Additional Standard HSA Preventive Drug List Effective January 1, 2019

Transcription

1 Additional Standard HSA Preventive Drug List Effective January 1, 2019 Employers can elect to include an additional HSA Preventive Drug coverage feature with your prescription benefit plan. Below is the list of medications available under your additional HSA Preventive Drug coverage. This list includes preventive drugs that are available in addition to the Standard Drug List and the ACA Preventive Drug List. Check your benefit booklet to find out if the Additional HSA Preventive Drug List applies to your plan. The actual cost of the medication will be applied toward the preventive benefit offered by your employer, allowing you to receive coverage even if you have not met your deductible. Benefits will be provided in accordance with U.S. Department of the Treasury and Internal Revenue Service (IRS) guidance with Health Spending Accounts (HSAs) and qualified High Deductible Health Plans (HDHPs). This list will be reviewed periodically and is subject to change. The drugs listed below are grouped into broad categories. Each category includes an alphabetical list of drugs. Generic drugs are available for many of the brands noted on this list. Please verify with your plan if a generic drug must be tried before filling a brand version of a drug. Please refer to your benefit materials for coverage details and the plan website for current information as this publication is subject to change. Generic prescription drugs are shown in lower-case boldface type. Most generic drugs are followed by a reference brand drug in (parentheses). Some generic products have no reference brand. Brand prescription drugs are shown in capital letters followed by the generic name. Generic medicines are available for many of the brand-name drugs listed though may not be available in all strengths. ANTI-ANGINA DILATRATE SR isosorbide dinitrate cap er 40 mg ISORDIL TITRADOSE isosorbide dinitrate tab 5 mg ISORDIL TITRADOSE isosorbide dinitrate tab 40 mg isosorbide dinitrate tab 5 mg (Isordil titradose) isosorbide dinitrate tab 10 mg isosorbide dinitrate tab 20 mg isosorbide dinitrate tab 30 mg ISOSORBIDE DINITRATE ER isosorbide dinitrate tab er 40 mg isosorbide mononitrate tab 10 mg isosorbide mononitrate tab 20 mg isosorbide mononitrate tab er 24hr 30 mg isosorbide mononitrate tab er 24hr 60 mg isosorbide mononitrate tab er 24hr 120 mg NITRO-BID nitroglycerin oint 2% NITRO-DUR nitroglycerin td patch 24hr 0.1 mg/hr NITRO-DUR nitroglycerin td patch 24hr 0.2 mg/hr NITRO-DUR nitroglycerin td patch 24hr 0.3 mg/hr NITRO-DUR nitroglycerin td patch 24hr 0.4 mg/hr NITRO-DUR nitroglycerin td patch 24hr 0.6 mg/hr NITRO-DUR nitroglycerin td patch 24hr 0.8 mg/hr nitroglycerin cap er 2.5 mg nitroglycerin cap er 6.5 mg nitroglycerin cap er 9 mg NITROGLYCERIN LINGUAL nitroglycerin lingual aerosol 400 mcg/spray nitroglycerin sl tab 0.3 mg (Nitrostat) nitroglycerin sl tab 0.4 mg (Nitrostat) nitroglycerin sl tab 0.6 mg (Nitrostat) nitroglycerin tl soln 0.4 mg/spray (400 mcg/spray) (Nitrolingual pumpspr) nitroglycerin td patch 24hr 0.1 mg/hr (Nitro-dur) nitroglycerin td patch 24hr 0.2 mg/hr (Nitro-dur) nitroglycerin td patch 24hr 0.4 mg/hr (Nitro-dur) nitroglycerin td patch 24hr 0.6 mg/hr (Nitro-dur) NITROLINGUAL PUMPSPRAY nitroglycerin tl soln 0.4 mg/spray (400 mcg/spray) NITROMIST nitroglycerin lingual aerosol 400 mcg/spray NITROSTAT nitroglycerin sl tab 0.3 mg NITROSTAT nitroglycerin sl tab 0.4 mg NITROSTAT nitroglycerin sl tab 0.6 mg RANEXA ranolazine tab er 12hr 500 mg RANEXA ranolazine tab er 12hr 1000 mg ANTI-ARRHYTHMICS amiodarone hcl tab 100 mg amiodarone hcl tab 200 mg (Cordarone) amiodarone hcl tab 400 mg BETAPACE sotalol hcl tab 80 mg BETAPACE sotalol hcl tab 120 mg BETAPACE sotalol hcl tab 160 mg BETAPACE AF sotalol hcl (afib/afl) tab 80 mg BETAPACE AF sotalol hcl (afib/afl) tab 120 mg BETAPACE AF sotalol hcl (afib/afl) tab 160 mg DIGOXIN digoxin oral soln 0.05 mg/ml digoxin tab 125 mcg (0.125 mg) (Lanoxin) digoxin tab 250 mcg (0.25 mg) (Lanoxin) disopyramide phosphate cap 100 mg (Norpace) disopyramide phosphate cap 150 mg (Norpace) dofetilide cap 125 mcg (0.125 mg) (Tikosyn) dofetilide cap 250 mcg (0.25 mg) (Tikosyn) dofetilide cap 500 mcg (0.5 mg) (Tikosyn) flecainide acetate tab 50 mg flecainide acetate tab 100 mg flecainide acetate tab 150 mg LANOXIN digoxin tab 62.5 mcg ( mg) LANOXIN digoxin tab 125 mcg (0.125 mg) LANOXIN digoxin tab mcg ( mg) LANOXIN digoxin tab 250 mcg (0.25 mg) mexiletine hcl cap 150 mg mexiletine hcl cap 200 mg mexiletine hcl cap 250 mg MULTAQ dronedarone hcl tab 400 mg (base equivalent) NORPACE disopyramide phosphate cap 100 mg NORPACE disopyramide phosphate cap 150 mg NORPACE CR disopyramide phosphate cap er 12hr 100 mg NORPACE CR disopyramide phosphate cap er 12hr 150 mg propafenone hcl tab 150 mg 3160-C Prime Therapeutics LLC 06/18 Product names listed are the property of their respected owners. Page 1 of 16

2 propafenone hcl tab 225 mg (Rythmol) propafenone hcl tab 300 mg propafenone hcl cap er 12hr 225 mg (Rythmol sr) propafenone hcl cap er 12hr 325 mg (Rythmol sr) propafenone hcl cap er 12hr 425 mg (Rythmol sr) quinidine gluconate tab er 324 mg ANTI-ARRHYTHMICS (continued) QUINIDINE SULFATE quinidine sulfate tab 200 mg QUINIDINE SULFATE quinidine sulfate tab 300 mg RYTHMOL SR propafenone hcl cap er 12hr 225 mg RYTHMOL SR propafenone hcl cap er 12hr 325 mg RYTHMOL SR propafenone hcl cap er 12hr 425 mg sotalol hcl tab 80 mg (Betapace) sotalol hcl tab 120 mg (Betapace) sotalol hcl tab 160 mg (Betapace) sotalol hcl tab 240 mg sotalol hcl (afib/afl) tab 80 mg (Betapace af) sotalol hcl (afib/afl) tab 120 mg (Betapace af) sotalol hcl (afib/afl) tab 160 mg (Betapace af) SOTYLIZE sotalol hcl oral solution 5 mg/ml TIKOSYN dofetilide cap 125 mcg (0.125 mg) TIKOSYN dofetilide cap 250 mcg (0.25 mg) TIKOSYN dofetilide cap 500 mcg (0.5 mg) ANTI-COAGULANTS/ ANTI-PLATELETS AGGRENOX aspirin-dipyridamole cap er 12hr mg AGRYLIN anagrelide hcl cap 0.5 mg anagrelide hcl cap 0.5 mg (Agrylin) anagrelide hcl cap 1 mg aspirin-dipyridamole cap er 12hr mg (Aggrenox) BEVYXXA betrixaban maleate cap 40 mg (base equivalent) BEVYXXA betrixaban maleate cap 80 mg (base equivalent) BRILINTA ticagrelor tab 60 mg BRILINTA ticagrelor tab 90 mg cilostazol tab 50 mg (Pletal) cilostazol tab 100 mg (Pletal) clopidogrel bisulfate tab 75 mg (Plavix) clopidogrel bisulfate tab 300 mg (Plavix) COUMADIN warfarin sodium tab 1 mg COUMADIN warfarin sodium tab 2 mg COUMADIN warfarin sodium tab 2.5 mg COUMADIN warfarin sodium tab 3 mg COUMADIN warfarin sodium tab 4 mg COUMADIN warfarin sodium tab 5 mg COUMADIN warfarin sodium tab 6 mg COUMADIN warfarin sodium tab 7.5 mg COUMADIN warfarin sodium tab 10 mg dipyridamole tab 25 mg (Persantine) dipyridamole tab 50 mg (Persantine) dipyridamole tab 75 mg (Persantine) EFFIENT prasugrel hcl tab 5 mg EFFIENT prasugrel hcl tab 10 mg ELIQUIS apixaban tab 2.5 mg ELIQUIS apixaban tab 5 mg ELIQUIS STARTER PACK apixaban tab 5 mg PLAVIX clopidogrel bisulfate tab 75 mg PLAVIX clopidogrel bisulfate tab 300 mg PRADAXA dabigatran etexilate mesylate cap 75 mg (etexilate base eq) PRADAXA dabigatran etexilate mesylate cap 110 mg (etexilate base eq) PRADAXA dabigatran etexilate mesylate cap 150 mg (etexilate base eq) prasugrel hcl tab 5 mg (Effient) prasugrel hcl tab 10 mg (Effient) SAVAYSA edoxaban tosylate tab 15 mg (base equivalent) SAVAYSA edoxaban tosylate tab 30 mg (base equivalent) SAVAYSA edoxaban tosylate tab 60 mg (base equivalent) warfarin sodium tab 1 mg (Coumadin) warfarin sodium tab 2 mg (Coumadin) warfarin sodium tab 2.5 mg (Coumadin) warfarin sodium tab 3 mg (Coumadin) warfarin sodium tab 4 mg (Coumadin) warfarin sodium tab 5 mg (Coumadin) warfarin sodium tab 6 mg (Coumadin) warfarin sodium tab 7.5 mg (Coumadin) warfarin sodium tab 10 mg (Coumadin) XARELTO rivaroxaban tab 10 mg XARELTO rivaroxaban tab 15 mg XARELTO rivaroxaban tab 20 mg XARELTO STARTER PACK rivaroxaban tab starter therapy pack 15 mg & 20 mg ZONTIVITY vorapaxar sulfate tab 2.08 mg (base equivalent) DIABETES Rx - Hypoglycemic Agents - GLUCAGEN HYPOKIT glucagon hcl (rdna) for inj 1 mg GLUCAGON EMERGENCY KIT glucagon (rdna) for inj kit 1 mg - Insulin only - ADMELOG insulin lispro inj ADMELOG SOLOSTAR insulin lispro soln pen-injector AFREZZA insulin regular (human) inhalation powder 4 unit/cartridge AFREZZA insulin regular (human) inhalation powder 8 unit/cartridge AFREZZA insulin regular (human) inhalation powder 12 unit/cartridge AFREZZA insulin regular (human) inhal powd 4 (30) & 8 (60) unit/cart AFREZZA insulin regular (human) inhal powd 4 (60) & 8 (30) unit/cart AFREZZA insulin regular (human) inhal powd 4 (90) & 8 (90) unit/cart AFREZZA insulin regular (human) inh powd 8 (60) & 12 (30) unit/cart AFREZZA insulin regular (human) inh powd 4 & 8 & 12 unit/cart (60) APIDRA insulin glulisine inj APIDRA SOLOSTAR insulin glulisine soln pen-injector inj BASAGLAR KWIKPEN insulin glargine soln pen-injector FIASP insulin aspart inj FIASP FLEXTOUCH insulin aspart soln pen-injector 3160-C Prime Therapeutics LLC 06/18 Product names listed are the property of their respected owners. Page 2 of 16

3 HUMALOG insulin lispro soln cartridge HUMALOG insulin lispro inj HUMALOG JUNIOR KWIKPEN insulin lispro soln pen-injector HUMALOG KWIKPEN insulin lispro soln pen-injector DIABETES Rx - Insulin only - (continued) HUMALOG KWIKPEN insulin lispro soln pen-injector 200 unit/ml HUMALOG MIX 50/50 insulin lispro protamine & lispro inj (50-50) HUMALOG MIX 50/50 KWIKPEN insulin lispro prot & lispro sus pen-inj (50-50) HUMALOG MIX 75/25 insulin lispro prot & lispro inj (75-25) HUMALOG MIX 75/25 KWIKPEN insulin lispro prot & lispro sus pen-inj (75-25) HUMULIN N insulin nph (human) (isophane) inj HUMULIN N KWIKPEN insulin nph (human) (isophane) susp pen-injector HUMULIN R insulin regular (human) inj HUMULIN R U-500 (CONCENTRATED) insulin regular (human) inj 500 unit/ml HUMULIN R U-500 KWIKPEN insulin regular (human) soln pen-injector 500 unit/ml HUMULIN 70/30 insulin nph isophane & regular human inj (70-30) HUMULIN 70/30 KWIKPEN insulin nph & regular susp peninj (70-30) LANTUS insulin glargine inj LANTUS SOLOSTAR insulin glargine soln pen-injector LEVEMIR insulin detemir inj LEVEMIR FLEXTOUCH insulin detemir soln pen-injector 100 unit/ml NOVOLIN N insulin nph (human) (isophane) inj NOVOLIN N RELION insulin nph (human) (isophane) inj NOVOLIN R insulin regular (human) inj NOVOLIN R RELION insulin regular (human) inj NOVOLIN 70/30 insulin nph isophane & regular human inj (70-30) NOVOLIN 70/30 RELION insulin nph isophane & regular human inj (70-30) NOVOLOG insulin aspart inj NOVOLOG FLEXPEN insulin aspart soln pen-injector NOVOLOG MIX 70/30 insulin aspart prot & aspart (human) inj (70-30) NOVOLOG MIX 70/30 PREFILL insulin aspart prot & aspart sus pen-inj (70-30) NOVOLOG PENFILL insulin aspart soln cartridge RELION R insulin regular (human) inj TOUJEO MAX SOLOSTAR insulin glargine soln pen-injector 300 unit/ml TOUJEO SOLOSTAR insulin glargine soln pen-injector 300 unit/ml TRESIBA FLEXTOUCH insulin degludec soln pen-injector TRESIBA FLEXTOUCH insulin degludec soln pen-injector 200 unit/ml - Insulin Combinations SOLIQUA 100/33 insulin glargine-lixisenatide sol pen-inj unit-mcg/ml XULTOPHY 100/3.6 insulin degludec-liraglutide sol pen-inj unit-mg/ml - Orals only - acarbose tab 25 mg (Precose) acarbose tab 50 mg (Precose) acarbose tab 100 mg (Precose) ACTOPLUS MET pioglitazone hcl-metformin hcl tab mg ACTOPLUS MET pioglitazone hcl-metformin hcl tab mg ACTOPLUS MET XR pioglitazone hcl-metformin hcl tab er 24hr mg ACTOPLUS MET XR pioglitazone hcl-metformin hcl tab er 24hr mg ACTOS pioglitazone hcl tab 15 mg ACTOS pioglitazone hcl tab 30 mg ACTOS pioglitazone hcl tab 45 mg ALOGLIPTIN alogliptin benzoate tab 6.25 mg ALOGLIPTIN alogliptin benzoate tab 12.5 mg ALOGLIPTIN alogliptin benzoate tab 25 mg ALOGLIPTIN/METFORMIN HCL alogliptin-metformin hcl tab mg ALOGLIPTIN/METFORMIN HCL alogliptin-metformin hcl tab mg ALOGLIPTIN/PIOGLITAZONE alogliptin-pioglitazone tab mg ALOGLIPTIN/PIOGLITAZONE alogliptin-pioglitazone tab mg ALOGLIPTIN/PIOGLITAZONE alogliptin-pioglitazone tab mg ALOGLIPTIN/PIOGLITAZONE alogliptin-pioglitazone tab mg ALOGLIPTIN/PIOGLITAZONE alogliptin-pioglitazone tab mg ALOGLIPTIN/PIOGLITAZONE alogliptin-pioglitazone tab mg AMARYL glimepiride tab 1 mg AMARYL glimepiride tab 2 mg AMARYL glimepiride tab 4 mg AVANDIA - rosiglitazone maleate tab 2 mg AVANDIA - rosiglitazone maleate tab 4 mg CHLORPROPAMIDE chlorpropamide tab 100 mg CHLORPROPAMIDE chlorpropamide tab 250 mg CYCLOSET bromocriptine mesylate tab 0.8 mg (base equivalent) DUETACT pioglitazone hcl-glimepiride tab 30-2 mg DUETACT pioglitazone hcl-glimepiride tab 30-4 mg 3160-C Prime Therapeutics LLC 06/18 Product names listed are the property of their respected owners. Page 3 of 16

4 FARXIGA dapagliflozin propanediol tab 5 mg (base equivalent) FARXIGA dapagliflozin propanediol tab 10 mg (base equivalent) glimepiride tab 1 mg (Amaryl) glimepiride tab 2 mg (Amaryl) glimepiride tab 4 mg (Amaryl) glipizide tab 5 mg (Glucotrol) DIABETES Rx - Orals only (continued) glipizide tab 10 mg (Glucotrol) glipizide tab er 24hr 2.5 mg (Glucotrol xl) glipizide tab er 24hr 5 mg (Glucotrol xl) glipizide tab er 24hr 10 mg (Glucotrol xl) glipizide-metformin hcl tab mg glipizide-metformin hcl tab mg glipizide-metformin hcl tab mg GLUCOPHAGE metformin hcl tab 500 mg GLUCOPHAGE metformin hcl tab 850 mg GLUCOPHAGE metformin hcl tab 1000 mg GLUCOPHAGE XR metformin hcl tab er 24hr 500 mg GLUCOPHAGE XR metformin hcl tab er 24hr 750 mg GLUCOTROL glipizide tab 5 mg GLUCOTROL glipizide tab 10 mg GLUCOTROL XL glipizide tab er 24hr 2.5 mg GLUCOTROL XL glipizide tab er 24hr 5 mg GLUCOTROL XL glipizide tab er 24hr 10 mg GLUCOVANCE glyburide-metformin tab mg GLUCOVANCE glyburide-metformin tab mg glyburide tab 1.25 mg glyburide tab 2.5 mg glyburide tab 5 mg glyburide micronized tab 1.5 mg (Glynase) glyburide micronized tab 3 mg (Glynase) glyburide micronized tab 6 mg (Glynase) glyburide-metformin tab mg glyburide-metformin tab mg (Glucovance) glyburide-metformin tab mg (Glucovance) GLYNASE glyburide micronized tab 1.5 mg GLYNASE glyburide micronized tab 3 mg GLYNASE glyburide micronized tab 6 mg GLYSET miglitol tab 25 mg GLYSET miglitol tab 50 mg GLYSET miglitol tab 100 mg GLYXAMBI empagliflozin-linagliptin tab 10-5 mg GLYXAMBI empagliflozin-linagliptin tab 25-5 mg INVOKAMET canagliflozin-metformin hcl tab mg INVOKAMET canagliflozin-metformin hcl tab mg INVOKAMET canagliflozin-metformin hcl tab mg INVOKAMET canagliflozin-metformin hcl tab mg INVOKAMET XR canagliflozin-metformin hcl tab er 24hr mg INVOKAMET XR canagliflozin-metformin hcl tab er 24hr mg INVOKAMET XR canagliflozin-metformin hcl tab er 24hr mg INVOKAMET XR canagliflozin-metformin hcl tab er 24hr mg INVOKANA canagliflozin tab 100 mg INVOKANA canagliflozin tab 300 mg JANUMET sitagliptin-metformin hcl tab mg JANUMET sitagliptin-metformin hcl tab mg JANUMET XR sitagliptin-metformin hcl tab er 24hr mg JANUMET XR sitagliptin-metformin hcl tab er 24hr mg JANUMET XR sitagliptin-metformin hcl tab er 24hr mg JANUVIA sitagliptin phosphate tab 25 mg JANUVIA sitagliptin phosphate tab 50 mg JANUVIA sitagliptin phosphate tab 100 mg JARDIANCE empagliflozin tab 10 mg JARDIANCE empagliflozin tab 25 mg JENTADUETO linagliptin-metformin hcl tab mg JENTADUETO linagliptin-metformin hcl tab mg JENTADUETO linagliptin-metformin hcl tab mg JENTADUETO XR linagliptin-metformin hcl tab er 24hr mg JENTADUETO XR linagliptin-metformin hcl tab er 24hr mg KAZANO alogliptin-metformin hcl tab mg KAZANO alogliptin-metformin hcl tab mg KOMBIGLYZE XR saxagliptin-metformin hcl tab er 24hr mg KOMBIGLYZE XR saxagliptin-metformin hcl tab er 24hr mg KOMBIGLYZE XR saxagliptin-metformin hcl tab er 24hr mg metformin hcl tab 500 mg (Glucophage) metformin hcl tab 850 mg (Glucophage) metformin hcl tab 1000 mg (Glucophage) metformin hcl tab er 24hr 500 mg (Glucophage xr) metformin hcl tab er 24hr 750 mg (Glucophage xr) miglitol tab 25 mg (Glyset) miglitol tab 50 mg (Glyset) miglitol tab 100 mg (Glyset) nateglinide tab 60 mg (Starlix) nateglinide tab 120 mg (Starlix) NESINA alogliptin benzoate tab 6.25 mg NESINA alogliptin benzoate tab 12.5 mg NESINA alogliptin benzoate tab 25 mg ONGLYZA saxagliptin hcl tab 2.5 mg ONGLYZA saxagliptin hcl tab 5 mg OSENI alogliptin-pioglitazone tab mg OSENI alogliptin-pioglitazone tab mg OSENI alogliptin-pioglitazone tab mg OSENI alogliptin-pioglitazone tab mg OSENI alogliptin-pioglitazone tab mg OSENI alogliptin-pioglitazone tab mg pioglitazone hcl tab 15 mg (Actos) pioglitazone hcl tab 30 mg (Actos) pioglitazone hcl tab 45 mg (Actos) pioglitazone hcl-glimepiride tab 30-2 mg (Duetact) pioglitazone hcl-glimepiride tab 30-4 mg (Duetact) pioglitazone hcl-metformin hcl tab mg (Actoplus met) pioglitazone hcl-metformin hcl tab mg (Actoplus met) PRANDIN repaglinide tab 0.5 mg PRANDIN repaglinide tab 1 mg PRANDIN repaglinide tab 2 mg 3160-C Prime Therapeutics LLC 06/18 Product names listed are the property of their respected owners. Page 4 of 16

5 PRECOSE acarbose tab 25 mg PRECOSE acarbose tab 50 mg PRECOSE acarbose tab 100 mg QTERN dapagliflozin-saxagliptin tab 10-5 mg repaglinide tab 0.5 mg repaglinide tab 1 mg (Prandin) repaglinide tab 2 mg (Prandin) DIABETES Rx - Orals only (continued) REPAGLINIDE/METFORMIN HYDROCHLORIDE repaglinidemetformin hcl tab mg REPAGLINIDE/METFORMIN HYDROCHLORIDE repaglinidemetformin hcl tab mg SEGLUROMET ertugliflozin-metformin hcl tab mg SEGLUROMET ertugliflozin-metformin hcl tab mg SEGLUROMET ertugliflozin-metformin hcl tab mg SEGLUROMET ertugliflozin-metformin hcl tab mg STARLIX nateglinide tab 60 mg STARLIX nateglinide tab 120 mg STEGLATRO ertugliflozin l-pyroglutamic acid tab 5 mg STEGLATRO ertugliflozin l-pyroglutamic acid tab 15 mg STEGLUJAN ertugliflozin-sitagliptin tab mg STEGLUJAN ertugliflozin-sitagliptin tab mg SYNJARDY empagliflozin-metformin hcl tab mg SYNJARDY empagliflozin-metformin hcl tab mg SYNJARDY empagliflozin-metformin hcl tab mg SYNJARDY empagliflozin-metformin hcl tab mg SYNJARDY XR empagliflozin-metformin hcl tab er 24hr mg SYNJARDY XR empagliflozin-metformin hcl tab er 24hr mg SYNJARDY XR empagliflozin-metformin hcl tab er 24hr mg SYNJARDY XR empagliflozin-metformin hcl tab er 24hr mg TOLAZAMIDE tolazamide tab 250 mg TOLAZAMIDE tolazamide tab 500 mg TOLBUTAMIDE tolbutamide tab 500 mg TRADJENTA linagliptin tab 5 mg XIGDUO XR dapagliflozin-metformin hcl tab er 24hr mg XIGDUO XR dapagliflozin-metformin hcl tab er 24hr mg XIGDUO XR dapagliflozin-metformin hcl tab er 24hr mg XIGDUO XR dapagliflozin-metformin hcl tab er 24hr mg XIGDUO XR dapagliflozin-metformin hcl tab er 24hr mg - Other Diabetic Injectables - ADLYXIN lixisenatide soln pen-injector 20 mcg/0.2ml (100 mcg/ml) ADLYXIN STARTER PACK lixisenatide pen-inj starter kit 10 mcg/0.2ml & 20 mcg/0.2ml BYDUREON exenatide for inj extended release susp 2 mg BYDUREON BCISE exenatide extended release susp autoinjector 2 mg/0.85ml BYDUREON PEN exenatide extended release for susp peninjector 2 mg BYETTA exenatide soln pen-injector 5 mcg/0.02ml BYETTA exenatide soln pen-injector 10 mcg/0.04ml OZEMPIC semaglutide soln pen-inj 0.25 or 0.5 mg/dose (2 mg/1.5ml) OZEMPIC semaglutide soln pen-inj 1 mg/dose (2 mg/1.5ml) SYMLINPEN 60 pramlintide acetate pen-inj 1500 mcg/1.5ml (1000 mcg/ml) SYMLINPEN 120 pramlintide acetate pen-inj 2700 mcg/2.7ml (1000 mcg/ml) TANZEUM albiglutide for soln pen-injector 30 mg TANZEUM albiglutide for soln pen-injector 50 mg TRULICITY dulaglutide soln pen-injector 0.75 mg/0.5ml TRULICITY dulaglutide soln pen-injector 1.5 mg/0.5ml VICTOZA liraglutide soln pen-injector 18 mg/3ml (6 mg/ml) DIABETIC DEVICES Blood Glucose Monitoring Devices, Kits Injection Devices DIABETIC SUPPLIES Insulin Syringes Lancets Pen Needles Test Strips and Disks (blood glucose) HEPARINS/LOW MOLECULAR WEIGHT HEPARIN ARIXTRA fondaparinux sodium subcutaneous inj 2.5 mg/0.5ml ARIXTRA fondaparinux sodium subcutaneous inj 5 mg/0.4ml ARIXTRA fondaparinux sodium subcutaneous inj 7.5 mg/0.6ml ARIXTRA fondaparinux sodium subcutaneous inj 10 mg/0.8ml enoxaparin sodium inj 30 mg/0.3ml (Lovenox) enoxaparin sodium inj 40 mg/0.4ml (Lovenox) enoxaparin sodium inj 60 mg/0.6ml (Lovenox) enoxaparin sodium inj 80 mg/0.8ml (Lovenox) enoxaparin sodium inj 100 mg/ml (Lovenox) enoxaparin sodium inj 120 mg/0.8ml (Lovenox) enoxaparin sodium inj 150 mg/ml (Lovenox) enoxaparin sodium inj 300 mg/3ml (Lovenox) fondaparinux sodium subcutaneous inj 2.5 mg/0.5ml (Arixtra) fondaparinux sodium subcutaneous inj 5 mg/0.4ml (Arixtra) fondaparinux sodium subcutaneous inj 7.5 mg/0.6ml (Arixtra) fondaparinux sodium subcutaneous inj 10 mg/0.8ml (Arixtra) FRAGMIN dalteparin sodium inj 2500 unit/0.2ml FRAGMIN dalteparin sodium inj 5000 unit/0.2ml FRAGMIN dalteparin sodium inj 7500 unit/0.3ml FRAGMIN dalteparin sodium inj unit/ml FRAGMIN dalteparin sodium inj unit/0.5ml FRAGMIN dalteparin sodium inj unit/0.6ml 3160-C Prime Therapeutics LLC 06/18 Product names listed are the property of their respected owners. Page 5 of 16

6 FRAGMIN dalteparin sodium inj unit/0.72ml FRAGMIN dalteparin sodium inj unit/3.8ml heparin sodium (porcine) inj 5000 unit/ml heparin sodium (porcine) pf inj 5000 unit/0.5ml LOVENOX enoxaparin sodium inj 30 mg/0.3ml LOVENOX enoxaparin sodium inj 40 mg/0.4ml LOVENOX enoxaparin sodium inj 60 mg/0.6ml LOVENOX enoxaparin sodium inj 80 mg/0.8ml HEPARINS/LOW MOLECULAR WEIGHT HEPARIN (continued) LOVENOX enoxaparin sodium inj 100 mg/ml LOVENOX enoxaparin sodium inj 120 mg/0.8ml LOVENOX enoxaparin sodium inj 150 mg/ml LOVENOX enoxaparin sodium inj 300 mg/3ml HIGH BLOOD PRESSURE ACCUPRIL quinapril hcl tab 5 mg ACCUPRIL quinapril hcl tab 10 mg ACCUPRIL quinapril hcl tab 20 mg ACCUPRIL quinapril hcl tab 40 mg ACCURETIC quinapril-hydrochlorothiazide tab mg ACCURETIC quinapril-hydrochlorothiazide tab mg ACCURETIC quinapril-hydrochlorothiazide tab mg acebutolol hcl cap 200 mg (Sectral) acebutolol hcl cap 400 mg (Sectral) ACEON perindopril erbumine tab 4 mg ACEON perindopril erbumine tab 8 mg ADALAT CC nifedipine tab er 24hr 30 mg ADALAT CC nifedipine tab er 24hr 60 mg ADALAT CC nifedipine tab er 24hr 90 mg ALDACTAZIDE spironolactone & hydrochlorothiazide tab mg ALDACTAZIDE spironolactone & hydrochlorothiazide tab mg ALDACTONE spironolactone tab 25 mg ALDACTONE spironolactone tab 50 mg ALDACTONE spironolactone tab 100 mg ALTACE ramipril cap 1.25 mg ALTACE ramipril cap 2.5 mg ALTACE ramipril cap 5 mg ALTACE ramipril cap 10 mg amiloride hcl tab 5 mg amiloride & hydrochlorothiazide tab 5-50 mg amlodipine besylate tab 2.5 mg (base equivalent) (Norvasc) amlodipine besylate tab 5 mg (base equivalent) (Norvasc) amlodipine besylate tab 10 mg (base equivalent) (Norvasc) amlodipine besylate-atorvastatin calcium tab mg amlodipine besylate-atorvastatin calcium tab mg amlodipine besylate-atorvastatin calcium tab mg amlodipine besylate-atorvastatin calcium tab 5-10 mg amlodipine besylate-atorvastatin calcium tab 5-20 mg amlodipine besylate-atorvastatin calcium tab 5-40 mg amlodipine besylate-atorvastatin calcium tab 5-80 mg amlodipine besylate-atorvastatin calcium tab mg amlodipine besylate-atorvastatin calcium tab mg amlodipine besylate-atorvastatin calcium tab mg amlodipine besylate-atorvastatin calcium tab mg amlodipine besylate-benazepril hcl cap mg amlodipine besylate-benazepril hcl cap 5-10 mg (Lotrel) amlodipine besylate-benazepril hcl cap 5-20 mg (Lotrel) amlodipine besylate-benazepril hcl cap 5-40 mg amlodipine besylate-benazepril hcl cap mg (Lotrel) amlodipine besylate-benazepril hcl cap mg (Lotrel) amlodipine besylate-olmesartan medoxomil tab 5-20 mg (Azor) amlodipine besylate-olmesartan medoxomil tab 5-40 mg (Azor) amlodipine besylate-olmesartan medoxomil tab mg (Azor) amlodipine besylate-olmesartan medoxomil tab mg (Azor) amlodipine besylate-valsartan tab mg (Exforge) amlodipine besylate-valsartan tab mg (Exforge) amlodipine besylate-valsartan tab mg (Exforge) amlodipine besylate-valsartan tab mg (Exforge) amlodipine-valsartan-hydrochlorothiazide tab mg (Exforge hct) amlodipine-valsartan-hydrochlorothiazide tab mg (Exforge hct) amlodipine-valsartan-hydrochlorothiazide tab mg (Exforge hct) amlodipine-valsartan-hydrochlorothiazide tab mg (Exforge hct) amlodipine-valsartan-hydrochlorothiazide tab mg (Exforge hct) ATACAND candesartan cilexetil tab 4 mg ATACAND candesartan cilexetil tab 8 mg ATACAND candesartan cilexetil tab 16 mg ATACAND candesartan cilexetil tab 32 mg ATACAND HCT candesartan cilexetil-hydrochlorothiazide tab mg ATACAND HCT candesartan cilexetil-hydrochlorothiazide tab mg ATACAND HCT candesartan cilexetil-hydrochlorothiazide tab mg atenolol tab 25 mg (Tenormin) atenolol tab 50 mg (Tenormin) atenolol tab 100 mg (Tenormin) atenolol & chlorthalidone tab mg (Tenoretic 50) atenolol & chlorthalidone tab mg (Tenoretic 100) AVALIDE irbesartan-hydrochlorothiazide tab mg AVALIDE irbesartan-hydrochlorothiazide tab mg AVAPRO irbesartan tab 75 mg AVAPRO irbesartan tab 150 mg AVAPRO irbesartan tab 300 mg AZOR amlodipine besylate-olmesartan medoxomil tab 5-20 mg AZOR amlodipine besylate-olmesartan medoxomil tab 3160-C Prime Therapeutics LLC 06/18 Product names listed are the property of their respected owners. Page 6 of 16

7 5-40 mg AZOR amlodipine besylate-olmesartan medoxomil tab mg AZOR amlodipine besylate-olmesartan medoxomil tab mg benazepril hcl tab 5 mg benazepril hcl tab 10 mg benazepril hcl tab 20 mg (Lotensin) HIGH BLOOD PRESSURE (continued) benazepril hcl tab 40 mg (Lotensin) benazepril & hydrochlorothiazide tab mg benazepril & hydrochlorothiazide tab mg (Lotensin hct) benazepril & hydrochlorothiazide tab mg (Lotensin hct) benazepril & hydrochlorothiazide tab mg (Lotensin hct) BENICAR olmesartan medoxomil tab 5 mg BENICAR olmesartan medoxomil tab 20 mg BENICAR olmesartan medoxomil tab 40 mg BENICAR HCT olmesartan medoxomil-hydrochlorothiazide tab mg BENICAR HCT olmesartan medoxomil-hydrochlorothiazide tab mg BENICAR HCT olmesartan medoxomil-hydrochlorothiazide tab mg betaxolol hcl tab 10 mg betaxolol hcl tab 20 mg BIDIL isosorbide dinitrate-hydralazine hcl tab mg bisoprolol fumarate tab 5 mg bisoprolol fumarate tab 10 mg (Zebeta) bisoprolol & hydrochlorothiazide tab mg (Ziac) bisoprolol & hydrochlorothiazide tab mg (Ziac) bisoprolol & hydrochlorothiazide tab mg (Ziac) bumetanide tab 0.5 mg (Bumex) bumetanide tab 1 mg (Bumex) bumetanide tab 2 mg (Bumex) BUMEX bumetanide tab 0.5 mg BUMEX bumetanide tab 1 mg BUMEX bumetanide tab 2 mg BYSTOLIC nebivolol hcl tab 2.5 mg (base equivalent) BYSTOLIC nebivolol hcl tab 5 mg (base equivalent) BYSTOLIC nebivolol hcl tab 10 mg (base equivalent) BYSTOLIC nebivolol hcl tab 20 mg (base equivalent) BYVALSON nebivolol-valsartan tab 5-80 mg 5-10 mg 5-20 mg 5-40 mg 5-80 mg mg mg mg mg CALAN verapamil hcl tab 80 mg CALAN verapamil hcl tab 120 mg CALAN SR verapamil hcl tab er 120 mg CALAN SR verapamil hcl tab er 180 mg CALAN SR verapamil hcl tab er 240 mg candesartan cilexetil tab 4 mg (Atacand) candesartan cilexetil tab 8 mg (Atacand) candesartan cilexetil tab 16 mg (Atacand) candesartan cilexetil tab 32 mg (Atacand) candesartan cilexetil-hydrochlorothiazide tab mg (Atacand hct) candesartan cilexetil-hydrochlorothiazide tab mg (Atacand hct) candesartan cilexetil-hydrochlorothiazide tab mg (Atacand hct) captopril tab 12.5 mg captopril tab 25 mg captopril tab 50 mg captopril tab 100 mg CAPTOPRIL/HYDROCHLOROTHIA captopril & hydrochlorothiazide tab mg CAPTOPRIL/HYDROCHLOROTHIA captopril & hydrochlorothiazide tab mg CAPTOPRIL/HYDROCHLOROTHIA captopril & hydrochlorothiazide tab mg CAPTOPRIL/HYDROCHLOROTHIA captopril & hydrochlorothiazide tab mg CARDIZEM diltiazem hcl tab 30 mg CARDIZEM diltiazem hcl tab 60 mg CARDIZEM diltiazem hcl tab 120 mg CARDIZEM CD diltiazem hcl coated beads cap er 24hr 120 mg CARDIZEM CD diltiazem hcl coated beads cap er 24hr 180 mg CARDIZEM CD diltiazem hcl coated beads cap er 24hr 240 mg CARDIZEM CD diltiazem hcl coated beads cap er 24hr 300 mg CARDIZEM CD diltiazem hcl coated beads cap er 24hr 360 mg CARDIZEM LA diltiazem hcl coated beads tab er 24hr 120 mg CARDIZEM LA diltiazem hcl coated beads tab er 24hr 180 mg CARDIZEM LA diltiazem hcl coated beads tab er 24hr 240 mg CARDIZEM LA diltiazem hcl coated beads tab er 24hr 300 mg CARDIZEM LA diltiazem hcl coated beads tab er 24hr 360 mg CARDIZEM LA diltiazem hcl coated beads tab er 24hr 420 mg CARDURA doxazosin mesylate tab 1 mg CARDURA doxazosin mesylate tab 2 mg CARDURA doxazosin mesylate tab 4 mg CARDURA doxazosin mesylate tab 8 mg carvedilol tab mg (Coreg) carvedilol tab 6.25 mg (Coreg) carvedilol tab 12.5 mg (Coreg) carvedilol tab 25 mg (Coreg) carvedilol phosphate cap er 24hr 10 mg (Coreg cr) carvedilol phosphate cap er 24hr 20 mg (Coreg cr) carvedilol phosphate cap er 24hr 40 mg (Coreg cr) carvedilol phosphate cap er 24hr 80 mg (Coreg cr) CATAPRES clonidine hcl tab 0.1 mg CATAPRES clonidine hcl tab 0.2 mg 3160-C Prime Therapeutics LLC 06/18 Product names listed are the property of their respected owners. Page 7 of 16

8 CATAPRES clonidine hcl tab 0.3 mg CATAPRES-TTS-1 clonidine hcl td patch weekly 0.1 mg/24hr CATAPRES-TTS-2 clonidine hcl td patch weekly 0.2 mg/24hr CATAPRES-TTS-3 clonidine hcl td patch weekly 0.3 mg/24hr CHLOROTHIAZIDE chlorothiazide tab 250 mg chlorothiazide tab 500 mg chlorthalidone tab 25 mg chlorthalidone tab 50 mg HIGH BLOOD PRESSURE (continued) clonidine hcl tab 0.1 mg (Catapres) clonidine hcl tab 0.2 mg (Catapres) clonidine hcl tab 0.3 mg (Catapres) clonidine hcl td patch weekly 0.1 mg/24hr (Catapres-tts-1) clonidine hcl td patch weekly 0.2 mg/24hr (Catapres-tts-2) clonidine hcl td patch weekly 0.3 mg/24hr (Catapres-tts-3) CLORPRES clonidine & chlorthalidone tab mg CLORPRES clonidine & chlorthalidone tab mg CLORPRES clonidine & chlorthalidone tab mg COREG carvedilol tab mg COREG carvedilol tab 6.25 mg COREG carvedilol tab 12.5 mg COREG carvedilol tab 25 mg COREG CR carvedilol phosphate cap er 24hr 10 mg COREG CR carvedilol phosphate cap er 24hr 20 mg COREG CR carvedilol phosphate cap er 24hr 40 mg COREG CR carvedilol phosphate cap er 24hr 80 mg CORGARD nadolol tab 20 mg CORGARD nadolol tab 40 mg CORGARD nadolol tab 80 mg CORZIDE nadolol & bendroflumethiazide tab 40-5 mg CORZIDE nadolol & bendroflumethiazide tab 80-5 mg COZAAR losartan potassium tab 25 mg COZAAR losartan potassium tab 50 mg COZAAR losartan potassium tab 100 mg DEMADEX torsemide tab 10 mg DEMADEX torsemide tab 20 mg DIBENZYLINE phenoxybenzamine hcl cap 10 mg diltiazem hcl tab 30 mg (Cardizem) diltiazem hcl tab 60 mg (Cardizem) diltiazem hcl tab 90 mg diltiazem hcl tab 120 mg (Cardizem) diltiazem hcl cap er 12hr 60 mg diltiazem hcl cap er 12hr 90 mg diltiazem hcl cap er 12hr 120 mg diltiazem hcl cap er 24hr 120 mg diltiazem hcl cap er 24hr 180 mg diltiazem hcl cap er 24hr 240 mg diltiazem hcl coated beads cap er 24hr 120 mg (Cardizem cd) diltiazem hcl coated beads cap er 24hr 180 mg (Cardizem cd) diltiazem hcl coated beads cap er 24hr 240 mg (Cardizem cd) diltiazem hcl coated beads cap er 24hr 300 mg diltiazem hcl coated beads cap er 24hr 360 mg (Cardizem cd) diltiazem hcl coated beads tab er 24hr 180 mg (Cardizem la) diltiazem hcl coated beads tab er 24hr 240 mg (Cardizem la) diltiazem hcl coated beads tab er 24hr 300 mg (Cardizem la) diltiazem hcl coated beads tab er 24hr 360 mg (Cardizem la) diltiazem hcl coated beads tab er 24hr 420 mg (Cardizem la) diltiazem hcl extended release beads cap er 24hr 120 mg (Tiazac) diltiazem hcl extended release beads cap er 24hr 180 mg (Tiazac) diltiazem hcl extended release beads cap er 24hr 240 mg (Tiazac) diltiazem hcl extended release beads cap er 24hr 300 mg (Tiazac) diltiazem hcl extended release beads cap er 24hr 360 mg (Tiazac) diltiazem hcl extended release beads cap er 24hr 420 mg (Tiazac) DIOVAN valsartan tab 40 mg DIOVAN valsartan tab 80 mg DIOVAN valsartan tab 160 mg DIOVAN valsartan tab 320 mg DIOVAN HCT valsartan-hydrochlorothiazide tab mg DIOVAN HCT valsartan-hydrochlorothiazide tab mg DIOVAN HCT valsartan-hydrochlorothiazide tab mg DIOVAN HCT valsartan-hydrochlorothiazide tab mg DIOVAN HCT valsartan-hydrochlorothiazide tab mg DIURIL chlorothiazide susp 250 mg/5ml doxazosin mesylate tab 1 mg (Cardura) doxazosin mesylate tab 2 mg (Cardura) doxazosin mesylate tab 4 mg (Cardura) doxazosin mesylate tab 8 mg (Cardura) DUTOPROL metoprolol & hydrochlorothiazide tab er 24hr mg DUTOPROL metoprolol & hydrochlorothiazide tab er 24hr mg DUTOPROL metoprolol & hydrochlorothiazide tab er 24hr mg DYAZIDE triamterene & hydrochlorothiazide cap mg DYRENIUM triamterene cap 50 mg DYRENIUM triamterene cap 100 mg EDARBI azilsartan medoxomil tab 40 mg EDARBI azilsartan medoxomil tab 80 mg EDARBYCLOR azilsartan medoxomil-chlorthalidone tab mg EDARBYCLOR azilsartan medoxomil-chlorthalidone tab mg enalapril maleate tab 2.5 mg (Vasotec) enalapril maleate tab 5 mg (Vasotec) enalapril maleate tab 10 mg (Vasotec) enalapril maleate tab 20 mg (Vasotec) enalapril maleate & hydrochlorothiazide tab mg enalapril maleate & hydrochlorothiazide tab mg (Vaseretic) EPANED enalapril maleate oral soln 1 mg/ml EPANED enalapril maleate for oral soln 1 mg/ml eplerenone tab 25 mg (Inspra) eplerenone tab 50 mg (Inspra) EPROSARTAN MESYLATE eprosartan mesylate tab 600 mg 3160-C Prime Therapeutics LLC 06/18 Product names listed are the property of their respected owners. Page 8 of 16

9 EXFORGE amlodipine besylate-valsartan tab mg EXFORGE amlodipine besylate-valsartan tab mg EXFORGE amlodipine besylate-valsartan tab mg EXFORGE amlodipine besylate-valsartan tab mg EXFORGE HCT amlodipine-valsartan-hydrochlorothiazide tab mg EXFORGE HCT amlodipine-valsartan-hydrochlorothiazide tab mg HIGH BLOOD PRESSURE (continued) EXFORGE HCT amlodipine-valsartan-hydrochlorothiazide tab mg EXFORGE HCT amlodipine-valsartan-hydrochlorothiazide tab mg EXFORGE HCT amlodipine-valsartan-hydrochlorothiazide tab mg felodipine tab er 24hr 2.5 mg felodipine tab er 24hr 5 mg felodipine tab er 24hr 10 mg fosinopril sodium tab 10 mg fosinopril sodium tab 20 mg fosinopril sodium tab 40 mg fosinopril sodium & hydrochlorothiazide tab mg fosinopril sodium & hydrochlorothiazide tab mg FUROSEMIDE furosemide oral soln 8 mg/ml furosemide oral soln 10 mg/ml furosemide tab 20 mg (Lasix) furosemide tab 40 mg (Lasix) furosemide tab 80 mg (Lasix) guanfacine hcl tab 1 mg (Tenex) guanfacine hcl tab 2 mg (Tenex) hydralazine hcl tab 10 mg hydralazine hcl tab 25 mg hydralazine hcl tab 50 mg hydralazine hcl tab 100 mg hydrochlorothiazide cap 12.5 mg (Microzide) hydrochlorothiazide tab 12.5 mg hydrochlorothiazide tab 25 mg hydrochlorothiazide tab 50 mg HYZAAR losartan potassium & hydrochlorothiazide tab mg HYZAAR losartan potassium & hydrochlorothiazide tab mg HYZAAR losartan potassium & hydrochlorothiazide tab mg indapamide tab 1.25 mg indapamide tab 2.5 mg INDERAL LA propranolol hcl cap er 24hr 60 mg INDERAL LA propranolol hcl cap er 24hr 80 mg INDERAL LA propranolol hcl cap er 24hr 120 mg INDERAL LA propranolol hcl cap er 24hr 160 mg INDERAL XL propranolol hcl sustained-release beads cap er 24hr 80 mg INDERAL XL propranolol hcl sustained-release beads cap er 24hr 120 mg INNOPRAN XL propranolol hcl sustained-release beads cap er 24hr 80 mg INNOPRAN XL propranolol hcl sustained-release beads cap er 24hr 120 mg INSPRA eplerenone tab 25 mg INSPRA eplerenone tab 50 mg irbesartan tab 75 mg (Avapro) irbesartan tab 150 mg (Avapro) irbesartan tab 300 mg (Avapro) irbesartan-hydrochlorothiazide tab mg (Avalide) irbesartan-hydrochlorothiazide tab mg (Avalide) isradipine cap 2.5 mg isradipine cap 5 mg KAPSPARGO SPRINKLE metoprolol succ cap er 24hr sprinkle 25 mg (tartrate equiv) KAPSPARGO SPRINKLE metoprolol succ cap er 24hr sprinkle 50 mg (tartrate equiv) KAPSPARGO SPRINKLE metoprolol succ cap er 24hr sprinkle 100 mg (tartrate equiv) KAPSPARGO SPRINKLE metoprolol succ cap er 24hr sprinkle 200 mg (tartrate equiv) labetalol hcl tab 100 mg labetalol hcl tab 200 mg labetalol hcl tab 300 mg LASIX furosemide tab 20 mg LASIX furosemide tab 40 mg LASIX furosemide tab 80 mg lisinopril tab 2.5 mg (Zestril) lisinopril tab 5 mg (Prinivil) lisinopril tab 10 mg (Prinivil) lisinopril tab 20 mg (Prinivil) lisinopril tab 30 mg (Zestril) lisinopril tab 40 mg (Zestril) lisinopril & hydrochlorothiazide tab mg (Zestoretic) lisinopril & hydrochlorothiazide tab mg (Zestoretic) lisinopril & hydrochlorothiazide tab mg (Zestoretic) LOPRESSOR metoprolol tartrate tab 50 mg LOPRESSOR metoprolol tartrate tab 100 mg LOPRESSOR HCT metoprolol & hydrochlorothiazide tab mg losartan potassium tab 25 mg (Cozaar) losartan potassium tab 50 mg (Cozaar) losartan potassium tab 100 mg (Cozaar) losartan potassium & hydrochlorothiazide tab mg (Hyzaar) losartan potassium & hydrochlorothiazide tab mg (Hyzaar) losartan potassium & hydrochlorothiazide tab mg (Hyzaar) LOTENSIN benazepril hcl tab 10 mg LOTENSIN benazepril hcl tab 20 mg LOTENSIN benazepril hcl tab 40 mg LOTENSIN HCT benazepril & hydrochlorothiazide tab mg LOTENSIN HCT benazepril & hydrochlorothiazide tab mg LOTENSIN HCT benazepril & hydrochlorothiazide tab mg LOTREL amlodipine besylate-benazepril hcl cap 5-10 mg LOTREL amlodipine besylate-benazepril hcl cap 5-20 mg LOTREL amlodipine besylate-benazepril hcl cap mg LOTREL amlodipine besylate-benazepril hcl cap mg MAVIK trandolapril tab 1 mg 3160-C Prime Therapeutics LLC 06/18 Product names listed are the property of their respected owners. Page 9 of 16

10 MAVIK trandolapril tab 2 mg MAXZIDE triamterene & hydrochlorothiazide tab mg MAXZIDE-25 triamterene & hydrochlorothiazide tab mg METHYCLOTHIAZIDE methyclothiazide tab 5 mg methyldopa tab 250 mg methyldopa tab 500 mg HIGH BLOOD PRESSURE (continued) METHYLDOPA/HYDROCHLOROTHI methyldopa & hydrochlorothiazide tab mg METHYLDOPA/HYDROCHLOROTHI methyldopa & hydrochlorothiazide tab mg metolazone tab 2.5 mg metolazone tab 5 mg metolazone tab 10 mg metoprolol succinate tab er 24hr 25 mg (tartrate equiv) (Toprol xl) metoprolol succinate tab er 24hr 50 mg (tartrate equiv) (Toprol xl) metoprolol succinate tab er 24hr 100 mg (tartrate equiv) (Toprol xl) metoprolol succinate tab er 24hr 200 mg (tartrate equiv) (Toprol xl) METOPROLOL SUCCINATE ER/H metoprolol & hydrochlorothiazide tab er 24hr mg METOPROLOL SUCCINATE ER/H metoprolol & hydrochlorothiazide tab er 24hr mg METOPROLOL SUCCINATE ER/H metoprolol & hydrochlorothiazide tab er 24hr mg metoprolol tartrate tab 25 mg metoprolol tartrate tab 50 mg (Lopressor) metoprolol tartrate tab 100 mg (Lopressor) METOPROLOL TARTRATE metoprolol tartrate tab 37.5 mg METOPROLOL TARTRATE metoprolol tartrate tab 75 mg metoprolol & hydrochlorothiazide tab mg (Lopressor hct) metoprolol & hydrochlorothiazide tab mg METOPROLOL/HYDROCHLOROTHI metoprolol & hydrochlorothiazide tab mg MICARDIS telmisartan tab 20 mg MICARDIS telmisartan tab 40 mg MICARDIS telmisartan tab 80 mg MICARDIS HCT telmisartan-hydrochlorothiazide tab mg MICARDIS HCT telmisartan-hydrochlorothiazide tab mg MICARDIS HCT telmisartan-hydrochlorothiazide tab mg MICROZIDE hydrochlorothiazide cap 12.5 mg MINIPRESS prazosin hcl cap 1 mg MINIPRESS prazosin hcl cap 2 mg MINIPRESS prazosin hcl cap 5 mg minoxidil tab 2.5 mg minoxidil tab 10 mg moexipril hcl tab 7.5 mg moexipril hcl tab 15 mg moexipril-hydrochlorothiazide tab mg moexipril-hydrochlorothiazide tab mg moexipril-hydrochlorothiazide tab mg nadolol tab 20 mg (Corgard) nadolol tab 40 mg (Corgard) nadolol tab 80 mg (Corgard) nadolol & bendroflumethiazide tab 40-5 mg (Corzide) nadolol & bendroflumethiazide tab 80-5 mg (Corzide) nicardipine hcl cap 20 mg nicardipine hcl cap 30 mg nifedipine cap 10 mg (Procardia) nifedipine cap 20 mg nifedipine tab er 24hr 30 mg (Adalat cc) nifedipine tab er 24hr 60 mg (Adalat cc) nifedipine tab er 24hr 90 mg (Adalat cc) nifedipine tab er 24hr osmotic release 30 mg (Procardia xl) nifedipine tab er 24hr osmotic release 60 mg (Procardia xl) nifedipine tab er 24hr osmotic release 90 mg (Procardia xl) nisoldipine tab er 24hr 8.5 mg (Sular) nisoldipine tab er 24hr 17 mg (Sular) nisoldipine tab er 24hr 34 mg (Sular) NISOLDIPINE ER nisoldipine tab er 24hr 20 mg NISOLDIPINE ER nisoldipine tab er 24hr 25.5 mg NISOLDIPINE ER nisoldipine tab er 24hr 30 mg NISOLDIPINE ER nisoldipine tab er 24hr 40 mg NORVASC amlodipine besylate tab 2.5 mg (base equivalent) NORVASC amlodipine besylate tab 5 mg (base equivalent) NORVASC amlodipine besylate tab 10 mg (base equivalent) olmesartan medoxomil tab 5 mg (Benicar) olmesartan medoxomil tab 20 mg (Benicar) olmesartan medoxomil tab 40 mg (Benicar) olmesartan medoxomil-hydrochlorothiazide tab mg (Benicar hct) olmesartan medoxomil-hydrochlorothiazide tab mg (Benicar hct) olmesartan medoxomil-hydrochlorothiazide tab mg (Benicar hct) olmesartan-amlodipine-hydrochlorothiazide tab mg (Tribenzor) olmesartan-amlodipine-hydrochlorothiazide tab mg (Tribenzor) olmesartan-amlodipine-hydrochlorothiazide tab mg (Tribenzor) olmesartan-amlodipine-hydrochlorothiazide tab mg (Tribenzor) olmesartan-amlodipine-hydrochlorothiazide tab mg (Tribenzor) perindopril erbumine tab 2 mg perindopril erbumine tab 4 mg (Aceon) perindopril erbumine tab 8 mg (Aceon) phenoxybenzamine hcl cap 10 mg (Dibenzyline) pindolol tab 5 mg pindolol tab 10 mg prazosin hcl cap 1 mg (Minipress) prazosin hcl cap 2 mg (Minipress) prazosin hcl cap 5 mg (Minipress) PRESTALIA perindopril arginine-amlodipine besylate tab mg PRESTALIA perindopril arginine-amlodipine besylate tab 7-5 mg PRESTALIA perindopril arginine-amlodipine besylate tab mg 3160-C Prime Therapeutics LLC 06/18 Product names listed are the property of their respected owners. Page 10 of 16

11 PRINIVIL lisinopril tab 5 mg PRINIVIL lisinopril tab 10 mg PRINIVIL lisinopril tab 20 mg PROCARDIA nifedipine cap 10 mg PROCARDIA XL nifedipine tab er 24hr osmotic release 30 mg PROCARDIA XL nifedipine tab er 24hr osmotic release 60 mg PROCARDIA XL nifedipine tab er 24hr osmotic release 90 mg PROPRANOLOL HCL propranolol hcl oral soln 20 mg/5ml HIGH BLOOD PRESSURE (continued) PROPRANOLOL HCL propranolol hcl oral soln 40 mg/5ml propranolol hcl tab 10 mg propranolol hcl tab 20 mg propranolol hcl tab 40 mg propranolol hcl tab 60 mg propranolol hcl tab 80 mg propranolol hcl cap er 24hr 60 mg (Inderal la) propranolol hcl cap er 24hr 80 mg (Inderal la) propranolol hcl cap er 24hr 120 mg (Inderal la) propranolol hcl cap er 24hr 160 mg (Inderal la) PROPRANOLOL/HYDROCHLOROTH propranolol & hydrochlorothiazide tab mg PROPRANOLOL/HYDROCHLOROTH propranolol & hydrochlorothiazide tab mg QBRELIS lisinopril oral soln 1 mg/ml quinapril hcl tab 5 mg (Accupril) quinapril hcl tab 10 mg (Accupril) quinapril hcl tab 20 mg (Accupril) quinapril hcl tab 40 mg (Accupril) quinapril-hydrochlorothiazide tab mg (Accuretic) quinapril-hydrochlorothiazide tab mg (Accuretic) quinapril-hydrochlorothiazide tab mg (Accuretic) ramipril cap 1.25 mg (Altace) ramipril cap 2.5 mg (Altace) ramipril cap 5 mg (Altace) ramipril cap 10 mg (Altace) SECTRAL acebutolol hcl cap 200 mg SECTRAL acebutolol hcl cap 400 mg spironolactone tab 25 mg (Aldactone) spironolactone tab 50 mg (Aldactone) spironolactone tab 100 mg (Aldactone) spironolactone & hydrochlorothiazide tab mg (Aldactazide) SULAR nisoldipine tab er 24hr 8.5 mg SULAR nisoldipine tab er 24hr 17 mg SULAR nisoldipine tab er 24hr 34 mg TARKA trandolapril-verapamil hcl tab er mg TARKA trandolapril-verapamil hcl tab er mg TARKA trandolapril-verapamil hcl tab er mg TARKA trandolapril-verapamil hcl tab er mg TEKTURNA aliskiren fumarate tab 150 mg (base equivalent) TEKTURNA aliskiren fumarate tab 300 mg (base equivalent) TEKTURNA HCT aliskiren-hydrochlorothiazide tab mg TEKTURNA HCT aliskiren-hydrochlorothiazide tab mg TEKTURNA HCT aliskiren-hydrochlorothiazide tab mg TEKTURNA HCT aliskiren-hydrochlorothiazide tab mg telmisartan tab 20 mg (Micardis) telmisartan tab 40 mg (Micardis) telmisartan tab 80 mg (Micardis) telmisartan-amlodipine tab 40-5 mg (Twynsta) telmisartan-amlodipine tab mg (Twynsta) telmisartan-amlodipine tab 80-5 mg (Twynsta) telmisartan-amlodipine tab mg (Twynsta) telmisartan-hydrochlorothiazide tab mg (Micardis hct) telmisartan-hydrochlorothiazide tab mg (Micardis hct) telmisartan-hydrochlorothiazide tab mg (Micardis hct) TENEX guanfacine hcl tab 1 mg TENEX guanfacine hcl tab 2 mg TENORETIC 50 atenolol & chlorthalidone tab mg TENORETIC 100 atenolol & chlorthalidone tab mg TENORMIN atenolol tab 25 mg TENORMIN atenolol tab 50 mg TENORMIN atenolol tab 100 mg terazosin hcl cap 1 mg (base equivalent) terazosin hcl cap 2 mg (base equivalent) terazosin hcl cap 5 mg (base equivalent) terazosin hcl cap 10 mg (base equivalent) TIAZAC diltiazem hcl extended release beads cap er 24hr 120 mg TIAZAC diltiazem hcl extended release beads cap er 24hr 180 mg TIAZAC diltiazem hcl extended release beads cap er 24hr 240 mg TIAZAC diltiazem hcl extended release beads cap er 24hr 300 mg TIAZAC diltiazem hcl extended release beads cap er 24hr 360 mg TIAZAC diltiazem hcl extended release beads cap er 24hr 420 mg TIMOLOL MALEATE timolol maleate tab 5 mg TIMOLOL MALEATE timolol maleate tab 10 mg TIMOLOL MALEATE timolol maleate tab 20 mg TOPROL XL metoprolol succinate tab er 24hr 25 mg (tartrate equiv) TOPROL XL metoprolol succinate tab er 24hr 50 mg (tartrate equiv) TOPROL XL metoprolol succinate tab er 24hr 100 mg (tartrate equiv) TOPROL XL metoprolol succinate tab er 24hr 200 mg (tartrate equiv) torsemide tab 5 mg torsemide tab 10 mg (Demadex) torsemide tab 20 mg (Demadex) torsemide tab 100 mg trandolapril tab 1 mg (Mavik) trandolapril tab 2 mg (Mavik) trandolapril tab 4 mg trandolapril-verapamil hcl tab er mg (Tarka) trandolapril-verapamil hcl tab er mg (Tarka) trandolapril-verapamil hcl tab er mg (Tarka) TRANDOLAPRIL/VERAPAMIL HC trandolapril-verapamil hcl tab er mg triamterene & hydrochlorothiazide cap mg (Dyazide) triamterene & hydrochlorothiazide tab mg (Maxzide-25) 3160-C Prime Therapeutics LLC 06/18 Product names listed are the property of their respected owners. Page 11 of 16

12 triamterene & hydrochlorothiazide tab mg (Maxzide) TRIAMTERENE/HYDROCHLOROTH triamterene & hydrochlorothiazide cap mg TRIBENZOR olmesartan-amlodipine-hydrochlorothiazide tab mg HIGH BLOOD PRESSURE (continued) TRIBENZOR olmesartan-amlodipine-hydrochlorothiazide tab mg TRIBENZOR olmesartan-amlodipine-hydrochlorothiazide tab mg TRIBENZOR olmesartan-amlodipine-hydrochlorothiazide tab mg TRIBENZOR olmesartan-amlodipine-hydrochlorothiazide tab mg TWYNSTA telmisartan-amlodipine tab 40-5 mg TWYNSTA telmisartan-amlodipine tab mg TWYNSTA telmisartan-amlodipine tab 80-5 mg TWYNSTA telmisartan-amlodipine tab mg valsartan tab 40 mg (Diovan) valsartan tab 80 mg (Diovan) valsartan tab 160 mg (Diovan) valsartan tab 320 mg (Diovan) valsartan-hydrochlorothiazide tab mg (Diovan hct) valsartan-hydrochlorothiazide tab mg (Diovan hct) valsartan-hydrochlorothiazide tab mg (Diovan hct) valsartan-hydrochlorothiazide tab mg (Diovan hct) valsartan-hydrochlorothiazide tab mg (Diovan hct) VASERETIC enalapril maleate & hydrochlorothiazide tab mg VASOTEC enalapril maleate tab 2.5 mg VASOTEC enalapril maleate tab 5 mg VASOTEC enalapril maleate tab 10 mg VASOTEC enalapril maleate tab 20 mg verapamil hcl tab 40 mg verapamil hcl tab 80 mg (Calan) verapamil hcl tab 120 mg (Calan) verapamil hcl cap er 24hr 100 mg (Verelan pm) verapamil hcl cap er 24hr 120 mg (Verelan) verapamil hcl cap er 24hr 180 mg (Verelan) verapamil hcl cap er 24hr 200 mg (Verelan pm) verapamil hcl cap er 24hr 240 mg (Verelan) verapamil hcl cap er 24hr 300 mg (Verelan pm) verapamil hcl tab er 120 mg (Calan sr) verapamil hcl tab er 180 mg (Calan sr) verapamil hcl tab er 240 mg (Calan sr) VERAPAMIL HCL SR - verapamil hcl cap er 24hr 360 mg VERELAN verapamil hcl cap er 24hr 120 mg VERELAN verapamil hcl cap er 24hr 180 mg VERELAN verapamil hcl cap er 24hr 240 mg VERELAN verapamil hcl cap er 24hr 360 mg VERELAN PM verapamil hcl cap er 24hr 100 mg VERELAN PM verapamil hcl cap er 24hr 200 mg VERELAN PM verapamil hcl cap er 24hr 300 mg ZEBETA bisoprolol fumarate tab 10 mg ZESTORETIC lisinopril & hydrochlorothiazide tab mg ZESTORETIC lisinopril & hydrochlorothiazide tab mg ZESTORETIC lisinopril & hydrochlorothiazide tab mg ZESTRIL lisinopril tab 2.5 mg ZESTRIL lisinopril tab 5 mg ZESTRIL lisinopril tab 10 mg ZESTRIL lisinopril tab 20 mg ZESTRIL lisinopril tab 30 mg ZESTRIL lisinopril tab 40 mg ZIAC bisoprolol & hydrochlorothiazide tab mg ZIAC bisoprolol & hydrochlorothiazide tab mg ZIAC bisoprolol & hydrochlorothiazide tab mg HIGH CHOLESTEROL ALTOPREV lovastatin tab er 24hr 20 mg ALTOPREV lovastatin tab er 24hr 40 mg ALTOPREV lovastatin tab er 24hr 60 mg amlodipine besylate-atorvastatin calcium tab mg amlodipine besylate-atorvastatin calcium tab mg amlodipine besylate-atorvastatin calcium tab mg amlodipine besylate-atorvastatin calcium tab 5-10 mg amlodipine besylate-atorvastatin calcium tab 5-20 mg amlodipine besylate-atorvastatin calcium tab 5-40 mg amlodipine besylate-atorvastatin calcium tab 5-80 mg amlodipine besylate-atorvastatin calcium tab mg amlodipine besylate-atorvastatin calcium tab mg amlodipine besylate-atorvastatin calcium tab mg amlodipine besylate-atorvastatin calcium tab mg atorvastatin calcium tab 10 mg (base equivalent) (Lipitor) atorvastatin calcium tab 20 mg (base equivalent) (Lipitor) atorvastatin calcium tab 40 mg (base equivalent) (Lipitor) atorvastatin calcium tab 80 mg (base equivalent) (Lipitor) 5-10 mg 5-20 mg 5-40 mg 5-80 mg mg mg mg mg cholestyramine light powder 4 gm/dose (Questran light) 3160-C Prime Therapeutics LLC 06/18 Product names listed are the property of their respected owners. Page 12 of 16