Common Covered Over-The-Counter Products Last Updated 08/19/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Childrens Ibuprofen Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 00121091700 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Childrens Ibuprofen Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 00121091705 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Childrens Ibuprofen Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 00904530909 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Childrens Ibuprofen Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 00904530920 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Childrens Ibuprofen Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 00904557720 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Childrens Ibuprofen Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 45802013326 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Childrens Ibuprofen Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 45802089726 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Childrens Ibuprofen Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 45802089734 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** GNP Childrens Ibuprofen Suspension 100 *Nonsteroidal Anti-inflammatory Agents MG/5ML Oral 24385036126 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** GNP Childrens Ibuprofen Suspension 100 *Nonsteroidal Anti-inflammatory Agents MG/5ML Oral 24385036134 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** GNP Childrens Ibuprofen Suspension 100 *Nonsteroidal Anti-inflammatory Agents MG/5ML Oral 24385037226 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** GNP Childrens Ibuprofen Suspension 100 *Nonsteroidal Anti-inflammatory Agents MG/5ML Oral 24385090526 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** GNP Childrens Ibuprofen Suspension 100 *Nonsteroidal Anti-inflammatory Agents MG/5ML Oral 24385090534 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** GNP Childrens Ibuprofen Suspension 100 *Nonsteroidal Anti-inflammatory Agents MG/5ML Oral 46122011026 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** *Nonsteroidal Anti-inflammatory Agents GNP Ibuprofen Tablet 200 MG Oral 46122054890 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** GoodSense Ibuprofen Childrens Suspension 100 *Nonsteroidal Anti-inflammatory Agents MG/5ML Oral 00113016626 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** GoodSense Ibuprofen Childrens Suspension 100 *Nonsteroidal Anti-inflammatory Agents MG/5ML Oral 00113016634 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** GoodSense Ibuprofen Childrens Suspension 100 *Nonsteroidal Anti-inflammatory Agents MG/5ML Oral 00113066026 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** GoodSense Ibuprofen Childrens Suspension 100 *Nonsteroidal Anti-inflammatory Agents MG/5ML Oral 00113068526 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** GoodSense Ibuprofen Childrens Suspension 100 *Nonsteroidal Anti-inflammatory Agents MG/5ML Oral 00113089726 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** GoodSense Ibuprofen Childrens Suspension 100 *Nonsteroidal Anti-inflammatory Agents MG/5ML Oral 00113089734 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** *Nonsteroidal Anti-inflammatory Agents GoodSense Ibuprofen Tablet 200 MG Oral 00113051771 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** *Nonsteroidal Anti-inflammatory Agents GoodSense Ibuprofen Tablet 200 MG Oral 00113060452 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** *Nonsteroidal Anti-inflammatory Agents GoodSense Ibuprofen Tablet 200 MG Oral 00113060462 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** *Nonsteroidal Anti-inflammatory Agents GoodSense Ibuprofen Tablet 200 MG Oral 00113060471 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

*Nonsteroidal Anti-inflammatory Agents GoodSense Ibuprofen Tablet 200 MG Oral 00113060478 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** *Nonsteroidal Anti-inflammatory Agents GoodSense Ibuprofen Tablet 200 MG Oral 00113060490 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** HM Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 62011001001 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** HM Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 62011001101 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** HM Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 62011003001 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** HM Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 62011021401 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** *Nonsteroidal Anti-inflammatory Agents HM Ibuprofen IB Tablet 200 MG Oral 62011022202 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** *Nonsteroidal Anti-inflammatory Agents HM Ibuprofen Tablet 200 MG Oral 62011001407 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** *Nonsteroidal Anti-inflammatory Agents IBU-200 Tablet 200 MG Oral 00904791451 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** *Nonsteroidal Anti-inflammatory Agents IBU-200 Tablet 200 MG Oral 00904791459 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 00121091400 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 00121091405 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 00121182800 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 00121182810 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 00472176094 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 45802014026 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 51672213001 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 51672213008 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 61269076194 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 61269076394 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 68001043592 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 68001043594 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 69230030811 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 69230030812 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 69230030911 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 69230030912 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 69230031011 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 69230031111 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 69230031112 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 70000018101 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 70000025901 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 70000026201 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 70000026301 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 70000026302 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** Ibuprofen Childrens Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 70000026401 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** *Nonsteroidal Anti-inflammatory Agents Ibuprofen Tablet 200 MG Oral 00904674759 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** *Nonsteroidal Anti-inflammatory Agents Ibuprofen Tablet 200 MG Oral 00904674780 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** *Nonsteroidal Anti-inflammatory Agents Ibuprofen Tablet 200 MG Oral 00904791251 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** *Nonsteroidal Anti-inflammatory Agents Ibuprofen Tablet 200 MG Oral 00904791259 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** *Nonsteroidal Anti-inflammatory Agents Ibuprofen Tablet 200 MG Oral 00904791461 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** *Nonsteroidal Anti-inflammatory Agents Ibuprofen Tablet 200 MG Oral 70000000301 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** *Nonsteroidal Anti-inflammatory Agents Ibuprofen Tablet 200 MG Oral 70000030802 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** QC Childrens Ibuprofen Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 63868077604 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** QC Childrens Ibuprofen Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 63868077904 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** QC Childrens Ibuprofen Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 63868077908 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** SM Childrens Ibuprofen Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 49348022934 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** SM Childrens Ibuprofen Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 49348022937 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** SM Childrens Ibuprofen Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 49348049934 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** SM Childrens Ibuprofen Suspension 100 MG/5ML *Nonsteroidal Anti-inflammatory Agents Oral 49348050034 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)*** *Nonsteroidal Anti-inflammatory Agents SM Ibuprofen IB Tablet 200 MG Oral 49348092709 *ANALGESICS - ANTI-INFLAMMATORY* (NSAIDs)***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Back & Body Extra Strength Tablet 500-32.5 MG Oral 70000012701 *ANALGESICS - NonNarcotic* *Analgesic Combinations*** Back & Body Extra Strength Tablet 500-32.5 MG Oral 70000012702 *ANALGESICS - NonNarcotic* *Analgesic Combinations*** GNP Headache Relief Extra Str TABLET 250-250- 65 MG Oral 46122038278 *ANALGESICS - NonNarcotic* *Analgesic Combinations*** GoodSense Migraine Formula TABLET 250-250-65 MG Oral 00113037462 *ANALGESICS - NonNarcotic* *Analgesic Combinations*** Headache Relief Tablet 250-250-65 MG Oral 70000006601 *ANALGESICS - NonNarcotic* *Analgesic Combinations*** Headache Relief Tablet 250-250-65 MG Oral 70000014601 *ANALGESICS - NonNarcotic* *Analgesic Combinations*** Headache Relief Tablet 250-250-65 MG Oral 70000025801 *ANALGESICS - NonNarcotic* *Analgesic Combinations*** Migraine Relief Tablet 250-250-65 MG Oral 70000024701 *ANALGESICS - NonNarcotic* *Analgesic Combinations*** Tension Headache Tablet 500-65 MG Oral 70000015901 *ANALGESICS - NonNarcotic* *Analgesic Combinations*** Tension Headache Tablet 500-65 MG Oral 70000015902 *ANALGESICS - NonNarcotic* *Analgesic Combinations*** 8 Hour Arthritis Pain Reliever Tablet Extended Release 650 MG Oral 70000018002 *ANALGESICS - NonNarcotic* *Analgesics Other*** 8 Hour Arthritis Pain Reliever Tablet Extended Release 650 MG Oral 70000018003 *ANALGESICS - NonNarcotic* *Analgesics Other*** 8HR Muscle Aches & Pain Tablet Extended Release 650 MG Oral 70000030601 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Childrens Solution 160 MG/5ML Oral 00904701416 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Childrens Solution 160 MG/5ML Oral 00904701420 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Childrens Suspension 160 MG/5ML Oral 00536132197 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Childrens Suspension 160 MG/5ML Oral 00904676620 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Childrens Suspension 160 MG/5ML Oral 45802020126 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Childrens Suspension 160 MG/5ML Oral 45802020326 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Childrens Tablet Chewable 160 MG Oral 70000031001 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen ER Tablet Extended Release 650 MG Oral 00904688365 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen ER Tablet Extended Release 650 MG Oral 68084077725 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Extra Strength Tablet 500 MG Oral 00536129229 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Extra Strength Tablet 500 MG Oral 00904672024 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Extra Strength Tablet 500 MG Oral 00904672040 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Extra Strength Tablet 500 MG Oral 00904672051 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Extra Strength Tablet 500 MG Oral 00904672059 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Extra Strength Tablet 500 MG Oral 00904672060 *ANALGESICS - NonNarcotic* *Analgesics Other*** Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Acetaminophen Extra Strength Tablet 500 MG Oral 00904672080 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Extra Strength Tablet 500 MG Oral 00904673059 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Extra Strength Tablet 500 MG Oral 00904673060 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Extra Strength Tablet 500 MG Oral 00904673061 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Extra Strength Tablet 500 MG Oral 00904673080 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Extra Strength Tablet 500 MG Oral 00904674959 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Extra Strength Tablet 500 MG Oral 49483034110 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Extra Strength Tablet 500 MG Oral 49483034150 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Extra Strength Tablet 500 MG Oral 70000003601 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Extra Strength Tablet 500 MG Oral 70000037301 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Extra Strength Tablet 500 MG Oral 70000037302 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Extra Strength Tablet 500 MG Oral 70000037303 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Extra Strength Tablet 500 MG Oral 70000037305 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Infants Suspension 160 MG/5ML Oral 00536121277 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Liquid 160 MG/5ML Oral 69367032304 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Liquid 160 MG/5ML Oral 69367032316 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Solution 160 MG/5ML Oral 00121065700 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Solution 160 MG/5ML Oral 00121065705 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Solution 160 MG/5ML Oral 00904673870 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Solution 160 MG/5ML Oral 66689005401 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Solution 160 MG/5ML Oral 66689005499 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Solution 325 MG/10.15ML Oral 00121131400 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Solution 325 MG/10.15ML Oral 00121131411 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Solution 325 MG/10.15ML Oral 00904673971 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Solution 325 MG/10.15ML Oral 66689005501 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Solution 325 MG/10.15ML Oral 66689005599 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Solution 650 MG/20.3ML Oral 00121197100 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Solution 650 MG/20.3ML Oral 00121197121 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Solution 650 MG/20.3ML Oral 00904682076 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Solution 650 MG/20.3ML Oral 66689005601 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Solution 650 MG/20.3ML Oral 66689005699 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Suppository 120 MG Rectal 45802073230 *ANALGESICS - NonNarcotic* *Analgesics Other*** Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Acetaminophen Suppository 120 MG Rectal 45802073233 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Suppository 650 MG Rectal 45802073030 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Suppository 650 MG Rectal 45802073032 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Suppository 650 MG Rectal 45802073033 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Suspension 160 MG/5ML Oral 68094023159 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Suspension 160 MG/5ML Oral 68094023161 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Suspension 160 MG/5ML Oral 68094023162 *ANALGESICS - NonNarcotic* *Analgesics Other***

Acetaminophen Suspension 650 MG/20.3ML Oral 68094003059 *ANALGESICS - NonNarcotic* *Analgesics Other***

Acetaminophen Suspension 650 MG/20.3ML Oral 68094003062 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Tablet 325 MG Oral 00536116401 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Tablet 325 MG Oral 00536132701 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Tablet 325 MG Oral 00536132706 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Tablet 325 MG Oral 00536132710 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Tablet 325 MG Oral 00904671950 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Tablet 325 MG Oral 00904671960 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Tablet 325 MG Oral 00904671980 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Tablet 325 MG Oral 00904677361 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Tablet 325 MG Oral 49483034001 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Tablet 325 MG Oral 49483034010 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Tablet 325 MG Oral 51645070301 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Tablet 325 MG Oral 51645070310 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Tablet 325 MG Oral 63739044001 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Tablet 500 MG Oral 00536117201 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Tablet 500 MG Oral 00536117210 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Tablet 500 MG Oral 51645070501 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Tablet 500 MG Oral 51645070510 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Tablet 500 MG Oral 51645070601 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Tablet 500 MG Oral 51645070610 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Tablet 500 MG Oral 70000031202 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Tablet 500 MG Oral 70000041001 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Tablet 500 MG Oral 70000041002 *ANALGESICS - NonNarcotic* *Analgesics Other*** Acetaminophen Tablet Chewable 160 MG Oral 70000030901 *ANALGESICS - NonNarcotic* *Analgesics Other*** Arthritis Pain Relief Tablet Extended Release 650 MG Oral 51660033301 *ANALGESICS - NonNarcotic* *Analgesics Other*** Arthritis Pain Relief Tablet Extended Release 650 MG Oral 51660033350 *ANALGESICS - NonNarcotic* *Analgesics Other*** Childrens Acetaminophen Suspension 160 MG/5ML Oral 00121178100 *ANALGESICS - NonNarcotic* *Analgesics Other*** Childrens Acetaminophen Suspension 160 MG/5ML Oral 00121178105 *ANALGESICS - NonNarcotic* *Analgesics Other***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Childrens Acetaminophen Suspension 160 MG/5ML Oral 68094001559 *ANALGESICS - NonNarcotic* *Analgesics Other*** Childrens Acetaminophen Suspension 160 MG/5ML Oral 68094001561 *ANALGESICS - NonNarcotic* *Analgesics Other*** Childrens Acetaminophen Suspension 160 MG/5ML Oral 68094001562 *ANALGESICS - NonNarcotic* *Analgesics Other*** Childrens Silapap Liquid 160 MG/5ML Oral 54838014440 *ANALGESICS - NonNarcotic* *Analgesics Other*** Childrens Silapap Liquid 160 MG/5ML Oral 54838014470 *ANALGESICS - NonNarcotic* *Analgesics Other*** Childrens Silapap Liquid 160 MG/5ML Oral 54838014480 *ANALGESICS - NonNarcotic* *Analgesics Other*** FeverAll Adults SUPPOSITORY 650 MG Rectal 51672211704 *ANALGESICS - NonNarcotic* *Analgesics Other*** FeverAll Childrens Suppository 120 MG Rectal 51672211502 *ANALGESICS - NonNarcotic* *Analgesics Other*** FeverAll Childrens Suppository 120 MG Rectal 51672211504 *ANALGESICS - NonNarcotic* *Analgesics Other*** FeverAll Infants SUPPOSITORY 80 MG Rectal 51672211402 *ANALGESICS - NonNarcotic* *Analgesics Other*** FeverAll Infants SUPPOSITORY 80 MG Rectal 51672211404 *ANALGESICS - NonNarcotic* *Analgesics Other*** FeverAll Junior Strength Suppository 325 MG Rectal 51672211602 *ANALGESICS - NonNarcotic* *Analgesics Other*** FeverAll Junior Strength Suppository 325 MG Rectal 51672211604 *ANALGESICS - NonNarcotic* *Analgesics Other*** GNP 8 Hour Arthritis Relief Tablet Extended Release 650 MG Oral 46122062978 *ANALGESICS - NonNarcotic* *Analgesics Other*** GNP 8 Hour Arthritis Relief Tablet Extended Release 650 MG Oral 46122062981 *ANALGESICS - NonNarcotic* *Analgesics Other*** GNP 8 Hour Pain Relief Tablet Extended Release 650 MG Oral 46122063078 *ANALGESICS - NonNarcotic* *Analgesics Other*** GNP 8 Hour Pain Reliever Tablet Extended Release 650 MG Oral 46122006271 *ANALGESICS - NonNarcotic* *Analgesics Other*** GNP Acetaminophen Tablet 325 MG Oral 46122043078 *ANALGESICS - NonNarcotic* *Analgesics Other*** GNP Acetaminophen Tablet Chewable 160 MG Oral 46122042462 *ANALGESICS - NonNarcotic* *Analgesics Other*** GNP Pain & Fever Childrens Suspension 160 MG/5ML Oral 46122032226 *ANALGESICS - NonNarcotic* *Analgesics Other*** GNP Pain Relief Extra Strength Tablet 500 MG Oral 24385014571 *ANALGESICS - NonNarcotic* *Analgesics Other*** GNP Pain Relief Extra Strength Tablet 500 MG Oral 24385048447 *ANALGESICS - NonNarcotic* *Analgesics Other*** GNP Pain Relief Extra Strength Tablet 500 MG Oral 24385048471 *ANALGESICS - NonNarcotic* *Analgesics Other*** GNP Pain Relief Extra Strength Tablet 500 MG Oral 24385048490 *ANALGESICS - NonNarcotic* *Analgesics Other*** GNP Pain Relief Extra Strength Tablet 500 MG Oral 46122031278 *ANALGESICS - NonNarcotic* *Analgesics Other*** GNP Pain Relief Extra Strength Tablet 500 MG Oral 46122054382 *ANALGESICS - NonNarcotic* *Analgesics Other*** GNP Pain Relief Tablet 325 MG Oral 46122024778 *ANALGESICS - NonNarcotic* *Analgesics Other*** GNP Pain Relief Tablet 325 MG Oral 46122039078 *ANALGESICS - NonNarcotic* *Analgesics Other*** GoodSense Arthritis Pain Tablet Extended Release 650 MG Oral 00113054462 *ANALGESICS - NonNarcotic* *Analgesics Other***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

GoodSense Arthritis Pain Tablet Extended Release 650 MG Oral 00113054471 *ANALGESICS - NonNarcotic* *Analgesics Other*** GoodSense Arthritis Pain Tablet Extended Release 650 MG Oral 00113054478 *ANALGESICS - NonNarcotic* *Analgesics Other*** GoodSense Pain & Fever Child Suspension 160 MG/5ML Oral 00113002026 *ANALGESICS - NonNarcotic* *Analgesics Other*** GoodSense Pain & Fever Child Suspension 160 MG/5ML Oral 00113021226 *ANALGESICS - NonNarcotic* *Analgesics Other*** GoodSense Pain & Fever Child Suspension 160 MG/5ML Oral 00113895926 *ANALGESICS - NonNarcotic* *Analgesics Other*** GoodSense Pain & Fever Infants Suspension 160 MG/5ML Oral 00113016110 *ANALGESICS - NonNarcotic* *Analgesics Other*** GoodSense Pain & Fever Infants Suspension 160 MG/5ML Oral 00113059010 *ANALGESICS - NonNarcotic* *Analgesics Other*** GoodSense Pain & Fever Infants Suspension 160 MG/5ML Oral 00113094610 *ANALGESICS - NonNarcotic* *Analgesics Other*** GoodSense Pain Relief Extra St Tablet 500 MG Oral 00113002562 *ANALGESICS - NonNarcotic* *Analgesics Other*** GoodSense Pain Relief Extra St Tablet 500 MG Oral 00113002571 *ANALGESICS - NonNarcotic* *Analgesics Other*** GoodSense Pain Relief Extra St Tablet 500 MG Oral 00113022771 *ANALGESICS - NonNarcotic* *Analgesics Other*** GoodSense Pain Relief Extra St Tablet 500 MG Oral 00113048452 *ANALGESICS - NonNarcotic* *Analgesics Other*** GoodSense Pain Relief Extra St Tablet 500 MG Oral 00113048462 *ANALGESICS - NonNarcotic* *Analgesics Other*** GoodSense Pain Relief Extra St Tablet 500 MG Oral 00113048471 *ANALGESICS - NonNarcotic* *Analgesics Other*** GoodSense Pain Relief Extra St Tablet 500 MG Oral 00113048478 *ANALGESICS - NonNarcotic* *Analgesics Other*** GoodSense Pain Relief Extra St Tablet 500 MG Oral 00113048490 *ANALGESICS - NonNarcotic* *Analgesics Other*** GoodSense Pain Relief Tablet 325 MG Oral 00113040378 *ANALGESICS - NonNarcotic* *Analgesics Other*** GoodSense Pain Relief Tablet Extended Release 650 MG Oral 00113021771 *ANALGESICS - NonNarcotic* *Analgesics Other*** HM Acetaminophen Childrens Tablet Chewable 160 MG Oral 62011033901 *ANALGESICS - NonNarcotic* *Analgesics Other*** HM Arthritis Pain Relief Tablet Extended Release 650 MG Oral 62011033701 *ANALGESICS - NonNarcotic* *Analgesics Other*** HM Pain & Fever Childrens Suspension 160 MG/5ML Oral 62011018301 *ANALGESICS - NonNarcotic* *Analgesics Other*** HM Pain & Fever Childrens Suspension 160 MG/5ML Oral 62011024601 *ANALGESICS - NonNarcotic* *Analgesics Other*** HM Pain & Fever Childrens Suspension 160 MG/5ML Oral 62011024701 *ANALGESICS - NonNarcotic* *Analgesics Other*** HM Pain & Fever Infants Suspension 160 MG/5ML Oral 62011000101 *ANALGESICS - NonNarcotic* *Analgesics Other***

HM Pain Relief Extra Strength Tablet 500 MG Oral 62011002301 *ANALGESICS - NonNarcotic* *Analgesics Other***

HM Pain Relief Extra Strength Tablet 500 MG Oral 62011002302 *ANALGESICS - NonNarcotic* *Analgesics Other*** Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

HM Pain Relief Extra Strength Tablet 500 MG Oral 62011002303 *ANALGESICS - NonNarcotic* *Analgesics Other***

HM Pain Relief Extra Strength Tablet 500 MG Oral 62011002701 *ANALGESICS - NonNarcotic* *Analgesics Other***

HM Pain Relief Extra Strength Tablet 500 MG Oral 62011043401 *ANALGESICS - NonNarcotic* *Analgesics Other*** HM Pain Relief Tablet Extended Release 650 MG Oral 62011033601 *ANALGESICS - NonNarcotic* *Analgesics Other*** HM Pain Relieve Child Dye-Free Suspension 160 MG/5ML Oral 62011046001 *ANALGESICS - NonNarcotic* *Analgesics Other*** HM Pain Reliever Childrens Suspension 160 MG/5ML Oral 62011046101 *ANALGESICS - NonNarcotic* *Analgesics Other*** HM Pain Reliever Infants Suspension 160 MG/5ML Oral 62011046201 *ANALGESICS - NonNarcotic* *Analgesics Other*** HM Pain Reliever Tablet 325 MG Oral 62011003201 *ANALGESICS - NonNarcotic* *Analgesics Other*** HM Pain Reliever Tablet 325 MG Oral 62011003202 *ANALGESICS - NonNarcotic* *Analgesics Other*** Mapap Arthritis Pain Tablet Extended Release 650 MG Oral 00904576960 *ANALGESICS - NonNarcotic* *Analgesics Other*** Mapap Capsule 500 MG Oral 00904198760 *ANALGESICS - NonNarcotic* *Analgesics Other*** Mapap Childrens Tablet Chewable 80 MG Oral 00904579146 *ANALGESICS - NonNarcotic* *Analgesics Other*** Mapap Tablet 500 MG Oral 00904198860 *ANALGESICS - NonNarcotic* *Analgesics Other*** M-PAP Liquid 160 MG/5ML Oral 58657052504 *ANALGESICS - NonNarcotic* *Analgesics Other*** M-PAP Liquid 160 MG/5ML Oral 58657052516 *ANALGESICS - NonNarcotic* *Analgesics Other*** Pain & Fever Childrens Suspension 160 MG/5ML Oral 70000002801 *ANALGESICS - NonNarcotic* *Analgesics Other*** Pain & Fever Childrens Suspension 160 MG/5ML Oral 70000048101 *ANALGESICS - NonNarcotic* *Analgesics Other*** Pain & Fever Childrens Suspension 160 MG/5ML Oral 70000049601 *ANALGESICS - NonNarcotic* *Analgesics Other*** Pain & Fever Infants Suspension 160 MG/5ML Oral 70000047201 *ANALGESICS - NonNarcotic* *Analgesics Other*** QC Arthritis Pain Relief Tablet Extended Release 650 MG Oral 63868008901 *ANALGESICS - NonNarcotic* *Analgesics Other*** QC Arthritis Pain Relief Tablet Extended Release 650 MG Oral 63868008950 *ANALGESICS - NonNarcotic* *Analgesics Other*** QC Non-Aspirin Extra Strength Tablet 500 MG Oral 63868050350 *ANALGESICS - NonNarcotic* *Analgesics Other*** QC Non-Aspirin Extra Strength Tablet 500 MG Oral 63868050701 *ANALGESICS - NonNarcotic* *Analgesics Other*** QC Non-Aspirin Extra Strength Tablet 500 MG Oral 63868098710 *ANALGESICS - NonNarcotic* *Analgesics Other*** QC Pain Relief Childrens Suspension 160 MG/5ML Oral 63868017418 *ANALGESICS - NonNarcotic* *Analgesics Other***

QC Pain Relief Extra Strength Tablet 500 MG Oral 63868008405 *ANALGESICS - NonNarcotic* *Analgesics Other***

QC Pain Relief Extra Strength Tablet 500 MG Oral 63868008410 *ANALGESICS - NonNarcotic* *Analgesics Other***

QC Pain Relief Extra Strength Tablet 500 MG Oral 63868008424 *ANALGESICS - NonNarcotic* *Analgesics Other***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

QC Pain Relief Extra Strength Tablet 500 MG Oral 63868008450 *ANALGESICS - NonNarcotic* *Analgesics Other*** QC Pain Relief Tablet 325 MG Oral 63868008210 *ANALGESICS - NonNarcotic* *Analgesics Other*** SM Pain & Fever Childrens Suspension 160 MG/5ML Oral 49348009334 *ANALGESICS - NonNarcotic* *Analgesics Other*** SM Pain & Fever Childrens Suspension 160 MG/5ML Oral 49348011934 *ANALGESICS - NonNarcotic* *Analgesics Other*** SM Pain & Fever Childrens Suspension 160 MG/5ML Oral 49348012334 *ANALGESICS - NonNarcotic* *Analgesics Other*** SM Pain & Fever Childrens Suspension 160 MG/5ML Oral 49348032534 *ANALGESICS - NonNarcotic* *Analgesics Other*** SM Pain Relief Tablet 500 MG Oral 49348011610 *ANALGESICS - NonNarcotic* *Analgesics Other*** SM Pain Reliever Ex St Tablet 500 MG Oral 49348004209 *ANALGESICS - NonNarcotic* *Analgesics Other*** SM Pain Reliever Ex St Tablet 500 MG Oral 49348004210 *ANALGESICS - NonNarcotic* *Analgesics Other*** SM Pain Reliever Ex St Tablet 500 MG Oral 49348004214 *ANALGESICS - NonNarcotic* *Analgesics Other*** SM Pain Reliever Ex St Tablet 500 MG Oral 49348073009 *ANALGESICS - NonNarcotic* *Analgesics Other*** SM Pain Reliever Ex St Tablet 500 MG Oral 49348073010 *ANALGESICS - NonNarcotic* *Analgesics Other*** SM Pain Reliever Ex St Tablet 500 MG Oral 49348099810 *ANALGESICS - NonNarcotic* *Analgesics Other*** SM Pain Reliever Tablet 325 MG Oral 49348097316 *ANALGESICS - NonNarcotic* *Analgesics Other*** Adult Aspirin Regimen Tablet Delayed Release 81 MG Oral 70000017801 *ANALGESICS - NonNarcotic* *Salicylates*** Adult Aspirin Regimen Tablet Delayed Release 81 MG Oral 70000017802 *ANALGESICS - NonNarcotic* *Salicylates*** Adult Aspirin Regimen Tablet Delayed Release 81 MG Oral 70000017803 *ANALGESICS - NonNarcotic* *Salicylates*** Adult Aspirin Regimen Tablet Delayed Release 81 MG Oral 70000021801 *ANALGESICS - NonNarcotic* *Salicylates*** Adult Aspirin Regimen Tablet Delayed Release 81 MG Oral 70000021802 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin Low Dose Tablet Chewable 81 MG Oral 00904679480 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin Low Dose Tablet Chewable 81 MG Oral 00904679489 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin Low Dose Tablet Chewable 81 MG Oral 49483033463 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin Low Dose Tablet Delayed Release 81 MG Oral 00536123441 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin Low Dose Tablet Delayed Release 81 MG Oral 00904671318 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin Low Dose Tablet Delayed Release 81 MG Oral 00904675180 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin Low Dose Tablet Delayed Release 81 MG Oral 00904678370 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin Low Dose Tablet Delayed Release 81 MG Oral 49483038710 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin Low Dose Tablet Delayed Release 81 MG Oral 49483038712 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin Low Dose Tablet Delayed Release 81 MG Oral 49483048110 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin Low Dose Tablet Delayed Release 81 MG Oral 49483048112 *ANALGESICS - NonNarcotic* *Salicylates*** Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Aspirin Low Dose Tablet Delayed Release 81 MG Oral 63739021201 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin Low Dose Tablet Delayed Release 81 MG Oral 63739021210 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin SUPPOSITORY 300 MG Rectal 00574703412 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin Tablet 325 MG Oral 00536105405 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin Tablet 325 MG Oral 00536105429 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin Tablet 325 MG Oral 51645071610 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin Tablet 325 MG Oral 70000050701 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin Tablet 325 MG Oral 70000050702 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin Tablet Chewable 81 MG Oral 00536100836 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin Tablet Chewable 81 MG Oral 00904404073 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin Tablet Chewable 81 MG Oral 70000041901 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin Tablet Chewable 81 MG Oral 70000042001 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin Tablet Chewable 81 MG Oral 70000042002 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin Tablet Delayed Release 325 MG Oral 00536123201 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin Tablet Delayed Release 325 MG Oral 70000001401 *ANALGESICS - NonNarcotic* *Salicylates*** Aspirin Tablet Delayed Release 325 MG Oral 70000003501 *ANALGESICS - NonNarcotic* *Salicylates*** GNP Adult Aspirin Low Strength Tablet Chewable 81 MG Oral 24385027868 *ANALGESICS - NonNarcotic* *Salicylates*** GNP Aspirin Low Dose Tablet Delayed Release 81 MG Oral 46122018076 *ANALGESICS - NonNarcotic* *Salicylates*** GNP Aspirin Low Dose Tablet Delayed Release 81 MG Oral 46122018087 *ANALGESICS - NonNarcotic* *Salicylates*** GNP Aspirin Low Dose Tablet Delayed Release 81 MG Oral 46122059848 *ANALGESICS - NonNarcotic* *Salicylates*** GNP Aspirin Low Dose Tablet Delayed Release 81 MG Oral 46122059887 *ANALGESICS - NonNarcotic* *Salicylates*** GNP Aspirin Tablet Delayed Release 81 MG Oral 46122018248 *ANALGESICS - NonNarcotic* *Salicylates*** GNP Aspirin Tablet Delayed Release 81 MG Oral 46122026248 *ANALGESICS - NonNarcotic* *Salicylates*** GNP Aspirin Tablet Delayed Release 81 MG Oral 46122026287 *ANALGESICS - NonNarcotic* *Salicylates*** GNP Aspirin Tablet Delayed Release 81 MG Oral 46122061576 *ANALGESICS - NonNarcotic* *Salicylates*** GNP Aspirin Tablet Delayed Release 81 MG Oral 46122061587 *ANALGESICS - NonNarcotic* *Salicylates*** GoodSense Aspirin Adult Low St Tablet Chewable 81 MG Oral 00113025968 *ANALGESICS - NonNarcotic* *Salicylates*** GoodSense Aspirin Tablet 325 MG Oral 00113041678 *ANALGESICS - NonNarcotic* *Salicylates*** GoodSense Aspirin Tablet Chewable 81 MG Oral 00113027408 *ANALGESICS - NonNarcotic* *Salicylates*** GoodSense Aspirin Tablet Chewable 81 MG Oral 00113046708 *ANALGESICS - NonNarcotic* *Salicylates*** GoodSense Aspirin Tablet Chewable 81 MG Oral 00113046768 *ANALGESICS - NonNarcotic* *Salicylates*** HM Aspirin EC Low Dose Tablet Delayed Release 81 MG Oral 62011000301 *ANALGESICS - NonNarcotic* *Salicylates*** HM Aspirin EC Low Dose Tablet Delayed Release 81 MG Oral 62011001901 *ANALGESICS - NonNarcotic* *Salicylates***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

HM Aspirin EC Low Dose Tablet Delayed Release 81 MG Oral 62011001902 *ANALGESICS - NonNarcotic* *Salicylates*** HM Aspirin Tablet 325 MG Oral 62011002001 *ANALGESICS - NonNarcotic* *Salicylates*** HM Aspirin Tablet Chewable 81 MG Oral 62011002101 *ANALGESICS - NonNarcotic* *Salicylates*** HM Aspirin Tablet Chewable 81 MG Oral 62011002801 *ANALGESICS - NonNarcotic* *Salicylates*** HM Aspirin Tablet Chewable 81 MG Oral 62011021201 *ANALGESICS - NonNarcotic* *Salicylates*** HM Aspirin Tablet Chewable 81 MG Oral 62011040401 *ANALGESICS - NonNarcotic* *Salicylates*** HM Aspirin Tablet Delayed Release 325 MG Oral 62011040501 *ANALGESICS - NonNarcotic* *Salicylates*** QC Aspirin Low Dose Tablet Chewable 81 MG Oral 63868002936 *ANALGESICS - NonNarcotic* *Salicylates*** QC Aspirin Low Dose Tablet Chewable 81 MG Oral 63868024036 *ANALGESICS - NonNarcotic* *Salicylates*** QC Aspirin Low Dose Tablet Delayed Release 81 MG Oral 63868036320 *ANALGESICS - NonNarcotic* *Salicylates*** QC Aspirin Low Dose Tablet Delayed Release 81 MG Oral 63868036336 *ANALGESICS - NonNarcotic* *Salicylates*** QC Aspirin Low Dose Tablet Delayed Release 81 MG Oral 63868037305 *ANALGESICS - NonNarcotic* *Salicylates*** QC Aspirin Tablet 325 MG Oral 63868035210 *ANALGESICS - NonNarcotic* *Salicylates*** SM Aspirin Adult Low Strength Tablet Chewable 81 MG Oral 49348049807 *ANALGESICS - NonNarcotic* *Salicylates*** SM Aspirin Adult Low Strength Tablet Chewable 81 MG Oral 70677007001 *ANALGESICS - NonNarcotic* *Salicylates*** SM Aspirin Adult Low Strength Tablet Delayed Release 81 MG Oral 49348098015 *ANALGESICS - NonNarcotic* *Salicylates*** SM Aspirin Adult Low Strength Tablet Delayed Release 81 MG Oral 49348098023 *ANALGESICS - NonNarcotic* *Salicylates*** SM Aspirin Adult Low Strength Tablet Delayed Release 81 MG Oral 49348098053 *ANALGESICS - NonNarcotic* *Salicylates*** SM Aspirin Adult Low Strength Tablet Delayed Release 81 MG Oral 49348098115 *ANALGESICS - NonNarcotic* *Salicylates*** SM Aspirin EC Tablet Delayed Release 325 MG Oral 70677007101 *ANALGESICS - NonNarcotic* *Salicylates*** SM Aspirin Low Dose Tablet Chewable 81 MG Oral 49348075707 *ANALGESICS - NonNarcotic* *Salicylates*** SM Aspirin Tablet 325 MG Oral 49348000110 *ANALGESICS - NonNarcotic* *Salicylates*** SM Aspirin Tablet 325 MG Oral 49348000123 *ANALGESICS - NonNarcotic* *Salicylates*** SM Childrens Aspirin Tablet Chewable 81 MG Oral 49348019107 *ANALGESICS - NonNarcotic* *Salicylates*** St Joseph Low Dose Tablet Delayed Release 81 MG Oral 69536018112 *ANALGESICS - NonNarcotic* *Salicylates*** Almacone Double Strength Suspension 400-400- 40 MG/5ML Oral 00536001583 *ANTACIDS* *Antacid & Simethicone*** Almacone Suspension 200-200-20 MG/5ML Oral 00536118583 *ANTACIDS* *Antacid & Simethicone*** Alum & Mag Hydroxide-Simeth Suspension 200- 200-20 MG/5ML Oral 00904683873 *ANTACIDS* *Antacid & Simethicone*** Alum & Mag Hydroxide-Simeth Suspension 400- 400-40 MG/5ML Oral 00904683973 *ANTACIDS* *Antacid & Simethicone***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Alum & Mag Hydroxide-Simeth Suspension 400- 400-40 MG/5ML Oral 66689006199 *ANTACIDS* *Antacid & Simethicone*** Alumina-Magnesia-Simethicone Suspension 200- 200-20 MG/5ML Oral 66689006099 *ANTACIDS* *Antacid & Simethicone*** Antacid Anti-Gas Max Strength Suspension 400- 400-40 MG/5ML Oral 00113058840 *ANTACIDS* *Antacid & Simethicone*** Antacid Maximum Strength Suspension 400-400- 40 MG/5ML Oral 70000042201 *ANTACIDS* *Antacid & Simethicone*** Antacid Maximum Strength Suspension 800-800- 80 MG/10ML Oral 70000006201 *ANTACIDS* *Antacid & Simethicone*** Antacid Plus Anti-Gas Relief Suspension 200-200- 20 MG/5ML Oral 00113035740 *ANTACIDS* *Antacid & Simethicone*** Antacid Plus Anti-Gas Relief Suspension 400-400- 40 MG/5ML Oral 00113034040 *ANTACIDS* *Antacid & Simethicone*** Antacid Regular Strength Suspension 200-200-20 MG/5ML Oral 00536129383 *ANTACIDS* *Antacid & Simethicone*** Antacid Suspension 200-200-20 MG/5ML Oral 00113085140 *ANTACIDS* *Antacid & Simethicone*** Antacid/Antigas Suspension 400-400-40 MG/10ML Oral 00536131783 *ANTACIDS* *Antacid & Simethicone*** Antacid/Anti-Gas Suspension 400-400-40 MG/5ML Oral 00536131883 *ANTACIDS* *Antacid & Simethicone*** GNP Antacid & Anti-Gas Suspension 400-400-40 MG/5ML Oral 46122043140 *ANTACIDS* *Antacid & Simethicone*** GNP Antacid & Anti-Gas Suspension 400-400-40 MG/5ML Oral 46122043240 *ANTACIDS* *Antacid & Simethicone*** GNP Antacid Anti-Gas Suspension 200-200-20 MG/5ML Oral 24385035640 *ANTACIDS* *Antacid & Simethicone*** GNP Antacid Regular Strength Suspension 200- 200-20 MG/5ML Oral 46122043340 *ANTACIDS* *Antacid & Simethicone*** HM Advanced Antacid Max St Suspension 400- 400-40 MG/5ML Oral 62011012201 *ANTACIDS* *Antacid & Simethicone*** HM Antacid Anti-Gas Ex St Suspension 400-400- 40 MG/5ML Oral 62011014901 *ANTACIDS* *Antacid & Simethicone*** HM Antacid Suspension 200-200-20 MG/5ML Oral 62011029201 *ANTACIDS* *Antacid & Simethicone*** HM Antacid/Antigas Suspension 200-200-20 MG/5ML Oral 62011014801 *ANTACIDS* *Antacid & Simethicone*** Mag-Al Plus Liquid 200-200-20 MG/5ML Oral 00121176130 *ANTACIDS* *Antacid & Simethicone*** Mi-Acid Maximum Strength Suspension 400-400- 40 MG/5ML Oral 00904675514 *ANTACIDS* *Antacid & Simethicone*** Mintox Maximum Strength Suspension 400-400- 40 MG/5ML Oral 00904572514 *ANTACIDS* *Antacid & Simethicone*** Mintox Regular Strength Suspension 200-200-20 MG/5ML Oral 00904676414 *ANTACIDS* *Antacid & Simethicone***

QC Antacid Suspension 200-200-20 MG/5ML Oral 63868069457 *ANTACIDS* *Antacid & Simethicone*** QC Antacid/Anti-Gas Suspension 200-200-20 MG/5ML Oral 63868071257 *ANTACIDS* *Antacid & Simethicone*** SM Antacid Advanced Suspension 200-200-20 MG/5ML Oral 49348015339 *ANTACIDS* *Antacid & Simethicone***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

SM Antacid Maximum Strength Suspension 400- 400-40 MG/5ML Oral 49348030339 *ANTACIDS* *Antacid & Simethicone*** SM Antacid/Antigas Suspension 200-200-20 MG/5ML Oral 49348001939 *ANTACIDS* *Antacid & Simethicone*** Acid Gone Suspension 95-358 MG/15ML Oral 00904772714 *ANTACIDS* *Antacid Combinations*** Aluminum Hydroxide Gel SUSPENSION 320 MG/5ML Oral 00536009185 *ANTACIDS* *Antacids - Aluminum Salts*** Sodium Bicarbonate Tablet 650 MG Oral 00536104710 *ANTACIDS* *Antacids - Bicarbonate*** Antacid Calcium Tablet Chewable 500 MG Oral 00536104815 *ANTACIDS* *Antacids - Calcium Salts*** Antacid Calcium Tablet Chewable 500 MG Oral 68084098832 *ANTACIDS* *Antacids - Calcium Salts*** Antacid Regular Strength Tablet Chewable 500 MG Oral 70000003401 *ANTACIDS* *Antacids - Calcium Salts*** Antacid Ultra Strength Tablet Chewable 1000 MG Oral 70000043601 *ANTACIDS* *Antacids - Calcium Salts*** Calcium Antacid Tablet Chewable 500 MG Oral 00904641292 *ANTACIDS* *Antacids - Calcium Salts*** Calcium Antacid Tablet Chewable 500 MG Oral 51645073515 *ANTACIDS* *Antacids - Calcium Salts*** Calcium Carbonate Antacid Suspension 1250 MG/5ML Oral 00054311763 *ANTACIDS* *Antacids - Calcium Salts*** Calcium Carbonate Antacid Suspension 1250 MG/5ML Oral 00904709894 *ANTACIDS* *Antacids - Calcium Salts*** Cal-Gest Antacid Tablet Chewable 500 MG Oral 00536100715 *ANTACIDS* *Antacids - Calcium Salts*** HM Antacid Regular Strength Tablet Chewable 500 MG Oral 62011039801 *ANTACIDS* *Antacids - Calcium Salts*** QC Antacid Tablet Chewable 500 MG Oral 63868004715 *ANTACIDS* *Antacids - Calcium Salts*** SM Antacid Tablet Chewable 500 MG Oral 70677006601 *ANTACIDS* *Antacids - Calcium Salts*** SM Antacid Tablet Chewable 500 MG Oral 70677006701 *ANTACIDS* *Antacids - Calcium Salts*** Magnesium Oxide Tablet 400 MG Oral 00603020922 *ANTACIDS* *Antacids - Magnesium Salts*** Magnesium Oxide Tablet 400 MG Oral 57629050012 *ANTACIDS* *Antacids - Magnesium Salts*** Magnesium Oxide Tablet 400 MG Oral 69367029820 *ANTACIDS* *Antacids - Magnesium Salts*** Magnesium Oxide Tablet 420 MG Oral 00603021321 *ANTACIDS* *Antacids - Magnesium Salts*** Magnesium Oxide Tablet 420 MG Oral 54738097401 *ANTACIDS* *Antacids - Magnesium Salts*** Glucose Tablet Chewable 4 GM Oral 00904671015 *ANTIDIABETICS* *Diabetic Other*** Glucose Tablet Chewable 4 GM Oral 80681010000 *ANTIDIABETICS* *Diabetic Other*** HumuLIN 70/30 KwikPen Suspension Pen-injector (70-30) 100 UNIT/ML Subcutaneous 00002880359 *ANTIDIABETICS* *Human Insulin*** HumuLIN 70/30 Suspension (70-30) 100 UNIT/ML Subcutaneous 00002871501 *ANTIDIABETICS* *Human Insulin*** HumuLIN 70/30 Suspension (70-30) 100 UNIT/ML Subcutaneous 00002871517 *ANTIDIABETICS* *Human Insulin*** HumuLIN N KwikPen Suspension Pen-injector 100 UNIT/ML Subcutaneous 00002880501 *ANTIDIABETICS* *Human Insulin*** HumuLIN N KwikPen Suspension Pen-injector 100 UNIT/ML Subcutaneous 00002880559 *ANTIDIABETICS* *Human Insulin*** HumuLIN N Suspension 100 UNIT/ML Subcutaneous 00002831501 *ANTIDIABETICS* *Human Insulin***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

HumuLIN N Suspension 100 UNIT/ML Subcutaneous 00002831517 *ANTIDIABETICS* *Human Insulin*** HumuLIN R Solution 100 UNIT/ML Injection 00002821501 *ANTIDIABETICS* *Human Insulin*** HumuLIN R Solution 100 UNIT/ML Injection 00002821517 *ANTIDIABETICS* *Human Insulin*** NovoLIN 70/30 FlexPen Relion Suspension Pen- Injector (70-30) 100 UNIT/ML Subcutaneous 00169300712 *ANTIDIABETICS* *Human Insulin*** NovoLIN 70/30 FlexPen Relion Suspension Pen- Injector (70-30) 100 UNIT/ML Subcutaneous 00169300725 *ANTIDIABETICS* *Human Insulin*** NovoLIN 70/30 FlexPen Suspension Pen-Injector (70-30) 100 UNIT/ML Subcutaneous 00169300701 *ANTIDIABETICS* *Human Insulin*** NovoLIN 70/30 FlexPen Suspension Pen-Injector (70-30) 100 UNIT/ML Subcutaneous 00169300715 *ANTIDIABETICS* *Human Insulin*** NovoLIN 70/30 ReliOn SUSPENSION (70-30) 100 UNIT/ML Subcutaneous 00169183702 *ANTIDIABETICS* *Human Insulin*** NovoLIN 70/30 Suspension (70-30) 100 UNIT/ML Subcutaneous 00169183711 *ANTIDIABETICS* *Human Insulin*** NovoLIN N FlexPen ReliOn Suspension Pen- Injector 100 UNIT/ML Subcutaneous 00169300425 *ANTIDIABETICS* *Human Insulin*** NovoLIN N FlexPen Suspension Pen-Injector 100 UNIT/ML Subcutaneous 00169300415 *ANTIDIABETICS* *Human Insulin*** NovoLIN N ReliOn SUSPENSION 100 UNIT/ML Subcutaneous 00169183402 *ANTIDIABETICS* *Human Insulin*** NovoLIN N Suspension 100 UNIT/ML Subcutaneous 00169183411 *ANTIDIABETICS* *Human Insulin*** NovoLIN R FlexPen ReliOn Solution Pen-Injector 100 UNIT/ML Injection 00169300325 *ANTIDIABETICS* *Human Insulin*** NovoLIN R FlexPen Solution Pen-Injector 100 UNIT/ML Injection 00169300315 *ANTIDIABETICS* *Human Insulin*** NovoLIN R ReliOn SOLUTION 100 UNIT/ML INJECTION 00169183302 *ANTIDIABETICS* *Human Insulin*** NovoLIN R Solution 100 UNIT/ML Injection 00169183311 *ANTIDIABETICS* *Human Insulin*** Bismatrol Suspension 262 MG/15ML Oral 00904131309 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antidiarrheal/Probiotic Agents - Misc.*** Bismatrol Tablet Chewable 262 MG Oral 00904131546 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antidiarrheal/Probiotic Agents - Misc.*** Bismuth Subsalicylate Suspension 525 MG/30ML Oral 00121091030 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antidiarrheal/Probiotic Agents - Misc.*** Bismuth Subsalicylate Suspension 525 MG/30ML Oral 00121091040 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antidiarrheal/Probiotic Agents - Misc.*** GoodSense Stomach Relief Tablet Chewable 262 MG Oral 00113046991 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antidiarrheal/Probiotic Agents - Misc.*** HM Stomach Relief Suspension 525 MG/30ML Oral 62011039301 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antidiarrheal/Probiotic Agents - Misc.*** Peptic Relief Tablet Chewable 262 MG Oral 00536102107 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antidiarrheal/Probiotic Agents - Misc.*** SM Stomach Relief Suspension 525 MG/30ML Oral 49348001441 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antidiarrheal/Probiotic Agents - Misc.*** SM Stomach Relief Suspension 525 MG/30ML Oral 70677006201 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antidiarrheal/Probiotic Agents - Misc.***

SM Stomach Relief Tablet Chewable 262 MG Oral 49348095344 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antidiarrheal/Probiotic Agents - Misc.*** Stomach Relief Suspension 525 MG/30ML Oral 00536128636 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antidiarrheal/Probiotic Agents - Misc.***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Stomach Relief Suspension 525 MG/30ML Oral 70000004401 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antidiarrheal/Probiotic Agents - Misc.*** Stomach Relief Suspension 525 MG/30ML Oral 70000004402 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antidiarrheal/Probiotic Agents - Misc.*** Stomach Relief Tablet Chewable 262 MG Oral 00113046965 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antidiarrheal/Probiotic Agents - Misc.*** Stomach Relief Tablet Chewable 262 MG Oral 70000043301 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antidiarrheal/Probiotic Agents - Misc.*** Stomach Relief Tablet Chewable 262 MG Oral 70000043302 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antidiarrheal/Probiotic Agents - Misc.*** Anti-Diarrheal Capsule 2 MG Oral 70000046101 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antiperistaltic Agents*** Anti-Diarrheal Liquid 1 MG/7.5ML Oral 70000041801 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antiperistaltic Agents*** Anti-Diarrheal Tablet 2 MG Oral 00113022453 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antiperistaltic Agents*** Anti-Diarrheal Tablet 2 MG Oral 00113022462 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antiperistaltic Agents*** Anti-Diarrheal Tablet 2 MG Oral 00904772512 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antiperistaltic Agents*** Anti-Diarrheal Tablet 2 MG Oral 00904772524 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antiperistaltic Agents*** Anti-Diarrheal Tablet 2 MG Oral 70000022502 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antiperistaltic Agents*** GNP Anti-Diarrheal Capsule 2 MG Oral 46122058162 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antiperistaltic Agents*** GNP Loperamide HCl Liquid 1 MG/7.5ML Oral 46122054426 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antiperistaltic Agents*** GoodSense Anti-Diarrheal Liquid 1 MG/7.5ML Oral 00113164526 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antiperistaltic Agents*** HM Anti-Diarrheal Capsule 2 MG Oral 62011039001 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antiperistaltic Agents*** HM Anti-Diarrheal Tablet 2 MG Oral 62011015001 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antiperistaltic Agents*** HM Anti-Diarrheal Tablet 2 MG Oral 62011015002 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antiperistaltic Agents*** HM Anti-Diarrheal Tablet 2 MG Oral 62011015003 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antiperistaltic Agents*** Loperamide HCl Liquid 1 MG/7.5ML Oral 00904683620 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antiperistaltic Agents*** SM Anti-Diarrheal Tablet 2 MG Oral 49348052902 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antiperistaltic Agents*** SM Anti-Diarrheal Tablet 2 MG Oral 49348052904 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antiperistaltic Agents*** SM Anti-Diarrheal Tablet 2 MG Oral 49348052908 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antiperistaltic Agents*** SM Anti-Diarrheal Tablet 2 MG Oral 49348052934 *ANTIDIARRHEAL/PROBIOTIC AGENTS* *Antiperistaltic Agents*** Driminate Tablet 50 MG Oral 00904205159 *ANTIEMETICS* *Antiemetics - Anticholinergic*** GNP Motion Sickness Relief Tablet 25 MG Oral 46122053551 *ANTIEMETICS* *Antiemetics - Anticholinergic*** GNP Motion Sickness Relief Tablet 50 MG Oral 46122053653 *ANTIEMETICS* *Antiemetics - Anticholinergic*** HM Motion Sickness TABLET 50 MG Oral 62011034101 *ANTIEMETICS* *Antiemetics - Anticholinergic*** Meclizine HCl Tablet 12.5 MG Oral 00536129701 *ANTIEMETICS* *Antiemetics - Anticholinergic*** Meclizine HCl Tablet 12.5 MG Oral 00536129710 *ANTIEMETICS* *Antiemetics - Anticholinergic*** SM Motion Sickness TABLET 50 MG Oral 70677002201 *ANTIEMETICS* *Antiemetics - Anticholinergic*** Aller-Chlor Tablet 4 MG Oral 00536100601 *ANTIHISTAMINES* *Antihistamines - Alkylamines*** Aller-Chlor Tablet 4 MG Oral 00536100610 *ANTIHISTAMINES* *Antihistamines - Alkylamines*** Allergy Relief Tablet 4 MG Oral 00113004278 *ANTIHISTAMINES* *Antihistamines - Alkylamines*** Allergy Relief Tablet 4 MG Oral 70000016001 *ANTIHISTAMINES* *Antihistamines - Alkylamines*** Allergy Relief Tablet 4 MG Oral 70000016002 *ANTIHISTAMINES* *Antihistamines - Alkylamines*** Allergy Tablet 4 MG Oral 00904001224 *ANTIHISTAMINES* *Antihistamines - Alkylamines*** Allergy Tablet 4 MG Oral 00904001259 *ANTIHISTAMINES* *Antihistamines - Alkylamines*** Allergy-Time Tablet 4 MG Oral 49483024210 *ANTIHISTAMINES* *Antihistamines - Alkylamines*** Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

GNP Allergy Relief Tablet 4 MG Oral 46122061862 *ANTIHISTAMINES* *Antihistamines - Alkylamines*** GNP Allergy Relief Tablet 4 MG Oral 46122061878 *ANTIHISTAMINES* *Antihistamines - Alkylamines*** HM Allergy Relief Tablet 4 MG Oral 62011005901 *ANTIHISTAMINES* *Antihistamines - Alkylamines*** HM Allergy Relief Tablet 4 MG Oral 62011031101 *ANTIHISTAMINES* *Antihistamines - Alkylamines*** Allergy Childrens Liquid 12.5 MG/5ML Oral 63868082354 *ANTIHISTAMINES* *Antihistamines - Ethanolamines***

Allergy Relief Childrens Liquid 12.5 MG/5ML Oral 70000047401 *ANTIHISTAMINES* *Antihistamines - Ethanolamines***

Allergy Relief Childrens Liquid 12.5 MG/5ML Oral 70000047402 *ANTIHISTAMINES* *Antihistamines - Ethanolamines***

Allergy Relief Childrens Liquid 12.5 MG/5ML Oral 70000049201 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** Allergy Relief Tablet 25 MG Oral 00113047953 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** Allergy Relief Tablet 25 MG Oral 00113047979 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** Allergy Relief Tablet 25 MG Oral 70000013601 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** Allergy Relief Tablet 25 MG Oral 70000013602 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** Allergy Relief Tablet 25 MG Oral 70000013603 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** Banophen Capsule 50 MG Oral 00904530760 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** Banophen Capsule 50 MG Oral 00904530780 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** Banophen Tablet 25 MG Oral 00904555159 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** DiphenhydrAMINE HCl Capsule 50 MG Oral 42806064901 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** DiphenhydrAMINE HCl Capsule 50 MG Oral 42806064910 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** DiphenhydrAMINE HCl Liquid 12.5 MG/5ML Oral 00121086500 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** DiphenhydrAMINE HCl Liquid 12.5 MG/5ML Oral 00121086505 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** DiphenhydrAMINE HCl Liquid 12.5 MG/5ML Oral 00121086530 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** DiphenhydrAMINE HCl Liquid 12.5 MG/5ML Oral 00121173000 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** DiphenhydrAMINE HCl Liquid 12.5 MG/5ML Oral 00121173010 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** DiphenhydrAMINE HCl Liquid 12.5 MG/5ML Oral 00121173030 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** DiphenhydrAMINE HCl Liquid 12.5 MG/5ML Oral 00904674070 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** DiphenhydrAMINE HCl Liquid 12.5 MG/5ML Oral 00904674172 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** DiphenhydrAMINE HCl Liquid 12.5 MG/5ML Oral 00904698516 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** DiphenhydrAMINE HCl Liquid 12.5 MG/5ML Oral 00904698520 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** DiphenhydrAMINE HCl Liquid 12.5 MG/5ML Oral 60687026742 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** DiphenhydrAMINE HCl Liquid 12.5 MG/5ML Oral 60687026756 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** DiphenhydrAMINE HCl Liquid 12.5 MG/5ML Oral 69339015117 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** DiphenhydrAMINE HCl Liquid 12.5 MG/5ML Oral 69339015119 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** DiphenhydrAMINE HCl Liquid 12.5 MG/5ML Oral 69339015217 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** DiphenhydrAMINE HCl Liquid 12.5 MG/5ML Oral 69339015219 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** DiphenhydrAMINE HCl Tablet 25 MG Oral 00536121429 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** DiphenhydrAMINE HCl Tablet 25 MG Oral 68094001859 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** DiphenhydrAMINE HCl Tablet 25 MG Oral 68094001861 *ANTIHISTAMINES* *Antihistamines - Ethanolamines***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

GNP Allergy Antihistamine Liquid 12.5 MG/5ML Oral 46122035626 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** GNP Allergy Antihistamine Liquid 12.5 MG/5ML Oral 46122036126 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** HM Allergy Relief Childrens Liquid 12.5 MG/5ML Oral 62011028401 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** HM Allergy Relief Tablet 25 MG Oral 62011031001 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** HM Allergy Relief Tablet 25 MG Oral 62011031601 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** M-Dryl Liquid 12.5 MG/5ML Oral 58657052804 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** M-Dryl Liquid 12.5 MG/5ML Oral 58657052816 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** QC Allergy Childrens Liquid 12.5 MG/5ML Oral 63868037004 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** SM Allergy Relief Liquid 12.5 MG/5ML Oral 49348004534 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** SM Allergy Relief Liquid 12.5 MG/5ML Oral 49348004537 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** SM Allergy Relief Tablet 25 MG Oral 70677000301 *ANTIHISTAMINES* *Antihistamines - Ethanolamines*** 24HR Allergy Relief Tablet 180 MG Oral 70000036101 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** 24HR Allergy Relief Tablet 180 MG Oral 70000036102 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** 24HR Allergy Relief Tablet 180 MG Oral 70000036103 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** 24HR Allergy Relief Tablet 180 MG Oral 70000036104 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** 24HR Allergy Relief Tablet 180 MG Oral 70000036105 *ANTIHISTAMINES* *Antihistamines - Non-Sedating***

All Day Allergy Childrens Solution 5 MG/5ML Oral 70000018601 *ANTIHISTAMINES* *Antihistamines - Non-Sedating***

All Day Allergy Childrens Solution 5 MG/5ML Oral 70000021401 *ANTIHISTAMINES* *Antihistamines - Non-Sedating***

All Day Allergy Childrens Solution 5 MG/5ML Oral 70000021501 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** All Day Allergy Tablet 10 MG Oral 70000004701 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** All Day Allergy Tablet 10 MG Oral 70000038001 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** All Day Allergy Tablet 10 MG Oral 70000038002 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** All Day Allergy Tablet 10 MG Oral 70000038003 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** All Day Allergy Tablet 10 MG Oral 70000038004 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Allergy Childrens Syrup 5 MG/5ML Oral 70000012501 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Allergy Childrens Syrup 5 MG/5ML Oral 70000025201 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Allergy Rel Child (Loratadine) Solution 5 MG/5ML Oral 70000047301 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Allergy Relief Childrens Solution 1 MG/ML Oral 69230031611 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Allergy Relief Tablet 10 MG Oral 00113061239 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Allergy Relief Tablet 10 MG Oral 51660052601 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Allergy Relief Tablet 10 MG Oral 51660052605 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Allergy Relief Tablet 10 MG Oral 51660052631 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Allergy Relief Tablet 10 MG Oral 51660052653 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Allergy Relief Tablet 10 MG Oral 51660052660 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Allergy Relief Tablet 10 MG Oral 69230031230 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Allergy Relief Tablet 10 MG Oral 69230031701 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Allergy Relief Tablet 10 MG Oral 69230031703 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Allergy Relief Tablet 10 MG Oral 70000021301 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Allergy Relief Tablet 10 MG Oral 70000021302 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Allergy Relief Tablet 10 MG Oral 70000021303 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Allergy Relief Tablet 10 MG Oral 70000021304 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Allergy Relief Tablet 10 MG Oral 70000021306 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Allergy Relief Tablet 180 MG Oral 69230020201 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Allergy Relief Tablet 180 MG Oral 69230020230 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Allergy Relief Tablet 180 MG Oral 69230030001 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Allergy Relief Tablet 180 MG Oral 69230030005 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Allergy Relief Tablet 180 MG Oral 69230030030 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Allergy Relief Tablet 5 MG Oral 69230032131 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Allergy Relief Tablet 5 MG Oral 69230032133 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Allergy Relief Tablet 5 MG Oral 70000036201 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Allergy Child Solution 5 MG/5ML Oral 00904676520 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Allergy Child Solution 5 MG/5ML Oral 51672210208 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Childrens Alrgy Solution 1 MG/ML Oral 45802097426 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Childrens Alrgy Solution 1 MG/ML Oral 51672208808 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 00378363701 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 00378363705 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 00904671740 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 00904671741 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 00904671743 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 00904671746 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 00904671760 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 00904671761 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 00904671772 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 00904671786 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 16571040210 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 16571040250 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 16714027102 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 16714079901 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 16714079902 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 16714079903 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 16714079904 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 43598081112 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 43598081115 *ANTIHISTAMINES* *Antihistamines - Non-Sedating***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Cetirizine HCl Tablet 10 MG Oral 45802091939 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 45802091987 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 51079059701 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 51079059720 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 51660093901 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 51660093930 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 51660093990 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 55111069990 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 60505263301 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 60505263308 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 68001043604 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 68001043696 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 10 MG Oral 68001043697 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 5 MG Oral 00378363501 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 5 MG Oral 16571040110 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Cetirizine HCl Tablet 5 MG Oral 60505263201 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Childrens Loratadine Solution 5 MG/5ML Oral 54838055840 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Childrens Loratadine Syrup 5 MG/5ML Oral 51672207308 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Childrens Loratadine Syrup 5 MG/5ML Oral 51672208508 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Fexofenadine HCl Tablet 180 MG Oral 00378078205 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Fexofenadine HCl Tablet 180 MG Oral 00378078293 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Fexofenadine HCl Tablet 180 MG Oral 00904671110 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Fexofenadine HCl Tablet 180 MG Oral 00904671146 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Fexofenadine HCl Tablet 180 MG Oral 00904697840 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Fexofenadine HCl Tablet 180 MG Oral 00904697860 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Fexofenadine HCl Tablet 180 MG Oral 00904705040 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Fexofenadine HCl Tablet 180 MG Oral 00904705060 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Fexofenadine HCl Tablet 180 MG Oral 16714089901 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Fexofenadine HCl Tablet 180 MG Oral 16714089902 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Fexofenadine HCl Tablet 180 MG Oral 45802057178 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Fexofenadine HCl Tablet 180 MG Oral 55111078401 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Fexofenadine HCl Tablet 180 MG Oral 55111078430 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Fexofenadine HCl Tablet 180 MG Oral 68001044000 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Fexofenadine HCl Tablet 180 MG Oral 68001044004 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Fexofenadine HCl Tablet 60 MG Oral 00378078105 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Fexofenadine HCl Tablet 60 MG Oral 00378078191 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Fexofenadine HCl Tablet 60 MG Oral 00904697940 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Fexofenadine HCl Tablet 60 MG Oral 00904697960 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Fexofenadine HCl Tablet 60 MG Oral 45802042578 *ANTIHISTAMINES* *Antihistamines - Non-Sedating***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Fexofenadine HCl Tablet 60 MG Oral 55111078301 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Fexofenadine HCl Tablet 60 MG Oral 68001043900 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** GNP All Day Allergy Childrens Solution 5 MG/5ML Oral 46122002026 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** GNP All Day Allergy Childrens Solution 5 MG/5ML Oral 46122010126 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** GNP All Day Allergy Tablet 10 MG Oral 24385099865 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** GNP All Day Allergy Tablet 10 MG Oral 24385099874 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** GNP All Day Allergy Tablet 10 MG Oral 24385099875 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** GNP Allergy Relief 24 HR Tablet 5 MG Oral 46122053105 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** GNP Allergy Relief Tablet 180 MG Oral 46122046222 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** GNP Allergy Relief Tablet 180 MG Oral 46122046261 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** GNP Allergy Relief Tablet 180 MG Oral 46122046265 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** GNP Allergy Relief Tablet 180 MG Oral 46122046275 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** GNP Loratadine Childrens Solution 5 MG/5ML Oral 46122042326 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** GNP Loratadine Syrup 5 MG/5ML Oral 24385053126 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** GNP Loratadine Tablet 10 MG Oral 24385047199 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** GoodSense All Day Allergy Solution 5 MG/5ML Oral 00113018926 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** GoodSense All Day Allergy Tablet 10 MG Oral 00113945813 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** GoodSense All Day Allergy Tablet 10 MG Oral 00113945839 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** GoodSense All Day Allergy Tablet 10 MG Oral 00113945866 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** GoodSense Aller-Ease Tablet 180 MG Oral 00113057122 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** GoodSense Aller-Ease Tablet 180 MG Oral 00113057139 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** GoodSense Aller-Ease Tablet 180 MG Oral 00113057195 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** GoodSense Allergy Relief Tablet 10 MG Oral 00113061275 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** HM All Day Allergy Childrens Solution 5 MG/5ML Oral 62011032301 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** HM Cetirizine HCl Tablet 10 MG Oral 62011030701 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** HM Fexofenadine HCl Tablet 180 MG Oral 62011023301 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** HM Loratadine Childrens SYRUP 5 MG/5ML Oral 62011030501 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** HM Loratadine Childrens SYRUP 5 MG/5ML Oral 62011034801 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** HM Loratadine Tablet 10 MG Oral 62011024801 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** HM Loratadine Tablet 10 MG Oral 62011024803 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** HM Loratadine Tablet 10 MG Oral 62011024804 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** HM Loratadine Tablet 10 MG Oral 62011024805 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** HM Loratadine Tablet 10 MG Oral 62011025801 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Loratadine Childrens Syrup 5 MG/5ML Oral 00121084910 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Loratadine Childrens Syrup 5 MG/5ML Oral 00121084940 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Loratadine Childrens Syrup 5 MG/5ML Oral 00904676720 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Loratadine Childrens Syrup 5 MG/5ML Oral 51672209208 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Loratadine Childrens Syrup 5 MG/5ML Oral 51672213108 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Loratadine Syrup 5 MG/5ML Oral 68001044998 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Loratadine Tablet 10 MG Oral 00904685207 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Loratadine Tablet 10 MG Oral 00904685260 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Loratadine Tablet 10 MG Oral 00904685261 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Loratadine Tablet 10 MG Oral 00904685272 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Loratadine Tablet 10 MG Oral 00904685289 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Loratadine Tablet 10 MG Oral 16714089801 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Loratadine Tablet 10 MG Oral 16714089802 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Loratadine Tablet 10 MG Oral 16714089803 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Loratadine Tablet 10 MG Oral 45802065065 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Loratadine Tablet 10 MG Oral 45802065078 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Loratadine Tablet 10 MG Oral 45802065087 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Loratadine Tablet 10 MG Oral 50268048915 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Loratadine Tablet 10 MG Oral 60505014701 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Loratadine Tablet 10 MG Oral 60505014708 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Loratadine Tablet 10 MG Oral 68001043800 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Loratadine Tablet 10 MG Oral 68001043804 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Loratadine Tablet 10 MG Oral 68001043896 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Loratadine Tablet 10 MG Oral 68001043897 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** QC Fexofenadine Hydrochloride Tablet 180 MG Oral 63868014130 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** QC Loratadine Allergy Relief Tablet 10 MG Oral 63868015110 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** QC Loratadine Allergy Relief Tablet 10 MG Oral 63868015130 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** SM All Day Allergy Childrens Solution 5 MG/5ML Oral 49348093434 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** SM All Day Allergy Tablet 10 MG Oral 70677005701 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** SM All Day Allergy Tablet 10 MG Oral 70677007502 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** SM Allergy Childrens Syrup 5 MG/5ML Oral 70677002901 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** SM Fexofenadine HCl Tablet 180 MG Oral 49348096856 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** SM Fexofenadine HCl Tablet 180 MG Oral 70677007402 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** SM Fexofenadine HCl Tablet 60 MG Oral 70677007901 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** SM Loratadine SYRUP 5 MG/5ML ORAL 49348063634 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** SM Loratadine Tablet 10 MG Oral 49348011213 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** SM Loratadine Tablet 10 MG Oral 49348081845 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** SM Loratadine Tablet 10 MG Oral 49348081856 *ANTIHISTAMINES* *Antihistamines - Non-Sedating*** Lactic Acid Solution 38779056508 *CHEMICALS* *Acids*** Sodium Hydroxide Pellet 51927123700 *CHEMICALS* *Bases*** Hydroxocobalamin Powder 38779253303 *CHEMICALS* *Bulk Chemicals - Hy's*** Propylene Glycol Liquid 38779051008 *CHEMICALS* *Bulk Chemicals - Pr's***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Psyllium Husk Powder 51552106107 *CHEMICALS* *Bulk Chemicals - Ps's*** Pyridoxal-5-Phosphate Powder 38779155604 *CHEMICALS* *Bulk Chemicals - Py's*** Stevia Extract Powder 38779193004 *CHEMICALS* *Bulk Chemicals - St's*** Dimethyl Sulfoxide Solution 38779061401 *CHEMICALS* *Liquids*** Citric Acid Anhydrous POWDER 38779006801 *CHEMICALS* *Solids*** Silica GEL 51927900900 *CHEMICALS* *Solids*** EContra EZ TABLET 1.5 MG ORAL 50102011101 *CONTRACEPTIVES* *Emergency Contraceptives*** EContra EZ TABLET 1.5 MG ORAL 50102011112 *CONTRACEPTIVES* *Emergency Contraceptives*** EContra One-Step Tablet 1.5 MG Oral 50102021111 *CONTRACEPTIVES* *Emergency Contraceptives*** EContra One-Step Tablet 1.5 MG Oral 50102021113 *CONTRACEPTIVES* *Emergency Contraceptives*** Levonorgestrel Tablet 1.5 MG Oral 00536114263 *CONTRACEPTIVES* *Emergency Contraceptives*** My Choice Tablet 1.5 MG Oral 62756072060 *CONTRACEPTIVES* *Emergency Contraceptives*** My Way Tablet 1.5 MG Oral 68180085211 *CONTRACEPTIVES* *Emergency Contraceptives*** New Day Tablet 1.5 MG Oral 16714080901 *CONTRACEPTIVES* *Emergency Contraceptives*** Opcicon One-Step TABLET 1.5 MG ORAL 62756071860 *CONTRACEPTIVES* *Emergency Contraceptives*** Option 2 TABLET 1.5 MG ORAL 00113200312 *CONTRACEPTIVES* *Emergency Contraceptives*** Take Action Tablet 1.5 MG Oral 51285010088 *CONTRACEPTIVES* *Emergency Contraceptives*** Take Action Tablet 1.5 MG Oral 69536020088 *CONTRACEPTIVES* *Emergency Contraceptives*** Cough DM Childrens Suspension Extended Release 30 MG/5ML Oral 70000019501 *COUGH/COLD/ALLERGY* *Antitussive - Nonnarcotic*** Cough DM Suspension Extended Release 30 MG/5ML Oral 00904631256 *COUGH/COLD/ALLERGY* *Antitussive - Nonnarcotic*** Cough DM Suspension Extended Release 30 MG/5ML Oral 70000018701 *COUGH/COLD/ALLERGY* *Antitussive - Nonnarcotic*** Cough DM Suspension Extended Release 30 MG/5ML Oral 70000030201 *COUGH/COLD/ALLERGY* *Antitussive - Nonnarcotic*** Dextromethorphan Polistirex ER Suspension Extended Release 30 MG/5ML Oral 45802043321 *COUGH/COLD/ALLERGY* *Antitussive - Nonnarcotic*** GoodSense Cough DM Childrens Suspension Extended Release 30 MG/5ML Oral 00113095828 *COUGH/COLD/ALLERGY* *Antitussive - Nonnarcotic*** GoodSense Cough DM Suspension Extended Release 30 MG/5ML Oral 00113038428 *COUGH/COLD/ALLERGY* *Antitussive - Nonnarcotic*** SM Cough DM Suspension Extended Release 30 MG/5ML Oral 49348031584 *COUGH/COLD/ALLERGY* *Antitussive - Nonnarcotic*** HM Daytime Cold & Flu Liquid 10-5-325 MG/15ML Oral 62011006502 *COUGH/COLD/ALLERGY* *Antitussive-Decongestant-Analgesic*** Chest Congestion Relief DM Syrup 10-100 MG/5ML Oral 00536131385 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Cough/Chest Congestion DM Syrup 10-100 MG/5ML Oral 00536118497 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Delsym Cgh/Chest Cong DM Child Liquid 5-100 MG/5ML Oral 63824021464 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** GNP Mucus Relief DM Max Liquid 5-100 MG/5ML Oral 46122037130 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** GNP Mucus Relief DM Tablet 20-400 MG Oral 24385002671 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

GNP Tussin DM Liquid 20-200 MG/10ML Oral 24385035926 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** GNP Tussin DM Liquid 20-200 MG/10ML Oral 24385035934 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** HM Mucus Relief Cough Children Liquid 5-100 MG/5ML Oral 62011036601 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** HM Mucus Relief DM Tablet Extended Release 12 Hour 60-1200 MG Oral 62011042301 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Maxi-Tuss G Liquid 10-100 MG/5ML Oral 58605031116 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Mucinex Childrens Freefrom Liquid 5-100 MG/5ML Oral 63824095764 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Mucinex DM Tablet Extended Release 12 Hour 30-600 MG Oral 63824005601 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Mucinex DM Tablet Extended Release 12 Hour 30-600 MG Oral 63824005632 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Mucinex DM Tablet Extended Release 12 Hour 30-600 MG Oral 63824005689 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Mucinex Fast-Max DM Max Liquid 20-400 MG/20ML Oral 63824001966 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Mucinex Fast-Max DM Max Liquid 20-400 MG/20ML Oral 63824053566 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Mucus & Cough Relief Childrens Liquid 5-100 MG/5ML Oral 70000000801 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Mucus & Cough Relief Childrens Liquid 5-100 MG/5ML Oral 70000013101 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Mucus Relief DM Max Tablet Extended Release 12 Hour 60-1200 MG Oral 00536121388 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Mucus Relief DM Max Tablet Extended Release 12 Hour 60-1200 MG Oral 70000046401 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Mucus Relief DM Max Tablet Extended Release 12 Hour 60-1200 MG Oral 70000046402 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Mucus Relief DM Tablet Extended Release 12 Hour 30-600 MG Oral 00536116134 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Mucus Relief DM Tablet Extended Release 12 Hour 30-600 MG Oral 00536116137 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Mucus Relief DM Tablet Extended Release 12 Hour 30-600 MG Oral 70000049101 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** MucusRelief DM Cough Tablet 20-400 MG Oral 00904681652 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Robafen DM Cgh/Chest Congest Liquid 10-100 MG/5ML Oral 00904646420 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Robafen DM Cough Liquid 10-100 MG/5ML Oral 00904675816 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Robafen DM Cough Liquid 10-100 MG/5ML Oral 00904675859 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Robafen DM Cough Liquid 10-100 MG/5ML Oral 00904675920 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Siltussin DM DAS Liquid 100-10 MG/5ML Oral 54838013340 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Siltussin-DM Alcohol Free Syrup 100-10 MG/5ML Oral 54838020940 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Siltussin-DM Alcohol Free Syrup 100-10 MG/5ML Oral 54838020970 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Siltussin-DM Alcohol Free Syrup 100-10 MG/5ML Oral 54838020980 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

SM Chest Congestion Relief DM Tablet 20-400 MG Oral 49348072809 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** SM Mucus Relief Cough Children Liquid 5-100 MG/5ML Oral 49348082834 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** SM Tussin Cough/Chest Congest Syrup 100-10 MG/5ML Oral 49348086134 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** SM Tussin Cough/Chest Congest Syrup 100-10 MG/5ML Oral 49348086137 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** SM Tussin DM Syrup 100-10 MG/5ML Oral 49348001734 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** SM Tussin DM Syrup 100-10 MG/5ML Oral 49348001737 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** SM Tussin DM Syrup 100-10 MG/5ML Oral 49348001739 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Tusnel Diabetic Liquid 10-100 MG/5ML Oral 54859050504 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Tussin DM Cough + Chest Liquid 10-100 MG/5ML Oral 70000031901 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Tussin DM Cough + Chest Liquid 10-100 MG/5ML Oral 70000031902 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Tussin DM Max Adult Liquid 5-100 MG/5ML Oral 70000038701 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Tussin DM Max Adult Liquid 5-100 MG/5ML Oral 70000038702 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Tussin DM Syrup 100-10 MG/5ML Oral 00113035926 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** Tussin DM Syrup 100-10 MG/5ML Oral 00113035934 *COUGH/COLD/ALLERGY* *Antitussive-Expectorant*** GNP Tussin CF Cough & Cold SYRUP 5-10-100 *Antitussive-Expectorants- MG/5ML ORAL 24385090434 *COUGH/COLD/ALLERGY* Decongestant*** Robafen CF Multi-Symptom Cold Liquid 5-10-100 *Antitussive-Expectorants- MG/5ML Oral 00904653720 *COUGH/COLD/ALLERGY* Decongestant*** All Day Allergy-D Tablet Extended Release 12 Hour 5-120 MG Oral 00113017653 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** All Day Allergy-D Tablet Extended Release 12 Hour 5-120 MG Oral 00113017662 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** Allergy Relief D-12 Tablet Extended Release 12 Hour 5-120 MG Oral 70000050401 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** Allergy Relief D-12 Tablet Extended Release 12 Hour 5-120 MG Oral 70000050402 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** Allergy Relief D-12 Tablet Extended Release 12 Hour 5-120 MG Oral 70000050403 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** Allergy Relief D-24 Tablet Extended Release 24 Hour 10-240 MG Oral 70000016201 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** Allergy Relief/Nasal Decongest Tablet Extended Release 24 Hour 10-240 MG Oral 51660072415 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** Allergy/Congestion Relief Tablet Extended Release 12 Hour 5-120 MG Oral 00113200760 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** Aprodine Tablet 2.5-60 MG Oral 00904025024 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** Cetirizine-Pseudoephedrine ER Tablet Extended Release 12 Hour 5-120 MG Oral 00536127912 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** Cetirizine-Pseudoephedrine ER Tablet Extended Release 12 Hour 5-120 MG Oral 00536127935 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** Cetirizine-Pseudoephedrine ER Tablet Extended Release 12 Hour 5-120 MG Oral 45802014753 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** Cetirizine-Pseudoephedrine ER Tablet Extended Release 12 Hour 5-120 MG Oral 45802014762 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Cetirizine-Pseudoephedrine ER Tablet Extended Release 12 Hour 5-120 MG Oral 45802072153 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** Cetirizine-Pseudoephedrine ER Tablet Extended Release 12 Hour 5-120 MG Oral 45802072162 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** GNP All Day Allergy-D Tablet Extended Release 12 Hour 5-120 MG Oral 24385017562 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** GNP All Day Allergy-D Tablet Extended Release 12 Hour 5-120 MG Oral 46122062662 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** HM Allergy & Congestion Tablet Extended Release 12 Hour 5-120 MG Oral 62011035401 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** HM Allergy Complete-D Tablet Extended Release 12 Hour 5-120 MG Oral 62011005501 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** HM Allergy Complete-D Tablet Extended Release 12 Hour 5-120 MG Oral 62011041101 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** HM Allergy Relief/Nasal Decong Tablet Extended Release 24 Hour 10-240 MG Oral 62011007101 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** Loratadine-D 12HR Tablet Extended Release 12 Hour 5-120 MG Oral 45802012246 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** Loratadine-D 12HR Tablet Extended Release 12 Hour 5-120 MG Oral 45802012260 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** Loratadine-D 12HR Tablet Extended Release 12 Hour 5-120 MG Oral 45802012265 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** Loratadine-D 24HR Tablet Extended Release 24 Hour 10-240 MG Oral 00904583315 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** Loratadine-D 24HR Tablet Extended Release 24 Hour 10-240 MG Oral 00904583348 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** SM All Day Allergy-D Tablet Extended Release 12 Hour 5-120 MG Oral 49348085104 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** SM All Day Allergy-D Tablet Extended Release 12 Hour 5-120 MG Oral 70677007701 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** SM Cold & Allergy Childrens Elixir 1-2.5 MG/5ML Oral 49348077734 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** SM Lorata-dine D Tablet Extended Release 24 Hour 10-240 MG Oral 49348054301 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** SM Lorata-dine D Tablet Extended Release 24 Hour 10-240 MG Oral 49348054357 *COUGH/COLD/ALLERGY* *Decongestant & Antihistamine*** Chest Congestion Relief PE Tablet 10-400 MG Oral 00536130907 *COUGH/COLD/ALLERGY* *Decongestant w/ Expectorant*** Chest Congestion Relief PE Tablet 10-400 MG Oral 00536130908 *COUGH/COLD/ALLERGY* *Decongestant w/ Expectorant*** GNP Mucus Relief PE Tablet 10-400 MG Oral 24385092571 *COUGH/COLD/ALLERGY* *Decongestant w/ Expectorant*** MucusRelief Sinus Tablet 10-400 MG Oral 00904579246 *COUGH/COLD/ALLERGY* *Decongestant w/ Expectorant*** MucusRelief Sinus Tablet 10-400 MG Oral 00904579252 *COUGH/COLD/ALLERGY* *Decongestant w/ Expectorant*** Pseudoephedrine-guaiFENesin ER Tablet Extended Release 12 Hour 60-600 MG Oral 55111079818 *COUGH/COLD/ALLERGY* *Decongestant w/ Expectorant*** Pseudoephedrine-guaiFENesin ER Tablet Extended Release 12 Hour 60-600 MG Oral 55111079835 *COUGH/COLD/ALLERGY* *Decongestant w/ Expectorant*** Pseudoephedrine-guaiFENesin ER Tablet Extended Release 12 Hour 60-600 MG Oral 55111079836 *COUGH/COLD/ALLERGY* *Decongestant w/ Expectorant***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Pseudoephedrine-guaiFENesin ER Tablet Extended Release 12 Hour 60-600 MG Oral 55111079841 *COUGH/COLD/ALLERGY* *Decongestant w/ Expectorant*** SM Chest Congestion Relief PE Tablet 10-400 MG Oral 49348077409 *COUGH/COLD/ALLERGY* *Decongestant w/ Expectorant*** Chest Congestion Relief Syrup 100 MG/5ML Oral 00536131485 *COUGH/COLD/ALLERGY* *Expectorants*** Chest Congestion Relief Tablet 400 MG Oral 00536131108 *COUGH/COLD/ALLERGY* *Expectorants*** Chest Congestion Relief Tablet 400 MG Oral 70000045201 *COUGH/COLD/ALLERGY* *Expectorants*** Chest Congestion Relief Tablet 400 MG Oral 70000045202 *COUGH/COLD/ALLERGY* *Expectorants*** GNP Tussin Mucus & Chest Cong Liquid 100 MG/5ML Oral 46122029926 *COUGH/COLD/ALLERGY* *Expectorants*** GNP Tussin Mucus & Chest Cong Liquid 100 MG/5ML Oral 46122029934 *COUGH/COLD/ALLERGY* *Expectorants*** HM Chest Congestion Relief Tablet 400 MG Oral 62011006001 *COUGH/COLD/ALLERGY* *Expectorants*** HM Mucus Relief Max St Tablet Extended Release 12 Hour 1200 MG Oral 62011037801 *COUGH/COLD/ALLERGY* *Expectorants*** Mucinex Fast-Max Chest Cong MS Liquid 400 MG/20ML Oral 63824053766 *COUGH/COLD/ALLERGY* *Expectorants*** Mucus & Chest Congestion Liquid 100 MG/5ML Oral 00536118285 *COUGH/COLD/ALLERGY* *Expectorants*** Mucus & Chest Congestion Liquid 100 MG/5ML Oral 00536118297 *COUGH/COLD/ALLERGY* *Expectorants*** Mucus Relief ER Tablet Extended Release 12 Hour 600 MG Oral 00904671839 *COUGH/COLD/ALLERGY* *Expectorants*** Mucus Relief Max St Tablet Extended Release 12 Hour 1200 MG Oral 69230031531 *COUGH/COLD/ALLERGY* *Expectorants*** Mucus Relief Max St Tablet Extended Release 12 Hour 1200 MG Oral 69230031532 *COUGH/COLD/ALLERGY* *Expectorants*** Mucus Relief Max St Tablet Extended Release 12 Hour 1200 MG Oral 70000047901 *COUGH/COLD/ALLERGY* *Expectorants*** Mucus Relief Max St Tablet Extended Release 12 Hour 1200 MG Oral 70000047902 *COUGH/COLD/ALLERGY* *Expectorants*** Mucus Relief Tablet Extended Release 12 Hour 600 MG Oral 00536116361 *COUGH/COLD/ALLERGY* *Expectorants*** Mucus Relief Tablet Extended Release 12 Hour 600 MG Oral 00904698640 *COUGH/COLD/ALLERGY* *Expectorants*** QC Medifin 400 Tablet 400 MG Oral 63868099850 *COUGH/COLD/ALLERGY* *Expectorants*** QC Mucus Relief ER Tablet Extended Release 12 Hour 1200 MG Oral 63868039014 *COUGH/COLD/ALLERGY* *Expectorants*** Robafen Mucus/Chest Congestion Liquid 200 MG/10ML Oral 00904676320 *COUGH/COLD/ALLERGY* *Expectorants*** Robafen Syrup 100 MG/5ML Oral 00904676316 *COUGH/COLD/ALLERGY* *Expectorants*** Siltussin SA Syrup 100 MG/5ML Oral 54838011740 *COUGH/COLD/ALLERGY* *Expectorants*** Siltussin SA Syrup 100 MG/5ML Oral 54838011770 *COUGH/COLD/ALLERGY* *Expectorants*** Siltussin SA Syrup 100 MG/5ML Oral 54838011780 *COUGH/COLD/ALLERGY* *Expectorants*** SM Chest Congestion Relief Tablet 400 MG Oral 49348072909 *COUGH/COLD/ALLERGY* *Expectorants*** SM Mucus Relief Max Strength Tablet Extended Release 12 Hour 1200 MG Oral 70677005001 *COUGH/COLD/ALLERGY* *Expectorants***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Tussin Mucus+Chest Congestion Liquid 100 MG/5ML Oral 70000029901 *COUGH/COLD/ALLERGY* *Expectorants*** Tussin Mucus+Chest Congestion Liquid 100 MG/5ML Oral 70000029902 *COUGH/COLD/ALLERGY* *Expectorants*** Tussin Mucus+Chest Congestion Syrup 100 MG/5ML Oral 00113006126 *COUGH/COLD/ALLERGY* *Expectorants*** *Non-Narc Antitussive-Decongestant- Brotapp DM Liquid 15-1-5 MG/5ML Oral 54838013640 *COUGH/COLD/ALLERGY* Antihistamine*** *Non-Narc Antitussive-Decongestant- Brotapp DM Liquid 15-1-5 MG/5ML Oral 54838013670 *COUGH/COLD/ALLERGY* Antihistamine*** Cold & Cough Childrens Liquid 2.5-1-5 MG/5ML *Non-Narc Antitussive-Decongestant- Oral 70000018901 *COUGH/COLD/ALLERGY* Antihistamine*** Dimaphen DM Cold/Cough Liquid 2.5-1-5 *Non-Narc Antitussive-Decongestant- MG/5ML Oral 00904646320 *COUGH/COLD/ALLERGY* Antihistamine*** *Non-Narc Antitussive-Decongestant- EndaCof-DM Liquid 2.5-1-5 MG/5ML Oral 68047014316 *COUGH/COLD/ALLERGY* Antihistamine*** GNP Cold/Cough Childrens Liquid 2.5-1-5 *Non-Narc Antitussive-Decongestant- MG/5ML Oral 24385051926 *COUGH/COLD/ALLERGY* Antihistamine*** Acne Medication 10 Gel 10 % External 00536105625 *DERMATOLOGICALS* *Acne Products*** Acne Medication 10 Gel 10 % External 00536105656 *DERMATOLOGICALS* *Acne Products*** Acne Medication 5 Gel 5 % External 00536105525 *DERMATOLOGICALS* *Acne Products*** Acne Medication 5 Gel 5 % External 00536105556 *DERMATOLOGICALS* *Acne Products*** Acne Medication 5 Gel 5 % External 00536105557 *DERMATOLOGICALS* *Acne Products*** Adapalene Gel 0.1 % External 70000004302 *DERMATOLOGICALS* *Acne Products*** Benzoyl Peroxide Gel 10 % External 45802030801 *DERMATOLOGICALS* *Acne Products*** Benzoyl Peroxide Gel 10 % External 45802030896 *DERMATOLOGICALS* *Acne Products*** Benzoyl Peroxide Gel 5 % External 45802021696 *DERMATOLOGICALS* *Acne Products*** BP Gel Gel 5 % External 24470090960 *DERMATOLOGICALS* *Acne Products***

Clean & Clear Persa-Gel Max St Gel 10 % External 08137003405 *DERMATOLOGICALS* *Acne Products*** Differin Gel 0.1 % External 00299492030 *DERMATOLOGICALS* *Acne Products*** Differin Gel 0.1 % External 00299492045 *DERMATOLOGICALS* *Acne Products*** KP Benzoyl Peroxide Gel 10 % External 00179870360 *DERMATOLOGICALS* *Acne Products*** KP Benzoyl Peroxide Gel 5 % External 00179870260 *DERMATOLOGICALS* *Acne Products*** Bengay Ultra Strength Patch 5 % External 74300008150 *DERMATOLOGICALS* *Analgesics - Topical*** Cold & Hot Medicated Patch 5 % External 70000036701 *DERMATOLOGICALS* *Analgesics - Topical*** Icy Hot Back Extra Strength Patch 5 % External 41167000843 *DERMATOLOGICALS* *Analgesics - Topical*** Icy Hot Back Patch 5 % External 41167000847 *DERMATOLOGICALS* *Analgesics - Topical*** Icy Hot Patch 5 % External 41167000841 *DERMATOLOGICALS* *Analgesics - Topical*** First Aid Antibiotic Ointment 3.5-400-5000 MG- UNIT External 00113008464 *DERMATOLOGICALS* *Antibiotic Mixtures Topical*** GNP Triple Antibiotic Ointment External 46122041405 *DERMATOLOGICALS* *Antibiotic Mixtures Topical*** HM Triple Antibiotic Ointment 3.5-400-5000 External 62011032101 *DERMATOLOGICALS* *Antibiotic Mixtures Topical***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Triple Antibiotic Ointment 3.5-400-5000 External 45802014301 *DERMATOLOGICALS* *Antibiotic Mixtures Topical***

Triple Antibiotic Ointment 3.5-400-5000 External 51672212001 *DERMATOLOGICALS* *Antibiotic Mixtures Topical***

Triple Antibiotic Ointment 3.5-400-5000 External 51672212002 *DERMATOLOGICALS* *Antibiotic Mixtures Topical*** Triple Antibiotic Ointment 5-400-5000 External 70512010230 *DERMATOLOGICALS* *Antibiotic Mixtures Topical*** Triple Antibiotic Ointment External 61269017934 *DERMATOLOGICALS* *Antibiotic Mixtures Topical*** Triple Antibiotic Ointment External 61269017956 *DERMATOLOGICALS* *Antibiotic Mixtures Topical*** Triple Antibiotic Ointment External 70000005801 *DERMATOLOGICALS* *Antibiotic Mixtures Topical*** Bacitracin Ointment 500 UNIT/GM External 00536125628 *DERMATOLOGICALS* *Antibiotics - Topical*** Bacitracin Ointment 500 UNIT/GM External 00713028031 *DERMATOLOGICALS* *Antibiotics - Topical*** Bacitracin Ointment 500 UNIT/GM External 45802006001 *DERMATOLOGICALS* *Antibiotics - Topical*** Bacitracin Ointment 500 UNIT/GM External 45802006003 *DERMATOLOGICALS* *Antibiotics - Topical*** Bacitracin Zinc Ointment 500 UNIT/GM External 00536126328 *DERMATOLOGICALS* *Antibiotics - Topical*** Bacitracin Zinc Ointment 500 UNIT/GM External 00904702367 *DERMATOLOGICALS* *Antibiotics - Topical*** Bacitracin Zinc Ointment 500 UNIT/GM External 00904880467 *DERMATOLOGICALS* *Antibiotics - Topical*** Bacitracin Zinc Ointment 500 UNIT/GM External 51672207501 *DERMATOLOGICALS* *Antibiotics - Topical*** Bacitracin Zinc Ointment 500 UNIT/GM External 61269010534 *DERMATOLOGICALS* *Antibiotics - Topical*** Bacitracin Zinc Ointment 500 UNIT/GM External 61269010556 *DERMATOLOGICALS* *Antibiotics - Topical*** Bacitracin Zinc Ointment 500 UNIT/GM External 70000047001 *DERMATOLOGICALS* *Antibiotics - Topical*** GNP Bacitracin Zinc Ointment 500 UNIT/GM External 24385006003 *DERMATOLOGICALS* *Antibiotics - Topical*** HM Bacitracin Zinc Ointment 500 UNIT/GM External 62011009401 *DERMATOLOGICALS* *Antibiotics - Topical*** SM Antibiotic Ointment 500 UNIT/GM External 49348015472 *DERMATOLOGICALS* *Antibiotics - Topical*** Antifungal (Tolnaftate) Cream 1 % External 00904072236 *DERMATOLOGICALS* *Antifungals - Topical*** Anti-Fungal Powder 1 % External 00536515026 *DERMATOLOGICALS* *Antifungals - Topical*** Athletes Foot (Terbinafine) Cream 1 % External 70000033801 *DERMATOLOGICALS* *Antifungals - Topical*** Butenafine HCl Cream 1 % External 51672210002 *DERMATOLOGICALS* *Antifungals - Topical*** Butenafine HCl Cream 1 % External 51672210008 *DERMATOLOGICALS* *Antifungals - Topical*** GNP Terbinafine Hydrochloride Cream 1 % External 24385052403 *DERMATOLOGICALS* *Antifungals - Topical*** GNP Terbinafine Hydrochloride Cream 1 % External 24385052405 *DERMATOLOGICALS* *Antifungals - Topical*** QC Tolnaftate Cream 1 % External 63868010446 *DERMATOLOGICALS* *Antifungals - Topical*** SM Antifungal Tolnaftate Cream 1 % External 49348015529 *DERMATOLOGICALS* *Antifungals - Topical*** SM Athletes Foot CREAM 1 % EXTERNAL 49348079072 *DERMATOLOGICALS* *Antifungals - Topical*** Terbinafine HCl Cream 1 % External 51672208001 *DERMATOLOGICALS* *Antifungals - Topical*** Terbinafine HCl Cream 1 % External 51672208002 *DERMATOLOGICALS* *Antifungals - Topical*** Tolnaftate Antifungal Cream 1 % External 70000049401 *DERMATOLOGICALS* *Antifungals - Topical*** Tolnaftate Cream 1 % External 51672202001 *DERMATOLOGICALS* *Antifungals - Topical*** Tolnaftate Cream 1 % External 51672202002 *DERMATOLOGICALS* *Antifungals - Topical*** Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Tolnaftate Powder 1 % External 00904072645 *DERMATOLOGICALS* *Antifungals - Topical*** Arthritis Pain Reliever Gel 1 % External 70000055501 *DERMATOLOGICALS* *Anti-inflammatory Agents - Topical*** Arthritis Pain Reliever Gel 1 % External 70000055502 *DERMATOLOGICALS* *Anti-inflammatory Agents - Topical*** Arthritis Pain Reliever Gel 1 % External 70000055503 *DERMATOLOGICALS* *Anti-inflammatory Agents - Topical*** Diclofenac Sodium Gel 1 % External 00536129431 *DERMATOLOGICALS* *Anti-inflammatory Agents - Topical*** Diclofenac Sodium Gel 1 % External 00536129434 *DERMATOLOGICALS* *Anti-inflammatory Agents - Topical*** Diclofenac Sodium Gel 1 % External 00536129497 *DERMATOLOGICALS* *Anti-inflammatory Agents - Topical*** Diclofenac Sodium Gel 1 % External 43598097710 *DERMATOLOGICALS* *Anti-inflammatory Agents - Topical*** Diclofenac Sodium Gel 1 % External 45802095301 *DERMATOLOGICALS* *Anti-inflammatory Agents - Topical*** Diclofenac Sodium Gel 1 % External 70512010610 *DERMATOLOGICALS* *Anti-inflammatory Agents - Topical*** GNP Arthritis Pain Gel 1 % External 46122064654 *DERMATOLOGICALS* *Anti-inflammatory Agents - Topical*** GoodSense Arthritis Pain Gel 1 % External 00113118901 *DERMATOLOGICALS* *Anti-inflammatory Agents - Topical*** QC Diclofenac Sodium Gel 1 % External 63868073001 *DERMATOLOGICALS* *Anti-inflammatory Agents - Topical*** Docosanol Cream 10 % External 70000051701 *DERMATOLOGICALS* *Antivirals - Topical*** GNP Docosanol Cream 10 % External 46122062407 *DERMATOLOGICALS* *Antivirals - Topical*** HM Docosanol Cream 10 % External 62011043301 *DERMATOLOGICALS* *Antivirals - Topical*** Alum Sulfate-Ca Acetate Packet External 51224016212 *DERMATOLOGICALS* *Astringents*** Hypercare Solution 15 % External 58980015511 *DERMATOLOGICALS* *Astringents*** Hypercare Solution 15 % External 58980015520 *DERMATOLOGICALS* *Astringents*** Zinc Oxide Ointment 20 % External 00536570025 *DERMATOLOGICALS* *Astringents*** Zinc Oxide Ointment 20 % External 00536570028 *DERMATOLOGICALS* *Astringents*** Zinc Oxide Ointment 20 % External 70000033401 *DERMATOLOGICALS* *Astringents*** Zinc Oxide Ointment 20 % External 70512010330 *DERMATOLOGICALS* *Astringents*** Hydrocortisone Acetate Ointment 1 % External 70000048901 *DERMATOLOGICALS* *Corticosteroids - Topical*** Hydrocortisone Cream 1 % External 45802043803 *DERMATOLOGICALS* *Corticosteroids - Topical*** Hydrocortisone Cream 1 % External 45802043805 *DERMATOLOGICALS* *Corticosteroids - Topical*** Hydrocortisone Cream 1 % External 70000048501 *DERMATOLOGICALS* *Corticosteroids - Topical*** Hydrocortisone Max St Cream 1 % External 51672206902 *DERMATOLOGICALS* *Corticosteroids - Topical*** Hydrocortisone Ointment 1 % External 45802027603 *DERMATOLOGICALS* *Corticosteroids - Topical*** Hydrocortisone Ointment 1 % External 51672201802 *DERMATOLOGICALS* *Corticosteroids - Topical***

Antifungal Clotrimazole Cream 1 % External 00536127211 *DERMATOLOGICALS* *Imidazole-Related Antifungals - Topical***

Antifungal Clotrimazole Cream 1 % External 00536127222 *DERMATOLOGICALS* *Imidazole-Related Antifungals - Topical***

Clotrimazole Anti-Fungal Cream 1 % External 00536126526 *DERMATOLOGICALS* *Imidazole-Related Antifungals - Topical***

Clotrimazole Cream 1 % External 00904782231 *DERMATOLOGICALS* *Imidazole-Related Antifungals - Topical***

Clotrimazole Cream 1 % External 00904782236 *DERMATOLOGICALS* *Imidazole-Related Antifungals - Topical***

Clotrimazole Cream 1 % External 45802043401 *DERMATOLOGICALS* *Imidazole-Related Antifungals - Topical***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Clotrimazole Cream 1 % External 45802043411 *DERMATOLOGICALS* *Imidazole-Related Antifungals - Topical***

Clotrimazole Cream 1 % External 51672200201 *DERMATOLOGICALS* *Imidazole-Related Antifungals - Topical***

Clotrimazole Cream 1 % External 51672200202 *DERMATOLOGICALS* *Imidazole-Related Antifungals - Topical***

GNP Athletes Foot Cream 1 % External 24385020503 *DERMATOLOGICALS* *Imidazole-Related Antifungals - Topical***

Miconazole Nitrate Cream 2 % External 00536113428 *DERMATOLOGICALS* *Imidazole-Related Antifungals - Topical***

Miconazole Nitrate Cream 2 % External 51672200101 *DERMATOLOGICALS* *Imidazole-Related Antifungals - Topical***

Miconazole Nitrate Cream 2 % External 51672200102 *DERMATOLOGICALS* *Imidazole-Related Antifungals - Topical***

Miconazole Nitrate Cream 2 % External 61269073514 *DERMATOLOGICALS* *Imidazole-Related Antifungals - Topical***

Miconazole Nitrate Cream 2 % External 61269073542 *DERMATOLOGICALS* *Imidazole-Related Antifungals - Topical***

Miconazole Nitrate Cream 2 % External 61269073556 *DERMATOLOGICALS* *Imidazole-Related Antifungals - Topical***

Miconazole Nitrate Cream 2 % External 70000034001 *DERMATOLOGICALS* *Imidazole-Related Antifungals - Topical***

SM Antifungal Clotrimazole Cream 1 % External 49348027972 *DERMATOLOGICALS* *Imidazole-Related Antifungals - Topical*** Icy Hot Extra Strength Cream 10-30 % External 41167000885 *DERMATOLOGICALS* *Liniment Combinations*** Icy Hot Extra Strength Cream 10-30 % External 41167000891 *DERMATOLOGICALS* *Liniment Combinations*** Icy Hot Original Pain Relief Cream 10-30 % External 41167000881 *DERMATOLOGICALS* *Liniment Combinations*** Icy Hot Original Pain Relief Cream 10-30 % External 41167000883 *DERMATOLOGICALS* *Liniment Combinations*** Arthritis Pain Relieving Cream 0.075 % External 00536111825 *DERMATOLOGICALS* *Local Anesthetics - Topical*** Capsaicin Cream 0.1 % External 00536126456 *DERMATOLOGICALS* *Local Anesthetics - Topical*** GNP Lidocaine Pain Relief Patch 4 % External 46122045021 *DERMATOLOGICALS* *Local Anesthetics - Topical***

GNP Lidocaine Pain Relieving Cream 4 % External 46122061410 *DERMATOLOGICALS* *Local Anesthetics - Topical*** HM Lidocaine Patch Patch 4 % External 62011041501 *DERMATOLOGICALS* *Local Anesthetics - Topical*** Lidocaine Pain Relief Patch 4 % External 00536120215 *DERMATOLOGICALS* *Local Anesthetics - Topical*** Lidocaine Pain Relief Patch 4 % External 70000036601 *DERMATOLOGICALS* *Local Anesthetics - Topical*** Lidocaine Pain Relieving Patch 4 % External 70000055701 *DERMATOLOGICALS* *Local Anesthetics - Topical*** Pain Relieving Cream 4 % External 00536113920 *DERMATOLOGICALS* *Local Anesthetics - Topical*** Zostrix Natural Pain Relief CREAM 0.033 % External 61787044202 *DERMATOLOGICALS* *Local Anesthetics - Topical*** GNP Lice Treatment Shampoo 0.33-4 % External 24385011603 *DERMATOLOGICALS* *Scabicide Combinations*** Lice Killing Maximum Strength Shampoo 0.33-4 % External 00113086626 *DERMATOLOGICALS* *Scabicide Combinations*** Lice Killing Maximum Strength Shampoo 0.33-4 % External 00904252820 *DERMATOLOGICALS* *Scabicide Combinations*** Lice Killing Shampoo 0.33-4 % External 70000054001 *DERMATOLOGICALS* *Scabicide Combinations*** Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

SM Lice Killing Max Strength Shampoo 0.33-4 % External 49348044334 *DERMATOLOGICALS* *Scabicide Combinations*** VanaLice Gel 0.3-3.5 % External 58809065008 *DERMATOLOGICALS* *Scabicide Combinations*** GNP Lice Treatment Liquid 1 % External 46122010846 *DERMATOLOGICALS* *Scabicides & Pediculicides*** HM Lice Treatment Liquid 1 % External 62011025501 *DERMATOLOGICALS* *Scabicides & Pediculicides*** Lice Treatment Creme Rinse Liquid 1 % External 70000004101 *DERMATOLOGICALS* *Scabicides & Pediculicides*** HM Hydrocortisone Plus CREAM 1 % EXTERNAL 62011009601 *DERMATOLOGICALS* *Topical Steroid Combinations*** HM Hydrocortisone-Aloe Max St CREAM 1 % EXTERNAL 62011009501 *DERMATOLOGICALS* *Topical Steroid Combinations*** Gas Relief Extra Strength Tablet Chewable 125 MG Oral 00536122308 *GASTROINTESTINAL AGENTS - MISC.* *Antiflatulents***

Gas Relief Infants Suspension 20 MG/0.3ML Oral 70000005101 *GASTROINTESTINAL AGENTS - MISC.* *Antiflatulents*** Gas Relief Tablet Chewable 80 MG Oral 70000043401 *GASTROINTESTINAL AGENTS - MISC.* *Antiflatulents*** HM Gas Relief Infants Drops Suspension 20 MG/0.3ML Oral 62011018701 *GASTROINTESTINAL AGENTS - MISC.* *Antiflatulents*** HM Gas Relief Tablet Chewable 125 MG Oral 62011018901 *GASTROINTESTINAL AGENTS - MISC.* *Antiflatulents*** Mi-Acid Gas Relief TABLET CHEWABLE 80 MG ORAL 00904506860 *GASTROINTESTINAL AGENTS - MISC.* *Antiflatulents*** Simethicone Drops Infants Liquid 20 MG/0.3ML Oral 00536130375 *GASTROINTESTINAL AGENTS - MISC.* *Antiflatulents*** Simethicone Tablet Chewable 125 MG Oral 69618003206 *GASTROINTESTINAL AGENTS - MISC.* *Antiflatulents*** SM Gas Relief Tablet Chewable 125 MG Oral 49348086348 *GASTROINTESTINAL AGENTS - MISC.* *Antiflatulents*** SM Gas Relief TABLET CHEWABLE 80 MG Oral 49348018810 *GASTROINTESTINAL AGENTS - MISC.* *Antiflatulents***

Potassium Citrate POWDER 51927140600 *GENITOURINARY AGENTS - MISCELLANEOUS* *Citrates*** Potassium Citrate-Citric Acid Solution 1100-334 MG/5ML Oral 00121067616 *GENITOURINARY AGENTS - MISCELLANEOUS* *Citrates***

Sodium Citrate CRYSTALS 38779054308 *GENITOURINARY AGENTS - MISCELLANEOUS* *Citrates*** Vitamin B-12 Tablet 100 MCG Oral 80681007100 *HEMATOPOIETIC AGENTS* *Cobalamins*** Vitamin B-12 Tablet 1000 MCG Oral 10006070022 *HEMATOPOIETIC AGENTS* *Cobalamins*** Vitamin B-12 Tablet 1000 MCG Oral 20555000600 *HEMATOPOIETIC AGENTS* *Cobalamins*** Vitamin B-12 Tablet 1000 MCG Oral 20555001600 *HEMATOPOIETIC AGENTS* *Cobalamins*** Vitamin B-12 Tablet 1000 MCG Oral 54629058605 *HEMATOPOIETIC AGENTS* *Cobalamins*** Vitamin B-12 Tablet 500 MCG Oral 20555003200 *HEMATOPOIETIC AGENTS* *Cobalamins*** Vitamin B-12 Tablet 500 MCG Oral 50268085415 *HEMATOPOIETIC AGENTS* *Cobalamins*** Vitamin B-12 Tablet 500 MCG Oral 51645091301 *HEMATOPOIETIC AGENTS* *Cobalamins*** Vitamin B-12 Tablet 500 MCG Oral 54629058501 *HEMATOPOIETIC AGENTS* *Cobalamins*** Vitamin B-12 Tablet 500 MCG Oral 80681007200 *HEMATOPOIETIC AGENTS* *Cobalamins*** Vitamin B-12 Tablet 500 MCG Oral 80681012800 *HEMATOPOIETIC AGENTS* *Cobalamins*** Folic Acid Tablet 400 MCG Oral 54629065002 *HEMATOPOIETIC AGENTS* *Folic Acid/Folates*** Folic Acid Tablet 400 MCG Oral 80681009900 *HEMATOPOIETIC AGENTS* *Folic Acid/Folates*** Ferate TABLET 240 (27 Fe) MG Oral 00904640360 *HEMATOPOIETIC AGENTS* *Iron*** Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

FeroSul Tablet 325 (65 Fe) MG Oral 00904759082 *HEMATOPOIETIC AGENTS* *Iron*** FeroSul Tablet 325 (65 Fe) MG Oral 00904759160 *HEMATOPOIETIC AGENTS* *Iron*** FeroSul Tablet 325 (65 Fe) MG Oral 00904759180 *HEMATOPOIETIC AGENTS* *Iron*** FeroSul Tablet 325 (65 Fe) MG Oral 00904759182 *HEMATOPOIETIC AGENTS* *Iron*** Ferrex 150 Capsule 150 MG Oral 00904539561 *HEMATOPOIETIC AGENTS* *Iron*** Ferrex 150 Capsule 150 MG Oral 51991020301 *HEMATOPOIETIC AGENTS* *Iron*** Ferrex 150 Capsule 150 MG Oral 51991020311 *HEMATOPOIETIC AGENTS* *Iron*** Ferrous Gluconate Tablet 324 (37.5 Fe) MG Oral 00904213761 *HEMATOPOIETIC AGENTS* *Iron*** Ferrous Gluconate Tablet 324 (37.5 Fe) MG Oral 20555001900 *HEMATOPOIETIC AGENTS* *Iron*** Ferrous Gluconate Tablet 324 (38 Fe) MG Oral 00574050801 *HEMATOPOIETIC AGENTS* *Iron*** Ferrous Gluconate Tablet 324 (38 Fe) MG Oral 00574050810 *HEMATOPOIETIC AGENTS* *Iron*** Ferrous Gluconate Tablet 324 (38 Fe) MG Oral 00574050811 *HEMATOPOIETIC AGENTS* *Iron*** Ferrous Sulfate Elixir 220 (44 Fe) MG/5ML Oral 54838000180 *HEMATOPOIETIC AGENTS* *Iron*** Ferrous Sulfate Solution 75 (15 Fe) MG/ML Oral 50383062750 *HEMATOPOIETIC AGENTS* *Iron*** Ferrous Sulfate Solution 75 (15 Fe) MG/ML Oral 54838001150 *HEMATOPOIETIC AGENTS* *Iron*** Ferrous Sulfate Tablet 325 (65 Fe) MG Oral 00536100901 *HEMATOPOIETIC AGENTS* *Iron*** Ferrous Sulfate Tablet 325 (65 Fe) MG Oral 00904759161 *HEMATOPOIETIC AGENTS* *Iron*** Ferrous Sulfate Tablet 325 (65 Fe) MG Oral 49483006301 *HEMATOPOIETIC AGENTS* *Iron*** Ferrous Sulfate Tablet 325 (65 Fe) MG Oral 49483006310 *HEMATOPOIETIC AGENTS* *Iron*** Ferrous Sulfate Tablet 325 (65 Fe) MG Oral 49483006410 *HEMATOPOIETIC AGENTS* *Iron*** Ferrous Sulfate Tablet 325 (65 Fe) MG Oral 57664007001 *HEMATOPOIETIC AGENTS* *Iron*** Ferrous Sulfate Tablet 325 (65 Fe) MG Oral 57664007010 *HEMATOPOIETIC AGENTS* *Iron*** Ferrous Sulfate Tablet 325 (65 Fe) MG Oral 57664007101 *HEMATOPOIETIC AGENTS* *Iron*** Ferrous Sulfate Tablet 325 (65 Fe) MG Oral 57664007110 *HEMATOPOIETIC AGENTS* *Iron*** Ferrous Sulfate Tablet Delayed Release 324 (65 Fe) MG Oral 00574060801 *HEMATOPOIETIC AGENTS* *Iron*** Ferrous Sulfate Tablet Delayed Release 324 (65 Fe) MG Oral 00574060810 *HEMATOPOIETIC AGENTS* *Iron*** Ferrous Sulfate Tablet Delayed Release 324 (65 Fe) MG Oral 00574060811 *HEMATOPOIETIC AGENTS* *Iron*** Ferrous Sulfate Tablet Delayed Release 325 (65 Fe) MG Oral 00245010801 *HEMATOPOIETIC AGENTS* *Iron*** Ferrous Sulfate Tablet Delayed Release 325 (65 Fe) MG Oral 00245010811 *HEMATOPOIETIC AGENTS* *Iron*** Poly-Iron 150 Capsule 150 MG Oral 60258018501 *HEMATOPOIETIC AGENTS* *Iron*** Fiber Tablet 625 MG Oral 00904250091 *LAXATIVES* *Bulk Laxatives*** Fiber-Lax Tablet 625 MG Oral 00536430605 *LAXATIVES* *Bulk Laxatives*** Fiber-Lax Tablet 625 MG Oral 00536430608 *LAXATIVES* *Bulk Laxatives*** Fiber-Lax Tablet 625 MG Oral 00536430611 *LAXATIVES* *Bulk Laxatives*** GNP Fiber-Caps Tablet 625 MG Oral 24385012576 *LAXATIVES* *Bulk Laxatives*** GNP Natural Fiber Powder 28.3 % Oral 24385029950 *LAXATIVES* *Bulk Laxatives*** HM Fiber TABLET 500 MG ORAL 62011013401 *LAXATIVES* *Bulk Laxatives*** Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Konsyl Daily Fiber Packet 100 % Oral 00224180124 *LAXATIVES* *Bulk Laxatives*** Konsyl Original Daily Fiber Packet 100 % Oral 00224190185 *LAXATIVES* *Bulk Laxatives*** Natural Fiber Therapy Powder 28.3 % Oral 00904520065 *LAXATIVES* *Bulk Laxatives*** Natural Fiber Therapy Powder 28.3 % Oral 00904520066 *LAXATIVES* *Bulk Laxatives*** Natural Fiber Therapy Powder 48.57 % Oral 00904519965 *LAXATIVES* *Bulk Laxatives*** Reguloid Powder 28.3 % Oral 00536444554 *LAXATIVES* *Bulk Laxatives*** Reguloid Powder 28.3 % Oral 00536444589 *LAXATIVES* *Bulk Laxatives*** Reguloid Powder 28.3 % Oral 80681009600 *LAXATIVES* *Bulk Laxatives*** SM Fiber Laxative TABLET 500 MG ORAL 49348054110 *LAXATIVES* *Bulk Laxatives*** SM Fiber Powder Powder 25 % Oral 10939081444 *LAXATIVES* *Bulk Laxatives*** ClearLax Powder 17 GM/SCOOP Oral 70000041501 *LAXATIVES* *Laxatives - Miscellaneous*** ClearLax Powder 17 GM/SCOOP Oral 70000041502 *LAXATIVES* *Laxatives - Miscellaneous*** GaviLAX Powder 17 GM/SCOOP Oral 43386031208 *LAXATIVES* *Laxatives - Miscellaneous*** GaviLAX Powder 17 GM/SCOOP Oral 43386031214 *LAXATIVES* *Laxatives - Miscellaneous*** Glycerin Childrens Suppository 1 GM Rectal 70000042901 *LAXATIVES* *Laxatives - Miscellaneous*** GlycoLax Powder 17 GM/SCOOP Oral 62175019015 *LAXATIVES* *Laxatives - Miscellaneous*** GlycoLax Powder 17 GM/SCOOP Oral 62175019031 *LAXATIVES* *Laxatives - Miscellaneous*** GNP ClearLax Powder 17 GM/SCOOP Oral 46122001433 *LAXATIVES* *Laxatives - Miscellaneous*** GNP ClearLax Powder 17 GM/SCOOP Oral 46122001471 *LAXATIVES* *Laxatives - Miscellaneous*** GoodSense ClearLax Powder 17 GM/SCOOP Oral 00113030602 *LAXATIVES* *Laxatives - Miscellaneous*** GoodSense ClearLax Powder 17 GM/SCOOP Oral 00113030603 *LAXATIVES* *Laxatives - Miscellaneous*** HealthyLax Packet 17 GM Oral 60687043192 *LAXATIVES* *Laxatives - Miscellaneous*** HealthyLax Packet 17 GM Oral 60687043198 *LAXATIVES* *Laxatives - Miscellaneous*** HealthyLax Packet 17 GM Oral 60687043199 *LAXATIVES* *Laxatives - Miscellaneous*** HM ClearLax Powder 17 GM/SCOOP Oral 62011015304 *LAXATIVES* *Laxatives - Miscellaneous*** HM ClearLax Powder 17 GM/SCOOP Oral 62011028701 *LAXATIVES* *Laxatives - Miscellaneous*** HM ClearLax Powder 17 GM/SCOOP Oral 62011028702 *LAXATIVES* *Laxatives - Miscellaneous*** PEG 3350 Packet 17 GM Oral 00904693126 *LAXATIVES* *Laxatives - Miscellaneous*** PEG 3350 Packet 17 GM Oral 00904693181 *LAXATIVES* *Laxatives - Miscellaneous*** PEG 3350 Packet 17 GM Oral 63739019861 *LAXATIVES* *Laxatives - Miscellaneous*** PEG 3350 Packet 17 GM Oral 63739019862 *LAXATIVES* *Laxatives - Miscellaneous*** PEG 3350 Powder 17 GM/SCOOP Oral 00536105224 *LAXATIVES* *Laxatives - Miscellaneous*** PEG 3350 Powder 17 GM/SCOOP Oral 00536105227 *LAXATIVES* *Laxatives - Miscellaneous*** PEG 3350 Powder 17 GM/SCOOP Oral 00536105284 *LAXATIVES* *Laxatives - Miscellaneous*** Polyethylene Glycol 3350 Packet 17 GM Oral 62559015710 *LAXATIVES* *Laxatives - Miscellaneous*** Polyethylene Glycol 3350 Packet 17 GM Oral 62559015730 *LAXATIVES* *Laxatives - Miscellaneous*** Polyethylene Glycol 3350 Powder 17 GM/SCOOP Oral 11534018028 *LAXATIVES* *Laxatives - Miscellaneous*** Polyethylene Glycol 3350 Powder 17 GM/SCOOP Oral 11534018050 *LAXATIVES* *Laxatives - Miscellaneous***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Polyethylene Glycol 3350 Powder 17 GM/SCOOP Oral 45802086801 *LAXATIVES* *Laxatives - Miscellaneous*** Polyethylene Glycol 3350 Powder 17 GM/SCOOP Oral 45802086802 *LAXATIVES* *Laxatives - Miscellaneous*** Polyethylene Glycol 3350 Powder 17 GM/SCOOP Oral 45802086803 *LAXATIVES* *Laxatives - Miscellaneous*** Polyethylene Glycol 3350 Powder 17 GM/SCOOP Oral 68001050555 *LAXATIVES* *Laxatives - Miscellaneous*** QC Natura-LAX Powder 17 GM/SCOOP Oral 63868000214 *LAXATIVES* *Laxatives - Miscellaneous*** SM ClearLax Powder 17 GM/SCOOP Oral 49348089350 *LAXATIVES* *Laxatives - Miscellaneous*** DOK Plus Tablet 50-8.6 MG Oral 00904672360 *LAXATIVES* *Laxatives & DSS*** GNP Stool Softener/Laxative Tablet 8.6-50 MG Oral 46122056778 *LAXATIVES* *Laxatives & DSS*** HM Senna-S Tablet 8.6-50 MG Oral 62011036401 *LAXATIVES* *Laxatives & DSS*** HM Stool Softener/Laxative Tablet 8.6-50 MG Oral 62011039501 *LAXATIVES* *Laxatives & DSS*** QC Stool Softener Pls Laxative Tablet 8.6-50 MG Oral 63868013510 *LAXATIVES* *Laxatives & DSS*** QC Stool Softener Pls Laxative Tablet 8.6-50 MG Oral 63868013760 *LAXATIVES* *Laxatives & DSS*** Senexon-S Tablet 8.6-50 MG Oral 00536116901 *LAXATIVES* *Laxatives & DSS*** Senexon-S Tablet 8.6-50 MG Oral 00536116910 *LAXATIVES* *Laxatives & DSS*** Senexon-S Tablet 8.6-50 MG Oral 00536124701 *LAXATIVES* *Laxatives & DSS*** Senexon-S Tablet 8.6-50 MG Oral 00536124710 *LAXATIVES* *Laxatives & DSS*** Senexon-S Tablet 8.6-50 MG Oral 00536408610 *LAXATIVES* *Laxatives & DSS*** Senna Plus Tablet 8.6-50 MG Oral 00904672461 *LAXATIVES* *Laxatives & DSS*** Senna Plus Tablet 8.6-50 MG Oral 51645085001 *LAXATIVES* *Laxatives & DSS*** Senna Plus Tablet 8.6-50 MG Oral 51645085010 *LAXATIVES* *Laxatives & DSS*** Senna Plus Tablet 8.6-50 MG Oral 70000052001 *LAXATIVES* *Laxatives & DSS*** SM Senna-S Tablet 8.6-50 MG Oral 70677004201 *LAXATIVES* *Laxatives & DSS*** SM Stool Softener/Laxative Tablet 8.6-50 MG Oral 70677005901 *LAXATIVES* *Laxatives & DSS*** SM Stool Softener/Laxative Tablet 8.6-50 MG Oral 70677008301 *LAXATIVES* *Laxatives & DSS*** Stimulant Laxative Tablet 8.6-50 MG Oral 00536124801 *LAXATIVES* *Laxatives & DSS*** Stimulant Laxative Tablet 8.6-50 MG Oral 00536124810 *LAXATIVES* *Laxatives & DSS*** Stool Softener Plus Laxative Tablet 8.6-50 MG Oral 70000052601 *LAXATIVES* *Laxatives & DSS*** Enema Enema 7-19 GM/118ML Rectal 00536741551 *LAXATIVES* *Saline Laxative Mixtures*** Enema Enema 7-19 GM/118ML Rectal 00904632078 *LAXATIVES* *Saline Laxative Mixtures*** Enema Ready-To-Use Enema 7-19 GM/118ML Rectal 70000010801 *LAXATIVES* *Saline Laxative Mixtures*** Fleet Enema Enema 7-19 GM/118ML Rectal 00132020142 *LAXATIVES* *Saline Laxative Mixtures*** GNP Enema Enema Rectal 46122036428 *LAXATIVES* *Saline Laxative Mixtures*** HM Enema Enema 7-19 GM/118ML Rectal 62011027101 *LAXATIVES* *Saline Laxative Mixtures*** Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

QC Enema Enema 16-6 GM/133ML Rectal 63868038045 *LAXATIVES* *Saline Laxative Mixtures*** QC Enema Enema 16-6 GM/133ML Rectal 63868038090 *LAXATIVES* *Saline Laxative Mixtures*** SM Enema Enema 7-19 GM/118ML Rectal 49348018614 *LAXATIVES* *Saline Laxative Mixtures*** SM Enema Enema 7-19 GM/118ML Rectal 49348018620 *LAXATIVES* *Saline Laxative Mixtures*** GNP Milk of Magnesia Suspension 1200 MG/15ML Oral 24385033240 *LAXATIVES* *Saline Laxatives*** GNP Milk of Magnesia Suspension 1200 MG/15ML Oral 46122043740 *LAXATIVES* *Saline Laxatives*** HM Magnesium Citrate Solution 1.745 GM/30ML Oral 62011038001 *LAXATIVES* *Saline Laxatives*** HM Magnesium Citrate Solution 1.745 GM/30ML Oral 62011038101 *LAXATIVES* *Saline Laxatives*** HM Milk of Magnesia Suspension 1200 MG/15ML Oral 62011012301 *LAXATIVES* *Saline Laxatives*** HM Milk of Magnesia Suspension 1200 MG/15ML Oral 62011012401 *LAXATIVES* *Saline Laxatives***

Magnesium Citrate Solution 1.745 GM/30ML Oral 00904678744 *LAXATIVES* *Saline Laxatives***

Magnesium Citrate Solution 1.745 GM/30ML Oral 70000042401 *LAXATIVES* *Saline Laxatives*** Milk of Magnesia Suspension 1200 MG/15ML Oral 00113033240 *LAXATIVES* *Saline Laxatives*** Milk of Magnesia Suspension 1200 MG/15ML Oral 00113039640 *LAXATIVES* *Saline Laxatives*** Milk of Magnesia Suspension 1200 MG/15ML Oral 00536131983 *LAXATIVES* *Saline Laxatives*** Milk of Magnesia Suspension 1200 MG/15ML Oral 00904675714 *LAXATIVES* *Saline Laxatives*** Milk of Magnesia Suspension 1200 MG/15ML Oral 70000006501 *LAXATIVES* *Saline Laxatives*** Milk of Magnesia Suspension 2400 MG/30ML Oral 00904684673 *LAXATIVES* *Saline Laxatives*** Milk of Magnesia Suspension 400 MG/5ML Oral 60687042976 *LAXATIVES* *Saline Laxatives*** Milk of Magnesia Suspension 400 MG/5ML Oral 66689005301 *LAXATIVES* *Saline Laxatives*** Milk of Magnesia Suspension 400 MG/5ML Oral 66689005399 *LAXATIVES* *Saline Laxatives*** Milk of Magnesia Suspension 7.75 % Oral 00113094940 *LAXATIVES* *Saline Laxatives*** Milk of Magnesia Suspension 7.75 % Oral 00121043130 *LAXATIVES* *Saline Laxatives*** Milk of Magnesia Suspension 7.75 % Oral 00536247085 *LAXATIVES* *Saline Laxatives*** QC Magnesium Citrate Solution 1.745 GM/30ML Oral 63868094410 *LAXATIVES* *Saline Laxatives*** QC Milk of Magnesia Suspension 400 MG/5ML Oral 63868031012 *LAXATIVES* *Saline Laxatives*** SM Magnesium Citrate Solution 1.745 GM/30ML Oral 70677005101 *LAXATIVES* *Saline Laxatives*** SM Milk of Magnesia Suspension 1200 MG/15ML Oral 49348030539 *LAXATIVES* *Saline Laxatives*** SM Milk of Magnesia Suspension 1200 MG/15ML Oral 49348030739 *LAXATIVES* *Saline Laxatives***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

SM Milk of Magnesia Suspension 1200 MG/15ML Oral 49348030839 *LAXATIVES* *Saline Laxatives*** Bisacodyl EC Tablet Delayed Release 5 MG Oral 00904674817 *LAXATIVES* *Stimulant Laxatives*** Bisacodyl EC Tablet Delayed Release 5 MG Oral 00904674860 *LAXATIVES* *Stimulant Laxatives*** Bisacodyl EC Tablet Delayed Release 5 MG Oral 00904674880 *LAXATIVES* *Stimulant Laxatives*** Bisacodyl Suppository 10 MG Rectal 00536123801 *LAXATIVES* *Stimulant Laxatives*** Bisacodyl Suppository 10 MG Rectal 00574705012 *LAXATIVES* *Stimulant Laxatives*** Bisacodyl Suppository 10 MG Rectal 00574705050 *LAXATIVES* *Stimulant Laxatives*** Bisacodyl Suppository 10 MG Rectal 00904698112 *LAXATIVES* *Stimulant Laxatives*** Bisacodyl Suppository 10 MG Rectal 00904698160 *LAXATIVES* *Stimulant Laxatives*** Fleet Bisacodyl ENEMA 10 MG/30ML Rectal 00132070336 *LAXATIVES* *Stimulant Laxatives*** Gentle Laxative Suppository 10 MG Rectal 70000045101 *LAXATIVES* *Stimulant Laxatives*** Gentle Laxative Suppository 10 MG Rectal 70000045102 *LAXATIVES* *Stimulant Laxatives*** Gentle Laxative Tablet Delayed Release 5 MG Oral 70000022103 *LAXATIVES* *Stimulant Laxatives*** Gentle Laxative Tablet Delayed Release 5 MG Oral 70000053801 *LAXATIVES* *Stimulant Laxatives*** GNP Gentle Laxative Suppository 10 MG Rectal 46122060851 *LAXATIVES* *Stimulant Laxatives*** GNP Gentle Laxative Tablet Delayed Release 5 MG Oral 46122052978 *LAXATIVES* *Stimulant Laxatives*** GNP Laxative Tablet Delayed Release 5 MG Oral 24385090363 *LAXATIVES* *Stimulant Laxatives*** GNP Senna Lax Tablet 8.6 MG Oral 46122057578 *LAXATIVES* *Stimulant Laxatives*** HM Laxative Tablet Delayed Release 5 MG Oral 62011027701 *LAXATIVES* *Stimulant Laxatives*** HM Laxative Tablet Delayed Release 5 MG Oral 62011027703 *LAXATIVES* *Stimulant Laxatives*** HM Senna Tablet 8.6 MG Oral 62011038701 *LAXATIVES* *Stimulant Laxatives*** Laxative Max Str Tablet 25 MG Oral 70000007701 *LAXATIVES* *Stimulant Laxatives*** Laxative Max Str Tablet 25 MG Oral 70000038601 *LAXATIVES* *Stimulant Laxatives*** QC Natural Vegetable Laxative Tablet 8.6 MG Oral 63868025710 *LAXATIVES* *Stimulant Laxatives*** Senna Liquid 8.8 MG/5ML Oral 00536126659 *LAXATIVES* *Stimulant Laxatives*** Senna Tablet 8.6 MG Oral 00904643480 *LAXATIVES* *Stimulant Laxatives*** Senna Tablet 8.6 MG Oral 00904672559 *LAXATIVES* *Stimulant Laxatives*** Senna Tablet 8.6 MG Oral 00904672580 *LAXATIVES* *Stimulant Laxatives*** Senna Tablet 8.6 MG Oral 51645085101 *LAXATIVES* *Stimulant Laxatives*** Senna Tablet 8.6 MG Oral 51645085110 *LAXATIVES* *Stimulant Laxatives*** Senna Tablet 8.6 MG Oral 51645085199 *LAXATIVES* *Stimulant Laxatives*** Senna Tablet 8.6 MG Oral 70000044701 *LAXATIVES* *Stimulant Laxatives*** Senna Tablet 8.6 MG Oral 70000044702 *LAXATIVES* *Stimulant Laxatives*** Senna Tablet 8.6 MG Oral 70000044703 *LAXATIVES* *Stimulant Laxatives*** Senna-Lax Tablet 8.6 MG Oral 00904652261 *LAXATIVES* *Stimulant Laxatives*** SM Gentle Laxative Tablet Delayed Release 5 MG Oral 49348003205 *LAXATIVES* *Stimulant Laxatives***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Docu Liquid 50 MG/5ML Oral 50383077111 *LAXATIVES* *Surfactant Laxatives*** Docu Liquid 50 MG/5ML Oral 50383077116 *LAXATIVES* *Surfactant Laxatives*** Docusate Mini Enema 283 MG/5ML Rectal 00904692093 *LAXATIVES* *Surfactant Laxatives*** Docusate Sodium Capsule 100 MG Oral 00904699860 *LAXATIVES* *Surfactant Laxatives*** Docusate Sodium Capsule 100 MG Oral 00904699880 *LAXATIVES* *Surfactant Laxatives*** Docusate Sodium Capsule 100 MG Oral 00904711561 *LAXATIVES* *Surfactant Laxatives*** Docusate Sodium Capsule 100 MG Oral 45802048678 *LAXATIVES* *Surfactant Laxatives*** Docusate Sodium Capsule 100 MG Oral 60687012901 *LAXATIVES* *Surfactant Laxatives*** Docusate Sodium Capsule 100 MG Oral 60687012911 *LAXATIVES* *Surfactant Laxatives*** Docusate Sodium Capsule 250 MG Oral 00904699960 *LAXATIVES* *Surfactant Laxatives*** Docusate Sodium Capsule 250 MG Oral 00904699980 *LAXATIVES* *Surfactant Laxatives*** Docusate Sodium Liquid 50 MG/5ML Oral 00121054410 *LAXATIVES* *Surfactant Laxatives*** Docusate Sodium Liquid 50 MG/5ML Oral 00536130485 *LAXATIVES* *Surfactant Laxatives*** DOK Capsule 100 MG Oral 00904645561 *LAXATIVES* *Surfactant Laxatives*** DOK Capsule 100 MG Oral 00904645760 *LAXATIVES* *Surfactant Laxatives*** DOK Capsule 100 MG Oral 00904645780 *LAXATIVES* *Surfactant Laxatives*** DOK Tablet 100 MG Oral 00904675060 *LAXATIVES* *Surfactant Laxatives*** Enemeez Mini Enema 283 MG/5ML Rectal 17433987603 *LAXATIVES* *Surfactant Laxatives*** Enemeez Plus ENEMA 20-283 MG Rectal 17433987703 *LAXATIVES* *Surfactant Laxatives*** GNP Stool Softener Capsule 100 MG Oral 46122045172 *LAXATIVES* *Surfactant Laxatives*** GNP Stool Softener Capsule 100 MG Oral 46122045178 *LAXATIVES* *Surfactant Laxatives*** GNP Stool Softener Capsule 100 MG Oral 46122045185 *LAXATIVES* *Surfactant Laxatives*** HM Stool Softener Capsule 100 MG Oral 62011038601 *LAXATIVES* *Surfactant Laxatives*** QC Stool Softener Capsule 100 MG Oral 63868056025 *LAXATIVES* *Surfactant Laxatives*** Silace Liquid 150 MG/15ML Oral 54838011680 *LAXATIVES* *Surfactant Laxatives*** SM Stool Softener Capsule 100 MG Oral 49348048310 *LAXATIVES* *Surfactant Laxatives*** SM Stool Softener Capsule 100 MG Oral 49348048319 *LAXATIVES* *Surfactant Laxatives*** SM Stool Softener Capsule 100 MG Oral 70677003401 *LAXATIVES* *Surfactant Laxatives*** SM Stool Softener Capsule 100 MG Oral 70677003402 *LAXATIVES* *Surfactant Laxatives*** SM Stool Softener Tablet 100 MG Oral 49348016710 *LAXATIVES* *Surfactant Laxatives*** Stool Softener Capsule 100 MG Oral 00113048672 *LAXATIVES* *Surfactant Laxatives*** Stool Softener Capsule 100 MG Oral 00536106210 *LAXATIVES* *Surfactant Laxatives*** Stool Softener Capsule 100 MG Oral 00536106229 *LAXATIVES* *Surfactant Laxatives*** Stool Softener Capsule 100 MG Oral 70000009101 *LAXATIVES* *Surfactant Laxatives*** Stool Softener Capsule 100 MG Oral 70000009102 *LAXATIVES* *Surfactant Laxatives*** Stool Softener Capsule 100 MG Oral 70000009103 *LAXATIVES* *Surfactant Laxatives*** Calcium + Vitamin D3 Tablet 600-10 MG-MCG Oral 80681013900 *MINERALS & ELECTROLYTES* *Calcium Combinations***

Calcium + Vitamin D3 Tablet 600-5 MG-MCG Oral 80681013801 *MINERALS & ELECTROLYTES* *Calcium Combinations***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Calcium Carb-Cholecalciferol Tablet 600-400 MG- UNIT Oral 00904323392 *MINERALS & ELECTROLYTES* *Calcium Combinations*** Calcium Carb-Cholecalciferol Tablet 600-400 MG- UNIT Oral 00904323393 *MINERALS & ELECTROLYTES* *Calcium Combinations*** Calcium Carb-Cholecalciferol Tablet 600-400 MG- UNIT Oral 20555001700 *MINERALS & ELECTROLYTES* *Calcium Combinations*** Calcium Carb-Cholecalciferol Tablet Chewable 500-10 MG-MCG Oral 80681013700 *MINERALS & ELECTROLYTES* *Calcium Combinations*** Calcium Carbonate-Vitamin D3 Tablet 600-400 MG-UNIT Oral 80681002900 *MINERALS & ELECTROLYTES* *Calcium Combinations*** Calcium Carbonate-Vitamin D3 Tablet 600-400 MG-UNIT Oral 80681013901 *MINERALS & ELECTROLYTES* *Calcium Combinations*** Os-Cal Extra D3 Tablet 500-600 MG-UNIT Oral 00088165125 *MINERALS & ELECTROLYTES* *Calcium Combinations*** Os-Cal Extra D3 Tablet 500-600 MG-UNIT Oral 00088165149 *MINERALS & ELECTROLYTES* *Calcium Combinations*** Oysco 500+D Tablet 500-200 MG-UNIT Oral 00536781708 *MINERALS & ELECTROLYTES* *Calcium Combinations*** Oysco 500+D Tablet 500-200 MG-UNIT Oral 00536781710 *MINERALS & ELECTROLYTES* *Calcium Combinations*** Oyster Shell Calcium/D Tablet 500-200 MG-UNIT Oral 00904546052 *MINERALS & ELECTROLYTES* *Calcium Combinations*** Oyster Shell Calcium/D Tablet 500-200 MG-UNIT Oral 00904546072 *MINERALS & ELECTROLYTES* *Calcium Combinations*** Oyster Shell Calcium/D Tablet 500-200 MG-UNIT Oral 00904546080 *MINERALS & ELECTROLYTES* *Calcium Combinations*** Oyster Shell Calcium/D Tablet 500-200 MG-UNIT Oral 00904546092 *MINERALS & ELECTROLYTES* *Calcium Combinations***

Calcium Carbonate Tablet 1500 (600 Ca) MG Oral 20555000500 *MINERALS & ELECTROLYTES* *Calcium***

Calcium Carbonate Tablet 1500 (600 Ca) MG Oral 80681000500 *MINERALS & ELECTROLYTES* *Calcium*** GNP Calcium Tablet 1500 (600 Ca) MG Oral 46122007772 *MINERALS & ELECTROLYTES* *Calcium*** Oyster Shell Calcium Tablet 500 MG Oral 00904188361 *MINERALS & ELECTROLYTES* *Calcium*** Oyster Shell Calcium Tablet 500 MG Oral 00904188372 *MINERALS & ELECTROLYTES* *Calcium*** Oyster Shell Calcium Tablet 500 MG Oral 20555000300 *MINERALS & ELECTROLYTES* *Calcium*** Oyster Shell Calcium Tablet 500 MG Oral 20555000301 *MINERALS & ELECTROLYTES* *Calcium*** Oyster Shell Calcium Tablet 500 MG Oral 80681000400 *MINERALS & ELECTROLYTES* *Calcium*** Oyster Shell Calcium Tablet 500 MG Oral 80681005800 *MINERALS & ELECTROLYTES* *Calcium*** Pedialyte Freezer Pops Solution Oral 00074024501 *MINERALS & ELECTROLYTES* *Electrolytes Oral*** Pedialyte Singles Solution Oral 00074549820 *MINERALS & ELECTROLYTES* *Electrolytes Oral*** Pedialyte Solution Oral 00074024001 *MINERALS & ELECTROLYTES* *Electrolytes Oral*** Pedialyte Solution Oral 00074517530 *MINERALS & ELECTROLYTES* *Electrolytes Oral*** Pedialyte Solution Oral 00074647032 *MINERALS & ELECTROLYTES* *Electrolytes Oral*** Pedialyte Solution Oral 00074647132 *MINERALS & ELECTROLYTES* *Electrolytes Oral*** SM Pediatric Electrolyte Solution Oral 49348016162 *MINERALS & ELECTROLYTES* *Electrolytes Oral*** Floriva Liquid 0.25-400 MG-UNIT/ML Oral 52796017250 *MINERALS & ELECTROLYTES* *Fluoride Combinations*** Sodium Fluoride Tablet Chewable 0.55 (0.25 F) MG Oral 59088010473 *MINERALS & ELECTROLYTES* *Fluoride***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Sodium Fluoride Tablet Chewable 1.1 (0.5 F) MG Oral 59088010573 *MINERALS & ELECTROLYTES* *Fluoride*** Sodium Fluoride Tablet Chewable 2.2 (1 F) MG Oral 59088010673 *MINERALS & ELECTROLYTES* *Fluoride***

Magnesium Oxide Tablet 400 (241.3 Mg) MG Oral 10135058362 *MINERALS & ELECTROLYTES* *Magnesium***

Magnesium Oxide Tablet 400 (241.3 Mg) MG Oral 69543021712 *MINERALS & ELECTROLYTES* *Magnesium*** Magnesium Oxide TABLET 500 MG ORAL 00904423960 *MINERALS & ELECTROLYTES* *Magnesium*** K-Phos-Neutral Tablet 155-852-130 MG Oral 00486112501 *MINERALS & ELECTROLYTES* *Phosphate*** Sodium Chloride Tablet 1 GM Oral 69367022001 *MINERALS & ELECTROLYTES* *Sodium*** B Complex CAPSULE ORAL 00536478701 *MULTIVITAMINS* *B-Complex Vitamins*** B-Complex/B-12 Tablet Oral 00904418160 *MULTIVITAMINS* *B-Complex Vitamins*** B Complex-C Tablet Oral 80681012600 *MULTIVITAMINS* *B-Complex w/ C*** Vitamin B + C Complex Tablet Oral 80681015400 *MULTIVITAMINS* *B-Complex w/ C*** B Complex Vitamins (w/ FA) Capsule Oral 54629056102 *MULTIVITAMINS* *B-Complex w/ Folic Acid*** Tab-A-Vite/Iron Tablet Oral 00904053160 *MULTIVITAMINS* *Multiple Vitamins w/ Iron*** Tab-A-Vite/Iron Tablet Oral 80681012400 *MULTIVITAMINS* *Multiple Vitamins w/ Iron*** Tab-A-Vite/Iron/Beta Carotene Tablet Oral 80681006300 *MULTIVITAMINS* *Multiple Vitamins w/ Iron*** Tab-A-Vite/Iron/Beta Carotene Tablet Oral 80681006301 *MULTIVITAMINS* *Multiple Vitamins w/ Iron*** CertaVite Senior Tablet Oral 80681014101 *MULTIVITAMINS* *Multiple Vitamins w/ Minerals*** CertaVite Senior/Antioxidant Tablet Oral 00904548652 *MULTIVITAMINS* *Multiple Vitamins w/ Minerals*** CertaVite Senior/Antioxidant Tablet Oral 00904548689 *MULTIVITAMINS* *Multiple Vitamins w/ Minerals*** CertaVite/Antioxidants Tablet Oral 00904264113 *MULTIVITAMINS* *Multiple Vitamins w/ Minerals*** CertaVite/Antioxidants Tablet Oral 00904264146 *MULTIVITAMINS* *Multiple Vitamins w/ Minerals*** CertaVite/Antioxidants Tablet Oral 00904264172 *MULTIVITAMINS* *Multiple Vitamins w/ Minerals*** CertaVite/Antioxidants Tablet Oral 80681014201 *MULTIVITAMINS* *Multiple Vitamins w/ Minerals*** CertaVite/Antioxidants Tablet Oral 80681014202 *MULTIVITAMINS* *Multiple Vitamins w/ Minerals*** DEKAs Plus Capsule Oral 68176000011 *MULTIVITAMINS* *Multiple Vitamins w/ Minerals*** DEKAs Plus TABLET CHEWABLE ORAL 68176000015 *MULTIVITAMINS* *Multiple Vitamins w/ Minerals*** ICaps MV Tablet Oral 00065804083 *MULTIVITAMINS* *Multiple Vitamins w/ Minerals*** Ocuvite-Lutein Tablet Oral 24208038760 *MULTIVITAMINS* *Multiple Vitamins w/ Minerals*** Oncovite Tablet Oral 00178055001 *MULTIVITAMINS* *Multiple Vitamins w/ Minerals*** Prosight Tablet Oral 00904773518 *MULTIVITAMINS* *Multiple Vitamins w/ Minerals*** Prosight Tablet Oral 00904773552 *MULTIVITAMINS* *Multiple Vitamins w/ Minerals*** Thera M Plus Tablet Oral 00904549261 *MULTIVITAMINS* *Multiple Vitamins w/ Minerals*** Thera-M Tablet Oral 00904549213 *MULTIVITAMINS* *Multiple Vitamins w/ Minerals*** Thera-M Tablet Oral 00904549280 *MULTIVITAMINS* *Multiple Vitamins w/ Minerals*** Vitamins/Minerals Tablet Oral 00904504260 *MULTIVITAMINS* *Multiple Vitamins w/ Minerals*** Daily-Vite Multivitamin Tablet Oral 80681005000 *MULTIVITAMINS* *Multivitamins*** DEKAs Essential Capsule Oral 68176000012 *MULTIVITAMINS* *Multivitamins***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

DEKAs Essential Liquid Oral 68176000013 *MULTIVITAMINS* *Multivitamins*** High Potency Multivitamin Tablet Oral 20555002200 *MULTIVITAMINS* *Multivitamins*** Multivitamin Tablet Oral 80681002000 *MULTIVITAMINS* *Multivitamins*** Tab-A-Vite Tablet Oral 00904053060 *MULTIVITAMINS* *Multivitamins*** Tab-A-Vite Tablet Oral 20555002700 *MULTIVITAMINS* *Multivitamins*** Tab-A-Vite/Beta Carotene Tablet Oral 00904053061 *MULTIVITAMINS* *Multivitamins*** Thera Tablet Oral 00904053961 *MULTIVITAMINS* *Multivitamins*** Therems Tablet Oral 80681000300 *MULTIVITAMINS* *Multivitamins*** Therems Tablet Oral 80681006400 *MULTIVITAMINS* *Multivitamins*** Poly-Vi-Flor/Iron Suspension 0.25-7 MG/ML Oral 23594060050 *MULTIVITAMINS* *Ped Multi Vitamins w/Fl & FE***

Poly-Vi-Flor/Iron Tablet Chewable 0.5-10 MG Oral 23594010030 *MULTIVITAMINS* *Ped Multi Vitamins w/Fl & FE*** Quflora FE Pediatric Liquid 0.25-9.5 MG/ML Oral 15370010250 *MULTIVITAMINS* *Ped Multi Vitamins w/Fl & FE***

AquADEKs Liquid Oral 58914021460 *MULTIVITAMINS* *Ped Multiple Vitamins w/ Minerals & C*** DEKAs Plus Liquid Oral 68176000010 *MULTIVITAMINS* *Ped Multiple Vitamins w/ Minerals***

Multivitamin/Fluoride Solution 0.25 MG/ML Oral 61269016150 *MULTIVITAMINS* *Ped MV w/ Fluoride*** Multi-Vitamin/Fluoride Solution 0.25 MG/ML Oral 58657032550 *MULTIVITAMINS* *Ped MV w/ Fluoride*** Multivitamin/Fluoride Tablet Chewable 0.25 MG Oral 59088010759 *MULTIVITAMINS* *Ped MV w/ Fluoride*** Multivitamin/Fluoride Tablet Chewable 0.5 MG Oral 59088010859 *MULTIVITAMINS* *Ped MV w/ Fluoride*** Multivitamin/Fluoride Tablet Chewable 1 MG Oral 59088010959 *MULTIVITAMINS* *Ped MV w/ Fluoride*** Poly-Vi-Flor Suspension 0.25 MG/ML Oral 23594050050 *MULTIVITAMINS* *Ped MV w/ Fluoride*** Poly-Vi-Flor Tablet Chewable 0.25 MG Oral 23594020030 *MULTIVITAMINS* *Ped MV w/ Fluoride*** Poly-Vi-Flor Tablet Chewable 0.5 MG Oral 23594030030 *MULTIVITAMINS* *Ped MV w/ Fluoride*** Poly-Vi-Flor Tablet Chewable 1 MG Oral 23594040030 *MULTIVITAMINS* *Ped MV w/ Fluoride***

Animal Shapes/Iron Tablet Chewable 18 MG Oral 00904053670 *MULTIVITAMINS* *Ped MV w/ Iron*** Poly-Vi-Sol/Iron Solution 11 MG/ML Oral 00087040501 *MULTIVITAMINS* *Ped MV w/ Iron*** Tri-Vi-Flor Suspension 0.25 MG/ML Oral 23594070050 *MULTIVITAMINS* *Ped Vitamins ACD & FA w/ Fluoride*** Tri-Vi-Flor SUSPENSION 0.5 MG/ML ORAL 23594080050 *MULTIVITAMINS* *Ped Vitamins ACD & FA w/ Fluoride*** *Pediatric Multiple Vitamins & Minerals w/ Floriva TABLET CHEWABLE 0.25 MG ORAL 52796017390 *MULTIVITAMINS* Fluoride*** *Pediatric Multiple Vitamins & Minerals w/ Floriva TABLET CHEWABLE 1 MG ORAL 52796017790 *MULTIVITAMINS* Fluoride***

Animal Shapes Tablet Chewable with C & FA Oral 00904262160 *MULTIVITAMINS* *Pediatric Multiple Vitamins w/ C & FA***

Animal Shapes Tablet Chewable with C & FA Oral 00904262170 *MULTIVITAMINS* *Pediatric Multiple Vitamins w/ C & FA*** Childrens Chew Multivitamin Tablet Chewable Oral 80681011600 *MULTIVITAMINS* *Pediatric Multiple Vitamins w/ C & FA***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Multivitamin Childrens Tablet Chewable Oral 80681004800 *MULTIVITAMINS* *Pediatric Multiple Vitamins*** Multivitamin Childrens Tablet Chewable Oral 80681004900 *MULTIVITAMINS* *Pediatric Multiple Vitamins*** Poly-Vi-Sol Solution Oral 00087040203 *MULTIVITAMINS* *Pediatric Multiple Vitamins*** Tri-Vi-Sol A/C/D Solution 250-50-10 Oral 00087040303 *MULTIVITAMINS* *Pediatric Vitamins A & D w/ C*** Elite-OB Tablet 50-1.25 MG Oral 13811002710 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** EnBrace HR CAPSULE ORAL 64661065030 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** Folivane-OB Capsule 130-92.4-1 MG Oral 13811053530 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** GNP PreNatal Tablet 28-0.8 MG Oral 46122009878 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** Marnatal-F Capsule 60-1 MG Oral 00682157001 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** Nestabs TABLET 32-1 MG Oral 50967021990 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** OB Complete One Capsule 50-1-476 MG Oral 68025004430 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** OB Complete Petite CAPSULE 35-5-1-200 MG ORAL 68025005930 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** OB Complete Premier TABLET 30-20-1 MG ORAL 68025004330 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** OB Complete TABLET 50-1.25 MG ORAL 68025001010 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** O-Cal FA Tablet 27-1 MG Oral 00813931601 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** Prenatal Tablet 27-1 MG Oral 39328010610 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** Prenatal Vitamin Plus Low Iron TABLET 27-1 MG ORAL 63044015001 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** Prenatal Vitamin Plus Low Iron TABLET 27-1 MG ORAL 63044015005 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** Prenate Elite TABLET 20-0.6-0.4 MG ORAL 75854031430 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** PrePLUS TABLET 27-1 MG Oral 69543025810 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** PrePLUS TABLET 27-1 MG Oral 69543025850 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** PreTAB Tablet 29-1 MG Oral 69543025910 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** Select-OB TABLET CHEWABLE 29-0.6-0.4 MG ORAL 00642012090 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** Select-OB TABLET CHEWABLE 29-1 MG ORAL 00642007790 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** Se-Natal 19 Tablet 29-1 MG Oral 13925011601 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** Se-Natal 19 Tablet Chewable 29-1 MG Oral 13925011701 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** Taron-C DHA Capsule 53.5-38-1 MG Oral 13811053630 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** TriCare Tablet Oral 67112010100 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** Virt-Nate DHA CAPSULE 28-1-200 MG ORAL 69543037030 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** Vitafol Gummies TABLET CHEWABLE 3.33-0.333- 34.8 MG ORAL 00642012590 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** Vitafol-Nano Tablet 18-0.6-0.4 MG Oral 00642009430 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** Vitafol-OB TABLET ORAL 00642007912 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** VP-PNV-DHA Capsule 28-1-215.8 MG Oral 69543022330 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** Zatean-Pn Plus Capsule 28-0.6-0.4-340 MG Oral 13811058230 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA*** Nestabs One CAPSULE 38-1-225 MG Oral 50967041030 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA-DHA*** PNV-DHA CAPSULE 27-0.6-0.4-300 MG ORAL 42192032130 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA-DHA*** Prenate DHA CAPSULE 18-0.6-0.4-300 MG ORAL 75854031230 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA-DHA*** Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Prenate Enhance CAPSULE 28-0.6-0.4-400 MG ORAL 75854030930 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA-DHA*** Prenate Essential CAPSULE 18-0.6-0.4-300 MG ORAL 75854031330 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA-DHA*** Prenate Mini CAPSULE 18-0.6-0.4-350 MG ORAL 75854031530 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA-DHA*** Prenate Pixie CAPSULE 10-0.6-0.4-200 MG ORAL 75854031630 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA-DHA*** Prenate Restore CAPSULE 27-0.6-0.4-400 MG ORAL 75854030830 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA-DHA*** TriStart DHA CAPSULE 31-0.6-0.4-200 MG ORAL 15370025030 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA-DHA*** Vitafol Ultra CAPSULE 29-0.6-0.4-200 MG Oral 00642009330 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA-DHA*** Vitafol-One Capsule 29-1-200 MG Oral 00642007030 *MULTIVITAMINS* *Prenatal MV & Min w/FE-FA-DHA*** *Prenatal MV & Minerals w/FA without Prenate TABLET CHEWABLE 0.6-0.4 MG ORAL 75854030630 *MULTIVITAMINS* Iron*** Prenate AM TABLET 1 MG ORAL 75854030730 *MULTIVITAMINS* *Prenatal Vitamins*** Nasal Moisturizing Spray Solution 0.65 % Nasal 70030013173 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Nasal Agents - Misc.*** Ocean Nasal Spray Solution 0.65 % Nasal 00187526003 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Nasal Agents - Misc.*** Saline Mist Spray Solution 0.65 % Nasal 45802035758 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Nasal Agents - Misc.*** Saline Nasal Spray Solution 0.65 % Nasal 32953068965 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Nasal Agents - Misc.*** Cromolyn Sodium Aerosol Solution 5.2 MG/ACT Nasal 57782039726 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Nasal Mast Cell Stabilizers*** Budesonide Suspension 32 MCG/ACT Nasal 00536111248 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Nasal Steroids*** GNP Budesonide Nasal Spray Suspension 32 MCG/ACT Nasal 46122038976 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Nasal Steroids*** Childrens Silfedrine Liquid 15 MG/5ML Oral 54838010440 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants*** Childrens Silfedrine Liquid 15 MG/5ML Oral 54838010470 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants*** GNP Nasal Decongestant PE Tablet 10 MG Oral 46122065068 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants*** GNP Nasal Decongestant Tablet 30 MG Oral 24385043262 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants*** GNP Nasal Decongestant Tablet 30 MG Oral 46122042862 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants*** HM Nasal Decongestant PE Tablet 10 MG Oral 62011007702 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants*** HM Nasal Decongestant Tablet 30 MG Oral 62011031201 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants*** HM Nasal Decongestant Tablet 30 MG Oral 62011031202 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants*** HM Nasal Decongestant Tablet 30 MG Oral 62011031203 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants***

Nasal Decongestant PE Max St Tablet 10 MG Oral 00113009423 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants***

Nasal Decongestant PE Max St Tablet 10 MG Oral 00113009468 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants***

Nasal Decongestant PE Max St Tablet 10 MG Oral 00113009489 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants*** Nasal Decongestant PE Tablet 10 MG Oral 70000012601 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants*** Nasal Decongestant PE Tablet 10 MG Oral 70000012602 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants*** Nasal Decongestant Tablet 30 MG Oral 70000000201 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants*** Nasal Decongestant Tablet 30 MG Oral 70000000202 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants*** Phenylephrine HCl Tablet 10 MG Oral 00536129136 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Pseudoephedrine HCl Tablet 30 MG Oral 00904699061 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants*** Pseudoephedrine HCl Tablet 30 MG Oral 45802043262 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants*** SM Nasal Decongestant Max St Tablet 30 MG Oral 70677000501 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants*** SM Nasal Decongestant Max St Tablet 30 MG Oral 70677000502 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants*** SudoGest Maximum Strength Tablet 30 MG Oral 00904633724 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants*** Sudogest PE Tablet 10 MG Oral 00904675349 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants*** Sudogest PE Tablet 10 MG Oral 00904675373 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants*** SudoGest Tablet 30 MG Oral 00904505324 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants*** SudoGest Tablet 30 MG Oral 00904505359 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants*** SudoGest Tablet 30 MG Oral 00904672760 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Systemic Decongestants*** 12 Hour Nasal Decongestant Solution 0.05 % Nasal 00904676130 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Topical Decongestants*** Mucinex Childrens Stuffy Nose Solution 0.05 % Nasal 63824096122 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Topical Decongestants*** Mucinex Sinus-Max Clear & Cool Solution 0.05 % Nasal 63824012917 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Topical Decongestants*** Mucinex Sinus-Max Sinus/Allrgy Solution 0.05 % Nasal 63824012011 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Topical Decongestants***

Nasal Decongestant Spray Solution 0.05 % Nasal 00904700635 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Topical Decongestants*** Nasal Spray No Drip Solution 0.05 % Nasal 70000000101 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Topical Decongestants*** SM Nasal Spray 12 Hour Solution 0.05 % Nasal 49348002827 *NASAL AGENTS - SYSTEMIC AND TOPICAL* *Topical Decongestants*** Dry Eye Relief Drops Solution 0.2-0.2-1 % *Artificial Tear and Lubricant Ophthalmic 70000050201 *OPHTHALMIC AGENTS* Combinations*** *Artificial Tear and Lubricant FreshKote PF Solution 2.7-2 % Ophthalmic 71776000110 *OPHTHALMIC AGENTS* Combinations*** GenTeal Tears Severe Day/Night Gel 0.4-0.3 % *Artificial Tear and Lubricant Ophthalmic 00065806701 *OPHTHALMIC AGENTS* Combinations*** HM Dry Eye Relief Solution 0.2-0.2-1 % *Artificial Tear and Lubricant Ophthalmic 62011019601 *OPHTHALMIC AGENTS* Combinations*** Lubricant Eye Drops Solution 0.4-0.3 % *Artificial Tear and Lubricant Ophthalmic 00536109994 *OPHTHALMIC AGENTS* Combinations*** Lubricant Eye Drops Solution 0.4-0.3 % *Artificial Tear and Lubricant Ophthalmic 70000045501 *OPHTHALMIC AGENTS* Combinations*** Lubricant Eye Drops Solution 0.4-0.3 % *Artificial Tear and Lubricant Ophthalmic 70000045502 *OPHTHALMIC AGENTS* Combinations*** *Artificial Tear and Lubricant Lubricant Eye Nighttime Ointment Ophthalmic 70000051301 *OPHTHALMIC AGENTS* Combinations*** Lubricating Eye Drops Solution 0.4-0.3 % *Artificial Tear and Lubricant Ophthalmic 00536121994 *OPHTHALMIC AGENTS* Combinations*** *Artificial Tear and Lubricant Puralube Ointment 85-15 % Ophthalmic 00574402535 *OPHTHALMIC AGENTS* Combinations*** *Artificial Tear and Lubricant Refresh Lacri-Lube Ointment Ophthalmic 00023031204 *OPHTHALMIC AGENTS* Combinations*** *Artificial Tear and Lubricant Refresh Lacri-Lube Ointment Ophthalmic 00023031207 *OPHTHALMIC AGENTS* Combinations***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

*Artificial Tear and Lubricant Refresh Optive PF Solution 0.5-0.9 % Ophthalmic 00023341630 *OPHTHALMIC AGENTS* Combinations*** *Artificial Tear and Lubricant Refresh Optive PF Solution 0.5-0.9 % Ophthalmic 00023341660 *OPHTHALMIC AGENTS* Combinations*** *Artificial Tear and Lubricant Refresh P.M. Ointment Ophthalmic 00023024004 *OPHTHALMIC AGENTS* Combinations*** *Artificial Tear and Lubricant Refresh Solution 1.4-0.6 % Ophthalmic 00023050601 *OPHTHALMIC AGENTS* Combinations*** *Artificial Tear and Lubricant Refresh Solution 1.4-0.6 % Ophthalmic 00023050650 *OPHTHALMIC AGENTS* Combinations*** Ultra Lubricating Eye Drops Solution 0.4-0.3 % *Artificial Tear and Lubricant Ophthalmic 70000045701 *OPHTHALMIC AGENTS* Combinations*** Ultra Lubricating Eye Drops Solution 0.4-0.3 % *Artificial Tear and Lubricant Ophthalmic 70000045702 *OPHTHALMIC AGENTS* Combinations*** Carboxymethylcellulose Sodium Solution 0.5 % Ophthalmic 50268006815 *OPHTHALMIC AGENTS* *Artificial Tears and Lubricants*** GenTeal Severe Gel 0.3 % Ophthalmic 00065806401 *OPHTHALMIC AGENTS* *Artificial Tears and Lubricants*** GenTeal Severe Gel 0.3 % Ophthalmic 00078042957 *OPHTHALMIC AGENTS* *Artificial Tears and Lubricants*** HM Lubricating Plus Solution 0.5 % Ophthalmic 62011020301 *OPHTHALMIC AGENTS* *Artificial Tears and Lubricants*** Lubricant Eye Drops PF Solution 0.5 % Ophthalmic 70000001201 *OPHTHALMIC AGENTS* *Artificial Tears and Lubricants*** Lubricant Eye Drops PF Solution 0.5 % Ophthalmic 70000001202 *OPHTHALMIC AGENTS* *Artificial Tears and Lubricants*** Lubricant Eye Drops Solution 0.6 % Ophthalmic 70000001301 *OPHTHALMIC AGENTS* *Artificial Tears and Lubricants*** Lubricant Eye Drops Solution 0.6 % Ophthalmic 70000001302 *OPHTHALMIC AGENTS* *Artificial Tears and Lubricants*** Polyvinyl Alcohol Solution 1.4 % Ophthalmic 59390019613 *OPHTHALMIC AGENTS* *Artificial Tears and Lubricants*** Refresh Celluvisc GEL 1 % Ophthalmic 00023455430 *OPHTHALMIC AGENTS* *Artificial Tears and Lubricants*** Systane Overnight Therapy GEL 0.3 % OPHTHALMIC 00065047401 *OPHTHALMIC AGENTS* *Artificial Tears and Lubricants*** Alaway Childrens Allergy Solution 0.025 % Ophthalmic 24208060105 *OPHTHALMIC AGENTS* *Ophthalmic Antiallergic*** Alaway Solution 0.025 % Ophthalmic 24208060110 *OPHTHALMIC AGENTS* *Ophthalmic Antiallergic*** Eye Allergy Itch Relief Solution 0.2 % Ophthalmic 70000005301 *OPHTHALMIC AGENTS* *Ophthalmic Antiallergic*** Eye Allergy Itch/Redness Rel Solution 0.1 % Ophthalmic 70000005401 *OPHTHALMIC AGENTS* *Ophthalmic Antiallergic*** Eye Itch Relief Solution 0.025 % Ophthalmic 00536125240 *OPHTHALMIC AGENTS* *Ophthalmic Antiallergic*** Eye Itch Relief Solution 0.025 % Ophthalmic 70000052201 *OPHTHALMIC AGENTS* *Ophthalmic Antiallergic*** Eye Itch Relief Solution 0.025 % Ophthalmic 70000052202 *OPHTHALMIC AGENTS* *Ophthalmic Antiallergic*** GNP Olopatadine HCl Solution 0.2 % Ophthalmic 46122067127 *OPHTHALMIC AGENTS* *Ophthalmic Antiallergic***

Ketotifen Fumarate Solution 0.025 % Ophthalmic 17478071710 *OPHTHALMIC AGENTS* *Ophthalmic Antiallergic*** Pataday Solution 0.1 % Ophthalmic 00065427401 *OPHTHALMIC AGENTS* *Ophthalmic Antiallergic*** Pataday Solution 0.2 % Ophthalmic 00065815001 *OPHTHALMIC AGENTS* *Ophthalmic Antiallergic*** Pataday Solution 0.2 % Ophthalmic 00065815003 *OPHTHALMIC AGENTS* *Ophthalmic Antiallergic*** Pataday Solution 0.7 % Ophthalmic 00065081601 *OPHTHALMIC AGENTS* *Ophthalmic Antiallergic*** Pataday Solution 0.7 % Ophthalmic 00065081604 *OPHTHALMIC AGENTS* *Ophthalmic Antiallergic*** Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Muro 128 Solution 2 % Ophthalmic 24208027615 *OPHTHALMIC AGENTS* *Ophthalmic Hyperosmolar Products*** Sodium Chloride (Hypertonic) Ointment 5 % Ophthalmic 00536125391 *OPHTHALMIC AGENTS* *Ophthalmic Hyperosmolar Products*** Sodium Chloride (Hypertonic) Solution 5 % Ophthalmic 00536125494 *OPHTHALMIC AGENTS* *Ophthalmic Hyperosmolar Products*** Ear Drops Earwax Aid Solution 6.5 % Otic 57896033905 *OTIC AGENTS* *Otic Agents - Miscellaneous*** Earwax Removal Solution 6.5 % Otic 70000049001 *OTIC AGENTS* *Otic Agents - Miscellaneous*** Earwax Removal Solution 6.5 % Otic 70000049002 *OTIC AGENTS* *Otic Agents - Miscellaneous*** GNP Earwax Removal Drops Solution 6.5 % Otic 46122055705 *OTIC AGENTS* *Otic Agents - Miscellaneous*** Murine Ear Solution 6.5 % Otic 78112073623 *OTIC AGENTS* *Otic Agents - Miscellaneous*** Murine Ear Wax Removal System Solution 6.5 % Otic 78112073621 *OTIC AGENTS* *Otic Agents - Miscellaneous*** Methylparaben POWDER 38779143904 *PHARMACEUTICAL ADJUVANTS* *Antimicrobial Agents*** Propylparaben POWDER 51927116400 *PHARMACEUTICAL ADJUVANTS* *Antimicrobial Agents*** Methylcellulose Powder 38779008505 *PHARMACEUTICAL ADJUVANTS* *External Vehicle Ingredients*** Suspendol-S Liquid 00574030716 *PHARMACEUTICAL ADJUVANTS* *External Vehicles*** Cherry Syrup Oral 00395266216 *PHARMACEUTICAL ADJUVANTS* *Oral Vehicles*** Ora-Blend SF Suspension Oral 00574031216 *PHARMACEUTICAL ADJUVANTS* *Oral Vehicles*** Ora-Blend Suspension Oral 00574031116 *PHARMACEUTICAL ADJUVANTS* *Oral Vehicles*** Ora-Plus Liquid Oral 00574030316 *PHARMACEUTICAL ADJUVANTS* *Oral Vehicles*** Ora-Sweet SF Syrup Oral 00574030216 *PHARMACEUTICAL ADJUVANTS* *Oral Vehicles*** Ora-Sweet Syrup Oral 00574030416 *PHARMACEUTICAL ADJUVANTS* *Oral Vehicles*** Simple Syrup Syrup Oral 00395266116 *PHARMACEUTICAL ADJUVANTS* *Oral Vehicles*** Simple Syrup Syrup Oral 38779177908 *PHARMACEUTICAL ADJUVANTS* *Oral Vehicles*** SyrSpend SF Liquid Oral 51552107905 *PHARMACEUTICAL ADJUVANTS* *Oral Vehicles*** SyrSpend SF Liquid Oral 51552116709 *PHARMACEUTICAL ADJUVANTS* *Oral Vehicles*** Lactose Monohydrate Powder 38779031608 *PHARMACEUTICAL ADJUVANTS* *Pharmaceutical Excipients*** Sodium Benzoate POWDER 38779055108 *PHARMACEUTICAL ADJUVANTS* *Pharmaceutical Excipients*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL GNP Nicotine Gum 2 MG Mouth/Throat 46122066478 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL GNP Nicotine Gum 4 MG Mouth/Throat 46122066678 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL GNP Nicotine Mini Lozenge 2 MG Mouth/Throat 46122025415 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL GNP Nicotine Mini Lozenge 2 MG Mouth/Throat 46122025460 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL GNP Nicotine Mini Lozenge 2 MG Mouth/Throat 46122066315 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL GNP Nicotine Mini Lozenge 4 MG Mouth/Throat 46122066515 AGENTS - MISC.* *Smoking Deterrents*** GNP Nicotine Patch 24 Hour 14 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 46122035274 AGENTS - MISC.* *Smoking Deterrents*** GNP Nicotine Patch 24 Hour 21 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 46122056807 AGENTS - MISC.* *Smoking Deterrents***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

GNP Nicotine Patch 24 Hour 7 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 46122035474 AGENTS - MISC.* *Smoking Deterrents*** GNP Nicotine Polacrilex Gum 2 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 46122017125 AGENTS - MISC.* *Smoking Deterrents*** GNP Nicotine Polacrilex Gum 2 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 46122028460 AGENTS - MISC.* *Smoking Deterrents*** GNP Nicotine Polacrilex Gum 2 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 46122044858 AGENTS - MISC.* *Smoking Deterrents*** GNP Nicotine Polacrilex Gum 4 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 46122017460 AGENTS - MISC.* *Smoking Deterrents*** GNP Nicotine Polacrilex Gum 4 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 46122028660 AGENTS - MISC.* *Smoking Deterrents*** GNP Nicotine Polacrilex Gum 4 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 46122044958 AGENTS - MISC.* *Smoking Deterrents*** GNP Nicotine Polacrilex Lozenge 2 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 46122017608 AGENTS - MISC.* *Smoking Deterrents*** GNP Nicotine Polacrilex Lozenge 4 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 46122025515 AGENTS - MISC.* *Smoking Deterrents*** GNP Nicotine Polacrilex Lozenge 4 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 46122025560 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL GoodSense Nicotine Gum 2 MG Mouth/Throat 00113002971 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL GoodSense Nicotine Gum 2 MG Mouth/Throat 00113045660 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL GoodSense Nicotine Gum 4 MG Mouth/Throat 00113017060 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL GoodSense Nicotine Gum 4 MG Mouth/Throat 00113017071 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL GoodSense Nicotine Gum 4 MG Mouth/Throat 00113053260 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL GoodSense Nicotine Gum 4 MG Mouth/Throat 00113053278 AGENTS - MISC.* *Smoking Deterrents*** GoodSense Nicotine Lozenge 2 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 00113073402 AGENTS - MISC.* *Smoking Deterrents*** GoodSense Nicotine Lozenge 4 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 00113087305 AGENTS - MISC.* *Smoking Deterrents*** GoodSense Nicotine Lozenge 4 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 00113087306 AGENTS - MISC.* *Smoking Deterrents*** GoodSense Nicotine Lozenge 4 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 00113095702 AGENTS - MISC.* *Smoking Deterrents*** GoodSense Nicotine Lozenge 4 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 00113095760 AGENTS - MISC.* *Smoking Deterrents*** HM Nicotine Patch 24 Hour 14 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 62011035001 AGENTS - MISC.* *Smoking Deterrents*** HM Nicotine Patch 24 Hour 21 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 62011035101 AGENTS - MISC.* *Smoking Deterrents*** HM Nicotine Patch 24 Hour 7 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 62011034901 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL HM Nicotine Polacrilex Gum 2 MG Mouth/Throat 62011004702 AGENTS - MISC.* *Smoking Deterrents***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

*PSYCHOTHERAPEUTIC AND NEUROLOGICAL HM Nicotine Polacrilex Gum 2 MG Mouth/Throat 62011042501 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL HM Nicotine Polacrilex Gum 4 MG Mouth/Throat 62011017001 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL HM Nicotine Polacrilex Gum 4 MG Mouth/Throat 62011042601 AGENTS - MISC.* *Smoking Deterrents*** HM Nicotine Polacrilex Lozenge 2 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 62011004801 AGENTS - MISC.* *Smoking Deterrents*** HM Nicotine Polacrilex Lozenge 2 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 62011019901 AGENTS - MISC.* *Smoking Deterrents*** HM Nicotine Polacrilex Lozenge 2 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 62011042701 AGENTS - MISC.* *Smoking Deterrents*** HM Nicotine Polacrilex Lozenge 2 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 62011042901 AGENTS - MISC.* *Smoking Deterrents*** HM Nicotine Polacrilex Lozenge 4 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 62011020001 AGENTS - MISC.* *Smoking Deterrents*** HM Nicotine Polacrilex Lozenge 4 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 62011042801 AGENTS - MISC.* *Smoking Deterrents*** HM Nicotine Polacrilex Lozenge 4 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 62011043001 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Mini Lozenge 2 MG Mouth/Throat 00536123981 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Mini Lozenge 4 MG Mouth/Throat 00536124181 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Patch 24 Hour 14 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 00536589553 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Patch 24 Hour 14 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 00536589571 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Patch 24 Hour 14 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 00536589588 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Patch 24 Hour 14 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 43598044770 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Patch 24 Hour 14 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 43598044774 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Patch 24 Hour 21 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 00536589653 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Patch 24 Hour 21 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 00536589671 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Patch 24 Hour 21 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 00536589688 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Patch 24 Hour 21 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 43598044828 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Patch 24 Hour 21 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 43598044870 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Patch 24 Hour 21 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 43598044874 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Patch 24 Hour 21 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 46122035374 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Patch 24 Hour 7 MG/24HR Transdermal 00536589453 AGENTS - MISC.* *Smoking Deterrents***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

*PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Patch 24 Hour 7 MG/24HR Transdermal 00536589488 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Patch 24 Hour 7 MG/24HR Transdermal 43598044670 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Patch 24 Hour 7 MG/24HR Transdermal 43598044674 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 2 MG Mouth/Throat 00113020625 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 2 MG Mouth/Throat 00536136206 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 2 MG Mouth/Throat 00536136223 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 2 MG Mouth/Throat 00536136234 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 2 MG Mouth/Throat 00536302906 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 2 MG Mouth/Throat 00536302923 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 2 MG Mouth/Throat 00536302934 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 2 MG Mouth/Throat 00536311201 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 2 MG Mouth/Throat 00536311237 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 2 MG Mouth/Throat 00536338601 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 2 MG Mouth/Throat 00536340401 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 2 MG Mouth/Throat 45802020625 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 2 MG Mouth/Throat 63739037010 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 2 MG Mouth/Throat 63739037163 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 2 MG Mouth/Throat 70000034501 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 2 MG Mouth/Throat 70000034601 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 2 MG Mouth/Throat 70000034701 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 2 MG Mouth/Throat 70000034801 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 2 MG Mouth/Throat 70000034802 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 4 MG Mouth/Throat 00113042225 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 4 MG Mouth/Throat 00536137206 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 4 MG Mouth/Throat 00536137223 AGENTS - MISC.* *Smoking Deterrents***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

*PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 4 MG Mouth/Throat 00536137234 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 4 MG Mouth/Throat 00536303006 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 4 MG Mouth/Throat 00536303023 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 4 MG Mouth/Throat 00536311301 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 4 MG Mouth/Throat 00536311337 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 4 MG Mouth/Throat 00536338701 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 4 MG Mouth/Throat 00536340501 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 4 MG Mouth/Throat 45802000125 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 4 MG Mouth/Throat 63739036810 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 4 MG Mouth/Throat 63739036910 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 4 MG Mouth/Throat 70000034101 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 4 MG Mouth/Throat 70000034201 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 4 MG Mouth/Throat 70000034301 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 4 MG Mouth/Throat 70000034401 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Gum 4 MG Mouth/Throat 70000034402 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Lozenge 2 MG Mouth/Throat 43598048672 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Lozenge 2 MG Mouth/Throat 45802008901 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Lozenge 2 MG Mouth/Throat 45802008902 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Lozenge 2 MG Mouth/Throat 45802034403 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Lozenge 2 MG Mouth/Throat 45802034405 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Lozenge 2 MG Mouth/Throat 70000011701 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Lozenge 2 MG Mouth/Throat 70000034901 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Lozenge 2 MG Mouth/Throat 70000056201 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Lozenge 4 MG Mouth/Throat 43598048772 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Lozenge 4 MG Mouth/Throat 45802087303 AGENTS - MISC.* *Smoking Deterrents***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

*PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Lozenge 4 MG Mouth/Throat 45802087305 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Lozenge 4 MG Mouth/Throat 45802095701 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Lozenge 4 MG Mouth/Throat 45802095702 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Lozenge 4 MG Mouth/Throat 70000012100 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Lozenge 4 MG Mouth/Throat 70000035001 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Lozenge 4 MG Mouth/Throat 70000055901 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Nicotine Polacrilex Lozenge 4 MG Mouth/Throat 70000056101 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Polacrilex Mini Lozenge 2 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 70000056001 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Step 1 Patch 24 Hour 21 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 68001043488 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Step 1 Patch 24 Hour 21 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 68001043490 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Step 1 Patch 24 Hour 21 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 68001043491 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Step 1 Patch 24 Hour 21 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 70000051201 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Step 1 Patch 24 Hour 21 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 70000051202 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Step 2 Patch 24 Hour 14 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 00536110788 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Step 2 Patch 24 Hour 14 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 68001043388 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Step 2 Patch 24 Hour 14 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 68001043390 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Step 2 Patch 24 Hour 14 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 70000051101 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Step 2 Patch 24 Hour 14 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 70000051102 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Step 3 Patch 24 Hour 7 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 00536110688 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Step 3 Patch 24 Hour 7 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 68001043288 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Step 3 Patch 24 Hour 7 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 68001043290 AGENTS - MISC.* *Smoking Deterrents*** Nicotine Step 3 Patch 24 Hour 7 MG/24HR *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Transdermal 70000051001 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL SM Nicotine Gum 4 MG Mouth/Throat 49348069236 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL SM Nicotine Gum 4 MG Mouth/Throat 49348078810 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL SM Nicotine Lozenge 2 MG Mouth/Throat 49348085216 AGENTS - MISC.* *Smoking Deterrents***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

*PSYCHOTHERAPEUTIC AND NEUROLOGICAL SM Nicotine Lozenge 2 MG Mouth/Throat 70677008901 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL SM Nicotine Polacrilex Gum 2 MG Mouth/Throat 49348057308 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL SM Nicotine Polacrilex Gum 2 MG Mouth/Throat 49348057336 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL SM Nicotine Polacrilex Gum 2 MG Mouth/Throat 49348069136 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL SM Nicotine Polacrilex Gum 2 MG Mouth/Throat 49348078710 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL SM Nicotine Polacrilex Gum 2 MG Mouth/Throat 70677008501 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL SM Nicotine Polacrilex Gum 4 MG Mouth/Throat 49348057208 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL SM Nicotine Polacrilex Gum 4 MG Mouth/Throat 49348057236 AGENTS - MISC.* *Smoking Deterrents*** *PSYCHOTHERAPEUTIC AND NEUROLOGICAL SM Nicotine Polacrilex Gum 4 MG Mouth/Throat 70677008601 AGENTS - MISC.* *Smoking Deterrents*** SM Nicotine Polacrilex Lozenge 2 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 70677008701 AGENTS - MISC.* *Smoking Deterrents*** SM Nicotine Polacrilex Lozenge 4 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 49348085316 AGENTS - MISC.* *Smoking Deterrents*** SM Nicotine Polacrilex Lozenge 4 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 70677008801 AGENTS - MISC.* *Smoking Deterrents*** SM Nicotine Polacrilex Lozenge 4 MG *PSYCHOTHERAPEUTIC AND NEUROLOGICAL Mouth/Throat 70677009001 AGENTS - MISC.* *Smoking Deterrents***

Acid Reducer Maximum Strength Tablet 20 MG *ULCER Oral 70000004901 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *H-2 Antagonists***

*ULCER Acid Reducer Tablet 10 MG Oral 00113014165 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *H-2 Antagonists***

*ULCER Acid Reducer Tablet 10 MG Oral 70000004801 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *H-2 Antagonists***

Famotidine Maximum Strength Tablet 20 MG *ULCER Oral 00536129801 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *H-2 Antagonists***

Famotidine Maximum Strength Tablet 20 MG *ULCER Oral 55111039601 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *H-2 Antagonists***

*ULCER Famotidine Orig St Tablet 10 MG Oral 55111011890 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *H-2 Antagonists***

*ULCER GNP Acid Reducer Max St Tablet 20 MG Oral 24385038571 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *H-2 Antagonists***

*ULCER GNP Acid Reducer Tablet 10 MG Oral 46122039475 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *H-2 Antagonists***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

*ULCER GNP Heartburn Relief Tablet 200 MG Oral 24385011165 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *H-2 Antagonists***

*ULCER Heartburn Relief Max St Tablet 20 MG Oral 00904578017 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *H-2 Antagonists***

*ULCER Heartburn Relief Tablet 10 MG Oral 00904552952 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *H-2 Antagonists***

*ULCER Heartburn Relief Tablet 10 MG Oral 00904552987 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *H-2 Antagonists***

*ULCER HM Famotidine Tablet 10 MG Oral 62011014201 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *H-2 Antagonists***

*ULCER SM Acid Reducer Max St Tablet 20 MG Oral 49348081709 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *H-2 Antagonists***

*ULCER SM Acid Reducer Tablet 10 MG Oral 49348012812 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *H-2 Antagonists***

*ULCER SM Acid Reducer Tablet 10 MG Oral 49348012813 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *H-2 Antagonists***

*ULCER SM Acid Reducer Tablet 10 MG Oral 49348012844 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *H-2 Antagonists***

*ULCER SM Acid Reducer TABLET 200 MG ORAL 49348024644 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *H-2 Antagonists***

GNP Esomeprazole Magnesium Capsule Delayed *ULCER Release 20 MG Oral 46122064104 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *Proton Pump Inhibitors***

GNP Esomeprazole Magnesium Capsule Delayed *ULCER Release 20 MG Oral 46122064803 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *Proton Pump Inhibitors***

GNP Esomeprazole Magnesium Capsule Delayed *ULCER Release 20 MG Oral 46122064804 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *Proton Pump Inhibitors***

GNP Esomeprazole Magnesium Capsule Delayed *ULCER Release 20 MG Oral 46122064874 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *Proton Pump Inhibitors***

Lansoprazole Capsule Delayed Release 15 MG *ULCER Oral 00536123613 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *Proton Pump Inhibitors***

Omeprazole Magnesium Tablet Delayed Release *ULCER 20 MG Oral 00536132213 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *Proton Pump Inhibitors***

Omeprazole Magnesium Tablet Delayed Release *ULCER 20 MG Oral 00536132271 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *Proton Pump Inhibitors***

Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Omeprazole Magnesium Tablet Delayed Release *ULCER 20 MG Oral 00536132288 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *Proton Pump Inhibitors***

Omeprazole Magnesium Tablet Delayed Release *ULCER 20 MG Oral 69230031835 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *Proton Pump Inhibitors***

Omeprazole Magnesium Tablet Delayed Release *ULCER 20 MG Oral 69230031836 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *Proton Pump Inhibitors***

Omeprazole Magnesium Tablet Delayed Release *ULCER 20 MG Oral 69230031837 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *Proton Pump Inhibitors***

Omeprazole Magnesium Tablet Delayed Release *ULCER 20 MG Oral 70000052101 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *Proton Pump Inhibitors***

Omeprazole Magnesium Tablet Delayed Release *ULCER 20 MG Oral 70000052102 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *Proton Pump Inhibitors***

Omeprazole Magnesium Tablet Delayed Release *ULCER 20 MG Oral 70000052103 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *Proton Pump Inhibitors***

Omeprazole Magnesium Tablet Delayed Release *ULCER 20 MG Oral 70000052104 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *Proton Pump Inhibitors***

*ULCER Omeprazole Tablet Delayed Release 20 MG Oral 68001044139 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *Proton Pump Inhibitors***

*ULCER Omeprazole Tablet Delayed Release 20 MG Oral 68001044140 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *Proton Pump Inhibitors***

*ULCER Omeprazole Tablet Delayed Release 20 MG Oral 68001044198 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *Proton Pump Inhibitors***

QC Lansoprazole Capsule Delayed Release 15 MG *ULCER Oral 63868042914 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *Proton Pump Inhibitors***

QC Lansoprazole Capsule Delayed Release 15 MG *ULCER Oral 63868042942 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *Proton Pump Inhibitors***

SM Lansoprazole Capsule Delayed Release 15 MG *ULCER Oral 49348030161 DRUGS/ANTISPASMODICS/ANTICHOLINERGICS* *Proton Pump Inhibitors*** Oxytrol For Women Patch Twice Weekly 3.9 *Urinary Antispasmodic - Antimuscarinic MG/24HR Transdermal 00023963704 *URINARY ANTISPASMODICS* (Anticholinergic)*** Oxytrol For Women Patch Twice Weekly 3.9 *Urinary Antispasmodic - Antimuscarinic MG/24HR Transdermal 00023963708 *URINARY ANTISPASMODICS* (Anticholinergic)*** Clotrimazole Cream 1 % Vaginal 51672200306 *VAGINAL AND RELATED PRODUCTS* *Imidazole-Related Antifungals*** Clotrimazole Cream 1 % Vaginal 61269022063 *VAGINAL AND RELATED PRODUCTS* *Imidazole-Related Antifungals*** GNP Miconazole 7 CREAM 2 % VAGINAL 24385059029 *VAGINAL AND RELATED PRODUCTS* *Imidazole-Related Antifungals*** Miconazole 3 Combo-Supp Kit 200 & 2 MG-% (9GM) Vaginal 70000002501 *VAGINAL AND RELATED PRODUCTS* *Imidazole-Related Antifungals*** Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Miconazole 3 Combo-Supp Kit 200 & 2 MG-% (9GM) Vaginal 70000002502 *VAGINAL AND RELATED PRODUCTS* *Imidazole-Related Antifungals*** Miconazole 7 Cream 2 % Vaginal 00904773445 *VAGINAL AND RELATED PRODUCTS* *Imidazole-Related Antifungals*** Miconazole 7 Cream 2 % Vaginal 61269073041 *VAGINAL AND RELATED PRODUCTS* *Imidazole-Related Antifungals*** Miconazole 7 Cream 2 % Vaginal 61269073063 *VAGINAL AND RELATED PRODUCTS* *Imidazole-Related Antifungals*** Miconazole 7 Cream 2 % Vaginal 70000000901 *VAGINAL AND RELATED PRODUCTS* *Imidazole-Related Antifungals*** Miconazole 7 Suppository 100 MG Vaginal 61269073607 *VAGINAL AND RELATED PRODUCTS* *Imidazole-Related Antifungals*** Miconazole Nitrate Cream 2 % Vaginal 51672203506 *VAGINAL AND RELATED PRODUCTS* *Imidazole-Related Antifungals*** SM Miconazole 7 CREAM 2 % VAGINAL 49348053077 *VAGINAL AND RELATED PRODUCTS* *Imidazole-Related Antifungals*** SM Miconazole 7 CREAM 2 % VAGINAL 49348087277 *VAGINAL AND RELATED PRODUCTS* *Imidazole-Related Antifungals*** SM Miconazole 7 SUPPOSITORY 100 MG VAGINAL 49348083361 *VAGINAL AND RELATED PRODUCTS* *Imidazole-Related Antifungals*** Options Gynol II Contraceptive Gel 3 % Vaginal 34362030201 *VAGINAL AND RELATED PRODUCTS* *Spermicides*** VCF Vaginal Contraceptive Film 28 % Vaginal 52925011201 *VAGINAL AND RELATED PRODUCTS* *Spermicides*** Biotin Capsule 5 MG Oral 74312013430 *VITAMINS* *Biotin*** Biotin Maximum Strength CAPSULE 5000 MCG ORAL 40985027116 *VITAMINS* *Biotin*** Biotin Tablet 5 MG Oral 10542009512 *VITAMINS* *Biotin*** Meribin Capsule 5 MG Oral 00394013012 *VITAMINS* *Biotin*** Vitamin A Capsule 3 MG (10000 UT) Oral 00904208560 *VITAMINS* *Vitamin A*** GNP Vitamin B-1 TABLET 100 MG ORAL 87701040729 *VITAMINS* *Vitamin B-1*** Thiamine HCl Tablet 100 MG Oral 10006070011 *VITAMINS* *Vitamin B-1*** Thiamine HCl Tablet 100 MG Oral 10006073021 *VITAMINS* *Vitamin B-1*** Thiamine HCl Tablet 100 MG Oral 80681009800 *VITAMINS* *Vitamin B-1*** Niacin ER Tablet Extended Release 500 MG Oral 80681009000 *VITAMINS* *Vitamin B-3*** Niacin Tablet 500 MG Oral 00904227260 *VITAMINS* *Vitamin B-3*** Niacinamide Tablet 500 MG Oral 80681001900 *VITAMINS* *Vitamin B-3*** Vitamin B-6 Tablet 100 MG Oral 51645091001 *VITAMINS* *Vitamin B-6*** Vitamin B-6 Tablet 100 MG Oral 74312000650 *VITAMINS* *Vitamin B-6*** Vitamin B-6 Tablet 100 MG Oral 80681002500 *VITAMINS* *Vitamin B-6*** Vitamin B-6 Tablet 25 MG Oral 00536440601 *VITAMINS* *Vitamin B-6*** Vitamin B6 Tablet 50 MG Oral 10006073017 *VITAMINS* *Vitamin B-6*** Vitamin B-6 Tablet 50 MG Oral 10006073016 *VITAMINS* *Vitamin B-6*** Ascorbic Acid Tablet 500 MG Oral 00904052360 *VITAMINS* *Vitamin C*** Ascorbic Acid Tablet 500 MG Oral 00904052361 *VITAMINS* *Vitamin C*** Ascorbic Acid Tablet 500 MG Oral 00904052372 *VITAMINS* *Vitamin C*** Ascorbic Acid Tablet 500 MG Oral 00904052380 *VITAMINS* *Vitamin C*** Vitamin C Tablet 250 MG Oral 20555000100 *VITAMINS* *Vitamin C*** Vitamin C Tablet Chewable 250 MG Oral 80681012900 *VITAMINS* *Vitamin C*** Ergocalciferol Solution 200 MCG/ML Oral 69543023460 *VITAMINS* *Vitamin D*** GNP Vitamin D Tablet 25 MCG (1000 UT) Oral 87701040749 *VITAMINS* *Vitamin D*** Last Updated 09/20/21

Common Covered Over-the-Counter Products DRUG NAME NDC CATEGORY CLASS

Vitamin D Liquid 10 MCG/ML Oral 50383091750 *VITAMINS* *Vitamin D*** Vitamin D Tablet 50 MCG (2000 UT) Oral 80681013200 *VITAMINS* *Vitamin D*** Vitamin D3 Capsule 50 MCG (2000 UT) Oral 80681000900 *VITAMINS* *Vitamin D*** Vitamin D3 Tablet 25 MCG (1000 UT) Oral 00904582460 *VITAMINS* *Vitamin D*** Vitamin D3 Tablet 25 MCG (1000 UT) Oral 51645091999 *VITAMINS* *Vitamin D*** Vitamin D3 Tablet 25 MCG (1000 UT) Oral 80681016800 *VITAMINS* *Vitamin D*** Vitamin D3 Tablet 25 MCG (1000 UT) Oral 80681016900 *VITAMINS* *Vitamin D*** Vitamin D3 Tablet 25 MCG Oral 20555003300 *VITAMINS* *Vitamin D*** Vitamin D3 Tablet 25 MCG Oral 80681016801 *VITAMINS* *Vitamin D*** Vitamin D3 Tablet 50 MCG (2000 UT) Oral 54629041120 *VITAMINS* *Vitamin D*** Vitamin D3 Tablet 50 MCG (2000 UT) Oral 80681017000 *VITAMINS* *Vitamin D*** Aqua-E Liquid 75 UNIT/ML Oral 68176000017 *VITAMINS* *Vitamin E***

Last Updated 09/20/21