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Preferred Drug List

Preferred Drug List

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

sulindac Third Generation

cefdinir NSAIDs, COMBINATIONS cefixime (SUPRAX) diclofenac sodium delayed-rel/misoprostol Erythromycins/Macrolides Effective 07/01/2020 NSAIDs, TOPICAL azithromycin diclofenac sodium gel 1% * clarithromycin For questions or additional information, diclofenac sodium soln clarithromycin ext-rel access the State of Kansas website at erythromycin delayed-rel http://www.kdheks.gov/hcf/sehp or call * Listing does not include NDC 69499031866. Drug erythromycin ethylsuccinate products are identified by unique numerical product erythromycin stearate the Kansas State Employees Prescription identifiers, called National Drug Codes (NDC), which Drug Program at 1-800-294-6324. identify the manufacturer, strength, dosage form, fidaxomicin (DIFICID) formulation and package size. The Preferred Drug List is subject to change. Fluoroquinolones To locate covered prescriptions online, COX-2 INHIBITORS ciprofloxacin access the State of Kansas website at celecoxib levofloxacin for the http://www.kdheks.gov/hcf/sehp moxifloxacin most current drug list. GOUT What is a Preferred Drug List? allopurinol Penicillins A Preferred Drug List is a list of safe and colchicine amoxicillin cost-effective drugs, chosen by a committee probenecid amoxicillin/clavulanate of physicians and pharmacists. Drug lists amoxicillin/clavulanate ext-rel ampicillin have been used in hospitals for many years OPIOID ANALGESICS to help ensure quality drug use. The Kansas dicloxacillin buprenorphine transdermal penicillin VK State Employees Preferred Drug List will be codeine/acetaminophen continually revised to reflect the changing fentanyl transdermal Tetracyclines drug market. fentanyl transmucosal lozenge doxycycline hyclate hydrocodone/acetaminophen Should I ask my physician to switch my minocycline hydromorphone current medications to a medication that tetracycline hydromorphone ext-rel is on the Preferred Drug List? methadone Many of your medications will already be on morphine ANTIFUNGALS the Preferred Drug List. However, if you morphine ext-rel clotrimazole troches have a medication that is not, ask your morphine supp fluconazole physician to choose a similar Preferred Drug oxycodone caps 5 mg griseofulvin ultramicrosize List product for you to use. oxycodone concentrate 20 mg/mL itraconazole oxycodone soln 5 mg/5 mL nystatin Should I use generics? terbinafine tabs There are many medications on the market oxycodone tabs 5 mg, 15 mg, 30 mg voriconazole that do not come in generic form. For those oxycodone/acetaminophen 5/325 drugs that do, your pharmacist should tramadol * suggest safe and effective generic tramadol ext-rel ANTIMALARIALS alternatives. buprenorphine (BELBUCA) atovaquone/proguanil fentanyl sublingual spray (SUBSYS) chloroquine This document is subject to state-specific oxycodone ext-rel (XTAMPZA ER) mefloquine regulations and rules, including, but not tapentadol (NUCYNTA) tapentadol ext-rel (NUCYNTA ER) limited to, those regarding generic ANTITUBERCULAR AGENTS substitution, controlled substance schedules, ethambutol preference for brands and mandatory * Listing does not include NDC 52817019610. Drug products are identified by unique numerical product isoniazid generics whenever applicable. identifiers, called National Drug Codes (NDC), which pyrazinamide identify the manufacturer, strength, dosage form, rifampin Boldface type indicates generic availability; formulation and package size. boldface may not apply to every strength or dosage form under the listed generic name. NON-OPIOID ANALGESICS ANTIVIRALS butalbital/acetaminophen/caffeine tabs Cytomegalovirus Agents butalbital/aspirin/caffeine valganciclovir

1 Herpes Agents captopril ANGIOTENSIN II acyclovir caps, tabs enalapril ANTAGONIST/CALCIUM CHANNEL fosinopril famciclovir BLOCKER/DIURETIC COMBINATIONS valacyclovir lisinopril perindopril amlodipine/valsartan/hydrochlorothiazide olmesartan/amlodipine/hydrochlorothiazide Influenza Agents quinapril ramipril oseltamivir trandolapril zanamivir (RELENZA) ANTIARRHYTHMICS

amiodarone ACE INHIBITOR/CALCIUM CHANNEL disopyramide MISCELLANEOUS flecainide clindamycin BLOCKER COMBINATIONS propafenone amlodipine/benazepril dapsone propafenone ext-rel trandolapril/ ext-rel ivermectin sotalol linezolid dronedarone (MULTAQ) metronidazole ACE INHIBITOR/DIURETIC nitrofurantoin ext-rel COMBINATIONS nitrofurantoin macrocrystals ANTILIPEMICS benazepril/hydrochlorothiazide Bile Acid Resins nitrofurantoin susp captopril/hydrochlorothiazide cholestyramine sulfamethoxazole/trimethoprim enalapril/hydrochlorothiazide colesevelam sulfamethoxazole/trimethoprim DS fosinopril/hydrochlorothiazide colestipol tinidazole lisinopril/hydrochlorothiazide trimethoprim quinapril/hydrochlorothiazide vancomycin caps Cholesterol Absorption Inhibitors mebendazole chewable (EMVERM) ezetimibe rifaximin 550 mg (XIFAXAN) ADRENOLYTICS, CENTRAL Fibrates clonidine transdermal ANTINEOPLASTIC AGENTS fenofibrate * guanfacine fenofibric acid delayed-rel

ALKYLATING AGENTS gemfibrozil cyclophosphamide caps ALDOSTERONE RECEPTOR melphalan ANTAGONISTS * Listing does not include fenofibrate tablet 120 mg. busulfan (MYLERAN) eplerenone chlorambucil (LEUKERAN) spironolactone HMG-CoA Reductase Inhibitors/Combinations ANTIMETABOLITES atorvastatin ALPHA BLOCKERS ezetimibe/simvastatin mercaptopurine doxazosin methotrexate (TREXALL) fluvastatin terazosin lovastatin thioguanine (TABLOID) pravastatin ANGIOTENSIN II RECEPTOR rosuvastatin HORMONAL ANTINEOPLASTIC AGENTS ANTAGONISTS/DIURETIC simvastatin Antiandrogens bicalutamide COMBINATIONS candesartan Niacins flutamide niacin ext-rel candesartan/hydrochlorothiazide eprosartan Antiestrogens irbesartan Omega-3 Fatty Acids tamoxifen irbesartan/hydrochlorothiazide omega-3 acid ethyl esters losartan icosapent ethyl (VASCEPA) Aromatase Inhibitors losartan/hydrochlorothiazide anastrozole olmesartan BETA-BLOCKERS exemestane olmesartan/hydrochlorothiazide atenolol letrozole telmisartan bisoprolol telmisartan/hydrochlorothiazide carvedilol valsartan Progestins carvedilol phosphate ext-rel valsartan/hydrochlorothiazide megestrol acetate tabs labetalol metoprolol succinate ext-rel MISCELLANEOUS ANGIOTENSIN II RECEPTOR metoprolol tartrate etoposide ANTAGONIST/CALCIUM CHANNEL nadolol hydroxyurea BLOCKER COMBINATIONS pindolol tretinoin caps amlodipine/olmesartan propranolol ext-rel mitotane (LYSODREN) amlodipine/telmisartan nebivolol (BYSTOLIC) procarbazine (MATULANE) amlodipine/valsartan uridine triacetate (VISTOGARD) BETA-BLOCKER/DIURETIC CARDIOVASCULAR COMBINATIONS ACE INHIBITORS atenolol/chlorthalidone bisoprolol/hydrochlorothiazide benazepril metoprolol/hydrochlorothiazide

2

CALCIUM CHANNEL BLOCKERS Transdermal Selective Serotonin Reuptake Inhibitors Dihydropyridines nitroglycerin transdermal (SSRIs) amlodipine citalopram felodipine ext-rel MISCELLANEOUS escitalopram nifedipine ext-rel hydralazine fluoxetine * methyldopa paroxetine HCl Nondihydropyridines midodrine paroxetine HCl ext-rel diltiazem ext-rel * ranolazine ext-rel sertraline verapamil ext-rel vilazodone (VIIBRYD) vortioxetine (TRINTELLIX) CENTRAL NERVOUS SYSTEM * Listing does not include generic CARDIZEM LA ANTIANXIETY * Listing does not include fluoxetine tablet 60 mg. CALCIUM CHANNEL Benzodiazepines Serotonin Norepinephrine Reuptake BLOCKER/ANTILIPEMIC COMBINATIONS alprazolam amlodipine/atorvastatin clonazepam Inhibitors (SNRIs) diazepam desvenlafaxine ext-rel duloxetine delayed-rel DIGITALIS GLYCOSIDES lorazepam oxazepam venlafaxine digoxin 0.125 mg, 0.25 mg venlafaxine ext-rel digoxin ped elixir Miscellaneous buspirone Tricyclic Antidepressants (TCAs) DIRECT RENIN INHIBITORS/DIURETIC clomipramine COMBINATIONS fluvoxamine desipramine aliskiren doxepin HCl aliskiren/hydrochlorothiazide (TEKTURNA HCT) DIURETICS carbamazepine ext-rel Miscellaneous Agents clobazam Carbonic Anhydrase Inhibitors bupropion diazepam rectal gel acetazolamide bupropion ext-rel divalproex sodium delayed-rel acetazolamide ext-rel mirtazapine divalproex sodium ext-rel methazolamide trazodone ethosuximide

Loop Diuretics gabapentin bumetanide lamotrigine ANTIPARKINSONIAN AGENTS amantadine furosemide lamotrigine ext-rel benztropine torsemide lamotrigine orally disintegrating tabs levetiracetam levetiracetam ext-rel carbidopa/levodopa Potassium-sparing Diuretics carbidopa/levodopa ext-rel amiloride phenobarbital carbidopa/levodopa orally disintegrating tabs triamterene phenytoin carbidopa/levodopa/entacapone phenytoin sodium extended entacapone Thiazides and Thiazide-like Diuretics primidone pramipexole chlorthalidone tiagabine pramipexole ext-rel hydrochlorothiazide rasagiline indapamide topiramate ext-rel ropinirole metolazone valproic acid ropinirole ext-rel zonisamide selegiline Diuretic Combinations lacosamide (VIMPAT) trihexyphenidyl amiloride/hydrochlorothiazide oxcarbazepine ext-rel (OXTELLAR XR) rotigotine transdermal (NEUPRO) spironolactone/hydrochlorothiazide perampanel (FYCOMPA) triamterene/hydrochlorothiazide topiramate ext-rel (TROKENDI XR) ANTIPSYCHOTICS Atypicals HEART FAILURE ANTIDEMENTIA aripiprazole isosorbide dinitrate/hydralazine (BIDIL) donepezil clozapine ivabradine (CORLANOR) galantamine olanzapine /valsartan (ENTRESTO) galantamine ext-rel quetiapine memantine quetiapine ext-rel NITRATES memantine ext-rel rivastigmine Oral ziprasidone rivastigmine transdermal aripiprazole ext-rel injection (ABILIFY MAINTENA) isosorbide dinitrate memantine/donepezil (NAMZARIC) aripiprazole lauroxil ext-rel inj (ARISTADA) isosorbide mononitrate cariprazine (VRAYLAR) isosorbide mononitrate ext-rel lurasidone (LATUDA) ANTIDEPRESSANTS Monoamine Oxidase Inhibitors (MAOIs) risperidone long-acting inj (RISPERDAL CONSTA) Sublingual/Translingual nitroglycerin lingual spray phenelzine nitroglycerin sublingual tranylcypromine

3 Miscellaneous inj (ZEMBRACE SYMTOUCH) ENDOCRINE AND METABOLIC chlorpromazine sumatriptan nasal powder (ONZETRA XSAIL) fluphenazine nasal spray (ZOMIG) ANDROGENS haloperidol testosterone cypionate perphenazine Preventive Agents testosterone enanthate thiothixene Monoclonal Antibodies testosterone gel * trifluoperazine erenumab-aooe (AIMOVIG) testosterone soln -vfrm (AJOVY) testosterone transdermal (ANDRODERM) ATTENTION DEFICIT HYPERACTIVITY -gnlm (EMGALITY) * Listing does not include the authorized generics for DISORDER TESTIM and VOGELXO. amphetamine/dextroamphetamine mixed salts MOOD STABILIZERS amphetamine/ lithium carbonate ANTIDIABETICS dextroamphetamine mixed salts ext-rel ^ lithium carbonate ext-rel Alpha-glucosidase Inhibitors atomoxetine acarbose dexmethylphenidate MUSCULOSKELETAL THERAPY AGENTS dexmethylphenidate ext-rel baclofen Analogs dextroamphetamine carisoprodol dextroamphetamine ext-rel (SYMLINPEN) chlorzoxazone 500 mg guanfacine ext-rel cyclobenzaprine * methylphenidate dantrolene Biguanides methylphenidate ext-rel ^ metaxalone metformin metformin ext-rel amphetamine/ methocarbamol dextroamphetamine mixed salts ext-rel tizanidine tabs (MYDAYIS) Biguanide/Sulfonylurea Combinations lisdexamfetamine (VYVANSE) * Listing does not include cyclobenzaprine tablet 7.5 mg. glipizide/metformin

^ Listing does not include certain NDCs. Drug products are identified by unique numerical product identifiers, MYASTHENIA GRAVIS Dipeptidyl Peptidase-4 (DPP-4) Inhibitors called National Drug Codes (NDC), which identify the pyridostigmine sitagliptin phosphate (JANUVIA) manufacturer, strength, dosage form, formulation and pyridostigmine ext-rel package size. Dipeptidyl Peptidase-4 (DPP-4) FIBROMYALGIA NARCOLEPSY Inhibitor/Biguanide Combinations sitagliptin/metformin (JANUMET) pregabalin armodafinil sitagliptin/metformin ext-rel (JANUMET XR) solriamfetol (SUNOSI)

HYPNOTICS POSTHERPETIC NEURALGIA (PHN) Incretin Mimetic Agents Benzodiazepines gabapentin ext-rel (GRALISE) (TRULICITY) temazepam (VICTOZA) (OZEMPIC) Nonbenzodiazepines PSYCHOTHERAPEUTIC- semaglutide (RYBELSUS) eszopiclone MISCELLANEOUS ramelteon Alcohol Deterrents Incretin Mimetic Agent/ zolpidem acamprosate calcium Combinations zolpidem ext-rel disulfiram liraglutide/ (XULTOPHY) zolpidem sublingual / (SOLIQUA) (BELSOMRA) Opioid Antagonists naloxone inj Tricyclics naltrexone (FIASP) doxepin (SILENOR) naloxone nasal spray (NARCAN) insulin aspart (NOVOLOG) insulin aspart protamine 70%/insulin aspart 30% MIGRAINE Partial Opioid /Opioid Antagonist (NOVOLOG MIX 70/30) Acute Migraine Agents Combinations insulin degludec (TRESIBA) Derivatives buprenorphine/naloxone sublingual (LEVEMIR) insulin glargine (BASAGLAR) inj buprenorphine/naloxone sublingual tabs (ZUBSOLV) insulin human (HUMULIN R U-500)

Pseudobulbar Affect Agents insulin human (NOVOLIN R) Newer Agents insulin isophane human (NOVOLIN N) dextromethorphan/quinidine (NUEDEXTA) (REYVOW) insulin isophane human 70%/regular 30% (NURTEC ODT) (NOVOLIN 70/30) (UBRELVY) Smoking Deterrents

bupropion ext-rel Insulin Sensitizers pioglitazone Vasomotor Symptom Agents paroxetine mesylate Insulin Sensitizer/Biguanide sumatriptan Combinations sumatriptan inj pioglitazone/metformin sumatriptan nasal spray zolmitriptan

4 Insulin Sensitizer/Sulfonylurea 30 mcg ESTROGEN/PROGESTINS Combinations desogestrel/EE 0.15/30 Oral pioglitazone/glimepiride drospirenone/EE 3/30 EE/norethindrone acetate - Jinteli drospirenone/EE/levomefolate 3/30 and /norethindrone levomefolate , conjugated/medroxyprogesterone Meglitinides levonorgestrel/EE 0.15/30 - Levora nateglinide (PREMPHASE) norethindrone acetate/EE 1.5/30 repaglinide estrogens, conjugated/medroxyprogesterone norethindrone acetate/EE 1.5/30 and iron (PREMPRO) norgestrel/EE 0.3/30 - Low-Ogestrel Sodium-Glucose Co-Transporter 2 Transdermal (SGLT2) Inhibitors 35 mcg Estrogen estradiol/levonorgestrel (CLIMARA PRO) dapagliflozin (FARXIGA) ethynodiol diacetate/EE 1/35 - Zovia 1/35 estradiol/norethindrone acetate (COMBIPATCH) empagliflozin (JARDIANCE) norethindrone/EE 0.5/35

norethindrone/EE 1/35 Sodium-Glucose Co-Transporter 2 /EE 0.25/35 ESTROGEN/SELECTIVE ESTROGEN (SGLT2) Inhibitor/Biguanide Combinations Biphasic COMBINATIONS dapagliflozin/metformin ext-rel (XIGDUO XR) desogestrel/EE conjugated estrogens/bazedoxifene (DUAVEE) empagliflozin/metformin (SYNJARDY) norethindrone acetate/EE 1/10 and EE 10 and iron empagliflozin/metformin ext-rel (SYNJARDY XR) (LO LOESTRIN FE) GLUCOCORTICOIDS

dexamethasone Sodium-Glucose Co-Transporter 2 Triphasic fludrocortisone desogestrel/EE hydrocortisone (SGLT2) Inhibitor/Dipeptidyl Peptidase-4 levonorgestrel/EE - Trivora (DPP-4) Inhibitor Combinations methylprednisolone norethindrone/EE prednisolone empagliflozin/linagliptin (GLYXAMBI) norgestimate/EE prednisone

Sulfonylureas Extended Cycle GLUCOSE ELEVATING AGENTS glimepiride levonorgestrel/EE 0.1/20 and EE 10 nasal powder (BAQSIMI) glipizide levonorgestrel/EE 0.15/30 glucagon, human recombinant glipizide ext-rel levonorgestrel/EE 0.15/30 and EE 10 (GLUCAGEN HYPOKIT)

Supplies glucagon, human recombinant Progestin Only (GLUCAGON EMERGENCY KIT) ACCU-CHEK AVIVA PLUS kits and test strips norethindrone ACCU-CHEK COMPACT PLUS kits and test strips HYPERPARATHYROID TREATMENT, ACCU-CHEK GUIDE kits and test strips Injectable ACCU-CHEK SMARTVIEW kits and test strips medroxyprogesterone acetate 150 mg/mL VITAMIN D ANALOGS BD ULTRAFINE insulin syringes and needles calcitriol (1,25-D3) lancets doxercalciferol Transdermal paricalcitol norelgestromin/EE

ANTIOBESITY liraglutide (SAXENDA) Vaginal PHOSPHATE BINDER AGENTS

etonogestrel/EE ring calcium acetate CALCIUM REGULATORS sevelamer carbonate Bisphosphonates calcium acetate (PHOSLYRA) ENDOMETRIOSIS sucroferric oxyhydroxide (VELPHORO) alendronate danazol ibandronate elagolix (ORILISSA) risedronate POTASSIUM-REMOVING AGENTS risedronate delayed-rel patiromer sorbitex (VELTASSA) ESTROGENS sodium zirconium cyclosilicate (LOKELMA) Calcitonins Oral -salmon spray estradiol PROGESTINS estrogens, conjugated (PREMARIN) Oral medroxyprogesterone acetate CARNITINE DEFICIENCY AGENTS Transdermal levocarnitine megestrol acetate susp estradiol norethindrone acetate estradiol (DIVIGEL) CONTRACEPTIVES , micronized estradiol (EVAMIST) EE = ethinyl estradiol SELECTIVE ESTROGEN RECEPTOR Monophasic Vaginal estradiol vaginal crm MODULATORS 20 mcg Estrogen estradiol vaginal tabs raloxifene drospirenone/EE 3/20 estradiol vaginal ring (ESTRING) ospemifene (OSPHENA) drospirenone/EE/levomefolate 3/20 and estrogens, conjugated crm (PREMARIN) levomefolate levonorgestrel/EE 0.1/20 - Lessina THYROID AGENTS norethindrone acetate/EE 1/20 Antithyroid Agents norethindrone acetate/EE 1/20 and iron methimazole norethindrone acetate/EE 1/20 and iron chewable propylthiouracil

5 Thyroid Supplements Irritable Bowel Syndrome with Diarrhea VAGINAL ANTI-INFECTIVES levothyroxine alosetron clindamycin crm levothyroxine (SYNTHROID) eluxadoline (VIBERZI) metronidazole levothyroxine - Levoxyl terconazole liothyronine LAXATIVES lactulose soln MISCELLANEOUS VASOPRESSINS peg 3350/electrolytes bethanechol desmopressin spray, tabs sodium sulfate/potassium sulfate/magnesium sulfate potassium citrate ext-rel (SUPREP) MISCELLANEOUS HEMATOLOGIC OPIOID-INDUCED naldemedine (SYMPROIC) ANTICOAGULANTS GASTROINTESTINAL naloxegol (MOVANTIK) Injectable enoxaparin ANTIDIARRHEALS PANCREATIC ENZYMES diphenoxylate/atropine pancrelipase (VIOKACE) Oral loperamide pancrelipase delayed-rel (CREON) warfarin pancrelipase delayed-rel (ZENPEP) apixaban (ELIQUIS) ANTIEMETICS rivaroxaban (XARELTO) doxylamine/pyridoxine delayed-rel PROSTAGLANDINS Synthetic Heparinoid-like Agents dronabinol misoprostol fondaparinux granisetron meclizine PROTON PUMP INHIBITORS PLATELET AGGREGATION INHIBITORS esomeprazole delayed-rel ondansetron clopidogrel lansoprazole delayed-rel prochlorperazine dipyridamole omeprazole delayed-rel promethazine dipyridamole ext-rel/aspirin pantoprazole delayed-rel scopolamine transdermal prasugrel dexlansoprazole delayed-rel (DEXILANT) trimethobenzamide ticagrelor (BRILINTA) granisetron transdermal (SANCUSO) rolapitant (VARUBI) SALIVA STIMULANTS PLATELET SYNTHESIS INHIBITORS cevimeline anagrelide pilocarpine tabs ANTISPASMODICS dicyclomine STEROIDS, RECTAL MISCELLANEOUS cilostazol hydrocortisone crm CHOLELITHOLYTICS ursodiol hydrocortisone acetate/pramoxine foam (PROCTOFOAM-HC) IMMUNOLOGIC AGENTS

H2 RECEPTOR ANTAGONISTS ALLERGENIC EXTRACTS cimetidine ULCER THERAPY COMBINATIONS ragweed pollen allergen extract (RAGWITEK) famotidine lansoprazole + amoxicillin + clarithromycin timothy grass pollen allergen extract (GRASTEK) bismuth/metronidazole/tetracycline (PYLERA)

INFLAMMATORY BOWEL DISEASE DISEASE-MODIFYING ANTIRHEUMATIC Oral Agents MISCELLANEOUS DRUGS (DMARDs) sucralfate balsalazide hydroxychloroquine budesonide delayed-rel caps leflunomide budesonide ext-rel GENITOURINARY methotrexate mesalamine delayed-rel caps BENIGN PROSTATIC HYPERPLASIA mesalamine delayed-rel tabs IMMUNOSUPPRESSANTS mesalamine ext-rel caps alfuzosin ext-rel sulfasalazine dutasteride Antimetabolites azathioprine sulfasalazine delayed-rel dutasteride/tamsulosin azathioprine (AZASAN) mesalamine ext-rel caps (PENTASA) finasteride silodosin tamsulosin NUTRITIONAL/SUPPLEMENTS Rectal Agents hydrocortisone enema ELECTROLYTES mesalamine susp URINARY ANTISPASMODICS hydrocortisone acetate foam (CORTIFOAM) darifenacin ext-rel Potassium oxybutynin potassium chloride ext-rel oxybutynin ext-rel potassium chloride liquid IRRITABLE BOWEL SYNDROME solifenacin Irritable Bowel Syndrome with tolterodine VITAMINS AND MINERALS Constipation tolterodine ext-rel Folic Acid/Combinations linaclotide (LINZESS) trospium folic acid lubiprostone (AMITIZA) trospium ext-rel folic acid/vitamin B6/vitamin B12 fesoterodine ext-rel (TOVIAZ)

mirabegron ext-rel (MYRBETRIQ)

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

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

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

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

Atopic Dermatitis podofilox Antivirals Topical trifluridine pimecrolimus MOUTH/THROAT/DENTAL AGENTS tacrolimus Anesthetics - Topical Oral Beta-blockers crisaborole (EUCRISA) lidocaine viscous Nonselective levobunolol Corticosteroids Steroids - Mouth/Throat maleate Low Potency triamcinolone paste timolol maleate gel alclometasone crm, oint 0.05% timolol hemihydrate (BETIMOL) desonide crm, lotion, oint 0.05% OPHTHALMIC fluocinolone acetonide soln 0.01% Selective hydrocortisone crm 2.5% Antiallergics betaxolol (BETOPTIC S) hydrocortisone lotion 1% azelastine

cromolyn sodium Medium Potency olopatadine OTC Carbonic Anhydrase Inhibitors betamethasone valerate crm, lotion, oint 0.1% alcaftadine (LASTACAFT) Topical desoximetasone crm, oint 0.05% olopatadine (PAZEO) dorzolamide fluocinolone acetonide crm, oint 0.025% brinzolamide (AZOPT) fluticasone propionate crm, lotion 0.05%, Anti-infectives oint 0.005% bacitracin Carbonic Anhydrase Inhibitor/Beta- hydrocortisone butyrate crm, lotion, oint, ciprofloxacin soln blocker Combinations soln 0.1% erythromycin dorzolamide/timolol maleate hydrocortisone valerate crm, oint 0.2% gentamicin mometasone crm, lotion, oint 0.1% levofloxacin Carbonic Anhydrase triamcinolone acetonide crm, lotion 0.025% moxifloxacin triamcinolone acetonide crm, lotion, oint 0.1% neomycin/polymyxin B/gramicidin Inhibitor/Sympathomimetic Combinations brinzolamide/brimonidine (SIMBRINZA) ofloxacin

High Potency polymyxin B/bacitracin betamethasone dipropionate augmented crm, polymyxin B/trimethoprim Dry Eye Disease lotion 0.05% sulfacetamide oint, soln 10% cyclosporine, emulsion (RESTASIS) betamethasone dipropionate crm, lotion, tobramycin (XIIDRA) oint 0.05% besifloxacin (BESIVANCE) desoximetasone crm, oint 0.25%, gel 0.05% ciprofloxacin oint (CILOXAN) Prostaglandins fluocinonide crm, gel, oint, soln 0.05% moxifloxacin (MOXEZA) latanoprost triamcinolone acetonide crm 0.5% bimatoprost 0.01% (LUMIGAN) halobetasol propionate lotion 0.01% (BRYHALI) Anti-infective/Anti-inflammatory travoprost (TRAVATAN Z) Combinations Very High Potency neomycin/polymyxin B/bacitracin/ Rho Kinase Inhibitors betamethasone dipropionate augmented gel, hydrocortisone oint netarsudil (RHOPRESSA) oint 0.05% neomycin/polymyxin B/dexamethasone clobetasol propionate crm, foam, gel, lotion, neomycin/polymyxin B/hydrocortisone susp Rho Kinase Inhibitor / Prostaglandin oint, shampoo, soln sulfacetamide/ Combinations halobetasol propionate crm, oint 0.05% prednisolone phosphate 10%/0.25% netarsudil/latanoprost (ROCKLATAN)

tobramycin/dexamethasone susp 0.3%/0.1% Emollients tobramycin/dexamethasone oint 0.3%/0.1% Sympathomimetics ammonium lactate 12% (TOBRADEX) brimonidine (ALPHAGAN P) tobramycin/dexamethasone susp 0.3%/0.05% brimonidine 0.2% (TOBRADEX ST) Local Analgesics lidocaine patch Sympathomimetic/Beta-blocker Anti-inflammatories Nonsteroidal Combinations Local Anesthetics brimonidine/timolol (COMBIGAN) lidocaine/prilocaine bromfenac sodium

diclofenac sodium Rosacea ketorolac azelaic acid gel ketorolac tromethamine (ACUVAIL) doxycycline monohydrate delayed-rel caps nepafenac (ILEVRO)

8 OTIC Anti-infective/Anti-inflammatory Anti-infectives Combinations acetic acid neomycin/polymyxin B/hydrocortisone ofloxacin otic ciprofloxacin/dexamethasone (CIPRODEX)

QUICK REFERENCE DRUG LIST

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

9 cimetidine, 6 desonide crm, lotion, oint 0.05%, 8 EE/norethindrone acetate - Jinteli, 5 CIPRODEX, 9 desoximetasone crm, oint 0.05%, 8 elagolix, 5 ciprofloxacin, 1 desoximetasone crm, oint 0.25%, gel 0.05%, 8 eletriptan, 4 ciprofloxacin oint, 8 desvenlafaxine ext-rel, 3 ELIQUIS, 6 ciprofloxacin soln, 8 dexamethasone, 5, 8 eluxadoline, 6 ciprofloxacin/dexamethasone, 9 dexamethasone sodium phosphate, 8 EMGALITY, 4 citalopram, 3 DEXILANT, 6 empagliflozin, 5 CITRANATAL 90 DHA, 7 dexlansoprazole delayed-rel, 6 empagliflozin/linagliptin, 5 CITRANATAL ASSURE, 7 dexmethylphenidate, 4 empagliflozin/metformin, 5 CITRANATAL B-CALM, 7 dexmethylphenidate ext-rel, 4 empagliflozin/metformin ext-rel, 5 CITRANATAL DHA, 7 dextroamphetamine, 4 EMVERM, 2 CITRANATAL HARMONY, 7 dextroamphetamine ext-rel, 4 enalapril, 2 CITRANATAL RX, 7 dextromethorphan/brompheniramine/pseudo enalapril/hydrochlorothiazide, 2 clarithromycin, 1 ephedrine, 7 enoxaparin, 6 clarithromycin ext-rel, 1 dextromethorphan/promethazine, 7 entacapone, 3 clemastine 2.68 mg, 7 dextromethorphan/quinidine, 4 ENTRESTO, 3 CLIMARA PRO, 5 diazepam, 3 EPIDUO, 7 clindamycin, 2 diazepam rectal gel, 3 EPIDUO FORTE, 7 clindamycin crm, 6 diclofenac sodium, 8 epinephrine, 7 clindamycin gel, lotion, soln, 7 diclofenac sodium delayed-rel, 1 epinephrine auto-injector, 7 clindamycin/benzoyl peroxide, 7 diclofenac sodium delayed-rel/misoprostol, 1 EPIPEN, 7 clobazam, 3 diclofenac sodium gel 1%, 1 EPIPEN JR., 7 clobetasol propionate crm, foam, gel, lotion, diclofenac sodium soln, 1 eplerenone, 2 oint, shampoo, soln, 8 dicloxacillin, 1 eprosartan, 2 clomipramine, 3 dicyclomine, 6 erenumab-aooe, 4 clonazepam, 3 DIFICID, 1 ergocalciferol (D2), 7 clonidine, 2 diflunisal, 1 erythromycin, 8 clonidine transdermal, 2 difluprednate, 8 erythromycin delayed-rel, 1 clopidogrel, 6 digoxin 0.125 mg, 0.25 mg, 3 erythromycin ethylsuccinate, 1 clotrimazole, 7 digoxin ped elixir, 3 erythromycin gel 2%, 7 clotrimazole troches, 1 dihydroergotamine inj, 4 erythromycin soln, 7 clozapine, 3 diltiazem ext-rel, 3 erythromycin stearate, 1 codeine/acetaminophen, 1 diphenoxylate/atropine, 6 erythromycin/benzoyl peroxide, 7 codeine/guaifenesin liquid, 7 dipyridamole, 6 escitalopram, 3 codeine/guaifenesin/pseudoephedrine, 7 dipyridamole ext-rel/aspirin, 6 esomeprazole delayed-rel, 6 codeine/promethazine, 7 disopyramide, 2 estradiol, 5 codeine/promethazine/phenylephrine, 7 disulfiram, 4 estradiol vaginal crm, 5 colchicine, 1 divalproex sodium delayed-rel, 3 estradiol vaginal ring, 5 colesevelam, 2 divalproex sodium ext-rel, 3 estradiol vaginal tabs, 5 colestipol, 2 DIVIGEL, 5 estradiol/levonorgestrel, 5 COMBIGAN, 8 donepezil, 3 estradiol/norethindrone, 5 COMBIPATCH, 5 dorzolamide, 8 estradiol/norethindrone acetate, 5 conjugated estrogens/bazedoxifene, 5 dorzolamide/timolol maleate, 8 ESTRING, 5 CORLANOR, 3 doxazosin, 2 estrogens, conjugated, 5 CORTIFOAM, 6 doxepin, 3, 4 estrogens, conjugated crm, 5 CREON, 6 doxercalciferol, 5 estrogens, conjugated/medroxyprogesterone, 5 crisaborole, 8 doxycycline hyclate, 1 eszopiclone, 4 cromolyn sodium, 8 doxycycline monohydrate delayed-rel caps, 8 ethambutol, 1 cromolyn soln, 7 doxylamine/pyridoxine delayed-rel, 6 ethosuximide, 3 cyanocobalamin inj, 7 dronabinol, 6 ethynodiol diacetate/EE 1/35 - Zovia 1/35, 5 cyclobenzaprine, 4 dronedarone, 2 etodolac, 1 cyclophosphamide caps, 2 drospirenone/EE 3/20, 5 etonogestrel/EE ring, 5 cyclosporine, emulsion, 8 drospirenone/EE 3/30, 5 etoposide, 2 cyproheptadine, 7 drospirenone/EE/levomefolate 3/20 and EUCRISA, 8 levomefolate, 5 EVAMIST, 5 D drospirenone/EE/levomefolate 3/30 and exemestane, 2 DALIRESP, 7 levomefolate, 5 ezetimibe, 2 danazol, 5 DUAVEE, 5 ezetimibe/simvastatin, 2 dantrolene, 4 dulaglutide, 4 dapagliflozin, 5 duloxetine delayed-rel, 3 F dapagliflozin/metformin ext-rel, 5 DUREZOL, 8 famciclovir, 2 dapsone, 2 dutasteride, 6 famotidine, 6 darifenacin ext-rel, 6 dutasteride/tamsulosin, 6 FARXIGA, 5 desipramine, 3 DYMISTA, 7 felodipine ext-rel, 3 desmopressin spray, tabs, 6 fenofibrate, 2 desogestrel/EE, 5 E fenofibric acid delayed-rel, 2 desogestrel/EE 0.15/30, 5 econazole, 7 fentanyl sublingual spray, 1 10 fentanyl transdermal, 1 guanfacine, 2 K fentanyl transmucosal lozenge, 1 guanfacine ext-rel, 4 ketoconazole crm 2%, 7 fesoterodine ext-rel, 6 ketoconazole shampoo 2%, 8 FIASP, 4 H ketorolac, 8 fidaxomicin, 1 halobetasol propionate crm, oint 0.05%, 8 ketorolac tromethamine, 8 FINACEA FOAM, 8 halobetasol propionate lotion 0.01%, 8 finasteride, 6 haloperidol, 4 L flecainide, 2 HUMULIN R U-500, 4 labetalol, 2 FLOVENT DISKUS, 7 hydralazine, 3 lacosamide, 3 FLOVENT HFA, 7 hydrochlorothiazide, 3 lactulose soln, 6 fluconazole, 1 hydrocodone/acetaminophen, 1 lamotrigine, 3 fludrocortisone, 5 hydrocodone/homatropine, 7 lamotrigine ext-rel, 3 fluocinolone acetonide crm, oint 0.025%, 8 hydrocortisone, 5 lamotrigine orally disintegrating tabs, 3 fluocinolone acetonide soln 0.01%, 8 hydrocortisone acetate foam, 6 lancets, 5 fluocinonide crm, gel, oint, soln 0.05%, 8 hydrocortisone acetate/pramoxine foam, 6 lansoprazole + amoxicillin + clarithromycin, 6 fluoride drops, tabs, 7 hydrocortisone butyrate crm, lotion, oint, lansoprazole delayed-rel, 6 fluorometholone, 8 soln 0.1%, 8 lasmiditan, 4 fluorouracil cream 4%, 7 hydrocortisone crm, 6 LASTACAFT, 8 fluorouracil crm 5%, soln 5%, soln 2%, 7 hydrocortisone crm 2.5%, 8 latanoprost, 8 fluoxetine, 3 hydrocortisone enema, 6 LATUDA, 3 fluphenazine, 4 hydrocortisone lotion 1%, 8 leflunomide, 6 flutamide, 2 hydrocortisone valerate crm, oint 0.2%, 8 letrozole, 2 fluticasone, 7 hydromorphone, 1 LEUKERAN, 2 fluticasone propionate crm, lotion 0.05%, oint hydromorphone ext-rel, 1 levalbuterol tartrate, CFC-free aerosol, 7 0.005%, 8 hydroxychloroquine, 6 LEVEMIR, 4 fluticasone, CFC-free aerosol, 7 hydroxyurea, 2 levetiracetam, 3 fluticasone/salmeterol, 7 hydroxyzine HCl, 7 levetiracetam ext-rel, 3 fluticasone/salmeterol, CFC-free aerosol, 7 levobunolol, 8 fluticasone/umeclidinium/vilanterol, 7 I levocarnitine, 5 fluticasone/vilanterol, 7 ibandronate, 5 levofloxacin, 1, 8 fluvastatin, 2 ibuprofen, 1 levonorgestrel/EE - Trivora, 5 fluvoxamine, 3 icosapent ethyl, 2 levonorgestrel/EE 0.1/20 - Lessina, 5 FML FORTE, 8 ILEVRO, 8 levonorgestrel/EE 0.1/20 and EE 10, 5 FML S.O.P., 8 imipramine HCl, 3 levonorgestrel/EE 0.15/30, 5 folic acid, 6 imiquimod, 7, 8 levonorgestrel/EE 0.15/30 - Levora, 5 folic acid/vitamin B6/vitamin B12, 6 INCRUSE ELLIPTA, 7 levonorgestrel/EE 0.15/30 and EE 10, 5 fondaparinux, 6 indapamide, 3 levothyroxine, 6 formoterol inhalation soln, 7 ingenol mebutate, 7 levothyroxine - Levoxyl, 6 fosinopril, 2 insulin aspart, 4 lidocaine patch, 8 fosinopril/hydrochlorothiazide, 2 insulin aspart protamine 70%/insulin aspart 30%, lidocaine viscous, 8 fremanezumab-vfrm, 4 4 lidocaine/prilocaine, 8 furosemide, 3 insulin degludec, 4 lifitegrast, 8 FYCOMPA, 3 insulin detemir, 4 linaclotide, 6 insulin glargine, 4 linezolid, 2 G insulin human, 4 LINZESS, 6 gabapentin, 3 insulin isophane human, 4 liothyronine, 6 gabapentin ext-rel, 4 insulin isophane human 70%/regular 30%, 4 liraglutide, 4, 5 galantamine, 3 ipratropium soln, 7 liraglutide/insulin degludec, 4 galantamine ext-rel, 3 ipratropium spray, 7 lisdexamfetamine, 4 galcanezumab-gnlm, 4 ipratropium/albuterol soln, 7 lisinopril, 2 gemfibrozil, 2 irbesartan, 2 lisinopril/hydrochlorothiazide, 2 gentamicin, 7, 8 irbesartan/hydrochlorothiazide, 2 lithium carbonate, 4 glimepiride, 5 isoniazid, 1 lithium carbonate ext-rel, 4 glipizide, 5 isosorbide dinitrate, 3 lixisenatide/insulin glargine, 4 glipizide ext-rel, 5 isosorbide dinitrate/hydralazine, 3 LO LOESTRIN FE, 5 glipizide/metformin, 4 isosorbide mononitrate, 3 LOKELMA, 5 GLUCAGEN HYPOKIT, 5 isosorbide mononitrate ext-rel, 3 loperamide, 6 GLUCAGON EMERGENCY KIT, 5 isotretinoin, 7 lorazepam, 3 glucagon nasal powder, 5 itraconazole, 1 losartan, 2 glucagon, human recombinant, 5 ivabradine, 3 losartan/hydrochlorothiazide, 2 glycopyrrolate/formoterol, 7 ivermectin, 2, 8 loteprednol, 8 GLYXAMBI, 5 J lovastatin, 2 GRALISE, 4 lubiprostone, 6 granisetron, 6 JANUMET, 4 JANUMET XR, 4 luliconazole, 7 granisetron transdermal, 6 LUMIGAN, 8 GRASTEK, 6 JANUVIA, 4 JARDIANCE, 5 lurasidone, 3 griseofulvin ultramicrosize, 1 LYSODREN, 2 11

M naftifine, 7 olmesartan, 2 malathion, 8 NAFTIN, 7 olmesartan/amlodipine/hydrochlorothiazide, MATULANE, 2 naldemedine, 6 2 MAXIDEX, 8 naloxegol, 6 olmesartan/hydrochlorothiazide, 2 mebendazole chewable, 2 naloxone inj, 4 olodaterol, CFC-free aerosol, 7 meclizine, 6 naloxone nasal spray, 4 olopatadine, 8 medroxyprogesterone acetate, 5 naltrexone, 4 olopatadine spray, 7 medroxyprogesterone acetate 150 mg/mL, 5 NAMZARIC, 3 omega-3 acid ethyl esters, 2 mefloquine, 1 naproxen sodium tabs, 1 omeprazole delayed-rel, 6 megestrol acetate susp, 5 naproxen tabs, 1 ondansetron, 6 megestrol acetate tabs, 2 naratriptan, 4 ONEXTON, 7 meloxicam, 1 NARCAN, 4 ONZETRA XSAIL, 4 melphalan, 2 nateglinide, 5 ORILISSA, 5 memantine, 3 nebivolol, 2 oseltamivir, 2 memantine ext-rel, 3 neomycin/polymyxin ospemifene, 5 memantine/donepezil, 3 B/bacitracin/hydrocortisone oint, 8 OSPHENA, 5 mercaptopurine, 2 neomycin/polymyxin B/dexamethasone, 8 oxaprozin, 1 mesalamine delayed-rel caps, 6 neomycin/polymyxin B/gramicidin, 8 oxazepam, 3 mesalamine delayed-rel tabs, 6 neomycin/polymyxin B/hydrocortisone, 9 oxcarbazepine, 3 mesalamine ext-rel caps, 6 neomycin/polymyxin B/hydrocortisone susp, oxcarbazepine ext-rel, 3 mesalamine susp, 6 8 OXTELLAR XR, 3 metaxalone, 4 nepafenac, 8 oxybutynin, 6 metformin, 4 netarsudil, 8 oxybutynin ext-rel, 6 metformin ext-rel, 4 netarsudil/latanoprost, 8 oxycodone caps 5 mg, 1 methadone, 1 NEUPRO, 3 oxycodone concentrate 20 mg/mL, 1 methazolamide, 3 NEVANAC, 8 oxycodone ext-rel, 1 methimazole, 5 niacin ext-rel, 2 oxycodone soln 5 mg/5 mL, 1 methocarbamol, 4 nifedipine ext-rel, 3 oxycodone tabs 5 mg, 15 mg, 30 mg, 1 methotrexate, 2, 6 nitrofurantoin ext-rel, 2 oxycodone/acetaminophen 5/325, 1 methoxsalen oral, 8 nitrofurantoin macrocrystals, 2 OZEMPIC, 4 methyldopa, 3 nitrofurantoin susp, 2 methylphenidate, 4 nitroglycerin lingual spray, 3 P methylphenidate ext-rel, 4 nitroglycerin sublingual, 3 pancrelipase, 6 methylprednisolone, 5 nitroglycerin transdermal, 3 pancrelipase delayed-rel, 6 metoclopramide, 6 norelgestromin/EE, 5 pantoprazole delayed-rel, 6 metolazone, 3 norethindrone, 5 paricalcitol, 5 metoprolol succinate ext-rel, 2 norethindrone acetate, 5 paroxetine HCl, 3 metoprolol tartrate, 2 norethindrone acetate/EE 1.5/30, 5 paroxetine HCl ext-rel, 3 metoprolol/hydrochlorothiazide, 2 norethindrone acetate/EE 1.5/30 and iron, 5 paroxetine mesylate, 4 metronidazole, 2, 6 norethindrone acetate/EE 1/10 and EE 10 and patiromer sorbitex, 5 metronidazole crm, gel, lotion 0.75%, 8 iron, 5 PAZEO, 8 metronidazole gel 1%, 8 norethindrone acetate/EE 1/20, 5 peg 3350/electrolytes, 6 midodrine, 3 norethindrone acetate/EE 1/20 and iron, 5 penicillin VK, 1 minocycline, 1 norethindrone acetate/EE 1/20 and iron PENTASA, 6 mirabegron ext-rel, 6 chewable, 5 perampanel, 3 mirtazapine, 3 norethindrone/EE, 5 PERFOROMIST, 7 misoprostol, 6 norethindrone/EE 0.5/35, 5 perindopril, 2 mitotane, 2 norethindrone/EE 1/35, 5 permethrin 5%, 8 mometasone crm, lotion, oint 0.1%, 8 norgestimate/EE, 5 perphenazine, 4 montelukast, 7 norgestimate/EE 0.25/35, 5 phenelzine, 3 morphine, 1 norgestrel/EE 0.3/30 - Low-Ogestrel, 5 phenobarbital, 3 morphine ext-rel, 1 nortriptyline, 3 phenytoin, 3 morphine supp, 1 NOVOLIN 70/30, 4 phenytoin sodium extended, 3 MOVANTIK, 6 NOVOLIN N, 4 PHOSLYRA, 5 MOXEZA, 8 NOVOLIN R, 4 PICATO, 7 moxifloxacin, 1, 8 NOVOLOG, 4 pilocarpine tabs, 6 MULTAQ, 2 NOVOLOG MIX 70/30, 4 pimecrolimus, 8 multivitamins/fluoride drops, tabs, 7 NUCYNTA, 1 pindolol, 2 multivitamins/fluoride/iron drops, tabs, 7 NUCYNTA ER, 1 pioglitazone, 4 mupirocin oint, 7 NUEDEXTA, 4 pioglitazone/glimepiride, 5 MYDAYIS, 4 NURTEC ODT, 4 pioglitazone/metformin, 4 MYLERAN, 2 nystatin, 1, 7 podofilox, 8 MYRBETRIQ, 6 polymyxin B/bacitracin, 8 O polymyxin B/trimethoprim, 8 N ofloxacin, 8 potassium chloride ext-rel, 6 nabumetone, 1 ofloxacin otic, 9 potassium chloride liquid, 6 nadolol, 2 olanzapine, 3 potassium citrate ext-rel, 6 12 pramipexole, 3 rivastigmine, 3 SYMLINPEN, 4 pramipexole ext-rel, 3 rivastigmine transdermal, 3 SYMPROIC, 6 pramlintide, 4 rizatriptan, 4 SYNJARDY, 5 prasugrel, 6 ROCKLATAN, 8 SYNJARDY XR, 5 pravastatin, 2 roflumilast, 7 SYNTHROID, 6 PRED MILD, 8 rolapitant, 6 prednisolone, 5 ropinirole, 3 T prednisolone acetate, 8 ropinirole ext-rel, 3 TABLOID, 2 prednisolone acetate 1%, 8 rosuvastatin, 2 tacrolimus, 8 prednisone, 5 rotigotine transdermal, 3 tamoxifen, 2 pregabalin, 4 RYBELSUS, 4 tamsulosin, 6 PREMARIN, 5 tapentadol, 1 PREMPHASE, 5 S tapentadol ext-rel, 1 PREMPRO, 5 sacubitril/valsartan, 3 tazarotene, 7 prenatal vitamins, 7 salmeterol xinafoate, 7 TAZORAC, 7 prenatal vitamins/DHA/docusate/folic acid, 7 SANCUSO, 6 TEKTURNA HCT, 3 prenatal vitamins/docusate/folic acid, 7 SAXENDA, 5 telmisartan, 2 prenatal vitamins/docusate/folic acid + DHA, 7 scopolamine transdermal, 6 telmisartan/hydrochlorothiazide, 2 prenatal vitamins/folic acid + pyridoxine, 7 selegiline, 3 temazepam, 4 primidone, 3 selenium sulfide lotion 2.5%, 8 terazosin, 2 probenecid, 1 semaglutide, 4 terbinafine tabs, 1 procarbazine, 2 SEREVENT, 7 terbutaline, 7 prochlorperazine, 6 sertraline, 3 terconazole, 6 PROCTOFOAM-HC, 6 sevelamer carbonate, 5 testosterone cypionate, 4 progesterone, micronized, 5 SILENOR, 4 testosterone enanthate, 4 promethazine, 6 silodosin, 6 testosterone gel, 4 propafenone, 2 silver sulfadiazine, 7 testosterone soln, 4 propafenone ext-rel, 2 SIMBRINZA, 8 testosterone transdermal, 4 propranolol, 2 simvastatin, 2 tetracycline, 1 propranolol ext-rel, 2 sitagliptin phosphate, 4 theophylline ext-rel tabs, 7 propylthiouracil, 5 sitagliptin/metformin, 4 thioguanine, 2 PULMICORT FLEXHALER, 7 sitagliptin/metformin ext-rel, 4 thiothixene, 4 PYLERA, 6 sodium sulfate/potassium sulfate/magnesium tiagabine, 3 pyrazinamide, 1 sulfate, 6 ticagrelor, 6 pyridostigmine, 4 sodium zirconium cyclosilicate, 5 timolol hemihydrate, 8 pyridostigmine ext-rel, 4 solifenacin, 6 timolol maleate, 8 SOLIQUA, 4 timolol maleate gel, 8 Q solriamfetol, 4 timothy grass pollen allergen extract, 6 quetiapine, 3 SOOLANTRA, 8 tinidazole, 2 quetiapine ext-rel, 3 sotalol, 2 tiotropium, 7 quinapril, 2 SPIRIVA, 7 tiotropium/olodaterol, 7 quinapril/hydrochlorothiazide, 2 spironolactone, 2 tizanidine tabs, 4 QVAR REDIHALER, 7 spironolactone/hydrochlorothiazide, 3 TOBRADEX, 8 STIOLTO RESPIMAT, 7 TOBRADEX ST, 8 R STRIVERDI RESPIMAT, 7 tobramycin, 8 ragweed pollen allergen extract, 6 SUBSYS, 1 tobramycin/dexamethasone oint 0.3%/0.1%, 8 RAGWITEK, 6 sucralfate, 6 tobramycin/dexamethasone susp 0.3%/0.05%, 8 raloxifene, 5 sucroferric oxyhydroxide, 5 tobramycin/dexamethasone susp 0.3%/0.1%, ramelteon, 4 sulfacetamide lotion 10%, 7 8 ramipril, 2 sulfacetamide oint, soln 10%, 8 TOLAK, 7 ranolazine ext-rel, 3 sulfacetamide/prednisolone phosphate tolterodine, 6 rasagiline, 3 10%/0.25%, 8 tolterodine ext-rel, 6 RELENZA, 2 sulfamethoxazole/trimethoprim, 2 topiramate, 3 repaglinide, 5 sulfamethoxazole/trimethoprim DS, 2 topiramate ext-rel, 3 RESTASIS, 8 sulfasalazine, 6 torsemide, 3 revefenacin inhalation solution, 7 sulfasalazine delayed-rel, 6 TOVIAZ, 6 REYVOW, 4 sulindac, 1 tramadol, 1 RHOPRESSA, 8 sumatriptan, 4 tramadol ext-rel, 1 rifampin, 1 sumatriptan inj, 4 trandolapril, 2 rifaximin 550 mg, 2 sumatriptan nasal powder, 4 trandolapril/verapamil ext-rel, 2 rimegepant, 4 sumatriptan nasal spray, 4 tranylcypromine, 3 risedronate, 5 SUNOSI, 4 TRAVATAN Z, 8 risedronate delayed-rel, 5 SUPRAX, 1 travoprost, 8 RISPERDAL CONSTA, 3 SUPREP, 6 trazodone, 3 risperidone, 3 suvorexant, 4 TRELEGY ELLIPTA, 7 risperidone long-acting inj, 3 SYMBICORT, 7 TRESIBA, 4 rivaroxaban, 6 SYMJEPI, 7 tretinoin, 7 13 tretinoin - Avita, 7 V W tretinoin caps, 2 valacyclovir, 2 warfarin, 6 tretinoin gel microsphere, 7 valganciclovir, 1 TREXALL, 2 valproic acid, 3 X triamcinolone acetonide crm 0.5%, 8 valsartan, 2 XARELTO, 6 triamcinolone acetonide crm, lotion 0.025%, 8 valsartan/hydrochlorothiazide, 2 XIFAXAN, 2 triamcinolone acetonide crm, lotion, oint vancomycin caps, 2 XIGDUO XR, 5 0.1%, 8 VARUBI, 6 XIIDRA, 8 triamcinolone paste, 8 VASCEPA, 2 XTAMPZA ER, 1 triamterene, 3 VELPHORO, 5 XULTOPHY, 4 triamterene/hydrochlorothiazide, 3 VELTASSA, 5 trifluoperazine, 4 venlafaxine, 3 Y trifluridine, 8 venlafaxine ext-rel, 3 YUPELRI, 7 trihexyphenidyl, 3 verapamil ext-rel, 3 trimethobenzamide, 6 Z VIBERZI, 6 zafirlukast, 7 trimethoprim, 2 VICTOZA, 4 TRINTELLIX, 3 zanamivir, 2 VIIBRYD, 3 ZEMBRACE SYMTOUCH, 4 TROKENDI XR, 3 vilazodone, 3 trospium, 6 ZENPEP, 6 VIMPAT, 3 zileuton ext-rel, 7 trospium ext-rel, 6 VIOKACE, 6 TRULICITY, 4 ziprasidone, 3 VISTOGARD, 2 zolmitriptan, 4 vitamin ADC/fluoride drops, 7 zolmitriptan nasal spray, 4 U vitamin ADC/fluoride/iron drops, 7 UBRELVY, 4 zolpidem, 4 voriconazole, 1 zolpidem ext-rel, 4 ubrogepant, 4 vortioxetine, 3 umeclidinium bromide, 7 zolpidem sublingual, 4 VRAYLAR, 3 ZOMIG, 4 umeclidinium/vilanterol, 7 VYVANSE, 4 uridine triacetate, 2 zonisamide, 3 ursodiol, 6 ZUBSOLV, 4 ZYCLARA, 7

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