Horizon Blue Cross Blue Shield of New Jersey Classic Drug Guide

Transcription

1 October Horizon Blue Cross Blue Shield of New Jersey Classic Drug Guide Please talk to your doctor about prescribing medicines from this drug list (formulary). It may help you and your doctor to choose an appropriate medicine and may help reduce your out-of-pocket costs. This Drug Guide is regularly updated. Please sign Member Online Services at to search for medicines according to your benefit design and applicable exclusions. Contents Introduction... I Drug selection... I Member Prescription Benefit... I Generics... II Affordable Care Act... II Utilization management (UM)... II (PA)/Medical Necessity Review and Determination... II Dispensing Limit... III... III How to use this list... IV Key... IV Therapeutic Class Drug List Anti-Infective Drugs... 1 Cancer Drugs... 6 Hormones, Diabetes and Related Drugs... 8 Heart and Circulatory Drugs Respiratory Agents Gastrointestinal Drugs Genitourinary Drugs Central Nervous System Drugs Pain Relief Drugs Neuromuscular Drugs Supplements Blood Modifying Drugs Topical Drugs Miscellaneous Categories Index To search for a drug name within this PDF document, use the Control and F keys on your keyboard, or go to Edit in the drop-down menu and select Find/Search. Type in the word or phrase you are looking for and click on Search A NJ Prime Therapeutics LLC 10/16

2 Introduction Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) is pleased to present the Classic Drug Guide. Our goal is to give our members access to safe and effective prescription medicines. Refer to this guide for information, and present it to your doctor if you need a prescription. The drug list (formulary) is a list of medicines included on the formulary. Coverage of medicines and supplies included on this drug list is subject to your coverage provisions and applicable exclusions, and may differ from that listed. Please refer to the policy and benefit information you received from Horizon BCBSNJ to identify coverage provisions and exclusions. When we refer to policy and benefit information, we are referring to one or more of the following: Certificate of Coverage, Contract, or Member Handbook. Drug selection Each drug chosen for this drug list was evaluated for its safety, efficacy and value by Horizon BCBSNJ s Pharmacy and Therapeutics Committee (P&T Committee). Our P&T Committee is comprised of local, independent practicing doctors and pharmacists and meets at least quarterly. Decisions to add or remove drugs are based on the drug s safety, efficacy, uniqueness and cost. To find recent changes or the most current version of this guide, and to search for medicines according to your benefit design and applicable exclusions, log into Member Online Services at You can also access the most current version of the Guide at Generic (Tier 1) and Preferred brands (Tier 2) are listed. Non-Preferred brands (Tier 3) are not listed. Horizon BCBSNJ may choose to not add a brand drug to the Preferred brand tier (Tier 2) and therefore not list it because of effectiveness, safety concerns, or because a similar, more cost-effective drug is already available. New drugs are considered Non-Preferred (Tier 3) until reviewed and approved for inclusion by the P&T Committee. Horizon BCBSNJ encourages providers to prescribe generic and Preferred brand drugs. While coverage is provided for Non-Preferred brand medicines, members pay the highest copayment or cost share for these drugs. Member prescription benefit The drug list is grouped into tiers, and your co-payment or cost share is determined by the tier that the medicine is on: generic (Tier 1), Preferred brand (Tier 2) and Non-Preferred brand (Tier 3). Tier 1 Lowest copayment Generics. Tier 1 includes all generic medicines although not all generics are listed. Tier 2 Middle copayment Preferred brands. Tier 2 medicines are displayed. Tier 3 Highest copayment Non-Preferred brands. Tier 3 medicines are not displayed. The drug list is an open formulary. This means all FDA approved medicines are included. However, certain drug classes are excluded from coverage (not covered) including investigational and cosmetic drugs (such as Propecia for hair growth). Coverage, copayment, and additional restrictions and exclusions may vary depending on your pharmacy plan design. Please refer to the policy and benefit information you received from Horizon BCBSNJ. Classic Drug Guide October, I

3 Generic drugs Horizon BCBSNJ encourages the use of generics as a way to provide high-quality medicine at a reduced cost. Generics are as safe and effective as their brand counterparts, and are usually less expensive. Generics are manufactured under the same strict requirements of the Food and Drug Administration s (FDA s) current Good Manufacturing Practice regulations required for brand drugs in manufacturing, strength, purity and quality. An FDA-approved generic medicine may be substituted for the brand counterpart when it: Contains the same active ingredient(s) as the brand. Is identical in strength, dosage form and route of administration. Is therapeutically equivalent and can be expected to have the same clinical effect and safety profile. To encourage use of generics, Tier 2 Preferred brand medicines typically move to Tier 3 after an equivalent generic version becomes available in Tier 1. If you choose to receive a brand name medicine that has a generic equivalent is available, you may be subject to a reduced benefit and a higher out-of-pocket expense for that brand name medicine. Affordable Care Act Some medicines may have limited or $0 cost-sharing under the Affordable Care Act; examples of categories that may be subject to limited or $0 cost share include aspirin, breast cancer preventive, fluoride supplements, folic acid supplements, gonorrhea prophylaxis (newborn), iron supplements, some tobacco cessation products, vitamin D supplements, and some contraceptive drugs and devices. These medicines may also have age restrictions in order to have limited or $0 cost-sharing. If you do not find the medicine you are searching for in this Guide, call Pharmacy Member Services at to find out if the drug is available over-the-counter, or is covered under your medical benefit. You can also log into Member Online Services at Utilization management (UM) Some medicines have special requirements where your doctor must provide clinical information to Horizon BCBSNJ before the medicine will be approved and covered by the plan. These special requirements are called utilization management. Medicines with utilization management requirements such as (PA), Medical Necessity Review and Determination (MND), or that are subject to a Dispensing Limit (DL) are noted on the drug list. /Medical Necessity Review and Determination Some medicines require (PA) before coverage is approved. PA encourages medically necessary, safe, cost-effective medicine use by allowing coverage when certain conditions are met. PA makes sure a prescription is being filled that is suitable for the intended use and covered by the pharmacy benefit. Only drugs that are considered medically necessary are covered. If the Drug List shows that you need a PA for a medicine, your doctor must submit a PA request to Horizon BCBSNJ for review. After your PA is reviewed, you and your doctor will receive an approval letter that indicates how long it s approved. If the PA request is not approved (denied), the denial reason will be stated along with instructions about the appeal process if you or your doctor wish to appeal. You also have the choice to buy the medicine at your own expense. Some drugs may be reviewed for medical necessity from time to time, even though they are not subject to our PA requirements. Detailed PA/MND information can be found here. Classic Drug Guide October, II

4 Dispensing Limit A Dispensing Limit (DL) controls the maximum amount of medicine covered per prescription. It can also identify gender or age restrictions and amount of medicine. DL are placed on certain categories and are based upon FDA-approved drug labeling. These limits help encourage safe and proper use. If the drug list shows that there is a DL, your doctor must submit a PA request to Horizon BCBSNJ for review if he/she wants to exceed the DL for your medicine. Clinical information will be required to be submitted with the PA request to explain why you need to exceed the quantity limit. If the PA request is approved, your medicine will be covered by your plan. If the request is not approved, there is an appeals process available or you may choose to buy the medicine at your own expense. Detailed DL information can be found here. medicines require special handling, patient monitoring, and unique education prior to use. These specialty medicines also require your doctor to submit a (PA) request to Horizon BCBSNJ for review. Horizon BCBSNJ has contracted with certain specialty pharmacies that specialize in providing these medicines and providing these therapies. Members who want to minimize their cost-sharing are required to obtain the specialty medicines from a participating specialty pharmacy. You cannot receive specialty medicine at a retail pharmacy, through Prim home delivery or from a non-participating specialty pharmacy. To find out more information about our Rx Program and to see the list and phone numbers of the participating specialty pharmacies, please refer to Classic Drug Guide October, III

5 How to use this list The drug list is organized into broad categories (e.g. HORMONES, DIABETES AND RELATED DRUGS). The graphic below shows the information that is provided in each column of the drug list and is an example only. Please use the drug search function to find current information for medicines on the drug list. Key The first column of the chart lists the drug name. Generics are shown in lower-case boldface type. Most generic medicines are followed by a reference brand medicine in (parentheses). Some generics have no reference brand. Brand medicines are shown in capital letters followed by the generic name. The second column indicates if the drug is a specialty medicine. The remaining columns indicate the Utilization Management (UM) program(s) that apply to the prescription drug (e.g., /Medical Necessity Determination (PA/MND) and. If an indicator is present in the column(s), then the UM program applies. cap... capsules chew... chewable conc... concentrate cr... controlled release dr... delayed release ec... enteric coated effe... effervescent equiv... equivalent er... extended release inhal... inhalation inj... injection liq... liquid lotn... lotion nebu... nebulizer odt... orally disintegrating tablets oint... ointment ophth... ophthalmic osm... osmotic release powd... powder sa... sustained action sl... sublingual soln... solution sr... sustained release suppos... suppositories susp... suspension tab... tablets td... transdermal This Drug Guide is regularly updated. Please sign Member Online Services at to search for medicines according to your benefit design and applicable exclusions. Classic Drug Guide October, IV

6 ANTI-INFECTIVE DRUGS penicillin v potassium tab 250 mg PENICILLINS penicillin v potassium tab 500 mg amoxicillin (trihydrate) cap 250 mg CEPHALOSPORINS amoxicillin (trihydrate) cap 500 mg cefaclor cap 250 mg amoxicillin (trihydrate) for susp 125 mg/5ml amoxicillin (trihydrate) for susp 200 mg/5ml amoxicillin (trihydrate) for susp 250 mg/5ml amoxicillin (trihydrate) for susp 400 mg/5ml amoxicillin (trihydrate) tab 500 mg amoxicillin (trihydrate) tab 875 mg amoxicillin & k clavulanate for susp mg/5ml amoxicillin & k clavulanate for susp mg/5ml (Augmentin) amoxicillin & k clavulanate for susp mg/5ml amoxicillin & k clavulanate for susp mg/5ml (Augmentin es-600) amoxicillin & k clavulanate tab sr 12hr mg (Augmentin xr) amoxicillin & k clavulanate tab mg amoxicillin & k clavulanate tab mg (Augmentin) amoxicillin & k clavulanate tab mg (Augmentin) ampicillin cap 250 mg ampicillin cap 500 mg dicloxacillin sodium cap 250 mg dicloxacillin sodium cap 500 mg penicillin v potassium for soln 125 mg/5ml penicillin v potassium for soln 250 mg/5ml cefaclor cap 500 mg cefadroxil cap 500 mg cefadroxil for susp 250 mg/5ml cefadroxil for susp 500 mg/5ml cefadroxil tab 1 gm cefdinir cap 300 mg cefdinir for susp 125 mg/5ml cefdinir for susp 250 mg/5ml cefixime for susp 100 mg/5ml (Suprax) cefixime for susp 200 mg/5ml (Suprax) cefpodoxime proxetil for susp 50 mg/5ml cefpodoxime proxetil for susp 100 mg/5ml cefpodoxime proxetil tab 100 mg cefpodoxime proxetil tab 200 mg cefprozil for susp 125 mg/5ml cefprozil for susp 250 mg/5ml cefprozil tab 250 mg cefprozil tab 500 mg ceftriaxone sodium for inj 250 mg ceftriaxone sodium for inj 500 mg (Rocephin) ceftriaxone sodium for inj 1 gm (Rocephin) ceftriaxone sodium for inj 2 gm cefuroxime axetil tab 250 mg (Ceftin) cefuroxime axetil tab 500 mg (Ceftin) cephalexin cap 250 mg (Keflex) cephalexin cap 500 mg (Keflex) cephalexin for susp 125 mg/5ml cephalexin for susp 250 mg/5ml MACROLIDES Classic Drug Guide October, 1

7 azithromycin for susp 100 mg/5ml (Zithromax) azithromycin for susp 200 mg/5ml (Zithromax) azithromycin tab 250 mg (Zithromax) azithromycin tab 500 mg (Zithromax) azithromycin tab 600 mg (Zithromax) clarithromycin for susp 125 mg/5ml clarithromycin for susp 250 mg/5ml (Biaxin) clarithromycin tab sr 24hr 500 mg (Biaxin xl pac) clarithromycin tab 250 mg (Biaxin) clarithromycin tab 500 mg (Biaxin) ERY-TAB erythromycin tab delayed release 250 mg ERY-TAB erythromycin tab delayed release 333 mg ERY-TAB erythromycin tab delayed release 500 mg erythromycin w/ delayed release particles cap 250 mg TETRACYCLINES demeclocycline hcl tab 150 mg demeclocycline hcl tab 300 mg doxycycline hyclate cap 50 mg doxycycline hyclate cap 100 mg (Vibramycin) doxycycline hyclate tab 20 mg doxycycline hyclate tab 100 mg doxycycline monohydrate cap 50 mg doxycycline monohydrate cap 75 mg (Monodox) doxycycline monohydrate cap 100 mg (Monodox) doxycycline monohydrate cap 150 mg (Adoxa) doxycycline monohydrate tab 50 mg (Adoxa) doxycycline monohydrate tab 75 mg (Adoxa) doxycycline monohydrate tab 100 mg (Adoxa pak 1/100) doxycycline monohydrate tab 150 mg (Adoxa pak 1/150) minocycline hcl cap 50 mg (Minocin) minocycline hcl cap 75 mg (Minocin) minocycline hcl cap 100 mg (Minocin) minocycline hcl tab 50 mg minocycline hcl tab 75 mg minocycline hcl tab 100 mg tetracycline hcl cap 250 mg (Tetracycline hcl) tetracycline hcl cap 500 mg (Tetracycline hcl) FLUOROQUINOLONES ciprofloxacin for oral susp 250 mg/5ml (5%) (5 gm/100ml) (Cipro) ciprofloxacin for oral susp 500 mg/5ml (10%) (10 gm/100ml) (Cipro) ciprofloxacin hcl tab 250 mg (base equiv) (Cipro) ciprofloxacin hcl tab 500 mg (base equiv) (Cipro) ciprofloxacin hcl tab 750 mg (base equiv) ciprofloxacin-ciprofloxacin hcl tab sr 24hr 500 mg (base eq) (Cipro xr) ciprofloxacin-ciprofloxacin hcl tab sr 24hr 1000 mg(base eq) (Cipro xr) levofloxacin oral soln 25 mg/ml (Levaquin) levofloxacin tab 250 mg (Levaquin) levofloxacin tab 500 mg (Levaquin) levofloxacin tab 750 mg (Levaquin) AMINOGLYCOSIDES Classic Drug Guide October, 2

8 neomycin sulfate tab 500 mg paromomycin sulfate cap 250 mg TOBI PODHALER tobramycin inhal cap 28 mg tobramycin nebu soln 300 mg/5ml (Tobi) TUBERCULOSIS ethambutol hcl tab 100 mg (Myambutol) ethambutol hcl tab 400 mg (Myambutol) isoniazid tab 100 mg isoniazid tab 300 mg pyrazinamide tab 500 mg rifabutin cap 150 mg (Mycobutin) rifampin cap 150 mg (Rifadin) rifampin cap 300 mg (Rifadin) SEROMYCIN cycloserine cap 250 mg FUNGAL INFECTIONS fluconazole for susp 10 mg/ml (Diflucan) fluconazole for susp 40 mg/ml (Diflucan) fluconazole tab 50 mg (Diflucan) fluconazole tab 100 mg (Diflucan) fluconazole tab 150 mg (Diflucan) fluconazole tab 200 mg (Diflucan) flucytosine cap 250 mg (Ancobon) flucytosine cap 500 mg (Ancobon) griseofulvin microsize susp 125 mg/5ml griseofulvin microsize tab 500 mg (Grifulvin v) itraconazole cap 100 mg (Sporanox) NOXAFIL posaconazole susp 40 mg/ml nystatin tab unit terbinafine hcl tab 250 mg (Lamisil) voriconazole for susp 40 mg/ml (Vfend) voriconazole tab 50 mg (Vfend) voriconazole tab 200 mg (Vfend) VIRAL INFECTIONS Cytomegalovirus VALCYTE valganciclovir hcl for soln 50 mg/ml (base equiv) valganciclovir hcl tab 450 mg (base equivalent) (Valcyte) Hepatitis adefovir dipivoxil tab 10 mg (Hepsera) BARACLUDE entecavir oral soln 0.05 mg/ml DAKLINZA daclatasvir dihydrochloride tab 30 mg (base equivalent) DAKLINZA daclatasvir dihydrochloride tab 60 mg (base equivalent) DAKLINZA daclatasvir dihydrochloride tab 90 mg (base equivalent) entecavir tab 0.5 mg (Baraclude) entecavir tab 1 mg (Baraclude) EPIVIR HBV lamivudine oral soln 5 mg/ ml (hbv) HARVONI ledipasvir-sofosbuvir tab mg lamivudine tab 100 mg (hbv) (Epivir hbv) PEGASYS peginterferon alfa-2a inj 180 mcg/ml PEGASYS peginterferon alfa-2a inj 180 mcg/0.5ml PEGASYS PROCLICK peginterferon alfa-2a inj 135 mcg/0.5ml PEGASYS PROCLICK peginterferon alfa-2a inj 180 mcg/0.5ml ribavirin cap 200 mg (Rebetol) ribavirin tab 200 mg (Copegus) SOVALDI sofosbuvir tab 400 mg TYZEKA telbivudine tab 600 mg Herpes acyclovir cap 200 mg (Zovirax) acyclovir susp 200 mg/5ml (Zovirax) acyclovir tab 400 mg (Zovirax) Classic Drug Guide October, 3

9 acyclovir tab 800 mg (Zovirax) famciclovir tab 125 mg (Famvir) famciclovir tab 250 mg (Famvir) famciclovir tab 500 mg (Famvir) valacyclovir hcl tab 500 mg (Valtrex) valacyclovir hcl tab 1 gm (Valtrex) HIV/AIDS abacavir sulfate tab 300 mg (base equiv) (Ziagen) abacavir sulfate-lamivudine-zidovudine tab mg (Trizivir) ATRIPLA efavirenz-emtricitabinetenofovir df tab mg DESCOVY emtricitabine-tenofovir alafenamide fumarate tab mg didanosine delayed release capsule 125 mg (Videx ec) didanosine delayed release capsule 200 mg (Videx ec) didanosine delayed release capsule 250 mg (Videx ec) didanosine delayed release capsule 400 mg (Videx ec) EMTRIVA emtricitabine caps 200 mg EMTRIVA emtricitabine soln 10 mg/ml EPZICOM abacavir sulfate-lamivudine tab mg GENVOYA elvitegrav-cobic-emtricitabtenofov af tab mg ISENTRESS raltegravir potassium tab 400 mg (base equiv) ISENTRESS raltegravir potassium packet for susp 100 mg (base equiv) ISENTRESS raltegravir potassium chew tab 25 mg (base equiv) ISENTRESS raltegravir potassium chew tab 100 mg (base equiv) lamivudine oral soln 10 mg/ml (Epivir) lamivudine tab 150 mg (Epivir) lamivudine tab 300 mg (Epivir) lamivudine-zidovudine tab mg (Combivir) nevirapine tab sr 24hr 100 mg (Viramune xr) nevirapine tab sr 24hr 400 mg (Viramune xr) nevirapine tab 200 mg (Viramune) NORVIR ritonavir tab 100 mg NORVIR ritonavir oral soln 80 mg/ml PREZCOBIX darunavir-cobicistat tab mg PREZISTA darunavir ethanolate susp 100 mg/ml (base equiv) PREZISTA darunavir ethanolate tab 75 mg (base equiv) PREZISTA darunavir ethanolate tab 150 mg (base equiv) PREZISTA darunavir ethanolate tab 600 mg (base equiv) PREZISTA darunavir ethanolate tab 800 mg (base equiv) stavudine cap 15 mg (Zerit) stavudine cap 20 mg (Zerit) stavudine cap 30 mg (Zerit) stavudine cap 40 mg (Zerit) stavudine for oral soln 1 mg/ml (Zerit) STRIBILD elvitegrav-cobic-emtricitabtenofovdf tab mg SUSTIVA efavirenz tab 600 mg SUSTIVA efavirenz cap 50 mg SUSTIVA efavirenz cap 200 mg TIVICAY dolutegravir sodium tab 10 mg (base equiv) TIVICAY dolutegravir sodium tab 25 mg (base equiv) Classic Drug Guide October, 4

10 TIVICAY dolutegravir sodium tab 50 mg (base equiv) TRIUMEQ abacavir-dolutegravirlamivudine tab mg TRUVADA emtricitabine-tenofovir disoproxil fumarate tab mg TRUVADA emtricitabine-tenofovir disoproxil fumarate tab mg TRUVADA emtricitabine-tenofovir disoproxil fumarate tab mg TRUVADA emtricitabine-tenofovir disoproxil fumarate tab mg TYBOST cobicistat tab 150 mg VIDEX didanosine for soln 2 gm VIDEX didanosine for soln 4 gm VIREAD tenofovir disoproxil fumarate oral powder 40 mg/gm VIREAD tenofovir disoproxil fumarate tab 150 mg VIREAD tenofovir disoproxil fumarate tab 200 mg VIREAD tenofovir disoproxil fumarate tab 250 mg VIREAD tenofovir disoproxil fumarate tab 300 mg VITEKTA elvitegravir tab 85 mg VITEKTA elvitegravir tab 150 mg zidovudine cap 100 mg (Retrovir) zidovudine syrup 10 mg/ml (Retrovir) zidovudine tab 300 mg MALARIA atovaquone-proguanil hcl tab mg (Malarone) atovaquone-proguanil hcl tab mg (Malarone) chloroquine phosphate tab 250 mg chloroquine phosphate tab 500 mg (Aralen) COARTEM artemether-lumefantrine tab mg DARAPRIM pyrimethamine tab 25 mg hydroxychloroquine sulfate tab 200 mg (Plaquenil) mefloquine hcl tab 250 mg PRIMAQUINE PHOSPHATE primaquine phosphate tab 26.3 mg (15 mg base) WORM INFECTIONS BILTRICIDE praziquantel tab 600 mg ivermectin tab 3 mg (Stromectol) OTHER ANTI-INFECTIVES ALINIA nitazoxanide tab 500 mg ALINIA nitazoxanide for susp 100 mg/5ml CAYSTON aztreonam lysine for inhal soln 75 mg (base equivalent) CLEOCIN clindamycin hcl cap 75 mg CLEOCIN clindamycin hcl cap 150 mg CLEOCIN clindamycin hcl cap 300 mg CLEOCIN PEDIATRIC GRANULE clindamycin palmitate hcl for soln 75 mg/5ml (base equiv) clindamycin hcl cap 75 mg (Cleocin) clindamycin hcl cap 150 mg (Cleocin) clindamycin hcl cap 300 mg (Cleocin) clindamycin palmitate hcl for soln 75 mg/5ml (base equiv) (Cleocin pediatric gr) dapsone tab 25 mg dapsone tab 100 mg IMPAVIDO miltefosine cap 50 mg linezolid for susp 100 mg/5ml (Zyvox) linezolid tab 600 mg (Zyvox) metronidazole tab 250 mg (Flagyl) metronidazole tab 500 mg (Flagyl) Classic Drug Guide October, 5

11 NEBUPENT pentamidine isethionate for nebulization soln 300 mg sulfamethoxazole-trimethoprim susp mg/5ml sulfamethoxazole-trimethoprim tab mg (Bactrim) sulfamethoxazole-trimethoprim tab mg (Bactrim ds) trimethoprim tab 100 mg vancomycin hcl cap 125 mg (Vancocin hcl) vancomycin hcl cap 250 mg (Vancocin hcl) XIFAXAN rifaximin tab 550 mg CANCER DRUGS ACTIMMUNE interferon gamma-1b inj 100 mcg/0.5ml ( unit/0.5ml) AFINITOR everolimus tab 2.5 mg AFINITOR everolimus tab 5 mg AFINITOR everolimus tab 7.5 mg AFINITOR everolimus tab 10 mg AFINITOR DISPERZ everolimus tab for oral susp 2 mg AFINITOR DISPERZ everolimus tab for oral susp 3 mg AFINITOR DISPERZ everolimus tab for oral susp 5 mg ALECENSA alectinib hcl cap 150 mg (base equivalent) ALKERAN melphalan tab 2 mg anastrozole tab 1 mg (Arimidex) bexarotene cap 75 mg (Targretin) bicalutamide tab 50 mg (Casodex) BOSULIF bosutinib tab 100 mg BOSULIF bosutinib tab 500 mg capecitabine tab 150 mg (Xeloda) capecitabine tab 500 mg (Xeloda) CAPRELSA vandetanib tab 100 mg CAPRELSA vandetanib tab 300 mg COMETRIQ cabozantinib s-malate cap 3 x 20 mg (60 mg dose) kit COMETRIQ cabozantinib s-mal cap 1 x 80 mg & 1 x 20 mg (100 dose) kit COMETRIQ cabozantinib s-mal cap 1 x 80 mg & 3 x 20 mg (140 dose) kit COTELLIC cobimetinib fumarate tab 20 mg (base equivalent) EMCYT estramustine phosphate sodium cap 140 mg ERIVEDGE vismodegib cap 150 mg exemestane tab 25 mg (Aromasin) FARESTON toremifene citrate tab 60 mg (base equivalent) FARYDAK panobinostat lactate cap 10 mg (base equivalent) FARYDAK panobinostat lactate cap 15 mg (base equivalent) FARYDAK panobinostat lactate cap 20 mg (base equivalent) flutamide cap 125 mg GILOTRIF afatinib dimaleate tab 20 mg (base equivalent) GILOTRIF afatinib dimaleate tab 30 mg (base equivalent) GILOTRIF afatinib dimaleate tab 40 mg (base equivalent) HEXALEN altretamine cap 50 mg HYCAMTIN topotecan hcl cap 0.25 mg (base equiv) HYCAMTIN topotecan hcl cap 1 mg (base equiv) hydroxyurea cap 500 mg (Hydrea) IBRANCE palbociclib cap 75 mg IBRANCE palbociclib cap 100 mg IBRANCE palbociclib cap 125 mg ICLUSIG ponatinib hcl tab 15 mg (base equiv) Classic Drug Guide October, 6

12 ICLUSIG ponatinib hcl tab 45 mg (base equiv) imatinib mesylate tab 100 mg (base equivalent) (Gleevec) imatinib mesylate tab 400 mg (base equivalent) (Gleevec) IMBRUVICA ibrutinib cap 140 mg INLYTA axitinib tab 1 mg INLYTA axitinib tab 5 mg IRESSA gefitinib tab 250 mg JAKAFI ruxolitinib phosphate tab 5 mg (base equivalent) JAKAFI ruxolitinib phosphate tab 10 mg (base equivalent) JAKAFI ruxolitinib phosphate tab 15 mg (base equivalent) JAKAFI ruxolitinib phosphate tab 20 mg (base equivalent) JAKAFI ruxolitinib phosphate tab 25 mg (base equivalent) LENVIMA 10 MG DAILY DOSE lenvatinib cap therapy pack 10 mg (10 mg daily dose) LENVIMA 14 MG DAILY DOSE lenvatinib cap therapy pack 10 & 4 mg (14 mg daily dose) LENVIMA 18 MG DAILY DOSE lenvatinib cap therapy pack 10 & 4 (2) mg (18 mg daily dose) LENVIMA 20 MG DAILY DOSE lenvatinib cap therapy pack 10 (2) mg (20 mg daily dose) LENVIMA 24 MG DAILY DOSE lenvatinib cap therapy pack 10 (2) & 4 mg (24 mg daily dose) LENVIMA 8 MG DAILY DOSE lenvatinib cap therapy pack 4 (2) mg (8 mg daily dose) letrozole tab 2.5 mg (Femara) leucovorin calcium tab 5 mg leucovorin calcium tab 25 mg LEUKERAN chlorambucil tab 2 mg LONSURF trifluridine-tipiracil tab mg LONSURF trifluridine-tipiracil tab mg LYNPARZA olaparib cap 50 mg LYSODREN mitotane tab 500 mg MATULANE procarbazine hcl cap 50 mg megestrol acetate susp 40 mg/ml (Megace oral) megestrol acetate tab 20 mg megestrol acetate tab 40 mg MEKINIST trametinib dimethyl sulfoxide tab 0.5 mg (base equivalent) MEKINIST trametinib dimethyl sulfoxide tab 2 mg (base equivalent) mercaptopurine tab 50 mg (Purinethol) MESNEX mesna tab 400 mg methotrexate sodium tab 2.5 mg (base equiv) MYLERAN busulfan tab 2 mg NEXAVAR sorafenib tosylate tab 200 mg (base equivalent) nilutamide tab 150 mg (Nilandron) NINLARO ixazomib citrate cap 2.3 mg (base equivalent) NINLARO ixazomib citrate cap 3 mg (base equivalent) NINLARO ixazomib citrate cap 4 mg (base equivalent) ODOMZO sonidegib phosphate cap 200 mg (base equivalent) POMALYST pomalidomide cap 1 mg POMALYST pomalidomide cap 2 mg POMALYST pomalidomide cap 3 mg POMALYST pomalidomide cap 4 mg SPRYCEL dasatinib tab 20 mg Classic Drug Guide October, 7

13 SPRYCEL dasatinib tab 50 mg SPRYCEL dasatinib tab 70 mg SPRYCEL dasatinib tab 80 mg SPRYCEL dasatinib tab 100 mg SPRYCEL dasatinib tab 140 mg STIVARGA regorafenib tab 40 mg SUTENT sunitinib malate cap 12.5 mg (base equivalent) SUTENT sunitinib malate cap 25 mg (base equivalent) SUTENT sunitinib malate cap 37.5 mg (base equivalent) SUTENT sunitinib malate cap 50 mg (base equivalent) SYLATRON peginterferon alfa-2b for inj kit 200 mcg SYLATRON peginterferon alfa-2b for inj kit 300 mcg SYLATRON peginterferon alfa-2b for inj kit 600 mcg TABLOID thioguanine tab 40 mg TAFINLAR dabrafenib mesylate cap 50 mg (base equivalent) TAFINLAR dabrafenib mesylate cap 75 mg (base equivalent) TAGRISSO osimertinib mesylate tab 40 mg (base equivalent) TAGRISSO osimertinib mesylate tab 80 mg (base equivalent) tamoxifen citrate tab 10 mg (base equivalent) tamoxifen citrate tab 20 mg (base equivalent) TARCEVA erlotinib hcl tab 25 mg (base equivalent) TARCEVA erlotinib hcl tab 100 mg (base equivalent) TARCEVA erlotinib hcl tab 150 mg (base equivalent) TASIGNA nilotinib hcl cap 150 mg (base equivalent) TASIGNA nilotinib hcl cap 200 mg (base equivalent) temozolomide cap 5 mg (Temodar) temozolomide cap 20 mg (Temodar) temozolomide cap 100 mg (Temodar) temozolomide cap 140 mg (Temodar) temozolomide cap 180 mg (Temodar) temozolomide cap 250 mg (Temodar) tretinoin cap 10 mg TYKERB lapatinib ditosylate tab 250 mg (base equiv) VOTRIENT pazopanib hcl tab 200 mg (base equiv) XALKORI crizotinib cap 200 mg XALKORI crizotinib cap 250 mg XTANDI enzalutamide cap 40 mg ZELBORAF vemurafenib tab 240 mg ZOLINZA vorinostat cap 100 mg ZYDELIG idelalisib tab 100 mg ZYDELIG idelalisib tab 150 mg ZYKADIA ceritinib cap 150 mg ZYTIGA abiraterone acetate tab 250 mg HORMONES, DIABETES AND RELATED DRUGS CORTICOSTEROIDS budesonide delayed release particles cap 3 mg (Entocort ec) dexamethasone conc 1 mg/ml dexamethasone elixir 0.5 mg/5ml dexamethasone tab 0.5 mg dexamethasone tab 0.75 mg dexamethasone tab 1.5 mg dexamethasone tab 4 mg dexamethasone tab 6 mg fludrocortisone acetate tab 0.1 mg Classic Drug Guide October, 8

14 hydrocortisone tab 5 mg (Cortef) hydrocortisone tab 10 mg (Cortef) hydrocortisone tab 20 mg (Cortef) methylprednisolone tab therapy pack 4 mg (21) (Medrol dosepak) methylprednisolone tab 4 mg (Medrol) methylprednisolone tab 8 mg (Medrol) methylprednisolone tab 16 mg (Medrol) methylprednisolone tab 32 mg (Medrol) prednisolone sod phosph oral soln 6.7 mg/5ml (5 mg/5ml base) (Pediapred) prednisolone sod phosphate oral soln 15 mg/5ml (base equiv) prednisolone sodium phosphate oral soln 25 mg/5ml (base eq) prednisolone syrup 15 mg/5ml (usp solution equivalent) (Prelone) prednisone conc 5 mg/ml prednisone tab 1 mg prednisone tab 2.5 mg prednisone tab 5 mg prednisone tab 10 mg prednisone tab 20 mg MALE HORMONES ANDRODERM testosterone td patch 24hr 2 mg/24hr ANDRODERM testosterone td patch 24hr 4 mg/24hr ANDROGEL testosterone td gel mg/1.25gm (1.62%) ANDROGEL testosterone td gel 40.5 mg/2.5gm (1.62%) ANDROGEL PUMP testosterone td gel mg/act (1.62%) danazol cap 50 mg danazol cap 100 mg danazol cap 200 mg testosterone cypionate im inj in oil 100 mg/ml (Depo-testosterone) testosterone cypionate im inj in oil 200 mg/ml (Depo-testosterone) testosterone enanthate im inj in oil 200 mg/ml testosterone td gel 25 mg/2.5gm (1%) (Androgel) testosterone td gel 50 mg/5gm (1%) (Androgel) testosterone td gel 12.5 mg/act (1%) (Androgel pump) ESTROGENS CLIMARA PRO estradiol-levonorgestrel td patch weekly mg/day estradiol & norethindrone acetate tab mg (Activella) estradiol & norethindrone acetate tab mg (Activella) estradiol tab 0.5 mg (Estrace) estradiol tab 1 mg (Estrace) estradiol tab 2 mg (Estrace) estradiol td patch twice weekly mg/24hr (Vivelle-dot) estradiol td patch twice weekly mg/24hr (Vivelle-dot) estradiol td patch twice weekly 0.05 mg/24hr (Vivelle-dot) estradiol td patch twice weekly mg/24hr (Vivelle-dot) estradiol td patch twice weekly 0.1 mg/24hr (Vivelle-dot) estradiol td patch weekly mg/24hr (Climara) estradiol td patch weekly mg/24hr (37.5 mcg/24hr) (Climara) estradiol td patch weekly 0.05 mg/24hr (Climara) estradiol td patch weekly 0.06 mg/24hr (Climara) Classic Drug Guide October, 9

15 estradiol td patch weekly mg/24hr (Climara) estradiol td patch weekly 0.1 mg/24hr (Climara) norethindrone acetate tab 5 mg (Aygestin) progesterone micronized cap 100 mg (Prometrium) norethindrone acetate-ethinyl estradiol tab 0.5 mg-2.5 mcg (Femhrt low dose) progesterone micronized cap 200 mg (Prometrium) norethindrone acetate-ethinyl estradiol tab 1 mg-5 mcg PREMARIN estrogens, conjugated for inj 25 mg BIRTH CONTROL DEPO-SUBQ PROVERA 104 medroxyprogesterone acetate subcutaneous susp 104 mg/0.65ml PREMARIN estrogens, conjugated tab 0.3 mg desogest-eth estrad & eth estrad tab /0.01 mg(21/5) (Mircette) PREMARIN estrogens, conjugated tab 0.45 mg PREMARIN estrogens, conjugated tab mg PREMARIN estrogens, conjugated tab 0.9 mg PREMARIN estrogens, conjugated tab 1.25 mg PREMPHASE conj est 0.625(14)/conj est-medroxypro ac tab mg(14) desogest-ethin est tab / / mg-mg (Cyclessa) desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg (Desogen) drospirenone-ethinyl estradiol tab mg (Yaz) drospirenone-ethinyl estradiol tab mg (Yasmin 28) ELLA ulipristal acetate tab 30 mg PREMPRO conjugated estrogenmedroxyprogest acetate tab mg ethynodiol diacetate & ethinyl estradiol tab 1 mg-35 mcg PREMPRO conjugated estrogenmedroxyprogest acetate tab mg PREMPRO conjugated estrogenmedroxyprogest acetate tab mg PREMPRO conjugated estrogenmedroxyprogest acetate tab mg PROGESTINS medroxyprogesterone acetate tab 2.5 mg (Provera) medroxyprogesterone acetate tab 5 mg (Provera) medroxyprogesterone acetate tab 10 mg (Provera) levonorg-eth est tab mg(84) & eth est tab 0.01mg(7) (Loseasonique) levonorg-eth est tab mg(84) & eth est tab 0.01mg(7) (Seasonique) levonorgestrel & ethinyl estradiol (91- day) tab mg levonorgestrel & ethinyl estradiol tab 0.1 mg-20 mcg levonorgestrel & ethinyl estradiol tab 0.15 mg-30 mcg levonorgestrel tab 1.5 mg (Plan b onestep) levonorgestrel-eth estra tab / / mg-mcg Classic Drug Guide October, 10

16 LO LOESTRIN FE norethin-eth estradiol-fe tab 1 mg-10 mcg (24)/10 mcg (2) medroxyprogesterone acetate im susp 150 mg/ml (Depo-provera contrac) norethindrone & ethinyl estradiol tab 0.4 mg-35 mcg (Ovcon-35) norethindrone & ethinyl estradiol tab 0.5 mg-35 mcg (Brevicon-28) norethindrone & ethinyl estradiol tab 1 mg-35 mcg (Norinyl 1+35) norethindrone & ethinyl estradiol-fe chew tab 0.4 mg-35 mcg (Femcon fe) norethindrone ac-ethinyl estrad-fe tab 1-20/1-30/1-35 mg-mcg (Estrostep fe) norethindrone ace & ethinyl estradiol tab 1 mg-20 mcg (Loestrin 1/20-21) norethindrone ace & ethinyl estradiol tab 1.5 mg-30 mcg (Loestrin 1.5/30-21) norethindrone ace & ethinyl estradiol-fe tab 1 mg-20 mcg (Loestrin fe 1/20) norethindrone ace & ethinyl estradiol-fe tab 1.5 mg-30 mcg (Loestrin fe 1.5/30) norethindrone tab 0.35 mg (Nor-qd) norethindrone-eth estradiol tab / /1-35 mg-mcg (Orthonovum 7/7/7) norethindrone-eth estradiol tab /1-35/ mg-mcg (Tri-norinyl 28) norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg (Ortho-cyclen) norgestimate-eth estrad tab / / mg-mcg (Ortho tri-cyclen lo) norgestimate-eth estrad tab / / mg-mcg (Ortho tri-cyclen) norgestrel & ethinyl estradiol tab 0.3 mg-30 mcg NUVARING etonogestrel-ethinyl estradiol va ring mg/24hr INFERTILITY BRAVELLE urofollitropin purified for inj 75 unit chorionic gonadotropin for inj unit clomiphene citrate tab 50 mg (Clomid) FOLLISTIM AQ follitropin beta inj 75 unit/0.5ml FOLLISTIM AQ follitropin beta inj 300 unit/0.36ml FOLLISTIM AQ follitropin beta inj 600 unit/0.72ml FOLLISTIM AQ follitropin beta inj 900 unit/1.08ml GANIRELIX ACETATE ganirelix acetate inj 250 mcg/0.5ml LUPRON DEPOT-PED leuprolide acetate for inj pediatric kit 7.5 mg LUPRON DEPOT-PED leuprolide acetate for inj pediatric kit mg LUPRON DEPOT-PED leuprolide acetate for inj pediatric kit 15 mg LUPRON DEPOT-PED leuprolide acetate (3 month) for inj pediatric kit mg LUPRON DEPOT-PED leuprolide acetate (3 month) for inj pediatric kit 30 mg MENOPUR menotropins for subcutaneous inj 75 unit SYNAREL nafarelin acetate nasal soln 2 mg/ml (200 mcg/act) (base eq) DIABETES acarbose tab 25 mg (Precose) acarbose tab 50 mg (Precose) acarbose tab 100 mg (Precose) BYDUREON exenatide extended release for susp pen-injector 2 mg Classic Drug Guide October, 11

17 BYDUREON exenatide for inj extended release susp 2 mg BYETTA exenatide soln pen-injector 5 mcg/0.02ml BYETTA exenatide soln pen-injector 10 mcg/0.04ml glimepiride tab 1 mg (Amaryl) glimepiride tab 2 mg (Amaryl) glimepiride tab 4 mg (Amaryl) glipizide tab sr 24hr 2.5 mg (Glucotrol xl) glipizide tab sr 24hr 5 mg (Glucotrol xl) glipizide tab sr 24hr 10 mg (Glucotrol xl) glipizide tab 5 mg (Glucotrol) glipizide tab 10 mg (Glucotrol) glipizide-metformin hcl tab mg glipizide-metformin hcl tab mg glipizide-metformin hcl tab mg GLUCAGEN HYPOKIT glucagon hcl (rdna) for inj 1 mg (base equiv) GLUCAGON EMERGENCY KIT glucagon (rdna) for inj kit 1 mg glyburide micronized tab 1.5 mg (Glynase) glyburide micronized tab 3 mg (Glynase) glyburide micronized tab 6 mg (Glynase) glyburide tab 1.25 mg glyburide tab 2.5 mg glyburide tab 5 mg glyburide-metformin tab mg (Glucovance) glyburide-metformin tab mg (Glucovance) glyburide-metformin tab mg (Glucovance) INVOKAMET canagliflozin-metformin hcl tab mg INVOKAMET canagliflozin-metformin hcl tab mg INVOKAMET canagliflozin-metformin hcl tab mg INVOKAMET canagliflozin-metformin hcl tab 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 sr 24hr mg JANUMET XR sitagliptin-metformin hcl tab sr 24hr mg JANUMET XR sitagliptin-metformin hcl tab sr 24hr mg JANUVIA sitagliptin phosphate tab 25 mg (base equiv) JANUVIA sitagliptin phosphate tab 50 mg (base equiv) JANUVIA sitagliptin phosphate tab 100 mg (base equiv) JARDIANCE empagliflozin tab 10 mg JARDIANCE empagliflozin tab 25 mg KOMBIGLYZE XR saxagliptinmetformin hcl tab sr 24hr mg KOMBIGLYZE XR saxagliptinmetformin hcl tab sr 24hr mg KOMBIGLYZE XR saxagliptinmetformin hcl tab sr 24hr mg KORLYM mifepristone tab 300 mg metformin hcl tab sr 24hr 500 mg (Glucophage xr) metformin hcl tab sr 24hr 750 mg (Glucophage xr) metformin hcl tab 500 mg (Glucophage) metformin hcl tab 850 mg (Glucophage) metformin hcl tab 1000 mg (Glucophage) nateglinide tab 60 mg (Starlix) Classic Drug Guide October, 12

18 nateglinide tab 120 mg (Starlix) ONGLYZA saxagliptin hcl tab 2.5 mg (base equiv) ONGLYZA saxagliptin hcl tab 5 mg (base equiv) pioglitazone hcl tab 15 mg (base equiv) (Actos) pioglitazone hcl tab 30 mg (base equiv) (Actos) pioglitazone hcl tab 45 mg (base equiv) (Actos) pioglitazone hcl-metformin hcl tab mg (Actoplus met) pioglitazone hcl-metformin hcl tab mg (Actoplus met) repaglinide tab 0.5 mg (Prandin) repaglinide tab 1 mg (Prandin) repaglinide tab 2 mg (Prandin) SYMLINPEN 120 pramlintide acetate pen-inj 2700 mcg/2.7ml (1000 mcg/ml) SYMLINPEN 60 pramlintide acetate pen-inj 1500 mcg/1.5ml (1000 mcg/ml) SYNJARDY empagliflozin-metformin hcl tab mg SYNJARDY empagliflozin-metformin hcl tab mg SYNJARDY empagliflozin-metformin hcl tab mg SYNJARDY empagliflozin-metformin hcl tab mg VICTOZA liraglutide soln pen-injector 18 mg/3ml (6 mg/ml) DIABETES - INSULINS Rapid-Acting Insulins NOVOLOG insulin aspart inj 100 unit/ml NOVOLOG FLEXPEN insulin aspart soln pen-injector 100 unit/ml NOVOLOG PENFILL insulin aspart soln cartridge 100 unit/ml Short-Acting Insulins NOVOLIN R insulin regular (human) inj 100 unit/ml NOVOLIN R RELION insulin regular (human) inj 100 unit/ml Intermediate-Acting Insulins NOVOLIN N insulin nph (human) (isophane) inj 100 unit/ml NOVOLIN N RELION insulin nph (human) (isophane) inj 100 unit/ml NOVOLIN N U-100 insulin nph (human) (isophane) inj 100 unit/ml NOVOLIN 70/30 insulin nph isophane & regular human inj 100 unit/ml (70-30) NOVOLIN 70/30 RELION insulin nph isophane & regular human inj 100 unit/ ml (70-30) NOVOLOG MIX 70/30 insulin aspart prot & aspart (human) inj 100 unit/ml (70-30) NOVOLOG MIX 70/30 PREFILL insulin aspart prot & aspart sus pen-inj 100 unit/ml (70-30) Basal Insulins LANTUS insulin glargine inj 100 unit/ml LANTUS SOLOSTAR insulin glargine soln pen-injector 100 unit/ml LEVEMIR insulin detemir inj 100 unit/ml LEVEMIR FLEXTOUCH insulin detemir soln pen-injector 100 unit/ml TOUJEO SOLOSTAR insulin glargine soln pen-injector 300 unit/ml THYROID REGULATION ARMOUR THYROID thyroid tab 15 mg (1/4 grain) ARMOUR THYROID thyroid tab 120 mg (2 grain) ARMOUR THYROID thyroid tab 180 mg (3 grain) Classic Drug Guide October, 13

19 ARMOUR THYROID thyroid tab 240 mg (4 grain) ARMOUR THYROID thyroid tab 300 mg (5 grain) CYTOMEL liothyronine sodium tab 5 mcg CYTOMEL liothyronine sodium tab 25 mcg CYTOMEL liothyronine sodium tab 50 mcg levothyroxine sodium tab 25 mcg (Synthroid) levothyroxine sodium tab 50 mcg (Synthroid) levothyroxine sodium tab 75 mcg (Synthroid) levothyroxine sodium tab 88 mcg (Synthroid) levothyroxine sodium tab 100 mcg (Synthroid) levothyroxine sodium tab 112 mcg (Synthroid) levothyroxine sodium tab 125 mcg (Synthroid) levothyroxine sodium tab 137 mcg (Synthroid) levothyroxine sodium tab 150 mcg (Synthroid) levothyroxine sodium tab 175 mcg (Synthroid) levothyroxine sodium tab 200 mcg (Synthroid) levothyroxine sodium tab 300 mcg (Synthroid) liothyronine sodium tab 5 mcg (Cytomel) liothyronine sodium tab 25 mcg (Cytomel) liothyronine sodium tab 50 mcg (Cytomel) methimazole tab 5 mg (Tapazole) methimazole tab 10 mg (Tapazole) propylthiouracil tab 50 mg SSKI potassium iodide soln 1 gm/ml THYROLAR-1 liotrix (t3-t4) tab 60 mg ( mcg) THYROLAR-1/2 liotrix (t3-t4) tab 30 mg ( mcg) THYROLAR-1/4 liotrix (t3-t4) tab 15 mg ( mcg) THYROLAR-2 liotrix (t3-t4) tab 120 mg ( mcg) THYROLAR-3 liotrix (t3-t4) tab 180 mg ( mcg) GROWTH HORMONE NORDITROPIN FLEXPRO somatropin inj 5 mg/1.5ml NORDITROPIN FLEXPRO somatropin inj 10 mg/1.5ml NORDITROPIN FLEXPRO somatropin inj 15 mg/1.5ml NORDITROPIN FLEXPRO somatropin inj 30 mg/3ml SEROSTIM somatropin (nonrefrigerated) for subcutaneous inj 4 mg SEROSTIM somatropin (nonrefrigerated) for subcutaneous inj 5 mg SEROSTIM somatropin (nonrefrigerated) for subcutaneous inj 6 mg ZORBTIVE somatropin (nonrefrigerated) for subcutaneous inj 8.8 mg OTHER HORMONES AND RELATED DRUGS alendronate sodium tab 5 mg alendronate sodium tab 10 mg alendronate sodium tab 35 mg alendronate sodium tab 70 mg (Fosamax) cabergoline tab 0.5 mg calcitonin (salmon) nasal soln 200 unit/ act (Miacalcin) Classic Drug Guide October, 14

20 calcitriol cap 0.25 mcg (Rocaltrol) calcitriol cap 0.5 mcg (Rocaltrol) calcitriol oral soln 1 mcg/ml (Rocaltrol) desmopressin acetate inj 4 mcg/ml (Ddavp) desmopressin acetate nasal soln 0.01% (refrigerated) (Ddavp) desmopressin acetate nasal spray soln 0.01% (Ddavp) desmopressin acetate nasal spray soln 0.01% (refrigerated) desmopressin acetate tab 0.1 mg (Ddavp) desmopressin acetate tab 0.2 mg (Ddavp) FORTEO teriparatide (recombinant) inj 600 mcg/2.4ml FORTICAL calcitonin (salmon) nasal soln 200 unit/act ibandronate sodium tab 150 mg (base equivalent) (Boniva) KUVAN sapropterin dihydrochloride soluble tab 100 mg KUVAN sapropterin dihydrochloride powder packet 100 mg KUVAN sapropterin dihydrochloride powder packet 500 mg levocarnitine oral soln 1 gm/10ml (10%) (Carnitor) levocarnitine tab 330 mg (Carnitor) LUPRON DEPOT-PED leuprolide acetate for inj pediatric kit 7.5 mg LUPRON DEPOT-PED leuprolide acetate for inj pediatric kit mg LUPRON DEPOT-PED leuprolide acetate for inj pediatric kit 15 mg methylergonovine maleate tab 0.2 mg NATPARA parathyroid hormone (recombinant) for inj cartridge 25 mcg NATPARA parathyroid hormone (recombinant) for inj cartridge 50 mcg NATPARA parathyroid hormone (recombinant) for inj cartridge 75 mcg NATPARA parathyroid hormone (recombinant) for inj cartridge 100 mcg octreotide acetate inj 50 mcg/ml (0.05 mg/ml) (Sandostatin) octreotide acetate inj 100 mcg/ml (0.1 mg/ml) (Sandostatin) octreotide acetate inj 200 mcg/ml (0.2 mg/ml) (Sandostatin) octreotide acetate inj 500 mcg/ml (0.5 mg/ml) (Sandostatin) octreotide acetate inj 1000 mcg/ml (1 mg/ ml) (Sandostatin) paricalcitol cap 1 mcg (Zemplar) paricalcitol cap 2 mcg (Zemplar) paricalcitol cap 4 mcg (Zemplar) raloxifene hcl tab 60 mg (Evista) risedronate sodium tab 5 mg (Actonel) risedronate sodium tab 30 mg (Actonel) risedronate sodium tab 35 mg (Actonel) risedronate sodium tab 150 mg (Actonel) SAMSCA tolvaptan tab 15 mg SAMSCA tolvaptan tab 30 mg SENSIPAR cinacalcet hcl tab 30 mg (base equiv) SENSIPAR cinacalcet hcl tab 60 mg (base equiv) SENSIPAR cinacalcet hcl tab 90 mg (base equiv) SOMATULINE DEPOT lanreotide acetate extended release inj 60 mg/0.2ml SOMATULINE DEPOT lanreotide acetate extended release inj 90 mg/0.3ml SOMATULINE DEPOT lanreotide acetate extended release inj 120 mg/0.5ml Classic Drug Guide October, 15

21 SOMAVERT pegvisomant for inj 10 mg (as protein) SOMAVERT pegvisomant for inj 15 mg (as protein) SOMAVERT pegvisomant for inj 20 mg (as protein) SOMAVERT pegvisomant for inj 25 mg (as protein) SOMAVERT pegvisomant for inj 30 mg (as protein) STRENSIQ asfotase alfa subcutaneous inj 18 mg/0.45ml STRENSIQ asfotase alfa subcutaneous inj 28 mg/0.7ml STRENSIQ asfotase alfa subcutaneous inj 40 mg/ml STRENSIQ asfotase alfa subcutaneous inj 80 mg/0.8ml HEART AND CIRCULATORY DRUGS ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITORS AND COMBINATIONS benazepril & hydrochlorothiazide tab mg benazepril & hydrochlorothiazide tab mg (Lotensin hct) benazepril & hydrochlorothiazide tab mg (Lotensin hct) benazepril & hydrochlorothiazide tab mg (Lotensin hct) benazepril hcl tab 5 mg benazepril hcl tab 10 mg (Lotensin) benazepril hcl tab 20 mg (Lotensin) benazepril hcl tab 40 mg (Lotensin) captopril tab 12.5 mg captopril tab 25 mg captopril tab 50 mg captopril tab 100 mg enalapril maleate & hydrochlorothiazide tab mg enalapril maleate & hydrochlorothiazide tab mg (Vaseretic) 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) fosinopril sodium & hydrochlorothiazide tab mg fosinopril sodium & hydrochlorothiazide tab mg fosinopril sodium tab 10 mg fosinopril sodium tab 20 mg fosinopril sodium tab 40 mg lisinopril & hydrochlorothiazide tab mg (Zestoretic) lisinopril & hydrochlorothiazide tab mg (Zestoretic) lisinopril & hydrochlorothiazide tab mg (Zestoretic) 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) moexipril hcl tab 7.5 mg (Univasc) moexipril hcl tab 15 mg (Univasc) moexipril-hydrochlorothiazide tab mg moexipril-hydrochlorothiazide tab mg (Uniretic) moexipril-hydrochlorothiazide tab mg perindopril erbumine tab 2 mg perindopril erbumine tab 4 mg (Aceon) perindopril erbumine tab 8 mg (Aceon) quinapril hcl tab 5 mg (Accupril) Classic Drug Guide October, 16

22 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) BENICAR HCT olmesartan medoxomilhydrochlorothiazide tab mg BENICAR HCT olmesartan medoxomilhydrochlorothiazide tab mg BENICAR HCT olmesartan medoxomilhydrochlorothiazide tab mg candesartan cilexetil tab 4 mg (Atacand) candesartan cilexetil tab 8 mg (Atacand) candesartan cilexetil tab 16 mg (Atacand) ramipril cap 1.25 mg (Altace) candesartan cilexetil tab 32 mg (Atacand) ramipril cap 2.5 mg (Altace) ramipril cap 5 mg (Altace) ramipril cap 10 mg (Altace) trandolapril tab 1 mg (Mavik) trandolapril tab 2 mg (Mavik) trandolapril tab 4 mg (Mavik) ANGIOTENSIN II RECEPTOR ANTAGONISTS (ARBS) AND COMBINATIONS amlodipine-valsartanhydrochlorothiazide tab mg (Exforge hct) amlodipine-valsartanhydrochlorothiazide tab mg (Exforge hct) amlodipine-valsartanhydrochlorothiazide tab mg (Exforge hct) amlodipine-valsartanhydrochlorothiazide tab mg (Exforge hct) amlodipine-valsartanhydrochlorothiazide tab mg (Exforge hct) BENICAR olmesartan medoxomil tab 5 mg BENICAR olmesartan medoxomil tab 20 mg BENICAR olmesartan medoxomil tab 40 mg candesartan cilexetilhydrochlorothiazide tab mg (Atacand hct) candesartan cilexetilhydrochlorothiazide tab mg (Atacand hct) candesartan cilexetilhydrochlorothiazide tab mg (Atacand hct) 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) losartan potassium & hydrochlorothiazide tab mg (Hyzaar) losartan potassium & hydrochlorothiazide tab mg (Hyzaar) losartan potassium & hydrochlorothiazide tab mg (Hyzaar) losartan potassium tab 25 mg (Cozaar) losartan potassium tab 50 mg (Cozaar) losartan potassium tab 100 mg (Cozaar) telmisartan tab 20 mg (Micardis) Classic Drug Guide October, 17

23 telmisartan tab 40 mg (Micardis) bisoprolol fumarate tab 5 mg (Zebeta) telmisartan tab 80 mg (Micardis) bisoprolol fumarate tab 10 mg (Zebeta) telmisartan-hydrochlorothiazide tab mg (Micardis hct) telmisartan-hydrochlorothiazide tab mg (Micardis hct) telmisartan-hydrochlorothiazide tab mg (Micardis hct) 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) BETA BLOCKERS AND COMBINATIONS acebutolol hcl cap 200 mg (Sectral) acebutolol hcl cap 400 mg (Sectral) atenolol & chlorthalidone tab mg (Tenoretic 50) atenolol & chlorthalidone tab mg (Tenoretic 100) atenolol tab 25 mg (Tenormin) atenolol tab 50 mg (Tenormin) atenolol tab 100 mg (Tenormin) bisoprolol & hydrochlorothiazide tab mg (Ziac) bisoprolol & hydrochlorothiazide tab mg (Ziac) bisoprolol & hydrochlorothiazide tab mg (Ziac) carvedilol tab mg (Coreg) carvedilol tab 6.25 mg (Coreg) carvedilol tab 12.5 mg (Coreg) carvedilol tab 25 mg (Coreg) labetalol hcl tab 100 mg (Trandate) labetalol hcl tab 200 mg (Trandate) labetalol hcl tab 300 mg (Trandate) metoprolol & hydrochlorothiazide tab mg (Lopressor hct) metoprolol & hydrochlorothiazide tab mg (Lopressor hct) metoprolol & hydrochlorothiazide tab mg metoprolol succinate tab sr 24hr 25 mg (tartrate equiv) (Toprol xl) metoprolol succinate tab sr 24hr 50 mg (tartrate equiv) (Toprol xl) metoprolol succinate tab sr 24hr 100 mg (tartrate equiv) (Toprol xl) metoprolol succinate tab sr 24hr 200 mg (tartrate equiv) (Toprol xl) metoprolol tartrate tab 25 mg metoprolol tartrate tab 50 mg (Lopressor) metoprolol tartrate tab 100 mg (Lopressor) nadolol tab 20 mg (Corgard) nadolol tab 40 mg (Corgard) nadolol tab 80 mg (Corgard) pindolol tab 5 mg pindolol tab 10 mg propranolol hcl cap sr 24hr 60 mg (Inderal la) propranolol hcl cap sr 24hr 80 mg (Inderal la) propranolol hcl cap sr 24hr 120 mg (Inderal la) Classic Drug Guide October, 18