v Department of Human Services IOWA Medicaid Program Draft PDL for P&T Committee Meeting November 8, 2007 PDL DRUG LIST (Two Drug Columns)

Highlighted categories denote new changes to the PDL since previous update Column Header Explanations: B, G or O: P, N, R, or NR: B = Brand P = Preferred G = Generic N = Non-Preferred O = OTC R = Recommended NR = Non-Recommended COM: 1 ANTIVERT 50mg - Use two MECLIZINE HCL 27 PA required for quantities exceeding 12-4mg 25mg instead capsules and 8-80mg capsules. 2 BENZONATATE 200mg - Use two 28 PA REQUIRED FOR QUANTITIES EXCEEDING BENZONATATE 100mg instead 12-4MG TABS, 12-8MG TABS, 4-24 TABS, 3 BUSPIRONE 30mg - Use 2 BUSPIRONE 15mg 50ML/MONTH - ORAL SOL, 4-20ML VIALS, tablets AND 8-2ML VIALS. 4 CLINDAMYCIN HCL 300MG - Use Multiples of 29 PA required for quantities exceeding 12-4mg CLINDAMYCIN HCL 150mg tabs, 12-8mg tabs. 5 Flumist Nasal Vaccine: Preferred 19-49 until 30 PA required for doses exceeding two tablets per 3-15-08. Those 2-18 should be referred to day of the same strength Vaccines for Children Program or for more than two strengths per month. 6 FLUOXETINE HCL 20mg TABS - Use 31 PA required limited to package size of #14 FLUOXETINE HCL 20mg CAPS instead 32 PA required limited to package size of #110 7 Preferred only for children 12 years of age and 33 Established users who have tried preferred under. opthalmic prostaglandins will be grandfathered. 8 A 90 day transition period will be allowed to move 35 PA Required / After 30 days only the generic will established users to a preferred product. be preferred 9 HYDROXYZINE HCL - Use HYDROXYZINE 36 PA Required >= 21 yo. / After 30 days only the PAMOATE generic will be preferred 10 HYDROXYZINE PAMOATE 100mg - Use two 37 Payable for members who are 12 years of age HYDROXYZINE PAMOATE 50mg instead and older. Quantity limitations of 12 packets/4 11 PA Required weeks (28 days) or a total of 48 packets/16 12 PA Required > 60 days weeks (112 days). 13 PA Required > 90 days 38 Restricted to persons 40 years of age and older. 14 PA Required > Quantity Limit 10 Days 39 Payable for children 6-12 years old. 15 PA Required for > 4 Bottles/30 Days 40 Grandfathered 16 PA Required from Day 1 41 Preferred with conditions by POS look-back. 17 PA Required: > 18 Units/30Days Supply Must be currently using Metformin or a 18 Preferred < 14yo phosphate binder. 19 Preferred < 8yo 42 Renagel 800mg - Use two Renagel 400mgs 20 Preferred only for children 12 years of instead. age and under for the first 60 days of therapy. 43 Must have trial of immediate release form prior to 21 PROZAC,FLUOXETINE HCL 40mg CAPS - Use use of extended release form. two FLUOXETINE HCL 20mg CAPS instead 22 RHEUMATREX - Write METHOTREXATE instead 23 ULTRACET - Use Tramadol & Acetaminophen separately 24 PA Required >= 21 yo. 25 PA Required: > 14 Units/30Days Supply 26 After 60 days only the generic will be preferred. NEW DRUG REVIEW PROCESS: See Page 2. PDL IMPLEMENTATION DATE 01-15-05 Iowa Medicaid Preferred Drug List (PDL) New Drug Process

1). Therapeutic classes of drugs already reviewed by the Pharmaceutical and Therapeutics (P&T) Committee

· New drug entities (including new generics), and new drug product dosage forms of existing drug entities) in therapeutic classes already reviewed by the P&T Committee will be identified weekly and immediately be coded as "Non-preferred-Prior Authorization required" until presented at the next quarterly scheduled P&T Committee meeting. These prior authorization restrictions will continue through the review process, including while committee recommendations are being made, and lasting until DHS makes a final determination.

2). Therapeutic classes of drugs not yet reviewed by the Pharmaceutical and Therapeutics (P&T) Committee

New drug entities for conditions without any available PDL choices in therapeutic classes not yet reviewed by the P&T Committee will remain payable, in effect preferred by default, until the therapeutic class is discussed. Once this review occurs for the new therapeutic class, the non- preferred default policy will apply to subsequent new drug entries.

3). Exceptions to the Non-preferred default policy for new PDL drugs

There are two major potential exceptions to the non-preferred default policy for new PDL drugs:

A). If a new medication is classified as a priority drug by the FDA, the State may indicate that such a drug is preferred, until the drug is reviewed by the P&T Committee at the nearest scheduled meeting.

B). The State may decide to designate a new drug as "draft preferred" and provide immediate access and increased therapeutic choice to physicians until the drug is reviewed by the P&T Committee at the nearest scheduled meeting if: - a new drug is therapeutically equivalent or superior to existing preferred or non-preferred choices, and - is as safe or safer than existing preferred or non-preferred choices, and - the net cost, adjusted for all rebates, is less expensive than all existing preferred choices.

4). Existing PDL Drugs

· Although the State discourages supplemental rebate offers on existing PDL drugs between annual bidding periods, it may entertain such bids and may accept them if they are determined to represent significant additional savings or if they would replace a delinquent manufacturer's product or a preferred drug pulled from the marketplace or significantly restricted by the FDA. This interim preferred status will remain in effect until the drug is reviewed by the P&T Committee at the next scheduled meeting. Supplemental rebates will only be invoiced for approved drugs under contract. Draft preferred drugs with supplemental rebates will not be invoiced until approved by the Committee and accepted by the State. At that time, the supplemental rebates will be invoiced back to the effective date of the agreement, which is the date the drug began to benefit from B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories B N LEXXEL ACE AND THIAZIDE COMBO'S B P TARKA

B N LOTENSIN HCT ACNE PRODUCTS: ISOTRETINOIN

G P benazepril & hydrochlorothiazide

B N CAPOZIDE B 11 P ACCUTANE

G P captopril & hydrochlorothiazide G 11 N isotretinoin

B N VASERETIC AGENTS FOR FABRYS DISEASE G P enalapril maleate & hydrochlorothiazide

B P MONOPRIL HCT B P FABRAZYME G N fosinopril sodium & hydrochlorothiazide

B N PRINZIDE AGENTS FOR GAUCHER DISEASE B N ZESTORETIC

G P lisinopril & hydrochlorothiazide B P CEREZYME B P UNIRETIC B N ACCURETIC AGENTS FOR PHEOCHROMOCYTOMA G N quinapril-hydrochlorothiazide B P PHENTOLAMINE MESYLATE

ACE INHIBITORS B N DEMSER

B N LOTENSIN ALCOHOL DETERRENTS G P benazepril hcl

B N CAPOTEN B P CAMPRAL

G P captopril B P ANTABUSE

B N VASOTEC

G P enalapril maleate ALS DRUG

B N MONOPRIL B P RILUTEK G P fosinopril sodium

B N PRINIVIL ALZHEIMER - CHOLINOMIMETICS B N ZESTRIL

G P lisinopril B 38 P ARICEPT G N MOEXIPRIL TAB 7.5MG B 38 P ARICEPT ODT B N UNIVASC B 38 N REMINYL G N MOEXIPRIL TAB 15MG B 38 N RAZADYNE ER B N ACEON B 38 N EXELON DIS 4.6MG/24 B N ACCUPRIL B 38 N EXELON DIS 9.5MG/24 G N quinapril hcl B 38 P EXELON B P ALTACE B 38 P NAMENDA G N TRANDOLAPRIL TAB 1MG B 38 P NAMENDA TITRATION PAK G N TRANDOLAPRIL TAB 2MG

B N MAVIK AMINO GLYCOSIDES G N TRANDOLAPRIL TAB 4MG

B P AMIKIN

ACE INHIBITORS AND CA CHANNEL BLOCKERS G P amikacin sulfate

B N GARAMYCIN G N AMLOD/BENAZP CAP 2.5-10MG G P gentamicin sulfate G N AMLOD/BENAZP CAP 5-10MG G P gentamicin in saline G N AMLOD/BENAZP CAP 5-20MG B P KANTREX B P LOTREL G P kanamycin sulfate G N AMLOD/BENAZP CAP 10-20MG

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories G P butalbital-acetaminophen-caffeine tab 50-500-40 mg AMINO GLYCOSIDES B N DOLGIC PLUS - Continued - B P FIORINAL G P neomycin sulfate G N butalbital-aspirin-caffeine cap 50-325-40 mg

B P HUMATIN G P butalbital-aspirin-caffeine tab 50-325-40 mg

G P paromomycin sulfate

B P STREPTOMYCIN SULFATE ANAPHYLAXIS THERAPY

B P TOBI B P EPIPEN-JR B N TOBRAMYCIN SULFATE ADD-VA B P EPIPEN G P tobramycin sulfate

ANDROGENS / ANABOLICS ANALGESICS - MISC.

G N danazol cap 50 mg O P aspirin tab 81 mg G N danazol cap 100 mg O P aspirin tab 325 mg B P DANOCRINE CAP 200MG O P ASPIRIN TAB 650 MG G N danazol cap 200 mg B N ZORPRIN B P FLUOXYMESTERONE O P aspirin chew tab 81 mg B P ANDROID O P aspirin tab delayed release 81 mg B P TESTRED O P aspirin tab delayed release 325 mg B N METHITEST O P aspirin tab delayed release 650 mg B P ANDROGEL G P aspirin tab delayed release 975 mg B N ANDROGEL PUMP B N DOLOBID B N TESTIM G P diflunisal tab 500 mg B P ANDRODERM G P salsalate tab 500 mg B P DEPO-TESTOSTERONE G P salsalate tab 750 mg G P testosterone cypionate im in oil 200 mg/ml G P aspirin buffered (ca carb-mg carb-mg ox) tab 325 mg B N DELATESTRYL O P aspirin buffered tab 325 mg G P testosterone enanthate im in oil 200 mg/ml G P choline & mag salicylate G N OXANDROLONE TAB 2.5MG B P PRIALT B P OXANDRIN O P acetaminophen tab 325 mg G N OXANDROLONE TAB 10MG O P acetaminophen tab 500 mg B P WINSTROL O P acetaminophen elixir 160 mg/5ml

O P acetaminophen soln 100 mg/ml ANGIOTENSIN RECEPTOR BLOCKER O P acetaminophen suppos 120 mg

B N DURABAC TAB FORTE B N ATACAND B N DURABAC B N TEVETEN B N PHRENILIN FORTE B P AVAPRO B N PHRENILIN B P COZAAR G P butalbital-acetaminophen tab 50-325 mg B P BENICAR G N butalbital-acetaminophen tab 50-650 mg B P MICARDIS B N EQUAGESIC B P DIOVAN G N phenyltoloxamine w/ mag salicylate tab 25-600 mg B P EXFORGE TAB 5-160MG G P butalbital-acetaminophen-caffeine cap 50-325-40 mg B P EXFORGE TAB 5-320MG G N butalbital-acetaminophen-caffeine cap 50-500-40 mg B P EXFORGE TAB 10-160MG B N ESGIC B P EXFORGE TAB 10-320MG B N FIORICET

G P butalbital-acetaminophen-caffeine tab 50-325-40 mg ANORECTAL - MISC. B N ESGIC-PLUS

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories G N disopyramide phosphate ANORECTAL - MISC. B P PRONESTYL - Continued - G P procainamide hcl B N ANUSOL-HC G N procainamide hcl sr

G P hydrocortisone rectal cream 2.5% B N PROCAINAMIDE HCL ER

G P hydrocortisone enema 100 mg/60ml B P PROCANBID

B N CORTIFOAM G P quinidine gluconate

B N ANAMANTLE HC G P quinidine sulfate

G N lidocaine-hydrocortisone acetate rectal cream kit 3-0.5% B N QUINIDINE SULFATE ER

G N hydrocortisone acetate w/ pramoxine rectal cream 2.5-1% G N lidocaine hcl (cardiac)

B N PROCTOFOAM HC G P mexiletine hcl B N TAMBOCOR

ANTHELMINTICS G P flecainide acetate

B N RYTHMOL B P ALBENZA G P propafenone hcl B P STROMECTOL B N RYTHMOL SR G P mebendazole chew tab 100 mg B N CORDARONE B P BILTRICIDE G P amiodarone hcl tab 200 mg B P MINTEZOL B N PACERONE

G N amiodarone hcl tab 400 mg ANTI INFECTIVE COMBO'S - MISC. B P TIKOSYN

B N PEDIAZOLE ANTIASTHMATIC - ADRENERGIC COMBOS G P erythromycin-sulfisoxazole for susp 200-600 mg/5ml

B N BACTRIM B P DUONEB G P sulfamethoxazole-trimethoprim tab 400-80 mg B P COMBIVENT G P trimethoprim-sulfamethoxazole tab 80-400 mg B P SYMBICORT AER 80-4.5 B N SEPTRA DS B P SYMBICORT AER 160-4.5 G P sulfamethoxazole-trimethoprim tab 800-160 mg B P ADVAIR HFA B N SEPTRA B P ADVAIR DISKUS G P sulfamethoxazole-trimethoprim susp 200-40 mg/5ml

ANTIASTHMATIC - ALPHA-PROTEINASE INHIBITOR ANTIANGINALS

B 11 N ARALAST B N RANEXA B 11 P PROLASTIN B N ZYFLO CR TAB 600MG B 11 N ZEMAIRA

ANTIANGINALS--ISOSORBIDE NITRATE ANTIASTHMATIC - ANTI-CHOLINERGICS

B N DILATRATE SR G P ipratropium bromide inhal soln 0.02% B N ISORDIL TITRADOSE B P ATROVENT G P isosorbide dinitrate B P SPIRIVA HANDIHALER B N IMDUR B P ATROVENT HFA G P isosorbide mononitrate

ANTIASTHMATIC - ANTIINFLAMMATORY AGENTS ANTIARRHYTHMICS

B N INTAL B N ETHMOZINE G P cromolyn sodium soln nebu 20 mg/2ml B P NORPACE B P INTAL INHALER B P NORPACE CR B P TILADE

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories ANTIASTHMATIC - MIXED ADRENERGICS ANTIASTHMATIC - ANTIINFLAMMATORY AGENTS - Continued - G P epinephrine hcl inj 0.1 mg/ml B 11 N XOLAIR B N ADRENALIN G P epinephrine hcl inj 1 mg/ml ANTIASTHMATIC - BETA - ADRENERGICS ANTIASTHMATIC - MUCOLYTICS B N PROVENTIL

G N albuterol inhal aerosol 90 mcg/act B P MUCOMYST-10

G P albuterol sulfate tab 2 mg B P MUCOMYST

G P albuterol sulfate tab 4 mg G P acetylcysteine

G P albuterol sulfate syrup 2 mg/5ml

G P albuterol sulfate soln nebu 0.083% ANTIASTHMATIC - NASAL MISC.

G P albuterol sulfate soln nebu 0.5% (5 mg/ml) B N ATROVENT B P ACCUNEB G P ipratropium bromide (nasal) G P albuterol sulfate soln nebu 1.25 mg/3ml (base equiv)

B N ALBUTEROL SULFATE HFA ANTIASTHMATIC - NASAL STEROIDS B N PROVENTIL HFA

B N VENTOLIN HFA B N BECONASE AQ B P VOSPIRE ER B N RHINOCORT AQUA B N BROVANA G N flunisolide nasal soln 0.025% B N FORADIL AEROLIZER B N NASAREL B N PERFOROMIST NEB 20MCG B P VERAMYST B P XOPENEX B N FLONASE B P XOPENEX HFA G P fluticasone propionate nasal susp 50 mcg/act B P METAPROTEREN TAB 10MG B P NASONEX B P METAPROTEREN TAB 20MG B N NASACORT AQ G P metaproterenol sulfate syrup 10 mg/5ml

B N ALUPENT INH AER 0.65/ACT ANTIASTHMATIC - STEROID INHALANTS B P MAXAIR AUTOHALER

B P SEREVENT B P QVAR

B P SEREVENT DISKUS B 19 P PULMICORT SUS 0.25MG/2

G P terbutaline sulfate tab 2.5 mg B 19 P PULMICORT SUS 0.5MG/2

G P terbutaline sulfate tab 5 mg B P PULMICORT INH 90MCG

G P terbutaline sulfate inj 1 mg/ml B P PULMICORT INH 180MCG

B 18 P PULMICORT TURBUHALER

ANTIASTHMATIC - HYDRO-LYTIC ENZYMES B P AEROBID

B P AEROBID-M B 11 P PULMOZYME B P FLOVENT

B P FLOVENT DISKUS ANTIASTHMATIC - LEUKOTRIENE RECEPTOR ANTAGONISTS B P FLOVENT HFA

B P ASMANEX B P SINGULAIR B P AZMACORT B N ACCOLATE

ANTIASTHMATIC - XANTHINES ANTIASTHMATIC - MISC. RESPIRATORY INHALANTS

G P aminophylline G P sodium chloride soln nebu 0.9% G N dyphylline O P sodium chloride aero soln 0.9% B P ELIXOPHYLLIN

B P THEO-24

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories G P hep flush-10 ANTIASTHMATIC - XANTHINES G P hep-lock - Continued - G P heparin lock

B N QUIBRON-T/SR G P heparin lock flush

B N UNIPHYL G P heparin sodium lock flush

G P theophylline G P heparin sodium

G N dyphylline-guaifenesin B P HEPARIN SODIUM DCU

B N QUIBRON G N heparin sodium lock flush

B N ELIXOPHYLLIN-GG G P heparin (porcine) in sodium chloride B 14 P FRAGMIN ANTIBIOTICS - MISC. B 14 P LOVENOX B 14 P INNOHEP

B P SULFADIAZINE B 14 P ARIXTRA

B P SULFISOXAZOLE G P warfarin sodium

B P SULFISOXIZOLE B N COUMADIN B P GANTRISIN PEDIATRIC B P AZACTAM ANTICONVULSANTS B N COLY-MYCIN-M

G P colistimethate sodium for inj 150 mg B N EQUETRO

B N LORABID B N KLONOPIN

B N FLAGYL G P clonazepam

G N metronidazole cap 375 mg B N KLONOPIN WAFERS

G P metronidazole tab 250 mg B P DIASTAT PEDIATRIC

G P metronidazole tab 500 mg B P DIASTAT UNIVERSAL

B N FLAGYL ER B P DIASTAT

G N metronidazole tab sr 24hr 750 mg B P DIASTAT ADULT

G P metronidazole in nacl 0.79% iv soln 500 mg/100ml B P FELBATOL

B P PENTAM 300 B P GABITRIL

B P NEBUPENT B N PEGANONE

B N XIFAXAN B N CEREBYX

B N PROLOPRIM B P DILANTIN INFATABS

G P trimethoprim tab 100 mg G N phenytoin susp 125 mg/5ml

B P VANCOCIN HCL CAP 125MG G P phenytoin sodium inj 50 mg/ml

B P VANCOCIN HCL CAP 250MG B P PHENYTOIN SODIUM PROMPT

G P vancomycin hcl for inj 500 mg B P DILANTIN

G P vancomycin hcl for inj 1000 mg G P phenytoin sodium extended cap 100 mg

G P vancomycin hcl for inj 5000 mg B P PHENYTEK

G P vancomycin hcl for inj 10 gm B P ZARONTIN CAP 250MG

B N VANCOCIN HCL INJ G N ethosuximide cap 250 mg

B P VANCOCIN HCL ISO-OSMOTIC B N ZARONTIN SYP 250/5ML

B N POLYMYXIN B SULFATE G P ethosuximide soln 250 mg/5ml

B P TYGACIL B P CELONTIN

B P XIGRIS B P DEPAKOTE B P DEPAKOTE SPRINKLES ANTI-CATAPLECTIC AGENTS G P valproate sodium syrup 250 mg/5ml G P valproate sodium inj 100 mg/ml

B P XYREM B N DEPAKENE

G P valproic acid cap 250 mg ANTICOAGULANTS B N TEGRETOL TAB 200MG

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories B 26 N ZOFRAN ODT ANTICONVULSANTS G 29 P ONDANSETRON TAB 8MG ODT - Continued - G 28 P ONDANSETRON SOL 32/50ML G P carbamazepine tab 200 mg B 28 P ONDANSETRON SOL 32MG/50M

B N TEGRETOL CHW 100MG B N ALOXI

G P carbamazepine chew tab 100 mg B 27 P EMEND

B P TEGRETOL SUS 100/5ML

G N carbamazepine susp 100 mg/5ml ANTIEMETIC - ANTICHOLINERGIC / DOPAMINERGIC

B P CARBATROL G N promethazine tab 12.5mg B P TEGRETOL-XR G P promethazine tab 25mg G P gabapentin cap 100 mg G P promethazine tab 50mg G P gabapentin cap 300 mg G P promethazine syp 6.25/5ml G P gabapentin cap 400 mg B N PHENERGAN INJ 25MG/ML G N gabapentin tab 100 mg G N promethazine inj 25mg/ml G N gabapentin tab 300 mg B N PHENERGAN INJ 50MG/ML G N gabapentin tab 400 mg G N promethazine inj 50mg/ml G P gabapentin tab 600 mg B P PHENERGAN SUP 12.5MG G P gabapentin tab 800 mg G P promethazine sup 12.5mg B N NEURONTIN B P PHENERGAN SUP 25MG B P LAMICTAL G P promethazine sup 25mg B P KEPPRA B P PHENERGAN SUP 50MG B P TRILEPTAL G P promethazine sup 50mg B N LYRICA B N ANTIVERT TAB 12.5MG G N primidone tab 50 mg O P meclizine hcl tab 12.5 mg B P MYSOLINE B N ANTIVERT TAB 25MG G P primidone tab 250 mg O P meclizine hcl tab 25 mg B N TOPAMAX B 1 N ANTIVERT TAB 50MG G N zonisamide O P meclizine hcl chew Tab 25 MG B P ZONEGRAN B P TRANSDERM-SCOP

ANTIDOTES B N SCOPACE G P scopolamine hydrobromide tab 0.4 mg

B P DESFERAL B N TIGAN CAP 300MG G P trimethobenzamide hcl cap 300 mg

ANTIDOTES - CHELATING AGENTS B N TIGAN INJ 100MG/ML

B N EXJADE ANTIEMETIC - TETRAHYDROCANNABINOL (THC) B P CHEMET DERIVATIVES B P MARINOL

ANTIEMETIC - 5-HT3 RECEPTOR ANTAGONISTS/ SUBSTANCE P B N CESAMET NEUROKININ

B N ANZEMET ANTIFUNGALS - ASSORTED B N KYTRIL

G 28 P ONDANSETRON TAB 4MG B 13 P FUNGIZONE

G 28 P ONDANSETRON TAB 8MG G 11 N amphotericin b

B 28 P ONDANSETRON TAB 24MG B 13 P AMBISOME

G 28 P ONDANSETRON VIAL B 13 P ANCOBON

B 26 N ZOFRAN B 13 P GRIFULVIN-V

G 28 P ONDANSETRON SOL HCL G 11 N griseofulvin microsize

G 29 P ONDANSETRON TAB 4MG ODT B 13 P GRIS-PEG

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories G 11 N Fexofenadine-Pseudoephedrine ER ANTIFUNGALS - ASSORTED B 11 N ALLEGRA-D 24 HOUR - Continued - B 11 N SUDAL 12 G P nystatin tab 500000 unit

B P NYSTATIN ORAL POWDER ANTIHISTAMINES - OTHER

B 13 P LAMISIL

G 11 N TERBINAFINE TAB 250MG G N brompheniramine maleate tab sr 12hr 6 mg

B 11 N NIZORAL TAB 200MG B N BROVEX CT

G 13 P ketoconazole B N LODRANE XR

G 11 N fluconazole tab 50 mg B N BROVEX

G 13 P fluconazole tab 100 mg G P chlorpheniramine maleate cap cr 8 mg

G 13 P fluconazole tab 150 mg G P chlorpheniramine maleate cap cr 12 mg

G 13 P fluconazole tab 200 mg O P chlorpheniramine maleate tab 4 mg

G 13 P fluconazole sus 10mg/ml G N dexchlorpheniramine maleate tab cr 4 mg

B 11 N DIFLUCAN G N dexchlorpheniramine maleate tab cr 6 mg

G 13 P fluconazole sus 40mg/ml B N PALGIC

B 13 P DIFLUCAN IN NACL B N HISTEX PD

B 13 P DIFLUCAN IN ISO-OSMOTIC D G N carbinoxamine maleate liquid 4 mg/5ml

B 11 N SPORANOX PULSEPAK B N HISTEX IE

G 11 N itraconazole B N HISTEX CT

B 11 N SPORANOX G N carbinoxamine maleate tab sr 12hr 8 mg

B 11 N NOXAFIL G N clemastine fumarate tab 2.68 mg

B 13 P VFEND G N clemastine fumarate syrup 0.67 mg/5ml

B 13 P VFEND IV O P diphenhydramine hcl cap 25 mg

B 13 P CANCIDAS G P diphenhydramine hcl cap 50 mg

B P MYCAMINE O P diphenhydramine hcl liquid 12.5 mg/5ml

B 13 P MYCELEX TRO 10MG O P diphenhydramine hcl elixir 12.5 mg/5ml

G 11 N clotrimazole tro 10mg O P diphenhydramine hcl syrup 12.5 mg/5ml B P BENADRYL

ANTIHISTAMINES - NON-SEDATING G P diphenhydramine hcl inj 50 mg/ml G N diphenhydramine tannate susp 25 mg/5ml

B 11 P ZYRTEC G P cyproheptad tab 4mg

B 11 P CLARINEX B P CYPROHEPTAD SYP 2MG/5ML

B 11 P CLARINEX REDITABS B N HISTEX PD 12

G 11 N fexofenadine hcl tab 30 mg B N POLY-HISTINE

G 11 N fexofenadine hcl tab 60 mg G P hydroxyzine hcl tab 10 mg

B 11 N ALLEGRA G 9 N hydroxyzine hcl tab 25 mg

G 11 N fexofenadine hcl tab 180 mg G 9 N hydroxyzine hcl tab 50 mg

B 11 N XYZAL TAB 5MG B N ATARAX

O P loratadine tab 10 mg G P hydroxyzine hcl syrup 10 mg/5ml

O P loratadine syrup 10 mg/10ml G P hydroxyzine hcl im soln 25 mg/ml

B 11 N ASTELIN G P hydroxyzine hcl im soln 50 mg/ml

B N VISTARIL CAP 25MG

ANTIHISTAMINES - NON-SEDATING / DECONGESTANTS G P hydroxyzine pamoate cap 25 mg

B P VISTARIL CAP 50MG B 11 P ZYRTEC-D G P hydroxyzine pamoate cap 50 mg G 11 N dexchlorphen tan & pseudoephed tan susp 2.5-75 mg/5ml G 10 N hydroxyzine pamoate cap 100 mg B 11 P CLARINEX-D TAB 2.5-120 B N VISTARIL SUS 25MG/5ML B 11 P CLARINEX-D TAB 5-240MG B N PROCHLORPER SUP 2.5MG B 11 N ALLEGRA-D

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories B N RYNA-12 S ANTIHISTAMINES - OTHER G N pyrilamine tannate-phenylephrine tannate - Continued - B N NALEX-A B N PROCHLORPER SUP 5MG G N chlorphen-phenyltolox-pe

B N COMPAZINE SUP 25MG G N chlorpheniramine-pyrilamine & phenylephrine

G P prochlorperazine suppos 25 mg

B N COMPAZINE TAB 5MG ANTIHYPERTENSIVE COMBOS

G P prochlorperazine maleate tab 5 mg B N ENDURONYL FORTE B N COMPAZINE TAB 10MG B N CLORPRES G P prochlorperazine maleate tab 10 mg B N ALDORIL-15 B P COMPAZINE INJ 5MG/ML B N ALDORIL-25 G N prochlorperazine edisylate inj 5 mg/ml G P methyldopa & hydrochlorothiazide

ANTIHISTAMINES/DECONGESTANTS B N MINIZIDE B P HYDRAL/HCTZ CAP 25/25

B N SEMPREX-D B P HYDRAL/HCTZ CAP 50/50

B N TRINALIN REPETABS

B N BROMFED-PD ANTIHYPERTENSIVES - CENTRAL

G N brompheniramine & phenyleph B N CATAPRES B N BROMFED G P clonidine hcl B N HISTEX SR B P CATAPRES-TTS-1 B N LODRANE 12D B P CATAPRES-TTS-2 G N brompheniramine & pseudoeph B P CATAPRES-TTS-3 B N COLDEC D B N GUANABENZ ACETATE B N PEDIATEX-D B N TENEX B N RONDEC G P guanfacine hcl B N PALGIC D B N ALDOMET B N RONDEC-TR G P methyldopa G N carbinoxamine & pseudoeph B N MINIPRESS B N RESCON-JR G P prazosin hcl B N DALLERGY JR B P RESERPINE B N DECONAMINE SR B N APRESOLINE G N cpm/pse cap 8-120 cr G P hydralazine hcl G N cpm/pse cap 8-120 sr B N LONITEN B N PEDIOX G P minoxidil B N DECONAMINE

G N cpm/pse syp ANTILEPROTIC B N QDALL

B N BIOHIST LA B P THALOMID G N chlorpheniramine & pseudoeph

G N chlorphen tan & pseudoeph tan ANTIMALARIAL AGENTS B N RYNATAN

B N DALLERGY-JR B P CHLOROQUINE PHOSPHATE TAB 250 MG

B N RYNATAN PEDIATRIC B N ARALEN

G N chlorpheniramine tannate-phenylephrine tannate G P chloroquine phosphate tab 500 mg

B N TANAFED DP B N PLAQUENIL

G N dexbrompheniramine & pseudoephedrine G P hydroxychloroquine sulfate

B N PROMETHAZINE VC B P LARIAM

B N RYNA-12 G N mefloquine hcl

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories B P RAPTIVA ANTIMALARIAL AGENTS - Continued - ANTI-PSORIATICS - NON-BIOLOGICALS B P DARAPRIM B N PSORIATEC B N QUALAQUIN G P anthralin cream 1% B P MALARONE B P DOVONEX

ANTIMYCOBACTERIALS / ANTITUBERCULOSIS B P TAZORAC B N SORIATANE

G P ethambutol hcl B P OXSORALEN ULTRA

B P TRECATOR

G P isoniazid ANTISPASMODICS

G P pyrazinamide B P URISPAS B N MYCOBUTIN G N flavoxate hcl tab 100 mg G P rifampin cap 150 mg G P oxybutynin chloride tab 5 mg B N RIFADIN B N DITROPAN G P rifampin cap 300 mg G P oxybutynin chloride syrup 5 mg/5ml

ANTI-PARKINSONIAN DRUGS B P CYSTOSPAZ G P hyoscyamine tab 0.15 mg

G P amantadine hcl cap 100 mg B N DETROL

G N amantadine hcl tab 100 mg

B N SYMMETREL ANTISPASMODICS - LONG ACTING

G P amantadine hcl syrup 50 mg/5ml B P ENABLEX B P PARLODEL B N OXYTROL G N bromocriptine mesylate G N OXYBUTYNIN TAB 5MG ER B N SINEMET G N OXYBUTYNIN TAB 10MG ER B N SINEMET CR B 7 P DITROPAN XL G P carbidopa-levodopa G N OXYBUTYNIN TAB 15MG ER B P PARCOPA B P VESICARE B P STALEVO B P DETROL LA B N AZILECT B P SANCTURA B N ELDEPRYL CAP 5MG

G P selegiline hcl cap 5 mg ANTITHYROID THERAPIES G P selegiline hcl tab 5 mg

B N ZELAPAR TAB 1.25MG B P TAPAZOLE TAB 5MG B P LODOSYN G N methimazole tab 5mg G N atracurium besylate B N TAPAZOLE TAB 10MG

G N methimazole tab 10mg ANTIPROTOZOAL AGENTS B N METHIMAZOLE TAB 20MG

G P propylthiouracil tab 50 mg B N TINDAMAX

B P MEPRON ARB'S AND DIURETICS B P ALINIA

B P NEUTREXIN B N ATACAND HCT

B N TEVETEN HCT ANTI-PSORIATICS - BIOLOGICALS B P AVALIDE

B P HYZAAR B P ENBREL B P BENICAR HCT B N AMEVIVE

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories G P metoprolol tab 50mg ARB'S AND DIURETICS B N LOPRESSOR - Continued - G P metoprolol tab 100mg B P MICARDIS HCT G P metoprolol inj 1mg/ml

B P DIOVAN HCT BETA BLOCKERS - NON SELECTIVE ARTHRITIS - MISC. B N CARTROL

B P RIDAURA B N CORGARD

B P MYOCHRYSINE G P nadolol

B 22 N RHEUMATREX B P LEVATOL

G P methotrexate sodium tab 2.5 mg (antirheumatic) G P pindolol B N INDERAL

ARTIFICIAL SALIVA/STIMULANTS G P propranolol hcl

B P INDERAL LA CAP 60MG B N EVOXAC B P INDERAL LA CAP 80MG B N SALAGEN B P INDERAL LA CAP 120MG G P pilocarpine hcl tab 5 mg B P INDERAL LA CAP 160MG

B N INNOPRAN XL BETA BLOCKERS - ALPHA / BETA B N BETAPACE

G P sotalol hcl B P COREG CR CAP 10MG G N sotalol hcl (afib/afl) B P COREG CR CAP 20MG B P BETAPACE AF B P COREG CR CAP 40MG G P timolol maleate tab 5 mg B P COREG CR CAP 80MG B N BLOCADREN B N NORMODYNE G P timolol maleate tab 10 mg B N TRANDATE G P timolol maleate tab 20 mg G P labetalol hcl G P CARVEDILOL TAB 3.125MG

G P CARVEDILOL TAB 6.25MG BETA BLOCKERS - CARDIO SELECTIVE G P CARVEDILOL TAB 12.5MG

B N SECTRAL B N COREG

G P acebutolol hcl G P CARVEDILOL TAB 25MG

B N TENORMIN TAB 25MG

G P atenolol tab 25 mg BETA BLOCKERS AND DIURETIC COMBO'S

B N TENORMIN TAB 50MG B N TENORETIC G P atenolol tab 50 mg G P atenolol & chlorthalidone B N TENORMIN TAB 100MG B N ZIAC G P atenolol tab 100 mg G P bisoprolol & hydrochlorothiazide B P KERLONE B N LOPRESSOR HCT G N betaxolol hcl G N metoprolol & hydrochlorothiazide B P ZEBETA B N CORZIDE G N bisoprolol fumarate B N INDERIDE 40/25 B N BREVIBLOC B N INDERIDE 80/25 G N METOPROLOL TAB 25MG ER G P propranolol & hydrochlorothiazide G N METOPROLOL TAB 50MG ER B N TIMOLIDE 10/25 G N METOPROLOL TAB 100MG ER

B P TOPROL XL BETA-LACTAMS / CLAVULANATE COMBO'S G N METOPROLOL TAB 200MG ER

G P metoprolol tab 25mg B P PFIZERPEN-G

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories B P AUGMENTIN CHW 200MG BETA-LACTAMS / CLAVULANATE COMBO'S G N amoxicillin & k clavulanate chew tab 200-28.5 mg - Continued - B P AUGMENTIN CHW 250MG B P PENICILLIN G POTASSIUM IN B N AUGMENTIN CHW 400MG

B P BICILLIN L-A G P amoxicillin & k clavulanate chew tab 400-57 mg

G P penicillin v potassium tab 250 mg B P AUGMENTIN SUS 125/5ML

G P penicillin v potassium tab 500 mg B P AUGMENTIN SUS 200/5ML

G P penicillin v potassium for soln 125 mg/5ml G N amoxicillin & k clavulanate for susp 200-28.5 mg/5ml

G P penicillin v potassium for soln 250 mg/5ml B P AUGMENTIN SUS 250/5ML

G P amoxicillin (trihydrate) cap 250 mg B P AUGMENTIN SUS 400/5ML

G P amoxicillin (trihydrate) cap 500 mg G N amoxicillin & k clavulanate for susp 400-57 mg/5ml

G P amoxil cap 500mg B N AUGMENTIN ES-600

B P AMOXIL TAB 500MG G P amoxicillin & k clavulanate for susp 600-42.9 mg/5ml

G P amoxicillin (trihydrate) tab 500 mg B P AUGMENTIN XR

B N AMOXIL TAB 875MG B P UNASYN

G P amoxicillin (trihydrate) tab 875 mg G N ampicillin

G P amoxicillin (trihydrate) chew tab 125 mg B P UNASYN ADD-VANTAGE

B N AMOXIL CHW 200MG B P UNASYN BULK PACK

G N amoxicillin (trihydrate) chew tab 200 mg B P TIMENTIN

G P amoxicillin (trihydrate) chew tab 250 mg B P ZOSYN

B N AMOXIL CHW 400MG

G N amoxicillin (trihydrate) chew tab 400 mg BPH

B P AMOXIL DRO 50MG/ML B N CARDURA G P amoxicillin (trihydrate) for susp 125 mg/5ml G P doxazosin mesylate G P amoxil sus 125/5ml B N HYTRIN B N AMOXIL SUS 200/5ML G P terazosin hcl G N amoxicillin (trihydrate) for susp 200 mg/5ml B P AVODART G P amoxicillin (trihydrate) for susp 250 mg/5ml B P PROSCAR G P amoxil sus 250/5ml G N Finasteride Tab 5 MG B N AMOXIL SUS 400/5ML B 11 N UROXATRAL G N amoxicillin (trihydrate) for susp 400 mg/5ml B N CARDURA XL B N DISPERMOX B 11 N FLOMAX G P ampicillin

G P dicloxacillin sodium cap 250 mg CALCIUM CHANNEL BLOCKERS--AMLODIPINES G P dicloxacillin sodium cap 500 mg

G P nafcillin sodium for inj 1 gm G P AMLODIPINE TAB 2.5MG G P nafcillin sodium for iv soln 1 gm G P AMLODIPINE TAB 5MG G P nafcillin sodium for iv soln 2 gm B 26 N NORVASC B P NAFCILLIN SODIUM G P AMLODIPINE TAB 10MG B P OXACILLIN SODIUM

B P BACTOCILL IN DEXTROSE CALCIUM CHANNEL BLOCKERS--DILTIAZEMS B P GEOCILLIN

B P PIPERACILLIN SODIUM B N CARDIZEM

B P BICILLIN C-R G P diltiazem hcl

B P AUGMENTIN TAB 250MG B N DILTIAZEM HCL IV FOR SOLN 100 MG

B N AUGMENTIN TAB 500MG B N DILACOR XR

G P amoxicillin & k clavulanate tab 500-125 mg G P diltia xt

B N AUGMENTIN TAB 875MG G P diltiazem hcl er

G P amoxicillin & k clavulanate tab 875-125 mg G P diltiazem xr

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories B N VERELAN CAP 180MG CALCIUM CHANNEL BLOCKERS--DILTIAZEMS B N VERELAN CAP 240MG SR - Continued - G P verapamil hcl er G N diltiazem hcl extended release beads B P VERELAN PM

B P TIAZAC B N VERELAN CAP 360MG SR

G N diltiazem hcl coated beads G P verapamil hcl sr

B N CARDIZEM CD B N COVERA-HS

B P CARDIZEM LA CARBAPENEMS CALCIUM CHANNEL BLOCKERS--FELODIPINES B P INVANZ

G N felodipine tab sr 24hr 2.5 mg B P MERREM

G N felodipine tab sr 24hr 5 mg B N PRIMAXIN IV

B N PLENDIL B N PRIMAXIN IV ADD-VANTAGE

G N felodipine tab sr 24hr 10 mg B N PRIMAXIN I.M.

CALCIUM CHANNEL BLOCKERS--ISRADIPINES CARDIAC GLYCOSIDES

B N DYNACIRC B P LANOXICAPS

B N DYNACIRC CR B P LANOXIN G P digoxin CALCIUM CHANNEL BLOCKERS--NIFEDIPINES CARNITINE REPLENISHER - AGENTS B N PROCARDIA

G P nifedipine B P CARNITOR

G N afeditab cr

G N nifediac cc CCB / LIPID

B P ADALAT CC B N CADUET G N nifedical xl B N BIDIL B N PROCARDIA XL

G N nifedipine er CEPHALOSPORINS B N NIMOTOP

G P cefadroxil cap 500 mg CALCIUM CHANNEL BLOCKERS--NISOLDIPINE G N cefadroxil tab 1 gm

B P DURICEF B N SULAR G P cefazolin sodium for inj 500 mg

CALCIUM CHANNEL BLOCKERS--VERAPAMILS G P cefazolin sodium for inj 1 gm G P cefazolin sodium for iv soln 1 gm

B N CALAN TAB 40MG B P ANCEF

G P verapamil tab 40mg G P cefazolin sodium for inj 10 gm

B N CALAN TAB 80MG G P cefazolin sodium for inj 20 gm

G P verapamil tab 80mg B P CEFAZOLIN SODIUM

B N CALAN TAB 120MG G P cephalexin cap 250 mg

G P verapamil tab 120mg B N KEFLEX

B N CALAN SR G P cephalexin cap 500 mg

B N ISOPTIN SR B P CEPHALEXIN MONOHYDRATE

G P verapamil hcl cr G P cephalexin for susp 125 mg/5ml

G N verapamil inj 2.5mg/ml G P cephalexin for susp 250 mg/5ml

B P VERELAN CAP 120MG SR B N VELOSEF

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories G P cholestyramine powder 4 gm/dose CEPHALOSPORINS B N QUESTRAN - Continued - G P cholestyramine powder packets 4 gm

G P cefaclor cap 250 mg G P cholestyramine light powder 4 gm/dose

G N cefaclor cap 500 mg B N QUESTRAN LIGHT

G N cefaclor for susp 125 mg/5ml G P cholestyramine light powder packets 4 gm

G N cefaclor for susp 187 mg/5ml B N WELCHOL

G P cefaclor for susp 250 mg/5ml G N colestipol hcl

B N CECLOR B P COLESTID G N cefaclor for susp 375 mg/5ml

G N cefaclor monohydrate tab sr 12hr 500 mg CHOLESTEROL - FIBRIC ACID DERIVATIVES

B N CEFZIL TAB 250MG FC

G N cefprozil B N TRIGLIDE

B N CEFZIL TAB 500 B N ANTARA

B N CEFZIL TAB 500MG B N LOFIBRA

B N CEFZIL TAB 500MG FC B P TRICOR

B P CEFZIL SUS 125/5ML B N LOPID

B P CEFZIL SUS 250/5ML G P gemfibrozil tab 600 mg

G P cefuroxime axetil tab 250 mg B P NIASPAN

G P cefuroxime axetil tab 500 mg CHOLESTEROL - HMG COA + ABSORB INHIBITORS: High Potency B P CEFTIN Drugs/Combinations B P ZINACEF B P LIPITOR G N CEFDINIR CAP 300MG B P CRESTOR G N CEFDINIR SUS 125/5ML G P Simvastatin B P OMNICEF B N ZOCOR G N CEFDINIR SUS 250/5ML B P VYTORIN B N SPECTRACEF

B P SUPRAX CHOLESTEROL - HMG COA + ABSORB INHIBITORS: Low Potency G N cefpodoxime proxetil tab 100 mg Drugs/Combinations

G N cefpodoxime proxetil tab 200 mg B P ZETIA

B P VANTIN B P LESCOL

B P CLAFORAN B P LESCOL XL

G N ceftazidime for inj 1 gm B N MEVACOR

B P FORTAZ INFUSION PACK G P lovastatin

G N ceftazidime for inj 2 gm B N ALTOPREV

B P FORTAZ G N Pravastatin Sodium

B P CEDAX B N PRAVACHOL

G N ceftriaxone B N PRAVIGARD PAC

B P ROCEPHIN B P ADVICOR

B P ROCEPHIN IN ISO-OSMOTIC D B N LOVAZA B P MAXIPIME CHOLINERGIC CHELATING AGENTS

B N URECHOLINE

B P SYPRINE G P bethanechol chloride B N CUPRIMINE B P DEPEN TITRATABS COMPOUNDING MATERIALS

CHOLESTEROL - BILE SEQUESTRANTS B P STERILE DILUENT FOR FLOLA

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories G P levonorgestrel & ethinyl estradiol tab 0.15 mg-30mcg COMPOUNDING MATERIALS B N FEMCOM FE - Continued - B P OVCON-35/28 G P water for injection B N BREVICON-28

G P water for iv injection B P MODICON-28

G P water for inject, bacteriostatic G N norethindrone & ethinyl estradiol tab 0.5 mg-35 mcg

G P water for inject, bacteriostatic benzyl alcohol B N NORINYL 1+35

B P BACTERIOSTATIC WATER PARA B P ORTHO-NOVUM 1/35-28

G P saline injection bacteriostatic G N norethindrone & ethinyl estradiol tab 1 mg-35 mcg

B P SODIUM CHLORIDE BACTERIOS B P OVCON-50 28

B P CEBO #1 BLUE B N LOESTRIN 1/20-21

B P CEBO #2 GREEN G N norethindrone ace & ethinyl estradiol tab 1 mg-20 mcg

B P CEBO #3 ORANGE B N LOESTRIN 1.5/30-21 G N norethindrone ace & ethinyl estradiol tab 1.5 mg-30 mcg

CONTRACEPTIVES - BI-PHASIC COMBINATIONS B P NORINYL 1+50

B P ORTHO-NOVUM 1/50-28 B P ORTHO-NOVUM 10/11-28 G N norethindrone & mestranol tab 1 mg-50 mcg G N norethindrone-eth estradiol tab 0.5-35/1-35 mg-mcg (10/11) B P LO/OVRAL 28

G N norgestrel & ethinyl estradiol tab 0.3 mg-30 mcg CONTRACEPTIVES - EMERGENCY CONTRACEPTIVE G N norgestrel & ethinyl estradiol tab 0.5 mg-50 mcg

B N ORTHO-CYCLEN-28 B P PLAN B G P norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg

B N LOESTRIN FE 1/20 CONTRACEPTIVES - INJECTABLE G N norethindrone ace & ethinyl estradiol-fe tab 1 mg-20 mcg

B P DEPO-PROVERA CONTRACEPTIV B N LOESTRIN 24 FE

G N medroxyprogesterone acetate im susp 150 mg/ml B N LOESTRIN FE

B P DEPO-SUBQ PROVERA 104 G N norethindrone ace & ethinyl estradiol-fe tab 1.5 mg-30 mcg

B N LUNELLE B N SEASONALE B N SEASONIQUE CONTRACEPTIVES - MONOPHASIC COMBINATION O/C'S B N LYBREL

B N DESOGEN CONTRACEPTIVES - PATCHES/ VAGINAL PRODUCTS B P ORTHO-CEPT-28

G N desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg B P ORTHO EVRA

B P MIRCETTE B P NUVARING

G N desogest-eth estrad & eth estrad tab 0.15-0.02/0.01 mg(21/5)

B N YAZ TAB 3-0.02MG CONTRACEPTIVES - PROGESTIN ONLY

B N YASMIN 28 B N NOR-QD B P DEMULEN 1/35-28 B N ORTHO MICRONOR G P ethynodiol diacetate & ethinyl estradiol tab 1 mg-35mcg G P norethindrone tab 0.35 mg B P DEMULEN 1/50-28 B N OVRETTE 28 G P ethynodiol diacetate & ethinyl estradiol tab 1 mg-50 mcg

B P ALESSE-28 CONTRACEPTIVES - TRI-PHASIC COMBINATIONS B P LEVLITE-28

G P levonorgestrel & ethinyl estradiol tab 0.10 mg-20 mcg B P CYCLESSA B N LEVLEN CONTRACT PACK G N desogest-ethin est tab 0.1-0.025/0.125-0.025/0.15-0.025mg-mg B N LEVLEN-28 B P TRI-LEVLEN B N NORDETTE-21 B P TRIPHASIL 28 B N NORDETTE-28 G N levonorgestrel-eth estra tab 0.05-30/0.075-40/0.125-30mg-mcg

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories G N guaifenex dm CONTRACEPTIVES - TRI-PHASIC COMBINATIONS G N q-bid-dm - Continued - B N Z-COF LAX B N ORTHO-NOVUM 7/7/7-28 G N exefen-dm

G P norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35 mg-mcg B N MUCO-FEN DM

B N TRI-NORINYL 28 G N gfn 1000/dm 60

G N norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35 mg-mcg G N gg/dm la tab

B N ORTHO TRI-CYCLEN LO G N guaifenesin tab dm

B N ORTHO TRI-CYCLEN B N AQUATAB DM

G P norgestimate-eth estrad tab 0.18-35/0.215-35/0.25-35 mg-mcg G N entab-dm

B N ESTROSTEP FE G N g-bid dm G N gfn 1200/dm 60

COUGH/COLD - ANTITUSSIVE - NARCOTIC G N guaifenesin tab /dm er

G N guaifenesin/dm sr B N HYCODAN TAB 5MG G N tussi-bid G N hydrocodone/ tab homatrop G N tussitab G N hydrocod/hom syp 5-1.5/5 B N HYCOTUSS EXPECTORANT G N hydromet syp 5-1.5/5 G N hydrocodone-guaifenesin

B N M-CLEAR JR COUGH/COLD - ANTITUSSIVE - NONNARCOTIC B N PRO-CLEAR

B P PRO-CLEAR SYP G N benzonatate cap 100 mg B N PROLEX DH B N TESSALON G N hydrocodone-potassium guaiacolsulfonate G 2 N benzonatate cap 200 mg B N HUMIBID DM

COUGH/COLD - ANTITUSSIVE-EXPECTORANT COUGH/COLD - ANTITUSSIVE-EXPECTORANT - DECONGEST-ANTIHIST B N BRONTEX G N pseudoephed-bromphen-dm-gg syrup 30-2-5-50 mg/5ml G N gg/codeine tab 300-10

B N TUSSI-ORGANIDIN NR COUGH/COLD - B N TUSSI-ORGANIDIN-S NR ANTITUSSIVE-EXPECTORANTS-DECONGESTANT B P DIABETIC TUSSIN C B N ENTEX HC G P CHERATUSSIN SYP AC B N LEVALL 5.0 G P codeine-guaifenesin G N phenylephrine w/hydrocodone-gg G N gg/codeine syp 100-10/5 B N DURATUSS HD B N PROLEX DM B N NUCOFED EXPECTORANT G N dextromethorphan-potassium guaiacolsulfonate B N NOVAHISTINE EXPECTORANT G N drituss dm G N pseudoephedrine w/ codeine-gg G N guiadrine dm B N Z-COF DMX G N ht-tuss dm G P coldmist dm syp 40-15-10 G N hydro-tussin dm G P pseudoephedrine w/ dm-gg syrup 40-15-100 mg/5ml G N su-tuss dm G P TRI-VENT DM SYP O P dextromethorphan-guaifenesin syrup 10-100 mg/5ml B N PROFEN II DM B N DURATUSS DM G N pseudoephedrine w/ dm-gg tab sr 12hr 45-30-800 mg B N DURADEX B N PANMIST DM G N dextromethorphan/guaifene G P coldmist dm tab 12hr G N amibid dm G N pseudoephedrine w/ dm-gg tab sr 12hr 48-32-595 mg G N aquabid-dm G N pseudoephedrine w/ dm-gg tab sr 12hr 60-30-600 mg G N gg/dm cr tab 600-30mg B N AQUATAB C G N gg/dm sr tab 600-30mg B N MAXIFED DMX

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories G N PSEUDO/GG LA TAB 12HR COUGH/COLD - G N pseudoephedrine-guaifenesin tab sr 12hr 85-795 mg ANTITUSSIVE-EXPECTORANTS-DECONGESTANT - Continued - B N H 9600 SR

B N PROFEN FORTE DM B N PROFEN FORTE

G N pseudoephedrine w/ dm-gg B N DYNEX

B N PANCOF EXP B N ZEPHREX LA

G N pseudoephedrine-dihydrocodeine-guaifenesin G N GG/PSE CR TAB 600-120

G N pseudoephedrine w/ hydrocodone-gg syrup 15-3-100 mg/5ml G N GUAIFENEX TAB PSE 120

G N pseudoeph w/hydrocodone-gg G N MIRAPHEN PSE TAB 120-600

B N LEVALL G N pseudoephedrine-guaifenesin tab sr 12hr 120-600 mg

G N phenylephrine-carbetapentane-guaifenesin G N pseudoephedrine-guaifenesin

G N pseudoephedrine-guaifenesin tab sr 12hr 120-1200 mg COUGH/COLD - DECONGESTANT & ANTICHOLINERGIC COUGH/COLD - DECONGESTANT-ANTIHISTAMINE W/ B N ALLERX-D EXPECTORANT

G N pseudoephedrine-methscopolamine B N RYNA-12X

COUGH/COLD - DECONGESTANT W/ EXPECTORANT COUGH/COLD - DECONGESTANT-ANTIHISTAMINE-ANTICHOLINERGIC

B N ENTEX B N PANNAZ S

B N GUAIFED-PD B N PANNAZ

B N ENTEX ER G N carbinoxamine-pseudoephedrine-methscopolamine

B N GUAIFED B N ALLERX DOSE PACK

B N DECONSAL II B N DURAHIST

B N ENTEX LA B N MESCOLOR

B N PROLEX PD G N chlorpheniramine-pseudoephedrine & methscopolamine

B N PROLEX D B N EXTENDRYL JR

B N MAXIPHEN-G B N EXTENDRYL

B N DURAPHEN II B N EXTENDRYL SR

B N DURATUSS B N DURAHIST PE

B N DURATUSS GP B N OMNIHIST II LA

B N J-MAX B N DALLERGY

B N LIQUIBID-D G N chlorpheniramine-phenylephrine-methscopolamine B N MAXIPHEN

G N phenylephrine-guaifenesin COUGH/COLD - EXPECTORANT MIXTURES

B N ALDEX G

B N SINA-12X B N HUMIBID LA

B N RESPAIRE-60 COUGH/COLD - EXPECTORANTS B N PANMIST S

G N pseudoephedrine-guaifenesin syrup 40-200 mg/5ml B N ORGANIDIN NR B N LEVALL G G N guaifenesin B N ENTEX PSE

G N pseudoephedrine-guaifenesin tab sr 12hr 45-800 mg COUGH/COLD - NARCOTIC ANTITUSSIVE-ANTIHISTAMINE B N PANMIST JR

G N pseudoephedrine-guaifenesin tab sr 12hr 60-600 mg B N TUSSIONEX PENNKINETIC EXT

G N pseudoephedrine-guaifenesin tab sr 12hr 60-1200 mg G N PROMETH/COD SYP 6.25-10

B N AQUATAB D G N promethazine w/ codeine syrup 6.25-10 mg/5ml B N MAXIFED G N pseudoephedrine-guaifenesin tab sr 12hr 80-800 mg COUGH/COLD - NARCOTIC ANTITUSSIVE-DECONGESTANT B N PANMIST LA

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories O P pseudoephedrine-dm syrup 30-15 mg/5ml B N NALEX DH O P pseudoephedrine-dm soln 7.5-2.5 mg/0.8ml

G P phenyleph-hydrocodone

G P pseudoephedrine w/ hydrocodone COUGH/COLD - NON-NARC ANTITUSSIVE-DECONGESTANT-ANTIHISTAMINE B N NUCOFED G N phenylephrine-chlorphen-dm

G N phenyleph tannate-chlorphen tannate-carbetapentane tannate COUGH/COLD - NARCOTIC ANTITUSSIVE-DECONGESTANT-ANTIHISTAMINE G N phenylephrine-pyrilamine-dm

B N PROMETHAZINE VC/CODEINE B N TUSSI-12D

B N CODIMAL PH B N TUSSI-12D S

B N PANCOF PD G N pseudoephedrine tan-chlorphen tan-dextromethorphan tan

G N phenylephrine-chlorpheniramine-dihydrocodeine B N DELTUSS DMX

G N pseudoeph-chlorphen w/ cod G N ANDEHIST DM SYP NR

B N B-TUSS G N BROMAXEFED SYP DM RF

B N Phenyleph-CPM w/ Hydrocod G N pseudoephed-bromphen-dm

G N Phenyleph-CPM w/ Hydrocod B N TANAFED DMX

G N HISTINEX HC SYP B N PEDIATEX DM

B N CODIMAL DH B N CORDRON-DM

G N CODITUSS DH SYP B N RONDEC DM

G N phenyleph-pyril w/ hydrocod G N pseudoephed-carbinox-dm

B N PRO-RED B N RYNATUSS

B N PRO-RED SYP B N RYNATUSS PEDIATRIC

B N BROVEX HC G N phenylephrine-ephedrine-chlorpheniramine w/ carbetapentane

B N M-END (REFORMULATED)

G N pseudoephed-cpm w/ hydrocod COUGH/COLD - SYSTEMIC DECONGESTANTS

B N PANCOF O P pseudoephedrine hcl tab 30 mg G N pseudoephedrine-chlorpheniramine-dihydrocodeine O P pseudoephedrine hcl tab 60 mg B N HISTEX HC O P pseudoephedrine hcl syrup 30 mg/5ml G N PSE/HYDROCOD LIQ /CARBINX

G N pseudoephedrine-carbinoxamine w/ hydrocodone COUGH/COLD - TOPICAL DECONGESTANTS G N TRI-VENT HC LIQ

B N ADRENALIN COUGH/COLD - NON-NARC ANTITUSSIVE-ANTIHISTAMINE B N TYZINE PEDIATRIC NASAL DR

B N TYZINE B N TUSSI-12

G N tussizone-12 tab 5-60mg COX 2 INHIBITORS - SELECTIVE B N TUSSI-12 S

G N chlorpheniramine tannate-carbetapentane tannate G 11 N ketorolac tromethamine tab 10 mg G N tussizone-12 sus 4-30mg/5 G P ketorolac tromethamine inj 15 mg/ml G N PROMETHAZINE SYP DM B 11 N TORADOL IV/IM G N promethazine-dm G P ketorolac tromethamine inj 30 mg/ml

G 11 N meloxicam COUGH/COLD - NON-NARC ANTITUSSIVE-DECONGESTANT B 11 N MOBIC TAB 15MG

B 11 N MOBIC SUS 7.5/5ML B N RESPI-TANN B 11 N RELAFEN O P pseudoephedrine-dm liqd 15-7.5 mg/5ml G P nabumetone O P pseudoephedrine-dm liqd 20-10 mg/5ml B 11 N CELEBREX O P pseudoephedrine-dm liqd 30-15 mg/5ml

O P pseudoephedrine-dm elixir 20-10 mg/5ml CYTO-MEGALOVIRUS AGENTS O P pseudoephedrine-dm syrup 15-7.5 mg/5ml

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories O P NOVOLIN 70/30

B P VISTIDE O P RELION 70/30

B N FOSCAVIR B N HUMULIN 50/50

G P FOSCARNET INJ 24MG/ML DIABETIC - INSULIN PENFILLS B P CYTOVENE CAP 250MG

B P CYTOVENE CAP 500MG B 11 P NOVOLOG FLEXPEN G P ganciclovir B 11 P NOVOLOG PENFILL B N CYTOVENE INJ 500MG B 11 N LANTUS OPTICLIK B P VALCYTE B 11 N APIDRA INJ OPTICLIK

B 11 N HUMALOG DENTAL PRODUCTS B 11 N HUMALOG PEN

B P PREVIDENT B 11 P LEVEMIR INJ FLEXPEN

B P PREVIDENT 5000 PLUS O 11 P NOVOLIN R INNOLET

G P sodium fluoride cream 1.1% O 11 P NOVOLIN R U-100 PENFILL

B P PREVIDENT 5000 BOOSTER B 11 N HUMULIN N U-100 PEN

B P PREVIDENT FLUORIDE O 11 P NOVOLIN N INNOLET

B N THERA-FLUR-N O 11 P NOVOLIN N U-100 PENFILL

G P sodium fluoride gel 1.1% (0.5% f) B 11 P NOVOLOG MIX 70/30 PENFILL

B P GEL-KAM ORAL CARE RINSE B 11 P NOVOLOG MIX 70/30 PREFILL

G P stannous fluoride conc 0.63% B 11 N HUMALOG MIX 75/25 PEN B 11 N HUMULIN 70/30 PEN

DIABETIC - ALPHAGLUCOSIDASE O 11 P NOVOLIN 70/30 INNOLET O 11 P NOVOLIN 70/30 PENFILL B N PRECOSE

B P GLYSET DIABETIC - MEGLITINIDES

DIABETIC - INSULIN B P STARLIX B N PRANDIN O P ILETIN II REGULAR/PORK

O P ILETIN II NPH/PORK DIABETIC - ORAL BIGUANIDES

B P NOVOLOG

B N LANTUS B N GLUCOPHAGE

B P LEVEMIR G P metformin hcl

B 11 N LANTUS INJ SOLOSTAR B N RIOMET

B N APIDRA INJ U-100 B N GLUCOPHAGE XR

B N HUMALOG B N GLUMETZA

O P NOVOLIN R G P metformin hcl tab sr 24hr 500 mg

O P RELION R G N metformin hcl tab sr 24hr 750 mg

B N HUMULIN R B N FORTAMET

B N EXUBERA COMBINATION PACK DIABETIC - ORAL SULFONYLUREAS O P VELOSULIN BR

B N HUMULIN N G P chlorpropamide O P NOVOLIN N B N AMARYL O P RELION N G P glimepiride B N HUMULIN L B N GLUCOTROL B N HUMULIN U G P glipizide B P NOVOLOG MIX 70/30 B N GLUCOTROL XL B N HUMALOG MIX 75/25 G N glipizide er B N HUMULIN 70/30

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories B N THYROGEN DIABETIC - ORAL SULFONYLUREAS - Continued - DIURETICS G N glipizide xl B 11 P INSPRA B N DIABETA G P acetazolamide B N MICRONASE B N DIAMOX G P glyburide G P methazolamide B N GLYNASE B N BUMEX G P glyburide micronized G P bumetanide B N TOLINASE B P EDECRIN G P tolazamide B N LASIX B P TOLBUTAMIDE G P furosemide

DIABETIC - OTHER B N DEMADEX G P torsemide

B 11 N SYMLIN B N MIDAMOR

B 11 N BYETTA G P amiloride hcl tab 5 mg

B N GLUCAGEN B N ALDACTONE

B P GLUCAGON EMERGENCY KIT G P spironolactone

B P PROGLYCEM B N NATURETIN

B N JANUVIA G P chlorothiazide

B N JANUMET TAB 50-500MG B N DIURIL

B N JANUMET TAB 50-1000 B N DIURIL IV

B P GLUCAGON B N THALITONE G P chlorthalidone

DIABETIC - SULFONYLUREA / BIGUANIDE B N MICROZIDE

G P hydrochlorothiazide B N METAGLIP B N LOZOL B N GLUCOVANCE G P indapamide G P glyburide-metformin G P methyclothiazide B P AVANDARYL B P ZAROXOLYN

G P metolazone DIABETIC - THIAZOL B N MODURETIC 5-50

G P amiloride & hydrochlorothiazide B P ACTOS B P ALDACTAZIDE TAB 25/25 B P AVANDIA G P spironolactone & hydrochlorothiazide B N DUETACT B P ALDACTAZIDE TAB 50/50

B N DYAZIDE DIABETIC - THIAZOL / BIGUANIDE COMBO B N MAXZIDE-25

B P ACTOPLUS MET B N MAXZIDE

B P AVANDAMET G P triamterene & hydrochlorothiazide

DIAGNOSTIC BIOLOGICALS DOPAMINE RECEPTOR AGONISTS

B P APLISOL B P DOSTINEX

B N TUBERSOL G N CABERGOLINE TAB 0.5MG

DIAGNOSTIC DRUGS EAR

B N CORTROSYN B P FLOXIN OTIC

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories G P dextrose inj 5% EAR G P dextrose inj 10% - Continued - G P dextrose inj 50% B P FLOXIN OTIC SINGLES G P dextrose inj 70%

G P benzocaine (otic) B N LIPOSYN III

G N hydrocortisone w/acetic acid G P fat emulsion iv soln 20%

G P acetic acid (otic) B N FREAMINE III

B N DOMEBORO B P PREMASOL

G P acetic acid-aluminum acetate B P TRAVASOL

B N CORTANE-B B N TROPHAMINE

B P CIPRODEX B P AMINOSYN II

B P CIPRO HC G N *amino acid infusion 15%***

B N CORTISPORIN SUS 1% OTIC G N albumin, human inj 5%

B P PEDIOTIC G P buminate inj 25%

G N antibiot ear sus 1% otic G P flexbumin inj 25%

G N cortomycin sus 1% otic G P plasbumin-25 inj 25%

G P neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000 unit/ml-1%

B N CORTISPORIN SOL 1% OTIC ERYTHROPOEISIS STIMULATING AGENTS

G P antibiot ear sol 1% otic B 11 N ARANESP G P cortomycin sol 1% otic B 11 N EPOGEN G P neomycin-polymyxin-hc otic soln 1% B 11 P PROCRIT B N COLY-MYCIN-S

B N CORTISPORIN-TC ESTROGEN COMBOS G P benzocaine & antipyrine

B N CORTANE-B-OTIC G N estradiol & testosterone cypionates im in oil 2-50 mg/ml G N pramoxine-hc-chloroxylenol G N estradiol val & testosterone enanthate im in oil 4-90 mg/ml B N CORTANE-B AQUEOUS G N estradiol val & testosterone enanthate im in oil 8-180 mg/ml G N pramoxine-hc-chloroxylenol aqueous B N ANGELIQ B N TYMPAGESIC DROPS B P PREMPRO G P benzocaine-phenylephrine-antipyrine B P PREMPHASE

B N ACTIVELLA ELECTROLYTES/ NUTRITIONALS B N COMBIPATCH

B N FEMHRT 1/5 O P *oral electrolyte solution*** B N CLIMARA PRO B N MULTILYTE-20 B N PREFEST G P lactated ringer's solution G N Estradiol-Norgestimate G P kcl 0.15% in nacl 0.9%

G P dextrose 5% w/ kcl 0.15% ESTROGEN COMBO'S G P dextrose 5% w/ kcl 0.224%

G P dextrose 5% w/ sodium chloride 0.2% G N estradiol & testosterone cypionates im in oil 2-50 mg/ml G P dextrose 5% w/ sodium chloride 0.45% G N estradiol val & testosterone enanthate im in oil 4-90 mg/ml G P dextrose 5% w/ sodium chloride 0.9% G N estradiol val & testosterone enanthate im in oil 8-180 mg/ml G P dextrose 10% w/ sodium chloride 0.2% B N ANGELIQ G P dextrose 5% in lactated ringers B P PREMPRO G P kcl 0.075% in d5/0.2% nacl B P PREMPHASE G P kcl 0.075% in d5/0.45% nacl B N ACTIVELLA G P kcl 0.15% in d5/0.33% nacl B N COMBIPATCH G P kcl 0.15% in d5/0.45% nacl B N FEMHRT 1/5 G P kcl 0.224% in d5/0.45% nacl B N CLIMARA PRO

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories B N AVELOX ESTROGEN COMBO'S B N NOROXIN - Continued - B N FLOXIN B N PREFEST G N ofloxacin

G N Estradiol-Norgestimate B N TEQUIN G N gatifloxacin

ESTROGENS - PATCHES B N FACTIVE

B N ELESTRIN GI - ANTI - FLATULENTS / GI STIMULANTS B N ESTROGEL

B N DIVIGEL B N OSMOPREP

B N ALORA B N VISICOL TAB 1.5GM

B N ESCLIM O P senna tab 187 mg

B P ESTRADERM O P sennosides tab 8.6 mg

B P VIVELLE G P lactulose solution 10 gm/15ml

B P VIVELLE-DOT B N KRISTALOSE PAK 10GM

B N MENOSTAR B N KRISTALOSE PAK 20GM

B N CLIMARA B N MIRALAX POW 3350 NF

G N estradiol G 7 P polyethylene glycol 3350 oral powder B N MIRALAX PAK 3350 NF

ESTROGENS - TABS G 7 P polyethylene glycol 3350 oral packet

B P NULYTELY SOL B P PREMARIN G P peg 3350-kcl-sod bicarb-nacl for soln 420 gm B P CENESTIN B P COLYTE SOL B N ENJUVIA B P COLYTE-FLAV SOL B P MENEST B P GOLYTELY SOL PINEAPPL B N ESTRACE B P COLYTE/FLAVR SOL PACKS G P estradiol G P peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240 gm G P gynodiol B P GOLYTELY SOL B P DEPO-ESTRADIOL B P GASTROCROM CON 100/5ML G N estradiol cypionate B N REGLAN TAB 5MG B N DELESTROGEN G P metoclopramide hcl tab 5 mg G N estradiol valerate B N REGLAN TAB 10MG B N ESTRONE G P metoclopramide hcl tab 10 mg B N OGEN G P metoclopramide hcl syrup 5 mg/5ml G P estropipate G P metoclopramide hcl inj 5 mg/ml

G P lactulose (encephalopathy) solution 10 gm/15ml FLUOROQUINOLONES B N AMITIZA

B P CIPROFLOXACIN GI - ANTIDIARRHEAL / ANTACID - MISC. B N CIPRO XR

B P CIPRO CYSTITIS O 11 P sodium bicarbonate tab 325 mg B N CIPRO O 11 P sodium bicarbonate tab 650 mg G P ciprofloxacin hcl O 11 P magnesium oxide cap 140 mg (85 mg elemental mg) B N PROQUIN XR O 11 P magnesium oxide tab 400 mg B P CIPRO I.V. B P SAL-TROPINE B P LEVAQUIN LEVA-PAK G P atropine sulfate B P LEVAQUIN B N BELLADONNA ALKALOIDS B P LEVAQUIN PREMIX B P ANASPAZ B N AVELOX ABC PACK B N SYMAX DUOTAB

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories G 11 P amylase-lipase-protease tab 30000-8000-30000 unit GI - ANTIDIARRHEAL / ANTACID - MISC. B 11 P VIOKASE 16 - Continued - G 11 N amylase-lipase-protease tab 60000-16000-60000 unit

B N LEVSIN/SL B 11 P VIOKASE

G P hyoscyamine sub 0.125mg B 11 N PANCREASE MT 4

G P hyoscyamine elx 0.125/5 B 11 N CREON 5

B N LEVSIN G 11 P lipram-cr5

G P hyoscyamine dro 0.125/ml B 11 N PANCREASE

B N LEVSINEX B 11 N PANOCAPS

B N NULEV G 11 P lipram 4500

G P hyoscyamine tab 0.125mg G 11 P pancrelipase

B N LEVBID G 11 P pangestyme ec

G P hyoscyamine tab 0.375mg G 11 P ultrase

G P hyoscyamine sulfate B 11 N PANCRECARB MS-4

B N ROBINUL TAB 1MG B 11 N PANCREASE MT 10

B N ROBINUL FORTE G 11 P lipram-pn10

B N ROBINUL INJ 0.2MG/ML B 11 N CREON 10

G P glycopyrrolate B 11 N PALCAPS 10

B P PAMINE G 11 P lipram-cr10

B P PAMINE FORTE G 11 P pangestyme cn 10

B P PROPANTHELINE BROMIDE B 11 P ULTRASE MT 12

B N BENTYL CAP 10MG G 11 P lipram-ul12

B N BENTYL TAB 20MG G 11 P pangestyme ul 12

G P dicyclomine hcl B 11 N PANCRECARB MS-8

B P BENTYL SYP 10MG/5ML B 11 N PANCREASE MT 16

B N B & O 15-A SUPPRETTE B 11 N PANOCAPS MT 16

G P belladonna alkaloids & opium suppos 16.2-30 mg G 11 P lipram-pn16

B N B & O 16-A SUPPRETTE G 11 P pancrelipase mst-16

G N belladonna alkaloids & opium suppos 16.2-60 mg G 11 P pangestyme mt 16

B 11 N PANCREASE MT 20

GI - ANTIPERISTALTIC AGENTS B 11 N PANOCAPS MT 20

G 11 P lipram-pn20 B N LOMOTIL B 11 P ULTRASE MT 18 G P diphenoxylate w/ atropine G 11 P pangestyme ul 18 B N MOTOFEN B 11 N CREON 20 G P loperamide cap 2mg B 11 N PALCAPS 20 O P loperamide hcl tab 2 mg G 11 P lipram-cr20 O P loperamide hcl liq 1 mg/5ml (0.2 mg/ml) G 11 P pangestyme cn 20 B P OPIUM TINCTURE B 11 P ULTRACAPS MT 20 G P paregoric B 11 P ULTRASE MT 20

G 11 P lipram-ul20 GI - DIGESTIVE ENZYMES G 11 P pangestyme ul 20

G 11 N digestive enzymes w/ anticholinergics GI - H2-ANTAGONISTS B 11 N KU-ZYME HP

B 11 N KU-ZYME G P cimetidine tab 200 mg B 11 N LAPASE G P cimetidine tab 300 mg B 11 N DYGASE B N TAGAMET B 11 N KUTRASE G P cimetidine tab 400 mg B 11 P VIOKASE 8

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories G P ursodiol cap 300 mg GI - H2-ANTAGONISTS B P URSO - Continued - B N URSO 250 G P cimetidine tab 800 mg B N URSO FORTE TAB 500MG

G P cimetidine hcl B P SORBITOL

G N ranitidine cap 150mg

G N ranitidine cap 300mg GI - MISC. ANTI-ULCER

B N ZANTAC TAB 150MG B N CARAFATE TAB 1GM G P ranitidine tab 150mg G P sucralfate tab 1 gm B N ZANTAC TAB 300MG B P CARAFATE SUS 1GM/10ML G P ranitidine tab 300mg

B N ZANTAC TAB 150MG EF GI - PROSTAGLANDINS B N RANITIDINE SYP 75MG/5ML

B P ZANTAC SYP 75MG/5ML B N CYTOTEC B N ZANTAC INJ 25MG/ML G P misoprostol G P ranitidine inj 150/6ml

G P ranitidine inj 50mg/2ml GI - PROTON PUMP INHIBITOR B N PEPCID

G P famotidine B 11 N NEXIUM

G N nizatidine B 12 P PREVACID

B N AXID B 20 P PREVACID SOLUTAB

B 11 N ZEGERID

GI - INFLAMMATORY BOWEL AGENTS G 11 N omeprazole caps

B 11 N PRILOSEC B P COLAZAL O 12 P OMEPRAZOLE MAGNESIUM DELAYED RELEASE TAB 20 MG (BASE EQUIV) B P PENTASA B 12 P PROTONIX B P ASACOL B 11 N ACIPHEX B N LIALDA B 11 N ZEGERID CAP 20-1100 B P ROWASA B 11 N ZEGERID CAP 40-1100 G P mesalamine enema 4 gm

B N CANASA GI - PROTON PUMP INHIBITOR/NSAID COMBO B P DIPENTUM

B N AZULFIDINE B 12 P PREVACID NAPRAPAC G P sulfasalazine tab 500 mg B N AZULFIDINE EN-TABS GI - ULCER ANTI-INFECTIVE G P sulfasalazine tab delayed release 500 mg

B N REMICADE B P HELIDAC B 12 P PREVPAC GI - IRRITABLE BOWEL SYNDROME AGENTS GLUCOCORTICOIDS - CORTICOTROPIN B N LOTRONEX B P ACTHAR HP GI - MISC. GLUCOCORTICOIDS - MINERALOCORTICOIDS O P magnesium hydroxide susp 400 mg/5ml

O P sennosides syrup 8.8 mg/5ml B P CELESTONE

O P sennosides-docusate sodium tab 8.6-50 mg B P ENTOCORT EC

B P HALFLYTELY BOWEL PREP KIT G P cortisone acetate

B N MOVIPREP B P DEXAMETHASONE INTENSOL

B P ACTIGALL B N DECADRON

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories GROWTH HORMONE GLUCOCORTICOIDS - MINERALOCORTICOIDS - Continued - B 11 N PROTROPIN G P dexamethasone B 11 P NUTROPIN AQ

G P dexamethasone sodium phosphate inj 4 mg/ml B 11 P NUTROPIN AQ PEN

G P dexamethasone sodium phosphate inj 10 mg/ml B 11 N NORDITROPIN CARTRIDGE

B P HYDROCORTONE B 11 N NORDITROPIN NORDIFLEX PEN

B P CORTEF B 11 N IPLEX

G P hydrocortisone B 11 N HUMATROPE COMBO PACK

B P SOLU-CORTEF B 11 P NUTROPIN INJ 5MG

B N MEDROL B 11 P TEV-TROPIN

G P methylprednisolone B 11 P GENOTROPIN INTRA-MIX

B P DEPO-MEDROL B 11 P GENOTROPIN

G N methylprednisolone acetate B 11 P NUTROPIN INJ 10MG

B P SOLU-MEDROL B 11 N HUMATROPE

G N methylprednisolone sod succ B 11 P GENOTROPIN MINIQUICK

B N PRELONE B 11 N NUTROPIN DEPOT

G P prednisolone B 11 N SAIZEN

B N PEDIAPRED B 11 N ZORBTIVE

B N ORAPRED B 11 N INCRELEX

G P prednisolone sodium phosphate

B N ORAPRED ODT HEMOSTATIC

G P deltasone B P AMICAR G P orasone G P aminocaproic acid B N PREDNISONE INTENSOL B N SURGICEL FIBRILLAR ABSORB G P prednisone B N SURGICEL ABSORBABLE HEMOS B P KENALOG-10 B N SURGICEL NU-KNIT ABSORBAB B P KENALOG-40

B N CELESTONE-SOLUSPAN HEPATITIS B ONLY B P FLORINEF

G P fludrocortisone acetate B N HEPSERA

B P BARACLUDE GOUT B P TYZEKA

B N ZYLOPRIM HEPATITIS C AGENTS G P allopurinol

B N COLCHICINE TAB 0.6 MG B N INFERGEN G P colchicine B P PEGASYS G P probenecid B P PEG-INTRON B P SULFINPYRAZONE B P PEG-INTRON REDIPEN G P colchicine w/ probenecid B P PEG-INTRON REDIPEN PAK 4

B P REBETOL GRANULOCYTE CSF G N ribavirin cap 200 mg

B N COPEGUS B 11 P NEUPOGEN G N ribapak B 11 N NEULASTA B P REBETRON B 11 N LEUKINE

B 11 N NEUMEGA HEREDITARY TYROSINEMIA TYPE 1 (HT-1) TREATMENT - AGENTS

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories B P BAYTET HEREDITARY TYROSINEMIA TYPE 1 (HT-1) TREATMENT - AGENTS - Continued - IMPOTENCE AGENTS B P ORFADIN B 11 N CAVERJECT

HERPES AGENTS B 11 N CAVERJECT IMPULSE B 11 N MUSE

B N ZOVIRAX CAP 200MG B 11 P VIAGRA

G P acyclovir cap 200mg B 11 N CIALIS

B N ZOVIRAX TAB 400MG B 11 N LEVITRA

G P acyclovir tab 400mg G 11 P yohimbine hcl tab 5.4 mg

B N ZOVIRAX TAB 800MG B 11 N PROSTIN VR PEDIATRIC

G P acyclovir tab 800mg

B P ZOVIRAX SUS 200/5ML INFLUENZA AGENTS

G N acyclovir sus 200/5ml B N FLUMADINE TAB 100MG G P acyclovir sodium G P rimantadine hydrochloride tab 100 mg B P VALTREX B P FLUMADINE SYP 50MG/5ML B N FAMVIR B 25 P TAMIFLU

HYPERPARATHYROID TREATMENT - VITAMIN D ANALOGS B P RELENZA DISKHALER B P FLUARIX 2005-2006

B P HECTOROL B 5 P FLUMIST NASAL VACCINE 200

HYPERPARATHYROID TREATMENT - VITAMIN D ANALOGS IRRIGATION SOLUTIONS AND CALCIMIMETICS

B N ZEMPLAR G P water for irrigation, sterile irrigation soln

B N SENSIPAR K REMOVING RESINS IMMUNE SERUMS G P sodium polystyrene sulfonate oral susp 15 gm/60ml

B N CYTOGAM G P sodium polystyrene sulfonate rectal susp 30 gm/120ml

B N BAYHEP B B P KAYEXALATE

G P hepatitis b immune globulin (human) inj G P sodium polystyrene sulfonate powder

G N immune globulin (human) inj

G N gammagard s/d LINCOSAMIDES / OXAZOLIDINONES / LEPROSTATICS

G P GAMMAGARD SD INJ 0.5GM HU G N chloramphenicol sodium succinate for iv inj 1 gm G N POLYGAM S/D SOL 2.5GM B N LINCOCIN G P immune globulin (human) iv for soln 5 gm B N CLEOCIN CAP 150MG G N immune globulin (human) iv for soln 6 gm G P clindamycin hcl cap 150 mg G P immune globulin (human) iv for soln 10 gm B N CLEOCIN CAP 300MG B P FLEBOGAMMA G 4 N clindamycin hcl cap 300 mg B P GAMIMUNE N B P CLEOCIN PEDIATRIC GRANULE B P GAMUNEX B P CLEOCIN INJ 300MG G P GAMMAGARD LIQUID B P CLEOCIN INJ 9GM G N immune globulin (human) iv soln 10% G P clindamycin phosphate inj 150 mg/ml B N VIVAGLOBIN G P clindamycin phosphate iv soln 150 mg/ml G P rabies immune globulin (human) inj 150 unit/ml B P CLEOCIN INJ 600MG B P WINRHO SDF B P CLEOCIN INJ 900MG G P rho d immune globulin (human) im inj 50 mcg B 11 P ZYVOX B P RHOGAM HUMAN

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories B P BIAXIN XL PAC LINCOSAMIDES / OXAZOLIDINONES / LEPROSTATICS G N clarithromycin er - Continued - B N DYNABAC D5-PAK B P CUBICIN B N KETEK

B P DAPSONE MIGRAINE - CARBOXYLIC ACID DERIVATIVES MACROLIDES / ERYTHROMYCIN'S / KETOLIDES B P DEPAKOTE ER

B P ERYTHROMYCIN BASE

B P ERY-TAB MIGRAINE - ERGOTAMINE DERIVATIVES

B N ERYC B 11 N D.H.E. 45 G P erythromycin w/ delayed release particles cap 250 mg G 17 P dihydroergotamine mesylate inj 1 mg/ml B N PCE B 17 P MIGRANAL G P erythromycin stearate tab 250 mg

G P erythromycin stearate tab 500 mg MIGRAINE - MISC. B P ERYTHROMYCIN ESTOLATE

G P erythromycin ethylsuccinate tab 400 mg B 11 N CAFERGOT TAB 1-100MG G P erythromycin ethylsuccinate susp 200 mg/5ml G 11 N ergotamine w/ caffeine tab 1-100 mg G P erythromycin ethylsuccinate susp 400 mg/5ml B 17 P CAFERGOT SUP 2/100 B P ERYPED

B P E.E.S. GRANULES MIGRAINE - SELECTIVE SEROTONIN AGONISTS (5HT)- B P ERYPED 200 -INJECTABLES

B P ERYPED 400 B 17 P IMITREX SPR 5MG/ACT

B N ZITHROMAX TAB 250MG B 17 P IMITREX SPR 20MG/ACT

B P ZITHROMAX Z-PAK B 17 P IMITREX INJ 6MG/0.5

G P azithromycin tab 250 mg B 17 P IMITREX STATDOSE PEN

B N ZITHROMAX TAB 500MG B 17 P IMITREX STATDOSE REFILL

B N ZITHROMAX TRI-PAK B 11 N ZOMIG G P azithromycin tab 500 mg B P ZITHROMAX TAB 600MG MIGRAINE - SELECTIVE SEROTONIN AGONISTS (5HT)--TABS G P azithromycin tab 600 mg

B P ZITHROMAX SUS 100/5ML B 11 N AXERT

B P ZITHROMAX SUS 200/5ML B 17 P RELPAX

B P ZITHROMAX SUS 200MG/5 B 11 N FROVA

B P ZMAX B 11 N AMERGE

B N ZITHROMAX INJ 500MG B 17 P MAXALT

B N ZITHROMAX POW 1GM PAK B 17 P MAXALT-MLT

B N BIAXIN TAB 250MG B 17 P IMITREX TAB 25MG

G N clarithromycin tab 250 mg B 17 P IMITREX TAB 50MG

B N BIAXIN TAB 500MG B 17 P IMITREX TAB 100MG

G N clarithromycin tab 500 mg B 11 N ZOMIG

B P BIAXIN SUS 125/5ML B 11 N ZOMIG ZMT

B N BIAXIN SUS 125/5ML MINERALS G N CLARITHROMYC SUS 125/5ML

B N BIAXIN SUS 187.5/5 G P sodium acetate inj 2 meq/ml B P BIAXIN SUS 250/5ML B N SODIUM ACETATE TRIHYDRATE B N BIAXIN SUS 250/5ML G P sodium bicarbonate inj 8.4% G N CLARITHROMYC SUS 250/5ML O 11 P calcium carbonate tab 600 mg B P BIAXIN XL O 11 P calcium carbonate chew tab 1250 mg (500 mg elemental ca)

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories B N KLOR-CON M15 MINERALS B P K-DUR - Continued - G P potassium chloride microencapsulated crys cr tab 20 meq O 11 P calcium carbonate susp 1250 mg/5ml B N K-LYTE/CL

O 11 P calcium gluconate tab 650 mg G N pot bicarbonate & chloride effer tab 25 meq

G 11 N calcium gluconate inj 10% G P sodium chloride inj 0.45%

O P calcium lactate tab 650 mg G P sodium chloride inj 0.9%

O 11 P calcium carbonate-vitamin d tab 500 mg-200 unit G P sodium chloride iv soln 0.9%

O 11 P calcium carbonate-vitamin d tab 600 mg-200 unit G N sodium chloride inj 5%

B 11 N CALVITE P&D B N SODIUM CHLORIDE

B 11 N CALCIFOL G N sodium chloride inj 4 meq/ml (23.4%)

B N AMMONIUM CHLORIDE G N sodium chloride inj 2.5 meq/ml (14.6%)

B P SODIUM FLUORIDE G N zinc sulfate cap 220 mg

G P sodium fluoride chew tab 0.55 mg (0.25mg f) B P ZINC SULFATE

G P sodium fluoride chew tab 1.1 mg (0.5mg f) B N GLUTOFAC-MX

G P sodium fluoride chew tab 2.2 mg (1 mg f) G N selenious acid inj 40 mcg/ml

G P sodium fluoride soln 0.275 mg/drop (0.125 mg/drop f) B N TRACE METALS ADDITIVE FTV

G P sodium fluoride soln 0.55 mg/drop (0.25 mg/drop f) G N trace min (cr-cu-mn-se-zn) inj 4-400-100-20-1000 mcg/ml

B P LURIDE G P trace min (cr-cu-mn-se-zn) inj 10-1000-500-60-5000 mcg/ml

B N PEDIAFLOR B N M.T.E. 7

G P sodium fluoride soln 1.1 mg/ml (0.5 mg/ml f) O P ferrous sulfate tab 325 mg

B P PIMA O P ferrous sulfate soln 75 mg/0.6ml (15 mg/0.6ml elemental fe)

B P SSKI O P ferrous gluconate tab 325 mg

G P magnesium sulfate inj 50% O P ferrous fumarate tab 325 mg

B 11 P MAGNEBIND 400 G P iron dextran inj 50 mg/ml

G P potassium phosphate dibasic inj 3 mmole/ml B N VENOFER

B P K-PHOS

G P sodium phosphate inj 3 mmole/ml MOUTH - ANESTHETICS TOPICAL ORAL

B N K-PHOS NEUTRAL B N XYLOCAINE SOL 2% VISC G P pot phos monobasic w/sod phos di & monobas tab 155-852-130mg G P lidocaine hcl viscous soln 2% B N POTASSIUM ACETATE

G P potassium acetate inj 2 meq/ml MOUTH - STEROIDS B N K-LYTE

G P potassium bicarbonate effer tab 25 meq G P triamcinolone acetonide in orabase 0.1% B N K-LYTE DS

B P MICRO-K MOUTH ANTI-INFECTIVES G P potassium chloride cap cr 10 meq

G P potassium chloride tab cr 8 meq G P nystatin susp 100000 u/ml B N K-TABS G P potassium chloride tab cr 10 meq MOUTH ANTISEPTICS G P potassium chloride oral liq 10%

B N RUM-K B N PERIDEX ORAL RINSE

B N KAON-CL G P chlorhexidine gluconate soln 0.12%

G P potassium chloride oral liq 20% B N DEBACTEROL

G P potassium chloride inj 2 meq/ml MUCOPOLYSACCHARIDOSIS B N POTASSIUM CHLORIDE

G P potassium chloride powder packet 20 meq B P ALDURAZYME B N KLOR-CON 25

G P potassium chloride microencapsulated crys cr tab 10 meq

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories B N REVIA MULTIPLE SCLEROSIS AGENTS G P naltrexone hcl tab 50 mg

B P COPAXONE NARCOTICS - MISC.

B P REBIF B P CODEINE PHOSPHATE B P REBIF TITRATION PACK B P CODEINE SULFATE B P AVONEX B 11 N FENTORA B N BETASERON G P fentanyl citrate inj 0.05 mg/ml B N TYSABRI B 11 N ACTIQ

MUSCLE RELAXANT -COMBINATIONS G P hydromorphon tab 2mg G P hydromorphon tab 4mg

B 11 N SOMA COMPOUND G P hydromorphon tab 8mg

G 11 N carisoprodol w/ asa tab 200-325 mg B N DILAUDID-5

B 11 N SOMA COMPOUND/CODEINE G P hydromorphon inj 2mg/ml

G 11 N carisoprodol w/ asa & codeine tab 200-325-16 mg B N DILAUDID-HP

G P orphenadrine w/ aspirin & caffeine tab 25-385-30 mg G P hydromorphon inj 10mg/ml

B P NORGESIC FORTE G P hydromorphon inj 50mg/5ml

G 11 N orphenadrine w/ aspirin & caffeine tab 50-770-60 mg B N DILAUDID G N hydromorphon sup 3mg

MUSCLE RELAXANTS B N DEMEROL TAB 50MG

G P meperidine tab 50mg G P baclofen B N DEMEROL TAB 100MG B P LIORESAL INTRATHECAL G P meperidine tab 100mg B 11 N SOMA G P meperitab G 11 N carisoprodol B P DEMEROL SYP 50MG/5ML B 11 N PARAFON FORTE DSC G N meperidine syp 50mg/5ml G P chlorzoxazone B N DEMEROL INJ 25MG/ML G P Cyclobenzaprine HCl Tab 5 MG B N DEMEROL INJ 100/2ML B 11 N FLEXERIL B N DEMEROL INJ 50MG/ML G P cyclobenzapr tab 10mg B N DEMEROL INJ 75MG/1.5 B 11 N AMRIX CAP 15MG G P meperidine inj 50mg/ml B 11 N AMRIX CAP 30MG B P DEMEROL INJ 75MG/ML B 11 N SKELAXIN B P DEMEROL INJ 100MG/ML B 11 N ROBAXIN G P meperidine inj 100mg/ml B 11 N ROBAXIN-750 G P msir G P methocarbamol B P ROXANOL B 11 N NORFLEX B N ROXANOL-T G P orphenadrine citrate G P morphine sul sol 20mg/ml G 11 N tizanidine hcl tab 2 mg B P MORPHINE SUL TAB 10MG B 11 N ZANAFLEX G P morphine sul tab 15mg G P tizanidine hcl tab 4 mg G P morphine sul tab 30mg B 11 N DANTRIUM B N OXYIR CAP 5MG G 11 N dantrolene sodium G P oxycodone cap 5mg

G P oxycodone hcl tab 5 mg NARCOTIC - ANTAGONISTS G P roxicodone tab 5mg

G P oxycodone hcl tab 15 mg B N NARCAN G P roxicodone tab 15mg G N naloxone hcl inj 0.4 mg/ml G P oxycodone hcl tab 30 mg B N VIVITROL INJ 380MG

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories B N LORTAB 7.5 TAB NARCOTICS - MISC. B N LORTAB 10 TAB - Continued - B P ANEXSIA G P roxicodone tab 30mg B P LORCET PLUS

G P oxycodone con 20mg/ml B N LORCET 10/650

G P oxydose B N MAXIDONE

G P oxyfast B N NORCO

G N roxicodone intensol B N ZYDONE

G P oxycodone sol 5mg/5ml B P XODOL

G P roxicodone sol 5mg/5ml B N HYCET

B N OPANA B N LORTAB ELX

B N DARVON G P hydrocodone-acetaminophen

G P propoxyphene hcl B N REPREXAIN

B N DARVON-N B N VICOPROFEN

B P SUBUTEX G N hydrocodone-ibuprofen

B P SUBOXONE SUB 2-0.5MG B N DARVON COMPOUND-65

B P SUBOXONE SUB 8-2MG G P propoxyphene hcl w/ apap

B P TALWIN NX B N DARVOCET-N 50

G N pentazocine w/ naloxone G P propoxyphene-n w/ apap tab 50-325 mg

B N TYLOX B N TRYCET

G P oxycod/apap cap 5-500mg G N BALACET 325

G P oxycod/apap tab 5-325mg G N propoxyphene-n w/ apap tab 100-325 mg

G P oxycodone w/ acetaminophen tab 5-325 mg B N DARVOCET A500

G N oxycodone w/ acetaminophen tab 7.5-325 mg B N DARVOCET-N 100

G P oxycodone w/ acetaminophen tab 7.5-500 mg G P propoxyphene-n w/ apap tab 100-650 mg

G N oxycodone w/ acetaminophen tab 10-325 mg B P TALACEN

B N PERCOCET G N pentazocine w/ apap

G N oxycodone w/ acetaminophen tab 10-650 mg

B P ROXICET NARCOTICS - SELECTED

B P PERCODAN B N ULTRAM G P oxycodone w/ aspirin G P tramadol hcl tab 50 mg B N COMBUNOX B N ULTRAM ER B N TYLENOL/CODEINE #3 G N tramadol hcl tab sr 24hr B N TYLENOL/CODEINE #4 B N BUPRENEX B N VOPAC B 11 N STADOL NS G P acetaminophen w/ codeine G 11 P butorphanol tartrate nasal soln 10 mg/ml B N CAPITAL/CODEINE G P nalbuphine hcl inj 10 mg/ml G P aspirin w/ codeine B N NUBAIN B N FIORICET/CODEINE G P nalbuphine hcl inj 20 mg/ml G N butalbital-acetaminophen-caffeine w/ codeine B 23 N ULTRACET B P FIORINAL/CODEINE #3

G N butalbital-aspirin-caffeine w/cod NARCOTICS-LONG ACTING B N PANLOR DC

B N PANLOR SS B N DURAGESIC B N SYNALGOS-DC G N fentanyl B N LORCET-HD G P methadone hcl B N LORTAB 2.5 TAB G P morphine sul inj 2mg/ml B N LORTAB 5 TAB B P MORPHINE SUL INJ 4MG/ML B N VICODIN G P morphine sul inj 5mg/ml

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories B N CARDENE NARCOTICS-LONG ACTING G N nicardipine hcl - Continued - B N CARDENE SR

G P morphine sul inj 8mg/ml

G P morphine sul inj 10mg/ml NICOTINE REPLACEMENT THERAPY

G P morphine sul inj 15mg/ml O 31 P nicotine td patch 24hr 7 mg/24hr G P morphine sul inj 25mg/ml O 31 P nicotine td patch 24hr 14 mg/24hr G N morphine sul inj 50mg/ml O 31 P nicotine td patch 24hr 21 mg/24hr B P MORPHINE SUL SOL 10MG/5ML O 32 P nicotine polacrilex gum 2 mg B P MORPHINE SUL SOL 20MG/10 O 32 P nicotine polacrilex gum 4 mg B P MORPHINE SUL SOL 20MG/5ML

G N morphine sul sup 5mg NITRO - OINTMENT/CAP/CR G P morphine sul sup 10mg

B P RMS G P nitroglycerin G P morphine sul sup 20mg B P NITROBID B P KADIAN G N nitroglycerin in d5w B N MS CONTIN TAB 15MG CR

G P morphine sulfate tab sr 12hr 15 mg NITRO - PATCHES B N MS CONTIN TAB 30MG CR

G P morphine sulfate tab sr 12hr 30 mg B N NITRO-DUR DIS 0.1MG/HR

B N MS CONTIN TAB 60MG CR G P nitroglycerin td patch 24hr 0.1 mg/hr

G P morphine sulfate tab sr 12hr 60 mg B N NITRO-DUR DIS 0.2MG/HR

B N MS CONTIN TAB 100MG CR G P nitroglycerin td patch 24hr 0.2 mg/hr

B N ORAMORPH SR B N NITRO-DUR DIS 0.3MG/HR

G P morphine sulfate tab sr 12hr 100 mg B N NITRO-DUR DIS 0.4MG/HR

B N MS CONTIN TAB 200MG CR G P nitroglycerin td patch 24hr 0.4 mg/hr

G P morphine sulfate tab sr 12hr 200 mg B N NITRO-DUR DIS 0.6MG/HR

B N AVINZA G P nitroglycerin td patch 24hr 0.6 mg/hr

B N DEPODUR B P NITRO-DUR DIS 0.8MG/HR B 30 N OXYCONTIN

G 30 P oxycodone hcl er NITRO - SUBLINGUAL/ SPRAY

B N OPANA ER B P NITROSTAT SUB 0.3MG

NEUROLOGICS - MISC. G P nitroglycerin sl tab 0.3 mg B N NITROSTAT SUB 0.4MG

G P ergoloid mesylates tab 1 mg G P nitroglycerin sl tab 0.4 mg

B P ORAP B P NITROSTAT SUB 0.6MG

B P PROSTIGMIN G P nitroglycerin sl tab 0.6 mg

B N MESTINON TAB 60MG B N NITROLINGUAL PUMPSPRAY G P pyridostigmine bromide tab 60 mg

B P MESTINON TIMESPAN NSAIDS

B P MESTINON SYP 60MG/5ML B 11 N VOLTAREN TAB 50MG EC

NEUROMUSCULAR BLOCKING AGENTS G P diclofenac sodium B 11 N VOLTAREN TAB 75MG EC

B N MYOBLOC G P diclofenac sodium dr

B N BOTOX G P diclofenac sodium ec

B 11 N VOLTAREN-XR

NICARDIPINES G 11 N diclofenac sodium er

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories B 11 N DAYPRO NSAIDS G P oxaprozin - Continued - G P piroxicam cap 10 mg G 11 N diclofenac sodium xr B 11 N FELDENE

B 11 N CATAFLAM G P piroxicam cap 20 mg

G 11 N diclofenac potassium B 11 N CLINORIL

G 11 N etodolac cap 200mg G P sulindac

B 11 N LODINE G 11 N tolmetin sodium

G 11 N etodolac cap 300mg B 11 N ARTHROTEC

G P etodolac tab 400mg

G P etodolac tab 500mg OP. ADRENERGIC AGENTS

B 11 N LODINE XL tab 400mg B N PROPINE G 11 N etodolac cr tab 400mg G P dipivefrin hcl ophth soln 0.1% G 11 N etodolac er tab 400mg

B 11 N LODINE XL tab 500mg OP. ANTIALLERGICS - ANTIHISTAMINES G 11 N etodolac cr tab 500mg

G 11 N etodolac er tab 500mg B P OPTIVAR B 11 N LODINE XL tab 600mg B N EMADINE G 11 N etodolac cr tab 600mg B N ELESTAT G 11 N etodolac er tab 600mg B N ZADITOR G P fenoprofen calcium B N LIVOSTIN B 11 N ANSAID B P PATANOL G P flurbiprofen B P PATADAY O P ibuprofen tabs

B 11 N MOTRIN OP. ANTIALLERGICS - MAST CELL STABILIZERS O P ibuprofen susp 100 mg/5ml

G P indomethacin cap 25mg B N CROLOM

G P indomethacin cap 50mg G P cromolyn sodium ophth soln 4%

G 11 N indomethacin cr B N ALOMIDE

G 11 N indomethacin er B N ALOCRIL

B 11 N INDOCIN B P ALAMAST G 11 N indomethacin sup 50mg B 11 N ORUVAIL OP. ANTIBIOTICS G P ketoprofen

B 11 N MECLOFENAMATE SODIUM B N AZASITE

B 11 N PONSTEL G P bacitracin ophth oint 500 unit/gm

B 11 N MEFENAMIC ACID G P erythromycin ophth oint 5 mg/gm

B 11 N NAPROSYN TAB 250MG G P gentamicin sulfate ophth soln 0.3%

B 11 N NAPROSYN TAB 375MG B P GARAMYCIN

B 11 N NAPROSYN TAB 500MG B P GENTAK

B 11 N EC-NAPROSYN G P gentamicin sulfate ophth oint 0.3%

B P NAPROSYN SUS 125/5ML G P tobramycin sulfate ophth soln 0.3%

G P naproxen B N TOBREX

B 11 N ANAPROX B P BLEPH-10

G 11 N naproxen sodium tab 275 mg G P sulfacetamide sodium ophth soln 10%

B 11 N ANAPROX DS B P SULFACETAMIDE SODIUM

G P naproxen sodium tab 550 mg B P VIROPTIC

B 11 N NAPRELAN G N trifluridine ophth soln 1%

G 11 N naproxen sodium tab sr 24hr 500 mg (base equiv) B N POLYSPORIN

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories OP. BETA - BLOCKERS OP. ANTIBIOTICS - Continued - B P BETOPTIC-S G P bacitracin-polymyxin b ophth oint G N betaxolol hcl ophth soln 0.5%

B P TERRAMYCIN W/POLYMYXIN B G P carteolol hcl ophth soln 1%

B P POLYTRIM B N OPTIPRANOLOL

G P polymyxin b-trimethoprim ophth soln 10000 unit/ml-0.1% G P metipranolol ophth soln 0.3%

B N NEOSPORIN G P levobunolol hcl ophth soln 0.25%

G P neomycin-bacitrac zn-polymyx 3.5(5)mg-400unt-10000unt op oin B N BETAGAN

G P neomycin-polymyxin b-gramicidin ophth soln G P levobunolol hcl ophth soln 0.5% B N BETIMOL

OP. ANTIINFLAMMATORY / STEROIDS OPHTH. G P timolol maleate ophth soln 0.25%

B N ISTALOL

B N MAXIDEX B N TIMOPTIC

G N dexamethasone sodium phosphate ophth soln 0.1% G P timolol maleate ophth soln 0.5%

B N FML LIQUIFILM G N timolol maleate ophth gel forming soln 0.25%

G P fluorometholone ophth susp 0.1% B P TIMOPTIC-XE

B P FML FORTE G N timolol maleate ophth gel forming soln 0.5% B P FML S.O.P. B P FLAREX OP. CARBONIC ANHYDRASE INHIBITORS/COMBO B P ALREX

B P LOTEMAX B P COSOPT

B P HMS LIQUIFILM B P AZOPT

B P PRED MILD B P TRUSOPT

B N ECONOPRED PLUS

B N PRED FORTE OP. CYCLOPLEGICS

G P prednisolone acetate ophth susp 1% B N ISOPTO ATROPINE B N INFLAMASE MILD G P atropine sulfate (ophthalmic) B N INFLAMASE FORTE G P cyclopentolate hcl G N prednisolone sodium phosphate ophth soln 1% B N CYCLOGYL B N VEXOL B N ISOPTO HOMATROPINE B N PRED-G B P ISOPTO HYOSCINE B N PRED-G S.O.P. B P MYDRIACYL B N ZYLET G P tropicamide B P FML-S LIQUIFILM B N CYCLOMYDRIL B P BLEPHAMIDE

B N VASOCIDIN OP. MIOTICS - DIRECT ACTING G N sulfacetamide sodium-prednisolone ophth soln 10-0.25%

B N BLEPHAMIDE S.O.P. B P ISOPTO CARBACHOL B P TOBRADEX B N ISOPTO CARPINE G P neomycin-polymyxin-dexamethasone ophth susp 0.1% G P pilocarpine hcl B N MAXITROL B P PILOPINE HS G P neomycin-polymyxin-dexamethasone ophth oint 0.1% B P PHOSPHOLINE IODIDE B P CORTISPORIN SUS OP 1%

G N neomycin-polymyxin-hc ophth susp OP. MISC B N POLY-PRED

B P CORTISPORIN OIN OP 1% O P *artificial tear ophth solution***

G N bacitracin-polymyxin-neomycin-hc ophth oint 1% O P *artificial tear ophth ointment***

G P naphazoline hcl ophth soln 0.1%

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories G N brimonidine tartrate ophth soln 0.2% OP. MISC - Continued - OSTEOPOROSIS G P phenylephrine hcl ophth soln 2.5% B P FOSAMAX G P phenylephrine hcl ophth soln 10% B P FOSAMAX PLUS D B N PHENYLEPHRINE HCL B N DIDRONEL B N RESTASIS B P BONIVA B N ALCAINE B P BONIVA KIT 3MG/3ML B N OPHTHETIC B N AREDIA G P proparacaine hcl ophth soln 0.5% G N pamidronate disodium G P tetracaine hcl ophth soln 0.5% B N ACTONEL B N BSS PLUS B N ACTONEL WITH CALCIUM O P SODIUM CHLORIDE HYPERTONIC OPHTH SOLN 5% B N ZOMETA O P SODIUM CHLORIDE HYPERTONIC OPHTH OINT 5% B N MIACALCIN INJ 200/ML G N fluorescein sodium inj 10% B P MIACALCIN SPR 200/ACT G N fluorescein sodium inj 25% G N FORTICAL

OP. NSAID'S B N FORTEO B N EVISTA

B N XIBROM

B P VOLTAREN SOL 0.1% OP OXYTOCICS

B N OCUFEN B P METHERGINE G P flurbiprofen sodium ophth soln 0.03%

B P ACULAR LS PARKINSONS - ANTICHOLINERGICS B P ACULAR

B N ACULAR PF G P benztropine mesylate B N NEVANAC B P COGENTIN

B P AKINETON OP. PROSTAGLANDINS B P KEMADRIN

G P trihexyphenidyl hcl B P LUMIGAN

B 33 N XALATAN PARKINSONS - COMT INHIBITORS B P TRAVATAN

B P TRAVATAN Z B N TASMAR B N RESCULA B P COMTAN

OP. QUINOLONES PARKINSONS - SELECTED DOPAMIN AGONISTS

G P ciprofloxacin hcl ophth soln 0.3% B P APOKYN B P CILOXAN B P MIRAPEX B P ZYMAR B P REQUIP B P QUIXIN B N NEUPRO DIS 2MG/24HR B P VIGAMOX B N NEUPRO DIS 4MG/24HR B P OCUFLOX B N NEUPRO DIS 6MG/24HR G P ofloxacin ophth soln 0.3%

PERIPHERAL VASODILATORS OP. SELECTIVE ALPHA ADRENERGIC AGONISTS

G P papaverine hcl cap cr 150 mg B N IOPIDINE G P papaverine hcl inj 30 mg/ml B P ALPHAGAN P

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories B 11 P FLOLAN PHOSPHATE BINDERS B 11 P VENTAVIS

B P PHOSLO PULMONARY ANTI-HYPERTENSIVES-ENDOTHELIN RECEPTOR ANTAGONIST B P FOSRENOL B 11 N LETAIRIS TAB 5MG B P RENAGEL TAB 400MG B 11 N LETAIRIS TAB 10MG B 42 N RENAGEL TAB 800MG B 11 P TRACLEER

PHOSPHODIESTERASE INHIBITORS PURINE ANALOG

B N PRIMACOR B N IMURAN

PLATELET AGGR. INHIBITORS / COMBO'S - MISC. G P azathioprine tab 50 mg B P AZASAN

G P cilostazol tab 50 mg

B N PLETAL RHEUMATOID ARTHRITIS - BIOLOGICALS

G P cilostazol tab 100 mg B N KINERET G P anagrelide hcl cap 0.5 mg B P HUMIRA B N AGRYLIN B P HUMIRA PEN G P anagrelide hcl cap 1 mg B P ENBREL SURECLICK B N AGGRENOX B P ENBREL B N TRENTAL B N ORENCIA G P pentoxifylline tab cr 400 mg

RHEUMATOID ARTHRITIS - NON-BIOLOGICALS PLATELET AGGREGATION INHIBITORS

G P leflunomide tab 10 mg B N PERSANTINE B N ARAVA G P dipyridamole G P leflunomide tab 20 mg B P PLAVIX

G N clopidogrel bisulfate RSV PROPHYLAXIS B N TICLID

G P ticlopidine hcl B 11 P SYNAGIS

PRESSORS SEDATIVE/HYPNOTICS - NON-BENZODIAZEPINES

G N ephedrine sulfate (pressors) B 13 P LUNESTA B P PROAMATINE B 11 N SONATA G N midodrine hcl B 11 N AMBIEN

B 11 N ROZEREM PROGESTINS G 13 P ZOLPIDEM

B 13 P AMBIEN CR B N PROVERA

G P medroxyprogesterone acetate SMOKING CESSATION (ORAL) B P AYGESTIN

G N norethindrone acetate G P Bupropion SR 150mg G N progesterone inj 50mg/ml

B N PROMETRIUM SOMATOSTATIC AGENTS

PULMONARY ANTI-HYPERTENSIVES G N octreotide acetate inj 0.05 mg/ml

G N octreotide acetate inj 0.1 mg/ml B 11 P REVATIO

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories G P levothyroxin tab 300mcg SOMATOSTATIC AGENTS G P levoxyl - Continued - G N levothyroxin inj 200mcg

G N octreotide acetate inj 0.2 mg/ml G N levothyroxin inj 500mcg

G N octreotide acetate inj 0.5 mg/ml B P CYTOMEL

B P SANDOSTATIN B P THYROLAR-1/2

G N octreotide acetate inj 1 mg/ml B P THYROLAR-1

B P SANDOSTATIN LAR DEPOT B P THYROLAR-2

B N SOMAVERT B P THYROLAR-3

G P thyroid

TETRACYCLINES B P ARMOUR THYROID

B N DECLOMYCIN TISSUE PLASMINOGEN ACTIVATOR G N demeclocycline hcl

B N MONODOX B P CATHFLO ACTIVASE

G N doxycycline (monohydrate) B P ACTIVASE B N ADOXA

B N ADOXA PAK 1/100 TOPICAL - ACNE PREPARATIONS

B N ADOXA PAK 2/100

B N VIBRAMYCIN SUS 25MG/5ML B 11 P DIFFERIN

B N VIBRAMYCIN CAP 50MG B 11 P AZELEX

B N VIBRAMYCIN CAP 100MG B 11 N BREVOXYL-4 CREAMY WASH

B N PERIOSTAT B 11 N BENZAC AC WASH

G P doxycycline hyclate O P benzoyl peroxide liq 5%

B N DORYX B 11 N BREVOXYL-8 CREAMY WASH

B P VIBRAMYCIN SYP 50MG/5ML O P benzoyl peroxide liq 10%

B N DYNACIN B 11 N NEOBENZ MICRO

G P minocycline hcl B 11 N BENZASHAVE 5

B N MINOCIN G 11 N benzoyl peroxide cream 10%

B N SOLODYN ER B 11 N TRIAZ GEL 3%

G P tetracycline hcl B 11 N BENZIQ

B P SUMYCIN O P benzoyl peroxide gel 5%

B N ORACEA CAP 40MG B 11 N TRIAZ GEL 6% B 11 N BREVOXYL

THYROID HORMONES B 11 P BENZAC AC GEL 10% B 11 P BENZAC W GEL 10%

G P levothyroxin tab 25mcg B 11 P DESQUAM-E GEL 10%

G P levothyroxin tab 50mcg B 11 P DESQUAM-X GEL 10%

G P levothyroxin tab 75mcg O P benzoyl peroxide gel 10%

G P levothyroxin tab 88mcg B 11 N CLINAC BPO

G P levothyroxin tab 100mcg B 11 P TRIAZ GEL 9%

G P levothyroxin tab 112mcg B 11 N BREVOXYL CLEANSING

G P levothyroxin tab 125mcg G 11 P benzoyl peroxide lotion 4%

G P levothyroxin tab 137mcg O P benzoyl peroxide lotion 5%

G P levothyroxin tab 150mcg B 11 N BREVOXYL-8 CLEANSING

G P levothyroxin tab 175mcg G P benzoyl peroxide lotion 8%

G P levothyroxin tab 200mcg B 11 P TRIAZ CLEANSER

G P unithroid O P benzoyl peroxide lotion 10%

B N SYNTHROID B 11 P TRIAZ PAD 3%

G P levothroid B 11 P TRIAZ PAD 6%

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories TOPICAL - ANTIBIOTIC TOPICAL - ACNE PREPARATIONS - Continued - O P bacitracin oint 500 unit/gm B 11 P TRIAZ PAD 9% G P gentamicin sulfate cream 0.1% B 11 N SULFOXYL REGULAR G P gentamicin sulfate oint 0.1% B 11 N SULFOXYL STRONG B P BACTROBAN OIN 2% B 11 P METROCREAM G N mupirocin oint 2% G 11 N metronidazole cream 0.75% B P BACTROBAN CRE 2% B 11 N NORITATE B N ALTABAX B 11 P METROGEL O P *neomycin-bacitracin-polymyxin oint*** B 11 P METROLOTION B N CORTISPORIN CRE 0.5% B 11 P CLEOCIN-T SOL 1% B N CORTISPORIN OIN 1% G 11 P clindamycin phosphate soln 1%

B 11 N EVOCLIN TOPICAL - ANTIFUNGALS B 11 N CLEOCIN-T GEL 1%

B 11 N CLINDAGEL B N MENTAX

G 11 P clindamycin phosphate gel 1% B N PENLAC NAIL LACQUER

B 11 P CLEOCIN-T LOT 1% B N LOPROX SHAMPOO

G 11 N clindamycin phosphate lotion 1% G P ciclopirox olamine cream 0.77% (base equiv)

B 11 P CLEOCIN-T PAD 1% B N LOPROX

G 11 N clindamycin phosphate swab 1% G P ciclopirox olamine lotion 0.77% (base equiv)

G 11 P erythromycin soln 2% B P NAFTIN

B 11 P ERYGEL B N MYCOSTATIN

G 11 P erythromycin gel 2% G P nystatin topical powder

B 11 P AKNE-MYCIN B N NYSTAT-RX

G 11 P erythromycin pads 2% B N NYSTATIN (BULK) POWDER

B 11 N KLARON G P nystatin cream 100000 unit/gm

B 11 N ACZONE GEL G P nystatin oint 100000 unit/gm

B 11 P BENZAMYCINPAK O P tolnaftate soln 1%

B 11 N BENZAMYCIN B P TOLNAFTATE

G 11 N benzoyl peroxide-erythromycin gel 5-3% O P tolnaftate powder 1%

B 11 N ZODERM O P tolnaftate cream 1%

B 11 N BENZACLIN G P clotrimazole soln 1%

B 11 P DUAC G P clotrimazole cream 1%

B N ZIANA B N SPECTAZOLE

B 11 P PLEXION G P econazole nitrate cream 1%

G 11 N sulfacetamide sodium w/ sulfur emulsion 10-5% G P ketoconazole cream 2%

B 11 P PLEXION TS B N XOLEGEL

G 11 N sulfacetamide sodium w/ sulfur susp 10-5% B P NIZORAL SHA 2%

B 11 P PLEXION SCT G N ketoconazole shampoo 2%

G 11 N sulfacetamide sodium w/ sulfur cream 10-5% O P miconazole nitrate cream 2%

B 11 N AVAR B N OXISTAT

B 11 N AVAR GREEN B P ERTACZO

B 11 N SULFACET-R B N EXELDERM

G 11 N sulfacetamide sodium w/ sulfur lotion 10-5% B P LOTRISONE CRE

B 11 N PLEXION CLEANSING CLOTH G P clotrimazole w/ betamethasone cream 1-0.05%

B 11 N ROSULA B N LOTRISONE LOT

B 11 P ROSAC G P clotrimazole w/ betamethasone lotion 1-0.05%

B 11 N FINACEA G P nystatin-triamcinolone cream 100000-0.1 unit/gm-%

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories TOPICAL - BURN PRODUCTS TOPICAL - ANTIFUNGALS - Continued - B N SULFAMYLON B N MYCOLOG-II B N FURACIN

G P nystatin-triamcinolone oint 100000-0.1 unit/gm-% B N SILVADENE

B N VUSION G P silver sulfadiazine cream 1%

TOPICAL - ANTINEOPLASTICS TOPICAL - CAUTERIZING AGENTS

G P fluorouracil soln 2% B P SILVER NITRATE

G P fluorouracil soln 5%

B N CARAC TOPICAL - CORTICOSTEROIDS

B P FLUOROPLEX B N ACLOVATE B P EFUDEX G N alclometasone dipropionate oint 0.05% B P SOLARAZE B N CYCLOCORT CRE 0.1%

TOPICAL - ANTIPRURITICS G P amcinonide cream 0.1% B P CYCLOCORT LOT 0.1%

B P ZONALON B P CYCLOCORT OIN 0.1%

G N doxepin hcl cream 5% G N amcinonide oint 0.1% G P betamethasone dipropionate cream 0.05%

TOPICAL - ANTISEBORRHEICS B P DIPROSONE

G P betamethasone dipropionate lotion 0.05%

B P CAPITROL G P betamethasone dipropionate oint 0.05%

B N SELSUN SHAMPOO B N DIPROLENE AF

G P selenium sulfide lotion 2.5% G P augmented betamethasone dipropionate cream 0.05%

B P OVACE WASH G N augmented betamethasone dipropionate gel 0.05%

G P sulfacetamide sodium liquid 10% B P DIPROLENE

B N OVACE G N augmented betamethasone dipropionate oint 0.05%

B N CARMOL SCALP TREATMENT G P betamethasone valerate cream 0.1%

B N SELSEB B N LUXIQ

G P betamethasone valerate lotion 0.1% TOPICAL - ANTISEPTICS / DISINFECTANTS G P betamethasone valerate oint 0.1%

B N TEMOVATE B N LAZERFORMALYDE SOLUTION G P clobetasol propionate soln 0.05% B N FORMALYDE-10 G P clobetasol propionate cream 0.05% B P PHISOHEX B N OLUX B N OPERAND POVIDONE/IODINE G P clobetasol propionate gel 0.05%

G P clobetasol propionate oint 0.05% TOPICAL - ANTIVIRALS B N CLOBEX

B N ZOVIRAX CRE 5% G P clobetasol propionate emollient base cream 0.05%

B P ZOVIRAX OIN 5% B N CLODERM

B N DENAVIR B P DESOWEN CRE 0.05% B P TRIDESILON TOPICAL - ASTRINGENTS / PROTECTANTS G P desonide cream 0.05% B N VERDESO FOAM

B P DRYSOL B N DESONATE

B P XERAC AC B N DESOWEN LOT 0.05%

G P desonide lotion 0.05%

B P DESOWEN OIN 0.05%

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories G N hydrocortisone valerate oint 0.2% TOPICAL - CORTICOSTEROIDS B N PANDEL - Continued - G N hydrocortisone butyrate soln 0.1% G P desonide oint 0.05% B N LOCOID

B P DESOXIMETASONE G N hydrocortisone butyrate oint 0.1%

G P desoximetasone cream 0.25% B N LOCOID LIPOCREAM

G P desoximetasone gel 0.05% B P ELOCON LOT 0.1%

B N TOPICORT G N mometasone furoate cream 0.1%

G P desoximetasone oint 0.25% B P ELOCON CRE 0.1%

G P diflorasone diacetate cream 0.05% G N mometasone furoate lotion 0.1%

G N diflorasone diacetate oint 0.05% G P mometasone furoate oint 0.1%

G P diflorasone diacetate emollient base cream 0.05% B N ELOCON OIN 0.1%

B P DERMA-SMOOTHE/FS B N DERMATOP

B P SYNALAR G P triamcinolone acetonide cream 0.025%

G P fluocinolone acetonide soln 0.01% G P triamcinolone acetonide cream 0.1%

G P fluocinolone acetonide cream 0.01% B N ARISTOCORT A

G P fluocinolone acetonide cream 0.025% G P triamcinolone acetonide cream 0.5%

G P fluocinolone acetonide oint 0.025% G P triamcinolone acetonide lotion 0.025%

B P CAPEX B N KENALOG

G P fluocinonide soln 0.05% G P triamcinolone acetonide lotion 0.1%

G P fluocinonide cream 0.05% G P triamcinolone acetonide oint 0.025%

B N VANOS G P triamcinolone acetonide oint 0.1%

G P fluocinonide gel 0.05% G P triamcinolone acetonide oint 0.5%

B N LIDEX

G P fluocinonide oint 0.05% TOPICAL - DEPIGMENTING AGENTS

B N LIDEX-E G N hydroquinone cream 4% G P fluocinonide emulsified base cream 0.05%

B N CORDRAN SP TOPICAL - EMOLLIENTS B N CORDRAN

B N CORDRAN TAPE G N lactic acid (ammonium lactate) cream 12% G P fluticasone propionate cream 0.05% B N LACTINOL B N CUTIVATE B N LAC-HYDRIN G N fluticasone propionate oint 0.005% O P lactic acid (ammonium lactate) lotion 12% B P HALOG B N LACTINOL-E B P ULTRAVATE CRE 0.05% G P lactic acid w/ vitamin e cream 10%-3500 unit/30gm G N halobetasol propionate cream 0.05% B N UMECTA B N ULTRAVATE OIN 0.05% B N VANAMIDE G P halobetasol propionate oint 0.05% G N U-KERA E CRE 40% B N TEXACORT G N urea gel 40% B N PROCTOCORT G N urea gel 50% G P hydrocortisone cream 1% B N KERALAC G P hydrocortisone cream 2.5% G P urea lotion 35% G P hydrocortisone lotion 1% B N CARMOL 40 B N HYTONE G P urea lotion 40% G P hydrocortisone lotion 2.5%

G P hydrocortisone oint 1% TOPICAL - ENZYMES / KERATOLYTICS / UREA G N hydrocortisone oint 2.5%

G P hydrocortisone valerate cream 0.2% B N SANTYL

B N WESTCORT G P trypsin w/ castor oil & peruvian balsam spray

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories B P EMLA TOPICAL - ENZYMES / KERATOLYTICS / UREA G N lidocaine-prilocaine cream 2.5-2.5% - Continued - B P EMLA/TEGADERM B P ACCUZYME SE EMU

B P PANAFIL SE EMU TOPICAL - NASAL ANTIBIOTICS

B P PANAFIL B P BACTROBAN NASAL G P *papain-urea-chlorophyllin ointment***

G P podophyllum resin soln 25% TOPICAL - SCABICIDES AND PEDICULICIDES O P salicylic acid liquid 17%

B P SALEX B P EURAX

B N LINDANE TOPICAL - GENITAL WARTS G N lindane shampoo 1%

B N OVIDE G N podofilox soln 0.5% O P permethrin creme rinse 1% B N CONDYLOX B P ELIMITE B 37 P ALDARA G P permethrin cream 5%

TOPICAL - IMMUNOMODULATORS O P pyrethrins-piperonyl butoxide liq 0.33-4% O P pyrethrins-piperonyl butoxide shampoo 0.3-3%

B P ELIDEL O P pyrethrins-piperonyl butoxide shampoo 0.33-4%

B P PROTOPIC TOPICAL - STEROID COMBINATIONS TOPICAL - LOCAL ANESTHETICS B N TACLONEX

B P MARCAINE B N CARMOL-HC

B P MARCAINE W/O EPI G N urea-hc acetate cream 1%

G N bupivacaine 0.75% in dextrose inj 8.25%

B P XYLOCAINE INJ -MPF 1% TOPICAL - STEROID LOCAL ANESTHETICS

B P XYLOCAINE INJ 1% G N lidocaine-hydrocortisone acetate rectal cream 3-0.5% G P lidocaine hcl local inj 1% B N LIDAMANTLE CRE HC3-0.5% B P XYLOCAINE INJ 2% G P lidocaine-hydrocortisone acetate cream 3-0.5% G P lidocaine hcl local inj 2% B N LIDAMANTLE LOT HC3-0.5% G N lidocaine hcl local inj 4% B N EPIFOAM B N CARBOCAINE

B N PONTOCAINE TOPICAL - TRETINOIDS G P lidocaine inj 1% w/ epinephrine-1:100000

G P lidocaine inj 1.5% w/ epinephrine-1:200000 G 11 N tretinoin cream 0.025% G P lidocaine inj 2% w/ epinephrine-1:100000 G 11 N tretinoin cream 0.05% B N AMERICAINE G 11 N tretinoin cream 0.1% B N COCAINE HCL G 11 N tretinoin gel 0.01% B N LIDODERM B 11 P RETIN-A B N SYNERA G 11 N tretinoin gel 0.025% B P XYLOCAINE SOL 4% B 11 N RETIN-A MICRO G P lidocaine hcl soln 4%

G P lidocaine hcl cream 3% TOPICAL - WOUND / DECUBITUS CARE B P XYLOCAINE GEL 2%

G P lidocaine hcl gel 2% B P ETHEZYME

B N LIDAMANTLE B P ACCUZYME

G P lidocaine hcl oint 5% G P papain-urea ointment 0.83 mmu-100 mg/gm (usp ref std f-3)

B N ANESTHETIC SKIN REFRIGERA B N RADIAPLEXRX

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories G P phenazopyridine hcl TOPICAL - WOUND / DECUBITUS CARE B N CYSTAGON - Continued - B N ELMIRON

G N *wound dressings - gel*** B N LITHOSTAT

B 11 N REGRANEX B N THIOLA

B N REGENECARE WOUND B P RENACIDIN

G P acetic acid

UREA CYCLE DISORDER - AGENTS G P sodium chloride (gu irrigant)

B P NEOSPORIN GU IRRIGANT B P AMMONUL

B N BUPHENYL VAGINAL - ANTI FUNGALS

UROLOGICAL - MISC. G P clindamycin phosphate vaginal cream 2%

B P CLINDESSE B P MONUROL B P NYSTATIN VAGINAL TAB 100000 UNIT B N MANDELAMINE B N AVC G P methenamine mandelate B N GYNAZOLE-1 B N HIPREX O P miconazole nitrate vaginal cream 2% B P UREX O P miconazole nitrate vaginal suppos 100 mg G N methenamine hippurate B N MONISTAT 3 B N NEGGRAM G N miconazole nitrate vaginal suppos 200 mg B P FURADANTIN B N MONISTAT 7 COMBINATION PA B P MACRODANTIN G N miconazole nitrate vaginal supp 200 mg & 2% cream 9 gm kit B N NITROFURANTOIN MACROCRYST B N MONISTAT DUAL-PAK G N nitrofurantoin macrocrystal B N TERAZOL 7 B N MACROBID G N terconazole vaginal cream 0.4% G N nitrofurantoin monohyd macro B N TERAZOL 3 W/APPLICATOR B P UROQID #2 B N ZAZOLE B P URISED G N terconazole vaginal cream 0.8% G P meth-bell-meth bl-phenyl sal B N TERAZOL 3 B N URIMAX

G N methenamine-hyosc-methylene blue-sod biphos-phenyl sal VAGINAL - ANTIBACTERIALS B P PROSED/DS

G N methenamine-methylene blue-benz acd-phenyl sal-atrop-hyosc B P CLEOCIN VAG CRE 2%

B P PROSED EC B P CLEOCIN SUP 100MG

B N PYRIDIUM PLUS B N METROGEL VAGINAL

G P phenazopyridine-butabarbital-hyoscyamine G N VANDAZOLE GEL 0.75%

B P K-PHOS NO 2 G P Metronidazole Vaginal Gel 0.75% B P UROCIT-K 5

B P UROCIT-K 10 VAGINAL - ESTROGENS

B P BICITRA

G N sodium citrate & citric acid B N VAGIFEM

B P POLYCITRA-K B N ESTRACE

G P cytra-k B N ESTRING

B P POLYCITRA-K CRYSTALS B N FEMRING

G N cytra k crystals B P PREMARIN

B P POLYCITRA B P PREMARIN W/APPLICATOR

G P pot & sod citrates w/citric ac VAGINAL - OTHER B P POLYCITRA-LC

B N PYRIDIUM

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories B 11 N CEFOL VAGINAL - OTHER G 11 N *b-complex w/ c & folic acid tab*** - Continued - B 11 N NEPHRO-VITE RX G P amino acid-urea cervical cream G 11 P *b-complex w/ c & folic acid tab 1 mg***

G P acetic acid vaginal gel B 11 N DIATX

B N RELAGARD G 11 N *b-complex w/ c & folic acid tab 5 mg***

G N acetic acid-oxyquinoline vaginal gel 0.9-0.025% G 11 N *b-complex w/ c-min-fe & folic acid tab 106-1 mg*** B 11 P DIALYVITE/ZINC

VASOPRESSINS B 11 P NEPHPLEX RX

B 11 P M.V.I. -12 B 11 P DDAVP TAB 0.1MG G 11 N *multiple vitamin inj** B 11 P DDAVP TAB 0.2MG G 11 P *multiple vitamins w/ minerals cap** B 11 P STIMATE G 11 P *multiple vitamins w/ minerals tab** B 11 N DDAVP INJ 4MCG/ML B 11 N RENAX G 11 N desmopressin acetate inj 4 mcg/ml G 11 P *pediatric vitamins acd w/ fluoride chew tab 1 mg*** B 11 P DDAVP SOL 0.01% B 11 N TRI-VI-FLOR G 11 N desmopressin acetate nasal soln 0.01% (refrigerated) G 11 P *pediatric vitamins acd w/ fluoride soln 0.25 mg/ml*** G 11 N desmopressin acetate nasal spray soln 0.01% (refrigerated) G 11 P *pediatric vitamins acd w/ fluoride soln 0.5 mg/ml*** G 11 N minirin B 11 N POLY-VI-FLOR CHW 0.25MG B 11 P DDAVP SPR 0.01% G 11 P *pediatric multiple vitamins w/ fluoride chew tab 0.25 mg*** G 11 N desmopressin acetate nasal spray soln 0.01% B 11 P POLY-VI-FLOR CHW 0.5MG G 11 N vasopressin inj 20 unit/ml G 11 P *pediatric multiple vitamins w/ fluoride chew tab 0.5 mg***

B 11 N POLY-VI-FLOR CHW 1MG VITAMINS G 11 P *pediatric multiple vitamins w/ fluoride chew tab 1 mg***

B 11 N POLY-VI-FLOR DRO 0.25MG G 11 P thiamine hcl G 11 P *pediatric multiple vitamins w/ fluoride soln 0.25 mg/ml*** O P niacin tab 50 mg G 11 P *pediatric multiple vitamins w/ fluoride soln 0.5 mg/ml*** O P niacin tab 100 mg G 11 P *pediatric multiple vitamins w/ fl-fe chew tab 0.5-12 mg** O P niacin tab 250 mg G 11 P *pediatric multiple vitamins w/ fl-fe chew tab 1-12 mg** O P niacin tab 500 mg B 11 N POLY-VI-FLOR/IRON G 11 P pyridoxine hcl G 11 P *pediatric multiple vitamins w/ fl-fe drops 0.25-10 mg/ml** B 11 N DRISDOL G 11 P *pediatric multiple vitamins w/ fl-fe drops 0.5-10 mg/ml** G 11 N ergocalciferol B 11 N TRI-VI-FLOR/IRON B 11 N CALCIJEX G 11 P *pediatric vitamins acd fluoride & fe drops 0.25-10 mg/ml*** B 11 P ROCALTROL B 11 N NESTABS RX G 11 N calcitriol G 11 N *prenatal vit w/ iron carbonyl-fa tab 29-1 mg*** B 11 N DHT B 11 N NESTABS CBF B 11 N DHT INTENSOL B 11 N ATABEX PRENATAL B 11 P MEPHYTON B 11 N NOVASTART B 11 P AQUA-MEPHYTON G 11 N *prenatal vit w/ fe fumarate-fa tab 17-1 mg*** G 11 P phytonadione G P *prenatal vit w/ fe fumarate-fa tab 27-0.5 mg*** G 11 P cyanocobalamin inj 1000 mcg/ml G P *prenatal vit w/ fe fumarate-fa tab 27-1 mg*** B 11 N CYANOCOBALAMIN CRYSTALS B 11 N STUARTNATAL PLUS 3 B 11 N NASCOBAL G 11 N *prenatal vit w/ fe fumarate-fa tab 28-1 mg*** G P folic acid B 11 N NESTABS FA

G 11 N *prenatal vit w/ fe fumarate-fa tab 29-1 mg*** VITAMINS - MISC. G 11 N *prenatal vit w/ fe fumarate-fa tab 60-1 mg***

B 11 N NEPHROCAPS B 11 N LACTOCAL-F

G 11 N *b-complex w/ c & folic acid cap 1 mg*** G P *prenatal vit w/ fe fumarate-fa tab 65-1 mg***

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR PDL Categories G 11 P fe fumarate w/ b12-vit c-fa-ifc cap 110-0.015-75-0.5-240 mg VITAMINS - MISC. B 11 N CHROMAGEN FORTE - Continued - B 11 N NIFEREX-150 FORTE B 11 N NATACHEW

G P *prenatal vit w/ fe fumarate-fa chew tab 29-1 mg*** WEIGHT LOSS

G 11 N *prenatal vit w/ fe polysac cmplx-fa tab 60-1 mg*** B 11 P XENICAL G 11 N *prenatal vit w/ iron carbonyl-fe sulf-fa tab 60-1 mg***

B 11 N CITRACAL PRENATAL RX

G P *prenatal vit w/ iron carbonyl-fe gluc-fa tab 27-1 mg***

B 11 N NATELLE

B P DUET TAB

B 11 N VINATE II

B 11 N DUET CHW

B 11 N PRECARE PRENATAL

B 11 N PRECARE

B 11 N NOVANATAL

B 11 N PRECARE TAB PREMIER

G 11 N *prenatal without a w/ fe carbonyl-docusate-fa tab 90-1mg***

B 11 N PRENATE ELITE

B 11 N PRECARE CONCEIVE

B 11 N ANEMAGEN OB

G P *prenatal vit w/ sel-fe fumarate-fa tab 27-1 mg***

G 11 N *prenatal vit w/ dss-iron carbonyl-fa tab 29-1 mg***

G P *prenatal vit w/ dss-iron carbonyl-fa tab 90-1 mg***

G 11 N *prenatal vit w/ dss-fe fumarate-fa tab 29-1 mg***

G P *prenatal vit w/ dss-fe fumarate-fa tab cr 90-1 mg***

B 11 N EMBREX 600

G P *prenatal mv-min w/fe-fa tab & ca chew tab therapy pack***

B 11 N CITRACAL PRENATAL + DHA

B 11 N OPTINATE

G 11 P *iron w/ vitamin tab**

B 11 N IBERET-FOLIC-500

G 11 N *iron w/ vitamin tab cr**

B 11 P FOLGARD RX 2.2

G 11 N folic acid-vitamin b6-vitamin b12 tab 2.2-25-0.5 mg

G 11 N folic acid-vitamin b6-vitamin b12 tab 2.5-25-1 mg

G 11 N folic acid-vitamin b6-vitamin b12 tab 2.5-25-2 mg

B 11 P MYO VYT

G 11 N *iron combination cap***

G 11 P iron polysacch complex-vit b12-fa cap 150-0.025-1 mg

B 11 N FERO-FOLIC-500

G 11 P ferrous sulfate-vit c-folic acid tab cr 105-500-0.8 mg

B 11 N ICAR-C PLUS

B 11 N CHROMAGEN FA

G 11 N fe fumarate-vit c-vit b12-fa cap 200-250-0.01-1 mg

G 11 N fe fumarate-vit c-vit b12-fa cap 460-60-0.01-1 mg

B 11 N CHROMAGEN

B 11 N NEPHRON FA

B 11 N TRINSICON

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR Mental Health Categories PDL/RDL B N WELLBUTRIN TAB 75MG ANTIDEPRESSANTS - MAO INHIBITORS G P bupropion hcl tab 75 mg B N WELLBUTRIN TAB 100MG

B R NARDIL G P bupropion hcl tab 100 mg

B NR EMSAM B P WELLBUTRIN TAB 100MG SR

B R PARNATE G P BUPROPION TAB 100MG ER G N bupropion hcl tab sr 12hr 100 mg

ANTIDEPRESSANTS - SELECTED SSRI'S B P WELLBUTRIN TAB 150MG SR

G N BUPROPION TAB 150MG ER B P REMERON G P bupropion hcl tab sr 12hr 150 mg B P REMERON SOLTAB B P WELLBUTRIN TAB 200MG SR G P mirtazapine G P bupropion hcl tab sr 12hr 200 mg G P nefazodone hcl B R WELLBUTRIN XL G P trazodone hcl tab 50 mg B P EFFEXOR G P trazodone hcl tab 100 mg B NR EFFEXOR XR G P trazodone hcl tab 150 mg

B N DESYREL ANTIDEPRESSANTS - TRI-CYCLICS G N trazodone hcl tab 300 mg

B N CELEXA G P amitriptyline hcl tab 10 mg

G P citalopram hydrobromide G P amitriptyline hcl tab 25 mg

G N citalopram ODT G P amitriptyline hcl tab 50 mg

B R LEXAPRO B N ELAVIL

B N PROZAC CAP 10MG G P amitriptyline hcl tab 75 mg

B N PROZAC TAB 20MG G P amitriptyline hcl tab 100 mg

G P fluoxetine hcl cap 10 mg G P amitriptyline hcl tab 150 mg

B N PROZAC CAP 20MG B R AMOXAPINE

B N SARAFEM B N ANAFRANIL

G P fluoxetine hcl cap 20 mg G P clomipramine hcl

B 21 N PROZAC CAP 40MG B N NORPRAMIN

G 21 N fluoxetine hcl cap 40 mg G P desipramine hcl

B N PROZAC TAB 10MG B N SINEQUAN

G P fluoxetine hcl tab 10 mg G P doxepin hcl

B N RAPIFLUX B N TOFRANIL

G 6 N fluoxetine hcl tab 20 mg G P imipramine hcl

B N PROZAC LIQ 20MG/5ML B NR TOFRANIL-PM

G P fluoxetine liq 20mg/5ml B N AVENTYL

G P fluoxetine sol 20mg/5ml B N PAMELOR

B N PROZAC WEEKLY G P nortriptyline hcl

G P fluvoxamine maleate B R VIVACTIL

B N PAXIL B R SURMONTIL

G P paroxetine hcl

B R PAXIL SUS 10MG/5ML ANTIPSYCHOTICS - ATYPICALS

B R PAXIL CR B NR INVEGA B NR PEXEVA B R RISPERDAL B N ZOLOFT B NR RISPERDAL M-TAB G P sertraline B NR RISPERDAL CONSTA B NR CYMBALTA B NR SEROQUEL G N venlafaxine hcl B 43 NR SEROQUEL XR TAB 200MG G R maprotiline hcl B 43 NR SEROQUEL XR TAB 300MG

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

Mental Health Categories PDL/RDL G P fluphenazine hcl elixir 2.5 mg/5ml ANTIPSYCHOTICS - ATYPICALS B N PROLIXIN - Continued - G P fluphenazine hcl oral conc 5 mg/ml

B 43 NR SEROQUEL XR TAB 400MG B R FLUPHENAZINE HCL

B NR ZYPREXA B N PROLIXIN DECANOATE

B NR ZYPREXA ZYDIS G P fluphenazine decanoate inj 25 mg/ml

B NR ABILIFY G P perphenazine tab 2 mg

B NR ABILIFY DISCMELT G P perphenazine tab 4 mg

B R GEODON G P perphenazine tab 8 mg

G P perphenazine tab 16 mg

ANTIPSYCHOTICS - SPECIAL ATYPICALS G P thioridazine hcl tab 10 mg

G P thioridazine hcl tab 25 mg B N CLOZARIL G P thioridazine hcl tab 50 mg G P Clozapine G P thioridazine hcl tab 100 mg B P FAZACLO B P THIORIDAZINE HCL

G P trifluoperazine hcl tab 1 mg ANTIPSYCHOTICS - TYPICAL G P trifluoperazine hcl tab 2 mg

G P trifluoperazine hcl tab 5 mg G P haloperidol tab 0.5 mg G P trifluoperazine hcl tab 10 mg G P haloperidol tab 1 mg G P thiothixene cap 1 mg G P haloperidol tab 2 mg G P thiothixene cap 2 mg G P haloperidol tab 5 mg G P thiothixene cap 5 mg G P haloperidol tab 10 mg G P thiothixene cap 10 mg B P HALOPERIDOL B N NAVANE G P haloperidol lactate oral conc 2 mg/ml

B P HALDOL ANXIOLYTICS - BENZODIAZEPINES B P HALOPERIDOL LACTATE

G P haloperidol lactate inj 5 mg/ml B 11 N XANAX B N HALDOL DECANOATE-50 G P alprazolam G P haloperidol decanoate im soln 50 mg/ml B R ALPRAZOLAM INTENSOL B N HALDOL DECANOATE-100 B 11 N NIRAVAM G P haloperidol decanoate im soln 100 mg/ml B 11 N LIBRIUM G P loxapine succinate cap 5 mg G P chlordiazepoxide hcl G P loxapine succinate cap 10 mg B P TRANXENE T TAB 3.75MG G P loxapine succinate cap 25 mg G P cloraz dipot tab 3.75mg B N LOXITANE B 11 N TRANXENE T TAB 7.5MG G P loxapine succinate cap 50 mg G P cloraz dipot tab 7.5mg B NR MOBAN B 11 N TRANXENE T TAB 15MG G P chlorpromazine hcl tab 10 mg G P cloraz dipot tab 15mg G P chlorpromazine hcl tab 25 mg B 11 N TRANXENE-SD G P chlorpromazine hcl tab 50 mg G P diazepam tab 2mg G P chlorpromazine hcl tab 100 mg G P diazepam tab 5mg B N THORAZINE G P diazepam tab 10mg G P chlorpromazine hcl tab 200 mg B R DIAZEPAM INTENSOL G P chlorpromazine hcl conc 100 mg/ml B R DIAZEPAM SOL 1MG/ML G P chlorpromazine hcl inj 25 mg/ml B 11 N VALIUM G P fluphenazine hcl tab 1 mg G P diazepam inj 5mg/ml G P fluphenazine hcl tab 2.5 mg G P lorazepam tab 0.5mg G P fluphenazine hcl tab 5 mg G P lorazepam tab 1mg G P fluphenazine hcl tab 10 mg

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR Mental Health Categories PDL/RDL B N LIMBITROL ANXIOLYTICS - BENZODIAZEPINES G P chlordiazepoxide-amitriptyline tab 5-12.5 mg - Continued - B N LIMBITROL DS G P lorazepam tab 2mg G P chlordiazepoxide-amitriptyline tab 10-25 mg

B P LORAZEPAM CON 2MG/ML G P perphenazine-amitriptyline tab 2-25 mg

G P lorazepam inj 2mg/ml G P perphenazine-amitriptyline tab 4-10 mg

B 11 N ATIVAN G P perphenazine-amitriptyline tab 4-25 mg

G P lorazepam inj 4mg/ml B R PERPHENAZINE/AMITRIPTYLIN

B 11 N SERAX B NR SYMBYAX

G P oxazepam

G NR flumazenil SEDATIVE/HYPNOTICS - BARBITURATE

ANXIOLYTICS - LONG ACTING B R BUTISOL SODIUM B R MEBARAL

G 11 N ALPRAZOLAM TAB 0.5MG ER G P phenobarbital

G 11 N ALPRAZOLAM TAB 1MG ER B NR PHENOBARBITAL SODIUM

G 11 N ALPRAZOLAM TAB 2MG ER B NR LUMINAL

B 11 N XANAX XR B NR SECONAL

G 11 N ALPRAZOLAM TAB 3MG ER B NR SOMNOTE G P chloral hydrate syrup 500 mg/5ml

ANXIOLYTICS - MISC. B NR CHLORAL HYDRATE CRYSTALS

G P buspirone hcl tab 5 mg SEDATIVE/HYPNOTICS - BENZODIAZEPINES B N VANSPAR

G P buspirone hcl tab 7.5 mg G P estazolam

G P buspirone hcl tab 10 mg B N DALMANE

G P buspirone hcl tab 15 mg G P flurazepam hcl

B 3 N BUSPAR G P midazolam syp 2mg/ml

G 3 N buspirone hcl tab 30 mg B N VERSED

B N INAPSINE G P midazolam inj 1mg/ml

G P droperidol inj 2.5 mg/ml G P midazolam inj 2mg/2ml

G P meprobamate tab 200 mg B R DORAL

B N MILTOWN B R RESTORIL CAP 7.5MG

G P meprobamate tab 400 mg B N RESTORIL CAP 15MG B NR RESTORIL CAP 22.5MG

LITHIUM B N RESTORIL CAP 30MG

G P temazepam G P lithium carbonate cap 150 mg B N HALCION B P ESKALITH G P triazolam G P lithium carbonate cap 300 mg

G N lithium carbonate cap 600 mg STIMULANTS - AMPHETAMINES - LONG ACTING B P LITHIUM CARBONATE

B P LITHOBID B 24 P DEXEDRINE CAP 5MG CR

G P lithium carbonate tab cr 300 mg B 24 P DEXEDRINE CAP 10MG

B P ESKALITH CR B 24 P DEXEDRINE CAP 10MG CR

G P lithium carbonate tab cr 450 mg B 24 P DEXEDRINE CAP 15MG CR

G P lithium citrate syrup 8 meq/5ml G 24 N dextroamphetamine sulfate B 39 R VYVANSE CAP 30MG

PSYCHOTHERAPEUTIC COMBINATION B 39 R VYVANSE CAP 50MG

B 39 R VYVANSE CAP 70MG

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR Mental Health Categories PDL/RDL STIMULANTS - AMPHETAMINES - LONG ACTING - Continued - B 24 R ADDERALL XR

STIMULANTS - AMPHETAMINES - SHORT ACTING

G 24 N dextroamphetamine sulfate tab 5 mg

B 24 P DEXTROSTAT

B 24 N DEXTROSTAT TAB 10MG

G 24 P dextroamphetamine sulfate tab 10 mg

B 24 N ADDERALL

G 24 P amphetamine-dextroamphetamine

STIMULANTS - METHYLPHENIDATE

B 24 R FOCALIN

G 24 P methylphenidate hcl tab 5 mg

G 24 P methylphenidate hcl tab 10 mg

B 24 N RITALIN

G 24 P methylphenidate hcl tab 20 mg

STIMULANTS - METHYLPHENIDATE - LONG ACTING

B 24 R FOCALIN XR

B 24 R DAYTRANA

B 24 NR METADATE CD

B 24 N METADATE ER

G 24 P methylphenidate hcl tab cr

B 24 N RITALIN SR

B 24 R CONCERTA

B 24 NR RITALIN LA

STIMULANTS - OTHER STIMULANTS / LIKE STIMULANTS

G 24 R methamphetamine hcl

B NR DOPRAM

B 24 NR STRATTERA

B 24 NR PROVIGIL

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR Other RDL Categories B NR BLENOXANE ANTIHEMOPHILIC AGENTS G R bleomycin sulfate for inj 15 unit B NR ADRIAMYCIN PFS

B R HEMOFIL M HUMAN G R doxorubicin hcl inj 2 mg/ml

B R MONARC-M B R DOXIL

B R KOATE-DVI

B R ALPHANATE ANTINEOPLASTICS - ANTIESTROGENS

B R MONOCLATE-P B NR NOLVADEX B R BIOCLATE G R tamoxifen citrate G NR kogenate B R FARESTON B R RECOMBINATE

B NR KOGENATE FS INJ 250UNIT ANTINEOPLASTICS - ANTIMETABOLITES B NR KOGENATE FS INJ 500UNIT

B R HELIXATE FS B R VIDAZA B R REFACTO B R XELODA B NR KOGENATE FS INJ 1000UNIT B R CYTOSAR-U B NR KOGENATE FS INJ 2000UNIT G NR cytarabine for inj 100 mg B NR ADVATE G NR cytarabine for inj 500 mg B R HUMATE-P B NR DEPOCYT B NR AUTOPLEX T B NR FLUOROURACIL B NR FEIBA VH IMMUNO G R fluorouracil inj 50 mg/ml G R antiinhibitor coagulant complex for inj B R GEMZAR B R NOVOSEVEN B R ARRANON B R ALPHANINE SD B R PURINETHOL B R MONONINE G NR mercaptopurine tab 50 mg B R BENEFIX G R methotrexate sodium tab 2.5 mg (base equiv) B R BEBULIN VH B R TREXALL B R PROPLEX T FACTOR IX COMP G R methotrexate sodium inj 25 mg/ml B R PROFILNINE SD B R ALIMTA

B R THIOGUANINE ANTINEOPLASTICS - ALKYLATING AGENTS B R AVASTIN

B R ERBITUX B R MYLERAN B R HERCEPTIN B R BUSULFEX B R BEXXAR B NR PLATINOL AQ B R BEXXAR 131 IODINE G R cisplatin inj 1 mg/ml

ANTINEOPLASTICS - AROMATASE INHIBITORS ANTINEOPLASTICS - ANTIADRENALS

B R ARIMIDEX B R LYSODREN B R AROMASIN

ANTINEOPLASTICS - ANTIANDROGENS B R FEMARA

B R CASODEX ANTINEOPLASTICS - CARDIAC PROTECTIVE AGENTS

B R EULEXIN B R ZINECARD G NR flutamide cap 125 mg

B R NILANDRON ANTINEOPLASTICS - COMBINATIONS

ANTINEOPLASTICS - ANTIBIOTICS B NR IFEX/MESNEX COMBO PACK

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR Other RDL Categories B R TAXOL ANTINEOPLASTICS - COMBINATIONS G NR paclitaxel iv conc 6 mg/ml - Continued - B NR ABRAXANE G R ifosfamide & mesna inj kit 1000-1000 mg G R vincristine sulfate iv soln 1 mg/ml B R VINBLASTINE SULFATE

ANTINEOPLASTICS - ESTROGEN RECEPTOR ANTAGONIST B R NAVELBINE

B R FASLODEX ANTINEOPLASTICS - NITROGEN MUSTARDS

ANTINEOPLASTICS - ESTROGENS B R LEUKERAN

G NR cyclophosphamide B R EMCYT B R CYTOXAN

B R ALKERAN ANTINEOPLASTICS - FOLIC ACID ANTAGONISTS RESCUE AGENTS ANTINEOPLASTICS - NITROSOUREAS G R leucovorin calcium

B R GLIADEL ANTINEOPLASTICS - IMIDAZOTETRAZINES B R GLIADEL WAFER

B R CEENU B R TEMODAR

ANTINEOPLASTICS - PROGESTINS ANTINEOPLASTICS - INTERLEUKINS

B R DEPO-PROVERA B R PROLEUKIN G R megestrol acetate

B R MEGACE ORAL ANTINEOPLASTICS - LHRH ANALOGS G NR megestrol acetate susp 40 mg/ml

B R TESLAC B R MEGACE ES

B R ZOLADEX

B R LUPRON DEPOT-PED ANTINEOPLASTICS - PROTEIN-TYROSINE KINASE INHIBITORS

B R LUPRON DEPOT B NR ZOLINZA B R TRELSTAR DEPOT B NR NEXAVAR B R TRELSTAR LA B R SUTENT

B NR SPRYCEL ANTINEOPLASTICS - MISC. B R TARCEVA

B NR HYDREA B R IRESSA

G R hydroxyurea cap 500 mg B R GLEEVEC

B R MATULANE B NR TYKERB

B NR ROFERON-A B R VELCADE

B NR INTRON-A W/DILUENT

B NR INTRON-A ANTINEOPLASTICS - RETINOIDS

B NR ACTIMMUNE B R VESANOID B NR DROXIA

B NR REVLIMID ANTINEOPLASTICS - SELECTIVE RETINOID X RECEPTOR AGONISTS ANTINEOPLASTICS - MITOTIC INHIBITORS B R TARGRETIN

B R TAXOTERE ANTINEOPLASTICS - TOPOISOMERASE I INHIBITORS B R VEPESID

G NR etoposide B R CAMPTOSAR

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR Other RDL Categories ANTIRETROVIRALS - RTI-NUCLEOSIDE ANTINEOPLASTICS - TOPOISOMERASE I INHIBITORS ANALOGUES-PYRIMIDINES - Continued - B R EMTRIVA B R HYCAMTIN B R EPIVIR HBV

B R EPIVIR ANTINEOPLASTICS - URINARY TRACT PROTECTIVE AGENTS B R HIVID

B R ETHYOL ANTIRETROVIRALS - RTI-NUCLEOSIDE B R MESNEX ANALOGUES-THYMIDINES

B R ZERIT ANTIRETROVIRAL COMBINATIONS G R zidovudine tab 300 mg

B NR RETROVIR B R COMBIVIR G R zidovudine syrup 10 mg/ml B R KALETRA

B R TRIZIVIR ANTIRETROVIRALS - RTI-NUCLEOTIDE ANALOGUES

ANTIRETROVIRALS B R VIREAD

B R PREZISTA TAB 300MG GI - PROTON PUMP INHIBITOR/NSAID COMBO B R EPZICOM

B R TRUVADA B N TEKTURNA TAB 150MG B R ATRIPLA B N TEKTURNA TAB 300MG

ANTIRETROVIRALS - FUSION INHIBITORS IMMUNOSUPPRESSANTS

B R FUZEON G NR cyclosporine

G NR cyclosporine iv soln 50 mg/ml ANTIRETROVIRALS - PROTEASE INHIBITORS B R SANDIMMUNE

B R CYCLOSPORINE MODIFIED B R AGENERASE G R cyclosporine modified (for microemulsion) B NR REYATAZ B R NEORAL B R LEXIVA G R cyclosporine modified oral soln 100 mg/ml B R CRIXIVAN B R CELLCEPT B R VIRACEPT B R MYFORTIC B R NORVIR B R RAPAMUNE B R FORTOVASE B R PROGRAF B R INVIRASE

B R APTIVUS

ANTIRETROVIRALS - RTI-NON-NUCLEOSIDE ANALOGUES

B R RESCRIPTOR

B R SUSTIVA

B R VIRAMUNE

ANTIRETROVIRALS - RTI-NUCLEOSIDE ANALOGUES-PURINES

B R ZIAGEN

B R VIDEX

B R VIDEX EC

G R didanosine

DRAFT_Report_rt16920_PDL_14_gpi_WEB 10/11/2007