JULY 2017 ADDITIONS. NP Thyroid 120mg NP Thyroid 15mg JUNE 2017 CHANGES

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2 APRIL 2017 Ivermectin, Pin-X and Reeses (Pyrantel Pamoate) Selzentry 25mg and 75mg tablets Linzess 72 mcg capsule-with QLL Levalbuterol Tartrate Inhal Aerosol (Generic Xopenex HFA) with ST & QLL Jentadueto XR-with ST & QLL Vitamin D3 chewable 500 U Zepatier-with PA Extavia-with PA MARCH 2017 Guanfacine 1mg-with QLL Guanfacine 2mg-with QLL Dextroamphetamine tab 5mg- with QLL Dextroamphetamine tab 10mg-with QLL Dextroamphetamine cap 5mg ER-with QLL Dextroamphetamine cap 10mg ER-withQLL Dextroamphetamine 15mg ER-with QLL Methylphenidate tab 10mg ER- with QLL Methylphenidate tab 20mg ER-with QLL Methylphenidate cap 20mg ER-with QLL Methylphenidate cap 30mg ER-with QLL Methylphenidate cap 40mg ER-with QLL Amphetamine/Dextroamphetamine tab 5mg-add QLL Amphetamine/Dextroamphetamine tab 7.5mg-add QLL Amphetamine/Dextroamphetamine tab 10mg- add QLL Amphetamine/Dextroamphetamine tab 12.5mg- add QLL Amphetamine/Dextroamphetamine tab 15mg- add QLL Amphetamine/Dextroamphetamine tab 20mg- add QLL Amphetamine/Dextroamphetamine tab 30mg- add QLL Amphetamine/Dextroamphetamine cap 5mg ER- add QLL Amphetamine/Dextroamphetamine cap 10mg ER- add QLL Amphetamine/Dextroamphetamine cap 15mg ER- add QLL

3 Amphetamine/Dextroamphetamine cap 20mg ER- add QLL Amphetamine/Dextroamphetamine cap 25mg ER- add QLL Amphetamine/Dextroamphetamine cap 30mg ER- add QLL Dexmethylphenidate tab 2.5mg- add QLL Dexmethylphenidate tab 5mg- add QLL Dexmethylphenidate tab 10mg- add QLL Methylphenidate cap 10mg- add QLL Methylphenidate cap 20mg- add QLL Methylphenidate cap 30mg- add QLL Methylphenidate cap 40mg- add QLL Methylphenidate cap 50mg- add QLL Methylphenidate cap 60mg- add QLL Methylphenidate tab 5mg- add QLL Methylphenidate tab 10mg- add QLL Methylphenidate tab 20mg- add QLL Methylphenidate tab 18mg ER- add QLL Methylphenidate tab 27mg ER- add QLL Methylphenidate tab 36mg ER- add QLL Methylphenidate tab 54mg ER- add QLL Methylphenidate sol 5mg/5mL- add QLL Methylphenidate sol 10mg/5mL- add QLL Modafinil tab 100mg- add QLL Modafinil tab 200mg- add QLL FEBRUARY 2017 Testosterone Cypionate inj 100mg-with PA Testosterone Gel 25mg/2.5gm Transdermal-with PA Testosterone Gel 50mg/5gm Transdermal-with PA Testosterone Gel 12.5mg/Act 1% Transdermal-with PA Testosterone Gel 10mg/Act 2% Transdermal-with PA Lidocaine 5% Ointment-with QLL Lidocaine 5% Patch-with PA Lidocaine/Prilocaine Cream %-with QLL Epogen -with PA Epinephrine Pen (all strengths)-with QLL Montelukast Granules-with PA Zarfirlukast tab (all strengths)-with ST Colchicine 0.6mg-with QLL Albuterol Neb 0.63MG/3mL-with ST

4 Albuterol Neb 1.25MG/3mL-with ST Ciprofloxacn Sol Otic Mupirocin Ointment 2%-with QLL Truvada (all strengths) Paragard IUD-with QLL Tacrolimus Ointment-with ST Orphenadrine Adapalene-with QLL Tretinoin cream-with QLL Tretinoin gel-with QLL Zenatane-with ST Myorisan-with ST Imbruvica-with PA Gilenya-with PA Tecfidera-with PA Glatopa 20mg-with PA Auryxia-with ST Apriso Viokace Xarelto-with PA Zarxio- with PA Breo Ellipta Dexmethylphenidate ER caps Lopinavir/Ritonavir 80-20mg/mL soln Ezetimibe-with ST DELETIONS Androderm Patch (all strengths) Lidocaine 3% lotion Epoetin Alpha Aranesp Doxycycline Hyclate cap (all strengths) Doxycycline Hyclate 100mg tab Doxycycline Monohydrate 150mg Capsule Minocycline tablets (all strengths) Nystatin/Triamcinolone cream/ointment Cipro HC Ciprodex Naproxen Sodium 550mg Fluoxetine 20mg and 60mg Tablets Venlafaxine ER tablet (all strengths)

5 Buspirone 30mg Mupirocin cream 2% Diltiazem ER/LA Tablets Clomipramine Imipramine CAPS* Trazodone 300mg tab Omeprazole 20mg tabs Metaxalone 400mg and 800mg* Carisoprodol 250mg Clindamycin Aerosol Clindamycin/Benzoyl Peroxide combo Erythromycin/Benzoyl Peroxide combo* Sulfacetamide/Sulfur* Isotretinoin caps Salicylic AC Gel 6% * BP Wash Liq 7%* Glatiramer 20mg Farxiga* Delzicol Dipentum Pentasa Amitiza Pancreaze Neupogen Neulasta Advair * Symbicort* Spiriva Tudorza* Celecoxib-add ST Elidel-add ST Savella-add ST JANUARY 2017 GENERIC Oseltamivir caps Yuvafem 10mg Abacavir/Lamivudine tab

6 DECEMBER 2016 Tivicay Nilutamide Nitroglycerin SL (all strengths) Erythromycin Ethylsuccinate Susp 200mg/5mL Tradjenta-with ST Prevnar 13 Pneumovax Narcan Nasal 4mg/0.1mL Naloxone 0.4mg/mL inj NOVEMBER 2016 Children s Flonase Nasal Suspension 50mcg/act-with QLL Carbamazepine ER tabs 100mg-with QLL Entresto-with PA & QLL Anoro Elipta-with QLL Stiolto-with ST & QLL Linzess-with ST & QLL Movantik-with PA & QLL Omeprazole-with QLL Lansoprazole-with QLL Cabometyx-with PA & QLL Ciprofloxacin Otic Prevacid Solutabs-with PA DELETIONS Asacol HD Mometasone Furoate Nasal Spray 50mg-add QLL Rabeprazole-add QLL Genvoya-add QLL Stribild-add QLL

7 Tivicay-add QLL Isentress-add QLL Truvada-add QLL Descovy-add QLL Epinephrine Pens-add QLL Amitiza-add ST SEPTEMBER 2016 Alogliptin-with QLL Alogliptin/Metformin-with QLL Alogliptin/Pioglitazone-with QLL Rhinocort Allergy and Children s Allergy OTC-with QLL First Vancomycin Mometasone Nasal Spray-with ST Genvoya-with QLL Descovy-with QLL Pamidronate IV sln Ibandronate IV sln Nasacort OTC-with QLL Rosuvastatin-with QLL & PA Omeprazole-with QLL Lansoprazole-with QLL Rabeprazole-with QLL DELETIONS Calcitrol Ointment-allow GF Chantix-add PA & QLL Pantoprazole-Remove ST Nicotrol Inhaler and Nasal Spray-add PA AUGUST 2016 Lantus Pens

8 Levemir Pens Methotrexate 25mg/mL Chambers and Spacers-with QLL Cefixime 100mg/5mL, 200mg/5mL Abreva Travoprost DELETIONS Temazepam 7.5mg & 22.5mg Minocycline ER Minocycline tabs 100mg, 50mg, 75mg Suprax caps & susp Lumigan 0.01% Bimatoprost 0.03% Zovirax cream Levalbuterol 0.31mg, 0.63mg, 1.25mg/3mL & 1.25mg/0.5mL Januvia 100mg Byetta 5mg & 10mg Betaseron-all GF Relpax Sensipar Minocycline ER Minocycline tabs Lamotrigine ER-allow GF Trexall Azasan Zovirax 5% cream Olopatidine (generic Patanol)-allow GF Harvoni-allow GF Janumet Janumet XR Nevance-allow GF Paroxetine ER-allow GF Sovaldi-allow GF Talidomide-add PA Paricalcitrol-add ST Rozerem-add ST

9 Suprax tabs-add QLL Azopt-add ST Acyclovir Ointment-add ST Gabapentin-add max dose 3600mg/day Azopt 1% Ophthalmic Susp-add ST Tramadol-add Age Edit Azelastine Opthalmic-ST Carbamazepine ER-add Age Edit Diclofenac Sodium Topical Gel-add ST Humalog Pens-add Age Edit Nexavar-add QLL Novolog Pens-remove Age Edit Tanzeum-add ST Testosterone Cyp for inj-add PA Testosterone Ethinate for inj-add PA Viread-add QLL Zepatier-add PA Revlimid-add QLL MAY 2016 Naratriptan Tanzeum-with ST Thalidomide-with QLL Revlimid-with Smart Edit Tykerb-with PA Entecavir Lamivudine HBV 100mg Lamivudine Sln Testosterone topical (Generic Androgel & Testim)-with PA Capecitabine Sutent-add QLL Testosterone Ethinate for inj-add PA

10 APRIL 2016 Sumatriptan-add QLL Naratriptan-add QLL Rizatriptan-add QLL MARCH 2016 Gel-One-with PA Hyalgan-with PA Arcapta Striverdi Tradjenta-with ST & QLL Invokana-with ST & QLL Jentadueto-with ST & QLL Invokamet-with QLL Trulicity-with ST Esomeprazole OTC-with QLL Lansoprazole OTC-with QLL Incruse Ellipta-with QLL DELETIONS Flovent HFA Omeprazole 10mg, 20mg, 40mg RX-allow GF Lansoprazole RX-allow GF Serevent Diskus Relpax Celecoxib-add ST Pantoprazole-add ST Spiriva-add ST Farxiga-add QLL Glatimer Acetate/Glatopa-add PA & QLL Aubagio-add PA Zyprexa Relprevv-add PA

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