How to Search. For PC Users: Hold down the Ctrl and F keys at the same time, or click on the Binoculars icon, to open the search pane.

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1 To help make the use of prescription drugs safer and more affordable, our plan is now using a Drug Quantity Management program (Quantity Limits or QL). That is, for certain medications, you can receive an amount of medication to last you a certain number of days. This gives you the right amount to take and a daily dose that is considered safe and effective, according to the recommendations of the U.S. Food and Drug Administration (FDA). Based on the FDA s guidelines and other medical information, our plan developed this program together with Express Scripts, the company chosen to manage our prescription drug benefit. The following limits are based on a 30-day supply. If your benefit plan allows for additional days supply, your limits may be higher. For instance, you may be able to get a 90-day supply. How to Search For PC Users: Hold down the Ctrl and F keys at the same time, or click on the Binoculars icon, to open the search pane. For Mac Users: Hold down the Command and F keys at the same time, or click on the Binoculars icon, to open the search pane. Please Note: Medications listed on this Quantity Limits list may not be included in your pharmacy benefit coverage. Quantity limits are based on dose and packaging. Refer to the 2017 Formulary Guide for a list of covered medications and pharmacy benefit coverage descriptions. The quantity limits below, displayed in the center column titled Maximum Quantity, apply to both the BRAND medication (left column) and the generic equivalent (right column). Drug Target Maximum Quantity Generic Name ABILIFY 2 MG TABLET 30 tablets per prescription aripiprazole ABILIFY 5 MG TABLET 30 tablets per prescription aripiprazole ABILIFY 10 MG TABLET 30 tablets per prescription aripiprazole ABILIFY 15 MG TABLET 30 tablets per prescription aripiprazole ABILIFY 20 MG TABLET 30 tablets per prescription aripiprazole ABILIFY 30 MG TABLET 30 tablets per prescription aripiprazole ABILIFY DISCMELT 10 MG TABLET 60 tablets per prescription aripiprazole ABILIFY DISCMELT 15 MG TABLET 60 tablets per prescription aripiprazole ACTIQ 200 MCG LOZENGE 90 units per 30 days fentanyl citrate ACTIQ 400 MCG LOZENGE 90 units per 30 days fentanyl citrate ACTIQ 600 MCG LOZENGE 90 units per 30 days fentanyl citrate ACTIQ 800 MCG LOZENGE 90 units per 30 days fentanyl citrate ACTIQ 1,200 MCG LOZENGE 90 units per 30 days fentanyl citrate ACTIQ 1,600 MCG LOZENGE 90 units per 30 days fentanyl citrate ACTONEL 150 MG TABLET 1 tablet per 30 days risedtronate sodium

2 ACTONEL 5 MG TABLET 30 tablets per prescription risedtronate sodium ACTONEL 30 MG TABLET 30 tablets per prescription risedtronate sodium ACTONEL 35 MG TABLET 4 tablets per 28 days risedtronate sodium ACTONEL 75 MG TABLET 2 tablet per 30 days risedtronate sodium ACTONEL WITH CALCIUM TABLETS 1 (28 day) Blister Package per prescription risedtronate sodium ACTOPLUS MET 15 MG-500 MG TAB 90 tablets per prescription pioglitazone/metformin HCL ACTOPLUS MET 15 MG-850 MG TAB 90 tablets per prescription pioglitazone/metformin HCL ACTOPLUS MET XR 15-1,000 MG TB 60 tablets per prescription pioglitazone/metformin HCL ACTOPLUS MET XR 30-1,000 MG TB 30 tablets per prescription pioglitazone/metformin HCL ACTOS 15 MG TABLET 30 tablets per prescription pioglitazone HCL ACTOS 30 MG TABLET 30 tablets per prescription pioglitazone HCL ACTOS 45 MG TABLET 30 tablets per prescription pioglitazone HCL ADCIRCA 20 MG TABLET 60 tablets per prescription tadalfil ADVAIR DISKUS 1 device (60 blisters) per prescription fluticasone/salmeterol ADVAIR DISKUS 1 device (60 blisters) per prescription fluticasone/salmeterol ADVAIR DISKUS 1 device (60 blisters) per prescription fluticasone/salmeterol ADVAIR HFA (60) MCG INHALER 1 inhaler per prescription fluticasone/ salmeterol ADVAIR HFA (120) MCG INHALER 1 inhaler per prescription fluticasone/ salmeterol ADVAIR HFA (60) MCG INHALER 1 inhaler per prescription fluticasone/ salmeterol ADVAIR HFA (120) MCG INHALER 1 inhaler per prescription fluticasone/salmeterol ADVAIR HFA (60) MCG INHALER 1 inhaler per prescription fluticasone/ salmeterol ADVAIR HFA (120) MCG INHALER 1 inhaler per prescription fluticasone/salmeterol ADVICOR 500 MG-20 MG TABLET 30 tablets per prescription lovastatin/ niacin ADVICOR 750 MG-20 MG TABLET 60 tablets per prescription lovastatin/ niacin ADVICOR 1,000 MG-20 MG TABLET 60 tablets per prescription lovastatin/ niacin AEROBID/AEROBID-M 3 inhalers per prescription flunisolide AEROSPAN 80 MCG INHALER 18 g (2 inhalers, 8.9 g each) per prescription flunisolide AFINITOR 2.5 MG TABLET 30 tablets per prescription everolimus AFINITOR 5 MG TABLET 30 tablets per prescription everolimus AFINITOR 7.5 MG TABLET 30 tablets per prescription everolimus AFINITOR 10 MG TABLET 30 tablets per prescription everolimus AKYNZEO 300/0.5MG CAPSULE 1 capsule per chemotherapy course netupitant/palonosetron HCl ALECENSA 150 MG CAPSULE 240 capsules per prescription alectinib HCl ALLEGRA ALLERGY 12 HR 60 MG 60 tablets per prescription fexofenadine HCl ALLEGRA ALLERGY 24 HR 180 MG 30 tablets per prescription fexofenadine HCl ALLEGRA CHILDREN'S ALLERGY 30 MG TABLET 60 tablets per prescription fexofenadine HCl ALLEGRA-D 12 HOUR ALLERGY & CONGESTION 60 tablets per prescription fexofenadine/pseudophedri ALLEGRA-D 24 HOUR ALLERGY & CONGESTION 30 tablets per prescription fexofenadine/pseudophedri ALORA MG PATCH 8 patches per 28 days estradiol ALORA 0.05 MG PATCH 8 patches per 28 days estradiol

3 ALORA MG PATCH 8 patches per 28 days estradiol ALORA 0.1 MG PATCH 8 patches per 28 days estradiol ALOXI 0.25 MG/5 ML VIAL 1 vial per prescription palonosetron HCl ALSUMA 6 MG/0.5 ML AUTO-INJECT 1 kit/2 syringes per prescription sumatriptan succinate ALTOPREV 20 MG TABLET 30 tablets per prescription lovastatin ALTOPREV 40 MG TABLET 30 tablets per prescription lovastatin ALTOPREV 60 MG TABLET 30 tablets per prescription lovastatin AMBIEN 5 MG TABLET 30 tablets per prescription zolpidem tartrate AMBIEN 10 MG TABLET 30 tablets per prescription zolpidem tartrate AMBIEN CR 6.25 MG TABLET 30 tablets per prescription zolpidem tartrate AMBIEN CR 12.5 MG TABLET 30 tablets per prescription zolpidem tartrate AMERGE 1 MG TABLET 9 tablets per prescription naratriptan HCl AMERGE 2.5 MG TABLET 9 tablets per prescription naratriptan HCl ANORO ELLIPTA 62.5/25 MCG 14 blisters (institutional pack) per prescription umeclidinium/vilanterol ANORO ELLIPTA 62.5/25 MCG 60 blisters per prescription umeclidinium/vilanterol ANZEMET 50 MG TABLET 3 tablet per prescription dolasetron mesylate ANZEMET 100 MG TABLET 3 tablet per prescription dolasetron mesylate APLENZIN ER 174 MG TABLET 30 tablets per prescription bupropion HBr APLENZIN ER 348 MG TABLET 30 tablets per prescription bupropion HBr APLENZIN ER 522 MG TABLET 30 tablets per prescription bupropion HBr ARAVA 10 MG TABLET 30 tablets per prescription leflunomide ARAVA 20 MG TABLET 30 tablets per prescription leflunomide ARCAPTA NEOHALER 75 MCG CAP 1 package (30 capsules) per prescription indacaterol maleate ARNUITY ELLIPTA 100 MCG INHALER 1 inhaler (30 blisters OR 14 blisters institutional pack) per presciption fluticasone furoate ARNUITY ELLIPTA 200 MCG INHALER 1 inhaler (30 blisters OR 14 blisters institutional pack) per presciption fluticasone furoate ASMANEX HFA 100 MCG INHALER 13 g (1 inhaler) per prescription mometasone fuorate ASMANEX HFA 200 MCG INHALER 13 g (1 inhaler) per prescription mometasone fuorate ASMANEX TWISTHALER 110 MCG #7 1 inhaler per prescription mometasone fuorate ASMANEX TWISTHALER 110 MCG #30 1 inhaler per prescription mometasone fuorate ASMANEX TWISTHALER 220 MCG #14 1 inhaler per prescription mometasone fuorate ASMANEX TWISTHALER 220 MCG #30 1 inhaler per prescription mometasone fuorate ASMANEX TWISTHALER 220 MCG #60 1 inhaler per prescription mometasone fuorate ASMANEX TWISTHALR 220 MCG #120 1 inhaler per prescription mometasone fuorate ASTELIN 137 MCG NASAL SPRAY 2 bottles per prescription azelastine HCl ATELVIA 35 MG TABLET 4 tablets per 28 days ridedronate ATROVENT 0.03% SPRAY 1 bottle per prescription ipratropium bromide ATROVENT 0.06% SPRAY 2 bottles per prescription ipratropium bromide ATROVENT HFA INHALER 2 inhalers per prescription ipratropium bromide ATROVENT INHALER 2 inhalers per prescription ipratropium bromide AUVI-Q 0.15 MG 2 units (1 carton) per prescription epinephrine

4 AUVI-Q 0.3 MG 2 units (1 carton) per prescription epinephrine AVANDAMET 2 MG/500 MG TABLET 60 tablets per prescription rosiglitazone/metformin HCL AVANDAMET 2 MG-1,000 MG TAB 60 tablets per prescription rosiglitazone/metformin HCL AVANDAMET 4 MG/500 MG TABLET 60 tablets per prescription rosiglitazone/metformin HCL AVANDAMET 4 MG-1,000 MG TABLET 60 tablets per prescription rosiglitazone/metformin HCL AVANDARYL 4 MG-1 MG TABLET 30 tablets per prescription rosiglitazone/metformin HCL AVANDARYL 4 MG-2 MG TABLET 30 tablets per prescription rosiglitazone/metformin HCL AVANDARYL 4 MG-4 MG TABLET 30 tablets per prescription rosiglitazone/metformin HCL AVANDARYL 8 MG-2 MG TABLET 30 tablets per prescription rosiglitazone/metformin HCL AVANDARYL 8 MG-4 MG TABLET 30 tablets per prescription rosiglitazone/metformin HCL AVANDIA 2 MG TABLET 60 tablets per prescription rosiglitazone AVANDIA 4 MG TABLET 60 tablets per prescription rosiglitazone AVANDIA 8 MG TABLET 30 tablets per prescription rosiglitazone AVINZA 30 MG CAPSULE 60 capsules per 30 days morphine sulfate AVINZA 45 MG CAPSULE 60 capsules per 30 days morphine sulfate AVINZA 60 MG CAPSULE 60 capsules per 30 days morphine sulfate AVINZA 75 MG CAPSULE 60 capsules per 30 days morphine sulfate AVINZA 90 MG CAPSULE 60 capsules per 30 days morphine sulfate AVINZA 120 MG CAPSULE 60 capsules per 30 days morphine sulfate AVONEX ADMIN PACK 30 MCG VL 4 vials per 28 days interferon beta- 1a AVONEX PEN 30 MCG/0.5 ML 1 box (4 pens) per 28 days interferon beta- 1a AVONEX PREFILLED SYR 30 MCG 4 syringes per 28 days interferon beta- 1a AXERT 6.25 MG TABLET 6 tablets per prescription almotriptan AXERT 12.5 MG TABLET 12 tablets per prescription almotriptan BELSOMRA 5 MG TABLET 30 tablets per prescription suvorexant BELSOMRA 10 MG TABLET 30 tablets per prescription suvorexant BELSOMRA 15 MG TABLET 30 tablets per prescription suvorexant BELSOMRA 20 MG TABLET 30 tablets per prescription suvorexant BELBUCA 75 MCG FILM 60 films per presciption buprenorphine HCl BELBUCA 150 MCG FILM 60 films per presciption buprenorphine HCl BELBUCA 300 MCG FILM 60 films per presciption buprenorphine HCl BELBUCA 450 MCG FILM 60 films per presciption buprenorphine HCl BELBUCA 600 MCG FILM 60 films per presciption buprenorphine HCl BELBUCA 750 MCG FILM 60 films per presciption buprenorphine HCl BELBUCA 900 MCG FILM 60 films per presciption buprenorphine HCl BETASERON 0.3 MG KIT 14 vials per 30 days interferon beta- 1b BETHKIS 300 MG/4 ML AMPULE 56 ampules per prescription tobramycin BEVESPI AEROSPHERE 1 canister (120 inhalations per canister) per prescription glycopyrrolate and formoterol fumarate BINOSTO 70 MG TABLET EFF 4 tablets per 28 days alendronate BOSULIF 100 MG TABLET 120 tablets per prescription bosutinib

5 BONIVA 150 MG TABLET 1 tablet per 30 days ibandronate BOSULIF 500 MG TABLET 30 tablets per prescription bosutinib BREO ELLIPTA 100MCG/25MCG #28 28 blisters (1 inhaler) per prescription fluticasone/vilanterol BREO ELLIPTA 100MCG/25MCG #60 60 blisters per prescription fluticasone/vilanterol BREO ELLIPTA 200 MCG/25 MCG, PACKAGE SIZE 28 1 inhaler (28 blisters) flutocasone/vilanterol BREO ELLIPTA 200 MCG/25 MCG, PACKAGE SIZE 60 1 inhaler (60 blisters) fluticasone/vilanterol BRINTELLIX 5 MG TABLET 30 tablets per prescription vortioxetine HBr BRINTELLIX 10 MG TABLET 30 tablets per prescription vortioxetine HBr BRINTELLIX 20 MG TABLET 30 tablets per prescription vortioxetine HBr BRISDELLE 7.5 MG CAPSULE 30 capsules per prescription paroxetine BROVANA 15 MCG/2 ML SOLUTION 2 cartons (60 vials) per prescription arformoterol tartrate BUDEPRION SR 100 MG TABLET 60 tablets per prescription bupropion BUDEPRION SR 150 MG TABLET 60 tablets per prescription bupropion BUDEPRION XL 300 MG TABLET 30 tablets per prescription bupropion XL BUNAVAIL 2.1 MG/0.3 MG FILM 30 films per presciption buprenorphine/naloxone BUNAVAIL 4.2 MG/0.7 MG FILM 60 films per presciption buprenorphine/naloxone BUNAVAIL 6.3 MG/1 MG FILM 60 films per presciption bu[renorphine/naloxone BUTORPHANOL NASAL SPRAY 10 MG/ML 2 bottles per prescription butorphanol tartrate BYDUREON 2 MG PEN 4 Pens (1 package) per prescription exenatide BYDUREON 2 MG VIAL 1 carton (4 single-dose trays) per prescription exenatide BYETTA 5 MCG DOSE PEN INJ 1 syringe per prescription exenatide BYETTA 10 MCG DOSE PEN INJ 1 syringe per prescription exenatide CADUET 2.5 MG-10 MG TABLET 30 tablets per prescription amlodipine/atorvastatin CADUET 2.5 MG-20 MG TABLET 30 tablets per prescription amlodipine/atorvastatin CADUET 2.5 MG-40 MG TABLET 30 tablets per prescription amlodipine/atorvastatin CADUET 5 MG-10 MG TABLET 30 tablets per prescription amlodipine/atorvastatin CADUET 5 MG-20 MG TABLET 30 tablets per prescription amlodipine/atorvastatin CADUET 5 MG-40 MG TABLET 30 tablets per prescription amlodipine/atorvastatin CADUET 5 MG-80 MG TABLET 30 tablets per prescription amlodipine/atorvastatin CADUET 10 MG-10 MG TABLET 30 tablets per prescription amlodipine/atorvastatin CADUET 10 MG-20 MG TABLET 30 tablets per prescription amlodipine/atorvastatin CADUET 10 MG-40 MG TABLET 30 tablets per prescription amlodipine/atorvastatin CADUET 10 MG-80 MG TABLET 30 tablets per prescription amlodipine/atorvastatin CAMBIA 50 MG POWDER PACKET 9 packets per prescription diclofenac potassium CARDURA 1 MG TABLET 30 tablets per prescription doxazosin mesylate CARDURA 2 MG TABLET 30 tablets per prescription doxazosin mesylate CARDURA 4 MG TABLET 30 tablets per prescription doxazosin mesylate CARDURA 8 MG TABLET 60 tablets per prescription doxazosin mesylate CARDURA XL 4 MG TABLET 30 tablets per prescription doxazosin mesylate CARDURA XL 8 MG TABLET 30 tablets per prescription doxazosin mesylate

6 CATAPRES-TTS 1 PATCH 4 patches per 28 days clonidine HCl CATAPRES-TTS 2 PATCH 4 patches per 28 days clonidine HCl CATAPRES-TTS 3 PATCH 4 patches per 28 days clonidine HCl CAYSTON 75 MG INHAL SOLUTION 1 kit (84 vials of aztreonam and 88 vials of dliuent) per prescription aztreonam lysine CELEXA 10 MG TABLET 30 tablets per prescription citalopram HBr CELEXA 20 MG TABLET 30 tablets per prescription citalopram HBr CELEXA 40 MG TABLET 30 tablets per prescription citalopram HBr CESAMET 1 MG PULVULE 30 capsules per prescription nabilone CHILDREN'S QNASAL 40 MCG (4.9 G) 5 grams (1 bottle) per prescription beclamethasone diproprionate CHILD'S CLARITIN 5 MG TAB CHEW 30 tablets per prescription loratidine CHLD ALLEGRA ALLERGY 30 MG ODT 60 tablets per prescription fexofenadine/pseudoephedrine HCl CHOLBAM 50 MG CAPSULE 120 capsules per prescription cholic acid CHORIONIC GONAD 10000U VIAL 3 vials per prescription chorionic gonadotropin CIALIS 2.5 MG TABLET 30 tablets per prescription tadalafil CIALIS 5 MG TABLET 8 tablets per prescription tadalafil CLARINEX 2.5 MG REDITABS 30 tablets per prescription desloratadine CLARINEX 5 MG REDITABS 30 tablets per prescription desloratadine CLARINEX-D 12 HOUR TABLET 60 tablets per prescription desloratadine/pseudoephedrine CLARINEX-D 24 HOUR TABLET 30 tablets per prescription desloratidine/pseudoephedrine CLARITIN 10 MG LIQUI-GEL CAP 30 tablets per prescription loratidine CLARITIN 10 MG REDITABS 30 tablets per prescription loratidine CLARITIN 10 MG TABLET 30 tablets per prescription loratidine CLARITIN-D 12 HOUR TABLET 60 tablets per prescription pseudoephedrine sulfate/loratidine CLARITIN-D 24 HOUR TAB ER 30 tablets per prescription pseudoephedrine sulfate/loratidine CLIMARA MG/DAY PATCH 4 patches per 28 days estradiol CLIMARA MG/DAY PATCH 4 patches per 28 days estradiol CLIMARA 0.05 MG/DAY PATCH 4 patches per 28 days estradiol CLIMARA 0.06/MG DAY PATCH 4 patches per 28 days estradiol CLIMARA MG/DAY PATCH 4 patches per 28 days estradiol CLIMARA 0.1 MG/DAY PATCH 4 patches per 28 days estradiol CLIMARA PRO PATCH 4 patches per 28 days estradiol/levonogestrel COMBIVENT INHALER 2 inhalers per prescription albuterol sulfate/ipratropium COMBIVENT RESPIMAT INHAL SPRAY 2 inhalers per prescription albuterol sulfate/ipratropium CONZIP ER 100 MG CAPSULE 30 tablets per prescription tramadol HCl CONZIP ER 200 MG CAPSULE 30 tablets per prescription tramadol HCl CONZIP ER 300 MG CAPSULE 30 tablets per prescription tramadol HCl COPAXONE 20 MG 1 kit (30 prefilled syringes) per 30 days glatiramer acetate COPAXONE 40 MG/ML SYRINGE 12 syringes per 30 days glatiramer acetate COTELLIC 20 MG TABLET 63 tablets per prescription cobimetinib CRESTOR 5 MG TABLET 30 tablets per prescription rosuvastatin

7 CRESTOR 10 MG TABLET 30 tablets per prescription rosuvastatin CRESTOR 20 MG TABLET 30 tablets per prescription rosuvastatin CRESTOR 40 MG TABLET 30 tablets per prescription rosuvastatin CYMBALTA 20 MG CAPSULE 60 capsules per prescription duloxetine CYMBALTA 30 MG CAPSULE 30 capsules per prescription duloxetine CYMBALTA 60 MG CAPSULE 60 capsules per prescription duloxetine DEPO-PROVERA 150 MG/ML SYRINGE 1 vial/syringe per 30 days progesterone DEPO-SUBQ PROVERA 104 SYRINGE 1 syringe per 30 days progesterone DESVENLAFAXINE ER 50 MG TABLET 30 tablets per prescription desvenlafaxine ER DESVENLAFAXINE ER 100 MG TABLET 30 tablets per prescription desvenlafaxine ER DEXILANT DR 30 MG CAPSULE 30 capsules per prescription dexlansoprazole DEXILANT DR 60 MG CAPSULE 30 capsules per prescription dexlansoprazole DIFLUCAN 150 MG TABLET 2 tablets per prescription fluconazole DIVIGEL 0.25 MG GEL PACKET 30 packets per prescription estradiol DIVIGEL 0.5 MG GEL PACKET 30 packets per prescription estradiol DIVIGEL 1 MG GEL PACKET 30 packets per prescription estradiol DOSTINEX 0.5 MG TABLET 8 tablets per 28 days cabergoline DUETACT 30-2 MG TABLET 30 tablets per prescription glimepiride/pioglitazone HCl DUETACT 30-4 MG TABLET 30 tablets per prescription glimepiride/pioglitazone HCl DULERA 100 MCG/5 MCG INHALER 1 inhaler per prescription formoterol/mometasone DULERA 200 MCG/5 MCG INHALER 1 inhaler per prescription formoterol/mometasone DULERA 200 MCG/5 MCG INHALER 1 inhaler per prescription formoterol/mometasone DUONEB 0.5 MG-3 MG/3 ML SOLN 180 vials (package size 3) per prescription ipratropium bromide/albuterol DYMISTA NASAL SPRAY 1 bottle per prescription azelastine HCl/fluticasone propionate EDLUAR 5 MG SL TABLET 30 tablets per prescription zolpidem tartrate EDLUAR 10 MG SL TABLET 30 tablets per prescription zolpidem tartrate EFFEXOR 25 MG TABLET 90 tablets per prescription venlafaxine HCl EFFEXOR 37.5 MG TABLET 90 tablets per prescription venlafaxine HCl EFFEXOR 50 MG TABLET 90 tablets per prescription venlafaxine HCl EFFEXOR 75 MG TABLET 90 tablets per prescription venlafaxine HCl EFFEXOR 100 MG TABLET 90 tablets per prescription venlafaxine HCl EFFEXOR XR 37.5 MG CAPSULE 30 tablets per prescription venlafaxine HCl XR EFFEXOR XR 75 MG CAPSULE 90 tablets per prescription venlafaxine HCl XR EFFEXOR XR 150 MG CAPSULE 30 tablets per prescription venlafaxine HCl XR ELESTRIN 0.06% GEL 52 grams (2 pumps) per prescription estradiol ELIDEL CREAM 1% 100 grams per 30 days pimecrolimus ELLA 30 MG TABLET 1 tablet (1 dose) per prescription ulipristal acetate EMBEDA MG CAPSULE 90 capsules per 30 days morphine sulfate/naltrexone EMBEDA MG CAPSULE 90 capsules per 30 days morphine sulfate/naltrexone EMBEDA 50-2 MG CAPSULE 90 capsules per 30 days morphine sulfate/naltrexone

8 EMBEDA MG CAPSULE 90 capsules per 30 days morphine sulfate/naltrexone EMBEDA MG CAPSULE 90 capsules per 30 days morphine sulfate/naltrexone EMBEDA MG CAPSULE 90 capsules per 30 days morphine sulfate/naltrexone EMEND 40 MG CAPSULE 1 capsule per prescription aprepitant EMEND 80 MG CAPSULE 2 capsules per prescription aprepitant EMEND 115 MG VIAL 1 vial per prescription aprepitant EMEND 125 MG CAPSULE 1 capsule per prescription aprepitant EMEND 125 MG ORAL SUSPENSION 3 packets per prescription aprepitant EMEND 150 MG VIAL 1 vial per prescription aprepitant EMEND TRIFOLD PACK 1 pack per prescription aprepitant ENBREL 25 MG/0.5 ML SYRINGE 8 vials/syringes per 28 days etanercept ENBREL 50 MG/0.5 ML SYRINGE 4 vials/syringes per 28 days etanercept ENTRESTO 24 MG/26 MG TABLET 60 tablets per prescription sacubitril/valsartan ENTRESTO 49 MG/51 MG TABLET 60 tablets per prescription sacubitril/valsartan ENTRESTO 97 MG/103 MG TABLET 60 tablets per prescription sacubitril/valsartan EPCLUSA 84 tablets per 365 days sofosbuvir and velpatasvir EPINEPHRINE 0.15 MG AUTO-INJCT (TWO PACK) 2 units (1 carton) per prescription epinephrine EPINEPHRINE 0.3 MG AUTO-INJECT (TWO PACK) 2 units (1 carton) per prescription epinephrine EPIPEN 0.3 MG AUTO-INJECTOR 3 units (package size 1), 2 units (package size 2) per prescription epinephrine EPIPEN JR 0.15 MG AUTO-INJCT 3 units(package size 1), 2 units (package size 2) per prescription epinephrine ERIVEDGE 150 MG CAPSULE 30 capsules per prescription vismodegib ESBRIET 267 MG CAPSULE: 14-DAY TITRATION BLISTER PACK 1 pack (63 capsules) per prescription pirfenidone ESBRIET 267 MG CAPSULE 270 capsules per prescription pirfenidone ESBRIET 267 MG CAPSULE: 4-WEEK MAINTENANCE BLISTER PACK 1 carton (252 capsules) per prescription pirfenidone ESOMEPRAZOLE STRONTIUM MG CAPSULE 30 capsules per prescription esomeprazole strontium ESTRADERM 0.05 MG PATCH 8 patches per 28 days estradiol ESTRADERM 0.1 MG PATCH 8 patches per 28 days estradiol ESTRASORB PACKET 56 packets (97.44 g) per prescription estradiol EVAMIST 1.53 MG/SPRAY 2 pumps per prescription estradiol EVZIO 0.4 MG AUTOINJECTOR 1 package (2 devices plus 1 trainer) per prescription naloxone HCl EXALGO ER 8 MG TABLET 60 tablets per 30 days hydromorphone HCl EXALGO ER 12 MG TABLET 60 tablets per 30 days hydromorphone HCl EXALGO ER 16 MG TABLET 60 tablets per 30 days hydromorphone HCl EXALGO ER 32 MG TABLET 60 tablets per 30 days hydromorphone HCl EXTAVIA 0.3 MG KIT 15 blister units/vials per 30 days interferon beta-1b EXTAVIA 0.3MG VIAL 14 or 15 vials with prefilled diluent syringe per 30 days interferon beta-1b FAMVIR 125 MG TABLET 21 tablets per prescription famciclovir FAMVIR 250 MG TABLET 60 tablets per prescription famciclovir FAMVIR 500 MG TABLET 21 tablets per prescription famciclovir FANAPT 1 MG TABLET 60 tablets per prescription iloperidone

9 FANAPT 2 MG TABLET 60 tablets per prescription iloperidone FANAPT 4 MG TABLET 60 tablets per prescription iloperidone FANAPT 6 MG TABLET 60 tablets per prescription iloperidone FANAPT 8 MG TABLET 60 tablets per prescription iloperidone FANAPT 10 MG TABLET 60 tablets per prescription iloperidone FANAPT 12 MG TABLET 60 tablets per prescription iloperidone FANAPT TITRATION PACK 1 pack (8 tablets) per prescription iloperidone FARXIGA 5 MG TABLET 30 tablets per prescription dapagliflozin FARXIGA 10 MG TABLET 30 tablets per prescription dapagliflozin FARYDAK 10 MG CAPSULE 6 capsules per prescription panobinostat FARYDAK 15 MG CAPSULE 6 capsules per prescription panobinostat FARYDAK 20 MG CAPSULE 6 capsules per prescription panobinostat FLECTOR 1.3% PATCH 60 patches per prescription diclofenac epolamine FLONASE 0.05% NASAL SPRAY 1 bottle per prescription fluticasone FLONASE ALLERGY RELIEF 50 MCG SRAY PACKAGE SIZE unit per prescription fluticasone FLONASE ALLERGY RELIEF 50 MCG SRAY PACKAGE SIZE unit per prescription fluticasone FLOVENT 50 MCG ROTADISK 1 inhaler per prescription fluticasone propionate FLOVENT 100 MCG DISKUS 1 inhaler per prescription fluticasone propionate FLOVENT 250 MCG DISKUS 4 inhalers per prescription fluticasone propionate FLOVENT HFA 44 MCG INHALER 1 inhaler per prescription fluticasone propionate FLOVENT HFA 110 MCG INHALER 1 inhaler per prescription fluticasone propionate FLOVENT HFA 220 MCG INHALER 2 inhalers per prescription fluticasone propionate FLUNISOLIDE 0.025% SPRAY 2 inhalers/bottles per prescription flunisolide FLUOCINONIDE OINTMENT, GEL, SOLUTION, OR CREAM EMULSIFIED 120 grams per 30 days fluocinonide FLUOXETINE 10 MG CAPSULE 30 capsules, tablets per prescription fluoxetine FLUOXETINE HCL 40 MG CAPSULE 60 capsules per prescription fluoxetine HCl FLUVOXAMINE 25 MG TABLET 30 capsules per prescription fluvoxamine FLUVOXAMINE 50 MG TABLET 60 capsules per prescription fluvoxamine FLUVOXAMINE 100 MG TABLET 90 capsules per prescription fluvoxamine FORADIL AEROLIZER 12 MCG CAP 1 package (package size 12) (12 capsules) per prescription formoterol fumarate FORADIL AEROLIZER 12 MCG CAP 1 package (package size 60) (60 capsules) per prescription formoterol fumarate FORTEO 600 MCG/2.4 ML PEN INJ 1 pen per 28 days teriparatide FORTIVO XL 450 MG TABLET 30 tablets per prescription bupropion HCl FOSAMAX 5 MG TABLET 30 tablets per prescription alendronate FOSAMAX 10 MG TABLET 30 tablets per prescription alendronate FOSAMAX 35 MG TABLET 4 tablets per 28 days alendronate FOSAMAX 40 MG TABLET 30 tablets per prescription alendronate FOSAMAX 70 MG TABLET 4 tablets per 28 days alendronate FOSAMAX 70 MG/75 ML SOLUTION 4 bottles per 28 days alendronate

10 FOSAMAX PLUS D 70 MG-2,800 IU 4 tablets per 28 days alendronate/vitamin D FOSAMAX PLUS D 70 MG-5,600 IU 4 tablets per 28 days alendronate/vitamin D FROVA 2.5 MG TABLET 9 tablets per prescription frovatriptan GELNIQUE 3% GEL 1 pump per prescription oxybutynin GELNIQUE 10% GEL SACHETS 30 sachets (1 carton) per prescription oxybutynin GEODON 20 MG CAPSULE 60 capsules per prescription ziprasidone GEODON 40 MG CAPSULE 60 capsules per prescription ziprasidone GEODON 60 MG CAPSULE 60 capsules per prescription ziprasidone GEODON 80 MG CAPSULE 60 capsules per prescription ziprasidone GILOTRIF 20 MG TABLET 30 tablets per prescription afatinib GILOTRIF 30 MG TABLET 30 tablets per prescription afatinib GILOTRIF 40 MG TABLET 30 tablets per prescription afatinib GLEEVEC 100 MG TABLET 180 tablets per prescription imatinib mesylate GLEEVEC 400 MG TABLET 60 capsules per prescription imatinib mesylate GLYXAMBI 10 MG/5 MG TABLET 30 tablets per prescription empagliflozin/linagliptin GLYXAMBI 25 MG/5 MG TABLET 30 tablets per prescription empagliflozin/linagliptin GRANISOL 2 MG/10 ML SOLUTION 1 bottle per prescription granisetron HARVONI 400 MG/90 MG TABLET 56 tablets per 365 days sofosbuvir/ledipasvir HUMIRA 10 MG/0.2 ML SYRINGE 2 syringes per 28 days adalimumab HUMIRA 20 MG/0.4 ML SYRINGE 2 syringes per 28 days adalimumab HUMIRA 40 MG/0.8 ML PEN 2 pen per 28 days adalimumab HUMIRA 40 MG/0.8 ML SYRINGE 2 syringes per 28 days adalimumab HUMIRA CROHN'S STARTER PACK 2 syringes per 28 days adalimumab HUMIRA PSORIASIS STARTER PACK 2 syringes per 28 days adalimumab HYSINGLA ER 20 mg tablet 60 tablets per 30 days hydrocodone bitartrate ER HYSINGLA ER 30 mg tablet 60 tablets per 30 days hydrocodone bitartrate ER HYSINGLA ER 40 mg tablet 60 tablets per 30 days hydrocodone bitartrate ER HYSINGLA ER 60 mg tablet 60 tablets per 30 days hydrocodone bitartrate ER HYSINGLA ER 80 mg tablet 60 tablets per 30 days hydrocodone bitartrate ER HYSINGLA ER 100 mg tablet 60 tablets per 30 days hydrocodone bitartrate ER HYSINGLA ER 120 mg tablet 60 tablets per 30 days hydrocodone bitartrate ER HYTRIN 1 MG CAPSULE 30 capsules per prescription terazosin HYTRIN 2 MG CAPSULE 30 capsules per prescription terazosin HYTRIN 5 MG CAPSULE 30 capsules per prescription terazosin HYTRIN 10 MG CAPSULE 60 capsules per prescription terazosin IBRANCE 75 MG CAPSULE 21 capsules per prescription palbociclib IBRANCE 100 MG CAPSULE 21 capsules per prescription palbociclib IBRANCE 125 MG CAPSULE 21 capsules per prescription palbociclib ICLUSIG 15 MG 60 tablets per prescription ponatinib ICLUSIG 45 MG 30 tablets per prescription ponatinib

11 IMITREX 25 MG TABLET 9 tablets per prescription sumatriptan succinate IMITREX 50 MG TABLET 9 tablets per prescription sumatriptan succinate IMITREX 100 MG TABLET 9 tablets per prescription sumatriptan succinate IMITREX 5 MG NASAL SPRAY 6 devices per prescription sumatriptan succinate IMITREX 20 MG NASAL SPRAY 6 devices per prescription sumatriptan succinate IMITREX 4 MG/0.5 ML CARTRIDGES 2 vials per prescription sumatriptan succinate IMITREX 6 MG/0.5 ML CARTRIDGE 2 vials per prescription sumatriptan succinate IMITREX 4 MG/0.5 ML PEN INJECT 1 kit per prescription sumatriptan succinate IMITREX 6 MG/0.5 ML PEN INJECT 1 kit per prescription sumatriptan succinate IMITREX 6 MG/0.5 ML SYRNG KIT 1 kit per prescription sumatriptan succinate IMITREX 6 MG/0.5 ML VIAL 2 vials per prescription sumatriptan succinate INCRUSE ELLIPTA 62.5 MCG INHALER 1 inhaler (30 blisters OR 7 blisters institutional pack) per prescription umeclidinium INLYTA 1 MG TABLET 180 tablets per prescription axitinib INLYTA 5 MG TABLET 120 tablets per prescription axitinib INTERMEZZO 1.75 MG TAB SUBLING 30 tablets per prescription zolpidem tartrate INTERMEZZO 3.5 MG TAB SUBLING 30 tablets per prescription zolpidem tartrate INVEGA ER 1.5 MG TABLET 30 tablets per prescription paliperidone INVEGA ER 3 MG TABLET 30 tablets per prescription paliperidone INVEGA ER 6 MG TABLET 60 tablets per prescription paliperidone INVEGA ER 9 MG TABLET 30 tablets per prescription paliperidone INVOKAMET 50 MG/500 MG TABLET 60 tablets per prescription canagliflozin/metformin HCl INVOKAMET 50 MG/1000 MG TABLET 60 tablets per prescription canagliflozin/metformin HCl INVOKAMET 150 MG/500 MG TABLET 60 tablets per prescription canagliflozin/metformin HCl INVOKAMET 150 MG/1000 MG TABLET 60 tablets per prescription canagliflozin/metformin HCl INVOKANA 100 MG TABLET 30 tablets per prescription canagliflozin INVOKANA 300 MG TABLET 30 tablets per prescription canagliflozin IRENKA (DULOXETINE) 40 MG CAPSULE 30 capsules per prescription duloxetine HCl IRESSA 250 MG TABLET 30 tablets per prescription gefitinib JAKAFI 5 MG TABLET 60 tablets per prescription ruxolitinib JAKAFI 10 MG TABLET 60 tablets per prescription ruxolitinib JAKAFI 15 MG TABLET 60 tablets per prescription ruxolitinib JAKAFI 20 MG TABLET 60 tablets per prescription ruxolitinib JAKAFI 25 MG TABLET 60 tablets per prescription ruxolitinib JANUMET MG TABLET 60 tablets per prescription sitagliptin/metformin HCl JANUMET 50-1,000 MG TABLET 60 tablets per prescription sitagliptin/metformin HCl JANUMET XR MG TABLET 60 tablets per prescription sitagliptin/metformin HCl XR JANUMET XR 50-1,000 MG TABLET 60 tablets per prescription sitagliptin/metformin HCl XR JANUMET XR 100-1,000 MG TABLET 30 tablets per prescription sitagliptin/metformin HCl XR JANUVIA 25 MG TABLET 30 tablets per prescription sitagliptin JANUVIA 50 MG TABLET 30 tablets per prescription sitagliptin

12 JANUVIA 100 MG TABLET 30 tablets per prescription sitagliptin JARDIANCE 10 MG TABLET 30 tablets per prescription empagliflozin JARDIANCE 25 MG TABLET 30 tablets per prescription empagliflozin JENTADUETO 2.5 MG-500 MG TAB 60 tablets per prescription linagliptin/metformin HCl JENTADUETO 2.5 MG-850 MG TAB 60 tablets per prescription linagliptin/metformin HCl JENTADUETO 2.5 MG-1000 MG TAB 60 tablets per prescription linagliptin/metformin HCl JENTADUETO XR 2.5 MG TABLET 60 tablets per prescription linagliptin/metformin JENTADUETO XR 5 MG TABLET 30 tablets per prescription linagliptin/metformin JUVISYNC MG TABLET 30 tablets per prescription simvastatin/sitagliptin JUVISYNC MG TABLET 30 tablets per prescription simvastatin/sitagliptin JUVISYNC MG TABLET 30 tablets per prescription simvastatin/sitagliptin JUVISYNC MG TABLET 30 tablets per prescription simvastatin/sitagliptin JUVISYNC MG TABLET 30 tablets per prescription simvastatin/sitagliptin JUVISYNC MG TABLET 30 tablets per prescription simvastatin/sitagliptin KADIAN ER 10 MG CAPSULE 90 capsules per 30 days morphine sulfate ER KADIAN ER 100 MG CAPSULE 90 capsules per 30 days morphine sulfate ER KADIAN ER 130 MG CAPSULE 90 capsules per 30 days morphine sulfate ER KADIAN ER 150 MG CAPSULE 90 capsules per 30 days morphine sulfate ER KADIAN ER 20 MG CAPSULE 90 capsules per 30 days morphine sulfate ER KADIAN ER 30 MG CAPSULE 90 capsules per 30 days morphine sulfate ER KADIAN ER 40 MG CAPSULE 90 capsules per 30 days morphine sulfate ER KADIAN ER 50 MG CAPSULE 90 capsules per 30 days morphine sulfate ER KADIAN ER 60 MG CAPSULE 90 capsules per 30 days morphine sulfate ER KADIAN ER 70 MG CAPSULE 90 capsules per 30 days morphine sulfate ER KADIAN ER 80 MG CAPSULE 90 capsules per 30 days morphine sulfate ER KADIAN ER 200 MG CAPSULE 90 capsules per 30 days morphine sulfate ER KALYDECO 50 MG GRANULES PACKET 56 packets (1 package) per prescription ivacaftor KALYDECO 75 MG GRANULES PACKET 56 packets (1 package) per prescription ivacaftor KALYDECO 150 MG TABLET 60 tablets per prescription ivacaftor KHEDEZLA 50 MG TABLET 30 tablets per prescription desvenlafaxine ER KHEDEZLA 100 MG TABLET 30 tablets per prescription desvenlafaxine ER KITABIS PACK 300 MG/5 ML SOLUTION 280 ml (1 package) per prescription tobramycin KYTRIL 1 MG TABLET 6 tablets per prescription granisetron KYTRIL 2 MG/10 ML SOLUTION 1 bottle (30 ml) per prescription granisetron LATUDA 20 MG TABLET 30 tablets per prescription lurasidone HCl LATUDA 40 MG TABLET 30 tablets per prescription lurasidone HCl LATUDA 60 MG TABLET 30 tablets per prescription lurasidone HCl LATUDA 80 MG TABLET 60 tablets per prescription lurasidone HCl LATUDA 120 MG TABLET 30 tablets per prescription lurasidone HCl LAZANDA 100 MCG NASAL SPRAY 23 units (1 unit = 1 bottle with 8 sprays) per 30 days fentanyl

13 LAZANDA 400 MCG NASAL SPRAY 23 units (1 unit = 1 bottle with 8 sprays) per 30 days fentanyl LESCOL 20 MG CAPSULE 30 capsules per prescription fluvastatin LESCOL 40 MG CAPSULE 60 capsules per prescription fluvastatin LESCOL XL 80 MG TABLET 30 tablets per prescription fluvastatin LEXAPRO 5 MG TABLET 30 tablets per prescription escitalopram LEXAPRO 10 MG TABLET 30 tablets per prescription escitalopram LEXAPRO 20 MG TABLET 30 tablets per prescription escitalopram LiDOCAINE 2.5%/PRILOCAINE 2.5% CREAM 30 grams per 30 days lidocaine LIDOCAINE JELLY 2% 60 ml per 30 days lidocaine LIDOCAINE OINTMENT One tube, or 50 grams per 30 days lidocaine LIPITOR 10 MG TABLET 30 tablets per prescription atorvastatin LIPITOR 20 MG TABLET 30 tablets per prescription atorvastatin LIPITOR 40 MG TABLET 30 tablets per prescription atorvastatin LIPITOR 80 MG TABLET 30 tablets per prescription atorvastatin LIPTRUZET 10 MG TABLET 30 tablets per prescription ezetimibe/atorvastatin LIPTRUZET 20 MG TABLET 30 tablets per prescription ezetimibe/atorvastatin LIPTRUZET 40 MG TABLET 30 tablets per prescription ezetimibe/atorvastatin LIPTRUZET 80 MG TABLET 30 tablets per prescription ezetimibe/atorvastatin LIVALO 1 MG TABLET 30 tablets per prescription pitavastatin LIVALO 2 MG TABLET 30 tablets per prescription pitavastatin LIVALO 4 MG TABLET 30 tablets per prescription pitavastatin LUNESTA 1 MG TABLET 30 tablets per prescription eszopiclone LUNESTA 2 MG TABLET 30 tablets per prescription eszopiclone LUNESTA 3 MG TABLET 30 tablets per prescription eszopiclone LUVOX CR 100 MG CAPSULE 60 tablets per prescription fluvoxamine maleate CR LUVOX CR 150 MG CAPSULE 60 tablets per prescription fluvoxamine maleate CR MAXAIR AUTOHALER 0.2 MG AERO 1 inhaler per prescription pirbuterol MAXALT 5 MG TABLET 18 tablets per prescription rizatriptan MAXALT 10 MG TABLET 18 tablets per prescription rizatriptan MAXALT MLT 5 MG TABLET 18 tablets per prescription rizatriptan MAXALT MLT 10 MG TABLET 18 tablets per prescription rizatriptan MEKINIST 0.5 MG TABLET 90 tablets per prescription trametinib MEKINIST 2MG TABLET 30 tablets per prescription trametinib MENOSTAR 14 MCG/DAY PATCH 4 patches per 28 days estradiol MEVACOR 10MG TABLET 30 tablets per prescription lovastatin MEVACOR 20 MG TABLET 60 tablets per prescription lovastatin MEVACOR 40 MG TABLET 60 tablets per prescription lovastatin MIGRANAL 4 MG/ML NASAL SPRAY 8 spray devices = 1 kit per prescription dihydroergotamine MINIVELLE MG PATCH 8 patches per 28 days estradiol MINIVELLE 0.05 MG PATCH 8 patches per 28 days estradiol

14 MINIVELLE MG PATCH 8 patches per 28 days estradiol MINIVELLE 0.1 MG PATCH 8 patches per 28 days estradiol MOBIC 7.5 MG TABLET 30 tablets per prescription meloxicam MS CONTIN 200 MG TABLET 120 tablets per 30 days morphine sulfate ER MS CONTIN 15 MG TABLET ORAMORPH SR 15 MG TABLET MS CONTIN 30 MG TABLET SA ORAMORPH SR 30 MG TABLET 120 tablets per 30 days 120 tablets per 30 days morphine sulfate ER morphine sulfate ER MS CONTIN 60 MG TABLET 120 tablets per 30 days ORAMORPH SR 60 MG TABLET morphine sulfate ER MS CONTIN 100 MG TABLET 120 tablets per 30 days ORAMORPH SR 100 MG TABLET morphine sulfate ER NARCAN 4 MG/0.1 NASAL SPRAY 1 pack (2 devices) per prescription naloxone HCl NASACORT AQ NASAL SPRAY 55 MCG 1 bottle per prescription triamcinolone NASONEX 50 MCG NASAL SPRAY 1 bottle per prescription mometasone fuorate NEBUPENT 300 MG INHAL POWDER 1 container (inhaler) per 28 days pentamidine isethionate NESINA 6.25 MG TABLET 30 tablets per prescription alogliptin NESINA 12.5 MG TABLET 30 tablets per prescription alogliptin NESINA 25 MG TABLET 30 tablets per prescription alogliptin NEULASTA 6 MG/0.6 ML SYRINGE 2 syringes per 30 days pegfilgrastim NEXAVAR 200 MG TABLET 120 tablets per prescription sorafenib NEXIUM 2.5 MG PACKET 30 packets per prescription esomeprazole NEXIUM 5 MG PACKET 30 packets per prescription esomeprazole NEXIUM 20 MG CAPSULE 30 capsules per prescription esomeprazole NEXIUM DR 10 MG PACKET 30 packets per prescription esomeprazole NEXIUM DR 20 MG PACKET 30 packets per prescription esomeprazole NINLARO 2.3 MG CAPSULE 30 tablets per prescription ixazomib NINLARO 3 MG CAPSULE 3 capsules per prescription ixazomib NINLARO 4 MG CAPSULE 3 capsules per prescription ixazomib NUCALA 100 MG VIAL 1 vial per 28 days mepolizumab NUCYNTA 50 MG TABLET 181 tablets per prescription tapentadol NUCYNTA 75 MG TABLET 181 tablets per prescription tapentadol NUCYNTA 100 MG TABLET 181 tablets per prescription tapentadol NUCYNTA ER 50 MG TABLET 60 tablets per 30 days tapentadol ER NUCYNTA ER 100 MG TABLET 60 tablets per 30 days tapentadol ER NUCYNTA ER 150 MG TABLET 60 tablets per 30 days tapentadol ER NUCYNTA ER 200 MG TABLET 60 tablets per 30 days tapentadol ER NUCYNTA ER 250 MG TABLET 60 tablets per 30 days tapentadol ER OCALIVA 5 MG TABLET 30 tablets per prescription obeticholic acid

15 OCALIVA 10 MG TABLET 30 tablets per prescription obeticholic acid ODOMZO 200 MG CAPSULE 30 capsules per prescription sonidegib OFEV 100 MG CAPSULE 60 capsules per prescription nintedanib OFEV 150 MG CAPSULE 60 capsules per prescription nintedanib OLYSIO 150 MG CAPSULE 84 tablets per 365 days simeprevir OMECLAMOX-PAK COMBO PACK 80 caps/tabs (10 cards) = 1 combo pack per prescription amoxicillin, clarithromycin, imeprazole ONGLYZA 2.5 MG TABLET 30 tablets per prescription saxagliptin ONGLYZA 5 MG TABLET 30 tablets per prescription saxagliptin ONMEL 200 MG TABLET 15 tablets per prescription itraconazole ONSOLIS 200 MCG SOLUBLE FILM 90 films per 30 days fentanyl ONSOLIS 400 MCG SOLUBLE FILM 90 films per 30 days fentanyl ONSOLIS 600 MCG SOLUBLE FILM 90 films per 30 days fentanyl ONSOLIS 800 MCG SOLUBLE FILM 90 films per 30 days fentanyl ONSOLIS 1,200 MCG SOLUBLE FILM 90 films per 30 days fentanyl ONZENTRA XSAIL 11 MG NOSEPIECE 1 kit (8 doses/16 nose pieces) per prescription sumatriptan nasal powder OPANA ER 5 MG TABLET 90 tablets per 30 days oxymorphone ER OPANA ER 7.5 MG TABLET 90 tablets per 30 days oxymorphone ER OPANA ER 10 MG TABLET 90 tablets per 30 days oxymorphone ER OPANA ER 15 MG TABLET 90 tablets per 30 days oxymorphone ER OPANA ER 20 MG TABLET 90 tablets per 30 days oxymorphone ER OPANA ER 30 MG TABLET 90 tablets per 30 days oxymorphone ER OPANA ER 40 MG TABLET 90 tablets per 30 days oxymorphone ER ORAMORPH SR 15 MG 120 tablets per 30 days morphine sulfate ORAMORPH SR 30 MG 120 tablets per 30 days morphine sulfate ORAMORPH SR 60 MG 120 tablets per 30 days morphine sulfate ORAMORPH SR 100 MG 120 tablets per 30 days morphine sulfate ORKAMBI 200 MCG/125 MG 112 tablets (1 package) lumacaftor/ivacaftor OSENI MG TABLET 30 tablets per prescription alogliptin/pioglitazone OSENI MG TABLET 30 tablets per prescription alogliptin/pioglitazone OSENI MG TABLET 30 tablets per prescription alogliptin/pioglitazone OSENI MG TABLET 30 tablets per prescription alogliptin/pioglitazone OSENI MG TABLET 30 tablets per prescription alogliptin/pioglitazone OSENI MG TABLET 30 tablets per prescription alogliptin/pioglitazone OXYCONTIN 10 MG TABLET 90 tablets per 30 days oxycodone HCl OXYCONTIN 15 MG TABLET 90 tablets per 30 days oxycodone HCl OXYCONTIN 20 MG TABLET 90 tablets per 30 days oxycodone HCl OXYCONTIN 30 MG TABLET 90 tablets per 30 days oxycodone HCl OXYCONTIN 40 MG TABLET 90 tablets per 30 days oxycodone HCl OXYCONTIN 60 MG TABLET 90 tablets per 30 days oxycodone HCl OXYCONTIN 80 MG TABLET 90 tablets per 30 days oxycodone HCl

16 OXYTROL 3.9 MG/24HR PATCH 8 patches per 28 days oxybutynin PATANASE 0.6% NASAL SPRAY 1 bottle per prescription olopatadine HCl PAXIL 10 MG TABLET 30 tablets per prescription paroxetine HCl PAXIL 20 MG TABLET 60 tablets per prescription paroxetine HCl PAXIL 30 MG TABLET 60 tablets per prescription paroxetine HCl PAXIL 40 MG TABLET 30 tablets per prescription paroxetine HCl PAXIL CR 12.5 MG TABLET 60 tablets per prescription paroxetine HCl CR PAXIL CR 25 MG TABLET 60 tablets per prescription paroxetine HCl CR PAXIL CR 37.5 MG TABLET 60 tablets per prescription paroxetine HCl CR PEGASYS 180 MCG/0.5 ML SYRINGE 1 box per 28 days peginterferon alfa-2b PEGASYS 180 MCG/0.5 ML SYRINGE 1 box per 28 days peginterferon alfa-2b PEGASYS 180 MCG/ML VIAL 4 vials per 28 days peginterferon alfa-2b PEGASYS PROCLICK 135 MCG/0.5 1 box per 28 days peginterferon alfa-2b PEGASYS PROCLICK 180 MCG/0.5 1 box per 28 days peginterferon alfa-2b PEGINTRON Redipen 150 MCG 4 pens per 28 days peginterferon alfa-2b PEGINTRON 50 MCG KIT 4 vials per 28 days peginterferon alfa-2b PEGINTRON 80 MCG KIT 4 vials per 28 days peginterferon alfa-2b PEGINTRON 120 MCG KIT 4 vials per 28 days peginterferon alfa-2b PEGINTRON 150 MCG KIT 4 vials per 28 days peginterferon alfa-2b PEGINTRON Redipen 50 MCG 4 pens per 28 days peginterferon alfa-2b PEGINTRON Redipen 80 MCG 4 pens per 28 days peginterferon alfa-2b PEGINTRON Redipen 120 MCG 4 pens per 28 days peginterferon alfa-2b PENNSAID 2% SOLUTION 112 grams per 28 days diclofenac sodium PENNSAID AND KLOFENSAID 1.5 DROPS 150 ml per 28 days diclofenac sodium PERFOROMIST 20 MCG/2 ML SOLN 1 carton (60 vials) per prescription formoterol fumarate PEXEVA 10 MG TABLET 30 tablets per prescription paroxetine mesylate PEXEVA 20 MG TABLET 60 tablets per prescription paroxetine mesylate PEXEVA 30 MG TABLET 60 tablets per prescription paroxetine mesylate PEXEVA 40 MG TABLET 30 tablets per prescription paroxetine mesylate PLAN B 0.75 MG TABLET 2 tablets per prescription levonorgestrel PLAN B ONE-STEP 1.5 MG TABLET 1 tablet per prescription levonorgestrel PLEGRIDY 63 MCG SINGLE DOSE AND 94 MCG SINGLE DOSE 1 starter pack (Pen and Syringe) per 365 days peginterferon beta-1a PLEGRIDY 125 MCG/0.5 ML 2 units (Pen and Syringe) per 28 days peginterferon beta-1a PRANDIMET 1 MG-500 MG TABLET 150 tablets per prescription rapeglinide/metformin HCl PRANDIMET 2 MG-500 MG TABLET 150 tablets per prescription rapeglinide/metformin HCl PRAVACHOL 10 MG TABLET 30 tablets per prescription pravastatin PRAVACHOL 20 MG TABLET 30 tablets per prescription pravastatin PRAVACHOL 40 MG TABLET 30 tablets per prescription pravastatin PRAVACHOL 80 MG TABLET 30 tablets per prescription pravastatin PREVACID 15 MG CAPSULE DR 30 capsules per prescription lansoprazole

17 PREVACID 15 MG SOLUTAB 30 solutabs per prescription lansoprazole PREVPAC PATIENT PAC 112 caps/tabs (14 cards) = 1 pack per prescription lansoprazole/amoxicillin/clarithromycin PRILOSEC 10 MG CAPSULE DR 30 capsules per prescription omeprazole PRILOSEC 20 MG CAPSULE DR 30 capsules per prescription omeprazole PRILOSEC DR 2.5 MG SUSPENSION 60 packets per prescription omeprazole PRILOSEC DR 10 MG SUSPENSION 30 packets per prescription omeprazole PRISTIQ 25 MG TABLET 30 tablets per prescription desvenlafaxine PRISTIQ ER 50 MG TABLET 30 tablets per prescription desvenlafaxine ER PRISTIQ ER 100 MG TABLET 30 tablets per prescription desvenlafaxine ER PROAIR HFA 90 MCG INHALER 2 inhalers per prescription albuterol sulfate PROAIR RESPICLICK 90 MCG INHALER 2 inhalers per prescription albuterol sulfate PROTONIX DR 20 MG TABLET 30 tablets per prescription pantoprazole PROTOPIC OINTMENT 0.03% 100 grams per 30 days tacrolimus PROTOPIC OINTMENT 0.10% 100 grams per 30 days tacrolimus PROZAC 10 MG PULVULE 30 pulvules per prescription fluoxetine HCl PROZAC 40 MG PULVULE 60 pulvules per prescription fluoxetine HCL PROZAC WEEKLY 90 MG CAPSULE 4 capsules per prescription fluoxetine HCL PULMICORT 0.25 MG/2 ML RESPUL 60 respules per prescription budesonide PULMICORT 0.5 MG/2 ML RESPULE 60 respules per prescription budesonide PULMICORT 1 MG/2 ML RESPULE 30 respules per prescription budesonide PULMICORT 90 MCG FLEXHALER 1 inhaler per prescription budesonide PULMICORT 180 MCG FLEXHALER 2 inhalers per prescription budesonide QNASL 80MCG NASAL SPRAY 1 bottle per prescription beclomethasone dipropionate QVAR 40 MCG INHALER 2 inhalers per prescription beclomethasone dipropionate QVAR 80 MCG INHALER 3 inhalers per prescription beclomethasone dipropionate REBETRON Combination (Rebetol capsules and Intron A injection) RebetronTherapy Pak 2 packages per 28 days 600 ribavirin/intron A REBETRON Combination (Rebetol capsules and Intron A injection) RebetronTherapy Pak packages per 28 days ribavirin/intron A REBETRON Combination (Rebetol capsules and Intron A injection) RebetronTherapy Pak 2 packages per 28 days 1200 ribavirin/intron A REBIF 22 MCG/0.5 ML SYRINGE 12 syringes per 28 days interferon beta-1a REBIF 44 MCG/0.5 ML SYRINGE 12 syringes per 28 days interferon beta-1a REBIF TITRATION PACK 1 package per 28 days interferon beta-1a REGRANEX 0.01% GEL 1 tube per prescription becaplermin RELENZA 5 MG DISKHALER 20 blisters (1 carton) per prescription becaplermin RELPAX 20 MG TABLET 6 tablets per prescription eletriptan HBr RELPAX 40 MG TABLET 6 tablets per prescription eletriptan HBr RESTASIS 0.05% EYE EMULSION 60 vials per prescription cyclosporine REVATIO 10 MG/ML ORAL SUSPENSION 1 (112 ml) bottle per prescription sildenafil citrate

18 REVATIO 20 MG TABLET 90 tablets per prescription sildenafil citrate REXULTI 0.25 MG TABLET 30 tablets per prescription brexpiprazole REXULTI 0.5 MG TABLET 30 tablets per prescription brexpiprazole REXULTI 1 MG TABLET 30 tablets per prescription brexpiprazole REXULTI 2 MG TABLET 30 tablets per prescription brexpiprazole REXULTI 3 MG TABLET 30 tablets per prescription brexpiprazole REXULTI 4 MG TABLET 30 tablets per prescription brexpiprazole RHINOCORT ALLERGY SPRAY 32 MCG 9 gm (8.6 g = 1 bottle) and 5 g (1 bottle) per prescription budesonide RHINOCORT AQUA NASAL SPRAY 2 bottles per prescription budesonide RISPERDAL 0.25 MG TABLET 60 tablets per prescription risperidone RISPERDAL 0.5 MG TABLET 60 tablets per prescription risperidone RISPERDAL 1 MG TABLET 60 tablets per prescription risperidone RISPERDAL 2 MG TABLET 60 tablets per prescription risperidone RISPERDAL 3 MG TABLET 60 tablets per prescription risperidone RISPERDAL 4 MG TABLET 60 tablets per prescription risperidone RISPERDAL M-TAB 0.5 MG ODT 60 tablets per prescription risperidone RISPERDAL M-TAB 1 MG ODT 60 tablets per prescription risperidone RISPERDAL M-TAB 2 MG ODT 60 tablets per prescription risperidone RISPERDAL M-TAB 3 MG ODT 60 tablets per prescription risperidone RISPERDAL M-TAB 4 MG ODT 60 tablets per prescription risperidone RISPERIDONE ODT (GENERIC ONLY) 0.25 MG TABLET 60 tablets per prescription risperidone ROZEREM 8 MG TABLET 30 tablets per prescription ramelteon RYBIX ODT 50 MG TABLET 240 tablets per prescription tramadol HCl RYZOLT ER 100 MG TABLET 30 tablets per prescription tramadol HCl ER RYZOLT ER 200 MG TABLET 30 tablets per prescription tramadol HCl ER RYZOLT ER 300 MG TABLET 30 tablets per prescription tramadol HCl ER SAMSCA 15 MG TABLET 30 tablets per prescription tolvaptan SAMSCA 30 MG TABLET 60 tablets per prescription tolvaptan SANCUSO 3.1 MG/24 HR PATCH 1 patch per prescription granisetron SAPHRIS 2.5 MG TABLET 60 tablets per prescription asenapine SAPHRIS 5 MG TAB SL BLK CHERRY 60 tablets per prescription asenapine SAPHRIS 10 MG TAB SL BLK CHERY 60 tablets per prescription asenapine SARAFEM 10 MG TABLET 30 capsules or tablets per prescription fluoxetine SARAFEM 15 MG TABLET 28 capsules per prescription fluoxetine SARAFEM 20 MG TABLET 126 capsules per prescription fluoxetine SAVELLA 12.5 MG TABLET 60 tablets per prescription milnacipran SAVELLA 25 MG TABLET 60 tablets per prescription milnacipran SAVELLA 50 MG TABLET 60 tablets per prescription milnacipran SAVELLA 100 MG TABLET 60 tablets per prescription milnacipran SAVELLA TITRATION PACK 55 tablets per prescription milnacipran

19 SECONAL 100 MG CAPSULE 30 capsules per prescription secobarbital sodium SEEBRI NEOHALER 15.6 MCG INHALATION POWDER 60 inhalations (1 package) per prescription glycopyrrolate SEREVENT DISKUS 50 MCG (28 BLISTERS) 1 package per prescription salmeterol xinafoate SEREVENT DISKUS 50 MCG (60 BLISTERS) 1 package per prescription salmeterol xinafoate SEROQUEL 25 MG TABLET 90 tablets per prescription quetiapine fumarate SEROQUEL 50 MG TABLET 90 tablets per prescription quetiapine fumarate SEROQUEL 100 MG TABLET 90 tablets per prescription quetiapine fumarate SEROQUEL 200 MG TABLET 90 tablets per prescription quetiapine fumarate SEROQUEL 300 MG TABLET 60 tablets per prescription quetiapine fumarate SEROQUEL 400 MG TABLET 60 tablets per prescription quetiapine fumarate SEROQUEL XR 50 MG TABLET 60 tablets per prescription quetiapine fumarate XR SEROQUEL XR 150 MG TABLET 30 tablets per prescription quetiapine fumarate XR SEROQUEL XR 200 MG TABLET 30 tablets per prescription quetiapine fumarate XR SEROQUEL XR 300 MG TABLET 60 tablets per prescription quetiapine fumarate XR SEROQUEL XR 400 MG TABLET 60 tablets per prescription quetiapine fumarate XR SILENOR 3 MG TABLET 30 tablets per prescription doxepin SILENOR 6 MG TABLET 30 tablets per prescription doxepin SIMCOR 1, MG TABLET 60 tablets per prescription niacin/simvastatin SIMCOR 1, MG TABLET 30 tablets per prescription niacin/simvastatin SIMCOR MG TABLET 30 tablets per prescription niacin/simvastatin SIMCOR MG TABLET 30 tablets per prescription niacin/simvastatin SIMCOR MG TABLET 60 tablets per prescription niacin/simvastatin SOLARAZE 3% GEL 100 grams per 28 days diclofenac sodium SONATA 5 MG CAPSULE 30 tablets per prescription zaleplon SONATA 10 MG CAPSULE 60 tablets per prescription zaleplon SOVALDI 400 MG TABLET 84 tablets per 365 days sofosbuvir SPIRIVA 18 MCG CP-HANDIHALER 1 package (30 doses) per prescription tiotropium bromide SPIRIVA 28 INHALATIONS PACK AND 60 INHALATIONS PACK 1 inhaler (4 g) per prescription tiotropium bromide SPIRIVA RESPIMAT 1.25 MCG INHALATION SPRAY 4 g = 1 inhaler (60 inhalations) tiotropium bromide SPORANOX 100 MG CAPSULE 30 capsules per prescription itraconazole SPRIX MG NASAL SPRAY 5 bottles per prescription ketorolac tromethamine SPRYCEL 20 MG TABLET 60 tablets per prescription dasatinib SPRYCEL 50 MG TABLET 30 tablets per prescription dasatinib SPRYCEL 70 MG TABLET 60 tablets per prescription dasatinib SPRYCEL 80 MG TABLET 30 tablets per prescription dasatinib SPRYCEL 100 MG TABLET 30 tablets per prescription dasatinib SPRYCEL 140 MG TABLET 30 tablets per prescription dasatinib STIOLTO RESPIMAT 2.5/2.5 MCG INHALATION SPRAY 1 inhaler = 4 g (60 inhalations OR 28 inhalations institutional pack) tiotropium bromide/olodaterol STIVARGA 40 MG 84 tablets per prescription regorafenib STRIVERDI RESPIMAT 28 INHALATIONS PACK, 60 INHALATIONS PACK 1 inhaler (60 inhalations OR 28 inhalations institutional pack) per prescription olodaterol

20 SUBOXONE 2 MG-0.5 MG SL FILM 90 tablets/films per prescription buprenorphine/naloxone SUBOXONE 2 MG-0.5 MG TABLET SL 90 tablets/films per prescription buprenorphine/naloxone SUBOXONE 4 MG-1 MG SL FILM 90 tablets/films per prescription buprenorphine/naloxone SUBOXONE 8 MG-2 MG SL FILM 90 tablets/films per prescription buprenorphine/naloxone SUBOXONE 8 MG-2 MG TABLET SL 90 tablets/films per prescription buprenorphine/naloxone SUBOXONE 12 MG-3 MG SL FILM 60 tablets/films per prescription buprenorphine/naloxone SUMAVEL DOSEPRO 4 MG/0.5 ML 3 ml (1 box) per prescription sumatriptan SUMAVEL DOSEPRO 4 MG/0.5 ML 9 ml (3 boxes) per 28 days sumatriptan SUMAVEL DOSEPRO 6 MG/0.5 ML 6 units per prescription sumatriptan SUTENT 12.5 MG CAPSULE 90 capsules per prescription sunitinib malate SUTENT 25 MG CAPSULE 30 capsules per prescription sunitinib malate SUTENT 50 MG CAPSULE 30 capsules per prescription sunitinib malate SYMBICORT MCG INHALER 1 package per prescription budesonide/formoterol SYMBICORT MCG INHALER 1 package per prescription budesonide/formoterol SYMLINPEN 60 PEN INJECTOR 7 pens per prescription pramlintide acetate SYMLINPEN 120 PEN INJECTOR 7 pens per prescription pramlintide acetate SYNJARDY 5 MG/500 MG TABLET 60 tablets per prescription empagliflozin/metformin HCl SYNJARDY 5 MG/1000 MG TABLET 60 tablets per prescription empagliflozin/metformin HCl SYNJARDY 12.5 MG/500 MG TABLET 60 tablets per prescription empagliflozin/metformin HCl SYNJARDY 12.5 MG/1000 MG TABLET 60 tablets per prescription empagliflozin/metformin HCl TAFINLAR 50 MG 120 capsules per prescription dabrafenib TAFINLAR 75 MG 120 capsules per prescription dabrafenib TAGRISSO 40 MG TABLET 30 tablets per prescription osimertinib TAGRISSO 80 MG TABLET 30 tablets per prescription osimertinib TAMIFLU 12 MG/ML SUSPENSION 3 bottles per prescription oseltamivir phosphate TAMIFLU 30 MG GELCAP 20 capsules per prescription oseltamivir phosphate TAMIFLU 45 MG GELCAP 10 capsules per prescription oseltamivir phosphate TAMIFLU 75 MG GELCAP 10 capsules per prescription oseltamivir phosphate TAMIFLU 6 MG/ML SUSPENSION 3 bottles per prescription oseltamivir phosphate TARCEVA 25 MG TABLET 60 tablets per prescription erlotinib TARCEVA 100 MG TABLET 30 tablets per prescription erlotinib TARCEVA 150 MG TABLET 30 tablets per prescription erlotinib TASIGNA 150 MG CAPSULE 112 capsules per prescription nilotinib TASIGNA 200 MG CAPSULE 112 capsules per prescription nilotinib TECHNIVIE DOSE PACK 3 cartons (168 tablets) per 365 days ombitasvir, paritaprevir, rinonavir TIVORBEX 20 MG CAPSULE 90 capsules per prescription indomethacin TOBI 300 MG/5 ML SOLUTION 56 ampoules per prescription tobramycin TOBI PODHALER 28 MG INHALE CAP 224 capsules per prescription tobramycin TORADOL 10 MG TABLET 20 tablets per prescription ketorolac TRADJENTA 5 MG TABLET 30 tablets per prescription linagliptin

21 TRAMADOL HCL 50 MG TABLET 240 tablets per prescription tramadol HCl TRAMADOL HCL ER 150 MG CAPSULE 60 capsules per prescription tramadol HCl ER TREXIMET MG TABLET 9 tablets per prescription sumatriptan/naproxen sodium TRULICITY 0.75 MG/0.5 ML 4 units (Pen OR Syringe) per prescription dulaglutide TRULICITY 1.5 MG/0.5 ML 4 units (Pen OR Syringe) per prescription dulaglutide TUDORZA PRESSAIR 400 MCG INH 1 inhaler per prescription aclidinium bromide TYKERB 250 MG TABLET 180 tablets per prescription capecitabine ULTRACET 37.5 MG-325 MG TABLET 240 tablets per prescription tramadol/acetaminophen ULTRAM 50 MG TABLET 240 tablets per prescription tramadol HCl ULTRAM ER 100 MG TABLET 30 tablets per prescription tramadol HCl ER ULTRAM ER 200 MG TABLET 30 tablets per prescription tramadol HCl ER ULTRAM ER 300 MG TABLET 30 tablets per prescription tramadol HCL ER UTIBRON NEOHALER 27.5/15.6 INHLATION POWDER (PACKAGE SIZE 6) 6 inhalations (1 package) per prescription indacaterol/glycopyrrolate UTIBRON NEOHALER 27.5/15.6 INHLATION POWDER (PACKAGE SIZE 60) 60 inhalations (1 package) per prescription indacaterol/glycopyrrolate VALTREX 500 MG CAPLET 30 caplets (tablets) per prescription valocyclovir VALTREX 1 GM CAPLET 30 caplets (tablets) per prescription valocyclovir VANDETANIB 100 MG TABLET 60 tablets per prescription vandetanib VANDETANIB 300 MG TABLET 30 tablets per prescription vandetanib VARUBI 90 MG TABLET 2 tablets (1 package) per prescription rolapitant VENCLEXTA STARTING PACK 1 Starting Pack = 42 tablets per prescription venetoclax VENLAFAXINE HCL ER 37.5 MG TAB 30 tablets per prescription venlafaxine VENLAFAXINE HCL ER 75 MG TAB 90 tablets per prescription venlafaxine VENLAFAXINE HCL ER 150 MG TAB 30 tablets per prescription venlafaxine VENLAFAXINE HCL ER 225 MG TAB 30 tablets per prescription venlafaxine VENTOLIN HFA 90 MCG INHALER 2 inhalers per prescription albuterol sulfate VENTOLIN HFA 90 MCG INHALER 1 inhaler per prescription albuterol sulfate VIEKIRA PAK 3 paks (336 tablets) per 365 days ombitasvir, paritaprevir, rinonavir VIEKIRA XR 252 tablets per 365 days ombitasvir/paritaprevir/ritonavir; dasabuvir VIIBRYD 10 MG TABLET 30 tablets per prescription vilazodone VIIBRYD 20 MG TABLET 30 tablets per prescription vilazodone VIIBRYD 40 MG TABLET 30 tablets per prescription vilazodone VIIBRYD STARTER KIT 1 pack per prescription vilazodone VIVELLE-DOT MG PATCH 8 patches per 28 days estradiol VIVELLE-DOT MG PATCH 8 patches per 28 days estradiol VIVELLE-DOT 0.05 MG PATCH 8 patches per 28 days estradiol VIVELLE-DOT MG PATCH 8 patches per 28 days estradiol VIVELLE-DOT 0.1 MG PATCH 8 patches per 28 days estradiol VIVLODEX 5 MG CAPSULE 30 capsules per prescription meloxicam VOLTAREN 1% GEL 500 grams per 28 days diclofenac VOTRIENT 200 MG TABLET 120 tablets per prescription pazopanib

22 VRAYLAR 1.5 MG CAPSULE 30 capsules per prescription cariprazine VRAYLAR 1.5 MG-3MG CAPSULE BLISTER PACK 30 capsules per prescription cariprazine VRAYLAR 3 MG CAPSULE 30 capsules per prescription cariprazine VRAYLAR 4.5 MG CAPSULE 30 capsules per prescription cariprazine VRAYLAR 6 MG CAPSULE 30 capsules per prescription cariprazine VYTORIN MG TABLET 30 tablets per prescription ezetimibe/ simvastatin VYTORIN MG TABLET 30 tablets per prescription ezetimibe/simvastatin VYTORIN MG TABLET 30 tablets per prescription ezetimibe/simvastatin VYTORIN MG TABLET 30 tablets per prescription ezetimibe/simvastatin WELLBUTRIN SR 100 MG TABLET 60 tablets per prescription bupropion HCL WELLBUTRIN SR 150 MG TABLET 60 tablets per prescription bupropion HCL WELLBUTRIN SR 200 MG TABLET 60 tablets per prescription burpopion HCL WELLBUTRIN XL 150 MG TABLET 30 tablets per prescription bupropion HCL XL WELLBUTRIN XL 300 MG TABLET 30 tablets per prescription bupropion HCL XL XALKORI 200 MG CAPSULE 60 capsules per prescription crizotinib XALKORI 250 MG CAPSULE 60 capsules per prescription crizotinib XIFAXAN 200 MG TABLET 9 tablets per prescription rifaximin XIFAXAN 550 MG TABLET 60 tablets per prescription rifaximin XIGDUO ER 10 MG/500 MG TABLET 30 tablets per prescription dapagliflozin/metformin HCl XIGDUO ER 10 MG/1000 MG TABLET 30 tablets per prescription dapagliflozin/metformin HCl XIGDUO XR 5 MG/500 MG TABLET 30 tablets per prescription dapagliflozin/metformin HCl XIGDUO XR 5 MG/1000 MG TABLET 60 tablets per prescription dapagliflozin/metformin HCl XIIDRA 5% SOLUTION 60 vials per prescription lifitegrast ophthalmic solution XOLAIR 150 MG VIAL 6 vials per 28 days omalizumab XTAMPZA 9 MG TABLET 90 capsules per 30 days oxycodone XTAMPZA 13.5 MG TABLET 90 capsules per 30 days oxycodone XTAMPZA 18 MG TABLET 90 capsules per 30 days oxycodone XTAMPZA 27 MG TABLET 90 capsules per 30 days oxycodone XTAMPZA 36 MG TABLET 90 capsules per 30 days oxycodone XTANDI 40 MG CAPSULE 120 capsules per prescription enzalutamide XYZAL 5 MG TABLET 30 tablets per prescription levocetirizine ZECUITY TDS 6.5 MG/4 HOUR 4 patches per prescription sumatriptan iontophoretic ZEGERID 20 MG CAPSULE 30 capsules per prescription omeprazole, sodium bicarbonate ZEGERID 20 MG PACKET 30 packets per prescription omeprazole, sodium bicarbonate ZELBORAF 240 MG TABLET 240 tablets per prescription vemurafenib ZEMBRACE 3 MG/0.5 ML SYRINGE 4 syringes (1 kit) per prescription sumatriptan ZETONNA 37 MCG NASAL SPRAY 1 canister (60 actuations per canister) per prescription ciclesonide ZOCOR 5 MG TABLET 30 tablets per prescription simvastatin ZOCOR 10 MG TABLET 30 tablets per prescription simvastatin ZOCOR 20 MG TABLET 30 tablets per prescription simvastatin

23 ZOCOR 40 MG TABLET 30 tablets per prescription simvastatin ZOCOR 80 MG TABLET 30 tablets per prescription simvastatin ZOFRAN 4 MG TABLET 9 tablets or orally disintegrating tablets per prescription ondansetron ZOFRAN 8 MG TABLET 9 tablets or orally disintegrating tablets per prescription ondansetron ZOFRAN 24 MG TABLET 1 tablet per prescription ondansetron ZOFRAN ODT 4 MG TABLET 9 tablets or orally disintegrating tablets per prescription ondansetron ZOFRAN ODT 8 MG TABLET 9 tablets or orally disintegrating tablets per prescription ondansetron ZOFRAN SOLUTION 2 bottles per prescription ondansetron ZOLOFT 25 MG TABLET 30 tablets per prescription sertraline HCL ZOLOFT 50 MG TABLET 60 tablets per prescription sertraline HCL ZOLOFT 100 MG TABLET 60 tablets per prescription sertraline HCL ZOLPIMIST 5 MG ORAL SPRAY 1 bottle per prescription zolpidem ZOMIG 2.5 MG TABLET 6 tablets per prescription zolmitriptan ZOMIG 5 MG NASAL SPRAY 6 nasal spray devices per prescription zolmitriptan ZOMIG 5 MG TABLET 6 tablets per prescription zolmitriptan ZOMIG ZMT 2.5 MG TABLET 6 tablets per prescription zolmitriptan ZOMIG ZMT 5 MG TABLET 6 tablets per prescription zolmitriptan ZORVOLEX 18 MG CAPSULES 90 capsules per prescription diclofenac ZOVIRAX 5% CREAM 1 tube/5 grams per prescription acyclovir ZOVIRAX 5% OINTMENT 1 tube/30 grams per prescription acyclovir ZUBSOLV 1.4 MG/0.36 MG TABLET 30 tablets per prescription buprenorphine/naloxone ZUBSOLV 2.9 MG/0.71 MG TABLET 30 tablets per prescription buprenorphine/naloxone ZUBSOLV 5.7 MG/1.4 MG TABLET 30 tablets per prescription buprenorphine/naloxone ZUBSOLV 8.6 MG/2.1 MG TABLET 60 tablets per prescription buprenorphine/naloxone ZUBSOLV 11.4 MG/2.9 MG TABLET 30 tablets per prescription buprenorphine/naloxone ZUPLENZ 4 MG SOLUBLE FILM 9 films per prescription ondansetron ZUPLENZ 8 MG SOLUBLE FILM 9 films per prescription ondansetron ZYDELIG 100 MG TABLET 60 tablets per prescription idelalisib ZYDELIG 150 MG TABLET 60 tablets per prescription idelalisib ZYPREXA 2.5 MG TABLET 30 tablets per prescription olanzapine ZYPREXA 5 MG TABLET 30 tablets per prescription olanzapine ZYPREXA 7.5 MG TABLET 30 tablets per prescription olanzapine ZYPREXA 10 MG TABLET 30 tablets per prescription olanzapine ZYPREXA 15 MG TABLET 30 tablets per prescription olanzapine ZYPREXA 20 MG TABLET 30 tablets per prescription olanzapine ZYPREXA ZYDIS 5 MG TABLET 30 tablets per prescription olanzapine ZYPREXA ZYDIS 10 MG TABLET 30 tablets per prescription olanzapine ZYPREXA ZYDIS 15 MG TABLET 30 tablets per prescription olanzapine ZYPREXA ZYDIS 20 MG TABLET 30 tablets per prescription olanzapine ZYRTEC 5 MG CHEWABLE TABLET 30 tablets per prescription certirizine

24 ZYRTEC 5 MG TABLET 30 tablets per prescription certirizine ZYRTEC 10 MG CHEWABLE TABLET 30 tablets per prescription certirizine ZYRTEC 10 MG TABLET 30 tablets per prescription certirizine ZYRTEC-D TABLET 60 tablets per prescription certirizine/pseudoephedrine ZYTIGA 250 MG TABLET 120 tablets per prescription abiraterone acetate