately at a network pharmacy while mailing the second prescription to UnitedHealthcare’s Mail Order Pharmacy. Once you receive your medication through the Mail Order Pharmacy Program, you should stop filling the prescription at the network pharmacy.

How do I locate and fill a prescription at a specialty pharmacy? Call the phone number on the back of your health plan ID card or visit specialty.optumrx.com to locate a designated specialty pharmacy for your medication.

Designated Pharmacies If you require certain Specialty Prescription Drug Products, we may direct you to a Designated Pharmacy with whom we have an arrangement to provide those Specialty Prescription Drug Products. There are both retail and mail pharmacies in the Designated Pharmacy network. Note that not all contracted retail pharmacies are in the Designated Pharmacy network. Only retail pharmacies that are in the Designated Pharmacy network will provide access to these Specialty Prescription Drug Products. If you choose not to obtain your Specialty Prescription Drug Product from the Designated Pharmacy, you may opt-out of the Designated Pharmacy program through the Internet at myuhc.com or by calling the telephone number on your ID card. If you want to opt-out of the program and fill your Specialty Prescription Drug Product at a non-Designated Pharmacy but do not inform us, you will be responsible for the entire cost of the Specialty Prescription Drug Product and no Benefits will be paid. In urgent or emergent circumstances, you may contact Customer Service by calling the telephone number on the back of your ID card. This will allow you access to the retail network override process and allow the urgent or emergent prescription claim to pay at your local pharmacy for same day access if they have the Prescription Drug Product available.

How do I get updated information about my pharmacy benefit? Since the PDL may change during your plan year, we encourage you to visit myuhc.com or call the toll-free member phone number on your health plan ID card for more current information.

Log in to myuhc.com for the following pharmacy information and tools: • Pharmacy benefit and coverage information • Possible lower-cost medication options • Medication interactions and side effects • Participating retail pharmacies by ZIP code • Your prescription history

And, if mail order services are included in your pharmacy benefit, you can also: • Refill prescriptions • Check the status of your order • Set up reminders for refills • Manage your account

Learn more Call the toll-free member phone number on your health plan ID card, or visit myuhc.com.

8 Nondiscrimination notice and access to communication services UnitedHealthcare Services, Inc. on behalf of itself and its affiliates does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability. If you think you were treated unfairly for any of these reasons, you can send a complaint to: Online: [email protected] Mail: Civil Rights Coordinator UnitedHealthcare Civil Rights Grievance P.O. Box 30608 Salt Lake City, UT 84130 You must send the complaint within 60 days of when you found out about it. A decision will be sent to you within 30 days. If you disagree with the decision, you have 15 days to ask us to look at it again. If you need help with your complaint, please call the toll- free phone number listed on your ID card. If you think you were treated unfairly because of your race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability, you can also send a complaint to the California Department of Managed Health Care: DMHC California Help Center 980 9th Street, Suite 500 Sacramento, CA 95814-2725 1-888-HMO-2219 (1-888-466-2219) 1-800-735-2929 or 1-888-877-5378 (TTY) Internet Website: www.hmohelp.ca.gov If you think you were treated unfairly because of your sex, age, race, color, national origin, or disability, you can also file a complaint with the U.S. Dept. of Health and Human Services: Online: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. Phone: Toll-free 1-800-368-1019, 1-800-537-7697 (TDD) Mail: U.S. Dept. of Health and Human Services 200 Independence Avenue SW Room 509F, HHH Building Washington, D.C. 20201

9 English IMPORTANT LANGUAGE INFORMATION: You may be entitled to the rights and services below. You can get an interpreter or translation services at no charge. Written information may also be available in some languages at no charge. To get help in your language, please call your health plan at: UnitedHealthcare of California 1-800-624-8822 / TTY: 711. If you need more help, call HMO Help Line at 1-888-466-2219.

Spanish INFORMACIÓN IMPORTANTE SOBRE IDIOMAS: Es probable que usted disponga de los derechos y servicios a continuación. Puede pedir un intérprete o servicios de traducción sin cargo. Es posible que tenga disponible documentación impresa en algunos idiomas sin cargo. Para recibir ayuda en su idioma, llame a su plan de salud de UnitedHealthcare of California al 1-800- 624-8822 / TTY: 711. Si necesita más ayuda, llame a la línea de ayuda de la HMO al 1-888-466-2219.

Chinese 重要語言資訊：您可能有資格享有下列權利並取得下列服務。您可以免費獲取口譯員或翻譯服務。部分語言亦備有免費書面資訊。如需取得您語言的協助，請撥打下列電話與您的健保計畫聯絡： UnitedHealthcare of California 1-800-624-8822 / 聽力語言殘障服務專線 (TTY)：711。若您需要更多協助，請撥打 HMO 協助專線 1-888-466-2219。

Armenian ԿԱՐԵՎՈՐ ԼԵԶՎԱԿԱՆ ՏԵՂԵԿՈՒԹՅՈՒՆ՝ Հավանական է, որ Ձեզ հասանելի լինեն հետևյալ իրավունքներն ու ծառայությունները: Կարող եք ստանալ բանավոր թարգմանչի կամ թարգմանության անվճար ծառայություններ: Հնարավոր է, որ մի շարք լեզուներով նաև առկա լինի անվճար գրավոր տեղեկություն: Ձեր լեզվով օգնություն ստանալու համար խնդրում ենք զանգահարել Ձեր առողջապահական ծրագիր՝ UnitedHealthcare of California 1-800-624-8822 / TTY 711 համարով: Հավելյալ օգնության կարիքի դեպքում, զանգահարեք HMO-ի Օգնության հեռախոսագիծ 1-888-466-2219 համարով:

10 Hmong COV NTAUB NTAWV LUS TSEEM CEEB: Tej zaum koj yuav muaj cai rau cov cai pab cuam hauv qab no. Koj tuaj yeem tau txais ib tug kws txhais lus los sis txhais ntawv pub dawb. Cov ntaub ntawv sau no muaj sau ua qee yam ntaub ntawv pub dawb rau sawd daws. Yuav tau txais kev cov ntaub ntawv sau ua koj lus, thov hu rau qhov chaw npaj kho mob rau ntawm: UnitedHealthcare of California 1-800-624-8822 / TTY: 711. Yog koj xav tau kev pab ntxiv, hu rau HMO Help Line ntawm tus xov tooj 1-888-466-2219.

Japanese 言語支援サービスについての重要なお知らせ：お客様には、以下権利があり、必要なサービスをご利用いただける可能性があります。お客様は、通訳または翻訳のサービスを無料でご利用いただけます。言語によっては、文書化された情報を無料でご利用できる場合もあります。ご希望の言語による援助をご希望の方は、お客様の医療保険プランにご連絡ください。UnitedHealthcare of California 1-800-624-8822 / TTY: 711。この他のサポートが必要な場合には、HMO Help Line に 1-888-466-2219 にてお問い合わせください。

Korean 중요 언어 정보: 귀하는 아래와 같은 권리 및 서비스를 누리실 수 있습니다. 귀하는 통역 혹은 번역 서비스를 비용 부담없이 이용하실 수 있습니다. 일부 언어의 경우 서면 번역 서비스 또한 비용 부담없이 제공될 수도 있습니다. 귀하의 언어 지원 서비스가 필요하시면 귀하의 건강보험에 다음 전화번호로 문의하십시오. UnitedHealthcare of California 1-800-624-8822 / TTY: 711. 더 많은 도움이 필요하신 분은 HMO 헬프 라인(안내번호: 1-888-466-2219)으로 문의하십시오.

Punjabi ਮਹੱ ਤਵਪੂਰਨ ਭਾ,ਾ ਦੀ ਜਾਣਕਾਰੀ: ਤੁਸ4 ਹੇਠ7 ਿਦੱ ਤੇ ਅਿਧਕਾਰ ਅਤੇ ਸੇਵਾਵ7 ਦੇ ਹੱ ਕਦਾਰ ਹੋ ਸਕਦੇ ਹੋ। ਤੁਸ4 ਿਬਨਾ ਿਕਸੇ ਲਾਗਤ 'ਤੇ ਦੁਭਾ,ੀਆ ਜ7 ਅਨੁਵਾਦ ਸੇਵਾਵ7 ਪ@ਾਪਤ ਕਰ ਸਕਦੇ ਹੋ। ਿਲਖਤੀ ਜਾਣਕਾਰੀ ਕੁਝ ਭਾ,ਾਵ7 ਿਵਚ ਿਬਨਾ ਿਕਸੇ ਖਰਚੇ ਦੇ ਿਮਲ ਸਕਦੀ ਹੈ। ਆਪਣੀ ਭਾ,ਾ ਿਵਚ ਸਹਾਇਤਾ ਪ@ਾਪਤ ਕਰਨ ਲਈ, ਿਕਰਪਾ ਕਰਕੇ ਆਪਣੀ ਿਸਹਤ ਯੋਜਨਾ ਨੂੰ ਇੱ ਥੇ ਕਾਲ ਕਰੋ: UnitedHealthcare of California 1-800-624-8822 / TTY: 711। ਜੇ ਤੁਹਾ ੰਨੂ ਹੋਰ ਮਦਦ ਚਾਹੀਦੀ ਹੈ, ਤ7 HMO ਹੈਲਪ ਲਾਈਨ 'ਤੇ ਕਾਲ ਕਰੋ 1-888-466-2219।

11 Russian :

12 Table of Contents of Prescription Drug List Informational Section...... 1 ANTIHISTAMINE DRUGS - Drugs for Allergy...... 13 ANTI-INFECTIVE AGENTS - Drugs for Infections...... 15 ANTINEOPLASTIC AGENTS - Drugs for Cancer ...... 36 ANTITOXINS,IMMUNE GLOB,TOXOIDS,VACCINES - DRUGS FOR THE IMMUNE SYSTEM...... 45 AUTONOMIC DRUGS - Drugs for the Nervous System ...... 49 BLOOD FORMATION, COAGULATION, THROMBOSIS - Drugs for the Blood ...... 59 CARDIOVASCULAR DRUGS - Drugs for the Heart...... 69 CENTRAL NERVOUS SYSTEM AGENTS - Drugs for the Nervous System ...... 90 DENTAL AGENTS - Oral Care ...... 128 DEVICES - Medical Supplies and Durable Medical Equipment...... 128 DIAGNOSTIC AGENTS...... 131 DISINFECTANTS (FOR NON-DERMATOLOGIC USE) - Disinfectants ...... 132 ELECTROLYTIC, CALORIC, AND WATER BALANCE ...... 132 ENZYMES...... 139 EYE, EAR, NOSE AND THROAT (EENT) PREPS...... 140 GASTROINTESTINAL DRUGS ...... 150 GASTROINTESTINAL DRUGS - Drugs for the Stomach ...... 150 GOLD COMPOUNDS...... 158 HEAVY METAL ANTAGONISTS - Drugs to Reduce Iron ...... 158 HORMONES AND SYNTHETIC SUBSTITUTES - Hormones ...... 158 LOCAL ANESTHETICS (PARENTERAL) - Drugs for Numbing ...... 197 MISCELLANEOUS THERAPEUTIC AGENTS ...... 198 NONHORMONAL CONTRACEPTIVES - Drugs for Women ...... 217 OXYTOCICS - Drugs for Women...... 218 PHARMACEUTICAL AIDS...... 218 RESPIRATORY TRACT AGENTS - Drugs for the Lungs ...... 218 SKIN AND MUCOUS MEMBRANE AGENTS - Drugs for the Skin ...... 226 SMOOTH MUSCLE RELAXANTS - Drugs to Relax Muscles ...... 247 VITAMINS...... 248

TOC-1 Coverage Requirements & Prescription Drug Name Drug Tier Limits ANTIHISTAMINE DRUGS - Drugs for Allergy ANTIHISTAMINE DRUGS - Drugs for Allergy promethazine hcl oral tablet 25 mg 1 ETHANOLAMINE DERIVATIVES - Drugs for Allergy carbinoxamine maleate oral solution 4 mg/5ml 1 carbinoxamine maleate oral tablet 4 mg 1 clemastine fumarate oral tablet 2.68 mg 1 DICOPANOL FUSEPAQ ORAL SUSPENSION 3 PA RECONSTITUTED 5 MG/ML (diphenhydramine hcl) DICOPANOL RAPIDPAQ ORAL SUSPENSION 3 PA RECONSTITUTED 5 MG/ML (diphenhydramine hcl) diphen oral elixir 12.5 mg/5ml 1 diphenhydramine hcl oral elixir 12.5 mg/5ml 1 FIRST-MOUTHWASH BLM MOUTH/THROAT SUSPENSION 3 PA (dph-lido-alhydr-mghydr-simeth) FIRST GEN. ANTIHIST. DERIVATIVES, MISC. - Drugs for Allergy cyproheptadine hcl oral syrup 2 mg/5ml 1 cyproheptadine hcl oral tablet 4 mg 1 FIRST GENERATION ANTIHISTAMINES - Drugs for Allergy ANTIVERT ORAL TABLET 50 MG ( meclizine hcl) 2 carbinoxamine maleate oral solution 4 mg/5ml 1 carbinoxamine maleate oral tablet 4 mg 1 clemastine fumarate oral tablet 2.68 mg 1 cyproheptadine hcl oral syrup 2 mg/5ml 1 cyproheptadine hcl oral tablet 4 mg 1 DICOPANOL FUSEPAQ ORAL SUSPENSION 3 PA RECONSTITUTED 5 MG/ML (diphenhydramine hcl) DICOPANOL RAPIDPAQ ORAL SUSPENSION 3 PA RECONSTITUTED 5 MG/ML (diphenhydramine hcl) diphen oral elixir 12.5 mg/5ml 1 diphenhydramine hcl oral elixir 12.5 mg/5ml 1 hydroxyzine hcl oral syrup 10 mg/5ml 1 hydroxyzine hcl oral tablet 10 mg, 25 mg, 50 mg 1

Drug Tier 1: Your lowest cost medications; Drug Tier 2: Your mid-range cost medications; Drug Tier 3: Your mid-range cost medications; Drug Tier 4: Your highest cost medications; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-N: May be part of health care reform preventive when used for appropriate preventive purposes; SP: Specialty medication; CM: Orally administered anticancer medication; M: May be covered under the medical benefit with prior authorization for HMO plans; SMCS: Specialty medication cost share may apply (for HMO plans, does not apply to injectables covered under the medical benefit). 24 Coverage Requirements & Prescription Drug Name Drug Tier Limits HCV REPLICATION COMPLEX INHIBITORS - Drugs for Viral Infections EPCLUSA ORAL TABLET 200-50 MG (sofosbuvir- PA; SL (1 tablet per day.); 2 velpatasvir) SMCS EPCLUSA ORAL TABLET 400-100 MG (sofosbuvir- PA; SL (84 tablets per 720 2 velpatasvir) days.); SMCS HARVONI ORAL PACKET 33.75-150 MG, 45-200 MG SL (1 pellet per day and 84 2 (ledipasvir-sofosbuvir) pellets per 720 days.); SMCS PA; ST; SL (84 tablets per HARVONI ORAL TABLET 45-200 MG (ledipasvir-sofosbuvir) 2 720 days.); SMCS PA; ST; SL (56 tablets per HARVONI ORAL TABLET 90-400 MG (ledipasvir-sofosbuvir) 2 720 days.); SMCS PA; ST; SL (56 tablets per LEDIPASVIR-SOFOSBUVIR ORAL TABLET 90-400 MG 2 720 days.); SMCS MAVYRET ORAL TABLET 100-40 MG (glecaprevir- PA; SL (168 tablets per 720 2 pibrentasvir) days.); SMCS; SP PA; SL (84 tablets per 720 SOFOSBUVIR-VELPATASVIR ORAL TABLET 400-100 MG 2 days.); SMCS VIEKIRA PAK ORAL TABLET THERAPY PACK 12.5-75-50 PA; ST; SL (336 tablets per 4 &250 MG (ombitas-paritapre-ritona-dasab) 720 days.); SMCS; SP VOSEVI ORAL TABLET 400-100-100 MG (sofosbuv- PA; SL (84 tablets per 720 2 velpatasv-voxilaprev) days.); SMCS; SP PA; SL (84 tablets per 720 ZEPATIER ORAL TABLET 50-100 MG (elbasvir-grazoprevir) 2 days (12 weeks).); SMCS; SP HIV ENTRY AND FUSION INHIBITORS - Drugs for Viral Infections FUZEON SUBCUTANEOUS SOLUTION RECONSTITUTED 90 4 M MG (enfuvirtide) RUKOBIA ORAL TABLET EXTENDED RELEASE 12 HOUR 4 PA 600 MG (fostemsavir tromethamine) SELZENTRY ORAL SOLUTION 20 MG/ML (maraviroc) 2 PA SELZENTRY ORAL TABLET 150 MG, 25 MG, 300 MG, 75 MG 2 PA (maraviroc) HIV INTEGRASE INHIBITOR ANTIRETROVIRALS - Drugs for Viral Infections BIKTARVY ORAL TABLET 50-200-25 MG (bictegravir- 3 SL (1 tablet per day.) emtricitab-tenofov) Drug Tier 1: Your lowest cost medications; Drug Tier 2: Your mid-range cost medications; Drug Tier 3: Your mid-range cost medications; Drug Tier 4: Your highest cost medications; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-N: May be part of health care reform preventive when used for appropriate preventive purposes; SP: Specialty medication; CM: Orally administered anticancer medication; M: May be covered under the medical benefit with prior authorization for HMO plans; SMCS: Specialty medication cost share may apply (for HMO plans, does not apply to injectables covered under the medical benefit). 25 Coverage Requirements & Prescription Drug Name Drug Tier Limits DOVATO ORAL TABLET 50-300 MG (dolutegravir- 2 SL (1 tablet per day.) lamivudine) GENVOYA ORAL TABLET 150-150-200-10 MG (elviteg-cobic- 2 SL (1 tablet per day.) emtricit-tenofaf) ISENTRESS HD ORAL TABLET 600 MG (raltegravir 2 potassium) ISENTRESS ORAL PACKET 100 MG (raltegravir potassium) 2 ISENTRESS ORAL TABLET 400 MG (raltegravir potassium) 2 ISENTRESS ORAL TABLET CHEWABLE 100 MG, 25 MG 2 (raltegravir potassium) JULUCA ORAL TABLET 50-25 MG (dolutegravir-rilpivirine) 2 SL (1 tablet per day.) STRIBILD ORAL TABLET 150-150-200-300 MG (elviteg- 2 SL (1 tablet per day.) cobic-emtricit-tenofdf) TIVICAY ORAL TABLET 50 MG (dolutegravir sodium) 3 TIVICAY PD ORAL TABLET SOLUBLE 5 MG (dolutegravir 3 sodium) TRIUMEQ ORAL TABLET 600-50-300 MG (abacavir- 2 SL (1 tablet per day.) dolutegravir-lamivud) HIV NONNUCLEOSIDE REV.TRANSCRIP. INHIB. - Drugs for Viral Infections BIKTARVY ORAL TABLET 50-200-25 MG (bictegravir- 3 SL (1 tablet per day.) emtricitab-tenofov) COMPLERA ORAL TABLET 200-25-300 MG (emtricitab- 3 SL (1 tablet per day.) rilpivir-tenofovir) DELSTRIGO ORAL TABLET 100-300-300 MG (doravirin- 2 SL (1 tablet per day.) lamivudin-tenofov df) EDURANT ORAL TABLET 25 MG (rilpivirine hcl) 2 efavirenz oral capsule 200 mg, 50 mg 2 efavirenz oral tablet 600 mg 2 efavirenz-emtricitab-tenofovir oral tablet 600-200-300 mg 2 SL (1 tablet per day.) efavirenz-lamivudine-tenofovir oral tablet 400-300-300 mg, 600-300-300 mg 2 SL (1 tablet per day.) etravirine oral tablet 100 mg, 200 mg 2 INTELENCE ORAL TABLET 100 MG, 200 MG ( etravirine) 4 INTELENCE ORAL TABLET 25 MG ( etravirine) 2 JULUCA ORAL TABLET 50-25 MG (dolutegravir-rilpivirine) 2 SL (1 tablet per day.)

Drug Tier 1: Your lowest cost medications; Drug Tier 2: Your mid-range cost medications; Drug Tier 3: Your mid-range cost medications; Drug Tier 4: Your highest cost medications; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-N: May be part of health care reform preventive when used for appropriate preventive purposes; SP: Specialty medication; CM: Orally administered anticancer medication; M: May be covered under the medical benefit with prior authorization for HMO plans; SMCS: Specialty medication cost share may apply (for HMO plans, does not apply to injectables covered under the medical benefit). 38 Coverage Requirements & Prescription Drug Name Drug Tier Limits PA; SL (180 capsules per HYCAMTIN ORAL CAPSULE 0.25 MG (topotecan hcl) 2 prescription.); SMCS; SP; CM PA; SL (40 capsules per HYCAMTIN ORAL CAPSULE 1 MG (topotecan hcl) 2 prescription.); SMCS; SP; CM HYDREA ORAL CAPSULE 500 MG (hydroxyurea) 4 hydroxyurea oral capsule 500 mg 1 IBRANCE ORAL CAPSULE 100 MG, 125 MG, 75 MG PA; SL (21 capsules per 2 (palbociclib) month.); SMCS; SP; CM IBRANCE ORAL TABLET 100 MG, 125 MG, 75 MG PA; SL (0.75 tablets per 2 (palbociclib) day.); SMCS; SP; CM PA; SL (2 tablets per day.); ICLUSIG ORAL TABLET 15 MG (ponatinib hcl) 3 SMCS; SP; CM PA; SL (1 tablet per day.); ICLUSIG ORAL TABLET 45 MG (ponatinib hcl) 3 SMCS; SP; CM IDHIFA ORAL TABLET 100 MG, 50 MG (enasidenib PA; SL (1 tablet per day.); 2 mesylate) SMCS; SP; CM PA; SL (6 tablets per day.); imatinib mesylate oral tablet 100 mg 1 SMCS; SP; CM PA; SL (1 tablet per day.); imatinib mesylate oral tablet 400 mg 1 SMCS; SP; CM PA; SL (3 capsules per day.); IMBRUVICA ORAL CAPSULE 140 MG (ibrutinib) 2 SMCS; SP; CM PA; SL (1 capsule per day.); IMBRUVICA ORAL CAPSULE 70 MG (ibrutinib) 2 SMCS; SP; CM IMBRUVICA ORAL TABLET 140 MG, 280 MG, 420 MG, 560 PA; SL (1 tablet per day.); 2 MG (ibrutinib) SMCS; SP; CM PA; SL (4 tablets per day.); INLYTA ORAL TABLET 1 MG (axitinib) 3 SMCS; SP; CM PA; SL (124 tablets per 30 INLYTA ORAL TABLET 5 MG (axitinib) 3 days.); SMCS; SP; CM PA; SL (5 tablets per INQOVI ORAL TABLET 35-100 MG (decitabine-cedazuridine) 4 month.); SMCS; SP; CM PA; ST; SL (4 capsules per INREBIC ORAL CAPSULE 100 MG (fedratinib hcl) 4 day.); SMCS; SP INTRON A INJECTION SOLUTION 10000000 UNIT/ML, 4 PA; M; SMCS; SP 6000000 UNIT/ML (interferon alfa-2b) Drug Tier 1: Your lowest cost medications; Drug Tier 2: Your mid-range cost medications; Drug Tier 3: Your mid-range cost medications; Drug Tier 4: Your highest cost medications; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-N: May be part of health care reform preventive when used for appropriate preventive purposes; SP: Specialty medication; CM: Orally administered anticancer medication; M: May be covered under the medical benefit with prior authorization for HMO plans; SMCS: Specialty medication cost share may apply (for HMO plans, does not apply to injectables covered under the medical benefit). 39 Coverage Requirements & Prescription Drug Name Drug Tier Limits INTRON A INJECTION SOLUTION RECONSTITUTED 10000000 UNIT, 18000000 UNIT, 50000000 UNIT (interferon 4 PA; M; SMCS; SP alfa-2b) PA; SL (1 tablet per day.); IRESSA ORAL TABLET 250 MG (gefitinib) 3 SMCS; SP; CM JAKAFI ORAL TABLET 10 MG, 15 MG, 20 MG, 25 MG, 5 MG PA; SL (2 tablets per day.); 2 (ruxolitinib phosphate) SMCS; SP; CM KISQALI (400 MG DOSE) TABLET THERAPY PACK 200 MG 4 PA; ST; SMCS; SP; CM ORAL 200 MG (ribociclib succinate) KISQALI (400 MG DOSE) TABLET THERAPY PACK 200 MG PA; ST; SL (42 tablets per 4 ORAL 200 MG (ribociclib succinate) month.); SMCS; SP; CM KISQALI (600 MG DOSE) TABLET THERAPY PACK 200 MG 4 PA; ST; SMCS; SP; CM ORAL 200 MG (ribociclib succinate) KISQALI (600 MG DOSE) TABLET THERAPY PACK 200 MG PA; ST; SL (63 tablets per 4 ORAL 200 MG (ribociclib succinate) month.); SMCS; SP; CM KISQALI FEMARA ORAL TABLET THERAPY PACK 200 & 2.5 4 PA; ST; SMCS; CM MG (ribociclib-letrozole) KISQALI ORAL TABLET THERAPY PACK 200 MG (ribociclib PA; ST; SL (21 tablets per 4 succinate) month.); SMCS; SP; CM PA; SL (8 capsules per day.); KOSELUGO ORAL CAPSULE 10 MG (selumetinib sulfate) 3 SMCS; SP; CM PA; SL (4 capsules per day.); KOSELUGO ORAL CAPSULE 25 MG (selumetinib sulfate) 3 SMCS; SP; CM PA; SL (186 tablets per lapatinib ditosylate oral tablet 250 mg 2 prescription); SMCS; SP; CM LENVIMA ORAL CAPSULE THERAPY PACK 10 & 4 MG, 2 X PA; SL (2 capsules per day.); 3 10 MG, 2 X 4 MG (lenvatinib mesylate) SMCS; SP; CM LENVIMA ORAL CAPSULE THERAPY PACK 10 MG & 2 X 4 PA; SL (3 capsules per day.); 3 MG, 2 X 10 MG & 4 MG, 3 X 4 MG (lenvatinib mesylate) SMCS; SP; CM LENVIMA ORAL CAPSULE THERAPY PACK 10 MG, 4 MG PA; SL (1 capsule per day.); 3 (lenvatinib mesylate) SMCS; SP; CM letrozole oral tablet 2.5 mg 1 leuprolide acetate injection kit 1 mg/0.2ml 1 PA; M; SMCS LONSURF ORAL TABLET 15-6.14 MG, 20-8.19 MG PA; SL (100 tablets per 2 (trifluridine-tipiracil) month.); SMCS; SP; CM LORBRENA ORAL TABLET 100 MG, 25 MG ( lorlatinib) 3 PA; SMCS; SP; CM LUMAKRAS ORAL TABLET 120 MG (sotorasib) 4 PA; SMCS; SP; CM

Drug Tier 1: Your lowest cost medications; Drug Tier 2: Your mid-range cost medications; Drug Tier 3: Your mid-range cost medications; Drug Tier 4: Your highest cost medications; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-N: May be part of health care reform preventive when used for appropriate preventive purposes; SP: Specialty medication; CM: Orally administered anticancer medication; M: May be covered under the medical benefit with prior authorization for HMO plans; SMCS: Specialty medication cost share may apply (for HMO plans, does not apply to injectables covered under the medical benefit). 52 Coverage Requirements & Prescription Drug Name Drug Tier Limits DICOPANOL FUSEPAQ ORAL SUSPENSION 3 PA RECONSTITUTED 5 MG/ML (diphenhydramine hcl) DICOPANOL RAPIDPAQ ORAL SUSPENSION 3 PA RECONSTITUTED 5 MG/ML (diphenhydramine hcl) diphen oral elixir 12.5 mg/5ml 1 diphenhydramine hcl oral elixir 12.5 mg/5ml 1 trihexyphenidyl hcl oral solution 0.4 mg/ml 1 trihexyphenidyl hcl oral tablet 2 mg, 5 mg 1 AUTONOMIC DRUGS, MISCELLANEOUS - Drugs for the Nervous System CHANTIX CONTINUING MONTH PAK ORAL TABLET 1 MG 4 H (varenicline tartrate) CHANTIX ORAL TABLET 0.5 MG, 1 MG (varenicline tartrate) 4 H CHANTIX STARTING MONTH PAK ORAL TABLET 0.5 MG X 4 H 11 & 1 MG X 42 (varenicline tartrate) goodsense nicotine mouth/throat lozenge 4 mg 1 H habitrol transdermal patch 24 hour 21 mg/24hr 1 H NICORETTE MOUTH/THROAT GUM 2 MG (nicotine 4 H polacrilex) nicotine polacrilex mini mouth/throat lozenge 2 mg 1 H nicotine polacrilex mouth/throat gum 2 mg, 4 mg 1 H nicotine polacrilex mouth/throat lozenge 2 mg, 4 mg 1 H nicotine step 1 transdermal patch 24 hour 21 mg/24hr 1 H nicotine step 2 transdermal patch 24 hour 14 mg/24hr 1 H nicotine step 3 transdermal patch 24 hour 7 mg/24hr 1 H NICOTROL INHALATION INHALER 10 MG (nicotine) 4 H NICOTROL NS NASAL SOLUTION 10 MG/ML (nicotine) 4 H CENTRALLY ACTING SKELETAL MUSCLE RELAXNT - Drugs for Relaxing Muscles aif #2 drug preparation kit external cream 1 PA AIF #3 DRUG PREPARATION KIT EXTERNAL CREAM 3 PA carisoprodol oral tablet 350 mg 1 carisoprodol-aspirin-codeine oral tablet 200-325-16 mg 1 chlorzoxazone oral tablet 500 mg 1 cyclobenzaprine hcl oral tablet 10 mg, 5 mg 1 Drug Tier 1: Your lowest cost medications; Drug Tier 2: Your mid-range cost medications; Drug Tier 3: Your mid-range cost medications; Drug Tier 4: Your highest cost medications; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-N: May be part of health care reform preventive when used for appropriate preventive purposes; SP: Specialty medication; CM: Orally administered anticancer medication; M: May be covered under the medical benefit with prior authorization for HMO plans; SMCS: Specialty medication cost share may apply (for HMO plans, does not apply to injectables covered under the medical benefit). 53 Coverage Requirements & Prescription Drug Name Drug Tier Limits CYCLOPHENE RAPIDPAQ TRANSDERMAL CREAM 5 % 3 PA (cyclobenzaprine hcl) DUAL COMPLEX FORMULA 1 KIT EXTERNAL CREAM 3 PA metaxalone oral tablet 400 mg, 800 mg 3 methocarbamol oral tablet 500 mg, 750 mg 1 TABRADOL FUSEPAQ ORAL SUSPENSION 1 MG/ML 3 PA (cyclobenzaprine hcl-msm) TABRADOL RAPIDPAQ ORAL SUSPENSION 1 MG/ML 3 PA (cyclobenzaprine hcl-msm) tizanidine hcl oral capsule 2 mg, 4 mg, 6 mg 3 tizanidine hcl oral tablet 2 mg, 4 mg 1 VP FC KIT EXTERNAL CREAM 3 PA ZANAFLEX ORAL CAPSULE 2 MG, 4 MG, 6 MG (tizanidine 4 hcl) ZANAFLEX ORAL TABLET 4 MG (tizanidine hcl) 4 DIRECT-ACTING SKELETAL MUSCLE RELAXANTS - Drugs for Relaxing Muscles DANTRIUM ORAL CAPSULE 25 MG, 50 MG (dantrolene 4 sodium) dantrolene sodium oral capsule 100 mg, 25 mg, 50 mg 1 GABA-DERIVATIVE SKELETAL MUSCLE RELAXANT - Drugs for Relaxing Muscles AIF #3 DRUG PREPARATION KIT EXTERNAL CREAM 3 PA BACLOFEN EXTERNAL CREAM 2 % 3 PA baclofen oral tablet 10 mg, 20 mg, 5 mg 1 FBL KIT EXTERNAL CREAM 15-4-5 % 3 PA FIRST-BACLOFEN ORAL SUSPENSION 1 MG/ML, 5 MG/ML 3 PA (baclofen) K.B.G.L IN TERODERM EXTERNAL CREAM 15-4-10-2 % 3 PA (ketoprofen-baclofen-gabap-lido ) OZOBAX ORAL SOLUTION 5 MG/5ML (baclofen) 4 PA NON-SEL. BETA-ADRENERGIC BLOCKING AGENTS - Drugs for the Heart BETAPACE AF ORAL TABLET 120 MG, 160 MG, 80 MG 4 (sotalol hcl af) carvedilol oral tablet 12.5 mg, 25 mg, 3.125 mg, 6.25 mg 1 Drug Tier 1: Your lowest cost medications; Drug Tier 2: Your mid-range cost medications; Drug Tier 3: Your mid-range cost medications; Drug Tier 4: Your highest cost medications; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-N: May be part of health care reform preventive when used for appropriate preventive purposes; SP: Specialty medication; CM: Orally administered anticancer medication; M: May be covered under the medical benefit with prior authorization for HMO plans; SMCS: Specialty medication cost share may apply (for HMO plans, does not apply to injectables covered under the medical benefit). 54 Coverage Requirements & Prescription Drug Name Drug Tier Limits CORGARD ORAL TABLET 20 MG, 40 MG, 80 MG (nadolol) 4 labetalol hcl oral tablet 100 mg, 200 mg, 300 mg 1 nadolol oral tablet 20 mg, 40 mg, 80 mg 1 pindolol oral tablet 10 mg, 5 mg 1 propranolol hcl er oral capsule extended release 24 hour 120 mg, 160 mg, 60 mg, 80 mg 2 propranolol hcl oral solution 20 mg/5ml, 40 mg/5ml 1 propranolol hcl oral tablet 10 mg, 20 mg, 40 mg, 60 mg, 80 mg 1 sotalol hcl (af) oral tablet 120 mg, 160 mg, 80 mg 1 sotalol hcl oral tablet 120 mg, 160 mg, 240 mg, 80 mg 1 SOTYLIZE ORAL SOLUTION 5 MG/ML (sotalol hcl) 4 PA timolol maleate oral tablet 10 mg, 20 mg, 5 mg 1 NON-SEL.ALPHA-1-ADRENERGIC BLOCKING AGTS - Drugs for the Heart CARDURA ORAL TABLET 1 MG, 2 MG, 4 MG, 8 MG 4 (doxazosin mesylate) CARDURA XL ORAL TABLET EXTENDED RELEASE 24 3 HOUR 4 MG, 8 MG (doxazosin mesylate) doxazosin mesylate oral tablet 1 mg, 2 mg, 4 mg, 8 mg 1 MINIPRESS ORAL CAPSULE 1 MG, 2 MG, 5 MG (prazosin 4 hcl) prazosin hcl oral capsule 1 mg, 2 mg, 5 mg 1 terazosin hcl oral capsule 1 mg, 10 mg, 2 mg, 5 mg 1 NON-SEL.ALPHA-ADRENERGIC BLOCKING AGENTS - Drugs for the Heart CAFERGOT ORAL TABLET 1-100 MG (ergotamine-caffeine) 4 dihydroergotamine mesylate injection solution 1 mg/ml 1 M PA; SL (8 mL per dihydroergotamine mesylate nasal solution 4 mg/ml 4 prescription.) ergoloid mesylates oral tablet 1 mg 1 ERGOMAR SUBLINGUAL TABLET SUBLINGUAL 2 MG PA; SL (5 tablets per 4 (ergotamine tartrate) prescription.) ergotamine-caffeine oral tablet 1-100 mg 3

Drug Tier 1: Your lowest cost medications; Drug Tier 2: Your mid-range cost medications; Drug Tier 3: Your mid-range cost medications; Drug Tier 4: Your highest cost medications; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-N: May be part of health care reform preventive when used for appropriate preventive purposes; SP: Specialty medication; CM: Orally administered anticancer medication; M: May be covered under the medical benefit with prior authorization for HMO plans; SMCS: Specialty medication cost share may apply (for HMO plans, does not apply to injectables covered under the medical benefit). 69 Coverage Requirements & Prescription Drug Name Drug Tier Limits doxazosin mesylate oral tablet 1 mg, 2 mg, 4 mg, 8 mg 1 labetalol hcl oral tablet 100 mg, 200 mg, 300 mg 1 MINIPRESS ORAL CAPSULE 1 MG, 2 MG, 5 MG (prazosin 4 hcl) prazosin hcl oral capsule 1 mg, 2 mg, 5 mg 1 terazosin hcl oral capsule 1 mg, 10 mg, 2 mg, 5 mg 1 ANGIOTENSIN II RECEPTOR ANTAGON.(HYPOTN) - Drugs for High Blood Pressure & Angina candesartan cilexetil oral tablet 16 mg, 32 mg, 4 mg, 8 mg 3 EDARBI ORAL TABLET 40 MG, 80 MG (azilsartan 3 medoxomil) irbesartan oral tablet 150 mg, 300 mg, 75 mg 1 losartan potassium oral tablet 100 mg, 25 mg, 50 mg 1 olmesartan medoxomil oral tablet 20 mg, 40 mg, 5 mg 2 telmisartan oral tablet 20 mg, 40 mg, 80 mg 2 valsartan oral tablet 160 mg, 320 mg, 40 mg, 80 mg 2 ANGIOTENSIN II RECEPTOR ANTAGONISTS - Drugs for the Heart amlodipine besylate-valsartan oral tablet 10-160 mg, 10-320 mg, 5-160 mg, 5-320 mg 2 candesartan cilexetil oral tablet 16 mg, 32 mg, 4 mg, 8 mg 3 candesartan cilexetil-hctz oral tablet 16-12.5 mg, 32-12.5 mg, 32-25 mg 3 EDARBI ORAL TABLET 40 MG, 80 MG (azilsartan 3 medoxomil) EDARBYCLOR ORAL TABLET 40-12.5 MG, 40-25 MG 3 (azilsartan-chlorthalidone) ENTRESTO ORAL TABLET 24-26 MG, 49-51 MG, 97-103 MG 4 PA; SL (2 tablets per day.) (sacubitril-valsartan) irbesartan oral tablet 150 mg, 300 mg, 75 mg 1 irbesartan-hydrochlorothiazide oral tablet 150-12.5 mg, 300- 12.5 mg 1 losartan potassium oral tablet 100 mg, 25 mg, 50 mg 1 losartan potassium-hctz oral tablet 100-12.5 mg, 100-25 mg, 50-12.5 mg 1 olmesartan medoxomil oral tablet 20 mg, 40 mg, 5 mg 2 Drug Tier 1: Your lowest cost medications; Drug Tier 2: Your mid-range cost medications; Drug Tier 3: Your mid-range cost medications; Drug Tier 4: Your highest cost medications; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-N: May be part of health care reform preventive when used for appropriate preventive purposes; SP: Specialty medication; CM: Orally administered anticancer medication; M: May be covered under the medical benefit with prior authorization for HMO plans; SMCS: Specialty medication cost share may apply (for HMO plans, does not apply to injectables covered under the medical benefit). 70 Coverage Requirements & Prescription Drug Name Drug Tier Limits olmesartan medoxomil-hctz oral tablet 20-12.5 mg, 40-12.5 mg, 40-25 mg 2 telmisartan oral tablet 20 mg, 40 mg, 80 mg 2 telmisartan-hctz oral tablet 40-12.5 mg, 80-12.5 mg, 80-25 mg 2 valsartan oral tablet 160 mg, 320 mg, 40 mg, 80 mg 2 valsartan-hydrochlorothiazide oral tablet 160-12.5 mg, 160- 25 mg, 320-12.5 mg, 320-25 mg, 80-12.5 mg 1 ANGIOTENSIN-CONVERT.ENZYME INHIB(HYPOTN) - Drugs for High Blood Pressure & Angina ACCUPRIL ORAL TABLET 10 MG, 20 MG, 40 MG, 5 MG 4 (quinapril hcl) benazepril hcl oral tablet 10 mg, 20 mg, 40 mg, 5 mg 1 captopril oral tablet 100 mg, 12.5 mg, 25 mg, 50 mg 1 enalapril maleate oral tablet 10 mg, 2.5 mg, 20 mg, 5 mg 1 EPANED ORAL SOLUTION 1 MG/ML (enalapril maleate) 4 PA fosinopril sodium oral tablet 10 mg, 20 mg, 40 mg 1 lisinopril oral tablet 10 mg, 2.5 mg, 20 mg, 30 mg, 40 mg, 5 mg 1 LOTENSIN ORAL TABLET 10 MG, 20 MG, 40 MG ( benazepril 4 hcl) moexipril hcl oral tablet 15 mg, 7.5 mg 1 perindopril erbumine oral tablet 2 mg, 4 mg, 8 mg 2 PRINIVIL ORAL TABLET 20 MG (lisinopril) 4 quinapril hcl oral tablet 10 mg, 20 mg, 40 mg, 5 mg 1 ramipril oral capsule 1.25 mg, 10 mg, 2.5 mg, 5 mg 1 trandolapril oral tablet 1 mg, 2 mg, 4 mg 1 ANGIOTENSIN-CONVERTING ENZYME INHIBITORS - Drugs for the Heart ACCUPRIL ORAL TABLET 10 MG, 20 MG, 40 MG, 5 MG 4 (quinapril hcl) ACCURETIC ORAL TABLET 10-12.5 MG, 20-12.5 MG, 20-25 4 MG (quinapril-hydrochlorothiazide) amlodipine besylate-benazepril hcl oral capsule 10-20 mg, 10-40 mg, 2.5-10 mg, 5-10 mg, 5-20 mg, 5-40 mg 1 benazepril hcl oral tablet 10 mg, 20 mg, 40 mg, 5 mg 1 Drug Tier 1: Your lowest cost medications; Drug Tier 2: Your mid-range cost medications; Drug Tier 3: Your mid-range cost medications; Drug Tier 4: Your highest cost medications; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-N: May be part of health care reform preventive when used for appropriate preventive purposes; SP: Specialty medication; CM: Orally administered anticancer medication; M: May be covered under the medical benefit with prior authorization for HMO plans; SMCS: Specialty medication cost share may apply (for HMO plans, does not apply to injectables covered under the medical benefit). 71 Coverage Requirements & Prescription Drug Name Drug Tier Limits benazepril-hydrochlorothiazide oral tablet 10-12.5 mg, 20- 12.5 mg, 20-25 mg, 5-6.25 mg 1 captopril oral tablet 100 mg, 12.5 mg, 25 mg, 50 mg 1 enalapril maleate oral tablet 10 mg, 2.5 mg, 20 mg, 5 mg 1 enalapril-hydrochlorothiazide oral tablet 10-25 mg, 5-12.5 mg 1 EPANED ORAL SOLUTION 1 MG/ML (enalapril maleate) 4 PA fosinopril sodium oral tablet 10 mg, 20 mg, 40 mg 1 fosinopril sodium-hctz oral tablet 10-12.5 mg, 20-12.5 mg 1 lisinopril oral tablet 10 mg, 2.5 mg, 20 mg, 30 mg, 40 mg, 5 mg 1 lisinopril-hydrochlorothiazide oral tablet 10-12.5 mg, 20- 12.5 mg, 20-25 mg 1 LOTENSIN HCT ORAL TABLET 10-12.5 MG, 20-12.5 MG, 20- 4 25 MG (benazepril-hydrochlorothiazide) LOTENSIN ORAL TABLET 10 MG, 20 MG, 40 MG ( benazepril 4 hcl) moexipril hcl oral tablet 15 mg, 7.5 mg 1 perindopril erbumine oral tablet 2 mg, 4 mg, 8 mg 2 PRINIVIL ORAL TABLET 20 MG (lisinopril) 4 QBRELIS ORAL SOLUTION 1 MG/ML (lisinopril) 4 PA quinapril hcl oral tablet 10 mg, 20 mg, 40 mg, 5 mg 1 quinapril-hydrochlorothiazide oral tablet 10-12.5 mg, 20- 12.5 mg, 20-25 mg 2 ramipril oral capsule 1.25 mg, 10 mg, 2.5 mg, 5 mg 1 TARKA ORAL TABLET EXTENDED RELEASE 2-180 MG, 2- 4 240 MG, 4-240 MG (trandolapril-verapamil hcl) trandolapril oral tablet 1 mg, 2 mg, 4 mg 1 trandolapril-verapamil hcl er oral tablet extended release 1- 240 mg, 2-180 mg, 2-240 mg, 4-240 mg 3 ANTIARRHYTHMICS, MISCELLANEOUS - Drugs for Angina digitek oral tablet 125 mcg, 250 mcg 1 digox oral tablet 125 mcg, 250 mcg 1 digoxin oral solution 0.05 mg/ml 1 digoxin oral tablet 125 mcg, 250 mcg 1

Drug Tier 1: Your lowest cost medications; Drug Tier 2: Your mid-range cost medications; Drug Tier 3: Your mid-range cost medications; Drug Tier 4: Your highest cost medications; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-N: May be part of health care reform preventive when used for appropriate preventive purposes; SP: Specialty medication; CM: Orally administered anticancer medication; M: May be covered under the medical benefit with prior authorization for HMO plans; SMCS: Specialty medication cost share may apply (for HMO plans, does not apply to injectables covered under the medical benefit). 114 Coverage Requirements & Prescription Drug Name Drug Tier Limits SL (40 tablets per apap-caff-dihydrocodeine oral tablet 325-30-16 mg 1 prescription.) ascomp-codeine oral capsule 50-325-40-30 mg 1 belladonna alkaloids-opium rectal suppository 16.2-30 mg, 16.2-60 mg 1 BENZHYDROCODONE-ACETAMINOPHEN ORAL TABLET 3 4.08-325 MG, 6.12-325 MG, 8.16-325 MG butalbital-apap-caff-cod oral capsule 50-325-40-30 mg 1 SL (6 capsules per day.) butalbital-asa-caff-codeine oral capsule 50-325-40-30 mg 1 carisoprodol-aspirin-codeine oral tablet 200-325-16 mg 1 codeine sulfate oral tablet 15 mg, 30 mg, 60 mg 1 DILAUDID ORAL LIQUID 1 MG/ML (hydromorphone hcl) 4 DILAUDID ORAL TABLET 2 MG, 4 MG, 8 MG 4 (hydromorphone hcl) endocet oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5- 325 mg 1 fentanyl citrate buccal lozenge on a handle 1200 mcg, 1600 mcg, 200 mcg, 400 mcg, 600 mcg, 800 mcg 2 PA; SL (4 lozenges per day) fentanyl transdermal patch 72 hour 100 mcg/hr, 50 mcg/hr, PA; SL (0.34 patches per 2 75 mcg/hr day.) PA; SL (15 patches per 31 fentanyl transdermal patch 72 hour 12 mcg/hr, 25 mcg/hr 2 days.) hydrocodone bitartrate er oral capsule extended release 12 PA; ST; SL (2 capsules per 3 hour 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 50 mg day.) hydrocodone-acetaminophen oral solution 10-325 mg/15ml 1 hydrocodone-acetaminophen oral solution 7.5-325 mg/15ml 2 hydrocodone-acetaminophen oral tablet 10-325 mg, 5-325 mg, 7.5-325 mg 1 hydrocodone-ibuprofen oral tablet 10-200 mg, 5-200 mg, 7.5-200 mg 1 hydromorphone hcl er oral tablet extended release 24 hour PA; ST; SL (2 tablets per 4 12 mg day.) hydromorphone hcl er oral tablet extended release 24 hour 16 mg, 8 mg 4 PA; ST; SL (1 tablet per day.) hydromorphone hcl er oral tablet extended release 24 hour PA; ST; SL (0 tablet per 100 32 mg 4 days, diagnosis review required.) Drug Tier 1: Your lowest cost medications; Drug Tier 2: Your mid-range cost medications; Drug Tier 3: Your mid-range cost medications; Drug Tier 4: Your highest cost medications; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-N: May be part of health care reform preventive when used for appropriate preventive purposes; SP: Specialty medication; CM: Orally administered anticancer medication; M: May be covered under the medical benefit with prior authorization for HMO plans; SMCS: Specialty medication cost share may apply (for HMO plans, does not apply to injectables covered under the medical benefit). 115 Coverage Requirements & Prescription Drug Name Drug Tier Limits hydromorphone hcl oral liquid 1 mg/ml 1 hydromorphone hcl oral tablet 2 mg, 4 mg, 8 mg 1 hydromorphone hcl rectal suppository 3 mg 1 LAZANDA NASAL SOLUTION 100 MCG/ACT, 400 MCG/ACT PA; SL (15 bottles per 4 (fentanyl citrate) month) levorphanol tartrate oral tablet 2 mg, 3 mg 4 ST; SL (4 tablets per day.) LORTAB ORAL ELIXIR 10-300 MG/15ML (hydrocodone- 4 acetaminophen) meperidine hcl oral solution 50 mg/5ml 1 meperidine hcl oral tablet 50 mg 1 methadone hcl intensol oral concentrate 10 mg/ml 1 SL (6 ml per day.) methadone hcl oral concentrate 10 mg/ml 1 SL (6 ml per day.) methadone hcl oral solution 10 mg/5ml 1 PA; SL (11.3 ml per day.) methadone hcl oral solution 5 mg/5ml 1 PA; SL (22.6 ml per day.) methadone hcl oral tablet 10 mg 1 PA; SL (2 tablets per day.) methadone hcl oral tablet 5 mg 1 PA; SL (4 tablets per day.) methadone hcl oral tablet soluble 40 mg 1 SL (1.5 tablets per day.) methadose oral concentrate 10 mg/ml 1 SL (6 ml per day.) methadose oral tablet soluble 40 mg 1 SL (1.5 tablets per day.) methadose sugar-free oral concentrate 10 mg/ml 1 SL (6 ml per day.) morphine sulfate (concentrate) oral solution 100 mg/5ml, 20 mg/ml 1 morphine sulfate er beads oral capsule extended release 24 PA; ST; SL (0 capsule per 4 100 days, diagnosis review hour 120 mg required.) morphine sulfate er beads oral capsule extended release 24 PA; ST; SL (1 capsule per 4 hour 30 mg, 45 mg, 60 mg, 75 mg, 90 mg day.) PA; SL (0 capsules per 100 morphine sulfate er oral tablet extended release 100 mg, 200 mg, 60 mg 1 days, diagnosis review required.) morphine sulfate er oral tablet extended release 15 mg, 30 PA; SL (93 tablets per 31 1 mg days.) morphine sulfate oral solution 10 mg/5ml, 20 mg/5ml 1 morphine sulfate oral tablet 15 mg, 30 mg 1

Drug Tier 1: Your lowest cost medications; Drug Tier 2: Your mid-range cost medications; Drug Tier 3: Your mid-range cost medications; Drug Tier 4: Your highest cost medications; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-N: May be part of health care reform preventive when used for appropriate preventive purposes; SP: Specialty medication; CM: Orally administered anticancer medication; M: May be covered under the medical benefit with prior authorization for HMO plans; SMCS: Specialty medication cost share may apply (for HMO plans, does not apply to injectables covered under the medical benefit). 117 Coverage Requirements & Prescription Drug Name Drug Tier Limits ULTRACET ORAL TABLET 37.5-325 MG (tramadol- SL (40 tablets per 4 acetaminophen) prescription.) XTAMPZA ER ORAL CAPSULE ER 12 HOUR ABUSE- 2 PA; SL (2 tablets per day.) DETERRENT 13.5 MG, 18 MG, 27 MG, 9 MG (oxycodone) PA; SL (0 capsules per 100 XTAMPZA ER ORAL CAPSULE ER 12 HOUR ABUSE- 2 days, diagnosis review DETERRENT 36 MG (oxycodone) required.) OPIATE ANTAGONISTS - Drugs for Overdose or Poisoning BUNAVAIL BUCCAL FILM 4.2-0.7 MG, 6.3-1 MG PA; ST; SL (2 buccal films 4 (buprenorphine hcl-naloxone hcl) per day.) buprenorphine hcl-naloxone hcl sublingual film 12-3 mg 1 SL (2 films per day.) buprenorphine hcl-naloxone hcl sublingual film 2-0.5 mg, 4- 1 mg 1 SL (1 film per day.) buprenorphine hcl-naloxone hcl sublingual film 8-2 mg 1 SL (3 films per day.) buprenorphine hcl-naloxone hcl sublingual tablet 1 SL (3 tablets per day.) sublingual 2-0.5 mg, 8-2 mg naloxone hcl injection solution 0.4 mg/ml, 4 mg/10ml 1 naloxone hcl injection solution cartridge 0.4 mg/ml 1 naloxone hcl injection solution prefilled syringe 2 mg/2ml 1 naltrexone hcl oral tablet 50 mg 1 SL (2 auto-injectors per NARCAN NASAL LIQUID 4 MG/0.1ML (naloxone hcl) 2 prescription.) pentazocine-naloxone hcl oral tablet 50-0.5 mg 1 RELISTOR SUBCUTANEOUS SOLUTION 12 MG/0.6ML 4 PA; M; SL (0.6 ml per day.) (methylnaltrexone bromide) RELISTOR SUBCUTANEOUS SOLUTION 8 MG/0.4ML 4 PA; M; SL (0.4 ml per day.) (methylnaltrexone bromide) SUBOXONE SUBLINGUAL FILM 12-3 MG (buprenorphine 4 PA; ST; SL (2 films per day.) hcl-naloxone hcl) SUBOXONE SUBLINGUAL FILM 2-0.5 MG, 4-1 MG 4 PA; ST; SL (1 film per day.) (buprenorphine hcl-naloxone hcl) SUBOXONE SUBLINGUAL FILM 8-2 MG (buprenorphine hcl- 4 PA; ST; SL (3 films per day.) naloxone hcl) ZUBSOLV SUBLINGUAL TABLET SUBLINGUAL 0.7-0.18 MG, 1 SL (1 tablet per day.) 2.9-0.71 MG (buprenorphine hcl-naloxone hcl) ZUBSOLV SUBLINGUAL TABLET SUBLINGUAL 1.4-0.36 MG, 1 SL (3 tablets per day.) 5.7-1.4 MG (buprenorphine hcl-naloxone hcl) Drug Tier 1: Your lowest cost medications; Drug Tier 2: Your mid-range cost medications; Drug Tier 3: Your mid-range cost medications; Drug Tier 4: Your highest cost medications; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-N: May be part of health care reform preventive when used for appropriate preventive purposes; SP: Specialty medication; CM: Orally administered anticancer medication; M: May be covered under the medical benefit with prior authorization for HMO plans; SMCS: Specialty medication cost share may apply (for HMO plans, does not apply to injectables covered under the medical benefit). 118 Coverage Requirements & Prescription Drug Name Drug Tier Limits ZUBSOLV SUBLINGUAL TABLET SUBLINGUAL 11.4-2.9 MG, 1 SL (2 tablets per day.) 8.6-2.1 MG (buprenorphine hcl-naloxone hcl) OPIATE PARTIAL AGONISTS - Drugs for Pain BELBUCA BUCCAL FILM 150 MCG, 300 MCG, 450 MCG, 600 3 PA; SL (2 Films per day.) MCG, 75 MCG, 900 MCG (buprenorphine hcl) BELBUCA BUCCAL FILM 750 MCG (buprenorphine hcl) 3 PA; SL (2 films per day.) BUNAVAIL BUCCAL FILM 4.2-0.7 MG, 6.3-1 MG PA; ST; SL (2 buccal films 4 (buprenorphine hcl-naloxone hcl) per day.) SL (3 sublingual tablets per buprenorphine hcl sublingual tablet sublingual 2 mg 1 day.) buprenorphine hcl sublingual tablet sublingual 8 mg 1 SL (3 tablets per day.) buprenorphine hcl-naloxone hcl sublingual film 12-3 mg 1 SL (2 films per day.) buprenorphine hcl-naloxone hcl sublingual film 2-0.5 mg, 4- 1 mg 1 SL (1 film per day.) buprenorphine hcl-naloxone hcl sublingual film 8-2 mg 1 SL (3 films per day.) buprenorphine hcl-naloxone hcl sublingual tablet 1 SL (3 tablets per day.) sublingual 2-0.5 mg, 8-2 mg SL (7.5 ml (3 bottles) per butorphanol tartrate nasal solution 10 mg/ml 2 prescription.) pentazocine-naloxone hcl oral tablet 50-0.5 mg 1 SUBOXONE SUBLINGUAL FILM 12-3 MG (buprenorphine 4 PA; ST; SL (2 films per day.) hcl-naloxone hcl) SUBOXONE SUBLINGUAL FILM 2-0.5 MG, 4-1 MG 4 PA; ST; SL (1 film per day.) (buprenorphine hcl-naloxone hcl) SUBOXONE SUBLINGUAL FILM 8-2 MG (buprenorphine hcl- 4 PA; ST; SL (3 films per day.) naloxone hcl) ZUBSOLV SUBLINGUAL TABLET SUBLINGUAL 0.7-0.18 MG, 1 SL (1 tablet per day.) 2.9-0.71 MG (buprenorphine hcl-naloxone hcl) ZUBSOLV SUBLINGUAL TABLET SUBLINGUAL 1.4-0.36 MG, 1 SL (3 tablets per day.) 5.7-1.4 MG (buprenorphine hcl-naloxone hcl) ZUBSOLV SUBLINGUAL TABLET SUBLINGUAL 11.4-2.9 MG, 1 SL (2 tablets per day.) 8.6-2.1 MG (buprenorphine hcl-naloxone hcl) OTHER NONSTEROIDAL ANTI-INFLAM. AGENTS - Drugs for Pain aif #2 drug preparation kit external cream 1 PA AIF #3 DRUG PREPARATION KIT EXTERNAL CREAM 3 PA

Drug Tier 1: Your lowest cost medications; Drug Tier 2: Your mid-range cost medications; Drug Tier 3: Your mid-range cost medications; Drug Tier 4: Your highest cost medications; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-N: May be part of health care reform preventive when used for appropriate preventive purposes; SP: Specialty medication; CM: Orally administered anticancer medication; M: May be covered under the medical benefit with prior authorization for HMO plans; SMCS: Specialty medication cost share may apply (for HMO plans, does not apply to injectables covered under the medical benefit). 120 Coverage Requirements & Prescription Drug Name Drug Tier Limits MOBIC ORAL TABLET 15 MG, 7.5 MG (meloxicam) 4 nabumetone oral tablet 500 mg, 750 mg 1 naproxen oral suspension 125 mg/5ml 1 PA naproxen oral tablet 250 mg, 375 mg, 500 mg 1 naproxen oral tablet delayed release 375 mg, 500 mg 1 naproxen sodium oral tablet 275 mg, 550 mg 1 NP #2 DRUG PREPARATION KIT EXTERNAL CREAM 3 PA oxaprozin oral tablet 600 mg 1 piroxicam oral capsule 10 mg, 20 mg 1 SPRIX NASAL SOLUTION 15.75 MG/SPRAY (ketorolac ST; SL (5 bottles per 4 tromethamine) prescription.) sulindac oral tablet 150 mg, 200 mg 1 PHENOTHIAZINES - Drugs for Depression & Psychosis chlorpromazine hcl oral tablet 10 mg, 100 mg, 200 mg, 25 mg, 50 mg 1 compro rectal suppository 25 mg 1 fluphenazine hcl oral concentrate 5 mg/ml 1 fluphenazine hcl oral elixir 2.5 mg/5ml 1 fluphenazine hcl oral tablet 1 mg, 10 mg, 2.5 mg, 5 mg 1 perphenazine oral tablet 16 mg, 2 mg, 4 mg, 8 mg 1 perphenazine-amitriptyline oral tablet 2-10 mg, 2-25 mg, 4- 10 mg, 4-25 mg, 4-50 mg 1 prochlorperazine maleate oral tablet 10 mg, 5 mg 1 prochlorperazine rectal suppository 25 mg 1 thioridazine hcl oral tablet 10 mg, 100 mg, 25 mg, 50 mg 1 trifluoperazine hcl oral tablet 1 mg, 10 mg, 2 mg, 5 mg 1 RESPIRATORY AND CNS STIMULANTS - Drugs for the Nervous System SL (40 capsules per apap-caff-dihydrocodeine oral capsule 320.5-30-16 mg 4 prescription.) SL (40 tablets per apap-caff-dihydrocodeine oral tablet 325-30-16 mg 1 prescription.) ascomp-codeine oral capsule 50-325-40-30 mg 1 AZSTARYS ORAL CAPSULE 26.1-5.2 MG, 39.2-7.8 MG, 52.3- 4 PA 10.4 MG (serdexmethylphen-dexmethylphen) Drug Tier 1: Your lowest cost medications; Drug Tier 2: Your mid-range cost medications; Drug Tier 3: Your mid-range cost medications; Drug Tier 4: Your highest cost medications; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-N: May be part of health care reform preventive when used for appropriate preventive purposes; SP: Specialty medication; CM: Orally administered anticancer medication; M: May be covered under the medical benefit with prior authorization for HMO plans; SMCS: Specialty medication cost share may apply (for HMO plans, does not apply to injectables covered under the medical benefit). 121 Coverage Requirements & Prescription Drug Name Drug Tier Limits bac oral tablet 50-325-40 mg 1 SL (6 tablets per day) butalbital-apap-caff-cod oral capsule 50-325-40-30 mg 1 SL (6 capsules per day.) butalbital-apap-caffeine oral capsule 50-300-40 mg 3 SL (6 capsules per day.) butalbital-apap-caffeine oral capsule 50-325-40 mg 1 SL (6 capsules per day) butalbital-apap-caffeine oral tablet 50-325-40 mg 1 SL (6 tablets per day) butalbital-asa-caff-codeine oral capsule 50-325-40-30 mg 1 butalbital-aspirin-caffeine oral capsule 50-325-40 mg 1 CAFERGOT ORAL TABLET 1-100 MG (ergotamine-caffeine) 4 caffeine citrate oral solution 20 mg/ml, 60 mg/3ml 1 CONCERTA ORAL TABLET EXTENDED RELEASE 18 MG, 27 2 SL (1 tablet per day.) MG, 54 MG (methylphenidate hcl) CONCERTA ORAL TABLET EXTENDED RELEASE 36 MG 2 SL (2 tablets per day.) (methylphenidate hcl) dexmethylphenidate hcl er oral capsule extended release SL (31 capsules per 31 24 hour 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg, 3 5 mg days.) dexmethylphenidate hcl oral tablet 10 mg, 2.5 mg, 5 mg 1 ELIXOPHYLLIN ORAL ELIXIR 80 MG/15ML (theophylline) 3 ergotamine-caffeine oral tablet 1-100 mg 3 ESGIC ORAL CAPSULE 50-325-40 MG (butalbital-apap- 4 SL (6 capsules per day) caffeine) ESGIC ORAL TABLET 50-325-40 MG (butalbital-apap- 4 SL (6 tablets per day) caffeine) FIORICET ORAL CAPSULE 50-300-40 MG (butalbital-apap- 4 SL (6 capsules per day.) caffeine) FOCALIN ORAL TABLET 10 MG, 2.5 MG, 5 MG 4 (dexmethylphenidate hcl) METHYLIN ORAL SOLUTION 10 MG/5ML, 5 MG/5ML 4 (methylphenidate hcl) methylphenidate hcl er (cd) oral capsule extended release 10 mg, 20 mg, 30 mg 2 SL (31 tablets per 31 days.) methylphenidate hcl er (cd) oral capsule extended release SL (31 capsules per 31 2 40 mg, 50 mg, 60 mg days.) methylphenidate hcl er (la) oral capsule extended release 2 SL (1 capsule per day) 24 hour 10 mg, 20 mg, 40 mg

Drug Tier 1: Your lowest cost medications; Drug Tier 2: Your mid-range cost medications; Drug Tier 3: Your mid-range cost medications; Drug Tier 4: Your highest cost medications; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-N: May be part of health care reform preventive when used for appropriate preventive purposes; SP: Specialty medication; CM: Orally administered anticancer medication; M: May be covered under the medical benefit with prior authorization for HMO plans; SMCS: Specialty medication cost share may apply (for HMO plans, does not apply to injectables covered under the medical benefit). 157 Coverage Requirements & Prescription Drug Name Drug Tier Limits rabeprazole sodium oral tablet delayed release 20 mg 2 SL (1 tablet per day) GOLD COMPOUNDS GOLD COMPOUNDS RIDAURA ORAL CAPSULE 3 MG (auranofin) 3 SMCS; SP HEAVY METAL ANTAGONISTS - Drugs to Reduce Iron HEAVY METAL ANTAGONISTS - Drugs to Reduce Iron CHEMET ORAL CAPSULE 100 MG (succimer) 2 clovique oral capsule 250 mg 3 PA; SMCS; SP deferasirox granules oral packet 180 mg, 360 mg, 90 mg 2 PA; SMCS; SP deferasirox oral packet 180 mg, 360 mg, 90 mg 2 PA; SMCS; SP deferasirox oral tablet 180 mg, 360 mg, 90 mg 2 PA; SMCS; SP deferasirox oral tablet soluble 125 mg, 250 mg, 500 mg 2 PA; SMCS; SP deferiprone oral tablet 500 mg 1 PA; SMCS; SP DEPEN TITRATABS ORAL TABLET 250 MG ( penicillamine) 2 SMCS; SP FERRIPROX ORAL SOLUTION 100 MG/ML (deferiprone) 2 PA; SMCS; SP FERRIPROX ORAL TABLET 1000 MG (deferiprone) 4 SMCS FERRIPROX ORAL TABLET 500 MG (deferiprone) 4 PA; SMCS; SP FERRIPROX TWICE-A-DAY ORAL TABLET 1000 MG 4 SMCS (deferiprone) penicillamine oral capsule 250 mg 4 SMCS; SP penicillamine oral tablet 250 mg 2 SMCS; SP trientine hcl oral capsule 250 mg 3 PA; SMCS; SP HORMONES AND SYNTHETIC SUBSTITUTES - Hormones ADRENALS - Hormones ADVAIR DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 100-50 MCG/DOSE, 250-50 MCG/DOSE, 500-50 3 SL (2 blisters per day) MCG/DOSE (fluticasone-salmeterol) ADVAIR HFA INHALATION AEROSOL 115-21 MCG/ACT, 230- 3 SL (0.4 grams per day.) 21 MCG/ACT, 45-21 MCG/ACT (fluticasone-salmeterol) aif #2 drug preparation kit external cream 1 PA ARNUITY ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 100 MCG/ACT, 200 MCG/ACT 1 SL (1 blister per day.) (fluticasone furoate) ARNUITY ELLIPTA INHALATION AEROSOL POWDER 1 SL (1 packet per day.) BREATH ACTIVATED 50 MCG/ACT (fluticasone furoate) Drug Tier 1: Your lowest cost medications; Drug Tier 2: Your mid-range cost medications; Drug Tier 3: Your mid-range cost medications; Drug Tier 4: Your highest cost medications; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-N: May be part of health care reform preventive when used for appropriate preventive purposes; SP: Specialty medication; CM: Orally administered anticancer medication; M: May be covered under the medical benefit with prior authorization for HMO plans; SMCS: Specialty medication cost share may apply (for HMO plans, does not apply to injectables covered under the medical benefit). 158 Coverage Requirements & Prescription Drug Name Drug Tier Limits BREO ELLIPTA INHALATION AEROSOL POWDER BREATH 3 SL (2 inhalers per day.) ACTIVATED 100-25 MCG/INH (fluticasone furoate-vilanterol) BREO ELLIPTA INHALATION AEROSOL POWDER BREATH 3 SL (2 blisters per day.) ACTIVATED 200-25 MCG/INH (fluticasone furoate-vilanterol) BREZTRI AEROSPHERE INHALATION AEROSOL 160-9-4.8 3 SL (0.36 grams per day.) MCG/ACT (budeson-glycopyrrol-formoterol) SL (120 ml (2 boxes) per 30 budesonide inhalation suspension 0.25 mg/2ml, 0.5 mg/2ml 2 days.) SL (60 ml (1 box) per 30 budesonide inhalation suspension 1 mg/2ml 2 days.) budesonide oral capsule delayed release particles 3 mg 2 CORTEF ORAL TABLET 10 MG, 20 MG, 5 MG 4 (hydrocortisone) dexamethasone intensol oral concentrate 1 mg/ml 1 dexamethasone oral elixir 0.5 mg/5ml 1 dexamethasone oral solution 0.5 mg/5ml 1 dexamethasone oral tablet 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg 1 dexamethasone oral tablet therapy pack 1.5 mg (21), 1.5 mg (35), 1.5 mg (51) 3 FLOVENT DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 100 MCG/BLIST, 50 MCG/BLIST 1 SL (2 packages per day) (fluticasone propionate (inhal)) FLOVENT DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 250 MCG/BLIST (fluticasone 1 SL (4 packages per day) propionate (inhal)) FLOVENT HFA INHALATION AEROSOL 110 MCG/ACT, 44 1 SL (1 inhaler per month) MCG/ACT (fluticasone propionate hfa) FLOVENT HFA INHALATION AEROSOL 220 MCG/ACT 1 SL (2 inhalers per month) (fluticasone propionate hfa) fludrocortisone acetate oral tablet 0.1 mg 1 flunisolide nasal solution 25 mcg/act (0.025%) 3 SL (16 grams (1 bottle) per fluticasone propionate nasal suspension 50 mcg/act 2 prescription) FLUTICASONE-SALMETEROL INHALATION AEROSOL POWDER BREATH ACTIVATED 113-14 MCG/ACT, 232-14 2 SL (0.04 mcg per day.) MCG/ACT, 55-14 MCG/ACT

Drug Tier 1: Your lowest cost medications; Drug Tier 2: Your mid-range cost medications; Drug Tier 3: Your mid-range cost medications; Drug Tier 4: Your highest cost medications; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-N: May be part of health care reform preventive when used for appropriate preventive purposes; SP: Specialty medication; CM: Orally administered anticancer medication; M: May be covered under the medical benefit with prior authorization for HMO plans; SMCS: Specialty medication cost share may apply (for HMO plans, does not apply to injectables covered under the medical benefit). 210 Coverage Requirements & Prescription Drug Name Drug Tier Limits KESIMPTA SUBCUTANEOUS SOLUTION AUTO-INJECTOR PA; M; SL (0.02 ml per day.); 2 20 MG/0.4ML (ofatumumab) SMCS; SP PA; M; SL (0.67 ml (1 KINERET SUBCUTANEOUS SOLUTION PREFILLED 3 syringe) per day.); SMCS; SYRINGE 100 MG/0.67ML (anakinra) SP leflunomide oral tablet 10 mg, 20 mg 1 PA; SL (4 tablets per day.); MAYZENT ORAL TABLET 0.25 MG ( siponimod fumarate) 3 SMCS PA; SL (1 tablet per day.); MAYZENT ORAL TABLET 2 MG ( siponimod fumarate) 3 SMCS methotrexate oral tablet 2.5 mg 1 methotrexate sodium (pf) injection solution 1 gm/40ml, 250 mg/10ml, 50 mg/2ml 1 M methotrexate sodium injection solution 250 mg/10ml, 50 mg/2ml 1 M methotrexate sodium injection solution reconstituted 1 gm 1 M methotrexate sodium oral tablet 2.5 mg 1 PA; ST; M; SL (4 auto- ORENCIA CLICKJECT SUBCUTANEOUS SOLUTION AUTO- 3 injectors per month.); SMCS; INJECTOR 125 MG/ML (abatacept) SP ORENCIA SUBCUTANEOUS SOLUTION PREFILLED PA; ST; M; SL (4 syringes 3 SYRINGE 125 MG/ML (abatacept) per month); SMCS; SP ORENCIA SUBCUTANEOUS SOLUTION PREFILLED PA; ST; M; SL (0.06 ml per 3 SYRINGE 50 MG/0.4ML (abatacept) day.); SMCS; SP ORENCIA SUBCUTANEOUS SOLUTION PREFILLED PA; ST; M; SL (0.1 ml per 3 SYRINGE 87.5 MG/0.7ML (abatacept) day.); SMCS; SP PA; SL (2 tablets per day.); OTEZLA ORAL TABLET 30 MG (apremilast) 2 SMCS; SP PA; SL (55 tablets (one OTEZLA ORAL TABLET THERAPY PACK 10 & 20 & 30 MG 2 starter pack) per year.); (apremilast) SMCS; SP PLEGRIDY INTRAMUSCULAR SOLUTION PREFILLED PA; SL (1 ml per month.); 3 SYRINGE 125 MCG/0.5ML (peginterferon beta-1a) SMCS PLEGRIDY STARTER PACK SUBCUTANEOUS SOLUTION PA; M; SL (1 ml per year.); 3 PEN-INJECTOR 63 & 94 MCG/0.5ML (peginterferon beta-1a) SMCS; SP PLEGRIDY STARTER PACK SUBCUTANEOUS SOLUTION PA; M; SL (1 ml per year.); PREFILLED SYRINGE 63 & 94 MCG/0.5ML (peginterferon 3 SMCS; SP beta-1a) Drug Tier 1: Your lowest cost medications; Drug Tier 2: Your mid-range cost medications; Drug Tier 3: Your mid-range cost medications; Drug Tier 4: Your highest cost medications; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-N: May be part of health care reform preventive when used for appropriate preventive purposes; SP: Specialty medication; CM: Orally administered anticancer medication; M: May be covered under the medical benefit with prior authorization for HMO plans; SMCS: Specialty medication cost share may apply (for HMO plans, does not apply to injectables covered under the medical benefit). 211 Coverage Requirements & Prescription Drug Name Drug Tier Limits PLEGRIDY SUBCUTANEOUS SOLUTION PEN-INJECTOR PA; M; SL (1 ml per month.); 3 125 MCG/0.5ML (peginterferon beta-1a) SMCS; SP PLEGRIDY SUBCUTANEOUS SOLUTION PREFILLED PA; M; SL (1 ml per month.); 3 SYRINGE 125 MCG/0.5ML (peginterferon beta-1a) SMCS; SP PA; SL (21 capsules per POMALYST ORAL CAPSULE 1 MG, 2 MG, 3 MG, 4 MG 3 prescription.); SMCS; SP; (pomalidomide) CM REBIF REBIDOSE SUBCUTANEOUS SOLUTION AUTO- PA; ST; M; SL (6 ml (12 INJECTOR 22 MCG/0.5ML, 44 MCG/0.5ML (interferon beta- 4 syringes) per month); SMCS; 1a) SP REBIF REBIDOSE TITRATION PACK SUBCUTANEOUS PA; ST; M; SL (4.2 mL (1 SOLUTION AUTO-INJECTOR 6X8.8 & 6X22 MCG (interferon 4 pack) per year); SMCS; SP beta-1a) PA; ST; M; SL (6 ml (12 REBIF SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 4 syringes) per month); SMCS; 22 MCG/0.5ML, 44 MCG/0.5ML (interferon beta-1a) SP REBIF TITRATION PACK SUBCUTANEOUS SOLUTION PA; ST; M; SL (4.2 ml (1 PREFILLED SYRINGE 6X8.8 & 6X22 MCG (interferon beta- 4 pack) per year); SMCS; SP 1a) PA; SL (28 capsules per REVLIMID ORAL CAPSULE 10 MG, 2.5 MG, 5 MG 2 prescription.); SMCS; SP; (lenalidomide) CM PA; SL (21 capsules per REVLIMID ORAL CAPSULE 15 MG, 20 MG, 25 MG 2 prescription.); SMCS; SP; (lenalidomide) CM RIDAURA ORAL CAPSULE 3 MG (auranofin) 3 SMCS; SP SANDIMMUNE ORAL SOLUTION 100 MG/ML (cyclosporine) 4 SMCS SIMPONI SUBCUTANEOUS SOLUTION AUTO-INJECTOR PA; M; SL (1 syringe per 21 2 100 MG/ML (golimumab) days.); SMCS; SP SIMPONI SUBCUTANEOUS SOLUTION AUTO-INJECTOR 50 PA; M; SL (0.5 ml (1 syringe) 2 MG/0.5ML (golimumab) per month); SMCS; SP SIMPONI SUBCUTANEOUS SOLUTION PREFILLED PA; M; SL (1 syringe per 21 2 SYRINGE 100 MG/ML (golimumab) days.); SMCS; SP SIMPONI SUBCUTANEOUS SOLUTION PREFILLED PA; M; SL (0.5 ml (1 syringe) 2 SYRINGE 50 MG/0.5ML (golimumab) per month); SMCS; SP sulfasalazine oral tablet 500 mg 1 sulfasalazine oral tablet delayed release 500 mg 1

255 anagrelide hcl...... 69 ATENOLOL+SYRSPEND SF BACTRIM DS...... 19, 33, 34 ANALPRAM HC ...... 229, 233 ...... 58, 73, 74, 80 BAFIERTAM...... 209 ANALPRAM HC SINGLES atenolol-chlorthalidone .. 73, 138 balsalazide disodium ...... 151 ...... 229, 233 atomoxetine hcl ...... 110 BALVERSA...... 36 ANALPRAM-HC ...... 229, 233 atorvastatin calcium ...... 84 balziva...... 165, 173, 185 ANASPAZ...... 50 atovaquone...... 19 BANZEL...... 94 anastrozole ...... 36, 162 atovaquone-proguanil hcl ...... 18 BAQSIMI ONE PACK..... 181, 198 ANCOBON...... 32 atropine sulfate...... 149 BAQSIMI TWO PACK.....181, 198 ANDRODERM...... 161 ATROVENT HFA ...... 50, 218 BARACLUDE...... 31 ANGELIQ...... 173, 185 AUBAGIO...... 208 BAXDELA...... 33 ANNOVERA ...... 164, 173, 185 aubra...... 164, 173, 185 BELBUCA...... 119 ANORO ELLIPTA ...... 50, 57 aubra eq...... 164, 173, 185 belladonna alkaloids-opium ANTICOAGULANT SODIUM aurovela 1.5/30...... 164, 173, 185 ...... 50, 115 CITRATE ...... 60 aurovela 1/20...... 164, 173, 185 BELSOMRA ...... 103 ANTIVERT...... 13, 151 aurovela 24 fe...... 164, 173, 185 benazepril hcl...... 71 anucort-hc ...... 233 aurovela fe 1.5/30.. 164, 173, 185 benazepril- ANUSOL-HC...... 233 aurovela fe 1/20..... 164, 173, 185 hydrochlorothiazide ...... 72, 137 apap-caff-dihydrocodeine AURYXIA...... 134 BENEFIX...... 63 ...... 91, 114, 115, 121 AUSTEDO...... 127 BENLYSTA ...... 213 APEXICON E...... 233 AUTOLET LANCING DEVICE 129 BENZALKONIUM CHLORIDE 240 APOKYN...... 114 AVAR CLEANSER...... 226, 239 benzalkonium chloride ...... 240 apraclonidine hcl...... 147 AVAR-E EMOLLIENT..... 226, 239 BENZAMYCIN...... 226, 240 aprepitant...... 156 AVAR-E GREEN...... 226, 239 BENZHYDROCODONE- apri...... 164, 173, 185 AVAR-E LS...... 226, 239 ACETAMINOPHEN...... 91, 115 APRISO...... 151 aviane...... 164, 173, 185 BENZNIDAZOLE ...... 20 APTIOM...... 94 avidoxy...... 18, 34 BENZOIN...... 232 APTIVUS...... 29 AVIDOXY DK...... 34, 239, 247 benzoin compound ...... 232 ARAKODA...... 18 AVONEX PEN...... 208 benzonatate ...... 219 aranelle...... 164, 173, 185 AVONEX PREFILLED...... 208 benzoyl peroxide- ARANESP (ALBUMIN FREE) AYGESTIN...... 185 erythromycin...... 226, 240 ...... 59, 61, 62 ayuna...... 164, 173, 185 benzphetamine hcl ...... 90 ARAVA...... 204, 208, 213 AYVAKIT...... 36 benztropine mesylate ...... 52, 93 arformoterol tartrate ...... 57 AZASAN...... 204, 208, 213 BERINERT...... 204 ARIKAYCE...... 17 AZASITE...... 141 beser...... 233 aripiprazole...... 99, 104 azathioprine...... 204, 208, 213 BESIVANCE...... 141 armodafinil...... 127, 128 azelaic acid...... 243 BETADINE OPHTHALMIC ARMOUR THYROID...... 197 azelastine hcl...... 140, 224 PREP...... 147 ARNUITY ELLIPTA ...... 158, 223 AZELEX...... 243 betamethasone dipropionate ARTISS...... 243 azithromycin...... 31 ...... 233 ARZOL SILVER NIT AZOPT...... 144 betamethasone dipropionate APPLICATORS...... 147 AZSTARYS...... 121 aug...... 233 ascomp-codeine AZULFIDINE..... 33, 151, 205, 209 betamethasone valerate ...... 233 ...... 106, 115, 121, 123 AZULFIDINE EN-TABS BETAPACE AF. 54, 73, 74, 80, 81 ashlyna...... 164, 173, 185 ...... 33, 151, 205, 208 BETASERON...... 209 aspirin-dipyridamole er .. 69, 123 azurette...... 165, 173, 185 betaxolol hcl.. 58, 73, 74, 80, 143 ASTRAZENECA COVID-19 bac...... 91, 106, 122 bethanechol chloride ...... 56 VACCINE...... 47 bacitracin...... 141 BETOPTIC-S...... 143 ASTRINGYN...... 63 bacitracin-polymyxin b ...... 141 BEVESPI AEROSPHERE...50, 57 ATABEX OB...... 67, 248, 250 bacitra-neomycin- BEXSERO...... 47 atazanavir sulfate ...... 29 polymyxin-hc...... 141, 145 bicalutamide...... 36 atenolol...... 58, 73, 74, 80 BACLOFEN...... 54 BIDIL...... 84, 86 baclofen...... 54 BIJUVA...... 173, 185 BACTRIM...... 20, 33, 35 BIKTARVY...... 25, 26, 27

256 BILTRICIDE...... 18 butalbital-asa-caff-codeine CARETOUCH CONTROL SOL bisoprolol fumarate ...... 106, 115, 122, 123 LEVEL 2...... 129 ...... 58, 73, 74, 80 butalbital-aspirin-caffeine CARETOUCH bisoprolol- ...... 106, 122, 123 LANCING/EJECTOR...... 129 hydrochlorothiazide ...... 73, 137 butorphanol tartrate ...... 102, 119 carisoprodol...... 53 BLEPH-10...... 141 BYDUREON BCISE carisoprodol-aspirin-codeine BLEPHAMIDE...... 141, 145 AUTOINJECTOR...... 182 ...... 53, 115, 123 BLEPHAMIDE S.O.P...... 141, 145 BYETTA 10 MCG PEN ...... 182 CARNITOR...... 214 blisovi 24 fe...... 165, 173, 185 BYETTA 5 MCG PEN ...... 182 CARNITOR SF...... 214 blisovi fe 1.5/30..... 165, 173, 185 cabergoline...... 112 CAROSPIR...... 85, 86, 87, 135 blisovi fe 1/20...... 165, 173, 185 CABLIVI...... 60 carteolol hcl...... 143 BONIVA...... 200 CABOMETYX ...... 37 cartia xt...... 76, 77, 81, 88 BOOSTRIX...... 46, 47 CAFERGOT...... 55, 102, 122 carvedilol... 54, 56, 69, 73, 74, 80 bosentan...... 225 caffeine citrate...... 102, 122 cascara sagrada...... 152 BOSULIF...... 37 CALAN SR...... 76, 77, 81, 88 CASODEX...... 37 bp 10-1...... 226, 239 CALCIFOL...... 135, 250, 253 cavarest...... 202 bp cleansing wash...... 226, 239 calcipotriene...... 243 CAVERJECT...... 88 BRAFTOVI ...... 37 calcipotriene-betameth CAVERJECT IMPULSE...... 88 BREO ELLIPTA ...... 57, 159 diprop...... 233, 243 CAYA...... 217 BREZTRI AEROSPHERE calcitonin (salmon) ...... 163, 200 CAYSTON...... 30 ...... 50, 57, 159 CALCITRENE ...... 243 caziant...... 165, 173, 186 briellyn...... 165, 173, 185 calcitriol...... 243, 253 cefaclor...... 15 BRILINTA ...... 69 calcium acetate...... 134, 135 cefaclor er...... 15 brimonidine tartrate ...... 140 calcium acetate (phos cefadroxil...... 15 brinzolamide ...... 144 binder)...... 134, 135 cefdinir...... 16 BRIVIACT...... 94 calcium-folic acid plus d cefixime...... 16 bromocriptine mesylate ...... 112 ...... 135, 250, 253 cefpodoxime proxetil ...... 16 BRONCHITOL ...... 224 CALQUENCE...... 37 cefprozil...... 16 BRONCHITOL TOLERANCE camila...... 165, 186 cefuroxime axetil...... 16 TEST...... 224 camrese...... 165, 173, 186 celecoxib...... 111 BROVANA...... 57 camrese lo...... 165, 173, 186 CELONTIN...... 126 BRUKINSA...... 37 candesartan cilexetil...... 70 CENTANY ...... 227 budesonide ...... 159, 223 candesartan cilexetil-hctz cephalexin...... 15 bumetanide ...... 85, 134 ...... 70, 137 CERDELGA...... 214 BUMEX...... 85, 134 capecitabine...... 37 cerovel...... 239 BUNAVAIL...... 118, 119 CAPEX...... 233 CERVIDIL...... 218 BUPAP...... 91, 106 CAPLYTA...... 104 CETRAXAL...... 141 buprenorphine hcl ...... 119 CAPRELSA...... 37 cevimeline hcl...... 56 buprenorphine hcl-naloxone captopril...... 71, 72 CHANTIX...... 53 hcl...... 118, 119 CARAC...... 244 CHANTIX CONTINUING bupropion hcl ...... 98 CARBAGLU...... 133 MONTH PAK ...... 53 bupropion hcl er (smoking carbamazepine...... 94, 99 CHANTIX STARTING MONTH det)...... 98 carbamazepine er...... 94, 99 PAK...... 53 bupropion hcl er (sr) ...... 98 CARBATROL...... 94, 99 charlotte 24 fe...... 165, 173, 186 bupropion hcl er (xl) ...... 98 carbidopa...... 111 chateal...... 165, 174, 186 buspirone hcl ...... 103 carbidopa-levodopa ...... 111 chateal eq...... 165, 173, 186 butalbital-acetaminophen carbidopa-levodopa er ...... 111 CHEMET...... 158, 198 ...... 91, 106 carbidopa-levodopa- CHENODAL...... 154 butalbital-apap-caff-cod entacapone ...... 110, 111 chlordiazepoxide hcl ...... 108 ...... 91, 106, 115, 122 carbinoxamine maleate .. 13, 221 chlordiazepoxide- butalbital-apap-caffeine CARDURA...... 55, 69 amitriptyline...... 108, 127 ...... 91, 106, 122 CARDURA XL...... 55, 69

257 chlordiazepoxide-clidinium clobazam...... 107, 108 CORGARD...... 55, 73, 74 ...... 50, 108 clobetasol prop emollient CORIFACT...... 63 chlorhexidine gluconate base...... 233 CORLANOR...... 78, 88 ...... 147, 240 clobetasol propionate ...233, 234 CORTANE-B...... 229, 234, 240 chloroquine phosphate ...... 18 clobetasol propionate e ...... 233 CORTEF...... 159 chlorpromazine hcl ...... 121 CLOBETAVIX...... 234 CORTENEMA ...... 234 chlorthalidone ...... 88, 138 clocortolone pivalate ...... 234 cortic-nd...... 145, 147, 148 chlorzoxazone ...... 53 clomipramine hcl...... 127 CORTIFOAM...... 234 CHOLBAM...... 154 clonazepam ...... 107, 108 CORTI-SAV...... 234, 240 cholestyramine...... 75 clonidine...... 49, 79 CORTISPORIN-TC...... 141, 145 cholestyramine light...... 75 clonidine hcl...... 49, 79 CORTROSYN...... 131 ciclodan...... 238 clopidogrel bisulfate ...... 69 COSENTYX (300 MG DOSE).244 ciclopirox...... 238 clorazepate dipotassium COSENTYX 150 MG/ML ...... 244 ciclopirox olamine...... 238 ...... 107, 108 COSENTYX SENSOREADY cilostazol...... 69, 87 clotrimazole...... 231 (300 MG)...... 244 CILOXAN...... 141 clotrimazole-betamethasone COSENTYX SENSOREADY CIMDUO...... 27 ...... 231, 234 PEN...... 244 cimetidine...... 14, 156 clovique...... 158 COSOPT...... 144 cimetidine hcl...... 14, 156 clozapine...... 104 cosyntropin...... 131 CIMZIA PREFILLED KIT CLOZARIL...... 104 COVARYX...... 161, 174 ...... 154, 205, 209 COAGADEX...... 63 COVARYX HS...... 161, 174 CIMZIA STARTER KIT COAL TAR...... 240 CREON...... 139, 154 ...... 154, 205, 209 COARTEM...... 18 CRESEMBA...... 22 cinacalcet hcl...... 163 codeine sulfate ...... 115, 219 CRINONE...... 186 CIPRO...... 21, 33 colchicine-probenecid ..139, 199 CRIXIVAN...... 29 CIPRO HC...... 141, 145 COLESTID...... 75, 76 cromolyn sodium .. 140, 147, 222 CIPRODEX...... 141, 145 COLESTID FLAVORED...... 75 crotan...... 242 ciprofloxacin hcl...... 21, 33, 141 colestipol hcl...... 76 cryselle-28...... 165, 174, 186 citalopram hydrobromide .....125 colistimethate sodium (cba) .. 32 CUTIVATE...... 234 CITRANATAL BLOOM COLY-MYCIN M...... 32 CUVPOSA...... 50 ...... 67, 153, 250, 252 COMBIGAN...... 140, 144 cyanocobalamin...... 68, 250 CITRANATAL ESSENCE COMBIPATCH...... 174, 186 CYANOCOBALAMIN...... 68, 250 ...... 67, 135, 215, 248, 250 COMBIVENT RESPIMAT cyclafem 1/35...... 165, 174, 186 CITRANATAL MEDLEY ...... 50, 57, 219 cyclafem 7/7/7...... 165, 174, 186 ...... 67, 215, 248, 250 COMBIVIR...... 27 cyclobenzaprine hcl...... 53 claravis...... 244 COMETRIQ...... 37 CYCLOGYL...... 149 clarithromycin...... 21, 31, 152 COMPLERA...... 26, 27 CYCLOMYDRIL...... 149, 150 clarithromycin er...... 21, 31, 152 compro...... 121, 151 cyclopentolate hcl ...... 149 clemastine fumarate ...... 13, 221 COMTAN...... 110 CYCLOPHENE RAPIDPAQ...... 54 CLENPIQ...... 153 CONCERTA ...... 122 cyclophosphamide ...... 37, 213 CLEOCIN...... 30, 227 CONDYLOX...... 244 CYCLOPHOSPHAMIDE... 37, 213 CLEOCIN-T...... 227 constulose ...... 133 cycloserine...... 21 CLIMARA PRO...... 174, 186 CONTOUR CONTROL ...... 129 CYCLOSET...... 162 clindacin etz...... 227 CONTOUR NEXT CONTROL .129 cyclosporine...... 205, 209, 213 clindacin-p...... 227 CONTOUR NEXT EZ ...... 129 cyclosporine modified clindamycin hcl...... 30 CONTOUR NEXT LINK ...... 129 ...... 205, 209, 213 clindamycin palmitate hcl ...... 30 CONTOUR NEXT MONITOR . 129 cyproheptadine hcl ...... 13, 221 clindamycin phos-benzoyl CONTOUR NEXT ONE ...... 129 cyred...... 165, 174, 186 perox...... 227, 240 CONTOUR NEXT TEST ...... 132 cyred eq...... 165, 174, 186 clindamycin phosphate ...... 227 CONTRAVE ...... 93 CYSTADANE ...... 215 CLINDESSE...... 227 COPASIL...... 244 CYSTADROPS...... 147 CLINOIN...... 75, 227, 232, 244 COPIKTRA...... 37 CYSTAGON...... 215 CLINPRO 5000...... 202 CORDRAN...... 234 CYSTARAN...... 148

258 CYTOTEC...... 157 desogestrel-ethinyl estradiol diltiazem hcl er beads cytra k crystals...... 132 ...... 165, 174, 186 ...... 76, 77, 81, 88 dalfampridine er...... 215 DESONATE...... 234 diltiazem hcl er coated DALIRESP...... 223 desonide...... 234 beads...... 76, 77, 81, 82, 88 danazol...... 161 DESOWEN...... 234 dilt-xr...... 76, 77, 82, 89 DANTRIUM...... 54 desoximetasone ...... 235 dimethyl fumarate ...... 209 dantrolene sodium ...... 54 desrx...... 235 dimethyl fumarate starter dapsone...... 19, 20 desvenlafaxine succinate er 124 pack...... 209 DAPTACEL...... 46, 47 dexamethasone ...... 159 DIPENTUM...... 151 DARAPRIM...... 18 dexamethasone intensol ...... 159 diphen.. 13, 53, 94, 103, 219, 222 dasetta 1/35...... 165, 174, 186 dexamethasone sodium diphenhydramine hcl dasetta 7/7/7...... 165, 174, 186 phosphate ...... 145 ...... 13, 53, 94, 103, 219, 222 DAURISMO...... 37 DEXILANT...... 157 diphenoxylate-atropine .. 50, 150 DAYPRO...... 120 dexmethylphenidate hcl ...... 122 DIPROLENE...... 235 daysee...... 165, 174, 186 dexmethylphenidate hcl er ...122 DIPROLENE AF...... 235 DAYVIGO...... 103 DEXTENZA ...... 145 dipyridamole...... 69, 89 DEBACTEROL...... 148, 240 dextroamphetamine sulfate ... 91 disopyramide phosphate ...... 79 deblitane...... 165, 186 dextroamphetamine sulfate disulfiram...... 198 deferasirox...... 158 er...... 90 DITROPAN XL...... 247 deferasirox granules...... 158 DIACOMIT...... 95 DIURIL...... 88, 137 deferiprone...... 158 DIASTAT ACUDIAL...... 107, 108 divalproex sodium.... 95, 99, 102 DELESTROGEN...... 174, 200 DIASTAT PEDIATRIC.....107, 108 divalproex sodium er 95, 99, 102 DELSTRIGO...... 26, 27 diazepam...... 107, 108, 109 DIVIGEL...... 174, 200 delyla...... 165, 174, 186 diazepam intensol ...... 107, 108 dofetilide...... 81 demeclocycline hcl...... 34 diazoxide...... 162 DOJOLVI...... 133 DEMSER...... 215 diclofenac potassium ...... 120 dolishale...... 166, 174, 186 DENTA 5000 PLUS...... 202 diclofenac sodium 120, 148, 241 donepezil hcl ...... 56 DENTAGEL...... 202 diclofenac sodium er ...... 120 DOPTELET...... 62 DEPAKOTE...... 94, 99, 102 diclofenac-misoprostol 120, 157 DORZOLAMIDE HCL...... 144 DEPAKOTE ER...... 94, 99, 102 dicloxacillin sodium...... 32 dorzolamide hcl ...... 144 DEPAKOTE SPRINKLES DICOPANOL FUSEPAQ dorzolamide hcl-timolol mal 144 ...... 95, 99, 102 ...... 13, 53, 94, 103, 219, 222 DOUBLE PM...... 141, 145 DEPEN TITRATABS ...... 158, 205 DICOPANOL RAPIDPAQ DOVATO...... 26, 27 DEPO-ESTRADIOL...... 174, 200 ...... 13, 53, 94, 103, 219, 222 DOVONEX...... 244 DEPO-PROVERA...... 165, 186 dicyclomine hcl...... 50 doxazosin mesylate .... 55, 69, 70 DEPO-SUBQ PROVERA 104 diethylpropion hcl ...... 90 doxepin hcl ...... 127, 229 ...... 165, 186 diethylpropion hcl er ...... 90 doxercalciferol...... 253 DEPO-TESTOSTERONE ...... 161 DIFICID...... 32 doxycycline hyclate...... 18, 34 DERMA-SMOOTHE/FS BODY diflorasone diacetate ...... 235 doxycycline monohydrate ...... 234 DIFLUCAN...... 22 ...... 18, 19, 34 DERMA-SMOOTHE/FS diflunisal...... 120 DRISDOL...... 253 SCALP...... 234 digitek...... 72, 79 DRIZALMA SPRINKLE...... 124 DERMOTIC...... 145 digox...... 72, 79 dronabinol...... 151 DESCOVY...... 27 digoxin...... 72, 79 drospiren-eth estrad- desipramine hcl...... 127 dihydroergotamine mesylate levomefol...... 166, 174, 187, 251 desmopressin ace spray ...... 55, 102 drospirenone-ethinyl refrig...... 63, 184 DILANTIN...... 79, 80, 113 estradiol...... 166, 174, 187 desmopressin acetate .... 63, 184 DILANTIN INFATABS ...... 79, 113 DROXIA...... 38 desmopressin acetate pf 63, 184 DILATRATE-SR...... 86 droxidopa...... 49 desmopressin acetate spray DILAUDID...... 115 DRYSOL...... 231 ...... 63, 184 diltiazem hcl ...... 76, 77, 82, 88 DUAKLIR PRESSAIR...... 50, 58 diltiazem hcl er...... 76, 77, 82, 88 DUAL COMPLEX FORMULA 1 KIT...... 54, 241, 244

259 DUAVEE...... 172, 174 EMGALITY...... 109, 110 ERYTHROCIN STEARATE ...... 23 DUETACT...... 196 EMGALITY (300 MG DOSE).. 109 erythromycin...... 23, 141, 227 duloxetine hcl ...... 112, 124 emoquette ...... 166, 175, 187 erythromycin base...... 23 DUOPA...... 111 EMSAM...... 113 erythromycin ethylsuccinate . 23 DUPIXENT...... 222, 244 emtricitabine...... 27 ESBRIET...... 219 DUREZOL...... 145 emtricitabine-tenofovir df .27, 28 escitalopram oxalate...... 125 dutasteride...... 198 EMTRIVA...... 28 ESGIC...... 92, 107, 122 DYRENIUM...... 87, 135 EMVERM...... 18 esomeprazole magnesium ... 157 E.E.S. GRANULES...... 23 enalapril maleate...... 71, 72 est estrogens-methyltest EASIVENT...... 129 enalapril- ...... 162, 175 easygel...... 202 hydrochlorothiazide ...... 72, 137 est estrogens-methyltest ds EASYMAX 15 LEVEL 2-3 ENBRACE HR .. 67, 215, 248, 251 ...... 161, 175 CONTROL ...... 129 ENBREL...... 205, 209 est estrogens-methyltest hs EASYMAX CONTROL...... 129 ENBREL MINI ...... 205, 209 ...... 161, 175 EASYMAX CONTROL ENBREL SURECLICK.... 205, 209 estarylla...... 166, 175, 187 NORMAL/HIGH...... 129 ENDARI...... 215 estazolam...... 109 EC-NAPROSYN...... 102, 120, 199 endocet...... 91, 115 estradiol...... 175, 201 ec-naproxen...... 102, 120, 199 ENDOMETRIN...... 187 estradiol valerate...... 175, 201 econazole nitrate ...... 231 ENGERIX-B...... 47 estradiol-norethindrone acet EDARBI...... 70 enoxaparin sodium ...... 66 ...... 175, 187 EDARBYCLOR...... 70, 137 enpresse-28...... 166, 175, 187 ESTRING...... 175, 201 EDECRIN...... 85, 134 enskyce...... 166, 175, 187 ESTROGEL...... 175, 201 EDEX...... 89 ENSPRYNG...... 209 ESTROSTEP FE.....166, 175, 187 ED-SPAZ...... 50 ENSTILAR...... 235, 244 eszopiclone...... 103 EDURANT...... 26 entacapone ...... 110 ethacrynic acid...... 85, 134 EEMT...... 161, 175 entecavir...... 31 ethambutol hcl ...... 21 EEMT HS ...... 161, 175 ENTEREG ...... 154 ethosuximide...... 126 efavirenz...... 26 ENTRESTO ...... 70, 87 ethynodiol diac-eth estradiol efavirenz-emtricitab- enulose...... 133 ...... 166, 175, 187 tenofovir ...... 26, 27 EPANED...... 71, 72 etodolac...... 120 efavirenz-lamivudine- EPCLUSA...... 24, 25 etodolac er...... 120 tenofovir ...... 26, 27 EPIDIOLEX...... 95 etoposide...... 38 EFFER-K...... 136 EPIFOAM...... 229, 235 etravirine...... 26 effer-k...... 136 epinephrine...... 49, 218 EUCRISA...... 229 EFUDEX...... 244 epitol...... 95, 99 euthyrox...... 197 EGATEN...... 18 EPIVIR...... 28 EVAMIST...... 175, 201 EGRIFTA SV...... 195 EPIVIR HBV...... 28 everolimus...... 38, 213 ELESTRIN...... 175, 200 eplerenone...... 85, 86, 87, 135 EVOCLIN...... 227 eletriptan hydrobromide ...... 124 EQUETRO...... 95, 99 EVOTAZ...... 29, 215 ELIGARD...... 38, 182 ERGOCAL...... 253 EVRYSDI...... 215 elinest...... 166, 175, 187 ergocalciferol...... 253 EXELDERM...... 231 ELIQUIS...... 61 ergoloid mesylates...... 55 exemestane...... 38, 162 ELIQUIS DVT/PE STARTER ERGOMAR...... 55, 102 EXTINA...... 231 PACK...... 61 ergotamine-caffeine 55, 102, 122 EZALLOR SPRINKLE ...... 84 ELITE-OB...... 67, 248, 251 ERIVEDGE...... 38 ezetimibe...... 79 ELIXOPHYLLIN ERLEADA...... 38 ezetimibe-simvastatin ...... 79, 84 ...... 84, 122, 133, 226, 247 erlotinib hcl...... 38 falmina...... 166, 175, 187 ELLA...... 166, 187 errin...... 166, 187 famciclovir...... 31 ELMIRON...... 215 ery...... 227 famotidine...... 14, 156 ELOCTATE ...... 64 ERYGEL...... 227 FANAPT...... 104, 105 EMCYT...... 38 ERYPED 200...... 23 FANAPT TITRATION PACK ... 105 EMEND ...... 156 ERYPED 400...... 23 FANATREX FUSEPAQ...... 92, 95 EMEND TRI-PACK...... 156 ERY-TAB...... 23 FARYDAK...... 38

260 FASENRA PEN...... 222 FLOVENT HFA ...... 159, 223 formaldehyde...... 132 fayosim...... 166, 175, 187 FLUAD QUADRIVALENT...... 47 FORMALDEHYDE...... 132 FBL KIT...... 54, 229, 242, 244 FLUARIX QUADRIVALENT...... 47 FORTISCARE CONTROL...... 129 febuxostat...... 199 FLUCELVAX FOSAMAX...... 201 FEIBA...... 64 QUADRIVALENT...... 47 FOSAMAX PLUS D...... 201, 253 felbamate...... 95 fluconazole ...... 22 fosamprenavir calcium...... 29 FELBATOL ...... 95 flucytosine ...... 32 fosfomycin tromethamine ...... 35 FELDENE ...... 120 fludrocortisone acetate ...... 159 fosinopril sodium ...... 71, 72 felodipine er...... 83 FLULAVAL QUADRIVALENT... 47 fosinopril sodium-hctz ... 72, 137 FEM PH...... 240, 244 flunisolide ...... 145, 159, 223 FOSRENOL...... 134, 198 FEMHRT...... 176, 187 fluocinolone acetonide .145, 235 FRAGMIN...... 66 FEMRING ...... 176, 201 fluocinolone acetonide body 235 FREESTYLE LIBRE 14 DAY femynor...... 166, 176, 187 fluocinolone acetonide scalp READER...... 129 fenofibrate ...... 84 ...... 235 FREESTYLE LIBRE 14 DAY fentanyl...... 115 fluocinonide ...... 235 SENSOR...... 130 fentanyl citrate ...... 115 fluocinonide emulsified base FREESTYLE LIBRE 2 FERRIPROX...... 158 ...... 235 READER...... 130 FERRIPROX TWICE-A-DAY.. 158 FLUORIDEX...... 202 FREESTYLE LIBRE 2 FETZIMA ...... 124 fluoridex daily renewal...... 202 SENSOR...... 130 FETZIMA TITRATION ...... 124 FLUORIDEX ENHANCED FREESTYLE LIBRE READER 130 FINACEA...... 244 WHITENING...... 202 FREESTYLE LIBRE SENSOR finasteride...... 198 FLUORIDEX SENSITIVITY SYSTEM...... 130 FINTEPLA ...... 95 RELIEF...... 128, 202 FROTEK...... 242 FIORICET...... 92, 107, 122 fluoritab...... 202 frovatriptan succinate ...... 124 FIRAZYR...... 204 fluorometholone ...... 145 furosemide...... 85, 134 FIRMAGON...... 38, 162 FLUOROPLEX...... 244 FUZEON...... 25 FIRMAGON (240 MG DOSE) FLUOROURACIL...... 244 fyavolv...... 176, 187 ...... 38, 162 fluorouracil...... 244, 245 FYCOMPA...... 95 FIRST-BACLOFEN...... 54 fluoxetine hcl...... 125 gabapentin...... 92, 95 FIRST-LANSOPRAZOLE...... 157 fluphenazine hcl ...... 121 GABITRIL...... 95 FIRST-METRONIDAZOLE flurandrenolide...... 235, 236 GALAFOLD...... 215 ...... 16, 20, 152 flurazepam hcl ...... 109 galantamine hydrobromide ....56 FIRST-MOUTHWASH BLM flurbiprofen...... 120 galantamine hydrobromide ...... 13, 148, 150, 151, 153, 229 flurbiprofen sodium ...... 148 er...... 56 FIRST-OMEPRAZOLE...... 157 flutamide ...... 38 GALZIN...... 136 FIRST-PROGESTERONE fluticasone propionate GARDASIL 9...... 47, 48 VGS...... 187 ...... 145, 159, 223, 236 gatifloxacin...... 142 FIRVANQ...... 23 FLUTICASONE- GATTEX ...... 154 flac...... 145 SALMETEROL...... 58, 159 gavilyte-c...... 153 FLAGYL...... 16, 20, 152 fluvastatin sodium ...... 85 gavilyte-g...... 153 FLAREX...... 145 fluvastatin sodium er ...... 84 gavilyte-n with flavor pack... 153 flavoxate hcl...... 247 fluvoxamine maleate...... 126 GAVRETO...... 38 flecainide acetate...... 80 fluvoxamine maleate er ...... 126 GELFILM...... 64 FLEXICHAMBER ADULT FLUZONE HIGH-DOSE gemfibrozil...... 84 MASK/SMALL...... 129 QUADRIVALENT...... 47 gemmily...... 166, 176, 187 FLEXICHAMBER CHILD FLUZONE QUADRIVALENT.... 47 generlac...... 133 MASK/LARGE...... 129 FML...... 145 gengraf...... 205, 209, 213 FLEXICHAMBER CHILD FML FORTE ...... 145 gentak...... 142 MASK/SMALL...... 129 FML LIQUIFILM...... 145 gentamicin sulfate ...... 142, 227 FLOLIPID...... 84 FOCALIN...... 122 GENVOYA...... 26, 28 FLORIVA...... 202, 253 folic acid...... 251 GILENYA...... 209 FLORIVA PLUS...... 202, 248 fondaparinux sodium ...... 60 GILOTRIF...... 38 FLOVENT DISKUS...... 159, 223 FORANE...... 113 GILPHEX TR...... 49, 221

261 glatiramer acetate...... 210 HARVONI...... 24, 25 hydrocodone bitartrate er .... 115 glatopa...... 210 HAVRIX...... 48 hydrocodone polst- GLEOSTINE...... 38 heather...... 166, 187 chlorphen polst er susp. 15, 220 glimepiride...... 196 hematinic/folic acid...... 67, 251 hydrocodone- glipizide...... 196 HEMLIBRA...... 64 acetaminophen...... 92, 115 glipizide er...... 196 hemocyte-f...... 67, 251 hydrocodone-homatropine glipizide xl...... 196 HEMOFIL M...... 64 ...... 50, 51, 220 glipizide-metformin hcl .163, 196 heparin lock flush...... 66 hydrocodone-ibuprofen 115, 120 GLUCAGEN HYPOKIT... 181, 198 heparin sodium (porcine) ...... 67 hydrocortisone...... 160, 236 glucagon emergency kit heparin sodium (porcine) pf .. 67 hydrocortisone (perianal) .....236 ...... 181, 198 heparin sodium lock flush ..... 67 hydrocortisone ace- GLUCAGON EMERGENCY HEPLISAV-B...... 48 pramoxine...... 230, 236 KIT...... 181, 198 HETLIOZ...... 103 hydrocortisone acetate ...... 236 GLUCOTROL XL...... 196 HIBERIX...... 48 hydrocortisone butyrate ...... 236 GLUTARALDEHYDE...... 132 HIPREX...... 35 hydrocortisone valerate...... 236 glyburide...... 196 homatropaire...... 149 hydrocortisone-acetic acid glyburide micronized ...... 196 HUMALOG...... 194 ...... 146, 148 glyburide-metformin ..... 163, 196 HUMALOG KWIKPEN...... 193 hydrocortisone-iodoquinol glycopyrrolate...... 50 HUMALOG MIX 50/50 ...... 236, 240 glydo...... 230 KWIKPEN...... 193 hydrocort-pramoxine GLYNASE...... 196 HUMALOG MIX 50/50 VIAL....193 (perianal)...... 230, 236 GLYXAMBI...... 171, 194 HUMALOG MIX 75/25 hydromet...... 51, 220 GOLYTELY ...... 153 KWIKPEN...... 194 hydromorphone hcl ...... 116 goodsense nicotine ...... 53 HUMALOG MIX 75/25 VIAL....194 hydromorphone hcl er ...... 115 GORDOFILM...... 232, 239 HUMALOG U-100 JUNIOR hydroxychloroquine sulfate GRALISE...... 92, 95 KWIKPEN...... 194 ...... 19, 206, 210 granisetron hcl...... 150 HUMATE-P...... 64 hydroxyurea...... 39 GRASTEK...... 45 HUMIRA...... 155, 206, 210 hydroxyzine hcl...... 13, 14, 104 griseofulvin microsize ...... 18 HUMIRA PEDIATRIC hydroxyzine pamoate ..... 14, 104 griseofulvin ultramicrosize .... 18 CROHNS START HYOPHEN...... 35, 51, 92 guaiatussin ac...... 219, 221 ...... 154, 155, 205, 210 hyoscyamine sulfate...... 51 guaifenesin ac...... 219, 221 HUMIRA PEN...... 155, 205, 210 hyoscyamine sulfate er...... 51 guanfacine hcl ...... 79, 110 HUMIRA PEN-CD/UC/HS hyoscyamine sulfate sl...... 51 guanfacine hcl er ...... 110 STARTER ...... 155, 205, 210 hyosyne...... 51 GVOKE HYPOPEN 1-PACK HUMIRA PEN-PEDIATRIC UC HYPOCYN...... 245 ...... 182, 198 START...... 155, 206, 210 ibandronate sodium ...... 201 GVOKE HYPOPEN 2-PACK HUMIRA PEN-PS/UV/ADOL IBRANCE...... 39 ...... 182, 198 HS START...... 155, 206, 210 ibuprofen...... 102, 120 GVOKE PFS...... 182, 198 HUMIRA PEN-PSOR/UVEIT iclevia...... 166, 176, 187 GYNAZOLE-1...... 231 STARTER ...... 155, 206, 210 ICLUSIG...... 39 habitrol...... 53 HUMULIN 70/30 KWIKPEN IDELVION...... 64 HAEGARDA...... 204 ...... 183, 194 IDHIFA...... 39 hailey 1.5/30...... 166, 176, 187 HUMULIN 70/30 VIAL.....183, 194 imatinib mesylate...... 39 hailey 24 fe...... 166, 176, 187 HUMULIN N KWIKPEN...... 183 IMBRUVICA...... 39 hailey fe 1.5/30...... 166, 176, 187 HUMULIN N VIAL...... 183 IMCIVREE...... 93 hailey fe 1/20...... 166, 176, 187 HUMULIN R U-500 KWIKPEN194 imipramine hcl...... 127 halcinonide ...... 236 HUMULIN R U-500 VIAL...... 194 imipramine pamoate ...... 127 HALCION...... 109 HUMULIN R VIAL...... 194 imiquimod...... 245 halobetasol propionate ...... 236 HYCAMTIN...... 39 IMITREX...... 124 HALOG...... 236 hydralazine hcl...... 84 IMPAVIDO...... 20 haloperidol...... 109 HYDREA...... 39 IMVEXXY MAINTENANCE haloperidol lactate ...... 109 HYDRO 40...... 239 PACK...... 176 HALUCORT...... 245 hydrochlorothiazide ...... 88, 138 IMVEXXY STARTER PACK... 176

262 INBRIJA...... 111 ivermectin...... 18, 242 KISQALI FEMARA...... 40, 162 incassia...... 166, 187 jaimiess...... 166, 176, 188 KLARON...... 227 INCRELEX...... 195 JAKAFI...... 40 klor-con...... 136 indapamide ...... 88, 138 JANSSEN COVID-19 klor-con 10...... 136 INDOCIN...... 120, 199 VACCINE...... 48 klor-con m10...... 136 indomethacin ...... 120, 200 jantoven...... 60 klor-con m15...... 136 indomethacin er ...... 120, 199 JARDIANCE...... 194 klor-con m20...... 136 INFANRIX...... 46, 48 jasmiel...... 166, 176, 188 klor-con/ef...... 136 INLYTA ...... 39 jencycla...... 166, 188 KOGENATE FS...... 64 INOVA...... 238, 241 JENTADUETO ...... 163, 171 KOMBIGLYZE XR...... 163, 172 INOVA 4/1 ACNE CONTROL JENTADUETO XR.. 163, 171, 172 KOSELUGO...... 40 THERAPY...... 238, 239, 241 jinteli...... 176, 188 KOVALTRY...... 64 INOVA 8/2 ACNE CONTROL JIVI...... 64 K-PHOS...... 136 THERAPY...... 238, 239, 241 jolessa...... 166, 176, 188 K-PHOS NO 2...... 132 INQOVI...... 39 JUBLIA...... 231 K-PHOS-NEUTRAL...... 136 INREBIC...... 39 juleber...... 166, 176, 188 k-prime...... 136 INSPIREASE RESERVOIR JULUCA...... 26 KRINTAFEL...... 19 BAGS...... 130 junel 1.5/30...... 167, 176, 188 KRISTALOSE...... 133 INSULIN PEN NEEDLES ...... 130 junel 1/20...... 167, 176, 188 K-TAB...... 136 INSULIN SYRINGES...... 130 junel fe 1.5/30...... 167, 176, 188 kurvelo...... 167, 177, 188 INTELENCE ...... 26 junel fe 1/20...... 167, 176, 188 KYNMOBI...... 114 INTRAROSA...... 160 junel fe 24...... 167, 176, 188 KYNMOBI TITRATION KIT .....114 INTRON A ...... 30, 39, 40, 210 JYNARQUE...... 139 labetalol hcl introvale...... 166, 176, 187 K.B.G.L IN TERODERM ...... 55, 56, 69, 70, 73, 75, 80 INVELTYS...... 146 ...... 54, 120, 230, 242, 245 LACRISERT...... 148 INVIRASE...... 29 kaitlib fe...... 167, 176, 188 lactulose...... 133 IODINE STRONG...... 221 KALETRA...... 29 lactulose encephalopathy .... 133 iodine tincture ...... 241 kalliga...... 167, 176, 188 LAMICTAL...... 96, 100 IOPIDINE...... 148 KALYDECO...... 221 LAMICTAL ODT ...... 96, 99, 100 IPOL...... 48 KAPSPARGO SPRINKLE LAMICTAL STARTER ...... 96, 100 ipratropium bromide ...... 51, 219 ...... 59, 73, 75, 80 LAMICTAL XR...... 96, 100 ipratropium-albuterol 51, 58, 219 kariva...... 167, 176, 188 lamivudine...... 28 irbesartan...... 70 KATERZIA...... 83, 89 lamivudine-zidovudine ...... 28 irbesartan- KAZANO...... 163, 172 lamotrigine...... 96, 100 hydrochlorothiazide ...... 70, 138 KEFLEX...... 15 lamotrigine er...... 96, 100 IRESSA...... 40 kelnor 1/35...... 167, 176, 188 lamotrigine starter kit-blue ISENTRESS...... 26 kelnor 1/50...... 167, 177, 188 ...... 96, 100 ISENTRESS HD...... 26 KEPPRA...... 95 lamotrigine starter kit-green isibloom...... 166, 176, 188 KEPPRA XR...... 95 ...... 96, 100 isoflurane...... 113 KERYDIN...... 242 lamotrigine starter kit- isoniazid...... 21 KESIMPTA...... 211 orange...... 96, 100 ISOPTO ATROPINE...... 149 ketoconazole ...... 22, 231 LAMPIT...... 20 ISOPTO CARPINE...... 149 ketodan...... 231 LANOXIN...... 73, 79 ISORDIL TITRADOSE...... 86 KETONE TEST ...... 132 lansoprazole...... 157 isosorbide dinitrate ...... 86 KETOPHENE RAPIDPAQ...... 242 lanthanum carbonate ....134, 199 isosorbide mononitrate ...... 86 KETOROLAC LANTUS SOLOSTAR ...... 183 isosorbide mononitrate er ...... 86 TROMETHAMINE ...... 120, 242 LANTUS U-100 VIAL...... 183 isotretinoin ...... 245 ketorolac tromethamine120, 148 lapatinib ditosylate ...... 40 isoxsuprine hcl...... 89 KETOSTIX...... 132 larin 1.5/30...... 167, 177, 188 isradipine...... 83 KEVEYIS...... 202 larin 1/20...... 167, 177, 188 ISTALOL...... 144 KEVZARA...... 206 larin 24 fe...... 167, 177, 188 ISTURISA...... 215 KINERET...... 206, 211 larin fe 1.5/30...... 167, 177, 188 itraconazole...... 22 KISQALI...... 40 larin fe 1/20...... 167, 177, 188

263 larissia...... 167, 177, 188 lidocaine hcl LUMAKRAS...... 40 LASIX...... 85, 134 urethral/mucosal...... 230 LUMIGAN...... 149 LASTACAFT...... 14, 141 lidocaine viscous hcl...... 148 lutera...... 168, 178, 189 latanoprost ...... 149 lidocaine-prilocaine ...... 230 lyleq...... 168, 189 LATUDA...... 105 LIDOPIN...... 230 LYNPARZA...... 41 layolis fe...... 167, 177, 188 LIDTOPIC MAX...... 230 LYRICA...... 96, 97, 112 LAZANDA ...... 116 lillow...... 167, 177, 189 LYSTEDA...... 64 L-CYSTINE...... 133 lindane...... 242 LYUMJEV KWIKPEN...... 194 LEDIPASVIR-SOFOSBUVIR linezolid...... 32 LYUMJEV VIAL...... 194 ...... 24, 25 LINZESS...... 155 lyza...... 168, 189 leena...... 167, 177, 188 liothyronine sodium ...... 197 MACROBID...... 35 leflunomide ...... 206, 211, 213 lisinopril...... 71, 72 MACRODANTIN...... 35 LENVIMA...... 40 lisinopril- mafenide acetate...... 241 lessina...... 167, 177, 188 hydrochlorothiazide ...... 72, 138 MALARONE...... 19 letrozole...... 40, 162 L-ISOLEUCINE...... 133 malathion...... 242 lets...... 49, 197 lithium carbonate ...... 100 MARINOL...... 151 leucovorin calcium...... 199, 251 lithium carbonate er ...... 100 marlissa...... 168, 178, 189 LEUKINE...... 62 LITHOBID...... 100 MARPLAN...... 113 leuprolide acetate...... 40, 182 LITHOSTAT...... 133 MATULANE ...... 41 levalbuterol hcl...... 58, 224 LO LOESTRIN FE ...168, 177, 189 matzim la...... 76, 77, 82, 89 LEVALBUTEROL HFA ...... 58, 224 LOESTRIN 1.5/30 (21) MAVENCLAD ...... 213 LEVBID...... 51 ...... 168, 177, 189 MAVYRET...... 24, 25 levetiracetam...... 96 LOESTRIN 1/20 (21) MAXIDEX...... 146 levetiracetam er...... 96 ...... 168, 177, 189 MAXITROL...... 142, 146 levobunolol hcl ...... 144 LOESTRIN FE 1.5/30 maxi-tuss ac...... 220, 221 levocarnitine...... 215 ...... 168, 177, 189 MAXZIDE...... 135, 138 levocarnitine sf...... 215 lojaimiess...... 168, 177, 189 MAXZIDE-25...... 135, 138 levocetirizine LOKELMA ...... 135 MAYZENT...... 211 dihydrochloride ...... 15 LOMAIRA...... 90 me/naphos/mb/hyo1 . 35, 51, 215 levofloxacin...... 21, 33, 142 LOMOTIL...... 51, 150 meclofenamate sodium ...... 120 levonest...... 167, 177, 188 LONSURF...... 40 MEDERMA SPF 30...... 245 levonorgest-eth est & eth est LOPID...... 84 MEDROL...... 160 ...... 167, 177, 188 lopinavir-ritonavir ...... 29 medroxyprogesterone levonorgest-eth estrad 91- LOPRESSOR...... 59, 73, 75, 80 acetate...... 168, 189 day...... 167, 177, 188 lorazepam...... 107, 109 mefenamic acid...... 120 levonorgestrel...... 167, 188 lorazepam intensol ...... 107, 109 mefloquine hcl ...... 19 levonorgestrel-ethinyl estrad LORBRENA ...... 40 megestrol acetate...... 41, 189 ...... 167, 177, 189 LORTAB ...... 92, 116 MEKINIST...... 41 levonorg-eth estrad triphasic loryna...... 168, 177, 189 MEKTOVI...... 41 ...... 167, 177, 189 losartan potassium ...... 70 meloxicam...... 120 levora 0.15/30 (28). 167, 177, 189 losartan potassium-hctz .70, 138 melphalan...... 41 levorphanol tartrate ...... 116 LOSEASONIQUE... 168, 177, 189 memantine hcl...... 111 levo-t...... 197 LOTEMAX ...... 146 MENACTRA ...... 48 levothyroxine sodium ...... 197 LOTEMAX SM ...... 146 MENEST...... 178, 201 levoxyl...... 197 LOTENSIN...... 71, 72 MENOSTAR ...... 178, 201 LEVSIN...... 51 LOTENSIN HCT ...... 72, 138 MENQUADFI...... 48 LEVSIN/SL...... 51 loteprednol etabonate ...... 146 MENTAX ...... 232 LEVULAN KERASTICK...... 245 lovastatin...... 85 MENVEO...... 48 LEXIVA...... 29 low-ogestrel...... 168, 178, 189 meperidine hcl...... 116 LIALDA...... 151 loxapine succinate ...... 103 MEPHYTON...... 199, 254 lidocaine...... 230 lo-zumandimine .....168, 178, 189 meprobamate...... 104 lidocaine hcl...... 230 LUBIPROSTONE...... 155 mercaptopurine...... 41, 213 LUGOLS STRONG IODINE....241 merzee...... 168, 178, 189

264 mesalamine...... 151, 152 miconazole 3 ...... 231 moxifloxacin hcl (2x day) ..... 142 mesalamine-cleanser...... 152 microgestin 1.5/30.168, 178, 190 MOZOBIL...... 62 MESNEX...... 217 microgestin 1/20....168, 178, 190 MS CONTIN...... 117 MESTINON...... 56 microgestin 24 fe.. 168, 178, 190 MUCOSITISRX...... 148 metaxalone...... 54 microgestin fe 1.5/30 MULPLETA ...... 62 metformin hcl ...... 163 ...... 168, 178, 190 MULTAQ...... 81 metformin hcl er ...... 163 microgestin fe 1/20168, 178, 190 multi-vit/iron/fluoride methadone hcl ...... 116 MICROLET NEXT LANCING ...... 67, 202, 248 methadone hcl intensol ...... 116 DEVICE...... 130 multivitamin/fluoride .....202, 248 methadose ...... 116 midazolam hcl...... 109 multi-vitamin/fluoride ... 202, 248 methadose sugar-free ...... 116 MIDAZOLAM+SYRSPEND SF multi-vitamin/fluoride/iron methamphetamine hcl ...... 91 ...... 109 ...... 67, 202, 248 methazolamide ...... 78, 144 midodrine hcl ...... 49 mupirocin...... 228 methenamine hippurate ...... 35 MIGERGOT...... 56, 102, 123 mupirocin calcium...... 228 methenamine mandelate ...... 35 miglitol...... 161 MUSE...... 89 methergine...... 218 miglustat...... 215 MYAMBUTOL ...... 21 methimazole ...... 163 mili...... 168, 178, 190 MYCOBUTIN...... 21, 33 METHITEST ...... 162 MILLIPRED...... 160 mycophenolate mofetil ...... 214 methocarbamol ...... 54 mimvey...... 178, 190 mycophenolate sodium ...... 214 methotrexate ... 41, 206, 211, 213 mineral oil heavy...... 153 myorisan...... 245 methotrexate sodium MINIPRESS...... 55, 69, 70 MYSOLINE...... 106 ...... 41, 206, 211, 214 minocycline hcl...... 19, 34 MYTESI...... 150 methotrexate sodium (pf) minoxidil...... 84 nabumetone ...... 121 ...... 41, 206, 211, 214 MIRAPEX...... 114 nadolol...... 55, 74, 75 methoxsalen rapid ...... 242 MIRCETTE ...... 168, 178, 190 nafrinse...... 203 methscopolamine bromide .... 51 mirtazapine ...... 98 NAFRINSE DAILY methyl salicylate...... 232 MIRVASO...... 245 ACIDULATED...... 128, 202 methyldopa ...... 49, 79 misoprostol ...... 157 NAFRINSE DAILY/NEUTRAL.202 methylergonovine maleate ...218 MITIGARE...... 200 nafrinse drops...... 203 METHYLIN...... 122 MITOSOL...... 142 NAFRINSE WEEKLY...... 203 methylphenidate hcl ...... 123 M-M-R II...... 48 naloxone hcl...... 118, 199 methylphenidate hcl er ...... 123 M-NATAL PLUS ...... 67, 248, 251 naltrexone hcl...... 118, 198, 199 methylphenidate hcl er (cd) . 122 MOBIC...... 121 NAMENDA TITRATION PAK ..111 methylphenidate hcl er (la) modafinil ...... 128 naproxen...... 102, 121, 200 ...... 122, 123 moexipril hcl...... 71, 72 naproxen sodium .. 102, 121, 200 methylprednisolone ...... 160 molindone hcl ...... 103 naratriptan hcl...... 124 methyltestosterone ...... 162 mometasone furoate ...... 236 NARCAN...... 118 metoclopramide hcl ...... 156, 157 mondoxyne nl ...... 19, 34 NARDIL...... 114 metolazone ...... 88, 138 mono-linyah ...... 168, 178, 190 NASCOBAL...... 68, 251 metoprolol succinate er MONONINE ...... 64 NATACYN...... 143 ...... 59, 73, 74, 75, 80 monsels ferric subsulfate ...... 64 NATAZIA...... 168, 178, 190 metoprolol tartrate 59, 74, 75, 80 montelukast sodium ...... 222 nateglinide...... 184 metoprolol- MONUROL...... 35 NATPARA...... 184, 200 hydrochlorothiazide ...... 74, 138 morgidox...... 19, 34 NATURE-THROID...... 197 METROCREAM...... 227 morphine sulfate ...... 116, 117 NAYZILAM...... 108 METROLOTION ...... 227 morphine sulfate NEBUPENT...... 20 metronidazole ....17, 20, 152, 228 (concentrate)...... 116 necon 0.5/35 (28)... 169, 178, 190 METRONIDAZOLE morphine sulfate er ...... 116 nefazodone hcl ...... 126 BENZO+SYRSPEND ..17, 20, 152 morphine sulfate er beads ... 116 neomycin sulfate ...... 17 metyrosine...... 215 MOTEGRITY...... 155 neomycin-bacitracin zn- mexiletine hcl...... 80 MOVIPREP...... 153, 252 polymyx...... 142 MIACALCIN...... 163, 201 MOXEZA...... 142 neomycin-polymyxin- mibelas 24 fe...... 168, 178, 190 moxifloxacin hcl ...... 21, 33, 142 dexameth...... 142, 146

265 neomycin-polymyxin- nitroglycerin...... 86 NUEDEXTA...... 111 gramicidin...... 142 NITROSTAT ...... 86 NULEV...... 51 neomycin-polymyxin-hc NITRO-TIME ...... 86 NULYTELY LEMON-LIME ...... 153 ...... 142, 146 nizatidine...... 14, 156 NUPLAZID...... 105 NEONATAL COMPLETE NOCDURNA...... 64, 184 NUTRIDOX...... 34, 215, 253 ...... 67, 248, 251 nolix...... 236, 237 NUTROPIN AQ NUSPIN 10 NEONATAL PLUS .... 67, 248, 251 nora-be...... 169, 190 ...... 184, 195 neo-polycin ...... 142 norethin ace-eth estrad-fe NUTROPIN AQ NUSPIN 20 neo-polycin hc ...... 142, 146 ...... 169, 178, 190 ...... 184, 195 NERLYNX ...... 41 norethindrone ...... 169, 190 NUTROPIN AQ NUSPIN 5 NESINA...... 172 norethindrone acetate ...... 190 ...... 184, 195 NESTABS ...... 67, 248, 251 norethindrone acet-ethinyl NUVAIL...... 245 neuac...... 228, 241 est...... 169, 178, 190 NUVARING...... 169, 179, 191 NEULASTA ...... 62 norethindrone-eth estradiol NUWIQ...... 65 NEUPRO...... 114 ...... 178, 190 NUZYRA...... 17 NEURAPTINE...... 92 norethin-eth estradiol-fe nyamyc...... 242 NEURONTIN...... 92, 97 ...... 169, 179, 190 nylia 7/7/7...... 169, 179, 191 NEVANAC...... 148 norgestimate-eth estradiol NYMALIZE...... 83, 84, 89 nevirapine...... 27 ...... 169, 179, 190 nymyo...... 169, 179, 191 NEXAVAR...... 41 norgestimate-ethinyl nystatin...... 32, 242 NEXIUM...... 157 estradiol triphasic. 169, 179, 191 nystop...... 242 NEXLETOL ...... 73 norlyda...... 169, 191 OCALIVA...... 155 NEXLIZET...... 73, 79 norlyroc...... 169, 191 ocella...... 169, 179, 191 NEXTSTELLIS ...... 169, 178, 190 NORPACE...... 79 octreotide acetate...... 155, 195 niacin er NORPACE CR...... 79 OCUFLOX...... 142 (antihyperlipidemic) ...... 73 NORPRAMIN...... 127 ODACTRA...... 45 NIASPAN...... 73 nortrel 0.5/35 (28).. 169, 179, 191 ODEFSEY...... 27, 28 nicardipine hcl...... 83, 89 nortrel 1/35 (21)..... 169, 179, 191 ODOMZO...... 41 NICORETTE ...... 53 nortrel 1/35 (28)..... 169, 179, 191 OFEV...... 219 nicotine polacrilex...... 53 nortrel 7/7/7...... 169, 179, 191 ofloxacin...... 33, 142 nicotine polacrilex mini...... 53 nortriptyline hcl...... 127 olanzapine...... 100, 101, 105 nicotine step 1 ...... 53 NORVIR...... 29 olanzapine-fluoxetine hcl nicotine step 2 ...... 53 NOURIANZ...... 111 ...... 105, 126 nicotine step 3 ...... 53 NOVOEIGHT...... 64, 65 olmesartan medoxomil ...... 70 NICOTROL...... 53 NOVOFINE AUTOCOVER olmesartan medoxomil-hctz NICOTROL NS ...... 53 PEN NEEDLE ...... 130 ...... 71, 138 nifedipine ...... 83, 89 NOVOFINE PEN NEEDLE ..... 130 olopatadine hcl ...... 14, 141 nifedipine er...... 83, 89 NOVOFINE PLUS PEN OLUMIANT...... 206 nifedipine er osmotic release NEEDLE ...... 130 OMECLAMOX-PAK.... 17, 32, 157 ...... 83, 89 NOVOPEN ECHO...... 130 omega-3-acid ethyl esters ...... 73 nikki...... 169, 178, 190 NOVOSEVEN RT...... 65 omeprazole ...... 157 NILANDRON ...... 41 NOVOTWIST PEN NEEDLE .. 130 OMEPRAZOLE+SYRSPEND nilutamide ...... 41 NOXAFIL...... 22 SF ALKA...... 157 nimodipine ...... 83, 89 NP #2 DRUG PREPARATION ondansetron hcl ...... 150 NINLARO ...... 41 KIT ondansetron odt ...... 150 nisoldipine er...... 83, 84 49, 79, 92, 117, 121, 127, 230, ONE VITE WOMENS PLUS nitazoxanide ...... 20 242, 245 ...... 67, 248, 251 NITRO-BID...... 86 np thyroid...... 197 ONETOUCH DELICA NITRO-DUR...... 86 NUBEQA...... 41 LANCING DEVICE...... 130 nitrofurantoin ...... 35 NUCALA...... 219 ONETOUCH DELICA PLUS nitrofurantoin macrocrystal ... 35 NUCORT...... 237 LANCING DEVICE...... 130 nitrofurantoin monohydrate NUCYNTA ...... 117 ONETOUCH ULTRA ...... 132 macrocrystals...... 35 NUCYNTA ER ...... 117 ONETOUCH ULTRA 2...... 130

266 ONETOUCH ULTRA MINI ...... 131 oxybutynin chloride er ...... 247 phenazo...... 230 ONETOUCH VERIO...... 131, 132 oxycodone hcl ...... 117 phenazopyridine hcl ...... 230 ONETOUCH VERIO FLEX oxycodone-acetaminophen phendimetrazine tartrate ...... 90 SYSTEM KIT W/DEVICE...... 131 ...... 92, 117 phendimetrazine tartrate er ....90 ONETOUCH VERIO IQ oxymorphone hcl ...... 117 phenelzine sulfate ...... 114 SYSTEM...... 131 oxymorphone hcl er ...... 117 phenobarbital ...... 106, 107 ONETOUCH VERIO OZEMPIC...... 182 phenoxybenzamine hcl .... 56, 85 REFLECT...... 131 OZOBAX...... 54 phentermine hcl...... 90 ONETOUCH VERIO SYNC PACERONE...... 81 phenylephrine hcl...... 149, 150 SYSTEM KIT W/DEVICE...... 131 PALFORZIA...... 45, 46 PHENYTEK...... 80, 113 ONEVITE...... 136, 248, 251 paliperidone er...... 105 phenytoin...... 80, 113 ONFI...... 108, 109 PALYNZIQ...... 139 phenytoin infatabs ...... 80, 113 ONGLYZA ...... 172 PANCREAZE...... 139, 154 phenytoin sodium extended ONUREG...... 41 PANDEL...... 237 ...... 80, 113 opium...... 150 PANRETIN...... 245 PHEXXI...... 217 OPSUMIT...... 225 pantoprazole sodium ...... 157 philith...... 169, 179, 191 ORACIT...... 132 paricalcitol...... 253 PHOSLYRA...... 134, 136 ORALAIR...... 45 PARNATE ...... 114 PHOSPHA 250 NEUTRAL...... 136 ORALAIR ADULT STARTER paromomycin sulfate ...... 17 PHOSPHASAL...... 35, 52, 92, 216 PACK...... 45 paroxetine hcl...... 126 phosphorous ...... 136 ORALAIR CHILDRENS paroxetine hcl er...... 126 phospho-trin 250 neutral ...... 136 STARTER PACK ...... 45 PASER...... 21 phytonadione ...... 199, 254 oralone...... 237 PATANASE...... 14, 141 PIFELTRO...... 27 ORAPRED ODT...... 160 PAXIL...... 126 pilocarpine hcl...... 56, 149 ORENCIA...... 206, 207, 211 PEDIAPRED...... 160 pimecrolimus...... 214, 245 ORENCIA CLICKJECT... 206, 211 PEDVAX HIB...... 48 pimozide...... 103 ORENITRAM...... 225 peg 3350-kcl-na bicarb-nacl .153 pimtrea...... 170, 179, 191 ORFADIN...... 215, 216 peg-3350/electrolytes...... 153 pindolol...... 55, 74, 75, 81 ORIAHNN...... 162, 179, 191 peg- pioglitazone hcl ...... 196 ORILISSA...... 162 3350/electrolytes/ascorbat pioglitazone hcl-glimepiride 196 ORKAMBI...... 220, 221 ...... 153, 252 pioglitazone hcl-metformin orphenadrine citrate er .....59, 94 PEGASYS...... 30 hcl...... 163, 196 orsythia...... 169, 179, 191 peg-kcl-nacl-nasulf-na asc-c PIQRAY...... 42 oscimin...... 51 ...... 153, 252 pirmella 1/35...... 170, 179, 191 oscimin sr...... 51 peg-prep...... 153 pirmella 7/7/7...... 170, 179, 191 oseltamivir phosphate ...... 30 PEMAZYRE...... 42 piroxicam...... 121 OSENI...... 172, 196 penicillamine...... 158, 207 PLAN B ONE-STEP ...... 170, 191 OSMOLEX ER...... 16, 90 penicillin v potassium ...... 30 PLEGRIDY...... 211, 212 OSPHENA...... 172 pentamidine isethionate ...... 20 PLEGRIDY STARTER PACK. 211 OTEZLA ...... 207, 211, 245 pentazocine-naloxone hcl PLENVU...... 153, 252 OVACE PLUS...... 228 ...... 118, 119 PNEUMOVAX 23...... 48 OVACE PLUS WASH...... 228 pentoxifylline er ...... 62 podocon...... 245 OVACE WASH...... 228 PERFOROMIST...... 58, 224 podofilox ...... 245 OVIDE...... 243 PERIDEX...... 147, 241 polycin...... 142 oxandrolone ...... 162 perindopril erbumine ...... 71, 72 polymyxin b-trimethoprim ....142 oxaprozin...... 121 periogard...... 147, 241 POLYTRIM...... 142 oxazepam...... 109 permethrin...... 243 POLY-VI-FLOR...... 203, 248, 249 OXBRYTA ...... 60 perphenazine...... 121 POLY-VI-FLOR/IRON oxcarbazepine...... 97 perphenazine-amitriptyline ...... 67, 203, 249 OXERVATE...... 148 ...... 121, 127 POMALYST...... 42, 212 oxiconazole nitrate ...... 231 PERTZYE...... 139, 154 portia-28...... 170, 179, 191 OXISTAT...... 231 PFIZER-BIONTECH COVID- posaconazole ...... 22 oxybutynin chloride ...... 247 19 VACC...... 48 POTABA...... 251

267 potassium chloride ...... 136 PREVIDENT 5000 PLUS...... 203 PROVERA...... 192 potassium chloride crys er .. 136 PREVIDENT 5000 SENSITIVE pseudoephedrine- potassium chloride er ...... 136 ...... 128, 203 bromphen-dm ...... 15, 49, 220 potassium citrate er ...... 132 previfem...... 170, 180, 191 PSORCON...... 237 potassium citrate-citric acid 132 PREVNAR 13...... 48 PULMICORT FLEXHALER PRADAXA...... 61 PREVYMIS...... 21 ...... 160, 223 pramipexole dihydrochloride PREZCOBIX...... 29, 216 PULMOZYME...... 140, 223 ...... 114 PREZISTA...... 29 PURIXAN...... 42, 214 pramosone...... 230, 237 PRIFTIN...... 21, 33 PYLERA...... 18, 20, 34, 150, 152 PRAMOSONE...... 230, 237 primaquine phosphate ...... 19 pyrazinamide...... 21 PRAMOTIC...... 147, 148 primidone...... 106 PYRIDIUM...... 230 pramox...... 230 PRIMSOL...... 35 pyridostigmine bromide ...... 56 prasugrel hcl...... 69 PRINIVIL...... 71, 72 pyridostigmine bromide er .....56 pravastatin sodium ...... 85 probenecid...... 139, 200 pyrimethamine...... 19 praziquantel ...... 18 PROCENTRA ...... 91 PYROGALLIC ACID218, 239, 245 prazosin hcl...... 55, 69, 70 prochlorperazine ...... 121, 151 QBRELIS...... 72 PRECOSE...... 161 prochlorperazine maleate QSYMIA...... 93 PRED MILD...... 146 ...... 121, 151 QUALAQUIN...... 19 PRED-G...... 143, 146 PROCTOFOAM HC...... 230, 237 QUESTRAN...... 76 PRED-G S.O.P...... 143, 146 procto-med hc ...... 237 QUESTRAN LIGHT...... 76 prednicarbate...... 237 procto-pak...... 237 quetiapine fumarate ...... 101, 105 prednisolone ...... 160 proctozone-hc ...... 237 quetiapine fumarate er . 101, 105 prednisolone acetate ...... 146 PROFILNINE...... 65 QUFLORA PEDIATRIC.. 203, 249 prednisolone sodium progesterone ...... 191 quinapril hcl...... 71, 72 phosphate ...... 146, 160 PROGESTERONE quinapril- prednisone...... 160 MICRONIZED...... 191 hydrochlorothiazide ...... 72, 138 prednisone intensol ...... 160 PROGRAF...... 214 quinidine gluconate er ...... 19, 79 PREFEST...... 179, 191 PROMACTA...... 62 quinidine sulfate ...... 19, 79 pregabalin...... 97, 112 promethazine hcl quinine sulfate ...... 19 PREMARIN...... 179, 201 ...... 13, 14, 104, 151, 222 rabeprazole sodium ...... 158 premium lidocaine ...... 230 promethazine vc ...... 14, 49 RADIOGARDASE...... 134, 199 PREMPHASE...... 179, 191 promethazine vc/codeine RAGWITEK...... 46 PREMPRO...... 179, 191 ...... 14, 50, 220 raloxifene hcl...... 172, 201 PRENAISSANCE promethazine-codeine ....14, 220 ramelteon...... 104 ...... 67, 153, 216, 249, 251 promethazine-dm ...... 14, 220 ramipril...... 71, 72 prenatal...... 68, 249, 251 promethazine-phenyleph- ranolazine er...... 78 prenatal plus iron....68, 249, 251 codeine...... 15, 50, 220 RAPAMUNE...... 214 prenatal vitamin plus low promethazine-phenylephrine rasagiline mesylate...... 113, 114 iron...... 68, 249, 251 ...... 15, 50 RASUVO...... 207 PREPIDIL...... 218 promethegan RAZADYNE ER...... 56 preplus...... 68, 249, 251 ...... 14, 15, 104, 151, 222 REBIF...... 212 PRETAB...... 68, 249, 251 PROMISEB...... 239 REBIF REBIDOSE...... 212 PRETOMANID...... 21 propafenone hcl ...... 80 REBIF REBIDOSE prevalite...... 76 propafenone hcl er ...... 80 TITRATION PACK...... 212 PREVIDENT...... 203 proparacaine hcl...... 148 REBIF TITRATION PACK...... 212 PREVIDENT 5000 BOOSTER propranolol hcl reclipsen...... 170, 180, 192 PLUS...... 203 ...... 55, 74, 75, 81, 103 RECOMBINATE ...... 65 PREVIDENT 5000 DRY propranolol hcl er RECOMBIVAX HB...... 48 MOUTH...... 203 ...... 55, 74, 75, 81, 103 RECOTHROM...... 65 PREVIDENT 5000 ENAMEL propylthiouracil...... 163 RECOTHROM SPRAY KIT...... 65 PROTECT...... 128, 203 PROSCAR...... 198 RECTIV...... 245 PREVIDENT 5000 ORTHO PROSTIN E2...... 218 REGLAN...... 157 DEFENSE...... 203 protriptyline hcl...... 127 REGRANEX...... 245

268 RELENZA DISKHALER...... 30 RUKOBIA...... 25 SIRTURO...... 21 RELISTOR...... 118, 155 RUZURGI...... 216 SIVEXTRO...... 32 RELNATE DHA .68, 216, 249, 251 RYBELSUS...... 182 SKYRIZI...... 246 REMERON...... 98 RYDAPT...... 42 SKYRIZI (150 MG DOSE)...... 246 REMERON SOLTAB ...... 98 SABRIL...... 97 SKYRIZI PEN...... 246 REMIGEN...... 246 SALAGEN...... 56 SLYND...... 170, 192 RENAGEL...... 134, 199 salicylic acid...... 239 sod citrate-citric acid...... 133 RENVELA...... 134, 199 salimez...... 239 SODIUM BICARBONATE repaglinide...... 184 salsalate...... 123 ...... 150, 152 REPATHA...... 86 SALVAX DUO PLUS...... 232, 239 sodium chloride...... 223 REPATHA PUSHTRONEX SAMSCA...... 139 sodium fluoride ...... 204 SYSTEM...... 86 SANDIMMUNE ...... 207, 212, 214 sodium fluoride 5000 enamel REPATHA SURECLICK...... 86 SANTYL ...... 140, 246 ...... 128, 203 RESTASIS...... 147 SAPHRIS...... 101, 106 sodium fluoride 5000 plus ....203 RESTORIL...... 109 sapropterin dihydrochloride 216 sodium fluoride 5000 ppm RETACRIT...... 60, 62 SAVAYSA...... 61 ...... 203, 204 RETEVMO...... 42 SAVELLA...... 112, 124 sodium fluoride 5000 RETROVIR...... 28 SAVELLA TITRATION PACK sensitive...... 128, 204 REVLIMID...... 42, 212 ...... 113, 124 sodium phenylbutyrate ...... 133 REXULTI...... 105 SAXENDA...... 183 sodium polystyrene REYATAZ...... 29 SCALACORT DK...... 237, 239 sulfonate...... 135, 199 REYVOW...... 125 SCARCIN...... 246 sodium sulfacetamide ...... 228 RHOFADE...... 246 scopolamine...... 52, 151 sodium sulfacetamide wash 228 RHOPRESSA...... 149 SELECT-OB...... 68, 249, 251 SODIUM SULFACETAMIDE- ribavirin...... 31 selegiline hcl...... 113, 114 BAKUCHIOL...... 216, 228 RIDAURA...... 158, 207, 212 selenium sulfide ...... 239, 241 SOFOSBUVIR-VELPATASVIR rifabutin...... 21, 33 SELZENTRY ...... 25 ...... 24, 25 rifampin...... 21, 33 SEREVENT DISKUS...... 58, 224 solifenacin succinate...... 247 RIFAMPIN+SYRSPEND SF21, 33 SEROSTIM...... 184, 195 SOLIQUA...... 183 RILUTEK...... 111 sertraline hcl...... 126 SOLOSEC...... 20 riluzole...... 111 setlakin...... 170, 180, 192 SOMATULINE DEPOT...... 195 rimantadine hcl ...... 16 sevelamer carbonate.... 134, 199 SOMAVERT...... 195 RINVOQ...... 207 sevelamer hcl...... 134, 199 SOOLANTRA...... 243 risedronate sodium...... 201 sevoflurane...... 113 sotalol hcl...... 55, 74, 75, 81 risperidone...... 101, 105, 106 sf...... 203 sotalol hcl (af)...... 55, 74, 75, 81 RITALIN...... 123 sf 5000 plus...... 203 SOTYLIZE...... 55, 74, 75, 81 ritonavir...... 29 SFROWASA...... 152 SOVALDI...... 24 rivastigmine...... 56 sharobel...... 170, 192 spinosad...... 243 rivastigmine tartrate...... 56 SHARPS CONTAINER...... 131 SPIRIVA HANDIHALER....52, 219 rivelsa...... 170, 180, 192 SHINGRIX...... 48 SPIRIVA RESPIMAT...... 52, 219 RIXUBIS...... 65 SIGNIFOR...... 195 spironolactone .... 85, 86, 87, 135 rizatriptan benzoate ...... 125 sildenafil citrate...... 87, 225, 247 spironolactone-hctz ...... 85, 138 ROCALTROL...... 253 silodosin...... 56 SPORANOX...... 22 ROCKLATAN...... 149 SILVADENE...... 241 SPORANOX PULSEPAK...... 22 ropinirole hcl...... 114 silver nitrate...... 147 SPRAVATO (56 MG DOSE)..... 99 rosadan...... 228 silver sulfadiazine...... 241 SPRAVATO (84 MG DOSE)..... 99 rosuvastatin calcium ...... 85 simliya...... 170, 180, 192 sprintec 28...... 170, 180, 192 ROWASA...... 152 simpesse...... 170, 180, 192 SPRIX...... 121 roweepra...... 97 SIMPONI.155, 156, 207, 208, 212 SPRYCEL...... 42 ROZLYTREK ...... 42 simvastatin...... 85 sps...... 135, 199 RUBRACA...... 42 SINEMET...... 112 sronyx...... 170, 180, 192 RUCONEST...... 204 SINGULAIR...... 222 ssd...... 241 rufinamide...... 97 sirolimus...... 214 SSKI...... 221

269 sss 10-5...... 228, 239 SUPREP BOWEL PREP KIT..153 TAVALISSE...... 60 STALEVO 100...... 110, 112 SURESTEP PRO HIGH tazarotene...... 246 STALEVO 125...... 110, 112 GLUCOSE...... 131 TAZORAC...... 246 STALEVO 150...... 110, 112 SURESTEP PRO LOW taztia xt...... 76, 78, 82, 89 STALEVO 200...... 110, 112 GLUCOSE...... 131 TAZVERIK...... 43 STALEVO 50...... 110, 112 SURESTEP PRO NORMAL TEGRETOL...... 97, 101 STALEVO 75...... 110, 112 GLUCOSE...... 131 TEGRETOL-XR...... 97, 101 stavudine...... 28 SUSTIVA...... 27 TEGSEDI...... 200 STELARA...... 246 SUTAB...... 153 TEKTURNA ...... 87 STENDRA ...... 87 SUTENT...... 43 TEKTURNA HCT ...... 87, 138 STIMATE ...... 65, 184 syeda...... 170, 180, 192 telmisartan...... 70, 71 STIVARGA...... 42 SYMAX DUOTAB...... 52 telmisartan-hctz...... 71, 138 STRENSIQ...... 140 SYMAX-SL...... 52 temazepam...... 109 STRIBILD...... 26, 28, 216 SYMAX-SR...... 52 TEMOVATE ...... 237 STRIVERDI RESPIMAT... 58, 224 SYMBICORT...... 58, 160 temozolomide ...... 43 STROMECTOL ...... 18 SYMBYAX...... 106, 126 TENCON...... 92, 107 SUBOXONE...... 118, 119 SYMDEKO...... 220, 221 TENIVAC...... 46 subvenite...... 97, 101 SYMFI...... 27, 28 tenofovir disoproxil fumarate 28 subvenite starter kit-blue97, 101 SYMFI LO...... 27, 28 TEPMETKO ...... 43 subvenite starter kit-green SYMLINPEN 120...... 161 terazosin hcl...... 55, 69, 70 ...... 97, 101 SYMLINPEN 60...... 161 terbinafine hcl...... 16 subvenite starter kit-orange SYMPROIC...... 156 terbutaline sulfate ...... 58, 224 ...... 97, 101 SYMTUZA...... 28, 29, 216 terconazole ...... 231 SUCRAID...... 140 SYNAPRYN FUSEPAQ...... 117 TERIPARATIDE sucralfate...... 157 SYNAREL...... 182 (RECOMBINANT) ...... 184, 200 SULAR...... 83, 84 SYNDROS...... 151 terrell...... 113 SULCONAZOLE NITRATE .....231 SYNJARDY...... 164, 194 TESSALON PERLES...... 220 sulfacetamide sodium .. 143, 228 SYNJARDY XR...... 164, 194, 195 TESTIM...... 162 sulfacetamide sodium (acne) SYNRIBO...... 43 testosterone cypionate ...... 162 ...... 228 TABRADOL FUSEPAQ...... 54 testosterone enanthate ...... 162 sulfacetamide sodium-sulfur TABRADOL RAPIDPAQ...... 54 tetrabenazine...... 127 ...... 228, 229, 239, 240 TABRECTA ...... 43 tetracaine hcl...... 149 sulfacetamide sod-sulfur TACLONEX ...... 237, 246 tetracycline hcl...... 19, 34, 152 wash...... 229, 240 tacrolimus...... 214, 246 TETRIX...... 246 sulfacetamide-prednisolone tadalafil...... 87 TEXACORT...... 237 ...... 143, 146 tadalafil (pah) ...... 87, 225 THALOMID...... 213 sulfacetamide-sulfur in urea TAFINLAR ...... 43 THEO-24...84, 123, 133, 226, 247 ...... 229, 240 TAGRISSO...... 43 theophylline sulfadiazine ...... 33 TAKHZYRO...... 204 ...... 84, 123, 134, 226, 248 sulfamethoxazole- TALZENNA ...... 43 theophylline er trimethoprim ...... 20, 33, 34, 35 tamoxifen citrate...... 43, 172 ...... 84, 123, 134, 226, 248 sulfamez wash...... 229, 240 tamsulosin hcl ...... 56 THIOLA...... 216 SULFAMYLON...... 241 TAPAZOLE...... 163 THIOLA EC...... 216 sulfasalazine....34, 152, 208, 212 TAPERDEX 12-DAY...... 160 thioridazine hcl ...... 121 sulfatrim pediatric ...... 20, 34, 35 TAPERDEX 6-DAY...... 160, 161 thiothixene...... 126 SULFURATED LIME...... 243 TAPERDEX 7-DAY...... 161 THROMBIN-JMI ...... 65 sulindac...... 121 TARGRETIN...... 43, 246 THROMBIN-JMI EPISTAXIS.... 65 sumatriptan ...... 125 tarina 24 fe...... 170, 180, 192 THROMBOGEN...... 65 sumatriptan succinate ...... 125 tarina fe 1/20...... 170, 180, 192 tiadylt er...... 77, 78, 82, 89 sumatriptan succinate refill . 125 tarina fe 1/20 eq.....170, 180, 192 tiagabine hcl...... 97 SUMAXIN...... 229, 240 TARKA...... 72, 78 TIAZAC...... 77, 78, 82, 89 SUNOSI...... 128 TASIGNA...... 43 TIBSOVO...... 43 SUPRAX...... 16 tavaborole...... 242 TIGLUTIK...... 111

270 TIKOSYN...... 81 TRETTEN ...... 65 TRI-VI-FLORO tilia fe...... 170, 180, 192 TREXALL ...... 43, 208, 213, 214 ...... 204, 249, 250, 252, 253 timolol maleate TREZIX...... 93, 117, 123 tri-vite/fluoride ...... 55, 74, 75, 81, 103, 144 tri femynor...... 170, 180, 192 ...... 204, 249, 250, 253 timolol maleate ocudose ...... 144 triamcinolone acetonide ...... 238 trivora (28)...... 170, 180, 192 timolol maleate pf ...... 144 triamterene...... 87, 135 tri-vylibra...... 171, 180, 192 TIMOPTIC...... 144 triamterene-hctz ...... 135, 138 tri-vylibra lo...... 171, 180, 192 TIMOPTIC OCUDOSE...... 144 triazolam...... 109 TRUE METRIX LEVEL 1 ...... 131 TIMOPTIC-XE...... 144 TRICARE PRENATAL DHA TRUE METRIX LEVEL 2 ...... 131 tinidazole ...... 20 ONE...... 68, 153, 216, 249, 251 TRUE METRIX LEVEL 3 ...... 131 tiopronin ...... 216 TRI-CHLOR...... 216 TRULANCE ...... 156 TIROSINT-SOL...... 197 TRICITRASOL...... 60 TRULICITY...... 183 TISSEEL...... 246 tricitrates...... 133 TRUMENBA ...... 49 TIVICAY...... 26 triderm...... 238 TRUSOPT...... 145 TIVICAY PD...... 26 TRIDESILON...... 238 TRUVADA...... 28 tizanidine hcl ...... 54 trientine hcl...... 158 TUKYSA...... 43 TOBI PODHALER...... 17 tri-estarylla...... 170, 180, 192 tulana...... 171, 192 TOBRADEX...... 143, 146 trifluoperazine hcl ...... 121 TURALIO...... 44 tobramycin...... 17, 143 trifluridine...... 143 TURPENTINE ...... 232 tobramycin-dexamethasone trihexyphenidyl hcl ...... 53, 94 TUSSICAPS...... 15, 220 ...... 143, 147 TRIJARDY XR...... 164, 172, 195 TWINRIX...... 49 TOBREX...... 143 TRIKAFTA...... 220, 221 TWIRLA...... 171, 180, 193 tolbutamide ...... 132, 196 tri-legest fe...... 170, 180, 192 tyblume...... 171, 180, 193 tolcapone ...... 110 TRILEPTAL...... 98 TYBOST...... 216 TOLVAPTAN ...... 139 tri-linyah...... 170, 180, 192 tydemy...... 171, 180, 193, 252 tolvaptan...... 139 tri-lo-estarylla...... 170, 180, 192 TYKERB...... 44 TOPAMAX...... 97, 103 tri-lo-marzia ...... 170, 180, 192 TYMLOS ...... 184, 200 TOPAMAX SPRINKLE...... 97, 103 tri-lo-mili...... 170, 180, 192 TYVASO...... 225 TOPICORT...... 237, 238 tri-lo-sprintec...... 170, 180, 192 TYVASO REFILL...... 225 topiramate...... 97, 103 trimethobenzamide hcl ...... 151 TYVASO STARTER...... 225 TOPROL XL...... 59, 74, 75, 81 trimethoprim...... 35 UBRELVY...... 110 toremifene citrate ...... 43, 172 tri-mili...... 170, 180, 192 UCERIS...... 161, 238 torsemide...... 85, 134 trimipramine maleate...... 127 UDAMIN SP...... 137, 249, 252 TOUJEO MAX SOLOSTAR.... 183 TRINATE ...... 68, 249, 251 ULTANE ...... 113 TOUJEO SOLOSTAR...... 183 TRINTELLIX ...... 126 ULTRACET...... 93, 118 TOVIAZ...... 247 tri-nymyo...... 170, 180, 192 unithroid...... 197 TRACLEER ...... 225 TRIPLE COMPLEX FORMULA UPTRAVI...... 225 TRADJENTA ...... 172 3 KIT...... 230, 242, 247 urea...... 240 tramadol hcl...... 117 TRIPLE PMB...... 143, 147, 148 urea nail...... 240 tramadol hcl er ...... 117 TRIPLE PMK...... 143, 147, 148 URELLE...... 35, 52, 93, 216 tramadol-acetaminophen92, 117 tri-previfem...... 170, 180, 192 UREMEZ-40...... 240 trandolapril...... 71, 72 tri-sprintec...... 170, 180, 192 URIBEL...... 35, 52, 93, 217 trandolapril-verapamil hcl er TRISTART DHA urin ds...... 35, 52, 93, 217 ...... 72, 78 ...... 68, 137, 216, 249, 251 URO-458...... 35, 52, 93, 217 tranexamic acid...... 65 TRISTART FREE UROCIT-K 10...... 133 TRANXENE-T ...... 108, 109 ...... 68, 137, 216, 249, 252 UROCIT-K 15...... 133 tranylcypromine sulfate ...... 114 TRISTART ONE UROCIT-K 5...... 133 travoprost (bak free)...... 149 ...... 68, 137, 216, 249, 252 UROGESIC-BLUE...... 35, 52, 217 trazodone hcl ...... 126 TRIUMEQ...... 26, 28 uro-mp...... 36, 52, 93, 217 TRECATOR ...... 21 TRI-VI-FLOR URSO 250...... 154 TRELEGY ELLIPTA ....52, 58, 161 ...... 204, 249, 250, 252, 253 URSO FORTE...... 154 TREMFYA ...... 246, 247 ursodiol...... 154 tretinoin...... 43, 232 URSODIOL+SYRSPEND SF..154

271 USTELL...... 36, 52, 93, 217 viorele...... 171, 181, 193 WIDE-SEAL DIAPHRAGM 90 218 UTIRA-C...... 36, 52, 93, 217 VIRACEPT...... 29 WIDE-SEAL DIAPHRAGM 95 218 valacyclovir hcl...... 31 VIRAMUNE...... 27 WILATE...... 66 VALCHLOR...... 247 VIRAZOLE...... 31 WILZIN...... 137 valganciclovir hcl...... 31 VIREAD...... 28 WP THYROID...... 197 valproic acid...... 98, 101, 103 virt-phos 250 neutral...... 137 wymzya fe...... 171, 181, 193 valsartan...... 70, 71 virtussin ac w/alc...... 220, 221 XALKORI...... 44 valsartan- VISTARIL...... 14, 104 XARELTO...... 61 hydrochlorothiazide ...... 71, 138 VISTOGARD...... 199 XARELTO STARTER PACK .....61 VALTOCO ...... 108 VITAFOL FE+ XATMEP...... 44, 208, 213, 214 VANCOCIN...... 23 ...... 68, 137, 217, 250, 252 XCOPRI...... 98 VANCOCIN HCL...... 23 VITAFOL STRIPS...... 250 XELJANZ...... 208 vancomycin hcl...... 23 VITAFOL-NANO ...... 68, 250, 252 XELJANZ XR...... 208 VANCOMYCIN+SYRSPEND VITAFOL-OB+DHA XELPROS...... 149 SF...... 23 ...... 68, 137, 217, 250, 252 XENICAL...... 156 vandazole...... 17, 229 vitamin d (ergocalciferol) ..... 253 XENLETA ...... 32 VAQTA...... 49 vitamins acd-fluoride XEPI...... 229 vardenafil hcl...... 87 ...... 204, 250, 253 XERMELO...... 150 VARIVAX...... 49 VITATHELY WITH GINGER XIFAXAN...... 33 VECAMYL...... 85 ...... 68, 250, 252 XIIDRA...... 147 velivet...... 171, 180, 193 VITRAKVI...... 44 XOFLUZA (40 MG DOSE)...... 21 VELPHORO...... 135 VIVELLE-DOT...... 181, 202 XOFLUZA (80 MG DOSE)...... 22 VELTASSA...... 135 VIZIMPRO...... 44 XOLEGEL...... 232 VEMLIDY...... 31 volnea...... 171, 181, 193 XOLEGEL COREPAK.....232, 238 VENCLEXTA ...... 44 VONVENDI...... 65 XOLEGEL DUO/HEAD & VENCLEXTA STARTING voriconazole...... 22 SHOULDERS...... 232, 241 PACK...... 44 VOSEVI...... 24, 25 XOLEGEL DUO/XOLEX. 232, 241 VENELEX...... 247 VOTRIENT...... 44 XOPENEX HFA...... 58, 225 venlafaxine hcl...... 124 VP FC KIT...... 54, 242, 247 XOSPATA...... 44 venlafaxine hcl er...... 124 VP GKL KIT...... 230, 242, 247 XPOVIO (100 MG ONCE VENTAVIS...... 226 vp-pnv-dha ...... 68, 217, 250, 252 WEEKLY)...... 44 VENTRIXYL...... 137, 249, 252 VRAYLAR...... 106 XPOVIO (40 MG ONCE verapamil hcl...... 77, 78, 82, 89 VTOL LQ ...... 93, 107, 123 WEEKLY)...... 44 verapamil hcl er.....77, 78, 82, 89 vyfemla...... 171, 181, 193 XPOVIO (40 MG TWICE VEREGEN...... 247 vylibra...... 171, 181, 193 WEEKLY)...... 44 VERELAN...... 77, 78, 82, 89 VYNDAMAX...... 78, 111 XPOVIO (60 MG ONCE VERELAN PM...... 77, 78, 82, 90 VYNDAQEL...... 78 WEEKLY)...... 44 VERZENIO...... 44 VYVANSE...... 91 XPOVIO (60 MG TWICE vestura...... 171, 181, 193 WAKIX...... 128 WEEKLY)...... 44 VFEND...... 22 warfarin sodium...... 61 XPOVIO (80 MG ONCE VIBERZI...... 156 WEGOVY...... 183 WEEKLY)...... 45 VIBRAMYCIN...... 19, 34 WELCHOL...... 76, 162 XPOVIO (80 MG TWICE VICTOZA...... 183 wera...... 171, 181, 193 WEEKLY)...... 45 VIEKIRA PAK...... 24, 25 WESTGEL DHA XTAMPZA ER...... 118 vienva...... 171, 181, 193 ...... 68, 137, 217, 250, 252 XTANDI ...... 45 vigabatrin...... 98 WESTHROID...... 197 xulane...... 171, 181, 193 vigadrone ...... 98 WHEAT GERM OIL...... 254 XURIDEN...... 217 VIIBRYD...... 126 WIDE-SEAL DIAPHRAGM 60 217 XYNTHA...... 66 VIIBRYD STARTER PACK..... 126 WIDE-SEAL DIAPHRAGM 65 217 XYNTHA SOLOFUSE...... 66 VILAMIT MB...... 36, 52, 93, 217 WIDE-SEAL DIAPHRAGM 70 217 XYREM...... 111 VILEVEV MB...... 36, 52, 93, 217 WIDE-SEAL DIAPHRAGM 75 218 XYWAV...... 111 VIMPAT...... 98 WIDE-SEAL DIAPHRAGM 80 218 YASMIN 28...... 171, 181, 193 VINATE ONE...... 68, 250, 252 WIDE-SEAL DIAPHRAGM 85 218 YAZ...... 171, 181, 193

272 YUPELRI...... 52 ZYFLO...... 222 yuvafem...... 181, 202 ZYKADIA...... 45 ZACARE...... 232, 241 ZYLET...... 143, 147 zaclir cleansing...... 241 ZYLOPRIM...... 200 zafemy...... 171, 181, 193 ZYMAXID...... 143 zafirlukast...... 222 ZYVOX...... 32 zaleplon...... 104 ZANAFLEX ...... 54 zarah...... 171, 181, 193 ZARONTIN...... 126 ZARXIO...... 62 ZEBUTAL...... 93, 107, 123 ZEJULA...... 45 ZELAPAR...... 113, 114 ZELBORAF...... 45 ZELNORM ...... 157 ZEMPLAR...... 253 zenatane...... 247 ZENPEP...... 140, 154 ZEPATIER...... 24, 25 ZEPOSIA...... 213 ZEPOSIA 7-DAY STARTER PACK...... 213 ZEPOSIA STARTER KIT...... 213 ZETONNA ...... 147 ZIAC...... 74, 138 ZIAGEN...... 29 zidovudine ...... 29 ZIEXTENZO ...... 62 zileuton er ...... 222 ZILXI...... 229 ZIOPTAN...... 149 ziprasidone hcl ...... 101, 106 ZIRGAN...... 143 ZITHROMAX ...... 32 ZITHROMAX TRI-PAK...... 32 ZITHROMAX Z-PAK...... 32 ZOLINZA...... 45 zolmitriptan ...... 125 zolpidem tartrate ...... 104 zolpidem tartrate er ...... 104 ZOLPIMIST...... 104 ZOMIG...... 125 ZONEGRAN...... 98 zonisamide ...... 98 ZONTIVITY...... 69 ZORBTIVE...... 184, 195 zovia 1/35 (28)...... 171, 181, 193 zovia 1/35e (28)...... 171, 181, 193 ZOVIRAX...... 31 ZUBSOLV...... 118, 119 zumandimine ...... 171, 181, 193 ZYDELIG...... 45

273