Colorado Medicaid January 7, 2020 Meeting MANUFACTURER BRAND NAME THERAPEUTIC CLASS ABBVIE US LLC DUOPA (MISCELL) ANTIPARKINSON'S AGENTS ABBVIE US LLC NIASPAN (ORAL) LIPOTROPICS, OTHER ABBVIE US LLC TRICOR (ORAL) LIPOTROPICS, OTHER ABBVIE US LLC TRILIPIX (ORAL) LIPOTROPICS, OTHER ACADIA PHARMACE NUPLAZID CAPSULE (ORAL) ANTIPSYCHOTICS ACADIA PHARMACE NUPLAZID TABLET (ORAL) ANTIPSYCHOTICS ACORDA THERAPEU AMPYRA (ORAL) MULTIPLE SCLEROSIS AGENTS ACORDA THERAPEU INBRIJA (INHALATION) ANTIPARKINSON'S AGENTS ACTAVIS U.S. BR NAMENDA XR (ORAL) ALZHEIMER'S AGENTS ACTAVIS U.S. BR SAPHRIS (SUBLINGUAL) ANTIPSYCHOTICS ACTAVIS U.S. BR VRAYLAR (ORAL) ANTIPSYCHOTICS ADAMAS PHARMA, GOCOVRI (ORAL) ANTIPARKINSON'S AGENTS AERIE PHARMACEU RHOPRESSA (OPHTHALMIC) OPHTHALMICS, GLAUCOMA AGENTS AERIE PHARMACEU ROCKLATAN (OPHTHALMIC) OPHTHALMICS, GLAUCOMA AGENTS AKORN INC. COSOPT PF (OPHTHALMIC) OPHTHALMICS, GLAUCOMA AGENTS AKORN INC. ZIOPTAN (OPHTHALMIC) OPHTHALMICS, GLAUCOMA AGENTS ALCON (P.R.) MAXIDEX (OPHTHALMIC) OPHTHALMICS, ANTI-INFLAMMATORIES ALCON LABS. ALOMIDE (OPHTHALMIC) OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS ALCON LABS. AZOPT (OPHTHALMIC) OPHTHALMICS, GLAUCOMA AGENTS ALCON LABS. BETOPTIC S (OPHTHALMIC) OPHTHALMICS, GLAUCOMA AGENTS ALCON LABS. DUREZOL (OPHTHALMIC) OPHTHALMICS, ANTI-INFLAMMATORIES ALCON LABS. FLAREX (OPHTHALMIC) OPHTHALMICS, ANTI-INFLAMMATORIES ALCON LABS. ILEVRO (OPHTHALMIC) OPHTHALMICS, ANTI-INFLAMMATORIES ALCON LABS. NEVANAC (OPHTHALMIC) OPHTHALMICS, ANTI-INFLAMMATORIES ALCON LABS. PATADAY (OPHTHALMIC) OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS ALCON LABS. PATANASE (NASAL) INTRANASAL RHINITIS AGENTS ALCON LABS. PAZEO (OPHTHALMIC) OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS ALCON LABS. SIMBRINZA (OPHTHALMIC) OPHTHALMICS, GLAUCOMA AGENTS ALCON LABS. TRAVATAN Z 2.5 ML (OPHTHALMIC) OPHTHALMICS, GLAUCOMA AGENTS ALCON LABS. TRAVATAN Z 5 ML (OPHTHALMIC) OPHTHALMICS, GLAUCOMA AGENTS ALLERGAN INC. ACUVAIL (OPHTHALMIC) OPHTHALMICS, ANTI-INFLAMMATORIES ALLERGAN INC. ALOCRIL (OPHTHALMIC) OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS ALLERGAN INC. ALPHAGAN P 0.1% (OPHTHALMIC) OPHTHALMICS, GLAUCOMA AGENTS ALLERGAN INC. COMBIGAN (OPHTHALMIC) OPHTHALMICS, GLAUCOMA AGENTS ALLERGAN INC. CORDRAN TAPE (TOPICAL) STEROIDS, TOPICAL MEDIUM ALLERGAN INC. FML FORTE (OPHTHALMIC) OPHTHALMICS, ANTI-INFLAMMATORIES ALLERGAN INC. FML S.O.P. (OPHTHALMIC) OPHTHALMICS, ANTI-INFLAMMATORIES ALLERGAN INC. LASTACAFT (OPHTHALMIC) OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS ALLERGAN INC. LUMIGAN 2.5ML (OPHTHALMIC) OPHTHALMICS, GLAUCOMA AGENTS ALLERGAN INC. LUMIGAN 5ML (OPHTHALMIC) OPHTHALMICS, GLAUCOMA AGENTS ALLERGAN INC. LUMIGAN 7.5ML (OPHTHALMIC) OPHTHALMICS, GLAUCOMA AGENTS ALLERGAN INC. NAMZARIC (ORAL) ALZHEIMER'S AGENTS ALLERGAN INC. NAMZARIC DOSE PACK (ORAL) ALZHEIMER'S AGENTS ALLERGAN INC. PRED MILD (OPHTHALMIC) OPHTHALMICS, ANTI-INFLAMMATORIES AMARIN PHARMA I VASCEPA (ORAL) LIPOTROPICS, OTHER AMGEN AIMOVIG (SUBCUTANEOUS) ANTIMIGRAINE AGENTS, OTHER ASTRAZENECA SEROQUEL XR (ORAL) ANTIPSYCHOTICS BAUSCH & LOMB ALREX (OPHTHALMIC) OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS BAUSCH & LOMB BEPREVE (OPHTHALMIC) OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS BAUSCH & LOMB ISTALOL (OPHTHALMIC) OPHTHALMICS, GLAUCOMA AGENTS BAUSCH & LOMB LOTEMAX DROPS (OPHTHALMIC) OPHTHALMICS, ANTI-INFLAMMATORIES BAUSCH & LOMB LOTEMAX OINTMENT (OPHTHALMIC) OPHTHALMICS, ANTI-INFLAMMATORIES BAUSCH & LOMB PROLENSA (OPHTHALMIC) OPHTHALMICS, ANTI-INFLAMMATORIES BAYER,PHARM DIV BETASERON KIT (SUBCUTANE.) MULTIPLE SCLEROSIS AGENTS BAYER,PHARM DIV BETASERON VIAL (SUBCUTANE.) MULTIPLE SCLEROSIS AGENTS BIO PRODUCTS LA GAMMAPLEX (INTRAVEN) IMMUNE GLOBULINS BIOGEN-IDEC AVONEX (INTRAMUSC.) MULTIPLE SCLEROSIS AGENTS BIOGEN-IDEC AVONEX PEN (INTRAMUSC.) MULTIPLE SCLEROSIS AGENTS BIOGEN-IDEC PLEGRIDY (SUBCUTANE.) MULTIPLE SCLEROSIS AGENTS BIOGEN-IDEC TECFIDERA (ORAL) MULTIPLE SCLEROSIS AGENTS BIOGEN-IDEC TECFIDERA STARTER PACK (ORAL) MULTIPLE SCLEROSIS AGENTS BIOGEN-IDEC VUMERITY (ORAL) MULTIPLE SCLEROSIS AGENTS BIOTEST PHARMAC BIVIGAM (INTRAVEN) IMMUNE GLOBULINS BOEHRINGER ING. MIRAPEX ER (ORAL) ANTIPARKINSON'S AGENTS CHIESI ZYFLO (ORAL) LEUKOTRIENE MODIFIERS COVIS PHARMA OMNARIS (NASAL) INTRANASAL RHINITIS AGENTS COVIS PHARMA ZETONNA (NASAL) INTRANASAL RHINITIS AGENTS COVIS PHARMACEU ALTOPREV (ORAL) LIPOTROPICS, STATINS CSL BEHRING LLC HIZENTRA (SUBCUT.) IMMUNE GLOBULINS CSL BEHRING LLC PRIVIGEN (INTRAVEN) IMMUNE GLOBULINS DAIICHI SANKYO, WELCHOL POWDER PACK (ORAL) LIPOTROPICS, OTHER DAIICHI SANKYO, WELCHOL TABLET (ORAL) LIPOTROPICS, OTHER January 2020 Magellan Rx Management Colorado Medicaid January 7, 2020 Meeting MANUFACTURER BRAND NAME THERAPEUTIC CLASS ELI LILLY & CO. BAQSIMI (NASAL) GLUCAGON AGENTS ELI LILLY & CO. BASAGLAR KWIKPEN (SUBCUTANE.) HYPOGLYCEMICS, INSULIN AND RELATED AGENTS ELI LILLY & CO. EMGALITY PEN (SUBCUTANEOUS) ANTIMIGRAINE AGENTS, OTHER ELI LILLY & CO. EMGALITY SYRINGE 100 MG (SUBCUTANEOUS) ANTIMIGRAINE AGENTS, OTHER ELI LILLY & CO. EMGALITY SYRINGE 120 MG (SUBCUTANEOUS) ANTIMIGRAINE AGENTS, OTHER ELI LILLY & CO. HUMALOG 200 U/ML PEN (SUBCUTANE.) HYPOGLYCEMICS, INSULIN AND RELATED AGENTS ELI LILLY & CO. HUMALOG CARTRIDGE (SUBCUTANE.) HYPOGLYCEMICS, INSULIN AND RELATED AGENTS ELI LILLY & CO. HUMALOG JUNIOR KWIKPEN (SUBCUTANE.) HYPOGLYCEMICS, INSULIN AND RELATED AGENTS ELI LILLY & CO. HUMALOG MIX PEN (SUBCUTANE.) HYPOGLYCEMICS, INSULIN AND RELATED AGENTS ELI LILLY & CO. HUMALOG MIX VIAL (SUBCUTANE.) HYPOGLYCEMICS, INSULIN AND RELATED AGENTS ELI LILLY & CO. HUMALOG PEN (SUBCUTANE.) HYPOGLYCEMICS, INSULIN AND RELATED AGENTS ELI LILLY & CO. HUMALOG VIAL (SUBCUTANE.) HYPOGLYCEMICS, INSULIN AND RELATED AGENTS ELI LILLY & CO. HUMATROPE CARTRIDGE (INJECTION) GROWTH HORMONE ELI LILLY & CO. HUMATROPE VIAL (INJECTION) GROWTH HORMONE ELI LILLY & CO. HUMULIN 500 U/M PEN (SUBCUTANE.) HYPOGLYCEMICS, INSULIN AND RELATED AGENTS ELI LILLY & CO. HUMULIN 500 U/M VIAL (SUBCUTANE.) HYPOGLYCEMICS, INSULIN AND RELATED AGENTS ELI LILLY & CO. HUMULIN 70/30 PEN OTC (SUBCUTANE.) HYPOGLYCEMICS, INSULIN AND RELATED AGENTS ELI LILLY & CO. HUMULIN 70/30 VIAL OTC (SUBCUTANE.) HYPOGLYCEMICS, INSULIN AND RELATED AGENTS ELI LILLY & CO. HUMULIN PEN OTC (SUBCUTANE.) HYPOGLYCEMICS, INSULIN AND RELATED AGENTS ELI LILLY & CO. HUMULIN VIAL OTC (SUBCUTANE.) HYPOGLYCEMICS, INSULIN AND RELATED AGENTS EMD SERONO, INC MAVENCLAD (ORAL) MULTIPLE SCLEROSIS AGENTS EMD SERONO, INC REBIF (SUBCUTANE.) MULTIPLE SCLEROSIS AGENTS EMD SERONO, INC REBIF REBIDOSE PEN INJCTR (SUBCUTANE.) MULTIPLE SCLEROSIS AGENTS EMD SERONO, INC SAIZEN CARTRIDGE (INJECTION) GROWTH HORMONE EMD SERONO, INC SAIZEN VIAL (INJECTION) GROWTH HORMONE EMD SERONO, INC SEROSTIM VIAL (INJECTION) GROWTH HORMONE EMD SERONO, INC ZORBTIVE VIAL (INJECTION) GROWTH HORMONE EPI HEALTH LLC CLODERM (TOPICAL) STEROIDS, TOPICAL MEDIUM FERRING PH INC ZOMACTON VIAL (INJECTION) GROWTH HORMONE GALDERMA LABORA CAPEX SHAMPOO (TOPICAL) STEROIDS, TOPICAL LOW GENENTECH, INC. NUTROPIN AQ PEN (INJECTION) GROWTH HORMONE GLAXOSMITHKLINE BECONASE AQ (NASAL) INTRANASAL RHINITIS AGENTS GLAXOSMITHKLINE LOVAZA (ORAL) LIPOTROPICS, OTHER GRIFOLS FLEBOGAMMA DIF (INTRAVEN) IMMUNE GLOBULINS GRIFOLS THERAPE GAMUNEX-C (INJECTION) IMMUNE GLOBULINS GRIFOLS THERAPE XEMBIFY (SUBCUTANEOUS) IMMUNE GLOBULINS GSK CONSUMER HE FLONASE (FUROATE) OTC (NASAL) INTRANASAL RHINITIS AGENTS GSK CONSUMER HE FLONASE (PROPIONATE) OTC (NASAL) INTRANASAL RHINITIS AGENTS HILL DERM DERMA-SMOOTHE-FS (TOPICAL) STEROIDS, TOPICAL LOW IMPAX PHARMACEU RYTARY (ORAL) ANTIPARKINSON'S AGENTS INTERCEPT PHARM OCALIVA (ORAL) BILE SALTS JAZZ PHARMACEUT FAZACLO (ORAL) ANTIPSYCHOTICS JAZZ PHARMACEUT VERSACLOZ (ORAL) ANTIPSYCHOTICS KALA PHARMACEUT INVELTYS (OPHTHALMIC) OPHTHALMICS, ANTI-INFLAMMATORIES KEDRION BIOPHAR GAMMAKED (INTRAVEN) IMMUNE GLOBULINS KEY THERAPEUTIC TRIGLIDE (ORAL) LIPOTROPICS, OTHER KOWA PHARMACEUT LIVALO (ORAL) LIPOTROPICS, STATINS KYOWA KIRIN, IN NOURIANZ (ORAL) ANTIPARKINSON'S AGENTS LEO PHARMA INC. DESONATE GEL (TOPICAL) STEROIDS, TOPICAL LOW MANCHESTER PHAR CHOLBAM (ORAL) BILE SALTS MANNKIND CORPOR AFREZZA CARTRIDGE (INHALATION) HYPOGLYCEMICS, INSULIN AND RELATED AGENTS MAYNE PHARMA IN LEXETTE (TOPICAL) STEROIDS, TOPICAL VERY HIGH MEDA PHARMACEUT DYMISTA (NASAL) INTRANASAL RHINITIS AGENTS MEDA PHARMACEUT EDLUAR (SUBLINGUAL) SEDATIVE HYPNOTICS MEDICURE INTERN ZYPITAMAG (ORAL) LIPOTROPICS, STATINS MEDIMETRIKS PHA BESER KIT (TOPICAL) STEROIDS, TOPICAL MEDIUM MEDIMETRIKS PHA CLODAN KIT (TOPICAL) STEROIDS, TOPICAL VERY HIGH MEDIMETRIKS PHA SYNALAR CREAM KIT (TOPICAL) STEROIDS, TOPICAL MEDIUM MEDIMETRIKS PHA SYNALAR OINTMENT KIT (TOPICAL) STEROIDS, TOPICAL MEDIUM MEDIMETRIKS PHA SYNALAR TS KIT (TOPICAL) STEROIDS, TOPICAL MEDIUM MEDIMETRIKS PHA TOVET KIT (TOPICAL) STEROIDS, TOPICAL VERY HIGH MERCK SHARP & D BELSOMRA (ORAL) SEDATIVE HYPNOTICS MERCK SHARP & D NASONEX (NASAL) INTRANASAL RHINITIS AGENTS MERCK/SCHERING VYTORIN (ORAL) LIPOTROPICS, STATINS MISSION PHARM. TEXACORT (TOPICAL) STEROIDS, TOPICAL LOW NOVARTIS EXELON (TRANSDERM.) ALZHEIMER'S AGENTS NOVARTIS EXTAVIA KIT (SUBCUTANE.) MULTIPLE SCLEROSIS AGENTS NOVARTIS EXTAVIA VIAL (SUBCUTANE.) MULTIPLE SCLEROSIS AGENTS NOVARTIS GILENYA (ORAL) MULTIPLE SCLEROSIS AGENTS NOVARTIS LESCOL XL (ORAL) LIPOTROPICS, STATINS NOVARTIS MAYZENT DOSE PACK (ORAL) MULTIPLE SCLEROSIS AGENTS NOVARTIS MAYZENT TABLET (ORAL) MULTIPLE SCLEROSIS AGENTS January 2020 Magellan Rx Management Colorado Medicaid January 7, 2020 Meeting MANUFACTURER BRAND NAME THERAPEUTIC CLASS NOVO NORDISK FIASP FLEXTOUCH PEN (SUBCUTANE.) HYPOGLYCEMICS, INSULIN AND RELATED AGENTS NOVO NORDISK FIASP PENFILL (SUBCUT) HYPOGLYCEMICS, INSULIN