Kansas State Employee ANALGESICS ANTI-INFECTIVES Health Plan NSAIDs ANTIBACTERIALS diclofenac sodium delayed-rel Cephalosporins Preferred Drug List diflunisal First Generation etodolac cefadroxil 2020 ibuprofen cephalexin meloxicam nabumetone Second Generation naproxen sodium tabs cefprozil naproxen tabs cefuroxime axetil oxaprozin

sulindac Third Generation

cefdinir NSAIDs, COMBINATIONS cefixime (SUPRAX) diclofenac sodium delayed-rel/misoprostol Erythromycins/Macrolides Effective 10/01/2020 NSAIDs, TOPICAL azithromycin diclofenac sodium gel 1% * clarithromycin For questions or additional information, diclofenac sodium soln clarithromycin ext-rel access the State of Kansas website at erythromycin delayed-rel http://www.kdheks.gov/hcf/sehp or call * Listing does not include NDC 69499031866. Drug erythromycin ethylsuccinate products are identified by unique numerical product erythromycin stearate the Kansas State Employees Prescription identifiers, called National Drug Codes (NDC), which Drug Program at 1-800-294-6324. identify the manufacturer, strength, dosage form, fidaxomicin (DIFICID) formulation and package size. The Preferred Drug List is subject to change. Fluoroquinolones To locate covered prescriptions online, COX-2 INHIBITORS ciprofloxacin access the State of Kansas website at celecoxib levofloxacin for the http://www.kdheks.gov/hcf/sehp moxifloxacin most current drug list. GOUT What is a Preferred Drug List? allopurinol Penicillins A Preferred Drug List is a list of safe and colchicine amoxicillin cost-effective drugs, chosen by a committee probenecid amoxicillin/clavulanate of physicians and pharmacists. Drug lists amoxicillin/clavulanate ext-rel ampicillin have been used in hospitals for many years OPIOID ANALGESICS to help ensure quality drug use. The Kansas dicloxacillin buprenorphine transdermal penicillin VK State Employees Preferred Drug List will be codeine/acetaminophen continually revised to reflect the changing fentanyl transdermal drug market. fentanyl transmucosal lozenge doxycycline hyclate hydrocodone ext-rel Should I ask my physician to switch my minocycline hydrocodone/acetaminophen current medications to a medication that hydromorphone is on the Preferred Drug List? hydromorphone ext-rel Many of your medications will already be on methadone ANTIFUNGALS the Preferred Drug List. However, if you morphine clotrimazole troches have a medication that is not, ask your morphine ext-rel fluconazole physician to choose a similar Preferred Drug morphine supp griseofulvin ultramicrosize List product for you to use. oxycodone caps 5 mg itraconazole oxycodone concentrate 20 mg/mL nystatin Should I use generics? terbinafine tabs There are many medications on the market oxycodone soln 5 mg/5 mL voriconazole that do not come in generic form. For those oxycodone tabs 5 mg, 15 mg, 30 mg drugs that do, your pharmacist should oxycodone/acetaminophen 5/325 suggest safe and effective generic tramadol * ANTIMALARIALS alternatives. tramadol ext-rel atovaquone/proguanil buprenorphine (BELBUCA) chloroquine This document is subject to state-specific fentanyl sublingual spray (SUBSYS) mefloquine regulations and rules, including, but not oxycodone ext-rel (XTAMPZA ER) tapentadol (NUCYNTA) limited to, those regarding generic ANTITUBERCULAR AGENTS substitution, controlled substance schedules, tapentadol ext-rel (NUCYNTA ER) ethambutol preference for brands and mandatory Listing does not include NDC 52817019610. Drug products isoniazid generics whenever applicable. * are identified by unique numerical product identifiers, called pyrazinamide National Drug Codes (NDC), which identify the manufacturer, rifampin Boldface type indicates generic availability; strength, dosage form, formulation and package size. boldface may not apply to every strength or NON-OPIOID ANALGESICS dosage form under the listed generic name. butalbital/acetaminophen/caffeine tabs ANTIVIRALS butalbital/aspirin/caffeine Cytomegalovirus Agents valganciclovir

1 Herpes Agents captopril ANTIARRHYTHMICS acyclovir caps, tabs enalapril amiodarone famciclovir fosinopril disopyramide valacyclovir lisinopril flecainide perindopril propafenone Influenza Agents quinapril propafenone ext-rel ramipril oseltamivir sotalol trandolapril zanamivir (RELENZA) dronedarone (MULTAQ)

MISCELLANEOUS ACE INHIBITOR/CALCIUM CHANNEL ANTILIPEMICS clindamycin BLOCKER COMBINATIONS Bile Acid Resins dapsone amlodipine/benazepril cholestyramine ivermectin trandolapril/verapamil ext-rel colesevelam linezolid colestipol ACE INHIBITOR/DIURETIC nitrofurantoin ext-rel COMBINATIONS Cholesterol Absorption Inhibitors nitrofurantoin macrocrystals benazepril/hydrochlorothiazide ezetimibe nitrofurantoin susp captopril/hydrochlorothiazide sulfamethoxazole/trimethoprim enalapril/hydrochlorothiazide Fibrates sulfamethoxazole/trimethoprim DS fosinopril/hydrochlorothiazide fenofibrate * tinidazole lisinopril/hydrochlorothiazide fenofibric acid delayed-rel trimethoprim quinapril/hydrochlorothiazide gemfibrozil vancomycin caps mebendazole chewable (EMVERM) * Listing does not include fenofibrate tablet 120 mg. 550 mg (XIFAXAN) ADRENOLYTICS, CENTRAL clonidine HMG-CoA Reductase ANTINEOPLASTIC AGENTS clonidine transdermal guanfacine Inhibitors/Combinations atorvastatin ALKYLATING AGENTS ezetimibe/simvastatin cyclophosphamide caps ALDOSTERONE RECEPTOR fluvastatin melphalan ANTAGONISTS lovastatin busulfan (MYLERAN) eplerenone pravastatin chlorambucil (LEUKERAN) spironolactone rosuvastatin simvastatin ANTIMETABOLITES ALPHA BLOCKERS mercaptopurine doxazosin Niacins methotrexate (TREXALL) terazosin niacin ext-rel thioguanine (TABLOID)

ANGIOTENSIN II RECEPTOR Omega-3 Fatty Acids HORMONAL ANTINEOPLASTIC AGENTS omega-3 acid ethyl esters ANTAGONISTS/DIURETIC Antiandrogens icosapent ethyl (VASCEPA) bicalutamide COMBINATIONS flutamide candesartan candesartan/hydrochlorothiazide BETA-BLOCKERS atenolol irbesartan bisoprolol Antiestrogens irbesartan/hydrochlorothiazide carvedilol tamoxifen losartan carvedilol phosphate ext-rel losartan/hydrochlorothiazide labetalol Aromatase Inhibitors olmesartan metoprolol succinate ext-rel anastrozole olmesartan/hydrochlorothiazide metoprolol tartrate exemestane telmisartan nadolol letrozole telmisartan/hydrochlorothiazide pindolol valsartan propranolol Progestins valsartan/hydrochlorothiazide propranolol ext-rel megestrol acetate tabs nebivolol (BYSTOLIC)

ANGIOTENSIN II RECEPTOR MISCELLANEOUS ANTAGONIST/CALCIUM CHANNEL BETA-BLOCKER/DIURETIC etoposide BLOCKER COMBINATIONS hydroxyurea COMBINATIONS amlodipine/olmesartan atenolol/chlorthalidone tretinoin caps amlodipine/telmisartan mitotane (LYSODREN) bisoprolol/hydrochlorothiazide amlodipine/valsartan metoprolol/hydrochlorothiazide procarbazine (MATULANE) uridine triacetate (VISTOGARD) ANGIOTENSIN II RECEPTOR CALCIUM CHANNEL BLOCKERS CARDIOVASCULAR ANTAGONIST/CALCIUM CHANNEL Dihydropyridines BLOCKER/DIURETIC COMBINATIONS amlodipine ACE INHIBITORS amlodipine/valsartan/hydrochlorothiazide felodipine ext-rel benazepril olmesartan/amlodipine/hydrochlorothiazide nifedipine ext-rel

2 Nondihydropyridines methyldopa paroxetine HCl diltiazem ext-rel * midodrine paroxetine HCl ext-rel verapamil ext-rel ranolazine ext-rel sertraline vilazodone (VIIBRYD) * Listing does not include generics for CARDIZEM LA CENTRAL NERVOUS SYSTEM vortioxetine (TRINTELLIX)

ANTIANXIETY * Listing does not include fluoxetine tablet 60 mg, CALCIUM CHANNEL fluoxetine tablet (generics for SARAFEM). BLOCKER/ANTILIPEMIC COMBINATIONS Benzodiazepines amlodipine/atorvastatin alprazolam Serotonin Norepinephrine Reuptake clonazepam diazepam Inhibitors (SNRIs) DIGITALIS GLYCOSIDES lorazepam desvenlafaxine ext-rel digoxin 0.125 mg, 0.25 mg oxazepam duloxetine delayed-rel digoxin ped elixir venlafaxine Miscellaneous venlafaxine ext-rel

DIRECT RENIN INHIBITORS/DIURETIC buspirone COMBINATIONS clomipramine Tricyclic Antidepressants (TCAs) amitriptyline aliskiren fluvoxamine desipramine aliskiren/hydrochlorothiazide (TEKTURNA HCT) doxepin

ANTICONVULSANTS imipramine HCl DIURETICS carbamazepine nortriptyline Carbonic Anhydrase Inhibitors carbamazepine ext-rel acetazolamide clobazam Miscellaneous Agents diazepam rectal gel acetazolamide ext-rel bupropion divalproex sodium delayed-rel methazolamide bupropion ext-rel divalproex sodium ext-rel mirtazapine ethosuximide trazodone Loop Diuretics gabapentin bumetanide lamotrigine furosemide lamotrigine ext-rel ANTIPARKINSONIAN AGENTS torsemide lamotrigine orally disintegrating tabs amantadine levetiracetam benztropine Potassium-sparing Diuretics levetiracetam ext-rel bromocriptine amiloride oxcarbazepine carbidopa/levodopa triamterene phenobarbital carbidopa/levodopa ext-rel phenytoin carbidopa/levodopa orally disintegrating tabs Thiazides and Thiazide-like Diuretics phenytoin sodium extended carbidopa/levodopa/entacapone chlorthalidone primidone entacapone hydrochlorothiazide tiagabine pramipexole indapamide topiramate pramipexole ext-rel metolazone topiramate ext-rel rasagiline valproic acid ropinirole Diuretic Combinations zonisamide ropinirole ext-rel amiloride/hydrochlorothiazide lacosamide (VIMPAT) selegiline spironolactone/hydrochlorothiazide oxcarbazepine ext-rel (OXTELLAR XR) trihexyphenidyl triamterene/hydrochlorothiazide perampanel (FYCOMPA) rotigotine transdermal (NEUPRO) topiramate ext-rel (TROKENDI XR)

HEART FAILURE ANTIPSYCHOTICS isosorbide dinitrate/hydralazine (BIDIL) ANTIDEMENTIA Atypicals ivabradine (CORLANOR) donepezil aripiprazole sacubitril/valsartan (ENTRESTO) galantamine clozapine galantamine ext-rel olanzapine memantine quetiapine NITRATES memantine ext-rel quetiapine ext-rel Oral rivastigmine risperidone isosorbide dinitrate rivastigmine transdermal ziprasidone isosorbide mononitrate memantine/donepezil (NAMZARIC) aripiprazole ext-rel injection (ABILIFY MAINTENA) isosorbide mononitrate ext-rel aripiprazole lauroxil ext-rel inj (ARISTADA) ANTIDEPRESSANTS cariprazine (VRAYLAR) Sublingual/Translingual Monoamine Oxidase Inhibitors (MAOIs) lurasidone (LATUDA) nitroglycerin lingual spray risperidone long-acting inj (RISPERDAL CONSTA) phenelzine nitroglycerin sublingual tranylcypromine

Miscellaneous Transdermal Selective Serotonin Reuptake Inhibitors chlorpromazine nitroglycerin transdermal fluphenazine (SSRIs) haloperidol citalopram MISCELLANEOUS perphenazine escitalopram thiothixene hydralazine fluoxetine * trifluoperazine

3 ATTENTION DEFICIT HYPERACTIVITY MOOD STABILIZERS testosterone transdermal (ANDRODERM) DISORDER lithium carbonate lithium carbonate ext-rel * Listing does not include the authorized generics for amphetamine/dextroamphetamine mixed salts TESTIM and VOGELXO. amphetamine/dextroamphetamine mixed salts ext-rel ^ MUSCULOSKELETAL THERAPY AGENTS ANTIDIABETICS atomoxetine baclofen dexmethylphenidate carisoprodol Alpha-glucosidase Inhibitors acarbose dexmethylphenidate ext-rel chlorzoxazone 500 mg * dextroamphetamine cyclobenzaprine ** dextroamphetamine ext-rel dantrolene Amylin Analogs guanfacine ext-rel metaxalone pramlintide (SYMLINPEN) methylphenidate methocarbamol *** methylphenidate ext-rel ^ tizanidine tabs Biguanides amphetamine/dextroamphetamine mixed salts ext- metformin rel (MYDAYIS) * Listing does not include NDC 73007001303. Drug metformin ext-rel * lisdexamfetamine (VYVANSE) products are identified by unique numerical product identifiers, called National Drug Codes (NDC), which identify the manufacturer, strength, dosage form, * Listing does not include generics for FORTAMET and ^ Listing does not include certain NDCs. Drug products formulation and package size. GLUMETZA. are identified by unique numerical product identifiers, ** Listing does not include cyclobenzaprine tablet 7.5 mg. called National Drug Codes (NDC), which identify the *** Listing does not include NDCs 69036093090 and Biguanide/Sulfonylurea Combinations manufacturer, strength, dosage form, formulation and 70868090190. Drug products are identified by unique package size. numerical product identifiers, called National Drug Codes glipizide/metformin (NDC), which identify the manufacturer, strength, dosage FIBROMYALGIA form, formulation and package size. Dipeptidyl Peptidase-4 (DPP-4) Inhibitors pregabalin sitagliptin phosphate (JANUVIA) MYASTHENIA GRAVIS HYPNOTICS pyridostigmine Dipeptidyl Peptidase-4 (DPP-4) pyridostigmine ext-rel Inhibitor/Biguanide Combinations Benzodiazepines temazepam sitagliptin/metformin (JANUMET) NARCOLEPSY sitagliptin/metformin ext-rel (JANUMET XR) armodafinil Nonbenzodiazepines solriamfetol (SUNOSI) eszopiclone Incretin Mimetic Agents ramelteon dulaglutide (TRULICITY) zolpidem POSTHERPETIC NEURALGIA (PHN) liraglutide (VICTOZA) zolpidem ext-rel gabapentin ext-rel (GRALISE) semaglutide (OZEMPIC) zolpidem sublingual semaglutide (RYBELSUS) suvorexant (BELSOMRA) PSYCHOTHERAPEUTIC- Incretin Mimetic Agent/Insulin MISCELLANEOUS Combinations Tricyclics Alcohol Deterrents doxepin liraglutide/insulin degludec (XULTOPHY) acamprosate calcium lixisenatide/insulin glargine (SOLIQUA) disulfiram

MIGRAINE Acute Migraine Agents Insulins Opioid Antagonists insulin aspart (FIASP) naloxone inj Ergotamine Derivatives insulin aspart (NOVOLOG) naltrexone dihydroergotamine inj insulin aspart protamine 70%/insulin aspart 30% naloxone nasal spray (NARCAN) (NOVOLOG MIX 70/30)

Newer Agents insulin degludec (TRESIBA) lasmiditan (REYVOW) Partial Opioid Agonist/Opioid Antagonist insulin detemir (LEVEMIR) rimegepant (NURTEC ODT) Combinations insulin glargine (BASAGLAR) ubrogepant (UBRELVY) buprenorphine/naloxone sublingual insulin human (HUMULIN R U-500) buprenorphine/naloxone sublingual tabs (ZUBSOLV) insulin human (NOVOLIN R) Triptans insulin isophane human (NOVOLIN N) eletriptan Pseudobulbar Affect Agents insulin isophane human 70%/regular 30% naratriptan dextromethorphan/quinidine (NUEDEXTA) (NOVOLIN 70/30) rizatriptan sumatriptan Insulin Sensitizers sumatriptan inj Smoking Deterrents bupropion ext-rel pioglitazone sumatriptan nasal spray zolmitriptan sumatriptan inj (ZEMBRACE SYMTOUCH) Vasomotor Symptom Agents Insulin Sensitizer/Biguanide sumatriptan nasal powder (ONZETRA XSAIL) paroxetine mesylate Combinations zolmitriptan nasal spray (ZOMIG) pioglitazone/metformin ENDOCRINE AND METABOLIC Preventive Migraine Agents Insulin Sensitizer/Sulfonylurea Monoclonal Antibodies ANDROGENS Combinations erenumab-aooe (AIMOVIG) testosterone cypionate pioglitazone/glimepiride fremanezumab-vfrm (AJOVY) testosterone enanthate galcanezumab-gnlm (EMGALITY) testosterone gel * testosterone soln

4 Meglitinides norethindrone acetate/EE 1/20 ESTROGEN/PROGESTINS nateglinide norethindrone acetate/EE 1/20 and iron Oral norethindrone acetate/EE 1/20 and iron chewable repaglinide EE/norethindrone acetate - Jinteli

estradiol/norethindrone Sodium-Glucose Co-Transporter 2 30 mcg Estrogen estrogens, conjugated/medroxyprogesterone (SGLT2) Inhibitors desogestrel/EE 0.15/30 (PREMPHASE) drospirenone/EE 3/30 dapagliflozin (FARXIGA) estrogens, conjugated/medroxyprogesterone drospirenone/EE/levomefolate 3/30 and empagliflozin (JARDIANCE) (PREMPRO) levomefolate

levonorgestrel/EE 0.15/30 - Levora Sodium-Glucose Co-Transporter 2 norethindrone acetate/EE 1.5/30 Transdermal estradiol/levonorgestrel (CLIMARA PRO) (SGLT2) Inhibitor/Biguanide norethindrone acetate/EE 1.5/30 and iron estradiol/norethindrone acetate (COMBIPATCH) norgestrel/EE 0.3/30 - Low-Ogestrel Combinations dapagliflozin/metformin ext-rel (XIGDUO XR) empagliflozin/metformin (SYNJARDY) 35 mcg Estrogen ESTROGEN/SELECTIVE ESTROGEN empagliflozin/metformin ext-rel (SYNJARDY XR) ethynodiol diacetate/EE 1/35 - Zovia 1/35 RECEPTOR MODULATOR norethindrone/EE 0.5/35 COMBINATIONS Sodium-Glucose Co-Transporter 2 norethindrone/EE 1/35 conjugated estrogens/bazedoxifene (DUAVEE) (SGLT2) Inhibitor/Dipeptidyl Peptidase-4 norgestimate/EE 0.25/35

(DPP-4) Inhibitor Combinations Biphasic GLUCOCORTICOIDS empagliflozin/linagliptin (GLYXAMBI) dexamethasone desogestrel/EE fludrocortisone norethindrone acetate/EE 1/10 and EE 10 and iron hydrocortisone Sodium-glucose Co-transporter 2 (Sglt2) (LO LOESTRIN FE) methylprednisolone Inhibitor / Dipeptidyl Peptidase-4 (Dpp-4) prednisolone Inhibitor / Biguanide Combinations Triphasic prednisone empagliflozin/linagliptin/metformin ext-rel desogestrel/EE (TRIJARDY XR) levonorgestrel/EE - Trivora norethindrone/EE GLUCOSE ELEVATING AGENTS Sulfonylureas norgestimate/EE glucagon nasal powder (BAQSIMI) glucagon subcutaneous soln (GVOKE) glimepiride glucagon, human recombinant (GLUCAGEN glipizide Extended Cycle HYPOKIT) glipizide ext-rel levonorgestrel/EE 0.1/20 and EE 10 glucagon, human recombinant (GLUCAGON levonorgestrel/EE 0.15/30 EMERGENCY KIT) levonorgestrel/EE 0.15/30 and EE 10 Supplies ACCU-CHEK AVIVA PLUS kits and test strips ACCU-CHEK COMPACT PLUS kits and test strips Progestin Only HYPERPARATHYROID TREATMENT, ACCU-CHEK GUIDE kits and test strips norethindrone VITAMIN D ANALOGS ACCU-CHEK SMARTVIEW kits and test strips calcitriol (1,25-D3) BD ULTRAFINE insulin syringes and needles Injectable doxercalciferol lancets medroxyprogesterone acetate 150 mg/mL paricalcitol

ANTIOBESITY Transdermal PHOSPHATE BINDER AGENTS liraglutide (SAXENDA) norelgestromin/EE calcium acetate sevelamer carbonate CALCIUM REGULATORS Vaginal calcium acetate (PHOSLYRA) etonogestrel/EE ring sucroferric oxyhydroxide (VELPHORO) Bisphosphonates alendronate ibandronate ENDOMETRIOSIS POTASSIUM-REMOVING AGENTS risedronate danazol patiromer sorbitex (VELTASSA) risedronate delayed-rel elagolix (ORILISSA) sodium zirconium cyclosilicate (LOKELMA)

Calcitonins ESTROGENS PROGESTINS calcitonin-salmon spray Oral Oral

estradiol medroxyprogesterone acetate CARNITINE DEFICIENCY AGENTS estrogens, conjugated (PREMARIN) megestrol acetate susp levocarnitine norethindrone acetate progesterone, micronized Transdermal CONTRACEPTIVES estradiol EE = ethinyl estradiol estradiol (DIVIGEL) SELECTIVE ESTROGEN RECEPTOR estradiol (EVAMIST) MODULATORS Monophasic raloxifene 20 mcg Estrogen Vaginal ospemifene (OSPHENA) drospirenone/EE 3/20 estradiol vaginal crm drospirenone/EE/levomefolate 3/20 and estradiol vaginal tabs THYROID AGENTS levomefolate estradiol vaginal ring (ESTRING) Antithyroid Agents levonorgestrel/EE 0.1/20 - Lessina estrogens, conjugated crm (PREMARIN) methimazole

5 propylthiouracil Irritable Bowel Syndrome with Diarrhea VAGINAL ANTI-INFECTIVES alosetron clindamycin crm Thyroid Supplements eluxadoline (VIBERZI) metronidazole levothyroxine terconazole levothyroxine (SYNTHROID) LAXATIVES levothyroxine - Levoxyl lactulose soln MISCELLANEOUS liothyronine peg 3350/electrolytes bethanechol sodium sulfate/potassium sulfate/magnesium sulfate potassium citrate ext-rel VASOPRESSINS (SUPREP) desmopressin spray, tabs HEMATOLOGIC OPIOID-INDUCED CONSTIPATION MISCELLANEOUS naldemedine (SYMPROIC) ANTICOAGULANTS cabergoline naloxegol (MOVANTIK) Injectable enoxaparin GASTROINTESTINAL PANCREATIC ENZYMES pancrelipase (VIOKACE) Oral ANTIDIARRHEALS pancrelipase delayed-rel (CREON) warfarin diphenoxylate/atropine pancrelipase delayed-rel (ZENPEP) apixaban (ELIQUIS) loperamide rivaroxaban (XARELTO)

PROSTAGLANDINS Synthetic Heparinoid-like Agents ANTIEMETICS misoprostol fondaparinux doxylamine/pyridoxine delayed-rel dronabinol granisetron PROTON PUMP INHIBITORS PLATELET AGGREGATION INHIBITORS esomeprazole delayed-rel meclizine clopidogrel lansoprazole delayed-rel metoclopramide dipyridamole omeprazole delayed-rel ondansetron dipyridamole ext-rel/aspirin pantoprazole delayed-rel prochlorperazine prasugrel dexlansoprazole delayed-rel (DEXILANT) promethazine ticagrelor (BRILINTA) scopolamine transdermal trimethobenzamide SALIVA STIMULANTS PLATELET SYNTHESIS INHIBITORS granisetron transdermal (SANCUSO) cevimeline anagrelide rolapitant (VARUBI) pilocarpine tabs

ANTISPASMODICS STEROIDS, RECTAL MISCELLANEOUS cilostazol dicyclomine hydrocortisone crm

hydrocortisone acetate/pramoxine foam CHOLELITHOLYTICS (PROCTOFOAM-HC) IMMUNOLOGIC AGENTS ursodiol ALLERGENIC EXTRACTS ULCER THERAPY COMBINATIONS ragweed pollen allergen extract (RAGWITEK) H2 RECEPTOR ANTAGONISTS lansoprazole + amoxicillin + clarithromycin timothy grass pollen allergen extract (GRASTEK) cimetidine bismuth/metronidazole/tetracycline (PYLERA) famotidine DISEASE-MODIFYING ANTIRHEUMATIC MISCELLANEOUS DRUGS (DMARDs) sucralfate tablet INFLAMMATORY BOWEL DISEASE hydroxychloroquine Oral Agents leflunomide balsalazide GENITOURINARY methotrexate budesonide delayed-rel caps BENIGN PROSTATIC HYPERPLASIA budesonide ext-rel IMMUNOSUPPRESSANTS mesalamine delayed-rel caps alfuzosin ext-rel mesalamine delayed-rel tabs dutasteride Antimetabolites azathioprine mesalamine ext-rel caps dutasteride/tamsulosin azathioprine (AZASAN) sulfasalazine finasteride sulfasalazine delayed-rel silodosin mesalamine ext-rel caps (PENTASA) tamsulosin NUTRITIONAL/SUPPLEMENTS

ELECTROLYTES Rectal Agents URINARY ANTISPASMODICS hydrocortisone enema darifenacin ext-rel Potassium mesalamine susp oxybutynin potassium chloride ext-rel hydrocortisone acetate foam (CORTIFOAM) oxybutynin ext-rel potassium chloride liquid solifenacin tolterodine IRRITABLE BOWEL SYNDROME VITAMINS AND MINERALS tolterodine ext-rel Folic Acid/Combinations Irritable Bowel Syndrome with trospium folic acid Constipation trospium ext-rel folic acid/vitamin B6/vitamin B12 linaclotide (LINZESS) fesoterodine ext-rel (TOVIAZ) lubiprostone (AMITIZA) mirabegron ext-rel (MYRBETRIQ)

6 Prenatal Vitamins ANTITUSSIVES fluticasone/salmeterol, CFC-free aerosol (ADVAIR prenatal vitamins benzonatate * HFA) prenatal vitamins/DHA/docusate/folic acid fluticasone/vilanterol (BREO ELLIPTA) (CITRANATAL 90 DHA) * Listing does not include NDCs 69336012615 and 69499032915. Drug products are identified by unique prenatal vitamins/DHA/docusate/folic acid numerical product identifiers, called National Drug Codes STEROID INHALANTS (CITRANATAL DHA) (NDC), which identify the manufacturer, strength, dosage budesonide inhalation susp prenatal vitamins/DHA/docusate/folic acid form, formulation and package size. beclomethasone breath-activated aerosol (QVAR

(CITRANATAL HARMONY) REDIHALER) prenatal vitamins/docusate/folic acid (CITRANATAL ANTITUSSIVE COMBINATIONS budesonide (PULMICORT FLEXHALER) RX) Opioid fluticasone (ARNUITY ELLIPTA) prenatal vitamins/docusate/folic acid + DHA codeine/guaifenesin liquid fluticasone (FLOVENT DISKUS) (CITRANATAL ASSURE) codeine/guaifenesin/pseudoephedrine fluticasone, CFC-free aerosol (FLOVENT HFA) prenatal vitamins/folic acid + pyridoxine codeine/promethazine (CITRANATAL B-CALM) codeine/promethazine/phenylephrine XANTHINES hydrocodone/homatropine theophylline ext-rel tabs Miscellaneous cyanocobalamin inj Non-opioid MISCELLANEOUS ergocalciferol (D2) dextromethorphan/brompheniramine/pseudoeph ipratropium spray fluoride drops, tabs edrine multivitamins/fluoride drops, tabs dextromethorphan/promethazine multivitamins/fluoride/iron drops, tabs TOPICAL vitamin ADC/fluoride drops vitamin ADC/fluoride/iron drops BETA AGONISTS DERMATOLOGY Inhalants Acne RESPIRATORY Short Acting Oral albuterol soln isotretinoin ANAPHYLAXIS TREATMENT AGENTS albuterol sulfate CFC-free aerosol epinephrine auto-injector levalbuterol tartrate, CFC-free aerosol Topical epinephrine auto-injector (EPIPEN) adapalene epinephrine auto-injector (EPIPEN JR.) Long Acting adapalene/benzoyl peroxide (EPIDUO) epinephrine (SYMJEPI) Hand-held Active Inhalation benzoyl peroxide olodaterol, CFC-free aerosol (STRIVERDI clindamycin gel, lotion, soln * ANTICHOLINERGICS RESPIMAT) clindamycin/benzoyl peroxide salmeterol xinafoate (SEREVENT) ipratropium soln erythromycin gel 2% revefenacin inhalation solution (YUPELRI) erythromycin soln Nebulized Passive Inhalation tiotropium (SPIRIVA) erythromycin/benzoyl peroxide formoterol inhalation soln (PERFOROMIST) umeclidinium bromide (INCRUSE ELLIPTA) sulfacetamide lotion 10%

tazarotene (TAZORAC) Oral Agents tretinoin ANTICHOLINERGIC/BETA AGONIST albuterol tretinoin - Avita COMBINATIONS albuterol ext-rel tretinoin gel microsphere Short Acting terbutaline adapalene/benzoyl peroxide (EPIDUO FORTE) ipratropium/albuterol soln clindamycin/benzoyl peroxide (ONEXTON) LEUKOTRIENE MODULATORS * Listing does not include NDC 68682046275. Drug Long Acting montelukast products are identified by unique numerical product glycopyrrolate/formoterol (BEVESPI zafirlukast identifiers, called National Drug Codes (NDC), which AEROSPHERE) zileuton ext-rel identify the manufacturer, strength, dosage form, tiotropium/olodaterol (STIOLTO RESPIMAT) formulation and package size. umeclidinium/vilanterol (ANORO ELLIPTA) MAST CELL STABILIZERS cromolyn soln fluorouracil crm 5%, soln 5%, soln 2% ANTICHOLINERGIC/BETA (ZYCLARA) AGONIST/STEROID INHALANT NASAL ANTIHISTAMINES fluorouracil cream 4% (TOLAK) COMBINATIONS azelastine spray ingenol mebutate (PICATO) fluticasone/umeclidinium/vilanterol (TRELEGY olopatadine spray ELLIPTA) NASAL ANTIHISTAMINE/STEROID ANTIHISTAMINES, SEDATING COMBINATIONS oint clemastine 2.68 mg azelastine/fluticasone spray (DYMISTA) cyproheptadine hydroxyzine HCl Antifungals PHOSPHODIESTERASE-4 INHIBITORS ciclopirox roflumilast (DALIRESP) clotrimazole econazole STEROID/BETA AGONIST ketoconazole crm 2% COMBINATIONS luliconazole budesonide/formoterol (SYMBICORT) naftifine (NAFTIN) fluticasone/salmeterol (ADVAIR DISKUS) nystatin

7 Antipsoriatics metronidazole crm, gel, lotion 0.75% Steroidal Oral metronidazole gel 1% dexamethasone sodium phosphate acitretin azelaic acid foam (FINACEA FOAM) fluorometholone methoxsalen oral ivermectin (SOOLANTRA) loteprednol prednisolone acetate 1% Topical Scabicides and Pediculicides dexamethasone (MAXIDEX) calcipotriene oint, soln 0.005% malathion difluprednate (DUREZOL) permethrin 5% fluorometholone (FML FORTE) fluorometholone (FML S.O.P.) Antiseborrheics prednisolone acetate (PRED MILD) ketoconazole shampoo 2% Miscellaneous Skin and Mucous selenium sulfide lotion 2.5% Membrane imiquimod Antivirals Atopic Dermatitis podofilox trifluridine

Topical Beta-blockers pimecrolimus MOUTH/THROAT/DENTAL AGENTS tacrolimus Nonselective Anesthetics - Topical Oral levobunolol crisaborole (EUCRISA) lidocaine viscous timolol maleate timolol maleate gel Corticosteroids Steroids - Mouth/Throat timolol hemihydrate (BETIMOL) Low Potency triamcinolone paste alclometasone crm, oint 0.05% Selective desonide crm, lotion, oint 0.05% betaxolol (BETOPTIC S) fluocinolone acetonide soln 0.01% OPHTHALMIC hydrocortisone crm 2.5% Antiallergics hydrocortisone lotion 1% azelastine Carbonic Anhydrase Inhibitors cromolyn sodium Topical Medium Potency olopatadine OTC dorzolamide betamethasone valerate crm, lotion, oint 0.1% alcaftadine (LASTACAFT) brinzolamide (AZOPT) desoximetasone crm, oint 0.05% olopatadine (PAZEO) fluocinolone acetonide crm, oint 0.025% Carbonic Anhydrase Inhibitor/Beta- fluticasone propionate crm, lotion 0.05%, oint Anti-infectives blocker Combinations 0.005% dorzolamide/timolol maleate hydrocortisone butyrate crm, lotion, oint, soln ciprofloxacin soln 0.1% erythromycin Carbonic Anhydrase hydrocortisone valerate crm, oint 0.2% gentamicin mometasone crm, lotion, oint 0.1% levofloxacin Inhibitor/Sympathomimetic Combinations brinzolamide/brimonidine (SIMBRINZA) triamcinolone acetonide crm, lotion 0.025% moxifloxacin triamcinolone acetonide crm, lotion, oint 0.1% /polymyxin B/gramicidin ofloxacin Dry Eye Disease High Potency polymyxin B/bacitracin cyclosporine, emulsion (RESTASIS) betamethasone dipropionate augmented crm, polymyxin B/trimethoprim lifitegrast (XIIDRA) lotion 0.05% sulfacetamide oint, soln 10% betamethasone dipropionate crm, lotion, oint tobramycin Prostaglandins 0.05% besifloxacin (BESIVANCE) latanoprost desoximetasone crm, oint 0.25%, gel 0.05% ciprofloxacin oint (CILOXAN) travoprost fluocinonide crm, gel, oint, soln 0.05% bimatoprost 0.01% (LUMIGAN) triamcinolone acetonide crm 0.5% Anti-infective/Anti-inflammatory halobetasol propionate lotion 0.01% (BRYHALI) Combinations Rho Kinase Inhibitors neomycin/polymyxin B/bacitracin/hydrocortisone netarsudil (RHOPRESSA) Very High Potency oint betamethasone dipropionate augmented gel, oint neomycin/polymyxin B/dexamethasone Rho Kinase Inhibitor / Prostaglandin 0.05% neomycin/polymyxin B/hydrocortisone susp Combinations clobetasol propionate crm, foam, gel, lotion, oint, sulfacetamide/prednisolone phosphate netarsudil/latanoprost (ROCKLATAN) shampoo, soln 10%/0.25% halobetasol propionate crm, oint 0.05% tobramycin/dexamethasone susp 0.3%/0.1% Sympathomimetics tobramycin/dexamethasone oint 0.3%/0.1% brimonidine (ALPHAGAN P) (TOBRADEX) Emollients brimonidine 0.2% ammonium lactate 12% tobramycin/dexamethasone susp 0.3%/0.05%

(TOBRADEX ST) Sympathomimetic/Beta-blocker Local Analgesics lidocaine patch Anti-inflammatories Combinations Nonsteroidal brimonidine/timolol (COMBIGAN) Local Anesthetics bromfenac sodium lidocaine/prilocaine diclofenac sodium OTIC ketorolac Anti-infectives Rosacea ketorolac tromethamine (ACUVAIL) acetic acid azelaic acid gel nepafenac (ILEVRO) ofloxacin otic doxycycline monohydrate delayed-rel caps nepafenac (NEVANAC)

8 Anti-infective/Anti-inflammatory Combinations neomycin/polymyxin B/hydrocortisone ciprofloxacin/dexamethasone (CIPRODEX)

QUICK REFERENCE DRUG LIST

aripiprazole, 3 brinzolamide/brimonidine, 8 A aripiprazole ext-rel injection, 3 bromfenac sodium, 8 ABILIFY MAINTENA, 3 aripiprazole lauroxil ext-rel inj, 3 bromocriptine, 3 acamprosate calcium, 4 ARISTADA, 3 BRYHALI, 8 acarbose, 4 armodafinil, 4 budesonide, 7 ACCU-CHEK AVIVA PLUS kits and test strips, 5 ARNUITY ELLIPTA, 7 budesonide delayed-rel caps, 6 ACCU-CHEK COMPACT PLUS kits and test atenolol, 2 budesonide ext-rel, 6 strips, 5 atenolol/chlorthalidone, 2 budesonide inhalation susp, 7 ACCU-CHEK GUIDE kits and test strips, 5 atomoxetine, 4 budesonide/formoterol, 7 ACCU-CHEK SMARTVIEW kits and test strips, 5 atorvastatin, 2 bumetanide, 3 acetazolamide, 3 atovaquone/proguanil, 1 buprenorphine, 1 acetazolamide ext-rel, 3 AZASAN, 6 buprenorphine transdermal, 1 acetic acid, 8 azathioprine, 6 buprenorphine/naloxone sublingual, 4 acitretin, 8 azelaic acid foam, 8 buprenorphine/naloxone sublingual tabs, 4 ACUVAIL, 8 azelaic acid gel, 8 bupropion, 3 acyclovir caps, tabs, 2 azelastine, 8 bupropion ext-rel, 3, 4 adapalene, 7 azelastine spray, 7 buspirone, 3 adapalene/benzoyl peroxide, 7 azelastine/fluticasone spray, 7 busulfan, 2 ADVAIR DISKUS, 7 azithromycin, 1 butalbital/acetaminophen/caffeine tabs, 1 ADVAIR HFA, 7 AZOPT, 8 butalbital/aspirin/caffeine, 1 AIMOVIG, 4 BYSTOLIC, 2 AJOVY, 4 B albuterol, 7 bacitracin, 8 C albuterol ext-rel, 7 baclofen, 4 cabergoline, 6 albuterol soln, 7 balsalazide, 6 calcipotriene oint, soln 0.005%, 8 albuterol sulfate CFC-free aerosol, 7 BAQSIMI, 5 calcitonin-salmon spray, 5 alcaftadine, 8 BASAGLAR, 4 calcitriol (1,25-D3), 5 alclometasone crm, oint 0.05%, 8 BD ULTRAFINE insulin syringes and needles, 5 calcium acetate, 5 alendronate, 5 beclomethasone breath-activated aerosol, 7 candesartan, 2 alfuzosin ext-rel, 6 BELBUCA, 1 candesartan/hydrochlorothiazide, 2 aliskiren, 3 BELSOMRA, 4 captopril, 2 aliskiren/hydrochlorothiazide, 3 benazepril, 2 captopril/hydrochlorothiazide, 2 allopurinol, 1 benazepril/hydrochlorothiazide, 2 carbamazepine, 3 alosetron, 6 benzonatate, 7 carbamazepine ext-rel, 3 ALPHAGAN P, 8 benzoyl peroxide, 7 carbidopa/levodopa, 3 alprazolam, 3 benztropine, 3 carbidopa/levodopa ext-rel, 3 amantadine, 3 besifloxacin, 8 carbidopa/levodopa orally disintegrating amiloride, 3 BESIVANCE, 8 tabs, 3 amiloride/hydrochlorothiazide, 3 betamethasone dipropionate augmented crm, carbidopa/levodopa/entacapone, 3 amiodarone, 2 lotion 0.05%, 8 cariprazine, 3 AMITIZA, 6 betamethasone dipropionate augmented gel, carisoprodol, 4 amitriptyline, 3 oint 0.05%, 8 carvedilol, 2 amlodipine, 2 betamethasone dipropionate crm, lotion, oint carvedilol phosphate ext-rel, 2 amlodipine/atorvastatin, 3 0.05%, 8 cefadroxil, 1 amlodipine/benazepril, 2 betamethasone valerate crm, lotion, oint cefdinir, 1 amlodipine/olmesartan, 2 0.1%, 8 cefixime, 1 amlodipine/telmisartan, 2 betaxolol, 8 cefprozil, 1 amlodipine/valsartan, 2 bethanechol, 6 cefuroxime axetil, 1 amlodipine/valsartan/hydrochlorothiazide, 2 BETIMOL, 8 celecoxib, 1 ammonium lactate 12%, 8 BETOPTIC S, 8 cephalexin, 1 amoxicillin, 1 BEVESPI AEROSPHERE, 7 cevimeline, 6 amoxicillin/clavulanate, 1 bicalutamide, 2 chlorambucil, 2 amoxicillin/clavulanate ext-rel, 1 BIDIL, 3 chloroquine, 1 amphetamine/dextroamphetamine mixed bimatoprost 0.01%, 8 chlorpromazine, 3 salts, 4 bismuth/metronidazole/tetracycline, 6 chlorthalidone, 3 amphetamine/dextroamphetamine mixed bisoprolol, 2 chlorzoxazone 500 mg, 4 salts ext-rel, 4 bisoprolol/hydrochlorothiazide, 2 cholestyramine, 2 ampicillin, 1 BREO ELLIPTA, 7 ciclopirox, 7 anagrelide, 6 BRILINTA, 6 cilostazol, 6 anastrozole, 2 brimonidine, 8 CILOXAN, 8 ANDRODERM, 4 brimonidine 0.2%, 8 cimetidine, 6 ANORO ELLIPTA, 7 brimonidine/timolol, 8 CIPRODEX, 9 apixaban, 6 brinzolamide, 8 ciprofloxacin, 1

9 ciprofloxacin oint, 8 desvenlafaxine ext-rel, 3 ELIQUIS, 6 ciprofloxacin soln, 8 dexamethasone, 5, 8 eluxadoline, 6 ciprofloxacin/dexamethasone, 9 dexamethasone sodium phosphate, 8 EMGALITY, 4 citalopram, 3 DEXILANT, 6 empagliflozin, 5 CITRANATAL 90 DHA, 7 dexlansoprazole delayed-rel, 6 empagliflozin/linagliptin, 5 CITRANATAL ASSURE, 7 dexmethylphenidate, 4 empagliflozin/linagliptin/metformin ext-rel, 5 CITRANATAL B-CALM, 7 dexmethylphenidate ext-rel, 4 empagliflozin/metformin, 5 CITRANATAL DHA, 7 dextroamphetamine, 4 empagliflozin/metformin ext-rel, 5 CITRANATAL HARMONY, 7 dextroamphetamine ext-rel, 4 EMVERM, 2 CITRANATAL RX, 7 dextromethorphan/brompheniramine/pseudo enalapril, 2 clarithromycin, 1 ephedrine, 7 enalapril/hydrochlorothiazide, 2 clarithromycin ext-rel, 1 dextromethorphan/promethazine, 7 enoxaparin, 6 clemastine 2.68 mg, 7 dextromethorphan/quinidine, 4 entacapone, 3 CLIMARA PRO, 5 diazepam, 3 ENTRESTO, 3 clindamycin, 2 diazepam rectal gel, 3 EPIDUO, 7 clindamycin crm, 6 diclofenac sodium, 8 EPIDUO FORTE, 7 clindamycin gel, lotion, soln, 7 diclofenac sodium delayed-rel, 1 epinephrine, 7 clindamycin/benzoyl peroxide, 7 diclofenac sodium delayed-rel/misoprostol, 1 epinephrine auto-injector, 7 clobazam, 3 diclofenac sodium gel 1%, 1 EPIPEN, 7 clobetasol propionate crm, foam, gel, lotion, diclofenac sodium soln, 1 EPIPEN JR., 7 oint, shampoo, soln, 8 dicloxacillin, 1 eplerenone, 2 clomipramine, 3 dicyclomine, 6 erenumab-aooe, 4 clonazepam, 3 DIFICID, 1 ergocalciferol (D2), 7 clonidine, 2 diflunisal, 1 erythromycin, 8 clonidine transdermal, 2 difluprednate, 8 erythromycin delayed-rel, 1 clopidogrel, 6 digoxin 0.125 mg, 0.25 mg, 3 erythromycin ethylsuccinate, 1 clotrimazole, 7 digoxin ped elixir, 3 erythromycin gel 2%, 7 clotrimazole troches, 1 dihydroergotamine inj, 4 erythromycin soln, 7 clozapine, 3 diltiazem ext-rel, 3 erythromycin stearate, 1 codeine/acetaminophen, 1 diphenoxylate/atropine, 6 erythromycin/benzoyl peroxide, 7 codeine/guaifenesin liquid, 7 dipyridamole, 6 escitalopram, 3 codeine/guaifenesin/pseudoephedrine, 7 dipyridamole ext-rel/aspirin, 6 esomeprazole delayed-rel, 6 codeine/promethazine, 7 disopyramide, 2 estradiol, 5 codeine/promethazine/phenylephrine, 7 disulfiram, 4 estradiol vaginal crm, 5 colchicine, 1 divalproex sodium delayed-rel, 3 estradiol vaginal ring, 5 colesevelam, 2 divalproex sodium ext-rel, 3 estradiol vaginal tabs, 5 colestipol, 2 DIVIGEL, 5 estradiol/levonorgestrel, 5 COMBIGAN, 8 donepezil, 3 estradiol/norethindrone, 5 COMBIPATCH, 5 dorzolamide, 8 estradiol/norethindrone acetate, 5 conjugated estrogens/bazedoxifene, 5 dorzolamide/timolol maleate, 8 ESTRING, 5 CORLANOR, 3 doxazosin, 2 estrogens, conjugated, 5 CORTIFOAM, 6 doxepin, 3, 4 estrogens, conjugated crm, 5 CREON, 6 doxercalciferol, 5 estrogens, conjugated/medroxyprogesterone, 5 crisaborole, 8 doxycycline hyclate, 1 eszopiclone, 4 cromolyn sodium, 8 doxycycline monohydrate delayed-rel caps, 8 ethambutol, 1 cromolyn soln, 7 doxylamine/pyridoxine delayed-rel, 6 ethosuximide, 3 cyanocobalamin inj, 7 dronabinol, 6 ethynodiol diacetate/EE 1/35 - Zovia 1/35, 5 cyclobenzaprine, 4 dronedarone, 2 etodolac, 1 cyclophosphamide caps, 2 drospirenone/EE 3/20, 5 etonogestrel/EE ring, 5 cyclosporine, emulsion, 8 drospirenone/EE 3/30, 5 etoposide, 2 cyproheptadine, 7 drospirenone/EE/levomefolate 3/20 and EUCRISA, 8 levomefolate, 5 EVAMIST, 5 D drospirenone/EE/levomefolate 3/30 and exemestane, 2 DALIRESP, 7 levomefolate, 5 ezetimibe, 2 danazol, 5 DUAVEE, 5 ezetimibe/simvastatin, 2 dantrolene, 4 dulaglutide, 4 dapagliflozin, 5 duloxetine delayed-rel, 3 F dapagliflozin/metformin ext-rel, 5 DUREZOL, 8 famciclovir, 2 dapsone, 2 dutasteride, 6 famotidine, 6 darifenacin ext-rel, 6 dutasteride/tamsulosin, 6 FARXIGA, 5 desipramine, 3 DYMISTA, 7 felodipine ext-rel, 2 desmopressin spray, tabs, 6 fenofibrate, 2 desogestrel/EE, 5 E fenofibric acid delayed-rel, 2 desogestrel/EE 0.15/30, 5 econazole, 7 fentanyl sublingual spray, 1 desonide crm, lotion, oint 0.05%, 8 EE/norethindrone acetate - Jinteli, 5 fentanyl transdermal, 1 desoximetasone crm, oint 0.05%, 8 elagolix, 5 fentanyl transmucosal lozenge, 1 desoximetasone crm, oint 0.25%, gel 0.05%, 8 eletriptan, 4 fesoterodine ext-rel, 6 10

FIASP, 4 GVOKE, 5 K fidaxomicin, 1 ketoconazole crm 2%, 7 FINACEA FOAM, 8 H ketoconazole shampoo 2%, 8 finasteride, 6 halobetasol propionate crm, oint 0.05%, 8 ketorolac, 8 flecainide, 2 halobetasol propionate lotion 0.01%, 8 ketorolac tromethamine, 8 FLOVENT DISKUS, 7 haloperidol, 3 FLOVENT HFA, 7 HUMULIN R U-500, 4 L fluconazole, 1 hydralazine, 3 labetalol, 2 fludrocortisone, 5 hydrochlorothiazide, 3 lacosamide, 3 fluocinolone acetonide crm, oint 0.025%, 8 hydrocodone ext-rel, 1 lactulose soln, 6 fluocinolone acetonide soln 0.01%, 8 hydrocodone/acetaminophen, 1 lamotrigine, 3 fluocinonide crm, gel, oint, soln 0.05%, 8 hydrocodone/homatropine, 7 lamotrigine ext-rel, 3 fluoride drops, tabs, 7 hydrocortisone, 5 lamotrigine orally disintegrating tabs, 3 fluorometholone, 8 hydrocortisone acetate foam, 6 lancets, 5 fluorouracil cream 4%, 7 hydrocortisone acetate/pramoxine foam, 6 lansoprazole + amoxicillin + clarithromycin, 6 fluorouracil crm 5%, soln 5%, soln 2%, 7 hydrocortisone butyrate crm, lotion, oint, lansoprazole delayed-rel, 6 fluoxetine, 3 soln 0.1%, 8 lasmiditan, 4 fluphenazine, 3 hydrocortisone crm, 6 LASTACAFT, 8 flutamide, 2 hydrocortisone crm 2.5%, 8 latanoprost, 8 fluticasone, 7 hydrocortisone enema, 6 LATUDA, 3 fluticasone propionate crm, lotion 0.05%, oint hydrocortisone lotion 1%, 8 leflunomide, 6 0.005%, 8 hydrocortisone valerate crm, oint 0.2%, 8 letrozole, 2 fluticasone, CFC-free aerosol, 7 hydromorphone, 1 LEUKERAN, 2 fluticasone/salmeterol, 7 hydromorphone ext-rel, 1 levalbuterol tartrate, CFC-free aerosol, 7 fluticasone/salmeterol, CFC-free aerosol, 7 hydroxychloroquine, 6 LEVEMIR, 4 fluticasone/umeclidinium/vilanterol, 7 hydroxyurea, 2 levetiracetam, 3 fluticasone/vilanterol, 7 hydroxyzine HCl, 7 levetiracetam ext-rel, 3 fluvastatin, 2 levobunolol, 8 fluvoxamine, 3 I levocarnitine, 5 FML FORTE, 8 ibandronate, 5 levofloxacin, 1, 8 FML S.O.P., 8 ibuprofen, 1 levonorgestrel/EE - Trivora, 5 folic acid, 6 icosapent ethyl, 2 levonorgestrel/EE 0.1/20 - Lessina, 5 folic acid/vitamin B6/vitamin B12, 6 ILEVRO, 8 levonorgestrel/EE 0.1/20 and EE 10, 5 fondaparinux, 6 imipramine HCl, 3 levonorgestrel/EE 0.15/30, 5 formoterol inhalation soln, 7 imiquimod, 7, 8 levonorgestrel/EE 0.15/30 - Levora, 5 fosinopril, 2 INCRUSE ELLIPTA, 7 levonorgestrel/EE 0.15/30 and EE 10, 5 fosinopril/hydrochlorothiazide, 2 indapamide, 3 levothyroxine, 6 fremanezumab-vfrm, 4 ingenol mebutate, 7 levothyroxine - Levoxyl, 6 furosemide, 3 insulin aspart, 4 lidocaine patch, 8 FYCOMPA, 3 insulin aspart protamine 70%/insulin aspart 30%, lidocaine viscous, 8 4 lidocaine/prilocaine, 8 G insulin degludec, 4 lifitegrast, 8 gabapentin, 3 insulin detemir, 4 linaclotide, 6 gabapentin ext-rel, 4 insulin glargine, 4 linezolid, 2 galantamine, 3 insulin human, 4 LINZESS, 6 galantamine ext-rel, 3 insulin isophane human, 4 liothyronine, 6 galcanezumab-gnlm, 4 insulin isophane human 70%/regular 30%, 4 liraglutide, 4, 5 gemfibrozil, 2 ipratropium soln, 7 liraglutide/insulin degludec, 4 gentamicin, 7, 8 ipratropium spray, 7 lisdexamfetamine, 4 glimepiride, 5 ipratropium/albuterol soln, 7 lisinopril, 2 glipizide, 5 irbesartan, 2 lisinopril/hydrochlorothiazide, 2 glipizide ext-rel, 5 irbesartan/hydrochlorothiazide, 2 lithium carbonate, 4 glipizide/metformin, 4 isoniazid, 1 lithium carbonate ext-rel, 4 GLUCAGEN HYPOKIT, 5 isosorbide dinitrate, 3 lixisenatide/insulin glargine, 4 GLUCAGON EMERGENCY KIT, 5 isosorbide dinitrate/hydralazine, 3 LO LOESTRIN FE, 5 glucagon nasal powder, 5 isosorbide mononitrate, 3 LOKELMA, 5 glucagon subcutaneous soln, 5 isosorbide mononitrate ext-rel, 3 loperamide, 6 glucagon, human recombinant, 5 isotretinoin, 7 lorazepam, 3 glycopyrrolate/formoterol, 7 itraconazole, 1 losartan, 2 GLYXAMBI, 5 ivabradine, 3 losartan/hydrochlorothiazide, 2 GRALISE, 4 ivermectin, 2, 8 loteprednol, 8 granisetron, 6 J lovastatin, 2 granisetron transdermal, 6 lubiprostone, 6 GRASTEK, 6 JANUMET, 4 JANUMET XR, 4 luliconazole, 7 griseofulvin ultramicrosize, 1 LUMIGAN, 8 guanfacine, 2 JANUVIA, 4 JARDIANCE, 5 lurasidone, 3 guanfacine ext-rel, 4 LYSODREN, 2 11

M NAFTIN, 7 olmesartan/amlodipine/hydrochlorothiazide, malathion, 8 naldemedine, 6 2 MATULANE, 2 naloxegol, 6 olmesartan/hydrochlorothiazide, 2 MAXIDEX, 8 naloxone inj, 4 olodaterol, CFC-free aerosol, 7 mebendazole chewable, 2 naloxone nasal spray, 4 olopatadine, 8 meclizine, 6 naltrexone, 4 olopatadine spray, 7 medroxyprogesterone acetate, 5 NAMZARIC, 3 omega-3 acid ethyl esters, 2 medroxyprogesterone acetate 150 mg/mL, 5 naproxen sodium tabs, 1 omeprazole delayed-rel, 6 mefloquine, 1 naproxen tabs, 1 ondansetron, 6 megestrol acetate susp, 5 naratriptan, 4 ONEXTON, 7 megestrol acetate tabs, 2 NARCAN, 4 ONZETRA XSAIL, 4 meloxicam, 1 nateglinide, 5 ORILISSA, 5 melphalan, 2 nebivolol, 2 oseltamivir, 2 memantine, 3 neomycin/polymyxin ospemifene, 5 memantine ext-rel, 3 B/bacitracin/hydrocortisone oint, 8 OSPHENA, 5 memantine/donepezil, 3 neomycin/polymyxin B/dexamethasone, 8 oxaprozin, 1 mercaptopurine, 2 neomycin/polymyxin B/gramicidin, 8 oxazepam, 3 mesalamine delayed-rel caps, 6 neomycin/polymyxin B/hydrocortisone, 9 oxcarbazepine, 3 mesalamine delayed-rel tabs, 6 neomycin/polymyxin B/hydrocortisone susp, oxcarbazepine ext-rel, 3 mesalamine ext-rel caps, 6 8 OXTELLAR XR, 3 mesalamine susp, 6 nepafenac, 8 oxybutynin, 6 metaxalone, 4 netarsudil, 8 oxybutynin ext-rel, 6 metformin, 4 netarsudil/latanoprost, 8 oxycodone caps 5 mg, 1 metformin ext-rel, 4 NEUPRO, 3 oxycodone concentrate 20 mg/mL, 1 methadone, 1 NEVANAC, 8 oxycodone ext-rel, 1 methazolamide, 3 niacin ext-rel, 2 oxycodone soln 5 mg/5 mL, 1 methimazole, 5 nifedipine ext-rel, 2 oxycodone tabs 5 mg, 15 mg, 30 mg, 1 methocarbamol, 4 nitrofurantoin ext-rel, 2 oxycodone/acetaminophen 5/325, 1 methotrexate, 2, 6 nitrofurantoin macrocrystals, 2 OZEMPIC, 4 methoxsalen oral, 8 nitrofurantoin susp, 2 methyldopa, 3 nitroglycerin lingual spray, 3 P methylphenidate, 4 nitroglycerin sublingual, 3 pancrelipase, 6 methylphenidate ext-rel, 4 nitroglycerin transdermal, 3 pancrelipase delayed-rel, 6 methylprednisolone, 5 norelgestromin/EE, 5 pantoprazole delayed-rel, 6 metoclopramide, 6 norethindrone, 5 paricalcitol, 5 metolazone, 3 norethindrone acetate, 5 paroxetine HCl, 3 metoprolol succinate ext-rel, 2 norethindrone acetate/EE 1.5/30, 5 paroxetine HCl ext-rel, 3 metoprolol tartrate, 2 norethindrone acetate/EE 1.5/30 and iron, 5 paroxetine mesylate, 4 metoprolol/hydrochlorothiazide, 2 norethindrone acetate/EE 1/10 and EE 10 and patiromer sorbitex, 5 metronidazole, 2, 6 iron, 5 PAZEO, 8 metronidazole crm, gel, lotion 0.75%, 8 norethindrone acetate/EE 1/20, 5 peg 3350/electrolytes, 6 metronidazole gel 1%, 8 norethindrone acetate/EE 1/20 and iron, 5 penicillin VK, 1 midodrine, 3 norethindrone acetate/EE 1/20 and iron PENTASA, 6 minocycline, 1 chewable, 5 perampanel, 3 mirabegron ext-rel, 6 norethindrone/EE, 5 PERFOROMIST, 7 mirtazapine, 3 norethindrone/EE 0.5/35, 5 perindopril, 2 misoprostol, 6 norethindrone/EE 1/35, 5 permethrin 5%, 8 mitotane, 2 norgestimate/EE, 5 perphenazine, 3 mometasone crm, lotion, oint 0.1%, 8 norgestimate/EE 0.25/35, 5 phenelzine, 3 montelukast, 7 norgestrel/EE 0.3/30 - Low-Ogestrel, 5 phenobarbital, 3 morphine, 1 nortriptyline, 3 phenytoin, 3 morphine ext-rel, 1 NOVOLIN 70/30, 4 phenytoin sodium extended, 3 morphine supp, 1 NOVOLIN N, 4 PHOSLYRA, 5 MOVANTIK, 6 NOVOLIN R, 4 PICATO, 7 moxifloxacin, 1, 8 NOVOLOG, 4 pilocarpine tabs, 6 MULTAQ, 2 NOVOLOG MIX 70/30, 4 pimecrolimus, 8 multivitamins/fluoride drops, tabs, 7 NUCYNTA, 1 pindolol, 2 multivitamins/fluoride/iron drops, tabs, 7 NUCYNTA ER, 1 pioglitazone, 4 mupirocin oint, 7 NUEDEXTA, 4 pioglitazone/glimepiride, 4 MYDAYIS, 4 NURTEC ODT, 4 pioglitazone/metformin, 4 MYLERAN, 2 nystatin, 1, 7 podofilox, 8 MYRBETRIQ, 6 polymyxin B/bacitracin, 8 O polymyxin B/trimethoprim, 8 N ofloxacin, 8 potassium chloride ext-rel, 6 nabumetone, 1 ofloxacin otic, 8 potassium chloride liquid, 6 nadolol, 2 olanzapine, 3 potassium citrate ext-rel, 6 naftifine, 7 olmesartan, 2 pramipexole, 3 12 pramipexole ext-rel, 3 rivastigmine transdermal, 3 SYNJARDY, 5 pramlintide, 4 rizatriptan, 4 SYNJARDY XR, 5 prasugrel, 6 ROCKLATAN, 8 SYNTHROID, 6 pravastatin, 2 roflumilast, 7 PRED MILD, 8 rolapitant, 6 T prednisolone, 5 ropinirole, 3 TABLOID, 2 prednisolone acetate, 8 ropinirole ext-rel, 3 tacrolimus, 8 prednisolone acetate 1%, 8 rosuvastatin, 2 tamoxifen, 2 prednisone, 5 rotigotine transdermal, 3 tamsulosin, 6 pregabalin, 4 RYBELSUS, 4 tapentadol, 1 PREMARIN, 5 tapentadol ext-rel, 1 PREMPHASE, 5 S tazarotene, 7 PREMPRO, 5 sacubitril/valsartan, 3 TAZORAC, 7 prenatal vitamins, 7 salmeterol xinafoate, 7 TEKTURNA HCT, 3 prenatal vitamins/DHA/docusate/folic acid, 7 SANCUSO, 6 telmisartan, 2 prenatal vitamins/docusate/folic acid, 7 SAXENDA, 5 telmisartan/hydrochlorothiazide, 2 prenatal vitamins/docusate/folic acid + DHA, 7 scopolamine transdermal, 6 temazepam, 4 prenatal vitamins/folic acid + pyridoxine, 7 selegiline, 3 terazosin, 2 primidone, 3 selenium sulfide lotion 2.5%, 8 terbinafine tabs, 1 probenecid, 1 semaglutide, 4 terbutaline, 7 procarbazine, 2 SEREVENT, 7 terconazole, 6 prochlorperazine, 6 sertraline, 3 testosterone cypionate, 4 PROCTOFOAM-HC, 6 sevelamer carbonate, 5 testosterone enanthate, 4 progesterone, micronized, 5 silodosin, 6 testosterone gel, 4 promethazine, 6 silver sulfadiazine, 7 testosterone soln, 4 propafenone, 2 SIMBRINZA, 8 testosterone transdermal, 4 propafenone ext-rel, 2 simvastatin, 2 tetracycline, 1 propranolol, 2 sitagliptin phosphate, 4 theophylline ext-rel tabs, 7 propranolol ext-rel, 2 sitagliptin/metformin, 4 thioguanine, 2 propylthiouracil, 6 sitagliptin/metformin ext-rel, 4 thiothixene, 3 PULMICORT FLEXHALER, 7 sodium sulfate/potassium sulfate/magnesium tiagabine, 3 PYLERA, 6 sulfate, 6 ticagrelor, 6 pyrazinamide, 1 sodium zirconium cyclosilicate, 5 timolol hemihydrate, 8 pyridostigmine, 4 solifenacin, 6 timolol maleate, 8 pyridostigmine ext-rel, 4 SOLIQUA, 4 timolol maleate gel, 8 solriamfetol, 4 timothy grass pollen allergen extract, 6 Q SOOLANTRA, 8 tinidazole, 2 quetiapine, 3 sotalol, 2 tiotropium, 7 quetiapine ext-rel, 3 SPIRIVA, 7 tiotropium/olodaterol, 7 quinapril, 2 spironolactone, 2 tizanidine tabs, 4 quinapril/hydrochlorothiazide, 2 spironolactone/hydrochlorothiazide, 3 TOBRADEX, 8 QVAR REDIHALER, 7 STIOLTO RESPIMAT, 7 TOBRADEX ST, 8 STRIVERDI RESPIMAT, 7 tobramycin, 8 R SUBSYS, 1 tobramycin/dexamethasone oint 0.3%/0.1%, 8 ragweed pollen allergen extract, 6 sucralfate tablet, 6 tobramycin/dexamethasone susp 0.3%/0.05%, 8 RAGWITEK, 6 sucroferric oxyhydroxide, 5 tobramycin/dexamethasone susp 0.3%/0.1%, raloxifene, 5 sulfacetamide lotion 10%, 7 8 ramelteon, 4 sulfacetamide oint, soln 10%, 8 TOLAK, 7 ramipril, 2 sulfacetamide/prednisolone phosphate tolterodine, 6 ranolazine ext-rel, 3 10%/0.25%, 8 tolterodine ext-rel, 6 rasagiline, 3 sulfamethoxazole/trimethoprim, 2 topiramate, 3 RELENZA, 2 sulfamethoxazole/trimethoprim DS, 2 topiramate ext-rel, 3 repaglinide, 5 sulfasalazine, 6 torsemide, 3 RESTASIS, 8 sulfasalazine delayed-rel, 6 TOVIAZ, 6 revefenacin inhalation solution, 7 sulindac, 1 tramadol, 1 REYVOW, 4 sumatriptan, 4 tramadol ext-rel, 1 RHOPRESSA, 8 sumatriptan inj, 4 trandolapril, 2 rifampin, 1 sumatriptan nasal powder, 4 trandolapril/verapamil ext-rel, 2 rifaximin 550 mg, 2 sumatriptan nasal spray, 4 tranylcypromine, 3 rimegepant, 4 SUNOSI, 4 travoprost, 8 risedronate, 5 SUPRAX, 1 trazodone, 3 risedronate delayed-rel, 5 SUPREP, 6 TRELEGY ELLIPTA, 7 RISPERDAL CONSTA, 3 suvorexant, 4 TRESIBA, 4 risperidone, 3 SYMBICORT, 7 tretinoin, 7 risperidone long-acting inj, 3 SYMJEPI, 7 tretinoin - Avita, 7 rivaroxaban, 6 SYMLINPEN, 4 tretinoin caps, 2 rivastigmine, 3 SYMPROIC, 6 tretinoin gel microsphere, 7 13

TREXALL, 2 valganciclovir, 1 X triamcinolone acetonide crm 0.5%, 8 valproic acid, 3 XARELTO, 6 triamcinolone acetonide crm, lotion 0.025%, 8 valsartan, 2 XIFAXAN, 2 triamcinolone acetonide crm, lotion, oint valsartan/hydrochlorothiazide, 2 XIGDUO XR, 5 0.1%, 8 vancomycin caps, 2 XIIDRA, 8 triamcinolone paste, 8 VARUBI, 6 XTAMPZA ER, 1 triamterene, 3 VASCEPA, 2 XULTOPHY, 4 triamterene/hydrochlorothiazide, 3 VELPHORO, 5 trifluoperazine, 3 VELTASSA, 5 Y trifluridine, 8 venlafaxine, 3 YUPELRI, 7 trihexyphenidyl, 3 venlafaxine ext-rel, 3 TRIJARDY XR, 5 verapamil ext-rel, 3 Z trimethobenzamide, 6 VIBERZI, 6 zafirlukast, 7 trimethoprim, 2 VICTOZA, 4 zanamivir, 2 TRINTELLIX, 3 VIIBRYD, 3 ZEMBRACE SYMTOUCH, 4 TROKENDI XR, 3 vilazodone, 3 ZENPEP, 6 trospium, 6 VIMPAT, 3 zileuton ext-rel, 7 trospium ext-rel, 6 VIOKACE, 6 ziprasidone, 3 TRULICITY, 4 VISTOGARD, 2 zolmitriptan, 4 vitamin ADC/fluoride drops, 7 zolmitriptan nasal spray, 4 U vitamin ADC/fluoride/iron drops, 7 zolpidem, 4 UBRELVY, 4 voriconazole, 1 zolpidem ext-rel, 4 ubrogepant, 4 vortioxetine, 3 zolpidem sublingual, 4 umeclidinium bromide, 7 VRAYLAR, 3 ZOMIG, 4 umeclidinium/vilanterol, 7 VYVANSE, 4 zonisamide, 3 uridine triacetate, 2 ZUBSOLV, 4 ursodiol, 6 W ZYCLARA, 7 warfarin, 6 V valacyclovir, 2

14