Not all formularies will require step therapy. arkansasbluecross.com, healthadvantage-hmo.com, or blueadvantagearkansas.com.

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1 You may be responsible for the full cost of certain non-formulary products that are removed from coverage. Please check with your plan sponsor for more information. FOR YOUR INFORMATION: Generics should be considered the first line of prescribing. This drug list represents a summary of prescription coverage. It is not all-inclusive and does not guarantee coverage. New-to-market products and new variations of products already in the marketplace will not be added to the formulary until the product has been evaluated, determined to be clinically appropriate and cost-effective, and approved by an independent National Pharmacy and Therapeutics Committee (or other appropriate reviewing body). In most instances, a brand-name drug for which a generic product becomes available will be designated as a non-preferred option upon release of the generic product to the market. Specific prescription benefit plan design may not cover certain products or categories, regardless of their appearance in this document. The member's prescription benefit plan may have a different copay 1 for specific products on the list. Unless specifically indicated, drug list products will include all dosage forms. This list represents brand products in CAPS, branded generics in upper- and lowercase italics, and generic products in lowercase italics. Generics listed in therapeutic categories are for representational purposes only. Listed products may be available generically in certain strengths or dosage forms. Dosage forms on this list will be consistent with the category and use where listed. Log in to arkansasbluecross.com to check coverage and copay 1 information for a specific medicine. An exception process may exist for specific clinical or regulatory circumstances that may require coverage of an excluded medication. * # OTC PA QL SGM ST The preferred options in this list are a broad representation within therapeutic categories of available treatment options and do not necessarily represent clinical equivalency. Generics are available in this class and should be considered the first line of prescribing. Coverage determined under the medical benefit Expected Availability 12/15/16 Over the Counter Prior Authorization Quantity Limit Specialty Guideline Management Step Therapy Copayment, copay or coinsurance means the amount a member is required to pay for a prescription in accordance with a Plan, which may be a deductible, a percentage of the prescription price, a fixed amount or other charge, with the balance, if any, paid by a Plan. Listing does not include generic CARDIZEM LA. A ONETOUCH blood glucose meter may be provided at no charge by the manufacturer to those individuals currently using a meter other than ONETOUCH. For more information on how to obtain a blood glucose meter, call: ONETOUCH brand test strips are the only preferred options. BD ULTRAFINE syringes and needles are the only preferred options. Coverage may be altered or copay 1 amounts may vary based on the condition being treated (e.g. psoriasis). Listing reflects the authorized generics for TESTIM and VOGELXO. Plan member privacy is important to us. Our employees are trained regarding the appropriate way to handle members' private health information. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers. Listed products are for informational purposes only and are not intended to replace the clinical judgment of the prescriber. The document is subject to state-specific regulations and rules, including, but not limited to, those regarding generic substitution, controlled substance schedules, preference for brands and mandatory generics whenever applicable. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission All rights reserved ARKANSAS BLUE CROSS AND BLUE SHIELD STANDARD WITH STEP THERAPY DRUG LIST The Arkansas Blue Cross and Blue Shield Standard with Step Therapy Drug List (formerly known as value drug list) is a guide within select therapeutic categories for clients, plan members and healthcare providers. Generics should always be considered the first option. If there is no generic available, there may be more than one brandname medicine to treat a condition. These preferred brand-name medicines are listed to help identify products that are clinically appropriate and cost effective. Generics listed in therapeutic categories are for representational purposes only. This is not an all-inclusive list. This list represents brand products in CAPS, branded generics in uppercase and lowercase italics and generic products in lowercase italics. Your specifc prescription benefit plan design may not cover certain products or categories, regardless of their appearance in this document. Our Company complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. arkansasbluecross.com, healthadvantage-hmo.com, or blueadvantagearkansas.com. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số This is not a comprehensive list of covered medications. For the most up-to-date listing of medications, visit our website at: Not all formularies will require step therapy. PA Prior Authorization MPI /16 QL Quantity Limit SGM Specialty Guideline Management ST Step Therapy OTC Over the Counter Generics are available in the class and should be considered the first line of prescribing

2 ANALGESICS NSAIDs diclofenac sodium meloxicam naproxen NSAIDs, diclofenac sodium- misoprostol NSAIDs, TOPICAL diclofenac sodium solution VOLTAREN GEL PA COX-2 celecoxib GOUT allopurinol colchicine tablet probenecid COLCRYS ULORIC ST OPIOID ANALGESICS PLAN MEMBER Your benefit plan provides you with a prescription benefit program administered by Arkansas Blue Cross and Blue Shield, Health Advantage or BlueAdvantage Administrators of Arkansas. Ask your doctor to consider prescribing, when medically appropriate, a preferred medicine from this list. Take this list with you when you or a covered family member sees a doctor. Please note: Your specific prescription plan may not cover certain products or categories, regardless of their appearance in this document. Products recently approved by the U.S. Food and Drug Administration (FDA) may not be covered upon release to the market. You may be responsible for the full cost of non-formulary products that are removed from coverage. For specific information regarding your prescription coverage and copay1 information, please see our website or contact a customer service representative: arkansasbluecross.com healthadvantage-hmo.com blueadvantagearkansas.com Your plan may contact your doctor after receiving your prescription to request consideration of a drug list product or generic equivalent. This may result in your doctor prescribing, when medically appropriate, a different brand-name product or generic equivalent in place of your original prescription. In most instances, a brand-name drug will be designated as a non-preferred option when a generic product becomes available to the market. HEALTHCARE PROVIDER Your patient is covered under a prescription benefit plan administered by Arkansas Blue Cross and Blue Shield, Health Advantage or BlueAdvantage Administrators of Arkansas. As a way to help manage healthcare costs authorize generic substitution whenever possible. If you believe a brand-name product is necessary, consider prescribing a brand name on this list. Please note: Generics should be considered the first line of prescribing. This drug list represents a summary of prescription coverage. It is not all-inclusive and does not guarantee coverage. The member s specific prescription benefit plan design may not cover certain products or categories, regardless of their appearance in this document. Products recently approved by the FDA may not be covered upon release into the market. The member s prescription benefit plan may have different copay for specific products on the list. Unless specifically indicated, drug list products will include all dosage forms. Log on to the plan s website to check coverage and copay information for a specific medicine. codeine-acetaminophen fentanyl transdermal fentanyl transmucosal lozenge PA hydrocodone-acetaminophen hydromorphone hydromorphone ext-rel methadone morphine morphine ext-rel QL morphine suppository oxycodone oxycodone-acetaminophen tramadol tramadol ext-rel BUTRANS FENTORA PA HYSINGLA ER QL NUCYNTA QL NUCYNTA ER QL OPANA ER QL OXYCONTIN QL SUBSYS PA ANTI-INFECTIVES ANTIBACTERIALS CEPHALOSPORINS cefdinir cefprozil cefuroxime axetil cephalexin SUPRAX ERYTHROMYCINS / MACROLIDES azithromycin clarithromycin clarithromycin ext-rel erythromycins DIFICID FLUOROQUINOLONES ciprofloxacin ciprofloxacin ext-rel levofloxacin moxifloxacin PENICILLINS amoxicillin amoxicillin-clavulanate dicloxacillin penicillin VK ZYTIGA SGM TETRACYCLINES doxycycline hyclate minocycline tetracycline imatinib mesylate SGM BOSULIF SGM SPRYCEL SGM ANTIFUNGALS fluconazole itraconazole PA terbinafine tablet ANTIRETROVIRAL ANTIRETROVIRAL ATRIPLA COMPLERA EPZICOM EVOTAZ PREZCOBIX STRIBILD TRIUMEQ TRUVADA INTEGRASE ISENTRESS TIVICAY NUCLEOSIDE REVERSE TRANSCRIPTASE abacavir lamivudine PROTEASE NORVIR PREZISTA REYATAZ ANTIVIRALS CYTOMEGALOVIRUS valganciclovir HEPATITIS C ribavirin SGM EPCLUSA (genotypes 2, 3) SGM HARVONI (genotypes 1, 4, 5, 6) SGM HERPES acyclovir valacyclovir INFLUENZA RELENZA QL TAMIFLU QL MISCELLANEOUS clindamycin ivermectin metronidazole nitrofurantoin sulfamethoxazole-trimethoprim ALBENZA SIVEXTRO XIFAXAN 550 MG ANTINEOPLASTIC HORMONAL ANTINEOPLASTIC ANTIANDROGENS bicalutamide KINASE KINASE VISTOGARD CARDIOVASCULAR ACE fosinopril lisinopril quinapril ramipril ACE INHIBITOR / DIURETIC fosinopril-hydrochlorothiazide lisinopril-hydrochlorothiazide quinapril-hydrochlorothiazide ANGIOTENSIN II RECEPTOR ANTAGONISTS / DIURETIC candesartan / candesartanhydrochlorothiazide eprosartan irbesartan / irbesartanhydrochlorothiazide losartan / losartan-hydrochlorothiazide telmisartan / telmisartanhydrochlorothiazide valsartan / valsartan-hydrochlorothiazide BENICAR/ BENICAR HCT ANGIOTENSIN II RECEPTOR ANTAGONIST / CALCIUM CHANNEL BLOCKER amlodipine-telmisartan amlodipine-valsartan AZOR ANGIOTENSIN II RECEPTOR ANTAGONIST / CALCIUM CHANNEL BLOCKER / DIURETIC amlodipine-valsartanhydrochlorothiazide TRIBENZOR rosuvastatin simvastatin NIACINS niacin ext-rel OMEGA-3 FATTY ACIDS omega-3 acid ethyl esters VASCEPA PCSK9 REPATHA SGM BETA-BLOCKERS atenolol carvedilol metoprolol succinate ext-rel metoprolol tartrate nadolol propranolol propranolol ext-rel BYSTOLIC COREG CR CALCIUM CHANNEL BLOCKERS amlodipine diltiazem ext-rel 2 nifedipine ext-rel verapamil ext-rel CALCIUM CHANNEL BLOCKER / ANTILIPEMIC amlodipine-atorvastatin DIGITALIS GLYCOSIDES digoxin DIRECT RENIN / DIURETIC TEKTURNA ST/ TEKTURNA HCT ST DIURETICS furosemide hydrochlorothiazide metolazone spironolactone-hydrochlorothiazide torsemide triamterene-hydrochlorothiazide NEPRILYSIN INHIBITOR / ANGIOTENSIN II RECEPTOR ANTAGONIST ENTRESTO PA ANTILIPEMICS NITRATES CHOLESTEROL ABSORPTION ZETIA NITRATE / VASODILATOR FIBRATES fenofibrate fenofibric acid PULMONARY ARTERIAL HYPERTENSION BILE ACID RESINS cholestyramine WELCHOL HMG-CoA REDUCTASE / atorvastatin fluvastatin lovastatin pravastatin nitroglycerin lingual spray NITROLINGUAL NITROSTAT BIDIL ENDOTHELIN RECEPTOR ANTAGONISTS LETAIRIS SGM TRACLEER SGM PHOSPHODIESTERASE

3 sildenafil SGM PROSTAGLANDIN VASODILATORS ORENITRAM SGM SOLUBLE GUANYLATE CYCLASE STIMULATORS ADEMPAS SGM MISCELLANEOUS RANEXA CENTRAL NERVOUS SYSTEM ANTICONVULSANTS carbamazepine carbamazepine ext-rel diazepam rectal gel divalproex sodium divalproex sodium ext-rel ethosuximide gabapentin lamotrigine lamotrigine ext-rel levetiracetam levetiracetam ext-rel oxcarbazepine phenobarbital phenytoin phenytoin sodium extended primidone tiagabine topiramate valproic acid zonisamide FYCOMPA OXTELLAR XR VIMPAT PA ANTIDEMENTIA donepezil galantamine galantamine ext-rel memantine rivastigmine rivastigmine transdermal NAMENDA XR ANTIDEPRESSANTS SELECTIVE SEROTONIN REUPTAKE (SSRIs) citalopram escitalopram fluoxetine paroxetine paroxetine ext-rel sertraline FLUOXETINE 60 MG TRINTELLIX ST VIIBRYD ST SEROTONIN NOREPINEPHRINE REUPTAKE (SNRIs) duloxetine venlafaxine venlafaxine ext-rel capsule PRISTIQ ST MISCELLANEOUS bupropion bupropion ext-rel mirtazapine trazodone ANTIPARKINSONIAN amantadine carbidopa-levodopa carbidopa-levodopa ext-rel carbidopa-levodopa-entacapone entacapone pramipexole ropinirole ropinirole ext-rel selegiline AZILECT MIRAPEX ER NEUPRO ANTIPSYCHOTICS ATYPICALS aripiprazole clozapine olanzapine quetiapine risperidone ziprasidone ARISTADA LATUDA ST SEROQUEL XR ATTENTION DEFICIT HY- PERACTIVITY DISORDER amphetamine-dextroamphetamine mixed salts amphetamine-dextroamphetamine mixed salts ext-rel guanfacine ext-rel methylphenidate methylphenidate ext-rel APTENSIO XR QUILLIVANT XR STRATTERA VYVANSE FIBROMYALGIA LYRICA ST SAVELLA HUNTINGTON S DISEASE tetrabenazine SGM HYPNOTICS NONBENZODIAZEPINES eszopiclone zolpidem zolpidem ext-rel TRICYCLICS SILENOR ST MIGRAINE SELECTIVE SEROTONIN AGONISTS naratriptan QL rizatriptan QL sumatriptan QL zolmitriptan QL RELPAX ST, QL ZOMIG NASAL SPRAY QL MULTIPLE SCLEROSIS AUBAGIO SGM COPAXONE SGM GILENYA SGM REBIF SGM TECFIDERA SGM MUSCULOSKELETAL THERAPY cyclobenzaprine NARCOLEPSY NUVIGIL PA POSTHERPETIC NEURALGIA GRALISE ST PSYCHOTHERAPEUTIC - MISCELLANEOUS OPIOID ANTAGONISTS naloxone injection NARCAN NASAL SPRAY PARTIAL OPIOID AGONIST / OPI- OID ANTAGONIST buprenorphine-naloxone sublingual tablet PA SUBOXONE FILM PA VASOMOTOR SYMPTOM BRISDELLE ENDOCRINE AND METABOLIC ANDROGENS ANDRODERM PA AXIRON PA ANTIDIABETICS AMYLIN ANALOGS SYMLINPEN BIGUANIDES metformin metformin ext-rel BIGUANIDE / SULFONYLUREA glipizide-metformin DIPEPTIDYL PEPTIDASE-4 (DPP-4) JANUVIA TRADJENTA DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITOR JANUMET JANUMET XR JENTADUETO JENTADUETO XR INCRETIN MIMETIC TRULICITY VICTOZA INSULINS BASAGLAR HUMULIN R U-500 LEVEMIR NOVOLIN 70/30 OTC NOVOLIN N OTC NOVOLIN R OTC NOVOLOG NOVOLOG MIX 70/30 TRESIBA INSULIN SENSITIZERS pioglitazone INSULIN SENSITIZER / BIGUA- NIDE pioglitazone-metformin INSULIN SENSITIZER / SULFONY- LUREA pioglitazone-glimepiride MEGLITINIDES nateglinide repaglinide SODIUM-GLUCOSE CO-TRANS- PORTER 2 (SGLT2) FARXIGA JARDIANCE SODIUM-GLUCOSE CO-TRANS- PORTER 2 (SGLT2) INHIBITOR / BIGUANIDE XIGDUO XR SULFONYLUREAS glimepiride glipizide glipizide ext-rel SUPPLIES BD INSULIN SYRINGES AND NEEDLES OTC DEXCOM CONTINUOUS GLUCOSE MONITORING SYSTEM ONETOUCH ULTRA STRIPS AND KITS 3 OTC ONETOUCH VERIO STRIPS AND KITS 3 OTC CALCIUM REGULATORS BISPHOSPHONATES alendronate ibandronate risedronate ATELVIA CALCITONINS calcitonin-salmon PARATHYROID HORMONES FORTEO SGM CARNITINE DEFICIENCY levocarnitine CONTRACEPTIVES MONOPHASIC ethinyl estradiol-drospirenone ethinyl estradiol-norethindrone acetate BEYAZ LO LOESTRIN FE MINASTRIN 24 FE SAFYRAL TRIPHASIC ethinyl estradiol-norgestimate ORTHO TRI-CYCLEN LO FOUR PHASE NATAZIA EXTENDED CYCLE ethinyl estradiol-levonorgestrel TRANSDERMAL ethinyl estradiol-norelgestromin VAGINAL NUVARING ESTROGENS ORAL estradiol estropipate PREMARIN TRANSDERMAL estradiol DIVIGEL EVAMIST MINIVELLE VAGINAL ESTRACE CREAM PREMARIN CREAM VAGIFEM ESTROGEN / PROGESTINS ORAL estradiol-norethindrone PREMPHASE PREMPRO ESTROGEN / SELECTIVE ES- TROGEN RECEPTOR MODU- LATOR DUAVEE FERTILITY REGULATORS GNRH / LHRH ANTAGONISTS CETROTIDE PA OVULATION STIMULANTS, GO- NADOTROPINS FOLLISTIM AQ PA OVIDREL PA GLUCOCORTICOIDS dexamethasone methylprednisolone prednisone GLUCOSE ELEVATING GLUCAGEN HYPOKIT GLUCAGON EMERGENCY KIT HUMAN GROWTH HOR- MONES HUMATROPE SGM NORDITROPIN SGM PHOSPHATE BINDER calcium acetate PHOSLYRA RENVELA VELPHORO PROGESTINS ORAL medroxyprogesterone progesterone, micronized MEGACE ES VAGINAL CRINONE ENDOMETRIN SELECTIVE ESTROGEN RECEPTOR MODULATORS raloxifene OSPHENA THYROID SUPPLEMENTS levothyroxine SYNTHROID GASTROINTESTINAL ANTIEMETICS dronabinol PA, QL granisetron QL meclizine metoclopramide ondansetron QL prochlorperazine promethazine trimethobenzamide DICLEGIS SANCUSO PA,QL VARUBI QL H2 RECEPTOR ANTAGO- NISTS ranitidine INFLAMMATORY BOWEL DISEASE ORAL balsalazide budesonide capsule sulfasalazine sulfasalazine delayed-rel APRISO LIALDA PENTASA UCERIS RECTAL enema mesalamine rectal suspension CANASA CORTIFOAM IRRITABLE BOWEL SYN- DROME AMITIZA LINZESS LOTRONEX VIBERZI LAXATIVES lactulose peg 3350-electrolytes MOVIPREP SUPREP OPIOID-INDUCED CONSTI- PATION MOVANTIK PANCREATIC ENZYMES CREON VIOKACE ZENPEP PROTON PUMP INHIBI- TORS esomeprazole lansoprazole omeprazole DEXILANT ST STEROIDS, RECTAL PROCTOFOAM-HC ULCER THERAPY COMBI- NATIONS PYLERA GENITOURINARY BENIGN PROSTATIC HY- PERPLASIA alfuzosin ext-rel doxazosin dutasteride finasteride tamsulosin terazosin CARDURA XL ST RAPAFLO ST URINARY ANTISPASMOD- ICS oxybutynin oxybutynin ext-rel tolterodine tolterodine ext-rel trospium trospium ext-rel MYRBETRIQ ST TOVIAZ ST VESICARE ST HEMATOLOGIC ANTICOAGULANTS warfarin ELIQUIS XARELTO HEMATOPOIETIC GROWTH FACTORS ARANESP SGM PROCRIT SGM ZARXIO SGM HEMOPHILIA KOGENATE FS KOVALTRY NOVOEIGHT NUWIQ PLATELET AGGREGATION clopidogrel dipyridamole ext-rel-aspirin BRILINTA EFFIENT IMMUNOLOGIC ALLERGENIC EXTRACTS GRASTEK PA ORALAIR PA RAGWITEK PA BIOLOGIC DISEASE-MODI- FYING 6 ENBREL SGM HUMIRA SGM DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs) RASUVO SGM NUTRITIONAL / SUPPLEMENTS ELECTROLYTES potassium chloride liquid VITAMINS AND MINERALS PRENATAL VITAMINS prenatal vitamins CITRANATAL RESPIRATORY ANAPHYLAXIS TREATMENT EPIPEN EPIPEN JR ANTICHOLINERGICS ANTICHOLINERGIC / BETA AGONIST SHORT ACTING ipratropium-albuterol inhalation solution QL COMBIVENT RESPIMAT QL BETA AGONISTS, INHALANTS SHORT ACTING albuterol inhalation solution QL PROAIR HFA QL PROAIR RESPICLICK QL LONG ACTING Hand-held Active Inhalation ARCAPTA QL SEREVENT QL Nebulized Passive Inhalation PERFOROMIST QL CYSTIC FIBROSIS tobramycin inhalation solution SGM BETHKIS SGM LEUKOTRIENE RECEPTOR ANTAGONISTS montelukast zafirlukast NASAL ANTIHISTAMINES azelastine spray QL olopatadine spray QL NASAL STEROIDS / flunisolide QL fluticasone QL mometasone nasal spray QL triamcinolone nasal spray QL DYMISTA QL ST PHOSPHODIESTERASE-4 DALIRESP

4 PULMONARY FIBROSIS ESBRIET SGM OFEV SGM STEROID / BETA AGONIST ADVAIR QL BREO ELLIPTA QL DULERA QL STEROID INHALANTS budesonide inhalation suspension QL ASMANEX QL FLOVENT DISKUS QL FLOVENT HFA QL PULMICORT FLEXHALER QL QVAR QL TOPICAL DERMATOLOGY ACNE adapalene benzoyl peroxide clindamycin solution clindamycin-benzoyl peroxide erythromycin solution erythromycin-benzoyl peroxide tretinoin ACANYA ST ATRALIN PA BENZACLIN DIFFERIN PA EPIDUO RETIN-A MICRO PA TAZORAC PA ACTINIC KERATOSIS fluorouracil cream 5% fluorouracil solution imiquimod PICATO ZYCLARA ANTIFUNGALS ciclopirox PA clotrimazole econazole ketoconazole nystatin JUBLIA PA LUZU NAFTIN ANTIPSORIATICS acitretin calcipotriene methoxsalen CORTICOSTEROIDS Low Potency desonide Medium Potency butyrate mometasone triamcinolone CLODERM LOCOID LOTION High Potency desoximetasone fluocinonide Very High Potency clobetasol cream, foam, gel, lotion, ointment, shampoo IMMUNOMODULATORS tacrolimus ELIDEL PA ROSACEA metronidazole FINACEA ORACEA SOOLANTRA OPHTHALMIC ANTIALLERGICS azelastine cromolyn sodium olopatadine PATADAY PATANOL ANTI-INFECTIVES ciprofloxacin erythromycin gentamicin levofloxacin ofloxacin sulfacetamide tobramycin BESIVANCE MOXEZA VIGAMOX ANTI-INFECTIVE / ANTI- INFLAMMATORY neomycin-polymyxin B-bacitracin neomycin-polymyxin B-dexamethasone tobramycin-dexamethasone TOBRADEX OINTMENT TOBRADEX ST ZYLET ANTI-INFLAMMATORIES Nonsteroidal bromfenac diclofenac ketorolac PROLENSA Steroidal dexamethasone ALREX DUREZOL LOTEMAX BETA-BLOCKERS Nonselective timolol maleate solution BETIMOL Selective BETOPTIC S CARBONIC ANHYDRASE dorzolamide AZOPT CARBONIC ANHYDRASE INHIBITOR / BETA-BLOCKER dorzolamide-timolol COSOPT PF CARBONIC ANHYDRASE INHIBITOR / SYMPATHOMI- METIC SIMBRINZA DRY EYE DISEASE RESTASIS XIIDRA PROSTAGLANDINS latanoprost travoprost TRAVATAN Z ST ZIOPTAN ST SYMPATHOMIMETICS brimonidine ALPHAGAN P SYMPATHOMIMETIC / BETA- BLOCKER COMBIGAN OTIC ANTI-INFECTIVE / ANTI- INFLAMMATORY CIPRODEX A abacavir ACANYA ST acitretin acyclovir adapalene ADEMPAS SGM ADVAIR QL ALBENZA albuterol inhalation solution QL alendronate alfuzosin ext-rel allopurinol ALPHAGAN P ALREX amantadine AMITIZA amlodipine amlodipine-atorvastatin amlodipine-telmisartan amlodipine-valsartan amlodipine-valsartan-hydrochlorothiazide amoxicillin amoxicillin-clavulanate amphetamine-dextroamphetamine mixed salts amphetamine-dextroamphetamine mixed salts ext-rel ANDRODERM PA ANORO ELLIPTA QL APRISO APTENSIO XR ARANESP SGM ARCAPTA QL aripiprazole ARISTADA ASMANEX QL ATELVIA atenolol atorvastatin ATRALIN PA ATRIPLA AUBAGIO SGM AXIRON PA azelastine azelastine spray QL AZILECT azithromycin AZOPT AZOR B balsalazide BASAGLAR # BD ULTRAFINE INSULIN QUICK REFERENCE DRUG LIST SYRINGES AND NEEDLES OTC BENICAR BENICAR HCT BENZACLIN benzoyl peroxide BESIVANCE BETASERON SGM BETHKIS SGM BETIMOL BETOPTIC S BEVESPI AEROSPHERE QL BEYAZ bicalutamide BIDIL BOSULIF SGM BREO ELLIPTA QL BRILINTA brimonidine BRISDELLE bromfenac budesonide capsule budesonide inhalation suspension QL buprenorphine-naloxone sublingual tablet PA bupropion bupropion ext-rel BUTRANS BYSTOLIC C calcipotriene calcitonin-salmon calcium acetate CANASA candesartan candesartan-hydrochlorothiazide carbamazepine carbamazepine ext-rel carbidopa-levodopa carbidopa-levodopa ext-rel carbidopa-levodopa-entacapone CARDURA XL ST carvedilol cefdinir cefprozil cefuroxime axetil celecoxib cephalexin CETROTIDE PA cholestyramine ciclopirox PA CIPRODEX ciprofloxacin ciprofloxacin ext-rel citalopram CITRANATAL clarithromycin clarithromycin ext-rel clindamycin clindamycin solution clindamycin-benzoyl peroxide clobetasol cream, foam, gel, lotion, ointment, shampoo CLODERM clopidogrel clotrimazole clozapine codeine-acetaminophen colchicine tablet COLCRYS COMBIGAN COMBIPATCH COMBIVENT RESPIMAT QL COMPLERA COPAXONE 40 MG SGM COREG CR CORTIFOAM COSOPT PF CREON CRINONE cromolyn sodium cyclobenzaprine D DALIRESP desonide desoximetasone dexamethasone DEXCOM CONTINUOUS GLUCOSE MONITORING SYSTEM DEXILANT ST diazepam rectal gel DICLEGIS diclofenac diclofenac sodium diclofenac sodium solution diclofenac sodium-misoprostol dicloxacillin DIFFERIN PA DIFICID digoxin diltiazem ext-rel 2 dipyridamole ext-rel-aspirin divalproex sodium divalproex sodium ext-rel DIVIGEL donepezil dorzolamide dorzolamide-timolol doxazosin doxycycline hyclate dronabinol PA, QL DUAVEE DULERA QL duloxetine DUREZOL dutasteride DYMISTA QL ST E econazole EFFIENT ELIDEL PA ELIQUIS ENBREL SGM ENDOMETRIN entacapone ENTRESTO PA EPCLUSA SGM EPIDUO EPIPEN EPIPEN JR eprosartan EPZICOM erythromycin erythromycin solution erythromycin-benzoyl peroxide erythromycins ESBRIET SGM escitalopram esomeprazole ESTRACE CREAM estradiol estradiol-norethindrone estropipate eszopiclone ethinyl estradiol-drospirenone ethinyl estradiol-levonorgestrel ethinyl estradiol-norelgestromin ethinyl estradiol-norethindrone acetate ethinyl estradiol-norgestimate ethosuximide EVAMIST EVOTAZ F FARXIGA fenofibrate fenofibric acid fentanyl transdermal fentanyl transmucosal lozenge PA

5 QUICK REFERENCE DRUG LIST QUICK REFERENCE DRUG LIST FENTORA PA FINACEA finasteride FLOVENT DISKUS QL FLOVENT HFA QL fluconazole flunisolide QL fluocinonide fluorouracil cream 5% fluorouracil solution fluoxetine FLUOXETINE 60 MG fluticasone QL fluvastatin FOLLISTIM AQ PA FORTEO SGM fosinopril fosinopril-hydrochlorothiazide furosemide FYCOMPA G gabapentin galantamine galantamine ext-rel gentamicin GILENYA SGM glatiramer SGM glimepiride glipizide glipizide ext-rel glipizide-metformin GLUCAGEN HYPOKIT GLUCAGON EMERGENCY KIT GRALISE ST granisetron QL GRASTEK PA guanfacine ext-rel H HARVONI SGM HUMATROPE SGM HUMIRA SGM HUMULIN R U-500 hydrochlorothiazide hydrocodone-acetaminophen butyrate enema hydromorphone hydromorphone ext-rel HYSINGLA ER QL I ibandronate imatinib mesylate SGM imiquimod ipratropium-albuterol inhalation solution QL irbesartan irbesartan-hydrochlorothiazide ISENTRESS itraconazole PA ivermectin J JANUMET JANUMET XR JANUVIA JARDIANCE JENTADUETO JENTADUETO XR JUBLIA PA K ketoconazole ketorolac KOGENATE FS KOVALTRY L lactulose lamivudine lamotrigine lamotrigine ext-rel lansoprazole latanoprost LATUDA ST LETAIRIS SGM LEVEMIR levetiracetam levetiracetam ext-rel levocarnitine levofloxacin levothyroxine LIALDA LINZESS lisinopril lisinopril-hydrochlorothiazide LO LOESTRIN FE LOCOID LOTION losartan losartan-hydrochlorothiazide LOTEMAX LOTRONEX lovastatin LUZU LYRICA ST M meclizine medroxyprogesterone MEGACE ES meloxicam memantine mesalamine rectal suspension metformin metformin ext-rel methadone methoxsalen methylphenidate methylphenidate ext-rel methylprednisolone metoclopramide metolazone metoprolol succinate ext-rel metoprolol tartrate metronidazole MINASTRIN 24 FE MINIVELLE minocycline MIRAPEX ER mirtazapine mometasone mometasone nasal spray QL montelukast morphine morphine ext-rel QL morphine suppository MOVANTIK MOVIPREP MOXEZA moxifloxacin MYRBETRIQ ST N nadolol NAFTIN naloxone injection NAMENDA XR naproxen naratriptan QL NARCAN NASAL SPRAY NATAZIA nateglinide neomycin-polymyxin B-bacitracin- neomycin-polymyxin B-dexamethasone NEUPRO niacin ext-rel nifedipine ext-rel nitrofurantoin nitroglycerin lingual spray NITROLINGUAL NITROSTAT NORDITROPIN SGM NORVIR NOVOEIGHT NOVOLIN 70/30 OTC NOVOLIN N OTC NOVOLIN R OTC NOVOLOG NOVOLOG MIX 70/30 NUCYNTA QL NUCYNTA ER QL NUVARING NUVIGIL PA NUWIQ nystatin O OFEV SGM ofloxacin olanzapine olopatadine olopatadine spray QL omega-3 acid ethyl esters omeprazole ondansetron QL ONETOUCH ULTRA STRIPS AND KITS 3 OTC ONETOUCH VERIO STRIPS AND KITS 3 OTC OPANA ER QL ORACEA ORALAIR PA ORENITRAM SGM ORTHO TRI-CYCLEN LO OSPHENA OVIDREL PA oxcarbazepine OXTELLAR XR oxybutynin oxybutynin ext-rel oxycodone oxycodone-acetaminophen OXYCONTIN QL P pantoprazole paroxetine paroxetine ext-rel PATADAY PAZEO peg 3350-electrolytes penicillin VK PENTASA PERFOROMIST QL phenobarbital phenytoin phenytoin sodium extended PHOSLYRA PICATO pioglitazone pioglitazone-glimepiride pioglitazone-metformin potassium chloride liquid pramipexole pravastatin prednisone PREMARIN PREMARIN CREAM PREMPHASE PREMPRO prenatal vitamins PREZCOBIX PREZISTA primidone PRISTIQ ST PROAIR HFA QL PROAIR RESPICLICK QL probenecid prochlorperazine PROCRIT SGM PROCTOFOAM-HC progesterone, micronized PROLENSA promethazine propranolol propranolol ext-rel PULMICORT FLEXHALER QL PYLERA Q quetiapine QUILLIVANT XR quinapril quinapril-hydrochlorothiazide QVAR QL R RAGWITEK PA raloxifene ramipril RANEXA ranitidine RAPAFLO ST RASUVO SGM REBIF SGM RELENZA QL RELPAX ST, QL RENVELA repaglinide REPATHA SGM RESTASIS RETIN-A MICRO PA REYATAZ ribavirin SGM risedronate risperidone rivastigmine rivastigmine transdermal rizatriptan QL ropinirole ropinirole ext-rel rosuvastatin S SAFYRAL SANCUSO PA, QL SAVELLA selegiline SEREVENT QL SEROQUEL XR sertraline sildenafil SGM SILENOR ST SIMBRINZA simvastatin SIVEXTRO SOOLANTRA spironolactone-hydrochlorothiazide SPRYCEL SGM STRATTERA STRIBILD SUBOXONE FILM PA SUBSYS PA sulfacetamide sulfamethoxazole-trimethoprim sulfasalazine sulfasalazine delayed-rel sumatriptan QL SUPRAX SUPREP SYMLINPEN SYNTHROID T tacrolimus TAMIFLU QL tamsulosin TAZORAC PA TECFIDERA SGM TEKTURNA ST TEKTURNA HCT ST telmisartan telmisartan-hydrochlorothiazide terazosin terbinafine tablet tetrabenazine SGM tetracycline tiagabine timolol maleate solution TIVICAY TOBRADEX OINTMENT TOBRADEX ST tobramycin tobramycin inhalation solution SGM tobramycin-dexamethasone tolterodine tolterodine ext-rel topiramate torsemide TOVIAZ ST TRACLEER SGM TRADJENTA tramadol tramadol ext-rel TRAVATAN Z ST travoprost trazodone TRESIBA tretinoin triamcinolone triamcinolone nasal spray QL triamterene-hydrochlorothiazide TRIBENZOR trimethobenzamide TRINTELLIX ST TRIUMEQ trospium trospium ext-rel TRULICITY TRUVADA U UCERIS ULORIC ST V VAGIFEM valacyclovir valganciclovir valproic acid valsartan valsartan-hydrochlorothiazide VARUBI QL VASCEPA VELPHORO venlafaxine venlafaxine ext-rel capsule verapamil ext-rel VESICARE ST VIBERZI VICTOZA VIGAMOX VIIBRYD ST VIMPAT PA VIOKACE VOLTAREN GEL PA VYVANSE W warfarin WELCHOL X XARELTO XIFAXAN 550 MG XIGDUO XR XIIDRA Z zafirlukast ZARXIO SGM ZENPEP ZETIA ZIOPTAN ST ziprasidone zolmitriptan QL zolpidem zolpidem ext-rel ZOMIG NASAL SPRAY QL zonisamide ZYCLARA ZYLET ZYTIGA SGM

6 ABILIFY ABSTRAL ACCU-CHEK STRIPS AND KITS 4 ACTOS ADDERALL XR ADRENACLICK ADVICOR AEROSPAN ALCORTIN A ALLISON MEDICAL INSULIN SYRINGES 5 ALOQUIN ALORA ALTOPREV ALVESCO AMRIX ANDROGEL ANGELIQ ANTARA APEXICON E APIDRA ARMOUR THYROID ARTHROTEC ASACOL HD ASCENSIA STRIPS AND KITS 4 ATACAND, ATACAND HCT ATROVENT HFA aripiprazole, clozapine, olanzapine, quetiapine, risperidone, ziprasidone, LATUDA ST, SEROQUEL XR fentanyl transmucosal lozenge PA, FENTORA PA, SUBSYS PA ONETOUCH ULTRA STRIPS AND KITS 3 OTC pioglitazone amphetamine-dextroamphetamine mixed salts, amphetamine-dextroamphetamine mixed salts ext-rel, guanfacine ext-rel, methylphenidate, methylphenidate ext-rel, APTENSIO XR, QUILLIVANT XR, STRATTERA, VYVANSE EPIPEN, EPIPEN JR ASMANEX QL, FLOVENT DISKUS QL, FLOVENT HFA QL, PULMICORT FLEXHALER QL, QVAR QL BD ULTRAFINE INSULIN SYRINGES OTC estradiol, DIVIGEL, EVAMIST, MINIVELLE ASMANEX QL, FLOVENT DISKUS QL, FLOVENT HFA QL, PULMICORT FLEXHALER QL, QVAR QL cyclobenzaprine estradiol-norethindrone, PREMPHASE, PREMPRO fenofibrate, fenofibric acid desoximetasone, fluocinonide NOVOLOG levothyroxine, SYNTHROID celecoxib; diclofenac sodium, meloxicam or celecoxib; diclofenac sodium, meloxicam or naproxen WITH esomeprazole, lansoprazole, omeprazole, pantoprazole or DEXILANT ST balsalazide, sulfasalazine, sulfasalazine delayed-rel, APRISO, LIALDA, PEN- TASA, UCERIS candesartan, candesartan-hydrochlorothiazide, eprosartan, irbesartan, irbesartan-hydrochlorothiazide, losartan, candesartan, candesartan-hydrochlorothiazide, eprosartan, irbesartan, irbesartan-hydrochlorothiazide, losartan, losartan-hydrochlorothiazide, telmisartan, telmisartan-hydrochlorothiazide, valsartan, valsartan-hydrochlorothiazide, BENICAR, BENICAR HCT AVONEX glatiramer SGM, AUBAGIO SGM, BETASERON SGM, COPAXONE 40 MG SGM, GILENYA SGM, REBIF SGM, TECFIDERA SGM AXERT naratriptan QL, rizatriptan QL, sumatriptan nasal spray QL, sumatriptan tablet QL, zolmitriptan QL, RELPAX ST, QL, ZOMIG NASAL SPRAY QL AZELEX BECONASE AQ BENZAC AC, BENZAC W BENZIQ BREEZE 2 STRIPS AND KITS 4 butalbital-acetaminophen-caffeine capsule BYDUREON BYETTA CARAC CARDIZEM CARDIZEM CD CARDIZEM LA (and its generics) CARNITOR CARNITOR SF CLIMARA PRO CLINDAGEL clobetasol spray CLOBEX SPRAY CONTOUR NEXT STRIPS AND KITS 4 CONTOUR STRIPS AND KITS 4 CRESTOR CYMBALTA DAKLINZA DELZICOL DETROL LA DEXPAK DIOVAN, DIOVAN HCT DORAL DUTOPROL EDARBI, EDARBYCLOR adapalene, benzoyl peroxide, clindamycin solution, clindamycin-benzoyl peroxide, erythromycin solution, erythromycin-benzoyl peroxide, tretinoin, ACANYA ST, ATRALIN PA, BENZACLIN, DIFFERIN PA, EPIDUO, RETIN-A MICRO PA, TAZORAC PA triamcinolone nasal spray QL, DYMISTA QL ST adapalene, benzoyl peroxide, clindamycin solution, clindamycin-benzoyl peroxide, erythromycin solution, erythromycin-benzoyl peroxide, tretinoin, ACANYA ST, ATRALIN PA, BENZACLIN, DIFFERIN PA, EPIDUO, RETIN-A MICRO PA, TAZORAC PA adapalene, benzoyl peroxide, clindamycin solution, clindamycin-benzoyl peroxide, erythromycin solution, erythromycin-benzoyl peroxide, tretinoin, ACANYA ST, ATRALIN PA, BENZACLIN, DIFFERIN PA, EPIDUO, RETIN-A MICRO PA, TAZORAC PA naratriptan QL, rizatriptan QL, sumatriptan QL, zolmitriptan QL, RELPAX ST, QL, ZOMIG NASAL SPRAY QL TRULICITY, VICTOZA TRULICITY, VICTOZA fluorouracil cream 5%, fluorouracil solution, imiquimod, PICATO, ZYCLARA diltiazem ext-rel (except generic CARDIZEM LA) diltiazem ext-rel (except generic CARDIZEM LA) diltiazem ext-rel (except generic CARDIZEM LA) levocarnitine levocarnitine COMBIPATCH erythromycin solution clobetasol foam clobetasol foam ONETOUCH VERIO STRIPS AND KITS 3 OTC duloxetine, venlafaxine, venlafaxine ext-rel capsule, PRISTIQ ST EPCLUSA (genotypes 2, 3) SGM, HARVONI (genotypes 1, 4, 5, 6) SGM balsalazide, sulfasalazine, sulfasalazine delayed-rel, APRISO, LIALDA, PEN- TASA, UCERIS oxybutynin ext-rel, tolterodine, tolterodine ext-rel, trospium, trospium extrel, MYRBETRIQ ST, TOVIAZ ST, VESICARE ST dexamethasone, methylprednisolone, prednisone candesartan, candesartan-hydrochlorothiazide, eprosartan, irbesartan, irbesartan-hydrochlorothiazide, losartan, telmisartan-hydrochlorothiazide, valsartan, valsartan-hydrochlorothiazide, BENICAR, BENICAR HCT metoprolol succinate ext-rel WITH hydrochlorothiazide candesartan, candesartan-hydrochlorothiazide, eprosartan, irbesartan, irbesartan-hydrochlorothiazide, losartan, losartan-hydrochlorothiazide, telmisartan, telmisartan-hydrochlorothiazide, valsartan, valsartanhydrochlorothiazide, BENICAR, BENICAR HCT

7 EDLUAR ENABLEX ENJUVIA ESTRING EVZIO EXFORGE EXFORGE HCT EXTAVIA FEMRING FETZIMA FIORICET CAPSULE FIRST TESTOSTERONE fluorouracil cream 0.5% FORTAMET FORTESTA FOSAMAX PLUS D FOSRENOL FREESTYLE STRIPS AND KITS 4 FROVA GELNIQUE GENOTROPIN GLEEVEC GLUMETZA oxybutynin ext-rel, tolterodine, tolterodine ext-rel, trospium, trospium extrel, MYRBETRIQ ST, TOVIAZ ST, VESICARE ST estradiol, estropipate, PREMARIN ESTRACE CREAM, PREMARIN CREAM, VAGIFEM naloxone injection, NARCAN NASAL SPRAY amlodipine-telmisartan, amlodipine-valsartan, AZOR amlodipine-valsartan-hydrochlorothiazide, TRIBENZOR glatiramer SGM, AUBAGIO SGM, BETASERON SGM, COPAXONE 40 MG SGM, GILENYA SGM, REBIF SGM, TECFIDERA SGM ESTRACE CREAM, PREMARIN CREAM, VAGIFEM duloxetine, venlafaxine, venlafaxine ext-rel capsule, PRISTIQ ST naratriptan QL, rizatriptan QL, sumatriptan QL, zolmitriptan QL, RELPAX ST, QL, ZOMIG NASAL SPRAY QL fluorouracil cream 5%, fluorouracil solution, imiquimod, PICATO, ZYCLARA metformin, metformin ext-rel alendronate, ibandronate, risedronate, ATELVIA calcium acetate, PHOSLYRA, RENVELA, VELPHORO ONETOUCH ULTRA STRIPS AND KITS 3 OTC naratriptan QL, rizatriptan QL, sumatriptan nasal spray QL, sumatriptan tablet QL, zolmitriptan QL, RELPAX ST, QL, ZOMIG NASAL SPRAY QL oxybutynin ext-rel, tolterodine, tolterodine ext-rel, trospium, trospium extrel, MYRBETRIQ ST, TOVIAZ ST, VESICARE ST HUMATROPE SGM, NORDITROPIN SGM imatinib mesylate SGM, BOSULIF SGM, SPRYCEL SGM metformin, metformin ext-rel HELIXATE FS KOGENATE FS, KOVALTRY, NOVOEIGHT, NUWIQ HUMALOG NOVOLOG HUMALOG MIX 50/50 NOVOLOG MIX 70/30 HUMALOG MIX 75/25 NOVOLOG MIX 70/30 HUMULIN INCRUSE ELLIPTA INNOPRAN XL INTERMEZZO INTUNIV INVOKAMET INVOKANA ISTALOL NOVOLIN OTC atenolol, carvedilol, metoprolol succinate ext-rel, metoprolol tartrate, nadolol, propranolol, propranolol ext-rel, BYSTOLIC, COREG CR amphetamine-dextroamphetamine mixed salts, amphetamine-dextroamphetamine mixed salts ext-rel, guanfacine ext-rel, methylphenidate, methylphenidate ext-rel, APTENSIO XR, QUILLIVANT XR, STRATTERA, VYVANSE XIGDUO XR FARXIGA, JARDIANCE timolol maleate solution, BETIMOL JALYN KAZANO KLOR-CON/25 KOMBIGLYZE XR LANTUS LASTACAFT LESCOL XL LIPITOR LIPTRUZET LIVALO LUMIGAN LUNESTA Matzim LA MENEST MENOSTAR MICARDIS, MICARDIS HCT MILLIPRED NAPRELAN NATESTO NESINA dutasteride or finasteride WITH alfuzosin ext-rel, doxazosin, tamsulosin, terazosin or RAPAFLO ST JANUMET, JANUMET XR, JENTADUETO, JENTADUETO XR potassium chloride liquid JANUMET, JANUMET XR, JENTADUETO, JENTADUETO XR BASAGLAR #, LEVEMIR, TRESIBA azelastine, cromolyn sodium, olopatadine, PATADAY, PAZEO latanoprost, travoprost, TRAVATAN Z ST, ZIOPTAN ST diltiazem ext-rel (except generic CARDIZEM LA) estradiol, estropipate, PREMARIN estradiol candesartan, candesartan-hydrochlorothiazide, eprosartan, irbesartan, irbesartan-hydrochlorothiazide, losartan, losartan-hydrochlorothiazide, telmisartan, telmisartan-hydrochlorothiazide, valsartan, valsartan-hydrochlorothiazide, BENICAR, BENICAR HCT dexamethasone, methylprednisolone, prednisone celecoxib, diclofenac sodium, meloxicam, naproxen JANUVIA, TRADJENTA NEUPOGEN ZARXIO SGM NEXIUM NILANDRON NITROMIST NORITATE NORVASC NOVACORT NOVO NORDISK NEEDLES 5 NUTROPIN AQ OLEPTRO OLUX-E esomeprazole, lansoprazole, omeprazole, pantoprazole, DEXILANT ST bicalutamide, ZYTIGA SGM nitroglycerin lingual spray, NITROLINGUAL, NITROSTAT metronidazole, FINACEA, SOOLANTRA amlodipine BD ULTRAFINE NEEDLES OTC HUMATROPE SGM, NORDITROPIN SGM trazodone clobetasol foam OLYSIO EPCLUSA (genotypes 2, 3) SGM, HARVONI (genotypes 1, 4, 5, 6) SGM OMNARIS OMNITROPE ONGLYZA HUMATROPE SGM, NORDITROPIN SGM JANUVIA, TRADJENTA

8 OPSUMIT OSENI OWEN MUMFORD NEEDLES 5 OXYTROL PANCREAZE PENNSAID PERRIGO NEEDLES 5 PERTZYE PEXEVA PLAVIX PLEGRIDY PRADAXA PRALUENT PRECISION XTRA STRIPS AND KITS 4 PRED MILD PREFERAOB PREFEST PRENATAL PLUS PREVACID PROTONIX PROTOPIC PROVENTIL HFA QNASL RAYOS RELION INSULIN RELISTOR RHINOCORT AQUA RIOMET ROZEREM SAIZEN STRIANT SURE-TEST STRIPS AND KITS 4 SYMBICORT TANZEUM TASIGNA LETAIRIS SGM, TRACLEER SGM JANUMET, JANUMET XR, JENTADUETO, JENTADUETO XR BD ULTRAFINE NEEDLES OTC oxybutynin ext-rel, tolterodine, tolterodine ext-rel, trospium, trospium extrel, MYRBETRIQ ST, TOVIAZ ST, VESICARE ST CREON, VIOKACE, ZENPEP diclofenac sodium, diclofenac sodium solution, meloxicam, naproxen, VOLTAREN GEL PA BD ULTRAFINE NEEDLES OTC CREON, VIOKACE, ZENPEP citalopram, escitalopram, fluoxetine, paroxetine, paroxetine ext-rel, sertraline, FLUOXETINE 60 MG, TRINTELLIX ST, VIIBRYD ST clopidogrel, BRILINTA, EFFIENT glatiramer SGM, AUBAGIO SGM, BETASERON SGM, COPAXONE 40 MG SGM, GILENYA SGM, REBIF SGM, TECFIDERA SGM warfarin, ELIQUIS, XARELTO REPATHA SGM dexamethasone, DUREZOL, LOTEMAX generic prenatal vitamins, CITRANATAL estradiol-norethindrone, PREMPHASE, PREMPRO generic prenatal vitamins, CITRANATAL esomeprazole, lansoprazole, omeprazole, pantoprazole, DEXILANT ST esomeprazole, lansoprazole, omeprazole, pantoprazole, DEXILANT ST tacrolimus, ELIDEL PA PROAIR HFA QL, PROAIR RESPICLICK QL dexamethasone, methylprednisolone, prednisone NOVOLIN INSULIN OTC MOVANTIK metformin, metformin ext-rel HUMATROPE SGM, NORDITROPIN SGM ONETOUCH ULTRA STRIPS AND KITS 3 OTC ADVAIR QL, BREO ELLIPTA QL, DULERA QL TRULICITY, VICTOZA imatinib mesylate SGM, BOSULIF SGM, SPRYCEL SGM TECHNIVIE EPCLUSA (genotypes 2, 3) SGM, HARVONI (genotypes 1, 4, 5, 6) SGM TESTIM testosterone gel 1% 7 TEVETEN, TEVETEN HCT TOBI TOBI PODHALER TOUJEO TRICOR TRIGLIDE TRILIPIX TRIVIDIA INSULIN SYRINGES 5 TRUETEST STRIPS AND KITS 4 TRUETRACK STRIPS AND KITS 4 TUDORZA ULTIMED INSULIN SYRINGES 5 ULTIMED NEEDLES 5 VALCYTE VALTREX venlafaxine ext-rel tablet (except 225 mg) VENLAFAXINE EXT-REL TABLET (except 225 mg) VENTOLIN HFA VERAMYST candesartan, candesartan-hydrochlorothiazide, eprosartan, irbesartan, irbesartan-hydrochlorothiazide, losartan, losartan-hydrochlorothiazide, telmisartan, telmisartan-hydrochlorothiazide, valsartan, valsartan-hydrochlorothiazide, BENICAR, BENICAR HCT tobramycin inhalation solution SGM, BETHKIS SGM tobramycin inhalation solution SGM, BETHKIS SGM BASAGLAR #, LEVEMIR, TRESIBA fenofibrate, fenofibric acid fenofibrate, fenofibric acid fenofibrate, fenofibric acid BD ULTRAFINE INSULIN SYRINGES OTC ONETOUCH VERIO STRIPS AND KITS 3 OTC BD ULTRAFINE INSULIN SYRINGES OTC BD ULTRAFINE NEEDLES OTC valganciclovir acyclovir, valacyclovir duloxetine, venlafaxine, venlafaxine ext-rel capsule, PRISTIQ ST duloxetine, venlafaxine, venlafaxine ext-rel capsule, PRISTIQ ST PROAIR HFA QL, PROAIR RESPICLICK QL VIEKIRA PAK EPCLUSA (genotypes 2, 3) SGM, HARVONI (genotypes 1, 4, 5, 6) SGM VITAFOL-ONE VOGELXO XENAZINE XOPENEX HFA XTANDI ZEGERID generic prenatal vitamins, CITRANATAL tetrabenazine SGM PROAIR HFA QL, PROAIR RESPICLICK QL bicalutamide, ZYTIGA SGM esomeprazole, lansoprazole, omeprazole, pantoprazole, DEXILANT ST ZEPATIER EPCLUSA (genotypes 2, 3) SGM, HARVONI (genotypes 1, 4, 5, 6) SGM ZETONNA ZUBSOLV ZYFLO, ZYFLO CR buprenorphine-naloxone sublingual tablet PA, SUBOXONE FILM PA montelukast, zafirlukast