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Prior Authorization Drug List for 2021*

Brand Name Generic Name Therapeutic Category AMPHOTERICIN B LIPID INJ SUSP (FOR IV ABELCET INJ 5MG/ML INFUSION) 5 MG/ML ANTI-INFECTIVES ABIRATERONE TAB 250MG ABIRATERONE ACETATE TAB 250 MG ANTINEOPLASTIC AGENTS ACETYLCYST SOL 10% ACETYLCYSTEINE INHAL SOLN 10% RESPIRATORY ACETYLCYST SOL 20% ACETYLCYSTEINE INHAL SOLN 20% RESPIRATORY ACITRETIN CAP 10MG ACITRETIN CAP 10 MG TOPICAL ACITRETIN CAP 17.5MG ACITRETIN CAP 17.5 MG TOPICAL ACITRETIN CAP 25MG ACITRETIN CAP 25 MG TOPICAL INTERFERON GAMMA-1B INJ 100 MCG/0.5ML ACTIMMUNE INJ 2MU/0.5 (2000000 UNIT/0.5ML) IMMUNOLOGIC AGENTS ACYCLOVIR NA INJ 50MG/ML ACYCLOVIR SODIUM IV SOLN 50 MG/ML ANTI-INFECTIVES ADEMPAS TAB 0.5MG RIOCIGUAT TAB 0.5 MG CARDIOVASCULAR ADEMPAS TAB 1.5MG RIOCIGUAT TAB 1.5 MG CARDIOVASCULAR ADEMPAS TAB 1MG RIOCIGUAT TAB 1 MG CARDIOVASCULAR ADEMPAS TAB 2.5MG RIOCIGUAT TAB 2.5 MG CARDIOVASCULAR ADEMPAS TAB 2MG RIOCIGUAT TAB 2 MG CARDIOVASCULAR AFINITOR DIS TAB 2MG TAB FOR ORAL SUSP 2 MG ANTINEOPLASTIC AGENTS AFINITOR DIS TAB 3MG EVEROLIMUS TAB FOR ORAL SUSP 3 MG ANTINEOPLASTIC AGENTS AFINITOR DIS TAB 5MG EVEROLIMUS TAB FOR ORAL SUSP 5 MG ANTINEOPLASTIC AGENTS AFINITOR TAB 10MG EVEROLIMUS TAB 10 MG ANTINEOPLASTIC AGENTS ERENUMAB-AOOE SUBCUTANEOUS SOLN AUTO- AIMOVIG INJ 140MG/ML INJECTOR 140 MG/ML CENTRAL NERVOUS SYSTEM ERENUMAB-AOOE SUBCUTANEOUS SOLN AUTO- AIMOVIG INJ 70MG/ML INJECTOR 70 MG/ML CENTRAL NERVOUS SYSTEM ALBUTEROL SULFATE SOLN NEBU 0.083% (2.5 ALBUTEROL NEB 0.083% MG/3ML) RESPIRATORY ALBUTEROL NEB 0.5% ALBUTEROL SULFATE SOLN NEBU 0.5% (5 MG/ML) RESPIRATORY ALBUTEROL SULFATE SOLN NEBU 0.63 MG/3ML ALBUTEROL NEB 0.63MG/3 (BASE EQUIV) RESPIRATORY ALBUTEROL SULFATE SOLN NEBU 1.25 MG/3ML ALBUTEROL NEB 1.25MG/3 (BASE EQUIV) RESPIRATORY ALECENSA CAP 150MG ALECTINIB HCL CAP 150 MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS ALOSETRON TAB 0.5MG ALOSETRON HCL TAB 0.5 MG (BASE EQUIV) GASTROINTESTINAL ALOSETRON TAB 1MG ALOSETRON HCL TAB 1 MG (BASE EQUIV) GASTROINTESTINAL BRIGATINIB TAB INITIATION THERAPY PACK 90 MG ALUNBRIG PAK & 180 MG ANTINEOPLASTIC AGENTS ALUNBRIG TAB 180MG BRIGATINIB TAB 180 MG ANTINEOPLASTIC AGENTS ALUNBRIG TAB 30MG BRIGATINIB TAB 30 MG ANTINEOPLASTIC AGENTS ALUNBRIG TAB 90MG BRIGATINIB TAB 90 MG ANTINEOPLASTIC AGENTS AMBISOME INJ 50MG AMPHOTERICIN B LIPOSOME IV FOR SUSP 50 MG ANTI-INFECTIVES TAB 10MG AMBRISENTAN TAB 10 MG CARDIOVASCULAR AMBRISENTAN TAB 5MG AMBRISENTAN TAB 5 MG CARDIOVASCULAR AMINOSYN-PF INJ 7% * INFUSION 7%*** NUTRITIONAL/SUPPLEMENTS AMNESTEEM CAP 10MG ISOTRETINOIN CAP 10 MG TOPICAL AMNESTEEM CAP 20MG ISOTRETINOIN CAP 20 MG TOPICAL AMNESTEEM CAP 40MG ISOTRETINOIN CAP 40 MG TOPICAL AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 AMPHET/DEXTR TAB 10MG MG CENTRAL NERVOUS SYSTEM AMPHETAMINE-DEXTROAMPHETAMINE TAB 12.5 AMPHET/DEXTR TAB 12.5MG MG CENTRAL NERVOUS SYSTEM

* Effective 01/01/2021 for the Blue MedicareRxSM Value Plus (PDP) Plan

AMPHETAMINE-DEXTROAMPHETAMINE TAB 15 AMPHET/DEXTR TAB 15MG MG CENTRAL NERVOUS SYSTEM AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 AMPHET/DEXTR TAB 20MG MG CENTRAL NERVOUS SYSTEM AMPHETAMINE-DEXTROAMPHETAMINE TAB 30 AMPHET/DEXTR TAB 30MG MG CENTRAL NERVOUS SYSTEM AMPHET/DEXTR TAB 5MG AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG CENTRAL NERVOUS SYSTEM AMPHETAMINE-DEXTROAMPHETAMINE TAB 7.5 AMPHET/DEXTR TAB 7.5MG MG CENTRAL NERVOUS SYSTEM AMPHOTERICIN INJ 50MG AMPHOTERICIN B FOR IV SOLN 50 MG ANTI-INFECTIVES ENDOCRINE AND ANADROL-50 TAB 50MG OXYMETHOLONE TAB 50 MG METABOLIC ENDOCRINE AND ANDRODERM DIS 2MG/24HR TESTOSTERONE TD PATCH 24HR 2 MG/24HR METABOLIC ENDOCRINE AND ANDRODERM DIS 4MG/24HR TESTOSTERONE TD PATCH 24HR 4 MG/24HR METABOLIC APOKYN INJ 10MG/ML APOMORPHINE HCL SOLN CARTRIDGE 30 MG/3ML CENTRAL NERVOUS SYSTEM APREPITANT CAP 125MG APREPITANT CAPSULE 125 MG GASTROINTESTINAL APREPITANT CAP 40MG APREPITANT CAPSULE 40 MG GASTROINTESTINAL APREPITANT CAP 80MG APREPITANT CAPSULE 80 MG GASTROINTESTINAL APREPITANT CAPSULE THERAPY PACK 80 & 125 APREPITANT PAK 80 & 125 MG GASTROINTESTINAL ALPHA1-PROTEINASE INHIBITOR (HUMAN) FOR IV ARALAST NP INJ 1000MG SOLN 1000 MG RESPIRATORY ALPHA1-PROTEINASE INHIBITOR (HUMAN) FOR IV ARALAST NP INJ 500MG SOLN 500 MG RESPIRATORY ARCALYST INJ 220MG RILONACEPT FOR INJ 220 MG IMMUNOLOGIC AGENTS ARMODAFINIL TAB 150MG ARMODAFINIL TAB 150 MG CENTRAL NERVOUS SYSTEM ARMODAFINIL TAB 200MG ARMODAFINIL TAB 200 MG CENTRAL NERVOUS SYSTEM ARMODAFINIL TAB 250MG ARMODAFINIL TAB 250 MG CENTRAL NERVOUS SYSTEM ARMODAFINIL TAB 50MG ARMODAFINIL TAB 50 MG CENTRAL NERVOUS SYSTEM ENDOCRINE AND AURYXIA TAB 210MG FERRIC CITRATE TAB 1 GM (210 MG FERRIC IRON) METABOLIC AUSTEDO TAB 12MG DEUTETRABENAZINE TAB 12 MG CENTRAL NERVOUS SYSTEM AUSTEDO TAB 6MG DEUTETRABENAZINE TAB 6 MG CENTRAL NERVOUS SYSTEM AUSTEDO TAB 9MG DEUTETRABENAZINE TAB 9 MG CENTRAL NERVOUS SYSTEM AVITA CRE 0.025% TRETINOIN CREAM 0.025% TOPICAL AVITA GEL 0.025% TRETINOIN GEL 0.025% TOPICAL AYVAKIT TAB 100MG AVAPRITINIB TAB 100 MG ANTINEOPLASTIC AGENTS AYVAKIT TAB 200MG AVAPRITINIB TAB 200 MG ANTINEOPLASTIC AGENTS AYVAKIT TAB 300MG AVAPRITINIB TAB 300 MG ANTINEOPLASTIC AGENTS AZATHIOPRINE TAB 50MG AZATHIOPRINE TAB 50 MG IMMUNOLOGIC AGENTS BALVERSA TAB 3MG ERDAFITINIB TAB 3 MG ANTINEOPLASTIC AGENTS BALVERSA TAB 4MG ERDAFITINIB TAB 4 MG ANTINEOPLASTIC AGENTS BALVERSA TAB 5MG ERDAFITINIB TAB 5 MG ANTINEOPLASTIC AGENTS BANZEL SUS 40MG/ML RUFINAMIDE SUSP 40 MG/ML CENTRAL NERVOUS SYSTEM BANZEL TAB 200MG RUFINAMIDE TAB 200 MG CENTRAL NERVOUS SYSTEM BANZEL TAB 400MG RUFINAMIDE TAB 400 MG CENTRAL NERVOUS SYSTEM BENLYSTA INJ 120MG BELIMUMAB FOR IV SOLN 120 MG IMMUNOLOGIC AGENTS BELIMUMAB SUBCUTANEOUS SOLUTION AUTO- BENLYSTA INJ 200MG/ML INJECTOR 200 MG/ML IMMUNOLOGIC AGENTS BELIMUMAB SUBCUTANEOUS SOLUTION BENLYSTA INJ 200MG/ML PREFILLED SYRINGE 200 MG/ML IMMUNOLOGIC AGENTS BENLYSTA INJ 400MG BELIMUMAB FOR IV SOLN 400 MG IMMUNOLOGIC AGENTS BENZTROPINE TAB 0.5MG BENZTROPINE MESYLATE TAB 0.5 MG CENTRAL NERVOUS SYSTEM BENZTROPINE TAB 1MG BENZTROPINE MESYLATE TAB 1 MG CENTRAL NERVOUS SYSTEM BENZTROPINE TAB 2MG BENZTROPINE MESYLATE TAB 2 MG CENTRAL NERVOUS SYSTEM C1 ESTERASE INHIBITOR (HUMAN) FOR IV INJ KIT BERINERT INJ 500UNIT 500 UNIT HEMATOLOGIC

BETASERON INJ 0.3MG INTERFERON BETA-1B FOR INJ KIT 0.3 MG CENTRAL NERVOUS SYSTEM BEXAROTENE CAP 75MG BEXAROTENE CAP 75 MG ANTINEOPLASTIC AGENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 5 BIVIGAM INJ 10% GM/50ML IMMUNOLOGIC AGENTS TAB 125MG BOSENTAN TAB 125 MG CARDIOVASCULAR BOSENTAN TAB 62.5MG BOSENTAN TAB 62.5 MG CARDIOVASCULAR BOSULIF TAB 100MG BOSUTINIB TAB 100 MG ANTINEOPLASTIC AGENTS BOSULIF TAB 400MG BOSUTINIB TAB 400 MG ANTINEOPLASTIC AGENTS BOSULIF TAB 500MG BOSUTINIB TAB 500 MG ANTINEOPLASTIC AGENTS BRAFTOVI CAP 75MG ENCORAFENIB CAP 75 MG ANTINEOPLASTIC AGENTS BRIVIACT INJ 50MG/5ML BRIVARACETAM IV SOLN 50 MG/5ML CENTRAL NERVOUS SYSTEM BRIVIACT SOL 10MG/ML BRIVARACETAM ORAL SOLN 10 MG/ML CENTRAL NERVOUS SYSTEM BRIVIACT TAB 100MG BRIVARACETAM TAB 100 MG CENTRAL NERVOUS SYSTEM BRIVIACT TAB 10MG BRIVARACETAM TAB 10 MG CENTRAL NERVOUS SYSTEM BRIVIACT TAB 25MG BRIVARACETAM TAB 25 MG CENTRAL NERVOUS SYSTEM BRIVIACT TAB 50MG BRIVARACETAM TAB 50 MG CENTRAL NERVOUS SYSTEM BRIVIACT TAB 75MG BRIVARACETAM TAB 75 MG CENTRAL NERVOUS SYSTEM BRUKINSA CAP 80MG ZANUBRUTINIB CAP 80 MG ANTINEOPLASTIC AGENTS BUDESONIDE SUS 0.25MG/2 BUDESONIDE INHALATION SUSP 0.25 MG/2ML RESPIRATORY BUDESONIDE SUS 0.5MG/2 BUDESONIDE INHALATION SUSP 0.5 MG/2ML RESPIRATORY BUPRENORPHIN SUB 2MG BUPRENORPHINE HCL SL TAB 2 MG (BASE EQUIV) CENTRAL NERVOUS SYSTEM BUPRENORPHIN SUB 8MG BUPRENORPHINE HCL SL TAB 8 MG (BASE EQUIV) CENTRAL NERVOUS SYSTEM CABOZANTINIB S-MALATE TAB 20 MG (BASE CABOMETYX TAB 20MG EQUIVALENT) ANTINEOPLASTIC AGENTS CABOZANTINIB S-MALATE TAB 40 MG (BASE CABOMETYX TAB 40MG EQUIVALENT) ANTINEOPLASTIC AGENTS CABOZANTINIB S-MALATE TAB 60 MG (BASE CABOMETYX TAB 60MG EQUIVALENT) ANTINEOPLASTIC AGENTS CALCIPOTRIEN CRE 0.005% CALCIPOTRIENE CREAM 0.005% TOPICAL CALCIPOTRIEN OIN 0.005% CALCIPOTRIENE OINT 0.005% TOPICAL CALCIPOTRIEN SOL 0.005% CALCIPOTRIENE SOLN 0.005% (50 MCG/ML) TOPICAL ENDOCRINE AND SPR 200/ACT CALCITONIN (SALMON) NASAL SOLN 200 UNIT/ACT METABOLIC CALCITRENE OIN 0.005% CALCIPOTRIENE OINT 0.005% TOPICAL ENDOCRINE AND CALCITRIOL CAP 0.25MCG CALCITRIOL CAP 0.25 MCG METABOLIC ENDOCRINE AND CALCITRIOL CAP 0.5MCG CALCITRIOL CAP 0.5 MCG METABOLIC ENDOCRINE AND CALCITRIOL INJ 1MCG/ML CALCITRIOL INJ 1 MCG/ML METABOLIC ENDOCRINE AND CALCITRIOL SOL 1MCG/ML CALCITRIOL ORAL SOLN 1 MCG/ML METABOLIC CALQUENCE CAP 100MG ACALABRUTINIB CAP 100 MG ANTINEOPLASTIC AGENTS CAPRELSA TAB 100MG VANDETANIB TAB 100 MG ANTINEOPLASTIC AGENTS CAPRELSA TAB 300MG VANDETANIB TAB 300 MG ANTINEOPLASTIC AGENTS ENDOCRINE AND CARBAGLU TAB 200MG CARGLUMIC ACID TAB 200 MG METABOLIC AZTREONAM LYSINE FOR INHAL SOLN 75 MG CAYSTON INH 75MG (BASE EQUIVALENT) ANTI-INFECTIVES ELIGLUSTAT TARTRATE CAP 84 MG (BASE ENDOCRINE AND CERDELGA CAP 84MG EQUIVALENT) METABOLIC VARENICLINE TARTRATE TAB 0.5 MG X 11 & TAB 1 CHANTIX PAK 0.5& 1MG MG X 42 PACK CENTRAL NERVOUS SYSTEM CHANTIX PAK 1MG VARENICLINE TARTRATE TAB 1 MG (BASE EQUIV) CENTRAL NERVOUS SYSTEM CHANTIX TAB 0.5MG VARENICLINE TARTRATE TAB 0.5 MG (BASE EQUIV) CENTRAL NERVOUS SYSTEM CHANTIX TAB 1MG VARENICLINE TARTRATE TAB 1 MG (BASE EQUIV) CENTRAL NERVOUS SYSTEM ENDOCRINE AND CINACALCET TAB 30MG CINACALCET HCL TAB 30 MG (BASE EQUIV) METABOLIC CINACALCET TAB 60MG CINACALCET HCL TAB 60 MG (BASE EQUIV) ENDOCRINE AND

METABOLIC ENDOCRINE AND CINACALCET TAB 90MG CINACALCET HCL TAB 90 MG (BASE EQUIV) METABOLIC CLARAVIS CAP 10MG ISOTRETINOIN CAP 10 MG TOPICAL CLARAVIS CAP 20MG ISOTRETINOIN CAP 20 MG TOPICAL CLARAVIS CAP 30MG ISOTRETINOIN CAP 30 MG TOPICAL CLARAVIS CAP 40MG ISOTRETINOIN CAP 40 MG TOPICAL CLINIMIX INJ 4.25/D10 *AMINO ACID INFUSION 4.25% IN D10W*** NUTRITIONAL/SUPPLEMENTS CLINIMIX INJ 4.25/D5W *AMINO ACID INFUSION 4.25% IN D5W*** NUTRITIONAL/SUPPLEMENTS CLINIMIX INJ 5%/D15W *AMINO ACID INFUSION 5% IN D15W*** NUTRITIONAL/SUPPLEMENTS CLINIMIX INJ 5%/D20W *AMINO ACID INFUSION 5% IN D20W*** NUTRITIONAL/SUPPLEMENTS CLINISOL SF INJ 15% *AMINO ACID INFUSION 15%*** NUTRITIONAL/SUPPLEMENTS CLINOLIPID EMU 20% FAT EMULSION PLANT BASED IV EMULSION 20% NUTRITIONAL/SUPPLEMENTS CLOBAZAM SUS 2.5MG/ML CLOBAZAM SUSPENSION 2.5 MG/ML CENTRAL NERVOUS SYSTEM CLOBAZAM TAB 10MG CLOBAZAM TAB 10 MG CENTRAL NERVOUS SYSTEM CLOBAZAM TAB 20MG CLOBAZAM TAB 20 MG CENTRAL NERVOUS SYSTEM CLOMIPRAMINE CAP 25MG CLOMIPRAMINE HCL CAP 25 MG CENTRAL NERVOUS SYSTEM CLOMIPRAMINE CAP 50MG CLOMIPRAMINE HCL CAP 50 MG CENTRAL NERVOUS SYSTEM CLOMIPRAMINE CAP 75MG CLOMIPRAMINE HCL CAP 75 MG CENTRAL NERVOUS SYSTEM CLORAZ DIPOT TAB 15MG CLORAZEPATE DIPOTASSIUM TAB 15 MG CENTRAL NERVOUS SYSTEM CLORAZ DIPOT TAB 3.75MG CLORAZEPATE DIPOTASSIUM TAB 3.75 MG CENTRAL NERVOUS SYSTEM CLORAZ DIPOT TAB 7.5MG CLORAZEPATE DIPOTASSIUM TAB 7.5 MG CENTRAL NERVOUS SYSTEM ENDOCRINE AND CLOVIQUE CAP 250MG TRIENTINE HCL CAP 250 MG METABOLIC CLOZAPINE TAB 100/ODT CLOZAPINE ORALLY DISINTEGRATING TAB 100 MG CENTRAL NERVOUS SYSTEM CLOZAPINE TAB 12.5/ODT CLOZAPINE ORALLY DISINTEGRATING TAB 12.5 MG CENTRAL NERVOUS SYSTEM CLOZAPINE TAB 150/ODT CLOZAPINE ORALLY DISINTEGRATING TAB 150 MG CENTRAL NERVOUS SYSTEM CLOZAPINE TAB 200/ODT CLOZAPINE ORALLY DISINTEGRATING TAB 200 MG CENTRAL NERVOUS SYSTEM CLOZAPINE TAB 25MG ODT CLOZAPINE ORALLY DISINTEGRATING TAB 25 MG CENTRAL NERVOUS SYSTEM CABOZANTINIB S-MAL CAP 1 X 80 MG & 1 X 20 MG COMETRIQ KIT 100MG (100 DOSE) KIT ANTINEOPLASTIC AGENTS CABOZANTINIB S-MAL CAP 1 X 80 MG & 3 X 20 MG COMETRIQ KIT 140MG (140 DOSE) KIT ANTINEOPLASTIC AGENTS CABOZANTINIB S-MALATE CAP 3 X 20 MG (60 MG COMETRIQ KIT 60MG DOSE) KIT ANTINEOPLASTIC AGENTS GLATIRAMER ACETATE SOLN PREFILLED SYRINGE COPAXONE INJ 20MG/ML 20 MG/ML CENTRAL NERVOUS SYSTEM GLATIRAMER ACETATE SOLN PREFILLED SYRINGE COPAXONE INJ 40MG/ML 40 MG/ML CENTRAL NERVOUS SYSTEM COPIKTRA CAP 15MG DUVELISIB CAP 15 MG ANTINEOPLASTIC AGENTS COPIKTRA CAP 25MG DUVELISIB CAP 25 MG ANTINEOPLASTIC AGENTS COBIMETINIB FUMARATE TAB 20 MG (BASE COTELLIC TAB 20MG EQUIVALENT) ANTINEOPLASTIC AGENTS CROMOLYN SOD NEB 20MG/2ML CROMOLYN SODIUM SOLN NEBU 20 MG/2ML RESPIRATORY CYCLOBENZAPR TAB 10MG CYCLOBENZAPRINE HCL TAB 10 MG CENTRAL NERVOUS SYSTEM CYCLOBENZAPR TAB 5MG CYCLOBENZAPRINE HCL TAB 5 MG CENTRAL NERVOUS SYSTEM CYCLOPHOSPH CAP 25MG CYCLOPHOSPHAMIDE CAP 25 MG ANTINEOPLASTIC AGENTS CYCLOPHOSPH CAP 50MG CYCLOPHOSPHAMIDE CAP 50 MG ANTINEOPLASTIC AGENTS CYCLOSPORINE CAP 100MG CYCLOSPORINE CAP 100 MG IMMUNOLOGIC AGENTS CYCLOSPORINE CAP 100MG MD CYCLOSPORINE MODIFIED CAP 100 MG IMMUNOLOGIC AGENTS CYCLOSPORINE CAP 25MG CYCLOSPORINE CAP 25 MG IMMUNOLOGIC AGENTS CYCLOSPORINE CAP 25MG MOD CYCLOSPORINE MODIFIED CAP 25 MG IMMUNOLOGIC AGENTS CYCLOSPORINE CAP 50MG MOD CYCLOSPORINE MODIFIED CAP 50 MG IMMUNOLOGIC AGENTS CYCLOSPORINE SOL MODIFIED CYCLOSPORINE MODIFIED ORAL SOLN 100 MG/ML IMMUNOLOGIC AGENTS CYPROHEPTAD SYP 2MG/5ML CYPROHEPTADINE HCL SYRUP 2 MG/5ML RESPIRATORY CYPROHEPTAD TAB 4MG CYPROHEPTADINE HCL TAB 4 MG RESPIRATORY CYSTAGON CAP 150MG CYSTEAMINE BITARTRATE CAP 150 MG ENDOCRINE AND

METABOLIC ENDOCRINE AND CYSTAGON CAP 50MG CYSTEAMINE BITARTRATE CAP 50 MG METABOLIC CYSTEAMINE HCL OPHTH SOLN 0.44% (BASE CYSTARAN SOL 0.44% EQUIVALENT) OPHTHALMIC DALFAMPRIDIN TAB 10MG ER DALFAMPRIDINE TAB ER 12HR 10 MG CENTRAL NERVOUS SYSTEM GLASDEGIB MALEATE TAB 100 MG (BASE DAURISMO TAB 100MG EQUIVALENT) ANTINEOPLASTIC AGENTS GLASDEGIB MALEATE TAB 25 MG (BASE DAURISMO TAB 25MG EQUIVALENT) ANTINEOPLASTIC AGENTS ENDOCRINE AND DEFERASIROX GRA 180MG DEFERASIROX GRANULES PACKET 180 MG METABOLIC ENDOCRINE AND DEFERASIROX GRA 360MG DEFERASIROX GRANULES PACKET 360 MG METABOLIC ENDOCRINE AND DEFERASIROX GRA 90MG DEFERASIROX GRANULES PACKET 90 MG METABOLIC ENDOCRINE AND DEFERASIROX TAB 180MG DEFERASIROX TAB 180 MG METABOLIC ENDOCRINE AND DEFERASIROX TAB 360MG DEFERASIROX TAB 360 MG METABOLIC ENDOCRINE AND DEFERASIROX TAB 90MG DEFERASIROX TAB 90 MG METABOLIC DEMSER CAP 250MG METYROSINE CAP 250 MG CARDIOVASCULAR DESVENLAFAXINE SUCCINATE TAB ER 24HR 100 DESVENLAFAX TAB 100MG ER MG (BASE EQUIV) CENTRAL NERVOUS SYSTEM DESVENLAFAXINE SUCCINATE TAB ER 24HR 25 MG DESVENLAFAX TAB 25MG ER (BASE EQUIV) CENTRAL NERVOUS SYSTEM DESVENLAFAXINE SUCCINATE TAB ER 24HR 50 MG DESVENLAFAX TAB 50MG ER (BASE EQUIV) CENTRAL NERVOUS SYSTEM DEXMETHYLPH TAB 10MG DEXMETHYLPHENIDATE HCL TAB 10 MG CENTRAL NERVOUS SYSTEM DEXMETHYLPH TAB 2.5MG DEXMETHYLPHENIDATE HCL TAB 2.5 MG CENTRAL NERVOUS SYSTEM DEXMETHYLPH TAB 5MG DEXMETHYLPHENIDATE HCL TAB 5 MG CENTRAL NERVOUS SYSTEM DEXTROSE INJ 50% DEXTROSE INJ 50% NUTRITIONAL/SUPPLEMENTS DEXTROSE INJ 70% DEXTROSE INJ 70% NUTRITIONAL/SUPPLEMENTS DIAZEPAM CON 5MG/ML DIAZEPAM CONC 5 MG/ML CENTRAL NERVOUS SYSTEM DIAZEPAM SOL 5MG/5ML DIAZEPAM ORAL SOLN 1 MG/ML CENTRAL NERVOUS SYSTEM DIAZEPAM TAB 10MG DIAZEPAM TAB 10 MG CENTRAL NERVOUS SYSTEM DIAZEPAM TAB 2MG DIAZEPAM TAB 2 MG CENTRAL NERVOUS SYSTEM DIAZEPAM TAB 5MG DIAZEPAM TAB 5 MG CENTRAL NERVOUS SYSTEM DICLOFENAC GEL 1% DICLOFENAC SODIUM GEL 1% TOPICAL MESYLATE NASAL SPRAY 4 DIHYDROERGOT SPR 4MG/ML MG/ML CENTRAL NERVOUS SYSTEM DIPHTHERIA-TETANUS TOX ADSORBED (DT) IM INJ DIP/TET PED INJ 25-5LFU 25-5 UNIT/0.5ML IMMUNOLOGIC AGENTS DIPYRIDAMOLE TAB 25MG DIPYRIDAMOLE TAB 25 MG HEMATOLOGIC DIPYRIDAMOLE TAB 50MG DIPYRIDAMOLE TAB 50 MG HEMATOLOGIC DIPYRIDAMOLE TAB 75MG DIPYRIDAMOLE TAB 75 MG HEMATOLOGIC DULOXETINE HCL CAP DELAYED RELEASE SPRINKLE DRIZALMA CAP 20MG DR 20 MG (BASE EQ) CENTRAL NERVOUS SYSTEM DULOXETINE HCL CAP DELAYED RELEASE SPRINKLE DRIZALMA CAP 30MG DR 30 MG (BASE EQ) CENTRAL NERVOUS SYSTEM DULOXETINE HCL CAP DELAYED RELEASE SPRINKLE DRIZALMA CAP 40MG DR 40 MG (BASE EQ) CENTRAL NERVOUS SYSTEM DULOXETINE HCL CAP DELAYED RELEASE SPRINKLE DRIZALMA CAP 60MG DR 60 MG (BASE EQ) CENTRAL NERVOUS SYSTEM DRONABINOL CAP 10MG DRONABINOL CAP 10 MG GASTROINTESTINAL DRONABINOL CAP 2.5MG DRONABINOL CAP 2.5 MG GASTROINTESTINAL DRONABINOL CAP 5MG DRONABINOL CAP 5 MG GASTROINTESTINAL

APREPITANT FOR ORAL SUSP 125 MG (125 EMEND SUS 125MG MG/5ML) GASTROINTESTINAL EMSAM DIS 12MG/24H SELEGILINE TD PATCH 24HR 12 MG/24HR CENTRAL NERVOUS SYSTEM EMSAM DIS 6MG/24HR SELEGILINE TD PATCH 24HR 6 MG/24HR CENTRAL NERVOUS SYSTEM EMSAM DIS 9MG/24HR SELEGILINE TD PATCH 24HR 9 MG/24HR CENTRAL NERVOUS SYSTEM ETANERCEPT SUBCUTANEOUS SOLN PREFILLED ENBREL INJ 25/0.5ML SYRINGE 25 MG/0.5ML IMMUNOLOGIC AGENTS ENBREL INJ 25MG ETANERCEPT SUBCUTANEOUS INJ 25 MG/0.5ML IMMUNOLOGIC AGENTS ENBREL INJ 25MG ETANERCEPT FOR SUBCUTANEOUS INJ 25 MG IMMUNOLOGIC AGENTS ETANERCEPT SUBCUTANEOUS SOLN PREFILLED ENBREL INJ 50MG/ML SYRINGE 50 MG/ML IMMUNOLOGIC AGENTS ETANERCEPT SUBCUTANEOUS SOLUTION ENBREL MINI INJ 50MG/ML CARTRIDGE 50 MG/ML IMMUNOLOGIC AGENTS ETANERCEPT SUBCUTANEOUS SOLUTION AUTO- ENBREL SRCLK INJ 50MG/ML INJECTOR 50 MG/ML IMMUNOLOGIC AGENTS ENDARI POW 5GM GLUTAMINE (SICKLE CELL) POWD PACK 5 GM HEMATOLOGIC HEPATITIS B VACCINE (RECOMBINANT) SUSP 10 ENGERIX-B INJ 10/0.5ML MCG/0.5ML IMMUNOLOGIC AGENTS HEPATITIS B VACCINE (RECOMBINANT) SUSP 20 ENGERIX-B INJ 20MCG/ML MCG/ML IMMUNOLOGIC AGENTS CALCIPOTRIENE-BETAMETHASONE DIPROPIONATE ENSTILAR AER FOAM 0.005-0.064% TOPICAL EPCLUSA TAB 400-100 SOFOSBUVIR-VELPATASVIR TAB 400-100 MG ANTI-INFECTIVES EPIDIOLEX SOL 100MG/ML CANNABIDIOL SOLN 100 MG/ML CENTRAL NERVOUS SYSTEM ERIVEDGE CAP 150MG VISMODEGIB CAP 150 MG ANTINEOPLASTIC AGENTS ERLEADA TAB 60MG APALUTAMIDE TAB 60 MG ANTINEOPLASTIC AGENTS ERLOTINIB TAB 100MG ERLOTINIB HCL TAB 100 MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS ERLOTINIB TAB 150MG ERLOTINIB HCL TAB 150 MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS ERLOTINIB TAB 25MG ERLOTINIB HCL TAB 25 MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS ESBRIET CAP 267MG PIRFENIDONE CAP 267 MG RESPIRATORY ESBRIET TAB 267MG PIRFENIDONE TAB 267 MG RESPIRATORY ESBRIET TAB 801MG PIRFENIDONE TAB 801 MG RESPIRATORY EVEROLIMUS TAB 0.25MG EVEROLIMUS TAB 0.25 MG IMMUNOLOGIC AGENTS EVEROLIMUS TAB 0.5 MG EVEROLIMUS TAB 0.5 MG IMMUNOLOGIC AGENTS EVEROLIMUS TAB 0.75MG EVEROLIMUS TAB 0.75 MG IMMUNOLOGIC AGENTS EVEROLIMUS TAB 2.5MG EVEROLIMUS TAB 2.5 MG ANTINEOPLASTIC AGENTS EVEROLIMUS TAB 5MG EVEROLIMUS TAB 5 MG ANTINEOPLASTIC AGENTS EVEROLIMUS TAB 7.5MG EVEROLIMUS TAB 7.5 MG ANTINEOPLASTIC AGENTS ILOPERIDONE TAB 1 MG & 2 MG & 4 MG & 6 MG FANAPT PAK TITRATION PAK CENTRAL NERVOUS SYSTEM FANAPT TAB 10MG ILOPERIDONE TAB 10 MG CENTRAL NERVOUS SYSTEM FANAPT TAB 12MG ILOPERIDONE TAB 12 MG CENTRAL NERVOUS SYSTEM FANAPT TAB 1MG ILOPERIDONE TAB 1 MG CENTRAL NERVOUS SYSTEM FANAPT TAB 2MG ILOPERIDONE TAB 2 MG CENTRAL NERVOUS SYSTEM FANAPT TAB 4MG ILOPERIDONE TAB 4 MG CENTRAL NERVOUS SYSTEM FANAPT TAB 6MG ILOPERIDONE TAB 6 MG CENTRAL NERVOUS SYSTEM FANAPT TAB 8MG ILOPERIDONE TAB 8 MG CENTRAL NERVOUS SYSTEM PANOBINOSTAT LACTATE CAP 10 MG (BASE FARYDAK CAP 10MG EQUIVALENT) ANTINEOPLASTIC AGENTS PANOBINOSTAT LACTATE CAP 20 MG (BASE FARYDAK CAP 20MG EQUIVALENT) ANTINEOPLASTIC AGENTS BENRALIZUMAB SUBCUTANEOUS SOLN PREFILLED FASENRA INJ 30MG/ML SYRINGE 30 MG/ML RESPIRATORY BENRALIZUMAB SUBCUTANEOUS SOLN AUTO- FASENRA PEN INJ 30MG/ML INJECTOR 30 MG/ML RESPIRATORY FENTANYL DIS 100MCG/H FENTANYL TD PATCH 72HR 100 MCG/HR ANALGESICS FENTANYL DIS 12MCG/HR FENTANYL TD PATCH 72HR 12 MCG/HR ANALGESICS FENTANYL DIS 25MCG/HR FENTANYL TD PATCH 72HR 25 MCG/HR ANALGESICS

FENTANYL DIS 50MCG/HR FENTANYL TD PATCH 72HR 50 MCG/HR ANALGESICS FENTANYL DIS 75MCG/HR FENTANYL TD PATCH 72HR 75 MCG/HR ANALGESICS FENTANYL CITRATE LOZENGE ON A HANDLE 1200 FENTANYL OT LOZ 1200MCG MCG ANALGESICS FENTANYL CITRATE LOZENGE ON A HANDLE 1600 FENTANYL OT LOZ 1600MCG MCG ANALGESICS FENTANYL CITRATE LOZENGE ON A HANDLE 200 FENTANYL OT LOZ 200MCG MCG ANALGESICS FENTANYL CITRATE LOZENGE ON A HANDLE 400 FENTANYL OT LOZ 400MCG MCG ANALGESICS FENTANYL CITRATE LOZENGE ON A HANDLE 600 FENTANYL OT LOZ 600MCG MCG ANALGESICS FENTANYL CITRATE LOZENGE ON A HANDLE 800 FENTANYL OT LOZ 800MCG MCG ANALGESICS LEVOMILNACIPRAN HCL CAP ER 24HR 120 MG FETZIMA CAP 120MG (BASE EQUIVALENT) CENTRAL NERVOUS SYSTEM LEVOMILNACIPRAN HCL CAP ER 24HR 20 MG FETZIMA CAP 20MG (BASE EQUIVALENT) CENTRAL NERVOUS SYSTEM LEVOMILNACIPRAN HCL CAP ER 24HR 40 MG FETZIMA CAP 40MG (BASE EQUIVALENT) CENTRAL NERVOUS SYSTEM LEVOMILNACIPRAN HCL CAP ER 24HR 80 MG FETZIMA CAP 80MG (BASE EQUIVALENT) CENTRAL NERVOUS SYSTEM LEVOMILNACIPRAN HCL CAP ER 24HR 20 & 40 MG FETZIMA CAP TITRATIO THERAPY PACK CENTRAL NERVOUS SYSTEM FINTEPLA SOL 2.2MG/ML FENFLURAMINE HCL ORAL SOLN 2.2 MG/ML CENTRAL NERVOUS SYSTEM IMMUNE GLOBULIN (HUMAN) IV SOLN 10 FLEBOGAMMA INJ 10/100ML GM/100ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 10 FLEBOGAMMA INJ 10/200ML GM/200ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 20 FLEBOGAMMA INJ 20/200ML GM/200ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 20 FLEBOGAMMA INJ 20/400ML GM/400ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 5 FLEBOGAMMA INJ 5GM/50ML GM/50ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 5 FLEBOGAMMA INJ DIF 5% GM/100ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 2.5 FLEBOGAMMA INJ DIF 5% GM/50ML IMMUNOLOGIC AGENTS (RECOMBINANT) SOLN PEN-INJ 600 ENDOCRINE AND FORTEO SOL 600/2.4 MCG/2.4ML METABOLIC FREAMINE HBC INJ 6.9% *AMINO ACID INFUSION 6.9%*** NUTRITIONAL/SUPPLEMENTS FREAMINE III INJ 10% *AMINO ACID INFUSION 10%*** NUTRITIONAL/SUPPLEMENTS FYCOMPA SUS 0.5MG/ML PERAMPANEL SUSP 0.5 MG/ML CENTRAL NERVOUS SYSTEM FYCOMPA TAB 10MG PERAMPANEL TAB 10 MG CENTRAL NERVOUS SYSTEM FYCOMPA TAB 12MG PERAMPANEL TAB 12 MG CENTRAL NERVOUS SYSTEM FYCOMPA TAB 2MG PERAMPANEL TAB 2 MG CENTRAL NERVOUS SYSTEM FYCOMPA TAB 4MG PERAMPANEL TAB 4 MG CENTRAL NERVOUS SYSTEM FYCOMPA TAB 6MG PERAMPANEL TAB 6 MG CENTRAL NERVOUS SYSTEM FYCOMPA TAB 8MG PERAMPANEL TAB 8 MG CENTRAL NERVOUS SYSTEM GAMASTAN INJ IMMUNE GLOBULIN (HUMAN) IM INJ IMMUNOLOGIC AGENTS GAMASTAN INJ IMMUNE GLOBULIN (HUMAN) IM INJ IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV OR GAMMAGARD INJ 10GM/100 SUBCUTANEOUS SOLN 10 GM/100ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV OR GAMMAGARD INJ 1GM/10ML SUBCUTANEOUS SOLN 1 GM/10ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV OR GAMMAGARD INJ 2.5GM/25 SUBCUTANEOUS SOLN 2.5 GM/25ML IMMUNOLOGIC AGENTS

IMMUNE GLOBULIN (HUMAN) IV OR GAMMAGARD INJ 20GM/200 SUBCUTANEOUS SOLN 20 GM/200ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV OR GAMMAGARD INJ 30GM/300 SUBCUTANEOUS SOLN 30 GM/300ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV OR GAMMAGARD INJ 5GM/50ML SUBCUTANEOUS SOLN 5 GM/50ML IMMUNOLOGIC AGENTS GAMMAGARD SD INJ 10GM HU IMMUNE GLOBULIN (HUMAN) IV FOR SOLN 10 GM IMMUNOLOGIC AGENTS GAMMAGARD SD INJ 5GM HU IMMUNE GLOBULIN (HUMAN) IV FOR SOLN 5 GM IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV OR GAMMAKED INJ 10GM/100 SUBCUTANEOUS SOLN 10 GM/100ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV OR GAMMAKED INJ 1GM/10ML SUBCUTANEOUS SOLN 1 GM/10ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV OR GAMMAKED INJ 20GM/200 SUBCUTANEOUS SOLN 20 GM/200ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV OR GAMMAKED INJ 5GM/50ML SUBCUTANEOUS SOLN 5 GM/50ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 10 GAMMAPLEX INJ 10% GM/100ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 20 GAMMAPLEX INJ 10% GM/200ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 5 GAMMAPLEX INJ 10% GM/50ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 10 GAMMAPLEX INJ 5% GM/200ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 5 GAMMAPLEX INJ 5% GM/100ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 20 GAMMAPLEX INJ 5% GM/400ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV OR GAMUNEX-C INJ 10GM/100 SUBCUTANEOUS SOLN 10 GM/100ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV OR GAMUNEX-C INJ 1GM/10ML SUBCUTANEOUS SOLN 1 GM/10ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV OR GAMUNEX-C INJ 2.5GM/25 SUBCUTANEOUS SOLN 2.5 GM/25ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV OR GAMUNEX-C INJ 20GM/200 SUBCUTANEOUS SOLN 20 GM/200ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV OR GAMUNEX-C INJ 40/400ML SUBCUTANEOUS SOLN 40 GM/400ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV OR GAMUNEX-C INJ 5GM/50ML SUBCUTANEOUS SOLN 5 GM/50ML IMMUNOLOGIC AGENTS GANCICLOVIR INJ 500MG GANCICLOVIR SODIUM FOR INJ 500 MG ANTI-INFECTIVES GATTEX KIT 5MG (RDNA) FOR INJ KIT 5 MG GASTROINTESTINAL GENGRAF CAP 100MG CYCLOSPORINE MODIFIED CAP 100 MG IMMUNOLOGIC AGENTS GENGRAF CAP 25MG CYCLOSPORINE MODIFIED CAP 25 MG IMMUNOLOGIC AGENTS GENGRAF SOL 100MG/ML CYCLOSPORINE MODIFIED ORAL SOLN 100 MG/ML IMMUNOLOGIC AGENTS ENDOCRINE AND GENOTROPIN INJ 0.2MG SOMATROPIN FOR INJ 0.2 MG METABOLIC ENDOCRINE AND GENOTROPIN INJ 0.4MG SOMATROPIN FOR INJ 0.4 MG METABOLIC ENDOCRINE AND GENOTROPIN INJ 0.6MG SOMATROPIN FOR INJ 0.6 MG METABOLIC ENDOCRINE AND GENOTROPIN INJ 0.8MG SOMATROPIN FOR INJ 0.8 MG METABOLIC ENDOCRINE AND GENOTROPIN INJ 1.2MG SOMATROPIN FOR INJ 1.2 MG METABOLIC ENDOCRINE AND GENOTROPIN INJ 1.4MG SOMATROPIN FOR INJ 1.4 MG METABOLIC ENDOCRINE AND GENOTROPIN INJ 1.6MG SOMATROPIN FOR INJ 1.6 MG METABOLIC GENOTROPIN INJ 1.8MG SOMATROPIN FOR INJ 1.8 MG ENDOCRINE AND

METABOLIC ENDOCRINE AND GENOTROPIN INJ 12MG SOMATROPIN FOR INJ 12 MG (13.8 MG OVERFILL) METABOLIC ENDOCRINE AND GENOTROPIN INJ 1MG SOMATROPIN FOR INJ 1 MG METABOLIC ENDOCRINE AND GENOTROPIN INJ 2MG SOMATROPIN FOR INJ 2 MG METABOLIC ENDOCRINE AND GENOTROPIN INJ 5MG SOMATROPIN FOR SUBCUTANEOUS INJ 5 MG METABOLIC GILENYA CAP 0.5MG FINGOLIMOD HCL CAP 0.5 MG (BASE EQUIV) CENTRAL NERVOUS SYSTEM AFATINIB DIMALEATE TAB 20 MG (BASE GILOTRIF TAB 20MG EQUIVALENT) ANTINEOPLASTIC AGENTS AFATINIB DIMALEATE TAB 30 MG (BASE GILOTRIF TAB 30MG EQUIVALENT) ANTINEOPLASTIC AGENTS AFATINIB DIMALEATE TAB 40 MG (BASE GILOTRIF TAB 40MG EQUIVALENT) ANTINEOPLASTIC AGENTS LIDOCAINE HCL URETHRAL/MUCOSAL GEL GLYDO GEL 2% PREFILLED SYRINGE 2% TOPICAL GRANISETRON TAB 1MG GRANISETRON HCL TAB 1 MG GASTROINTESTINAL GUANFACINE TAB 1MG GUANFACINE HCL TAB 1 MG CARDIOVASCULAR GUANFACINE HCL TAB ER 24HR 1 MG (BASE GUANFACINE TAB 1MG ER EQUIV) CENTRAL NERVOUS SYSTEM GUANFACINE TAB 2MG GUANFACINE HCL TAB 2 MG CARDIOVASCULAR GUANFACINE HCL TAB ER 24HR 2 MG (BASE GUANFACINE TAB 2MG ER EQUIV) CENTRAL NERVOUS SYSTEM GUANFACINE HCL TAB ER 24HR 3 MG (BASE GUANFACINE TAB 3MG ER EQUIV) CENTRAL NERVOUS SYSTEM GUANFACINE HCL TAB ER 24HR 4 MG (BASE GUANFACINE TAB 4MG ER EQUIV) CENTRAL NERVOUS SYSTEM C1 ESTERASE INHIBITOR (HUMAN) FOR HAEGARDA INJ 2000UNIT SUBCUTANEOUS INJ 2000 UNIT HEMATOLOGIC C1 ESTERASE INHIBITOR (HUMAN) FOR HAEGARDA INJ 3000UNIT SUBCUTANEOUS INJ 3000 UNIT HEMATOLOGIC LEDIPASVIR-SOFOSBUVIR PELLET PACK 33.75-150 HARVONI PAK MG ANTI-INFECTIVES HARVONI PAK 45-200MG LEDIPASVIR-SOFOSBUVIR PELLET PACK 45-200 MG ANTI-INFECTIVES HARVONI TAB 45-200MG LEDIPASVIR-SOFOSBUVIR TAB 45-200 MG ANTI-INFECTIVES HARVONI TAB 90-400MG LEDIPASVIR-SOFOSBUVIR TAB 90-400 MG ANTI-INFECTIVES HEPARIN SOD INJ 1000/ML HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML HEMATOLOGIC HEPARIN SOD INJ 10000/ML HEPARIN SODIUM (PORCINE) INJ 10000 UNIT/ML HEMATOLOGIC HEPARIN SOD INJ 20000/ML HEPARIN SODIUM (PORCINE) INJ 20000 UNIT/ML HEMATOLOGIC HEPARIN SOD INJ 5000/ML HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML HEMATOLOGIC HEPATAMINE SOL 8% *AMINO ACID INFUSION 8%*** NUTRITIONAL/SUPPLEMENTS HETLIOZ CAP 20MG TASIMELTEON CAPSULE 20 MG CENTRAL NERVOUS SYSTEM ADALIMUMAB PREFILLED SYRINGE KIT 10 HUMIRA INJ 10/0.1ML MG/0.1ML IMMUNOLOGIC AGENTS ADALIMUMAB PREFILLED SYRINGE KIT 10 HUMIRA INJ 10MG/0.2 MG/0.2ML IMMUNOLOGIC AGENTS ADALIMUMAB PREFILLED SYRINGE KIT 20 HUMIRA INJ 20/0.2ML MG/0.2ML IMMUNOLOGIC AGENTS ADALIMUMAB PREFILLED SYRINGE KIT 40 HUMIRA INJ 40/0.4ML MG/0.4ML IMMUNOLOGIC AGENTS ADALIMUMAB PREFILLED SYRINGE KIT 20 HUMIRA KIT 20MG/0.4 MG/0.4ML IMMUNOLOGIC AGENTS ADALIMUMAB PREFILLED SYRINGE KIT 40 HUMIRA KIT 40MG/0.8 MG/0.8ML IMMUNOLOGIC AGENTS ADALIMUMAB PREFILLED SYRINGE KIT 80 HUMIRA PEDIA INJ CROHNS MG/0.8ML & 40 MG/0.4ML IMMUNOLOGIC AGENTS

ADALIMUMAB PREFILLED SYRINGE KIT 80 HUMIRA PEDIA INJ CROHNS MG/0.8ML IMMUNOLOGIC AGENTS HUMIRA PEN INJ 40/0.4ML ADALIMUMAB PEN-INJECTOR KIT 40 MG/0.4ML IMMUNOLOGIC AGENTS HUMIRA PEN INJ 40MG/0.8 ADALIMUMAB PEN-INJECTOR KIT 40 MG/0.8ML IMMUNOLOGIC AGENTS HUMIRA PEN INJ CD/UC/HS ADALIMUMAB PEN-INJECTOR KIT 40 MG/0.8ML IMMUNOLOGIC AGENTS HUMIRA PEN INJ PS/UV ADALIMUMAB PEN-INJECTOR KIT 40 MG/0.8ML IMMUNOLOGIC AGENTS HUMIRA PEN KIT CD/UC/HS ADALIMUMAB PEN-INJECTOR KIT 80 MG/0.8ML IMMUNOLOGIC AGENTS ADALIMUMAB PEN-INJECTOR KIT 80 MG/0.8ML & HUMIRA PEN KIT PS/UV 40 MG/0.4ML IMMUNOLOGIC AGENTS ENDOCRINE AND HUMULIN R INJ U-500 REGULAR (HUMAN) INJ 500 UNIT/ML METABOLIC HYDROXYZ HCL INJ 25MG/ML HYDROXYZINE HCL IM SOLN 25 MG/ML RESPIRATORY HYDROXYZ HCL INJ 50MG/ML HYDROXYZINE HCL IM SOLN 50 MG/ML RESPIRATORY HYDROXYZ HCL SYP 10MG/5ML HYDROXYZINE HCL SYRUP 10 MG/5ML RESPIRATORY HYDROXYZ HCL TAB 10MG HYDROXYZINE HCL TAB 10 MG RESPIRATORY HYDROXYZ HCL TAB 25MG HYDROXYZINE HCL TAB 25 MG RESPIRATORY HYDROXYZ HCL TAB 50MG HYDROXYZINE HCL TAB 50 MG RESPIRATORY HYDROXYZ PAM CAP 25MG HYDROXYZINE PAMOATE CAP 25 MG RESPIRATORY HYDROXYZ PAM CAP 50MG HYDROXYZINE PAMOATE CAP 50 MG RESPIRATORY HYDROCODONE BITARTRATE TAB ER 24HR DETER HYSINGLA ER TAB 100 MG 100 MG ANALGESICS HYDROCODONE BITARTRATE TAB ER 24HR DETER HYSINGLA ER TAB 120 MG 120 MG ANALGESICS HYDROCODONE BITARTRATE TAB ER 24HR DETER HYSINGLA ER TAB 20 MG 20 MG ANALGESICS HYDROCODONE BITARTRATE TAB ER 24HR DETER HYSINGLA ER TAB 30 MG 30 MG ANALGESICS HYDROCODONE BITARTRATE TAB ER 24HR DETER HYSINGLA ER TAB 40 MG 40 MG ANALGESICS HYDROCODONE BITARTRATE TAB ER 24HR DETER HYSINGLA ER TAB 60 MG 60 MG ANALGESICS HYDROCODONE BITARTRATE TAB ER 24HR DETER HYSINGLA ER TAB 80 MG 80 MG ANALGESICS IBANDRONATE SODIUM TAB 150 MG (BASE ENDOCRINE AND IBANDRONATE TAB 150MG EQUIVALENT) METABOLIC IBRANCE CAP 100MG PALBOCICLIB CAP 100 MG ANTINEOPLASTIC AGENTS IBRANCE CAP 125MG PALBOCICLIB CAP 125 MG ANTINEOPLASTIC AGENTS IBRANCE CAP 75MG PALBOCICLIB CAP 75 MG ANTINEOPLASTIC AGENTS IBRANCE TAB 100MG PALBOCICLIB TAB 100 MG ANTINEOPLASTIC AGENTS IBRANCE TAB 125MG PALBOCICLIB TAB 125 MG ANTINEOPLASTIC AGENTS IBRANCE TAB 75MG PALBOCICLIB TAB 75 MG ANTINEOPLASTIC AGENTS ACETATE INJ 30 MG/3ML (BASE ICATIBANT INJ 30MG/3ML EQUIVALENT) HEMATOLOGIC ICLUSIG TAB 15MG PONATINIB HCL TAB 15 MG (BASE EQUIV) ANTINEOPLASTIC AGENTS ICLUSIG TAB 45MG PONATINIB HCL TAB 45 MG (BASE EQUIV) ANTINEOPLASTIC AGENTS ENASIDENIB MESYLATE TAB 100 MG (BASE IDHIFA TAB 100MG EQUIVALENT) ANTINEOPLASTIC AGENTS ENASIDENIB MESYLATE TAB 50 MG (BASE IDHIFA TAB 50MG EQUIVALENT) ANTINEOPLASTIC AGENTS IMATINIB MESYLATE TAB 100 MG (BASE IMATINIB MES TAB 100MG EQUIVALENT) ANTINEOPLASTIC AGENTS IMATINIB MESYLATE TAB 400 MG (BASE IMATINIB MES TAB 400MG EQUIVALENT) ANTINEOPLASTIC AGENTS IMBRUVICA CAP 140MG IBRUTINIB CAP 140 MG ANTINEOPLASTIC AGENTS IMBRUVICA CAP 70MG IBRUTINIB CAP 70 MG ANTINEOPLASTIC AGENTS IMBRUVICA TAB 140MG IBRUTINIB TAB 140 MG ANTINEOPLASTIC AGENTS IMBRUVICA TAB 280MG IBRUTINIB TAB 280 MG ANTINEOPLASTIC AGENTS IMBRUVICA TAB 420MG IBRUTINIB TAB 420 MG ANTINEOPLASTIC AGENTS

IMBRUVICA TAB 560MG IBRUTINIB TAB 560 MG ANTINEOPLASTIC AGENTS IMOVAX RABIE INJ 2.5/ML RABIES VIRUS VACCINE, HDC INJ IMMUNOLOGIC AGENTS ENDOCRINE AND INCRELEX INJ 40MG/4ML INJ 40 MG/4ML (10 MG/ML) METABOLIC VALBENAZINE TOSYLATE CAP THERAPY PACK 40 INGREZZA CAP 40-80MG MG (7) & 80 MG (21) CENTRAL NERVOUS SYSTEM INGREZZA CAP 40MG VALBENAZINE TOSYLATE CAP 40 MG (BASE EQUIV) CENTRAL NERVOUS SYSTEM INGREZZA CAP 80MG VALBENAZINE TOSYLATE CAP 80 MG (BASE EQUIV) CENTRAL NERVOUS SYSTEM INLYTA TAB 1MG AXITINIB TAB 1 MG ANTINEOPLASTIC AGENTS INLYTA TAB 5MG AXITINIB TAB 5 MG ANTINEOPLASTIC AGENTS INQOVI TAB 35-100MG DECITABINE-CEDAZURIDINE TAB 35-100 MG ANTINEOPLASTIC AGENTS INREBIC CAP 100MG FEDRATINIB HCL CAP 100 MG ANTINEOPLASTIC AGENTS INTRALIPID INJ 20% FAT EMULSION PLANT BASED IV EMULSION 20% NUTRITIONAL/SUPPLEMENTS INTRALIPID INJ 30% FAT EMULSION PLANT BASED IV EMULSION 30% NUTRITIONAL/SUPPLEMENTS INTRON A INJ 10MU INTERFERON ALFA-2B FOR INJ 10000000 UNIT IMMUNOLOGIC AGENTS INTRON A INJ 18MU INTERFERON ALFA-2B INJ 6000000 UNIT/ML IMMUNOLOGIC AGENTS INTRON A INJ 18MU INTERFERON ALFA-2B FOR INJ 18000000 UNIT IMMUNOLOGIC AGENTS INTRON A INJ 25MU INTERFERON ALFA-2B INJ 10000000 UNIT/ML IMMUNOLOGIC AGENTS INTRON A INJ 50MU INTERFERON ALFA-2B FOR INJ 50000000 UNIT IMMUNOLOGIC AGENTS IPRATROPIUM SOL 0.02%INH IPRATROPIUM BROMIDE INHAL SOLN 0.02% RESPIRATORY IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) IPRATROPIUM/ SOL ALBUTER MG/3ML RESPIRATORY IRESSA TAB 250MG GEFITINIB TAB 250 MG ANTINEOPLASTIC AGENTS ISOTRETINOIN CAP 10MG ISOTRETINOIN CAP 10 MG TOPICAL ISOTRETINOIN CAP 20MG ISOTRETINOIN CAP 20 MG TOPICAL ISOTRETINOIN CAP 30MG ISOTRETINOIN CAP 30 MG TOPICAL ISOTRETINOIN CAP 40MG ISOTRETINOIN CAP 40 MG TOPICAL ITRACONAZOLE CAP 100MG ITRACONAZOLE CAP 100 MG ANTI-INFECTIVES RUXOLITINIB PHOSPHATE TAB 10 MG (BASE JAKAFI TAB 10MG EQUIVALENT) ANTINEOPLASTIC AGENTS RUXOLITINIB PHOSPHATE TAB 15 MG (BASE JAKAFI TAB 15MG EQUIVALENT) ANTINEOPLASTIC AGENTS RUXOLITINIB PHOSPHATE TAB 20 MG (BASE JAKAFI TAB 20MG EQUIVALENT) ANTINEOPLASTIC AGENTS RUXOLITINIB PHOSPHATE TAB 25 MG (BASE JAKAFI TAB 25MG EQUIVALENT) ANTINEOPLASTIC AGENTS RUXOLITINIB PHOSPHATE TAB 5 MG (BASE JAKAFI TAB 5MG EQUIVALENT) ANTINEOPLASTIC AGENTS JUXTAPID CAP 10MG LOMITAPIDE MESYLATE CAP 10 MG (BASE EQUIV) CARDIOVASCULAR JUXTAPID CAP 20MG LOMITAPIDE MESYLATE CAP 20 MG (BASE EQUIV) CARDIOVASCULAR JUXTAPID CAP 30MG LOMITAPIDE MESYLATE CAP 30 MG (BASE EQUIV) CARDIOVASCULAR JUXTAPID CAP 40MG LOMITAPIDE MESYLATE CAP 40 MG (BASE EQUIV) CARDIOVASCULAR JUXTAPID CAP 5MG LOMITAPIDE MESYLATE CAP 5 MG (BASE EQUIV) CARDIOVASCULAR JUXTAPID CAP 60MG LOMITAPIDE MESYLATE CAP 60 MG (BASE EQUIV) CARDIOVASCULAR KALYDECO PAK 25MG IVACAFTOR PACKET 25 MG RESPIRATORY KALYDECO PAK 50MG IVACAFTOR PACKET 50 MG RESPIRATORY KALYDECO PAK 75MG IVACAFTOR PACKET 75 MG RESPIRATORY KALYDECO TAB 150MG IVACAFTOR TAB 150 MG RESPIRATORY KETOCONAZOLE TAB 200MG KETOCONAZOLE TAB 200 MG ANTI-INFECTIVES RIBOCICLIB 200 MG DOSE (200 MG TAB) & KISQALI 200 PAK FEMARA LETROZOLE 2.5 MG TBPK ANTINEOPLASTIC AGENTS RIBOCICLIB 400 MG DOSE (200 MG TAB) & KISQALI 400 PAK FEMARA LETROZOLE 2.5 MG TBPK ANTINEOPLASTIC AGENTS RIBOCICLIB 600 MG DOSE (200 MG TAB) & KISQALI 600 PAK FEMARA LETROZOLE 2.5 MG TBPK ANTINEOPLASTIC AGENTS RIBOCICLIB SUCCINATE TAB PACK 200 MG DAILY KISQALI TAB 200DOSE DOSE ANTINEOPLASTIC AGENTS

RIBOCICLIB SUCCINATE TAB PACK 400 MG DAILY KISQALI TAB 400DOSE DOSE (200 MG TAB) ANTINEOPLASTIC AGENTS RIBOCICLIB SUCCINATE TAB PACK 600 MG DAILY KISQALI TAB 600DOSE DOSE (200 MG TAB) ANTINEOPLASTIC AGENTS ENDOCRINE AND KORLYM TAB 300MG MIFEPRISTONE TAB 300 MG METABOLIC SAPROPTERIN DIHYDROCHLORIDE POWDER ENDOCRINE AND KUVAN POW 100MG PACKET 100 MG METABOLIC SAPROPTERIN DIHYDROCHLORIDE POWDER ENDOCRINE AND KUVAN POW 500MG PACKET 500 MG METABOLIC SAPROPTERIN DIHYDROCHLORIDE SOLUBLE TAB ENDOCRINE AND KUVAN TAB 100MG 100 MG METABOLIC LENVATINIB CAP THERAPY PACK 10 MG (10 MG LENVIMA CAP 10 MG DAILY DOSE) ANTINEOPLASTIC AGENTS LENVATINIB CAP THERAPY PACK 3 X 4 MG (12 MG LENVIMA CAP 12MG DAILY DOSE) ANTINEOPLASTIC AGENTS LENVATINIB CAP THERAPY PACK 10 & 4 MG (14 LENVIMA CAP 14 MG MG DAILY DOSE) ANTINEOPLASTIC AGENTS LENVATINIB CAP THER PACK 10 MG & 2 X 4 MG LENVIMA CAP 18 MG (18 MG DAILY DOSE) ANTINEOPLASTIC AGENTS LENVATINIB CAP THERAPY PACK 2 X 10 MG (20 MG LENVIMA CAP 20 MG DAILY DOSE) ANTINEOPLASTIC AGENTS LENVATINIB CAP THER PACK 2 X 10 MG & 4 MG LENVIMA CAP 24 MG (24 MG DAILY DOSE) ANTINEOPLASTIC AGENTS LENVATINIB CAP THERAPY PACK 4 MG (4 MG LENVIMA CAP 4MG DAILY DOSE) ANTINEOPLASTIC AGENTS LENVATINIB CAP THERAPY PACK 2 X 4 MG (8 MG LENVIMA CAP 8 MG DAILY DOSE) ANTINEOPLASTIC AGENTS LEUPROLIDE INJ 1MG/0.2 LEUPROLIDE ACETATE INJ KIT 5 MG/ML ANTINEOPLASTIC AGENTS ENDOCRINE AND LEVOCARNITIN SOL 1GM/10ML LEVOCARNITINE ORAL SOLN 1 GM/10ML (10%) METABOLIC ENDOCRINE AND LEVOCARNITIN TAB 330MG LEVOCARNITINE TAB 330 MG METABOLIC LIDO/PRILOCN CRE 2.5-2.5% LIDOCAINE-PRILOCAINE CREAM 2.5-2.5% TOPICAL LIDOCAINE GEL 2% JELLY LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2% TOPICAL LIDOCAINE INJ 0.5% LIDOCAINE HCL LOCAL INJ 0.5% ANESTHETICS LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ LIDOCAINE INJ 0.5% 0.5% ANESTHETICS LIDOCAINE INJ 1% LIDOCAINE HCL LOCAL INJ 1% ANESTHETICS LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ LIDOCAINE INJ 1% 1% ANESTHETICS LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ LIDOCAINE INJ 1.5% 1.5% ANESTHETICS LIDOCAINE INJ 2% LIDOCAINE HCL LOCAL INJ 2% ANESTHETICS LIDOCAINE OIN 5% LIDOCAINE OINT 5% TOPICAL LIDOCAINE PAD 5% LIDOCAINE PATCH 5% TOPICAL LIDOCAINE SOL 4% LIDOCAINE HCL SOLN 4% TOPICAL LONSURF TAB 15-6.14 TRIFLURIDINE-TIPIRACIL TAB 15-6.14 MG ANTINEOPLASTIC AGENTS LONSURF TAB 20-8.19 TRIFLURIDINE-TIPIRACIL TAB 20-8.19 MG ANTINEOPLASTIC AGENTS LORBRENA TAB 100MG LORLATINIB TAB 100 MG ANTINEOPLASTIC AGENTS LORBRENA TAB 25MG LORLATINIB TAB 25 MG ANTINEOPLASTIC AGENTS LEUPROLIDE ACETATE (3 MONTH) FOR INJ KIT LUPRON DEPOT INJ 11.25MG 11.25 MG ANTINEOPLASTIC AGENTS LUPRON DEPOT INJ 3.75MG LEUPROLIDE ACETATE FOR INJ KIT 3.75 MG ANTINEOPLASTIC AGENTS LYNPARZA TAB 100MG OLAPARIB TAB 100 MG ANTINEOPLASTIC AGENTS LYNPARZA TAB 150MG OLAPARIB TAB 150 MG ANTINEOPLASTIC AGENTS LYRICA CR TAB 165MG PREGABALIN TAB ER 24HR 165 MG CENTRAL NERVOUS SYSTEM LYRICA CR TAB 330MG PREGABALIN TAB ER 24HR 330 MG CENTRAL NERVOUS SYSTEM LYRICA CR TAB 82.5MG PREGABALIN TAB ER 24HR 82.5 MG CENTRAL NERVOUS SYSTEM

MAVYRET TAB 100-40MG GLECAPREVIR-PIBRENTASVIR TAB 100-40 MG ANTI-INFECTIVES ENDOCRINE AND MEGESTROL SUS 625MG/5M MEGESTROL ACETATE SUSP 625 MG/5ML METABOLIC TRAMETINIB DIMETHYL SULFOXIDE TAB 0.5 MG MEKINIST TAB 0.5MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS TRAMETINIB DIMETHYL SULFOXIDE TAB 2 MG MEKINIST TAB 2MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS MEKTOVI TAB 15MG BINIMETINIB TAB 15 MG ANTINEOPLASTIC AGENTS MEMANTINE HC CAP 14MG ER MEMANTINE HCL CAP ER 24HR 14 MG CENTRAL NERVOUS SYSTEM MEMANTINE HC CAP 21MG ER MEMANTINE HCL CAP ER 24HR 21 MG CENTRAL NERVOUS SYSTEM MEMANTINE HC CAP 28MG ER MEMANTINE HCL CAP ER 24HR 28 MG CENTRAL NERVOUS SYSTEM MEMANTINE HC CAP 7MG ER MEMANTINE HCL CAP ER 24HR 7 MG CENTRAL NERVOUS SYSTEM MEMANTINE HC SOL 2MG/ML MEMANTINE HCL ORAL SOLUTION 2 MG/ML CENTRAL NERVOUS SYSTEM MEMANTINE TAB HCL 10MG MEMANTINE HCL TAB 10 MG CENTRAL NERVOUS SYSTEM MEMANTINE TAB HCL 5MG MEMANTINE HCL TAB 5 MG CENTRAL NERVOUS SYSTEM METADATE TAB 20MG ER METHYLPHENIDATE HCL TAB ER 20 MG CENTRAL NERVOUS SYSTEM METHADONE CON 10MG/ML METHADONE HCL CONC 10 MG/ML ANALGESICS METHADONE SOL 10MG/5ML METHADONE HCL SOLN 10 MG/5ML ANALGESICS METHADONE SOL 5MG/5ML METHADONE HCL SOLN 5 MG/5ML ANALGESICS METHADONE TAB 10MG METHADONE HCL TAB 10 MG ANALGESICS METHADONE TAB 5MG METHADONE HCL TAB 5 MG ANALGESICS METHOTREXATE INJ 1GM METHOTREXATE SODIUM FOR INJ 1 GM ANTINEOPLASTIC AGENTS METHOTREXATE SODIUM INJ PF 1000 MG/40ML METHOTREXATE INJ 1GM/40ML (25 MG/ML) ANTINEOPLASTIC AGENTS METHOTREXATE SODIUM INJ PF 250 MG/10ML (25 METHOTREXATE INJ 250/10ML MG/ML) ANTINEOPLASTIC AGENTS METHOTREXATE SODIUM INJ 50 MG/2ML (25 METHOTREXATE INJ 25MG/ML MG/ML) ANTINEOPLASTIC AGENTS METHOTREXATE SODIUM INJ 250 MG/10ML (25 METHOTREXATE INJ 25MG/ML MG/ML) ANTINEOPLASTIC AGENTS METHOTREXATE SODIUM INJ PF 50 MG/2ML (25 METHOTREXATE INJ 50MG/2ML MG/ML) ANTINEOPLASTIC AGENTS METHYLDOPA TAB 250MG METHYLDOPA TAB 250 MG CARDIOVASCULAR METHYLDOPA TAB 500MG METHYLDOPA TAB 500 MG CARDIOVASCULAR METHYLPHENID SOL 10MG/5ML METHYLPHENIDATE HCL SOLN 10 MG/5ML CENTRAL NERVOUS SYSTEM METHYLPHENID SOL 5MG/5ML METHYLPHENIDATE HCL SOLN 5 MG/5ML CENTRAL NERVOUS SYSTEM METHYLPHENID TAB 10MG METHYLPHENIDATE HCL TAB 10 MG CENTRAL NERVOUS SYSTEM METHYLPHENID TAB 10MG ER METHYLPHENIDATE HCL TAB ER 10 MG CENTRAL NERVOUS SYSTEM METHYLPHENID TAB 20MG METHYLPHENIDATE HCL TAB 20 MG CENTRAL NERVOUS SYSTEM METHYLPHENID TAB 20MG ER METHYLPHENIDATE HCL TAB ER 20 MG CENTRAL NERVOUS SYSTEM METHYLPHENID TAB 5MG METHYLPHENIDATE HCL TAB 5 MG CENTRAL NERVOUS SYSTEM METHYLPREDNISOLONE ACETATE INJ SUSP 40 ENDOCRINE AND METHYLPR ACE INJ 40MG/ML MG/ML METABOLIC METHYLPREDNISOLONE ACETATE INJ SUSP 80 ENDOCRINE AND METHYLPR ACE INJ 80MG/ML MG/ML METABOLIC METHYLPREDNISOLONE SOD SUCC FOR INJ 1000 ENDOCRINE AND METHYLPR SS INJ 1000MG MG (BASE EQUIV) METABOLIC METHYLPREDNISOLONE SOD SUCC FOR INJ 125 ENDOCRINE AND METHYLPR SS INJ 125MG MG (BASE EQUIV) METABOLIC METHYLPREDNISOLONE SOD SUCC FOR INJ 40 MG ENDOCRINE AND METHYLPR SS INJ 40MG (BASE EQUIV) METABOLIC ENDOCRINE AND METHYLPRED TAB 16MG METHYLPREDNISOLONE TAB 16 MG METABOLIC ENDOCRINE AND METHYLPRED TAB 32MG METHYLPREDNISOLONE TAB 32 MG METABOLIC ENDOCRINE AND METHYLPRED TAB 4MG METHYLPREDNISOLONE TAB 4 MG METABOLIC ENDOCRINE AND METHYLPRED TAB 8MG METHYLPREDNISOLONE TAB 8 MG METABOLIC

METYROSINE CAP 250MG METYROSINE CAP 250 MG CARDIOVASCULAR ENDOCRINE AND MIGLUSTAT CAP 100MG MIGLUSTAT CAP 100 MG METABOLIC MORPHINE SUL INJ 10MG/ML MORPHINE SULFATE IV SOLN PF 10 MG/ML ANALGESICS MORPHINE SUL INJ 10MG/ML MORPHINE SULFATE IV SOLN PF 10 MG/ML ANALGESICS MORPHINE SUL INJ 10MG/ML MORPHINE SULFATE INJ PF 10 MG/ML ANALGESICS MORPHINE SUL INJ 1MG/ML MORPHINE SULFATE IV SOLN 1 MG/ML ANALGESICS MORPHINE SUL INJ 2MG/ML MORPHINE SULFATE INJ PF 2 MG/ML ANALGESICS MORPHINE SUL INJ 2MG/ML MORPHINE SULFATE IV SOLN PF 2 MG/ML ANALGESICS MORPHINE SUL INJ 4MG/ML MORPHINE SULFATE INJ PF 4 MG/ML ANALGESICS MORPHINE SUL INJ 4MG/ML MORPHINE SULFATE IV SOLN PF 4 MG/ML ANALGESICS MORPHINE SUL INJ 4MG/ML MORPHINE SULFATE IV SOLN PF 4 MG/ML ANALGESICS MORPHINE SUL INJ 5MG/ML MORPHINE SULFATE INJ PF 5 MG/ML ANALGESICS MORPHINE SUL INJ 8MG/ML MORPHINE SULFATE IV SOLN PF 8 MG/ML ANALGESICS MORPHINE SUL INJ 8MG/ML MORPHINE SULFATE IV SOLN PF 8 MG/ML ANALGESICS MORPHINE SUL INJ 8MG/ML MORPHINE SULFATE INJ PF 8 MG/ML ANALGESICS MORPHINE SUL TAB 100MG ER MORPHINE SULFATE TAB ER 100 MG ANALGESICS MORPHINE SUL TAB 15MG ER MORPHINE SULFATE TAB ER 15 MG ANALGESICS MORPHINE SUL TAB 200MG ER MORPHINE SULFATE TAB ER 200 MG ANALGESICS MORPHINE SUL TAB 30MG ER MORPHINE SULFATE TAB ER 30 MG ANALGESICS MORPHINE SUL TAB 60MG ER MORPHINE SULFATE TAB ER 60 MG ANALGESICS MYCOPHENOLAT CAP 250MG MYCOPHENOLATE MOFETIL CAP 250 MG IMMUNOLOGIC AGENTS MYCOPHENOLAT SUS MYCOPHENOLATE MOFETIL FOR ORAL SUSP 200 200MG/ML MG/ML IMMUNOLOGIC AGENTS MYCOPHENOLAT TAB 500MG MYCOPHENOLATE MOFETIL TAB 500 MG IMMUNOLOGIC AGENTS MYCOPHENOLATE SODIUM TAB DR 180 MG MYCOPHENOLIC TAB 180MG DR (MYCOPHENOLIC ACID EQUIV) IMMUNOLOGIC AGENTS MYCOPHENOLATE SODIUM TAB DR 360 MG MYCOPHENOLIC TAB 360MG DR (MYCOPHENOLIC ACID EQUIV) IMMUNOLOGIC AGENTS MYORISAN CAP 10MG ISOTRETINOIN CAP 10 MG TOPICAL MYORISAN CAP 20MG ISOTRETINOIN CAP 20 MG TOPICAL MYORISAN CAP 30MG ISOTRETINOIN CAP 30 MG TOPICAL MYORISAN CAP 40MG ISOTRETINOIN CAP 40 MG TOPICAL (RECOMBINANT) FOR ENDOCRINE AND NATPARA INJ 100MCG INJ CARTRIDGE 100 MCG METABOLIC PARATHYROID HORMONE (RECOMBINANT) FOR ENDOCRINE AND NATPARA INJ 25MCG INJ CARTRIDGE 25 MCG METABOLIC PARATHYROID HORMONE (RECOMBINANT) FOR ENDOCRINE AND NATPARA INJ 50MCG INJ CARTRIDGE 50 MCG METABOLIC PARATHYROID HORMONE (RECOMBINANT) FOR ENDOCRINE AND NATPARA INJ 75MCG INJ CARTRIDGE 75 MCG METABOLIC NEPHRAMINE INJ 5.4% *AMINO ACID INFUSION 5.4%*** NUTRITIONAL/SUPPLEMENTS NERATINIB MALEATE TAB 40 MG (BASE NERLYNX TAB 40MG EQUIVALENT) ANTINEOPLASTIC AGENTS SORAFENIB TOSYLATE TAB 200 MG (BASE NEXAVAR TAB 200MG EQUIVALENT) ANTINEOPLASTIC AGENTS IXAZOMIB CITRATE CAP 2.3 MG (BASE NINLARO CAP 2.3MG EQUIVALENT) ANTINEOPLASTIC AGENTS NINLARO CAP 3MG IXAZOMIB CITRATE CAP 3 MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS NINLARO CAP 4MG IXAZOMIB CITRATE CAP 4 MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS ENDOCRINE AND NITISINONE CAP 10MG NITISINONE CAP 10 MG METABOLIC ENDOCRINE AND NITISINONE CAP 2MG NITISINONE CAP 2 MG METABOLIC ENDOCRINE AND NITISINONE CAP 5MG NITISINONE CAP 5 MG METABOLIC NORTHERA CAP 100MG DROXIDOPA CAP 100 MG CARDIOVASCULAR NORTHERA CAP 200MG DROXIDOPA CAP 200 MG CARDIOVASCULAR NORTHERA CAP 300MG DROXIDOPA CAP 300 MG CARDIOVASCULAR

NUBEQA TAB 300MG DAROLUTAMIDE TAB 300 MG ANTINEOPLASTIC AGENTS DEXTROMETHORPHAN HBR-QUINIDINE SULFATE NUEDEXTA CAP 20-10MG CAP 20-10 MG CENTRAL NERVOUS SYSTEM PIMAVANSERIN TARTRATE CAP 34 MG (BASE NUPLAZID CAP 34MG EQUIVALENT) CENTRAL NERVOUS SYSTEM PIMAVANSERIN TARTRATE TAB 10 MG (BASE NUPLAZID TAB 10MG EQUIVALENT) CENTRAL NERVOUS SYSTEM NUTRILIPID EMU 20% FAT EMULSION PLANT BASED IV EMULSION 20% NUTRITIONAL/SUPPLEMENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 10 OCTAGAM INJ 10/100ML GM/100ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 10 OCTAGAM INJ 10GM GM/200ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 1 OCTAGAM INJ 1GM GM/20ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 2.5 OCTAGAM INJ 2.5GM GM/50ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 20 OCTAGAM INJ 20/200ML GM/200ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 25 OCTAGAM INJ 25GM GM/500ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 2 OCTAGAM INJ 2GM/20ML GM/20ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 30 OCTAGAM INJ 30/300ML GM/300ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 5 OCTAGAM INJ 5GM GM/100ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 5 OCTAGAM INJ 5GM/50ML GM/50ML IMMUNOLOGIC AGENTS OCTREOTIDE ACETATE INJ 1000 MCG/ML (1 ENDOCRINE AND OCTREOTIDE INJ 1000MCG MG/ML) METABOLIC OCTREOTIDE ACETATE INJ 100 MCG/ML (0.1 ENDOCRINE AND OCTREOTIDE INJ 100MCG MG/ML) METABOLIC OCTREOTIDE ACETATE INJ 200 MCG/ML (0.2 ENDOCRINE AND OCTREOTIDE INJ 200MCG MG/ML) METABOLIC OCTREOTIDE ACETATE INJ 500 MCG/ML (0.5 ENDOCRINE AND OCTREOTIDE INJ 500MCG MG/ML) METABOLIC OCTREOTIDE ACETATE INJ 50 MCG/ML (0.05 ENDOCRINE AND OCTREOTIDE INJ 50MCG/ML MG/ML) METABOLIC SONIDEGIB PHOSPHATE CAP 200 MG (BASE ODOMZO CAP 200MG EQUIVALENT) ANTINEOPLASTIC AGENTS NINTEDANIB ESYLATE CAP 100 MG (BASE OFEV CAP 100MG EQUIVALENT) RESPIRATORY NINTEDANIB ESYLATE CAP 150 MG (BASE OFEV CAP 150MG EQUIVALENT) RESPIRATORY ENDOCRINE AND OMNIPOD KIT STARTER *INSULIN INFUSION DISPOSABLE PUMP KIT*** METABOLIC *INSULIN INFUSION DISPOSABLE PUMP ENDOCRINE AND OMNIPOD MIS 5 PACK SUPPLIES*** METABOLIC *INSULIN INFUSION DISPOSABLE PUMP ENDOCRINE AND OMNIPOD MIS 5 PACK SUPPLIES*** METABOLIC ONDANSETRON SOL 4MG/5ML ONDANSETRON HCL ORAL SOLN 4 MG/5ML GASTROINTESTINAL ONDANSETRON TAB 24MG ONDANSETRON HCL TAB 24 MG GASTROINTESTINAL ONDANSETRON TAB 4MG ONDANSETRON HCL TAB 4 MG GASTROINTESTINAL ONDANSETRON ORALLY DISINTEGRATING TAB 4 ONDANSETRON TAB 4MG ODT MG GASTROINTESTINAL ONDANSETRON TAB 8MG ONDANSETRON HCL TAB 8 MG GASTROINTESTINAL ONDANSETRON ORALLY DISINTEGRATING TAB 8 ONDANSETRON TAB 8MG ODT MG GASTROINTESTINAL OPSUMIT TAB 10MG TAB 10 MG CARDIOVASCULAR

LUMACAFTOR-IVACAFTOR GRANULES PACKET 100- ORKAMBI GRA 100-125 125 MG RESPIRATORY LUMACAFTOR-IVACAFTOR GRANULES PACKET 150- ORKAMBI GRA 150-188 188 MG RESPIRATORY ORKAMBI TAB 100-125 LUMACAFTOR-IVACAFTOR TAB 100-125 MG RESPIRATORY ORKAMBI TAB 200-125 LUMACAFTOR-IVACAFTOR TAB 200-125 MG RESPIRATORY ENDOCRINE AND OSPHENA TAB 60MG OSPEMIFENE TAB 60 MG METABOLIC ENDOCRINE AND OXANDROLONE TAB 10MG OXANDROLONE TAB 10 MG METABOLIC ENDOCRINE AND OXANDROLONE TAB 2.5MG OXANDROLONE TAB 2.5 MG METABOLIC ENDOCRINE AND PAMIDRONATE INJ 30/10ML PAMIDRONATE DISODIUM IV SOLN 3 MG/ML METABOLIC ENDOCRINE AND PAMIDRONATE INJ 30MG PAMIDRONATE DISODIUM FOR INJ 30 MG METABOLIC ENDOCRINE AND PAMIDRONATE INJ 6MG/ML PAMIDRONATE DISODIUM IV SOLN 6 MG/ML METABOLIC ENDOCRINE AND PAMIDRONATE INJ 90/10ML PAMIDRONATE DISODIUM IV SOLN 9 MG/ML METABOLIC ENDOCRINE AND PAMIDRONATE INJ 90MG PAMIDRONATE DISODIUM FOR INJ 90 MG METABOLIC IMMUNE GLOBULIN (HUMAN)-IFAS IV SOLN 10 PANZYGA SOL 10/100ML GM/100ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN)-IFAS IV SOLN 1 PANZYGA SOL 1GM/10ML GM/10ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN)-IFAS IV SOLN 2.5 PANZYGA SOL 2.5/25ML GM/25ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN)-IFAS IV SOLN 20 PANZYGA SOL 20/200ML GM/200ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN)-IFAS IV SOLN 30 PANZYGA SOL 30/300ML GM/300ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN)-IFAS IV SOLN 5 PANZYGA SOL 5GM/50ML GM/50ML IMMUNOLOGIC AGENTS ENDOCRINE AND PARICALCITOL CAP 1 MCG PARICALCITOL CAP 1 MCG METABOLIC ENDOCRINE AND PARICALCITOL CAP 2 MCG PARICALCITOL CAP 2 MCG METABOLIC ENDOCRINE AND PARICALCITOL CAP 4 MCG PARICALCITOL CAP 4 MCG METABOLIC PEGASYS INJ PEGINTERFERON ALFA-2A INJ 180 MCG/0.5ML ANTI-INFECTIVES PEGASYS INJ 180MCG/M PEGINTERFERON ALFA-2A INJ 180 MCG/ML ANTI-INFECTIVES PEGASYS INJ PROCLICK PEGINTERFERON ALFA-2A INJ 180 MCG/0.5ML ANTI-INFECTIVES PEMAZYRE TAB 13.5MG PEMIGATINIB TAB 13.5 MG ANTINEOPLASTIC AGENTS PEMAZYRE TAB 4.5MG PEMIGATINIB TAB 4.5 MG ANTINEOPLASTIC AGENTS PEMAZYRE TAB 9MG PEMIGATINIB TAB 9 MG ANTINEOPLASTIC AGENTS PENTAMIDINE ISETHIONATE FOR NEBULIZATION PENTAMIDINE INH 300MG SOLN 300 MG ANTI-INFECTIVES PHENOBARB ELX 20MG/5ML PHENOBARBITAL ELIXIR 20 MG/5ML CENTRAL NERVOUS SYSTEM PHENOBARB INJ 130MG/ML PHENOBARBITAL SODIUM INJ 130 MG/ML CENTRAL NERVOUS SYSTEM PHENOBARB INJ 65MG/ML PHENOBARBITAL SODIUM INJ 65 MG/ML CENTRAL NERVOUS SYSTEM PHENOBARB TAB 100MG PHENOBARBITAL TAB 100 MG CENTRAL NERVOUS SYSTEM PHENOBARB TAB 15MG PHENOBARBITAL TAB 15 MG CENTRAL NERVOUS SYSTEM PHENOBARB TAB 16.2MG PHENOBARBITAL TAB 16.2 MG CENTRAL NERVOUS SYSTEM PHENOBARB TAB 30MG PHENOBARBITAL TAB 30 MG CENTRAL NERVOUS SYSTEM PHENOBARB TAB 32.4MG PHENOBARBITAL TAB 32.4 MG CENTRAL NERVOUS SYSTEM PHENOBARB TAB 60MG PHENOBARBITAL TAB 60 MG CENTRAL NERVOUS SYSTEM PHENOBARB TAB 64.8MG PHENOBARBITAL TAB 64.8 MG CENTRAL NERVOUS SYSTEM PHENOBARB TAB 97.2MG PHENOBARBITAL TAB 97.2 MG CENTRAL NERVOUS SYSTEM

SODIUM PHENYLBUTYRATE ORAL POWDER 3 ENDOCRINE AND PHENYLBUTYRA POW SODIUM GM/TEASPOONFUL METABOLIC PIQRAY 200MG TAB DOSE ALPELISIB TAB THERAPY PACK 200 MG DAILY DOSE ANTINEOPLASTIC AGENTS ALPELISIB TAB PACK 250 MG DAILY DOSE (200 MG PIQRAY 250MG TAB DOSE & 50 MG TABS) ANTINEOPLASTIC AGENTS ALPELISIB TAB PACK 300 MG DAILY DOSE (2X150 PIQRAY 300MG TAB DOSE MG TAB) ANTINEOPLASTIC AGENTS PLENAMINE INJ 15% *AMINO ACID INFUSION 15%*** NUTRITIONAL/SUPPLEMENTS POMALYST CAP 1MG POMALIDOMIDE CAP 1 MG ANTINEOPLASTIC AGENTS POMALYST CAP 2MG POMALIDOMIDE CAP 2 MG ANTINEOPLASTIC AGENTS POMALYST CAP 3MG POMALIDOMIDE CAP 3 MG ANTINEOPLASTIC AGENTS POMALYST CAP 4MG POMALIDOMIDE CAP 4 MG ANTINEOPLASTIC AGENTS SUBCUTANEOUS SOLUTION AUTO- PRALUENT INJ 150MG/ML INJECTOR 150 MG/ML CARDIOVASCULAR ALIROCUMAB SUBCUTANEOUS SOLUTION AUTO- PRALUENT INJ 75MG/ML INJECTOR 75 MG/ML CARDIOVASCULAR PREDNISOLONE SOD PHOSPH ORAL SOLN 6.7 ENDOCRINE AND PRED SOD PHO SOL 5MG/5ML MG/5ML (5 MG/5ML BASE) METABOLIC PREDNISOLONE SYRUP 15 MG/5ML (USP ENDOCRINE AND PREDNISOLONE SOL 15MG/5ML SOLUTION EQUIVALENT) METABOLIC PREDNISOLONE SOD PHOSPHATE ORAL SOLN 15 ENDOCRINE AND PREDNISOLONE SOL 15MG/5ML MG/5ML (BASE EQUIV) METABOLIC PREDNISOLONE SODIUM PHOSPHATE ORAL SOLN ENDOCRINE AND PREDNISOLONE SOL 25MG/5ML 25 MG/5ML (BASE EQ) METABOLIC ENDOCRINE AND PREDNISONE CON 5MG/ML PREDNISONE CONC 5 MG/ML METABOLIC ENDOCRINE AND PREDNISONE SOL 5MG/5ML PREDNISONE ORAL SOLN 5 MG/5ML METABOLIC ENDOCRINE AND PREDNISONE TAB 10MG PREDNISONE TAB 10 MG METABOLIC ENDOCRINE AND PREDNISONE TAB 1MG PREDNISONE TAB 1 MG METABOLIC ENDOCRINE AND PREDNISONE TAB 2.5MG PREDNISONE TAB 2.5 MG METABOLIC ENDOCRINE AND PREDNISONE TAB 20MG PREDNISONE TAB 20 MG METABOLIC ENDOCRINE AND PREDNISONE TAB 50MG PREDNISONE TAB 50 MG METABOLIC ENDOCRINE AND PREDNISONE TAB 5MG PREDNISONE TAB 5 MG METABOLIC PREGABALIN CAP 100MG PREGABALIN CAP 100 MG CENTRAL NERVOUS SYSTEM PREGABALIN CAP 150MG PREGABALIN CAP 150 MG CENTRAL NERVOUS SYSTEM PREGABALIN CAP 200MG PREGABALIN CAP 200 MG CENTRAL NERVOUS SYSTEM PREGABALIN CAP 225MG PREGABALIN CAP 225 MG CENTRAL NERVOUS SYSTEM PREGABALIN CAP 25MG PREGABALIN CAP 25 MG CENTRAL NERVOUS SYSTEM PREGABALIN CAP 300MG PREGABALIN CAP 300 MG CENTRAL NERVOUS SYSTEM PREGABALIN CAP 50MG PREGABALIN CAP 50 MG CENTRAL NERVOUS SYSTEM PREGABALIN CAP 75MG PREGABALIN CAP 75 MG CENTRAL NERVOUS SYSTEM PREGABALIN SOL 20MG/ML PREGABALIN SOLN 20 MG/ML CENTRAL NERVOUS SYSTEM PREMASOL SOL 10% *AMINO ACID INFUSION 10%*** NUTRITIONAL/SUPPLEMENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 10 PRIVIGEN INJ 10GRAMS GM/100ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 20 PRIVIGEN INJ 20GRAMS GM/200ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 40 PRIVIGEN INJ 40GRAMS GM/400ML IMMUNOLOGIC AGENTS IMMUNE GLOBULIN (HUMAN) IV SOLN 5 PRIVIGEN INJ 5 GRAMS GM/50ML IMMUNOLOGIC AGENTS PROCALAMINE INJ 3% *AMINO ACID ELECTROLYTE INFUSION 3%*** NUTRITIONAL/SUPPLEMENTS PROCRIT INJ 10000/ML EPOETIN ALFA INJ 10000 UNIT/ML HEMATOLOGIC

PROCRIT INJ 2000/ML EPOETIN ALFA INJ 2000 UNIT/ML HEMATOLOGIC PROCRIT INJ 20000/ML EPOETIN ALFA INJ 20000 UNIT/ML HEMATOLOGIC PROCRIT INJ 3000/ML EPOETIN ALFA INJ 3000 UNIT/ML HEMATOLOGIC PROCRIT INJ 4000/ML EPOETIN ALFA INJ 4000 UNIT/ML HEMATOLOGIC PROCRIT INJ 40000/ML EPOETIN ALFA INJ 40000 UNIT/ML HEMATOLOGIC PROGRAF GRA 0.2MG TACROLIMUS PACKET FOR SUSP 0.2 MG IMMUNOLOGIC AGENTS PROGRAF GRA 1MG TACROLIMUS PACKET FOR SUSP 1 MG IMMUNOLOGIC AGENTS ALPHA1-PROTEINASE INHIBITOR (HUMAN) FOR IV PROLASTIN-C INJ 1000MG SOLN 1000 MG RESPIRATORY ALPHA1-PROTEINASE INHIBITOR (HUMAN) INJ PROLASTIN-C INJ 1000MG 1000 MG/20ML RESPIRATORY ELTROMBOPAG OLAMINE POWDER PACK FOR PROMACTA PAK 25MG SUSP 25 MG (BASE EQUIV) HEMATOLOGIC ELTROMBOPAG OLAMINE POWDER PACK FOR PROMACTA POW 12.5MG SUSP 12.5 MG (BASE EQ) HEMATOLOGIC ELTROMBOPAG OLAMINE TAB 12.5 MG (BASE PROMACTA TAB 12.5MG EQUIV) HEMATOLOGIC ELTROMBOPAG OLAMINE TAB 25 MG (BASE PROMACTA TAB 25MG EQUIV) HEMATOLOGIC ELTROMBOPAG OLAMINE TAB 50 MG (BASE PROMACTA TAB 50MG EQUIV) HEMATOLOGIC ELTROMBOPAG OLAMINE TAB 75 MG (BASE PROMACTA TAB 75MG EQUIV) HEMATOLOGIC PROMETHAZINE INJ 25MG/ML PROMETHAZINE HCL INJ 25 MG/ML GASTROINTESTINAL PROMETHAZINE INJ 50MG/ML PROMETHAZINE HCL INJ 50 MG/ML GASTROINTESTINAL PROMETHAZINE SYP 6.25/5ML PROMETHAZINE HCL SYRUP 6.25 MG/5ML GASTROINTESTINAL PROMETHAZINE TAB 12.5MG PROMETHAZINE HCL TAB 12.5 MG GASTROINTESTINAL PROMETHAZINE TAB 25MG PROMETHAZINE HCL TAB 25 MG GASTROINTESTINAL PROMETHAZINE TAB 50MG PROMETHAZINE HCL TAB 50 MG GASTROINTESTINAL PROSOL INJ 20% *AMINO ACID INFUSION 20%*** NUTRITIONAL/SUPPLEMENTS PULMOZYME SOL 1MG/ML DORNASE ALFA INHAL SOLN 1 MG/ML RESPIRATORY QINLOCK TAB 50MG RIPRETINIB TAB 50 MG ANTINEOPLASTIC AGENTS QUETIAPINE TAB 150MG ER QUETIAPINE FUMARATE TAB ER 24HR 150 MG CENTRAL NERVOUS SYSTEM QUETIAPINE TAB 200MG ER QUETIAPINE FUMARATE TAB ER 24HR 200 MG CENTRAL NERVOUS SYSTEM QUETIAPINE TAB 300MG ER QUETIAPINE FUMARATE TAB ER 24HR 300 MG CENTRAL NERVOUS SYSTEM QUETIAPINE TAB 400MG ER QUETIAPINE FUMARATE TAB ER 24HR 400 MG CENTRAL NERVOUS SYSTEM QUETIAPINE TAB 50MG ER QUETIAPINE FUMARATE TAB ER 24HR 50 MG CENTRAL NERVOUS SYSTEM QUININE SULF CAP 324MG QUININE SULFATE CAP 324 MG ANTI-INFECTIVES RABAVERT INJ RABIES VACCINE, PCEC FOR INJ IMMUNOLOGIC AGENTS HEPATITIS B VACCINE (RECOMBINANT) SUSP 10 RECOMBIVA HB INJ 10MCG/ML MCG/ML IMMUNOLOGIC AGENTS HEPATITIS B VACCINE (RECOMBINANT) SUSP 10 RECOMBIVA HB INJ 10MCG/ML MCG/ML IMMUNOLOGIC AGENTS HEPATITIS B VACCINE (RECOMBINANT) SUSP 5 RECOMBIVA HB INJ 5MCG/0.5 MCG/0.5ML IMMUNOLOGIC AGENTS HEPATITIS B VACCINE (RECOMBINANT) SUSP 40 RECOMBIVA-HB INJ 40MCG/ML MCG/ML IMMUNOLOGIC AGENTS REGRANEX GEL 0.01% BECAPLERMIN GEL 0.01% TOPICAL METHYLNALTREXONE BROMIDE INJ 12 MG/0.6ML RELISTOR INJ 12/0.6ML (20 MG/ML) GASTROINTESTINAL METHYLNALTREXONE BROMIDE INJ 12 MG/0.6ML RELISTOR INJ 12/0.6ML (20 MG/ML) GASTROINTESTINAL METHYLNALTREXONE BROMIDE INJ 8 MG/0.4ML RELISTOR INJ 8/0.4ML (20 MG/ML) GASTROINTESTINAL RETEVMO CAP 40MG SELPERCATINIB CAP 40 MG ANTINEOPLASTIC AGENTS RETEVMO CAP 80MG SELPERCATINIB CAP 80 MG ANTINEOPLASTIC AGENTS REVLIMID CAP 10MG LENALIDOMIDE CAP 10 MG ANTINEOPLASTIC AGENTS REVLIMID CAP 15MG LENALIDOMIDE CAP 15 MG ANTINEOPLASTIC AGENTS

REVLIMID CAP 2.5MG LENALIDOMIDE CAPS 2.5 MG ANTINEOPLASTIC AGENTS REVLIMID CAP 20MG LENALIDOMIDE CAP 20 MG ANTINEOPLASTIC AGENTS REVLIMID CAP 25MG LENALIDOMIDE CAP 25 MG ANTINEOPLASTIC AGENTS REVLIMID CAP 5MG LENALIDOMIDE CAP 5 MG ANTINEOPLASTIC AGENTS RINVOQ TAB 15MG ER UPADACITINIB TAB ER 24HR 15 MG IMMUNOLOGIC AGENTS ROZLYTREK CAP 100MG ENTRECTINIB CAP 100 MG ANTINEOPLASTIC AGENTS ROZLYTREK CAP 200MG ENTRECTINIB CAP 200 MG ANTINEOPLASTIC AGENTS RUCAPARIB CAMSYLATE TAB 200 MG (BASE RUBRACA TAB 200MG EQUIVALENT) ANTINEOPLASTIC AGENTS RUCAPARIB CAMSYLATE TAB 250 MG (BASE RUBRACA TAB 250MG EQUIVALENT) ANTINEOPLASTIC AGENTS RUCAPARIB CAMSYLATE TAB 300 MG (BASE RUBRACA TAB 300MG EQUIVALENT) ANTINEOPLASTIC AGENTS RYDAPT CAP 25MG MIDOSTAURIN CAP 25 MG ANTINEOPLASTIC AGENTS SANDIMMUNE SOL 100MG/ML CYCLOSPORINE ORAL SOLN 100 MG/ML IMMUNOLOGIC AGENTS SCOPOLAMINE DIS 1MG/3DAY SCOPOLAMINE TD PATCH 72HR 1 MG/3DAYS GASTROINTESTINAL PASIREOTIDE DIASPARTATE INJ 0.3 MG/ML (BASE ENDOCRINE AND SIGNIFOR INJ 0.3MG/ML EQUIV) METABOLIC PASIREOTIDE DIASPARTATE INJ 0.6 MG/ML (BASE ENDOCRINE AND SIGNIFOR INJ 0.6MG/ML EQUIV) METABOLIC PASIREOTIDE DIASPARTATE INJ 0.9 MG/ML (BASE ENDOCRINE AND SIGNIFOR INJ 0.9MG/ML EQUIV) METABOLIC SILDENAFIL TAB 20MG SILDENAFIL CITRATE TAB 20 MG CARDIOVASCULAR SOL 1MG/ML SIROLIMUS ORAL SOLN 1 MG/ML IMMUNOLOGIC AGENTS SIROLIMUS TAB 0.5MG SIROLIMUS TAB 0.5 MG IMMUNOLOGIC AGENTS SIROLIMUS TAB 1MG SIROLIMUS TAB 1 MG IMMUNOLOGIC AGENTS SIROLIMUS TAB 2MG SIROLIMUS TAB 2 MG IMMUNOLOGIC AGENTS BEDAQUILINE FUMARATE TAB 100 MG (BASE SIRTURO TAB 100MG EQUIV) ANTI-INFECTIVES BEDAQUILINE FUMARATE TAB 20 MG (BASE SIRTURO TAB 20MG EQUIV) ANTI-INFECTIVES RISANKIZUMAB-RZAA SOL PREFILLED SYRINGE 2 X SKYRIZI INJ 150DOSE 75 MG/0.83ML KIT IMMUNOLOGIC AGENTS ENDOCRINE AND SODIUM PHENY TAB 500MG SODIUM PHENYLBUTYRATE TAB 500 MG METABOLIC LANREOTIDE ACETATE EXTENDED RELEASE INJ 120 ENDOCRINE AND SOMATULINE INJ 120/.5ML MG/0.5ML METABOLIC LANREOTIDE ACETATE EXTENDED RELEASE INJ 60 ENDOCRINE AND SOMATULINE INJ 60/0.2ML MG/0.2ML METABOLIC LANREOTIDE ACETATE EXTENDED RELEASE INJ 90 ENDOCRINE AND SOMATULINE INJ 90/0.3ML MG/0.3ML METABOLIC ENDOCRINE AND SOMAVERT INJ 10MG PEGVISOMANT FOR INJ 10 MG (AS PROTEIN) METABOLIC ENDOCRINE AND SOMAVERT INJ 15MG PEGVISOMANT FOR INJ 15 MG (AS PROTEIN) METABOLIC ENDOCRINE AND SOMAVERT INJ 20MG PEGVISOMANT FOR INJ 20 MG (AS PROTEIN) METABOLIC ENDOCRINE AND SOMAVERT INJ 25MG PEGVISOMANT FOR INJ 25 MG (AS PROTEIN) METABOLIC ENDOCRINE AND SOMAVERT INJ 30MG PEGVISOMANT FOR INJ 30 MG (AS PROTEIN) METABOLIC SPRYCEL TAB 100MG DASATINIB TAB 100 MG ANTINEOPLASTIC AGENTS SPRYCEL TAB 140MG DASATINIB TAB 140 MG ANTINEOPLASTIC AGENTS SPRYCEL TAB 20MG DASATINIB TAB 20 MG ANTINEOPLASTIC AGENTS SPRYCEL TAB 50MG DASATINIB TAB 50 MG ANTINEOPLASTIC AGENTS SPRYCEL TAB 70MG DASATINIB TAB 70 MG ANTINEOPLASTIC AGENTS SPRYCEL TAB 80MG DASATINIB TAB 80 MG ANTINEOPLASTIC AGENTS STELARA INJ 45MG/0.5 USTEKINUMAB INJ 45 MG/0.5ML IMMUNOLOGIC AGENTS

USTEKINUMAB SOLN PREFILLED SYRINGE 45 STELARA INJ 45MG/0.5 MG/0.5ML IMMUNOLOGIC AGENTS USTEKINUMAB SOLN PREFILLED SYRINGE 90 STELARA INJ 90MG/ML MG/ML IMMUNOLOGIC AGENTS STIVARGA TAB 40MG REGORAFENIB TAB 40 MG ANTINEOPLASTIC AGENTS SUNITINIB MALATE CAP 12.5 MG (BASE SUTENT CAP 12.5MG EQUIVALENT) ANTINEOPLASTIC AGENTS SUNITINIB MALATE CAP 25 MG (BASE SUTENT CAP 25MG EQUIVALENT) ANTINEOPLASTIC AGENTS SUNITINIB MALATE CAP 37.5 MG (BASE SUTENT CAP 37.5MG EQUIVALENT) ANTINEOPLASTIC AGENTS SUNITINIB MALATE CAP 50 MG (BASE SUTENT CAP 50MG EQUIVALENT) ANTINEOPLASTIC AGENTS TEZACAFTOR-IVACAFTOR 100-150 MG & SYMDEKO TAB 100-150 IVACAFTOR 150 MG TAB TBPK RESPIRATORY TEZACAFTOR-IVACAFTOR 50-75 MG & IVACAFTOR SYMDEKO TAB 50-75MG 75 MG TAB TBPK RESPIRATORY SYMPAZAN MIS 10MG CLOBAZAM ORAL FILM 10 MG CENTRAL NERVOUS SYSTEM SYMPAZAN MIS 20MG CLOBAZAM ORAL FILM 20 MG CENTRAL NERVOUS SYSTEM SYMPAZAN MIS 5MG CLOBAZAM ORAL FILM 5 MG CENTRAL NERVOUS SYSTEM SYNRIBO INJ 3.5MG OMACETAXINE MEPESUCCINATE FOR INJ 3.5 MG ANTINEOPLASTIC AGENTS TABRECTA TAB 150MG CAPMATINIB HCL TAB 150 MG ANTINEOPLASTIC AGENTS TABRECTA TAB 200MG CAPMATINIB HCL TAB 200 MG ANTINEOPLASTIC AGENTS TACROLIMUS CAP 0.5MG TACROLIMUS CAP 0.5 MG IMMUNOLOGIC AGENTS TACROLIMUS CAP 1MG TACROLIMUS CAP 1 MG IMMUNOLOGIC AGENTS TACROLIMUS CAP 5MG TACROLIMUS CAP 5 MG IMMUNOLOGIC AGENTS DABRAFENIB MESYLATE CAP 50 MG (BASE TAFINLAR CAP 50MG EQUIVALENT) ANTINEOPLASTIC AGENTS DABRAFENIB MESYLATE CAP 75 MG (BASE TAFINLAR CAP 75MG EQUIVALENT) ANTINEOPLASTIC AGENTS OSIMERTINIB MESYLATE TAB 40 MG (BASE TAGRISSO TAB 40MG EQUIVALENT) ANTINEOPLASTIC AGENTS OSIMERTINIB MESYLATE TAB 80 MG (BASE TAGRISSO TAB 80MG EQUIVALENT) ANTINEOPLASTIC AGENTS IXEKIZUMAB SUBCUTANEOUS SOLN AUTO- TALTZ INJ 80MG/ML INJECTOR 80 MG/ML IMMUNOLOGIC AGENTS IXEKIZUMAB SUBCUTANEOUS SOLN PREFILLED TALTZ INJ 80MG/ML SYRINGE 80 MG/ML IMMUNOLOGIC AGENTS TALAZOPARIB TOSYLATE CAP 0.25 MG (BASE TALZENNA CAP 0.25MG EQUIVALENT) ANTINEOPLASTIC AGENTS TALAZOPARIB TOSYLATE CAP 1 MG (BASE TALZENNA CAP 1MG EQUIVALENT) ANTINEOPLASTIC AGENTS TARGRETIN GEL 1% BEXAROTENE GEL 1% TOPICAL TASIGNA CAP 150MG NILOTINIB HCL CAP 150 MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS TASIGNA CAP 200MG NILOTINIB HCL CAP 200 MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS TASIGNA CAP 50MG NILOTINIB HCL CAP 50 MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS TAZAROTENE CRE 0.1% TAZAROTENE CREAM 0.1% TOPICAL TAZORAC CRE 0.05% TAZAROTENE CREAM 0.05% TOPICAL TAZVERIK TAB 200MG TAZEMETOSTAT HBR TAB 200 MG ANTINEOPLASTIC AGENTS TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 2-2 TDVAX INJ 2-2 LF LF/0.5ML IMMUNOLOGIC AGENTS DIMETHYL FUMARATE CAPSULE DELAYED RELEASE TECFIDERA CAP 120MG 120 MG CENTRAL NERVOUS SYSTEM DIMETHYL FUMARATE CAPSULE DELAYED RELEASE TECFIDERA CAP 240MG 240 MG CENTRAL NERVOUS SYSTEM TEMAZEPAM CAP 15MG TEMAZEPAM CAP 15 MG CENTRAL NERVOUS SYSTEM TEMAZEPAM CAP 30MG TEMAZEPAM CAP 30 MG CENTRAL NERVOUS SYSTEM TEMAZEPAM CAP 7.5MG TEMAZEPAM CAP 7.5 MG CENTRAL NERVOUS SYSTEM

TENIVAC INJ 5-2LF TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 5-2 LFU IMMUNOLOGIC AGENTS TESTOSTERONE CYPIONATE IM INJ IN OIL 100 ENDOCRINE AND TESTOST CYP INJ 100MG/ML MG/ML METABOLIC TESTOSTERONE CYPIONATE IM INJ IN OIL 200 ENDOCRINE AND TESTOST CYP INJ 200MG/ML MG/ML METABOLIC TESTOSTERONE CYPIONATE IM INJ IN OIL 200 ENDOCRINE AND TESTOST CYP INJ 200MG/ML MG/ML METABOLIC TESTOSTERONE ENANTHATE IM INJ IN OIL 200 ENDOCRINE AND TESTOST ENAN INJ 200MG/ML MG/ML METABOLIC ENDOCRINE AND TESTOSTERONE GEL 1%(25MG) TESTOSTERONE TD GEL 25 MG/2.5GM (1%) METABOLIC ENDOCRINE AND TESTOSTERONE GEL 1%(50MG) TESTOSTERONE TD GEL 50 MG/5GM (1%) METABOLIC ENDOCRINE AND TESTOSTERONE GEL PUMP 1% TESTOSTERONE TD GEL 12.5 MG/ACT (1%) METABOLIC TETRABENAZIN TAB 12.5MG TETRABENAZINE TAB 12.5 MG CENTRAL NERVOUS SYSTEM TETRABENAZIN TAB 25MG TETRABENAZINE TAB 25 MG CENTRAL NERVOUS SYSTEM TETRACYCLINE CAP 250MG TETRACYCLINE HCL CAP 250 MG ANTI-INFECTIVES TETRACYCLINE CAP 500MG TETRACYCLINE HCL CAP 500 MG ANTI-INFECTIVES THALOMID CAP 100MG THALIDOMIDE CAP 100 MG ANTINEOPLASTIC AGENTS THALOMID CAP 150MG THALIDOMIDE CAP 150 MG ANTINEOPLASTIC AGENTS THALOMID CAP 200MG THALIDOMIDE CAP 200 MG ANTINEOPLASTIC AGENTS THALOMID CAP 50MG THALIDOMIDE CAP 50 MG ANTINEOPLASTIC AGENTS TIBSOVO TAB 250MG IVOSIDENIB TAB 250 MG ANTINEOPLASTIC AGENTS TOBRAMYCIN NEB 300/5ML TOBRAMYCIN NEBU SOLN 300 MG/5ML ANTI-INFECTIVES TPN ELECTROL INJ *PARENTERAL ELECTROLYTE CONC*** NUTRITIONAL/SUPPLEMENTS TRAVASOL INJ 10% *AMINO ACID INFUSION 10%*** NUTRITIONAL/SUPPLEMENTS TRELSTAR MIX INJ 11.25MG TRIPTORELIN PAMOATE FOR IM SUSP 11.25 MG ANTINEOPLASTIC AGENTS TRELSTAR MIX INJ 3.75MG TRIPTORELIN PAMOATE FOR IM SUSP 3.75 MG ANTINEOPLASTIC AGENTS TRETINOIN CRE 0.025% TRETINOIN CREAM 0.025% TOPICAL TRETINOIN CRE 0.05% TRETINOIN CREAM 0.05% TOPICAL TRETINOIN CRE 0.1% TRETINOIN CREAM 0.1% TOPICAL TRETINOIN GEL 0.01% TRETINOIN GEL 0.01% TOPICAL TRETINOIN GEL 0.025% TRETINOIN GEL 0.025% TOPICAL ENDOCRINE AND TRIENTINE CAP 250MG TRIENTINE HCL CAP 250 MG METABOLIC TRIHEXYPHEN SOL 0.4MG/ML TRIHEXYPHENIDYL HCL ORAL SOLN 0.4 MG/ML CENTRAL NERVOUS SYSTEM TRIHEXYPHEN TAB 2MG TRIHEXYPHENIDYL HCL TAB 2 MG CENTRAL NERVOUS SYSTEM TRIHEXYPHEN TAB 5MG TRIHEXYPHENIDYL HCL TAB 5 MG CENTRAL NERVOUS SYSTEM ELEXACAF-TEZACAF-IVACAF 100-50-75 MG TRIKAFTA TAB &IVACAFTOR 150 MG TBPK RESPIRATORY TROPHAMINE INJ 10% *AMINO ACID INFUSION 10%*** NUTRITIONAL/SUPPLEMENTS TUKYSA TAB 150MG TUCATINIB TAB 150 MG ANTINEOPLASTIC AGENTS TUKYSA TAB 50MG TUCATINIB TAB 50 MG ANTINEOPLASTIC AGENTS PEXIDARTINIB HCL CAP 200 MG (BASE TURALIO CAP 200MG EQUIVALENT) ANTINEOPLASTIC AGENTS TYKERB TAB 250MG LAPATINIB DITOSYLATE TAB 250 MG (BASE EQUIV) ANTINEOPLASTIC AGENTS SUBCUTANEOUS SOLN PEN- ENDOCRINE AND TYMLOS INJ INJECTOR 3120 MCG/1.56ML METABOLIC MECHLORETHAMINE HCL GEL 0.016% (BASE VALCHLOR GEL 0.016% EQUIVALENT) TOPICAL PATIROMER SORBITEX CALCIUM FOR SUSP PACKET ENDOCRINE AND VELTASSA POW 16.8GM 16.8 GM (BASE EQ) METABOLIC PATIROMER SORBITEX CALCIUM FOR SUSP PACKET ENDOCRINE AND VELTASSA POW 25.2GM 25.2 GM (BASE EQ) METABOLIC PATIROMER SORBITEX CALCIUM FOR SUSP PACKET ENDOCRINE AND VELTASSA POW 8.4GM 8.4 GM (BASE EQ) METABOLIC VEMLIDY TAB 25MG TENOFOVIR ALAFENAMIDE FUMARATE TAB 25 MG ANTI-INFECTIVES VENCLEXTA TAB 100MG VENETOCLAX TAB 100 MG ANTINEOPLASTIC AGENTS

VENCLEXTA TAB 10MG VENETOCLAX TAB 10 MG ANTINEOPLASTIC AGENTS VENCLEXTA TAB 50MG VENETOCLAX TAB 50 MG ANTINEOPLASTIC AGENTS VENETOCLAX TAB THERAPY STARTER PACK 10 & 50 VENCLEXTA TAB START PK & 100 MG ANTINEOPLASTIC AGENTS VENTAVIS SOL 10MCG/ML ILOPROST INHALATION SOLUTION 10 MCG/ML CARDIOVASCULAR VENTAVIS SOL 20MCG/ML ILOPROST INHALATION SOLUTION 20 MCG/ML CARDIOVASCULAR VERSACLOZ SUS 50MG/ML CLOZAPINE SUSP 50 MG/ML CENTRAL NERVOUS SYSTEM VERZENIO TAB 100MG ABEMACICLIB TAB 100 MG ANTINEOPLASTIC AGENTS VERZENIO TAB 150MG ABEMACICLIB TAB 150 MG ANTINEOPLASTIC AGENTS VERZENIO TAB 200MG ABEMACICLIB TAB 200 MG ANTINEOPLASTIC AGENTS VERZENIO TAB 50MG ABEMACICLIB TAB 50 MG ANTINEOPLASTIC AGENTS ENDOCRINE AND V-GO 20 KIT *INSULIN INFUSION DISPOSABLE PUMP KIT*** METABOLIC ENDOCRINE AND V-GO 30 KIT *INSULIN INFUSION DISPOSABLE PUMP KIT*** METABOLIC ENDOCRINE AND V-GO 40 KIT *INSULIN INFUSION DISPOSABLE PUMP KIT*** METABOLIC VIGABATRIN PAK 500MG VIGABATRIN POWD PACK 500 MG CENTRAL NERVOUS SYSTEM VIGABATRIN TAB 500MG VIGABATRIN TAB 500 MG CENTRAL NERVOUS SYSTEM VIGADRONE POW 500MG VIGABATRIN POWD PACK 500 MG CENTRAL NERVOUS SYSTEM LAROTRECTINIB SULFATE CAP 100 MG (BASE VITRAKVI CAP 100MG EQUIVALENT) ANTINEOPLASTIC AGENTS LAROTRECTINIB SULFATE CAP 25 MG (BASE VITRAKVI CAP 25MG EQUIVALENT) ANTINEOPLASTIC AGENTS LAROTRECTINIB SULFATE ORAL SOLN 20 MG/ML VITRAKVI SOL 20MG/ML (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS VIZIMPRO TAB 15MG DACOMITINIB TAB 15 MG ANTINEOPLASTIC AGENTS VIZIMPRO TAB 30MG DACOMITINIB TAB 30 MG ANTINEOPLASTIC AGENTS VIZIMPRO TAB 45MG DACOMITINIB TAB 45 MG ANTINEOPLASTIC AGENTS VORICONAZOLE INJ 200MG VORICONAZOLE FOR INJ 200 MG ANTI-INFECTIVES VORICONAZOLE SUS 40MG/ML VORICONAZOLE FOR SUSP 40 MG/ML ANTI-INFECTIVES VORICONAZOLE TAB 200MG VORICONAZOLE TAB 200 MG ANTI-INFECTIVES VORICONAZOLE TAB 50MG VORICONAZOLE TAB 50 MG ANTI-INFECTIVES SOFOSBUVIR-VELPATASVIR-VOXILAPREVIR TAB VOSEVI TAB 400-100-100 MG ANTI-INFECTIVES VOTRIENT TAB 200MG PAZOPANIB HCL TAB 200 MG (BASE EQUIV) ANTINEOPLASTIC AGENTS CARIPRAZINE HCL CAP THERAPY PACK 1.5 MG (1) VRAYLAR CAP 1.5-3MG & 3 MG (6) CENTRAL NERVOUS SYSTEM

VRAYLAR CAP 1.5MG CARIPRAZINE HCL CAP 1.5 MG (BASE EQUIVALENT) CENTRAL NERVOUS SYSTEM VRAYLAR CAP 3MG CARIPRAZINE HCL CAP 3 MG (BASE EQUIVALENT) CENTRAL NERVOUS SYSTEM

VRAYLAR CAP 4.5MG CARIPRAZINE HCL CAP 4.5 MG (BASE EQUIVALENT) CENTRAL NERVOUS SYSTEM VRAYLAR CAP 6MG CARIPRAZINE HCL CAP 6 MG (BASE EQUIVALENT) CENTRAL NERVOUS SYSTEM XALKORI CAP 200MG CRIZOTINIB CAP 200 MG ANTINEOPLASTIC AGENTS XALKORI CAP 250MG CRIZOTINIB CAP 250 MG ANTINEOPLASTIC AGENTS XATMEP SOL 2.5MG/ML METHOTREXATE ORAL SOLN 2.5 MG/ML IMMUNOLOGIC AGENTS TOFACITINIB CITRATE TAB 10 MG (BASE XELJANZ TAB 10MG EQUIVALENT) IMMUNOLOGIC AGENTS TOFACITINIB CITRATE TAB 5 MG (BASE XELJANZ TAB 5MG EQUIVALENT) IMMUNOLOGIC AGENTS TOFACITINIB CITRATE TAB ER 24HR 11 MG (BASE XELJANZ XR TAB 11MG EQUIVALENT) IMMUNOLOGIC AGENTS TOFACITINIB CITRATE TAB ER 24HR 22 MG (BASE XELJANZ XR TAB 22MG EQUIVALENT) IMMUNOLOGIC AGENTS ENDOCRINE AND XGEVA INJ INJ 120 MG/1.7ML METABOLIC XIFAXAN TAB 550MG RIFAXIMIN TAB 550 MG GASTROINTESTINAL

OMALIZUMAB SUBCUTANEOUS SOLN PREFILLED XOLAIR INJ 150MG/ML SYRINGE 150 MG/ML RESPIRATORY OMALIZUMAB SUBCUTANEOUS SOLN PREFILLED XOLAIR INJ 75/0.5 SYRINGE 75 MG/0.5ML RESPIRATORY XOLAIR SOL 150MG OMALIZUMAB FOR INJ 150 MG RESPIRATORY GILTERITINIB FUMARATE TABLET 40 MG (BASE XOSPATA TAB 40MG EQUIVALENT) ANTINEOPLASTIC AGENTS SELINEXOR TAB THERAPY PACK 20 MG (100 MG XPOVIO PAK 100MG ONCE WEEKLY) ANTINEOPLASTIC AGENTS SELINEXOR TAB THERAPY PACK 20 MG (40 MG XPOVIO PAK 40MG ONCE WEEKLY) ANTINEOPLASTIC AGENTS SELINEXOR TAB THERAPY PACK 20 MG (40 MG XPOVIO PAK 40MG TWICE WEEKLY) ANTINEOPLASTIC AGENTS SELINEXOR TAB THERAPY PACK 20 MG (60 MG XPOVIO PAK 60MG TWICE WEEKLY) ANTINEOPLASTIC AGENTS SELINEXOR TAB THERAPY PACK 20 MG (60 MG XPOVIO PAK 60MG ONCE WEEKLY) ANTINEOPLASTIC AGENTS SELINEXOR TAB THERAPY PACK 20 MG (80 MG XPOVIO PAK 80MG TWICE WEEKLY) ANTINEOPLASTIC AGENTS SELINEXOR TAB THERAPY PACK 20 MG (80 MG XPOVIO PAK 80MG ONCE WEEKLY) ANTINEOPLASTIC AGENTS XTANDI CAP 40MG ENZALUTAMIDE CAP 40 MG ANTINEOPLASTIC AGENTS XYREM SOL 500MG/ML SODIUM OXYBATE ORAL SOLUTION 500 MG/ML CENTRAL NERVOUS SYSTEM FILGRASTIM-SNDZ SOLN PREFILLED SYRINGE 300 ZARXIO INJ 300/0.5 MCG/0.5ML HEMATOLOGIC FILGRASTIM-SNDZ SOLN PREFILLED SYRINGE 480 ZARXIO INJ 480/0.8 MCG/0.8ML HEMATOLOGIC NIRAPARIB TOSYLATE CAP 100 MG (BASE ZEJULA CAP 100MG EQUIVALENT) ANTINEOPLASTIC AGENTS ZELBORAF TAB 240MG VEMURAFENIB TAB 240 MG ANTINEOPLASTIC AGENTS ALPHA1-PROTEINASE INHIBITOR (HUMAN) FOR IV ZEMAIRA INJ 1000MG SOLN 1000 MG RESPIRATORY ZENATANE CAP 10MG ISOTRETINOIN CAP 10 MG TOPICAL ZENATANE CAP 20MG ISOTRETINOIN CAP 20 MG TOPICAL ZENATANE CAP 30MG ISOTRETINOIN CAP 30 MG TOPICAL ZENATANE CAP 40MG ISOTRETINOIN CAP 40 MG TOPICAL ENDOCRINE AND ZOLEDRONIC INJ 4MG/100 ZOLEDRONIC ACID IV SOLN 4 MG/100ML METABOLIC ZOLEDRONIC ACID INJ CONC FOR IV INFUSION 4 ENDOCRINE AND ZOLEDRONIC INJ 4MG/5ML MG/5ML METABOLIC ENDOCRINE AND ZOLEDRONIC INJ 5/100ML ZOLEDRONIC ACID IV SOLN 5 MG/100ML METABOLIC ZOLINZA CAP 100MG VORINOSTAT CAP 100 MG ANTINEOPLASTIC AGENTS ZOLPIDEM TAB 10MG ZOLPIDEM TARTRATE TAB 10 MG CENTRAL NERVOUS SYSTEM ZOLPIDEM TAB 5MG ZOLPIDEM TARTRATE TAB 5 MG CENTRAL NERVOUS SYSTEM ZORTRESS TAB 1MG EVEROLIMUS TAB 1 MG IMMUNOLOGIC AGENTS ZYDELIG TAB 100MG IDELALISIB TAB 100 MG ANTINEOPLASTIC AGENTS ZYDELIG TAB 150MG IDELALISIB TAB 150 MG ANTINEOPLASTIC AGENTS ZYKADIA TAB 150MG CERITINIB TAB 150 MG ANTINEOPLASTIC AGENTS OLANZAPINE PAMOATE FOR EXTENDED REL IM ZYPREXA RELP INJ 210MG SUSP 210 MG (BASE EQ) CENTRAL NERVOUS SYSTEM OLANZAPINE PAMOATE FOR EXTENDED REL IM ZYPREXA RELP INJ 300MG SUSP 300 MG (BASE EQ) CENTRAL NERVOUS SYSTEM OLANZAPINE PAMOATE FOR EXTENDED REL IM ZYPREXA RELP INJ 405MG SUSP 405 MG (BASE EQ) CENTRAL NERVOUS SYSTEM ZYTIGA TAB 500MG ABIRATERONE ACETATE TAB 500 MG ANTINEOPLASTIC AGENTS

Blue MedicareRx (PDP) is a Plan with a Medicare Contract. Blue MedicareRx Value Plus (PDP) and Blue MedicareRx Premier (PDP) are two Medicare Prescription Drug Plans available to service residents of Connecticut, Massachusetts, Rhode Island, and Vermont.

Coverage is available to residents of the service area or members of an employer or union group and separately issued by one of the following plans: Anthem Blue Cross® and Blue Shield® of Connecticut, Blue Cross Blue Shield of Massachusetts, Blue Cross and Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont.

Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont are the legal entities which have contracted as a joint enterprise with the Centers for Medicare & Medicaid Services (CMS) and are the risk-bearing entities for Blue MedicareRx (PDP) plans. The joint enterprise is a Medicare-approved Part D Sponsor. Enrollment in Blue MedicareRx (PDP) depends on contract renewal.

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