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Home , Cidofovir, Delavirdine, Fomivirsen, Nicorette

MICHIGAN DRUG ASSISTANCE PROGRAM

AIDS Related Treatments

Antiretrovirals

Nucleoside/Nucleotide Reverse Non-Nucleoside Reverse Protease Inhibitors Transcriptase Inhibitors Transcriptase Inhibitors

Abacavir (ZIAGEN) (RESCRIPTOR) (AGENERASE) / (EPZICOM) (SUSTIVA) (REYATAZ) Abacavir/lamivudine/ (VIRAMUNE) (LEXIVA) (TRIZIVIR) (VIDEX, VIDEX EC)* (CRIXIVAN) (EMTRIVA) / (KALETRA) Emtricitabine/tenofovir (TRUVADA) (VIRACEPT) Lamivudine (EPIVIR) Ritonavir (NORVIR) Lamivudine/zidovudine (COMBIVIR) (FORTOVASE, INVIRASE) (ZERIT) (APTIVUS) Tenofovir (VIREAD) (HIVID) Zidovudine (RETROVIR)*

Fusion Inhibitors * (FUZEON) (PA is required)

Opportunistic PCP infections Toxoplasmosis Fungal infections Co-trimoxazole, TMP/SMX Co-trimoxazole, TMP/SMX (AMPHOCIN)* (BACTRIM/SEPTRA SS, DS)* (BACTRIM/SEPTRA SS, DS)* Dapsone* Dapsone* Clotrimazole (MYCELEX)* Pentamidine (PENTAM)* Pyrimethamine (DARAPRIM) (NIZORAL)* Atovaquone (MEPRON)* Leucovorin* Terbinafine (LAMISIL) Primaquine* Azithromycin (ZITHROMAX)* Fluconazole (DIFLUCAN)* Trimethoprim* Clindamycin (CLEOCIN)* Voriconazole (VFEND) Clindamycin (CLEOCIN)* Leucovorin* (SPORANOX)* Sulfadiazine* Nystatin* Mycobacterial infections Atovaquone (MEPRON)* Azithromycin (ZITHROMAX)* Others Clarithromycin (BIAXIN)* Herpes infections Vaccine Ethambutol (MYAMBUTOL)* Acyclovir (ZOVIRAX)* Hepatitis A Vaccine (MYCOBUTIN)* (FAMVIR) Pneumococcal Vaccine (CIPRO)* Valacyclovir (VALTREX) Influenza Vaccine Levofloxicin (LEVAQUIN)* (REBETOL, RIBASPHERE, COPEGUS)* CMV infections alfa-2b (INTRON-A) Cryptosporidiosis (VISTIDE) Peginterferon alfa-2a (PEGASYS) Paromomycin (HUMATIN)* (VITRAVENE) Peginterferon alfa-2b (PEG-INTRON KIT ) Atovaquone (MEPRON)* (FOSCARVIR) Azithromycin (ZITHROMAX)* (CYTOVENE)* (VALCYTE)

1) BRAND-NAME DRUG indicated by CAPITAL. 2) Generic drugs indicated by lower case. 1 3) Product names in parenthesis are the brand names for the generic. 4) * indicates the generic equivalent is available. MICHIGAN DRUG ASSISTANCE PROGRAM

Analgesics Ketoconazole (NIZORAL)* COPEGUS)* Terbinafine (LAMISIL) Rimantadine (FLUMADINE)* Nonsteroidal Anti-inflammatory Voriconazole (VFEND) Valacyclovir (VALTREX) Agents Valganciclovir (VALCYTE) Celecoxib (CELEBREX) Antiprotozoals, Miscellaneous Diclofenac (VOLTEREN)* Atovaquone (MEPRON)* Cephalosporins Diclofenac/misoprostol (ARTHROTEC)* Paromomycin (HUMATIN)* Cephalexin (KEFLEX)* Nabumetone (RELAFEN)* Pentamidine (PENTAM)* (MOTRIN)* Quinolones Ciprofloxacin (CIPRO)* Antiretroviral Agents Levofloxicin (LEVAQUIN)* Opiate Agonists Abacavir (ZIAGEN) Ofloxacin (FLOXIN)* acetaminophen /caffeine/butabital Abacavir/lamivudine (EPZICOM) (FIORICET)* Abacavir/lamivudine/zidovudine Macrolides acetaminophen (TRIZIVIR) Azithromycin (ZITHROMAX)* /caffeine/butabital/codeine Amprenavir (AGENERASE) Clarithromycin (BIAXIN*, BIAXIN (FIORICET/CODEINE)* Atazanavir (REYATAZ) Asa/caffeine/butabital (FIORINAL)* XL) Delavirdine (RESCRIPTOR) Erythromycin* Asa/caffeine/butabital/codeine Didanosine (VIDEX, VIDEX EC)* (FIORINAL/CODEINE)* Efavirenz (SUSTIVA) Asa/codeine* Penicillins Emtricitabine (EMTRIVA) Codeine* (TRIMOX, AMOXIL)* Emtricitabine/tenofovir (TRUVADA) Codeine/Acetaminophen ( Amoxicllin/clavulanic acid #2, #3, #4)* Fosamprenavir (LEXIVA) (AUGMENTIN*, AUGMENTIN ES- 600, AUGMENTIN XR) (DURAGESIC)* Indinavir (CRIXIVAN) Penicillin (PEN-VK, BICILLIN LA)* Hydrocodone/Acetaminophen Lamivudine (EPIVIR) (VICODIN, VICODIN ES, LORTAB)* Lamivudine/zidovudine (COMBIVIR) Tetracyclines Hydromorphone (DILAUDID)* Lopinavir/ritonavir (KALETRA) Doxycycline* Meperidine (DEMEROL)* Nelfinavir (VIRACEPT) Nevirapine (VIRAMUNE) Methadone* Vaginal Antimicrobials Ritonavir (NORVIR) Morphine (ROXANOL, ORAMORPH Metronidazole (METROGEL)* vag SR, MS-CONTIN)* Saquinavir (FORTOVASE, INVIRASE) Oxycodone (OXYCONTIN, OXY-IR)* Stavudine (ZERIT) Ophthalmic Antimicrobials Oxycodone/Acetaminophen Tenofovir (VIREAD) Ciprofloxacin (CILOXAN)* (PERCOCET)* Tipranavir (APTIVUS) Erythromycin* Propoxyphene (DARVON)* Zalcitabine (HIVID) Ofloxacin (OCUFLOX)* Propoxyphene/Acetaminophen Zidovudine (RETROVIR)* (DARVOCET-N)* Otic Antimicrobials (ULTRAM)* Fusion Inhibitor Ciprofloxacin/dexamethasone Tramadol/Acetaminophen Enfuvirtide (FUZEON) (PA is required) (CIPRODEX) (ULTRACET)* Ciprofloxacin/hc (CIPRO HC)* Antituberculosis Agents Analgesics and Antipyretics, Ethambutol (MYAMBUTOL)* Topical Antimicrobials Miscellaneous Rifabutin (MYCOBUTIN)* Acetaminophen (TYLENOL)* Acyclovir (ZOVIRAX) Clindamycin (CLEOCIN-T)* Other Antivirals Clotrimazole/betamethasone Anti-Infectives Acyclovir (ZOVIRAX)* (LOTRISONE)* Cidofovir (VISTIDE) Erythromycin* Antifungal Antibiotics Famciclovir (FAMVIR) Ketoconazole (NIZORAL)* Amphotericin B (AMPHOCIN)* Fomivirsen (VITRAVENE) Metronidazole (METROCREAM*, Clotrimazole (MYCELEX)* Foscarnet (FOSCARVIR)* METROGEL) Fluconazole (DIFLUCAN)* Ganciclovir (CYTOVENE)* Nystatin* Itraconazole (SPORANOX)* Ribavirin (REBETOL, RIBASPHERE, Silvadene (SSD)*

1) BRAND-NAME DRUG indicated by CAPITAL. 2) Generic drugs indicated by lower case. 2 3) Product names in parenthesis are the brand names for the generic. 4) * indicates the generic equivalent is available. MICHIGAN DRUG ASSISTANCE PROGRAM

Terbinafine (LAMISIL AT) ADALAT) * Anxiolytics, Sedatives and Hypnotics Verapamil (VERELAN, COVERA-HS, (BUSPAR)* Other Antimicrobials ISOPTIN SR, CALAN, CALAN SR)* Zolpidem (AMBIEN, AMBIEN CR) Co-trimoxazole, TMP/SMX (BACTRIM / SEPTRA SS, DS)* Central Agonists Benzodiazepines Clindamycin (CLEOCIN)* Clonidine (CATAPRESS)* Alprazolam (XANAX)* Dapsone* (LONITEN)* Clonazepam (KLONOPIN)* Metronidazole (FLAGYL)* Diazepam (VALIUM)* Primaquine* Lipid Lowering Agents Lorazepam (ATIVAN)* Pyrimethamine (DARAPRIM) Atorvastatin (LIPITOR) Temazepam (RESTORIL)* Sulfadiazine* Cholestyramine (QUESTRAN)* Trimethoprim* Fenofibrate (TRICOR, LOFIBRA) Selective Serotonin Agonists Gemfibrozil (LOPID)* (IMITREX) Niacin (NIASPAN)* Interferon alfa-2b (INTRON-A) Pravastatin (PRAVACHOL) Skeletal Muscle Relaxants Peginterferon alfa-2a (PEGASYS) Baclofen (LIORESAL)* Peginterferon alfa-2b (PEG- Nitrates and Nitrites INTRON KIT ) Cyclobenzaprine (FLEXERIL)* Nitroglycerin sublingual tab, spray, cap* Tizanidine (ZANAFLEX)*

Cardiovasculars Diuretics Furosemide (LASIX)* patch (NICOTROL, Angiotensin II Receptor Antagonists Hydrochlorothiazide (HYDRODIURIL) * NICODERM)* Losartan (COZAAR) Hctz/triamterene (DYAZIDE, Nicotine nasal spray (NICOTROL NS) Losartan/hctz (HYZAAR) MAXZIDE) * () Valsartan (DIOVAN Valsartan/hctz (DIOVAN HCT) CNS Substance Abuse Agents Acamprosate (CAMPRAL) Angiotensin-Converting Enzyme Anticonvulsants Inhibitors Buprenorphine (SUBUTEX) Divalproex sodium (DEPAKOTE, Buprenorphine/naloxone (SUBOXONE) Benazepril (LOTENSIN)* DEPAKOTE ER) Enalapril (VASOTEC)* Gabapentin (NEURONTIN)* Enalapril/hctz (VASORETIC)* Levetiracetam (KEPPRA) Endocrine Lisinopril (PRINIVIL, ZESTRIL)* Phenytoin (DILANTIN)* Antidiabetic: Combinations Lisinopril/hctz (PRINZIDE, (TOPAMAX) ZESTORETIC)* Glyburide/metformin (GLUCOVANCE)* Quinapril (ACCUPRIL)* Antidepressants /metformin (AVANDAMET) Ramipril (ALTACE) Amitriptyline (ELAVIL)* Antidiabetic: Bigunanides (WELLBUTRIN SR* Beta-Adrenergic Blocking Agents WELLBUTRIN XL) Metformin (GLUCOPHAGE GLUCOPHAGE XL)* Atenolol (TENORMIN)* Citalopram (CELEXA)* Atenolol/chlorthalidone Doxepin* (TENORETIC)* Antidiabetic: Sulfonylureas Escitalopram (LEXAPRO) Glipizide (GLUCOTROL, XL) * Timolol (BLOCADREN)* Fluoxetine (PROZAC)* Metoprolol (LOPRESSOR*, TOPROL Glyburide (DIABETA, XL) (REMERON)* MICRONASE) * Propranolol (INDERAL, INDERAL (PAXIL*, PAXIL CR) LA)* Sertraline (ZOLOFT) Antidiabetic: Thiazolidinediones Venlafaxine (EFFEXOR, EFFEXOR XR) Pioglitazone (ACTOS) Calcium-Channel Blocking Agents Rosiglitazone (AVANDIA) Amlodipine (NORVASC) Antipsychotics (Atypical) Diltiazem (CARDIZEM, TAZTIA XT) * (ZYPREXA) Antidiabetic: Insulins NOVOLOG (all formulations) Felodipine (PLENDIL) * Quetiapine (SEROQUEL) NOVOLIN (all formulations) Nifedipine XL, ER (PROCARDIA, (RISPERDAL) NOVOLIN 70/30

1) BRAND-NAME DRUG indicated by CAPITAL. 2) Generic drugs indicated by lower case. 3 3) Product names in parenthesis are the brand names for the generic. 4) * indicates the generic equivalent is available. MICHIGAN DRUG ASSISTANCE PROGRAM

NOVOLOG MIX FLEXPEN Omeprazole (PRILOSEC) Leukotrene Modifier Insulin glargine (LANTUS) Histamine H2-Antagonists Montelukast (SINGULAIR) HUMULIN (all formulations) (PEPCID)* HUMALOG (all formulations) Nizatidine (AXID)* Nasal Corticosteroids (ZANTAC)* Beclomethasone (BECONASE AQ) Bone Metabolism Alendronate (FOSAMAX) Anticholinergics/Motility Urologicals Dicyclomine (BENTYL)* Estrogen and Estrogen Modifier Metoclopramide (REGLAN)* (DITROPAN*, Conjugated estrogens tablet, vaginal DITROPAN XL) cream (PREMARIN) Miscellaneous GI Tamsulosin (FLOMAX) Lactulose* Terazosin (HYTRIN)* Thyroid Agents Megestrol (MEGACE) Levothyroxine (LEVOXYL, Mesalamine, 5-ASA (ROWASA, Topical Agents SYNTHROID) * ASACOL) Topical Anti-inflammatory Agents Androgens Desonide (DESOWEN)* Methyltestosterone (TESTRED) * Blood Modifiers, Hydrocortisone 2.5% cream* Oxandrolone (OXANDRIN) Nutritionals, Electrolytes Triamcinolone cream, oint, lot* Testostosterone injection(DEPO- TESTOSTERONE, DELATESTRYL)* Anticoagulants/Antiplatelets Miscellaneous Dermatological Agent Testostosterone oral (ANDROXY)* Cilostazol (PLETAL)* (ALDARA) Testostosterone topical Clopidogrel (PLAVIX)* (ANDRODERM, ANDROGEL)* Warfarin (COUMADIN)* Ophthalmic Agents Timolol (TIMOPTIC, XE)* Corticosteroids Hematopoietic Agents Prednisone* Epoetin alfa (EPOGEN, PROCRIT) Other Filgrastim, G-CSF (NEUPOGEN) Gastrointestinal Vaccines Vitamines and K replacement Hepatitis B Vaccine Antiemetics Potassium chloride* Hepatitis A Vaccine Dronabinol (MARINOL)* Pneumococcal Vaccine (COMPAZINE)* Respiratory Influenza Vaccine Promethazine (PHENERGAN)* Cough and Cold Products Trimethobenzamide (TIGAN)* Antihistamines Guaifenesin* (ZYRTEC) Guaifenesin/phenylephrine* Antidiarrhea Agents Cetirizine/ (ZYRTEC-D) Diphenoxylate/atropine (LONOX, Diphenhydramine ()* Other LOMOTIL)* Fexofenadine (ALLEGRA)* Aldesleukin (PROLEUKIN) * (IMODIUM)* Fexofenadine/pseudoephedrine Epinephrine (EPIPEN) Opium tincture* (ALLEGRA-D) Hydroxyurea* Loratadine (CLARITIN)* Leucovorin, Folinic Acid* Digestants Loratadine/pseudoephedrine Hydroxyurea (HYDREA, DROXIA)* Pancrelipase (PANCREASE, (CLARITIN-D)* LIPRAM-UL20, ULTRASE, Acrivastine/pseudophedrine (SEMPREX-D) Dental Products PANGESTYME, VIOKASE) PREVIDENT-5000 Bronchodilators Proton-Pump Inhibitors Albuterol (PROVENTIL)* Devices Amoxicillin/clarithromycin/ Ipratropium (ATROVENT)* Insulin syringe (PREVPAC) Lancets Lansoprazole (PREVACID) Inhaled Corticosteroids Teststrip Beclomethasone (QVAR, BECLOVENT)

1) BRAND-NAME DRUG indicated by CAPITAL. 2) Generic drugs indicated by lower case. 4 3) Product names in parenthesis are the brand names for the generic. 4) * indicates the generic equivalent is available. MICHIGAN DRUG ASSISTANCE PROGRAM

BACTRIM SS, 1,3 D Beclomethasone, 4 A BECLOVENT, 4 Dapsone, 1, 3 Abacavir, 1, 2 BECONASE AQ, 4 DARAPRIM, 1, 3 Abacavir/lamivudine, 1, 2 Benazepril, 3 DARVOCET-N, 2 Abacavir/lamivudine/zidovudine, 1, 2 BENTYL, 4 DARVON, 2 Acamprosate, 3 BIAXIN, 1, 2 DELATESTRYL, 4 ACCUPRIL, 3 BIAXIN XL, 2 Delavirdine, 1, 2 Acetaminophen, 2 BICILLIN LA, 2 DEMEROL, 2 Acrivastine/pseudophedrine, 4 Buprenorphine, 3 DEPAKOTE, 3 ACTOS, 3 Buprenorphine/naloxone, 3 DEPAKOTE ER, 3 Acyclovir, 1, 2 Bupropion, 3 DEPO-TESTOSTERONE, 4 ADALAT, 3 BUSPAR, 3 Desonide, 4 AGENERASE, 1, 2 DESOWEN, 4 Albuterol, 4 C DIABETA, 3 ALDARA, 4 Diazepam, 3 Aldesleukin, 4 CAMPRAL, 3 Diclofenac, 2 Alendronate, 4 CARDIZEM, 3 Diclofenac/misoprostol, 2 ALLEGRA, 4 CATAPRESS, 3 Dicyclomine, 4 ALLEGRA-D, 4 CELEBREX, 2 Didanosine, 1, 2 Alprazolam, 3 Celecoxib, 2 DIFLUCAN, 1, 2 ALTACE, 3 CELEXA, 3 DILANTIN, 3 AMBIEN, 3 Cephalexin, 2 DILAUDID, 2 AMBIEN CR, 3 Cetirizine, 4 Diltiazem, 3 Amitriptyline, 3 Cetirizine/pseudoephedrine, 4 DIOVAN, 3 Amlodipine, 3 Cholestyramine, 3 DIOVAN HCT, 3 Amoxicillin, 2, 4 Cidofovir, 2 Diphenhydramine, 4 Amoxicillin/clarithromycin/lansoprazole, 4 Cilostazol, 4 Diphenoxylate/atropine, 4 Amoxicllin/clavulanic acid, 2 CILOXAN, 2 DITROPAN, 4 AMOXIL, 2 CIPRO, 1, 2 DITROPAN XL, 4 AMPHOCIN, 1, 2 CIPRO HC, 2 divalproex sodium, 3 Amphotericin B, 1, 2 CIPRODEX, 2 Doxepin, 3 Amprenavir, 1, 2 Ciprofloxacin, 1, 2 Doxycycline, 2 ANDRODERM, 4 Ciprofloxacin/dexamethasone, 2 Dronabinol, 4 ANDROGEL, 4 Ciprofloxacin/hc, 2 DROXIA, 4 ANDROXY, 4 Citalopram, 3 DURAGESIC, 2 Acetaminophen /caffeine/butabital, 2 Clarithromycin, 1, 2 DYAZIDE, 3 Acetaminophen /caffeine/butabital/codeine, 2 CLARITIN, 4 APTIVUS, 1, 2 CLARITIN-D, 4 E ARTHROTEC, 2 CLEOCIN, 1, 3 Asa/caffeine/butabital, 2 CLEOCIN-T, 2 Efavirenz, 1, 2 Asa/caffeine/butabital/codeine, 2 Clindamycin, 1, 2, 3 EFFEXOR, 3 Asa/codeine, 2 Clonazepam, 3 EFFEXOR XR, 3 ASACOL, 4 Clonidine, 3 ELAVIL, 3 Atazanavir, 1, 2 Clopidogrel, 4 Emtricitabine, 1, 2 Atenolol, 3 Clotrimazole, 1, 2 Emtricitabine/tenofovir, 1, 2 Atenolol/chlorthalidone, 3 Clotrimazole/betamethasone, 2 EMTRIVA, 1, 2 ATIVAN, 3 Codeine, 2 Enalapril, 3 Atorvastatin, 3 Codeine/Acetaminophen , 2 Enalapril/hctz, 3 Atovaquone, 1, 2 COMBIVIR, 1, 2 Enfuvirtide, 1, 2 ATROVENT, 4 COMPAZINE, 4 Epinephrine, 4 AUGMENTIN, 2 Conjugated estrogens tablet, vaginal cream, 4 EPIPEN, 4 AVANDAMET, 3 COPEGUS, 1, 2 EPIVIR, 1, 2 AVANDIA, 3 Co-trimoxazole, 1, 3 Epoetin alfa, 4 AXID, 4 COUMADIN, 4 EPOGEN, 4 Azithromycin, 1, 2 COVERA-HS, 3 EPZICOM, 1, 2 COZAAR, 3 Erythromycin, 2 B Escitalopram, 3 CRIXIVAN, 1, 2 Ethambutol, 1, 2 Baclofen, 3 Cyclobenzaprine, 3 CYTOVENE, 1, 2 BACTRIM DS, 1,3

1) BRAND-NAME DRUG indicated by CAPITAL. 2) Generic drugs indicated by lower case. 5 3) Product names in parenthesis are the brand names for the generic. 4) * indicates the generic equivalent is available. MICHIGAN DRUG ASSISTANCE PROGRAM

F HYTRIN, 4 Lorazepam, 3 HYZAAR, 3 LORTAB, 2 Famciclovir, 1, 2 Losartan, 3 Famotidine, 4 Losartan/hctz, 3 FAMVIR, 1, 2 I LOTENSIN, 3 Felodipine, 3 Ibuprofen, 2 LOTRISONE, 2 Fenofibrate, 3 Imiquimod, 4 Fentanyl, 2 IMITREX, 3 M Filgrastim, 4 IMODIUM, 4 FIORICET, 2 INDERAL, 3 MARINOL, 4 FIORICET/CODEINE, 2 INDERAL LA, 3 MAXZIDE, 3 FIORINAL, 2 Indinavir, 1, 2 MEGACE, 4 FIORINAL/CODEINE, 2 Influenza Vaccine, 1, 4 Megestrol, 4 FLAGYL, 3 Insulin glargine, 4 Meperidine, 2 FLEXERIL, 3 Insulin syringe, 4 MEPRON, 1, 2 FLOMAX, 4 Interferon alfa-2b, 1, 3 Mesalamine, 4 FLOXIN, 2 INTRON-A, 1, 3 Metformin, 3 Fluconazole, 1, 2 INVIRASE, 1, 2 Methadone, 2 FLUMADINE, 2 Ipratropium, 4 Methyltestosterone, 4 Fluoxetine, 3 Itraconazole, 1, 2 Metoclopramide, 4 Folinic acid, 1, 4 Metoprolol, 3 Fomivirsen, 1, 2 METROCREAM, 2 FORTOVASE, 1, 2 K METROGEL, 2 FOSAMAX, 4 KALETRA, 1, 2 Metronidazole, 2, 3 Fosamprenavir, 1, 2 KEFLEX, 2 MICRONASE, 3 Foscarnet, 1, 2 KEPPRA, 3 Minoxidil, 3 FOSCARVIR, 1, 2 Ketoconazole, 1, 2 Mirtazapine, 3 Furosemide, 3 KLONOPIN, 3 Montelukast, 4 FUZEON, 1, 2 Morphine, 2 L MOTRIN, 2 G MS-CONTIN, 2 Lactulose, 4 MYAMBUTOL, 1, 2 G-CSF, 4 LAMISIL, 1, 2 MYCELEX, 1, 2 Gabapentin, 3 LAMISIL AT, 2 MYCOBUTIN, 1, 2 Ganciclovir, 1, 2 Lamivudine, 1, 2 Gemfibrozil, 3 Lamivudine/zidovudine, 1, 2 N Glipizide, 3 Lancets, 4 GLUCOPHAGE, 3 Lansoprazole, 4 Nabumetone, 2 GLUCOPHAGE XL, 3 LANTUS, 4 Nelfinavir, 1, 2 GLUCOTROL, 3 Leucovorin, 1, 4 NEUPOGEN, 4 GLUCOTROL, XL, 3 LEVAQUIN, 1, 2 NEURONTIN, 3 GLUCOVANCE, 3 Levetiracetam, 3 Nevirapine, 1, 2 Glyburide, 3 Levofloxicin, 1, 2 Niacin, 3 Glyburide/metformin, 3 Levothyroxine, 4 NIASPAN, 3 Guaifenesin, 4 LEVOXYL, 4 NICODERM, 3 Guaifenesin/phenylephrine, 4 LEXAPRO, 3 NICORETTE, 3 LEXIVA, 1, 2 Nicotine gum, 3 H LIORESAL, 3 Nicotine nasal spray, 3 LIPITOR, 3 , 3 Hctz/triamterene, 3 LIPRAM-UL20, 4 NICOTROL, 3 Hepatitis A Vaccine, 1, 4 Lisinopril, 3 NICOTROL NS, 3 Hepatitis B Vaccine, 1, 4 Lisinopril/hctz, 3 Nifedipine ER, 3 HIVID, 1, 2 LOFIBRA, 3 Nifedipine XL, 3 HUMALOG, 4 LOMOTIL, 4 Nitroglycerin sublingual tab, spray, cap, 3 HUMATIN, 1, 2 LONITEN, 3 Nizatidine, 4 HUMULIN, 4 LONOX, 4 NIZORAL, 1, 2 HYDREA, 4 Loperamide, 4 NORVASC, 3 Hydrochlorothiazide, 3 LOPID, 3 NORVIR, 1, 2 Hydrocodone/Acetaminophen , 2 Lopinavir/ritonavir, 1, 2 NOVOLIN, 3 Hydrocortisone 2.5% cream, 4 LOPRESSOR, 3 NOVOLIN 70/30, 3 Hydromorphone, 2 Loratadine, 4 NOVOLOG, 3 Hydroxyurea, 4 Loratadine/pseudoephedrine, 4 NOVOLOG MIX FLEXPEN, 3

1) BRAND-NAME DRUG indicated by CAPITAL. 2) Generic drugs indicated by lower case. 6 3) Product names in parenthesis are the brand names for the generic. 4) * indicates the generic equivalent is available. MICHIGAN DRUG ASSISTANCE PROGRAM

Nystatin, 1, 2 PROVENTIL, 4 TENORMIN, 3 PROZAC, 3 Terazosin, 4 Pyrimethamine, 1, 3 Terbinafine, 1, 2 O Testostosterone injection, 4 OCUFLOX, 2 Q Testostosterone oral, 4 Ofloxacin, 2 Testostosterone topical, 4 Olanzapine, 3 QUESTRAN, 3 TESTRED, 4 Omeprazole, 4 Quetiapine, 3 Teststrip, 4 Opium tincture, 4 Quinapril, 3 TIGAN, 4 ORAMORPH SR, 2 QVAR, 4 Timolol, 3, 4 Oxybutynin, 4 TIMOPTIC XE, 4 Oxycodone, 2 Tipranavir, 1, 2 Oxycodone/Acetaminophen , 2 R Tizanidine, 3 OXYCONTIN, 2 Ramipril, 3 TMP/SMZ ,1,3 OXY-IR, 2 Ranitidine, 4 TOPROL XL, 3 REBETOL, 1, 2 Tramadol, 2 P REGLAN, 4 Tramadol/Acetaminophen , 2 RELAFEN, 2 Triamcinolone cream, oint, lot, 4 PANCREASE, 4 REMERON, 3 TRICOR, 3 Pancrelipase, 4 RESCRIPTOR, 1, 2 Trimethobenzamide, 4 PANGESTYME, 4 RESTORIL, 3 Trimethoprim, 1, 3 Paromomycin, 1, 2 RETROVIR, 1, 2 TRIMOX, 2 Paroxetine, 3 REYATAZ, 1, 2 TRIZIVIR, 1, 2 PAXIL, 3 RIBASPHERE, 1, 2 TRUVADA, 1, 2 PAXIL CR, 3 Ribavirin, 1, 2 TYLENOL, 2 PEGASYS, 1, 3 Rifabutin, 1, 2 TYLENOL #2, 2 Peginterferon alfa-2a, 1, 3 Rimantadine, 2 TYLENOL #3, 2 Peginterferon alfa-2b, 1, 3 RISPERDAL, 3 TYLENOL #4, 2 PEG-INTRON KIT, 1, 3 Risperidone, 3 Penicillin, 2 Ritonavir, 1, 2 U PENTAM, 1, 2 Rosiglitazone, 3 Pentamidine, 1, 2 Rosiglitazone/metformin, 3 ULTRACET, 2 PEN-VK, 2 ROWASA, 4 ULTRAM, 2 PEPCID, 4 ROXANOL, 2 ULTRASE, 4 PERCOCET, 2 PHENERGAN, 4 V Phenytoin, 3 S Pioglitazone, 3 Saquinavir, 1, 2 Valacyclovir, 1, 2 PLAVIX, 4 SEMPREX-D, 4 VALCYTE, 1, 2 PLENDIL, 3 SEPTRA DS, 1,3 Valganciclovir, 1, 2 PLETAL, 4 SEPTRA SS, 1,3 VALIUM, 3 Pneumococcal Vaccine, 1, 4 SEROQUEL, 3 Valsartan, 3 Potassium chloride, 4 Sertraline, 3 Valsartan/hctz, 3 PRAVACHOL, 3 Silvadene, 2 VALTREX, 1, 2 Pravastatin, 3 SINGULAIR, 4 VASORETIC, 3 Prednisone, 4 Sodium fluoride, 4 VASOTEC, 3 PREMARIN, 4 SPORANOX, 1, 2 Venlafaxine, 3 PREVACID, 4 SSD, 2 Verapamil, 3 PREVIDENT, 4 Stavudine, 1, 2 VERELAN, 3 PREVPAC, 4 SUBOXONE, 3 VFEND, 1, 2 PRILOSEC, 4 SUBUTEX, 3 VICODIN, 2 Primaquine, 1, 3 Sulfadiazine, 1, 3 VICODIN ES, 2 PRINIVIL, 3 SUSTIVA, 1, 2 VIDEX, 1, 2 PRINZIDE, 3 SYNTHROID, 4 VIDEX EC, 1, 2 PROCARDIA, 3 VIOKASE, 4 Prochlorperazine, 4 VIRACEPT, 1, 2 PROCRIT, 4 T VIRAMUNE, 1, 2 PROLEUKIN, 4 Tamsulosin, 4 VIREAD, 1, 2 Promethazine, 4 TAZTIA XT, 3 VISTIDE, 1, 2 Propoxyphene, 2 Temazepam, 3 VITRAVENE, 1, 2 Propoxyphene/Acetaminophen , 2 Tenofovir, 1, 2 VOLTEREN, 2 Propranolol, 3 TENORETIC, 3 Voriconazole, 1, 2

1) BRAND-NAME DRUG indicated by CAPITAL. 2) Generic drugs indicated by lower case. 7 3) Product names in parenthesis are the brand names for the generic. 4) * indicates the generic equivalent is available. MICHIGAN DRUG ASSISTANCE PROGRAM

W Z ZITHROMAX, 1, 2 ZOLOFT, 3 Warfarin, 4 Zalcitabine, 1, 2 Zolpidem, 3 WELLBUTRIN SR, 3 ZANAFLEX, 3 ZOVIRAX, 1, 2 WELLBUTRIN XL, 3 ZANTAC, 4 ZYPREXA, 3 ZERIT, 1, 2 ZYRTEC, 4 ZESTORETIC, 3 ZYRTEC-D, 4 X ZESTRIL, 3 XANAX, 3 ZIAGEN, 1, 2 5-ASA, 4 Zidovudine, 1, 2

1) BRAND-NAME DRUG indicated by CAPITAL. 2) Generic drugs indicated by lower case. 8 3) Product names in parenthesis are the brand names for the generic. 4) * indicates the generic equivalent is available.