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Commonly Prescribed Maintenance

Maintenance (or long-term) medications are those dosage form may be used to treat more than one drugs you may take on a regular basis to treat conditions medical condition. In these cases, each may such as high , high or . be classified according to its first U.S. Food and Drug Based on your benefit plan, you may get up to a 90-day Administration (FDA) approved use. Some strengths supply of covered maintenance medication delivered and/or formulations listed may not be covered. to you through a home delivery program or at select Please note that oral contraceptives are maintenance retail pharmacies. medications and are part of this list. However, this Some plans may require you to fill these prescriptions list does not include the trade names of all available through home delivery or at select retail pharmacies oral contraceptives because there are a large number in order to receive coverage. of products. Commonly used maintenance medications are listed in Coverage is always subject to the terms and limits of this guide. This list is not all-inclusive and may change your benefit plan. Please verify with your plan if there from time to time. are any additional requirements before a drug may be Most generic drugs listed are followed by a reference covered. For details about your plan, check your benefit brand drug in (parentheses). The brand name drug materials or call the number on your member ID card. in parentheses is listed for reference and may not be Third-party brand names are the property of their covered under your benefit. Some drugs in the same respective owners.

ADHD/Stimulants Allergies GALANTAMINE HYDROBROMIDE - galantamine hydrobromide oral hcl cap 10 mg, 18 mg, ipratropium nasal soln soln 4 mg/mL 25 mg, 40 mg, 60 mg, 80 mg, 0.03% (21 mcg/spray), 0.06% 100 mg (base equivalent) (42 mcg/spray) galantamine hydrobromide tab (Strattera) 4 mg (Razadyne) Alzheimer’s clonidine hcl tab er 12hr 0.1 mg galantamine hydrobromide tab ARICEPT - hydrochloride (Kapvay) 8 mg, 12 mg tab 5 mg, 10 mg, 23 mg guanfacine hcl tab er 24hr 1 mg, hcl cap er 24hr 7 mg, 2 mg, 3 mg, 4 mg donepezil hydrochloride orally 14 mg, 21 mg, 28 mg (base equivalent) (Intuniv) disintegrating tab 5 mg, 10 mg (Namenda xr) INTUNIV - guanfacine hcl tab er 24hr donepezil hydrochloride tab 5 mg, memantine hcl oral 1 mg, 2 mg, 3 mg, 4 mg 10 mg, 23 mg (Aricept) 2 mg/mL (base equivalent) EXELON - rivastigmine td patch 24hr memantine hcl tab 5 mg, 10 mg KAPVAY - clonidine hcl tab er 12hr 4.6 mg/24hr, 9.5 mg/24hr, (Namenda) 13.3 mg/24hr 0.1 mg NAMENDA - memantine hcl tab 5 mg, STRATTERA - atomoxetine hcl cap galantamine hydrobromide cap er 10 mg 24hr 8 mg, 16 mg, 24 mg 10 mg, 18 mg, 25 mg, 40 mg, NAMENDA XR - memantine hcl cap er (Razadyne er) 60 mg, 80 mg, 100 mg 24hr 7 mg, 14 mg, 21 mg, 28 mg (base equivalent)

BRAND DRUGS generic drugs 1 Commonly Prescribed Maintenance Medications

NAMZARIC - memantine hcl- nitroglycerin td patch 24hr propafenone hcl tab 150 mg, donepezil hcl cap er 24hr 7-10 mg, 0.1 mg/hr, 0.2 mg/hr, 0.4 mg/hr, 225 mg, 300 mg 14-10 mg, 21-10 mg, 28-10 mg 0.6 mg/hr (Nitro-dur) propafenone hcl cap er 12hr 225 mg, RAZADYNE - galantamine PROCARDIA - cap 10 mg 325 mg, 425 mg (Rythmol sr) hydrobromide tab 4 mg RANEXA - tab er 12hr gluconate tab er 324 mg RAZADYNE ER - galantamine 500 mg, 1000 mg QUINIDINE - quinidine hydrobromide cap er 24hr 8 mg, ranolazine tab er 12hr 500 mg, sulfate tab 200 mg, 300 mg 16 mg, 24 mg 1000 mg (Ranexa) RYTHMOL SR - propafenone hcl cap rivastigmine tartrate cap er 12hr 225 mg, 325 mg, 425 mg 1.5 mg, 3 mg, 4.5 mg, 6 mg Antiarrhythmics (base equivalent) hcl tab 100 mg, hcl tab 80 mg, 120 mg, 160 mg (Betapace) rivastigmine td patch 24hr 200 mg, 400 mg 4.6 mg/24hr, 9.5 mg/24hr, BETAPACE - sotalol hcl tab 80 mg, sotalol hcl tab 240 mg 13.3 mg/24hr (Exelon) 120 mg, 160 mg sotalol hcl (afib/afl) tab 80 mg, 120 mg, 160 mg (Betapace af) Antiangina BETAPACE AF - sotalol hcl (afib/afl) tab 80 mg, 120 mg, 160 mg SOTYLIZE - sotalol hcl oral solution CARDIZEM - hcl tab 30 mg, - digoxin oral soln 5 mg/mL 60 mg, 120 mg 0.05 mg/mL TIKOSYN - cap 125 mcg DILATRATE SR - (0.125 mg), 250 mcg (0.25 mg), cap er 40 mg digoxin oral soln 0.05 mg/mL (Digoxin) 500 mcg (0.5 mg) diltiazem hcl tab 30 mg, 60 mg, digoxin tab 125 mcg (0.125 mg), 120 mg (Cardizem) Anticoagulants/Antiplatelets 250 mcg (0.25 mg) (Lanoxin) AGGRENOX - -dipyridamole diltiazem hcl tab 90 mg disopyramide phosphate cap cap er 12hr 25-200 mg ISORDIL TITRADOSE - isosorbide 100 mg, 150 mg (Norpace) dinitrate tab 5 mg, 40 mg AGRYLIN - anagrelide hcl cap 0.5 mg dofetilide cap 125 mcg (0.125 mg), anagrelide hcl cap 0.5 mg (Agrylin) isosorbide dinitrate tab 5 mg, 250 mcg (0.25 mg), 500 mcg 40 mg (Isordil titradose) (0.5 mg) (Tikosyn) anagrelide hcl cap 1 mg isosorbide dinitrate tab 10 mg, acetate tab 50 mg, aspirin-dipyridamole cap er 12hr 20 mg, 30 mg 100 mg, 150 mg 25-200 mg (Aggrenox) isosorbide mononitrate tab 10 mg, LANOXIN - digoxin tab 62.5 mcg ASPIRIN/ – aspirin- 20 mg (0.0625 mg), 125 mcg (0.125 mg), omeprazole tab delayed release 81-40 mg, 325-40 mg isosorbide mononitrate tab er 250 mcg (0.25 mg) 24hr 30 mg, 60 mg, 120 mg HCL - mexiletine hcl cap BRILINTA - ticagrelor tab 60 mg, 90 mg nifedipine cap 10 mg (Procardia), 150 mg, 200 mg, 250 mg 20 mg MULTAQ - dronedarone hcl tab cilostazol tab 50 mg, 100 mg NITRO-BID - nitroglycerin oint 2% 400 mg (base equivalent) clopidogrel bisulfate tab 75 mg NITRO-DUR - nitroglycerin td patch NORPACE - disopyramide phosphate (base equivalent) (Plavix) 24hr 0.1 mg/hr, 0.2 mg/hr, 0.3 mg/hr, cap 100 mg, 150 mg dipyridamole tab 25 mg, 50 mg, 0.4 mg/hr, 0.6 mg/hr, 0.8 mg/hr NORPACE CR - disopyramide 75 mg NITRO-TIME – nitroglycerin cap er phosphate cap er 12hr 100 mg, DURLAZA - aspirin capsule er 24hr 2.5 mg, 6.5 mg, 9 mg 150 mg 162.5 mg

BRAND DRUGS generic drugs 2 Commonly Prescribed Maintenance Medications

EFFIENT - prasugrel hcl tab 5 mg, hcl tab er 24hr 150 mg, FETZIMA - hcl cap er 10 mg (base equivalent) 300 mg (Wellbutrin xl) 24hr 20 mg, 40 mg, 80 mg, 120 mg ELIQUIS – apixaban tab 2.5 mg BUPROPION HYDROCHLORIDE ER - (base equivalent) PLAVIX - clopidogrel bisulfate tab bupropion hcl tab er 24hr 450 mg DR - fluoxetine hcl cap 75 mg (base equivalent) CAPLYTA – lumateperone tosylate delayed release 90 mg PRADAXA - dabigatran etexilate cap 42 mg FLUOXETINE HYDROCHLORIDE - mesylate cap 75 mg, 150 mg CELEXA - hydrobromide fluoxetine hcl tab 60 mg (etexilate base equivalent) tab 10 mg, 20 mg, 40 mg fluoxetine hcl (pmdd) tab 10 mg, prasugrel hcl tab 5 mg, 10 mg (base equivalent) 20 mg (Sarafem) (base equivalent) (Effient) citalopram hydrobromide oral fluoxetine hcl cap 10 mg, 20 mg, SAVAYSA - edoxaban tosylate tab soln 10 mg/5 mL 40 mg (Prozac) 15 mg, 30 mg, 60 mg citalopram hydrobromide tab fluoxetine hcl solution 20 mg/5 mL (base equivalent) 10 mg, 20 mg, 40 mg fluoxetine hcl tab 10 mg, 20 mg (base equivalent) (Celexa) XARELTO - rivaroxaban tab 2.5 mg, fluoxetine hcl tab 60 mg 15 mg, 20 mg CYMBALTA - duloxetine hcl enteric (Fluoxetine hcl) YOSPRALA - aspirin-omeprazole tab coated pellets cap 20 mg, 30 mg, 60 mg (base equivalent) maleate tab 25 mg, delayed release 81-40 mg, 50 mg, 100 mg 325-40 mg DESVENLAFAXINE ER – desvenlafaxine tab er 24hr 50 mg, fluvoxamine maleate cap er 24hr ZONTIVITY - vorapaxar sulfate tab 100 mg, 150 mg 2.08 mg (base equivalent) 100 mg FORFIVO XL - bupropion hcl tab er desvenlafaxine succinate tab er 24hr 450 mg Arterial Disease 24hr 25 mg, 50 mg, 100 mg pentoxifylline tab er 400 mg (base equivalent) (Pristiq) GEODON - ziprasidone hcl cap 20 mg, 40 mg, 60 mg, 80 mg Behavioral Health DRIZALMA SPRINKLE – duloxetine hcl cap delayed release sprinkle INVEGA - paliperidone tab er 24hr ABILIFY - aripiprazole tab 2 mg, 5 mg, 20 mg, 30 mg, 40 mg, 60 mg 1.5 mg, 3 mg, 6 mg, 9 mg 10 mg, 15 mg, 20 mg, 30 mg (base equivalent) LATUDA - lurasidone hcl tab 20 mg, ABILIFY MYCITE - aripiprazole tab duloxetine hcl enteric coated 40 mg, 60 mg, 80 mg, 120 mg 2 mg with sensor, 5 mg with sensor, pellets cap 20 mg, 30 mg, 60 mg 10 mg with sensor, 15 mg with LEXAPRO - oxalate tab (base equivalent) (Cymbalta) sensor, 20 mg with sensor, 30 mg 5 mg, 10 mg, 20 mg with sensor duloxetine hcl enteric coated (base equivalent) pellets cap 40 mg APLENZIN - bupropion hbr tab er CARBONATE - lithium (base equivalent) 24hr 174 mg, 348 mg, 522 mg carbonate cap 150 mg, 600 mg EFFEXOR XR - hcl cap er aripiprazole oral solution 1 mg/mL cap 150 mg, 24hr 37.5 mg, 75 mg, 150 mg 600 mg (Lithium carbonate) aripiprazole orally disintegrating (base equivalent) tab 10 mg, 15 mg lithium carbonate cap 300 mg EMSAM - td patch 24hr 6 lithium carbonate tab 300 mg aripiprazole tab 2 mg, 5 mg, 10 mg, mg/24hr, 9 mg/24hr, 12 mg/24hr 15 mg, 20 mg, 30 mg (Abilify) lithium carbonate tab er 300 mg escitalopram oxalate soln 5 mg/ (Lithobid) bupropion hcl tab 75 mg, 100 mg 5 mL (base equivalent) lithium carbonate tab er 450 mg bupropion hcl tab er 12hr 100 mg, escitalopram oxalate tab 5 mg, 150 mg, 200 mg (Wellbutrin sr) 10 mg, 20 mg (base equivalent) LITHIUM - lithium oral solution (Lexapro) 8 meq/5 mL

BRAND DRUGS generic drugs 3 Commonly Prescribed Maintenance Medications

LITHOBID - lithium carbonate tab er sulfate tab 15 mg SECUADO – asenapine td patch 24 hr 300 mg (Nardil) 3.8 mg/24hr, 5.7 mg/24hr, HCL - maprotiline hcl - pimozide tab 1 mg, 2 mg 7.6 mg/24hr tab 25 mg, 50 mg, 75 mg PRISTIQ - desvenlafaxine succinate SEROQUEL - fumarate tab MARPLAN - tab 10 mg tab er 24hr 25 mg, 50 mg, 100 mg 25 mg, 50 mg, 100 mg, 200 mg, 300 mg, 400 mg orally disintegrating (base equivalent) tab 15 mg, 30 mg, 45 mg PROZAC - fluoxetine hcl cap 10 mg, SEROQUEL XR - quetiapine fumarate (Remeron soltab) 20 mg, 40 mg tab er 24hr 50 mg, 150 mg, 200 mg, 300 mg, 400 mg mirtazapine tab 7.5 mg, 45 mg quetiapine fumarate tab 25 mg, 50 mg, 100 mg, 200 mg, 300 mg, hcl oral concentrate for mirtazapine tab 15 mg, 30 mg solution 20 mg/mL (Zoloft) (Remeron) 400 mg (Seroquel) sertraline hcl tab 25 mg, 50 mg, NARDIL - phenelzine sulfate tab quetiapine fumarate tab er 24hr 100 mg (Zoloft) 15 mg 50 mg, 150 mg, 200 mg, 300 mg, 400 mg (Seroquel xr) SYMBYAX - -fluoxetine hcl olanzapine orally disintegrating REMERON - mirtazapine tab 15 mg, cap 3-25 mg, 6-25 mg, 6-50 mg, tab 5 mg, 10 mg, 15 mg, 20 mg 12-50 mg (Zyprexa zydis) 30 mg REMERON SOLTAB - mirtazapine sulfate tab 10 mg olanzapine tab 2.5 mg, 5 mg, (Parnate) 7.5 mg, 10 mg, 15 mg, 20 mg orally disintegrating tab 15 mg, (Zyprexa) 30 mg, 45 mg trazodone hcl tab 50 mg, 100 mg, 150 mg, 300 mg olanzapine-fluoxetine hcl cap REXULTI - brexpiprazole tab 0.25 mg, 3-25 mg, 6-25 mg, 6-50 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg TRINTELLIX - vortioxetine hbr tab 5 12-50 mg (Symbyax) RISPERDAL - soln mg, 10 mg, 20 mg (base equivalent) olanzapine-fluoxetine hcl cap 1 mg/mL venlafaxine hcl cap er 24hr 12-25 mg RISPERDAL - risperidone tab 0.5 mg, 37.5 mg, 75 mg, 150 mg (base equivalent) (Effexor xr) paliperidone tab er 24hr 1.5 mg, 1 mg, 2 mg, 3 mg, 4 mg 3 mg, 6 mg, 9 mg (Invega) RISPERIDONE ODT - risperidone venlafaxine hcl tab 25 mg, 37.5 mg, 50 mg, 75 mg, 100 mg PARNATE - tranylcypromine sulfate orally disintegrating tab 0.25 mg (base equivalent) tab 10 mg risperidone orally disintegrating venlafaxine hcl tab er 24hr hcl tab 10 mg, 20 mg, tab 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg 37.5 mg, 75 mg, 150 mg, 225 mg 30 mg, 40 mg (Paxil) (base equivalent) paroxetine hcl tab er 24hr 12.5 mg, risperidone soln 1 mg/mL (Risperdal) VIIBRYD - vilazodone hcl tab 10 mg, 25 mg, 37.5 mg (Paxil cr) 20 mg, 40 mg risperidone tab 0.25 mg PAXIL - paroxetine hcl oral susp VRAYLAR - cariprazine hcl cap 10 mg/5 mL (base equivalent) risperidone tab 0.5 mg, 1 mg, 1.5 mg, 3 mg, 4.5 mg, 6 mg PAXIL - paroxetine hcl tab 10 mg, 2 mg, 3 mg, 4 mg (Risperdal) (base equivalent) 20 mg, 30 mg, 40 mg SAPHRIS - asenapine maleate sl tab WELLBUTRIN SR - bupropion hcl tab PAXIL CR - paroxetine hcl tab er 24hr 2.5 mg, 5 mg, 10 mg er 12hr 100 mg, 150 mg, 200 mg (base equivalent) 12.5 mg, 25 mg, 37.5 mg WELLBUTRIN XL - bupropion hcl tab PEXEVA - paroxetine mesylate tab SARAFEM - fluoxetine hcl (pmdd) tab er 24hr 150 mg, 300 mg 10 mg, 20 mg, 30 mg, 40 mg 10 mg, 20 mg (base equivalent)

BRAND DRUGS generic drugs 4 Commonly Prescribed Maintenance Medications ziprasidone hcl cap 20 mg, 40 mg, LOSEASONIQUE - levonorg-eth est Diabetes 60 mg, 80 mg (Geodon) tab 0.1-0.02 mg (84) & eth est tab acarbose 25 mg, 50 mg, 100 mg 0.01 mg (7) ZOLOFT - sertraline hcl oral (Precose) concentrate for solution 20 mg/mL MINASTRIN 24 FE - norethindrone ACTOPLUS MET - ace-eth -fe chew tab ZOLOFT - sertraline hcl tab 25 mg, hcl-metformin hcl tab 15-500 mg, 1 mg-20 mcg (24) 50 mg, 100 mg 15-850 mg MIRCETTE - desogest-eth estrad & ZYPREXA - olanzapine tab 2.5 mg, ACTOS - pioglitazone hcl tab 15 mg, eth estrad tab 0.15-0.02/0.01 mg 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mg 30 mg, 45 mg (base equivalent) (21/5) ZYPREXA ZYDIS - olanzapine orally ADLYXIN - lixisenatide soln NATAZIA - - disintegrating tab 5 mg, 10 mg, pen-injector 20 mcg/0.2 mL tab 3 mg/2-2 mg/ 15 mg, 20 mg (100 mcg/mL) 2-3 mg/1 mg ALOGLIPTIN - alogliptin benzoate tab Contraceptives ORTHO MICRONOR - norethindrone 6.25 mg, 12.5 mg, 25 mg Oral tab 0.35 mg (base equivalent) oral contraceptives – all generics QUARTETTE - levonor-eth est tab ALOGLIPTIN/METFORMIN HCL - 0.15-0.02/0.025/0.03 mg & eth est BALCOLTRA - -ethinyl alogliptinmetformin hcl tab 0.01 mg estradiol-fe tab 0.1 mg-20 mcg (21) 12.5-500 mg, 12.5-1000 mg SAFYRAL - -ethinyl BEYAZ - drospirenone-ethinyl ALOGLIPTIN/PIOGLITAZONE - estradlevomefolate tab estradlevomefolate tab alogliptinpioglitazone tab 3-0.03-0.451 mg 3-0.02-0.451 mg 12.5-15 mg, 12.5-30 mg, ESTROSTEP FE - norethindrone SEASONIQUE - levonorg-eth est tab 12.5-45 mg, 25-15 mg, ac-ethinyl estrad-fe tab 1-20/ 0.15-0.03 mg (84) & eth est tab 25-30 mg, 25-45 mg 0.01 mg (7) 1-30/1-35 mg-mcg AMARYL - tab 1 mg, 2 mg, GENERESS FE - norethindrone & SLYND – drospirenone tab 4 mg 4 mg ethinyl estradiol-fe chew tab TAYTULLA - norethindrone ace- AVANDIA - maleate tab 0.8 mg-25 mcg ethinyl estradiol-fe cap 2 mg, 4 mg (base equivalent) 1 mg-20 mcg (24) LOESTRIN 1/20-21 - norethindrone BYDUREON BCISE - exenatide ace & ethinyl estradiol tab YASMIN 28 - drospirenone-ethinyl extended release susp 1 mg-20 mcg estradiol tab 3-0.03 mg auto-injector 2 mg/0.85 mL LOESTRIN 1.5/30-21 - norethindrone YAZ - drospirenone-ethinyl estradiol BYDUREON PEN - exenatide ace & ethinyl estradiol tab tab 3-0.02 mg extended release for susp 1.5 mg-30 mcg pen-injector 2 mg LOESTRIN FE 1/20 - norethindrone XULANE - -ethinyl BYETTA - exenatide soln pen-injector ace & ethinyl estradiol-fe tab estradiol td ptwk 150-35 mcg/24hr 5 mcg/0.02 mL, 10 mcg/0.04 mL 1 mg-20 mcg Vaginal CYCLOSET - bromocriptine mesylate LOESTRIN FE 1.5/30 - norethindrone tab 0.8 mg (base equivalent) ace & ethinyl estradiol-fe tab -ethinyl estradiol va DUETACT - pioglitazone hcl- 1.5 mg-30 mcg ring 0.120-0.015 mg/24hr (Nuvaring) glimepiride tab 30-2 mg, 30-4 mg LO LOESTRIN FE - norethin-eth FARXIGA - dapagliflozin propanediol estradiol-fe tab 1 mg-10 mcg NUVARING - etonogestrel-ethinyl tab 5 mg, 10 mg (base equivalent) (24)/10 mcg (2) estradiol va ring 0.120-0.015 mg/24hr FORTAMET - metformin hcl tab er 24hr osmotic 500 mg, 1000 mg

BRAND DRUGS generic drugs 5 Commonly Prescribed Maintenance Medications glimepiride tab 1 mg, 2 mg, 4 mg JANUVIA - sitagliptin phosphate tab pioglitazone hcl tab 15 mg, 30 mg, (Amaryl) 25 mg, 50 mg, 100 mg 45 mg (base equivalent) (Actos) tab 5 mg, 10 mg (base equivalent) pioglitazone hcl-glimepiride tab (Glucotrol) JARDIANCE - empagliflozin tab 10 mg, 30-2 mg, 30-4 mg (Duetact) glipizide tab er 24hr 2.5 mg, 5 mg, 25 mg pioglitazone hcl-metformin hcl tab 10 mg (Glucotrol xl) JENTADUETO - linagliptin-metformin 15-500 mg, 15-850 mg glipizide-metformin hcl tab hcl tab 2.5-500 mg, 2.5-850 mg, (Actoplus met) 2.5-250 mg, 2.5-500 mg, 5-500 mg 2.5-1000 mg PRECOSE - acarbose tab 25 mg, GLUCOTROL - glipizide tab 5 mg, JENTADUETO XR - linagliptin- 50 mg, 100 mg 10 mg metformin hcl tab er 24hr QTERN - dapagliflozin-saxagliptin tab 2.5-1000 mg, 5-1000 mg GLUCOTROL XL - glipizide tab er 24hr 5-5 mg, 10-5 mg 2.5 mg, 5 mg, 10 mg KAZANO - alogliptin-metformin hcl tab 0.5 mg, 1 mg, 2 mg tab 12.5-500 mg, 12.5-1000 mg GLUMETZA - metformin hcl tab er RIOMET - metformin hcl oral soln 24hr modified release 500 mg, KOMBIGLYZE XR - saxagliptin- 500 mg/5 mL 1000 mg metformin hcl tab er 24hr 2.5-1000 mg, 5-500 mg, 5-1000 mg RIOMET ER – metformin hcl for oral glyburide tab 1.25 mg, 2.5 mg, er susp 500 mg/5 mL metformin hcl oral soln 500 mg/ 5 mg RYBELSUS – semaglutide tab 3 mg, 5 mL (Riomet) glyburide micronized tab 1.5 mg, 7 mg, 14 mg metformin hcl tab 500 mg, 850 mg, 3 mg, 6 mg (Glynase) SEGLUROMET - ertugliflozin- 1000 mg glyburide-metformin tab metformin hcl tab 2.5-500 mg, 1.25-250 mg, 2.5-500 mg, metformin hcl tab er 24hr 500 mg, 2.5-1000 mg, 7.5-500 mg, 5-500 mg 750 mg 7.5-1000 mg GLYNASE - glyburide micronized tab metformin hcl tab er 24hr STARLIX - tab 60 mg, 1.5 mg, 3 mg, 6 mg modified release 500 mg, 120 mg 1000 mg (Glumetza) GLYSET - miglitol tab 25 mg, 50 mg, STEGLATRO - ertugliflozin 100 mg metformin hcl tab er 24hr osmotic I-pyroglutamic acid tab 5 mg, 15 mg 500 mg, 1000 mg (Fortamet) GLYXAMBI - empagliflozin-linagliptin (base equivalent) tab 10-5 mg, 25-5 mg miglitol tab 25 mg, 50 mg, 100 mg STEGLUJAN - ertugliflozin-sitagliptin (Glyset) INVOKAMET - canagliflozin-metformin tab 5-100 mg, 15-100 mg hcl tab 50-500 mg, 50-1000 mg, nateglinide tab 60 mg, 120 mg SYMLINPEN 60 - pramlintide acetate 150-500 mg, 150-1000 mg (Starlix) pen-inj 1500 mcg/1.5 mL INVOKAMET XR - canagliflozin- NESINA - alogliptin benzoate tab (1000 mcg/mL) metformin hcl tab er 24hr 6.25 mg, 12.5 mg, 25 mg SYMLINPEN 120 - pramlintide acetate 50-500 mg, 50-1000 mg, (base equivalent) pen-inj 2700 mcg/2.7 mL 150-500 mg, 150-1000 mg ONGLYZA - saxagliptin hcl tab 2.5 mg, (1000 mcg/mL) INVOKANA - canagliflozin tab 100 mg, 5 mg (base equivalent) SYNJARDY - empagliflozin-metformin 300 mg OSENI - alogliptin-pioglitazone tab hcl tab 5-500 mg, 5-1000 mg, JANUMET - sitagliptin-metformin hcl 12.5-15 mg, 12.5-30 mg, 12.5-500 mg, 12.5-1000 mg tab 50-500 mg, 50-1000 mg 12.5-45 mg, 25-15 mg, 25-30 mg, SYNJARDY XR - empagliflozin- 25-45 mg JANUMET XR - sitagliptin-metformin metformin hcl tab er 24hr hcl tab er 24hr 50-500 mg, OZEMPIC - semaglutide soln pen inj 5-1000 mg, 10-1000 mg, 50-1000 mg, 100-1000 mg 0.25 mg/dose, 0.5 mg/dose, 12.5-1000 mg, 25-1000 mg 1 mg/dose (2 mg/1.5 mL) BRAND DRUGS generic drugs 6 Commonly Prescribed Maintenance Medications

TOLBUTAMIDE - tab ethacrynic acid tab 25 mg (Edecrin) /Progestin 500 mg - furosemide oral soln ACTIVELLA – estradiol & TRADJENTA - linagliptin tab 5 mg 8 mg/mL norethindrone acetate tab TRIJARDY XR – empagliflozin- furosemide oral soln 10 mg/mL 1-0.5 mg linagliptin-metformin tab er 24hr furosemide tab 20 mg, 40 mg, ALORA – estradiol td patch twice 5-2.5-1000, 10-5-1000, 80 mg (Lasix) weekly 0.025 mg/24hr, 12.5-2.5-1000, 25-5-1000 0.05 mg/24hr, 0.075 mg/24hr, LASIX - furosemide tab 20 mg, 40 mg, 0.1 mg/24hr TRULICITY - dulaglutide soln 80 mg pen-injector 0.75 mg/0.5 mL, ANGELIQ – drospirenone-estradiol torsemide tab 5 mg, 10 mg, 20 mg, 1.5 mg/0.5 mL tab 0.25-0.5 mg, 0.5-1 mg 100 mg VICTOZA - liraglutide soln AYGESTIN – norethindrone acetate cap 50 mg, 100 mg pen-injector 18 mg/3 mL (6 mg/mL) tab 5 mg (Dyrenium) XIGDUO XR - dapagliflozin-metformin BIJUVA – estradiol- cap hcl tab er 24hr 2.5-1000 mg, 1-100 mg 5-500 mg, 5-1000 mg, 10-500 mg, CREON - pancrelipase (lip-prot-amyl) CLIMARA – estradiol td patch weekly 10-1000 mg dr cap 3000-9500-15000 unit, 0.025 mg/24hr, 0.0375 mg/24hr Dry Eye 6000-19000-30000 unit, (37.5 mcg/24hr), 0.05 mg/24hr, 12000-38000-60000 unit, 0.06 mg/24hr, 0.075 mg/24hr, RESTASIS - cyclosporine (ophth) 24000-76000-120000 unit, 0.1 mg/24hr emulsion 0.05% 36000-114000-180000 unit CLIMARA PRO – estradiol- RESTASIS MULTIDOSE - cyclosporine PANCREAZE - pancrelipase levonorgestrel td patch weekly (ophth) emulsion 0.05% (lip-prot-amyl) dr cap 0.045-0.015 mg/day XIIDRA - lifitegrast ophth soln 5% 2600-6200-10850 unit, COMBIPATCH – estradiol- 4200-14200-24600 unit, norethindrone ace td pttw 0.05- Dry Mouth 10500-35500-61500 unit, 0.14 mg/day, 0.05-0.25 mg/day hcl cap 30 mg (Evoxac) 16800-56800-98400 unit, DIVIGEL – estradiol td gel EVOXAC - cevimeline hcl cap 30 mg 21000-54700-83900 unit 0.25 mg/0.25 gm (0.1%), 0.5 mg/ PERTZYE - pancrelipase hcl tab 5 mg, 7.5 mg 0.5 gm (0.1%), 0.75 mg/0.75 gm (lip-prot-amyl) dr cap (Salagen) (0.1%), 1 mg/gm (0.1%), 4000-14375-15125 unit, SALAGEN - pilocarpine hcl tab 5 mg, 1.25 mg/1.25 gm (0.1%) 8000-28750-30250 unit, 7.5 mg 16000-57500-60500 unit, DUAVEE – conjugated estrogensbazedoxifene tab 24000-86250-90750 unit 0.45-20 mg cap er 12hr 500 mg VIOKACE - pancrelipase (lip-prot-amyl) tab ELESTRIN – estradiol gel 0.06% acetazolamide tab 125 mg, 250 mg 10440-39150-39150 unit, (0.52 mg/0.87 gm metered-dose tab 0.5 mg, 1 mg, 20880-78300-78300 unit pump) 2 mg (Bumex) ZENPEP - pancrelipase (lip-prot-amyl) ESTRACE – estradiol tab 0.5 mg, BUMEX - bumetanide tab 0.5 mg, dr cap 10000-32000-42000 unit, 1 mg, 2 mg 1 mg, 2 mg 15000-47000-63000 unit, ESTRACE – estradiol vaginal cream DYRENIUM - triamterene cap 50 mg, 20000-63000-84000 unit, 0.1 mg/gm 25000-79000-105000 unit, 100 mg estradiol & norethindrone acetate 3000-10000-14000 unit, EDECRIN - ethacrynic acid tab 25 mg tab 0.5-0.1 mg 40000-126000-168000 unit, 5000-17000-24000 unit BRAND DRUGS generic drugs 7 Commonly Prescribed Maintenance Medications estradiol & norethindrone acetate MINIVELLE – estradiol td patch tab 1-0.5 mg (Activella) twice weekly 0.025 mg/24hr, SAVELLA - hcl tab 0.0375 mg/24hr, 0.05 mg/24hr, estradiol tab 0.5 mg, 1 mg, 2 mg 12.5 mg, 25 mg, 50 mg, 100 mg (Estrace) 0.075 mg/24hr, 0.1 mg/24hr Fluoride estradiol td patch twice weekly norethindrone acetate tab 5 mg 0.025 mg/24hr, 0.0375 mg/24hr, (Aygestin) FLUORABON - fluoride soln 0.05 mg/24hr, 0.075 mg/24hr, norethindrone acetate-ethinyl 0.25 mg/0.6 mL (from 0.55 mg/ 0.1 mg/24hr (Vivelle-dot) estradiol tab 0.5 mg-2.5 mcg 0.6 mL naf) estradiol td patch weekly (Femhrt low dose) FLURA-DROPS - sodium fluoride soln 0.025 mg/24hr, 0.0375 mg/24hr norethindrone acetate-ethinyl 0.25 mg/drop f (from 0.55 mg/ (37.5 mcg/24hr), 0.05 mg/24hr, estradiol tab 1 mg-5 mcg drop naf) 0.06 mg/24hr, 0.075 mg/24hr, OSPHENA – tab 60 mg NAFRINSE DAILY/NEUTRAL - sodium 0.1 mg/24hr (Climara) fluoride for soln rinse 0.05% PREFEST – estradiol tab 1 mg (15)/ estradiol vaginal cream 0.1 mg/gm estradnorgestimate tab NAFRINSE WEEKLY - sodium fluoride (Estrace) 1-0.09 mg (15) for soln rinse 0.2% estradiol vaginal tab 10 mcg PREMARIN – , conjugated PREVIDENT 5000 BOOSTER PLUS - (Vagifem) tab 0.3 mg, 0.45 mg, 0.625 mg, sodium fluoride paste 1.1% ESTRING – estradiol vaginal ring 2 mg 0.9 mg, 1.25 mg PREVIDENT 5000 DRY MOUTH - (7.5 mcg/24hrs) PREMARIN – estrogens, conjugated sodium fluoride gel 1.1% (0.5% f) ESTROGEL – estradiol gel 0.06% vaginal cream 0.625 mg/gm PREVIDENT 5000 ORTHO DEFE - (0.75 mg/1.25 gm metered-dose PREMPHASE – conj est 0.625 (14)/ sodium fluoride paste 1.1% pump) conj est-medroxypro ac tab PREVIDENT 5000 PLUS - sodium EVAMIST – estradiol transdermal 0.625-5 mg (14) fluoride cream 1.1% spray 1.53 mg/spray PREMPRO – conjugated PREVIDENT FLUORIDE - sodium FEMHRT LOW DOSE – norethindrone estrogenmedroxyprogest acetate fluoride gel 1.1% (0.5% f) acetate-ethinyl estradiol tab tab 0.3-1.5 mg, 0.45-1.5 mg, PREVIDENT RINSE - sodium fluoride 0.5 mg-2.5 mcg 0.625-2.5 mg, 0.625-5 mg rinse 0.2% FEMRING – vaginal progesterone micronized cap SODIUM FLUORIDE - sodium fluoride ring 0.05 mg/24hr, 0.1 mg/24hr 100 mg, 200 mg (Prometrium) tab 0.5 mg f (from 1.1 mg naf), IMVEXXY – estradiol vaginal insert PROMETRIUM – progesterone 1 mg f (from 2.2 mg naf) 4 mcg, 10 mcg micronized cap 100 mg, 200 mg sodium fluoride chew tab INTRAROSA - vaginal PROVERA – 0.25 mg f (from 0.55 mg naf), insert 6.5 mg acetate tab 2.5 mg, 5 mg, 10 mg 0.5 mg f (from 1.1 mg naf), 1 mg f medroxyprogesterone acetate tab VAGIFEM – estradiol vaginal tab (from 2.2 mg naf) 2.5 mg, 5 mg, 10 mg (Provera) 10 mcg sodium fluoride cream 1.1% acetate susp VIVELLE-DOT – estradiol td patch (Prevident 5000 plus) 625 mg/5 mL twice weekly 0.025 mg/24hr, sodium fluoride gel 1.1% (0.5% f) MENEST – tab 0.0375 mg/24hr, 0.05 mg/24hr, (Prevident fluoride) 0.3 mg, 0.625 mg, 1.25 mg 0.075 mg/24hr, 0.1 mg/24hr sodium fluoride paste 1.1% MENOSTAR – estradiol td patch (Prevident 5000 boost) weekly 14 mcg/24hr sodium fluoride rinse 0.2% (Prevident)

BRAND DRUGS generic drugs 8 Commonly Prescribed Maintenance Medications sodium fluoride soln 0.125 mg/ DEXILANT - dexlansoprazole cap LEVBID - sulfate tab er drop f (0.275 mg/drop naf), 0.5 delayed release 30 mg, 60 mg 12hr 0.375 mg mg/mL f (from 1.1 mg/mL naf) DIPENTUM - olsalazine sodium cap LEVSIN - hyoscyamine sulfate tab stannous fluoride conc 0.63% 250 mg 0.125 mg

Folic Acid esomeprazole cap LEVSIN/SL - hyoscyamine sulfate tab delayed release 20 mg, 40 mg sl 0.125 mg folic acid 1 mg (base equivalent) (Nexium) LIALDA - mesalamine tab delayed Gastrointestinal esomeprazole magnesium for release 1.2 gm ACIPHEX - rabeprazole sodium ec tab delayed release susp packet LINZESS - linaclotide cap 72 mcg, 20 mg 10 mg, 20 mg, 40 mg (Nexium) 145 mcg, 290 mcg ACIPHEX SPRINKLE - rabeprazole ESOMEPRAZOLE - LOTRONEX - alosetron hcl tab sodium capsule sprinkle dr 5 mg, esomeprazole strontium cap 0.5 mg, 1 mg (base equivalent) 10 mg delayed release 49.3 mg mesalamine cap dr 400 mg ACTIGALL - ursodiol cap 300 mg famotidine tab 20 mg, 40 mg (Delzicol) (Pepcid) alosetron hcl tab 0.5 mg, 1 mg mesalamine cap er 24hr 0.375 gm (base equivalent) (Lotronex) GASTROCROM - cromolyn sodium (Apriso) oral conc 100 mg/5 mL AMITIZA - lubiprostone cap 8 mcg, mesalamine tab delayed release 24 mg hyoscyamine sulfate elixir 1.2 gm (Lialda) 0.125 mg/5 mL ANASPAZ - hyoscyamine sulfate tab misoprostol tab 100 mcg, 200 mcg disint 0.125 mg hyoscyamine sulfate soln (Cytotec) 0.125 mg/mL APRISO - mesalamine cap er 24hr MOTEGRITY - prucalopride succinate 0.375 gm hyoscyamine sulfate tab 0.125 mg tab 1 mg, 2 mg (base equivalent) (Levsin) AZULFIDINE - sulfasalazine tab NEXIUM - esomeprazole magnesium 500 mg hyoscyamine sulfate tab disint cap delayed release 20 mg, 40 mg 0.125 mg (Anaspaz) AZULFIDINE EN-TABS - sulfasalazine (base equivalent) tab delayed release 500 mg hyoscyamine sulfate tab er 12hr NEXIUM - esomeprazole magnesium 0.375 mg (Levbid) CARAFATE - sucralfate susp for delayed release susp packet 1 gm/10 mL hyoscyamine sulfate sl tab 0.125 2.5 mg, 5 mg, 10 mg, 20 mg, 40 mg mg (Levsin/sl) CARAFATE - sucralfate tab 1 gm NIZATIDINE – nizatidine cap 150 mg KRISTALOSE - lactulose oral crystal HCL - cimetidine hcl soln nizatidine cap 300 mg packet 10 gm, 20 gm 300 mg/5 mL NIZATIDINE - nizatidine oral soln LACTULOSE – lactulose oral crystal cimetidine tab 300 mg, 400 mg, 15 mg/mL packet 10 gm 800 mg omeprazole cap delayed release lactulose (encephalopathy) cromolyn sodium oral conc 10 mg, 20 mg, 40 mg solution 10 gm/15 mL 100 mg/5 mL (Gastrocrom) omeprazole-sodium bicarbonate lactulose solution 10 gm/15 mL CYTOTEC - misoprostol tab 100 mcg, cap 20-1100 mg, 40-1100 mg 200 mcg lansoprazole cap delayed release (Zegerid) 15 mg, 30 mg (Prevacid) DELZICOL - mesalamine cap dr omeprazole-sodium bicarbonate 400 mg lansoprazole tab delayed release powd pack for susp 20-1680 mg, orally disintegrating 15 mg, 40-1680 mg (Zegerid) 30 mg (Prevacid solutab)

BRAND DRUGS generic drugs 9 Commonly Prescribed Maintenance Medications pantoprazole sodium ec tab VIBERZI - eluxadoline tab 75 mg, dorzolamide hcl-timolol maleate 20 mg, 40 mg (base equivalent) 100 mg ophth soln 22.3-6.8 mg/mL (Protonix) XIFAXAN - tab 550 mg (Cosopt), 22.3-6.8 mg/mL pf (Cosopt PF) PENTASA - mesalamine cap er ZEGERID - omeprazole-sodium 250 mg, 500 mg bicarbonate cap 20-1100 mg, ISOPTO CARPINE - pilocarpine hcl PEPCID - famotidine tab 20 mg, 40-1100 mg ophth soln 1%, 2%, 4% 40 mg ZEGERID - omeprazole-sodium ISTALOL - timolol maleate ophth soln PREVACID - lansoprazole cap delayed bicarbonate powd pack for susp 0.5% (once-daily) release 15 mg, 30 mg 20-1680 mg, 40-1680 mg LATANOPROST - latanoprost ophth soln 0.005% PREVACID SOLUTAB - lansoprazole Glaucoma tab delayed release orally latanoprost ophth soln 0.005% disintegrating 15 mg, 30 mg acetazolamide cap er 12hr 500 mg (Xalatan) PRILOSEC - omeprazole magnesium ALPHAGAN P - tartrate LEVOBUNOLOL HCL – levobunolol for delayed release susp packet ophth soln 0.1%, 0.15% hcl ophth soln 0.5% 2.5 mg, 10 mg AZOPT - brinzolamide ophth susp 1% LUMIGAN - bimatoprost ophth soln PROTONIX - pantoprazole sodium ec betaxolol hcl ophth soln 0.5% 0.01% tab 20 mg, 40 mg (base equivalent) BETIMOL - timolol ophth soln 0.25%, methazolamide tab 25 mg, 50 mg 0.5% PROTONIX - pantoprazole sodium for pilocarpine hcl ophth soln 1%, 2%, delayed release susp packet 40 mg BETOPTIC-S - betaxolol hcl ophth 4% (Isopto carpine) RABEPRAZOLE SODIUM DR SPR – susp 0.25% RHOPRESSA - netarsudil dimesylate rabeprazole sodium capsule bimatoprost ophth soln 0.03% ophth soln 0.02% sprinkle dr 10 mg brimonidine tartrate ophth soln ROCKLATAN - netarsudil dimesylate- rabeprazole sodium ec tab 20 mg 0.15% (Alphagan p), 0.2% latanoprost ophth soln 0.02-0.005% (Aciphex) CARTEOLOL HCL - carteolol hcl ophth SIMBRINZA - brinzolamide- sucralfate susp 1 gm/10 mL soln 1% brimonidine tartrate ophth susp (Carafate) COMBIGAN - brimonidine 1-0.2% sucralfate tab 1 gm (Carafate) tartrate-timolol maleate ophth soln timolol maleate ophth soln 0.25%, sulfasalazine tab 500 mg 0.2-0.5% 0.5% (Timoptic) (Azulfidine) COSOPT - dorzolamide hcl-timolol timolol maleate ophth soln 0.5% sulfasalazine tab delayed release maleate ophth soln 22.3-6.8 mg/mL (once-daily) (Istalol) 500 mg (Azulfidine en-tabs) COSOPT PF - dorzolamide TIMOLOL MALEATE OPHTHALMIC SYMAX DUOTAB - hyoscyamine hcl-timolol maleate ophth soln GEL FORMING - timolol maleate sulfate tab er 0.375 mg 22.3-6.8 mg/mL pf ophth gel forming soln 0.25%, 0.5% (0.125 mg ir/0.25 mg er) DORZOLAMIDE HCL – dorzolamide TIMOPTIC - timolol maleate ophth TRULANCE - plecanatide tab 3 mg hcl ophth soln 2% soln 0.25%, 0.5% URSO 250 - ursodiol tab 250 mg dorzolamide hcl ophth soln 2% TIMOPTIC OCUDOSE - timolol URSO FORTE - ursodiol tab 500 mg (Trusopt) maleate preservative free ophth DORZOLAMIDE HCL/TIMOLOL M - soln 0.25%, 0.5% ursodiol cap 300 mg (Actigall) dorzolamide hcl-timolol maleate TIMOPTIC-XE - timolol maleate ophth ursodiol tab 250 mg (Urso 250), ophth soln 22.3-6.8 mg/mL gel forming soln 0.25%, 0.5% 500 mg (Urso forte)

BRAND DRUGS generic drugs 10 Commonly Prescribed Maintenance Medications

TRAVATAN Z - travoprost ophth soln acebutolol hcl cap 200 mg, 400 mg atenolol & chlorthalidone tab 0.004% (benzalkonium free) ALDACTAZIDE - & 50-25 mg (Tenoretic 50), travoprost ophth soln 0.004% tab 25-25 mg, 100-25 mg (Tenoretic 100) (benzalkonium free) (Travatan z) 50-50 mg AVALIDE - irbesartan- TRUSOPT - dorzolamide hcl ophth ALDACTONE - spironolactone tab hydrochlorothiazide tab soln 2% 25 mg, 50 mg, 100 mg 150-12.5 mg, 300-12.5 mg VYZULTA - latanoprostene bunod aliskiren fumarate tab 150 mg, AVAPRO - irbesartan tab 75 mg, ophth soln 0.024% 300 mg (base equivalent) 150 mg, 300 mg XALATAN - latanoprost ophth soln (Tekturna) AZOR - besylate- 0.005% ALTACE - ramipril cap 1.25 mg, olmesartan medoxomil tab 2.5 mg, 5 mg, 10 mg 5-20 mg, 5-40 mg, 10-20 mg, XELPROS - latanoprost ophth 10-40 mg emulsion 0.005% hcl tab 5 mg hcl tab 5 mg ZIOPTAN – tafluprost preservative amiloride & hydrochlorothiazide free (pf) ophth soln 0.0015% tab 5-50 mg benazepril hcl tab 10 mg, 20 mg, 40 mg (Lotensin) Gout amlodipine besylate 2.5 mg, 5 mg, 10 mg (base equivalent) benazepril & hydrochlorothiazide allopurinol tab 100 mg, 300 mg (Norvasc) tab 5-6.25 mg (Zyloprim) amlodipine besylate benazepril hcl benazepril & hydrochlorothiazide colchicine w/ tab cap 2.5-10 mg, 5-40 mg tab 10-12.5 mg, 20-12.5 mg, 0.5-500 mg 20-25 mg (Lotensin hct) amlodipine besylate-benazepril DUZALLO - lesinurad-allopurinol tab hcl 5-10 mg, 5-20 mg, 10-20 mg, BENICAR - olmesartan medoxomil 200-200 mg, 200-300 mg 10-40 mg (Lotrel) tab 5 mg, 20 mg, 40 mg febuxostat tab 40 mg, 80 mg amlodipine besylate olmesartan BENICAR HCT - olmesartan (Uloric) medoxomil tab 5-20 mg, 5-40 mg, medoxomil-hydrochlorothiazide tab probenecid tab 500 mg 10-20 mg, 10-40 mg (Azor) 20-12.5 mg, 40-12.5 mg, 40-25 mg ULORIC - febuxostat tab 40 mg, amlodipine besylate-valsartan tab betaxolol hcl tab 10 mg, 20 mg 80 mg 5-160 mg, 5-320 mg, 10-160 mg, bisoprolol fumarate tab 5 mg, ZYLOPRIM - allopurinol tab 100 mg, 10-320 mg (Exforge) 10 mg 300 mg amlodipine-valsartan- bisoprolol & hydrochlorothiazide hydrochlorothiazide tab tab 2.5-6.25 mg, 5-6.25 mg, Failure 5-160-12.5 mg, 5-160-25 mg, 10-6.25 mg (Ziac) BIDIL - isosorbide dinitrate- 10-160-12.5 mg, 10-160-25 mg, BYSTOLIC - nebivolol hcl tab hydralazine hcl tab 20-37.5 mg 10-320-25 mg (Exforge hct) 2.5 mg, 5 mg, 10 mg, 20 mg ENTRESTO - sacubitril-valsartan tab ATACAND - cilexetil tab (base equivalent) 24-26 mg, 49-51 mg, 97-103 mg 4 mg, 8 mg, 16 mg, 32 mg CALAN SR - hcl tab er High Blood Pressure ATACAND HCT - candesartan 120 mg, 180 mg, 240 mg cilexetilhydrochlorothiazide tab ACCUPRIL - quinapril hcl tab 5 mg, candesartan cilexetil tab 4 mg, 16-12.5 mg, 32-12.5 mg, 32-25 mg 10 mg, 20 mg, 40 mg 8 mg, 16 mg, 32 mg (Atacand) atenolol tab 25 mg, 50 mg, 100 mg ACCURETIC - quinapril- candesartan cilexetil- (Tenormin) hydrochlorothiazide tab hydrochlorothiazide tab 10-12.5 mg, 20-12.5 mg, 20-25 mg 16-12.5 mg, 32-12.5 mg, 32-25 mg (Atacand hct)

BRAND DRUGS generic drugs 11 Commonly Prescribed Maintenance Medications captopril tab 12.5 mg, 25 mg, CORGARD - nadolol tab 20 mg, enalapril maleate tab 2.5 mg, 50 mg, 100 mg 40 mg, 80 mg 5 mg, 10 mg, 20 mg (Vasotec) CAPTOPRIL/HYDROCHLOROTHIAZIDE COZAAR - losartan tab enalapril maleate & - captopril & hydrochlorothiazide 25 mg, 50 mg, 100 mg hydrochlorothiazide tab tab 25-15 mg, 25-25 mg, diltiazem hcl cap er 12hr 60 mg, 5-12.5 mg 50-15 mg, 50-25 mg 90 mg, 120 mg enalapril maleate & CARDIZEM CD - diltiazem hcl coated diltiazem hcl coated beads cap er hydrochlorothiazide tab beads cap er 24hr 120 mg, 180 mg, 24hr 120 mg, 180 mg, 240 mg, 10-25 mg (Vaseretic) 240 mg, 300 mg, 360 mg 300 mg, 360 mg (Cardizem cd) EPANED - enalapril maleate oral soln CARDIZEM LA - diltiazem hcl coated diltiazem hcl coated beads tab er 1 mg/mL beads tab er 24hr 120 mg, 180 mg, 24hr 180 mg, 240 mg, 300 mg, tab 25 mg, 50 mg 240 mg, 300 mg, 360 mg, 420 mg 360 mg, 420 mg (Cardizem la) (Inspra) CAROSPIR - spinonolactone susp diltiazem hcl extended release EXFORGE - amlodipine besylate- 25 mg/5 mL beads cap er 24hr 120 mg, valsartan tab 5-160 mg, 5-320 mg, phosphate cap er 24hr 180 mg, 240 mg, 300 mg, 10-160 mg, 10-320 mg 10 mg, 20 mg, 40 mg, 80 mg 360 mg, 420 mg (Tiazac) EXFORGE HCT - amlodipine- (Coreg cr) diltiazem hcl tab 30 mg, 60 mg, valsartan-hydrochlorothiazide tab carvedilol tab 3.125 mg, 6.25 mg, 120 mg (Cardizem) 5-160-12.5 mg, 5-160-25 mg, 12.5 mg, 25 mg (Coreg) diltiazem hcl tab 90 mg 10-160-12.5 mg, 10-160-25 mg, 10-320-25 mg CATAPRES - clonidine hcl tab 0.1 mg, DILT-XR - diltiazem hcl cap er 24hr 0.2 mg, 0.3 mg 120 mg, 180 mg, 240 mg tab er 24hr 2.5 mg, 5 mg, 10 mg CATAPRES-TTS-1 - clonidine td patch DIOVAN - valsartan tab 40 mg, 80 mg, weekly 0.1 mg/24hr 160 mg, 320 mg fosinopril sodium & hydrochlorothiazide tab CATAPRES-TTS-2 - clonidine td patch DIOVAN HCT - valsartan- 10-12.5 mg, 20-12.5 mg weekly 0.2 mg/24hr hydrochlorothiazide tab CATAPRES-TTS-3 - clonidine td patch 80-12.5 mg, 160-12.5 mg, fosinopril sodium tab 10 mg, weekly 0.3 mg/24hr 160-25 mg, 320-12.5 mg, 20 mg, 40 mg - chlorothiazide 320-25 mg guanfacine hcl tab 1 mg, 2 mg tab 250 mg, 500 mg DIURIL - chlorothiazide susp hydralazine hcl tab 10 mg, 25 mg, chlorthalidone tab 25 mg, 50 mg 250 mg/5 mL 50 mg, 100 mg clonidine hcl tab 0.1 mg, 0.2 mg, DUTOPROL - metoprolol & hydrochlorothiazide cap 12.5 mg 0.3 mg (Catapres) hydrochlorothiazide tab er 24hr hydrochlorothiazide tab 12.5 mg, 25-12.5 mg, 50-12.5 mg, 25 mg, 50 mg clonidine td patch weekly 100-12.5 mg 0.1 mg/24hr (Catapres-tts-1), HYZAAR - losartan potassium & 0.2 mg/24hr (Catapres-tts-2), DYAZIDE - triamterene & hydrochlorothiazide tab 0.3 mg/24hr (Catapres-tts-3) hydrochlorothiazide cap 50-12.5 mg, 100-12.5 mg, 37.5-25 mg COREG - carvedilol tab 3.125 mg, 100-25 mg 6.25 mg, 12.5 mg, 25 mg EDARBI - azilsartan medoxomil tab tab 1.25 mg, 2.5 mg 40 mg, 80 mg COREG CR - carvedilol phosphate INDERAL LA - hcl cap er cap er 24hr 10 mg, 20 mg, 40 mg, EDARBYCLOR - azilsartan medoxomil- 24hr 60 mg, 80 mg, 120 mg, 80 mg chlorthalidone tab 40-12.5 mg, 160 mg 40-25 mg

BRAND DRUGS generic drugs 12 Commonly Prescribed Maintenance Medications

INDERAL XL - propranolol hcl LOTENSIN - benazepril hcl tab 10 mg, tab 2.5 mg, 10 mg sustained release beads cap er 20 mg, 40 mg moexipril hcl tab 7.5 mg, 15 mg 24hr 80 mg, 120 mg LOTENSIN HCT - benazepril & nadolol tab 20 mg, 40 mg, 80 mg INNOPRAN XL - propranolol hcl hydrochlorothiazide tab (Corgard) sustained release beads cap er 10-12.5 mg, 20-12.5 mg, 20-25 mg hcl cap 20 mg, 30 mg 24hr 80 mg, 120 mg LOTREL - amlodipine besylate- INSPRA - eplerenone tab 25 mg, benazeptril hcl cap 5-10 mg, nifedipine tab er 24hr 30 mg, 50 mg 5-20 mg, 10-20 mg, 10-40 mg 60 mg, 90 mg irbesartan tab 75 mg, 150 mg, MAXZIDE - triamterene & nifedipine tab er 24hr osmotic 300 mg (Avapro) hydrochlorothiazide tab 75-50 mg release 30 mg, 60 mg, 90 mg (Procardia xl) irbesartan-hydrochlorothiazide MAXZIDE-25 - triamterene & ER - nisoldipine tab er tab 150-12.5 mg, 300-12.5 mg hydrochlorothiazide tab 37.5-25 mg 24hr 20 mg, 25.5 mg, 30 mg, 40 mg (Avalide) tab 250 mg, 500 mg cap 2.5 mg, 5 mg nisoldipine tab er 24 hr 8.5 mg, METHYLDOPA/ 17 mg, 34 mg (Sular) KAPSPARGO SPRINKLE - metoprolol HYDROCHLOROTHIAZIDE- succ cap er 24hr sprinkle 25 mg, methyldopa & hydrochlorothiazide NORVASC - amlodipine besylate 24hr sprinkle 50 mg, 24hr sprinkle tab 250-15 mg, 250-25 mg 2.5 mg, 5 mg, 10 mg (base equivalent) 100 mg, 24hr sprinkle 200 mg tab 2.5 mg, 5 mg, (tartrate equivalent) 10 mg olmesartan medoxomil tab 5 mg, 20 mg, 40 mg (Benicar) KATERZIA – amlodipine benzoate oral metoprolol & hydrochlorothiazide susp 1 mg/mL (base equivalent) tab 50-25 mg (Lopressor hct) olmesartan medoxomil- hydrochlorothiazide tab labetalol hcl tab 100 mg, 200 mg, metoprolol & hydrochlorothiazide 300 mg 20-12.5 mg, 40-12.5 mg, tab 100-25 mg 40-25 mg (Benicar hct) lisinopril & hydrochlorothiazide metoprolol succinate tab er 24hr olmesartan-amlodipine- tab 10-12.5 mg, 20-12.5 mg, 25 mg, 50 mg, 100 mg, 200 mg 20-25 mg (Zestoretic) hydrochlorothiazide tab (tartrate equiv) (Toprol xl) 20-5-12.5 mg, 40-5-12.5 mg, lisinopril tab 2.5 mg, 5 mg, 30 mg, metoprolol tartrate tab 25 mg, 40-5-25 mg, 40-10-12.5 mg, 40 mg (Zestril) 37.5 mg, 75 mg 40-10-25 mg (Tribenzor) lisinopril tab 10 mg, 20 mg metoprolol tartrate tab 50 mg, perindopril erbumine tab 2 mg, (Prinivil) 100 mg (Lopressor) 4 mg, 8 mg LOPRESSOR - metoprolol tartrate tab METOPROLOL/ pindolol tab 5 mg, 10 mg 50 mg, 100 mg HYDROCHLOROTHIAZIDE - prazosin hcl cap 1 mg, 2 mg, 5 mg LOPRESSOR HCT - metoprolol & metoprolol & hydrochlorothiazide (Minipress) hydrochlorothiazide tab 50-25 mg tab 100-50 mg PRESTALIA - perindopril arginine- losartan potassium & MICARDIS - tab 20 mg, amlodipine besylate tab 3.5-2.5 mg, hydrochlorothiazide tab 40 mg, 80 mg 7-5 mg, 14-10 mg 50-12.5 mg, 100-12.5 mg, MICARDIS HCT - telmisartan - PRINIVIL - lisinopril tab 10 mg, 20 mg 100-25 mg (Hyzaar) hydrochlorothiazide tab PROCARDIA XL - nifedipine tab er losartan potassium tab 25 mg, 40-12.5 mg, 80-12.5 mg, 80-25 mg 24hr osmotic release 30 mg, 60 mg, 50 mg, 100 mg (Cozaar) MINIPRESS - prazosin hcl cap 1 mg, 90 mg 2 mg, 5 mg

BRAND DRUGS generic drugs 13 Commonly Prescribed Maintenance Medications

PROPRANOLOL HCL - propranolol hcl TENORETIC 50 - atenolol & VASERETIC - enalapril maleate & oral soln 20 mg/5 mL, 40 mg/5 mL chlorthalidone tab 50-25 mg hydrochlorothiazide tab 10-25 mg propranolol hcl cap er 24hr 60 mg, TENORETIC 100 - atenolol & VASOTEC - enalapril maleate tab 80 mg, 120 mg, 160 mg (Inderal la) chlorthalidone tab 100-25 mg 2.5 mg, 5 mg, 10 mg, 20 mg propranolol hcl tab 10 mg, 20 mg, TENORMIN - atenolol tab 25 mg, verapamil hcl cap er 24hr 120 mg, 40 mg, 60 mg 80 mg 50 mg, 100 mg 180 mg, 240 mg (Verelan) PROPRANOLOL/ terazosin hcl cap 1 mg, 2 mg, 5 mg, VERAPAMIL HCL ER - verapamil hcl HYDROCHLOROTHIAZIDE - 10 mg (base equivalent) cap er 24hr 100 mg, 200 mg, propranolol & hydrochlorothiazide TIAZAC - diltiazem hcl extended 300 mg tab 40-25 mg, 80-25 mg release beads cap er 24hr 120 mg, VERAPAMIL HCL SR - verapamil hcl QBRELIS - lisinopril oral soln 1 mg/mL 180 mg, 240 mg, 300 mg, 360 mg, cap er 24hr 360 mg quinapril hcl tab 5 mg, 10 mg, 420 mg verapamil hcl tab 40 mg, 80 mg, 20 mg, 40 mg (Accupril) timolol maleate tab 5 mg, 10 mg, 120 mg quinapril-hydrochlorothiazide tab 20 mg verapamil hcl tab er 120 mg, 10-12.5 mg, 20-12.5 mg, 20-25 mg TOPROL XL - metoprolol succinate 180 mg, 240 mg (Calan sr) (Accuretic) tab er 24hr 25 mg, 50 mg, 100 mg, VERELAN - verapamil hcl cap er 24hr ramipril cap 1.25 mg, 2.5 mg, 5 mg, 200 mg (tartrate equiv) 120 mg, 180 mg, 240 mg, 360 mg 10 mg (Altace) trandolapril tab 1 mg, 2 mg, 4 mg VERELAN PM - verapamil hcl cap er spironolactone tab 25 mg, 50 mg, TRANDOLAPRIL/VERAPAMIL HCL - 24hr 100 mg, 200 mg, 300 mg 100 mg (Aldactone) trandolapril-verapamil hcl tab er ZESTORETIC - lisinopril & spironolactone & 1-240 mg hydrochlorothiazide tab hydrochlorothiazide tab trandolapril-verapamil hcl tab er 10-12.5 mg, 20-12.5 mg, 20-25 mg 25-25 mg (Aldactazide) 2-180 mg, 2-240 mg, 4-240 mg ZESTRIL - lisinopril tab 2.5 mg, 5 mg, SULAR - nisoldipine tab er 24hr (Tarka) 10 mg, 20 mg, 30 mg, 40 mg 8.5 mg, 17 mg, 34 mg triamterene & hydrochlorothiazide ZIAC - bisoprolol & TARKA - trandolapril-verapamil hcl cap 37.5-25 mg (Dyazide) hydrochlorothiazide tab tab er 2-180 mg, 2-240 mg, triamterene & hydrochlorothiazide 2.5-6.25 mg, 5-6.25 mg, 10-6.25 mg 4-240 mg tab 37.5-25 mg (Maxzide-25), 75-50 (Maxzide) High Blood Pressure TEKTURNA - aliskiren fumarate tab and High Cholesterol 150 mg, 300 mg (base equivalent) TRIBENZOR - olmesartan-amlodipine- amlodipine besylate-atorvastatin TEKTURNA HCT - aliskiren- hydrochlorothiazide tab 20-5-12.5 mg, 40-5-12.5 mg, tab 2.5-10 mg, 2.5-20 mg, hydrochlorothiazide tab 2.5-40 mg 150-12.5 mg, 150-25 mg, 40-5-25 mg, 40-10-12.5 mg, 300-12.5 mg, 300-25 mg 40-10-25 mg amlodipine besylate-atorvastatin TWYNSTA - telmisartan-amlodipine calcium tab 5-10 mg, 5-20 mg, telmisartan tab 20 mg, 40 mg, 5-40 mg, 5-80 mg, 10-10 mg, 80 mg (Micardis) tab 40-5 mg, 40-10 mg, 80-5 mg, 80-10 mg 10-20 mg, 10-40 mg, 10-80 mg telmisartan-amlodipine tab (Caduet) valsartan tab 40 mg, 80 mg, 40-5 mg, 40-10 mg, 80-5 mg, CADUET - amlodipine besylate- 160 mg, 320 mg (Diovan) 80-10 mg (Twynsta) atorvastatin calcium tab 5-10 mg, telmisartan-hydrochlorothiazide valsartan-hydrochlorothiazide tab 5-20 mg, 5-40 mg, 5-80 mg, 10-10 tab 40-12.5 mg, 80-12.5 mg, 80-12.5 mg, 160-12.5 mg, mg, 10-20 mg, 10-40 mg, 10-80 mg 80-25 mg (Micardis hct) 160-25 mg, 320-12.5 mg, 320-25 mg (Diovan hct)

BRAND DRUGS generic drugs 14 Commonly Prescribed Maintenance Medications

High Cholesterol EZALLOR SPRINKLE – tab 10 mg, 20 mg, 40 mg calcium sprinkle cap 5 mg, 10 mg, ALTOPREV - lovastatin tab er 24hr LOVAZA - omega-3-acid ethyl 20 mg, 40 mg (base equivalent) 20 mg, 40 mg, 60 mg cap 1 gm ezetimibe tab 10 mg (Zetia) ANTARA - micronized cap NEXLETOL – bempedoic acid tab 30 mg, 90 mg ezetimibe- tab 180 mg 10-10 mg, 10-20 mg, 10-40 mg, atorvastatin calcium tab NEXLIZET – bempedoic acid- 10-80 mg (Vytorin) 10 mg, 20 mg, 40 mg, 80 mg ezetimibe tab 180-10 mg (base equivalent) (Lipitor) FENOFIBRATE - fenofibrate cap tab er 500 mg, 750 mg, 50 mg, 150 mg cholestyramine light powder 1000 mg (antihyperlipidemic) 4 gm/dose (Questran light) fenofibrate micronized cap 43 mg, (Niaspan) 67 mg, 130 mg, 134 mg, 200 mg cholestyramine light powder NIASPAN - niacin tab er packets 4 gm fenofibrate tab 40 mg, 120 mg 500 mg, 750 mg, 1000 mg (Fenoglide) (antihyperlipidemic) cholestyramine powder 4 gm/dose (Questran) fenofibrate tab 48 mg, 145 mg omega-3-acid ethyl esters cap (Tricor) 1 gm (Lovaza) cholestyramine powder packets 4 gm (Questran) fenofibrate tab 54 mg, 160 mg PRAVACHOL - sodium tab 20 mg, 40 mg fenofibrate cap dr 45 mg, FENOFIBRIC ACID - fenofibric acid tab 135 mg (fenofibric acid equiv) 105 mg pravastatin sodium tab 10 mg, (Trilipix) FENOGLIDE - fenofibrate tab 40 mg, 80 mg colesevelam hcl packet for susp 120 mg pravastatin sodium tab 20 mg, 3.75 gm (Welchol) FIBRICOR - fenofibric acid tab 35 mg, 40 mg (Pravachol) colesevelam hcl tab 625 mg 105 mg QUESTRAN - cholestyramine powder (Welchol) FLOLIPID - simvastatin susp 20 mg/ 4 gm/dose COLESTID - colestipol hcl granule 5 mL (4 mg/mL), 40 mg/5 mL QUESTRAN - cholestyramine powder packet 5 gm (8 mg/mL) packets 4 gm COLESTID - colestipol hcl granules fluvastatin sodium cap 20 mg, QUESTRAN LIGHT - cholestyramine 5 gm 40 mg (base equivalent) light powder 4 gm/dose COLESTID - colestipol hcl tab 1 gm fluvastatin sodium tab er 24hr rosuvastatin calcium tab 5 mg, 80 mg (Lescol xl) 10 mg, 20 mg, 40 mg (Crestor) COLESTID FLAVORED - colestipol hcl granule packets 5 gm tab 600 mg (Lopid) simvastatin tab 5 mg COLESTID FLAVORED - colestipol hcl LESCOL XL - fluvastatin sodium tab er simvastatin tab 10 mg, 20 mg, granules 5 gm 24hr 80 mg 40 mg, 80 mg (Zocor) colestipol hcl granule packets LIPITOR - atorvastatin calcium tab TRICOR - fenofibrate tab 48 mg, 5 gm (Colestid flavored) 10 mg, 20 mg, 40 mg, 80 mg 145 mg (base equivalent) colestipol hcl granules 5 gm TRIGLIDE - fenofibrate tab 160 mg (Colestid flavored) LIPOFEN - fenofibrate cap 50 mg, TRILIPIX - choline fenofibrate cap dr 150 mg colestipol hcl tab 1 gm (Colestid) 45 mg, 135 mg (fenofibric acid LIVALO - pitavastatin calcium tab equiv) CRESTOR - rosuvastatin calcium tab 1 mg, 2 mg, 4 mg 5 mg, 10 mg, 20 mg, 40 mg VASCEPA - icosapent ethyl cap LOPID - gemfibrozil tab 600 mg 0.5 gm, 1 gm

BRAND DRUGS generic drugs 15 Commonly Prescribed Maintenance Medications

VYTORIN - ezetimibe-simvastatin tab td gel 20.25 mg/ FOSAMAX - alendronate sodium tab 10-10 mg, 10-20 mg, 10-40 mg, 1.25 gm (1.62%), 25 mg/2.5 gm 70 mg 10-80 mg (1%), 40.5 mg/2.5 gm (1.62%), FOSAMAX PLUS D - alendronate WELCHOL - colesevelam hcl packet 50 mg/5 gm (1%) (Androgel) sodium-cholecalciferol tab for susp 3.75 gm testosterone td gel 20.25 mg/act 70-2800 mg-unit, 70-5600 mg-unit WELCHOL - colesevelam hcl tab (1.62%) (Androgel pump) ibandronate sodium tab 150 mg 625 mg testosterone td soln 30 mg/act (base equivalent) (Boniva) ZETIA - ezetimibe tab 10 mg VOGELXO - testosterone td gel hcl tab 60 mg (Evista) ZOCOR - simvastatin tab 10 mg, 50 mg/5 gm (1%) risedronate sodium tab 5 mg, 20 mg, 40 mg, 80 mg VOGELXO PUMP - testosterone td gel 35 mg, 150 mg (Actonel) ZYPITAMAG - pitavastatin magnesium 12.5 mg/act (1%) risedronate sodium tab delayed tab 1 mg, 2 mg, 4 mg release 35 mg (Atelvia) (base equivalent) (non-hormonal) Parkinson’s Disease BRISDELLE - paroxetine mesylate cap hcl cap 100 mg 7.5 mg (base equivalent) ANDRODERM - testosterone td patch amantadine hcl syrup 50 mg/5 mL 24hr 2 mg/24hr, 4 mg/24hr OSPHENA - ospemifene tab 60 mg amantadine hcl tab 100 mg ANDROGEL - testosterone td gel paroxetine mesylate cap 7.5 mg AZILECT - mesylate tab 20.25 mg/1.25 gm (1.62%), (base equivalent) (Brisdelle) 25 mg/2.5 gm (1%), 40.5 mg/ 0.5 mg, 1 mg (base equivalent) 2.5 gm (1.62%), 50 mg/5 gm (1%) Osteoporosis benztropine mesylate tab 0.5 mg, ANDROGEL PUMP - testosterone td ACTONEL - risedronate sodium 5 mg, 1 mg, 2 mg gel 20.25 mg/act (1.62%) 35 mg, 150 mg bromocriptine mesylate cap 5 mg FORTESTA - testosterone td gel ALENDRONATE SODIUM - (base equivalent) (Parlodel) 10 mg/act (2%) alendronate sodium oral soln bromocriptine mesylate tab 70 mg/75 mL NATESTO - testosterone nasal gel 2.5 mg (base equivalent) 5.5 mg/act ALENDRONATE SODIUM – (Parlodel) alendronate sodium tab 5 mg STRIANT - testosterone buccal & levodopa orally mucoadhesive system 30 mg alendronate sodium tab 10 mg, disintegrating tab 10-100 mg, 35 mg 25-100 mg, 25-250 mg TESTIM - testosterone td gel 50 mg/5 gm (1%) alendronate sodium tab 70 mg carbidopa & levodopa tab (Fosamax) 10-100 mg, 25-100 mg, 25-250 mg TESTOSTERONE - testosterone td gel (Sinemet) 50 mg/5 gm (1%) ATELVIA - risedronate sodium tab delayed release 35 mg carbidopa & levodopa tab er TESTOSTERONE PUMP - testosterone 25-100 mg, 50-200 mg td gel 12.5 mg/act (1%) BINOSTO - alendronate sodium effervescent tab 70 mg carbidopa tab 25 mg (Lodosyn) testosterone td gel 10 mg/act (2%) BONIVA - ibandronate sodium tab CARBIDOPA/LEVODOPA/ (Fortesta) 150 mg (base equivalent) - carbidopa- testosterone td gel 12.5 mg/act levodopa-entacapone tabs (1%) calcitonin (salmon) nasal soln 200 unit/act 12.5-50-200 mg, 18.75-75-200 mg, 25-100-200 mg, 31.25-125-200 mg, EVISTA - raloxifene hcl tab 60 mg 37.5-150-200 mg, 50-200-200 mg

BRAND DRUGS generic drugs 16 Commonly Prescribed Maintenance Medications

COMTAN - entacapone tab 200 mg ropinirole hydrochloride tab er Posttherpetic Neuralgia Pain 24hr 2 mg, 4 mg, 8 mg DUOPA - carbidopa-levodopa enteral GRALISE - (once-daily) tab (base equivalent) susp 4.63-20 mg/mL 300 mg, 600 mg ropinirole hydrochloride tab er entacapone tab 200 mg (Comtan) LYRICA CR - tab er 24hr 24 hr 6 mg, 12 mg LODOSYN - carbidopa tab 25 mg 82.5 mg, 165 mg, 330 mg (base equivalent) (Requip xl) MIRAPEX - RYTARY - carbidopa & levodopa cap Potassium Removing dihydrochloride tab 0.125 mg, er 23.75-95 mg, 36.25-145 mg, Agent Drugs 0.5 mg, 0.75 mg, 1 mg 48.75-195 mg, 61.25-245 mg LOKELMA - sodium zirconium MIRAPEX ER - pramipexole selegiline hcl cap 5 mg cyclosilicate for susp packet 5 gm, dihydrochloride tab er 24hr susp packet 10 gm 0.375 mg, 0.75 mg, 1.5 mg, SELEGILINE HCL – selegiline hcl tab VELTASSA - patiromer sorbitex 2.25 mg, 3 mg, 3.75 mg, 4.5 mg 5 mg calcium for susp packet 8.4 gm, SINEMET - carbidopa & levodopa tab NEUPRO - rotigotine td patch 24hr susp packet 16.8 gm, susp packet 10-100 mg, 25-100 mg, 25-250 mg 1 mg/24hr, 2 mg/24hr, 3 mg/24hr, 25.2 gm (base equivalent) 4 mg/24hr, 6 mg/ 24hr, 8 mg/24hr STALEVO 50 - carbidopa- Renal Failure OSMOLEX ER - amantadine hcl tab er levodopaentacapone tabs 129 mg, 193 mg, 258 mg 12.5-50-200 mg AURYXIA - ferric citrate tab 1 gm (base equivalent) STALEVO 75 - carbidopa- (210 mg ferric iron) OSMOLEX ER – amantadine hcl tab er levodopaentacapone tabs calcium acetate (phosphate 24hr pak 129 mg & 193 mg 18.75-75-200 mg binder) cap 667 mg (169 mg ca) (322 mg dose) STALEVO 100 - carbidopa- calcium acetate (phosphate PARLODEL - bromocriptine mesylate levodopaentacapone tabs binder) tab 667 mg cap 5 mg (base equivalent) 25-100-200 mg FOSRENOL - carbonate PARLODEL - bromocriptine mesylate STALEVO 125 - carbidopa- chew tab 500 mg, 750 mg, 1000 mg tab 2.5 mg (base equivalent) levodopaentacapone tabs (elemental) 31.25-125-200 mg pramipexole dihydrochloride tab FOSRENOL - lanthanum carbonate 0.125 mg, 0.5 mg, 0.75 mg, 1 mg STALEVO 150 - carbidopa- oral powder pack 750 mg, 1000 mg (Mirapex) levodopaentacapone tabs (elemental) 37.5-150-200 mg pramipexole dihydrochloride tab lanthanum carbonate chew tab 0.25 mg, 1.5 mg STALEVO 200 - carbidopa- 500 mg, 750 mg, 1000 mg levodopaentacapone tabs (elemental) (Fosrenol) pramipexole dihydrochloride tab 50-200-200 mg er 24hr 0.375 mg, 0.75 mg, PHOSLYRA - calcium acetate 1.5 mg, 2.25 mg, 3 mg, 3.75 mg, TASMAR - tab 100 mg (phosphate binder) oral soln 4.5 mg (Mirapex er) tolcapone tab 100 mg (Tasmar) 667 mg/5 mL rasagiline mesylate tab 0.5 mg, hcl oral soln RENAGEL - sevelamer hcl tab 800 mg 1 mg (base equivalent) (Azilect) 0.4 mg/mL RENVELA - sevelamer carbonate REQUIP XL - ropinirole hydrochloride trihexyphenidyl hcl tab 2 mg, 5 mg packet 0.8 gm, 2.4 gm tab er 24hr 6 mg, 12 mg XADAGO - mesylate tab RENVELA - sevelamer carbonate tab (base equivalent) 50 mg, 100 mg (base equivalent) 800 mg ropinirole hydrochloride tab ZELAPAR - selegiline hcl orally sevelamer carbonate packet 0.25 mg, 0.5 mg, 1 mg, 2 mg, disintegrating tab 1.25 mg 0.8 mg, 2.4 mg (Renvela) 3 mg, 4 mg, 5 mg

BRAND DRUGS generic drugs 17 Commonly Prescribed Maintenance Medications sevelamer carbonate tab 800 mg ASMANEX HFA - cromolyn sodium soln nebu (Renvela) furoate inhal aerosol 20 mg/2 mL sevelamer hcl tab 800 mg 50 mcg/act, 100 mcg/act, DALIRESP - roflumilast tab 500 mcg 200 mcg/act (Renagel) DUAKLIR PRESSAIR – aclidinium SEVELAMER HYDROCHLORIDE - ASMANEX TWISTHALER 7 METE - br-formoterol fum aero pow br act sevelamer hcl tab 400 mg mometasone furoate inhal powd 400-12 mcg/act 110 mcg/inh (breath activated) VELPHORO - sucroferric DULERA - mometasone furoate- oxyhydroxide chew tab 500 mg ASMANEX TWISTHALER 14 MET - formoterol fumarate aerosol mometasone furoate inhal powd 50-5 mcg/act, 100-5 mcg/act, Respiratory 220 mcg/inh (breath activated) 200-5 mcg/act ACCOLATE - tab 10 mg, ASMANEX TWISTHALER 30 MET - ELIXOPHYLLIN - theophylline elixir 20 mg mometasone furoate inhal powd 80 mg/15 mL 110 mcg/inh (breath activated) ADVAIR DISKUS - fluticasone- FLOVENT DISKUS - fluticasone salmeterol aer powder ba ASMANEX TWISTHALER 30 MET - propionate aer pow ba 50 mcg/ 100-50 mcg/dose, 250-50 mcg/ mometasone furoate inhal powd blister, 100 mcg/blister, 250 mcg/ dose, 500-50 mcg/dose 220 mcg/inh (breath activated) blister ADVAIR HFA - fluticasone-salmeterol ASMANEX TWISTHALER 60 MET - FLOVENT HFA - fluticasone inhal aerosol 45-21 mcg/act, mometasone furoate inhal powd propionate hfa inhal aer 44 mcg/act 115-21 mcg/act, 230-21 mcg/act 220 mcg/inh (breath activated) (50/valve), 110 mcg/act (125/valve), AIRDUO RESPICLICK ASMANEX TWISTHALER 120 ME - 220 mcg/act (250/valve) 55/14 - fluticasonesalmeterol mometasone furoate inhal powd FLUTICASONE PROPIONATE/ aer powder ba 55-14 mcg/act 220 mcg/inh (breath activated) SALMETEROL - fluticasone- AIRDUO RESPICLICK 113/14 - ATROVENT HFA - ipratropium salmeterol aer powder ba fluticasonesalmeterol aer powder bromide hfa inhal aerosol 55-14 mcg/act, 113-14 mcg/act, ba 113-14 mcg/act 17 mcg/act 232-14 mcg/act AIRDUO RESPICLICK 232/14 - BEVESPI AEROSHPERE - fluticasone-salmeterol aer powder fluticasonesalmeterol aer powder glycopyrrolateformoterol fumarate ba 100-50 mcg/dose, 250-50 mcg/ ba 232-14 mcg/act aerosol 9-4.8 mcg/act dose, 500-50 mcg/dose ALVESCO - ciclesonide inhal aerosol BREO ELLIPTA - fluticasone (Advair diskus) 80 mcg/act, 160 mcg/act furoate-vilanterol aero powd ba INCRUSE ELLIPTA - umeclidinium br ANORO ELLIPTA - umeclidinium- 100-25 mcg/inh, 200-25 mcg/inh aero powd breath act 62.5 mcg/inh vilanterol aero pwd ba BROVANA - arformoterol tartrate (base equivalent) 62.5-25 mcg/inh soln nebu 15 mcg/2 mL inhal soln ARCAPTA NEOHALER - indacaterol (base equivalent) 0.02% maleate inhal powder cap 75 mcg BUDESONIDE/FORMOTEROL FUM – montelukast sodium chew tab (base equivalent) budesonide-formoterol fumarate 4 mg, 5 mg (base equivalent) ARNUITY ELLIPTA - fluticasone dihyd aerosol 80-4.5 mcg/act, (Singulair) furoate aerosol powder breath 160-4.5 mcg/act montelukast sodium oral granules activ 50 mcg/act, 100 mcg/act, budesonide inhalation susp packet 4 mg (base equivalent) 200 mcg/act 0.25 mg/2 mL, 0.5 mg/2 mL, (Singulair) 1 mg/2 mL (Pulmicort) montelukast sodium tab 10 mg (base equivalent) (Singulair)

BRAND DRUGS generic drugs 18 Commonly Prescribed Maintenance Medications

PERFOROMIST - formoterol fumarate THEO-24 - theophylline cap er 24hr ergocalciferol cap 1.25 mg soln nebu 20 mcg/2 mL 100 mg, 200 mg, 300 mg, 400 mg (50000 unit) (Drisdol) PULMICORT - budesonide inhalation THEOPHYLLINE ER - theophylline tab KLOR-CON M15 - potassium chloride susp 0.25 mg/2 mL, 0.5 mg/2 mL, er 12hr 300 mg, 450 mg microencapsulated crys er tab 1 mg/2 mL theophylline soln 80 mg/15 mL 15 meq PULMICORT FLEXHALER - theophylline tab er 24hr 400 mg, K-TAB - potassium chloride tab er budesonide inhal aero powd 600 mg 8 meq (600 mg), 10 meq, 20 meq 90 mcg/act, 180 mcg/act (1500 mg) (breath activated) TRELEGY ELLIPTA - fluticasone- umeclidinium-vilanterol aepb NASCOBAL - cyanocobalamin nasal QVAR REDIHALER - beclomethasone 100-62.5- 25 mcg/inh spray 500 mcg/0.1 mL diprop hfa breath act inh aer paricalcitol cap 1 mcg, 2 mcg 40 mcg/act, 80 mcg/act TUDORZA PRESSAIR - aerosol powd breath (Zemplar) SEEBRI NEOHALER - glycopyrrolate activated 400 mcg/act paricalcitol cap 4 mcg inhal cap 15.6 mcg UTIBRON NEOHALER - indacaterol- potassium chloride cap er 8 meq, SEREVENT DISKUS - salmeterol glycopyrrolate inhal cap 10 meq xinafoate aer pow ba 50 mcg/dose 27.5-15.6 mcg (base equivalent) POTASSIUM CHLORIDE ER - YUPELRI - inhalation potassium chloride tab er 8 meq SINGULAIR - montelukast sodium solution 175 mcg/3 mL (600 mg) chew tab 4 mg, 5 mg (base equivalent) zafirlukast tab 10 mg, 20 mg potassium chloride (Accolate) microencapsulated crys er tab SINGULAIR - montelukast sodium 10 meq, 20 meq oral granules packet 4 mg Restless Leg Syndrome & (base equivalent) Postherpetic Neuralgia Pain potassium chloride oral soln 10% (20 meq/15 mL), HORIZANT - tab SINGULAIR - montelukast sodium tab 20% (40 meq/15 mL) 10 mg (base equivalent) er 300 mg, 600 mg potassium chloride powder packet SPIRIVA HANDIHALER - tiotropium 20 meq bromide monohydrate inhal cap tab 25 mg, 100 mg 18 mcg (base equivalent) potassium chloride tab er 8 meq (600 mg) SPIRIVA RESPIMAT - tiotropium Sleep/Wake Agents potassium chloride tab er 10 meq bromide monohydrate inhal SUNOSI – hcl tab 75 mg, (K-tab) aerosol 1.25 mcg/act, 2.5 mcg/act 150 mg (base equivalent) STIOLTO RESPIMAT - tiotropium potassium chloride tab er 20 meq Supplements br-olodaterol inhal aero soln (1500 mg) (K-tab) 2.5-2.5 mcg/act calcitriol cap 0.25 mcg, 0.5 mcg RAYALDEE - calcifediol cap er 30 mcg (Rocaltrol) STRIVERDI RESPIMAT - olodaterol hcl ROCALTROL - calcitriol cap 0.25 mcg, inhal aerosol soln 2.5 mcg/act calcitriol oral soln 1 mcg/mL 0.5 mcg (Rocaltrol) (base equivalent) ROCALTROL - calcitriol oral soln SYMBICORT - budesonide-formoterol doxercalciferol cap 0.5 mcg, 1 mcg, 1 mcg/mL 2.5 mcg fumarate dihyd aerosol ZEMPLAR - paricalcitol cap 1 mcg, 80-4.5 mcg/act, 160-4.5 mcg/act DRISDOL – ergocalciferol cap 2 mcg 1.25 mg (50000 unit)

BRAND DRUGS generic drugs 19 Commonly Prescribed Maintenance Medications

Urinary/BPH (Benign chloride syrup Prostatic Hyperplasia) 5 mg/5 mL alfuzosin hcl tab er 24hr 10 mg oxybutynin chloride tab 5 mg (Uroxatral) oxybutynin chloride tab er 24hr AVODART - cap 0.5 mg 5 mg, 10 mg (Ditropan xl) CARDURA - doxazosin mesylate tab oxybutynin chloride tab er 24hr 1 mg, 2 mg, 4 mg, 8 mg 15 mg CARDURA XL - doxazosin mesylate OXYTROL - oxybutynin td patch twice tab er 24hr 4 mg, 8 mg weekly 3.9 mg/24hr (base equivalent) PROSCAR - tab 5 mg hydrobromide tab er RAPAFLO - silodosin cap 4 mg, 8 mg 24hr 7.5 mg, 15 mg silodosin cap 4 mg, 8 mg (Rapaflo) (base equivalent) (Enablex) succinate tab 5 mg, DETROL - tartrate tab 10 mg (Vesicare) 1 mg, 2 mg tamsulosin hcl cap 0.4 mg (Flomax) DETROL LA - tolterodine tartrate cap er 24hr 2 mg, 4 mg terazosin hcl cap 1 mg, 2 mg, 5 mg, 10 mg (base equivalent) DITROPAN XL - oxybutynin chloride tab er 24hr 5 mg, 10 mg tolterodine tartrate cap er 24hr 2 mg, 4 mg (Detrol la) doxazosin mesylate tab 1 mg, 2 mg, 4 mg, 8 mg (Cardura) tolterodine tartrate tab 1 mg, 2 mg (Detrol) dutasteride cap 0.5 mg (Avodart) TOVIAZ - fumarate tab dutasteride-tamsulosin hcl cap er 24hr 4 mg, 8 mg 0.5-0.4 mg (Jalyn) cap er 24hr ENABLEX - darifenacin hydrobromide 60 mg tab er 24hr 7.5 mg (base equivalent) trospium chloride tab 20 mg finasteride tab 5 mg (Proscar) UROXATRAL - alfuzosin hcl tab er 24hr 10 mg FLOMAX - tamsulosin hcl cap 0.4 mg VESICARE - solifenacin succinate tab GELNIQUE - oxybutynin chloride td 5 mg, 10 mg gel 10% GELNIQUE PUMP - oxybutynin Weight Management chloride td gel 10% SAXENDA - liraglutide (weight JALYN - dutasteride-tamsulosin hcl management) soln pen-injector cap 0.5-0.4 mg 18 mg/3 mL MYRBETRIQ - mirabergron tab er 24hr 25 mg, 50 mg

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Blue Cross and Blue Shield of Montana contracts with Prime Therapeutics to provide pharmacy benefit management and related other services. In addition, contracting pharmacies are contracted through Prime. The relationship between BCBSMT and contracting pharmacies is that of independent contractors. Blue Cross and Blue Shield of Montana, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.

Blue Cross and Blue Shield of Montana, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 350202.0820