Horizon Blue Cross Blue Shield of New Jersey Drug Guide

Transcription

1 April Horizon Blue Cross Blue Shield of New Jersey Drug Guide Horizon BCBSNJ Classic Drug Guide Click to search for a drug name in this document Contents Introduction... I Drug selection... I Generic drugs... I Member Prescription Benefit... II Affordable Care Act... II Utilization management (UM)... II /Medical Necessity Review and Determination... II Dispensing Limit... II Smart... III... III How to use this list... IV Key... IV Therapeutic Class Drug List... 1 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 Please consider talking to your doctor about prescribing formulary medications, which may help reduce your out-of-pocket costs. This Drug Guide may help guide you and your doctor in choosing an appropriate medication for you. The Drug Guide is regularly updated. Please visit for the most up-to-date Drug Guide. 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 04/15

2 Introduction Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) is pleased to present the Drug Guide for the Horizon Classic Formulary. Your plans covered drug list (formulary), or drug list, is a list of medications that your prescription drug plan covers. At Horizon BCBSNJ, our goal is to give members access to safe and effective prescription drugs. Please refer to this guide for information and present the guide to your doctor if you require a prescription. Drug selection Each drug chosen for this formulary was analyzed for its safety, efficacy and value by our 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 from the Horizon Classic formulary are based on the drug s safety, efficacy, uniqueness and cost. You can find recent changes and the current version of the Drug Guide at Only Preferred brand name drugs are listed in the Drug Guide. Non-Preferred (NP) brand name drugs will not be listed. Horizon BCBSNJ may choose to not add a drug to the Preferred brand tier and hence not list it in the Drug Guide because of effectiveness or safety concerns, or because a similar, more cost-effective drug is already on the Horizon Classic formulary. New drugs are Non-Preferred until reviewed and approved for inclusion by the P&T Committee. Horizon BCBSNJ encourages providers to prescribe Preferred drugs. While coverage is provided for Non-Preferred drugs, members are required to pay the highest copayment or cost share for drugs on this tier. Generic drugs Horizon BCBSNJ encourages the use of generic drugs as a way to provide high-quality drugs at a reduced cost. Generic drugs are as safe and effective as their brand counterparts, but are usually less expensive. Generic drugs 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 drug may be substituted for the brand counterpart when it: Contains the same active ingredient(s) as the brand drug. 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 generic drugs, Tier 2 Preferred brand drugs typically move to Tier 3 after an equivalent generic version becomes available. If you choose to receive a brand name prescription drug and a generic equivalent is available, you may be subject to a reduced benefit and a higher out-of-pocket expense I Classic Drug Guide April,

3 Member prescription benefit Investigational drugs and drugs indicated for cosmetic purposes (e.g., Propecia for hair growth) typically are not covered. Coverage, copayment, additional restrictions and exclusions may vary depending on the individual plan design. The Horizon BCBSNJ prescription benefit is multi-tiered, placing prescription drugs into one of three copayment levels; Generic drugs (Tier 1), Preferred brand drugs (Tier 2) and Non-Preferred brand drugs (Tier 3). Tier 1 Lowest copayment Generic drugs. Tier 1 includes all generic drugs although not all generic drugs are listed in the Drug Guide. Tier 2 Middle copayment Preferred brand drugs. All Tier 2 drugs are shown in the Drug Guide. Tier 3 Highest copayment Non-Preferred brand drugs. Tier 3 drugs are not shown in the Drug Guide. The Horizon Classic Drug List is an open formulary. This means all FDA approved medicines are included. However, certain drug classes are excluded from coverage. Investigational, cosmetic (such as Propecia for hair growth) and erectile dysfunction (such as Viagra) drugs are excluded (not covered). Coverage, copayment, and additional restrictions and exclusions may vary depending on the individual plan design. Please refer to the policy and benefit information you received from Horizon BCBSNJ. Affordable Care Act Please note, some drugs may have limited or $0 cost-sharing under the Affordable Care Act; examples of categories of drugs 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, tobacco cessation, vitamin D supplements, and some contraceptive drugs and devices. If you do not find the drug you are searching for, consult or contact Horizon BCBSNJ to find out if the drug is available over-the-counter or is covered under your medical benefit. 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. This is called utilization management. Medicines that require (PA), Medical Necessity Review and Determination (MND), a Smart process ( Smart PA) or that are subject to a Quantity Limits (QL) are noted on the drug list. /Medical Necessity Review and Determination Some drugs require (PA) before coverage is approved. Drugs subject to PA require that specific clinical criteria are met to demonstrate the medical necessity of the drug before it is covered under your benefits. Only drugs that are medically necessary are covered, which helps keep the cost of drugs and your benefits lower. If this Drug Guide shows that you need a PA for a certain drug, your doctor must send a PA request form to Horizon BCBSNJ for approval. If the request is not approved, please remember that there is an appeals process available to you and/or you may choose to buy the drug 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. If so, your prescribing doctor may be asked for clinical information to support your use of the drug. In instances where the medical necessity determination (MND) results in an unfavorable decision, please remember such determinations may also be eligible for the appeals process or you may choose to buy the drug at your own expense. Detailed PA/MND information can be found here. Classic Drug Guide April, II

4 Dispensing Limit A Quantity Limit (QL) controls the maximum amount of medicine covered per prescription. It can also identify gender or age restrictions and amount of medicine. Quantity limits are placed in 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 QL, your doctor must submit a PA request to Horizon BCBSNJ for review if he/she wants to exceed the QL 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 to you or you may choose to buy the medicine at your own expense. Detailed DL information can be found here. Smart The Smart ( Smart PA) process applies to certain therapeutic drug classes. If the drug list shows that Smart PA is used for a certain medicine, it requires the previous use of one or more medicines (usually a generic drug) before a different medicine (usually a brand name drug) is covered. The Smart PA process will automatically search for the previous use of one or more of the required generic drugs before the brand name drug will be covered. If that previous use history is present, the request for the brand name drug will be approved automatically. If the Smart PA process applies, you must first use a generic. Or your doctor must submit a PA request to Horizon BCBSNJ stating the clinical reason(s) why you cannot use the generic and that the brand is medically necessary 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 to you or you may choose to buy the medicine at your own expense. Detailed Smart PA information can be found here. pharmaceuticals require special patient monitoring and handling, and unique education prior to use. These specialty medicines also require your doctor to submit a request to Horizon BCBSNJ for review. Horizon BCBSNJ has contracted with select specialty pharmacies that specialize in these therapies. Members who want to minimize their cost-sharing are required to obtain the specialty medicines from a 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 the following webpage: III Classic Drug Guide April,

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 medication list and is an example only. Please use the drug search function to find current information for the drugs on the medication list Key The first column of the chart lists the drug name. Generic drugs are shown in lower-case boldface type. Most generic drugs are followed by a reference brand drug in (parentheses). Some generic products have no reference brand. Brand prescription drugs are shown in capital letters followed by the generic name. The second column indicates if the drug is a specialty drug. The remaining columns indicate the Utilization Management (UM) program(s) that apply to the prescription drug (e.g., /Medical Necessity Determination (PA/MND), and Smart ( Smart PA). If an indicator is present in the column(s), then the UM program applies. caps... 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 guide is subject to change. Please visit our web site, for the most current information. Classic Drug Guide April, IV

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

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

9 AMINOGLYCOSIDES neomycin sulfate tab 500 paromomycin sulfate cap 250 TOBI PODHALER tobramycin inhal cap 28 tobramycin nebu soln 300 /5ml (Tobi) TUBERCULOSIS ethambutol hcl tab 100 (Myambutol) ethambutol hcl tab 400 (Myambutol) isoniazid tab 100 isoniazid tab 300 pyrazinamide tab 500 rifabutin cap 150 (Mycobutin) rifampin cap 150 (Rifadin) rifampin cap 300 (Rifadin) SEROMYCIN cycloserine cap 250 FUNGAL INFECTIONS fluconazole for susp 10 /ml (Diflucan) fluconazole for susp 40 /ml (Diflucan) fluconazole tab 100 (Diflucan) fluconazole tab 150 (Diflucan) fluconazole tab 200 (Diflucan) fluconazole tab 50 (Diflucan) flucytosine cap 250 (Ancobon) flucytosine cap 500 (Ancobon) griseofulvin microsize susp 125 /5ml griseofulvin microsize tab 500 (Grifulvin v) itraconazole cap 100 (Sporanox) NOXAFIL posaconazole susp 40 / ml nystatin tab unit terbinafine hcl tab 250 (Lamisil) voriconazole for susp 40 /ml (Vfend) voriconazole tab 200 (Vfend) voriconazole tab 50 (Vfend) VIRAL INFECTIONS Cytomegalovirus VALCYTE valganciclovir hcl for soln 50 /ml (base equiv) valganciclovir hcl tab 450 (Valcyte) Hepatitis adefovir dipivoxil tab 10 (Hepsera) BARACLUDE entecavir oral soln 0.05 /ml entecavir tab 0.5 (Baraclude) entecavir tab 1 (Baraclude) EPIVIR HBV lamivudine oral soln 5 /ml HARVONI ledipasvir-sofosbuvir tab lamivudine tab 100 (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 (Rebetol) ribavirin tab 200 (Copegus) SOVALDI sofosbuvir tab 400 TYZEKA telbivudine tab 600 Classic Drug Guide April, 3

10 VIEKIRA PAK ombitas-paritapre-riton & dasab tab pak & 250 Herpes acyclovir cap 200 (Zovirax) acyclovir susp 200 /5ml (Zovirax) acyclovir tab 400 (Zovirax) acyclovir tab 800 (Zovirax) famciclovir tab 125 (Famvir) famciclovir tab 250 (Famvir) famciclovir tab 500 (Famvir) valacyclovir hcl tab 1 gm (Valtrex) valacyclovir hcl tab 500 (Valtrex) HIV/AIDS abacavir sulfate tab 300 (base equiv) (Ziagen) abacavir sulfate-lamivudinezidovudine tab (Trizivir) APTIVUS tipranavir cap 250 APTIVUS tipranavir oral soln 100 / ml ATRIPLA efavirenz-emtricitabinetenofovir df tab COMPLERA emtricitabine-rilpivirinetenofovir df tab CRIXIVAN indinavir sulfate cap 200 CRIXIVAN indinavir sulfate cap 400 didanosine delayed release capsule 125 (Videx ec) didanosine delayed release capsule 200 (Videx ec) didanosine delayed release capsule 250 (Videx ec) didanosine delayed release capsule 400 (Videx ec) EDURANT rilpivirine hcl tab 25 (base equivalent) EMTRIVA emtricitabine caps 200 EMTRIVA emtricitabine soln 10 / ml EPZICOM abacavir sulfatelamivudine tab FUZEON enfuvirtide for inj 90 INTELENCE etravirine tab 25 INTELENCE etravirine tab 100 INTELENCE etravirine tab 200 INVIRASE saquinavir mesylate cap 200 INVIRASE saquinavir mesylate tab 500 ISENTRESS raltegravir potassium tab 400 (base equiv) ISENTRESS raltegravir potassium chew tab 25 (base equiv) ISENTRESS raltegravir potassium chew tab 100 (base equiv) ISENTRESS raltegravir potassium packet for susp 100 (base equiv) KALETRA lopinavir-ritonavir tab KALETRA lopinavir-ritonavir tab KALETRA lopinavir-ritonavir soln /5ml (80-20 /ml) lamivudine oral soln 10 /ml (Epivir) lamivudine tab 150 (Epivir) lamivudine tab 300 (Epivir) lamivudine-zidovudine tab (Combivir) LEXIVA fosamprenavir calcium tab 700 (base equiv) LEXIVA fosamprenavir calcium susp 50 /ml (base equiv) 4 Classic Drug Guide April,

11 nevirapine tab sr 24hr 400 (Viramune xr) nevirapine tab 200 (Viramune) NORVIR ritonavir cap 100 NORVIR ritonavir tab 100 NORVIR ritonavir oral soln 80 /ml PREZISTA darunavir ethanolate tab 75 (base equiv) PREZISTA darunavir ethanolate tab 150 (base equiv) PREZISTA darunavir ethanolate tab 600 (base equiv) PREZISTA darunavir ethanolate tab 800 (base equiv) PREZISTA darunavir ethanolate susp 100 /ml (base equiv) RESCRIPTOR delavirdine mesylate tab 100 RESCRIPTOR delavirdine mesylate tab 200 REYATAZ atazanavir sulfate cap 150 (base equiv) REYATAZ atazanavir sulfate cap 200 (base equiv) REYATAZ atazanavir sulfate cap 300 (base equiv) REYATAZ atazanavir sulfate oral powder packet 50 (base equiv) SELZENTRY maraviroc tab 150 SELZENTRY maraviroc tab 300 stavudine cap 15 (Zerit) stavudine cap 20 (Zerit) stavudine cap 30 (Zerit) stavudine cap 40 (Zerit) stavudine for oral soln 1 /ml (Zerit) STRIBILD elvitegrav-cobicisemtricitab-tenofov tab SUSTIVA efavirenz cap 50 SUSTIVA efavirenz cap 200 SUSTIVA efavirenz tab 600 TIVICAY dolutegravir sodium tab 50 (base equiv) TRIUMEQ abacavir-dolutegravirlamivudine tab TRUVADA emtricitabine-tenofovir disoproxil fumarate tab TYBOST cobicistat tab 150 VIDEX didanosine for soln 2 gm VIDEX didanosine for soln 4 gm VIRACEPT nelfinavir mesylate tab 250 VIRACEPT nelfinavir mesylate tab 625 VIRAMUNE XR nevirapine tab sr 24hr 100 VIREAD tenofovir disoproxil fumarate tab 150 VIREAD tenofovir disoproxil fumarate tab 200 VIREAD tenofovir disoproxil fumarate tab 250 VIREAD tenofovir disoproxil fumarate tab 300 VIREAD tenofovir disoproxil fumarate oral powder 40 /gm ZIAGEN abacavir sulfate tab 300 (base equiv) ZIAGEN abacavir sulfate soln 20 / ml (base equiv) zidovudine cap 100 (Retrovir) zidovudine syrup 10 /ml (Retrovir) zidovudine tab 300 MALARIA atovaquone-proguanil hcl tab (Malarone) Classic Drug Guide April, 5

12 atovaquone-proguanil hcl tab (Malarone) chloroquine phosphate tab 250 chloroquine phosphate tab 500 (Aralen) COARTEM artemether-lumefantrine tab DARAPRIM pyrimethamine tab 25 hydroxychloroquine sulfate tab 200 (Plaquenil) mefloquine hcl tab 250 primaquine phosphate tab 26.3 WORM INFECTIONS BILTRICIDE praziquantel tab 600 ivermectin tab 3 (Stromectol) OTHER ANTI-INFECTIVES ALINIA nitazoxanide tab 500 ALINIA nitazoxanide for susp 100 /5ml CAYSTON aztreonam lysine for inhal soln 75 (base equivalent) CLEOCIN clindamycin hcl cap 75 CLEOCIN clindamycin hcl cap 150 CLEOCIN clindamycin hcl cap 300 CLEOCIN PEDIATRIC GRANULE clindamycin palmitate hcl for soln 75 /5ml (base equiv) clindamycin hcl cap 150 (Cleocin) clindamycin hcl cap 300 (Cleocin) clindamycin hcl cap 75 (Cleocin) clindamycin palmitate hcl for soln 75 /5ml (base equiv) (Cleocin pediatric gr) metronidazole tab 250 (Flagyl) metronidazole tab 500 (Flagyl) NEBUPENT pentamidine isethionate for nebulization soln 300 sulfamethoxazole-trimethoprim susp /5ml sulfamethoxazole-trimethoprim tab (Bactrim) sulfamethoxazole-trimethoprim tab (Bactrim ds) trimethoprim tab 100 vancomycin hcl cap 125 (Vancocin hcl) vancomycin hcl cap 250 (Vancocin hcl) XIFAXAN rifaximin tab 550 CANCER DRUGS ACTIMMUNE interferon gamma-1b inj 100 mcg/0.5ml ( unit/0.5ml) AFINITOR everolimus tab 2.5 AFINITOR everolimus tab 5 AFINITOR everolimus tab 7.5 AFINITOR everolimus tab 10 AFINITOR DISPERZ everolimus tab for oral susp 2 AFINITOR DISPERZ everolimus tab for oral susp 3 AFINITOR DISPERZ everolimus tab for oral susp 5 ALKERAN melphalan tab 2 anastrozole tab 1 (Arimidex) bicalutamide tab 50 (Casodex) BOSULIF bosutinib tab 100 BOSULIF bosutinib tab 500 capecitabine tab 150 (Xeloda) capecitabine tab 500 (Xeloda) CAPRELSA vandetanib tab 100 CAPRELSA vandetanib tab 300 CEENU lomustine cap 10 6 Classic Drug Guide April,

13 CEENU lomustine cap 40 CEENU lomustine cap 100 COMETRIQ cabozantinib s-malate cap 3 x 20 (60 dose) kit COMETRIQ cabozantinib s-mal cap 1 x 80 & 1 x 20 (100 dose) kit COMETRIQ cabozantinib s-mal cap 1 x 80 & 3 x 20 (140 dose) kit EMCYT estramustine phosphate sodium cap 140 ERIVEDGE vismodegib cap 150 exemestane tab 25 (Aromasin) FARESTON toremifene citrate tab 60 (base equivalent) flutamide cap 125 GILOTRIF afatinib dimaleate tab 20 (base equivalent) GILOTRIF afatinib dimaleate tab 30 (base equivalent) GILOTRIF afatinib dimaleate tab 40 (base equivalent) GLEEVEC imatinib mesylate tab 100 (base equivalent) GLEEVEC imatinib mesylate tab 400 (base equivalent) HEXALEN altretamine cap 50 HYCAMTIN topotecan hcl cap 0.25 (base equiv) HYCAMTIN topotecan hcl cap 1 (base equiv) hydroxyurea cap 500 (Hydrea) ICLUSIG ponatinib hcl tab 15 (base equiv) ICLUSIG ponatinib hcl tab 45 (base equiv) IMBRUVICA ibrutinib cap 140 INLYTA axitinib tab 1 INLYTA axitinib tab 5 JAKAFI ruxolitinib phosphate tab 5 (base equivalent) JAKAFI ruxolitinib phosphate tab 10 (base equivalent) JAKAFI ruxolitinib phosphate tab 15 (base equivalent) JAKAFI ruxolitinib phosphate tab 20 (base equivalent) JAKAFI ruxolitinib phosphate tab 25 (base equivalent) letrozole tab 2.5 (Femara) leucovorin calcium tab 25 leucovorin calcium tab 5 LEUKERAN chlorambucil tab 2 LYSODREN mitotane tab 500 MATULANE procarbazine hcl cap 50 megestrol acetate susp 40 /ml (Megace oral) megestrol acetate tab 20 megestrol acetate tab 40 MEKINIST trametinib dimethyl sulfoxide tab 0.5 (base equivalent) MEKINIST trametinib dimethyl sulfoxide tab 2 (base equivalent) mercaptopurine tab 50 (Purinethol) MESNEX mesna tab 400 methotrexate sodium tab 2.5 (base equiv) MYLERAN busulfan tab 2 NEXAVAR sorafenib tosylate tab 200 (base equivalent) NILANDRON nilutamide tab 150 POMALYST pomalidomide cap 1 POMALYST pomalidomide cap 2 POMALYST pomalidomide cap 3 Classic Drug Guide April, 7

14 POMALYST pomalidomide cap 4 SPRYCEL dasatinib tab 20 SPRYCEL dasatinib tab 50 SPRYCEL dasatinib tab 70 SPRYCEL dasatinib tab 80 SPRYCEL dasatinib tab 100 SPRYCEL dasatinib tab 140 STIVARGA regorafenib tab 40 SUTENT sunitinib malate cap 12.5 (base equivalent) SUTENT sunitinib malate cap 25 (base equivalent) SUTENT sunitinib malate cap 37.5 (base equivalent) SUTENT sunitinib malate cap 50 (base equivalent) SYLATRON peginterferon alfa-2b for inj kit 296 mcg SYLATRON peginterferon alfa-2b for inj kit 444 mcg SYLATRON peginterferon alfa-2b for inj kit 888 mcg SYLATRON peginterferon alfa-2b for inj kit 4 x 296 mcg SYLATRON peginterferon alfa-2b for inj kit 4 x 444 mcg TABLOID thioguanine tab 40 TAFINLAR dabrafenib mesylate cap 50 (base equivalent) TAFINLAR dabrafenib mesylate cap 75 (base equivalent) tamoxifen citrate tab 10 (base equivalent) tamoxifen citrate tab 20 (base equivalent) TARCEVA erlotinib hcl tab 25 (base equivalent) TARCEVA erlotinib hcl tab 100 (base equivalent) TARCEVA erlotinib hcl tab 150 (base equivalent) TARGRETIN bexarotene cap 75 TASIGNA nilotinib hcl cap 150 (base equivalent) TASIGNA nilotinib hcl cap 200 (base equivalent) temozolomide cap 100 (Temodar) temozolomide cap 140 (Temodar) temozolomide cap 180 (Temodar) temozolomide cap 20 (Temodar) temozolomide cap 250 (Temodar) temozolomide cap 5 (Temodar) tretinoin cap 10 TYKERB lapatinib ditosylate tab 250 (base equiv) VOTRIENT pazopanib hcl tab 200 (base equiv) XALKORI crizotinib cap 200 XALKORI crizotinib cap 250 XTANDI enzalutamide cap 40 ZELBORAF vemurafenib tab 240 (base equivalent) ZOLINZA vorinostat cap 100 ZYDELIG idelalisib tab 100 ZYDELIG idelalisib tab 150 ZYKADIA ceritinib cap 150 ZYTIGA abiraterone acetate tab 250 HORMONES, DIABETES AND RELATED DRUGS CORTICOSTEROIDS budesonide cap sr 24hr 3 (Entocort ec) dexamethasone conc 1 /ml dexamethasone elixir 0.5 /5ml dexamethasone tab 0.5 dexamethasone tab Classic Drug Guide April,

15 dexamethasone tab 1.5 dexamethasone tab 4 dexamethasone tab 6 fludrocortisone acetate tab 0.1 hydrocortisone tab 10 (Cortef) hydrocortisone tab 20 (Cortef) hydrocortisone tab 5 (Cortef) methylprednisolone tab 16 (Medrol) methylprednisolone tab 32 (Medrol) methylprednisolone tab 4 (Medrol) methylprednisolone tab 4 dose pack (Medrol dosepak) methylprednisolone tab 8 (Medrol) prednisolone sod phosph oral soln 6.7 /5ml (5 /5ml base) (Pediapred) prednisolone sod phosphate oral soln 15 /5ml (base equiv) prednisolone sodium phosphate oral soln 25 /5ml (base eq) prednisolone syrup 15 /5ml (usp solution equivalent) (Prelone) prednisone conc 5 /ml prednisone tab 1 prednisone tab 10 prednisone tab 2.5 prednisone tab 20 prednisone tab 5 MALE HORMONES ANDRODERM testosterone td patch 24hr 2 /24hr ANDRODERM testosterone td patch 24hr 4 /24hr danazol cap 100 danazol cap 200 danazol cap 50 TESTIM testosterone td gel 50 /5gm (1%) testosterone cypionate im inj in oil 100 /ml (Depo-testosterone) testosterone cypionate im inj in oil 200 /ml (Depo-testosterone) testosterone enanthate im inj in oil 200 /ml ESTROGENS CLIMARA PRO estradiollevonorgestrel td patch weekly /day ENJUVIA estrogens, conjugated synthetic b tab 0.3 ENJUVIA estrogens, conjugated synthetic b tab 0.45 ENJUVIA estrogens, conjugated synthetic b tab ENJUVIA estrogens, conjugated synthetic b tab 0.9 ENJUVIA estrogens, conjugated synthetic b tab 1.25 estradiol & norethindrone acetate tab (Activella) estradiol & norethindrone acetate tab (Activella) estradiol tab 0.5 (Estrace) estradiol tab 1 (Estrace) estradiol tab 2 (Estrace) estradiol td patch twice weekly /24hr (Vivelle-dot) estradiol td patch twice weekly /24hr (Vivelle-dot) estradiol td patch twice weekly 0.05 /24hr (Vivelle-dot) estradiol td patch twice weekly /24hr (Vivelle-dot) Classic Drug Guide April, 9

16 estradiol td patch twice weekly 0.1 /24hr (Vivelle-dot) estradiol td patch weekly /24hr (Climara) estradiol td patch weekly /24hr (37.5 mcg/24hr) (Climara) estradiol td patch weekly 0.05 /24hr (Climara) estradiol td patch weekly 0.06 /24hr (Climara) estradiol td patch weekly /24hr (Climara) estradiol td patch weekly 0.1 /24hr (Climara) estropipate tab 0.75 PREMPRO conjugated estrogenmedroxyprogest acetate tab PROGESTINS medroxyprogesterone acetate tab 10 (Provera) medroxyprogesterone acetate tab 2.5 (Provera) medroxyprogesterone acetate tab 5 (Provera) MEGACE ES megestrol acetate susp 625 /5ml norethindrone acetate tab 5 (Aygestin) progesterone micronized cap 100 (Prometrium) estropipate tab 1.5 PREMARIN estrogens, conjugated tab 0.3 progesterone micronized cap 200 (Prometrium) BIRTH CONTROL PREMARIN estrogens, conjugated tab 0.45 PREMARIN estrogens, conjugated tab PREMARIN estrogens, conjugated tab 0.9 PREMARIN estrogens, conjugated tab 1.25 PREMARIN estrogens, conjugated for inj 25 PREMPHASE conj est 0.625(14)/conj est-medroxypro ac tab (14) PREMPRO conjugated estrogenmedroxyprogest acetate tab DEPO-SUBQ PROVERA 104 medroxyprogesterone acetate subcutaneous susp 104 /0.65ml desogest-eth estrad & eth estrad tab /0.01 (21/5) (Mircette) desogest-ethin est tab / / (Cyclessa) desogestrel & ethinyl estradiol tab mcg (Desogen) drospirenone-ethinyl estradiol tab (Yaz) drospirenone-ethinyl estradiol tab (Yasmin 28) ELLA ulipristal acetate tab 30 PREMPRO conjugated estrogenmedroxyprogest acetate tab PREMPRO conjugated estrogenmedroxyprogest acetate tab ethynodiol diacetate & ethinyl estradiol tab 1-35 mcg levonorg-eth est tab (84) & eth est tab 0.01(7) (Loseasonique) 10 Classic Drug Guide April,

17 levonorg-eth est tab (84) & eth est tab 0.01(7) (Seasonique) norethindrone ace & ethinyl estradiol-fe tab 1-20 mcg (Loestrin fe 1/20) levonorgestrel & ethinyl estradiol (91-day) tab levonorgestrel & ethinyl estradiol tab mcg norethindrone ace & ethinyl estradiol-fe tab mcg (Loestrin fe 1.5/30) norethindrone tab 0.35 (Nor-qd) levonorgestrel & ethinyl estradiol tab mcg levonorgestrel tab 0.75 (Plan b) levonorgestrel tab 1.5 (Plan b one-step) levonorgestrel-eth estra tab / / mcg LO LOESTRIN FE norethin-eth estradiol-fe tab 1-10 mcg (24)/10 mcg (2) medroxyprogesterone acetate im susp 150 /ml (Depo-provera contrac) norelgestromin-ethinyl estradiol td ptwk mcg/24hr (Ortho evra) norethindrone & ethinyl estradiol tab mcg (Ovcon-35) norethindrone & ethinyl estradiol tab mcg (Brevicon-28) norethindrone & ethinyl estradiol tab 1-35 mcg (Norinyl 1+35) norethindrone & ethinyl estradiol-fe chew tab mcg (Femcon fe) norethindrone ac-ethinyl estradfe tab 1-20/1-30/1-35 -mcg (Estrostep fe) norethindrone ace & ethinyl estradiol tab 1-20 mcg (Loestrin 1/20-21) norethindrone ace & ethinyl estradiol tab mcg (Loestrin 1.5/30-21) norethindrone-eth estradiol tab / /1-35 -mcg (Orthonovum 7/7/7) norethindrone-eth estradiol tab /1-35/ mcg (Trinorinyl 28) norgestimate & ethinyl estradiol tab mcg (Ortho-cyclen) norgestimate-eth estrad tab / / mcg (Ortho tri-cyclen) norgestrel & ethinyl estradiol tab mcg NUVARING etonogestrel-ethinyl estradiol va ring /24hr ORTHO TRI-CYCLEN LO norgestimate-eth estrad tab / / mcg PLAN B levonorgestrel tab 0.75 INFERTILITY BRAVELLE urofollitropin purified for inj 75 unit chorionic gonadotropin for inj unit clomiphene citrate tab 50 (Clomid) FOLLISTIM AQ follitropin beta inj 75 unit/0.5ml FOLLISTIM AQ follitropin beta inj 150 unit/0.5ml FOLLISTIM AQ follitropin beta inj 300 unit/0.36ml FOLLISTIM AQ follitropin beta inj 600 unit/0.72ml Classic Drug Guide April, 11

18 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 LUPRON DEPOT-PED leuprolide acetate for inj pediatric kit LUPRON DEPOT-PED leuprolide acetate for inj pediatric kit 15 LUPRON DEPOT-PED leuprolide acetate (3 month) for inj pediatric kit LUPRON DEPOT-PED leuprolide acetate (3 month) for inj pediatric kit 30 MENOPUR menotropins for subcutaneous inj 75 unit REPRONEX menotropins for inj 75 unit SYNAREL nafarelin acetate nasal soln 2 /ml DIABETES acarbose tab 100 (Precose) acarbose tab 25 (Precose) acarbose tab 50 (Precose) BYDUREON exenatide extended release for susp pen-injector 2 BYDUREON exenatide extended release for inj susp 2 BYETTA exenatide soln pen-injector 5 mcg/0.02ml BYETTA exenatide soln pen-injector 10 mcg/0.04ml glimepiride tab 1 (Amaryl) glimepiride tab 2 (Amaryl) glimepiride tab 4 (Amaryl) glipizide tab sr 24hr 10 (Glucotrol xl) glipizide tab sr 24hr 2.5 (Glucotrol xl) glipizide tab sr 24hr 5 (Glucotrol xl) glipizide tab 10 (Glucotrol) glipizide tab 5 (Glucotrol) glipizide-metformin hcl tab glipizide-metformin hcl tab glipizide-metformin hcl tab GLUCAGEN glucagon hcl (rdna) for inj 1 (base equiv) GLUCAGEN HYPOKIT glucagon hcl (rdna) for inj 1 (base equiv) GLUCAGON EMERGENCY KIT glucagon (rdna) for inj kit 1 glyburide micronized tab 1.5 (Glynase) glyburide micronized tab 3 (Glynase) glyburide micronized tab 6 (Glynase) glyburide tab 1.25 glyburide tab 2.5 glyburide tab 5 glyburide-metformin tab (Glucovance) glyburide-metformin tab (Glucovance) glyburide-metformin tab (Glucovance) GLYSET miglitol tab 25 GLYSET miglitol tab 50 GLYSET miglitol tab 100 INVOKAMET canagliflozin-metformin hcl tab INVOKAMET canagliflozin-metformin hcl tab Classic Drug Guide April,

19 INVOKAMET canagliflozin-metformin hcl tab INVOKAMET canagliflozin-metformin hcl tab INVOKANA canagliflozin tab 100 INVOKANA canagliflozin tab 300 JANUMET sitagliptin-metformin hcl tab JANUMET sitagliptin-metformin hcl tab JANUMET XR sitagliptin-metformin hcl tab sr 24hr JANUMET XR sitagliptin-metformin hcl tab sr 24hr JANUMET XR sitagliptin-metformin hcl tab sr 24hr JANUVIA sitagliptin phosphate tab 25 (base equiv) JANUVIA sitagliptin phosphate tab 50 (base equiv) JANUVIA sitagliptin phosphate tab 100 (base equiv) JARDIANCE empagliflozin tab 10 JARDIANCE empagliflozin tab 25 KOMBIGLYZE XR saxagliptinmetformin hcl tab sr 24hr KOMBIGLYZE XR saxagliptinmetformin hcl tab sr 24hr KOMBIGLYZE XR saxagliptinmetformin hcl tab sr 24hr KORLYM mifepristone tab 300 metformin hcl tab sr 24hr 500 (Glucophage xr) metformin hcl tab sr 24hr 750 (Glucophage xr) metformin hcl tab 1000 (Glucophage) metformin hcl tab 500 (Glucophage) metformin hcl tab 850 (Glucophage) nateglinide tab 120 (Starlix) nateglinide tab 60 (Starlix) ONGLYZA saxagliptin hcl tab 2.5 (base equiv) ONGLYZA saxagliptin hcl tab 5 (base equiv) pioglitazone hcl tab 15 (base equiv) (Actos) pioglitazone hcl tab 30 (base equiv) (Actos) pioglitazone hcl tab 45 (base equiv) (Actos) pioglitazone hcl-metformin hcl tab (Actoplus met) pioglitazone hcl-metformin hcl tab (Actoplus met) repaglinide tab 0.5 (Prandin) repaglinide tab 1 (Prandin) repaglinide tab 2 (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) VICTOZA liraglutide soln pen-injector 18 /3ml (6 /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 NOVOLOG PENFILL insulin aspart inj 100 unit/ml Classic Drug Guide April, 13

20 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 isophane (human) inj 100 unit/ml NOVOLIN N RELION insulin isophane (human) inj 100 unit/ml NOVOLIN N U-100 insulin isophane (human) inj 100 unit/ml NOVOLIN 70/30 insulin isophane & regular (human) inj 100 unit/ml (70-30) NOVOLIN 70/30 RELION insulin isophane & regular (human) inj 100 unit/ml (70-30) ARMOUR THYROID thyroid tab 60 (1 grain) ARMOUR THYROID thyroid tab 90 (1 1/2 grain) ARMOUR THYROID thyroid tab 120 (2 grain) ARMOUR THYROID thyroid tab 180 (3 grain) ARMOUR THYROID thyroid tab 240 (4 grain) ARMOUR THYROID thyroid tab 300 (5 grain) CYTOMEL liothyronine sodium tab 5 mcg CYTOMEL liothyronine sodium tab 25 mcg CYTOMEL liothyronine sodium tab 50 mcg 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 peninj 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 FLEXPEN insulin detemir soln pen-injector 100 unit/ml LEVEMIR FLEXTOUCH insulin detemir soln pen-injector 100 unit/ml THYROID REGULATION 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 25 mcg (Synthroid) levothyroxine sodium tab 300 mcg (Synthroid) ARMOUR THYROID thyroid tab 15 (1/4 grain) levothyroxine sodium tab 50 mcg (Synthroid) ARMOUR THYROID thyroid tab 30 (1/2 grain) levothyroxine sodium tab 75 mcg (Synthroid) 14 Classic Drug Guide April,

21 levothyroxine sodium tab 88 mcg (Synthroid) THYROLAR-1/4 liotrix (t3-t4) tab 15 ( mcg) liothyronine sodium tab 25 mcg (Cytomel) THYROLAR-2 liotrix (t3-t4) tab 120 ( mcg) liothyronine sodium tab 5 mcg (Cytomel) THYROLAR-3 liotrix (t3-t4) tab 180 ( mcg) liothyronine sodium tab 50 mcg (Cytomel) methimazole tab 10 (Tapazole) methimazole tab 5 (Tapazole) propylthiouracil tab 50 SSKI potassium iodide soln 1 gm/ml SYNTHROID 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 THYROLAR-1 liotrix (t3-t4) tab 60 ( mcg) THYROLAR-1/2 liotrix (t3-t4) tab 30 ( mcg) GROWTH HORMONE EGRIFTA tesamorelin acetate for inj 1 (base equiv) EGRIFTA tesamorelin acetate for inj 2 (base equiv) NORDITROPIN CARTRIDGE somatropin inj 5 /1.5ml NORDITROPIN FLEXPRO somatropin inj 5 /1.5ml NORDITROPIN FLEXPRO somatropin inj 10 /1.5ml NORDITROPIN FLEXPRO somatropin inj 15 /1.5ml NORDITROPIN NORDIFLEX PEN somatropin inj 30 /3ml SEROSTIM somatropin (nonrefrigerated) for subcutaneous inj 4 SEROSTIM somatropin (nonrefrigerated) for subcutaneous inj 5 SEROSTIM somatropin (nonrefrigerated) for subcutaneous inj 6 ZORBTIVE somatropin (nonrefrigerated) for subcutaneous inj 8.8 OTHER HORMONES AND RELATED DRUGS ACTONEL risedronate sodium tab 5 ACTONEL risedronate sodium tab 30 ACTONEL risedronate sodium tab 35 Classic Drug Guide April, 15

22 ACTONEL risedronate sodium tab 150 alendronate sodium tab 10 alendronate sodium tab 35 alendronate sodium tab 5 alendronate sodium tab 70 (Fosamax) cabergoline tab 0.5 calcitonin (salmon) nasal soln 200 unit/act (Miacalcin) 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 (Ddavp) desmopressin acetate tab 0.2 (Ddavp) FORTEO teriparatide (recombinant) inj 600 mcg/2.4ml FORTICAL calcitonin (salmon) nasal soln 200 unit/act ibandronate sodium tab 150 (base equivalent) (Boniva) KUVAN sapropterin dihydrochloride powder packet 100 KUVAN sapropterin dihydrochloride soluble tab 100 levocarnitine oral soln 1 gm/10ml (10%) (Carnitor) levocarnitine tab 330 (Carnitor) LUPRON DEPOT-PED leuprolide acetate for inj pediatric kit 7.5 LUPRON DEPOT-PED leuprolide acetate for inj pediatric kit LUPRON DEPOT-PED leuprolide acetate for inj pediatric kit 15 METHERGINE methylergonovine maleate tab 0.2 methylergonovine maleate tab 0.2 octreotide acetate inj 100 mcg/ml (0.1 /ml) (Sandostatin) octreotide acetate inj 1000 mcg/ml (1 /ml) (Sandostatin) octreotide acetate inj 200 mcg/ml (0.2 /ml) (Sandostatin) octreotide acetate inj 50 mcg/ml (0.05 /ml) (Sandostatin) octreotide acetate inj 500 mcg/ml (0.5 /ml) (Sandostatin) paricalcitol cap 1 mcg (Zemplar) paricalcitol cap 2 mcg (Zemplar) paricalcitol cap 4 mcg (Zemplar) raloxifene hcl tab 60 (Evista) risedronate sodium tab 150 (Actonel) SAMSCA tolvaptan tab 15 SAMSCA tolvaptan tab 30 SANDOSTATIN LAR DEPOT octreotide acetate for im inj kit 10 SANDOSTATIN LAR DEPOT octreotide acetate for im inj kit 20 SANDOSTATIN LAR DEPOT octreotide acetate for im inj kit 30 SENSIPAR cinacalcet hcl tab 30 (base equiv) SENSIPAR cinacalcet hcl tab 60 (base equiv) 16 Classic Drug Guide April,

23 SENSIPAR cinacalcet hcl tab 90 (base equiv) SOMATULINE DEPOT lanreotide acetate extended release inj 60 /0.2ml SOMATULINE DEPOT lanreotide acetate extended release inj 90 /0.3ml SOMATULINE DEPOT lanreotide acetate extended release inj 120 /0.5ml SOMAVERT pegvisomant for inj 10 (as protein) SOMAVERT pegvisomant for inj 15 (as protein) SOMAVERT pegvisomant for inj 20 (as protein) SOMAVERT pegvisomant for inj 25 (as protein) SOMAVERT pegvisomant for inj 30 (as protein) HEART AND CIRCULATORY DRUGS ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITORS AND COMBINATIONS benazepril & hydrochlorothiazide tab (Lotensin hct) benazepril & hydrochlorothiazide tab (Lotensin hct) benazepril & hydrochlorothiazide tab (Lotensin hct) benazepril & hydrochlorothiazide tab benazepril hcl tab 10 (Lotensin) benazepril hcl tab 20 (Lotensin) benazepril hcl tab 40 (Lotensin) benazepril hcl tab 5 captopril tab 100 captopril tab 12.5 captopril tab 25 captopril tab 50 enalapril maleate & hydrochlorothiazide tab (Vaseretic) enalapril maleate & hydrochlorothiazide tab enalapril maleate tab 10 (Vasotec) enalapril maleate tab 2.5 (Vasotec) enalapril maleate tab 20 (Vasotec) enalapril maleate tab 5 (Vasotec) fosinopril sodium & hydrochlorothiazide tab fosinopril sodium & hydrochlorothiazide tab fosinopril sodium tab 10 fosinopril sodium tab 20 fosinopril sodium tab 40 lisinopril & hydrochlorothiazide tab (Zestoretic) lisinopril & hydrochlorothiazide tab (Zestoretic) lisinopril & hydrochlorothiazide tab (Zestoretic) lisinopril tab 10 (Prinivil) lisinopril tab 2.5 (Zestril) lisinopril tab 20 (Prinivil) lisinopril tab 30 (Zestril) lisinopril tab 40 (Zestril) lisinopril tab 5 (Prinivil) moexipril hcl tab 15 (Univasc) moexipril hcl tab 7.5 (Univasc) moexipril-hydrochlorothiazide tab (Uniretic) moexipril-hydrochlorothiazide tab moexipril-hydrochlorothiazide tab Classic Drug Guide April, 17

24 perindopril erbumine tab 2 perindopril erbumine tab 4 (Aceon) perindopril erbumine tab 8 (Aceon) quinapril hcl tab 10 (Accupril) quinapril hcl tab 20 (Accupril) quinapril hcl tab 40 (Accupril) quinapril hcl tab 5 (Accupril) quinapril-hydrochlorothiazide tab (Accuretic) quinapril-hydrochlorothiazide tab (Accuretic) quinapril-hydrochlorothiazide tab (Accuretic) ramipril cap 1.25 (Altace) ramipril cap 10 (Altace) ramipril cap 2.5 (Altace) ramipril cap 5 (Altace) trandolapril tab 1 (Mavik) trandolapril tab 2 (Mavik) trandolapril tab 4 (Mavik) ANGIOTENSIN II RECEPTOR ANTAGONISTS (ARBS) AND COMBINATIONS amlodipine-valsartanhydrochlorothiazide tab (Exforge hct) amlodipine-valsartanhydrochlorothiazide tab (Exforge hct) amlodipine-valsartanhydrochlorothiazide tab (Exforge hct) amlodipine-valsartanhydrochlorothiazide tab (Exforge hct) amlodipine-valsartanhydrochlorothiazide tab (Exforge hct) BENICAR olmesartan medoxomil tab 5 BENICAR olmesartan medoxomil tab 20 BENICAR olmesartan medoxomil tab 40 BENICAR HCT olmesartan medoxomil-hydrochlorothiazide tab BENICAR HCT olmesartan medoxomil-hydrochlorothiazide tab BENICAR HCT olmesartan medoxomil-hydrochlorothiazide tab irbesartan tab 150 (Avapro) irbesartan tab 300 (Avapro) irbesartan tab 75 (Avapro) irbesartan-hydrochlorothiazide tab (Avalide) irbesartan-hydrochlorothiazide tab (Avalide) losartan potassium & hydrochlorothiazide tab (Hyzaar) losartan potassium & hydrochlorothiazide tab (Hyzaar) losartan potassium & hydrochlorothiazide tab (Hyzaar) losartan potassium tab 100 (Cozaar) losartan potassium tab 25 (Cozaar) losartan potassium tab 50 (Cozaar) valsartan tab 160 (Diovan) valsartan tab 320 (Diovan) valsartan tab 40 (Diovan) 18 Classic Drug Guide April,

25 valsartan tab 80 (Diovan) valsartan-hydrochlorothiazide tab (Diovan hct) valsartan-hydrochlorothiazide tab (Diovan hct) valsartan-hydrochlorothiazide tab (Diovan hct) valsartan-hydrochlorothiazide tab (Diovan hct) DUTOPROL metoprolol & hydrochlorothiazide tab sr 24hr DUTOPROL metoprolol & hydrochlorothiazide tab sr 24hr labetalol hcl tab 100 (Trandate) labetalol hcl tab 200 (Trandate) labetalol hcl tab 300 (Trandate) valsartan-hydrochlorothiazide tab (Diovan hct) metoprolol succinate tab sr 24hr 100 (Toprol xl) BETA BLOCKERS AND COMBINATIONS acebutolol hcl cap 200 (Sectral) acebutolol hcl cap 400 (Sectral) atenolol & chlorthalidone tab (Tenoretic 100) atenolol & chlorthalidone tab (Tenoretic 50) atenolol tab 100 (Tenormin) atenolol tab 25 (Tenormin) atenolol tab 50 (Tenormin) bisoprolol & hydrochlorothiazide tab (Ziac) bisoprolol & hydrochlorothiazide tab (Ziac) bisoprolol & hydrochlorothiazide tab (Ziac) metoprolol succinate tab sr 24hr 200 (Toprol xl) metoprolol succinate tab sr 24hr 25 (Toprol xl) metoprolol succinate tab sr 24hr 50 (Toprol xl) metoprolol tartrate tab 100 (Lopressor) metoprolol tartrate tab 25 metoprolol tartrate tab 50 (Lopressor) nadolol tab 20 (Corgard) nadolol tab 40 (Corgard) nadolol tab 80 (Corgard) pindolol tab 10 pindolol tab 5 bisoprolol fumarate tab 10 (Zebeta) propranolol hcl cap sr 24hr 120 (Inderal la) bisoprolol fumarate tab 5 (Zebeta) propranolol hcl cap sr 24hr 160 (Inderal la) carvedilol tab 12.5 (Coreg) carvedilol tab 25 (Coreg) carvedilol tab (Coreg) carvedilol tab 6.25 (Coreg) DUTOPROL metoprolol & hydrochlorothiazide tab sr 24hr propranolol hcl cap sr 24hr 60 (Inderal la) propranolol hcl cap sr 24hr 80 (Inderal la) propranolol hcl tab 10 propranolol hcl tab 20 propranolol hcl tab 40 Classic Drug Guide April, 19

26 propranolol hcl tab 60 propranolol hcl tab 80 CALCIUM CHANNEL BLOCKERS AND COMBINATIONS amlodipine besylate tab 10 (Norvasc) amlodipine besylate tab 2.5 (Norvasc) amlodipine besylate tab 5 (Norvasc) amlodipine besylate-benazepril hcl cap (Lotrel) amlodipine besylate-benazepril hcl cap (Lotrel) amlodipine besylate-benazepril hcl cap (Lotrel) amlodipine besylate-benazepril hcl cap 5-10 (Lotrel) diltiazem hcl coated beads cap sr 24hr 300 (Cardizem cd) diltiazem hcl coated beads cap sr 24hr 360 (Cardizem cd) diltiazem hcl extended release beads cap sr 24hr 120 (Tiazac) diltiazem hcl extended release beads cap sr 24hr 180 (Tiazac) diltiazem hcl extended release beads cap sr 24hr 240 (Tiazac) diltiazem hcl extended release beads cap sr 24hr 300 (Tiazac) diltiazem hcl extended release beads cap sr 24hr 360 (Tiazac) diltiazem hcl extended release beads cap sr 24hr 420 (Tiazac) diltiazem hcl tab 120 (Cardizem) diltiazem hcl tab 30 (Cardizem) amlodipine besylate-benazepril hcl cap 5-20 (Lotrel) amlodipine besylate-benazepril hcl cap 5-40 (Lotrel) amlodipine besylate-valsartan tab (Exforge) amlodipine besylate-valsartan tab (Exforge) amlodipine besylate-valsartan tab (Exforge) amlodipine besylate-valsartan tab (Exforge) diltiazem hcl cap sr 24hr 120 diltiazem hcl cap sr 24hr 180 diltiazem hcl cap sr 24hr 240 diltiazem hcl coated beads cap sr 24hr 120 (Cardizem cd) diltiazem hcl coated beads cap sr 24hr 180 (Cardizem cd) diltiazem hcl coated beads cap sr 24hr 240 (Cardizem cd) diltiazem hcl tab 60 (Cardizem) diltiazem hcl tab 90 felodipine tab sr 24hr 10 felodipine tab sr 24hr 2.5 felodipine tab sr 24hr 5 nifedipine tab sr 24hr osmotic 30 (Procardia xl) nifedipine tab sr 24hr osmotic 60 (Procardia xl) nifedipine tab sr 24hr osmotic 90 (Procardia xl) nifedipine tab sr 24hr 30 (Adalat cc) nifedipine tab sr 24hr 60 (Adalat cc) nifedipine tab sr 24hr 90 (Adalat cc) verapamil hcl cap sr 24hr 120 (Verelan) verapamil hcl cap sr 24hr 180 (Verelan) 20 Classic Drug Guide April,