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Physician and Pharmacist Reference Guide October 2008 Value Plus For the most up-to-date drug list visit www.caremark.com

The Caremark Value Plus 3-Tier Formulary, formerly the PharmaCare Value Plus 3-Tier Formulary, is a guide within select therapeutic categories for clients, plan participants and health care providers. Generics should be considered the first line of prescribing. If there is no generic available, there may be more than one brand-name medicine to treat a condition. These preferred brand-name medicines are listed to help identify products that are clinically appropriate and cost-effective. Generics listed in therapeutic categories are for representational purposes only. This is not an all-inclusive list. This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics.

HEALTH CARE PROVIDER THERAPEUTIC CATEGORIES Your patient is covered under a prescription benefit plan administered by Antidiabetic Agents 2 Caremark. As a way to help manage health care costs, authorize generic Allergy, Cough & Cold 2 substitution whenever possible. If you believe a brand-name product is necessary, consider prescribing a brand name on this list. Anti-Infective Agents 2 Please note: Antineoplastic 2 ● Generics should be considered the first line of prescribing. Autonomic and Central Nervous System Agents 2 ● This drug list represents a summary of prescription coverage. It is not inclusive Cardiovascular Agents 3 and does not guarantee coverage. Contraceptives 3 ● The plan participant’s specific prescription benefit plan may have a different Corticosteroids 4 copay1 for specific products on the list. Dermatologicals 4 ● Unless specifically indicated, drug list products will include all dosage forms. Diagnostics 4 ● Log in to www.caremark.com to check coverage and copay information for a specific medicine. Gastrointestinal Agents 4 Gout Agents 4 Hematopoietic Growth Factors 4 PLAN PARTICIPANT Hormones 4 Your benefit plan provides you with a prescription benefit program administered Immunologic Agents 4 by Caremark. Ask your doctor to consider prescribing, when medically appropriate, Immunosuppressive Agents 4 a preferred medicine from this list. Take this list along when you or a covered family member sees a doctor. Ophthalmics 4 Please note: Osteoporosis Agents 5 ● Your specific prescription benefit plan design may not cover certain categories, Otics 5 regardless of their appearance in this document. Phosphate Binder Agents 5 ● For specific information regarding your prescription benefit coverage and copay1 Respiratory/Asthma 5 information, please visit our Web site at www.caremark.com or contact a Skeletal Muscle Relaxants 5 Caremark Customer Care representative. Thyroid and Antithyroid Agents 5 ● Caremark may contact your doctor after receiving your prescription to request consideration of a drug list product or generic equivalent. This may result in Urinary Agents 5 your doctor prescribing, when medically appropriate, a different brand-name Vaginal Preparations 5 product or generic equivalent in place of your original prescription. Vitamins 5

Your specific prescription benefit plan design may not cover certain categories, regardless of their appearance in this document. For specific information, visit our Web site at www.caremark.com or contact a Caremark Customer Care representative. Page 1 of 5 ANTIDIABETIC AGENTS ANTITUSSIVE SULFONAMIDES ANTINEOPLASTIC ANALGESICS, SALICYLATES sulfamethoxazole- INSULINS COMBINATIONS diflunisal trimethoprim DS Generally, self-administered codeine-chlorpheniramine- single source brand drugs salsalate RAPID-ACTING INSULINS TETRACYCLINES pseudoephedrine indicated for the treatment APIDRA ANTICONVULSANTS codeine-guaifenesin doxycycline hyclate of cancer are formulary. HUMALOG minocycline carbamazepine HUMULIN R codeine-guaifenesin- pseudoephedrine tetracycline AUTONOMIC AND clonazepam NOVOLIN R ORACEA CENTRAL NERVOUS ethosuximide NOVOLOG codeine-promethazine codeine-promethazine- OTHER ANTI-INFECTIVES SYSTEM AGENTS gabapentin INTERMEDIATE-ACTING phenylephrine chloroquine ALZHEIMER’S AGENTS lamotrigine ODT INSULINS dextromethorphan- clindamycin phenobarbital HUMALOG MIX ARICEPT brompheniramine- dapsone phenytoin HUMULIN MIX EXELON pseudoephedrine ethambutol primidone HUMULIN N NAMENDA dextromethorphan- isoniazid valproic acid NOVOLIN MIX RAZADYNE promethazine mefloquine zonisamide NOVOLIN N RAZADYNE ER hydrocodone-homatropine metronidazole CARBATROL NOVOLOG MIX nitrofurantoin macrocrystals ANALGESICS, NARCOTIC DEPAKOTE LONG-ACTING INSULINS NASAL CORTICOSTEROIDS pyrazinamide codeine-acetaminophen DEPAKOTE ER LANTUS flunisolide rifampin fentanyl transdermal DEPAKOTE SPRINKLE LEVEMIR fluticasone trimethoprim hydrocodone- DIASTAT NASACORT AQ DILANTIN INFATAB ORAL ALINIA acetaminophen NASONEX FURADANTIN hydromorphone GABITRIL acarbose RHINOCORT AQUA MALARONE morphine KEPPRA glimepiride VERAMYST TINDAMAX morphine ext-rel LAMICTAL tablet glipizide TOBI morphine supp LYRICA glipizide ext-rel NASAL ANTIHISTAMINES VANCOCIN oxycodone TEGRETOL XR glipizide-metformin ASTELIN ZYVOX oxycodone ext-rel TOPAMAX glyburide oxycodone soln TRILEPTAL glyburide-metformin ANTI-INFECTIVE AGENTS ANTIFUNGAL AGENTS oxycodone-acetaminophen metformin ANTIPARKINSON AGENTS ANTHELMINTICS fluconazole AVINZA metformin ext-rel mebendazole itraconazole KADIAN benztropine ACTOPLUS MET terbinafine tablet OPANA ER bromocriptine ACTOS ANTIBIOTICS carbidopa-levodopa ANTIVIRALS OXYCONTIN DUETACT CEPHALOSPORINS carbidopa-levodopa ext-rel JANUMET cefaclor acyclovir ANALGESICS, selegiline JANUVIA cefdinir ganciclovir NON-NARCOTIC trihexyphenidyl PRANDIN cephalexin ribavirin butalbital-acetaminophen- APOKYN BARACLUDE MACROLIDES caffeine AZILECT OTHER DIABETIC AGENTS EPIVIR HBV azithromycin butalbital-aspirin-caffeine COMTAN BYETTA HEPSERA clarithromycin tramadol MIRAPEX GLUCAGEN HYPOKIT INFERGEN clarithromycin ext-rel PARCOPA GLUCAGON EMERGENCY KIT INTRON A ANALGESICS, erythromycin REQUIP SYMLIN PEGASYS NONSTEROIDAL delayed-rel STALEVO PEGINTRON ANTI-INFLAMMATORY erythromycin ethylsuccinate ALLERGY, PEGINTRON REDIPEN diclofenac ANXIOLYTICS, SEDATIVES, erythromycin stearate COUGH & COLD REBETOL soln etodolac AND HYPNOTICS ANTIHISTAMINE/ PENICILLINS TAMIFLU ibuprofen alprazolam DECONGESTANTS amoxicillin TYZEKA indomethacin buspirone amoxicillin-clavulanate cyproheptadine VALCYTE indomethacin ext-rel diazepam dicloxacillin fexofenadine VALTREX meloxicam lorazepam penicillin VK nabumetone oxazepam hydroxyzine HCl Generally, self-administered ALLEGRA-D QUINOLONES naproxen temazepam ciprofloxacin ext-rel single source brand drugs indicated for the treatment naproxen sodium triazolam ciprofloxacin tablet of HIV are formulary. oxaprozin zolpidem AVELOX sulindac LUNESTA LEVAQUIN

Your specific prescription benefit plan design may not cover certain categories, regardless of their appearance in this document. For specific information, visit our Web site at www.caremark.com or contact a Caremark Customer Care representative. Page 2 of 5 CEREBRAL STIMULANTS ANTIMANIC AGENTS PERIPHERALLY ACTING COMBINATION CONTRACEPTIVES lithium carbonate doxazosin amphetamine- ANTIHYPERTENSIVES EE = ethinyl estradiol lithium carbonate ext-rel terazosin dextroamphetamine amlodipine-benazepril ME = mestranol FLOMAX dexmethylphenidate ANTIPSYCHOTIC AGENTS atenolol-chlorthalidone MONOPHASIC dextroamphetamine chlorpromazine ANTIARRHYTHMICS bisoprolol- clozapine desogestrel-EE dextroamphetamine ext-rel amiodarone hydrochlorothiazide fluphenazine ethynodiol diacetate-EE methylphenidate digoxin fosinopril- haloperidol levonorgestrel-EE methylphenidate ext-rel disopyramide hydrochlorothiazide perphenazine norethindrone acetate-EE ADDERALL XR disopyramide ext-rel lisinopril- thioridazine norethindrone CONCERTA flecainide hydrochlorothiazide thiothixene acetate-EE-iron DAYTRANA mexiletine metoprolol- trifluoperazine norethindrone-EE FOCALIN XR propafenone hydrochlorothiazide ABILIFY norethindrone-ME METADATE CD sotalol quinapril- FAZACLO norgestimate-EE METHYLIN sotalol AF hydrochlorothiazide GEODON norgestrel-EE RITALIN LA RYTHMOL SR ATACAND HCT INVEGA Apri STRATTERA TIKOSYN AVALIDE VYVANSE RISPERDAL BENICAR HCT Aviane SEROQUEL ANTICOAGULANTS/ CADUET Cryselle MIGRAINE AGENTS ZYPREXA ANTITHROMBOTICS MICARDIS HCT Junel dihydroergotamine warfarin Lessina CARDIOVASCULAR TARKA ergotamine-caffeine tablet AGGRENOX TEKTURNA HCT Levora IMITREX AGENTS ARIXTRA Low-Ogestrel MAXALT ALDOSTERONE COUMADIN DIRECT RENIN INHIBITORS Microgestin MIGRANAL ANTAGONISTS FRAGMIN TEKTURNA Microgestin FE ZOMIG Mononessa spironolactone INNOHEP DIURETICS Necon 1/50 MULTIPLE SCLEROSIS LOVENOX ANGIOTENSIN II furosemide Nortrel AGENTS PLAVIX ANTAGONISTS hydrochlorothiazide Portia COPAXONE ATACAND 2 ANTILIPEMICS metolazone Previfem REBIF AVAPRO cholestyramine spironolactone- Quasense hydrochlorothiazide OBSESSIVE-COMPULSIVE BENICAR colestipol Sprintec torsemide DISORDER AGENTS MICARDIS fenofibrate Zovia pravastatin triamterene- fluvoxamine YASMIN ANGIOTENSIN simvastatin hydrochlorothiazide CONVERTING ENZYME YAZ PSYCHOTHERAPEUTIC ADVICOR INHIBITORS PULMONARY BIPHASIC AGENTS LIPITOR HYPERTENSION fosinopril LOVAZA desogestrel-EE ANTIDEPRESSANTS REVATIO lisinopril NIASPAN Kariva amitriptyline TRACLEER quinapril SIMCOR bupropion TRIPHASIC ramipril TRICOR VASODILATORS bupropion ext-rel desogestrel-EE trandolapril VYTORIN citalopram dipyridamole levonorgestrel-EE WELCHOL clomipramine ANTI-ADRENERGIC hydralazine norethindrone-EE ZETIA desipramine AGENTS isosorbide dinitrate ext-rel norgestimate-EE doxepin BETA-ADRENERGIC CALCIUM CHANNEL isosorbide dinitrate oral Aranelle fluoxetine BLOCKERS BLOCKERS isosorbide mononitrate Cesia isosorbide mononitrate imipramine atenolol amlodipine Enpresse ext-rel mirtazapine carvedilol diltiazem ext-rel Necon 7/7/7 nitroglycerin sublingual nortriptyline metoprolol nifedipine ext-rel Nortrel 7/7/7 nitroglycerin transdermal paroxetine metoprolol succinate ext-rel verapamil ext-rel Trinessa paroxetine ext-rel nadolol OTHER CARDIOVASCULAR Tri-Previfem sertraline propranolol AGENTS Tri-Sprintec trazodone propranolol ext-rel midodrine Trivora venlafaxine COREG CR RANEXA Velivet CYMBALTA CENTRALLY ACTING ORTHO TRI-CYCLEN LO EFFEXOR XR clonidine PROGESTIN ONLY LEXAPRO guanfacine Camila methyldopa Errin CATAPRES TTS Jolivette

Your specific prescription benefit plan design may not cover certain categories, regardless of their appearance in this document. For specific information, visit our Web site at www.caremark.com or contact a Caremark Customer Care representative. Page 3 of 5 EMERGENCY HIGH POTENCY ANTIULCER ESTROGENS IMMUNOSUPPRESSIVE betamethasone CONTRACEPTION omeprazole estradiol AGENTS dipropionate PLAN B pantoprazole estradiol transdermal azathioprine desoximetasone ranitidine estropipate cyclosporine CONTRACEPTIVE DEVICES diflorasone diacetate crm sucralfate CLIMARA cyclosporine-modified diflorasone diacetate NUVARING NEXIUM ENJUVIA CELLCEPT emollient crm PREVACID ESTRACE VAG CREAM PROGRAF CORTICOSTEROIDS fluocinonide PREVPAC ESTRADERM RAPAMUNE triamcinolone acetonide dexamethasone ESTRING BOWEL EVACUANTS fludrocortisone HIGHEST POTENCY FEMRING OPHTHALMICS betamethasone polyethylene glycol hydrocortisone oral PREMARIN ANTI-ALLERGIC AGENTS methylprednisolone dipropionate augmented HALFLYTELY PREMARIN VAG CREAM cromolyn prednisolone syrup clobetasol propionate NULYTELY VAGIFEM ketotifen prednisolone tablet diflorasone diacetate oint VISICOL VIVELLE-DOT ACULAR LS prednisone halobetasol propionate DIGESTANTS ACULAR PF ENTOCORT EC CLOBEX ESTROGEN AND OLUX-E CREON PROGESTERONE ALOCRIL DERMATOLOGICALS ULTRASE COMBINATIONS ALOMIDE OTHER ULTRASE MT ACTIVELLA OPTIVAR ACNE DERMATOLOGICALS VIOKASE PATADAY isotretinoin CLIMARA PRO ammonium lactate COMBIPATCH PATANOL sulfacetamide-sulfur calcipotriene soln OTHER GI PRODUCTS PREFEST ANTI-GLAUCOMA AGENTS tretinoin fluorouracil hydrocortisone enema DIFFERIN lactulose PREMPHASE brimonidine ketoconazole shampoo PREMPRO RETIN-A MICRO permethrin 5% mesalamine pilocarpine ZIANA podofilox misoprostol FERTILITY REGULATORS ALPHAGAN P sulfasalazine AZOPT ANTIBIOTICS selenium sulfide shampoo chorionic gonadotropin ALDARA sulfasalazine delayed-rel COMBIGAN erythromycin- clomiphene CAPEX ursodiol COSOPT benzoyl peroxide ganirelix CARAC ASACOL LUMIGAN gentamicin CETROTIDE DOVONEX cream CANASA TRAVATAN metronidazole GONAL-F ELIDEL CORTIFOAM TRAVATAN Z mupirocin GONAL-F RFF EURAX KRISTALOSE TRUSOPT silver sulfadiazine OVIDREL FINACEA LIALDA XALATAN ALTABAX OVIDE PENTASA PROGESTINS BENZACLIN ANTI-INFECTIVE/ OXSORALEN ULTRA PROCTOFOAM-HC medroxyprogesterone DUAC CS ANTIVIRAL AGENTS PROTOPIC URSO megestrol acetate METROGEL URSO FORTE norethindrone acetate bacitracin SORIATANE ciprofloxacin FUNGICIDES TARGRETIN capsule CRINONE GOUT AGENTS MEGACE ES erythromycin ciclopirox TAZORAC gentamicin allopurinol PROCHIEVE clotrimazole neomycin-polymyxin B- DIAGNOSTICS colchicine tablet PROMETRIUM econazole gramicidin probenecid ketoconazole ACCU-CHEK products SELECTIVE RECEPTOR ofloxacin MENTAX BD INSULIN SYRINGES HEMATOPOIETIC MODULATORS polymyxin B-bacitracin OXISTAT AND NEEDLES GROWTH FACTORS EVISTA polymyxin B-trimethoprim ONETOUCH products TOPICAL ANTI- sulfacetamide ARANESP IMMUNOLOGIC AGENTS tobramycin INFLAMMATORY AGENTS GASTROINTESTINAL NEULASTA trifluridine LOW POTENCY AGENTS DMARDs NEUPOGEN QUIXIN desonide hydroxychloroquine ANTISPASMODIC/ PROCRIT VIGAMOX fluocinolone acetonide methotrexate GI MOTILITY ZYMAR hydrocortisone HORMONES CUPRIMINE chlordiazepoxide-clidinium ENBREL INTERMEDIATE POTENCY ANDROGENS dicyclomine HUMIRA alclometasone diphenoxylate-atropine ANDRODERM dipropionate KINERET hyoscyamine ANDROGEL RIDAURA fluocinolone acetonide loperamide fluticasone propionate ANTIESTROGENS/ TREXALL hydrocortisone butyrate ANTIANDROGENS hydrocortisone valerate finasteride mometasone furoate tamoxifen triamcinolone acetonide AVODART CORDRAN lotion CORDRAN TAPE LUXIQ

FOR YOUR INFORMATION: Generics should be considered the first line of prescribing. This Caremark Drug List represents a summary of prescription coverage. It is not inclusive and does not guarantee coverage. Specific prescription benefit plan design may not cover certain categories, regardless of their appearance in this document. The plan participant’s prescription benefit plan may have a different copay for specific products on the list. Unless otherwise indicated, drug list products will include all dosage forms. This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics. Generics listed in therapeutic categories are for representational purposes only. This is not an all-inclusive list. Listed products may be available generically in certain strengths or dosage forms. Dosage forms on this list will be consistent with the category and use where listed. This is not a complete list of all formulary products. Any brand-name drug for which a generic product becomes available may be designated as a non-formulary product. Log in to www.caremark.com to check coverage and copay information for a specific medicine.

1 Copayment, copay or coinsurance means the amount a plan participant is required to pay for a prescription in accordance with a Plan, which may be a deductible, a percentage of the prescription price, a fixed amount or other charge, with the balance, if any, paid by a Plan. 2 Atacand should be reserved for patients who meet CHARM (Candesartan in Heart Failure - Assessment of Reduction in Mortality and Morbidity) trial criteria.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information. Caremark may receive rebates, discounts and service fees from pharmaceutical manufacturers for certain listed products. This Caremark Drug List contains references to brand- name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers that are not affiliated with Caremark. Listed products are for informational purposes only and are not intended to replace the clinical judgment of the prescriber.

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