Short Form Disclosure

Information for Vermont Prescribers of Prescription Drugs (Short Form)

XCOPRI® (cenobamate tablets) CV

• This list does not imply that the products on this chart are interchangeable or have the same efficacy or safety. Please refer to the product’s FDA-approved label and indication for further information.

• The prices listed below are Average Wholesale Prices (“AWP”) as established and made available to the public by a third-party publisher or as calculated from data made available to the public by a third-party publisher. The price paid by consumers may be higher or lower than the prices listed below. Information about AWP of these drugs is being provided to Vermont prescribers pursuant to Vermont law, to give you information about the relative prices of marketed drugs and other drugs in the same therapeutic class.

• The prices listed here do not necessarily reflect price per dosage, price per course of treatment or the cost effectiveness, of all the products listed. For simplicity, only the smallest package sizes available for each product are included.

Price Comparison: Marketed product and lowest dosage of other products in same therapeutic class*

Marketed Product Unit Price XCOPRI® Cenobamate Tablets 50mg $39.40

Other Products Unit Price 100 mg $ 0.08 25 mg $ 0.13 25 mg $ 0.17 25 mg $ 0.30 50 mg $ 0.35 150 mg $ 0.37 DIVALPROEX SODIUM 125 mg $ 0.55 SODIUM EXTENDED 100 mg $ 0.58 ER 500 mg $ 0.82 DIVALPROEX SODIUM ER 250 mg $ 0.87 200 mg $ 1.04 0.125 mg $ 1.12 DILANTIN 30 mg $ 1.41 10 mg $ 1.50 EPITOL 200 mg $ 1.54 TEGRETOL XR 100 mg $ 1.63 CARBAMAZEPINE ER 100 mg $ 1.64 250 mg $ 1.67 PHENYTEK 200 mg $ 1.75 DEPAKOTE SPRINKLE 125 mg $ 2.03 CARBATROL 100 mg $ 2.13 1

DEPAKOTE 125 mg $ 2.13 NEURONTIN 100 mg $ 2.81 KLONOPIN 0.5 mg $ 3.02 TEGRETOL 200 mg $ 3.04 PEGANONE 250 mg $ 3.51 DEPAKOTE ER 250 mg $ 3.92 LAMOTRIGINE ER 25 mg $ 4.01 400 mg $ 4.21 CELONTIN 300 mg $ 5.12 TRILEPTAL 150 mg $ 5.73 TOPAMAX 15 mg $ 7.01 HCL 2 mg $ 7.62 TOPIRAMATE ER 25 mg $ 8.28 LAMOTRIGINE ODT 25 mg $ 8.56 OXTELLAR XR 150 mg $ 8.58 KEPPRA XR 500 mg $ 8.81 QUDEXY XR 25 mg $ 10.15 SPRITAM 250 mg $ 10.37 LAMOTRIGINE ODT (BLUE) 25 mg (21)-50 mg (7) $ 10.93 GABITRIL 2 mg $ 11.94 VIMPAT 50 mg $ 11.96 TROKENDI XR 25 mg $ 12.39 LAMICTAL ODT 25 mg $ 13.28 LAMICTAL XR 25 mg $ 13.88 FELBATOL 400 mg $ 15.17 BANZEL 200 mg $ 15.20 LAMICTAL 25 mg $ 15.79 LAMICTAL (BLUE) 25 mg (35 tabs) $ 15.79 ZONEGRAN 25 mg $ 16.20 LAMICTAL ODT (BLUE) 25 mg (21)-50 mg (7) $ 16.60 LAMICTAL XR (BLUE) 25 mg (21)-50 mg (7) $ 17.36 MYSOLINE 50 mg $ 17.82 FYCOMPA 2 mg $ 20.40 BRIVIACT 10 mg $ 23.59 ONFI 10 mg $ 26.43 APTIOM 200 mg $ 40.62 500 mg $ 95.41 VIGADRONE 500 mg $ 112.57 SABRIL 500 mg $ 192.00 DIASTAT 2.5 mg $ 354.82 PENTICAN 100 mg-5 % $ 3,681.60 LIPRITIN 100 mg-2.5 %-2.5 %-6 cm X 7 cm $ 3,930.00

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*Prices shown are the lowest dosage of each product. Prices for multi-source products have been averaged. Multiple forms of the same product (e.g., tabs and caps) have been considered one product, and the prices have been averaged. Chewable forms of the product are not included.

For additional price comparison information, see: https://vtrxlaw.com or [http://sklifesci.com/innovation.html#/transparency].

XCOPRI® is a registered trademark of SK Biopharmaceuticals, Co., Ltd.

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