Information for Vermont Prescribers of Prescription Drugs

NUEDEXTA® (dextromethorphan hydrobromide and quinidine sulfate) Capsules 20mg/10mg

• This list does not imply that the products on this chart are interchangeable or have the same efficacy or safety. Please refer to each 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.

Note: Avanir does not set or suggest the prices listed on this disclosure form.

Product Name Manufacturer NDC Package Size Price/Pack Price/Pill Marketed Product Nuedexta Capsule Avanir Pharmaceuticals, Inc. 64597-0301-60 60 $1,602.00 $26.70

Other Products Acamprosate Calcium 333mg Delayed-Release Tablet Glenmark Pharmaceuticals 68462-0435-18 180$ 316.26 $ 1.76 Acamprosate Calcium 333mg Delayed-Release Tablet Mylan Pharmaceuticals Inc. 00378-6333-80 180$ 249.50 $ 1.39 Acamprosate Calcium 333mg Delayed-Release Tablet Mylan Institutional LLC 51079-0241-06 50$ 72.95 $ 1.46 Acamprosate Calcium 333mg Delayed-Release Tablet Mylan Institutional LLC 51079-0241-01 1 $ 1.46 $ 1.46 Acamprosate Calcium 333mg Delayed-Release Tablet American Health Packaging 60687-0121-25 30$ 70.76 $ 2.36 Acamprosate Calcium 333mg Delayed-Release Tablet American Health Packaging 60687-0121-95 1 $ 2.36 $ 2.36 Acamprosate Calcium 333mg Delayed-Release Tablet Teva Pharmaceuticals USA 00093-5352-86 180$ 316.26 $ 1.76 Acamprosate Calcium 333mg Delayed-Release Tablet AvKARE, Inc. 42291-0104-18 180$ 316.26 $ 1.76 Acamprosate Calcium 333mg Delayed-Release Tablet Marlex Pharmaceuticals 10135-0636-32 180$ 486.95 $ 2.71 Acamprosate Calcium 333mg Delayed-Release Tablet Zydus Pharmaceuticals (USA) Inc. 68382-0569-28 180$ 316.26 $ 1.76

Atomoxetine 100mg Capsule Glenmark Pharmaceuticals 68462-0271-30 30$ 500.58 $ 16.69 Atomoxetine 100mg Capsule Prasco Laboratories 66993-0046-30 30$ 500.02 $ 16.67 Atomoxetine 100mg Capsule Teva Pharmaceuticals USA 00093-3548-56 30$ 500.58 $ 16.69 Atomoxetine 100mg Capsule Rising Pharmaceuticals Inc 64980-0379-03 30$ 500.58 $ 16.69 Atomoxetine 100mg Capsule Apotex Corp 60505-2836-03 30$ 500.58 $ 16.69 Atomoxetine 100mg Capsule Golden State Medical Supply, Inc. 51407-0106-30 30$ 212.91 $ 7.10 Atomoxetine 100mg Capsule NorthStar Rx LLC 16714-0761-01 30$ 500.44 $ 16.68 Atomoxetine 100mg Capsule Dr. Reddy's Laboratories, Inc. 55111-0564-30 30$ 500.58 $ 16.69 Atomoxetine 100mg Capsule Burel Pharmaceuticals 35573-0421-30 30$ 500.02 $ 16.67

Atomoxetine 10mg Capsule Glenmark Pharmaceuticals 68462-0265-30 30$ 427.03 $ 14.23 Atomoxetine 10mg Capsule Prasco Laboratories 66993-0040-30 30$ 426.56 $ 14.22 Atomoxetine 10mg Capsule Teva Pharmaceuticals USA 00093-3542-56 30$ 427.03 $ 14.23 Atomoxetine 10mg Capsule Rising Pharmaceuticals Inc 64980-0373-03 30$ 427.03 $ 14.23 Atomoxetine 10mg Capsule Apotex Corp 60505-2830-03 30$ 427.03 $ 14.23 Atomoxetine 10mg Capsule Golden State Medical Supply, Inc. 51407-0100-30 30$ 176.76 $ 5.89 Atomoxetine 10mg Capsule NorthStar Rx LLC 16714-0755-01 30$ 426.89 $ 14.23 Atomoxetine 10mg Capsule Dr. Reddy's Laboratories, Inc. 55111-0519-30 30$ 427.03 $ 14.23 Atomoxetine 10mg Capsule Burel Pharmaceuticals 35573-0415-30 30$ 426.56 $ 14.22

Atomoxetine 18mg Capsule Glenmark Pharmaceuticals 68462-0266-30 30$ 427.03 $ 14.23 Atomoxetine 18mg Capsule Prasco Laboratories 66993-0041-30 30$ 426.56 $ 14.22 Atomoxetine 18mg Capsule Teva Pharmaceuticals USA 00093-3543-56 30$ 427.03 $ 14.23 Atomoxetine 18mg Capsule Rising Pharmaceuticals Inc 64980-0374-03 30$ 427.03 $ 14.23 Atomoxetine 18mg Capsule Apotex Corp 60505-2831-03 30$ 427.03 $ 14.23 Atomoxetine 18mg Capsule Golden State Medical Supply, Inc. 51407-0101-30 30$ 175.77 $ 5.86 Atomoxetine 18mg Capsule NorthStar Rx LLC 16714-0756-01 30$ 426.91 $ 14.23 Atomoxetine 18mg Capsule Dr. Reddy's Laboratories, Inc. 55111-0520-30 30$ 427.03 $ 14.23 Atomoxetine 18mg Capsule Burel Pharmaceuticals 35573-0416-30 30$ 426.56 $ 14.22 Atomoxetine 25mg Capsule Glenmark Pharmaceuticals 68462-0267-30 30$ 427.03 $ 14.23 Atomoxetine 25mg Capsule Prasco Laboratories 66993-0042-30 30$ 426.56 $ 14.22 Atomoxetine 25mg Capsule Teva Pharmaceuticals USA 00093-3544-56 30$ 427.03 $ 14.23 Atomoxetine 25mg Capsule Rising Pharmaceuticals Inc 64980-0375-03 30$ 427.03 $ 14.23 Atomoxetine 25mg Capsule Apotex Corp 60505-2832-03 30$ 427.03 $ 14.23 Atomoxetine 25mg Capsule Golden State Medical Supply, Inc. 51407-0102-30 30$ 171.45 $ 5.72 Atomoxetine 25mg Capsule NorthStar Rx LLC 16714-0757-01 30$ 426.88 $ 14.23 Atomoxetine 25mg Capsule Dr. Reddy's Laboratories, Inc. 55111-0528-30 30$ 427.03 $ 14.23 Atomoxetine 25mg Capsule Burel Pharmaceuticals 35573-0417-30 30$ 426.56 $ 14.22 Atomoxetine 25mg Capsule AvPAK; a Division of AvKARE Inc 50268-0057-13 30$ 126.40 $ 4.21 Atomoxetine 25mg Capsule AvPAK; a Division of AvKARE Inc 50268-0057-11 1 $ 4.21 $ 4.21 Atomoxetine 25mg Capsule American Health Packaging 60687-0567-21 30$ 132.00 $ 4.40 Atomoxetine 25mg Capsule American Health Packaging 60687-0567-11 1 $ 4.40 $ 4.40

Atomoxetine 40mg Capsule Prasco Laboratories 66993-0043-30 30$ 463.45 $ 15.45 Atomoxetine 40mg Capsule Glenmark Pharmaceuticals 68462-0268-30 30$ 463.97 $ 15.47 Atomoxetine 40mg Capsule Teva Pharmaceuticals USA 00093-3545-56 30$ 463.97 $ 15.47 Atomoxetine 40mg Capsule Rising Pharmaceuticals Inc 64980-0376-03 30$ 463.97 $ 15.47 Atomoxetine 40mg Capsule American Health Packaging 60687-0326-25 30$ 227.63 $ 7.59 Atomoxetine 40mg Capsule American Health Packaging 60687-0326-95 1 $ 7.59 $ 7.59 Atomoxetine 40mg Capsule Apotex Corp 60505-2833-03 30$ 463.97 $ 15.47 Atomoxetine 40mg Capsule Golden State Medical Supply, Inc. 51407-0103-30 30$ 181.68 $ 6.06 Atomoxetine 40mg Capsule NorthStar Rx LLC 16714-0758-01 30$ 463.82 $ 15.46 Atomoxetine 40mg Capsule Dr. Reddy's Laboratories, Inc. 55111-0521-30 30$ 463.97 $ 15.47 Atomoxetine 40mg Capsule Burel Pharmaceuticals 35573-0418-30 30$ 463.46 $ 15.45 Atomoxetine 40mg Capsule AvPAK; a Division of AvKARE Inc 50268-0058-13 30$ 227.63 $ 7.59 Atomoxetine 40mg Capsule AvPAK; a Division of AvKARE Inc 50268-0058-11 1 $ 7.59 $ 7.59

Atomoxetine 60mg Capsule Glenmark Pharmaceuticals 68462-0269-30 30$ 463.97 $ 15.47 Atomoxetine 60mg Capsule Prasco Laboratories 66993-0044-30 30$ 463.45 $ 15.45 Atomoxetine 60mg Capsule Teva Pharmaceuticals USA 00093-3546-56 30$ 463.97 $ 15.47 Atomoxetine 60mg Capsule Rising Pharmaceuticals Inc 64980-0377-03 30$ 463.97 $ 15.47 Atomoxetine 60mg Capsule Apotex Corp 60505-2834-03 30$ 463.97 $ 15.47 Atomoxetine 60mg Capsule Golden State Medical Supply, Inc. 51407-0104-30 30$ 187.11 $ 6.24 Atomoxetine 60mg Capsule NorthStar Rx LLC 16714-0759-01 30$ 463.81 $ 15.46 Atomoxetine 60mg Capsule Dr. Reddy's Laboratories, Inc. 55111-0522-30 30$ 463.97 $ 15.47 Atomoxetine 60mg Capsule Burel Pharmaceuticals 35573-0419-30 30$ 463.46 $ 15.45 Atomoxetine 60mg Capsule AvPAK; a Division of AvKARE Inc 50268-0059-13 30$ 171.77 $ 5.73 Atomoxetine 60mg Capsule AvPAK; a Division of AvKARE Inc 50268-0059-11 1 $ 5.73 $ 5.73

Atomoxetine 80mg Capsule Glenmark Pharmaceuticals 68462-0270-30 30$ 500.58 $ 16.69 Atomoxetine 80mg Capsule Prasco Laboratories 66993-0045-30 30$ 500.02 $ 16.67 Atomoxetine 80mg Capsule Teva Pharmaceuticals USA 00093-3547-56 30$ 500.58 $ 16.69 Atomoxetine 80mg Capsule Rising Pharmaceuticals Inc 64980-0378-03 30$ 500.58 $ 16.69 Atomoxetine 80mg Capsule Apotex Corp 60505-2835-03 30$ 500.58 $ 16.69 Atomoxetine 80mg Capsule Golden State Medical Supply, Inc. 51407-0105-30 30$ 196.41 $ 6.55 Atomoxetine 80mg Capsule NorthStar Rx LLC 16714-0760-01 30$ 500.41 $ 16.68 Atomoxetine 80mg Capsule Dr. Reddy's Laboratories, Inc. 55111-0563-30 30$ 500.58 $ 16.69 Atomoxetine 80mg Capsule Burel Pharmaceuticals 35573-0420-30 30$ 500.02 $ 16.67

Guanfacine 1mg Extended-Release Tablet Teva/Actavis US 00228-2850-11 100$ 1,049.11 $ 10.49 Guanfacine 1mg Extended-Release Tablet Teva Pharmaceuticals USA 00093-5960-01 100$ 1,049.11 $ 10.49 Guanfacine 1mg Extended-Release Tablet Mylan Pharmaceuticals Inc. 00378-1061-01 100$ 1,047.95 $ 10.48 Guanfacine 1mg Extended-Release Tablet Sandoz Inc. a Novartis Company 00781-5451-01 100$ 687.50 $ 6.88 Guanfacine 1mg Extended-Release Tablet AvKARE, Inc. 42291-0324-01 100$ 1,049.11 $ 10.49 Guanfacine 1mg Extended-Release Tablet TWi Pharmaceuticals USA, Inc. 24979-0533-01 100$ 1,049.11 $ 10.49 Guanfacine 1mg Extended-Release Tablet Sun Pharmaceutical Industries, Inc. 63304-0924-01 100$ 1,049.11 $ 10.49 Guanfacine 1mg Extended-Release Tablet Apotex Corp 60505-3927-01 100$ 1,049.11 $ 10.49

Guanfacine 2mg Extended-Release Tablet Teva/Actavis US 00228-2851-11 100$ 1,049.11 $ 10.49 Guanfacine 2mg Extended-Release Tablet Teva Pharmaceuticals USA 00093-5961-01 100$ 1,049.11 $ 10.49 Guanfacine 2mg Extended-Release Tablet Mylan Pharmaceuticals Inc. 00378-1062-01 100$ 1,047.95 $ 10.48 Guanfacine 2mg Extended-Release Tablet Sandoz Inc. a Novartis Company 00781-5452-01 100$ 687.50 $ 6.88 Guanfacine 2mg Extended-Release Tablet AvKARE, Inc. 42291-0325-01 100$ 1,049.11 $ 10.49 Guanfacine 2mg Extended-Release Tablet TWi Pharmaceuticals USA, Inc. 24979-0534-01 100$ 1,049.11 $ 10.49 Guanfacine 2mg Extended-Release Tablet Sun Pharmaceutical Industries, Inc. 63304-0925-01 100$ 1,049.11 $ 10.49 Guanfacine 2mg Extended-Release Tablet Apotex Corp 60505-3928-01 100$ 1,049.11 $ 10.49

Guanfacine 3mg Extended-Release Tablet Teva/Actavis US 00228-2853-11 100$ 1,049.11 $ 10.49 Guanfacine 3mg Extended-Release Tablet Mylan Pharmaceuticals Inc. 00378-1063-01 100$ 1,047.95 $ 10.48 Guanfacine 3mg Extended-Release Tablet Sandoz Inc. a Novartis Company 00781-5456-01 100$ 687.50 $ 6.88 Guanfacine 3mg Extended-Release Tablet AvKARE, Inc. 42291-0326-01 100$ 1,049.11 $ 10.49 Guanfacine 3mg Extended-Release Tablet TWi Pharmaceuticals USA, Inc. 24979-0536-01 100$ 1,049.11 $ 10.49 Guanfacine 3mg Extended-Release Tablet Sun Pharmaceutical Industries, Inc. 63304-0926-01 100$ 1,049.11 $ 10.49 Guanfacine 3mg Extended-Release Tablet Apotex Corp 60505-3929-01 100$ 1,049.11 $ 10.49

Guanfacine 4mg Extended-Release Tablet Teva/Actavis US 00228-2855-11 100$ 1,049.11 $ 10.49 Guanfacine 4mg Extended-Release Tablet Mylan Pharmaceuticals Inc. 00378-1065-01 100$ 1,047.95 $ 10.48 Guanfacine 4mg Extended-Release Tablet Sandoz Inc. a Novartis Company 00781-5457-01 100$ 687.50 $ 6.88 Guanfacine 4mg Extended-Release Tablet AvKARE, Inc. 42291-0327-01 100$ 1,049.11 $ 10.49 Guanfacine 4mg Extended-Release Tablet TWi Pharmaceuticals USA, Inc. 24979-0538-01 100$ 1,049.11 $ 10.49 Guanfacine 4mg Extended-Release Tablet Sun Pharmaceutical Industries, Inc. 63304-0927-01 100$ 1,049.11 $ 10.49 Guanfacine 4mg Extended-Release Tablet Apotex Corp 60505-3930-01 100$ 1,049.11 $ 10.49 Guanfacine Hydrochloride 1mg Tablet Mylan Pharmaceuticals Inc. 00378-1160-01 100$ 87.20 $ 0.87 Guanfacine Hydrochloride 1mg Tablet Teva/Actavis US 00591-0444-01 100$ 87.20 $ 0.87 Guanfacine Hydrochloride 1mg Tablet Amneal Pharmaceuticals LLC 65162-0711-10 100$ 101.60 $ 1.02 Guanfacine Hydrochloride 1mg Tablet AvKARE, Inc. 42291-0310-90 90$ 91.44 $ 1.02 Guanfacine Hydrochloride 1mg Tablet American Health Packaging 68084-0748-21 30$ 29.00 $ 0.97 Guanfacine Hydrochloride 1mg Tablet American Health Packaging 68084-0748-11 10$ 9.67 $ 0.97 Guanfacine Hydrochloride 1mg Tablet Epic Pharma LLC 42806-0048-01 100$ 127.00 $ 1.27 Guanfacine Hydrochloride 1mg Tablet American Health Packaging 68084-0748-25 30$ 58.63 $ 1.95 Guanfacine Hydrochloride 1mg Tablet American Health Packaging 68084-0748-95 1 $ 1.95 $ 1.95 Guanfacine Hydrochloride 1mg Tablet Golden State Medical Supply, Inc. 60429-0124-01 100$ 56.70 $ 0.57 Guanfacine Hydrochloride 1mg Tablet Golden State Medical Supply, Inc. 60429-0124-90 90$ 50.42 $ 0.56 Guanfacine Hydrochloride 1mg Tablet Golden State Medical Supply, Inc. 60429-0861-01 100$ 45.36 $ 0.45 Guanfacine Hydrochloride 1mg Tablet Golden State Medical Supply, Inc. 60429-0861-90 90$ 40.32 $ 0.45 Guanfacine Hydrochloride 1mg Tablet Blu Pharmaceuticals, LLC 24658-0730-01 100$ 87.20 $ 0.87 Guanfacine Hydrochloride 1mg Tablet Precision Dose, Inc. 68094-0019-62 30$ 51.47 $ 1.72 Guanfacine Hydrochloride 1mg Tablet Precision Dose, Inc. 68094-0019-59 1 $ 1.72 $ 1.72

Guanfacine Hydrochloride 2mg Tablet Teva/Actavis US 00591-0453-01 100$ 117.60 $ 1.18 Guanfacine Hydrochloride 2mg Tablet Mylan Pharmaceuticals Inc. 00378-1190-01 100$ 117.60 $ 1.18 Guanfacine Hydrochloride 2mg Tablet Amneal Pharmaceuticals LLC 65162-0713-10 100$ 156.30 $ 1.56 Guanfacine Hydrochloride 2mg Tablet Epic Pharma LLC 42806-0049-01 100$ 117.60 $ 1.18 Guanfacine Hydrochloride 2mg Tablet Golden State Medical Supply, Inc. 60429-0125-01 100$ 79.92 $ 0.80 Guanfacine Hydrochloride 2mg Tablet Golden State Medical Supply, Inc. 60429-0862-01 100$ 67.26 $ 0.67 Guanfacine Hydrochloride 2mg Tablet AvPAK; a Division of AvKARE Inc 50268-0374-15 50$ 128.91 $ 2.58 Guanfacine Hydrochloride 2mg Tablet AvPAK; a Division of AvKARE Inc 50268-0374-11 1 $ 2.58 $ 2.58 Guanfacine Hydrochloride 2mg Tablet Blu Pharmaceuticals, LLC 24658-0731-01 100$ 117.60 $ 1.18 Guanfacine Hydrochloride 2mg Tablet Epic Pharma LLC 42806-0296-01 100$ 201.21 $ 2.01

Memantine Hydrochloride 10mg Tablet Golden State Medical Supply, Inc. 51407-0285-60 60$ 37.50 $ 0.63 Memantine Hydrochloride 10mg Tablet American Health Packaging 60687-0184-57 60$ 48.00 $ 0.80 Memantine Hydrochloride 10mg Tablet American Health Packaging 60687-0184-11 1 $ 0.80 $ 0.80 Memantine Hydrochloride 10mg Tablet Alembic Pharmaceuticals, Inc. 62332-0076-42 3000$ 16,453.80 $ 5.48 Memantine Hydrochloride 10mg Tablet Alembic Pharmaceuticals, Inc. 62332-0076-71 500$ 2,833.71 $ 5.67 Memantine Hydrochloride 10mg Tablet Viona Pharmaceuticals Inc. 72578-0004-05 500$ 2,833.71 $ 5.67 Memantine Hydrochloride 10mg Tablet Unichem Pharmaceuticals USA, Inc 29300-0172-05 500$ 3,046.28 $ 6.09 Memantine Hydrochloride 10mg Tablet Lannett Company, Inc. 00527-1222-05 500$ 3,046.28 $ 6.09 Memantine Hydrochloride 10mg Tablet Alembic Pharmaceuticals, Inc. 62332-0076-60 60$ 365.64 $ 6.09 Memantine Hydrochloride 10mg Tablet MacLeods Pharma 33342-0298-15 500$ 3,047.00 $ 6.09 Memantine Hydrochloride 10mg Tablet Alembic Pharmaceuticals, Inc. 62332-0076-31 100$ 609.40 $ 6.09 Memantine Hydrochloride 10mg Tablet Sun Pharmaceutical Industries, Inc. 47335-0322-13 500$ 3,047.08 $ 6.09 Memantine Hydrochloride 10mg Tablet Sun Pharmaceutical Industries, Inc. 47335-0322-86 60$ 365.65 $ 6.09 Memantine Hydrochloride 10mg Tablet MacLeods Pharma 33342-0298-09 60$ 365.65 $ 6.09 Memantine Hydrochloride 10mg Tablet Unichem Pharmaceuticals USA, Inc 29300-0172-16 60$ 365.70 $ 6.10 Memantine Hydrochloride 10mg Tablet Lannett Company, Inc. 00527-1222-06 60$ 365.70 $ 6.10 Memantine Hydrochloride 10mg Tablet Dr. Reddy's Laboratories, Inc. 55111-0597-05 500$ 3,048.06 $ 6.10 Memantine Hydrochloride 10mg Tablet Ajanta Pharma USA Inc 27241-0071-05 500$ 3,048.08 $ 6.10 Memantine Hydrochloride 10mg Tablet Mylan Pharmaceuticals Inc. 00378-1104-91 60$ 365.77 $ 6.10 Memantine Hydrochloride 10mg Tablet Dr. Reddy's Laboratories, Inc. 55111-0597-60 60$ 365.77 $ 6.10 Memantine Hydrochloride 10mg Tablet Upsher-Smith Laboratories, LLC 00832-1113-60 60$ 365.77 $ 6.10 Memantine Hydrochloride 10mg Tablet Torrent Pharma, Inc 13668-0223-60 60$ 365.77 $ 6.10 Memantine Hydrochloride 10mg Tablet Ajanta Pharma USA Inc 27241-0071-06 60$ 365.77 $ 6.10 Memantine Hydrochloride 10mg Tablet Viona Pharmaceuticals Inc. 72578-0004-14 60$ 365.77 $ 6.10 Memantine Hydrochloride 10mg Tablet Amneal Pharmaceuticals 53746-0169-60 60$ 365.77 $ 6.10 Memantine Hydrochloride 10mg Tablet Teva/Actavis US 00591-3875-44 100$ 610.25 $ 6.10 Memantine Hydrochloride 10mg Tablet Teva/Actavis US 00591-3875-45 10$ 61.03 $ 6.10 Memantine Hydrochloride 10mg Tablet Mylan Institutional LLC 42292-0006-06 50$ 305.13 $ 6.10 Memantine Hydrochloride 10mg Tablet Mylan Institutional LLC 42292-0006-01 1 $ 6.10 $ 6.10 Memantine Hydrochloride 10mg Tablet Teva/Actavis US 00591-3875-60 60$ 366.17 $ 6.10 Memantine Hydrochloride 10mg Tablet Lupin Pharmaceuticals, Inc. 68180-0230-07 60$ 366.17 $ 6.10 Memantine Hydrochloride 10mg Tablet Aurobindo Pharma USA Inc. 65862-0653-60 60$ 366.17 $ 6.10 Memantine Hydrochloride 10mg Tablet Wockhardt USA, LLC 64679-0122-03 60$ 366.17 $ 6.10 Memantine Hydrochloride 10mg Tablet Aurobindo Pharma USA Inc. 65862-0653-99 1000$ 6,102.83 $ 6.10 Memantine Hydrochloride 10mg Tablet Wockhardt USA, LLC 64679-0122-02 500$ 3,051.42 $ 6.10

Memantine Hydrochloride 14mg Extended-Release Capsule Golden State Medical Supply, Inc. 51407-0055-90 90$ 1,104.99 $ 12.28 Memantine Hydrochloride 14mg Extended-Release Capsule Golden State Medical Supply, Inc. 51407-0055-30 30$ 368.34 $ 12.28 Memantine Hydrochloride 14mg Extended-Release Capsule Amneal Pharmaceuticals LLC 65162-0783-09 90$ 1,373.69 $ 15.26 Memantine Hydrochloride 14mg Extended-Release Capsule Mylan Pharmaceuticals Inc. 00378-5436-77 90$ 1,373.69 $ 15.26 Memantine Hydrochloride 14mg Extended-Release Capsule Amneal Pharmaceuticals LLC 65162-0783-03 30$ 457.90 $ 15.26 Memantine Hydrochloride 14mg Extended-Release Capsule Mylan Pharmaceuticals Inc. 00378-5436-93 30$ 457.90 $ 15.26 Memantine Hydrochloride 14mg Extended-Release Capsule NorthStar Rx LLC 16714-0960-02 90$ 1,374.89 $ 15.28 Memantine Hydrochloride 14mg Extended-Release Capsule NorthStar Rx LLC 16714-0960-01 30$ 458.30 $ 15.28 Memantine Hydrochloride 14mg Extended-Release Capsule Par Pharmaceuticals, an Endo Company 10370-0347-11 30$ 458.38 $ 15.28 Memantine Hydrochloride 14mg Extended-Release Capsule Par Pharmaceuticals, an Endo Company 10370-0347-09 90$ 1,375.14 $ 15.28 Memantine Hydrochloride 14mg Extended-Release Capsule Lupin Pharmaceuticals, Inc. 68180-0247-06 30$ 458.40 $ 15.28 Memantine Hydrochloride 14mg Extended-Release Capsule Lupin Pharmaceuticals, Inc. 68180-0247-09 90$ 1,375.20 $ 15.28 Memantine Hydrochloride 14mg Extended-Release Capsule Apotex Corp 60505-6209-03 30$ 458.40 $ 15.28 Memantine Hydrochloride 14mg Extended-Release Capsule Apotex Corp 60505-6209-09 90$ 1,375.20 $ 15.28 Memantine Hydrochloride 14mg Extended-Release Capsule ANI Pharmaceuticals, Inc. 43975-0264-03 30$ 458.40 $ 15.28 Memantine Hydrochloride 14mg Extended-Release Capsule ANI Pharmaceuticals, Inc. 43975-0264-09 90$ 1,375.20 $ 15.28 Memantine Hydrochloride 14mg Extended-Release Capsule Zydus Pharmaceuticals (USA) Inc. 68382-0547-06 30$ 458.40 $ 15.28 Memantine Hydrochloride 14mg Extended-Release Capsule Zydus Pharmaceuticals (USA) Inc. 68382-0547-16 90$ 1,375.20 $ 15.28

Memantine Hydrochloride 21mg Extended-Release Capsule Golden State Medical Supply, Inc. 51407-0056-30 30$ 448.44 $ 14.95 Memantine Hydrochloride 21mg Extended-Release Capsule Amneal Pharmaceuticals LLC 65162-0784-03 30$ 457.90 $ 15.26 Memantine Hydrochloride 21mg Extended-Release Capsule Mylan Pharmaceuticals Inc. 00378-5437-93 30$ 457.90 $ 15.26 Memantine Hydrochloride 21mg Extended-Release Capsule NorthStar Rx LLC 16714-0961-01 30$ 458.30 $ 15.28 Memantine Hydrochloride 21mg Extended-Release Capsule Par Pharmaceuticals, an Endo Company 10370-0348-11 30$ 458.38 $ 15.28 Memantine Hydrochloride 21mg Extended-Release Capsule Lupin Pharmaceuticals, Inc. 68180-0248-06 30$ 458.40 $ 15.28 Memantine Hydrochloride 21mg Extended-Release Capsule Apotex Corp 60505-6210-03 30$ 458.40 $ 15.28 Memantine Hydrochloride 21mg Extended-Release Capsule ANI Pharmaceuticals, Inc. 43975-0243-03 30$ 458.40 $ 15.28 Memantine Hydrochloride 21mg Extended-Release Capsule Zydus Pharmaceuticals (USA) Inc. 68382-0548-06 30$ 458.40 $ 15.28 Memantine Hydrochloride 28mg Extended-Release Capsule Golden State Medical Supply, Inc. 51407-0057-90 90$ 1,104.99 $ 12.28 Memantine Hydrochloride 28mg Extended-Release Capsule Golden State Medical Supply, Inc. 51407-0057-30 30$ 368.34 $ 12.28 Memantine Hydrochloride 28mg Extended-Release Capsule Amneal Pharmaceuticals LLC 65162-0785-09 90$ 1,373.69 $ 15.26 Memantine Hydrochloride 28mg Extended-Release Capsule Mylan Pharmaceuticals Inc. 00378-5438-77 90$ 1,373.69 $ 15.26 Memantine Hydrochloride 28mg Extended-Release Capsule Amneal Pharmaceuticals LLC 65162-0785-03 30$ 457.90 $ 15.26 Memantine Hydrochloride 28mg Extended-Release Capsule Mylan Pharmaceuticals Inc. 00378-5438-93 30$ 457.90 $ 15.26 Memantine Hydrochloride 28mg Extended-Release Capsule NorthStar Rx LLC 16714-0962-02 90$ 1,374.63 $ 15.27 Memantine Hydrochloride 28mg Extended-Release Capsule NorthStar Rx LLC 16714-0962-01 30$ 458.29 $ 15.28 Memantine Hydrochloride 28mg Extended-Release Capsule Par Pharmaceuticals, an Endo Company 10370-0349-11 30$ 458.38 $ 15.28 Memantine Hydrochloride 28mg Extended-Release Capsule Par Pharmaceuticals, an Endo Company 10370-0349-09 90$ 1,375.14 $ 15.28 Memantine Hydrochloride 28mg Extended-Release Capsule Lupin Pharmaceuticals, Inc. 68180-0249-06 30$ 458.40 $ 15.28 Memantine Hydrochloride 28mg Extended-Release Capsule Lupin Pharmaceuticals, Inc. 68180-0249-09 90$ 1,375.20 $ 15.28 Memantine Hydrochloride 28mg Extended-Release Capsule Apotex Corp 60505-6211-03 30$ 458.40 $ 15.28 Memantine Hydrochloride 28mg Extended-Release Capsule Apotex Corp 60505-6211-09 90$ 1,375.20 $ 15.28 Memantine Hydrochloride 28mg Extended-Release Capsule ANI Pharmaceuticals, Inc. 43975-0266-03 30$ 458.40 $ 15.28 Memantine Hydrochloride 28mg Extended-Release Capsule ANI Pharmaceuticals, Inc. 43975-0266-09 90$ 1,375.20 $ 15.28 Memantine Hydrochloride 28mg Extended-Release Capsule Zydus Pharmaceuticals (USA) Inc. 68382-0549-06 30$ 458.40 $ 15.28 Memantine Hydrochloride 28mg Extended-Release Capsule Zydus Pharmaceuticals (USA) Inc. 68382-0549-16 90$ 1,375.20 $ 15.28 Memantine Hydrochloride 28mg Extended-Release Capsule Lupin Pharmaceuticals, Inc. 68180-0249-02 500$ 7,640.02 $ 15.28

Memantine Hydrochloride 5mg & 10mg Tablet Titration Pak Teva/Actavis US 00591-3900-87 49$ 298.99 $ 6.10

Memantine Hydrochloride 5mg Tablet Golden State Medical Supply, Inc. 51407-0284-60 60$ 34.44 $ 0.57 Memantine Hydrochloride 5mg Tablet American Health Packaging 60687-0173-57 60$ 48.00 $ 0.80 Memantine Hydrochloride 5mg Tablet American Health Packaging 60687-0173-11 1 $ 0.80 $ 0.80 Memantine Hydrochloride 5mg Tablet Alembic Pharmaceuticals, Inc. 62332-0075-91 1000$ 5,484.60 $ 5.48 Memantine Hydrochloride 5mg Tablet Viona Pharmaceuticals Inc. 72578-0003-05 500$ 2,833.71 $ 5.67 Memantine Hydrochloride 5mg Tablet Unichem Pharmaceuticals USA, Inc 29300-0171-05 500$ 3,046.28 $ 6.09 Memantine Hydrochloride 5mg Tablet Alembic Pharmaceuticals, Inc. 62332-0075-60 60$ 365.64 $ 6.09 Memantine Hydrochloride 5mg Tablet Alembic Pharmaceuticals, Inc. 62332-0075-31 100$ 609.40 $ 6.09 Memantine Hydrochloride 5mg Tablet Sun Pharmaceutical Industries, Inc. 47335-0321-86 60$ 365.65 $ 6.09 Memantine Hydrochloride 5mg Tablet MacLeods Pharma 33342-0297-09 60$ 365.65 $ 6.09 Memantine Hydrochloride 5mg Tablet Unichem Pharmaceuticals USA, Inc 29300-0171-16 60$ 365.70 $ 6.10 Memantine Hydrochloride 5mg Tablet Lannett Company, Inc. 00527-1221-06 60$ 365.70 $ 6.10 Memantine Hydrochloride 5mg Tablet Amneal Pharmaceuticals 53746-0173-60 60$ 365.77 $ 6.10 Memantine Hydrochloride 5mg Tablet Mylan Pharmaceuticals Inc. 00378-1103-91 60$ 365.77 $ 6.10 Memantine Hydrochloride 5mg Tablet Dr. Reddy's Laboratories, Inc. 55111-0596-60 60$ 365.77 $ 6.10 Memantine Hydrochloride 5mg Tablet Upsher-Smith Laboratories, LLC 00832-1112-60 60$ 365.77 $ 6.10 Memantine Hydrochloride 5mg Tablet Torrent Pharma, Inc 13668-0222-60 60$ 365.77 $ 6.10 Memantine Hydrochloride 5mg Tablet Ajanta Pharma USA Inc 27241-0070-06 60$ 365.77 $ 6.10 Memantine Hydrochloride 5mg Tablet Viona Pharmaceuticals Inc. 72578-0003-14 60$ 365.77 $ 6.10 Memantine Hydrochloride 5mg Tablet Teva/Actavis US 00591-3870-44 100$ 610.25 $ 6.10 Memantine Hydrochloride 5mg Tablet Teva/Actavis US 00591-3870-45 10$ 61.03 $ 6.10 Memantine Hydrochloride 5mg Tablet Mylan Institutional LLC 42292-0005-06 50$ 305.13 $ 6.10 Memantine Hydrochloride 5mg Tablet Mylan Institutional LLC 42292-0005-01 1 $ 6.10 $ 6.10 Memantine Hydrochloride 5mg Tablet Teva/Actavis US 00591-3870-60 60$ 366.17 $ 6.10 Memantine Hydrochloride 5mg Tablet Lupin Pharmaceuticals, Inc. 68180-0229-07 60$ 366.17 $ 6.10 Memantine Hydrochloride 5mg Tablet Aurobindo Pharma USA Inc. 65862-0652-60 60$ 366.17 $ 6.10 Memantine Hydrochloride 5mg Tablet Wockhardt USA, LLC 64679-0121-03 60$ 366.17 $ 6.10 Memantine Hydrochloride 5mg Tablet Wockhardt USA, LLC 64679-0121-02 500$ 3,051.42 $ 6.10

Memantine Hydrochloride 7mg Extended-Release Capsule Amneal Pharmaceuticals LLC 65162-0782-03 30$ 114.60 $ 3.82 Memantine Hydrochloride 7mg Extended-Release Capsule Golden State Medical Supply, Inc. 51407-0054-30 30$ 448.44 $ 14.95 Memantine Hydrochloride 7mg Extended-Release Capsule Mylan Pharmaceuticals Inc. 00378-5435-93 30$ 457.90 $ 15.26 Memantine Hydrochloride 7mg Extended-Release Capsule NorthStar Rx LLC 16714-0959-01 30$ 458.30 $ 15.28 Memantine Hydrochloride 7mg Extended-Release Capsule Par Pharmaceuticals, an Endo Company 10370-0346-11 30$ 458.38 $ 15.28 Memantine Hydrochloride 7mg Extended-Release Capsule Lupin Pharmaceuticals, Inc. 68180-0246-06 30$ 458.40 $ 15.28 Memantine Hydrochloride 7mg Extended-Release Capsule Apotex Corp 60505-6208-03 30$ 458.40 $ 15.28 Memantine Hydrochloride 7mg Extended-Release Capsule ANI Pharmaceuticals, Inc. 43975-0242-03 30$ 458.40 $ 15.28 Memantine Hydrochloride 7mg Extended-Release Capsule Zydus Pharmaceuticals (USA) Inc. 68382-0546-06 30$ 458.40 $ 15.28

Riluzole 50mg Tablet Rising Pharmaceuticals Inc 64980-0191-06 60$ 2,217.17 $ 36.95 Riluzole 50mg Tablet Apotex Corp 60505-3285-06 60$ 2,242.06 $ 37.37 Riluzole 50mg Tablet Sun Pharmaceutical Industries, Inc. 62756-0538-86 60$ 2,239.55 $ 37.33 Riluzole 50mg Tablet Glenmark Pharmaceuticals 68462-0381-60 60$ 1,961.82 $ 32.70 Riluzole 50mg Tablet Mylan Pharmaceuticals Inc. 00378-4145-91 60$ 2,239.59 $ 37.33 Riluzole 50mg Tablet Ascend Laboratories, LLC a Subsidiary of Alkem Laboratories Ltd 67877-0286-60 60$ 2,216.40 $ 36.94 Riluzole 50mg Tablet AvKARE, Inc. 42291-0775-60 60$ 2,217.17 $ 36.95

Gold Standard is the source of this information. 03.17.2021

MLR-NUE-US-1355-0321