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NH Medicaid Top 25 Drugs by Cost

State Fiscal Year 2018 (7/1/17 - 60/30/18) Fee for Service Medicaid NH Healthy Families Well Sense Health Plan 1 LEDIPASVIR/SOFOSBUVIR Methylphenidate HCl SUBOXONE 2 SOFOSBUVIR/VELPATASVIR Amphetamine-Dextroamphetamine METHYLPHENIDATE HCL ER 3 Adalimumab VYVANSE 4 ANTIHEMOPH.FVIII,FULL LENGTH Somatropin HUMIRA PEN 5 Budesonide-Formoterol Fumarate Dihydrate NORDITROPIN FLEXPRO 6 ANTIHEMOPHILIC FACTOR, HUM REC Aspart LATUDA 7 GLECAPREVIR/PIBRENTASVIR Fluticasone Propionate HFA AMPHETAMINE/DEXTROAMPHETA 8 ANTIHEMOPH.FVIII REC,FC FUSION FLOVENT HFA 9 ANTIHEMOPHILIC FACTOR/VWF Albuterol Sulfate ENBREL SURECLICK 10 BUPRENORPHINE HCL/NALOXONE HCL Etanercept VIVITROL 11 FACTOR IX REC, FC FUSION PROTN Aripiprazole ADVAIR DISKUS 12 SOFOSBUVIR/VELPATAS/VOXILAPREV Lisdexamfetamine Dimesylate LYRICA 13 NALTREXONE MICROSPHERES Lumacaftor-Ivacaftor PROAIR HFA 14 ALBUTEROL SULFATE Paliperidone Palmitate INVEGA SUSTENNA 15 Buprenorphine HCl-Naloxone HCl Dihydrate FREESTYLE LITE TEST STRIP 16 INSULIN GLARGINE,HUM.REC.ANLOG PULMOZYME 17 ADALIMUMAB Lurasidone HCl NOVOLOG FLEXPEN 18 FLUTICASONE/SALMETEROL ONFI 19 DEXTROAMPHETAMINE/AMPHETAMINE Atomoxetine HCl DEXMETHYLPHENIDATE HCL ER 20 LISDEXAMFETAMINE DIMESYLATE Omalizumab STELARA 21 SOFOSBUVIR Clobazam SABRIL 22 BLOOD SUGAR DIAGNOSTIC Dornase Alfa NOVOLOG 23 FLUTICASONE PROPIONATE Epinephrine (Anaphylaxis) SYMBICORT 24 LURASIDONE HCL Teduglutide (rDNA) OXYCONTIN 25 LUMACAFTOR/IVACAFTOR Pancrelipase (Lipase-Protease-Amylase) LANTUS SOLOSTAR

Page 1 of 5 MAC 09/18/18 NH Medicaid Top 25 Drugs by Cost

State Fiscal Year 2017 (7/1/16 - 60/30/17) Fee for Service Medicaid NH Healthy Families Well Sense Health Plan 1 LEDIPASVIR/SOFOSBUVIR Methylphenidate HCl SUBOXONE 2 SOFOSBUVIR/VELPATASVIR Amphetamine-Dextroamphetamine VYVANSE 3 ANTIHEMOPH.FVIII,FULL LENGTH Somatropin HUMIRA PEN 4 ANTIHEMOPHILIC FACTOR, HUM REC Aripiprazole AMPHETAMINE/DEXTROAMPHETA 5 CARGLUMIC ACID Insulin Aspart NORDITROPIN FLEXPRO 6 GLYCEROL PHENYLBUTYRATE Adalimumab LATUDA 7 SOFOSBUVIR Insulin Glargine FLOVENT HFA 8 BUPRENORPHINE HCL/NALOXONE HCL Albuterol Sulfate METHYLPHENIDATE HCL ER 9 ANTIHEMOPHILIC FACTOR/VWF Fluticasone Propionate HFA ENBREL SURECLICK 10 DACLATASVIR DIHYDROCHLORIDE Lisdexamfetamine Dimesylate ADVAIR DISKUS 11 FACTOR IX REC, FC FUSION PROTN Budesonide-Formoterol Fumarate Dihydrate METHYLPHENIDATE HCL ER 12 OMBITA/PARITAP/RITON/DASABUVIR Alglucosidase Alfa PROAIR HFA 13 INSULIN ASPART Lurasidone HCl STRATTERA 14 FLUTICASONE/SALMETEROL Paliperidone Palmitate LYRICA 15 ALBUTEROL SULFATE Epinephrine (Anaphylaxis) PULMOZYME 16 DEXTROAMPHETAMINE/AMPHETAMINE Atomoxetine HCl SABRIL 17 LUMACAFTOR/IVACAFTOR Etanercept INVEGA SUSTENNA 18 PYRIMETHAMINE Quetiapine Fumarate FREESTYLE LITE TEST STRIP 19 INSULIN GLARGINE,HUM.REC.ANLOG Buprenorphine HCl-Naloxone HCl Dihydrate FABRAZYME 20 LURASIDONE HCL Glatiramer Acetate NOVOLOG FLEXPEN 21 NALTREXONE MICROSPHERES Pancrelipase (Lipase-Protease-Amylase) DEXMETHYLPHENIDATE HCL ER 22 Levetiracetam KALYDECO 23 LISDEXAMFETAMINE DIMESYLATE Fluticasone-Salmeterol NOVOLOG 24 BLOOD SUGAR DIAGNOSTIC Lumacaftor-Ivacaftor ORKAMBI 25 METHYLPHENIDATE HCL Dimethyl Fumarate OXYCONTIN

Page 2 of 5 MAC 09/18/18 NH Medicaid Top 25 Drugs by Cost

State Fiscal Year 2016 (7/1/15 - 60/30/16) Fee for Service Medicaid NH Healthy Families Well Sense Health Plan 1 ARIPIPRAZOLE Ledipasvir-Sofosbuvir SUBOXONE 2 LEDIPASVIR/SOFOSBUVIR Amphetamine-Dextroamphetamine HARVONI 3 Methylphenidate HCl METHYLPHENIDATE HCL ER 4 LUMACAFTOR/IVACAFTOR Antihemophilic Factor rAHF-PFM VYVANSE 5 ANTIHEMOPH.FVIII,FULL LENGTH Aripiprazole AMPHETAMINE/DEXTROAMPHETA 6 SOMATROPIN Fluticasone-Salmeterol SOVALDI 7 NITISINONE Insulin Aspart ARIPIPRAZOLE 8 BUPRENORPHINE HCL/NALOXONE HCL Carglumic Acid ADVAIR DISKUS 9 DEXTROAMPHETAMINE/AMPHETAMINE Lisdexamfetamine Dimesylate HUMIRA PEN 10 INSULIN ASPART Albuterol Sulfate RECOMBINATE 11 METHYLPHENIDATE HCL Adalimumab NORDITROPIN FLEXPRO 12 FLUTICASONE/SALMETEROL Glycerol Phenylbutyrate LATUDA 13 LISDEXAMFETAMINE DIMESYLATE Somatropin FLOVENT HFA 14 ALBUTEROL SULFATE Insulin Glargine PROAIR HFA 15 LIPASE/PROTEASE/AMYLASE Fluticasone Propionate HFA ENBREL SURECLICK 16 INSULIN DETEMIR Insulin Detemir STRATTERA 17 BLOOD SUGAR DIAGNOSTIC Quetiapine Fumarate ABILIFY 18 SOFOSBUVIR Alglucosidase Alfa FREESTYLE LITE TEST STRIP 19 DORNASE ALFA Epinephrine (Anaphylaxis) DEXMETHYLPHENIDATE HCL ER 20 INSULIN GLARGINE,HUM.REC.ANLOG Dexmethylphenidate HCl OXYCONTIN 21 Compounds Lurasidone HCl NOVOLOG FLEXPEN 22 FLUTICASONE PROPIONATE Buprenorphine HCl-Naloxone HCl Dihydrate LANTUS 23 EPINEPHRINE Oxycodone HCl SEROQUEL XR 24 LURASIDONE HCL Atomoxetine HCl NOVOLOG 25 CLOBAZAM Etanercept LYRICA

Page 3 of 5 MAC 09/18/18 NH Medicaid Top 25 Drugs by Cost

State Fiscal Year 2015 (7/1/14 - 60/30/15) Fee for Service Medicaid NH Healthy Families Well Sense Health Plan 1 ANTIHEMOPHILIC FACTOR/VWF Aripiprazole ABILIFY 2 ARIPIPRAZOLE Amphetamine-Dextroamphetamine SUBOXONE 3 SOMATROPIN Ledipasvir-Sofosbuvir VYVANSE 4 DEXTROAMPHETAMINE/AMPHETAMINE Methylphenidate HCl ADVAIR DISKUS 5 IDURSULFASE Antihemophilic Factor rAHF-PFM HARVONI 6 NITISINONE Lisdexamfetamine Dimesylate AMPHETAMINE/DEXTROAMPHETA 7 LEDIPASVIR/SOFOSBUVIR Fluticasone-Salmeterol NORDITROPIN FLEXPRO 8 METHYLPHENIDATE HCL Albuterol Sulfate PROAIR HFA 9 BUPRENORPHINE HCL/NALOXONE HCL Sofosbuvir FLOVENT HFA 10 INSULIN ASPART Insulin Aspart METHYLPHENIDATE HCL ER 11 FLUTICASONE/SALMETEROL Dexmethylphenidate HCl H.P. ACTHAR 12 GUANFACINE HCL Insulin Glargine LATUDA 13 LISDEXAMFETAMINE DIMESYLATE Quetiapine Fumarate METHYLPHENIDATE HCL ER 14 ALBUTEROL SULFATE Buprenorphine HCl-Naloxone HCl Dihydrate FOCALIN XR 15 ENOXAPARIN SODIUM Guanfacine HCl (ADHD) STRATTERA 16 INSULIN GLARGINE,HUM.REC.ANLOG Fluticasone Propionate HFA LANTUS 17 BLOOD SUGAR DIAGNOSTIC Alglucosidase Alfa INTUNIV 18 DORNASE ALFA Somatropin SEROQUEL XR 19 DEXMETHYLPHENIDATE HCL Oxycodone HCl OXYCONTIN 20 FLUTICASONE PROPIONATE Insulin Detemir FREESTYLE LITE TEST STRIP 21 LIPASE/PROTEASE/AMYLASE Adalimumab HUMIRA PEN 22 ATOMOXETINE HCL Lurasidone HCl NOVOLOG 23 RUFINAMIDE Duloxetine HCl RECOMBINATE 24 QUETIAPINE FUMARATE Epinephrine (Anaphylaxis) COPAXONE 25 GLATIRAMER ACETATE Atomoxetine HCl ADDERALL XR

Page 4 of 5 MAC 09/18/18 NH Medicaid Top 25 Drugs by Cost

State Fiscal Year 2014 (7/1/13 - 60/30/14) Fee for Service Medicaid NH Healthy Families Well Sense Health Plan 1 ARIPIPRAZOLE Aripiprazole ABILIFY 2 DEXTROAMPHETAMINE/AMPHETAMINE Methylphenidate HCl SOVALDI 3 ANTIHEMOPHILIC FACTOR/VWF Amphetamine-Dextroamphetamine METHYLPHENIDATE HCL ER 4 COAGULATION FACTOR VIIA,RECOMB Coagulation Factor VIIa (Recombinant) VYVANSE 5 METHYLPHENIDATE HCL Lisdexamfetamine Dimesylate INTUNIV 6 SOMATROPIN Antihemophilic Factor rAHF-PFM NORDITROPIN FLEXPRO 7 FLUTICASONE/SALMETEROL Fluticasone-Salmeterol FOCALIN XR 8 LISDEXAMFETAMINE DIMESYLATE Dexmethylphenidate HCl ADVAIR DISKUS 9 BUPRENORPHINE HCL/NALOXONE HCL Guanfacine HCl (ADHD) AMPHETAMINE/DEXTROAMPHETA 10 GUANFACINE HCL Albuterol Sulfate SUBOXONE 11 DEXMETHYLPHENIDATE HCL Buprenorphine HCl-Naloxone HCl Dihydrate FLOVENT HFA 12 ALBUTEROL SULFATE Insulin Aspart SYNAGIS 13 ANTIHEMOPH.FVIII,FULL LENGTH Insulin Glargine ADDERALL XR 14 FLUTICASONE PROPIONATE Quetiapine Fumarate PROAIR HFA 15 QUETIAPINE FUMARATE Oxycodone HCl OLYSIO 16 INSULIN ASPART Fluticasone Propionate HFA STRATTERA 17 DULOXETINE HCL Glucose Blood SEROQUEL XR 18 BLOOD SUGAR DIAGNOSTIC Somatropin LANTUS 19 OXYCODONE HCL Duloxetine HCl FREESTYLE LITE TEST STRIP 20 INSULIN GLARGINE,HUM.REC.ANLOG Etanercept DULOXETINE HCL 21 ATOMOXETINE HCL Atomoxetine HCl GENOTROPIN 22 ESOMEPRAZOLE MAGNESIUM Interferon Gamma-1B OXYCONTIN 23 ETANERCEPT Esomeprazole Magnesium NEXIUM 24 EPINEPHRINE Divalproex Sodium NOVOLOG 25 BUDESONIDE Adalimumab INVEGA SUSTENNA

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