Western Sky Community Care Preferred Drug Locator Instructions: Preferred Drug List Includes a List of Drug Covered by Your Prescription 1

Preferred Drug List The Western Sky Community care Preferred Drug Locator Instructions: Preferred Drug List includes a list of drug covered by your prescription 1. Within the PDF, click on the benefit. This list is updated often and Edit menu, then click Find. may change. 2. In the Find box, type the name of To get the most up-to-date the medication you want to information, you may view the latest locate. Preferred Drug List on our website: WesternSkyCommunityCare.com 3. Click the Next button or call 1-844-543-8996 (TTY/TDD until you find the drug(s). 711).

What is the Western Sky made to the drug list that may impact you. Community Care Preferred Drug List (PDL)? How do I use the Preferred Drug The preferred drug list (which is also List? called a “formulary”) is a list showing The best way to find your drug is by the drugs that can be covered by your going to the back of this book to the Western Sky Community Health Plan. index and looking it up by name. If the The drug listed will be covered as long drug is in all CAPITAL LETTERS (EX: as you: CIPRO TABS) the drug is a BRAND  Have a medical need for the drug name drug and if the drug is in all lower case letters (ex: ciprofloxacin)  Fill your drugs at a pharmacy the drug is a generic name drug. Next that we cover to your drug, you will see the page  Follow any other rules that number where you can find coverage may apply to you as a member information.

For more information on how to fill your What are generic drugs? drugs, please review your Member A generic drug is approved by the Handbook or call Western Sky Food and Drug Administration Community Care (WSCC) Member (FDA) as having the same active Services at 1-844-543-8996 (TTY/TDD ingredient as the BRAND name 711). drug, but often costs less.

How will I know what I will pay? Does the plan cover over–the – In most cases you will not have a counter (OTC) drugs? copay. However, depending on the Yes, Western Sky Community Care category you are eligible for or the covers certain OTC drugs. All drug(s) you are taking, you may have covered OTC drugs appear in the a copay PDL. All OTC drugs must be written on a valid prescription by a licensed Will the Preferred Drug List provider in order to be covered. change? Yes, it will change if there is a new Are there any limits on my drug drug or there is a less expensive coverage? generic that becomes available. You There may be some limits on covered will be notified if any changes are drugs such as:

PRIOR AUTHORIZATION (PA): HOW MUCH IS 90 MME/DAY FOR Your provider may need to get approval COMMONLY PRESCRIBED from us before you fill some of your OPIOIDS? 90 MME/day: drug orders. Drugs that require prior  90 mg of hydrocodone (9 tablets authorization are found in the PDL by a of hydrocodone/ PA in the Additional Information acetaminophen 10/325) column. To find out more about this process, please call Member Services  60 mg of oxycodone (2 tablets at 1-844-543-8996 (TTY/ TDD 711) and of oxycodone sustained- a representative will explain the release 30 mg) process to you.  20 mg of methadone (4 tablets of methadone 5 mg) QUANTITY LIMITS (QL): For certain drugs there are limits to the amount of a drug that will be covered SPECIALTY PHARMACY (SP) for a period of time. You can tell if your DRUGS: Specialty drugs are certain drug needs a QL in prescription drugs used to treat special Additional Information column. health conditions and often require special attention. These drugs need a  You can also contact your provider prior authorization before a prescription to decide if you should first try a may be filled. Your prescription can be different drug on our list or different filled for up to a 30-day supply and dose of the drug before you request must be filled at Acaria Specialty an exception. Pharmacy. Your drugs will then be mailed to you. For more information  Contact Member Services at 1- about specialty drugs, contact Member 844-543-8996 (TTY/TDD 711) Services at 1-844-543-8996 (TTY/TDD and ask how you or your provider 711). can submit a quantity limit exception request. What if my drug(s) is not on the Preferred Drug List? MORPHINE MILLIGRAM Talk to your provider to decide if you EQUIVALENT (MME) DOSING: should first try a different drug on the list MME dosing is a tool used to make sure before you request an exception. you are taking a safe dose of pain drugs. Member Services will tell you how you or This tool helps WSCC calculate the total your provider can ask for an exception if daily dose of pain drugs a member is your drug(s) are not covered. Contact taking no matter which pain drug is WSCC Member Services at 1-844- 543- prescribed. The current daily limit is 8996 (TTY/TDD 711) for further 90MME per day. If you are taking more assistance. than 90MME per day of pain drugs, you will need to get a prior authorization.

Which drug categories are not calling Member Services at 1-844-543- covered by the Preferred Drug 8996 (TTY/TDD 711). List? Providers: In the event that a The following drug categories provider disagrees with the decision are not part of the benefit: regarding coverage of a drug, the provider may request an appeal by  Fertility drugs submitting additional information to  Weight loss or weight gain in writing to the Appeals Department at the following address:  Drug Efficacy Study Implementation (DESI). These are Western Sky Community Care Health drugs that are not shown to be Plan safe and effective. Appeals Department 5300 Homestead Rd NE Albuquerque, NM, 87110  Drugs and other agents used for cosmetic purposes or for hair After a decision is made, the provider growth will receive a response by mail. An expedited appeal may be requested  Erectile dysfunction drugs at any time the provider believes the prescribed to treat adverse determination might impotence seriously endanger the life or health of a member by calling Western Sky  Bulk chemicals/powders Community Care Health Plan at 1- 844-543-8996 (TTY/TDD 711).  Experimental and investigational drugs Abbreviations:  Drugs and devices not approved  AL: Age Limit by the FDA  PA: Prior Authorization  QL: Quantity Limit Contacts for Pharmacy  SP: Specialty Medication Appeals/Grievances  MP: Maintenance drug eligible for Members: In the event that a 90 day supply member disagrees with the decision regarding coverage of a drug, the member may request an appeal by

iii Such services are funded in part with the State of New Mexico Drug Requirements/ Drug Requirements/ Drug Name Tier Limits Drug Name Tier Limits ADHD/ANTI-NARCOLEPSY/ANTI- DEXEDRINE CP24 5 MG QL(1 ea daily); OBESITY/ANOREXIANTS - Drugs to Treat (Use dextroamphetamine NP AL(At least 6 ADHD, Sleep and Eating Disorders sulfate) yrs old) QL(2 ea daily); Amphetamines dextroamphetamine sulfate P AL(At least 6 cp24 10 mg, 15 mg ADDERALL TABS (Use QL(2 ea daily); yrs old) amphetamine- NP AL(At least 3 dextroamphetamine) yrs old) QL(1 ea daily); dextroamphetamine sulfate P AL(At least 6 cp24 5 mg ADDERALL XR CP24 (Use QL(1 ea daily); yrs old) amphetamine- NP AL(At least 6 dextroamphetamine) yrs old) dextroamphetamine sulfate P AL(At least 3 soln 5 mg/5ml yrs old) ADZENYS ER SUER (Use P AL(At least 6 amphetamine) yrs old) QL(3 ea daily); dextroamphetamine sulfate P AL(At least 3 AL(At least 6 tabs 10 mg, 5 mg ADZENYS XR-ODT TBED P yrs old) yrs old) dextroamphetamine sulfate AL(At least 3 AL(At least 6 amphetamine suer P tabs 2.5 mg, 7.5 mg, 15 P yrs old) yrs old) mg, 20 mg, 30 mg AL(At least 3 amphetamine sulfate tabs P DYANAVEL XR SUER P AL(At least 6 yrs old) yrs old) amphetamine- QL(1 ea daily); EVEKEO TABS (Use NP AL(At least 3 dextroamphetamine cp24 AL(At least 6 amphetamine sulfate) yrs old) 1.25 mg-1.25 mg-1.25 mg- yrs old) 1.25 mg, 2.5 mg-2.5 mg- methamphetamine hcl tabs P 2.5 mg-2.5 mg, 3.75 mg- P AL(At least 13 3.75 mg-3.75 mg-3.75 mg, MYDAYIS CP24 P 5 mg-5 mg-5 mg-5 mg, yrs old) 6.25 mg-6.25 mg-6.25 mg- VYVANSE CAPS 10 MG, QL(1 ea daily); 6.25 mg, 7.5 mg-7.5 mg- 20 MG, 30 MG, 40 MG, 50 P AL(At least 6 7.5 mg-7.5 mg MG, 60 MG, 70 MG yrs old) amphetamine- QL(2 ea daily); VYVANSE CHEW 10 MG, AL(At least 6 dextroamphetamine tabs AL(At least 3 20 MG, 30 MG, 40 MG, 50 P yrs old) 1.25 mg-1.25 mg-1.25 mg- yrs old) MG, 60 MG 1.25 mg, 1.875 mg-1.875 Analeptics mg-1.875 mg-1.875 mg, CAFCIT SOLN (Use 2.5 mg-2.5 mg-2.5 mg-2.5 P NP mg, 3.125 mg-3.125 mg- caffeine citrate) 3.125 mg-3.125 mg, 3.75 caffeine & sodium P mg-3.75 mg-3.75 mg-3.75 benzoate soln mg, 5 mg-5 mg-5 mg-5 mg, caffeine citrate soln iv 60 P 7.5 mg-7.5 mg-7.5 mg-7.5 mg/3ml mg caffeine citrate soln or 20 P QL(45 ml per DESOXYN TABS (Use NP mg/ml, 60 mg/3ml fill retail) methamphetamine hcl) DEXEDRINE CP24 10 MG, QL(2 ea daily); caffeine tabs P 15 MG (Use NP AL(At least 6 dextroamphetamine yrs old) DOPRAM SOLN P sulfate) ENERGY CHEWS CHEW P

FELBATOL SUSP (Use NP Succinimides felbamate) ethosuximide caps P MP FELBATOL TABS (Use NP felbamate) ethosuximide soln P MP GABA Modulators ZARONTIN CAPS (Use MP GABITRIL TABS 12 MG, NP NP 16 MG (Use tiagabine hcl) ethosuximide) ZARONTIN SOLN (Use MP GABITRIL TABS 2 MG, 4 NP MP NP MG (Use tiagabine hcl) ethosuximide) Valproic Acid SABRIL PACK (Use NP SP vigabatrin) DEPACON SOLN (Use NP valproate sodium) SABRIL TABS (Use NP SP vigabatrin) DEPAKENE CAPS (Use NP MP valproic acid) tiagabine hcl tabs 12 mg, P 16 mg DEPAKOTE ER TB24 (Use NP AL(At least 6 divalproex sodium) yrs old); MP tiagabine hcl tabs 2 mg, 4 P MP mg DEPAKOTE SPRINKLES AL(At least 6 SP CSDR (Use divalproex NP yrs old); MP vigabatrin pack P sodium) SP vigabatrin tabs P DEPAKOTE TBEC (Use NP AL(At least 6 divalproex sodium) yrs old); MP AL(At least 6 Hydantoins divalproex sodium csdr P yrs old); MP CEREBYX SOLN (Use NP fosphenytoin sodium) AL(At least 6 divalproex sodium tb24 P DILANTIN CAPS 100 MG MP yrs old); MP NP AL(At least 6 (Use phenytoin sodium divalproex sodium tbec P extended) yrs old); MP DILANTIN CAPS 30 MG P valproate sodium soln P

DILANTIN INFATABS NP MP valproic acid caps or P MP CHEW (Use phenytoin) DILANTIN-125 SUSP (Use NP MP ANTIDEPRESSANTS - Drugs to Treat phenytoin) Depression fosphenytoin sodium soln P Alpha-2 Receptor Antagonists (Tetracyclics) QL(1 ea daily); PHENYTEK CAPS (Use MP mirtazapine tabs 15 mg, 30 P AL(At least 3 mg, 45 mg phenytoin sodium NP yrs old); MP extended) QL(1 ea daily); phenytoin chew P MP mirtazapine tabs 7.5 mg P AL(At least 3 yrs old) phenytoin sodium extended P MP caps

ZOCOR TABS 5 MG, 10 QL(1 ea daily); PRINIVIL TABS (Use NP QL(2 ea daily); MG, 20 MG, 40 MG (Use NP MP lisinopril) MP simvastatin) QL(1 ea daily); quinapril hcl tabs P ZOCOR TABS 80 MG (Use NP MP MP simvastatin) QL(2 ea daily); ramipril caps P Intestinal Cholesterol Absorption Inhibitors MP trandolapril tabs 1 mg, 2 P QL(1 ea daily); ezetimibe tabs P mg MP QL(2 ea daily); ZETIA TABS (Use NP trandolapril tabs 4 mg P ezetimibe) MP Nicotinic Acid Derivatives VASOTEC TABS (Use NP QL(2 ea daily); enalapril maleate) MP niacin (antihyperlipidemic) P MP tabs 500 mg ZESTRIL TABS 10 MG, 20 QL(2 ea daily); MG, 30 MG, 40 MG, 5 MG NP MP niacin (antihyperlipidemic) (Use lisinopril) tbcr 1000 mg, 500 mg, 750 P mg ZESTRIL TABS 2.5 MG NP QL(1 ea daily); (Use lisinopril) MP NIASPAN TBCR (Use NP niacin (antihyperlipidemic)) Agents for Pheochromocytoma ANTIHYPERTENSIVES - Drugs to Treat High DIBENZYLINE CAPS (Use NP Blood Pressure phenoxybenzamine hcl) phenoxybenzamine hcl P ACE Inhibitors caps ACCUPRIL TABS (Use NP QL(1 ea daily); quinapril hcl) MP Angiotensin II Receptor Antagonists ATACAND TABS (Use ALTACE CAPS (Use NP QL(2 ea daily); NP ramipril) MP candesartan cilexetil) AVAPRO TABS (Use QL(1 ea daily); benazepril hcl tabs 10 mg, P QL(1 ea daily); NP 20 mg, 5 mg MP irbesartan) MP QL(2 ea daily); BENICAR TABS (Use benazepril hcl tabs 40 mg P NP MP olmesartan medoxomil) captopril tabs P QL(3 ea daily) candesartan cilexetil tabs P

Antineoplastic Antibiotics SUTENT CAPS (Use NP PA; SP sunitinib malate) DAUNORUBICIN PA; SP HYDROCHLORIDE SOLN NF TAFINLAR CAPS P 20 MG/4ML (Use daunorubicin hcl) TASIGNA CAPS P PA; SP Antineoplastic Enzyme Inhibitors TYKERB TABS (Use NP PA; SP AFINITOR DISPERZ TBSO P PA; SP lapatinib ditosylate) VOTRIENT TABS P PA; SP AFINITOR TABS 10 MG P PA; SP PA; SP AFINITOR TABS 2.5 MG, 5 PA; SP XALKORI CAPS P MG, 7.5 MG (Use NP PA; SP everolimus) ZELBORAF TABS P PA; SP BOSULIF TABS P ZOLINZA CAPS P PA; SP PA; SP COTELLIC TABS P ZYKADIA CAPS P PA; SP everolimus tabs P PA; SP Antineoplastics Misc.

HYDREA CAPS (Use NP LODOSYN TABS (Use NP hydroxyurea) carbidopa) hydroxyurea caps P Antiparkinson Anticholinergics benztropine mesylate soln P MATULANE CAPS P PA; SP ij 1 mg/ml benztropine mesylate tabs MP TARGRETIN CAPS (Use NP PA; SP P bexarotene) or 0.5 mg, 1 mg, 2 mg COGENTIN SOLN (Use tretinoin (chemotherapy) P PA; SP NP caps benztropine mesylate) trihexyphenidyl hcl soln 0.4 P QL(16.67 ml Chemotherapy Rescue/Antidote/Protective Agents mg/ml daily); MP SP dexrazoxane hcl solr P trihexyphenidyl hcl tabs 2 P MP mg, 5 mg FUSILEV SOLR (Use NP SP levoleucovorin calcium) Antiparkinson COMT Inhibitors COMTAN TABS (Use leucovorin calcium tabs or P NP 25 mg, 5 mg, 10 mg, 15 mg entacapone) levoleucovorin calcium solr P SP entacapone tabs P SP TASMAR TABS (Use NP mesna soln P tolcapone) MESNEX SOLN IV 100 NP SP tolcapone tabs P MG/ML (Use mesna) MESNEX TABS OR 400 P PA; SP Antiparkinson Dopaminergics MG amantadine hcl caps P MP ZINECARD SOLR (Use NP SP dexrazoxane hcl) amantadine hcl syrp P MP Mitotic Inhibitors bromocriptine mesylate P etoposide caps P SP caps bromocriptine mesylate P Topoisomerase I Inhibitors tabs CAMPTOSAR SOLN (Use NP SP MP irinotecan hcl) carbidopa-levodopa tabs P HYCAMTIN CAPS OR 0.25 P PA; SP MP MG, 1 MG carbidopa-levodopa tbcr P HYCAMTIN SOLR IV 4 MG NP SP MIRAPEX ER TB24 (Use (Use topotecan hcl) pramipexole NP dihydrochloride) irinotecan hcl soln P SP MIRAPEX TABS (Use QL(3 ea daily) NP topotecan hcl solr P SP pramipexole dihydrochloride) ANTIPARKINSON AND RELATED THERAPY PARLODEL CAPS (Use NP AGENTS - Drugs to Treat Parkinson's Disease bromocriptine mesylate) Antiparkinson Adjunctive Therapy New Mexico Western Sky Updated September 1, 2021 P-Preferred drug, NP-Non-preferred, AL-Age Limit, PA-Prior Authorization QL-Quantity limit, SP-Specialty drug, RX/OTC - both Rx and OTC NDCs MP-Maintenance drug eligible for 90 day supply, NF = Non-formulary SmartPA-Automated Prior Authorization, Formulary Contraceptives covered up to 12 month 34 Drug Requirements/ Drug Requirements/ Drug Name Tier Limits Drug Name Tier Limits PARLODEL TABS (Use NP Antimanic Agents bromocriptine mesylate) lithium carbonate caps 150 P AL(At least 12 pramipexole QL(3 ea daily) mg, 300 mg, 600 mg yrs old) dihydrochloride tabs 0.125 P AL(At least 12 mg, 0.25 mg, 0.5 mg, 0.75 lithium carbonate tabs 300 P mg yrs old) mg, 1 mg, 1.5 mg lithium carbonate tbcr 450 P AL(At least 12 pramipexole yrs old) dihydrochloride tb24 0.375 mg, 300 mg P AL(At least 12 mg, 0.75 mg, 1.5 mg, 2.25 LITHIUM SOLN P mg, 3 mg, 3.75 mg, 4.5 mg yrs old) LITHOBID TBCR (Use AL(At least 12 REQUIP XL TB24 (Use NP P ropinirole hydrochloride) lithium carbonate) yrs old) ropinirole hydrochloride P QL(6 ea daily); Antipsychotics - Misc. tabs 0.25 mg, 3 mg, 4 mg MP QL(1 ea daily); ropinirole hydrochloride QL(3 ea daily); CAPLYTA CAPS P AL(At least 18 tabs 0.5 mg, 1 mg, 2 mg, 5 P MP yrs old) mg QL(2 ea daily); GEODON CAPS (Use NP ropinirole hydrochloride ziprasidone hcl) AL(At least 10 tb24 12 mg, 2 mg, 4 mg, 6 P yrs old) mg, 8 mg AL(At least 10 LATUDA TABS P SINEMET CR TBCR (Use NP MP yrs old) carbidopa-levodopa) NUPLAZID CAPS 34 MG P QL(1 ea daily) SINEMET TABS (Use NP MP carbidopa-levodopa) NUPLAZID TABS 10 MG P QL(3 ea daily) STALEVO 100 TABS NF VRAYLAR CPPK P AL(At least 18 yrs old) STALEVO 125 TABS NF QL(2 ea daily); STALEVO 150 TABS NF ziprasidone hcl caps P AL(At least 10 yrs old) STALEVO 200 TABS NF Benzisoxazoles Limit 1 syringe STALEVO 50 TABS NF per 21 days;1 rtl pack lmt STALEVO 75 TABS NF INVEGA SUSTENNA P amt,21 rtl pack SUSY lmt day(s),; Antiparkinson Monoamine Oxidase Inhibitors AL(At least 18 yrs old) AZILECT TABS (Use NP rasagiline mesylate) INVEGA TB24 (Use NP AL(At least 12 rasagiline mesylate tabs P paliperidone) yrs old) Limit 1 syringe AL(At least 18 selegiline hcl caps P every 3 yrs old); MP months;1 rtl AL(At least 18 pack lmt selegiline hcl tabs P INVEGA TRINZA SUSY P yrs old); MP amt,90 rtl pack lmt day(s),; ANTIPSYCHOTICS/ANTIMANIC AGENTS - AL(At least 18 Drugs to Treat Mood Disorders yrs old) New Mexico Western Sky Updated September 1, 2021 P-Preferred drug, NP-Non-preferred, AL-Age Limit, PA-Prior Authorization QL-Quantity limit, SP-Specialty drug, RX/OTC - both Rx and OTC NDCs MP-Maintenance drug eligible for 90 day supply, NF = Non-formulary SmartPA-Automated Prior Authorization, Formulary Contraceptives covered up to 12 month 35 Drug Requirements/ Drug Requirements/ Drug Name Tier Limits Drug Name Tier Limits AL(At least 12 AL(At least 3 paliperidone tb24 P haloperidol lactate soln P yrs old) yrs old) PERSERIS PRSY P QL(3 ea daily); haloperidol tabs 0.5 mg, 1 P AL(At least 3 mg Limit 2 vials per yrs old) RISPERDAL CONSTA P month;QL(0.07 SRER QL(3 ea daily); 2 ea daily) haloperidol tabs 10 mg P AL(At least 12 QL(4 ml daily); yrs old) RISPERDAL SOLN 1 NP AL(At least 4 MG/ML (Use risperidone) haloperidol tabs 2 mg, 5 P AL(At least 3 yrs old) mg yrs old) RISPERDAL TABS 0.25 QL(2 ea daily); AL(At least 18 haloperidol tabs 20 mg P MG, 0.5 MG, 1 MG, 2 MG, NP AL(At least 4 yrs old) 3 MG (Use risperidone) yrs old) Dibenzapines QL(2 ea daily); RISPERDAL TABS 4 MG NP AL(At least 12 (Use risperidone) ADASUVE AEPB P yrs old) QL(9 ea daily); QL(4 ml daily); P AL(At least 8 risperidone soln 1 mg/ml P AL(At least 4 clozapine tabs 100 mg yrs old) yrs old) QL(3 ea daily); QL(2 ea daily); clozapine tabs 200 mg, 50 P risperidone tabs 0.25 mg, P AL(At least 4 AL(At least 8 0.5 mg, 1 mg, 2 mg, 3 mg mg, 25 mg yrs old) yrs old) QL(9 ea daily); QL(2 ea daily); CLOZARIL TABS 100 MG NP P AL(At least 12 ) AL(At least 8 risperidone tabs 4 mg (Use clozapine yrs old) yrs old) CLOZARIL TABS 200 MG, QL(3 ea daily); QL(1 ea daily); NP P AL(At least 4 50 MG, 25 MG (Use AL(At least 8 risperidone tbdp 0.25 mg clozapine) yrs old) yrs old) QL(4 ea daily) QL(2 ea daily); loxapine succinate caps P risperidone tbdp 0.5 mg, 1 P AL(At least 4 mg, 2 mg, 3 mg yrs old) QL(1 ea daily); olanzapine tabs 10 mg, 2.5 P AL(At least 4 mg, 5 mg, 7.5 mg QL(2 ea daily); yrs old) risperidone tbdp 4 mg P AL(At least 12 yrs old) QL(1 ea daily); olanzapine tabs 15 mg, 20 P AL(At least 6 mg Butyrophenones yrs old) HALDOL DECANOATE AL(At least 18 quetiapine fumarate tabs QL(2 ea daily); 100 SOLN (Use haloperidol NP yrs old) 100 mg, 200 mg, 25 mg, P AL(At least 5 decanoate) 300 mg, 400 mg, 50 mg yrs old) HALDOL DECANOATE 50 AL(At least 18 quetiapine fumarate tb24 AL(At least 5 SOLN (Use haloperidol NP yrs old) 150 mg, 200 mg, 300 mg, P yrs old) decanoate) 400 mg, 50 mg HALDOL SOLN (Use NP AL(At least 3 QL(1 ea daily); haloperidol lactate) yrs old) SECUADO PT24 P AL(At least 18 AL(At least 18 yrs old) haloperidol decanoate soln P yrs old) QL(2 ea daily); SEROQUEL TABS (Use AL(At least 3 NP AL(At least 5 haloperidol lactate conc P quetiapine fumarate) yrs old) yrs old)

PREZISTA TABS 600 MG, P QL(2 ea daily) TEMIXYS TABS P 75 MG QL(1 ea daily) tenofovir disoproxil P QL(1 ea daily) PREZISTA TABS 800 MG P fumarate tabs RESCRIPTOR TABS P QL(6 ea daily) TIVICAY PD TBSO P QL(1 ea daily) RETROVIR CAPS 100 MG NP QL(6 ea daily) TIVICAY TABS P (Use zidovudine) RETROVIR SYRP 50 NP QL(60 ml daily) TRIUMEQ TABS P MG/5ML (Use zidovudine) REYATAZ CAPS 150 MG, QL(2 ea daily) TRIZIVIR TABS (Use QL(2 ea daily) 200 MG, 300 MG (Use NP abacavir sulfate- NP atazanavir sulfate) lamivudine-zidovudine) SP REYATAZ PACK 50 MG P QL(6 ea daily) TROGARZO SOLN P QL(12 ea daily) TRUVADA TABS 133 MG- ritonavir tabs P 200 MG, 150 MG-100 MG, 167 MG-250 MG (Use NP RUKOBIA TB12 P emtricitabine-tenofovir disoproxil fumarate) SELZENTRY SOLN 20 P MG/ML TRUVADA TABS 200 MG- QL(1 ea daily) 300 MG (Use emtricitabine- NP SELZENTRY TABS 150 P QL(2 ea daily) tenofovir disoproxil MG, 25 MG, 75 MG fumarate) SELZENTRY TABS 300 P QL(4 ea daily) QL(1 ea daily) MG TYBOST TABS P STAVUDINE CAPS 15 MG, P QL(2 ea daily) QL(1 ea daily) 20 MG, 30 MG, 40 MG VIDEX EC CPDR 125 MG P stavudine caps 15 mg, 20 P QL(2 ea daily) VIDEX EC CPDR 200 MG, QL(1 ea daily) mg, 30 mg, 40 mg 250 MG, 400 MG (Use NF didanosine) STRIBILD TABS P QL(1 ea daily) VIDEXPEDIATRIC SOLR P QL(20 ml daily) SUSTIVA CAPS 200 MG NP QL(1 ea daily) (Use efavirenz) VIRACEPT TABS 250 MG P QL(9 ea daily) SUSTIVA CAPS 50 MG NP QL(2 ea daily) (Use efavirenz) VIRACEPT TABS 625 MG P QL(4 ea daily) SUSTIVA TABS 600 MG NP QL(1 ea daily) (Use efavirenz) VIRAMUNE SUSP 50 NP QL(40 ml daily) MG/5ML (Use nevirapine) SYMFI LO TABS (Use VIRAMUNE TABS 200 MG QL(2 ea daily) efavirenz-lamivudine- NP NP tenofovir disoproxil (Use nevirapine) fumarate) VIRAMUNE XR TB24 (Use NP QL(1 ea daily) nevirapine) New Mexico Western Sky Updated September 1, 2021 P-Preferred drug, NP-Non-preferred, AL-Age Limit, PA-Prior Authorization QL-Quantity limit, SP-Specialty drug, RX/OTC - both Rx and OTC NDCs MP-Maintenance drug eligible for 90 day supply, NF = Non-formulary SmartPA-Automated Prior Authorization, Formulary Contraceptives covered up to 12 month 40 Drug Requirements/ Drug Requirements/ Drug Name Tier Limits Drug Name Tier Limits VIREAD POWD 40 MG/GM P QL(8 gm daily) lamivudine (hbv) tabs P VIREAD TABS 150 MG, QL(1 ea daily) P MAVYRET TABS P PA; QL(3 ea 200 MG, 250 MG daily); SP VIREAD TABS 300 MG QL(1 ea daily) ribavirin (hepatitis c) caps P PA; SP (Use tenofovir disoproxil NP fumarate) ribavirin (hepatitis c) tabs P PA; SP VOCABRIA TABS P SOFOSBUVIR/VELPATAS P PA; SP VIR TABS ZIAGEN SOLN 20 MG/ML NP QL(30 ml daily) (Use abacavir sulfate) Herpes Agents ZIAGEN TABS 300 MG NP QL(2 ea daily) Limit 50 per (Use abacavir sulfate) month;QL(50 acyclovir caps 200 mg P zidovudine caps 100 mg P QL(6 ea daily) ea per 30 days retail) zidovudine syrp 50 mg/5ml P QL(60 ml daily) Limit 400ml per month;QL(400 acyclovir susp 200 mg/5ml P zidovudine tabs 300 mg P QL(2 ea daily) ml per 30 days retail) CMV Agents Limit 50 per acyclovir tabs 400 mg, 800 month;QL(50 CYTOVENE SOLR (Use NP P ganciclovir sodium) mg ea per 30 days retail) ganciclovir sodium solr P famciclovir tabs P VALCYTE SOLR 50 MG/ML (Use valganciclovir NP valacyclovir hcl tabs 1 gm, P QL(3 ea daily) hcl) 1000 mg valacyclovir hcl tabs 500 QL(2 ea daily) VALCYTE TABS 450 MG NP QL(2 ea daily) P (Use valganciclovir hcl) mg VALTREX TABS 1 GM QL(3 ea daily) valganciclovir hcl solr 50 P NP mg/ml (Use valacyclovir hcl) VALTREX TABS 500 MG QL(2 ea daily) valganciclovir hcl tabs 450 P QL(2 ea daily) NP mg (Use valacyclovir hcl) Hepatitis Agents Limit 50 per ZOVIRAX CAPS OR 200 NP month;QL(50 adefovir dipivoxil tabs P MG (Use acyclovir) ea per 30 days retail) BARACLUDE TABS (Use NP entecavir) Limit 400ml per ZOVIRAX SUSP OR 200 NP month;QL(400 entecavir tabs P MG/5ML (Use acyclovir) ml per 30 days retail) EPCLUSA TABS 400 MG- NF SP Limit 50 per 100 MG ZOVIRAX TABS OR 400 month;QL(50 EPIVIR HBV TABS (Use MG, 800 MG (Use NP NP acyclovir) ea per 30 days lamivudine (hbv)) retail) HEPSERA TABS (Use NP Influenza Agents adefovir dipivoxil)

Transthyretin Stabilizers ceftazidime solr P

OXISTAT CREA (Use NP OXSORALEN ULTRA oxiconazole nitrate) CAPS (Use methoxsalen NP rapid) PENLAC NAIL LACQUER NP SOLN (Use ciclopirox) SORIATANE CAPS (Use NP acitretin) terbinafine hcl (topical) P QL(30 gm per crea fill retail) TALTZ SOAJ P PA; SP TINACTIN CREA (Use NP QL(30 gm per tolnaftate) fill retail) TALTZ SOSY P PA; SP QL(30 gm per tolnaftate crea P fill retail) PA; QL(60 gm P per fill retail); VYTONE CREA (Use tazarotene crea AL(Up to 21 yrs iodoquinol-hydrocortisone NP old ) in aloe vehicle) PA; QL(60 gm Antihistamines-Topical P per fill retail); TAZORAC CREA 0.05 % AL(Up to 21 yrs ITCH RELIEF CREA P old ) Antineoplastic or Premalignant Lesion Agents - PA; QL(60 gm TAZORAC CREA 0.1 % per fill retail); CARAC CREA (Use P QL(30 gm per NP fluorouracil (topical)) fill retail) (Use tazarotene) AL(Up to 21 yrs old ) diclofenac sodium (actinic P PA keratoses) gel PA; QL(60 gm TAZORAC GEL 0.05 %, P per fill retail); EFUDEX CREA (Use NP QL(40 gm per 0.1 % AL(Up to 21 yrs fluorouracil (topical)) fill retail) old ) fluorouracil (topical) crea P QL(30 gm per 0.5 % fill retail) Antiseborrheic Products OVACE PLUS SHAM (Use NP fluorouracil (topical) crea 5 P QL(40 gm per sulfacetamide sodium) % fill retail) OVACE PLUS WASH GEL fluorouracil (topical) soln 2 QL(10 ml per P (Use sulfacetamide NP %, 5 % fill retail) sodium) Antipruritics - Topical OVACE PLUS WASH LIQD QL(360 ml per QL(222 ml per (Use sulfacetamide NP fill retail) camphor & menthol lotn P fill retail) sodium) SARNA LOTN (Use NP QL(222 ml per OVACE WASH LIQD (Use NP QL(360 ml per camphor & menthol) fill retail) sulfacetamide sodium) fill retail) QL(240 ml per Antipsoriatics selenium sulfide lotn 1 % P fill retail) acitretin caps P QL(120 ml per selenium sulfide lotn 2.5 % P QL(60 gm per fill retail) calcipotriene crea P QL(240 ml per fill retail) selenium sulfide sham 1 % P QL(60 ml per fill retail) calcipotriene soln P fill retail) SELSUN BLUE DAILY QL(240 ml per LOTN (Use selenium NP fill retail) DOVONEX CREA (Use NP QL(60 gm per calcipotriene) fill retail) sulfide)

SILVADENE CREA (Use NP QL(50 gm per clobetasol propionate lotn P silver sulfadiazine) fill retail) QL(50 gm per QL(60 gm per silver sulfadiazine crea P clobetasol propionate oint P fill retail) fill retail) SULFAMYLON PACK (Use NP clobetasol propionate sham P mafenide acetate) QL(25 ml per clobetasol propionate soln P Corticosteroids - Topical fill retail) ALA-SCALP LOTN NP CLOBEX LIQD (Use NP clobetasol propionate) alclometasone dipropionate P CLOBEX LOTN (Use NP crea clobetasol propionate) QL(60 gm per APEXICON E CREA P CLOBEX SHAM (Use NP fill retail) clobetasol propionate)

New Mexico Western Sky Updated September 1, 2021 P-Preferred drug, NP-Non-preferred, AL-Age Limit, PA-Prior Authorization QL-Quantity limit, SP-Specialty drug, RX/OTC - both Rx and OTC NDCs MP-Maintenance drug eligible for 90 day supply, NF = Non-formulary SmartPA-Automated Prior Authorization, Formulary Contraceptives covered up to 12 month 54 Drug Requirements/ Drug Requirements/ Drug Name Tier Limits Drug Name Tier Limits hydrocortisone (topical) P MONISTAT SOOTHING QL(60 gm per oint 0.5 % CARE ITCH RELIEF CREA NP fill retail); 1 rtl pack lmt (Use hydrocortisone RX/OTC (topical)) hydrocortisone (topical) P amt,30 rtl pack oint 1 % lmt day(s),; NOVACORT GEL NP RX/OTC 1 rtl pack lmt OLUX FOAM (Use NP hydrocortisone (topical) P amt,30 rtl pack clobetasol propionate) oint 2.5 % lmt day(s), OLUX-E FOAM (Use clobetasol propionate NP hydrocortisone butyrate P crea emulsion) PRAMOSONE CREA (Use hydrocortisone butyrate P NP hydrophilic lipo base crea pramoxine-hc) hydrocortisone butyrate P pramoxine-hc crea P lotn hydrocortisone butyrate P pramoxine-hc gel P oint QL(60 gm per prednicarbate crea P hydrocortisone butyrate P QL(60 ml per fill retail) soln fill retail) QL(60 gm per prednicarbate oint P hydrocortisone valerate P fill retail) oint QL(60 gm per PSORCON CREA P hydrocortisone-aloe vera P QL(60 gm per fill retail) crea fill retail) SYNALAR CREA (Use NP KENALOG AERS (Use fluocinolone acetonide) triamcinolone acetonide NP (topical)) SYNALAR OINT (Use NP fluocinolone acetonide) LOCOID CREA (Use NP hydrocortisone butyrate) SYNALAR SOLN (Use NP fluocinolone acetonide) LOCOID LIPOCREAM TACLONEX OINT (Use CREA (Use hydrocortisone NP butyrate hydrophilic lipo calcipotriene- NP base) betamethasone dipropionate) LOCOID LOTN (Use NP hydrocortisone butyrate) TEMOVATE CREA (Use NP QL(45 gm per clobetasol propionate) fill retail) LOCOID SOLN (Use NP QL(60 ml per hydrocortisone butyrate) fill retail) TEMOVATE OINT (Use NP QL(60 gm per clobetasol propionate) fill retail) LUXIQ FOAM (Use NP betamethasone valerate) TOPICORT CREA 0.05 % NP QL(60 gm per (Use desoximetasone) fill retail) QL(45 gm per mometasone furoate crea P fill retail) TOPICORT CREA 0.25 % NP QL(2 gm daily) (Use desoximetasone) QL(45 gm per mometasone furoate oint P fill retail) TOPICORT GEL 0.05 % NP QL(2 gm daily) (Use desoximetasone) QL(60 ml per mometasone furoate soln P fill retail) TOPICORT OINT 0.05 % NP (Use desoximetasone) TOPICORT OINT 0.25 % NP QL(2 gm daily) (Use desoximetasone) New Mexico Western Sky Updated September 1, 2021 P-Preferred drug, NP-Non-preferred, AL-Age Limit, PA-Prior Authorization QL-Quantity limit, SP-Specialty drug, RX/OTC - both Rx and OTC NDCs MP-Maintenance drug eligible for 90 day supply, NF = Non-formulary SmartPA-Automated Prior Authorization, Formulary Contraceptives covered up to 12 month 55 Drug Requirements/ Drug Requirements/ Drug Name Tier Limits Drug Name Tier Limits triamcinolone acetonide P LAC-HYDRIN CREA (Use QL(140 gm per (topical) aers 0.147 mg/gm lactic acid (ammonium NP fill retail); lactate)) RX/OTC triamcinolone acetonide P QL(454 gm per (topical) crea 0.025 % fill retail) 1 rtl pack lmt LAC-HYDRIN TWELVE amt,30 rtl pack triamcinolone acetonide P QL(30 gm per LOTN (Use lactic acid NP (topical) crea 0.1 % fill retail) (ammonium lactate)) lmt day(s),; RX/OTC triamcinolone acetonide P QL(15 gm per (topical) crea 0.5 % fill retail) QL(140 gm per lactic acid (ammonium P fill retail); lactate) crea triamcinolone acetonide QL(60 ml per RX/OTC (topical) lotn 0.025 %, 0.1 P fill retail) % 1 rtl pack lmt lactic acid (ammonium P amt,30 rtl pack triamcinolone acetonide QL(80 gm per lactate) lotn lmt day(s),; (topical) oint 0.025 %, 0.1 P fill retail) RX/OTC % Immunomodulating Agents - Topical triamcinolone acetonide P QL(15 gm per (topical) oint 0.5 % fill retail) ALDARA CREA (Use NP imiquimod) TRIDESILON CREA (Use NP desonide) imiquimod crea 5 % P VANOS CREA (Use NP fluocinonide) Immunosuppressive Agents - Topical Emollient/Keratolytic Agents PA; 1 rtl pack ELIDEL CREA (Use NP lmt amt,30 rtl P QL(240 ml per pimecrolimus) pack lmt CEROVEL LOTN fill retail) day(s), HYDRO 35 FOAM (Use NF PA; 1 rtl pack urea in lactic acid vehicle) lmt amt,30 rtl pimecrolimus crea P HYDRO 40 FOAM FOAM NP pack lmt (Use urea) day(s), KERALAC CREA (Use NP PA; 1 rtl pack urea) PROTOPIC OINT (Use NP lmt amt,30 rtl tacrolimus (topical)) pack lmt URAMAXIN GEL (Use NP urea) day(s), QL(210 gm per PA; 1 rtl pack lmt amt,30 rtl urea crea 40 % P fill retail); tacrolimus (topical) oint P RX/OTC pack lmt day(s), urea crea 47 %, 39 % P Keratolytic/Antimitotic Agents urea foam 40 % P KERALYT GEL (Use NP QL(40 gm per salicylic acid) fill retail) urea gel 45 % P QL(4 ml per fill podofilox soln P retail) urea in lactic acid vehicle P foam SALEX SHAM (Use NP salicylic acid) QL(240 ml per urea lotn 40 % P fill retail) salicylic acid foam 6 % P Emollients QL(40 gm per salicylic acid gel 6 % P fill retail) New Mexico Western Sky Updated September 1, 2021 P-Preferred drug, NP-Non-preferred, AL-Age Limit, PA-Prior Authorization QL-Quantity limit, SP-Specialty drug, RX/OTC - both Rx and OTC NDCs MP-Maintenance drug eligible for 90 day supply, NF = Non-formulary SmartPA-Automated Prior Authorization, Formulary Contraceptives covered up to 12 month 56 Drug Requirements/ Drug Requirements/ Drug Name Tier Limits Drug Name Tier Limits salicylic acid liqd 27.5 % P LIDOTRAL CREA NP salicylic acid sham 6 % P LMX 4 CREA (Use NP QL(30 gm per lidocaine) fill retail) salicylic acid soln 28.5 % P PREDATOR CREA (Use NP QL(65 ml per lidocaine hcl) fill retail) SALVAX FOAM (Use NP salicylic acid) Misc. Topical COLEMAN BOTANICALS ULTRASAL-ER SOLN NP P (Use salicylic acid) INSECTREPELLENT LIQD COLEMAN SKINSMART VIRASAL LIQD (Use NP salicylic acid) INSECTREPELLENT P AERO Local Anesthetics - Topical COLEMAN SKINSMART P ARTHRITIS PAIN P QL(60 gm per INSECTREPELLENT LIQD RELIEVING CREA fill retail) COLEMAN SKINSMART capsaicin crea 0.025 % P INSECTREPELLENT/GO P READY SPRAY PEN LIQD QL(60 gm per capsaicin crea 0.075 % P CUTTER LEMON P fill retail) EUCALYPTUS LIQD QL(42.5 gm per capsaicin crea 0.1 % P fill retail) CUTTER NATURAL AERO P CAPZASIN-HP CREA (Use QL(42.5 gm per NP P capsaicin) fill retail) CUTTER NATURAL LIQD QL(30 gm per CVS TOTAL HOME dibucaine oint P fill retail) INSECT REPELLENT P QL(30 gm per AERO lidocaine crea ex 3 %, 4 % P QL(60 ml per fill retail) DRYSOL SOLN P QL(30 gm per fill retail) lidocaine hcl crea 3 % P fill retail); EAGLE WATCH RX/OTC MOSQUITO ELIMINATOR P QL(65 ml per LIQD lidocaine hcl crea 4 % P fill retail) REPEL LEMON QL(30 ml per EUCALYPTUS INSECT P lidocaine hcl gel 2 % P fill retail); REPELLENT AERO QL(60 gm per RX/OTC zinc oxide (topical) oint P QL(30 ml per fill retail) lidocaine hcl gel 2 % P fill retail) Rosacea Agents QL(30 ml per lidocaine hcl prsy 2 % P METROCREAM CREA QL(45 gm per fill retail) (Use metronidazole NP fill retail) (topical)) lidocaine hcl soln 4 % P METROGEL GEL (Use NP lidocaine ptch ex 5 % P PA metronidazole (topical)) METROLOTION LOTN QL(30 gm per lidocaine-prilocaine crea P (Use metronidazole NP fill retail) (topical)) LIDODERM PTCH (Use NP PA lidocaine) New Mexico Western Sky Updated September 1, 2021 P-Preferred drug, NP-Non-preferred, AL-Age Limit, PA-Prior Authorization QL-Quantity limit, SP-Specialty drug, RX/OTC - both Rx and OTC NDCs MP-Maintenance drug eligible for 90 day supply, NF = Non-formulary SmartPA-Automated Prior Authorization, Formulary Contraceptives covered up to 12 month 57 Drug Requirements/ Drug Requirements/ Drug Name Tier Limits Drug Name Tier Limits metronidazole (topical) P QL(45 gm per pyrethrins-piperonyl crea 0.75 % fill retail) butoxide-permethrin-nit P remover kit metronidazole (topical) gel P QL(45 gm per 0.75 % fill retail) RID COMPLETE LICE ELIMINATION KIT (Use metronidazole (topical) gel P 1 % pyrethrins-piperonyl NP butoxide-permethrin-nit metronidazole (topical) lotn P remover) 0.75 % RID LIQD (Use pyrethrins- NP QL(60 ml per Scabicides & Pediculicides piperonyl butoxide) fill retail) QL(60 gm per crotamiton lotn P QL(120 ml per fill retail) spinosad susp P fill retail); AL(At least 1 yrs old) CVS LICE SOLUTION KIT P 3-STEP KIT Tar Products ELIMITE CREA (Use NP QL(60 gm per permethrin) fill retail) coal tar extract sham P QL(60 gm per EURAX CREA P DHS TAR GEL SHAM (Use NP fill retail) coal tar extract) EURAX LOTN (Use QL(60 gm per NF DHS TAR SHAM (Use coal NP crotamiton) fill retail) tar extract) QL(59 ml per malathion lotn P NEUTROGENA T/GEL fill retail) SHAM (Use coal tar NP QL(120 ml per extract) NATROBA SUSP (Use P spinosad) fill retail); AL(At NEUTROGENA T/GEL least 1 yrs old) STUBBORN ITCH NP NIX CREME RINSE LIQD NP CONTROL SHAM (Use (Use permethrin) coal tar extract) OVIDE LOTN (Use NP QL(59 ml per malathion) fill retail) DIAGNOSTIC PRODUCTS QL(60 gm per permethrin crea 5 % P Diagnostic Tests fill retail) CHEMSTRIP-K STRP P permethrin liqd 1 % P FORA GTEL BLOOD QL(1 ea daily) QL(120 ml per permethrin lotn 1 % P KETONE TEST STRIPS P fill retail) STRP pyrethrins-piperonyl GOJJI BLOOD KETONE P QL(1 ea daily) butoxide liqd 0.3 %-0.3 %- P TEST STRIPS STRP 1.2 %-2.4 %-3 % KETONE STRP P pyrethrins-piperonyl P QL(60 ml per butoxide liqd 0.33 %-4 % fill retail) KETONE TEST STRIPS P pyrethrins-piperonyl STRP butoxide sham 0.3 %-0.33 P %-4 %, 4 %-0.33 % KETOSTIX STRP P NOVA MAX PLUS QL(1 ea daily) pyrethrins-piperonyl P QL(60 ml per butoxide sham 0.33 %-4 % fill retail) KETONE TESTSTRIPS P STRP

CIMZIA KIT P PA; SP RENVELA PACK (Use NP sevelamer carbonate) New Mexico Western Sky Updated September 1, 2021 P-Preferred drug, NP-Non-preferred, AL-Age Limit, PA-Prior Authorization QL-Quantity limit, SP-Specialty drug, RX/OTC - both Rx and OTC NDCs MP-Maintenance drug eligible for 90 day supply, NF = Non-formulary SmartPA-Automated Prior Authorization, Formulary Contraceptives covered up to 12 month 63 Drug Requirements/ Drug Requirements/ Drug Name Tier Limits Drug Name Tier Limits RENVELA TABS (Use NP FLOMAX CAPS (Use NP QL(2 ea daily); sevelamer carbonate) tamsulosin hcl) MP sevelamer carbonate pack P JALYN CAPS (Use NP dutasteride-tamsulosin hcl) sevelamer carbonate tabs P PROSCAR TABS (Use NP QL(1 ea daily); finasteride) MP GENITOURINARY AGENTS - MISCELLANEOUS QL(2 ea daily); tamsulosin hcl caps P - Miscellaneous Drugs to Treat Reproductive MP Organs and Urinary System UROXATRAL TB24 (Use NP Alkalinizers alfuzosin hcl) potassium citrate P Urinary Analgesics (alkalinizer) tbcr phenazopyridine hcl tabs P potassium citrate-citric acid P 100 mg, 200 mg, 95 mg pack PYRIDIUM TABS (Use NP 1 rtl pack lmt phenazopyridine hcl) sodium citrate & citric acid P amt,30 rtl pack soln lmt day(s),; GOUT AGENTS - Drugs to Treat Gout RX/OTC Gout Agent Combinations UROCIT-K 10 TBCR (Use potassium citrate NP colchicine w/ probenecid P (alkalinizer)) tabs UROCIT-K 15 TBCR (Use Gout Agents potassium citrate NP (alkalinizer)) allopurinol sodium solr P UROCIT-K 5 TBCR (Use allopurinol tabs P MP potassium citrate NP (alkalinizer)) ALOPRIM SOLR (Use NP Genitourinary Irrigants allopurinol sodium) PA; Limit 6 per neomycin/polymyxin b gu P soln colchicine tabs P claim;QL(6 ea per fill retail) sodium chloride (gu P irrigant) soln PA; Limit 6 per COLCRYS TABS (Use NP colchicine) claim;QL(6 ea Interstitial Cystitis Agents per fill retail) QL(3 ea daily) ELMIRON CAPS P ZYLOPRIM TABS (Use NP MP allopurinol) Prostatic Hypertrophy Agents Uricosurics alfuzosin hcl tb24 P probenecid tabs P AVODART CAPS (Use NP dutasteride) HEMATOLOGICAL AGENTS - MISC. - Drugs to Treat Blood Disorders dutasteride caps P Antihemophilic Products PA; SP dutasteride-tamsulosin hcl P ADVATE SOLR P caps QL(1 ea daily); PA; SP finasteride tabs P ADYNOVATE SOLR P MP New Mexico Western Sky Updated September 1, 2021 P-Preferred drug, NP-Non-preferred, AL-Age Limit, PA-Prior Authorization QL-Quantity limit, SP-Specialty drug, RX/OTC - both Rx and OTC NDCs MP-Maintenance drug eligible for 90 day supply, NF = Non-formulary SmartPA-Automated Prior Authorization, Formulary Contraceptives covered up to 12 month 64 Drug Requirements/ Drug Requirements/ Drug Name Tier Limits Drug Name Tier Limits AFSTYLA KIT P PA; SP NUWIQ KIT P PA; SP

ALPHANATE SOLR P PA; SP NUWIQ SOLR P PA; SP

ALPHANATE/VON PA; SP OBIZUR SOLR P PA; SP WILLEBRANDFACTOR P COMPLEX/HUMAN SOLR PROFILNINE SD SOLR P PA; SP ALPHANINE SD SOLR P PA; SP PROFILNINE SOLR P PA; SP ALPROLIX SOLR P PA; SP REBINYN SOLR P PA; SP BENEFIX KIT P PA; SP RECOMBINATE SOLR P PA; SP COAGADEX SOLR P PA; SP RIASTAP SOLR P PA; SP CORIFACT KIT P PA; SP RIXUBIS SOLR P PA; SP ELOCTATE SOLR P PA; SP TRETTEN SOLR P PA; SP FEIBA SOLR P PA; SP VONVENDI SOLR P PA; SP FIBRYGA SOLR P PA; SP WILATE KIT P PA; SP HELIXATE FS KIT P PA; SP XYNTHA KIT P PA; SP HEMOFIL M SOLR P PA; SP XYNTHA SOLOFUSE KIT P PA; SP HUMATE-P SOLR P PA; SP Bradykinin B2 Receptor Antagonists IDELVION SOLR 1000 PA; SP FIRAZYR SOLN ( Use NP PA UNIT, 2000 UNIT, 250 P icatibant acetate) UNIT, 500 UNIT icatibant acetate soln P PA IXINITY SOLR P PA; SP Complement Inhibitors KCENTRA KIT P PA; SP HAEGARDA SOLR P PA KOATE SOLR P PA; SP Hematorheologic Agents PA; SP KOATE-DVI SOLR P pentoxifylline tbcr P MP KOGENATE FS KIT P PA; SP Platelet Aggregation Inhibitors QL(2 ea daily) KOVALTRY SOLR P PA; SP BRILINTA TABS P QL(2 ea daily); PA; SP cilostazol tabs P MONONINE SOLR P MP PA; SP clopidogrel bisulfate tabs P NOVOEIGHT SOLR P 300 mg NOVOSEVEN RT SOLR P PA; SP

QL(1 ea daily); psyllium powd P zaleplon caps P AL(At least 18 yrs old) Laxative Combinations zolpidem tartrate subl sl P AL(At least 18 COLYTE-FLAVOR PACKS QL(4000 ml per 1.75 mg, 3.5 mg yrs old) SOLR (Use peg 3350-kcl- NF fill retail) QL(1 ea daily); sod bicarb-sod chloride-sod zolpidem tartrate tabs or 10 P AL(At least 18 mg, 5 mg sulfate) yrs old) GOLYTELY SOLR (Use QL(4000 ml per zolpidem tartrate tbcr or P AL(At least 18 peg 3350-kcl-sod bicarb- NP fill retail) 6.25 mg, 12.5 mg yrs old) sod chloride-sod sulfate) Orexin Receptor Antagonists NULYTELY SOLR (Use QL(4000 ml per PA; QL(1 ea peg 3350-potassium NP fill retail) chloride-sod bicarbonate- P daily); AL(At BELSOMRA TABS least 18 yrs sod chloride) old) NULYTELY/FLAVOR QL(4000 ml per PACKS SOLR (Use peg fill retail) Selective Melatonin Receptor Agonists 3350-potassium chloride- NP HETLIOZ CAPS P SP sod bicarbonate-sod chloride) AL(At least 18 ramelteon tabs P peg 3350-kcl-sod bicarb- QL(4000 ml per yrs old) sod chloride-sod sulfate P fill retail) solr ROZEREM TABS (Use NP AL(At least 18 ramelteon) yrs old) peg 3350-potassium QL(4000 ml per chloride-sod bicarbonate- P fill retail) LAXATIVES - Bowel Treatment Drugs sod chloride solr Bulk Laxatives PREPOPIK PACK P calcium polycarbophil tabs P QL(10 ea daily) sennosides-docusate P QL(4 ea daily) sodium tabs EVAC POWD (Use NP psyllium) SENOKOT S TABS (Use QL(4 ea daily) sennosides-docusate NP FIBERCON TABS (Use NP QL(10 ea daily) calcium polycarbophil) sodium) SUPREP BOWEL PREP KONSYL DAILY FIBER P P PACK KIT SOLN Laxatives - Miscellaneous KONSYL DAILY FIBER NP POWD (Use psyllium) glycerin (laxative) supp P KONSYL ORIGINAL DAILY P FIBER PACK GLYCERIN ADULT SUPP NP (Use glycerin (laxative)) METAMUCIL CAPS (Use NP psyllium)

ATABEX OB TABS P GNP PRENATAL TABS P QL(1 ea daily)

BAL-CARE DHA MISC P GOODSENSE PRENATAL P QL(1 ea daily) VITAMINS TABS C-NATE DHA CAPS P HM PRENATAL TABS P QL(1 ea daily)

CITRANATAL 90 DHA P MISC

RIGHT STEP PRENATAL P QL(1 ea daily) PRENATE AM TABS P TABS PRENATE CHEW P SE-NATAL 19 CHEW 7 MG-1 MG-3 MG-3 MG-12 PRENATE DHA CAPS P MCG-15 MG-20 MG-20 P MG-29 MG-30 UNIT-100 MG-200 MG-400 UNIT- PRENATE ELITE TABS P 1000 UNIT PRENATE ENHANCE P SE-NATAL 19 TABS 1 MG- RX/OTC CAPS 3 MG-3 MG-7 MG-12 MCG-15 MG-20 MG-20 PRENATE ESSENTIAL P P CAPS MG-29 MG-30 UNIT-100 MG-200 MG-400 UNIT- PRENATE MINI CAPS P 1000 UNIT PRENATE PIXIE CAPS P SELECT-OB CHEW P

PRENATE RESTORE P SELECT-OB+DHA MISC P CAPS SM PRENATAL VITAMINS QL(1 ea daily) PRENATRIX TABS P QL(1 ea daily); P RX/OTC TABS TARON-BC MISC P PRENATRYL TABS P QL(1 ea daily); RX/OTC TARON-C DHA CAPS P PRENATVITE RX TABS P QL(1 ea daily); RX/OTC TARON-PREX CAPS P PREPLUS TABS P QL(1 ea daily); RX/OTC THERANATAL CORE P QL(1 ea daily); PRETAB TABS P RX/OTC NUTRITION TABS RX/OTC THRIVITE RX TABS P

TRI-TABS DHA MISC P VITATHELY/GINGER P QL(1 ea daily); TABS RX/OTC TRICARE PRENATAL P DHA ONE CAPS VITATRUE MISC P TRICARE TABS P QL(1 ea daily); RX/OTC VIVA DHA CAPS P TRINATAL RX 1 TABS P VOL-NATE TABS P

TRISTART DHA CAPS P VOL-PLUS TABS P QL(1 ea daily); RX/OTC TRISTART ONE CAPS P VOL-TAB RX TABS P

TRIVEEN-DUO DHA MISC P VP-PNV-DHA CAPS P ULTIMATECARE ONE QL(1 ea daily); P WESTAB PLUS TABS P CAPS RX/OTC VENA-BAL DHA MISC P WESTGEL DHA CAPS P

VINATE DHA RF CAPS P ZATEAN-PN PLUS CAPS P VINATE II TABS P Vitamins w/ Lipotropics QL(1 ea daily) VINATE ONE TABS P vitamins w/ lipotropics caps P

VIRT-C DHA CAPS P MUSCULOSKELETAL THERAPY AGENTS - Drugs to Treat Spasms VIRT-NATE DHA CAPS P Central Muscle Relaxants baclofen tabs or 10 mg, 20 P MP VIRT-PN PLUS CAPS P mg VITAFOL GUMMIES P chlorzoxazone tabs P CHEW cyclobenzaprine hcl tabs P QL(3 ea daily) VITAFOL ULTRA CAPS P 10 mg, 5 mg cyclobenzaprine hcl tabs P VITAFOL-NANO TABS P 7.5 mg VITAFOL-OB TABS P metaxalone tabs 800 mg P

VITAFOL-OB+DHA MISC P methocarbamol soln P

VITAFOL-ONE CAPS P methocarbamol tabs P

PLEGRIDY SOPN SC P PA; SP HORIZANT TBCR P Smoking Deterrents PLEGRIDY SOSY SC P PA; SP APO-VARENICLINE TABS P PLEGRIDY STARTER P PA; SP PACK SOPN bupropion hcl (smoking P QL(2 ea daily) deterrent) tb12 PLEGRIDY STARTER P PA; SP PACK SOSY CHANTIX CONTINUING P MONTHPAK TABS REBIF REBIDOSE SOAJ P PA; SP CHANTIX STARTING P MONTH PAK TABS

New Mexico Western Sky Updated September 1, 2021 P-Preferred drug, NP-Non-preferred, AL-Age Limit, PA-Prior Authorization QL-Quantity limit, SP-Specialty drug, RX/OTC - both Rx and OTC NDCs MP-Maintenance drug eligible for 90 day supply, NF = Non-formulary SmartPA-Automated Prior Authorization, Formulary Contraceptives covered up to 12 month 94 Drug Requirements/ Drug Requirements/ Drug Name Tier Limits Drug Name Tier Limits Thyroid Hormones PEDIARIX SUSP P ARMOUR THYROID TABS PENTACEL SUSR P 120 MG, 15 MG, 30 MG, NP 60 MG, 90 MG (Use thyroid) QUADRACEL SUSP P ARMOUR THYROID TABS P TDVAX SUSP P AL(At least 19 180 MG, 240 MG, 300 MG yrs old) CYTOMEL TABS (Use MP NP TENIVAC INJ P AL(At least 19 liothyronine sodium) yrs old) levothyroxine sodium tabs MP TETANUS/DIPHTHERIA AL(At least 19 or 300 mcg, 100 mcg, 112 TOXOIDS-ADSORBED P yrs old) mcg, 125 mcg, 137 mcg, P ADULT SUSP 150 mcg, 175 mcg, 200 mcg, 25 mcg, 50 mcg, 75 ULCER DRUGS - Drugs to Treat Bowel, Intestine mcg, 88 mcg and Stomach Conditions liothyronine sodium soln iv P Proton Pump Inhibitors 10 mcg/ml Omeprazole Delayed P QL(1 ea daily); liothyronine sodium tabs or P MP Release Tab 20mg 50 mcg, 25 mcg, 5 mcg Antispasmodics NATURE-THROID TABS P ANASPAZ TBDP (Use NP hyoscyamine sulfate) SYNTHROID TABS (Use NP MP levothyroxine sodium) BENTYL SOLN (Use NP dicyclomine hcl) thyroid tabs P chlordiazepoxide hcl- P clidinium bromide caps TRIOSTAT SOLN (Use NP liothyronine sodium) dicyclomine hcl caps or 10 P mg WESTHROID TABS P dicyclomine hcl soln im 10 P WP THYROID TABS P mg/ml dicyclomine hcl soln or 10 P QL(40 ml daily) TOXOIDS mg/5ml dicyclomine hcl tabs or 20 P Toxoid Combinations mg ADACEL SUSP P AL(At least 11 DONNATAL TABS (Use yrs old) phenobarbital- NP hyoscyamine-atropine- BOOSTRIX SUSP P AL(At least 11 yrs old) scopolamine) glycopyrrolate soln ij 0.2 DAPTACEL SUSP P mg/ml, 0.4 mg/2ml, 1 P DIPHTHERIA/TETANUS mg/5ml, 4 mg/20ml TOXOIDS ADSORBED P glycopyrrolate tabs or 1 P QL(4 ea daily) PEDIATRIC SUSP mg, 2 mg INFANRIX SUSP P hyoscyamine sulfate elix or P 0.125 mg/5ml KINRIX SUSP P hyoscyamine sulfate soln P or 0.125 mg/ml New Mexico Western Sky Updated September 1, 2021 P-Preferred drug, NP-Non-preferred, AL-Age Limit, PA-Prior Authorization QL-Quantity limit, SP-Specialty drug, RX/OTC - both Rx and OTC NDCs MP-Maintenance drug eligible for 90 day supply, NF = Non-formulary SmartPA-Automated Prior Authorization, Formulary Contraceptives covered up to 12 month 95 Drug Requirements/ Drug Requirements/ Drug Name Tier Limits Drug Name Tier Limits hyoscyamine sulfate subl sl P PEPCID TABS 40 MG (Use NP MP 0.125 mg famotidine) hyoscyamine sulfate tabs P TAGAMET HB TABS (Use NP RX/OTC or 0.125 mg cimetidine) hyoscyamine sulfate tb12 P QL(4 ea daily) Misc. Anti-Ulcer or 0.375 mg QL(420 ml per hyoscyamine sulfate tbdp P CARAFATE SUSP 1 NP fill retail); or 0.125 mg GM/10ML (Use sucralfate) AL(Up to 6 yrs old ) LEVBID TB12 (Use NP QL(4 ea daily) hyoscyamine sulfate) CARAFATE TABS 1 GM NP QL(4 ea daily) (Use sucralfate) LEVSIN TABS (Use NP hyoscyamine sulfate) QL(420 ml per fill retail); LEVSIN/SL SUBL (Use NP sucralfate susp 1 gm/10ml P hyoscyamine sulfate) AL(Up to 6 yrs LIBRAX CAPS (Use old ) chlordiazepoxide hcl- NP sucralfate tabs 1 gm P QL(4 ea daily) clidinium bromide) methscopolamine bromide P Proton Pump Inhibitors tabs ACIPHEX TBEC (Use NP PA phenobarbital- rabeprazole sodium) hyoscyamine-atropine- P esomeprazole magnesium P RX/OTC scopolamine tabs cpdr H-2 Antagonists QL(4 ea daily); lansoprazole cpdr 15 mg P RX/OTC cimetidine hcl soln P QL(27 ml daily) lansoprazole cpdr 30 mg P cimetidine tabs 200 mg P RX/OTC lansoprazole tbdd 15 mg P PA; RX/OTC cimetidine tabs 300 mg, P 400 mg, 800 mg lansoprazole tbdd 30 mg P PA famotidine susr 40 mg/5ml P NEXIUM 24HR CLEAR RX/OTC MINIS CPDR (Use NP famotidine tabs 10 mg P esomeprazole magnesium) famotidine tabs 20 mg P RX/OTC; MP NEXIUM 24HR CPDR (Use NP RX/OTC esomeprazole magnesium) MP famotidine tabs 40 mg P NEXIUM CPDR (Use NP RX/OTC esomeprazole magnesium) PEPCID AC MAXIMUM RX/OTC; MP STRENGTH TABS (Use NP omeprazole cpdr 10 mg P famotidine) QL(1 ea daily); omeprazole cpdr 20 mg P PEPCID AC TABS 10 MG NP RX/OTC (Use famotidine) omeprazole cpdr 40 mg P QL(1 ea daily) PEPCID AC TABS 20 MG NP RX/OTC; MP (Use famotidine) pantoprazole sodium tbec P QL(1 ea daily) 20 mg PEPCID TABS 20 MG (Use NP RX/OTC; MP famotidine) pantoprazole sodium tbec P QL(2 ea daily) 40 mg New Mexico Western Sky Updated September 1, 2021 P-Preferred drug, NP-Non-preferred, AL-Age Limit, PA-Prior Authorization QL-Quantity limit, SP-Specialty drug, RX/OTC - both Rx and OTC NDCs MP-Maintenance drug eligible for 90 day supply, NF = Non-formulary SmartPA-Automated Prior Authorization, Formulary Contraceptives covered up to 12 month 96 Drug Requirements/ Drug Requirements/ Drug Name Tier Limits Drug Name Tier Limits PREVACID 24HR CPDR NP QL(4 ea daily); tolterodine tartrate tabs 1 P QL(2 ea daily) (Use lansoprazole) RX/OTC mg, 2 mg PREVACID CPDR 15 MG NP QL(4 ea daily); trospium chloride tabs P QL(2 ea daily) (Use lansoprazole) RX/OTC PREVACID CPDR 30 MG NP Urinary Antispasmodics - Cholinergic Agonists (Use lansoprazole) bethanechol chloride tabs P MP PREVACID SOLUTAB PA; RX/OTC TBDD 15 MG (Use NP URECHOLINE TABS (Use NP MP lansoprazole) bethanechol chloride) PREVACID SOLUTAB PA Urinary Antispasmodics - Direct Muscle Relaxants TBDD 30 MG (Use NP lansoprazole) flavoxate hcl tabs P PROTONIX TBEC 20 MG NP QL(1 ea daily) (Use pantoprazole sodium) VACCINES PROTONIX TBEC 40 MG NP QL(2 ea daily) Bacterial Vaccines (Use pantoprazole sodium) ACTHIB SOLR P AL(At least 19 rabeprazole sodium tbec P PA yrs old) BEXSERO SUSY P AL(At least 16 Ulcer Drugs - Prostaglandins yrs old) CYTOTEC TABS (Use AL(At least 19 NP HIBERIX SOLR P misoprostol) yrs old) misoprostol tabs P MENACTRA INJ P AL(At least 11 yrs old) URINARY ANTISPASMODICS - Drugs to Treat MENQUADFI INJ P AL(At least 11 Miscellaneous Bladder Spasms yrs old) Urinary Antispasmodic - Antimuscarinics MENVEO SOLR P AL(At least 11 yrs old) darifenacin hydrobromide P tb24 PEDVAX HIB SUSP P AL(At least 19 yrs old) DETROL LA CP24 (Use NP QL(1 ea daily) tolterodine tartrate) One per lifetime;QL(1 ml DETROL TABS (Use NP QL(2 ea daily) tolterodine tartrate) P per 999 days PNEUMOVAX 23 INJ retail); AL(At DITROPAN XL TB24 (Use NP QL(2 ea daily); oxybutynin chloride) MP least 65 yrs old) ENABLEX TB24 (Use NP darifenacin hydrobromide) One per lifetime;QL(1 ml oxybutynin chloride syrp 5 QL(16 ml P PNEUMOVAX 23/1 DOSE P per 999 days mg/5ml daily); MP INJ retail); AL(At oxybutynin chloride tabs 5 P QL(3 ea daily); least 65 yrs mg MP old) oxybutynin chloride tb24 10 P QL(2 ea daily); One per mg, 15 mg, 5 mg MP lifetime;QL(0..5 ml per 999 tolterodine tartrate cp24 2 P QL(1 ea daily) PREVNAR 13 SUSP P mg, 4 mg days retail); AL(At least 65 yrs old) New Mexico Western Sky Updated September 1, 2021 P-Preferred drug, NP-Non-preferred, AL-Age Limit, PA-Prior Authorization QL-Quantity limit, SP-Specialty drug, RX/OTC - both Rx and OTC NDCs MP-Maintenance drug eligible for 90 day supply, NF = Non-formulary SmartPA-Automated Prior Authorization, Formulary Contraceptives covered up to 12 month 97 Drug Requirements/ Drug Requirements/ Drug Name Tier Limits Drug Name Tier Limits TRUMENBA SUSY P AL(At least 16 ROTATEQ SOLN P yrs old) Viral Vaccines SHINGRIX SUSR P AL(At least 50 yrs old) AL(At least 19 ENGERIX-B INJ P yrs old) TWINRIX SUSY P AL(At least 19 yrs old) AL(At least 19 ENGERIX-B SUSP P yrs old) VAQTA SUSP P AL(At least 19 yrs old) FLUAD QUADRIVALENT P 2021-2022 PRSY VARIVAX INJ P AL(At least 19 yrs old) FLUAD QUADRIVALENT AL(At least 60 INFLUENZA VACCINE P ZOSTAVAX SUSR P FOR ADULTS PRSY yrs old) AL(At least 2 VAGINAL AND RELATED PRODUCTS FLUMIST P QUADRIVALENT SUSP yrs old - Up to 49 yrs old) Spermicides FLUZONE HIGH-DOSE PF P AL(At least 65 ENCARE SUPP P 2020-2021 SUSY yrs old) OPTIONS CONCEPTROL FLUZONE HIGH-DOSE PF P AL(At least 65 2021-2022 SUSY yrs old) VAGINAL NP CONTRACEPTIVE GEL AL(At least 9 GARDASIL 9 SUSP P yrs old - Up to OPTIONS GYNOL II 45 yrs old) VAGINALCONTRACEPTIV P E GEL AL(At least 9 GARDASIL 9 SUSY P yrs old - Up to SHUR-SEAL GEL P 45 yrs old) TODAY SPONGE MISC P HAVRIX SUSP P AL(At least 19 yrs old) VCF VAGINAL Limit 1 per Influenza Vaccine P CONTRACEPTIVE FILM P season FILM Limit 1 per VCF VAGINAL season; AL (At CONTRACEPTIVE FOAM P Influenza Vaccine - Flumist P least 2 yrs old - FOAM Up to 49 yrs old) VCF VAGINAL CONTRACEPTIVEGEL P Limit 1 per GEL Influenza Vaccine - High P season; AL: (At Dose least 65 yrs Vaginal Anti-infectives old) CLEOCIN CREA VA 2 % QL(40 gm per (Use clindamycin NP fill retail) IPOL INACTIVATED IPV P AL(At least 19 INJ yrs old) phosphate vaginal) clindamycin phosphate QL(40 gm per M-M-R II SOLR P AL(At least 19 P yrs old) vaginal crea fill retail) clotrimazole vaginal crea 1 QL(45 gm per RECOMBIVAX HB SUSP P AL(At least 19 P yrs old) % fill retail) clotrimazole vaginal crea 2 P QL(20 gm per ROTARIX SUSR P % fill retail)

MEPHYTON TABS (Use NP phytonadione) phytonadione tabs P vitamin e caps 180 mg, 100 QL(2 ea daily) unit, 45 mg, 200 unit, 90 P mg, 400 unit Water Soluble Vitamins ascorbic acid tabs or 250 mg, 1000 mg, 1000 mg-37 mg, 37 mg-1000 mg, 10 mg-500 mg, 14 mg-25 mg- P 500 mg, 37 mg-500 mg, 500 mg-10 mg, 500 mg-25 mg-35 mg niacin cpcr P niacin tabs P niacin tbcr P

NIACIN TR TBCR P

Index 1 ANTI-DIARRHEAL 24 ATROVENT HFA 13 BD GLUCOSE 22 ANUSOL-HC 9 AUBAGIO 93 BD INSULIN SYRINGE/U- APEXICON E 53 AUGMENTIN 91 100/2ML/27.5G X 5/8" 73 BD INSULIN SYRINGE/U- APO-VARENICLINE 93 AUGMENTIN ES-600 91 500/0.5ML/31G X 6MM 73 apraclonidine hcl 88 AUSTEDO 93 BD PEN aprepitant 25 AUVI-Q 99 NEEDLE/MICRO/ULTRA- FINE/32G X 6MM 73 APTENSIO XR 2 AVALIDE 29 BD PEN NEEDLE/MINI/ULTRA- APTIOM 16 AVANDIA 22 FINE/31G X 5MM 73 APTIVUS 38 AVAPRO 28 BD PEN NEEDLE/NANO 2ND AQUORAL 79 AVAR LS CLEANSER 49 GEN/32G X 5/32" 73 BD PEN ARAKODA 31 AVAR-E LS 49 NEEDLE/NANO/ULTRA- ARAVA 5 AVODART 64 FINE/32G X 4MM 73 ARICEPT 92 AVONEX 93 BD PEN NEEDLE/ORIGINAL/ULTRA- ARIKAYCE 3 AVONEX PEN 93 FINE/29G X 12.7MM 73 ARIMIDEX 32 AVSOLA 63 BD PEN aripiprazole 37 AYGESTIN 91 NEEDLE/SHORT/ULTRA- ARISTADA 37,38 AZACTAM 11 FINE/31G X 8MM 73 73 ARISTADA INITIO 37 AZASAN 77 BD PEN NEEDLES BD SAFETYGLIDE INSULIN ARIXTRA 14 azathioprine 77 SYRINGE/0.3ML/31G X armodafinil 2 azelastine hcl 86 15/64" 73 ARMOUR THYROID 95 AZILECT 35 BD SAFETYGLIDE INSULIN ARNUITY ELLIPTA 13 azithromycin 70 SYRINGE/0.5ML/31G X 15/64" 73 AROMASIN 32 AZOPT 89 BD VEO INSULIN SYRINGE ARTHRITIS PAIN AZOR 29 ULTR-FINE/U-100/0.5ML/31G X RELIEVING 57 aztreonam 11 15/64" 73 ascorbic acid 100 BD VEO INSULIN SYRINGE AZULFIDINE 63 aspirin 6 ULTRA-AFINE/0.3ML/31G X AZULFIDINE EN-TABS 63 6MM 73 ASPIRIN 6 b-complex vitamins 79 BD VEO INSULIN SYRINGE aspirin 6 b-complex w/ c & folic ULTRA-FINE/0.3ML/31G X aspirin buffered (cal carb-mag acid 79,80 6MM 73 carb-mag oxide) 6 BABY DDROPS 100 BD VEO INSULIN SYRINGE ATABEX EC 81 ULTRA-FINE/0.5ML/31G X BACIGUENT 50 ATABEX OB 81 6MM 73 bacitracin (topical) 50 BD VEO INSULIN SYRINGE ATACAND 28 bacitracin zinc 50 ULTRA-FINE/1/2 ATACAND HCT 29 UNIT/0.3ML/31G X 6MM 73 bacitracin-polymyxin b 50 BD VEO INSULIN SYRINGE atazanavir sulfate 38 bacitracin-polymyxin b atenolol 42 ULTRA-FINE/U-100/0.3ML/31G (ophth) 88 X 15/64" 73 atenolol & chlorthalidone 29 baclofen 85 BELSOMRA 68 ATIVAN 12 BACTRIM 10 BENADRYL ALLERGY 26 atomoxetine hcl 2 BACTRIM DS 10 BENADRYL ALLERGY atorvastatin calcium 27 BAL-CARE DHA 81 CHILDRENS 26 atovaquone 10 balsalazide disodium 63 BENADRYL ALLERGY ULTRATABS 26 atovaquone-proguanil hcl 31 BANZEL 16 benazepril & ATRALIN 48 BARACLUDE 41 hydrochlorothiazide 29 ATRIPLA 38 BASAGLAR KWIKPEN 23 benazepril hcl 28 ATROPINE SULFATE 87 BD AUTOSHIELD 29G X BENAZEPRIL atropine sulfate (ophthalmic) 87 5/16" 73 HCL/HYDROCHLOROTHIAZIDE 29

Index 2 BENEFIX 65 BRIVIACT 16 CALAN 43 BENICAR 28 bromocriptine mesylate 34 CALAN SR 43 BENICAR HCT 29 brompheniramine & calcipotriene 52 BENTYL 95 phenyleph 47 calcipotriene-betamethasone brompheniramine & BENZAC AC WASH 49 dipropionate 53 pseudoeph 47 calcitonin (salmon) 60 BENZACLIN 49 BSS 89 calcitriol 61 BENZACLIN WITH PUMP 49 BSS PLUS 89 CALCIUM 76 BENZAMYCIN 49 budesonide 46 calcium acetate (phosphate benzonatate 47 budesonide (inhalation) 13 binder) 63 benzoyl peroxide 49 budesonide-formoterol CALCIUM CARBONATE 76 benzoyl peroxide- fumarate dihydrate 14 calcium carbonate 76 erythromycin 49 BUFFERIN 6 calcium carbonate (antacid) 9 benztropine mesylate 34 bumetanide 59 calcium carbonate- betamethasone dipropionate BUMEX 59 cholecalciferol 76 augmented 53 BUNAVAIL 8 calcium carbonate-vitamin d 76 betamethasone valerate 53 BUPHENYL 61 calcium citrate 76 BETAPACE 42 BUPIVACAINE calcium polycarbophil 68 BETAPACE AF 42 FISIOPHARMA 70 CALTRATE 600+D3 76 BETASERON 93 bupivacaine hcl 70 camphor & menthol 52 betaxolol hcl (ophth) 87 bupivacaine in dextrose 70 CAMPTOSAR 34 bethanechol chloride 97 bupivacaine w/ candesartan cilexetil 28 bexarotene 34 epinephrine 69 candesartan cilexetil- BEXSERO 97 buprenorphine hcl 8 buprenorphine hcl-naloxone hcl hydrochlorothiazide 29 BEYAZ 45 dihydrate 8 capecitabine 32 bicalutamide 32 bupropion hcl 19 CAPHOSOL 79 BIKTARVY 38 bupropion hcl (smoking CAPLYTA 35 BIOLYTE 76 deterrent) 93 capsaicin 57 BIOTENE DRY MOUTH buspirone hcl 12 captopril 28 MOISTURIZING SPRAY 79 butalbital-acetaminophen 5 captopril & bisacodyl 69 butalbital-acetaminophen- hydrochlorothiazide 29 bismuth subsalicylate 24 caffeine 5 CAPZASIN-HP 57 butalbital-acetaminophen- bisoprolol & CARAC 52 hydrochlorothiazide 29 caffeine w/ codeine 7 CARAFATE 96 bisoprolol fumarate 42 butalbital-aspirin-caffeine 5 carbamazepine 16 BLEPH-10 88 butalbital-aspirin-caffeine w/cod 7 carbamide peroxide (otic) 90 BLEPHAMIDE 89 BUTALBITAL/ACETAMINOPH CARBATROL 16 BLEPHAMIDE S.O.P. 88 EN 5 carbidopa 34 BONIVA 60 BYDUREON BCISE 22 carbidopa-levodopa 34 BOOSTRIX 95 BYDUREON PEN 22 CARBOCAINE 70 BOSULIF 33 BYETTA 22 BPROTECTED PEDIA POLY- C-NATE DHA 81 CARDIZEM 43 VITE 81 CABENUVA 38 CARDIZEM CD 43 BPROTECTED PEDIA POLY- CADUET 44 CARDIZEM LA 43 VITE/IRON 80 CARDURA 29 BREVIBLOC 42 CAFCIT 1 CARNITOR 61 BRILINTA 65 CAFERGOT 74 CARNITOR SF 61 brimonidine tartrate 88 caffeine 1 carteolol hcl (ophth) 87 brinzolamide 89 caffeine & sodium benzoate 1 carvedilol 42 BRISDELLE 94 caffeine citrate 1

Index 3 carvedilol phosphate 42 chlorhexidine gluconate 38 CLARITIN-D 24 HOUR 48 CASODEX 32 chlorhexidine gluconate CLASSIC PRENATAL 81 CATAPRES 29 (mouth-throat) 78 clemastine fumarate 26 chloroprocaine hcl 70 CAYA 71 CLEOCIN 10,98 chloroquine phosphate 31 cefaclor 44 CLEOCIN PEDIATRIC chlorothiazide 60 cefadroxil 44 GRANULES 11 chlorothiazide sodium 60 CLEOCIN PHOSPHATE 11 cefdinir 44 chlorpheniramine maleate 25 CLEOCIN-T 49 cefepime hcl 45 chlorpromazine hcl 37 CLIMARA 62 cefixime 44 chlorthalidone 60 CLIMARA PRO 61 CEFOTAN 44 chlorzoxazone 85 CLINDAGEL 49 cefotetan disodium 44 cholecalciferol 100 clindamycin hcl 11 cefprozil 44 cholestyramine 27 clindamycin palmitate ceftazidime 44 cholestyramine light 27 hydrochloride 11 ceftriaxone sodium 45 clindamycin phosphate 11 choline fenofibrate 27 cefuroxime axetil 44 clindamycin phosphate CICLODAN SOLUTION cefuroxime sodium 44 (topical) 49 KIT 51 clindamycin phosphate in CELEBREX 4 ciclopirox 51 d5w 11 celecoxib 4 ciclopirox olamine 51 clindamycin phosphate CELEXA 19 cilostazol 65 vaginal 98 CELLCEPT 77 clindamycin phosphate-benzoyl CILOXAN 88 peroxide 49 CENTANY 50 CIMDUO 38 clindamycin phosphate-benzoyl cephalexin 44 cimetidine 96 peroxide (refrigerate) 49 CERALYTE 70 76 cimetidine hcl 96 clobazam 15 CERASPORT 76 CIMZIA 63 clobetasol propionate 53 CERASPORT EX1 76 CIMZIA STARTER KIT 63 clobetasol propionate emollient base 53 CEREBYX 18 CIPRO 62 clobetasol propionate CEROVEL 56 ciprofloxacin 62 emulsion 53 cetirizine hcl 26 ciprofloxacin hcl 62 CLOBEX 53 cetirizine-pseudoephedrine 47 ciprofloxacin hcl (ophth) 88 clomipramine hcl 20 cevimeline hcl 79 ciprofloxacin in d5w 62 clonazepam 15 CHANTIX 94 citalopram hydrobromide 19 clonidine hcl 29 CHANTIX CONTINUING CITRANATAL 90 DHA 81 clonidine hcl (adhd) 2 MONTHPAK 93 clopidogrel bisulfate 65,66 CHANTIX STARTING MONTH CITRANATAL ASSURE 81 PAK 93 CITRANATAL B-CALM 81 clorazepate dipotassium 12 CHEMET 24 CITRANATAL BLOOM 81 clotrimazole (topical) 51 CHEMSTRIP-K 58 CITRANATAL BLOOM clotrimazole vaginal 98 CHERACOL PLUS 48 DHA 81 clotrimazole w/ CITRANATAL DHA 81 betamethasone 51 CHERACOL-D COUGH 48 CITRANATAL HARMONY 81 clozapine 36 CHEWABLE CALCIUM/D3 76 CITRANATAL RX 81 CLOZARIL 36 CHILDRENS ADVIL 4 CLARINEX 26 CO-NATAL FA 81 CHILDRENS MOTRIN 4 clarithromycin 70 COAGADEX 65 CHLOR-TRIMETON 25 CLARITIN 26 coal tar extract 58 chlordiazepoxide hcl 12 CLARITIN ALLERGY COARTEM 31 chlordiazepoxide hcl-clidinium CHILDRENS 26 bromide 95 CODEINE SULFATE 6 chlordiazepoxide-amitriptyline CLARITIN REDITABS 26 codeine sulfate 6 92 CLARITIN-D 12 HOUR 48

Index 4 COGENTIN 34 COZAAR 29 DAPTOMYCIN 10 COLACE 69 CREON 59 daptomycin 10 COLACE CLEAR 69 CRIXIVAN 38 darifenacin hydrobromide 97 COLAZAL 63 cromolyn sodium 13 DAUNORUBICIN colchicine 64 cromolyn sodium HYDROCHLORIDE 33 DAYPRO 4 colchicine w/ probenecid 64 (mastocytosis) 63 cromolyn sodium (nasal) 86 DAYTRANA 2 COLCRYS 64 COLEMAN BOTANICALS cromolyn sodium (ophth) 89 DDAVP 61 INSECTREPELLENT 57 crotamiton 58 DEBROX 90 COLEMAN SKINSMART CUBICIN 10 deferasirox 24 INSECTREPELLENT 57 CUBICIN RF 10 DELESTROGEN 62 COLEMAN SKINSMART INSECTREPELLENT/GO CUTIVATE 54 DELSTRIGO 38 READY SPRAY PEN 57 CUTTER LEMON DELZICOL 63 COLESTID 27 EUCALYPTUS 57 DEPACON 18 CUTTER NATURAL 57 COLESTID FLAVORED 27 DEPAKENE 18 CVS DRY MOUTH SPRAY79 colestipol hcl 27 DEPAKOTE 18 CVS GLUCOSE 22 colistimethate sodium 11 DEPAKOTE ER 18 CVS LICE SOLUTION KIT 3- COLY-MYCIN M 11 STEP 58 DEPAKOTE SPRINKLES 18 COLYTE-FLAVOR PACKS 68 CVS PRENATAL 81 DEPEN TITRATABS 77 COMBIPATCH 61 CVS SOFT GLUCOSE 22 DEPO-ESTRADIOL 62 COMBIVENT RESPIMAT 14 CVS TOTAL HOME INSECT DEPO-MEDROL 46 COMBIVIR 38 REPELLENT 57 DEPO-PROVERA COMPLERA 38 cyanocobalamin 66 CONTRACEPTIVE 46 cyclobenzaprine hcl 85 DEPO-SUBQ PROVERA COMPLETE NATAL DHA 81 104 46 CYCLOGYL 87 COMPLETENATE 81 DEPO-TESTOSTERONE 8 COMTAN 34 cyclopentolate hcl 87,88 DERMA-SMOOTHE/FS CONCEPT DHA 81 cyclophosphamide 32 BODY 54 CONCEPT OB 81 cyclosporine 77 DERMA-SMOOTHE/FS SCALP 54 CONCERTA 2 cyclosporine modified (for microemulsion) 77 DERMOTIC 90 CONDOMS 71 CYMBALTA 20 DESCOVY 38 Condoms Latex Lubricated- Misc 71 cyproheptadine hcl 27 desipramine hcl 21 CONVENIENCE PAK 93 CYTOMEL 95 desloratadine 26 COPAXONE 93 CYTOTEC 97 desmopressin acetate 61 CORDRAN 54 CYTOVENE 41 desmopressin acetate spray 61 COREG 42 D-VI-SOL 100 desmopressin acetate spray D.H.E. 45 74 refrigerated 61 COREG CR 42 desogestrel & ethinyl CORGARD 42 DAKINS SOLUTION FULL estradiol 45 STRENGTH 38 CORIFACT 65 desogestrel-ethinyl estradiol DAKINS SOLUTION HALF (biphasic) 45 CORTEF 46 STRENGTH 38 desogestrel-ethinyl estradiol CORTENEMA 8 DAKINS SOLUTION (triphasic) 45 QUARTER STRENGTH 38 cortisone acetate 46 desonide 54 DANTRIUM 86 CORVITE 150 66 DESOWEN 54 DANTRIUM IV 86 COSOPT 87 desoximetasone 54 dantrolene sodium 86 COTELLIC 33 DESOXYN 1 dapsone 10 COTEMPLA XR-ODT 2 desvenlafaxine succinate 20 dapsone (topical) 49 COUMADIN 14 DETROL 97 DAPTACEL 95

Index 5 DETROL LA 97 diltiazem hcl extended release DROPLET INSULIN SYRINGE DEX4 QUICK DISSOLVE beads 43 U-100/0.3ML/31G X 15/64" 73 GLUCOSE 22 dimenhydrinate 24 DROPLET INSULIN dexamethasone 47 DIMETAPP COLD & SYRINGE/U-100/0.3ML/31G X 15/64" 73 DEXAMETHASONE ALLERGY 48 dimethyl fumarate 93 DROPLET INSULIN INTENSOL 47 SYRINGE/U-100/0.5ML/31G X dexamethasone sodium DIOVAN 29 15/64" 74 phosphate 47 DIOVAN HCT 30 drospirenone-ethinyl DEXAMETHASONE SODIUM diphenhydramine hcl 26 estradiol 45 PHOSPHATE 47 drospirenone-ethinyl estradiol- dexamethasone sodium diphenhydramine hcl levomefolate calcium 45 phosphate (ophth) 89 (sleep) 67 DROXIA 66 DEXEDRINE 1 diphenoxylate w/ atropine 24 DRYSOL 57 dexmedetomidine hcl 67 DIPHTHERIA/TETANUS TOXOIDS ADSORBED DUAC 49 dexmethylphenidate hcl 2 PEDIATRIC 95 DUAVEE 61 dexrazoxane hcl 34 DIPROLENE 54 DUET DHA 400 81 dextroamphetamine sulfate 1 DIPROLENE AF 54 DUET DHA BALANCED 81 dextromethorphan-guaifenesin dipyridamole 66 48 DUETACT 21 DHS TAR 58 disopyramide phosphate 13 DULCOLAX 69 DHS TAR GEL 58 disulfiram 92 duloxetine hcl 20 DIASTAT ACUDIAL 15 DITROPAN XL 97 DURAGESIC 6 DIASTAT PEDIATRIC 15 divalproex sodium 18 DUREX EXTRA SENSITIVE 71 diazepam 12 docusate calcium 69 DUREX REALFEEL NON- diazepam (anticonvulsant) 15 docusate sodium 69 LATEX 71 dutasteride 64 diazoxide 22 dofetilide 13 dutasteride-tamsulosin hcl 64 DIBENZYLINE 28 donepezil hydrochloride 92 DUTOPROL 30 dibucaine 57 DONNATAL 95 DYANAVEL XR 1 diclofenac potassium 4 DOPRAM 1 DYAZIDE 59 diclofenac sodium 4 DORAL 67 diclofenac sodium (actinic DORYX 94 E.E.S. GRANULES 70 keratoses) 52 DORZOLAMIDE HCL 89 EAGLE WATCH MOSQUITO ELIMINATOR 57 diclofenac sodium (ophth) 89 dorzolamide hcl 89 EC-NAPROSYN 4 diclofenac sodium (topical) 50 dorzolamide hcl-timolol econazole nitrate 51 dicloxacillin sodium 91 maleate 87 ECOTRIN 6 dicyclomine hcl 95 DOVATO 38 DOVONEX 52 ECOTRIN MAXIMUM didanosine 38 STRENGTH 6 DIFFERIN 49 doxazosin mesylate 29 ECOTRIN REGULAR diflorasone diacetate 54 doxepin hcl 21 STRENGTH 6 DIFLUCAN 25 doxepin hcl (sleep) 67 EDECRIN 59 diflunisal 6 doxercalciferol 61 EDLUAR 67 digoxin 44 doxycycline (monohydrate)94 EDURANT 38 dihydroergotamine mesylate 74 doxycycline hyclate 94 efavirenz 38 doxylamine succinate efavirenz-emtricitabine-tenofovir DILANTIN 18 (sleep) 67 disoproxil fumarate 38 DILANTIN INFATABS 18 DRAMAMINE 24 efavirenz-lamivudine-tenofovir DILANTIN-125 18 DRISDOL 100 disoproxil fumarate 38 EFFEXOR XR 20 DILAUDID 6 dronabinol 25 EFFIENT 66 diltiazem hcl 43 droperidol 12 EFUDEX 52 diltiazem hcl coated beads 43 DROPERIDOL 12

Index 6 eletriptan hydrobromide 74 eplerenone 31 EVAC 68 ELIDEL 56 EPZICOM 39 EVEKEO 1 ELIMITE 58 EQL DRY MOUTH ORAL everolimus 33 ELIQUIS 14 RINSE 79 everolimus EQL PRENATAL ELIQUIS STARTER PACK 14 (immunosuppressant) 77 FORMULA 81 EVISTA 61 ELIXOPHYLLIN 14 EQUALYTE 76 EVOCLIN 49 ELLA 46 ergocalciferol 100 EVOTAZ 39 ELMIRON 64 ergoloid mesylates 93 EVOXAC 79 ELOCON 54 ergotamine w/ caffeine 74 EX-LAX 69 ELOCTATE 65 ERIVEDGE 32 EXELON 92 EMCYT 32 erlotinib hcl 32 exemestane 32 EMEND 25 ERYGEL 49 EXFORGE 30 EMEND TRIPACK 25 ERYPED 200 71 EXFORGE HCT 30 emtricitabine 38 ERYPED 400 71 EXTAVIA 93 emtricitabine-tenofovir disoproxil erythromycin (acne aid) 49 fumarate 38,39 EXTINA 51 erythromycin (ophth) 88 EMTRIVA 39 ezetimibe 28 erythromycin base 71 EMVERM 10 ezetimibe-simvastatin 27 erythromycin ENABLEX 97 ethylsuccinate 71 famciclovir 41 enalapril maleate 28 erythromycin stearate 71 famotidine 96 enalapril maleate & escitalopram oxalate 19 FANTASY LUBRICATED 71 hydrochlorothiazide 30 ESGIC 5 FANTASY ENBRACE HR 81 LUBRICATED/SPERMICIDE esmolol hcl 42 ENBREL 5 71 esomeprazole magnesium 96 ENBREL MINI 5 FARESTON 32 estazolam 67 ENBREL SURECLICK 5 FARYDAK 33 esterified estrogens & FC FEMALE CONDOM 71 ENCARE 98 methyltestosterone 61 ENERGY CHEWS 1 ESTRACE 62,99 FC2 FEMALE CONDOM 71 ENFAMIL ENFALYTE 76 fe fum-iron polysacch complex-fa- estradiol 62 b complex-c-zn-mn-cu 66 ENGERIX-B 98 estradiol & norethindrone FEIBA 65 enoxaparin sodium 14,15 acetate 61 estradiol vaginal 99 felbamate 18 entacapone 34 FELBATOL 18 entecavir 41 estradiol valerate 62 ESTROFACTORS 80 FELDENE 4 ENTOCORT EC 47 felodipine 43 ENTRESTO 44 ESTROSTEP FE 45 ethacrynate sodium 59 FEMARA 32 ENTYVIO 63 FEMCAP 71 EPCLUSA 41 ethacrynic acid 59 ethambutol hcl 31 FEMHRT 62 EPIDIOLEX 16 fenofibrate 27 EPIDUO 49 ethosuximide 18 ethynodiol diacet & eth FENOFIBRATE 27 EPIFOAM 54 estrad 45 fenofibrate 27 epinastine hcl (ophth) 89 etodolac 4 fenofibrate micronized 27 epinephrine (anaphylaxis) 99 etonogestrel-ethinyl FENOGLIDE 27 estradiol 46 epinephrine hcl (nasal) 87 fentanyl 6 etoposide 34 EPIPEN 2-PAK 99 fentanyl citrate 6 etravirine 39 EPIPEN-JR 2-PAK 99 FENTANYL CITRATE 6 EUFLEXXA 86 EPIVIR 39 FER-IN-SOL 66 EURAX 58 EPIVIR HBV 41 FERRETTS 66

Index 7 FERRLECIT 66 fluocinonide 54 FROVA 74 ferrous fumarate-fa-b complex-c- fluocinonide emulsified frovatriptan succinate 74 zn-mg-mn-cu 66 base 54 FURADANTIN 11 ferrous gluconate 66 FLUORABON 76 furosemide 59 FERROUS GLUCONATE 66 fluorometholone (ophth) 89 FUSILEV 34 ferrous sulfate 66 fluorouracil (topical) 52 FUZEON 39 FERROUS SULFATE 66 fluoxetine hcl 19 FYCOMPA 15 ferrous sulfate 66 fluoxetine hcl (pmdd) 93 gabapentin 16 ferrous sulfate dried 66 FLUOXETINE GABITRIL 18 FEVERALL JUNIOR HYDROCHLORIDE 19 STRENGTH 5 fluphenazine decanoate 37 galantamine hydrobromide 92 fexofenadine hcl 26 fluphenazine hcl 37 ganciclovir sodium 41 FIBERCON 68 flurandrenolide 54 GARDASIL 9 98 FIBRYGA 65 flurazepam hcl 67 GAS-X 62 finasteride 64 flurbiprofen 4 GASTROCROM 63 FIORICET 5 flurbiprofen sodium 89 gatifloxacin (ophth) 88 FIORICET/CODEINE 7 flutamide 32 Gauze Pads & Dressings- Misc 71 FIORINAL 5 fluticasone propionate 54 gemfibrozil 27 FIORINAL/CODEINE #3 7 fluticasone propionate GENERESS FE 45 FIRAZYR 65 (nasal) 86 fluticasone-salmeterol 14 gentamicin sulfate (ophth) 88 FIRVANQ 10 fluvastatin sodium 27 gentamicin sulfate (topical) 50 FLAGYL 10 fluvoxamine maleate 19 GENVOYA 39 flavoxate hcl 97 FLUZONE HIGH-DOSE PF GEODON 35 flecainide acetate 13 2020-2021 98 GILENYA 93 FLECTOR 50 FLUZONE HIGH-DOSE PF GILOTRIF 32 FLEET ENEMA 69 2021-2022 98 glatiramer acetate 93 FLEET ENEMA SIX PACK 69 FML 89 GLEEVEC 33 FLEET PEDIATRIC 69 FML LIQUIFILM 89 glimepiride 23 FLOMAX 64 FOCALIN 2 glipizide 23 FLONASE ALLERGY FOCALIN XR 2 RELIEF 86 FOLET ONE 81 glipizide-metformin hcl 21 FLONASE ALLERGY RELIEF FOLGARD RX 66 GLOBAL EASY GLIDE INSULIN CHILDRENS 86 SYRINGE/0.3ML/31G X folic acid 66 FLORIVA 76 15/64" 74 folic acid-vitamin b6-vitamin GLOBAL EASY GLIDE INSULIN FLOVENT HFA 13 b12 66 SYRINGE/0.5ML/31G X FLOXIN OTIC 90 FOLIVANE-OB 81 15/64" 74 FLUAD QUADRIVALENT 2021- fondaparinux sodium 15 glucagon (rdna) 22 2022 98 FORA GTEL BLOOD KETONE GLUCAGON EMERGENCY FLUAD QUADRIVALENT TEST STRIPS 58 KIT 22 INFLUENZA VACCINE FOR GLUCOSE 22 ADULTS 98 formaldehyde 38 fluconazole 25 FORTAMET 21 GLUCOTROL 23 flucytosine 25 FORTAZ 45 GLUCOTROL XL 24 fludrocortisone acetate 47 FOSAMAX 60 GLUMETZA 21 FLUMADINE 42 fosamprenavir calcium 39 glyburide 24 FLUMIST QUADRIVALENT 98 fosinopril sodium 28 glyburide micronized 24 flunisolide (nasal) 86 fosinopril sodium & glyburide-metformin 21 hydrochlorothiazide 30 glycerin (laxative) 68 fluocinolone acetonide 54 fosphenytoin sodium 18 GLYCERIN ADULT 68 fluocinolone acetonide (otic) 90 FOSRENOL 63

Index 8 glycopyrrolate 95 HUMALOG MIX 50/50 23 hydrocortisone valerate 55 GLYNASE 24 HUMALOG MIX 50/50 hydrocortisone w/acetic acid 90 GLYSET 21 KWIKPEN 23 hydrocortisone-aloe vera 55 HUMALOG MIX 75/25 23 GNP GLUCOSE 22 hydromorphone hcl 6 HUMALOG MIX 75/25 GNP PRENATAL 81 KWIKPEN 23 HYDROMORPHONE HCL 6 GNP QUICK DISSOLVE HUMATE-P 65 hydromorphone hcl 6 GLUCOSE 22 HUMIRA 3 HYDROMORPHONE GOJJI BLOOD KETONE TEST HYDROCHLORIDE 6 STRIPS 58 HUMIRA PEDIATRIC CROHNS DISEASE STARTER PACK 3 hydroxychloroquine sulfate 31 GOLYTELY 68 hydroxyprogesterone GOODSENSE PRENATAL HUMIRA PEN 3 HUMIRA PEN-CD/UC/HS caproate 91 VITAMINS 81 hydroxyprogesterone caproate GRALISE 93 STARTER 3 HUMIRA PEN-PEDIATRIC UC (antineoplastic) 33 griseofulvin microsize 25 STARTER PACK 3 hydroxyurea 34 griseofulvin ultramicrosize 25 HUMIRA PEN-PS/UV hydroxyzine hcl 12 guaifenesin-codeine 48 STARTER 3 hydroxyzine pamoate 12 guanfacine hcl 29 HUMULIN 70/30 23 hyoscyamine sulfate 95,96 HUMULIN 70/30 guanfacine hcl (adhd) 2 KWIKPEN 23 HYZAAR 30 GYNAZOLE-1 99 HUMULIN N 23 ibandronate sodium 60 GYNE-LOTRIMIN 99 HUMULIN N KWIKPEN 23 IBRANCE 33 GYNE-LOTRIMIN 3 99 HUMULIN R 23 ibuprofen 4 HAEGARDA 65 HUMULIN R U-500 icatibant acetate 65 HALCION 67 (CONCENTRATED) 23 ICLUSIG 33 HALDOL 36 HUMULIN R U-500 IDELVION 65 KWIKPEN 23 HALDOL DECANOATE 100 36 HYCAMTIN 34 imatinib mesylate 33 HALDOL DECANOATE 50 36 HYCODAN 47 imipenem-cilastatin 10 halobetasol propionate 54 hydralazine hcl 31 imipramine hcl 21 haloperidol 36 HYDRALYTE 76 imipramine pamoate 21 haloperidol decanoate 36 HYDRALYTE FREEZER imiquimod 56 haloperidol lactate 36 POPS 76 IMITREX 74,75 HAVRIX 98 HYDREA 34 IMITREX STATDOSE HECTOROL 61 HYDRO 35 56 REFILL 74 IMITREX STATDOSE HELIXATE FS 65 HYDRO 40 FOAM 56 SYSTEM 74,75 HEMANGEOL 42 hydrochlorothiazide 60 IMODIUM A-D 24 HEMOFIL M 65 hydrocodone w/ IMURAN 77 homatropine 47 heparin (porcine) in sodium INCRUSE ELLIPTA 13 chloride 15 hydrocodone- acetaminophen 7,8 indapamide 60 heparin sodium (porcine) 15 hydrocodone-ibuprofen 8 HEPARIN SODIUM/SODIUM INDERAL LA 42 CHLORIDE 0.9% 15 hydrocortisone 47 indomethacin 4 HEPSERA 41 hydrocortisone (intrarectal) 9 INFANRIX 95 HETLIOZ 68 hydrocortisone (rectal) 9 INFANTS ADVIL 4 HIBERIX 97 hydrocortisone (topical) 54,55 INFLECTRA 63 HIBICLENS 38 hydrocortisone acetate Influenza Vaccine 98 (rectal) 9 HIGH POTENCY Influenza Vaccine - Flumist 98 MULTIVITAMIN 80 hydrocortisone acetate w/ pramoxine 9 Influenza Vaccine - High HIPREX 11 hydrocortisone butyrate 55 Dose 98 HM PRENATAL 81 hydrocortisone butyrate INGREZZA 93 HORIZANT 93 hydrophilic lipo base 55 INLYTA 32

Index 9 INSPRA 31 JAKAFI 33 KIMONO PS PLUS INSULIN ASPART JALYN 64 SPERMICIDE/LUBRICATED 71 PROTAMINE/INSULIN JENLIVA ASPART 23 KIMONO SENSATION PRENATAL/POSTNATAL 82 LUBRICATED 71 INSULIN ASPART JORNAY PM 2 PROTAMINE/INSULIN ASPART KIMONO SENSATION PLUS FLEXPEN 23 JULUCA 39 SPERMICIDE LUBRICATED71 INSULIN LISPRO K-PHOS NEUTRAL 77 KIMONO SPECIAL 71 PROTAMINE/INSULIN LISPRO K-TAB 77 KINDERLYTE 76 KWIKPEN 23 K-Y ME & YOU EXTRA KINDERLYTE PREMAX 76 Insulin Syringe/Needle-Misc 74 LUBRICATED 71 KINRIX 95 INTELENCE 39 K-Y ME & YOU INTENSE 71 KITABIS PAK 3 INTERMEZZO 67 KADIAN 6 KLARON 49 INTUNIV 2 KALETRA 39 KLONOPIN 15 INVEGA 35 KALYDECO 94 KOATE 65 INVEGA SUSTENNA 35 KAMELEON KOATE-DVI 65 INVEGA TRINZA 35 LUBRICATED 71 KAPVAY 2 KOGENATE FS 65 INVIRASE 39 KAZANO 21 KONSYL DAILY FIBER 68 iodoquinol-hydrocortisone in aloe KONSYL ORIGINAL DAILY vehicle 51 KCENTRA 65 FIBER 68 IOPIDINE 88 KEFLEX 44 KOSHER PRENATAL PLUS IPOL INACTIVATED IPV 98 KENALOG 55 IRON 82 ipratropium bromide 13 KENALOG-40 47 KOVALTRY 65 ipratropium bromide (nasal) 86 KEPPRA 16 KP PRENATAL MULTIVITAMINS 82 ipratropium-albuterol 14 KEPPRA XR 16 KPN PRENATAL 82 irbesartan 29 KERALAC 56 KYLEENA 46 irbesartan-hydrochlorothiazide KERALYT 56 labetalol hcl 42 30 ketoconazole (topical) 51 irinotecan hcl 34 LAC-HYDRIN 56 KETONE 58 IRON CHEWS PEDIATRIC 66 LAC-HYDRIN TWELVE 56 iron-folic acid-vitamin c-vitamin KETONE TEST STRIPS 58 lactic acid (ammonium b6-vitamin b12-zinc 66 ketoprofen 4 lactate) 56 ISENTRESS 39 ketorolac tromethamine 4 lactulose 69 ISENTRESS HD 39 ketorolac tromethamine lactulose (encephalopathy) 63 isoniazid 31 (ophth) 89 LAMICTAL 16 KETOSTIX 58 isoproterenol hcl 14 LAMICTAL CHEWABLE ketotifen fumarate (ophth) 89 ISOPTO ATROPINE 88 DISPERSIBLE 16 KEVZARA 3 LAMICTAL ODT 16 ISOPTO CARPINE 88 KIMONO COLORS 71 LAMICTAL STARTER/NOT ISORDIL TITRADOSE 11 KIMONO LUBRICATED 71 TAKING CARBAMAZEPINE 16 isosorbide dinitrate 11 LAMICTAL STARTER/TAKING KIMONO MICRO THIN 71 isosorbide mononitrate 11 CARBAMAZEPINE/NOT TAKING KIMONO MICRO THIN PLUS VALPROATE 16 isotretinoin 49 SPERMICIDE LAMICTAL STARTER/TAKING isoxsuprine hcl 44 LUBRICATED 71 VALPROATE 16 ISUPREL 14 KIMONO PLUS SPERMICIDE LAMICTAL XR 16 LUBRICATED 71 ITCH RELIEF 52 KIMONO PLUS LAMISIL AT 51 itraconazole 25 SPERMICIDE/LUBRICATED LAMISIL AT JOCK ITCH 51 ivermectin 10 71 lamivudine 39 IXINITY 65 KIMONO PS lamivudine (hbv) 41 LUBRICATED 71 JADENU 24 lamivudine-zidovudine 39

Index 10 lamotrigine 16 LIDOCAINE lopinavir-ritonavir 39 Lancet Devices-Misc 73 HYDROCHLORIDE 70 LOPRESSOR 42 lidocaine w/ epinephrine 69 Lancets-Misc 73 LOPRESSOR HCT 30 lidocaine-prilocaine 57 LANOXIN 44 LOPROX 51 LIDODERM 57 lansoprazole 96 LOPROX SHAMPOO 51 LIDOTRAL 57 lanthanum carbonate 63 loratadine 26 LIFESTYLES ASSORTED lapatinib ditosylate 33 COLORS 71 loratadine & LASIX 59 LIFESTYLES EXTRA pseudoephedrine 48 lorazepam 12 latanoprost 90 STRENGTH 71 LIFESTYLES FORM losartan potassium 29 LATUDA 35 FITTING 71 losartan potassium & LEADER QUICK DISSOLVE LIFESTYLES hydrochlorothiazide 30 GLUCOSE 22 LUBRICATED 71 LOSEASONIQUE 45 leflunomide 5 LIFESTYLES RIBBED 71 LOTENSIN 28 LESCOL XL 27 LIFESTYLES SKYN LOTENSIN HCT 30 letrozole 33 ORIGINAL 71 LOTREL 30 leucovorin calcium 34 LIFESTYLES SPERMICIDALLYLUBRICATE LOTRIMIN AF 51 LEUKERAN 32 D 72 LOTRIMIN AF JOCK ITCH 51 levalbuterol hcl 14 LIFESTYLES STUDDED 72 LOTRISONE 51 LEVAQUIN 62 LIFESTYLES ULTRA LOTRONEX 63 LEVBID 96 SENSITIVE 72 LIFESTYLES ULTRA lovastatin 28 LEVETIRACETAM 17 SENSITIVE/SPERMICIDE 72 LOVAZA 27 levetiracetam 17 LIFESTYLES VIBRA- levetiracetam in sodium RIBBED 72 LOVENOX 15 chloride 16 LIFESTYLES VIBRA- loxapine succinate 36 levobunolol hcl 87 RIBBED/SPERMICIDE 72 LUCEMYRA 92 levocarnitine (metabolic LIFESTYLES XTRA LUXIQ 55 PLEASURE 72 modifiers) 61 LYRICA 17 levocetirizine dihydrochloride26 LILETTA 46 LYRICA CR 93 levofloxacin 62 LINCOCIN 11 LYSODREN 33 levoleucovorin calcium 34 lincomycin hcl 11 LYSTEDA 67 levonorgestrel & eth linezolid 11 estradiol 45 liothyronine sodium 95 M-M-R II 98 levonorgestrel (emergency LIPITOR 28 M-NATAL PLUS 82 oc) 46 MACROBID 11 levonorgestrel-eth estradiol lisinopril 28 (triphasic) 45 lisinopril & MACRODANTIN 11 levonorgestrel-ethinyl estradiol hydrochlorothiazide 30 mafenide acetate 53 (91-day) 45 LITHIUM 35 magnesium citrate 69 levothyroxine sodium 95 lithium carbonate 35 magnesium hydroxide 69 LEVSIN 96 LITHOBID 35 magnesium oxide 9 LEVSIN/SL 96 LMX 4 57 magnesium oxide (mg LEXAPRO 19,20 LO LOESTRIN FE 45 supplement) 76 LEXIVA 39 LOCOID 55 MAKENA 91 LIALDA 63 LOCOID LIPOCREAM 55 MALARONE 31 LIBRAX 96 LODINE 4 malathion 58 lidocaine 57 LODOSYN 34 maprotiline hcl 19 lidocaine hcl 57 LOMOTIL 24 MARCAINE 70 lidocaine hcl (local anesth.) 70 loperamide hcl 24 MARCAINE SPINAL 70 lidocaine hcl (mouth-throat) 78 LOPID 27 MARCAINE/EPINEPHRINE 69

Index 11 MARINOL 25 MESTINON TIMESPAN 31 MICATIN 51 MARNATAL-F 82 METAMUCIL 68 miconazole nitrate (topical) 51 MATULANE 34 METAMUCIL ORIGINAL miconazole nitrate vaginal 99 MAVYRET 41 TEXTURE 68 midazolam hcl 67 metaxalone 85 MAXALT 75 midodrine hcl 99 metformin hcl 21 MAXALT-MLT 75 miglitol 21 methamphetamine hcl 1 MAXIPIME 45 MIGRANAL 74 methazolamide 59 MAXITROL 89 MINASTRIN 24 FE 45 methenamine hippurate 11 MAXX LUBRICATED 72 MINIPRESS 29 methenamine mandelate 11 MAXX PLUS SPERMICIDE MINIVELLE 62 methenamine-hyosc-methylene LUBRICATED 72 MINOCIN 94 MAXZIDE 59 blue-sod phos-phenyl sal 10 methimazole 94 minocycline hcl 94 MAXZIDE-25 59 methocarbamol 85 minoxidil 31 meclizine hcl 24 METHOTREXATE 3 MIRALAX 69 MEDROL 47 methotrexate sodium 32 MIRALAX MIX-IN PAX 69 MEDROL DOSEPAK 47 MIRAPEX 34 medroxyprogesterone methoxsalen rapid 52 acetate 91 methscopolamine bromide 96 MIRAPEX ER 34 medroxyprogesterone acetate methyldopa 29 MIRCETTE 45 (contraceptive) 46 methylergonovine maleate 90 MIRENA 46 mefenamic acid 4 METHYLIN 2 mirtazapine 18 mefloquine hcl 31 methylphenidate hcl 2,3 misoprostol 97 MEGACE ES 91 METHYLPHENIDATE MOBIC 4 megestrol acetate 33 HYDROCHLORIDE ER 3 modafinil 3 megestrol acetate (appetite) 91 methylprednisolone 47 MOI-STIR 79 methylprednisolone MEKINIST 33 mometasone furoate 55 MELATONIN 3 acetate 47 methylprednisolone sod mometasone furoate (nasal) 86 melatonin 3 succ 47 MONISTAT 1 COMBO meloxicam 4 metoclopramide hcl 63 PACK 99 melphalan 32 metolazone 60 MONISTAT 1 DAY OR NIGHT COMBO PACK 99 melphalan hcl 32 metoprolol & MONISTAT 3 99 memantine hcl 92 hydrochlorothiazide 30 metoprolol succinate 42 MONISTAT 3 COMBINATION MENACTRA 97 PACK 99 METOPROLOL SUCCINATE MONISTAT 7 SIMPLY MENQUADFI 97 ER/HYDROCHLOROTHIAZIDE MENVEO 97 CURE 99 30 MONISTAT SOOTHING CARE MEPHYTON 100 metoprolol tartrate 42 ITCH RELIEF 55 mepivacaine hcl 70 METROCREAM 57 MONONINE 65 meprobamate 12 METROGEL 57 MONOVISC 86 MEPRON 10 METROGEL-VAGINAL 99 montelukast sodium 13 mercaptopurine 32 METROLOTION 57 morphine sulfate 6 meropenem 10 metronidazole 10 MORPHINE SULFATE 6,7 MERREM 10 metronidazole (topical) 58 morphine sulfate 7 mesalamine 63 metronidazole vaginal 99 MOTRIN CHILDRENS 4 mesalamine w/ cleanser 63 mexiletine hcl 13 MOTRIN INFANTS DROPS 4 mesna 34 MIACALCIN 60 MOUTH KOTE 79 MESNEX 34 MICARDIS 29 MOUTH KOTE REMINT 79 MESTINON 31 MICARDIS HCT 30 moxifloxacin hcl 62

Index 12 moxifloxacin hcl (ophth) 88 NAPRELAN 4 NESACAINE 70 MS CONTIN 7 NAPROSYN 4 NESACAINE-MPF 70 MULTI PRENATAL 82 naproxen 4 NESINA 22 MULTI VITAMIN 80 naproxen sodium 4 NESTABS 82 MULTI VITAMIN/D-3 80 naratriptan hcl 75 NESTABS DHA 82 multiple vitamin 80 NARCAN 24 NESTABS ONE 82 multiple vitamins w/ iron 80 NARDIL 19 NEURONTIN 17 Multiple Vitamins w/ Minerals NAROPIN 70 NEUTROGENA T/GEL 58 Tab-Misc 80 NASACORT ALLERGY NEUTROGENA T/GEL Multiple Vitamins w/ Minerals- 24HR 86 STUBBORN ITCH Misc 80 NASACORT ALLERGY 24HR CONTROL 58 MULTIVITAMIN 80 CHILDRENS 86 nevirapine 39 MULTIVITAMIN ADULT 80 NASALCROM 86 NEXA PLUS 82 MULTIVITAMIN INFANT & NASONEX 86 NEXAVAR 33 TODDLER 81 NATACHEW 82 mupirocin 51 NEXIUM 96 NATALVIT 82 MYAMBUTOL 31 NEXIUM 24HR 96 NATAZIA 45 NEXIUM 24HR CLEAR MYCOBUTIN 31 nateglinide 23 MINIS 96 mycophenolate mofetil 77 NATELLE ONE 82 NEXPLANON 46 mycophenolate sodium 77 NATROBA 58 niacin 100 MYDAYIS 1 NATURE-THROID 95 niacin (antihyperlipidemic) 28 MYDRIACYL 88 NAYZILAM 15 NIACIN TR 100 MYFORTIC 77 NEEVO DHA 82 NIASPAN 28 MYLERAN 32 nefazodone hcl 20 nicardipine hcl 43 MYLICON INFANTS GAS NICODERM CQ 94 RELIEF 63 NEMBUTAL SODIUM 67 MYLICON INFANTS GAS NEOMULTIVITE 80 NICORETTE 94 RELIEF DYE FREE 62 neomycin sulfate 3 NICORETTE MINI 94 MYNATAL 82 neomycin-bacitracin zn- NICORETTE STARTER KIT 94 MYNATAL ADVANCE 82 polymyxin 88 nicotine 94 MYNATAL PLUS 82 neomycin-bacitracin-polymyxin nicotine polacrilex 94 51 MYNATAL ULTRACAPLET 82 neomycin-polymy- NICOTINE TRANSDERMAL MYNATAL-Z 82 dexameth 89 SYSTEM 94 MYNATE 90 PLUS 82 neomycin-polymyxin w/ NICOTROL INHALER 94 MYSOLINE 17 pramoxine 51 NICOTROL NS 94 neomycin-polymyxin-gramicidin nifedipine 43 nabumetone 4 88 nadolol 42 neomycin-polymyxin-hc NILANDRON 33 naftifine hcl 51 (ophth) 89 nilutamide 33 NAFTIFINE neomycin-polymyxin-hc NINLARO 33 HYDROCHLORIDE 51 (otic) 90 nisoldipine 43 neomycin/polymyxin b gu 64 NAFTIN 51 NITRO-BID 11 NEONATAL COMPLETE 82 naloxone hcl 24 NITRO-DUR 11 NEONATAL PLUS 82 naltrexone hcl 24 nitrofurantoin 11 NEONATAL VITAMIN 82 NAMENDA 92 nitrofurantoin macrocrystal 11 NAMENDA TITRATION PAK92 NEORAL 77,78 nitrofurantoin monohyd NAMENDA XR 92 NEOSPORIN ORIGINAL 51 macro 11 NAMENDA XR TITRATION NEOSPORIN PLUS PAIN nitroglycerin 11,12 PACK 92 RELIEF MAXIMUM NITROLINGUAL STRENGTH 51 NAMZARIC 92 PUMPSPRAY 12 NEPHRO-VITE RX 80

Index 13 NITROPRESS 31 NOVOLOG MIX 70/30 23 olopatadine hcl 90 nitroprusside sodium 31 NOVOLOG MIX 70/30 olopatadine hcl (nasal) 86 NITROSTAT 12 PREFILLED FLEXPEN 23 OLUX 55 NOVOLOG MIX 70/30 NIVA-PLUS 82 PREFILLED FLEXPEN OLUX-E 55 NIX CREME RINSE 58 RELION 23 omega-3 fatty acids 87 NIZORAL 51 NOVOLOG MIX 70/30 omega-3-acid ethyl esters 27 RELION 23 NORCO 8 omeprazole 96 NOVOSEVEN RT 65 norelgestromin-ethinyl Omeprazole Delayed Release estradiol 46 NUEDEXTA 93 Tab 20mg 95 norethin acet & estrad-fe 45 NULYTELY 68 OMNICAP 80 norethindrone & eth estradiol45 NULYTELY/FLAVOR OMNIFLEX DIAPHRAGM 72 PACKS 68 norethindrone & ethinyl estradiol- ondansetron 24 NUMOISYN 79 fe 45 ondansetron hcl 24 norethindrone NUPLAZID 35 ONE DAILY ESSENTIAL 80 (contraceptive) 46 NUVARING 46 norethindrone acet & eth ONE VITE WOMENS estra 45 NUVIGIL 3 PRENATALVITAMIN 82 norethindrone acetate 91 NUWIQ 65 ONE VITE WOMENS norethindrone acetate-ethinyl nystatin 25 PRENATALVITAMIN PLUS 82 estradiol 62 nystatin (mouth-throat) 78 ONE-A-DAY ESSENTIAL 80 norethindrone acetate-ethinyl nystatin (topical) 51 ONE-A-DAY MENS 80 estradiol-fe 45 ONE-A-DAY VITACRAVES norethindrone-eth estradiol nystatin-triamcinolone 51 GUMMIES+OMEGA-3 DHA 81 (triphasic) 45 NYTOL MAXIMUM ONEVITE 80 norgestimate-ethinyl STRENGTH 67 estradiol 45 O-CAL FA 82 ONFI 15 norgestimate-ethinyl estradiol O-CAL PRENATAL 82 OPANA 7 (triphasic) 45 ophthalmic irrigation solution - OB COMPLETE 82 norgestrel & ethinyl estradiol 45 intraocular 90 OB COMPLETE ONE 82 NORPACE 13 OPTIONS CONCEPTROL OB COMPLETE PETITE 82 VAGINAL NORPRAMIN 21 OB COMPLETE PREMIER82 CONTRACEPTIVE 98 NORTEMP INFANTS 5 OPTIONS GYNOL II OB COMPLETE/DHA 82 nortriptyline hcl 21 VAGINALCONTRACEPTIVE OBIZUR 65 NORVASC 43 98 OBSTETRIX ONE 82 oral electrolytes 76 NORVIR 39 OCEAN NASAL SPRAY 86 ORAL RELIEF SPRAY FOR NOVA MAX PLUS KETONE DRYMOUTH & TESTSTRIPS 58 OCREVUS 93 DISCOMFORT 79 NOVACORT 55 octreotide acetate 61 ORAPRED ODT 47 NOVOEIGHT 65 OCUFLOX 88 ORILISSA 60 NOVOLIN 70/30 23 ODEFSEY 39 ORKAMBI 94 NOVOLIN 70/30 FLEXPEN 23 ODOMZO 32 orphenadrine citrate 86 NOVOLIN 70/30 FLEXPEN ofloxacin 62 ORTHO MICRONOR 46 RELION 23 ofloxacin (ophth) 88 NOVOLIN 70/30 RELION 23 ORTHO TRI-CYCLEN LO 45 ofloxacin (otic) 90 NOVOLIN N 23 ORTHO-NOVUM 1/35 45 olanzapine 36 NOVOLIN N FLEXPEN 23 ORTHO-NOVUM 7/7/7 45 NOVOLIN N FLEXPEN olanzapine-fluoxetine hcl 92 ORTHOVISC 86 RELION 23 olmesartan medoxomil 29 oseltamivir phosphate 42 NOVOLIN N RELION 23 olmesartan medoxomil- OSENI 21 NOVOLIN R 23 amlodipine-hydrochlorothiazide 30 OTICIN HC NR 90 NOVOLIN R RELION 23 olmesartan medoxomil- OVACE PLUS 52 hydrochlorothiazide 30

Index 14 OVACE PLUS WASH 52 PEDIALYTE SINGLES 76 phenylephrine-shark liver oil- OVACE WASH 52 PEDIAPRED 47 mineral oil-petrolatum 9 PHENYTEK 18 OVIDE 58 PEDIARIX 95 phenytoin 18 oxaprozin 4 pediatric multiple vitamin w/ c & phenytoin sodium 18 OXAYDO 7 fa 81 pediatric multiple vitamins 81 phenytoin sodium extended 18 oxazepam 12 Pediatric Multiple Vitamins w/ PHEXXI 99 oxcarbazepine 17 FluorideChew 80 phytonadione 100 oxiconazole nitrate 52 Pediatric Multiple Vitamins w/ PIFELTRO 39 OXISTAT 52 FluorideSoln 80 pilocarpine hcl 88 OXSORALEN ULTRA 52 PEDVAX HIB 97 peg 3350-kcl-sod bicarb-sod pilocarpine hcl (oral) 79 OXTELLAR XR 17 chloride-sod sulfate 68 pimecrolimus 56 oxybutynin chloride 97 peg 3350-potassium chloride- pimozide 93 oxycodone hcl 7 sod bicarbonate-sod pindolol 42 oxycodone w/ acetaminophen 8 chloride 68 penicillamine 77 pioglitazone hcl 22 oxycodone-aspirin 8 penicillin g potassium 90 pioglitazone hcl-glimepiride 21 oxymorphone hcl 7 penicillin v potassium 90 pioglitazone hcl-metformin oxytocin 90 PENLAC NAIL LACQUER 52 hcl 21 oyster shell 76 piperacillin sodium-tazobactam PENTACEL 95 OZEMPIC 22 sodium 91 pentobarbital sodium 67 paliperidone 36 piroxicam 4 pentoxifylline 65 PAMELOR 21 PITOCIN 90 PEPCID 96 PANCREAZE 59 PLAN B ONE-STEP 46 PEPCID AC 96 pantoprazole sodium 96 PLAQUENIL 31 PEPCID AC MAXIMUM PLAVIX 66 PARAGARD INTRAUTERINE STRENGTH 96 COPPER CONTRACEPTIVE PLEGRIDY 93 PEPTO-BISMOL 24 T380A 46 PLEGRIDY STARTER paricalcitol 61 PEPTO-BISMOL MAX PACK 93 STRENGTH 24 PLEXION 50 PARLODEL 34 PEPTO-BISMOL TO-GO 24 PLEXION CLEANSER 49 PARNATE 19 PERCOCET 8 PNEUMOVAX 23 97 paroxetine hcl 20 PERIDEX 78 paroxetine mesylate PNEUMOVAX 23/1 DOSE 97 perindopril erbumine 28 (vasomotor) 94 PNV TABS 29-1 82 permethrin 58 PARVA-CAL 76 PNV-DHA+DOCUSATE 82 perphenazine 37 PATADAY 90 PNV-OMEGA 82 perphenazine-amitriptyline 92 PATANASE 86 podofilox 56 PERSERIS 36 PATANOL 90 POLY-VI-SOL 81 phenazopyridine hcl 64 PAXIL 20 POLY-VI-SOL/IRON 81 phenelzine sulfate 19 PAXIL CR 20 POLY-VITA 81 PC PEDIATRIC POLY-VITAMIN PHENERGAN 26 POLY-VITA/IRON 81 DROPS 81 phenobarbital 67 PC PEDIATRIC POLY-VITAMIN phenobarbital-hyoscyamine- POLY-VITE PEDIATRIC 81 DROPS/IRON 81 atropine-scopolamine 96 POLY-VITE/IRON 81 ped multivitamins w/fl & iron 81 phenoxybenzamine hcl 28 polyethylene glycol 3350 69 PEDIA-LAX 69 phenylephrine hcl polyethylene glycol-propylene PEDIALYTE 76 (mydriatic) 88 glycol (ophth) 87 PEDIALYTE ADVANCED phenylephrine hcl (oral) 87 polymyxin b-trimethoprim 88 CARE 76 phenylephrine-dm 48 polysaccharide iron complex 66 PEDIALYTE FREEZER phenylephrine-shark liver oil- POLYSPORIN 51 POPS 76 cocoa butter 9

Index 15 POLYTRIM 88 PREMARIN 62,99 PREPLUS 84 polyvinyl alcohol 87 PREMESISRX 83 PREPOPIK 68 POMALYST 33 PREMIUM CONDOMS PRETAB 84 pot phosphate monobasic w/ sod LUBRICATED 72 PREVACID 97 PREMPHASE 62 phosphate dibasic & PREVACID 24HR 97 monobasic 77 PREMPRO 62 potassium acetate 77 PREVACID SOLUTAB 97 PRENA 1 TRUE 83 PREVIDENT 5000 BOOSTER potassium bicarbonate 77 PRENA1 CHEW 83 PLUS 78 potassium chloride 77 PRENA1 PEARL 83 PREVIDENT 5000 DRY potassium chloride PRENAISSANCE 83 MOUTH 78 microencapsulated crystals PREVIDENT 5000 ENAMEL er 77 PRENAISSANCE PLUS 83 PROTECT 78 potassium citrate PRENATABS FA 83 PREVIDENT 5000 ORTHO (alkalinizer) 64 PRENATAL 83 DEFENSE 78 potassium citrate-citric acid 64 PRENATAL 19 83 PREVIDENT 5000 PLUS 78 PREVIDENT 5000 PR NATAL 400 82 PRENATAL AND IRON 83 PR NATAL 400 EC 82 SENSITIVE 78 PRENATAL FORTE 83 PREVIDENT FLUORIDE 78 PR NATAL 430 83 PRENATAL LOW IRON 83 PREVIDENT RINSE 78 PR NATAL 430 EC 82 PRENATAL PREVNAR 13 97 pramipexole dihydrochloride 35 MULTIVITAMIN 83 PREZCOBIX 40 PRAMOSONE 55 PRENATAL ONE DAILY 83 PREZISTA 40 pramoxine hcl (rectal) 9 PRENATAL PLUS IRON 83 PRIMACARE 84 pramoxine-hc 55 prenatal vit w/ docusate-fe fumarate-folic acid 83 PRIMAXIN IV 10 pramoxine-hc-chloroxylenol 90 prenatal vit w/ docusate-iron primidone 17 PRANDIN 23 carbonyl-folic acid 83 PRINIVIL 28 prasugrel hcl 66 prenatal vit w/ ferrous fumarate- PRISTIQ 20 PRAVACHOL 28 folic acid 84 prenatal vit w/ iron carbonyl- PROAIR HFA 14 pravastatin sodium 28 folic acid 84 probenecid 64 prazosin hcl 29 PRENATAL VITAMIN 84 PROBUPHINE IMPLANT KIT 8 PRE-NATAL FORMULA 83 PRENATAL VITAMIN & PROCARDIA 43 PRECEDEX 67 MINERAL 84 PRENATAL PROCARDIA XL 43 PRECISION XTRA 59 VITAMIN/IRON 84 prochlorperazine 37 PRECOSE 21 PRENATAL VITAMINS 84 prochlorperazine edisylate 37 PRED FORTE 89 PRENATAL VITAMINS PLUS prochlorperazine maleate 37 PRED MILD 89 LOW IRON 84 PROCTOCORT 9 PRED-G 89 PRENATAL-U 84 PROCTOFOAM 9 PREDATOR 57 PRENATE 84 PROFILNINE 65 prednicarbate 55 PRENATE AM 84 PROFILNINE SD 65 prednisolone 47 PRENATE DHA 84 progesterone 91,92 prednisolone acetate (ophth) 89 PRENATE ELITE 84 prednisolone sodium PRENATE ENHANCE 84 PROGLYCEM 22 phosphate 47 PRENATE ESSENTIAL 84 PROGRAF 78 PREDNISOLONE SODIUM PRENATE MINI 84 promethazine & PHOSPHATE 89 phenylephrine 48 PRENATE PIXIE 84 prednisone 47 promethazine hcl 26,27 PRENATE RESTORE 84 PREDNISONE INTENSOL 47 promethazine w/codeine 48 PRENATRIX 84 PREFEST 62 promethazine-phenylephrine- PRENATRYL 84 pregabalin 17 codeine 48 PRENATVITE RX 84 PROMETRIUM 92 pregabalin (once-daily) 93

Index 16 propafenone hcl 13 quinapril-hydrochlorothiazide REMERON 19 proparacaine hcl 88 30 REMERON SOLTAB 19 quinidine gluconate 13 propranolol & RENFLEXIS 63 quinidine sulfate 13 hydrochlorothiazide 30 RENVELA 63 propranolol hcl 43 quinine sulfate 31 repaglinide 23 propylthiouracil 94 QUINTABS 80 REPEL LEMON EUCALYPTUS PROSCAR 64 QVAR REDIHALER 13 INSECT REPELLENT 57 PROSTIN VR PEDIATRIC 78 R-NATAL OB 84 REQUIP XL 35 PROTONIX 97 RA DRY MOUTH 79 RESCRIPTOR 40 PROTOPIC 56 RA OYSTER SHELL RESOURCE THICKENUP 91 protriptyline hcl 21 CALCIUM/VITAMIN D 76 RESTORIL 67 RA PRENATAL 84 PROVENTIL HFA 14 RETACRIT 66 RA PRENATAL PROVERA 92 FORMULA/FOLICACID 84 RETIN-A 50 PROVIDA DHA 84 rabeprazole sodium 97 RETIN-A MICRO 50 PROVIDA OB 84 raloxifene hcl 61 RETIN-A MICRO PUMP 50 PROVIGIL 3 ramelteon 68 RETROVIR 40 PROZAC 20 ramipril 28 REYATAZ 40 PSORCON 55 RAPAMUNE 78 RIASTAP 65 psyllium 68 rasagiline mesylate 35 ribavirin 42 PTS PANELS KETONE RAZADYNE 92 ribavirin (hepatitis c) 41 TEST 59 RAZADYNE ER 92 riboflavin 100 PULMICORT 13 REALITY LATEX RID 58 PURIXAN 32 CONDOMS/LUBRICATED 72 RID COMPLETE LICE PX LANCETS MICROTHIN REALITY LATEX/ULTRA ELIMINATION 58 33G 73 TEXTURED 72 rifabutin 32 PX PRENATAL REALITY LATEX/ULTRA MULTIVITAMINS 84 THIN 72 RIFADIN 32 pyrantel pamoate 10 REBIF 93 rifampin 32 pyrazinamide 31 REBIF REBIDOSE 93 RIGHT STEP PRENATAL 84 pyrethrins-piperonyl butoxide58 REBIF REBIDOSE RILUTEK 87 pyrethrins-piperonyl butoxide- TITRATIONPACK 93 riluzole 87 permethrin-nit remover 58 REBIF TITRATION PACK 93 rimantadine hydrochloride 42 PYRIDIUM 64 REBINYN 65 risedronate sodium 60 pyridostigmine bromide 31 RECLAST 60 RISPERDAL 36 pyridoxine hcl 100 RECOMBINATE 65 RISPERDAL CONSTA 36 QC PRENATAL 84 RECOMBIVAX HB 98 risperidone 36 QELBREE 2 REGLAN 63 RITALIN 3 QUADRACEL 95 RELENZA DISKHALER 42 RITALIN LA 3 QUALAQUIN 31 RELEXXII 3 ritonavir 40 QUARTETTE 45 RELION INSULIN SYRINGE rivastigmine 92 quazepam 67 0.5ML/31G X 15/64" 74 RELION INSULIN SYRINGE/U- rivastigmine tartrate 92 QUDEXY XR 17 100/0.3ML/31G X 15/64" 74 RIXUBIS 65 QUESTRAN 27 RELION KETONE TEST rizatriptan benzoate 75 STRIPS 59 QUESTRAN LIGHT 27 ROBAXIN 86 quetiapine fumarate 36 RELION TRUE METRIX BLOODGLUCOSE TEST ROBAXIN-750 86 QUILLICHEW ER 3 STRIPS 59 ROCALTROL 61 QUILLIVANT XR 3 RELNATE DHA 84 ropinirole hydrochloride 35 quinapril hcl 28 RELPAX 75 ropivacaine hcl 70

Index 17 ROTARIX 98 SEROQUEL XR 37 SORIATANE 52 ROTATEQ 98 sertraline hcl 20 sotalol hcl 43 ROWASA 63 sevelamer carbonate 64 sotalol hcl (afib/afl) 43 ROXICODONE 7 SFROWASA 63 Spacer/Aerosol Holding ROZEREM 68 SHINGRIX 98 Chambers-Misc 74 spinosad 58 rufinamide 17 SHUR-SEAL 98 spironolactone 60 RUKOBIA 40 SILENOR 67 spironolactone & RUZURGI 31 SILVADENE 53 hydrochlorothiazide 59 RYTHMOL SR 13 silver sulfadiazine 53 SPORANOX 25 SABRIL 18 simethicone 63 SPORANOX PULSEPAK 25 SAFYRAL 46 simvastatin 28 SPRITAM 17 SALAGEN 79 SINEMET 35 SPRYCEL 33 SALEX 56 SINEMET CR 35 STALEVO 100 35 salicylic acid 56,57 SINGULAIR 13 STALEVO 125 35 saline 86 sirolimus 78 STALEVO 150 35 salsalate 6 SIVEXTRO 11 STALEVO 200 35 SALVAX 57 SKELAXIN 86 STALEVO 50 35 SANDIMMUNE 78 SKYLA 46 STALEVO 75 35 SANDOSTATIN 61 SLO-NIACIN 100 stannous fluoride 79 SARAFEM 93 SLYND 46 starch-maltodextrin SARNA 52 SM GLUCOSE 22 (thickening) 91 SAVELLA 92 SM PRENATAL VITAMINS84 STARLIX 23 SAVELLA TITRATION sodium bicarbonate STAVUDINE 40 PACK 93 (antacid) 9 stavudine 40 scopolamine 24 sodium chloride (gu STEGLATRO 23 irrigant) 64 SE-NATAL 19 84 STIVARGA 33 sodium chloride (inhalant) 48 SEASONIQUE 46 STRATTERA 2 sodium citrate & citric acid 64 SECUADO 36 STRIBILD 40 SODIUM DIURIL 60 SELECT-OB 84 STROMECTOL 10 SODIUM EDECRIN 59 SELECT-OB+DHA 84 sodium ferric gluconate SUBLOCADE 8 selegiline hcl 35 complex in sucrose 66 SUBOXONE 8 selenium sulfide 52 sodium fluoride 76 sucralfate 96 SELSUN BLUE 53 sodium fluoride (dental) 78 SUDAFED PE SINUS SELSUN BLUE DAILY 52 sodium fluoride-potassium CONGESTION 87 SELSUN BLUE nitrate 78 SULAR 43 MEDICATED 53 sodium hypochlorite 38 sulfacetamide sod- SELSUN BLUE sodium phenylbutyrate 61 prednisolone 89 MOISTURIZING 53 sulfacetamide sodium 53 sodium phosphates 69 SELZENTRY 40 sodium polystyrene sulfacetamide sodium (acne)50 SEMGLEE 23 sulfonate 78 sulfacetamide sodium SENNA 69 SODIUM (ophth) 88 sulfacetamide sodium w/ sennosides 69 SULFACETAMIDE/SULFUR 50 sulfur 50 sennosides-docusate sulfamethoxazole-trimethoprim sodium 68 SOFOSBUVIR/VELPATASVIR 41 10 SENOKOT 69 SOLODYN 94 SULFAMYLON 53 SENOKOT S 68 SOLU-MEDROL 47 sulfasalazine 63 SEREVENT DISKUS 14 SORBITOL 69 sulindac 5 SEROQUEL 36 SUMADAN WASH 50

Index 18 sumatriptan 75 TAZORAC 52 thiamine mononitrate 100 sumatriptan succinate 75 TDVAX 95 THICK-IT #2 91 SUMAXIN 50 TECFIDERA 93 THICK-IT ORIGINAL 91 SUMAXIN WASH 50 TECFIDERA STARTER thioridazine hcl 37 sunitinib malate 33 PACK 93 thiothixene 38 TECHLITE INSULIN SUPRAX 45 SYRINGEU-100/0.3ML/31G X THRIVITE 19 80 SUPREP BOWEL PREP KIT68 15/64" 74 THRIVITE RX 84 SUSTIVA 40 TECHLITE INSULIN thyroid 95 SYRINGEU-100/0.5ML/31G X SUTENT 33 15/64" 74 tiagabine hcl 18 SYMBICORT 14 TEGRETOL 17 TIAZAC 43 SYMBYAX 92 TEGRETOL-XR 17 TIGAN 25 SYMFI 40 telmisartan 29 TIKOSYN 13 SYMFI LO 40 telmisartan-amlodipine 30 timolol maleate 43 SYMLINPEN 120 21 telmisartan-hydrochlorothiazide timolol maleate (ophth) 87 SYMLINPEN 60 21 30 TIMOPTIC 87 SYMTUZA 40 temazepam 67,68 TIMOPTIC OCUDOSE 87 SYNAGIS 90 TEMIXYS 40 TIMOPTIC-XE 87 SYNALAR 55 TEMODAR 32 TINACTIN 52 SYNTHROID 95 TEMOVATE 55 tinidazole 10 SYNVISC 86 temozolomide 32 tioconazole vaginal 99 SYNVISC ONE 86 TENIVAC 95 TIVICAY 40 SYPRINE 77 tenofovir disoproxil TIVICAY PD 40 fumarate 40 SYSTANE 87 TENORETIC 100 30 tizanidine hcl 86 SYSTANE ULTRA 87 TENORETIC 50 30 TL FOLATE 85 TAB-A-VITE TENORMIN 42 TL-CARE DHA 85 MULTIVITAMIN/IRON AND TL-SELECT 85 BETA-CAROTENE 80 terazosin hcl 29 TACLONEX 55 terbinafine hcl 25 TOBI 3 tacrolimus 78 terbinafine hcl (topical) 52 TOBRADEX 89 tacrolimus (topical) 56 terbutaline sulfate 14 tobramycin 3 TAFINLAR 33 terconazole vaginal 99 tobramycin (ophth) 88 TAGAMET HB 96 TESSALON PERLES 47 tobramycin sulfate 3 TALTZ 52 testosterone 8 tobramycin-dexamethasone 89 TAMIFLU 42 testosterone cypionate 8 TOBREX 88 tamoxifen citrate 33 TETANUS/DIPHTHERIA TODAY SPONGE 98 tamsulosin hcl 64 TOXOIDS-ADSORBED TOFRANIL 21 ADULT 95 tolcapone 34 TAPAZOLE 94 tetrabenazine 93 TARCEVA 32 tolmetin sodium 5 tetracycline hcl 94 tolnaftate 52 TARGRETIN 34 tetrahydrozoline hcl TARKA 30 (ophth) 88 tolterodine tartrate 97 TARON-BC 84 THEO-24 14 TOPAMAX 17 TARON-C DHA 84 theophylline 14 TOPAMAX SPRINKLE 17 TARON-PREX 84 THERA 80 TOPICORT 55 TASIGNA 33 THERANATAL CORE topiramate 17 NUTRITION 84 TASMAR 34 topotecan hcl 34 THEREMS TOPROL XL 42 TAYTULLA 46 MULTIVITAMIN 80 tazarotene 52 thiamine hcl 100 toremifene citrate 33

Index 19 torsemide 60 TRISTART ONE 85 TUDORZA PRESSAIR 13 tramadol hcl 7 TRIUMEQ 40 TUMS 9 tramadol-acetaminophen 8 TRIVEEN-DUO DHA 85 TUMS CHEWY BITES 9 trandolapril 28 TRIZIVIR 40 TUMS E-X 750 9 trandolapril-verapamil hcl 30 TROGARZO 40 TUMS EXTRA STRENGTH tranexamic acid 67 TROKENDI XR 17 750 9 TUMS LASTING EFFECTS 9 TRANSDERM SCOP 25 tropicamide 88 TUMS SMOOTHIES 9 TRANSDERM-SCOP 25 trospium chloride 97 TWINRIX 98 TRANXENE T 12 TRUE METRIX BLOOD TWIRLA 46 tranylcypromine sulfate 19 GLUCOSETEST STRIPS 59 TRUECONTROL GLUCOSE TWYNSTA 31 trazodone hcl 20 CONTROL LEVEL 0 73 TYBLUME 46 TRECATOR 32 TRUECONTROL GLUCOSE TYBOST 40 tretinoin 50 CONTROL LEVEL 1 73 TYKERB 33 tretinoin (chemotherapy) 34 TRUETRACK TEST 59 TYLENOL 6 tretinoin microsphere 50 TRULICITY 22 TYLENOL CHILDRENS 5 TRETTEN 65 TRUMENBA 98 TYLENOL CHILDRENS TREXALL 32 TRUSOPT 90 TRUSTEX COLOR CONDOMS CHEWABLES/PAIN + FEVER5 TRI-TABS DHA 85 + LUBE 72 TYLENOL EXTRA triamcinolone acetonide 47 STRENGTH 5 TRUSTEX LUBRICATED 72 TYLENOL FOR triamcinolone acetonide TRUSTEX LUBRICATED (mouth) 79 CHILDREN/ADULTS 5 EXTRALARGE 72 TYLENOL INFANTS 5 triamcinolone acetonide TRUSTEX LUBRICATED (nasal) 87 EXTRASTRENGTH 72 TYLENOL INFANTS triamcinolone acetonide TRUSTEX PAIN+FEVER 5 (topical) 56 LUBRICATED/RIBBED/STUDD TYLENOL/CODEINE #3 8 triamterene & ED 72 TYLENOL/CODEINE #4 8 hydrochlorothiazide 59 TRUSTEX TYMLOS 60 triazolam 68 LUBRICATED/SPERMICIDE UDAMIN SP 80 TRIBENZOR 30 72 ULTILET INSULIN SYRINGE TRICARE 85 TRUSTEX LUBRICATED/SPERMICIDE 31X6MM 74 TRICARE PRENATAL DHA EXTRA LARGE 72 ULTILET INSULIN SYRINGE/U- ONE 85 TRUSTEX 100/0.5ML/31GX6MM 74 TRICOR 27 LUBRICATED/SPERMICIDE ULTIMATECARE ONE 85 TRIDESILON 56 EXTRA STRENGTH 72 ULTRACET 8 trientine hcl 77 TRUSTEX NATURAL ULTRAM 7 trifluoperazine hcl 37 CONDOMS +LUBE/LUBRICATED 72 ULTRASAL-ER 57 trifluridine 88 TRUSTEX NON- UNASYN 91 TRIGLIDE 27 LUBRICATED 72 UNASYN BULK PACK 91 trihexyphenidyl hcl 34 TRUSTEX WITH UNISOM SLEEPGELS 67 NONOXYNOL- TRIKAFTA 94 9/RIBBED/STUDDED 72 UNISOM SLEEPTABS 67 TRILEPTAL 17 TRUSTEX/RIA URAMAXIN 56 TRILIPIX 27 LUBRICATED 72 urea 56 trimethobenzamide hcl 25 TRUSTEX/RIA LUBRICATED SPERMICIDE 72 urea in lactic acid vehicle 56 trimethoprim 10 TRUSTEX/RIA URECHOLINE 97 trimipramine maleate 21 LUBRICATED/SPERMICIDE UROCIT-K 10 64 TRINATAL RX 1 85 72 UROCIT-K 15 64 TRUSTEX/RIA NON- TRIOSTAT 95 LUBRICATED 72 UROCIT-K 5 64 TRISTART DHA 85 TRUVADA 40 UROXATRAL 64

Index 20 URSO 250 63 VIRACEPT 40 WALGREENS GLUCOSE 22 URSO FORTE 63 VIRAMUNE 40 warfarin sodium 14 ursodiol 63 VIRAMUNE XR 40 WELLBUTRIN SR 19 VAGIFEM 99 VIRASAL 57 WELLBUTRIN XL 19 valacyclovir hcl 41 VIRAZOLE 42 WESTAB PLUS 85 VALCYTE 41 VIREAD 41 WESTGEL DHA 85 valganciclovir hcl 41 VIRT-C DHA 85 WESTHROID 95 VALIUM 12 VIRT-NATE DHA 85 white petrolatum-mineral oil 87 valproate sodium 18 VIRT-PN PLUS 85 WIDE-SEAL SILICONE valproic acid 18 VISINE 88 DIAPHRAGM KIT 60 72 WIDE-SEAL SILICONE valsartan 29 VISINE RED EYE DIAPHRAGM KIT 65 72 valsartan-hydrochlorothiazide COMFORT 88 WIDE-SEAL SILICONE 31 VISTARIL 12 DIAPHRAGM KIT 70 72 VALTOCO 15 VITAFOL GUMMIES 85 WIDE-SEAL SILICONE VALTREX 41 VITAFOL ULTRA 85 DIAPHRAGM KIT 75 72 WIDE-SEAL SILICONE VANCOCIN 10 VITAFOL-NANO 85 DIAPHRAGM KIT 80 72 VANCOCIN HCL 10 VITAFOL-OB 85 WIDE-SEAL SILICONE vancomycin hcl 10 VITAFOL-OB+DHA 85 DIAPHRAGM KIT 85 72 VANOS 56 VITAFOL-ONE 85 WIDE-SEAL SILICONE DIAPHRAGM KIT 90 72 VAQTA 98 VITAMEDMD ONE WIDE-SEAL SILICONE VARIVAX 98 RX/QUATREFOLIC 85 DIAPHRAGM KIT 95 73 VITAMEDMD REDICHEW VASERETIC 31 RX 85 WILATE 65 VASOTEC 28 vitamin e 100 WP THYROID 95 VCF VAGINAL vitamins w/ lipotropics 85 XALATAN 90 CONTRACEPTIVE FILM 98 XALKORI 33 VCF VAGINAL VITAPEARL 85 CONTRACEPTIVE FOAM 98 VITATHELY/GINGER 85 XANAX 12 VCF VAGINAL VITATRUE 85 XANAX XR 12 CONTRACEPTIVEGEL 98 VIVA DHA 85 XELJANZ 3 VENA-BAL DHA 85 VIVARIN 2 XELJANZ XR 3 venlafaxine hcl 20 VIVELLE-DOT 62 XELODA 32 VENTOLIN HFA 14 VIVITROL 24 XENAZINE 93 VENTRIXYL 80 VOCABRIA 41 XEROSTOMIA RELIEF verapamil hcl 43,44 SPRAY 79 VOL-NATE 85 VERELAN 44 XIMINO 94 VOL-PLUS 85 VERELAN PM 44 XOPENEX 14 VOL-TAB RX 85 VFEND 25 XOPENEX CONCENTRATE 14 VOLTAREN 50 VFEND IV 25 XTANDI 33 VONVENDI 65 VIBRAMYCIN 94 XURIDEN 61 voriconazole 25 VIDEX EC 40 XYLOCAINE 70 VOTRIENT 33 VIDEXPEDIATRIC 40 XYLOCAINE-MPF 70 VP-PNV-DHA 85 vigabatrin 18 XYLOCAINE- VRAYLAR 35 MPF/EPINEPHRINE 69 VIGAMOX 88 VYNDAMAX 44 XYLOCAINE/EPINEPHRINE VIIBRYD 20 70 VYNDAQEL 44 VIMPAT 17 XYNTHA 65 VYTONE 52 VINATE DHA RF 85 XYNTHA SOLOFUSE 65 VYTORIN 27 VINATE II 85 XYREM 92 VYVANSE 1 VINATE ONE 85 XYZAL ALLERGY 24HR 26

Index 21 YASMIN 28 46 ZYPREXA RELPREVV 37 YAZ 46 ZYRTEC ALLERGY 26 ZADITOR 90 ZYRTEC CHILDRENS zafirlukast 13 ALLERGY 26 ZYRTEC-D zaleplon 68 ALLERGY/CONGESTION 48 ZANAFLEX 86 ZYTIGA 33 ZARONTIN 18 ZYVOX 11 ZARXIO 66 ZATEAN-PN PLUS 85 ZELBORAF 33 ZEMPLAR 61 ZESTORETIC 31 ZESTRIL 28 ZETIA 28 ZIAC 31 ZIAGEN 41 zidovudine 41 zileuton 13 zinc oxide (topical) 57 zinc sulfate 77 ZINECARD 34 ziprasidone hcl 35 ZITHROMAX 70 ZITHROMAX TRI-PAK 70 ZITHROMAX Z-PAK 70 ZOCOR 28 ZOFRAN 24 zoledronic acid 60 ZOLINZA 33 zolmitriptan 75 ZOLOFT 20 zolpidem tartrate 68 ZOMACTON 61 ZOMIG 75 ZOMIG ZMT 76 ZONEGRAN 17 zonisamide 17 ZORTRESS 78 ZOSTAVAX 98 ZOSYN 91 ZOVIRAX 41,53 ZUBSOLV 8 ZYKADIA 33 ZYLOPRIM 64 ZYMAXID 88 ZYPREXA 37

Index 22