v Department of Human Services IOWA Medicaid Program Effective Date 1/1/2007 PDL DRUG LIST (Two Drug Columns)

Highlighted categories denote new changes to the PDL since previous update

Column Header Explanations:

P, N, R, or NR: B, G or O: P = Preferred B = Brand N = Non-Preferred G = Generic R = Recommended O = OTC NR = Non-Recommended

COM: 20 Preferred only for children 12 years of 1 ANTIVERT 50mg - Use two MECLIZINE HCL age and under for the first 60 days of therapy. 25mg instead 21 PROZAC,FLUOXETINE HCL 40mg CAPS - Use 2 BENZONATATE 200mg - Use two two FLUOXETINE HCL 20mg CAPS instead BENZONATATE 100mg instead 22 RHEUMATREX - Write METHOTREXATE 3 BUSPIRONE 30mg - Use 2 BUSPIRONE 15mg instead tablets 23 ULTRACET - Use Tramadol & Acetaminophen 4 CLINDAMYCIN HCL 300MG - Use Multiples of separately CLINDAMYCIN HCL 150mg 24 PA Required >= 21 yo 5 FLUMIST NASAL VACCINE 200 - Preferred 5 - 25 PA Required: > 14 Units/30Days Supply 49 yo until 3/15/2006. 6 FLUOXETINE HCL 20mg TABS - Use 26 After 30 days only the generic will be preferred. FLUOXETINE HCL 20mg CAPS instead 7 Preferred only for children 12 years of age and 27 PA Required for quantities exceeding 4-125mg under. capsules and 8 - 80mg capsules. 8 A 90 day transition period will be allowed to move established users to a preferred product. 28 PA required for quantities exceeding 12-4mg tabs, HYDROXYZINE HCL - Use HYDROXYZINE 9 12-8mg tabs, 4-24 tabs, 50ml/month - oral sol, 4-20ml PAMOATE vials, and 8-2ml vials. 10 HYDROXYZINE PAMOATE 100mg - Use two HYDROXYZINE PAMOATE 50mg instead 29 PA required for quantities exceeding 12-4mg tabs, 11 PA Required 12-8mg tabs. 30 PA required for doses exceeding two tablets per day 12 PA Required > 60 days of the same strength or for more than two strengths per month. 13 PA Required > 90 days 31 PA required limited to package size of #14. 14 PA Required > Quantity Limit 10 Days 32 PA required limited to package size of #110. 15 PA Required for > 4 Bottles/30 Days 33 Established users who have tried preferred opthalmic 16 PA Required from Day 1 prostaglandins will be grandfathered. 34 Preferred with conditions by POS look-back. Must be 17 PA Required: > 18 Units/30Days Supply 18 years of age or older, fail at least two potent oral 18 Preferred < 14yo antidiabetic medications, no concurrent nicotine replacement therapy, no concurrent inhaled COPD or 19 Preferred < 8yo asthma medications.

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 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 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 preferred status. TABLE OF CONTENTS

Page Page CATEGORY DESCRIPTION CATEGORY DESCRIPTION Number Number ACE AND THIAZIDE COMBO'S 7 ANTIHISTAMINES - NON-SEDATING / 12 DECONGESTANTS ACE INHIBITORS 7 ANTIHISTAMINES - OTHER 12 ACE INHIBITORS AND CA CHANNEL BLOCKERS 7 ANTIHISTAMINES/DECONGESTANTS 13 ACNE PRODUCTS: ISOTRETINOIN 7 ANTIHYPERTENSIVE COMBOS 13 AGENTS FOR FABRYS DISEASE 7 ANTIHYPERTENSIVES - CENTRAL 13 AGENTS FOR GAUCHER DISEASE 7 ANTILEPROTIC 13 AGENTS FOR PHEOCHROMOCYTOMA 7 ANTIMALARIAL AGENTS 13 ALCOHOL DETERRENTS 7 ANTIMYCOBACTERIALS / ANTITUBERCULOSIS 13 ALS DRUG 7 ANTINEOPLASTICS - ALKYLATING AGENTS 48 ALZHEIMER - CHOLINOMIMETICS 7 ANTINEOPLASTICS - ANTIADRENALS 48 AMINO GLYCOSIDES 7 ANTINEOPLASTICS - ANTIANDROGENS 48 ANALGESICS - MISC. 7 ANTINEOPLASTICS - ANTIBIOTICS 48 ANAPHYLAXIS THERAPY 8 ANTINEOPLASTICS - ANTIESTROGENS 48 ANDROGENS / ANABOLICS 8 ANTINEOPLASTICS - ANTIMETABOLITES 48 ANGIOTENSIN RECEPTOR BLOCKER 8 ANTINEOPLASTICS - AROMATASE INHIBITORS 48 ANORECTAL - MISC. 8 ANTINEOPLASTICS - CARDIAC PROTECTIVE AGENTS 48 ANTHELMINTICS 8 ANTINEOPLASTICS - COMBINATIONS 48 ANTI INFECTIVE COMBO'S - MISC. 8 ANTINEOPLASTICS - ESTROGEN RECEPTOR 48 ANTIANGINALS--ISOSORBIDE NITRATE 8 ANTAGONIST ANTIARRHYTHMICS 9 ANTINEOPLASTICS - ESTROGENS 48 ANTIASTHMATIC - ADRENERGIC COMBOS 9 ANTINEOPLASTICS - FOLIC ACID ANTAGONISTS 48 ANTIASTHMATIC - ALPHA-PROTEINASE INHIBITOR 9 RESCUE AGENTS ANTIASTHMATIC - ANTI-CHOLINERGICS 9 ANTINEOPLASTICS - IMIDAZOTETRAZINES 48 ANTIASTHMATIC - ANTIINFLAMMATORY AGENTS 9 ANTINEOPLASTICS - INTERLEUKINS 48 ANTIASTHMATIC - BETA - ADRENERGICS 9 ANTINEOPLASTICS - LHRH ANALOGS 49 ANTIASTHMATIC - HYDRO-LYTIC ENZYMES 9 ANTINEOPLASTICS - MISC. 49 ANTIASTHMATIC - LEUKOTRIENE RECEPTOR 9 ANTINEOPLASTICS - MITOTIC INHIBITORS 49 ANTAGONISTS ANTINEOPLASTICS - NITROGEN MUSTARDS 49 ANTIASTHMATIC - MISC. RESPIRATORY INHALANTS 9 ANTINEOPLASTICS - NITROSOUREAS 49 ANTIASTHMATIC - MIXED ADRENERGICSS 9 ANTINEOPLASTICS - PROGESTINS 49 ANTIASTHMATIC - MUCOLYTICS 9 ANTINEOPLASTICS - PROTEIN-TYROSINE KINASE 49 ANTIASTHMATIC - NASAL MISC. 10 INHIBITORS ANTIASTHMATIC - NASAL STEROIDS 10 ANTINEOPLASTICS - RETINOIDS 49 ANTIASTHMATIC - STEROID INHALANTS 10 ANTINEOPLASTICS - SELECTIVE RETINOID X 49 RECEPTOR AGONISTS ANTIASTHMATIC - XANTHINES 10 ANTINEOPLASTICS - TOPOISOMERASE I INHIBITORS 49 ANTIBIOTICS - MISC. 10 ANTINEOPLASTICS - URINARY TRACT PROTECTIVE 49 ANTI-CATAPLECTIC AGENTS 10 AGENTS ANTICOAGULANTS 10 ANTI-PARKINSONIAN DRUGS 14 ANTICONVULSANTS 10 ANTIPROTOZOAL AGENTS 14 ANTIDEPRESSANTS - MAO INHIBITORS 44 ANTI-PSORIATICS - BIOLOGICALS 14 ANTIDEPRESSANTS - SELECTED SSRI'S 44 ANTI-PSORIATICS - NON-BIOLOGICALS 14 ANTIDEPRESSANTS - TRI-CYCLICS 44 ANTIPSYCHOTICS - ATYPICALS 44 ANTIDOTES 11 ANTIPSYCHOTICS - SPECIAL ATYPICALS 45 ANTIDOTES - CHELATING AGENTS 11 ANTIPSYCHOTICS - TYPICAL 45 ANTIEMETIC - 5-HT3 RECEPTOR ANTAGONISTS/ 11 ANTIRETROVIRAL COMBINATIONS 49 SUBSTANCE P NEUROKININ ANTIRETROVIRALS 49 ANTIEMETIC - ANTICHOLINERGIC / DOPAMINERGIC 11 ANTIRETROVIRALS - FUSION INHIBITORS 49 ANTIFUNGALS - ASSORTED 12 ANTIRETROVIRALS - PROTEASE INHIBITORS 49 ANTIHEMOPHILIC AGENTS 48 ANTIRETROVIRALS - RTI-NON-NUCLEOSIDE 49 ANTIHISTAMINES - NON-SEDATING 12 ANALOGUES ANTIRETROVIRALS - RTI-NUCLEOSIDE 49 COUGH/COLD - DECONGESTANT W/ EXPECTORANT 20 ANALOGUES-PURINES COUGH/COLD - DECONGESTANT-ANTIHISTAMINE W/ 20 ANTIRETROVIRALS - RTI-NUCLEOSIDE 50 EXPECTORANT ANALOGUES-PYRIMIDINES COUGH/COLD - 20 ANTIRETROVIRALS - RTI-NUCLEOSIDE 50 DECONGESTANT-ANTIHISTAMINE-ANTICHOLINERGIC ANALOGUES-THYMIDINES COUGH/COLD - EXPECTORANT MIXTURES 20 ANTIRETROVIRALS - RTI-NUCLEOTIDE ANALOGUES 50 COUGH/COLD - EXPECTORANTS 20 ANTISPASMODICS 14 COUGH/COLD - NARCOTIC 20 ANTISPASMODICS - LONG ACTING 14 ANTITUSSIVE-ANTIHISTAMINE ANTITHYROID THERAPIES 14 COUGH/COLD - NARCOTIC 20 ANTITUSSIVE-DECONGESTANT ANXIOLYTICS - BENZODIAZEPINES 45 COUGH/COLD - NARCOTIC 20 ANXIOLYTICS - LONG ACTING 46 ANTITUSSIVE-DECONGESTANT-ANTIHISTAMINE ANXIOLYTICS - MISC. 46 COUGH/COLD - NON-NARC 21 ARB'S AND DIURETICS 14 ANTITUSSIVE-ANTIHISTAMINE ARTHRITIS - MISC. 14 COUGH/COLD - NON-NARC 21 ANTITUSSIVE-DECONGESTANT ARTIFICIAL SALIVA/STIMULANTS 14 COUGH/COLD - NON-NARC 21 BETA BLOCKERS - ALPHA / BETA 14 ANTITUSSIVE-DECONGESTANT-ANTIHISTAMINE BETA BLOCKERS - CARDIO SELECTIVE 14 COUGH/COLD - SYSTEMIC DECONGESTANTS 21 BETA BLOCKERS - NON SELECTIVE 15 COUGH/COLD - TOPICAL DECONGESTANTS 21 BETA BLOCKERS AND DIURETIC COMBO'S 15 COX 2 INHIBITORS - HIGHLY SELECTIVE 21 BETA-LACTAMS / CLAVULANATE COMBO'S 15 COX 2 INHIBITORS - SELECTIVE 21 BPH 16 CYTO-MEGALOVIRUS AGENTS 21 CALCIUM CHANNEL BLOCKERS--AMLODIPINES 16 DENTAL PRODUCTS 21 CALCIUM CHANNEL BLOCKERS--DILTIAZEMS 16 DIABETIC - ALPHAGLUCOSIDASE 22 CALCIUM CHANNEL BLOCKERS--FELODIPINES 16 DIABETIC - INSULIN 22 CALCIUM CHANNEL BLOCKERS--ISRADIPINES 16 DIABETIC - INSULIN PENFILLS 22 CALCIUM CHANNEL BLOCKERS--NIFEDIPINES 16 DIABETIC - MEGLITINIDES 22 CALCIUM CHANNEL BLOCKERS--NISOLDIPINE 16 DIABETIC - ORAL BIGUANIDES 22 CALCIUM CHANNEL BLOCKERS--VERAPAMILS 16 DIABETIC - ORAL SULFONYLUREAS 22 CARBAPENEMS 17 DIABETIC - OTHER 22 CARDIAC GLYCOSIDES 17 DIABETIC - SULFONYLUREA / BIGUANIDE 22 CARNITINE REPLENISHER - AGENTS 17 DIABETIC - THIAZOL 22 CCB / LIPID 17 DIABETIC - THIAZOL / BIGUANIDE COMBO 23 CEPHALOSPORINS 17 DIAGNOSTIC BIOLOGICALS 23 CHELATING AGENTS 17 DIURETICS 23 CHOLESTEROL - BILE SEQUESTRANTS 17 DOPAMINE RECEPTOR AGONISTS 23 CHOLESTEROL - FIBRIC ACID DERIVATIVES 17 EAR 23 CHOLESTEROL - HMG COA + ABSORB INHIBITORS 17 ELECTROLYTES/ NUTRITIONALS 23 CHOLINERGIC 18 ERYTHROPOEISIS STIMULATING AGENTS 24 COMPOUNDING MATERIALS 18 ESTROGEN COMBO'S 24 CONTRACEPTIVES - BI-PHASIC COMBINATIONS 18 ESTROGENS - PATCHES 24 CONTRACEPTIVES - INJECTABLE 18 ESTROGENS - TABS 24 CONTRACEPTIVES - MONOPHASIC COMBINATION 18 FLUOROQUINOLONES 24 O/C'S GI - ANTI - FLATULENTS / GI STIMULANTS 24 CONTRACEPTIVES - PATCHES/ VAGINAL PRODUCTS 18 GI - ANTIDIARRHEAL / ANTACID - MISC. 25 CONTRACEPTIVES - PROGESTIN ONLY 18 GI - ANTIPERISTALTIC AGENTS 25 CONTRACEPTIVES - TRI-PHASIC COMBINATIONS 18 GI - DIGESTIVE ENZYMES 25 COUGH/COLD - ANTITUSSIVE - NARCOTIC 19 GI - H2-ANTAGONISTS 26 COUGH/COLD - ANTITUSSIVE - NONNARCOTIC 19 GI - INFLAMMATORY BOWEL AGENTS 26 COUGH/COLD - ANTITUSSIVE-EXPECTORANT 19 GI - IRRITABLE BOWEL SYNDROME AGENTS 26 COUGH/COLD - ANTITUSSIVE-EXPECTORANT - 19 GI - MISC. 26 DECONGEST-ANTIHIST COUGH/COLD - 19 GI - MISC. ANTI-ULCER 26 ANTITUSSIVE-EXPECTORANTS-DECONGESTANT GI - PROSTAGLANDINS 26 COUGH/COLD - DECONGESTANT & 20 GI - PROTON PUMP INHIBITOR 26 ANTICHOLINERGIC GI - PROTON PUMP INHIBITOR/NSAID COMBO 26 GI - ULCER ANTI-INFECTIVE 26 OP. ANTIINFLAMMATORY / STEROIDS OPHTH. 34 GLUCOCORTICOIDS - CORTICOTROPIN 26 OP. BETA - BLOCKERS 34 GLUCOCORTICOIDS - MINERALOCORTICOIDS 27 OP. CARBONIC ANHYDRASE INHIBITORS/COMBO 34 GOUT 27 OP. CYCLOPLEGICS 34 GRANULOCYTE CSF 27 OP. MIOTICS - DIRECT ACTING 34 GROWTH HORMONE 27 OP. MISC 35 HEMOSTATIC 27 OP. NSAID'S 35 HEPATITIS B ONLY 27 OP. PROSTAGLANDINS 35 HEPATITIS C AGENTS 27 OP. QUINOLONES 35 HEREDITARY TYROSINEMIA TYPE 1 (HT-1) 28 OP. SELECTIVE ALPHA ADRENERGIC AGONISTS 35 TREATMENT - AGENTS OSTEOPOROSIS 35 HERPES AGENTS 28 OXYTOCICS 35 HYPERPARATHYROID TREATMENT - VITAMIN D 28 PARKINSONS - ANTICHOLINERGICS 35 ANALOGS HYPERPARATHYROID TREATMENT - VITAMIN D 28 PARKINSONS - COMT INHIBITORS 35 ANALOGS AND CALCIMIMETICS PARKINSONS - SELECTED DOPAMIN AGONISTS 35 IMMUNE SERUMS 28 PERIPHERAL VASODILATORS 35 IMMUNOSUPPRESSANTS 50 PHOSPHATE BINDERS 35 INFLUENZA AGENTS 28 PHOSPHODIESTERASE INHIBITORS 35 IRRIGATION SOLUTIONS 28 PLATELET AGGR. INHIBITORS / COMBO'S - MISC. 35 K REMOVING RESINS 28 PLATELET AGGREGATION INHIBITORS 36 LINCOSAMIDES / OXAZOLIDINONES / LEPROSTATICS 28 PRESSORS 36 LITHIUM 46 PROGESTINS 36 MACROLIDES / ERYTHROMYCIN'S / KETOLIDES 28 PSYCHOTHERAPEUTIC COMBINATION 46 MIGRAINE - CARBOXYLIC ACID DERIVATIVES 29 PULMONARY ANTI-HYPERTENSIVES 36 MIGRAINE - ERGOTAMINE DERIVATIVES 29 PURINE ANALOG 36 MIGRAINE - MISC. 29 RHEUMATOID ARTHRITIS - BIOLOGICALS 36 MIGRAINE - SELECTIVE SEROTONIN AGONISTS (5HT) 29 RHEUMATOID ARTHRITIS - NON-BIOLOGICALS 36 --INJECTABLES RSV PROPHYLAXIS 36 MIGRAINE - SELECTIVE SEROTONIN AGONISTS (5HT) 29 --TABS SEDATIVE/HYPNOTICS - BARBITURATE 46 MINERALS 29 SEDATIVE/HYPNOTICS - BENZODIAZEPINES 46 MOUTH - ANESTHETICS TOPICAL ORAL 30 SEDATIVE/HYPNOTICS - NON-BENZODIAZEPINES 46 MOUTH - STEROIDS 30 SOMATOSTATIC AGENTS 36 MOUTH ANTI-INFECTIVES 30 STIMULANTS - AMPHETAMINES - LONG ACTING 47 MOUTH ANTISEPTICS 30 STIMULANTS - AMPHETAMINES - SHORT ACTING 47 MUCOPOLYSACCHARIDOSIS 30 STIMULANTS - METHYLPHENIDATE 47 MULTIPLE SCLEROSIS AGENTS 30 STIMULANTS - METHYLPHENIDATE - LONG ACTING 47 MUSCLE RELAXANT -COMBINATIONS 30 STIMULANTS - OTHER STIMULANTS / LIKE 47 STIMULANTS MUSCLE RELAXANTS 30 TETRACYCLINES 36 NARCOTIC - ANTAGONISTS 30 THYROID HORMONES 36 NARCOTICS - MISC. 30 TISSUE PLASMINOGEN ACTIVATOR 37 NARCOTICS - SELECTED 32 TOPICAL - ACNE PREPARATIONS 37 NARCOTICS-LONG ACTING 32 TOPICAL - ANTIBIOTIC 38 NEUROLOGICS - MISC. 32 TOPICAL - ANTIFUNGALS 38 NEUROMUSCULAR BLOCKING AGENTS 32 TOPICAL - ANTINEOPLASTICS 38 NEW DRUG PROCESS 2 TOPICAL - ANTIPRURITICS 38 NICARDIPINES 32 TOPICAL - ANTISEBORRHEICS 38 NITRO - OINTMENT/CAP/CR 32 TOPICAL - ANTISEPTICS / DISINFECTANTS 38 NITRO - PATCHES 32 TOPICAL - ANTIVIRALS 38 NITRO - SUBLINGUAL/ SPRAY 33 TOPICAL - ASTRINGENTS / PROTECTANTS 38 NSAIDS 33 TOPICAL - BURN PRODUCTS 38 OP. ADRENERGIC AGENTS 33 TOPICAL - CAUTERIZING AGENTS 38 OP. ANTIALLERGICS - ANTIHISTAMINES 33 TOPICAL - CORTICOSTEROIDS 38 OP. ANTIALLERGICS - MAST CELL STABILIZERS 33 TOPICAL - EMOLLIENTS 40 OP. ANTIBIOTICS 34 TOPICAL - ENZYMES / KERATOLYTICS / UREA 40 TOPICAL - GENITAL WARTS 40 TOPICAL - IMMUNOMODULATORS 40 TOPICAL - LOCAL ANESTHETICS 40 TOPICAL - NASAL ANTIBIOTICS 40 TOPICAL - SCABICIDES AND PEDICULICIDES 40 TOPICAL - STEROID COMBINATIONS 40 TOPICAL - STEROID LOCAL ANESTHETICS 40 TOPICAL - TRETINOIDS 41 TOPICAL - WOUND / DECUBITUS CARE 41 UREA CYCLE DISORDER - AGENTS 41 UROLOGICAL - MISC. 41 VAGINAL - ANTI FUNGALS 41 VAGINAL - ANTIBACTERIALS 41 VAGINAL - CONTRACEPTIVES 41 VAGINAL - ESTROGENS 41 VAGINAL - OTHER 42 VASOPRESSINS 42 VITAMINS 42 VITAMINS - MISC. 43 WEIGHT LOSS 43

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 6 of 50 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 AGENTS FOR PHEOCHROMOCYTOMA ACE AND THIAZIDE COMBO'S B P PHENTOLAMINE MESYLATE

B N LOTENSIN HCT B N DEMSER G P benazepril & hydrochlorothiazide ALCOHOL DETERRENTS B N CAPOZIDE B P CAMPRAL G P captopril & hydrochlorothiazide B P ANTABUSE B N VASERETIC

G P enalapril maleate & hydrochlorothiazide ALS DRUG

B P MONOPRIL HCT B P RILUTEK G N fosinopril sodium & hydrochlorothiazide ALZHEIMER - CHOLINOMIMETICS B N PRINZIDE

B N ZESTORETIC B P ARICEPT

G P lisinopril & hydrochlorothiazide B P ARICEPT ODT

B P UNIRETIC B N REMINYL

B N ACCURETIC B N RAZADYNE ER

G N quinapril-hydrochlorothiazide B N EXELON

ACE INHIBITORS B P NAMENDA

B P NAMENDA TITRATION PAK B N LOTENSIN AMINO GLYCOSIDES G P benazepril hcl

B N CAPOTEN B P AMIKIN

G P captopril G P amikacin sulfate

B N VASOTEC B N GARAMYCIN

G P enalapril maleate G P gentamicin sulfate

B P MONOPRIL G P gentamicin in saline

G N fosinopril sodium B P KANTREX

B N PRINIVIL G P kanamycin sulfate

B N ZESTRIL G P neomycin sulfate

G P lisinopril B P HUMATIN

B N UNIVASC G P paromomycin sulfate

B N ACEON B P STREPTOMYCIN SULFATE

B N ACCUPRIL B P TOBI

G N quinapril hcl B N TOBRAMYCIN SULFATE ADD-VA

B P ALTACE G P tobramycin sulfate B N MAVIK ANALGESICS - MISC. ACE INHIBITORS AND CA CHANNEL BLOCKERS O P aspirin tab 81 mg

B P LOTREL O P aspirin tab 325 mg

B N LEXXEL O P ASPIRIN TAB 650 MG

B P TARKA B N ZORPRIN

ACNE PRODUCTS: ISOTRETINOIN O P aspirin chew tab 81 mg

O P aspirin tab delayed release 81 mg B 11 P ACCUTANE O P aspirin tab delayed release 325 mg G 11 N isotretinoin O P aspirin tab delayed release 650 mg AGENTS FOR FABRYS DISEASE G P aspirin tab delayed release 975 mg

B N DOLOBID B P FABRAZYME G P diflunisal tab 500 mg AGENTS FOR GAUCHER DISEASE G P salsalate tab 500 mg

B P CEREZYME G P salsalate tab 750 mg

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 7 of 50 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 - Continued - G P testosterone cypionate im in oil 200 mg/ml ANALGESICS - MISC. B N DELATESTRYL - Continued - G P testosterone enanthate im in oil 200 mg/ml G P aspirin buffered (ca carb-mg carb-mg ox) tab 325 mg B P OXANDRIN

O P aspirin buffered tab 325 mg B P WINSTROL G P choline & mag salicylate ANGIOTENSIN RECEPTOR BLOCKER B P PRIALT

O P acetaminophen tab 325 mg B N ATACAND

O P acetaminophen tab 500 mg B N TEVETEN

O P acetaminophen elixir 160 mg/5ml B P AVAPRO

O P acetaminophen soln 100 mg/ml B P COZAAR

O P acetaminophen suppos 120 mg B P BENICAR

B N DURABAC TAB FORTE B P MICARDIS

B N DURABAC B P DIOVAN

B N PHRENILIN FORTE ANORECTAL - MISC. B N PHRENILIN B N ANUSOL-HC G P butalbital-acetaminophen tab 50-325 mg G P hydrocortisone rectal cream 2.5% G N butalbital-acetaminophen tab 50-650 mg G P hydrocortisone enema 100 mg/60ml B N EQUAGESIC B N CORTIFOAM G N phenyltoloxamine w/ mag salicylate tab 25-600 mg B N ANAMANTLE HC G P butalbital-acetaminophen-caffeine cap 50-325-40 mg G N lidocaine-hydrocortisone acetate rectal cream kit 3-0.5% G N butalbital-acetaminophen-caffeine cap 50-500-40 mg B P ANALPRAM-HC B N ESGIC G N hydrocortisone acetate w/ pramoxine rectal cream 2.5-1% B N FIORICET B N PROCTOFOAM HC G P butalbital-acetaminophen-caffeine tab 50-325-40 mg

B N ESGIC-PLUS ANTHELMINTICS

G P butalbital-acetaminophen-caffeine tab 50-500-40 mg B P ALBENZA B N DOLGIC PLUS B P STROMECTOL B P FIORINAL G P mebendazole chew tab 100 mg G N butalbital-aspirin-caffeine cap 50-325-40 mg B P BILTRICIDE G P butalbital-aspirin-caffeine tab 50-325-40 mg B P MINTEZOL ANAPHYLAXIS THERAPY ANTI INFECTIVE COMBO'S - MISC.

B P EPIPEN-JR B N PEDIAZOLE B P EPIPEN G P erythromycin-sulfisoxazole for susp 200-600 mg/5ml ANDROGENS / ANABOLICS B N BACTRIM

G P sulfamethoxazole-trimethoprim tab 400-80 mg G N danazol cap 50 mg G P trimethoprim-sulfamethoxazole tab 80-400 mg G N danazol cap 100 mg B N SEPTRA DS B P DANOCRINE CAP 200MG G P sulfamethoxazole-trimethoprim tab 800-160 mg G N danazol cap 200 mg B N SEPTRA B P FLUOXYMESTERONE G P sulfamethoxazole-trimethoprim susp 200-40 mg/5ml B P ANDROID

B P TESTRED ANTIANGINALS--ISOSORBIDE NITRATE

B N METHITEST B N DILATRATE SR B P ANDROGEL B N ISORDIL TITRADOSE B N ANDROGEL PUMP G P isosorbide dinitrate B N TESTIM B N IMDUR B P ANDRODERM G P isosorbide mononitrate B P DEPO-TESTOSTERONE

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 8 of 50 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 - Continued - ANTIASTHMATIC - BETA - ADRENERGICS ANTIARRHYTHMICS B N PROVENTIL

B N ETHMOZINE G N albuterol inhal aerosol 90 mcg/act

B P NORPACE G P albuterol sulfate tab 2 mg

B P NORPACE CR G P albuterol sulfate tab 4 mg

G N disopyramide phosphate G P albuterol sulfate syrup 2 mg/5ml

B P PRONESTYL G P albuterol sulfate soln nebu 0.083%

G P procainamide hcl G P albuterol sulfate soln nebu 0.5% (5 mg/ml)

G N procainamide hcl sr B P ACCUNEB

B N PROCAINAMIDE HCL ER G P albuterol sulfate soln nebu 1.25 mg/3ml (base equiv)

B P PROCANBID B N ALBUTEROL SULFATE HFA

G P quinidine gluconate B N PROVENTIL HFA

G P quinidine sulfate B N VENTOLIN HFA

B N QUINIDINE SULFATE ER B P VOSPIRE ER

G N lidocaine hcl (cardiac) B N FORADIL AEROLIZER

G P mexiletine hcl B P XOPENEX

B P TAMBOCOR B P XOPENEX HFA

G N flecainide acetate B P METAPROTEREN TAB 10MG

B N RYTHMOL B P METAPROTEREN TAB 20MG

G P propafenone hcl G P metaproterenol sulfate syrup 10 mg/5ml

B N RYTHMOL SR B N ALUPENT INH AER 0.65/ACT

B N CORDARONE B P MAXAIR AUTOHALER

G P amiodarone hcl tab 200 mg B P SEREVENT

B N PACERONE B P SEREVENT DISKUS

G N amiodarone hcl tab 400 mg G P terbutaline sulfate tab 2.5 mg

B P TIKOSYN G P terbutaline sulfate tab 5 mg

ANTIASTHMATIC - ADRENERGIC COMBOS G P terbutaline sulfate inj 1 mg/ml ANTIASTHMATIC - HYDRO-LYTIC ENZYMES B P DUONEB

B P COMBIVENT B 11 P PULMOZYME B P ADVAIR HFA ANTIASTHMATIC - LEUKOTRIENE RECEPTOR B P ADVAIR DISKUS ANTAGONISTS B P SINGULAIR ANTIASTHMATIC - ALPHA-PROTEINASE INHIBITOR B N ACCOLATE

B 11 N ARALAST ANTIASTHMATIC - MISC. RESPIRATORY INHALANTS B 11 P PROLASTIN G P sodium chloride soln nebu 0.9% B 11 N ZEMAIRA O P sodium chloride aero soln 0.9% ANTIASTHMATIC - ANTI-CHOLINERGICS ANTIASTHMATIC - MIXED ADRENERGICS G P ipratropium bromide inhal soln 0.02% G P epinephrine hcl inj 0.1 mg/ml B P ATROVENT B N ADRENALIN B P SPIRIVA HANDIHALER G P epinephrine hcl inj 1 mg/ml B P ATROVENT HFA ANTIASTHMATIC - MUCOLYTICS ANTIASTHMATIC - ANTIINFLAMMATORY AGENTS

B P MUCOMYST-10 B N INTAL B P MUCOMYST G P cromolyn sodium soln nebu 20 mg/2ml G P acetylcysteine B P INTAL INHALER

B P TILADE ANTIASTHMATIC - NASAL MISC.

B 11 N XOLAIR

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 9 of 50 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 - Continued - G N metronidazole cap 375 mg ANTIASTHMATIC - NASAL MISC. G P metronidazole tab 250 mg - Continued - G P metronidazole tab 500 mg B P ATROVENT B N FLAGYL ER

G N ipratropium bromide (nasal) G N metronidazole tab sr 24hr 750 mg

ANTIASTHMATIC - NASAL STEROIDS G P metronidazole in nacl 0.79% iv soln 500 mg/100ml

B P PENTAM 300 B N BECONASE AQ B P NEBUPENT B N RHINOCORT AQUA B N XIFAXAN G N flunisolide nasal soln 0.025% B N PROLOPRIM B N NASAREL G P trimethoprim tab 100 mg G N fluticasone propionate nasal susp 50 mcg/act B P VANCOCIN HCL CAP 125MG B P FLONASE B P VANCOCIN HCL CAP 250MG B P NASONEX G P vancomycin hcl for inj 500 mg B P NASACORT AQ G P vancomycin hcl for inj 1000 mg ANTIASTHMATIC - STEROID INHALANTS G P vancomycin hcl for inj 5000 mg

G P vancomycin hcl for inj 10 gm B P QVAR B N VANCOCIN HCL INJ B 19 P PULMICORT SUS 0.25MG/2 B P VANCOCIN HCL ISO-OSMOTIC B 19 P PULMICORT SUS 0.5MG/2 B N POLYMYXIN B SULFATE B 18 P PULMICORT TURBUHALER B P TYGACIL B P AEROBID B P XIGRIS B P AEROBID-M

B P FLOVENT ANTI-CATAPLECTIC AGENTS

B P FLOVENT ROTADISK B P XYREM B P FLOVENT HFA ANTICOAGULANTS B P ASMANEX

B P AZMACORT G P hep flush-10

ANTIASTHMATIC - XANTHINES G P hep-lock

G P heparin lock G P aminophylline G P heparin lock flush G N dyphylline G P heparin sodium lock flush B P ELIXOPHYLLIN G P heparin sodium B P THEO-24 B P HEPARIN SODIUM DCU B N QUIBRON-T/SR G N heparin sodium lock flush B N UNIPHYL G P heparin (porcine) in sodium chloride G P theophylline B 14 P FRAGMIN G N dyphylline-guaifenesin B 14 P LOVENOX B N QUIBRON B 14 P INNOHEP B N ELIXOPHYLLIN-GG B 14 P ARIXTRA ANTIBIOTICS - MISC. G P warfarin sodium

B P COUMADIN B P SULFADIAZINE

B P SULFISOXAZOLE ANTICONVULSANTS

B P SULFISOXIZOLE B N EQUETRO B P GANTRISIN PEDIATRIC B N KLONOPIN B P AZACTAM G P clonazepam B N COLY-MYCIN-M B N KLONOPIN WAFERS G P colistimethate sodium for inj 150 mg B P DIASTAT PEDIATRIC B N LORABID B P DIASTAT UNIVERSAL B N FLAGYL

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 10 of 50 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 - Continued - G P primidone tab 250 mg ANTICONVULSANTS B N TOPAMAX - Continued - G N zonisamide B P DIASTAT B P ZONEGRAN B P DIASTAT ADULT ANTIDOTES B P FELBATOL

B P GABITRIL B P DESFERAL

B N PEGANONE ANTIDOTES - CHELATING AGENTS B N CEREBYX B N EXJADE B P DILANTIN INFATABS B P CHEMET G N phenytoin susp 125 mg/5ml

G P phenytoin sodium inj 50 mg/ml ANTIEMETIC - 5-HT3 RECEPTOR ANTAGONISTS/ SUBSTANCE P NEUROKININ B P PHENYTOIN SODIUM PROMPT B N ANZEMET B P DILANTIN B N KYTRIL G P phenytoin sodium extended cap 100 mg B 28 P ZOFRAN B P PHENYTEK B 29 P ZOFRAN ODT B P ZARONTIN CAP 250MG B N ALOXI G N ethosuximide cap 250 mg B 27 P EMEND B N ZARONTIN SYP 250/5ML B P MARINOL G P ethosuximide soln 250 mg/5ml ANTIEMETIC - ANTICHOLINERGIC / DOPAMINERGIC B P CELONTIN

B P DEPAKOTE G N promethazine tab 12.5mg

B P DEPAKOTE SPRINKLES G P promethazine tab 25mg

G P valproate sodium syrup 250 mg/5ml G P promethazine tab 50mg

G P valproate sodium inj 100 mg/ml G P promethazine syp 6.25/5ml

B N DEPAKENE B N PHENERGAN INJ 25MG/ML

G P valproic acid cap 250 mg G N promethazine inj 25mg/ml

B N TEGRETOL TAB 200MG B N PHENERGAN INJ 50MG/ML

G P carbamazepine tab 200 mg G N promethazine inj 50mg/ml

B N TEGRETOL CHW 100MG B P PHENERGAN SUP 12.5MG

G P carbamazepine chew tab 100 mg G P promethazine sup 12.5mg

B P TEGRETOL SUS 100/5ML B P PHENERGAN SUP 25MG

G N carbamazepine susp 100 mg/5ml G P promethazine sup 25mg

B P CARBATROL B P PHENERGAN SUP 50MG

B P TEGRETOL-XR G P promethazine sup 50mg

G P gabapentin cap 100 mg B N ANTIVERT TAB 12.5MG

G P gabapentin cap 300 mg O P meclizine hcl tab 12.5 mg

G P gabapentin cap 400 mg B N ANTIVERT TAB 25MG

G N gabapentin tab 100 mg O P meclizine hcl tab 25 mg

G N gabapentin tab 300 mg B 1 N ANTIVERT TAB 50MG

G N gabapentin tab 400 mg O P meclizine hcl chew Tab 25 MG

G P gabapentin tab 600 mg B P TRANSDERM-SCOP

G P gabapentin tab 800 mg B N SCOPACE

B N NEURONTIN G P scopolamine hydrobromide tab 0.4 mg

B P LAMICTAL B N TIGAN CAP 300MG

B P KEPPRA G P trimethobenzamide hcl cap 300 mg

B P TRILEPTAL B N TIGAN INJ 100MG/ML

B P LYRICA B N CESAMET G N primidone tab 50 mg ANTIFUNGALS - ASSORTED B P MYSOLINE

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 11 of 50 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 - Continued - B 11 P CLARINEX-D TAB 5-240MG ANTIFUNGALS - ASSORTED B 11 N ALLEGRA-D - Continued - G 11 N Fexofenadine-Pseudoephedrine ER B 13 P FUNGIZONE B 11 N ALLEGRA-D 24 HOUR

G 11 N amphotericin b B 11 N SUDAL 12 B 13 P AMBISOME ANTIHISTAMINES - OTHER B 13 P ANCOBON

B 13 P GRIFULVIN-V G N brompheniramine maleate tab sr 12hr 6 mg

G 11 N griseofulvin microsize B N BROVEX CT

B 13 P GRIS-PEG B N LODRANE XR

G P nystatin tab 500000 unit B N BROVEX

B P NYSTATIN ORAL POWDER G P chlorpheniramine maleate cap cr 8 mg

B 13 P LAMISIL G P chlorpheniramine maleate cap cr 12 mg

B 11 N NIZORAL TAB 200MG O P chlorpheniramine maleate tab 4 mg

G 13 P ketoconazole G N dexchlorpheniramine maleate tab cr 4 mg

G 11 N fluconazole tab 50 mg G N dexchlorpheniramine maleate tab cr 6 mg

G 13 P fluconazole tab 100 mg B N PALGIC

G 13 P fluconazole tab 150 mg B N HISTEX PD

G 13 P fluconazole tab 200 mg G N carbinoxamine maleate liquid 4 mg/5ml

G 13 P fluconazole sus 10mg/ml B N HISTEX IE

B 13 P DIFLUCAN B N HISTEX CT

G 13 P fluconazole sus 40mg/ml G N carbinoxamine maleate tab sr 12hr 8 mg

B 13 P DIFLUCAN IN NACL G N clemastine fumarate tab 2.68 mg

B 13 P DIFLUCAN IN ISO-OSMOTIC D G N clemastine fumarate syrup 0.67 mg/5ml

B 11 N SPORANOX PULSEPAK O P diphenhydramine hcl cap 25 mg

G 11 N itraconazole G P diphenhydramine hcl cap 50 mg

B 11 N SPORANOX O P diphenhydramine hcl liquid 12.5 mg/5ml

B 13 P VFEND O P diphenhydramine hcl elixir 12.5 mg/5ml

B 13 P VFEND IV O P diphenhydramine hcl syrup 12.5 mg/5ml

B 13 P CANCIDAS B P BENADRYL

B P MYCAMINE G P diphenhydramine hcl inj 50 mg/ml

B 13 P MYCELEX TRO 10MG G N diphenhydramine tannate susp 25 mg/5ml

G 11 N clotrimazole tro 10mg G P cyproheptad tab 4mg

ANTIHISTAMINES - NON-SEDATING B P CYPROHEPTAD SYP 2MG/5ML B N HISTEX PD 12

B 11 P ZYRTEC B N POLY-HISTINE

B 11 P CLARINEX G P hydroxyzine hcl tab 10 mg

B 11 P CLARINEX REDITABS G 9 N hydroxyzine hcl tab 25 mg

G 11 N fexofenadine hcl tab 30 mg G 9 N hydroxyzine hcl tab 50 mg

G 11 N fexofenadine hcl tab 60 mg B N ATARAX

B 11 N ALLEGRA G P hydroxyzine hcl syrup 10 mg/5ml

G 11 N fexofenadine hcl tab 180 mg G P hydroxyzine hcl im soln 25 mg/ml

O P loratadine tab 10 mg G P hydroxyzine hcl im soln 50 mg/ml

O P loratadine syrup 10 mg/10ml B N VISTARIL CAP 25MG

B 11 N ASTELIN G P hydroxyzine pamoate cap 25 mg

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

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 12 of 50 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 - Continued - G N pyrilamine tannate-phenylephrine tannate ANTIHISTAMINES - OTHER B N NALEX-A - Continued - G N chlorphen-phenyltolox-pe B N PROCHLORPER SUP 5MG G N chlorpheniramine-pyrilamine & phenylephrine B N COMPAZINE SUP 25MG ANTIHYPERTENSIVE COMBOS G P prochlorperazine suppos 25 mg

B N COMPAZINE TAB 5MG B N ENDURONYL FORTE

G P prochlorperazine maleate tab 5 mg B N CLORPRES

B N COMPAZINE TAB 10MG B N ALDORIL-15

G P prochlorperazine maleate tab 10 mg B N ALDORIL-25

B P COMPAZINE INJ 5MG/ML G P methyldopa & hydrochlorothiazide

G N prochlorperazine edisylate inj 5 mg/ml B N MINIZIDE

ANTIHISTAMINES/DECONGESTANTS B P HYDRAL/HCTZ CAP 25/25 B P HYDRAL/HCTZ CAP 50/50 B N SEMPREX-D ANTIHYPERTENSIVES - CENTRAL B N TRINALIN REPETABS

B N BROMFED-PD B N CATAPRES

G N brompheniramine & phenyleph G P clonidine hcl

B N BROMFED B P CATAPRES-TTS-1

G P CARDEC SYP 4-45MG/5 B P CATAPRES-TTS-2

B N HISTEX SR B P CATAPRES-TTS-3

B N LODRANE 12D B N GUANABENZ ACETATE

G N brompheniramine & pseudoeph B N TENEX

B N COLDEC D G P guanfacine hcl

B N PEDIATEX-D B N ALDOMET

B N RONDEC G P methyldopa

B N PALGIC D B N MINIPRESS

B N RONDEC-TR G P prazosin hcl

G N carbinoxamine & pseudoeph B P RESERPINE

B N RESCON-JR B N APRESOLINE

B N DALLERGY JR G P hydralazine hcl

B N DECONAMINE SR B N LONITEN

G N cpm/pse cap 8-120 cr G P minoxidil

G N cpm/pse cap 8-120 sr ANTILEPROTIC B N PEDIOX B P THALOMID B N DECONAMINE

G N cpm/pse syp ANTIMALARIAL AGENTS

B N QDALL B P CHLOROQUINE PHOSPHATE TAB 250 MG B N BIOHIST LA B N ARALEN G N chlorpheniramine & pseudoeph G P chloroquine phosphate tab 500 mg G N chlorphen tan & pseudoeph tan B N PLAQUENIL B N RYNATAN G P hydroxychloroquine sulfate B N DALLERGY-JR B P LARIAM B N RYNATAN PEDIATRIC G N mefloquine hcl G N chlorpheniramine tannate-phenylephrine tannate B P DARAPRIM B N TANAFED DP G P quinine sulfate G N dexbrompheniramine & pseudoephedrine B P MALARONE B N PROMETHAZINE VC ANTIMYCOBACTERIALS / ANTITUBERCULOSIS B N RYNA-12

B N RYNA-12 S G P ethambutol hcl

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 13 of 50 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 - Continued - B P URISPAS ANTIMYCOBACTERIALS / ANTITUBERCULOSIS G N flavoxate hcl tab 100 mg - Continued - G P oxybutynin chloride tab 5 mg B P TRECATOR B N DITROPAN

G P isoniazid G P oxybutynin chloride syrup 5 mg/5ml

G P pyrazinamide B P CYSTOSPAZ

B N MYCOBUTIN G P hyoscyamine tab 0.15 mg

G P rifampin cap 150 mg B N DETROL B N RIFADIN ANTISPASMODICS - LONG ACTING G P rifampin cap 300 mg

ANTI-PARKINSONIAN DRUGS B P ENABLEX B N OXYTROL

G P amantadine hcl cap 100 mg B 8 N DITROPAN XL

G N amantadine hcl tab 100 mg B P VESICARE

B N SYMMETREL B P DETROL LA

G P amantadine hcl syrup 50 mg/5ml B P SANCTURA B P PARLODEL ANTITHYROID THERAPIES G N bromocriptine mesylate

B N SINEMET B P TAPAZOLE TAB 5MG

B N SINEMET CR G N methimazole tab 5mg

G P carbidopa-levodopa B N TAPAZOLE TAB 10MG

B P PARCOPA G N methimazole tab 10mg

B P STALEVO B N METHIMAZOLE TAB 20MG

B N AZILECT G P propylthiouracil tab 50 mg

B N ELDEPRYL CAP 5MG ARB'S AND DIURETICS G P selegiline hcl cap 5 mg B N ATACAND HCT G P selegiline hcl tab 5 mg B N TEVETEN HCT B N ZELAPAR TAB 1.25MG B P AVALIDE B P LODOSYN B P HYZAAR G N atracurium besylate B P BENICAR HCT ANTIPROTOZOAL AGENTS B P MICARDIS HCT

B N TINDAMAX B P DIOVAN HCT

B P MEPRON ARTHRITIS - MISC. B P ALINIA B P RIDAURA B P NEUTREXIN B P MYOCHRYSINE ANTI-PSORIATICS - BIOLOGICALS B 22 N RHEUMATREX

B P ENBREL G P methotrexate sodium tab 2.5 mg (antirheumatic)

B N AMEVIVE ARTIFICIAL SALIVA/STIMULANTS B P RAPTIVA B P EVOXAC ANTI-PSORIATICS - NON-BIOLOGICALS B N SALAGEN

B N PSORIATEC G N pilocarpine hcl tab 5 mg

G P anthralin cream 1% BETA BLOCKERS - ALPHA / BETA B P DOVONEX B N NORMODYNE B P TAZORAC B N TRANDATE B N SORIATANE G P labetalol hcl B P OXSORALEN ULTRA

ANTISPASMODICS BETA BLOCKERS - CARDIO SELECTIVE

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 14 of 50 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 - Continued - B N ZIAC BETA BLOCKERS - CARDIO SELECTIVE G P bisoprolol & hydrochlorothiazide - Continued - B N LOPRESSOR HCT B N SECTRAL G N metoprolol & hydrochlorothiazide

G P acebutolol hcl B N CORZIDE

B N TENORMIN TAB 25MG B N INDERIDE 40/25

G P atenolol tab 25 mg B N INDERIDE 80/25

B N TENORMIN TAB 50MG G P propranolol & hydrochlorothiazide

G P atenolol tab 50 mg B N TIMOLIDE 10/25 B N TENORMIN TAB 100MG BETA-LACTAMS / CLAVULANATE COMBO'S G P atenolol tab 100 mg

B P KERLONE B P PFIZERPEN-G

G N betaxolol hcl B P PENICILLIN G POTASSIUM IN

B P ZEBETA B P BICILLIN L-A

G N bisoprolol fumarate G P penicillin v potassium tab 250 mg

B N BREVIBLOC G P penicillin v potassium tab 500 mg

B P TOPROL XL G P penicillin v potassium for soln 125 mg/5ml

G P metoprolol tab 25mg G P penicillin v potassium for soln 250 mg/5ml

G P metoprolol tab 50mg G P amoxicillin (trihydrate) cap 250 mg

B N LOPRESSOR G P amoxicillin (trihydrate) cap 500 mg

G P metoprolol tab 100mg G P amoxil cap 500mg

G P metoprolol inj 1mg/ml B P AMOXIL TAB 500MG

BETA BLOCKERS - NON SELECTIVE G P amoxicillin (trihydrate) tab 500 mg B P AMOXIL TAB 875MG

B N RANEXA G N amoxicillin (trihydrate) tab 875 mg

B N CARTROL G P amoxicillin (trihydrate) chew tab 125 mg

B N CORGARD B N AMOXIL CHW 200MG

G P nadolol G N amoxicillin (trihydrate) chew tab 200 mg

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

G P pindolol B N AMOXIL CHW 400MG

B N INDERAL G N amoxicillin (trihydrate) chew tab 400 mg

G P propranolol hcl B P AMOXIL DRO 50MG/ML

B P INDERAL LA CAP 60MG G P amoxicillin (trihydrate) for susp 125 mg/5ml

B P INDERAL LA CAP 80MG G P amoxil sus 125/5ml

B P INDERAL LA CAP 120MG B N AMOXIL SUS 200/5ML

B P INDERAL LA CAP 160MG G N amoxicillin (trihydrate) for susp 200 mg/5ml

B N INNOPRAN XL G P amoxicillin (trihydrate) for susp 250 mg/5ml

B N BETAPACE G P amoxil sus 250/5ml

G P sotalol hcl B N AMOXIL SUS 400/5ML

G N sotalol hcl (afib/afl) G N amoxicillin (trihydrate) for susp 400 mg/5ml

B P BETAPACE AF B N DISPERMOX

G P timolol maleate tab 5 mg G P ampicillin

B N BLOCADREN G P dicloxacillin sodium cap 250 mg

G P timolol maleate tab 10 mg G P dicloxacillin sodium cap 500 mg

G P timolol maleate tab 20 mg G P nafcillin sodium for inj 1 gm

B P COREG G P nafcillin sodium for iv soln 1 gm

BETA BLOCKERS AND DIURETIC COMBO'S G P nafcillin sodium for iv soln 2 gm

B P NAFCILLIN SODIUM B N TENORETIC B P OXACILLIN SODIUM G P atenolol & chlorthalidone B P BACTOCILL IN DEXTROSE

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 15 of 50 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 - Continued - B N DILACOR XR BETA-LACTAMS / CLAVULANATE COMBO'S G P diltia xt - Continued - G P diltiazem hcl er B P GEOCILLIN G P diltiazem xr

B P PIPERACILLIN SODIUM G N diltiazem hcl extended release beads

B P BICILLIN C-R B P TIAZAC

B P AUGMENTIN TAB 250MG G N diltiazem hcl coated beads

B N AUGMENTIN TAB 500MG B N CARDIZEM CD

G P amoxicillin & k clavulanate tab 500-125 mg B P CARDIZEM LA B N AUGMENTIN TAB 875MG CALCIUM CHANNEL BLOCKERS--FELODIPINES G P amoxicillin & k clavulanate tab 875-125 mg

B P AUGMENTIN CHW 200MG G N felodipine tab sr 24hr 2.5 mg

G N amoxicillin & k clavulanate chew tab 200-28.5 mg G N felodipine tab sr 24hr 5 mg

B P AUGMENTIN CHW 250MG B N PLENDIL

B P AUGMENTIN CHW 400MG G N felodipine tab sr 24hr 10 mg

G N amoxicillin & k clavulanate chew tab 400-57 mg CALCIUM CHANNEL BLOCKERS--ISRADIPINES B P AUGMENTIN SUS 125/5ML B N DYNACIRC B P AUGMENTIN SUS 200/5ML B N DYNACIRC CR G N amoxicillin & k clavulanate for susp 200-28.5 mg/5ml

B P AUGMENTIN SUS 250/5ML CALCIUM CHANNEL BLOCKERS--NIFEDIPINES

B P AUGMENTIN SUS 400/5ML B N PROCARDIA G N amoxicillin & k clavulanate for susp 400-57 mg/5ml G P nifedipine B P AUGMENTIN ES-600 G N afeditab cr G N amoxicillin & k clavulanate for susp 600-42.9 mg/5ml G N nifediac cc B P AUGMENTIN XR B P ADALAT CC B P UNASYN G N nifedical xl G N ampicillin B N PROCARDIA XL B P UNASYN ADD-VANTAGE G N nifedipine er B P UNASYN BULK PACK B N NIMOTOP B P TIMENTIN CALCIUM CHANNEL BLOCKERS--NISOLDIPINE B P ZOSYN

BPH B P SULAR

CALCIUM CHANNEL BLOCKERS--VERAPAMILS B N CARDURA

G P doxazosin mesylate B N CALAN TAB 40MG

B N HYTRIN G P verapamil tab 40mg

G P terazosin hcl B N CALAN TAB 80MG

B P AVODART G P verapamil tab 80mg

G N Finasteride Tab 5 MG B N CALAN TAB 120MG

B P PROSCAR G P verapamil tab 120mg

B 11 N UROXATRAL B N CALAN SR

B N CARDURA XL B N ISOPTIN SR

B 11 N FLOMAX G P verapamil hcl cr

CALCIUM CHANNEL BLOCKERS--AMLODIPINES G N verapamil inj 2.5mg/ml

B P VERELAN CAP 120MG SR B P NORVASC B N VERELAN CAP 180MG CALCIUM CHANNEL BLOCKERS--DILTIAZEMS B N VERELAN CAP 240MG SR

G P verapamil hcl er B N CARDIZEM B P VERELAN PM G P diltiazem hcl B N VERELAN CAP 360MG SR B N DILTIAZEM HCL IV FOR SOLN 100 MG Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 16 of 50 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 - Continued - G N cefprozil CALCIUM CHANNEL BLOCKERS--VERAPAMILS B P CEFZIL - Continued - G P cefuroxime axetil tab 250 mg G P verapamil hcl sr G P cefuroxime axetil tab 500 mg

B N COVERA-HS B P CEFTIN

CARBAPENEMS B P ZINACEF

B P OMNICEF B P INVANZ B N SPECTRACEF B P MERREM B P SUPRAX B N PRIMAXIN IV G N cefpodoxime proxetil tab 100 mg B N PRIMAXIN IV ADD-VANTAGE G N cefpodoxime proxetil tab 200 mg B N PRIMAXIN I.M. B P VANTIN CARDIAC GLYCOSIDES B P CLAFORAN

G N ceftazidime for inj 1 gm B P LANOXICAPS B P FORTAZ INFUSION PACK B P LANOXIN G N ceftazidime for inj 2 gm G P digoxin B P FORTAZ CARNITINE REPLENISHER - AGENTS B P CEDAX

B P CARNITOR G N ceftriaxone

CCB / LIPID B P ROCEPHIN B P ROCEPHIN IN ISO-OSMOTIC D B P CADUET B P MAXIPIME B N BIDIL CHELATING AGENTS CEPHALOSPORINS B P SYPRINE G P cefadroxil cap 500 mg B N CUPRIMINE G N cefadroxil tab 1 gm B P DEPEN TITRATABS B P DURICEF CHOLESTEROL - BILE SEQUESTRANTS G P cefazolin sodium for inj 500 mg

G N cefazolin sodium for inj 1 gm G P cholestyramine powder 4 gm/dose

G P cefazolin sodium for iv soln 1 gm B N QUESTRAN

B P ANCEF G P cholestyramine powder packets 4 gm

G P cefazolin sodium for inj 10 gm G P cholestyramine light powder 4 gm/dose

G P cefazolin sodium for inj 20 gm B N QUESTRAN LIGHT

B P CEFAZOLIN SODIUM G P cholestyramine light powder packets 4 gm

G P cephalexin cap 250 mg B N WELCHOL

B N KEFLEX B P COLESTID

G P cephalexin cap 500 mg CHOLESTEROL - FIBRIC ACID DERIVATIVES B P CEPHALEXIN MONOHYDRATE B P TRIGLIDE G P cephalexin for susp 125 mg/5ml B N ANTARA G P cephalexin for susp 250 mg/5ml B N LOFIBRA B N VELOSEF B P TRICOR G P cefaclor cap 250 mg B N LOPID G N cefaclor cap 500 mg G P gemfibrozil tab 600 mg G N cefaclor for susp 125 mg/5ml B P NIASPAN G N cefaclor for susp 187 mg/5ml

G P cefaclor for susp 250 mg/5ml CHOLESTEROL - HMG COA + ABSORB INHIBITORS: High Potency Drugs/Combinations B N CECLOR B P LIPITOR G N cefaclor for susp 375 mg/5ml B P CRESTOR G N cefaclor monohydrate tab sr 12hr 500 mg G P Simvastatin Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 17 of 50 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 - Continued - G N desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg CHOLESTEROL - HMG COA + ABSORB INHIBITORS: B P MIRCETTE High Potency Drugs/Combinations - Continued - G N desogest-eth estrad & eth estrad tab 0.15-0.02/0.01 mg(21/5) B 26 P ZOCOR B N YAZ TAB 3-0.02MG

B P VYTORIN B N YASMIN 28

CHOLESTEROL - HMG COA + ABSORB INHIBITORS: B P DEMULEN 1/35-28 Low Potency Drugs/Combinations G N ethynodiol diacetate & ethinyl estradiol tab 1 mg-35mcg B P ZETIA B P DEMULEN 1/50-28 B P LESCOL G N ethynodiol diacetate & ethinyl estradiol tab 1 mg-50 mcg B P LESCOL XL B P ALESSE-28 B N MEVACOR B P LEVLITE-28 G P lovastatin G N levonorgestrel & ethinyl estradiol tab 0.10 mg-20 mcg B N ALTOPREV B N LEVLEN CONTRACT PACK G N Pravastatin Sodium B N LEVLEN-28 B N PRAVACHOL B P NORDETTE-21 B N PRAVIGARD PAC B P NORDETTE-28 B P ADVICOR G N levonorgestrel & ethinyl estradiol tab 0.15 mg-30mcg B N OMACOR B P OVCON-35/28 CHOLINERGIC B N BREVICON-28

B P MODICON-28 B N URECHOLINE G N norethindrone & ethinyl estradiol tab 0.5 mg-35 mcg G P bethanechol chloride B N NORINYL 1+35 COMPOUNDING MATERIALS B P ORTHO-NOVUM 1/35-28

B P STERILE DILUENT FOR FLOLA G N norethindrone & ethinyl estradiol tab 1 mg-35 mcg

G P water for injection B P OVCON-50 28

G P water for iv injection B N LOESTRIN 1/20-21

G P water for inject, bacteriostatic G N norethindrone ace & ethinyl estradiol tab 1 mg-20 mcg

G P water for inject, bacteriostatic benzyl alcohol B N LOESTRIN 1.5/30-21

B P BACTERIOSTATIC WATER PARA G N norethindrone ace & ethinyl estradiol tab 1.5 mg-30 mcg

G P saline injection bacteriostatic B P NORINYL 1+50

B P SODIUM CHLORIDE BACTERIOS B P ORTHO-NOVUM 1/50-28

B P CEBO #1 BLUE G N norethindrone & mestranol tab 1 mg-50 mcg

B P CEBO #2 GREEN B P LO/OVRAL 28

B P CEBO #3 ORANGE G N norgestrel & ethinyl estradiol tab 0.3 mg-30 mcg

CONTRACEPTIVES - BI-PHASIC COMBINATIONS G N norgestrel & ethinyl estradiol tab 0.5 mg-50 mcg B P ORTHO-CYCLEN-28 B P ORTHO-NOVUM 10/11-28 G N norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg G N norethindrone-eth estradiol tab 0.5-35/1-35 mg-mcg (10/11) B N LOESTRIN FE 1/20

CONTRACEPTIVES - EMERGENCY CONTRACEPTIVE G N norethindrone ace & ethinyl estradiol-fe tab 1 mg-20 mcg

B N LOESTRIN 24 FE B P PLAN B B N LOESTRIN FE CONTRACEPTIVES - INJECTABLE G N norethindrone ace & ethinyl estradiol-fe tab 1.5 mg-30 mcg

B P DEPO-PROVERA CONTRACEPTIV B N SEASONALE

G N medroxyprogesterone acetate im susp 150 mg/ml B N SEASONIQUE

B P DEPO-SUBQ PROVERA 104 CONTRACEPTIVES - PATCHES/ VAGINAL PRODUCTS

B N LUNELLE B P ORTHO EVRA CONTRACEPTIVES - MONOPHASIC COMBINATION B P NUVARING O/C'S B N DESOGEN CONTRACEPTIVES - PROGESTIN ONLY

B P ORTHO-CEPT-28 Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 18 of 50 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 - Continued - O P dextromethorphan-guaifenesin syrup 10-100 mg/5ml CONTRACEPTIVES - PROGESTIN ONLY B N DURATUSS DM - Continued - B N DURADEX B N ABRAXANE G N dextromethorphan/guaifene

B N NOR-QD G N amibid dm

B P ORTHO MICRONOR G N aquabid-dm

G N norethindrone tab 0.35 mg G N gg/dm cr tab 600-30mg

B N OVRETTE 28 G N gg/dm sr tab 600-30mg

CONTRACEPTIVES - TRI-PHASIC COMBINATIONS G N guaifenex dm

G N q-bid-dm B P CYCLESSA B N Z-COF LAX G N desogest-ethin est tab 0.1-0.025/0.125-0.025/0.15-0.025mg-mg G N exefen-dm B P TRI-LEVLEN B N MUCO-FEN DM B P TRIPHASIL 28 G N gfn 1000/dm 60 G N levonorgestrel-eth estra tab 0.05-30/0.075-40/0.125-30mg-mcg G N gg/dm la tab B P ORTHO-NOVUM 7/7/7-28 G N guaifenesin tab dm G N norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35 mg-mcg B N AQUATAB DM B N TRI-NORINYL 28 G N entab-dm G N norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35 mg-mcg G N g-bid dm B N ORTHO TRI-CYCLEN LO G N gfn 1200/dm 60 B P ORTHO TRI-CYCLEN G N guaifenesin tab /dm er G N norgestimate-eth estrad tab 0.18-35/0.215-35/0.25-35 mg-mcg G N guaifenesin/dm sr B N ESTROSTEP FE G N tussi-bid COUGH/COLD - ANTITUSSIVE - NARCOTIC G N tussitab

B N HYCOTUSS EXPECTORANT B N HYCODAN TAB 5MG G N hydrocodone-guaifenesin G N hydrocodone/ tab homatrop B N M-CLEAR JR G N hydrocod/hom syp 5-1.5/5 B N PRO-CLEAR G N hydromet syp 5-1.5/5 B P PRO-CLEAR SYP COUGH/COLD - ANTITUSSIVE - NONNARCOTIC B N PROLEX DH

G N benzonatate cap 100 mg G N hydrocodone-potassium guaiacolsulfonate

B N TESSALON B N HUMIBID DM

G 2 N benzonatate cap 200 mg COUGH/COLD - ANTITUSSIVE-EXPECTORANT - COUGH/COLD - ANTITUSSIVE-EXPECTORANT DECONGEST-ANTIHIST G N pseudoephed-bromphen-dm-gg syrup 30-2-5-50 mg/5ml

B N BRONTEX COUGH/COLD - G N gg/codeine tab 300-10 ANTITUSSIVE-EXPECTORANTS-DECONGESTANT B N ENTEX HC B N TUSSI-ORGANIDIN NR B N LEVALL 5.0 B N TUSSI-ORGANIDIN-S NR G N phenylephrine w/hydrocodone-gg B N DIABETIC TUSSIN C B N DURATUSS HD G P CHERATUSSIN SYP AC B N NUCOFED EXPECTORANT G N codeine-guaifenesin B N NOVAHISTINE EXPECTORANT G N gg/codeine syp 100-10/5 G N pseudoephedrine w/ codeine-gg B N PROLEX DM B N Z-COF DMX G N dextromethorphan-potassium guaiacolsulfonate G N coldmist dm syp 40-15-10 G N drituss dm G N pseudoephedrine w/ dm-gg syrup 40-15-100 mg/5ml G N guiadrine dm G P TRI-VENT DM SYP G N ht-tuss dm B N PROFEN II DM G N hydro-tussin dm G N pseudoephedrine w/ dm-gg tab sr 12hr 45-30-800 mg G N su-tuss dm

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 19 of 50 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 - Continued - B N AQUATAB D COUGH/COLD - B N MAXIFED ANTITUSSIVE-EXPECTORANTS-DECONGESTANT - Continued - G N pseudoephedrine-guaifenesin tab sr 12hr 80-800 mg B N PANMIST DM B N PANMIST LA

G N coldmist dm tab 12hr G N PSEUDO/GG LA TAB 12HR

G N pseudoephedrine w/ dm-gg tab sr 12hr 48-32-595 mg G N pseudoephedrine-guaifenesin tab sr 12hr 85-795 mg

G N pseudoephedrine w/ dm-gg tab sr 12hr 60-30-600 mg B N H 9600 SR

B N AQUATAB C B N PROFEN FORTE

B N MAXIFED DMX B N DYNEX

B N PROFEN FORTE DM B N ZEPHREX LA

G N pseudoephedrine w/ dm-gg G N GG/PSE CR TAB 600-120

B N PANCOF EXP G N GUAIFENEX TAB PSE 120

G N pseudoephedrine-dihydrocodeine-guaifenesin G N MIRAPHEN PSE TAB 120-600

G N pseudoephedrine w/ hydrocodone-gg syrup 15-3-100 mg/5ml G N pseudoephedrine-guaifenesin tab sr 12hr 120-600 mg

G N pseudoeph w/hydrocodone-gg G N pseudoephedrine-guaifenesin

B N LEVALL G N pseudoephedrine-guaifenesin tab sr 12hr 120-1200 mg G N phenylephrine-carbetapentane-guaifenesin COUGH/COLD - DECONGESTANT-ANTIHISTAMINE W/ COUGH/COLD - DECONGESTANT & EXPECTORANT ANTICHOLINERGIC B N RYNA-12X B N ALLERX-D COUGH/COLD - G N pseudoephedrine-methscopolamine DECONGESTANT-ANTIHISTAMINE-ANTICHOLINERGI COUGH/COLD - DECONGESTANT W/ EXPECTORANT B N PANNAZ S B N PANNAZ

B N ENTEX G N carbinoxamine-pseudoephedrine-methscopolamine

B N GUAIFED-PD B N ALLERX DOSE PACK

B N ENTEX ER B N DURAHIST

B N GUAIFED B N MESCOLOR

B N DECONSAL II G N chlorpheniramine-pseudoephedrine & methscopolamine

B N ENTEX LA B N EXTENDRYL JR

B N PROLEX PD B N EXTENDRYL

B N PROLEX D B N EXTENDRYL SR

B N MAXIPHEN-G B N DURAHIST PE

B N DURAPHEN II B N OMNIHIST II LA

B N DURATUSS B N DALLERGY

B N DURATUSS GP G N chlorpheniramine-phenylephrine-methscopolamine B N J-MAX COUGH/COLD - EXPECTORANT MIXTURES B N LIQUIBID-D

B N MAXIPHEN B N HUMIBID LA

G N phenylephrine-guaifenesin COUGH/COLD - EXPECTORANTS B N ALDEX G B N ORGANIDIN NR B N SINA-12X G N guaifenesin B N RESPAIRE-60

B N PANMIST S COUGH/COLD - NARCOTIC ANTITUSSIVE-ANTIHISTAMINE G N pseudoephedrine-guaifenesin syrup 40-200 mg/5ml B N TUSSIONEX PENNKINETIC EXT B N LEVALL G G N PROMETH/COD SYP 6.25-10 B N ENTEX PSE G N promethazine w/ codeine syrup 6.25-10 mg/5ml G N pseudoephedrine-guaifenesin tab sr 12hr 45-800 mg COUGH/COLD - NARCOTIC B N PANMIST JR ANTITUSSIVE-DECONGESTANT G N pseudoephedrine-guaifenesin tab sr 12hr 60-600 mg B N NALEX DH

G N pseudoephedrine-guaifenesin tab sr 12hr 60-1200 mg G P phenyleph-hydrocodone

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 20 of 50 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 - Continued - COUGH/COLD - NON-NARC ANTITUSSIVE-DECONGESTANT-ANTIHISTAMINE COUGH/COLD - NARCOTIC ANTITUSSIVE-DECONGESTANT - Continued - G N phenylephrine-chlorphen-dm G P pseudoephedrine w/ hydrocodone G N phenyleph tannate-chlorphen tannate-carbetapentane tannate

B N NUCOFED G N phenylephrine-pyrilamine-dm

COUGH/COLD - NARCOTIC B N TUSSI-12D ANTITUSSIVE-DECONGESTANT-ANTIHISTAMINE B N TUSSI-12D S

B N PROMETHAZINE VC/CODEINE G N pseudoephedrine tan-chlorphen tan-dextromethorphan tan

B N CODIMAL PH B N DELTUSS DMX

B N PANCOF PD G N ANDEHIST DM SYP NR

G N phenylephrine-chlorpheniramine-dihydrocodeine G N BROMAXEFED SYP DM RF

G N pseudoeph-chlorphen w/ cod G N pseudoephed-bromphen-dm

B N B-TUSS B N TANAFED DMX

B N Phenyleph-CPM w/ Hydrocod B N PEDIATEX DM

G N Phenyleph-CPM w/ Hydrocod B N CORDRON-DM

G N HISTINEX HC SYP B N RONDEC DM

B N CODIMAL DH G N pseudoephed-carbinox-dm

G N CODITUSS DH SYP B N RYNATUSS

G N phenyleph-pyril w/ hydrocod B N RYNATUSS PEDIATRIC

B N PRO-RED G N phenylephrine-ephedrine-chlorpheniramine w/ carbetapentane B N PRO-RED SYP COUGH/COLD - SYSTEMIC DECONGESTANTS B N BROVEX HC

B N M-END (REFORMULATED) O P pseudoephedrine hcl tab 30 mg

G N pseudoephed-cpm w/ hydrocod O P pseudoephedrine hcl tab 60 mg

B N PANCOF O P pseudoephedrine hcl syrup 30 mg/5ml G N pseudoephedrine-chlorpheniramine-dihydrocodeine COUGH/COLD - TOPICAL DECONGESTANTS B N HISTEX HC B N ADRENALIN G N PSE/HYDROCOD LIQ /CARBINX B N TYZINE PEDIATRIC NASAL DR G N pseudoephedrine-carbinoxamine w/ hydrocodone B N TYZINE G N TRI-VENT HC LIQ COX 2 INHIBITORS - HIGHLY SELECTIVE COUGH/COLD - NON-NARC ANTITUSSIVE-ANTIHISTAMINE B 11 P CELEBREX B N TUSSI-12

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

B N TUSSI-12 S G 11 N ketorolac tromethamine tab 10 mg G N chlorpheniramine tannate-carbetapentane tannate G P ketorolac tromethamine inj 15 mg/ml G N tussizone-12 sus 4-30mg/5 B 11 N TORADOL IV/IM G N PROMETHAZINE SYP DM G P ketorolac tromethamine inj 30 mg/ml G N promethazine-dm G 11 N meloxicam COUGH/COLD - NON-NARC B 11 N MOBIC TAB 15MG ANTITUSSIVE-DECONGESTANT 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

O P pseudoephedrine-dm liqd 30-15 mg/5ml CYTO-MEGALOVIRUS AGENTS

O P pseudoephedrine-dm elixir 20-10 mg/5ml B P VISTIDE O P pseudoephedrine-dm syrup 15-5 mg/5ml B P FOSCAVIR O P pseudoephedrine-dm syrup 15-7.5 mg/5ml B P CYTOVENE CAP 250MG O P pseudoephedrine-dm syrup 30-15 mg/5ml B P CYTOVENE CAP 500MG O P pseudoephedrine-dm soln 7.5-2.5 mg/0.8ml G P ganciclovir

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 21 of 50 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 - Continued - B 11 N HUMALOG CYTO-MEGALOVIRUS AGENTS B 11 N HUMALOG PEN - Continued - B 11 P LEVEMIR INJ FLEXPEN B N CYTOVENE INJ 500MG O 11 P NOVOLIN R INNOLET

B P VALCYTE O 11 P NOVOLIN R U-100 PENFILL

DENTAL PRODUCTS B 11 N HUMULIN N U-100 PEN

O 11 P NOVOLIN N INNOLET B P PREVIDENT O 11 P NOVOLIN N U-100 PENFILL B P PREVIDENT 5000 PLUS B 11 P NOVOLOG MIX 70/30 PENFILL G P sodium fluoride cream 1.1% B 11 P NOVOLOG MIX 70/30 PREFILL B P PREVIDENT 5000 BOOSTER B 11 N HUMALOG MIX 75/25 PEN B P PREVIDENT FLUORIDE B 11 N HUMULIN 70/30 PEN B N THERA-FLUR-N O 11 P NOVOLIN 70/30 INNOLET G P sodium fluoride gel 1.1% (0.5% f) O 11 P NOVOLIN 70/30 PENFILL B P GEL-KAM ORAL CARE RINSE DIABETIC - MEGLITINIDES G P stannous fluoride conc 0.63%

DIABETIC - ALPHAGLUCOSIDASE B P STARLIX

B N PRANDIN B N PRECOSE DIABETIC - ORAL BIGUANIDES B P GLYSET

DIABETIC - INSULIN B N GLUCOPHAGE

G P metformin hcl O P ILETIN II REGULAR/PORK B N RIOMET O P ILETIN II NPH/PORK B N GLUCOPHAGE XR B P NOVOLOG B N GLUMETZA B N LANTUS G N metformin hcl tab sr 24hr 750 mg B P LEVEMIR G P metformin hcl tab sr 24hr 500 mg B N APIDRA INJ U-100 B N FORTAMET B N HUMALOG DIABETIC - ORAL SULFONYLUREAS O P NOVOLIN R

O P RELION R G P chlorpropamide

B N HUMULIN R B N AMARYL

B 34 P EXUBERA COMBINATION PACK G P glimepiride

O P VELOSULIN BR B N GLUCOTROL

B N HUMULIN N G P glipizide

O P NOVOLIN N B N GLUCOTROL XL

O P RELION N G N glipizide er

B N HUMULIN L G N glipizide xl

B N HUMULIN U B N DIABETA

B P NOVOLOG MIX 70/30 B N MICRONASE

B N HUMALOG MIX 75/25 G P glyburide

B N HUMULIN 70/30 B N GLYNASE

O P NOVOLIN 70/30 G P glyburide micronized

O P RELION 70/30 B N TOLINASE

B N HUMULIN 50/50 G P tolazamide

DIABETIC - INSULIN PENFILLS B P TOLBUTAMIDE

DIABETIC - OTHER B 11 P NOVOLOG FLEXPEN

B 11 P NOVOLOG PENFILL B 11 P SYMLIN

B 11 N LANTUS OPTICLIK B 11 P BYETTA

B 11 N APIDRA INJ OPTICLIK B N GLUCAGEN Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 22 of 50 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 - Continued - G P methyclothiazide DIABETIC - OTHER B P ZAROXOLYN - Continued - G P metolazone B P GLUCAGON EMERGENCY KIT B N MODURETIC 5-50

B P PROGLYCEM G P amiloride & hydrochlorothiazide

B P GLUCAGON B P ALDACTAZIDE TAB 25/25

DIABETIC - SULFONYLUREA / BIGUANIDE G P spironolactone & hydrochlorothiazide

B P ALDACTAZIDE TAB 50/50 B N METAGLIP B N DYAZIDE B N GLUCOVANCE B N MAXZIDE-25 G P glyburide-metformin B N MAXZIDE B P AVANDARYL G P triamterene & hydrochlorothiazide DIABETIC - THIAZOL DOPAMINE RECEPTOR AGONISTS

B P ACTOS B P DOSTINEX B P AVANDIA EAR DIABETIC - THIAZOL / BIGUANIDE COMBO

B P FLOXIN OTIC B P ACTOPLUS MET B P FLOXIN OTIC SINGLES B P AVANDAMET G P benzocaine (otic) DIAGNOSTIC BIOLOGICALS G N hydrocortisone w/acetic acid

G P acetic acid (otic) B P APLISOL B N DOMEBORO B N TUBERSOL G P acetic acid-aluminum acetate DIURETICS B N CORTANE-B

B 11 P INSPRA B P CIPRODEX

G P acetazolamide B P CIPRO HC

B N DIAMOX B N CORTISPORIN SUS 1% OTIC

G P methazolamide B P PEDIOTIC

B N BUMEX G N antibiot ear sus 1% otic

G P bumetanide G N cortomycin sus 1% otic

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

B N LASIX B N CORTISPORIN SOL 1% OTIC

G P furosemide G P antibiot ear sol 1% otic

B N DEMADEX G P cortomycin sol 1% otic

G P torsemide G P neomycin-polymyxin-hc otic soln 1%

B N MIDAMOR B N COLY-MYCIN-S

G P amiloride hcl tab 5 mg B N CORTISPORIN-TC

B N ALDACTONE G P benzocaine & antipyrine

G P spironolactone B N CORTANE-B-OTIC

B N NATURETIN G N pramoxine-hc-chloroxylenol

G P chlorothiazide B N CORTANE-B AQUEOUS

B N DIURIL G N pramoxine-hc-chloroxylenol aqueous

B N DIURIL IV B N TYMPAGESIC DROPS

B N THALITONE G P benzocaine-phenylephrine-antipyrine

G P chlorthalidone ELECTROLYTES/ NUTRITIONALS B N MICROZIDE O P *oral electrolyte solution*** G P hydrochlorothiazide B N MULTILYTE-20 B N LOZOL G P lactated ringer's solution G P indapamide

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 23 of 50 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 - Continued - B N PREFEST ELECTROLYTES/ NUTRITIONALS G N Estradiol-Norgestimate - Continued - ESTROGENS - PATCHES G P kcl 0.15% in nacl 0.9%

G P dextrose 5% w/ kcl 0.15% B N ESTROGEL

G P dextrose 5% w/ kcl 0.224% B N ALORA

G P dextrose 5% w/ sodium chloride 0.2% B N ESCLIM

G P dextrose 5% w/ sodium chloride 0.45% B P ESTRADERM

G P dextrose 5% w/ sodium chloride 0.9% B P VIVELLE

G P dextrose 10% w/ sodium chloride 0.2% B P VIVELLE-DOT

G P dextrose 5% in lactated ringers B N MENOSTAR

G P kcl 0.075% in d5/0.2% nacl B N CLIMARA

G P kcl 0.075% in d5/0.45% nacl G N estradiol

G P kcl 0.15% in d5/0.33% nacl ESTROGENS - TABS G P kcl 0.15% in d5/0.45% nacl B P PREMARIN G P kcl 0.224% in d5/0.45% nacl B P CENESTIN G P dextrose inj 5% B N ENJUVIA G P dextrose inj 10% B P MENEST G P dextrose inj 50% B N ESTRACE G P dextrose inj 70% G P estradiol B N LIPOSYN III G P gynodiol G P fat emulsion iv soln 20% B P DEPO-ESTRADIOL B N FREAMINE III G N estradiol cypionate B P PREMASOL B N DELESTROGEN B P TRAVASOL G N estradiol valerate B N TROPHAMINE B N ESTRONE B P AMINOSYN II B N OGEN G N *amino acid infusion 15%*** G P estropipate G N albumin, human inj 5%

G P buminate inj 25% FLUOROQUINOLONES

G P flexbumin inj 25% B P CIPROFLOXACIN G P plasbumin-25 inj 25% B N CIPRO XR ERYTHROPOEISIS STIMULATING AGENTS B P CIPRO CYSTITIS

B N CIPRO B 11 N ARANESP G P ciprofloxacin hcl B 11 N EPOGEN B N PROQUIN XR B 11 P PROCRIT B P CIPRO I.V. ESTROGEN COMBOS B P LEVAQUIN LEVA-PAK

B N ANGELIQ B P LEVAQUIN

B N CLIMARA PRO B P LEVAQUIN PREMIX

ESTROGEN COMBO'S B N AVELOX ABC PACK B N AVELOX

G N estradiol & testosterone cypionates im in oil 2-50 mg/ml B N NOROXIN

G N estradiol val & testosterone enanthate im in oil 4-90 mg/ml B N FLOXIN

G N estradiol val & testosterone enanthate im in oil 8-180 mg/ml G N ofloxacin

B P PREMPRO B N TEQUIN

B P PREMPHASE G N gatifloxacin

B N ACTIVELLA B N FACTIVE B N COMBIPATCH GI - ANTI - FLATULENTS / GI STIMULANTS B N FEMHRT 1/5 Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 24 of 50 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 - Continued - B N LEVBID GI - ANTI - FLATULENTS / GI STIMULANTS G P hyoscyamine tab 0.375mg - Continued - G P hyoscyamine sulfate B N OSMOPREP B P ROBINUL TAB 1MG

B N VISICOL TAB 1.5GM B P ROBINUL FORTE

O P senna tab 187 mg B N ROBINUL INJ 0.2MG/ML

O P sennosides tab 8.6 mg G N glycopyrrolate

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

B N KRISTALOSE PAK 10GM B P PAMINE FORTE

B N KRISTALOSE PAK 20GM B P PROPANTHELINE BROMIDE

B N MIRALAX POW 3350 NF B N BENTYL CAP 10MG

G 7 P polyethylene glycol 3350 oral powder B N BENTYL TAB 20MG

B N MIRALAX PAK 3350 NF G P dicyclomine hcl

G 7 P polyethylene glycol 3350 oral packet B P BENTYL SYP 10MG/5ML

B P NULYTELY SOL B N B & O 15-A SUPPRETTE

G P peg 3350-kcl-sod bicarb-nacl for soln 420 gm G P belladonna alkaloids & opium suppos 16.2-30 mg

B P COLYTE SOL B N B & O 16-A SUPPRETTE

B P COLYTE-FLAV SOL G N belladonna alkaloids & opium suppos 16.2-60 mg B P GOLYTELY SOL PINEAPPL GI - ANTIPERISTALTIC AGENTS B P COLYTE/FLAVR SOL PACKS

G P peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240 gm B N LOMOTIL

B P GOLYTELY SOL G P diphenoxylate w/ atropine

B P GASTROCROM CON 100/5ML B N MOTOFEN

B N REGLAN TAB 5MG G P loperamide cap 2mg

G P metoclopramide hcl tab 5 mg O P loperamide hcl tab 2 mg

B N REGLAN TAB 10MG O P loperamide hcl liq 1 mg/5ml (0.2 mg/ml)

G P metoclopramide hcl tab 10 mg B P OPIUM TINCTURE

G P metoclopramide hcl syrup 5 mg/5ml G P paregoric

G P metoclopramide hcl inj 5 mg/ml GI - DIGESTIVE ENZYMES G P lactulose (encephalopathy) solution 10 gm/15ml G 11 N digestive enzymes w/ anticholinergics B N AMITIZA B 11 N KU-ZYME HP GI - ANTIDIARRHEAL / ANTACID - MISC. B 11 N KU-ZYME

O 11 P sodium bicarbonate tab 325 mg B 11 N LAPASE

O 11 P sodium bicarbonate tab 650 mg B 11 N DYGASE

O 11 P magnesium oxide cap 140 mg (85 mg elemental mg) B 11 N KUTRASE

O 11 P magnesium oxide tab 400 mg B 11 P VIOKASE 8

B P SAL-TROPINE G 11 P amylase-lipase-protease tab 30000-8000-30000 unit

G P atropine sulfate B 11 P VIOKASE 16

B N BELLADONNA ALKALOIDS G 11 N amylase-lipase-protease tab 60000-16000-60000 unit

B P ANASPAZ B 11 P VIOKASE

B N SYMAX DUOTAB B 11 N PANCREASE MT 4

B N LEVSIN/SL B 11 N CREON 5

G P hyoscyamine sub 0.125mg G 11 P lipram-cr5

G P hyoscyamine elx 0.125/5 B 11 N PANCREASE

B N LEVSIN B 11 N PANOCAPS

G P hyoscyamine dro 0.125/ml G 11 P lipram 4500

B N LEVSINEX G 11 P pancrelipase

B N NULEV G 11 P pangestyme ec

G P hyoscyamine tab 0.125mg G 11 P ultrase

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 25 of 50 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 - Continued - G P ranitidine inj 150/6ml GI - DIGESTIVE ENZYMES G P ranitidine inj 50mg/2ml - Continued - B N PEPCID B 11 N PANCRECARB MS-4 G P famotidine

B 11 N PANCREASE MT 10 G N nizatidine

G 11 P lipram-pn10 B N AXID B 11 N CREON 10 GI - INFLAMMATORY BOWEL AGENTS B 11 N PALCAPS 10

G 11 P lipram-cr10 B P COLAZAL

G 11 P pangestyme cn 10 B P PENTASA

B 11 P ULTRASE MT 12 B P ASACOL

G 11 P lipram-ul12 B P ROWASA

G 11 P pangestyme ul 12 G P mesalamine enema 4 gm

B 11 N PANCRECARB MS-8 B N CANASA

B 11 N PANCREASE MT 16 B P DIPENTUM

B 11 N PANOCAPS MT 16 B P AZULFIDINE

G 11 P lipram-pn16 G P sulfasalazine tab 500 mg

G 11 P pancrelipase mst-16 B P AZULFIDINE EN-TABS

G 11 P pangestyme mt 16 G N sulfasalazine tab delayed release 500 mg

B 11 N PANCREASE MT 20 B N REMICADE

B 11 N PANOCAPS MT 20 GI - IRRITABLE BOWEL SYNDROME AGENTS G 11 P lipram-pn20 B N LOTRONEX B 11 P ULTRASE MT 18 B 11 N ZELNORM G 11 P pangestyme ul 18

B 11 N CREON 20 GI - MISC.

B 11 N PALCAPS 20 O P magnesium hydroxide susp 400 mg/5ml G 11 P lipram-cr20 O P senna syrup 176 mg/5ml G 11 P pangestyme cn 20 O P sennosides syrup 8.8 mg/5ml B 11 P ULTRACAPS MT 20 O P sennosides-docusate sodium tab 8.6-50 mg B 11 P ULTRASE MT 20 B P HALFLYTELY BOWEL PREP KIT G 11 P lipram-ul20 B P ACTIGALL G 11 P pangestyme ul 20 G P ursodiol cap 300 mg GI - H2-ANTAGONISTS B P URSO

B P URSO 250 G P cimetidine tab 200 mg B N URSO FORTE TAB 500MG G P cimetidine tab 300 mg B P SORBITOL B N TAGAMET

G P cimetidine tab 400 mg GI - MISC. ANTI-ULCER

G P cimetidine tab 800 mg B N CARAFATE TAB 1GM G P cimetidine hcl G P sucralfate tab 1 gm G N ranitidine cap 150mg B P CARAFATE SUS 1GM/10ML G N ranitidine cap 300mg GI - PROSTAGLANDINS B N ZANTAC TAB 150MG

G P ranitidine tab 150mg B P CYTOTEC

B N ZANTAC TAB 300MG G N misoprostol G P ranitidine tab 300mg GI - PROTON PUMP INHIBITOR B N ZANTAC TAB 150MG EF

B N RANITIDINE SYP 75MG/5ML B 11 N NEXIUM

B P ZANTAC SYP 75MG/5ML B 12 P PREVACID

B N ZANTAC INJ 25MG/ML B 20 P PREVACID SOLUTAB

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 26 of 50 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 - Continued - B P KENALOG-10 GI - PROTON PUMP INHIBITOR B P KENALOG-40 - Continued - B N CELESTONE-SOLUSPAN B 11 N ZEGERID B P FLORINEF

G 11 N omeprazole caps G N fludrocortisone acetate B 11 N PRILOSEC GOUT O 12 P OMEPRAZOLE MAGNESIUM DELAYED RELEASE TAB 20 MG (BASE EQUIV)

B 12 P PROTONIX B N ZYLOPRIM

B 11 N ACIPHEX G P allopurinol

B 11 N ZEGERID CAP 20-1100 B N COLCHICINE TAB 0.6 MG

B 11 N ZEGERID CAP 40-1100 G P colchicine

GI - PROTON PUMP INHIBITOR/NSAID COMBO G P probenecid B P SULFINPYRAZONE

B 12 P PREVACID NAPRAPAC G P colchicine w/ probenecid

GI - ULCER ANTI-INFECTIVE GRANULOCYTE CSF

B P HELIDAC B 11 P NEUPOGEN

B 12 P PREVPAC B 11 N NEULASTA

GLUCOCORTICOIDS - CORTICOTROPIN B 11 N LEUKINE

B 11 N NEUMEGA B P ACTHAR HP GROWTH HORMONE GLUCOCORTICOIDS - MINERALOCORTICOIDS

B 11 N PROTROPIN B P CELESTONE B 11 P NUTROPIN AQ B P ENTOCORT EC B 11 P NUTROPIN AQ PEN G P cortisone acetate B 11 N NORDITROPIN CARTRIDGE B P DEXAMETHASONE INTENSOL B 11 N NORDITROPIN NORDIFLEX PEN B N DECADRON B 11 N IPLEX G P dexamethasone B 11 N HUMATROPE COMBO PACK G P dexamethasone sodium phosphate inj 4 mg/ml B 11 P NUTROPIN INJ 5MG G P dexamethasone sodium phosphate inj 10 mg/ml B 11 P TEV-TROPIN B P HYDROCORTONE B 11 P GENOTROPIN INTRA-MIX B P CORTEF B 11 P GENOTROPIN G P hydrocortisone B 11 P NUTROPIN INJ 10MG B P SOLU-CORTEF B 11 N HUMATROPE B N MEDROL B 11 P GENOTROPIN MINIQUICK G P methylprednisolone B 11 N NUTROPIN DEPOT B P DEPO-MEDROL B 11 N SAIZEN G N methylprednisolone acetate B 11 N ZORBTIVE B P SOLU-MEDROL B 11 N INCRELEX G N methylprednisolone sod succ HEMOSTATIC B N PRELONE

G P prednisolone B P AMICAR

B P PEDIAPRED G P aminocaproic acid

B P ORAPRED B N SURGICEL FIBRILLAR ABSORB

G N prednisolone sodium phosphate B N SURGICEL ABSORBABLE HEMOS

B N ORAPRED ODT B N SURGICEL NU-KNIT ABSORBAB G P deltasone HEPATITIS B ONLY G P orasone

B N PREDNISONE INTENSOL B P HEPSERA

G P prednisone B P BARACLUDE

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 27 of 50 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 - Continued - G P GAMMAGARD LIQUID HEPATITIS C AGENTS G N immune globulin (human) iv soln 10% B N VIVAGLOBIN

B N INFERGEN G P rabies immune globulin (human) inj 150 unit/ml

B P PEGASYS B P WINRHO SDF

B P PEG-INTRON G P rho d immune globulin (human) im inj 50 mcg

B P PEG-INTRON REDIPEN B P RHOGAM HUMAN

B P PEG-INTRON REDIPEN PAK 4 B P BAYTET B P REBETOL INFLUENZA AGENTS G N ribavirin cap 200 mg

B N COPEGUS B N FLUMADINE TAB 100MG

G N ribapak G P rimantadine hydrochloride tab 100 mg

B P REBETRON B P FLUMADINE SYP 50MG/5ML

HEREDITARY TYROSINEMIA TYPE 1 (HT-1) B 25 P TAMIFLU TREATMENT - AGENTS B P RELENZA DISKHALER

B P ORFADIN B P FLUARIX 2005-2006

HERPES AGENTS B 5 P FLUMIST NASAL VACCINE 200

IRRIGATION SOLUTIONS B N ZOVIRAX CAP 200MG

G P acyclovir cap 200mg G P water for irrigation, sterile irrigation soln B N ZOVIRAX TAB 400MG K REMOVING RESINS G P acyclovir tab 400mg

B N ZOVIRAX TAB 800MG G P sodium polystyrene sulfonate oral susp 15 gm/60ml

G P acyclovir tab 800mg G P sodium polystyrene sulfonate rectal susp 30 gm/120ml

B P ZOVIRAX SUS 200/5ML B P KAYEXALATE

G N acyclovir sus 200/5ml G P sodium polystyrene sulfonate powder

G P acyclovir sodium LINCOSAMIDES / OXAZOLIDINONES / LEPROSTATICS B P VALTREX G N chloramphenicol sodium succinate for iv inj 1 gm B N FAMVIR B N LINCOCIN HYPERPARATHYROID TREATMENT - VITAMIN D ANALOGS B N CLEOCIN CAP 150MG B P HECTOROL G P clindamycin hcl cap 150 mg

HYPERPARATHYROID TREATMENT - VITAMIN D B N CLEOCIN CAP 300MG ANALOGS AND CALCIMIMETICS G 4 N clindamycin hcl cap 300 mg

B N ZEMPLAR B P CLEOCIN PEDIATRIC GRANULE

B N SENSIPAR B P CLEOCIN INJ 300MG

IMMUNE SERUMS B P CLEOCIN INJ 9GM

G P clindamycin phosphate inj 150 mg/ml B N CYTOGAM G P clindamycin phosphate iv soln 150 mg/ml B N BAYHEP B B P CLEOCIN INJ 600MG G P hepatitis b immune globulin (human) inj B P CLEOCIN INJ 900MG G N immune globulin (human) inj B 11 P ZYVOX G N gammagard s/d B P CUBICIN G P GAMMAGARD SD INJ 0.5GM HU B P DAPSONE G N POLYGAM S/D SOL 2.5GM MACROLIDES / ERYTHROMYCIN'S / KETOLIDES G P immune globulin (human) iv for soln 5 gm

G N immune globulin (human) iv for soln 6 gm B P ERYTHROMYCIN BASE

G P immune globulin (human) iv for soln 10 gm B P ERY-TAB

B P FLEBOGAMMA B N ERYC

B P GAMIMUNE N G P erythromycin w/ delayed release particles cap 250 mg

B P GAMUNEX B N PCE

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 28 of 50 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 - Continued - MIGRAINE - SELECTIVE SEROTONIN AGONISTS (5HT)- MACROLIDES / ERYTHROMYCIN'S / KETOLIDES -INJECTABLES - Continued - B 17 P IMITREX SPR 5MG/ACT G P erythromycin stearate tab 250 mg B 17 P IMITREX SPR 20MG/ACT

G P erythromycin stearate tab 500 mg B 17 P IMITREX INJ 6MG/0.5

B P ERYTHROMYCIN ESTOLATE B 17 P IMITREX STATDOSE PEN

G P erythromycin ethylsuccinate tab 400 mg B 17 P IMITREX STATDOSE REFILL

G P erythromycin ethylsuccinate susp 200 mg/5ml B 11 N ZOMIG

G P erythromycin ethylsuccinate susp 400 mg/5ml MIGRAINE - SELECTIVE SEROTONIN AGONISTS (5HT)- B P ERYPED -TABS B 11 N AXERT B P E.E.S. GRANULES B 17 P RELPAX B P ERYPED 200 B 11 N FROVA B P ERYPED 400 B 11 N AMERGE B P ZITHROMAX TAB 250MG B 17 P MAXALT B P ZITHROMAX Z-PAK B 17 P MAXALT-MLT G P azithromycin tab 250 mg B 17 P IMITREX TAB 25MG B P ZITHROMAX TAB 500MG B 17 P IMITREX TAB 50MG B N ZITHROMAX TRI-PAK B 17 P IMITREX TAB 100MG G P azithromycin tab 500 mg B 11 N ZOMIG B P ZITHROMAX TAB 600MG B 11 N ZOMIG ZMT G P azithromycin tab 600 mg

B P ZITHROMAX SUS 100/5ML MINERALS

B P ZITHROMAX SUS 200/5ML G P sodium acetate inj 2 meq/ml B P ZITHROMAX SUS 200MG/5 B N SODIUM ACETATE TRIHYDRATE B P ZMAX G P sodium bicarbonate inj 8.4% B N ZITHROMAX INJ 500MG O 11 P calcium carbonate tab 600 mg B N ZITHROMAX POW 1GM PAK O 11 P calcium carbonate chew tab 1250 mg (500 mg elemental ca) B N BIAXIN TAB 250MG O 11 P calcium carbonate susp 1250 mg/5ml G N clarithromycin tab 250 mg O 11 P calcium gluconate tab 650 mg B N BIAXIN TAB 500MG G 11 N calcium gluconate inj 10% G N clarithromycin tab 500 mg O P calcium lactate tab 650 mg B P BIAXIN SUS 125/5ML O 11 P calcium carbonate-vitamin d tab 500 mg-200 unit B P BIAXIN SUS 250/5ML O 11 P calcium carbonate-vitamin d tab 600 mg-200 unit B P BIAXIN XL B 11 N CALVITE P&D B P BIAXIN XL PAC B 11 N CALCIFOL G N clarithromycin er B N AMMONIUM CHLORIDE B N DYNABAC D5-PAK B P SODIUM FLUORIDE B N KETEK G P sodium fluoride chew tab 0.55 mg (0.25mg f) MIGRAINE - CARBOXYLIC ACID DERIVATIVES G P sodium fluoride chew tab 1.1 mg (0.5mg f)

G P sodium fluoride chew tab 2.2 mg (1 mg f) B P DEPAKOTE ER G P sodium fluoride soln 0.275 mg/drop (0.125 mg/drop f) MIGRAINE - ERGOTAMINE DERIVATIVES G P sodium fluoride soln 0.55 mg/drop (0.25 mg/drop f)

B 11 N D.H.E. 45 B P LURIDE

G 17 P dihydroergotamine mesylate inj 1 mg/ml B N PEDIAFLOR

B 17 P MIGRANAL G P sodium fluoride soln 1.1 mg/ml (0.5 mg/ml f)

MIGRAINE - MISC. B P PIMA B P SSKI

B 11 N CAFERGOT TAB 1-100MG G P magnesium sulfate inj 50%

G 11 N ergotamine w/ caffeine tab 1-100 mg B 11 P MAGNEBIND 400 B 17 P CAFERGOT SUP 2/100 Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 29 of 50 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 - Continued - O P ferrous sulfate soln 75 mg/0.6ml (15 mg/0.6ml elemental fe) MINERALS O P ferrous gluconate tab 325 mg - Continued - O P ferrous fumarate tab 325 mg G P potassium phosphate dibasic inj 3 mmole/ml G P iron dextran inj 50 mg/ml

B P K-PHOS B N VENOFER G P sodium phosphate inj 3 mmole/ml MOUTH - ANESTHETICS TOPICAL ORAL B N K-PHOS NEUTRAL

G P pot phos monobasic w/sod phos di & monobas tab 155-852-130mg B P XYLOCAINE SOL 2% VISC

B N POTASSIUM ACETATE G P lidocaine hcl viscous soln 2%

G P potassium acetate inj 2 meq/ml MOUTH - STEROIDS B N K-LYTE G P triamcinolone acetonide in orabase 0.1% G P potassium bicarbonate effer tab 25 meq

B N K-LYTE DS MOUTH ANTI-INFECTIVES

B P MICRO-K G P nystatin susp 100000 u/ml G P potassium chloride cap cr 10 meq MOUTH ANTISEPTICS G P potassium chloride tab cr 8 meq

B N K-TABS B N PERIDEX ORAL RINSE

G P potassium chloride tab cr 10 meq G P chlorhexidine gluconate soln 0.12%

G P potassium chloride oral liq 10% B N DEBACTEROL B N RUM-K MUCOPOLYSACCHARIDOSIS B N KAON-CL

G P potassium chloride oral liq 20% B P ALDURAZYME

G P potassium chloride inj 2 meq/ml MULTIPLE SCLEROSIS AGENTS B N POTASSIUM CHLORIDE B N COPAXONE G P potassium chloride powder packet 20 meq B P REBIF B N KLOR-CON 25 B P REBIF TITRATION PACK G P potassium chloride microencapsulated crys cr tab 10 meq B P AVONEX B N KLOR-CON M15 B P BETASERON B P K-DUR B N TYSABRI G P potassium chloride microencapsulated crys cr tab 20 meq

B N K-LYTE/CL MUSCLE RELAXANT -COMBINATIONS

G N pot bicarbonate & chloride effer tab 25 meq B 11 N SOMA COMPOUND G P sodium chloride inj 0.45% G 11 N carisoprodol w/ asa tab 200-325 mg G P sodium chloride inj 0.9% B 11 N SOMA COMPOUND/CODEINE G P sodium chloride iv soln 0.9% G 11 N carisoprodol w/ asa & codeine tab 200-325-16 mg G N sodium chloride inj 5% G P orphenadrine w/ aspirin & caffeine tab 25-385-30 mg B N SODIUM CHLORIDE B P NORGESIC FORTE G N sodium chloride inj 4 meq/ml (23.4%) G 11 N orphenadrine w/ aspirin & caffeine tab 50-770-60 mg G N sodium chloride inj 2.5 meq/ml (14.6%) MUSCLE RELAXANTS G N zinc sulfate cap 220 mg

B P ZINC SULFATE G P baclofen

B N GLUTOFAC-MX B P LIORESAL INTRATHECAL

G N selenious acid inj 40 mcg/ml B 11 N SOMA

B N TRACE METALS ADDITIVE FTV G P carisoprodol

G N trace min (cr-cu-mn-se-zn) inj 4-400-100-20-1000 mcg/ml B 11 N PARAFON FORTE DSC

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

B N M.T.E. 7 G P Cyclobenzaprine HCl Tab 5 MG

O P FERROUS SULFATE TAB 300 MG B 11 N FLEXERIL

O P ferrous sulfate tab 325 mg G P cyclobenzapr tab 10mg

O P ferrous sulfate elixir 220 mg/5ml B 11 N SKELAXIN

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 30 of 50 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 - Continued - G P meperidine inj 100mg/ml MUSCLE RELAXANTS G P msir - Continued - B P ROXANOL B 11 N ROBAXIN B N ROXANOL-T

B 11 N ROBAXIN-750 G P morphine sul sol 20mg/ml

G P methocarbamol B P MORPHINE SUL TAB 10MG

B 11 N NORFLEX G P morphine sul tab 15mg

G P orphenadrine citrate G P morphine sul tab 30mg

G 11 N tizanidine hcl tab 2 mg B N OXYIR CAP 5MG

G P tizanidine hcl tab 4 mg G P oxycodone cap 5mg

B 11 N ZANAFLEX G P roxicodone tab 5mg

B 11 N DANTRIUM G N oxycodone hcl tab 5 mg

G 11 N dantrolene sodium G P roxicodone tab 15mg

NARCOTIC - ANTAGONISTS G P oxycodone hcl tab 15 mg

G P roxicodone tab 30mg B N NARCAN G P oxycodone hcl tab 30 mg G N naloxone hcl inj 0.4 mg/ml G N roxicodone intensol B N VIVITROL INJ 380MG G P oxycodone con 20mg/ml B N REVIA G P oxydose G P naltrexone hcl tab 50 mg G P oxyfast NARCOTICS - MISC. G P roxicodone sol 5mg/5ml

G P oxycodone sol 5mg/5ml B P CODEINE PHOSPHATE B N DARVON B P CODEINE SULFATE G P propoxyphene hcl G P fentanyl citrate inj 0.05 mg/ml B N DARVON-N B 11 N ACTIQ B P SUBUTEX G P hydromorphon tab 2mg B P SUBOXONE SUB 2-0.5MG G P hydromorphon tab 4mg B P SUBOXONE SUB 8-2MG G P hydromorphon tab 8mg B P TALWIN NX B N DILAUDID-5 G N pentazocine w/ naloxone G P hydromorphon inj 2mg/ml B N TYLOX B N DILAUDID-HP G P oxycod/apap cap 5-500mg G P hydromorphon inj 10mg/ml G P oxycod/apap tab 5-325mg G P hydromorphon inj 50mg/5ml G P oxycodone w/ acetaminophen tab 5-325 mg B N DILAUDID G N oxycodone w/ acetaminophen tab 7.5-325 mg G N hydromorphon sup 3mg G P oxycodone w/ acetaminophen tab 7.5-500 mg B N DEMEROL TAB 50MG G N oxycodone w/ acetaminophen tab 10-325 mg G P meperidine tab 50mg B N PERCOCET B N DEMEROL TAB 100MG G N oxycodone w/ acetaminophen tab 10-650 mg G P meperidine tab 100mg B P ROXICET G P meperitab B P PERCODAN B P DEMEROL SYP 50MG/5ML G P oxycodone w/ aspirin G N meperidine syp 50mg/5ml B N COMBUNOX B N DEMEROL INJ 25MG/ML B N TYLENOL/CODEINE #3 B N DEMEROL INJ 100/2ML B N TYLENOL/CODEINE #4 B N DEMEROL INJ 50MG/ML B N VOPAC B N DEMEROL INJ 75MG/1.5 G P acetaminophen w/ codeine G P meperidine inj 50mg/ml B N CAPITAL/CODEINE B P DEMEROL INJ 75MG/ML G P aspirin w/ codeine B P DEMEROL INJ 100MG/ML B N FIORICET/CODEINE Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 31 of 50 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 - Continued - B N NUBAIN NARCOTICS - MISC. G P nalbuphine hcl inj 20 mg/ml - Continued - B 23 N ULTRACET G N butalbital-acetaminophen-caffeine w/ codeine NARCOTICS-LONG ACTING B P FIORINAL/CODEINE #3

G N butalbital-aspirin-caffeine w/cod B N DURAGESIC

B N PANLOR DC G N fentanyl

B N PANLOR SS G P methadone hcl

B N SYNALGOS-DC G P morphine sul inj 2mg/ml

B N LORCET-HD B P MORPHINE SUL INJ 4MG/ML

B N LORTAB 2.5 TAB G P morphine sul inj 5mg/ml

B N LORTAB 5 TAB G P morphine sul inj 8mg/ml

B N VICODIN G P morphine sul inj 10mg/ml

B N LORTAB 7.5 TAB G P morphine sul inj 15mg/ml

B N LORTAB 10 TAB G P morphine sul inj 25mg/ml

B P ANEXSIA G N morphine sul inj 50mg/ml

B P LORCET PLUS B P MORPHINE SUL SOL 10MG/5ML

B N LORCET 10/650 B P MORPHINE SUL SOL 20MG/10

B N MAXIDONE B P MORPHINE SUL SOL 20MG/5ML

B N NORCO G N morphine sul sup 5mg

B N ZYDONE G P morphine sul sup 10mg

B P XODOL B P RMS

B N HYCET G P morphine sul sup 20mg

B N LORTAB ELX B N KADIAN

G P hydrocodone-acetaminophen B N MS CONTIN TAB 15MG CR

B N REPREXAIN G P morphine sulfate tab sr 12hr 15 mg

B N VICOPROFEN B N MS CONTIN TAB 30MG CR

G N hydrocodone-ibuprofen G P morphine sulfate tab sr 12hr 30 mg

B N DARVON COMPOUND-65 B N MS CONTIN TAB 60MG CR

G P propoxyphene hcl w/ apap G P morphine sulfate tab sr 12hr 60 mg

B N DARVOCET-N 50 B N MS CONTIN TAB 100MG CR

G P propoxyphene-n w/ apap tab 50-325 mg B N ORAMORPH SR

B N TRYCET G P morphine sulfate tab sr 12hr 100 mg

G N BALACET 325 B N MS CONTIN TAB 200MG CR

G N propoxyphene-n w/ apap tab 100-325 mg G P morphine sulfate tab sr 12hr 200 mg

B N DARVOCET A500 B P AVINZA

B N DARVOCET-N 100 B N DEPODUR

G P propoxyphene-n w/ apap tab 100-650 mg B 30 N OXYCONTIN

B P TALACEN G 30 P oxycodone hcl er

G N pentazocine w/ apap B N OPANA

NARCOTICS - SELECTED B N OPANA ER NEUROLOGICS - MISC. B N ULTRAM

G P tramadol hcl tab 50 mg G P ergoloid mesylates tab 1 mg

B N ULTRAM ER B P ORAP

G N tramadol hcl tab sr 24hr B P PROSTIGMIN

B N BUPRENEX B N MESTINON TAB 60MG

B 11 N STADOL NS G P pyridostigmine bromide tab 60 mg

G 15 P butorphanol tartrate nasal soln 10 mg/ml B P MESTINON TIMESPAN

G P nalbuphine hcl inj 10 mg/ml B P MESTINON SYP 60MG/5ML

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 32 of 50 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 - Continued - G 11 N diclofenac sodium er NEUROMUSCULAR BLOCKING AGENTS G 11 N diclofenac sodium xr B 11 N CATAFLAM

B N MYOBLOC G 11 N diclofenac potassium

B N BOTOX G 11 N etodolac cap 200mg

NICARDIPINES B 11 N LODINE

G 11 N etodolac cap 300mg B N CARDENE G P etodolac tab 400mg G N nicardipine hcl G P etodolac tab 500mg B N CARDENE SR B 11 N LODINE XL tab 400mg NICOTINE REPLACEMENT THERAPY G 11 N etodolac cr tab 400mg

G 11 N etodolac er tab 400mg O 31 P nicotine td patch 24hr 7 mg/24hr B 11 N LODINE XL tab 500mg O 31 P nicotine td patch 24hr 14 mg/24hr G 11 N etodolac cr tab 500mg O 31 P nicotine td patch 24hr 21 mg/24hr G 11 N etodolac er tab 500mg O 32 P nicotine polacrilex gum 2 mg B 11 N LODINE XL tab 600mg O 32 P nicotine polacrilex gum 4 mg G 11 N etodolac cr tab 600mg NITRO - OINTMENT/CAP/CR G 11 N etodolac er tab 600mg

G P nitroglycerin G P fenoprofen calcium

B P NITROBID B 11 N ANSAID

G N nitroglycerin in d5w G P flurbiprofen

NITRO - PATCHES O P ibuprofen tabs B 11 N MOTRIN B N NITRO-DUR DIS 0.1MG/HR O P ibuprofen susp 100 mg/5ml G P nitroglycerin td patch 24hr 0.1 mg/hr G P indomethacin cap 25mg B N NITRO-DUR DIS 0.2MG/HR G P indomethacin cap 50mg G P nitroglycerin td patch 24hr 0.2 mg/hr G 11 N indomethacin cr B N NITRO-DUR DIS 0.3MG/HR G 11 N indomethacin er B N NITRO-DUR DIS 0.4MG/HR B 11 N INDOCIN G P nitroglycerin td patch 24hr 0.4 mg/hr G 11 N indomethacin sup 50mg B N NITRO-DUR DIS 0.6MG/HR B 11 N ORUVAIL G P nitroglycerin td patch 24hr 0.6 mg/hr G P ketoprofen B P NITRO-DUR DIS 0.8MG/HR B 11 N MECLOFENAMATE SODIUM

NITRO - SUBLINGUAL/ SPRAY B 11 N PONSTEL

B 11 N MEFENAMIC ACID B P NITROSTAT SUB 0.3MG B 11 N NAPROSYN TAB 250MG G P nitroglycerin sl tab 0.3 mg B 11 N NAPROSYN TAB 375MG B N NITROSTAT SUB 0.4MG B 11 N NAPROSYN TAB 500MG G P nitroglycerin sl tab 0.4 mg B 11 N EC-NAPROSYN B P NITROSTAT SUB 0.6MG B P NAPROSYN SUS 125/5ML G P nitroglycerin sl tab 0.6 mg G P naproxen B N NITROLINGUAL PUMPSPRAY B 11 N ANAPROX NSAIDS G 11 N naproxen sodium tab 275 mg

B 11 N VOLTAREN TAB 50MG EC B 11 N ANAPROX DS

G P diclofenac sodium G P naproxen sodium tab 550 mg

B 11 N VOLTAREN TAB 75MG EC B 11 N NAPRELAN

G P diclofenac sodium dr G 11 N naproxen sodium tab sr 24hr 500 mg (base equiv)

G P diclofenac sodium ec B 11 N DAYPRO

B 11 N VOLTAREN-XR G P oxaprozin G P piroxicam cap 10 mg Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 33 of 50 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 - Continued - OP. ANTIINFLAMMATORY / STEROIDS OPHTH. NSAIDS - Continued - B N MAXIDEX B 11 N FELDENE G N dexamethasone sodium phosphate ophth soln 0.1%

G P piroxicam cap 20 mg B P FML LIQUIFILM

B 11 N CLINORIL G N fluorometholone ophth susp 0.1%

G P sulindac B P FML FORTE

G 11 N tolmetin sodium B P FML S.O.P.

B 11 N ARTHROTEC B P FLAREX

OP. ADRENERGIC AGENTS B P ALREX B P LOTEMAX

B N PROPINE B P HMS LIQUIFILM

G P dipivefrin hcl ophth soln 0.1% B P PRED MILD

OP. ANTIALLERGICS - ANTIHISTAMINES B N ECONOPRED PLUS

B P PRED FORTE B N OPTIVAR G N prednisolone acetate ophth susp 1% B N EMADINE B N INFLAMASE MILD B P ELESTAT B N INFLAMASE FORTE B N ZADITOR G N prednisolone sodium phosphate ophth soln 1% B N LIVOSTIN B N VEXOL B P PATANOL B N PRED-G OP. ANTIALLERGICS - MAST CELL STABILIZERS B N PRED-G S.O.P.

B N ZYLET B N CROLOM B P FML-S LIQUIFILM G P cromolyn sodium ophth soln 4% B P BLEPHAMIDE B N ALOMIDE B N VASOCIDIN B N ALOCRIL G N sulfacetamide sodium-prednisolone ophth soln 10-0.25% B P ALAMAST B N BLEPHAMIDE S.O.P. OP. ANTIBIOTICS B P TOBRADEX

G P bacitracin ophth oint 500 unit/gm G P neomycin-polymyxin-dexamethasone ophth susp 0.1%

G P erythromycin ophth oint 5 mg/gm B N MAXITROL

G P gentamicin sulfate ophth soln 0.3% G P neomycin-polymyxin-dexamethasone ophth oint 0.1%

B P GARAMYCIN B P CORTISPORIN SUS OP 1%

B P GENTAK G N neomycin-polymyxin-hc ophth susp

G P gentamicin sulfate ophth oint 0.3% B N POLY-PRED

G P tobramycin sulfate ophth soln 0.3% B P CORTISPORIN OIN OP 1%

B N TOBREX G N bacitracin-polymyxin-neomycin-hc ophth oint 1% B P BLEPH-10 OP. BETA - BLOCKERS G P sulfacetamide sodium ophth soln 10% B P BETOPTIC-S B P SULFACETAMIDE SODIUM G N betaxolol hcl ophth soln 0.5% B P VIROPTIC G P carteolol hcl ophth soln 1% G N trifluridine ophth soln 1% B N OPTIPRANOLOL B N POLYSPORIN G P metipranolol ophth soln 0.3% G P bacitracin-polymyxin b ophth oint G P levobunolol hcl ophth soln 0.25% B P TERRAMYCIN W/POLYMYXIN B B N BETAGAN B P POLYTRIM G P levobunolol hcl ophth soln 0.5% G P polymyxin b-trimethoprim ophth soln 10000 unit/ml-0.1% B N BETIMOL B N NEOSPORIN G P timolol maleate ophth soln 0.25% G P neomycin-bacitrac zn-polymyx 3.5(5)mg-400unt-10000unt op oin B N ISTALOL G P neomycin-polymyxin b-gramicidin ophth soln

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 34 of 50 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 - Continued - B N XIBROM OP. BETA - BLOCKERS B P VOLTAREN SOL 0.1% OP - Continued - B N OCUFEN B N TIMOPTIC G P flurbiprofen sodium ophth soln 0.03%

G P timolol maleate ophth soln 0.5% B P ACULAR LS

G N timolol maleate ophth gel forming soln 0.25% B P ACULAR

B P TIMOPTIC-XE B N ACULAR PF

G N timolol maleate ophth gel forming soln 0.5% B N NEVANAC

OP. CARBONIC ANHYDRASE INHIBITORS/COMBO OP. PROSTAGLANDINS

B P COSOPT B P LUMIGAN

B P AZOPT B 33 N XALATAN

B P TRUSOPT B P TRAVATAN

OP. CYCLOPLEGICS B N RESCULA

OP. QUINOLONES B N ISOPTO ATROPINE

G P atropine sulfate (ophthalmic) G P ciprofloxacin hcl ophth soln 0.3%

G P cyclopentolate hcl B P CILOXAN

B N CYCLOGYL B P ZYMAR

B N ISOPTO HOMATROPINE B N QUIXIN

B P ISOPTO HYOSCINE B P VIGAMOX

B P MYDRIACYL B P OCUFLOX

G P tropicamide G N ofloxacin ophth soln 0.3% B N CYCLOMYDRIL OP. SELECTIVE ALPHA ADRENERGIC AGONISTS OP. MIOTICS - DIRECT ACTING B N IOPIDINE

B P ISOPTO CARBACHOL B P ALPHAGAN P

B N ISOPTO CARPINE G N brimonidine tartrate ophth soln 0.2% G P pilocarpine hcl OSTEOPOROSIS B P PILOPINE HS

B P PHOSPHOLINE IODIDE B P FOSAMAX

OP. MISC B P FOSAMAX PLUS D B N DIDRONEL

O P *artificial tear ophth solution*** B P BONIVA

O P *artificial tear ophth ointment*** B P BONIVA KIT 3MG/3ML

G P naphazoline hcl ophth soln 0.1% B N AREDIA

G P phenylephrine hcl ophth soln 2.5% G N pamidronate disodium

G P phenylephrine hcl ophth soln 10% B N ACTONEL

B N PHENYLEPHRINE HCL B N ACTONEL WITH CALCIUM

B N RESTASIS B N ZOMETA

B N ALCAINE B N MIACALCIN INJ 200/ML

B N OPHTHETIC B P MIACALCIN SPR 200/ACT

G P proparacaine hcl ophth soln 0.5% G N FORTICAL

G P tetracaine hcl ophth soln 0.5% B N FORTEO

B N BSS PLUS B N EVISTA O P SODIUM CHLORIDE HYPERTONIC OPHTH SOLN 5% OXYTOCICS O P SODIUM CHLORIDE HYPERTONIC OPHTH OINT 5%

G N fluorescein sodium inj 10% B P METHERGINE

G N fluorescein sodium inj 25% PARKINSONS - ANTICHOLINERGICS OP. NSAID'S G P benztropine mesylate

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 35 of 50 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 - Continued - B P PROAMATINE PARKINSONS - ANTICHOLINERGICS G N midodrine hcl - Continued - PROGESTINS B P COGENTIN

B P AKINETON B N PROVERA

B P KEMADRIN G P medroxyprogesterone acetate

G P trihexyphenidyl hcl B P AYGESTIN

PARKINSONS - COMT INHIBITORS G N norethindrone acetate G N progesterone inj 50mg/ml

B N TASMAR B N PROMETRIUM B P COMTAN PULMONARY ANTI-HYPERTENSIVES PARKINSONS - SELECTED DOPAMIN AGONISTS B 11 P REVATIO

B N PERMAX B 11 N TRACLEER

G N pergolide mesylate B 11 P FLOLAN

B P APOKYN B 11 P VENTAVIS B P MIRAPEX PURINE ANALOG B P REQUIP

PERIPHERAL VASODILATORS B N IMURAN G P azathioprine tab 50 mg

G P papaverine hcl cap cr 150 mg B P AZASAN G P papaverine hcl inj 30 mg/ml RHEUMATOID ARTHRITIS - BIOLOGICALS PHOSPHATE BINDERS B N KINERET

B P PHOSLO B P HUMIRA PEN

B P FOSRENOL B P HUMIRA

B P RENAGEL B P ENBREL SURECLICK

PHOSPHODIESTERASE INHIBITORS B P ENBREL

B N ORENCIA B N PRIMACOR RHEUMATOID ARTHRITIS - NON-BIOLOGICALS PLATELET AGGR. INHIBITORS / COMBO'S - MISC.

G P leflunomide tab 10 mg G P cilostazol tab 50 mg B 26 N ARAVA B N PLETAL G P leflunomide tab 20 mg G P cilostazol tab 100 mg RSV PROPHYLAXIS G P anagrelide hcl cap 0.5 mg

B N AGRYLIN B 11 P SYNAGIS G P anagrelide hcl cap 1 mg SEDATIVE/HYPNOTICS - NON-BENZODIAZEPINES B P AGGRENOX

B N TRENTAL B 13 P LUNESTA

G P pentoxifylline tab cr 400 mg B 11 N SONATA

PLATELET AGGREGATION INHIBITORS B 11 N AMBIEN B 11 N ROZEREM

B N PERSANTINE B 13 P AMBIEN CR G P dipyridamole SMOKING CESSATION (ORAL) G N clopidogrel bisulfate

B P PLAVIX G P Bupropion SR 150mg

B N TICLID SOMATOSTATIC AGENTS G P ticlopidine hcl G N octreotide acetate inj 0.05 mg/ml PRESSORS G N octreotide acetate inj 0.1 mg/ml

G N ephedrine sulfate (pressors) G N octreotide acetate inj 0.2 mg/ml

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 36 of 50 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 - Continued - G N levothyroxin inj 500mcg SOMATOSTATIC AGENTS B P CYTOMEL - Continued - B P THYROLAR-1/2 G N octreotide acetate inj 0.5 mg/ml B P THYROLAR-1

B P SANDOSTATIN B P THYROLAR-2

G N octreotide acetate inj 1 mg/ml B P THYROLAR-3

B P SANDOSTATIN LAR DEPOT G P thyroid

B N SOMAVERT B P ARMOUR THYROID

TETRACYCLINES TISSUE PLASMINOGEN ACTIVATOR

B N DECLOMYCIN B P CATHFLO ACTIVASE

G N demeclocycline hcl B P ACTIVASE B N MONODOX TOPICAL - ACNE PREPARATIONS G N doxycycline (monohydrate)

B N ADOXA B 11 P DIFFERIN

B N ADOXA PAK 1/100 B 11 P AZELEX

B N ADOXA PAK 2/100 B 11 N BREVOXYL-4 CREAMY WASH

B N VIBRAMYCIN SUS 25MG/5ML B 11 N BENZAC AC WASH

B N VIBRAMYCIN CAP 50MG O P benzoyl peroxide liq 5%

B N VIBRAMYCIN CAP 100MG B 11 N BREVOXYL-8 CREAMY WASH

B N PERIOSTAT O P benzoyl peroxide liq 10%

G P doxycycline hyclate B 11 N NEOBENZ MICRO

B N DORYX B 11 N BENZASHAVE 5

B P VIBRAMYCIN SYP 50MG/5ML G 11 N benzoyl peroxide cream 10%

B N DYNACIN B 11 N TRIAZ GEL 3%

G P minocycline hcl O P benzoyl peroxide gel 5%

B N MINOCIN B 11 N TRIAZ GEL 6%

B N SOLODYN ER B 11 N BREVOXYL

G P tetracycline hcl B 11 P BENZAC AC GEL 10%

B P SUMYCIN B 11 P BENZAC W GEL 10%

B N ORACEA CAP 40MG B 11 P DESQUAM-E GEL 10%

THYROID HORMONES B 11 P DESQUAM-X GEL 10% O P benzoyl peroxide gel 10%

G P levothyroxin tab 25mcg B 11 N CLINAC BPO

G P levothyroxin tab 50mcg B 11 P TRIAZ GEL 9%

G P levothyroxin tab 75mcg B 11 N BREVOXYL CLEANSING

G P levothyroxin tab 88mcg G 11 P benzoyl peroxide lotion 4%

G P levothyroxin tab 100mcg O P benzoyl peroxide lotion 5%

G P levothyroxin tab 112mcg B 11 N BREVOXYL-8 CLEANSING

G P levothyroxin tab 125mcg G P benzoyl peroxide lotion 8%

G P levothyroxin tab 137mcg B 11 P TRIAZ CLEANSER

G P levothyroxin tab 150mcg O P benzoyl peroxide lotion 10%

G P levothyroxin tab 175mcg B 11 P TRIAZ PAD 3%

G P levothyroxin tab 200mcg B 11 P TRIAZ PAD 6%

G P unithroid B 11 P TRIAZ PAD 9%

B N SYNTHROID B 11 N SULFOXYL REGULAR

G P levothroid B 11 N SULFOXYL STRONG

G P levothyroxin tab 300mcg B 11 P METROCREAM

G P levoxyl G 11 N metronidazole cream 0.75%

G N levothyroxin inj 200mcg B 11 N NORITATE

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 37 of 50 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 - Continued - TOPICAL - ANTIFUNGALS TOPICAL - ACNE PREPARATIONS - Continued - B N MENTAX B 11 P METROGEL B N PENLAC NAIL LACQUER

B 11 P METROLOTION B N LOPROX SHAMPOO

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

B 11 N EVOCLIN B N LOPROX

B 11 N CLINDAGEL G P ciclopirox olamine lotion 0.77% (base equiv)

G 11 N clindamycin phosphate gel 1% B P NAFTIN

G 11 N clindamycin phosphate lotion 1% B N MYCOSTATIN

B 11 P CLEOCIN-T G P nystatin topical powder

G 11 N clindamycin phosphate swab 1% B N NYSTAT-RX

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

B 11 P ERYGEL G P nystatin cream 100000 unit/gm

G 11 P erythromycin gel 2% G P nystatin oint 100000 unit/gm

B 11 P AKNE-MYCIN O P tolnaftate soln 1%

G 11 P erythromycin pads 2% B P TOLNAFTATE

B 11 N KLARON O P tolnaftate powder 1%

B 11 N ACZONE GEL O P tolnaftate cream 1%

B 11 P BENZAMYCINPAK G P clotrimazole soln 1%

B 11 N BENZAMYCIN G P clotrimazole cream 1%

G 11 N benzoyl peroxide-erythromycin gel 5-3% B N SPECTAZOLE

B 11 N ZODERM G P econazole nitrate cream 1%

B 11 N BENZACLIN G P ketoconazole cream 2%

B 11 P DUAC B P NIZORAL SHA 2%

B 11 P PLEXION G N ketoconazole shampoo 2%

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

B 11 P PLEXION TS B N OXISTAT

G 11 N sulfacetamide sodium w/ sulfur susp 10-5% B P ERTACZO

B 11 P PLEXION SCT B N EXELDERM

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

B 11 N AVAR G P clotrimazole w/ betamethasone cream 1-0.05%

B 11 N AVAR GREEN B P LOTRISONE LOT

B 11 N SULFACET-R G N clotrimazole w/ betamethasone lotion 1-0.05%

G 11 N sulfacetamide sodium w/ sulfur lotion 10-5% G P nystatin-triamcinolone cream 100000-0.1 unit/gm-%

B 11 N PLEXION CLEANSING CLOTH B N MYCOLOG-II

B 11 N ROSULA G P nystatin-triamcinolone oint 100000-0.1 unit/gm-%

B 11 P ROSAC B N VUSION B 11 N FINACEA TOPICAL - ANTINEOPLASTICS TOPICAL - ANTIBIOTIC G P fluorouracil soln 2%

O P bacitracin oint 500 unit/gm G P fluorouracil soln 5%

G P gentamicin sulfate cream 0.1% B N CARAC

G P gentamicin sulfate oint 0.1% B P FLUOROPLEX

B P BACTROBAN OIN 2% B P EFUDEX

G N mupirocin oint 2% B P SOLARAZE B P BACTROBAN CRE 2% TOPICAL - ANTIPRURITICS O P *neomycin-bacitracin-polymyxin oint*** B P ZONALON B N CORTISPORIN CRE 0.5% G N doxepin hcl cream 5% B N CORTISPORIN OIN 1%

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 38 of 50 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 - Continued - B P DIPROLENE TOPICAL - ANTISEBORRHEICS G N augmented betamethasone dipropionate oint 0.05% G P betamethasone valerate cream 0.1%

B P CAPITROL B N LUXIQ

B P SELSUN SHAMPOO G P betamethasone valerate lotion 0.1%

G P selenium sulfide lotion 2.5% G P betamethasone valerate oint 0.1%

B P OVACE WASH B N TEMOVATE

G P sulfacetamide sodium liquid 10% G P clobetasol propionate soln 0.05%

B N OVACE G P clobetasol propionate cream 0.05%

B N CARMOL SCALP TREATMENT B N OLUX

B N SELSEB G P clobetasol propionate gel 0.05%

TOPICAL - ANTISEPTICS / DISINFECTANTS G P clobetasol propionate oint 0.05%

B N CLOBEX B N LAZERFORMALYDE SOLUTION G P clobetasol propionate emollient base cream 0.05% B N FORMALYDE-10 B N CLODERM B P PHISOHEX B P DESOWEN CRE 0.05% B N OPERAND POVIDONE/IODINE B P TRIDESILON TOPICAL - ANTIVIRALS G P desonide cream 0.05%

B N DESOWEN LOT 0.05% B N ZOVIRAX CRE 5% G P desonide lotion 0.05% B P ZOVIRAX OIN 5% B P DESOWEN OIN 0.05% B N DENAVIR G P desonide oint 0.05% TOPICAL - ASTRINGENTS / PROTECTANTS B P DESOXIMETASONE

B P DRYSOL G P desoximetasone cream 0.25%

B P XERAC AC G P desoximetasone gel 0.05%

TOPICAL - BURN PRODUCTS B N TOPICORT G P desoximetasone oint 0.25% B N SULFAMYLON G N diflorasone diacetate cream 0.05% B N FURACIN G N diflorasone diacetate oint 0.05% B N SILVADENE G N diflorasone diacetate emollient base cream 0.05% G P silver sulfadiazine cream 1% B P DERMA-SMOOTHE/FS

TOPICAL - CAUTERIZING AGENTS B P SYNALAR

G P fluocinolone acetonide soln 0.01% B P SILVER NITRATE G P fluocinolone acetonide cream 0.01% TOPICAL - CORTICOSTEROIDS G P fluocinolone acetonide cream 0.025%

B N ACLOVATE G P fluocinolone acetonide oint 0.025%

G N alclometasone dipropionate oint 0.05% B P CAPEX

B N CYCLOCORT CRE 0.1% G P fluocinonide soln 0.05%

G P amcinonide cream 0.1% G P fluocinonide cream 0.05%

B P CYCLOCORT LOT 0.1% B N VANOS

B P CYCLOCORT OIN 0.1% G P fluocinonide gel 0.05%

G N amcinonide oint 0.1% B N LIDEX

G P betamethasone dipropionate cream 0.05% G P fluocinonide oint 0.05%

B P DIPROSONE B N LIDEX-E

G P betamethasone dipropionate lotion 0.05% G P fluocinonide emulsified base cream 0.05%

G P betamethasone dipropionate oint 0.05% B N CORDRAN SP

B N DIPROLENE AF B N CORDRAN

G P augmented betamethasone dipropionate cream 0.05% B N CORDRAN TAPE

G N augmented betamethasone dipropionate gel 0.05% G P fluticasone propionate cream 0.05% B N CUTIVATE Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 39 of 50 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 - Continued - G N U-KERA E CRE 40% TOPICAL - CORTICOSTEROIDS G N urea gel 40% - Continued - G N urea gel 50% G N fluticasone propionate oint 0.005% B N KERALAC

B P HALOG G P urea lotion 35%

G N halobetasol propionate cream 0.05% B N CARMOL 40

B P ULTRAVATE G P urea lotion 40% G N halobetasol propionate oint 0.05% TOPICAL - ENZYMES / KERATOLYTICS / UREA B N TEXACORT

B N PROCTOCORT B N SANTYL

G P hydrocortisone cream 1% B N GRANULEX

G P hydrocortisone cream 2.5% G P trypsin w/ castor oil & peruvian balsam spray

G P hydrocortisone lotion 1% B N OPTASE GEL

B N HYTONE B P XENADERM

G P hydrocortisone lotion 2.5% B P ACCUZYME SE EMU

G P hydrocortisone oint 1% B P PANAFIL SE EMU

G N hydrocortisone oint 2.5% B P PANAFIL

G P hydrocortisone valerate cream 0.2% G P *papain-urea-chlorophyllin ointment***

B N WESTCORT G P podophyllum resin soln 25%

G N hydrocortisone valerate oint 0.2% O P salicylic acid liquid 17%

B N PANDEL B P SALEX

G N hydrocortisone butyrate soln 0.1% TOPICAL - GENITAL WARTS B N LOCOID G N podofilox soln 0.5% G N hydrocortisone butyrate oint 0.1% B N CONDYLOX B N LOCOID LIPOCREAM B P ALDARA G N mometasone furoate cream 0.1%

G N mometasone furoate lotion 0.1% TOPICAL - IMMUNOMODULATORS

B P ELOCON B P ELIDEL G N mometasone furoate oint 0.1% B P PROTOPIC B N DERMATOP TOPICAL - LOCAL ANESTHETICS G P triamcinolone acetonide cream 0.025%

G P triamcinolone acetonide cream 0.1% B P MARCAINE

B N ARISTOCORT A B P MARCAINE W/O EPI

G P triamcinolone acetonide cream 0.5% G N bupivacaine 0.75% in dextrose inj 8.25%

G P triamcinolone acetonide lotion 0.025% B P XYLOCAINE INJ -MPF 1%

B N KENALOG B P XYLOCAINE INJ 1%

G P triamcinolone acetonide lotion 0.1% G P lidocaine hcl local inj 1%

G P triamcinolone acetonide oint 0.025% B P XYLOCAINE INJ 2%

G P triamcinolone acetonide oint 0.1% G P lidocaine hcl local inj 2%

G P triamcinolone acetonide oint 0.5% G N lidocaine hcl local inj 4%

TOPICAL - EMOLLIENTS B N CARBOCAINE

B N PONTOCAINE G N lactic acid (ammonium lactate) cream 12% G P lidocaine inj 1% w/ epinephrine-1:100000 B N LACTINOL G P lidocaine inj 1.5% w/ epinephrine-1:200000 B N LAC-HYDRIN G P lidocaine inj 2% w/ epinephrine-1:100000 O P lactic acid (ammonium lactate) lotion 12% B N AMERICAINE B N LACTINOL-E B N COCAINE HCL G P lactic acid w/ vitamin e cream 10%-3500 unit/30gm B N LIDODERM B N UMECTA B N SYNERA B N VANAMIDE B P XYLOCAINE SOL 4% Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 40 of 50 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 - Continued - B P ETHEZYME TOPICAL - LOCAL ANESTHETICS B P ACCUZYME - Continued - G P papain-urea ointment 0.83 mmu-100 mg/gm (usp ref std f-3) G P lidocaine hcl soln 4% B N RADIAPLEXRX

G P lidocaine hcl cream 3% G N *wound dressings - gel***

B P XYLOCAINE GEL 2% B 11 N REGRANEX

G P lidocaine hcl gel 2% B N REGENECARE WOUND B N LIDAMANTLE UREA CYCLE DISORDER - AGENTS G P lidocaine hcl oint 5%

B N ANESTHETIC SKIN REFRIGERA B P AMMONUL

B P EMLA B N BUPHENYL

G N lidocaine-prilocaine cream 2.5-2.5% UROLOGICAL - MISC. B P EMLA/TEGADERM B P MONUROL TOPICAL - NASAL ANTIBIOTICS B N MANDELAMINE

B P BACTROBAN NASAL G P methenamine mandelate

TOPICAL - SCABICIDES AND PEDICULICIDES B N HIPREX B P UREX

B P EURAX G N methenamine hippurate

B N LINDANE B N NEGGRAM

G N lindane shampoo 1% B P FURADANTIN

B N OVIDE B P MACRODANTIN

O P permethrin creme rinse 1% B N NITROFURANTOIN MACROCRYST

B P ELIMITE G N nitrofurantoin macrocrystal

G N permethrin cream 5% B N MACROBID

O P pyrethrins-piperonyl butoxide liq 0.33-4% G N nitrofurantoin monohyd macro

O P pyrethrins-piperonyl butoxide shampoo 0.3-3% B P UROQID #2

O P pyrethrins-piperonyl butoxide shampoo 0.33-4% B N URISED

TOPICAL - STEROID COMBINATIONS G P meth-bell-meth bl-phenyl sal

B N URIMAX B N TACLONEX G N methenamine-hyosc-methylene blue-sod biphos-phenyl sal B N CARMOL-HC B P PROSED/DS G N urea-hc acetate cream 1% G N methenamine-methylene blue-benz acd-phenyl sal-atrop-hyosc TOPICAL - STEROID LOCAL ANESTHETICS B P PROSED EC

B P PYRIDIUM PLUS G N lidocaine-hydrocortisone acetate rectal cream 3-0.5% G N phenazopyridine-butabarbital-hyoscyamine B P LIDAMANTLE CRE HC3-0.5% B P K-PHOS NO 2 G N lidocaine-hydrocortisone acetate cream 3-0.5% B P UROCIT-K 5 B N LIDAMANTLE LOT HC3-0.5% B P UROCIT-K 10 B N EPIFOAM B P BICITRA TOPICAL - TRETINOIDS G N sodium citrate & citric acid

G 11 N tretinoin cream 0.025% B P POLYCITRA-K

G 11 N tretinoin cream 0.05% G P cytra-k

G 11 N tretinoin cream 0.1% B P POLYCITRA-K CRYSTALS

G 11 N tretinoin gel 0.01% G N cytra k crystals

B 11 P RETIN-A B P POLYCITRA

G 11 N tretinoin gel 0.025% G P pot & sod citrates w/citric ac

B 11 N RETIN-A MICRO B P POLYCITRA-LC

TOPICAL - WOUND / DECUBITUS CARE B N PYRIDIUM G P phenazopyridine hcl

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 41 of 50 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 - Continued - VASOPRESSINS UROLOGICAL - MISC. - Continued - B 11 P DDAVP TAB 0.1MG B N CYSTAGON B 11 P DDAVP TAB 0.2MG

B N ELMIRON B 11 P STIMATE

B N LITHOSTAT B 11 N DDAVP INJ 4MCG/ML

B N THIOLA G 11 N desmopressin acetate inj 4 mcg/ml

B P RENACIDIN B 11 P DDAVP SOL 0.01%

G P acetic acid G 11 N desmopressin acetate nasal soln 0.01% (refrigerated)

G P sodium chloride (gu irrigant) G 11 N desmopressin acetate nasal spray soln 0.01% (refrigerated)

B P NEOSPORIN GU IRRIGANT G 11 N minirin

VAGINAL - ANTI FUNGALS B 11 P DDAVP SPR 0.01% G 11 N desmopressin acetate nasal spray soln 0.01%

G P clindamycin phosphate vaginal cream 2% G 11 N vasopressin inj 20 unit/ml B P CLINDESSE VITAMINS B P NYSTATIN VAGINAL TAB 100000 UNIT

B N AVC G 11 P thiamine hcl

B N GYNAZOLE-1 O P niacin tab 50 mg

O P miconazole nitrate vaginal cream 2% O P niacin tab 100 mg

O P miconazole nitrate vaginal suppos 100 mg O P niacin tab 250 mg

B N MONISTAT 3 O P niacin tab 500 mg

G N miconazole nitrate vaginal suppos 200 mg G 11 P pyridoxine hcl

B P MONISTAT 7 COMBINATION PA B 11 N DRISDOL

G N miconazole nitrate vaginal supp 200 mg & 2% cream 9 gm kit G 11 N ergocalciferol

B P MONISTAT DUAL-PAK B 11 N CALCIJEX

B N TERAZOL 7 B 11 P ROCALTROL

G N terconazole vaginal cream 0.4% G 11 N calcitriol

B N TERAZOL 3 W/APPLICATOR B 11 N DHT

B N ZAZOLE B 11 N DHT INTENSOL

G N terconazole vaginal cream 0.8% B 11 P MEPHYTON

B N TERAZOL 3 B 11 P AQUA-MEPHYTON

VAGINAL - ANTIBACTERIALS G 11 P phytonadione G 11 P cyanocobalamin inj 1000 mcg/ml

B P CLEOCIN VAG CRE 2% B 11 N CYANOCOBALAMIN CRYSTALS

B P CLEOCIN SUP 100MG B 11 N NASCOBAL

G N VANDAZOLE GEL 0.75% G 11 P folic acid B P METROGEL VAGINAL VITAMINS - MISC. VAGINAL - ESTROGENS B 11 N NEPHROCAPS

B N VAGIFEM G 11 N *b-complex w/ c & folic acid cap 1 mg***

B N ESTRACE B 11 N CEFOL

B N ESTRING G 11 N *b-complex w/ c & folic acid tab***

B N FEMRING B 11 N NEPHRO-VITE RX

B P PREMARIN G 11 P *b-complex w/ c & folic acid tab 1 mg***

B P PREMARIN W/APPLICATOR B 11 N DIATX

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

G 11 N *b-complex w/ c-min-fe & folic acid tab 106-1 mg*** G P amino acid-urea cervical cream B 11 P DIALYVITE/ZINC G P acetic acid vaginal gel B 11 P NEPHPLEX RX B N RELAGARD B 11 P M.V.I. -12 G N acetic acid-oxyquinoline vaginal gel 0.9-0.025%

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 42 of 50 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 - Continued - B 11 N VINATE II VITAMINS - MISC. B 11 N DUET CHW - Continued - B 11 N PRECARE PRENATAL G 11 N *multiple vitamin inj** B 11 N PRECARE

G 11 P *multiple vitamins w/ minerals cap** B 11 N NOVANATAL

G 11 P *multiple vitamins w/ minerals tab** B 11 N PRECARE TAB PREMIER

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

G 11 P *pediatric vitamins acd w/ fluoride chew tab 1 mg*** B 11 N PRENATE ELITE

B 11 N TRI-VI-FLOR B 11 N PRECARE CONCEIVE

G 11 P *pediatric vitamins acd w/ fluoride soln 0.25 mg/ml*** B 11 N ANEMAGEN OB

G 11 P *pediatric vitamins acd w/ fluoride soln 0.5 mg/ml*** G P *prenatal vit w/ sel-fe fumarate-fa tab 27-1 mg***

B 11 N POLY-VI-FLOR CHW 0.25MG G 11 N *prenatal vit w/ dss-iron carbonyl-fa tab 29-1 mg***

G 11 P *pediatric multiple vitamins w/ fluoride chew tab 0.25 mg*** G P *prenatal vit w/ dss-iron carbonyl-fa tab 90-1 mg***

B 11 P POLY-VI-FLOR CHW 0.5MG G 11 N *prenatal vit w/ dss-fe fumarate-fa tab 29-1 mg***

G 11 P *pediatric multiple vitamins w/ fluoride chew tab 0.5 mg*** G P *prenatal vit w/ dss-fe fumarate-fa tab cr 90-1 mg***

B 11 N POLY-VI-FLOR CHW 1MG B 11 N EMBREX 600

G 11 P *pediatric multiple vitamins w/ fluoride chew tab 1 mg*** G P *prenatal mv-min w/fe-fa tab & ca chew tab therapy pack***

B 11 N POLY-VI-FLOR DRO 0.25MG B 11 N CITRACAL PRENATAL + DHA

G 11 P *pediatric multiple vitamins w/ fluoride soln 0.25 mg/ml*** B 11 N OPTINATE

G 11 P *pediatric multiple vitamins w/ fluoride soln 0.5 mg/ml*** G 11 P *iron w/ vitamin tab**

G 11 P *pediatric multiple vitamins w/ fl-fe chew tab 0.5-12 mg** B 11 N IBERET-FOLIC-500

G 11 P *pediatric multiple vitamins w/ fl-fe chew tab 1-12 mg** G 11 N *iron w/ vitamin tab cr**

B 11 N POLY-VI-FLOR/IRON B 11 P FOLGARD RX 2.2

G 11 P *pediatric multiple vitamins w/ fl-fe drops 0.25-10 mg/ml** G 11 N folic acid-vitamin b6-vitamin b12 tab 2.2-25-0.5 mg

G 11 P *pediatric multiple vitamins w/ fl-fe drops 0.5-10 mg/ml** G 11 N folic acid-vitamin b6-vitamin b12 tab 2.5-25-1 mg

B 11 N TRI-VI-FLOR/IRON G 11 N folic acid-vitamin b6-vitamin b12 tab 2.5-25-2 mg

G 11 P *pediatric vitamins acd fluoride & fe drops 0.25-10 mg/ml*** B 11 P MYO VYT

B 11 N NESTABS RX G 11 N *iron combination cap***

G 11 N *prenatal vit w/ iron carbonyl-fa tab 29-1 mg*** G 11 P iron polysacch complex-vit b12-fa cap 150-0.025-1 mg

B 11 N NESTABS CBF B 11 N FERO-FOLIC-500

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

B 11 N NOVASTART B 11 N ICAR-C PLUS

G 11 N *prenatal vit w/ fe fumarate-fa tab 17-1 mg*** B 11 N CHROMAGEN FA

G P *prenatal vit w/ fe fumarate-fa tab 27-0.5 mg*** G 11 N fe fumarate-vit c-vit b12-fa cap 200-250-0.01-1 mg

G P *prenatal vit w/ fe fumarate-fa tab 27-1 mg*** G 11 N fe fumarate-vit c-vit b12-fa cap 460-60-0.01-1 mg

B 11 N STUARTNATAL PLUS 3 B 11 N CHROMAGEN

G 11 N *prenatal vit w/ fe fumarate-fa tab 28-1 mg*** B 11 N NEPHRON FA

B 11 N NESTABS FA B 11 N TRINSICON

G 11 N *prenatal vit w/ fe fumarate-fa tab 29-1 mg*** G 11 P fe fumarate w/ b12-vit c-fa-ifc cap 110-0.015-75-0.5-240 mg

G 11 N *prenatal vit w/ fe fumarate-fa tab 60-1 mg*** B 11 N CHROMAGEN FORTE

B 11 N LACTOCAL-F B 11 N NIFEREX-150 FORTE G P *prenatal vit w/ fe fumarate-fa tab 65-1 mg*** WEIGHT LOSS B 11 N NATACHEW

G P *prenatal vit w/ fe fumarate-fa chew tab 29-1 mg*** B 11 P XENICAL

G 11 N *prenatal vit w/ fe polysac cmplx-fa tab 60-1 mg***

G 11 N *prenatal vit w/ iron carbonyl-fe sulf-fa tab 60-1 mg***

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

B 11 N CITRACAL PRENATAL RX

B 11 N NATELLE

B P DUET TAB

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 43 of 50 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 NR CYMBALTA ANTIDEPRESSANTS - MAO INHIBITORS G N venlafaxine hcl G R maprotiline hcl

B R NARDIL G P bupropion hcl tab 75 mg

B NR EMSAM B P WELLBUTRIN

B R PARNATE G P bupropion hcl tab 100 mg

ANTIDEPRESSANTS - SELECTED SSRI'S B P WELLBUTRIN TAB 100MG SR

G N bupropion hcl tab sr 12hr 100 mg B P REMERON B P WELLBUTRIN TAB 150MG SR B P REMERON SOLTAB G N bupropion hcl er G P mirtazapine G N bupropion hcl tab sr 12hr 150 mg G P nefazodone hcl B P WELLBUTRIN TAB 200MG SR G P trazodone hcl tab 50 mg G N bupropion hcl tab sr 12hr 200 mg G P trazodone hcl tab 100 mg B R WELLBUTRIN XL G P trazodone hcl tab 150 mg B P EFFEXOR B N DESYREL B NR EFFEXOR XR G N trazodone hcl tab 300 mg ANTIDEPRESSANTS - TRI-CYCLICS B N CELEXA

G P citalopram hydrobromide G P amitriptyline hcl tab 10 mg

G N citalopram ODT G P amitriptyline hcl tab 25 mg

B R LEXAPRO G P amitriptyline hcl tab 50 mg

B N PROZAC CAP 10MG B N ELAVIL

G P fluoxetine hcl cap 10 mg G P amitriptyline hcl tab 75 mg

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

B N SARAFEM G P amitriptyline hcl tab 150 mg

G P fluoxetine hcl cap 20 mg B R AMOXAPINE

B 21 N PROZAC CAP 40MG B N ANAFRANIL

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

B N PROZAC TAB 10MG B N NORPRAMIN

G P fluoxetine hcl tab 10 mg G P desipramine hcl

B N RAPIFLUX B N SINEQUAN

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

B P PROZAC LIQ 20MG/5ML B N TOFRANIL

G P fluoxetine liq 20mg/5ml G P imipramine hcl

G P fluoxetine sol 20mg/5ml B NR TOFRANIL-PM

B N PROZAC WEEKLY B N AVENTYL

G P fluvoxamine maleate B N PAMELOR

B P PAXIL TAB 10MG G P nortriptyline hcl

G N paroxetine hcl tab 10 mg B R VIVACTIL

B P PAXIL TAB 20MG B R SURMONTIL G N paroxetine hcl tab 20 mg ANTIPSYCHOTICS - ATYPICALS B P PAXIL TAB 30MG

G P paroxetine hcl tab 30 mg B R RISPERDAL

B P PAXIL TAB 40MG B NR RISPERDAL M-TAB

G P paroxetine hcl tab 40 mg B NR RISPERDAL CONSTA

B R PAXIL SUS 10MG/5ML B R SEROQUEL

B R PAXIL CR B NR ZYPREXA

B NR PEXEVA B NR ZYPREXA ZYDIS

B P ZOLOFT B NR ABILIFY

G N sertraline B R GEODON

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 44 of 50 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 - Continued - G P perphenazine tab 8 mg ANTIPSYCHOTICS - SPECIAL ATYPICALS G P perphenazine tab 16 mg G P thioridazine hcl tab 10 mg

G P clozapine tab 25 mg G P thioridazine hcl tab 25 mg

B N CLOZARIL G P thioridazine hcl tab 50 mg

G P clozapine tab 100 mg G P thioridazine hcl tab 100 mg

G P clozapine tab 200 mg B P THIORIDAZINE HCL

B P FAZACLO 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 ANXIOLYTICS - BENZODIAZEPINES B P HALDOL

B P HALOPERIDOL LACTATE B 11 N XANAX

G P haloperidol lactate inj 5 mg/ml G P alprazolam

B N HALDOL DECANOATE-50 B R ALPRAZOLAM INTENSOL

G P haloperidol decanoate im soln 50 mg/ml B 11 N NIRAVAM

B N HALDOL DECANOATE-100 B 11 N LIBRIUM

G P haloperidol decanoate im soln 100 mg/ml G P chlordiazepoxide hcl

G P loxapine succinate cap 5 mg B P TRANXENE T TAB 3.75MG

G P loxapine succinate cap 10 mg G P cloraz dipot tab 3.75mg

G P loxapine succinate cap 25 mg B 11 N TRANXENE T TAB 7.5MG

B N LOXITANE G P cloraz dipot tab 7.5mg

G P loxapine succinate cap 50 mg B 11 N TRANXENE T TAB 15MG

B NR MOBAN G P cloraz dipot tab 15mg

G P chlorpromazine hcl tab 10 mg B 11 N TRANXENE-SD

G P chlorpromazine hcl tab 25 mg G P diazepam tab 2mg

G P chlorpromazine hcl tab 50 mg G P diazepam tab 5mg

G P chlorpromazine hcl tab 100 mg G P diazepam tab 10mg

B N THORAZINE B R DIAZEPAM INTENSOL

G P chlorpromazine hcl tab 200 mg B R DIAZEPAM SOL 1MG/ML

G P chlorpromazine hcl conc 100 mg/ml B 11 N VALIUM

G P chlorpromazine hcl inj 25 mg/ml G P diazepam inj 5mg/ml

G P fluphenazine hcl tab 1 mg G P lorazepam tab 0.5mg

G P fluphenazine hcl tab 2.5 mg G P lorazepam tab 1mg

G P fluphenazine hcl tab 5 mg G P lorazepam tab 2mg

G P fluphenazine hcl tab 10 mg B P LORAZEPAM CON 2MG/ML

G P fluphenazine hcl elixir 2.5 mg/5ml G P lorazepam inj 2mg/ml

B N PROLIXIN B 11 N ATIVAN

G P fluphenazine hcl oral conc 5 mg/ml G P lorazepam inj 4mg/ml

B R FLUPHENAZINE HCL B 11 N SERAX

B N PROLIXIN DECANOATE G P oxazepam

G P fluphenazine decanoate inj 25 mg/ml G NR flumazenil G P perphenazine tab 2 mg ANXIOLYTICS - LONG ACTING G P perphenazine tab 4 mg

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 45 of 50 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 - Continued - B NR CHLORAL HYDRATE CRYSTALS ANXIOLYTICS - LONG ACTING SEDATIVE/HYPNOTICS - BENZODIAZEPINES - Continued - B 11 NR XANAX XR B N PROSOM

ANXIOLYTICS - MISC. G P estazolam B N DALMANE

G P buspirone hcl tab 5 mg G P flurazepam hcl

B N VANSPAR G P midazolam syp 2mg/ml

G P buspirone hcl tab 7.5 mg B N VERSED

G P buspirone hcl tab 10 mg G P midazolam inj 1mg/ml

G P buspirone hcl tab 15 mg G P midazolam inj 2mg/2ml

B 3 N BUSPAR B R DORAL

G 3 N buspirone hcl tab 30 mg B R RESTORIL CAP 7.5MG

B N INAPSINE B N RESTORIL CAP 15MG

G P droperidol inj 2.5 mg/ml B NR RESTORIL CAP 22.5MG

G P meprobamate tab 200 mg B N RESTORIL CAP 30MG

B N MILTOWN G P temazepam

G P meprobamate tab 400 mg B N HALCION

LITHIUM G P triazolam

STIMULANTS - AMPHETAMINES - LONG ACTING G P lithium carbonate cap 150 mg

B P ESKALITH B 24 P DEXEDRINE

G P lithium carbonate cap 300 mg G 24 N dextroamphetamine sulfate

G N lithium carbonate cap 600 mg B 24 R ADDERALL XR B P LITHIUM CARBONATE STIMULANTS - AMPHETAMINES - SHORT ACTING B P LITHOBID

G N lithium carbonate tab cr 300 mg B 24 P DEXEDRINE

B P ESKALITH CR G 24 N dextroamphetamine sulfate tab 5 mg

G P lithium carbonate tab cr 450 mg B 24 P DEXTROSTAT

G P lithium citrate syrup 8 meq/5ml G 24 P dextroamphetamine sulfate tab 10 mg

PSYCHOTHERAPEUTIC COMBINATION B 24 P ADDERALL G 24 N amphetamine-dextroamphetamine B N LIMBITROL STIMULANTS - METHYLPHENIDATE G P chlordiazepoxide-amitriptyline tab 5-12.5 mg

B N LIMBITROL DS B 24 R FOCALIN

G P chlordiazepoxide-amitriptyline tab 10-25 mg G 24 P methylphenidate hcl tab 5 mg

G P perphenazine-amitriptyline tab 2-25 mg G 24 P methylphenidate hcl tab 10 mg

G P perphenazine-amitriptyline tab 4-10 mg B 24 N RITALIN

G P perphenazine-amitriptyline tab 4-25 mg G 24 P methylphenidate hcl tab 20 mg

B R PERPHENAZINE/AMITRIPTYLIN STIMULANTS - METHYLPHENIDATE - LONG ACTING B NR SYMBYAX B 24 R FOCALIN XR SEDATIVE/HYPNOTICS - BARBITURATE B 24 R DAYTRANA

B R BUTISOL SODIUM B 24 NR METADATE CD

B R MEBARAL B 24 N METADATE ER

G P phenobarbital G 24 P methylphenidate hcl tab cr

B NR PHENOBARBITAL SODIUM B 24 NR RITALIN SR

B NR LUMINAL B 24 R CONCERTA

B NR SECONAL B 24 NR RITALIN LA

B NR SOMNOTE STIMULANTS - OTHER STIMULANTS / LIKE G P chloral hydrate syrup 500 mg/5ml STIMULANTS

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 46 of 50 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 - Continued - STIMULANTS - OTHER STIMULANTS / LIKE STIMULANTS - Continued - G 24 R methamphetamine hcl

B NR DOPRAM

B 24 NR STRATTERA

B 24 NR PROVIGIL

G 24 N pemoline tab 18.75 mg

G 24 NR pemoline tab 37.5 mg

G 24 NR pemoline tab 75 mg

G 24 NR pemoline

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 47 of 50 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 FARESTON ANTIHEMOPHILIC AGENTS ANTINEOPLASTICS - ANTIMETABOLITES

B R HEMOFIL M HUMAN B R VIDAZA

B R MONARC-M B R XELODA

B R KOATE-DVI B R CYTOSAR-U

B R ALPHANATE G NR cytarabine for inj 100 mg

B R MONOCLATE-P G NR cytarabine for inj 500 mg

B R BIOCLATE B NR DEPOCYT

G NR kogenate B NR FLUOROURACIL

B R RECOMBINATE G R fluorouracil inj 50 mg/ml

B R HELIXATE FS B R GEMZAR

B R REFACTO B R ARRANON

B NR ADVATE B R PURINETHOL

B R HUMATE-P G NR mercaptopurine tab 50 mg

B NR AUTOPLEX T G R methotrexate sodium tab 2.5 mg (base equiv)

B NR FEIBA VH IMMUNO B R TREXALL

G R antiinhibitor coagulant complex for inj G R methotrexate sodium inj 25 mg/ml

B R NOVOSEVEN B R ALIMTA

B R ALPHANINE SD B R THIOGUANINE

B R MONONINE B R AVASTIN

B R BENEFIX B R ERBITUX

B R BEBULIN VH B R HERCEPTIN

B R PROPLEX T FACTOR IX COMP B R BEXXAR

B R PROFILNINE SD B R BEXXAR 131 IODINE

ANTINEOPLASTICS - ALKYLATING AGENTS ANTINEOPLASTICS - AROMATASE INHIBITORS

B R MYLERAN B R ARIMIDEX

B R BUSULFEX B R AROMASIN

B NR PLATINOL AQ B R FEMARA

G R cisplatin inj 1 mg/ml ANTINEOPLASTICS - CARDIAC PROTECTIVE AGENTS ANTINEOPLASTICS - ANTIADRENALS B R ZINECARD

B R LYSODREN ANTINEOPLASTICS - COMBINATIONS ANTINEOPLASTICS - ANTIANDROGENS B NR IFEX/MESNEX COMBO PACK

B R CASODEX G R ifosfamide & mesna inj kit 1000-1000 mg

B R EULEXIN ANTINEOPLASTICS - ESTROGEN RECEPTOR G NR flutamide cap 125 mg ANTAGONIST B R FASLODEX B R NILANDRON

ANTINEOPLASTICS - ANTIBIOTICS ANTINEOPLASTICS - ESTROGENS

B R EMCYT B NR BLENOXANE

G R bleomycin sulfate for inj 15 unit ANTINEOPLASTICS - FOLIC ACID ANTAGONISTS RESCUE AGENTS B NR ADRIAMYCIN PFS G R leucovorin calcium G R doxorubicin hcl inj 2 mg/ml ANTINEOPLASTICS - IMIDAZOTETRAZINES B R DOXIL

ANTINEOPLASTICS - ANTIESTROGENS B R TEMODAR

ANTINEOPLASTICS - INTERLEUKINS B NR NOLVADEX

G R tamoxifen citrate B R PROLEUKIN

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 48 of 50 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 - Continued - B R SUTENT ANTINEOPLASTICS - LHRH ANALOGS B NR SPRYCEL B R TARCEVA

B R TESLAC B R IRESSA

B R ZOLADEX B R GLEEVEC

B R LUPRON DEPOT-PED B R VELCADE B R LUPRON DEPOT ANTINEOPLASTICS - RETINOIDS B R TRELSTAR DEPOT

B R TRELSTAR LA B R VESANOID

ANTINEOPLASTICS - MISC. ANTINEOPLASTICS - SELECTIVE RETINOID X RECEPTOR AGONISTS B NR HYDREA B R TARGRETIN

G R hydroxyurea cap 500 mg ANTINEOPLASTICS - TOPOISOMERASE I INHIBITORS B R MATULANE B R CAMPTOSAR B NR ROFERON-A B R HYCAMTIN B NR INTRON-A W/DILUENT

B NR INTRON-A ANTINEOPLASTICS - URINARY TRACT PROTECTIVE AGENTS B NR ACTIMMUNE B R ETHYOL B NR DROXIA B R MESNEX B NR REVLIMID ANTIRETROVIRAL COMBINATIONS ANTINEOPLASTICS - MITOTIC INHIBITORS

B R COMBIVIR B R TAXOTERE B R KALETRA B R VEPESID B R TRIZIVIR G NR etoposide ANTIRETROVIRALS B R TAXOL

G NR paclitaxel iv conc 6 mg/ml B R PREZISTA TAB 300MG

G R vincristine sulfate iv soln 1 mg/ml B R EPZICOM

B R VINBLASTINE SULFATE B R TRUVADA

B R NAVELBINE B R ATRIPLA

ANTINEOPLASTICS - NITROGEN MUSTARDS ANTIRETROVIRALS - FUSION INHIBITORS

B R LEUKERAN B R FUZEON G NR cyclophosphamide ANTIRETROVIRALS - PROTEASE INHIBITORS B R CYTOXAN

B R ALKERAN B R AGENERASE

ANTINEOPLASTICS - NITROSOUREAS B R REYATAZ B R LEXIVA

B R GLIADEL B R CRIXIVAN

B R GLIADEL WAFER B R VIRACEPT

B R CEENU B R NORVIR

ANTINEOPLASTICS - PROGESTINS B R FORTOVASE

B R INVIRASE B R DEPO-PROVERA B R APTIVUS G R megestrol acetate ANTIRETROVIRALS - RTI-NON-NUCLEOSIDE B R MEGACE ORAL ANALOGUES G NR megestrol acetate susp 40 mg/ml B R RESCRIPTOR

B R MEGACE ES B R SUSTIVA

ANTINEOPLASTICS - PROTEIN-TYROSINE KINASE B R VIRAMUNE INHIBITORS ANTIRETROVIRALS - RTI-NUCLEOSIDE B NR NEXAVAR ANALOGUES-PURINES

Report_rt11884_PDL_A1 draft_10092006_verB 10/09/2006 Page 49 of 50 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 - Continued - ANTIRETROVIRALS - RTI-NUCLEOSIDE ANALOGUES-PURINES - Continued - B R ZIAGEN

B R VIDEX

B R VIDEX EC

G R didanosine

ANTIRETROVIRALS - RTI-NUCLEOSIDE ANALOGUES-PYRIMIDINES B R EMTRIVA

B R EPIVIR HBV

B R EPIVIR

B R HIVID

ANTIRETROVIRALS - RTI-NUCLEOSIDE ANALOGUES-THYMIDINES B R ZERIT

G R zidovudine tab 300 mg

B NR RETROVIR

G R zidovudine syrup 10 mg/ml

ANTIRETROVIRALS - RTI-NUCLEOTIDE ANALOGUES

B R VIREAD

IMMUNOSUPPRESSANTS

G NR cyclosporine

G NR cyclosporine iv soln 50 mg/ml

B R SANDIMMUNE

B R CYCLOSPORINE MODIFIED

G R cyclosporine modified (for microemulsion)

B R NEORAL

G R cyclosporine modified oral soln 100 mg/ml

B R CELLCEPT

B R MYFORTIC

B R RAPAMUNE

B R PROGRAF

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