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Pharmacy | PDLYour 2023 Prescription Drug ListAdvantage 4-TierEffective January 1, 2023This Prescription Drug List (PDL) is accurate as of January 1, 2023 and is subject to change after this date. This PDL applies to members of our UnitedHealthcare, Neighborhood Health Plan, UnitedHealthcare Freedom Plans, River Valley, All Savers and Oxford medical plans with a pharmacy benefit subject to the Advantage 4-Tier PDL. Your estimated coverage and copayment/coinsurance may vary based on the benefit plan you choose and the effective date of the plan.

Table of contentsUnderstanding your Prescription Drug List (PDL) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Medication tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Reading your PDL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Analgesics Drugs for Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Drugs for Pain and Inflammation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Anti-Addiction / Substance Abuse Treatment Agents. . . . . . . . . . . . . . . . . . . . . . . . 10Antibacterials Drugs for Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Anticoagulants Drugs to Treat or Prevent Blood Clots. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Anticonvulsants Drugs for Seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Antidementia Agents Drugs for Alzheimer’s Disease and Dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Antidepressants Drugs for Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Antiemetics Drugs for Nausea and Vomiting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Antifungals Drugs for Fungal Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Antigout Agents Drugs for Gout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Antimigraine Agents Drugs for Migraines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Antineoplastics Drugs for Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Antiparasitics Drugs for Parasitic Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Antiparkinson Agents Drugs for Parkinson’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Antiplatelets Drugs for Heart Attack and Stroke Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Antipsychotics Drugs for Mood Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Antivirals Drugs for Viral Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Anxiolytics Drugs for Anxiety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Bipolar Agents Drugs for Mood Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Cardiovascular Agents Drugs for Heart and Circulation Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Central Nervous System Agents Drugs for Attention Deficit Disorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Drugs for Multiple Sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Dental and Oral Agents Drugs for Mouth and Throat Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202

Dermatological Agents Drugs for Skin Conditions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Diabetes Glucose Monitoring and Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Diabetes Insulin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Diabetes Non-Insulin Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Drugs for Blood Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Drugs for Sexual Dysfunction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Electrolytes / Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Gastrointestinal Agents Drugs for Acid Reflux and Ulcer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Drugs for Bowel, Intestine and Stomach Conditions . . . . . . . . . . . . . . . . . . . . . . . 28Genetic or Enzyme Disorder Drugs for Replacement, Modification, Treatment . . . . . . . . . . . . . . . . . . . . . . . . . 29Genitourinary Agents Drugs for Bladder, Genital and Kidney Conditions. . . . . . . . . . . . . . . . . . . . . . . . . 29Drugs for Prostate Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Hormonal Agents Hormone Replacement and Birth Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Oral Steroids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Testosterone Replacement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Thyroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Immunological Agents Drugs for Immune System Stimulation or Suppression. . . . . . . . . . . . . . . . . . . . . 33Infertility Agents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35Inflammatory Bowel Disease Agents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35Metabolic Bone Disease Agents Drugs for Osteoporosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35Ophthalmic Agents Drugs for Eye Allergy, Infection and Inflammation . . . . . . . . . . . . . . . . . . . . . . . . . 35Drugs for Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Drugs for Miscellaneous Eye Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Otic Agents Drugs for Ear Conditions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Respiratory Drugs for Anaphylaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Respiratory Tract / Pulmonary Agents Drugs for Allergies, Cough, Cold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Drugs for Asthma and COPD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Drugs for Cystic Fibrosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Drugs for Pulmonary Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Skeletal Muscle Relaxants Drugs for Muscle Pain and Spasm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Sleep Disorder Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403

Understanding your Prescription Drug List (PDL)What is a PDL?This document is a list of the most commonly prescribed medications. It includes About this PDLboth brand-name and generic prescription medications approved by the Food and Where differences exist between Drug Administration (FDA). Medications are listed by common categories or classes this PDL and your benefit plan and placed in tiers that represent the cost you pay out-of-pocket. They are then documents, the benefit plan listed in alphabetical order. documents rule. This PDL is not a complete list of medications, How do I use my PDL?and not all medications listed may be covered by your plan. You and your doctor can consult the PDL to help you select the most cost-effective Please look at the benefit plan prescription medications. This guide tells you if a medication is generic or a brand-documents provided by your name, and if there are coverage requirements or limits. Bring this list with you employer or health plan to see when you see your doctor. If your medication is not listed here, please visit your which medications are covered plan’s member website or call the toll-free member phone number on your member under your plan. ID card.What are tiers?Tiers are the different cost levels you pay for a medication. Each tier is assigned a cost, set by your employer or benefit plan. This is how much you will pay when you fill a prescription. See page 6 for more information.When does the PDL change?PDL changes typically occur 2-3 times per year. However, changes that have a positive impact for you — such as coverage for new medications or cost savings — may occur at any time. You can log in to the member website listed on your member ID card at any time to check your medication coverage and lower-cost options.Why are some medications excluded from coverage?We review medications based on their total value, including effectiveness and safety, how much they cost, and the availability of alternative medications to treat the same or similar medical conditions. Certain medications may be excluded from coverage 1 or be subject to prior authorization (sometimes referred to as precertification) if similar alternatives are available at a lower cost. Examples include medications that work the same way, but one is much more expensive than the other, or options that 2 are available without a prescription (also referred to as over-the-counter medications ). There are also some instances where the same product can be made by two or more manufacturers, but greatly vary in cost. In these instances, only the lower-cost product may be covered. You should review your benefit plan documents to confirm if any medications are excluded from your plan. You can log in to the member website listed on your member ID card at any time to check your medication coverage. Talk to your doctor to see if there are lower-cost options or over-the-counter medications available. Who decides which medications are covered?Thousands of medications are already available and more come to the market regularly. Often, several medications are available ® to treat the same condition. The UnitedHealthcare Pharmacy and Therapeutics Committee, which includes both internal and external doctors and pharmacists, meets regularly to provide clinical reviews of all medications. Using this information, the PDL ® Management Committee, which includes senior UnitedHealth Group doctors and business leaders, meets to evaluate overall health care value. They also set coverage and tier status for all medications.1. Depending on your benefit, you may have notification or medical necessity requirements for select medications. 2. For New York and New Jersey plans, a prescription drug product that is therapeutically equal to an over-the-counter drug may be covered if it is determined to be medically necessary.4

Medication tipsWhat is the difference between brand-name and Over-the-counter generic medications? (OTC) medicationsGeneric medications contain the same active ingredients (what makes the An OTC medication may be the medication work) as brand-name medications, but they often cost less. Once right treatment option for some the patent for a brand-name medication ends, the FDA can approve a generic conditions. Talk to your doctor version with the same active ingredients. These types of medications are about available OTC options. known as generic medications. Sometimes, the same company that makes a Even though these medications brand-name medication also makes the generic version. may not be covered by your pharmacy benefit, they may What if my doctor writes a brand-name prescription?cost less than a prescription If your doctor gives you a prescription for a brand-name medication, ask if a medication. generic equivalent or lower-cost option is available and could be right for you. Generic medications are usually your lowest-cost option, but not always. For some benefit plans, if a brand-name drug is prescribed and a generic equal is available, your cost-share may be the copayment PLUS the cost difference between the brand-name drug and the generic equivalent.What if I am taking a specialty medication?Specialty medications are high-cost and are used to treat rare or complex conditions that require additional care and support. For most plans, these medications are managed through the specialty pharmacy program. Take advantage of personalized support designed to help you get the most out of your treatment plan. Visit the member website listed on your member ID card or call the toll-free phone number on your member ID card to learn more.Please note, not all specialty medications are listed here. If you’re taking a specialty medication that is on a higher tier, call the toll-free phone number on your member ID card to talk with a pharmacist about finding lower-cost options.5

Reading your PDLThe PDL gives you choices so you and your doctor can decide your best course of treatment. In this PDL, brand-name medications are shown in UPPERCASE and generic medications in lowercase.Tier informationUsing lower-tier medications can help you pay your lowest out-of-pocket cost. Your plan may have multiple or no tiers. Please note: If you have a high deductible plan, the tier cost levels may apply once you hit your deductible.In the chart below, overall value indicates medications’ effectiveness and safety, cost, and the availability of alternative medications to treat the same or similar medical condition(s).Drug Tier Includes Helpful TipsTier 1 $ Lower-cost Medications that provide the highest overall value. Mostly generic drugs. Some brand-name drugs may also be included.Use Tier 1 drugs for the lowest out-of-pocket costs.Tiers $$ Mid-range cost Use Tier 2 or Tier 3 drugs, 2 and 3Medications that provide good overall value. A mix of brand instead of Tier 4, to help reduce name and generic drugs.your out-of-pocket costs.Tier 4 $$$ Highest-cost Many Tier 4 drugs have lower-cost Medications that provide the lowest overall value. Mostly options in Tiers 1, 2 or 3. Ask your brand-name drugs, as well as some generics.doctor if they could work for you.Drug list informationIn this drug list, some medications are noted with letters next to them to help you see which ones may have coverage requirements or limits. Your benefit plan sets how these medications may be covered for you.E May be excluded from coverage. May be subject to Prior Authorization for fully insured benefit plans governed by state law in Connecticut, New Jersey, and New York. (Referred to as First Start in New Jersey) — Lower-cost options are available and covered.H Health Care Reform Preventive— This medication is part of a health care reform preventive benefit and may be available at no additional cost to you.H-PA Health Care Reform Preventive with Prior Authorization — May be part of health care reform preventive and available at no additional cost to you if prior authorization criteria is met.3PA Prior Authorization (sometimes referred to as precertification) — Requires your doctor to provide information about why you are taking a medication to determine how it may be covered by your plan.QL Quantity Limits — Specifies the largest quantity of medication covered per copayment or in a defined period of time.4RS Refill and Save Program — Save money on your copayment when you refill your prescription on time as prescribed. Program eligibility may vary.SP Specialty Medication —Specialty medications treat complex or rare conditions and may require special storage and handling. You may be required to obtain these medications from a specialty pharmacy.ST Step Therapy (referred to as First Start in New Jersey) — Requires prior authorization and may require you to try one or more other medications before the medication you are requesting may be covered.3. Depending on your benefit, you may have notification or medical necessity requirements for select medications. 4. Not applicable to Neighborhood Health Plan, some UnitedHealthcare Freedom Plans, Golden Rule, Oxford and UnitedHealthOne.6

Reading your PDL (continued)Coverage detailsSome drug classes in this PDL have additional/important coverage details. Review this list to see if drug classes that apply to you are noted.• Central nervous system: sedatives/hypnotics Coverage is set by the consumer’s prescription drug benefit plan. Please consult plan documents regarding benefit coverage and cost-share.• Diabetes: blood glucose monitoring; insulin; non-insulin Diabetic supplies and prescription medications may be subject to different cost-share arrangements for Oxford plans. Please see your Summary of Benefits and Coverage (SBC) for specifics. • Diabetes: continuous glucose monitors, sensors Coverage is set by the consumer’s prescription drug benefit plan. Please consult plan documents regarding benefit coverage and cost-share. Diabetic self-management items, including continuous glucose monitors, may be covered under the consumer pharmacy and/or medical plan depending on the benefit.• Endocrine: growth hormone Coverage is set by the consumer’s prescription drug benefit plan. Please consult plan documents regarding benefit coverage and cost-share.• Infertility Coverage is set by the consumer’s prescription drug benefit plan. Please consult plan documents regarding benefit coverage and cost-share. Prior authorization (sometimes referred to as precertification) may be required for Oxford plans or where a state mandates infertility drug coverage. This is not a covered benefit for Neighborhood Health Plan.• Medications for sexual dysfunction Coverage is set by the consumer’s prescription drug benefit plan. Please consult plan documents regarding benefit coverage and cost-share. QuestionsFor the most current list of covered medications or if you have questions:Call the toll-free phone number on your member ID cardAnd, if home delivery services are included in your pharmacy Visit your plan’s member website listed on your member ID card to: benefit, you can also:• View your pharmacy benefit and coverage information, including • Refill prescriptions prescription history• Check the status of your order• View medication interactions and side effects• Set up reminders for refills• Locate a participating retail pharmacy by ZIP code• Manage your account• Look up possible lower-cost medication alternatives• Compare medication pricing and options7

Drug Name Drug RequirementsTier & LimitsgBgg gg gggg Bg BB gggggggBgBBBBgBBBBgBBBgggBBgBgBggBgBgggBgBBgggBSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & LimitsAnalgesics - Drugs for Painacetaminophen-codeine 1acetaminophen-codeine #2 1acetaminophen-codeine #3 1acetaminophen-codeine #4 1apap-caff-dihydrocodeine 4 QLbac 1 QLBELBUCA 3 PA, QLbutalbital-apap-caffeine oral capsule 50-300-40 mg3 QLbutalbital-apap-caffeine oral capsule 50-325-40 mg1 QLbutalbital-apap-caffeine oral tablet 1 QLCONZIP E QLDILAUDID ORAL EDUROLANE Eendocet 1ESGIC 4 QLEUFLEXXA Efentanyl transdermal patch 72 hour 100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr2 PA, QLfentanyl transdermal patch 72 hour 37.5 mcg/hr, 62.5 mcg/hr, 87.5 mcg/hrE PA, ST, QLFIORICET 4 QLGELSYN-3 EGEN7T EXTERNAL PATCH EHYALGAN INTRA-ARTICULAR SOLUTION PREFILLED SYRINGEEhydrocodone bitartrate er oral capsule extended release 12 hour3 PA, ST, QLhydrocodone bitartrate er oral tablet er 24 hour abuse-deterrent3 PA, ST, QLhydrocodone-acetaminophen oral solution 7.5-325 mg/15ml2hydrocodone-acetaminophen oral tablet 10-300 mg, 5-300 mg, 7.5-300 mgEhydrocodone-acetaminophen oral tablet 10-325 mg, 5-325 mg, 7.5-325 mg1hydromorphone hcl er 3 PA, ST, QLhydromorphone hcl oral 1hydromorphone hcl rectal 1HYSINGLA ER E PA, ST, QLlidocaine external ointment 5 % 2 QLlidocaine external patch 5 % 3 PA, QLlidocaine-prilocaine external cream 1LIDODERM E PA, QLLORTAB 4morphine sulfate (concentrate) oral solution 100 mg/5ml, 20 mg/ml1morphine sulfate er oral capsule extended release 24 hour3 PA, ST, QLmorphine sulfate er oral tablet extended release1 PA, QLmorphine sulfate oral 1morphine sulfate rectal 1MS CONTIN E PA, ST, QLNALOCET E QLNUCYNTA ER 3 PA, QLNUCYNTA ORAL TABLET 100 MG, 75 MG4 QLNUCYNTA ORAL TABLET 50 MG 4 QLOXAYDO E QLOXYCODONE HCL ER E PA, ST, QLoxycodone hcl oral capsule 1oxycodone hcl oral concentrate 100 mg/5ml1oxycodone hcl oral solution 1oxycodone hcl oral tablet 10 mg, 15 mg, 20 mg, 30 mg1oxycodone hcl oral tablet 5 mg 1 QLOXYCODONE-ACETAMINOPHEN ORAL SOLUTIONEOXYCODONE-ACETAMINOPHEN ORAL TABLET 10-300 MG, 5-300 MG, 7.5-300 MGEoxycodone-acetaminophen oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg1OXYCODONE-ACETAMINOPHEN ORAL TABLET 2.5-300 MGE QLOXYCONTIN E PA, ST, QLPERCOCET Epremium lidocaine 2 QLPROLATE E8

Drug Name Drug RequirementsTier & LimitsB BBBBgB BggBgBgBBBggBBggBBggBgBBgBBBgBgBBBBBBgBgBgBggggBggggBgBgSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & LimitsQDOLO E PA, QLROXICODONE ORAL TABLET 15 MG, 30 MGEROXICODONE ORAL TABLET 5 MGE QLROXYBOND ORAL TABLET ABUSE-DETERRENT 15 MG, 30 MGE QLROXYBOND ORAL TABLET ABUSE-DETERRENT 5 MGESUBSYS E PA, QLSUPARTZ FX ESYNOJOYNT Etramadol hcl er (biphasic) 2 (generic for Ryzolt), QLTRAMADOL HCL ER ORAL CAPSULE EXTENDED RELEASE 24 HOURE (generic for Conzip), QLtramadol hcl er oral tablet extended release 24 hour2 (generic for Ultram ER), QLTRAMADOL HCL ORAL SOLUTION E PA, QLtramadol hcl oral tablet 100 mg Etramadol hcl oral tablet 50 mg 1TREZIX 4 QLTRILURON EULTRAM EVTOL LQ 2 PA, QLXTAMPZA ER 4 PA, QLZEBUTAL 4 QLZTLIDO 3 PA, QLAnalgesics - Drugs for Pain and InflammationANAPROX DS ECATAFLAM ECELEBREX E QLcelecoxib oral 2 QLdiclofenac potassium oral capsule Ediclofenac potassium oral tablet 25 mgEdiclofenac potassium oral tablet 50 mg2diclofenac sodium er 3diclofenac sodium external gel 1 % Ediclofenac sodium external solution Ediclofenac sodium oral 1EC-NAPROSYN ORAL TABLET DELAYED RELEASE 375 MG3EC-NAPROSYN ORAL TABLET DELAYED RELEASE 500 MG4ec-naproxen 1ENOVARX-DICLOFENAC SODIUM Eetodolac 2etodolac er 3ibuprofen oral suspension 100 mg/5mlEibuprofen oral tablet 400 mg, 600 mg, 800 mg1INDOCIN 3 PAindomethacin er 2INDOMETHACIN ORAL CAPSULE 20 MGEindomethacin oral capsule 25 mg, 50 mg1KETOROLAC TROMETHAMINE NASAL4 ST, QLketorolac tromethamine oral 1LODINE ELOFENA Emeloxicam oral capsule E QLMELOXICAM ORAL SUSPENSION 4meloxicam oral tablet 1nabumetone oral 1NAPRELAN ENAPROSYN ORAL SUSPENSION E PANAPROSYN ORAL TABLET Enaproxen oral suspension E PAnaproxen oral tablet 1naproxen oral tablet delayed release1naproxen sodium er oral tablet extended release 24 hour 375 mg, 500 mgENAPROXEN SODIUM ER ORAL TABLET EXTENDED RELEASE 24 HOUR 750 MGEnaproxen sodium oral tablet 275 mg, 550 mg2PENNSAID ERELAFEN E9

Drug Name Drug RequirementsTier & LimitsB BBBBgBBggBgBg BgBggg gggBBggBBBBgggggBgBgggBBgBBgggggBBBggBggggggSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & LimitsRELAFEN DS ESPRIX 4 ST, QLTIVORBEX EZIPSOR EAnti-Addiction / Substance Abuse Treatment Agentsbuprenorphine hcl sublingual 1 QLbuprenorphine hcl-naloxone hcl sublingual film2 QLbuprenorphine hcl-naloxone hcl sublingual tablet sublingual2 QLKLOXXADO 2 QLnaloxone hcl injection 1naloxone hcl nasal 1 QLnaltrexone hcl oral 1NARCAN 2 QLSUBOXONE E PA, QLvarenicline tartrate 3 PA, HZIMHI 2 QLZUBSOLV 2 QLAntibacterials - Drugs for InfectionsACTICLATE Eamoxicillin 1amoxicillin-potassium clavulanate 1amoxicillin-potassium clavulanate er EAUGMENTIN EAUGMENTIN ES-600 Eavidoxy 1azithromycin oral 1BACTRIM 4BACTRIM DS 4cefadroxil 1cefdinir 1cefuroxime axetil 1CENTANY 4 QLCENTANY AT Ecephalexin 1CIPRO ORAL TABLET 4ciprofloxacin hcl oral 1clarithromycin er 2clarithromycin oral suspension reconstituted2clarithromycin oral tablet 1CLEOCIN ORAL CAPSULE 150 MG, 300 MG4CLEOCIN ORAL CAPSULE 75 MG 2clindamycin hcl oral 1CLINDESSE 2coremino E PADIFICID 3 QLDORYX EDORYX MPC Edoxycycline hyclate oral capsule 2doxycycline hyclate oral tablet 100 mg2doxycycline hyclate oral tablet 150 mg, 50 mg, 75 mgEdoxycycline hyclate oral tablet 20 mg1doxycycline hyclate oral tablet delayed release 100 mg, 150 mg, 200 mg, 50 mg, 75 mgEDOXYCYCLINE HYCLATE ORAL TABLET DELAYED RELEASE 80 MGEdoxycycline monohydrate oral capsule 100 mg, 50 mg1doxycycline monohydrate oral capsule 150 mg, 75 mgEdoxycycline monohydrate oral suspension reconstituted3doxycycline monohydrate oral tablet1FLAGYL 4levofloxacin oral 1LYMEPAK Emetronidazole oral 1metronidazole vaginal 2MINOCYCLINE HCL ER ORAL CAPSULE EXTENDED RELEASE 24 HOURE PAminocycline hcl er oral tablet extended release 24 hour 105 mg, 115 mg, 55 mg, 65 mg, 80 mgE PAminocycline hcl er oral tablet extended release 24 hour 135 mg, 45 mg, 90 mgE PAminocycline hcl oral capsule 110

Drug Name Drug RequirementsTier & Limitsg gB Bg Bg Bg Bg gg gB gBBggBBggggBBBBBgBBBBBgBBBBBBgBBBgBgBBgBgggBgBggBggggggSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & Limitsminocycline hcl oral tablet EMINOLIRA E PAmondoxyne nl 1mupirocin calcium 3 QLmupirocin external 1 QLnitrofurantoin macrocrystal 1nitrofurantoin monohydrate macrocrystals1NUVESSA ENUZYRA ORAL 4 QLpenicillin v potassium 1SOLODYN E PAsulfamethoxazole-trimethoprim oral 1sulfatrim pediatric 1TARGADOX EVANDAZOLE 4VIBRAMYCIN ORAL CAPSULE 4VIBRAMYCIN ORAL SUSPENSION RECONSTITUTED4XENLETA ORAL 3XEPI 3 QLXIMINO E PAZITHROMAX ORAL 4ZITHROMAX TRI-PAK 4ZITHROMAX Z-PAK 4Anticoagulants - Drugs to Treat or Prevent Blood Clotsdabigatran etexilate mesylate 1 QLELIQUIS 2 QLELIQUIS DVT/PE STARTER PACK 2 QLenoxaparin sodium 2 QLjantoven 1LOVENOX E QLPRADAXA 4 QLwarfarin sodium oral 1XARELTO 2 QLXARELTO STARTER PACK 2 QLAnticonvulsants - Drugs for SeizuresBRIVIACT ORAL TABLET 3 PAcarbamazepine er oral capsule extended release 12 hour2carbamazepine er oral tablet extended release 12 hour3carbamazepine oral 1CARBATROL 4DEPAKOTE 4 PADEPAKOTE ER 4 PADEPAKOTE SPRINKLES 4 PAdivalproex sodium er 2divalproex sodium oral capsule delayed release sprinkle2divalproex sodium oral tablet delayed release1ELEPSIA XR E PAepitol 1EPRONTIA E PAgabapentin oral capsule 1gabapentin oral solution 250 mg/5ml1GABAPENTIN ORAL TABLET 25 MG, 50 MGE PA, STgabapentin oral tablet 600 mg, 800 mg1KEPPRA ORAL 4 PAKEPPRA XR 4 PAlacosamide oral 3 PALAMICTAL 4 PALAMICTAL ODT ORAL KIT 21 X 25 MG & 7 X 50 MG, 42 X 50 MG & 14X100 MG3 PALAMICTAL ODT ORAL KIT 25 & 50 & 100 MG4 PALAMICTAL ODT ORAL TABLET DISPERSIBLE4 PALAMICTAL STARTER 4 PALAMICTAL XR 3 PAlamotrigine er 3 PA, STlamotrigine oral kit 3 PA, STlamotrigine oral tablet 1lamotrigine oral tablet chewable 1lamotrigine oral tablet dispersible 3 PA, STlamotrigine starter kit-blue 1lamotrigine starter kit-green 1lamotrigine starter kit-orange 1levetiracetam er 2levetiracetam oral 111

Drug Name Drug RequirementsTier & LimitsB gB Bg BBgBggBBgggggggBBgBBBggBggBgBgBgBgBgBgggggBBBBggggBggggggBgBBBBBSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & LimitsNAYZILAM 3 PA, QLNEURONTIN 4 PAoxcarbazepine 1OXTELLAR XR EQUDEXY XR Eroweepra 1SPRITAM Esubvenite 1subvenite starter kit-blue 1subvenite starter kit-green 1subvenite starter kit-orange 1TEGRETOL 3TEGRETOL-XR 4TOPAMAX 4 PATOPAMAX SPRINKLE 4 PAtopiramate er E STtopiramate oral 1TRILEPTAL 4 PATROKENDI XR EVALTOCO NASAL LIQUID 10 MG/0.1ML, 5 MG/0.1ML3 PA, QLVIMPAT ORAL 4 PAXCOPRI ORAL TABLET 100 MG, 150 MG, 200 MG, 50 MG3 PAZONEGRAN 4 PAzonisamide oral 1Antidementia Agents - Drugs for Alzheimer's Disease and DementiaADLARITY EARICEPT Edonepezil hcl oral tablet 10 mg, 5 mg1donepezil hcl oral tablet 23 mg Edonepezil hcl oral tablet dispersible 1Antidepressants - Drugs for Depressionamitriptyline hcl oral 1bupropion hcl er (sr) 1bupropion hcl er (xl) oral tablet extended release 24 hour 150 mg, 300 mg1BUPROPION HCL ER (XL) ORAL TABLET EXTENDED RELEASE 24 HOUR 450 MGE QLbupropion hcl oral 1CELEXA ECITALOPRAM HYDROBROMIDE ORAL CAPSULEEcitalopram hydrobromide oral solution1citalopram hydrobromide oral tablet 1CYMBALTA E QLdesvenlafaxine succinate er 3 QLdoxepin hcl oral capsule 1doxepin hcl oral concentrate 1DRIZALMA SPRINKLE 4 PA, QLduloxetine hcl oral capsule delayed release particles 20 mg, 30 mg, 60 mg2 QLduloxetine hcl oral capsule delayed release particles 40 mgEEFFEXOR XR Eescitalopram oxalate oral solution 3escitalopram oxalate oral tablet 1fluoxetine hcl oral capsule 1fluoxetine hcl oral capsule delayed release3 QLfluoxetine hcl oral solution 1fluoxetine hcl oral tablet 10 mg 3 QLfluoxetine hcl oral tablet 20 mg 3fluoxetine hcl oral tablet 60 mg Efluvoxamine maleate 1fluvoxamine maleate er 3 QLFORFIVO XL E QLLEXAPRO Emirtazapine oral 1nortriptyline hcl oral 1PAMELOR Eparoxetine hcl er 3 QLparoxetine hcl oral suspension 3paroxetine hcl oral tablet 1PAXIL CR E QLPAXIL ORAL SUSPENSION 4PAXIL ORAL TABLET EPRISTIQ E QLPROZAC E12

Drug Name Drug RequirementsTier & LimitsB gB BBBBgBgggBBgggggggBgBgBgggBgBgBBBgBBggBBgggBgBBgBggBgBggBBgBgBgBgg BgSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & LimitsREMERON EREMERON SOLTAB ORAL TABLET DISPERSIBLE 15 MG, 30 MGESERTRALINE HCL ORAL CAPSULE E QLsertraline hcl oral concentrate 1sertraline hcl oral tablet 1trazodone hcl oral 1TRINTELLIX 4 ST, QLvenlafaxine hcl 1venlafaxine hcl er oral capsule extended release 24 hour1venlafaxine hcl er oral tablet extended release 24 hourE QLVIIBRYD E QLVIIBRYD STARTER PACK 4vilazodone hcl 3 QLWELLBUTRIN SR EWELLBUTRIN XL EZOLOFT EAntiemetics - Drugs for Nausea and VomitingBONJESTA E PADICLEGIS E PAdoxylamine-pyridoxine E PAGIMOTI E QLmetoclopramide hcl oral solution 1metoclopramide hcl oral tablet 1metoclopramide hcl oral tablet dispersibleEondansetron hcl oral 1ondansetron odt 1prochlorperazine maleate oral 1promethazine hcl oral tablet 1promethazine hcl rectal 1promethegan 1REGLAN 4scopolamine 3TRANSDERM-SCOP EAntifungals - Drugs for Fungal Infectionsciclodan 1ciclopirox external gel 1ciclopirox external shampoo 2ciclopirox external solution 1ciclopirox treatment ECRESEMBA INTRAVENOUS ECRESEMBA ORAL 3DIFLUCAN EEXTINA 4 STfluconazole oral 1GYNAZOLE-1 3ketoconazole external cream 1 QLketoconazole external foam 3 STketoconazole external shampoo 1ketodan external foam 3 STLOPROX EXTERNAL SHAMPOO Enyamyc 1 QLnystatin external 1 QLnystatin mouth/throat 1nystop 1 QLterbinafine hcl oral 1 QLterconazole 1XOLEGEL 3Antigout Agents - Drugs for Goutallopurinol oral 1COLCHICINE ORAL CAPSULE Ecolchicine oral tablet ECOLCRYS Efebuxostat 3 ST, QLGLOPERBA 4 PAMITIGARE 2ULORIC E ST, QLZYLOPRIM 4Antimigraine Agents - Drugs for MigrainesAIMOVIG 2 PA, STAIMOVIG SUBCUTANEOUS SOLUTION AUTO-INJECTOR 140 MG/ML2 PA, ST, QLAMERGE ORAL TABLET 1 MG, 2.5 MGE QLeletriptan hydrobromide 2 QLEMGALITY (300 MG DOSE) 2 PA, ST, QLEMGALITY SUBCUTANEOUS SOLUTION AUTO-INJECTOR2 PA, ST, QLEMGALITY SUBCUTANEOUS SOLUTION PREFILLED SYRINGE2 PA, ST, QL13

Drug Name Drug RequirementsTier & LimitsB BB gB gB Bg gB BB BB Bg Bg Bg BBgggBBBBBBBBBBBBBBBgBBgggggBBgBBgBBBBgggBBBBBBBBBBBBgSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & LimitsIMITREX ORAL E QLIMITREX STATDOSE REFILL E QLIMITREX STATDOSE SYSTEM E QLMAXALT E QLnaratriptan hcl 1 QLNURTEC ODT 2 PA, ST, QLONZETRA XSAIL E QLRELPAX E QLrizatriptan benzoate 1 QLsumatriptan succinate oral 1 QLsumatriptan succinate refill subcutaneous solution cartridge1 QLsumatriptan succinate subcutaneous1 QLUBRELVY 2 PA, ST, QLZEMBRACE SYMTOUCH E QLZOLMITRIPTAN NASAL SOLUTION 2.5 MGE QLZOMIG NASAL SOLUTION 2.5 MG 3 QLZOMIG NASAL SOLUTION 5 MG 2 QLAntineoplastics - Drugs for CancerALECENSA 2PA, QL, SPALUNBRIG 2 PA, QL, SPanastrozole oral 1 H-PAARIMIDEX Ebexarotene external E QL, SPbexarotene oral E SPCALQUENCE 2 PA, QL, SPcapecitabine 1 QL, SPERIVEDGE 2 PA, QL, SPERLEADA 2 PA, QL, SPEXKIVITY 4 PA, QL, SPFEMARA Efluorouracil external solution 1GAVRETO 4 PA, QL, SPIBRANCE 2 PA, QL, SPICLUSIG ORAL TABLET 10 MG, 30 MG3PA, QL, SPICLUSIG ORAL TABLET 15 MG, 45 MG3 PA, QL, SPIDHIFA 2 PA, QL, SPIMBRUVICA ORAL TABLET 2 PA, QL, SPKOSELUGO 3 PA, QL, SPlenalidomide 2 PA, QL, SPletrozole oral 1 H-PALYNPARZA 2 PA, QL, SPmercaptopurine oral 1NUBEQA 2 PA, QL, SPODOMZO 2 PA, QL, SPORGOVYX 3 PA, QL, SPPURIXAN 4 PA, SPREVLIMID 2 PA, QL, SPSOLTAMOX ESTIVARGA 2 PA, QL, SPtamoxifen citrate oral tablet 10 mg 1tamoxifen citrate oral tablet 20 mg 1 H-PATARGRETIN EXTERNAL 3 QL, SPTARGRETIN ORAL 2 SPTASIGNA 2 PA, ST, QL, SPUKONIQ 4 PA, QLVERZENIO 2 PA, QL, SPVITRAKVI 2 PA, QL, SPXELODA E QL, SPZEJULA 2 PA, QL, SPAntiparasitics - Drugs for Parasitic InfectionsARAKODA 4 QLatovaquone-proguanil hcl 2hydroxychloroquine sulfate oral 1ivermectin oral 1 PA, QLKRINTAFEL 1 QLMALARONE 4permethrin external 1PLAQUENIL EAntiparkinson Agents - Drugs for Parkinson's Diseasecarbidopa-levodopa 1carbidopa-levodopa er 1DHIVY EDUOPA 4 PAINBRIJA 3 PA, QL, SPKYNMOBI 3 PA, QL, SPMIRAPEX ER ENOURIANZ 3 PA, QLpramipexole dihydrochloride 114

Drug Name Drug RequirementsTier & Limitsg gg gg g BBg gBBgBBBBBBggBgBgBBBBBgBgBgBgBBBBBgBBBBBBgBggBBBgBgBBBBBBBBBBBBSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & Limitspramipexole dihydrochloride er Eropinirole hcl 1ropinirole hcl er ERYTARY ESINEMET 4Antiplatelets - Drugs for Heart Attack and Stroke PreventionBRILINTA 4 QLclopidogrel bisulfate oral 1PLAVIX EZONTIVITY 4 QLAntipsychotics - Drugs for Mood DisordersABILIFY E QLaripiprazole oral solution 3aripiprazole oral tablet 2 QLaripiprazole oral tablet dispersible 2 QLasenapine maleate E QLGEODON ORAL E QLLATUDA 4 QLolanzapine oral tablet 1 QLolanzapine oral tablet dispersible 2 QLquetiapine fumarate 1quetiapine fumarate er 3 QLREXULTI 4 PA, ST, QLRISPERDAL Erisperidone 1SAPHRIS 3 QLSEROQUEL ESEROQUEL XR E QLVRAYLAR ORAL CAPSULE 4 QLziprasidone hcl 2 QLZYPREXA ORAL E QLZYPREXA ZYDIS E QLAntivirals - Drugs for Viral Infectionsacyclovir oral 1BARACLUDE ORAL SOLUTION 2 SPBARACLUDE ORAL TABLET E SPBIKTARVY 4 QLCIMDUO 2 QLDESCOVY E PA, ST, QLDOVATO 2 QLefavirenz-emtricitab-tenofovir 2 QLefavirenz-lamivudine-tenofovir 2 QLemtricitabine-tenofovir df oral tablet 100-150 mg, 133-200 mg, 167-250 mg1 QLemtricitabine-tenofovir df oral tablet 200-300 mg1 QL, Hentecavir 1 SPEPCLUSA ORAL PACKET 150-37.5 MG2 PA, QL, SPEPCLUSA ORAL PACKET 200-50 MG2PA, QL, SPEPCLUSA ORAL TABLET 200-50 MG2PA, QL, SPEPCLUSA ORAL TABLET 400-100 MG2 PA, QL, SPGENVOYA 4 QLHARVONI ORAL PACKET 2PA, ST, QL, SPHARVONI ORAL TABLET 2 PA, ST, QL, SPISENTRESS 2ISENTRESS 2ISENTRESS HD 2JULUCA 2 QLLEDIPASVIR-SOFOSBUVIR 2 PA, ST, QL, SPMAVYRET ORAL PACKET 2PA, QL, SPMAVYRET ORAL TABLET 2 PA, QL, SPNORVIR ORAL PACKET 2NORVIR ORAL SOLUTION 2NORVIR ORAL TABLET EODEFSEY 4 QLoseltamivir phosphate oral capsule 2oseltamivir phosphate oral suspension reconstituted2 QLPREZCOBIX 2ritonavir 2RUKOBIA 4 PASITAVIG E QLSOFOSBUVIR-VELPATASVIR 2 PA, QL, SPSTRIBILD 4 QLSYMFI 2 QLSYMFI LO 2 QLTAMIFLU ORAL CAPSULE E15

Drug Name Drug RequirementsTier & LimitsB BBgBBBBBgBgBBBBgggBBBgBBBBgBgBgBgBBBggggggggBBgBgggggBBBgBgBBggggBBgBBBgSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & LimitsTAMIFLU ORAL SUSPENSION RECONSTITUTEDE QLtenofovir disoproxil fumarate 1 HTIVICAY 3TIVICAY PD 3TRIUMEQ 2 QLTRIUMEQ PD 2 QLTRUVADA ORAL TABLET 100-150 MG, 133-200 MG, 167-250 MG4 QLTRUVADA ORAL TABLET 200-300 MGE QLvalacyclovir hcl oral 1 QLVALTREX E QLVEMLIDY E PA, ST, SPVIREAD ORAL TABLET 150 MG, 200 MG, 250 MG2VIREAD ORAL TABLET 300 MG EVOSEVI 2 PA, QL, SPXOFLUZA (40 MG DOSE) 3 QLXOFLUZA (80 MG DOSE) 3 QLZEPATIER 2 PA, QL, SPZOVIRAX ORAL 4Anxiolytics - Drugs for Anxietyalprazolam er 1alprazolam intensol 1alprazolam oral 1alprazolam xr 1ATIVAN ORAL Ebuspirone hcl oral 1clonazepam oral 1diazepam intensol 1diazepam oral 1HALCION 4hydroxyzine hcl oral 1hydroxyzine pamoate oral 1KLONOPIN Elorazepam intensol 1lorazepam oral concentrate 2 mg/ml1lorazepam oral tablet 1LOREEV XR Etriazolam 1VALIUM EVISTARIL 4XANAX EXANAX XR EBipolar Agents - Drugs for Mood Disorderslithium carbonate er 1lithium carbonate oral 1LITHOBID 4 PACardiovascular Agents - Drugs for Heart and Circulation ConditionsACCUPRIL Eacetazolamide er 1acetazolamide oral 1ALDACTONE Ealiskiren fumarate 3ALTACE EALTOPREV Eamiodarone hcl oral 1amlodipine besylate oral 1amlodipine besylate-benazepril hcl 1amlodipine besylate-valsartan 2ASPRUZYO SPRINKLE Eatenolol oral 1atenolol-chlorthalidone 1atorvastatin calcium oral tablet 10 mg, 20 mg1 QL, H-PAatorvastatin calcium oral tablet 40 mg, 80 mg1 QLAVALIDE EAVAPRO Ebenazepril hcl oral 1benazepril-hydrochlorothiazide 1BENICAR EBENICAR HCT EBETAPACE EBIDIL 2bisoprolol fumarate oral 1bisoprolol-hydrochlorothiazide 1BYSTOLIC ECALAN SR 4CARDIZEM ECARDIZEM CD E16

Drug Name Drug RequirementsTier & LimitsB gB BB gg gg Bg gg Bg gB gB gB gB gB Bg gg Bg Bg BB gB gg BB BB gg gg BB BB BB gB Bg gg Bg Bggg gB gggBgBgBBSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & LimitsCARDIZEM LA ECARDURA 4CAROSPIR 4 PAcartia xt 2carvedilol 1chlorthalidone 1clonidine hcl oral 1colesevelam hcl 2COREG ECORGARD 4CORLANOR 3 PA, QLCOZAAR ECRESTOR E QLdiltiazem hcl er 1diltiazem hcl er coated beads 2diltiazem hcl oral 1dilt-xr 1DIOVAN EDIOVAN HCT Edoxazosin mesylate oral 1EDARBI 3EDARBYCLOR 3enalapril maleate oral solution 3 PAenalapril maleate oral tablet 1ENTRESTO 4 PA, QLEPANED 4 PAEXFORGE EEZALLOR SPRINKLE 3 PAezetimibe 2ezetimibe-simvastatin 3fenofibrate oral capsule 150 mg, 50 mgEfenofibrate oral tablet 120 mg, 40 mg, 48 mgEfenofibrate oral tablet 145 mg, 160 mg, 54 mg2FENOGLIDE Eflecainide acetate 1FLOLIPID 4 PAfurosemide oral 1gemfibrozil oral 1GONITRO E QLguanfacine hcl 1HEMANGEOL Ehydralazine hcl oral 1hydrochlorothiazide oral 1HYZAAR Eicosapent ethyl E PAINDERAL LA Eirbesartan 1irbesartan-hydrochlorothiazide 1isosorb dinitrate-hydralazine 2isosorbide mononitrate 1isosorbide mononitrate er 1KAPSPARGO SPRINKLE 4labetalol hcl oral 1LASIX 4LIPITOR E QLLIPOFEN Elisinopril oral 1lisinopril-hydrochlorothiazide 1LOPID 4LOPRESSOR 4losartan potassium oral 1losartan potassium-hctz 1LOTENSIN 4LOTENSIN HCT 4LOTREL Elovastatin oral 1 HLOVAZA Ematzim la 2MAXZIDE 4MAXZIDE-25 4metoprolol succinate er oral tablet extended release 24 hour 100 mg, 200 mg, 50 mg2metoprolol succinate er oral tablet extended release 24 hour 25 mg1metoprolol tartrate oral tablet 100 mg, 25 mg, 50 mg1metoprolol tartrate oral tablet 37.5 mg, 75 mgEMICARDIS EMINIPRESS 417

Drug Name Drug RequirementsTier & LimitsB Bg Bg BB gB gBggBgggBBggBgBggBgBBgBgBgBBBBgBgBBBBBggggBgBBgBBgggBggggBBBgBgBBBgSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & LimitsMULTAQ 4 PAnadolol oral 1nebivolol hcl ENEXICLON XR ENEXLETOL 2 PA, ST, QLNEXLIZET 2 PA, ST, QLniacin (antihyperlipidemic) Eniacin er (antihyperlipidemic) 2niacor ENIASPAN Enifedipine er 1nifedipine er osmotic release 1nifedipine oral 1NITRO-BID 2NITRO-DUR 3nitroglycerin sublingual 1nitroglycerin transdermal 1nitroglycerin translingual E QLNITROLINGUAL E QLNITROMIST 4 QLNITROSTAT 4NITRO-TIME 3NORLIQVA ENORVASC Eolmesartan medoxomil oral 2olmesartan medoxomil-hctz 2omega-3-acid ethyl esters 2PACERONE ORAL TABLET 100 MG, 400 MG3PACERONE ORAL TABLET 200 MG 4PRALUENT E PA, ST, QLpravastatin sodium 1prazosin hcl oral 1PROCARDIA XL Epropranolol hcl er 2propranolol hcl oral 1QBRELIS 4 PAquinapril hcl 1ramipril 1RANEXA Eranolazine er 2REPATHA 2 PA, ST, QLREPATHA PUSHTRONEX SYSTEM 2 PA, ST, QLREPATHA SURECLICK 2 PA, ST, QLrosuvastatin calcium 2 QLsimvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg1 H-PAsimvastatin oral tablet 80 mg 1SOAANZ E QLsotalol hcl oral 1SOTYLIZE 4 PAspironolactone oral 1TEKTURNA 3TEKTURNA HCT 3telmisartan 2telmisartan-hctz 2TENORETIC 100 ETENORETIC 50 ETENORMIN ETHALITONE ETOPROL XL Etorsemide 1triamterene-hctz 1TRICOR EVALSARTAN ORAL SOLUTION Evalsartan oral tablet 2valsartan-hydrochlorothiazide 1VASCEPA E PAVASOTEC Everapamil hcl er oral capsule extended release 24 hour 100 mg, 200 mg, 300 mg3verapamil hcl er oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 360 mg1verapamil hcl er oral tablet extended release1verapamil hcl oral 1VERELAN 4VERELAN PM 4VERQUVO 4 PA, QLVYTORIN EWELCHOL E18

Drug Name Drug RequirementsTier & LimitsB gBgBBggBgBBBBBBBBggBgBB BBgBBBgBgBgBgBg BBgBgBBBBggBgBBBBgBgBBBgBBggBSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & LimitsZESTORETIC EZESTRIL EZETIA EZIAC ORAL TABLET 10-6.25 MG, 2.5-6.25 MG3ZIAC ORAL TABLET 5-6.25 MG 4ZOCOR ECentral Nervous System Agents - Drugs for Attention Deficit DisorderADDERALL EADDERALL XR 2 QLADHANSIA XR E QLamphetamine-dextroamphetamine 1amphetamine-dextroamphetamine erE QLAPTENSIO XR E QLatomoxetine hcl 3 QLCONCERTA 2 QLDEXEDRINE E QLdexmethylphenidate hcl 1dexmethylphenidate hcl er 3 QLdextroamphetamine sulfate er 3 QLdextroamphetamine sulfate oral solution1dextroamphetamine sulfate oral tablet 10 mg, 5 mg3dextroamphetamine sulfate oral tablet 15 mg, 20 mg, 30 mgEFOCALIN 4FOCALIN XR E QLguanfacine hcl er 2 QLINTUNIV E QLJORNAY PM E QLMETHYLIN 4methylphenidate hcl er (cd) 2 QLmethylphenidate hcl er (la) oral capsule extended release 24 hour 10 mg, 20 mg, 30 mg, 40 mg2 QLmethylphenidate hcl er (la) oral capsule extended release 24 hour 60 mg2methylphenidate hcl er (osm) E QLmethylphenidate hcl er (xr) E QLmethylphenidate hcl er oral tablet extended release4 QLmethylphenidate hcl er oral tablet extended release 24 hourE QLmethylphenidate hcl oral solution 1methylphenidate hcl oral tablet 1methylphenidate hcl oral tablet chewable3MYDAYIS E QLPROCENTRA 3QUILLICHEW ER E QLQUILLIVANT XR E QLrelexxii E QLRITALIN ERITALIN LA E QLSTRATTERA E QLVYVANSE 3 QLZENZEDI ECentral Nervous System Agents - Drugs for Multiple SclerosisAMPYRA E PA, QL, SPAUBAGIO 3 PA, QL, SPAVONEX PEN 2 PA, QL, SPAVONEX PREFILLED 2 PA, QL, SPBAFIERTAM 2 PA, QL, SPBETASERON 2 PA, QL, SPCOPAXONE E PA, QL, SPdalfampridine er 2 PA, QL, SPEXTAVIA E PA, ST, QL, SPGILENYA 3 PA, QL, SPglatiramer acetate 2 PA, QL, SPglatopa 2 PA, QL, SPKESIMPTA 2 PA, QL, SPMAVENCLAD 3 PA, ST, QL, SPPLEGRIDY INTRAMUSCULAR 3PA, QL, SPPLEGRIDY STARTER PACK 3 PA, QL, SPPLEGRIDY SUBCUTANEOUS 3 PA, QL, SPREBIF E PA, QL, SPREBIF REBIDOSE E PA, QL, SPREBIF REBIDOSE TITRATION PACKE PA, QL, SPREBIF TITRATION PACK E PA, QL, SP19

Drug Name Drug RequirementsTier & LimitsggBB gB ggBBg Bg gg BB Bg gB gB BB gB BBBgBgBBBBBBBgBgBgBBggggBgBBggBgBBggBgBBBBgBSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & LimitsCentral Nervous System Agents - MiscellaneousAUSTEDO 2 PA, QL, SPEXSERVAN E PA, SPLYRICA 4 PA, QLLYRICA CR E ST, QLNUEDEXTA 2 PA, QLpregabalin er E ST, QLpregabalin oral capsule 2 QLpregabalin oral solution 3 QLRILUTEK E SPriluzole 1 SPTIGLUTIK 4 PAZEPOSIA 3 PA, ST, QL, SPZEPOSIA 7-DAY STARTER PACK 3 PA, ST, QL, SPZEPOSIA STARTER KIT 3 PA, ST, QL, SPDental and Oral Agents - Drugs for Mouth and Throat Conditionscavarest 1chlorhexidine gluconate mouth/ throat1CLINPRO 5000 3DENTA 5000 PLUS 4DENTAGEL 4FLUORIDEX 3FLUORIDEX ENHANCED WHITENING3FLUORIMAX 5000 3JUST RIGHT 5000 3lidocaine hcl mouth/throat 1lidocaine viscous hcl 1NAFRINSE DAILY/NEUTRAL 2NAFRINSE WEEKLY 4PERIDEX 4periogard 1PREVIDENT 5000 BOOSTER PLUS 3PREVIDENT 5000 DRY MOUTH 4PREVIDENT 5000 ORTHO DEFENSE3PREVIDENT 5000 PLUS 4PREVIDENT DENTAL 4PREVIDENT MOUTH/THROAT 3sf 1sf 5000 plus 1sodium fluoride 5000 plus 1sodium fluoride 5000 ppm 1sodium fluoride dental 1sodium fluoride mouth/throat 1Dermatological Agents - Drugs for Skin ConditionsABSORICA E PAaccutane 2ACZONE E QLALA SCALP 4ala-cort external cream 1 % Eala-cort external cream 2.5 % 1ALTRENO E PA, QLamnesteem 2AMZEEQ 4 PA, QLATRALIN E PA, QLAVAR CLEANSER 4AVAR LS CLEANSER EAVAR-E EMOLLIENT 3AVAR-E GREEN 3AVAR-E LS 3AVITA E PA, QLazelaic acid external 3betamethasone dipropionate aug external cream1betamethasone dipropionate aug external gel1betamethasone dipropionate aug external lotion3betamethasone dipropionate aug external ointment3betamethasone dipropionate external cream2betamethasone dipropionate external lotion1betamethasone dipropionate external ointment2bp 10-1 1calcipotriene-betameth diprop E QLcalcitriol external 1 QLCAPEX 2CARAC ECIBINQO 2 PA, QL, SP20

Drug Name Drug RequirementsTier & Limitsg gB gg Bg gB Bg Bg BgBgBgBg BBgBggggggggggggggggggBBBBgggggggggBBggggSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & Limitsclaravis 2CLEOCIN-T 4clindacin etz external swab 1clindacin-p 1CLINDAGEL E QLclindamycin phos-benzoyl perox external gel 1.2-5 %3 QLclindamycin phosphate external foam3clindamycin phosphate external lotion3clindamycin phosphate external solution1clindamycin phosphate external swab1clindamycin phosphate gel 1 % externalE QLclindamycin phosphate gel 1 % external3 QLclobetasol propionate external cream2 QLclobetasol propionate external foam E QLclobetasol propionate external gel 2 QLclobetasol propionate external liquid1 QLclobetasol propionate external lotionE QLclobetasol propionate external ointment2 QLclobetasol propionate external shampooE QLclobetasol propionate external solution1 QLCLOBEX E QLCLOBEX SPRAY E QLclodan external shampoo E QLclotrimazole-betamethasone external cream1 QLclotrimazole-betamethasone external lotion1dapsone external 3 QLDERMA-SMOOTHE/FS BODY 4 QLDERMA-SMOOTHE/FS SCALP 4desonide external cream 3 QLdesonide external gel 3 ST, QLdesonide external lotion 3 QLdesonide external ointment 3 QLDESOWEN 3 QLdesrx 3 ST, QLDIPROLENE 4DUPIXENT SUBCUTANEOUS SOLUTION PEN-INJECTOR2 PA, QL, SPDUPIXENT SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MG/0.67ML2 PA, QL, SPDUPIXENT SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 200 MG/1.14ML, 300 MG/2ML2 PA, QL, SPEFUDEX 4ENSTILAR 4 QLEUCRISA 3 ST, QLEVOCLIN 4FINACEA 4fluocinolone acetonide body 3 QLfluocinolone acetonide external cream3 QLfluocinolone acetonide external ointment2 QLfluocinolone acetonide external solution3 QLfluocinolone acetonide scalp 3fluocinonide external cream 0.05 % 1fluocinonide external cream 0.1 % E QLfluocinonide external gel 1fluocinonide external ointment 1fluocinonide external solution 1FLUOROPLEX EXTERNAL CREAM 1 %4FLUOROURACIL EXTERNAL CREAM 0.5 %Efluorouracil external cream 5 % 1hydrocortisone external cream 1 % Ehydrocortisone external cream 2.5 %1hydrocortisone external lotion 2.5 % 1hydrocortisone external ointment 1 %, 2.5 %1imiquimod external cream 3.75 % E QLimiquimod external cream 5 % 121

Drug Name Drug RequirementsTier & Limitsg gBgBggggggggggggggBgBBgBgBgggBgggBBBgBgBgBBBgBggBBBBgBgBBgggggBBgBgSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & Limitsimiquimod pump E QLIMPEKLO E QLIMPOYZ E QLisotretinoin capsule 10 mg oral E PAisotretinoin capsule 10 mg oral 2isotretinoin capsule 20 mg oral E PAisotretinoin capsule 20 mg oral 2isotretinoin capsule 30 mg oral E PAisotretinoin capsule 30 mg oral 2isotretinoin capsule 40 mg oral E PAisotretinoin capsule 40 mg oral 2isotretinoin oral capsule 25 mg, 35 mgE PAKENALOG EXTERNAL E QLKLISYRI 4 ST, QLMETROCREAM 4METROGEL EMETROLOTION 4metronidazole external cream 1metronidazole external gel 0.75 % 1metronidazole external gel 1 % Emetronidazole external lotion 1MIRVASO 4 PA, QLmometasone furoate external 1myorisan 2neuac external gel 3 QLNORITATE EOLUX E QLPICATO 3 QLpimecrolimus 3 ST, QLPLEXION EPLEXION CLEANSER EPLEXION CLEANSING CLOTH ERETIN-A E PA, QLRHOFADE 4 PA, QLrosadan external cream 1rosadan external gel 1SANTYL 3 QLSERNIVO E QLSOOLANTRA 4 QLsss 10-5 1sulfacetamide sodium-sulfur external cream 10-2 %, 10-5 %1sulfacetamide sodium-sulfur external cream 9.8-4.8 %Esulfacetamide sodium-sulfur external liquid 10-2 %, 9.8-4.8 %Esulfacetamide sodium-sulfur external liquid 10-5 %, 9-4 %, 9-4.5 %1sulfacetamide sodium-sulfur external lotion 10-5 %1sulfacetamide sodium-sulfur external lotion 9.8-4.8 %Esulfacetamide sodium-sulfur external pad 10-4 %1sulfacetamide sodium-sulfur external pad 9.8-4.8 %Esulfacetamide sodium-sulfur external suspension 10-5 %1sulfacetamide sodium-sulfur external suspension 8-4 %Esulfacetamide sod-sulfur wash 1SULFACLEANSE 8/4 Esulfamez wash 1SUMADAN WASH ESUMAXIN 4SYNALAR E QLTACLONEX EXTERNAL OINTMENT E QLTACLONEX EXTERNAL SUSPENSION3 QLtacrolimus external 2 ST, QLtazarotene external cream 3 PA, QLTAZORAC 4 PA, QLTEXACORT 2tretinoin external cream 3 QLtretinoin external gel 0.01 %, 0.025 %E QLtretinoin external gel 0.05 % E PA, QLtriamcinolone acetonide external aerosol solution2 QLtriamcinolone acetonide external cream 0.025 %, 0.1 %1triamcinolone acetonide external cream 0.5 %1 QL22

Drug Name Drug RequirementsTier & Limitsg gggBgBBgBBBgBgBBgBBB BB BBBgBBBBBBBBBBBBBBBBBBBBB BBBBBBBBBBBBgBBSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & Limitstriamcinolone acetonide external lotion1triamcinolone acetonide external ointment 0.025 %, 0.1 %, 0.5 %1triamcinolone acetonide external ointment 0.05 %Etriamcinolone in absorbase ETRIANEX Etriderm external cream 0.1 % 1triderm external cream 0.5 % 1 QLTRIDESILON 3 QLtritocin EVANOS E QLVECTICAL E QLVERDESO E QLWYNZORA E QLzenatane 2ZILXI 4 PA, ST, QLZYCLARA E QLZYCLARA PUMP E QLDiabetes - Glucose Monitoring and SuppliesACCU-CHEK AVIVA PLUS TEST STRIPSE QLACCU-CHEK FASTCLIX LANCET KIT1ACCU-CHEK FASTCLIX LANCETS 1ACCU-CHEK GUIDE KIT W/DEVICE 3 (Accu-Chek Guide Me)ACCU-CHEK GUIDE TEST STRIPS 3 QLACCU-CHEK MULTICLIX LANCET KIT1ACCU-CHEK MULTICLIX LANCETS 1ACCU-CHEK SAFE-T PRO LANCETS1ACCU-CHEK SMARTVIEW TEST STRIPSE QLACCU-CHEK SOFT TOUCH LANCETS1ACCU-CHEK SOFTCLIX LANCET DEVICE KIT1ACCU-CHEK SOFTCLIX LANCETS 1ACCUTREND GLUCOSE E QLbd autoshield duo pen needles 2BD INSULIN SYRINGE U-500 2bd ultra-fine insulin syringes 2bd ultra-fine pen needles 2BD VEO INSULIN SYRINGE ULTRA-FINE2BLOOD GLUCOSE TEST STRIPS E QLCARETOUCH MONITOR SYSTEM ECARETOUCH TEST E QLCHEMSTRIP BG LOG BOOK 1CONTOUR MONITOR DEVICE ECONTOUR MONITOR KIT W/DEVICEECONTOUR NEXT EZ KIT W/DEVICEECONTOUR NEXT GEN MONITOR ECONTOUR NEXT LINK KIT W/DEVICE4CONTOUR NEXT LINK KIT W/DEVICEE (Contour Next Link 24 )CONTOUR NEXT MONITOR KIT W/DEVICE2CONTOUR NEXT ONE DEVICE ECONTOUR NEXT ONE KIT 2CONTOUR NEXT TEST STRIPS 2 QLCONTOUR TEST STRIPS E QLCVS ADVANCED GLUCOSE TEST E QLCVS GLUCOSE METER TEST STRIPSE QLD-CARE BLOOD GLUCOSE E QLD-CARE GLUCOMETER EDEXCOM G4 MOBILE RECEIVER 3 PA, QLDEXCOM G4 PLATINUM 3 PA, QLDEXCOM G4 PLATINUM PEDIATRIC RECEIVER KIT3 PA, QLDEXCOM G4 PLATINUM PEDIATRIC RECEIVER KIT/SHARE3 PA, QLDEXCOM G4 PLATINUM RECEIVER KIT3 PA, QLDEXCOM G4 PLATINUM RECEIVER KIT/SHARE3 PA, QLDEXCOM G4 PLATINUM SENSOR KIT3 PA, QLDEXCOM G4 PLATINUM TRANSMITTER KIT3 PA, QLDEXCOM G4 SENSOR 3 PA, QL23

Drug Name Drug RequirementsTier & LimitsB BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & LimitsDEXCOM G4 TRANSMITTER 3 PA, QLDEXCOM G5 MOBILE RECEIVER 3 PA, QLDEXCOM G5 SENSOR 3 PA, QLDEXCOM G5 TRANSMITTER 3 PA, QLDEXCOM G6 RECEIVER 3 PA, QLDEXCOM G6 SENSOR 3 PA, QLDEXCOM G6 TRANSMITTER 3 PA, QLEASY TOUCH TEST E QLEASYMAX 15 TEST E QLEASYMAX NG BLOOD GLUCOSE EEASYMAX V BLOOD GLUCOSE EENLITE GLUCOSE SENSOR 3 PAEQ BLOOD GLUCOSE TEST E QLFORTISCARE G1 TEST STRIP E QLFORTISCARE T1 GLUCOSE SYSTEMEFORTISCARE TEST E QLFREESTYLE LIBRE 14 DAY READER3 PAFREESTYLE LIBRE 14 DAY SENSOR3 PAFREESTYLE LIBRE 2 READER 3 PAFREESTYLE LIBRE 2 SENSOR 3 PAFREESTYLE LIBRE 3 SENSOR 3 PAFREESTYLE LIBRE READER 3 PA, QLFREESTYLE PRECISION NEO SYSTEMEFREESTYLE PRECISION NEO TESTE QLGENTLE-LET PLATFORMS 3GLUCOCARD EXPRESSION TEST E QLGLUCOCARD SHINE TEST E QLGLUCOCARD VITAL TEST E QLGUARDIAN LINK 3 TRANSMITTER 3GUARDIAN REAL-TIME REPLACE PED3 PAGUARDIAN SENSOR (3) 3 PAIN TOUCH 1INSULIN PEN NEEDLES 2LANCETS 3MICRODOT TEST E QLMINILINK REAL-TIME TRANSMITTER3MM EASY TOUCH GLUCOSE METERENEUTEK 2TEK TEST E QLNOVOFINE AUTOCOVER PEN NEEDLE2NOVOFINE PEN NEEDLE 2NOVOFINE PLUS PEN NEEDLE 2NOVOTWIST 2OMNIPOD 5 G6 INTRO KIT (Gen 5) 2 PA, QLOMNIPOD 5 G6 PODS (Gen 5) 2 PA, QLONETOUCH CLUB LANCETS FINE PT1ONETOUCH DELICA LANCETS 30G1ONETOUCH DELICA LANCETS 33G1ONETOUCH DELICA PLUS LANCET30G1 (Onetouch Delica Plus Lancets)ONETOUCH DELICA PLUS LANCET33G1 (Onetouch Delica Plus Lancets)ONETOUCH FINEPOINT LANCETS 1ONETOUCH SOLUTIONS STARTER KITEONETOUCH SURESOFT LANCING DEV1ONETOUCH ULTRA 2 KIT W/DEVICE1ONETOUCH ULTRA MINI KIT W/DEVICE1ONETOUCH ULTRA TEST STRIPS 1 QLONETOUCH ULTRASOFT LANCETS1 (Onetouch Ultrasoft Plus lancets)ONETOUCH VERIO FLEX SYSTEM 1ONETOUCH VERIO IQ SYSTEM 1ONETOUCH VERIO KIT W/DEVICE 1ONETOUCH VERIO REFLECT KIT W/DEVICE1ONETOUCH VERIO TEST STRIPS 1 QLOPTIUMEZ TEST E QLPARADIGM REAL-TIME TRANSMITTER3PENLET II BLOOD SAMPLER 124

Drug Name Drug RequirementsTier & LimitsB BB BB BBBB BB BB BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & LimitsPENLET II REPLACEMENT CAP 3PRECISION XTRA EPRECISION XTRA BLOOD GLUCOSEE QLPREMIUM BLOOD GLUCOSE TEST E QLPSS SELECT PLATFORMS 3QUINTET AC BLOOD GLUCOSE EQUINTET AC BLOOD GLUCOSE TESTE QLQUINTET BLOOD GLUCOSE SYSTEMEQUINTET BLOOD GLUCOSE TEST E QLRELION TRUE MET AIR GLUC METERERELION TRUE METRIX TEST STRIPSE QLRELION ULTIMA GLUCOSE SYSTEMERELION ULTIMA TEST E QLSURESTEP PRO LINEARITY 1TRUE FOCUS BLOOD GLUCOSE STRIPE QLTRUE METRIX AIR GLUCOSE METERETRUE METRIX BLOOD GLUCOSE TESTE QLTRUE METRIX GO GLUCOSE METERETRUE METRIX METER KIT ETRUE METRIX PRO BLOOD GLUCOSEE QLTRUETRACK BLOOD GLUCOSE DEVICEETRUETRACK TEST E QLUNISTRIP1 GENERIC E QLDiabetes - InsulinADMELOG E QLADMELOG SOLOSTAR E QLAFREZZA E PA, QLBASAGLAR KWIKPEN E QLHUMALOG INJECTION 1 QLHUMALOG KWIKPEN 2 QLHUMALOG MIX 50/50 KWIKPEN 2 QLHUMALOG MIX 50/50 VIAL 1 QLHUMALOG MIX 75/25 KWIKPEN 2 QLHUMALOG MIX 75/25 VIAL 1 QLHUMALOG SUBCUTANEOUS 2 QLHUMALOG U-100 JUNIOR KWIKPEN2 QLHUMULIN 70/30 KWIKPEN 2 QLHUMULIN 70/30 VIAL 1 QLHUMULIN N KWIKPEN 2 QLHUMULIN N VIAL 1 QLHUMULIN R U-500 KWIKPEN 2 QLHUMULIN R U-500 VIAL 1 QLHUMULIN R VIAL 1 QLINSULIN ASPART E ST, QLINSULIN ASPART FLEXPEN E ST, QLINSULIN ASPART PENFILL E ST, QLINSULIN GLARGINE E QLINSULIN GLARGINE SOLOSTAR E QLINSULIN LISPRO E QLINSULIN LISPRO (1 UNIT DIAL) E QLINSULIN LISPRO JUNIOR KWIKPENE QLINSULIN LISPRO KWIKPEN EINSULIN LISPRO PROT & LISPRO E QLLANTUS SOLOSTAR 1 QLLANTUS U-100 VIAL 1 QLLEVEMIR U-100 FLEXTOUCH E PA, QLLEVEMIR U-100 VIAL E PA, QLLYUMJEV KWIKPEN 2 QLLYUMJEV VIAL 1 QLNOVOLIN 70/30 FLEXPEN E ST, QLNOVOLIN 70/30 FLEXPEN RELION E ST, QLNOVOLIN 70/30 RELION E ST, QLNOVOLIN 70/30 VIAL E ST, QLNOVOLIN N FLEXPEN E ST, QLNOVOLIN N FLEXPEN RELION E ST, QLNOVOLIN N RELION E ST, QLNOVOLIN N VIAL E ST, QLNOVOLIN R FLEXPEN E ST, QLNOVOLIN R FLEXPEN RELION E ST, QLNOVOLIN R RELION E ST, QLNOVOLIN R VIAL E ST, QLNOVOLOG FLEXPEN E ST, QL25

Drug Name Drug RequirementsTier & LimitsB gB gB gB gB gBgBBBBBBBBBBBBBBBgBBBBBBBBBBBBgBgBgBgBgBBBBBBggBBBBBB BBBB BSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & LimitsNOVOLOG FLEXPEN RELION E ST, QLNOVOLOG PENFILL E ST, QLNOVOLOG RELION E ST, QLNOVOLOG U-100 VIAL E ST, QLTOUJEO MAX SOLOSTAR 2 QLTOUJEO SOLOSTAR 2 QLTRESIBA E QLTRESIBA FLEXTOUCH E QLDiabetes - Non-Insulin AgentsACTOS E QLADLYXIN 4 PA, ST, QLADLYXIN STARTER PACK 4 PA, ST, QLALOGLIPTIN BENZOATE E QLALOGLIPTIN-METFORMIN HCL E QLALOGLIPTIN-PIOGLITAZONE E QLAMARYL EBAQSIMI ONE PACK 2 QLBAQSIMI TWO PACK 2 QLBYDUREON BCISE AUTOINJECTOR2 PA, ST, QLBYETTA 10 MCG PEN 2 PA, ST, QLBYETTA 5 MCG PEN 2 PA, ST, QLFARXIGA E ST, QLglimepiride 1glipizide er 1glipizide ir 1glipizide xl 1glucagon emergency kit 1 mg injection 1 mg2 QLGLUCAGON EMERGENCY KIT 1 MG INJECTION 1 MGE QLGLUCOTROL XL 4GLUMETZA E PAglyburide oral 1glyburide-metformin 1GLYXAMBI 2 ST, QLJANUVIA E ST, QLJARDIANCE 2 ST, QLJENTADUETO 2 QLJENTADUETO XR 2 QLKAZANO 2 QLKOMBIGLYZE XR 2 QLmetformin hcl er 1metformin hcl er (mod) E PAmetformin hcl er (osm) E PAmetformin hcl oral solution 3metformin hcl oral tablet 1000 mg, 500 mg, 850 mg1metformin hcl oral tablet 625 mg EMOUNJARO 2 PA, ST, QLNESINA 2 QLONGLYZA 2 QLOSENI 2 QLOZEMPIC SUBCUTANEOUS SOLUTION PEN-INJECTOR 2 MG/1.5ML, 4 MG/3ML2 PA, ST, QLOZEMPIC SUBCUTANEOUS SOLUTION PEN-INJECTOR 8 MG/3ML2 PA, STpioglitazone hcl 1 QLRIOMET ERYBELSUS 2 PA, ST, QLSOLIQUA 2 QLSYMLINPEN 120 3 QLSYMLINPEN 60 3 QLSYNJARDY 2 QLSYNJARDY XR 2 QLTRADJENTA 2 QLTRIJARDY XR 2 QLTRULICITY 2 PA, ST, QLVICTOZA SOLUTION PEN-INJECTOR 18 MG/3ML SUBCUTANEOUS2 PA, ST, (2 Pak), QLVICTOZA SOLUTION PEN-INJECTOR 18 MG/3ML SUBCUTANEOUS3 PA, ST, (3 Pak), QLZEGALOGUE SUBCUTANEOUS SOLUTION AUTO-INJECTOR2 QLDrugs for Blood DisordersADVATE 2 SPADYNOVATE 4 PA, SPAFSTYLA INTRAVENOUS KIT 1000 UNIT, 2000 UNIT, 250 UNIT, 3000 UNIT, 500 UNIT4PA, SPAFSTYLA INTRAVENOUS KIT 1500 UNIT, 2500 UNIT4 PA, SP26

Drug Name Drug RequirementsTier & LimitsB BB gBBBgBBBBBBgBBBBBBBBBBBgBBgggBgBggBBBgBgBB gBB BBgBBB BBBBBBgBBSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & LimitsALPHANATE 2 SPARANESP (ALBUMIN FREE) 2 QL, SPDOPTELET 4 PA, ST, QL, SPELOCTATE 4 PA, SPEMPAVELI 2 PA, QL, SPHEMOFIL M 2 SPHUMATE-P 2 SPJIVI 4 PA, SPKOATE 2 SPKOATE-DVI 2 SPKOGENATE FS 2 SPKOVALTRY 2 SPMULPLETA 2 PA, QL, SPNEULASTA 3SPNOVOEIGHT 2 SPNUWIQ INTRAVENOUS KIT 1000 UNIT, 2000 UNIT, 250 UNIT, 2500 UNIT, 3000 UNIT, 4000 UNIT, 500 UNIT2 SPNUWIQ INTRAVENOUS KIT 1500 UNIT2SPNUWIQ INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT, 2000 UNIT, 250 UNIT, 2500 UNIT, 3000 UNIT, 4000 UNIT, 500 UNIT2 SPNUWIQ INTRAVENOUS SOLUTION RECONSTITUTED 1500 UNIT2SPRECOMBINATE 2 SPRETACRIT INJECTION SOLUTION 10000 UNIT/ML, 2000 UNIT/ML, 3000 UNIT/ML, 4000 UNIT/ML, 40000 UNIT/ML2 QL, SPRETACRIT INJECTION SOLUTION 20000 UNIT/ML2SPTAVALISSE 4 PA, QL, SPWILATE 2ZARXIO 2SPZIEXTENZO 3 SPDrugs for Sexual DysfunctionADDYI 4 PA, QLCIALIS E QLIMVEXXY MAINTENANCE PACK 2 QLIMVEXXY STARTER PACK 2 QLINTRAROSA 4 PA, QLOSPHENA 3 PA, QLsildenafil citrate oral tablet 100 mg, 25 mg, 50 mg2 QLSTENDRA 4 PA, QLtadalafil oral 2 QLVIAGRA E QLVYLEESI 4 PA, QLElectrolytes / Vitaminscyanocobalamin injection solution 1000 mcg/ml1CYANOCOBALAMIN INJECTION SOLUTION 2000 MCG/ML3DODEX 4DRISDOL 4ERGOCAL 3ergocalciferol oral capsule 1FLORIVA PLUS 3folic acid oral tablet 1 mg 1klor-con 1klor-con 10 1klor-con m10 1klor-con m15 3klor-con m20 1K-TAB 3LOKELMA 3 PA, QLmulti-vitamin/fluoride 1multivitamin/fluoride tablet chewable 0.25 mg oral (rx)1MULTIVITAMIN/FLUORIDE TABLET CHEWABLE 0.25 MG ORAL (RX)3multivitamin/fluoride tablet chewable 0.5 mg oral1MULTIVITAMIN/FLUORIDE TABLET CHEWABLE 0.5 MG ORAL3multivitamin/fluoride tablet chewable 1 mg oral1MULTIVITAMIN/FLUORIDE TABLET CHEWABLE 1 MG ORAL3MULTI-VIT-FLOR 3NASCOBAL 3POLY-VI-FLOR 3potassium chloride crys er oral tablet extended release 10 meq, 20 meq127

Drug Name Drug RequirementsTier & LimitsggBg BgggBggBgBgBBBBgBgggggBBBBBBBBBBBBBgBBBBggBgggBBBgBgBBBBBBBBgggggSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & Limitspotassium chloride crys er oral tablet extended release 15 meq3potassium chloride er 1potassium chloride oral packet 1potassium chloride oral solution 20 meq/15ml (10%), 40 meq/15ml (20%)1potassium citrate er 1PRENA1 PEARL 3QUFLORA PEDIATRIC 3UROCIT-K 10 4UROCIT-K 15 4UROCIT-K 5 4VELTASSA 3 PA, QLvitamin d (ergocalciferol) oral capsule 1.25 mg (50000 ut), 50000 unit1VITAPEARL 3Gastrointestinal Agents - Drugs for Acid Reflux and UlcerACIPHEX E QLCARAFATE ECYTOTEC 4DEXILANT E QLDEXLANSOPRAZOLE E QLfamotidine oral suspension reconstituted1FIRST-OMEPRAZOLE 3 PAmisoprostol oral 1OMECLAMOX-PAK 3 QLomeprazole oral capsule delayed release1OMEPRAZOLE+SYRSPEND SF ALKA3 PApantoprazole sodium oral packet Epantoprazole sodium oral tablet delayed release1PROTONIX ORAL EPYLERA 3 QLRABEPRAZOLE SODIUM ORAL CAPSULE SPRINKLEE QLrabeprazole sodium oral tablet delayed release2 QLsucralfate oral suspension 3sucralfate oral tablet 1Gastrointestinal Agents - Drugs for Bowel, Intestine and Stomach ConditionsANASPAZ 2CLENPIQ 3dicyclomine hcl oral 1diphenoxylate-atropine 1ED-SPAZ 3gavilyte-c 1 Hgavilyte-g 1 QL, Hglycopyrrolate oral tablet 1 mg, 2 mg1GOLYTELY 4 QLhyoscyamine sulfate er 1hyoscyamine sulfate oral 1hyoscyamine sulfate sl 1hyoscyamine sulfate sublingual 1hyosyne 1LEVBID 4LEVSIN ORAL 4LEVSIN/SL 4LINZESS 2 PA, QLLOMOTIL 4MOTEGRITY 3 PA, QLMOVIPREP 3 QLNA SULFATE-K SULFATE-MG SULF 3 QLNULEV 4OSCIMIN 4peg-3350/electrolytes 1 QL, Hpeg-3350/electrolytes/ascorbat 3 QLpeg-kcl-nacl-nasulf-na asc-c 3 QLPLENVU 3 QLRELTONE ESUPREP BOWEL PREP KIT 3 QLSUTAB 3SYMPROIC 2 PA, QLURSO 250 EURSO FORTE EURSODIOL ORAL CAPSULE 200 MG, 400 MGEursodiol oral capsule 300 mg 1ursodiol oral tablet 128

Drug Name Drug RequirementsTier & LimitsB BB ggBBBB gB BB gg gB gB BB gg gg gB gB gBgBgggBgBgBgBgBggBBBgggggggggBgBgBgBgBBBggggBSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & LimitsVIBERZI 4 PA, QLZELNORM 3 PA, ST, QLGenetic or Enzyme Disorder - Drugs for Replacement, Modification, TreatmentCERDELGA 2 PA, SPCREON 2CUPRIMINE E SPDEPEN TITRATABS 2 SPENDARI 4 PA, QLnitisinone E PA, SPNITYR E PAORFADIN 2 PA, SPPANCREAZE 3 STpenicillamine oral capsule E SPpenicillamine oral tablet 2 SPPERTZYE 4 STSTRENSIQ 2 PA, QL, SPSYPRINE E PA, SPTEGSEDI 2 PA, QL, SPtrientine hcl 3 PA, SPVIOKACE 4 STZENPEP 2Genitourinary Agents - Drugs for Bladder, Genital and Kidney ConditionsAURYXIA EDITROPAN XL Efesoterodine fumarate er EGELNIQUE Eoxybutynin chloride er 2oxybutynin chloride oral 1phenazo oral tablet 200 mg 1phenazopyridine hcl oral tablet 100 mg, 200 mg1PYRIDIUM 3THIOLA 4 SPTHIOLA EC 3 SPTOVIAZ EVELPHORO 2Genitourinary Agents - Drugs for Prostate Conditionsalfuzosin hcl er 1finasteride oral tablet 5 mg 1FLOMAX EPROSCAR Etamsulosin hcl 1terazosin hcl 1UROXATRAL EHormonal Agents - Hormone Replacement and Birth Controlafirmelle 1 HALORA 3 QLaltavera 1 Halyacen 1/35 1 Hamethia 3ANNOVERA 3 QLapri 1 Hashlyna 3aubra 1 Haubra eq 1 Haurovela 1.5/30 1Haurovela 1/20 1Haurovela 24 fe 1Haurovela fe 1.5/30 1 Haurovela fe 1/20 1 Haviane 1 HAYGESTIN 4ayuna 1 Hazurette 2balziva 1HBEYAZ EBIJUVA 3blisovi 24 fe 1Hblisovi fe 1.5/30 1 Hblisovi fe 1/20 1 Hbriellyn 1Hcamila 1 Hcamrese 3camrese lo 3chateal 1 Hchateal eq 1 HCLIMARA E QLCLIMARA PRO 3 QLcryselle-28 1 Hcyred 1 H29

Drug Name Drug RequirementsTier & Limitsg gggggggBgBggBggggBBBgBBggggggggBgBgggggggggggggBgggggggggggggggggSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & Limitscyred eq 1 Hdasetta 1/35 1 Hdaysee 3deblitane 1 Hdelyla 1 HDEPO-PROVERA INTRAMUSCULAR SUSPENSION4 QLDEPO-PROVERA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE4 QLDEPO-SUBQ PROVERA 104 2 QLdesogestrel-ethinyl estradiol oral tablet 0.15-0.02/0.01 mg (21/5)2desogestrel-ethinyl estradiol oral tablet 0.15-30 mg-mcg1 HDIVIGEL TRANSDERMAL GEL 0.25 MG/0.25GM, 0.5 MG/0.5GM, 0.75 MG/0.75GM, 1 MG/GM3DIVIGEL TRANSDERMAL GEL 1.25 MG/1.25GM3dotti 2 QLdrospiren-eth estrad-levomefol Edrospirenone-ethinyl estradiol 3DUAVEE 3 QLELESTRIN 3elinest 1 Heluryng 1 Hemoquette 1 Henskyce 1 Herrin 1 Hestarylla 1 HESTRACE Eestradiol oral 1estradiol patch twice weekly 0.025 mg/24hr transdermal2 (generic for Minivelle), QLestradiol patch twice weekly 0.025 mg/24hr transdermal2 (generic for Vivelle-Dot), QLestradiol patch twice weekly 0.0375 mg/24hr transdermal2 (generic for Minivelle), QLestradiol patch twice weekly 0.0375 mg/24hr transdermal2 (generic for Vivelle-Dot), QLestradiol patch twice weekly 0.05 mg/24hr transdermal2 (generic for Minivelle), QLestradiol patch twice weekly 0.05 mg/24hr transdermal2 (generic for Vivelle-Dot), QLestradiol patch twice weekly 0.075 mg/24hr transdermal2 (generic for Minivelle), QLestradiol patch twice weekly 0.075 mg/24hr transdermal2 (generic for Vivelle-Dot), QLestradiol patch twice weekly 0.1 mg/24hr transdermal2 (generic for Minivelle), QLestradiol patch twice weekly 0.1 mg/24hr transdermal2 (generic for Vivelle-Dot), QLestradiol transdermal patch weekly 1 (generic for Climara), QLestradiol vaginal cream 3estradiol vaginal tablet 2ESTRING 2 QLESTROGEL 3 QLetonogestrel-ethinyl estradiol 1 HEVAMIST 2falmina 1 Hfayosim Efemynor 1 Hgemmily Ehailey 1.5/30 1Hhailey 24 fe 1Hhailey fe 1.5/30 1 Hhailey fe 1/20 1 Hheather 1 Hiclevia 2 Hincassia 1 Hintrovale 2 Hisibloom 1 Hjaimiess 3jasmiel 3jencycla 1 Hjolessa 2 Hjuleber 1 Hjunel 1.5/30 1Hjunel 1/20 1Hjunel fe 1.5/30 1 Hjunel fe 1/20 1 Hjunel fe 24 1Hkalliga 1 H30

Drug Name Drug RequirementsTier & Limitsg gggggggggg gg Bg Bg Bg gg BBggggggggggBgBgBgBgBgggBgggggggggggBggggg gggggBggSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & Limitskariva 2kurvelo 1 Hlarin 1.5/30 1Hlarin 1/20 1Hlarin 24 fe 1Hlarin fe 1.5/30 1 Hlarin fe 1/20 1 Hlarissia 1 Hlessina 1 Hlevonorgest-eth est & eth est Elevonorgest-eth estrad 91-day oral tablet 0.1-0.02 & 0.01 mg, 0.15-0.03 &0.01 mg3levonorgest-eth estrad 91-day oral tablet 0.15-0.03 mg2 Hlevonorgestrel-ethinyl estrad oral tablet 0.1-20 mg-mcg, 0.15-30 mg-mcg1 Hlevora 0.15/30 (28) 1 Hlillow oral tablet 0.15-30 mg-mcg 1 HLO LOESTRIN FE 1HLOESTRIN 1.5/30 (21) ELOESTRIN 1/20 (21) ELOESTRIN FE 1.5/30 ELOESTRIN FE 1/20 Elojaimiess 3loryna 3LOSEASONIQUE 4low-ogestrel 1 Hlo-zumandimine 3lutera 1 Hlyleq 1 Hlyllana 4 QLlyza 1 Hmarlissa 1 Hmedroxyprogesterone acetate intramuscular suspension1 QL, Hmedroxyprogesterone acetate intramuscular suspension prefilled syringe1 Hmedroxyprogesterone acetate oral 1MENOSTAR 3 QLmerzee Emicrogestin 1.5/30 1Hmicrogestin 1/20 1Hmicrogestin 24 fe 1Hmicrogestin fe 1.5/30 1 Hmicrogestin fe 1/20 1 Hmili 1 HMINASTRIN 24 FE EMINIVELLE E QLMIRCETTE Emono-linyah 1 HMYFEMBREE 2 PA, QLNATAZIA 2necon 0.5/35 (28) 1 Hnikki 3nora-be 1 Hnorethin ace-eth estrad-fe oral capsuleEnorethin ace-eth estrad-fe oral tablet1 Hnorethindrone acetate oral 1norethindrone acet-ethinyl est 1Hnorethindrone oral 1 Hnorgestimate-eth estradiol 1 Hnorgestimate-ethinyl estradiol triphasic oral tablet 0.18/0.215/ 0.25 mg-25 mcg2norgestimate-ethinyl estradiol triphasic oral tablet 0.18/0.215/ 0.25 mg-35 mcg1 Hnorlyda 1 Hnorlyroc 1 Hnortrel 0.5/35 (28) 1 Hnortrel 1/35 (21) 1 Hnortrel 1/35 (28) 1 HNUVARING Enylia 1/35 1 Hnymyo 1 Hocella 3philith 1Hpimtrea 2pirmella 1/35 1 Hportia-28 1 H31

Drug Name Drug RequirementsTier & LimitsB BB gB gBgggBgBBgBggBgBgggBgBgBggggggggg ggBgBBBgggBggBgBgB ggggBgBgBgggggBgggggSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & LimitsPREMARIN ORAL 3PREMARIN VAGINAL 3PREMPHASE 3PREMPRO 3progesterone oral 2PROVERA 4QUARTETTE Ereclipsen 1 Hrivelsa ESAFYRAL ESEASONIQUE Esetlakin 2 Hsharobel 1 Hsimliya 2simpesse 3sprintec 28 1 Hsronyx 1 Hsyeda 3tarina 24 fe 1Htarina fe 1/20 1 Htarina fe 1/20 eq 1 Htaysofy ETAYTULLA Etri femynor 1 Htri-estarylla 1 Htri-linyah 1 Htri-lo-estarylla 2tri-lo-marzia 2tri-lo-mili 2tri-lo-sprintec 2tri-mili 1 Htri-nymyo 1 Htri-sprintec 1 Htri-vylibra 1 Htri-vylibra lo 2tyblume 1 Htydemy EVAGIFEM Evestura 3vienva 1 Hviorele 2VIVELLE-DOT E QLvolnea 2vyfemla 1Hvylibra 1 Hwera 1 Hxulane 3 HYASMIN 28 2YAZ 2yuvafem 2zafemy 3 Hzumandimine 3Hormonal Agents - Oral SteroidsALKINDI SPRINKLE E PACORTEF 4DEXABLISS Edexamethasone intensol 1dexamethasone oral elixir 1dexamethasone oral solution 1dexamethasone oral tablet 1dexamethasone oral tablet therapy pack3DXEVO 11-DAY EHEMADY EHIDEX 6-DAY Ehydrocortisone oral 1MEDROL ORAL TABLET 16 MG, 4 MG, 8 MG4MEDROL ORAL TABLET 2 MG 2MEDROL ORAL TABLET 32 MG 3MEDROL ORAL TABLET THERAPY PACK4methylprednisolone oral 1MILLIPRED 2ORAPRED ODT 4PEDIAPRED 2prednisolone oral 1prednisolone sodium phosphate oral solution 10 mg/5ml, 25 mg/5ml, 6.7 (5 base) mg/5mlEprednisolone sodium phosphate oral solution 15 mg/5ml1prednisolone sodium phosphate oral solution 20 mg/5mlE QL32

Drug Name Drug RequirementsTier & Limitsg BgBgBBBBBBBgBgBBBgBBBBggBggBgBgBgBgBgBgBBBBBBBBBgBBBBBBBBBBBBgBgBBSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & Limitsprednisolone sodium phosphate oral tablet dispersible1prednisone intensol 1prednisone oral 1RAYOS ETAPERDEX 12-DAY 3TAPERDEX 6-DAY ORAL TABLET THERAPY PACK 1.5 MG4TAPERDEX 6-DAY ORAL TABLET THERAPY PACK 1.5 MG (21)3TAPERDEX 7-DAY 3ZCORT 7-DAY EHormonal Agents - Othercabergoline 2DDAVP EDDAVP PF Edesmopressin acetate injection 1DESMOPRESSIN ACETATE NASAL 3desmopressin acetate oral 1desmopressin acetate pf 1GENOTROPIN E PA, QL, SPGENOTROPIN MINIQUICK E PA, QL, SPHUMATROPE E PA, QL, SPLANREOTIDE ACETATE E SPNOCDURNA 3 PA, QLNORDITROPIN FLEXPRO 2 PA, QL, SPNUTROPIN AQ NUSPIN 10 2 PA, QL, SPNUTROPIN AQ NUSPIN 20 2 PA, QL, SPNUTROPIN AQ NUSPIN 5 2 PA, QL, SPOMNITROPE E PA, QL, SPORIAHNN 2 PA, QLORILISSA 2 PA, QLSOMATULINE DEPOT 4 SPSTIMATE 3ZOMACTON E PA, QL, SPHormonal Agents - Testosterone ReplacementANDRODERM 2 PA, QLANDROGEL PUMP E PA, QLANDROGEL TRANSDERMAL GEL 25 MG/2.5GM (1%), 40.5 MG/2.5GM (1.62%), 50 MG/5GM (1%)E PA, QLDEPO-TESTOSTERONE INTRAMUSCULAR SOLUTION 100 MG/ML3DEPO-TESTOSTERONE INTRAMUSCULAR SOLUTION 200 MG/ML4FORTESTA E PA, QLNATESTO E PA, QLTESTIM 2 PA, QLtestosterone cypionate intramuscular1testosterone transdermal E PA, QLVOGELXO E PA, QLVOGELXO PUMP E PA, QLHormonal Agents - ThyroidARMOUR THYROID 3CYTOMEL Eeuthyrox 1levo-t 1LEVOTHYROXINE SODIUM ORAL CAPSULEElevothyroxine sodium oral tablet 1levoxyl 2liothyronine sodium oral 2methimazole oral 1np thyroid 1SYNTHROID ETHYQUIDITY E PATIROSINT ETIROSINT-SOL 2 PAunithroid 1Immunological Agents - Drugs for Immune System Stimulation or SuppressionACTEMRA ACTPEN 3 PA, ST, QL, SPACTEMRA SUBCUTANEOUS 3 PA, ST, QL, SPADBRY 2 PA, SPASTAGRAF XL EAZASAN 4azathioprine oral tablet 100 mg, 75 mg3azathioprine oral tablet 50 mg 1BERINERT 4 PA, ST, QL, SPCELLCEPT E33

Drug Name Drug RequirementsTier & LimitsB gB gB gB gB BB BBBBBBBBBBBBgBBBBBBBBBBBBgBBggBgBBBBBBBBgBBBBBBgBBBBBBgSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & LimitsCIMZIA E PACIMZIA PREFILLED KIT 2 PA, QL, SPCIMZIA STARTER KIT 2 PA, QL, SPCINRYZE E PA, QL, SPCOSENTYX (300 MG DOSE) 3 PA, ST, QL, SPCOSENTYX 150 MG/ML SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 150 MG/ML3 PA, ST, QL, SPCOSENTYX 150 MG/ML SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 75 MG/0.5ML3PA, ST, QL, SPCOSENTYX SENSOREADY (300 MG)3 PA, ST, QL, SPCOSENTYX SENSOREADY PEN 3 PA, ST, QL, SPcyclosporine modified 1ENBREL MINI 4 PA, ST, QL, SPENBREL SUBCUTANEOUS SOLUTION4PA, ST, QL, SPENBREL SUBCUTANEOUS SOLUTION PREFILLED SYRINGE4 PA, ST, QL, SPENBREL SURECLICK 4 PA, ST, QL, SPENVARSUS XR EFIRAZYR E PA, QL, SPgengraf 1HAEGARDA 2 PA, QL, SPHUMIRA 2 PA, QL, SPHUMIRA PEDIATRIC CROHNS START2 PA, QL, SPHUMIRA PEN 2 PA, QL, SPHUMIRA PEN-CD/UC/HS STARTER 2 PA, QL, SPHUMIRA PEN-PEDIATRIC UC START2 PA, QL, SPHUMIRA PEN-PS/UV/ADOL HS START2 PA, QL, SPHUMIRA PEN-PSOR/UVEIT STARTER2 PA, QL, SPicatibant acetate 2 PA, QL, SPIMURAN EMAYZENT STARTER PACK ORAL TABLET THERAPY PACK 0.25 MG4PA, QL, SPMAYZENT STARTER PACK ORAL TABLET THERAPY PACK 12 X 0.25 MG3 PA, QL, SPmethotrexate oral 1methotrexate sodium 1methotrexate sodium (pf) 1mycophenolate mofetil oral 1mycophenolate sodium 2MYFORTIC ENEORAL EOLUMIANT ORAL TABLET 1 MG 2 PA, QL, SPOLUMIANT ORAL TABLET 2 MG 2 PA, QL, SPOLUMIANT ORAL TABLET 4 MG E PA, SPORENCIA CLICKJECT 3 PA, ST, QL, SPORENCIA SUBCUTANEOUS 3 PA, ST, QL, SPOTEZLA 2 PA, QL, SPOTREXUP E QLPROGRAF ORAL CAPSULE 4PROGRAF ORAL PACKET 4 PARAPAMUNE ORAL SOLUTION 4RAPAMUNE ORAL TABLET ERASUVO 2 QLREDITREX E QLRINVOQ 2 PA, QL, SPRUCONEST 4 PA, QL, SPsajazir E PA, QL, SPSIMPONI 2 PA, QL, SPsirolimus oral solution 2sirolimus oral tablet 1SKYRIZI SUBCUTANEOUS SOLUTION CARTRIDGEESKYRIZI SUBCUTANEOUS SOLUTION PREFILLED SYRINGE2 PA, QL, SPSTELARA SUBCUTANEOUS 2 PA, QL, SPtacrolimus oral 1TAKHZYRO 2 PA, QL, SPTREMFYA 2 PA, QL, SPTREXALL 2XELJANZ 2 PA, QL, SPXELJANZ XR ORAL TABLET EXTENDED RELEASE 24 HOUR 11 MG2 PA, QL, SPXELJANZ XR ORAL TABLET EXTENDED RELEASE 24 HOUR 22 MG2 PA, QL, SPXOLAIR SUBCUTANEOUS SOLUTION PREFILLED SYRINGE2 PA, QL, SP34

Drug Name Drug RequirementsTier & LimitsB BBBBBgBBBBBBgggBBggBBBBgBBBBBBBBBBBBBBBBggBgBBgBgBBBBgBggBBBgBgBggBBSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & LimitsXOLAIR SUBCUTANEOUS SOLUTION RECONSTITUTEDE PA, SPInfertility AgentsCHORIONIC GONADOTROPIN INTRAMUSCULAR4 SPCRINONE 4 STENDOMETRIN 2FOLLISTIM AQ 2 SPfyremadel 3 QL, SPganirelix acetate solution prefilled syringe 250 mcg/0.5ml subcutaneous2 (Merck/ Organon), QL, SPganirelix acetate solution prefilled syringe 250 mcg/0.5ml subcutaneous4 (Ferring), QL, SPNOVAREL 3 SPPREGNYL 1 SPInflammatory Bowel Disease AgentsANALPRAM HC 4ANALPRAM HC SINGLES 4ANALPRAM-HC EXTERNAL CREAM4ANALPRAM-HC EXTERNAL LOTION3APRISO 2ASACOL HD EAZULFIDINE 4AZULFIDINE EN-TABS 4budesonide er Ebudesonide oral 2CANASA ECORTIFOAM 2DELZICOL EDIPENTUM 3hydrocortisone ace-pramoxine external cream 1-1 %1hydrocort-pramoxine (perianal) 1LIALDA 2mesalamine er oral capsule Emesalamine oral Emesalamine rectal enema 1mesalamine rectal suppository 2 QLORTIKOS EPENTASA EPROCORT EPROCTOFOAM HC 2SFROWASA 4sulfasalazine oral 1TARPEYO 4 PA, QL, SPUCERIS ORAL 3UCERIS RECTAL 2Metabolic Bone Disease Agents - Drugs for Osteoporosisalendronate sodium 1BINOSTO E QLBONIVA ORAL TABLET 150 MG Ecalcitriol oral 1FORTEO E PA, ST, SPFOSAMAX 4ibandronate sodium oral 2ROCALTROL 4TERIPARATIDE (RECOMBINANT) 3 PA, SPTYMLOS 3 PA, SPOphthalmic Agents - Drugs for Eye Allergy, Infection and InflammationACULAR 4ACULAR LS 4ACUVAIL EALREX 4 QLAZASITE 3azelastine hcl ophthalmic 1BESIVANCE 3CILOXAN 3ciprofloxacin hcl ophthalmic 1erythromycin ophthalmic 1 H-PAEYSUVIS 4 QLILEVRO EINVELTYS 3ketorolac tromethamine ophthalmic 1KLARITY-A ELASTACAFT 3 QLLOTEMAX OPHTHALMIC GEL ELOTEMAX OPHTHALMIC OINTMENT3LOTEMAX OPHTHALMIC SUSPENSIONE QL35

Drug Name Drug RequirementsTier & LimitsB gggggB gg Bg BBggggBgBBBBBggggggggBBBBBBgBBBBgBBBgBgBBBBBBBgBBBBBBBBgSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & LimitsLOTEMAX SM 3 QLloteprednol etabonate ophthalmic gelEloteprednol etabonate ophthalmic suspension3 QLMAXITROL 4moxifloxacin hcl (2x day) 3moxifloxacin hcl ophthalmic solution3neomycin-polymyxin-dexameth ophthalmic ointment1neomycin-polymyxin-dexameth ophthalmic suspension 3.5-10000-0.11NEVANAC 4OCUFLOX 4ofloxacin ophthalmic 1olopatadine hcl ophthalmic solution 0.1 %3olopatadine hcl ophthalmic solution 0.2 %Epolymyxin b-trimethoprim 1POLYTRIM 4PRED FORTE EPRED MILD 3prednisolone acetate ophthalmic 1TOBRADEX OPHTHALMIC OINTMENT3TOBRADEX OPHTHALMIC SUSPENSION4TOBRADEX ST Etobramycin ophthalmic 1 QLtobramycin-dexamethasone 2TOBREX 3 QLVIGAMOX EZYLET 3Ophthalmic Agents - Drugs for GlaucomaALPHAGAN P OPHTHALMIC SOLUTION 0.1 %2 QLALPHAGAN P OPHTHALMIC SOLUTION 0.15 %4 QLAZOPT E QLBETIMOL 2 QLbimatoprost ophthalmic E QLbrimonidine tartrate ophthalmic solution 0.15 %2 QLbrimonidine tartrate ophthalmic solution 0.2 %1brimonidine tartrate-timolol E QLbrinzolamide 2 QLCOMBIGAN 2 QLCOSOPT 4COSOPT PF E QLdorzolamide hcl-timolol mal 2dorzolamide hcl-timolol mal pf E QLISTALOL 4latanoprost ophthalmic 1LUMIGAN 2RHOPRESSA 3 QLROCKLATAN 3 QLtimolol maleate (once-daily) 3timolol maleate ocudose 2timolol maleate ophthalmic 1timolol maleate pf 2TIMOPTIC 4TIMOPTIC OCUDOSE OPHTHALMIC SOLUTION 0.25 %2TIMOPTIC OCUDOSE OPHTHALMIC SOLUTION 0.5 %4TIMOPTIC-XE 4TRAVATAN Z E QLtravoprost (bak free) E QLVYZULTA E ST, QLXALATAN EXELPROS 3 QLZIOPTAN 3 ST, QLOphthalmic Agents - Drugs for Mi Conditionsscellaneous Eye CEQUA E PA, QLCYCLOSPORINE IN KLARITY E PAcyclosporine ophthalmic E PA, QLFLAREX 2RESTASIS 4 PA, QLRESTASIS MULTIDOSE E PA, QLTYRVAYA 4 PA, QLVERKAZIA E PA, QL36

Drug Name Drug RequirementsTier & LimitsB BgB gg gggg gBBBgg BBBgBgBgBBgBBgBBg BgB BgggggggBgBgBgBBgBgBgBBSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & LimitsXIIDRA 4 PA, QLOtic Agents - Drugs for Ear ConditionsCIPRODEX 3ciprofloxacin-dexamethasone Eneomycin-polymyxin-hc otic 1ofloxacin otic 2Respiratory - Drugs for AnaphylaxisAUVI-Q 2 QLepinephrine injection solution auto-injector 0.15 mg/0.15ml1 (generic for Adrenaclick), QLepinephrine solution auto-injector 0.15 mg/0.3ml injection1 (generic for EpiPen-Single Pack), QLepinephrine solution auto-injector 0.15 mg/0.3ml injection1 (generic for EpiPen), QLepinephrine solution auto-injector 0.3 mg/0.3ml injection1 (generic for Adrenaclick), QLepinephrine solution auto-injector 0.3 mg/0.3ml injection1 (generic for EpiPen-Single Pack), QLepinephrine solution auto-injector 0.3 mg/0.3ml injection1 QLepinephrine solution auto-injector 0.3 mg/0.3ml injection1 (generic for EpiPen), QLEPIPEN 2-PAK E QLEPIPEN JR 2-PAK E QLSYMJEPI 2 QLRespiratory Tract / Pulmonary Agents - Drugs for Allergies, Cough, Coldazelastine hcl nasal solution 0.1 %, 137 mcg/spray3azelastine hcl nasal solution 0.15 % Ebenzonatate oral capsule 100 mg, 200 mg1benzonatate oral capsule 150 mg Ecyproheptadine hcl oral 1fluticasone propionate nasal 2 QLhydrocodone polst-chlorphen polst er susp3 PA, QLipratropium bromide nasal 1levocetirizine dihydrochloride oral solution3levocetirizine dihydrochloride oral tablet1OMNARIS E QLpromethazine hcl oral solution 1promethazine hcl oral syrup 1promethazine-codeine 1 PA, QLpromethazine-dm 1pseudoephedrine-bromphen-dm 1XHANCE E QLZETONNA 3 QLRespiratory Tract / Pulmonary Agents - Drugs for Asthma and COPDADVAIR DISKUS 3 QL, RSADVAIR HFA 3 QL, RSAEROCHAMBER PLUS FLO-VU 3AEROCHAMBER PLUS FLO-VU LARGE3AEROCHAMBER PLUS FLO-VU SMALL3AEROCHAMBER PLUS FLO-VU W/MASK3AIRDUO DIGIHALER E QLAIRDUO RESPICLICK 113/14 E QLAIRDUO RESPICLICK 232/14 E QLAIRDUO RESPICLICK 55/14 E QLalbuterol sulfate hfa aerosol solution 108 (90 base) mcg/act inhalation2 QLalbuterol sulfate hfa aerosol solution 108 (90 base) mcg/act inhalation2 (ProAir HFA or Proventil HFA), QLALBUTEROL SULFATE HFA AEROSOL SOLUTION 108 (90 BASE) MCG/ACT INHALATIONE (Ventolin HFA), QLalbuterol sulfate inhalation 1albuterol sulfate oral syrup 1albuterol sulfate oral tablet 3 PAALVESCO E QLANORO ELLIPTA 3 QLARCAPTA NEOHALER 3ARMONAIR DIGIHALER E QLARNUITY ELLIPTA 1 QLASMANEX (120 METERED DOSES) E QLASMANEX (14 METERED DOSES) E QLASMANEX (30 METERED DOSES) E QLASMANEX (60 METERED DOSES) E QL37

Drug Name Drug RequirementsTier & LimitsB BBBBBBBgBBBBBBBBBBBBBBBBBBBBBBBBgBBBBBBBBggBBBBBBBBBBgBBBBgBggSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & LimitsASMANEX HFA E QLATROVENT HFA 3 QLBEVESPI AEROSPHERE 2 QLBREO ELLIPTA 3 QL, RSBREZTRI AEROSPHERE 3 QL, RSbudesonide inhalation 2 QLBUDESONIDE-FORMOTEROL FUMARATEE QL, RSCOMBIVENT RESPIMAT 3 QLEASIVENT 3EASIVENT MASK LARGE 3EASIVENT MASK MEDIUM 3EASIVENT MASK SMALL 3FASENRA PEN 4 PA, QLFLEXICHAMBER 3FLOVENT DISKUS 1 QLFLOVENT HFA 1 QLFLUTICASONE FUROATE-VILANTEROLE QL, RSFLUTICASONE PROPIONATE HFA E QLfluticasone-salmeterol inhalation aerosol powder breath activated 100-50 mcg/act, 250-50 mcg/act, 500-50 mcg/actE QL, RSFLUTICASONE-SALMETEROL INHALATION AEROSOL POWDER BREATH ACTIVATED 113-14 MCG/ ACT, 232-14 MCG/ACT, 55-14 MCG/ ACT2 QLformoterol fumarate inhalation 3 QLINCRUSE ELLIPTA E QLINSPIRACHAMBER/LARGE 3INSPIRACHAMBER/MEDIUM 3INSPIRACHAMBER/MOUTHPIECE 3INSPIRACHAMBER/SMALL 3INSPIREASE 3ipratropium-albuterol 2LEVALBUTEROL HFA INHALATION AEROSOL 45 MCG/ACT3 QLmontelukast sodium oral packet 2montelukast sodium oral tablet 1montelukast sodium oral tablet chewable1NUCALA SUBCUTANEOUS SOLUTION AUTO-INJECTOR4 PA, QL, SPNUCALA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MG/ML4 PA, QL, SPNUCALA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 40 MG/0.4ML4PA, QL, SPPERFOROMIST 4 QLPROAIR HFA E QLPROAIR RESPICLICK E QLPROVENTIL HFA E QLPULMICORT FLEXHALER 1 QLPULMICORT SUSPENSION E QLQVAR REDIHALER E QLSEREVENT DISKUS 2 QLSINGULAIR ORAL PACKET 3SINGULAIR ORAL TABLET ESINGULAIR ORAL TABLET CHEWABLEESPIRIVA HANDIHALER 2 QLSPIRIVA RESPIMAT 2 QLSTIOLTO RESPIMAT 2 QLSTRIVERDI RESPIMAT 2 QLSYMBICORT 3 QL, RSTRELEGY ELLIPTA 3 QL, RSVENTOLIN HFA E QLVORTEX VALVED HOLDING CHAMBER2wixela inhub E QL, RSXOPENEX HFA 3 QLYUPELRI 4 PA, QLRespiratory Tract / Pulmonary Agents - Drugs for Cystic FibrosisBETHKIS E PA, QL, SPBRONCHITOL 3 PA, ST, QL, SPBRONCHITOL TOLERANCE TEST 3 PA, ST, QL, SPKITABIS PAK E PA, QL, SPPULMOZYME 2 PA, QL, SPTOBI NEBULIZATION SOLUTION 300 MG/5ML INHALATION 300 MG/5MLEPA, QL, SP38

Drug Name Drug RequirementsTier & LimitsB BggBBgBgBBBBBBgBBggBBBBBBggBBBBBBBgBgBgBBBggggggBBBggBSee page 6, 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY (referred to as First Start in New Jersey).Drug Name Drug TierRequirements & LimitsTOBI NEBULIZATION SOLUTION 300 MG/5ML INHALATION 300 MG/5MLE PA, QL, SPTOBI PODHALER 3 PA, QL, SPtobramycin inhalation nebulization solution 300 mg/4ml2 PA, QL, SPtobramycin nebulization solution 300 mg/5ml inhalationE PA, QL, SPTOBRAMYCIN NEBULIZATION SOLUTION 300 MG/5ML INHALATIONE PA, QL, SPRespiratory Tract / Pulmonary Agents - Drugs for Pulmonary HypertensionADEMPAS 2 PA, QL, SPbosentan 2 PA, QL, SPOPSUMIT 2 PA, QL, SPREMODULIN E PATRACLEER 2 PA, QL, SPtreprostinil EPA, SPTYVASO DPI MAINTENANCE KIT EPA, SPTYVASO DPI TITRATION KIT EPA, SPTYVASO INHALATION POWDER EPA, SPTYVASO INHALATION SOLUTION 2 PA, SPTYVASO REFILL 2 PA, SPTYVASO STARTER 2 PA, SPSkeletal Muscle Relaxants - Drugs for Muscle Pain and SpasmAMRIX EBACLOFEN ORAL SOLUTION 4 PAbaclofen oral tablet 1carisoprodol oral tablet 250 mg Ecarisoprodol oral tablet 350 mg 1cyclobenzaprine hcl er Ecyclobenzaprine hcl oral tablet 10 mg, 5 mg1cyclobenzaprine hcl oral tablet 7.5 mgEFEXMID EFLEQSUVY 4 PALYVISPAH Emetaxalone 3methocarbamol oral 1OZOBAX 4 PASOMA Etizanidine hcl oral capsule 3tizanidine hcl oral tablet 1VANADOM EZANAFLEX 4Sleep Disorder AgentsAMBIEN E QLAMBIEN CR E QLBELSOMRA 4 ST, QLDAYVIGO 4 ST, QLEDLUAR E QLeszopiclone 2 QLLUNESTA E QLmodafinil 2 PA, QLPROVIGIL E PA, QLRESTORIL 4SUNOSI 3 PA, QLtemazepam 1WAKIX 4 PA, QL, SPXYREM 4 PA, QL, SPXYWAV 4 PA, QL, SPzolpidem tartrate er 3 QLzolpidem tartrate oral 1 QLzolpidem tartrate sublingual E QLZOLPIMIST 4 ST, QL39

IndexAABILIFY . . . . . . . . . . . . . . . . . . . . . . . . 15ABSORICA . . . . . . . . . . . . . . . . . . . . . . 20ACCU-CHEK AVIVA PLUS TEST STRIPS . . . . . . . . . . . . . . . . . . . . . . . . . 23ACCU-CHEK FASTCLIX LANCET KIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23ACCU-CHEK FASTCLIX LANCETS . . 23ACCU-CHEK GUIDE KIT W/DEVICE . 23ACCU-CHEK GUIDE TEST STRIPS . . 23ACCU-CHEK MULTICLIX LANCET KIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23ACCU-CHEK MULTICLIX LANCETS . 23ACCU-CHEK SAFE-T PRO LANCETS . . . . . . . . . . . . . . . . . . . . . . . 23ACCU-CHEK SMARTVIEW TEST STRIPS . . . . . . . . . . . . . . . . . . . . . . . . . 23ACCU-CHEK SOFT TOUCH LANCETS . . . . . . . . . . . . . . . . . . . . . . . 23ACCU-CHEK SOFTCLIX LANCET DEVICE KIT . . . . . . . . . . . . . . . . . . . . . 23ACCU-CHEK SOFTCLIX LANCETS. . 23ACCUPRIL . . . . . . . . . . . . . . . . . . . . . . 16accutane . . . . . . . . . . . . . . . . . . . . . . . . 20ACCUTREND GLUCOSE . . . . . . . . . . 23acetaminophen-codeine . . . . . . . . . . . . 8acetaminophen-codeine #2 . . . . . . . . . 8acetaminophen-codeine #3 . . . . . . . . . 8acetaminophen-codeine #4 . . . . . . . . . 8acetazolamide er . . . . . . . . . . . . . . . . . 16acetazolamide oral . . . . . . . . . . . . . . . 16ACIPHEX . . . . . . . . . . . . . . . . . . . . . . . 28ACTEMRA ACTPEN . . . . . . . . . . . . . . 33ACTEMRA SUBCUTANEOUS . . . . . . 33ACTICLATE . . . . . . . . . . . . . . . . . . . . . 10ACTOS . . . . . . . . . . . . . . . . . . . . . . . . . 26ACULAR . . . . . . . . . . . . . . . . . . . . . . . . 35ACULAR LS . . . . . . . . . . . . . . . . . . . . . 35ACUVAIL . . . . . . . . . . . . . . . . . . . . . . . . 35acyclovir oral . . . . . . . . . . . . . . . . . . . . 15ACZONE . . . . . . . . . . . . . . . . . . . . . . . . 20ADBRY . . . . . . . . . . . . . . . . . . . . . . . . . 33ADDERALL . . . . . . . . . . . . . . . . . . . . . 19ADDERALL XR . . . . . . . . . . . . . . . . . . 19ADDYI . . . . . . . . . . . . . . . . . . . . . . . . . . 27ADEMPAS . . . . . . . . . . . . . . . . . . . . . . 39ADHANSIA XR . . . . . . . . . . . . . . . . . . . 19 ADLARITY . . . . . . . . . . . . . . . . . . . . . . 12ADLYXIN . . . . . . . . . . . . . . . . . . . . . . . . 26ADLYXIN STARTER PACK . . . . . . . . . 26ADMELOG . . . . . . . . . . . . . . . . . . . . . . 25ADMELOG SOLOSTAR . . . . . . . . . . . . 25ADVAIR DISKUS . . . . . . . . . . . . . . . . . 37ADVAIR HFA . . . . . . . . . . . . . . . . . . . . . 37ADVATE . . . . . . . . . . . . . . . . . . . . . . . . 26ADYNOVATE . . . . . . . . . . . . . . . . . . . . 26AEROCHAMBER PLUS FLO-VU . . . . 37AEROCHAMBER PLUS FLO-VU LARGE . . . . . . . . . . . . . . . . . . . . . . . . . 37AEROCHAMBER PLUS FLO-VU SMALL . . . . . . . . . . . . . . . . . . . . . . . . . 37AEROCHAMBER PLUS FLO-VU W/MASK . . . . . . . . . . . . . . . . . . . . . . . . 37afirmelle . . . . . . . . . . . . . . . . . . . . . . . . 29AFREZZA . . . . . . . . . . . . . . . . . . . . . . . 25AFSTYLA INTRAVENOUS KIT 1000 UNIT, 2000 UNIT, 250 UNIT, 3000 UNIT, 500 UNIT . . . . . . . . . . . . . . . . . . 26AFSTYLA INTRAVENOUS KIT 1500 UNIT, 2500 UNIT . . . . . . . . . . . . . . . . . 26AIMOVIG. . . . . . . . . . . . . . . . . . . . . . . . 13AIMOVIG SUBCUTANEOUS SOLUTION AUTO-INJECTOR 140 MG/ML . . . . . . . . . . . . . . . . . . . . . 13AIRDUO DIGIHALER . . . . . . . . . . . . . . 37AIRDUO RESPICLICK 113/14 . . . . . . 37AIRDUO RESPICLICK 232/14 . . . . . . 37AIRDUO RESPICLICK 55/14 . . . . . . . 37ALA SCALP . . . . . . . . . . . . . . . . . . . . . 20ala-cort external cream 1 % . . . . . . . . 20ala-cort external cream 2.5 % . . . . . . 20albuterol sulfate hfa aerosol solution 108 (90 base) mcg/act inhalation . . . . . . . . . . . . . . . . . . . . . . . 37albuterol sulfate inhalation . . . . . . . . . 37albuterol sulfate oral syrup . . . . . . . . . 37albuterol sulfate oral tablet . . . . . . . . . 37ALDACTONE . . . . . . . . . . . . . . . . . . . . 16ALECENSA . . . . . . . . . . . . . . . . . . . . . . 14alendronate sodium . . . . . . . . . . . . . . 35alfuzosin hcl er . . . . . . . . . . . . . . . . . . . 29aliskiren fumarate . . . . . . . . . . . . . . . . 16ALKINDI SPRINKLE . . . . . . . . . . . . . . 32allopurinol oral . . . . . . . . . . . . . . . . . . . 13 ALOGLIPTIN BENZOATE . . . . . . . . . . 26ALOGLIPTIN-METFORMIN HCL . . . . 26ALOGLIPTIN-PIOGLITAZONE . . . . . . 26ALORA . . . . . . . . . . . . . . . . . . . . . . . . . 29ALPHAGAN P OPHTHALMIC SOLUTION 0.1 % . . . . . . . . . . . . . . . . . 36ALPHAGAN P OPHTHALMIC SOLUTION 0.15 % . . . . . . . . . . . . . . . . 36ALPHANATE . . . . . . . . . . . . . . . . . . . . 27alprazolam er . . . . . . . . . . . . . . . . . . . . 16alprazolam intensol . . . . . . . . . . . . . . . 16alprazolam oral . . . . . . . . . . . . . . . . . . 16alprazolam xr . . . . . . . . . . . . . . . . . . . . 16ALREX . . . . . . . . . . . . . . . . . . . . . . . . . 35ALTACE . . . . . . . . . . . . . . . . . . . . . . . . . 16altavera . . . . . . . . . . . . . . . . . . . . . . . . . 29ALTOPREV . . . . . . . . . . . . . . . . . . . . . . 16ALTRENO . . . . . . . . . . . . . . . . . . . . . . . 20ALUNBRIG . . . . . . . . . . . . . . . . . . . . . . 14ALVESCO . . . . . . . . . . . . . . . . . . . . . . . 37alyacen 1/35 . . . . . . . . . . . . . . . . . . . . . 29AMARYL . . . . . . . . . . . . . . . . . . . . . . . . 26AMBIEN . . . . . . . . . . . . . . . . . . . . . . . . 39AMBIEN CR . . . . . . . . . . . . . . . . . . . . . 39AMERGE ORAL TABLET 1 MG, 2.5 MG . . . . . . . . . . . . . . . . . . . . . . . . . 13amethia . . . . . . . . . . . . . . . . . . . . . . . . . 29amiodarone hcl oral . . . . . . . . . . . . . . 16amitriptyline hcl oral . . . . . . . . . . . . . . 12amlodipine besylate oral . . . . . . . . . . . 16amlodipine besylate-benazepril hcl . . 16amlodipine besylate-valsartan . . . . . . 16amnesteem . . . . . . . . . . . . . . . . . . . . . 20amoxicillin . . . . . . . . . . . . . . . . . . . . . . . 10amoxicillin-potassium clavulanate . . . 10amoxicillin-potassium clavulanate er . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10amphetamine-dextroamphetamine . . 19amphetamine-dextroamphetamine er . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19AMPYRA . . . . . . . . . . . . . . . . . . . . . . . 19AMRIX . . . . . . . . . . . . . . . . . . . . . . . . . . 39AMZEEQ . . . . . . . . . . . . . . . . . . . . . . . . 20ANALPRAM HC . . . . . . . . . . . . . . . . . . 35ANALPRAM HC SINGLES . . . . . . . . . 35ANALPRAM-HC EXTERNAL CREAM . . . . . . . . . . . . . . . . . . . . . . . . . 3540

ANALPRAM-HC EXTERNAL LOTION . . . . . . . . . . . . . . . . . . . . . . . . . 35ANAPROX DS . . . . . . . . . . . . . . . . . . . . 9ANASPAZ . . . . . . . . . . . . . . . . . . . . . . . 28anastrozole oral . . . . . . . . . . . . . . . . . . 14ANDRODERM . . . . . . . . . . . . . . . . . . . 33ANDROGEL PUMP . . . . . . . . . . . . . . . 33ANDROGEL TRANSDERMAL GEL 25 MG/2.5GM (1%), 40.5 MG/2.5GM (1.62%), 50 MG/5GM (1%) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33ANNOVERA . . . . . . . . . . . . . . . . . . . . . 29ANORO ELLIPTA . . . . . . . . . . . . . . . . . 37apap-caff-dihydrocodeine . . . . . . . . . . 8apri . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29APRISO . . . . . . . . . . . . . . . . . . . . . . . . 35APTENSIO XR . . . . . . . . . . . . . . . . . . . 19ARAKODA . . . . . . . . . . . . . . . . . . . . . . 14ARANESP (ALBUMIN FREE) . . . . . . . 27ARCAPTA NEOHALER . . . . . . . . . . . . 37ARICEPT . . . . . . . . . . . . . . . . . . . . . . . 12ARIMIDEX . . . . . . . . . . . . . . . . . . . . . . 14aripiprazole oral solution . . . . . . . . . . 15aripiprazole oral tablet . . . . . . . . . . . . 15aripiprazole oral tablet dispersible . . 15ARMONAIR DIGIHALER . . . . . . . . . . . 37ARMOUR THYROID . . . . . . . . . . . . . . 33ARNUITY ELLIPTA . . . . . . . . . . . . . . . 37ASACOL HD . . . . . . . . . . . . . . . . . . . . . 35asenapine maleate . . . . . . . . . . . . . . . 15ashlyna . . . . . . . . . . . . . . . . . . . . . . . . . 29ASMANEX (120 METERED DOSES) . 37ASMANEX (14 METERED DOSES) . . 37ASMANEX (30 METERED DOSES) . . 37ASMANEX (60 METERED DOSES) . . 37ASMANEX HFA . . . . . . . . . . . . . . . . . . 38ASPRUZYO SPRINKLE . . . . . . . . . . . . 16ASTAGRAF XL . . . . . . . . . . . . . . . . . . . 33atenolol oral . . . . . . . . . . . . . . . . . . . . . 16atenolol-chlorthalidone . . . . . . . . . . . . 16ATIVAN ORAL . . . . . . . . . . . . . . . . . . . 16atomoxetine hcl . . . . . . . . . . . . . . . . . . 19atorvastatin calcium oral tablet 10 mg, 20 mg . . . . . . . . . . . . . . . . . . . . 16atorvastatin calcium oral tablet 40 mg, 80 mg . . . . . . . . . . . . . . . . . . . . 16atovaquone-proguanil hcl . . . . . . . . . . 14ATRALIN . . . . . . . . . . . . . . . . . . . . . . . . 20ATROVENT HFA . . . . . . . . . . . . . . . . . 38AUBAGIO . . . . . . . . . . . . . . . . . . . . . . . 19aubra . . . . . . . . . . . . . . . . . . . . . . . . . . . 29aubra eq . . . . . . . . . . . . . . . . . . . . . . . . 29AUGMENTIN . . . . . . . . . . . . . . . . . . . . 10AUGMENTIN ES-600 . . . . . . . . . . . . . 10aurovela 1/20 . . . . . . . . . . . . . . . . . . . . 29aurovela 1.5/30 . . . . . . . . . . . . . . . . . . 29aurovela 24 fe . . . . . . . . . . . . . . . . . . . . 29aurovela fe 1/20 . . . . . . . . . . . . . . . . . . 29aurovela fe 1.5/30 . . . . . . . . . . . . . . . . 29AURYXIA . . . . . . . . . . . . . . . . . . . . . . . 29AUSTEDO . . . . . . . . . . . . . . . . . . . . . . . 20AUVI-Q . . . . . . . . . . . . . . . . . . . . . . . . . 37AVALIDE . . . . . . . . . . . . . . . . . . . . . . . . 16AVAPRO . . . . . . . . . . . . . . . . . . . . . . . . 16AVAR CLEANSER . . . . . . . . . . . . . . . . 20AVAR LS CLEANSER . . . . . . . . . . . . . 20AVAR-E EMOLLIENT . . . . . . . . . . . . . . 20AVAR-E GREEN . . . . . . . . . . . . . . . . . . 20AVAR-E LS . . . . . . . . . . . . . . . . . . . . . . 20aviane . . . . . . . . . . . . . . . . . . . . . . . . . . 29avidoxy . . . . . . . . . . . . . . . . . . . . . . . . . 10AVITA . . . . . . . . . . . . . . . . . . . . . . . . . . 20AVONEX PEN . . . . . . . . . . . . . . . . . . . . 19AVONEX PREFILLED . . . . . . . . . . . . . 19AYGESTIN . . . . . . . . . . . . . . . . . . . . . . 29ayuna . . . . . . . . . . . . . . . . . . . . . . . . . . 29AZASAN . . . . . . . . . . . . . . . . . . . . . . . . 33AZASITE . . . . . . . . . . . . . . . . . . . . . . . . 35azathioprine oral tablet 100 mg, 75 mg . . . . . . . . . . . . . . . . . . . . . . . . . . 33azathioprine oral tablet 50 mg . . . . . . 33azelaic acid external . . . . . . . . . . . . . . 20azelastine hcl nasal solution 0.1 %, 137 mcg/spray . . . . . . . . . . . . . . . . . . . 37azelastine hcl nasal solution 0.15 % . . 37azelastine hcl ophthalmic . . . . . . . . . . 35azithromycin oral . . . . . . . . . . . . . . . . . 10AZOPT . . . . . . . . . . . . . . . . . . . . . . . . . 36AZULFIDINE . . . . . . . . . . . . . . . . . . . . . 35AZULFIDINE EN-TABS . . . . . . . . . . . . 35azurette . . . . . . . . . . . . . . . . . . . . . . . . . 29Bbac . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8BACLOFEN ORAL SOLUTION . . . . . . 39baclofen oral tablet . . . . . . . . . . . . . . . 39BACTRIM . . . . . . . . . . . . . . . . . . . . . . . 10BACTRIM DS . . . . . . . . . . . . . . . . . . . . 10BAFIERTAM . . . . . . . . . . . . . . . . . . . . . 19balziva . . . . . . . . . . . . . . . . . . . . . . . . . . 29BAQSIMI ONE PACK . . . . . . . . . . . . . . 26BAQSIMI TWO PACK . . . . . . . . . . . . . 26BARACLUDE ORAL SOLUTION . . . . 15BARACLUDE ORAL TABLET . . . . . . . 15BASAGLAR KWIKPEN . . . . . . . . . . . . 25bd autoshield duo pen needles . . . . . 23BD INSULIN SYRINGE U-500 . . . . . . 23bd ultra-fine insulin syringes . . . . . . . . 23bd ultra-fine pen needles . . . . . . . . . . 23BD VEO INSULIN SYRINGE ULTRA-FINE . . . . . . . . . . . . . . . . . . . . . 23BELBUCA . . . . . . . . . . . . . . . . . . . . . . . . 8BELSOMRA . . . . . . . . . . . . . . . . . . . . . 39benazepril hcl oral . . . . . . . . . . . . . . . . 16benazepril-hydrochlorothiazide . . . . . 16BENICAR . . . . . . . . . . . . . . . . . . . . . . . 16BENICAR HCT . . . . . . . . . . . . . . . . . . . 16benzonatate oral capsule 100 mg, 200 mg . . . . . . . . . . . . . . . . . . . . . . . . . 37benzonatate oral capsule 150 mg . . . 37BERINERT . . . . . . . . . . . . . . . . . . . . . . 33BESIVANCE . . . . . . . . . . . . . . . . . . . . . 35betamethasone dipropionate aug external cream . . . . . . . . . . . . . . . . . . . 20betamethasone dipropionate aug external gel . . . . . . . . . . . . . . . . . . . . . . 20betamethasone dipropionate aug external lotion . . . . . . . . . . . . . . . . . . . 20betamethasone dipropionate aug external ointment . . . . . . . . . . . . . . . . . 20betamethasone dipropionate external cream . . . . . . . . . . . . . . . . . . . 20betamethasone dipropionate external lotion . . . . . . . . . . . . . . . . . . . 20betamethasone dipropionate external ointment . . . . . . . . . . . . . . . . . 20BETAPACE . . . . . . . . . . . . . . . . . . . . . . 16BETASERON . . . . . . . . . . . . . . . . . . . . 19BETHKIS . . . . . . . . . . . . . . . . . . . . . . . 38BETIMOL . . . . . . . . . . . . . . . . . . . . . . . 36BEVESPI AEROSPHERE . . . . . . . . . . 38bexarotene external . . . . . . . . . . . . . . 14bexarotene oral . . . . . . . . . . . . . . . . . . 14BEYAZ . . . . . . . . . . . . . . . . . . . . . . . . . 29BIDIL . . . . . . . . . . . . . . . . . . . . . . . . . . . 16BIJUVA . . . . . . . . . . . . . . . . . . . . . . . . . 29BIKTARVY . . . . . . . . . . . . . . . . . . . . . . 15bimatoprost ophthalmic . . . . . . . . . . . 3641

BINOSTO . . . . . . . . . . . . . . . . . . . . . . . 35bisoprolol fumarate oral . . . . . . . . . . . 16bisoprolol-hydrochlorothiazide . . . . . 16blisovi 24 fe . . . . . . . . . . . . . . . . . . . . . 29blisovi fe 1/20 . . . . . . . . . . . . . . . . . . . . 29blisovi fe 1.5/30 . . . . . . . . . . . . . . . . . . 29BLOOD GLUCOSE TEST STRIPS . . . 23BONIVA ORAL TABLET 150 MG . . . . 35BONJESTA . . . . . . . . . . . . . . . . . . . . . . 13bosentan . . . . . . . . . . . . . . . . . . . . . . . 39bp 10-1 . . . . . . . . . . . . . . . . . . . . . . . . . 20BREO ELLIPTA . . . . . . . . . . . . . . . . . . 38BREZTRI AEROSPHERE . . . . . . . . . . 38briellyn . . . . . . . . . . . . . . . . . . . . . . . . . 29BRILINTA . . . . . . . . . . . . . . . . . . . . . . . 15brimonidine tartrate ophthalmic solution 0.15 % . . . . . . . . . . . . . . . . . . . 36brimonidine tartrate ophthalmic solution 0.2 % . . . . . . . . . . . . . . . . . . . . 36brimonidine tartrate-timolol . . . . . . . . 36brinzolamide . . . . . . . . . . . . . . . . . . . . 36BRIVIACT ORAL TABLET . . . . . . . . . . 11BRONCHITOL . . . . . . . . . . . . . . . . . . . 38BRONCHITOL TOLERANCE TEST . . 38budesonide er . . . . . . . . . . . . . . . . . . . 35budesonide inhalation. . . . . . . . . . . . . 38budesonide oral . . . . . . . . . . . . . . . . . . 35BUDESONIDE-FORMOTEROL FUMARATE . . . . . . . . . . . . . . . . . . . . . 38buprenorphine hcl sublingual . . . . . . 10buprenorphine hcl-naloxone hcl sublingual film . . . . . . . . . . . . . . . . . . . 10buprenorphine hcl-naloxone hcl sublingual tablet sublingual . . . . . . . . 10bupropion hcl er (sr) . . . . . . . . . . . . . . 12bupropion hcl er (xl) oral tablet extended release 24 hour 150 mg, 300 mg . . . . . . . . . . . . . . . . . . . . . . . . . 12BUPROPION HCL ER (XL) ORAL TABLET EXTENDED RELEASE 24 HOUR 450 MG . . . . . . . . . . . . . . . . 12bupropion hcl oral . . . . . . . . . . . . . . . . 12buspirone hcl oral . . . . . . . . . . . . . . . . 16butalbital-apap-caffeine oral capsule 50-300-40 mg . . . . . . . . . . . . . 8butalbital-apap-caffeine oral capsule 50-325-40 mg . . . . . . . . . . . . . 8butalbital-apap-caffeine oral tablet . . . 8BYDUREON BCISE AUTOINJECTOR . . . . . . . . . . . . . . . . . 26BYETTA 10 MCG PEN . . . . . . . . . . . . . 26BYETTA 5 MCG PEN . . . . . . . . . . . . . . 26BYSTOLIC . . . . . . . . . . . . . . . . . . . . . . 16Ccabergoline . . . . . . . . . . . . . . . . . . . . . 33CALAN SR . . . . . . . . . . . . . . . . . . . . . . 16calcipotriene-betameth diprop. . . . . . 20calcitriol external . . . . . . . . . . . . . . . . . 20calcitriol oral . . . . . . . . . . . . . . . . . . . . . 35CALQUENCE . . . . . . . . . . . . . . . . . . . . 14camila . . . . . . . . . . . . . . . . . . . . . . . . . . 29camrese . . . . . . . . . . . . . . . . . . . . . . . . 29camrese lo . . . . . . . . . . . . . . . . . . . . . . 29CANASA . . . . . . . . . . . . . . . . . . . . . . . . 35capecitabine . . . . . . . . . . . . . . . . . . . . 14CAPEX . . . . . . . . . . . . . . . . . . . . . . . . . 20CARAC . . . . . . . . . . . . . . . . . . . . . . . . . 20CARAFATE . . . . . . . . . . . . . . . . . . . . . . 28carbamazepine er oral capsule extended release 12 hour . . . . . . . . . . 11carbamazepine er oral tablet extended release 12 hour . . . . . . . . . . 11carbamazepine oral . . . . . . . . . . . . . . 11CARBATROL . . . . . . . . . . . . . . . . . . . . 11carbidopa-levodopa . . . . . . . . . . . . . . 14carbidopa-levodopa er . . . . . . . . . . . . 14CARDIZEM . . . . . . . . . . . . . . . . . . . 16, 17CARDIZEM CD . . . . . . . . . . . . . . . . . . 16CARDIZEM LA . . . . . . . . . . . . . . . . . . . 17CARDURA . . . . . . . . . . . . . . . . . . . . . . 17CARETOUCH MONITOR SYSTEM . . 23CARETOUCH TEST . . . . . . . . . . . . . . 23carisoprodol oral tablet 250 mg . . . . . 39carisoprodol oral tablet 350 mg . . . . . 39CAROSPIR . . . . . . . . . . . . . . . . . . . . . . 17cartia xt . . . . . . . . . . . . . . . . . . . . . . . . . 17carvedilol . . . . . . . . . . . . . . . . . . . . . . . 17CATAFLAM . . . . . . . . . . . . . . . . . . . . . . . 9cavarest . . . . . . . . . . . . . . . . . . . . . . . . 20cefadroxil . . . . . . . . . . . . . . . . . . . . . . . 10cefdinir . . . . . . . . . . . . . . . . . . . . . . . . . 10cefuroxime axetil . . . . . . . . . . . . . . . . . 10CELEBREX . . . . . . . . . . . . . . . . . . . . . . . 9celecoxib oral. . . . . . . . . . . . . . . . . . . . . 9CELEXA . . . . . . . . . . . . . . . . . . . . . . . . 12CELLCEPT . . . . . . . . . . . . . . . . . . . . . . 33CENTANY . . . . . . . . . . . . . . . . . . . . . . . 10CENTANY AT . . . . . . . . . . . . . . . . . . . . 10cephalexin . . . . . . . . . . . . . . . . . . . . . . 10CEQUA . . . . . . . . . . . . . . . . . . . . . . . . . 36CERDELGA . . . . . . . . . . . . . . . . . . . . . 29chateal . . . . . . . . . . . . . . . . . . . . . . . . . 29chateal eq . . . . . . . . . . . . . . . . . . . . . . . 29CHEMSTRIP BG LOG BOOK . . . . . . . 23chlorhexidine gluconate mouth/ throat. . . . . . . . . . . . . . . . . . . . . . . . . . . 20chlorthalidone . . . . . . . . . . . . . . . . . . . 17CHORIONIC GONADOTROPIN INTRAMUSCULAR . . . . . . . . . . . . . . . 35CIALIS . . . . . . . . . . . . . . . . . . . . . . . . . . 27CIBINQO. . . . . . . . . . . . . . . . . . . . . . . . 20ciclodan . . . . . . . . . . . . . . . . . . . . . . . . 13ciclopirox external gel . . . . . . . . . . . . . 13ciclopirox external shampoo . . . . . . . 13ciclopirox external solution . . . . . . . . . 13ciclopirox treatment . . . . . . . . . . . . . . 13CILOXAN . . . . . . . . . . . . . . . . . . . . . . . 35CIMDUO . . . . . . . . . . . . . . . . . . . . . . . . 15CIMZIA . . . . . . . . . . . . . . . . . . . . . . . . . 34CIMZIA PREFILLED KIT . . . . . . . . . . . 34CIMZIA STARTER KIT . . . . . . . . . . . . . 34CINRYZE . . . . . . . . . . . . . . . . . . . . . . . 34CIPRO ORAL TABLET . . . . . . . . . . . . 10CIPRODEX . . . . . . . . . . . . . . . . . . . . . . 37ciprofloxacin hcl ophthalmic . . . . . . . 35ciprofloxacin hcl oral . . . . . . . . . . . . . . 10ciprofloxacin-dexamethasone . . . . . . 37CITALOPRAM HYDROBROMIDE ORAL CAPSULE . . . . . . . . . . . . . . . . . 12citalopram hydrobromide oral solution . . . . . . . . . . . . . . . . . . . . . . . . . 12citalopram hydrobromide oral tablet . 12claravis . . . . . . . . . . . . . . . . . . . . . . . . . 21clarithromycin er . . . . . . . . . . . . . . . . . 10clarithromycin oral suspension reconstituted . . . . . . . . . . . . . . . . . . . . 10clarithromycin oral tablet . . . . . . . . . . 10CLENPIQ . . . . . . . . . . . . . . . . . . . . . . . 28CLEOCIN ORAL CAPSULE 150 MG, 300 MG . . . . . . . . . . . . . . . . . 10CLEOCIN ORAL CAPSULE 75 MG . . 10CLEOCIN-T . . . . . . . . . . . . . . . . . . . . . . 21CLIMARA . . . . . . . . . . . . . . . . . . . . 29, 30CLIMARA PRO . . . . . . . . . . . . . . . . . . 29clindacin etz external swab . . . . . . . . 21clindacin-p . . . . . . . . . . . . . . . . . . . . . . 2142

CLINDAGEL . . . . . . . . . . . . . . . . . . . . . 21clindamycin hcl oral . . . . . . . . . . . . . . 10clindamycin phos-benzoyl perox external gel 1.2-5 % . . . . . . . . . . . . . . . 21clindamycin phosphate external foam . . . . . . . . . . . . . . . . . . . . . . . . . . . 21clindamycin phosphate external lotion . . . . . . . . . . . . . . . . . . . . . . . . . . . 21clindamycin phosphate external solution . . . . . . . . . . . . . . . . . . . . . . . . . 21clindamycin phosphate external swab . . . . . . . . . . . . . . . . . . . . . . . . . . . 21clindamycin phosphate gel 1 % external . . . . . . . . . . . . . . . . . . . . . . . . . 21CLINDESSE . . . . . . . . . . . . . . . . . . . . . 10CLINPRO 5000 . . . . . . . . . . . . . . . . . . 20clobetasol propionate external cream . . . . . . . . . . . . . . . . . . . . . . . . . . 21clobetasol propionate external foam . 21clobetasol propionate external gel . . 21clobetasol propionate external liquid . . . . . . . . . . . . . . . . . . . . . . . . . . . 21clobetasol propionate external lotion . . . . . . . . . . . . . . . . . . . . . . . . . . . 21clobetasol propionate external ointment . . . . . . . . . . . . . . . . . . . . . . . . 21clobetasol propionate external shampoo . . . . . . . . . . . . . . . . . . . . . . . 21clobetasol propionate external solution . . . . . . . . . . . . . . . . . . . . . . . . . 21CLOBEX . . . . . . . . . . . . . . . . . . . . . . . . 21CLOBEX SPRAY . . . . . . . . . . . . . . . . . 21clodan external shampoo . . . . . . . . . . 21clonazepam oral . . . . . . . . . . . . . . . . . 16clonidine hcl oral . . . . . . . . . . . . . . . . . 17clopidogrel bisulfate oral . . . . . . . . . . 15clotrimazole-betamethasone external cream . . . . . . . . . . . . . . . . . . . 21clotrimazole-betamethasone external lotion . . . . . . . . . . . . . . . . . . . 21COLCHICINE ORAL CAPSULE . . . . . 13colchicine oral tablet . . . . . . . . . . . . . . 13COLCRYS . . . . . . . . . . . . . . . . . . . . . . . 13colesevelam hcl . . . . . . . . . . . . . . . . . . 17COMBIGAN . . . . . . . . . . . . . . . . . . . . . 36COMBIVENT RESPIMAT . . . . . . . . . . 38CONCERTA . . . . . . . . . . . . . . . . . . . . . 19CONTOUR MONITOR DEVICE . . . . . 23CONTOUR MONITOR KIT W/DEVICE . . . . . . . . . . . . . . . . . . . . . . 23CONTOUR NEXT EZ KIT W/DEVICE . . . . . . . . . . . . . . . . . . . . . . 23CONTOUR NEXT GEN MONITOR . . . 23CONTOUR NEXT LINK KIT W/DEVICE . . . . . . . . . . . . . . . . . . . . . . 23CONTOUR NEXT MONITOR KIT W/DEVICE . . . . . . . . . . . . . . . . . . . . . . 23CONTOUR NEXT ONE DEVICE . . . . . 23CONTOUR NEXT ONE KIT . . . . . . . . . 23CONTOUR NEXT TEST STRIPS . . . . 23CONTOUR TEST STRIPS . . . . . . . . . . 23CONZIP . . . . . . . . . . . . . . . . . . . . . . . 8, 9COPAXONE . . . . . . . . . . . . . . . . . . . . . 19COREG . . . . . . . . . . . . . . . . . . . . . . . . . 17coremino . . . . . . . . . . . . . . . . . . . . . . . 10CORGARD . . . . . . . . . . . . . . . . . . . . . . 17CORLANOR . . . . . . . . . . . . . . . . . . . . . 17CORTEF . . . . . . . . . . . . . . . . . . . . . . . . 32CORTIFOAM . . . . . . . . . . . . . . . . . . . . 35COSENTYX (300 MG DOSE) . . . . . . . 34COSENTYX 150 MG/ML SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 150 MG/ML . . 34COSENTYX 150 MG/ML SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 75 MG/0.5ML . . . . . . . . . . . . . . . . . . . . 34COSENTYX SENSOREADY (300 MG) . . . . . . . . . . . . . . . . . . . . . . . . 34COSENTYX SENSOREADY PEN . . . . 34COSOPT . . . . . . . . . . . . . . . . . . . . . . . . 36COSOPT PF . . . . . . . . . . . . . . . . . . . . . 36COZAAR . . . . . . . . . . . . . . . . . . . . . . . 17CREON . . . . . . . . . . . . . . . . . . . . . . . . . 29CRESEMBA INTRAVENOUS . . . . . . . 13CRESEMBA ORAL . . . . . . . . . . . . . . . 13CRESTOR. . . . . . . . . . . . . . . . . . . . . . . 17CRINONE . . . . . . . . . . . . . . . . . . . . . . . 35cryselle-28 . . . . . . . . . . . . . . . . . . . . . . 29CUPRIMINE . . . . . . . . . . . . . . . . . . . . . 29CVS ADVANCED GLUCOSE TEST . . 23CVS GLUCOSE METER TEST STRIPS . . . . . . . . . . . . . . . . . . . . . . . . . 23cyanocobalamin injection solution 1000 mcg/ml . . . . . . . . . . . . . . . . . . . . 27CYANOCOBALAMIN INJECTION SOLUTION 2000 MCG/ML. . . . . . . . . 27cyclobenzaprine hcl er . . . . . . . . . . . . 39cyclobenzaprine hcl oral tablet 10 mg, 5 mg . . . . . . . . . . . . . . . . . . . . . 39cyclobenzaprine hcl oral tablet 7.5 mg . . . . . . . . . . . . . . . . . . . . . . . . . . 39CYCLOSPORINE IN KLARITY . . . . . . 36cyclosporine modified . . . . . . . . . . . . 34cyclosporine ophthalmic. . . . . . . . . . . 36CYMBALTA . . . . . . . . . . . . . . . . . . . . . . 12cyproheptadine hcl oral . . . . . . . . . . . 37cyred . . . . . . . . . . . . . . . . . . . . . . . . 29, 30cyred eq . . . . . . . . . . . . . . . . . . . . . . . . 30CYTOMEL . . . . . . . . . . . . . . . . . . . . . . 33CYTOTEC . . . . . . . . . . . . . . . . . . . . . . . 28DD-CARE BLOOD GLUCOSE . . . . . . . . 23D-CARE GLUCOMETER . . . . . . . . . . . 23dabigatran etexilate mesylate . . . . . . 11dalfampridine er. . . . . . . . . . . . . . . . . . 19dapsone external . . . . . . . . . . . . . . . . . 21dasetta 1/35 . . . . . . . . . . . . . . . . . . . . . 30daysee . . . . . . . . . . . . . . . . . . . . . . . . . 30DAYVIGO . . . . . . . . . . . . . . . . . . . . . . . 39DDAVP . . . . . . . . . . . . . . . . . . . . . . . . . 33DDAVP PF . . . . . . . . . . . . . . . . . . . . . . 33deblitane . . . . . . . . . . . . . . . . . . . . . . . . 30delyla . . . . . . . . . . . . . . . . . . . . . . . . . . 30DELZICOL . . . . . . . . . . . . . . . . . . . . . . 35DENTA 5000 PLUS . . . . . . . . . . . . . . . 20DENTAGEL . . . . . . . . . . . . . . . . . . . . . . 20DEPAKOTE . . . . . . . . . . . . . . . . . . . . . . 11DEPAKOTE ER . . . . . . . . . . . . . . . . . . . 11DEPAKOTE SPRINKLES . . . . . . . . . . . 11DEPEN TITRATABS . . . . . . . . . . . . . . . 29DEPO-PROVERA INTRAMUSCULAR SUSPENSION . . 30DEPO-PROVERA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE . . . . . . . . . . . . . 30DEPO-SUBQ PROVERA 104 . . . . . . . 30DEPO-TESTOSTERONE INTRAMUSCULAR SOLUTION 100 MG/ML . . . . . . . . . . . . . . . . . . . . . 33DEPO-TESTOSTERONE INTRAMUSCULAR SOLUTION 200 MG/ML . . . . . . . . . . . . . . . . . . . . . 33DERMA-SMOOTHE/FS BODY . . . . . . 21DERMA-SMOOTHE/FS SCALP . . . . . 21DESCOVY. . . . . . . . . . . . . . . . . . . . . . . 15desmopressin acetate injection . . . . . 33DESMOPRESSIN ACETATE NASAL . 33desmopressin acetate oral . . . . . . . . . 3343

desmopressin acetate pf . . . . . . . . . . 33desogestrel-ethinyl estradiol oral tablet 0.15-0.02/0.01 mg (21/5) . . . . . 30desogestrel-ethinyl estradiol oral tablet 0.15-30 mg-mcg . . . . . . . . . . . . 30desonide external cream . . . . . . . . . . 21desonide external gel . . . . . . . . . . . . . 21desonide external lotion . . . . . . . . . . . 21desonide external ointment . . . . . . . . 21DESOWEN . . . . . . . . . . . . . . . . . . . . . . 21desrx . . . . . . . . . . . . . . . . . . . . . . . . . . . 21desvenlafaxine succinate er . . . . . . . . 12DEXABLISS . . . . . . . . . . . . . . . . . . . . . 32dexamethasone intensol . . . . . . . . . . . 32dexamethasone oral elixir . . . . . . . . . . 32dexamethasone oral solution . . . . . . . 32dexamethasone oral tablet . . . . . . . . . 32dexamethasone oral tablet therapy pack . . . . . . . . . . . . . . . . . . . . . . . . . . . 32DEXCOM G4 MOBILE RECEIVER . . . 23DEXCOM G4 PLATINUM . . . . . . . . . . 23DEXCOM G4 PLATINUM PEDIATRIC RECEIVER KIT . . . . . . . . . 23DEXCOM G4 PLATINUM PEDIATRIC RECEIVER KIT/SHARE . . 23DEXCOM G4 PLATINUM RECEIVER KIT . . . . . . . . . . . . . . . . . . . 23DEXCOM G4 PLATINUM RECEIVER KIT/SHARE . . . . . . . . . . . . 23DEXCOM G4 PLATINUM SENSOR KIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23DEXCOM G4 PLATINUM TRANSMITTER KIT . . . . . . . . . . . . . . . 23DEXCOM G4 SENSOR . . . . . . . . . . . . 23DEXCOM G4 TRANSMITTER . . . . . . 24DEXCOM G5 MOBILE RECEIVER . . . 24DEXCOM G5 SENSOR . . . . . . . . . . . . 24DEXCOM G5 TRANSMITTER . . . . . . 24DEXCOM G6 RECEIVER. . . . . . . . . . . 24DEXCOM G6 SENSOR . . . . . . . . . . . . 24DEXCOM G6 TRANSMITTER . . . . . . 24DEXEDRINE . . . . . . . . . . . . . . . . . . . . . 19DEXILANT . . . . . . . . . . . . . . . . . . . . . . 28DEXLANSOPRAZOLE . . . . . . . . . . . . 28dexmethylphenidate hcl . . . . . . . . . . . 19dexmethylphenidate hcl er . . . . . . . . . 19dextroamphetamine sulfate er . . . . . . 19dextroamphetamine sulfate oral solution . . . . . . . . . . . . . . . . . . . . . . . . . 19dextroamphetamine sulfate oral tablet 10 mg, 5 mg . . . . . . . . . . . . . . . . 19dextroamphetamine sulfate oral tablet 15 mg, 20 mg, 30 mg . . . . . . . . 19DHIVY . . . . . . . . . . . . . . . . . . . . . . . . . . 14diazepam intensol . . . . . . . . . . . . . . . . 16diazepam oral . . . . . . . . . . . . . . . . . . . 16DICLEGIS . . . . . . . . . . . . . . . . . . . . . . . 13diclofenac potassium oral capsule . . . 9diclofenac potassium oral tablet 25 mg . . . . . . . . . . . . . . . . . . . . . . . . . . . 9diclofenac potassium oral tablet 50 mg . . . . . . . . . . . . . . . . . . . . . . . . . . . 9diclofenac sodium er . . . . . . . . . . . . . . . 9diclofenac sodium external gel 1 % . . . 9diclofenac sodium external solution . . 9diclofenac sodium oral . . . . . . . . . . . . . 9dicyclomine hcl oral . . . . . . . . . . . . . . 28DIFICID . . . . . . . . . . . . . . . . . . . . . . . . . 10DIFLUCAN . . . . . . . . . . . . . . . . . . . . . . 13DILAUDID ORAL . . . . . . . . . . . . . . . . . . 8dilt-xr . . . . . . . . . . . . . . . . . . . . . . . . . . . 17diltiazem hcl er . . . . . . . . . . . . . . . . . . . 17diltiazem hcl er coated beads . . . . . . 17diltiazem hcl oral . . . . . . . . . . . . . . . . . 17DIOVAN . . . . . . . . . . . . . . . . . . . . . . . . 17DIOVAN HCT . . . . . . . . . . . . . . . . . . . . 17DIPENTUM . . . . . . . . . . . . . . . . . . . . . . 35diphenoxylate-atropine . . . . . . . . . . . . 28DIPROLENE . . . . . . . . . . . . . . . . . . . . . 21DITROPAN XL . . . . . . . . . . . . . . . . . . . 29divalproex sodium er . . . . . . . . . . . . . . 11divalproex sodium oral capsule delayed release sprinkle . . . . . . . . . . . 11divalproex sodium oral tablet delayed release . . . . . . . . . . . . . . . . . . 11DIVIGEL TRANSDERMAL GEL 0.25 MG/0.25GM, 0.5 MG/0.5GM, 0.75 MG/0.75GM, 1 MG/GM . . . . . . . 30DIVIGEL TRANSDERMAL GEL 1.25 MG/1.25GM . . . . . . . . . . . . . . . . . 30DODEX . . . . . . . . . . . . . . . . . . . . . . . . . 27donepezil hcl oral tablet 10 mg, 5 mg . . . . . . . . . . . . . . . . . . . . . . . . . . . 12donepezil hcl oral tablet 23 mg . . . . . 12donepezil hcl oral tablet dispersible . 12DOPTELET . . . . . . . . . . . . . . . . . . . . . . 27DORYX . . . . . . . . . . . . . . . . . . . . . . . . . 10DORYX MPC . . . . . . . . . . . . . . . . . . . . 10dorzolamide hcl-timolol mal . . . . . . . . 36dorzolamide hcl-timolol mal pf . . . . . . 36dotti . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30DOVATO . . . . . . . . . . . . . . . . . . . . . . . . 15doxazosin mesylate oral . . . . . . . . . . . 17doxepin hcl oral capsule . . . . . . . . . . . 12doxepin hcl oral concentrate . . . . . . . 12doxycycline hyclate oral capsule . . . . 10doxycycline hyclate oral tablet 100 mg . . . . . . . . . . . . . . . . . . . . . . . . . 10doxycycline hyclate oral tablet 150 mg, 50 mg, 75 mg . . . . . . . . . . . . 10doxycycline hyclate oral tablet 20 mg . . . . . . . . . . . . . . . . . . . . . . . . . . 10doxycycline hyclate oral tablet delayed release 100 mg, 150 mg, 200 mg, 50 mg, 75 mg . . . . . . . . . . . . 10DOXYCYCLINE HYCLATE ORAL TABLET DELAYED RELEASE 80 MG . . . . . . . . . . . . . . . . . . . . . . . . . . 10doxycycline monohydrate oral capsule 100 mg, 50 mg . . . . . . . . . . . 10doxycycline monohydrate oral capsule 150 mg, 75 mg . . . . . . . . . . . . 10doxycycline monohydrate oral suspension reconstituted . . . . . . . . . . 10doxycycline monohydrate oral tablet . . . . . . . . . . . . . . . . . . . . . . . . . . . 10doxylamine-pyridoxine . . . . . . . . . . . . 13DRISDOL . . . . . . . . . . . . . . . . . . . . . . . 27DRIZALMA SPRINKLE . . . . . . . . . . . . 12drospiren-eth estrad-levomefol . . . . . 30drospirenone-ethinyl estradiol . . . . . . 30DUAVEE . . . . . . . . . . . . . . . . . . . . . . . . 30duloxetine hcl oral capsule delayed release particles 20 mg, 30 mg, 60 mg . . . . . . . . . . . . . . . . . . . . . . . . . . 12duloxetine hcl oral capsule delayed release particles 40 mg . . . . . . . . . . . 12DUOPA . . . . . . . . . . . . . . . . . . . . . . . . . 14DUPIXENT SUBCUTANEOUS SOLUTION PEN-INJECTOR . . . . . . . . 21DUPIXENT SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MG/0.67ML . . . . . . . . . . . . . . . . . . 21DUPIXENT SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 200 MG/1.14ML, 300 MG/2ML . . . . . 21DUROLANE . . . . . . . . . . . . . . . . . . . . . . 8DXEVO 11-DAY . . . . . . . . . . . . . . . . . . . 32EEASIVENT . . . . . . . . . . . . . . . . . . . . . . 3844

EASIVENT MASK LARGE . . . . . . . . . . 38EASIVENT MASK MEDIUM . . . . . . . . 38EASIVENT MASK SMALL . . . . . . . . . . 38EASY TOUCH TEST . . . . . . . . . . . . . . 24EASYMAX 15 TEST . . . . . . . . . . . . . . . 24EASYMAX NG BLOOD GLUCOSE . . 24EASYMAX V BLOOD GLUCOSE . . . . 24EC-NAPROSYN ORAL TABLET DELAYED RELEASE 375 MG . . . . . . . . 9EC-NAPROSYN ORAL TABLET DELAYED RELEASE 500 MG . . . . . . . . 9ec-naproxen . . . . . . . . . . . . . . . . . . . . . . 9ED-SPAZ . . . . . . . . . . . . . . . . . . . . . . . 28EDARBI . . . . . . . . . . . . . . . . . . . . . . . . . 17EDARBYCLOR . . . . . . . . . . . . . . . . . . . 17EDLUAR . . . . . . . . . . . . . . . . . . . . . . . . 39efavirenz-emtricitab-tenofovir . . . . . . . 15efavirenz-lamivudine-tenofovir . . . . . . 15EFFEXOR XR . . . . . . . . . . . . . . . . . . . . 12EFUDEX . . . . . . . . . . . . . . . . . . . . . . . . 21ELEPSIA XR . . . . . . . . . . . . . . . . . . . . . 11ELESTRIN . . . . . . . . . . . . . . . . . . . . . . . 30eletriptan hydrobromide . . . . . . . . . . . 13elinest . . . . . . . . . . . . . . . . . . . . . . . . . . 30ELIQUIS . . . . . . . . . . . . . . . . . . . . . . . . 11ELIQUIS DVT/PE STARTER PACK. . . 11ELOCTATE . . . . . . . . . . . . . . . . . . . . . . 27eluryng . . . . . . . . . . . . . . . . . . . . . . . . . 30EMGALITY (300 MG DOSE) . . . . . . . . 13EMGALITY SUBCUTANEOUS SOLUTION AUTO-INJECTOR . . . . . . 13EMGALITY SUBCUTANEOUS SOLUTION PREFILLED SYRINGE . . . 13emoquette . . . . . . . . . . . . . . . . . . . . . . 30EMPAVELI . . . . . . . . . . . . . . . . . . . . . . 27emtricitabine-tenofovir df oral tablet 100-150 mg, 133-200 mg, 167-250 mg . . . . . . . . . . . . . . . . . . . . . . 15emtricitabine-tenofovir df oral tablet 200-300 mg . . . . . . . . . . . . . . . . . . . . . 15enalapril maleate oral solution . . . . . . 17enalapril maleate oral tablet . . . . . . . . 17ENBREL MINI. . . . . . . . . . . . . . . . . . . . 34ENBREL SUBCUTANEOUS SOLUTION . . . . . . . . . . . . . . . . . . . . . . 34ENBREL SUBCUTANEOUS SOLUTION PREFILLED SYRINGE . . . 34ENBREL SURECLICK . . . . . . . . . . . . . 34ENDARI . . . . . . . . . . . . . . . . . . . . . . . . . 29endocet . . . . . . . . . . . . . . . . . . . . . . . . . 8ENDOMETRIN . . . . . . . . . . . . . . . . . . . 35ENLITE GLUCOSE SENSOR . . . . . . . 24ENOVARX-DICLOFENAC SODIUM . . . 9enoxaparin sodium . . . . . . . . . . . . . . . 11enskyce . . . . . . . . . . . . . . . . . . . . . . . . 30ENSTILAR . . . . . . . . . . . . . . . . . . . . . . 21entecavir . . . . . . . . . . . . . . . . . . . . . . . . 15ENTRESTO . . . . . . . . . . . . . . . . . . . . . . 17ENVARSUS XR . . . . . . . . . . . . . . . . . . 34EPANED . . . . . . . . . . . . . . . . . . . . . . . . 17EPCLUSA ORAL PACKET 150-37.5 MG . . . . . . . . . . . . . . . . . . . . . 15EPCLUSA ORAL PACKET 200-50 MG . . . . . . . . . . . . . . . . . . . . . . 15EPCLUSA ORAL TABLET 200-50 MG . . . . . . . . . . . . . . . . . . . . . . 15EPCLUSA ORAL TABLET 400-100 MG . . . . . . . . . . . . . . . . . . . . . 15epinephrine injection solution auto-injector 0.15 mg/0.15ml . . . . . . . . . . . . 37epinephrine solution auto-injector 0.15 mg/0.3ml injection . . . . . . . . . . . . 37epinephrine solution auto-injector 0.3 mg/0.3ml injection . . . . . . . . . . . . 37EPIPEN 2-PAK . . . . . . . . . . . . . . . . . . . 37EPIPEN JR 2-PAK . . . . . . . . . . . . . . . . 37epitol . . . . . . . . . . . . . . . . . . . . . . . . . . . 11EPRONTIA . . . . . . . . . . . . . . . . . . . . . . 11EQ BLOOD GLUCOSE TEST . . . . . . . 24ERGOCAL . . . . . . . . . . . . . . . . . . . . . . 27ergocalciferol oral capsule . . . . . . 27, 28ERIVEDGE . . . . . . . . . . . . . . . . . . . . . . 14ERLEADA . . . . . . . . . . . . . . . . . . . . . . . 14errin . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30erythromycin ophthalmic . . . . . . . . . . 35escitalopram oxalate oral solution . . . 12escitalopram oxalate oral tablet . . . . . 12ESGIC . . . . . . . . . . . . . . . . . . . . . . . . . . . 8estarylla . . . . . . . . . . . . . . . . . . . . . . . . 30ESTRACE . . . . . . . . . . . . . . . . . . . . . . . 30estradiol oral . . . . . . . . . . . . . . . . . . . . 30estradiol patch twice weekly 0.025 mg/24hr transdermal . . . . . . . . 30estradiol patch twice weekly 0.0375 mg/24hr transdermal . . . . . . . 30estradiol patch twice weekly 0.05 mg/24hr transdermal . . . . . . . . . 30estradiol patch twice weekly 0.075 mg/24hr transdermal . . . . . . . . 30estradiol patch twice weekly 0.1 mg/24hr transdermal . . . . . . . . . . 30estradiol transdermal patch weekly . . 30estradiol vaginal cream . . . . . . . . . . . . 30estradiol vaginal tablet . . . . . . . . . . . . 30ESTRING . . . . . . . . . . . . . . . . . . . . . . . 30ESTROGEL . . . . . . . . . . . . . . . . . . . . . 30eszopiclone . . . . . . . . . . . . . . . . . . . . . 39etodolac . . . . . . . . . . . . . . . . . . . . . . . . . 9etodolac er . . . . . . . . . . . . . . . . . . . . . . . 9etonogestrel-ethinyl estradiol . . . . . . . 30EUCRISA . . . . . . . . . . . . . . . . . . . . . . . 21EUFLEXXA . . . . . . . . . . . . . . . . . . . . . . . 8euthyrox . . . . . . . . . . . . . . . . . . . . . . . . 33EVAMIST . . . . . . . . . . . . . . . . . . . . . . . 30EVOCLIN . . . . . . . . . . . . . . . . . . . . . . . 21EXFORGE . . . . . . . . . . . . . . . . . . . . . . . 17EXKIVITY . . . . . . . . . . . . . . . . . . . . . . . 14EXSERVAN . . . . . . . . . . . . . . . . . . . . . . 20EXTAVIA . . . . . . . . . . . . . . . . . . . . . . . . 19EXTINA . . . . . . . . . . . . . . . . . . . . . . . . . 13EYSUVIS . . . . . . . . . . . . . . . . . . . . . . . . 35EZALLOR SPRINKLE . . . . . . . . . . . . . 17ezetimibe . . . . . . . . . . . . . . . . . . . . . . . 17ezetimibe-simvastatin . . . . . . . . . . . . . 17Ffalmina . . . . . . . . . . . . . . . . . . . . . . . . . 30famotidine oral suspension reconstituted . . . . . . . . . . . . . . . . . . . . 28FARXIGA . . . . . . . . . . . . . . . . . . . . . . . 26FASENRA PEN . . . . . . . . . . . . . . . . . . . 38fayosim . . . . . . . . . . . . . . . . . . . . . . . . . 30febuxostat . . . . . . . . . . . . . . . . . . . . . . 13FEMARA . . . . . . . . . . . . . . . . . . . . . . . . 14femynor . . . . . . . . . . . . . . . . . . . . . . 30, 32fenofibrate oral capsule 150 mg, 50 mg . . . . . . . . . . . . . . . . . . . . . . . . . . 17fenofibrate oral tablet 120 mg, 40 mg, 48 mg . . . . . . . . . . . . . . . . . . . . 17fenofibrate oral tablet 145 mg, 160 mg, 54 mg . . . . . . . . . . . . . . . . . . . 17FENOGLIDE . . . . . . . . . . . . . . . . . . . . . 17fentanyl transdermal patch 72 hour 100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr . . . . . . . . . . . . . . 8fentanyl transdermal patch 72 hour 37.5 mcg/hr, 62.5 mcg/hr, 87.5 mcg/hr . . . . . . . . . . . . . . . . . . . . . . 8fesoterodine fumarate er . . . . . . . . . . 2945

FEXMID . . . . . . . . . . . . . . . . . . . . . . . . . 39FINACEA . . . . . . . . . . . . . . . . . . . . . . . 21finasteride oral tablet 5 mg . . . . . . . . . 29FIORICET . . . . . . . . . . . . . . . . . . . . . . . . 8FIRAZYR . . . . . . . . . . . . . . . . . . . . . . . 34FIRST-OMEPRAZOLE . . . . . . . . . . . . . 28FLAGYL . . . . . . . . . . . . . . . . . . . . . . . . 10FLAREX . . . . . . . . . . . . . . . . . . . . . . . . 36flecainide acetate . . . . . . . . . . . . . . . . 17FLEQSUVY . . . . . . . . . . . . . . . . . . . . . . 39FLEXICHAMBER . . . . . . . . . . . . . . . . . 38FLOLIPID . . . . . . . . . . . . . . . . . . . . . . . 17FLOMAX . . . . . . . . . . . . . . . . . . . . . . . . 29FLORIVA PLUS . . . . . . . . . . . . . . . . . . 27FLOVENT DISKUS . . . . . . . . . . . . . . . . 38FLOVENT HFA . . . . . . . . . . . . . . . . . . . 38fluconazole oral . . . . . . . . . . . . . . . . . . 13fluocinolone acetonide body . . . . . . . 21fluocinolone acetonide external cream . . . . . . . . . . . . . . . . . . . . . . . . . . 21fluocinolone acetonide external ointment . . . . . . . . . . . . . . . . . . . . . . . . 21fluocinolone acetonide external solution . . . . . . . . . . . . . . . . . . . . . . . . . 21fluocinolone acetonide scalp . . . . . . . 21fluocinonide external cream 0.05 % . 21fluocinonide external cream 0.1 % . . . 21fluocinonide external gel . . . . . . . . . . 21fluocinonide external ointment . . . . . . 21fluocinonide external solution . . . . . . 21FLUORIDEX . . . . . . . . . . . . . . . . . . . . . 20FLUORIDEX ENHANCED WHITENING . . . . . . . . . . . . . . . . . . . . . 20FLUORIMAX 5000 . . . . . . . . . . . . . . . . 20FLUOROPLEX EXTERNAL CREAM 1 % . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21FLUOROURACIL EXTERNAL CREAM 0.5 % . . . . . . . . . . . . . . . . . . . 21fluorouracil external cream 5 % . . . . . 21fluorouracil external solution . . . . . . . 14fluoxetine hcl oral capsule . . . . . . . . . 12fluoxetine hcl oral capsule delayed release . . . . . . . . . . . . . . . . . . . . . . . . . 12fluoxetine hcl oral solution . . . . . . . . . 12fluoxetine hcl oral tablet 10 mg . . . . . 12fluoxetine hcl oral tablet 20 mg . . . . . 12fluoxetine hcl oral tablet 60 mg . . . . . 12FLUTICASONE FUROATE-VILANTEROL . . . . . . . . . . . . . . . . . . . . 38FLUTICASONE PROPIONATE HFA . . 38fluticasone propionate nasal . . . . . . . 37fluticasone-salmeterol inhalation aerosol powder breath activated 100-50 mcg/act, 250-50 mcg/act, 500-50 mcg/act . . . . . . . . . . . . . . . . . . 38FLUTICASONE-SALMETEROL INHALATION AEROSOL POWDER BREATH ACTIVATED 113-14 MCG/ ACT, 232-14 MCG/ACT, 55-14 MCG/ACT . . . . . . . . . . . . . . . . . 38fluvoxamine maleate . . . . . . . . . . . . . . 12fluvoxamine maleate er . . . . . . . . . . . . 12FOCALIN . . . . . . . . . . . . . . . . . . . . . . . 19FOCALIN XR . . . . . . . . . . . . . . . . . . . . 19folic acid oral tablet 1 mg . . . . . . . . . . 27FOLLISTIM AQ . . . . . . . . . . . . . . . . . . . 35FORFIVO XL . . . . . . . . . . . . . . . . . . . . . 12formoterol fumarate inhalation . . . . . . 38FORTEO . . . . . . . . . . . . . . . . . . . . . . . . 35FORTESTA . . . . . . . . . . . . . . . . . . . . . . 33FORTISCARE G1 TEST STRIP . . . . . . 24FORTISCARE T1 GLUCOSE SYSTEM . . . . . . . . . . . . . . . . . . . . . . . . 24FORTISCARE TEST . . . . . . . . . . . . . . 24FOSAMAX . . . . . . . . . . . . . . . . . . . . . . 35FREESTYLE LIBRE 14 DAY READER . . . . . . . . . . . . . . . . . . . . . . . . 24FREESTYLE LIBRE 14 DAY SENSOR . . . . . . . . . . . . . . . . . . . . . . . . 24FREESTYLE LIBRE 2 READER . . . . . 24FREESTYLE LIBRE 2 SENSOR . . . . . 24FREESTYLE LIBRE 3 SENSOR . . . . . 24FREESTYLE LIBRE READER . . . . . . . 24FREESTYLE PRECISION NEO SYSTEM . . . . . . . . . . . . . . . . . . . . . . . . 24FREESTYLE PRECISION NEO TEST . . . . . . . . . . . . . . . . . . . . . . . . . . . 24furosemide oral . . . . . . . . . . . . . . . . . . 17fyremadel . . . . . . . . . . . . . . . . . . . . . . . 35Ggabapentin oral capsule . . . . . . . . . . . 11gabapentin oral solution 250 mg/5ml . . . . . . . . . . . . . . . . . . . . . 11GABAPENTIN ORAL TABLET 25 MG, 50 MG . . . . . . . . . . . . . . . . . . . 11gabapentin oral tablet 600 mg, 800 mg . . . . . . . . . . . . . . . . . . . . . . . . . 11ganirelix acetate solution prefilled syringe 250 mcg/0.5ml subcutaneous . . . . . . . . . . . . . . . . . . . 35gavilyte-c . . . . . . . . . . . . . . . . . . . . . . . 28gavilyte-g . . . . . . . . . . . . . . . . . . . . . . . 28GAVRETO . . . . . . . . . . . . . . . . . . . . . . . 14GELNIQUE . . . . . . . . . . . . . . . . . . . . . . 29GELSYN-3 . . . . . . . . . . . . . . . . . . . . . . . 8gemfibrozil oral . . . . . . . . . . . . . . . . . . 17gemmily . . . . . . . . . . . . . . . . . . . . . . . . 30GEN7T EXTERNAL PATCH . . . . . . . . . 8gengraf . . . . . . . . . . . . . . . . . . . . . . . . . 34GENOTROPIN . . . . . . . . . . . . . . . . . . . 33GENOTROPIN MINIQUICK. . . . . . . . . 33GENTLE-LET PLATFORMS . . . . . . . . 24GENVOYA . . . . . . . . . . . . . . . . . . . . . . . 15GEODON ORAL . . . . . . . . . . . . . . . . . 15GILENYA . . . . . . . . . . . . . . . . . . . . . . . . 19GIMOTI . . . . . . . . . . . . . . . . . . . . . . . . . 13glatiramer acetate . . . . . . . . . . . . . . . . 19glatopa . . . . . . . . . . . . . . . . . . . . . . . . . 19glimepiride . . . . . . . . . . . . . . . . . . . . . . 26glipizide er . . . . . . . . . . . . . . . . . . . . . . 26glipizide ir . . . . . . . . . . . . . . . . . . . . . . . 26glipizide xl . . . . . . . . . . . . . . . . . . . . . . . 26GLOPERBA . . . . . . . . . . . . . . . . . . . . . 13glucagon emergency kit 1 mg injection 1 mg . . . . . . . . . . . . . . . . . . . 26GLUCOCARD EXPRESSION TEST . . 24GLUCOCARD SHINE TEST . . . . . . . . 24GLUCOCARD VITAL TEST . . . . . . . . . 24GLUCOTROL XL . . . . . . . . . . . . . . . . . 26GLUMETZA . . . . . . . . . . . . . . . . . . . . . 26glyburide oral . . . . . . . . . . . . . . . . . . . . 26glyburide-metformin . . . . . . . . . . . . . . 26glycopyrrolate oral tablet 1 mg, 2 mg . . . . . . . . . . . . . . . . . . . . . . . . . . . 28GLYXAMBI . . . . . . . . . . . . . . . . . . . . . . 26GOLYTELY . . . . . . . . . . . . . . . . . . . . . . 28GONITRO . . . . . . . . . . . . . . . . . . . . . . . 17guanfacine hcl . . . . . . . . . . . . . . . . 17, 19guanfacine hcl er . . . . . . . . . . . . . . . . . 19GUARDIAN LINK 3 TRANSMITTER . 24GUARDIAN REAL-TIME REPLACE PED . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24GUARDIAN SENSOR (3) . . . . . . . . . . . 24GYNAZOLE-1 . . . . . . . . . . . . . . . . . . . . 1346

HHAEGARDA . . . . . . . . . . . . . . . . . . . . . 34hailey 1.5/30 . . . . . . . . . . . . . . . . . . . . . 30hailey 24 fe . . . . . . . . . . . . . . . . . . . . . . 30hailey fe 1/20 . . . . . . . . . . . . . . . . . . . . 30hailey fe 1.5/30 . . . . . . . . . . . . . . . . . . . 30HALCION . . . . . . . . . . . . . . . . . . . . . . . 16HARVONI ORAL PACKET . . . . . . . . . 15HARVONI ORAL TABLET . . . . . . . . . . 15heather . . . . . . . . . . . . . . . . . . . . . . . . . 30HEMADY . . . . . . . . . . . . . . . . . . . . . . . . 32HEMANGEOL . . . . . . . . . . . . . . . . . . . 17HEMOFIL M . . . . . . . . . . . . . . . . . . . . . 27HIDEX 6-DAY . . . . . . . . . . . . . . . . . . . . 32HUMALOG INJECTION . . . . . . . . . . . 25HUMALOG KWIKPEN . . . . . . . . . . . . . 25HUMALOG MIX 50/50 KWIKPEN . . . 25HUMALOG MIX 50/50 VIAL . . . . . . . . 25HUMALOG MIX 75/25 KWIKPEN . . . 25HUMALOG MIX 75/25 VIAL . . . . . . . . 25HUMALOG SUBCUTANEOUS . . . . . . 25HUMALOG U-100 JUNIOR KWIKPEN . . . . . . . . . . . . . . . . . . . . . . . 25HUMATE-P . . . . . . . . . . . . . . . . . . . . . . 27HUMATROPE . . . . . . . . . . . . . . . . . . . . 33HUMIRA . . . . . . . . . . . . . . . . . . . . . . . . 34HUMIRA PEDIATRIC CROHNS START . . . . . . . . . . . . . . . . . . . . . . . . . . 34HUMIRA PEN . . . . . . . . . . . . . . . . . . . . 34HUMIRA PEN-CD/UC/HS STARTER . . . . . . . . . . . . . . . . . . . . . . . 34HUMIRA PEN-PEDIATRIC UC START . . . . . . . . . . . . . . . . . . . . . . . . . . 34HUMIRA PEN-PS/UV/ADOL HS START . . . . . . . . . . . . . . . . . . . . . . . . . . 34HUMIRA PEN-PSOR/UVEIT STARTER . . . . . . . . . . . . . . . . . . . . . . . 34HUMULIN 70/30 KWIKPEN . . . . . . . . 25HUMULIN 70/30 VIAL . . . . . . . . . . . . . 25HUMULIN N KWIKPEN . . . . . . . . . . . . 25HUMULIN N VIAL . . . . . . . . . . . . . . . . 25HUMULIN R U-500 KWIKPEN . . . . . . 25HUMULIN R U-500 VIAL . . . . . . . . . . . 25HUMULIN R VIAL . . . . . . . . . . . . . . . . 25HYALGAN INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE . . . . 8hydralazine hcl oral . . . . . . . . . . . . . . . 17hydrochlorothiazide oral . . . . . . . . . . . 17hydrocodone bitartrate er oral capsule extended release 12 hour . . . 8hydrocodone bitartrate er oral tablet er 24 hour abuse-deterrent . . . . 8hydrocodone polst-chlorphen polst er susp . . . . . . . . . . . . . . . . . . . . . . . . . 37hydrocodone-acetaminophen oral solution 7.5-325 mg/15ml . . . . . . . . . . . 8hydrocodone-acetaminophen oral tablet 10-300 mg, 5-300 mg, 7.5-300 mg . . . . . . . . . . . . . . . . . . . . . . . 8hydrocodone-acetaminophen oral tablet 10-325 mg, 5-325 mg, 7.5-325 mg . . . . . . . . . . . . . . . . . . . . . . . 8hydrocort-pramoxine (perianal) . . . . . 35hydrocortisone ace-pramoxine external cream 1-1 % . . . . . . . . . . . . . . 35hydrocortisone external cream 1 % . . 21hydrocortisone external cream 2.5 % . . . . . . . . . . . . . . . . . . . . . . . . . . . 21hydrocortisone external lotion 2.5 % . 21hydrocortisone external ointment 1 %, 2.5 % . . . . . . . . . . . . . . . . . . . . . . . 21hydrocortisone oral . . . . . . . . . . . . . . . 32hydromorphone hcl er . . . . . . . . . . . . . 8hydromorphone hcl oral . . . . . . . . . . . . 8hydromorphone hcl rectal . . . . . . . . . . 8hydroxychloroquine sulfate oral . . . . . 14hydroxyzine hcl oral . . . . . . . . . . . . . . 16hydroxyzine pamoate oral . . . . . . . . . 16hyoscyamine sulfate er . . . . . . . . . . . . 28hyoscyamine sulfate oral . . . . . . . . . . 28hyoscyamine sulfate sl . . . . . . . . . . . . 28hyoscyamine sulfate sublingual . . . . . 28hyosyne . . . . . . . . . . . . . . . . . . . . . . . . 28HYSINGLA ER . . . . . . . . . . . . . . . . . . . . 8HYZAAR . . . . . . . . . . . . . . . . . . . . . . . . 17Iibandronate sodium oral . . . . . . . . . . . 35IBRANCE . . . . . . . . . . . . . . . . . . . . . . . 14ibuprofen oral suspension 100 mg/5ml . . . . . . . . . . . . . . . . . . . . . . 9ibuprofen oral tablet 400 mg, 600 mg, 800 mg . . . . . . . . . . . . . . . . . . 9icatibant acetate . . . . . . . . . . . . . . . . . 34iclevia . . . . . . . . . . . . . . . . . . . . . . . . . . 30ICLUSIG ORAL TABLET 10 MG, 30 MG . . . . . . . . . . . . . . . . . . . . . . . . . . 14ICLUSIG ORAL TABLET 15 MG, 45 MG . . . . . . . . . . . . . . . . . . . . . . . . . . 14icosapent ethyl. . . . . . . . . . . . . . . . . . . 17IDHIFA. . . . . . . . . . . . . . . . . . . . . . . . . . 14ILEVRO . . . . . . . . . . . . . . . . . . . . . . . . . 35IMBRUVICA ORAL TABLET . . . . . . . . 14imiquimod external cream 3.75 % . . . 21imiquimod external cream 5 % . . . . . . 21imiquimod pump . . . . . . . . . . . . . . . . . 22IMITREX ORAL . . . . . . . . . . . . . . . . . . 14IMITREX STATDOSE REFILL . . . . . . . 14IMITREX STATDOSE SYSTEM . . . . . . 14IMPEKLO . . . . . . . . . . . . . . . . . . . . . . . 22IMPOYZ . . . . . . . . . . . . . . . . . . . . . . . . 22IMURAN . . . . . . . . . . . . . . . . . . . . . . . . 34IMVEXXY MAINTENANCE PACK . . . 27IMVEXXY STARTER PACK . . . . . . . . . 27IN TOUCH . . . . . . . . . . . . . . . . . . . . . . 24INBRIJA . . . . . . . . . . . . . . . . . . . . . . . . 14incassia . . . . . . . . . . . . . . . . . . . . . . . . . 30INCRUSE ELLIPTA . . . . . . . . . . . . . . . 38INDERAL LA . . . . . . . . . . . . . . . . . . . . 17INDOCIN . . . . . . . . . . . . . . . . . . . . . . . . . 9indomethacin er . . . . . . . . . . . . . . . . . . . 9INDOMETHACIN ORAL CAPSULE 20 MG . . . . . . . . . . . . . . . . . . . . . . . . . . . 9indomethacin oral capsule 25 mg, 50 mg . . . . . . . . . . . . . . . . . . . . . . . . . . . 9INSPIRACHAMBER/LARGE . . . . . . . 38INSPIRACHAMBER/MEDIUM . . . . . . 38INSPIRACHAMBER/MOUTHPIECE . 38INSPIRACHAMBER/SMALL . . . . . . . 38INSPIREASE . . . . . . . . . . . . . . . . . . . . 38INSULIN ASPART . . . . . . . . . . . . . . . . 25INSULIN ASPART FLEXPEN . . . . . . . 25INSULIN ASPART PENFILL . . . . . . . . 25INSULIN GLARGINE . . . . . . . . . . . . . . 25INSULIN GLARGINE SOLOSTAR . . . 25INSULIN LISPRO . . . . . . . . . . . . . . . . . 25INSULIN LISPRO (1 UNIT DIAL) . . . . . 25INSULIN LISPRO JUNIOR KWIKPEN . . . . . . . . . . . . . . . . . . . . . . . 25INSULIN LISPRO KWIKPEN . . . . . . . . 25INSULIN LISPRO PROT & LISPRO . . 25INSULIN PEN NEEDLES . . . . . . . . . . . 24INTRAROSA. . . . . . . . . . . . . . . . . . . . . 27introvale . . . . . . . . . . . . . . . . . . . . . . . . 30INTUNIV . . . . . . . . . . . . . . . . . . . . . . . . 19INVELTYS . . . . . . . . . . . . . . . . . . . . . . . 35ipratropium bromide nasal . . . . . . . . . 3747

ipratropium-albuterol . . . . . . . . . . . . . 38irbesartan . . . . . . . . . . . . . . . . . . . . . . . 17irbesartan-hydrochlorothiazide . . . . . 17ISENTRESS . . . . . . . . . . . . . . . . . . . . . 15ISENTRESS HD . . . . . . . . . . . . . . . . . . 15isibloom . . . . . . . . . . . . . . . . . . . . . . . . 30isosorb dinitrate-hydralazine . . . . . . . 17isosorbide mononitrate . . . . . . . . . . . . 17isosorbide mononitrate er . . . . . . . . . 17isotretinoin capsule 10 mg oral . . . . . 22isotretinoin capsule 20 mg oral . . . . . 22isotretinoin capsule 30 mg oral . . . . . 22isotretinoin capsule 40 mg oral . . . . . 22isotretinoin oral capsule 25 mg, 35 mg . . . . . . . . . . . . . . . . . . . . . . . . . . 22ISTALOL . . . . . . . . . . . . . . . . . . . . . . . . 36ivermectin oral . . . . . . . . . . . . . . . . . . . 14Jjaimiess . . . . . . . . . . . . . . . . . . . . . . . . . 30jantoven . . . . . . . . . . . . . . . . . . . . . . . . 11JANUVIA . . . . . . . . . . . . . . . . . . . . . . . . 26JARDIANCE . . . . . . . . . . . . . . . . . . . . . 26jasmiel. . . . . . . . . . . . . . . . . . . . . . . . . . 30jencycla. . . . . . . . . . . . . . . . . . . . . . . . . 30JENTADUETO . . . . . . . . . . . . . . . . . . . 26JENTADUETO XR . . . . . . . . . . . . . . . . 26JIVI . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27jolessa. . . . . . . . . . . . . . . . . . . . . . . . . . 30JORNAY PM . . . . . . . . . . . . . . . . . . . . . 19juleber . . . . . . . . . . . . . . . . . . . . . . . . . . 30JULUCA . . . . . . . . . . . . . . . . . . . . . . . . 15junel 1/20 . . . . . . . . . . . . . . . . . . . . . . . 30junel 1.5/30 . . . . . . . . . . . . . . . . . . . . . 30junel fe 1/20 . . . . . . . . . . . . . . . . . . . . . 30junel fe 1.5/30 . . . . . . . . . . . . . . . . . . . 30junel fe 24 . . . . . . . . . . . . . . . . . . . . . . . 30JUST RIGHT 5000 . . . . . . . . . . . . . . . . 20KK-TAB . . . . . . . . . . . . . . . . . . . . . . . . . . 27kalliga . . . . . . . . . . . . . . . . . . . . . . . . . . 30KAPSPARGO SPRINKLE . . . . . . . . . . 17kariva . . . . . . . . . . . . . . . . . . . . . . . . . . 31KAZANO . . . . . . . . . . . . . . . . . . . . . . . 26KENALOG EXTERNAL . . . . . . . . . . . . 22KEPPRA ORAL . . . . . . . . . . . . . . . . . . 11KEPPRA XR . . . . . . . . . . . . . . . . . . . . . 11KESIMPTA . . . . . . . . . . . . . . . . . . . . . . 19ketoconazole external cream . . . . . . . 13ketoconazole external foam . . . . . . . . 13ketoconazole external shampoo . . . . 13ketodan external foam . . . . . . . . . . . . 13KETOROLAC TROMETHAMINE NASAL . . . . . . . . . . . . . . . . . . . . . . . . . . 9ketorolac tromethamine ophthalmic . 35ketorolac tromethamine oral . . . . . . . . 9KITABIS PAK . . . . . . . . . . . . . . . . . . . . 38KLARITY-A . . . . . . . . . . . . . . . . . . . . . . 35KLISYRI . . . . . . . . . . . . . . . . . . . . . . . . 22KLONOPIN . . . . . . . . . . . . . . . . . . . . . . 16klor-con . . . . . . . . . . . . . . . . . . . . . . . . . 27klor-con 10 . . . . . . . . . . . . . . . . . . . . . . 27klor-con m10 . . . . . . . . . . . . . . . . . . . . 27klor-con m15. . . . . . . . . . . . . . . . . . . . . 27klor-con m20 . . . . . . . . . . . . . . . . . . . . 27KLOXXADO . . . . . . . . . . . . . . . . . . . . . 10KOATE . . . . . . . . . . . . . . . . . . . . . . . . . 27KOATE-DVI . . . . . . . . . . . . . . . . . . . . . . 27KOGENATE FS . . . . . . . . . . . . . . . . . . . 27KOMBIGLYZE XR . . . . . . . . . . . . . . . . 26KOSELUGO . . . . . . . . . . . . . . . . . . . . . 14KOVALTRY . . . . . . . . . . . . . . . . . . . . . . 27KRINTAFEL . . . . . . . . . . . . . . . . . . . . . 14kurvelo . . . . . . . . . . . . . . . . . . . . . . . . . 31KYNMOBI . . . . . . . . . . . . . . . . . . . . . . . 14Llabetalol hcl oral . . . . . . . . . . . . . . . . . 17lacosamide oral . . . . . . . . . . . . . . . . . . 11LAMICTAL . . . . . . . . . . . . . . . . . . . . . . 11LAMICTAL ODT ORAL KIT 21 X 25 MG & 7 X 50 MG, 42 X 50 MG & 14X100 MG . . . . . . . . . . . . . . . . . . . . . . 11LAMICTAL ODT ORAL KIT 25 & 50 & 100 MG . . . . . . . . . . . . . . . . . . . . . . . 11LAMICTAL ODT ORAL TABLET DISPERSIBLE . . . . . . . . . . . . . . . . . . . 11LAMICTAL STARTER . . . . . . . . . . . . . 11LAMICTAL XR . . . . . . . . . . . . . . . . . . . 11lamotrigine er . . . . . . . . . . . . . . . . . . . . 11lamotrigine oral kit . . . . . . . . . . . . . . . . 11lamotrigine oral tablet . . . . . . . . . . . . . 11lamotrigine oral tablet chewable . . . . 11lamotrigine oral tablet dispersible . . . 11lamotrigine starter kit-blue . . . . . . . . . 11lamotrigine starter kit-green . . . . . . . . 11lamotrigine starter kit-orange . . . . . . . 11LANCETS . . . . . . . . . . . . . . . . . . . . 23, 24LANREOTIDE ACETATE . . . . . . . . . . . 33LANTUS SOLOSTAR . . . . . . . . . . . . . 25LANTUS U-100 VIAL . . . . . . . . . . . . . . 25larin 1/20 . . . . . . . . . . . . . . . . . . . . . . . 31larin 1.5/30 . . . . . . . . . . . . . . . . . . . . . . 31larin 24 fe . . . . . . . . . . . . . . . . . . . . . . . 31larin fe 1/20 . . . . . . . . . . . . . . . . . . . . . 31larin fe 1.5/30 . . . . . . . . . . . . . . . . . . . . 31larissia . . . . . . . . . . . . . . . . . . . . . . . . . . 31LASIX . . . . . . . . . . . . . . . . . . . . . . . . . . 17LASTACAFT . . . . . . . . . . . . . . . . . . . . . 35latanoprost ophthalmic . . . . . . . . . . . . 36LATUDA . . . . . . . . . . . . . . . . . . . . . . . . 15LEDIPASVIR-SOFOSBUVIR . . . . . . . . 15lenalidomide . . . . . . . . . . . . . . . . . . . . . 14lessina . . . . . . . . . . . . . . . . . . . . . . . . . . 31letrozole oral . . . . . . . . . . . . . . . . . . . . 14LEVALBUTEROL HFA INHALATION AEROSOL 45 MCG/ACT . . . . . . . . . . 38LEVBID . . . . . . . . . . . . . . . . . . . . . . . . . 28LEVEMIR U-100 FLEXTOUCH . . . . . . 25LEVEMIR U-100 VIAL . . . . . . . . . . . . . 25levetiracetam er . . . . . . . . . . . . . . . . . . 11levetiracetam oral . . . . . . . . . . . . . . . . 11levo-t . . . . . . . . . . . . . . . . . . . . . . . . . . . 33levocetirizine dihydrochloride oral solution . . . . . . . . . . . . . . . . . . . . . . . . . 37levocetirizine dihydrochloride oral tablet . . . . . . . . . . . . . . . . . . . . . . . . . . . 37levofloxacin oral . . . . . . . . . . . . . . . . . . 10levonorgest-eth est & eth est . . . . . . . 31levonorgest-eth estrad 91-day oral tablet 0.1-0.02 & 0.01 mg, 0.15-0.03 &0.01 mg . . . . . . . . . . . . . . . 31levonorgest-eth estrad 91-day oral tablet 0.15-0.03 mg . . . . . . . . . . . . . . . 31levonorgestrel-ethinyl estrad oral tablet 0.1-20 mg-mcg, 0.15-30 mg-mcg . . . . . . . . . . . . . . . . . . 31levora 0.15/30 (28) . . . . . . . . . . . . . . . . 31LEVOTHYROXINE SODIUM ORAL CAPSULE . . . . . . . . . . . . . . . . . . . . . . . 33levothyroxine sodium oral tablet . . . . 33levoxyl . . . . . . . . . . . . . . . . . . . . . . . . . . 33LEVSIN ORAL . . . . . . . . . . . . . . . . . . . 28LEVSIN/SL . . . . . . . . . . . . . . . . . . . . . . 28LEXAPRO . . . . . . . . . . . . . . . . . . . . . . . 12LIALDA . . . . . . . . . . . . . . . . . . . . . . . . . 35lidocaine external ointment 5 % . . . . . . 848

lidocaine external patch 5 % . . . . . . . . 8lidocaine hcl mouth/throat . . . . . . . . . 20lidocaine viscous hcl . . . . . . . . . . . . . . 20lidocaine-prilocaine external cream . . 8LIDODERM . . . . . . . . . . . . . . . . . . . . . . . 8lillow oral tablet 0.15-30 mg-mcg . . . . 31LINZESS . . . . . . . . . . . . . . . . . . . . . . . . 28liothyronine sodium oral . . . . . . . . . . . 33LIPITOR . . . . . . . . . . . . . . . . . . . . . . . . 17LIPOFEN . . . . . . . . . . . . . . . . . . . . . . . . 17lisinopril oral . . . . . . . . . . . . . . . . . . . . . 17lisinopril-hydrochlorothiazide . . . . . . . 17lithium carbonate er . . . . . . . . . . . . . . 16lithium carbonate oral . . . . . . . . . . . . . 16LITHOBID . . . . . . . . . . . . . . . . . . . . . . . 16LO LOESTRIN FE. . . . . . . . . . . . . . . . . 31lo-zumandimine . . . . . . . . . . . . . . . . . . 31LODINE . . . . . . . . . . . . . . . . . . . . . . . . . . 9LOESTRIN 1/20 (21) . . . . . . . . . . . . . . 31LOESTRIN 1.5/30 (21) . . . . . . . . . . . . . 31LOESTRIN FE 1/20 . . . . . . . . . . . . . . . 31LOESTRIN FE 1.5/30 . . . . . . . . . . . . . . 31LOFENA . . . . . . . . . . . . . . . . . . . . . . . . . 9lojaimiess . . . . . . . . . . . . . . . . . . . . . . . 31LOKELMA . . . . . . . . . . . . . . . . . . . . . . . 27LOMOTIL . . . . . . . . . . . . . . . . . . . . . . . 28LOPID . . . . . . . . . . . . . . . . . . . . . . . . . . 17LOPRESSOR . . . . . . . . . . . . . . . . . . . . 17LOPROX EXTERNAL SHAMPOO . . . 13lorazepam intensol . . . . . . . . . . . . . . . 16lorazepam oral concentrate 2 mg/ml . . . . . . . . . . . . . . . . . . . . . . . . 16lorazepam oral tablet . . . . . . . . . . . . . 16LOREEV XR . . . . . . . . . . . . . . . . . . . . . 16LORTAB . . . . . . . . . . . . . . . . . . . . . . . . . 8loryna . . . . . . . . . . . . . . . . . . . . . . . . . . 31losartan potassium oral . . . . . . . . . . . 17losartan potassium-hctz . . . . . . . . . . . 17LOSEASONIQUE . . . . . . . . . . . . . . . . . 31LOTEMAX OPHTHALMIC GEL . . . . . 35LOTEMAX OPHTHALMIC OINTMENT . . . . . . . . . . . . . . . . . . . . . . 35LOTEMAX OPHTHALMIC SUSPENSION . . . . . . . . . . . . . . . . . . . 35LOTEMAX SM . . . . . . . . . . . . . . . . . . . 36LOTENSIN . . . . . . . . . . . . . . . . . . . . . . 17LOTENSIN HCT . . . . . . . . . . . . . . . . . . 17loteprednol etabonate ophthalmic gel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36loteprednol etabonate ophthalmic suspension . . . . . . . . . . . . . . . . . . . . . . 36LOTREL . . . . . . . . . . . . . . . . . . . . . . . . 17lovastatin oral . . . . . . . . . . . . . . . . . . . . 17LOVAZA . . . . . . . . . . . . . . . . . . . . . . . . 17LOVENOX . . . . . . . . . . . . . . . . . . . . . . . 11low-ogestrel . . . . . . . . . . . . . . . . . . . . . 31LUMIGAN . . . . . . . . . . . . . . . . . . . . . . . 36LUNESTA . . . . . . . . . . . . . . . . . . . . . . . 39lutera . . . . . . . . . . . . . . . . . . . . . . . . . . . 31lyleq . . . . . . . . . . . . . . . . . . . . . . . . . . . 31lyllana . . . . . . . . . . . . . . . . . . . . . . . . . . 31LYMEPAK . . . . . . . . . . . . . . . . . . . . . . . 10LYNPARZA . . . . . . . . . . . . . . . . . . . . . . 14LYRICA . . . . . . . . . . . . . . . . . . . . . . . . . 20LYRICA CR . . . . . . . . . . . . . . . . . . . . . . 20LYUMJEV KWIKPEN . . . . . . . . . . . . . . 25LYUMJEV VIAL . . . . . . . . . . . . . . . . . . 25LYVISPAH . . . . . . . . . . . . . . . . . . . . . . . 39lyza . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31MMALARONE . . . . . . . . . . . . . . . . . . . . . 14marlissa . . . . . . . . . . . . . . . . . . . . . . . . 31matzim la . . . . . . . . . . . . . . . . . . . . . . . 17MAVENCLAD . . . . . . . . . . . . . . . . . . . . 19MAVYRET ORAL PACKET . . . . . . . . . 15MAVYRET ORAL TABLET . . . . . . . . . 15MAXALT . . . . . . . . . . . . . . . . . . . . . . . . 14MAXITROL . . . . . . . . . . . . . . . . . . . . . . 36MAXZIDE . . . . . . . . . . . . . . . . . . . . . . . 17MAXZIDE-25 . . . . . . . . . . . . . . . . . . . . 17MAYZENT STARTER PACK ORAL TABLET THERAPY PACK 0.25 MG . . 34MAYZENT STARTER PACK ORAL TABLET THERAPY PACK 12 X 0.25 MG . . . . . . . . . . . . . . . . . . . . . . . . 34MEDROL ORAL TABLET 16 MG, 4 MG, 8 MG . . . . . . . . . . . . . . . . . . . . . 32MEDROL ORAL TABLET 2 MG . . . . . 32MEDROL ORAL TABLET 32 MG . . . . 32MEDROL ORAL TABLET THERAPY PACK . . . . . . . . . . . . . . . . . . . . . . . . . . . 32medroxyprogesterone acetate intramuscular suspension . . . . . . . . . 31medroxyprogesterone acetate intramuscular suspension prefilled syringe . . . . . . . . . . . . . . . . . . . . . . . . . 31medroxyprogesterone acetate oral . . 31meloxicam oral capsule . . . . . . . . . . . . 9MELOXICAM ORAL SUSPENSION . . . 9meloxicam oral tablet . . . . . . . . . . . . . . 9MENOSTAR . . . . . . . . . . . . . . . . . . . . . 31mercaptopurine oral . . . . . . . . . . . . . . 14merzee . . . . . . . . . . . . . . . . . . . . . . . . . 31mesalamine er oral capsule . . . . . . . . 35mesalamine oral . . . . . . . . . . . . . . . . . 35mesalamine rectal enema . . . . . . . . . 35mesalamine rectal suppository . . . . . 35metaxalone . . . . . . . . . . . . . . . . . . . . . 39metformin hcl er . . . . . . . . . . . . . . . . . 26metformin hcl er (mod) . . . . . . . . . . . . 26metformin hcl er (osm) . . . . . . . . . . . . 26metformin hcl oral solution . . . . . . . . . 26metformin hcl oral tablet 1000 mg, 500 mg, 850 mg. . . . . . . . . . . . . . . . . . 26metformin hcl oral tablet 625 mg . . . . 26methimazole oral . . . . . . . . . . . . . . . . . 33methocarbamol oral . . . . . . . . . . . . . . 39methotrexate oral . . . . . . . . . . . . . . . . 34methotrexate sodium . . . . . . . . . . . . . 34methotrexate sodium (pf) . . . . . . . . . . 34METHYLIN . . . . . . . . . . . . . . . . . . . . . . 19methylphenidate hcl er (cd) . . . . . . . . 19methylphenidate hcl er (la) oral capsule extended release 24 hour 10 mg, 20 mg, 30 mg, 40 mg . . . . . . . 19methylphenidate hcl er (la) oral capsule extended release 24 hour 60 mg . . . . . . . . . . . . . . . . . . . . . . . . . . 19methylphenidate hcl er (osm) . . . . . . . 19methylphenidate hcl er (xr) . . . . . . . . . 19methylphenidate hcl er oral tablet extended release . . . . . . . . . . . . . . . . . 19methylphenidate hcl er oral tablet extended release 24 hour . . . . . . . . . . 19methylphenidate hcl oral solution . . . 19methylphenidate hcl oral tablet . . . . . 19methylphenidate hcl oral tablet chewable . . . . . . . . . . . . . . . . . . . . . . . 19methylprednisolone oral . . . . . . . . . . . 32metoclopramide hcl oral solution . . . 13metoclopramide hcl oral tablet . . . . . 13metoclopramide hcl oral tablet dispersible . . . . . . . . . . . . . . . . . . . . . . 13metoprolol succinate er oral tablet extended release 24 hour 100 mg, 200 mg, 50 mg . . . . . . . . . . . . . . . . . . . 17metoprolol succinate er oral tablet extended release 24 hour 25 mg . . . . 1749

metoprolol tartrate oral tablet 100 mg, 25 mg, 50 mg . . . . . . . . . . . . 17metoprolol tartrate oral tablet 37.5 mg, 75 mg . . . . . . . . . . . . . . . . . . 17METROCREAM . . . . . . . . . . . . . . . . . . 22METROGEL . . . . . . . . . . . . . . . . . . . . . 22METROLOTION . . . . . . . . . . . . . . . . . . 22metronidazole external cream . . . . . . 22metronidazole external gel 0.75 % . . . 22metronidazole external gel 1 % . . . . . 22metronidazole external lotion . . . . . . . 22metronidazole oral . . . . . . . . . . . . . . . . 10metronidazole vaginal . . . . . . . . . . . . . 10MICARDIS . . . . . . . . . . . . . . . . . . . . . . 17MICRODOT TEST . . . . . . . . . . . . . . . . 24microgestin 1/20 . . . . . . . . . . . . . . . . . 31microgestin 1.5/30 . . . . . . . . . . . . . . . 31microgestin 24 fe . . . . . . . . . . . . . . . . . 31microgestin fe 1/20 . . . . . . . . . . . . . . . 31microgestin fe 1.5/30 . . . . . . . . . . . . . 31mili . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31MILLIPRED . . . . . . . . . . . . . . . . . . . . . . 32MINASTRIN 24 FE . . . . . . . . . . . . . . . . 31MINILINK REAL-TIME TRANSMITTER . . . . . . . . . . . . . . . . . . 24MINIPRESS . . . . . . . . . . . . . . . . . . . . . 17MINIVELLE . . . . . . . . . . . . . . . . . . . 30, 31MINOCYCLINE HCL ER ORAL CAPSULE EXTENDED RELEASE 24 HOUR . . . . . . . . . . . . . . . . . . . . . . . 10minocycline hcl er oral tablet extended release 24 hour 105 mg, 115 mg, 55 mg, 65 mg, 80 mg . . . . . . 10minocycline hcl er oral tablet extended release 24 hour 135 mg, 45 mg, 90 mg . . . . . . . . . . . . . . . . . . . . 10minocycline hcl oral capsule . . . . . . . 10minocycline hcl oral tablet . . . . . . . . . 11MINOLIRA . . . . . . . . . . . . . . . . . . . . . . 11MIRAPEX ER . . . . . . . . . . . . . . . . . . . . 14MIRCETTE . . . . . . . . . . . . . . . . . . . . . . 31mirtazapine oral . . . . . . . . . . . . . . . . . . 12MIRVASO . . . . . . . . . . . . . . . . . . . . . . . 22misoprostol oral . . . . . . . . . . . . . . . . . . 28MITIGARE . . . . . . . . . . . . . . . . . . . . . . 13MM EASY TOUCH GLUCOSE METER . . . . . . . . . . . . . . . . . . . . . . . . . 24modafinil . . . . . . . . . . . . . . . . . . . . . . . . 39mometasone furoate external . . . . . . 22mondoxyne nl . . . . . . . . . . . . . . . . . . . 11mono-linyah . . . . . . . . . . . . . . . . . . . . . 31montelukast sodium oral packet . . . . 38montelukast sodium oral tablet . . . . . 38montelukast sodium oral tablet chewable . . . . . . . . . . . . . . . . . . . . . . . 38morphine sulfate (concentrate) oral solution 100 mg/5ml, 20 mg/ml . . . . . . 8morphine sulfate er oral capsule extended release 24 hour . . . . . . . . . . . 8morphine sulfate er oral tablet extended release . . . . . . . . . . . . . . . . . . 8morphine sulfate oral . . . . . . . . . . . . . . 8morphine sulfate rectal . . . . . . . . . . . . . 8MOTEGRITY . . . . . . . . . . . . . . . . . . . . 28MOUNJARO . . . . . . . . . . . . . . . . . . . . . 26MOVIPREP . . . . . . . . . . . . . . . . . . . . . . 28moxifloxacin hcl (2x day) . . . . . . . . . . . 36moxifloxacin hcl ophthalmic solution . . . . . . . . . . . . . . . . . . . . . . . . . 36MS CONTIN . . . . . . . . . . . . . . . . . . . . . . 8MULPLETA . . . . . . . . . . . . . . . . . . . . . . 27MULTAQ . . . . . . . . . . . . . . . . . . . . . . . . 18MULTI-VIT-FLOR . . . . . . . . . . . . . . . . . 27multi-vitamin/fluoride . . . . . . . . . . . . . 27multivitamin/fluoride tablet chewable 0.25 mg oral (rx) . . . . . . . . . 27multivitamin/fluoride tablet chewable 0.5 mg oral . . . . . . . . . . . . . 27multivitamin/fluoride tablet chewable 1 mg oral . . . . . . . . . . . . . . . 27mupirocin calcium . . . . . . . . . . . . . . . . 11mupirocin external . . . . . . . . . . . . . . . . 11mycophenolate mofetil oral . . . . . . . . 34mycophenolate sodium . . . . . . . . . . . 34MYDAYIS . . . . . . . . . . . . . . . . . . . . . . . 19MYFEMBREE . . . . . . . . . . . . . . . . . . . . 31MYFORTIC . . . . . . . . . . . . . . . . . . . . . . 34myorisan . . . . . . . . . . . . . . . . . . . . . . . . 22NNA SULFATE-K SULFATE-MG SULF . 28nabumetone oral . . . . . . . . . . . . . . . . . . 9nadolol oral . . . . . . . . . . . . . . . . . . . . . 18NAFRINSE DAILY/NEUTRAL . . . . . . . 20NAFRINSE WEEKLY . . . . . . . . . . . . . . 20NALOCET . . . . . . . . . . . . . . . . . . . . . . . . 8naloxone hcl injection . . . . . . . . . . . . . 10naloxone hcl nasal . . . . . . . . . . . . . . . . 10naltrexone hcl oral . . . . . . . . . . . . . . . . 10NAPRELAN . . . . . . . . . . . . . . . . . . . . . . 9NAPROSYN ORAL SUSPENSION . . . . 9NAPROSYN ORAL TABLET . . . . . . . . . 9naproxen oral suspension . . . . . . . . . . 9naproxen oral tablet . . . . . . . . . . . . . . . 9naproxen oral tablet delayed release . 9naproxen sodium er oral tablet extended release 24 hour 375 mg, 500 mg . . . . . . . . . . . . . . . . . . . . . . . . . . 9NAPROXEN SODIUM ER ORAL TABLET EXTENDED RELEASE 24 HOUR 750 MG . . . . . . . . . . . . . . . . . 9naproxen sodium oral tablet 275 mg, 550 mg . . . . . . . . . . . . . . . . . . . 9naratriptan hcl . . . . . . . . . . . . . . . . . . . 14NARCAN . . . . . . . . . . . . . . . . . . . . . . . 10NASCOBAL . . . . . . . . . . . . . . . . . . . . . 27NATAZIA . . . . . . . . . . . . . . . . . . . . . . . . 31NATESTO . . . . . . . . . . . . . . . . . . . . . . . 33NAYZILAM . . . . . . . . . . . . . . . . . . . . . . 12nebivolol hcl . . . . . . . . . . . . . . . . . . . . . 18necon 0.5/35 (28) . . . . . . . . . . . . . . . . 31neomycin-polymyxin-dexameth ophthalmic ointment . . . . . . . . . . . . . . 36neomycin-polymyxin-dexameth ophthalmic suspension 3.5-10000-0.1 . . . . . . . . . . . . . . . . . . . . 36neomycin-polymyxin-hc otic . . . . . . . . 37NEORAL . . . . . . . . . . . . . . . . . . . . . . . . 34NESINA . . . . . . . . . . . . . . . . . . . . . . . . . 26neuac external gel . . . . . . . . . . . . . . . . 22NEULASTA . . . . . . . . . . . . . . . . . . . . . . 27NEURONTIN . . . . . . . . . . . . . . . . . . . . 12NEUTEK 2TEK TEST . . . . . . . . . . . . . . 24NEVANAC . . . . . . . . . . . . . . . . . . . . . . . 36NEXICLON XR . . . . . . . . . . . . . . . . . . . 18NEXLETOL . . . . . . . . . . . . . . . . . . . . . . 18NEXLIZET . . . . . . . . . . . . . . . . . . . . . . . 18niacin (antihyperlipidemic) . . . . . . . . . 18niacin er (antihyperlipidemic) . . . . . . . 18niacor . . . . . . . . . . . . . . . . . . . . . . . . . . 18NIASPAN . . . . . . . . . . . . . . . . . . . . . . . 18nifedipine er . . . . . . . . . . . . . . . . . . . . . 18nifedipine er osmotic release . . . . . . . 18nifedipine oral . . . . . . . . . . . . . . . . . . . 18nikki . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31nitisinone . . . . . . . . . . . . . . . . . . . . . . . 29NITRO-BID . . . . . . . . . . . . . . . . . . . . . . 18NITRO-DUR . . . . . . . . . . . . . . . . . . . . . 18NITRO-TIME . . . . . . . . . . . . . . . . . . . . . 1850

nitrofurantoin macrocrystal . . . . . . . . 11nitrofurantoin monohydrate macrocrystals . . . . . . . . . . . . . . . . . . . 11nitroglycerin sublingual . . . . . . . . . . . . 18nitroglycerin transdermal . . . . . . . . . . 18nitroglycerin translingual . . . . . . . . . . 18NITROLINGUAL . . . . . . . . . . . . . . . . . . 18NITROMIST . . . . . . . . . . . . . . . . . . . . . 18NITROSTAT . . . . . . . . . . . . . . . . . . . . . 18NITYR . . . . . . . . . . . . . . . . . . . . . . . . . . 29NOCDURNA . . . . . . . . . . . . . . . . . . . . . 33nora-be . . . . . . . . . . . . . . . . . . . . . . . . . 31NORDITROPIN FLEXPRO . . . . . . . . . 33norethin ace-eth estrad-fe oral capsule . . . . . . . . . . . . . . . . . . . . . . . . . 31norethin ace-eth estrad-fe oral tablet . . . . . . . . . . . . . . . . . . . . . . . . . . . 31norethindrone acet-ethinyl est . . . . . . 31norethindrone acetate oral . . . . . . . . . 31norethindrone oral . . . . . . . . . . . . . . . . 31norgestimate-eth estradiol . . . . . . . . . 31norgestimate-ethinyl estradiol triphasic oral tablet 0.18/0.215/ 0.25 mg-25 mcg . . . . . . . . . . . . . . . . . . 31norgestimate-ethinyl estradiol triphasic oral tablet 0.18/0.215/ 0.25 mg-35 mcg. . . . . . . . . . . . . . . . . . 31NORITATE . . . . . . . . . . . . . . . . . . . . . . 22NORLIQVA . . . . . . . . . . . . . . . . . . . . . . 18norlyda . . . . . . . . . . . . . . . . . . . . . . . . . 31norlyroc . . . . . . . . . . . . . . . . . . . . . . . . 31nortrel 0.5/35 (28) . . . . . . . . . . . . . . . . 31nortrel 1/35 (21) . . . . . . . . . . . . . . . . . . 31nortrel 1/35 (28) . . . . . . . . . . . . . . . . . . 31nortriptyline hcl oral . . . . . . . . . . . . . . 12NORVASC . . . . . . . . . . . . . . . . . . . . . . 18NORVIR ORAL PACKET . . . . . . . . . . . 15NORVIR ORAL SOLUTION . . . . . . . . 15NORVIR ORAL TABLET . . . . . . . . . . . 15NOURIANZ . . . . . . . . . . . . . . . . . . . . . . 14NOVAREL . . . . . . . . . . . . . . . . . . . . . . . 35NOVOEIGHT . . . . . . . . . . . . . . . . . . . . 27NOVOFINE AUTOCOVER PEN NEEDLE . . . . . . . . . . . . . . . . . . . . . . . . 24NOVOFINE PEN NEEDLE . . . . . . . . . . 24NOVOFINE PLUS PEN NEEDLE . . . . 24NOVOLIN 70/30 FLEXPEN . . . . . . . . . 25NOVOLIN 70/30 FLEXPEN RELION . 25NOVOLIN 70/30 RELION . . . . . . . . . . 25NOVOLIN 70/30 VIAL . . . . . . . . . . . . . 25NOVOLIN N FLEXPEN . . . . . . . . . . . . 25NOVOLIN N FLEXPEN RELION . . . . . 25NOVOLIN N RELION . . . . . . . . . . . . . . 25NOVOLIN N VIAL . . . . . . . . . . . . . . . . . 25NOVOLIN R FLEXPEN . . . . . . . . . . . . 25NOVOLIN R FLEXPEN RELION . . . . . 25NOVOLIN R RELION . . . . . . . . . . . . . . 25NOVOLIN R VIAL . . . . . . . . . . . . . . . . . 25NOVOLOG FLEXPEN . . . . . . . . . . 25, 26NOVOLOG FLEXPEN RELION . . . . . . 26NOVOLOG PENFILL . . . . . . . . . . . . . . 26NOVOLOG RELION . . . . . . . . . . . . . . . 26NOVOLOG U-100 VIAL . . . . . . . . . . . . 26NOVOTWIST . . . . . . . . . . . . . . . . . . . . 24np thyroid . . . . . . . . . . . . . . . . . . . . . . . 33NUBEQA. . . . . . . . . . . . . . . . . . . . . . . . 14NUCALA SUBCUTANEOUS SOLUTION AUTO-INJECTOR . . . . . . 38NUCALA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MG/ML . . . . . . . . . . . . . . . . . . . . . 38NUCALA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 40 MG/0.4ML . . . . . . . . . . . . . . . . . . . . 38NUCYNTA ER . . . . . . . . . . . . . . . . . . . . . 8NUCYNTA ORAL TABLET 100 MG, 75 MG . . . . . . . . . . . . . . . . . . . . . . . . . . . 8NUCYNTA ORAL TABLET 50 MG . . . . 8NUEDEXTA . . . . . . . . . . . . . . . . . . . . . 20NULEV . . . . . . . . . . . . . . . . . . . . . . . . . 28NURTEC ODT . . . . . . . . . . . . . . . . . . . 14NUTROPIN AQ NUSPIN 10 . . . . . . . . 33NUTROPIN AQ NUSPIN 20 . . . . . . . . 33NUTROPIN AQ NUSPIN 5 . . . . . . . . . 33NUVARING . . . . . . . . . . . . . . . . . . . . . . 31NUVESSA . . . . . . . . . . . . . . . . . . . . . . . 11NUWIQ INTRAVENOUS KIT 1000 UNIT, 2000 UNIT, 250 UNIT, 2500 UNIT, 3000 UNIT, 4000 UNIT, 500 UNIT . . . . . . . . . . . . . . . . . . . . . . . . . . . 27NUWIQ INTRAVENOUS KIT 1500 UNIT . . . . . . . . . . . . . . . . . . . . . . . . . . . 27NUWIQ INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT, 2000 UNIT, 250 UNIT, 2500 UNIT, 3000 UNIT, 4000 UNIT, 500 UNIT . . . . . . . . 27NUWIQ INTRAVENOUS SOLUTION RECONSTITUTED 1500 UNIT . . . . . . 27NUZYRA ORAL . . . . . . . . . . . . . . . . . . 11nyamyc . . . . . . . . . . . . . . . . . . . . . . . . . 13nylia 1/35 . . . . . . . . . . . . . . . . . . . . . . . 31nymyo . . . . . . . . . . . . . . . . . . . . . . . . . . 31nystatin external . . . . . . . . . . . . . . . . . 13nystatin mouth/throat . . . . . . . . . . . . . 13nystop . . . . . . . . . . . . . . . . . . . . . . . . . . 13Oocella . . . . . . . . . . . . . . . . . . . . . . . . . . 31OCUFLOX . . . . . . . . . . . . . . . . . . . . . . . 36ODEFSEY . . . . . . . . . . . . . . . . . . . . . . . 15ODOMZO . . . . . . . . . . . . . . . . . . . . . . . 14ofloxacin ophthalmic . . . . . . . . . . . . . . 36ofloxacin otic . . . . . . . . . . . . . . . . . . . . 37olanzapine oral tablet . . . . . . . . . . . . . 15olanzapine oral tablet dispersible . . . 15olmesartan medoxomil oral . . . . . . . . 18olmesartan medoxomil-hctz . . . . . . . . 18olopatadine hcl ophthalmic solution 0.1 % . . . . . . . . . . . . . . . . . . . . . . . . . . . 36olopatadine hcl ophthalmic solution 0.2 % . . . . . . . . . . . . . . . . . . . . . . . . . . . 36OLUMIANT ORAL TABLET 1 MG . . . 34OLUMIANT ORAL TABLET 2 MG . . . 34OLUMIANT ORAL TABLET 4 MG . . . 34OLUX . . . . . . . . . . . . . . . . . . . . . . . . . . 22OMECLAMOX-PAK . . . . . . . . . . . . . . . 28omega-3-acid ethyl esters . . . . . . . . . 18omeprazole oral capsule delayed release . . . . . . . . . . . . . . . . . . . . . . . . . 28OMEPRAZOLE+SYRSPEND SF ALKA . . . . . . . . . . . . . . . . . . . . . . . . . . . 28OMNARIS . . . . . . . . . . . . . . . . . . . . . . . 37OMNIPOD 5 G6 INTRO KIT (Gen 5) . 24OMNIPOD 5 G6 PODS (Gen 5) . . . . . 24OMNITROPE . . . . . . . . . . . . . . . . . . . . 33ondansetron hcl oral . . . . . . . . . . . . . . 13ondansetron odt . . . . . . . . . . . . . . . . . 13ONETOUCH CLUB LANCETS FINE PT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24ONETOUCH DELICA LANCETS 30G . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24ONETOUCH DELICA LANCETS 33G . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24ONETOUCH DELICA PLUS LANCET30G . . . . . . . . . . . . . . . . . . . . 24ONETOUCH DELICA PLUS LANCET33G . . . . . . . . . . . . . . . . . . . . 24ONETOUCH FINEPOINT LANCETS . 24ONETOUCH SOLUTIONS STARTER KIT . . . . . . . . . . . . . . . . . . . . 2451

ONETOUCH SURESOFT LANCING DEV . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24ONETOUCH ULTRA 2 KIT W/DEVICE . . . . . . . . . . . . . . . . . . . . . . 24ONETOUCH ULTRA MINI KIT W/DEVICE . . . . . . . . . . . . . . . . . . . . . . 24ONETOUCH ULTRA TEST STRIPS . . 24ONETOUCH ULTRASOFT LANCETS . . . . . . . . . . . . . . . . . . . . . . . 24ONETOUCH VERIO FLEX SYSTEM. . 24ONETOUCH VERIO IQ SYSTEM . . . . 24ONETOUCH VERIO KIT W/DEVICE . 24ONETOUCH VERIO REFLECT KIT W/DEVICE . . . . . . . . . . . . . . . . . . . . . . 24ONETOUCH VERIO TEST STRIPS . . 24ONGLYZA . . . . . . . . . . . . . . . . . . . . . . . 26ONZETRA XSAIL . . . . . . . . . . . . . . . . . 14OPSUMIT . . . . . . . . . . . . . . . . . . . . . . . 39OPTIUMEZ TEST . . . . . . . . . . . . . . . . . 24ORAPRED ODT . . . . . . . . . . . . . . . . . . 32ORENCIA CLICKJECT . . . . . . . . . . . . 34ORENCIA SUBCUTANEOUS . . . . . . . 34ORFADIN . . . . . . . . . . . . . . . . . . . . . . . 29ORGOVYX . . . . . . . . . . . . . . . . . . . . . . 14ORIAHNN . . . . . . . . . . . . . . . . . . . . . . . 33ORILISSA . . . . . . . . . . . . . . . . . . . . . . . 33ORTIKOS . . . . . . . . . . . . . . . . . . . . . . . 35OSCIMIN . . . . . . . . . . . . . . . . . . . . . . . 28oseltamivir phosphate oral capsule . . 15oseltamivir phosphate oral suspension reconstituted . . . . . . . . . . 15OSENI . . . . . . . . . . . . . . . . . . . . . . . . . . 26OSPHENA . . . . . . . . . . . . . . . . . . . . . . 27OTEZLA . . . . . . . . . . . . . . . . . . . . . . . . 34OTREXUP . . . . . . . . . . . . . . . . . . . . . . . 34OXAYDO . . . . . . . . . . . . . . . . . . . . . . . . . 8oxcarbazepine . . . . . . . . . . . . . . . . . . . 12OXTELLAR XR . . . . . . . . . . . . . . . . . . . 12oxybutynin chloride er . . . . . . . . . . . . 29oxybutynin chloride oral . . . . . . . . . . . 29OXYCODONE HCL ER . . . . . . . . . . . . . 8oxycodone hcl oral capsule . . . . . . . . . 8oxycodone hcl oral concentrate 100 mg/5ml . . . . . . . . . . . . . . . . . . . . . . 8oxycodone hcl oral solution . . . . . . . . . 8oxycodone hcl oral tablet 10 mg, 15 mg, 20 mg, 30 mg . . . . . . . . . . . . . . 8oxycodone hcl oral tablet 5 mg . . . . . . 8OXYCODONE-ACETAMINOPHEN ORAL SOLUTION . . . . . . . . . . . . . . . . . 8OXYCODONE-ACETAMINOPHEN ORAL TABLET 10-300 MG, 5-300 MG, 7.5-300 MG . . . . . . . . . . . . . 8oxycodone-acetaminophen oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg . . . . . . . . . . . . . . 8OXYCODONE-ACETAMINOPHEN ORAL TABLET 2.5-300 MG . . . . . . . . . 8OXYCONTIN . . . . . . . . . . . . . . . . . . . . . 8OZEMPIC SUBCUTANEOUS SOLUTION PEN-INJECTOR 2 MG/1.5ML, 4 MG/3ML . . . . . . . . . . 26OZEMPIC SUBCUTANEOUS SOLUTION PEN-INJECTOR 8 MG/3ML . . . . . . . . . . . . . . . . . . . . . . 26OZOBAX . . . . . . . . . . . . . . . . . . . . . . . . 39PPACERONE ORAL TABLET 100 MG, 400 MG . . . . . . . . . . . . . . . . . 18PACERONE ORAL TABLET 200 MG . 18PAMELOR . . . . . . . . . . . . . . . . . . . . . . 12PANCREAZE . . . . . . . . . . . . . . . . . . . . 29pantoprazole sodium oral packet . . . 28pantoprazole sodium oral tablet delayed release . . . . . . . . . . . . . . . . . . 28PARADIGM REAL-TIME TRANSMITTER . . . . . . . . . . . . . . . . . . 24paroxetine hcl er . . . . . . . . . . . . . . . . . 12paroxetine hcl oral suspension . . . . . 12paroxetine hcl oral tablet . . . . . . . . . . 12PAXIL CR . . . . . . . . . . . . . . . . . . . . . . . 12PAXIL ORAL SUSPENSION . . . . . . . . 12PAXIL ORAL TABLET . . . . . . . . . . . . . 12PEDIAPRED . . . . . . . . . . . . . . . . . . . . . 32peg-3350/electrolytes . . . . . . . . . . . . . 28peg-3350/electrolytes/ascorbat . . . . 28peg-kcl-nacl-nasulf-na asc-c . . . . . . . 28penicillamine oral capsule . . . . . . . . . 29penicillamine oral tablet . . . . . . . . . . . 29penicillin v potassium . . . . . . . . . . . . . 11PENLET II BLOOD SAMPLER . . . . . . 24PENLET II REPLACEMENT CAP . . . . 25PENNSAID . . . . . . . . . . . . . . . . . . . . . . . 9PENTASA . . . . . . . . . . . . . . . . . . . . . . . 35PERCOCET . . . . . . . . . . . . . . . . . . . . . . 8PERFOROMIST . . . . . . . . . . . . . . . . . . 38PERIDEX . . . . . . . . . . . . . . . . . . . . . . . . 20periogard . . . . . . . . . . . . . . . . . . . . . . . 20permethrin external . . . . . . . . . . . . . . . 14PERTZYE . . . . . . . . . . . . . . . . . . . . . . . 29phenazo oral tablet 200 mg . . . . . . . . 29phenazopyridine hcl oral tablet 100 mg, 200 mg . . . . . . . . . . . . . . . . . . 29philith . . . . . . . . . . . . . . . . . . . . . . . . . . 31PICATO . . . . . . . . . . . . . . . . . . . . . . . . . 22pimecrolimus . . . . . . . . . . . . . . . . . . . . 22pimtrea . . . . . . . . . . . . . . . . . . . . . . . . . 31pioglitazone hcl . . . . . . . . . . . . . . . . . . 26pirmella 1/35 . . . . . . . . . . . . . . . . . . . . 31PLAQUENIL . . . . . . . . . . . . . . . . . . . . . 14PLAVIX . . . . . . . . . . . . . . . . . . . . . . . . . 15PLEGRIDY INTRAMUSCULAR . . . . . 19PLEGRIDY STARTER PACK . . . . . . . . 19PLEGRIDY SUBCUTANEOUS . . . . . . 19PLENVU . . . . . . . . . . . . . . . . . . . . . . . . 28PLEXION . . . . . . . . . . . . . . . . . . . . . . . 22PLEXION CLEANSER . . . . . . . . . . . . . 22PLEXION CLEANSING CLOTH . . . . . 22POLY-VI-FLOR . . . . . . . . . . . . . . . . . . . 27polymyxin b-trimethoprim . . . . . . . . . . 36POLYTRIM . . . . . . . . . . . . . . . . . . . . . . 36portia-28 . . . . . . . . . . . . . . . . . . . . . . . . 31potassium chloride crys er oral tablet extended release 10 meq, 20 meq . . . . . . . . . . . . . . . . . . . . . . . . . 27potassium chloride crys er oral tablet extended release 15 meq . . . . 28potassium chloride er . . . . . . . . . . . . . 28potassium chloride oral packet . . . . . 28potassium chloride oral solution 20 meq/15ml (10%), 40 meq/15ml (20%) . . . . . . . . . . . . . . . . . . . . . . . . . . . 28potassium citrate er. . . . . . . . . . . . . . . 28PRADAXA . . . . . . . . . . . . . . . . . . . . . . 11PRALUENT. . . . . . . . . . . . . . . . . . . . . . 18pramipexole dihydrochloride . . . . 14, 15pramipexole dihydrochloride er . . . . . 15pravastatin sodium . . . . . . . . . . . . . . . 18prazosin hcl oral . . . . . . . . . . . . . . . . . 18PRECISION XTRA . . . . . . . . . . . . . . . . 25PRECISION XTRA BLOOD GLUCOSE . . . . . . . . . . . . . . . . . . . . . . 25PRED FORTE . . . . . . . . . . . . . . . . . . . . 36PRED MILD . . . . . . . . . . . . . . . . . . . . . 36prednisolone acetate ophthalmic . . . 36prednisolone oral. . . . . . . . . . . . . . . . . 32prednisolone sodium phosphate oral solution 10 mg/5ml, 25 mg/5ml, 6.7 (5 base) mg/5ml . . . . 3252

prednisolone sodium phosphate oral solution 15 mg/5ml . . . . . . . . . . . 32prednisolone sodium phosphate oral solution 20 mg/5ml . . . . . . . . . . . 32prednisolone sodium phosphate oral tablet dispersible . . . . . . . . . . . . . 33prednisone intensol . . . . . . . . . . . . . . . 33prednisone oral . . . . . . . . . . . . . . . . . . 33pregabalin er . . . . . . . . . . . . . . . . . . . . 20pregabalin oral capsule . . . . . . . . . . . 20pregabalin oral solution . . . . . . . . . . . 20PREGNYL . . . . . . . . . . . . . . . . . . . . . . . 35PREMARIN ORAL . . . . . . . . . . . . . . . . 32PREMARIN VAGINAL . . . . . . . . . . . . . 32PREMIUM BLOOD GLUCOSE TEST . 25premium lidocaine . . . . . . . . . . . . . . . . . 8PREMPHASE . . . . . . . . . . . . . . . . . . . . 32PREMPRO . . . . . . . . . . . . . . . . . . . . . . 32PRENA1 PEARL . . . . . . . . . . . . . . . . . . 28PREVIDENT 5000 BOOSTER PLUS . 20PREVIDENT 5000 DRY MOUTH . . . . 20PREVIDENT 5000 ORTHO DEFENSE . . . . . . . . . . . . . . . . . . . . . . . 20PREVIDENT 5000 PLUS . . . . . . . . . . . 20PREVIDENT DENTAL . . . . . . . . . . . . . 20PREVIDENT MOUTH/THROAT . . . . . 20PREZCOBIX . . . . . . . . . . . . . . . . . . . . . 15PRISTIQ . . . . . . . . . . . . . . . . . . . . . . . . 12PROAIR HFA . . . . . . . . . . . . . . . . . 37, 38PROAIR RESPICLICK . . . . . . . . . . . . . 38PROCARDIA XL . . . . . . . . . . . . . . . . . . 18PROCENTRA . . . . . . . . . . . . . . . . . . . . 19prochlorperazine maleate oral . . . . . . 13PROCORT . . . . . . . . . . . . . . . . . . . . . . 35PROCTOFOAM HC . . . . . . . . . . . . . . . 35progesterone oral . . . . . . . . . . . . . . . . 32PROGRAF ORAL CAPSULE . . . . . . . 34PROGRAF ORAL PACKET . . . . . . . . . 34PROLATE . . . . . . . . . . . . . . . . . . . . . . . . 8promethazine hcl oral solution . . . . . . 37promethazine hcl oral syrup . . . . . . . . 37promethazine hcl oral tablet . . . . . . . . 13promethazine hcl rectal . . . . . . . . . . . 13promethazine-codeine . . . . . . . . . . . . 37promethazine-dm . . . . . . . . . . . . . . . . 37promethegan . . . . . . . . . . . . . . . . . . . . 13propranolol hcl er . . . . . . . . . . . . . . . . 18propranolol hcl oral . . . . . . . . . . . . . . . 18PROSCAR . . . . . . . . . . . . . . . . . . . . . . 29PROTONIX ORAL . . . . . . . . . . . . . . . . 28PROVENTIL HFA . . . . . . . . . . . . . . 37, 38PROVERA . . . . . . . . . . . . . . . . . . . . 30, 32PROVIGIL . . . . . . . . . . . . . . . . . . . . . . . 39PROZAC . . . . . . . . . . . . . . . . . . . . . . . . 12pseudoephedrine-bromphen-dm . . . 37PSS SELECT PLATFORMS . . . . . . . . 25PULMICORT FLEXHALER . . . . . . . . . 38PULMICORT SUSPENSION . . . . . . . . 38PULMOZYME . . . . . . . . . . . . . . . . . . . 38PURIXAN . . . . . . . . . . . . . . . . . . . . . . . 14PYLERA . . . . . . . . . . . . . . . . . . . . . . . . 28PYRIDIUM . . . . . . . . . . . . . . . . . . . . . . 29QQBRELIS . . . . . . . . . . . . . . . . . . . . . . . 18QDOLO . . . . . . . . . . . . . . . . . . . . . . . . . . 9QUARTETTE . . . . . . . . . . . . . . . . . . . . 32QUDEXY XR . . . . . . . . . . . . . . . . . . . . . 12quetiapine fumarate . . . . . . . . . . . . . . 15quetiapine fumarate er . . . . . . . . . . . . 15QUFLORA PEDIATRIC . . . . . . . . . . . . 28QUILLICHEW ER . . . . . . . . . . . . . . . . . 19QUILLIVANT XR . . . . . . . . . . . . . . . . . . 19quinapril hcl . . . . . . . . . . . . . . . . . . . . . 18QUINTET AC BLOOD GLUCOSE . . . 25QUINTET AC BLOOD GLUCOSE TEST . . . . . . . . . . . . . . . . . . . . . . . . . . . 25QUINTET BLOOD GLUCOSE SYSTEM . . . . . . . . . . . . . . . . . . . . . . . . 25QUINTET BLOOD GLUCOSE TEST . 25QVAR REDIHALER . . . . . . . . . . . . . . . 38RRABEPRAZOLE SODIUM ORAL CAPSULE SPRINKLE . . . . . . . . . . . . . 28rabeprazole sodium oral tablet delayed release . . . . . . . . . . . . . . . . . . 28ramipril . . . . . . . . . . . . . . . . . . . . . . . . . 18RANEXA . . . . . . . . . . . . . . . . . . . . . . . . 18ranolazine er . . . . . . . . . . . . . . . . . . . . 18RAPAMUNE ORAL SOLUTION . . . . . 34RAPAMUNE ORAL TABLET . . . . . . . . 34RASUVO . . . . . . . . . . . . . . . . . . . . . . . . 34RAYOS . . . . . . . . . . . . . . . . . . . . . . . . . 33REBIF . . . . . . . . . . . . . . . . . . . . . . . . . . 19REBIF REBIDOSE . . . . . . . . . . . . . . . . 19REBIF REBIDOSE TITRATION PACK . . . . . . . . . . . . . . . . . . . . . . . . . . . 19REBIF TITRATION PACK . . . . . . . . . . 19reclipsen . . . . . . . . . . . . . . . . . . . . . . . . 32RECOMBINATE . . . . . . . . . . . . . . . . . . 27REDITREX . . . . . . . . . . . . . . . . . . . . . . 34REGLAN . . . . . . . . . . . . . . . . . . . . . . . . 13RELAFEN . . . . . . . . . . . . . . . . . . . . . 9, 10RELAFEN DS . . . . . . . . . . . . . . . . . . . . 10relexxii . . . . . . . . . . . . . . . . . . . . . . . . . 19RELION TRUE MET AIR GLUC METER . . . . . . . . . . . . . . . . . . . . . . . . . 25RELION TRUE METRIX TEST STRIPS . . . . . . . . . . . . . . . . . . . . . . . . . 25RELION ULTIMA GLUCOSE SYSTEM . . . . . . . . . . . . . . . . . . . . . . . . 25RELION ULTIMA TEST . . . . . . . . . . . . 25RELPAX . . . . . . . . . . . . . . . . . . . . . . . . 14RELTONE . . . . . . . . . . . . . . . . . . . . . . . 28REMERON . . . . . . . . . . . . . . . . . . . . . . 13REMERON SOLTAB ORAL TABLET DISPERSIBLE 15 MG, 30 MG . . . . . . 13REMODULIN . . . . . . . . . . . . . . . . . . . . 39REPATHA . . . . . . . . . . . . . . . . . . . . . . . 18REPATHA PUSHTRONEX SYSTEM. . 18REPATHA SURECLICK . . . . . . . . . . . . 18RESTASIS . . . . . . . . . . . . . . . . . . . . . . . 36RESTASIS MULTIDOSE . . . . . . . . . . . 36RESTORIL . . . . . . . . . . . . . . . . . . . . . . 39RETACRIT INJECTION SOLUTION 10000 UNIT/ML, 2000 UNIT/ML, 3000 UNIT/ML, 4000 UNIT/ML, 40000 UNIT/ML . . . . . . . . . . . . . . . . . . 27RETACRIT INJECTION SOLUTION 20000 UNIT/ML . . . . . . . . . . . . . . . . . . 27RETIN-A . . . . . . . . . . . . . . . . . . . . . . . . 22REVLIMID . . . . . . . . . . . . . . . . . . . . . . . 14REXULTI . . . . . . . . . . . . . . . . . . . . . . . . 15RHOFADE. . . . . . . . . . . . . . . . . . . . . . . 22RHOPRESSA . . . . . . . . . . . . . . . . . . . . 36RILUTEK . . . . . . . . . . . . . . . . . . . . . . . . 20riluzole . . . . . . . . . . . . . . . . . . . . . . . . . 20RINVOQ . . . . . . . . . . . . . . . . . . . . . . . . 34RIOMET . . . . . . . . . . . . . . . . . . . . . . . . 26RISPERDAL . . . . . . . . . . . . . . . . . . . . . 15risperidone . . . . . . . . . . . . . . . . . . . . . . 15RITALIN . . . . . . . . . . . . . . . . . . . . . . . . 19RITALIN LA. . . . . . . . . . . . . . . . . . . . . . 19ritonavir . . . . . . . . . . . . . . . . . . . . . . . . . 15rivelsa . . . . . . . . . . . . . . . . . . . . . . . . . . 32rizatriptan benzoate . . . . . . . . . . . . . . . 1453

ROCALTROL . . . . . . . . . . . . . . . . . . . . 35ROCKLATAN . . . . . . . . . . . . . . . . . . . . 36ropinirole hcl . . . . . . . . . . . . . . . . . . . . 15ropinirole hcl er . . . . . . . . . . . . . . . . . . 15rosadan external cream . . . . . . . . . . . 22rosadan external gel . . . . . . . . . . . . . . 22rosuvastatin calcium . . . . . . . . . . . . . . 18roweepra . . . . . . . . . . . . . . . . . . . . . . . 12ROXICODONE ORAL TABLET 15 MG, 30 MG . . . . . . . . . . . . . . . . . . . . 9ROXICODONE ORAL TABLET 5 MG . 9ROXYBOND ORAL TABLET ABUSE-DETERRENT 15 MG, 30 MG . 9ROXYBOND ORAL TABLET ABUSE-DETERRENT 5 MG . . . . . . . . . 9RUCONEST . . . . . . . . . . . . . . . . . . . . . 34RUKOBIA . . . . . . . . . . . . . . . . . . . . . . . 15RYBELSUS . . . . . . . . . . . . . . . . . . . . . . 26RYTARY . . . . . . . . . . . . . . . . . . . . . . . . 15SSAFYRAL . . . . . . . . . . . . . . . . . . . . . . . 32sajazir . . . . . . . . . . . . . . . . . . . . . . . . . . 34SANTYL . . . . . . . . . . . . . . . . . . . . . . . . 22SAPHRIS . . . . . . . . . . . . . . . . . . . . . . . 15scopolamine . . . . . . . . . . . . . . . . . . . . 13SEASONIQUE . . . . . . . . . . . . . . . . . . . 32SEREVENT DISKUS . . . . . . . . . . . . . . 38SERNIVO . . . . . . . . . . . . . . . . . . . . . . . 22SEROQUEL . . . . . . . . . . . . . . . . . . . . . 15SEROQUEL XR . . . . . . . . . . . . . . . . . . 15SERTRALINE HCL ORAL CAPSULE . 13sertraline hcl oral concentrate . . . . . . 13sertraline hcl oral tablet . . . . . . . . . . . 13setlakin . . . . . . . . . . . . . . . . . . . . . . . . . 32sf . . . . . . . . . . . . . . . . . . . . . . . . . . . 20, 28sf 5000 plus . . . . . . . . . . . . . . . . . . . . . 20SFROWASA . . . . . . . . . . . . . . . . . . . . . 35sharobel . . . . . . . . . . . . . . . . . . . . . . . . 32sildenafil citrate oral tablet 100 mg, 25 mg, 50 mg . . . . . . . . . . . . . . . . . . . . 27simliya . . . . . . . . . . . . . . . . . . . . . . . . . . 32simpesse . . . . . . . . . . . . . . . . . . . . . . . 32SIMPONI . . . . . . . . . . . . . . . . . . . . . . . . 34simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg . . . . . . . . . . . . . . 18simvastatin oral tablet 80 mg . . . . . . . 18SINEMET . . . . . . . . . . . . . . . . . . . . . . . 15SINGULAIR ORAL PACKET . . . . . . . . 38SINGULAIR ORAL TABLET . . . . . . . . 38SINGULAIR ORAL TABLET CHEWABLE . . . . . . . . . . . . . . . . . . . . . 38sirolimus oral solution . . . . . . . . . . . . . 34sirolimus oral tablet . . . . . . . . . . . . . . . 34SITAVIG . . . . . . . . . . . . . . . . . . . . . . . . 15SKYRIZI SUBCUTANEOUS SOLUTION CARTRIDGE . . . . . . . . . . 34SKYRIZI SUBCUTANEOUS SOLUTION PREFILLED SYRINGE . . . 34SOAANZ . . . . . . . . . . . . . . . . . . . . . . . . 18sodium fluoride 5000 plus . . . . . . . . . 20sodium fluoride 5000 ppm . . . . . . . . . 20sodium fluoride dental . . . . . . . . . . . . 20sodium fluoride mouth/throat . . . . . . 20SOFOSBUVIR-VELPATASVIR . . . . . . . 15SOLIQUA . . . . . . . . . . . . . . . . . . . . . . . 26SOLODYN . . . . . . . . . . . . . . . . . . . . . . 11SOLTAMOX . . . . . . . . . . . . . . . . . . . . . 14SOMA . . . . . . . . . . . . . . . . . . . . . . . . . . 39SOMATULINE DEPOT . . . . . . . . . . . . . 33SOOLANTRA . . . . . . . . . . . . . . . . . . . . 22sotalol hcl oral . . . . . . . . . . . . . . . . . . . 18SOTYLIZE . . . . . . . . . . . . . . . . . . . . . . . 18SPIRIVA HANDIHALER . . . . . . . . . . . . 38SPIRIVA RESPIMAT . . . . . . . . . . . . . . 38spironolactone oral . . . . . . . . . . . . . . . 18sprintec 28 . . . . . . . . . . . . . . . . . . . . . . 32SPRITAM . . . . . . . . . . . . . . . . . . . . . . . 12SPRIX . . . . . . . . . . . . . . . . . . . . . . . . . . 10sronyx . . . . . . . . . . . . . . . . . . . . . . . . . . 32sss 10-5 . . . . . . . . . . . . . . . . . . . . . . . . 22STELARA SUBCUTANEOUS . . . . . . . 34STENDRA . . . . . . . . . . . . . . . . . . . . . . . 27STIMATE . . . . . . . . . . . . . . . . . . . . . . . . 33STIOLTO RESPIMAT . . . . . . . . . . . . . . 38STIVARGA . . . . . . . . . . . . . . . . . . . . . . 14STRATTERA . . . . . . . . . . . . . . . . . . . . 19STRENSIQ . . . . . . . . . . . . . . . . . . . . . . 29STRIBILD . . . . . . . . . . . . . . . . . . . . . . . 15STRIVERDI RESPIMAT . . . . . . . . . . . . 38SUBOXONE . . . . . . . . . . . . . . . . . . . . . 10SUBSYS . . . . . . . . . . . . . . . . . . . . . . . . . 9subvenite . . . . . . . . . . . . . . . . . . . . . . . 12subvenite starter kit-blue . . . . . . . . . . 12subvenite starter kit-green . . . . . . . . . 12subvenite starter kit-orange . . . . . . . . 12sucralfate oral suspension . . . . . . . . . 28sucralfate oral tablet . . . . . . . . . . . . . . 28sulfacetamide sod-sulfur wash . . . . . 22sulfacetamide sodium-sulfur external cream 10-2 %, 10-5 % . . . . . . 22sulfacetamide sodium-sulfur external cream 9.8-4.8 % . . . . . . . . . . 22sulfacetamide sodium-sulfur external liquid 10-2 %, 9.8-4.8 % . . . . 22sulfacetamide sodium-sulfur external liquid 10-5 %, 9-4 %, 9-4.5 % . . . . . . . . . . . . . . . . . . . . . . . . . 22sulfacetamide sodium-sulfur external lotion 10-5 % . . . . . . . . . . . . . 22sulfacetamide sodium-sulfur external lotion 9.8-4.8 % . . . . . . . . . . . 22sulfacetamide sodium-sulfur external pad 10-4 % . . . . . . . . . . . . . . 22sulfacetamide sodium-sulfur external pad 9.8-4.8 % . . . . . . . . . . . . 22sulfacetamide sodium-sulfur external suspension 10-5 % . . . . . . . . 22sulfacetamide sodium-sulfur external suspension 8-4 % . . . . . . . . . 22SULFACLEANSE 8/4 . . . . . . . . . . . . . . 22sulfamethoxazole-trimethoprim oral . 11sulfamez wash . . . . . . . . . . . . . . . . . . . 22sulfasalazine oral . . . . . . . . . . . . . . . . . 35sulfatrim pediatric . . . . . . . . . . . . . . . . 11SUMADAN WASH . . . . . . . . . . . . . . . . 22sumatriptan succinate oral . . . . . . . . . 14sumatriptan succinate refill subcutaneous solution cartridge . . . . 14sumatriptan succinate subcutaneous . . . . . . . . . . . . . . . . . . . 14SUMAXIN . . . . . . . . . . . . . . . . . . . . . . . 22SUNOSI . . . . . . . . . . . . . . . . . . . . . . . . 39SUPARTZ FX . . . . . . . . . . . . . . . . . . . . . 9SUPREP BOWEL PREP KIT . . . . . . . . 28SURESTEP PRO LINEARITY . . . . . . . 25SUTAB . . . . . . . . . . . . . . . . . . . . . . . . . 28syeda . . . . . . . . . . . . . . . . . . . . . . . . . . 32SYMBICORT . . . . . . . . . . . . . . . . . . . . 38SYMFI . . . . . . . . . . . . . . . . . . . . . . . . . . 15SYMFI LO . . . . . . . . . . . . . . . . . . . . . . . 15SYMJEPI . . . . . . . . . . . . . . . . . . . . . . . . 37SYMLINPEN 120 . . . . . . . . . . . . . . . . . 26SYMLINPEN 60 . . . . . . . . . . . . . . . . . . 26SYMPROIC . . . . . . . . . . . . . . . . . . . . . . 28SYNALAR . . . . . . . . . . . . . . . . . . . . . . . 2254

SYNJARDY . . . . . . . . . . . . . . . . . . . . . . 26SYNJARDY XR . . . . . . . . . . . . . . . . . . . 26SYNOJOYNT . . . . . . . . . . . . . . . . . . . . . 9SYNTHROID . . . . . . . . . . . . . . . . . . . . . 33SYPRINE. . . . . . . . . . . . . . . . . . . . . . . . 29TTACLONEX EXTERNAL OINTMENT . 22TACLONEX EXTERNAL SUSPENSION . . . . . . . . . . . . . . . . . . . 22tacrolimus external . . . . . . . . . . . . . . . 22tacrolimus oral . . . . . . . . . . . . . . . . . . . 34tadalafil oral . . . . . . . . . . . . . . . . . . . . . 27TAKHZYRO . . . . . . . . . . . . . . . . . . . . . 34TAMIFLU ORAL CAPSULE . . . . . . . . . 15TAMIFLU ORAL SUSPENSION RECONSTITUTED . . . . . . . . . . . . . . . . 16tamoxifen citrate oral tablet 10 mg . . 14tamoxifen citrate oral tablet 20 mg . . 14tamsulosin hcl . . . . . . . . . . . . . . . . . . . 29TAPERDEX 12-DAY . . . . . . . . . . . . . . . 33TAPERDEX 6-DAY ORAL TABLET THERAPY PACK 1.5 MG . . . . . . . . . . . 33TAPERDEX 6-DAY ORAL TABLET THERAPY PACK 1.5 MG (21) . . . . . . . 33TAPERDEX 7-DAY . . . . . . . . . . . . . . . . 33TARGADOX . . . . . . . . . . . . . . . . . . . . . 11TARGRETIN EXTERNAL . . . . . . . . . . 14TARGRETIN ORAL . . . . . . . . . . . . . . . 14tarina 24 fe . . . . . . . . . . . . . . . . . . . . . . 32tarina fe 1/20 . . . . . . . . . . . . . . . . . . . . 32tarina fe 1/20 eq . . . . . . . . . . . . . . . . . . 32TARPEYO . . . . . . . . . . . . . . . . . . . . . . . 35TASIGNA . . . . . . . . . . . . . . . . . . . . . . . 14TAVALISSE . . . . . . . . . . . . . . . . . . . . . . 27taysofy . . . . . . . . . . . . . . . . . . . . . . . . . 32TAYTULLA . . . . . . . . . . . . . . . . . . . . . . 32tazarotene external cream . . . . . . . . . 22TAZORAC . . . . . . . . . . . . . . . . . . . . . . . 22TEGRETOL . . . . . . . . . . . . . . . . . . . . . . 12TEGRETOL-XR . . . . . . . . . . . . . . . . . . . 12TEGSEDI. . . . . . . . . . . . . . . . . . . . . . . . 29TEKTURNA . . . . . . . . . . . . . . . . . . . . . 18TEKTURNA HCT . . . . . . . . . . . . . . . . . 18telmisartan . . . . . . . . . . . . . . . . . . . . . . 18telmisartan-hctz . . . . . . . . . . . . . . . . . . 18temazepam . . . . . . . . . . . . . . . . . . . . . 39tenofovir disoproxil fumarate . . . . . . . 16TENORETIC 100 . . . . . . . . . . . . . . . . . 18TENORETIC 50 . . . . . . . . . . . . . . . . . . 18TENORMIN . . . . . . . . . . . . . . . . . . . . . 18terazosin hcl . . . . . . . . . . . . . . . . . . . . . 29terbinafine hcl oral . . . . . . . . . . . . . . . . 13terconazole . . . . . . . . . . . . . . . . . . . . . 13TERIPARATIDE (RECOMBINANT). . . 35TESTIM . . . . . . . . . . . . . . . . . . . . . . . . . 33testosterone cypionate intramuscular . . . . . . . . . . . . . . . . . . . . 33testosterone transdermal . . . . . . . . . . 33TEXACORT . . . . . . . . . . . . . . . . . . . . . 22THALITONE . . . . . . . . . . . . . . . . . . . . . 18THIOLA . . . . . . . . . . . . . . . . . . . . . . . . . 29THIOLA EC . . . . . . . . . . . . . . . . . . . . . . 29THYQUIDITY . . . . . . . . . . . . . . . . . . . . 33TIGLUTIK . . . . . . . . . . . . . . . . . . . . . . . 20timolol maleate (once-daily) . . . . . . . . 36timolol maleate ocudose . . . . . . . . . . 36timolol maleate ophthalmic . . . . . . . . 36timolol maleate pf . . . . . . . . . . . . . . . . 36TIMOPTIC . . . . . . . . . . . . . . . . . . . . . . 36TIMOPTIC OCUDOSE OPHTHALMIC SOLUTION 0.25 % . . . 36TIMOPTIC OCUDOSE OPHTHALMIC SOLUTION 0.5 % . . . . 36TIMOPTIC-XE . . . . . . . . . . . . . . . . . . . . 36TIROSINT . . . . . . . . . . . . . . . . . . . . . . . 33TIROSINT-SOL . . . . . . . . . . . . . . . . . . . 33TIVICAY. . . . . . . . . . . . . . . . . . . . . . . . . 16TIVICAY PD . . . . . . . . . . . . . . . . . . . . . 16TIVORBEX . . . . . . . . . . . . . . . . . . . . . . 10tizanidine hcl oral capsule . . . . . . . . . 39tizanidine hcl oral tablet . . . . . . . . . . . 39TOBI NEBULIZATION SOLUTION 300 MG/5ML INHALATION 300 MG/5ML . . . . . . . . . . . . . . . . . 38, 39TOBI PODHALER . . . . . . . . . . . . . . . . 39TOBRADEX OPHTHALMIC OINTMENT . . . . . . . . . . . . . . . . . . . . . . 36TOBRADEX OPHTHALMIC SUSPENSION . . . . . . . . . . . . . . . . . . . 36TOBRADEX ST . . . . . . . . . . . . . . . . . . 36tobramycin inhalation nebulization solution 300 mg/4ml . . . . . . . . . . . . . . 39tobramycin nebulization solution 300 mg/5ml inhalation . . . . . . . . . . . . 39tobramycin ophthalmic . . . . . . . . . . . . 36tobramycin-dexamethasone . . . . . . . . 36TOBREX . . . . . . . . . . . . . . . . . . . . . . . . 36TOPAMAX . . . . . . . . . . . . . . . . . . . . . . 12TOPAMAX SPRINKLE . . . . . . . . . . . . . 12topiramate er . . . . . . . . . . . . . . . . . . . . 12topiramate oral . . . . . . . . . . . . . . . . . . . 12TOPROL XL . . . . . . . . . . . . . . . . . . . . . 18torsemide . . . . . . . . . . . . . . . . . . . . . . . 18TOUJEO MAX SOLOSTAR . . . . . . . . . 26TOUJEO SOLOSTAR . . . . . . . . . . . . . 26TOVIAZ . . . . . . . . . . . . . . . . . . . . . . . . . 29TRACLEER . . . . . . . . . . . . . . . . . . . . . . 39TRADJENTA . . . . . . . . . . . . . . . . . . . . . 26tramadol hcl er (biphasic) . . . . . . . . . . . 9TRAMADOL HCL ER ORAL CAPSULE EXTENDED RELEASE 24 HOUR . . . . . . . . . . . . . . . . . . . . . . . . 9tramadol hcl er oral tablet extended release 24 hour . . . . . . . . . . . . . . . . . . . 9TRAMADOL HCL ORAL SOLUTION . . 9tramadol hcl oral tablet 100 mg . . . . . . 9tramadol hcl oral tablet 50 mg . . . . . . . 9TRANSDERM-SCOP . . . . . . . . . . . . . . 13TRAVATAN Z . . . . . . . . . . . . . . . . . . . . 36travoprost (bak free) . . . . . . . . . . . . . . 36trazodone hcl oral . . . . . . . . . . . . . . . . 13TRELEGY ELLIPTA . . . . . . . . . . . . . . . 38TREMFYA . . . . . . . . . . . . . . . . . . . . . . . 34treprostinil . . . . . . . . . . . . . . . . . . . . . . 39TRESIBA . . . . . . . . . . . . . . . . . . . . . . . . 26TRESIBA FLEXTOUCH . . . . . . . . . . . . 26tretinoin external cream . . . . . . . . . . . 22tretinoin external gel 0.01 %, 0.025 % . . . . . . . . . . . . . . . . . . . . . . . . . 22tretinoin external gel 0.05 % . . . . . . . . 22TREXALL . . . . . . . . . . . . . . . . . . . . . . . 34TREZIX . . . . . . . . . . . . . . . . . . . . . . . . . . 9tri femynor . . . . . . . . . . . . . . . . . . . . . . 32tri-estarylla . . . . . . . . . . . . . . . . . . . . . . 32tri-linyah . . . . . . . . . . . . . . . . . . . . . . . . 32tri-lo-estarylla . . . . . . . . . . . . . . . . . . . . 32tri-lo-marzia . . . . . . . . . . . . . . . . . . . . . 32tri-lo-mili . . . . . . . . . . . . . . . . . . . . . . . . 32tri-lo-sprintec . . . . . . . . . . . . . . . . . . . . 32tri-mili . . . . . . . . . . . . . . . . . . . . . . . . . . 32tri-nymyo . . . . . . . . . . . . . . . . . . . . . . . . 32tri-sprintec . . . . . . . . . . . . . . . . . . . . . . 32tri-vylibra . . . . . . . . . . . . . . . . . . . . . . . . 32tri-vylibra lo . . . . . . . . . . . . . . . . . . . . . . 3255

triamcinolone acetonide external aerosol solution . . . . . . . . . . . . . . . . . . 22triamcinolone acetonide external cream 0.025 %, 0.1 % . . . . . . . . . . . . . 22triamcinolone acetonide external cream 0.5 % . . . . . . . . . . . . . . . . . . . . . 22triamcinolone acetonide external lotion . . . . . . . . . . . . . . . . . . . . . . . . . . . 23triamcinolone acetonide external ointment 0.025 %, 0.1 %, 0.5 % . . . . . 23triamcinolone acetonide external ointment 0.05 % . . . . . . . . . . . . . . . . . . 23triamcinolone in absorbase . . . . . . . . 23triamterene-hctz . . . . . . . . . . . . . . . . . 18TRIANEX . . . . . . . . . . . . . . . . . . . . . . . 23triazolam . . . . . . . . . . . . . . . . . . . . . . . . 16TRICOR . . . . . . . . . . . . . . . . . . . . . . . . 18triderm external cream 0.1 % . . . . . . . 23triderm external cream 0.5 % . . . . . . . 23TRIDESILON . . . . . . . . . . . . . . . . . . . . 23trientine hcl. . . . . . . . . . . . . . . . . . . . . . 29TRIJARDY XR . . . . . . . . . . . . . . . . . . . 26TRILEPTAL . . . . . . . . . . . . . . . . . . . . . . 12TRILURON . . . . . . . . . . . . . . . . . . . . . . . 9TRINTELLIX . . . . . . . . . . . . . . . . . . . . . 13tritocin . . . . . . . . . . . . . . . . . . . . . . . . . . 23TRIUMEQ . . . . . . . . . . . . . . . . . . . . . . . 16TRIUMEQ PD . . . . . . . . . . . . . . . . . . . . 16TROKENDI XR . . . . . . . . . . . . . . . . . . . 12TRUE FOCUS BLOOD GLUCOSE STRIP . . . . . . . . . . . . . . . . . . . . . . . . . . 25TRUE METRIX AIR GLUCOSE METER . . . . . . . . . . . . . . . . . . . . . . . . . 25TRUE METRIX BLOOD GLUCOSE TEST . . . . . . . . . . . . . . . . . . . . . . . . . . . 25TRUE METRIX GO GLUCOSE METER . . . . . . . . . . . . . . . . . . . . . . . . . 25TRUE METRIX METER KIT. . . . . . . . . 25TRUE METRIX PRO BLOOD GLUCOSE . . . . . . . . . . . . . . . . . . . . . . 25TRUETRACK BLOOD GLUCOSE DEVICE . . . . . . . . . . . . . . . . . . . . . . . . . 25TRUETRACK TEST . . . . . . . . . . . . . . . 25TRULICITY . . . . . . . . . . . . . . . . . . . . . . 26TRUVADA ORAL TABLET 100-150 MG, 133-200 MG, 167-250 MG . . . . . . . . . . . . . . . . . . . . . 16TRUVADA ORAL TABLET 200-300 MG . . . . . . . . . . . . . . . . . . . . . 16tyblume . . . . . . . . . . . . . . . . . . . . . . . . . 32tydemy . . . . . . . . . . . . . . . . . . . . . . . . . 32TYMLOS . . . . . . . . . . . . . . . . . . . . . . . . 35TYRVAYA . . . . . . . . . . . . . . . . . . . . . . . 36TYVASO DPI MAINTENANCE KIT . . . 39TYVASO DPI TITRATION KIT . . . . . . . 39TYVASO INHALATION POWDER . . . 39TYVASO INHALATION SOLUTION . . 39TYVASO REFILL . . . . . . . . . . . . . . . . . 39TYVASO STARTER . . . . . . . . . . . . . . . 39UUBRELVY . . . . . . . . . . . . . . . . . . . . . . . 14UCERIS ORAL . . . . . . . . . . . . . . . . . . . 35UCERIS RECTAL . . . . . . . . . . . . . . . . . 35UKONIQ . . . . . . . . . . . . . . . . . . . . . . . . 14ULORIC . . . . . . . . . . . . . . . . . . . . . . . . 13ULTRAM . . . . . . . . . . . . . . . . . . . . . . . . . 9UNISTRIP1 GENERIC . . . . . . . . . . . . . 25unithroid . . . . . . . . . . . . . . . . . . . . . . . . 33UROCIT-K 10 . . . . . . . . . . . . . . . . . . . . 28UROCIT-K 15 . . . . . . . . . . . . . . . . . . . . 28UROCIT-K 5 . . . . . . . . . . . . . . . . . . . . . 28UROXATRAL . . . . . . . . . . . . . . . . . . . . 29URSO 250 . . . . . . . . . . . . . . . . . . . . . . 28URSO FORTE . . . . . . . . . . . . . . . . . . . 28URSODIOL ORAL CAPSULE 200 MG, 400 MG . . . . . . . . . . . . . . . . . 28ursodiol oral capsule 300 mg . . . . . . . 28ursodiol oral tablet . . . . . . . . . . . . . . . 28VVAGIFEM . . . . . . . . . . . . . . . . . . . . . . . 32valacyclovir hcl oral . . . . . . . . . . . . . . . 16VALIUM . . . . . . . . . . . . . . . . . . . . . . . . . 16VALSARTAN ORAL SOLUTION . . . . . 18valsartan oral tablet . . . . . . . . . . . . . . . 18valsartan-hydrochlorothiazide . . . . . . 18VALTOCO NASAL LIQUID 10 MG/0.1ML, 5 MG/0.1ML . . . . . . . . 12VALTREX . . . . . . . . . . . . . . . . . . . . . . . 16VANADOM . . . . . . . . . . . . . . . . . . . . . . 39VANDAZOLE . . . . . . . . . . . . . . . . . . . . 11VANOS . . . . . . . . . . . . . . . . . . . . . . . . . 23varenicline tartrate . . . . . . . . . . . . . . . . 10VASCEPA . . . . . . . . . . . . . . . . . . . . . . . 18VASOTEC . . . . . . . . . . . . . . . . . . . . . . . 18VECTICAL . . . . . . . . . . . . . . . . . . . . . . 23VELPHORO . . . . . . . . . . . . . . . . . . . . . 29VELTASSA . . . . . . . . . . . . . . . . . . . . . . 28VEMLIDY . . . . . . . . . . . . . . . . . . . . . . . 16venlafaxine hcl . . . . . . . . . . . . . . . . . . . 13venlafaxine hcl er oral capsule extended release 24 hour . . . . . . . . . . 13venlafaxine hcl er oral tablet extended release 24 hour . . . . . . . . . . 13VENTOLIN HFA . . . . . . . . . . . . . . . 37, 38verapamil hcl er oral capsule extended release 24 hour 100 mg, 200 mg, 300 mg . . . . . . . . . . . . . . . . . 18verapamil hcl er oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 360 mg . . . . . . . . . . 18verapamil hcl er oral tablet extended release . . . . . . . . . . . . . . . . . 18verapamil hcl oral . . . . . . . . . . . . . . . . 18VERDESO . . . . . . . . . . . . . . . . . . . . . . . 23VERELAN . . . . . . . . . . . . . . . . . . . . . . . 18VERELAN PM . . . . . . . . . . . . . . . . . . . 18VERKAZIA . . . . . . . . . . . . . . . . . . . . . . 36VERQUVO . . . . . . . . . . . . . . . . . . . . . . 18VERZENIO . . . . . . . . . . . . . . . . . . . . . . 14vestura . . . . . . . . . . . . . . . . . . . . . . . . . 32VIAGRA . . . . . . . . . . . . . . . . . . . . . . . . 27VIBERZI . . . . . . . . . . . . . . . . . . . . . . . . 29VIBRAMYCIN ORAL CAPSULE . . . . . 11VIBRAMYCIN ORAL SUSPENSION RECONSTITUTED . . . . . . . . . . . . . . . . 11VICTOZA SOLUTION PEN-INJECTOR 18 MG/3ML SUBCUTANEOUS . . . . . . . . . . . . . . . . 26vienva . . . . . . . . . . . . . . . . . . . . . . . . . . 32VIGAMOX . . . . . . . . . . . . . . . . . . . . . . . 36VIIBRYD . . . . . . . . . . . . . . . . . . . . . . . . 13VIIBRYD STARTER PACK . . . . . . . . . . 13vilazodone hcl . . . . . . . . . . . . . . . . . . . 13VIMPAT ORAL . . . . . . . . . . . . . . . . . . . 12VIOKACE . . . . . . . . . . . . . . . . . . . . . . . 29viorele . . . . . . . . . . . . . . . . . . . . . . . . . . 32VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG . . . . . . . . . . . . . . . . . 16VIREAD ORAL TABLET 300 MG . . . . 16VISTARIL . . . . . . . . . . . . . . . . . . . . . . . 16vitamin d (ergocalciferol) oral capsule 1.25 mg (50000 ut), 50000 unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28VITAPEARL . . . . . . . . . . . . . . . . . . . . . 28VITRAKVI . . . . . . . . . . . . . . . . . . . . . . . 14VIVELLE-DOT . . . . . . . . . . . . . . . . . 30, 3256

VOGELXO . . . . . . . . . . . . . . . . . . . . . . . 33VOGELXO PUMP . . . . . . . . . . . . . . . . . 33volnea . . . . . . . . . . . . . . . . . . . . . . . . . . 32VORTEX VALVED HOLDING CHAMBER . . . . . . . . . . . . . . . . . . . . . . 38VOSEVI . . . . . . . . . . . . . . . . . . . . . . . . . 16VRAYLAR ORAL CAPSULE . . . . . . . . 15VTOL LQ . . . . . . . . . . . . . . . . . . . . . . . . . 9vyfemla . . . . . . . . . . . . . . . . . . . . . . . . . 32VYLEESI . . . . . . . . . . . . . . . . . . . . . . . . 27vylibra . . . . . . . . . . . . . . . . . . . . . . . . . . 32VYTORIN . . . . . . . . . . . . . . . . . . . . . . . 18VYVANSE . . . . . . . . . . . . . . . . . . . . . . . 19VYZULTA . . . . . . . . . . . . . . . . . . . . . . . 36WWAKIX . . . . . . . . . . . . . . . . . . . . . . . . . . 39warfarin sodium oral . . . . . . . . . . . . . . 11WELCHOL . . . . . . . . . . . . . . . . . . . . . . 18WELLBUTRIN SR . . . . . . . . . . . . . . . . 13WELLBUTRIN XL . . . . . . . . . . . . . . . . . 13wera . . . . . . . . . . . . . . . . . . . . . . . . . . . 32WILATE . . . . . . . . . . . . . . . . . . . . . . . . . 27wixela inhub . . . . . . . . . . . . . . . . . . . . . 38WYNZORA . . . . . . . . . . . . . . . . . . . . . . 23XXALATAN . . . . . . . . . . . . . . . . . . . . . . . 36XANAX . . . . . . . . . . . . . . . . . . . . . . . . . 16XANAX XR . . . . . . . . . . . . . . . . . . . . . . 16XARELTO . . . . . . . . . . . . . . . . . . . . . . . 11XARELTO STARTER PACK. . . . . . . . . 11XCOPRI ORAL TABLET 100 MG, 150 MG, 200 MG, 50 MG . . . . . . . . . . 12XELJANZ . . . . . . . . . . . . . . . . . . . . . . . 34XELJANZ XR ORAL TABLET EXTENDED RELEASE 24 HOUR 11 MG . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34XELJANZ XR ORAL TABLET EXTENDED RELEASE 24 HOUR 22 MG . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34XELODA . . . . . . . . . . . . . . . . . . . . . . . . 14XELPROS . . . . . . . . . . . . . . . . . . . . . . . 36XENLETA ORAL . . . . . . . . . . . . . . . . . 11XEPI . . . . . . . . . . . . . . . . . . . . . . . . . . . 11XHANCE . . . . . . . . . . . . . . . . . . . . . . . . 37XIIDRA . . . . . . . . . . . . . . . . . . . . . . . . . 37XIMINO . . . . . . . . . . . . . . . . . . . . . . . . . 11XOFLUZA (40 MG DOSE) . . . . . . . . . . 16XOFLUZA (80 MG DOSE) . . . . . . . . . . 16XOLAIR SUBCUTANEOUS SOLUTION PREFILLED SYRINGE . . . 34XOLAIR SUBCUTANEOUS SOLUTION RECONSTITUTED . . . . . . 35XOLEGEL . . . . . . . . . . . . . . . . . . . . . . . 13XOPENEX HFA . . . . . . . . . . . . . . . . . . . 38XTAMPZA ER . . . . . . . . . . . . . . . . . . . . . 9xulane . . . . . . . . . . . . . . . . . . . . . . . . . . 32XYREM . . . . . . . . . . . . . . . . . . . . . . . . . 39XYWAV . . . . . . . . . . . . . . . . . . . . . . . . . 39YYASMIN 28 . . . . . . . . . . . . . . . . . . . . . . 32YAZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32YUPELRI . . . . . . . . . . . . . . . . . . . . . . . . 38yuvafem . . . . . . . . . . . . . . . . . . . . . . . . 32Zzafemy . . . . . . . . . . . . . . . . . . . . . . . . . 32ZANAFLEX . . . . . . . . . . . . . . . . . . . . . . 39ZARXIO . . . . . . . . . . . . . . . . . . . . . . . . 27ZCORT 7-DAY . . . . . . . . . . . . . . . . . . . 33ZEBUTAL . . . . . . . . . . . . . . . . . . . . . . . . 9ZEGALOGUE SUBCUTANEOUS SOLUTION AUTO-INJECTOR . . . . . . 26ZEJULA . . . . . . . . . . . . . . . . . . . . . . . . 14ZELNORM . . . . . . . . . . . . . . . . . . . . . . 29ZEMBRACE SYMTOUCH . . . . . . . . . . 14zenatane . . . . . . . . . . . . . . . . . . . . . . . . 23ZENPEP . . . . . . . . . . . . . . . . . . . . . . . . 29ZENZEDI . . . . . . . . . . . . . . . . . . . . . . . . 19ZEPATIER . . . . . . . . . . . . . . . . . . . . . . . 16ZEPOSIA . . . . . . . . . . . . . . . . . . . . . . . 20ZEPOSIA 7-DAY STARTER PACK . . . 20ZEPOSIA STARTER KIT . . . . . . . . . . . 20ZESTORETIC . . . . . . . . . . . . . . . . . . . . 19ZESTRIL . . . . . . . . . . . . . . . . . . . . . . . . 19ZETIA . . . . . . . . . . . . . . . . . . . . . . . . . . 19ZETONNA. . . . . . . . . . . . . . . . . . . . . . . 37ZIAC ORAL TABLET 10-6.25 MG, 2.5-6.25 MG . . . . . . . . . . . . . . . . . . . . . 19ZIAC ORAL TABLET 5-6.25 MG . . . . 19ZIEXTENZO . . . . . . . . . . . . . . . . . . . . . 27ZILXI . . . . . . . . . . . . . . . . . . . . . . . . . . . 23ZIMHI . . . . . . . . . . . . . . . . . . . . . . . . . . 10ZIOPTAN . . . . . . . . . . . . . . . . . . . . . . . 36ziprasidone hcl. . . . . . . . . . . . . . . . . . . 15ZIPSOR . . . . . . . . . . . . . . . . . . . . . . . . . 10ZITHROMAX ORAL . . . . . . . . . . . . . . . 11ZITHROMAX TRI-PAK . . . . . . . . . . . . . 11ZITHROMAX Z-PAK . . . . . . . . . . . . . . . 11ZOCOR . . . . . . . . . . . . . . . . . . . . . . . . . 19ZOLMITRIPTAN NASAL SOLUTION 2.5 MG . . . . . . . . . . . . . . . . . . . . . . . . . 14ZOLOFT . . . . . . . . . . . . . . . . . . . . . . . . 13zolpidem tartrate er . . . . . . . . . . . . . . . 39zolpidem tartrate oral . . . . . . . . . . . . . 39zolpidem tartrate sublingual . . . . . . . . 39ZOLPIMIST . . . . . . . . . . . . . . . . . . . . . . 39ZOMACTON . . . . . . . . . . . . . . . . . . . . . 33ZOMIG NASAL SOLUTION 2.5 MG . . 14ZOMIG NASAL SOLUTION 5 MG . . . 14ZONEGRAN . . . . . . . . . . . . . . . . . . . . . 12zonisamide oral . . . . . . . . . . . . . . . . . . 12ZONTIVITY . . . . . . . . . . . . . . . . . . . . . . 15ZOVIRAX ORAL . . . . . . . . . . . . . . . . . . 16ZTLIDO . . . . . . . . . . . . . . . . . . . . . . . . . . 9ZUBSOLV . . . . . . . . . . . . . . . . . . . . . . . 10zumandimine . . . . . . . . . . . . . . . . . . . . 32ZYCLARA . . . . . . . . . . . . . . . . . . . . . . . 23ZYCLARA PUMP . . . . . . . . . . . . . . . . . 23ZYLET . . . . . . . . . . . . . . . . . . . . . . . . . . 36ZYLOPRIM . . . . . . . . . . . . . . . . . . . . . . 13ZYPREXA ORAL . . . . . . . . . . . . . . . . . 15ZYPREXA ZYDIS . . . . . . . . . . . . . . . . . 1557

Nondiscrimination notice and access to communication services ® UnitedHealthcare and its subsidiaries do not discriminate on the basis of race, color, national origin, age, disability or sex in their health programs or activities. If you think you were treated unfairly because of your sex, age, race, color, disability or national origin, you can send a complaint to the Civil Rights Coordinator. Online: UHC_Civil_Rights@uhc.comMail: Civil Rights Coordinator UnitedHealthcare Civil Rights Grievance P.O. Box 30608 Salt Lake City, UT 84130You must send the complaint within 60 days of your experience. A decision will be sent to you within 30 days. If you disagree with the decision, you have 15 days to ask us to look at it again. If you need help with your complaint, please call the toll-free phone number listed on your member ID card, TTY 711, Monday through Friday, 8 a.m. to 8 p.m., or at the times listed in your health plan documents.You can also file a complaint with the U.S. Dept. of Health and Human Services.Online: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.htmlPhone: Toll-free 1-800-368-1019, 800-537-7697 (TDD)Mail: U.S. Dept. of Health and Human Services 200 Independence Avenue SW Room 509F, HHH Building Washington, D.C. 20201We provide free services to help you communicate with us, including letters in other languages or large print. Or, you can ask for an interpreter. To ask for help, please call the toll-free phone number listed on your member ID card, TTY 711, Monday through Friday, 8 a.m. to 8 p.m., or at the times listed in your health plan documents.58

請注意：如果您說中文 (Chinese)，我們免費為您提供語言協助服務。請撥打會員卡所列的免付費會員電話號碼。Ýý, quýôýATANSYON: Si w pale Kreyl ayisyen (Haitian Creole), ou kapab  sèvis ki gratis pou ede w nan lang pa w. Tanpri rele nimewo gratis ki sou kat  w.     (Farsi)   ध्यान दें: यदि आप हिंदी (Hindi) बोलते है, आपको भाषा सहायता सेबाएं, नि:शुल्क उपलब्ध हैं। कृपया अपने पहचान पत्र पर सूचीबद्ध टोल-फ्री फोन नंबर पर कॉल करें।CEEB TOOM: Yog koj hais Lus Hmoob (Hmong), muaj kev pab txhais lus pub dawb rau koj. Thov hu rau tus xov tooj hu deb dawb uas teev muaj nyob rau ntawm koj daim yuaj cim qhia tus kheej.ចំណាប់អារម្មណ៍ៈ បើសិនអ្នកនិយាយភាសាខ្មែរ(Khmer)សេវាជំនួយភាសាដោយឥតគិតថ្លៃ គឺមានសំរាប់អ្នក។ សូមទូរស័ព្ទទៅលេខឥតគិតថ្លៃ ដែលមាននៅលើអត្ដសញ្ញាណប័ណ្ណរបស់អ្នក។PAKDAAR: Nu saritaem ti Ilocano (Ilocano), ti serbisyo para ti baddang ti lengguahe nga awanan bayadna, ket sidadaan para kenyam. Maidawat nga awagan iti toll-free a numero ti telepono nga nakalista ayan iti DÍÍ BAA’ÁKONÍNÍZIN: Diné (Navajo)OGOW: Haddii aad ku hadasho Soomaali (Somali), adeegyada taageerada luqadda, oo bilaash ah, ayaad heli kartaa. Fadlan wac lambarka telefonka khadka bilaashka ee ku yaalla kaarkaaga aqoonsiga.Multi-language interpreter servicesMulti-language interpreter servicesATTENTION: If you speak English, language assistance services, free of charge, are available to you. Please ATENCIÓN: Si habla español (Spanish), hay servicios de asistencia de idiomas, sin cargo, a su disposición. 알림: 한국어(Korean)를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다. 귀하의 신분증 카드에 기재된 무료 회원 전화번호로 문의하십시오.PAALALA: Kung nagsasalita ka ng Tagalog (Tagalog), may makukuha kang mga libreng serbisyo ng tulong   (Russian)(Arabic) ATTENTION : Si vous parlez français (French), des services d’aide linguistique vous sont proposés polsku (Polish)português (Portuguese)ATTENZIONE: in caso la lingua parlata sia l’italiano (Italian), sono disponibili servizi di assistenza linguistica ACHTUNG: Falls Sie Deutsch (German) sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Bitte rufen Sie die gebührenfreie Rufnummer auf der Rückseite Ihres Mitgliedsausweises an.注意事項：日本語(Japanese)を話される場合、無料の言語支援サービスをご利用いただけます。健康保険証に記載されているフリーダイヤルにお電話ください。59

This document applies to members of UnitedHealthcare, Oxford New York and New Jersey and UnitedHealthOne plans.Insurance coverage provided by or through UnitedHealthcare Insurance Company, Oxford Health Insurance, Inc. or their affiliates. Stop-loss insurance is underwritten by All Savers Insurance Company (except CA, MA, MN, NJ and NY), UnitedHealthcare Insurance Company in MA and MN, UnitedHealthcare Life Insurance Company in NJ, UnitedHealthcare Insurance Company of New York in NY, and All Savers Life Insurance Company of California in CA. UnitedHealthcare Freedom Plans are underwritten by Tufts Health Freedom Insurance Company. Administrative services provided by UnitedHealthcare Insurance Company, UnitedHealthcare Services, Inc., Oxford Health Plans LLC or their affiliates, and UnitedHealthcare Service LLC in NY. Health Plan coverage provided by or through a UnitedHealthcare company. OptumRx is an affiliate of UnitedHealthcare Insurance Company. UnitedHealthOne plans provided by or through Oxford Health Plans (NJ), Inc. UnitedHealthcare® is a registered trademark owned by UnitedHealth Group Incorporated. All other trademarks are the property of their respective owners. 8/22 ©2023 United HealthCare Services, Inc. WF7969203-B 2023 Prescription Drug List — Advantage 4-Tier