Great Plains Medicare Advantage Gold (HMO SNP) Nebraska Comprehensive Formulary. (List of Covered Drugs)

Transcription

1 09 Part D Model Formulary (Comprehensive) Great Plains Medicare Advantage Gold (HMO SNP) Nebraska 09 Comprehensive Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN HPMS Approved Formulary File Submission ID, Version Number 7 This formulary was updated on 0/0/08. For more recent information or other questions, please contact Great Plains Medicare Advantage Gold (HMO SNP) Member Services, at or, for TTY users, 7, Hours of Operation: 8a.m. to 8 p.m., seven days a week (except Thanksgiving and Christmas) from October through March and Monday to Friday (except holidays) from April through September 0, or visit GreatPlainsMedicareAdvantage.com. July 08 H7_09FormGold_C

2 09 Part D Model Formulary (Comprehensive) Note to existing members: This formulary has changed since last year. Please review this document to make sure that it still contains the drugs you take. When this drug list (formulary) refers to we, us, or our, it means Great Plains Medicare Advantage Gold (HMO SNP). When it refers to plan or our plan, it means Great Plains Medicare Advantage Gold. This document includes a list of the drugs (formulary) for our plan which is current as of 0/0/08. For an updated formulary, please contact us. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. You must generally use network pharmacies to use your prescription drug benefit. Benefits, formulary, pharmacy network, and/or copayments/coinsurance may change on January, 09, and from time to time during the year. What is the Great Plains Medicare Advantage Gold (HMO SNP) Formulary? A formulary is a list of covered drugs selected by Great Plains Medicare Advantage Gold in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Great Plains Medicare Advantage Gold will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Great Plains Medicare Advantage Gold network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage. Can the Formulary (drug list) change? Generally, if you are taking a drug on our 09 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 09 coverage year except when a new, less expensive generic drug becomes available, when new information about the safety or effectiveness of a drug is released, or the drug is removed from the market. (See bullets below for more information on changes that affect members currently taking the drug.) Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same cost-sharing for those members taking it for the remainder of the coverage year. Below are changes to the drug list that will also affect members currently taking a drug: New generic drugs. We may immediately remove a brand name drug on our Drug List if we are replacing it with a new generic drug that will appear on the same or lower cost sharing tier and with the same or fewer restrictions. Also, when adding the new generic drug, we may decide to keep the brand name drug on our Drug List, but immediately move it to a different cost-sharing tier or add new restrictions. If you are currently taking that brand name drug, we may not tell you in advance before we make that change, but we will later provide you with information about the specific change(s) we have made. o If we make such a change, you or your prescriber can ask us to make an exception and continue to cover the brand name drug for you. The notice we provide you will also include information on the steps you may take to request an exception, and you can also find information in the section below entitled How do I request an exception to the Great Plains Medicare Advantage Gold (HMO SNP) s Formulary? July 08 H7_09FormGold_C

3 09 Part D Model Formulary (Comprehensive) Drugs removed from the market. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug. Other changes. We may make other changes that affect members currently taking a drug. For instance, we may add a generic drug that is not new to market to replace a brand name drug currently on the formulary or add new restrictions to the brand name drug or move it to a different cost-sharing tier. Or we may make changes based on new clinical guidelines. If we remove drugs from our formulary, [or] add prior authorization, quantity limits and/or step therapy restrictions on a drug or move a drug to a higher cost-sharing tier, we must notify affected members of the change at least 0 days before the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 0-day supply of the drug. The enclosed formulary is current as of 0/0/08. To get updated information about the drugs covered by Great Plains Medicare Advantage Gold, please contact us. Our contact information appears on the front and back cover pages. In the event that Great Plains Medicare Advantage Gold has CMS-approved nonmaintenance changes to the formulary throughout the plan year (i.e. remove drugs from our formulary, add prior authorization, quantity limits and/or step therapy restrictions on a drug, or move a drug to a higher cost-sharing tier, Great Plains Medicare Advantage Gold will update our formulary and post it on our website. How do I use the Formulary? There are two ways to find your drug within the formulary: Medical Condition The formulary begins on page 8. The drugs in this formulary are grouped into categories depending on the type of medical conditions that they are used to treat. For example, drugs used to treat a heart condition are listed under the category, Cardiovascular Agents. If you know what your drug is used for, look for the category name in the list that begins 8. Then look under the category name for your drug. Alphabetical Listing If you are not sure what category to look under, you should look for your drug in the Index that begins on page 06. The Index provides an alphabetical list of all of the drugs included in this document. Both brand name drugs and generic drugs are listed in the Index. Look in the Index and find your drug. Next to your drug, you will see the page number where you can find coverage information. Turn to the page listed in the Index and find the name of your drug in the first column of the list. July 08 H7_09FormGold_C

4 09 Part D Model Formulary (Comprehensive) What are generic drugs? Great Plains Medicare Advantage Gold covers both brand name drugs and generic drugs. A generic drug is approved by the FDA as having the same active ingredient as the brand name drug. Generally, generic drugs cost less than brand name drugs. Are there any restrictions on my coverage? Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include: Prior Authorization: Great Plains Medicare Advantage Gold requires you [or your physician] to get prior authorization for certain drugs. This means that you will need to get approval from Great Plains Medicare Advantage Gold before you fill your prescriptions. If you don t get approval, Great Plains Medicare Advantage Gold may not cover the drug. Quantity Limits: For certain drugs, Great Plains Medicare Advantage Gold limits the amount of the drug that Great Plains Medicare Advantage Gold will cover. For example, Great Plains Medicare Advantage Gold provides 0 units per 0-day prescription of morphine sulfate mg er lets. This may be in addition to a standard one-month or three-month supply. Step Therapy: In some cases, Great Plains Medicare Advantage Gold requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, Great Plains Medicare Advantage Gold may not cover Drug B unless you try Drug A first. If Drug A does not work for you, Great Plains Medicare Advantage Gold will then cover Drug B. You can find out if your drug has any additional requirements or limits by looking in the formulary that begins on page 8. You can also get more information about the restrictions applied to specific covered drugs by visiting our Web site. We have posted on line documents that explain our prior authorization and step therapy restrictions. You may also ask us to send you a copy. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. You can ask Great Plains Medicare Advantage Gold to make an exception to these restrictions or limits or for a list of other, similar drugs that may treat your health condition. See the section, How do I request an exception to the Great Plains Medicare Advantage Gold s formulary? on page for information about how to request an exception. What if my drug is not on the Formulary? If your drug is not included in this formulary (list of covered drugs), you should first contact Member Services and ask if your drug is covered. If you learn that Great Plains Medicare Advantage Gold does not cover your drug, you have two options: July 08 H7_09FormGold_C

5 09 Part D Model Formulary (Comprehensive) You can ask Member Services for a list of similar drugs that are covered by Great Plains Medicare Advantage Gold. When you receive the list, show it to your doctor and ask him or her to prescribe a similar drug that is covered by Great Plains Medicare Advantage Gold. You can ask Great Plains Medicare Advantage Gold to make an exception and cover your drug. See below for information about how to request an exception. How do I request an exception to the Great Plains Medicare Advantage Gold (HMO SNP) s Formulary? You can ask Great Plains Medicare Advantage Gold to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make. You can ask us to cover a drug even if it is not on our formulary. If approved, this drug will be covered at a pre-determined cost-sharing level, and you would not be able to ask us to provide the drug at a lower cost-sharing level. You can ask us to cover a formulary drug at a lower cost-sharing level [if this drug is not on the specialty tier]. If approved this would lower the amount you must pay for your drug.] You can ask us to waive coverage restrictions or limits on your drug. For example, for certain drugs, Great Plains Medicare Advantage Gold limits the amount of the drug that we will cover. If your drug has a quantity limit, you can ask us to waive the limit and cover a greater amount. Generally, Great Plains Medicare Advantage Gold will only approve your request for an exception if the alternative drugs included on the plan s formulary, [the lower cost-sharing drug] or additional utilization restrictions would not be as effective in treating your condition and/or would cause you to have adverse medical effects. You should contact us to ask us for an initial coverage decision for a formulary or utilization restriction exception. When you request a formulary or utilization restriction exception you should submit a statement from your prescriber or physician supporting your request. Generally, we must make our decision within 7 hours of getting your prescriber s supporting statement. You can request an expedited (fast) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 7 hours for a decision. If your request to expedite is granted, we must give you a decision no later than hours after we get a supporting statement from your doctor or other prescriber. What do I do before I can talk to my doctor about changing my drugs or requesting an exception? As a new or continuing member in our plan you may be taking drugs that are not on our formulary. Or, you may be taking a drug that is on our formulary but your ability to get it is limited. For example, you may need a prior authorization from us before you can fill your prescription. You should talk to your doctor to decide if you should switch to an appropriate drug that we cover or request a formulary exception so that we will July 08 H7_09FormGold_C

6 09 Part D Model Formulary (Comprehensive) cover the drug you take. While you talk to your doctor to determine the right course of action for you, we may cover your drug in certain cases during the first 90 days you are a member of our plan. For each of your drugs that is not on our formulary or if your ability to get your drugs is limited, we will cover a temporary -day supply. If your prescription is written for fewer days, we ll allow refills to provide up to a maximum -day supply of medication. After your first -day supply, we will not pay for these drugs, even if you have been a member of the plan less than 90 days. If you are a resident of a long-term care facility and you need a drug that is not on our formulary or if your ability to get your drugs is limited, but you are past the first 90 days of membership in our plan, we will cover a -day emergency supply of that drug while you pursue a formulary exception. We will provide a one-time -day transition supply per drug, which will cover a temporary supply if you have a change in your medications due to a level-of-care change. A level of care change may include: Entering or leaving a LTC facility Discharged from a hospital or home End a Medicare Part A skilled nursing facility stay Give up Hospice status and revert back to standard Medicare benefits End an LTC Facility stay and return to their home For more information For more detailed information about your Great Plains Medicare Advantage Gold prescription drug coverage, please review your Evidence of Coverage and other plan materials. If you have questions about Great Plains Medicare Advantage Gold, please contact us. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. If you have general questions about Medicare prescription drug coverage, please call Medicare at MEDICARE ( ) hours a day/7 days a week. TTY users should call Or, visit Great Plains Medicare Advantage Gold s Formulary The formulary below provides coverage information about the drugs covered by Great Plains Medicare Advantage Gold. If you have trouble finding your drug in the list, turn to the Index that begins on page 06. The first column of the chart lists the drug name. Brand name drugs are capitalized (e.g., VYVANSE 0MG CAP) and generic drugs are listed in lower-case italics (e.g., atomoxetine 00mg cap). The information in the Requirements/Limits column tells you if Great Plains Medicare Advantage Gold has any special requirements for coverage of your drug. o Quantity Limits (QL): For certain drugs, Great Plains Medicare Advantage Gold limits the amount of the drug that Great Plains Medicare Advantage Gold will cover. This could include a: per fill, daily, monthly or yearly limitation. July 08 6 H7_09FormGold_C

7 09 Part D Model Formulary (Comprehensive) o o Limited Distribution (LD): The symbol [LD] next to a drug name indicates that the drug has been noted as being restricted to certain pharmacies by the Food and Drug Administration. These drugs can only be obtained at specialty designated pharmacies able to appropriately handle the drugs. Non-Extended Day Supply (): You may be able to receive greater than -month supply of most of the drugs on your Formulary via mail order at a reduced cost share. Drugs noted with are limited to -month supply for both Retail and Mail Order. o Prior Authorization (): Navitus Medicare Rx (PDP) requires you [or your physician] to get prior authorization for certain drugs. This means that you will need to get approval from Great Plains Medicare Advantage Gold before you fill your prescriptions. If you don t get approval, Great Plains Medicare Advantage Gold may not cover the drug. o Prior Authorization Restriction for Part B vs. Part D Determination (_BvD): This drug may be eligible for payment under Medicare Part B or Part D. You (or your physician) are required to get prior authorization from Great Plains Medicare Advantage Gold to determine that this drug is covered under Medicare Part D before you fill you prescription for the drug. Without prior approval, Great Plains Medicare Advantage Gold may not cover this drug. o Prior Authorization Restriction for New Starts Only (_NSO): If this drug is new to a member, you (or your physician) are required to get prior authorization from Great Plains Medicare Advantage Gold before you fill your prescription for this drug. Without prior approval, Great Plains Medicare Advantage Gold will not cover this drug. o Step Therapy (ST): In some cases, Great Plains Medicare Advantage Gold requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, Great Plains Medicare Advantage Gold may not cover Drug B unless you try Drug A first. If Drug A does not work for you, Great Plains Medicare Advantage Gold will then cover Drug B. o Step Therapy for New Starts Only (ST_NSO): If this drug is new to the member, you are required to first try certain drugs to treat your medical condition before we will cover another drug for that condition. July 08 7 H7_09FormGold_C

8 ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS AMPHETAMINES amphetamine 0mg er cap amphetamine 0mg amphetamine.mg amphetamine mg er cap amphetamine mg amphetamine 0mg er cap amphetamine 0mg amphetamine mg er cap amphetamine 0mg er cap amphetamine 0mg amphetamine mg er cap amphetamine mg amphetamine 7.mg dextroamphetamine sulfate 0mg er cap dextroamphetamine sulfate 0mg dextroamphetamine sulfate mg er cap dextroamphetamine sulfate mg er cap dextroamphetamine sulfate mg VYVANSE 0MG CAP VYVANSE 0MG CHEW VYVANSE 0MG CAP VYVANSE 0MG CHEW VYVANSE 0MG CAP VYVANSE 0MG CHEW VYVANSE 0MG CAP VYVANSE 0MG CHEW VYVANSE 0MG CAP VYVANSE 0MG CHEW VYVANSE 60MG CAP VYVANSE 60MG CHEW VYVANSE 70MG CAP ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) AGENTS atomoxetine 00mg cap QL=60 EA/0 Days atomoxetine 0mg cap QL=60 EA/0 Days atomoxetine 8mg cap QL=60 EA/0 Days atomoxetine mg cap QL=60 EA/0 Days atomoxetine 0mg cap QL=60 EA/0 Days atomoxetine 60mg cap QL=60 EA/0 Days atomoxetine 80mg cap QL=60 EA/0 Days guanfacine mg er guanfacine mg er guanfacine mg er guanfacine mg er STIMULANTS - MISC. You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le. 8

9 armodafinil 0mg QL=0 EA/0 Days armodafinil 00mg QL=0 EA/0 Days armodafinil 0mg QL=0 EA/0 Days armodafinil 0mg QL=0 EA/0 Days dexmethylphenidate 0mg er cap dexmethylphenidate 0mg dexmethylphenidate mg er cap dexmethylphenidate.mg dexmethylphenidate 0mg er cap dexmethylphenidate mg er cap dexmethylphenidate 0mg er cap dexmethylphenidate mg er cap dexmethylphenidate 0mg er cap dexmethylphenidate mg er cap dexmethylphenidate mg metadate 0mg er METHYLPHENIDATE 0MG CHEW methylphenidate 0mg cr cap methylphenidate 0mg er methylphenidate 0mg la cap methylphenidate 0mg METHYLPHENIDATE 8MG SR methylphenidate mg/ml oral soln METHYLPHENIDATE.MG CHEW methylphenidate 0mg cr cap methylphenidate 0mg er methylphenidate 0mg la cap methylphenidate 0mg METHYLPHENIDATE 7MG SR methylphenidate mg/ml oral soln methylphenidate 0mg cr cap methylphenidate 0mg la cap METHYLPHENIDATE 6MG SR methylphenidate 0mg cr cap methylphenidate 0mg la cap methylphenidate 0mg cr cap METHYLPHENIDATE MG SR METHYLPHENIDATE MG CHEW methylphenidate mg methylphenidate 60mg cr cap METHYLPHENIDATE 60MG LA CAP modafinil 00mg QL=60 EA/0 Days modafinil 00mg QL=60 EA/0 Days SOLOSEC GM GRANULE CKET AMEBICIDES AMEBICIDES You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le. 9

10 amikacin 0mg/ml inj AMINOGLYCOSIDES AMINOGLYCOSIDES GENTAMICIN SULFATE 0.8MG/ML INJ gentamicin sulfate.mg/ml inj GENTAMICIN SULFATE.6MG/ML INJ GENTAMICIN SULFATE MG/ML INJ gentamicin sulfate 0mg/ml inj neomycin sulfate 00mg paromomycin 0mg cap STREPTOMYCIN 00MG INJ TOBI PODHALER KIT 8MG CK TOBRAMYCIN 0MG/ML INJ tobramycin 0mg/ml inj tobramycin 60mg/ml inh soln ANALGESICS - ANTI-INFLAMMATORY ANTI-TNF-ALPHA - MONOCLONAL ANTIBODIES HUMIRA 0MG/0.ML HUMIRA 0MG/0.ML HUMIRA 0MG/0.ML HUMIRA 0MG/0.ML HUMIRA 0MG/0.ML AUTO-INJECTOR HUMIRA 0MG/0.ML HUMIRA 0MG/0.8ML AUTO-INJECTOR HUMIRA 0MG/0.8ML HUMIRA PEDIATRIC CROHN'S STARTER CK () 0MG/0.8ML INJ HUMIRA PEDIATRIC CROHN'S STARTER CK () 80MG/0.8ML INJ HUMIRA PEDIATRIC CROHN'S STARTER CK (6) 0MG/0.8ML INJ HUMIRA PEDIATRIC CROHN'S STARTER CK () 0MG/0.ML, 80MG/0.8ML HUMIRA PEN - CROHN'S STARTER CK 0MG/0.8ML INJ HUMIRA PEN - CROHN'S STARTER CK 80MG/0.8ML INJ HUMIRA PEN - PSORIASIS STARTER CK 0MG/0.8ML INJ HUMIRA PEN - PSORIASIS STARTER CK 80MG/0.8ML INJ SIMPONI 00MG/ML AUTO-INJECTOR SIMPONI 00MG/ML INJ SIMPONI 0MG/0.ML AUTO-INJECTOR SIMPONI 0MG/0.ML GOLD COMPOU You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le. 0

11 RIDAURA MG CAP ARCALYST 0MG INJ INTERLEUKIN- BLOCKERS INTERLEUKIN-6 RECEPTOR INHIBITORS ACTEMRA 6MG/0.9ML KEVZARA 0MG/.ML PF INJ KEVZARA 00MG/.ML PF INJ NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS) celecoxib 00mg cap QL=60 EA/0 Days celecoxib 00mg cap QL=60 EA/0 Days celecoxib 00mg cap QL=60 EA/0 Days celecoxib 0mg cap QL=60 EA/0 Days diclofenac potassium 0mg diclofenac sodium 00mg er diclofenac sodium mg dr diclofenac sodium 0mg dr diclofenac sodium 0mg/misoprostol 0.mg diclofenac sodium 7mg dr diclofenac sodium 7mg/misoprostol 0.mg etodolac 00mg cap etodolac 00mg cap etodolac 00mg er etodolac 00mg etodolac 00mg er etodolac 00mg etodolac 600mg er FENOPROFEN 00MG CAP fenoprofen 600mg flurbiprofen 00mg flurbiprofen 0mg ibu 600mg ibu 800mg ibuprofen 0mg/ml susp ibuprofen 00mg ibuprofen 600mg ibuprofen 800mg KETOPROFEN 00MG ER CAP ketorolac tromethamine 0mg QL=0 EA/ Days MECLOFENAMATE 00MG CAP MECLOFENAMATE 0MG CAP mefenamic acid 0mg cap meloxicam mg meloxicam 7.mg nabumetone 00mg nabumetone 70mg naproxen 0mg You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.

12 naproxen mg/ml susp naproxen 7mg dr naproxen 7mg naproxen 00mg dr naproxen 00mg naproxen sodium 7mg naproxen sodium 0mg oxaprozin 600mg piroxicam 0mg cap piroxicam 0mg cap profeno 600mg sulindac 0mg sulindac 00mg TOLMETIN 00MG CAP TOLMETIN 600MG PHOSPHODIESTERASE (PDE) INHIBITORS OTEZLA 8-DAY STARTER CK OTEZLA 0MG PYRIMIDINE SYNTHESIS INHIBITORS leflunomide 0mg leflunomide 0mg SELECTIVE COSTIMULATION MODULATORS ORENCIA MG/ML AUTO-INJECTOR ORENCIA MG/ML ORENCIA 0MG/0.ML ORENCIA 87.MG/0.7ML SOLUBLE TUMOR NECROSIS FACTOR RECEPTOR AGENTS ENBREL MG INJ ENBREL MG/0.ML ENBREL 0MG/ML SURECLICK INJ ENBREL 0MG/ML ANALGESICS - NONNARCOTIC SALICYLATES diflunisal 00mg ABSTRAL 00MCG SL ANALGESICS - OPIOID OPIOID AGONISTS QL=0 EA/0 Days ABSTRAL 00MCG SL QL=0 EA/0 Days ABSTRAL 00MCG SL QL=0 EA/0 Days ABSTRAL 00MCG SL QL=0 EA/0 Days ABSTRAL 600MCG SL QL=0 EA/0 Days ABSTRAL 800MCG SL QL=0 EA/0 Days codeine sulfate mg QL=0 EA/0 Days codeine sulfate 0mg QL=0 EA/0 Days codeine sulfate 60mg QL=80 EA/0 Days duramorph 0.mg/ml inj You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.

13 duramorph mg/ml inj fentanyl 0.0mg/hr patch QL=0 EA/0 Days fentanyl 0.0mg/hr patch QL=0 EA/0 Days fentanyl 0.0mg/hr patch QL=0 EA/0 Days fentanyl 0.07mg/hr patch QL=0 EA/0 Days fentanyl 0.mg/hr patch QL=0 EA/0 Days fentanyl 0.mg lozenge QL=0 EA/0 Days fentanyl 0.mg lozenge QL=0 EA/0 Days fentanyl 0.6mg lozenge QL=0 EA/0 Days fentanyl 0.8mg lozenge QL=0 EA/0 Days fentanyl.mg lozenge QL=0 EA/0 Days fentanyl.6mg lozenge QL=0 EA/0 Days FENTORA 00MCG BUCCAL QL=0 EA/0 Days FENTORA 00MCG BUCCAL QL=0 EA/0 Days FENTORA 00MCG BUCCAL QL=0 EA/0 Days FENTORA 600MCG BUCCAL QL=0 EA/0 Days FENTORA 800MCG BUCCAL QL=0 EA/0 Days hydromorphone 0mg/ml (ml) inj hydromorphone 0mg/ml (ml) inj hydromorphone mg/ml oral soln QL=00 ML/0 Days hydromorphone mg QL=0 EA/0 Days hydromorphone mg/ml syringe hydromorphone mg QL=0 EA/0 Days hydromorphone 8mg QL=0 EA/0 Days HYSINGLA 00MG ER QL=0 EA/0 Days HYSINGLA 0MG ER QL=0 EA/0 Days HYSINGLA 0MG ER QL=0 EA/0 Days HYSINGLA 0MG ER QL=0 EA/0 Days HYSINGLA 0MG ER QL=0 EA/0 Days HYSINGLA 60MG ER QL=0 EA/0 Days HYSINGLA 80MG ER QL=0 EA/0 Days LAZANDA 00MCG/ACT NASAL SPRAY QL=0 EA/0 Days LAZANDA 00MCG/ACT NASAL SPRAY QL=0 EA/0 Days LAZANDA 00MCG/ACT NASAL SPRAY QL=0 EA/0 Days LEVORPHANOL MG QL=0 EA/0 Days methadone 0mg QL=60 EA/0 Days METHADONE MG/ML ORAL SOLN QL=600 ML/0 Days METHADONE MG/ML ORAL SOLN QL=800 ML/0 Days methadone mg QL=60 EA/0 Days morphine sulfate 00mg er QL=0 EA/0 Days MORPHINE SULFATE 0MG/ML morphine sulfate mg er QL=0 EA/0 Days morphine sulfate mg QL=80 EA/0 Days morphine sulfate 00mg er QL=0 EA/0 Days morphine sulfate 0mg/ml oral soln QL=80 ML/0 Days morphine sulfate mg/ml oral soln QL=800 ML/0 Days You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.

14 MORPHINE SULFATE MG/ML morphine sulfate 0mg er QL=0 EA/0 Days morphine sulfate 0mg QL=80 EA/0 Days morphine sulfate mg/ml oral soln QL=900 ML/0 Days MORPHINE SULFATE MG/ML MORPHINE SULFATE MG/ML morphine sulfate 60mg er QL=0 EA/0 Days MORPHINE SULFATE 8MG/ML NUCYNTA 00MG ER QL=60 EA/0 Days NUCYNTA 0MG ER QL=60 EA/0 Days NUCYNTA 00MG ER QL=60 EA/0 Days NUCYNTA 0MG ER QL=60 EA/0 Days NUCYNTA 0MG ER QL=60 EA/0 Days oxycodone 0mg QL=80 EA/0 Days oxycodone mg QL=80 EA/0 Days oxycodone mg/ml oral soln QL=00 ML/0 Days oxycodone 0mg QL=80 EA/0 Days oxycodone 0mg/ml oral soln QL=70 ML/0 Days oxycodone 0mg QL=80 EA/0 Days oxycodone mg cap QL=60 EA/0 Days oxycodone mg QL=60 EA/0 Days oxymorphone 0mg QL=60 EA/0 Days oxymorphone mg QL=60 EA/0 Days tramadol 00mg er QL=60 EA/0 Days tramadol 00mg er (matrix delivery) QL=60 EA/0 Days tramadol 00mg er QL=60 EA/0 Days tramadol 00mg er (matrix delivery) QL=60 EA/0 Days tramadol 00mg er QL=60 EA/0 Days tramadol 00mg er (matrix delivery) QL=60 EA/0 Days tramadol 0mg QL=0 EA/0 Days XTAMPZA.MG ER CAP QL=0 EA/0 Days XTAMPZA 8MG ER CAP QL=0 EA/0 Days XTAMPZA 7MG ER CAP QL=0 EA/0 Days XTAMPZA 6MG ER CAP QL=0 EA/0 Days XTAMPZA 9MG ER CAP QL=0 EA/0 Days OPIOID COMBINATIONS acetaminophen.7mg/ml/hydrocodone bitartrate QL=00 ML/0 Days 0.mg/ml oral soln acetaminophen mg/ml/codeine phosphate.mg/ml QL=980 ML/0 Days oral soln acetaminophen 00mg/codeine phosphate mg QL=90 EA/0 Days acetaminophen 00mg/codeine phosphate 0mg QL=90 EA/0 Days acetaminophen 00mg/codeine phosphate 60mg QL=90 EA/0 Days acetaminophen 00mg/hydrocodone bitartrate 0mg QL=90 EA/0 Days You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.

15 acetaminophen 00mg/hydrocodone bitartrate mg QL=90 EA/0 Days acetaminophen 00mg/hydrocodone bitartrate 7.mg QL=90 EA/0 Days acetaminophen mg/hydrocodone bitartrate 0mg QL=60 EA/0 Days acetaminophen mg/hydrocodone bitartrate.mg QL=60 EA/0 Days acetaminophen mg/hydrocodone bitartrate mg QL=60 EA/0 Days acetaminophen mg/hydrocodone bitartrate 7.mg QL=60 EA/0 Days acetaminophen mg/oxycodone 0mg QL=60 EA/0 Days acetaminophen mg/oxycodone.mg QL=60 EA/0 Days acetaminophen mg/oxycodone mg QL=60 EA/0 Days acetaminophen mg/oxycodone 7.mg QL=60 EA/0 Days acetaminophen mg/tramadol 7.mg QL=60 EA/0 Days aspirin mg/oxycodone.8mg QL=60 EA/0 Days endocet 0-mg QL=60 EA/0 Days endocet -mg QL=60 EA/0 Days endocet 7.-mg QL=60 EA/0 Days hydrocodone 0mg/ibuprofen 00mg QL=80 EA/0 Days hydrocodone mg/ibuprofen 00mg QL=80 EA/0 Days hydrocodone bitartrate 7.mg/ibuprofen 00mg QL=80 EA/0 Days IBUPROFEN 00MG/OXYCODONE MG QL=0 EA/0 Days lorcet 0-mg QL=60 EA/0 Days lorcet -mg QL=60 EA/0 Days lorcet 7.-mg QL=60 EA/0 Days vicodin 0-00mg QL=90 EA/0 Days vicodin -00mg QL=90 EA/0 Days vicodin 7.-00mg QL=90 EA/0 Days OPIOID RTIAL AGONISTS BUNAVAIL.-0.MG FILM BUNAVAIL.-0.7MG FILM BUNAVAIL 6.-MG FILM BUPRENORPHINE 0MCG/HR WEEKLY TCH QL= EA/8 Days BUPRENORPHINE MCG/HR WEEKLY TCH QL= EA/8 Days BUPRENORPHINE 0MCG/HR WEEKLY TCH QL= EA/8 Days buprenorphine mg sl BUPRENORPHINE MCG/HR WEEKLY TCH QL= EA/8 Days buprenorphine 8mg sl butorphanol tartrate 0mg/ml nasal spray QL=0 ML/0 Days SUBOXONE -MG STRIP SUBOXONE -0.MG STRIP SUBOXONE -MG STRIP SUBOXONE 8-MG STRIP You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.

16 ZUBSOLV.-.9MG SL QL=60 EA/0 Days ZUBSOLV.-0.6MG SL QL=90 EA/0 Days ZUBSOLV.9-0.7MG SL QL=90 EA/0 Days ZUBSOLV.7-.MG SL QL=90 EA/0 Days ZUBSOLV 8.6-.MG SL QL=60 EA/0 Days ANADROL-0 0MG ANDROGENS-ANABOLIC ANABOLIC STEROIDS oxandrolone 0mg oxandrolone.mg ANDRODERM MG/HR TCH ANDROGENS QL=60 EA/0 Days ANDRODERM MG/HR TCH QL=0 EA/0 Days ANDROGEL.6% (.GM) GEL QL=7 GM/0 Days ANDROGEL.6% (.GM) GEL QL=0 GM/0 Days ANDROGEL.6% GEL QL=0 GM/0 Days danazol 00mg cap danazol 00mg cap danazol 0mg cap METHITEST 0MG methyltestosterone 0mg cap testosterone % (mg) gel QL=00 GM/0 Days testosterone % (0mg) gel QL=00 GM/0 Days testosterone % gel pump QL=00 GM/0 Days testosterone cypionate 00mg/ml inj testosterone cypionate 00mg/ml inj testosterone enanthate 00mg/ml inj colocort 00mg/60ml enema ANORECTAL AGENTS INTRARECTAL STEROIDS hydrocortisone.67mg/ml enema UCERIS MG/ACT FOAM RECTAL COMBINATIONS hydrocortisone/pramoxine -% rectal cream RECTAL STEROIDS procto-med.% cream procto-pak % rectal cream proctosol.% cream proctozone hc.% cream ALBENZA 00MG ANTHELMINTICS ANTHELMINTICS BENZNIDAZOLE 00MG BENZNIDAZOLE.MG ivermectin mg ANTIANGINAL AGENTS You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le. 6

17 RANEXA 000MG ER ANTIANGINALS-OTHER RANEXA 00MG ER ISORDIL 0MG NITRATES isosorbide dinitrate 0mg isosorbide dinitrate 0mg isosorbide dinitrate 0mg ISOSORBIDE DINITRATE 0MG ER isosorbide dinitrate mg isosorbide mononitrate 0mg isosorbide mononitrate 0mg er isosorbide mononitrate 0mg isosorbide mononitrate 0mg er isosorbide mononitrate 60mg er minitran 0.mg/hr patch minitran 0.mg/hr patch minitran 0.mg/hr patch minitran 0.6mg/hr patch NITRO-BID % OINTMENT NITRO-DUR 0.MG/HR TCH NITRO-DUR 0.8MG/HR TCH nitroglycerin 0.mg/hr patch nitroglycerin 0.mg/hr patch nitroglycerin 0.mg sl nitroglycerin 0.mg sl nitroglycerin 0.mg/act spray nitroglycerin 0.mg/hr patch nitroglycerin 0.6mg sl nitroglycerin 0.6mg/hr patch ANTIANXIETY AGENTS ANTIANXIETY AGENTS - MISC. buspirone 0mg buspirone mg buspirone 0mg buspirone mg buspirone 7.mg hydroxyzine 0mg hydroxyzine mg hydroxyzine mg/ml oral soln hydroxyzine 0mg HYDROXYZINE MOATE 00MG CAP hydroxyzine pamoate mg cap hydroxyzine pamoate 0mg cap BENZODIAZEPINES alprazolam 0.mg odt You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le. 7

18 alprazolam 0.mg alprazolam 0.mg er alprazolam 0.mg odt alprazolam 0.mg alprazolam mg er alprazolam mg odt alprazolam mg ALPRAZOLAM MG/ML ORAL SOLN alprazolam mg er alprazolam mg odt alprazolam mg alprazolam mg er chlordiazepoxide 0mg cap chlordiazepoxide mg cap chlordiazepoxide mg cap clorazepate dipotassium mg clorazepate dipotassium.7mg clorazepate dipotassium 7.mg diazepam 0mg DIAZEM MG/ML ORAL SOLN diazepam mg diazepam mg diazepam mg/ml oral soln lorazepam 0.mg lorazepam mg lorazepam mg lorazepam mg/ml conc oxazepam 0mg cap oxazepam mg cap OXAZEM 0MG CAP ANTIARRHYTHMICS disopyramide 00mg cap ANTIARRHYTHMICS TYPE I-A disopyramide 0mg cap NORCE 00MG ER CAP NORCE 0MG ER CAP quinidine gluconate mg er QUINIDINE SULFATE 00MG QUINIDINE SULFATE 00MG ANTIARRHYTHMICS TYPE I-B mexiletine 0mg cap mexiletine 00mg cap mexiletine 0mg cap ANTIARRHYTHMICS TYPE I-C flecainide acetate 00mg flecainide acetate 0mg You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le. 8

19 flecainide acetate 0mg propafenone 0mg propafenone mg er cap propafenone mg propafenone 00mg propafenone mg er cap propafenone mg sr cap amiodarone 00mg ANTIARRHYTHMICS TYPE III amiodarone 00mg amiodarone hydrochloride 00mg dofetilide mcg cap dofetilide 0mcg cap dofetilide 00mcg cap MULTAQ 00MG pacerone 00mg pacerone 00mg pacerone 00mg ANTIASTHMATIC AND BRONCHODILATOR AGENTS ANTIASTHMATIC - MONOCLONAL ANTIBODIES NUCALA 00MG INJ XOLAIR 0MG INJ cromolyn sodium 0mg/ml inh soln ANTI-INFLAMMATORY AGENTS BRONCHODILATORS - ANTICHOLINERGICS ATROVENT 7MCG INH INCRUSE 6.MCG INH ipratropium bromide 0.0% inh soln LONHALA 0.00% INH SOLN ST SPIRIVA.MCG RESPIMAT INH ST QL= GM/0 Days LEUKOTRIENE MODULATORS montelukast 0mg montelukast mg chew montelukast mg granules montelukast mg chew zafirlukast 0mg zafirlukast 0mg zileuton 600mg er ZYFLO 600MG SELECTIVE PHOSPHODIESTERASE (PDE) INHIBITORS DALIRESP 0MCG DALIRESP 00MCG ARNUITY 00MCG INH STEROID INHALANTS QL=0 EA/0 Days ARNUITY 00MCG INH QL=0 EA/0 Days ARNUITY 0MCG INH QL=0 EA/0 Days You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le. 9

20 ASMANEX 00MCG (0ACT) HFA INH QL= GM/0 Days ASMANEX 0MCG (0ACT) INH QL= EA/0 Days ASMANEX 00MCG (0ACT) HFA INH QL= GM/0 Days ASMANEX 0MCG (0ACT) INH QL= EA/0 Days ASMANEX 0MCG (0ACT) INH QL= EA/0 Days ASMANEX 0MCG (60ACT) INH QL= EA/0 Days budesonide 0.mg/ml inh soln QL=0 ML/0 Days budesonide 0.mg/ml inh soln QL=0 ML/0 Days budesonide 0.mg/ml inh soln QL=0 ML/0 Days FLOVENT 00MCG DISKUS QL=60 EA/0 Days FLOVENT 0MCG HFA INH QL= GM/0 Days FLOVENT 0MCG HFA INH QL= GM/0 Days FLOVENT 0MCG DISKUS QL=60 EA/0 Days FLOVENT MCG HFA INH QL=.0 GM/0 Days FLOVENT 0MCG DISKUS QL=60 EA/0 Days ADVAIR 00-0MCG DISKUS SYMTHOMIMETICS QL=60 EA/0 Days ADVAIR -MCG HFA INH QL= GM/0 Days ADVAIR 0-MCG HFA INH QL= GM/0 Days ADVAIR 0-0MCG DISKUS QL=60 EA/0 Days ADVAIR -MCG HFA INH QL= GM/0 Days ADVAIR 00-0MCG DISKUS QL=60 EA/0 Days albuterol 0.mg/ml (0.6mg/ml) inh soln albuterol 0.7mg/ml (.mg/ml) inh soln albuterol 0.mg/ml (mg/ml) oral oral soln albuterol 0.8mg/ml (0.08%) inh soln albuterol mg/ml (0.%) inh soln albuterol mg ALBUTEROL MG ER albuterol mg ALBUTEROL 8MG ER ANORO 6.-MCG ELLIPTA INH QL=60 EA/0 Days BREO 00-MCG ELLIPTA INH QL=60 EA/0 Days BREO 00-MCG ELLIPTA INH QL=60 EA/0 Days BROVANA MCG/ML INH SOLN COMBIVENT RESPIMAT 0-00MCG INH DULERA 00-MCG INH QL= GM/0 Days DULERA 00-MCG INH QL= GM/0 Days FLUTICASONE PROPIONATE/SALMETEROL XINAFOATE -MCG/ACT POWDER INH FLUTICASONE PROPIONATE/SALMETEROL XINAFOATE -MCG/ACT POWDER INH FLUTICASONE PROPIONATE/SALMETEROL XINAFOATE -MCG/ACT POWDER INH ipratropium/albuterol 0.-.mg/ml inh soln levalbuterol 0.mg inh soln You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le. 0

21 levalbuterol 0.6mg inh soln levalbuterol.mg inh soln levalbuterol.mg inh soln LEVALBUTEROL MCG INH ST QL=0 GM/0 Days METAPROTERENOL SULFATE 0MG METAPROTERENOL SULFATE 0MG METAPROTERENOL SULFATE MG/ML ORAL SOLN PERFOROMIST 0MCG/ML INH SOLN SEREVENT 0MCG/DOSE INH STIOLTO.-.MCG INH QL= GM/0 Days terbutaline sulfate.mg terbutaline sulfate mg TRELEGY 6.-MCG ELLIPTA INH QL=60 EA/0 Days VENTOLIN 08MCG INH QL=6 GM/0 Days XOPENEX MCG INH ST QL=0 GM/0 Days XANTHINES THEO- 00MG ER CAP THEO- 00MG ER CAP THEO- 00MG ER CAP THEO- ER CAP theophylline 00mg er theophylline 00mg er theophylline 00mg er theophylline 00mg er theophylline.mg/ml oral soln theophylline 600mg er ANTICOAGULANTS COUMARIN ANTICOAGULANTS COUMADIN 0MG COUMADIN MG COUMADIN.MG COUMADIN MG COUMADIN MG COUMADIN MG COUMADIN MG COUMADIN 6MG COUMADIN 7.MG jantoven 0mg jantoven mg jantoven.mg jantoven mg jantoven mg jantoven mg jantoven mg jantoven 6mg You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.

22 jantoven 7.mg warfarin sodium 0mg warfarin sodium mg warfarin sodium.mg warfarin sodium mg warfarin sodium mg warfarin sodium mg warfarin sodium mg warfarin sodium 6mg warfarin sodium 7.mg DIRECT FACTOR XA INHIBITORS ELIQUIS.MG ELIQUIS 0-DAY STARTER CK ELIQUIS MG XARELTO 0MG XARELTO MG XARELTO 0MG XARELTO STARTER CK HERINS AND HERINOID-LIKE AGENTS enoxaparin sodium 00mg/ml syringe QL=60 ML/0 Days enoxaparin sodium 0mg/0.8ml syringe QL=8 ML/0 Days enoxaparin sodium 0mg/ml syringe QL=60 ML/0 Days enoxaparin sodium 0mg/0.ml syringe QL=8 ML/0 Days enoxaparin sodium 0mg/0.ml syringe QL= ML/0 Days enoxaparin sodium 60mg/0.6ml syringe QL=6 ML/0 Days enoxaparin sodium 80mg/0.8ml syringe QL=8 ML/0 Days fondaparinux sodium.mg/ml (0.ml) syringe fondaparinux sodium.mg/ml (0.6ml) syringe fondaparinux sodium.mg/ml (0.8ml) syringe fondaparinux sodium mg/ml syringe FRAGMIN 0000UNIT/ML FRAGMIN 00UNIT/0.ML FRAGMIN 000UNIT/0.6ML FRAGMIN 8000UNIT/0.7ML FRAGMIN 00UNIT/0.ML FRAGMIN 000UNIT/0.ML FRAGMIN 700UNIT/0.ML FRAGMIN 9000UNIT/.8ML INJ heparin sodium porcine 0000unit/ml inj heparin sodium porcine 000unit/ml inj heparin sodium porcine 0000unit/ml inj heparin sodium porcine 000unit/ml inj THROMBIN INHIBITORS PRADAXA 0MG CAP PRADAXA 0MG CAP PRADAXA 7MG CAP You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.

23 ANTICONVULSANTS AM GLUTAMATE RECEPTOR ANTAGONISTS FYCOM 0.MG/ML SUSP FYCOM 0MG FYCOM MG FYCOM MG FYCOM MG FYCOM 6MG FYCOM 8MG clonazepam 0.mg odt ANTICONVULSANTS - BENZODIAZEPINES clonazepam 0.mg odt clonazepam 0.mg odt clonazepam 0.mg clonazepam mg odt clonazepam mg clonazepam mg odt clonazepam mg DIASTAT 0MG APPLICATOR DIASTAT.MG APPLICATOR DIASTAT 0MG APPLICATOR ONFI 0MG ONFI.MG/ML SUSP ONFI 0MG APTIOM 00MG ANTICONVULSANTS - MISC. APTIOM 00MG APTIOM 600MG APTIOM 800MG BANZEL 00MG BANZEL 00MG BANZEL 0MG/ML SUSP BRIVIACT 00MG QL=60 EA/0 Days BRIVIACT 0MG QL=60 EA/0 Days BRIVIACT 0MG/ML ORAL SOLN BRIVIACT MG QL=60 EA/0 Days BRIVIACT 0MG QL=60 EA/0 Days BRIVIACT 7MG QL=60 EA/0 Days carbamazepine 00mg chew carbamazepine 00mg er cap carbamazepine 00mg er carbamazepine 00mg er cap carbamazepine 00mg er carbamazepine 00mg carbamazepine 0mg/ml susp carbamazepine 00mg er cap You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.

24 carbamazepine 00mg er epitol 00mg gabapentin 00mg cap gabapentin 00mg cap gabapentin 00mg cap gabapentin 0mg/ml oral soln gabapentin 600mg gabapentin 800mg LAMICTAL XR BLUE KIT LAMICTAL XR GREEN KIT LAMICTAL XR ORANGE KIT lamotrigine 00mg er lamotrigine 00mg odt lamotrigine 00mg lamotrigine 0mg lamotrigine 00mg er lamotrigine 00mg odt lamotrigine 00mg lamotrigine 0mg er lamotrigine mg () starter pack lamotrigine mg chew lamotrigine mg er lamotrigine mg odt lamotrigine mg lamotrigine 00mg er lamotrigine 0mg er lamotrigine 0mg odt lamotrigine mg chew lamotrigine mg ()/00mg (7) starter pack lamotrigine mg (8)/00mg () starter pack levetiracetam 000mg levetiracetam 00mg/ml oral soln levetiracetam 0mg levetiracetam 00mg er levetiracetam 00mg levetiracetam 70mg er levetiracetam 70mg LYRICA 00MG CAP LYRICA 0MG CAP LYRICA 00MG CAP LYRICA 0MG/ML ORAL SOLN LYRICA MG CAP LYRICA MG CAP LYRICA 00MG CAP LYRICA 0MG CAP LYRICA 7MG CAP You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.

25 oxcarbazepine 0mg oxcarbazepine 00mg oxcarbazepine 600mg oxcarbazepine 60mg/ml susp OXTELLAR 0MG XR OXTELLAR 00MG XR OXTELLAR 600MG XR primidone 0mg primidone 0mg QUDEXY 00MG XR CAP QUDEXY 0MG XR CAP QUDEXY 00MG XR CAP QUDEXY MG XR CAP QUDEXY 0MG XR CAP roweepra 000mg roweepra 00mg er roweepra 00mg roweepra 70mg er roweepra 70mg SPRITAM 000MG ODT SPRITAM 0MG ODT SPRITAM 00MG ODT SPRITAM 70MG ODT TOPIRAMATE 00MG ER CAP topiramate 00mg TOPIRAMATE 0MG ER CAP topiramate mg cap TOPIRAMATE 00MG ER CAP topiramate 00mg topiramate mg cap TOPIRAMATE MG ER CAP topiramate mg TOPIRAMATE 0MG ER CAP topiramate 0mg TROKENDI 00MG XR CAP TROKENDI 00MG XR CAP TROKENDI MG XR CAP TROKENDI 0MG XR CAP VIMT 00MG QL=60 EA/0 Days VIMT 0MG/ML ORAL SOLN VIMT 0MG QL=60 EA/0 Days VIMT 00MG QL=60 EA/0 Days VIMT 0MG QL=60 EA/0 Days zonisamide 00mg cap zonisamide mg cap zonisamide 0mg cap You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.

26 felbamate 0mg/ml susp CARBAMATES felbamate 00mg felbamate 600mg SABRIL 00MG GABA MODULATORS NSO tiagabine mg tiagabine 6mg tiagabine mg tiagabine mg vigabatrin 0mg/ml oral soln NSO DILANTIN 0MG ER CAP HYDANTOINS PEGANONE 0MG phenytoin mg/ml susp phenytoin 0mg chew phenytoin sodium 00mg er cap phenytoin sodium 00mg er cap phenytoin sodium 00mg er cap CELONTIN 00MG CAP SUCCINIMIDES ethosuximide 0mg cap ethosuximide 0mg/ml oral soln divalproex sodium mg dr cap VALPROIC ACID divalproex sodium mg dr divalproex sodium 0mg dr divalproex sodium 0mg er divalproex sodium 00mg dr divalproex sodium 00mg er valproic acid 0mg cap valproic acid 0mg/ml oral soln ANTIDEPRESSANTS ALPHA- RECEPTOR ANTAGONISTS (TETRACYCLICS) mirtazapine mg odt mirtazapine mg mirtazapine 0mg odt mirtazapine 0mg mirtazapine mg odt mirtazapine mg mirtazapine 7.mg APLENZIN 7MG ER ANTIDEPRESSANTS - MISC. ST_NSO APLENZIN 8MG ER ST_NSO APLENZIN MG ER ST_NSO bupropion 00mg sr You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le. 6

27 bupropion 00mg bupropion 0mg sr ( hr) bupropion 0mg xl ( hr) bupropion 00mg sr bupropion 00mg xl bupropion 7mg MAPROTILINE MG MAPROTILINE 0MG MAPROTILINE 7MG MONOAMINE OXIDASE INHIBITORS (MAOIS) EMSAM MG/HR TCH EMSAM 6MG/HR TCH EMSAM 9MG/HR TCH MARPLAN 0MG phenelzine mg tranylcypromine 0mg SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) citalopram 0mg citalopram 0mg citalopram mg/ml oral soln citalopram 0mg escitalopram 0mg escitalopram mg/ml oral soln escitalopram 0mg escitalopram mg fluoxetine 0mg cap fluoxetine 0mg fluoxetine 0mg cap fluoxetine 0mg fluoxetine 0mg cap fluoxetine mg/ml oral soln fluvoxamine maleate 00mg er cap ST_NSO fluvoxamine maleate 00mg fluvoxamine maleate 0mg er cap ST_NSO fluvoxamine maleate mg fluvoxamine maleate 0mg paroxetine 0mg paroxetine.mg er paroxetine 0mg paroxetine mg er paroxetine 0mg paroxetine 7.mg er paroxetine 0mg XIL 0MG/ML SUSP PEXEVA 0MG PEXEVA 0MG You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le. 7

28 PEXEVA 0MG PEXEVA 0MG sertraline 00mg sertraline 0mg/ml oral soln sertraline mg sertraline 0mg NEFAZODONE 00MG SEROTONIN MODULATORS NEFAZODONE 0MG NEFAZODONE 00MG nefazodone 0mg nefazodone 0mg trazodone 00mg trazodone 0mg trazodone 00mg trazodone 0mg TRINTELLIX 0MG ST_NSO QL=0 EA/0 Days TRINTELLIX 0MG ST_NSO QL=0 EA/0 Days TRINTELLIX MG ST_NSO QL=0 EA/0 Days VIIBRYD 0/0MG STARTER CK ST_NSO QL=0 EA/0 Days VIIBRYD 0MG ST_NSO QL=0 EA/0 Days VIIBRYD 0MG ST_NSO QL=0 EA/0 Days VIIBRYD 0MG ST_NSO QL=0 EA/0 Days SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS) desvenlafaxine succinate 00mg er desvenlafaxine succinate mg er desvenlafaxine succinate 0mg er duloxetine 0mg dr cap duloxetine 0mg dr cap DULOXETINE 0MG DR CAP ST_NSO QL=0 EA/0 Days duloxetine 60mg dr cap FETZIMA 0MG ER CAP ST_NSO QL=0 EA/0 Days FETZIMA 0MG ER CAP ST_NSO QL=0 EA/0 Days FETZIMA 0MG ER CAP ST_NSO QL=0 EA/0 Days FETZIMA 80MG ER CAP ST_NSO QL=0 EA/0 Days FETZIMA CK ST_NSO QL=0 EA/0 Days venlafaxine 00mg venlafaxine 0mg er cap venlafaxine mg venlafaxine 7.mg er cap venlafaxine 7.mg venlafaxine 0mg venlafaxine 7mg er cap venlafaxine 7mg amitriptyline 00mg TRICYCLIC AGENTS You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le. 8

29 amitriptyline 0mg amitriptyline 0mg amitriptyline mg amitriptyline 0mg amitriptyline 7mg AMOXAPINE 00MG AMOXAPINE 0MG AMOXAPINE MG AMOXAPINE 0MG clomipramine mg cap clomipramine 0mg cap clomipramine 7mg cap desipramine 00mg desipramine 0mg desipramine 0mg desipramine mg desipramine 0mg desipramine 7mg doxepin 00mg cap doxepin 0mg cap doxepin 0mg/ml oral soln doxepin 0mg cap doxepin mg cap doxepin 0mg cap doxepin 7mg cap imipramine 0mg imipramine mg imipramine 0mg imipramine pamoate 00mg cap imipramine pamoate mg cap imipramine pamoate 0mg cap imipramine pamoate 7mg cap nortriptyline 0mg cap nortriptyline mg cap nortriptyline mg/ml oral soln nortriptyline 0mg cap nortriptyline 7mg cap protriptyline 0mg protriptyline mg trimipramine 00mg cap trimipramine mg cap trimipramine 0mg cap ANTIDIABETICS ALPHA-GLUCOSIDASE INHIBITORS acarbose 00mg acarbose mg You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le. 9

30 acarbose 0mg miglitol 00mg miglitol mg miglitol 0mg ANTIDIABETIC COMBINATIONS ACTOPLUS MET -000MG XR ACTOPLUS MET 0-000MG XR glimepiride mg/pioglitazone 0mg glimepiride mg/pioglitazone 0mg glipizide.mg/metformin 0mg glipizide.mg/metformin 00mg glipizide mg/metformin 00mg glyburide.mg/metformin 0mg glyburide.mg/metformin 00mg glyburide mg/metformin 00mg GLYXAMBI 0-MG QL=0 EA/0 Days GLYXAMBI -MG QL=0 EA/0 Days JANUMET MG XR QL=0 EA/0 Days JANUMET 0-000MG QL=60 EA/0 Days JANUMET 0-000MG XR QL=60 EA/0 Days JANUMET 0-00MG QL=60 EA/0 Days JANUMET 0-00MG XR QL=60 EA/0 Days JENTADUETO.-000MG QL=60 EA/0 Days JENTADUETO.-000MG XR QL=0 EA/0 Days JENTADUETO.-00MG QL=60 EA/0 Days JENTADUETO.-80MG QL=60 EA/0 Days JENTADUETO -000MG XR QL=0 EA/0 Days metformin 00mg/pioglitazone mg METFORMIN 00MG/REGLINIDE MG METFORMIN 00MG/REGLINIDE MG metformin 80mg/pioglitazone mg SYNJARDY.-000MG QL=60 EA/0 Days SYNJARDY.-00MG QL=60 EA/0 Days SYNJARDY -000MG QL=60 EA/0 Days SYNJARDY -00MG QL=60 EA/0 Days SYNJARDY XR 0-000MG QL=0 EA/0 Days SYNJARDY XR.-000MG QL=60 EA/0 Days SYNJARDY XR -000MG QL=0 EA/0 Days SYNJARDY XR -000MG QL=60 EA/0 Days XIGDUO 0-000MG XR QL=0 EA/0 Days XIGDUO 0-00MG XR QL=0 EA/0 Days XIGDUO.-000MG XR QL=60 EA/0 Days XIGDUO -000MG XR QL=60 EA/0 Days XIGDUO -00MG XR QL=0 EA/0 Days XULTOPHY 00UNIT-.6MG/ML PEN INJ QL= ML/0 Days BIGUANIDES You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le. 0

31 metformin 000mg metformin 00mg er metformin 00mg metformin 70mg er metformin 80mg RIOMET 00MG/ML ORAL SOLN GLUCAGEN MG INJ DIABETIC OTHER GLUCAGON MG INJ KORLYM 00MG PROGLYCEM 0MG/ML SUSP DIPEPTIDYL PEPTIDASE- (DPP-) INHIBITORS JANUVIA 00MG QL=0 EA/0 Days JANUVIA MG QL=0 EA/0 Days JANUVIA 0MG QL=0 EA/0 Days TRADJENTA MG QL=0 EA/0 Days DOMINE RECEPTOR AGONISTS - ANTIDIABETIC CYCLOSET 0.8MG INCRETIN MIMETIC AGENTS (GLP- RECEPTOR AGONISTS) BYDUREON.MG/ML AUTO-INJECTOR BYDUREON MG INJ BYDUREON MG PEN INJ BYETTA 0MCG/0.0ML PEN INJ BYETTA MCG/0.0ML PEN INJ OZEMPIC MG/.ML PEN INJ OZEMPIC MG/.ML PEN INJ (MG DOSE) TRULICITY 0.7MG/0.ML AUTO-INJECTOR TRULICITY.MG/0.ML AUTO-INJECTOR VICTOZA 8MG/ML PEN INJ INSULIN FIASP 00UNIT/ML INJ FIASP 00UNIT/ML PEN INJ HUMULIN R 00UNIT/ML INJ HUMULIN R 00UNIT/ML PEN INJ LANTUS 00UNIT/ML INJ LANTUS 00UNIT/ML SOLOSTAR LEVEMIR 00UNIT/ML FLEXTOUCH LEVEMIR 00UNIT/ML INJ NOVOLIN 00UNIT/ML INJ NOVOLIN N 00UNIT/ML INJ NOVOLIN R 00UNIT/ML INJ NOVOLOG 00UNIT/ML FLEXPEN NOVOLOG 00UNIT/ML INJ NOVOLOG 00UNIT/ML PENFILL NOVOLOG MIX 00UNIT/ML FLEXPEN NOVOLOG MIX 00UNIT/ML INJ You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.

32 TOUJEO 00UNIT/ML PEN INJ TOUJEO MAX 00UNIT/ML PEN INJ (ML) TRESIBA 00UNIT/ML PEN INJ TRESIBA 00UNIT/ML PEN INJ INSULIN SENSITIZING AGENTS AVANDIA MG AVANDIA MG pioglitazone mg pioglitazone 0mg pioglitazone mg MEGLITINIDE ANALOGUES nateglinide 0mg nateglinide 60mg repaglinide 0.mg repaglinide mg repaglinide mg SODIUM-GLUCOSE CO-TRANSPORTER (SGLT) INHIBITORS FARXIGA 0MG QL=0 EA/0 Days FARXIGA MG QL=0 EA/0 Days JARDIANCE 0MG QL=0 EA/0 Days JARDIANCE MG QL=0 EA/0 Days glimepiride mg SULFONYLUREAS glimepiride mg glimepiride mg glipizide 0mg er glipizide 0mg glipizide.mg er glipizide mg er glipizide mg tolazamide 0mg tolazamide 00mg TOLBUTAMIDE 00MG ANTIDIARRHEAL/PROBIOTIC AGENTS ANTIPERISTALTIC AGENTS atropine sulfate 0.00mg/ml/diphenoxylate 0.mg/ml oral soln ANTIDIARRHEALS ANTIPERISTALTIC AGENTS atropine sulfate 0.0mg/diphenoxylate.mg loperamide mg cap ANTIDOTES AND SPECIFIC ANTAGONISTS ANTIDOTES - CHELATING AGENTS CHEMET 00MG CAP EXJADE MG SUSP EXJADE 0MG SUSP You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.

33 EXJADE 00MG SUSP FERRIPROX 00MG/ML ORAL SOLN FERRIPROX 00MG JADENU 80MG GRANULE CKET JADENU 80MG JADENU 60MG GRANULE CKET JADENU 60MG JADENU 90MG GRANULE CKET JADENU 90MG NALOXONE 0.MG/ML CARTRIDGE OPIOID ANTAGONISTS QL= ML/ Days naloxone 0.mg/ml inj QL= ML/ Days NALOXONE MG/ML QL= ML/ Days naltrexone 0mg NARCAN MG/0.ML NASAL SPRAY QL= EA/ Days ANTIEMETICS granisetron mg -HT RECEPTOR ANTAGONISTS QL=60 EA/0 Days ondansetron 0.8mg/ml oral soln ondansetron mg ondansetron mg odt ondansetron mg ondansetron 8mg odt ondansetron 8mg SANCUSO.MG/HR TCH QL= EA/ Days ANTIEMETICS - ANTICHOLINERGIC meclizine.mg meclizine mg scopolamine mg/days patch trimethobenzamide 00mg cap CESAMET MG CAP ANTIEMETICS - MISCELLANEOUS dronabinol 0mg cap dronabinol.mg cap dronabinol mg cap SUBSTANCE P/NEUROKININ (NK) RECEPTOR ANTAGONISTS aprepitant mg cap QL= EA/ Days aprepitant mg/80mg pack QL= EA/ Days aprepitant 0mg cap QL= EA/ Days aprepitant 80mg cap QL= EA/ Days VARUBI 90MG QL= EA/8 Days ANTIFUNGALS ANTIFUNGAL - GLUCAN SYNTHESIS INHIBITORS (ECHINOCANDINS) CASPOFUNGIN ACETATE 0MG INJ CASPOFUNGIN ACETATE 70MG INJ ERAXIS 00MG INJ You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.