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United Mine Workers of America Health and Retirement Funds 2021

UPDATED 04/01/2021

INTRODUCTION ...... 5 NONDISCRIMINATION STATEMENT ...... 5 PREFACE ...... 8 PHARMACY AND THERAPEUTICS (P&T) COMMITTEE ...... 8 PRODUCT SELECTION CRITERIA ...... 8 DRUG LIST PRODUCT DESCRIPTIONS ...... 8 GENERIC SUBSTITUTION ...... 9 PREFERRED PRODUCT PROGRAM ...... 9 ADVANCED CONTROL SPECIALTY FORMULARY ...... 11 SPECIFIC LIMITATIONS AND EXCLUSIONS ...... 11 PRESCRIPTION QUANTITY LIMITS ...... 13 SPECIALTY PHARMACY ...... 14 NOTICE ...... 14 LEGEND ...... 14 FUNDS' WEBSITE ...... 14 ...... 16 ANALGESICS, OTHER ...... 16 NSAIDs ...... 16 NSAIDs, COMBINATIONS ...... 16 NSAIDs, TOPICAL ...... 16 COX-2 INHIBITORS ...... 16 GOUT ...... 16 OPIOID ANALGESICS ...... 16 VISCOSUPPLEMENTS...... 17 ANTI-INFECTIVES ...... 17 ANTIBACTERIALS ...... 18 ANTIFUNGALS ...... 19 ANTIMALARIALS ...... 19 ANTIRETROVIRAL AGENTS...... 19 ANTITUBERCULAR AGENTS ...... 20 ANTIVIRALS ...... 20 MISCELLANEOUS ...... 21 ANTINEOPLASTIC AGENTS ...... 21 ALKYLATING AGENTS ...... 21 ANTIMETABOLITES ...... 21 HORMONAL ANTINEOPLASTIC AGENTS ...... 22 KINASE INHIBITORS ...... 22 MULTIPLE MYELOMA ...... 23 MISCELLANEOUS ...... 23 CARDIOVASCULAR ...... 23 ACE INHIBITORS ...... 23 ACE INHIBITOR/ COMBINATIONS ...... 24 ACE INHIBITOR/DIURETIC COMBINATIONS ...... 24 ADRENOLYTICS, CENTRAL ...... 24 ALDOSTERONE RECEPTOR ANTAGONISTS ...... 24 ALPHA BLOCKERS ...... 24 ANGIOTENSIN II RECEPTOR ANTAGONISTS/DIURETIC COMBINATIONS ...... 24 ANGIOTENSIN II /CALCIUM CHANNEL BLOCKER COMBINATIONS ...... 25

1 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER/DIURETIC COMBINATIONS ...... 25 ANTIARRHYTHMICS ...... 25 ANTILIPEMICS ...... 25 BETA-BLOCKERS ...... 26 BETA-BLOCKER/DIURETIC COMBINATIONS ...... 26 CALCIUM CHANNEL BLOCKERS...... 27 CALCIUM CHANNEL BLOCKER/ANTILIPEMIC COMBINATIONS ...... 27 DIGITALIS GLYCOSIDES ...... 27 DIRECT RENIN INHIBITORS/DIURETIC COMBINATIONS ...... 27 DIURETICS ...... 27 ...... 28 ...... 28 PULMONARY ARTERIAL ...... 28 MISCELLANEOUS ...... 28 CENTRAL NERVOUS SYSTEM ...... 28 ANTIANXIETY ...... 29 ...... 29 ANTIDEMENTIA ...... 29 ...... 30 ANTIPARKINSONIAN AGENTS ...... 31 ...... 31 ATTENTION DEFICIT HYPERACTIVITY DISORDER ...... 31 FIBROMYALGIA ...... 32 HYPNOTICS ...... 32 ...... 32 MOOD STABILIZERS ...... 33 MOVEMENT DISORDERS ...... 33 MULTIPLE SCLEROSIS AGENTS ...... 33 MUSCULOSKELETAL THERAPY AGENTS...... 34 MYASTHENIA GRAVIS...... 34 NARCOLEPSY ...... 34 POSTHERPETIC NEURALGIA (PHN) ...... 34 PSYCHOTHERAPEUTIC-MISCELLANEOUS ...... 34 ENDOCRINE AND METABOLIC ...... 35 ACROMEGALY ...... 35 ...... 35 ANTIDIABETICS ...... 35 ANTIOBESITY ...... 38 CALCIUM RECEPTOR ANTAGONISTS...... 38 CALCIUM REGULATORS...... 38 CARNITINE DEFICIENCY AGENTS ...... 38 CONTRACEPTIVES...... 38 ...... 40 FERTILITY REGULATORS ...... 40 GAUCHER DISEASE ...... 40 ...... 40 GLUCOSE ELEVATING AGENTS ...... 40 HEREDITARY TYROSINEMIA TYPE 1 AGENTS ...... 40 HUMAN GROWTH ...... 40 HYPERPARATHYROID TREATMENT, VITAMIN D ANALOGS ...... 41 MENOPAUSAL SYMPTOM AGENTS...... 41 PHOSPHATE BINDER AGENTS ...... 41 POLYNEUROPATHY ...... 41 POTASSIUM-REMOVING AGENTS ...... 41 PROGESTINS ...... 42 SELECTIVE RECEPTOR MODULATORS ...... 42 THYROID AGENTS ...... 42 UREA CYCLE DISORDERS ...... 42 UTERINE FIBROIDS ...... 42

2 VASOPRESSINS ...... 42 MISCELLANEOUS ...... 42 GASTROINTESTINAL ...... 42 ANTIDIARRHEALS ...... 42 ...... 43 ANTISPASMODICS ...... 43 CHOLELITHOLYTICS ...... 43 H2 RECEPTOR ANTAGONISTS ...... 43 INFLAMMATORY BOWEL DISEASE ...... 43 IRRITABLE BOWEL SYNDROME ...... 44 ...... 44 OPIOID-INDUCED ...... 44 PANCREATIC ENZYMES ...... 44 ...... 44 PROTON PUMP INHIBITORS ...... 44 SALIVA ...... 44 , RECTAL ...... 45 ULCER THERAPY COMBINATIONS...... 45 MISCELLANEOUS ...... 45 GENITOURINARY ...... 45 BENIGN PROSTATIC HYPERPLASIA ...... 45 ...... 45 URINARY ANTISPASMODICS ...... 45 VAGINAL ANTI-INFECTIVES ...... 46 MISCELLANEOUS ...... 46 HEMATOLOGIC ...... 46 ANTICOAGULANTS ...... 46 HEMATOPOIETIC GROWTH FACTORS ...... 46 HEMOPHILIA A AGENTS ...... 46 HEMOPHILIA B AGENTS ...... 47 PLATELET AGGREGATION INHIBITORS ...... 47 PLATELET SYNTHESIS INHIBITORS ...... 47 THROMBOCYTOPENIA AGENTS ...... 47 MISCELLANEOUS ...... 47 IMMUNOLOGIC AGENTS ...... 47 ALLERGENIC EXTRACTS ...... 47 AUTOIMMUNE AGENTS (PHYSICIAN-ADMINISTERED) ...... 47 AUTOIMMUNE AGENTS (SELF-ADMINISTERED) ...... 47 DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs) ...... 48 HEREDITARY ANGIOEDEMA ...... 48 IMMUNOSUPPRESSANTS ...... 48 NUTRITIONAL/SUPPLEMENTS ...... 49 ELECTROLYTES ...... 49 VITAMINS AND MINERALS ...... 49 RESPIRATORY ...... 49 ANAPHYLAXIS TREATMENT AGENTS ...... 49 ...... 50 /BETA COMBINATIONS ...... 50 ANTICHOLINERGIC/BETA AGONIST/ INHALANT COMBINATIONS ...... 50 , LOW SEDATING ...... 50 ANTIHISTAMINES, NONSEDATING ...... 50 ANTIHISTAMINES, SEDATING ...... 50 /DECONGESTANT COMBINATIONS ...... 50 ANTITUSSIVES ...... 50 ANTITUSSIVE COMBINATIONS ...... 51 BETA ...... 51 CYSTIC FIBROSIS ...... 51 LEUKOTRIENE MODULATORS ...... 51

3 MAST CELL STABILIZERS ...... 51 NASAL ANTIHISTAMINES ...... 51 NASAL STEROIDS/COMBINATIONS...... 52 -4 INHIBITORS ...... 52 PULMONARY ENZYME DEFICIENCY AGENTS ...... 52 PULMONARY FIBROSIS AGENTS ...... 52 SEVERE AGENTS ...... 52 STEROID/BETA AGONIST COMBINATIONS ...... 52 STEROID INHALANTS ...... 52 XANTHINES ...... 52 MISCELLANEOUS ...... 53 TOPICAL ...... 53 DERMATOLOGY ...... 53 MOUTH/THROAT/DENTAL AGENTS ...... 56 OPHTHALMIC ...... 56 OTIC ...... 58 FUNDS' WEBSITE ...... 59 WEBSITES ...... 60 INDEX ...... 62

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INTRODUCTION The UMWA Health and Retirement Funds ("the Funds") is pleased to provide the 2021 Prescribing Guide as a useful reference and informational tool. The Prescribing Guide can assist practitioners in selecting clinically appropriate and cost-effective products for their patients. The drugs represented have been reviewed by a National Pharmacy and Therapeutics (P&T) Committee and are approved for inclusion by the Funds. The Prescribing Guide is reflective of current medical practice as of the date of review. The information contained in this Prescribing Guide and its appendices is provided solely for the convenience of medical providers. We do not warrant or assure accuracy of such information nor is it intended to be comprehensive in nature. This Prescribing Guide is not intended to be a substitute for the knowledge, expertise, skill and judgment of the medical provider in his or her choice of prescription drugs. All the information in the Prescribing Guide is provided as a reference for drug therapy selection. Specific drug selection for an individual patient rests solely with the prescriber. The document is subject to state- specific regulations and rules, including, but not limited to, those regarding generic substitution, controlled substance schedules, preference for brands and mandatory generics whenever applicable. We assume no responsibility for the actions or omissions of any medical provider based upon reliance, in whole or in part, on the information contained herein. The medical provider should consult the drug manufacturer's product literature or standard references for more detailed information. National guidelines can be found on the National Guideline Clearinghouse site at https://www.ahrq.gov/gam/, on the websites listed under each therapeutic class and on the sites listed in the WEBSITES section of this publication. NONDISCRIMINATION STATEMENT Discrimination is Against the Law The UMWA Health and Retirement Funds complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. The UMWA Health and Retirement Funds does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. The UMWA Health and Retirement Funds: Provides free aids and services to people with disabilities to communicate effectively with us, such as:

• Qualified sign language interpreters • Written information in other formats (large print, audio, accessible electronic formats, other formats) Provides free language services to people whose primary language is not English, such as:

• Qualified interpreters • Information written in other languages If you need these services, contact the Funds' Call Center at 800-291-1425. If you believe that the UMWA Health and Retirement Funds has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:

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Compliance Manager UMWA Health and Retirement Funds 160 Heartland Drive Beckley, WV 25801 1-800-291-1425 (TTY: 711) You can file a grievance in person or by mail. If you need help filing a grievance, the Compliance Manager is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 800-537-7697 (TDD) Complaint forms are available at https://www.hhs.gov/ocr/office/file/index.html.

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PREFACE The Prescribing Guide is organized by sections. Each section is divided by therapeutic primarily defined by mechanism of action. Products are listed by generic name with brand name for reference only. Unless exceptions are noted, generally all applicable dosage forms and strengths of the drug cited are included in the Prescribing Guide. Generics should be considered the first line of prescribing. The Funds has an open, preferred product formulary; therefore, most drugs are covered whether listed in the Prescribing Guide or not. However, specific limitations do apply and will be described on subsequent pages in the preface. In addition, over-the-counter (OTC) products, with the exception of and diabetes monitoring products, are not included in the pharmacy benefit, except those provided to specific benefit plans that require compliance with the Affordable Care Act (ACA) provisions. Pharmacy law requires a valid prescription for the purchase of needles and syringes in certain states. OTC products are listed for informational purposes. If covered in the pharmacy benefit, OTC products require a valid prescription Drugs represented in the Prescribing Guide may have varying cost to the plan member. Prescription benefit plan may alter coverage of certain products or vary copay amounts based on the condition being treated. Generic typically are available at the lowest cost, brand-name medications in the Prescribing Guide will generally cost more than generics, and brand-name medications not on the list may cost the most. PHARMACY AND THERAPEUTICS (P&T) COMMITTEE The Funds' P&T Committee was established to review and approve safe and clinically effective drug therapies. The P&T Committee's voting members include physicians, pharmacists, and nurses. The Committee meets quarterly to review drug usage patterns, evaluate medications and establish guidelines for optimal use. The services of an independent National Pharmacy and Therapeutics Committee ("P&T Committee") are utilized to approve safe and clinically effective drug therapies. The P&T Committee is an external advisory body of clinical professionals from across the . The P&T Committee's voting members include physicians, pharmacists, a pharmacoeconomist and a medical ethicist, all of whom have a broad background of clinical and academic expertise regarding prescription drugs. Employees with significant clinical expertise are invited to meet with the P&T Committee, but no CVS Caremark® employee may vote on issues before the P&T Committee. Voting members of the P&T Committee must disclose any financial relationship or conflicts of interest with any pharmaceutical manufacturers. PRODUCT SELECTION CRITERIA Physicians are encouraged to prescribe drugs in the Prescribing Guide. All the information in the Prescribing Guide is provided as a reference for drug therapy selection. Specific drug selection for an individual patient rests solely with the prescriber. DRUG LIST PRODUCT DESCRIPTIONS To assist in understanding which specific strengths and dosage forms are in the Prescribing Guide, examples are noted below. The general principles shown in the examples can usually be extended to other entries in the book. Any exceptions are noted.

Products in the Prescribing Guide include all strengths and dosage forms of the cited brand- name product. cefixime Suprax Oral capsules, oral chewable tablets, oral suspension and all strengths of Suprax would be included in this listing.

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When a strength or dosage form is specified, only the specified strength and dosage form is in the Prescribing Guide. Other strengths/dosage forms of the reference product are not. tabs Zanaflex The tablets of Zanaflex are on the Prescribing Guide. From this entry, the capsules cannot be assumed to be in the list unless there is a specific entry.

Extended-release and delayed-release products require their own entry. sitagliptin/ Janumet The immediate-release product listing of Janumet alone would not include the extended-release product Janumet XR.

sitagliptin/metformin ext-rel Janumet XR A separate entry for Janumet XR confirms that the extended-release product is in the Prescribing Guide.

Dosage forms in the Prescribing Guide will be consistent with the category and use where listed. nystatin The above nystatin entry listed in the TOPICAL/DERMATOLOGY section is limited to the topical dosage forms. From this entry the oral formulations cannot be assumed to be on the list unless there is an entry for this product in the ANTI-INFECTIVES section of the Prescribing Guide.

GENERIC SUBSTITUTION Generic substitution is a pharmacy action whereby a generic version is dispensed rather than a prescribed brand-name product. Boldface type indicates generic availability. However, not all strengths or dosage forms of the generic name in boldface type may be generically available. In addition, boldface type may indicate that the brand name cited is a generic. An example of the latter includes Levoxyl. One way to reduce out-of-pocket cost is by requesting a . Generic drugs are usually priced lower than their brand-name equivalents. Prescription generic drugs are:

• Approved by the U.S. Food and Drug Administration (FDA) for safety and effectiveness, and are manufactured under the same strict standards that apply to brand-name drugs. • Tested in humans to assure the generic is absorbed into the bloodstream in a similar rate and extent compared to the brand-name drug. Generics may be different from the brand in size, color, and inactive ingredients, but this does not alter their effectiveness or ability to be absorbed just like the brand-name drug. • Manufactured in the same strength and dosage form as the brand-name drugs. When a generic drug is substituted for a brand-name drug, you can expect the generic to produce the same clinical effect and safety profile as the brand-name drug. PREFERRED PRODUCT PROGRAM Effective 04/01/2021

The Funds has a Preferred Product Program in eight drug classes. These classes are Lipid Lowering Agents (HMG-CoA Reductase Inhibitors/Combinations), ARB/ARB Combinations, Hypnotics, DPP-4 Inhibitors/Combinations (Diabetes), Nasal Inhalers/Combinations (), Urinary Antispasmodics (Overactive Bladder), Irritable Bowel Syndrome with Constipation/Chronic Idiopathic Constipation and Opioid-Induced Constipation. The preferred drugs in these classes are available to the beneficiary at the standard copay. If a non-preferred drug within these classes is selected, the beneficiary will be required to

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pay the standard copay plus an additional charge. See the appropriate sections for the preferred and non- preferred lists. Additional classes may be added in the future. If you have questions, please call CVS Caremark® Customer Care at 1-800-294-4741. The current Preferred Product Program Drug List is as follows:

DRUG CLASS Lipid Lowering Agents (HMG-CoA Reductase Inhibitors/Combinations) PREFERRED NON-PREFERRED generic atorvastatin Livalo (pitavastatin) generic ezetimibe/simvastatin generic pravastatin generic rosuvastatin generic simvastatin DRUG CLASS ARB/ARB Combinations PREFERRED NON-PREFERRED generic candesartan, candesartan/HCTZ Edarbi (azilsartan) generic irbesartan, irbesartan/HCTZ Edarbyclor (azilsartan/chlorthalidone) generic losartan, losartan/HCTZ generic olmesartan, olmesartan/HCTZ generic telmisartan, telmisartan/HCTZ generic valsartan, valsartan/HCTZ DRUG CLASS Hypnotics PREFERRED NON-PREFERRED generic 3 mg, 6 mg Edluar (zolpidem sublingual) generic eszopiclone generic ramelteon generic zaleplon generic zolpidem, zolpidem extended-release Belsomra () DRUG CLASS DPP-4 Inhibitors/Combinations (Diabetes) PREFERRED NON-PREFERRED Janumet (sitagliptin/metformin) Jentadueto (linagliptin/metformin) Janumet XR (sitagliptin/metformin extended-release) Jentadueto XR (linagliptin/metformin extended-release) Januvia (sitagliptin) Tradjenta (linagliptin) Kombiglyze XR (saxagliptin/metformin extended-release) Onglyza (saxagliptin) DRUG CLASS Nasal Inhalers/Combinations (Allergies) PREFERRED NON-PREFERRED generic nasal Beconase AQ (beclomethasone) generic nasal Omnaris () Dymista (/fluticasone) Qnasl (beclomethasone) Qnasl Childrens (beclomethasone)

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Zetonna (ciclesonide) DRUG CLASS Urinary Antispasmodics (Overactive Bladder) PREFERRED NON-PREFERRED generic darifenacin extended-release Gelnique (oxybutynin ) generic oxybutynin, oxybutynin extended-release Oxytrol (oxybutynin transdermal) generic solifenacin Toviaz (fesoterodine extended-release) generic tolterodine, tolterodine extended-release generic trospium, trospium extended-release Myrbetriq ( extended-release) DRUG CLASS Irritable Bowel Syndrome with Constipation/Chronic Idiopathic Constipation PREFERRED NON-PREFERRED Amitiza () Motegrity () Linzess () Trulance () DRUG CLASS Opioid-Induced Constipation PREFERRED NON-PREFERRED Movantik () Relistor tablets () Symproic ( tosylate)

Note: Brand names listed on the preferred column are subject to a change of status when a generic or OTC version becomes available. All medications contained in this list are subject to coverage based on FDA-approved maximum dosages(s). For more information about The Funds' Drug Benefit, go to https://www.umwafunds.org

ADVANCED CONTROL SPECIALTY FORMULARY Effective 01/01/2021 The Funds has a preferred product program called the Advanced Control Specialty Formulary (ACSF). The preferred drugs in ACSF classes are available to the beneficiary at the standard copay. If a non-preferred drug within these classes is selected, the prescriber will be asked to consider preferred drug(s) to be used before the non-preferred drug will be covered. If you have questions, please call CVS Caremark Customer Care at 1-800-294-4741. The ACSF Drug List and more information about The Funds’ Drug Benefit are available at https://www.umwafunds.org SPECIFIC LIMITATIONS AND EXCLUSIONS Prior Authorization: The following drugs require Prior Authorization. Prescribers may call the CVS Caremark Prior Authorization Department at 1-800-294-5979 to request Prior Authorization review:

• Acne o Adapalene Products (Differin – PA required only in adults age 36 and older, Epiduo, Epiduo Forte)

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o Topical Retinoids (such as tretinoin products and all products of the following brands: Altreno, Atralin, Avita, Retin-A, Retin-A Micro, Tretin-X, Veltin, Ziana) – PA required only in adults age 26 and older o Tazarotene Products (Tazorac, Fabior, Arazlo) o Trifarotene (Aklief) • Anabolic Steroids (Anadrol-50, Oxandrin) • Auvi-Q (epinephrine auto-injector) - use alternative instead (examples include generic epinephrine auto-injector, Adrenaclick, EpiPen, EpiPen Jr.) • Contraceptives (approved for non-contraceptive indications), except for benefit plans with required compliance with the Affordable Care Act (ACA) • auto-injector (Evzio) - use alternative instead (examples include Narcan nasal spray, naloxone injection (excluding auto-injector)) • Hypoactive Sexual Desire Disorder (Addyi) • Multi-Ingredient Compounds (A compounded is one that is made by combining, mixing, or altering ingredients, in response to a prescription, to create a customized medication that is not otherwise commercially available.) • Obesity Drugs (benzphetamine, Contrave, diethylpropion, phendimetrazine, phentermine, Qsymia, Saxenda, Xenical) [Note: Treatment of obesity is not covered except for pathological, morbid forms of severe obesity] • Oral/Intranasal Fentanyl Products (including Actiq, fentanyl buccal tablet, fentanyl sublingual tablet, fentanyl transmucosal lozenge, Fentora, Lazanda, Subsys) • Glumetza and Fortamet (including their generic metformin ER versions) - use generic Glucophage XR (metformin ER) instead • Zegerid (including generic omeprazole/) - use an alternative generic Proton Pump Inhibitor (PPI) instead • Extended-release Opioids - must use an immediate-release opioid before an extended-release form is covered • Duexis (combination of ibuprofen + ) and Vimovo (combination of naproxen + esomeprazole) - use generic NSAID and generic H2 Blocker or PPI instead • Omnipod and V-GO (disposable insulin pump devices) • Palforzia • Select Medical Devices (510K Pathway) and Artificial Saliva Products • Select oral and injectable and antifungal agents (, daptomycin, , streptomycin, vancomycin) • Hyperinflation Management - Select drugs that are exponentially more expensive than readily available lower-cost alternatives and whose price is not supported by evidence of greater clinical efficacy. For more information about The Fund's Drug Benefit, go to https://www.umwafunds.org (Note: Some products listed in this Prescribing Guide may be subject to Hyperinflation Management prior authorization review.) Specialty medications (including biotech injectables and complex oral therapies) require Prior Authorization review by the Specialty Guideline Management (SGM) program. Prescribers may call 1-866-814-5506 to request SGM review.

The Funds may choose to modify this list prior to the next quarterly publication of the Prescribing Guide. Not covered:

• Certain legend products (other than Insulin) that have an OTC equivalent • OTC products, with the exception of insulin and diabetes monitoring products. OTC products are listed for informational purposes. If covered in the pharmacy benefit, OTC products require a valid prescription.

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• Medications for cosmetic purposes • Investigational or experimental therapies • Contraceptives (oral, injectable and other drug delivery systems), except as prior approved for non- contraceptive indications or as a provision of the ACA • OTC smoking cessation products, except as required as a provision of the ACA • Miscellaneous formulations, including select topical analgesics (e.g., patches, lotions and creams), which contain products used for the temporary relief of minor aches and muscle pains. These products may be marketed contrary to the Federal Food, Drug and Cosmetic Act (the FD&C Act). They may contain an ingredient or ingredients for which the efficacy and safety are unknown or have not been adequately studied based on their . U.S. Food and Drug Administration (FDA)-approved drugs (either legend or over-the-counter [OTC]) are available to treat the conditions targeted by these agents, and many of the ingredients within multi-ingredient products may also be commercially available individually. • Select bulk powders and proprietary bases for compounding • Dietary Management Products (Medical Foods) Specific Covered Items:

• The first fill of prescriptions for diabetic supplies, including insulin syringes with needles, swabs, blood glucose testing strips (with the exception of continuous glucose monitoring supplies), urine glucose testing strips, ketone testing strips, ketone tablets, lancets, and lancet devices, are covered under the Funds' benefit at $0 co-pay. The Funds prefers that refills for these supplies should be obtained through the Funds' DME vendor. To locate a participating DME vendor with the Funds, contact the Funds' Call Center at 1-800-291-1425. Insulin is not included in this category and is available under the drug benefit only. • Infertility medications • Injectables, unless previously listed as not covered • Durable Medical Equipment (DME) used for respiratory use (e.g. respiratory spacers like InspirEase and AeroChamber), unless urgently required, should be obtained through one of the Funds' participating DME vendors. To locate a participating DME vendor with the Funds, contact the Funds' Call Center at 1-800-291-1425. • Legend vitamins (with a prescription) except prenatal vitamins • Medication Assisted Treatment of Substance Abuse Disorder - the following products are covered at $0 Copayment: buprenorphine sublingual tablet (2mg, 8mg), buprenorphine-naloxone sublingual tablet (2mg-0.5mg, 8mg-2mg), Naltrexone tablet (50mg) PRESCRIPTION QUANTITY LIMITS All medications contained in this Prescribing Guide are subject to coverage based on FDA-approved maximum quantity limits. Prescriptions for quantity limits that exceed the FDA-approved dosing are subject to enhanced medical necessity approval guidelines. Listed below are some of the benefit limits on certain drugs based on either benefit design or FDA maximum dosing criteria.

Erectile Dysfunction Drugs - combined limit of 18 tablets per 3 month supply

• Cialis () [Note: 2.5 mg and 5 mg strengths are allowed for once daily dosing] • Levitra (vardenafil) • Staxyn (vardenafil) • Stendra • Viagra ()

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Miscellaneous

• 5% Ointment - 100 grams per month • Oral vancomycin (80 capsules/10 days; 450mL/10 days) • Oxycodone extended-release (Oxycontin) – 120 tablets per month • Select topical and antifungal agents (maximum quantity based on practice guidelines) SPECIALTY PHARMACY CVS Specialty™ is a full-service specialty pharmaceutical provider and the preferred, sole vendor provider for the Funds. Specialty pharmaceuticals or products are used in the management of specific chronic or genetic conditions and certain catastrophic diseases such as cancer. They are often injectable or infused medications, but may also include oral agents. CVS Caremark offers these services combined with professional pharmaceutical care management. Products distributed by CVS Caremark and therapies may change. To learn more about how CVS Specialty can help you or your patients, please visit the website https://www.CVSspecialty.com or call 1-800-237- 2767. NOTICE The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission of the Funds. ©2021. All rights reserved.

This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with the Funds.

The Funds and CVS Caremark do not operate the websites/organizations listed here, nor are they responsible for the availability or reliability of the websites' content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by the Funds or CVS Caremark. LEGEND OTC Over the counter P Indicates preferred brand drugs or representative generic drugs for consideration # Indicates brand product remains preferred. boldface Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name delayed-rel Delayed-release (also known as enteric-coated), refer to the reference brand listed for clarification ext-rel Extended-release (also known as sustained-release), refer to the reference brand listed for clarification

FUNDS' WEBSITE For more information about the Funds' drug benefit, please access our website at: https://www.umwafunds.org Frequently Used Telephone Numbers:

CVS Caremark Customer Care Phone 1-800-294-4741

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CVS Caremark Prior Authorization Phone 1-800-294-5979 Fax 1-888-836-0730

CVS Specialty Phone 1-800-237-2767 Fax 1-866-295-2778

The Funds Call Center (Beckley, WV) Phone 1-800-291-1425

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ANALGESICS Practice guidelines of pain management are available at: https://www.asahq.org

ANALGESICS, OTHER Treatment recommendations for osteoarthritis are available at: https://www.rheumatology.org

OTC acetaminophen TYLENOL

NSAIDs OTC ibuprofen ADVIL OTC naproxen sodium ALEVE P diclofenac sodium delayed-rel diflunisal etodolac P ibuprofen P meloxicam nabumetone P naproxen P naproxen sodium tabs oxaprozin sulindac

NSAIDs, COMBINATIONS P diclofenac sodium delayed-rel/misoprostol

NSAIDs, TOPICAL P diclofenac sodium gel 1% P diclofenac sodium soln

COX-2 INHIBITORS P celecoxib

GOUT P allopurinol P colchicine P probenecid

OPIOID ANALGESICS Practice Guidelines for Cancer Pain Management (includes WHO ladder) are available at: https://www.asahq.org https://www.nccn.org

Opioid guidelines in the management of chronic non-malignant pain are available at: https://www.asipp.org/ASIPP-Guidelines.html

P buprenorphine transdermal P codeine/acetaminophen P fentanyl transdermal P fentanyl transmucosal lozenge

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P hydrocodone ext-rel P hydrocodone/acetaminophen P hydromorphone P hydromorphone ext-rel P methadone P morphine P morphine ext-rel P morphine supp P oxycodone caps 5 mg P oxycodone concentrate 20 mg/mL P oxycodone soln 5 mg/5 mL P oxycodone tabs 5 mg, 15 mg, 30 mg P oxycodone/acetaminophen 5/325 P P tramadol ext-rel P buprenorphine BELBUCA P fentanyl sublingual spray SUBSYS P hydrocodone ext-rel HYSINGLA ER P oxycodone ext-rel OXYCONTIN P oxycodone ext-rel XTAMPZA ER P tapentadol NUCYNTA P tapentadol ext-rel NUCYNTA ER

VISCOSUPPLEMENTS P sodium hyaluronate DUROLANE P sodium hyaluronate EUFLEXXA P sodium hyaluronate GELSYN-3 P sodium hyaluronate SUPARTZ FX

ANTI-INFECTIVES Practice guidelines and statements developed and endorsed by the Infectious Diseases Society of America are available at: https://www.idsociety.org

Hepatitis: CDC recommendations on the treatment of are available at: https://www.cdc.gov/hepatitis/Resources/

Guidelines for the management of chronic hepatitis by the American Association for the Study of Disease are available at: https://www.aasld.org

HIV/AIDS: Guidelines for the treatment of HIV patients by the U.S. Department of Health and Human Services are available at: https://www.aidsinfo.nih.gov

Infective Endocarditis: American Heart Association recommendations for the prevention of bacterial endocarditis are available at: https://professional.heart.org

Influenza: Recommendations of the Advisory Committee on Immunization Practices are available at:

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https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html

International Travel: CDC recommendations for international travel are available at: https://wwwnc.cdc.gov/travel

Respiratory Tract Infection/Antibiotic Use/Community Acquired Pneumonia/Other: Principles of appropriate antibiotic use for treatment of nonspecific upper respiratory tract infection in adults are available at: https://www.cdc.gov/pneumonia/management-prevention-guidelines.html

Sexually Transmitted Diseases: CDC Sexually Transmitted Diseases Guidelines are available at: https://www.cdc.gov/std/treatment/default.htm

ANTIBACTERIALS Cephalosporins First Generation cefadroxil P cephalexin KEFLEX

Second Generation P cefprozil P cefuroxime axetil

Third Generation P cefdinir P, # cefixime SUPRAX

# Brand SUPRAX remains preferred.

Erythromycins/ P azithromycin ZITHROMAX P P clarithromycin ext-rel P delayed-rel P erythromycin ethylsuccinate P erythromycin stearate P fidaxomicin DIFICID

Fluoroquinolones P CIPRO P levofloxacin P moxifloxacin

Penicillins P amoxicillin P amoxicillin/clavulanate AUGMENTIN amoxicillin/clavulanate ext-rel ampicillin P dicloxacillin P penicillin VK

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Tetracyclines P doxycycline hyclate VIBRAMYCIN P doxycycline hyclate 20 mg P minocycline P

ANTIFUNGALS clotrimazole troches P fluconazole DIFLUCAN griseofulvin ultramicrosize P nystatin P terbinafine tabs voriconazole VFEND

ANTIMALARIALS atovaquone/proguanil MALARONE chloroquine mefloquine

ANTIRETROVIRAL AGENTS Antiretroviral Combinations P abacavir/lamivudine EPZICOM P /emtricitabine/tenofovir disoproxil fumarate P efavirenz/lamivudine/tenofovir disoproxil fumarate P, # emtricitabine/tenofovir disoproxil fumarate TRUVADA P lamivudine/zidovudine COMBIVIR P abacavir/dolutegravir/lamivudine TRIUMEQ P atazanavir/cobicistat EVOTAZ P bictegravir/emtricitabine/tenofovir alafenamide BIKTARVY P darunavir/cobicistat PREZCOBIX P darunavir/cobicistat/emtricitabine/tenofovir alafenamide SYMTUZA P dolutegravir/lamivudine DOVATO P elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide GENVOYA P emtricitabine/rilpivirine/tenofovir alafenamide ODEFSEY P emtricitabine/tenofovir alafenamide DESCOVY P lamivudine/tenofovir disoproxil fumarate CIMDUO P lamivudine/tenofovir disoproxil fumarate TEMIXYS

# Brand TRUVADA remains preferred.

Fusion Inhibitors P enfuvirtide FUZEON

Integrase Inhibitors P dolutegravir TIVICAY P raltegravir ISENTRESS

Non-nucleoside Reverse Transcriptase Inhibitors P efavirenz P nevirapine

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P nevirapine ext-rel P etravirine INTELENCE P rilpivirine EDURANT

Nucleoside Reverse Transcriptase Inhibitors P abacavir tabs ZIAGEN P didanosine delayed-rel P, # emtricitabine EMTRIVA P lamivudine EPIVIR P stavudine P zidovudine RETROVIR

# Brand EMTRIVA remains preferred.

Nucleotide Reverse Transcriptase Inhibitors P tenofovir disoproxil fumarate

Protease Inhibitors P atazanavir P lopinavir/ soln KALETRA P, # ritonavir NORVIR P darunavir PREZISTA P lopinavir/ritonavir tabs KALETRA

# Brand NORVIR remains preferred.

ANTITUBERCULAR AGENTS ethambutol MYAMBUTOL isoniazid pyrazinamide rifampin RIFADIN

ANTIVIRALS Cytomegalovirus Agents P valganciclovir

Hepatitis Agents Hepatitis B P entecavir tabs P lamivudine P tenofovir disoproxil fumarate P entecavir soln BARACLUDE P tenofovir alafenamide VEMLIDY

Hepatitis C P ribavirin P, † ledipasvir/sofosbuvir HARVONI P, † sofosbuvir/velpatasvir EPCLUSA P, † sofosbuvir/velpatasvir/voxilaprevir VOSEVI

† HARVONI only for genotypes 1, 4, 5, and 6

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EPCLUSA for genotypes 1, 2, 3, 4, 5, 6 VOSEVI for use in patients previously treated with an HCV regimen containing an NS5A inhibitor (for genotypes 1- 6) or sofosbuvir without an NS5A inhibitor (for genotypes 1a or 3)

Herpes Agents P acyclovir caps, tabs famciclovir P valacyclovir

Influenza Agents P oseltamivir P zanamivir RELENZA

MISCELLANEOUS P clindamycin CLEOCIN dapsone P ivermectin STROMECTOL P linezolid P FLAGYL P nitrofurantoin ext-rel MACROBID P nitrofurantoin macrocrystals P nitrofurantoin susp P pyrimethamine P sulfamethoxazole/trimethoprim P sulfamethoxazole/trimethoprim DS tinidazole trimethoprim P vancomycin caps VANCOCIN P mebendazole chewable EMVERM P 550 mg XIFAXAN

ANTINEOPLASTIC AGENTS Clinical practice guidelines in oncology are available at: https://www.asco.org https://www.nccn.org

ALKYLATING AGENTS cyclophosphamide caps melphalan ALKERAN P temozolomide TEMODAR busulfan MYLERAN chlorambucil LEUKERAN

ANTIMETABOLITES P capecitabine XELODA mercaptopurine methotrexate TREXALL

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thioguanine TABLOID

HORMONAL ANTINEOPLASTIC AGENTS P abiraterone P CASODEX flutamide P abiraterone YONSA P apalutamide ERLEADA P NUBEQA P enzalutamide XTANDI

Antiestrogens tamoxifen

Aromatase Inhibitors anastrozole ARIMIDEX exemestane AROMASIN letrozole FEMARA

Luteinizing -Releasing Hormone (LHRH) Agonists P leuprolide P leuprolide acetate ELIGARD

Progestins acetate tabs

KINASE INHIBITORS P erlotinib P, # AFINITOR P mesylate GLEEVEC P lapatinib P alectinib ALECENSA P bosutinib BOSULIF P brigatinib ALUNBRIG P cabozantinib CABOMETYX P SPRYCEL P duvelisib COPIKTRA P gefitinib IRESSA P gilteritinib XOSPATA P midostaurin RYDAPT P palbociclib IBRANCE P pazopanib VOTRIENT P ribociclib KISQALI P ribociclib + letrozole KISQALI FEMARA CO-PACK P sunitinib SUTENT

# Brand AFINITOR remains preferred.

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MULTIPLE MYELOMA Immunomodulators P lenalidomide REVLIMID P thalidomide THALOMID

Proteasome Inhibitors P bortezomib VELCADE P ixazomib NINLARO

MISCELLANEOUS P bexarotene caps TARGRETIN etoposide hydroxyurea HYDREA tretinoin caps mitotane LYSODREN P niraparib ZEJULA P olaparib LYNPARZA P pertuzumab PERJETA P pertuzumab/trastuzumab/hyaluronidase-zzxf PHESGO procarbazine MATULANE P rucaparib RUBRACA P sonidegib ODOMZO P uridine triacetate VISTOGARD P vismodegib ERIVEDGE P vorinostat ZOLINZA

CARDIOVASCULAR The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High is available at: https://jamanetwork.com/journals/jama/fullarticle/1791497

Guidelines for the evaluation and management of cardiovascular diseases in adults are available at: https://www.acc.org https://professional.heart.org

ACE INHIBITORS Guidelines for the use of ACE inhibitors are available at: https://jamanetwork.com/journals/jama/fullarticle/1791497 https://professional.diabetes.org https://www.acc.org https://professional.heart.org

benazepril LOTENSIN captopril enalapril VASOTEC P fosinopril P lisinopril ZESTRIL perindopril P quinapril ACCUPRIL P ramipril ALTACE

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trandolapril

ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS amlodipine/benazepril LOTREL trandolapril/ ext-rel TARKA

ACE INHIBITOR/DIURETIC COMBINATIONS benazepril/ LOTENSIN HCT captopril/hydrochlorothiazide enalapril/hydrochlorothiazide VASERETIC P fosinopril/hydrochlorothiazide P lisinopril/hydrochlorothiazide ZESTORETIC P quinapril/hydrochlorothiazide ACCURETIC

ADRENOLYTICS, CENTRAL CATAPRES clonidine transdermal CATAPRES-TTS

ALDOSTERONE RECEPTOR ANTAGONISTS eplerenone INSPRA ALDACTONE

ALPHA BLOCKERS Guidelines for the use of alpha blockers in various patient populations are available at: https://jamanetwork.com/journals/jama/fullarticle/1791497

P CARDURA P

ANGIOTENSIN II RECEPTOR ANTAGONISTS/DIURETIC COMBINATIONS Guidelines for the use of angiotensin II receptor antagonists in various patient populations are available at: https://jamanetwork.com/journals/jama/fullarticle/1791497 https://professional.diabetes.org

P candesartan P candesartan/hydrochlorothiazide P irbesartan P irbesartan/hydrochlorothiazide P losartan COZAAR P losartan/hydrochlorothiazide HYZAAR P olmesartan P olmesartan/hydrochlorothiazide P telmisartan MICARDIS P telmisartan/hydrochlorothiazide MICARDIS HCT P valsartan P valsartan/hydrochlorothiazide

Non-Preferred Agents: EDARBI

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EDARBYCLOR Your Funds patients will pay an additional charge for these brand products.

ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER COMBINATIONS P amlodipine/olmesartan AZOR P amlodipine/telmisartan P amlodipine/valsartan

ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER/DIURETIC COMBINATIONS P amlodipine/valsartan/hydrochlorothiazide P olmesartan/amlodipine/hydrochlorothiazide TRIBENZOR

ANTIARRHYTHMICS Guidelines for the use of antiarrhythmics and cardiac glycosides in various patient populations are available at: https://www.acc.org

NORPACE propafenone ext-rel RYTHMOL SR P disopyramide ext-rel NORPACE CR P MULTAQ

ANTILIPEMICS The 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol is available at: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000625

ACL Inhibitors/Combinations P bempedoic acid NEXLETOL P bempedoic acid/ezetimibe NEXLIZET

Bile Acid Resins P cholestyramine QUESTRAN/QUESTRAN LIGHT P colesevelam colestipol COLESTID

Cholesterol Absorption Inhibitors P ezetimibe ZETIA

Fibrates P fenofibrate P fenofibric acid delayed-rel TRILIPIX gemfibrozil LOPID fenofibrate ANTARA

HMG-CoA Reductase Inhibitors/Combinations P atorvastatin

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P ezetimibe/simvastatin VYTORIN P fluvastatin P lovastatin P pravastatin PRAVACHOL P rosuvastatin P simvastatin ZOCOR

Non-Preferred Agents: LIVALO Your Funds patients will pay an additional charge for these brand products.

Niacins P niacin ext-rel NIASPAN

Omega-3 Fatty Acids P omega-3 acid ethyl esters LOVAZA P icosapent ethyl VASCEPA

PCSK9 Inhibitors P alirocumab PRALUENT

BETA-BLOCKERS Guidelines for the use of beta-blockers and beta-blocker combinations in various patient populations are available at: https://jamanetwork.com/journals/jama/fullarticle/1791497 https://www.acc.org

P P COREG P carvedilol phosphate ext-rel P succinate ext-rel TOPROL-XL P metoprolol tartrate LOPRESSOR P CORGARD P P P propranolol ext-rel INDERAL LA P BYSTOLIC

BETA-BLOCKER/DIURETIC COMBINATIONS Guidelines for the use of beta-blockers and diuretic combinations in various patient populations are available at: https://jamanetwork.com/journals/jama/fullarticle/1791497 https://www.acc.org

atenolol/chlorthalidone bisoprolol/hydrochlorothiazide ZIAC metoprolol/hydrochlorothiazide LOPRESSOR HCT

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CALCIUM CHANNEL BLOCKERS Dihydropyridines P amlodipine felodipine ext-rel P nifedipine ext-rel P nifedipine ext-rel PROCARDIA XL

Nondihydropyridines P ext-rel P diltiazem ext-rel TIAZAC P verapamil ext-rel CALAN SR

CALCIUM CHANNEL BLOCKER/ANTILIPEMIC COMBINATIONS P amlodipine/atorvastatin CADUET

DIGITALIS GLYCOSIDES P 0.125 mg, 0.25 mg P digoxin ped elixir digoxin 0.0625 mg, 0.1875 mg LANOXIN

DIRECT RENIN INHIBITORS/DIURETIC COMBINATIONS P aliskiren P aliskiren/hydrochlorothiazide TEKTURNA HCT

DIURETICS Carbonic Anhydrase Inhibitors acetazolamide acetazolamide ext-rel methazolamide

Loop Diuretics bumetanide P furosemide LASIX P torsemide

Potassium-sparing Diuretics P P triamterene

Thiazides and -like Diuretics chlorthalidone P hydrochlorothiazide indapamide P metolazone

Diuretic Combinations amiloride/hydrochlorothiazide P spironolactone/hydrochlorothiazide ALDACTAZIDE P triamterene/hydrochlorothiazide DYAZIDE P triamterene/hydrochlorothiazide MAXZIDE

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HEART FAILURE P isosorbide dinitrate/hydralazine BIDIL P ivabradine CORLANOR P /valsartan ENTRESTO

NITRATES Oral P isosorbide dinitrate P isosorbide mononitrate isosorbide mononitrate ext-rel

Sublingual/Translingual P nitroglycerin lingual spray NITROLINGUAL P nitroglycerin sublingual NITROSTAT

Transdermal nitroglycerin transdermal nitroglycerin transdermal NITRO-DUR

PULMONARY ARTERIAL HYPERTENSION Receptor Antagonists P P P OPSUMIT

Phosphodiesterase Inhibitors P sildenafil P tadalafil

Prostacyclin Receptor Agonists P selexipag UPTRAVI

Prostaglandin Vasodilators P treprostinil P treprostinil ext-rel ORENITRAM

Soluble Guanylate Cyclase Stimulators P riociguat ADEMPAS

MISCELLANEOUS hydralazine P ext-rel

CENTRAL NERVOUS SYSTEM Practice guidelines for psychiatric disorders are available at: https://www.psychiatry.org

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ANTIANXIETY Benzodiazepines P alprazolam P clonazepam KLONOPIN P VALIUM P ATIVAN P oxazepam

Miscellaneous ANAFRANIL fluvoxamine

ANTICONVULSANTS Practice guidelines for the treatment of epilepsy are available at: https://www.aan.com

P TEGRETOL P carbamazepine ext-rel P carbamazepine ext-rel CARBATROL P clobazam P diazepam rectal gel DIASTAT P divalproex sodium delayed-rel DEPAKOTE P divalproex sodium ext-rel DEPAKOTE ER P ethosuximide ZARONTIN P gabapentin NEURONTIN P LAMICTAL P lamotrigine ext-rel LAMICTAL XR P lamotrigine orally disintegrating tablets LAMICTAL ODT P levetiracetam KEPPRA P levetiracetam ext-rel KEPPRA XR P TRILEPTAL P phenobarbital P DILANTIN INFATABS P phenytoin sodium extended DILANTIN P primidone MYSOLINE P rufinamide P tiagabine P TOPAMAX topiramate ext-rel P valproic acid P vigabatrin P zonisamide P lacosamide VIMPAT P oxcarbazepine ext-rel OXTELLAR XR P perampanel FYCOMPA P topiramate ext-rel TROKENDI XR

ANTIDEMENTIA Practice guidelines for the management of dementia are available at: https://www.aan.com

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P donepezil ARICEPT P galantamine RAZADYNE P galantamine ext-rel RAZADYNE ER P NAMENDA memantine ext-rel P rivastigmine P rivastigmine transdermal EXELON P memantine/donepezil NAMZARIC

ANTIDEPRESSANTS Although these agents are primarily indicated for , some of these are also approved for other indications including bipolar disorder, obsessive-compulsive disorder, panic disorder and premenstrual dysphoric disorder.

Guidelines for the evaluation and management of bipolar and depressive disorders are available at: https://www.psychiatry.org

Monoamine Oxidase Inhibitors (MAOIs) phenelzine NARDIL tranylcypromine PARNATE

Selective Reuptake Inhibitors (SSRIs) P citalopram CELEXA P escitalopram LEXAPRO P PROZAC fluoxetine 60 mg P HCl PAXIL P paroxetine HCl ext-rel PAXIL CR P sertraline ZOLOFT P VIIBRYD P TRINTELLIX

Serotonin Reuptake Inhibitors (SNRIs) P desvenlafaxine ext-rel PRISTIQ P duloxetine delayed-rel P venlafaxine P venlafaxine ext-rel EFFEXOR XR P levomilnacipran ext-rel FETZIMA

Tricyclic Antidepressants (TCAs) NORPRAMIN doxepin HCl PAMELOR

Miscellaneous Agents P P bupropion ext-rel WELLBUTRIN SR P bupropion ext-rel WELLBUTRIN XL P REMERON

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P

ANTIPARKINSONIAN AGENTS Practice guidelines for the diagnosis and treatment of Parkinson's disease are available at: https://www.aan.com

P benztropine PARLODEL P carbidopa/levodopa SINEMET P carbidopa/levodopa ext-rel P carbidopa/levodopa orally disintegrating tabs P carbidopa/levodopa/entacapone STALEVO P entacapone COMTAN P MIRAPEX P pramipexole ext-rel P rasagiline P P ropinirole ext-rel REQUIP XL P selegiline trihexyphenidyl P levodopa inhalation powder INBRIJA P transdermal NEUPRO

ANTIPSYCHOTICS Atypicals P P CLOZARIL P ZYPREXA P SEROQUEL P quetiapine ext-rel P RISPERDAL P P aripiprazole ext-rel inj ABILIFY MAINTENA P ext-rel inj ARISTADA P aripiprazole lauroxil ext-rel inj ARISTADA INITIO P VRAYLAR P LATUDA

Miscellaneous thiothixene

ATTENTION DEFICIT HYPERACTIVITY DISORDER Guidelines for the evaluation and management of attention deficit disorder are available at: https://www.aacap.org https://www.aap.org

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P /dextroamphetamine mixed salts P amphetamine/dextroamphetamine mixed salts ext-rel P atomoxetine STRATTERA dexmethylphenidate FOCALIN P dexmethylphenidate ext-rel FOCALIN XR dextroamphetamine dextroamphetamine ext-rel DEXEDRINE SPANSULE P guanfacine ext-rel P METHYLIN P methylphenidate RITALIN P methylphenidate ext-rel P amphetamine/dextroamphetamine mixed salts ext-rel MYDAYIS P lisdexamfetamine VYVANSE

FIBROMYALGIA P pregabalin P milnacipran SAVELLA

HYPNOTICS Practice parameters for the treatment of sleep disorders and clinical guidelines for the evaluation and management of chronic insomnia in adults are available at: https://aasm.org

Benzodiazepines temazepam RESTORIL

Nonbenzodiazepines P eszopiclone P ramelteon P zaleplon P zolpidem AMBIEN P zolpidem ext-rel AMBIEN CR zolpidem sublingual P suvorexant BELSOMRA

Non-Preferred Agents: EDLUAR Your Funds patients will pay an additional charge for these brand products.

Tricyclics P doxepin

Non-Preferred Agents: EDLUAR Your Funds patients will pay an additional charge for these brand products.

MIGRAINE Guidelines for prevention and management of migraine are available at: https://www.aan.com

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Acute Migraine Agents Derivatives inj D.H.E. 45 dihydroergotamine spray P ergotamine/

Selective Serotonin Agonist/ Anti-inflammatory Drug (NSAID) Combinations /naproxen sodium

Triptans P RELPAX P P MAXALT P sumatriptan IMITREX P sumatriptan inj IMITREX P sumatriptan nasal spray IMITREX P ZOMIG P, # zolmitriptan nasal spray ZOMIG P sumatriptan inj ZEMBRACE SYMTOUCH P sumatriptan nasal powder ONZETRA XSAIL

# Brand ZOMIG NASAL SPRAY remains preferred.

Miscellaneous OTC acetaminophen/aspirin/caffeine EXCEDRIN MIGRAINE P REYVOW P NURTEC ODT P UBRELVY

Preventative Migraine Agents Monoclonal Antibodies P -aooe AIMOVIG P -vfrm AJOVY P -gnlm EMGALITY

MOOD STABILIZERS lithium carbonate lithium carbonate ext-rel tabs 300 mg LITHOBID lithium carbonate ext-rel tabs 450 mg

MOVEMENT DISORDERS P tetrabenazine P deutetrabenazine AUSTEDO P valbenazine INGREZZA

MULTIPLE SCLEROSIS AGENTS Practice guidelines for multiple sclerosis are available at: https://www.aan.com

P dimethyl fumarate delayed-rel P, # glatiramer COPAXONE

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P diroximel fumarate delayed-rel VUMERITY P fingolimod GILENYA P interferon beta-1a REBIF P interferon beta-1b BETASERON P natalizumab TYSABRI P ocrelizumab OCREVUS P ofatumumab KESIMPTA P ozanimod ZEPOSIA P siponimod MAYZENT P teriflunomide AUBAGIO

# Brand COPAXONE remains preferred.

MUSCULOSKELETAL THERAPY AGENTS baclofen carisoprodol chlorzoxazone P dantrolene DANTRIUM metaxalone SKELAXIN methocarbamol ROBAXIN /aspirin/caffeine tizanidine tabs ZANAFLEX

MYASTHENIA GRAVIS pyridostigmine pyridostigmine ext-rel

NARCOLEPSY P NUVIGIL P solriamfetol SUNOSI

POSTHERPETIC NEURALGIA (PHN) P gabapentin ext-rel GRALISE P pregabalin ext-rel LYRICA CR

PSYCHOTHERAPEUTIC-MISCELLANEOUS Alcohol Deterrents acamprosate calcium disulfiram ANTABUSE

Opioid Antagonists P naloxone inj naltrexone P naloxone nasal spray NARCAN

Partial Opioid Agonists buprenorphine sublingual

Partial Opioid Agonist/ Combinations P buprenorphine/naloxone sublingual

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P buprenorphine/naloxone BUNAVAIL P buprenorphine/naloxone ZUBSOLV

Pseudobulbar Affect Agents P dextromethorphan/ NUEDEXTA

Smoking Deterrents Treating Tobacco Use and Dependence: 2008 Update-Clinical Practice Guideline is available at: https://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/index.html

OTC nicotine polacrilex gum OTC nicotine transdermal NICODERM CQ OTC nicotine polacrilex lozenge NICORETTE bupropion ext-rel varenicline CHANTIX

Vasomotor Symptom Agents P paroxetine mesylate

ENDOCRINE AND METABOLIC ACROMEGALY P lanreotide acetate SOMATULINE DEPOT

ANDROGENS Clinical practice guidelines for the treatment of hypogonadism are available at: https://www.aace.com

cypionate testosterone enanthate P testosterone gel P testosterone soln P testosterone transdermal ANDRODERM

ANTIDIABETICS Guidelines of treatment and management of diabetes are available at: https://professional.diabetes.org

Alpha-glucosidase Inhibitors acarbose PRECOSE

Amylin Analogs P SYMLINPEN

Biguanides P metformin P metformin ext-rel

Biguanide/ Combinations P glipizide/metformin

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Dipeptidyl Peptidase-4 (DPP-4) Inhibitors P saxagliptin ONGLYZA P sitagliptin phosphate JANUVIA

Non-Preferred Agents: TRADJENTA Your Funds patients will pay an additional charge for these brand products.

Dipeptidyl Peptidase-4 (DPP-4) Inhibitor/Biguanide Combinations P saxagliptin/metformin ext-rel KOMBIGLYZE XR P sitagliptin/metformin JANUMET P sitagliptin/metformin ext-rel JANUMET XR

Non-Preferred Agents: JENTADUETO JENTADUETO XR Your Funds patients will pay an additional charge for these brand products.

Incretin Mimetic Agents P TRULICITY P VICTOZA P OZEMPIC P semaglutide RYBELSUS

Incretin Mimetic Agent/Insulin Combinations P liraglutide/ XULTOPHY P / SOLIQUA

Insulins OTC, P insulin human NOVOLIN R OTC, P insulin isophane human NOVOLIN N OTC, P insulin isophane human 70%/regular 30% NOVOLIN 70/30 P insulin human HUMULIN R P insulin isophane human HUMULIN N P insulin isophane human 70%/regular 30% HUMULIN 70/30 P FIASP P insulin aspart NOVOLOG P insulin aspart protamine 70%/insulin aspart 30% NOVOLOG MIX 70/30 P insulin degludec TRESIBA P LEVEMIR P insulin glargine BASAGLAR P insulin glargine LANTUS P insulin glargine TOUJEO P insulin human HUMULIN R U-500 P HUMALOG P insulin lispro INSULIN LISPRO P insulin lispro protamine/insulin lispro HUMALOG MIX P insulin lispro-aabc LYUMJEV

Insulin Sensitizers P pioglitazone

36

Insulin Sensitizer/Biguanide Combinations P pioglitazone/metformin ACTOPLUS MET

Insulin Sensitizer/Sulfonylurea Combinations P pioglitazone/glimepiride DUETACT

Meglitinides P nateglinide P repaglinide

Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors P canagliflozin INVOKANA P dapagliflozin FARXIGA P empagliflozin JARDIANCE

Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitor/Biguanide Combinations P canagliflozin/metformin INVOKAMET P canagliflozin/metformin ext-rel INVOKAMET XR P dapagliflozin/metformin ext-rel XIGDUO XR P empagliflozin/metformin SYNJARDY P empagliflozin/metformin ext-rel SYNJARDY XR

Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitor/Dipeptidyl Peptidase-4 (DPP-4) Inhibitor Combinations P dapagliflozin/saxagliptin QTERN P empagliflozin/linagliptin GLYXAMBI

Sodium Glucose Co-Transporter 2 (SGLT2) Inhibitor/Dipeptidyl Peptidase-4 (DPP-4) Inhibitor/Biguanide Combinations P empagliflozin/linagliptin/metformin ext-rel TRIJARDY XR

Sulfonylureas P glimepiride AMARYL P glipizide GLUCOTROL P glipizide ext-rel GLUCOTROL XL

Supplies OTC, P insulin syringes, needles BD ULTRAFINE insulin syringes and needles OTC lancets P blood glucose continuous monitoring receivers, sensors FREESTYLE LIBRE CONTINUOUS GLUCOSE MONITORING SYSTEM P blood glucose continuous monitoring receivers, sensors, DEXCOM CONTINUOUS transmitters GLUCOSE MONITORING SYSTEM P blood glucose monitoring kits, test strips ACCU-CHEK AVIVA PLUS kits and test strips P blood glucose monitoring kits, test strips ACCU-CHEK COMPACT PLUS kits and test strips P blood glucose monitoring kits, test strips ACCU-CHEK GUIDE kits and

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test strips P blood glucose monitoring kits, test strips ACCU-CHEK SMARTVIEW kits and test strips P blood glucose monitoring kits, test strips ONETOUCH ULTRA kits and test strips P blood glucose monitoring kits, test strips ONETOUCH VERIO kits and test strips P insulin infusion disposable pump OMNIPOD DASH INSULIN INFUSION PUMP P insulin infusion disposable pump OMNIPOD INSULIN INFUSION PUMP P insulin infusion disposable pump V-GO INSULIN INFUSION PUMP

ANTIOBESITY Guidelines of treatment and management of obesity are available at: https://www.aace.com https://www.nhlbi.nih.gov/health-topics/managing-overweight-obesity-in-adults

P liraglutide SAXENDA

CALCIUM RECEPTOR ANTAGONISTS P cinacalcet

CALCIUM REGULATORS Guidelines of treatment and management of osteoporosis are available at: https://www.aace.com https://www.nof.org

Bisphosphonates P alendronate FOSAMAX P ibandronate BONIVA P risedronate ACTONEL risedronate delayed-rel ATELVIA

Calcitonins P -salmon spray

Parathyroid Hormones P TYMLOS P FORTEO

Miscellaneous P denosumab PROLIA

CARNITINE DEFICIENCY AGENTS P levocarnitine

CONTRACEPTIVES EE = ethinyl

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Monophasic 20 mcg Estrogen P /EE 3/20 YAZ P drospirenone/EE/levomefolate 3/20 and levomefolate /EE 0.1/20 - Lessina P norethindrone acetate/EE 1/20 P norethindrone acetate/EE 1/20 and iron P norethindrone acetate/EE 1/20 and iron TAYTULLA P norethindrone acetate/EE 1/20 and iron chewable

30 mcg Estrogen /EE 0.15/30 P drospirenone/EE 3/30 YASMIN P drospirenone/EE/levomefolate 3/30 and levomefolate levonorgestrel/EE 0.15/30 - Levora P norethindrone acetate/EE 1.5/30 P norethindrone acetate/EE 1.5/30 and iron /EE 0.3/30 - Low-Ogestrel

35 mcg Estrogen ethynodiol diacetate/EE 1/35 - Zovia 1/35 norethindrone/EE 0.5/35 norethindrone/EE 1/35 /EE 0.25/35

Biphasic desogestrel/EE MIRCETTE P norethindrone acetate/EE 1/10 and EE 10 and iron LO LOESTRIN FE

Triphasic desogestrel/EE levonorgestrel/EE - Trivora norethindrone/EE P norgestimate/EE

Four Phase P estradiol valerate and /estradiol valerate NATAZIA

Extended Cycle P levonorgestrel/EE 0.1/20 and EE 10 LOSEASONIQUE P levonorgestrel/EE 0.15/30 P levonorgestrel/EE 0.15/30 and EE 10 SEASONIQUE

Progestin Only norethindrone norethindrone ORTHO MICRONOR

Injectable acetate 150 mg/mL DEPO-PROVERA

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Progestin Intrauterine Devices P levonorgestrel releasing IUD KYLEENA P levonorgestrel releasing IUD MIRENA P levonorgestrel releasing IUD SKYLA

Transdermal P /EE

Vaginal P /EE ring P acetate/EE ring ANNOVERA

ENDOMETRIOSIS P elagolix ORILISSA

FERTILITY REGULATORS GNRH/LHRH Antagonists P cetrorelix CETROTIDE

Ovulation Stimulants, Gonadotropins P choriogonadotropin alfa OVIDREL P follitropin alfa GONAL-F

Ovulation Stimulants, Synthetic clomiphene

GAUCHER DISEASE P eliglustat CERDELGA P imiglucerase CEREZYME

GLUCOCORTICOIDS P P P CORTEF P MEDROL P P

GLUCOSE ELEVATING AGENTS P nasal powder BAQSIMI P glucagon subcutaneous soln GVOKE P glucagon, human recombinant GLUCAGEN HYPOKIT P glucagon, human recombinant GLUCAGON EMERGENCY KIT

HEREDITARY TYROSINEMIA TYPE 1 AGENTS P nitisinone ORFADIN

HUMAN GROWTH HORMONES Guidelines for use of are available at: https://www.aace.com/publications/guidelines

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P somatropin NORDITROPIN

HYPERPARATHYROID TREATMENT, VITAMIN D ANALOGS calcitriol (1,25-D3) ROCALTROL doxercalciferol HECTOROL paricalcitol ZEMPLAR

MENOPAUSAL SYMPTOM AGENTS Guidelines of treatment and management of and menopause are available at: https://www.menopause.org https://www.aace.com/files/menopause.pdf

Oral EE/norethindrone acetate - Jinteli P estradiol ESTRACE P estradiol/norethindrone P , conjugated PREMARIN P estrogens, conjugated/bazedoxifene DUAVEE P estrogens, conjugated/medroxyprogesterone PREMPHASE P estrogens, conjugated/medroxyprogesterone PREMPRO

Transdermal P estradiol P estradiol CLIMARA P estradiol VIVELLE-DOT P estradiol DIVIGEL P estradiol EVAMIST P estradiol/levonorgestrel CLIMARA PRO P estradiol/norethindrone acetate COMBIPATCH

Vaginal P estradiol vaginal crm P estradiol vaginal tabs VAGIFEM P estradiol ESTRING P estrogens, conjugated crm PREMARIN

PHOSPHATE BINDER AGENTS P calcium acetate P lanthanum carbonate P sevelamer carbonate P calcium acetate PHOSLYRA P sucroferric oxyhydroxide VELPHORO

POLYNEUROPATHY P inotersen TEGSEDI

POTASSIUM-REMOVING AGENTS P patiromer sorbitex VELTASSA P sodium zirconium cyclosilicate LOKELMA

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PROGESTINS Oral P medroxyprogesterone acetate PROVERA P susp norethindrone acetate AYGESTIN P , micronized PROMETRIUM

Vaginal P progesterone gel CRINONE P progesterone vaginal inserts ENDOMETRIN

SELECTIVE MODULATORS P raloxifene EVISTA P ospemifene OSPHENA

THYROID AGENTS Antithyroid Agents methimazole TAPAZOLE propylthiouracil

Thyroid Supplements P P, # levothyroxine SYNTHROID levothyroxine - Levoxyl P liothyronine CYTOMEL

# Brand SYNTHROID remains preferred.

UREA CYCLE DISORDERS P sodium phenylbutyrate

UTERINE FIBROIDS P elagolix sodium/estradiol/norethindrone acetate ORIAHNN

VASOPRESSINS desmopressin spray, tabs DDAVP

MISCELLANEOUS P cysteamine bitartrate CYSTAGON

GASTROINTESTINAL Guidelines for the treatment and management of various gastrointestinal diseases/conditions are available at: https://gi.org https://www.gastro.org

ANTIDIARRHEALS OTC loperamide IMODIUM A-D P diphenoxylate/ LOMOTIL P loperamide

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ANTIEMETICS P P /pyridoxine delayed-rel P MARINOL P P P REGLAN P ZOFRAN P P P transdermal P TIGAN P granisetron transdermal SANCUSO P VARUBI

ANTISPASMODICS dicyclomine sulfate LEVSIN hyoscyamine sulfate ext-rel hyoscyamine sulfate orally disintegrating tabs

CHOLELITHOLYTICS ursodiol ACTIGALL ursodiol URSO

H2 RECEPTOR ANTAGONISTS OTC TAGAMET HB 200 OTC famotidine PEPCID AC cimetidine P famotidine PEPCID

INFLAMMATORY BOWEL DISEASE Oral Agents P balsalazide P delayed-rel caps P budesonide ext-rel P mesalamine delayed-rel caps P, # mesalamine delayed-rel tabs LIALDA P mesalamine ext-rel caps P sulfasalazine AZULFIDINE P sulfasalazine delayed-rel AZULFIDINE EN-TABS P mesalamine ext-rel caps PENTASA

# Brand LIALDA remains preferred.

Rectal Agents P hydrocortisone P mesalamine supp P mesalamine susp ROWASA P foam CORTIFOAM

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IRRITABLE BOWEL SYNDROME Irritable Bowel Syndrome with Constipation P, # lubiprostone AMITIZA P linaclotide LINZESS

# Brand AMITIZA remains preferred.

Non-Preferred Agents: MOTEGRITY TRULANCE Your Funds patients will pay an additional charge for these brand products.

Irritable Bowel Syndrome with P P eluxadoline VIBERZI

LAXATIVES OTC 3350 MIRALAX P soln P peg 3350/electrolytes GOLYTELY P peg 3350/electrolytes NULYTELY P /potassium sulfate/ SUPREP

OPIOID-INDUCED CONSTIPATION P naloxegol MOVANTIK

Non-Preferred Agents: RELISTOR TABLETS SYMPROIC Your Funds patients will pay an additional charge for these brand products.

PANCREATIC ENZYMES P pancrelipase VIOKACE P pancrelipase delayed-rel CREON P pancrelipase delayed-rel ZENPEP

PROSTAGLANDINS misoprostol CYTOTEC

PROTON PUMP INHIBITORS OTC omeprazole magnesium delayed-rel PRILOSEC OTC P esomeprazole delayed-rel P lansoprazole delayed-rel P omeprazole delayed-rel PRILOSEC P pantoprazole delayed-rel P dexlansoprazole delayed-rel DEXILANT

SALIVA STIMULANTS cevimeline EVOXAC pilocarpine tabs SALAGEN

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STEROIDS, RECTAL hydrocortisone crm ANUSOL-HC P hydrocortisone acetate/pramoxine foam PROCTOFOAM-HC

ULCER THERAPY COMBINATIONS lansoprazole + amoxicillin + clarithromycin P bismuth/metronidazole/tetracycline PYLERA

MISCELLANEOUS P sucralfate

GENITOURINARY BENIGN PROSTATIC HYPERPLASIA Guidelines for the management of BPH are available at: https://www.auanet.org/guidelines

P ext-rel P dutasteride AVODART P dutasteride/ P finasteride PROSCAR P P tamsulosin FLOMAX

ERECTILE DYSFUNCTION Guidelines for the management of erectile dysfunction are available at: https://www.auanet.org/guidelines

Alprostadil Agents P alprostadil supp MUSE

Phosphodiesterase Inhibitors P sildenafil P tadalafil

URINARY ANTISPASMODICS P darifenacin ext-rel P oxybutynin P oxybutynin ext-rel DITROPAN XL P solifenacin P tolterodine DETROL P tolterodine ext-rel P trospium P trospium ext-rel P mirabegron ext-rel MYRBETRIQ

Non-Preferred Agents: GELNIQUE OXYTROL TOVIAZ Your Funds patients will pay an additional charge for these brand products.

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VAGINAL ANTI-INFECTIVES OTC clotrimazole GYNE-LOTRIMIN OTC MONISTAT OTC tioconazole VAGISTAT-1 clindamycin crm CLEOCIN metronidazole terconazole

MISCELLANEOUS OTC phenazopyridine bethanechol potassium citrate ext-rel UROCIT-K

HEMATOLOGIC Guidelines of treatment and management of hemophilia are available at: https://www.hemophilia.org

ANTICOAGULANTS CHEST guidelines are available at: https://www.chestnet.org/Guidelines-and-Resources/CHEST-Guideline-Topic-Areas/Pulmonary-Vascular

Injectable enoxaparin dalteparin FRAGMIN

Oral P warfarin P apixaban ELIQUIS P rivaroxaban XARELTO

Synthetic Heparinoid-like Agents fondaparinux ARIXTRA

HEMATOPOIETIC GROWTH FACTORS Guidelines for the management of neutropenia are available at: https://www.asco.org Guidelines for the management of anemia associated with chronic disease are available at: https://www.kidney.org/professionals/guidelines#guidelines

P darbepoetin alfa ARANESP P epoetin alfa-epbx RETACRIT P filgrastim-aafi NIVESTYM P pegfilgrastim-bmez ZIEXTENZO

HEMOPHILIA A AGENTS P antihemophilic factor (recombinant) KOGENATE FS P antihemophilic factor (recombinant) KOVALTRY P antihemophilic factor (recombinant) NOVOEIGHT P antihemophilic factor (recombinant) pegylated ADYNOVATE P antihemophilic factor (recombinant) pegylated-aucl JIVI P human coagulation factor VIII (rDNA) simoctocog alfa NUWIQ

46

HEMOPHILIA B AGENTS P coagulation factor IX (recombinant), glycopegylated REBINYN

PLATELET AGGREGATION INHIBITORS OTC aspirin P clopidogrel P dipyridamole ext-rel/aspirin AGGRENOX P prasugrel P ticagrelor BRILINTA

PLATELET SYNTHESIS INHIBITORS AGRYLIN

THROMBOCYTOPENIA AGENTS P avatrombopag DOPTELET P lusutrombopag MULPLETA

MISCELLANEOUS

IMMUNOLOGIC AGENTS Guidelines for the management of rheumatic diseases are available at: https://www.rheumatology.org

ALLERGENIC EXTRACTS P grass mixed pollen allergen extract ORALAIR P ragweed pollen allergen extract RAGWITEK P timothy grass pollen allergen extract GRASTEK

AUTOIMMUNE AGENTS (PHYSICIAN-ADMINISTERED) P golimumab SIMPONI ARIA P infliximab REMICADE P ustekinumab STELARA INTRAVENOUS

AUTOIMMUNE AGENTS (SELF-ADMINISTERED) Ankylosing Spondylitis P adalimumab HUMIRA P etanercept ENBREL P secukinumab COSENTYX

Crohn's Disease P adalimumab HUMIRA P, ‡ ustekinumab STELARA SUBCUTANEOUS

‡ After failure of HUMIRA

Psoriasis P adalimumab HUMIRA P OTEZLA

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P guselkumab TREMFYA P ixekizumab TALTZ P risankizumab-rzaa SKYRIZI P ustekinumab STELARA SUBCUTANEOUS

Psoriatic Arthritis P adalimumab HUMIRA P apremilast OTEZLA P etanercept ENBREL P secukinumab COSENTYX

Rheumatoid Arthritis P abatacept ORENCIA CLICKJECT P abatacept ORENCIA SUBCUTANEOUS P adalimumab HUMIRA P etanercept ENBREL P sarilumab KEVZARA P tofacitinib XELJANZ P tofacitinib ext-rel XELJANZ XR P upadacitinib RINVOQ

Ulcerative Colitis P adalimumab HUMIRA P, ‡ tofacitinib XELJANZ P, ‡ tofacitinib ext-rel XELJANZ XR P, ‡ ustekinumab STELARA SUBCUTANEOUS

‡ After failure of HUMIRA

All Other Conditions P adalimumab HUMIRA P etanercept ENBREL

DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs) hydroxychloroquine PLAQUENIL leflunomide ARAVA methotrexate P methotrexate auto-injector RASUVO

HEREDITARY ANGIOEDEMA P, # FIRAZYR P C1 esterase inhibitor, recombinant RUCONEST P lanadelumab-flyo TAKHZYRO

# Brand FIRAZYR remains preferred.

IMMUNOSUPPRESSANTS Antimetabolites azathioprine IMURAN P mycophenolate mofetil P mycophenolate sodium delayed-rel

48

azathioprine AZASAN

Calcineurin Inhibitors P cyclosporine P cyclosporine, modified P tacrolimus

Rapamycin Derivatives P everolimus P

NUTRITIONAL/SUPPLEMENTS ELECTROLYTES Potassium potassium chloride ext-rel P potassium chloride liquid

Miscellaneous OTC electrolyte soln, oral PEDIALYTE

VITAMINS AND MINERALS Folic Acid/Combinations folic acid folic acid/vitamin B6/vitamin B12

Miscellaneous OTC calcium carbonate OTC ferrous sulfate FEOSOL OTC multivitamins/minerals CENTRUM cyanocobalamin inj fluoride drops, tabs multivitamins/fluoride drops, tabs multivitamins/fluoride/iron drops, tabs vitamin ADC/fluoride drops vitamin ADC/fluoride/iron drops

RESPIRATORY Guidelines to the management, prevention, or treatment of COPD and asthma are available at: https://www.aaaai.org https://ginasthma.org https://goldcopd.org https://www.nhlbi.nih.gov

The Report and guidelines for allergy-related conditions are available at: https://www.aaaai.org

ANAPHYLAXIS TREATMENT AGENTS P epinephrine auto-injector P, # epinephrine auto-injector EPIPEN P, # epinephrine auto-injector EPIPEN JR.

49

P epinephrine SYMJEPI

# Brands EPIPEN and EPIPEN JR remain preferred.

ANTICHOLINERGICS P ipratropium soln P ipratropium, CFC-free aerosol ATROVENT HFA P revefenacin inhalation soln YUPELRI P tiotropium SPIRIVA P umeclidinium INCRUSE ELLIPTA

ANTICHOLINERGIC/BETA AGONIST COMBINATIONS Short Acting P ipratropium/albuterol soln

Long Acting P glycopyrrolate/ BEVESPI AEROSPHERE P tiotropium/olodaterol STIOLTO RESPIMAT P umeclidinium/ ANORO ELLIPTA

ANTICHOLINERGIC/BETA AGONIST/STEROID INHALANT COMBINATIONS P budesonide/glycopyrrolate/formoterol BREZTRI AEROSPHERE P fluticasone/umeclidinium/vilanterol TRELEGY ELLIPTA

ANTIHISTAMINES, LOW SEDATING OTC ZYRTEC levocetirizine

ANTIHISTAMINES, NONSEDATING OTC CLARITIN OTC ALLEGRA

ANTIHISTAMINES, SEDATING OTC chlorpheniramine 4 mg CHLOR-TRIMETON ALLERGY OTC 1.34 mg OTC BENADRYL clemastine 2.68 mg HCl

ANTIHISTAMINE/DECONGESTANT COMBINATIONS OTC cetirizine/ ext-rel ZYRTEC-D 12 HOUR OTC /pseudoephedrine ext-rel 6 mg/120 mg DRIXORAL OTC loratadine/pseudoephedrine ext-rel CLARITIN-D

ANTITUSSIVES Clinical practice guidelines are available at: https://journal.chestnet.org/article/S0012-3692(15)52856-0/pdf

benzonatate TESSALON

50

ANTITUSSIVE COMBINATIONS Opioid codeine/guaifenesin liquid codeine/guaifenesin/pseudoephedrine codeine/promethazine codeine/promethazine/ hydrocodone/homatropine

Non-opioid OTC dextromethorphan/guaifenesin ROBITUSSIN-DM dextromethorphan//pseudoephedrine dextromethorphan/promethazine

BETA AGONISTS Inhalants Short Acting P albuterol soln P albuterol sulfate, CFC-free aerosol P levalbuterol tartrate, CFC-free aerosol

Long Acting Hand-held Active Inhalation P olodaterol, CFC-free aerosol STRIVERDI RESPIMAT P xinafoate SEREVENT

Nebulized Passive Inhalation P formoterol inhalation soln PERFOROMIST

Oral Agents albuterol albuterol ext-rel

CYSTIC FIBROSIS P tobramycin inhalation soln P, # tobramycin inhalation soln BETHKIS

# Brand BETHKIS remains preferred.

LEUKOTRIENE MODULATORS P SINGULAIR P zafirlukast P zileuton ext-rel

MAST CELL STABILIZERS cromolyn soln

NASAL ANTIHISTAMINES P azelastine spray P spray PATANASE

51

NASAL STEROIDS/COMBINATIONS P, # azelastine/fluticasone spray DYMISTA P flunisolide spray P fluticasone spray P spray

# Brand DYMISTA remains preferred

Non-Preferred Agents: BECONASE AQ OMNARIS QNASL QNASL CHILDRENS ZETONNA Your Funds patients will pay an additional charge for these brand products.

PHOSPHODIESTERASE-4 INHIBITORS P DALIRESP

PULMONARY ENZYME DEFICIENCY AGENTS P alpha-1 proteinase inhibitor PROLASTIN-C

PULMONARY FIBROSIS AGENTS P nintedanib OFEV P pirfenidone ESBRIET

SEVERE ASTHMA AGENTS P benralizumab FASENRA P dupilumab DUPIXENT P mepolizumab NUCALA P omalizumab XOLAIR

STEROID/BETA AGONIST COMBINATIONS P, # budesonide/formoterol SYMBICORT P, # fluticasone/salmeterol ADVAIR DISKUS P fluticasone/salmeterol, CFC-free aerosol ADVAIR HFA P fluticasone/vilanterol BREO ELLIPTA

# Brands ADVAIR DISKUS and SYMBICORT remain preferred.

STEROID INHALANTS P budesonide inhalation susp PULMICORT RESPULES P beclomethasone breath-activated aerosol QVAR REDIHALER P budesonide PULMICORT FLEXHALER P fluticasone ARNUITY ELLIPTA P fluticasone FLOVENT DISKUS P fluticasone, CFC-free aerosol FLOVENT HFA P mometasone ASMANEX

XANTHINES ext-rel tabs

52

MISCELLANEOUS ipratropium spray

TOPICAL DERMATOLOGY Acne Guidelines for the care and treatment of acne vulgaris are available at: https://www.aad.org/practicecenter/quality/clinical-guidelines

Oral isotretinoin P isotretinoin ABSORICA

Topical OTC benzoyl peroxide P adapalene P, # adapalene/benzoyl peroxide EPIDUO P benzoyl peroxide BENZAC AC P clindamycin gel P clindamycin gel, lotion, soln CLEOCIN T P clindamycin/benzoyl peroxide clindamycin/tretinoin erythromycin gel 2% P erythromycin soln P erythromycin/benzoyl peroxide BENZAMYCIN sulfacetamide lotion 10% KLARON P, # tazarotene TAZORAC P tretinoin P tretinoin RETIN-A P tretinoin - Avita tretinoin gel microsphere adapalene/benzoyl peroxide EPIDUO FORTE P clindamycin/benzoyl peroxide ONEXTON

# Brands EPIDUO and TAZORAC remain preferred.

Actinic Keratosis P fluorouracil crm 5%, soln 5%, soln 2% P, # ZYCLARA P fluorouracil crm 4% TOLAK P PICATO

# Brand ZYCLARA remains preferred.

Antibiotics OTC OTC /polymyxin B/bacitracin NEOSPORIN OTC polymyxin B/bacitracin POLYSPORIN P gentamicin P oint

53

SILVADENE

Antifungals OTC clotrimazole LOTRIMIN AF OTC miconazole MICATIN OTC tolnaftate TINACTIN OTC terbinafine LAMISIL AT P ciclopirox LOPROX P clotrimazole P econazole P P luliconazole P, # naftifine NAFTIN P nystatin

# Brand NAFTIN remains preferred.

Antipsoriatics Guidelines of care for the management and treatment of psoriasis with topical therapies are available at: https://www.aad.org

Oral P acitretin SORIATANE P methoxsalen oral OXSORALEN-ULTRA

Topical P calcipotriene P calcipotriene/ P calcipotriene/betamethasone ENSTILAR

Antiseborrheics P ketoconazole shampoo 2% P selenium sulfide lotion 2.5%

Atopic Dermatitis Guidelines for the treatment of atopic dermatitis are available at: https://www.aad.org/practicecenter/quality/clinical-guidelines

Injectable P dupilumab DUPIXENT

Topical P pimecrolimus P tacrolimus P EUCRISA

Corticosteroids Low OTC hydrocortisone crm, oint 0.5%, 1% CORTIZONE crm, oint 0.05% P crm, lotion, oint 0.05% DESOWEN

54

acetonide soln 0.01% P hydrocortisone crm 2.5% P hydrocortisone lotion 1%

Medium Potency crm, lotion, oint 0.1% crm, oint 0.05% crm, oint 0.025% crm, lotion 0.05%, oint 0.005% P crm, lotion, oint, soln 0.1% crm, oint 0.2% P mometasone crm, lotion, oint 0.1% P acetonide crm, lotion 0.025% P crm, lotion, oint 0.1%

High Potency betamethasone dipropionate augmented crm 0.05% DIPROLENE AF betamethasone dipropionate augmented lotion 0.05% betamethasone dipropionate crm, lotion, oint 0.05% P desoximetasone crm, oint 0.25%, gel 0.05% diacetate crm 0.05% P crm, gel, oint, soln 0.05% triamcinolone acetonide crm 0.5% P halobetasol propionate lotion 0.01% BRYHALI

Very High Potency betamethasone dipropionate augmented gel, oint 0.05% DIPROLENE P propionate crm, gel, oint, soln 0.05% TEMOVATE P foam 0.05% P clobetasol propionate lotion, shampoo 0.05% CLOBEX oint 0.05% halobetasol propionate crm, oint 0.05% ULTRAVATE

Emollients ammonium lactate 12%

Local Analgesics P lidocaine patch LIDODERM

Local Anesthetics OTC lidocaine LMX-4 lidocaine/prilocaine

Rosacea P azelaic acid gel P doxycycline monohydrate delayed-rel caps P metronidazole crm 0.75% METROCREAM P metronidazole gel 0.75% P metronidazole gel 1% METROGEL P metronidazole lotion 0.75% METROLOTION P azelaic acid foam FINACEA FOAM

55

P ivermectin SOOLANTRA

Scabicides and Pediculicides OTC permethrin creme rinse 1% NIX OTC pyrethrins/piperonyl butoxide shampoo 4% A-200 OTC pyrethrins/piperonyl butoxide shampoo 4% RID malathion OVIDE permethrin 5%

Miscellaneous Skin and Mucous Membrane OTC salicylic acid 17%/collodion DUOFILM imiquimod podofilox CONDYLOX

MOUTH/THROAT/DENTAL AGENTS Anesthetics - Topical Oral lidocaine viscous

Protectants - Mouth/Throat P benzyl alcohol/carbomer 941/glycerin MUGARD P soy phospholipid/ dioleate EPISIL

Steroids - Mouth/Throat triamcinolone paste

OPHTHALMIC Preferred Practice Pattern Guidelines for the treatment of various ophthalmic conditions are available at: https://one.aao.org

Antiallergics OTC ZADITOR OTC olopatadine PATADAY P azelastine P cromolyn sodium P olopatadine P LASTACAFT P olopatadine PAZEO

Anti-infectives bacitracin P ciprofloxacin soln CILOXAN P erythromycin P gentamicin P levofloxacin P moxifloxacin P moxifloxacin VIGAMOX neomycin/polymyxin B/gramicidin P ofloxacin OCUFLOX polymyxin B/bacitracin polymyxin B/trimethoprim POLYTRIM P sulfacetamide oint 10%

56

P sulfacetamide soln 10% BLEPH-10 P tobramycin TOBREX P besifloxacin BESIVANCE P ciprofloxacin oint CILOXAN

Anti-infective/Anti-inflammatory Combinations P neomycin/polymyxin B/bacitracin/hydrocortisone oint P neomycin/polymyxin B/dexamethasone MAXITROL neomycin/polymyxin B/hydrocortisone susp sulfacetamide/prednisolone phosphate 10%/0.25% P tobramycin/dexamethasone susp 0.3%/0.1% TOBRADEX P tobramycin/dexamethasone oint 0.3%/0.1% TOBRADEX P tobramycin/dexamethasone susp 0.3%/0.05% TOBRADEX ST

Anti-inflammatories Nonsteroidal P bromfenac sodium P diclofenac sodium P ketorolac ACULAR P ketorolac ACUVAIL P nepafenac ILEVRO P nepafenac NEVANAC

Steroidal P dexamethasone sodium phosphate P P 1% P dexamethasone MAXIDEX P DUREZOL P fluorometholone FML FORTE P fluorometholone FML S.O.P. P prednisolone acetate PRED MILD prednisolone phosphate 1%

Antivirals P trifluridine

Beta-blockers Nonselective P maleate TIMOPTIC timolol maleate gel P timolol hemihydrate BETIMOL

Selective P BETOPTIC S

Carbonic Anhydrase Inhibitors Topical P dorzolamide TRUSOPT

57

P brinzolamide AZOPT

Carbonic Anhydrase Inhibitor/Beta-blocker Combinations P dorzolamide/timolol maleate COSOPT

Carbonic Anhydrase Inhibitor/Sympathomimetic Combinations P brinzolamide/ SIMBRINZA

Dry Eye Disease P cyclosporine, emulsion RESTASIS P XIIDRA

Prostaglandins P latanoprost XALATAN P travoprost P bimatoprost 0.01% LUMIGAN P tafluprost ZIOPTAN

Retinal Disorders P aflibercept EYLEA P ranibizumab LUCENTIS

Rho Kinase Inhibitors P netarsudil RHOPRESSA

Rho Kinase Inhibitor/ Combinations P netarsudil/latanoprost ROCKLATAN

Sympathomimetics P, # brimonidine ALPHAGAN P P brimonidine 0.2%

# Brand ALPHAGAN P remains preferred.

Sympathomimetic/Beta-blocker Combinations P brimonidine/timolol COMBIGAN

OTIC Clinical practice guidelines for the treatment of otitis media are available at: https://www.aap.org

Anti-infectives P acetic acid P ofloxacin otic

Anti-infective/Anti-inflammatory Combinations P ciprofloxacin/dexamethasone P neomycin/polymyxin B/hydrocortisone

Miscellaneous OTC carbamide peroxide 6.5% DEBROX

58

FUNDS' WEBSITE For more information about the Funds' drug benefit, please access our website at: https://www.umwafunds.org Frequently Used Telephone Numbers: CVS Caremark Customer Care Phone 1-800-294-4741

CVS Caremark Prior Authorization Phone 1-800-294-5979 Fax 1-888-836-0730

CVS Specialty Phone 1-800-237-2767 Fax 1-866-295-2778

The Funds Call Center (Beckley, WV) Phone 1-800-291-1425

59

WEBSITES For more information about the Funds' drug benefit, please access our website at: American College of Chest Physicians https://www.umwafunds.org https://www.chestnet.org

Agency for Healthcare Research and Quality American College of Gastroenterology https://www.ahrq.gov https://gi.org

Alzheimer's Association American College of Physicians https://www.alz.org https://www.acponline.org

American Academy of Allergy, Asthma and American College of Rheumatology Immunology https://www.rheumatology.org https://www.aaaai.org American Congress of Obstetricians and American Academy of Child & Adolescent Gynecologists Psychiatry https://www.acog.org https://www.aacap.org American Diabetes Association American Academy of Dermatology http://www.diabetes.org https://www.aad.org American Gastroenterological Association American Academy of Neurology https://www.gastro.org https://www.aan.com American Society Committee for American Academy of Ophthalmology Headache Education https://www.aao.org https://americanheadachesociety.org

American Academy of Pediatrics American Heart Association https://www.aap.org https://professional.heart.org

American Association for the Study of Liver American Lung Association Disease https://www.lung.org https://www.aasld.org American Medical Association American Association of Clinical https://www.ama-assn.org Endocrinologists https://www.aace.com American Psychiatric Association https://www.psychiatry.org American Association of Diabetes Educators https://www.diabeteseducator.org American Society of Anesthesiologists https://www.asahq.org American Cancer Society https://www.cancer.org American Society of Clinical Oncology https://www.asco.org American College of Allergy, Asthma and Immunology American Society of Interventional Pain https://www.acaai.org Physicians https://www.asipp.org American College of Cardiology https://www.acc.org

60

American Urological Association National Agricultural Library https://www.auanet.org https://www.nal.usda.gov

Centers for Disease Control and Prevention National Cancer Institute https://www.cdc.gov https://www.cancer.gov/about-cancer

Centers for Disease Control and Prevention National Comprehensive Cancer Network Guideline topics: AIDS https://www.nccn.org https://www.cdc.gov/hiv/default.html National Foundation for Infectious Diseases Centers for Disease Control and Prevention http://www.nfid.org Guideline topics: Sexually Transmitted Diseases https://www.cdc.gov/std/treatment/default.htm National Guideline Clearinghouse https://www.ahrq.gov CVS Caremark https://www.caremark.com National Heart, Lung and Blood Institute https://www.nhlbi.nih.gov The Food and Drug Administration https://www.fda.gov National Institutes of Health https://www.nih.gov Global Initiative for Asthma https://ginasthma.org National Kidney Foundation https://www.kidney.org Infectious Diseases Society of America https://www.idsociety.org National Osteoporosis Foundation https://www.nof.org Institute for Safe Medication Practices https://www.ismp.org North American Menopause Society https://www.menopause.org Johns Hopkins AIDS Service https://www.thebody.com/content/art12096.html United Mine Workers of America Health and Retirement Funds Juvenile Diabetes Research Foundation https://www.umwafunds.org International https://www.jdrf.org United States Department of Health and Human Services MedWatch https://www.hhs.gov https://www.fda.gov/Safety/MedWatch/default.htm World Health Organization https://www.who.int

61

INDEX

ALKERAN, 21 A ALLEGRA, 50 A-200, 56 allopurinol, 16 abacavir tabs, 20 alosetron, 44 abacavir/dolutegravir/lamivudine, 19 alpha-1 proteinase inhibitor, 52 abacavir/lamivudine, 19 ALPHAGAN P, 58 abaloparatide, 38 alprazolam, 29 abatacept, 48 alprostadil supp, 45 ABILIFY MAINTENA, 31 ALTACE, 23 abiraterone, 22 ALUNBRIG, 22 ABSORICA, 53 amantadine, 31 acamprosate calcium, 34 AMARYL, 37 acarbose, 35 AMBIEN, 32 ACCU-CHEK AVIVA PLUS kits and test strips, 37 AMBIEN CR, 32 ACCU-CHEK COMPACT PLUS kits and test strips, 37 ambrisentan, 28 ACCU-CHEK GUIDE kits and test strips, 38 amiloride, 27 ACCU-CHEK SMARTVIEW kits and test strips, 38 amiloride/hydrochlorothiazide, 27 ACCUPRIL, 23 amiodarone, 25 ACCURETIC, 24 AMITIZA, 44 acetaminophen, 16 amitriptyline, 30 acetaminophen/aspirin/caffeine, 33 amlodipine, 27 acetazolamide, 27 amlodipine/atorvastatin, 27 acetazolamide ext-rel, 27 amlodipine/benazepril, 24 acetic acid, 58 amlodipine/olmesartan, 25 acitretin, 54 amlodipine/telmisartan, 25 ACTIGALL, 43 amlodipine/valsartan, 25 ACTONEL, 38 amlodipine/valsartan/hydrochlorothiazide, 25 ACTOPLUS MET, 37 ammonium lactate 12%, 55 ACULAR, 57 amoxicillin, 18 ACUVAIL, 57 amoxicillin/clavulanate, 18 acyclovir caps, tabs, 21 amoxicillin/clavulanate ext-rel, 18 adalimumab, 47, 48 amphetamine/dextroamphetamine mixed salts, 32 adapalene, 53 amphetamine/dextroamphetamine mixed salts ext-rel, 32 adapalene/benzoyl peroxide, 53 ampicillin, 18 ADEMPAS, 28 ANAFRANIL, 29 ADVAIR DISKUS, 52 anagrelide, 47 ADVAIR HFA, 52 anastrozole, 22 ADVIL, 16 ANDRODERM, 35 ADYNOVATE, 46 ANNOVERA, 40 AFINITOR, 22 ANORO ELLIPTA, 50 aflibercept, 58 ANTABUSE, 34 AGGRENOX, 47 ANTARA, 25 AGRYLIN, 47 antihemophilic factor (recombinant), 46 AIMOVIG, 33 antihemophilic factor (recombinant) pegylated, 46 AJOVY, 33 antihemophilic factor (recombinant) pegylated-aucl, 46 albuterol, 51 ANUSOL-HC, 45 albuterol ext-rel, 51 apalutamide, 22 albuterol soln, 51 apixaban, 46 albuterol sulfate, CFC-free aerosol, 51 apremilast, 47, 48 alcaftadine, 56 aprepitant, 43 alclometasone crm, oint 0.05%, 54 ARANESP, 46 ALDACTAZIDE, 27 ARAVA, 48 ALDACTONE, 24 ARICEPT, 30 ALECENSA, 22 ARIMIDEX, 22 alectinib, 22 aripiprazole, 31 alendronate, 38 aripiprazole ext-rel inj, 31 ALEVE, 16 aripiprazole lauroxil ext-rel inj, 31 alfuzosin ext-rel, 45 ARISTADA, 31 alirocumab, 26 ARISTADA INITIO, 31 aliskiren, 27 ARIXTRA, 46 aliskiren/hydrochlorothiazide, 27

62

armodafinil, 34 BETASERON, 34 ARNUITY ELLIPTA, 52 betaxolol, 57 AROMASIN, 22 bethanechol, 46 ASMANEX, 52 BETHKIS, 51 aspirin, 47 BETIMOL, 57 atazanavir, 20 BETOPTIC S, 57 atazanavir/cobicistat, 19 BEVESPI AEROSPHERE, 50 ATELVIA, 38 bexarotene caps, 23 atenolol, 26 bicalutamide, 22 atenolol/chlorthalidone, 26 bictegravir/emtricitabine/tenofovir alafenamide, 19 ATIVAN, 29 BIDIL, 28 atomoxetine, 32 BIKTARVY, 19 atorvastatin, 25 bimatoprost 0.01%, 58 atovaquone/proguanil, 19 bismuth/metronidazole/tetracycline, 45 ATROVENT HFA, 50 bisoprolol, 26 AUBAGIO, 34 bisoprolol/hydrochlorothiazide, 26 AUGMENTIN, 18 BLEPH-10, 57 AUSTEDO, 33 blood glucose continuous monitoring receivers, sensors, 37 avatrombopag, 47 blood glucose continuous monitoring receivers, sensors, AVODART, 45 transmitters, 37 AYGESTIN, 42 blood glucose monitoring kits, test strips, 37, 38 AZASAN, 49 BONIVA, 38 azathioprine, 48, 49 bortezomib, 23 azelaic acid foam, 55 bosentan, 28 azelaic acid gel, 55 BOSULIF, 22 azelastine, 56 bosutinib, 22 azelastine spray, 51 BREO ELLIPTA, 52 azelastine/fluticasone spray, 52 BREZTRI AEROSPHERE, 50 azithromycin, 18 brigatinib, 22 AZOPT, 58 BRILINTA, 47 AZOR, 25 brimonidine, 58 AZULFIDINE, 43 brimonidine 0.2%, 58 AZULFIDINE EN-TABS, 43 brimonidine/timolol, 58 brinzolamide, 58 B brinzolamide/brimonidine, 58 bacitracin, 53, 56 bromfenac sodium, 57 baclofen, 34 bromocriptine, 31 balsalazide, 43 BRYHALI, 55 BAQSIMI, 40 budesonide, 52 BARACLUDE, 20 budesonide delayed-rel caps, 43 BASAGLAR, 36 budesonide ext-rel, 43 BD ULTRAFINE insulin syringes and needles, 37 budesonide inhalation susp, 52 beclomethasone breath-activated aerosol, 52 budesonide/formoterol, 52 BELBUCA, 17 budesonide/glycopyrrolate/formoterol, 50 BELSOMRA, 32 bumetanide, 27 bempedoic acid, 25 BUNAVAIL, 35 bempedoic acid/ezetimibe, 25 buprenorphine, 17 BENADRYL, 50 buprenorphine sublingual, 34 benazepril, 23 buprenorphine transdermal, 16 benazepril/hydrochlorothiazide, 24 buprenorphine/naloxone, 35 benralizumab, 52 buprenorphine/naloxone sublingual, 34 BENZAC AC, 53 bupropion, 30 BENZAMYCIN, 53 bupropion ext-rel, 30, 35 benzonatate, 50 buspirone, 29 benzoyl peroxide, 53 busulfan, 21 benztropine, 31 BYSTOLIC, 26 benzyl alcohol/carbomer 941/glycerin, 56 besifloxacin, 57 C BESIVANCE, 57 C1 esterase inhibitor, recombinant, 48 betamethasone dipropionate augmented crm 0.05%, 55 cabergoline, 42 betamethasone dipropionate augmented gel, oint 0.05%, 55 CABOMETYX, 22 betamethasone dipropionate augmented lotion 0.05%, 55 cabozantinib, 22 betamethasone dipropionate crm, lotion, oint 0.05%, 55 CADUET, 27 betamethasone valerate crm, lotion, oint 0.1%, 55 CALAN SR, 27

63

calcipotriene, 54 ciprofloxacin oint, 57 calcipotriene/betamethasone, 54 ciprofloxacin soln, 56 calcitonin-salmon spray, 38 ciprofloxacin/dexamethasone, 58 calcitriol (1,25-D3), 41 citalopram, 30 calcium acetate, 41 clarithromycin, 18 calcium carbonate, 49 clarithromycin ext-rel, 18 canagliflozin, 37 CLARITIN, 50 canagliflozin/metformin, 37 CLARITIN-D, 50 canagliflozin/metformin ext-rel, 37 clemastine 1.34 mg, 50 candesartan, 24 clemastine 2.68 mg, 50 candesartan/hydrochlorothiazide, 24 CLEOCIN, 21, 46 capecitabine, 21 CLEOCIN T, 53 captopril, 23 CLIMARA, 41 captopril/hydrochlorothiazide, 24 CLIMARA PRO, 41 carbamazepine, 29 clindamycin, 21 carbamazepine ext-rel, 29 clindamycin crm, 46 carbamide peroxide 6.5%, 58 clindamycin gel, 53 CARBATROL, 29 clindamycin gel, lotion, soln, 53 carbidopa/levodopa, 31 clindamycin/benzoyl peroxide, 53 carbidopa/levodopa ext-rel, 31 clindamycin/tretinoin, 53 carbidopa/levodopa orally disintegrating tabs, 31 clobazam, 29 carbidopa/levodopa/entacapone, 31 clobetasol propionate crm, gel, oint, soln 0.05%, 55 CARDURA, 24 clobetasol propionate foam 0.05%, 55 cariprazine, 31 clobetasol propionate lotion, shampoo 0.05%, 55 carisoprodol, 34 CLOBEX, 55 carvedilol, 26 clomiphene, 40 carvedilol phosphate ext-rel, 26 clomipramine, 29 CASODEX, 22 clonazepam, 29 CATAPRES, 24 clonidine, 24 CATAPRES-TTS, 24 clonidine transdermal, 24 cefadroxil, 18 clopidogrel, 47 cefdinir, 18 clotrimazole, 46, 54 cefixime, 18 clotrimazole troches, 19 cefprozil, 18 clozapine, 31 cefuroxime axetil, 18 CLOZARIL, 31 celecoxib, 16 coagulation factor IX (recombinant), glycopegylated, 47 CELEXA, 30 codeine/acetaminophen, 16 CENTRUM, 49 codeine/guaifenesin liquid, 51 cephalexin, 18 codeine/guaifenesin/pseudoephedrine, 51 CERDELGA, 40 codeine/promethazine, 51 CEREZYME, 40 codeine/promethazine/phenylephrine, 51 cetirizine, 50 colchicine, 16 cetirizine/pseudoephedrine ext-rel, 50 colesevelam, 25 cetrorelix, 40 COLESTID, 25 CETROTIDE, 40 colestipol, 25 cevimeline, 44 COMBIGAN, 58 CHANTIX, 35 COMBIPATCH, 41 chlorambucil, 21 COMBIVIR, 19 chloroquine, 19 COMTAN, 31 chlorpheniramine 4 mg, 50 CONDYLOX, 56 chlorpromazine, 31 COPAXONE, 33 chlorthalidone, 27 COPIKTRA, 22 CHLOR-TRIMETON ALLERGY, 50 COREG, 26 chlorzoxazone, 34 CORGARD, 26 cholestyramine, 25 CORLANOR, 28 choriogonadotropin alfa, 40 CORTEF, 40 ciclopirox, 54 CORTIFOAM, 43 cilostazol, 47 CORTIZONE, 54 CILOXAN, 56, 57 COSENTYX, 47, 48 CIMDUO, 19 COSOPT, 58 cimetidine, 43 COZAAR, 24 cinacalcet, 38 CREON, 44 CIPRO, 18 CRINONE, 42 ciprofloxacin, 18 crisaborole, 54

64

cromolyn sodium, 56 dextromethorphan/guaifenesin, 51 cromolyn soln, 51 dextromethorphan/promethazine, 51 cyanocobalamin inj, 49 dextromethorphan/quinidine, 35 cyclobenzaprine, 34 DIASTAT, 29 cyclophosphamide caps, 21 diazepam, 29 cyclosporine, 49 diazepam rectal gel, 29 cyclosporine, emulsion, 58 diclofenac sodium, 57 cyclosporine, modified, 49 diclofenac sodium delayed-rel, 16 cyproheptadine, 50 diclofenac sodium delayed-rel/misoprostol, 16 CYSTAGON, 42 diclofenac sodium gel 1%, 16 cysteamine bitartrate, 42 diclofenac sodium soln, 16 CYTOMEL, 42 dicloxacillin, 18 CYTOTEC, 44 dicyclomine, 43 didanosine delayed-rel, 20 D DIFICID, 18 D.H.E. 45, 33 diflorasone diacetate crm 0.05%, 55 DALIRESP, 52 diflorasone diacetate oint 0.05%, 55 dalteparin, 46 DIFLUCAN, 19 danazol, 40 diflunisal, 16 DANTRIUM, 34 difluprednate, 57 dantrolene, 34 digoxin 0.0625 mg, 0.1875 mg, 27 dapagliflozin, 37 digoxin 0.125 mg, 0.25 mg, 27 dapagliflozin/metformin ext-rel, 37 digoxin ped elixir, 27 dapagliflozin/saxagliptin, 37 dihydroergotamine inj, 33 dapsone, 21 dihydroergotamine spray, 33 darbepoetin alfa, 46 DILANTIN, 29 darifenacin ext-rel, 45 DILANTIN INFATABS, 29 darolutamide, 22 diltiazem ext-rel, 27 darunavir, 20 dimethyl fumarate delayed-rel, 33 darunavir/cobicistat, 19 diphenhydramine, 50 darunavir/cobicistat/emtricitabine/tenofovir alafenamide, 19 diphenoxylate/atropine, 42 dasatinib, 22 DIPROLENE, 55 DDAVP, 42 DIPROLENE AF, 55 DEBROX, 58 dipyridamole, 47 denosumab, 38 dipyridamole ext-rel/aspirin, 47 DEPAKOTE, 29 diroximel fumarate delayed-rel, 34 DEPAKOTE ER, 29 disopyramide, 25 DEPO-PROVERA, 39 disopyramide ext-rel, 25 DESCOVY, 19 disulfiram, 34 desipramine, 30 DITROPAN XL, 45 desmopressin spray, tabs, 42 divalproex sodium delayed-rel, 29 desogestrel/EE, 39 divalproex sodium ext-rel, 29 desogestrel/EE 0.15/30, 39 DIVIGEL, 41 desonide crm, lotion, oint 0.05%, 54 dolutegravir, 19 DESOWEN, 54 dolutegravir/lamivudine, 19 desoximetasone crm, oint 0.05%, 55 donepezil, 30 desoximetasone crm, oint 0.25%, gel 0.05%, 55 DOPTELET, 47 desvenlafaxine ext-rel, 30 dorzolamide, 57 DETROL, 45 dorzolamide/timolol maleate, 58 deutetrabenazine, 33 DOVATO, 19 dexamethasone, 40, 57 doxazosin, 24 dexamethasone sodium phosphate, 57 doxepin, 30, 32 dexbrompheniramine/pseudoephedrine ext-rel 6 mg/120 mg, doxercalciferol, 41 50 doxycycline hyclate, 19 DEXCOM CONTINUOUS GLUCOSE MONITORING SYSTEM, doxycycline hyclate 20 mg, 19 37 doxycycline monohydrate delayed-rel caps, 55 DEXEDRINE SPANSULE, 32 doxylamine/pyridoxine delayed-rel, 43 DEXILANT, 44 DRIXORAL, 50 dexlansoprazole delayed-rel, 44 dronabinol, 43 dexmethylphenidate, 32 dronedarone, 25 dexmethylphenidate ext-rel, 32 drospirenone/EE 3/20, 39 dextroamphetamine, 32 drospirenone/EE 3/30, 39 dextroamphetamine ext-rel, 32 drospirenone/EE/levomefolate 3/20 and levomefolate, 39 dextromethorphan/brompheniramine/pseudoephedrine, 51 drospirenone/EE/levomefolate 3/30 and levomefolate, 39

65

DUAVEE, 41 EPIVIR, 20 DUETACT, 37 eplerenone, 24 dulaglutide, 36 epoetin alfa-epbx, 46 duloxetine delayed-rel, 30 EPZICOM, 19 DUOFILM, 56 erenumab-aooe, 33 dupilumab, 52, 54 ergotamine/caffeine, 33 DUPIXENT, 52, 54 ERIVEDGE, 23 DUREZOL, 57 ERLEADA, 22 DUROLANE, 17 erlotinib, 22 dutasteride, 45 erythromycin, 56 dutasteride/tamsulosin, 45 erythromycin delayed-rel, 18 duvelisib, 22 erythromycin ethylsuccinate, 18 DYAZIDE, 27 erythromycin gel 2%, 53 DYMISTA, 52 erythromycin soln, 53 erythromycin stearate, 18 E erythromycin/benzoyl peroxide, 53 econazole, 54 ESBRIET, 52 EDURANT, 20 escitalopram, 30 EE/norethindrone acetate - Jinteli, 41 esomeprazole delayed-rel, 44 efavirenz, 19 ESTRACE, 41 efavirenz/emtricitabine/tenofovir disoproxil fumarate, 19 estradiol, 41 efavirenz/lamivudine/tenofovir disoproxil fumarate, 19 estradiol vaginal crm, 41 EFFEXOR XR, 30 estradiol vaginal ring, 41 elagolix, 40 estradiol vaginal tabs, 41 elagolix sodium/estradiol/norethindrone acetate, 42 estradiol valerate and dienogest/estradiol valerate, 39 electrolyte soln, oral, 49 estradiol/levonorgestrel, 41 eletriptan, 33 estradiol/norethindrone, 41 ELIGARD, 22 estradiol/norethindrone acetate, 41 eliglustat, 40 ESTRING, 41 ELIQUIS, 46 estrogens, conjugated, 41 eluxadoline, 44 estrogens, conjugated crm, 41 elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide, 19 estrogens, conjugated/bazedoxifene, 41 EMGALITY, 33 estrogens, conjugated/medroxyprogesterone, 41 empagliflozin, 37 eszopiclone, 32 empagliflozin/linagliptin, 37 etanercept, 47, 48 empagliflozin/linagliptin/metformin ext-rel, 37 ethambutol, 20 empagliflozin/metformin, 37 ethosuximide, 29 empagliflozin/metformin ext-rel, 37 ethynodiol diacetate/EE 1/35 - Zovia 1/35, 39 emtricitabine, 20 etodolac, 16 emtricitabine/rilpivirine/tenofovir alafenamide, 19 etonogestrel/EE ring, 40 emtricitabine/tenofovir alafenamide, 19 etoposide, 23 emtricitabine/tenofovir disoproxil fumarate, 19 etravirine, 20 EMTRIVA, 20 EUCRISA, 54 EMVERM, 21 EUFLEXXA, 17 enalapril, 23 EVAMIST, 41 enalapril/hydrochlorothiazide, 24 everolimus, 22, 49 ENBREL, 47, 48 EVISTA, 42 ENDOMETRIN, 42 EVOTAZ, 19 enfuvirtide, 19 EVOXAC, 44 enoxaparin, 46 EXCEDRIN MIGRAINE, 33 ENSTILAR, 54 EXELON, 30 entacapone, 31 exemestane, 22 entecavir soln, 20 EYLEA, 58 entecavir tabs, 20 ezetimibe, 25 ENTRESTO, 28 ezetimibe/simvastatin, 26 enzalutamide, 22 EPCLUSA, 20 F EPIDUO, 53 famciclovir, 21 EPIDUO FORTE, 53 famotidine, 43 epinephrine, 50 FARXIGA, 37 epinephrine auto-injector, 49 FASENRA, 52 EPIPEN, 49 felodipine ext-rel, 27 EPIPEN JR., 49 FEMARA, 22 EPISIL, 56 fenofibrate, 25

66

fenofibric acid delayed-rel, 25 G fentanyl sublingual spray, 17 gabapentin, 29 fentanyl transdermal, 16 gabapentin ext-rel, 34 fentanyl transmucosal lozenge, 16 galantamine, 30 FEOSOL, 49 galantamine ext-rel, 30 ferrous sulfate, 49 galcanezumab-gnlm, 33 FETZIMA, 30 gefitinib, 22 fexofenadine, 50 GELSYN-3, 17 FIASP, 36 gemfibrozil, 25 fidaxomicin, 18 gentamicin, 53, 56 filgrastim-aafi, 46 GENVOYA, 19 FINACEA FOAM, 55 GILENYA, 34 finasteride, 45 gilteritinib, 22 fingolimod, 34 glatiramer, 33 FIRAZYR, 48 GLEEVEC, 22 FLAGYL, 21 glimepiride, 37 flecainide, 25 glipizide, 37 FLOMAX, 45 glipizide ext-rel, 37 FLOVENT DISKUS, 52 glipizide/metformin, 35 FLOVENT HFA, 52 GLUCAGEN HYPOKIT, 40 fluconazole, 19 GLUCAGON EMERGENCY KIT, 40 fludrocortisone, 40 glucagon nasal powder, 40 flunisolide spray, 52 glucagon subcutaneous soln, 40 fluocinolone acetonide crm, oint 0.025%, 55 glucagon, human recombinant, 40 fluocinolone acetonide soln 0.01%, 55 GLUCOTROL, 37 fluocinonide crm, gel, oint, soln 0.05%, 55 GLUCOTROL XL, 37 fluoride drops, tabs, 49 glycopyrrolate/formoterol, 50 fluorometholone, 57 GLYXAMBI, 37 fluorouracil crm 4%, 53 golimumab, 47 fluorouracil crm 5%, soln 5%, soln 2%, 53 GOLYTELY, 44 fluoxetine, 30 GONAL-F, 40 fluoxetine 60 mg, 30 GRALISE, 34 fluphenazine, 31 granisetron, 43 flutamide, 22 granisetron transdermal, 43 fluticasone, 52 grass mixed pollen allergen extract, 47 fluticasone propionate crm, lotion 0.05%, oint 0.005%, 55 GRASTEK, 47 fluticasone spray, 52 griseofulvin ultramicrosize, 19 fluticasone, CFC-free aerosol, 52 guanfacine, 24 fluticasone/salmeterol, 52 guanfacine ext-rel, 32 fluticasone/salmeterol, CFC-free aerosol, 52 guselkumab, 48 fluticasone/umeclidinium/vilanterol, 50 GVOKE, 40 fluticasone/vilanterol, 52 GYNE-LOTRIMIN, 46 fluvastatin, 26 fluvoxamine, 29 H FML FORTE, 57 halobetasol propionate crm, oint 0.05%, 55 FML S.O.P., 57 halobetasol propionate lotion 0.01%, 55 FOCALIN, 32 haloperidol, 31 FOCALIN XR, 32 HARVONI, 20 folic acid, 49 HECTOROL, 41 folic acid/vitamin B6/vitamin B12, 49 HUMALOG, 36 follitropin alfa, 40 HUMALOG MIX, 36 fondaparinux, 46 human coagulation factor VIII (rDNA) simoctocog alfa, 46 formoterol inhalation soln, 51 HUMIRA, 47, 48 FORTEO, 38 HUMULIN 70/30, 36 FOSAMAX, 38 HUMULIN N, 36 fosinopril, 23 HUMULIN R, 36 fosinopril/hydrochlorothiazide, 24 HUMULIN R U-500, 36 FRAGMIN, 46 hydralazine, 28 FREESTYLE LIBRE CONTINUOUS GLUCOSE MONITORING HYDREA, 23 SYSTEM, 37 hydrochlorothiazide, 27 fremanezumab-vfrm, 33 hydrocodone ext-rel, 17 furosemide, 27 hydrocodone/acetaminophen, 17 FUZEON, 19 hydrocodone/homatropine, 51 FYCOMPA, 29 hydrocortisone, 40

67

hydrocortisone acetate foam, 43 ipratropium spray, 53 hydrocortisone acetate/pramoxine foam, 45 ipratropium, CFC-free aerosol, 50 hydrocortisone butyrate crm, lotion, oint, soln 0.1%, 55 ipratropium/albuterol soln, 50 hydrocortisone crm, 45 irbesartan, 24 hydrocortisone crm 2.5%, 55 irbesartan/hydrochlorothiazide, 24 hydrocortisone crm, oint 0.5%, 1%, 54 IRESSA, 22 hydrocortisone enema, 43 ISENTRESS, 19 hydrocortisone lotion 1%, 55 isoniazid, 20 hydrocortisone valerate crm, oint 0.2%, 55 isosorbide dinitrate, 28 hydromorphone, 17 isosorbide dinitrate/hydralazine, 28 hydromorphone ext-rel, 17 isosorbide mononitrate, 28 hydroxychloroquine, 48 isosorbide mononitrate ext-rel, 28 hydroxyurea, 23 isotretinoin, 53 hydroxyzine HCl, 50 itraconazole, 19 hyoscyamine sulfate, 43 ivabradine, 28 hyoscyamine sulfate ext-rel, 43 ivermectin, 21, 56 hyoscyamine sulfate orally disintegrating tabs, 43 ixazomib, 23 HYSINGLA ER, 17 ixekizumab, 48 HYZAAR, 24 J I JANUMET, 36 ibandronate, 38 JANUMET XR, 36 IBRANCE, 22 JANUVIA, 36 ibuprofen, 16 JARDIANCE, 37 icatibant, 48 JIVI, 46 icosapent ethyl, 26 ILEVRO, 57 K imatinib mesylate, 22 KALETRA, 20 imiglucerase, 40 KEFLEX, 18 imipramine HCl, 30 KEPPRA, 29 imiquimod, 53, 56 KEPPRA XR, 29 IMITREX, 33 KESIMPTA, 34 IMODIUM A-D, 42 ketoconazole, 54 IMURAN, 48 ketoconazole shampoo 2%, 54 INBRIJA, 31 ketorolac, 57 INCRUSE ELLIPTA, 50 ketotifen, 56 indapamide, 27 KEVZARA, 48 INDERAL LA, 26 KISQALI, 22 infliximab, 47 KISQALI FEMARA CO-PACK, 22 ingenol mebutate, 53 KLARON, 53 INGREZZA, 33 KLONOPIN, 29 inotersen, 41 KOGENATE FS, 46 INSPRA, 24 KOMBIGLYZE XR, 36 insulin aspart, 36 KOVALTRY, 46 insulin aspart protamine 70%/insulin aspart 30%, 36 KYLEENA, 40 insulin degludec, 36 L insulin detemir, 36 labetalol, 26 insulin glargine, 36 lacosamide, 29 insulin human, 36 lactulose soln, 44 insulin infusion disposable pump, 38 LAMICTAL, 29 insulin isophane human, 36 LAMICTAL ODT, 29 insulin isophane human 70%/regular 30%, 36 LAMICTAL XR, 29 insulin lispro, 36 LAMISIL AT, 54 INSULIN LISPRO, 36 lamivudine, 20 insulin lispro protamine/insulin lispro, 36 lamivudine/tenofovir disoproxil fumarate, 19 insulin lispro-aabc, 36 lamivudine/zidovudine, 19 insulin syringes, needles, 37 lamotrigine, 29 INTELENCE, 20 lamotrigine ext-rel, 29 interferon beta-1a, 34 lamotrigine orally disintegrating tablets, 29 interferon beta-1b, 34 lanadelumab-flyo, 48 INVOKAMET, 37 lancets, 37 INVOKAMET XR, 37 LANOXIN, 27 INVOKANA, 37 lanreotide acetate, 35 ipratropium soln, 50 lansoprazole + amoxicillin + clarithromycin, 45

68

lansoprazole delayed-rel, 44 lopinavir/ritonavir tabs, 20 lanthanum carbonate, 41 LOPRESSOR, 26 LANTUS, 36 LOPRESSOR HCT, 26 lapatinib, 22 LOPROX, 54 LASIX, 27 loratadine, 50 lasmiditan, 33 loratadine/pseudoephedrine ext-rel, 50 LASTACAFT, 56 lorazepam, 29 latanoprost, 58 losartan, 24 LATUDA, 31 losartan/hydrochlorothiazide, 24 ledipasvir/sofosbuvir, 20 LOSEASONIQUE, 39 leflunomide, 48 LOTENSIN, 23 lenalidomide, 23 LOTENSIN HCT, 24 letrozole, 22 loteprednol, 57 LEUKERAN, 21 LOTREL, 24 leuprolide acetate, 22 LOTRIMIN AF, 54 levalbuterol tartrate, CFC-free aerosol, 51 lovastatin, 26 LEVEMIR, 36 LOVAZA, 26 levetiracetam, 29 lubiprostone, 44 levetiracetam ext-rel, 29 LUCENTIS, 58 levobunolol, 57 luliconazole, 54 levocarnitine, 38 LUMIGAN, 58 levocetirizine, 50 lurasidone, 31 levodopa inhalation powder, 31 lusutrombopag, 47 levofloxacin, 18, 56 LYNPARZA, 23 levomilnacipran ext-rel, 30 LYRICA CR, 34 levonorgestrel releasing IUD, 40 LYSODREN, 23 levonorgestrel/EE - Trivora, 39 LYUMJEV, 36 levonorgestrel/EE 0.1/20 - Lessina, 39 levonorgestrel/EE 0.1/20 and EE 10, 39 M levonorgestrel/EE 0.15/30, 39 macitentan, 28 levonorgestrel/EE 0.15/30 - Levora, 39 MACROBID, 21 levonorgestrel/EE 0.15/30 and EE 10, 39 MALARONE, 19 levothyroxine, 42 malathion, 56 levothyroxine - Levoxyl, 42 MARINOL, 43 LEVSIN, 43 MATULANE, 23 LEXAPRO, 30 MAXALT, 33 LIALDA, 43 MAXIDEX, 57 lidocaine, 55 MAXITROL, 57 lidocaine patch, 55 MAXZIDE, 27 lidocaine viscous, 56 MAYZENT, 34 lidocaine/prilocaine, 55 mebendazole chewable, 21 LIDODERM, 55 meclizine, 43 lifitegrast, 58 MEDROL, 40 linaclotide, 44 medroxyprogesterone acetate, 42 linezolid, 21 medroxyprogesterone acetate 150 mg/mL, 39 LINZESS, 44 mefloquine, 19 liothyronine, 42 megestrol acetate susp, 42 liraglutide, 36, 38 megestrol acetate tabs, 22 liraglutide/insulin degludec, 36 meloxicam, 16 lisdexamfetamine, 32 melphalan, 21 lisinopril, 23 memantine, 30 lisinopril/hydrochlorothiazide, 24 memantine ext-rel, 30 lithium carbonate, 33 memantine/donepezil, 30 lithium carbonate ext-rel tabs 300 mg, 33 mepolizumab, 52 lithium carbonate ext-rel tabs 450 mg, 33 mercaptopurine, 21 LITHOBID, 33 mesalamine delayed-rel caps, 43 lixisenatide/insulin glargine, 36 mesalamine delayed-rel tabs, 43 LMX-4, 55 mesalamine ext-rel caps, 43 LO LOESTRIN FE, 39 mesalamine supp, 43 LOKELMA, 41 mesalamine susp, 43 LOMOTIL, 42 metaxalone, 34 loperamide, 42 metformin, 35 LOPID, 25 metformin ext-rel, 35 lopinavir/ritonavir soln, 20 methadone, 17

69

methazolamide, 27 MYSOLINE, 29 methimazole, 42 methocarbamol, 34 N methotrexate, 21, 48 nabumetone, 16 methotrexate auto-injector, 48 nadolol, 26 methoxsalen oral, 54 naftifine, 54 methyldopa, 28 NAFTIN, 54 METHYLIN, 32 naloxegol, 44 methylphenidate, 32 naloxone inj, 34 methylphenidate ext-rel, 32 naloxone nasal spray, 34 methylprednisolone, 40 naltrexone, 34 metoclopramide, 43 NAMENDA, 30 metolazone, 27 NAMZARIC, 30 metoprolol succinate ext-rel, 26 naproxen, 16 metoprolol tartrate, 26 naproxen sodium, 16 metoprolol/hydrochlorothiazide, 26 naproxen sodium tabs, 16 METROCREAM, 55 naratriptan, 33 METROGEL, 55 NARCAN, 34 METROLOTION, 55 NARDIL, 30 metronidazole, 21, 46 natalizumab, 34 metronidazole crm 0.75%, 55 NATAZIA, 39 metronidazole gel 0.75%, 55 nateglinide, 37 metronidazole gel 1%, 55 nebivolol, 26 metronidazole lotion 0.75%, 55 neomycin/polymyxin B/bacitracin, 53 MICARDIS, 24 neomycin/polymyxin B/bacitracin/hydrocortisone oint, 57 MICARDIS HCT, 24 neomycin/polymyxin B/dexamethasone, 57 MICATIN, 54 neomycin/polymyxin B/gramicidin, 56 miconazole, 46, 54 neomycin/polymyxin B/hydrocortisone, 58 midodrine, 28 neomycin/polymyxin B/hydrocortisone susp, 57 midostaurin, 22 NEOSPORIN, 53 milnacipran, 32 nepafenac, 57 minocycline, 19 netarsudil, 58 mirabegron ext-rel, 45 netarsudil/latanoprost, 58 MIRALAX, 44 NEUPRO, 31 MIRAPEX, 31 NEURONTIN, 29 MIRCETTE, 39 NEVANAC, 57 MIRENA, 40 nevirapine, 19 mirtazapine, 30 nevirapine ext-rel, 20 misoprostol, 44 NEXLETOL, 25 mitotane, 23 NEXLIZET, 25 mometasone, 52 niacin ext-rel, 26 mometasone crm, lotion, oint 0.1%, 55 NIASPAN, 26 mometasone spray, 52 NICODERM CQ, 35 MONISTAT, 46 NICORETTE, 35 montelukast, 51 nicotine polacrilex gum, 35 morphine, 17 nicotine polacrilex lozenge, 35 morphine ext-rel, 17 nicotine transdermal, 35 morphine supp, 17 nifedipine ext-rel, 27 MOVANTIK, 44 NINLARO, 23 moxifloxacin, 18, 56 nintedanib, 52 MUGARD, 56 niraparib, 23 MULPLETA, 47 nitisinone, 40 MULTAQ, 25 NITRO-DUR, 28 multivitamins/fluoride drops, tabs, 49 nitrofurantoin ext-rel, 21 multivitamins/fluoride/iron drops, tabs, 49 nitrofurantoin macrocrystals, 21 multivitamins/minerals, 49 nitrofurantoin susp, 21 mupirocin oint, 53 nitroglycerin lingual spray, 28 MUSE, 45 nitroglycerin sublingual, 28 MYAMBUTOL, 20 nitroglycerin transdermal, 28 mycophenolate mofetil, 48 NITROLINGUAL, 28 mycophenolate sodium delayed-rel, 48 NITROSTAT, 28 MYDAYIS, 32 NIVESTYM, 46 MYLERAN, 21 NIX, 56 MYRBETRIQ, 45 NORDITROPIN, 41

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norelgestromin/EE, 40 ONEXTON, 53 norethindrone, 39 ONGLYZA, 36 norethindrone acetate, 42 ONZETRA XSAIL, 33 norethindrone acetate/EE 1.5/30, 39 OPSUMIT, 28 norethindrone acetate/EE 1.5/30 and iron, 39 ORALAIR, 47 norethindrone acetate/EE 1/10 and EE 10 and iron, 39 ORENCIA CLICKJECT, 48 norethindrone acetate/EE 1/20, 39 ORENCIA SUBCUTANEOUS, 48 norethindrone acetate/EE 1/20 and iron, 39 ORENITRAM, 28 norethindrone acetate/EE 1/20 and iron chewable, 39 ORFADIN, 40 norethindrone/EE, 39 ORIAHNN, 42 norethindrone/EE 0.5/35, 39 ORILISSA, 40 norethindrone/EE 1/35, 39 orphenadrine/aspirin/caffeine, 34 norgestimate/EE, 39 ORTHO MICRONOR, 39 norgestimate/EE 0.25/35, 39 oseltamivir, 21 norgestrel/EE 0.3/30 - Low-Ogestrel, 39 ospemifene, 42 NORPACE, 25 OSPHENA, 42 NORPACE CR, 25 OTEZLA, 47, 48 NORPRAMIN, 30 OVIDE, 56 nortriptyline, 30 OVIDREL, 40 NORVIR, 20 oxaprozin, 16 NOVOEIGHT, 46 oxazepam, 29 NOVOLIN 70/30, 36 oxcarbazepine, 29 NOVOLIN N, 36 oxcarbazepine ext-rel, 29 NOVOLIN R, 36 OXSORALEN-ULTRA, 54 NOVOLOG, 36 OXTELLAR XR, 29 NOVOLOG MIX 70/30, 36 oxybutynin, 45 NUBEQA, 22 oxybutynin ext-rel, 45 NUCALA, 52 oxycodone caps 5 mg, 17 NUCYNTA, 17 oxycodone concentrate 20 mg/mL, 17 NUCYNTA ER, 17 oxycodone ext-rel, 17 NUEDEXTA, 35 oxycodone soln 5 mg/5 mL, 17 NULYTELY, 44 oxycodone tabs 5 mg, 15 mg, 30 mg, 17 NURTEC ODT, 33 oxycodone/acetaminophen 5/325, 17 NUVIGIL, 34 OXYCONTIN, 17 NUWIQ, 46 ozanimod, 34 nystatin, 19, 54 OZEMPIC, 36 O P ocrelizumab, 34 palbociclib, 22 OCREVUS, 34 PAMELOR, 30 OCUFLOX, 56 pancrelipase, 44 ODEFSEY, 19 pancrelipase delayed-rel, 44 ODOMZO, 23 pantoprazole delayed-rel, 44 ofatumumab, 34 paricalcitol, 41 OFEV, 52 PARLODEL, 31 ofloxacin, 56 PARNATE, 30 ofloxacin otic, 58 paroxetine HCl, 30 olanzapine, 31 paroxetine HCl ext-rel, 30 olaparib, 23 paroxetine mesylate, 35 olmesartan, 24 PATADAY, 56 olmesartan/amlodipine/hydrochlorothiazide, 25 PATANASE, 51 olmesartan/hydrochlorothiazide, 24 patiromer sorbitex, 41 olodaterol, CFC-free aerosol, 51 PAXIL, 30 olopatadine, 56 PAXIL CR, 30 olopatadine spray, 51 PAZEO, 56 omalizumab, 52 pazopanib, 22 omega-3 acid ethyl esters, 26 PEDIALYTE, 49 omeprazole delayed-rel, 44 peg 3350/electrolytes, 44 omeprazole magnesium delayed-rel, 44 pegfilgrastim-bmez, 46 OMNIPOD DASH INSULIN INFUSION PUMP, 38 penicillin VK, 18 OMNIPOD INSULIN INFUSION PUMP, 38 PENTASA, 43 ondansetron, 43 PEPCID, 43 ONETOUCH ULTRA kits and test strips, 38 PEPCID AC, 43 ONETOUCH VERIO kits and test strips, 38 perampanel, 29

71

PERFOROMIST, 51 progesterone vaginal inserts, 42 perindopril, 23 progesterone, micronized, 42 PERJETA, 23 PROLASTIN-C, 52 permethrin 5%, 56 PROLIA, 38 permethrin creme rinse 1%, 56 promethazine, 43 perphenazine, 31 PROMETRIUM, 42 pertuzumab, 23 propafenone, 25 pertuzumab/trastuzumab/hyaluronidase-zzxf, 23 propafenone ext-rel, 25 phenazopyridine, 46 propranolol, 26 phenelzine, 30 propranolol ext-rel, 26 phenobarbital, 29 propylthiouracil, 42 phenytoin, 29 PROSCAR, 45 phenytoin sodium extended, 29 PROVERA, 42 PHESGO, 23 PROZAC, 30 PHOSLYRA, 41 PULMICORT FLEXHALER, 52 PICATO, 53 PULMICORT RESPULES, 52 pilocarpine tabs, 44 PYLERA, 45 pimecrolimus, 54 pyrazinamide, 20 pindolol, 26 pyrethrins/piperonyl butoxide shampoo 4%, 56 pioglitazone, 36 pyridostigmine, 34 pioglitazone/glimepiride, 37 pyridostigmine ext-rel, 34 pioglitazone/metformin, 37 pyrimethamine, 21 pirfenidone, 52 PLAQUENIL, 48 Q podofilox, 56 QTERN, 37 polyethylene glycol 3350, 44 QUESTRAN/QUESTRAN LIGHT, 25 polymyxin B/bacitracin, 53, 56 quetiapine, 31 polymyxin B/trimethoprim, 56 quetiapine ext-rel, 31 POLYSPORIN, 53 quinapril, 23 POLYTRIM, 56 quinapril/hydrochlorothiazide, 24 potassium chloride ext-rel, 49 QVAR REDIHALER, 52 potassium chloride liquid, 49 R potassium citrate ext-rel, 46 ragweed pollen allergen extract, 47 PRALUENT, 26 RAGWITEK, 47 pramipexole, 31 raloxifene, 42 pramipexole ext-rel, 31 raltegravir, 19 pramlintide, 35 ramelteon, 32 prasugrel, 47 ramipril, 23 PRAVACHOL, 26 ranibizumab, 58 pravastatin, 26 ranolazine ext-rel, 28 PRECOSE, 35 rasagiline, 31 PRED MILD, 57 RASUVO, 48 prednisolone, 40 RAZADYNE, 30 prednisolone acetate, 57 RAZADYNE ER, 30 prednisolone acetate 1%, 57 REBIF, 34 prednisolone phosphate 1%, 57 REBINYN, 47 prednisone, 40 REGLAN, 43 pregabalin, 32 RELENZA, 21 pregabalin ext-rel, 34 RELPAX, 33 PREMARIN, 41 REMERON, 30 PREMPHASE, 41 REMICADE, 47 PREMPRO, 41 repaglinide, 37 PREZCOBIX, 19 REQUIP XL, 31 PREZISTA, 20 RESTASIS, 58 PRILOSEC, 44 RESTORIL, 32 PRILOSEC OTC, 44 RETACRIT, 46 primidone, 29 RETIN-A, 53 PRISTIQ, 30 RETROVIR, 20 probenecid, 16 revefenacin inhalation soln, 50 procarbazine, 23 REVLIMID, 23 PROCARDIA XL, 27 REYVOW, 33 prochlorperazine, 43 RHOPRESSA, 58 PROCTOFOAM-HC, 45 ribavirin, 20 progesterone gel, 42

72

ribociclib, 22 silodosin, 45 ribociclib + letrozole, 22 SILVADENE, 54 RID, 56 silver sulfadiazine, 54 RIFADIN, 20 SIMBRINZA, 58 rifampin, 20 SIMPONI ARIA, 47 rifaximin 550 mg, 21 simvastatin, 26 rilpivirine, 20 SINEMET, 31 rimegepant, 33 SINGULAIR, 51 RINVOQ, 48 siponimod, 34 riociguat, 28 sirolimus, 49 risankizumab-rzaa, 48 sitagliptin phosphate, 36 risedronate, 38 sitagliptin/metformin, 36 risedronate delayed-rel, 38 sitagliptin/metformin ext-rel, 36 RISPERDAL, 31 SKELAXIN, 34 risperidone, 31 SKYLA, 40 RITALIN, 32 SKYRIZI, 48 ritonavir, 20 sodium hyaluronate, 17 rivaroxaban, 46 sodium phenylbutyrate, 42 rivastigmine, 30 sodium sulfate/potassium sulfate/magnesium sulfate, 44 rivastigmine transdermal, 30 sodium zirconium cyclosilicate, 41 rizatriptan, 33 sofosbuvir/velpatasvir, 20 ROBAXIN, 34 sofosbuvir/velpatasvir/voxilaprevir, 20 ROBITUSSIN-DM, 51 solifenacin, 45 ROCALTROL, 41 SOLIQUA, 36 ROCKLATAN, 58 solriamfetol, 34 roflumilast, 52 somatropin, 41 rolapitant, 43 SOMATULINE DEPOT, 35 ropinirole, 31 sonidegib, 23 ropinirole ext-rel, 31 SOOLANTRA, 56 rosuvastatin, 26 SORIATANE, 54 rotigotine transdermal, 31 sotalol, 25 ROWASA, 43 soy phospholipid/glycerol dioleate, 56 RUBRACA, 23 SPIRIVA, 50 rucaparib, 23 spironolactone, 24 RUCONEST, 48 spironolactone/hydrochlorothiazide, 27 rufinamide, 29 SPRYCEL, 22 RYBELSUS, 36 STALEVO, 31 RYDAPT, 22 stavudine, 20 RYTHMOL SR, 25 STELARA INTRAVENOUS, 47 STELARA SUBCUTANEOUS, 47, 48 S STIOLTO RESPIMAT, 50 sacubitril/valsartan, 28 STRATTERA, 32 SALAGEN, 44 STRIVERDI RESPIMAT, 51 salicylic acid 17%/collodion, 56 STROMECTOL, 21 salmeterol xinafoate, 51 SUBSYS, 17 SANCUSO, 43 sucralfate, 45 sarilumab, 48 sucroferric oxyhydroxide, 41 SAVELLA, 32 sulfacetamide lotion 10%, 53 saxagliptin, 36 sulfacetamide oint 10%, 56 saxagliptin/metformin ext-rel, 36 sulfacetamide soln 10%, 57 SAXENDA, 38 sulfacetamide/prednisolone phosphate 10%/0.25%, 57 scopolamine transdermal, 43 sulfamethoxazole/trimethoprim, 21 SEASONIQUE, 39 sulfamethoxazole/trimethoprim DS, 21 secukinumab, 47, 48 sulfasalazine, 43 /EE ring, 40 sulfasalazine delayed-rel, 43 selegiline, 31 sulindac, 16 selenium sulfide lotion 2.5%, 54 sumatriptan, 33 selexipag, 28 sumatriptan inj, 33 semaglutide, 36 sumatriptan nasal powder, 33 SEREVENT, 51 sumatriptan nasal spray, 33 SEROQUEL, 31 sumatriptan/naproxen sodium, 33 sertraline, 30 sunitinib, 22 sevelamer carbonate, 41 SUNOSI, 34 sildenafil, 28, 45 SUPARTZ FX, 17

73

SUPRAX, 18 ticagrelor, 47 SUPREP, 44 TIGAN, 43 SUTENT, 22 timolol hemihydrate, 57 suvorexant, 32 timolol maleate, 57 SYMBICORT, 52 timolol maleate gel, 57 SYMJEPI, 50 TIMOPTIC, 57 SYMLINPEN, 35 timothy grass pollen allergen extract, 47 SYMTUZA, 19 TINACTIN, 54 SYNJARDY, 37 tinidazole, 21 SYNJARDY XR, 37 tioconazole, 46 SYNTHROID, 42 tiotropium, 50 tiotropium/olodaterol, 50 T TIVICAY, 19 TABLOID, 22 tizanidine tabs, 34 tacrolimus, 49, 54 TOBRADEX, 57 tadalafil, 28, 45 TOBRADEX ST, 57 tafluprost, 58 tobramycin, 57 TAGAMET HB 200, 43 tobramycin inhalation soln, 51 TAKHZYRO, 48 tobramycin/dexamethasone oint 0.3%/0.1%, 57 TALTZ, 48 tobramycin/dexamethasone susp 0.3%/0.05%, 57 tamoxifen, 22 tobramycin/dexamethasone susp 0.3%/0.1%, 57 tamsulosin, 45 TOBREX, 57 TAPAZOLE, 42 tofacitinib, 48 tapentadol, 17 tofacitinib ext-rel, 48 tapentadol ext-rel, 17 TOLAK, 53 TARGRETIN, 23 tolnaftate, 54 TARKA, 24 tolterodine, 45 TAYTULLA, 39 tolterodine ext-rel, 45 tazarotene, 53 TOPAMAX, 29 TAZORAC, 53 topiramate, 29 TEGRETOL, 29 topiramate ext-rel, 29 TEGSEDI, 41 TOPROL-XL, 26 TEKTURNA HCT, 27 torsemide, 27 telmisartan, 24 TOUJEO, 36 telmisartan/hydrochlorothiazide, 24 tramadol, 17 temazepam, 32 tramadol ext-rel, 17 TEMIXYS, 19 trandolapril, 24 TEMODAR, 21 trandolapril/verapamil ext-rel, 24 TEMOVATE, 55 tranylcypromine, 30 temozolomide, 21 travoprost, 58 tenofovir alafenamide, 20 trazodone, 31 tenofovir disoproxil fumarate, 20 TRELEGY ELLIPTA, 50 terazosin, 24 TREMFYA, 48 terbinafine, 54 treprostinil, 28 terbinafine tabs, 19 treprostinil ext-rel, 28 terbutaline, 51 TRESIBA, 36 terconazole, 46 tretinoin, 53 teriflunomide, 34 tretinoin - Avita, 53 teriparatide, 38 tretinoin caps, 23 TESSALON, 50 tretinoin gel microsphere, 53 testosterone cypionate, 35 TREXALL, 21 testosterone enanthate, 35 triamcinolone acetonide crm 0.5%, 55 testosterone gel, 35 triamcinolone acetonide crm, lotion 0.025%, 55 testosterone soln, 35 triamcinolone acetonide crm, lotion, oint 0.1%, 55 testosterone transdermal, 35 triamcinolone paste, 56 tetrabenazine, 33 triamterene, 27 tetracycline, 19 triamterene/hydrochlorothiazide, 27 thalidomide, 23 TRIBENZOR, 25 THALOMID, 23 trifluoperazine, 31 theophylline ext-rel tabs, 52 trifluridine, 57 thioguanine, 22 trihexyphenidyl, 31 thiothixene, 31 TRIJARDY XR, 37 tiagabine, 29 TRILEPTAL, 29 TIAZAC, 27 TRILIPIX, 25

74

trimethobenzamide, 43 VISTOGARD, 23 trimethoprim, 21 vitamin ADC/fluoride drops, 49 TRINTELLIX, 30 vitamin ADC/fluoride/iron drops, 49 TRIUMEQ, 19 VIVELLE-DOT, 41 TROKENDI XR, 29 voriconazole, 19 trospium, 45 vorinostat, 23 trospium ext-rel, 45 vortioxetine, 30 TRULICITY, 36 VOSEVI, 20 TRUSOPT, 57 VOTRIENT, 22 TRUVADA, 19 VRAYLAR, 31 TYLENOL, 16 VUMERITY, 34 TYMLOS, 38 VYTORIN, 26 TYSABRI, 34 VYVANSE, 32 U W UBRELVY, 33 warfarin, 46 ubrogepant, 33 WELLBUTRIN SR, 30 ULTRAVATE, 55 WELLBUTRIN XL, 30 umeclidinium, 50 umeclidinium/vilanterol, 50 X upadacitinib, 48 XALATAN, 58 UPTRAVI, 28 XARELTO, 46 uridine triacetate, 23 XELJANZ, 48 UROCIT-K, 46 XELJANZ XR, 48 URSO, 43 XELODA, 21 ursodiol, 43 XIFAXAN, 21 ustekinumab, 47, 48 XIGDUO XR, 37 XIIDRA, 58 V XOLAIR, 52 VAGIFEM, 41 XOSPATA, 22 VAGISTAT-1, 46 XTAMPZA ER, 17 valacyclovir, 21 XTANDI, 22 valbenazine, 33 XULTOPHY, 36 valganciclovir, 20 VALIUM, 29 Y valproic acid, 29 YASMIN, 39 valsartan, 24 YAZ, 39 valsartan/hydrochlorothiazide, 24 YONSA, 22 VANCOCIN, 21 YUPELRI, 50 vancomycin caps, 21 Z varenicline, 35 ZADITOR, 56 VARUBI, 43 zafirlukast, 51 VASCEPA, 26 zaleplon, 32 VASERETIC, 24 ZANAFLEX, 34 VASOTEC, 23 zanamivir, 21 VELCADE, 23 ZARONTIN, 29 VELPHORO, 41 ZEJULA, 23 VELTASSA, 41 ZEMBRACE SYMTOUCH, 33 VEMLIDY, 20 ZEMPLAR, 41 venlafaxine, 30 ZENPEP, 44 venlafaxine ext-rel, 30 ZEPOSIA, 34 verapamil ext-rel, 27 ZESTORETIC, 24 VFEND, 19 ZESTRIL, 23 V-GO INSULIN INFUSION PUMP, 38 ZETIA, 25 VIBERZI, 44 ZIAC, 26 VIBRAMYCIN, 19 ZIAGEN, 20 VICTOZA, 36 zidovudine, 20 vigabatrin, 29 ZIEXTENZO, 46 VIGAMOX, 56 zileuton ext-rel, 51 VIIBRYD, 30 ZIOPTAN, 58 vilazodone, 30 ziprasidone, 31 VIMPAT, 29 ZITHROMAX, 18 VIOKACE, 44 ZOCOR, 26 vismodegib, 23 ZOFRAN, 43

75

ZOLINZA, 23 ZOMIG, 33 zolmitriptan, 33 zonisamide, 29 zolmitriptan nasal spray, 33 ZUBSOLV, 35 ZOLOFT, 30 ZYCLARA, 53 zolpidem, 32 ZYPREXA, 31 zolpidem ext-rel, 32 ZYRTEC, 50 zolpidem sublingual, 32 ZYRTEC-D 12 HOUR, 50

76